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Home My WebLink About3658DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdoes.com 631- 589 -8100 74.14 -1 -15 BOX 29 . I I Is Is I ir TIC 8 ti ' �� T IN IF 1 . A� 1' . 1 I r� ILL I PUTNAM COUNTY DEPARTMENT OF HEALTH ENGINEER MUST PROVIDE Q \�j� Division of Environmental Herelth Services, Carmel, N. Y. 10512 PERM I T # 'v C RTIFIC OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM p Town or Village w. t` � Located at �'�` 4 �_ '�� Tax Map �dv Block 111'r-0 Owner 111'r-0 � � / / Formerly Tax Map Lot k Subd. Lot U Separate Sewerage System built by ge�A-X POF O / f/ {� Address Consisting of /W`00 Gal. Se tic Tank and � e, /°+�!i lf✓ G'3 Other requirements Au I7Wi`/ri G `=4;z i lC '"ri, Water Supply: Public Supply From Private Supply Drilled By Address /rY� r.- •�!`,�'� Building Type Has Erosion Control Been Completed? No. of Bedrooms Date Permit Issued Has garbage grinder been installed? 0 t/ I certify that the system(s) as listed serving the above premises were constructed,.essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulations, in ac��twix the filed plan, and the permit issued by the Putnam County Department Of Health. ,a Ctt. ()F 7NIc "",¢�.� /I Certifi by Oats � -7 _ W t Address a- i3 A3` . Any person occupying premises served by the above system(s) shall promptly take suc n as ' conditions resulting from such usage. Approval of the separate sewerage system she ` me available and the approval of the private water supply shall become null and void who l iviltilk subject to modification or change when, in the judgment of the Commissioner dL 5h'` Date J By Rev. 6/85 P.E. R.A. s !Y 2 � License No. r Q�sX tte_ ecessary?,to secure the correction of any unsanitary r�uil and void as won as a public sanitary sewer becomes water supply .44Comes available. Such approvals are revocation,, modl fication or change Is necessary. ;�z:,-i—lilllllllllllllllll11111111,111111111 III w"Al 1`i► Mlli PUTNAM COUNTY DEPARTMENT OF HEALTH 2 Division of Environmental Health Services. Carmel, N.Y. 10511 Engineer to Provide Permit p CON& MON PE R SEWAGE DISPOSAL SYSTEM on CERTIFICATE OF COMPLIANCE J/ 017' Permit N �/ Town or Village Tax Map Block Lot fRenewal_ ❑ Revision O Owner /Applicant Name „�°�� / � 4 r Date of Previous Approval Melling Address /W'1_7 / Town Zip Building Type / -� Lot Area 47 7 ,z.i y Fm Section Only Li Depth Volume XoF Number of Bedrooms 7-3 Design Flow G /P/D - PCHD Notification is Required Wh FIB is completed Separate Sewerage System to consist of & 00 Gallon Septic Tank en r L �" ' � „ W .4' ezz �� To be constructed by Rf t Water Supply; Public Supply From Address or: A"'A Private Supply Drilled by Address Other Requirements � �y alas ov represent that 1 am wholly and completely responsible f the design and location of ro®6s above described will be constructed as shown on the approved amendment there to an t bropp County Department of Health, and that on completion thereof a "Certificate of gym, be submitted to the Department, and a written guarantee will be furnished th wn u place in good operating condition any part of said sewage disposal system d g ri id ante of the approval of the Certificate of Construction Compliance of the o 1 a0's�ste or will be located as shown on the approved plan and that said well will be installed i .scep�anc�• rt County Department of Health. a, �/d o., V. Date &Ikz B/ Q � 1Z. ^ b 4. APPROVED FOR CONSTRUCTION: is approval expires one year from the date v-s�sue' revocable for cause or may be amends or modified when considered necessary by the -moo r3 requires a new permit. Approved for disposal of domestic nitary sewr= n.,. 716 -6 ( s); 1) that the separate sewage disposal system ' andards, rules an regu a ions of e Fu nam isfactory to the Commissioner of Healthwill hAirs o ssigns by the builder, that said builder will iyear immediately following the date of the issu- tiD K* o; 2) that the drilled well described above t O;ds rules and reyu a suns of the Putnam P.E. R.A. !y_License No g� y QA of the building has been undertaken and is k11651th. Any change or alteration of construction fly only. (Ai 1,,,yLo/, __ - -- Title °'�• , <S' . TTTTT T AALdnT "MT^KT 1]TT7/1T]T .t *t r* W L'LL VVL -ll Lli L. 1VL\ LVJL VL%1 DEPARTMENT OF HEALTH ...Division Of Environmental Health, Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET ADDRESS: WN/vt Y TAX GRID NUMBER Shamrock Road Putnam. Valley WELL OWNER NAME: ADDRESS: 2 Stanley Ave. COLETTI, Leo, Jr. & Theresa Ossining., NY 10562 O PRIVATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary ❑ RESIDENTIAL O PUBLIC SUPPLY O AIR /COND. /HEAT PUMP 0 ABANDONED ❑ BUSINESS O FARM ❑ TEST /OBSERVATION O OTHER (specify) ❑ .INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY O MOUNT OF USE YIELD SOUGHT 5 gpm. 1N0. PEOPLE SERVED 3 / EST. OF DAILY USAGE 300 gal REASON FOR DRILLING ❑ NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 360 ft. I STATIC WATER LEVEL 3 ._, ft. DATE MEASURED 1/13/87_ DRILLING EQUIPMENT O ROTARY ❑ 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 51� ft MATERIALS: O STEEL O PLASTIC O OTHER LENGTH.BELOW GRADE 50 n, JOINTS: O WELDED O THREADED O OTHER DIAMETER h in. SEAL: O CEMENT GROUT ❑ BENTONITE ❑-OTHER WEIGHT PER FOOT 19 lb./ft. DRIVE SHOE O YES p NO LINER: O YES, O NO SCREEN DETAILS -, DIAMETER (in) SL07 SIZE LENGTH. (1t) DEPTH TO SCREEN (ft) DEVELOPED? FIRST 0 -YES : to y0 . SECOND :. V - -FTO GRAVEL PACK ❑ YES ❑ NO GRAVEL DIAMETER SIZE OF PACK in. TOP DEPTH tt- BOTTOM DEPTH It. WELL YIELD TEST If detailed pumping METHOD: O PUMPED � tests were done is in- t O COMPRESSED AIR , formation attached? O BAILED ❑ OTHER i O YES ONO WELL LOG If more detailed formation descriptions or sieve analyses are available. please attach. DEPTH FROM SURFACE Water Bear• ing Well Dia- in FORMATION OESCRIPitON G7oE• ft. (t WELL DEPTH WELL ft. DURATION hr. min. DRAWDOWN ft. YIELD in- Land 3 killed area w /boulders 3 34 Clay & boulders 300 2 30 300 3 34 38 Soft weathered bedrock 360 6 - 300 8 -Hard granite WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE Diaphragm CAPACITY 62 GAL. 18 PUMP INFORMATION TYPE submersible CAPACITY 7 MAKER Goil 1 d G DEPTH 2 6 0 MODEL 7EH 0 7 412 VOLTAGE 2 3 0HP3 / 4 WELL DRILLER NAME MILL DRILLIN IN 30/87 ADDRESS SIG' Putnam Ave. Brewster, NY 10509 Ro e t M. Mil__l,_Pres PUTNAM COUN`T'Y DEPAR'QKENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES `r Building Constructed by _5:441� Location - Street Municipality 1�s . Building Type Subdivision Name Subdivision Lot # GUARAFP= OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it-has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of. Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage disposal system,'or any _.- - -rpaJ �niaiiy ZT�e _o su:h syste3n, except:wMere ,the.failureltoeflerae:.rrtgper 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 to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this day of 1987 Signature - e", Gener `Contractor (Own - Signature Corporation Nam �(if Corp.) MV ,7 4'A Address rev. 9/85 mk Title'z✓2r ri- Corporation Name (if Corp.) /-14 Al env J'e Address Owner or Purchaser of Building Section Block Lot `r Building Constructed by _5:441� Location - Street Municipality 1�s . Building Type Subdivision Name Subdivision Lot # GUARAFP= OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it-has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of. Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage disposal system,'or any _.- - -rpaJ �niaiiy ZT�e _o su:h syste3n, except:wMere ,the.failureltoeflerae:.rrtgper 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 to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this day of 1987 Signature - e", Gener `Contractor (Own - Signature Corporation Nam �(if Corp.) MV ,7 4'A Address rev. 9/85 mk Title'z✓2r ri- Corporation Name (if Corp.) /-14 Al env J'e Address ELLIS A. TARLTON LABORATORY DIVISION OF ELLIS A. TARLTON, ENGINEERS, INC. CHEMICAL 34 PLEASANT STREET DAIVBURY, CONN. 06813 -2328 WATER - WASTEWATER PHYSICAL METHODOLOGY BIOLOGICAL P.O. BOX 2328 203- 748 -7903 APHA - EPA - ASTM REPORT OF BACTERIOLOGICAL AND CHEMICAL EXAMINATION OF WATER NAME AND ADDRESS OF PERSON TO RECEIVE REPORT F Mill Drilling, Inc. 7 Putnam Ave. RrewSte_r, N.Y- 1050A DATA J SOURCE OF SAMPLE Coletti, Jr. Shamrock Rd. Put =nam Valley, N.Y. DATE O� COLLECTION 1/23/87 COLLECTED BY Mill Drilling y� Hydrogen Ion COLOR TURBIDITY ODOR CORROSION INDEX DISSOLVED SOLIDS Concentration LANGELIER (PM) RY2NAR NTU Mg /L Alkalinity as CaCO3 Fluoride (F) Bicarbonate Nitrite Mg /L Mg /L Mg /L NITROGEN Alkalinity as CaCO 3 Chlorine Residual Carbonate CONSTITUENTS Nitrate Mg /L Mg /L Mg /L AS Total Hardness as CaCO 3 Conductivity NITROGEN (N) Ammonia Mg/ L Mg /L M icromohos/cm Mg /L Iron as Fe Mg /L Mg /L Chlorides as CL Mg /L Manganese as Mn Mg /L Mg /L Detergent as MBAS Mg /L Sulfate as SO4 Mg /L Mg /L The arithmetic mean of all standard samples examined per month using the membrane filter jechnique shall not exceed MEMBRANE FILTER TEST .... Colifbrrtr blonles /100 L';: orte „co(gOY.P9e_�OOrDI•'. �cpljCorm cplonigs, per., standard, ssmpla, sngll noi= excaed ?150m1, .4J.100rn1;._Td20vml, 0m!. • - ,- __..._. >. — - -' in: (a) Two consecutive samples; (b) More than one standard sample when less than 20 are examined per month; or (C) —0— More than five per cent of the samples when 20 or more are examined. per month. AT THE TIME THE SAMPLE WAS SUBMITTED: 1. The results of the analysis of this sample were satisfactory and met requirements for a potable water. 2. The results of the analysis of this sample were satisfactory for a potable water but certain of the chemical or physical constituents were high. These are as follows: 3. This sample was not satisfactory since it did not meet the bacterial requirements for potable water. The presence of organisms of the coliform group in a sample of potable water is undersirable and, while not necessarily indicating the presence of any disease - producing organisms, does indicate that such contamination might survive to the same extent. The presence of organisms of the coliform group may also Indicate that the treatment was not adequate at the time the sample was collected. El4. This sample was unsatisfactory as a potable water because certain chemical or physical constituents were above acceptable limits. These are as follows: COMMENTS ,.' Certified ........... ........... 4:........../._42 ............ A -1 /,A f. IV. V. Vi. FINAL SITE INSPECTION Date V, OWNER Inspected by rim # OR SUBDIVISION . LOT # YE,c SEWAGE DISPOSAL AREA a. SDS, area located as per approved plans. b. Fill section - Date of placement 2:1 barrier. LGTH WIDTH AVG. DPrH c. Natural soil not stripped.. Ij s d.' Stone, brush, etc., greater than 151- frcrn SDS area. e. 100 ft. fran water course/wetlands. k- SEWAGE DISPOSAL SYSTEM ' I'm a. Septic tank size -171f,000 1,250 b. Septic tank instal' 6vel c. 10' minimum fram foundation d. No 90* bends, cleanout within 10 ft. of 45' bend e. DISTRIBUTION BOX 1. All outlets at same elevation - water tested 2. Protected below frost 3. Minimum 2 ft. original soil between box and trenches f. JUNCTION BOX - properly set g. TRENCHES 1. Iength required Len installed 2. Distance to watercourse measured: ft. 3. Installed according to plan -4. Distance center to center 5. Slope of trench acceptable 1/16 - 1/32 6. 10 feet from property line - 20 feet - foundations 7. Depth of trench < 30 inches from surface 8. Rom allowed for expansion 50% 9. Size of gravel 3/4 - 11" diameter 10. Depth Of gravel in trench 1211 minimum h. PUMP OR DOSE SYSTEM 1. Size of pijnp chamber 2. Overflow tank 3. Alarm, visual/audio 4. PLunp easily accessible manhole to grade 5. First box baffled 6. Cycle witnessed by Health Departrnent- estimated flow per cycle HOUSE a. House located per approved plans. b. Number of bedroans WELL a. Well located as per approved plans b. Distance from SDS area measured / &6 ft. c. Zai�sing 18" above grade. d. Surface drainage around well acceptable. OVERALL WOPJQWHIP a. Boxes properly grouted b. All pipes partially backfilled C. All -pipes flush with inside of box d. Backfill material contains stones < 411 in diameter e. Curtain drain installed according to plan f. Curtain drain outfall protected & dir. to exist.watercourse g. Footing drains discharge awa from SDS, area h. Surface water protection adequate i. Errosion control provided on slopes agrjeater:1—than 15t. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL-HEALTH SERVICES Date A -,;J A r,4 201 I'l ?'V U Re: Property of j r- A "i El x- i-5 Located at 0.9 PV -v, A V4 k 6: 1-5 a 7i.1 C I V (T) -section -'7P Block Lot Subdivision of C1 A A ACS Subdv. Lot # Filed Map # IIZ 2- A Date 7 — 2L., 9 Gentlemen: This letter is to authorize j F, v A a duly licensed professional engineer J-'/ or registeredarchit bet ( indic—at—e�_ to apply for a Construction Permit for a. separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said -system. 'tile' prbvis"ibns - Uf-'Artib-167 145*-Z&'- 147, Education Law, the Public Health Law, and the Putnam.County'Sani- tary Code. Very truly yours, Ogg A-1 Signed Owner of Property C o un t'e-r s i g - VR�f r. i jq EA9T '7�D W . . .......... P . E Address 0 C -2-1 Address Town 12- Telephone Telephone TI �Z !L 11 ox)s ti, N t rllsT,n CJIECE' 1A ST ST. ' Date: AN 5 ..Insp. by INITIAL SITE INSPrCTIO ?; ' yes. No Comment ,Property lines or corners found . . . . . .. Can estimate house location Will drivcway need cut . . G C . Must trees be removed -note these . .Is deep hole representative of entire SDS dreg Additional deep hole's needed. . . . : : . Sufficient SDS area available considering driveway cut, house location, separation ... distances, etc. . . e C . . U Y ; DEEP BOLE DATA Dapth: .� Water elevation: Rock elevation: Soils descri ption : SAI� y r _ Dame. FINAL SITE' DDT, PMBC`!7Gi` Insp, by: Houso located when•. 's hotrn on approved plan . ,• : _ SDS located where approved . . . . . . :I.en -i;h of trench measured Width of trench average Slope of tile line and trench. acceptable . . . Room allowed for expansion trenches Over 40__�'t;., t_-fr om swa,r�p, ;rawrc.eurs natural soil rot.stripped or SDS area tnuiecessarily graded . . . . . . o . o . 10 Ft. maintained from prop.line and 20 ft. from house Sepora.tion of trench from house, well --etc, follows plan . - - -; -- ,----- ------- - - - - -- - - - -- Nwnber of bedroo,,rs 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, ground surface., etc. chalulel near SDS area. . . . . . . . > . - Does l.ot dr. a i na ;e at��` ar O.K. :i.n area, of SDS 1+INAL CMI)ING OF SITE ACCDPT11BIT!, i PUTNAM COUNTY DEPARTMENT OF.HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of ..I —le Located (T)'�� /'� Section Block Lot j Subdivision of Subdv. Lot #_ Filed Map # Date Gentlemen: This letter is to authorize y3 � 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"sy"stems in conformity "w t i the provisions of Article 145r or 147, - Education Law, the Public Health Law, and the Putnam'County Sani- tary Code.. Very truly yours, $�sro P. Signed Counters g Owne of Property D. n. P.E. , R.A. , ��:�/�� ,,�..0 e Y' i4 of N 4 Address Address5 Town Jai �% y Telephone K2, _ 9 Telephone '.. "�::':.yti .':,.t i.f AFF Sy :v K. ie . :'y '1r]?rp�MGjg�a�i+'.! •P t+L :«�i ,'..)+371 ( 1+4 5 es 3" . t/ 'a .,..Y(:� S._r. 7' �i�- Y.:. ��u.f: . a 21 South Putt.Corners Road, New Paltz, NY 12561 v.. _.._.._. _ _ _ � v 2. June 19, 1986 James Hodgens Asst. Public Health Engineer Putnam County Department of He t o Two County Center � - Carmel. NY 10512�� Re: Wetland 9iolatio - WP - and -4 ..Dear Mr. Hodgens: I fteld.checked these two locations as per your request of June 129-1986.' Both sites are clear violations of Article 24 since no permits have been issued for either site. I a�a'referring.both_cases.to the local Environmental Conservation Officer - "t or enforcement action . ;. Sincerely yours, r O - _ rn z. - - -` - . ' :-- Joseph A. Steeley, Jr. Senior Wildlife Biologist a Region 3 f JAS /1g ,%•.,.'.... ! V ______._._.—.-........... �-.,: ��mx�.. w: auxsiwv: �� .x:rcrintilvir�x ::iav»BiYv�d;:�n :u.'a�•o,:.i�.x.�t�5: .�.. .. a.t, .u..w .._...n'; /Y�� /s;>sls I DAVID D. BRUEN rJl '4 r JOHN SIMMONS, M.D. County Executive �►j, �O` Deputy Commissioner' DEPARTMENT OF HEALTH Division Of Environmental Health Services June 12, 1986 Mr. Frank Sullivan 2972 Ferncrest Drive Yorktown Heights, NY 10598 Re: Leo Coletti SDS Const. Permit Application Shamrock Drive, PV, Tax Map 68 -6 -8. Glocamorra Acres. Lot 28 Dear Mr. Sullivan: 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: "Note correct tax map number above. Construction within 100 feet of a State protected wetland requires a Department of Environmental Conservation permit. Wetland to rear'of lot apparently is part of State Wetland—• E - designate.d.= as- M•L- -';: As part— of- the application materials for permit issuance, either a D.E.C. permit or documentation ,that activities do not require a permit will be required. -`�3. Topographic f re-s-- th observed field conditions; specifically, r are not shown. ,,_�4. Field observation indicates clearing and-grubbing operations have been completed and..trees have been left in sewage disposal area. All trees within ten feet of sewage disposal system must be removed prior to system installation. Plans should note this clearly. 5. Approved subdivision plan indicates 20 foot wide drainage easement exists adjacent to SW property line and has been designated to culvert road drainage.. To maintain 35 foot separation to a culvert, trenches must be at least 25 feet from SW property..line. -continued- TWO. COUNTY CENTER - CARMEL, N.Y. 10512 (914) :225 -3641 _..µ .� .,� . . �a...�,....: sue► F. Sullivan Leo Colletti SDS CPA Z' 6. Location of stormwater inlets in vicinity of sewage disposal system must be shown to assure minimum 25 foot separation. 7. Enlargement of pump chamber to incorporate overflows in event of pump failure is recommended,as installation is 'simplified and post pump failure sewage disposal in a sanitary manner is more assured. This will eliminate the need for a separate chamber. 8. Proposed well is within 200 feet and in direct line of drainage of proposed.sewage disposal area. 9. Field' demarcation of proposed sewage disposal area is necessary to assure adequate separations. have been provided as noted in items 2, 3, 4, 5 and 6. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, �mes S. Hod g ens Assistant Public Health Engineer JSH:�amm ' cc: File Joe Steeley, NYS DEC (Note Item 2) Mike Priano, PV CAC (Note Item 2) PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMEMAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT --DATE' tl3m: ((:J `, a�kc�xti�i�r�y.-.t�, - BY: Name of Owner) (Street Location) DOC[AUNM Permit Application Corporate Resolution l�'G Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank —Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area;shown; gravity flaw,suff. size. "wed "hit &~ ll Box -Shawn &- Detailed V House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max. Bends 45° w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields - -- 10' to P. L. Drivewa e Tree 20' to Foundat s=°�_� 100' to Well; 00' in D.L.O.D 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains-Curtain ,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fran Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Lots Checked Wetland (T EC Pernut? R & D) Data On DDS P1 't Same ° - MM MM y &I mm MM �®_m _ A ®m mm �� mm mm MM •• �■ _ NMI DOC[AUNM Permit Application Corporate Resolution l�'G Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank —Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area;shown; gravity flaw,suff. size. "wed "hit &~ ll Box -Shawn &- Detailed V House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max. Bends 45° w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields - -- 10' to P. L. Drivewa e Tree 20' to Foundat s=°�_� 100' to Well; 00' in D.L.O.D 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains-Curtain ,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fran Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Lots Checked Wetland (T EC Pernut? R & D) Data On DDS P1 't Same PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS F.TFTD INSPECTION REPORT DATE: QQ 01, r rlu INSP. BY: La� (Name of Owner) (Street Location) INITIAL SITE INSPECTION Z F, 1 3 71 YES NO CATS Wetlands on/or proximate to property ........ ..°... Si? /- Property lines or corners found ................... MD p Can estimate house location ....................... Will driveway need cut ............................ I N Must trees be removed - note these ................ Yc> I kooxi -rX C'S4T-s Deep holes representative of entire SDS area...... s Additional deep holes needed.. .. .... .... ocm Sufficient SDS area available considering driveway / cut, house location, separation distances,etc... t� Adjacent wells/ septics ............................ iu �U D D.H. - Deep Hole G.W.- Groundwater D.H. 1 Lot D.H. 2 Lot D.H.-3 Lot Depth to G. W. Depth to G. W. Depth to G. W. Depth to rock Depth to rock Depth to rock Soil Descri t 0 ft. 3 ft. U9� 6 ft. "C 9 ft.�� 12 ft. Soil 0 ft. 3 ft. YES 6 ft. House SSDS located per approved plan ............. 9 ft. f "�• 0 ft. 3 ft. 6 ft. 9 ft. - 12--ft- Soil Descr 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......... Roan allowed for expansion trenches .............. Over 100 ft. fran watercourse....... • ........... Natural soil not stripped or SDS area unnecessarly graded.......... ............... 10 ft. maintained fran 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.. ........... 15 ft. of peripheral soil horizontally fran trench ..... ............................... Boxes properly set.. . ...... ......... .......... :ould surface runoff fran driveway, roads, ground surface, etc., channel near SDS area.... L_ L1 Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE .................. D PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ,: =: .r.- :♦.:.m; ..... COUNTY OFFICE- BUILDING, CARREL `N ' ix` : .` 0512 -..:z .:.. DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner z- Address Located at (Street r rz' /li ,-�9,;wrSec. Block Lot (indicate nearest cross street) Municipalityi Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS 1/ P. 3,le r � 5 1 2 3 5 Notes: 1) Tuts to be repeated at same depth until approximatelyy 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. Hole Number CLOCK TIME PERCOLATION PERCOLATION Run apse No. Time Start =Stop Min. Deptti.to Water From Ground Surface Start Stop Inches Inches Water Level in Inches Drop in Inches Soil Rate Min. /in drop g 1/ P. 3,le r � 5 1 2 3 5 Notes: 1) Tuts to be repeated at same depth until approximatelyy 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. O TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO HOLE NO. G.L. 611 1211 24 1t 3011 3611 4211 48" 8 54" 6011 w. 66" 6 7211 78" 8411. INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE -LF,,7-,L -TO..WHICH WATER - LEVEL-. RISES - AFTER BEING- ENCOUNTERED J.- TESTS MOZBY' DESIGN Soil Rate Used --12-dMinl1 "Drop: S.D. Usable Area Provided -5-0 No. of Bedrooms Septic Tank Capacity j cve�, Gals Type Absorption Area Provided, By -3jfL L-Y-x2411 2 7- Yi w -,.Ah trench. 41-- Address o-eo-,�- G ,,S,/ THIS SPACE FOR USE BY HEALTH Soil Rate Approved Sq. Ft/Gal. EaF ly M ONLY: Checked age T. 24 tj 00 ® W AFE *00.00A �, 1 40.. SSIG. F.- byp `1ate ro 0 7- -Y .Aa /l `1 A, 111 ..� s —stem le is to r struc* ; or _ _..... Al t� es an? Butnat County Doartment Health )ivision of Environmental Health Servic. 1 47 ea3' - = - JOS a- 4v Jc- d . 7 14o za _ W2 ~ 7�- /0. 12 A, 111 ..� s —stem le is to r struc* ; or _ _..... Al t� es an? Butnat County Doartment Health )ivision of Environmental Health Servic. f. Pwm 1`. •� _h ,/ , f15 •gyp %� �.�„y,��;r' /ODc qC7 I