Loading...
HomeMy WebLinkAbout3326DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.05 -1 -85 BOX 27 IN a J 0 1 02 1-9 jr 03326 ev. 3/' �1 �l PUTNAM COUNTY DirPAJKTfi 441' Uk nr;.v,rn Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Mast Provide C7� - P.C.H.D. Permit 0— tUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Putnam Valley or I I �! _tS.l �1C1 NVINI iP - - -- . _. �T_axXsr! -- n Co Owner /applit�nt Name Dawn & John Kubi chko —Formerly - Subdivision Name Camp Look ,. Lot # 166 -170 Matling Address Ridge Avenue Putnam Valley Zwp 10579 Date Permit Issued Separate Sewerage System built by Joyl and Construction Cor'— Address 222 Sprout Brook Road Putnam Valley Consisting of 1000 Gallon Septic Tank and 500 LF of 24" Trench Water Supply: Public Supply From Address or: X Private Supply Drilled - Beal & Sons Address PO Box B Brewster, N.Y. 10509 Building Type Modular Has Erosion Control Been Completed? Yes •weer Number of Bedrooms 3 Has Garbage Grinder Been Installed? ��c-.. F � 0 Other Requirements 1 1 1 1 1 1 a 1.11 U I K U D r , r r: v e l 1 1 1 _1y!JI.IU mi-ell I certify that the system(s) as listed serving the above premises were constructed eaps@�tY �aen� tans of the completed work ( copies of which are attached), and in accordance with the standards, rules.and regulations? a car d t e * plan, and the permit issued by the Putnam County Department Of Health. • W i,;;,:�'ti3 r` � � Date Sept 25, 1989 Ce►tifbd Dy `-.y ;, a'` + P.E.�_R.A. Address 1 Northri d Road P kskl-l=Y "' N 566 License No, 27846 CA z7a4fr Any person occupying premises served by the above system(s) shall promptly take such action a ry tocu►e the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall becdt>Pe �1l aafbon as -a publ': unitary sewer becomes available and the approval of the private water supply shall become null and void when a pubRaaWo if becomes available. Such approvals are subject .do modiflcca°tilofi or change r/ when, in the Judgment of the Commissioner of Health,, such revo' ton, modification or change Is�nnee-coulilryy.. Oats % / �I& el By 1 e -IO1L.I�� Title �L—"' PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services. Carmel. N.Y. 10517 Engineer to Provide Permit # 'ISED FOR FILL RMIT FOR SEWAGE DISPOSAL SYSTEM .....��Y�lrlax -��. v.r..w �. ��,���- /� -YLG 11"u \: v..r.+.. ea. ....• �.. ... _..._. .... �_ .r. - -w on CERMCATE OF COMPLIANCE Permit N y --�` Putnam.._Val_1_,,ev., .__. Subdivislon Name Camp Lookout Subd. Lot 1 166 -170 T. Map 54 Block 7 Lot 5 Owner /Applicant Name Dawn &John Kubi tchko Renewal— Revision ry J. Date of Previous A pproy el Mailing Address 33 Ridge Avenue Town Putnam valley NY 7Jp 10579 Building Type Modular Lot Area 1 .1394 Ac. Fill Section Only LJ Depth volume Number of Bedrooms 3 Design Flow G P D 600 PCHD Notification Is Required When Fill Is completed Separate Sewerage System to consist of 10 0 0 Gabon Septic Tank and 500 L F of 24" Trench To beconehuctedby Howard Gragert Address Oscawana Lake Road Putnam Valley NY Water Supply: Public Supply From Address or: private Supply Drilled by Beal _Address Brewster, N.Y. Other Requirements i Ti min oT Hum t•ira ye I in N I ace 1 represent that I am wholly and completely responsible for the design and location of the propotielle st . %that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accord ;%A,ruiesandreguiationsof the Putnam County Department of Health, and that on completion thereof a "Certificate of Construq% tbp to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, ,hi r • h scby the builder, that said builder Will place in good operating condition any part of said sewage disposal system during the9pe It etSFp diately following thedate of the Issu- ance of the approval of the Certificate of Construction Compliance of the original s st� � e s eret ; &t4t the drilled well described above will be located as shown on the approved plan and that said well will be installed in ccor4ar,O dh 1! s, fk Md ►egu ads of the Putnam County Department of Health, y + r .r F Data July 24, 1989 signed s C e P. E. R.A. - Address 1 North i e Road ° eepp% ki " NY 105Z,iicense No 27846 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issueC qunfA6v.co �f thd° building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Comr��sgler/pl�f� Any change or alteration of construction Rev. requires a new permit. Approved for disposal of domestic sanita sewage, and /or private r SL 01WI&R l/87 Date 1 8 s e e Title PUTNAM COUNTY DEPARTMENT OF HEALTH Rev. 3186 Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer to Provide Permit # on CERTIFIC J�F C �J CONSTRUCTION PERAHT %SGE DISPOSAL SYSTEM Permit # ►/ Located at 17C�t y /�oie tJl �31r Town or Village y /y Subdivisfim-Name __Sabd.-Lot# lids 1C7 Renewal_�_Revision ❑_ Owner /Applicant Name DOW 14 � Ll 4 t �C'+it<C , Date of Previous Approval 3 Mailing Address t`� IG = F� 1 Town Zip Building Type PV•l: a"A'e- wo ;:i2m it Lot Area FBI Section Only Depth Volume r Number .of Bedrooms Design Flow G /P /D PCHD Notification Is Required When FIB is completed Separate Sewerage System to consist of Gallon Septic Tank and L. C t �ti t tJ� Stl iy �t r-,,A •T 1�� C:idL� 5 To be constructed by A - F IOV tTO 4 SO t i 15 ; i t3 c Address "�irn4 V-J%iC- 2 +ZJ -4 (JS S "'n-4 / t.i V.. , iz3iU Z Water Supply; pl&nc Supply From Address or: Private Supply Drilled by15 .E 512L-4 ZAddeess Other Requirements (_,fs/RPfTt:t/ VW11,1 GfiJ represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to be submitted t0 the Department, and a written guarantee will be furnished the owner, his successors, heirs or a ns by I place in good operating condition any part of said sewage disposal system during the period of two (2) years 'mediate ance of the approval of the Certificate of Construction Compliance of the o iginal system or any repairs ther o; 2) that will be located as shown on the approved plan and that said well will be installed accordance with the stand s rules an( County Department of Health. Date Sign APPROVED FOR CONSTRUCTION: This approval expi revocable for cause or may be amended or modified when requires a new perms Approved for disposal of dome Date Lo-h- By - Rev. 3/86 CONSTRUCTION PERMIT r..Y, vn+R,.,/ .-.. LAAA if,+1MS c •9-i . /vv License No _r • /v rest n.d from the ^date i ssued unless Construction of the building has been undertaken and is co ecessary by the Commissioner of Health. Any change or alteration of construction c sewage, and /or jjvate water supply only. Title Is PUTNAMf COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer to Provide Permit # on CERTIFICATE F COMPLIANCE Permit # DISPOSAL SYSTEM! Located at Town or Village 1504C S4. Subdivbilon Name Subd. Lot # , a T Block Lot 114A t 117 Renewal— ❑ Rovision ❑ Owner /Applicant Name a 1� P�14'� �s �A / J • A Date of Previous Approval Mailing Address d�A�e� Aaa- I..'ltli° Town Zip Building Type PF WO Lot Area L"'3 �'3 ACIPME5 Fill Section Only Depth 3 ' volume. Number of Bedrooms Design Flow G /P /D ��� PCHD Notification is Required When Fill is oomplotell Separate Sewerage System to consist of I WV Gallon Septic Tank and SOO CO 2' °t 1 �02°?'itta0.3 it AC O� � �S t w! d r h9 �To be constructed by A' �� � D Water Supply: —Public Supply From Address or: _��Private Supply Drilled Address Other Requirements represent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that th a t se fspoS87,s 1 above described will be constructed as shown on the approved amendment there to and in accordance with the standard , rul ti .0 3o he County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory t a o i¢�tl`,� eaith be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns b build ii3?�• side► place in good operating condition any part of said sewage disposal system during the period of two (2) years I ollow the3Ja�t�F the' ante of the approval of the Certificate of Construction Compliance of the r' inal system or any repairs ereto; 2) th drill . ,fcJ}' d will be located as shown on the approved plan and that said well will be install ac_ cordance with the st ds, u a the P County Department of Health. Date �ag. / signs ,...e.. 14 9A.. M_V_.JaM- 2. APPROVED FOR CONSTRUCTION: This approval expiresf lFb year from the date issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction .requires a new permit. Approved for disposal of domestic sanitary sewage, and/or p 'v water su /only. Date , �� By �'�" L itle Cp —Sciw. Lt 445, Towm� TAW , Ion pL aft r ad Date '— ~ an to WAx nor f Hwilih. Any change or V/ sup,ly only. Title WELL UU1v1rLL11%JA B%nrUA1 DEPARTMENT .OF HEALTH _--Divie-ion Of. Environmentil Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET ADDRESS: W'GRIO NUMBER:— Ridge Ave. Putnam Valley, NY 4- ' WELL OWNER NAME: ADDRESS: John & Dawn Kubichkof.110A.Johnson St. qLkPeekskill,NY 9 PRIVATE ❑ PUBLIC USE OF WELL 1- primary' 2 - secondary 29 RESIDENTIAL ❑ PUBLIC SUPPLY 0 AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM. 0 TEST/OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY. 0 AMOUNT OF USE YIELD SOUGHT 5 gpm./NO. PEOPLE SERVED gal. EST. OF DAILY USAGE REASON FOR -DRILLING CD NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY. 0 TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 505 -ft. STATIC WATER LEVEL 70 ft.1 DATE MEASURED 2/7/89 DRILLING EQUIPMENT IN ROTARY 12 COMPRESSED AIR PERCUSSION ❑ DUG .❑ WELL POINT 0 CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED 0 OPEN END CASING. M OPEN HOLE IN BEDROCK 0 OTHER CASING DETAILS TOTAL LENGTH 21 ft. MATERIALS: El STEEL ❑ PLASTIC 0 OTHER LENGTH.BELOW GRADE 20 ft. JOINTS: ❑ WELDED fia THREADED ❑ OTHER DIAMETER ti in. SEAL: 12 CEMENT GROUT 0 BENTONITE ❑ OTHER WEIGHT PER FOOT 12- lb./ft. DRIVE SHOE: DYES 0 NO LINER: 0 YES -E] NO SCREEN A I I . DIAMETER (in) 'SLOT SIZE LENGTH (it) DEPTH TO SCREEN (f Q DEVELOPED? FIRST GRAVEL PACK ❑ 1E1 ❑ NO GRAVEL SIZE DIAMETER OF PACK in. TOP DEPTH —ft. BOTTOM DEPTH it. WELL YIELD TEST If detailed pumping METHOD: 0 PUMPED i tests were done is in- (I COMPRESSED AIR formation attached? 0 BAILED 0 OTHER ❑ YES ❑ NO It more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. DEPTH FROM SURFACE 1 Water pear- ing Welt Dia- meter In FORMATION DESCRIPTION CODE. ft. It. WELL DEPTH It. DURATION hr. min. DRAWOOWN It. YIELD 9prn. d S Lainurface 1 Diiiing in overburden clay & b1dr., 1 T4 -t-lock at 1-1 � 505 6 485 5, 1-1 2 21 D -illing in rock,*set casing,grouted. Lll:lna in rock grariite. WATER 0 CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS A U Ty ❑ COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? N YES ❑ NO A STORAGE TANK: TYPE Well Xtrol 250 CAPACITY 44 GAL. PUMP INFORMATION TYPE submersible CAPACITY 5 9 Gould _770-1 MAKER DEPTH MODEL 5ES07412_ VOLTAGE 23'tiP 3/4 WELL DRILLER NAME P.F. Beal Sons,, InCq BAT /12/89- PO Box B 9 ADDRESS SIG? - Brewster,NY 10509 001A PUTNAM COUNTY DEPARTMENT OF HEALTH -- - DIVISION OF ENVIROiToMAL HEALTH SERVICES - 4 -♦:�vm .y�.>.R. y Y.�P7'.3`.- R:�_Wir C_.�'.. 0/:'_n wM..r..T .v:w. l / owl or Purchaser of Building Section Block Lot Building Constructed by Location - Street Subclivisicfn Dame Municipality Subdivision Lot # Building Type GUARANTEE 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 "a f'°�a� Hof Corisr�,c ��:n- C;pli3nce". far:.he::sa e_isp�asal st;:...nY -are 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. i 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 of the building utilizing the system. Dated this day of 19 ) /, AV, / eA114,'O � V , � Ge al Conir'actor (Owner) - Signature Corporation Name (if Corp.') 13 �5 3 69--� d.�,Jr, -nom �✓ fix_ , 2r - rev. 9/85 mk Signature r Title zJa 47j Con x Cv/ . ration Name (if rp.) tT E°�C9V f Box 224 - BREWSTER, N.Y. (914) 279-4945 WATER ANALYSIS REPORT'- SAMPLE NO. FAUCET WELL SOURCE: John kubicfko Ridge Rd. Putnam Valley, N.Y. COLLECTED: 7 - 2 8 - 8,9 BY: P.F. Beal & Sons BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 0 per 100 ml: This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected 7-30-89 FS1P1j Jl' - J1\ .:!'itiV Llama= Sm I=ION � / /J� �- l ►" � P M?T a A�✓�" 'l M a OR Su�DIZTI5IG�1 LOT a a. SDS area located as b. Fill sec` ica - Date 2.1 barrier. cw-N7 - -R o 1 Z r f5 C lj XF-9 NQ [Zu�sn; f • arrorove-dyplaris_ I=- bx-= AVG.DPTE c. Natgraj, soil not strizzcd . d. tone Fsz, etc., creat- - than 15' fran SDS area. e_ ft. from water.- course /wetlands. II. DISPOSPl, SYsT a. Septic tank siz1, 250 b. Septic tank ir-L c. 10' miniu= fran fcur_ on d. IIb 900 be ^rs, cle=_nout witain 10 ft- of 45° bend e. DISZ: Tj -TICN BOX 1. KU outlets at sa- - el evert; an - water ts' 2. Proter..ed be cw f=ast 3. Mini= 2 f= oric; n`1 soil i>---=rieen box and ire:- Ic'_es f. JU& TICN BOX - yronG_v set 1. Lznq-En re-c'u red - y Ie_ ^_g`*i installed 0-6 -b 2. Dis to rics to wat= rc -ur =C sue= �,--n ' /y frf t. 3 . L-- to 1 1 ea ac= crdi-_q to o? sn 4 Distance to c--=e- 5. Slane of trench acc_atable 1/16 - 1/32 " /fcot 6. 10 f--t- fran vrcnc"v l? ne - 20 feet-- foun-da 7. Dent_h of trench < 30 inches fraa snrace B. Roan all cw i for ex-.a_-sicn, i . E csicn c--n=o urcvi de: i cn slcces cr ==eta- than 15%- I` 1 I 00 57.1 I � I i I I I �-I I I I I °. Size of crrvel 3/4 chart =�- 10. Deotn Qf gravel y-1 trench 12" mini= - L. • Pine e--- s =-Iza i h. _F'?m-D OR DOSE SYS —S g e.. J Ze OZ: i.JU -- C24-:--"-, 3. P t arm, yi ss-? /a7adio 4 P=. easil V acces =ible w nhol°_ to anade 5. F? -s-t bcx b==f1 ed 6. Cycle w_ bv Health Dena- inen . est&e ed flaw per cycle IV. fi::USE a. E^, a Iecated rer aborcved plans. b. �*c--r of LTcams .. V. PE T a. Well as re-- a----)royea ylans b. Distance free SDS are.= ra=ssred (b,J eft. - c. C_s?nq 18" above grad= - d. Su -_ace areur^ well accentaHe. V? _ G`4 ALL 6+iORK, cH—lP a. Bcxes vrooe_ -lv crcut= b. P_il. Pines bade •lied c. All Pines f f� with inside of b,-,x d. Eackfill hate ial ccn --ins stones < 4" in diameter e_ C" --tain drain installed according to Dlan f. Curtain drain cut_all protected & dir_to exist -wat g. Fcotinq di----ins disc: =ce away fran SDS area h. Surface water Drot_- e-=lion ademate i . E csicn c--n=o urcvi de: i cn slcces cr ==eta- than 15%- I` 1 I 00 57.1 I � I i I I I �-I I I I I PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 To Whom it May Concern: Re: Revised - For Fill Kubitchko Ridge Ave. (T) PV TM #54 -7 -5 Permit *PV-7 -87 August 21, 1989 ENID L. CARRUTH, M.P.H. Public Health Director JOHN KARELL Jr., P.E. Director Please be advised the delay in the final approval of this project vas due to necessary modifications to the design of the sevage treatment facility. Such modifications vere approved on August 7, 1989. .. .�._........ ........ ., .. _- .. , o ... .r. vz a .. -,... r �- ,.... ... - ...._ _.� _.. `. y -_y • x .. < .- •, .. ...+J.�.. .a.v. .ra... .. .. .. v�._r ... ... -_. . _ ..y _,.�wre... Joh Karell, Jr., P. Director Environmental Health Services JK /jp PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 John Romeo, PE 1 Northridge Road Peekskill, NY 10566 Dear Mr. Romeo: August 4, 1989 Re: Revised - For Fill Kubitchko Ridge Ave. (T) PV TM #54 -7 -5 Permit #PV -7 -87 ENID L. CARRUTH, M.P.H. Public Health Director JOHN KARELL Jr., P.E. Director Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: Details for trench, junction -box and septic tank must be provided. f 4i i[tic'rnmm nt'.c 3. 0.111., reCw�j �F (� , -.iJ _f A_ °� P( �. . _ k' _ _ . tom_ this application will be considered further. LCW: j r Very truly yours, Lawrence C. Werper Assistant Public Health Engineer 0 1 A Y�wa. .rr +.II'. wme,.Oly. O.4 M1..I��... F•- _'SR:+6 ?� :. � , 9P ll�, �,,Y 4 :IXyt., eti rrb�t �'4 9I.99♦ :.�'iID•:. ti' .. O.�t. •/- T_•v:n�'Y.• . •� •`y :'�''i1 '� "'?'t::f S3Y 'i1�'S'Ti'P'^.'iilh i1til.'S`� ''fY. Iq'" i ri ., "Vi°:'!1 .. TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION Street Address pGc P�.'e 0(jU� Town /Village /City, Tax Grid Number Pj—% a yaw V ALA_ e ( S114� � , 9_)Lor_%C , -7, L.cT 5 WELL OWNER Name @1ZESIDENAAL 0 BUSINESS ❑ INDUSTRIAL Address il..L� .t�y►°f o IJ - js. O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION C3 INSTITUTIONAL ❑ STAND -BY a�-rYivate 0 Public ❑ ABANDONED ❑ OTHER (specify ❑ USE OF WELL primar 2 - secondary AMOUNT OF USE YIELD SOUGHT ;D gpm /# PEOPLE SERVED N�, /EST. OF DAILY USAGE gal REASON FOR DRILLING NEW SUPPLY ❑PROVIDE ADDITIONAL SUPPLY ❑REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL OTEST /OBSERVATION DETAILED REASON FOR DRILLING JELL TYPE DRILLED DRIVEN ODUG GRAVEL OTHER .S WELL SITE SUBJECT TO FLOODING? YES ✓ NO F WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: GaN�p L-ooy.o,j-T Lot Nos f(o(o,i(o - re S, 1 r-7 I ATER WELL CONTRACTOR: Name Co Address: S :PI?B:.IC. -WATER SUPPLY AVAILA-BLE TO S-TT-F;c. I AME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY ISTANCE TO PROPERTY FROM NEAREST WATER MAIN: ti A/.. )CATION SKETCH & SOURCES OF CONTAMINATION PROVIDED [:]ON REAR OF THIS APPLICATION ON E SHE (date) �fi,. t re) — -- PERMIT `f TO CONSTRUCT A WATER WELL Rj This permit to construct one water well as set forth above is granted under the 'tip =i provisions of Subpart 5 -2 of Part 5 of the New York Stiif 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 H61.th 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 - - -� ermit Issuing ici �nv.mif• ie• Nlnn...Tv.�..r- �........�L.1.. DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 ..�.x-.�- ;:= •��:itisx . ..'+.._. a:R :T �.:..n:...::�': �: .,w`.-:r 7, _ - "_�.: _ .. i., .�..� :: APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # "All - 7 -, WELL LOCATION Street Address ?-% OGt-z Aoiv O(jz Town/Village/City Tax Grid Number Pv 'i o.1 A0zt% %4 A&14- y SVE-0'"i 5A- ;5L-cc K . -7, , L.cT 5 WELL OWNER Name / Address 5 C /s. r<? 0145 �kEM0s L-r0 / j-A+ l g1;-=0 -T ossi#J ..s4 iom,& �'rivate O Public USE OF WELL rimar p 2 - secondary 9 RESIDENTIAL ® BUSINESS O INDUSTRIAL O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O FARM O TEST/OBSERVATION 0 INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE gal REASON FOR DRILLING EW SUPPLY OPROVIDE ADDITIONAL SUPPLY OTEST /OBSERVATION O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING 1-400 sa —to Date of Issue 19___ Date of Expiration:,, --- 719 q 2 WELL TYPE DRILLED 13DRIVEN ODUG ®GRAVEL []OTHER IS WELL SITE SUBJECT TO FLOODING? YES v-' NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:_ C-Aly\? 1-0e> e-0 Lj -T Lot No BG(o, i(o-7, I!n64 1&- i 1,7 WATER WELL CONTRACTOR: Name 'o e Sa=Lac-°'(�- 0 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAMI OF...,PUBLIC WATER SUPPLY: ^' ( ry _ = TOWN /VIL /CITY DISTANCE TO PROPERTY.FROM NEAREST WATER MAIN: N �� LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED []ON REAR OF THIS APPLICATION ON E SHEET (date) si nature)" 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:,, --- 719 q 2 it Issui f ' Permit is Non - Transferrable s PUTNAM COUNTY DEPARTMENT OF HEALTH v..OVO. ::. "4n "..Ilf-�'.�'H'. :M1wsrw.:A��.S. -:p. -: •, ..._ ! � ..- ._ � "q"Y�� -. .. .._ - ..rn,.:.� se;;,+r:....(;.iroi.o •..� DIVISION �OF�ENVIRONMENTAL HEALTH SEAV•ICES Date 4I -1 -e-7 Re: Property of�� Located at 9-,OC.�5 PdGN�,Ie, (T) 154- Section - Block °% Lot 43 Subdivision of C,A ,p Subdv. Lot # Li y ,ItJ, IL38 Filed Map # % Date Gentlemen: This letter is. to authorize �y[�/ �jj/G,� �h�iKTCl- a duly licensed professional engineer V-11 or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the,Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and .to supery se'tfnd 'constriic'tiori VY" "Sa1'u'--"" °- -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 trl:ly yours, Signed Countersigned: P.E. ,- :A: , # .)p q ' Address ®SSinr��' /�l•` /- /ESL Telephone Address Town - telephone PUTNAM COUNTY DEPARTMENT OF HEALTH .. ...wx�. .:�a- .ice......,. :.r.. i ^= '��.V 1.5��1�f �"/t''- .L' 1V � l�(.1�1V�11".�V`l`1- �L�ti�l`L"1 t1" �'L�itC N'�Il:`L.7•:: , �" � �h.�'- :�-= si,..= .�-.'.i,o.. -. r. r.. ..� ..� .•- ...�a.. Date i'Z 1 -3, t 8r. Re: Property of OMS I:V-%664pS 1--M % J, AakLS-reip Located at 'Q %r,>C4C- A*,c oaUg . P�2 1 aaAd-A kffi . ft . r4 b (T) Section] Block -7 Lot Subdivision of P !..®py—®S" Subdve Lot # Ifolo� ��°1, 1C�€3 Filed Map # 1(q , 1-70 Gentlemen: "79 G Date This letter is to authorize,,ezwe "G4 -�ncr - a duly licensed professional engineer M� or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in "`- ""'�•'conneciioii`wYin` tni`s' rria �t'er'- "ana"t'u" sl�per�ise`�tr,e'Yc3ia crucio�i'-of' '�a�`�u��� °-' -° =- °•-° system or systems in conformity with the provisions of Article 145 or 147, Educatio ivt� �C4' �Nce sy �t •9 tary Code. '�-- � 0519$% Countersigned: P.E. , RoA. , # 061 g 16c `J J' S Q 0pdJry Address blic Health Law, and the Putnam County Sani- �S�a�«3� v � •�•, 1-Q��2 9A -'1 (o2 -'? O o 9 Telephone Very truly yours, Signed 1�?i�Lll Owner of Property 13 e ��" Address Town Telephone LAWRENCE SHACTEL, P.E. 14 SUSQUEHANNA ROAD OSSINING, NEW YORK 10562 t>G'� -,. .. N�R'0�.1: �w:.T'.... �rt4C �t.• ic3�... 1.e��'t.- K- ��'. "�..rrY+')' -•F+: �•Y::r�N.b t.t :awatWtsa�J14� .. .t.. Transmittal of Drawings, Specifications, Samples, eta To P,-j+nr,. Coti-n:tti D,,m- (�00. , I Transmittal No. o--rOwn ce'nJer'° Date r Carw"eA 1 N "1, ► o r'% L Attention • ©k ^ 4La I( Jr• '• C Subcontractor Prepared by L DRAWING NOS. DATE COPIES DESCRIPTION i IL Awl IC „ G Wa4ei�- Wer,11 n D a4-,r :5)%ee4- Or Nam The above mentioned are being submitted for. EkYo'ur Approval ofour Information ❑ Final Approval 1!rfour Use Kindly Return Copies ❑ With Comments Remarks cea qi (o-x2 -70! r Please acknowledge receipt by returning signed duplicate copy of this transmittal.. Distribution [] Corrections [] Corrected ❑ Your Comments [] With Approval Received by Date AISH CONSTT% ON COMPANY IVIYION OR GUY INGON COMPANY pUnM COUNTY DEpARTgENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES .•1 SUPPLY &SUBSURFACE SEWAGE DISPOSAL SYSTEMS . E, V . REVIEW SHEET - CONSTRUCTION PERMIT (Name of Owner) AW� 4 1-, U. BY r,ation) DOCUMENTS Pen-nit Application Corporate Resolution Plans - Three sets Engineers Authorization Desigd Data Sheet (DDS) Deep Hole Log Consistent Perc Results 30" Perc Hole other S/s SUBDIVISION Perc (3) Fill ad House Plans - Two sets If PWS - Letter if well1pendt Variance Request RBQUnM DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench/Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data TWO-Foot Contours Existing & Proposed Driveway & Slopes Cut Footing/Gutter Curtain Drains Perc &,Deep Holes Located --Representative*of Sewage & Expansion Area House - No. of Bedrooms Wells & SSDS's w/in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1/4"/ft. 4"0; Type pipe No Bends; Max. Bends 45' w/cleanout SEPARATION DISTAISKM SPECIFIED ON PLAN Fields 101 to P.L., Driveway, large Trees 20' to Foundation Walls 100' to Well; 2001 in D.L.O.D, 1501 pits lbol to Stream, Watercoursej Lake (inc. expan) 151 to Drains-Curtain, Leader, Footing .35'to catch basin,storndrain,pipea watercourse 101 to Water Line (pits-201) - 50' intermittent drainage course Septic Tanks 101 tran Foundation; 501 to well 151 Well to PL GENERAL .Legal Subdivision Subdivision Approval Checked Ex-approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same Ilawrence act . s .. _.: •', - ....:. —�'�y a ::•.mac ... . • _ _ _ - _, . - 14 stisquehanna road ossining, new york, 10562 914 - 7 62 - 4W27oog �. R£�,GIif�G E ;,Sep�emtier, 1987 IT �S Mr. John Karell, Jr., P.E. Sir Putnam County Department of Health Two Town Center Carmel, New Yorkp 10512 Dear Mr. Karell: Several months ago I applied for and.was given a permit to construct a Septic System on Ridge Avenue in Putnam Valley. Since that time the property has changed hands and I have.been retained by the new owners to transfer the permit approval to their name do that they may applyfor a Building Permit. Towards this goal I have attached the following documents with the new owner's name substituted for the previous owners name: 1.Construction Permit for Sewage Disposal System; 2.'OwnertsfAuthorization Form; 3.Application to Construct a Water Well. Should you have any questions of require additional information, feel free to call me at the number listed aboves 4 j. . COUNTY DEPARMAIENT OF HEALTH - DIVISICN OF ENVIR0I4]TAL HFALM SMV.LQ t.lt \ �O h_ +.!l liM�t:�.'1t1.'��M��"�.'iti:.tit ; �a► G��.' 1�:1 G� ll�tai.`f�t':`►��!■.'ii.'YY�3�7 REVIEW SHEET - CONSTRUCTION PERMIT - L - (Name of Owner) / CO[aSF,NTS YES LNO DOCTjl = = Permit Application Cor- c -rate Resolution Plans - Three sets Engineers Authorization Desicn Data Sheet (D -S' Dee: Hole Log Consistent Perc Re � __ Perc Hole Depth LF tra_ ^_eh provided required 60 ft. max. Parellel to contours House Plans - Two secs S/5 ISL1DIVIS -1 CN Perc (3) Fill - ca Well permit; P :S letter Variance Request GENERAL Legal Subdivision Subdivision Approval Check. Esc- approval SSDS Pd-. Lots Checked Wetland (Town /DEC Pe=it R & D) Data On DDS Plans & Pe*;rit SG.me REQUIRED DETAILS ON Pr =`:S Sewage System Plan - (north arrow) Sewage Systen Hydraulic Profile - Gravity Flcw Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data: perc and deep results Two -Foot Contours Existing & Proposed '.'Dl iveway_; & Slows C1it F6otingi(i11ti °i�L'1r = 'JiaiiS:� ^ryc,h�t'.aFjil:a. Perc & Deep Holes L•�:... =d Re,•r --=Sentatlye OZ ana e- xpansion E,r .__cn Area ; shav =_. _�v_ty flcw,s�= =. SiZe Tf _ Pi t & D -z,_-' & Detailed IEOus.= - No. of Ee:�r __ = Wa;1s _ SSDS's w /in G =t. of Proposed Sys 'Lams Prorer tv Metes & Bc?- House Settack Neces_a � ( Tight lot) HCl7 =_ : wee - ; I c -1; ` Y�e pi CS _i ds; -'a.. -_� wjCle?nOtlt SON D =S �_ = L� L= ON PI, =\ ?U'r-o P.L., lie_. .tic J, :er a ,T vL Z11 70 i to Foul_ ^da t._c% Ic'], to jvei' • ;0�, i:1. D.L.O.D, 150;' M I to Stream, i %cL ercourse, Lake ( — :_...ar to Drains- L'ti,rt in, Lcoer, FCdt,�g a a Pain i r-'i o catch hasin,S� __.,U -r-_ 4r�:�_ 10' to Water L-ine (pits -20' 50' intermittent drainage course Septic Tanks — 10' fran Foundation; 50' to well 15' Well to PL 9 10 PUTNAM COUNTY DEPARTMENT OF HEALTH 3 DIVISIOAT Ox . ENVTP0.1 TtTN TA1 °EQr T- ;E•.RvICES Date July 19, 1989 Located at Ridge Avenue (T) Putnam Valley Section 54 Block 7 Lot 5 Subdivision of Camp Lookout Subdv. Lot # IE6 -17(1 Filed Map # _ZgC Date Gentlemen: This letter is to authorize John S. Romeo a duly licensed professional engineer nxjxg *VJ cAXg �k)og � (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection teTith. this ^►a er arse u :pervi z tiie : ons �: cti;on of _;�.�..�.�. 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, Signed C_K_.L Countersigned: 916— A/ Owner of o erty P. E. ,>FX , # 27846 33 eidgc. Address 1 Northridge Rd r • r�V'� /V (L G Address 0� Town 0 Pekskill, N.Y. 10566 Telephone 737 -1056 E''`El ° Telephone a 2784 a 6 "�Of ry `l0�`� •• r r�J PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route ..Six Center, Carmel, New York 10512 (914) 225 -0310 July 19, 1989 John Romeo, PE 1 Northridge Road Peekskill, NY 10566 Re: Proposed SSDS - Kubitchko Ridge Avenue - (T) PV TM # 54 -7 -4 Permit # PV -7 -87 ENID L. CARRUTH, M.P.H. Public Health Director JOHN KARELL Jr., P.E. Director Dear Mr. Romeo: In response to our July 18, 1989 field. visit to the above captioned property, I offer the following comments: 1) Soil percolation tests in the settled fill, witnessed by this writer, 21 -30 Min /In. 2) Proposed sewage disposal system must_ be redesigned on the above mentioned percolation rate. If you have any questions, please contact me at your convenience. Very truly yours, Lawrence C .. We rpe r LCW:jr Assistant Public Health Engineer CC: John & Dawn Kubitchko 45 Boniello Drive Mahopac, NY 10591 ...... PUTNAM COUNTY ' HEALTH DEPARRIEff-. DIVISION Of ENVIRONMENTAL HEALTH SERVICES John M. Simmons-, M.D. Deputy Camnissioner of Health - FIELD ACTIVITY REPORT - NAME— K v 6 1 -rc me 6 r 1-1 C 1) V ,,No. -) C , vV4 L102 MAILING ADDRESS . P.O. Box Post Office Zip Code TELEPHONE PERSON IN CHARGE OR INTERVIEWED Nave and Title DATE S b, � A. TIME ARRIVED FINDINGS: TYPE FACILITY TIME LEFT Sheet of TM.QPVf'vPT0M Orig. Routine Orig. Complain Orig. Request Carpliance Carplaint Carp Final Group Illness Construction Reinspection Field, Sampling Only Field Conference Other , - Explain A INSPhCIOR: ture /4 P)4 6 TELEPHONE: PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. SIGNATURE: 6/86 TITLE: INSPhCIOR: ture /4 P)4 6 TELEPHONE: PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. SIGNATURE: 6/86 TITLE: Lawrence shacte�, p.e© 14 susqueli ®nn® rood Ossining, new york, 90562 (914) 76 2 ° 70o 9 Putnam County Department of Health 21 Old Route 6 Carmel, New York, 10512,. 13 March 1988 Attention: Mr. Lawrence Werper Gentlemen With reference to'Permit'Number PV-7.-;87 for property on Ridge Avenue in Putnam Valley,' attached please find Three. (3) sets_of each of the following raw'ngs BOH. L 2 dated 2 20 8.., 1 :thru` 4 dated _2- 29 -88, a Floor plans; location of driveway, and addition of a. deck are thesig- iL nificants changes on.these plans. The size of the house, number of bed- c r rooms,, and size and location. of fill and septic fields are unchanged,, A revzGpd perm!t :Applic<:tior: i� a? so attacrGd. Should you have any questions feel free to call;me4 very- tri ly 'yours, awrence Shac el, P.E. yo DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX .CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 _. .. -�_ •i. :1 °s ii iJi. iCi \. vi�vti'-'..l L:� '�Ei' vVtf1 L't'( �N Z',�L' PCHD PERMIT # WELL LOCATION Street Address 3 PERMIT Town Village C ty Tax Grid Number � B �7 WELL OWNER Name o 1 N u6tGh � Mailing 1 n Address cs.j x- xi o ivate Public USE OF W Crimar 2 - secondary M- OSIDENTIAL 0 BUSINESS 0 INDUSTRIAL .D PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP O FARM p TEST /OBSERVATION CIINSTITUTIONAL O STAND -BY O ABANDONED ❑ OTHER (specify 0 AMOUNT .OF USE YIELD SOUGHT gpm /# .PEOPLE SERVED /EST. OF DAILY USAGE gal REASON FOR DRILLING 13 REPLACE EXISTING SUPPLY 0-%EW SUPPLY NEW DWELLING O TEST /OBSERVATION 13. ADDITIONAL SUPPLY 13 DEEPEN EXISTING WELL DETAILED REASON FOR. DRILLING Date of Expiration: 19 ermit ssuing ic�a Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector Rev. 10/88 Pink Copy: Owner WELL TYPE ILLED C3DRIVEN DDUG (DGRAVEL 0OTHER IS WELL SITE SUBJECT'TO FLOODING? YES t. ENO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: (i 0- M to J,00 k O Wr Lot No. w- WATER WELL CONTRACTOR: Name IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES A10—WO NAME OF PUBLIC WATER SUPPLY:. TOWN /VIL /CITY LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED W SEPARATE SHEET . (date) (si nature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted avi er 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 s.hall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. Date of Issue: 19 Date of Expiration: 19 ermit ssuing ic�a Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector Rev. 10/88 Pink Copy: Owner Orange copy: Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIROMMM HEALTH SERVICES DESIGN DATA SHEET-SUBSUFACE SEWAGE DISPOSAL SYSTEM F :4 NO. ILE. Address Owner I-CM&O /n Located at (Street) KtOGU RA Sec. Block Lot (indicate nearest cross street) Municipality Watershed Wag- Date of Pre-Soaking Isl Date of Percolation 'rest -;/L-a Aq� F'/CL J'CQ-r/0AJ HOLE IR24BM CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start-Stop Min'. Start stop Drop In Min/In Drop Inches Inches Inches i /V: 3 a- /0,: 466 3 4 5 3 Co 2, 3 4 5 0 1 ZO NOM: 1. Tests to be repeated at same depth until apprcximtely equal soil rates are obtained at each percolation test hole. All data to*be suhnitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES 'DuL•lA mYes.:s_� - .-_ .s _'R_ - _•�.. i iaR_' _ .__ ... ... dun... . "r_ . ..nE .. - HOLE .:. H... O .L . -.� NO � o .-HOLE, NO.- t -E ... _ R +VP4.�O�ev.w4 ��ow ...Q... .: v'?':a r. ElA.u� -+G'. .... • l.c; �' �!' :r ^, g. G.L. 1' 2' 3' 4' 5' 6' 7' 8' " 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: -- DESIGN - Soil Rate Used Min /1" Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity gals. Type Absorption Area Provided By L.F. x 24" width trench Other Name Signature Address THIS SPACE FOR USE BY HEALTH DEPARZMENT ONLY: SEAL Soil Rate Approved sq.ft /gal. Checked by Date PUTNAM COLINTY DEPARIMERr OF r. DIVISION ENVI10NRML -,HEALTH CES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. +; Owner Dawn. -& John Kubichko ~Addressy -11- Ridgy `AvPnmi - `Putnam Vallai/I 41 10579 Located at (Street) Ridge Avenue Putnam Valley x•54 Block ,L_ Trot 5 . (indicate nearest cross street) Municipality Putnam Valley Watershed Peekskill SOIL PERCOLATION TEST DATA RDQUI1W TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking July 17, 1989 Date of Percolation Test July 18, 1989 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 Drop In Min/In Drop Inches Inches Inches (1) 1 10:32 10.:38 6 15.00 18.00 3.00. 2.00 2 10:39 10:42 3 17.00 18.00 1.00 3.00 3 4 . 5 (2) 1 1n•ja 10 :46 12 15.00 16:50 1.50 8.00 ._- ,i b. _ 3:25 ..:... w -- 9.23 �.._. 4 5 (3) 1 10:55 11:26 31 10.25 11.50. 1.25 24.80 2 3 5 (4) 11:18 11:25 7 :1.9.50 20.00 0.50 1;4.:OQ 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 sub= od for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA REQUIRED, TO BE SUBMITTED. WITH APPLICATION M 4° 5° 6° 7° 8° 9° 10° 11° 12° 13° 14° .__ INDICATE I VRL�Pfi'.Wf1Cli:c tCKINUWA'i'ER'15" CJCiCT[v1 u- None INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED - DEEP HOLE OBSERVATIONS MADE BY John S, Romeo DATE.- July 17, 1989 DESIGN Soil Rate Used-21-30 Min/1" Drop.- S.D. Usable Area Provided Soon SF + No. of Bedrooms 3 Septic Tank Capacity 1000 gays, Type Masonry Absorption Area Provided By 500 LoF, x 24'° width trench RRAM Nam John 5. Romeo Address 1 Northridge Road Peejkskill,.NY 10566 SPACE FOR USE BY HEALTH DEPARTMENT ONLY: b M1 vd� DESCRIPTION OF SOILPIS ENCOUNTERED IN TEST HOLES DEPTH pp r� Md NO e c HOffN04 EHV►RO' •i. �`� . NO. ee ...• a_.h .ta. Y'-... ^E.•;f..T .KC.a1✓�..n +. rt --,•i. .•�'r. _..K rr a n, an. �Yr.ir.4'1+�i.... .....a.lb �- .�at' . J'i+....�- `.�'In.�.aM -tiir a +f.'2 ?W- .M._..w.+ r . V G.L. ROB Gravel Rob Gravel ROB Gravel ROB Gravel ROB Gravel ROB Gravel some large some large some 1 arge °89so9W1.-1279EA 6 ;one large some large 1° Stooe-- � stones �t anes stenQsii 0 2° M 4° 5° 6° 7° 8° 9° 10° 11° 12° 13° 14° .__ INDICATE I VRL�Pfi'.Wf1Cli:c tCKINUWA'i'ER'15" CJCiCT[v1 u- None INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED - DEEP HOLE OBSERVATIONS MADE BY John S, Romeo DATE.- July 17, 1989 DESIGN Soil Rate Used-21-30 Min/1" Drop.- S.D. Usable Area Provided Soon SF + No. of Bedrooms 3 Septic Tank Capacity 1000 gays, Type Masonry Absorption Area Provided By 500 LoF, x 24'° width trench RRAM Nam John 5. Romeo Address 1 Northridge Road Peejkskill,.NY 10566 SPACE FOR USE BY HEALTH DEPARTMENT ONLY: b M1 vd� Signature SEAL e I � � Soil Rate Approved sgoft /gal. Checked by Date 1 PEMM CWNTY DEPARTMENT. OF HEALTH DIVISION.Of /• •' 1� Y •i �• M�° DESIGN DATA SHEET- SUBSUFACE S&gAGE DISPOSAL SYSTEM FILE NO. OwnerCQFl5 C-TV / J - A1rll.S7Tc, - t• Address 3C.A� -�►,� ANA? •. oss1,�71. �,c.+ �r a o 2 Located at (Street) V-LCCc AVC. M ?is' y.iEw ��l Sec. �. Block "'T Lot S . (indicate nearest cross street) Municipality -Rj'TN Pte. V ALi.Z y Watershed Date of Pre- Soaking j - 2 8 Date of Percolation Test i i - Z13 HOLE NUMBER CLOCK TIME PEROQLATICIN PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min/In Drop Inches Inches Inches 1 /0-112 G /4 /7 , p ka'�3 2 >dr2� l� /% %Z 3 /v :fit l'7 /o 13 5 - a , 3 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 Ihole. All data to' be submitted for review. 2. Depth measurements to be:.made fron top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESC_'RIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. Z. HOLE NO. HOLE NO. G.L. �� y ... AoPsO► U 1 X,. &,:, ..r ,2A14 -V .9,°-4,8 54" 1, sr, s;1¢ . , 4y. +- ale N6 w/a LPS©,t to s;� 1� -�-�r- � fir• I0�- � S�.►� �4eA 4 C4 [eo Sim -�• ar'GVel Co66 le, hoc- c too v&4-e� ..�Tµh `.,T'9:. T� �' G'f A, T.r47Tr'+L7 -, !Y1` P:IT i'C �'ni f'd �A1-/T-l�T - ✓T'� t �y + _ T^ _ _�— _ _ .._ .:.:.: ....._ . • �- "- :.L'9Li..J`l'�' �-lYJ y. \. -.+' �iuu-+\' J.J'.4V. %V•:LY.'�Ji 4 '!'iJ ., l '�i l5N .IC -,. .� l -. INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED tfo-t DEEP HOLE OBSERVATIONS MADE BY: `-- • to PC,'fc -- , C - DATE: i l -2i - 5(o - -- - DESIGN Soil Rate Used 7 Min /1" Drop: S.D. Usable Area Provided 7Zc .. Noe of Bedrooms Septic Tank Capacity IDOL gals. Type 604G . �"�'• Absorption Area Provided By By .+D0 L.F. x 24" width trench Other (C . 0.13 . J� Name Sig ure �► C Address k4- S n cr h � THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: SSt Soil Rate Approved sgeft /gal. Checked by Date P[TPNAM COUNTY DEPAR` KMr OF HEALTH CAA) DIVISION OF ENVIRONMENIAL HEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAT,,SYSTEM K ° _ Owner V 17; 'i c y iC o Address Located at ( Street) P 1 4 % E- (indicate nearest cross street) Sec. Block Lot Yjunicipal.ity Watershed SOIL PERCD=ON TEST DATA REQUIRED TO BE SUBNLi= WITH APPLICATIONS Date of Pre- Soaking" / p_ Date of Percolation Test" HOLE NUMBER CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Frcm Water Level No. Tine Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches %O 2 3 4 5 1 3 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated are obtained at each for review. 2. Depth measurements tc rev. 9/85 at same depth until approximately equal soil rates percolation test hole. .All data to'be submitted be made from top of hole. TEST PIT DATA RDQUIRED TO BE SUBMITTED WITH APPLICATION . DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HnTT ' HOLF NO, _ G.L. 1' HOLE X10. -: 2' 3' 4' 5' 6' 7' 8' 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided No. of Bedroans Septic Tank Capacity gals. Type Absorption Area Provided By L.F. x 24" width trench Other Name Signature Address SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date NI Al -'T-/ 420 /40"iv fi0 n- w DESIGNED :11 'SUPERVISED BY JOHN i'S,-- ROMEO, PC. CONSULTIk ENGINEERS h, I NORT)HRIDGE ROAD PEEK,iKILL, N. Y. I / I ,rY';. L11 -NO, 27846 g 29 T-1 Z -1� 7 J) /7 5* 4. 4- 13 it 4� 1.4 J g4t, A V E- At 0E 10 5 4- OA f 0 0. (P W Cf t- 0 4- A i-This is I . .0 cer-tis:,)� "that -the WaS cot Strutted as Jljldl:i6-cried on Lh j_s pl.ilrl ,old . Sys:uoru i spec-b"d ljy mobef'orc. -.�t was cov,(�r(-�ct. 'Vhf-, n t-cla , /60, 2-;•, was cons-L:riuc,t.bd ilT -accordmir.e w-i-th all s'Uandard .166 . w'd rooula-tions of -I;he Putriam Cburi-L'y Heal-th De t a ie York I'La*te Health SEPTIC 'SYSTE m 3 BEDROOM HOUFE FOR Z)Ai W/X/ A Nz; SOILS RATE= r,t.L b, /000 GAL. TANK ORIGINAL = -7-1-ILY ­lo, FINAL TOWN OF P071VAIV 114LI -, &17111A/ll C0614Ty NEW YORK SCALE I"-