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PUTNAM COLtNTKY �'DEPA�R'I'MENT= OF HEALTH ^
'N y ,,C iSiU ✓� j - ..c�'t% ,r , sh�£c DDB; fl1
_��CONSTRUCTIONiT E_RMiT FOR SEWAGE DISPOSAL SYSTEM
x � aFJ rr &Xx Town or Village:
da '`^,':s s>o H x.�r .v S .x ��' •.�
LOCatell"at
r px.�i,� q,y ¢ �,1 ;e ry �5j nc�"-,� n4�gfiy..x,s.d�..'Ktt i �q+:s ;erg 'z+,K^..c ^tc oa'•�
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1�. �, s a � v � t� �% m ? ,s5 "',ar "`,�+��5�.'�' -ate �'��``�'�". �- �riSS`:�`•�'�'"3i %'. t -.,- .�„ ,a ,.
<; �,, r F. "u 3 ,.n h Rtm n • 3 .,i c,. k r
Numbei of Bedrooms � ; r -� � fi< :ac Total Nab MI.15 ace Square Feet.
aE, x
•` YYxs.!x< r <_a. '2 ,,.. . m e. "'"� .�* < y, 7y i. •t�.xtL ka '� �u• *�,. r
separate Sewerage System to consist of I Gal Septic Tank lineal feet X _ 4 width trench;. '
;:: To be.iconstructetl by -� V <�jG�'uS ti Address -
x.. Water�.Supply Public Syupply.From -
:, gyp;
g
Prrvate,�Supply to be drilled
',
s �3 , r Address s t s s
'3i �•�: "v '.t.° �� S y,�' � .vim i� '? A � '* y� ,: \:,
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„�;'.� �..L� .� 'k`�� .�r ? � �5"'tt. -��'., �?ri. r '::.3:. "' 4.:'. � . k�°"•,��`.`` .�'� -`� �'""�`�,.- .7�..� 3� ...c�:�$i�'1 � __. �'�� c��.
,.,;. I represent that iz,am wholly anti ^.completely _responsible,f;or the design�and,locat�on ,of �the,,proposeC;.sy 1 spar t vage� tl�isposal,- ''system`,
:,k 1.:... ct' .. :,- €r�'a�m r,.�,',r�.c err+.. '� .', '" `'�=-§ •,�t�* ,e „r ,a "�' 'Yr^��r3
�atiov. e; descrabed: wUllbe; constr_ ucfed; ass hown, on�fheeapp _r ",o`ved�mendment�there"�to -and maccordancewit ��,�e nd�yrds;iryulg�A;l� ion ;o,_' _e::`,u nam,
Wa "a '* i� a": `%+, .,r a s •.+`K k`v.”` "'^�•F '° r as 'n'� �'
Date SignedG P E
D t U' 4 S �' i t 4 � q'c � ,( // /�y }� �c i � d rC,� 'M1. ti L -. •�G
Giddress License NO.
e APPROVED;FOR CONSTRUCTION T.hisapproval expires one year from -the date 'issued' u ss constructwn of the budding has;6een untlertaken` and is'
-,t. revocable for cause o�amayF be amendetl,or modified when;,consider.ed nec scary �bY'the Com 0.�oner of Health ;Anyrchahge or: alteration. ofeeghstruction
ek
s� 'requires a-�newp� miY,�Approved for "d�sposal`:ofi�domesticgs Ritar wage�a"nd% f'�',p iv�Ye a er su i :only �.�
`� ;.+_} `t2'.:�. .�""^" c4 �1 � i ,�> .'¢ -'u .1,;3" �'✓.^fr p:�rS'- �^"�"2`.�s'�33'� s: g ,�; xr.�?,� �s�,� G vs�v "��ic#4J�r a t��, � ��..
rurnD cBECY LIST
Date:
A17
LuJk. ti� „7we -i,. i`c �. :_:/:__�- ._ «-- •.r_oar. a.. .e..xwn, '^ ...................... ..w. u_
INITIAL SITE INSPECTION
Yes
No
Comments
Property lines. or corners found
_
_
Can estimate house location . .
Will driveway need cut
-
Must trees be removed -note these.
is deep-hole representative of entire SDS area
Additional deep holes needed. . . . . . . . . .
Sufficient SDS area available considering
driveway cut, house location, separation .
distances, etc..
v0000
-
DEEP HOLE DATA
Depth:
Water elevation:f
Rock elevation: t� C
Soils description:
Date.
FINAL SITE INSPECTIOn --Insp. by:
_
House located where shown on approved plan
SDS located where approved • . . . . . . o
Length of trench measured
Width of trench average
Slope of tile line and trenc acceptable .
_
Room allowed for expansion trenches . . , .
Over 50 ft. from swamp,watercourse
Natur.al:.oil not stripped or SDS area -
unnecessarily graded . . . . . . . . . . . .
1.0 Ft. maintained from prop.line and
20 ft. from house .
Separation of trench from house, well
-`
etc. follows plan
—
Number.of bedrooms checks . . . . .
--
Stones, brush, stumps, rubble, etc. greater
�-
than 15 ft. from nearest trench . . . . ,
15 Ft. of peripheral soil horizontally from
trench . . . . . . . . .. . . . . . . . .
Junction boxes properly set
Could surface run off from driveway, roads,
i
. ground surface, etc. channel near SDS
Does lot draina e a > >ear 0. K. in area of SDS
FINAL GRADING OF SITE ACCEPTABLE
.. II.L'�V11.'iN! I�.IJ.I!,'.iJ'� •7l11.5t5'.�•,�
� 6
Moot -1 std-J, Remarks
e s 1'No—T
DOCTIT/i-ET•bTS
iou�o .plans
Desi „n data sheet. !
--
Peres presoaked ?. !
Min. 30” pert test depth
Al
Const. results for 3 runs
D. Hole. log 0. Y.
Corporate Affidavit for other than individual I
Authorization for engineer !
Letter from Water Supply if' applicable
if variance requested -such rioted on plans & apps.: I`
DETAILS 1
if change is proposed,) ,
Existing contours snotim show new contours)
Slopms for driveway cuts, etc. shown I f
Water-service line location
Footing drain, etc. location I
Tip slope' bottom slope of fill . {
Percolation tests and deep test pit location
Septic tank size and conformance to .std.
3 B.R. house minimum I I
House setback shown I f
ow fro
,qli water wiznin "u it. or rL shown
Plan and profile SDS (�` All other wells and SDS closer 200'
shown or reference made �.. -
�Pr�p✓rty boundaries (metes and bounds- clearly sho I
SEPARATION DISTANCES SPECIFIED ON PLAN
10' to P. L.
?0' to Foundation walls i
)0' to Nearest well !
�0' to stream.,' march, lake, etc. (Incl. expansion
L5' to Curtain drain
LO' to waterline (pits -20'
L5' to storm drain
LO' to large .trees
'0' from foundation to septic tank
5' to pipe from leader drain & footing c
TO: 'eehea-t-;-n-- County Department of Health,,
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CQ�kce-
Mount Kisco Field Office
25 Moore Street
Mount Kisco, N. Y. 10545
Gentlemen:
Re: Property of
t6d&t6d it....
ALkt.
This letter is to authorize --Sah,atov,
a duly licensed professiohal engineer or registered architect to apply for a
Construction Permit for a separate 800etidge 6ystevh; privat-d water SU001y;
to serve the above -noted Okoo6riy in accordance with the OtAhdafd6i fu'164, or
regulations ai,,ptdinulgAted by the Cdiibiisionet of the Wed0hesit6k County beoatibierit of
Health, And
to sign Ali necessary papers on my behalf in d6hnedti6t.i with this matter
and to supervise the construction of said system or systems in coinf6rWity with the Ok6ii
visions
,of ,of Article - 145 or 147 of the State tdiiditidn taw, the iI61.it Health t&- and the
C 9
We6tchdattir County Sanitary
F
C etai ed:
A
-Y.E., Ri.A. #
,(Seal)
(Address)
(Tel6phohe)
IA-4/70
Very truly yours,
Signed_.
(Owner of'Property)
kel
(Adftiis)
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PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
_ ti ..di, �•+•.:.zc .. i'rx�'..=•.c�a �^F.1 o ».- ....a • +.v ,...1r .....
COUNTY— OFFICE BUILDING, CARMEL, N. Y. ~V 10512
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO..
Owner,-S-6 %yn ()r \mAftc,U Address L---(j:j 't ko" poi-no-M aAl ire!
Located at (Street Ydicatk �La Ro Sec. Block Lot
nearest cross street)
Municipality P(&VN tm Watershed M &,i) � O VX
SOIL PERCOLATION TEST DATA JQUIRED TO BE SUBMITTED WITH APPLICATIONS
oe
Number
CLOCK TIME
PERCOLATION
PERCOLATION
Elapse
Depth to Water
water Level
No.
Time
From Ground Surface
in Inches
Soil Rate
Start -Stop Min.
Start Stop
Drop in
Min. /in drop .
Inches Inches
Inches
• l
g•.�*�- 4'•3:2 '�
i � � �
�
�
2
� '•a� -- $'` �I �
1. q ��,
�
�
37.40)
' 2,0d A7 �•
�Z�
'�
�3
5�
Al. A-10,
COW AK T
1
Notes: 1) Tuts to be repeated at same depth until apppproximatelyy equal soil
rates are obtained at each percolation test hole. All data to be submitted
for review.
2) Depth measurements t�'be made from top of hole.
DEPTH
611
1211
1811
2411
3011
3611
4211
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION+
DESCRIPTION. OF SOILS ENCOUNTERED TN TEST ROTR� '
HOLE NO. I_
rr M
HOLE N0. Q,L
HOLE NO. �eqe�
';'ig,Frw., .r+f I
4811
5411
6011
6611
7211
7811 t
8411
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED Nttts
INDICATE LEVEL TO WHICH NAT E LEVEL RISES AFTER BEING ENCOUNTERED
TESTS MADE BY � g- \J �r-e �,'�i.Q p Date 11t& _jA, i Q �J
DESIGN
Soil: -Rate ''Usod a" � Min/1 "Drop: - ' S . D. Usable A ovided n�b
OF N E rV r
No. of Bedrooms Septic T k Capacity ° e Ras"
Absorption Area Provid ` By1 T F.x24f' t trench. -
�� $� r
Me 0 ot-
raTTIMMIM IBM
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Gal. Checked by Date
COUNTY BOARD OF HEALTH
JOSEPH P. CORIZZO
President
DANIEL SELDIN D.D.S.
Vice President
PAUL.ROLAND
Secretary
GERALDINE A. ZAMOYSKI M.D.
ALFREDO F. GARCIA Jr. M.D.
PAUL CHANG M.D.
JOYCE MILLER M.D.
WILLIAM ZURHELLEN M.D.
HON. THOMAS BERGIN
Putnam , County
DEPARTMENT Of HEALTH
County ' Office Building
Carmel, New York
10512
914/225-3641
JOHN SIMMONS M.D.
Deputy Cenrniesioner
'J. ROBERT FOLCHETTI P.E. M.S.
Director Of Environmental
Health Services
ELAINE KRUEGER R:N. M.A.
Director Of Patient Services
Date 1 Q
p
l Q Re: 017 la".
Dear I i /�1. �1SfM.a� Ld,191 f %. 4t MOv- l�Q 1CQ
A review of the submitted application to construct a sanitary sewage disposal
system for the proposed premises has been concluded.by.this_ department..
The plans are being returned to you.for the following reasons.
REQUIRED INFORMATION MISSING
..
N
),_Completed
application
-
(2)'
Design data sheet .....:.-
(3)
House plans (2 sets)
(4)
Authorization for engineer
(5)
Layout plans (SDS)
(a) House location
(b) Plan and profile of SDS
(c) Location of driveway.
(d) Location of well or public water main
(e) Contours of property
(f) Location of any water courses, ponds or lakes on property
or within 100 feet of property .
"° �•
(g) Location of deep test holes and percolation test holes
CM Location of all wells and sewage disposal systems within
200 feet of property lines
(i) House setback
p Footing and leader drain location
.(k) .10 feet to property line
(1) 20 feet to foundation walls
(m) 100 feet to nearest well
(n) 15 feet to curtain drain
(o) 10 feet to water line (pits 20 feet) `
(p) 15 feet to storm drain
--
(q) 10 feet to large trees
!�
(r) 10 feet from foundation to septic tank
dr in
J
„, -fgt t ipe froryry leader a�d footing drain .
(t) oe ' , rG do -s' riot S o w 3 Cor u-+ r n r .
k - s PerC i^��Cyc4irF' r 9�D L,1=o nod ).40 'LF
fmatter,
If
you have any questions concerning this please feel free to'
contact.me at this office.
Very truly yours, -.
..
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