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85.07 -2 -11
BOX 35
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IDTMAM OOG[P!'Y D1�Aii' OF HFAd.TH 7/ �"'�I/ � ��'
' 1> tiYtisa [Savloes:'C1�etd.N.Y.1�4U' �I�YeertoPimWeiatatit%
. = w CUTn+1CAT6 OF COMIFUANCB
COrGTRocMN,l W MR MAGB DMOSALITUM.
ow.adA@]P- ea.t Naas '
KIIIIIIIII Add eea J1�` ""�'R y loJ�%� Tmvn ZIP `
Date Subdivision - Anoroved- - - -.- Fee EncYosed 0` Amn;;nt-
oww" Tno [at Am hD
Number d Bedpooa 5 DafQn Flow G P »��
Swen/e Se mmy Sys*= to an,d-e St d. Sepdc Took —d � •�L
To hwo od if by ,[YO`' Q % %/u%/� Ad�Add. amQ
Wader SW*Z PdAt Sgt Plan _ Addre•i
an pao.f. Sw* Dead by ' Add..
FE Section, 0*. U Depth Vebtme
1 represanCdhat t am'wholly.and eompletaly refponsible for the design and location of the proposed system(s); 1) that the separate sew di Wl s stem
above described . will be constructed as shown on the approved amendment there to and in accordance' with the standards, rules a regu ns o • nam
County Department of Mielth, and that on completion :tt*eof a "Certificate of Construction Compliance". at to the Commissioner of H•si hwill
be subrnittW to the department, and a written. guarantee 4ill 0a furnished the owner, his successors. heirs or assigns by the builder, that said builder will
plan,• in good operating ;condNlon any part of 'saki sewage disposal system tluri the period of two ( ) yea►simmedlebly following the date of the ecru•
anq of the approval of tAe certificate of Construction Compliance of thi o', 1 syst, or any re thwdo; 2) that the drilled well described above
will be located is shoavn on the approved Plan and that +all well will b4 installed in rds with t sta' r ' a . r•gu ns of the. Putnam
county Del art" 01 Health.
Data n P.E. Jam,_ R.A.
- i Adore l ieeno No
APPROVED FOR CONSTRUCTION: TAis approval expfr•s two. , is :f _ ,the date A�nlsss construction of the building .Ads Men undertaken and is
revocable for cause or may be amended or modified when consiAer ry by tn ssioner of Health, Any change or attaration of construction
re0uires a new alprioitp Approved for tlispOYl of tlomestk san and/ -WAter_supply —On1Y. ---- ---�`W — I
LO/88 Date
By
Title
..q:. __ .. ". �.' '....fin.. ...,� ..a - .., .. ••. •; ,;•Q. .z;. ...,
SITE
R
PHCxNE
TO
PERSON INTERVIEWED PCHD Complaint $
Name & Relationship (i.e, owner,tenant, etc.) /
DATE TYPE FACILITY
PROPOSED INSTALLER in e z c o pHOM
Pro (include sketch locating all adjacent wells):
NOTE: Repair must be in same location and of same type as original sewage disposal system.
Different location may require submittal of proposal from licensed professional engineer or
registered architect.
Proposal approved
s `Signature &
Proposal Disapproved
W/X
roposal approved with the following conditions:
1. Procurement of any Town permit, if applicable.
2. Submission of as built repair sketch in duplicate showing:
a. Owner's name.
b. Site Street Name, Town and Tax Map number.
c. Location of installed components tied to two fixed points
d. System description (e.g., 1250 gal. concrete septic tank,
drywells surrounded by one foot + gravel).
e. Installer's name and number.
(e.g.,house corners).
three precast 6' diam. x 6' deep
3. System repair to be performed in accordance with the above proposal and conditions.
I, as owner, or repo agent of owner agree to the above conditions.
SIGNATURE`:. /.�-- -"' "� TITLE DATE
73Q'IE:: V&te (PC HD); Yellow Mva ffi); Pink ftpUamt)
s
/l
9
-Date
(e.g.,house corners).
three precast 6' diam. x 6' deep
3. System repair to be performed in accordance with the above proposal and conditions.
I, as owner, or repo agent of owner agree to the above conditions.
SIGNATURE`:. /.�-- -"' "� TITLE DATE
73Q'IE:: V&te (PC HD); Yellow Mva ffi); Pink ftpUamt)
11/07/1996 07:30 9145280306 MILOCONTRAcTING PAGE 01
V_
b.4 I
Mw Mb'w6S
Z I RON 96
l AM
.,.u,ijqoj wmand
(I D A I *:'I') -]'d
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL:HEALTH.;SERVICES.
Date
Re: Property of
Located-at r l Lo. �/ J l C, P%4 v OST_
(T ) (tTA '�1 U Section F6. -7 Block v� Lot /
Subdivision of
Subdv. Lot #
Gentlemen:
Filed Map #
Date
This letter is to authorize `✓ '�� / " (� G
a duly licensed professional engineer
(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. tha,.s. ma.taer and to supervise the• const•ructi-on ;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.
PEE OF�Gyo Very truly yours,
gne d,
Countersign
P.E., R.A.,v#
Po 66�
Address
6S,
i-�
Telephone
Owner of Property
_lJ !D /Oi/OST 17G
Address
To
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21
284.50'
NO WELLS WITHIN
200 FEET DOWNGRADE i`
- ----------- -- -------- ---
100
DEEP /.0e
102 0
10'/
PERC HOLE .4, Z
EXISTING 2
D IEV OF TRENCH. L.F
(43 0
LE s IC
Iw
SIL FENCE
106
EXISTING POOL
t-tv
108 Ito 112 114
SCA11j"
NO EXISTING OR PROPOSED WEI I WITHIN
100 FEET OF THE PROPOSED SYSTEM OR WITHIN
200 FEEL IF IN DIRECT LINE OF DRAINAGE
Putnam County Departmert
of HeaAg-
XVision Of Environmental
Health Services
Approved conEormance
S106.55E a noted fo
l
*ith
- —u Z gulations
ofthe
0 y Health
pa
S gnat & Title 9
ate'
PROPOSED
U
ADDITION
EXISTING 3
BEDROOM
HOUSE
TANK
(PROPOSED 5
BEDROOM
HOUSE)
V)
loo' -0" EXISTING WELL
EXISTING
GARAGE EXISTING DRIVE
SSDS DESIGN.,
FOR
JOHN KARELL, JR., P.E. DIANE AND STEVEN MIL01INIC
P.O. BOX 644 J,
11PROVOSTPLACE
CARL, NY 10512 PUTNAM VALLEY, NY
TM[# 85.7-2-11
120
/
'115
110
105
100
ARSOREBON TRENCH DETAIL
(N0T TO SCALE)
-
.aNRfnr aeTO,.E nTDT I.N.e e.oTRE Rm l...e ..
rr
oc N: -vw-
CROSS-SECTIONAL MEW 1ORGIUMNALMEW
rONrY.�[ mnxTRr Tarp IfPee
frvw.
T
•aa< TTmo reTTw M: -Hi1Oi n. T<uR Pm F .R.coe[cTm
TRENCH PROOLE
.Q
DROP BOX DETAIL
(NOT TO SCALE)
. t
RM SEPOC TM
nar OT
+721'
12- T T
IC
W.
j1 TANK
r
(PREFERRED) 2*-
ti
•'
EXISTING
SSDS
PROVIDE 405 LF. OF
• :` -rr GRAVEL FOOTwC
RUSH WM BOTTpr
4' POURED CONCRETE: B' MM MAS y; B' OR B' Cd MTE BLOCK:
CONCRETE OR COFENT ASBESTOS RPE QlT TO SPECS,
OR PRECAST ]' REMFOHCED CONCRETE
0
T'C
30 60 90 120 150 180,
SECTION A -A' THRU SYSTEM HORZ. SCALE 1'=30'
VERT.SCALE V = 10'
FOR: DIANE AND STEVE MILOHNIC PROVOST PLACE, PUTNAM VALLEY
PUTNAM COUNTY SSDS DOTES
1. ALL TREES WITHIN 10 FEET OF THE SSDS SHALL
BE REMOVED.
2. SSDS TO BE INSPECTED BY THE DESIGN ENGINEER/
ARCHITECT AND THE PUTNAM COUNTY HEALTH
DEPARTMENT AFTER CONSTRUCTION AND PRIOR
TO BACKFILL.
3. NO TRUCKS, MACHINERY, BUILDING MATERIALS
NOR EXCAVATED EARTH SHALL BE ALLOWED
IN THE SEWAGE DISPOSAL AREA.
4. THE SEWAGE DISPOSAL SYSTEM DISIGN SHOWN
HEREON DOES NOT PROVIDE FOR THE
INSTALLATION OF A GARBAGE GRINDER SUCH
INSTALLATION REQUIRES THE APPROVAL OF
THE P.C.D.H.
S(011. DATA
PERC HOLE # 1 14 M[N/IN
PERC HOLE # 2 15 MIN/IN
DEEP HOLE # 1 94.IN. TYPE: BROWN LOAM
DEEP HOLE # 2 84 IN. TYPE: BROWN LOAM
$Il_T FENCE DETAIL
(NOT TO SC1 )
,.f wro aaro i
T �
n.T
i
PERSPECTIVE MEW
�•PSrn r�"� ou
NTN nTO mTN o+R
Rrcm uP.o
°P�i «m ew°Oiro nNew fPRa
SEGIIOH _ - .e
OOH<T -QOON NOTES rM rMMT'ATFD SA T Ma
T. er•O. �[ 104 Te TR IglplP AP..Rt TR Pl6 DRq TNT � j
rnTOO��wf¢T�io AiaiS�iT 1 N K
Z
I; S
IC
j1 TANK
ti
EXISTING
SSDS
PROVIDE 405 LF. OF
ABSORBTION TREN
A
EXPANSION
AREA
y
'
-
®
EXISTING G
E
DROP B
X T,
kJ
. p.
0
T'C
30 60 90 120 150 180,
SECTION A -A' THRU SYSTEM HORZ. SCALE 1'=30'
VERT.SCALE V = 10'
FOR: DIANE AND STEVE MILOHNIC PROVOST PLACE, PUTNAM VALLEY
PUTNAM COUNTY SSDS DOTES
1. ALL TREES WITHIN 10 FEET OF THE SSDS SHALL
BE REMOVED.
2. SSDS TO BE INSPECTED BY THE DESIGN ENGINEER/
ARCHITECT AND THE PUTNAM COUNTY HEALTH
DEPARTMENT AFTER CONSTRUCTION AND PRIOR
TO BACKFILL.
3. NO TRUCKS, MACHINERY, BUILDING MATERIALS
NOR EXCAVATED EARTH SHALL BE ALLOWED
IN THE SEWAGE DISPOSAL AREA.
4. THE SEWAGE DISPOSAL SYSTEM DISIGN SHOWN
HEREON DOES NOT PROVIDE FOR THE
INSTALLATION OF A GARBAGE GRINDER SUCH
INSTALLATION REQUIRES THE APPROVAL OF
THE P.C.D.H.
S(011. DATA
PERC HOLE # 1 14 M[N/IN
PERC HOLE # 2 15 MIN/IN
DEEP HOLE # 1 94.IN. TYPE: BROWN LOAM
DEEP HOLE # 2 84 IN. TYPE: BROWN LOAM
$Il_T FENCE DETAIL
(NOT TO SC1 )
,.f wro aaro i
T �
n.T
i
PERSPECTIVE MEW
�•PSrn r�"� ou
NTN nTO mTN o+R
Rrcm uP.o
°P�i «m ew°Oiro nNew fPRa
SEGIIOH _ - .e
OOH<T -QOON NOTES rM rMMT'ATFD SA T Ma
T. er•O. �[ 104 Te TR IglplP AP..Rt TR Pl6 DRq TNT � j
rnTOO��wf¢T�io AiaiS�iT 1 N K
Z
TEST PIT DATA REQUIRED TO. BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. ... HOLE - -NO.• -
r . f:*', -
G.L.
I�OFJ44A/-
2
3'
4'
5'
6'
7'
8'
.9'
10
11'
.12'
13'
14'
,l INDICATE LEVEL AT'WHICH GROUNDWATER IS ENCOUNTERED
INDICATE LEVEL, TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED /v (l/IA -
DEEP HOLE OBSERVATIONS MADE ' BY:- II1(��(.� DATE:
11 DESIGN
Soil Rate Used 11 '�_ Min /1" Drop: S.D. Usable Area Provided.t S 00-d
No. of Bedrocros —67 Septic Tank Capacity ° gals. Type
Absorption Area Provided By �D L.F. x 24" width trench;}
Other
Name J ,-T7L— Signature
Address SEAL too, 05.;�
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved sq.ft /gal. Checked by Date
E���
DESIGN -W.TA- SHEET - SUBSUE?L:GS S&+Znr:jE DISPOSAL -SYSTEM
Owner _Mj L 0 (4-N C, Address ll
Located at (Street) pj�XJOEFPw 'Ck Sec. K. 7 Block Z _ Lot
(indicate nearest cross street)
municipaiity J a UAI-4— f- Watershed
SOIL PERCOLATION TEST D ATA PIWIRED TO BE SUBMITTED WITH APPLICATIONS
Date of Pre - Soaking 2i / � Date of Percolation Test J �i �0 f� ia�
HOLE
NUMBER CLOCK TDJE 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
/2
2
rV
3
,
4
2
3
5 17�'
1
04
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;subdtted
for review.
2• Depth measurements to be made frcan top of hole.
rev. 9/85