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BOX 29
03722
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03722
PUTNAM COUNTY =DEPARTMENT OF HEALTH ENGINEER MUST I DE
Division of Environmental Health Services, pROV Carmel, N. Y. 10512 j/
�0 PERM. T #
CERTIF �E OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM
Town or Village
Located at ' f� �cof �W Wt Map Block
Owner��_/c 240 -.t�Ad ` kl Xrly .� Tax Map t N Subd. Lot Y
Separate Sewerage System built by L' — `�f • Address a'k
)y ��,sy
Consisting of YGaI. Septic Tank and
Other requirements_ r ����
Water Supply: Public Supply From
Private Supply Orillod By AO�G �*O�Ifs
Address .�� ° '"
Building Type F No, of Bedrooms Date Permit Issued
Has Erosion Control Been Completed? Has garbage grinder been installed?
if 791
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 accordance with the filed plan, and the permit issued by the
Putnam County Department Of Health.
v
Date Certified b P.E. R.A.
if
Address . ' a License No.
Any person occupying premises served by the above system(s) shall promptly take such action as ma/be necessary to secure the correction of any unsanitary
conditions resulting from such usage. Approval of the separate se erage system shall become null and void a$ soon as a public sanitary sewer becomes
available and the approval of the private water supply shall become It and void when a Apc water supply becomes available. Such approvals are
subject to modification or change when, in 'the judgment of the missy r of Healtrevocation, modification or change Is necessary.
r i -n % 7 if I /, e--" cam, ,
Date a _ BY V Title
Rev. 6/85 +
0
a
_
WELL COMPLETION- REPORT
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTN .1 COUNTY DEPARTMENT` OF . HEAT,TH
Office Use Only
'A U
SIR ' AO SS:• WN /VIL / 1 Y TAX GRIO NUMBER:
WELL OWNER
NAME.- _ ADDRESS:
, .
a
_
WELL COMPLETION- REPORT
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTN .1 COUNTY DEPARTMENT` OF . HEAT,TH
Office Use Only
WELL LOCATION
SIR ' AO SS:• WN /VIL / 1 Y TAX GRIO NUMBER:
WELL OWNER
NAME.- _ ADDRESS:
, .
PflIVATE
❑ PUBLIC
USE OF WELL
1 - primary
2 - secondary
RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /CONO. /H PUMP O ABANDONED
❑ BUSINESS ❑ FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT gpm. /N0. PEOPLE SERVED EST. OF DAILY USAGE 2'10 0 gal.
REASON FOR
DRILLING
NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST/ OBSERVATION
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
? =�
WELL DEPTH — �� ft.
STATIC WATER LEVEL 3D ft.
DATE MEASURED
DRILLING
EQUIPMENT
X ROTARY . ❑ COMPRESSED AIR PERCUSSION • ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING. AOPEN HOLE IN BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL LENGTH - ft.
MATERIALS: )RI STEEL ❑ PLASTIC ❑ OTHER
LENGTH.BELOW GRADE ` ft.
JOINTS: ❑ WELDED KTHREADED ❑ OTHER
DIAMETER " in.
SEAL: ❑ CEMENT GROUT ❑ BENTONITE BOTHER
WEIGHT PER FOO'i 1b./ft.
I DRIVE SHOEfig—YES ❑ NO _
LINER: ❑YES)gNO
SCREEN
DETAILS
DIAMETER (in)
sL07 SIZE
LENGTH
if
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
O YES ONO
HQUAS...._.
SECOND -_
-...
GRAVEL PACK
°YES
❑ NO
GRAVEL
SIZE:
DIAMETER
OF PACK in.
TOP
DEPTH ft.
BOTTOM
DEPTH ft.
WELL YIELD TEST pumping
t If detailed
METHOD: ❑ PUMPED 1 tests were done is in-
COMPRESSED AIR formation ,attached?
O AILED O OTHER ; ❑ YES ❑ NO
If more detailed formation descriptions or sieve analyses
1AlELL LOG are available, please attach.
DEPTH FROM
SURFACE
Water
Bear-
ing
Well
Dia-
Ineter
FORMATION DESCRIPTION
CODE.
tt.
tt.
WELL DEPTH
ft.
DURATION
hr. min.
DRAWOOWN
ft.
YIELD
ggm.
Land
l
WATE$ O CLEAR .TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? O YES O 140
STORAGE TANK: TYPES
CAPACITY 3-o GAL. / v�
PUMP INFORMATION �/
TYPE CAPACITY _ `r
MAKER DEPTH =3 ®d
MODEL _W_1 VOLTAGE 136 HP�
WELL OR ER NAME_ DATfc
�� /
AoD��11/y TuRE
.,IA 1051P
Yorktown Medical Laboratory, Inc. LAB I ! ' ='7 . c_�car�7�� '
321 Kear Street Date Taken Time : -7•" -OR7
Yorktown Heights, N. Y. 10598 ,
K. .
.. _ Date ;Rc d:.. ,! .?/ Time
(914)245.3203 Date 'Re orted. JAfl�. 27 �988T
Director: Albert H. Padovard M. T. (ASCP) Collected B =-/,/
T_ -� Referred By:
Sample Location: ti
Jf 1(-'VW 7_1 A1e.. Phone #
��/7?✓/f7 -j r/ U� j /�% lOc/�7� Phone . # Sample .Type: .
L / Repeat Test? _ (check one)
_LABORATORY REPORT ON THE BACTERIOLOGICAL QUALITY OF WATER
GENERAL BACTERIA
v Standard Plate Count (CFU /1.OmL)
(Agar Plate @ 35 °C)
MEMBRANE FILTRATION TECHNIQUE (MFT)
�! Total Coliform (CFU /100mL)
_ Fecal Coliform (CFU /100mL)
_ Fecal Streptococcus (CFU /100mL)
MOST PROBABLE NUMBER TECHNIQUE (MPN)
_ Total Coliform: MPN Index (per 100mL)
Fecal Coliform: MPN Index per 100mL)
OTHER ANALYSES
REMARKS (For Laboratory Use)
r?0
0
V Potable
_ Non - potable
_ STP INF
STP EFF
_Other:
Sample Status:
(check each)
Outgoing
_ Na2S203.
Incoming
ALE 4 °C
_ GT 4 °C
_
Other:
KEY FOR TERMINOLOGY
RDS = Recommend Disinfec-
tion of Source
TNTC= Too Numerous To Count
CON = Confluent ( =TNTC)
LT = Less Than (<)
GT - Greater Than (>)
N/A = Not Applicable
LF. a LoRA than er eaual to
THESE RESULTS INDICATE THAT THE WATER SAMPLE WAS (WASN'T) (N /A) OF A
SATISFACTORY SANITARY QUALITY ACCORDING TO THE E YORK STATE DRINKING
WATER STANDARDS, FOR THE PARAMETERS TESTED, AT-THE TIME OF COLLECTION.
AA For Lab Use Only:
Alber
12 /85(Rvsd7 /87)RWE
, Yli"1C6 MVd"
H/C to
LAB OFFICE HOURS (fain Lab):
9AM -5PM9 Mon. -Fri.
9AM -NOON, Sat.
PETER C. ALEXANDERSON
County Executive
ENID L. CARRUTH, M.P.H.:
" •' =" '' ""'' 'Public Health Director
JOHN SIMMONS, M.D.
Deputy Commissioner
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
Memorandum
TO: All Engineers and Architects
FROM: John Kare ll, Jr., P.E., Director
SUBJECT: ADHERENCE TO SANITARY CODE
DATE: December 29, 1987
The Sanitary Code states that an application (sand its pesii►it� are
not legal until all amounts- required are paid and the Code implies
that payments should be guaranteed payab.le.
Q All potential permittees and all those responsible for paying fees
for Realty Subdivision,-Commercial Sewage and Individual Sewage
Disposal Systems, are to be advised that only :CERTIFIED; >CHECKS
OR 'MONEY --O,YLll be accepted from now on. This willassure that
we are in compliance with local laws and that payment has indeed
been received prior to the issuance of official approvals.
tew
�/�w,,c�1 ZSc�,alrk �xfi
7rrfiA✓� `a
f��v
PUTNAM COUbTlY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Ow er or Purchaser of Building Section Block Lot
Building Constructed by
Tv 6T;2Tf'
Location - Street
Municipality
Building Type
S vision Name
f-44 wCc -L 20
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
operating condition any part of said system constructed by me which fails to
operate for awperiod of two years immediately following the date of approval of the
"Certificate' of Construction Compliance" for the sewage disposal system, or any
repairs- nade�- •by- -m- to - -such system, except whe.�E tl-e 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 to operate was
caused by the willful or negligent act of the occupant of the building utilizing
the system.
Dated this - 1� day of 19K
General Contractor (Owner) - Signature
CorporatierrName (if Corp.)
R 471� u��'d t L rkne ,
Address Cc, oS ,& I i I i
rev. 9/85
mk
Signature
Title
Address
e.
II.
IV.
V.
FINAL SITE INSPECTION Z4d
fi
tA_
G� S 1 JAM �.- OWNER �AA --
Inspected 'by
4. IM # OR SUBDIVISION LOT #
1
YES
NO
SEWAGE DISPOSAL AREA
a.. SDS area located as per.approved plans
_.
b. Fill section - Date of placement
2:1 barrier.. LGTH WIDTH AVG.DPTH
c. Natural soil not stripped
d: Stone, brush, etc., qreater than 15' fran SDS area.
e.. 100 ft. fran water course /wetlands.
SEP&GE DISPOSAL SYSTEM
a. Septic tank size - 1,000 ,250
?�
b. Septic tank installed level
c. 10' minimum fran foundation
d. No 900 bends, cleanout within 10 ft. of 45" bend
e. DISTRIBUTION BOX
1. All outlets at same elevation - water tested
2. Protected below frost
3. Miniman 2 ft. original soil between box and trenches
-
f. JUNCTION BOX - properly set
S .
g. TRENCHES
1. Length required - Length 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 " /foot.
6. 10 feet fran property line - 20 feet - foundations
7. Depth of trench < 30 inches fran surface
8. Roan allowed for expansion, 50% (�
9. Size of gravel 3/4 - 11" diameter
10. Depth of gravel in trench 12" minimum
11. Pipe ends cappexa
h. PUMP OR DOSE SYSTE M3
1. -Size -of- -puny chInber
2. Overflow tank
3. Alarm, visual /audio
4. Pump easily accessible manhole to grade
5. First box baffled
6. Cycle witnessed. by Health Department
estimated flaw per cycle
HOUSE
a. House located per approved plans.
b. Number of bedroom:
WELL .
a. Well located as per approved plans
b. Distance fran SDS area measured -,o ft.
c. Casing 18" above grade.
d. Surface drainage around well acceptable.
OVERALL WORKMASHIP
a. Boxes proper y grouted
1`
b. All pipes partially backfilled
X
c. All pipes flush with inside of box
d. Backf ill material contains stones < 4" in diameter
e. Curtain drain installed according to plan
1
f. Curtain drain outfall protected & dir.to exist.watercours
g. Footing drains dl.schar a away from SDS area
h. Surface water protection adequate
i. Errosion control provided on slopes greater than 15 %.
1
z �. x�n°+. `.,..�. ', .,,A .N.• :rr �, 't"; tt esw 1iwi. -r,�`a, ' s'.�.�'"�-y`• t�`7�r�; .: Kx'"�"'�''•� ^s �. ^ � 4'" r�TT�r�.,°°3�:i�;'ik` _ �1. � k s� Mi'�
Qp ` PUTNAM COUNTY'DEPARTI!tIENT OFHEALTH
Rev. 3186 i oeetoProvldePermit#
Division of Environmental Hesdth Seevlcee Carmel NiY.1051? Eogln �J
on CERTIFICATE OF COMPLLANCE'
- , . � 'r Permit N / !!�� '•""
CONSTRUCTON PE FORS „ AGE DLSPOSAL SYSTEM ,Q
s /(%
I6; 0 A Town or Village
77 5abdlvlsioa Name Tea MapBlock Lot
Renewal „_❑ Revision ❑
Owner /Applicant
Date of Ii
revioas Approval �p
Melling Address / / war G /® Town ' . f 1/ ZIp u `:
Banding Type O /�L Lot Area zi; �C° FIll Secdon On1Y Depth Volmne
Naniber of Bedrooms • Des �0;. ' : PCBD Notification is!,Regalreil When Fill is completed,
ign,Flow G /P /D
Separate Sewerage System to consist of Ganon Septic Tank
To;be conscted by !< �" CtJ Address CGd (ii
Water Sappy; Pabnc Supply From Address.I /
orr Baivate Supply Dialled by
address lII/
Other. Requirements
ti d r �, c 1, :. vot lei !
represent, at•I am wholly and`completeiy responsible for th' tles�gmand location of the propose0 systems) 1). that the separate: sewage didposal. system
above ;tlescnbetl;will be constructed as shown on the approved amentlment thereto and m accordance wdh the ia- ndarq's rules arid, regu a ions o e Putnam
County ' Oepactment of ", Health ,,antl that on comDlet�on thereof a Certificate:'of Construction t omphance sat�sfactory,to the Commissioner•ot Health will
be sut milted %to the Depa►tmentj and a wntten guarantee wJl be furnahotl, the owner„ his successors heirs or assigns by the Dwider; that said; builder will
place ,in good operatmg: condition any part of said sewage; tlisposal'. system.,during the. nod'of two 2S: years immediately followirig thedate of -the issu-
ance,,, of the; approval of; the Cert�fitata ioi ConstrucLOn Compliance, -of the; ongmal•system.or,any repairs thereto; -2) that the drilled well described above
will be focated'as shown -on the approved Dian antl that said well will be install accor ce with the standards 'rul and .regu a-1a ns of t e `Putnam
County Depart et o Health
Date ..Sighed' • —
`:. 6 P E R.A
Address � Zee License No;
zz
APPROVED FOR CONSTRUCTION This +'approval exp ires_;Isw�yew,trom the -Gate issue unless construction of the building has been undertaken and is
ievocable fiiu se oi. may be amended or riiotl�f�ed when considered n essary ,by the Commissioner of Health. -,.Any change, or alferation of construction
requires a permit. ApprovetlforAis oral of,:domestic sanita ste• water supply only.• Date /= ri "1 ®. BY Titie. ° i
' DEPARTMENT OF HEALTH
Division of Environmental Healtb Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
- - - A:PDLICATION. TO CONSTRUCT.A- WATER- _W.ELL -,;_- �:• .
PCHD PERMIT # .�
WELL LOCATION
Street Addres
o A4 U/r
Town /Village /Cit Tax
D8 ,o �t cz
Grid Number
(' - Z, —/
WELL OWNER
Name
/� Address
za
GpIrrivate
❑ Public
USE OF WELL
primary
2 - secondary
ARESIDENTIAL
❑ BUSINESS
❑ INDUSTRIAL
❑PUBLIC SUPPLY
O FARM
O INSTITUTIONAL
QAIR /COND /HEAT PUMP
❑ TEST /OBSERVATION
❑ STAND -BY
0ABANDONED
❑ OTHER (specify
O
AMOUNT OF USE
YIELD SOUGHT
_'f-' gpm /# PEOPLE
SERVED .- /EST. OF DAILY USAGE PW gal
REASON FOR
DRILLING
DKEW SUPPLY []PROVIDE ADDITIONAL SUPPLY
❑REPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL
O TEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
-2 t-
&J 41671,0 67-
WELL TYPE
WDRILLED
DRIVEN
ODUG GRAVEL
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES ie"' NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION,
NAME
OF SUBDIVISION: 114P
!rlt3 O '
Lot go. �0,�,�lo��Z
za
WATER WELL CONTRACTOR: Name a r�"
Address:
lfr ul-I Ld
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES i,,"' NO
NAME OF PUBLIC WATER SUPPLY:
TOWN /VIL /CITY
DSST.ANCE.TO- _PROP.ERTY._.FROM .K:EARSC j�iATE.R.M.AIN:: ___ _.... �._..__,. _._..__...._.__ �...._ _..._.:.._.:..,._:.
LOCATION SKETCH & SOURCES OF CONTAMINATION
ON REAR OF THIS APPLICATION
(date)
PROVIDED
ON S -RATE SHEET -
(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 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: V�.. �5 19
Date of Expiration: 19 er �tIssuing Official
Permit is Non- Transferrab e
R /fif
L i
PETER C. ALEXANDERSON
County Executive
_.
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
May 1, 1987
William F. Zeiler, P.E.
Concord Road
Mahopac, New York 10541
ej'� Dear Mr. Zeiler:
RE: Proposed SSDS
Ericksen
Roberts Drive
Putnam Valley
66 -2 -1
JOHN SIMMONS, M.D.
Deputy Commissioner
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:
X Property metes and bounds are missing
f;_
...- ...:_..__.r.._....P,r.ov- ;-de- deaai= le�d- :-- d- r- awi,n•gs o r di si:ri bu`tiron._
box, junction boxes, septic tank, trenches and well
. Show clay barrier around fill section in plan view.
Upon reciept of a submission, revised to reflect the above
comments, this application will be considered further.
Very truly; yours ,
A
AB:pt Asst. Public Health Engineer
J
File
AB
APPENDIX B
PUTNAM COUNTY DEPART1,j= OF HEALTH - DIVISION OF ENVIRONMENTAL HE'ALTE SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
REVIEW SHEET - CONSTRUCTION PERMIT
(Name of Owner) (Street Location)
CONMENTI`S YES I NO I DOCUMENTS
Permit Application
Corporate Resolution
Plans. - Three sets
Engineers Authorization
Design Data Sheet (DDS)
Deep Hole Log
s/s
Consistent Perc Results (3)
Perc Hole Depth
SUBDIVISION
Perc
Fill
cd
House Plans - Two sets
Well permit; NIS letter
Variance Request
GaQERAL
Legal Subdivision
Subdivision Approval Checked _
Ex-approval _ SSDS Adj . Lots Checked
Wetland (Tcwn/DEC Permit R & D)
Data On DDS Plans & Permit Same
RBQUMM DETAILS ON PLANS
Sewage System Plan - (north arrow)
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: Perc and deep results .
Driveway & Slopes Cut
Footing /Gutter,Curtain Drains (discharge OK)
Perc & Deep Holes Located
Representative of primary and expansion
Expansion Area;shown;gravity flow,suff. size
If Pual)ed Pit & D Box Shown & Detailed
House - No. of Bedroans
Wells & SSDS's w /in 200 ft. of Proposed System
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., Driveway, large Trees,Top of fi'
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Take (inc. expa
15' to Drains - Curtain, Leader, Footing
35'to catch basin,stonndrain,piped watercour.
10'. to Water Line (pits -201)
50' intermittent drainage course
Septic Tanks -
10' fran Foundation; 50' to v�11
15' Well to PL
lit%(( �rf fit "jlTtJ,�t
I '
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date
Re: Property of Z1'K��%' lU_CA41 G .e /LI seS ;
Located at[ I-6 iUI,, �/lc'7.J j XC62Cs2' -S
(T) % Section Block Lot
Subdivision of
Subdv. Lot ## AA&16 -7- ht ZO Filed Map # Date
Gentlemen:
This letter is to authorize A4j11&t-4d&t
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
.in- c'uxrfor•mity- - w--ith. _.the-- p:ravis i oits--oF 1.45 5r _ ..._..
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Countersigned:
P.E. , R�rA. , #
Address
C
LJ
4 -;6p- 1171
Telephone
Very truly s = � =?
d
Signed
Owner of Prop: i:i�ty
rj
7) CDAJ i/ N AD
Address
Telephone
DESIGN DATA SHEET- SUBSIMCE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner �J,P /CVS,5/ Address 77 �a,�1���1r'� �' .SYo-s -sue -
Located at (Street)L ! & Vl674) /�) /1 a[3�i �/�'• Sec. Block Lot /
(indicate nearest cross street)
Municipality �� �d.% Watershed
Date of Pre- Soaking /o _ Date of Percolation Test
HOLE
gyp. 3.;
/j,'0 S"
-3o
2 s- j
NUMBER CLOCK TIME
PERCOLATION
PERCOLATION
Run Elapse
Depth
to Water From
Water Level
No. Time
Ground Surface
In Inches
Soil Rate
Start-Stop Min.
Start
Stop
Drop In
Min /In Drop
Inches
Inches
Inches
3
gyp. 3.;
/j,'0 S"
-3o
2 s- j
30
5
1
2
3
4
5
NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates
are obtained at each percolation test hole. All data to'be submitted
for review.
2. Depth measurements to be made fran top of hole.
rev. 9/85
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES.
- -
..._ ..;.HOLE N0.
- -- DEPTH. HLE .NO
G.L. Jif -
L_
- -T
2'
3'
4'
5'
6'
7'
8'
9'
10'
ill
12'
13'
14'
INDICATE LEVEL AT WHICH 'GROUNDWATER. IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED 3 /
DEEP HOLE OBSERVATIONS MADE BY:
DESIGN --
Soil Rate Used '20-310 Min /1" Drop: S.D. Usable Area Provided 6'0661 -'F
No. of Bedroans Septic Tank Capacity 00
Absorption Area Provided By L.F. x 24" width trench
Other 7 1WO. a /c- VJ o K i < %
Name AliCLI',1901 j6� Z 6-( ' Signatur
Address leo-rb 0 !// 9A/ _Z i Z- SEAL �
C_ A, /, 11�i
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
gals. Type COPe- o
i�i.� Aeoywl
PROFESSIOXO''
Soil Rate Approved sq.ft /gal. Checked by `""'"'r Date
PUrNAM COUNTY DEPAMU'VT OF HEALTH - DIVISION OF ENVIRONMENTAL. HEALTH SERVICES
IN- DIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS
FIELD PECTION REPORT.
INSP. BY:
(Name of Owner) (Street Location)
INITIAL SITE INSPECTION YES NO C n%IE 7S
Wetlands on /or proximate to property..............
Property lines or corners found ...................
Can estimate house location .......................
Willdriveway need cut ............................
Must trees be•renoved - note these........... ..
Deep holes representative of entire SDS area......
P.dditional deep holes neede3 ......................
Sufficient SDS area available considering driveway
cut, house location, separation distances,etc...
Adjacentwells /septics ............................
Arms to urccosed well location for drilling._...
D. H. 1 Lot,
Depth to G.-W. -.�--
Depth to rock
0 ft.
3 ft.
6 ft.
9 eft.
.12. ft
Soil Descr
D. H. 2 Lot
Depth to G. W.
Depth to rock
0
ft.
3
ft.
6
ft.
9
ft.
12
ft.
D. H. - Deep Hole
G.W. - Groundwater
D.H. 3 _ Lot -
Depth to G.W.
Depth to rock
0
ft.'
3
ft.
6
ft.
9
ft.
12 f t.-
Soil
r—
DATE:
FINAL SITE INSPECTION INSP.BY:
YESI
NO
CC1'S
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
unnecessarlygraded.......... ..............
10 ft. maintained from. property line and
20 ft. from house ..............................
Distance well to SSDS (ft.) ......................
Numberof bedrooms checks ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. from nearest trench ................
15 ft. of peripheral soil horizontally
fromtrench...... ........ .......................
Boxes properly set................................
Could surface runofffran driveway, roads, -
ground surface,, etc., channel near SDS area....
Does lot drainage appear OK•,in* area of SDS::.......
FINAL GRADNG OF SITE ACCEI ABLE .. .. ...
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rffS 19 TO CERTIFY THAT THE SETAGE DISPOt/A' ST
ST
WAS COINSTRUMM, A _T
S T'rCAT9M 0i'l THIS PLAN AL
THE SYSTT..'! V,"AS T'-'�. ' _ . -'In;L IT WAS CO
ED OVhR t -!':D IN ACCORAWE
WITH ALL Tu'OF THE PUTUAM
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Jivision of Environmental ��..lth Servioet
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Divisio., a"' aironmenta' i
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s0 Putnam County Health Deis::;;
.S.EPT /C DES /G ignQture & Title Date
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Divisio., a"' aironmenta' i
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s0 Putnam County Health Deis::;;
.S.EPT /C DES /G ignQture & Title Date
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F.E /L.ER
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s<eP. i,�• r mar -� Covco.eo .Poq� - �/q/ro�,gc - iY'Ew Yoer /054 /
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SOLID ROCK
2 MIN GROUT
EAL
HICKNESS
12
CASING 20 FT. MIN.
LENGTH UNDER ANY
CONDITIONS.
I USE CLAY PUDDLE CORE
BETWEEN CASING AND
r"DRILL HOLE.
CASING,
. MIN.' IN ROCK
54NI74RY SEAL
ON WELL CAP
- SCREEN VENT
/- WELDED SLEEVE
P TYPE COUPLING
.�.- FROM PUMP
TO PIMP
:LL CASING ^ -�
�1 BUSHING OR
LAD CAULKING
TYPICAL SECTION
OF
DRILLED WELL
_ s
ASPHALTIC
r I I SEAL
I+ I '
-+ INLETI i �,l I RBOLTS I I O OUTLET 4 =0"
it- 5 -D°
CONCRETE SEPTIC TANK III L I J
SLABS POURED IN PLACE I
ARE DESIGNED TO I I
SUPPORT A MIN. LOAD OF
300 P.SF. Ll
PLAN
LOCATION STAKE -----.. -� '
• MIN. '
REMOVABLE MANHOLE, REMOVABLE MANHOLE, 20••!MIN. OPENING
BA R$ 6`OL. 136" MAX. ;
20•• dflN. OPENING 4 rr I
T SOLO Por wiles TIGHT
CAST IRON;, PIPE, WITH I
TIGHT JOINTS'
1 14 /FT MI'-SLOPE INLET
CAULKED JOINT
:SANITARY TEE
' I
JOINTS, GRADED 1'!8 ` /FT. MIN.
OUTLET '-► ti'
CAULKED JOINT
SANITARY TEE
6` MIN. WALL THICKNESS
FOR POURED IN PLACE
CONCRETE
t P£A GRAVEL OR � .
$ ECTION �� CLEAN SAND , .
TYPICAL 1200 GAL. CONCRETE SEPTIC ' TANK
SF,PTIC DETAILS
prepared for
of NE
PM F.
prepared by. ✓ 1 .
WILLIAM F. ZEILER
Professional Engineer S Land Surveyor
Concord Road - Mahopac -New York 10541
(914>628-4764 FO ?a0F[SS(00*
• 2 003
i ..
I $.
aSPHALTIC SEAL
2 INVERT OF INLET
BERT n
' I F
OF OUT LE T.
IN
I I L:OUIU LEVEL I
�-
BAFFLES MAY BE I m
fJ_-
r , , USED INSTEAD
OF SANITARY TEES
I~
I W
2 C
I'• CEMENT PARGING �� c
ON INSIDE �
'
o
P -.J
JOINTS, GRADED 1'!8 ` /FT. MIN.
OUTLET '-► ti'
CAULKED JOINT
SANITARY TEE
6` MIN. WALL THICKNESS
FOR POURED IN PLACE
CONCRETE
t P£A GRAVEL OR � .
$ ECTION �� CLEAN SAND , .
TYPICAL 1200 GAL. CONCRETE SEPTIC ' TANK
SF,PTIC DETAILS
prepared for
of NE
PM F.
prepared by. ✓ 1 .
WILLIAM F. ZEILER
Professional Engineer S Land Surveyor
Concord Road - Mahopac -New York 10541
(914>628-4764 FO ?a0F[SS(00*
• 2 003
i ..
I $.
BUILDIIKI PAPER, UNTREATED
24 �� �EARTH BACKFlLL
t
i
SECTION
MIN. 3/4, MAX. 1 ".1.
OR CRUSHED
r STONE.
t�
DISPOSAL
INLET -A-
Bofile •
Removeoble
Cover
noI
I --
4" PERFORATED PVC 4B" MIN.
PIPE, GRADE '
I/16 '- f /31' /FL 60" MIN.
PROFILE GROUND
WATER t" ROCK
1 CONSTRUCTION NOTES
SUBSURFACE SEWAGE DISPOSAL SYSTEMS & WELL WATER SUPPLIES
S" MIN. - It" Max, i SERVING SINGLE FAMILY RESIDENCES
2" MIN, 1
1
3"
6" MIN.
BOTTOM OF TRENCH GRADED 1 /16 /PT.
Basic Required Notes
1. Tell trees within 10 feet of the proposed SSDS shall be removed.
2. SSDS to be 9nspected by the design engineer /architect and the Putnam
pDimty Health Department after construction and prior to backfill.
I
TRENCH DETAIL (INSTALL 6� ON CENTER) 3. loo trucks, machinery, building materials, nor excavated earth shall be
allowed in the sewage disposal area. Construction of SSDS to be in
DISTRIBUTION BOX
DETAIL
/{ //
n�
PIPE — P
prepared by
Cu.?TA //V ORA /N WILLIAM F. ZEILER
Professional Engineer S Land Surveyor If N 0 a�W�
Concord Road- Mahopac -New York 10541 rfsrFO az
(914)628-4764 3 43 FaolESSw +�°`
:accordance with these plans, any revisions thereto, and the rules and
regulations of the permit issuing governmental agency.
4. Minimum well yield of 5 gpm is required. Yields less than 5 gpm 'gill be
inuediately reported to the Putnam County Department of Health.
Notes Required When Fill Proposed
1. Fill must be allowed to stabilize for 60 to 90 days following placement
.z.nd be inspected by the Putnam County Department of Health for acceptance,
prior to installation of the sewage system. Date of placement must be
reported to Putnam County Department of Health.
• ° °•
2. ],,un of bank 'fill shall be suitable for sewage absorption, be free of fines
°,°
Or ether unsuitable
table material and shall have an in -place percolation rate
•
at least equal to that in the natural soil after the required stabilization
°•o° to
period. The engineer /architect shall perform a final percolation test in
o • o •
the fill .after stabilization.
o
3: impervious fill, clay barrier, shall be a dense clayey soil with little or
ho sewage absorption capacity.
u o °®
e" o
• ' ° ° C
0
SEPTIC DETAILS
• °o •e
prepared for
0 00
6'
O •Da
NEW
•oO
/TE;. /l� FYi'1;%" ci.I !/,!'�!!%j c- �t�/7�fC'i�
of
OF
r09
�P��
PIPE — P
prepared by
Cu.?TA //V ORA /N WILLIAM F. ZEILER
Professional Engineer S Land Surveyor If N 0 a�W�
Concord Road- Mahopac -New York 10541 rfsrFO az
(914)628-4764 3 43 FaolESSw +�°`