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02695
. �►1 • ®oI. 'ry
Office Use Only
DEPARTMENT OF HEALTH
-Env -i .onmq;nta1 ,Hea]:th Services--.---.
PUTNAM COUNTY DEPARTMENT OF HEALTH,
5 EET ADDRESS: TO LLAUICI I Y TAX GRID NUMBER:
WELL LOCATION
WELL OWNER
NAME ADDRESS:
a
21 PRIVATE
Q
❑ PUBLIC
USE OF WELL
Ja RESIDEdYIAL ❑ PUBLIC SUPPLY ❑ AIR /COND.IHEAT PUMP ❑ ;ABANDONED
1- primary .
❑ BUSINESS O FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify)
2 - secondary
❑ INDUSTRIAL 0 INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT S�' gpm. /N0. PEOPLE SERVED: - / EST. OF DAILY USAGE, gal.
REASON FOR
'S NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION
DRILLING
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH ft.
STATIC WATER LEVEL. � , ft.
DATE MEASURED
DRILLING
❑ ROTARY ❑ COMPRESSED AIR PERCUSSION O DUG
EQUIPMENT
❑ WELL POINT ❑ CABLE PERCUSSION O OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING Iff OPEN HOLE IN BEDROCK ❑ OTHER
TOTAL LENGTH A _ fL
MATERIALS: J'STEEL O PLASTIC D OTHER
CASING
LENGTH.BELOW GRADE ft,;
JOINTS. ❑ WELDED &THREADED ❑ OTHER
DIAMETER P • in.
SEAL: O CEMENT GROUT ❑ BENTONITE XOTHER
DETAILS
WEIGHT
PER FOOT Ib. /ft.
DRIVE SHOEZ YES ❑ NO
LINER: ❑ YES 19 NO
SCREEN
DIAMETER (in)
'SLOT SIZE
LENGTH
(ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
_.
N
DETAILS
SECOND
- _
_____ -�. _ . _ _
........ _._ .. d. , ... _.. _.
HOURS" "
GRAVEL PACK
P YES
GRAVEL
DIAMETER j1nOEPT
P
BOTTOM
❑ NO
SIZE:
OF PACK
H ft.
D EPTH It.
WELL YIELD TEST If detailed pump ing�LL
LAG If more detailed formation descriptions or sieve analyses
are available. please attach.
METHOD: O PUMPED tests were done is in-
COMPRESSED AIR , formation attached?
DEPTH FROM
SORFACE
wafer.
Bear -
weD
0ia-
O BAILED ❑ OTHER ; ❑ YES' `O NO
i "9
In
FORMATION DESCRIPTION
CaoE_
tt.
tt.
WELL DEPTH,
DURATION
DRAWOOWN
YIELD
Surface
D°
ft.
hr, min.
ft.
e
71:
14
OV W MO
agav
Vva
WATS O CLEAR
TEMP.
W
QUALITY O CLOUDY
HARD ESS
XO COLORED ANALY ? ES O NO
PROFESS0P�
ANALYSIS ATTACHED? O NO
STORAGE TANK: TYPE jeJc(_
PUMP INFORMATION
CAPACITY AL • �
TYPE CAPAC
MAKER L DEPTH
a h
WELL DRILLER NAME
AOOR X03 059"S,�,,
ICFt wii /
MODEL
VOLTAGE d HP
•
1 �
rV- fown A.4 A; 1 L b I LAB e
e ica a oratory, nc.
321.Kear Street Date Taken: Time:
Yorktown Heights, N Y 10598 Date Rc' d: Time: _�
i9141.245 -3203 , ...._ - -Y�, IIa t R.e
Albert N. AadovaniM. T.(ASCP) Collected By:
y Director: M
Referred By: G'/loSS S /.6�X;7��
Sample Location: _joarnp
�3 ZAS .S � Phone # �-
,, Phone # I Sample Type:
L S'vt-4-7_11 .5h2ALM J Repeat 'Test? _ (check one)
LABORATORY REPORT ON.THE QUALITY OF WATER
INORGANIC NON- METALS. (mg /L) MICROBIOLOGICAL (CFU /100mL)
_ Acidity
_ Alkalinity
Chloride
Detergents, MBAS
Hardness, Total
Nitrogen, Ammonia
Nitrogen, Nitrate
Phosphate, Total
_ Sulfate
_ Sulfide
Sulfite
METALS (mg/L-)
_ Copper
_ Iron
_ Lead
_ .Manganese
_ Sodium
Zinc
MISCELLANEOUS
pr. (units) .
Color (units)
Odor (TON)
Turbidity (NTU)
GENERAL BACTERIA
Standard Plate Count
(CFU /1.OmL)
MEMBRANE.FILTRATION TECHNIQUE
Total Coliform
Fecal Coliform
_ Fecal Streptococcus*
MOST PROBABLE NUMBER TECHNIQUE
Total Coliform Index .
Fecal== Col-iform Index
KEY FOR TERMINOLOGY
CFU' Colony Forming. Units
N /A'= Not Applicable
LT = ' Less Than (< )
GT = Greater Than ( >)
TNTC= Too Numerous To Count
CON = Confluent (= TNTC).
NR = Non- reactive
REMARKS /COMMENTS (For Lab Use)
_ ✓Potable
_ Non - potable
_ STP INF
_ STP EFF
Other:
Sample Status:
(check each)
Outgoing
_ HNO 3
_ HC1
_ H2SO4
_ NaOH
ZnOAc
Na2S203
Other:
Incoming,
LE
4 °C
_ GT
4 °C
_ pH
LE 2
_ pH
GE 9
pH
GE 12
Other:
ELAP #10323
THESE RESULTS INDICATE THAT THE WATER SAMPLE (WA ) (WASN'T) (N /A) OF A
SATISFACTORY SANITARY QUALITY. ACCORDING. TO T N YORK STATE DRINKING WATER
STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION
THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DIDN'T) ODR EET THE
S ATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STA ING WATER
CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION.
Ix/
2 /86(Rvsd7 /87)RWE
Albert H. Padovani, M.T. ASCP), Director
a�
s' WLLJL L.Ur1rLr,11UV1 .AGrUAl
Office Use Only
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
WELL LOCATION
ST.HEEi ADDRESS: L TOWNTY10mclir r TAX GRID NUMBER:
�.
WELL OWNER
NAME.'/?` `y ADDRESS:
PRIVATE
O PUBLIC
USE OF WELL
^ID. RESIDENTIAL . O PUBLIC SUPPLY O AIR /CONO. /HEAT PUMP O ABANDONED
1 - primary
O BUSINESS ❑ FARM 0 TESTIOBSERVATION ' ').0 OTHER (specify)
2 - secondary
❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND-BY, ,❑
MOUNT OF USE
YIELD SOUGHT -:} ` m. /N0. PEOPLE SERVED / EST. OF., DAILY USAGE � gal.
• REASON FOR
- El NEW SUPPLY '0 PROVIDE ADDITIONAL SUPPLY ' 0 TEST /OBSEERVATION
O` REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL
.DRILLING
�.,
DEPTH DATA
' WELL DEPTH r' D ft.
STATIC WATER LEVEL it..'DAM.MEASUAED
-
f
DRILLING
❑ ROTARY O COMPRESSED AIR PERCUSSION '\p DUG.
EQUIPMENT
O WELL•POINT y0 CABLE PERCUSSION D OTHER (Specify).
p EN
WELL TYPE
0 SCREENED OPEN END CASING. WOLE IN,,EDR C} ❑OTHER
.0 .
TOTAL LENGTH ft..
MATERIALS: - „EI`STEEL ❑ PLASTIC D OTHER
CASING
...
LENGTH.BELOW GRADE '`ice Eft:
JOINTS ;'} pt:WELDEO ” " ". HEADED ❑OTHER
:
DETAILS
,,
DIAME7 €R ` in: -
SEAL: ❑ CEiNENT GROUT ::O BENTONITE QOTHER
WEIGHT
PER FOOT 1b./ft.
I' DRIVE SHOE -0 YES : ❑ •N0, ..
LINER: OYES. ONO
SCREEN
DIAMETER (in)
'SLOT SIZE
LENGTH
(it)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
o Yt ❑ Na
DETAILS . _
SECOND
_.__..
.... _.. _ _ _
_ _ _. �_ ...
_.
.HOURS•
.'GRAVEL. PACK
YES
GRAVEL
DIAMETER
TOP
BOTTOM
•
O NO
SIZE:
OF PACK in.
DEPTH" ' ft.
;DEPTH, It.
WELL YIELD TEST ' If detailed pumping
'a��LL LOG • .11f more detailed formation descriptions or.sieve'analyses
tlY
are available, please attach.
METHOD: O PUMPED 1 tests were done is to
attached
DEPTH FROM
water
Welt
El- COMPRESSED AIR ,, ormation
,.
BAILED 0 OTHER i O YES D.N0
SURFACE.
Bear-
Dia-
.peter
gMAT1oNQESCflIPTION
poE,
ft.. •
' f� ..�ng.,
,0
WELL DEPTH
. DURATION
DRAWOOWN
YIELD
YIELD
Sumac
it.
hr. min.
it.
I
y ,1
-
k `
W-1141 �.
WATER O CLEAR
TEMP.
QUALITY O CLOUDY
HARDNESS �/
'10:
STORAGE TANK : TYP E /' �-•(� RoFESS!o" ''
O COLORED ANALY ED? ,/O YES ONO
ANALYSIS ATTACHED? OED, O NO.
~
PUMP UIFORMATIOf1"
-�
CAPACITY , ,GAL._ Q
TYPE C�U,�• CAPACITY
WELL DRILLER NAME $%.Yjy_ s , .. ; , .( :2> •crsy- , t, DAi e �
"-ADDRESS!
MAKER 1�
DEPTH
"" i '� - ;:�- 'SfGttA7URE �
MODEL
VOLTAGE � HP
i
Hpvel HOM. Jac:
"Owner or Purchaser of building Section .
hovel Notes. Inc.
:Tuildi- ne..Constructed .by_ _ ... BIock. ;. _.,,... ,-. _ . ... ....
WoM Hollow Road
Location -.Street Lot
Allen R. HBPr'W &. NanCY H. C.rUtc�Ski � &
:
fttnn valley Arthur .L., Herr0W : ,
Municipality Subdivision Name
Single -Fami ly 3
Building Type Subdv. Lot #
GUARANTEE OF SEPARATE SEWAGE SYSTEM
I represent that I�am wholly and completely responsible for the
location, workmanship, material, construction and drainage of the 'sewage
disposal system serving the above described property, and that it has been
constructed as shown on the approved plan�or approved amendment thereto,
and in accordance with.the standards, rules and regulations of the Putnam
County Department of Health, and hereby guarantee to the owner, his success -
ors, heirs or assigns, to place in good operating condition any part�'of
saiFd :system constructed by, me. which fails to operate for a period of two
years immediately following the date of initial use of the sewage disposal
system, or any repairs made by me to such system, except,where the failure
to operate properly is caused by the willful or negligent,,act of the occu-
pant of the building utilizing the system.
The undersigned further agrees to accept as conclusive the determin-
ation of the Director of the Division of Environmental Health Services
_ of: :tho%,Putnarri-County-Department of.- Health as to whe.ther°;or -not.: the ,:fail-
s.
ure of the system to operate.was caused by the w 1 or, ne,g 'gent act
of the occupant of the building utilizing the s st m
Dated this day of.00"Wr 198 Signatur
Title Py(Z S y� c—j_1-C
`4 vJP Vy�:)ME2� N C
Corporation Name if corp. Address ���Tt�✓
—— — — — — — — — — — — — — — — — — — — — — — — — — —— — 1QSR0 -
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPLETION WILL BE ISSUED.
T
GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department of Health
PgJT1V AM COUNTY DEPARTMENT. ®F HEAg..'1[['H ' , Permit
Division. of Environmental Health' Services, Carmel, N.. �Y..1o5i2 me�r-�y #P'V38 =87)
CONSTRUCTION PERMIT FOR SEwAdE DISPOSAL SYSTEM PUt66 in, :Vdl.ley'.
Town or Vi lags .
_S Located
at 'Ca'nopUS n1�11Ow� Rdad �~ Tax Map eiock a lot '{
sLtidtvgs�nG. Harrow &Nancy =;Ho _Crukowskis;tu. -L. Har>�ia1_
Revision' _❑
owner /Address Hovel Homes, Inc., Box. 4, Lake Peekskii`-1,,N.Yeate o£,Previous Approval .1'1.a�• 26 +.. -198'7
Building Type Single - Family. Lot Area 2+ acres Fill section only CX. RA R_ -� +
Number of Bedrooms —4 Design Flow G /P /D P.C. H. D. Noti£icatiorF,tt Qiz
Separate Sewerage. System to consist of 1200 Gel. Septic Tank and 40 1J. x 24" wide trenches
To be constructed by S.A.F. Septic Systems, iNc. Address Pe O. Box 141; Cross River, N.Y.
Water Supply: Public Supply From
X _ Private Supply to be drilled by jorlish
Address
Kaple'-Ave,, Armonk., N.Y.
Other Requirements 3'i' RAJ'- fill over. entire SSDA & '50% expansion area.
I represent that 1 am wholly and completely responsible for, the design and locAo
above described will be constructed as shown on the approved amendment th .
County Department of Health, and that on completion thereof a "Certifi e^
be submitted to the Department, and a written guarantee will be :furni ed
place in good operating condition any part of said sewage disposal s e ,1
ance of the approval of the. Certificate of Construction Compliance o) if c
will be located as shown on the approved plan and that said well will be Ins $11
County Department of Health.
Date August 11., 1987 signed
Address 186 Ka'tonah Ave:;
APPRO�VEO FOR CONSTRUCTION: This aDPCOVaI expires year:. m_4
revocable for tau or ma be amended.or Modified when eo red es I
requires a new_ rmit. Approved for disposal of domesti" itar :sewa ,
Date By 1
Rev. 9 -81
am(s); 1) that the separate sewage disposal system
the standards, rules and regulations o e u nam
jd.rd'. " satisfactory to the Commissioner of Health will
rs or assigns by. the builder, that said builder will
years immediately following the date of the issu-
thereto, 2) thatthe drilled well described above
rules and regu W ons of the ' Putnam
w
P.E._ R.A.
1053.6 51251
License No.
onstruction of the building has been undertaken and is
T rof Health. Any change or alteration of construction
onl
^ "Title lye
PETER C. ALEXANDERSON
County Executive
ENID L. CARRUTH, M.P.H.
Public Health Director
JOHN SIMMONS, M.D.
tr t y Deputy Commissioner
JOHN KARELL Jr., P.E.
DEPARTMENT OF HEALTH Director
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
October 12, 1988
Salvatore Rinna
Valley Pond Road
Katonah, New York 10536
Re: Compliance SSDS - Hovor Homes Inc.
Canopus Hollow Road
(T) Putnam Valley
Dear Mr. Rinna:
Review of plans and other supporting documents submitted at this time relative to
the above - captioned project has been completed. Comments are offered as follows:
1) Plans must include a legend, which reads as follows: "This is to certify that
the sewage disposal system was constructed as indicated on this plan and...that
the-= systeut was- by me. before it was covered over.. The system was.. _
constructed in accordance with all standard rules and regulations of the Putnam
County Department of Health and the New York State Department of Health."
Upon receipt of a submission, revised to.reflect the above comments, this application
will be considered further.
Very truly yours,
Lawrence C. Werper
Assistant Public Health Engineer
LCW /jz
PUTNAM COUNTY DEPARTMENT OF HEALTH
D IVI SION. -OE-..EN-VIRONMENTAL-'HEALTli.-.SER.VICES..
Date August 11, 1987
Re: Property of Hovel Homes, Inc.
Located at Canopus Hollow Road
(T) Putnam Valley Section Block Lot
Subdivision of Allen G. Harrow & Nancy H. Crukowski.& Arthur L. Harrow
Subdv. Lot # 3
Gentlemen:
Filed Map #
Date
This letter is to authorize—Salvatore V. Riina, P.E.
a duly licensed professional engineer X or registered architect
(IndicateT_
to apply for a Construction Permit for a separate sewage system, to
serve the above noted property in accordance with the standards, rules
or regulations a.s promulagated by the Commissioner of the Putnam County
Department of Health, and to sign all necessary papers on my behalf 0
connection with this.-Imatter and -the- construction of-said
system or systems in conformity with the provisions of Article 145 or
147, Educat
tary.Code
Countirsigne
P.E,e, R.A., #
�
Elb* W Public Health Law, and the Putnam County Sani-
0.
OFESS100'
51251
186 Katonah Avenue
Address
Katonah, New York 10536
Very "Ny yours G
C_
Signe=
Owner of Property
477�
Address
1 1)'V'-e Pe C.- K I row
Town
1 14 -Wog
Telephone
232-7408
Telephone
APPENDIX B
PUTNAM COUNTY DEPARTMM OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
_ - INDIVIDUAL WATER SUPPLY & SUBSURFACE SEMGE DISPOSAL SYSTEMS '
".. tFia �;IT SHEET CONSTRUCTION . PERMIT _ V
BY: 1
(Name of Owner) (Street Location)
COMMENTS YES
LF trench provided
required
60 ft. mex.
Parellel to contours
_L
NO DOCUMENTS
Pe nit Application
Corporate Resolution
Plans - Three sets s/s
Engineers Authorization
Design Data Sheet (DDS), SUBDIVISION
Deep Hole Log Perc
Consistent Perc Results (3) Fill
Perc Hole Depth cd
House Plans - Two sets
:Well permit; PWS letter
Variance Request
GENERAL
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Tcwn/DEC Permit R & D)
Data On DDS Plans & Permit Same
REQUIRED DETAILS ON PLANS
Sewage System Plan - (north arrow)
.Sewage System Hydraulic Profile - Gravity Flora
Fill Profile & Dimensions - Volume
D or J Box;Trench /Gallery; Pump pit details
Septic Tank - Size, Detail
Well Detail, Service Line if over
Construction Notes
Design Data: perc and :deep: _results _..... _
Two -Foot Contours Existing.& Proposed
Driveway & Slopes Cut.
Footing /Gutter,Curtain Drains (discharge OK)
Perc & Deep Holes Located
Representative of primary and expansion
Expansion Area;shown;gravity flow,suff. size
If Pmped Pit & D Box Shown & Detailed
House - No, of Bedroans
Wells & SSDS's w /in 200 ft, of Proposed System
Property Metes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4 " /ft. 4 "0; Type pipe .
No Bends; Max. Bends 450 w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Iarge Trees,Top of fi
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. expa
15' to Drains - Curtain, Leader, Footing
351to catch basin,stormdrain,piped watercour.
101. to Water Line (pits -201) -
50' intermittent drainage course
Septic Tanks
10' fran Foundation; 50' to well
15' Well to PL
Well A P;1J'C- ,lT,c);!
111 71'
-
�
..r
°
11 .-_.-..,.:.. ar': uR: Li. w• M�l: � ::fai::::Y�hilnMld�wNri+li�.t�a4 - '• ' � rn.�_...- -�.. -.
BATH
5' 6"
-
40' 0"
LOWER LEVEL
PLAN! # 502 0 ALEXANDRIA ® 28, X 40 - 28 X 40 0'4 BR - 21/213
iq
UPPER LEVEL
TWO STORY 2240 SQ. F1'.
"= BEDROOM! 3
12'0 "X13'3"
i
.. I
'I
-iRUrr
KITCHEN
s sort
BATH
5' 6"
-
40' 0"
LOWER LEVEL
PLAN! # 502 0 ALEXANDRIA ® 28, X 40 - 28 X 40 0'4 BR - 21/213
iq
UPPER LEVEL
TWO STORY 2240 SQ. F1'.
"= BEDROOM! 3
12'0 "X13'3"
i
.. I
'I
DESIGN.DATA- SHEET- SEPARATE
SEWAGE-DISPOSAL-SYSTEM
FILE NO.
- .Owner. John: Zarcone
°Address P:-O -Box 498-5 Putnam Valley, N.Y. 10579
Located at (Street Canopus - Hollow �R(tec.: Block
Lot' Sub. #3
Indicate
neares cress street)
Municipality Putnam
Valley (T). Watershed
New York
City
SOIL PERCOLATION TEST.DATA
REQUIRED.TO HE SUBMITTED WITH•APPLICATIONS
... ALL TEST'HOLES
WERE-PRESOAKED-PRIOR TO RUNNING
TESTS....
oe
_...........
Number CLOCK TIME
PERCOLATION
PERCOLATION
Elapse
.o..Water
:. ..Depth
Water, " Ve
: _ .
No. Time
From.Ground'Surface
in Inches
Soil:Rate
Start-Stop, ... -Min.
. 7Start.:-;.....:_.....-- Stop..
Drop "in
Mari: /in drop
Inches Inches
Inches
1 2:30/2:41 11
18, 21
3
4'.
2 2:42/2:54. 12
18 ..21
3
4
- 3 2:55/3 :08 13
17: ..20
3
4
1, 2-:45/2:X56' ' 11-.
1.6
4' n,. ._..
:2:57/3.10 13. ..,.. .1.7 .... 20 ........ 3....... .4
3 3:11/3:22 14
17 20
3.
4 .
f
1
2 1. 1.1/2 21:' ip�;`4 1.8; _ 21.... 3_ ._.._.. 3 .
� 1, �• ,} `�} •�; :'
2 2.22%2.30 8 ,_ 17 _.2U 3... 3
3_i.3112-41.' 10 .. �y._ ... -16.. ... ..:..19 .3 1
5. ._._... a .
Notes: 1) Tests to be repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole. All data to be submitted
for review.
2) Depth measurements to be made from top of hole.
TEST PIT DATA REQUIRED TO BE SU3MITTED,.;14ITH,:APPLICATION
DESCRIPTION OF.SO Ito .ENCOUNTERED IN TEST:HOLES:s. q
mot; ... �.. �p : +.�,DEP.TH:- . +'m -r a410rd.KI'z,-n..LMbv -.:{- .y Cr!x'..- c"'t. -•�wF �HOL�YJ4YLl�Vf -tl. .•t- .,.:W.:O. r...._... .a�. ia'+wn � v.^K,x. -.: �1N 4.. .+..Wr..ac :r..4a+uc+.
G.L. Blk. organic Blko, organic _. Blk'o. organic
611 topsoil topsoil
topsoil,.
12 "- sandy loam sandy loam.. sandy loam,
THIS SPACE FOR USE BY HEALTH DEPARTM' " T ONLY: Noa 512yti
Soil Rate Approved Sq. Ft /Gal. Checked by �pROFESStoN to
P�
John Za"cone
�, TEST PIT DATA REQUIRED TO TO BE WITH,APPLICATION
d DESCRIPTION OF..S.O.ILS._ENC,OUNTERED •.ZN" TEST HOLES'
d
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
.. .. 4:rF ^'0 5
Soil Rate Approved Sq..Ft /Gal1251
. Checked by e
HALE DT_ 13...
g
G.L. Blk. organic
;Blk organ -6 ::: ..' .:..:..
Blk. organic
6" topso,iI
topsoil
topsoil
12" sandy loam
sandy -loam
sandy loam
18"
30" (-sandy,-. gravel ly... ....,;, ,,.. '
" andy ,gravel ly ::. - .....-
sandy gravel iy
36�� subsoils .
subsoils'": . '
subsoils
r.
48"
gam, wtr_
54.
6011
66"
72" . :... ...
„ .
....78"
..... .
84"
INDICATE .LEVEL. AT WHICH .GROUND,
WATER..TS..ENCOUNTERED ....:...
..INDICATE LEVEL TO WHICH WATER..LEVEL
RISES AFTER BEING ENCOUNTERED
Salvatore V. Ri i
na., P.. E-___.-_
Date Mai J, _.1987_
:... .
Soil Rate Used Min/1 "Drop:
S.D. Usable
Area Provided
No. of Bedrooms Septic'Tank
Capacity
Gals. Type
p By
Absor ton.Area.Prov e
L. F x24" �bj `''-
_ ......... width trench.
d
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
.. .. 4:rF ^'0 5
Soil Rate Approved Sq..Ft /Gal1251
. Checked by e
PUTNAM:COUNTY DEPARTMENT OF.HEALTH.
\OUNTY VISION-_ OF_.ENiIIRONMENTAL_ .HEALTH SERVICES OFFICE BUILDING CARMEL N. Y. 10512
DESIGN DATA S T- SEPARATE SEWAGE DISPOSAL SYSTEM FT 0.
-Owner. Address
Located at (Stre t Sec. Block Lot
6dicate nearer cross s ree
Municipality Watershed
SOIL PERCOLATI TEST DATA REQUIRED TO.BE S MITTED WITH APPLICATIONS
o. e.Number CLOCK TIME PERC TION PERCOLATION
>a se p o Or Water ve
No. Time From Gro d Surface in Inches Soil Rate
Start: Stop-- Min. Start`: ` ' Stop Drop in Min. /in drop
Inches Inches Inches
1
2
3
Notes: 1) Tests to be repeated at same depth until proximately equal soil
rates are obtained at each percolation test hole. 1 data to be submitted
for review.
2) Depth measurements to be made from top of hole.
PUTNAM COUNTY DEPARDENT_OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY/ SUBSURFACE SEWAGE DISPOSAL SYSTEMS
YNSPxVI i
( P _ - -FIELD 0�7 2 ,R
� T
' _ , .•:- _ .,- �,. -.; .., .,x; ;. - ..a. _ , Q.
4&40 DATE. 4
1" 3.NSP. BY:
(Name of Owner) (Street Location)
INITIAL SITE INSPECTION YES NO COMMENTS
Wetlands on /or proximate to property..............
Property lines or corners found ...................
Can estimate house location .......................
Will driveway need cut ............................
Must trees be-removed - note these ................
.Deep holes representative of entire SDS area......
Additional deep holes needed..... ... ... ....
Sufficient SDS area available considering driveway
cut, house location, separation distances,etc... -5 ty V
Adjacent wells/ septics .............................
D.H. 1 Lot- _...__
Depth to G.W. -'
Depth to rock
Soil Descri tion
0 ft.
3 ft.
6 ft.
9,ft.
12 ft.
D.H. 2 Lot
Depth to G.W.
Depth to rock
Soil Description
0 ft.
3 ft.
6 ft.
9 ft.
12 ft.
D.H. - Deep Hole
G.W.- Groundwater
D.H. 3 _ Lot
Depth to G.W.v._
Depth to rock
soil Descri
0 ft.
3 ft.
6 ft.
9 ft.
12 ft.
DATE: •
FINAL SITE INSPECTION INSP.BY: YES NO CO MaM
House SSDS located per approved plan .............
Length of trench measured
Width of trench average
Slope of tile line and trench acceptable..........
Roan allowed for expansion trenches ..............
Over 100 ft. from watercourse.......... ........
Natural soil not stripped or SDS area
unnecessarly graded.........: . . .... ........
10 ft. maintained fran property line and
20 ft. fran house .:.. .........................
Distance well to SSDS (ft.) ......................
Number of bedroans checks ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. from nearest trench ................
15 ft. of peripheral soil horizontally
fran trench ..... ...............................
Boxes properly set ...............................
Could surface runoff fran driveway, roads,
ground surface,.etc., channel near SDS area....
Does lot drainage appear OK%,in' area of SDS::......_.
FINAL GRADNG OF SITE ASTABLE:...............
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