Loading...
HomeMy WebLinkAbout0017DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 1 -1 -17 BOX 1 00017 6� CO.. I a,at * 'fr WLLL 1,V1"1ri1n11UN rkzrval DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only STREET AoURESS: WNIVI T I Y TAx GRID NUMBER: /Vo. ,�, ✓r� WELL LOCATION WELL OWNER NA : ADDRESS: ,C_ /' v r4,,,� t� 1105, PRIVATE PUBLIC USE OF WELL 1 - primary 2 - secondary `&RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR/ OND. /HEAT PUMP ❑ A NOONED O BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING `p NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH � ft. STATIC WATER LEVEL 'e'." ftj DATE MEASURED I DRILLING EQUIPMENT ❑ ROTARY COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT O CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED • ❑ OPEN END CASING. OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH tL MATERIALS: '%STEEL O PLASTIC ❑ OTHER CASING DETAILS LENGTH.BELOW GRADE ft. JOINTS_ ❑ WELDED .THREADED O OTHER DIAMETER 16 in. SEAL: O CEMENT GROUT ❑ BENTONITE`9OTHER WEIGHT PER FOOT lb./ft. DRIVE SHOE O YES _S NO LINER: O YES O NO SCREEN DETAILS . DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (It) DEVELOPED? FIRST 0 YES ❑ NO HOURS SECOND GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. TOP OEM tt. BOTTOM DEPTH ft. WELL YIELD TEST + It detailed pumping METHOD: O PUMPED i tests were done is in- SfikCOMPRESSED AIR , formation attached? 0 BAILED ❑ OTHER ; ❑ YES ❑ NO It more detailed formation descriptions or sieve analyses IPI�LL LOG are available, please attach. DEPTH FROM. SURFACE Water Bear. ing Well Oia- meter FORMATION DESCRIPTION COOE. ft. I ft. WELL DEPTH It. DURATION hr. min. DRAWOOWN ft, YIELD gym. Land Surface CmA WATER 16L.CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ❑ NO ANALYSIS ATTACHED? `DYES ❑ NO STORAGE TANK: TYPE LW77ro �• , I CAPACITY L ' J— 5 GAL. `F PUMP IHF RMATION s, TYPE a) � CAPACITY MAKER t;' DEPTH MODEL � YOLTAGtG_1H(' - �1L WEL CHI EA�n ME -Afi /fit /"1" J� 5► i1fTURE Yorktown Medical Laboratory, Inc.. 321 Kear Street Yorktown Heights, N. Y. 10598 (914) 245 -3203 Director: Albert H. Padovani M. T. (ASCP) F TORLISH WELL DRILLING P0, Box 271 Armonk, NY 10504 L J LABORATORY REPORT ON THE QUALITY OF WATER INORGANIC NON- METALS (mg /L) Acidity Alkalinity Chloride Detergents, MBAS Hardness, Total _ Nitrogen, Ammonia Nitrogen, ,citrate Phosphate, Total _ Sulfate _ Sulfide Sulfite METALS (mg /L) Coone'r Iron _ _Lead Manganese Mercury Sodium Zinc 32. 014785 LAB j/ Date Taken.:" =,2;% Time: Date Rc' d : �'�'p Time Date Reported: � 1868 Collected By: Duane Toi•lish Referred By: Sample Location: '7/W' A2 Phone # 273 -3448 Phone # — I Sample Type: Repeat Test? (check one) MICROBIOLOGICAL (CFU /100mL) GENERAL BACTERIA _ ✓Standard Plate Count_ (CFU /1.0mL) MEMBRANE FILTRATION TECHNIQUE ✓ Total.Coliform L� Fecal Coliform Fecal Streptococcus MOST PROBABLE, NUMBER TECHNIQUE Total Coliform Index Fecal Coliform Index KEY FOR TERMINOLOGY N/A = Not Applicable MISCELLANEOUS LT = Less Than ( <) GT = Greater Than (>) pH (units) TNTC= Too Numerous To Count Color (units) CON = Confluent ( =TNTC) _ Odor (TON) NR = Non - reactive Turbidity (NTU) REMARKS /COMMENTS (For Lab Use) Potable _ icon - potable _ STP INF STP EFF Other: Sample Status: (check each) _Out Roinz — HNO3 _ HC1 H2SO4 _ NaOH _ ZnOAc Na2S203 Other: Incoming t�LE h °C _ GT 4 °C _ pH LE 2 pH GE 9 _ DH GE 12 Other: THESE RESULTS INDICATE THAT THE WATER - SAMPLE WA5 (WASN'T) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO TH YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTIQ•NOENKING THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DIDN'T) MEET THE SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STA WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. L�'ls /�-� �x/ c �t�G��,_,2��' � � 2 /86(Rvsd7 /87.)RWE Albert H. Padovani, M.T. (ASCP), Director / PUTNAM COUNTY DEPARTMENT OF HEALTH 5 I� )� Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer to Provide Permit If on CERTIFICATE OF CO LIAN CONSTRUCTI011imlT, FOR SEWAGE DISPOSAL SYSTEM Permit # PATTERSON �. Located at Mooney Hill Road Town or Village Subdivision Name Fairview Manor Subd. Lot N 18 Tax Map 1 Block 1 Lot 19 Owner /Applicant Name Amicucci Development Renewal_❑ Revision ❑ Date of Previous Approval Melling Address 10 Rockhagen Road Town Thornwood, NY Z(p 10594 Building Type A Single family Lot Area 1.837 ac FW Section Only Depth - Volume Number of Bedrooms 4 Design Flow G P D 800 PCHD Notification is Required When Fill is completed Separate Sewerage System to consist of 1250 Gallon Septic Tank an, 44,-• LF of .24" trench To be constructed by to be determined Address Water Supply; PdbOc Supply From Address or: X Private Supply Drilled by to be determine ddrees, Other Requirements 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 a pproveda mend ment 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 thedate 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 regu a ,Z'�I ono of the Putnam County /irt�f Health. 'Vr`' Date / � /y/ Signed _-t" 1t /A/i%_��✓ P.E. _ R.A. T' D-II A —, Q f-"_-14_ _ P C R 22 D APPROVED FOR C STRUC710N: Tnis approval expires two Years revocable for cause O may be a e ed or modified when consitlered r Rev. requires a new �ppr ve f disposal of domestic sanitary 1/87 Date By ev' 31 6 CERTIFIC located at Owner /applicant MaWn Address rewster License No ,e date ' ued un is construction of the building has been undertaken and is ry by a Com s' r of H ny change or alteration of construction age or pr;vat a s pl o ly Title PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Must Provide P.C.H.D. Permit k -- OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM ��n y� p Town or Village Q I Y1 w S s, 4� ' f / � I cL n c r t? xl .-_ J �/ 11 ac!aQ I u.1 �'D)aa Map C Block Lot I �.e 1-4 o „z S , ?-e As Sn f . Formeriv Subdivision Name "sO r Subdv. Lot # P. it , c3v , 2".S S- os- +f Date Permit Issued Separate Sewerage System built by 14e i't J z Address LEc 2C fU Consisting of / Z 5—c> Gallon Septic Tank and r— L' � Z (`� S 6 Water Supply: Public Supply From Address or: X Private Supply Drilled by 7 c , / r S dt Address r /'j t 0_1 di A/ Building Type S f n 2 e z 1`1 � � Has Erosion Control Been Completed? � OF NE Y Number of Bedrooms Has Garbage Grinder Been Inptadl�'d��tt''��yy° °]]e �. `ti... \,a7Lu f GJ YC��1 EAR Other Requirements /, - I certify that the system(s) as listed serving the above premises were t:oo ,tavi5b d� gsaAht� �•ly'<% 'thown on t e plan &q ; fhe compl ted rk ( copies of which are attached), and in accordance with the standards, rules and= zvegulations, in accord the;f1 ad .she pe it sued by the Putnam County epartment of Health. ;^..•„( -” •, Date Certified Dy` ~ry7 �° y P.E� R.A. -17V z Address ;y J� J LhAn�e N , w ,,7' G_ Any person occupying premises served by the above system(s) shall promptly Aaka such att(tia'•�sihey �e`necesury ttf�sy(5urs tha.. tl any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shill' eedms null4nd void as soon iiu-js� �� ry sower becomes available and the approval of the private water supply shall become null and vofd,,whenC$ pubi 4r,"ter supply beco`fnasi,,pva . Such approvals are subject to modification or change when, in the judgment of the Commissioner oi'Miea revocation, m fiction or change Is necessary. 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 IS WELL SITE SUBJECT TO FLOODING? YES x NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Fairview Manor Lot No. 18 WATER WELL CONTRACTOR: Name (to be determined) Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: Over 1,000' LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED O ON REAR OF THIS APPLICATION x110 °SEP EET (see SSDS plan) 5/5/87 (date) (signature) PERMIT . TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant s.hall: 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 p vid by t o Pu n o Ly_ Health Departm nt. Date of Issue: 19 l I'M I s l Date of Expiration: 19 rmit s u i g f cia White copy: H. D. File Permit is Non - Transferrable Yellow copy: Building Inspector Pink Copy: Owner 287 Orange copy: Well Driller Street Address Town/Village/City Tax Grid Number Mooney Hill Road Patterson 1 -1 -19 WELL OWNER Name Mailing Address OPrivate Amicucci Develop., 1(J Rockhagen Road, Thornwood,NY105&-Public USE OF WELL 1 - primary 2 - secondary ® RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED (3 BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify ® I.NDUSTRIAL 0 INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT 5+ gpm /# PEOPLE SERVED 4 -5 /EST. OF DAILY USAGE 800 gal REASON FOR 'DRILLING MNEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION OREPLACE EXISTING SUPPLY 0DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING NEW RESIDENCE WELL TYPE xODRILLED DRIVEN ODUG OGRAVEL OOTHER IS WELL SITE SUBJECT TO FLOODING? YES x NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Fairview Manor Lot No. 18 WATER WELL CONTRACTOR: Name (to be determined) Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: Over 1,000' LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED O ON REAR OF THIS APPLICATION x110 °SEP EET (see SSDS plan) 5/5/87 (date) (signature) PERMIT . TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant s.hall: 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 p vid by t o Pu n o Ly_ Health Departm nt. Date of Issue: 19 l I'M I s l Date of Expiration: 19 rmit s u i g f cia White copy: H. D. File Permit is Non - Transferrable Yellow copy: Building Inspector Pink Copy: Owner 287 Orange copy: Well Driller APPENDIX M POTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ;n AFFIDAVIT- CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTN M COUNTY HEALTR,DEPARMM 5M TO: Commissioner of Realth M In the matter of application for:= r¢i�?d�,sif- I/fjt/��' Sv/S�, v�s� c✓ I, Aom l e" I I . -tm, cA4 Cel represent that I am an officer or employee of the corporation and am authorized to act for Qeve ton; (Name of Corpora etc"- CURc'I having off ices at 10 (?o oei- m,6 env ;2 -. Th e ✓elu w ao a ltk t-7 /05771/ Whose officers are: President: l'oexrmg eNAJ A O IZAJ; UZ70 mil, 11! (Name and address) Vice - President: (Name and address) Secretary: - (Name and address Treasurer: 1326o/e, k/-" tl (Name and address) and that I am and will be, individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Sworn to before me this /��' %day Signed: , of l9 (/, Title: S . K, T71 BETTY L. ESPOSITO Notary Public, State of New York No. 4125303 Qualified in Putnam County Commission Expiras April 30, 19., 20 Fairview Manor tsLates • TEST' PIT DATA IIEgUIRED 'I10 13—V SUP1 M!77ED 1dITH APPLICATION DES- GIIII "1' T 011 OF' SOIL; E1000PTERM I11 TEST 11011',3 DE17I1 11012 IIO: 182 HOLE 110. 17? sandy 1nam _]nam ,6u• 1211 loll J 3!' 11 � 40211 3.5' to rock 413" 51111 6u 11 6611 7211 78" U�1t1 7' to rock 110LP, I40. 192 I1IDICA'1'E I.I VEL AT 1.1111011 GROUND WATER IS ENCOUNTERED IIIDICATE LEVEL TO W1iiC11 WATER LEVEL RISES AF!'ER BEING ENCOUNTERED TESTS MWE DY Date DESIUN Soil Rate Used b1livi Drop: S. D. Usable Area Provided 11o. of Bedrooms . Septio Tank Capacity Gals. 'Type Absorption Area rov dec By ' L.F.x2411 b width rreench. Other Tame Signature Address SEAL THIS SPACE FOR USE BY 11CAI.,'1'11 DEPAIi'1'ME -14T ONLY: Soil flaLe Approved Sq. Ft /Cal. Checkod by Date CF nE Baldwin & Cornelius, P.C�>L Wyo 0wne,r �,�ip ''r.Vte Assoc., Inc. RD 6 Route 22 `�P '.'� l ��r•P 134, o Loca �on•�TF�1 ign�ry" =J1ill Rd. Patterson .Brewster, NY 10509 L ,o C (1�-- F' cp; �1L C-)= fe 6.5' to GW 7' fn rnr'k •t I1IDICA'1'E I.I VEL AT 1.1111011 GROUND WATER IS ENCOUNTERED IIIDICATE LEVEL TO W1iiC11 WATER LEVEL RISES AF!'ER BEING ENCOUNTERED TESTS MWE DY Date DESIUN Soil Rate Used b1livi Drop: S. D. Usable Area Provided 11o. of Bedrooms . Septio Tank Capacity Gals. 'Type Absorption Area rov dec By ' L.F.x2411 b width rreench. Other Tame Signature Address SEAL THIS SPACE FOR USE BY 11CAI.,'1'11 DEPAIi'1'ME -14T ONLY: Soil flaLe Approved Sq. Ft /Cal. Checkod by Date CF nE Baldwin & Cornelius, P.C�>L Wyo 0wne,r �,�ip ''r.Vte Assoc., Inc. RD 6 Route 22 `�P '.'� l ��r•P 134, o Loca �on•�TF�1 ign�ry" =J1ill Rd. Patterson .Brewster, NY 10509 L ,o C (1�-- F' cp; �1L C-)= fe 6.5' to GW 7' fn rnr'k I1IDICA'1'E I.I VEL AT 1.1111011 GROUND WATER IS ENCOUNTERED IIIDICATE LEVEL TO W1iiC11 WATER LEVEL RISES AF!'ER BEING ENCOUNTERED TESTS MWE DY Date DESIUN Soil Rate Used b1livi Drop: S. D. Usable Area Provided 11o. of Bedrooms . Septio Tank Capacity Gals. 'Type Absorption Area rov dec By ' L.F.x2411 b width rreench. Other Tame Signature Address SEAL THIS SPACE FOR USE BY 11CAI.,'1'11 DEPAIi'1'ME -14T ONLY: Soil flaLe Approved Sq. Ft /Cal. Checkod by Date CF nE Baldwin & Cornelius, P.C�>L Wyo 0wne,r �,�ip ''r.Vte Assoc., Inc. RD 6 Route 22 `�P '.'� l ��r•P 134, o Loca �on•�TF�1 ign�ry" =J1ill Rd. Patterson .Brewster, NY 10509 L ,o C (1�-- F' cp; �1L C-)= fe 1'i111'VleVJ 1•1dIIUI L"JI.aLCJ PIT 11!1TA 1t1"QUIREI) '1'U L'► h:J.TH APPLIGATiUll : lll✓��C11II "1'iU11 OF' SOIL:; IN TE."T HOLE"," DEPTH ROLE 140. 163 . J10iE, HO. 17 1 ' . IIGL.r _, IdO. 181 G.L. sandy loam sandy loam sandy loam 1211 loll 21111 J 112" u 51111 —4.51 to- rock 60 " 66" 72" 6' to rock 7811 131111 7' to rock JUDICAT13, LEVEL AT 1111ICII GROUND WATER IS ENCOUNTERED 111UICATO, LEVEL TO WJLICII WA'T'ER LEVEL RISES AFTER BEING ENCOUNTERED TESTS I•lliDE BY Date Soil Rate Used blitV1 "Drop: S. D.. Usable Area Provided 11o. of Bedrooms Septic Taiik Capacity Gals. Type Absorption Ai.•ea—Trov dec By L.F.x24'l b"— width e :c :I Other ]tame Sigtiature Address '11113 SPACE FOR USE LAY Jll?A.L'1'J1 DEPARTMENT ONLY: Soil Bate Approved Sq. Ft /Cal. Baldwin & Corneli use, RD 6 Route 22 Brewster, NY 10509 SEAL Checkod by P . C %Ir�E c� n,E ty ro,Q 0+ �_o ,IJ Wte C, O IJ A/ OwnQ,f•1 �.- Home_4'a,e Assoc. , Inc. at egri: �"Mooriey-.` ll Rd. Patterson m - 1 •...n •.un•• •./4J.I. J.vuv VUU1111 U1110 11U1LU111U, UAIU,ILL;. Il. Y. 1U512 JAUIVII LILF111U1S •V1U1'0SnL WHIBI•I 11111A flu. Uurroi` _ naateaa LUCUIala ul;- (Utivut of Ueu. — bitiuk — Lut: jliiill�uGt�`Iie &iiini: ulwaa nE1:56V) CD .... Isj c` - Ihur1u1I1J1ILy JFE3S10� / Ilul;etal�ec� r- I;u1L IVIUULn'1'IUII '1'1;01' L"'ln IIE'aU11tLU '1'u UL t3UllII1Y'1' ' 111111 nl ILIt,'n'I'1yIIJ FARIVIEW MANOR Iluml�� „• t,'LvUI; '1'1tll; I'L4IUULA'1'IUII ItilyUTATIUll Ilut 'I'_lniv 11'run, U1,vwia• tlurfaue l.0 1-, 1:Irea Uv11 hobo IJLul'I; -Ul;vp Iall. Ubtirt; LAV 1 Ut't111 i11 Ittll. /Ill dt'ull Illollua Liu1len Lr�lrea 18A 1 139 - 200 .•21 21 24 3 7 2 202 - 223 21 2'1 24 3 7 232 - 2.5 3 . 21 2.1 2 4 '. ' 3' 7 18B I .139 - 201 22 2.1 24` 3 7.3 2 204 - 226 221 24 3 7.3 } 227 - 249 22 21 24' 3 7.3 I I • Z 3 - . ' Ur Hutt! r I j 'fmit” t;l, Im >t• p rated at- (11 um tleli'li uu1;11 nt� 11 11 it Lo ttt'U vUbu�.uoa u1: euuli ilei•vV1pb:�uu I;eu� livle. A au�u I;v l,v uu�lml�,�e� •tu►' rev ua. ' . Wpl;-h wouuuremeuLn to he made 11-via top v1' hule. of CD .... Isj c` - 4 37 JFE3S10� / • APPENDIX B PUTNAM COUNTY DEPAFa]MENr OF HEALTH - DIVISION OF ENVIRONMENMAL HEALTH SERVICES INDIVIDUAL Vv21TEI2 SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS n7vi EW SHEET - CONSTRUCTION PERMIT (Name of Owner) � v � DATE BY : (Street Location) C/. DOCUMENTS t (j Permit Application Corporate Resolution __ Plans - Three set�� Engineers Authorization Design Data Sheet (DDS) Deep Hole Log s/s Consistent Perc Results (3) Perc Hole Depth SUBDIVISION Perc Fill cd --- House P ans - Two sets Well permit; PWS letter Variance Request GENERAL Legal Subdivision Subdivision Approval Checked Etc- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flora 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 (grinder notes) Design Data: perc and deep results Two-Foot Contours Existing_& Proposed Driveway & Slopes cut Footing /Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If Pumped Pit & D Box Shown & Detailed House - No. of Bedroans Wells & SSDS's w /in 200 ft. of Proposed Systems Property Metes & Bounds . House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees,Top of fill 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-Curtain, Leader, Footing 351to catch basin,stormdrain,piped watercourse 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' fran Foundation; 50' to well 15' Well to PL I - -- Owner or Purchaser of Building ge5 /TP X75 "5ycit97-e5,_1N[ Building Constructed by MPIN'61� 124. Location - Street AJ7Tt250A_,/ Municipality Building Type Section Block Lot r Subdivision Name Subdv. Lot #f, 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 of the Putnam County Department of Health as to whether or not the fail- ure of the system to operate was caused by the willftA'-)oegligent act of the occupant of the building utilizing the syste / � Dated this day of 19 Signature Title t n HEKLA CONSTRUCTION INC. Excavation • Trucking • Equipment Hauling • Septic Systems Specialist Top Soil • Fill • Gravel • Black Top Bucksholiow Rd. RFD 9 Box 474 Mahopac, New York 10541 (914) 628.5738 THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES 0, 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 NO. 1 DATE JOSEPH MERRITT & CO /r w HIM .A -D 61' B -D 44' A=E:: 126' B -E S3'' .. C_f 77' B -F 59' C -G 83' B -G 64' C -H 89' B -H 69.5' C -I 95' B -I 74.5' A -K 138' B -K 97' A -J 115.5' B -J 73' C -L 92:5' B -L 84.5' '-"C -M 113' B -M 101' W 57' W -K 142' =D .W -J 112' C -E 71' REVISIONS If111!!�' f,,�r'�sr�iaaaffiffo =b�0 ° a n♦,o tt oiiffl, _th. 4pplicabloMi:nles ;anti Re, - ulations of the Piitriar1 Cbunt3�ii/kdk itii beep'4 iaent:, � & T!