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HomeMy WebLinkAbout2731DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 61.08 -1 -5 BOX 23 I ,, , , J I�` 02731 ............. ...,,e,,,,,, ..- 4— .r.r.+.a-.�. _... ..- ....,. --«.. ..., -.,a. .�..,..a ,...tea.. e,i.;.. '?,:'.M -x:+�t,.n. +vT m... -..y. �'";'.timaFro, .;�a-�RT � +�'1+".��- a�F.,�;C � q.:�:�u2'" ;. i`•_.. �1 Refit. 31816 Division COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N.Y. 16512 A. Engineer Must Provide O P.C.H.D. Permit q = —=- V -12 — 8 6 _CE CATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Putnam Valley •> .::6�:j. .....� rr. ._.._.........� _.....�.._ -�a-.. .: .. :.•.: _.. ..N =�., ...- e....._,_ ..- •• ,. .. n:•�;-t.:,. ... y:� ..., �'�nw67Yir {�ill8� m...�.T,n vC,.a....w•�r. ,,�.c�: Highl and'• Rd . L e Located at T Tax Map . Block 1 Lot 5.4 Owner /applicant Name Sw a r t zwe l d e r Formerly Subdivision Name D& 0 Subdv. Lot q 4 Mailing Address e W 1 y, ZIP Date Permit Issued 1-29-86 Separate Sewerage System bunt by Owner/G.C. Address 12 R P. P r v i o r Dr.,, New City , NY .Consisting of 0 Gallon Septic Tank and 383 LF x 210 trench Water. Supplyt Public Supply From Address, ors X Private Supply Drilled by N. .Anderson Address Barger St., Putnam Valley, NY Wding Type S. F. D. Has Erosion Control Been Completed? Yes Number of Bedrooms 3 Has Garbage Grinder Been Installed? No Other Requirements 2'0 fill Section i certify that the system(s) as listed serving the above premises were constri entially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and re ation n accordance with filed tan, end the permit issued by the Putnam County Department Of Health. osts un --5L 1989 Car tlf� P. E. X �t�k3c— Nor Address Perk' SCI -%7-8 _ r (`nl d Siring, NY 10516 License No. 49002 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become hull and void as soon as a pubt;: unitary lower becomes avalls6is and the approval of the private water supply shall become. null and void when a public water supply becomes available. Such approvals are subject to modfi utfon r Change when, in the judgment of the Commis over of Nalth, such revont n, moellfieation or change Is necessary. `,� > ''Date — Tltro �° v e'r'r"' °^'P {,ry. -.m+ ova. -.,q. .'�.-- .a— �"f'r_ -v.} A. .. 1. .. .T...�� t ' �' L. ? ' . a i�v S r -'" {, r ~< ix- t p PU'rAi.�fiq® Red 3/ y � � � r „� HDivislon of Envlroamental H®alth S®rvic®s, CePmel, EngineeP R6[nst Proovide PV :12 8 6_ .P .0 IDiPePmit (tr - r �r,.� . C o�- Qrr.�iv e�PL�.)e9;ta�s SE�iGE_aio sysla Putnam Vall�v:/ r c Town OP tie - Highland Rd. �T'�Me 23 Lot 5.4 r -Witild M. Owner /applicant 1Vame ,T Swart 2 W e 1 d e r Foemerly Snbdlvlelo a Snbdv. Lot N TF 109.5'.6 `T*C <j yetewba �, llt r t, Separate. Sewersg® S by Ad 16 se "Coneieting of t Ci ,2 0 r ” "'Gallon j$ tic T d L: F. X 2 0 t r e nC,71, d so i Water Supply Pabllc Supply x 3 N Anderson,adPeee eter 'St ;1Put. Vll N 'Y oe Priva pplyDrDled by Y s �s x �r s 5. gas Froeion Control Been from Ieted4 N0 i Bnlldhlg ape F i Nuinbee. of Bedrooms s. ^ Sil>oe Garbage G¢inder Been InetalledY e r r x e t # C x�, }Other RegWremen ` � � ., ......$; r"zSr +�:n � '' .. .: at ,•� rtI certify th a syatem(s) as¢ listed serving the ebove,lpremiaesvwere conetru essentially Eaeshown osrthe plans of the: completed' work K Y Y 2 }. ate �;of which: +` attached) find in accordance, with the standards rules and dr ario a in accardance;gwith -'` fil "lan, the 'permit issued by -t'he 1Putnam4 unt De" rtment Of Health } Y Pa ..�. _ E e�.},° s iDetO 2 2 3 8 8 4..2 Park's B�1vcl.,�ColdzSprngr ' r' r , Adtlrett , �LIG3nasiWO 49002: M :) Any person occuDYing •premises served by the aboJe''syst ®m(i) shall promptly alc0 such nation na moy bo noeoss3ry to asaoueo the cotioetion :!of.any;unsailitary, ` ;�, cohtlitJOns resulting from wch usage Approval of the =separate ys2ara ► age Esystem Shalt, bOCOMC nulPand void Da:coon,asi; a pub. ltinitary mower bacom ®e -, a' - ^w 's, ; e;n 1'aifd - void twrh0n�a uDlie'ev0tw'=su i ^,boeorrrcis= 'tivai1. 1 .:° ` tavallbble ,and the :'approve l. of the _private, water supply shall•beeom , ui y p _ pD l! . Such; approve s,.are as'ub)eet to modifltation ors change 3vrhen in the t)udgm0nt of 4h0zCommisslonor of Moalth Such rOVOCD41on, mcdi4fultion Or ehgngp Ia neee»aary,: S, y 3 � _ Oete a; 18Y r ; Tit 10 10 fj� e i BACTERIAL EXAMIN t 1 �'..� t :.Lab No W Lab No. ENT. r" y yi ", s Time Set �u 4 _PrN 11� Tests (C Grcl it,rhi,.MP CoIU :Coll 'd by Coll d from: Na" me "- Address .. 151.4d) " irftlN- VRifiCa ton of source _ Sampling Po(ht.witliin Premises t Chlonnateo? Yes o:NO Free i FiESULT,S'OF EXAMINATION OF WAtE i .:MPN /100 ml r Coliform 'Group kti F ?� Number Postbve Tubes✓ tw � Fecal Coliform_ �� eollected `�� i . a d ED WATERS '` ' M1 cx- V ' Bottle _Nojjc b' • T,Ime- Submitted• n Membrane :;Fecal Other � 1+4 Agency�Colt ipWn, v up� (zip code) 'ICownYl ;Refrigerated._ mg /I Total mg /I' pH a T. . Standard Plate Count Battens per ml. (48 hr) Membrar,q Method /100 ml i ,� Total.CoUform � w ry. 30ther ' ,py 0 WLLL UVrr1jz11Vn nr,rvni Office Use Only DEPARTMENT OF HEALTH Asian- Of . Fnui ro nxmenta1 Health Services ... o- -f mac -, •., .... . «.- �%=.�. a�i:....• ." r.n- •..'`a ....n-r. �•.Vr .. .".... .. ... ...,. •.,. : PUTNAM COUNTY DEPARTMENT OF HEALTH S "T AO R SS: WNIVI 1 I Y TAX GRlO NUMBER: WELL LOCATION WELL OWNER ME U j ADDRESS: /o j z PRIVATE O PUBLIC USE OF WELL 1 - primary 2 - secondary 0 RESIDENTIAL PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ABAN ONED ❑ BUSINESS O FARM ❑ TEST/ OBSERVATION OTHER (specify) ❑ INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAG 6 gal. REASON FOR DRILLING �Q NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION O REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 60O ft. STATIC WATER LEVEL � eft- DATE MEASURED ✓0 DRILLING EQUIPMENT QLROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG O WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED O OPEN END CASING ,OPEN HOLE IN BEDROCK ❑ OTHER CASING TOTAL LENGTH tL MATERIALS: B STEEL O PLASTIC ❑ OTHER LENGTH.BELOW GRADE eft. JOINTS: ❑ WELDED U THREADED O OTHER DETAILS DIAMETER —� '� in. SEAL: ❑ CEMENT GROUT ❑ BENTONITE .OTHER WEIGHT PER FOOT Ib. /ft. DRIVE SHOE kYES ONO I LINER:OYES4kNO SCREEN DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? -.-.-.-.-DETAILS.. -. FIRST _ ❑ YES ❑ NO - SECOND - - - �. _ :..: _. GRAVEL PACK O YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH tL BOTTOM DEPTH R. WELL YIELD TEST If detailed pumping p p 9 METHOD: ❑ PUMPED tests were done is in- 9COMPRESSED AIR , formation attached? 18AILED ❑ OTHER :OYES ONO It more detailed formation descriptions or sieve analyses 'WELL LOG are available, please attach. DEPTH FROM SURFACE Water Bear- Ing Well Ilia- meter FORMATION DESCRIPTION G70E, ft. it. WELL DEPTH ft. DURATION hr. min. ORAWOOWN ft, YIELD gpm. Surtace � 0 ` L.) 0, �6 0 C . WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE -4 . 2,66 CAPACITY / GAL. PUMP I RMATION , ' TYPE `3'� CAPACITY �_ MAK DEPTH MODEL VOLTAGE ?'BHP WELL DRILLER NAME n�- A 0 0 R E ju i52, �""�' • SIGFnMRE 7'I �,• D e PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF-ENVIRONMENTAL HEALTH SERVICESS Owner o Purchaser of Building VAN Building Constructed'by Location - Street Municipality FRarne S.+cr USX_ Building Type 22? Section Block Lot .,L3 Tax Map Number 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 operating condition any part of said system constructed by me which fails to operate for a period of two years immediately 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 mher-e. -.the • failure. =td- operate .pr'operly.: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 E nviromental 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 I S day of 19 S l Signature Genn ral ContractOr (Owner) - Signature Corporation Name (if Corp.) rev. 9/85 mk Title kGA4-17-1S'7Z)1V_C-' AeO o-r�5 Corporation flame (if Corp.) 18 SOv74 ,Uc tstr�D Address 16 FROM F LAWRENCE 0ELLUSCIO, P.E. Putnam Co. Dept of Health Perk's-Blvd. Dv of Envrnmltl Health servis Cold. _rT*0`­0_1_d` �R­u,.e-­b-_:C;Eni et L Carmel, N.Y. 10512 Attn: Mr. Lo Werper: SUBJECT: Cert. of Compliance PV-12-86 FOLD HERE DATE Jul 7, 1989 Dear Larry, In response to your Letter of June 29, 1989, the enclosed doc- umentation is resubmitted with the requested corrections. The applicant has been notified that the filing fee is now $100.00,which will be forwarded by the applicant. If every- thing is in order, I would appreciate that the certificate be sent direct to the applicant. I FORM 11253 RAPIDR Very truly yours, '"0 -m,. ,�...'- -v..ts �.. T e-:• - (---3. ,•�r -:�' ."T'.. .�,; .0 -, 'rte FROM F— Putnam Co. Dept of Health LAWRENCE BELLUSCIO, P.E. Dv of Envrnm' tl Hlth Srv' s Perk's Blvd. 110 Old Route 6 Center Cold Spring, NY 10516 _.._:, a r =.;.- ,� - -.- Carmel :l, -,--- A1Y- �= �.�:�2. -,ro ,: - � -,-� - ..._ -..- : �_..���� -�-�- - , - -_ -: - ' ;(91�)= 265 - .333.:.. _ ;, . - - •. _ J Attn: Mr. L. Werper SUBJECT: Cert. of compliance PV -12 -86 FOLD HERE • {..-5 June 5, 1989 Dear Larry, AD Enclosed please find the documentation for the above permit. Please send the final certificate to the applicant direct. Please contact me if there is any problem. Very truly yours, Lawrence Belluscio 1 Encls: (1) -Cert. of compliance (3)- Systme guarantee M- Certf!d check, $25.00 3 -As -built dwgs (1)- water analysis cc: John Swartzwelder, Applicant FORM 11253 RAPIDFORMS, INC.. BELLMAWR, N.J. 08031 SPEED -MEMO t .,4 l •,S ,1„1Laa PETER C. ALEXANDERSON County Executive ENID L. CARRUTH, M.P.H. Public Health . Director JUMN KAHCLL Jr., rA. DEPARTMENT OF HEALTH Director Division. Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225-0310 Mr.. Lawrence Belluscio, PE. Perks Blvd. Cold Spring, NY 10516 Dear Mr. Belluscio: June 29, 1989 Re: Compliance - Swartzewelder South Highland.Road (T) PV - TM #23 -1 -5.4 Permit # PV -12 -86 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) 'As Built' plans show 383 linear feet of fields,.Certificate of Construction Compliance indicates 500. 2) Certificate of Construction Compliance indicates a four bedroom house, field inspection indicates a three bedroom house. Please supply 'As Built' house plans. _:.. ,. - ... 3) . Document expansion area on .'A_s__Bu,ilt',_yp,lans /,fi.eld inspection idd "icat-es'- t'n'at "expansion 'area coul=d not be- loc&te,d •accord•ing = -:4 to approved plans. 4) Fee for Compliance is $100.00.1 Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, Lawrence C. Werper LCW:jr Assistant Public Health Engineer STREET dvHD OWNER TOWN TAX MAP �- � ��� ✓.5,.= Y.. , ... _,�. �, -- ,. „_ - �- , _ _ (� - PERMI r.. # t✓ 12 '� DATE NOTIFIED /6 y'� m NOTIFIED BY w(-•� TYPE INSPECTION - FILL SECT=- PRELIM Uvu FINAL �V OD I v V FINAL SITE INSPECTION Date Ofiff (� Inspe:� Y () C t ( A V � SST ILCATION OWiaJ („1 i w �2rJ Cam✓ PERMIT / (i�(1 1� 24 Q OR SUBDIVISION WT # 7-� \ 1 YES-NCJ 3:' ' SEWAGE; DISPOSAL' a. SDS area located as per approved plans - b. Fill section - Date'of placement / 2.1 barrier_ LGTH WIDTH AVG.DPTH C, c. Natural soil not stri=ped d. Stone, brush, etc., greater than 15' fran SDS area. e. 100 ft. fran water course /wetlands. { II. SEk&.Ca DISPOSP.L SYSTEM a. Septic tank size - 1,000 1,250 b. Septic tank installed level C. 10' minimum fran foundation �( d. No 90° bends, cleanout within 10.ft. of 45° bend AN e. DISTRIBUTION BOX 1. All outlets at same eievation water test 2. Protected below frost 3, Minimum. .2 ft. original soil between box and •trenches { f. JUNCTION BOX - prod set g- TRENCHES 1. L;-n r-- u i red - U Inn ' h instal-led -2. Distance to watercoursea�� : ft_ J/ 3. Instilled according to flan 4. Distance c`*ite_r to center L I { '� 5_. Slone of tench accab table 1/16 - 1/32 "/foot. A X1. ,/ -as 6. 10 fe't fran 'vrope_rty line - 20 feet - founda ticrs 7. Depth of t_encn < 30 inches fran surface { { 8. Roan allcwed for erarsion, 50% 9. Size of gravel 3/4 - 1j" diameter ( (. 10. Deoth of gravel in trench 12" minimum L. - Pipe ends capped : h. PCNT OR DOSE SYSTEMS 1: Sze o_ _- _T __ .. ., . -.. ... i r �...G1 2. Overflow tank (T ...� -, /j =. .-. ... 3. Alarm, visJal /audio ( . 4. Purim eesi? y accessible iranhole to grade 5. First box baffled / G 6. Cycle witnessed by Heall th De=e--trnent I A I esthmted flow per cycle V. HOUSE, a. House located ver approved plans. b. Number of bedroaas I . WELL located as a. Well l. r approved plans b. Distance from SDS area measured b�? -ft. c. Casing 18" above grade. d. Surface drainage around well acceptable. )IM-1 [. OVERALL WOREYASHIP a. Boxes vroperly grouted I b. All ipes partial1v backfilled c. All pipes flush with inside of box d. Bar-kf ill material contains stones < 4" in diarn° ter e. O tain drain installed according to plan f . Curtain drain cutfal1 vrot-ec-ted & dir. to exist.watercours g. Footing drains discia-rae away fran SDS area h. Surface water vrot-/ction adeouate i. Rrrosion conLro provided on slopes greater than 15 %. , \ 1 } 'c .._ L 0. j ` PUTN AM rco UNT-11 Division of EnJironmenia R ION PERMIT FOR SEWAGE DISPOSAL °SY . , r D & J sua y Subdlvision Swartzwelder2 R�viz .-Owner /Address P, -•ja' , • _Building! T. S• F• D• t Lot Area 5 2 s Number of Bedrooms , neaign Flow Separate `Sewerage System'to consist of � :-Harold Lyons::` &; 'Sorir To be constructed by - 1 K ^ Water Supply Public Supply;:F,rom X ' Pnvate Supply -to be tlrilled by fl i.Flddress Baraer, St: , 20' F111 section Other Requvements I represent that 1 `am wholly antl completely responsible foi,the'de above.,descrnbetl wUl tieco `County - Department of be submitted`to •the `Dal Place ,in good :operating, pnce of the approval of: will be located assnown o �COunty bepartment of H I APPROVED FOR.CONSI �.:revoeakie fo►,:cause,or _,ma iegwres-s new permit: '= _Date d as shown or the'approved;a and that --on completion •there ;,.and ,a,�.written guarantee''N m any 'part of°said Sewage. 4 w. AgdFess 'Perk! S ,F -i" 16-I00 This'approval_ expire i � P14 'ARTMEN7 �h Services .I Kx r C Fi 4 r _ Pc` 'fa- ar Anders( m Ua�lle ktL Sy e =�� ti atwn�of :thek j re�to�andrii%at:i to of Constrtkc id; the owner � t � � r �HEALTHy Permit 4 own or Ilage { Reviai'on ry -• Previous Approval"'i ion ,Only ❑ a � _ uir Yes D tiotification'Reqed - r � Arerich d �A- L 1 �•i' r A 1 ..I edrsystem(s) , he separate sewbge disposal system ce w,thktha4tandards,.►ules anci.regulations of e u nam ompliance satisfactory to the commissioner.of;Healthwill essors heirs or`assigns-by ttie builder; thaf:said' builder will t "� of- wo (2)_years immeGiately following thedate,of th'e issu- any,epairs thereto2j;thatrfhe drilled well described above i h the rstandar ule d regu aWons, of r he' Putnam ' , t P.E. X R A� 49002 License No ;lconstruction ,of the building`has been,.underiaken. and is >nei of "Health.' Any change'or•alteratlon of'construction ter .supply !only..­..1 s {' �.,_., t ,Title t •r:, I PTP."NAM �UNTY DEPARTMFT OF HEALTH - DIVISION OF RNMOMMAL HEALTH SERVICES "INDIVIDUAL 'WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEM REVIEW SHEET - CONSTRUCTION PERMIT DATE REVI (Name of Owner) (Street Location) CAS YES NO I DOCINIENTS Permit Application Corporate.Resolution Plans - Three sets Engineers Authorization F/ Design Data Sheet (DDS) Deep Hole Log 11 500 LF Consistent Perc Results (3) 30" Perc Hole Other RAP / House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON.PLANS Sewage System Plan Sewage System Hydraulic Pro ravity Flow Fill Profile & Dimensions - Vo D or J Box;Trench /Gallery; P pi details Septic Tank - Size, Detaila Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area;shown; gravity flow,suff. size If Rmped Pit & D Box Shown & Detailed House=_. Noe-..of Bedroars Wells & SSDS's w /in 200 ft. of Property Located 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 i 10' to E. ivewaLarge Trees 201 to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains-Curtain,Stom,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fran Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans &.Permit Same LETTER OF AUTHORIZATION FOR DEVELOPMENT PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date: Dec 6, 1985 Property of JD(K 15:C-04k Irt3 We(Cle -r-• Located at 14 lG�l t4-"LJ V-4• (T •}o.�ti Section od 3 Block b��-- Subdivision of Sub dv. •Lot . #_ Filed Map # Date Gentlemen: This letter is to authorize Lawrence Be.11uscio a duly licensed professional engineer to apply for a Construction Permit for the wastewater treatment X and /or the water s.u-pply systems(() to serve the above. noted. property in.accordance with the standards, rules or regulations as promulgated by the. Commissioner of the Putnam'lCounty Department of Health,. and to sign all necessary papers on my b-ehal.f in connection with this ma.tt.er and to s- upervise ..._.....__..._.._._.. t_he....c.nn.B..�rutt�.m.._o f -aa'-d syste�n oar- sys t•eu�s in °-conformi ty.. w•i th- .the...... ._. � .... . . provisions of Article 14.5 or 147, Education. Law, the Publi.c.-He:a-lth La:w, and th-e. Putnam County Sanitary Code.- o ers� ed: P.E., # 49002 2 Perk's Blvd. Address Cold''Spring, N�.,.Y,.•., .10516'. 914/2.6.5. -Q`�, Telephone Very truly yours, Signed. Owner of Property 12 Reservoir Dr%. Address New City, N.Y. 10956 Town 914/634 -0771 ;;Telephone �, ti PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner 6-Pac. rt &0 e- k4e -r � Address i ,e C��� , KJ t e_ Located at (Stree . l tt H d Sec. pBlock Lot a4 '� RrL e n os sree o Municipality ���� (� �g $-6,w �. _ Watershed uy,,s ®-. V_Vr- SOIL PERCOLATION. TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION apse p o a er Water ve �; ®� . No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in wMin. /in drop 3.5- Inches Inches Inches T 5 1 2 3 4 Notes: 1) Tests to be repeated at same depth until approximate) equal soil rates are obtained at each percolation test hole. All data to submitted for review. 2) Depth measurements to be evade from top of hole. Y 3 �:�� �; ®� . �® Z( y4- l4 4 5:054"4 Y O 1q 3.5- 1 Ctyz 7,2- 5 L'q i/4- 2- tf 2- z Ya 3.33 1 , 3 Z.ob Z. " 14 2-7- -Z 4.6 4 V ZO.'iQ x`37 1-7 Z l y�, 2-S � ©`� 4.86. 5 2 : 3? � V. d 4- A- 2- Z: of 4. Z. 5 Y4- . 4.7!F- 1 2 3 4 Notes: 1) Tests to be repeated at same depth until approximate) equal soil rates are obtained at each percolation test hole. All data to submitted for review. 2) Depth measurements to be evade from top of hole. Y TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SO.TU, NCOUNTERED IN TEST HOLES :.,'HOLE P&a=7- 'NQ No HYJE G. L. 7 1211 1811 . 24 11 3011 36111 4211 1114811 54 6011 661t 7211 a i, W . - I - AT WHICH GROUND WATER IS ENCOUNTERED LEVEL-TO.- WHILB.'WATER _LEVEL RISES AFTER. BEING ENCOUNTERED d .te:, 60 -Date- DESIGN 1dxVl111)r 16 6 0 , I S.D. Usable Area Provided )oil Rate Used LL6 op:. L (o. of Bedrooms Septic Tank Capacity Gals. bsorption Area ov e By_r2t).o L.F.x24" J_t" ime 04'- L.V!SGj e.. ignat 1dress SEAL PE TF F N US SPACE FOR USE BY HEALTH DEPARTMENT ONLY: I 11 Rate Approved Sq. Ft/Gal. Checked by Date i PUT NAM COUNTY DEPARTMENT OF HEALTH - DIVISION UY ZNV u,(y v=Avlrxa, INDIVIDUAL WATER SUPPLY SUBSURFACE SEKNGE DISPOSAL SYSTEMS a _ FIELD INSPECTION REPORT DATE. NLAr�p �� l/ INSP. BY: INITIAL SITE INSPECTION SO 6 A ( YES I NO I CONfl�NTS Property lines or corners found .............o.o..> Can estimate house location ....................... ✓ Will driveway need cut ............................ ►Q Must trees be removed - note these ................ Deep hole representative of entire SDS area....... Additional deep holes needed............,.......... N Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacent wells /septics ............................ D. H. 1 Lot Depth to G. W. °-- Depth to goek� Soil Descri tip 0 ft. 3 ft. 6 ft-$- ' " 9 ft. 12 ft D.H. 2 Lot Depth to G.W , Depth tb Soil Descri tion 0 ft. 3 ft. 6 ft. z 9 ft. 12 ft. FINAL SITE INSPECTION INSP.BY: 1 YES NO House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of the line and trench acceptable......... Room allowed for expansion trenches.............. Over 100 ft. from swamp, watercourse ............. Natural soil not stripped or SDS area unnecessarly graded ............................. 10 ft. maintained fram property line and 20 ft. from house .............................. Distance well to SSDS (ft.) ...................... Number of bedrooms checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench.......— . 000acoo 15 ft. of peripheral soil horizontally . from. trench ..... ............................... Boxes properly set ............................... Could surface runoff from driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE .................. rev /9/85 7 (;5_ !�-"C(�S 0 A I D. H. -Deep Hole G.W.- Groundwater D. H. 3 Lot Depth to G. W. Depth to rock soil Descri 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. 's .. Putnam County Department of'flealtL Mision of Environmental Health Servicd. Z, Qvi�� ipproved as noted for conformance with applicable Rules and Regulations of the Putnam County Health Department. �" ssanature m Ti e ift- This is to certify that the sewage disposal system was constructed as indicated on this plan and that:-the system was inspected by me. before it was covered over. The system was constucted in accordance with all standard rules and regulations of the Putnam Co. Dept. of Health and the..New York State Dept. of Health. Np fN A?j- (3u1� : ('vdA7,.e'�� SSR t_ .1GN�J j. S&M BARA G�J. swa. a�Z. �v .�L6ER.- ....,g- A;..►1_l�4►►�NO '��, m``� „\ LTL- P✓TN�r.�i �a6.►.6Y.� NAY. 3 p SGALE: l�� -50'- DR�NM. BAG••. 9TFOFN {o Bu1�.Cr8R'. p�nJ.�E2 - i''f:._i_FJ3te4J.EQ LAWK12k1GE 3ELk -u5Ct4 PERK'S 6k-\*/0.' coC0- 5P'RCa- GIfV- a "i0516 ni,Y,�, R =,NO 4A0o? I ala /��s- '9342: 5�1/O 'As - 9 U i LT PI AN "-sa=a CG-O {LC�1.+.4TE GMP�1Ti- g gtA t,OG F¢'^ 4 3oRVBY gY rjU,vJEY .4550Gip.7E•S, V-6 340 oarCD 7- 13-87. T 43 - .. r. _._.. � r M. 23 -1 - 5;4 GNaS 5.v B.o,N. vErzv�rrtk pV- i+- -86 SE Si' f� GO' -o ._ 72' 6 31--6 - -Nw uE j 79- 48-3_ .. Putnam County Department of'flealtL Mision of Environmental Health Servicd. Z, Qvi�� ipproved as noted for conformance with applicable Rules and Regulations of the Putnam County Health Department. �" ssanature m Ti e ift- This is to certify that the sewage disposal system was constructed as indicated on this plan and that:-the system was inspected by me. before it was covered over. The system was constucted in accordance with all standard rules and regulations of the Putnam Co. Dept. of Health and the..New York State Dept. of Health. Np fN A?j- (3u1� : ('vdA7,.e'�� SSR t_ .1GN�J j. S&M BARA G�J. swa. a�Z. �v .�L6ER.- ....,g- A;..►1_l�4►►�NO '��, m``� „\ LTL- P✓TN�r.�i �a6.►.6Y.� NAY. 3 p SGALE: l�� -50'- DR�NM. BAG••. 9TFOFN {o Bu1�.Cr8R'. p�nJ.�E2 - i''f:._i_FJ3te4J.EQ LAWK12k1GE 3ELk -u5Ct4 PERK'S 6k-\*/0.' coC0- 5P'RCa- GIfV- a "i0516 ni,Y,�, R =,NO 4A0o? I ala /��s- '9342: 5�1/O m ul I a/ 5C- A L-15 I u- 5D`- -o AL Aokt�; E q PN 8 u 1;. 0 6 F,.,. a Wit- rsi�� OF ..... .... .. 10 516 NO 4.9002