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HomeMy WebLinkAbout3429DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.17 -1 -41 BOX 27 I I INNS �L NOY „ -, l ' ,` rT , L % T r IN IN No a IN IN IN 03429 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION.OF ENVIRONMENTAL HEALTH SERVICES R D d 63-1) PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR Y" NO Internal Use Only Q ❑ Repair Permit issued in last 5 years ❑ ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland SITE LOCATION qS & cvl v, kQ4W TOWN OWNER'S NAME Ej'),eeti ; a} MAILING ADDRESS 4 PERMR # ❑ Not in Watershed ❑ Delegated ❑ Joint Review Ile TM# %S. N'�"I�•�� PHtNE # 91%S -5,W- 3114 APPLICANT 4 h to oa gielit (Cv�l�- f�R��O ✓, Name i, Relationship (.e., owner, tenant, contractor) DATE 7 I FACILITY TYPE &)e,41;AJ_� P HD COMPLAINT # PROPOSED INSTALLER UJS IN)AAACrnvi� S?"t6 PHONE# 8G'- ADDRESS 6;%sn REGISTRATION /LICENSE # Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the .nature and extent of the repair. I, as owner,agree to the SIGNATURE (owner) I, the septic it SIGNATUi (installer) on this form TITLE DATE 7 �� ions of this permit for the septic system repair TITLE DATE / 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. No completed work is to be backfilled until authorization to do so has been obtained from the Department. INTERNAL USE ONLY Proposal Approved ❑ Proposal Denied ❑ Inspector's Signature & Title Date Expiration Date Re air proposal is in com liance with applicable codes Yes ❑ No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 PUTNAM COUNTY HEATH DEPARTMENT � VJ DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL. FOR SEWAGE TREATMENT SYSTEM REPAIR YES N Internal Use Only PERMIT # ` t1-SY ❑ Repair Permit issued in last 5 years FIT Not In Watershed ❑ ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated ❑ ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION v �, TOWN TM # OWNER'S NAME A el '-ri Z_ PHONE #, _ S 5' 319b MAILING ADDRESS 1- ncoly% P d A,4m m Ua 4 t /V ! Jo57 APPLICANT ls' s � o o5 �Ah , 5ee yi& ..S C`I bc�_ g E J f r /91 Name & Relationship (i.e owner, tenant, contractor) DATE FACILITY TYPE kP__S41lf(.VL1 PCHD COMPLAINT # PROPOSED INSTALLER' PHONE #fzp q� ADDRESS Cr2t 4 t✓ REGISTRATION /LICENSE # :S C)-7q Proeosal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature and extent of the repair. I, as owner,agree to SIGNATURE (owner) I, the septic it SIGNATUR (Installer) ' this form . DATE S ions of this permit for the septic system repair A 1 TITLE Oc) �n� � DATE 1 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. No completed work is to be backfilled until authorization to do so has been obtained from the Department. INTERNAL USE ONLY Pro osal Approved Proposal Denied ❑ If, 1e� /1" 410 I pector's Signature & Title Datd Expiration Date Repair or000sal is in compliance with applicable codes Yes No D COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 ..�. - .:...',. ... .. ... ...., _ Y : �.Lti ,. b: :. ai' ,?.? T`•:.' i ".. .Y '3'77' ax, ,aY- £ .., ........._...... ..:.. . .- � -: s e � .. <. -: .. ,. -.:,. ::. �- .'.,x:�: a�r�, ,x b`w i:', a:. . e sa F..:zx :<. � *s`^i3C.+ ,F •.A�, • e, .. ,.,+'. „ A.' ' . ,_ , -:. .. a s. - .;.- S. - -. _ : ; . :4: - .x:.53 -,� '�.. r.-+" � �i •?? ,�`-, v. s,. �.. ,.: ,.. .. - v.;, ...- r -. ., �. F 't .= .-;, �' Wax .: r, r .,3v};,f�t y, �:. �'-vi. � ?'ia� :7�.� - .vr•,+�� i.. i. �y'J ��ai a:. V. �s, ;, .•y,_ rt.'; -c:_.d ' �. =:%.in � '.r+L ,� - .`e-, �. "C 7....:, k ',a '�Z-c7: ' ^.^r:t' r. _ -'+d -' 7'.,•s.s.c.- _er br: ti•'.r,. .. .,_; .a + -f=.+- o-¢•'n _•f$ ,�. «k i. '.�'.a.. tee°'-';, i' [,. y_ :`,s -`. s ! r z - ,�...: c�.. ,,. ,.. .. - . .. r � ....,. .. , ...: o c aetf f. t.: i'xn s w 7,'•?� ,, eu+:.a.,+ _ N 77 - z i w. x ,fit x .., „ . ,: i -: •. , ... . ��� '� � � � _ t - y' "+ � S ,x,�r' t�17 cam/ 'IK >r CfZN��vAY. Yutnea County. Department ai.'•flealta ,ivieion oi 64iviromntaV{1 { " ��• , i s: I Health,8ervio / a (J - -__... se no ` - 9D oved t for oonYormanoe p�9t' I F NEW elth vDlioable Sulee' 8nd. 8egulations .os the >r p cHq 'utuam County Health Department: P CfZN��vAY. Yutnea County. Department ai.'•flealta ,ivieion oi 64iviromntaV{1 { " ��• , i I Health,8ervio / c- ; v I 4 (J - -__... se no ` - 9D oved t for oonYormanoe p�9t' I F NEW elth vDlioable Sulee' 8nd. 8egulations .os the >r p cHq 'utuam County Health Department: cw� 1 --qjF��Y (- 113-90 • IG� ab� � -,, Dlel� e[I�eLeatmaulal HaaW 8an'le�e. 4a�e1I�i.Y. D4137t tDa Pese+Oda � e � SIMCMMICATROFCCROUAM 7 PW= "11'=WAft 111111on" UM= Femm. 0 L4 td ri BankP•� .� [� -� 91i. Ot+a /A�rt ialltri ii7i f)►q,2i�Ti�1,�.,L —.__ �. I'L ec ✓ —, ••� Daiae a= Prevlaao AjF��- �cj c_., / '7 i �g3 � '( 11.■rrD Aiwa ►�FL� i�_:3t' J67 Town z1p -J S'l p, a Subdivision Annrov d Fee Enclosed ❑ e,,,-,,,,* IM A. Fm Sol 11111 Daalyt Flow G P D JJ,, PCHD N H �q� When la IS ease kd t � SlM� is issad ) d Gasoo Slob Tub md-144 Ty be, eaoaaatei,ry— Wag"' SII!!b Fimo• Addreea -- y an I repremu-that 1 am wholly and completely nsponslble for the design and location of the proposed system(gs 1) that these rate saw di!a��YI s�yyatom County will b• constructed d shown on the approved amendment there to and in accordance With the standards. rules a regu ns o7- i�i"Rinarin Oounty DopartnNnt OI' ►1aeNh, and that on completion, thereof a'*Certifieate of Conatruetton Compileneo" atlsfactory to the Commissioner of McPutna ll a submitted to the Department, and a written guarantee will a furnished the owner, his fuCOMW16 Miry or assigns by the builder, that aid builder will film in good operating oandttlon any Dart at aid eawago disposal system during the period of two 2 or of the apP►Owal Of the Certificate of Construction Compliance of the O.IginaI system or any rooks years . Z) ele lately following th dad�de� ado wW M kliated as 111M on the approved plan and that aid well will ha installed M acoorean with r std AMY of ►Iaalth 4 ules reguM oWss-of the PutMm Date 4, g. �� Sa,nee Address APPROVED POR CONSTRUCTION :Thh approval revocatile.for cause or may be an:er:ded or modied when considered sn recesary by t the Commissioner ofruMOSlth of he cAeng eMOrhaaltberceatbnOtroor�structlons reouUea a Permit. Approved for disposal of domestic sanitary sew and /a phrase water supply H only. Due. PUTNAM COUNTY DEPARTMENT OF HEALTH V. 3116 Division of Environmental HeaIW Servlcelr, Caimel, N.Y. 10512 Engineer Must Provide 1 I - -- P.C.H.D. Permit li - .�... �. •` v..�ar..rs+.a. . ,+ .....o-.. .. �.:; -a��- _..+.... _ ^� -- +.w .P. .- ....— ...•... -I-: ..... ....... j ... ....:p- ..may..•. -..ter ..o-- rs.. -. � 7 � '^ .��• � p ..•:„ �. � �• FOR SEWAGE- `DISPOSAL SYSTEM} _., � ,� ~ y • / • CE CATE OF CONSTRUCTION COMPIdANCE Town or V -� Located Tar; Map_ 1 BI Lot. L Owner/ Ilcent Name �� 2 l /mac /1 a Formerly Subdivision Nam ubdv. Lot N 9 r Zip ADS � Date Permit issued 1VIaiWng Address r �� �oa..o r� t) �[k'� C Separate Sewerage System built by Address Consisting of - Gallon Septic Tank and Water Supply: Public Supply From / Address or:� Prlvate Supply Drilled by� . ?dJ " ° c Address�'T7 ---- Building Type -sj�n Has Erosion Control Been Completed? Number of Bedrooms Has Garb a Grinder Been Installed? Other Requirements / r I certify that the system(s) as listed serving the above p emises were constructed essentially as on t plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regula in ccordan th the f le plan, and the permit issued by the Putnam County eat Of Has h. i /�j n 5) Certified (b P.E. Z R.A. Oats _ / Address License nea No. Any person occupying premises served by the above system(:) shall promptly take such action as may be necesar to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become hull and void as soon as a pub(: Unitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the CommissionW Of Health, -h revocation, modification or change Is necessary. Date `�� ��`'- O �P L�—�r✓ eye / i PLPH'R)AlY! COYRY DEPAWrMM OF KM TB Division of Env04ommlental Health Swvkm. C=m d. Fl.y.19512 augineer to Pnvide Poemtlt d om Cfl RTIFICATL: OF COMPLIANCE CONSTRUCnON PERM FOR SEWAGE DISPOSAL. STSTM PesmOQ d � Nam tebd. let +y -., z,.. Tan Map Ltlsr$ i Danes /AppDtcamt Name M01=70 �{� ��� t G � Llenewal____ ❑ � �n Date of Pteviona Approval �C> 9'� ' ` "� It Addre®o —% �i+t1 �L�l7 To". m 2�lp 0�24� Banding Type 1=> I Let Area - ` `0 �� AIC- Nttmbes of Ltedtoem® Fm !F�CHD don Only Depth_Vobun® Deatgu Flow G P D �%� Nod&m&n Is Renulred Wben Fill le completed B Ya �PGallon Septic T.* rand �� �-- A t Separate Sew "e system 4o conelta4 of To be oaimbucted by_ ^ \ t �� s Water Supply: Pu blle Supply From Addreas or: kPPrivate Supply Drilled by � ' .� /`Add,= Other Blequireaaents I represent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules—and regu a ,ons o e u nam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance', satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written 'guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will Place in good operating condition any part of said sewage disposal system during the period of two (2) years im diately following thedate of the Issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs theret 2 that the drilled well described above will be located as shown on the approved plan and that said well will be installed . a Ord ce wi the sts rds rul a County Department of Health. egu aZiions of the Putnam Date , ' p �l Signed t� P.E. _ R.A.�Ir. Address___ License No ,; APPROVED FOR CONSTRUCTION; This approval expires two years from the date issued unless constructs n *of the building has been undertaken and Is revocable for Sjuse or may be amended or modified when considered Vicessary by the Commissioner of Health. Any change or alteration of construction requires a permi Approved for disposal of domestic�sanita�ry'' sewage, and private water supply only. Date / BY 'e, �-'"cD PLTI N AM C ®11M'fY DEPARTMENT OF HEALTH (� Division of Environmental Health Services, Carmel, N. Y. 10512 ENGINEER TO PROVIDE PERMIT # ON CERTIFICATE OF COMPLIANCE, PERMIT PV -5 -85 CONS UCTION PERMIT FOR SEWAGE DISPOSAL -SYSTEM Town or Q age Located at Lincoln Rd ° Tax Map 73 Block 1 Lot 17.2 Subd. Lot t Renewal _ Revision _JA May 1j 1986 Subdivision Owner /Address Stanley & Stella Brown _ 434 Cove.' Rd o y Date Of Previous eval A-nri 1 R 1 AR5 lAT I�dl[L V a 1.i c Building Type `S o F o D o Lot Area ° llJ Fill Section On y Number of Bedrooms Design Flow G /P /D 600 P.C. H. D. Notification Required Yes Separate Sewerage System to consist of 11000 Gal. Septic Tank and 37 5 L. F o x 210 trench 210 -B Peekskill Hollow Rdo To be constructed by J °Jo Construction Address .Putnam Valley, N.Y. Water Supply: Other Requirements Public Supply From X Private Supply to be drilled by Address Perimeter seal is &.Sons Inc. vepa, , Brewster, N.Y. curtain drain & 3' fill section. I 1 represent that 1 am wholly and completely responsible for the design and,location of the proposed system(s); 1) that the separate sewage dsal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules n a regulations 'T ispoe Putnam County Department of Health, and that on completion thereof a "Certificate - of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system. during the period of two (2) years immediately following thedate of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be Install In ccordance with the sta rds, rules and regulations of the Putnam County Department of Health. Date May 1, 1986 S P. E. X Address Perk's Blvd., Cold S- rijacr. N.Y. 10516 License No. 49nng APPROVED FOR CONSTRUCTION: This approval expires one y r from date is d unless construction of the building has been undertaken and is revocable for cau of ma be amended or modified when considers n ce by th missio er f Hoe h. Any change or alteration of construction requires a new p r- ' A ved for disposal of domestic sani r e, and /o ri e r ply only. Date By A/ Title r v PUTNAM. COUNTY DEPARTMENT OF HEALTH_ ic 1 Permit i P .. Division of Environmental Health Services, Carmel N: Y 10512 } Putnam VAlley .:, &ONSTRUCTION PERMIT FQR SEWAGE DISPOSAL SYSTEM rage Linco'n Rd., Put5lam Vai'le;- ""�•��° _�... -�.:, .. - -� •.Bl�c`k ". .. ....r,:•g ..Lot b 17 • �._.. .. -..�; Located at Tax Map Subdivision 'owner /Add ;e: . Stan'ley &. 'Stella Brown Lot N Renewal _ ❑ Revision _ ❑ Date Of Previous Approval S F . D... 1.05 ac Fill Section Onl ❑ Bu;Idm9+T�YDe ' Lot Area -- y 4 Number of Bedrooms Design.Fio . . H. D. PC N D Notification Required l, /Plop L Separate Sewerage System to consist of Gal. Septic Tank and 500 L F X 2'-0 trench r' To be constructed by Address Water Supply: Public Supply 'From } _X Private Supply to be drilled by Norman ANderson, Putnam VAlley, N.Y. Address Perimeter seal i.ndicated on plans. Placement of 3' of fill. Other Requirements I represent that I arty wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage dispose, A.W. stem above described, will be constructed as shown on the approved amendment there to and�:in accordance with the standards, rules an regu a ons o e am County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner.of Healthwill r be submitted to the. Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns. by the builder, that `said builder will 4i4 place in good operating condition any part of said sewage disposal system during the period, of two (2) years immediately following the date of the issu- ance of the approval of-the Certificate of Construction Compliance of the original system or'.any repairs thereto; 2) that the drilled well described above .will. be located as skwvn on'the approved plan and that said well will be install accordance with the standards, rules and regu a ons of the Putnam a+ -County Department of, Health. Date Nicer 7:� 7 �3R5 Si - w ' P.E. X R.A. + Pork's Blvd., Cold S ring, N.Y. 10516 49002-" Address p g License N0. APPROVED. FOR CONSTRUCTION: This approval 'expires one,year from the date' issued unless c s ction of the building has been undertaken and is revocable for cause. or may be amended or modified when considered nec ry th ommissio of Health. Any change oration of construction ^r requires a ne r per A o or disposal of domesti nits age, . ntljo p vale - - -- .. =� Title.? Date BY 9j r� Rev. 9 -81 d ` I PMAMcouNTr DEPARTNM oFaEALTB . o Division of Environmental Hesllth Servkfae. Carmel. N.Y. 10514 Engineer to Provide Petmit on CERTIFICATE OF COMPLIANCE -.•" ('T.CE3dII?!':Tdfi �.sx ':nn ..ee.,.i�:r vvu�wi�i ": - Permit _M Located akt �I /I1_"oW Subdt,Wm Name Owner/, .. .,, •.' ¢eg ..�-. �.•- 1 L% � fU1 ->.P" \,•• "- ^«a.ae.�.iw+iww.�w .... I�-�'7 F Town or Village Tax .Lot I I ] 1..,;? t Date of Previous Approval �( � I � to j S Wiling Address '17isdei'1�4Ki I>:/� Town M4 t n. Building Type kr�tti'p Lot Area dt? Number of Bedrooms Design Flow G P D PCHD Noti9cation Is Required When Fill completed `3 Cep C� 96paraft Sewerage System to consist of p� on Soptic Took crud__ �',J i - � _ Lk Ll To be constructed by v 7�) Address ~R Water supply: Public supply From Address !! or: Private Supply Drilled by Other Requirements: �v1 N1 �h? 1r_..[ �L V -- M � ��� �+ - 3- 1 represent that I am wholly and completely responsible for the design and location of the proposed system s); 1) that the se ( parato sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regu a rons o 0 Fulnern 7 County Department of Health, and that on completion thereof a °Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill ,be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will .%ace in good operating condition,any part of said sewage disposal system during the period of two (2) years immediately following thedsts of the Issu- ;e of the approval of the Certificate of Construction Compliance of the original syste or any repairs f veto- 2) that the drilled well described above I \be located as shown on the approved plan and that said well will be install anc with th d rds, les and regu a ons of the Putnam ntY Osprrt nt�of H lth.�7 Signed f P.E. R.A. i Address —Z22 License No a VED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of/ a building has been undertaken and Is s for cause or may be amended or modified when considered necessary py the Commissioner of Health• /Any change or alteration of construction ; now permit Approved for disposal of domestic sanitary sewage, and /or priv two vwater supply only. /��� '7":7 P. ��, "';.a �:y �. t... i II. i FINAL SITE INSP°CTION • InsFe_•ted by r •;CATION % �`" •`I C G �� a /� Civ2lE S (- . - -� '-7 3. / a !1 r �-_- el <-- mm 4 nn cr=nT-u -m TrW. Tuff # • . ..i'. �."' .p..T .F.. ^was- r:e.Ja,r:w .. - [f -" --'rc �.. _s .... .. .. .r. -. _ ..+�. S=face'drainace arcund :.J.N:f- .:raYkiv•wr -.n -. „ - �ii�...,!n IVIJ L Ljr• Sr y�_..- DISPOSAL AREA a. Sus area lccated as per armroved plans b. Y U section - Date of placQnent 2:1 barrier. . LGM . WIM "a AVG.DPTH -? ✓ � , a. c. Natural soil not stri rcd AL pipes flush with in d. d'. Stone, brush, etc_, greater than 15' from SDS area_ C , -tain drain installed f. e. 100 ft_ from water course /wetlands. ' Frotinq drains cu.— scnarai h. Si3 TMEF DIS'r'OSAL SYS= a. Sentic tank size - -14W 1,250 L oszcn concroi nrnui r?i b. Septic .tank installed level c. 10' minimum fran fcundation d. Nc 90° bends, cleancut within 10 ft. of 450 bend Ai e. DISTRIBUTION EOX 1. All' cutlets at same elexraticn - water, testers I 2 _ Protected be? cw frost { a /7 3. Minimum 2 f t. criginal soil be taeen box and trenches E. JUC=ION EOX = rcce_-1v set I I Z 1. Lencth rear - I,encth 1n5ta11 ea -- 2. Distance to wat=ccurse measur ft. 3 . Ins a 11 f_:-- acccr=cr to plan I' 4. Dis Dance center to center 5. Slcrz of trench accemta ble 1/16 - "1/32 "/foot. ( I 6. 10 feet f_an prcre—rty line - 20 feet - four_daticns i I 7. Depth of t_e_ncn < 30 jzic'hes fran surface 1 1 8. Rcan alleged for e cansicn, 50% 1 I 9. Size of Gravel 3/4 - 1 #" diameter I ' l0. Deptn of =vell in trench 12" mi nimtnn L. Pine ends Grpe.^_ Z. PMED OR, DOSE SYSTRAIS _ _.....I 'Size' of ` i� c�amce�� e . -..... �.. �: �-__...- ..._........................... ... - �.. -... .. • ...�..... �. 2- Ch7t= -fI cw t_7nk l 3. Al;; =, visual /audio 4. Puma easilv accessible manhole to cr 5. First bQx Yaffle---; 6. Cycle witnessed by Health DeDartnent estimated flcw per cycle IV. MUSE a. Fcuse located per apnrcved plans. b. Isk-mcer of bedroans V. WML a. We?1 located as per approved plans b. Distance fran SDS area measured C. C asinq 18" above a'rade. d. S=face'drainace arcund VI _ OVaq;vr . 6yORkCyi ASHIP a. Yes properly arcuted b. A -I pines pc -, ally bac c. AL pipes flush with in d. Badkfi11 material conta. e. C , -tain drain installed f. Certain drain cut all g. Frotinq drains cu.— scnarai h. Surface water prot°✓tiei L oszcn concroi nrnui r?i e. Lde ft. ' de of box s stones < 4" in diameter ccordin_q to plan tected & dir.to ecist.waterc awav from SDS area adeauate cn slopes are_=ter than 15 %. i PLTrNAM COUNTY DEPARrMENr OF HEALTH - DIVISION OF ENVIRONMENZAL HEALTH SERVICES INDIVIDUAL NAM SUPPLY SUBSURFACE SEDGE DISPOSAL SYSTEMS .n:,.- - �Tf- e.;.�"•, ;,.:v.. .;.:, " . %uSti _.� ~ .. _� � >. .�r/'y'� "iiVa7r�A..A1VtV •BVGC'l�[1 .,. c;.�^,,. �.. .. p:R�.•��ir,�. %,u% ._.s �/ i.. v';.+.��f "�vp-•is,,,• ;i':i•-y', 0�-4 -� e�►1,z,/ Jclwt aQ.T J (y. a J.arury DATE: INSP. BY: (Name of Owner) (Street Location) INITIAL SITE INSPECTION US NO I CM4am Wetlands on/or proximate to property .............. Property lines or corners found ............... >... Can estimate house location ° ..................0.000 Will driveway need cut ............................ Mast trees be removed - note these................ Deep holes representative of entire SDS area...... Additional deep holes needed ...................... Sufficient SDS area available considering driveway cut, house location, separation distances etc... Adjacent wells /septics ....................0010.... "1110 -, _7' JIL)f D.H. 1 Lot Lot �to G.W. a' Depth to G.W. Ca! _ Depth to rock Depth to rock Soil DescriDtii 0 ft. 1 � , , ue k 3 ft. �)�m �ZOL r 6 ft. wad Soil Descriptior 0 ft, 3 ft. 6 ft. D.H. - Deep Hole G.W. - Groundwater D.H. 3 Lot Depth to G.W. Depth to rock Sou Descrl 0 ft. 3 ft. 6 ft. 9 ft. 9 ft. 9 ft. 12 ft. 12 ft. DATE: FINAL SITE INSPECTION INSP.BY: YES NO CIXMMENrS House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Roam allowed for expansion trenches .............. Over 100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded ............................ 10 ft. maintained from property line and 20 ft. from house .............................. Distance well to SSDS (ft.) ...................... Number of bedrooms checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench ................ 15 ft. of-peripheral soil horizontally from trench ..... ............................... Boxes properly set .............. 0................ Could surface runoff from driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE .................. 1 / DEPARTMENT OF HEALTH Division of Environmental Health Services WO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 m .pJi -... tstly!!: -. � -' . -. - .r 4✓•":• -i. .w- . .. - - _ •- •. ,.- ;.- .I�.- .. -.I :. a•... • .. �... - ..•r'+...��'.•. J.t i, tn.. APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION }1 Street Address Town/Village/City Tax GridN']umber WELL OWNER Name Mailing Address Ck p 0- Private O Public E OF WELL 1 primary 2= secondary EkdSIDENTIAL 0 BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY O ABANDONED []OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE4SO ' gal REASON FOR DRILLING M31EW SUPPLY O PROVIDE ADDITIONAL SUPPLY OREPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL ❑ TEST OBSERVATION DETAILED REASON FOR - DRILLING -� WELL ' TYPE [31IRILLED DRIVEN DUG GRAVEL ❑ OTHER IS WELL SITE SUBJECT TO FLOODING? YES L/ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:1-czc���4� Lot No. WATER'WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ENO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM'NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED AR OF THIS APPLICATION SEP T (date) natuKg) 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 1� �,7 : Date of Expiration: 19 ermlt ssuin f i Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner 2/87 rlranrrc ry rnr- Gicl 1 nri 1 1 cr POST OFFICE ADDRESS RFD Z PUTNAM VALLEY. N. Y. 10879 914 838.3333 TOWN OF PUTNAM VALLEY NEW YORK Paul J. Kastuk , Highway Stip 1 t . f April 4, 1985 County Health Department County Building Carmel, New York 10512 ATT: Mr. Robert Tort(ani, Dear Sir, The Putnam Valley Highway Department agrees to re- direct the flow of water from culvert pipe under Lincoln Road, which flows on to .parcel of land, Tax Map No, 73- 1- 1.7,2, that Mr, Stan Brown plans to purchase. This will be accomplished with the installation of a.catch basin. ft " of Y - tMt P peYtg�, .� v.... P- Fe�ove-r -to • €i y "foo, "right of- -r--to ad;�en. ,, ro -.- - This will be done before Mr. Brown commences site 'improvement work, Sincerely, PAUL J . STUK -/ Highway Superintendent DAVID D. BRUEN County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services Mr. Lawrence Belluscio Perks Boulevard Cold Spring, NY 10516 Dear Mr. Belluscio: April 23, 1986 r. JOHN SIMMONS, M.D. Deputy Commissioner Re: Brown SDS Construction Permit Renewal PCHD Permit PV.5 -85 Lincoln Road, PV, TM 73 -1 -17.2 Review of plans and other application materials relative to above referenced property received 11 April 1986 has been completed by this Department. Based on site inspection on 17 April 198 a.review of the construction plans dated 7 March 1985 and'pursuent 'to Article III of the Putnam County Sanitary Code and Part 75 of ,the New York Official Compilation of Codes, Rules and.Regulations: You are hereby advised that the proposed method of providing sewage disposal and water supply are considered inadequate for the, following reasons: r 'l..r� -" T g}�: oiirid_�wa;ter.:was =f4'vx}d• .to exist -withirr- :2Z-- f- eet..o:f,- g-rade,.. _ _ - 2. Less than 50 feet between sewage disposal system and "catch - -- basin or pipe outlet has been provided. 3. Less than 100 feet to a year round stream or 50 feet to a seasonal stream has been provided. 4. Location of wetlands on property and separation to sewage disposal system has not been indicated. As such approval of proposal cannot be•granted. If you have any questions, please call me at 225 -3838 or 225 -3833. Very truly yours, James S. Hodgens Assistant Public Health Engineer JSH:amm cc: / File Stantley and Stella Brown,434 Cove Road, PV 10579 JSH TWO COUNTY CENTER - CARMEL, N.Y. .10512 (914) 225-3641 D f r RPo�2. PUTNAM VALLEY. N. V. _ 1057@ 914 526.3393 = i` TOWN OF PUTNAM .VALLEY NEW YORK Paul J. Kastitk, iiighway SAIp't. April 4, 1985 County Health Department County Building Carmel, New York 10512 ATT: Mr. Robert Tortoni, Dear Sir, The Putnam Valley Highway Department agrees to re- direct the flow.of water from culvert pipe under Lincoln Road, which flows on to parcel ' of - .land, Tax Map No. 73 -1 -17.2, that Mr. Stan Brown,plans to purchase. This will be.accomplished with the installation of a catch basin _., t acrddtrona� p 2Fe:: aver. :to ; f;%.f.t.y, fp4t. righ_t;c =rywa;_adjacent to property • - This will be done before Mr. Brown commences site improvement work. Sincerely, J AUL J. STUK Highway Superintendent PUTNAM COUNTY DEPART OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIF�I,D, INSPECTION;,REPORT.,. DATE: ~17 G1 �sa�lrt'�,vtit� _ �1 INSP. BY: (Name of Owner) (Street Location) INITIAL SITE INSPECTION YES NO COMMENTS Wetlands on /or' proximate to property .............. Property lines or corners found.. ........ o ....... o Can estimate house location ....................... Will driveway need cut ............................. /U Must trees be 'removed - note these ................ +� Deep holes representative'of entire SDS area...... Additional deep holes needed......... .... .... Sufficient SDS area available considering driveway Z cut, house location, separation distances,etc:.. ? 2 � CB? Adjacent wells /septics... .. D.H. 1 Depth; G:W. Depth to 3 ft. 6 ft. 9 ft. D.H. 2 Lot Depth to G.W. Depth to rock Soil DescriDtia 0 ft. 3 ft. 6 ft. 9 ft. `. i 2 D.H. - Deep Hole G.W.- Groundwater D.H. 3 Lot Depth to G. W. Depth to rock Soil Des cri tion 0 ft. I 3 ft. 6 ft. 9 ft. DATE: FINAL SITE INSPECTION INSP.BY: YES NO COMMENTS House;SSDS located per approved plan ............. Length of trench measured Width of trench average Slope,of tile line and trench acceptable......... Room allowed for expansion trenches.............. Over 100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded........... ... .......... 10 ft. maintained from property line and 20 ft. fran house ......................... ..... Distance well to SSDS (ft.) ...................... Number of bedrooms checks ........................ Stones, brush, stumps,.rubble, etc., greater than 15 ft.;fran nearest trench.. .......... L5 ft'. of peripheral soil horizontally from trench ..... ............................... Boxes properly set...... ... ..................... 2ould surface runoff fran driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... EINALiGRADNG OF SITE ACCEPTABLE.......... .... MM .�Q u� ; ,:. �., :�•4•, ". - f PUTNAM'..COUNTY 'DEPAR'IkPP-*'61? r-HEALZ11. DIVISION OF ENVIRO'11M MAL HEALTH SERVICES me Owner or Purchaser of Building Building Constructed by Location - Street L Municipality Building Section Block Lot Subdivisio4 Name Subdivision Lot # 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 .,:_.o- .,,,.o on. any, pArt,. of . said system constructed ,.by me ;which : fails toy.. __...� _. _. ... _ _ _. operate -for a periocT of t 3o years immec3ia ely follaiaing fhe"�a£e 6 --& proval- 'of -tlie "Certificate of Construction Compliance" for the sewage disposal system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environinental Health Services of the Putnam County Department of Health as to whether or not the failure of the system t to was caused by the willful or negligent act of the occupant of the ' lzaing utilizing the system. A n , Dated this day of inn4 19 Signature Title General Contractor (Owner) - S gnature Corporation Name.(if Corp.) LA- httan a UIR 1A //104 d�diress zev. 9/85 mk Corporation Name (if Corp.) Address /4 C� ®O /I. T-T TTT1Al'fT WELL UUr1rLL11UA rrrUni y :,* DEPARTMENT OF HEALTH- . ��• , ", = 'u�'w•i7ivisori1.Of �Environinental `He�al`th ~Services - FIB Y� PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only ��� ' WELL LOCATION STREET ADURESS: WN/ l TAX GRID NUMBER: Lincoln Rd. Putnam Valley,NY WELL OWNER' NAME: ADDRESS: Edward Stevens, 9 Brook Lane, Rye.Brook,NY 10573 p pgIVATE O PUBLIC USE OF WELL 1- primary 2 -.secondary II@ RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED ❑ BUSINESS O.FARM O TEST /OBSERVATION O OTHER (specify) p INDUSTRIAL O INSTITUTIONAL ❑ .STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING []REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY ®NEW SUPPLY (NEW DWELLING) ❑DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH zo 5 ft. STATIC WATER LEVEL 10 ft DATE MEASURED 8/25/$9 DRILLING EQUIPMENT C@ ROTARY XX COMPRESSED AIR PERCUSSd p DUG ❑ WELL POINT O CABLE PERCUSSION O OTHER (specify): WELL TYPE ❑ SCREENED O OPEN END CASING ® OPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH _ 31 _.— ft. MATERIALS: fI STEEL ❑ PLASTIC ❑ OTHER LENGTH BELOW GRADE 30 ft. JOINTS: O WELDED aTHREADED ❑ OTHER DIAMETER __ S --,--in. SEAL` J] CEMENT GROUT O BENTONITE O OTHER WEIGHT PER FOOT — 19 '1b. /ft. I DRIVE SHOE OYES ONO I LINER: DYES ZI NO SCREEN DE TAILS ` DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (it) DEVELOPED? FIRST _ o YES o NO. HOURS,. SECOND GRAVEL PACK ❑YES ❑ NO GRAVEL SIZE: .DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM OEM It. WELL YIELD TEST If detailed in um P P 9 METHOD: ❑ PUMPED i tests were done is in- (COMPRESSED AIR , formation attached? O BAILED ❑OTHER ; ❑YES ❑ NO WELL LOG ` 11 more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE water Bear- ing Well Oia- meter In FORMATION DESCRIPTION G70E ft. tt. WELL DEPTH It. DURATION hr. min. DRAWOOWN It, YIELD g(;m. Surface 10 lDrilline, in overburden clay & bl . it rock at 10' 205 6 185 7'—z 0 31 Drilling in rock,set casing,g ou granite, WATER O CLEAR TEMP. DUALITY ❑CLOUDY HARDNESS ❑ COLORED 'ANALYZED? .O YES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK : TYPE E CAPACITY GAL. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAME P. F. Beal & Sons , Inc unT�/ 0/90 ADDRESS PO BOX B IGTJ1tTURE Brewster,NY 1059 3/89 Irs . ed. DEPARTMENT OF HEALTH Division of Environmental Health Services 'WO COUNTY CENTER - CARMEL? N.Y. 10512 (914) 225 -3641 r � -.a an;. .'.. . "`,'M _..... .: .:. .. 1.`-1 .��- s -t�. -o :r �r Srwi .�f 7r•'.. .I`_i ... -.� n., _ APPLICATION TO-CONSTRUCT A WATER WELL ,p�/•5 PCHD PERMIT # WELL LOCATION Street Addres ,Two Village City Tax Grid Number Name Mailing Address GWrivate WELL OWNER M kJ L-• ,- 7 L-0"0 o 13 Public USE OF WELL OIRESIDENTIAL O PUBLIC SUPPLY C AIR /COND /HEAT PUMP ® ABANDONED 1- primary 13 BUSINESS O FARM O TEST /OBSERVATION O OTHER. (specify: 2 - secondary ® INDUSTRIAL 0 INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE -4�gal REASON FOR UNEW SUPPLY O PROVIDE ADDITIONAL SUPPLY ® TEST /OBSERVATION DRILLING O REPLACE'.EXISTI G SUPPLY ® DEEPEN EXISTING WELL DETAILED lio v �.REASON'AFOR DRILL•I•NG . -WELL TYPE DRILLED f [DRIVEN Li GRAVEL ® OTHER I' i WELL SITE • SUBJECT "TO' FLOODING,?., YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name 77, Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES L,--'NO I NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION T SHE C) f FT? (date) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30)•days of the completion of water well construction, the applicant s.hall: 1. 2. 3. Date of Date of Permi t 2/87 Pump the well until the water is clear. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. Submit a Well Completion Report on a form provided by the Putnam County Health Department. Issue:�`�" 19 ermit Issuing f icia Expiration: 19 is Non - Transferrable White copy: H.D. File Yellow copy: Bui.ldin Ins'pect�or Pink Copy: g Owner Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health In the matter of\ a plicati n for: represent that I am an o ficer or employee of the corporation and am authorized to act for�l�f ='sl�J (Name of Corporation) having offices at �� cc� %� �t i• Whose officers are: President: 'MbP (game and Address) Vice,— President: (Name and Address) l eere.tirya._ Treasurer: (Name and'Address RLIGrim << (Name and Address) and that I am and will be individually responsible for any and all acts of the Corp o ration with respect to the.approval requested and all subsequent acts relating theret). Sworn to before me this /6 day Signed: of L. rn 6s �� 19-' Title: Nota= Public; y J ;KEVIN L WRIGHT . Notary Puft State of New York Qualified in Putnam County ' Commission Expires \� 8/84 5 4 .1\ 1 Corvorate.Seai � e PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .t�'L :t {: J.�.n.Il��.w ... .4uti Ya r x �` R.. l� � •i � x .. - - r Date ^ ?7 c Re: Property of bL�dIi7 \Az Located at (T) Section Block t..`, Lot I. Subdivision of Subdva Lot # Filed Map ## Date Gentlemen: This letter is to authorize V V/ e C'14 e=-L.' r\-t-y a duly licensed professional engineer 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 supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersi-g PeEa, ReAe, # z Address Telephone Very truly yours, MO 1 'NJ\ Signed Owner o n Address Telephone perty d PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - COUNTY'OFFICE''BUILDING,- - CARMEL, N. "Y: DESIGN TA HEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner 4 ... a �... �row.n Address 5�3Y c.o✓e. .. 7v +�4�•y, 1Ja. sy7 . y. . Located at (street ) ,L/ j .Aeot H Sec. ..73 Block Jr 1 _Lot '! I. 'L . Indicate nearest cross " street) Municipality ! w H w ry 1 ti &M (_ 4 �y+atershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole . .0 7 y I f 3 Number CLOCK TIME PERCOLATION PERCOLATION /a% Elapse Depth to Water Water ve No. Time From Ground Surface in Inches Soil Rate 30 Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 1 11:333 11; 5'L I S. S- / qyz. 30 ce i4 2 .-7 s- eto'. 3 /2 :13V =[z:jl 2Szs- !Y 4 12 :Yo / :o7 y' ;Z 7.75- / y /7 3, t. zy —• 1 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 submitted for review. 2) Depth measurements to be made from top of hole. . .0 7 y I f 3 9,33 `A xy 1 1/: b I /7.'7S . /a% ,SyY 3 Sa/ 3 12; /(PV 12'.g&r- 30 [ 'L I ?/,g 2.e75'" i 1:43 30 1IA— i4 2 .-7 s- eto'. 1 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 submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS 11,MOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 611 1211 1811 2411 3011 3611 4211 4811 5411 6011 6611 1211 7811 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED st - 9- -WATER INDICATE- -LEVBL-:--T0--11 .-IBV-EL--,--.,RISESt-A-FT-ER-,BEING--ENCOUNTERED� -NaTe- STS DESIGN Soil. Rate Used Min/l"Drop: S.D.. Usable Area Provided- <LAC No. of Bedrooms Septic Tank Capacity 11�6 Gals. Type Absorption Area Provl—ded By 0 L.F.x241' -,i�,, ench. Name Egmill w3g�l-b bignature Address & It rr- S Pe-ek 45 i SEAL gf,-2(d 6 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft/Gal. Checked by 4 114�1 - A. r.0 4, Alf% �o J. 0) Date i PUTNAM COUNTY DEPARTMENT OF HEALTH_ DIVISION OF ENVIRONMENTAL HEALTH SERVICES r'T.... ... r. w.. :f. + _ - .....Y... r.� _ . f ,.VCr : .:T'.' n,. • .-T •.f,, .. .rTR.. _..r. r..... .s�.. .' .. COUNTY OFFICE BUILDING,'.CARMEL, N. Y. 10512' DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. _.,.Owner ���,�c> �;�•,�� �-� iA� ��cs:y Address Located .at (Street ,-Ilq6a_;v Block 1 Lot 1.-7,2- 61cate-nearestcross street) Municipality -mac 1)nfJ[..r Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole z- ( 31 'L 3/4- Number CLOCK TIME -'� PERCOLATION PERCOLATION Run 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 2 0 0 3 C� I 9 -71 Z' � to's 314 7 3td z 4....0 J C � 0. 19 z- ( 31 'L 3/4- ZI' /D i.5 `I— 1 5 Notes: 1) Tests 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 to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED.WITH APPLICATION _DESCRIPTION 'OF SOILS ,ENCOUNTERED IN TEST HOLES _ ._. a .'... Re. 1e. •1 .._..- . - C2 .I rna a •.. iP. s ♦`..l .._ .. I. ..•�.i- . _. DEPTH' HOLE NO.- HOLE NO• "Z_ HOLE.. NO. G.L. c •, car -� r L 6" 1811 < < 2 n 30,1 k' Ir 3611 4211 ' of 4811 5411 1 r 1 1 6011 i r 1r •1, _ 6611, 7811 i1 8411 r Ci�,, t� r . INDICATE LEVEL AT WHICH GROUND WATER IS .ENCOUNTERED __ Cd dT�IuATF,e L:TO:.tii�f ICH..WATER ._ T -RISES AF' EP, BE? T�� ENCOUNTERED _ - - TESTS MADE BY :X_- r w. , DESIGN- Soil Rate Used II-49 Min/1 "Drop: S.D. Usable Area Provided f , No. of Bedrooms Septic Tank Capacity co Gals• Absorption Area Prov ded By F•x24" width hetrenc • Address - ZCl SEAL - o' i"r a c4✓l THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY • �o o • 048AGO Soil Rate Approved Sq• A /Cal. Checked by Ess«