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HomeMy WebLinkAbout4598DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.07 -2 -5 BOX 35 k ,T r. { T k, Rev. 3186..' `. ONSTRUCTION PERMIT FOR SEWAGE �: a at.. 6✓✓r�.a� ao- �� Subdivision New.-- °✓%` PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer to Provide Permit N SYSTEM Lot Owner /Applicant Name ®e it ,7 SRS t DO4-1 64 e-1 Mailing Address on CERTIFICATE OF COMPLIANCE j'V—K(/ Q� Permit p To or Villaage Tax Map Renewal_ ❑ Revision ❑ Date of Previous Approval Town/ / +r7 -e Building 8 �a46 X 6 8. Type Lot Area Fill Section Only Li Depth Volume Number of Bedrooms - } Design Flow G /P /D PCHD Notification is Repaired When Fill Is completed Separate Sewerage System to consist of Gallon Septic Tann] and /1 r%'6� R To be constructed by Td 6-e— ckk d" r "C' Address Water Supply; Public Supply From Address or: � Private Supply Drilled b � *h r -7 4 ddresa . Other Requirements t' " t 1 -1_� f✓ v °/ .T c "' /sJ a '.%` represent that I am wholly add co pletely 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 or' al system or any re thereto; 2 hat the drilled well described above will be located as shown on the approved plan and that said well will be installed i coi�anc Jth. ' ndards, es and regu aiions of the Putnam County Departrpent of dealth, Date Signed p P.E. R.A. Address' �a License NO APPROVED FOR CONSTRUCTION: This approval expires one yYar 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 'sewayerapaMr private water supply only. Date Title Rev. 86 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N.Y. 10512 • -_•))-AAA' - . \ _ ..:,�. �...._,. _. tea.:- :-•._ _�......_. .� :.._ � - �� ; �� .. ... �,-w-• Engineer ..-, =R. Must 4 P- r,N o.v. id— e C H. . P enmlt (� — .. ._, .._. ..... -.. '� , `CERTIFI OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM oT /%( p NA Town or /V�llhlge �E- Located at D cS7RE� Tax Map �_Block s5_ Lot Owner /applicant Na�m /e LD71` Formerly Subdivision Name Subdv. Lot # Melling Address ���'���L �P -y— Data Permit Issued Separate Sewerage System built by 1<Jq F Address Consisting of �- Gallon Septic Tank and Water Supply: a Pgbllc Supply From f Address Private Supply red by Q�JJ4-iA� ma y!p or: Building Type �is rr� s r Has Erosion Control Been Completed? i �IA1 1 Number of Bedrooms , Has Garbage Grinder Been Installed? A Other Requirements I certify that the system(s) as listed serving the above premises were constructed of which are attached), and in accordance with the standards, rules and regulatia Putnam Countv Depaztment of Health. Date ps of the completed work ( copies plan, and the permit issued by the P.E. R.A. License No. Any person occupying premises served by the above system(s) shall promptly taste such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage sy3te shall become null and void as soon as a pub(;: unitary sewer becomes available and the approval of the private water supply shall Deco null d vo hen a public wet supply becomes available. Such approvals are subject to modification or chtnglejw-h-e —n'," in the judgment of Co info f ealt c rev lion, modiflatlon Or change Is nscessery. ,. WELL l;v1"lrLZ11UV AnrvAi Office Use Only DEPARTMENT OF HEALTH c Division Of Environmental, Health Services _ . •.fir 4 ... � _ ....... �'�x; r r�. m q ;5..:x•:;_'- r� _ 4 �- . --. r : • «- . e.�F . _ :� s r•„ . U, YO PUTNAM COUNTY DEPARTMENT OF HEALTH STREET ADDRESS: WN/ IL I Y TAX GRID NUMBER: WELL LOCATION wood Street Putnam Valley WELL OWNER NAME: ADDRESS:. DOUaM BUNYEA PO Box 343, Mahopac; NY PRIVATE O PUBLIC USE OF WELL 1- primary 2 - secondary tWESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /CONO. /HEAT PUMP ❑ ABANDONED O BUSINESS ❑ FARM 0 TEST /OBSERVATION ❑ OTHER (specify) p INDUSTRIAL ❑ INSTITUTIONAL. ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED 3 / EST. OF DAILY USAGE 350 gal REASON FOR DRILLING X3 NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 265 ft. STATIC WATER LEVEL 35 ft. DATE MEASURED 12/17/87 DRILLING . EQUIPMENT ❑ ROTARY 90 COMPRESSED AIR.PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. J: OPEN HOLE IN BEDROCK 0 OTHER TOTAL LENGTH 135 ft- MATERIALS: �R STEEL ❑ PLASTIC ❑ OTHER CASING DETAILS LENGTH.BELOW GRADE ft. JOINTS: ❑ WELDED )Q THREADED ❑ OTHER DIAMETER 6 in. SEAUZ CEMENT GROUT O BENTONITE O OTHER WEIGHT PER FOOT _12 lb./ft. DRIVE SHOE. O YES ❑ NO LINER: O YES ONO SCREEN DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? DETAILS . FIRST o YES ONO 'HOURS SECOND.." �.. _ - - GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE DIAMETER OF PACK T BOTTOM DEPTH It. WELL YIELD TEST pumping If detailed METHOD: ❑ PUMPED i tests were done is in- • COMPRESSED AIR , formation attached? • BAILED ❑ OTHER :OYES ONO 1 ALL LOG if more detailed formation descriptions or sieve analyses are available. please attach. DEPTH FROM SURFACE Water Bear- in9 Well Dia- meter FORh1ATlON DESCRIPTION G7oE, tt. ft. WELL DEPTH ft. DURATION hr. min. ORAWOOWN ft. YIELD gpm. Surface 110 no . 6 Hardpan & boulders 110 125 no. 6 Soft weathered bedrock 200 1 20 200 � 125 .265 767 nm to hadr 265 6 — 200 45 WATEP jibCLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS ❑ COLORED ANALYZED? AYES ❑ NO ANALYSIS ATTACHED? DYES ❑ NO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAME MILL DRILL ADDRESS PLTtT1aITt Ave, sl Brewster, NY C. - l�/23/87 E, . 1 1, -resi ent i 4 Box 224 - BREWSTER, N.Y. (91 4) 225-2072 WATER ANALYSIS REPORT SAMPLE No. 6824 SOURCE: Douglas Bunyea well Wood Street Putnam Valley, NY COLLECTED: December 17 9 1987 BY: Mill Drilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 7 This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. December 19, 1987 Roy ckwit P.E. lirector 0 per 100 mi. D'AQUINO and DONAHUE CONSULTING ENGINEERS. ❑'John V. D'Aquino, P.E. Daniel J. Donahue, P.E. 314 Oscawana Lake Road 200 Breckenridge Road :MahSPac:ri.Yc;1<<541' 914 -526 -2039 914- 628 -7576 TO AJ-784-I'l LLC UTEQ OF MUME DUUM - +-d /// •/ r J_ - NO. RE: �T SD v.0 Z" �° 6P WD jv Fr For your use ❑ Approved as noted WE ARE SENDING YOU Attached ❑ Under separate cover via the following items: • Shop drawings • Copy of letter [Prints ❑ Change order ❑ Plans ❑ Samples ❑ Specifications ❑� COPIES DATE NO. DESCRIPTION ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ _ v PRINTS RETURNED AFTER LOAN TO US THESE ARE TRANSMIT'D as checked' -below: � `PY V SIGNED: 20 If enclosures are not as noted, kindly notify us at once. For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US `PY V SIGNED: 20 If enclosures are not as noted, kindly notify us at once. PU NAM COUNTY DEPARTMENT OF HEALTH DIVISION. SERVICES - - SIOi� OF ENVIR �i'AL. HEALTH. mac.- d. �J..,�¢ ��.:.t;.w .�.�•= � . a� \ Owner or PLYchaser of Bui ing Building structed by ,Q Location - Street Municipality Building Type two 3 � Section Block Lot Subdivision 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 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 -"Certif-icate of.- Construction: Compliance" - fo_r ,the sewage . - c� _spyGal- system, -or- any repairs made b'y. me to such * system; except -where ttie 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 Environmental 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 5 t4-, day of'7'•`,_ 193t Signature 9 Title General tontractor (Owner) - Signature Corporation Name (if Corp.) Corporation Name (if Corp.) Address Address rev. 9/85 mk IT. A 11 P -TM a C FMAL SITE MPECTION Date l� Cf O Ste- Inspectf by OWNER M4 # OR SZTjDIV-TSICN LOT 7 _/ �`TvAG,E DISPr.SA.L ARFA a. SDS are= located as Fz approved plans I I . b.. Fill section - Date of plac--Tp-nt 2:1 harr ier LGTH W= A.VG.DPM c. Natural soil not s' --- i=ed d. Stone, br-Lssh, etc., greater than 151 from SDS area. e. 100 ft. from water course/wetlands, SFNAG✓ DISPOSAL SYSTal a. S-Zeotic tank size - 1,000 ---------- 1 b. -q=--.t4c t:--r-.*K inst.F-1 led levell c. 10 f -ran foundation I I-A I I d. No 900 b-rnds, cleancut within 10 ft. of 45' b--rid e. DISTRIBUTION BOX 1. A-!1 cut-le+--- at same elevation - water tested 2. Prctecteec-t be-'cv frost 3. Mlini:Traan 2 f-,-. original soil het7.,ie--n bcx and trenches f. JL--NCT-C-N EOX - properly set a. LTRE-2=S -- -Y� 1. Ler-c-L-i required - �� &' La7crth iristalled 2. Dist.�ce to wztarccurse meas-are-a ft. 3. Inst_-Lled ac---rdi.-Lic to plan 4. Distance center to c-enter L 5. Slcce of trench .acceptable 1/16 - 1/32 -1/fcot. 6. 10 feet f--an urcce--tv line - 20 - foundations 7. Dar:-Ei c--lc trench < 30 inches fran sur7a-ce 8. Rocni allowed for eTcansicn, 50% 9. Size of gravel. 3/4 - 11" diameter 10. Dentlh of gravell in trench 12" ndnLmua li. Pit-e unds cacced h. PD. T CR EC.S-E SYSTEMS am + d Si ze cr Eu -hartilc 2. Ove--=:-Icw tank 3. Alannu, visual /audio 4. Pnr) e-=silv accessible manhole to grade 5. First- -box baffled 6. 07clle witnessed by Health Deix---tre-,it estimated flow 2�1-r cycle HOUSE a. Ecusse lccz--ted per approved plans. b. Nmira--- of bearc= WELL a. We1 located as per approved plans b. Distance from SDS area measured ft. I I PLIC C. u7---) c. Casing 18" above grade. r d. Surf-Face drainage around well acceptable. OVERALL WOMD-FET-P a. Boxes properly grouted b. All pipes p�:qially backfilled c. A-11 pipes flush with inside of box d. Eadkf ill material contains stones < 411 in diameter e. Oarta-in drain installed according to plan f. Curtain drain cutfall prctdcted & dir.to exis-.watermur g. Footing drains dischar e from SDS area — h. Surface water protection , adequate i. Errcsion cantro rovid6d on slopes greater �tba�n�1 15%�E I I D kQUff O and DONAIH UE ❑ John V. D'Aquino, P.E. Daniel J. Donahue, P.E. 314 Oscawana Lake Road 200 Breckenridge Road,. ... i�,Rutna i:Valley,N.Y.1.05 ,y. 914 -526 -2039 914- 628 -7576 TO �T y DATE JOB NO. I TTENTIO x dq es 1 HESE ARE TRANSMITTED as checked RE. T 0 — ❑ Approved as submitted AAA a //e ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION REMARKS A /lti !r :�f >Y ��a�r �C � L, �is� 12! f .r �� - / / �i r"l�r fig X2 y d COPY TO c SIGNED: 1 HESE ARE TRANSMITTED as checked below: ` For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution "— ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FOR BIDS DUE • 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS A /lti !r :�f >Y ��a�r �C � L, �is� 12! f .r �� - / / �i r"l�r fig X2 y d COPY TO c SIGNED: DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 •APPLICATIt�N"`10-'CON5TRUCT' A' °WATE'R'- WELL' " ' PCHD PERMIT # Pv-D__ WELL LOCATION Street Address Town Village /City Tax Grid Number s4e-t � b V� e Mme' 1 �� - 014-2 WELL OWNER Name / Address Dot, '4T /- A'-C, M4 40,4c- OPrivate 0Public SE OF WELL - primary 2 - secondary $;RESIDENTIAL 0 PUBLIC SUPPLY O AIR /COND /HEAT PUMP ❑ BUSINESS 0 FARM O TEST /OBSERVATION ❑ INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY 0 ABANDONED 0 OTHER (specify O AMOUNT OF USE YIELD SOUGHT_ j_gpm /# PEOPLE SERVED_ 4 /EST. OF DAILY USAGE40 D gal REASON FOR DRILLING JWNEW SUPPLY []PROVIDE ADDITIONAL SUPPLY OREPLACE EXISTING SUPPLY ® DEEPEN EXISTING WELL ❑ TEST /OBSERVATION DETAILED REASON FOR DRILLING AJ ej w 4 .fr % Ier r eJ'i WELL TYPE IMDRILL ED ODRIVEN ®DUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES _ -NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name]. JA_ 7� /M,�J I r Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY _1ISTANCE TO PROPERTY FROM' NEAREST' WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED []ON REAR OF THIS APPLICATION ON SEPA SIi�E /< /6 /e� (date) (s gnature) 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: 19 Date of Expi rat ion: V,2U 19 op 4 Permit Issuinf Offici-dT Permit is Non - Transferrable PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date 04 Re:- Propbrty of Doiiqld.5 9"nii-e Located at Wo 6d S-A?,ee, (T) �r)gbpj V/4 //g!-4 Section t4,6 Block -3 Lot Subdivision of A Subdv. Lot # Filed Map # Date Gentlemen: This letter is to authorize j- 4)6.q a 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 --.sy§;tem.:or-,9ys.tems i.in conformity -with the provis1orrs of Articl ,l 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, S igned' Owner of Property Countersigned: P.E., R.A., # Address IV, 9 Telephone Address Town Telephone 2� 4. Av 6XVID D. BRUEN County Executive . &4:tiA44K661, DEPARTMENT .OF HEALTH Division Of Environmental Health Services October 24, 1986 Daniel Donahue, P.E. RFD #11, Box 200 Breckenridge Road Mahopac, New York 10541 JOHN SIMMONS, M.D. Deputy Commissioner RE: Proposed SSDS Bunyeau Wood Street (T) Putnam Valley TM 120-3-4 P.V. Dear Mr. Donahue: Review of plans and other supporting documents submitted at this time, relative to the *above"*captioned project has been completed., Comments are offered as f6llo'ws: .5�.Tax Map # is.missing on.several doc*uments -:1 4 revise DDS and all details on plans to.show'4 bedroom design recommend oversized pump fit instead of separate ovekflo -tank orj:nc-lude'-.pr,Q_ visi Dns r. ,:.,fo '.'empty lng -�eve-rf Ioiq tai k- automatically trenches too close to prope rty line; provide > 101 well too close to property line; provide =I- 151 Lx /move SSDS closer to dwelling or provide a new deep hole in SSDS area moving SSDS closer to house, space will be 'available to even up laterals ,-­,,-,two more copies of well permits are required,.- we enclose our new forms for your use.' electrical work in pump �it should be to NEC.codes ."-"c­ross off 'details on plans that do not apply provide 41 co " ver over pressure line throughout or'provide b6 drainage ok to pump pit.. 6,u 14 I r�l TWO. COUNTY CENTER. - CARMEL, N.Y. 10512 (9,14) 225-3641 Upon receipt of a submission, revised to refleot.the above comments, this application will be considered further. Very truly yours, AB:pt cc:JK AB Fi le Anne Bittner Asste.Public Health Engineer PUTNAM COUN'T'Y DEPARUFr OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIELD INSPECTION. PF20J - __ . � �..- r,'1:- ��i! y. .. t�+ .. � .. -,r - e�- :y, i , . - : �-. ., i.`«:w.:.fl. :: .V,� «'.,e.. n¢.x %: G,.. +n _• • a't q. +.. �v . .. C DATE: U Yl �( v� INSP. BY: (Name o Owner) (Street Location) INITIAL SITE INSPECTION YES NO COMMENTS 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.......... ... .... Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacent wells /septics............................ Access to iprgMsed well location for drillin . /..r. D.H. - Deep Hole G.W.- Groundwater D.H. 1 Lot D.H. 2 t 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 Descr 0 ft. 3 ft. 6 ft. © �. 9 ft. Soil Descr 0 ft. 3 ft. U � J 6 ft. f 9 ft. 0 ft. 3 ft. 6 ft. 9 ft. boil liescri 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 from property line and 20 ft. from house... ........................ Distance well to SSDS (ft.) ...................... Number of bedroans checks ......................... Stones, brush, stumps, rubble, etc., greater than 15 ft. fran nearest trench ................ 15 ft. of peripheral soil horizontally fran trench ..... ............................... Boxes properly set ......................... Zould surface runoff fran driveway, roads, ground surface, etc .', channel near SDS area.... )oes lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE.. PUTNAM COUNTY DEPART OF HEALTH.- DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS (Name of Owner) (Street Location) COMMENTS, YES NO DOCU,,OFrS X ►m ki= d Permit Application Ali Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) J Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other :..._. -- i �. 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 ry Perc & Deep Holes Located Representative of Sewage &_ Expansion Area -nsic PreashNn; gravity flow;suf size - - - If Pumped Pit & D Box Shown & Detailed 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 i 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 Unc. expan) i/ 15' to Drains- Curtain,Stom,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' from Foundation 50' to Well _.�-- 15' Well to PL GENERAL I� Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked L 2/Wetland ( Town /DEC Permit R & D) Data On DDS Plans & Permit Same TP DATE REVI ��� 3 )? I L � a ; r , BY: (Name of Owner) (Street Location) COMMENTS, YES NO DOCU,,OFrS X ►m ki= d Permit Application Ali Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) J Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other :..._. -- i �. 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 ry Perc & Deep Holes Located Representative of Sewage &_ Expansion Area -nsic PreashNn; gravity flow;suf size - - - If Pumped Pit & D Box Shown & Detailed 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 i 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 Unc. expan) i/ 15' to Drains- Curtain,Stom,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' from Foundation 50' to Well _.�-- 15' Well to PL GENERAL I� Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked L 2/Wetland ( Town /DEC Permit R & D) Data On DDS Plans & Permit Same PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL•HEALTH.SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 • • .,:.5:,, � -- .. .. v - .ow .y. a, .. M T V'@1• ...w. tl... rl� ..y • , • .r.n N.. .., ap .. 8 Ty Cia. .. _ .0 r _ .. ` bESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner )yg Af BU461 eg Address fir -, r ���. ����'�i e ' 114/iap .0t Located at ( Street IA/G6 D S�-- Sec . c ,Z Block Lot . Wdicate nearest cross street) Municipality Az,4 )`, Watershed f ,e e—ki�C', SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS 2/1 AV 3��Z c� � � 3U �-® �L�y �3Jy • /�, � 5 • 4. 5 �- 2 OG ®- •A fO.. VD 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. r Hole Number CLOCK TIME PERCOLATION PERCOLATION apse 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 #-/ 1 /� j, Zo J—Z 4 _ r/�_ 2/1 AV 3��Z c� � � 3U �-® �L�y �3Jy • /�, � 5 • 4. 5 �- 2 OG ®- •A fO.. VD 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. r A Aq Pa -pato °Tvo / °;.d°bS® Pa.&wddy a:�vI T-joS asa6rpPv �a9c —7—,t g °d°`l ®q Aq papT.Aaad va.TV uor2-d$ovgT abd ®� ®sue 0911 P.9 ) covde-n .T. aypdaS —T—M POP`AOad "JV aTqvaIl Tog od=a aWaw Paam nva TToS 1aImcl NnIY MMNR ORMF IM164V Sass W.IPM MXT.% =MR 7304 7= amim ply cmnoan 91 ISITA MoED EDMK XT 'MM 3XMIMII r - ON ZME °opt MOE ° ON MOH ° ox MOE GMDE Mil lu CMIUMooIE smos do mogwIdosaa molxmricwT slim cmallwms ars of M=bn TM =a XMI M#8 a$L aZL a�99 cast aZfp u9c acs a4pL es$ 6 e�9 ofl°,D 6oj ° }s S2o r9 /S" tv 12V, o,p �y �h'o. 4n� 1� I G� • This /.s fo cer f4l thot 4he.sewa3e dlsf sys,�cm was coms,Truc4'ad os Ind/cafed J-his Pion qnd the system waS lnsfre,j ! bef6ra , t was c ove red over. The sya rei conS�r�c tzcl !n OGCord&'Icc w /th 4!i sFohcia�d r,le's a-d re�,la-lEau of4Ac d -Mel �' ✓, �. N. �- MCGSurLm,ln�S - !•o� @n �}/ -fG/Oc� ,y '6y Ricdc.d $6ri- AS 8UILTi1 � N S DA RUN' tA,.� Z WDO.p STREcT PvFN/}M VALLEY P. Z � 99•s 98s 3 q/r qo t o l I !ol qq_ I /2y ne fl j 1Lf /64 1 12 1121 v !Y i 1/0 € or 1 i rS I I /ok 1 79 I �y �h'o. 4n� 1� I G� • This /.s fo cer f4l thot 4he.sewa3e dlsf sys,�cm was coms,Truc4'ad os Ind/cafed J-his Pion qnd the system waS lnsfre,j ! bef6ra , t was c ove red over. The sya rei conS�r�c tzcl !n OGCord&'Icc w /th 4!i sFohcia�d r,le's a-d re�,la-lEau of4Ac d -Mel �' ✓, �. N. �- MCGSurLm,ln�S - !•o� @n �}/ -fG/Oc� ,y '6y Ricdc.d $6ri- AS 8UILTi1 � N S DA RUN' tA,.� Z WDO.p STREcT PvFN/}M VALLEY