HomeMy WebLinkAbout3283DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
73. -2 -6
BOX 26
..
6 1I` ati
r - L -
03283
- -°-- -� -- --: iown or ♦wage
Located at rI:C�F- tJi9c� Tax MiP Z- :131ock_Lot
Owner_ /sippllcant Name' G Qn � 1 Formed Sobdivfsion Nerve +v I abdv. Lot N�
a �.. zi 1 o s 9 ��,-_
1 a1 Address P Date.l?ermit Issued 9
Separate: Sewerage' System ballt_ by�^�� �m�r Address N
Conalsting of A off. -s0 Gallon Septic Tank and i
Water Sapplyr public Supply From Address `
or: !% Private Sapply "Drilled by Address —� SZ ���le�'Q n: u-r AL1 i1'
Baps: Ty� 1Tt� Has Eroilon Control Been Completed?
Number of Bedrooms Has Garbage' Grinder Been Installed?
�' i7 tJ Willa
Other R.egdremeate .
'I certify that the systems) as listed serving the shove premises _were'conetructed'essentially as shown on a plans of the completed work ( copies
of which.a!e attached), an in accordance with the.standards, rules "and regul s` d cco ce wi h f led'' an; and the permit issued by the
Putnam County 6i r ent" f,Healt
" �
Date Csrtifled-bX ',: P E.. R.A.
Address . Ltesnq r4 v
Any per on occupying premises served by,the abov.'e system(sl••shsli promptly take •tuch;octbn 6s may bsi n,aeeuary to sacure tha,correction: of any "unsanitary
C6 resulting Yrom such usage Approval of the sepaiate sewerage;syttam shelf become. null end void ar,won`at a Pubt% sanitary tiwer.beeomes
r _-..
avallaDle and. the approval of "the private :water wDp�Y shall' "become null and void -When a Public water supply_ eKornes available. Such approvals are
wblect to Modification, : or change :when, do the judymsrrt of the "Commissioner of Malth such revocation, modificatbn or change If necessary.
Title .
" -6. A_sc
wzjaL t,.Vr1r1jr1LLV0 nrEV1%.L Office Use Only
DEPARTMENT OF HEALTH
Division Of ,:Environmental Hea1C Services U6
04 PUTNAM CO ME
1 COUNTY DEPARTMENT OF HEALTH
. I - I a
EET AOQRESS- TOW LAGILQL%_ TAX GRID tiUMSER:-
WELL LOCATION
WELL OWNER
NA ADDRESS:
*RESIDENTIAL
PRIVATE
C3 UBLI
C3 UBLIC
IC
USE OF WELL
1 - primary
2 - secondary
g6 ❑ LIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
0 BUSINESS ❑ FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY ❑
AMOUNT OF USE
YIELD SOUGHT gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE SU gal.
REASON FOR
DRILLING
)M-NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST/OBSERVATION
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH — wkoo ft.
STATIC WATER LEVEL. 34-11"Ift.1
DATE MEASURED
DRILLING
EQUIPMENT
AQ ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG
"'C�WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING. ><OPEN HOLE IN BEDROCK ❑ OTHER
TOTAL LENGTH ft
MATERIALS: OSTEEL 0 PLASTIC 0 OTHER
CASING
DETAILS
GRADE lalf&'ft.
JOINTS: OWELDED 19THREADED 00-IHER
_LENGTH.BELOW
DIAMETER _,L in.
SEAL: ❑ CEMENT GROUT ❑ BENTONITE ]ZOTHER
WEIGHT
PER FOOT 12 ib./ft.,
DRIVE SHOE: YES ❑ NO
I LINER: 0 YES ,4N0
SCREEN
UT -AILS-.1
DIAMETER (in)
-SLOT SIZE
LENGTH
(ft)
DEPTH TO SCREEN (I Q
DEVELOPED?
FIRST
IOUF
SECONO-
GRAVEL PACK
0 YES
0 NO
GRAVEL
SIZE.
DIAMETER
OF PACK in.
TOP
DEPTH ft.
BOTTOM
DE"i — It.
WELL YIELD TEST If detailed pumping
METHOD:. 0 PUMPED tests were done as h,
OCOMPRESSED AIR formation attached?
0 8AILIf0 ❑ OTHER '0 YES ❑ NO
It more detailed formation descriptions or sieve analyses
WELL LOG' are available, please attach.
DEPTH FROM
SURFACE 1Bear-
Water
ing
Well
Dia-
meter
FORMATION DESCRIPTION
CODE
ft.
I
WELL DEPTH
ft.
DURATION
hr. min.
DRAWOOWN
it.
YIELD
gpm-
d
s Lanuirlace
4jW
1.1
4
lie
A
Qf
WATER 0 CLEAR TEMP.
QUALITY ❑ CLOUDY HARDNESS
OC6LOREO ANALYZED? OYES ONO
ANALYSIS ATTACHED? OYES ONO
STORAGE TANK: TYPE-410&X 7- rd
CAPACITY GAh
BATE
WELL DRILLEB NAME A�
ADO
� f�,%0,5 - 7
K-,�
PUMP NF MATT
TYPE .4qq4,frA ACITY
MA 7-b-6d&. AAn DEPTH
MODEL 3_X1Q--4:_2�LTAGE?-_3_ChP_
11 -1
Yorktown Medic al T hf*ir for Inc LAB " -:�' : °" `= �7
J ,
321 Kear Street Date Taken : 1-f Time: 44 P1
Yorktown Heights, N. Y. 10598 Date Rc_' d :. - Time:
if2 5
.q): '_agGA.... _ .....
_, .< Dste ;Repo tad. °SE 209989 -
., • Y.. �.
Director: Albert H. Padovani M. T. (ASCP) Collected By: 4�rejAJ ulegA &_?1L<jA,6 -
Referred By:
T- Sample Location: Asr 7
�JFiLSc�.tJ 1.rJG�L �d��LG/NG ��c xa �� - tea.
� � l�X .J�L1 �.L.Ctrrt 112 L c�N
Phone #-�'
� � r�
4A7/ 10,S Phone # ` Sample Type:
L �G47iV�2 i J Repeat Test? _ I (check each)
LABORATORY REPORT ON THE QUALITY OF WATER
INORGANIC NON- METALS mg/L) MICROBIOLOGICAL (CFU /lOOmL
_ Acidity
Alkalinity
_.Chloride
Detergents, MBAS
Hardness, Total
Nitrogen, Ammonia
Nitrogen, Nitrate
Phosphate, Total
Sulfate
Sulfide
Sulfite
GENERAL BACTERIA
_ Standard Plate Count
(CFU /1.OmL)
MEMBRANE. FILTRATION TECHNIQUE
Total Coliform
Fecal Coliform
Fecal Streptococcus
METALS (.mg /L)
MOST PROBABLE NUMBER TECHNIQUE
Copper
Iron _ Total Coliform Index
Lead
Mangg.Ae.$g__._._ ',r �euK� _... - _- :Fecal -C6112 index
Mercury
Sodium KEY FOR TERMINOLOGY
Zinc CFU = C in F mi n Units
MISCELLANEOUS
pH (units)
Color (units)
Odor (TON)
Turbidity (NTU)
ooy or g
CON = Confluent (q.v. TNTC)
LT = C = Less Than
GT = �:> = Greater Than
N/A = Not Applicable
S/A = See Attached
TNTC= Too Numerous To Count
REMARKS /COMMENTS (For Lab Use)
_ ✓Potable
Non - potable
STP INF
STP EFF
Other:
Sample Status:
(check each)
Outgoing
HNO3
_ HC1
H2SO4
NaOH
ZnOAc
_ Na2S203
Other:
LE
4 °C
_
SGT
4 °C
pH
LE 2
'pH
GE 9
pH
GE 12
Other:
ELAP No. 10323
THESE RESULTS INDICATE THAT THE WATER SAMPLE (Was) (Wasn't) (N /A) OF A
SATISFACTORY SANITARY QUALITY ACCORDING TO TH NEW ORK STATE PUBLIC DRINKING
WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE COLLE TION.
THESE RESULTS INDICATE THAT THE WATER SAMPLE (Did) (Didn't) (N /A) MEET THE
SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK PUBLIC DRIN G WATER
CODES, FOR THE_ PARAMETERS TESTED, AT THE TIME OF SAMPLE COLLECTI .
lx/ RV i 2Z, ,e - ''. -2G /'07 /_ 2 /86(Rvsd7 /87)RWE
Albert H. Padovani, M.T. (ASCP), Director
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ _ . _. ....._..._
•:�- .„'c`�''.. "s =v.... .,.. r-, r r, _ -- . -•r ... _.. :ems 'F: w. "::.�;a,:.z•::*i_ i:+A-
Owner or Purchaser of Building
Building Constructed by
Location - Street
VAJ
Municipality
Building Type
Block Lot
t
°fit; J i �t . 7 G ' e-),-
Subdivision Nhnva
Subdivision Lot #
GUARA= OF SUBSURFACE SEWAGE DISPOSAL SYSTEM
I represent that I am wholly and completely responsible for the location,
workmanship, material, construction and drainage of the sewage disposal system
serving the above described property, and that it has been constructed as shown on
the approved plan or approved amendment thereto, and in accordance with the
standards, rules and regulations of the Putnam County Department of Health„ and
hereby guarantee to the owner, his successors, heirs or assigns, to place in good
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" f.or _the sewage disposal sy_stan, : or any - =..,.
�repairs,=made`•by rc�e fa sucE % system,' exeept where id-failur'e" to operate p "ropefly is
caused by the willful or negligent act of the occupant of the building utilizing
the system.
The undersigned further agrees to accept as conclusive the determination of
the Director of the Division of Environmental Health Services of the Putnam County
Department of Health as to whether or not the failure of the system to operate was
caused by the willful or negligent act of the occupant Q tTe fuilding utilizing
the system.
Dat this day of d�'�j'- 19e, Signature
Title
Gen al.%Contractor (Owner) - Signature
Corporation Name (if Corp.)
Address
rev. 9/85
mk
V '-t FXR -' ' Vyr
Corporation Name (if Corp.)
?-b �-U� -It � Ip
Address
a
�1 p vc PIITNAM COIINTY DEPARTMENT OF,HEALTH
'Dlvldon at Envhtiomentsl HesN6 Sevlces. Carmel N Y 1051? � Provtde�Peimtt Il' " r . !
on CERTIFICATE OF COMPLUNCE
. Peeanit N tire_
CONSTRII ON PERMir FOR SEWAGEkDLSPOSAL S]rSTEM '�..�i ±.`
Iocateal at l(.(,�° W� onm Will
Ts:
�1�DA� t Renewd,_O ReAsto' p
• Otl� /ApPRcpnt -Name .
Date of Prevloas Apptovd
,8'Aat!►.1r[' -Gf OJe�1�li�no�5 CTowa�_1c��J iEi� y>p IO518
BdW1aS Type�lt/�cL► Lot Ares ` ` FIU Sectloa Od r ;
Npmbei; of Bedrooaw "r ` Deeiga Flovi :G P D -EC®Nodficiildon is �etlglred 611:FiO tnpleted
Separate Seweitsae,Syatem to ooaatst 4 �� r Galtoa Septic Taal ari' f
To 6e twastrdcted by • Addrees
"�-
Water St = Pt(bilc Supply From Addeeee
ors �P.tvate.SuPPIr Dtlaed br 5 ° 3r !7 A:t.1..,v.
Otber, Rel(ahemeate
• L��l �JI l iZ',tLl�
1 represent that 1 °am wholly and completely }responsible4fo► the'tleugn and location of the.rproposed systems) 1) tnpt the separate ,'sewage'disposal�systsm
above' descnbea =wUl be constructed as shown on the`approvaG;amendmen4ithera to and in accordance wdh the`stangardi rules.an regq a ions o s, ' Putnam
County, Department of Heafth, inA that'on completion the,eot s Cerfrfreete ;.of Construetion,Complranee^ satisfactory to the Corrimiisioner ofi Healthwill 11
M submitted to �the:Department c,antl a „written'querantse will Ds—fu►nishedtha owners his;wctesso►s, lieiisor assign's by the Duikler ;that sai0`builtler will,
Place..;in gootl' oparahnq: contlition my pail of slid` sswa9e tlisposal System durirq the'perksd bf, two (2) ":Years imjnsdiately:followiig the Wti'of the isw
anea: of: the epprovN oI_khe Certifkati_', Construction t or ipliance 'bf the original system or any rapai►s,thereto U that'tha.drllleA' well tlasbigetl aboys
will Datoeated as'shorvn on the approved pleh, and that saitl well will be `inrialletl in aecordan wit, the sta " rtls u s a r`aqu ns of Me Putnam
bounty Department of Health s s rA t a
Date , A Signed PE N R A
Address 47 t ieense No
e
APPROVED. FOR CONSTRUCTION This a'oprovsl ezpues two years f om the .date issued unless eonst -ion ot:the building hai been undertaken antl`.is
revocsible4or uuse or,may beaamentled or;motlifietl vv hen considereQ:hefessar "Dy the Commissioner Health.,.,Any chanye.or al(eration,of construction
regwres. new :perm roved' for tlispo 1 domeriic sanitary sew tprivate w ei wpply,onry.
Y
ra
l87 Date' - ' /�� r �-�L`� Title
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
r- .^' -:2 -_ .ic.,. ..'ty`'- =: ".. —+_.._ ;:.. ', ''f ='�tii+ ,..:r;:.,. `:» vm'-=.-t +:►:nom.. .:-'<. '!..- :...uny%..w....+a* %. �. sJ._
APPLICATION TO CONSTRUCT A WATER WELL1,
PCHD PERMIT #
WELL LOCATION
C et Address
Town Vill ge City Tax Grid Num�berr
WELL OWNER
Name
Mailing Address `J
v ovate
O Public
USE OF WELL
1 - primary
2 - secondary
13ddSIDENTIAL
O BUSINESS
O.INDUSTRIAL
®PUBLIC SUPPLY [3AIR /COND /HEAT PUMP 17 ABANDONED
O FARM O TEST /OBSERVATION 0 OTHER (specify
O INSTITUTIONAL O STAND -BY
AMOUNT OF USE
YIELD SOUGHT
S gpm /# PEOPLE SERVED /EST. OF DAILY USAGE CPOO gal
REASON FOR
DRILLING
ZWEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION
QREPLACE XISTI G SUPPLY ❑DEEPEN EXISTING WELL
DETAILED
REASON FOR
DRILLING
WELL TYPE
OlIkILLED
DRIVEN
®DUG
®GRAVEL
C]
OTHER
IS WELL SITE SUBJECT'TO FLOODING? YES ✓ NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:. 57
Lot No.- g
WATER WELL CONTRACTOR: Name Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES L-90
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 Nee��
(date) (signature
PERMIT
TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the
provisions of Subpart 5 -2 of Part 5 of the New, York State Sanitary Code, and
provided that within thirty (30) days of the completion of water well 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.
Date of Issue: 19
Date of Expiration: 19
ermlt ssuin f lcl
Mite
Permit i.s Non - Transferrable copy: H. D. File
Yellow copy: Building Inspector
Pink Copy: Owner
2 87 Ornnr m mrnr- WAI I flri I I mr
t
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental. Health Services
w..r.� .�.+ �..- .rn.ss•.✓�,c�...y i... .r.�.. r.- ...�. . ..— ..�rr.....vvm� s.w.a�iwT.....e. .+� -r.a nM�u .rV ....�:• � ��� .. —.. -1..� � ..r..�.a
AFFIDAVIT — CORPORATE OWNER APPLICATION
FOR PEEL41T APPLICATION SUBMITTED TO
PUTNAM COUNTY HEALTH DEPARTMENT
TO: Commissioner of Health
In the matter of application for:
I �WAID Y)
represent that I am an officer or employee of the corporation and am authorized
to act for`�d
(Name of Corporation)
having offices at y j\`4 -L - C QV%Aoyk. �� pj�Q a �� �► g�� ��
Whose officers are:
President:
' WEk-WM-N (kQ
(Name and Address)
Vice — President:
�A1Q v� 1 ��
t'j.
�.�
�•
" (Name`and Address)
'
Secretary:
(Name and Address)
Treasurer:
) 0Qwzk,&D . , 0e_k (\%4 y)
\�
(Name and Address)
and that I am and
corporation with
thereto.
will.be individually responsible for
respect to the approval requested and
any
all
and all acts of the
subsequent acts relating
e
Sworn to before me this day Signed:
U&A��^
of
19_ Title:
U1
L� &21bej-
Notary Public
Corporate Seal
8/84•
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVI SION-QF... ENVIRONMEN.TA-L.-.HEAL.TH..SERVIC.ES�,,;.�-,- -
Date 1glon-. 1, 044'x3 Z
Re: Property of '-CX-:aACk3
Located at M
�Z-Blockkj Lot_ 163 A 19 I'm
Subdivision of
Subdv. Lot # Filed Map #
T. MICHAEL DALY,,P.E.
Gentlemen: CONSULTING ENGINEER
P. 0. BOX 243
This letter is to authorize SHENOROCK N. y-
a duly licensed professional engineer,or registered architect
t�
(Indic a e
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
conn.ect�orr wi-t--h:;thi,7s-- ma ter and, -to-.supervise the.----constructi:orr.af .-said..
system or systems in conformity with the provisions of Article 145 or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Very truly yours, A
SOned 44V
Countersigne Owner of Property MY
P.E., R.A., # Address
7,
enNS11 PAY, RE.
I I L?
Address P. O. Town
SHENOROCK, N.Y. 10,r,87 A
9 -zoo Telephone
Telephone
APPENDIX B
PUTNAM COUNTY DMAR`IME U OF HEALTH - DIVISIM OF ENVIRONMENML HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEMM DISrPOSAL SYSTEMS
`P2NiiT
_ ..+..... -� :_:..tea.- ...<....,r - •�i�'i` . r -. � - ,� , +ca. � ..�... 5:
'(;Name of Cwne --- )
CCi+%=S
reouired '
X6,0. f' t.
��Yar
A6 e_.
SYSTalS
fi4 notes
new aec.
contours
DA
BY
(Street Location)
YES NO DOCUMEM
Perni.t Application
Corporate. Resolution
°-� Plans - Three sets
Engineers Authorization
Design Data Sheet MCS)
Deep Hole Log
Consistent Perc Res;ilts
Perc Hole Depth
DATE
X
200 ft. reservoir, e
tc
150 ft. trigall /gall.
s/s C
CUBDIVISICN
Per` 4
(3) Fill
cd �—
--=two sets
_
per-mit; F -vs letter
Request
GENERAL
Legal Subdivision c- °
Subdivision Approval Checked
P-c-a_ proval SSDS Ad-J. Lots Checked
-Wetland (Town /DEC Pernait R & D).
Data Cn DDS Plans & Permit Safe
REQUIRED DETAILS CN PLAINS
Swage System Plan - (nor -Un arr;-w )
Selvage System Hydraulic Profile - Gravi =�_v F1cw
-Fill Profile & Dimensions - Voiu-ne
J Box;Trench /Gallery; PumD pit details
Septic Tank - Size, Detail � � v
Well Detail, Service Line if ever
.Construction Notes (gr nceY` rate)
Design -Dati: Perc and deep results
Two-Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footin /Gutter,Curtain Drains (discharge OK)
Perc & Deep Holes Located
Representative of primary and expansion
Expansion Area; shown; gravity flcw,suff. size
If Raped Pit & D Box Shown & Detailed
House - No. of Bedroons 57--
Wells & SSOS's Win 200 ft. of Proposed System
Property motes & �._.
House Setback Necessary (Tight lot)
House Sewer - 1 /4" /ft. 4 1'0; Type pipe
No Bends; Max. Bends 45° w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Tre- -s,Top of fi'
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, lake (inc. e.-,Pai
15' to Drains - Curtain, Leader, Footing
35'to catch basin,stormdrain, piped watercour:
0' to Water Line (pits -20')
50' intermittent drainage course
Septic Tanks
10' frcn Foundation; 50' to well
15' Well to PL 9
0400" e2 &.17 ea
o-
RnMM CUWY DEPAFUMENr OF Y.
•' • F ENVIRCNMENTAL HEALTH'SERVICES
DESIGN DATA SHEET SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO.
��
LXX
���,�����jjj iL e.SS•tj.. .._ (.�. =-0-r �n�:....;� ^.
. •- ` T�- .
Located at (Street) Kw t-t� `'ZUfh� -bee: -7, Block i L Lot l �
(indicate nearest cross street)
Municipality Watershed -7E�p �, LL-
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Date of Pre- Soaking
Date of Percolation Test
HOLE
NLMER CLOCK TIME
PERCOLATION
PERCOLATION
Run Elapse
Depth to Water From
Water Level
No. Time
Ground Surface
In Inches
Soil Rate
Start -Stop Min.
Start Stop
Drop In
Min /In Drop
Inches Inches
Inches
7�
2 �� ��� i �'g 7 17
3 I j . lB r i''t' I
3
7a
4
5
1
2
3
4'
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 snbmitttd
for review.
2.. Depth measurements to be made fran top of hole.
rev. 9/85
TEST PIT. DATA REQUIRED TO
DEPTH HOLE NO. HOLE NO. HOLE NO.
_G..L.�tL
2' +r
3' e r
5'
y�
A
6'
7'
o�
8'
�o
9'
10'
11'
12'
13'
q
14'
...�. e = INDICATE•wI�V ,-A' , :�'.1Qk - -- _,.I
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: �";� DATE:
DESIGN
Soil Rate Used `t[; Min /1" Drop: S.D. Usable Area Provided �`'UDea
No. of Bedrooms .4 Septic Tank Capacity I gals. 9)iW `
Absorption Area Provided By I(OB, - ago
Other - �j -`',"i�
Name Signature
Address r 3 SEAL
THIS SPACE FOR USE BY HEALTH DEPARUTM ONLY:
Soil Rate Approved sgaft /gal. Checked by Date
�rxF z rx'pL �€ „+ f,ae ctta
V
LOT
c0. x . 1.1968 AC;
lb
i
LOCATIONS
L R V
t {M � 3i .5 zn�?. AFT' '0 �' ...s..i& On',
x ,_` .. -:. � cc.. +� M"St '�� ..t,. J,;,., .., ... /iii, •�,., ....,.. 4). .,� b :k2'f';�:x t '. ig.� ,S�Y.-.yy ,t• _ L- � �
•{,,::Gw •. -h ",F �,• 'A .c •'3k � .. x'1
J �
:��
-V �1�p SA, p
aCONSTRLJCTED AS,INDI& ONx3HiS PLAN AND--THAT THE'
' ( r'TM iqs I ME,H]+FbRE ,(1 glas COVERm OVER:
N W i 'ONS1'RUCTE 1 IN ACCORDANCE 1NTTH ALLS
sxSTEI�
`THE RUBS ANQ it¢ - IL 710NS OF 7H£ PUTNAM COUNTY,
• � � pF:f�AFt1MENT�OF HEALTH 5 .,- ,:
pR
z
;YUtnam.C_ouniy llepartimeni birl, xeaith
Jivsipon 'of Enviror.•• n al Ilealtn Servicoe
2. ` _.ApDrove(C .o noted : x conformance with
ryC� ;pP?1caL 'Hal co a.d'Regulations of. the
?utnam C a ;cy ea D partment.
a. i Qlanatux'e "T.it
SEPTIC TANK J
.` A 61F
d�
REQUIRED '& INSTALLED - ?
.1250 'GAL MASONRY SEPTIC TANK
.168 LIN FT, OF TRIGALLEYS
.7' DEEP CURTAIN DRAIN '
NOTE:
HOUSE, DRIVE & WELL ,
LOCATIONS AS PER" SURVEY
BY' DON DONNELLY
AUG. 29, 1989 j
a
yI�
C,
d ,
4•
s�
PLAN @ SCALE 1" =30'
WELL
..AS BUILT. SEPTIC :, SYSTEM FOR
DEVON.: DEVELOPMENT CORP.
LOT NO.B;`' HUNTWG RID&
FM2276' lAA- 82- 11- 15 \19 \8'
MILLER : ROAD .
TOOT NAM OF -. PU RJAM VALLEY
PUTNAM CO. N.Y. SFpT'29,1989
REV.ISIONS::. 1_ CAR DtWY, FIX ..BOX U3 Smotoc I Y -
SEPTIC TANK
57' -5'
22' .
DIST. BOX 1
1191
POINT 2.
126'
106-1O'
POINT 3
132' —g'
114' -9'
POINT, 41
139' -8°
125' -5'
POINT 5 '
116'
125' -8"
POINT 6
106' —g'
118•
POINT 7
98'--
107• -7°
L R V
t {M � 3i .5 zn�?. AFT' '0 �' ...s..i& On',
x ,_` .. -:. � cc.. +� M"St '�� ..t,. J,;,., .., ... /iii, •�,., ....,.. 4). .,� b :k2'f';�:x t '. ig.� ,S�Y.-.yy ,t• _ L- � �
•{,,::Gw •. -h ",F �,• 'A .c •'3k � .. x'1
J �
:��
-V �1�p SA, p
aCONSTRLJCTED AS,INDI& ONx3HiS PLAN AND--THAT THE'
' ( r'TM iqs I ME,H]+FbRE ,(1 glas COVERm OVER:
N W i 'ONS1'RUCTE 1 IN ACCORDANCE 1NTTH ALLS
sxSTEI�
`THE RUBS ANQ it¢ - IL 710NS OF 7H£ PUTNAM COUNTY,
• � � pF:f�AFt1MENT�OF HEALTH 5 .,- ,:
pR
z
;YUtnam.C_ouniy llepartimeni birl, xeaith
Jivsipon 'of Enviror.•• n al Ilealtn Servicoe
2. ` _.ApDrove(C .o noted : x conformance with
ryC� ;pP?1caL 'Hal co a.d'Regulations of. the
?utnam C a ;cy ea D partment.
a. i Qlanatux'e "T.it
SEPTIC TANK J
.` A 61F
d�
REQUIRED '& INSTALLED - ?
.1250 'GAL MASONRY SEPTIC TANK
.168 LIN FT, OF TRIGALLEYS
.7' DEEP CURTAIN DRAIN '
NOTE:
HOUSE, DRIVE & WELL ,
LOCATIONS AS PER" SURVEY
BY' DON DONNELLY
AUG. 29, 1989 j
a
yI�
C,
d ,
4•
s�
PLAN @ SCALE 1" =30'
WELL
..AS BUILT. SEPTIC :, SYSTEM FOR
DEVON.: DEVELOPMENT CORP.
LOT NO.B;`' HUNTWG RID&
FM2276' lAA- 82- 11- 15 \19 \8'
MILLER : ROAD .
TOOT NAM OF -. PU RJAM VALLEY
PUTNAM CO. N.Y. SFpT'29,1989
REV.ISIONS::. 1_ CAR DtWY, FIX ..BOX U3 Smotoc I Y -