Loading...
HomeMy WebLinkAbout3173DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 72.-l-24.12 BOX 26 g 09 41. ti A I L Jr ; Li Irl 03173 PUTNAM COUNTY DEPARTMENT OF HEALTH C %TIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD ONSTRUCTION PERMIT # s �/ a ' � 7�2 "-' % 7, el. i 2— Located at %''`' "� `` ' `� �� d, Town or Villagedl Owner /Applicant Name At /'1Zdr. s s�r� /v C..0 Formerly Mailing Address Date Construction Permit Issued by PCHD ) y f Tax Map vz ' Block _**1— Lot s-> Subdivision Name 1A•✓l.7 0�-C"✓ Subd. Lot #° A" &fie zip ate' 3/ Separate Sewerage System built by 11�vlr 4rlcrre*7 '41h rr Address �1'A7a-»7 Ao� /ItY Consisting of /0 Gallon Septic Tank and 30d -,z r 2- V-11 Other Requirements Water Supply: Public Supply From Address or: 1�4 Private Supply Drilled b-vge y d f� e,-1 /_1 Address �r►''�� �� u.um"_irc, ' -I No •f r v; �L.. �iIa civsi(i�i i viiitul oeeii euinpleted? J P_ Number of Bedrooms Has garbage grinder been installed? A161 I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam Cou.epartment of Health. Date: / Certified by P. E. ✓' R. A. (Design Profe if��aense Address '2- 9 7 2- � �' �-r s Sri r� la �' A # V s Any person occupying premises served by the above system - 9 Rake such action as may be necessary to secure the correction of any unsanitary conditions resulting _ 4Wt usage. Approval of the separate sewage treatment system shall become null and void *as soon as a public sanitary sewer becomes available 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 modification or change when, in the judgment of the Public Health Director, such revocation, modificati n-or e i _necessary-- ----�° '- - - By Title.,5� Dater White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Desi Prof sional Form CC -97 03- 07 -199b 12 :10AM FROM NORTHEAST LAB OF DANBURY TO 39 -3 Mri.L kAm ROAD - DANBURY, CT 06811 (- 0Od) 748 -7903 - FAX (203) 748.0652 19149329623 P.01 LASOIRATC;RY REPORT -- WATER SUPPLY TESTi<NG REPOO Tot BOYD ARTESIAN WELL CO::- INC:- DATE SAMPLE COLLECTED: 3 /3/98 Rt, 52 TIME COLLECTED: P.M. CARMEL, N.Y. 10512 ! COLLECTED BY: H.B. DATE RECEIVED @ LAB: 3/4/99 FAX-MA, DYE -914- 832 -9628 TESTED BY: LAB #11471 REPORT DATE: 3/6/98 t SAMPLE SITE:. STRA LAGO,PUTNAM VALLEY, N.Y. i I t CT !Cert: PH -0404 NY Cert: 11471 SAMPLING PMT: )BATI MOOM SOURCE: ' 'TELL -NEW TREATMENT: N NONE ` ` TEST PhRFORMED ! RESULT: M I BACTERLA.L: Total Coliform (Bacteria) 0 p per 100 ml 0 0 per 100 ml IPHYSIdALS: P" 7.91 n no designated limit i Turbidity 0.35 N NTUs 5 5 NTUs j CHEAnSTY2'St?':: i i Nitrite N <0.01 m m&'L as N 1 1 mg/L as N Nitrate Vii_ 3.97 m mg/L as N con _ _. T �. * *Notification Level 1 * * *Ac;tion Level RESUI,I S BASED ON SA 41PLES SUBNDTTED :3/4/98 SAMPLE, AS TESTED XBbVE: u CITABLE or I UOTPOTABLE (PER NEW YORK STATE DEPT. OF HEALTH SFRVICFS sTANDARDS FOR POTABLE MATER) Laboratory Director ! i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION ♦.. ...... .. _q. .. __ •. -i �.cA r�l.ri�d. �tii�i9l"... /Ir%o. +, -s,i..i+ral. r'. - � Inspm..: ; ected by: StreetLocat'on Av/� Owner 4 0 Town 0�04;� Permit # pi/ TM 4r-r-' Subdivision Lot 9. 2 1. Seyyage System Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped .................................................. d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. Sewage System a. Septic tank size ,0Pevvel ......... 1,250 ......... other ................ b. Septic tank insta a . ............... ............................... c. 10' minimum from foundation .......... ......... ....................... d. Distribution Box T All outlets at same elevation -water tested ................. 2. Protected below frost ................................................. 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set .... ......... :............................ f. Irenches TTe—n—g—th required 3�D Length installed 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................:.. 8. Size. o_f_grav?l'.3 /4 -7_1 '1Z' - d_iameter cl - -�-- -= - - =° T ravei "ih— irench 12`' mirurriurn ................... 10. Pipe ends capped ............................ I........................... g. Pump or Dosed Systems Size ot pump chamber ................ ............................... 2. Overflow tank ............................................................ 3. Alarm, visual / audio ...... :............................................. 4. Pump easily accessible, manhole to grade ................ 5. First box baffled ......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle......... III. House/Buildin a. House located per approved plans .. ............................... b. Number of bedrooms .................. ............................... IV. Well a. Nell located as per approved plans ............................... b. Distance from STS area measured c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted .................. ............................... b. All pipes partially backfilled .......... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter ......... :... e. Curtain drain & standpipes installed according to plan, f Curtain drain outfall protected & dinto exist watercoui g. Footing drains discharge away from STS area .............. In Qturfnnn x_e+n ,,.n +on4i nr. ..A­ ­+. s b PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 14?f7 A4 1111-111, Y A :�/ o lol Owner or Purchaser of Building Building/constructed by _14417 /.`/Z141'1__ Location - Street Building Type � 7 , / z y 1`12- Tax Map Block 'Lot Town/Village A6_� �1� �s Subdivision Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that•is 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 treatment 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 Public Health Director 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: Month Day �) Year q g d General Contractpr (O r); Signature , iG• Corporation ggmfe (if corporation) Address: Zip S� State _ / o Signature: _ Title: 6 (, IVLJY Corporation Name (if corporation) Address: State Zip Form GS -97 WLIL UUr1rUr,11U14 r%ZrvL%' DEPARTMENT OF HEALTH, -vision of Environmental. HeAlth,Se"icats PUTNAM COUNTY DEPARTMENT OF HEALTH ------ 7 Office Use Only -WELL LOCATION STREET AOURESS. TOwN1vILCMUffrY TAX GRID NUMBER: 1-+Or-+On ' Q I I 0_AAr P_v+nayy% \/cL11ey WELL OWNER NAME: ADDRESS: Qa_ VjlaoaLlp PRIVATE T09PUBLIC USE OF WELL 1 - primary 2- secondary Cd RESIDENTIAL 0 PUBLIC SUPPLY 0 AIR/CONO./HEAT PUMP 0ABANDONED 0 BUSINESS 0 FARM 0 TEST /OBSERVATION 0 OTHER (specify) 0 INDUSTRIAL 0 INSTITUTIONAL 0 STAND-BY 0 AMOUNT OF USE YIELD SOUGHT gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE _2_)o gal. .REASON FOR DRILLING ❑REPLACE EXISTING SUPPLY ❑TEST/OBSERVATION []ADDITIONAL SUPPLY JgNEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 5-0 5 It STATIC WATER LEVEL 34 ft. DATE MEASURED IdI012:7 DRILLING EQUIPMENT 1 0 ROTARY COMPRESSED AIR PERCUSSION 0 DUG 0 WELL POINT 0 CABLE PERCUSSION 0 OTHER (specify): WELL TYPE 0 SCREENED 0 OPEN END CASING Ck OPEN HOLE IN BEDROCK 0 OTHER CASING DETAILS TOTAL LENGTH Q_ tL MATERIALS: STEEL 0 PLASTIC 0 OTHER LENGTH BELOW GRADE d_0 tt. JOINTS: 0 WELDED 19 THREADED ❑ OTHER ­DIAMETER (0 —in. SEAL: %CEMENT GROUT 0 BENTONITE '0 OTHER WEIGHT PER FOOT aL C/ lb./ft. I DRIVE SHOE: OYES 0 NO I LINER: 0 YES )o NO SCREEN DETAILS GRAVEL PACK DIAMETER (in) SLOT SIZE LENGTH (11) DEPTH TO SCREEN (it) DEVELOPED? FIRST 0 YES ONO HOURS -SECOND - 0 YES 0 NO GRAVEL SIZE: ~ DIAMETER OF PACK in. I TOP DEPTH —ft. BOTTOM OEM — ". WELL YIELD TEST If detailed pumping METHOD: 0 PUMPED 1 tests were done is in- 10 COMPRESSED AIR lormation attached? 0 SAILED 0 OTHER ❑ YES ❑ NO WELL LOG if more detailed formation descriptions or Sieve analyses . are available. please attach. I!DEPTH FROM SURFACE Water pea Ina Well Oia- mete (meter FORMATION DESCRIPTION coca WELL DEPTH It. DURATION hr. min. ORAWOOWN It. YIELD 9pm. Land url2ce J� H LL 16 b r'Q W Q lAIV.C1,4jA_2Q( oric"A gap., 5 IM47– VP U43ir WATER 0 CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? 0 YES 0 NO ANALYSIS ATTACHED? 0 YES 0 NO STORAGE, TANK: TYPE CAPACITY GAIT. WELL DRILLER NAME -j oyD A, TF,5iiw Wei-L Co AOOREss RD s P, r s7oz SIGNATURE _0P,1nFj_ AJY 1,05tA JUMP INFORMATION TYPE CAPACITY MAKER DEPTH — MODEL VOLTAGE — HP -it- ' -1 - I L7— � To bseamftadod by Addma3-- an k6amb sunk DREW W I reprasent-1hat I am wholivand c - ompt . awy . responsiblo.for the design and location of the proposed system(s); 1) that the separate sewage dispose above doscribed will be constr4ct6d as sho6h on tho app'iovGd amendment there to and in accordance with the standards. rules V0 —r"--uMonsoT County Oepartmcl�t Of Haefth, and,that on Completion thereof a i-Cartif icot Hance" satisfactory to the Commissioner.of Healthwill be submitted to the Dopertmoost. and a written guarantee will be furnisho: the airs or assigns by the builder. that said builder will Place in . go" opair I atin�j condition any - pait of Gild t3wage disposal system durl yous Immediately following the date of the Issu- ance of the approval of tho . Cortif I&to of Conitr6dion'ComPlibnca of the origi horGtO; 2) that the drilled Well &scrlbad above will Is I a located as sheirR on tft3 aoPi.oveti Plan and that Widwell will be Installed in with rds. rulas and reausymns of. the Putnam County Doportmem q? "With, License No.1— do APPROVED FOR CONSTRUCTION- This approval expires two years from the daie, "IMIWn jrtha buildinghas been unddij;ken and is revos�abia for cause or may be madI4cdWh6n ionsidared llpeessary by t Ith. Any change or alteration. i6t construction mulres a new permit... Approved for,di"We of domestic sanitary. U-7. }eV. vm� ^ «�� 10/88 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 c0"NST R ,3 - %AThE Prue P7. PMTM A WELL LOCATION Street Address Town Village Cit Tax Grid Number WELL OWNER Name Mailing v , ;'/� Address ``%ny a rivate %r�� ��e 19 -0 ^1 O Public USE OF WELL 1 - primary 2- secondary RESIDENTIAL 10 PUBLIC SUPP Y ❑ AIR /COND /HEAT PUMP D ABANDONED O BUSINESS O FARM p TEST /OBSERVATION p OTHER (specify 0 INDUSTRIAL O INSTITUTIONAL O STAND -BY Q AMOUNT OF USE YIELD SOUGHT -Ir gpm /# PEOPLE SERVED * /EST. OF DAILY USAGE old gal REASON FOR DRILLING 13 REPLACE EXISTING SUPPLY ONEW SUPPLY NEW DWELLING ❑ TEST /OBSERVATION LZ ADDITIONAL SUPPLY 0 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE WDRILLED 13DR ODUG GRAVEL. OTHER IS WELL SITE SUBJECT TO FLOODING? YES I-' NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name /i"' Address : ,/ ,0, IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES j,," NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY ,DIST- _ANQ,..TO _PROPERTY FROM NEAREST WATER -MA?u: LOCATION SKETCH &. SOURCES OF CONTAMINATION PROVIDED N SEPARATE SHEET 9� da e) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirt3* (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 con i,at�- .su7�frace or groundwater. Date of Issue:� 19 - Date of Expiration 19_2- Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller STREET LOCATION [1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET -FOR GDNSTRUCJJONJ, F� -- ':. -J.�a v'• :i..;x_ Icy' -,,,,, ..-s Hsi ....:.: �:n L<',r:�:w/ DOCUMENTS APPLICATION PC -I WELL PERMIT c1 PWS LETTER LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) BORATE RESOLUTION SHORT EAF -v PLANS - THREE SETS HOUSE PLANS - TWO SETS V?&IANCE REQUEST Y N TAX MAP # )SION CONTROL:HOUSE,WELL, SSDS :C & DEEP HOLES LOCATED 'RESENTATIVE OF PRIMARY & EXPANSION 'ATION MAP ',.AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE UMPED, PIT & D BOX SHOWN & DETAILED JSE - NO.OF BEDROOMS LLS & SSDS'S WAN 200' OF PROPOSED SYS. )PERTY METES & BOUNDS JSE SETBACK NECESSARY (TIGHT LOT) JSE SEWER - 1/4" FT. 4 "0; TYPE PIPE SUBDIVISION L�J=JNO BENDS; MAX.BENDS 45° W /CLEANOUT. LEGAL SUBDIVISION 190rl/d, �idJ�d'y FILL SYSTEMS SUBDIVISION APPROVAL CHECKED ER !7117 E— C RATE ,,1 l� ` IO- FT. HORI NTAL;SLOPE 3:1 TO GRADE , FI QUIRED ,y DEPTH FILL SPEC FILL NOTES CURTAIN DRAIN REQUIRED STANDPIPES FILL C TIFICATION NOTE GENERAL D GUAGES OCATED IN NYC WATERSHED ILL PROFILE &DIMENSIONS ELANS16BMITTED TO DEP VOLUME DELEG TED TO PCHD PROVAL, IF REQ'D FTR ,NCH DEEP TEST HOLES OBSERVEDIe6,�j LF TRENCH P.ROVIDkL) ��T.60 -APPROVAL SSDS ADf. LOTS 100% EXPANSION PROVIDED LANDS (TOWN/DEC PERMIT REQ'D ?) SEPARATION DISTANCES SPECIFIED TA—TA ON DDS PLANS & PERMIT SAME ON PLAN - FROM SSTS 1969 NEIGHBOR NOTIFICATION 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL BI/ZBA 0' FOUNDATION WALLS _15'WELL TO PL 00 YR. FLOOD ELEVATION Poi—TO WELL, 200' IN DLOD, I50' PITS Q'D PERMIT(S) 10 STREAM WATERCOURSE LAKE (inc. expan) [LS ON PLANS BASIN, 35' STORMDRAIN, PIPED WATER SEWAGE SYSTEM PLAN - (NORTH ARROW) I0' TO WATER LINE (pits -20') S HYDRAULIC PROFILE_ GRAVITY FLOW ' V INTERMITTENT DRAINAGE COURSE 59-N&TRUCTION NOTES! 0'1500' RESERVOIR, ETC. _150' GALLEY SYSTEMS D DATA: PERC &DEEP RESULTS 'min to CDS= >5 %,10'- 4 %,25'- 3 %,30'- 2 %,35'- 1%,100' - <I% 21—'b- RS EXISTING & PROPOSED 20'min to CD discharge /I 00'with 182 cons day discharge RI Y & SLOPES, CUT SEPTIC TANK FOOTING /GUTTER/CURTAIN DRAINS ETIMTROM FOUNDATION; 50' TO WELL COMMENTS: FORM ST -2 y -PC -1 PUT NAM COUNTY D E PART M E NT OF H EA EY H `w-wacAnow 'i�LANS` "F0 'A' A'STN — EIS I)ISPOSAt`'SYSTEM 1. Name and Address of Applicant: 16 v 2. Name of Project. S//� 3. Location T /V /C:/ //A w cu 4. Project Engineer: ° >��� %r��% 5. Address: 2:i1.;'_ r�Cr %fir, License Number: Phone: 6. Type o Project: Vrivate /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEQR)? /V--.-, Type Status (Check One) Type I.. Exempt Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ..........�� 9. Has DEIS been completed and found acceptable by Lead Agency? ...........� 10. Name of Lead Agency 1' Is th._ G,pjec� its are -are '&.•under. t"he control of- oval planning, 49n-ria, .. _� - .y.....�... ._ orother officials, ordinances? .......... ............................... !! 12. If so, have plans been submitted to such authorities? 13. Has preliminary approval been granted by such authorities? i Date Granted:e_u_ 14. Type of Sewage Disposal System Discharge...... Surface Water ✓4 Ground Waters 15. If surface water discharge, what is the stream class designation ?........ 16. Waters index number (surface) 17. Is project located near a public water supply system? .................. /ld A. 18. If yes, name of water supply Distance to water supply /�%' 19. Is project site near a public sewage collection or disposal system ?..... 4D 20. Name of sewage system Distance to sewage system 21. Date test holes observed: 1 22. Name of Health Inspector: 23. Project design flow (gallons per day)...? va ............................. 11/93 2. 24. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. 25. Has SPDES Application been submitted to local DEC Office? ............... 26. Is any portion of this project located within a designated Town or State wetland ? ....................... ....... ............................... 27. Wetland ID Number ........................ ............................... .. I p 28. Is Wetland Permit required? ............... ............................... .Has application been made to Town or Local DEC Office? .................. -&' 29. Does project require a DEC Stream Disturbance Permit? ................... A& 30. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ........ YES or NO 31. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or NO DESCRIBE: 32. Is there a local master plan or file with the Town'or Village? ........... `' 33. Are community water, sewer facilities planned to be developed within 15 years? 34. Are any sewage disposal areas in excess of 15% slope? ... .. ... - - - - - — - - - 35. Tax Map ID Number ......................... ............................... 36. Approved Plans are to be returned to: Applicant Z,/' Engineer If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: may' �- ��"�? C� ✓'�"�i �i�i d� MAILING ADDRES': toe -25 -1997 03: 16P(hl FR7i•1. DYE. BROTHERS- MODULAR t# 1' TO v pUTNAM COUNTY DEPARTMENT l ■�Y�.If OF MEALC.E Ali A ��w 1ilYi� il +r -.FYI. DIVISION 4F ENVIRONMENILAi HEALTH SERI Date ' 1 " , i Lo G-0 /'YEA yANI /4,�a 1 cared 1Ar � -Ma "ia �sr s .. e (T }� Section 7z, Block Oubdivi of 44`d e �rr �, ��„��, " _ ubdv. Lot Filed Map Gex�tJ. men: gip• his letter ie to authorize Cw. Es. I w w � t 2� no Nit 962z,248 P. 01. ,t �z ate ;2 1 a Aly licsnood professional engineer i. ' or registered arch itect�„� ( Indicatey'� 4 Lu.gp ly rur a Construction Permit for a separate s wage mystem, to serve the above noted property in accordance with tie standards, rules or re6ulations as promulagated by the Commissioner ff the Putnam County; bepar ment of Health, and to mgr► all necessary paptra on my behalf in connection with this matter acid to supervise the co 2truction of $aid systen or systems.,� tri conformity with the, provisions of Article 145 or 1471 Education La'wj, the Pubfi.e Health Law, and the Putnam County Sani- tary Pode. Very truly yours, P/IL';0U404 Signed 0 Counte si nsdi 20 �rs� Addross • Gc1 ra ��� T.+..wi 3 �-- ..rr Telephor property M-y. WjV TOTAL P.O3 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - i• r• •• a �• • -�� i� o y. DIVISION OF HEALTH SERVICES. DESIGN .DATA. SHEET SUBSUFACE SEKAGE DISPOSAL SYSTEM FILE NO. ' tfvJeY %�71i/ j.` J 'C7 AeSS' %JAh /' =Y%ft1 od Located at. .(Street) A 0 n/ //Ood Sec. % 2_' Block O%. Lot 24• Undicate nearest. : stret) ' p TIJA/'!'> /G Municipality ./ �1 i' G�'� Watershed 77" SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITIED WITH APPLICATIONS. Date of. Pre- Soaking LOZ q z Date of ' Percolation Test HOLE NUMBER. CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran. Water Level No. Time Ground- Surface .. In Inches Soil Rate .:Start -Stop Min. Start Stop c 74 Inches. Inches Drop In. Min /In Drop Inches . 4'Po,a ZZ Zs 3 d 30 4 5 1 �/z 8 -2 7 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 from top of hole. rev. 9/85 TEST PIT DATA RDQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES - _ DEP:['H HOPS : I HOLD . 13-0 _ 2- HOLE . NO G.L. 1' 3' 4' 5' 6' 71 81 10' 11' . 12! 13' 14' INDICATE LEVEL AT WHICH GROUNDRATER IS ENCOUNTERED C INDICATE LEVEL TO WHICH WATER LEVEL RASES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: o' O�Pil�f DATE: y0 q� DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided SCIa G No. of Bedrooms Septic Tank Capacity gals. Type Absorption Area Provided By L.F. x 24" width trench Other /�G�i^da�S - 3 OGd /�d� %� /40 �Z'I "%id OF Name �` �- K 1' Y'Cl �? Si na �w r g � Address Z F&CV7 Cvv..s D12 • S yo 4 24 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked' by Date EL w m O tC � Of CE J A 0 a! co CL' W F- 0 CQ W A c Ly U.. T- co ©® UXWL Nt AM ROAM= C� -=^ kUmXA. A *M" I BCT Ar"r WT ME: Iv 00 NAM VALLEY, A.Y m 1M W y YY moc yHHne '� i 4 DINING .ROOM w -1' X 3P' -3' 123 SF LIVING ROOM 16-1' x 12-3' 196 9F uH Is~ KITCHEN lel-W x 12• -3' . 145 sr 7 �d FOYER ""o" 6' -9' Y 9111• 33 66 SF 4 iY ]HnY �' -.T 1st • FRI S n a ai BEDROOM #3 BEDROOM #2 9' -16• x 10' -10' 1213' X 19-W i' 306 SF 132 Sr et 1• n' AA ie� ' AiE mrmasEa � tKt se�opoe ALL oOrrASns m PpotesT 016; eoemnaE Ili® off To rxM rae awaea M oMBeHOM� ws �aaao w NGO�AAA RYI :P7MAN C0 DRPARTWT* bP RYLALTR . am mavc=@: HOTISP - t sf BEDROW C UNT ONLY, - . ;. ,,. EDRO MS a. .0 f ' - an: - a Haw _ gnature Title. S MB '••"" MASTER BEDROOM r 60 Sf sp "12'-3' Y.15'. 5 0 .189 Si 52 sr iY ]HnY �' -.T 1st • FRI S n a ai BEDROOM #3 BEDROOM #2 9' -16• x 10' -10' 1213' X 19-W i' 306 SF 132 Sr ADDRESS V ROUTE 22 BOX 186 PRDJ. ID 0- C9A8 VINGDALE AY 12594 SERIAL z g, } DWe' At�L rly OIis,2Au. (DN1rN - 1�' r �1E1HAlMD�flERAIEAIOBEhtTlap vl.a AM APSNOM, SLOW V LM o;4V ae Bev" Z CHELSEA 89OULHIR HOES. DC now. PLM Et Rn nx 118 SINTE 9v � SH F ECT w -3 LiHEQ�IQ xY. ir.HZ n+- tas -aau DVl1 BY: D Ai } 94 Oc soV .)o oaarHle Or "PCs e w� u iIoa isVnx A°P. BY: a usa HHawl HHT C4TL 04/28/97 ( W-10.7/10/97 @7/18/47 D,A1 et n' AA ie� ' AiE mrmasEa � tKt se�opoe ALL oOrrASns m PpotesT 016; eoemnaE Ili® off To rxM rae awaea M oMBeHOM� ws �aaao w NGO�AAA RYI eu�oax S SITC L0C: �J1 am mavc=@: } DWe' At�L rly OIis,2Au. (DN1rN - 1�' r �1E1HAlMD�flERAIEAIOBEhtTlap vl.a AM APSNOM, SLOW V LM o;4V ae Bev" Z CHELSEA 89OULHIR HOES. DC now. PLM Et Rn nx 118 SINTE 9v � SH F ECT w -3 LiHEQ�IQ xY. ir.HZ n+- tas -aau DVl1 BY: D Ai } 94 Oc soV .)o oaarHle Or "PCs e w� u iIoa isVnx A°P. BY: a usa HHawl HHT C4TL 04/28/97 ( W-10.7/10/97 @7/18/47 D,A1 _ - ECE'VED iT'N4 -,1 C0UNTY 1 :r = I la 3. .,- i. •a* E •- '•"^'x^' y � _- "':�` __.- .. -ow^a: :c:a.__x,e'� .rw= :sxucc.::s:.v+sr -� G O t, 2� � i C y 7 S�.5tcr,, 5;x!41x 5 i j `J CJ je . 1 .? T i-s�i, �� `M r �.C. '�.' t-•:� Yt C 111` • •4ra I r _ z ;,r _ ? /777: prof P% :, r f wdr