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Divisron of fnviroriinente! Hale /th Set fcea x Carme% 10512
CERTIFICATE :OF TRUCTION COMPLIANCE'_,FO,R - `.SEWAGE ,DISPOSAL :SYSTEM
y J.
Loeatetl- at'
Stagecoach &..Birch :Hi 11; Rds Tax Map 7
L�
Y
Hermit r T2 -�86"
afterson' .
Will `V)IUpe -
�l
p„np R T S. J &G Ga l a l d 6FO:me =lY tax Map rot a 8 subs r or- #
x. 4
Separate Sewerage System built by" Owners -Address 1] Leewood Circle Eastchester. NY
"`. consliin or 560' ` °x 24 " >w x 18" D Laterals
g 1 50O dal Septic Tank and
oiner "requlrerrients R 0 B `Fiecon 36" D`ee x:'549 Cu Y.ds 1Berm on West Slde 160`'
z(,• y x Deep Curtain
Water Supply Dublic Supply From
P F Beal• &Sons, Inc s
X D_rivate Supply Drilled !BY
P 0: Box. B, Brewster, NY,. 1050
Address l
Building type "r' FY ame Y No of Bedroom: Five Oate(: Permit Issued
As 'required
Has Erosion Contrdl Been Completed? i
3fcertify that the•sy�tem(s) as listed serving the above p emises' were constructed .essentially as eiiown o-n .tine plans: of the'oompleted work ;( copies;
of ahSch'.are attached), and in accordance with the`etanaarda rules and requlationa:ain accordance .with thesfiled plan and '•the ,permit issued by the
Putnam County Department Of Healthy
Oats 20 July 1988 h '
R A .h oq
t =�AD9 -Fair `St j :scar ANY 10512 29206
Address s s License No
Anyf person occupying pre mJses served by the above system s) shall tom tl take such fiction as may be,oeeessar ao sawr�.th� eorr etbn of any unsinitary '
( p P Y,� Y
contlitions; resulting from,•such usage Approval of_the"6a'te sewerage system ;shall' -become'null'and vold_at,soonat "•a Dubllc,sanitary ewer WcomDS a
svailable;4nd the; approval' of the ,private water supply shall become _null antl void when .a -public wata►:, supplyr becomes "avatlabti. Such approvals are .. j
- sutilect to,' m diffeatlon'or. change when ;in _the Judgment: of the Commissioner of MSalt h, such revocation, motlification or eAinye I� .n�eewiy:
Oats 2._
'Rev. 9-81
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Scott Galeida
Owner or Purchaser of Building
Owner
Building Constructed by
Birch Hill & Stagecoach Roads
Location — Street
T. Patterson
Municipality
Modular
Building Type
7 1 8
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
"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 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 o the building utilizing
the system.
Dated this 29 June 19 88
G6ieral 66ntractor (Owner) - Signature
Corporation Name (if Corp.)
Signature
Title
17 Leewood Circle, Eastchester, NY 10709
Address
rev. 9/85
mk
Corporation Name (if Corp.)
17 Leewood er, NY
KEFe--ss
Yorktown Medical Laboratory, Inc. LAB ___ --
321 Kear Street
Date Taken: 6/9/88
Time: 11_ ; ?0am
Yorktown Heights, N. Y. 10598
,
Date Rc' d : 6 8 : 'R • 95 m
(914) 245 -3203
Date Reported : '
9��me
Director: Albert H. PadovaniAf. T. (ASCP) Collected By: Turgati
Referred By:
T- JOHN PRENTISS P.E.
1 Sample Location:
Kitchen Tap
RD. #9, FAIR STREET
Galaida Sta e Coach Ed.
CARMEL, NY. 10512
Patterson, Y. 125b?
(T" � - l - -g
Phone N
Phone #.
I
Sample Type:
L
J Repeat Test? _
(check one)
LABORATORY REPORT ON T'r'E QUALITY OF WATER
X Potable
.Non- Dotable
INORGA`1TC NON- METALS (mq /L)
MICROBIOLOGICAL (CFU /100mL)
_
_ STP I'iF
STP EFF
_ Acidity
GENERAL BACTERIA
_
Other:
Alkalinity
—.
—
— Chloride
i
Standard Plate Count,
_ Detergents, MBAS
(CFU /-1.OmL)
Sample Status:
— Hardness, Total
(check each)
— Nitrogen, Ammonia,
MEMBRANE FILTRATION TECHNIQUE
Nitrogen, Nitrate
Outcroin
_ Phosphate, Total
;.Total Coliform
— Sulfate
— HIN 03
— Sulfide
Fecal.Coliform
HC1
— Sulfite
_
_
_ H2SO4
Fecal Streptococcus
NaOH
METALS Img /L)
_
_
Zr.OAc
MOST PROBABLE. NUMBER TECHNIQUE
?a2S203
— Cooper
_
Other:
— Iron
Total Coliform Index
_
_ Lead
-
- Manganese
Fecal Coliform Index '
Incominc
— .Mercury
_
�
Sodium
KEY FOR TERMINOLOGY
X .LE 4 0C
— Zinc-
i
GT 4 °C
N/A = Not Applicable
pH LE 2
MISCELLANEOUS
LT = Less Than ( <)
_
pH GE 9
GT = Greater Than (>) I
—
pH GE 12
— pH (units)
TNTC= Too Numerous To Count
_
Other:
Color (units)
CON = Confluent ( =TNTC)
_
— Odor (TON)
NR = Non - reactive
_ Turbidity (NTU)
REMARKS/COMMENTS (For Lab Use)
THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS) I (WASN'T) (N /A) OF A
SATISFACTORY SANITARY QUALITY ACCORDING TO T NE YORK STATE DRINKING WATER.
STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIRE- OF COLLECTIOri
THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DIDN'T) ODR�
EET THE
SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STAT ING WAT ER
CODES, FOR THE PARAMET TESTED, AT THE TIME OF COLLECTION.
2 /86(Rvsd7 /87)RWE
Albert* H. i, M. . (ASCP), Director
0 --1—
ZW
WILL UUrirLZ11U1V AZrUAl
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Onl
WELL LOCATION
STREET ADDRESS: TOWNIVI'LOGI/ClIr W'GRIO NUMBER:
Stagecoach Rd., T.Patterson,NY ig
WELL OWNER
NAME: 'ADDRESS: Scott Gal I aida
RSG Con'st.Co.,PQ 'Rox ]2-,R, White Plain S
❑ - PRIVATE
O. PUBLIC
USE OF WELL
1 - primary
2 - secondary
U RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR/COND.IHEAT PUMP 0 ABANDONED
0 BUSINESS 0 FARM 0 TEST/OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND =BY
AMOUNT OF USE
YIELD SOUGHT gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
9 NEW SUPPLY 0 P ROVI DE. ADDITIONAL SUPPLY ❑ TEST/OBSERVATION
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH 120 _ft,
STATIC WATER LEVEL 0*-f- ft.
DATE MEASURED 11/7/86
DRILLING
EQUIPMENT
IN ROTARY 9 COMPRESSED AIR PERCUSSION ❑ DUG.
0 WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN. END CASING. ES OPEN HOLE IN BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL LENGTH 2- tL
MATERIALS: F&I STEEL ❑PLASTIG O-OTHER
LENGTH.BELOW GRADE 20 ft.
JOINTS: ❑ WELDED ID THREADED 0 OTHER
DIAMETER 6 in.
SEAL: 99 CEMENT GROUT 0 BENTONITE 0 OTHER
WEIGHT
PER FOOT 19 1b./ft.
DRIVE SHOE: 191 YES O'No
LINER: OYES ONO
SCREEN
DETAILS
DIAMETER (in)
'SLOT SIZE
LENGTH
(ft)
DEPTH TO SCREEN, (ft)
DEVELOPED?
FIRST
OYES ONO
HOURS
SECOND
GRAVEL PACK
❑ YES
❑ NO
GRAVEL
SIZE,
DIAMETER
OF PACK in.
TOP.
OEM ft.
BOTTOM
DEPTH — It.
WELL YIELD TEST It If detailed pumping
,METHOD: 0 PUMPED i tests were done is in-
0 COMPRESSED AIR formation attached?
0 BAILED ❑ OTHER ❑ YES 0 NO
If more detailed formation descriptions or Sieve analyses
WELL LOG are available, please attach.
DEPTH FROM
SURFACE
N
Water
Bear-
ing
Well
Oia-
mete
In
FORMATION DESCRIPTION
CODE,
I
WELL DEPTH
ft.
DURATION
hr. min.
DRAWDOWN
ft.
YIELD
gpm-
Land
Surface
11
MillLng
in overburden clay and bldrs.
I
it
rock at 3'
1,201
6
100,
30
3
21
ril
l-in in rock .set casing ,groutei.
21
T-"illing
iri -ronk
granite,
WATER ❑ CLEAR TEMP.
QUALITY 0 CLOUDY HARDNESS
0 COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? 0 YES 0 NO
STORAGE TANK: TYPE
CAPACITY GAL. 11
PUMP INFORMATION
TYPE
MAKER
Moo E
CAPACITY
DEPTH
VOLTAGE — HP
WELL DRILLER NAME P.F.- Beal & Sons,,�Flnq-F
PO Box B f /8/88
ADDRESS S:lGflMRE
Brewster,Ny 10509
ZW
II.
IV.
V.
VI.
FINAL SITE INSPECT-ION \ Date �
Inspec ed y
•;CATION OWNER �-c.
i 'R4 4 OR SUBDIVISION LOT 4
f. JUNCTION BOX --properly set
g, LRENC ,ES _
1. D-angth remAred installed
2. Distance to watercourse measured. ft.
3. Installed according to plan
4. Distance center to center f .�
5. Slone of trench acceptable 1/16 - 1/32 " /foot.
6. 10 feet fran prcverty line - 20 feet - four_dations
7. Depth of trench < 30 inches fran surface
8. Roan allowed for expansion, 50% x
9. Size of gravel 3/4 - 1 " diameter
10. Depth of gravel in trench 12" minimum
11. Pipe ends canned
h. PLAT OR DOSE SYSTEMS
1. Size of pump chamber
2. Overflow tank
3. Alarm, visual /audio
4. Pump easily accessible manhole to 2rade
5. First box baffled
6. Cycle witnessed by Health Devartlnent
estimated flaw per cycle
HOUSE '
a. House located r approved plans.
b. Number of bedrooms
WELL
a. Well located as per a proved lans ,
b. Distance fran SDS area measured ) ft.
c. Casing 18" above grade. I �.
d. Surface drainage around well acceptable.
OVMIALL WORKMA.SHIP �-yp ✓ �°
a. Boxes properly grouted
b. All i s partially bar-kfilled
c. All Ripes flush with inside of box
d. Bar-kf ill material contains stones < 4" in diameter
e. Curtain drain installed according to plan
f. C.irtain drain outfall protected & dir. to exist.watercours
g. Footing drains dischaFc a away fran SDS area
h. Surface water 2rotection adeauate
i. E=oszon controi providedo n slopes greater than 15 %_
1
YESI N
NO �
�S
SE+RGF. DISPOSAL AREA
a. SDS area located as per approved plans
b. Fill section - Date of plac nt
2:1 barrier. /( LGTH WIDTH AVG.DPTH
c. Natural soil not stripped'
d_ Stone, brush, etc_, greater than 15' fran SDS area.
e. 100 ft. fran water course /wetlands.
SERRAGE DISPOSAL SYSTEM
a. Seutic tank size - 1,000 1,250 X
X
b. Sentic tank installed level ,
,E-
c. 10' minimum fran foundation
d_ No 900 bends, cleanout within 10 ft. of 450 bend
e. DISTRIBUTION BOX
1. AU outlets at same elevation -water testes
2. Protected below frost C
C? ,
3. Minimum 2 ft. original soil between box and trenches '
'
1
�y
Izke \
cs/P
l
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES .
John M. Simmons, M.D.
Deputy Cainissioner of Health - FIELD ACTIVITY REPORT - Sheet of
�� INSPECTION
NAME � _ Orig. Routine
,�J \C). �a.�6� 0 ig• Complain
ADDRESS
g. Request-
No. reet TM No. Canpliance
Complaint Cam
MAILING ADDRESS Final
P.O. Box Post Office Zip code Group Illness
Construction
TELEPHONE
✓. Reinspection
PERSON IN CHARGE Field, Sampling Only
OR INTERVIEWED Field Conference
Name and Title
DATE CQ //C) _ TYPE FACILITY
TIME ARRIVED Q'. of TIME LEFT o� n 30
FINDINGS:
e
J
Other
. Explain
R ,
INSPECTOR: ` ,(,l�/j`� /��/Y�Q_.�,�//��//� TELEPHONE:
Signature and Title
PERSON IN CHARGE OR INTERVIEWED:
I acknowledge this Field Activity Report. SIGNATURE:
6/86 TITLE:
Z.
Az
.. Structwe located from snrvoy'•by surveyor n ito.d belo4DL._,� -»
t1
... • -, f 6 II tacato d by'. Surveyors sure y._
..-_.
- 'a
Wolf' _dnlfora report
.
n .,. Enamo,oro mesruromonts __ -
q
Gtx.L. 1 GSA' Tank, (Dozes, pttd, ealloriea d 1Qtierals lo•catod by:Contrl5ctor:
B2�AY ¢tgel.lC> PIPS 1t�K Enea+eers,
63`•f�B Health dept:
)' -
�_- Pteld inspection by; HeOltb dottl® dote:��o
Eneunoor Tra da4o
660 r0_T*A_L1
TSis is to certify khat the ae a E^
:1 Ciro
I disposal system was constructed. as
jZ,0. 3, l �Lr �D�`� F° 'NOTES: ind't.cated on this plan and that thm
.f Q - t aystem was inspected 'by ne b4ore a4;
�4 was covered Dear. 171e syatedS was
,r tonatrnr_ted in IICcordau°e trit6r.- .S
F.
a• i
staaderd roles and regulaCtan of
the F'.C.H.D. & the N:Y.S D.N.,
pury � N p I ME Po S10td.S
y J wl.l�Lll-'U
A - 8
92e °37 A - E a4 v-, -- �. a E - 12 .t - 7r --
A- _TL- a 2-018 ' n - r' �'LZI - (Q7r._
1 9o,e bIW z3! o� bzoe2 -�0 2��,9'g, A -=��° x -��a - d ' --Tar &-1/-
2 oo•!Z -6.7-14 C G
iA � A -r i�6 - H a__ aZP
A _ M 87,_x„
SANITARY SYSTEMO DE 519N
owl A_ C .
LOCATION Streeta�AyG coAct ,_ v. _
Tow n:p���G�r?oL`� _County:�iJ ? I`� to: -
.
SUSDI /1SIQN — -- - -- -- --
n f SlodesJ —. LOT NsL_
_ C^d
.. - tluillam uouna;a- Uepar>weuc ui noelL.. Surveyor: •!�,.„��_ _.... ..._ _
,ivislon of kavjr6nineutal Health Servic - .,
1 Orotzn, bat ®: Scale II 01
..,
ipproded as noted �or,confoimancb, with
Applioable i{ulee and Regul atione of the 4 Q H �N H PI P {� . E N T (` 5�.. P.
Putnam'County Health'Department.
seN•s'tt.i.�twa- �ettat�iarmm... 4 .. .
R,-,v. 31'-86
31 c
CONSTRUCTION PERMIT FOR
Located
PUTNAMCOUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services. Carmel, N.Y. 10512
AGE DISPOSAL SYSTEM
ill Roads
Subdivision Name Subd. Lot q
Owner /Applicant Name R. , T. , S. , J. , & G. Ga 1 a i d a
Engineer to Provide Permit t� 6
on CERTIFICATE OF COMPLIANCE
Permit q
T. Patterson
Town or Village
Tax Map 7 Block 1 Lot 8.
Renewal_ Revision �[ �r✓��o/rro
Date of Previous Approval 1/3/86
N ningAddress 17 Leewood Circle Town Eastchester, NY ZIP 10709
Building Type Frame Lot Area 2.7884 A ¢ F�U�Sen o U lr- e Yds ..
� ,1 tDepth •� - �Volumo °;h� ,� ••
Number of Bedrooms Five Design Flow G /P/D 1000EGNo on 'gip plated
tiHc'sti is Required �Itemin le coin
Separate Sewerage System to consist of 15 0 0 Gallon Septic Tank and x 24" wide x 18" deep l a t e r a l s
To be constructed by Owner Address
Water SaPPIy: Paibl(c Supply From Address
or: X Private Supply Drilled by
Other Requirements K— U —15 : .D 4 V 4 6Q. Y t . ✓tAezp
represent that 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 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 accordance with ths.—st4ndards, rules and regulates of the Putnam
County Department of Health.
Date 17 March 1987 Signed P.E._ R.A.
Address RD 9 - Fair StreCV, Carmel NY 10512 License No 29206
.APPROVED FOR CONSTRUCTION: This approval expires ear 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 necess �ry by the Commissioner of Health. Any change or alteration of construction
requires a new permit. Approved for disposal of domestic sanitary sewse, antl /or •ate water ply only.
' A /
Date �,7 By ' Title
Pi �D t' YITT M COUNTY LIG T E T OF HEALTH ENGINEER TO PROVIDE PERMIT #
�-V - '� ON CERT FIC gIANCE,
�( Division of Environmental Health Services, Carmel, N. Y. 10512 PERMIT
CONSTRUC ION PER FOR SEWAGE DISPOSAL SYSTEM T. Patterson
Town or Village
Located at Birch Hill & Stagecoach Roads Tax Map 7, Block 1 Lot 8
Subdivision — — — — — — — Subd. Lot M — — — — — Renewal _® Revision �.p S.O. 2306
owner /Address Scott Galeida et f4
al, 17 Leewood. Circle, ats�t�,.1., xY,�1QTD9 `� �3�'17%80
Wdi iio pproval
--.,, r j»
Building Type MOdular Lot Area 2, 78841dcrei ` Fill Section Only
Number of Bedrooms. fntt]Design Flow G /F /D 1900 _ y, M F C' N:�D BotllSaitt oe iRequired
Separate Sewerage System to consist of 1250 Gal. Septic Tank and .x., 24" w.,,_.x 18"-- deeP �l�aterals
To be constructed by 9 r Address `
Water Supply: Public Supply From
X Private Supply to be drilled by 7 J
Address '
other Requirements R-0-B Fill Section: 36" (479 cu. yds.)
I represent that 1 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 thereof a'!Certificate of Construction Compliance" satisfactory to the Commissioner of Health will
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 i accordance with the standards, rules and regu a cans of the Putnam
County Department of Health. n 1 _•..,
Address RD 9 -Fair St.. Carte, NY 10512 License No. 29206
APPROVED FOR CONSTRUCTION: This approval expires one year from the date issue onstruction of the building has been undertaken and is
revocable for cause or may be amended or mgdified when co 'der necessary by the .mission r of Health. Any change or alteration of construction
requires a n w per Appr7 for disposal of dome is nit ry se e, and /or rivate w er supply only.
Date— BY Title
Rao. A /RS \ .__.
PUTNAM COUNTY DEPARTMENT. OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
FIELD INSPECTION REPORT
1
DATE.
�j
C" �? ✓ i� e i r �- '� ° " A-' fey! INSP . BY:
( Name of Owner) (S tr t Location) "
INITIAL SITE INSPECTION YES NO C Mmam
Wetlands on /or proximate to property.............. S "
Property lines or corners found ...................
Can estimate house location .......................
Willdriveway 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 .......... ....... .........
D.H. 1 Lot -
Depth to G:W. Z -V
Depth to rock 4-t "S�- f
Soil Desc-ri
0 ft.
3 ft.
6 ft.
9 eft.
12 ft.
FINAL SITE INSPECTION
C
.H. 2 Lot
Depth to G.W.
Depth to rock
Soil De!
0 ft.
3 ft.
6 ft.
9 ft.
12 ft.
DATE: _
INSP.BY•
dies l`�
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
unnecessarlygraded ............................
10 ft. maintained from property line and
20 ft. fran house ..............................
Distance well to SSDS (ft.) ......................
Number of bedrooms checks ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. from nearest trench ................
15 ft. of peripheral soil horizontally
from trench ..... ...............................
Boxes properly set.. . ...... ....
Could surface runoff fran driveway, roads,
ground surface,.etc., channel near SDS area....
Does lot drainage appear OKJn area of SDS::......
VTMAr. r_s�n,nMr. OF SITE A(=PM=t .................
D.H. - Deep Hole
G.W. --Groundwater
D.H. 3 _ Lot =
Depth to G.W.
Depth to rock
Soil Descri tion
0 ft.
3 ft.
6 ft. 'A
1
0
G
3l1¢I X103 2.1
4 1203 121-5 Z2 Z4- ¢... Z`7 3 T -e
5
rev. 9/85
1. Tests to be repeated.at same-depth until apprc imately egaal 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.
PU1IW COUN'T'Y DEPARTMENT- OF HEALTH.
DIVISION -OF; RVI11aMMM HEALTH ; SERVICE'S
DESIGN DATA SHEET- SUBSUFACE S3aACE DISPOSAL, SYSTEM FILE. NO.
Owner C&47767 � 1
ek- 4' Address _Bird, • u, )a& 2di TO
Located at- ( Street)
k4 e , t2- • Sec . TM 7 Block �_ Lot .
(indi.cate.nearest
cross street) r
Municipality �
,,-ga„ Watershed Cr-b-6
SOIL PERCOLATION TEST DATA PXUIFtEQ TO BE SUBMIT= WITH APPLICATIONS
Date of Pre--Soaking. 17
Dt c . '85' Date of . Percolation Test 17
HOLE
NUMBER CI,OC'R TTME
PGERCOLATION PERCOLATION
Run Elapse
Depth to Water Fran Water Level
No. Time
Ground Surface 'In Inches Soil Rate
Start -Stop Min.
Start ;Stop „ Drop In Min/In Drop
Inches Inches _ Inches
1 1 trio 112-2. /2
2,7 w 3
212
3 1136 -1 r SB i0
,
3l1¢I X103 2.1
4 1203 121-5 Z2 Z4- ¢... Z`7 3 T -e
5
rev. 9/85
1. Tests to be repeated.at same-depth until apprc imately egaal 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.
TEST PIT DATA REQUIRED TO BE, SUBMITTED. WITH APPLICATION
DESCRIPTION OF SOIIS ENCOUNTERED IN TEST -HOLES
DEPTH HOLE NO. HOLE NO. HOLE NO.
G.L.
2'
3l. ---
4'
71
8' .
ae
10'
11'
12'
13 ... u... ,
14'
A\
�t
�c{�ge,✓btlE � ��
" � fib" a•
Ol ti
a -
I�"f�
ti :l C
INDICATE LEVEL AT MIC H GROUNDWATER IS ENCOUNTERED No" e
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED AA e
3
DEEP, -HOLE OBSERVATIONS MME BY: µ/2, T iEa !i DATE; 3 80
pa. ..
"Soil Rate Used 8-1f) Min /1" Drop:,'.Y� S.D. Usable Area Provided a �• f
No. of Bedroans Septic Tank Capacity , I 1: p gals. Type Md s °"e,,
Absorption Area Provided By L.F. x 24" width trench
Other-. - k -A-A e: # 1 <6 e+-•, j% t. ' 31 No,, d. 9. YJ
Name o nab
JOHN H. PRENTISS
Address RD9
S. P.E.
RMEI. NEW YORK '10512
0 �F
�; . y.. •_ 292 �
THIS SPACE FOR USE BY HEALTH DEP ,4!.1
Soil Rate Approved sci -ft /gal. Checked by Date
PiTTNAM COUNTY
CAS
OF HEALTH - DIVISION OF ENVIRONMENTAI, HEALTH SERVICES
SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
DATE REVIEWED: /
BY:
: -- -_
NO DOCENENTS
Permit Application
Corporate Resolution
Plans - Three sets-
Engineers Authorization
' Design Data Sheet (DDS)
Deep Hole Log.
Consistent Perc Results (3)
/ 30" Perc Hole
Other
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
or J Box Detail
Septic Tank - Size, Detail
Well Detail, Service Line if Pvt _
Trench /Gallery
Pump Pit
Two -Foot Contours Existing & Proposed
Slopes for Driveway Cuts
Footing /Gutter Curtain Drains
Perc & Deep Holes Located
Representative of Sewage & Expansion Area
Expansion Area; shown; gravity flow
' .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
House Sewer - 1 /4" /ft. 4 "0; `pipe pipe
No Bends; Max. Bends 45° w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
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 (inc. expan)
15' to Drains- Curtain,Storm,Leader,Footing
25' to Catch Basin
10' to Water Line (pits -201)
- -- Septic Tanks
REVIEW SHEET - CONSTRUCTION PERMIT.
50' to Well
15' Well to PL
GENERAL
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Town /DEC Permit R & D)
Data On DDS Plans & Permit Same
CONSTRUCTION PElf; run,-, uor-iijam i- alror f-r- ft': A" r:
I dLocated at--'5: -R
L-c-0A -Tax MA
'
Subdi vl sion L 6
Owner. Address;
Od 'Building Ty 'Lot •A rea
:Number of rooms, 'Design Flow Total. Hatikable-S
.System' st - of
Separate Sewerage to consist Gal. Septic Tank, and
To" be -constructed by Address
Water Supply: Public Supply From
Prliiate,,Supply. to be drilled by
Address
Other. Requirerhe*nts.
I represent that v'am'.wholly I and completely responsible for the design and location of the proposed systems) .. i) that the- 'siipa-ritc ii�kd .1
i6 11 , I the ove described will be constructed as shown on Approved amendment there to'and -in accordance With the standards ,I_rules.4pq.re
t:
P-,dmmls'U
rn
County - Qepak' erii hat,on completion thereof a "Certificate of Construc ion.'Compliancel satisfactoiy.td.thiii, S oner
tie.
bit 'submitted to-.the Depak'm int,% and a Written guarantee. will furnished the owner his sttccessci * r.s hei�-s` or
-assigns 'Ider* h-
ff
pIace in goo - oviitrating Kl�-!
d condition :a -part of'.sald '-sewage disposal syste m. during the ,;i6rio&oj-two Ir :any
inei - Of the approval of-ihe. Certificate,*of o
6 -nw*06.n .Cdmpilance the original system `or Any repairs thereto; 21). that ,t e-;
wilU be located as shown on the appro* vid plan And that said well will beinstalled.in accordance with the standards, rules and-remulatioRs-17 f 1!
couhty Depirtm6it of Health.
"k
Date 'l, k
r ,
Sign6
r
AN j License, No
APPROVED FOR CONSTRUCTION. This Ap proYal, expires one -ydAr'ficirn the d Ale is ss"donstruction -of the - tiuildmg-Fias been `undl revocable foe..ca-uW..60 may .6i-amended-.or*modif!61. when of Health, Any cha ngia or'. 6 lte4i &1;6i
1, 'fier
r e-46ires a new permit..Approyk'd- for dispo ial ci f
Oat. —3 Tit domestic
By
v
11
0
-i
PUTNAM COUNTY DEPARTMENT OF HEALTH
-DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY. OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA - SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE N0.
Owner A ddress 57-Ab C COACH L�,_/ ye
Located at (Street > 6,y. a o Sec. -- Block Lot
IMIcate.,
nearest cross. street)
_
.1 a ..Watershed_
SOIL PERCOJATION TEST DATA.. REQUIRED TO BE'SUBMITTED.WITH <<APPLICATIONS
o e
CLOCK.:...TIME PERCOLATION .
PERCOLATION
Zun EIapse 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_..__,37_. z.�s •` 8M /e/ -. ._.. .. Z� 2 �. .�lN _.:.._...8na
J
/ /�f
2.... z:_:.4G 2;;,'52 �� / �✓ Z4 .. 2 S / N .
6"�j 1i✓
.3.
__?E.....� ,: D. /...._�; Qa' �ML� .....; � S - 11/./.. ' . •. -.
.. ,awl / r/
.. ..
Ar_
..1
- .
3 .
5 •
Notes'o.`,l) Tp`�ts to.be' repeated at same depth until approximately equal soil
rates are obtained et each percolation test hole.. All data to_
be submitted
for review.,.
. Dep'tl measurements, to be
made from top of hole.
TEST PIT DATA REQUIRED
TO-BE SUBMITTED WITH 9PPLICATION .-
DESCRIPTION OF' SOILS ENCOUNTERED IN --TEST HOLES
DEPTH
HOLE NO.- %
HOLE NO. - HOLE NO.
G. L.
6"
1211 �.
GiaiT� �'cft > -,
��rT7f �t�tY -4, -
24
3011
.:.
36r'
r7r� C«a y -zoo. .
42
rTTy CcAZ- Z�4,,, ..
,� roc /c
48"
�ocK
5411
60"
721►
�
84 r
INDICATE
LEVEL: AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE
LEVEL-U WHICH WATER LEVEL
RISES AFTER BEING ENCOUNTERED
TESTS MADE BY .
Date
DESIGN
Soil Rate:.Tsed
>.:1d..n%1 "Drop:
S.D. Usable. Area provided
No. of Bedrooms-' !° Septic, Tank Capacity ooa Gals. Type
Absorption "Area Provided By 33 6 L.F.x24 5b". 'width rent" .
..,_ ... ...... .....
Other
Fame
_
Signature
Address
........ ...
SEAL
THIS SPACE FOR USE BY HEALTH DEPARTPMT ONLY:
Soil Rate
Approved Sq.
Ft /Cal. Checked'`-.by Date
�: ,�. ovswP w.w mw.,...1 w ... yr
I'II E- T Dint pros from sopt�c honk 10 boi and betwfn ail box®e
T CAL CURTAIN DRAIN TYPICAL F1 LL' SECTION FOR SI
4 eo fes tnotAI * eeplal.dret►rbWion engy b• riqu) rod,
P6 N SE CTIO
. ''` DUI 'flo ;P�oX -NP. "• r:LL ..Zd ��31E•OULE
N// / y` ' h'E'W� Gt G a Tank insrdolengthJP,
_ o _ Tank -inside wr 9 s
tiquid lave I
Capderfy_ /- -
Field R.r®dd - --.0 r
LA 1'cgiGA Lh Y. wii t . i WidtD
L � ECACv' O_"I ° c. Nalaterals -�
3q ow.�oss��c,, fGc�O t u; + +, p N�bogZes °a
IM /LYI.vl t I'lA (lal2.1A.1 ' • �r �?
Fill c Ion
Gol rGal /SgFtA
-,SqR Req
4 r� CJ 1<.r _ long H
y ' °>Or- wide D e
_ , . .. -.. - /V z.;�o .�ij. Mri .« :rr +i,, zM :� � `#,' w - `R'� u•:,ru •t _ � :.� s.}-- cam;-'' — ....�.,
n 3a
l . The current Ht?d
Go v
which
h nsti
\ ':r i
1` with inal.l're5
1
appr0 val7.ppmM1,F'
r r r n + lation.
12. plater Su t
r a. Tda er is: frc
�T.eG'! b. If a private
ca 6Zv -z ._'¢.'- -- -- , cordanee wit
n• i Village /City
5 7" �l -Gj C— Cr7 � C !Zo d s? Qo r. " drillga.;rdto"
required wei
cation is to
y_
Putnar
Lt Zoo o°
G ° Faguia ".
' ¢ �SoL Ip IPG_ a.
HATer Oate
l50o ciAL, ion OW N ER h_
3 -o r �PTic Tq+,/K 1076 LOCATION Stroat . h
D�E%'��lY lo7a Town: AT(0t��1 —J`.
t e - - --
i ++ 11 t-LC r�Of.l4J;lLrcf6> _ /c).¢ Sueul ISI N� "�`
m 'p ?ax
—
Js–o +v.