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Home My WebLink About0614DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -2 -22 BOX 7 ,,yti . ; i , ,� �i r r �4 ; A ,' IN 1�6 .♦ = ♦� . 00614 �ERTIF,TE `OF CO Located 's4 ,owner Evelyn RoggJ a RvP1ynY RR $ra Ross TM 73 Owner or urrch ser of Building Section owners Building Constructed by McManus Road Location - Street T. Patterson Municipality 3 Block 16 Lot Maggio Subdivision Name Frame 2 Building Type Subdv. Lot # GUARANTEE OF SEPARATE SEWAGE SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance.with the standards, rules.and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his success- ors, heirs or assigns, to .place in good operating condition any part of said system.constructed by me which fails to operate for period of two years immediately following the date of initial use of the sewage disposal system, or any repairs made by me to such system, except where-the-failure to operate properly is caused by the willful or negligent act of the occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determin- ation of the Director of the Division of Environmental Health Services of the Putnam County Department of Health as to whether Or not the fail= ure of the system to.operate was caused by the willful •or negligent act of the occupant of the building utilizing the system. Dated this 5th day of February 1566 S i g n a Title 1•-5 dQ Corporation Name if c.orp. Address THREE (3) COPIE$ ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED._: -- GUARANTOR IS . REQUIRED TO FILE NOTICE OF DATE OF FIRST USE Of-'"SSNI`: - - - - - - - - - - - - - - - - - - - - - - - - - - -F -2i-- - - - - Division of Environmental Health Services, Putnam Co u XJU"jaW1dWV of Health T. #JEALTH `Rnag/]2r. Joseph Ross Tn Owner or-Purchaser of Building owners Building Constructed by McManus Road Location - Street T. Patterson Municipality TM 73 Section 3 Block 16 Lot Maggio Subdivision Name Frame 2 Building Type Subdv. Lot # GIIARANTEE OF SEPARATE SEWAGE SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, ma-taraal, 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 success- ors, 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 initial use of 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 occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determin- ation of the Director of the Division of Environmental Health Services of the Putnam County Department of Health as to whether or not the fail- ure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this 5th day of February 1566 Signatures Title Corporation Name if core. Address THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL I I-68�U ,a d GUARANTOR IS REQUIRED TO FILA TICE OF DATE OF FIRST USE OF SYSTEM. - - - - - � - - - - ---- ��3t98_,- - - - - - - - - - - - - - OuloY Division of Environmental Hea1PATP, 3cLf�Tjfutnam County Department of Health 'DEPT, Yorktown Medical Laboratory, Inc. 321 Kcar Street Yorktown Heights, N. Y. 10598 (914) 245 -3203 Director: Albert H. Padovani Al. T. (ASCP) f— "'% -)` L° vC 0 -3S. LOCATIONS: ❑ 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245 -3203 ❑ 201 BUTTONWOOD AVE.. PEEKSK,ILL. N.Y. 10566 737.8777 ❑ 495 MAIN ST., MT. KISCO. N.Y. 10549 666.3335 'ATONELEIGH AVE. MW HOrS`PITAL), CARMEL, N. Y. 10512 278 -9330 DATE TAKEN:. `� ` DATE RECEIVED: DATE REPORTED: SAMPLE SOURCE: rJ�'1 I� L' REFERRED BY: I J Collector:��[ >4' LABORATORY REPORT mg /L 307. 830 ❑ ACIDITY ............................ ............................... ❑ ALUMINUM ❑ ALKALINITY i — Y— ............... A— ....................... ❑ANTIMONY ................................ ............................... BACTERIA, TOTAL /mL .......... ............................... ❑ ARSENIC .................................... ............................... ❑ BOD, 5 DAY ............................ ............................... ❑ BARIUM ..............:........................ ....:.......................... ❑ BROMIDE ............................................................ ❑ BERYLLIUM ...... ................................ ............................... ❑ CARBON DIOXIDE, FREE ........ ............................... ❑ BISMUTH .................................... ............................... ❑ CHLORIDE ............................ ............................... ❑ BORON ............ :.......................................................... ❑ CHLORINE ............................ ............................:.. ❑ CADMIUM .................................... ............................... ❑ COD .................................... ............................... ❑ CALCIUM ❑ COLOR (un i t S ) ................ ............................... ❑ CHROMIUM (tot.) ............................ ............................... ❑ CYANIDE ............................. ............................... ❑ CHROMIUM (hexavalent) .................... ............................... ❑ DETERGENT, ANIONIC ............ ............................... ❑ COBALT .................................... ............................... ❑ FLUORIDE ............................ ............................... ❑ COPPER .....................:.............. ............................... `❑ HARDNESS ...................:........ ............................... ❑ COLD ........................................ ............................... ❑ IRON .......... ❑ MPN COLIFORM COUNT/ 100 ml ........::, ................... ............... ............................... / }} �': 1' COLIFORM COUNT/ 100 ml ....v ................... ❑ LEAD ........................................ ...6........................... ❑ CONFIRMATORY TEST ........... ............................... ❑ LITHIUM .................................... ............................... ❑ NITROGEN, AMMONIA ............ ...................6........... ❑ MAGNESIUM ................................ ............................... ❑ NITROGEN, KJELDAHL ............ ............................... ❑ MANGANESE ................................ ................6.............. ❑ NITROGEN, NITRATE ............ ............................... ❑ MERCURY ....................:............... ......................6........ ❑ NITROGEN, ORGANIC ............ ............................... ❑ NICKEL ............................................... ......................... ❑ ODOR (Units", ........ ........................................ ❑ PALLADIUM ................................ ..6............................ ❑ OIL & GREASE ......................... ............................... ❑ POTASSIUM .............. ............................... ❑ PH (11II1 t 3 ) ...................... ............................... ❑ RHODIUM .................................... ...6........................... ❑ PHENOL ................................ ............................... ❑ SELENIUM .................................... ............................... ❑ PHOSPHATE (ortho) .............. ............................... ❑ SILICON .................. ............. ........................6...... ❑ PHOSPHATE (condensed) ............ ............................... ❑ SILVER ........................................ ............................... ❑ PHOSPHATE (total) ...... ......... . ..................:......... :.. ❑ SODIUM ........................................ ............................... ❑ SOLIDS. SETTLEABLE, mi /L .... ...................:........... ❑ TIN .........................:.... ............ ............................... ❑ SOLIDS. SUSPENDED ............................................ ❑ ZINC .............. ❑ SOLIDS. DISSOLVED ............. ............................... ❑ ...... .......................................... .....: ................. ' d�..'.y_� L:..%:.i..�.r .... ........... ❑ SOLIDS. TOTAL ................. ...0........................... ❑ ...,............. 4. 6; �........... .......... ............................... ❑ SOLIDS, VOLATILE ................. ........................6...... ❑ REMARKS :.................:....... Jr., ,. .............................. ❑ SPECIFIC CONDUCTANCE (uhmos /cm) ❑ �� ............... ... ............................... Ir ..0.............. 1 ........................ .................................................. . ..... ................ .............................................................................. ...�..M..P.�...].� Y .� . . . ..�..... .4.......................❑ SULFATE ❑ 13 SULFIDE .....0 ............. ❑ �® Y .. ......................... . ,6' ❑SULFITE ............................................................ ❑ ........................................................ ............. ............................... .. f j ................ SURFACTANTS ... ................ ...... .❑ ❑ TURBIDITY (NTU ). ............... ............................... ❑ .................................................... ............................... ( THESE RESULTS INDICATE THAT THE WATER WAS ( OF A.SATISFACTORY SANITARY QUALITY WHEN THE SAMPLE WAS COLLECTED. THESE RESULTS INDICATE THAT THE WATER DID MEET THE SATISFACTORY CHEM- IC.AL QUALITY OF THE NEW YORK STATE ADMINISTRATIVE RULES & REGULATIONS, DRINKING WATER STANDARDS (PART 72) FOR THE PARAMETERS TESTED WHEN THE SAMPLE WAS COLLECTED. j �,� +�', N/A = not applicable ,w WELL` COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEAL Division of Environmental Health Services{ COUNTY OFFICE BUILDING - CAFIMEL, NEW YO This report Ts to U completed y well driller and submitted to County Health Department together with laboratory report of analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME Evelyn Rogg lAfUrHomestead Ln. Brookfield, CT 06804 LOCATION OF WELL (No. 6 Street) (Town) (Lot Number) McManus Road Patterson PROPOSED USE OF WELL ❑ BUSINESS ❑ ❑ DOMESTIC ESTABLISHMENT FARM TEST WELL ❑ SUPPLY ❑ INDUSTRIAL AIR OTHER ❑ CONDITIONING (Specify) DRILLING EQUIPMENT j COMPRESSED CABLE OTHER ❑ ROTARY AIR PERCUSSION ❑ PERCUSSION ❑ (Specify) CASINO DETAILS LENGTH (feet) 21 DIAMETER (inches) 6 WEIGHT PER FOOT 19 ® THREADED ❑ WELDED 21l.YE SMO M YES NO CASING GROUTED? I YES 0 NO YIELD TEST ❑ BAILED ❑ PUMPED COMPRESSED AIR HOU G.P 1fA. YIELD (O.5 M.) WATER LEVEL MEASURE FROM LAND SURFACE— STATIC(Spec /fy Peat) 30 DURING YIELD TEST [feet) total drawdown In foot of Completed rfa 405 in feet below Land surface: SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER pie. SLOT SIZE DIAMETER nehes IF GRAY L PACKED, Diameter of well including gravel pack ( Inch"): E (Inches) FROM feet pleat) DEPTH PROM LAND SURFACE FORMATION DESCRIPTION Sketch *)reel location of well with distances, to of least two permanent landmarks. FEET to FEET 0 3 Overburden ~�^ j- T'B i '01 I N J PUTfyA M CoUNTv DEPT. of HEALTH Boyd Artesian Well Co. Rt. 52 Carmel, N.Y. 1051; 3 405 Granitic Gneiss If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COOM6PLETED Tcn 6F ,REPORT iSt�� WELL DRILLER (Signature) ter' /G /J v / n PUTNAM COUNTY 'DEPARTMENT OF HEALTH ,; NO. 313 -88 COMPLAINT OR SERVICE REQUEST RECOR "WN atterson DATE May _31. 1988 REFERRED TO Bill Hedges TP TAKEN BY Bill Hedges TELEPHONE CALL XXX IN PERSON LETTER CONFIDENTIAL 878 -9642 (h) REQUEST FROM Dr. ROSS TELEPHONE 279 -6230 (w) ADDRESS McManus Road South ENVIRONMENTAL HEALTH: Home Sewage XX Rodents Refuse Public Water Food Service Migrant Camp Other 38 COMPLAINT OR REQUEST Failing SSDS . DIRECTIONS• Bullett Hole Road to McManus. g "Rosss Road". :', �/ / �� .✓ ,; o /Sig- ,G'�cC -'N !? GiY . - ••�• • • / ` - - -may .v X T ��v �!/ E- �� '? ._ ��' Gr /G "... �' - -- - -_ S e a? /Y7 5 ;JC S -S �!// . ACTION TAKEN BY o�J/ �C i7 l_ d e.1 j' �'° d DATE Z X /171, FINDINGS / /"s�•�o �Gi��jTS'� s� /� ii �" i4s't�O1 - '� S ° O+• . a '-� / ! E v LCD "'9✓ •- eo qqty y 5 0 za r-!J 46> U,j FOLLOW UP INSPECTION (s) !J DATE FINDINGS G*- >�t �e,�i'`-�i `� , N -� s--Ci .• w- �^i .� �' �/� ,� �/ /S: g5� r 144G,0 5 J.°'. d ?fir _ �'�,r A e r r. ... 5 ea I % Gf f .✓ t� ./lL�i� .r' —°' ca , DATE FINDINGS^ PROBLEM ABATED � DATE 114L PERSON NOTIFIED ESTIMATED TOTAL MAN HOURS SPENT' John M. Simmons, M.D. PUTNAM COUNTY HEALTH DEPART DIVISION OF ENVIRONMENTAL HEALTH SERVICES Deputy Commissioner of Health - FIELD ACTIVITY REPORT - INS: NAME S �®• ADDRESS — / j� °c No. Street Town TM No. MAILING ADDRESS P.O. Box Post Office Zip Code TELEPHONE PERSON IN CHARGE OR INTERVIEWED Name and Title DATE 413,0-: /vp�TYPE FACILITY _ O'or TIME VED 2 , " TIME LEFT ,tom' �i ss FINDINGS: 41COW& 009 e- owe eswnlar CAM Sheet of Orig. Routine Orig. Complain Orig. Request Compliance Complaint Camp Final Group Illness Construction Reinspection Field, Sampling Only Field Conference Other Explain PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. SIGNATURE: 6/86 TITLE: PU'TI�iAM 'IQ Y, ®EPARTMEN'T OF HEALTH ENGINEER TO PROVIDE PERMIT # al..- f• ON, CERT FICATEOFCOMPLIANGE�.`3 Y _ ,: .� Division. of `Environmental Health' $erwces, Carme/ N Y 10512 PERMIT# P1, :1Q 85 CONSTRUCTION PERMIT- FOR SEWAdE :DISPOSAL SYSTEM T ' patrer:;on - - Town or ' Located at °McManus Road Tax MaP 7 alock i Lot Subdivision Magg� o Subd. Lot R .2 Renewal -_Q Revision,__ JOb S 0 2232`. owner /Address FVQlyb Rog /Dr. Joseph Rosa Date of Previous - Approval 9/'6/85 41-11' Sect- on -' Building Type. Fr_alae Lot Area 4 acreq Fill Section on1y.�I', omnleted a8 of .1/24/86 � Number of,Bedrooms T Pdesign Flow G /P /D 800 P.C. H. D. Notification Required Separate_ Sewerage System to consist of 1000 Gal. Septic Tank and 375' 'x 24" 'wide laterals .. ? Address To be constructed by Water'. SuPpiy: Public •Supply From 7 X Beiate SuppiY to be diilled by 'Address Other .Requirements'R.0 B Fz.11 Section• 36" deep x 4474 sq. ft. (455 cu.yds 1 represent that I am wholly, and completely "responsible for the design and location of the proposed system(s); 1) that the separate :sewage disposal: system above'descr� bed will be'constructed'as shown.on the approvetl amendment thereto and .in accordance with'the standards, rules sn :regu a ions.o e'' .. u, nam County Department of Health, and that on completion thereof a Certificate • of construction Compliance satisfactory.to the".. Commissioner of Healthwill be submitted.'to' the, Department - and a 'written ,guarantee will be furnished •the owner his'successors, heirs or_ assigns Dy the builder, that said ;builder •will place �n ;good operating ,condition any part of 'said 'sewage aiip"l, system ;during, the period. of two (2) years immediitely:followI thedat.- of t_he. issw ante of the approval ,of the Certificate 'of,;Constructlon Compliance of the original. system or any repairs thereto; 21 thaf'the dulled well described above will be located as'sfiown on, the aDProved plan and that said welt will,be installed.. i accordance with .the standards, rules antl regu a ions of the •Putnam, County Department of Health r -T Date 'da#Uar* _ 31y' 19Rh Signed P.E. X R.A. Aedress - C 1 NY 10512' License No. ' 29206 . APPROVED FOR CONSTRUCTION: This approval expires one year from the; date Jssu, unless eoristruction of the building has been undertaken and is revocable for cause or May am "'eniletl or modified when co_ neider necessary by the o missioner of Health. Any change or alteration of construction Vequires a hew permit. Approved for disposal. of, dome n s a e, and /or ate, water_ supply only. \\ ate _. - BY J;R,e'v'... Tit le 685'- -- - - - -- - - -- - . -.. - -' - -- .. - ....__ ._•... _ ..._ ._ ._ a t PUTNAM COUNTY -DEPARTMENT OF HEALTH ENGINEER TO PROVIDE 'PERMIT q ON CERTj:FICATE OF COMPLIANCE1.I 7rh .Sevces Cs armel PERM of Enwronmin61- He P 1 0 85 i CONSTRUCTION PERMITTFOA`,SEWAGE ,DISP0SA� Town or �Ilage McManus Road Tax 'rviap 73 :aioox 3 LOt 16 Located et ` Subdivision MagglU Subd. Lot X 2 __ ' Renewal Q'. Revision p;TOb ��x'$ 0 °2232 i ownei /Address EVelgn ROQQ�Di j6selih`:Ro6s Hate Of Fiegious Approval 4585 -. 6uiltling:Type FTalne " Lot Area 1 4 acres Fill section'' ..' Number of Bedrooms Three _besign' Flow G /P /D 900 P.C. .H. D. Noti1`acation Required 1000 375'. x 24 wide eater 1 Separate Sewerage - System „to consist .of Gat Septic Tank and To. be.'constructed by, ddress i1 .water, SuPdly: Public SuPPIY ,From - R .. - - Private ,SuPP)y to be tlrilled by } Address. Other Requirements` R -0 B: E11 section,: ..36 "; dee x 4474 sq. ft. (455':cu. ds.) 1'. re,_ that I am wholly_ and completely responsible for the design and location of the .proposed syitem(s)i 1): that the, separate sewage disposals m above- descnbetl will be- constructed as shovv.nl on the approveC amentlment there to and in accordance with'the standards rules an regu a wni;o e,; u na County- Oepartmept of :Health antl that on completion thereof a q-e,, cat : of Construction'ComP! ance satisfactory to the Commissioner of Weaithwill bey submitted to 3fie ',Department ' and a written 'guarantee will be furnished the `owner, his ,successors,'iheirs 'or assigns by the builder that Said builder .wlll place' in good operating condition any part of (said: sewage disposal; system during the period of two (2) years immetliately fol.lOwl-ng•hhedate oi.the idsyr ' . ante- of- the approval of the 'Cer"tificate of Construction `Comphbnce, of the original system or any repairs thereto; 2) that the'drillad well described above will be located as sttOWn on'the,apprOVed -plan antl;thatsaid;well will be`installed in 'accordance with the standards, ;rules `and -regu a.Tf'ons _ / the -_- Putnam to, ty:0epartmer't `oi; Health 30 Auust Date 1985 P E R:A Address RD 94F4ir St ,, mel, NY:'.10512 29206 APPROVED FOR :CONSTRUCTION This approval- expires one year from the .date ,iisu s tonstiucfion of the building pas, No revocable for rouse or may be amended oc motlified':w.hen: o Fred necessary_?Dy the 9mmiss Her :of ,Health. Any cha alteration ofrconstructon requires a new permit. Approvad'.for disposal 'c- dome sa 'ta sew e,'anC /or ri ' afar supply only. Date �.�. ' /i� °�•,_ . ] BY - Title .:. Rev. 6/85 y 21 F I PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225-0310 June 21, 1988 Bates Construction Co. c/o Walter Bates; Pres. Amenia, New York 12501 Re: D. Joseph Ross S. McManus Road Patterson, New York 12563 TM 73 -3 -1.6 Lot 32 Dear Mr. Bates: i ENID L. CARRUTH, M.P.H. Public Health Director JOHN SIMMONS, M.D. Deputy Commissioner JOHN KARELL Jr., P.E. Director On June 3, 1988 the.sewage disposal system serving the above mentioned residence was found to be failing. This is a violation of Article III Section 3 of the Putnam County Sanitary Code. An inspection of the system found that: 1. Insufficient.fill was placed on the south sie of the system (near the garden).. The code requires that 10 feet of peripheral soil exists horizonially from the end-of the trenches. 2. The distribution box was found to be incorrectly installed, allowing all the flow to be directed toward the south side of the system. Please make arrangements with Dr. Ross to make the necessary repairs or contact this office in writing within five.(5) days stating either a reasonable time table to complete the necessary repairs, or your reasons why you feel you are not responsible for these repairs. If you have any questions, please contact me at your convenience. Very truly yours,, William Hedges Sr. Environmental Health Tech. WH /jp cc: Ross Larry Logel, Gen. Contractor, Gage Road, Brewster, NY 10509 (BI) (T) Patterson EC JK PUTNAM COUNTY .DEPA'RTMENT OF HEALTH Perm,t a ;1 T S �D�wsion of °Enwronmenia/ Hea /th Services Carme/ N fY 10512 C�x� CONSTRUCTION PERMIT FOR SEWAGtE 'RISPOSAI 'SYSTEM r Patterson - Town or, illage J : Located :at PRrA►ann G Raced = Z;3 g sloox : 3, �c 16 r Tax Map , Subdivision Maggio < ' Subd, .lot # Renewal' Revision Job Owner /Address FVP1 BT Jose ti ROSS -. - -' .. Kam+-- 0 g - " Date Of Previous- Appropal i � r 'Builtling T,Ype Geodesic poi Area ■ r Fill Section Only L`f - ... _ , ,•- ice' � ✓ '� -: - ,' 9.'.. - Number of; Bedrooms Four Design Flow G /P /D �OO P Notif,catiorc "Required YeS Separate 5ewerage,System < ao cohsist of 1 BOO G51 Septic Tank and 5CO', X 24 "_- laterals To be constructed: by Atldressi Water Supply + public Supply Fro m Private Supply to De tlrilled by ct z f Address r Other Requirements R 0 B F lrlT Section 36` "�dee` �X S,`194�hsq Ufa` (- 2, cu. yds ) ^�' de , '' '--, r r ' 1' h r n i t +•]«r'ik far n -. w ° nry CF1 G fli ,` a (:represent' that 1 am whollyantl completely responsible for the tles�gn and location of the proposed, systems) '•1) that the'°separate'sewa a dis oral's stem; . „ t g P Y above tdascr�betl w ;li be constructed as showgj4?h the approved amendment there to and in' accordance with °the stanCa►ds rules an regu a �onro e':: u C nam! ,County Department of Health, anq that on. completion thereof a Cejt�ffcate of ConstrucLOn Compliance satisfactory : =to th'e Comrrlissfoner of 'Health will' be submitted to the Department and a written guarantee ,will be•.fumished`1he owner his successors;` -hers orassign's`by the.,builder. •that'said buildei whl place �n .gootl opeiat�ng ,contld�on `any par`.f of said, sewage disposal system :during the period�of two (2) yeais;Immetliately= following fhedate ot'.the issu ance'of, the a pproval of the Certificate of;,Constr_ucUon Compliance;,of theyornglnal system or -any repansYtheceto 2) tFiat thearilled,wel4describeC above, will be located as ;shown orithe approved plan'antl that -said well will De installed in accor'tlance with the standards; rules and _regu as iTfroni:. of the Putnamq': County bepartment of Health r Oate - �ia<�'C.21 2sy 1 A$ 5 Yy Signed - � P E:..X R:A - Address TY - ueenie'IVO 29206 APPROVED FOR C_ ONSTRUCTION: This approval expves.one year from the date �ssu ruction 'of. the building has been: undertaken and;, is revocable for cause `or, may tie amended or.modited:w,he ..... co ed ecessary`:by tti ` oMrn inner: o ",Health =Any "change?or. alteration of construction - requves a,.ne per Appr ve <for disposal of dome ic.'sanitn wage . rid /or private water ply only: Date ✓✓l' ` 9Y - _ Tdle ,. • •Rev -t. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION.OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N..Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM - FILE NO.' Owner ddress za _ Located at (Stree Block Lot x �n ca nea ess cross�s ree Municipality_ gif Watershed, e SOIL PERCOLATION TEST DATA REQUIRED TO BE .SUBMITTED WITH APPLICATIONS hole Number CLOCK TIME PERCOLATION. PERCOLATION:: Run apse Depth to Water water LeveI No. Time From Ground Surface in Inches Soil Rate . Start -Sto p Min. Start Stop Drop.in -- Mini/in drop Inches Inches Inches 1 2 ' -Y J R 0 2 1�8� rIVA, 1�8� ®$�r �' OIJJVr .®F Notes: 1) T6:�ts to be'r�IF4 at same depth until approximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. . .................. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED•IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO G.L. 6" 24 3011 _ °A 36.. t . r 48" 5411 6011 66" e• . 72.. " 7... 8 84" INDICATE LEVEL AT WHICH GROUND -WATER IS.ENEOUNTERED INDICATE LEVEL TO WHICH WATER °LEVEL RISES AFTER BEING ENGOUN TESTS MADE BY - r_r.A T.fDat DESIGN Soil Rate Used Min/1 "Drop: S. D. Usable Area Provided f NO. of Bedrooms Awe. Septic Tank Capacity Gals. Type Jfy ap'le Absorption Area Provided By L.F. x24" �Sg�treAWh. � _ Name - P - bignature RD9 FAIR ST 914- 878 -6170 Address CARMEL. NEW YORK In512 x THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by No°�F �FTHE Sjajtl Date PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SOQGE DISPOSAL SYSTEMS FIELD INSPECTION REPORT 4 C4. n�S hA c1y c�� 1Q ( of Owner) (S eet Location) INITIAL SITE INSPECTION YES NO Wetlands on /or proximate to property .............. Property lines or corners found ................... Can estimate house location ....................... Will driveway need cut..... • ..................... Must trees be removed - note these................. Deep holes representative of entire SDS area...... Additional deep holes needed ...................... Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacent wells/septics .. .. ...... D.H. 1 Lot Depth to G. W. Depth to rock _ Soil Descri 0 ft. ft. 3 ft. 3 6 ft. YES 9 ft. ft. 12 ft. D.H. 2 Lot Depth to G. W. Depth to rock Soil Descr 0 ft. 3 ft. YES 6 ft. House SSDS located per approved plan ............ Length of trench measured 9 ft. 12 ft. Width of trench average r DATE: INSP. BY: CONVENTS D.H. - Deep Hole G.W.- Groundwater D.H. 3 Lot Depth to G. W. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. Soil Descr DATE: "7.0 FINAL SITE INSPECTION INSP.BY: YES NO CCNMENTS House SSDS located per approved plan ............ Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Roan allowed for expansion trenches .............. Over 100 ft. fran watercourse .................... Natural soil not stripped or SDS area unnecessarly graded.......... ... ........ 10 ft. maintained from property line and 20 ft. from house .............................. Distance well to SSDS (ft.) ...................... Number of bedrooms checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench ................ 15 ft. of peripheral soil horizontally from trench .................................... Boxes properly set ................................ Could surface runoff from driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in.area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE.. ... i ❑0 Q <o�P 3 0. = ° Q — F L) zo z � a R 0 03 U I FB 529 I' NOTES I Underground Improvements, easements, encroachments, if any, not shown. 2 Surveyed in accordance with existing minimum standards as adopted by the New York State Association of Professional Land Surveyors. 3 Refer t, Leber 938 cp. 164. 4. Refer to town of PATTERSON tax map no. 73 -3 -16. 5. Refer to Filed map no. 2011 V Certified to' EVELYN Z. ROGG DRAOSEPH ROSS ULSTER SAVINGS BANK TIMELY TITLE SERVICES St) PROF MA G, TOWN SCALE Fj r4 \ ` `. - / � `