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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23.12-1-36 00711 irs 91 . , ' 3 I. 00711 "�A f PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL' HEAL'T'H SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE F S ATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at y / �'` i) U d -o a %.5 Town or page _,. 0 Ai (7—) Owner /Applicant NamdT 1il&) -2-270 Tax Map Block Lot 3b Formerly Mailing Address v_3 q " "04 efi-C& ST- :Date Construction Permit Issued by PCHD Subdivision Name kirm&t P611 l,D Subd. Lot # Separate Sewerage System built by 44 / %L- �. r Address Consisting of Gallon Septic Tank and Other Requirements: Water Supply: Public Supply From. Address Zip 10T-5d" or: Private Supply Drilled by 1Y ii¢ 77 Address Alr' V'o'A� Building Type /WC� 4 61 LA%nZ Has erosion control been completed? Number of Bedrooms Has garbage grinder been installed? _ fie, s 3 I certify that the system(s), as listed, serving the above pre onstructed essentially as shown on the as- built plans (copies of which are attached), in accordan d►j Construction Permit and approved plans and the standards, rules and regulati s of the 11, ent of Health. Date: Certified by P.E.�C R.A. fta Address # 6'32,77 Any person occupying premises served by the above syste s' "sh ll'pro tly take such action as may be necessary to secure the correction of any unsanitary conditions resulting om such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revoc i,qdificat,& or change is necessary. By: �� A� Title: 61k Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Fonn CC -97 � 3 � ,f~ ~ v �p � � YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani� Director LAB #: 32.809333 CLIENT #: ------------------ �-------------------- 9936 11 STAT PROC ------------ '--w ------- PAGE 1 --------- � ANTONAZZO, JOHN DATE/TIME TAKEN: 1104/98 11:40A 239 3� COMMERCE ST. DATE/TIME REC'D: ^ �� 1/14/98 12:20P HAWTHORNE, NY 10532 � REPORT DATE: 11/19/98 PHONE: (203)-961-7834 SAMPLING SITE: 17 POWDERHORN RD" SAMPLE TYPE. °: POTABLE . : 'PATTERSON NY PRESERVATIVES: NONE COL'D BY: 1, A. TEMPERATURE..: < 'C NOTES...: KT ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~=~~~~~~~~ COLIFORMMETH: ~~~~~~~~~~~~~~'~~~~~~~~~~~*~~~~~~~~~~~~~ MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE ` METHOD 11/14/98 MF T. COLIFORK ABSENT /100 ML ABSENT 1008 COMMENTS: 203 961 7898 COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE AS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDIN�=��~�HE NEW YORK STATE, AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS | TESTED, AT THE TIME OF COLLECTION. ` SUBMITTED BY: | A---' �r --- -h-, ' '__ h Direct�� m ELAP# 10323 � ^ ` . . �| \ YML ENVIRONMENTAL SERVICES 321 Kear Street � � Yorktown-Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director ` LAB #: 93.801884 CLIENT #: 9936 -~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ANTONAZZO, JOHN 17 POWDER HORN ROAD PATTERSON, NY 12563 NON STAT PROC PAGE 1 DATE/TIME TAKEN: 11/17/98 1000A' DATE/TIME REC'D: 11/17/98 11:30A REPORT ATE:' 12/1098 PHONE: (203)"961-7834 SAMPLING SITE: 17 PO WDERTORN -OAD° PATT _(TY_ -SAMPLE 'TYPE..: POTABLE : PRESERVATIVES: NONE COL'D BYt JOHN ANTONAZZO TEMPERATURE...: S [vu/E ...: VT COLIFORM METH: N/A DATE FLAG PROCEDURE RESULT NORMAL - RANGE, METHOD PUTNAM CNTY PROFILE ' ` 11/17/98 LEADAIMS) <1 ppb 0-15.ppb 9101 11/17/98 NITRATE NITRQG 0.66 MG/L 0 - 10 9139 11/17/98 NITRITE NITROG <0.01 MGjL N/A 9146 11/17/98 IRON' (Fe) <0.060 MG/L 0-00 mg/l 2037 11/17/98 MANGANESE (Mn) <0.010 MG/L 0-0.3 mg/1 2037 11117/98 SODIUM (Na) 14.6 MG/L N/A 11/17/98 pH . 7.2 UNITS 6.5-8.5 9043 11/17/98 HARDNESS,TOTAL 300:MG/L N/A 11/17/98 ALKALINITY (AS 222 MG/L N/A 11/17/98 - TURBIDITY (TUR <1 NTU 0r5 NTU COMMENTS: ` ' Pb/Cu LEAD limits for public'schools are set at 15 ppb. EPA Lead & Copper Rule for Public Systems requires that no more than 10% of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg/L, else water treatment must be Undertakeh'to reduce the waters corrosive ' potential. ' Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. ' . Na No limits for Sodium are proscribed. Suggested guidelines state thatfor people on a sodium restricted diet,the water should contain no more than"20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium is suggested. pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY" WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF.pH IS 6Z TO 8.5. ` YML ENVIRONMENTAL SERyICES ` ' ) 321 Kear Street � Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani Director ` �'' ' ` . LAB #: 93.801884 CLIE�T #: 9936� NON STAT PROC PAGE 2 ANTONAZZO, JOHN DATE/TIME TAKEN: 11/17/98 11:00A 17 POWDER HORN ROAD DATE/TIME REC'D: 11/17/98 11:3OA PATTERSON, NY 12563 ' REPORT DATE: 12/11/98 PHONE: (203)-961-7834 SAMPLING SITE: 17 POWDER TORN ROAD` PATTERSON NY SAMPLE TYPE..: POTABLE : PRESERVATIVES: NONE COL/D BY: JOHN ANTONAZZO TEMPERATURE..: COLIFORM METH: N/A ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLASPRO�EDORE RESULT NORMAL.- RANGE METHOD Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM/& MAGNESIUM CONCENTRATION-, BOTH EXPRESSED AS'CALCIUM CARBONATE, IN MG/L. THE HARDNESSMAY RANGE FROM 0TO HUNDREDS OF MG/Lv DEPENDS ON THE ' SOURCE' AND TREATMENT TOWHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARDWATER: ABOVE 300 MG/L .MODERATELY HARDWATER: 70-140 MG/L M��/L = MILL.IGRAM.PER LITER HARD WATER: 140-300 MG/L . (1 grain/gallon = 17.2 MG/L) SUBMITTED BY:___ Alb Dir ^ � H. Padovani, M.T.(ASCP) tor ELAP# 10323 PUTNAM COUNTY DEPARTi•IENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: Inspected by: lr 1!eQ�O Street Location �vl Rce, Owner Cub- I t_ ,e Town -pcz-Ittn, ,a Permit 9 Tito r 3, 1– 1— 3 6 Subdivision Lot # r L. Sewage System Area a. STS area located as per approved plans ........................... b.. Fill section - date of placement 3:1 barrier Lath.- Width Avg.Dpth c. \`atural.soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. Sen�aae System a. eptic tans size 1,000 ... Q ,250.......other .............:.. b. Septic tank installed level ............................................... c. 10' minimum from foundation .......... ............................... d. Distribtuion Bw outlets at ^same elevation - 'water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches Junction Box - roperly set ..................... engt9 required 5`a o Length installed 5oa 2. Distance to watercourse measured -i--,�_ ooFt.......... 3. Installe ding ... ............................... 4 Slo accep b e 6- 1/32" /foot ............. 5. 10 from prope line - f Ze lions.......... 6. De• f t c 3 the o s ............... 7.R 1 r son, l 00 ... 8. Siz ra�•el 3/4 - 1 %2" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped .....:.....:...:....... ................................ g. Pump or Dosed Systems ize of pump c am er ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual/ audio .................... ............................... 4. Pump easily accessible, manhole to grade.: ............... 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House(BuildinQ a. House located per approved plans ... ............................... b: Number of bedrooms ......................... .. wll..vp. t .►.'rs IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured t io o ft ........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanshia a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box . ........................ " "..... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto exist watercourse I' g. Footing drains discharge away from STS area ............... -CR h. Surface water protection adequate ... ............................... i Erosion control provided ............... ............................... YES NO COMMENTS X X x X X -0 o X X T. PUTNAM COUNTY DEPARTMENT OF. HEALTH DIVISION OF ENVIRONMENTAL -HEALTH SERVICES WELL COMPLETION REPORT Well Location . ' Street Address: A R Town/Village: Tax Grid # Map Block Lot(s) Well Owner: Name: n Address: TA V �3 beta <S Use of Well: 1- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion A Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock _ Other Casing Details Total length eft. Length below grade qft: Diameter —7in. Weight per foot Jlb /ft. Materials: K Steel _ Plastic Other Joints: _ Welded A Threaded Other Seal: _ Cement grout Bentonite Other Drive shoe: X Yes No Liner _ Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield. Test _ Bailed _ Pumped _X Compressed Air Hours Yield 450 gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of,coinpleted well in feet Well Log If more detailed information descriptions or sieve.analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft.. Land Surface - If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information a0 Pump Type Capacity Depth Model Voltage HP Tank Type Volume �,f- Date Wei orn leted Putnam County Certification No. Date of Re ort Well Driller (signature) -LiAaVL 1v,,4wi l Vl WG 11 Wtul UMMIUV5 to at least two permanent tancunarKs to oe provicea on a separate S ievpian. Jell Driller's Name 61 Address: lk&rsori, 63 ignature: ,,, Date: /D /hitd -c4yj HD File; Yellow, copy - Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 0 i i PUTNAM COUNTY DEPARTMENT OF HEALTH`sk*` DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM _Jl� ;A1 Av o a Owner or Purchaser of Building Building Constructed by V / � -ra_ DozoRl- s Location - Street S_ Ta�'� Building Type �71iZ / 09 Tax Map Block Lot TownNillage Subdivision Name Subdivision Lot # ,.:' I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is 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 treatment 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 Public Health Director 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 buildin ptilizing the system.. Dated: Mont Day. Year 4LZ G ra Contractor ( caner) R - Sign ture 1 Corporation Name (ir cpporaAon) Address: State Zip Signature: Title: Corporation Name 12d0r`l Form GS -97 s N 011 v! .t�w - z�. O fl sow "Zags is to certify that the se?age disposal systsn was constiucted as indicated-on' this plan and .that the syste-n was "inspected by me before it was covered over. The system was constructed in accordance with all standard rules and regulations of the Putnam county Department of Health and the New York Mate Leparbrank of Health." Y �h Q k °o Iz5 CONC i n /go � 0 TNST��c� soo L� putnam County Department of Health Division of Environmental Health Servioes Approved as noted for oonformgROB vith Rules and Regulations of the applio A•tm nt. Coun Health Dep .Date ture b Title ti ? > AZ ,-, Z. N ( wi 9� S«« v 0 o• A� • qty -.sr AS —BUILT MEASUREMENTS No A $ MARKS ;RE °�.r X- �,� I. 3-1 0 -Bo)c 3 P f -b (0 x� 5 40 S5 .fig 1 e2 2 -I q1 8 q5 (off S- 1� i¢ i� f✓oupawn vj sow Vey 1-'7 p.wALcorr +OIz14S 105fkl 1�9 M VI- ,;�c7l 64 .44' fir h . COT 00 m ARC- = l• 0804 - ti.REs M 430- PAS -G7- 9814 i 7 M&P 4 SORVE`/ LOT N 11 AS SAOWIJ *0 ;::_ SUS3Dl Vi Sl ©o ?LAT OF LITTLE POND HILL Cf:-ILEi> MAP N—° 1216) l owns of P14Tt�RsolJ .- R)TNAM 4ouNN, NY. Y, - Fled 6-'MM. 4 U ALcvl-r wl,oi�. a,�rcniure ours (n:�v.r t . ovtt� t} uk 41s "? —as m$4e 4V,., ow, ac" avfvej *FO* r,6� R ,1d,� locz%.d - �Xfa� 2, IaJ98 A WArtvTT - �A�D Sc�RVEYoR 04CEAJSE W2 .41. 54 LAAE CAR:M6L, waw: YaRtr' 9 W- 225- ?008 0 # # W r P I I ' �1. yLSTA DQ,L ©.RED' Ool e. ^^ Mar pve?avaJ for, �Y+cirl�I+raeN6s oreoiijni76 .Woo Job � Anilonaao grade, �.Bn� .oii%►�oaro.�MEOA•. L°e�e�yn' Auto Rosso • 430- PAS -G7- 9814 i 7 M&P 4 SORVE`/ LOT N 11 AS SAOWIJ *0 ;::_ SUS3Dl Vi Sl ©o ?LAT OF LITTLE POND HILL Cf:-ILEi> MAP N—° 1216) l owns of P14Tt�RsolJ .- R)TNAM 4ouNN, NY. Y, - Fled 6-'MM. 4 U ALcvl-r wl,oi�. a,�rcniure ours (n:�v.r t . ovtt� t} uk 41s "? —as m$4e 4V,., ow, ac" avfvej *FO* r,6� R ,1d,� locz%.d - �Xfa� 2, IaJ98 A WArtvTT - �A�D Sc�RVEYoR 04CEAJSE W2 .41. 54 LAAE CAR:M6L, waw: YaRtr' 9 W- 225- ?008 0 ('0T PUTNAM COUNTY DEPARTMENT OF HEALTH VISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRgUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM P T # Located at V ( r D 0 i.,o Town or Village oa 4.L.,VSdn rr) Subdivision name Subd. Lot # Tax Maps 3. 11- Block I Lot 3 l Date Subdivision Approved S-1 F R -7 Renewal x Revision DOUCl L k1.. A u= /i 1. .. Owner /Applicant Name G ACS E CC k 51-AVC770 N% Date of Previous Approval �/J �,S Mailing Address lit✓ � 'rL 57-7- ( 1ga, o% Zip l 0"r 2--. Amount of Fee Enclosed Building Type Wndn Lot Area . O® No. of Bedrooms -y— Design Flow GPD Fill Section Only Depth Separate Sewerage System to consist of Other Requirements: To be constructed byZ%� Address Volume septic tank and Water Supply: Public Supply From Address or: Private Supply Drilled by Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewagg treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. I Signed: Address P.E. X, R.A. Date 9--z 2 47 /) % IG'S /2--ri�cense # F3 2 7' APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. pprov d for discharge of domestic sanitary se a only. By: Title: l!L ke"—#f/% Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 P[7TNAM COUNTY DEPARTMENT OF HEALTH 'CJt Y DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL .� please print or type PCHD Permit # v Well Location: Street Address: Town/Vi lag (v Tax Grid # IST.,+ AL-Of t & � 61 : iof nj Map 11. Ui Block Lot(s) 3 Well Owner: NameMtl Wat. C -z- Address: Use of Well: - r Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought -5 gpm # People Served �� Est. of Daily Usage al. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling I, New Supply (new dwelling) Deepen Existing Well Detailed Reason Z22 t,/ for Drilling Well Type O'0-�Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision L4ir Ly !�� /l� % � Lot No. �I Water Well Contractor: 1432 432 Address: Is Public Water Supply available to site? .................................. ............................... Yes No (1 Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location &sources of contaminati n to b prov' ed on se p at sheet/ larf: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF EN' IRONMENTAE HEALTH SERVICES RE: Property of 170 U LETTER OF AUTHORIZATION goys& C0NS77ZUc770 N.. Locatedat VISTA- C &LUaa Xe//`f"D) -- TiV P%Ar7L�Shcl ��TaxMap -lar 23, )'2-- Block _ Lot 3 l -- Subdivision of Subdivision Lot —!r Gentlemen:. I -fTTL6 1-10NA 414 -L Filed Map = Date Filed This litter is to authorize - HW a duly lic °used Professional Enmineer � o. Rogii;;w ;e' ^ °44 "t to apply for the required :wastewater trearment ardor water supply pe.mit(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 treatment and/or water supply s�steri_ 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. Very truly yours, Couniersigned: P.E.. R.A., R 53 7 7 �o« :rr -� Prope Mailinz Address d U� 14Af -1,) /0-0:A'73 State /lily zip 1 ,456 3 Mailing A dd-ess. /-P-il / ffl2 S7;1Z!!V, T State_ /Vy Zip 51 _-Z, i'elephone: 9ly —P7, = 7 r�9`f Telephone: q/U—(''7� 9s Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DaTSIOIN OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM owne X OC 2 LA-!' &yAa &C Address 9 7NIZ 57iLZ-� C79OUSA CONSJr9u6WON Located a7 (Street) 111S Tax M ap-13i 17-- Block I Lot -r* Q a (indicate nearest cross street) -Municipality dAl r7) . Drainage Basin --.46WRL 79U,0-rdAl AjV417L- SOIL PERCOLATION' TEST DATA Date of Pre-soaklana Date • of Percolation Test - lests toot reneatp.d V, same denth until equal percolation rates are obta-ncd at percolation: test hole. (: e. K I min for 2 min for 3 1-60 min/inch) Ad data to be submitted for review. 2. Depth, measurement,-, to be made from top offhole. Fonn DD-97 Dyth to Water Water rom Ground Level Percolation 'No, Time ET .1a e Time N.Tj Surface (Inches) Start Stop Drop In Indies Rate 'Min"Inch role No. Run -Start - Stop L n.) 2 tA Js 4 lests toot reneatp.d V, same denth until equal percolation rates are obta-ncd at percolation: test hole. (: e. K I min for 2 min for 3 1-60 min/inch) Ad data to be submitted for review. 2. Depth, measurement,-, to be made from top offhole. Fonn DD-97 D�-EPTH. GJ- 0. 5' Lor 2.0' 2.5' �.0 4.5' 5.01 5.3' 6.0' 6.5' '71.0f 7.5' 8.0' 8.51 9.0' 9.5' 10.0' TEST PIT DATA DESCRfPTION OF SOILS ENCOUNTERED IN 'TEST HOLES HOLE N0. HOLE NO: a7 tWSotC, HOLE NO. Indicate level at which groundwater is encountered AV level at which mottling is observed Ah)AV� Indicate level to which water level rises after being encountered -- Deep hole observations made by %� - Date /0//987 Design Professional Name: Address: CU S#AfAj/ ,P.ah -0 PAVERS4 A) /V Signature; /y/ Design professional's Seal 4 r of N yo 3 s� DEPARTMENT OF HEALTH BRUCE R. FOLEY Acting Public Health Director Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278 - 6130 Fax (914) 278 - 7921 John Karell Jr., P. E. October 15, 1997 P.O. Box 644 Carmel, New York 10512 Re: Proposed SSDS: Wallace Vista Dolores Road, Lot #11 (T) Patterson Dear IMr. Karell: Retiiew of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: "The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." "You are referred to Article 128.1 of the official compilation of Codes, Rules and regulations of the State of New York, Title 10, relative -to the need for approval of individual sewage disposal systems by the City of New York. You should contact city Officials in this regard." 1) Photocopied and group Letters of Authorization are not acceptable.._ 2) Details and notes are not legible. 3) Standard well yield note has not been-provided. 4) The minimum of one deep test hole is required in the expansion area. 5) Erosion control for the well has not been shown. 6) Location map is to be provided. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Very truly yours, b,ar &,,, Robert Morris, P. E. Public Health Engineer R, mh watershed T A�7?V -L- Ft L" wl RE: Property of (3A0 Us COA1 S%%'UG7"IOA/ :,Located at-"V I S l A D OLU � - T/V 77W 0 �J (T) Tax Map # Z 3 1 Block / Lot 3 3 4 3j— Subdivision of Zr 3 � 5 1. Subdivision Lot # v� v Filed Map # Date Filed Gentlemen: - This letter is to authorize a duly licensed Professional Engineer X.-- to apply for the required _.. wastewater treatment and/or water supply permits) 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 treatment 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 a Code. �.REL P 4 Very truly yours, r• Countersigne A;,-. -',- w Signed: 6 0 ( �° 0 K S ! G�( VL .;� UPP.E•, R.A., # S ! a1^ V (owner of Property) Mailing Address State /U Zip /0 Telephone: '71'Y S-71 - 2 Mailing Address: r-Oi X- 0,;, 1" - State GG `uez 1j < Zip /dJ / 02 Telephone: q/4_ F— -I e' / S_y0 PVIWAM COUNI'T DWAK1 OW OF DNlgla� a[ �ivbeneseahl Heeltb Seedoee: Cassel. N.Y. INtS12 to Paovlde Peestt'N \� e� CESI�IGTE OF CO C8 Qask N ., CO N. PEl1 W FO): SEWAGE DWOM SUM Llieaead� r�9- LiULp & ourn err Vulfte a/ 4.0tt :AWAIV AW-L— Tax �" _�� % ,,r ✓(y eel°"'' .: �)!§ o . . . t Date of Pcevlobe Approval " Ad6eM IffAC&IFIC � le ivy /ij.� /i% Town zlP Date Subdivision Approved Jam" -'� :� Fee Enclosed Typ O Lot Aieb —LL_ FM Seedoe Ouby Dwo. Yalbme Nubee o[ Hetbooma : r Dealt Flow G P D PCHD Nedli tlon b peaked When PSI Is completed Sep�eaea SewaeeEe Systems teaaui+E'a! r Rmade Took To be oenshueted by Addno Water Std: 1/ vP��Ic S . . r A-P Addmn on Supply Deed by 1 rep►esant; that 1 am wholly and completety'responsible for the design and location of the pr above described Will be constructed at shown on the approved amendment there to and in acco► ,• County ,Department of ' Plei th, and that on.complation thereof a "Certificate of Construct r'C mi be asbmitted to, the Departmsnt, and a written guarantee will be furnished the owner. hi itl Place in good oporating condition any pa ge t of said saws" disposal' system during the ? f+t' ante of the approval of the Certificate of Construction Compliance of the anal syst "+ y *10S be located as shown on the approved plan and that said well will be instal rda with ti County Department 1ot signed APPROVED FOR CONSTRUCTION: This approval expires two years from the date ♦sued unless revocable for cause or may Ae amended or modified when considered necessary by the Commissioner requires a now perm♦ '• APWoved for disposal of domestic sanitary sewage �/o 01 cat 8 oats _ ey icto OAK Commissioner of Mealthwill ligrii this♦. Wider, that said bulkier will nmadia eN{ Ilowing the date Of the isau• r 2) t dri11e0 well described above ruleal n0 u ns of the Putnam building .has been undertaken and is change or alteration of construction Title DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT 0 / WELL LOCATION ee Address '�,qwn Villa a City T Grid Number _ ®� WELL OWNER Name C Mai .ing Address / IKPrivate D Public USE OF WELL 1 - primary 2 - secondary SIDENTIAL 0 BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION CIINSTITUTIONAL ❑ STAND -BY O ABANDONED ❑ OTHER (specify O AMOUNT OF USE YIELD SOUGHT S' gpm /# PEOPLE SERVED 00- /EST. OF DAILY USAGE &OZ gal D REPLACE EXISTING SUPPLY O TEST/ OBSERVATION GL ADDITIONAL SUPPLY EW SUPPLY NEW DWELLING Ll DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN ODUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING ?. YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name -76-; D Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES A._NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCHA SOURCES OF CONTAMINATION PROVIDED w� s,• "¢., �, ON SEPARATE SHEET (date) '(signn ) h PERMIT TO CONSTRUCT A WATER WELL F OF NE`N This permit to construct one water well as set forth above is granted unde —Ffhe provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and.in such a man er as not to degrade or otherwise con nate surface or groundwater. Date of Issue: 19 Date of Expirati 19 Permit Issuing Official Permit is Non- Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg-, Insp. Orange copy: Well Driller PUT NAM COUNTY DEPARTMENT OF HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: T) D L— D(U.i� G'1 M J OX 33 �1� my'bi r MAN or-L JO S16 2. Name of Project: ? I 3. Location T /V /C: lcsod -) 4. Project Engineer: � N 4�&N)Kkt�l 5. Address:U'd LI/ "&— License Number: 402,130 Phone: 7 I 6. Type of Project: _ Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEAR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. NO 9. Has DEIS been completed and found acceptable by Lead Agency? ........... IV .Ct 10. Name of Lead Agency 11. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ......... ............................... 12. If so, have plans been submitted to such authorities? .................. 13. Has preliminary approval been granted by such authorities ?' Date Granted: 14. Type of Sewage Disposal System Discharge...... Surface Water Ground Waters 15. If surface water discharge, what is the stream class designation ?........ 16. Waters index number (surface) ........... ............................... 17. Is project located near a public water supply system? .................. 18. If yes, name of water supply Distance to water supply 19. Is project site near a public sewage collection or disposal system ?..... 20. Name of sewage system Distance'to sewage system 21. Date test holes observed: �S�f', r. '._� 22. Name of Health Inspector:',��� -�� G� ��E�,1Ct 23. Project design flow (gallons per day) ....... ............................... ®C 11/93 0 �c 2. 24. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. 25. Has SPDES Application been submitted to local DEC Office? ............... 26. Is any portion of this project located within a designated Town or State wetland? .................................. ............................... 27. Wetland ID Number ........................ ............................... 28. Is Wetland Permit required? .............. ............................... J Has application been made to Town or Local DEC Office? .................. 29. Does project require a DEC Stream Disturbance Permit? ................... �Jf0 30. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ........ YES or NO 31. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or NO DESCRIBE: 32. Is there a local master plan or file with the Town or Village? ........... 33. Are community water, sewer facilities planned to be developed within 15 years? 34. Are any sewage disposal areas in excess I of 15% slope? ........................ 1J 35. Tax Map ID Number ........................................................ 36. Approved Plans are to be returned to: ................ Applicant Engineer If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the Pena 1 Law. SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: -a PUINAM COUNTY DEPARTMENT OF BEALTH DIVISION OF ENVIRONMENTAL HEALTH SEWICES DESIGN DATA SHEET- SUBSUFACE SELVAGE DISPOSAL: SYSM4 FILE NO. owner,��� /2/%(% Address A/11��� Located at (Street) U SST -le� Sec. 7--Block Lot (indicate nearest cross street) Municipality Y -t'� � Watershed N Y6 Date of Pre- Soaking Date of Percolation Test HOLE NUMBER C U)M TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Frcm Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 1 2 3 4 Si i- ILA-p �i/- 4C, -IA1113ws E rAl 5 NOTES• 1.. Tests to be repeated are obtained at each for review. 2. Depth measurements to at .same depth. until approximately equal soil rates percolation test hole: All data to' be sutmittbd be made.. fran top of hole. TEST PIT DATA RBQUISID: Tu. BE-SUBMIT!3 D, WITH APPLICATION DESCRIPTION 'OF'; SOILS ENCOUNTERED IlQ TEST HOLES DEPTH HOLE NO. HOLE NO. HOIZ NO. G.L. 2' 3' n 4' 5' L 7' s' 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL, TO WHICH WATER LEVEL RISES AFTER BEING E31 D �� DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used �� Min /1" Drop: S.D. Usable Area Provided - 204�)F7_2_ No. of Bedrooms _ Septic Tank Capacity. G��j' ® gals. Type COI Absorption Area Provided By 0 L.F. x 24" width trenct�±'' - °:� •f{ Other Name �. / U N��'� �" Signature Address { G� /i, v '� SEAL Ar9,G" ,iU V 16J 06/ THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft/gal. Checked by Date PUTNAM'COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property of Located at Date S (T)y6ih_ -MA) Section ,7-3`1w Block -. Lot Subdivision of �� T - �U �' l' lL. L Subdv. Lot # H Filed Map # Date Gentlemen: This letter is to authorize ;) �fC ��L 6 ! AOL a duly licensed professional engineer L, (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 in 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. C tersigned: Very truly yours, P.E., Al-1e. I # Telephone d 7j Owner of P operty Address Town Telephone 1 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION Street Address o Village City Tax Grid Number WELL OWNER Name Mailing Address affrivate O Public USE OF WELL primary 2- secondary 8fESIDENTIAL 0 BUSINESS 0 INDUSTRIAL 0PUBLIC SUPPLY OAIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION b INSTITUTIONAL O STAND -BY 0ABANDONED 0 OTHER (specify 0 AMOUNT OF USE YIELD SOUGHT �-'— gpm /# PEOPLE SERVED /EST. OF DAILY USAGE (aOQal REASON FOR DRILLING O REPLACE EXISTING SUPPLY W&W S PLY EW DWELLING ) 13 TEST/ OBSERVATION CI ADDITIONAL SUPPLY 13 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING -' WELL TYPE ILLED DRIVEN DDUG GRAVEL. OTHER IS WELL SITE SUBJECT TO FLOODING? YES _�NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: t-11'j Lot No. NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED SEPARATE SHEET ( !2�, :::i� (date) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: / r -2 19 - -� 2 Date of Expiration 19 Permit Issuing Official Permit is Non - Transferrable 3/89 White copy: HD File Pink copy: Owner Yellow copy: Bldg. Insp. Orange copy: Well Driller WATER WELL CONTRACTOR: Name 'Tl� _115'r7 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES 4---'NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED SEPARATE SHEET ( !2�, :::i� (date) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: / r -2 19 - -� 2 Date of Expiration 19 Permit Issuing Official Permit is Non - Transferrable 3/89 White copy: HD File Pink copy: Owner Yellow copy: Bldg. Insp. Orange copy: Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of DBlyy e &Lff_02TlAD -tOA Ci26t- iJSPA% P&%'_9 Located at �� V�S�zz -bDlar -es Section - f ?,,—Block.. Lot Subdivision of bif Subdv. Lot # Filed Map # Date T. MICHAEL DALY, P.E. Gentlemen: CONSULTING ENGINEER This letter is to authorize P. 0. BOX 243 cununw N4. ,,,r,,.. a duly licensed professional engineer V/ or (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 in connection with this matter and to supervise the,constru,ctkon 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. K Very truly yours, Signed Countersign Owner of Property P.E., R.A. , # X4'(0 Address s T. MICHAEL DALY P.E. Address CONSULTING ENGINEER Town N. 0. BOX 243 q ilCPi!) rij�.SL, N. Y. 10587 Telephone Telephone VC-1 P UTNAM C OUN TY D E PARTMENT O F H EALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: DO L AZGh MAKOL 2. Name of Project: �J 3. Locatio T V /C: 4. Project Engineer: 5. Address: License Number: 464 o8 Phone: 6. Tvae"of Project: V Private /Resident Apartments Office Building 7. Is this project subject Tvpe Status (Check One) ial Food Service Commercial , Institutional Mobile Home:Park Realty Subdivision f Other (specify) to State Environmental Quality Review tSEQR)? Type I.. Exempt Type II. Unlisted ✓ 8. Is a Draft Environmental Impact Statement (DEIS) required? Nl0' 9. Has DEIS been completed and found acceptable by Ldad.Agency? 0. Name of Lead Agency 1. 2. 3. 4. 5. Is this project in an area under the control of local planning, zoning; or other officials, ordinances ?__................ .. ..... ...................Cy(L'D .'paPT If so, have plans been submitted to such authorities ?` ........... Has preliminary approval been granted by such authorities? Date Granted: -' Type of Sewage Disposal System Discharge.f?:'.r� ��- Surface Water Ground Waters If surface water discharge, what is the stream class designation ?........ 1 3. Waters index number (surface) ........... ............................... _ F. Is project located near a public water supply system? ............�...... �� d 3. If yes, name of water supply Distance to water supply- . •. i. Is project site near a public sewage collection or disposal system ?..... I. Name of sewage system Distance to sewage system . Date observed: 23. Name of Health Inspector: Project design flow (gallons per day) ............. �U ................ 2. 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. b 26. Has SPDES Application been submitted to local DEC Office? ............... 27. Is any portion of this project located within.a designated Town or State 11 b wetland? ............. ............................... ...... 11 ........... ... 28. Wetland ID Number .................:. .. .. .................. 29. Is Wetland Permit required? .............................................. Has application been made to Town or Local DEC Office? .................. 30. Does project require a DEC Stream Disturbance Permit? ................... 1 C) 31. Is or was project-site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? .........YES or NO 32. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or NO DESCRIBE: 33. Is there a local master plan or file with the Town or Village? ........... 34. Are community water, sewer facilities planned to be developed within 15 years? 35. Are any sewage disposal areas in excess of 15% slope? ........................ A_ 36. Tax Map ID Number ......................... ............................... ' 2 _1 —3(0 37. Approved Plans are to be returned to: ................ Applicant Engineer If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. Failure to comply with this provision may be grounds. for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and be 1 ief. False statements made herein are punishable as a Class A Misdemeanor pursuan�jo Section 210.45 of the Penal Law. 1 SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: L-14'�S PUTNAM COUNTY DEPARTMENT' OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Address -la7oy_ Located at ( Street) r See., & JZ Block �_ Lot (in •cate nearest cross street) Municipality T=�� Jlj Watershed Date of Pre - Soaking Date of Percolation Test 4-(4-.9-9-6 HOLE NUMBER CLOCK PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground. Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 1 q! 10 - 93:t �14 Zd- 2 3 9 1 4 Its' 7J9— i(�'• °JI Z Z 4 'Z� 7i 1 f 5 z 1,4 Z 95� 2 2 J'42 - 10:og s+ Z�_ 2 :5 . Z 310:09-- 10•, -3C1 -e) Z4 Z i0 2 4V:'39-(J'01 ZZ 'Z 4 2ra 2 I l 5 '1 2 3 4 5 1. Tests to be repeated are obtainea.at each for review. 2. Depth measurements to rev. 9/85 at same depth until approximately equal soil rates percolation test hole. All data to'be submitted 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. L 1' 31 4' Moo 5' 6' 7' 8' 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED - - INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: ng-5-A;k� 6RxLJ�t _ o� DATE: DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided p No. of Bedrooms 4 Septic Tank Capacity J gals. Type Absorption Area Provided By 4_m�pPj L.F. x 24" width trench V Name T. MICHAEL DAIN, P.E. Signatu CONSULTING EINGIN Address P. 0. BOX 243 SEAL SHENOROC K, N. 1. THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by V60; ?P-Es S10�i Date APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DMSION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS ,/ REVIEW SHEET for CONSTRUCTION, , pgP. �IIT IE OF OWNER _ (/ f '� �S �`%'�� STREET LOCA ON C� DATE .a.- L TAX MAP # DdeMONTS. Cam.. Z55-HARGE (OK) PERMIT APPLICATION PC -1 ��.. DEEP HOLES LOCATED WELL PERMIT P ENTATIVE OF PRIMARY AND EXPANSION ENGINEERS AUTHORIZATION (��' EA; SHOWN; GRAVITY FLOW, SUFF.SIZE DESIGN DATA SHEET(DDS) L„/�' a:wm:s,& ID PIT & D BOX SHOWN & DETAILED DEEP HO F - NO. OF BEDROOMS LOG SSDS'S WAIN 200 FT. OF PROPOSED SYSTEM CONSISTENT PERC RESULTS (3) dd METES &BOUNDS PERC HOLE DEPTH RO CORPORATE RESOLUTION �+�lSE SETBACK NECESSARY ('TIGHT LOT) PLANS THREE SETS ' OUSE SEWER - U4 "/FT. 4 70; TYPE PIPE M NO BENDS; MAX. BENDS 45 W /CLEANOUT HOUSE PLANS - MUM .1010� FILL SYSTEMS VARIANCEREQUEST _ _ - ®rTA-ARRTFR GENERAL LEGAL SUBDIVISION SUBDIVISION APPROV CHECKE PERC RATE FILL REQUIRED CURTAIN DRAIN REQUIRED 'S"t S : SLOPE 3:1 TO GRADE GAUGES PROFILE & DIMENSIONS VOLUME EX- APPROVAL SSDS ADJ. LOTS TRENCH WETLAND (TOWN/DEC PERMIT R & D) =`�'' CH PROVIDED 60 FT MAX DATA ON DDS PLANS & PERMIT SAID , 'PARALLEL TO CONTOURS PRE -1969 -NEIGHBOR NO CATION ED 100% EXPANSION PROVIDED ' LETTERBI/ZBA SEPARATION DISTANCES SPECIFIED ON PLAN '100 YR. FLOOD ELEVATION WIRED DETAILS ON PLANS DRIVEWAY, LARGE TREES, TOP OF FILL SEWAGE SYSTEM PLAN - (NO 0' FOUNDATION WALLS I SSDS HYDRA OFILE GRAVITY FLOW 0 TO WELL, 200' IN D.L.O.D., 150' PITS D/ J BOX Q�NH/GALLEY M P- DETAILS TO STREAM WATERCOURSE LAKE (INC.EXPAN) SEPTIC TANK - SIZE, DETAIL O CATCH BASIN, 35' STORMDRA N, PIPED WATER WELL DETAIL, SERVICE LINE IF OVER 10' TO WATER LINE (PITS -20') CONSTRUCTION NOTES (GRINDER RATE) INTERMTITEWT DRAINAGE COURSE DESIGN DATA: PERC AND DEEP RESULTS 20 . RESERVOIR, ETC.[][] 150 FT. GALLEY SYSTEMS TWO -FOOT CONTOURS EXISTING & PROPOS SEPTIC TANKS DRIVEWAY & SLOPES CUT 10' M FOUNDATION; 50' TO WELL FOOTING/GUTTER/CURTAIN DRAINS r" WELLS KMENTS: 15' WELL TO P.L.