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HomeMy WebLinkAbout0551DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -1 -18 BOX 7 %b - ■ ra L ;Ilk.�. 00551 Rev. 3%86 PUTNAM COUNTY DEPARTMENT OF HEALTH ^ Division of Environmental Health Services, Carmel, N.Y. 10512 (( Engineer Must Provide . P.C.H.D. Permit N -- CER ATE OF CONSTRUCTION, COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM P e. -Q yz o K p Town Locatedatl?e l,ornl��/,�: �0�/R Tax Map Block�_Lot- pp —6_' CC' r9 WG a 1 Owner /applicant Name �ri!ce �'S l+� Formerly Subdivision Name 14_rrG Snbdv. Lot q Mailing Address <1k " A ' 0 �G' P v in cd ll U i7 Zip 0,611 12 Date Permit Issued Separate Sewerage System built by SC o s G yc r4 A4e e 1:0 y'w' Address & wlyn-c rG d jl ko ? l Cantu ,, i zy Consisting of t2j; b Gallon Septic Tank and :G © 4 L r i�Y. 6 ti n.,j %es >— Watei Supply: Public Supply From Address oy (J Well Address %Z� 2 (Id1 -IM4l' . N / A or: Private Supply Drilled by Building Type Has Erosion Control Been Completed? S Number of Bedrooms Has Garbage Grinder Been Installed? �� V Other Requirements I certify that the system(s) as listed serving the above premises were constructed essentially as shown on he plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and re ations, in accordance with th fil pl and the permit issued by the Putnam County Department of Health. ,/ Date 4�? l� Palo Certified by P.E. R.A. AddresS 1 r ✓1 12-15 license N0.56 12-q 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 pub :% sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Commissioner of Health, such revocation, modification or change Is necessary, Date By— ale MID - HUDSON PUMP CO. INC. MID - HUDSON P UM P CO. INC. WATER SYSTEM SPECIALISTS EMERGENCY SERVICES Affordable Housing Alternatives Studio Apt, Fox Run Apt. Carmel, N.Y. 10512 To Whom It May Concern: (914) 226 -4641 IF NO ANSWER (914)831 -8410 RD #4, BOX 558A, RT. 376 HOPEWELL JCT., NY 12533 October 23, 1987 On September 25, 1987 a 12 H.P. Goulds Submersible Pump was installed on Lot #164 -2 RT 164 & Cornwall Hill Road, Patterson N.Y.. This pump is capable of producing. 5.63 G.P.M. A 350 Well X Trol Tank was installed which is equivalent to a 360 galvanized tank. Sincerely Yours Lucy A Ruhle President PUrNAM CCUWY DEPAI MENT OF HEALTH DIVISION- OF ENVIROiNN=AL HEALTH SEKV -ICES /�f'Fo i ✓4 d�c. i%u.rT., � �GTe�.,o %�`�ol, .z-� < _ I � � 24 Owner or Purchaser of n__a Building - n- Block Lot ing- Constructed by Location - Street Municipality Co %_,a l Building Type ebrnwe l) 4 &,'e5 Subdivision Name 3 Subdivision Lot # GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTR4 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 irmediately 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 Putncim County Department of Health as to whether or not the fails caused by the willful or negligent act of the occup< the system. Dated this - day of ~�= 19 d' 7 Signatur( Title General Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk rporation Name (if Corp.) Andress / 17 � 12 ,2 S - 76 c� a. 3 .e WELL LOCATION WELL UUP1YL1;11.v1y nzrvnl Office Use Only DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH - STREET A00FIESS. 7OWNIVIELAultaly TAX GRIO NUMBER: (70kNw,44_1 -- /JELL Af / —w50/�/ WELL OWNER NAME. ADDRESS: J- 49,e_EzS:F11",r-7V !�/fG�L ���,� Ile-e .EN ��5� ,Gv e%&,)&7 )9 P8IVATE O PUBLIC USE OF WELL 1 - primary 2 - secondary -K RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED O BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify) O INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT �.5: gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE_ 4Q gal. REASON FOR DRILLING '. NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY El TEST /08SERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 6 -10 ft. STATIC WATER LEVEL �� ft. DATE MEASURED DRILLING EQUIPMENT O ROTARY TZ COMPRESSED AIR PERCUSSION O DUG O WELL POINT O CABLE PERCUSSION O OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING 'OPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH ft. MATERIALS: )'STEEL O PLASTIC D OTHER LENGTH .BELOW GRADE tL JOINTS: ❑ WELDED �'`fFfREADED O OTHER DIAMETER _._ 4 in. SEAL: WCEMENT GROUT O BENTONITE ❑OTHER. WEIGHT PER FOOT ` IMIL DRIVESHOE:j5YES ONO I LINER: OYES KNd SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (11) DEPTH TO SCREEN (ft) DEVELOPED? FIRST ❑ TES ONO HOURS SECOND GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH ft. WELL YIELD TEST If detailed pumping METHOD: O PUMPED tests were done is in- ,f COMPRESSED AIR ;formation attached? O 8AILE0 0 OTHER ; ❑ YES ❑ NO �IELL LOG If more detailed formation descriptions or sieve analyses are available. please attach. DEPTH FROM SURFACE Bea��- ing Well Oia- Deter FORMATION OESCRIPTION gtle, tt., ft WELL DEPTH It. DURATION hr. min. DRAWOOWN ft. YIELD gpm. Surface h 3 0 rO7-A WATER ❑ CLEAR TEMP. OUAUTY O CLOUDY HARDNESS ❑ COLORED ANALYZED? ❑ YES ❑ NO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP� WELL DRILLER NAME [lAkll b A RESS /r.�/e. SIG1 / AI i / lo5� BOYD 7 ARTESIAN WELL CO., I C'. TO: PUTNAM COUNTY HEALTH DEPARTMENT SUBJECT:.DOMESTIC WATER WELL YIELD - Paul Lill Rt. 164 & Cornwall Hill Rd., Patterson RE: Minimum water well yields Our practical experience with numerous wells of similar characteristics suggests that this well should provide an adequate, safe and reliable water supply when equipped with a properly sized pump and storage tank. In support of this opinion the following points are noted for your consideration. 1. WELL DIAMETER = 6" 2: WELL DEPTH = 630' i 3. STATIC WATER LEVEL = 38' 4. PUMP SETTING DEPTH = 600' 5. NET PUMP SUBMERGENCE FROM STATIC WATER LEVEL = 562' 6. WELL BORE UNIT VOLUME EQUALS APPROX. 1.5 GALLONS /L..F. 7. THEORETICAL MAXIMUM WELL BORE STORAGE CAPACITY = 843 GAL 8. 24 HOUR PUMPING TEST DEMONSTRATES WELL YIELD AT 2880 GPD 9. AT A DEMAND RATE OF 100 GPD /CAPITA, HOUSEHOLD WATER DEMAND WOULD BE 500 GPD FOR AN AVERAGE FAMILY OF FIVE,OR APPROXIMATELY 60 PER CENT OF THE MAXIMUM WELL STORAGE OR APPROXIMATELY 17 PER CENT OF THE DEMONSTRATED WELL'YIELD. THEREFORE AT A SUITABLE PUMP SETTING THE WATER SUPPLY FROM THE WELL IS MORE THAN ADEQUATE TO ACCOMMODATE A SIGNIFICANT INCREASE IN DAILY HOUSEHOLD WATER DEMAND. i 10. TO FURTHER ILLUSTRATE THIS, IF WE ASSUME THAT THERE WERE NO RECHARGE TO THE WELL FOR 24 HOURS, BUT HOUSEHOLD DEMAND CONTINUED AT THE ANTICIPATED RATE OF 500 GPD, THE WELL WATER LEVEL WOULD BE LOWERED APPROXIMATELY 335 FEET.HOWEVER, AS THE WELL HAS A DEMONSTRATED YIELD OF 2880 GPD AND A WATER LEVEL RECOVERY OF APPROXIMATELY 80 FEET PER HOUR, THE WELL WATER LEVEL WOULD RETURN TO THE STATIC WATER LEVEL AFTER 4.00 HOURS OF NO PUMPING. 11. OF COURSE, IN ACTUAL USE, ANY PUMPING FROM THE WELL WILL CAUSE SOME RECHARGE TO THE WELL FROM THE AQUIFER, AND TYPICALLY, HOUSEHOLD WATER USE IS NOT CONTINUOUS, BUT OCCURS IN SEVERAL "PEAK DEMAND PERIODS" THROUGHOUT THE DAY. DURING THIS TIME THE PUMP WILL DELIVER WATER AT 5 OR MORE GALLONS e x PER MINUTE.FROM THE STORAGE IN THE WELL BORE, AND AS THE PEAK DEMAND SLACKENS, THE RECOVERY WILL.CONTINUE AS OUTLINED ABOVE 12. IN`'A :1`:TYPICAL 24 HOUR PERI.OD;.INTERVALS OF LITTLE OR NO USE MAY COMPRISE A TOTAL OF MORE.THAN TWELVE HOURS, DURING WHICH WATER LEVEL RECOVERY CONTINUES AND WELL BORE STORAGE IS REPLENISHED, 13. IN REVIEW OF THESE POINTS, IT SHOULD BE APPARENT THAT THE DOMESTIC WATER WELL IN QUESTION CAN PROVIDE AN ADEQUATE SUPPLY OF WATER, WITH AMPLE MARGIN FOR FUTURE WATER DEMAND GROWTH. ry M. Boyd r es. Yorktown Medical Laboratory, Inc. 321 Kear Street Yorktown Heights, N. Y. 10598 (914) 245 -3203 Director: Albert H. Padovani M. T. (ASCP) - f�rjtns an (,06e L J LABORATORY REPORT ON THE QUALITY OF WATER LAB y CA.005658 Date Taken: Time : Date Rc'd: / Time: .� Date Reported: �o a13 g Collected By: - Referred By Sample Location: V/')0M FCU Phone 11 - Phone # I Sample Type: Repeat Test? _ (check one) INORGANIC NON- METALS (mg /L) MICROBIOLOGICAL (CFU /100mL) Acidity _ Alkalinity _ Chloride Detergents, MBAS Hardness, Total Nitrogen, Ammonia Nitrogen, Nitrate Phosphate, Total Sulfate _ Sulfide Sulfite METALS (mg /L) Copper _ Iron _ Lead Manganese _ Mercury Sodium Zinc MISCELLANEOUS pH (units) Color (units) _ Odor (TON) Turbidity (NTU) GENERAL BACTERIA ;"'�Standard Plate Count (CFU /1.OmL) MEMBRANE FILTRATION TECHNIQUE ✓ Total Coliform Fecal Coliform Fecal Streptococcus MOST PROBABLE NUMBER TECHNIQUE Total Coliform Index Fecal Coliform Index KEY FOR TERMINOLOGY N/A = Not Applicable LT = Less Than (< ) GT = Greater Than (>) TNTC= Too Numerous To Count CON = Confluent ( =TNTC) NR = Non - reactive REMARKS /COMMENTS (For Lab Use)_ Potable Non- potable _ STP INF STP EFF Other: Sample Status: (check each) Outgoing _ HN'03 _ HC1 H2SO4 _ NaOH ZnOAc Na2S203 Other: Incoming LE k °C _ GT k °C _ pH LE 2 pH GE 9 _ _ pH GE 12 Other: THESE RESULTS INDICATE THAT THE WATER SAMP (WAS) (WASN'T) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO W -YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DIDN' ) (N /A) EET THE SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STAT INKING WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. X1 2 /86(Rvsd7 /87)RWE lbert H. P.e.dovnnj, M..T.,:. (>ASCP).,,,.Dir..e.etor;. ,.,.,...,. �v..,... . L61 PUTNAM COUNTY DEPARTMENT OF HEALTH �/j, 111 Division of Envleonmegtal'Health Se vices Carmel, l N.Y. 10512 EnBlneer. to Provide Permit q; , on CERTIFICATE 'OP COMPLIANCE ' � CONSTRUCTIO FOR SEWAGE, DISPOSAL SYSTEM - Permit q -, �/ Hi�-a -1 v Located at B&ry_ 16 2°- b-aq A d�d.T'�2 �.7I o J Sabdivlelon Nand E1i�I&4tk'�! iys Sabel: Lot q -� Tax Agsp Block Lot 3� O wne li r /Appcant enewal_(] `Revision Date of Pttavioas Approval_ _ MaWog "Address y -� (U .. 1�7 . D7 Town Zip :. t�Lt�C7f Lot Area As Bill" �Pe Fill secdoa Onl Depth" Volume Number of Bedrooms Deeigti Flow G ,P "D_ ` �i PCHD N60catlon is Regained Wheel FIII is completed ; Separate Sew ®rage System to con®lst otQt `d �° l pallon Septic Taak,an 2 44F, To he constructed y � Add Water Sappy; Pab11c Supply From :_ Address -; :. � or: Private Supply DrWed.by Other Ren Wil elite I represent that am wholly and,'complefely responsible for the design antl. location of the propose4 systems) 1) that the separate sewage Disposal system above described will be Constructed as shown oritfie approveiJ'amendrnent there to antl lmaccordance with. the standards rules.an regu a �ons.o e"', u nam County Department - of,`�Health; .and that on completion thereof a,'fCertificate, of. Constr uc tion,Compliance':,satisfactory fo the Cominissfoner of Healthwill be, submitted to the -Department; and a written guarantee will be furnished the,owneri his successor s „heirs or assigns by the builder;.that said builder Will place in ,goo G'operating,contlit ion. any, .part of. said sewage ,diil osal system during the perlod.'of two (2) years immediately following thedate of the issu- ance;ol. tha,.:approval oY.;tho` Certdlcete, "o} Construction �Compliance,of the originafsystem,or. any repair's .., 6to; 2) that the drilled well described, ;above will'DeJlocated as shown on Me approvetl plan anG <that said yell w Iled? in accor_Gance 'wit_h'.th ' dartls, Mules lid •iegu a�'ons - of the Putnam County Oepa tment of Health.. ' - /S D 1� Date � /as.��pb � Signed J.Address ..jy^ • v .3License No APPROVED FOR CONSTRUCTION This approval exp�rei -two yeaii� from•thedate- issued unlesrconstruction 61 the building hiis been undertaken and is revocable for cause Of may.be amended or modified wrlenv considered necessary,,by the - .Commissioner of Health. Any change or alteration of construction . re. uires a new permit. " Approvetl foi ,disposal of domestic sanitary sewage /e n star su y onl _ Q 87 Date u ” ! T�: BY,. it le �--- Putnam County Department of Health Division of Environmental Sanitation AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT. APPLICATION SUBMITTED TO - PUTNAM COUNTY HEALTH DEPARTMENT. ; Tb: Commissioner of Health - In the matter of application for �f Lo -4, C`�,c. cx t� r%1 ��v !'S.� represent — — — — — — — — -- -- — — — ----- --- - -- that :B amr ,jApi46f &eef or employee of the corporation and aifi authorlied to act for —�ows %may --- — — — — — (name of corporation) having offices at _ FOX 664 � � Af% /_c i H� /e A, _ Ca e -n -- — - - -- — — — — — -- Whose- officers -are President —bawl_ G► i� d� — � } vw SD Ah -' Name and Address) - Vice- President ALL; a —�}o%_ f-ox �ry ����_ �ar.•x / � j��i� - '(Name and Addr se s) - — Secretary y= — — — — (Nme a and Address) Treasurer_ _ _ -------------------- . (Name. and Address) and that I am and will be individually responsible for any or all; acts of the corporation with -resIpect to the approval requested and all•sub- sequent acts relating thereto. ' =Sworn to before me this Vii. day Signed Of %� t' / L 19�J 7 Title Notary Publiclf8c� f 3 9 Corporate, Seal PUTNAM COUNTY DEPARTMENT OF HEALTH Rev. 3186 i q Dlv+siori of Environmental Health Services. Carmel, N.Y. 10511 :Engineer to Provide Permit q on CERTIFICATE OF COI IANCE MP Permit. N, CONSTRUCTION; PERMIT FOR WAGE DISPOSAL _SYSTEM Located at i� •� �� CAL i�, (L.L � or Village Subdivision Name �'^� tM 1. a .. o �r <cabd. Lot N Tax Map I'� Block - Lot Renewal-0 Revision " ❑ Owner /AppncentNeme�'O�I:AIAJ@.A Date of Previous Approval - . Melling Addreae. A�.ha"rtaA�k .. ti/- Town '. Bufldhig Type • ��� a�' . Lot. Area FIB Section Only Depth Volume Number of Bedrooms Design Flow G /P/D _IS t PCHD Notification is Required When FIB'le completed Separate Sewerage System to consist of VUBC) Gallon Septic Tank "and :A q-z- t_ - .T= A, To lie. constricted by Address Water Supply; Public "Supply From Address or: - Private`Snpply Drilled "by" — Address Other Requlremeate ,represent that !''am wholly and completely responsible for the.design and, location of. the' proposed systems) ;' 1)' that the separate.sewage disposal" system above described will be constructed as shown on the approved amendmept there to and in accordance with the standards, rules and regulations'of the Putnam County. Department -of Health,- and that -on completion thereof a'.'Certificate oi.Consiruction'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 the-date of the issu- ance of 'the approval of the Certificate of Construction" "Gomplian a origi system.or any repair reto; 2) that the drilled well described above will be located as s -shown on the approved plan and that said well will e. install in c rd a "'wit e, nd s, rules and regu a i� o_ s of , the Putnam County Department of Health. ` y// -Date ��a Signe" P.E. R.A,•AA— Address "License No APPROVED FOR CONSTRUCTION: This approval expires year: 'm th d e.issued _unless construction of the building has been undertaken and is revocable for y ause or may amended or modified when'co Bred cessar . Commissioner .Health. Any change or alteration of construction requires a pelmit. Approved for disposal of dome. I nitary ewag or rivate water pply only. Date �`� By Title ` -e DIVfSION OF •• •' ' 1E Y• HEALTH SMMCES APPENDIX I DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO.' - Owner LcCUVJ.� l��u FS-rs It�C_ Address 'Z�3 1C1cru�11�N ?�vs ILJ�TO�.lAIt t1 c63(o cocz►.►w� ��� e.a. Located at (Street)_ 1(D-4 Sec. 1 ! Block �'p Lot 2:4 (indicate nearest.cross street) Municipality P,I � Z_ 1-1 Watershed eQ,� SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMI= WITH APPLICATIONS y Date of Pre- Soaking Zl 8G Date of Percolation Test HOLE NU-BER CLOCK TIME PERCOLATION PERCOLATION . Run Elapse Depth to Water Fraa Water Level No. Time Ground Surface In Inches Soil Rate Start-Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 1 J • �� `� J' �� Z� �� \1 Z77 11 �\ 1 9 ZX 4 5 \I 3 A! ii •- A, Al 30 ,Z�I Z� ID 4 5 1 NOTES: 1. "Tests to be repeated' at same depth until approximately equal soil rates are'ditained at each percolation test hole. All data to'be subm tt?2i for review. 2. Depth reasurements to be made from top of hole. WmIly o /R r1 TEST PIT DATA REQU= TO BE SUBMITTED WITH APPLICATION DESCRIPTION- OF.SOILS ENCOUNTF.M IN TEST HOLES DEPTH HOLE NO. HOLE NO. 'Z HOLE NO. G.L. 't cpso kL S W IDY t>,hi" W/ SAI -►D*/ i� i-► w / � ��� �?c'I/F_TS CoMP�LFS�rIJ 'r�cY_EYS C�MP�SSF� ,. 2' 3' 4' 6' 7' 8' 91 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENOOUNTERED INDICATE J= TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERID DEEP HOLE OBSERVATIONS MADE BY: CLAA? 3 , 'VAG 5 DATE: - DESIGN Soil Rate Used _ 10 Min/1" Drop: S.D. Usable Area Provided BOO 5.�. No. of Bedrooms Septic Tank Capacity 125(D gals. Type Absorption Area Provided By L.F. x.24" width trench Other Name Zj► tZ -p L_+'tea W. L U-T Signatur Address ICI] L. Z)CZ.IQP— SEAL ` `s" ? z �, a r rATTEQ� �I uy 1Z�ro� e�1 0.0451 THIS SPACE FOR USE BY HEALTH DEPAR FM ONLY: ° Soil Rate Approved sq.ft /gal, Checked by Date :r,,..:.. »,v..ci.a_ .. •,:.......,«+,.+., �bri:•:;.. r. 4:.,. ,..,:uw..<.....:rx..;„ti...�e�:. .ter:..... .:, uiMmva. �b..,-.. wz. Y. � ...._.u,..._.....�..v_;<s.�h:ia .._.... ._._... INDIVIDUAL WATER SUPPLY & 1. 2 5p, a 121 •• w . �. DATE REVIEWED: BY: (Name of Owner) (Street Location) �• la 0=i M Mm MM EVA= ,.OEM /UM Mm MINI NEI WAM DOCLNE TPS 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 D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area; shown; gravity flow, suff . size If Pumped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's Win 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 110; Type 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). 151 'to Drains- Llirtain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -20') Septic Tanks 10' from Foundation 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 PUM M COUN'T'Y DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIFIa INSPECTION REPORT DATE: GD�<<?G�'d' /�l f�,y�Ti '�S ,/ 7° Co- 'Alce1����SP. BY: (Name of.Owner) (Street Location) INITIAL SITE INSPECTION YES I NO -1 COMMENTS Wetlands on/or proximate to property .............. Property lines or corners found ................... Can estimate house location ........................ Will driveway 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. �vz/ Depth to rock Soil Descri tior 0 ft. /�/ boa G ► 3 ft. c� „�. CV.os�.a�,� d 6 ft. i j l Gn�>> Jrs � 7� 12 ft. D.H. 2 Lot 2 Depth to G. W. r �� Depth to rock 12 ft. ----- - - - - -- - -- DATE: _ FINAL SITE INSPECTION INSP.BY: House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Roon.allowed for expansion trenches .............. Over 100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded ........ .................... 10 ft. maintained from property line and 20 ft. fran house .............................. Distance well to SSDS (ft.) ...................... Number of bedrocros checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. fran nearest trench................ 15 ft. of peripheral soil horizontally fran trench ..... ............................... Boxes properly set ............................... Could surface runoff fran driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACC'.EPTABLE..�.................. -�-. —”, ':y +%7 b oa 1, r J D.H. - Deep Hole G.W. - Groundwater D.H. 3 Lot Depth to G. W. Depth to rock Soil Descr 0 ft. sN-- 3 ft. 6 ft. 9 ft. 12 ft. Soil Descriptill 0 ft. s- ��nlycd� 3 ft.y�y- �•�'�. 6 ft. 'C'✓,. afleT 7 �f 12 ft. ----- - - - - -- - -- DATE: _ FINAL SITE INSPECTION INSP.BY: House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Roon.allowed for expansion trenches .............. Over 100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded ........ .................... 10 ft. maintained from property line and 20 ft. fran house .............................. Distance well to SSDS (ft.) ...................... Number of bedrocros checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. fran nearest trench................ 15 ft. of peripheral soil horizontally fran trench ..... ............................... Boxes properly set ............................... Could surface runoff fran driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACC'.EPTABLE..�.................. -�-. —”, ':y +%7 b oa 1, r J D.H. - Deep Hole G.W. - Groundwater D.H. 3 Lot Depth to G. W. Depth to rock Soil Descr 0 ft. sN-- 3 ft. 6 ft. 9 ft. 12 ft. PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health .In the inatter of application for: Cornwall Hill Estates, Inc. I Kenneth Emerson represent that I am an officer or employee of the corporation and am authorized to act for Cornwall Hill Estates, Inc. (Name of Corporation) having offices at 223 Katonah Avenue Katonah, N.Y. 10536 Whose officers are: President: Edward H. Emerson, 223 Katonah Ave., Katonah, N.Y. 10536 (Name and Address) Vice- President: Kenneth Emerson & Martin Diano, 223 Katonah Ave., Katonah, N . Y . (Name and Address) Secretary: Janet G. Mastropietro, 223 Katonah Ave., Katonah, N.Y. 10536 (Name and Address) Treasurer: Lynne Diano, 223 Katonah Ave., Katonah, N.Y. 10536 (Name and Address) and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto.; Sworn to before me this % day Signed: of N 19V Notary Public LIONEL VIEINSTEIN Notary Public, State of New YbIR No. 60. 4199150 Qua;ified in Wastchw:tcr Coun -R Cbnimissoh Expires 1y9gi;l5 W. 19 8/84 Title: Vice President Corporate Seal PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING. CARMEL. N. Y. 10 DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner �,4G 7in, h of ����. Address %���.'�� ✓camp'/ / ,72 W. � Located at ( Street 41-4,- Sec. Block Lot n ica e nearest cross street) Municipality 7�1_1 61,P -7 Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Water ve No. „t Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 2 4 4 1 2 4 AUG - 2 198 5 PUTNAM COUNTY Notes: 1) Tests to be repeated at same depth until approximatelyy 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. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES . DEPTH HOLE NO. HOLE N0. G.L. 6" 12" 1811 :� -mac+ -� �� � � ��,✓� 24" 30" 361+ 4211 48" 5411 60" 66" 72'1 78,E 84" HOLE NO. 3 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER L4VEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date DESIGN Soil Rate Used Min/1 "Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity Gals. Type Absorption Area Pro ded By L.F.x24" 5b" ,4 ° ° ° ° ° °° ° trncF. Name Signature @ P a Address = 5 i z - -r, r.��s^ (�-- \ r: EA p THIS SPACE FOR USE BY HEALTH DEPARTMENT.ONLY: Soil Rate Approved _Sq: Ft /Gal. Checked by 0.00 Date. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Located at (T) Z fa Section Block Lot Subdivision of W> A"v Subdv. Lot #— —3 Filed Map #Z� ,;, —.Date Gentlemen: This letter is to authorize- a duly licensed professional engineer — or registered architect (IndicateT to apply for a Construction Permit for a. separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, Signed� i Ve-l. Owner of Property Countersigned Address ;14� Al Address Town r. mZ2 IRt:CEIVF.&4elephone Telephone -21983 AUG pUTNAM COW4-iy DEpTk OF tiEAL-W K ,.K. - < 4. �� y i Clarksburg "Two Story" 83- 1782 -4 23'6 "x36', 26'x36' 3 Br: 1'A Bath w! 1st floor �fi Bath F1: plan option E available on this model. See option Fredericksburg "Two Story" 84 -11%2 -4 23'6'•x36'. 16'x36'.4 Br. -t Y. Bath wi 1st Floor Y2 Bath fFloor plan option E available on this model. See option page r. � s j b.b. m• .noo• � K Y,. Optional 1st floor plan, Center Kitchen. Y.AO ,0p0 "CK• � .00[ 1 \. -7 Optional 1st Floor plan, Center Kitchen. Second Story :r r 1 1 A j el itf AeA � pe-re 9-e-45 A-'-q Well-i n/i'A 17 200 P2- 191V r. S� 4- I�. 'r Q CL 0 J J �m bo ?ham 0.� UcOp �p3] d �J oi \tSb) , \ \ t , W i m � / � � 1 £�r' zb Q 0. =a W �du Q 4 n 3.1 J y �4 I , � f i 1 II ,I 1 1 1 1 Z Ott, �1 \ v / �"1„Ob,bS ,19 ry I � 0 4� a= � r c n c 3 of 0 u