Loading...
HomeMy WebLinkAbout0028DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 1 -1 -33 BOX 1 m =11 61 III i Ir r �` Ime I'm UL.. PUTNAM COUNTY DEPARTMENT OF HEALTH I `. Rev. 8� 86 Division of Environmental Health Camel, Services. Cael, N.Y.- 10512 Englneci to Provide Permit q on CERTIFICATE OF COMM CONSTRUCTION PERMIT FOR SEWAGE "DISPOSAL SYSTEM. Permit N. (T)Patt.arGnn Located at Route 292" Patterson, NY 12563 Town or Village bdvlsion Name. Ai at- -Sabd. Lot N 7 Ta: Map.; �` ,Block Lot S� Owner/Appucant Name Erna Neufeld Renewal_ ❑ Revision p Date of Previous Approval • Subd iV lsi on aPlj' S /1 C V87 Mawog Address RR 3, Box 191" Town Patterson Ztp 1256:3 . Building T y p e : R - i d n - i al Lot Area 2 - 6 ac - Fill Section Only I*': Depth 3 t Volume 600 C . . Number of Bedrooms" 3. Design Flow. G /P /D 600 PCHD Notification is Required When FIR Is'completed Separate Sewerage System to consist of Gallon Septic Tank,anA To be constructed by To be, determined Addreas ' Water Supply PdbUe Supply-Fro ' Address or: 1 Private Supply Drilled by . Hyatt and Son ddresa RR , 2, Box 171 'A, .Patterson;.. NY Other Requirements I represent that I am wholly and completety'responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed is.shown on.the approved amendment there to and in accordance with the standards, rules7an3 re gu a ions o e u nam County- Department of Health, :anti •tnaLon cornpletion thereof a- "Certificate of ;Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a'.written guarantee 'will be: furn'ithed the owner, his successors; hears o► assigrii 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 a' repairs. th reto; 2) that-the drilled well described above will be located as shown on the approved plan and that said well will be installed Ecordance with t stan ds, ► es,and regu aeons of the Putnam County Department of. Health... - - Date signed - �E�`_ _ p:E —* ., R.A.. — Address -: . :. Box I K _ License No 65884 APPROVED FOR CONSTRUCTION:' This approval expires one year from the date - issued untess construction of the building has been undertaken and is revocable for cause" or may be amended or modified when ,consitle ecessery by -the Commissioner of Health. Any change or alteration of construction requires nrfe�w rmit. A�psprovetl for dispOSal of tlomestic it sews /or private water supply only. Date 'F!qV - BY _ _ Title ■ DEPARTMENT OF HEALTH 3\ Division of Environmental Health Services TWO C NTY CENTER - CARMEL-, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL 4"" PCHD PERMIT # WELL LOCATION Street Address Town/Village/City Tax Grid Number Parcel No. 1 -1 -51.2 WELL OWNER Name Mailing Address Patterson, NY 12563 OPrivate OPublic USE OF WELL 1 - primary 2- secondary d RESIDENTIAL O BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT 9 gpm /# PEOPLE SERVED /EST. OF DAILY USAGE gal REASON FOR DRILLING 13NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY (:]TEST/OBSERVATION OREPLACE EXISTING SUPPLY 0DEEPEN EXISTING WELL DETAILED REASON. FOR DRILLING ence. 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: Lot No. WATER WELL CONTRACTOR: Name Alban- Nvat-t and Sons., Inc. Address:RR 3. Box 171A,Pattersc IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES * NO NAME OF PUBLIC WATER SUPPLY: NA TOWN /VIL /CITY NA DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: Over 5 miles LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED O ON REAR OF THIS APPLICATION ©ON WARATE SH A490 — (See Attached Sketch SK- ate (signatur 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 prov' by a utnam County Health Department. Date of Issue: �/b 19 Date of Expiration 19 `! Permit Issuing Official Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner % 2/87 Orange copy: Well Driller naa, z X86 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Mast Provide. P -26 -90 / P.C.H.D. Permit H ?, ?3 OF CONSTRUCTION, COMPLIANCE FOR SEW Located at RMte 292, Patterson, NY 12563 (T)Patterson . Town or Village Tax Map 1 Block I Lot 51.2 Owner /applicant Name Erna Neufeld Formerly Subdivision Name Amato • Subdv. Lot q l R R I Rnx 1Al' Patf-,Pr -Qm NV _. 19SAI ._ h /h /9n Mailing Address Date Permit Issued Separate Sewerage System built by MG ( onstn u-ti cm Address P = n- Box 490, Pattprspmy IN 12563 Consisting of 1250 Gallon Septic Tank and 515 LF Absorption Trenches Water Supply: Public Supply Flom Address or: l Private Supply Drilled by RTa tt (fir $cn. —, Address R _ R _ 3. Box 171 A, Patterson. ^ NY Building Type Residemti al Has Erosion Control Been Completed? Number of Bedrooms 3 Has Garbage Grinder Been Installed? NO Other Requirements I certify that the systems) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulati in accordance wivrthelfiled plan, and the permit issued by the Putnam County Department Of Health. Date <!n //�/%�,, ���9.19n Certified by —' +� — P.E._1i_R.A. �,, Address R:R. 3, Box 191, Patterson, NY 12563 U.S.. No. 65884 Any person occupying premises served by the above systems) shall promptly take such action as may be necessary to secure the Correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a pub!': unitary sewer becomes available and the approval of the private water supply shall become null void when a public water supply becomes available. Such approvals are subject to mo2fi change when, in the judgment of the Co m o er of H h such revocation, modification or change Is necc ssarry. Date By Title APAL i �sY PUI'NAM .CDUNI'Y DEPARTMENT OF HEALTH . DIVISION OF ENVIRONMENTAL HEALTH SERVICES Erna Neufeld owner or Purchaser of Building Owner Building Constructed by Route 292, Patterson, IqY 12563 Location - Street (T) Patterson Municipality Residential Building Type 1 1 51.2 Section Block Lot Amato Subdivision Name 1. Subdivision Lot L..a C `j GUARANME OF SUBSURFACE SEWAGE DISp(9SAL SYSTEM I represent that .I am wholly and completely responsible for thie"location, workmanship, material, construction. and drainage of .the sewage disposal system serving the above describers 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 inmeddiately 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 the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of,Environimntal 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 24 day of Sept 19 90 Signature - 1 ✓?' Title S tt Gal W, Bldg constr>>cted by awner General Contractor (Owner) - Signature RS(; construction Corporation Name of Corp.) Hampshire Center. Corporation Name of Corp.). 0. Box , Patterson, NY 12563 esS Address rev. 9/85 mk 4. j a WGLL liVa'ar Lf. t luau a�a:,r Va�r Office Use Only .t DEPARTMENT OF HEALTH Division Of Environmental Health Services ' O4 PUTNAM COUNTY DEPARTMENT OF HEALTH STREET AOORESS: TOWNIVILLAGAMIT TAX GRID NUMBErl: WELL LOCATION f . WELL OWNER NAME: A00RESS: Rft' 3� l' i /'�!..� PBIVATE ... d �r tea, �flcr�c� � . 0 PUBLIC USE OF WELL RESIDENTIAL .0 PUBLIC SUPPLY ❑ AIRICOND. /HEAT PUMP ❑ ABANDONED 1- primary ❑ BUSINESS . ❑ FARM ❑ TEST/OBSERVATION. Q OTHER (specify) 2 - secondary Q INDUSTRIAL. ❑ INSTITUTIONAL . Q STAND -BY ❑ MOUNT OF USE �rn YIELD SOUGHT .; gpm /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. EIR EW SPLY ❑PROVIDE ADDITREASON IONAL SUPPLY ❑ TEST /OBSERVATION DRILLING Q REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL . �ve:r- Fluz�r'hc. DEPTH DATA WELL DEPTH- ft.1 STATIC WATER LEVEV . ft. DATE MEASURED Ot DRILLING M] ROTARY. COMPRESSED AIR PERCUSSION ❑DUG EOUIPIYIENT 0 WELL POINT Q CABLE PERCUSSION O OTHER (specify): . WELL TYPE OPN ENCASING: Q SCREENEY, OPEN HOLE IN BEDROCK D OTHER TOTAL LEiVGTH / it MATERIALS: STEEL Q PLASTIC 'D OTHER CASING LENGTH BELOW GRADE ft JOINTS` ❑ WELDED THREADED 0 OTHER DETAILS DIAMETER —_, in.. SEAL: O CEMENT GROUT ❑ BENTONITE 60THER WEIGHT PER FOOT. — tb_ /ft_ ..DRIVE SHOE 'YES ❑ NO L1NER: Q YES_ NO SCREEN A ER (in) ; T S12E LENGTH (it} EPTHTO SCREEN (ft) DEVELOPOt FIRS YES ONO DETAILS SECON -- H URS GRAVEL PACK '. O YE.. GRAVEL DIAMETEe� :. TOP 8 TTOAt. O. NO StZEt OF PACK . in. DEPTH tL DEPTH tt. WELL YIELD Tot. If detailed :um in pumping 4 L LO more detaTep ormatron .descriptions o�sieve analyses are available lease attach METHOD 0 PUMPED t tests were done a rn 1e COMP RESSED AIR , formation attached Water �^? =1t Dia- Dia Ntq O. BAlLEtI QOTHER } OYES d : NQ 104 meter FORLIATION DESCRIPTION p0£ WELL DEPTH DURAT10114 DRAY10OWN YIELD . 5urtace I ,l• ' . n tf he: min. tf. 9C.,m- �0 V ..� WATER' CLEAR TEMP, rte, t, QUALITY O CLOUDY HARDNESS a O COLORED ANALYZED? O YES ONO � ANALYSIS ATTACHED? O YES ONO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE CAPACITY WELLgDRUER NAME •, "PATE �.� M. HYATT &SONS, INC. o�:� % MAKER DEPTH A �IRFsgRT Well Drilling SIGAI MRE MODEL VOLTAGE HP Rte. 311 R.R. 2 Box 171A 1' / %�� /"" "' /��i PATTERSO N, NEW YORK 12563 / CA MO LABC 367 VIOLETAVENUE POUF 'A SACTERIOLOGIC L E XAMIM i-4 tie No. ate CoWd-XV-?L�'. me % ob No MO_ Loy No_ Tests Requeste Agency c, -colm ame J Aciclress _t logo is, I V. T � vv n , Rd.) (C z Identification of su '..Simpiing oin SuoplV,,ChlorihatOdmihen-'sain0led' Yes 'EI 'No "7",E*1':4r'ee`t` RESULTS OF-ExAmINATION' QF WATER:; _Standard. � PN/lW ml. , i il, acti ,olif prm Group Tots J�q m G S Fedai Colifoern J --'These result! indicate sample bras was not) of satisfactory, sar -Was collected. Gate Report ed �D PUTNAM COUNTY DEPARTMENT OF HEALTH Engineer to Provide Perildt N \� r Division of Environmental Health Services. Carmel, N.Y10512 gin on CERTIFICATE OF CAMPLIANCE Permit : f CONS ON PERMIT FOR SEWAGE DISPOSAL SYSTEM Loma .t Route 292 Patterson, Ivy 12563 Subdivision Name AtilatO Subd. Lot # 1 Tax Map 1 Block 1 ' - - -Lot 51.2 Renewal_ ❑ Revision - p Owner /Applicant Name Erna 1 if e1 d Date of Previous Approval SL1bd1V1S1011 app. 9/10/87 1087 RR 3, Box 191 Patterson 12563 Mailing Address Town Zip Residential 2.6 ac. Building Type Lot Area Fill Section Only= Depth Volume Number of Bedrooms 3 Design Flow G P D 600 PCHD Notification is Required When Fill Is completed Separate Sewerage System to consist of 1000 Gallon Septic Tank and 515 LF Absorption Trenches To be cons"eted.by To ha d -ate '>:llin e d ,Addiees Water Supply: Public Supply From Address 1 Hyatt &. Sonsaa�e.. RR 3 , Box ,171 A, Patterson; I7Y or: Private Supply' DrWed by _ A Other Reouiremente I representthat.l.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 thereoCa "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) yOrs immediately following the date of the issu- ance of the approval of the Certificate 'of Construction Compliance of the origi I system or any repair hereto; 2) that the drilled well described above will be located as shown on the approved plan and that said, well will be installed ; ccordance with t - �Wjpdardys/ru,ies and regu a Mons of the Putnam County Department of Health. Date 9/4/90 Signed L'Vd'lI . _ P.E. * R.A. Address RR 3. Box 191., Patterson, NY 12563 - License No 65884 APPROVED FOR CONSTRUCTION: This approval expires two ye` r m the. date issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when comsicizied nel&ssary by the Co issioner of Health. Any change or alteration of construction requires a new /9ermit. Approved -for disposal of domestic � r n age, a tl/o r e water supply only. 1/87 Date / f /y� By Title t W ptT mm ODUN'I'Y DEPARM —U= OF HEALTH. DIVISION OF HEALTH SERVICES. DESIGN DATA MjEEr- SUBSM= S3gXM DISPOSAL SYSTEM, FILE, NO. Owner Erna Neufeld Address R.R. 3, Box 191.Patterson, NY 12563. Located at (Street) NYS Route 29.2 Sec. 1. Block 1 ' Tbt 57:2 (indica.te nearest cross street). Municipality (T) Patterson Watershed Croton SOIL PM MLATION .TEST .DATA REQUIRED TO EE SUB*ff3'I"rU WITH APPLICATIONS. Date of Pre- Sca_king 8/5/90,, Date of Percolation Test 8/5/90 PM HOLE Run 3:01 -3:24 Elapse Leptn to. rater .than rioter Level 3 No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop 21 3 8 Lnches Inches Inches, .. ; Nil 1 2.21 -2.33 12 24 21 3 4 2 2:36 -2:51 15 24 .21. 3 5... 3 _ 2:5371:07 14, 24 3 5 4 3:09-3:23 14 24 21., 3 5 5 Nf � 1 2 :3.9 73:00 21. 24. 21 3 7 2 3:01 -3:24 23 24 2.1 3 8 3 3:28 -3:51 23 24 21 3 8 4. 5 .JOTFS s 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. ter. 9/6 ' PIT DATA G.L. 1' 2' 3' 4' 5' 6' 7' 8' • m 1, M-.1 V HOLE NO. HOLE NO. 9' 10' u� 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ' ENCOUNTERED INDICATE .LEVEL M WHICH WATER LEVEL RISES AFTER. BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN 21 -30 11 S.D. Usable Area Provided Soil Rate Used Min/1 Drop: 5300 s:,, r P Capacity 1000 gals. . Type xCam-onc�-� No. of Bedroans 3 Septic Tank .Ca ci Absorption Area Provided By _ L.F. x 24" width trench. Other ^ - Name Fvan 7.Ps 1 i P P - P Signature Address R.R. 3, Box 191 $, W 2 Patterson, NY 12563 BOA 06sw 90 \ �N THIS SPACE MR USE BY HEALTH DEPARDIENP ONLY: Soil Rate Approved sq.ft/gal. Checked by Dater PUTNAM COMM E1• 'T ty OF DIVISION OF I• •' la Y• HFALTH SERVICES DESIGN DATA S=- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. . Owner Qo(c, 4,� ,G . Rh Address Pa. -60 y, .l✓. , ; 25- 31- ' NtP Located at (Street) R+ 29Z See z ( Block ! Lot �Ia (indicate nearest cross street) Municipality "tow^ 0-t ?eHevso- _ Watershed Cyc -ial.. SOIL PERCOLATION TEST DATA RDQUIRED TO BE SEMMr = WITH APPLICATIONS. Date of Pre- Soaking 12 b L �6 Date of Percolation Test HOLE - NUMHER CLOCK TIME PER012CION PERCOLATION Run Elapse= Depth to Water EYan Water Level- No. Time Ground Surface In Inches Soil Rate 1.0.� I Start-Stop Min. ': Start Stop Drop In Min /In Drop Inches Inches Inches 1 J'-ol - to•.07 24 2► 3 20 1 2 10:08 - 11111 (P'S 29 021 3 21 3 1112- 12:21 G5 24 Zl 3 23 4 5 zi t 1 3 Z•8 s� 2 Ia:S(,- IZ :24 ?14 3 12:25 -1-SS 10 24 z l 3 30 4 5 , NOTES: 1. Tests to be repeated' at same depth until apprOdmately 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. PUII�M OOUATI'Y DEPARTMFNr OF HEALTH DIVISION OF ERVIRUM71AL HEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. . Owner Oo(c,4 ., ,G : ncr,dg�s Address Po- 80X. Located at (Street) Rk 2 cyZ I Block ; t Lot 1 la (indicate nearest cross street) Municipality -Tower o4 ?a44e✓so�- Watershed Cvc -iutl. SOIL PERCOLATION TEST DATA RBOUIRED TO BE SUBrIInED WITH APPLICATIONS Date of Pre- Soaking 12 6 L 6 Date of Percolation Test r66 HOLE - NCHE'.R CLOCK TIME PERCOLATION PERCOLATION Run Elapse, Depth to Water Fran Water Level No. Time :- Ground Surface In Inches Soil Rate �o� ( Start-Stop Min. '_ Start Stop Drop In Min/In Drop Inches Inches Inches 1 �' 07 cv o? �•1 4 5 , 1 . 2 3 4 5 1. Tests to be repeated'at same depth until apprmirately equal soil rates are cbtained.at each percolation test hole. All data to' be submittbd for review.. 2. Depth veasuremehts to be made from top of hole. Z4 21 3 ?0 $I 2 (o�06 - (I'll l03 Z4 '21 3 2 3 11;12- 12:21 41 24 2t 2,3 4 5 1 °}�31- to �55 84 24 Z t 3 L8 sZ z 312:25 -I-*SS 10 24 ZI 3 30 4 5 , 1 . 2 3 4 5 1. Tests to be repeated'at same depth until apprmirately equal soil rates are cbtained.at each percolation test hole. All data to' be submittbd for review.. 2. Depth veasuremehts to be made from top of hole. PU11MM COUM DEPARTMENT OF DIVISION OF r • is v HEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. - Owner 0oro4. L Address Box i� �olt5 ., ✓. �, 2�� Nei? Located at (Street) V,. . Rk 29t fee: I Block , l tot ,V (indicate nearest cross street) Municipality -Tow ^ o� Watershed C o � SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking I 1 (b 6 Date of Percolation Test �Z HOLE NL1 BM CLiOCR TIME PERCOLATION . PERCOLATION Run Elapse= Depth to. Water Fran. Water Level Ho. Time Ground Surface In Inches Soil Rate �o.� i Start-Stop- Min. start Stop Drop In Min /In Drop Inches Inches Inches " .%t9 Z4 21 3 2.6 2 10; 08 - i l :11 l03 2q 2 i 3 21 3 1112- 12:Z1 45 Z4 2l 3 23 4 5 Z4 2 ( 3 Lg 2 10:542- lz: 21 3 (2:25-1 :SS g0 24 ZI 3 30 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated: at same depth until appradmately equal soil rates are obtained at each percolation test hole. All data to' be sutmittt!d for review.. 2. Depth measurements to be made from top of hole. L07"t j DEPTH G.L. �N 1' 2' TEST PIT DATA RDQUIRED TO BE SUEMITTED.WITH APPLICATION DESCRIPTION OF SOILS ENCOUN'T'ERED IN TEST HOLES HOLE NO. HOLE NO. 2- R` CEI VED H �r HE E�� rY A f. J 3' 2.5r v 4' Cc A`( LoAM 5'. - 6' 7' 8' ' - 9' 10' ' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENOOUN = '4 INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING EN:JOUNTERM jJ DEEP HOLE OBSERVATIONS MADE BY: ��v.r y li-� . fJ L�. IS Sy. P F. DATE: It 2-4 " POG - DESIGN Soil Rate Used 2 1' 3 O Min/1" Drop: S. D. Usable Area Provided S 3 D t 1Z No. of Bedrooms '� Septic Tank Capacity 12,50 gals. Type H �t Absorption Area Provided By L.F. x 24" width trench Other Name ktw/c�-1 Assoc. , 9-c- Signature Address ? 3 ��.�4 D✓� ye THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq. ft/gal. {a � r =Q r w SEAL • ci 1 u• Y� r sea No.5612d \OFESSIGNe'� Checked by Date Iz '-APP-711MIX B P-t':7 7k YIY CZE OF HEALTH - DIVISICN OF 2V_V=OkQnIF_NMaL HEALT91 SERV__'L_25 M 0OUN RkRRMI!_ INDIIWI✓',?_L PaT= SUPPLY & SUBSURFACE SF.&AGE DISIIP��_L SYST.EVIS REEVI=EN (%Ia.rne of C&fier_) SH=r - MNSTRUCTION PE-.',-V-,IT DST' REZTZl- 'By: Loc—ati0h) DOME,= Permit Application —Corporate Resolution Plans - Ziree sets S/S Engine-ers Authorization Design Data Sheet (DDS) SU=--_7�,- !SIGN L; Deep Role Log Perc Consistent Perc Resets (3) F L FL Perc Hole Depth cd House Plus Two sets Nell P,15 letter --VE:Hance Request G 4 k Legal Subdivision Subdivision Approval Checked EX-approval SSDS Adj. Lots Checked --tland (Tc,,-,n/DEC Permit R & D) Data On DDS Plans & Permit Sc-ure- REQUIRED DEIA =1 ON PLFLNIS Sewage System Plan - (north arrow) Sewage System hydraulic Profile - Gr=_4 ty Flcw Fill Profile & D-i--nsi--ns - Volt.--,n-a D or J Box; Trench/Gallery; ?LrV pit -Eet--a-ils Septic 'faink, - S-Lze, Detail Well Detail, Service Line if over Construction Notes (grinder rate) Design Bata: arc and deep results Two--Foot Cont-ours :-Icistina & PrqP­_==-7 Driveway & Slooes Cut FooL--inaJGatter,CLix-Lai-n Drains, (disch._=-�ze OK) Parc & Deep 'Holes L,----='Led Representative of pririrax-y and e_xpanzzion Expansion Ar-a; shown; gravity flow, s=, f. size if Pty Pit & D Box Shown & Detaild House - No. of Bedrocrs Wells & SSDSs w/in 200 ft. of Proposes sys'terLs Property Metes & Sounds Howse Sethack Necessary (Tight lot) Hcuse Sever - 1/4"/ft. 4"0; Tyke pier No Bends; Max. Bends 45' w/cle—anout- SERA RATION DISTAN-K—EES SPEC—IF IED ON PLJz�!, Fields 10' to P.L., Driv&,,�av, Large Trees,T--o of fill 20' to Folxi^ation Walls 100' to Well; 2001 in D.L.O.D, 150' pits 1001 to Streanz, WaterConrSe, Lake ex-zan) 13' to Drains-I-Durta-in, Taader, Foot-'ng L-0 _ h se 35"L ca-c tasin,s (Street =E J,-M ,14x-xz-. Zoaz�__t i ;;j Pre-1969 Nei r notification LF trench provided <'OD ;ecruired .5-&0 60 ft. max. to contours e_=. i I I FILL SYST•IS I clayba--rier 10 ft. fill notes I I new spec. i deoth Sauces 100 vr.- flood elev. 200 ft. reservoir, etc. Li 130 ft. tricall/c7all. 10' to Water Line (pits-20') 50' inte--ndttel'It drainace course S=:)tic Tanks 10' -From Fo,_:-ndat'ion; 50' to well jr, we to pr. / / ool • iii �� � —� / i �� ,�— ��� � � � / � /_� �.�/ / / / / / PAP• 1 � ,_ rSSVT I i I 1 . ONY��!'i - NE NCO x 6EN [! t..1. =\ _ PAW � � 1 Al 1 I I�I i l — JL-P -r e Inv. Vff PT -1 PT 2/ 1 Poi, 1 563.2q SFiZ.05 652.4E 66Z-- -10- I�