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631- 589 -8100
1 -1 -8
BOX 1
1111:
116'
ml
L7 '
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1.
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1111:
Any parson occupying premises served by the above system(:) shall promptly take such action as may be necessary to Secure the co►►ad10 of aay"-)u n y
conditions resulting from such usage. Approval of the tepewte aswgaga'system. shall become null and wokl as aDOri as' • pWS,: tartly Busier'
avaltable and the apPrawal of thb Private ':water supply shall become null arb void when a public water Supply beeomw wailabM., such :' (iti?a
subject to modification` or change whim, in'the Judgment of the Comml. O H such revocation., modification or change
3/89 ate �� 1�S/ ey°� Tlel.
PUTNAM COUNTY DEPARTMENT OF HEALTH
q Division of ElivlronmwtalHaft Services, Caimel, N.Y .- 10513
Pt
Falglooer Mast ovhie
P.r r
P:C.H.D. P"ft
-.
tCATE OF CONSTRUCTION CONIPLiANCE FOR SEWAGE DISPOSAL SYSTEM
,,. > ,•
; Tows or Village, .
'
Tax Map
Blots L,ott�
_ Forme Subdivision Name
Owner /applicant Name : 1 . rte • �y
,L
�V. t 6 i t . k?' - Z.
I
r Cli 4. I zo!g- Subdv. Lot #
his, Him.
Fee Enclo,ssed _Amount:_ 2, C702 Date Permit
Issued'
Separate Sewerage System built by i sm I•ii� Add�r^e7 a 42
Consfeting of - 12 �_ creed Sep& Teak aed._
Water S"Olys :- Publfc Supply From Addiese
.q-
- on . Private Supply Drilled by 1 O'A•58 • S Addeees 111 �p i
i—
Building Tn. Lot Siz.e. e.2. ! t& S�. , Has' Erosion Crintrnl Ropy Cnmpl
etpA 9 �1
Number of Bedrooms His Garbage Grinder Been Installed!
j 3j -r�cS j, tax
Other Reyairementa ,sr.',
serving he
_
d
I certify that the systan(s) as.listed the above premises were construgted essentially as s
accordance with standards, fi
ens the compl v��sk opies
by the
of which are attached), and in the rules and regulations, ce
- .plan, the pG&it & p
Putnam Coon De /tenant Of Health.
.. _
Oats 1— Certified by
Atldress Ibc r-_re_� r
Limp No
Any parson occupying premises served by the above system(:) shall promptly take such action as may be necessary to Secure the co►►ad10 of aay"-)u n y
conditions resulting from such usage. Approval of the tepewte aswgaga'system. shall become null and wokl as aDOri as' • pWS,: tartly Busier'
avaltable and the apPrawal of thb Private ':water supply shall become null arb void when a public water Supply beeomw wailabM., such :' (iti?a
subject to modification` or change whim, in'the Judgment of the Comml. O H such revocation., modification or change
3/89 ate �� 1�S/ ey°� Tlel.
V
iV
o
!7.
wzljL COMPLETION REPORT 0
0
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTP NAM COUNTY DEPARTMENT OF HEALTH
NAM
..Office Use only
WELL LOCATION
STREET AOURESS: TOwNIVILLACLICIR TAX GA 0 UAASEiL
;Axx&0Vj or
WELL OWNER
*ME: A001116S.
A vA P_ Ucr,% ' - . - 1. 1, .
0 P8 IVATE
0 PUBLIC
USE OF WELL',--J-5-RESIDENTIAL
nmar
2 - secondary -,-'_.,�'�,
0 PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP 0 ABANDONED
:O BUSINESS 0 FARM ❑ TEST /OBSERVATION 0 OTHE R s pecify)
'O INDUSTRIAL 0 INSTITUTIONAL 0 STAND -BY
❑
MOUNT OF USE
;YIELD SOUGHT. gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE
.REASON, R-4
F O
GRILLING
'-.[]REPLACE EXISTING SUPPLY [TEST /OBSERVATION E ADDIT . .
EW SUPPLY (NEW DWELLING) [DEEPEN E XISTING
WELL
DEPTH DATA
wEi DEPTH 196_5� ft.
STATIC WATER LEVEL ft.
4
DATE MEASURED
DRILLING 4
'EOUIPMENT,,-;
-0 ROTARY XOMPRESSED AIR PERCUSSION 0 DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE,.,
0 SCREENED 0 OPEN END CASING _-4
49-JOPEN HOLE IN BEDROCK ❑ OTHER"
CASING
DETAILS
TOTAL LENGTH L
_11—k
MATERIALS: TEEL- OPLASTIC 0 OTHER
LENGTH BELOW GRADE 0 ft.
JOINTS: 0 WELDED 'WHREADED 0 OTHER
DIAMETER —in.--
SEAL:'&.CEMENT GROUT 0 BENTONITE 0 OTHER
WEIGHT
PER FOOT Ib./ft.
DRIVE SHOE'SYES ❑ NO -LINER: 0 YES ONO
SCREEN
DIAMETER (in)
'SLOT SIZE
LENGTH (it)
DEPTH TO SCREEN (it)
DEVELOPED?
:
BE TAILS
"' ST
0 YES , ONO
HOURS
SECOND
GRAVEL 1.PACK '.�
0 YES
0 NO
GRAVEL
SIZE:
DIAMETER
OF PACK In.
I
TOP
OEM ttM
—.
Lr
BOTTO M
I OE
WELL YIELD TEST pumping
If detailed
METHOD: ' 0 PUMPED'. tests were done is in-
I&COMPRESSED AIR,:. lormation attached?
0 BAILED OTHER 10 YES U NO
It more detailed formation descriptions or Sieve analyses
VELI LOG are available, please attach.
DEPTH FROM
SURFACE.
Water
ing
Well
m
peter
FORMATION DESCRIFTION',":.
coat
WELL DEPTH
It. -
DURATION
hr. min.
DRAWOOWN
YIELD
gpm.
Land
Sujace
W E
WATER "&CLEAR*,":, TEMP.
QA
UAT
U
QUALITV0 CLOUDY.: ` HARDNESS
0 COLORED'- ANALYZED? alUXES 0 NO
""ANALYSIS ATTACHED?*QJES ONO
STORAGE TANK: TYPEWe �_T(Lo ,
0
CAPACITY Vi't GAT,.
WELL ORILtER VAME OA3
0 iJ
ADORESS $1 TURE
1A 777
�l coo Ilk- NA 75"
PUMP
FqRMATION
P
TYPE 4APrs CAPACITY
MA X
MAKER DEPTH
:�7_7 GS to,",
Moo I
MODEL VOLTAGO-3-0 HP
Y.
YML ENVIRONMENTAL SERVICES
321 Kear Street
Yorktown Heights, N.Y. 10598
(914) 245-2800
Albert H. Padovani, Director
CLIENT #3 114
---------------------
NON STAT PROC PAGE 1
------------------
.JORLISH
DATE/TIME TAKEN: 08/02/94 13:30
'-14:30
BOX 27
DATE/TIME RECD ; 08/Q2/94
-'.ATTENTIONS DWAYNE TORLISH
REPORT DATE: 08/03/94
'xl `
PHONE: (914)-273-3448
4.SAMPLING S I TE A AM I CUCC I DEV. LOT 10
nr
PATTERSON
PRESER VATIVES: NONE
'"
L-04 ORLISH
CO D
TEMPERATURE. .
::*'
'-NOTES.
COL IFORM METH: -M
# 3 3.- 400
148
YML ENVIRONMENTAL SERVICES
321 Kear Street
Yorktown Heights, N.Y. 10598
(914) 245-2800
Albert H. Padovani, Director
CLIENT #3 114
---------------------
NON STAT PROC PAGE 1
------------------
.JORLISH
DATE/TIME TAKEN: 08/02/94 13:30
'-14:30
BOX 27
DATE/TIME RECD ; 08/Q2/94
-'.ATTENTIONS DWAYNE TORLISH
REPORT DATE: 08/03/94
ARMONKi: NY, 10504
PHONE: (914)-273-3448
4.SAMPLING S I TE A AM I CUCC I DEV. LOT 10
SAMPLE TYPE..:. POTABLE :
PATTERSON
PRESER VATIVES: NONE
'"
L-04 ORLISH
CO D
TEMPERATURE. .
::*'
'-NOTES.
COL IFORM METH: -M
...... r"'ro"""ed .... fwfw"""p4jWfWfWA prow pwo op 10%omppe pw
FLAG PROCEDURE
RESULT NORMAL 'RANGE .
MF T. COLIFORM
ABSENT /100 ML ABSENT,
SUBMIT
-- - - - - - - - - - - - -
H. Padovani, M.T.(ASCP)
PCTTN M COUNTY DEPAEMMC OF HEALTH
DIVISION OF M IMVIEW= HEALTH SERVICES
N
Owner or Purchaser of Building:- Section Block Lot
2
Building.Canstructed by
tJ
-Location.- Street Subdivision Name '
Municipality - subdivision LoE7 #
Building Type
GUARAYCHE OF SUBSURFACE SEWAGE DISPOSAL SYSTa 1
?.I represent that I am wholly and completely responsible for the location
,';= :`';::
worknans`1 --ap, 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 Eealth, and.::.,- .
hereby S:ar ntee 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
overate for a period of two years immediately following the date of approval of the
"Certificate of Construction Compliance" for the sewage disposal system, or any
repairs made by me, to such system, except where the failure to operate properly is
caused by the willful or negligent act of the occupant of the building utilizing
Lhe 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 Eealth 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 _-7— day of 19 Y4, Signature b .;.. .
Title Alv S. l:
' Contractor (Owner) – Signature
g A/0k "esrr�
Corporation Name (if Corti c
Corporation Name (if Corp.) �! 2 Coh
? P ess
.Address _ SCI G�i7 r �! %NiN 3 � N �/, /0 6 p r-' - , � •
rev. 9/65
mk
PUMAM COUMM DEPAnUM OF HEALTH
DhYw at einioswW Red& Saevkei. Casale N.Y. 111512 �reea to Pwvlda Pwtalt � `
I . I M CE UMATB.OF OOIYIMMics �r
3
jiq CONSiHQ( WN PERdQr loll Se AGR DISPOSAL STUM # p
r eaw ad M,btJy� �ORT7 �PT'CE of VEMP
StiitSvY�a Njij FAI ITV (1✓w K.&IOL cued_ W / 10 T�eMoswal�3 . noeh W 8
Owl /A��t Nape' i'�O. N�� f'�'l�i ,�► ��SL� le�s 0
Date of Prevbaa Approval
)lfaieS Af arms 47— CIO 1515 (.� . IBD TZU . Town V4411-6, PLC 1 DCVO
nary Subdivision Approved Fee Enclosed ❑ Amn„nt-
D++`s Typo S f T� ( T A PA t IM Area t o 2 1 o rii�,?CM Seale. oeb valme
Neater of aoieo�o 4- Delp Flow G PD o O� NoMaden la ltegdmd Whoa Fm M Claim tad
SSIM8ft S_WW Spoe11111 to soadat of 12!0 CARS. Saplk Tank -d 6:10 (f AR--9?KPTI OtJ TgZ r L- +
To bo,oeaa4nefad by .. D die✓ tr'CEe.l11[NE>7 Ad&ws
W�/er Stipp • IP I up Sop* Frees Addleaa
end; _Pelvate SW* DOW bye E DE'(, ` `dad laes —
Otbar RAREbM date VI-7 1 -IC.I L;PU I trJ'y 2M: /' 0 L"S.41-011256e vrrr+(_ ir.4wM
1 represent; that 1 arh wholly and completely responsible for the design and location of the proposed system(%). 1) that the separate sew di sal astern
above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a regu ions o ha
County Oepertment of MeaKh, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner Of HMKh Will
be submitted to the Department and 'a written guarantee will be furnished ter owner, his Oasews, heirs, signs by the builder, that sold bulkier will
gfece in mod. ooeratinq ndMon-..#ny port of said sewage disposal system du►irp tha of two (2) y s Immediately following the date of ter Iwu-
and of the app►olral oT ertifJcat _6of Comiftri+_ )? Compliance of the orgi l sY any repairs eto*. 2) that the drilled well described &flow
Will be located as n ter approved pl1'n and+th;t',faid well will be installed in r Kh the std Ma, rules and reliGGI ons of the Putrid
County rt o b f •X/
Date w f i h Signed P.E._ PA.
License No
APPROVED FOR CONSTAg: IONI T! H"ppiova) umpires two years from the date .'issued unless construction of the building has been undertaken and is
revocable for cause or may &44 d jgr)"Jllied when considered necessary by the Commissioner of Health. Any Change or alteration of Construction
IesiYiras MW perTit. A OVed :f i%poYW Of domestic sanitary wwa e a LOf rivate water Supply only.
0/88 a :. //Z �yr —� ' Title
I
I
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
APPLICATION TO CONSTRUCT A WATER WELL
PCHD PERMIT # P. 44+"%4
WELL LOCATION
Street Address Town/Village/City Tax Grid Number
Malloft- -F-2 T A,-cte-f_Qdr-J 3. - l - �g'
WELL OWNER
Name Mailing Address 'Private
4004 tm AV CC uSF 61-P WACT6 I &Av"CS O Public
USE OF WELL
1 - primary
2- secondary
ESIDENTIAL O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O ABANDONED
INUSINESS O FARM O TEST /OBSERVATION O OTHER (specify,
0 INDUSTRIAL M INSTITUTIONAL O STAND -BY O
AMOUNT OF USE
YIELD SOUGHT Ia gpm /# PEOPLE SERVED[ F M /EST. OF DAILY USAGE�U Sal
E3/REPLACE EXISTING SUPPLY E3 TEST/ OBSERVATION 12-ADDITIONAL SUPPLY
NEW SUPPLY NEW DWELLING 0 DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
WELL TYPE
DRILLED
DRIVEN DDUG GRAVEL 0 OTHER
IS WELL SITE SUBJECT TO FLOODING? YES _2�_NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No. j0
WATER WELL CONTRACTOR: Name "I-0 1F.6 `ZtM=K1 Kf90 Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO
NAME OF PUBLIC WATER SUPPLY: N Ak TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: T*A-r-J MtL:!
11 -7r
LOCATION SKET,CE� 6 SOURCES OF CONTAMINATION PROVIDED
ON SEPARATE SHEET
(d e) (s re)
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
thirt3, (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.
During all well drilling operations, the applicant shall take appropriate action to assure that
any and all water or waste products from such well drilling operations be contained on this
property and in suc3 a:batfner,as;_not ,tp degrade or otherwise contaminate surface or groundwater.
Date of Issue: 19_� � -1' -��
Date of Expiration t !:'r -' 19 _ Permit Issuing Official
Permit is Non - Transfer able!-y< „r' ,
White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
Ar-
PUTNAM GOUN Y DEPARTBMM OF HEALTH
n r to Provide Permit N
t• Dlvteton of Pwhonmental Hereltb ServlceB. Caemel N.Y:1051?
on CERTIFICATE OF COMP
Polito
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SUM
Locntedat Meos.Ua2 4'- Moo►JssY "'kilw lZoao own of 7.
Sabdlvlslon Names .a.jr_aVlMW MA2,FQ Suitd. Lot N . ►c Tate Map I Bloeh
Romwal_ O Revision ❑
Owner /Apomt Nance '1- cim S:Tr: .bs ociaTe
Date of Previous Approval
11441111111 Address F, o •F3ox IBS Town Zip IoS99'
Building Typo F'�5 t Pt: NC E .. Lot A[oa 102 S40 s, F. FM Sectloti Only Depth Volume .
Number of Bedrooms '4 Design Flow G P D RDO PCHD NotMeation Is Required When FID Is completed
Sopaesto Seiyemso System to oonsist,of I7-50 Galion Septle Tank ana' !0'10 L. F .�.SSoI�F"i'tonl - Tier3/JGI -1
To be constructed by Address
WsterSappip Public SapplY gym :
Address
or: ` PAvat;a Sratpply, Dr-Mod by. Address
Other R"alrements iaLxr L otj .
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, systism
above. described will be constructed as shown on the approved °amendment there to and in accordance with the standards, rules and regu a ions o e ? u nam
County Department .of' Meslth `:-and that on completion theroof a "Certificate ,.of Construction _Compliance^ •satisfactory to,the Commissioner of Healthwill
fro submitted to the.'Depsrtment and'a_ written guarantee will be furnished the owner, his successors, heirs or assigns.by,the builder, that said builder will
viace. in good " :ope rating- cond_itioD any ;part of.. said sewage. disposal system',during the period of'two (2) years lmmediately' following the data of the issu-
ante. of the aDPr�at o}' the t:erUfiate of Construction' Compliance of the original: system or.any repairs then ; 2) that the drilled, wall tlete►:t:ed iDOVe
Will be located as shown in the approved plan and that said well will be1iistalled in accordance -with standar rules and regu a sons of the Putnam .
County De rtmSs'InCt�(of_FMealth
Date 'Jl)jIVV5 Signed P.E. %� R.A.
"AtltlressFll� /�SSOG'l TE.S li... t_icense No ?_4606,5 -
APPROVED FOR CONSTRUCTION This approval expires.two year tfrom dat issued unless construction of the building has been undertaken and is
revocable for cause or may be•amended or modified when con i or d� c ry b t .COm is ' n f ealth. Any change or alteration of, construction
requires a ew p d. p ve - disposal•of domestic so wag a., J - ri only.
Rev. Title
1/87 pate-
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER — CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATION TO CONSTRUCT A WATER WELL
PCHD PERMIT #
WELL LOCATION
Street Address
M,o 02 9r Mo ,Je"r
14 1 w.. lnD .
Town/Village/City Tax
5- 1J
Grid Number
'WELL OWNER
Name
Mailing
Address
QPrivate
O Public
USE OF WELL
.'1 - .primary
2- secondary
RESIDENTIAL
0 BUSINESS
0 INDUSTRIAL
O PUBLIC SUPPLY O AIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION
O INSTITUTIONAL O STAND -BY
D ABANDONED
O OTHER (specify
O
AMOUNT OF USE
YIELD SOUGHTr jjj 5 gpm /#
PEOPLE SERVEDI r:A" /EST. OF DAILY USAGE Boa gal
` ~REASON FOR
`: DRILLING
ISNEW SUPPLY
OREPLACE EXISTING SUPPLY
OPROVIDE ADDITIONAL SUPPLY
ODEEPEN EXISTING WELL
OTEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
'WELL TYPE
DRILLED
DRIVEN
ODUG GRAVEL
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
"IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
�s�ttz�It��,J %/lsat.lot= Lot No. /p
WATER WELL CONTRACTOR: Name--7.;- Address:
-IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES '-g- NO
'NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
_DISTANCE TO PROPERTY FROM NE_ AREST WATER MAIN:
tit t t.
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED �� ��} car
c
[]ON REAR OF THIS APPLICATION
(date)
PERMIT
�7f7h S(1 >j'
TO CONSTRUCT A WATER L
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 s.hall:
1. Pump the well until the water is clear.
2. Disinfect the well in accordance with the requirem nts of the Putnam
County Health Department attached to this permit.
3. Submit a Well/Completion Report on a form provide by e P nam C u ty
Health Depar Ft.
Ite of Issue: 1
ermi Is u fficial
to of Expiration: 19
mit is Non -Trans erra le White copy: H.D. File
Yellow copy: Building Inspector
Pink Copy: OHmer
Orange copy: Well Driller
APPEIDLC B
PUITTPta Cr-Tj - DEP- ARITM.Er7r OF !MALTS - DIVISICN OF E�Ii MCNMJD SL MUTE
D-MIGIDUL W = SUPPLY & SUB_SZW C✓ S�T_Ci 'DI- :'DI SYSTFAS
CU- --me of C•Hnar )
REVIFTnl S= - CONSZ -=ICN P_TRMTT
(Street L =ticn )
C?'iIS
(YES NO I
I
I
I
i I I
I I I
i
I I I
f I I
f
I
i
L
rwu__e d
L 2
so == r-
100=.-
f
17 1 I I
I I
I
i I i
I I.
i
I
I
i
F � SYS
10 ft. I
I I
=; i? n Dtes I
r:. S'C
i I
dezt _ Vauces I
I
1�''0 vr. f oca el=V. I
I
I
MO; ft_ res if, etc.
i
I
I
!I
I
!I
I
=av!Fw_Iz
DATE RE`v- --;may
BY:
/ 6
Per-ut Application
Corxrate Resolution
Plans - Three s`ts S's
Encinee_rs Autthorizat'cn
Design Data Sheet (DCS) Su�DIvISIC�i
Deep Hole Lcc p: rc
C=^ --T s ant Perc Re=_; 1 _S (3) F ill --�
Ps---- Hole Depth c �—
House Plans - Two set_
. V Gr iaLc-_ Rte: ues t
�t -RAITI1
Le-cal _ Sa�'c_sisicn
Ssi:,-H-r sicn P -ccrcval C.e_ked
Fti- _corcva' SSDS
We_and (Tc-wil /DEC Pe=-_c R & D)
Da` Cn DCS Plans & P�-:__«it Ste__
REr,=,,M DL-,' TT C CIN PT.]`C
Se.�a,a Svs �-f*t Plah - (or =h _ cw )
Ss,;ac7e SyS S . taq HVC -raul i c Prof `_ _ - G_ _
F; I Profile & Dim n =sicn= - Vc__.__
D or J _P pi _ ce =r--
..antic T:nk - SiZe, Der =, 1
We_' 1 Detail, Service Li: e if cve_
Ccnst-u&_icn Notes (grinder rate)
Design Data: perc and deeo re�� _..
`rwo -Foot Contours Existing & P_:._gcsw
Drivevav & Sloces Cat
E^.otshg/Gatte*',C}:rta n Drains (discharge CK)
P°_rc & Deeo Holes Locates
Retire se- ntative of pr rLL:ri% and ex- ansicn
Dxmansicn A_re_-;shcwin; ravitJ f_C.v,s-uf =. ,size
If P.>mpe3 Pit & D Bcx Shcw-n & Det..`.iled
House - No. of Bedrooms
Wells & SSDS's Win 200 ft. cf r ocosed Svsts
Proge_* ty Metes & B- curds
House Set± ck Necessary (Tight lot)
House Serer - 1 /41'/ft. 4110; r` yTe pice
No Bends; Max. Bends 45° w /clean -c t
SEPD.�-_R=CN DIST! -ti= SPECTP= CN PT;N
Fi elan
10' to P.L., Drive,,sav, L_rg Trrses,TcD of f
20' to Founc?aticn Walls
1001 to Well; 200' in D.L.O.D, 150' Pits
100' to Strea=m, watercourse, Lake (inc. exp"
15' to Drains - Cirt?in, Leader, Footing
351to m-tch bas in, s tor: -idra i n, ci --)P—m" wate-rcc�.T!
10' to '&_ter Line (pits -20')
50' intal-I ittent dr =ira-ce ccur se
Septic Tanks
10' f,an Foundation; 50' to well
15' Well to PL °
PUIMH COUNTY . DEPAR MENT . CIF HEALTH
'
DIVISION
OF
FAMM SEWIC ES
DESIGN DATA SHEET-
SUB.SUFACE SEWAGE ' DISPOSAL SYSTEM'
F= W.
Owner �1DMESfTE T%`_.SOGi �-r�S
Address
L sated at (Street)_Ms.1o� fin.
1; HOOjEY 171, L:L, 't�osp Sec: 1 Block 1 Lot ,g
(indicate nearest
cross street)
:. Municipality
1�a�rzs�.�
-Watershed. C�7v�/ .
50II► PEROQLATICV TEST DATA
,RDQUIR
TO BE SUBKVr= WITH APPLICATICNS
Date of Pre- Sgaking 4.18 88
Date of Percolation Test 4 19 "88
HOLE
�.
NWBm CLOCK
TIME
PERCOLATION
PEFbCI?LATIGQJ , .
Run
Elapse
Depth
to Plater. From
Water Level
No.
'•Time
Ground Surface
In Indies Soil Rate
Star Stop
Start-Stop
Min..
'Start
Strip
Drop In Mi� Drop
Inches
Inches
Inches •
1 9 : ors - ► 0: 24
04
2 ►
29
-3 zg
Z Io:2A- �z.-zs
8"I.
ZI
2q
3 29
�2:Z5= 1 SS
90
21
29
3 3a
4 1 55 - 3: a.S
9O
z1
Z9
3 30
55'25 -4 =55
n►O
21
24
3 30
l
'
2 q'tS- to:5 -1
8`I
2z
�5'
3 29
3 to :s-1- 12:25
90
2z _
r
25
•
30
4 12' Zs - l' S5
9 -o
ZZ
25
3 30
5 1;55- z' Zs
4o
ZZ
2� r.
3, 30
2
4
5 '
i4OIES : ' 1. Tests to be repeated' at same depth until • approximately equal soil rates
are'obtained.at each percolation test hole. All data to'be.suimitted
• fnr rPView.
DESCRIPTION OF SOILS F XXXIMEW IN TES'P .BOLES
DEPTU HOLE -NO. HOLE NO. HOLE ND.
.•.
G. L.. • . . • . ..
3' . ' CL
4'
61
91 .
10'
12•'
13'
14'
INDICATE LEVEL AT WHICH GROUNDWATER IS ENOOUNZWM
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENDOLRUMM ', j
DEEP' HOLE OBSERVATIONS MADE ' BY : F DATE:
. DESIGN '
Soil Rate Used 'zi - -3o Min/I" Drop; S.D., Usable Area Provided S0000
No. of Bedroans Septic Tank .Capacity gals. Type ,ASO.reY
Absorption Area Provided By &-7o L.F. x 24" Miidth trench
Other !_71 sT�t +,UTi of f x
Name Signature
' Dt1TG rJ`L '
SEAL
Address.
s ;' • .`. jI
rJ-/,' /OS /Z ��'y No
�
THIS SPACE FOR USE BY HEALTH •DEPAfrII1ENT ONLY:
PUTNAM COUNTY DEPARTMENT OF HEALTH
•DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Re: Property of 1�pGV1 eSi i -P
Located at
iT �iJ... Sect
Subdivision of 1'b�RJi��I
Subdv. Lot # ID
Gentlemen:
Date 10, 1988
/�SSOC /G97 -e' �l C.
hl�tilo2 2oa.p
ion Block 1 Lot 19
N'1,oaJoR
Filed Map # Date
This letter is to ,authorize 40_5 /� / /y� SOfiG1T�°S �.
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 conformity with the provisions of Article 145 or
'147, Education Law,
tary Code.
Countersigne
P.E., R:A.,
Addres's
the Public Health Law, and the Putnam County Sani-
T'o.1-r27- S2 Csr tEt _ . ►-►Y
C�'1•g> ZZs -Soes
Telephone
Very truly.yours,
Signed
.Owner of Property
Address
7_1,o�e,veoo Z
Town t
Y 2fl E. ?a6.
Telephone
J
Putnam County. Department of Health
Division of Environmental Sanitation
AFFIDAVIT - CORPOMTE GINNER APPLICATION
FOR PERMIT APPLICATION SUBMITTED TO
PUTNAM COUNTY 11DILTH DEPARTMtNT
TO:.Commissioner of Health - In the matter of application for
—� G� — — — — — — — —_— 7.. 'represent
— — — — — — — — — — — — — — '
that I am an officer or employee of the..corporation and am authorized
to act for — — l v� rs! T- P ASoc %u�1`�S:�ic��.
(name of corporation) _
having offices at — i0 — ieo,( ..JAQ�'K_u,,Q�,(
Whose officers are
President — �F�ti/ e_� —
—
1
(Dame and— ddress) — — — .
Vic ent A-1110, to c..4 e -� 3 N /3_,eleuwl CWuC i�ye ,(?:con f
(i amte and address) -- — _ — — —
Secretary — — — — — — — — — _
(Name and A— ddress) — — — — —
Treasurer _ _ _ _ _
(Name and Address) — — —
and that I..am and will,be individually responsible for any or.all acts
of the corporation with respect to the approval requested and all
sequent acts relating thereto.
Sworn•. to 4efore me this � � day ' ' ' '' Signed
of- i' 1900 Title
Nbtai- Publdc '
KELLY H. WILSON
NOTARY PUBLIC, NEW4YORK STATE
No. QUALIFIED
COMM
COMMISSION IRESS7 21199
Corporate Seal
m
• cashin associates, p.c.
design professionals
route 52
Carmel, new york 10512
(914) 225 -8088
TO oz Osis-Lav-t -
,-j In o iz�ouiE to <!:: Z n-nEP l3 .
LETTER OF TRANSMITTAL
DATE
JOB. No.
ATTENTION
RE:
1100�
MR.
WE ARE SENDING YOU XAttached ❑ Under separate cover via the following items:
• Shop drawings ❑ Prints Plans ❑ Samples ❑ Specifications
• Copy of letter ❑ Change order X Eam-
THESE ARE TRANSMITTED as checked below:
❑ For approval
❑ For your use
As requested
• For review and comment
• FOR BIDS DUE
REMARKS
COPY TO:
• Approved as submitted
• Approved as noted
• Returned for corrections
• Resubmit
copies for approval
• Submit
DESCRIPTION
1100�
MR.
F_,_
THESE ARE TRANSMITTED as checked below:
❑ For approval
❑ For your use
As requested
• For review and comment
• FOR BIDS DUE
REMARKS
COPY TO:
• Approved as submitted
• Approved as noted
• Returned for corrections
• Resubmit
copies for approval
• Submit
copies for distribution
• Return
corrected prints
19 ❑ PRINTS RETURNED AFTER LOAN TO US
SIGNED:.
If enclosures are not as noted, kindly notify us at once.
Lot II
Lot 'I
PLAO -
SCALE- 1' °509
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45
AS-�UILt 11�A5�REh1ENf5
ten was
ed over,
dard,
of
A4K,
REVISIONS
FES, P.c. No.
--- PLANNERS
NEW YORK
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