Loading...
HomeMy WebLinkAbout2792DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62. -2 -12 BOX 24 r ; ~ I � I ; � .. 7 1 ` 02792 ENGINEER MUST PUTNAM COUNTY DEPARTMENT OF HEALTH ENPROVIDE G GI I Division of Environmental Health Services, Carmel, N. Y. 10512 PERMIT # -02""5' CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Town -. COCafe d ay�t �9 �i• !i' '%���I / F� vi` -. .� , _ .y or V il.la.g.e . : �; ma- . = ,9 Tax Map Block Owner / -7 r,1 / a _ . ...........:,_ . a d ,�y,�! / Formerly Tax Map Lot # �/ subd. Lot 6 ,/� ' Separate Sewerage System built by �d �►'� too Address !J7�o�° 3 �? I • Al ale �v� � nom• �G� � Consisting of Gal. Septic Tank and Other requirements �. Water Supply: Building Type Public Supply From _ Private Supply Drilled By Has Erosion Control Been Completed? Has garbage grinder been installed? A10 I certify that the system(s) as listed serving the above premises were constructed e of which are attached), and in accordance with the standards, rules and regulations, Putnam County Department Of Health. / Date �d/ 7 Certified by_0 Address v ���r� C ".0 Any person occupying premises served by the above system(s) shall promptly take su conditions resulting from such usage. Approval of the separate sewerage system s available and the approval of thel private water supply shall become null and void w subject to modification or change when, in the Judgment of the Commissioner of Date y g - /f �y 8W�6� —^ Rev. 6/85 the plans of the completed work ( copies filed plan, and the permit issued by the ­1 P.E. CR.A. License No.2"4/o 0�� ;ure the correction of -any unsanitary as a public sanitary sewer becomes tes available. Such approvals are ition or change Is necessary. Title ./� WLIJIA uVrirlizilvo L%r,rVL%.L DEPARTMENT OF HEALTH T t vironmenta _.Healr.h_Serv4_ces__.� ... ... , PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET ADDRESS: TAX GRID NUMBER: NAME ADDRESS: P &I' BIVATE &le= —19PUBLIC WELL OWNER USE OF WELL 1 - primary 2 - secondary RESIDENTIAL 19 0 PUBLIC SUPPLY 0 AIRICOND.IHEAT PUMP 0 ABANDONED ❑ BUSINESS 0 FARM ❑ TEST/OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY ❑ AMOUNT OF USE YIELD SOUGHT gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE 44�AV. gal. REASON FOR DRILLING 0 NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST/OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH ft. [STATIC WATER LEVEL �J' ft. DATE MEASURED DRILLING EQUIPMENT .1 OTARY. ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING.' ;5IbPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH tL MATERIALS: 93STEEL ❑ PLASTIC 0 OTHER CASING LENGTH.BELOW GRADE le— lZf t JOINTS: 0 WELDED ]&THREADED ❑ OTHER DETAILS DIAMETER _4L in. SEAL: ❑ CEMENT GROUT ❑ BENTONITE .MOTHER WEIGHT PER FOOT 4r 1b./ft. DRIVE SHOE. BYE LINER: 0 YES SNO SCREEN DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? IPTA- FIRST 0 YES ONO _SEC6NdF GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE. DIAMETER OF PACK in. TOP DEPTH -ft. BOTTOM OEM It. WELL YIELD TEST If detailed pumping METHOD: 0 PUMPED tests were done is in- COMPRESSED RESSED AIR formation attached? 0 BAILED ❑ OTHER 0 YES ONO TELL LOG It more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE lin Water Bear- 19 Well Dia- meter In FORMATION DESCRIPTION CODE 'It. IL WELL DEPTH It. DURATION hr. min. DRAWOOWN ft. YIELD gpm- Surface 44dgogr .0 WATER ❑ CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS 0 COLORED ANALYZED? 0 YES ONO ANALYSIS ATTACHED? 0 YES 0 NO STORAGE TANK :.TYPE *30 CAPACITY 1.- -IV 4 GAL. PUMP INFORMATION TYPE CAPACITY, MA DEPTH 0 MODEL VOLTAGE2-70 14P 113" WELL DRILLER NAME O . ACIDS F ti11�1�1 (orktown Medical Laboratory, Inc. LAB y" _ 321 Kear Street - ate aken• ime: (914) 245 -3203 Date Reported: Director: Albert H. Padovani M. T. (ASCP) Collected By : r , Referred By: Sample Location: l ' 0 t e/' /lI� , Phone N SY /P9 ,,/ Phone N Sample Type: �-liG �/U�J�'% 1%�G'�� %'i J Repeat Test? ✓` + (check one) LABORATORY REPORT ON THE BACTERIOLOGICAL QUALITY OF WATER GENERAL BACTERIA ✓ Standard Plate Count (CFU /1.OmL) (Agar Plate @ 35 °C) MEMBRANE FILTRATION TECHNIQUE (MFT) v! -Total Coliform (CFU /100mL) Fecal Coliform (CFU /100mL) Fecal Streptococcus (CFU /100mL) MOST PROBABLE NUMBER TECHNIQUE (MPN) OTHER ANALYSES REMARKS (For Laboratory Use) _✓Potable Non- potable _ STP INF _ STP EFF Other: Sample Status: (check each) Outgoing _ Na2S203 Incoming ✓LE 4 °C GT 4 °C KEY FO;R._,TERMINOLOGY RDS = Recommend Disinfec- tion of Source TNTC.= Too Numerous To Count CON' Confluent ( =TNTC) LE = Less Than or Equal to GT = Greater Than - N/A = Not Applicable THESE RESULTS INDICATE THAT THE WATER SAMPLE WAS (WASN'T) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO TH NEW YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT 'E TIME.OF COLLECTION. 1x/ / / , Albert H. Padovani, M.T. For Lab Use Only:_ H/C to ASCP , Director o.rm:._.MPN Index (per 100mL -)_._ Fecal Coliform: MPN Index (per 100mL) OTHER ANALYSES REMARKS (For Laboratory Use) _✓Potable Non- potable _ STP INF _ STP EFF Other: Sample Status: (check each) Outgoing _ Na2S203 Incoming ✓LE 4 °C GT 4 °C KEY FO;R._,TERMINOLOGY RDS = Recommend Disinfec- tion of Source TNTC.= Too Numerous To Count CON' Confluent ( =TNTC) LE = Less Than or Equal to GT = Greater Than - N/A = Not Applicable THESE RESULTS INDICATE THAT THE WATER SAMPLE WAS (WASN'T) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO TH NEW YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT 'E TIME.OF COLLECTION. 1x/ / / , Albert H. Padovani, M.T. For Lab Use Only:_ H/C to ASCP , Director t 4 W �.<. y. ._ .. ,� - _- , v _r -a -xn+ .. _.. •• •rUlait•rl t.i►tl,r�%..,A . L+.a"�.a 1 .. 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 t ion -- =Fnq•- prat. of.,sa.id system -con s - trusted.::- .y:me, which,. fail, to ..._._. operate for a period of two years immediately following the date of appzoval &f' 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 systen to perate was caused by the willful or negligent act of the occupant of th ildin uti ng the system. -Dated this --"7 day f 1991' Signature Title eral o ( ) -ue Corporation Name of Corpo ;.e Corporation Name (if Corp.) ?} q s . r Address . rev. 9/85 mk R i. Owner or Purchaser of idng_ }: os� ;�' Block Lot Building Constructed by Location — Street Subdivision game - Municipality Subdivision Lot # Building Type._ 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 t ion -- =Fnq•- prat. of.,sa.id system -con s - trusted.::- .y:me, which,. fail, to ..._._. operate for a period of two years immediately following the date of appzoval &f' 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 systen to perate was caused by the willful or negligent act of the occupant of th ildin uti ng the system. -Dated this --"7 day f 1991' Signature Title eral o ( ) -ue Corporation Name of Corpo ;.e Corporation Name (if Corp.) ?} q s . r Address . rev. 9/85 mk MAL SITE OSPECTION ATICN 'Utu'- CWNES T. 24 OR SUEDIVISICN L C T Z�2 �n WAZ'ka DISPCSAL AREA a. SDS area located as per approved plans b. Fill sE--ticn - Date of plac-sruent 2:1 barrier. LGTH TA= AVG. DPTH c. Natural soil not stripped d. Stone, brush, etc., greater th.-a-ri 151 frcm SDS area. e. 100 ft. fran water course/wetlar-ds. I!. SZvAGE. DISPOSAL SYSM15----� a. Sc: �, 0 t i c t:---. k size k 1,000,/ 1,250 b. S=---tic ta-ra ins evell c. 10' ndnLrr-.u-n f--r-cm foundation d. No 90' bends, c-leanout within 10 ft. of 450 be-rid e. bISTRI-r-TiTICN BOX 1. A!! cut-'e-.—c at same ellevatilm - water tested 2. Prcte&teed belaw frost 3. M-inimim, 2 ft. original sail betgc--q box and trEE�nE f. JUNCTION BOX - properly set a. =Iz-:ES 1. Len -&Ln r=--uired Ler.&Lh ins -gilled 2. Distance to water-ccurse measu-red-*, ft_ 3. Iris tallied" acc--rdinc to plan 4. Distance center- to c--rlr-e-- 5. Slope of t--sn(±i,accsr)ta-ble 1/16 - 1/32 " /foot_ 6. 10 feet fran property line-- 20 fit - foundaticns 7. DectIn cf tremfh < 30 inches fran surface 8. Rom ailcwea for ex=sicn, :)u:s 9. Size of graves 3/4 - li" diameter a -1 12" miniman 10. rectLri of gravel in trench 11. Pitt ends ca-med h. PLC CR ECEE SYSTEMS -size- VI. OVERALL W ORKv -ASHIP 2. ove--=:Icw tank properly grouted Boxes ]Rrope- 3. Alan, visual/audio All pipes partially bac A. Pumm easilv accessib All pipes flush with ir. First box baffled Baickf ill material conta .5. 6. Cycle wit messed by J't estimated flow per c IV. HOUSt-, a. House located per aporc b -Number of bearocms V. WELL Errosion control provic a. Well located as per app b. Distance fran SDS area c. Casing 18" above grade- d. Surface drainage around VI. OVERALL W ORKv -ASHIP a. properly grouted Boxes ]Rrope- b. All pipes partially bac c. All pipes flush with ir. d. Baickf ill material conta e. Oirtain drain installer f. Curtain drain cutfall 9- Footing drains disch-arc h. Surface water rotectic i. Errosion control provic manhole to i 1 led de of box s stones < 4" in diamete ccording to plan tested & dir.to exis-Lk-.wa awav fran SDS area on to than 15%. Late Inspect -ea-ev- GW 0 - � � / -,;- I C6vv&.,O � 1=0 �e Ur -® �- z PUTNAM COUNTY DEPARTMENT OF BEALTH DlAsion of Environmental Health Services Cai met N:Y.1051? Engineer to;Provlde Permit # on CERTIFICATE _6F COMPLIANCE' `'STR ON R PERMIT FO SEWAGE DISPOSAL SYSTEM P® # �QAi .y or Subdlvlslon Name Subd. Lot # Tax Map-. �'° Black Lot. f f> Q f Renewal O R . Owner /Applicant Name j� Date of Previous Approval Mali n 6 Address Town 1t l7rri 71P fG s" 7,f jj t Bull dtng Type / Lot Area L Fill Sectlon Only Depth Volume Number of Bedrooms - Deslgn Flow G /P /.D PCBD Notification Is Requbvd When Fill is oom leted Separete Sewerage System to con 16t of Gabon Septic Tank and 'To be constricted 6y . Address Water SuPPU; bllc'Sapply From Address or: e', Prlyate Supply DrlDed.bY ' Other Regnlremente - . represent that I am wholly and;comp etely resp9 sable for the design arid-location of tffe iop6. systemis) 1)„ that the separate. sewage disposal system above. described will be. constructed as shovun on the;approved amendmerit there to and ;accordance with the standards, rules an ragu_a :ons:o e.' .0 nam County Department of Health, `and that on completion thereof a 'Certificate of ConsstructUOntCompliance! satisfactory to the.COmmissioner ot.Healthwill be submitted to the Department, and 'a wntten- guarantee will be Yurnished the owners his successors, heirs or assi4ps by the builder, that said builder will place: in good.;operating� cohd.ition any,,part of said: sewag"Aisposal fsystem:durin� the�pei�od ot�two t2) years ii g6gietely.following thedate of the issu- ance of the; approval of the'Certdicate - of,Constiuctidn "Compliance; of the origmal'system o %any r- ' irs thereto; 2) that the drilled well described above will be located as shown on the approved, plan and that said welt will be Installed. in ° rd'ance wit the bn rds rules and regu aTf on_i of the Putnam County Depa'rtnient of Health Oats gned I a. P.E. R.A. /l ZY S °h s .Address .I:'��`/ �` -.,a ' License NO APPROVED FOR CONSTROCTION This approval expires aa4 year -from. the date issue' n �5'�coris�ruction3�15 the building has been undertaken and is revocable for cause or maybe amended.or'mod�fied -when considers ecessary.by the'Com` its io er�'oi Health. 'Any change or' alteration of.consiruction repuires a rienpermit. Approved or dis o of domestic •sani y sew nd /or 'pr to water supply only. Date By �' Title 7 PUTNAM COUNTY DEPARTMENT OF HEALTH 3 Divisloa of Eavlrotimeatat liealtlt Services Carmel N Y:10511.. f v f on CERTI CONSTRT FOR SEWAGE DISPOSAL SYSTEM Perailt R ngineer to Provide Permit q FICATE OF COMPLIANCE Jam. />_ Ld: Located str_�c� •�/`yL/ ' • Town or Village Subdivision Name _ j Subd. Lot q ` - Tax v. r- _Block Owner /Appltcaat Name t7 �� d �G . Renewal_ ❑ '` Revision ❑ f' may✓ Pate of Previous Aip /proval ' Mail ng Address ,(J v�: � �-/ ®X Town P 1f Zip Budding Type :Wei° 4 • Lot Area . � �• � � C` Flll Secdori .On1Y Depth Volume Number of Bedrooms �„ Design Flow G /P /D ®CIO PCHD Notification ie Required `W6en Fill Wcopple ted Separate Sewerage System to consist of ,. , IV �0 v GltOn Sep ti c Tank 3 3 3 To be constructed by —. Address Water Sapoly: Pdbllc Supply From Address or: vats Supply Drilled by _Address Other.RequWmenta —'' ►D I'represent that 1 am wholly and' comple(ely� responsible forthe design and location of above described will be constructed as shown on'the:appioved amendment . there to.and; County ie artment' of Health;, and that "on completion thereof a 'Cert,fiute. of- 6p, be submitted -to' the Department, and a-:wntten' guarantee w;ll be' furnished the owi place in'. good operating condition any part of said sewage disposal system, d� ante of the approval of, the Certificate of Construction 'Compliance of the of wilt be located as shown on the approved plan and that said well" will be'inst ed County Department of Health. - - - Date Signed Address APPROVED FOR CONSTRUCTION T i approvai- expires one year from the d revocable for cause or may be amen le or rroAdied when considered. necessary b requires a new permit. pApproved for disposal of domestics nitary sews e, Date 1 U — EJ 61 By U ng Ihe•petrl,$ :o (2) y inal syste tccordanc i e` a issued unles the Commis sionyfi for private water skb`wD y: c ii,g,,��•tL the Commissioner'of Health will bji t. builder, that said builder'will miFJ' tel following the date of the issu- o; 2 "pt04 drilled well described above rulegrw r u a. rd ons , of the Putnam P.E. ,J R.A. Anse No 12— 4`146 49inq has been undertaken and is (Enyrplkange or alteration of construction Title NE DAVID D. BRUEN County Executive Mr. Frank Sullivan 2972 Ferncrest Drive Yorktown Heights, NY DEPARTMENT OF HEALTH Division Of Environmental Health Services 10598 July 24, 1986 F JOHN SIMMONS. M.D. Deputy Commissioner Re: Dooley SDS Constr..P.ermit Applic. Peekskill Hollow Road, PV, TM.60 -1 -17 Dear Mr. Sullivan: 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: el. Driveway and sewage disposal system locations conflict with existing drive and flagged sewage disposal areas. S 2. Metes and bounds are lacking from plan. Due to the expansive size of the parcel, metes and bounds need only be shown along southeast side of parcel from Peekskill Hollow Road.to a point west of proposed . sewage..disposal area. 0*"0'3. Percolation test hole depth conflicts with test results r P. (�I _.::. n n -. V Cam` ,, U n data s h Cv v t• +- ri � D 1 1 v , lii c �a s -a r o m, � c l l v J. 11 A J 1. a (i e. s tests were conducted in a 19 inch hole and design data represents tests were run in a hole at least 27 inches deep. Additionally, presoaking and test data are lacking from data sheet. Please arrange to permit Departmental witness of percolation test. 4. Use of an additional drop box upstream from first trench is recommended to reduce sewage velocity, instead of just a baffled box, due to the steep grade of pipe. 5. Location of water service line and separation to sewage disposal system is lacking. Upon receipt of a::submission, revised to.reflect the above comments, this application will be considered further. JSH:amm cc: File Very tru y yours,- . anes S. Ho ens Assistant Public Health Engineer TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 •P"C :i`Z: n-"�l:. OH �L'�n ��YUCt�SIJI�I: •• iue.- :c_vc..: •.a o- .nn...- - .er.,r County Executive Mr. Frank Sullivan 2972 Ferncrest Drive Yorktown Heights, NY 10598 Dear Mr. Sullivan: DEPARTMENT OF HEALTH Division Of Environmental Health Services March 26, 1987 RE: Proposed SSDS Dooley Peekskill Hollow Road TM #60 -1 -17 JOHN SIMMONS, M.D. Deputy Commissioner Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Camients are offered as follows: 1. Submit complete drawings showing site layout, property lines, metes and bounds, location of deep holes and perc tests, 2' contours and all neighboring wells and septics within 2001. Upon receipt of a submission revised to reflect the above ca-nents, this application will be considered further. Anne M. Bittner Assistant Public Health Engineer AMB:mk 110 OLD ROUTE SIX CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 Division Of Environmental H%.*h Services TWO COUNTY CENTER - CARMEL, N.Y.. 10512 (914) 225 -3641 F( WELL LOCATION A DRESS. �� r �riL(. WW i ILLAGE /GIIY IAx GRW NUMSER. /�� �1 v—nJd ��% 6o-/.7/7 WELL OWNER NAME ADDRESS.- $IVIAT[ POE UoLIC USE OF WELL ORESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /C0ND.IHEAT PUMP ❑ ABANDONED 1 - primary ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) 2- secondary ❑ JNDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ AMOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED Z' / EST. OF DAILY USAGE gal. REASON FOR $NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION DRILLING 10 $EPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL WELL TYPE DRILLED F_� DRIVEN ED DUG GRAVEL F_� OTHER 15 WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Ajt> LOT NO_: WATER WELL CONTRACTOR: Name s l ��� Address:_ Ow6e_ 5r, &**At I/t1t,C IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: r YES 1NO NAME OF PUBLIC - WATER SUPPLY: T06iNZ /V /C DISTANCE TO PROPERTY FROM NEAREST WATER-.MAIN LOCATION SKETCH & SOURCES OF CONTAMINATION. 7__06 (date) nature) PERMIT " TO CONSTRUCT A WATER WELL This permit to construct one water well as 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 orm p o ided b the Put m County Health Department Date of Issue: 19 Pe t Issu, t f cia Permit.-is Non-Transferrable PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL MUM SUPPLY SUBSURFACE SB%kGE DISPOSAL SYSTEMS FTET.D TNSPFI_TTnN RF.MRT (Name of Own et) (Street Locat INITIAL SITE I PECTION 2-Q 11 �J 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... Adjacent wells/ septics ............................ D. H. 1 Lot Depth to G. W. Depth to rock /x�) 0 ft.. y 3 ft. 6 ft. f-- 9 ft. 12 ft %S _11 .. . �J INSP. BY: NO COMMENTS I ,,-- I I 1 1 '�' sTx� D. H. 2 Lot Depth to G. W. N Depth to rock y3C -1_ Soil Descri do D. H. -Deep Hole G.W.- Groundwater D. H. 3 Lot Depth to G. W. Depth to rock 0 ft. _ 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. 3 ft. j— 6 ft. 9 ft. 12 ft. DATE: FINAL SITE INSPECTION INSP.BY: YES NO COMMENTS House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Rosen 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. fran 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 ACCEPTABLE.. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES �.a Date./ Re: Property of J-43�G' Located j at (T) /�lo'e" e:lf 'C:' .4v` Section 4:�� Block f Lot 1% Subdivision of Subdv. Lot ## Gentlemen: Filed Map ## Date 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 connection with this matter and to supervise the construction of said �� 9:: f ; -- +:_ ;y;ye - T �►i`t�;le:wlj*.j.. t .$•— i --•C� :i=v �:si �.y- -.r �:aa Vaec - "�i \7 C'i5ii� "'v 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. '�+ k Countersigned • K a P.E. , R.A. ,, xr& Address .. V AAA rO Telephone. Very truly our , Signe uwner or- Property / Ize � &1V /'Z/5Z es Town Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMEtUAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW of er) COMMENTS S 3 0 K. f SHEET - CONS UCTIONn PERMIT R DAM-. PZ7T7-. „ :7.- .7.4 -r8 Location) DOCLMWrS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow 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 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 House - No. of Bedrooms 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 45° w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN '(Street YES NO .i s X ,/ X N A* i i / X jvn ,r v Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake Unc. expan) 15' to. Drains-Curtain ,Storm,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 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Commissioner of Health — FIELD ACTIVITY REPORT — Sheet of INSPECTION NAME © Orig. Routine _ Orig. Complain ADDRESS Orig. Request No. Street Municipality (T)(V)(C) Compliance Complaint Comp MAILING ADDRESS Final P.O. Box Post Office Zip Code Group Illness _ Construction TELEPHONE _ Reinspection PERSON IN CHARGE Field, Sampling Only OR INTERVIEWED Field Conference Name and Title � � ' Other DATE g}`.(Z -B(, TYPE FACILITY TIME ARRIVED TIME LEFT Explain FINDINGS: -pR6soAK67D 1:1$' 3 2 iD�SI 11� fir) 1a 3 -P (� 11"10 INSPECTOR: Signature aft' Title PERSON.IN CHARWOR INTERVIEWED: I acknowledge receipt of a copy of this SIGNATURE: Field Activity Report .................. TITLE: DESIGN DATA SHEET= SUBSUFACE SUgAGE DISPOSAL SYSTEM FILE NO. Address Located at (Street) Sec. Block % Lot (indicate ",nearest cross street) Municipality / Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITIED WITH' APPLICATIONS Date of Pre- Soaking Date of Percolation Test HOLE 1. NUMBER C= 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 1-361 2,7 3 �•°• 5 39,V-5 oi 5 ' 1 -- 2 RECE I �►� 3 � ►�.� 71986 _ I 4 hi A ILA COUNTY 5 DEPT. OF HEA► r 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 sukmittithd for review. I 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA: REQUIRED TO. BE, SUBMITTED._ WITH. APPLICATION T • DESCRIPTION -OF SOILS ENCOUNTERED IN TEST HOLES DEM HOLE NO, /. HOLE NO. HOLE NO. :. ......... G.L. 2' 3' r .. ill 12' 13' - 14' _ INDICATE LEVEL~ AT WfiICH "GEtO[JNI71P;'rER ° 1 S ` L1Cx7UiJ'K�;i)" INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED. DFIP HOLE OBSERVATIONS MADE BY: c;� —Ao // i �a DATE: DESIGN SoiL Rate Used %�`° Min /1" Drop: S.D. Usable Area Provided��'o� f1 No. of Beclroccns -Septic Tank Capacity APer5l gals.. Type/f ® r A.ib:orption Area Provided By 36i L .F. x 24" width trench Otter naa,Hacall 1, t . yrG1C _ Signature Actress 9 Joseph F. Sullivan - — - Sb. 977 Garnnrant DrIM® Yorktown Heights, NY 10598 TIHS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Sol Rate Approved sq. ft /gal. a Checked by Date 5 i