Loading...
HomeMy WebLinkAbout2728DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 61.08 -1 -2 BOX 23 `�■ g 1 T1161 mire so rL 02728 PUTNAM COUNTY DEPARTMENT OF HEALTH 1 Rev. 3186 r Divleloe of Environmental.Health Services; Carmel; N.Y 10512' r , " Engineer Mast Providdo • a , P c.H D Permit a 31 7, T . • -._ : __ -CER .. _ CATE, OF CONSTRUCTION COMPLIANCE FOR-SEWAGE. DISPOSAL-SYSTEM Gt T- own ,or V Located et �ay s✓ as Y Tei MaP �-3 Block - Lot Owner /applicant Name / °�J Gil /, aerly - / Subdivision Name $abdv..I;ot q Mailing Address ZI -L °�? Date Permit" Isened " Separate Sewerage System built by C' A / ddrese r/ Conalsthtg of / G �� Gallon Septic Tank and . 3 ' YY/ dC -• G' Water Supply: Public Supply From Address or: )0r* P/rivate Supply.. DrWed, by A;nEW , - '�% Address /per " J O_I.; Ballding Type /� 4 e-79C Has "Etoelon Control Been Completed? Number of Bedrooms _ _Has: Garbage Grhtder Been InetalledY O Other Regalrementa / �-- •- --•.�: -' ,I certify that the systems) as listed serving the above. premises were cons tructe s¢b M,on the plans of the completed work ( copies of which are ,attached), and in'accordsnce with the standards, rules and regulati s y ord'd 640, the he filed plan, and the permit issued by the Putnam County De rtment'Of Health.. erti ed by P.E. r R.A. Date — _ Address !� GY 't' a License No.> y ►�-�' - .. .. .r Any person occupying premises served by the ove system- ystems) shall promptly,take wcMadt a},er ecesta►y.to secure the correction of any unsanitary conditions resulting hom such usage Approval of the. separate sewerage system shall beeco�e nd void is soon as a pub1% sanitary sewer becomes available and the approval of the private water supply shall become 1141146d -void when a •public we or ,supply becomes available. Such,'ipp ► ovals are subject to modification, or change when in the judgment of the_Commissoner of Health „such evoeatlon; modification or change Is necessary. PW Date 3, g, Title M ��. d W �4 WELL LOCATION WL'LL UUrlr1jn11UA AnrUAl Office Use Only DEPARTMENT OF HEALTH -.- .Division Of- Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH STR ET ADDRESS: IL Y 7 TAX GRID NUMBER: WELL OWNER Na ADDRESSFWOP UBLIC BIVATE USE OF WELL 1 - primary 2 - secondary a RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP 0 ABANDONED O BUSINESS ❑ FARM . ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL O INSTITUTIONAL 0 STAND -BY ❑ MOUNT OF USE YIELD SOUGHT --- =SJ gpm. /N0. PEOPLE SERVED Z / EST. OF DAILY USAGE gal. REASON FOR DRILLING NEW SUPPLY 0 PROVIDE ADDITIONAL SUPPLY ❑ TEST / OBSERVATION REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 0 ft. STATIC WATER LEVEL - ft. DATE MEASURED DRILLING EQUIPMENT !-ROTARY O COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT 0 CABLE PERCUSSION O OTHER (specify): WELL TYPE ❑ SCREENED O OPEN END CASING. If OPEN HOLE IN BEDROCK 0 OTHER CASING DETAILS TOTAL LENGTH 94 ft MATERIALS: 9STEEL ❑ PLASTIC ❑ OTHER LENGTH.BELOW GRADE JOINTS: 0 WELDED ® THREADED O OTHER DIAMETER G � in. SEAL: ❑ CEMENT GROUT ❑ BENTONITE BOTHER WEIGHT PER FOOT — =--- -- Ib. /ft. I DRIVE SHOE -04ES ONO I LINER: O YES 49NO SCREEN DETAILS - - , _ .. _. . _ . DIAMETER (in) ' SLOT SIZE LENGTH (it) DEPTH TO SCREEN (it) DEVELOPED? FIRST . - q xES o vD HOURS :: ...SECOND GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE DIAMETER OF PACK in. TOP DEPTH tL BOTTOht DEPTH ft. WELL YIELD TEST t If detailed pumping OMPRESSED AIR , formation attached? ktb3"C8AILIf0 HOO: O PUMPED t tests were done is in- O OTHER :OYES ONO MIELL LOG It more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water gar_ ing DiaFORMATION neeter DESCRIPTION raoE, ft. it WELL DEPTH it. DURATION. hr. min. DRAWOOWN ft. YIELD gpm. Land D r G b %d WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES ❑ NO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE MAKER MOO EL CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAME DATE A SS 3v ° °i` '� gStG�trATt1RE � Yorktown Medical Laboratory, Inc. i:2.' 0 2:232 8 7 LAB # - -- - - -�� 321 KearStreet Date Taken. Time: 73a/ � . -. .... 'orktow.n:,He,ights;-i ;1 Y- 1:,10598 Z. (914) 245 -2800 -Date Reported. MAR, 201989 Director: Albert H. Padovani M. T. (ASCP) Collected By : , frI/'S l fi Referred By: T- 1 Sample Location: 000 �� , Gt 7�l/✓�-m V % Phone # VXVA �-� ^/��U�-y�� Phone # Sample Type L i "� 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 e a'd — Manganese _ Mercury — Sodium Zinc MISCELLANEOUS — pH (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 Coliform 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 Potable Non- potable — STP INF STP EFF — Other: Sample Status: (check each) Outgoing — HNO3 HC1 _ H2SO4 _ NaOH ZnOAc _ Na2S203 _ Other: Incoming E 4 °C 1�/'GT 4 °C pH LE 2 — — pH GE 9 — pH GE 12 — Other: REMARKS /COMMENTS (For Lab Use) IELAP #10323 THESE RESULTS INDICATE THAT THE WATER SAMPLE WAS)" (WASN'T) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO TH N YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECT THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DIDN'T) (N /A MEET THE SATISFACTORY CHEMICAL QUALITY STANDARDS OF.THE NEW YORK STAT DR KING WATER CODES, FOR THE PARAMETERS TESTED, AT. THE TIME OF COLLECTION. x 2 /86(Rvsd7 /87)RWE PUTNAM. COUNTfY .DEPARTMENT - OF _ HFA Tfj DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ : _ ._.. .._.,,�.:,,, � -:•.., Owner or Purchaser of ilding or Building Constructed by 4rV I? d # 4/01-11 Locati n - pStreet cipality Building Type �� -$-- -Vg Section Block Lot Subdivision Name Subdivision Lot # GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL 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 successors, heirs or assigns, to place in good operati.ng._condition__any. part of said system constructed by me which fails to operate "fore a- period'- of two years• imanediately following:the..,date -of, approval of the "Certificate of Construction Compliance" for 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 occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environmental Health Services of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this �� day of IYOr"419 J7�' Signat \ Title 2�� General 09ntractor (Owner) - Signat e Corporation Name (if Corp.) Corporation Name (if Corp.) Address Address rev. 9/85 mk h .•' n PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer to Provide Permit N on CERTIFICATE OF Permit # -- NSTR CTI PERMIT FOR SEWAGE DISPOSAL SYSTEM �! Lxated at - �!`= �- _ d !°✓ - /f�GQ Q' :Town- or V�Ilage Subdivision Name a.-. Sabd. Lot IY Tax Map �� • Block Lot Owner /Applicant Name /�'� «e- Renewal_ O Revislon � Date of Previous Approval �y MttW / /0ng Address 'e ✓` 1 / / Town P. ye Zip "'e' Building Type _ / 1" �✓� " Lot Area • Fill Section Only De P th Volume Number of Bedrooms u Design Flow G P D� PCHD Notification le Regtslred.When Fill rnmpleted Separate Sewerage System to consist of Gallon Septic Tank an To be constructed by Address _ Water Supply: /Public Supply From Address Private Supply Drilled by - Address Other Reaalrements o" v�f'E+tli e- Al' % �• /Cb •"" / A t" tai 1 represent that 1 am wholly and completely responsible for the design and location of the tl i• t �vcs)-:K •e at:dh separate sewage disposals stem 1� .YiO�j'rj d1y. s r above described will be constructed as shown on the approved amendment there to and in o;4P R�ia�la'ttjd► iu� an regulations o e Putnam County Department of Health, and that on completion thereof a "Certificate of Const ctio o Ian f ct yltD the Commissioner of Healthwlll be submitted to the Department, and a written guarantee will be furnished the own , hisslyA� essors, heir i ign y�tba, builder, that said builder Will place in good operating condition any pert of said sewage disposal system during t e iQ� of ) years m �r44{�following thodate of the issu- ance of the approval of the Certificate of Construction Compliance of the original st r a tVhet )� at•"M- drilled well described above will be located as shown on the approved plan and that said well will be insta ' acco with 0f �le>n d'Ta9u amens of the Putnam County DQp rtment of Health. e Date Signed • P.E.- R.A. _ Address +g�e:'f ti►` ' LrC�i�cense No APPROVED FOR CONSTRUCTION: Thi pproval expires two years fro the date issued a he bd'iltlOil has been undertaken and is revocable for cause or may be amend r modified when considered necessary by the Com is Any change or alteration of construction Rev. requires a new permit. Approved r disposal of domesti n t ryy se�eywaage � //o]rr orriivvate water y only. %87 Date �'�, d i�Z By �*'�' / %!L Cl/ Title Ftl J I;. IV. `! . VI. APPE DC C FINAL SITE INSPECTION Date spected LOCATION �4t ( U UI • V CWNER r ,'IT TM .. # OR S'JEDIVISI ,. LOT.. CCM_MIIv'I'; SENAGE DISPCS2L AREA a. SDS area located as per approved plans b. Fill section -Date of placanent •� 2:1 barrier. LGTH WIMI - VG.DPrH c. Natural' soil not stripced d. e. Stone, brash, etc., greaster than 15` Fran SDS area. 100 ft. from water coq r wetlands. SL,v,GE DISPOSAL SYST 4 a. Septic tar]{ size f(1,000/ 1,250 I I eCv✓►� -. b. Seotic task instil evel c. 10' minor m fran foundation d. No 90° bends, cleanout within 10 ft. cf 45° bend I I e. DISTRIBLTICN BOX 1. All outlets at same elevation - water,- test I I 2. Protect= below frost 3. M-iniimum 2 ft. original soil between bcx and trenches f. Ji1NCTI0N BOX - properly see C. TP=HES talle�� 1. L-ngtn r�sired - Lar&LR ins wG. /cI 2. Distance to watercourse meas•lr d 3. Install= according to plan 4. Distance center to center 5. Slone cf tae -nch acceptable 1/16 - 1/32 " /Toot. 6. 10 feet from property line - 20 feet - foundations 7. Depth cf trench < 30 inches fran surface 8. Roan allowed for expansion, 50% 9. Size of gravel 3/4 - 1j" diameter- 10. Depth of gravel in trench 12" ndnimm e 5 a�pD= pr Kip OR DCSL SYSTEMS 1. Size of malTm chamber 2. O e'_ c,,4 tank I Psarm, visual /audio I 4. Pmo e =silv accessible manhole to trade �. First bcx baffled 6. Cycle w_ _messed by Heallmh DeTDar`ren I estlmc.ted flcw per cvcl e _ . =Clse lcc. _e-- pear aDtDrcve; plans. -=s C^_ a=c _ ; e plans I I I 0. Distance f_= SDS: -_ -_ :i:a asured =_ C. Casing 18" aboveg_ ace. I I C. S'._riace draimace arcur:C well accenc.=�__. CVE.PLL WOREqr� =p a. Boxes rcce*ly area:: b. All pices cart-t_-' v C. All pipes flu =t, *Nit:- inside of box d. Eackfill material ccntains stones < 4" in diameter e. Curtain drain installed according to clan f. Certain dram cut =all routed & dir.to eYist.watercours a. Footing drains d_iscd-iarQe awav from SDS area h. SurfaCe water protection adeauate I L Errosion ccnE provided on slopes crea=te than 15$. I: - :.:: :.. DESTG Owner r• •• m l • r i� • . •' • r •' ' i� v •1 DI tea,. N D4T4 -;;5 UFAC- E _ S39..A. GI h. 0 AL- . -SXTFM. FIE el"-. Address Located at (Street) (f -4 2 �1+/ Sec. -3 Block S Lot / (indicate nearest cross street) Municipality "l ,�' >�� G /� G '' Watershed SOIL PERCOIAT-.MON.TEST DATA REQUIRED TO BE SUBMI= WITH APPLICATIONS Date of Pre- Soaking Date of Peroolation Test HOLE NUMBER CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches Al- 4 5 4 5 1 2 3 4 5 NOTES: 1. 2. rev. 9/85 Tests to be repeated are obtained at each for review. Depth measurements to at same depth until approximately equal soil rates percolation test hole. All data to' be submitted be made fran top of hole. 10 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES G.L. , 5-e" 21 31 41 5' 61 4-e 71 81 14 INDICATE . LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED t4' il, INDICATE LEVEL To WHICH WATER LEVEL RISES AMR BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used U =5 Min/1" Drop: S.D. Usable Area Provided No. of Bedroans 2— _ septic Tank capacity lel-0 & gals . Type Absorption Area Provided By Ze0 L.F. x 24" width trench Other lam' X5 C!: Name Signa THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: NS�01 16QQI Soil Rate Approved sq.ft/gal. Checked by O o Date i 10, z. Lj 12' 13' 14 INDICATE . LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED t4' il, INDICATE LEVEL To WHICH WATER LEVEL RISES AMR BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used U =5 Min/1" Drop: S.D. Usable Area Provided No. of Bedroans 2— _ septic Tank capacity lel-0 & gals . Type Absorption Area Provided By Ze0 L.F. x 24" width trench Other lam' X5 C!: Name Signa THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: NS�01 16QQI Soil Rate Approved sq.ft/gal. Checked by O o Date i PUTM COUNrY DEPARTMENT OF HEALTH. • •' • •• •; I� V' L HEALTH SERVICES'. DESIGN DAAT'A' SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE /NO. . - , . �, . �-- "Owrier / ✓"� �/�rr G� /=-i>C�� .. AddresS %� / � Y i •/.7��Crr ,!�r •%� f''./'v. , ^. ...- . . Located at (Street) L ©�cw-:�' ���:� / Sec. Block Lot (indicate nearrest cross street) Municipality % i� 1' -nay /'��� Watershed TO BE SURMTI ED Wim APPLICATIONS Date of Pre - Soaking b J Date of Percolation Test I (� HOLE 1 2 3 �' a NUMBER CLOCK TIME PERCOIATION PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min/In Drop Inches Inches Inches �-x 2- .j 4 5 ?2 g,9 3 /ale % a 5 1 2 3 �' a 4 5 u;' NOTES: 1. Tests to be, rep- eated'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. rev. 9/85 DEPTH 1° 2° 3° 4° 5° 6.° 7° 8° 4° TEST PIT DATA.REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. j HOLE NO. HOLE No. Aa 1 u 1 _.......____ ...:. INDICATE LEVEL-AT WN,ICH- GROUNDWATER--IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: �T�T- I`�'" DATE e /6- s �� DESIGN Soil Rate Used �`'S Min /1" Drop: S.D. Usable Area Provided 3 No. of Bedrooms Septic Tank Capacity Absorption Area Provided By 3eo Ale a gals. r L.F. x 24" width trench THIS SPACE PUR USE BY HEALTH DEYAXIVI I UNLY e Soil Rate Approved sq.ft /gal. Checked by Date+ Re: PUTNAM COUNTY DEPARTMENT OF HEALTH ON OF ENVIRONMENTAL IRONMENTAL HEALTH SERVICES Date 3/ � Property of Located at Section Block �� Lot Subdivision of Subdv. Lot # Filed Map # Date MI Gentlemen: This letter is to authorize a duly licensed professional engineer or registered architect (Indicate 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 as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connectian__with this matter and to supervise th.e.- cons - truction .of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, r Signe •� 0 r of P o erty Counters ' �t�s1►1�+1i � _ P.E., R -r 5 Address �,� • P 4. k7 Addres Town y3� Telephone /Telephone DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION' TO".'CONSTA CT A WATER WLLL PrRn PRRMTT $! !/- WELL LOCATION Street Address Town/Villa ge Cit Tax Grid Number � -;,> a -o,. WELL OWNER Name Mailing Address f '� rivate i 0 Public USE OF WELL RESIDENTIAL ® PUBLIC SUPPLY Q AIR /COND /HEAT PUMP D ABANDONED 1 - primary ® BUSINESS D FARM O TEST /OBSERVATION D OTHER (specify 2 - secondary ® INDUSTRIAL C3INSTITUTIONAL ❑ STAND -BY AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED -�4 /EST. OF DAILY USAGE ld!�eagal REASON FOR EW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ® TEST /OBSERVATION DRILLING REPLACE EXISTING SUPPLY ® DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED ODRIVEN []DUG ®GRAVEL ®OTHER IS WELL SITE SUBJECT TO FLOODING? YES kl-' NO IF WELL IS LOCATED, IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name &—enz 4� Azz :;� VV ®" /12 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO / NAME OF PUBLIC.WATER SUPPLY: TOWN /VIL /CITY DISTANCE _TO PROPERTY FROM-NEAREST WATER HAIN:' LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED •� []ON REAR OF THIS APPLICATION (da e) (signature PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form pr by the Putnam County Health Department. Date of Issue: —:�D 19 Date of Expiration: .e 19 r ermit Issui ,,fi ng Official Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner 287 Orange copy: Well Driller 7- - -' i CO s•T PETER C ALEXAN(YtPSi JOHN SIMMONS, MD �, j': off, County Exectitivo Deputy Commissioner N. DEPARTMENT OF HEALTH JOHN KARELL, Ji . P.E a, Director Division Of Environmental Health Services 110 CXd Route Six Center, Carmel, New York 10512 (914) 225 -0310 ` June 19,;1987 E �Mr. jot;.h Sullivan " 2972 Fc'rncrest Drive- A_ ;ti Yorktown Heights., Nekp York 10598 !. RE: Proposed SSDS <. ]Finger Canopwq TIoJ low Road Priam Valley �• '; Tax M 23 -; -4 Mr. S61livan.: jF. a 'YtfM1 1 s`Rr aiew of plans and c. Lhe::r supp.o.c t•ing documenf-v4ubmitted at y ;ais time relative to the abo,,ia captione Pro. ?t has been NI""" mpleted. Comments are offered as .follms: 'r Ln E yb. is the ;requirement . r)f this U ep;Zrtme.n.t. that` the-prop 6 se6 _. _ SDS '•design is` to•'bk. blAsed on a minimum, of three bedrooms house.' As the ' ot: size is tore than adequate, there' ould be .ao difficu,lty with (.?;.; revised design. 4 F; Upon rece:;'ot of a s ii; mission, x ,t�ised to reflect the above comments, this ap)ECation wi:1': >e considered further. Your very truly, LW 6Z y' Fobert Morris RM:pt Environmental Health Technician . • • - ...ya. + v i►+ivaa vi' • •, r v 11<VL�l'1GLY 1(�L1 �j1Zi JrtCV 11.:C�� IT rti4 21114R J?J!2 ffmV DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT - j j DATE '�`J'0- C-L,� �T S t 1. (� t%.� BY e (Name of GWner) . � � CANTS -__ .- .�..- .._.�... _.... • �: - LF trench required -3-"Vo 60 ft. max. Parellel to contours :e t..Loaati on) NO DOCUMENTS = Permit 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 U permit; PWS letter Variance Request GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage Systen Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Galle ry; 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 _..: Foots rs /Gutter., Curtain. Dra ups - '(da:schage- OIL} Perc & Deep Holes Located i Representative of primary and expansion Expansion Area;shown; gravity flow,suff. size.; If PmVed Pit & D Box Shown & Detailed House - No. of Bedrooms Wells &-SSDS's Win 200 ft. of Proposed Systems - Property - s --& -Bo ds ` Hous etback Necessary (Tight lot) / Ho se Sewer - 1 /4 " /ft. 4'0; Type pipe o ,- . 5° w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields i 10' to P.L., Driveway, Large Trees,Top of fil. 20' to Foundation Walls i 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan'� 15' to Drains - Curtain, Leader, Footing 351to catch basin,stormdrain,piped watercourse 10' to Water Line (pits -201) a 50' intermittent drainage course i� Septic Tanks 10' fran Foundation; 50' to well 15' Well to PL .F 9 10 200 576 f4 9,&. g 12.15 5jQ its Jdl 7 '? ,Q J- ,v • 363 -AV -.3 7 e 3.5 .72' P-3? /Y,9 le-S Well /C/ r., W ev op" wdr�2 The Sewage Disposal system design hereon doe-9 not provide fo'. installation of a garbage grinder. Such installation requires 'fie approval of the Putru3ou County Department of Health. A F /Ov C/ r7 AC er 04 K 000,��17 2 e-.Ar MR. •V P » ? r k t t t't3S V f N rF r1"tt i t r ' a g,y^ �fi :?' JL <sm>rta"..,,.�' w"°'�'"w•''kav;a'�3 -F - /yam ,/ a.., f.. r 'Y` "tr nay - 3 ., u%+* . �'� r'1'y •�, i }� � :?� � §� ...fit t . � r �. „ _ aq r L' .i:+ y ea ', Y•�• 7 !r ..: i,.a.s fi'y .stX'4C.$' - L- S'F-1 ra r _ Q0 1 ��`� X ;•b s' S ,, yi .�• ,•r, !�'`` �?°�sl4F e � ' r� � fi_ "`�'e"`. r t'%R.7. y �`�r ...,q t _. - # r'�'t.. sn y t - �,, �,sr•.. ,i,•..sT•gy ��,ty * ,X ,fr -pew, S-. tr. __ ^�j E '� -'•' P' p,. A r �"� •..n:' y ^` kg ti ' "•'" 2" ru°i,; t t,".tw f'-t y 'fir 1 t '�' �r�,,',°��y •� �- "i l�h „v�styA.ta j 3T� 'r' 4 % -fi R� 1 n'> 3'>J `�' '� '.s�t'f•',L�','f 1` :4' •r° � , t �� ' �• �" ,fit r a _ �t - � _ _ . is -.p-• _� ?:;, :e..i.'w 'iG,`.•� -`a� '�' 7 ,iy +.?: j..�' "' Fzs� ,r *`i'a- � q '�i%y'3.'".,,��i` y n .a^ �.'�,�,�• � s. J. a z (• •S;'; .. •: •. rit. � � � .. -; . - ^ - -�.. ;,.- ...^g.� .:. .° -ef:;- 4'`s 90 :,: � S�j r.'�'H3 "rrq> �r / �'y.�s � -LL ��` �'/ 7. AK QW � r, ;� 6 �� s.e ,,y � -h: rrs•a: �,- �a•.�•�e5'R` {--4. -•r •+ _ •+ ''. r.+:� 1_ rf �++,�, �w -'� 3 � ° ! .'6miG .T1 fr � . h Z k" r k- i• ''{' M15 Y .DG,• y } r "+,."5, 3� „�, 3 r .�1.., �.ad'� ;, �, "W t G tr,r eve. KEY {a• "��t�•,•'{�,qp ,fit. r - r s � {, i •c any lef 10 �1- f., k5.e •, ^�c1t? 'K a.,, •,v -•.... Y. 'dqR WQ�Y.LU[ z Y ... - �� :��_� Ta;r_ 1��c -- qtr.' i"• � t .may- _ F; ! ��` ��• no r StF J "r fy; ,x3in .