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HomeMy WebLinkAbout0572DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -1 -36 BOX 7 to ` ' � ' t' . r ' , �I �� t . I r. 1 - • .. k- ir i -. I ' _ JL 00572 7 3 pUTNAm COUNTY .DEPARTMNT OF HEALTH n of Eqy" mnen t =61, MY. 1051k2 ei Must Provide ' W P.C.M.D.Pe CERTIFICA OF. ONSTRUCTION COMPLIANCE FOR SEWAGE'DISPO SAL SYSTEM A Tat Map ve- TMOi` or X, LV. L"4" at OvAieir/a, Mcant-NamO -PeV61-Maif 7T Su slon Nam tibdv.%Mt-#, P1 Date permit 7 Ini-pblAiV )�fi A) A-, Melling Address Z11p_ ado -A)09 H—u�,L-6� /i I/ T, Addrm 7,12p Soparitto'ie*oiage System tat by �SWT-fa -6�1-67.tm qVl2f +��AJ ;Conslstid'g of Gallon Septic Tank and —4 L Water Supply : Public Suolilk From Address Q0,0 t�A �W 1, L 5� A) ro. ya 7 a& Address or: BWld*i Type: —.Has Erosion Coitroi-Been Completed?_ Number of Bedroom' 4 Ris Garbage Gi inder Been Installed? dl7 0. Other;lleqxdrebients I certify t"t.,th . a systeia(s) as listed 'serving - the- abo Yr --premises were 'constructed essentially as shodn c . )p thp.plans of the completed work copies of which are attached),,,, and in 'ac6bidance with the standards, rules and lations' in accoidance rf�ian, and the permit issued by the Putnam C e h a . D to P.E. Av rb*b_klconse No. Address. h� !hap.promp y maybe-riocessor to of person occupying -promises served by uch octlon_as il, take's y any unsanitary separate'. I conditions rosuItInq::from'-- such uiage.-'.'Approv# . 'SeWs�a - SY null'and. of �tt_ go stem, shall �bocorne_ void as soon as .a pub. ?: sari Itsey siwisr. becomes when. a public water supply aromas available. available . and the approval private water supply ,shall _ become null nun d void s6c,h"ippiovals are . when, an. 'in t _C nor of revocationj modification or change Is ns� I C"Ury. I subject to modi CA or hi'ludgment of-the C 0 Heal such Date LN 'By., Title I UQi represent thatUx- aftCwholly 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 W which, fails o operate for a period of two years immediately following ; the date of approval of tthe . . "Certificate o Construction Compliance" for.the sewage disposal system, or; any: repairs made by 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 caused by the willful or negligent act of the occupant of the build' g u Utz n the system. Dated this day of 191 Signa f Title 4P , wrporauvn ivau�e tit t:orp. � c> N o 1U o ,_ 4-% /-i J c. /lke.L Address N. rev. 9/85 mk Corporation Name (if Corp.) MM A� C4r. :. a _ WC.LL UUr1rLL11ULV Rr•rUAl DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use.Only WELL LOCATION SIRE" .AOURESS: WNlvl / i __ /�'yy� I� ,{(` TAZ GRID Nua +eEa: s.,.p�' �} 6'� / / l WELL OWNER NAME A "� n �- ADDRESS: a Q %?�i1'r /hi-fi" ," G/ hIVATE ❑PUBLIC USE OF WELL 1 - primary 2 - secondary UPIESIOENTIAL p PUBLIC SUPPLY r-11 AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS. ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED _/ EST. OF DAILY USAGE j&_& gal. REASON FOR DRILLING W SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /08SERVATION REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH , �ftSTATIC WATER LEVEL ft_ DATE MEASURED Z4� DRILLING EQUIPMENT 0 ROTARY ❑ 9101PRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT UKABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED 24PEN END CASING. ❑ OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH 2 5 ft. MATERIALS: EEL ❑ PLASTIC ❑ OTHER LENGTH.BELOW GRADE JF_cl ft. JOINTS: ❑WELDED READED . ❑ OTHER DIAMETER iri. SEAL: gai'M NT GROUT 0•8ENTONITE ❑OTHER WEIGHT PER FOOT �Z Ib_Ift f DRIVE SHOE PJM � O NO ES 9:0YESOW SCREEN DETAILS DIAMETER (i SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FI ❑ YES O NO HOURS SECOND GRAVEL PACK O NO RAVEL S IAMEf OF P in. TOP DEPTH ft. BOTTOM OEM it. WELL YIELD TEST If detailed um in P P 9 METHOD: O PUMPED ; tests were done is in- O COMPRESSED AIR : formation attached? O BAILED ❑ OTHER :OYES ❑ NO . �IELL LQG It more detailed formation descriptions or sieve analyses are available. please attach. DEPTH FROM SURFACE water Bear- ing well D'a- In FORMATION DESCRIPTION CODE, iL WELL DEPTH 1t. DURATION hr. min. DRAWOOWN It. YIELD gpm. Surface Q j Q L WATER Pd6kR TEMP. QUALITY O"CLOUDY HARDNESS O COLORED ANALYZED? S O NO ANALYSIS ATTACHED? 1346 ONO STORAGE TANK : •TYPE ft►Qty CAPACITY G% GAL. (� PUMP INFORMATION TYPE CAPACITY 44gj!c�/+ MAKER 6 DEPTH MODEL Z VOLTAC rjHP i WELL DRILLER NAME OAT ADDRESS 30 /!? G (Q07'D /✓ )5f& Yorktown Medical Laboratory, Into 321 Kear Street Yorktown Heights, N. Y. 10598 (914) 245.3203 Director: ATberi H. Padovani M. T. (ASCP) F Dennis Malanchuk PO Box 313 Croton Falls, NY 1.0.519 L J n f' _ ._ LAB . !/' Date Taken ( 5' Time: _3Q pM Date Rc' d:. Time: 3 o PM Date Reported. SEP.201989 Collected'By: Dennis Malanchuk .Referred By:, yS�ipple Location:, { I G- h V1-eW U r`►n W A l h i► I Phone # Phone H" Sample Type: Reaeat Test? _ I (check one) LABORATORY REPORT ON THE QUALITY OF WATER' 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. LT = GT. _ TNTC= CON = NR. = Not Apvlicable Less Than ( <) Greater Than Too:Numerous To Count Confiuent (= TNTC). Non- reactive REMARKS /COMMENTS (For Lab Use) Potable _ Non - potable STP INF _ STP EFF Other: Sample Status: (check each) Outgoing HNO3 HC1 — H2SO4 _ NaOH _ ZnOAc — Na2S203 Other: Incoming Ci LE 40C _ GT 4 °C PH LE 2 PH GE 9 PH GE 12 Other: THESE RESULTS INDICATE THAT THE WATER SAMPLE O(WA (WASN'T) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO T YORK STATE.D RINKING WATER STANDARDS' FOR.THEPARAMETERS TESTED, AT THE OF CGLLECDNKING THESE RESULTS INDICATE THAT THE WATER. SAMPLE (DID) (DIDN'T) MEET THE ..SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW.YORK STA WATER CODES,. FOR THE PARA ET %%TED, AT THE TIME OF COLLECTION. /X/ Albert H. Padovani, M.T. CP), Director 2 /86(Rvsd7 /87)RWE J7. 4_ b__ FDIAr, SI?'E�L�ISpECI'_r, Lit= j C;vza OR SD�EDI i! SiC�I LJI' �L� — a i •roc �k-t rrnr�:f -,- S iPr^ DIS CSrr, PGA? 0 (`T G_S area- 1Cr':f GS r Gr./17rovEd c1a_ns b. F i ] se c—L i Ca - Date of piacl_=71�_rlt L:1 barr;E~ LGLF WDZ -r! ANG_D11n- c _ sci; nct s trircr i bra; ec_ L-�n 15' f =an SDS I 1 1 I e_ 100 ft- f=-. Wa. ccur =e/ iEt: any_ I I _ SZ-51= DISrC�P S.�S= -,, I Size _ 1,000 I.2� b. se:�LZC to: I % goo LGr:�� � C' °�_rlcut wi tr2].n 10 f,-, . Gf 450 e. i' 1 P '• cLr! =_ at s= ms e? = -rticn belt f res � I 7 bc rQ lcnes jtin ;:L L hc x I f. j�„ CI'TCN EC=' -- Crcceri y S_= I I C . r L'�+.. Dizi =nC= 1 = Lns == l _= ac- �rcinc tc�C1 -� - S1Cce C _ �n ac = -r�= ^! e 1/ 5 - /32 0 i= - =- r_-_ t l i ^- - 20 Lam- - SC 'Lrr --_C'S L,CJI� -} ^C= t= c'^_'" < 30 —i- I —4— 1 S. Rccn allc ec =cr 50!- 3/ I fit I 1: 1rEC% -1 C C= =zi c1 in t= E_n- '! 12" u it i r-i rl I h. F -HP OR LC.c- S ze Cf c_�� _ CcG'- -jcti- I ITani -. C Ci cle by Ee: -: th Cfe r a L ^cEr I I I I e =tiTi�t_� cN cvc_e b.� I E3 z:=a- accc rzveZ U! ans I­S _ =`te - -b_ ✓ I C_ CiEzinC 1,3" C�C..,C CiG�e b. � ZCCS T:� �_G � 1 �� l..GC� l 1 � C`r� ( C_ All vices f �•_ : wi z in<_ce of bcx I �� I I -- sat__al cent =?ns s -.ones < 4" in ci`rEr� e- C_ ai n d=i n ins, led accordinc to pian �� t. c - air a=—:n & d4 to emis`_wac- ( I C=-- ` c- acharce away t =CII C_5 ar== h_ - =ac- = ade=vt= I - + __ ll i I I I Cl l_� _ • -r l.i�_L1 C.1! Jl��...c •..mac_ ___ .lea U U John M. Simmons, M.D. PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES Deputy Commissioner of Health - FIELD ACTIVITY REPORT - Sheet of � INSPF7CTION NAME �Q/ /I �i� . - l % �o Orig. Routine �- o/� 2 �/ Orig. Complain ADDRESS Orig. Request No. Street Town Ti No. Caapliance Camplaint Comp MAILING ADDRESS Final P.O. Box Post Office Zip Code Group Illness Construction TELEPHONE Reinspection PERSON IN CHARGE / __ // Field, Sampling Only OR INTERVIEWED / C �' Field Conference Name and Title Other DATE 141&2 TYPE FACILITY i TIME TIME LEFT �; Explain c FINDINGS: INSPECTOR: ,7 " "411- � `-� TELEPHONE: Signature and Title PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. SIGNATURE: 6/86 TITLE: t?IM�N9tONG1- tAl2T' x 501, >%`APJ�O;(1•P71oN 0' 50.0' Iq • Tit ->✓NG� iT'(P) .. 50:0' '� fit• p� �J3.0�; ie 14 1>I�►� ' �' G 10:0. g� i'' t 1�la { t� tjJP ► 40 —or TR�U 6 f32.5' P �i. �✓`� M� _k. ICJ �,� � : °,� • �17.p � .. l OV..0' F .. Imo' Ali e I t0. I el.O Ii60.o'. t5. 11 121.5 1�o q5.5� 1:25:5 �7 I,Ot'..0, . 1,�, JUNG71ON 12'Sp GAL A 4 %a ': r r�mcoc *, l y�l°TIG"(?�N� Lf4 G K�zv 1,7 77 :.. -. 4. "dl c:i.P. ll tom, •_ 5.U1�-V FY O � IZT'(. P12.� 1°.q t2-� t?IM�N9tONG1- tAl2T' t 0' 50.0' a: O` 50:0' '� fit• p� �J3.0�; ie 14 1>I�►� ' �' G 10:0. g� i'' t 1�la { t� tjJP ► 40 —or TR�U 6 f32.5' P �i. �✓`� . t 0 q(o.'✓' �17.p � .. l OV..0' Imo' Ali e I t0. I el.O Ii60.o'. t5. 5�.0' 121.5 1�o q5.5� 1:25:5 �7 I,Ot'..0, . 1,�, I2iGJ I l7isih FGA ie 14 1>I�►� ' �' g� i'' t 1�la { t� tjJP ► 40 —or TR�U IAN-: ANN Imo' Ali e QO . 1 TAR 6YF:JI A 4 %a ': r r�mcoc *, G K�zv -�=- A ll tom, •_ 5.U1�-V FY O � IZT'(. P12.� 1°.q t2-� ,1°.!?•l>:P� HI &HNA-( 06,VeL. OVK"r- , VAT�d , A V E, i `';;hv . , . Pfe�PAt? Et7 t3'{ PJ(INit'f A54Gi:v? N < CoiM fwd: ;:aeow !, WM A of ' APPR� ;,iireeil nquMi RAV.. 10/88 °j A 0 _ .TRI L� Putnam County Department of Health Division of Environmental Sanitation AFFIDAVIT - CORPORATE OWNER APPLICATION- . , FOR PERMIT. APPLICAT-ION SUBMITTED- TO PUTNAM COUNTY }[EALTI{ DEPARTMENT 'r TO: Commissioner of Health - In the matter of application for` -- fig- - I, represent. that.I am officer or employee of the corporation and am.,- authorized to act for, wq / I . �.�f4 CLAM s°tt ��!%p •— — — — _ _ namb of cor oration having offices at'��r_��e,21 /�,�/Jg,����_ clee ` _ _ _ _Whose officers -are President ^��j�vs- vim - -< 's -f a a�6------- - --- - -- lame an Address) . Vice - President — Secretary ...— • (Name and Address) - Treasurer _ _ _ _ _ _ _ _ - _ — .(Name and Address) _ — — and that I= am-and w� ll be individually responsible for, any or all aptpr of. the- corporation Leith respect to the approval requested and- all .sub- Sequent acts relating thereto. - t Sworn to•liefore me this y"l day Signed — J of Ajohn+ 19. Title —P sid 4 A Notary Public BONNIE,J. DAVIS helaq Public, State 91 'Now York OutMae CwntY , MY Commission EXPires Apol 03,19 `11 t- 1 Corporate Seal Pr 3 2 -10 :1 :1 3 :90 =1,o:tl :11 4.. 5 z 10 '0 -10a ► 1-7 5 1 2 3 4 NAM: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to' be suimittmd for review. 2. Depth measurements to be made-from top of hole. TEST PIT DATA RMUIRED TO BE SUBMITTED WITH APPLICATION ' DESCRIPTION OF SOILS ENCOUNTERED IN " TEST . HOLES 12'. 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER. IS. IIQQOUN INDICATE LEM TO WHICH WATER I,EVF:I, RISES AFTER BEING II1000NTEEtID DEEP HOLE OBSERVATIONS MADE i BY: DATE: 7- DESIGN Soil Rafe Used X-10 Min/1" Drop: S.D. II,�able Area Provided . 0 0 D No. of Bedroans Septic Tank Capacity _/A D gals. Type ('0 10C,., Absorption Area Provided By L.F. x 24" width trench OtherF r , P'N I c�to',��— Name ....�R�2�T �fi�s/ �E�12 �� �S�oC ��ignature • � -� _ }Y, ,�,v uj Address 7� �A112�1 r✓zT7 D%O J I/� SEAL 16124 / No. o� 11 l✓ A9OFESS�o�?ry THIS SPACE FOR USE BY HEALTH DEPAPMM. ONLY: Soil Rate Approved sq. f%,%J. Checked by Date % ,:,e^ 'z 1� N J, �A w Carmel X Y - F; 'S, - V K MEW .g % ,Town "S Subdlvlt Aet :# L -Tiii r*W it n r4 `�;". AR J., &jj : of P, Val- ,4 p OUS, Mao ;4 % Sk J" y. BalldW -g Type �C �'T� �L- Lot Area x.' �-%� .d.0 FIII Section Only - Deptlty.3 Volume p. Number of Bidre6iipip, �"parmm-:Ae vikr ,S Gallon To be cone acted br or:PLrFvate Supply Dialed by -Z .... .. . . ;"�, S-4 17 :ez V -CIA-- a diipbsal.��.Systernl' wtiollnlT �, - -- - 9�:_ — 44 �flrreli;"Ilt,6 $;,rules !qv�e. a JA��;;4?!.I�n.c�.'.vvi h 06 s 4p� fand.regulat ions .of: fhA utnarn 'h-- iii';c6fiiplifliSn�'theii-7 to the tomrni�5!6Air'-f, Ith Ili be �County;� egiartment-o� I4e'4'Ith,,andVat-c eof,&!,!Certif itatq��-o s Vil 6 �hl , : I r,wIl t TR� - . I submitted NoWi4i.,1his successors,-, er�� - - . . i ate -f a' opera ing cononson 469,.ah'- p ce fin, good s i0o theiisu 0 r anc e.,o t 0 repairs a irs':t ;444 all will be; located as shawn!on the approved -ITIsaid I - ,pia .!C'oiiniy Department of' Health . I ssors, o�f 'two bove an�, rep! 4 is a JtnaT Dais License No —6 14 APP,ROVEO FOR CONSTRUCTION T h�s_approva) ;expues two 1, S, s r romithe -daze issue 00 of ¢ f Ingelpt-alt atkn, V r q, or,ca4sp or m ;U& 10!,"u". Pr�vT r 4-: new -.Mrrffiit.� A/ 64 for ,c1iij)dsiI,:of. nil q pr aq r ,Rev. By 1/8 Date Tate 13 DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL p l� PCHD PERMIT WELL LOCATION Street Addr ss own ill a City Tax. Grid Number U�- ED . Imo-- I WELL OWNER Name. Mailing Address � rivate L 1(L 'TES �1G 'C® � 14MO& 0 Public USE OF WELL RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED 1 - primary 0 BUSINESS O FARM O TEST /OBSERVATION ❑ OTHER (specify 2 - secondary O INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY Q AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED3--5 /EST. OF DAILY USAGE gal REASON FOR MEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION DRILLING OREPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE BILLED DRIVEN DDUG ❑ GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES W-___N0 IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: (!fyr&,in KLL__ Lot No. WATER WELL CONTRACTOR: Name Address:: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE:, YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY <DISTANCE TO PROPERTY FROM NEAREST. WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION ONEP jS TES E _ _j - (date) 0 (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 provide by t e Putnam Count Health De ar ment. Date of Issue: 19 c �! Date ' of Expiration : 19 ermi," Issuin ficia Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector :I Pink Copy: Owner 2/87 r'n- n- - T.T_'1'I I I __ nvvFmmTr n ' I �1• 1 ► V,►. � REVIEW SHEET - CONSTRUCTION PERMIT DATE REVIEWED: BY: - (Street Location) DOCUMENTS C P Permit Application Corporate Resolution Plans - Three sets s/s Engineers Authorization Design Data Sheet (DDS) SUBD1G Deep Hole Log Perc _ Consistent Perc Results (3) Fill Perc Hole Depth cd _ House Plans - Two sets Well permit; PWS letter Variance Request GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Tcwn/DEC Permit R & D) Data On DDS Plans & Permit Same REQUIFZED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pup pit detail Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes (grinder notes) Design Data: perc and deep results Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter,Curtain Drains (discharge OIL Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shcwn;gravity flow,suff. sit If Pumped Pit & D Box shown, & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Proposed Sy: 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 101 to P.L., Driveway, Large Tre--s,Top of 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake Unc. i 15' to Drains - Curtain, Leader, Footing 351to catch basin,stormdrain,piped water 10' to Water Line (pits -201) 50' intermittent drainage course Se tic Tanks 10' ran Foundation; 501 to well 15' Well to PL Notwa: 1) Tests to be-repeated at same de,th until ayyroximately equal soil rates aro obtained at each percolation to t hole.. All.daia to be submitted for rAvif•w. • i nth measurernPnts to. he nvide from t op ' o.f hol r-. D 'OF FUTNAW COUN`!'Y "DEPARTMENT HEALTH' DIVISION OF ENVIRONMENTAL HEALTH SERVICE COUNTY OFFICE BUILDING, CAWE.L, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE.; DISPOSAL SYSTEM FILE -,NO: (n+rlerCc�1.JWAL�- I -�I�,L EST�CS I.�•,.I .Addx!t�seZ� �p-t'�i.l,t1 -1 s�yL.,�1LA"Co►U�iI,I�Ly Ic�r3�o C_pVJ\,),VUL' JAALt 1?_�D. Located wt (Stmt Wizate ' CL. See. 15'.. Hock ... tom_ .IAt nearest cross a ree MwLLclpQlity C LSD :.... Watershed �.Z6T�l�,( SOIL PERCOLATION TEST DATA REQUIRW' TO BE SUBMITTED` WITH APPLICATIONS, Nwnbur CLOCK TIW PERCOLATION PERCOLATION —Tun kjapse Depth to Water Wa er ve No. Time ' From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop. Drop in, Min. /in drop Inches Inches Inches 1 3:4,3:4 . - ,2 . : 50 Notwa: 1) Tests to be-repeated at same de,th until ayyroximately equal soil rates aro obtained at each percolation to t hole.. All.daia to be submitted for rAvif•w. • i nth measurernPnts to. he nvide from t op ' o.f hol r-. TEST PI T DATA IRED TO BE . SUBMIZTIM WITH .APPLICATION F SOIIZ ENCOUNTERED IN TEST HOLES DEPTH HOLE 140. HOLE N0. HOLE NO. G.L. 12" .J LLCM 18" 2,►" 30 ".. 3600 42"- Qoc `,i4 N 60,, �ack I ND I CATS, UXE1, AT WHICH GROUND WATER IS ENCOUNTERED I NI )1 CATS LEVEL TO WHICH WATER IL-VEL RISES, AFTER BEING ENCOUNTERM 'PE.3TS Ku-)1K BY Date 3ui1 Rate Used IGN M1n/1 "Drop: S.D. Usable Area Provided Nei. ut' bu-druoma Septic Tank Capacity, Gals._ Tyj)e / AbsurpLion Area Provi ed By L. F. x24" —56"— nV *1d1z1-1.. renc Nts[rx �nl.-p- ) :U / lgria u -el Address �' G ., LJ � SI:AI,`r�. � � 4 ''�i =, •''- j1 11'1115 SPACE FOIJ USE BY HEALTH DEPARTMENT Nllvo ONLY: , ' x,r'l �f,;oF777jo J���i rn :coil hate Approved Sq. F't /Gul. Checked by`.' Date <<_ C��yy @ YVO E SEP 2 l' 1985 .. PurnrAAA DEPT, OF OF HEALTH 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 matter 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 co the approval requested and all subsequent acts relating thereto. ( A� Sworn to before me this n day Signed: of 6�" 19 �.l.J Notary Public LIONEL WEINSTEIN Notary Public, State of New YOM No. 60. 4199160 Qualified In Westchmter Coen*? of &*mrnLw11otr Expires Mtrcft 30.19. 8/84 Title: Vice President Corporate Seal " G NfSp _W7 I. - \�, - , . . . . . . A 6 c '5a`- 'E-r,Se-r -'at IM ve