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Home My WebLink About0410DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -3 -64 BOX 5 I I INS 11 1 Is or I ., NJ NJ him J6 'r ILr rX :,T L :L r L +L I� �'. I Muir, 7. 1 i r ��. J6 : L Lr I IN 00219 Rev. 3/86 r� CE OF CONS PUTNAM COUNTY DEPARTMENT OF'HEALTH Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Mast Provide p- 2 5- 8 7 P.C.H.D. Permit N -- . - -- FOR SEWAGE DISPOSAL SYSTE a Located 311 at Route . Owner /applicant Name William Von E S s en Formerly - Melling Address 09 =Fair St Carmel, NY Zip_ 10512 T. Patterson Town or VWage Tax Map 10 Block 3 Lot 11. 21 VotiEssen& 1 Subdivision Name _VnnFGaan Sabdv. Lot k Date Permit Issued 4116/87 Separate Sewerage System built by Owner . Address Same.. as above Consisting of 1000 Gallon Septic Tank and 500 Ft. x 24" wide x 18" deep Water Supply: • _ Public Supply From e r Hyatt Address or: ! X "Private SupplyDrWedby. $nna Tnr_ Address Rte. 311, Patterson, NY 12563 Building Type Frame I Has Erosion Control Been Completed? As required Number of Bedrooms Three Has Garbage Grinder Been Installed? No Other Requirements, None I certify that the systems) as listed serving the above premises were constructed,essantially as shown on the plans of the completed work ( copies of which are attached)•_and i;n'accordance.with the standards, rules and regula ns, in accordance with the filed plan, and the permit issued by the Putnam County Department of Health. Date 8 April 1988; I Certified by P.E. X R.A. Address License No. 29206 Any person occupying premises served by the above system(s) 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 pubt': unitary Sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes availablo. Such approvals are subject, to modific�tio or change when, in the judgment of the Commissio /iia" of Hea revocati nn, modification or change Is necessary. Date /�^ •�' ��I, T.TVT T rATMT VTTnNT V PnPT r VV"-" vv Office Use Only DEPARTMENT OF HEALTH Division Of Environmental Health Services 0 PUTNAM COUNTY DEPARTMENT OF HEALTH LOCATION STREET AD FIESS: WNlvt ' ! 1 Y W'010 NUMBER WELL �. i WELL OWNER NAME:. ADDS j PRIVATE c.. `7 1 , I ! D PUBLIC USE OF WELL RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP D ABANDONED 1 - primary ❑ BUSINESS O FARM ❑ TEST/ 0BSE,RVATION O OTHER (specify) 2 - secondary ❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY O MOUNT OF USE YIELD SOUGHT /0 gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE 600 gal. REASON FOR NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION DRILLING O REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH /�� ft. STATIC WATER LEVEL I� ft. DATE MEASURED K .� DRILLING ❑ ROTARY COMPRESSED AIR PERCUSSION ❑ DUG EQUIPMENT O WELL POINT, O CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. OPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH 2 ft. MATERIALS: STEEL ❑ PLASTIC 0 OTHER CASING LENGTH.BELOW GRADE ft. JOINTS: O WELDED YTHREADED ❑ OTHER DETAILS DIAMETER in. SEAL: ❑ CEMENT GROUT O BENTONITE 90THER WEIGHT PER FOOT � Ib. /ft. DRIVE SHOE AYES ❑ NO UNER: 0 YES KNO SCREEN DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST O YES ONO DETAILS SECOND HOURS GRAVEL PACK ❑ YES GRAVEL DIAMETER TP BOTTOM ❑ NO SIZE: OF PACK _ in. ft. DEPTH it. WELL YIELD TEST If detailed pumping WELL LOG if more detailed formation descriptions or sieve analyses t MEJHOO: O PUMPED tests were done IS in- are available, please attach. DEPTH FROM Water well COMPRESSED AIR , formation attached? O BAILED ❑OTHER D YES D NO SURFACE Bear- In9 Dia- FORMATION DESCRIPTION LOGE, ft. ft. In WELL DEPTH DURATION DRAWOOWN YIELD Surface ft. hr. min. It. gpm. .� J- i� /00 .0 WATER 9CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE tro CAPACITY GAL. PUMP INFORMATION - �Af- TYPE -SC4 6I'19 ErSf CAPACITY WELL DR►tIEA NAME DATE & SONS, INC. MAKI DEPTH /Oa Af BERT M. HYATT MODEL cS�� ° ®� VOLTAGE��0HP AOOR Well Drilling SIGhXTURE Rte. 311 R.R. 2 BOX 171A SON, NEW YORE( 12563 7 Yorktown Medical Laboratory, Inc. 321 Keai Street Yorktown Heighis, N. Y. 10598 (914) 245 -3203 Director: Albert H. Padovani M. T. (ASCP) T- VONESSEN, WILLIAM RD #9, FAIR STREET CARMEL, NY. 10,512 L -1 J LAB N 1 A.0065.99 Date Taken: !z /22/88 Time: 12;150m Date Rc' d : 7/2240 aa%sr : 7T."Mom Date Reported: Collected By: VonEssen Referred By: Sample Location: Well Roue 311, Patterson. Ny. M5b3 Phone N 0'(0-14000 Phone N 37b4006 Sample Type: Repeat Test? _ 1(check one) LABORATORY REPORT'ON THE BACTERIOLOGICAL QUALITY OF WATER GENERAL BACTERIA X Standard Plate Count (CFU /1.0mL) (Agar Plate @ 35 °C) MEMBRANE FILTRATION TECHNIQUE (MFT) X Total Coliform (CFU /100mL) Fecal Coliform (CFU /100mL)- Fecal Streptococcus (CFU /100mL) MOST PROBABLE NUMBER TECHNIQUE (MPN) Total Coliform: MPN Index .(per 1OOmL) Fecal Coliform: MPN Index (per 100mL) .OTHER ANALYSES REMARKS (For Laboratory Use)_ I 1�> X Potable Non- potable _ STP INF STP EFF _ Other: Sample Status: (check each') Outgoing Na2S203 Incoming X LE 4 °C GT 4 °C KEY FOR TERMINOLOGY RDS = Recommend Disinfec- tion of Source TNTC= Too Numerous To Count ,CON = Confluent ( =TNTC) LE = Less Than or Equal to GT = Greater Than. N/A = Not Applicable THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS) (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 COLLECTION. �Fzlvm g/ vV Albert H. Padovani', M.T. (ASCP), Director For Lab Use Only:_ H/C to PUTNAM COMY DEPARDIENT OF HEALTH DIVISION OF ENVIRONMMI`AL HEALTH SERVICES William Von Essen Jr_ Owner or Purchaser of Building Owner Building Constructed by Rte. 311 Location — Street T. Patterson Municipality Frame Building Type 10 3 11-21 Section Block Lot Von Essen & Von Essen Subdivision Name 1 Subdivision Lot # GUARANTEE OF SUBSURFACE SEtnTAGE 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 Environinental 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 6 day of April 1988 Signature X Title General Contractor (Owner) - Signature Corporation Name (if Corp.) RD9 Fair St., Carmel, NY 10512 Address rev. 9/85 mk Installer Corporation Name (if Corp.) RD9 Fair St., Carmel, NY 10512 Address FagAT SITE LNSPECTION Data Cam" iispe =tom by a. \ v z OR Sii EDD�T1S1CN ILZ a T I- Y'tS I`� cr_n —. TS DISFOSPL P• - -REA a_ SIDE �� jr ea as GJDrGVErL IGns b i-11 1 s2c: � ticn - Det cf placnt 2.1 L 711.1 P-VG _ DPTr_ _ -� " I ,_ r r-1 501 I1Gt 5 t'_• ir=Ed C_ � r-- II br�h, etc_ , cre =t =r t-�n 15' f =are SLS ._c, _I--- - I-- j d I C,✓� kv e. 100 ft- f=Qn' Wct =r ccur�c %ct_I arm. T-' 1,000 1,250 I/ a - C. 10 Ii�Ill? .irT4ii L =QI1 fC�'rC� -�-i CIi I I I COY li(� _ a_ within 10 fc_ cs A-50 band e. DDSu�LZTGti ECk _ I I I�� I CAA 1. Pi 11 i 1 c S aC E is e evatic ! - wa-a- t=��r /! CLL_' 2. Protr� b�aN f =cst 3_ r1i*liT':LT�[ 2 Lam_ Cric -i =- SG1l �c =ric_ ^_ bcx Er-d t== 'C_'�S I •I 1 f. - -T I I (lEl ��CI'ICN EL'X ' Crccerly - Q 1— L —_ ...� - �`./ Lc_C -�i1 inc =- l 1 =�.e V `✓ 2. Dist =nc°_ it^ wata'c .L�`c rrez a : f = 3. inst l 1 acs -rr nc tc Dist nCe C= '"1L =r to C_ntar /I 5 5. Slctz o= tra ch acc_o��1e 1/1 - 1/32 6 10 fir f crc-ce- lL re - 20 f —= - iC=,-= 7. Len z cf ; tench < 30 incZ_s f=an s: =ace I it 8 _ 1 fCZ EY^_c_nci CP_, 50% I / Q —Size Crave-O_ 3/4 i Mini ra 10. DCr ctl O= tr 1C1 I� I E_-lcs Cccer h. C?R MSE SES I I ] _ S1Ze Of 2. 3 _ P1a1, a'. =-i o i d p--m ers21 cc=eEs? ble Ira^^ol°_ to Crade 5. First bcx baf I I 6. Cwcle W i iTi = =° _ by Es �1II cte!1 flGTN � c c e I IV W. Ecci- l accrcv a . b. rti..e_r cf beErccros I I 1 V. V .+L I a_ well Zccat�S a5 a -crc' DI_i'S b_ Dis'nce fran -DS are= . ire =ss ft- c. C_ =_inc lb" ja-cve- crate_ C ir=cC° Cyr ^;C= cr n0 1 Gccas� G_ l_. '- CL wz_1 vi. . G"v .aPTiJ 4iORK�`nacr �� I ��•S a_ Ecxes rat lv C C:U b. P> > Aires -�a11v back filler c. All iras flLa wi t_'1 i_rlsice of bcx I I it tria ctc n? i ns s tcnes < a" in ciama t = c. Eackfill r I I _ _ i:1 CS'_' R 1 ^5 =11=? cCCGr^��' na to plan U l l rs Fi �r.t0 Ev_ic`_Wct =TCCL 2✓ J f_ cu in cr�i*� cLt =a-y prct__�__ ✓ r`i rs S..:_, -rGe a'NCV f�uu CI�.0 ar^E I / C i,=�r = ZvG�T �rCtr Cn cCe� =� h. �__ _ i _ C t=0! CrCV i (:led Ct1 s1CCes C=E= — t= �� 3 _ -tc i CP C PUTNAM COUNTY DEPARTMENT OF HEALTH Re V . 3/4 Division of Environmental Health Services. Carmel,,N.Y.10512 Engineer to Provide Permit q on CERTIFICATE OF COMPLIANCE 4 . Permit q ' = CONSTRUCTION RM1T FOR WAGE DISPOSAL SYSTEM T: Patterson Located at Route 311 -Town or Village Subdivision Name Von E s s en & . Von E s s tag �t q 1 Tax Map-Block 10 3 Let, 11.21 Owner /Applicant Name William Von 'Essen Renewal_❑ Revision ❑ Date of Previous Approval Mailing Address RD .9 - Fair Street Town Carmel. NY Zip 10512 Building Type .Frame Lot Area 43200 [FIll Section only NO Depth Volume - - Namber of Bedrooms Three Design Flow G /P /D 600 PCHD Notification Is Requkvd When Fill to completed 1000 500 ft. x 24 in. wide x 18 in.. deep Separate Sewerage System to, consist of Gallon Septic Tank end To be constructed by Address Water Supply: PubllcSupply From Address or; X Private Supply Drilled by - Address Other Requirements None I represent that 1 am- wholly and completely responsible for the design and location of the proposed system(sii. 1) that the separate sewage disposal .system above described will be constructed as shown on the approved amendment a _ there to and in accordance with the standards, rules an regu ions o e u nam County' Department of .Health, and'that on completion thereof a "Certif icate of Construction ,Compliance ".satisfactory to the Commissioner' of Healthwill be submitted to the Department' .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 off; said sewage :disDosa,l system tluring. 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 oiiginal 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.. i9l accordance .with the st ards, rules and regula —i'ons ' of the Putnam County Department Of Health. - Date 31 March 198.7 Signed P.E.— X R.A. — Address - RD 9 Fair S.tre. t. Carmel, ' NY 10512 29206 License No APPROVED FOR CONSTRUCTION: This approval expires one year from e e issued nless construction of the building has been undertaken and is revocable for cause or may be amended or modified when considered nece ry the Co is loner h. Any change or alteration of construction requires a ew p it. p ed for disposal Of domestic sanitary - g and /or a r O J Date By Title °3. DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVILhb il: Vol,* * ,' �iS l` `t.'ii�:L'�il:�a►:� «�.y�:r:�ell REVIEW SHEEP - CONSTRUCTION PERMIT DATE �E WED : BY: et Location) NO DOCUMFN'T'S Permit Application u ma- rporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth 4F trench provided required 60 ft.'max. Parellel to contour a _ House Plans - Two sets Well permit; PWS letter .. Uariance Request GENERAL Legal Subdivision Subdivision Approval Checked Ex- 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 Flow -Fill Profile & Dimensions - Volimle D or J Box;Trench /Gallery; Pump'.pit details Septic Tank - Size, Detail Well Detail, Service Line if over -Construction Notes s/s SUBDIVISION Perc ' (3) Fill cd — ,pesign 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 fil 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expar 15' to Drains - -Curtain, Leader, Footing 351to catch basin,stormdrain,piped watercour: 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' fran Foundation; 50' to well 15' Well to PL 9 10 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 # � ! �-v WELL LOCATION St et Address Rel 11 T Village City Tax Grid Number om� T t'd-E-E-e rsor) lo -)--111 �-I WELL OWNER r s Name it vm' c F-55e Mailing Address R '� + Vr' C4 rrjjef NY 10 QPrivate 12 ❑ Public USE OF WELL 1 - primary 2 - secondary 61RESIDENTIAL El BUSINESS ❑ INDUSTRIAL ❑ PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP ❑ FARM ❑ TEST /OBSERVATION O INSTITUTIONAL ❑ STAND -BY ® ABANDONED ❑ OTHER (specify AMOUNT OF USE YIELD SOUGHT riVe gpm /# PEOPLE SERVED 5;jX /EST. OF DAILY USAGE_+00 gal REASON FOR DRILLING KNEW SUPPLY ❑PROVIDE ADDITIONAL SUPPLY 0 REPLACE EXISTING SUPPLY ® DEEPEN EXISTING WELL ®TEST /OBSERVATION DETAILED REASON FOR DRILLING (dat C'(11-111 gnature) WELL TYPE DRILLED ❑ DRIVEN ®DUG ® GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES >_NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: VOil ESSNh I yav, Essen Lot No. WATER WELL CONTRACTOR: Name ? Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES __y_NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED l.See �!UTE g Ja - Sp 0<7 So h 41 []ON REAR OF THIS APPLICATION ON SHEET �i-o��rsSr�,ta f6 (dat C'(11-111 gnature) 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 permi . 3. Submit a Well Completion Report on a form provi t u Cou y Health Dep rtme t. Date of Issue: 1 Date of Expiration: 19 it ssuing ficia Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner 287 Orange copy: Well Driller DEPARTMENT OF HEALTH \ Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL /J PCHD PERMIT # WELL LOCATION IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATEDIN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name ( 'r`Say�$ J&t_,Address:jj,R. a& 171,4 &ffr_'Sdh PUBLIC WATER SUPP NAME OF PUBLIC WATER'SUPPLY: DISTANCE TO PROPERTY'FROM NEAREST WATER,MAIN: TOWN /VIL/CITY LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ®ON REAR OF THIS APPLICATION g N SEPARATE SHEET (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 appl i cant 's.hal l : 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 provide�,by the Putnam County Health Department. Date of Issue. 19 vim, Date of Expiration: 1g ermit Issuing �fi i a . Permit is Non - Transferrable copy: H.D. File o/Q% Yellow copy: Building Inspector Pink Copy: Owner 287 Orange copy: Well Driller 'Street Address 'f•, Sit Town/Village/City Tax Grid Number 7 r // WELL OWNER Name h r_,j Mailing Address Pp.#9 ).A;R:5 re,-f CA�117� � %> >V Private O Public USE OF WELL 1 - primary 2 - secondary RESIDENTIAL 0 BUSINESS INDUSTRIAL O PUBLIC SUPPLY O FARM O INSTITUTIONAL O AIR /COND /HEAT PUMP O TEST /OBSERVATION O STAND -BY ❑ ABANDONED ❑ OTHER (specify AMOUNT OF USE YIELD SOUGHT 4 gpm /# PEOPLE SERVED /EST. OF DAILY USAGE Qo gal REASON FOR DRILLING NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY OREPLACE EXISTING SUPPLY ODEEPEN EXISTING WELL ® TEST /OBSERVATION DETAILED REASON FOR DRILLING r p f , 0 4 WELL TYPE DRILLED DDRIVEN ®DUG ®GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATEDIN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name ( 'r`Say�$ J&t_,Address:jj,R. a& 171,4 &ffr_'Sdh PUBLIC WATER SUPP NAME OF PUBLIC WATER'SUPPLY: DISTANCE TO PROPERTY'FROM NEAREST WATER,MAIN: TOWN /VIL/CITY LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ®ON REAR OF THIS APPLICATION g N SEPARATE SHEET (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 appl i cant 's.hal l : 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 provide�,by the Putnam County Health Department. Date of Issue. 19 vim, Date of Expiration: 1g ermit Issuing �fi i a . Permit is Non - Transferrable copy: H.D. File o/Q% Yellow copy: Building Inspector Pink Copy: Owner 287 Orange copy: Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF HEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOaAL''$YSTEM FILE NO. Owner Y0,7 g5gpppAddiess 1 Located at ( Street) C4S t > i p Ni � �4,l 11 771 /V Block 2 Lot . 2 (indicate nearest cross street) Municipality Watershed Date, of, PrerSoaking G� 8 %$ G Date of Percolation Test G 1) a Le HOLE N[MM • CIACR TIME PIIt(7QL'ATION PERCOLATION Run Elapse Depth, to, Water -Fran Water Level No. Time Ground Surface In Inches Soil Rate Statt- SYop,Min: Start Stop Drop In Min /In Drop Inches Inches Inches •'4 )0 3 a �� '1,6�g ��f:..: l ; II I 3 30 VIll. z jl 'jlf� I 30 3 II��' tt�S 3° - - -- -_1-- - - -/3�8 - -- - - -- -3 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' 2' 3' 4' 5' 6' 7, w4 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. -I,- 8' J g' 10' 11' 12' 13' 14' m INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED G 'lL � 13e.( o w r-, Grade INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCJOUNTERID I\jo C�ar►�YP DEEP HOLE OBSERVATIONS MADE BY: Fn j d ,4 e R C . . H . DATE: G b DESIGN Soil Rate Used 11-30 Min /1" Drop: S.D. Usable Area Provided No. of Bedroams %'free Septic Tank Capacity /000 gals. Type 114rS Absorption Area Provided By 00 L.F. x 24" width trench Q�)f ESSIONgI Mer No n e Nate Signature Address JOHN N SEAT' FAIR ST 914 -8 •E' CARREL, NU YORK 1051270 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq. ft /gal. Checked by 6 rte. Cve G �"AJi ryo 292p6 �OFTHE ST�� ,•y rr, Date - , � - 9/ 9/ " e- tj'(S' k?13lJ -TL—:: 71 78 3 G----------- /J 4 al ft-cnam Gaunt':.? Department of Realtb X Ivieion of Envlr - "AS Q!J1Lj'-_DATA, Structure located from survey by surveyor noted belowO- Well located by': Surveyors survey*•- -- M - -- — Well drillers leport-- --Q- - — Engintiers,mesurementsfl- Tank, boxes, pits, galleries 8 laterals located by:Contr . actor; Engmeers He a Ith dapl;: ❑ Field inspection by: Health dept d a t a : En qt no 0 r- This is 1,0 certify that the seiJa 0 disposal system was constructed as NOTES: indicated on this plan and that the system wjj�� inspected by me before it -i's covered over. The system, was I constructed in accordance with ajI 5t.anda,.1 -1- and re f D I M F- N SIQN 5 A B A 0 B L) A E A & 7 G 7- A 'A 8 j A K -0 X rME solti: nw,on al Health Servioet Approved 09 I'D crinfortitanoe with applica*03 iT,j J.ii'l,%ilatlons of the I�t>isDCautrtY .h Lap rtment.. SAN ITARY SYSLEM DESIGN A UILT" attire Tit 10 a 9 LOCATION Srreet:_A,/,f'�� :�3ZII A. d L State: _7-C20un1y t •L 7 SUBDIVISION: ;7' BI ock LOT N4._- Z/t .ej A Builder; Dr..n: Style: �Pqb. N4 7- J O H N H_ PR E N TIS-S, PF r ��+ o oa or c o0.7 ma ens nq layer of ,` sertlrng or one over 4 DISTR Tole tram et i7i ' oar a opBT trench grade �ipes _ oft -4 ° /,p foot ceon l be c .�mai�doptA baffle I — „soli ii 1+ -- Pita a 1 le 17 1 IPe , A c 0 4rovol°f j`O \ 4 Oerfoot A from settling or �\. i 3/4ai!n�r (P— dosing links ` o°ull /2 max.l5minabova 4 "9perforaroundglater' in $ earth to be romped a 'edge rock pope lievei man• o tlggtly around to oddl -� - -i -- distribut on box I y laterals I I SECTION A -A SECTION 8 - 8 out DETAILS OF DISPOSAL FIELD EQUAL o l R TIM to at or to n Ilimit ofi�: gravel A inlet 4'J2( solid pipes I �ir� ddin9 POP 6 "top soil oo�t to next grade from septic ank box 12. "d - to absorption tro c 3 /4'stons or Both boxes) { ; gravel om of box must bo 11 t �f firmly supported to I I! a graded ..! 4 "0 foroted DoloW ground level. OVERFLOW i , � ; � 1 x g stone s. 2)Woterproefod m000nry. of SYSTEM IE T CAL CURTAIN DRAIN 3)Tilot joint prpo from s �_ 4 Bafflos to Insuro oque PLAN SECT16N f ° moo' - o; �✓ !82 •�7 r, 77S p1 ` 7�mph°iiiiii ;fcnedrancn/ro3 n ' J Jkpc o4vy ln+oi pomp P�drida t .vCnl �� 700 aAi-�. �:� a ^"�� %�olrl f7 �I � fcaimg; a.Acr . epurrrd. } • ma%��c I4 �U 45o In —7i•'' d :, , fla l dl' �,5� 4ti/G -L, �zY�y��rl, ,. �` h ° •t5 ga°°a Ap.., r t �6�,C1 'Wf�L :lri7` I• ` Y�r� a i-•` eft PS .'p,��t G sa •' 1 +. 1 I 452 !! LJ � 1 I I I l . r r