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HomeMy WebLinkAbout3060DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.26 -1 -8 BOX 25 1 ro I IN 9 4% 1 1 1 1 I t ji-t ,� IN {� is � T 1 ;r . 03060 I Ce Rev. 3/,86 __, �L PUTNAM COUNTY DEPARTMENT OF HEALTH m of Environmental Health Services, Carmel, N.Y. 10512 Englneer'Must Provide I '� P.C.H.D.. Permit q Owner /applicant Name ' ' ' " Maning Address % dam .1�// ,IA�ICER $BWAGE DISPO$�lL SYSTEM _.._._ �---z Town or Y"t - a Tax Map Block g•• Lot Subdivision Name Subdv. Lot N ZIP Date Permit Issued 1r 7 ,7 Separate Sewerage System built by a h' r,7 Address Consisting of AMC—) Gallon Septic Tank and -- — . D D L F QYr a2 .y w /�� % /QG/✓fi��t�' Water Supplys Public Supply From Address or: k"' Private Supply Drilled by��SO'h Address e4 V Building Type ,5 % ! �C Has Erosion Control Been Completed? Number of Bedrooms 3 Has. Garbage Grinder Been Installed? J N G Other Requirements I certify that the syetem(s) as listed serving the above premises were cc Bally as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and n ,trnY rdance with the filed plan, and the permit issued by the Putnam County Department Of Health. N C4•p a Date gortifle tl ` P.E. �r R.A. Address License No. Z Any person occupying premises served by th bove system(s) shall conditions resulting from such usage. Ap roval of the separate s available arid the approval of the private water supply, shall become subject to modification r change when, in the Judgment of'the Date ( Cf t be necessary to secure the correction of any unsanitary and void as soon as a pubt;: sanitary sewer becomes sta supply becomes available. Such approvals are cation, modification or change Is necessary. -.f � Title PEYMAM COUrTl, DEPARTME W OF HEALTH DIVISION OF ENVIMNMENM HEALTH SERVICES. K t.:.. `e- �C/�.�= �.'.a•c. ��:i_.�..� -= ..s - ♦ a+•- . .x.' Y: .•_ - i ....- .w�c-: � � . • ..x� ... 1. T' .: Cam.: _s ..c.�. a .*�- *c'�K.^�•im2', f'��� .. ^l .ate•... 4 �. ?v�[C . � - • D. a !. V Owner or Purchaser of Building Building Constructed by Location - Street - Municipality /�i d'we'e Building Type 3;Z 2 1/2- Section Block Lot Subdivision Name Subdivision Lot # 0 GUARMM OF.SUBSURFACE SB GE 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 �C_o_mplIance,'., for .the - ::sewage dis�go '� -s - ► ._ y 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 Environinental 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 _3 day. of C/40/ .19 yf General Contractor (Owner) - Signature Corporation Name (if.Corp.) Address rev. 9/85 mk Signature � - - Title Corporation Name (if Co .) ess WhLL LjUP'irLL 11U1V rtr"Al Jam, a office Use Only .e DEPARTMENT OF HEALTH Division Of Environmental Healrh Services sir'" - •±^• :AT+fi.'+/•'•• „_.'TaOls.lecna4T: O. •-CPC y =• : /'•!" "_..ni i4.. i�C!' _...r .!'- .7.vv� ^ i.'ihunFQ' 4 .:... �4��.�.....�y a Yo PUTNAM' COUNTY DEPARTMENT OF HEALTH EET AOURESS: � "LLAUIC11Y TAX GRlO NUMBER: WELL LOCATION w L _/ NA OORESS: 81 ATE WELL OWNER r ❑ PUBLIC USE OF WELL 1 - primary 2 -. Secondary -)B-RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ASAN NED ❑ BUSINESS ❑ FARM ' ❑ TEST /OBSERVATION -❑ OTHER (specify). ❑ INDUSTRIAL ❑ INSTITUTIONAL _ ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT -S gpm. /N0. PEOPLE SERVED -'—` / EST. OF DAILY USAGE J p� gal. REASON FOR DRILLING �' NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /085cRVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH a2lo 0 1 ft. STATIC WATER LEVEL Q JDATE MEASURED DRILLING EQUIPMENT x.BOTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION O OTHER (specify): WELL TYPE O SCREENED ❑ OPEN END CASING. X--OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH 2 ft. MATERIALS: STEEL ❑ PLASTIC O OTHER LENGTH.BELOW GRADE °� fL JOINTS: ❑ WELDED THREADED 0 OTHER DIAMETER in. SEAL: ❑ CEMENT GROUT ❑ BENTONITE IQTHER WEIGHT PER FOOT %,7 Ib.lft. DRIVE SHOE ES ONO LINER: ❑ YES WO SCREEN DETAILS _.� . DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (It) DEVELOPED? FIRST ❑YES ONO -SECOND_ , GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DErM It. WELL YIELD TEST It detailed pumping P P 9 ME;TH00: O PUMPED i tests were done is in- COMPRESSED AIR , formation attached? O BAILED ❑ OTHER i ❑ YES D NO It more detailed formation descriptions or sieve analyses �J ELL LOG are available, please attach. DEPTH FROM SURFACE Water Bear. 1n9 Well Dia- Ineter FORMATION DESCRIPTION code, it. ft. WELL DEPTH ft. DURATION hr, min. DRAWDOWN It. YIELD gpm. Surface 461 b WATE8 ❑ CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? O YES ONO ANALYSIS ATTACHED? ❑ YES O NO STORAGE TANK: TYPE CAPACITY l� GAL. PUMP IMF RMATON (,� TYPE"n�CAPACITY MAKER DEPTH MODEL -r� 3 VOLTAGE'-& HP WELL DRILLER NAM,-- OAT / ADORESS`S �l Y d r 5113f aRE !'p� t i '37, 011301:. Yorktown Medical b®ratory, Inca CAB - 321 Kear Street Date Taken: Time; Yorktown He,jg4 _ 10599 _ L _ -. s N. V. - Dat a Ric d �-�- (914) 245-3203 -taXe Reported Ni 1989 Director: Albert H. Padovani Al T. (ASCP) Collected By: Referred By: r Sample Location: r 2- 2- / Phone # --/ 77 N•cJ AQV_)c Phone # Sample-Type: L J Repeat Test? (the -k' one ) LABORATORY REPORT ON THE QUALITY OF WATER Potable 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) GENERAL BACTERIA _ Standard Plate Count .(CFU /1.OmL) MEMB,FANE FILTRATION TECHNIQUE Total Coliform �- Fecal Coliform Fecal Streptococcus MOST PROBABLE NUMBER TECHNIQUE Copper __.. Iron Total Coliform Index Lead..-. - n ^ arigan-ese' -'° -�° -" F'ecal Coliform Index �- _ Mercury _.Sodium KEY FOR TERMINOLOGY Zinc CFU = Colony Forming Units MISCELLANEOUS _- - GT = Greater an C ;;;-r _ pH (units) TNTC= Too Numerous To Count CON = Confluent ( =TNTC) _ Color (units) NR = Non- reactive O d ( TON) ---- Nor.. - potable. _ _ STP INF _ STP EFF Other: Sample Status: (check each) Outgoing _ HNO3 _ HC1 H2SO4 _ NaOH ZnOAc Na2S203 Other: Incoming 4°c _ OT 40c j _- .pH .LF 2_ Other: or Turbidity (NTU) REMARKS COMMENTS (For Lab Use) ELRP #10323 THESE SE RESULTS INDICATE THAT THE WATER SAMPLE (WANS YORKN STATE NDRINKING .WATER SATISFACTORY SANITARY QUALITY ACCORDING TO STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION THE THESE RESULTS INDICATE THAT THE WATER SAMPLE ( DID) (DIDNST)T /A R) KING WATER SATISFACTORY CHEMICAL QU LITY STANDARDS OF OF COLLECTION. CODES, FOR THE P. RA ETE S TESTED, AT. THE, _... 2 /86(Rvsd7 /87)RWE Albert H. Padov 0 M.T. ASCP), Director r uvrl, al_rr ���r:�'!'1U1V 'D Lt? STRF.E. LQCATION �'y ih-! n Ins '`"' by `-y l �- �J aWNER P- IT y' v U " '�� 24 a OR SJSDIVISION LOT v z- M*1 km V. mm I S SWAG D., POSAL ARFA - a_ SDS area located as� per amroved -plans ar b. Fill section - Date of placement 2:1 barrier_ LGTH W-TB AVG.DPTH c. Natural soil not strirced d. Stone, brush, etc -, greater than 15' fran SDS area. e. 100 ft. fran watery course /wetlands. I t� SF &C-EE DISPOSAL SYS M a. Septic tank size 11250 )n b. Seotic tank installed level. , c. 10' minimum fran foundation d. No 90° bends, cleanout within 10 ft- of 45° bend e. DISTRIBUTION BOX 1. All outlets at same elevat; on -water tested 2. Protects below frost 3, Minim= 2 ft. original .l soil between box and trenches I f. JUNCTION BOX - Dro�1v set g. TR•n`�-� 1. Length re?ui red - 3 ti b IzIl �h instal—I E3 I 2. Distance to wa-1, cot r =_e ne sur—ed : ft. 1 - --I- -I 3. Installe-A according to Dlan I 1 4. Distance center- to center 5. Sloca of trandh acceptable 1/16 - 1/32 " /foot. I I I At b 6. 10 feet from orcoe+Tv line - 20 'feet - foundations I I I lr 7. Demt_n of t_ nch < 30 incomes fran s•�ace I I Z. 8. Roan al..l.awe i for Em-p -a lion, 50% L. 9. Size of gravel 3/4 - li" diameter I I I 10. Depth of aravel i-n t_ encrl 7„2" m i n i nuza ( p 11. - Pipe ends cored h. Poe OR DOSE SYSTEMS 1. Size of rn= da*- i Oli 3. Alain, vi--,,z--1 /audio 4'. PL= easi? y accessible manhole to aide I I 5. First box hafled 6. Cvcle witnessed by H mil th Dere--tnent I I esLmeAtea flow per cycle i I EMISEE a. Eouse located peer apmreved plans. b. Number of bedrooms I W-EX, a. L Well located as r approved plans IX (, b. Distance from SDS area mm- -sured /&0 ft. I I c. Crsin 18" above arade_ d_ Surface drainage around well acceptable. I I OVZgALL WOM%- Iz"aIP a. Boxes Oraperly grouted b. A11 Ines war tially backf it led I c. All piDees flush with inside of box d. Bar-kfill material contains stones < 4" in di ter e. Curtain drain installed according to plan f. C.ir-tain drain outfall yrot_eted & dir. to exisLL- wate_rcours� I g. Footing drains dis._harae away fran SDS area SZ h_ Surface water Prote -ction adequate i. t_rosion canto orovsded on slopes cxreater than 15 %. I -5 .44 b eau cp PL1AP)GE < PON, .0 A� re, A"I'Aff Addmw :61: /1 D .BWMbg- Let Ared _V Fill Seca 0* epd Pcm Nuistba of De' 41 G Is o**016441 D 77 .4 UPWA.0- se_mg*Syil 46 climdafdZ_L Addreca o bo candi Y Polk, S A&WU ops 'DiM tily A -Pdvat6,Su p evi I represent- t hit .1 - arn-.Whoiiy"a44 co-i4 c#qn, of prpp,, -.the. sepirai a-,disposal"iystem .X , , Uhat G_-Sevv�ll c.o'nstr'uc't6da's's��-'ri-n.i,i,� the i*"iovW'&;"�di�i�i;�tA�retb�arvd in.accordad -,�viM_tqe4t4pdj.)-r :r e abov' so wjIl'beJ 6i s dr" uthaFF -�ry�to i f coi,ini, "d, �jnilAhjt'orfcoriipfetion ie tdniitrw C Construed the rhmls�onor of,!"palthwill Do' suDmdted to the - Department and a written guarantee will De .furnished the owner h eao the builder, will sA ., iift iii�n 4;Wipak:qt-sa sew �Iodiof)Awp (2) yoftlrnmed tOly f0II0w!0�'Ahe.qmtP`pf'thG issu- ance in 'good dperatiAi �64. c 'th' IT Oka' 6C414,�,iii06vii, of i a�4*hilnal sYjq!r,oc(jk"y repairs at-th6,drlslod,weli des6lb6il above Mrs ., p-uTaTTq—ns.5 " ' il tie Wds',oncl isqua ons.,�,pf-..,.tho_4lnam !I! in ds. I CountY' DOPSIt Mont. of'Hdilth':" �' vote ild E. R.A. Ftill Wil W, 'D �n V, lConse -No 4 RUCT06k: f 7 APPROVED FOR CO,NST e dultding has been undertaken and is PP , , !� revo4�ibljjdr., 'tise,or,ma be' -T'-!n-ded.ok.'rnddifi46d*.hjen-,,.. ilLdN_ !y.by-Ah A.,tIjy ,change or. 4lter�-iiop of 'construction r.eqluires-a now p r it. disj;oial- of a" r 'ate %Wi r'su-ph .16%.-1 - Rev. may T 4z 1/81 Do By -7— ii10 TO IN yj a e , r SUBJECTI�I6.ti :f <.. �" 1.V. 0 DATEx. I� r L L�(fits U J9 1.v o1? � � LEA =S.��. . &�C� �G �(• � � '- � - �G:. f<< d SIGNED ' REPLY } r a t ,SIGNED REDIFO�M`r •4S 472 s r - SEND PARTS'1 AND SrsINTACT: �carban/esS .+ a DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT 'A WATER WktL,_ PCHD PERMIT # WELL LOCATION Street Address Town/Village/City Tax Grid Number WELL OWNER am Mailing Address e �c�Se A1,Y &577 i d rivate O Public USE OF-WELL 1 - primary 2 - secondary RESIDENTIAL E) BUSINESS ® INDUSTRIAL ® PUBLIC SUPPLY (3 AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY ® ABANDONED ❑ OTHER (specify AMOUNT OF USE YIELD SOUGHT _50� gpm /# PEOPLE SERVED G /EST. OF DAILY USAGE eC gal REASON FOR DRILLING WM SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION O REPLACE EXISTING SUPPLY ® DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED ®DRIVEN ®DUG ®GRAVEL ® OTHER IS WELL SITE SUBJECT;TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: A/O Lot No. WATER WELL CONTRACTOR: Name 6e-,1 i3-e-o Address: .6�ee_wv 51�/ A'�. I IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES l," NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ®ON REAR OF THIS APPLICATION 21A SEPARATE SHEET (da e) (s ture ,p 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 provided b the utnam County Health Departm nt. Date of Issue: 1 19 Date of Expiration: 19 a mit Issuing ff cial White copy: H,D; File Permit is Non - Transferrable � Yellow copy: Building Inspector Pink Copy: Owner 287 Orange copy: Well Driller •' P •• IJ DI• W 1D Z 0 00) . 15 170 •' • I• •' ' 15 V-71 o• •ice. pESIGN DATA _SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM . �ITe+..e+.•RT. ._ ♦.. i:a%O /.a . /a- •� -.!•JT �s .. :C ..- . r• - trY Nr... -. rd..�+. �.`..11.. _. a ..T.....N•e . ♦ ../ ^R / !`. { � yw , Owner .� /f7 �°'/ `J�/�� Address G - 9 9� .+� re . Al Located at (Street) I"�' ©� G �/ Ae va' f Sec. 32- Block 2- Lot J 2- (indicate nearest cross street) 1Mnnicipality ,/Go 14, Ile, 1' Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre-Soaking % Date of Percolation Test HOLE NU BER CLACK 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 1J:3v 733 3 -3 2 ,733 X36 3 a / l 13 39-34' 4 5 39-y 31.7 9 `Z y >0 4 5 3 4 5 NOTES: 1. 2. rev. 9/85 Tests to be repeated are obtained at each for review. Depth measurements tc at same depth until approximately equal soil rates percolation test hole.. All data to* be submitted be made fran top of hole. 1° 3° 4° 5° 6° 7° 8° 9° 10° TEST PIT DATA REQUIRED. TO BE SUBMITTED WITH APPLICATION DESSCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES 11 ° W iI 12° 13° 14° INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED ®,l INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY:�/ 4�R DATE: DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided &r el P a No. of Bedroans Absorption Area Provided By -3 Other I /I e) /5 Name d '5�' A'--` Address Septic Tank Capacity % p O gals. Type L.F. x 24" width tren i"" -- ._.V;,4. Signature THIS SPACE FOR USE BY HEALTH DEPA MEET ONLY: Soil Rate Approved sq.ft /gal. Checked by Date CL 11 ° W iI 12° 13° 14° INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED ®,l INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY:�/ 4�R DATE: DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided &r el P a No. of Bedroans Absorption Area Provided By -3 Other I /I e) /5 Name d '5�' A'--` Address Septic Tank Capacity % p O gals. Type L.F. x 24" width tren i"" -- ._.V;,4. Signature THIS SPACE FOR USE BY HEALTH DEPA MEET ONLY: Soil Rate Approved sq.ft /gal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH rJ'ESiV-Iii�A:rt3Twn�.sn.afl Date Re: Property of Located at (T)�T / 4�� Section 32 Block 2- Lot % a- Subdivision of Subdv. Lot # "° Filed Map # — Date Gentlemen: g �f 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 _. __.._._ - -- :;b�i,n�c'.;�io�n ��� �• �h�s•�.�at�er�.�an�•v�tc. ��zFeriTise t? �e�.: ro�a�tr�c�t :.cn....�:£�.��aa:;d�.�.._ ..�. 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, a Ru Signed Owner of Property Countersi n Address x;�7�w,,� /,Address �a. -- Town !;e Telephone Telephone JOSEPH F. SULLIVAN, P.E. C'o.:sul'Euzg �nytnect -7.9,72 F.F.RNCRF�55T DRIVE.: .. r -c,- -e •- =�.o...a• ,.y, ....- .. +n+•- vc�.r_c �-,-m. �YORKTOWN HEIGHTS, N. Y. 10598 (914) 962 -4248 a s ew,-� e- tr "Iv. 0� to / O Ile rl A01 y a Diiiision of Environ CONSTRUCTION PERMIT "TOR -$EWAqE'D1SPQSA1 47, LOM613 ;Building 7- Nuftef r o- Spdrooms', Separate; Sewerage 0 system to c To be', constructed by Water UPP ly _r -Pubk 7 Addres s S :Other ,,Requirements�'i` 'z- I rep y - resent that I am wholly and .,abdve-'.de'scrjbe.d`wiI1 be constructs M i STEM 0 :Lo rea �M sDfleign Flow ns- to be drilled drilled 7. A� r u n r %Cbunty 'Dr66i'rtm'e.nt--�.'�ot';Heatt'h,i, and that t on corvioWion-066 ,IiWiWi m !itai to and a L �!•irittih place in good 0 n part of said sewage operating condition any aka of ifie appidvai of 4he.dehificate of:, Construction 1co WT be ibciied'gis,S601q!t.6n the approved plih:andiiiiitsaid Wei ` County Department of Health ' 61 -;Date Add re ,:APPROVED: FOR .'CONSTRU dtION- Th'is.'apprpya ;expires "; 'revocable for eause:'bir,mi'y."be amended o! modified-,when con r" it Q�pproved fordisposal of,, domestic, ,�,!as& new Perm -Da X: ti of ti f r lr;from the date 'd !`necessary by. A4 a d or TH, Permit: - V.bf,MEAL - Carmel N i2 Qx , Reir,8f6r, 1v i11 56dtion 'Only, Notification ', R'equi'red r �ef.,4e Cy i 'g $ J we &a * j % 'RI 'separate sewage disposal S stem , v R Xordi -Wi a rjqx g u d regWationsLof the CtIonx,orn Commissioner. of Healthwil'I IS, th�;,ilild -b su , cce rs,, a SA% 4 fo_ s`imm;c V I wing ,thedate I the SSU- a M or -a r 5 h� t t ow7mil-ed well desCilbed above ri aar ailpe uptions OfAhe Putnam • D oa on • and. is mmissior I i I- 6r f-1 , angeo r alter . ation of _conitr'uctlon, L 4tre ,w'a DDIY only PUTNAM COUNTY DEPARTMENT OF HEALTH _DIVISION OF ENVIRONMENTAL HEALTH. SERVICES .•'- a.':>'r� •i.�' i. 1•.. �eT::'. rt1- �`-'+ C^: �:.+ :...:r.Y.'_..s•...'My[f:[:Yir.. ...- m.. y.. T_.. a•. ��.- �+ fH[. M... Ny.. �.. ro. VJ-c �erv5'.? VVJ:.. ti_:,�r!...�Z':.�eu'.:�Y- �e�".1. :. �a[ fV.... �A1vnCi[ �: f�[_, � ..v_.mG...`.:S•_Oift....^Fw!1.: L, T.�R�fR�..rc� APR 21 '1982 PUTNAM COUNTY Date DEPT,, ®F HEALTH Re: Property of , c t� �" ��r �� - ; "G� d,� �•� de o% Located ate -r�v:� Section 3 Block 2—, Lot / Gentlemen: ✓ �j / Thi s letter is to authorize e 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 � VA1JJCL L_•V11 wl Lfl UL US ma L Lev anti to. supervise 'Lhe construc ciun of said system or systems in conformity with the provisions of Article 145 or 147,, - Edugation.,_Law,., the Public Health Law, and_ the _ Putnam County_ Sani- tary Code. Countersigned: P.E °, ., .j 5i OF i�Ejya� ° °e �qP 00000000 tog..� p Address - `� 0. 248 Has CIap• a Not Ali "2 Te ephone Very truly� ours, r Signed Owner of Prop ty Address /__1 617 NY j Telephone /9,S-j2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES q� 42` �.r - -:.: •F..- .;......a'w..tc•• K :.. r rro�: T^A Y. " . 4•� � _ ..r • a�.. v ti � . •r...- i' Q C! ,�fC . —.yL '� .•e raw•. w . ce,Un•l�- ��r�I�E�-BUy�. zNG; - ea-�nMEZ�;�.:NF, �.�•� - ���5�2�- DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owneri �� Address ? ����L C' D►/% . Located at (Street) /) Leo 41' A Sec. '30 Block Z Lot Ica a nearest cross street) Municipality�Gt Xr7 » Watershed SOIL PERCOLATION TEST DATA-REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number. CLOCK TIME PERCOLATION PERCOLATION RM apse Dep to Water Water Levei No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 2X33 93 6 3 3 5 11 3 APR 2 11982 PUTNAM COUNTY 5 Derv- OF MEAtTH Notes: 1) Tests to be repeated at same depth until approximately equal soil ,rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO-BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. 2- HOLE NO. - 6" 12" 24" 30 If 36n 4211 48" 5411 60 7211 EM 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED ®�' �'✓ INDICATE LEVEL TO W CH WATER EL RISES AFTER BEING ENCOUNTEM2r-?,-P TESTS MADE BY �-- '� '' ya" Date Soil Rate UsedCj o!5 min/1 "Drop: S.D. Usable Area Provided 3 OQG No. of Bedrooms Septic Tank Capacity /6*70 Gals. Type Absorption Area Provide �By Za L.F.x24" width trench. Q_ Other ME Address 72-11, ��.✓IC�G�'J ✓e SL THIS SP E FOR USE BY HEALTH DEPARTP'NT ONLY: Soil Rate Approved Sq. Ft /Cal. 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