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00560
Rev 3% Camel
86 PUTNAM COUNTY�DEPARTMENT OF HEALTH
Division of Environmental Health Services, , N.Y. 10512
Engineer rdust,ovi, de;
P.C.H D Permit#
CER A OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM M-17 S Q; N•.,
C Tiivn or'V- e
Located at S 5 1 Tax Map Lot
Owner /applicant.Name in A S yi 0 �� " Formerly Subdivision Nam Gv - Su V. Lot•# 4,10 S e i V zip Date Permit Issued
Mailing Address A
Separate Sewerage System built byV /S �� 1/ Ai Address
Consisting of /,a —Gallon Septic Tank and _ L �• �5 d`� � '
Water Supply: Public Supply From' Address
or: Private Supply Drilled, by Address
n ITT3
Biding Type S/a OJT, /4P Has Erosion Control Been Completed?
Number of Bedrooms J Has .Garbage Grinder Been Installed?
Other Requirements
I certify that the system(s) as listed serving the above premises were constructed essentially as shown on t lens of the completed work ( copies
of which are attached)', ,and in accordance with the standards, ru: regulations in accordance with th fi d plan, sued by the
Putnam County De /partmen Health. - Date ( [ Certified b �`/ �7
Address T� �� /��/ D ""�� " - • /�` - LIce., No.
Any person occupying premises served by the ,above systems) shall promptly take such action as may nece {wry to secure the,correction of any unsanitary
conditions resulting from such usage: Approval of the separate, sewerage systam shall become null and void as soon as a pub;': sanitary aawer becomes
available and the approval of the private water supply shall become null and void when a -public water supply becomes avallabhh Such approvals are
subject to modification or change when, in the judgment -of the Cofnmissioner of ealth, such revocstlon,'modlficatIon or change is necessary.
Date �� �Y �/. ..►-e
ey Title
WrILL
a -� DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
iWELL LOCATION
STREET ADURESS: wNiwt IIY TAi GRto NuNiOU'.
z,Z SUMM,�SET ®ir a e� Zl 17 R -3 L
WELL OWNER
ADDRESS:
'r�E,-,4-{ 57M't4hSR . Lc1 3Z 5-t"."wesE7{tL- l�r,U��411111)
PRIVATE
❑ PUBLIC
USE OF WELL
1 - primary
2 - secondary
KRESIOENTIAL ❑ PUBLIC SUPPLY O AIR /COND. /HEAT PUMP ❑ ABANDONED
❑ BUSINESS O FARM O TEST/ OBSERVATION O OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY ❑
AMOUNT OF USE
YIELD SOUGHT ____,,� gpm. /NO..PEOPLE SERVED / EST. OF DAILY USAGE tS�O gal.
REASON FOR
DRILLING
NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST/ OBSEERVATION
❑ REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH �°2 T ft.
STATIC WATER LEVEL 6� ft.
DATE MEASURED
DRILLING
EQUIPMENT
❑ ROTARY 9COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
O SCREENED ❑ OPEN END CASING. [) / OPEN HOLE IN BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL LENGTH ft.
MATERIALS: 9STEEL O PLASTIC ❑ OTHER
LENGTH .BELOW GRADE ft.
JOINTS: 0 WELDED THREADED ❑OTHER
DIAMETER 7 in.
SEAL: O CEMENT GROUT BENTONITE OOTHER
WEIGHT PER FOOT /7 - Ib. /fL
DRIVE SHOE IdYES ❑ NO
I LINER: ❑ YES NO
SCREEN
DETAILS
DIAMETER (in)
SLOT SIZE
LENGTH (It)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
o YES ❑ 140
SECOND
HOURS
GRAVEL PACK
o Nos
GRAVEL
SIZE:
DIAMETER
OF PACK in. I
TOP
DEPTH tL
BOTTOM
DEPTH It.
WELL YIELD TEST It detailed pumping
METHOD: O PUMPED i tests were done is in-
COMPRESSED AIR , formation attached?
O BAILED ❑ OTHER ❑ YES ❑ NO
IPIELL LAG It more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
water
gear.
ing
Well
Oia-
Imeter
FORMATION DESCRIPTION
cooE
ft.
It
WELL DEPTH
It.
DURATION
hr. min.
DRAWOOWN
It.
YIELD
gpm.
urlue Surf
f
/
WATER i7CLEAR, TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? O YES O No
STORAGE TANK: TYPE L� 1 Q1 O
CAPACITY- �'v`)C, GAL. �C-AL,
PUMP INFORMATION
TYPE SJb.4 CAPACITY
MAKER J DEPTH 400T
�t�epp,
MODEL IR t� VOLTAGE:'�_HP!
�-? ,
WELL DRILLER NAME DATE
m• HYATT & SONS, INC. 9 0?/
Well Drilling s►GrrTUaE
Rte. 311 R.R. 2 Box 171A ��f-
OATYCncnM NEW YORK 12563 M//1'�
LWMM
ADDRESS:
%
i-�: t�A I V*
flME SET
j
U
Nf,
DDRE ,P
�
NT- b,rw'L'l R NA-TED0(. P.M)FTENEb
❑ OTHER lj,�
,
S RQE:,.DklNKl:N6 WATER -"AS I R �E
LUENT 'OT HER
_TEV��,�fl
COLLECTED BY:. -vi AN
�CQL
TIME -7
77 0, o o
E 4
DATE
❑ APARTMENT Q 9 P'R_ I V AT E_ RESIDENCE P' ENf E ,
O SEWAGE TREATMENT'PLANT
REST Au A
00 L
0 OTH
'TOTAL CCOL IFORKCdOW.T.M .K.T.,
R j, T0TAL-C0L!f M P.N PER 100
U FECALCOLIFORM COUNT MlF T
_ORM�COUNY
PER 1.00 M.L.- ❑ FECAL COLIFORM COUNT 'M. -PER100 M '..
❑ "FROZEN :DESSEO':r?PLAtEooN
AGAR PLAi6,cou�� -0011 MA:
k,
LABORATORY.TECHNICIAN
ATE RVORTED
B RATORY DIRECTT0,R'_-
%
j
Nf,
r.
n
14 PT- DUPLICATE -
15k
l�O� %. /�/�L RTIT TTTATT TTTf AT]T
�" ry
fy �e
�. 'm
W `l
WL' LL UVrirL'z11VLV 1[J;r V1X1
DEPARTMENT OF HEALTH,/
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
a
WELL LOCATION
STREET ADDRESS: WN /VIl I Y TAX GRID NUMBER:
Loi3L 5v,�r�s s�7 ®g. c g -# z.l 0 A -3 L
WELL OWNER
ADDRESS:
Tom i- 74-i;- 5m 14VAj �1 . 4cfi 3`2 f�., �A
PRIVATE
❑ PUBLIC
USE OF WELL
1 - primary
2 - secondary
KRESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT —.15— gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE K ®o gal.
REASON FOR
DRILLING
NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
'WELL DEPTH qc q. ft.
STATIC WATER LEVEL _KL' ftj
DATE MEASURED
DRILLING
EQUIPMENT
❑ ROTARY YCOMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
10 SCREENED ❑ OPEN END CASING, APEN HOLE IN BEDROCK ❑ OTHER
TOTAL LENGTH ft.
MATERIALS: 9STEEL ❑ PLASTIC ❑ OTHER
CASING
LENGTH.BELOW GRADE ,L_ ft.
JOINTS: ❑ WELDED drTHREADED ❑ OTHER
DETAILS
DIAMETER in.
SEAL: ❑ CEMENT GROUT BENTONITE ❑OTHER
WEIGHT
PEA FOOT .__. -7 _ Ib. /ft..
DRIVE SHOE: YES ❑ NO
I LINER: OYES RNO
SCREEN
DETAILS
DIAMETER (in)
'SLOT SIZE
LENGTH
(ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
O YES ONO
HOURS
SECOND
GRAVEL PACK
❑ YES
❑ NO
GRAVEL
SIZE .
DIAMETER
OF PACK in.
TOP
DEPTH ft.
BOTTOM
DEPTH It.
WELL YIELD TEST ; If detailed pumping
MUH00: O PUMPED tests were done is in-
LaJ COMPRESSED AIR r formation attached?
❑OTHER
BAILED N
ELL LOG It more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
Water
gear.
��9
we11
Dia-
mete r
FORMATION DESCRIPTION
CODE.
.
.
WELL DEPTH
It.
DURATION
hr, min.
ORAWOOWN
ft.
YIELD
gpm.
Land
Surface
g
Y
,
iLaa
WATER CLEAR TEMP.
QUALITY ❑ CLOUDY HARDNESS
O COLORED ANALYZED? ❑ YES ❑ NO
ANALYSIS ATTACHED? ❑ YES ❑ NO
STORAGE TANK: TYPE
CAPACITY GAL.
WELL DRILLER NAME DATE
g T M. HYATT A SONS, INC.
Well Drilling SIOATURE
Rte. 311 R. R. 2 Box 171A
NEW YORK 12563
PUMP INFORMATION
TYPE Sib 6*1 MfLl ° CAPACITY
MAKER DEPTH 4 b®
MODEL VOLTAGE IN HP I "L
F%
e
PLTTNAM COUN'T'Y DEPARTMERr OF HEALTH
DIVISIOL9 OF ENVIRONMENTAL HEALTH SERVICES
Owner or Purchaser of Building
Ncc.k��s 3�,1�EA s
Building Constructed by
SOMP-"ElLStiV -DIZ1 V
Location - 1f v
Street n '
- '0` 'P�4 W t�Sy �v ► -\/-
Municipality
TD
Building Type
Section Block Lot
Subdivision Name
� 2
Subdivision Lot #
GUARANIIEE 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 a
the Director of the Division of Environinen
Department of Health as to whether or not
caused by the willful. or negligent act of t h
the system.
Dated this ID day of -Yg N . 1989
Genera Contractor, (Owner) - Signature
Corporation Name (if Corp.)
'go Ygg3 D try - AA
Address
V40 P6 W
rev. 9/85
mk
ccept as conclusive the determination of
tal Health Services of the Putnam County
the failure of the system to operate was
e occupant of the building utilizing
Signature y
Title /�i /p!i/ S� %%/✓
Corporation Name (if Corp.)
Address
pmce ;on g000mperail -.conaition,;any,part.'Ov,.S@#Oisawage �aisposai system,aurml
-t6rnOW16Z
il, the the,
mn� .16 j!iCate,
, ,!.h� �. qjrt , ,
wail i-be I To CWVFI -appyovedplair! and that said 1 e. in -ac,
w., l?!%Jhp - _ -I! -
do t t ofpHealth
ate
n
"T
Address"
Y R UCT'l Ok i-Th is o years �� from . the
APPROVED FOR CqNS,
rI 6v6" " b.l ' e L or , 4!YP! may
fie'am4nded or modified wte" confidered nee scary tf
requirei. n , '
Mit-L of domestic sanitary and'/
Rev.
DateL
:By.
77.
7
0
is.
:diin 'L 11 ,•-'rules . f I_- '
p u
ce, vithAtige Stai",rdl and..;regu anions m
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 #1$
WELL LOCATION
Street Address
g'0 i'l
Town
C'4� Tax Grid Number
WELL OWNER
Name
L AddressC
Q� v
Ut ► OLcl _
rivate
Public
SE OF WELL
- primary
2- secondary
,KRESIDENT'IAL ❑PUBLIC SUPPLY
0 BUSINESS O FARM
O INDUSTRIAL O INSTITUTIONAL
❑AIR /COND /HEAT PUMP
O TEST /OBSERVATION
O STAND -BY
SCAB ONED
0 OTHER (specify
O
AMOUNT OF USE
YIELD SOUGHT_ gpm /# PEOPLE
SERVED_ /EST. OF DAILY USAGE gal
REASON FOR
DRILLING
NEW SUPPLY
OREPLACE EXISTING
O PROVIDE ADDITIONAL SUPPLY
SUPPLY 0DEEPEN EXISTING WELL
O TEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
WELL TYPE
LL3 DRILLED
13DRIVEN
DUG
GRAVEL
O OTHER
IS WELL SITE SUBJECT TO FLOODING? YES K NO
IF WELL IS LOCATED I A R ALTY SUBDIVISION, NAME OF SUBDIVISION:
i a,c2r� �( C Lot No. �—
WATER WELL CONTRACTOR: Name i Ael �PgL�,I�Ltcve le Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE:
YES )C NO
NAME OF PUBLIC WATER SUPPLY: N 4 = TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: �� ✓✓�4`!
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
OON REAR OF THIS APPLICATION DEPAT
(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 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_y the P tnam County
Health Department. ���__— -7 —
Date of Issue: �� 19 ;ermit Date of Expiration: lg ssuing fficial
Permit is Non - Transferrable Whits copy: H.D. File
Yellow copy: Building Inspector
Pink Copy: Owner
287 Orange copy: Well Driller
Putnam bunty Department of Health
Division of Environmental Sanitation
AFFIDAVIT - CORPORATE OWNER APPLICATION
FOR PERMIT. APPLICATION SUBMITTED- TO
PUTNAM COUNTY IIFALTfi DEPARTMENT
TO: Commissioner of Health In the matter of application f , or`
�n�poi.tc- -S - - - s
- - - - - - - - - -- - -
Arepresent
that I am an officer or employee of the corpor& tion and am. authorized
to - - for act CA tes - Je_
- -
tj,_
- - - - - - - - - - - - - - - - - - - - -
(name of corporation)
having offices at sn' J�
Whose officers ,are
President N 6-6�jer 71'of 4 - OM RD. _W "Aki/A.
Name and NdUres-S, -- - - -
Vice-President 'YAME2 _A. 7JEUOAeS 30K qY/ - - 01 446-1,
K - - - - Address) -- - - - - - -
(Name and
Secre'tary
(Name and Address)
Treasurer
- - - - - 7- (Name and Addre-ss)
and that Ilam-an ' d will be individually responsible for any or all a ' pts
of the• corporation with respect to the approval reques-ted and-all sub-
sequebt acts relating thereto.
Sworn to before me this 2 g day Signed
-4 — — — — — — — — —
of 1988 Title
Notary Public
w�t,��s��y
Corporate Seal
Treasurer _ _ _�> _ _ _ _ _ _ _
.(Name and Address) -- w `
and that I =awand w-111 be individually responsible for, any or all acts
of. the- corporation with respect to the approval reques -ted and -all -sub-'
6eque,in't acts relating thereto. %•
a =.
Sworn to before me this day Signed _ _ '_ _ _ ^ ^ — ._
of 1986, Title
Notary Public'
YO 0 -
/v Gt/, z4pkee�
44
Corporate Seal
Putnam ,aunty Department of Health \<
Division of Environmental Sanitation
AFFIDAVIT - CORPORATE OWNER APPLICATION
FOR PERMIT. APPLICATION SUBMITTED- TO
PUTNAM COUNTY HEALTH DEPARTMENT
TO: Commissioner of Health - In the matter of application for` '
_ t�Npo &d_ --A-- - -�f - y -- - - -
- _ - - —
-`.^
N��kl
_
represent^
__ - - - - - - = _ _...
that .I am an officer or employee of the corporation
and am - authorized'
to act for.__I�ec,kles _Vi�Qf -IrvG.-
' (name of corporation)
having offices at _ �fl — —C{� _ oICc —tic'&+
Whose officers -are
President Nee,
R�
Ql� _ta+ fZD
(Name an a Address)
6'
Vice- - President TA �JSdCe ? ((/_
4! � - 5461, '
_Q —1?0K
(Name and Address)
— T L
Secre :tart' _ _ _
—
_
_ _ _ N
(ame and _ _ Address)
— - — _
Treasurer _ _ _�> _ _ _ _ _ _ _
.(Name and Address) -- w `
and that I =awand w-111 be individually responsible for, any or all acts
of. the- corporation with respect to the approval reques -ted and -all -sub-'
6eque,in't acts relating thereto. %•
a =.
Sworn to before me this day Signed _ _ '_ _ _ ^ ^ — ._
of 1986, Title
Notary Public'
YO 0 -
/v Gt/, z4pkee�
44
Corporate Seal
uI
RANDOLPH W LAURENT, P.E.
HARRY W. NICHOLS JR., P.E.
Job: 88070
LAURENT {ENGINEERING,
ASSOCIATES, PC.
73 FAIRFIELD DRIVE
PATTERSON. NEW YORK 12563
914.278.6108
CONSULTING SITE ENGINEERS
TO: Putnam County Health Department
110 Old Route 6 Center
Carmel, NY 10512
Att: John Karell, P.E.
Project: Proposed SSDS
Neckles Builders, Inc.
Cornwall Ridge
Patterson, NY
Description: Enclosed four (4) prints.
SS.32. "Proposed SSDS" -Lot #32
Revised well. location per our telephone
conversation.
Sent Via: Hand Delivery
Very truly yours,
LAURENT ENGINEERING ASSOCIATES, P.C.
(2-- &e-t�
Randolph W. Laurent, P.E.
/map
cc:
Mr. Wayne Neckles
Rev.No. /Date
Rev. 8 -26 -88
i
3�
`3
• APDaMrX B
PC r,ma1u c, um -' DEPARTM= OF HEALTH - DIVISICN OF ENV=CME= MZ.LTT--- SERVIC.FSS
LN[Dry .D[ML WATER SUPPLY & SUE' —c RFA=- DISr= Si'STRS
REV= S=- - CONSZ"'cC�CTICN P—vRM?T
f1b - e d,-"N
(Nat e O N . r) (Si :eet L cnticn)
cav- -N
( YES I NO I
Per -nit Application
(
Corporate Resolution
I
Plans - Thrae sets
I
Engineers P_ut`zcrizati cn
Design Data Sheet MCS)
SuTDrrSICy'
Deco Hole Lcc
I I
� 103b
I 1 I I
Ps_rc Hole Depth
cc
cjv ` 4 S
I I�
L `anch prcv d-er w
60 ft.
Pa .rai el to cc - s
100% ex--.
I I
i I.
I .I
I`
I I
I
I
i
I
F SYST VS i
cla r�rre -T I
I
10 A t.
I
f I? notes I
na— p`.
i
cecth eauces I
I
100 v--. food e1ev. I
I
•
I
200 ft. re 7vcir' etc.
I
1 =0 ft. tri_ L-_
I
I
DATE ''T = 47-M
BY: :
DOC'l'S
LA T
Per -nit Application
Corporate Resolution
Plans - Thrae sets
S/-
i
Engineers P_ut`zcrizati cn
Design Data Sheet MCS)
SuTDrrSICy'
Deco Hole Lcc
p`_; -!_
Consistent Perc Re= i _o
(3) Fill
Ps_rc Hole Depth
cc
House Plans - Two sa tS-
We 1 Fe-rani t; P "I'S
Varian-- Reg est.
v-V-1.
Le-m1 Surciv_sicn
Subcivisicn P -cprcval aem =Rec
- spprcval SSCS P Lcts Cam:: ==
Wet_' and nd (Tcw, ±/DEC Pe =-L' _ R & D)
Data Cn DDS Plans & Ps =i t Sa7z
REQMMED DE'.,.. TT c CN PI :L-,-S
S_waca SystVan Plan - (-or to a_r=cw )
15;.gace Sy 5tr*i nycra 1L i c Prof 1- - F.
F, i 1 Prof -le & Di.IP.ens`Lc ^s - VCS ...=
D or J Eex;T__nch /C11_ry; P,_,L_, p' = d�.i -�
Sectic Tank - Size, D✓T =i1
,tiVe,�� 1 Detail, Notes Lii e 1= C` ✓c:
Ccns ru &icn Notes (cr_nder rate)
Cescn Data: Perc and�ce_o ra__s
Two- -=oct Contours E`{is --Inc & P_cLcsea
Driveway & Slopes Cult
F�tin /Guttar,C=u -:in Drains (discharge CSC)
Perc & Deep Holes I cc =_tom
Repre_=a-ntative of primary and e.x ansicn
Mvc�-nsicn Pr- =;shown;gravity f_c�,suf ..size
If F.cd Pit & D Box Shcgm & Detailed
use - No. of Ee^'_rcozis
Wells & SSDS' s w /in 200 ft. cf r ccoser Sys--,z
Pr operri7 i•Ie _as & Bounds
House Setback Necessary (Ti(Ynt lot)
Heusi Seer - 1 /4 " /ft. 4 "0; T_,ce pipe
No Bands; Max- Bends 450 w /cleancut
SE`D'L=CN DIS=-,\V---S SP—=e-!F= CN PI; 2N
Fields
10' to P.L. , Driveway, Large T-raes,Tco of I
' Foundation Walls
0 well; 200' in D.L.O.D, 150' pits
' tD St1earn, Watercourse, Lake (inc. Ec_
15' to Dra i ns-Cur twin, Leader, Fcoting
35'to mtca basin, storrdrain,ci--ei wate -rc=
10' to W---tar Line (pits -20')
50, int m-m ittent dra i nace course
Sentic T-nks
10' from Foundation; 50' to well
15' We-! to PL °-
2 IX 3 l2,
NOTFS: 1. Tests to be repeated at same depth until approximately equal soil rates
are obtained at each percolation test hole. All data to* be suimittbd
for review.
2. Depth measurements to. be made frcn.top of hole.
rev. 9/85
�s 3 .1.:0
�: ..
a7
es
_...,..
_.. q
2 IX 3 l2,
NOTFS: 1. Tests to be repeated at same depth until approximately equal soil rates
are obtained at each percolation test hole. All data to* be suimittbd
for review.
2. Depth measurements to. be made frcn.top of hole.
rev. 9/85
TEST PIT DATA'RDQUIREDrTO BE SUBMITTED'WITS APPLICATION `
DESCRIPTION OF SOUS ENCOUNTERED IN TEST SOLES -
� DEPTH HOLE NO.: -•,. f HOLE N0. .... .. :HOLE N0._
G.L.
2'
6'
7° E
8°
10'
12°
13°
14'
INDICATE LEVEL, AT WHICH GROUNMATER IS ENCOUNTERED A)er" �
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENOOUNTERED /V-o-m e
DEEP HOLE.OBSERVATIONS MADE BY: DATE:
DESIGN
Soil Rate Used 9 Min/1" Drop: S.D. Usable Area Provided
No. of Bedrooms 3 Septic Tank Capacity 4 &tr'u gals. Type Cps. c
Absorption Area Provided By 3'25 L.P. x 24" width trench NEB .
O®
Other ��`' -LLI�q �� ®�
Naze` tJo• j n 0. IZ2,a Signature' `
Address 73 k:�_c irtl_ 1y r r yC° SEAL �`� N0. 0451
v
\� \Ft561 " "J�'.
THIS SPACE FOR USE BY HEALTH DEPARDOU ONLY:
Soil Rate Approved sq.ft/gal. Checked by Date
'I N I HlIM
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ION
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nr,. _d�.iitt T
s
-3,5ND(A. INLETS
NOTt%S
ONLY THE INt:ET,
z;
OUTLET ANC) TWO 60fl
OUTLETS TO 13E KRIOGKeP
`rI OUT A5. SHOWN:.
i
f%ItJ15HED �12AD�
VABLE (,OVEK �v
2'MIN.
U OUTFLOW
'A.
HIGH I /�'. MIN .
T1 t�IG
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GTA I tL
- E�UILT
I9IME%N'�110N GHAI2T
NO
A
P>
l
91170.0"
2
70.5"
04.0,
00.0"
100.52'
1'7.0
7
lD�v.O'
80.0'
S
I ► ; .5'
10
1 X5.0'
q0:g�'
12
121.0
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IIt
120.0'
&T5'
I.�
t I ��0'
�G•5'
1�570ALf�', I'
THIS 15 TO GE:t2TlE"( THAT THE �7eWA
dI PO�AL �Y�TE%M WAS 9 -UGTt
A� I N121 OAT EiI2 ON TH IS ?LA N AN b TH,
B M W A,j I e - M
t'J�FO12� IT WAS 6OVe,12 I:2 OVr—�,I2• THE
`�YSTE: M WAS IN AGGOi
17ANG[✓ WITH ALL JTANI2A►Zr2 t2ULE:�
r- I:GULATION42 OF `fHE% PUTNAM COUNT'
t2t,PAI2TME%N'f OF H�AL-TH ANV TH0 N
YOI2V- TAT E t7E PA IZTME:NT OF I-Ie,�A L-'
NOTE: HOU�� AN12 NEIL LOGATiON
TAKFlN �KOM ' �UI�VY OF. l°tzOP�I2T.. ".
PI2E:PAlee,v FQI2 TH`pNi A� PATt�1G l A
�M t-S H ; >7AT�O 12.28 =E3PI , PrzE%PA2E%n
7JUNNE%`( A��OGIAT��, LANt� �Ut2 -V�'�c
f,
'ANSFERABLE
PREMISES SHOWN HEREON BEING
LOT 32 AS SHOWN ON "SHEET I
OF SUBDIVISION MAP OF SECTION
TWO- CORNWALL RIDGE'; SAID
MAP FILED IN THE PUTNAM COUNTY
CLERK'S OF-ICE ON MAY 23, PIN&
AS MAP NO. 2117A..
WW
li
V•
0
%0
.UTHORIZED ALTERATION OR ADDITION TO A SURVEY
' BEARING A LICENSED LAND SURVEYOR'S SEAL 15
'OLATION OF SECTION 7209, SUB - DIVISION 2, OF
NEW YORK STATE EDUCATION LAW.
ertifications hereon are valid for the map and copies
of only if said map or copies bear the impressed
of the surveyor whose signature appears hereon.
SURVEYED & PREPARED BY
BUNNEY ASSOCIATES
LAND SURVEYORS
?AL ROUTE #2 FIELDS LANE
NORTH cet ctu
DEVON
LOT 3Z
AREA= 1.133 AC.
THE LOCATION OF UNDERGROUND IMPROVEMENTS OR
ENCROACHMENT5 HEREON, IF ANY EXIST, ARE NOT
CERTIFIED OR RWnwly
�%
01
SURVEY OF PROPER'
SITUATE IN THE
TOWN OF PATTE!
PUTNAM COUNTY
NEW YORK
SCALE'. I"=401 DATE
CERTIFICATIONS.
BROUGHT TO DA