HomeMy WebLinkAbout2860DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
62.13 -1 -11 & 62.13 -1 -19
BOX 24
4
,, ,
ou
ir'
-,
�,
,�
G�i v
vJ
l QfllY[0�lfPiDO!'�*!f�[QOFOEALTH .` <-
id[���rhlBfrM�Since.
�r M Pas.Na Pw®It 0 -}
77-777 �` T �` rx w C CaA18 OF OOMIIIAI�I(� a
r
a ,
�(� -::Fee Enclosed ."eminr
Lat Aatati X^ a, x aF1 A'
�OY SeW af .rte
-
wow, Flaw G P D' PC.®,NN�nntlafi'Is Rogdmd Wbm,- b ei wWad
MY
ii S�IIe 11nk bla,� 2 Z R� l.L-. �"
{
.S' � A11a171i1 '`
ii11N to ter dm ri and location of, -.EM prOoofW fyfNm(pi „1) ;that ter`; ati' ffw di YL` ftam
approwtl arnandn+ant thara ao an11 in acco►wiwa wiM 164 fand.►ds, rti a ►pu . of o ` m
datbn taNraof • 'CNtlfiCata. of Conftruetbn'Compliar cr fatiftittory to ter CC!M!nj lonar.of NwIEAwill
lwrantY` wits b� fumipNd'tM ownii► hi! fYCpNa►f. ,Mi►f of istl�nf py ter buiWM that „Yid bYildi► will
Ito faw ja dMpOft+l fy1lMl dwin� tIN pMifftl''_of twO (2) yaMf NYM w!mu y fOflawke the M tIM' ifaY
ruelbn ComplNnp of 'iM;Orlabal •yftarn or any rajlitrf tharato 2) ter drNNO wNl dalCr ab"s
tat Y W wall will M Mw- o
Za2 r 'G `kinie NO
;aRtraf twO yy►r�ylrom ter daH tfitJad unNff tonfts v ion of rt builairp tvf bean YnilMaken and if
1 whanooiniAanA llKasp/y' by tM='COmmiaionar of'FWRh. Any eMrip O► alteration of oomtruetbn
r domaf(k` fanitary swap, and /a p►hrata twata fuoply onb
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278-6130
December 1, 1992
Howard Kelly
RR 1, 222 B East Hill Road
Somers, NY 10589
Re: Proposed Construction Permit
Van De Veerdunk
Summit'Avenue
(T) PV TM #48-14-1, 2, 3, 10
Dear Mr. Kelly:
CL
JOHN KA.RELL Jr., P.E., M.S.
Review of plans dated December 20, 1988 and other materials relative to a construction
permit for the above captioned property has been completed by the Department.
isPd upon such-review, and pursuant to the provisions of Article III of the Putnam
CounLy - '-1-tary-Cody, - yo�j- h ��d
OCLL Ll k- ZLrC
supply and sewage disposal are considered inadequate as set forth below, theretore,
approval of these plans cannot be granted.
The SSDS is proposed on a slope greater than 15% (50 60%). Present day codes allows
the reduction of 20% slope to 155% by adding fill.
A 60% expansion area appears to be available. Present day codes require a 1000
expansion area.
If you have any questions, please call me at Ext. 151.
Ve ly y urs,
g' john Karell. Jr., P. E
Public Health Director
JK/jp
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
,1914) 278 -6130
December 1. 1992
Howard Kelly
RR 1, 222 B East Hi 11 Road
Somers, NY 10589
e: Proposed Construction Permit
Van De Veerdunk
Summit Avenue
(T) PV TM #48 -14 -1. 2, 3, 10
Dear Mr. Kelly:
JOHN KARELL Jr., P.E., M.S.
Review of plans dated December 2G, 1988 and other materials relative to a construction
permit for the above captioned property has been completed by the Department.
Based upon such review, and pursl:an_ to the provisions of Article III of the Putnam
f�LUit:r Sa ?fit ry Cede._ you .are lze -r al�ised thdt: th; proposed method.providing :rater _
supply and sewage disposal are cc � tiered inadequate as set forth below, therefore;
approval of these plans cannot granted.
The SSMS is proposed on a slope _re -azer than 150 (50 - 600). Present day codes allows
the reduction of 200 slope to 15� adding fill.
A 60% expansion area appears to 1-e available. Present day codes require a 100%
expansion area.
If you have any questions, please call me at Ext. 151-
.
Very l y y urs ,
I% !
Zohn Karell, Jr., P. E.
Public Health Director
JK /jp
APPENDIX 3
PUTNAM COUNTY DEPARTMENT OF HEALTH - DMSION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
RE W SHEET fox, CONSTRUCTION PERMIT,, _
NAME OF O R _ ���� �� r(/.iC lam/ /IsTREET �O° �`'�'�
BY DATES TAX MAP #
DOCUMENTS.
Y DISCHARGE (OK)
FDEEP APPLICATION ERC & DEEP HOLES LOCATE D
RESENTATIVE OF PRIMARY AND EXPANSION
ERMIT; PWS LETTER ,EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE
ERS AUTHORIZATION = IF PUMPED PIT & D BOX SHOWN & DETAILED
DATA SHEET(DDS) m HOUSE - NO.OF BEDROOMS
LE LOG = WELLS & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM
TENT PERC RESULTS (3) = PROPERTY METES & BOUNDS
OLE DEPTH = HOUSE SETBACK NECESSARY (TIGHT LOT)
PORATE RESOLUTION = HOUSE SEWER - 1/4"/FT. 4 "0; TYPE PIPE
NS THREE SETS = NO BENDS; MAX. BENDS 45 W /CLEANOUT
USE PLANS -TWO SETS >-iV M
VARIANCE REQUEST
GENERAL,
= LEGAL SUBDIVISION
= SUBDIVISION APPROVAL CHECKED
= PERC RATE_
M FILL REQUIRED
= CURTAIN DRAIN REQUIRED =STANDPIPES
CIS EX- APPROVAL SSDS ADJ. LOTS
[E] WETLAND (TOWN/DEC PERMIT R & D)
ll�bATA ON DDS PLANS & PERMIT SAME
PRE -1969 - NEIGHBOR NOTIFIFICATION
m LETTER BMA
ELEV A- IC N
'SEWAGE SYSTEM PLAN - (NORTH OW)
SSDS HYDRAULIC PROFILE LVJ GRAVITY FLOW
b/ J BOX = TRENCH/GALLEY ® P- PIT DETAILS
SEPTIC TANK - SIZE, DETAIL
WELL DETAIL, SERVICE LINE IF OVER
CONSTRUCTION NOTES (GRINDER RATE)
DATA: PERC AND DEEP RESULTS
OT CONTOURS EXISTING & PROPOSED
'AY & SLOPES CUT
3 /GUTI'ER/CURTAIN DRAINS ti Q_
COMMENTS -
emu'"' : FILL SYSTEMS
LAYBARRIER
10 FT HORIZONTAL: SLOP :1 TO GRAD
-a
FILL SPECS
=DEPTH GAUGES
ED FILL PROFILE & DIMENSIONS
= VOLUME
TRENCH.
=LF TRENCH PROVIDED
=60 FT MAX
PARALLEL TO CONTOURS
= 100% EXPANSION PROVIDED
O' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL
TO FOUNDATION WALLS.
E-US100 TO WELL, 200' IN D.L.O.D., 150' PITS
100 TO STREAM WATERCOURSE LAKE (INC.EXPAN)'
50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER
10' TO WATER LINE (PITS -20')
50' INTERMITTENT DRAINAGE COURSE
200 FT. RESERVOIR, ETC.= 150 FT. GALLEY SYSTEMS
SEPTIC TANKS
I O' FROM FOUNDATION; 50' TO WE
WELLS
15' WELL TO P.L. / G "�
-
Pummm C10 uN DEPARTmEh7r OF HEALTH \
DIVISION OF ENVIPLN4ENTAL HEALTH SERVICES
DESIGN DATA SHMT- SUBSUFACE SEWAGE DISPOSAL SYSUH FILE NO.
Owner � w l s t/ Q �.J ��-c u :address S'� !.c C ,-
Located at (Street) �Jc+ r-1 �L�-f - U �l U:. Sec. Block Lot _133 Jc
(indicate nearest cross street) n
Municipality u� C% (e Watershed LL_
SOIL PERCOLA.'CN TEST DATA RDQMM TO dSTjBmI= WITH APPLICATIONS
Date of Pre- Soaking [ 6— 3 Date of Percolation Test 10 — 73 -K_
HOLE
NUMBER CL0C K
TIME PERCOLATION
PERCCLUION
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
1 3L 2 - 'L--If -2- C__ cif-
---) - I/-IC
I :>.
2
4
1
11 1= - 1 /yQ 3J Z�
2 L!
4
5
2
3
4
5
PETER C. ALEXANDERSON
County Executive
Dear
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
Re: Proposed SSDSc
(T)
other p.parq- d6c�rbents submitted at this
the above- a project has been comp e e elf
JOHN KARELL Jr.. P.E„ y
Public Health Director
me relative to
ed as follows:
&bov t NAIO-A e d 'te r w c d V- -� 3 1: q"f5
S
'�1...__�_..e.
I,'� � �, Y1`i71'I,,fi&L. /•1' S ��.• 'Go��• �°""� `•^R'� � i i��c.( .�
16,
� � � L- � � y` :� � ��� � : CS rv► wt- �in.;�S avt� (r��..rrt,�C �� o�,
Upon Receipt of a submission, revised to reflect the above comments, this
application will be considered further.
�S Veeytruly yours,
Robert Morris
Assistant Public Health Engineer
RM /jp
SSDSProposed
LJOOAd tU /Leg LLAIVO
CD
lop,
yW i ei.A i ed i
Ov
e, To^6-( 4 h4 tew
Arm-)
s.
h o ov
rum co-(�
hu-
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
( 914) 278-6130 ' r
7 CL :I1. C 1Z wL
PCHD PERMIT #
WELL LOCATION
Street Address
tt, c,'i
Town/Village/City Tax
x
Grid Number
WELL OWNER
Name Ma ling
L e .iz.. i(a4-1
ddress
OPriv to
O Public
USE OF WELL
primary
2- secondary
SIDENTIAL 0 PUBLIC SUPPLY O AIR /COND /HEAT PUMP
00 BUSINESS O FARM O TEST /OBSERVATION
0 INDUSTRIAL O INSTITUTIONAL O STAND -BY
0 ABANDONED
❑ OTHER (specify,
O
AMOUNT OF USE
YIELD SOUGHT jr
13 REPLACE EXISTING SUPPLY
❑) SUPPLY NEW DWELLING
PEOPLE SERVED %. ST. OF DAILY USAGE�al
E3 TEST /OBSERVATION 13-ADDITIONAL SUPPLY
CI DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
WELL TYPE
ILLED
DRIVEN
ODUG
GRAVEL
C1
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES >e NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
-v Lot No.
WATER WELL CONTRACTOR: Name —T-Z" A-><' aeJ�_4Lt� D Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _,>k'— NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
_
DISTANCE T0 PROPER-11 rR0!. >tiEA..,:ST TWzR MAIN: ...�4,t_;.� .! !4,ec: .....
LOCATION SKETNON SOURCES OF CONTAMINATION PROVIDE�/
SEPARATE SHEET
date) (signatu e)
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
thirt;• (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 provided by the Putnam County Health Department.
During all well drilling operations, the applicant shall take appropriate action to assure that
any and all water or waste products from such well drilling operations be contained on this
property and in such a manner as not to degrade or otherwise contaminate surface or groundwater.
Date of Issue: 19
Date of Expiration
19 Permit
Issuing
Official
Permit is Non - Transferrable
White copy:
HD File
Pink copy: Owner
3/89
Yellow copy:
Bldg.
Insp. Orange copy: Well Driller
TEST PIT DATA RDQUIRED TO BE SUBIEMM WITH APPLICATION
DESC R=0N OF SOILS ENCOUbnTF D IN TEST HOLES
DEPTH HOLE NO. HOLE NO. 2 HOLE NO.
G.L.
2' _ �cc ` i � '4
3' Sd tr-c C&t�(
4'
5'
6
7' L
s'
9'
10'
11'
13'
14'
INDICATE M VE:L AT WHICH GROUNDWATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES A= BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: DATE:
DESIGN
Soil Rate Used Lf- IrMin/1" Drop: S.D. Usable Area Provided ZS?2--o
No. of Bedrooms �'' Septic Tank Capacity 10Jj:2- gals. Type CCU
tg55ip �.
Absorption Area Provided By -2-6 L.F. x 24" wig
Other , 2 jai. L, Cr '! c R <• f�., r �� =�
i � i y
Name "c'-w A- d) Signa
Address �� SEAL\`�;TF
TEST PIT DATA REQUIRED TO BE SUBMITTED Tt= APPLICATION
DESC R=0N OF SOILS MCM11ERED IN TEST HOLES
DEPTH HOLE NO. HOLE NO. 2 HOLE NO.
G.L.
8'
9'
10'
lI'
13'
14'
mI D . 0 21 oil ef* 0 21. at 24* D
DEEP HOLE OBSERVATIONS MADE BY:
DATE:
Soil Rate Used Lj— IrMi.n/1" Drop: DESI&N S.D. Usable Area Provided
No. of Bedrooms Septic Tank Capacity 1 QJ,a .gals. Zipe CCU
Absorption Area Provided By 2. O L.F. x 24" wig s n ���\
Other
Name JJ�� Si,
Address
�� bla --
Lk
21
L
4'
5'
61
rr
-v
71
1.... L�, �•—j ,
8'
9'
10'
lI'
13'
14'
mI D . 0 21 oil ef* 0 21. at 24* D
DEEP HOLE OBSERVATIONS MADE BY:
DATE:
Soil Rate Used Lj— IrMi.n/1" Drop: DESI&N S.D. Usable Area Provided
No. of Bedrooms Septic Tank Capacity 1 QJ,a .gals. Zipe CCU
Absorption Area Provided By 2. O L.F. x 24" wig s n ���\
Other
Name JJ�� Si,
Address
�� bla --
r• •• AROW09 •
r •' • � t• • ; i� v •i �• tea.
DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM
FILE NO.
Owner mhaw, -4s VAi.J js,,U4tk (
Located at (Street) �+ /1-, ►�_L-�- l Q� Sec. Block Lot Jc
(indicate nearest cross street)
Municipality U,-1 C., C%t t(.9- watershed
SOIL PCLCN TEST DATA REQiE TO :
WITH APPLICATIONS
Date of Pre- -Soaking t 6 1 �Ej= Date of Percolation Test
HOLE
t L o 6
NUMBER CLOCK TIME PERCOLATION
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
°) "/ � I
1 (I cr-� ( l 3L 3 - �yc -2- C_ � -
2 G f �� +�
t L o 6
t.)-
24
Y�L
Z ��
c
4
5
!.:.
2 LI
3 GL GL, 3, 2c f 1-&
4
5
1 �
2
3
4
5
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 fran top of hole.
FUMAM CGIUM D!A!'nID Hr OF MALTS
DleYawsti4rebw�eetM�1BeiftSeeeI Csd.KY. llftl
FlEl f FM UWAM DEPOSAL STU=
.....'�bSeYw Nlllr i'% J �f? .�r�..Y.��} <%•. � � � �� 4t /_
� r r
.as CIElEICA18 OF 00 ,
Ffaslt N
VOW
— Date of Prewloeis Appeovd
— Toww.t
DIISIDtIs 6-1-1 IM Aldo
—T
I tour of Ddid�g ''-- DWW Flow G P D
Sapafibb Sewdeep symba M eels" et i b Orman Serde Tona
Tli be eeaw4wded by �— 9 n Ad&m
Water Se*pbs Nub ORA Fniin-
at 1.:::f - langb DaE.d by
A
I F® &"= O.b " DePt6 Vdq I
FOW NoWlesdan Is Deslabred Wbe s M In amploted
Odwr
1 represent that 1 am wholly and completely responsible for the design and location of the proposed sy91em(s)1 1) that the separate sew di fal' stem
above dpuibed will be constructed as shown on the approve amendment there to and in accordance with the standards. rulef a rpu Ins Mm
County Department of HnRh. and that on comp»f»n.thereof a - 'Cartificate of Construction Compliance" Satisfactory to the Commissioner of Nealthwill
M submitted to the Department, and a written guarantee will be furnished the owner, his suCOHeers. Mfrs or assigns by the bulkier. that Said builder will
gees in good .opara:kl/ condition any per of said •1Mage disposal system during the period of two (2) Veers knmedtetely following'tMdeto Of the isiu-
saw of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the, drilled well. described abaw
gill be lecated as ellervn on the approved plan and that old well will be Installed I aCCOrde np with the standards, r s and regu s of re Putnam
county Department of R o!"
re
L . LS MN _/ Signed P.E. R.A.
Address License No :2 gc�
APPROVED FOR CONSTRUCTION: This approval cap ee two Vega from the date issued unless construction of the building .has been undertaken and is
revocable for cause or may be anse elect or modified when considered necessary by the Commissioner of MeeRh. Any change or alteration of construction
requires a new permit.. Approved for disposal of domestic sanitary sew&M and /or private water supply only.
Rev.'
10188 °iii gly — TRIG
PETER C ALEXAMCERSC.i
caWry Executive
DEFIgRTNEENT OF HEALTH _
Division Of Environmental Health Services
I-10 Old Route Six Cencer, Carme!. New York 105M
(914) 225 -0310
September 20, 1989
Howard Kelly., PE Re: Construction Permit = Vandeveerdonk
Route 52 Summit Avenue - (T) PV
Carmel, NY 10512 TM #48 -14 -1, 2, 3, 10
L'110 L C:.RRurN. M.p.,
Pueiic Hesirn 0irec�er
'CHH X -RE *_L
0irwc-�Mr
Dear Sir
Rev iew Of my files indicates no ac_ivity on the above caGCianed prcj -:eca. fcr scmne
time.
P e =sa advise
the writer as to the status of this project without delay. ..........:..__..r.....
Failure to receive a response byOctober 16,1989 will result in the file being
•. returned to you, DISAPPROVED.
Vary trul_yvurs,
1/Y
LCW:jr _ _ Lawrence C. Werper
Assistant Public Health Engineer
CC: Owner Thomas Vandeveerdonk•
195 Church Road, PV.NY 10579
PETER C. ALEXANDERSON
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
Mr. Howard Kelly
37 Fair Street
Carmel, NY 10512
February 3, 1989
Re: Proposed SSDS
Vandeveerdonk
Summit Avenue
(T) PV
TM #48 -14- 1,2,3,10
ENID L. CARRUTH, M.P.H.
Public Health Director.
JOHN KARELL Jr., P.E.
Director
Dear Mr. Kelly:
Review of plans and other s.upporting documents submitted at this
time relative to the above - captioned project has been completed.
Comments are offered as follows:
.1)_ Fill section greater than two feet deep requires plans
showing fill section only. This includes septic tank
and well but does not include trenches and boxes.
3) Maximum slope for a sewage disposal area is 20 %. Plans
submitted show 50 %.
4) Deep test holes and perc holes not representative of
expansion area.
5) Show wells within 2001 located on North -West side of
property. If none exist, indicate on plans.
Upon receipt of a submission, revised to reflect the above comments.
this application will be considered further.
Very truly yours,
�YV
Lawrence C. Werper
LCW:jr Assistant Public Health
Engineer
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914).225 -3641
- piPPLTCA'i`lUD7" `'r'O "'CUIVSTIRocf KA 'WATER
PCHD PERMIT
WELL LOCATION.
Street Addresa
Towngillage/Cit y / Tax Grid Number
WELL OWNER
Name �
` .
Mai=*g
Address _ /
1r�1 ( �� ��
ivate
D.Public
USE OF WELL
1 - primary
2 - secondary
r�j RESIDENTIAL
O BUSINESS
® INDUSTRIAL
O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION
U INSTITUTIONAL O STAND -BY
❑'ABANDONED
❑ OTHER (specify
AMOUNT OF USE
YIELD SOUGHT gpm /#
PEOPLE SERVED /EST. OF DAILY USAGE gal
REASON FOR
DRILLING
, EW SUPPLY
❑ REPLACE EXISTING SUPPLY
❑ PROVIDE ADDITIONAL SUPPLY
® DEEPEN EXISTING WELL
® TEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
_'e
WELL TYPE
Z DRILLED
DRIVEN
®DUG
®GRAVEL
®
OTHER
IS WELL SITE SUBJECT TO FLOODING? I YES _>!f _NO
IF WELL IS LOCATED IN /�j REALTY SUBDIVISION, NAME OF SUBDIVISION: It-tje -AC 4'0 4G_--e
Lot No.
a
E
WATER WELL CONTRACTOR: Name ::t-:o ZgTnf rte Ft/.J Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO
NAME OF PUBLIC WATER SUPPLY: `-- -'-'TOWN /VIL /CITY
- ~ L15'TAN E` TU P`KOPERTY FR0bf NEAREST `WATER MAIN:
LOCATION SKETCH.& SOURCES OF CONTAMINATION PROVIDED
O ON REAR OF THIS APPLICATION ®ON ARATE SHEET
(date) QJ (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 constrLiCtiOn.
the applicant s.hall
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 provided by the Putnam County
Health Department.
Date of Issue: 19
Date of Expiration: 19 Permit Issuing Official
Permit is Non - Transferrable Mite copy: H.D. File
Yellow copy: Building Inspector
Pink Copy: Owner
287 Orange copy: Well Driller
-'DESIGN-'DATA
SHBr"T- SUBSUFAC:E
SEWAGE DISPOSAL, SYSTEM
FILE N0.
Owner
►M.� s �fa hJ
��1J( C
�(%c k- 'Address Sl C
k c - t (/44
Located at (Street) v f" ",L U 1�1y-Q Sec. t— Block Lot 1131c
(indicate nearest cross street)
Municipality t '—'l✓� t-(-(Z watershed
SOIL PERCOLATION TEST DATA REQUIRED TO SUBMITTED WITH APPLICATIONS
Date of Pre- Soaking t Date of Percolation Test 1 0'
HOLE
NUMBER C= TIME PERCCILATION
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
1 t I &,(- ( 1 3(. 3 7 ZY 1- (,� I I E n 1 t;� I �- 11 1
2 P' 6 ( L a b ;
3 f � ar-- 11-,71- 3- 14 24 Yirc Z kr (11,
4
5
2 ,L I1 3 r 1~
3
4
9
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.
rev. 9/85
0
.,
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
i?t'T_,E z— - -
G.L.
2
3'
Sd C
54 m
4'
5'
6'
L
71
s'
9'
10°
11'
12'
13'
INDICATE
LEVEL AT WHICH GROUNDMTER IS ENCOUNTERED
INDICATE
LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY:
- c% .. �-0-444 DATE:
DESIGN �
Soil Rate Used - Min /1" Drop: S.D. Usable Area Provided
No. of Bedrooms Septic Tank Capacity d ()J,:-...,�-gals. Type
Absorption. Area Provided By 2•' Q L.F. x 24" w'. '` ?<
Other 24
Name
Address _
THIS SPACE FOR USE BY HEALTE
Soil Rate Approved
SEAL�;T�
sq.ft /gal. Checked by
Date
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
..'Date .., .�2.�� ... ..
Re: Property of
Located at J`�� C7"G✓
(T) ,tJ Section Block Lot L_L 0
Subdivision of /X4LZP12 �� T
Subdv. Lot # 3r /U/T/�/_ Filed Map # �N� Date 9 ;l6'��
Gentlemen:
This letter is to authorize
a duly licensed professional engineer LXor 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
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.
Countersigned
P.E., R.A.,
A
Address ��-
G ,0 &,Oct
2/ - .. 7
Z ---,? 2A-
Telep one
Very truly yours,
ES�Signed
Owner of Property
Address
pit nA�, I%l1 �,Y
Town
Telephone
A
Al� v
Ar-=- `U�'J-'- 0
- EE-I—ETH
IZ '
r=[L_.j CZ- - Cr EE —r 0-rJ
'V A�
Cr
Aj r�
NO 1 P C_i_�
rM
W
C,3 10 G
c:—,
c
F-:
cz
var_=---C= Raz---St
IT
CES,
& vc.
'c
D cr j
c E
nk
a-
17- C--'---
we
czr r-
�st - --
r. Nc
c
SIM
t—c
ic
Dr & S
ar a r
FCC or;
7a C
nsicn
S-c-
ken
S.cr
& ca
200 ft-
&
A"(D; Z.;7-=
tic r ma:c.
20t ;a2-ls
loo, tz ri,�ELI; 2co, in D-r..C.fir L
rig
water=::,--
to
50, 2 wEll
1=
��
e -'^
:r.
,T.�:
r`.'.
;,�`.
�,.
�t'.
��
��;
.. i
Fi��T : F.h.vo�:
w i �___
�t�
z
N