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HomeMy WebLinkAbout3409DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.17 -1 -8 BOX 27 03409 0 19 %" " - Oki I 1 rk'6 }■ ■ N �I I 1 l - I L ■ 03409 I�I PUTNAA COUNTY DEPARTMENT OF HEALTH I • - Rev. 3,-486. Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Mast Provide V j.f P.C.H.D. Permit 11 - -- CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM (ui-iJ A M V AL L F y own or Village Located at `� D O G MOCK D q 46415 PU %1%i1M ""&y Tag Map 73 ' 17 Block Let_ Owner /applicant Name b I)AiUF_ L /T MOON Formerly. Subdivision Name Subdv. Lot # '971 PrzF- ASK)ILL 1104W61! RD � AVs 7 9' MaWng Address P- Date Permit Iseaed Separate Sewerage System built by i.Tl U. I Addres® Consisting of 1, 00 Gallon Septic Tank and —300 , 71411 I,aAk All- "' Water Supply: Public Supply From Address p or y Private Supply Drilled by 4"'16%4"~ Address Building Type Has Erosion Control Been Completed? (� Number of Bedrooms Has Garbage Grinder Been installed? -- I Other Requirements I certify that the system(s) as listed serving the above premises were cons cte entially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and re ulations, i cordan wi` the filed plan, and the permit issued by the Putnam Count D partment Of Health. / Date �� � Certified by P.E. R.A. Address ?it iLAA \iJ 9C_ VJ 5,L 000 ILL C" N"i. (CS" License No. U1 36 Any person occupying premises served by the above system($) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a publi: sanitary sower 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 Commissioner of HHas n modification or change Is necessary._ 91 Date �C:�� -f' �' �i' /� g�J. -c_ . -- T It leis% .�,»�;.._ ..... - - -. _ . - - -..... -.� -- :.:ems- -�- _- •,-- ---- -_ - -:__ Pulp" COUIrI't DIWARTIUM OF 11tUM DM Setwk&e. Cap" N.Y.19U lis Pali o Pon* ii w CE1lTM*ATZ OF C0MPUA= SiotIWM Nair csa- Let / Ter: Nkv 71 meek ;3 rr o�f.edAMe.d Y'llan �o N ►� Ac t �i'' -AU r1 D Sx) Rmawaf_❑ Redai&d O - - - . .. . . . T.- i' Diis lyp rt'` "`°'� lot Awe Z -� I 1 Rest{_ FM Section 0* L jp&pm V4b,,m, Nltklettw &( 6rideo 3 DWV Flow G P D coo PC®N , 'M p tlaa Regdj)red WI)►&e Fm b o..viet&a M Swwllp S�&ta� to e&tu im at l C0 0 r..M.. kende Tmak 300 ' 2 y " i V Tl M enwhaetod.bP ` i°C Adllheas WEAK Slut's Pilk SEE* Feo� .�pt..f. 5.pliti, Doo-d by lfe Gf zxi, OtjY&e itagi. sat. 1 represent that 1 am wholly and Completely responsible for the design and location of the Proposed sysfern(s); 1) that the separate sowapa disposal tyRam above described will be constructed as shown on the approved arnendnnnt thereto and in accordance with the standards. rules an ►pu ns o nam county Depntment of MMllh, and that on completbn.the►eof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Health will be submitted to the Department. and a written guarantee will be furnisfM the owner, his successors, heirs or assigns by the bulkier. that mid bulkier will bleu in good operating condition any pert of sea sewage disposal syste he period of two (2) years imnledlatNy following thedats of the IM- W40 of the approval of the Certificate of Construction Compllenu of original stem or any repeMS theretot 2) that the drilled well dacrtbe0 &bow wiM be lecate0 as shown on the approved plan and that sea well w81 M instal nos ith t sf ►d% rules and regu aeons of the Putnam LLL Date // ynatki FN&Ith. Date 1 /Dt •y S� A) 1, P.E. A. —. Address l 2 y _ " LiN1� %C License No #3 ?316 APPROVED FOR CONSTRUCTION: This approval expires two ewe from the Fte i unless construction of the building has been undertaken and is revocable for cause or may be annnded or modified when eon ad ry t ommissioner 9j1 �Heenh. Any change or alteration of construction muNes & Permit. owed • for dispose) of dom"ikc Mar d/ hats water 441y on y- ReV . r� '���CC t n 100 Oele —5.-- MY Title C' . -'.. �lii�,td2a fiSlp ".f z� i 7 ID C%' L 3::a'Ska� •. T b! P F:iIF._Al `4Z:1 L4�r A!as aI .urn' +roe'el ®t�uafi r i . ,i ,}d IMEVORIM { C.-Mul . k T ROM : MCOMMMINOYCONRUANCIR PtarY / • $ racdreeg !leema SdA 9,9:2 1 5M AgErp ,� Q�roW � 4T.nricdra� ■ luaec .d Prr.Laa.a Ar;nre.d _ e , s a" d� F Fn Suhd 1>.m ir!war 4 e laa U 99 `art:ew cz%r ll! sA t ..kew too r%`aaei?,�r aL itsl.ka�a� GM.w�m M= . I f° D $09M @Wx wr 1 {r rlm S.ngark Tw:cl aae{ • f •' ' _ ,'��' y air �� �^ b '� tv i I3 , 0 revemm that 1 am tumliv aad COaopat00y va:soaama for tho ooagn aaw location. of tho poproczd wdom(ma u that the wilwate otwaga ditp0tal atom 0� C3WO.°'t31 0.'7101 tae esnE ruCtag as M=Q ca Qh0 Opwoucs otmeamc at thane t0 aad in occovenco with tho MnOorft. rums 0 regu g copubTAM 00 OMmi , Etas Rolm an =00aim 0111 e®f a '6a�tit astraea:tioa COVabilaQw, e7tro 04ory to the CommlWOnw Of Multhwi10 l to M f I . O 0 ter MCM CH07COM t7lu ®o f t� vzuftk Us tea, CMUS a OcstZpa by 010 buNSW. ROW SON 21INNO W WIN cmw In 4BW c9cw03u1 OMMIM ew 6W2 ®f M19 cMMGQ ©6S000Ol 0Qaslii Ow"SO tko t" Of WS 42D V=G ba6ric','U0" fOiftwing thOdMO Of tae !ate 8m taxi' ti* G=GUO Of Qft CM191as€,t0 of COCORa Ddlw Comptio N o tho woulaol w ay rc=1fs t � at eca the arwo wa■ daasrlbad cbewo OM W t J 08 on M Egm OW MOO Meer ww clill Do In A MO � v Dag v� a of the putmom fS�F3Q0 iG S ®.E.- R.A. AG foCS -zq Z 04" r V J t� td� 4" 2� Ai ®l9QD R ®Q COMTQL=TtO N: VOM G=Ml Ompbca ttva V=8 from too "0 i "am conmuction of th0 Ouitdkni Ras bw UrAertaken and is ra eo 9p a7�= 07 uo' W CO oc. or if�l G7= a e®nt�I MOtCSMV ®y the Cormmis®io= of H=Cth. Any ChnaB7 or 0cte7otton Of COnstruaction 0 639C7 v9mC2.. AGE Ap ©ftso 'il� i ®f a +le amt: wamery . 0 "Cuat0 tm=7 cu "Or Or Oaty Revo 9 TWO aa [:t±•.ia.�, r .� ,.. .•;w. �t+;re,:sa. ?� T 1 ita 1 : r <. e yM Idi"S its .+ :•µ :. 0 '04 w 9 4+4 i � ► I '4 .��. Ep 10,511 APPROW® VOR C TRL=00": Vow app mal am ®bps two yaps from the date IcBm d untetm coastvuction of the building has bw undonakoa and is v0.+7OCal0 for cause dr may be amandaS or moaif(Ad wftn considered afxesary by tho Commiwionor of Maalsh. Any che"N or alteration Of coratvuction mo�.bae o rear rrratD ®anea..rr Mo A:errm� wI M_ ®aa04 ear ApDEVDL� 3 PE D -M COL VI^T DE2AR �`IEW OF fsT -UTH - DIVISIO OF 2IFv LRC-Ru.�..?'L'�L HALM S�4-? CMS Lam'? -i 7,ML !�= Su'PDLI & SurSURFA= Mvt�= DISPr-ZU SYSTEMS AM��� ��� BY: C L✓ (Name of C,rarJ, (Street Lccat. -cn) Cal'�-2114—= . I YES I NO • t i 1 `•- --I-- 1 I i I I I I I I I AA C- I I I I L' tr enca prz:v_cen ? J 100 -- I I ) RI I I 1 —V — I CI I i _ c1av r - err I I 10 f� . fig not_.s eoth Cauces I i i I 10 vr. flood elev. I t 1-1-10 ft. reservci , etc - 1.J ft. t= ice? I RI - t Pe---7it A plicatica cc=ratr resolution Plans - Thrzz sets s/ Fmclneers Author_zat cn Desicn DGc; snE✓t (LcS) Sur_DIVISICti re-sp acle Lcc Consistent Perc 2P- fl t ( 3) Fi? i Pe_rc axle DeoLZ C.= House Plans - T,o Well / pexn i _; F;,S variance Rac-llest G AL Subdi r sicn A- =: :Va- Ex- -= rcva-' SS '-r,-t-= A '-r'-r,-t-= r 7 Cn Mg Plains & Pe_Mi t SaME S`.��ce S stV� r�rcra ilic Prefi == - G__-; :c_. 7_: Fill P_oz_'e D?z:ens_cns - V !! (l 5r J Hex; - .c Cam'' _rr • P=-,, ` i _ d=--*-- ____ `y�r'tic Tank - 17.=, )re-- it Well CeT=-;l, Service Line if over Cens `.-t cti cn Nctes (crincer ,­Des, cn.. >-t pe =t.. are •eeep -red, :_ nic -Foot Contours E`{i stinc & Prc_cs= Driveov & Sloces Cut Fcot?nc/C1t- r,Cu_r, ;r, Drains (discha -- e CY) Per.: & Dee_o Holes Lcc: t Reorg tive cf pr' m=r1 a i e�.,ansicn -nsian P*- ;shoN -n;.ravit,� ELCIW,suff. s_ze Pit & D Bcx Shcw-n & De+ -iled House No . of Ee^._rodas Wells & SSDS's w /in 200 ft. of Propose., S_st= Prca---ty Metes & Bour_ds House yet!Dack.NCcassar -v (Ticht 1Ct) House Suer - 1/4"/ft. 4 110; �T_,Ta pi .e No B°._^ds ; Max. Bends 43' w/ cisancut SEPARATION DIST,N=- SPE'CIFT-E-) CN PAN Fields 10' to P.L., Driveiav, La*_'= Tiees,Tcc cr - 20' to Foundation Walls 100' to Snell; 200' in D.L.O.D, 150' Pi== 100' to Stream, ivatarcour_e, it K` (inc. E`' 15' to Drains- C'urt=in, Leader, Fcctinc 35'tc =tG'1 Sin,StOrTilrcin,C1C?� t°^'�•'': 10' to Seater Line (pits -20' ) 50' inte_r dt -zant drainage Sectic Ttnk s 10' r::-an Found t_cn; 50' to ? c 15' We-i tO P- r] Daniel A. moon Pauline M. Yuen 971 Peekskill Hollow Road Putnam Valley, New York 10579 June 23, 1997 Putnam County Board of Health Dear Mr. Hedges, Per our telephone conversation on Monday, June 23, please find the enclosed teller's check for the amount of two hundred fifty dollars ($250.00) payable to Putnam County Board of 'Health. This payment is for our application for Certificate of Occupany at a new construction, 15 Dogwood Lave in Putnam Va11ey. The engineer preparing the Certificate of Construction Compliance for Sewage Disposal System and as -built sketch of our septic system is Fred Zenz. We have forwarded the necessary forms to Fred, namely, copy of Sewage Disposal Guarantee ® copy of Well Log copy of results of bacaterial analysis of our well water. Please call us at 528 -7092 if there are any problems regarding the C.O. Thank _..you for all your help: - Sincerely yours, Pauline M. Yuen YML k -NV I RUNMENTAL SERVI.CE'S 321 Kean S *rent Yorktown Heights, N.Y. 10598 Albert H. Fadovani , Director, LAB #: $2.423774 CLIENT #: 76!.92 NON S'iAT PROC PAGE 1 M MHN /r++rl ++�,YNIVNI +I1rNN/f!►I I9/NA•JYN MNNNAIN7 NNlV,VNI/ --- NNNN//NN /.NI/NNIiNNII.1fIVMIY ►I NIJ M.1/IIfN NNN--- tiIIV -- Y0I N, PAtlU.NI : / MvIEL Afoo DATE /TIME TAKEN: 06/17/97 05520 VV I PL-EK::KILL HOLLOW ROAD OATEMME RECD: 00/17/97 10'10 ' PUTNAM VALLEY, NY 1057.9 REPORT Btr}'ty 06/19/9 PH011e (9 14) SAJhPL INQ SITE! 1 ti, DjJGWC1UD LANE, P I NAM VALLEY SAMPLE TYPE..: POTABLE kr� FIMlrfV �' TAP PRESERVATIVESI NONE OUL'O BN: TEMPL- RATURE. t 4C /MMNNIY IIPJIJ IY IJ YJ It•'JV IVNN N�IN MNJy�1fA //�/M/NN/1/NKi/1rM�NN/Kf�fN%Ii NNIV NAIIJW RIIJNhIINMIJ/INI /IJ IV IV IJIJN�LNNMIVN NNIV rJIVNN MII DATE, FLAQ f RQC- EIXURF RESULT NORMAL. — RANGE METHOD i_16/17,�97 , MF= T. CALIIZURM ABSENT /100 ML ABSENT BAIT T1 C-8L kESIJC_TS MIUCAIE THAT THE WATER Q=1)r11T AS NOT) O A SA t 1 MFF�! `•'Tf_If Y r;(;N ITARY OLIAL.ITY ACI;OITUIN NEW YORK. STATE AND R PA, t=E.'LIERAL DRINKINU WATER STANDARDS, FOR TIME PARAMETERS TU.T o. AT .I'! -tL lIME OF CCiLLF.K.- ION. . r w y �. -. � .,. »• v . r..• ^'.r �K : r.... ^.. ww. -ter+ rte. � n . _ UJ�,RIJTTED J;' AIbf-rt H., Padovani, M.T.(AS(,-:P) UL re•,rtr�r• ELAP# 19323 .tea.. � r_vt+v 9 4feUT��AAt DL'vDADT _� ,� /,may/ WLrL6J Ova++ a+ua.a.vav su+a, vaa.r ::. DEPARTMENT OF HEALTH vision Of Environmental Health Services -!,., ® PLITINAM OUt_7NTY. Dk�'A1tTt!fC:NC OF )iT"AT�TII ._. _. ' Office Use Only �./ ELL LOCATION STREET AoORESS: ILL# TAX GRID HU6tdE+l _V iUELL OWNER tr - ADDRESS: PRIVATE D PUBLIC JSE OF WELL 9 - primary 2 - secondary 0 RESIDENTIAL PUBLIC SUPPLY O AIR /COND. /HEAT PUMP O ABANDONED 0 BUSINESS O FARM O TEST /OBSERVATION ❑ OTHER (specify) 0 INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY ❑ gGUNT OF USE YIELD SOUGHT 5'� gpm. /N0. PEOPLE SERVED ,/ EST. OF DAILY USAGE °O gal. REASON FOR DRILLING (X NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY 0 TESTIOBSERVATION ❑ REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH O o ft. I STATIC WATER LEVEL ft. DATE MEASURED d' DRILLING EQUIPMENT ZROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH _ _ ft. MATERIALS: R STEEL ❑ PLASTIC C1 OTHER LENGTH .BELOW GRADE it. JOINTS: O WELDED OLTHREADED ❑ 0 T HER DIAMETER '' In. SEAL: D CEMENT GROUT p BENTONITE MOTHER WEIGHT PER FOOT 10ft. DRIVE SHOE .YES ❑ NO I LINER: O YES I$NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST 0 YES ❑ Na HOURS SECOND iIlAVEL-PACK • O'YES-.. O NO GRAVEL SIZE: DIAMETER OF PACK In. TOP DEPTH tL BOTTOM DEPTH It. TELL YIELD TEST o It detailed pumping tTH00: O PUMPED i tests were done is in- LPMPRESSED AIR formation attached? I BAllEO [] OTHER DYES D NO WELL LOG it more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water sear- . wen 01e- mater FORMATION OESCRIFrION poE IL 1L 11. DEPTH IL DURATION hr. min. DRAWOOWN It. YIELD gpm. SuAace ri J e°tOD ► ¢ ATER O CLEAR TEMP. JALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES ONO STORAGE TANK: TYPE CAPACITY 4AL. JMP INFORMATION 'PE AKEA )DEL CAPACITY DEPTH VOLTAGE HP WELL RI LEA NAMti xo*,,� OAT AOO� jot . Gf1ytTURE ®� f PPENDIX C FINAL SITE INSPECTION ERM I T # `'� J TM # OR SUED I V I S I ON LOT # _ SE31fAGE D 1 SPOSAL AREA a. SDS area located as per approved olans b. Fill section - date of placement 2:1 barrier LGTH WIDTH. AVG.DPTN__ c. NaLUral so11 not d. Stone.brush, etc. e. 100 ft. from wat I SENAGE DISPOSAL SYS a. Septic tank siz_4 b. Septic tank.inst c. 10' minimum from d. DISTRIBUTION BOX 1. All outlets a 2. Protected bell 3. Minintm 2 ft. e. . A Nqj I LT! Box - f.. TRENCHES 1. Length recui 2. Distance to 3. Installed ac 4. Slope of tre 5. 10 feet f ran 6. Depth of trey 7. Rocm allowed 8. Size of crave 9. Depth of cra, g . PUMP OR DOSE. SY! f greater than 15' from SDS area course /wetlands X1,000 1,250 eve1 `oundation same elevation water tested �% r frost ri;inal soil between box and trenches ,perly set Length installed ercourse meastt ea ft. ding to plan accectabie 1/16.- 1/32 " /foot ooerty lire - 20 feet - f c undat i ons /4 - 17"" diameter c in tree&. 12" minis 1. Size of pump chamber 2. overflow tank 3. Alarm, visual /audio 4. Pump easily accessible marhole to gr 5.' First box baf f 1 ed 6. Cycle witnessed by Hea 1 th Departrnent oc4- irn!n+-cii f lrww nor rvt-1 o I. MORSE a. House located per approved plans b. Number, of bedrooms WELL a. Well located as per approved plans b. Distance fran SDS area measured ft c. Casing 18" above grade d. Surface drainage around well acceptable OVERALL WORK KANSH 1 P a. Boxes properly grouted b. All pipes partially backfilled c. All pipes flush with inside of box d. Backfill material contains stones < 4" diamete e. Curtain drain installed according to plan f. Curtain drain outfall protected & dir to exist g. Footing drains discharge away fran SOS area h. Surface water protection adecuate i. Erosion control provided DATE: Inspected by: YES 1 NO COMMENTS F PUTNAM COUNTY DEPARTMENT OF HEALTH I DIVISION OF ENVIRONMENTAL HEALTH,SERVICES Date 11 )21 Ig I Re: Property of q1k Located at P"d �j (T)- L& Section Block 1 Lot Subdivision of Subdv. Lot # Filed Map # Date Gentlemen: This letter is to authorize a duly licensed professional engineer --- ------or registered architect (Indicate T— I' 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 promula.gated 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 supervise the.construction of said sys-Leni--,or°•ays-t-elwisl-'fft -,cbn oYffft'Y*-*rtIY "the ons of. Article 1 5 or 147,.Education Law, the Public Health Law, #nd the Putnam County.S.ani- tary Code. Countersigned: P. E. # Y' ) 73 . ZYZ Address As/I Telephone Very truly yours Signed Own r of Pkoperty / Own 7 S A) L L) Address' .4LL • Town -7 Telephone DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER; CARMEL, N.Y. 10512 (914) 225 -0310 ,; R +::.::]W, PLICATION -fiO :CONST -RiJCT A WATER WEI,L - PrRn PP RMTT A WELL LOCATION Street Address Town/Village/City Tax RAW ��t 13_» Cjri Number WELL OWNER, Name c,' o Sa Mailin Address pp %cacti { S u r vate O Public USE OF WELL .l - primary 2- .secondary e' SIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP O FARM ❑ TEST /OBSERVATION O INSTITUTIONAL 0 STAND -BY O ABANDONED ❑ OTHER (specify 0 `AMOUNT OF USE YIELD SOUGHT &k,, `S gpm /# . PEOPLE SERVED__ /EST . OF DAILY USAGE /0 0 gal REASON FOR DRILLING 13 RE CE EXISTING SUPPLY ❑ TEST /OBSERVATION L% ADDITIONAL SUPPLY ff FMW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE ILLED 13DRIVEN ®DUG ® GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name Are Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: N�R' TOWN /VIL /CITY E_.DISTANDE--T_0 ^PROPERTY FROM NEAREST WATER MAIN.:... LOCATION SKETCH & SO JJRCES OF CONTAMINATION SEPARATE SHEET 3u (d t PROVIDED (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 Department attached to this permit. 3. Submit a Well Completion Report on a form requirements of the Putnam County Health provided by the Putnam County Health Department. During all well drill ing- operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue:_ -2 19_TZ Date of Expiration 192- Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD.ROUTE SIX CENTER,' CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION- TO 'CONSTRUCT__'A" -WATER WELL PCHD PERMIT #1�,��� WELL LOCATION Street Addre s 7AV '0 Town V lla a Cit Tax Grid Number WELL OWNER Name Mailing 'Address JpF4J �RJ�tuC� QCr- . fie-, t - ®.Private O Public USE OF WELL 1 - primary 2 - secondary ESIDENTIAL ® PUBLIC SUPPLY ® AIR /COND /HEAT PUMP ® ABANDONED ® BUSINESS ® FARM 0 TEST /OBSERVATION p OTHER (specify 0 INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY AMOUNT OF USE YIELD SOUGHT gpm /# fRrPWE EXISTING SUPPLY Ll NEW SUPPLY NEW DWELLING PEOPLE SERVED_' /EST. ® TEST /OBSERVATION 03 DEEPEN EXISTING WELL OF DAILY USAGE '4000 gal 12-ADDITIONAL' SUPPLY REASON FOR DRILLING DETAILED REASON FOR •DRILLING WELL TYPE. ILLED DRIVEN ®DUG ®GRAVEL. OTHER IS WELL SITE SUBJECT TO FLOODING? YES �0 IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name Get Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ,P�N0 NAME OF PUBLIC WATER SUPPLY: )A_ TOWN /VIL /CITY ..,s...,bISTANCE: tO-- P:ROPERTY FROM .,NEAREST WATER - MAIN..; LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED SEPARATE SHEET ` (date) (signature PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted onder 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 Departm nt. �� Date of Issue: 6 19 Date of Expiration: ___19 ermit Issui �141 Permit is Non - Transferrable White copy: H. a File Yellow copy: Building Inspector Rev. 10/88 Pink Copy: Owner Orange copy: Well Driller q PETER :C: >'AIEXANDERSON' County Executive Mr. Frederick Z'enz.PE 292 Main Street Nelsonville, NY 10516 Dear Mr. Zenz: ENID L. CARRUTH, M.P.H. Public Health Director JOHN KARELL Jr., P.E. DEPARTMENT OF HEALTH Director Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 June 2, 1989 Re: Proposed SSDS - Franciosa Kramers Pond Road (T) PV - TM #73 -3 -14.12 Enclosed is the approved well permit for the above captioned property. The following tests on the well water must be complete before approval for the proposed sewage disposal system can be granted. 1) Volatile Halogenated organics. 2) Volatile - Aromatics. 3) Part 5 Inorganics. 4) Bacteriological Analysis. These tests must be conducted by a State Health Department approved laboratory. L . If,you have, any questions:, — please ;contact „me; at.yQU � cG`tivPriiencE, -- - .�- �'��: , •;• .. _.... : -_.._. Very truly yours, Lawrence C. Werper Assistant-Public Health Engineer LCW: j r i COUNTY OF WESTCHESTER E-11 Rev. 86 DEPARTMENT OF LABORATORIES AND RESEARCH VALHALLA. NEW YORK 10595 BACTERIAL EXAMINATION OF DRINKING AND TREATED WATERS Lab. No. W- Bottle No. Lab. No. ENT. r Date Coli'd Time IVI "M Time Set" Time Submitted Fecal. , Other Tests (Circle): SPC, Coliform MP Worm M mbrane. Coll'd by &V ti, e Agency Coli'd fo �*Coll'd from: Narrie i4L-1 SA- Address— UA 'Y�., fe vil v. AIA, (51. Rd.) (Cay. Too., Vdiogo) r lz;—Ci (cowl" 1,of Source: Sampling Point within Promises Refrigerated.? Chlorinated? Yes 0 No 0 Free—mg/I Total mg /I. pH RESULTS OF EXAMINATION OF WATER MPN/100 mi. Standard Plate Count Bacteria per mi. (48 hr Coliform Group Membrane Method/100 mi. Number Positive Tubes Total Coliform Fecal Coliform These results indicate sample (& was not) of satisfactory sanitary quality when the sample was collected. Other Reported by: Date J l S ai 4j in N CL �--1 W V J 1-- .z W Z G CC N ^+ O i Analyses (Check Loxes) 0 i ..` .. Color (units) 17 GU ❑ BODS :U +.t U O a •r Turbidity (NTU) 1W W 4J . �. COD ;ra ,._ o U o � (5 r!,�j 13 � •� U r W E Corrosivity (Temp L!? "C) ¢ .kn mg/L o V k,) ❑ Aluminum a 4j ug /L `so Acidity �_ b3 J Antimony >, 0- Alkalinity, CaCO3 v no F9 41 N 2-0 ug /L 1` Chloride_ mg /L b� Barium �'C "U ug /L e 1 mg /L ,. Beryllium 4- c 4J = Fluoride o 0 04J U Cadmium 25 to 4J Hardness, Total.:CaCO3 3 mg /L � ��//�� Calciumaii�d GG� ug /L 4h Nitrogen, Ammonia, N _ mg /L W-M Chromium L/ U Ng /L Q/ Nitrogen, Nitrate, N mg /L Ln Copper z-U ug %L on 01 Nitrogen, Nitrite, N mg /L o Iron ug /L r o ;= Nitrogen, Total Kjeldahl, N '`4 mg /L o, Lead ug /L ❑ Oil & Grease 'r mg /L o •.. 1- Magnesium ug /L u o o Phenol mg /L +J �- Manganese < C') ug /L ❑ - Phosphorus, Total, P mg /1_ Z 4-J 0 Phosphorus, Ortho, P ` mg /L d V) bZC ug /L ❑ Solids, Total 'f mg /L ❑ Nickel J w W XSolids, Total Dissolved I,yG: mg /L U b t Potassium ug /L ❑ +j 4- .- • ;. f mg /L a� Selenium w O f- f ug /L C� Solids, Volatile N A 3 a 1 Q1 t ❑ T. ug /L � Solids, Settleable mg /L D/ Sodium a a Lo r, •�-g/L Sulfates ISM mg /L ❑ thallium ug /L _. ❑ Surfactants mg /L ❑ Vanadium V ug /L ❑ j mg /L. J S L' (— C3 mg /L ❑ J l S ai 4j in N CL �--1 W V J 1-- .z W Z G CC O i Analyses (Check Loxes) 0 .i(a .. Color (units) 17 GU ❑ BODS :U +.t U O a •r Turbidity (NTU) 1W W 4J . �. COD ;ra ,._ o U o (units) DO 13 � •� U r W E Corrosivity (Temp L!? "C) ¢ .kn mg/L o ❑ J l S ai 4j in N CL �--1 W V J 1-- .z W Z G CC Analyses (Check Loxes) ❑ Color (units) _ ❑ BODS mg /L o Turbidity (NTU) ❑ COD mg /L X (units) DO 13 Conductivity (umhos /cm @25 °C) Conductivity � TOC coPH mg /L W` Corrosivity (Temp L!? "C) ❑ mg/L o ❑ Aluminum ug /L ❑ Acidity �_ peg /L n Antimony ug /L Alkalinity, CaCO3 mg /L �' Arsenic 2-0 ug /L 1` Chloride_ mg /L b� Barium �'C "U ug /L ❑ Cyanide mg /L ❑ Beryllium ug /L Fluoride mg /L b" Cadmium �g /L • Hardness, Total.:CaCO3 3 mg /L ��//�� Calciumaii�d GG� ug /L • Nitrogen, Ammonia, N _ mg /L o" Chromium L/ U Ng /L Q/ Nitrogen, Nitrate, N mg /L m' Copper z-U ug %L ❑ Nitrogen, Nitrite, N mg /L o Iron ug /L 13 Nitrogen, Total Kjeldahl, N '`4 mg /L o, Lead ug /L ❑ Oil & Grease 'r mg /L ❑ Magnesium ug /L ❑ Phenol mg /L Manganese < C') ug /L ❑ - Phosphorus, Total, P mg /1_ th/Mercury ❑ Phosphorus, Ortho, P ` mg /L d 'Molybdenum. ug /L ❑ Solids, Total 'f mg /L ❑ Nickel ug /L XSolids, Total Dissolved I,yG: mg /L ❑ Potassium ug /L ❑ Solids, Total Suspended f mg /L a� Selenium z-- ug /L n Solids, Volatile mg /L ❑ Silver ug /L ❑-- Solids, Settleable mg /L D/ Sodium w, l X /G} •�-g/L Sulfates ISM mg /L ❑ thallium ug /L _. ❑ Surfactants mg /L ❑ Vanadium ug /L ❑ j mg /L. ❑� Zinc S L' ug /L ❑ mg /L ❑ ug /L ❑ il• m9 /L ° ug /L Reported By: s° na ftn pnnnw - #-^A. .p . , -ti � �•;�! /. \�`. q„y,'x -t �rt-- .. S.nnv r z{ • _ .iT?:6'.'�i C -01 WESTCHESTER COUNTY DEPARTMENT OF LABORATORIES AND RESEARCH VALHALLA, NEW YORK 10595 NYS -FLAP NO. 10108 Lab# 4353 Date /Time Received Agency Coll'd for_ Sample Location Sample Site WC Bottle# 3 Date /Ti Col 1' y J . t-tt U Type f Sa 14otab1e Water []Non- Potable Water []Other VOLATILE HALOGENATED ORGANIC COMPOUNDS (EPA 502, 601 ) ANALYTES (RESULTS IN UG /L FOR (CATER, UG /KG FOR SOLIDS) Results Bromochloromethane LT 0.5 Bromodichloromethane LT T Bromoform LT 0.5 Bromomethane LT 0.5 Carbon Tetrachloride- LT : 0..5 ,.....� -._ . --LT- LT 0 -.5 Chloroform LT 2.5 Chloromethane LT 0.5 Dibromochloromethane LT 0.5 Dibromomethane LT 0.5 Dichlorodifluoromethane LT 0.5 1.1- Dichloroethane LT 0.5 1.2- Dichloroethane LT 0.5 1.1-Dichloroethene. LT 0.5 cis -1.2- Dichloroethene LT 0.5 trans -1.2- Dichloroethene LT 0.5 1.2- Dichloropropane LT 0.5 1,3- Dichloropropane LT 0.5 Remarks: LT = Less Than T = Trace NA = Not AnalyQed Reported By: U Results 2.2 Dichloropropane LT 0.5 1,1- Dichloropropene LT 0.5 cis -1.3- Dichloropropene T trans- 1,3- Dichloropropene LT 0.5 Methyl- e. n .e.- Ch- o•r1d "e:�::::�:.,,. ^ „- ..,:ci- �,,:5- =- - -.. 1.1.1.2-Tetrachloroethane LT 0.S 1.1.2.2- Tetrachloroethane LT 0 5 Tetrachloroethene T 1.1.1 - Trichloroethane LT 0.5 1.1.2 - Trichloroethane LT 0.5 Trichloroethene LT 0.5 Trichlorofluoromethane LT 0.5 1.2.3- Trichloropropane LT 0.5 Vinyl Chloride LT 0.5 Date Reported a. i rn. WESTCHESTER COUNTY DEPARTMENT OF LABORATORIES AND RESEARCH VALHALLA, NEW YORK 10595 NYS -FLAP NO. 10108 Lab# 4358 Date /Time Received 6/30/89 -: 1:04 Agency Coll'd for PCHD Sample Location Franciosa Resid. Sample Site Tap Bottle# 37 Date /Time Coll'd 6/29/89:10:00 Coll'd by J. Luke Type of Sample_ CX]Potable Water I ]Non - Potable I ]Other VOLATILE AROMATIC AND UNSATURATED ORGANIC COMPOUNDS ( EPA 503. 602) RESULTS IN UG /L FOR WATER, UG /KG FOR SOLIDS Remarks: LT = Less-Than' T = Trace NA = Not Analyzed , Reported ay: 4��L Results Benzene LT 0.5 Bromobenzene LT 0.5 n- Butylbenzene LT 0.5 sec- Butylbenzene LT 0.5. tert - But'ylbenzene LT 0.5 Chlorobenzene LT 0.5 2- Chlorotoluene. LT 0.5 4- Chloro;tolue',ne LT 0.5 1,2- DichIorobenzene ,- ._t,... L.T.,,0,.5 :'�. S -- 1, 3` -Dbch J orobenz'en.e° - °... _._L- T-O,..5 1,4- Dichlorobenzene LT 0.5 Ethylbenzene LT 0.5 Hexachlorobutadiene LT 0.5 Isopropylbenzene LT 0.5 4- Isopropyltoluene LT 0.5 n- Propylbenzene LT 0.5 Remarks: LT = Less-Than' T = Trace NA = Not Analyzed , Reported ay: 4��L Date Reported /�y /3 Results Styrene LT 0.5 Toluene LT 0.5 1.2.3 - Trichlorobenzene LT 0.5 1.2.4 - Trichlorobenzene LT 0.5 1.2.4 -Tr imeth,y 1 benzene LT 0.5 1,3,5- Trimethylbenzene LT 0.5 o- Xylene LT 0.5 m- Xylene LT 0.5 P-Xy, hene> LT :'�. S Date Reported /�y /3 _I_- u (n Of (L) CYl Lr) LO *a C:) —4 00 4-) tf) CD -Id C) 0 S- &- --I 00 4-) 4.) 0 Q) w .0 CL u LLJ 4j to-- I (A 0 V) :M 4-) r- S- CL Ln V 0 E—= cli ;7— 443� (V 4-3 ro 0 u (1) 4-3 C) E V) O L14M 0 F-70 �51 LU 4-) LLJ a) C=) CL V) LLJ 14. ❑ Pesticides in Drinkif'n"g Water (SM509A) ❑ Herbicides in Drinkf!- g Water (SM509B) ❑ Trihalomethanes in Drinking Water (501)* Volatile Halogenated,' 0502, 601) Volatile Aromatics (5034-602 ❑ Phenols (604) ❑ Phthalates (606) • Pesticides (608) ❑ PCB's (608) s ❑ Polypuclear AromaticV. (610) • Halo Ethers (611) ❑ Chlorinated Hydrocar I aons (612) • Herbicides Non-Potab`fe Water (SM509B, 615). • M.S. Volatiles (524.,',624) ❑ M.S. Acid ExtractabIe's (625) • M.S. Base Neutrals i!625) ❑ M.S. Pesticides/PCB`s;:, (625) ❑ Gasoline/BTX (NYS31q'-19) • -Petroleum Hydrocarbo.hi- , -Scan (NYS310-13) 0 0 ❑ • EP Toxicity/Complete;i, ,-,(SW846) 'i. ❑ EP Toxicity/Metals Only ❑ EP Toxicity/Pesticide§ & Herbicides Only ❑ EP Toxicity/Volatilet:l Only 9. I (U E 4 Q: -, 4-) Qj 4-3 (1) 0 u (1) 4-3 C) E V) O L14M 0 F-70 �51 LU 4-) LLJ a) C=) CL V) LLJ 14. ❑ Pesticides in Drinkif'n"g Water (SM509A) ❑ Herbicides in Drinkf!- g Water (SM509B) ❑ Trihalomethanes in Drinking Water (501)* Volatile Halogenated,' 0502, 601) Volatile Aromatics (5034-602 ❑ Phenols (604) ❑ Phthalates (606) • Pesticides (608) ❑ PCB's (608) s ❑ Polypuclear AromaticV. (610) • Halo Ethers (611) ❑ Chlorinated Hydrocar I aons (612) • Herbicides Non-Potab`fe Water (SM509B, 615). • M.S. Volatiles (524.,',624) ❑ M.S. Acid ExtractabIe's (625) • M.S. Base Neutrals i!625) ❑ M.S. Pesticides/PCB`s;:, (625) ❑ Gasoline/BTX (NYS31q'-19) • -Petroleum Hydrocarbo.hi- , -Scan (NYS310-13) 0 0 ❑ • EP Toxicity/Complete;i, ,-,(SW846) 'i. ❑ EP Toxicity/Metals Only ❑ EP Toxicity/Pesticide§ & Herbicides Only ❑ EP Toxicity/Volatilet:l Only 9. I 4 Qj 4-3 (1) (U 4-) — 0 S- 4- 0 0 0 4-3 ❑ ❑ 0 u (1) 4-3 C) E V) O L14M 0 F-70 �51 LU 4-) LLJ a) C=) CL V) LLJ 14. ❑ Pesticides in Drinkif'n"g Water (SM509A) ❑ Herbicides in Drinkf!- g Water (SM509B) ❑ Trihalomethanes in Drinking Water (501)* Volatile Halogenated,' 0502, 601) Volatile Aromatics (5034-602 ❑ Phenols (604) ❑ Phthalates (606) • Pesticides (608) ❑ PCB's (608) s ❑ Polypuclear AromaticV. (610) • Halo Ethers (611) ❑ Chlorinated Hydrocar I aons (612) • Herbicides Non-Potab`fe Water (SM509B, 615). • M.S. Volatiles (524.,',624) ❑ M.S. Acid ExtractabIe's (625) • M.S. Base Neutrals i!625) ❑ M.S. Pesticides/PCB`s;:, (625) ❑ Gasoline/BTX (NYS31q'-19) • -Petroleum Hydrocarbo.hi- , -Scan (NYS310-13) 0 0 ❑ • EP Toxicity/Complete;i, ,-,(SW846) 'i. ❑ EP Toxicity/Metals Only ❑ EP Toxicity/Pesticide§ & Herbicides Only ❑ EP Toxicity/Volatilet:l Only 9. I PUTNAM COUNTY DEPARTMENT OF•HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES\ Date ... Q 2 0 Re: Property of JolayJ t Avjmk FRA�c jcs S �o Located <: a,t`. (T) J !'.�i�, ►�a VA Ay Section ��} Block 3 'Lot IYJZ _ Subdivision of :::Subdv, Lot # Filed Map # Gentlemen: Date This letter is to authorize F. /'t' a duly licensed professional engineer f 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.re•gulatlons as promulagated by the Commissioner of the Putnam County Department of Health, and -to sign all necessary papers on my behalf in connection with thisImatter and to supervise the construction of'said system or.: syst,ems::in conformity?: r .t'h -th'e proyi'sian's' of "�4r 147',.:Educatiofi Law, the Public Health Law, and the Putnam County Sani= tary Code. Very truly yours, Signed Countersigned: Owner o ropert P.E. , -R-. A! Address Address Town Telephone Telephone'. 1 0 Ii PETER C. ALEXANDERSON County Executive Mr. Frederick Zenz, PE 292 Main Street Nelsonville, NY 10516 Dear Mr. Zenz: DEPARTMENT OF HEALTH Division Of. Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 May 2, 1989 ENID L. CARRUTH, M.P.H. Public Health Director , Re: Proposed SSDS - Franciosa Kramers Pond Road .(T) PV - TM #3 -14.12 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: 1) The well must be drilled and water.tested for volatile halogenated organics, volatile aromatics and part 5 inorganics before further approval process can continue. Due to the close proximity of proposed Well to the Orlando landfill. 2) Proposed well is in direct line of drainage of .pr.opgged;. age di's�p l s osa . ` .... sytem: _ -.° `. .- ... ..... ... ..: . .. _. �. � .. �. .�, .. ..,_,,... .... 3) One D -Box should equally feed all trenches due to flat slope. 4) Septic tank detail must show length divided by width be greater than two and less than four. Very truly yours, Lawrence C. Werper LCW :jr Assistant Public Health Engineer Pr N�'M COUNTY DEPPRTigMa OF HEALTH - DIVISION OF EN=CN1\'M -L HEALTH SMVICES TNSPBCTICN FORT . c/9N c U J ✓j' (.�fJr �1�A�rG -, S ®./J / 1� (- of Cwner) (Street Lcc:ati cn) INITIAL SITE INS.P=ION j YES NO Wetlands cn /or proximate to property .......:...... Prcc,--rty lines or corners found ................... Can es- ILmate house lc..:ati cn ............. ....... _ Willdrive,,rav need. cut. .. .......................... M-jst trees he' r=rcved - note these ................ � Deep holes representative of entire SDS area...... I Pnditicral,deeo holes rc- ..._.ed ................... Sufficient SDS area available considerinc drive av cut, house lotion, separation distanc�sz,etc... ?Z I P -djace_nt wells/septics .. ............... ....... Arr-c_= tn nrccosed well location for D.H. 1 Lot - Depth to G.W. Depth to rc<',_ 0 ft. 3 ft. 6 ft. 9 ,ft. - r Soil Descrinticn FI'3AL SITE D.H. 2 Lot De: th to G.W. Depth to rock Soil Descrizticn 0 ft. 3 ft. 6 ft. 9 f t_ DATE: _ INSP.BY: House SSDS located per approved plan ............. } Length of trench pleas red Width of trench average Slope of tile line and trench acceptable......... Roan al lowed for e_,cpansion trenches ............... Over 100 ft.. fran waterccurse .................... Natural soil not stripped or SDS area unnecessarly gra (aed .......... . ............. . := 10 ft. maintained from prope_*tyline and 20 ft. fran house ............... ............ Distance well to SSDS (ft.) ...................... Numberof hedreams checks ........................ Stones, brush, stumps, rubble, etc., greater. ! them 15 ft. fran nearest trench ................ a 15 ft. of peripher-al soil horizontally _ fran trcncz ..... ...... Boxesproperly see-....... ....................... Could surface runoff fran•driveway, r,:.ads, around s-ur- face, etc-, channel near SDS area.... Does lot drainage aogear OK-,in' area of SDS::...... FLNA -r, CZP.DNG OF SI'f=' FCC PLAMLE . DATE: INSP. BY: CCHAMNTS _ " � &-4­1 D.E. - Deep Ecle G.W.- Lrcunc,Iate_'' D.H. 3 Lot - Depth to G.W. DenEa to roar 0 ft.' 3 ft. 6 ft. 9 ft. Soil Cescrioticn YES ( NO CCb�,rZS I I 1 _ PUrNAM COUNTY DEPA UMTr Or HEALTH DIVISION OF MUROMMM HEALTH SERVICES DESIGN. DATA - SHEET -_c4M FACE S'JEL, E DISPOSAL SYSTEM FILE. _m. - _ C", '�O �t,� ,c 20,`; - - Address `J� A Located' at ( Street) 04 sec. ? dock 3 riot ;9.)z (indicate nearest cross street) M � unicipality A V Watershed �• �s�• SOIL -PERCOLATION TEST DATA RBQU= TO BE SUBMITTED WITH APPLICATIONS ' Date of Pre - Soaking m. Date of Percolation Test q to-S HOLE 5 Nam C= TIME PERCOLATION 1 PERCOLATION Run " Elapse Depth to Water Fran Water Level Z-� No. Time. Ground Surface In Inches Soil Rate Start-Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 1 kcQ 2.y z 3 3.33 2 z7 .5 3.7 1 3 r'2- 2y 2y 3 �' n ). 4 l Z Z Lf Z1 3 n 5 2 1 2 4 5 1 Z 3 Io Z-� 2? 3 7_3 , 4 5 1 2 3' 4 5 NOTES: 1'. Tests to be repeate6 at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to'be submitted for review. "2. Depth measurements to be made ftan top of hole. J. rev. 9/85 •, DEPTH G.L. 29 MST PIT nATA RF'QU=i TO BE SUBMIT• WITH APPLICATION DESCRIPTION OF SOILS OXXXJNT TED IN TEST HOLES HOLE NO. HOLE NO. L HOLE NO. 31 nn 51 6° 71 81 91 10, 44 /Vpz L 129 13' 141 INDICATE LEVEL AT WHICH GRO-UND.RATER IS EN00UNTERED INDICATE LEVEL; TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTEP DEEP ROLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used 0 1 Min/1',' Drop: S.D. - Usable Aria Provided No. of Bedrocmt 3 Septic Tank Capacity gals. Type Absorption Area Provided By L.F. x 24" width trench Other Name S ig naturO Address SEAL t�) xvg INISn" A, _6 ).N THIS SPACE FOR USE BY HEALTH DEPAR24FM. ONLY: Soil Rate Approved sq.ft/gal. Checked by Date t. A <F d � - � � •� Y , 'ir R-', 1 Re f rkk r Tests`lCircle) BPoI ahfa :� ColldiromS�Hlamee� xg,, ,? ns- Address r + IdentdlcaUOn of Sourc y .� Siimphng�P�ohl within Nn CUNTY OF WESTCMESTER DEPARTMENT;OF t:ABORATORIES_ AND_RESEARCH ., VALHALLA NEW YORK 10595 ERIAL`EXAMIN'ATION OF_15*09. Y1RND TREATED WATERS ENbIRQNMEkITkL ti) %t I H � f � rx Oats Colt d tt`i Time* t �S limb d6lt�ad ." dorm MOP Colrform Membrane Fecal Other 4 a $ Agency Coll d for 4.. - _ � � a..n r � t � Ir�nn • �iC-ry Town,.�Veip0l 12q Co0o1 ,ICounryl . 71 Premisesy , t m �o, Free _ , mg /Id To al 9 P ATION OF 1NAT:ER ` k' L� r Coll d from Alame 17 Address R i f ` tsl R denUftcahon of S urce `- iaTPlmg Point withPrer A, ce E , htonnated� Yes ❑ No cr'E y C�olFforrn Gr Number Poai 7 i.;� Fecal Colifoi� CO! rf TY r34 1Q!E$TCkESTER 2 '' gYMENT OF tABORATORIES'ANQ i1EgEARCN VALHALLA NEWQ,ORK: ;0595 XAMINATION OF DRINKINGsAND TREATED WATERS 7 - Bottle•No ' ,> p to Colld✓d'Tlms °3> /T tf ) e } Tim $7 ;Rtteif Coliform Membrane; F; ; x y OCC Other 7 i flog /" ,.�+ �a Fi`k• t'9 Ifint) t' ae.IC ;y,,��< .. rzio coa.r Icown `¢ Refrigerated? _mg /I, Total _ - - ---- -= mg /1: pH - 1TEq Standard Plate Count ' � � 88Ctena; i Membrane Method /100 m1 `.Total Coliform` ' thdi Y S` "ly F 4 d Reported by <f t waa Data,- " y y MPN /100 rnl Standard Plate Count _� Bactena Per ml (If! 'hr.) x ` 3 CdIifo n GrouP, Membranby Method/ 100 ml Total Co iform Nu mber Posttne Tubes �x s Other< u� Fecal Coltform� y x ` Date F f Reported by sample *(was say These results indicate tt ae r; satiafactoryzsanary Quality twhe�fthe M,y tJ collected r i �xx �* t r'ra .. 'Sys (` FF - R 'As 04- +✓� % �,,'.'' r Coll d from Alame 17 Address R i f ` tsl R denUftcahon of S urce `- iaTPlmg Point withPrer A, ce E , htonnated� Yes ❑ No cr'E y C�olFforrn Gr Number Poai 7 i.;� Fecal Colifoi� CO! rf TY r34 1Q!E$TCkESTER 2 '' gYMENT OF tABORATORIES'ANQ i1EgEARCN VALHALLA NEWQ,ORK: ;0595 XAMINATION OF DRINKINGsAND TREATED WATERS 7 - Bottle•No ' ,> p to Colld✓d'Tlms °3> /T tf ) e } Tim $7 ;Rtteif Coliform Membrane; F; ; x y OCC Other 7 i flog /" ,.�+ �a Fi`k• t'9 Ifint) t' ae.IC ;y,,��< .. rzio coa.r Icown `¢ Refrigerated? _mg /I, Total _ - - ---- -= mg /1: pH - 1TEq Standard Plate Count ' � � 88Ctena; i Membrane Method /100 m1 `.Total Coliform` ' thdi Y S` "ly F 4 d Reported by <f t waa Data,- " A A s ' ,COUiNTY_OF INESTCHESTER E,t t Rev 86;,!._ DEPARTOEfNT OF LA ®ORATORIES AND RESEARCH VALHALLA NEW YORK 10595 BACTERIAL EXAMINATION OF DRINKING AND TREATED WATERS Lab No Bottle No ry } 4 Date Coll d Ttme t Ttme Sets Ttme=SUubmttted Tests (Circle) SPC ltItfor MFN Coliform Membrane Fecal 01. or Coll d by Agency;,Coll d for Colldfrom blame tCwtl � IF trot) a ,i 4 3 &- ✓fit :`" t t't l L 5 "� i Address } I s.. r f5t N01 t`tCry rorinvmspat t2wCoa1 'lt:ountyl ' IdenUhcatton of Source t t S mPling Point wt; Premts'ee {' 'Refngereted? a Ch'lormated? Yes o 'o Free mg /I Total mg /1 ;pH tiESULTS:OF EXAININATION.OF WATER RAPN /100 ml 3Standa►d Plate Count 8 ra per ml(d8 hr ) _ acre Coliform Group � _ Membrane:Method /100 ml m Number Posthve Tubes Total'GoUfo! Fecal `Coliform Other _ T These results indicate sample wa was not) of Reported by Date riatia'actCr�r Sant)�r+ quality eths + fhe sa npl® talcs - collected � � No -2 woe o N Z!"_ <51 301 e;l V\Q/ A IY vat the or 1,brmc�ly Frederick SET 0• 1 /-,T POND A C`lp'c's i. 19' 9 /UA0,70 H. (Deed 4 03.9 Corn p.403.9 I'll (-', , , dwe iN �tp L Ro-4C tv- of ot It 6.,--7-7 - vr Now ci- kj P SEPARATION DISTANCES IN FEET County Department of Heal-in iviaion, of Environmental Health Servic, nl 2 3 1 4 1 5 1 6 1 7 9 1 to 11 1k] 13 ['14'1 15 nw Oved,as noted for conformance with JA z. , Y3 Ifl. 1-4 03 so 5 1 '57' pplicabLe Rules and Regulations of the I I I I . !Anam I bp�mty-nai-tli_p zr 13-113313s,1yojq31't7 47 201791-19 1 771 -17 111 1 1 _uartment. AS-BUILT SURVEY By SUNNEY ASSOCIATES, L.S. ii AS-BUILT SEPTIC PLAN prepared for MOON / YEN RESIDENCE KRAMERS IR PONW i. - D. SCALE: 1"=501 ,.der, I'll (-', , , dwe iN �tp L Ro-4C tv- of ot It 6.,--7-7 - vr Now ci- kj P SEPARATION DISTANCES IN FEET County Department of Heal-in iviaion, of Environmental Health Servic, nl 2 3 1 4 1 5 1 6 1 7 9 1 to 11 1k] 13 ['14'1 15 nw Oved,as noted for conformance with JA z. , Y3 Ifl. 1-4 03 so 5 1 '57' pplicabLe Rules and Regulations of the I I I I . !Anam I bp�mty-nai-tli_p zr 13-113313s,1yojq31't7 47 201791-19 1 771 -17 111 1 1 _uartment. AS-BUILT SURVEY By SUNNEY ASSOCIATES, L.S. ii AS-BUILT SEPTIC PLAN prepared for MOON / YEN RESIDENCE KRAMERS IR PONW i. - D. SCALE: 1"=501