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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -2 -20 BOX 7 00612 I�yL -I.N . 1 16, II�� J .1 ■` I . % sI Af ' ' �' '� J , am `` T .�' :L �� I IN 00612 } K. ` PU'TNAM C O(JUN ' DEPAR' Mr CFHEALTH r DIVISION -CFMqVIRONMENM HEALTH `SEtY.[CE'S ' DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO:. Owner .S�.stio`1 Wit. �i►'Aa, Address Cv �-,�a► r�® ?mcated at (Su et) t-le _ "/-*J s -E,-P. sec. Block Lot ._ . x (indicate nearest cross street)' Municipality `j sc„y . Watershed -ro 1 SOIL . P�OOIATION TEST DATA REQUIRED TO BE SUBMI7MM WITH APPLICATIONS Date of Pre - Soaking . 6 Date of Percolation Test 7 /f NUMBER C ]LOCK -TIME PERCOLATION ._ PERCQLATIC N Run ;Elapse Depth to Water From Water LeYe1 " Time Ground Surface In Inches, Soil Rate 4jStart Stop Min. Start Stop Drop In Min /In Drop . Inches Inches Inches.. 2 i0:01 /a Z AA -,- _ 3 'ire Zi= tt coo C) z ls° A+ 2 2 3. :5 = NOTESz 1. .Tests to be repeated at same depth until approximately equal soil rates are.obtained at each percolation test hole. All data to'be submitted for review. -2. Depth measurements to be made from top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED -•WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. q Q HOLE NO. g HOLE NO. G.L.�� 1' - 2' 5' -ems 7' 8' i7c k 9' ►.Jr� N9n 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED QA INDICATE LEVEL, TO WHICH.WATER LEVEL RISES AFTER BEING ENCOUNTERED i�lA DEEP HOLE OBSERVATIONS MADE BY: _ �'_T� DATE: 7 /1 • /Rf DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided -�;,etno No. of Bedroams Septic, Tank Capacity 1 ©Up G gals. Type P_r . Absorption Area Provided Byr'S°` L.F. x 24" width trench Other I& 01C S� Nary �_��c ��r w A.<�cia� e, Signatur Address? �. ",c/ SEAL H r 7 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY : • SS►GN�`�' Soil Rate Approved pp sq.ft /gal. Checked by Date _ •.- ca.C:aa-a:w._:.. .n a:y:....r:::ev.i'.i:n+.: ti....:...1:.:..- . ... -.- ...._....w.«w- ar.u�ue... :. • r.. _........•.a-. _: ww..r --..._ .� - .-- ...,..... 0 F pUTNAM C XJWY DEPAR E�nU OF HEALTH - DIVISION Of ENVTRONMErTPP,L HEALTH SERVICES ' . INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS A REVIEW SHEET - CONSTRUCTION PERMIT DATE REVIE WM: -; / 5 A 6 tyosAN M._ IDA - • - •• eet Location) -� DOCLIAEM Pennit Application Corporate Resolution Plans - Three sets Beers Autiiorzatiori Design.Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other man-114c- • I i House Plans - Two sets If PWS - Letter Variance Request REY, Lr= DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flcw Fill Profile & Dimensions - Volume D or 'J -$ R-.-' ench /Gallery; Pump pit details f ti tw'94 l:Detail ice Line if over Construction Notes Ts Foot CShf tours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc &: Deep Holes I,ocat Re pr een xQsion iv & Fir ea _Expansion Area ;shown;gravity flow,suff. size If 'Pumped Pit & D Box Shoran & Detailed House - No. of Bedroams Wells & SSDS's w /in 200 ft. of Property Looted Property Metes & Bounds House Setback Necessary (Tight lot) House ;Sewer 1 /4 " " /ft =4 "0 -)Type pipe No Bends; Max. Bends 456 w /cleanout SEPARATION DISTANCES SPKIFIED.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- e.3n) . 15' to Drains- Cartain,Storm,Leader,Footing 25' to Cate Basin 10' to Water Line (pits -201) Septic Tanks 10' fray Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked F- approval SSD U. :;Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same � , %Y •PTnNAM COUNTY DEPARIMhNX urZ=,iuin SSDS/Yv'S REVIEW SH= - DFTA S a SFP= O{ DZJ= 1. Cutlet 211 belrw inlet 2. Minunm 3" bad a£ pea Tm7el 3. iAnimm d* h cf lagidd: 4' - 4. Ia#h - mnunm bam width to Mm= far tuns width. 5. mvirm 12" comer. 6. lcmticn sta)p- 7. Mrbnle - PPerling - n 20" in ti=ter _. dirmrziaL - 8. Baf 0 e aster 20% of ] io 3i d---th ab:;.e lig id IeRl (641, b--10-1, c=5' .b-72'1) mt-h - 9. If l� G.T. 9 feet - to 2 amprtzrerts. 70. Miriam tank cepcity ]000 ga14 bah ; 7200 c31/4 h c -134 d13 b53n;161 c E/4 b5m 11.. A Ct�- tic coating fcr re-ixifcroaa ax=ete- 12. 1-a Pt- tsqjl f 7.E1 balcw IIzw lit-p- .13. 0±1et tea/� 18" IE1rna flaw Line. 14 kaEt piga, sic. 14 11 pzrr fxt rain. (2%) . 155.. inl f-t gire cast i=, 4'lrrin. 16. a*1et Pipe slgx 1/8" P= fcot min. (1$). 17. � joints frr: s. -vita y teES. 2. All atlets at eleotiaL 3. • - to . •• - m ••■ . 4. Nirimn •e•. . ee • •: .e: qzvel. •: % - • MDdmjn 1211 cxer. .7. FavjaUe aver fcr 9. •1 ••- 0-tiets 1 •_ • • • 61606-1 ••- NAMM, W-M • 1 • / r . ..•r .f- p- . . 3. 4" minirrm. I atetal diaTetEr. 5. . rdnirnn ..0 � r •_ lateral. ...1 Q•- - •• - .: • ..J •� •- • ••�• •f- t.• cf casing 21 abame ID1, cc ukaticht. 1 viinimn g=± , .• rc=k. S. • , balcw aG. irdn. . S- nitity saals • .Ir• -• aay . ay • rcra uell. • 2. 6" - 12" raboual soil backfill. 4. J16 to 11" clean gmwa . • - _...- Pipe kn;ert 6- .- r_ • • -�- r MY r: a !m r ter. i � •.•■ • • •1 a- r . - .• .:.. APPENDIX D CONSTRUCTION NOTES SUBSURFACE SEWAGE DISPOSAL SYSTEMS & WELL WATER SUPPLIES SERVING SIN= FAMILY RESIDENCES Basic Required Notes 1. All trees within 10 feet of the proposed SSDS shall be removed_ 2. SSDS to be inspected by the design engineer/architect and the Putnam . County Health Department after construction and prior to backfill. 3. No trucks, machinery, building . materials, nor excavated earth shall be allowed in the sewage disposal area. Construction of SSDS to be in accordance with these plans, any revisions thereto, and the rules and regulations of the permit issuing governmental agency. 4. Minimum well yield of 5 gpm is required. Yields less than 5 gp-n will be inuediately reported to the Putnam County Department of Health. Notes Required When Fill Proposed 1. Fill must be allowed to stabilize for 60 to 90 days following placLrnent and be. inspected by the Putnam County Departffeht of Health for acceptance, prior to installation of the sewage system. Date of placerient must be reported to Putnam County Department of Health.. 2. Run of bank fill shall be suitable for sewage absorption, be free of fines or other unsuitable material and shall have an in-place percolation rate at least equal to that in the .natural. soil after. the required stabilization period. The engineer/architect shall perform a final percolation test in the fill after stablilization. 3. Impervious fill, clay barrier, shall be a dense clayey soil with little or no sewage absorption capacity. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date June 26, 1986 Re: Property of Vidal Located at McManus-Road (T) Patterson Section 73 Block 3 Lot 18 Subdivision of Maggio Real.ty.Compa.ny Subdv. Lot # 4 Filed Map # 2011 Date Gentlemen: This letter is to authorize J. Robert Folchetti & Associates a duly licensed professional engineer X or registered architect (Indicate) 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 iu 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, Si Countersigne P.E., R.A., # 051011 P. 0. Box 374 .Address Brewster. NY 10509 _ (914) 279 -3346 Telephone Town 7 as -mot 90 C� 1 Te ephone TRANSMITTAL # Tc): Putnam County Health Dept. 2 County Center Carmel, NY x.0512 Att. Mike Budzinski Date: 7 /11 IRA Job #: S-i.i.bjpctP. Maggio Subdivision, McManus Road, Pati-i—som, Lot#4 The following items are herewith transmitted: xx Attached Separate Cover Q Delivered ITEM COPIES Y DESCRIPTION l 1 Construction Permit 2 1 Letter of Authorization 3 1 Design Data Sheet 4 3 Drawings- Septic System Design 5 1 SSDS Plan and Profile 6 2 House Plans Approval Q use Review and Comment As Requested Record Other Ft� marks: _ Please advise us of any questions at your earliest convenience. c`^• file 0. Robert Folchetti & Associates F. 0. Box 374 Lrewster, NY 10509 -0297 Signed: Telephone #-(914) 279 -3155 279 -3346 - PUTNAM COUNTY HEALTH DEPARTMEPtT °- ` . . fit•• .,/' 4�'' _ , 'SERVICES DIVIS ION' OF ENVIRONMENTAL HEALTH -John.:M. Simmons,- M-.D. _ r = Zeputy Coinmis.sione-r of: Health = FlELD.ACTIVITY .REPORT >, Sheet -. r 'INSPECTION ` NAME = 5u5Rt,0 a✓t at�O.L - Orig. Routine z $DiV. Orig. Complain ADDRESS. MA�IvS , . �® #R -So�P Orsg. Request , No. Street _. . Municipali y (T)(V)(C)`. CompIian"ce.. f Complaint. Comp MAILING DRESS <, - Fina1 P.O. Box = Postr;Office Zip Code Group Illness Construction TELEPHONE . ,. _ r , t on PERSON IN ,CHARGE k_ - :Fields °r amp, ing Only -OR .INTERVIEWED Field Conference Name anal Title ` DATE-',- ATE /� g. TYPE FACILITY Other., TIME ARRIVED /o " TIME LEFT /f% Explain -FINDINGS: '14 Kf> 1 �. •._.' r r' pe n ° ' �I � nq � YqF .1 "" r 9 r � •� �„'� ,-y.. -�- M.; w.,..,,, #' � � � .� ,.Mi ,� + �'sw ;�+ R ," •_ ice! t / �,�*):a, ".:. .q ^� -•LLw�..,e,,,�. � ..k r*° .�.- ,+,..`�':.- • °.,�,,,R s .,�,,,•+. a �' 3. r. I a, p - -��. J .x�r a r s,,• of �` a- r � { f µ i F P J ; S: ° a n S, . +. �' "�" .• �' G / w.l � ,r, ., ,�1§ M r °�r,"kG � { � �� a t s J a ��� wt. � � r. rF e.s Y •��3d' r�5 �:� ,�% � v f �,r;,, s r .p,' Y - ,� + � F)Q Fk�r .� r v s � �. m 1 : � t 5 + R , L 74.$JD 2c t �r Y` n Y e /r;, -/ F a / F °/ r Fps41 /,s '. J ��� cr p �� ►zg "° 1 MiN M "c�16110 ,.S�DiviS`IC),j Kz Of } r t r r r 1 ' t r V tr t >•� ) f `. i DEPARTMENT OF HEALTH Dlybion of Envlrannwntal Health Services 4 Geneva Road Brewster, New York 10509 ZrL (914) 278-6130 Fox (914) 278.7921 BRUCE R. FOLEY Publid Health Director 325 AAC IAA PU S STREET 1� D c.�-t 9 TOWN 7'TE TX MAP # _ � NAME RONAW t tS""iy", PHONE g q` 'qS49PCHD # MAILING ADDRESS s _SID cm DESCRIPTION OF ADDITION � _ A P-r NUMBER OF EXISTING BEDROOMS PROPOSED'# OF BEDROOMS4_ (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING rNSPECrOR) *Any addition which is considered a bedroom requires formal approval of plans (Construction Permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health. Dept., 4 Geneva Rd., Brewster, NY 10509, Phone 278 -6130. .1125763 1. Certified check or money order for $100.00 2. Sketches of existing floor plan (drawn to scale, all living area including basement) * Non - professional sketches are acceptable 3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #) # Non - professional sketches are acceptable 4. Copy of siuvey showing well and septic location, to the best of your knowledge. include date. of installation if known. babel all wells and septic systems within 200 feet of the property line. Contact this office with.any questions..... 5. Copy of Cert. of Occupancy from Town or Certification from Building Dept. with-legal bedroom count of dwelling. OFFICE La Comments Feb 91 6^K:P aF H F-A 07H APPXV'P tefl ne ta N 191 -.7 "14 gyp/ PP_nP• � � � �� . f's o14. Hia L- ? Ar-EA74T. 2' T.94' .......... . ........ .. v 0 MR.& MRS. RONALD FISCHMANN 85 MCMANUS ROAD SOUTH PATTERSON, N.Y. 12563 '61%,11 V-0 ARCHITECT: JOEL GREENBERG,R.A.,N.C.A.R.B. 2 MUSCOOT ROAD NORTH "S'k MAHOPAC, N.Y. 10541 IN WITH TI-1p, (914)628-6613, FAX-628-2807 FEBRUARY 26, 1999 JOB 7-98-142 TV w m moll �44 AVW b �l l� OJ' ti 1 r ,ror oi:� e o I,, f%I L 16Gc or AoD 25ot� 5,o KIL.L i i 4 + P, vIELL T T T , A, iI NT 0. \ 2,7 5 rucnam County Uepartment us neat" Division of Environmental Health Service. i99r0ved as noted for conformance with •093icahle Anlno :,..t i� "AS BUILT" Structure located from survey by surveyor "not-ad b Well located by: Surveyors survey. - Well drillers report _ Engineers mesuremenfszj a , 1 7.F, Tank, boxes, pits, galleries a laterals lo-cat9d._byGCy Field Inspection by: Health dept ® dots. `• Eng+neer ® d:ate:`` This is to certify disposal sus•tgm was r. NOTES: indicated or' -this pl _ system vas ins'peeted was covered over m, constructed iri aeCor - standard rules_ and re rT . the P.C.H D 4�; the N iEi�l?��'?- ibIMENSIONS A 6 =iP� ' 4B - G A _ _ -� r _ yne - K A -M �Z��'V -r�i _�� Co SANITARY SYSTEM DE IG A . BU L: LOCATION Street: /'%L / ✓�q/�/h /�� �u�T �� Town:�,4j rc�L_�G7N_coumy: - f_�1�_r state _ susolvlsloN• A- M a p -3 Block:— - - -- LOT Ns��S� - - --- Surveyor: - -- Drawn:�i��• Date: /O -/Z B Scole: /��0 Jog s23 pJ$ NEW LOCATI RELOCATE EX. WINDOW r RAILROAD TM kETAMM0 WALL Fi�c -+I MANN " Joel Greenberg Architect - Planner Two Muscoot Road North Mahopac, NY 10541 . 'W=1_0" f t . } I � 0�1 Leo a 1 � - C��� I �i1- 11112j1 �; - fl�lpll J n�'12�I+:O � I u � n I II /��j'I•Lu I / � I� i I ww PDw-riON- i t G° 44 101'01/21 w5a y(RIP f%LOOfZ I IU A9 3 + )last W``/ FeTIII eA P ED !J • _N - � / PL s ICJ �: W� DA = j� qr QC G �t!'�! 2 PKSUVE -fK�irf V — — 1 3� _ -i LlWvl: or— MOM . -" -- - -- . _.. __ .- ... - -" -- 1 ' , — / �` _ y(F.P''� ` KAILINYo' •___—`�I —� Oti T -� • I • - 's 4x4 GoyfJ l a I t3A-f4 ITN MA�1(�IZ t��.IJM 2-2 MA 5LE; = hH7rV ER SP6E i 2 ^•� �I - - UUb pIzAIL W> �E hTAINED .__ _ ♦= OLYURETHANED j 2 -3 i 5 - -c( Pol.� a 20' � - � .hoNRY �,T WIN Pu wh MP � aMENT wlNVOWg � 'U ReC.EI�/E �'iAIN N t, k %.ToDa �4 °X411 'sD FI1.! I�jH• Xb Towc ur- :E:vE 'AvNT F NItH Ivlw(w.-�ZooM L!si& -ro }LEGBIvIt . . -rHAH? FWlliti. 0r....- PD.L6 � hNF�1.vFf� I - I SECONC =t,co� f SAN iZE�IDEN[.E C� MICHAEL ? SUSAN VIDAL, �o t'AT7���oN, NEW YORK �,GHDUI. ?Z � MUpD ?ARTNEI WHITE I°LAWy, NEW 'YORK a(vo& -a �I . UNE ,.FIfoN�;zxGl I SECONC =t,co� f SAN iZE�IDEN[.E C� MICHAEL ? SUSAN VIDAL, �o t'AT7���oN, NEW YORK �,GHDUI. ?Z � MUpD ?ARTNEI WHITE I°LAWy, NEW 'YORK a(vo& 41P -f-P' '0 0 gea 4040 . II i l✓ t7� � � � I III ; 00 �LSoI `. r i' 1= LI: ac-u /N-' � T I;, i�l �l . I NG, lELDS j j � t l oov GI eL. I-•IG� �• 2' 208 III 4 � �oi,l 7 �i �� dJI�G i c> i= Pion :3i oo,. s l i Z I,1x(f3 Z!>(.h CoI -rjI �, .. •� , e Ave oil; -6000 rutnam county vaparLment us aealti. 359'68 v revision of Environmental Health Service. - aflMn�u1� as nn +na Vnw nnwln�._.. w.... ��LL ' "AS BUILV DATA.. Structure loctand from survey by surveyor noted below(__- _ Well located by: Surveyors survey._ Well drillers report-- — - - - - -- Engineers mesurement.s.0 -- Tank, boxes, pits, galleries a Laterals lo-cot.e_d byc.Contrae.tor: Eng4asers. Health&pt: Field Inspection by: Health dept ® data:L° A 7 `! Engdneer ® date: _ This is to certify that the seJage% f .disp al system was constructed'as 'NOTES,: n this plan and that the eem vas inspected by me before it was covered over. The system iras ® constructed in accordance with all standard rules and regulations of P. C. H. D. 6 the H.Y.S.D'.H. ' s SION S 1--�.- A - e ir III jC A 'D �_ OMB - A - E .-FZ0- —_ 8 - E �1 :r zit A - 6 �P3r 4B - G =_ °10.1 _— O-il- _ A - H - -& 1= A - K B - K A l L A :)W*R: —t1 J S_ /� /v zr_L�_1 �!' iii'=JLy'- - - -- — OCATION Street: /OO 0 _ 3�7BDI 1 %G'ILi2�J,4 O7 c' o° un—ty�:44LJ, = _f7 l'r state: T �_ 'am4, —__ —_- -- ap T 13 Block:.— - - - - -- LOT NIt - - -- Survey or;��2���2! - - - - - -_ )rown:j�--)v�4• IDate:1O-1z-'6A Scalev rr —*�O �5°aL 2�J 9B T R XPUTNAM COUNTY "DEPARTMENT OF HEALTH Z, o i . 7 :.Division of, Environmental Health Servlces;_CirfilA -N.Y. , 10512 �` ( J K�_�,31_86� \v P H D PermiProvid e, r18,'s7 a CE. LATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM __ T . Patterson [ S 0 . 23981 Totvn or V e Located at McManus Road Tea Map 73: Block• Vm Lot 18 . 0wner /applicant :Name . Susan`& Michael :Vida ormOrly, Subdivision Name Maggio Subdv. Lot # — . MaWngAddress. GXPsy Trail Rd.,�GarmP7 NV Zip 10512 Date PermitIssued _Au$uStLJ9QA7. Separate `Sewerage.Syetem.,balltby Tyndall Septic System, 'Inc., Address Maple' Blvd 'BrewaYPrs} NY ._ 1175n9 Consibtingof " "IOUO 375 "x 24" "wide x•18:' Deep later`als:. Gallon Septic Tank and Water Sdpplys .. Public Supply From Address : '•:'or X Private Supply Dr(lled by Address Ball Frame , Has Erosion Control Been Completed? A require d dlnB Type , s Number of Bedrooms Three H-Garb age Grinder Been Installed? No OtberRegaieeme'nts R 0 -B F11 Section: 36" Deep Average x' 4475 Sq ,.Ft'. Z`440fcu.. YrtG. ) I.cert fy -that :the eye tem(s) as listed sery ing the aboye premises were constructed essentially as shown 'on the plans of the completed work'( copies of which are attached), and in accordance with =the ataddarda, and raga ations, in accordan ;'3th the filed plan; and the permit issued by the Putnam county Dephrtment`;Of Health. Oa :o 20 October >1987 cerrfied,by e.e. _Rn: Address RD _ -nj i r St , CarineiTMY 10512 License No.' 29206: Any p6rsOn oecupyiny premises served by :the above'system(s) shali'promptty'.take wch action a$ may be nocessary,to secure the correction of any unsanitary conditions resulting from ,such usage. ":`Appioval of !the ieparate;'sawerage ` systam shalPbecoms null and void n soon as a pub.'. sanitary awsr becomes available and the jpproval -of the:- private water - supply shall become null and`,woid" when a public 'vats supply bkomes available. Such approvals are subject to modification or'chanye. when, in the "judgment of the C, Mlislonerlbf Health, such redoeetion, modification or, change Is necessary. Date d /�_���— re 0 Yorktown ,Medical Laboratory, Inc. 321 Kear Street Yorktown Heights, N. Y. 10598 (914) 245.3203 Director: Albert H. Padovani M. T. (ASCP) T_ LAKE CARMEL PHARMACY 149.Smadbeck Ave Lake Carmel, NY 10512 LAB #. CA. 005793 Date Taken: Time:, Date Rc' d : / Time: Date Reported: K1011 Q a _ Collected By: •'UrQA . Referred By: Lake Carmel Pharmacy 1 Sample Location: 7 P L J LABORATORY REPORT ON THE QUALITY OF WATER I AI -;"mil r r "l r ' 1. 1 Phone # S Phone # Repeat Test? _ INORGANIC NON - METALS (mg /L). MICROBIOLOGICAL (CFU /100mL) _ Acidity GENERAL BACTERIA Alkalinity Ct _ _ .Chloride Standard Plate Count Detergents,.MBAS (CFU /1.OmL) _ Hardness, Total GE 12 _ Nitrogen; Ammonia MEMBRANE FILTRATION TECHNIQUE Nitrogen, Nitrate _ _ Phosphate, Total Total Coliform Sulfate _ Sulfide Fecal Coliform +_ Sulfite Fecal Streptococcus METALS ( mgr /L ) Comer Iron _ Lead Manganese Mercury Sodium Zinc MISCELLANEOUS pH (units) —.Color (units) _ Odor (TON) Turbidity .(NTU) 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_) Sample Type: (check one) .Potable Non- potable STP INF _ STP EFF Other.. Sample Status: (check each) Outgoing HNO3 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 SAMPLE (WAS) (WASN'T) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO T NE YORK STATE,DRINKING. WATER STANDARDS, FOR THE PARAMETERS TESTED.* AT THE . E OF COLLECTION. THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DIDN'T) (N /A) MEET THE SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STAT D KING WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Albert H.-Padovani. M.T. , Director 2 /86(Rvsd7 /87)RWE r` PUTNAM COUNTY DEPARIMEW OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Susan & Michael Vidal Owner or Purchaser of Building Owner Building Constructed by McManus Road Location — Street Carmel Municipality Frame Building Type 73 3 18 Section Block Lot Maggio Subdivision Name 4 Subdivision Lot # GUARAIUEE 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 13 day of Oct. 198_ Signatur, G ,' CL . Addrebs rev. 9/85 mk Title Corporation Name (if Corp.) ess A COQ WELL COMPLETION REPORT Office Use Only p„ �e DEPARTMENT OF HEALTH 18-0 Health Services Division Of Environmental ;f w O PUTNAM COUNTY DEPARTMENT OF HEALTH WELL LOCATION STREET ADDRESS: WNML / IIY _ TAX GRio NUMBER: Y1l /ti�r1: A/)7 2= 11, i WELL OWNER NAME ADDRESS: 'd 1e01.fl1✓D,,-.) 911 �) AL �`i �. �> i s- / �.<� o � �''� . /L , JZ PRIVATE ❑PUBLIC USE OF WELL `RRESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED 1 - primary ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION. O OTHER (specify) 2 - secondary ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE 1 YIELD SOUGHT gpm. /N0. PEOPLE SERVED /EST. OF DAILY USAGE_ gal. REASON FOR NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION DRILLING ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL I ' DEPTH DATA�- WELL DEPTH — �� ft STATIC WATER LEVEL ft. DATE MEASURED Y-1 I DRILLING O ROTARY i2rCOMPRESSED AIR PERCUSSION ❑ DUG EQUIPMENT I 0 WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE i ❑ SCREENED ❑ OPEN END CASING. OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH ft. MATERIALS: (STEEL O PLASTIC O OTHER CASING LENGTH.BELOW GRADE 2-0 ft JOINTS: ❑ WELDED KTHREADED ❑ OTHER DETAILS DIAMETER in. SEAL: OCEMENT GROUT O BENTONITE ❑ OTHER WEIGHT PER FOOT Ib. /ft. DRIVE SHOE:.)E�YES ❑ NO LINER: O YES M SCREEN DIAMETER (in) 'SLOT SIZE_ LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? DETAILS FIRST 0 YES O NO SECOND HOURS GRAVEL PACK O YES GRAVEL DIAMETER I TOP BOTTOM O NO SIZE: OF PACK in_ DEPTH ft. DEPTH It., WELL YIELD TEST It detailed pumping 'WELL LOG It more detailed formation descriptions or sieve analyses tlY are available. please attach. METHOD: O PUMPED tests were done is in- COMPRESSED AIR , formation attached? DEPTH FRortit SURFACE Water Wear D�a' O BAILED ❑ OTHER 0 YES 0 NO Bear- ing meter FORMATION DESCRIPTION CODE. tt. ft. WELL DEPTH DURATION DRAWOOWN YIELD Land Surface V4'64) It. hr. min. It. 0 6;e / jT r l_-S / - LILL 0 WATEii ❑ CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE CAPACITY WELL DRILLER NAME ,jr�;T I �aJf ��_ OATS_ _LS4L DEPTH ADDRESS /Q-1 rte✓ 5rG Erv�� AA/IrIFI tent TAGF _ __ HP PV410-1-1 l 6r-l— i 1),11V1i) T-� a � _ S 7a QA o V � Q � \� � �.- -�-. —, �' � � , � — 1- �\ � � \ � \ `% ✓/ � .. � GJ� LEI I P IZ • Vito of G \ _ Al QRpfESSIOpq, O PRFNrF���y�� 510 1 29 F��iryo �� Eat PUTNAM DEPARTMENT OF HEALTH En eer to Provide Permit q C 1 s . c ', ERTIFICA TE'OF-COMPLL4NI d", CONSTRUCTION E WAGEMISPOSAVSYSTEM.� - o T -"'VI Located at 0 Patter v�A, Namic., siibii., Lot # 4 Saw V: IS AS10ii, Re qn 6vuer/4011cmt Name 5usa>z Michael Vidal 7 D ate'ej Carmelo 10512 -ik a q MWOmI.Addrii 'T X 777 ;-,�'�CQWIITE Type - Depth I h :,volumv Yd§ �A�t 'A Ar Fill 9 1 me hP q Number of Bedrooms Th r a a •`' Design Flow: :D comploted G'P' No ilion I 4i; ui�4 Whop li — -0 t al'6 Separate .: 100 Sewerage yk 0 constructed bIt-it' t �',BreT.4s und'a"l,' §e' TI 0 8 1 $UPP13':' Supply Po'b,,C -A y 4 7 ddxvsi� -"or: Drilled by S Ft See above 'b 6th'. "ft . . ..... R". 5-` B, Fill 'section Or, -&eimts 1,repr-"!�t,. that) -.Iim wholly and conipletelyjess)onsib)eL. of tfie-T.lpii6`6osed that thi'separa elewagc disposal :system !q!,th�.je��gn,.apd jiqcitiqjn� , 4 _ wall -iho�w a� i, rules ,an reg?,10tipps.31 -t,ne . 1-51narp.: *�-6nthi�apor6�ed:jiii4naMeht�thiin,i;i",and-n, -�c abo'Vii.describiad on eoinpietson thereof a -,of'Cohstr-ucq6n7,4 missiii6ir of'Healt'6'�;ill C6jjrjtjfL �Mapartm�rt "91'... "W �'H"'I(h",a�"djhat will 'iut assigns -to the,-0epartrpq nt,.,fn by -.40 stili iii4id� a�-,writiin ouiiihtee ce"irs. eirs or ins, that siid '66iid0r,'w'ill T place in -, 'f pp, lor ",a ante the if onsfiruiitibn?,,Com Ppjjni;ep�,;-t 2)-,, that ,jhe,:drilled.well. Oesc!,ibej &Do a -dards. r!.g on* a utnam L: Will well, will bijn'itilliW':ti the ie n -:�U'IeLs _�C�oppi�c�wlth 1087 'j P E. .T --2 0 ILA 'S Pata Li cens!.No 9206. 06. APPROVED FOR CONSTRUCTION 06M 'the date issued unless construction L_, of, t he . building ha; ., b '�qnipd��taljn is Commissioner iit on of c6hit'ruit revocable or cays�o!;,T,�y�!ren" �odifi§ 'rp!�qi* w - 'Approved ',for --`disj)dsal o. d.onwvt ic'samtary sewage and /or pr'gie w ptev.- 1/87 Da Ti PU'IMM COUNTY DEPARTMENT OF HEALTH DIVISION OF HEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Omer Susan , MicAae( V'dal Address MC anus (�oaci. Located at (Street) & I lef E o 1,e ". i / S ec:i'I�1 7 � Block 3 Lot 18 ( indicate nearest cross street) Mai _�'i © SacEod.r Lod-4, Ii1Qd M4 �1) Municipality Watershed • ■ • �• •• FTVVUS 11 §-,4 : • Date of Pre - Soaking _ -3h �6 7 Date of Percolation Test 7 HOLE .1232 30 NUMBER CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min/in Drop Inches Inches Inches 1 Im 1132 Z7 3o 17 3 21131 (),o 2. 30 1 24 3 110 1 .1232 30 1 ZG /4 2.3i¢ 4 1232 I joZ 30 30 1GiS- ?./y 16 -Zn 2 1111h 113 3o i7 3 2115 ILeS 30 1 yG 31)0 F Ivy,!' 30 1 K 2f 41),3S 105 30 30 5 K 3 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. rev. 9/85 I TEST PIT DATA REQUIRED To BE SUBMITTED. WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE N0. ` HOLE NO. 12. G.L. Efe 2' Sa�4x g, tv 31 5' 61 L "q 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED ;Y%,' IS. � G. Oh INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED P DEEP HOLE OBSERVATIONS MADE BY: J-14-9 ff. F . r DATE :.21! 1 /87_ DESIGN Soil Rate Used A -?.8 Min /1" Drop: S.D. Usable Area Provided ®00+ No. of Bedrooms .16ree Septic Tank Capacity 0 O 0 gals. Type j;.o rir Absorption Area Provided By —375 L.F. x 24" width trench Other K -0- 8 Fi 0I 5 ®v): 4.47!!E,0 G" Desb 8 441 YaO Name Signature Address SEAL THIS SPACE FOR USE BY HEALTH DEPARMSENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date ? 10M COUN'T'Y DEPARTMENT OF HEALTH - DIVISION OF FNVIK AM N•1A1, Hrau.Ln Jr�mv i..i� INDIVIDUAL WAM SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT DA TE BY: (Street Location) OCUMENTS ermit Application orporate Resolution lans - Three sets ngineers Authorization esign Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth (Name of Owner) REVIEWED: ..�7- s/s SUBDIVISION - Perc - (3) Fill - cd e!o 3Plans - Two sets 1 L— permit; PWS letter ariance Request ENERAL egal Subdivision ubdivision Approval Checked x- approval SSDS Adj. Lots Checked etland (Tcwm /DEC Permit R & D) ata. On DDS Plans & Permit Same EQUIRED DETAILS ON PLANS ewage System Plan - (north arrow) ewage System Hydraulic Profile - Gravity Flow ill Profile & Dimensions - Volume or J Box;Trench /Gallery; Pump.pit details eptic Tank - Size, Detail ell Detail, Service Line if over onstruction Notes esign Data: perc and deep results.. wo -Foot Contours Existing & Proposed riveway & Slopes Cut ooting /Gutter,Curtain Drains'(discharge OK) erc & Deep Holes Located Representative of primary and expansion xpansion Area;shown;gravity flow,suff. size If Pmnped Pit & D Box Shown & Detailed ouse - No. of Bedroans ells & SSDS's Win 200 ft. of Proposed Systems roperty Metes & Bounds ouse Setback Necessary (Tight lot) ouse Sewer - 1 /4 " /ft. 4 "0; Type pipe No Bends; Max. Bends 45" w /cleanout EPARATION DISTANCES SPECIFIED ON PLAN 'ields 10' to P.L., Driveway, Large Trees,Top of fil 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake Unc. expan 15' to Drains - Curtain, Leader, Footing 351to catch basin,stormdrain,piped watercours 10' to Water Line (pits -201) 50' intermittent drainage course eptic Tanks 10' from Foundation; 50' to well .5' Well to PL 9 10 INAL I S INCECrION Dat e Z�J �v ,. 'h ^' spected - TION �% I� �, ! OWNER I Ul 01 i VT # U UB # OR SD SION LOT # s- II. IV. [JT . COMMQv'I.'S SEWAGE DISPOSAL AREA a. SDS area located as per approved plans b. Fill section - Date of placement 2:1 barrier, LGTH WIDTH AVG. DPTH c. Natural soil not stripped d. Stone, brush, etc., grter than 151 from SDS area. e. 100 ft. from water co _ se , etlands. SEWAGE DISPOSAL SYS a. Septic tank size(- 1, 00 1,250 b. Septic tank inst&led".jAvel c. 10' minimum fran fo tion d. No 900 bends, cleanout within 10 ft. of 450 bend e. DISTRIBUTION BOX 1. All outlets at same elevation -water tested 2. Protected below frost 3. Minimum 2 ft. original soil between box and trenches f. JUNCTION BOX - properly set g. TRENCHES 1. Length required - Length install S 2. Distance to watercou.r e measured. ft. 3. Installed according to plan 4. Distance center to center 5. Slope of trench acceptable 1/16 - 1/32 " /foot. 6. 10 feet fran property line - 20 feet- foundations 7. Depth of trench < 30 inches fran surface 8. Roan allowed for expansion, 50% 9. Size of gravel 3/4 - 1j" diameter 10. Depth of gravel in trench 12" minimum 11. Pipe ends capped h. Pty OR DOSE SYSTEMS 1. Size of p'mip chamber 2. Overflow tank 3. Alarm, vi su-1 /audio 4. Pum p easily accessible manhole to grade 5. First box baffled 6. gycle witnessed by Health Department estimated flaw per cycle HOUSE a. Hcuse located oer approved-, plans. b. Rmher of bedrw_ms WELL a. Well located as per Grp,Zv:_ =a glans b. Distance from SDS area mea=sured it. c. Casing 18" above grade. d. Surface drainage around well acceptable. OVERALL WOPMEk.SHIP a. Boxes properly routed b. All pipes ially backfilled c. All pipes flush with inside of box d. Backfill material contains stones < 4" in diameter e. Curtain drain installed according to plan f. Curtain drain outfall protected & dir.to exist.wa rcours g. Footing drains discharge away from SDS area h. Surface water protection adequate i. Errosi.on cont.ro provided on slopes greater than 15 %. represent at-1 am wholly an. conipletely, resp for onsible the design_;and.Iocation of the proposed •system(s): 1) that, the.,separate sewage,�disposal� system above described ::wJl be constructed,as shown on the' approved 'amendment there to and in accordance with the rd standas, rules an regu a, ions,o .. e u nam County apartment of �:Health.�:antl,thatlon completion there( f a "Certificate .of- .Construction Compliance" "satisfactory to the Commissioner of Health -will be sub(T146 to� le. 'a artment, antl. a written guarantee -"' a "' De.- furnishetl the owner, hif successors, heirs or assigns by the builder, that said builder' will 'place• in good operating condition any ,part of said sawage ..disposal'. system tluririg_the.,period of two (2) years immeCiately,following : thedat,e of the issu- ance of the approval of the Certificate,. Of Construction..COmpl�anca: of 'the original system or any repairs thereto;; 2) that the drilled we11 described above -, will be locateq,ad shown on the approved plan and thabsaid� well, wHC6e installed, in accordance with the standards.'rules -and regu_a rTf�ons > o> of.',the ',Putnam County„ Department of Health i Date 13 ;Mi3rch 1982 `signed`. : v E R A. Address'' 9_..= •Fair.��- t�Stree Garmel�,.NY.- _''10512.�i�e;;:e N;.;.2 -9206 APPROVED'FOR CONSTRUCTION This approval expires 3rTT r from the date issued - unless - construction of the building has been undertaken and - is revocable for cause 6r may be or modifietl.:when•considered necessary by the Commissioner. of Health. Any change or alteration, of construction requires a new "permit. ,; Approved for disposal of,.domest�c sanitary Avage, an r a e ter supply. only. e Dat- _ . ..:. .. -: _ , . _BY., -- Title LOW . �' IMI �r � OMNI - 4.�• PUTNAM COUNTY. HEALTH DEPAR24ENT y _ - D ENVIRO TH SERyICES.,r } IVISION:OF NMENTAI;�. "HEAL John M.:Simpons, M.D Deputy cmn�.ssioner- of, Health -FIELD ACTIVITY REPORT Sheet of INSPEr-TION NAM Orig. 'Routine" orig. Omv4iin ADDRESS Q. 5 . , Orig... Request Street :; T€ wn Im No YS Compliance - °u f Complaint Crmp MAILING ADDRESS cL J _ Final P.O Hoot .Post Office Zip Code Group Illness C5nstructio6 `Reinspec�lon h ,. PXRSON IN CHARGE -Fi eld, °Sampling -Or ly- (:INTERVIEED "Field Conference ' Name and Title:" ys DATE 4 9 TYPE FACILITY �5 W • Other ' F. TIME ARRIVED /y C�,4'_ - TIME I,ET . 6` b6 Explain . FINDINGS: LOW . �' IMI �r � OMNI t clean -�.. : + ° _ 1 Fitch. A soh A I • A m s o ne or i' . 4 per foot 4' pj dd I _ a grovel O.': 3 /4mm- yam... I `Qc j hom settling or 'd f a o i 4° erforated groundwater inlet dosing tanks nul /Z max. 4'minabove 1p pipe level "mini - p c I edge rock eonh to be tom ed � - - -•-� t,ghtly around 'o odd'I „_ � - d,stnbut,on box ;, IaterOts � =� _ SECTION .A__� _ _.--JUT I���! o 0 I' fir' a DETAILS OF DISPOSAL FIELD r EQUAL r. i• a Locci- T�':�N 3T.::K�.s. Ee.¢:r(t. eo�EZ= DISTRIBUTION PLAN -- _n• "�} /ub� F9r/fi Mnx I Z• to absor .on r it l' ' t't� , i a ' L�11�40•D.- ', \\ \ , �:s.:'- .°- �.•�FvnC�• -J,� Oft 1 limit of + `m 3+�i r r ' -jr o oPr,or� >xr �' cw Uda-; d A 4" solid pipes- � j �C��aaPo.vF?i 1 1 (yT oltlt .a1PPo�i j UPPoaf = p !'tjva �df Jon a - °x�a" t 14-v' 3'�z,F „1• � •'� ht��rde „ems ra+� rot�7 from septic t�ank tc oGCO(V1:on n f-S S6t 1�iJ�or3u v- .�ch.Pi�� TEg;`Both boxes) I` gr„� �'�rrJ o¢, PtlODxo c o ofi—m of box must t p b F j.y.�.L+{zlti6.L, .. :F- -, - :..'•: 02 EAZ!� fermi y supported it IC �.r.g _� ?. -• ta.° _ - Ioelow ground level • OVERFLOMI `') w I Y o toad c °t •Io2GL hfI 'b °�f�LG , ;Ya ilarproafed masonry Pilo (Anl t��'4 "' r clot joint pip% from _51.57EM_._ C 1 E W ASpNA v/e eoAT/ y /toTG?o �z= 4 ieoffles to ;nsure eq PLAN hC -PTlG T /�IJIL,N;r -'- e. e GG- r "" Al I i__ 8 V .` �✓ ` t�- x'''---999 �O CONSTRUCTLON uoTr n H Gasic Acquired Note, G p Flo i' ' I I ^y All trees within 10 feet o /t- +•►OJjp `j• ! � yt _ �-� "'• SSUS shall be removed. '+4ij -. r., SSDS to be inspected by ti, �\I �i�i - chitee[ and the Pctna,o C• I��,f -To D�3 -o ]?O,�J, 1) pa nt after, construct to backfill. 3. No trucks, machinery, buil. ` \ \ \ 'fi��i.L% �o -ill Ol ✓` ` nor excavated earth shall i �`�,_ ; , \� \� •� : -�:i ��,_o,, \ in the sewage disposal are. o5 SSJS to be in accordant, plans, any revisions there) `0p ` , \ �.� �� 'rules and regulations of ti issuing:governmental agency 11iiimum well yield of 5 gpr. Yields less than 5 gpm will el reported to the PutnamaCour 1�1. of Health. Pump house rcm /o red cemc4 r/ob. " " f!'` a o�oy lean pump. ProridP ' yin( (oo r hen'regu„rd aro: Oalside ."I or do // 4o/t u fa De 4`y eoeo er d,om. fhoo !, V .O /v•�f ✓ -fii/_-/ Ali cnnnq(9Smin.le*hfI r I.9 7% Poi coMMOi� lLL,oiG� e I ck 790 ci4 OA�151 -.7 /A°° `^,ae, _�G,�Ti. o-�4 -� ROCAS 786 . r !e u y� �-%. "2/�- � - o o,C •..TiPr�.G it X75 Tom% - s , 7 &-Z- TL- /Z Z . 78p Ty�icgG, 7YP/CAt SECTION Zr ED WEIR b w. i� �l In 0/ aV � N� pop. N SILL �G'G lot1 4-41 , t!.-�i -(. ,� so 60 4+�s. �, t / -4 / O T T T A' II \ wT I I I I ,�,, '`6 • c -. • jl t� l000 GI/�L. ��G� ' +"4h 2oLI I j I dl)IJ'G"ricii� P�oJc '1ti''i::/�'v, 1375 -rAL• rLLLnam County 1)Elpar'6metlt ui 11ea1LL 1vision of Environmental Health Servioe, approved as noted for conformanoe with .pplloable Rules and Regulations of the 'utnam Qottnty Health Department., 314netury & Ti Dat - iructtire located. from 'sutve44:tiy surebyo.r note d below( Well Ilocated by,: Surveyors s4rve.y•- Well drill@cs:roport �t-_ Enginee s mezuromontall -- - Tank, boxes, pits, galleries a_ta}erols lo•ca.tq.d. by_:;Coatraeton .., Eno4neeM Health dept.; Field inspection by: Health dept® dote:�`� -' Engo neer ® date : 2� T. This is to certify That the i disposal system was construct NOTES: indlcaced on this plan and tt system was inspected by me bt was covered over. The- systod constructed in accordance,ittt standard rules and regulatiot f the P.C.B.D. 6 the N. Y.S.7J'.H. A - 9 b 1 ME'N M' SION S "v�o 'i' h - -1-_ - pt _ Lit- , A E A - F a r -- 0- E 8 - .F s- p7�P1-�'-1�. tr� O-it- A _ 6 , jp r pe n. A K A a(2 t= SIB .., r2 A 0 -ICI A ITARY SY5JEM D [G I3U1 WVR: -�-2U /i/ _ G /a G-4 _ r -- OCATION Street: own;�f%/ yG /z�ON county:! �% i= 1�i State:T> OeDIVISION' C- n V, L7" ,o��� tap: CrA -�.13 _ —_ Ilock•. _ - - LOT N4_ luilder:l7- IGI/ -L raw n:�i��• Date: Scale: /rr-�p Job�N4� JOHN H PR E.NTISS PE CONSULTING ENGINEER RD, S', CARMEL NY 10812 -(810) ®78 -5170.