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HomeMy WebLinkAbout0575DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 21-1-39 BOX 7 ME a ', ;- ,I IN ON N4 A I I I IN �, - ,, qr f 1161 ■ • ti � tiE 1. ,I 00575 "?'Y�; :: +-+^-2+ ...zero - .e,- .. -.: -:: •. ".v"""'y2�": -xs - F.:.'?.^^ � .:V"" .�?_ ,'ia"""�?-� l "T� .'�^+'^, �•Y � 1^•� ...a. : - G']1A�4�T�.. • •✓ iF PUT NAM COUNTY,DEPARTMENT UFAI[EALTH f Rev. 3/86 DWislon of Environmental 11e61tL Servlcep, Carmel, N.Y 10512 Engineer Must Provide ',� " 1 • P.C.H D Permit N F` 1 CERTIFICATE . . CONSTRUCTION COMPUTANCE-FOR SEWAGE DISPOSAL SYSTEM c Town or V e . . Located' d Sa r R • o6--' Ta= Map es r r Block Lot Owne m on-) AO� D CC?A) Former Y Subdivsion l Nemec- arrNu?l1LL Sabdv. Lot N MaWng Address zip Date. Permit Issued. Ail Separate Sewerage " System built by lrgQrnp0aD Addressp Coniisting of I EJ _ Gallon Septic Tanktand3 3' 1 R6 $ , PCiLL> pklin R :' .pc,uS "So 7 EXP19A1:5,10A] .AR.E,4 water Supply-- Public Supply From Address or:" Private Supply. DrWed by Address r!t,n! F e(! /}�✓% Bail tI1n8 Type A)000 .T�/i,�'1 E Has.Eroslon Control Been Completed? Number of Bedrooms B.ee Garbage Grinder Been Iustaged? " .Other Req niremente I certify that the syatem(s) as,l'isted. serving the above'premises_ were constructed eso, `a' n.the�p�; the completed work ( copies of'which.are attached), ind'in accordance with the otandards, iuleE and reg ono, r w ile a 'and the permit isoueii.by the a Putnam County Department Of'[iealth. °9J Certified b� P.E. R.A. Date ; Address R 6V 49 O tuna No. Any person occupying premises saved by the abOWsystem(%) shall promptly take suchactio n�pess�S his Correction of any unsanitary .,conditions resulting from such usage. Approval of the separate sewelags: ystern (hall barn N' a pubs ?n sanitary qWN :becomes availibls"and "the approval' of the private water supply shall become :null and •void when a publ al: ., a avallable. ' Such approvals are subject to Modification or Change when, in the `judgment. of the Commissionar�ol.Me�alth, such r Iution or Change Is necessary. Oats'_7� Y r-I• / BY��.�L.� %� Title �� I s-MM b& AL.T.T TTT ALT T1TIT ATT �` vv W N VVZLL lrVrLr LP,11V" LXZr ViCl DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only — d� WELL LOCATION STAEi i ADDAE55: WN1 t 1 T NUMBER: Cornwall Estates Patterson NY Lot #17 WELL OWNER NAME: Joseph Mirra ADDRESS: Crompond Contracting Corp., Box 451,Crompond,NY 10517 Q PRIVATE Q PUBLIC USE OF WELL 1 - primary 2 - secondary 13 RESIDENTIAL C) PUBLIC SUPPLY O AIR /COND. /HEAT PUMP ❑ ABANDONED O BUSINESS ❑ FARM O TEST /OBSERVATION O OTHER (specify) p INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY p MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING []REPLACE EXISTING SUPPLY ®TEST /OBSERVATION []ADDITIONAL SUPPLY ©NEW SUPPLY (NEW DWELLING) ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 585 ft. STATIC WATER LEVEL 30 ft. DATE MEASURED 3111193 DRILLING EQUIPMENT (4 ROTARY 1] COMPRESSED AIR PERCUSSION 0 DUG ❑ WELL POINT ❑ CABLE PERCUSSION O OTHER (specify): WELL TYPE O SCREENED O OPEN END CASING ® OPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH 41 fL MATERIALS: IM STEEL 0 PLASTIC D OTHER LENGTH BELOW GRADE _ 10 ft. JOINTS: O WELDED ® THREADED O OTHER DIAMETER A in. SEAL: CkCEMENT GROUT O BENTONITE OOTHER WEIGHT PER FOOT 19 Ib. /ft. I DRIVE SHOE ® YES ❑ NO I LINER: OYES 0NO SCREEN DETAILS DIAMETER (in) -SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (IQ DEVELOPED? FIRST O YES ONO HOURS SECOND GRAVEL PACK O NOS GRAVEL SIZE DIAMETER OF PACK in. TOP DEPTH -ft. BOTTOM DEPTH ft. WELL YIELD TEST It detailed pumping METHOD: O PUMPED tests were done is in- t (7-COMPRESSED AIR ,formation attached? O BAILED ❑ OTHER ❑ YES O NO WELL LOG it more detailed formation descriptions or sieve analyses are available. please attach. DEPTH FROM SURFACE Water Bear- ing Well Oia- meter In FORMATION DESCRIPTION p0E ft fL WELLOEPTH It. DURATION min. hr, min. DRAWOOWN It. YIELD . ggm. Surface 5 Dr' lli g in overburden clay & boulders. k at ' 585 6 520 5 5 41 Dr 11' g in rock, set casing, grout (d. in rock granite. LITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES ❑ NO [MAKER ER O CLEAR TEMP. STORAGE TANK: TYPE WellXtrol #250 CAPACITY 44 GA . P INFORMATION submersible CAPACITY 5 g Gould DEPTH � 5ES10412 z30 � EL VOLTAGE HP WELL DRILLER NAME P . F . Beal & . S o , ADDREss 4 Putnam Ave. r"5/45/93 slcf RE Brewster,NY 10509 PUTNAM COLUEY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES L je-Q MQ of,� - �g a�, �✓�q c� Owner or Purchaser of Building----J Building Constructed by Location - Street --r g Building 23 Section Block Lot `-' -g'Z -r Subdivision Name Subdivision Lot # GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage disposal system, or any repairs made by 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 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 day of 19 Signa Title General Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk J 6 ew AddressT SAMPLE NO. SOURCE COLLECTED: BY: BREWSTER LABORATORIES Box 224 - BREWSTER, N.Y. (914) 855 -1930 IIJ1 .1, 11:.x_ '► ; L._ Y , .� 1; N. .. Crompond Contracting Lot #17, Cornwall Patterson, N.Y. 5/25/93 P.F. Beal & Sons BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method TEST WELL This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. 5/26/93 0 per 1.00 ml. I- ry PUTNAM COUNTY DEPARTMENT OF HEALTH NO. 552 -93 -19 t COMPLAINT OR SERVICE REQUEST RECOR f TOWN PATTERSON DATE 10/29/93 REFERRED TO BH -kFEN BY BH TELEPHONE CALL X IN PERSON LETTER CONFIDENTIAL REQUEST FROM M/M Hernandez TELEPHONE 878 -7470 ADDRESS ENVIRONMENTAL HEALTH: Home Sewage Rodents Refuse Public Water Food Service Migrant Camp Other rf)MVT -ATXVr no PPOTTFCm New house, septic tank and oil tank exposed, water pipes leak where they enter house, Lot.# 17. Joe Mira: Builder. ';77'F'12 10 S-2 lir Route 164, Cornwall Hill, Devon Road, Somerset Road, Lot 17. ACTION TAKEN BY FINDINGS DATE DATE PROBLEM ABATED / l) �101- / /--� l - DATE ��j`'- Z� ESTIMATED TOTAL MAN HOURS SPENT 77 j, _ � V��� /IVY d��% • 1 r r' i { _ alp TV r C � • Caen jr, fao JI nn T1 F' Enc 's % ©a ek, lies kv 'Adhcm i m I eprwom - that 1 40ANI Ody a" cpR00it6fy �R fp tM d NOe arsd Qotatton of =tM prypeaW i'yftamis)r l) tMt _tfN ate fawaNcdi�pOtal "Antam ateera dmxrroad will oanstruttae as e�ewn on tta approumd awNnenlent t"o to ;Mp Jr aecordanas, ` Isttie e. iuNS'na rTju m Y a0attf�rt N AlaaNh. and ttNt on eam01ot1sn,t6iV �, "Cortiticato of Conftvuetlop Aft to tM CommiglaN► of MNKhwM -, } M ,frtrnlgd to tM- 00owtiwint awd "a wrdtsA 4wrarit a wi11,®a fumutied tM owiaf hid +< tM twtpar. 4hat fNd OYNdM will i{�Oa M ''Oad at1�►aft110 OOf1/R1011 afty da►t ef; pif0 `aawama dtlooNl aYdaf dtMih®.'tM pa t) iollortw� tMAato M tM Nire aaKa N tM a0pewl d the %CartNkMe of Ceitetfwdlon: Comp i6nea o/ ties or tiwl sy. b} M didlad waft dawt trlN N foeieid ar riarw ow thi'aa]pesoat iiYn anA that P . mod wilt N In9ta ed of tqs Putwnw CflMly Oepmirmrit W_ toiaRti F Cka r wiofoovfati Fort collsTatxTloset Ypia auroral aaa ®ate two ymps eroh� tho dot® Its,rad a lass iftfuetan'ot t ui has boon "71 a rMOCaD1M falP iWfrt OI, 1MY N arnaneod,or modNied arhan eonaidorad naeasearY tiY aM Con�E� �\'A a or iltaratlon of oorotrudbn V feMrbaf{ m1t. ApYvaowW Bor`dksio9al 09 damp" IS. andaiy oNvat.Nat�r`� � F 'b ?C -1 PLJTNAM COUNTY DEPARTMENT OF HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM . Name and Address of Applicant: Name of Project: _ C�� /% 6LIg2g/IAZ /1 /�� 3. Location T /V /C: Project Engineer: J 4h`7wl6,11/� 5. Address: �. License Number: 7G L )J)Phone: 91q-7.7-7-2P,77 Type of Project: rivate /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) Is this project subject to State Environmental Quality Review (SEQR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted k_ Is a Draft Environmental Impact Statement (DEIS) required? ............. Has DEIS been completed and found acceptable by Lead Agency? Name of Lead Agency Is this project in an area under the control of 1 al plann. zonin C� or other officials, ordinances? ............... !;Y..l /!!!�I�... If so, have plans been submitted to such authorities? .................. /yy Has preliminary approval been granted by such authorities? Date Granted: Type of Sewage Disposal System Discharge...... Surface Water Ground Waters If surface water discharge, what is the stream class designation ?........ Waters index number (surface) ........... ............................... Is project located near a public water supply system? .................. If yes, name of water supply Distance to water supply _ Is project site near a public sewage collection or disposal system ?..... 4�2. Name of sewage system Distance to sewage system Date observed: 23. Name of Health Inspector: I Project design flow (gallons per day) ...... ............................... 6) 2. 5. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. 6. Has SPDES Application been submitted to local DEC Office? ............... r 7. Is any portion of this project located within a designated Town or State wetland? .............................'..... ............................... 3. Wetland ID Number ........................ ............................... ?. Is Wetland Permit required? .............. ............................... A Has application been made to Town or Local DEC Office? ). Does project require a DEC Stream Disturbance Permit? al�, f. Is or was project site used for agricultural activity-involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, Ald landfilling, sludge application or industrial activity? ........ YES or NO ?. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or NO DESCRIBE: 9-ld Is there a local master plan or file with the Town or Village? Are community water, sewer facilities planned to be developed within 15 years? �y Are any sewage disposal areas in excess of 15% slope? .....:, ' "d TaxMap ID Number ......................... ............................... Approved Plans are to be returned to: ................ Applicant _� Engineer the application is signed by a person other than the applicant shown in Item 1, the -plication must be accompanied by a Letter of Authorization. Failure to comply with this ovision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. Fa Ise statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the Pena 1 Law. GNATURES & OFFICIAL TITLES: ILING ADDRESS: 1 DESIGN DATA SHEET SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner �i�D�l7G�.0 ( "lamlr�rr mess ��OG��' l' C ®v�Gsi.��/11i Located at (Street) �l/��°� /�T / / /iv/ Sec. 2.2 Block Z, Lot (indicate nearest cross street) Municipality �CJJ /���'� Watershed Date of Pre- Soaking Date of Percolation Test HOLE NUMBER CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Frcm Water Level- No. Time Ground.Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 1 2 3 4 Aloe 2 3 4 5 2 4 5 NOTES: 1. Tests to be repeated' at. same depth until approximately equal soil rates are obtained at each percolation test hole. All data to'be submitted for review. 2. Depth measurements to be made fran top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN'TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 1' 2' 3' o 4P 5'1/� 6' �/ �` 7' 8' 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS. ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES /A^FTE/R BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: �/ U /I/ltl�lj 1%j DATE: DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided JZ:1061 V/ No. of Bedrocros Septic Tank Capacity gals. Tl w -- *C� Absorption Area Provided By L.F. x 24" width trench , Other v�/�� // /.+— s'r�.�� n� Name Signatur Address :c '`r ;Wrrt; +9 4 XG' THIS SPACE FOR USE BY HEALTH DEPARDNT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL d PCHD PERMIT # -I / �7 WELL LOCATION Street Address Town,j� it}A ge City Tax Grid Number WELL OWNER N e M 'ling Address vate blic MSIR E OF WELL ; primary 2- secondary RESIDENTIAL_ ❑ PUBLIC SUPPLY 0 BUSINESS O FARM 0 INDUSTRIAL b INSTITUTIONAL O AIR /COND /HEAT PUMP 0 ABANDONED O TEST /OBSERVATION O OTHER (specify, O STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED. /EST. E7 REPLACE EXISTING SUPPLY O TEST/ OBSERVATION EW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL OF DAILY USAGEd pW gal 13. ADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR DRILLING G✓ WELL TYPE DDIrILLED DRIVEN DDUG OGRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES No IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name Ale-, lfPll AddressJrnaf�" IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ✓ " NO NAME OF PUBLIC WATER SUPPLY: TOWNr?I�T�r/sCI j Q . / p. . DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: l �� /c�, ti%�,p LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED E)W'SEPARATE SHEET its, LeY If L (da e) sgnature)....::; PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: t° �� 1 /' <7 Date of Expiration 19� Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW HEET for CONSTRUCTION PERMIT dAE OF OWNER � =STREET TION DATE �l TAX MAP # DOCUMENTS. N 3 PERMIT APPLICATION DISCHARGE (OK) m PERC & DEEP HOLES LOCATED ] PC -1 m REPRESENTATIVE OF PRIMARY AND EXPANSION CD EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE 3 WELL PERmrrin PWS LETTER 3 ENGINEERS AUTHORIZATION :1 DESIGN DATA SHEET(DDS) m IF PUMPED PIT & D BOX SHOWN & DETAILED :1 DEEP HOLE LOG L77 HOUSE - NO. OF BEDROOMS CONSISTENT PERC RESULTS (3) m WELLS & SSDS'S WAIN 200 FT. OF PROPOSED SYSTEM CI7 PROPERTY METES & BOUNDS PERC HOLE DEPTH 3 CORPORATE RESOLUTION m HOUSE SETBACK NECESSARY (TIGHT LOT) :1 PLANS THREE SETS M HOUSE SEWER - 1 /4"/FT. 4-0; TYPE PIPE :1 HOUSE PLANS - TWO SETS m NO BENDS; MAX. BENDS 45 W /CLEANOUT -1 VARIANCE REQUEST FILL SYSTEMS MCLAYBARRIER GENERAL -1 LEGAL SUBDIVISION ^4 i Z34?lal HORIZONTAL: SLOPE 3:1 TO GRADE SPECS � SUBDIVISION APPROVAL CHECALL GAUGES PERC RATEEPTH FILL REQUIRED �L L PROFILE & DIMENSIONS 3 CURTAIN DRAIN REQUIRED mSTANDPIPES m VOLUME EX- APPROVAL SSDS ADJ. LOTS TRENCH mL.F TRENCH PROVIDED 3 WETLAND (TOWN/DEC PERMIT R & D) M60 FT MAX 3 DATA ON DDS PLANS & PERMIT SAME m PARALLEL TO CONTOURS 3 PRE- 1969 - NEIGHBOR NOTIFIFICATTON m 100% EXPANSION PROVIDED 3 LETTER BI/ZBA J 100 YR. FLOOD ELEVATION SEPARATION DISTANCES SPECIFIED ON PLAN FIELDS QUIRED DETAILS ON PLANS 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL 3 SEWAGE SYSTEM PLAN - (NORTH ARROW) m 20' TO FOUNDATION WALLS I SSDS HYDRAULIC PROFILE m GRAVITY FLOW m 100 TO WELL, 200' IN D.L.O.D., 150' PITS J D/ J BOX m TRENCH/GALLEY m P- PIT DETAILS m 100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) SEPTIC TANK - SIZE, DETAIL 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER WELL DETAIL, SERVICE LINE IF OVER m 10' TO WATER LINE (PTTS -20') CONSTRUCTION NOTES (GRINDER RATE) M 50' INTERMITTENT DRAINAGE COURSE DESIGN DATA: PERC AND DEEP RESULTS 200 FT. RESERVOIR, ETC.M 150 FT. GALLEY SYSTEMS TWO -FOOT CONTOURS EXISTING & PROPOSED SEPTIC TANKS DRIVEWAY & SLOPES CUT 0 ] 10' FROM FOUNDATION; 50' TO WELL 3 FOOTING /GUTTER/CURTAIN DRAINS WELLS m 15' WELL TO P. L. IMMENTS : PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 UE31UN DATA MW- SEPARATE UWAGE DISPOSAL SYSTEM FILE N0: uti+,�r Addreae.4t7.S �•lz(C AuE, SAE OJXE Located st ( Street Midlcate i W (g tL0 it �( sec. Co a4 Lot Z. rest cross s ree Mw►lcipality 'p- -r' Watershed CIZO70`r.k S01L PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS TT0 1 - -- NLmi k,v CLUCK TIME PERCOLATION PERCOLATION —"Rwi Elapse Depth to Water water Level No. Time Start -Stop Min. From Ground Surface Start Stop in Inches Drop in Soil Rate Min. /in drop Inches Inches Inches 30- `1:55 a5 as 25 3" 9 _ s \)=oD . �a5 as az .25 3 9 1 3 4 P.V, . 1 11:a�± T30 ^ 2..4 a X15 3, 2 ��:3�- \y'5� �!5 as a� 3�' Nut,,):, : 1) Tests to be repeated at same depth until ap1)roximatelyy equal soil rates e►r< obtained at eA h percolation test hole. All data to be submitted for mwv. t f -v . • , ".1ith measurewrit9 to be made from top of hole. -Te mo `ae w.t-so: an —� en" o4 the "approval of the tagtifk:ate' of Constructk"n' ComplH eigW tN to itid as dicjjrn on the approveA,Plan and that" wall wilt � County Department ot. MepRh. \` Mato ZQ L Sill m Address APPROVED FOR CONSTRUCTION Tnis.approwl.axpi►ei two you . rive 113 for cruse or may tie eTOnded or:,modifie0 wean considers T!\ requires a new Permit.. APProvad :for disposal of tloinastic saniy Date, ' CH 0 orY.4K,'Mle C0 of Health will : �- t ne btrti�� i t Itl; OliiWar will nadliRq (low ii/ tlia t� of the isau• tl►i1Ntl. 11" above Nb and,trNu yo the Putnam PE' RA._ t.t 0,� iki - n "undertaken and is y "C pri alteration of Construction Title TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOII; ENCOUNTERED IN TEST HOLES DEPTH HOLE N0. MOLE NO. oC HOLE 10. C.L. 601 1211 18" 24" -Non 36" 42" 4811 X11 Wo 6601 01 ,1 Qo�,� 64 11 1NDICATE: LI'.VE1, AT WHICH GROUND WATER IS ENCOUN'PI;RM I NI, I ( ,'A7'E LEVEL TO WHICH WATER L!JVEL RISE2) AFTER BEING ENCOUNTERED TkS'1'3 VAI)& BY �Z. W . �, . -- Date . DESIGN Soil Rate Uaed 9 Min/1 "Drop: S.D. Usable Area Provided 19000 S.F No. of I3c;drooms 3 Septic Tank Capacity 1000 Gals} �TYpe Absorption Area rov die3 By ±s.4 L.F.x24" �� .' '� ..% r�ene . A. Nciinc� Signatute Address '73rFLt� 2Q11✓� SF:F - j= �; _= ;; Al IL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Hate Approo Sq. Ft /Gal. Checked by Date . , SEP 2 e �� 5 F� H u v rY �NQF EaLrH V4 VVY n_3a rE E 7-- 1 'A 8 C 0 140TES X45- BU 1 Ur -FLAW SCALE �/= 40, P� o 6�u K 9 1 t C/ P /00' '. •This is to certify tvt the sewage d_sposal system was constructed as indi;a _ed on this plan a.^.d that the system was inspected by ma before it was covered over. .1Ae i system was constructed in accordance with all standard rules aid ' regulations of the Putnam County Department of Health and the Now York State D :!Wtur nt of Health.' V cull— County Department at "alu 3lvision of M►vlronmeatal Health OGW60i p ipDroved as noted for oonformance with ` applicable Rules and Regulations of the +atou County Health Department. n 'I Q��ttf}q• R'Tf tl. M }�j . FOUVOATION 5ClavEY By F0�/c r 2 �pICKEN50N 1� 69 LF REocol,,CO 334 F l°ROVIDED 339 KnTTERSOI,j Cr) �U6D CORAIG-)ALL RI -06E" 5—: CROM�POND COh1TaACT //JCJ C662P. �J 0T T� 17 23 ever 2 "1-39 P ct L �etAILs AS- BCU I ! 1 L1' WWI-' �r,/kj a��LI,PE ^fy�e o or Ox'. j z 3 . 2'7 48 7-,GOY, / 4 3'� 5/ s ./o' 6" 36 3 6 1/7'6', 62 T 7 37• 77 9 57 I a ENI� 9 22 to (g #3 AND 11 12 •This is to certify tvt the sewage d_sposal system was constructed as indi;a _ed on this plan a.^.d that the system was inspected by ma before it was covered over. .1Ae i system was constructed in accordance with all standard rules aid ' regulations of the Putnam County Department of Health and the Now York State D :!Wtur nt of Health.' V cull— County Department at "alu 3lvision of M►vlronmeatal Health OGW60i p ipDroved as noted for oonformance with ` applicable Rules and Regulations of the +atou County Health Department. n 'I Q��ttf}q• R'Tf tl. M }�j . FOUVOATION 5ClavEY By F0�/c r 2 �pICKEN50N 1� 69 LF REocol,,CO 334 F l°ROVIDED 339 KnTTERSOI,j Cr) �U6D CORAIG-)ALL RI -06E" 5—: CROM�POND COh1TaACT //JCJ C662P. �J 0T T� 17 23 ever 2 "1-39 P ct L �etAILs AS- BCU I ! 1 L1' WWI-' �r,/kj a��LI,PE ^fy�e o or Ox'.