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HomeMy WebLinkAbout0387DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -3 -10 BOX 5 00196 N ,. �; s � T wo ■ ' '' ' � �'6 r i 00196 Moat commumON.COMPUANCETOR SEWAGE DISPOSAL SYSTEM _a lot cl 9440 NIA rul 14 of of ho p; 'rules :onm 'in. aq�mrdance: ea Oat lconsm No.' Date Itie he ` W W✓LL L$Vr1rijz11V" A.ZrVAI DEPARTMENT OF HEALTH Division Of.Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION 'STREET ADDRESS: TAX GRIO NUMBER:— A-11. R(J. A-A I WELL OWNER NAME ADDRESS: 9 PBIVATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary `RESIDENTIAL 6',b PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED 0 BUSINESS 0 FARM ❑ TEST /OBSERVATION 0 OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY ❑ AMOUNT OF USE YIELD SOUGHT gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE* gal. REASON FOR DRILLING YNEW SUPPLY ❑ PROVIDE ADDITIONAL, SUPPLY ❑ TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA 6 WELL DEPTH ft. STATIC WATER LEVEL ft. DATE MEASURED DRILLING EQUIPMENT ❑ ROTARY COMPRESSED AIR PERCUSSION 0 DUG 0 WELL POINT ❑ CABLE PERCUSSION 0 OTHER (Specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING.. VOPEN HOLE IN BEDROCK ❑ OTHER CASING TOTAL LENGTH tL MATERIALS: Pf STEEL ❑ PLASTIC ❑ OTHER LENGTH.BEL OW GRADE ft. JOINTS: 0 WELDED EP(THREADED ❑ OTHER DETAILS DIAMETER in.. SEAL: 0 CEMENT GROUT O(BENTONITE 0 OTHER WEIGHT PER FOOT —1Z Ib./ft. I DRIVE SHOE 9YES 0 NO LINER: ❑ YES N DETAILS METER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FI ��E k-' ❑ NO HOURS, SECOND GRAVEL PACK (VYES 0 NO GRAVEL SIZE. DIAMETER OF PACK in. TOP DEPTH _A206' tL BOTTOM OEM �6 It. WELL YIELD TEST 13 It detailed pumping METHOD: 0 PUMPED 1 tests were done. is in- (6 COMPRESSED AIR :.formation attached? 0 BAILED 0 OTHER 1,OYES -ONO It more detailed formation descriptions or sieve analyses WELL LOG . are available, please attach. DEPTH FROM SURFACE-,` Water Bear- ing Well Pia- meter I rl FORMATION oEscRurrtw CODE. ft. ft. WELL DEPTH fL DURATION hr. min. DRAWOOWN ft. YIELD gpm- Larid Surface s� j, 6-2ni y e ra 0 7 WATER iCLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS 0 COLORED ANALYZED? 0 YES ONO ANALYSIS ATTACHED? 0 YES 0 NO — STORAGE TANK: 'TYPE CAPACITY c_16 6 n k,_ GAL. 1.20 WELL DRILLER NAME DATE V S�RT M. HYA17 & SONS, INC. AO&P SIGNIMRE W611 Drilling Rte. 311 R. R. 2 Box 174 A - EATTFRSQN. NEW YORK 12503 PUMP WFORMATION TYPE S&L k", CAPACITY Z P'l-cl MAKE DEPTH MODEL VOLTAGE-�10_ HP -4— 11 W Yorktown Medical Laboratory, Inc. 321 Kear Street Yorktown Heights, N. Y. 10598 (914) 245 -2800 Director: Albert H. Padovani M. T. (ASCP) L J LAB # 1'�` +•:. Date Taken: - ­-'j 1 Time: % Date Rc' d : Time: Date Reported : eu6 1 q 9990 Collected By: PO /Client ## Referred By: Sampling Site: i Phone 3 V� X° 3�_ 3 REPORT ON THE QUALITY OF WATER INORGANICS (mg/L MICROBIOLOGICAL 1 OmL Alkalinity _ Chloride _ Copper _ Detergents, MBAS Hardness, Calcium _ Hardness, Total _ Iron Lead _ Manganese Mercury Nitrogen, Ammonia _ Nitrogen, Nitrate _ Nitrogen, Nitrite _ Phosphate, Total Silver _ Sodium _ Sulfate Sulfide _ Sulfite Zinc PHYSI AL M S ELL.4NEOUS. _ pH (S.U.) _ Color (Units) Conductance (ohms /c) _ Odor (TON) _ Turbidity (NTU) _ Standard Plate Count (CFU /'I. mL) Membrane Filtration Method Total Coliform _/_ 1 --- Fecal Coliform _ Fecal Streptococcus Most.Probable-Number Method _ Total Coliform Fecal Coliform Fecal Streptococcus Presence /Absense (PA) Total Coliform P A. KEY FOR TERMINOLOGY CFU = Colony Forming Units IT = < = Less Than GT = > = Greater Than NA = Not Applicable SA = See Attached TNTC = Too Numerous To Count REMARKS /COMMENTS or ab se (For Lab Use) SAMPLE TYPE: (Check One) Potable _ Non - potable OUTGOING: (Check Each) HNO —_ HC13 _ H2SO4 _ NaOH ZnOAc _ Na2S203 _ Other: INCOMING: (Check Each) LE 40C %7:, 4 /I8 2000 GT 200C pH LE 2 pH GE 12 _ Other: NYS ELAP #10323 THESE RESULTS INDICATE THAT THE WATER SAMPLE WAS) ,(WAS NOT) (NA) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO YORE STATE PUBLIC DRINKING WATER CODES, FOR THE PARAMETERS TESTED, AT THE 7TIM OF SAMPLE COLU4TION. THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DID NOT) (NA) T THE SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STATE PUBL C R INK- ING WATER CODES, FOR THE PA "ITERS TESTED, AT THE TIME OF _COLLECTION.. x ( -t lL �� 7 /87(Rvsd1 /90)RWE ?, A Ar . 9 dnvwni A. i rPntnr ` PUrNAM ODURL"i DEPAEUMENr OF HEAL'111 DIVISION OF ENVIRONMENTAL HEALTH SERVICES Joanne & Robert Wolgast Owner or Purchaser of Building Owner Building Constructed by Cornwall Hill Road Location - Street T. Patterson Municipality Frame Building Type 1 5 10 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 we to such system, except where the failure to operate properly is caused by the willful or negligent act Qf the occupant of tie 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 tn caused by the willful or negligent act of the occupant of the build }ny the system. Date ,is/ 1 �,. t"C., 19%j Signature - Signature Corporation Name (if Corp.) Add..ess rev. 9/85 R:F - gr. Ar SI'I'� L�fS� ACT' =C�3 Cate o? i CRIER g(� T•t " OR �u-EDI�i'� SIC'1 LClI' � � _ �`�© c_ .; f,r7 DISPOSc r, ARE b_ F i 1 sac-LiCH - Date T� aunt C- I7a -c=1 Sol_ P.0 . ar -t- ^ 1 fran SiDs ter= e_ c`rr_•e, bras: , etc . , cre=.�_ t:r.Il L~ - lnn vDIsrCL-Z SY5 =! c. �.c= ��C t_- c..'- 1,000 I LC cn Eno LL within 10 =_. GF aca hard e. -[JTic y EaK _ i a l l nt ; =? -- c ScT-E �c7Gt? Cn I s a-- D; cztanc= - e 1/ u fCL_ ='_CAS C C_ze cr. Ca -a 2/4 1 _ 1 Size of r:-= /c^ i o P''1- ID E°S__�i cC -=S�i � i °_ rrani cle Co CZcC° es " at_- = =cw ca cv c i e , r7. EC U.- C a_ jj1 1 l CC=s °� rer a- c'O?'ove' U I Enc 1C° f- CL:c Grc= n n-c1'i ao� f C. C:--cinc crede- V-1. - cyV �-Z= b. ;LLL is r= —_s! _v h`c�i1h C_ ?? i Dices f- w `: inside o= hcti n stcre < �• in cic. E_ckfii Ir=___� ccn i e_ C -, i I1 c_� *'s ins 11 acccrdinc to. pla-*1 _ C=-7-- cat -11 L`±':tact; -44 & C =T.trJ C_ L•:Ct'_na (:Lra G_= �.arce away t -C it SDS a -c= Crl = -C1 C- Cy'C -_ Crl s7C:cs C;- t.? i ljj �s I I I I i ID- C I I I 1 IAL m Lm COUNTY DEPARTMENT OF HEALTH DWWon of Envtronme'ntal"Health Services Carmel N Y 10512 Ettglneer to Provide Permit q -on CERTMCA'T'E,, COMPLIANCE CONSTRIICTION FOR SEWAGE'DISPOSAL SYSTEM Permltw'N8:8; ;.. - T ,.,Patterson Located at Cornwall. Hill Rd:.'Town or vivage', . Sdbdlylsion Name cabd 1 :, Lot N 10 Tau Map Block 5 Lot Renewal ❑ . 1eviston ❑Job #S.0."24 %0 Owuer /AppllcantName- „JOSLlne. &. Robert `Wolgast , Date of Previous 'Approval Church Hill,Rd Mfg Add Town Carmel , NY gyp, 10512 B>.uamg Type Frame. Lot area 5`1;'5'96 Aeres rr`.. Section Only N0 Depth 18 Volume '25t) <_C Number of Hedsoome 'Tour Design Flow G P D '800 PCHD NotlBcatlon'Is Required W6en'FW Is completed •! Y ds 1250. '400' x ,24” w x 18" .D..`I;atera'ls, Separate Sewerage System to consist of Gallon Septle. Tank and �. To be constmcW by Owner . Address See :.abOVe Water Stippl): Pttbllc,'SpPpb From Address ors X Prl4ite Supply Drilled by NSA _Address ' Otbe Rogolemente R' -0 B Full Section See data above x`.4°f8t0 -sQ. ft (NO second filing required) I represent that I am wholly and completely responsible for.the design,and location `of he proposed aystam(s) 1)' that the separate sewage disposal,system' above described will Deconstructed as "shown on the approved, amendment there to and in accordance with the standards, rules an regu_ a ions o e u nam 11 County Department o}'; Health; land that on completion the eof a Cerbfieafa. "of Construction Compliance satisfactory to_ the;Commissioner of Healthwill I ba submitted,to, the Oepa►tment and a;.wntten;guarsntee will be furnished the owner his successors, heirs oi. assigns` by t builder, that, said buildei:WillI pMee iri good oDeratiny 'condition any'part of said sewage disposal: system 0unng;'the penod:of,two,(2) years lrrimeGiately;follovving fhedata of the Issu once of the "approval :of the 'Cortdicate of Construction Compliance, of the ong�nal'system or sny repairs theiefo; 2)'that the drilled we1l.Ceseribed above i will be 'located as 'shown on the approved`plan ano that said well will be installed' ",i acc'ordance with the tandard , -rules and .regu amens of the Putnam . County Depa iment'of Health: ' bata'.21 Jul. 1988 1 _ y Sign ed Pk—M– R.A. Andres: RD9'-Fair: St Care NY 105;12 9206 - - License No 2 APPROVED'FOR CONSTRUCTION This approval. expires two years: from the. pate issued unless. construction of the building has' been undeitakeri 'and is' revocable for -cause or may be amended of modified when considered necessary. by tfie.Commissioner of, Health.. Any change- or alteration of Construction reouires a per ' . Approvetl f/o�r disposai.of domestic, sinitary`se' age .fwd /or pr wa r supply only: 87 Date .d %'C�s:' ? / �'�Q' By —r�_•T 0 DEPARTMENT OF.HEALTH Division,o.f Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT 0 PYi! 88 WELL LOCATION Street Address Cornwall Hill Rd. Town/Village/city Tax Grid Number T. Patterson 1 -5 -10 WELL OWNER Name Mailing Address OPrivate Joanne & Robert Wol ast, Church Hill Rd., Carmel, NY 10512 O Public USE OF WELL 1 - primary 2- secondary 13 RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify O INSTITUTIONAL O STAND -BY p AMOUNT OF USE YIELD SOUGHT Five gpm /# PEOPLE SERVED '5 /EST. OF DAILY USAGE 400 gal REASON FOR DRILLING UNEW SUPPLY OPROVIDE ADDITIONAL SUPPLY ❑TEST /OBSERVATION OREPLACE EXISTING SUPPLY 0DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING Residential Use WELL TYPE XIDRILLED DRIVEN 0DUG ®GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name N/A Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: About % mile TOWN /VIL /CITY LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED(See dwg. #l, Job #S.0.2470 By John H. Prentiss, O ON REAR OF THIS APPLICATION ®ON SEPARATE SH T P,E,) 21 July 1988 (date) '(sig atu e) 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 provided by the Putap Cgunty Health Dep tment. Date of Issue: �19 Date of Exp ration: 19(% er it ssuing ficaal Permit is Non - Transferrable White copy: H.D. File 2/87 Ye11aW Copy: Pink Copy: Orange copy: Owner Well Driller APP"T7MIX B PT3rw]AI i CvUM"Y DEPAR�r OF HEALTH - DIVISICN OF MrIRCNMERM HFA.LTH SzRVICES INDD =UAL WATER SUPPLY & S'UBSU'RFACE S947A_C' DISPCEAL SISTEMS /_�` 0/,5>4 --I' CC1�TI'S r= e-q-1 irer -ft. ar, REVIEW -g=- - CONSTRUMON P-1E RMST (Street Loocanti.cn) DATE REV J7ED : BY: DCMT`OM Permit Application. Corporate Resolution Plans - Three sets Engineers A.utnorizaticn Design Data Sheet (Dr-S) Deep Hole Log Consist`nt Perc Results Perc Hole Depth ns ----1 Two P,P-m s==�z F;vs s/s S ED r JISICN P =r:. (3) Fill ci Variance Request G-_- R.A.L Lecal Su "i vi sicn C: :I_ A.poroval aerked Ex - -_c_ roval SSDS Ad'. Lots Ctiec:<_=f Wei? and (Tcw71/DEC Pe i t R & D) Data On DDS Plans & Perri t Sale REQU � RD DETA = 1 c CN PT : NS S =.Page Sys am P -an - (mortm a_rr,:+v ) ace Systam i��1l.rGul? C P_`�L? 1. - C =GV_ i Fill Prof i le & Dirmens_cns - Volt Fl; D on�„Jiox;Trencri /gallery; Pmp pit ce _Is Septic Tank - Size, De=vil Well Detail, Service Line if over CCnst'ucticn NOt°5 (grinder rate) Design Data: pert and deep resal =- Two -Foot Contours Eci sti ng & P_; _no=sed Drive:rav & Slopes Cut Footin /Gutter,Curtain Drains (discharge Perc & Deep Holes Lcca to Representative of primYry and e_r„ansicn OR) Expansion Area; shown; gravity fln�r, ssff . size Ii PImpea Pit & D Box Shorn & Detailed House -No. of Bedrooms Wells & SSDS's Win 200 ft, of Proposed Syst Prep* ty Metes. & Bounds House Setback Necessary (Tight lct) House Sewer - 1 /4 " /ft. 4 "0; Type pipe No Be-rids; Max. Bends 45° w /cle: -gout SEPA.RA.TION DISTANCES SPECIFIED CN PLAti Fields 10' to P.L. , Drive=way, Large Trees jcp of f 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' piu 100' to Stream, Watercourse, Lake (inc. e-'c--- 15' to Drains Curtain, Leader, Footing 35'to catch hasin,storm rain,vired waterccu 10' to Water Line (pits -20') 50' int nnitt`nt drainage course Sentic Tanks 10' fran Foundation; 50' to well 15' Well to PL 9 /I PU NAM aX NN DEPARTMENT OF HEALTH ­DIVISION OF . HFALTH SERVICES DESIGN. DATA SHEET -S MUFACE,SEWAGE..DISPOSAL`SYSTEM FILE NO. Owner J 0ck'AV, .P - 5 e.T' Wad loaf �s (�rv,r ra a ` Located at . (Street) iZ� e . ' :3 l ' 'Sec . 'T1� ' j Block Lot „ J 0 (indicate nearest cross street) Municipality r4+C-erS0v7 Watershed 45"t -, SOIL PERCOLATION TEST.DATA REQUIRED. TO BE SU34:= WITH APPLICATIONS 3 )ire °ti5 Date of Pre- Soaking ��c /V Date of Percolation Test 11 x 14 lerc' = A7 7 HOLE NUVIHER CLaM TIME PZRCOLATION PEROOLATION Run Elapse Depth to Water From ' WaW....Level No.. Time Ground Surface In-Inches Soil, Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches / l feco.. Ica 3c c� "I C-- 8 3+ 2 j �:� > ba�oC:i'i a ` 7 3 )ire °ti5 © = A7 7 1 .... 6 �- 7 2 3 4 h 3 4 5 NOTES: 1. Tests to be`repeated�at same depth until approximately equal soil rates are obtained at each.:. percolation test hole. All data to' be submitted for review. 2. Depth measurements to be made from top of hole. rev. 9/85 DEPTH G.L. 1' cr 2' 3' 4' 5' 6' 7' 8' 9' 10' 12' FAIN 14' TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION � DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE N0. HOLE NO. HOLE NO. /Ci'1'U �il. �A�%E:.;e�.l_"i�' V/� ,:..e• !�� _�.ae.vfalr"� u INDICATE LEVEL . AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED. Pty- DEEP HOLE OBSERVATIONS MADE BY: % '" �j DATE: /d/6, AIS DESIGN Soil Rate Used ' Min /1" Drop: S.D. Usable Area Provided 5o c d �- No. of Bedroams Septic Tank Capacity gals. Type �Ln�so Absorption Area Provided By 4-o o L.F. x 24" width trench Other g - `/ - Name Address JOHN H. PRENTISS, P.E: RD9 FAIR ST 914- 878 -6170 c �o " I-* Or THIS SPACE FOR USE BY HEALTH DEPARDYM ONLY:. Soil Rate Approved 41:ft/gai. Checked by Date S A. a 11 I k 504IIL- 4- 906f ;500 00 'm0 x I ) . 11 /,"K/ 4ZI. 24' > Z, ro WAY7 ;�N ON to ry 0 411 k7 Ile LA--1 HG A 4� ri su 6 r, 19� g2a,--57 . I I ,<,0 tq fir. Putnam bounty D ..i Of Health Approved "o-jePtal R,,Itb ServIcies II I as note fo 08 AS BUILT" Q A �TA. D I M N SION 5 ME, tructure located from survey by jiij�� noted beiowEr_ Yell I located by: Survejors s.,,,.y. VYOII Alliters report - Engineers mesurements zj�ic D Tor. k, boxes, pit;, galleries 6% iotet a i s located t)y: Copt, A actol.: Engineer: B F Health dapt: A 6 Pleld 'AsPection by: Health dept do 10:— /Z Engineer d ate 7 tl-r ,h,: S,,dage ,+ NOTES: J l' on Ii., 1,1;!,l an:,! that: the i,y u,- !,(Aorc it B K The syslem Was A t- •o,-rdn,,,:v With 'if, j. 'AI\IITADV C.\1C-rC'KA r-kr---61,� & OWNER LOCATION Street: Town: ::, .1 -7- County: _,f�jT to, SUBDIVISION: m a Block-, r LOT N2__ Builde: Surveyor: r �uw n a I e Job N I S , I Y4 70 J 0 H N H, P R ENTISS PE. CONSULTING ENGINFFP il �4ft� D I M N SION 5 ME, I - A zj�ic D A A F B F 4b mot' eta A 6 6f, 71 G ,+ J �06.11-- 8 j A K B K 4W- A t- 'AI\IITADV C.\1C-rC'KA r-kr---61,� OWNER LOCATION Street: Town: ::, .1 -7- County: _,f�jT to, SUBDIVISION: m a Block-, r LOT N2__ Builde: Surveyor: r �uw n a I e Job N I S , I Y4 70 J 0 H N H, P R ENTISS PE. CONSULTING ENGINFFP il �4ft� 1 ti moo 1 ti 4i 403k 4- Im JA ;e 4 1 ti PUTNAM COUNTY. DEPARTMENT OF HEALTH rDIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address Located at (Street) JZ­f; 3// Tax Map 13 Block 3 _Lot pelllo (indicate nearest 'cross street) Municipality Watershed ohs T 'B z/) A/&./-/ SOIL PERCOLATION TEST DATA ,-), I Date of Pre-soaking la / 7 le Date of Percolation Test ZQ Z-8 0-2 NOTES: 1. Tests to be reoeated at same death until aDDroximatelv equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 - \ ........... . . . . . ........ . X .. ...... .. ....... ...... ... .. . ... ..... . ........... ... .... . ........ In ... Level. ........ . . cola ....... -art tu T -_3 0 Ole_ ;L 2 3 23- 2.6 3 S 3 3 /0,'67- 11,=_ V- 33 ;2- 6 3 6,3 4: 5 /0; ®! -/0; .27 2 lo; �o - 10.,:3g /-1 -2-3-- .2-7 3 /0," 33 - to f -_3 e? 4 /0'#0 100'q7 7 .13 146 '2Z 2 H,'o e �L o i a3 - )_6 3 3 4 5 NOTES: 1. Tests to be reoeated at same death until aDDroximatelv equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 - \ y.M CO =� Sheet_ OU * : P,UTNAM COUNTY DEPARTMENT- QYHEALTH DIVISION OF ENVIRONMENTAL. HEATER" SERVICES ACTIVITYREP.ORT FIELD :iu xTer�G 1GL� �4it/S j"; G0, TPt : -`' '14- AnnRF��.o�IV.a�/L /�Y�i�Scs/l% '..street Town ' State Zip w IN CHARGE . PERSON O�? T1�TTRR �FTF�JVFII; / L/' x l �i - Name and Trtle _ -T TYPE: =:OF FACII,ITY . _ %�" D o 5 � ;D : 5, s rYT- t l /v /F'tiC.Pv^r� y r- , \ � _.-. ...- - iii c :fc ° -•^" - S`- ' -x r /` iloo- T •tea .._ ..:� � t'. i ...- k '� ' ,,,f a �e _ c• �d ✓: " ' + UY " s = _ a h - ° >h v - . TFT • ar, Signature and Title RFPORT RF(,,FT��n'RY• 1'acknowledge-,receipt of this report SIGNATURE; Trtle, - 0 ADGCy O A 19 P-1 0 05- .,., I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF. ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner I L Co /y!5, 7- C C2 , Address Located at (Street) e— Tax Map 13 Block 3 Lot (indicate nearest cross street) Watershed 9;g9 -T" ��C,4,e SOIL PERCOLATION TEST DATA Date of Pre-soaking /0 z -7 fO Date of Percolation Test /0 le, 10:2— ....... ...... ... ......... .... . .......... ............ ........... ............ . ...... . ...... . ........... e." -a ::.:>::;;:<:::::;.:.;;:.<:.;:.::.;:::.::::::::,:.:.;...::.:;:::'Gro N ... . ............. .. . . ........... T . .. ........ �T j m: . . ........ %r �M X. -X q . ... . .... .. ... ..... .. 2 //1137- 11;41 2-6 3 313 4 /430 0-7- 3 — a_ 03 2 1/159- AZ.0 Pub .13 — ;2- 6 3 C/, 3 4 5 1. 3 4 5 NOTES: 1. Tests to be reneated at same denth until annroximatelv eaual nerc6lation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 Sheet_ of_� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLH SERVICES FIELD ACTIVITY REPORT NAUP: �� IGL `l CO-4/5 CO. Tel: AZ AT)DRESS: COEV IA41_ Street Town . State Zip PERSON IN CHARGE ()R TNTFR VTFMM. ; /1/91yr%Z;l A-11e/l4�1 L 7-5 (4.. hate, lo 1-i % 4 2 Name and Title TYPE OF FACILITY: ?ro %0 515 E) Signature and Title RFPQRT RF.CF.TVFT) BY-* I acknowledge receipt of this report: SIGNATURE: 02/96 Rev. Title: '.WALL HILL ROAD 7 � 4 p Cf N00° 29'30 "6 X N/ ( SPRA 3 • o 0 'o a °o N 3' a 0 tw 4ol 0 e zZowoo.. L% 0 4c 16 °S: D N /F Ma6LASS0 BLDRS . I I 'I-, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner —Address Located at (Street) j�ft Tax Map 1:5 Block 3 LotA (indicate nearest cross street) Municipality_ Watershed SOIL PERCOLATION TEST DATA C Date of Pre-soaking Z 7 La Date of Percolation Test /C2z6z—CPQ- ........ ....... . ......... . .... ... .. ...... .... ... . ... . ...... ............... ....... -AhA.. D Rr .... . . ....... ........ ......... ..... ....... ..... xx ......... ......... .............. -9p . .... Van A r . . .. ....... p Mo a 'aft': .............. .......... .. ........... &19irV* 1101P..' ............ ...<; ... ii t -X-XX:.X .... ......... ... . .. ....... ....... 1,1007 - Id, I a 7 3 fl)-4 P 3 7 ;2� 3 3,7 4 5 2 3 4 5 2 .3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for. 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 Sheet--4—of_� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLH SERVICES FIELD ACTIVITY REPORT Street Town . State Zip PERSON IN CHARGE 0R TNTERVIFV��n /�i' %Z,/ fCJ /�f►1 L-55 T)atP_ / o % 7 % 0 2 Name and Title TYPE OF FACILITY: fie O %v D 15,5, L5 , Signature and Title RF.PDRT BECTIVFI) RY• I acknowledge receipt of this report: SIGNATURE: �-- 02/96 o 0 m Ix \ �> 3 D«p u. ;T / yle i - 2 NOO 29�3o�i '1 Io ! o SIM o 0 s .. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner _gg�Zje-y 66v -sT Co, Address Located at (Street) 3zz Tax Map (3 Block 3 Lot o (indicate nearest cross street) Municipality Watershed jFg,4AJ&,A1 .......... SOIL PERCOLATION TEST DATA Date of Pre-soaking 10271 /17 Date of Percolation Test o ...... .... .......... ... ........... .... . . . . ........ �:...X. V . ............. ............. . ... .... .. -D ep 6-:1. :g e ........... .. . .... . ....... ..J ... . .. . ..... T ......... ... ... ...... .... at S .. Start .. t .. ... ...... a-7 3 ? 3 3"15 30 :S7 4 —30 5 '7 27 2 2-,,,V4 36 2-1— a -/12 3 4 5 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. :5 1 min for 1-30 min/inch, :5 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 � - Sheet _of_� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLH SERVICES FIELD ACTIVITY REPORT NAMF• u �� 14Z y CDi(/S T, G0, Tel: 4Z AT)T)RF4C; Street Town . State Zip PERSON IN CHARGE f Date, INTER VIEVVE, yG Name and Title TYPE OF FACILITY : ?rev %05t,::: p S, 51 L5 , Signature and Title RF'PORT RFC'FTVF -D BY—' I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Rev. m � � 0 0 /l � x — NOO° 4 ��rp 9 � x . o J � 3 0 'o - o a .. PUTNAM COUNTY DEPARTMENT OF HEALTH ,,DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner -Eki I-Z-i/ Address 7? Located at (Street) R&, &ej Tax Map 3 Block 3 Lot (indicate nearest dross street) Municipality Watershed h �q5r:- 7:�, SOIL PERCOLATION TEST DATA Date of Pre-soaking IoZ71,oa Date of Percolation Test o/ /a -a. NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. < I min for 1-30 min/inch, _e. 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 ....... ....... ........... .... . . .... W. 6:1..V�a er ... .................. .... . .. .... . . S T fo up ..... . ` : 4n ....... at t 7 2 7 3 1 "ell �457 -Zq 12 7 3 4 13 1# 27 5 J ;20- eb 2. 3 49 13 7 a-Y— 27 5 00 6 31101°-3 +o8 7 07.7 3 2 &3 74 3:07— 3116 )_4 — �L7 88 11-7— 34':2-7 /0 �Lq -;L*7 3' -33 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. < I min for 1-30 min/inch, _e. 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 Sheet I of_� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLH SERVICES FIELD ACTIVITY REPORT WAMPf 7 X' az- `l noA.15 r, GO. Tel: Ad, Street Town . State Zip PERSON IN CHARGE ()R TNTFR VTFWFT): All DgtP• / o �/ 7 Name and Title TYPE OF FACILITY : pro 7;1.0:$ 15� S , L5 , FINDINGS: A Signature and Title REPORT RFC- FTVF.T) BY., I acknowledge receipt of this report: SIGNATURE: - 02/96 Title :. Rev. m 0 .I ' ,Deey x w b M o e m i 00 w N bc� ,{ W 9 -Xv r I� m Z o o�av 3 ro o r o 0 m a 1p iu In M a•a N00 °4230 "W 94.00^ woo* 5550 "W m NO2 °23' 10° W 41A.26' z •�'. — CORNIVALL HILL ROAD.. T "d JO 1N3WINdd30 AINnoo WUNind : 3WUN BRUCE R FOLEY Pubt. Health . Diesvor ATTENMONI t26Z- 8L2- Sb8 :�31 b2 :SZ NOW 2002- 6T -9nu LORETTA MOLINARI R.N., M.S,h, Msoclatt Public Health Director Dlrtcler aj. Patlent Servicti DEPARTIvMNT OF HEALTH . 1 Genova Road – Brewster, Now York IOS09 RQI ES1 FOR FIELD TESTING ❑ ADAM STIEBELING 0 GENE REED .-U information below must be Wli completed prior to any scheduling. DATE; -02. E NC,INEE,R 0R FIRM; A 2�i_ 1,CI. y�S .�, ; � PHONE a: 2 — X 00 REASON: / DEEPS: a PERCS; V/ PUMP TEST: ca ROAD /STREET, TONYM -T �So1111 ` TAX "N: l3 7-7 ,10,,�, S UB -D 1 VI S I ON,. LOT #: ; A —Z O WKER: 1),d _ CONS Te 0 C•1 1W Y•Y" I oh-Nj -•• I.II.WI��.�. H N'YC.DEP CRIJERIA FQJJ JOINT E.)aEW 6M WIT SSINQ „QF SQ1L TESTINQ 115 NV C Proposed SSTS-within the drainage basin of West Branch or B.oyds Corner oservoirs. C Proposed SSTS within 500'feet or a reservoir, reservoir stem or control lake. 0 Proposed SSTS within 200 feet of a watercourse or a DEC wetland. 0 Proposed SSTS design flow greater than 1000 gallonsldayor SPDES Permit required. 0 41 Proposed SSTS, for a Commerical Project. It is the responsibility of the design proiessional to provide the above information prior to soil testing. This Department will determine the NYCDEF project status (Joint or Delegated) based on the response. If you answeredym to any of the questions, NYCDEP must witness the soil testing. This. Department will coordinirte- a mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility, of the design professional to schedule re-witnessing of the soil testing with NYCDEP, FOR COus'ry USE ONLY DATE: l 4. TI�t$ :' �� �/ �1 ©(� ..�1 �4 I io 3 7,�s PRIVATE WAY A, --� 1 a �.�..,\ 3.0 7 1 3.08 M� • � 01 a n- rt AL 54 It 9.16 AC. CAL. s �,r �\ \ 1266se 53' 51.42 AC. CAL 5.9 AC \ • • �-- 192 m JJ ,645:39.x"' ' ✓ \ • �1.li. � l25 • 31018 N, ill iv `. i ter^ � U' ' \, J 52 ot27 AC.yg44 °N �12's �.._• .k o� s * 7 AC. CAL. 55 1, \ 7.9 AC i . CAL. �. '�• 820580 ? •co. a ;• w ° 1 ^�` Y 78.90 AC. 1\ e2• 1p8 ACJy� =� 22 V. 91.16 I AG. la G1L f A7 . y 1ttl9 e0 A . AC. = 8.02 AC. I\ ` 49.u4i� �e , x•-.. i. 320.1 .1 • O se's• 0 20 AL AL 4 43 14 4 AC. 340 856906. \ e4s.62 i °' J :1� 42 110.0 2 AC. i Q 1161.63 151 ° !1. 24 I.IOAC .J • 4 I • �z Q 29.6 AC. CAL z4 6u.31 I 47.45 AC. 4s9'4s I• ' 25 1 0 o,Aa 1g6eE I e .TV O \ 16 4980 °. Btie9 n° 56 \ "�6 40�a 4.32 AC 17 • 1. 4i 3.17 AC.52 81.48 AC, �; a �ay� 18 j \ b 39� • .0/2 -O2 3AS. SSG. e4 I "3.85 AC. 1T4� a 9t SAL 644 ki y\3.92 �1 AC I 5414 / • f •\ d O 67 \ �� C 34.42 AC.. _ * \ 37 40.16 hC. (I I 32.13 AC. MkGo 34 R� 6T AC. CAL. I \ I I 38 ��IL� ^� ry I Y ' \` I 158,4 AC. CAL. 1.5 ac. cAL.