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HomeMy WebLinkAbout3905DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.16 -1 -49 BOX 30 03905 .� 1 1'* ` . 03905 PUTNAM COUNTY DEPARTMENT OF HEALTH ENGINEER TO PROVIDE PERMIT # ON Division of Environmental Health Services, Carmel, N. Y. 10512 PERMITTj.FICAT OF C PL ACE, CONSTRUC ON PERMIT FOR SEWAGE DISPOSAL SYSTEM 20 1 Town or Vilmage i :Tax MaP ; L6� ASbek.: = Z .. Lot Subdivision Subd. Lot N Owner /Address 1 i to c-'.-5 10 3 O Building Type � .A Lot Area Number of Bedrooms 7-- Design Flow G /P /D !400 Separate Sewerage System to consist of 10 QIC_3 Gal. Septic Tank To be constructed by Water Supply: Public Supply From Private Supply to be drilled by Address Other Requirements Renewal Revision Date Of Previ s Fill Section ly l3f ,! Try P.C. H. D. Notillest ion Required and CGi L� o 1L� G LLL�it?.}f1 Address I represent that I 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 regulations of e 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 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 shown on the approved plan and that said well will be installed in accordance with the stancYrds , rules and regu a%ns of the Putnam County Department of Health. ]►��j Date �L Signed" .EI" R.A. B �� Address -3 �� License No. f) 57-0 /1 APPROVED FOR COI STRUCTION: This approval expires one I ear from a date issued Ynless construction of the building has been undertaken and is revocable for c suse orb ay be amended or modified when cogsid ed necessa y' b� the ommissioner of Health. Any change or alteration of construction requires a nie per it pproved for disposal of domesti lacy sewag )d/ r p ivy t water supply only. Date f By j Title Rev. 6/85 1 1 _ `. I 3< DAVID" b.' BW5N County Executive r';< y s•s , _. �.w ..:,: JOHN•' S DEPARTMENT OF HEALTH Division Of Environmental Health Services Mr. Frank G. Fowler, III, P.E., L.S. RD #8, North Horsepound Road Carmel, NY 10512 Dear Mr. Fowler: January 22, 1986 Re: Schiavone SDS Const. Brookdale Road, P.V., This Department is in receipt of the above referenced revised plans dated 10 January 1986 and received 15 January 1986. Your attention is again directed to "Program Review and Policies for Single Family Residences" dated 5 October 1985, revised 8 November 1985. Review of the submission indicates the following have not been provided: 1. Fill depth on fill plan. Four foot minimum is required. 2. Fill dimensions on fill plan. It is recommended that it be noted that fill must be staked with depth gages prior to fill placement to assure accurate placement. 3. Two sets of house floor plans signed and sealed by a P.E. or R.A. Only one set was.submitted.. 4. Perforated pipe must be specified in galleys on ultimate construction plan. See checklist C.in referenced document for required details that :... ; must "be sYiown; e.g. min of 20-°feet--of - :well casing, etc. 5. Construction notes are lacking from fill plan. 6. House setback from front of lot is lacking from fill plan and is conflicting on construction plan. 7. Construction plan cross section AA shows excavation in sewage disposal area. No cut is permitted. 8. No peripheral impervious material has been specified. Minimum thickness required is two feet. The above items were previously commented on in my letter of 10 December 1985 or referred to by reference to the above cited document. Upon receipt of three prints showing fill placement in conformance with "Program Review and Policies" review will continue. If you have any questions pertaining to the above, please call meat 225 -3838 or 225 -3833. Very truly yours, s S. Hodgens JSH:amm Assistant Public Health Engineer Enclosed: House Plans CCt M. Schiavone, 95 Columbia Ave., Hartsdale 10530 w/o enclosure File TWO. COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 'DAVID D. 8r2UEP1 " County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services December 10, 1985 Mr. Frank G. Fowler, III, P.E., L.S. RD #8, North Horsepound Road Carmel, NY 10512 Dear Mr. Fowler: JOHN SIMMONS. M.D. Deputy Commissioner Re: Schiavone SDS Construction Permit Application, Brookdale Rd. P.V., TM 117 -2 -15 This Department is in receipt of the above referenced application dated November 5, 1985. Review of the submission indicates the following items have not been provided: 1.r:4ill depth, volume and dimensions to-maintain two feet minimum from 6oY m of galley trench foigh groundwater. Two sets of house floor plans, only one was submitted. 03- Three sets of plans reflecting only necessary information to install fill must be provided. A fourth print, to be kept in Departmental files must show complete construction details for installation of sewage system. See page 3 of Submission Re- quirements. -'5. Maximum fill side slopes of 2:1. 6 Galley details must include minimum one foot of gravel around galleys (one -half foot permissible beneath) and perforated pipe to distribute flow in galley. - - IS� Z(2) House setback from front of lot. ✓8. Ten foot minimum setback from top of slope. Minimum separation of galleys is ten foot on center. /9. 100 foot separation from well to south. 10. Well a minimum of 15 feet from property line. 'il. Well detail. ✓]2. Proposed contours at two foot interval. Upon receipt of'three prints for fill.placement only, and one print showing proposed installation and addressing the.above items, review of this application with continue. If you have any questions, you may contact me at extension 242. Very tru y yours, �, mes S. H gens JSH:amm Assistant Environmental Health Engineer cc: Mario Schiavone, 95 Columbia Ave. Hartsdale 1 530 File TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: ' Property of Located at 12,00 (T) Punum Section LL_7 Block._ Subdivision of 61100 k c4 /c 6-0k- hde KA Subdv. Lot Filed Map —bate— I L&-T- Gentlemen: This letter is to authorize zzo OIX4! a duly licensed professional engineer F"----or registered architect (Indicate) to apply for a'Construction Permit for a separate sewage system, to serve the above noted property in accordance w;Lth'the standards, rules or regulations as promulaga.ted by the Commissioner of"the Putnam County .Department of Health, and to sign all necessary papers on my behalf in connect-ion 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. Very truly yours, Signed Owner"'c�f Property P.E R.A., # dZze - i Address gGt /�J A/Z /Oj _!TO Address Z Town V A VVV I e ph o n e C Eli Telephone L DEPIP of MEAT rd 19 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVSiON' OF ENVIRONTNTiL-- I;TILTH SER`I:ES -:.. f COUNT)( OPT1110t BUILDIN0, CAMI, N. Y. , 10 DESIGN DATA SIDIE;T- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Ow if r t� l� , 14� . �— ►as3i Located at (Street) I A It-1 flock Z Lot _ indicate nearest �s cross streee 3 Muriici lit ' Pa Y P�tT�(AM V�4 -� Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Dole Nunbor CLOCK TIME PERCOLATION PERCOLATION stun Elapse Depth to Water Water. ve No. Time From Ground Surface in Inches - Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Tnnhaa Tnrehaa Inches t`;UV Q 7 1985 NoLc " ,*: 1) R st s, to be repeated at same depth until as d ro � � � oil r,i0,o,,3 aro obtainod at oath porcolation test hole. 1 � rrfri�to(] for review. 2) Depth.measurements to be made from top of hole. 2 1a:�2 143/ :W kVIst 1 3> 5 boy .... o.- -taw .. �_ ...._._ - Z 3 . h 4 5 2 t2:43 28 Z2. z�` Te Z2- A Z3 q t`;UV Q 7 1985 NoLc " ,*: 1) R st s, to be repeated at same depth until as d ro � � � oil r,i0,o,,3 aro obtainod at oath porcolation test hole. 1 � rrfri�to(] for review. 2) Depth.measurements to be made from top of hole. .t TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED. IN `PEST HOLES DEPTH HOLE NO. I HOLE NO.. Z: HOLE N0. G. L. 126F.Irll To 'Z,u�is 6" 12" 1.811 24 11 3011 36" 4211 4811 541' 60'1 66" 7211 7811 8411 1-axre A i - i Darks- 2.zc1,CSsc INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED I=1JI):fC;A 1.'I °.f 1jLS%1 �� '.i'G.WIL�CII WA`l':ER LEVEL R:�.:�i,'.; 11.i ".i'f�R I3��liJG ENCuuiJ`l'Eiwi3 TESTS MADE BY -j C,�,���s . �� Date, s- gZ� Soil Rate Used Min/l "Drop: S.D. Usable Area Provided. �� ® No. of Tk.1d.roollin 'L Septic Tank Calvi-c.i.t.y, ICKOC� Clal.s. gype GCGm C. _ Absorption Area Provided By < f 1i: e her i n s Address SE Al. THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: /�fi�rrc�Lst NO Soil Rate Approved Sq. Ft/Gal'. Checked by � pR ?AI& Date � y' r ,• s �.. */ [ %i0V 0 7 1985 PUTNAM COUNITY DEPT, OF HEAL, ►-i :y 7777, 77- AV ,r) Iry IV / If rAp rr I, IF I N Ac-1— BUILT SP- :PT IC, -OCR ION ....... ..... 1A Z147442 PO WEk> ;ZkE 5/,(---.>14- 65.08E 4..w/ 24--7D6 1 /8-901 --- -- - 0 ; 38, 025 49,692- i 16769!�J - 105 92- 6 9 3 6 29./-+D 4-4.;�-64 4 4 � ro 'Putnam County Department of Health Division of Enviro men al Health Servj( Approved as noted for conformance with applicable Rules and Regulations of thq Putnam County Health Department, V- A Ti G THE SEW4PE DISPOSAL �xz(*I-NTG, TO THTS PLAN,., INSPECTtM iY -,ME BEFORE "HI'S SYStgM VAS. C.ON.':. WITH A-U, $TAW)AA )F THE PUTNAM COUNTY, OF TEAL H. Fowler, L-L3-.& Data* i-- ACPrE-- PA,4�?C-F-L T !,QU, - N.A.J.- - + V.A, AZEPARED BY Fk)ANK G.FOWLEP -N 3P6 MAIN 5T PID669ELD) C-O�JA)ECTICU7 oGe7r CALE 1"= 20 0/1k It_-; r / I 13Y CONN, B33t� FJKZQ 1Y, PE. 6 e ^- N. Y 59/13 "s 3 1 Y pg c r co tip1tvi = =r . j • !I .I � IL 41 Fr a. I ,. :! 1 � I � ._ � fr� �! :►L � . f . i Q I��ill 1 s • i 4+ r "v U.S a..�`M'�h'pt :✓ r'' � � t > f `" R '"F .��,, s• tt+ r i"�; Z.., tvF, yJ. '"--. �-r- ..n x wi.s� , a.".h'u. {.1+kSF .%�ilw.lYe �rcu'u^PLi�2'�' '4YirCn t , Y S r,. �h.�..'.: ���-^ •�. ..a._ „:; �4. .: � .,a,i, -..,» M.. >. '�,��'�A..r .,�- - :a._tt�r9�. ''.r.., �5. ..+��x.. ., ,tg: .,, ... ..�'`'�t r.. ..s a`�....�:a 4` `J / f RO�ekjEN s r , ,(U /u � �/ • y OpLE 0 V N R, n /off ` l ,t 'y o C t Cvk0N N/FF TOMPKINS shall run only to those individuals and institutions under the title policy No. sitpwn above_ Said cerfi- nof transferable 1 i� URVEYED & PREPAR^ED BY BUNNEY ASSOCIATES AREA= 15,132 S. F = 0.347 ACRES L�- Q R � \ I, yogis E E 4 a S /Nl)FE R.� NE�LSO/V 0 /STRic�,- k �t WELL lIl O SURVEY OF PROPERTY SITUATE IN THE i TOWN OF PUTNAM VAL PUTNAM COUNTY NEW YORK SCALE' I " =20' DATE AUGUST 5, 1985 BROUGHT TO DATE : MAY — . PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL £SYSTEM ✓C-aII�/ ^�y To n or village - t0!vtod -;at _ flax Map �� `' Block 2 Subdivision>�CY✓k Lot Job 0 gal ✓144f�f C) - ,L1 v rJ Am �i4r7�� a�' �A _ /J� _y Owner Address r✓� �/ Building Type Number of Bedrooms "T'A�ILot Area 3 Design Flow Separate Sewerage System to consist of To be constructed by lvo?7 Water Supply: Public Supply Private Supply Address ST ply Requirements cv q "7 5, 34 7 1e'E S C —, 4'- 04 ota Habitable Space h/2 %150 / �, -f Square Feet sf9 al. Se ti Tan / and /ft GF "i rit1yC 64,1_a.t f s'� l 'Po / ?Ki�Address 5 NIA01150r`7 P�� ✓�J' ' / 7 . by 1k011U114A4 I represent that I 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 regulations of the 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 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 shown on the approved plan and that said well will be installed in accordance with the standards, rules and, regulations of the Putnam County Department of Health. Date �j Signed ,t�r�0'� P.E, t� R.A. Address � "�� �! 131OX �`y� ��' `O/ ""``° License No, 6!52X32. APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction requires a new permit. Approved for disposal of domestic sanitary sewage, and /or private water supply only. Date By Title DAVID n. BRUEN CountV`i xecutive Mr. John Swanson RFD V, , Box 120 Geymer Drive Mahopac, NY 10541 Dear Mr. Swanson: �r JOHN SIMMONS. M.D. ``t 1 4 Deputy Commissioner DEPARTMENT OF HEALTH Division Of Environmental Health Services September 18, 1985 Re: Schiavone SDS Permit Application Brookdale Road, Putnam Valley TM PV117 -2 -15 The above referenced application received September 9, 1985-by this Department requires additional information to permit.review and. system modification to comply with Departmental requirements. The following items must be addressed: 1. One set of house plans was not submitted with the application. 2. The Design Data Sheet indicates percolation tests were not performed in accordance with-the Putnam County Health Depart- ment standard procedure. A copy of this procedure is enclosed for.your use. Use of fractional minutes or inches in computing the soil rate is to be discontinued and should be recorded in full minute or inch increments. Please contact 'me two days in „:adyance ;to permit Departmental inspection. of- percolation tests ... _. -- .. for this site. Departmental .. _ � _ . -. . 3. New York State Code of Rules and Regulations identifies the State Health Department Waste Treatment Handbook: Individual Household Systems as the basis for individual SDS standards. Please contact this office if you desire a copy. Additionally, Putnam County.Health Department has added additional regulations that dictate design wastewater flow for SDS is to be based on 200 gallons per day per bedroom. Depth of usable soil above bedrock has also been increased to seven feet for. trench systems. Accordingly: a. At least one more deep hole in the SDS area is required. Contact this Department to permit witnessing. b. Proposed trench length is inadequate. 4. Location of proposed driveway is lacking. 5. House setback is not shown. 6. Distribution box details do not conform with New York State Health Department Waste Treatment Handbook.. - continued- TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 -2- J. Swanson Schiavone SDS Permit, Putnam Valley 9/18/85 7. All wells or septics within 200 feet of proposed.systems are.not shown. 8. Property boundries are not defined by metes and bounds. 9. The meaning of Construction Note 2 is unclear. 10. Plan does not specify well casing to extend 12 inches above finished grade or two feet above high water level. Upon receipt of plans adequately addressing the above items and Departmental witnessing of the tests, review of this applicaiton will continue. JSH : amm Enclosure: Percolation Procedures cc: Mario Schiavone JSH File Very t00ru y yours, 1'q ,� mes S. Hodgens, Assistant Environmental Health Engineer L , � A. I", � q - Z5 � Meets Std.( R Remarks. MAP LdcH �lor vd 1JC rouse plans O.K. � ✓ ' IQNRTtlRE € be.9L oN PLR L L , n . r J : A)k I _o on tes s and deep test pit location Septic tank size and conformance to std. I I 3 B.R. house minimum 1 House setback shown Distribution box ft,, below frost ! c All water within ;6t t. of. PL shown g1ELL_ -CASING IV' iZ0vE- EiQRDC ✓ 1 , Plan and profile SW ' All other wells and SDS closer 001 shown or reference made Property boundaries (metes and bounds- clearly shown`)l LEGaL —ao1v rs A 3.� icc�nl�(a l+PPeOVAL RCA LTI cSOR D IJ IS ON `I(•Ep y,, .i�,,� ✓ - 7101 to P.L. �Q 7i P,J k1�s/ X201'to Foundatio_n wars J00 to Nearest well / LN f �Q KM to stream, march, lake, euc. rind: a5' to Curtain drain 01 to water line (pits -201) — W to storm drain 01'to larCc trees 01 from foundation to se��tic tan 51 to pipe from leader d,•ain lv.l 125 TD .cs}TCµ eASIKJ 15' WELL TD �' sEPTIG TR/JIC -TO• wEL.L_. .� J rlru,D Crrncic mur. — • . Mte: Insp.by: t, INITIAL SI'Z'E INSPECTIOT, Yes No :, Comment s Property lines or corners found Gan estimate house. location . . . . . . . . Will'. driveway need cut . . . . . . . . Must trees be removed -hote these Is deep hole representative of entire SD3 rhea 7 Additional deep holes needed. . . . s` Sufficient SDS area available considering driveway cut,house location, separation distances, etc• _ _• __ - -- - q]y. WELIS/SEPT%Cea - —_— DEEP HOLE DATA Depth: 6 Vater elevation: - Rock elevation: Soils descr_ia-L•ion: d i e; - FINAL SITE INSPECTION lIns , by:__ _. House located where 'shoran on approved plan – SDS located where approved . . . . . . . langLh of trench measured Width of trench average Slope of tile line and trenciacceptable Room allowed for expansion trenches _ Over'- O-Tt. from swamp, vatercourse _ Natural soil not .stripped or SDS'area • iuuiecessarily graded 10 Ft. maintained from prop.line and 20 ft. from house Sorxtration.of trench from house, well - -- etc. - follows -plan Number jof bedrooms checks • • . . . • . . Stones, brush,-stumps, rabble, etc-. greater , than 15 ft. from nearest trench . . . 15 Ft-. of peripheral soil horizontally from 4' trench _ Jiu-iction boxes properly set Could surface run off from driveway, roads, • ground surface, etc. channel near SDS ... {..; area . . . . . . . Does lot dra:inr.ige apicar. O.K. �i.n area of SDS FINAL GRADING OF SITE ACCEPTABLE e :,i 1 KM to stream, march, lake, euc. rind: a5' to Curtain drain 01 to water line (pits -201) — W to storm drain 01'to larCc trees 01 from foundation to se��tic tan 51 to pipe from leader d,•ain lv.l 125 TD .cs}TCµ eASIKJ 15' WELL TD �' sEPTIG TR/JIC -TO• wEL.L_. .� J rlru,D Crrncic mur. — • . Mte: Insp.by: t, INITIAL SI'Z'E INSPECTIOT, Yes No :, Comment s Property lines or corners found Gan estimate house. location . . . . . . . . Will'. driveway need cut . . . . . . . . Must trees be removed -hote these Is deep hole representative of entire SD3 rhea 7 Additional deep holes needed. . . . s` Sufficient SDS area available considering driveway cut,house location, separation distances, etc• _ _• __ - -- - q]y. WELIS/SEPT%Cea - —_— DEEP HOLE DATA Depth: 6 Vater elevation: - Rock elevation: Soils descr_ia-L•ion: d i e; - FINAL SITE INSPECTION lIns , by:__ _. House located where 'shoran on approved plan – SDS located where approved . . . . . . . langLh of trench measured Width of trench average Slope of tile line and trenciacceptable Room allowed for expansion trenches _ Over'- O-Tt. from swamp, vatercourse _ Natural soil not .stripped or SDS'area • iuuiecessarily graded 10 Ft. maintained from prop.line and 20 ft. from house Sorxtration.of trench from house, well - -- etc. - follows -plan Number jof bedrooms checks • • . . . • . . Stones, brush,-stumps, rabble, etc-. greater , than 15 ft. from nearest trench . . . 15 Ft-. of peripheral soil horizontally from 4' trench _ Jiu-iction boxes properly set Could surface run off from driveway, roads, • ground surface, etc. channel near SDS ... {..; area . . . . . . . Does lot dra:inr.ige apicar. O.K. �i.n area of SDS FINAL GRADING OF SITE ACCEPTABLE e :,i 1 :,i 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property of N%AJ21 Date �- �L 'f -16' .... . 5k41.4 ✓o e-1 AS Located a t ��O ©� L� VD, Pu 7��A /�/1 �'4�'G%��/ Pa +✓laws ale y (T) Section //% Block 2. Lot Subdivision of �j,2QQ�I�Li L� ��+�a��'✓3 Subdv. Lot # Filed Map # Date Gentlemen: -� This letter is to authorize y ®�r% �! • 5������% 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 _condor. mity with the, provisions . of : Article 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, Signed' Counter ?fined: Owner o Property P. E. , R. A. , # 02832 Address lv&holma C_ X28 --76s� Telephone 15 Cole ": kw'Gi Ads Address 1dS�30 .Town x114 qW9= 3 AO'7 Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTA_& HEALTH SERVICES COUN"IY OFFICE BUILDING, CARIMEL, N. Y. 10512 - DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner IVIAR10 SeNiA V014--= Address// Cp1L/�'ikyg AV& , �cTi- f �/©/i; ",V.. Located at (Street) Ornn�:�% , Seoop I17 Block 2- Lot / (Indicate neares cross street) Municipality 1�rdf l-;-i Vo <L&, l Watershed �4UCI G0,-7 ,42%' ✓e SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run apse Deptti to Water Water ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches dry /5 14 �,' Z� i.� % ism 2 - 14 Ah 2 4k'514 Ss �3 S. a l /Y 2.7E�, 3, /�✓mY,VXxL-14 Q 3 4 3 .. 5' 2 3 5 Notes: 1) Tests 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. Notes: 1) Tests 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. i i TEST PIT DATA REQUIRED TO BE SUBMITTE, WITH APPLICATION DESCRIPTION OF SOILS jENCOUN'1'EREb IN TEST HOLES DEPTH HOLE NO. v �` HOLE NO. HOLE NO. G.L. 7tc3n� % j 6�� t I 12 ";.% 1811 G Z _ law- & &01 - t i 2411 ., 3011 /7 i . 36'f 42" y ,, 48" I 54 n A, r 60" I 66" 72,► h �� I 78" 84" n GROUND WATER IS ENCOUNTERED INDICATE LEVEL AT WHICH �.:.�.IATICATE. °hEVE'L .TO: WHIG?i�-W,. ER,•LFVEL_:RZSE :l F, ER BEING BY SYYt3r7�/7 ENCOUNTERED,. ,. Date Si� TESTS MADE ..7o r� �-1 DESIGN th Soil Rate Used Dtn/l "Drop: S. D. U s a No. of Bedrooms s Septic Tank Capacity /p 3a Gals. Type %V& SDn rL Absorption Area Prod By iq.L L.F. x24" b'�7 enc . .. K. sVa,�., Name Jo /,,j S yvo n -<30,—j Signature _ Address /2,1=-o 7 ,.fix 120 SEA it tj THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:Q vill Soil Rate Approved Sq. Ft /Gal . Checked b to %S E P 9 1995 PUTNAM r0U;,�T}/ DEPT. OF 'j jEAii-j 7F- 7 F T AMq COUNTY , DEPARTMENT -"**- ' r &I-ff U -G ­ I -NE., E'- R' . _M': U" $ T PROVIDE Division of Efivii6ninentil w -S", N. Y 10512 RERMJT W NO � CERTIFICAt 0-660S fAUCTION OMPLIANCE .'FOR' SEWAGE,DISPOSAL SYS A Town _Village Located — at Tax Map k6ck z' /-Formerly Subd. Lot - #' Owne Tax. map Lot # A "(T Separate -Sewerage System. built. by, Address Consisting of eQal. Sapflc Tank and Other requirements Water Supply: Public S60ply' From Private 5_ pIY. Drilled By —7 Atldress ij es7 ,ice Building type No. of Bedrooms Date Permit Issued 1 I Is Has Erosion Control Been Coriipletbd? Has garbage grinder been installed? I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the,69mpleted work ( copies of which',ar*e 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.- k Date Certified 91-1 V_z P.E. R.A.— Se fi l Addre Any person occupying premises s4i►vid.by the:ab&e system(i) she it promptly take such oc , tion a I s May be nicasOry to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become I null and _40id is soon is a Public Unitary Viewer becomes available and the approval of the private Water supply shall become:nLil and void when a public water supply becomes available. Such approvals are subject to modification or change 'When, In ihe'judgm ant of the Commissioner of H")th, such revocation, modification or change Is necessary. Date Tit MAIM fieCL-AAA AP Rev. 6/85 m WELL COMMLMON RVORT PUTNAM COUNTY DEPARTMENT OR NEA DIWAM of 11 14"WIM Ham COUNTY OFFICE KRLDINO - CAIIMEL, NEW Yi >< npo.. . _ . _ , er s - sires C�utttl► 6t€t D.a+stnMrit 1D*tlm IMitii Iib 664 "port of ....' -`•:^ ��inhrb�ot rIR►tir.ympb htdb�dlp w�a. a of atl�fictary bRCart�l glalit�► bNon oe�tifie�u aR Iaonwllctten tlolnpllillo� h htwd. WORT MUBT BE SUBMITTED WITHIN 90 DAYB OF WELL COMPLETION "A" . arren Lafferty Amen 'lead Construction 49 Brewster Ave. Carmel N.Y. 10512 or ra Brookdale Road a Putnam Valley , NUSSS wine , oONAM ❑ ESTAM r SKVW ❑ PARM ❑ VW wet 051 OP WUL ❑ SUPPLY ❑ IIU01lA1lIAl ❑ ACOM110NINO ❑ (SP@dfff ❑ RO?AR1/ ® AIR PERCUSSION ❑PERCUSSION ❑ (Spedm CASING 6 19 ®tt WAND ❑ wum X tip NO X tip uo 0 ❑ R440 ❑ Fvwe • ® COAVII101101 AIR 6 10 wAf1� IA"Am Kew LAW tRYU SM -nAI =225 ta nea no p"Q pMA M C�r WON. 36 in 1.n Mbwr.tow wAww 225 MAN arm 15 AWN11 IN tellwu OnAK{ . n OAVRI Ewen. of wR M 7"M PACM VMV /" rpNAMlr eint( non ww AWAa POIIMA"M OIKIMRION ft W-T"iAwmw W WW ""w man@ . b «ww 0 26 Overburden - boulders _ 20 225 Green hornblende - R!T GALLONS PER MDiUN Boyd Artesian Well Co., Inc. Rt. 52 Carmel, N.Y. 1051; DA'N WILL CWUMID ° '0I1T %mi. DRILL[" (SwWur" 4 -30 -86 �- a k k Owner or Purchaser of Bui ding Buil.dins Cons.truct.d' VY -' Lo ation - Street Municipality l II J' ection Lot _ Subdivision Name Building Type Subdv. Lot # GUARANTEE OF SEPARATE SEWAGE 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 success- ors, 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 initial use of 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 occu- pant of the building utilizing the.system. The undersigned further agrees to accept as conclusive the determin- ation of the Director of the Division of Environmental Health Services th•o -Putnam- County- •Bepartm-er.t of I.ealth -as to whether :;r, not the fail= ure of the system to operate was caused.by the willful or negligent act of the occupant of the building utilizing the system*. Dated this Z day of 19 VIA TA Sign aiu Title `Corpor tin Name if corp. AU d ss IV THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health PUIMM COUN'T'Y DEPAMOU OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIELD INSPECTION REPORT .P ^. w . .. :c °'��c' TI'l ��`../ /v \�"' ^.'�. .��1•:1TC Vii'�.�' ;��" V-:rhf :— ^+T.w.+..} a ,.tiLMi�G Yw'..��Wx.y .� W_ ..- (Name of Owner) (Street Location) INITIAL SITE INSPECTION YES NO CCM ENTS Wetlands on /or proximate to property .............. Property lines or corners found ................... ✓ Can estimate house location .................. ..... Will driveway need cut ....................... Must trees be removed - note these................. Deep holes representative of entire SDS area...... ✓ Additional deep holes needed..... .. .. .... O Sufficient SDS area available considering driveway cut, house location, separation distances,etc... a Adjacent wells/ septics ............................ 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 tion 0 ft. Ts 0 ft. AA0 LO C? tZ (�Dft- a. 6 ft. 6 ft. 9 ft. 9 ft. 12 ft. 12,ft. Soil Descri tion Al . ti`T i. fit J$ LO e f2I L �. ..._y ... -..... ....p. r.. ... � ... ..... • -e+.. .......... - ... �...r�...s... .__... w..... .. +.-4.. wN . - a C ate. .. .. .._... �... .. �.... DATE:. Soli 1Jesci 0 ft. 3TE.-) M07r�,, 6 ft. CHI'S 9 ft. 7 12 ft. �. ..._y ... -..... ....p. r.. ... � ... ..... • -e+.. .......... - ... �...r�...s... .__... w..... .. +.-4.. wN . - a C ate. .. .. .._... �... .. �.... DATE:. FINAL SITE INSPECTION INSP.BY: YES NO CHI'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. frog 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. from nearest trench.. ............ 15 ft. of peripheral soil horizontally from trench ..... ............................... Boxes properly set ............................... 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.. a . PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL. WATER SUPPLY & SUBSURFACE SBU GE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT DP ice` i n,4L� to �1.� SC-Ei 1ANIn BY: (Name of Owner) (Street Location) COMMENTS YES NO 5 GI 1_u ET r/ I� M ✓ 0 ?- ©tv� 2 RmpcoAA ✓ 4- l 5 OF- su 'rs ✓ Figsr FLwk ELQ! Z,', i m k_ e. 4 M 10 PECE 1 Or G L 4 ✓ R w PALF O 501L �1i0 EXi c,/ -'RY 5PACW6 1}T P Q AiN TD TOP Jo ' 0,C, Or SLOP10 q �� �C% W IELL To Sov7r4 ✓ A Rr OP . Sr / 3 cp 4vv DOCUMENTS_ Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design' Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets 1 If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Prof' - Gravity Flow Fill Profile & imensions Volume D or J Box;Trench /Gallery; Pump pit etaiT Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing roposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area;shown;gravity flow,suff. size r� -P&Ped 'Pit. & - D- Box-ShownL -- &._Detar ed 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., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains- Cartain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fran Foundation 50' to Well 15' Well to PL GEKERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same