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HomeMy WebLinkAbout0671DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23.11 -1 -2 BOX 8 00671 , : 'I ti 1 -, r - r Er I IN , 00671 Water Supply: )Pub apply Rom Address or: Private Supply Drilled by Address —60,1 B - Bull din g Type _ I Has.Erosion Control Been Completed? Number o iba 1�- f Bedrooms Has Gste .Grinder Been Installed? A b 3 Other Requlremente S certify that the.system(s) as listed serving the above- premises were con s£ ct'. &�ess'entially as shown on the plans of the completed.work ( copies of which are attached), and 'in accordance with the standards, rules and •r let he, in accor oe with the filed plum, and the'pexmit issued by the Putnam County Department Of Health:. Date hy��/�7 AA�A► Certifietl by 12.E. , R.A. Address 27�i h!U 8,iwifN . tOS16 License No. yi�r Any person occupying premises served by the above systems) ..shall promptly.,take, such action si may be necessary to secure the correction of any unsanitary ,conditions resulting`. from such usage. • Approval o& ,the- separate .sewerage systom•ihalhbecome'null; and. void, is soon as, a'pub;t: unitary rawer becomes available and the approval of the piivate water supply shall•tiecome'riull and,,voli', when, a public water supply becomes available Such ,app►ovalf ere subject too mmod�ificasttion or' change •when; in 'the judgment,of the. CommisslonaT'of ►iealth;such revocation, modification or change Is�neee%iwry., 0 .1 sw� r_ R BREWSTER LABORATORIES Box 224 -. BREWSTER, N.Y. (914) 225 -2072 - WATER ANALYSIS REPORT - SAMPLE NO. 6717 SOURCE: Dr. Gandal McManus Rd. Patterson, NY COLLECTED: September 18, 1987 BY: P.F.Beal & Sons, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method hose bibb -well This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. 0 per 100 ml. September 22, 1987 ( - JA""Cr Roy Bickwit P.E. Director PUTNAM COUNTY DEPARIMENQT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Pa- C. 6A)op z Owner or Purchaser of Building C_ G�4a I Building Constructed by Location - Street PAU.a,, Municipality "t(_' Building Type Section Block Lot 6,teJo A WMUGtA.. Subdivision Name 'L . Subdivision Lot # GUARANM 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 6' of General Con ac - Signature Corporation Name (if Corp.) Address rev. 9/85 mk Title xr ) �? Corporation Name (if Corp.) Address II. IV. V. Vi. APPENDIX C i'. FINAL SI INSPECTION Date?- y ,r ' Insted by ;CATIO C' CWNER TM Q OR SJEDMSICN LOT (a - L YE5 S�yP_Gc^, DISi OSAL AREA a_ SDS area lccated as per amroved plans b. Fill section - Date of . plac�nt 2:1 barrier. LGTH WZD I'Ei P_VC . DPTH 1J _ c . Natsral soil not s t� inced ( . d. Store, brush, etc., gre=ter than 15' fran SDS area_ e. 100 ft. fran water co = /wetlands. I I SL,vr= DISPOSAL SYST a. Septic tank size 1,000 1,250 b. Septic tank ins t=...__ evel C. 10' min' �� fran fcurdaticn I- d_ No 90° bends, cl ��ncut within 10 fr. of 45° bend e _ DIS=U --TIGN EOX 1. P� out? ets rat sale elev ti cn - wat er tested. I o J C 2. Protected belcw frost I ( 6Z e.<3 3. R nimim 2 .ft. oriain:--1 soil h_twe_n box and tenches I �� f. J(%.CTION EOX — rccer1 set I c�S g. ZREZ{r c5 2. Distance Distance to water arse ft. 3. L-istalled acMrd; r_q to plan ( } 4. Distance center to center 5. Sloce of tre_ncz acceptable 1/16 - 1/32 " /fact. I I 6. 10 feet f =an mater `v line - 20 feet-- fcurZati cns 7. Depth of tre_^.cz < 30 inches fran s-urzace I 1 8. Roam allcwed for eXCAansion, 50% .9. Size of ravel 3/4 - 1j" di a_►neter I 10. Depth of c=ave? in trench 12" mtniman I L . Pine e_ ^mss ctced h. PLW OR EOSE SYSTEMS 1. Size of = &amber I 2. Overfica tank ( I I 3. Alarm, visor l /audio ( ( I 4. Rum easily acc= .=sible manhole to grade I I 5. First box baf_1ed I I 6. Cvcle witnessed by Health Decrtrent ( I estimated flame per c,;cle ! I I SOUSE a. House lccated per approved plans. b. Ntrn:^er of bedrocr5 �• I I = Well locates as per anoroyed Dlars Ia. b. Distance fran SOS area measured %Od ft. I c. Casing 18" above grade_ I d. Surface drair=ce around well acceptable. I GVE RAI L 4rORi4u.PSHIP a. Boxes prore l crcuted b. A11 RiEe=s partiall 1v har-kf illed I ' c_ All ices flesh wi ttn inside of box I d. Backf.ill uate_rial contains stones < 4" in diameter e. Curtain drain installed according to plan , f. Oartain drain cut=all protected & dir.to exist.wa -IC - Jursc g. Footinq Grains dl scnarce away from SDS area h. Surface water protec7ticn adec-:ate I L F= osion control provided on slops re te-r than 15 %. i� LI pUTNAM COUNTY DEPARTMENT OF HEALTH �' y DI'Khdou of Erivironmenta! Health Services Cnrme! N Y 1051? 'Englneer,to Provide Permit IY } 'oa &R' TIFICATE:0F COMPLIANT S CONSTRUCTION PERMIT FORS E,DISPOSAL SYSTEM Pecs Located atC •1KaNylj Town or Village , } Sabdlvision Name ea Saba. Lot q �^ Ta: Mttp i Block Lot ZS Ownor %Applicant Name `�. P , (,,I .14 14'1 Renewal_❑ Revision ❑ Date of Previoae Agpro `� MilingAddrees �OX a Two 17ha�L \1 -T Ztp BnUdhig TypeI �'�' Lot Area 6 -�t2� Fill Sectlon On1Y. De Volume P Number of Bedrooms J Design Flow G /P /D C 17 PCHD No cation Is R aired when Fm Is completed a--- Separate Sewerage System to rnrielst1.o_f 8 Gallon Se tic Teak m To be cone acted by `� .°l Address i Water ,SapplTt. Public Supply From Address or: `� • Private Sapply .DrWed by ;� ddrees ^ p r' t• Other Regalremente i `C> 1 �L G'w- `•f� Y D'/ -'l Z�' E� J �' ' represent , a am wholly and,•comDletely responsible for the design: end location of ^the proposetl system(s)' •1) -,that he separate' sewage tlisposat. "system above described.will be constructed asshown.on the'approved amendment there to and in. accordance with the standards, rules an regu a ons o e ,u nam County Department bf, Health, and that on completiondhereof a 'Cert,fic5te' of,Constructior'Compliance" satisfactory- to'.the.'COmmiisioner of Health will' be submitted to ^the Department, end a written guarantee will be'rurnished the: owner, his wccessors,'heirsor assigns by ;.the'buiider, thatsaid b91lder.,will . ,• place in good operating.,condition any'part of said 'sewage disposab system during period"of two (2j yeaiiiriimediately following the .9 of'the issu- ance of the approval of the Certificate of Construction Compliance- of ahe origi 1's tom of any•repairs thereto; 2) that the.drilled' well tlescribed above Will be located as shown 'on the approved-plan and that said well will be; installed in cc ace th the an s rules and regumop's - of the Putnam i County Dep rt ent of Health / Date sit t : Signed P.E. V R.A. _ I Address License No D7U APPROVED FOR CONSTRUCTION: This approval; expue one: year from the date issuetl unless construction• of the. building has :been untlertaken end Is . revocable for cause or may be amended of modified when considered necessary by the' Commissioner of Health. Any change or alteration of construction . reQuiies'a new permit. Approved for disposal of domestic sanitary sewage,. - 1n(T /or . private water supply only. ' D ate By le 0 m I WILL HAND DELIVER MYSELF PLEASE SUBMIT TO THE SPECIFIED DEPARTME NT FOR ME SIGNATURE �.,- -- APPLICATION FOR PUBLIC ACCESS TO RECORDS TO: RECORDS ACCESS OFFICER DATE: �,(� � X22 71&7 Name of Agency JOSEPH L. PELOSO, JR., PUBLIC INFORMATION OFFICER Address I HEREBY APPLY TO INSPECT THE FOLLOWING RECORD: 3 ?v L3 Signature RepresInting /c ailing Address j,.� .S 1'a N �3000.��i�� �f',Qdu•`IZ. V-1t Date , FOR AGENCY USE ONLY 9 APPROVED ® �� DENIED �y Record of which this agency is Legal Custodian cannot be found. Record is not maintained by this Agency Signature NOTICE: Title Date YOU HAVE A RIGHT TO APPEAL A DENIAL OF THIS APPLICATION TO THE PUTNAM COUNTY EXECUTIVE. Name Business Address WHO MUST FULLY EXPLAIN HIS REASONS FOR SUCH DENIAL IN WRITING SEVEN DAYS OF RECEIPT OF AN APPEAL. I HEREBY APPEAL: Signature Da t e .. : ::.;•,r� �.�q Yj'd�tl�•"'f w. z. ., .- .ry .-.: T'tiwv +- ro�:f^' ^.�R•t��"�s•^" .,s ..yy+'. \ 7A j4 c.r.. S; ENGINEER_ MUsfi eF` i 1 PUTNAM ;COUNTY DEPARTMENT OF ; HEALTH 4. 'k:. + t o 'PROVIDE -t.f Division of Environmental Hes /th Ser'i+ir©es, (:acme% N ;y 10512 ��' pEF2h1I7 ., G� Tj OICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM t�,`�` wrl br Village ;r� Tb a i �'.5• °p ; �r{:, s'e: ./ ! ' �` //�• ✓d/y �d �► L� Tax Map �z• ' rBlock @?u.�v:5 e�t ri ,; ye ed-at , - �Y"�y[. J st /�� tiY / Foxmezly '�,f[( ✓'[i Qom! L !/[✓ ''. Tax Map Lot � �tlbdi tbf t... � r>tte +�ewe/a9e SYStem bUitt. by ��� �l st � /f. L �� G J/1 S• bddress Dili •��''•�^'� �E<.t%.yQ/�.0 � C '" - ' Consisting of Oal. Septic Tank and aaii,,,,�� ,a vu Other 't6qulrement3 If 3UpP1Y: P3 blit Supply From na__� ._ OAVate Supply Drilled BY " �•p�r S< y �j'!.i r Addiass p v Type —7- 2 li No. of Bsdroomt Date 1►e►tntrlt ` ��totion Control Been Completed? Hat garbage g lied? : e oslf✓, �i�'% , RV c N •; ��,jj�� t{, si ify that the system(s) as listed serving the above premises were constru �ntYally 6,p1i<118 °t! to�slt� €d"t�orlt.) copia °!' rhichlare attached) and in accordance with the standards, rules and regal din a ce byith 'th i�l►-§d ?lafti tiF'` iii � bUed 1 I am County Department Of Health. LJl 71 i `? Certified • _ H _ I.S; 7: f Ii/ �./Lw! ;�� Address ii '� ,20, C. A6,11 / ;<. ; ;"�' (. peffdn oeeupyiny prenitslt'served by the above system(s) shall promptly take sue NO 4? Ihtb lMltFa x nteihit� t ditiotis resulting from tUeR usage. Approval of the separate sewerage system shat e o s)r?4tFai# at aedln'fttib lit Ob I�tilt�flii�IWtff ��Eoitiil 1ab161fnd the approval bf -the private water supply shall become null and void when a Pply 66 86n>i! JViIIiIS $Ilttill'tlbiitodllt .rit /, Ibct�tti: modificatloh Oi.; a6harlge when, in thej judgment of the Commissioner of. Halt h,_ suchitbv6latforl�� �bdiflf�4b 1 'xci ...ik 1 .: sF•,Z.� - i ., .. '- . '.. -. _.... ...r.,- �+/_�.. .i. L.� r ._ .... ,. -.,h- t !t ti. r v X s 7 r f t , .YL -y. t S � f i.. xy } r w ti 7 r< �f 7 ff r� tiJ .. : ::.;•,r� �.�q Yj'd�tl�•"'f w. z. ., .- .ry .-.: T'tiwv +- ro�:f^' ^.�R•t��"�s•^" .,s ..yy+'. \ 7A j4 c.r.. S; ENGINEER_ MUsfi eF` i 1 PUTNAM ;COUNTY DEPARTMENT OF ; HEALTH 4. 'k:. + t o 'PROVIDE -t.f Division of Environmental Hes /th Ser'i+ir©es, (:acme% N ;y 10512 ��' pEF2h1I7 ., G� Tj OICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM t�,`�` wrl br Village ;r� Tb a i �'.5• °p ; �r{:, s'e: ./ ! ' �` //�• ✓d/y �d �► L� Tax Map �z• ' rBlock @?u.�v:5 e�t ri ,; ye ed-at , - �Y"�y[. J st /�� tiY / Foxmezly '�,f[( ✓'[i Qom! L !/[✓ ''. Tax Map Lot � �tlbdi tbf t... � r>tte +�ewe/a9e SYStem bUitt. by ��� �l st � /f. L �� G J/1 S• bddress Dili •��''•�^'� �E<.t%.yQ/�.0 � C '" - ' Consisting of Oal. Septic Tank and aaii,,,,�� ,a vu Other 't6qulrement3 If 3UpP1Y: P3 blit Supply From na__� ._ OAVate Supply Drilled BY " �•p�r S< y �j'!.i r Addiass p v Type —7- 2 li No. of Bsdroomt Date 1►e►tntrlt ` ��totion Control Been Completed? Hat garbage g lied? : e oslf✓, �i�'% , RV c N •; ��,jj�� t{, si ify that the system(s) as listed serving the above premises were constru �ntYally 6,p1i<118 °t! to�slt� €d"t�orlt.) copia °!' rhichlare attached) and in accordance with the standards, rules and regal din a ce byith 'th i�l►-§d ?lafti tiF'` iii � bUed 1 I am County Department Of Health. LJl 71 i `? Certified • _ H _ I.S; 7: f Ii/ �./Lw! ;�� Address ii '� ,20, C. A6,11 / ;<. ; ;"�' (. peffdn oeeupyiny prenitslt'served by the above system(s) shall promptly take sue NO 4? Ihtb lMltFa x nteihit� t ditiotis resulting from tUeR usage. Approval of the separate sewerage system shat e o s)r?4tFai# at aedln'fttib lit Ob I�tilt�flii�IWtff ��Eoitiil 1ab161fnd the approval bf -the private water supply shall become null and void when a Pply 66 86n>i! JViIIiIS $Ilttill'tlbiitodllt .rit /, Ibct�tti: modificatloh Oi.; a6harlge when, in thej judgment of the Commissioner of. Halt h,_ suchitbv6latforl�� �bdiflf�4b 1 'xci ...ik 1 .: sF•,Z.� - i ., .. '- . '.. -. _.... ...r.,- �+/_�.. .i. L.� r ._ .... ,. -.,h- t !t A I " 11 4- %. � I/ I/ ..�Jl:.. ass...•.,•-..... a• .5.:'.r......:..c.:....�d..i:- :.......� -. ,�....t+..,....... ..�,...v. ..:�. .r......:�....�.- ti,-•.. c:' 'p(TII�M OOUNi'Y DEPAFtTMFN'r -OF HEALTH - DIVISION Oil ENVIRON4ENM HEALTH SERVICES . . INDIVIDUAL WATER. - SUPPLY, & SUBSLU&7CE SEKAGE DISPOSAL SYSTEMS (Name of Owner) CCwFIm .-. - - REVIEWED: BY: (Street Location) YES I NO DOC[ MaM Permit Application Corporate Resolution Plans - Three • sets Engineers Authorization Design. Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole X. Other Variance Request REQUIRED DEMIIS ON PLANS Sewage System .Plan Sewage System Hydraulic Profile - Gravity Fla Fill Profile & Dimensions - Voluire D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located ,Representative of Sewage,& Expansion Are=_ Expansion Area'; sham; gravity flow,suff. size if�iunpe t & D Box Sham & Detailed House - No. of Bedroans Wells & SSDS's w /in 200 ft. of Property Loc:---tea Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 110; Type pipe No Bends; Max. Bends 45° w /cleanout SEPARATION DISTANCES SPECIFIED 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. exxn). 15' to Drains - Curtain, Storm, Leader, Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' from Foundation 50' to Well 15' Well to PL GENERAL legal Subdivision Subdivision Approval Checked .Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same DEPARTMENT OF HEALTH Division Of Environmental Hgalth Services TWO COUNTY CENTER - CARMEL, N.Y.. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL WELL LOCATIONc A !OWN/VILLAGEICHY IAX URM NUMBER. WELL OWNER NAME. • ADDRESS: "IVATC ❑ PUBLIC USE OF WELL EfRESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED 1 - primary ❑ BUSINESS ❑ _FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) 2 - secondary ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY Cl AMOUNT OF USE YIELD SOUGHT e LIS S gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE zoo gal. REASON FOR 3"NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST/ OBSERVATION DRILLING ❑ gEPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL WELL TYPE ''DRILLED [__j DRIVEN DUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: �- LOT NO.: 2- WATER WELL CONTRACTOR: Name V-)o Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC-WATER SUPPLY:l TOWN] /V /C DISTANCE TO PROPERTY FROM NEAREST WATER.MAIN a.Jl� LOCATION SKETCH & SOURCES OF CONTAMINATION. see (date) (signature) - PERMIT - TO CONSTRUCT A WATER WELL This permit to construct one water well asset forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the, +well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. Date of Issue: 19 +a� Permit Issuing Official Permit is Non - Transferrable T PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONNIF,NTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIELD INSPECTION REPORT U• j DATE: C'" !' �G� 2� .. ...INSP. BY: (Name of Owner) (Street Location)Cj INITIAL SITE INSPECTION . . .1 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... G Adjacent wells /septics ............................ !:P � Access to proposed well location for drillin . D.H. 1 Lot D.H. 2 Lot Depth to G. W. `- Depth to G.W. — Depth to rock Depth to rock Soil Descri tion e Soil De cription 6 ft. �� 6 ft. ' 9 ft. .9 ft. ` 12 ft. 12 ft. ' NO COMMENTS _ D.H. - Deep Hole G.W.- Groundwater D.H. 3 'Lot Depth to G. W. Depth to rock ✓ Soil 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. DATE YES I NO I FINAL SITE .INSPECTION INSP.B Y: CONS House SSDS located per approved plan .........:... Length of trench measured Width of trench average Slope of tile line and trench acceptable.......... Room allowed for expansion trenches............ Over 100 ft. from watercourse......... .......... Natural soil not stripped or SDS area unnecessarly graded........................ ..... ....... 10 ft. maintained from property line and 20 ft, fran 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 fran 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....... RINAT. MAIM. OF SITE AQMPTAFiLE ED) P.4165 (97 MGM 07,50 r r 1370 v 0; 171 r: W1211VALIP OW1 DESIGN DATA SHEET- SUBSUFACE SETAGE DISPOSAL SYSTEM FILE W. Owner �1n,,�e.r_ l9ati.�� Address . ct.�u.c�;� Located at (Street) A, -H&,v4 N z eYa�e. 3l! Sec.1 Block Z Lot 2-S (indicate nearest cross street) Municipality �R Watershed SOIL PER=,ATION TEST DATA REQUIRED TO BE SUBMrrM) WITH APPLICATIONS Date of Pre- Soaking g Zo g6 Date of Percolation Test HOLE NUMBER CI= TIME PERCOLATION PE Rcor w Run Elapse Depth to Water'.FrCm Water Level No. Time Ground Surface- In Inches Soil Rate Start -Stop Min. Start Stop Drop In MWIn Drop Inches Inches Inches f 2 - jd 2'i Z7 3 2� S 3 7Z q . ?2 z'F 2? -3 Z 5 S 2 z 7 .3 � 1 � - _ -- 1 2 . 2 n ' z 4 3� 2 .3 .f -l".: :ILCS••�:..L�:.•..... ;>r(+��•� +�..Y SZ'+•S =' • ..• .. rr 1rt.. •..�J... .... _ .h1 to Y! .iffr' :••1VT�f...3a' . }S3J. tY }!%:X.'1�'I�t]1T . r NC)►i'F5: ~.. {Tess;:tdfie'` repeated at aaaie... °untihtely equal soil. rates -` "'• a=e `ova ipd .at eac' `per0ol ativai test dale f '"dAl`c7atas too be : sukitt�ci : ,i: foie ;•cei�i _, :2' '`°measurements : to be .made _:fra n of hole. _ u ..,:. _ �► top; `. , a'. : • -•,: . ..r�.$)t..� �. i�i��:.� � .�r-• rev. W85 TEST PIT DATA REQU= TO 13E SUMMED WMTH APPLICATION DESCRMIGN • SOUS EIMRMUD IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. fo f5o 21 1 31 41 51 61 71 81 91 10, 121 131 IAI - ZA 47V WARIMM" X; IM MY IA� ACE40R.--USE.J: O o uj z < L ffil m im uj O O ti / '1 ' / Y y a 0 00 41 6 41 160.001, o0g. 41 '00 0e 00 21 �t�;? 3 29 r O0. IV 30 °006 O. SF. or In a-7 14 IAI 9 _N V h NI Y! e o p � i A 2 0 o D`o oo0e� O �,o4o mpO0o ®oo 0 I A � 4 3 m ddr e. O residr« O h O rL 2 V/ uZb�ie ie 4n nei�ii., aL...♦ •� _ _ _ 1689.39' SEPARATION DISTANCES IN FEET S 84 -24 -11 E 2 1585. 07 AREA: 16.92, 1 2 1 3 1 4 5 6 7 .8 9 1 10 ll 1 12 1 13 1 14 b .16 A 43 103 110 1;5 Ito 115 131 141 145 i5° ;55 8b i2 �}8 1oy 110 B 35 ISM III 146 IS° 155 178 1%1 14S NO 19S 110 Its 110 116 131 S 84 -24 -11 E 2 1585. 07 AREA: 16.92, PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES W.I. �W—�4 � - - �_ OFFICIAL. USE ONLY 2�� SITE LOCATION c C✓ TM# — z —'' OWNER'S NAME PHONE MAILING ADDRESS c� �✓ _ ��l`�. -�� PERSON INTERVIEWED PCHD Complaint #. ame ER a atLons Lp (i.e., owner, tenant, etc. DATE TYPE FACILITY PROPOSED INSTALLER ADDRESS PHONE REGISTRATION# Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system .Different location may require submittal of proposal from licensed professional engineer or registered architect. 1 I, as owner, or reported agent o owner agree to the conditions stated on this form. SIGNATURE TITLE DATE Proposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name b. Site Street Name, Town and Tax Map number. C. Location of installed components tied to two fixed points (e.g.,house comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Proposal approved D� Inspector's Signature & Title DATE COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORVATION RE: Property of _J°12 - :H Q _ Located at __C550 M& TN n *a':, 4 r Tax Map # 12 Block Z Lot 25 Subdivision of Subdivision Lot # Filed.Map # Date Filed Gentlemen: This letter is to authorize_'���'PII a duly licensed Professional Engineer s,/ or Registered Architect _ to apply for the r;:quired wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. truly yours, Countcrsigned: ��--�' --Signed: R. P.E., A., # _ 2 76 7 �3 ow cr of Froperv) Mailing Address /03 Lq+ 2y-61E Mailing Address: � -- State �" Zip Oyu 7 76 State __ Zip _ Telephone:. .�Z-' d `- ,; (Z 2 l,f Telephone:. }*,•(a �'�y� �*�����'w"�')r2i�Kf�."vek;' �R.'r1q� }c �i r n - -- S h r. i5 ;. i F'}� {' f ,x c..r ♦�.� .�y�� . .a'. t }. �♦ T�i."� ��5�' .-'G� �a i. Y '`rlC� t.. t '�' ` } t r }. ,, 1. .l ' ". ... .. �. S, .L'p 5 Form LA -97 'S 80' Enaln®®rInu ®®rvia ®s Stephen J. Ferreira, P.E. 103 Perry Drive New Milford, Connecticut 06776 (8,60)-662-2618 W. Bill Hedges Putnam County Dept. of Health 1 Geneva Road Brewster, NY 10509 Re: Hunter Site Section: 12 Block: 2 Lot: 25 Dear Mr. Hedges: July 15, 2002 I have attached a set of plans for the proposed pool house located on Mr. Hunters property, 238 McManus Road North in Patterson, New York. I have prepared plans to connect to the existing septic system, with an additional 750 gallon concrete septic tank, to accommodate the proposed bathroom in the pool house. Please feel free to contact me at (860) 662 -2618 if there are any further questions or need any additional information for this application. Sine ely, Stephen . Ferrei/IP7. i" DIA. KNOCKOUT INLETS R —INLET MIN. SLOPE .1/4 "PER FT ,Z. ED P10D/F/C 7_/ON5 / WOP 5 TO 7-l7E5F PLiiNS l5 A VIOLA7-10N 7209(2) OF rt-ljff NSW rOPK STiiT,E -Aw. l .1 SURVEY & TOPOGRAPHY BY: BASED ON SURVEY PREPARED BY- DAVID L. O'DELL, LLS AND ORIGINAL SEPTIC PLANS BY: FREDERICKA. ZENZ ( #P -77 -86 DATED:9 123186) Flo. I Revision /Issue I Date Firm Name and Address Sif EXITMIT SEI�VIC�S OPE d. I'19t111m119 103P0RBY ME 9W HMO, CP 00776 (861)11 -20 Applicant Name and Property Information .PROPOSED POOL HOUSE MR JOSEPH HUNTER 298 MCMANUS ROAD NORTH PAMMON, - NY TAX INFO• Swr. IV Ex -I, LoT: ZS' Project Sheet HUNTER2002 Date JULY 10, 2002 scale AS SHORN fA PROPOSED POOL HOUSE NEW 750 GAL.CONC. SEPTICTANK PROPOSED POOL v/ ePIL T ej,4e� wqujr� lUrl�d� §d ®ll�ln�� py"s seen 1I�t U04 col palm 98 Idc l9d�� yp�ki Iii m uolowc uugi4nd BEND ® �3p. Est. O" BEND O — EXIST. LINE TO FIELDS 45' WYE CONNECTION W /CLEANOUT EXISTING \ SSDS 750 760 770 781 o� I V Z J co 3 a Q V � O O V y O :ry AO. 2 y0 PLAN VIEW S 84 -24 -11 E Mil LEGEND; ^' A-rlrw TFST HOLES !GN „/r � / / '4• '^ � ``'—•� w.......... -100' -_. / .._ "� .. 0 of SsPonsion area 756 1 73 cwtol z X00 � y°j n drmo �o�ip000w..yca m.e' ` \ _ Sea 1 runoff `` 740' g of / Pr�SO4 F VC pipe under drive be fully encased In e coacieta ono 8" e v g ,0 tooting 9 putts. drains � 6 enta footing /%— a � r // prgwsad V 750 bm / t / yro y 3 bedrm. O• residanca o � a. AD - --- • —• _._ ._ •. _ �`• 770' b • - 1689 39 "�- �-� T8p' LEGEND; ^' A-rlrw TFST HOLES !GN