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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -2 -29 BOX 7 00619 J - 00619 A f�j 00 cutlels same eievMcr, 4" I.mit. Vil: t' - V �c I a y F. i e Qu. V . T: r lior. ht .: rrt VIME.. US, e01 "?;d ow 4r+ i Ire. F. !:nil to F'itcnd IQ :56 )rcrcic is 1 14 A i. ?-.1 " ';A Vc.twaro lit boxec, 'Jslr:l M'j:! "'. e ro'�7ju;. a a. n I 5i 6-top trenches In see disposal d detail " I 'arvious mat T :c 16 y etc. T . ti WC— Tank ineide en4th Aot . od F-70,7 r Pth Tank innidG width 7V.1-:--j Licloid level "n.', 5—d _ , _ � 2 0-00-"- C a P el c I t Y- t.:2:- IS Field Ft.req d_ 6-r� - a, 5' . "'C�s Width T A N I I a I Cr6l� ------ f- 4 "�92 Len ,In e a - Ftil Ai cjifQ L). a I Ga Y - - j p-4 Ft Regd. ; air rg -77- �Wlde- its --iDcffe �NOT E S. 5 r-A c' V/ H-Q v sF \4, N A Revisions 7 -S A N I T AF Y 5 Y STE M D-Usj:l� o 1, ln-,E-6-Kz,-C cu illy oto: L4jEwi SU & L !V I -z:C N M '7 c T N Id Dwq. N* R E N T i S S -c- n M q I T N ;j r i 'M r ir-cy min it fill be R gravel leage F11 L SECT rl NOTES -71'iii Re-Run-Of -5,.inkk F%0.15) ;rdvel onl i'(V. 10 U-S* sources rces arr ceved r Y the locati he i conormcs. J required,,, aclm- clay 0 CT anall Ie presented to the cr-l�cal health officer. - 01,E tq ball i Fill snll.l consist.6f Run lilVeP J 'nlolm' ems"UN 40 all fill V) b a R .0 E- . D.Ps.'. t;rc%ujn N' 200. -.iev6:-shdI1:,h a rein. *,51jnt of lit :l: S.- cut e• c gravel At h n, p ability ind perc-cia.l. C's - n comr.-Oct 4r'd it 4 r 1", 1 2 pre. /sec:: JA '= p6r Std at 0 c c- TY ti WC— Tank ineide en4th Aot . od F-70,7 r Pth Tank innidG width 7V.1-:--j Licloid level "n.', 5—d _ , _ � 2 0-00-"- C a P el c I t Y- t.:2:- IS Field Ft.req d_ 6-r� - a, 5' . "'C�s Width T A N I I a I Cr6l� ------ f- 4 "�92 Len ,In e a - Ftil Ai cjifQ L). a I Ga Y - - j p-4 Ft Regd. ; air rg -77- �Wlde- its --iDcffe �NOT E S. 5 r-A c' V/ H-Q v sF \4, N A Revisions 7 -S A N I T AF Y 5 Y STE M D-Usj:l� o 1, ln-,E-6-Kz,-C cu illy oto: L4jEwi SU & L !V I -z:C N M '7 c T N Id Dwq. N* R E N T i S S -c- n M q I T N ;j r i 'M r ir-cy I., err i pes FRI a . r Y:' 118 10 baffle le DOCk f I It max. floit� - 1 r Sal d' 4C 'pupes . . I;ie 13P slone,or gray 4f 04per foot 7 , .." - , I 3/4spin '0j �: i e I �.P; e t I) /2 m a' X. 4'mi n above edge rock perf,)ral 16V e; -;Irt "M 1 rl. Ll mm' to �addl laterals SECT; U, E T A OF 'DISP05—'L FIELD Tn -�7 I L 7. A Pto rext box I. Jar E pildin g paper ,6" top soli grade i2'deep 3 r4; W 3/4'*stont or 'OT Both bo]x6- rn I Y s u P.) go rfe., graded rid, I e )w ele rho%, stone a ?Y CAa -3jT 1 1' joillf pipe f h CURTAIN- DR 4 ...... . es to ;nsure s cat. 47� Pz - - -. ; - --'a —� - . 'j� I -- 1 " a , , . � -,—, t - ", � , 'A4 -v t1m, 41 -A C -nt IRV `H ;P V', F4, EAL-T-H, � , � �n IRP MMXQUNTY-DEP T t W- yiron "K AW DJvdsibh4,,'df, tEp menta �44:'Y CONSTRUCTION PE RMIT FOR SEWAGE DISPOSAL SYSTE Att, 7- Located "at lock. Subdivision Lot �� 5 Job S01426 -,J A` ree ne : "R D P OWnir F rame 'New -GUb st "M 6 On 93 B Type .�pt A a. Number of eetlrooms V otal,',Habitabie Space 1 Q8 Square Feet X Separa e.,Sewerage System..to consist of , S: width trench, '+ '-, To e..qqqstructe d by 'A ddre 4:1 1-1 Water Supply :�v Public - Supply From . . . . . . . . . . . . . . Si"i"itin o" y 'Orivate �S60ply to be-drilled. y. j. • Other e Non p. -repr-so' e:,sewage 6is-posa i, °, syi! j (.n, ' above d `� ulat ions -o e_Mtname _0 nt "D s Si lihkifi will be located as shown on . o'i'Meal "County DepSh"6f" Mi 419 -Aftjl F e APPROVED '*pR'-6bNStRU , revocable for cause may,b4 ign R_ ::A AY I. :9.2-06e, No.,` 2- --L!c9pse, ;',t-4 'as unless construction' of the -buildhig' been.undertaken "I's iil ,nmissioner t' z. . -jron tction.," j Building TYPe Frame ew G.ues 1+ *i t - Yes -Has Erosion, Control Been "Completed? - 1 'certify thit,the system(s) =as listed`serving "the above "attached), and,in accordance with the:sfandards ;ru' .5/29%74 Date Address Il '� Any person .occupying premises'served by, a above: conditwns: resulting from °such usage Approval. 01 available and the approval w of the'prrvate ater supp ..'sUbject.to modification -or. 'change, when ; -.in the.,ju D j Date � a] e No, of Bedrooms Date permit Issued 57/74 raises were construcfed essentially as shown on the plans of the, completed work (copies of which are and.•regulitions; plans:'file-d'.and the permit issued tiY- --the. .. am .County Departinent-of-. .Health. Certified f F!' E X Ft 6 _ Sox .. • 53 Nicen=e No. 29206 stern shall promptly Ctake such actiorras maybe necessary to secure,the'correction of any: unsanitary' he separate sewerage ;'system shall become null and void as soon as a,p.ublic sam ary sewerbecomes shall.become null and' :void when a public water supp_ly_becomesr available Such - approvals are u' r o t' n modification'or ` chan e- i's'necessar ment of. the .Commissioner oC ;Health,. such ev ca to _ 9 ./_,],p. Y_ , '- 2, Tale fi., BYF - ,. 1 fiK/� /// _ . r OF - PUTNAM . DUNTY JEPAP:TIVIENT HEALTH Division of. -= EnvironmentaL.Hea /th Services, Carmel, N.: Y "'10512 4 :CERTIFICAT.E= :OF . CQNST;RUCTI.ON, _COMP,LIgNCE -FOR: ;SEWAGE 'DISPOSAL - ,SYSTEM Patt21"5011 - . Town o(Village >" McManus Road Tax Ma 73 t ocated of :4JK0iDQD�C P B,ack. 4: -Owner Dr Justin .L "Gre$ene` got 15 ,ob 501426 , �f Separate S:ewera e S stern built by w 1 + am' ^yBarr.. ett Patters ;On i � NY g y Address f1 1000 yo- E' 3U inch Consisting of = Gal. Septic Tank lineal =Feet X _ width trench Other requirements 'Pone r _ Water Supply ., P,ublic.,`Supply From X b == stlng ". pnvate Supply Dulled By' Building TYPe Frame ew G.ues 1+ *i t - Yes -Has Erosion, Control Been "Completed? - 1 'certify thit,the system(s) =as listed`serving "the above "attached), and,in accordance with the:sfandards ;ru' .5/29%74 Date Address Il '� Any person .occupying premises'served by, a above: conditwns: resulting from °such usage Approval. 01 available and the approval w of the'prrvate ater supp ..'sUbject.to modification -or. 'change, when ; -.in the.,ju D j Date � a] e No, of Bedrooms Date permit Issued 57/74 raises were construcfed essentially as shown on the plans of the, completed work (copies of which are and.•regulitions; plans:'file-d'.and the permit issued tiY- --the. .. am .County Departinent-of-. .Health. Certified f F!' E X Ft 6 _ Sox .. • 53 Nicen=e No. 29206 stern shall promptly Ctake such actiorras maybe necessary to secure,the'correction of any: unsanitary' he separate sewerage ;'system shall become null and void as soon as a,p.ublic sam ary sewerbecomes shall.become null and' :void when a public water supp_ly_becomesr available Such - approvals are u' r o t' n modification'or ` chan e- i's'necessar ment of. the .Commissioner oC ;Health,. such ev ca to _ 9 ./_,],p. Y_ , '- 2, Tale fi., BYF - ,. 1 { r , , TV TNAM COUNTY :UEPARTMENT'OF � HEALTH y: Drvisionxof,= ;Environmental Hea /th Services •,Carmel N.;,Y 10512 CERTIFICATE 'QF CONSTRUCTION: COMPLIANCE FOR, SEWAGE DISPOSAL• SYSTEM Patterson r Town or Vil { ; lage F 'McManusdad Tax a 73 BIbCk 4 Located at J�9C74 Dr t�,us061" t_ot 15 ,bb 501426 Owner s �1 D _ Separate Sewerage System' built by* �rtfi'1 I , uariett P7atters'On Nr Address *750- 2Q0 36 inch Consisting of.° Gal 'Septic Tank lineal` Feet X width trench tither requirements `?No R :0 6 'Re'1 orated area see Dvu 2 :'. S01426 . *Esstir Tank" Concreted Reused Water Supply Public 5 pply om r a " ate Su pply`Dr�lled ,By Gx� Pr iv `St¢Tnq= Address Extitfing -Uwel l �n s: Four 5/7/74 Bu�ldmg.Type q pig," Betlroom.s i]ate Permit Issued Ye$ d Has :Erosion `Control ,Been Completed? _ I tertify that the eystem(s)•'as listed`servmg.6e above -,premrs s were constructedessentially as shown oh. the2pians. of the`completetl work'(copies of which are I `:.attached),, 'and "ri% accordance with the standards, :rules and;reg:ulations plans f-Ied nd the permit issued by the; >'.PUtnam County Department of Health. " 1 Date 5127/74 CertifWdr ' p;E n R A Address R p 6 'BOX. y a el ` N 0512��ense No. 292Q6 Any person occupying premises- served by the above'_-tystem(s) shall promptly _,take such action <as may be necessary to,secure the correction of any unsanitary ' I`+ conditions resulting from `such .usage :Approval of the separate sewerages shall become null and void'as soon as _a public sanitary sewer becomes ? available and the approvaFof ,the Private water supply shaWbecome: null and,void when a..public -water supply beebmes available Such approvals'�are subj ect to motlif ication o► change_ when in the-judgment of the Commissioner of .'Health such re"voWt�on, mod�f� cation or change is necessary 7 r Date, ;Title r _ 3' .,. �P�_. r: _,., .,. �,.v4 <, : +1 -.,�tt i.:�G.. <,.,.in. F.s..,. .i, ... _ «. ...d .�- :.xr..b,ti,,.,�.._�... ,.��.�. •s- >F �.� c.. ".a, .� ,�:. n Dr. Justin L. Greene Owner or Rirehaser of building Owner Building Constructed by Patterson Municipality .Tax Map.73 90@C MX 1' McManus Road 4 Location - Street Block Frame 15 Building Type Lot GUARANTY.F 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 tlieNstandards, rules and regulations of the Putnam County Department of Health, and hereby''• guaranty 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 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 occupant of the building utilizing ti ie .'ws Lens 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 4th day of�v� 19 I y Signature ,L,L —i- Title (if corporation, give name and address) THREE (3) COPIES 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 SYSTEM... Division of Environmental Health Services, Putnam County Department of Health Dr. Justin L. Greene Owner or Purchaserof Building Owner Building Constructed by McManus Road Location - Street Frame Building Type Patterson Muni cip ality Tax Map 73 4 Block l� Lot GUARANTY 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 guaranty to the owne.r", his succes- sors, heirs or assigns, to place in good operating condition :any part of said system constructed by me which fails to, operate fo:r..a period of two years immediately following the date of initial use o'f -;,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 de- termination of the Director of the Division of Environmental Health Ser- vices 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 4th day of June 1974 Signature Title If corporation, give name and address) THREE "�(�.3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP��ETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of .Environmental Health Services, Putnam County Department of Health. Date.: Ins p. 1).y INITIAL SITE INSPF.CTI.ON � Yes No _4mments .Property lines or corner -, found Can estimate house location . . . . . . . . . Will driveway need cut . Must .trees be removed -note these Is deep hole representative of entire SDS area Additional deep holes needed. Sufficient SDS ar,.;a available considering _ •driveway cut, house location,.separation distances, etc. .. . DEEP HOLE 114, TA • Depth• - Water elevation: J` Rock elevation: • Soils description: .. Date: FINAL SITE 'IINSPEC''I0�`? Insp. by: . House located where 'shown on approved plan .. . ..�►o .Fvm•ia : %..rw w aM V Y'ioYf VYL'.�* • • . . . . . . . . Width of trench average Slope of tyle line and trench acceptable . . . Room a7.l.otred for e::r_sion trenches _ Over 50 ft. frcm ss•:p am, ::� _ atercovrse .. _ - Natural soil not stripped or SDS area unnecessarily graded 10 Ft . trair_te.ined from prop . line and 20 ft. from house . . . Separation of tren ^h iron house ��ell etc. follows plan . . . . . . . . . . . . . . Number of bedrooms checks . Stones; brush, stur:ps, rubble, etc . greater than 15 ft. from nearest trench . . . . . . 15 Ft. of peripheral soil horizontally from trench Junction boxes prope_Ply set Could surface run ot•f from dyivevay, roads, ground surface, etc. channel near SDS area .. . . . . . . . . . • . • . . .. . ' .. Does lot drainage, app ar 0.K. in area of SDS 'FINAL GR0ING OF SITE ACCEPTABLE . • d�a . rte. • Date.: ' I nsp. by: INITIAL SITE .IIISPECTIOId Yes No Comments Property lines or corners found _ Room all.oved for expansion trenches . . . . , . Can estimate house location '. . _ Will driveway reed cut Must trees be removed -note these . . . . . . Ys deep hole representative of entire SDS area j Additional deep holes needed. . . . . • d�a . rte. • Date.: ' I nsp. by: INITIAL SITE .IIISPECTIOId Yes No Comments Property lines or corners found _ Room all.oved for expansion trenches . . . . , . Can estimate house location '. . _ Will driveway reed cut Must trees be removed -note these . . . . . . Ys deep hole representative of entire SDS area Additional deep holes needed. . . . _ Sufficient SDS area available considering driveway cut, house location, separation distances, etc . . . . . . . . . . . . . . .. +� _ DEEP HOLE DATA Dapth: Water elevation: Rock elevation: • Soils description: Date: FINAL SITE INSPECTION Insa. bT: House located where 'shown on approved plan a]� ) iit(a+.ia -S(! t.7fu�f'•1-' Sa l'}!!f•[1Vyr 1 . q! 1 , .. -. .- Over 50 ft . from swamp, .- Tatercovrse .. �' _Natural soil not stripped or SDS area unnecessarily graded 10 Ft . tria intair_ed froRi prop . line and 2Q ft. from house . Sspa,ration of trench from house, well etc. follows plan . . . . . . . . . . . , Number of bedroo�as checks . . . . . . . . . . Stones; brush, stumps, rubble, etc. greater than 15 ft. from nearest trench . . . . . . ' `15 Ft. of peripheral soil horizon tally from trench . . . . . . . 0.0 .0 . . Junction boxes prop °_,ly set Could surface run off from driveway, roads., / ground surface, etc.. channel near SDS area . . . . . e - e . . . . . . Does lot drainage annzar O.K. in area of SDS FINAL MAM n OF RTTR ACCEP T P. 1 Width of trench aw erase -z . Slope of the line and trench acceptable . Room all.oved for expansion trenches . . . . , . .V.. FINAL MAM n OF RTTR ACCEP T P. 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING CARMEL, N. Y. 10512 r DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner. �e 1e v Addre s s M C, TU. Located at ( Street )&k\ek V\o\ Q e,.k • e WN Block �Lot �S indicate nearest cross s ree Municipality a�rSar Watershed �A-0Ux SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run apse Depth to Water Water.Level No. Time From Ground Surface.in Inches Soll Rate Start -Stop Min. Start Stop Drop in Min.. /in drop Inches Inches Inches 2® /® IS 7 3 ®p.3& af 6 4 5 Notes: 1) Te'�ts t.o be 'repeated at same rates are obtained at.each'percolation for review. 2) Depth measurements to be made depth until approximatelyy equal soil test hole. All data to be submitted from top of hole. DEPTH G.L. 611 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO._ HOLE NO 12" ®vim 18" 24" 30" 3611 42" 48" 54 60" 66 72 78•' 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date D SIGN v Soil Rate Used �Min/l "Drop: S.D: Usable Area Provided No. of Bedrooms Septic Tank Capacity Gals. Type Absorption Area Provided By L.F.x24" width trenc Other ., Name John ,.. Prent-Igs'. 1 :, Address PR ftiT�s�,yF THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY Soil Rate Approved Sq..Ft /Gal .Che c y APE Date Or SY a� a 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. OwnerA .Jar-&,% z. dP wo Address /fr 1YV4g X . %N+PiIa� Located at (Street�� )?Block.. Lot n i a e nearest-cross s re Municipality A ,tom Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME. PERCOLATION PERCOLATION Run Elapse Dep to Wat er a e. ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 2 4 5 ; Notes: 1) Te'gts to be` repeated at same depth until approximately equal soil rates are obtained'at.each.p9,rcolation 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 N0. G.L. ' 6 ►► �qo�$ 12" - 18" 24" 3011 36 11 42" 48 54 60" 66" 72" 78" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED 6J®M ,INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Dated Soil Rate Used .46""? Min/1 "Drop: S.D. Usable Area Provided 0 pg& ° No..of Bedrooms Septic Tank Capacity (O®® Gals. Type Absorption Area Provided BY_ZP9 L.F.x2411 r! width trench. Other hvzcD Name aignaLure Address . 04 � , ��a ►avti . A 5. N. P a te '. Few THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: ♦i Soil Rate Approved Sq. Ft /Gal.. Che' Date �s NO. �y�F rHE StAItpE i Dr. Justin L. Greene Owner or Purchaser of building h Ex i st i nq Building Constructed by Patterson Municipality Tax Map 73 N\ McManus Road Location - Street 4 Block 15 Building Type Lot GUARANTY 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'guaranty 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 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 occupant of the building utilizing 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 4th day of 19+ifi Signature1� -,�! Title (if corporation, give name anci address) THREE (3) COPIES 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 SYSTEM. Division of Environmental Health Services, Putnam County Department of Health PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner AJoL3 L G r" Address NI c Mg,tl V!s 7Z©,¢ ?:?- Located at (Street) g-g- 4p Tax Map. a3, Block .9,_ Lot 2 9 (indicate nearest cross street) Municipality PA Watershed 4,4f> 7- 73 aEz14 GAF- SOIL PERCOLATION TEST DATA Date of Pre - soaking d - Date of Percolation Test 0:5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 2 f0:a0- 10,3a 16 3 1 � 3 /0.37- l0;sb 117 / 9- 2- 3 6.3 4 10s5"$ - / / ;/7 /y /y -;z 6,3 5 1 /0:V 0- /0; 3 8 30 /19 2 0- :3 /0 2 - 30 -- / `/y �� 13,3 3 �It �r - ll; ��� i 2 4 y- 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. / HOLE NO. V- HOLE NO. Indicate level at which groundwater is encountered yo Aj,5 Indicate level at which mottling is observed AioA)g Indicate level to which water level rises after being encountered --- Deep hole observations made by: d4 TC is r- v Date io 03 Design Professional Name: Address: Signature: Design Pirofessional's Seal 2 'PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A: -GENERAL INFORMATION - Name of Project AL0 3G ,X:�f_- P1frTE7(2So&) County _Pc1r&Ae �! Site Location �ff �t/ y S IZZ. ;2-.3 a e2 — a 0 Flat Bodies of water Building construction begun IV O Extent Is property within NYC Watershed ? ................. 110/yes 0 No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. 2. F Hilly. .F__J Rolling F -1 Steep -slope �Gentle,slope Evidence of wetlands Low area subject to flooding 0 Flat Bodies of water a Drainage ditches Q Rock outcrops' _ 3. Property lines or comers evident ....................... ............................:.. 0 Yes O No 4. Do water courses exist on or adjoin the property? ... ! .t raw•,,,,.,,,,, Yes F7 No 5. Will these affect the design of the sewage system facilities ?............ F7 Yes No 6. Do watershed regulations apply in this development ?....................... F2/Yes F] No 7 Will extensive grading be necessary? ............... .... Yes rNo 8. Will extensive fill be necessary for SSTS? ......... ............................... F__J Yes �No' 9. Do filled areas exist within the SSTS area? ....... ............................... a Yes [El"No. If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: Sand Gravel a Lo;FBac Clay 0 Hardpan Mixture race 11. Observed from: F7 Borings Bank cut lch oe excavations 12. Soil borings /excavations observed by G . 2F P; G., " f _ on i,2 13. Depth to groundwater ?J o ,v ,g on 14. Depth to mottling N o nj F on 15. Are test holes representative of primary & reserve areas ...... ............................... 16. Soil percolation tests made by 9'apLz wwsou on 17. Soil percolation tests witnessed by ,may, R r g y P on SECTION D (on back) Form ST -1 2 SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? 0 Yes o 19. Will groundwater or surface drainage require special consideration? ....................... Yes 0 No 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ....................... .1. F Yes [2fNo SECTION E. REMARKS 21. If a common water supply is proposed; has an inspection been made of the existing or proposed source and facilities? ................................ ............................... LJ Yes No Inspection data 22. Do adjacent wells and /or sewage systems exist ?.............. . .0 .. . .O ............................. Yes :. No 23. Additional comments 7e4 as ee o r Sy r V e 41 ;:Lp 4,1 13a,� 24. Site observer /inspector and title 4', 25. Date(s) of observation(s)inspection(s) //6 /o TEST PIT PROFILES Hole # Lot # Hole # Lot # Hole # Lot # Depth to water Depth to water Depth to mottling Depth to mottling Depth to rock/imp. Depth to rock/imp. G.L. G.L. Depth to water Depth to mottling Depth to rock/imp. G.L. 0.5 .0.5 0.5 1.0 1.0 1.0 2.0 2.0 2.0 3.0' 3.0 4.0 5.0 6.0 7.0 8.0 4.0 5.0 6.0 7.0 8.0 3.0' 4.0 5.0 6.0 7.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Gat DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Ajpg L GT Address M g_ M,¢AV !'S 7Z ©,4- n- Located at (Street) Rvcz,Er 11o15 y,,4p Tax Map g.3, Block 2- Lot 2 j (indicate nearest cross street) Municipality Pg ZZr �,�� Watershed ��ST 15 �. AL4 --H- SOIL PERCOLATION TEST DATA Date of Pre - soaking /v Z/�E 3 Date of Percolation Test /o- G /03 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. . Form DD -97 2 1.,07 —/.. ; 3 7 3 /�Ll 3 , o 4 1a,27"/..r37 /A" a3- 2-6 3" 3 1 3 5 3 /2;12- /. ;3. It 4 12 ;37 - /a; /�- 19 ° �-� 3 �, O 5 z. . 1 - 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. . Form DD -97 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0'` 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST DOLES HOLE NO. 3 HOLE NO. HOLE N0. Indicate level at which groundwater is encountered ©NC— Indicate level at which mottling is observed A j oA,F Indicate level to which water level rises after being encountered log Deep hole observations made by: 12cE n Re_, D, H, Date lo � Design Professional Name: Address: Signature: Design Professional's Seal ,2 PiTTNAM COUNTY DEPARTMENT OF HEALTH N DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project /UD731 ET O(V) P r¢TT Tt5Oill . County PPu2SAzA Site Location IV<W,4'Al//5 Building construction begun Extent well Is property within NYC Watershed ? ................. Yes F--] No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. Hilly F--] Rolling F7. Steep slope �ntle slope Flat 2. Evidence of wetlands Low area subject to flooding F--J Bodies of water Drainage ditches 0 Rock outcrops 3. Property lines or corners evident .......... ly ....ill$ ........................ Yes No 4. Do water courses exist on or adjoin the property? ....... Yes 0 No 5. Will these affect the design of the sewage system facilities ?.. Yes 0 No 6. Do watershed regulations apply in this development ? ....................... dYes Q No 0 7 Will extensive grading be necessary? ................. ............................... Yes No 8. Will extensive fill be necessary for SSTS? ......... ............................... Yes No 9. Do filled areas exist within the SSTS area? ........ ............................... F—� Yes No If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS. 10.. Appearance of soil: E2rSand [3Gravel Loam F--� Clay 0 Hardpan 0 Mixture 11. Observed from: F--J Borings F-� Bank cut. �ackhoe excavations 12. Soil borings /excavations observed by mil° `7Z C E-o G D,} j, on 13. Depth to groundwater N61y'r on 14. Depth to mottling A.1e2 AJ, on 15. Are test holes representative of primary & reserve areas ...... ............................... 16. Soil percolation tests made by ,z ( IX"OA) on 17. Soil percolation tests witnessed by e!r:g, `Pkc. (17, 11, on SECTION D (on back) 0 Form ST -1 2 SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? F� Yes INo 19. Will groundwater or surface drainage require special consideration? ..sc�. k�... Yes 0 No 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... Yes o 0 SECTION E. REMARKS 21. If a common water supply is proposed; has an inspection been made of the existing or proposed source and facilities? ..... A 5%'41o. � s . a No Inspection data 22. Do adjacent wells and/or sewage systems exist? ......A ... 5 NSW ..o. ,..,r► t........... Yes a .No 23. Additional comments 24. Site observer /inspector and title 7!7ig6n Serb gz, 25. Date(s) of pbservation(s)inspection(s) 3 TEST PIT PROFILES Hole # Lot # Hole # 'Lot # Hole # Lot # Depth to water Depth to water Depth to water Depth to mottling Depth to mottling Depth to mottling Depth to rock/imp. Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L. 0.5 .0.5 0.5 1.0 1.0 1.0 2.0 2.0 2.0 3.0, : 3.0 3.0 4.0 4.0 4.0 5.0 5.0 . 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 - 8.0 9.0 9.0 9.0 10.0 10.0 10.0 s-°3.., -i,: "� ;,' ,r €> y� _: - QS.,µ mss' ` '+ ,«�f Y " " „' " ` ' ,° . -ri` "� x 2'.y,�> " `''' � ' .;+sr .tom- ;' .x*r� n,. ."e :. -..it F x. ,y'*. -i' x3 +sx'nj *. a �'$5% -tom ° s x -„ -s. �a s., ,z 3 __,segue e` a'"-` ?' ,5,. -`. '� � e rr x W '4 �A. s �i' ,, .� p ;, . 4i -±cj+� ,a,6'.� is;%§ t .: �° ; � `°a'- `'�S:si.. s'y �a'" gY > k'i # _rz 3'�r g,•. 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FOLEY Public Health Director BADEY & WATSON, PC P. 01/01 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH . 1 Geneva Road Brewster, New York 10509 MUTEST FOR FIELD TESTING ATTENTION: ❑ JOSEPH PARAVATI ® GENE REED All information below must.be full y completed prior to any scheduling. DATE, 9/26/2003 BADEY & WATSON, ENGINEER OR FIRM - Surveying & Engineering, P.C. PHONE # (M) 265.9217 REASON: DEEPS: i PERCS: ❑ PUMP TEST: O ROAD /STREET: McManus Road TOWN: Patterson TAX MAP #: 23. -2 -29 SUBDIVISION: r Jean -Yves Noblet LOT #: _ 1 & 2 OWNER: Jean.-Yves Noblet NYCDEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING YES ' NO Alo -D, e?, pLcr rasovL lolzlo 3, �t O�S� 13ea��k Proposed SSTS within the drainage basin of West Branch or Boyds Corner Reservoirs. o ® Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. Q ® Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ ® Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. ❑ ® ' Proposed SSTS for a Commercial Project. . It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered yes to any of the questions, NYCDEP must witness the soil testing_ This Department will coordinate a mutually suitable time for field testing with the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. pre — -5 ,PA, K DATE: ll /tv 3--',00 CTS: imm n -rccrN C _-PM 7 c FOR COUNTY USE ONLY }P ic ID TIME: X4 0 cc 311 18 a �P a sz T. !I Pond 45 SSf ru 1 d sa i teinbec Coner so a 1 a m 0 0 o 1 ' NDIA 1 . A HILL. t rnerS H4 RD HS own -rs ■.� Aq spy 12 L CT ks �q m •ES N Brewster > yM�EA Pond r c m S D I 1 RD�°�� `qQ� Gr O,q. y � RISE 9 k Iavous OX a� u No M' O PAN pEe g j �usRp = R q 0 •p /� e�vo t p r� p (O %1 1111} �y OR F Ia q%WN p9 t W BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Date: A93 To: `J jSSct Gct ©gs� From: Gene D. Reed Putnam County Department of Health For your information For your review As discussed Fax #: 7 -7 3 ® 3 �� No. Pages (Including cover sheet) . Please respond Attached as requested Please call Notes/Messages %ZG 5 1»65 P5 ®/V 1O7 16 /D; O® F In the event of transmission /reception difficulties, please contact this office at (845) 278 -6130 ext. 2261. L ' O e SENDING CONFIRMATION DATE OCT -2 -2003 THU 09:14 NAME PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 919147730355 PAGES : 3/3 START TIME : OCT -02 09:12 ELAPSED TIME : 01'55" MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... 0. BRUCB R FOM LORINTA MOLWARI R.N., M.S.N. PWAO ldrd th Desua- Malay P.Nk MOM Dbww DOwrkr or Px&W S.W- DEPARTMEDTr OF HE ALTH 1 occove Fad Bmwatcr, New York 10509 • 6Wa•�.ayl nem (N$)27e•6UO F.043)378-7501 nmMd1 amleo p4)27a -65$1 WIC (140271-6671 FW(96$)171 -601$ harp Larbdk. (14117/•6011 F-OW (n1)271 011 F=0145)171.1611 Date: !O �' /0 -3 No. Pago (Including cover sheet) From: Germ D- Reed Putnam County Department of Health For your information Pleasc respond For your revietr Attached as requested As discussed Please can Notes/me"Agas A X j ,59 P_5 O../ 1'9 AV 1D: 00 r1� Tt so T/1AnlK�7 � ' In the event of transmttsloo/reception difficulties, pkase contact this office at (845) 27&600 ad. 2161.