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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 72. -1 -24.13 BOX 26 y I I I Mal '41 1 0 it J f m �' I ' 8'r , I 03174 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT NOT Yact location of well with distances to at least two permangfii l�efdmarks to be provided on a separate sheet/plan. Well Driller's Name `�n Address: Signature: 42 4 Date: -/- -� / aS r White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 tiT !.�< ^:•1 _ 1Omi��� !S):.!.��3 %.: �:.�: -_'G �_ Map 74 Block / Lot(s) Well Owner: Name: Address: sr� - X651 Use of Well: 1- primary 2- secondary 2t�- Residential Public Supply Air pond/heat pump IrAgation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length ft. Length below grade ft. Diameter in. Weight per foot lb /ft. Materials: Steel Plastic. Other Joints: Welded Threaded Other Seal: _ Cement grout Bentonite Other Drive shoe; Yes No Liner: Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed Pumped Compressed Air Hours Yield -L>—' gpm Depth Data Measure from land surface- static (specify ft) 3G During yield test(ft) __ Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses are avaifable, please attach. Cn iii �> N Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface k lLS-� 5 i V� 'L 1A If y c d.�as tested at diferent depths - -� duri4( filling; '' list: o' LU Feet Gallons Per Minute Pump /Storage Tank Information Pump Typed Capacity Depth Model �. J o > Voltage HP Tank Typ & �6X Volume 7 Date Well Complete`d� Putnam County Certification No. Date of Report ell Driller (s' nature) NOT Yact location of well with distances to at least two permangfii l�efdmarks to be provided on a separate sheet/plan. Well Driller's Name `�n Address: Signature: 42 4 Date: -/- -� / aS r White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 AM COUNTY DEPARTMENT OF HEAL '#iS��T!A!-4 WYE k T ,. � "-V' 1 �• Y`►•1 \ i7aa�� '1 i aiJ 1i7 °L a � N R CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATN PCHD CONSTRUCTION PERMIT # Locate Ot�� /�lf'��/� ` Town or Village " Owner /Applicant Name S � ; Gj Z -7-e Tax Map _ 79 Block Lot ;� s Formed �fr"r i',/ Subdivision Name Subd. Lot # 3 Mailing Address % 4V r; 1",1,2 /V Z r 1116il_zol /V / Zip 1<1s ol Date Construction Permit Issued by PCHD 61-191" Separate Sewerage System built by e r-"*" Address Consisting of / j'� Gallon Septic Tank and 4 d . r� � def Other Requirements: Water Sup&: Public Supply From Address or: Private Supply Drilled by tea �i'i'I Nr����i� °ya Address/31C 1� 13uildirig °Type - /'�`t '-"ell -C;k i z' Has erosioli c5'nfrol'been completed% Number of Bedrooms Has garbage grinder been installed ?'� 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 Date: `f Certified by �- JDqS1J Address Any person occupying premises served by the above of Health. P.E. R.A. aLicense # ::�-7 %� jam' take such action as may be necessary to secure the correction of any unsanitary conditions resultift%,��Ch 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, modification or change is necessary. By Title: Af4%r Date: Whi a copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Associate Public Health Director Director of Patient Services Environmental Health (914)278-6130 Fax (914) 278-7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention .(914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 E911 ADDRESS VERIFICATION FORM OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS: TOWN: AUTHORIZED TOWN OF: . (Signature) DATE: 5S/-3 110111,67-s l41C , f / i The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERFRM) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT 'Wefi on . �wecf' dielsr _.:..__� ..: S d� �wif/ i�e* '"' °_ �_. l'ax" irid' #'_ Map 74 Block Lots) Well Owner: Name: Address: Use of Well: 1- primary 2- secondary Residential Public Supply Air cond/heat pump Irt4gation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing —,< Open hole in bedrock Other Casing Details Total length ft. Length below grade ft. Diameter in. Weight per foot lb /ft. Materials: Steel Plastic Other Joints: Welded Threaded Other Seal: Cement grout _ Bentonite Other Drive shoe: Yes No I Liner: Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped >� Compressed Air Hours Yield _Z2,f gpm Depth Data Measure from land surface- static (specify ft) 3& During yield test(ft) ._--- - ---- _. Depth of completed well in feet Well Log If more detailed information descriptions or 4 are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface ..i If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth 4 D Model Voltage �. - 3 y HP Tank Type y Volume . Date Well Completed 0,1 Gy Putnam County Certification No. 9 Date of Report � � 'o_�r I ell Driller (s' nature) - ) , I NOT Y. 59act location of well with distances to at least two permanght I�Admarks to be provided on a separate sheet/plan. Well Drillller's Name ` ten Address: j�Y - Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .., .r.r" -. -a .. -'a ••. r� ._..- .,- ::,s..: -.:r; .�•.'e ..- -c.:+. c..v�`r.�- cr�wc-- .moo-= :.+i•...�ae- _.�i�- '.:�ti�.. ter_ ..i+Y := a._-... • v.:.. ......c. v .. .- .s- .c =w::.. �-.a.r .ar�sw ... ._..... .- .n-... sri.'a- �i..:�::. GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 5 S b 11019Z'S' I �V e Owner or Purchaser of Building 55le //o/y,E5' , 4/c . Building Constructed by 73 *0A70 -v 110.E,e0jv R04V Location - Street ,4t=SI0eA1174 L 7a. 2'V, 13 Tax Map Block Lot Town/Village A101Zr0Ay 1Y0440hl Z.52 Ai ,S' Subdivision Name N Building Type 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 moo• 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 0 Y Day_ 7 Year :4 General Contractor (Owner) - Signature -5S •3 110& e s l'NC Corporation Name (if corporation) Address: 671 C 4 4 4l e LA24IZ-4 State /V ,✓ POA /< Zip /O T'� r) Signature: Title: �Stl f 60 S Corporation Name (if corporation) Address: _� __bbQ DQ d Cof4- VI(ld+ L40Ln State Q QLA) C k.. Zip WW1 Form GS -97 YML ENVIRONMENTAL SERVICES 321 Kear Street Albert H. Padovani, Director LAB #: 9.500720 CLIENT #: 58348 NON STAT PROC PAGE SSB HOMES INC ' DATE/TIME TAKEN: 04/13/05 10:45 61 REBECCA LANE ' DATE/TIME REC'D: 04/13/05 11:55 CARMEL, NY 10512 REPORT DATE: 04/21/05 PHONE: (914)-906-1742 SAMPLING SITE: 73 HORTON HOLLOW ROAD SAMPLE TYPE..: POTABLE : PUTNAM VALLEY PRESERVATIVES: NONE COL'D BY: VINCENT CRECCO 7��' � � ~Z TEMPERATURE..: NOTES ... A GARDEN HOSE COLlFORM METH: N/A ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 04/13/05 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 04/18/05 LEAD (IMS) 2.7 ppb 0-15 ppb 9003 04/18/05 NITRATE NITROG 0.54 MG/L 0 - 10 9052 04/15/05 NITRITE NITROG <0.01 MG/L N/A 9162 04/20/05 IRON (Fe) 0.105 MG/L 0-0.3 mg/1 9002 04/15/05 MANGANESE (Mn) 0.010 MG/L 0-0.3 mg/l 9002 04/15/05 SODIUM (Na) 14.5 MG/L N/A 9002 04/13/05 pH 7.5 UNITS 6.5-8.5 9043 04/19/05 HARDNESS,TOTAL 96.0 MG/L N/A 04/19/05 ALKALINITY (AS 78.0 MG/L N/A 9001 NJL! COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. ublic schools are set at 15 ppb. Rule for Public 8ystems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people an a sodium restqicted.d the water should contain no more than 20 mg/L of Sdbium` M those on a moderately restricted diet, a maximum of 270 mg/L of Sodium YML ENVIRONMENTAL SERVICES ' 321 Kear Street � Yorktown Heights. N Y 0598 Albert H. Paduvani, Director LAB #: 9.500720 CLIENT #: 58348 NON STAT PROC PAGE: 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ SSB HOMES INC 61 REBECCA LANE CARMEL, NY 10512, SAMPLING SITE: 73 HORTON HOLLOW ROAD : PUTNAM VALLEY COL'D 8Y: VINCENT CRECCO NOTES...: GARDEN HOSE ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE DATE/TIME TAKENi 04/13/05 10:45 DATE/TIME REC'D: 04/13/05 11:55 REPORT DATE: 04/21/05 PHONE: (914)-906-1742 SAMPLE TYPE..: POTABLE PRESERVATIVES; NONE TEMPERATURE..: COLIFDRM METH:N/A ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD is suggested. pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY,, WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED'' VARY ` -- 1�O[�]RATE��/-HAF�>-*kATER��70p=140'MG/�--�~ HARD WATEN 140-300 MG/1--- (1 grain/gallon = 17.2 MG/L) ` SUBMITTED BY; 0`1 Albert HT- hovani, M. T.(ASCP) Director 71 ELAP# 10323 ✓.V r:.►�`il]�<+~M � .pQ.- Y�i+'�Vi'4e•Ri�.r7.. x :t'Pi- r- :�.Y.'t rtQ1.�l!�- f�:+.r LORETTA MOLINARI Public Health Director April 22, 2004 DEPARTMENT. OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York 10598 Re: Dear Mr. Sullivan: ROBERT J. BONDI County Executive Field Inspection — DMS Homes Horton Hollow Road, (T) Putnam Valley TM# 72 -1 -24.13 inspection was made for the above referenced project on April 21, 2004. The following ;nts must be corrected in the field. ZA . -. �- Cast .: Junction box cover # 3 is cracked and needs to be replaced. T v ��.'A All large stone needs to be removed from the SSTS area. The first 60 foot lateral and trench has two large stones protruding into the trench. If the stone is not ledge, it has to be removed. If the stone is ledge, the trenches need to be a .,� minimum of 10 feet from the ledge. Please show preliminary as built if trenches have to. be relocated. t he well needs to be inspected when drilled. lease verify footing and roof drain discharge points.'S �b1Js% r,J�.ro� �DCI I l�V� If have any further questions, please contact me at (845) 278 -6130 ext. 2157. V5 Sincerely, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj �C:° . I�l�.'�'s,�``�W` feaov 6Je PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVI RONMTNTAL HEALTH SERVICES FINAL SITE INSPECTION Strept Location Town:.. "� ✓a�.. -y TM # 1. Sewage 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 .................. I.................. IL Sewage System a. Septic tank size - 1,000 .......... 1, 250 ... ......other ................ b. Septic'tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box / ,�' 1. All outlets at s va&n -w e 'tested .......:......... 2. Prot Blow frost .................. ............................... um 2 ft. Original soil between box & trenches e. Junction Box - properly set ...... ............................... 6 renc es Date: nspected by: 7S p Permit # Subdivision Lot #on[(ssd, 1. Length required Length installed S `� 2.. Distance to watercourse measured Ft.._/_: Rp 3. Installed according to plan ......... ............................... 4. Slope of trench.acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property he - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. T Room allowed for expansion, 100 % ......................:.. 8. Size of gravel 3/4 - VA" diameter clean ...................: 9. Depth of gravel in trench 12" minimum ....... :........... 10 —Pipe. ends cap�_ed...,,.:.. _ . :_. g:�F�iinp`or'33o'se �y�teiris ,,: 1. Size of pump chamber 2. Overflow tank. 3. Alarm, vis audio........:.......... . ............................... 4. Purnp egily accessible, manhole to grade ................. 5'�r t box baffled ........................... ............................... _,-6. Cycle witnessed by H.D.estimated flow /cycle........... a. House located per approved plans .................. ..:.......... b. Number of bedrooms ... ............................... IV. Well ,���Well located as per approved plans .......:.............AA'4..P b. Distance from STS area measured ft........... 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 watercourse' g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ........ :........................... i. Erosion control provided ................................................ Rev. 12/02 COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES PUTN .�'t � :. � n--. wG .r .�l�.Jf+Y ..._.•w« .,e ...G .. �i� rua.%L.'.a«B..t _ ..�.w ^s :.'C "'V �°'Ur•�9P ... - •+4 r �C' -. 1[.i'�.,h +... a.rs r. .a.r'c".s._ro n. .+a u..1 �.a. ��_.. -Oi .. s....m - .'.�c-.f 3 CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # ,%mil✓' Located at I/G�ey, - el? or Village 101:177011V Subdivision name' , r> A, ubd. Lot # _:3 Tax Map 7-2 Block Lot Date Subdivision Approved 1,9 91� Owner /Applicant Name :2 'e, %;�r, Mailing Address ,Po _'ryst Amount of Fee Enclosed 3. y v-- Renewal A--'O' Revision Date of Previous ApprovalA�4te,,� ,9S"" q Al- Building Type Lot Area gd"e- No. of Bedrooms 14 Design Flow GPD 9�W Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of %� Iii gallon septic tank and Other Requirements: To be constructed by p �� ��' Address 000 W_ Public Supply From Address or: Private Supply Drilled by f�,�e'O - Address >'e,,>`"�.% /_ I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition.any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. / o. NE�y Signed: Address �2 C�P��QANC /S�y�9 R.A. Date v� License # 3t� 1 n�l. it APPROVE OR C® STRUCTIOt,1 his ap®rovexXP1s.,,_ o- year s ' m the date issued unless construction of the sewage treatment system has been completed and inspected by th OHD�'and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new rmit. Approved for discharge of domestic sanitary se age only. By: — Title: Date: Z- White copy - HD ile; ell w copy -/Building Inspector; Pink copy - 41ne -range copy - Design Professional Form CP -97 PUTNAM. COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ APPLICATION TO A WAT ER WELL 'Wise print or type ._._ _ < _. PCND reli it it ) r e Well Location: Street Address: Town/Village Tax Grid # . J'�n I y 0/X/ f � 104 j&7 Xis ,11k Map %? Block / Lot(s) Well Owner: Name: Address: L Use of Well: Res tial Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought �` gpm #People Served _ Est. of Daily Usage ,0 al. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling � New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes ✓ No Name of subdivision Lot No. Water Well Contractor: _�{/' .,fin � �e� Address: 'OV Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: -- Town/Village Distance to property from nearest water main: 14111e/�� Proposed well location & sources of contamination to be provided on separate sheet/plan. T o•_ S «�rl• 4..Ci .plat., = r -✓- -- -.�+� •' ��A �fi..s P• L. F�"� -�' - --.:: Ila-�- :'�f'_� /; _��r ---- -7�V -t' -,- _ PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and 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 or their designated representative 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. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and 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. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue L Permi Date of Expiration <:J � Title: Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES RE: Property of LETTER OF AUTHORIZATION Located at IAle 4,11 f T/VX�ri!�ai� e � Tax Map # Subdivision of Subdivision Lot # 3 Gentlemen: 7j Block / Lot ��f /�✓ f�f���/ Filed Map # v This letter is to authorize �' i ��/� -' / Date Filed a duly licensed Professional Engineer '//-' _ or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformit- with the Provisions of_4rticle 145 and/nr•147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. - Countersigned: P.E., R.A., # Mailing Address Very truly yours, Signed:�� (o ner of Property) e'W Mailing Address: State Telephone: j� l State y Zip fa'7 Telephone: Form LA -97 4 i'. W PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEW:k( 'f'iFl�:�►iMiE'T i . STET i " 1. r PERMIT # I� / Located at 1. r �l � t, `� a a, Town or Village a Subdivision namal • � .44Aa w Subd. Lot # .3 Tax Map /.& Block / Lot ?,�p l 3 Date Subdivision Approved �Y x $1, Renewal -- Revision Owner /Applicant Name 17 *r !� `� /a/ / Date of Previous Approval IV— /9 YY Mailing Address %�G �` xJ r ` �' Gj `fir ��� zip/40 "7S' Amount of Fee Enclosed _ 3G 6i Building Type : t A >. Lorea ' C No. of Bedrooms Design Flow GPD Ye, v Fill Section Only Depth Volume PC HD NOTIFICATION IS REQ IRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of l 6 gallon septic tank and 40' f Other Requirements: To be constructed by Ci ,rt . ,r1 t � Address Water Supply: Public Supply From Address e*=z Private� .S.upply VDriller_hic.. �+�' _ ,r..s rigy _ Address 1 represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: 00 or ✓ R.A. Date '� �► ac: Address License # x !2 APPROVIFR IFQ ION: This a ars from the date issued unless construction of the sewage treOAA s b�empleted an d HD and is revocable for cause or may be amended or modified w ",n considered necesshry by the Public Any revision or alteration of the approved plan requires anew permit: r•.o Appved fQr. dig q arge of domestic. sanitary sewage only. By: ) I dz t Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 DIVISION OF ENVIRONME1®TTAL HEALTH SERV- 1C_.. ES... — .� e�:.�a:..:.. ..r�Y _ �_��__�- ..zap: -��_.. =r. �• .- r .. ,...;y .... ._ ..,_ - -• - CONSTRUCTION PERMIT FOR SEW ENT SYSTEM PERMIT # Located at 4 / Y�' Town or Villageoe ;10 / % S ` � Subdivision name /�� ,�,y,,� Subd. LoY# Tax Map %2- Block ! Lot /--3 Date Subdivision Approved % Renewal _/1"' Revision Owner /Applicant Name Date of Previous Approval y /,P 5 � Mailing Address All ��� Amount of Fee Enclosed ev e Building Type Lot Area -3fAC No. of Bedrooms -,-'( Design Flow GPD,9�a a Fill Section Only Depth Volume Separate Sewerage System to consist of / 245'61 gallon septic tank_ and tv Other Requirements: x' To be constructed by e hi 1,11 G� Address .Public.Supply From _ _ _ _.Address . or: a-" Private Supply Drilled by Al Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment s,, stem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address P.E. �' R.A. Date i r _ License # 2 ';��C-' ry G APPROVED FOR NSTR o res two ars from the date issued unless construction of the sewage treatment stem has be spected by the P HD and is revocable for cause or may be amended or modified when cone Aecessary ya Iic Health Dire%iF. Any revision or alteration of the approved plan requires a new pe it. Appr ve r 'sch e o omestic sanitary sew ge only. By: Title: Date: S 1 (D White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH ' DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER -WELL Y. a_`.7, _ .. :iA-n._ �aJG f�nl �( L' "T°• 1r / ZJ•D- -� `1'C1lD yPermit # Well Location: Street Address: Tax Grid # >� _ �� fi,,, /tz �v r✓ % a� y: Map l Z Block / Lot(s) Well Owner: Name: Address: _ / Use of Well: JfRes dential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served _ * Est. of Daily Usage Reason for Replace Existing Supply Test/Observation Additional Supply Drilling /'New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type y' Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No j-, ...................... ............................... Is well located in a realty subdivision? .............. .. Yes P'' No Name of subdivision �/� ,F/ , o Lot No. _ Water Well Contractor: A, er rw a /,I Address: /� • s �= .3�1 Is Public Water Supply available to site? .................................. ............................... Yes No_ Name of Public Water Supply: '—' TownNillage Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: Applicant Si¢natt�rP _ ,y �/ _. -_-. ` PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and 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 or their designated representative 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. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and 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. APPROVED_ FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified Putnam County. Date of Issue 1$ ©_ Permit is s ' Official: d--� Date of Expiratio S 2 Title: Permit is Non - Transferra le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION r r RE: Property of. Located at /1,al -Al h I_rl-_1110'ell X�10 TNA7, Tax Map # Block 1 Lot �? y. l-3 Subdivision of "AleIlf ell, /7` lle) I--- 1 f Subdivision Lot # � Gentlemen: Filed Map # Date Filed This letter is to authorize a duly licensed Professional Engineer "for Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and /or 147 of the Education Law, the Public Health T w, ,and -.the Putnar�1- :Cou_nty° Sani ary.C'ude.. Countersigned: P.E.,4-4., # Mailing Address Very truly yours, Signed: (Owner of Property) Mailing Address: /_' 10X State L Zip State G Zip Telephone: Telephone: F` Form LA -97 .O. TNAM COUNTY DEPARTMENT OF HEALTH �V S ION OF ENVIRONMENTAL ENTAI IEAITT SERVICES ..... ,. . _ r « � "r -�.K - �i:-' 3. :.-.. o'..: �c°.-'..: Fr�c'.e'n•:'►:�;n:::r�- -'.�. =: iii. ��•. a-: �= <�.:ez= .it:a- ..��:.�;,�.'..�:. ,.v �%. -'.:=..+=: �a�,.;.-_ re ..%s..o'•Se':s°s�= :::- d::x".a -. ;:::.�.'ti:.i,, -.� -.t�s. ., CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at Town or Village "p"40W Subdivision name �r�%� `�j�%�" ubd. Lot # Tax Map ;2 ,�_ Block / Lot Z l�k• %3 Date Subdivision Approved Renewal Revision Owner /Applicant Name Date of Previous Approval Mailing Address f1'Q�i'G'� Zip Amount of Fee EnclosedC�C� Building Type R,!!:0 �, e C" Lot Area No. of Bedrooms Design Flow GPD 7aey Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage -System / to consist of % �_4`��,J/ gallon septic tank and 4_-�re Other Requirements: To be constructed by Address Water Sup&: Public Supply From Address nvi e-Supply Uin"lfed by - A"diiress I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the sguarar to sewagc treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address re. P.E. APPROVED FOR CONSTRUCTION: This approval expires two sewage treatment system has been completed and inspected by the PC. OF NEW Y . ems. t,�rs ssued unless construction of the for cause or may be amended or modified when considered necessary by the Public Health Director. Any reviston-o�r"alteration of the approved plan requires, a nei Whir ge of domestic sanitary sew e only. %� �,,,,// ` 0 ''�'�Lt�( Title: Date: - Building Inspector; Pink copy - 4"er; Qge copy - Design Pr fessional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH E DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL �•..:'� - o'�..... r's:.: = >, �atii: s� .... . -' :y.^'�i 2::9�3ii"�:.:.•�� .�.r_,�. -...._ �.r-• : � -• �,c sv�..3'_..�� . .n T...,.� Well Location: Street Address: Town/Village Tax Grid # 14,4,17 114144 nl c7i 446, Map % Block 1 Lot(s)2y.13- Well Owner: Name: �i Address :: Use of Well: t,'Resi ential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought° gpm # People Served 4' Est. of Daily Usage�� Reason for Replace Existing Supply Test/Observation Additional Supply Drilling _1,� New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type I .Drilled Driven Gravel Other Is well site subject to flooding? ............................... Yes No ................................................. Is well located in a realty subdivision? .................... .................... .............................. Yes No Name of subdivision !i <� /r✓.�/ �� Lot No. 3 _f Water Well Contractor: !d%✓rNG�� %fin Address: %��.� i� 1 /� *� 41V Is Public Water Supply available to site? .................................. ............................... Yes No 'W- Name of Public Water Supply:. — Town/Village y Distance to property from nearest water main: Proposed well location .& sources of contamination to be provided on separate sheet/plan. Date .:LdG�-- �.._App1iot.Slgnature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and 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 or their designated representative 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. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and 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. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a wa yr well driller certified by Putnam County. P i it /L " Date of Issue Z 9y Permit Issu' Official: Date of Expiratio Title: Permit is Non -Trans rra le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 -M PUTNAM COUNTY DEPARTMENT OF HEALTH -DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR -A.W- A I;T W AT R TRE.—AT WNT SVSTIR.M 1. Name and - address of applicant: 19e wo 'Gwe d �I AJlf,"/ X""6 r G / 2. Name of project: j __4,t7A 3. Location TN: Pu )-A et-w1 �la ) 1 4. Design Professional: 0) + v,14vi 5. Address: A q'7 Z en Ceti 6. Drainage Basin: :11-1 ;` 7y, f e- c,* 4 vo 1 - 7. Type of Project: Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Ale :.Type Status (check one) ....................... ............................... Type I Exempt Type 11 Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ........... . �1-q ...... 10. Has DEIS been completed and found acceptable by Lead Agency? .....-7 ...... 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... 13. If so, have plans been submitted to such authorities? ........ ............................... k-�> 14. Has preliminary approval been granted by such authorities ?Date granted: jyy 15. Type of Sewage Treatment System Discharge ................. surface water t/ groundwater 16. If surface water discharge, what is the stream class designation? .................... 17. Waters index number (surface) ..............:........................:... ............................... J 18. Is project located near a public water supply system? ....... ............................... A& 19. If yes, name': ©f water supply Distance to water supply 4/ ;10 20. Is project site near a public sewage collection or treatment system? ................ A& 21. Name of sewage system Distance to sewage system 22. Date test holes observed 23. Name of Health Inspector 24. Project design flow (gallons per day) ............. ......... ............................... — 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? ......................... .Ala Form PC -97 2 ®• a 27. , Is any portion of this project located within a designated "Town or State wetland?_ 4/® 28. Wetlands ID Number., ............... .............. ...... ..................................................... T4 e�?t1 as d ". T.:� ............................. ` .:.. ...`...:::..:....:.......:..:: .:::..: Has application been made to Town or Local DEC off ce? ............................... 30. Does project require a DEC Stream. Disturbance Permit? .. ............................... . 31. 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/No Al,--, 32. Is project located within 1,000 feet of existing or.abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... /h 34.. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... _ Ala 35. Are any sewage treatment areas in excess of 15% slope? . ............................... Ala 36. _ Tax Map ID Number ................................. Map 22 Block i Lot ;;—�10 37.. Approved plans are to be returned to ..... Applicant k-,"^ Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall -- •--•- - -- : • Cni .t J - 'the D_ �;-a..I. 1T?_ri,:Ala IPe1- lO0- ;C Siil'; iii C11;1)IiCFtiP, iq.��F z� � -�r •�► al #fii��in'i the nrri�,C� � .. r approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwatrr plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for. review and approval. If the application is signed by a person other than the applicant shown in Item I .,the applictttiul) 111U.M . be accompanied by a Letter of Authorization (Form LA -97). failure; to comply with this prop isiorl 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: Mailing Address: ................................... 6�� r✓�/ PUTNAM COUNTY DEPARTMENT OF HEALTH ' DIVISION OF ENVIRONMENTAL HEALTH SERVICES .rrar •••t• C 'z'4 TrtT ,_ - .. `..�•"� .�..4�f -' . T 2 SH r ...�T::. F' +� raw,• r �' _ L;u I �►3 I o Ii -1li`� E �3i`i'WAGLi 1•"A*rii'Y�.1 , sysT.L' ivi Owner 2 e_ 'f ✓ _ Address.AeOy-jr 41l Located at (Street)Ar, //c � r�o�� Tax Map Block Lot >_ Lt. r---3 (indicate nearest cross. street) y Municipalit,- Jv'e'l',IXe Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test %-r__e/ Bole No. Run No. Time Start - Stop se Time n.) Depth to Water rom Ground Surface (Inches) Start Stop Water Level Drop In Indies Percolation Rate Min/Inch -�o 3 4 5 1 av3 3 4 5 1 2 3� * 4 5 r4 V 1 za; i . i ests to De repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH y -HOLE NO. jam- HOLE NO. NO.4 G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 10.0' Indicate level at which groundwater is encountered C Indicate level at which mottling is observed -- Indicate level to which water level rises after being encountered Deep hole observations made by: J/i ✓r"I Date Design Professional Name: °`�—j i ►��t, Address: e! w 1614� �%. c Signature: 9� Design Professional's Seal / 0p NEW cis o z PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION O.F. ENVIRONMENTAL HEALTH SERVICES RE: Property of Located at ��a4� %1-d TNJa A,� Kv ye_.Z Tax Map # 7 2, Block Lot .z 4-. Subdivision of Subdivision Lot # Filed Map # �' 3 Date Filed Gentlemen: This. letter is to authorize a duly licensed Professional Engineer r Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Direcior of the Putnam County Health Department, and to sign all necessary papers on.my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions. of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Very truly yours,' Countersigned: _ Signed: P.E., R ., # (owner of Property) Crs Mailin s Mailing Address: PO Ni lr ✓ Li` 211 I�tubVfLt'�( �� fv'fflc.� Vv� State Zip /o State ' `1 �1 V. Lip Telephone: ��L. �i �. y Telephone: ��H' 57 �`' �� �� Form LX-97 .. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT STREET LOCATION ' I -tM' lly f-r L� j "- NAME OF OWNER �'1'L D REVIEWED BY DATE `� Z i TAX MAP # %Z Z Y DOCUINIENTS Y PERMIT APPLICATION PC- I I ELL PEIU IIT PWS LETTER i LETTER OF AUTHORIZATION D GN DATA SHEET (DDS) CORPORATE RESOLUTION I �Z PLANS - THREE SETS HOUSE PLANS - TWO SETS VARIANCE REQUEST�� FEE SUBDIVISION SUBDIVISION 'ISION APPROVAL CHECKED FW REQUIRED DEPTH JRTAIN DRAIN REQUIRED STANDPIPES / GENERAL )CATED IN NYC WATERSHED ,ANS SUBMITTED TO DEP _eEGATED TO PCHD ?P APPROVAL, IF REQ'D ;EP TEST HOLES OBSERVED C- APPROVAL SSDS ADJ. LOTS ETLANDS (TOWN/DEC PERMIT REQ'D ?) k-fA ON DDS PLANS & PERMIT SAME tI 11969 NEIGHBOR NOTIFICATION TTER BI/ZBA 4YR. FLOOD ELEVATION fI-lER REQ'D PERMITS) REQUIRED DETAILS ON PLANS ;WAGE SYSTEM PLAN - (NORTH ARROW) ;DS HYDRAULIC PROFILE_ GRAVITY FLOW )NSTRUCTION NOTES :SIGN DATA: PERC & DEEP RESULTS CONTOURS EXISTING & PROPOSED UVEWAY & SLOPES, CUT )OTING /GUTTER/CURTAIN DRAINS COMMENTS: 70SION CONTROL:HOUSE,WELL, SSDS PERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY & EXPANSION LO TION MAP AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE eouuSE.- MPED, PIT & D BOX SHOWN & DETAILED NO.OF BEDROOMS (I WELLS & SSDS'S W(IN 200' OF PROPOSED SY . P ERTY METES & BOUNDS FUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE NO BENDS; MAX.BENDS 45° W /CLEANOUT FILL SYSTEMS CLAY BARRIER 10- FT. HORIZONTAL;S E 3:1 TO GRADE +4 FI PECS FILL NOTES ✓� FILL CE ION NOTE DEPTH G GE FILL OFILE & DIME S UME FILL I EXPANSION AREA 'TRENCH PROVIDED i jG _ 60 FT MAX. Co' 4, - vu RS• • •. u_--- -.•� -. - __ ._ -` 100% EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED ON PLAN - FROM SSTS NJ2NO O P.L., DRIVEWAY, LARGE TREES, TOP OF FELL FOUNDATION WALLS 15'WELL TO PL TO WELL, 200' IN DLOD, 150' PITS 0' TO STREAM WATERCOURSE LAKE (inc. expan) 5 TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER TO WATER LINE (pits -20') 5 ' INTERMITTENT DRAINAGE COURSE 200' /500' RESERVOIR, ETC. _150' GALLEY SYSTEMS 15'min to CDS= >5 %,10'- 4 0/o,25'- 3 %,30'- 2 0/o,35' -I %,100' - <I% min to CD discharge /100'with 182 cons day discharge SEPTIC TANK V.10'FROM FOUNDATION; 50' TO WELL FORM ST -2 04/19/2001 12:41 9149624248. JOSEPH SULLIVAN PAGE 01 PVTNAM COUNTY DEPA,WMICNT OF REA><'., R I'VI,SION OF LNV1110NMENTA,L HEALTH SERVICES A,':I'TENTION © (ANC M.-IQ t Y1_f -QZ MNAL L��pF.S� �'. N For: Fill All I :-!f F1W1ti011 roust be fully completed prior to any Trenches inspectiovs br•)Mg istade. PCf. D Cans/ 060.1 Permit # io fg {)�VIll.1'/ A�)pll( �111C r1iI]7C: Bloc, Lot �n►•�. Subdivision Narrte:or�i4,� -, /o / %�✓ �"s� Subdivision Lut # is systez►1 kill completed? Is S stoin C r1l )lete'! c Ae Is systOM ccrMStructed as per Flans, "' Is well drlRed? /If 1s we!] lucated as per plans "? Are erustort cowrof measures In place? Date: _ l v �V Date: — -- - - - -- - — Date: I. curtif:y tilut the syst.ern(s), as listed, at the above* premises lias been constnlcted and 1 have inspected ar.d verified thiair cutttplc: jon iii accordance with thL' ISSUed P(:HD Construction Permit mid approved plans and the Standards, Rules ano Regulatiurs o;' the Putrialn County =Uep�rt�a�ent. >a�..�.- . -...;, - _... -... _- ..... -...: Hui till �:l rtJl1C Cl �7�!: Cr r��- -� '►�LZ'/�ry _ ��l RA Uesibtii 1?rofessio�nal Addreas: Lie. # ;r—'c1 JO-S Furrt� I- �IIZ - -c7�) I*/ ��n_-7o04 NAME - PI ITNAM CIII INTY nFPARTMFNT nF P- 7 C6 Ile, 7,r sr-, A W� 101 4a. \ �� cam' �Z° - �.__._�.._._.� -r - ,:� � 1...___. _ ; 2 do' Of IFW 77p '44 -