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CORTLAND COUNTY HEALTH DEPARTMENT COUNTY OFFICE BUILDING Nicole Anjeski, MS, MPH 60 CENTRAL AVENUE Public Health Director CORTLAND, NEW YORK 13045-2746 Lisa Perfetti, BSN, RN (607) 753-5036 Deputy Public Health Director FAX: (607) 753-5209 Ngozi Mezu-Patel, MD http://www.cortland-co.org/432/Health-Department Medical Advisor WORKING TO BUILD A HEALTHY COMMUNITY SINCE 1929 CP CP Road Inspector Date C CC CC Inspector Date T APPLICATION FOR SUBSURFACE SEWAGE TREATMENT PERMIT Complete and return with fee to the above address. Application is hereby made for a Construction Permit to install a private sewage treatment system to serve the hereinafter described property, concerning which the following information is submitted: Owner Phone Mailing Map Property No. Applicant (if not owner) Email Phone or Address Use of Building New Existing……….; Lot Size . Residential or non-residential Number of: Bedrooms……..; Occupants Apartments…….. Yes or No: Garbage Disposal Hot tub/spa List Basement Fixtures Water Supply: Existing……… Well Spring Public….…name of New/proposed…………… Application for new well submitted ? Check one: Tank replacement only….…….; Replacement system New septic system…….…..; Repair Sketch provided if tank replacement or Name of Engineer Design included with application? Comments: Date Owner ******HEALTH DEPARTMENT USE ONLY****** Sewage Flow…………………….Gal/Day Replacement tank size Realty Subdivision Y N Engineering Plan Y ---PAGE BREAK--- TOPIC Cortland County Health Department Page 2 WORKING TO BUILD A HEALTHY COMMUNITY SINCE 1929 SKETCH AND SPECIFICATIONS BUILDING SEWER 4” cast iron, or NSF approved DWV schedule 40, water tight joints, minimum grade ¼” per foot, supported to prevent setting. Minimum distance to well 25 ft. SEPTIC TANK Water tight concrete, or Com Std. Metal, UL approved, Capacity ………….gallons; Minimum distance from house 10 feet; from water supply, 50 feet. Support on undisturbed ground free of large stones. Minimum 3” washed pea gravel or sand as base. SEWER FROM TANK TO TREATMENT AREA DWV Schedule 40 or SDR 35 plastic pipe over undisturbed ground. Tight joints; Minimum grade 1/8” per foot. DISTRIBUTION BOX No. outlets…………..; Outlets all same level and 4” from bottom; Inlet at least 1” above outlets. Concrete or approved equivalent. Place on min. 12” washed stone base, seal outlets with plastic roof cement. Test for proper operation with water. FILL Length Width Depth Use porous fill; Do not use heavy clay soil. Fill must be inspected and allowed to settle 45 days before trenching. Do not strip top soil within 50 feet of fill and in fill area. Provide for diversion of surface water where necessary. LEACHING FIELD 4’ perforated pipe; Total ft. No. laterals Length per Lateral Grade not more than 1/16” per ft.: trench width ……………inches; Depth …………..inches; Minimum distance from water supply Minimum distance between center of trenches of No. 1,2, or 3 washed gravel under pipe and 2” above pipe; Lay building paper or straw over gravel before replacing earth; Do not strip soil, nor work when wet nor run heavy equipment over tile field area. Keep laterals out of driveways and 20 ft from banks, edge of fills, footer drains, waterlines and gas lines. LEACHING PIT Minimum distance from water supply cylindrical; Size inside walls;………………….diameter depth below inlet Walls of concrete block or equivalent with openings facing out; Use 12” No. 2 or 3 gravel around walls; Use concrete cover with minimum 8” inspection hole, or call for inspection before placing cover. An equivalent sized precast leaching pit may be used. Repair/replacement only. SAND FILTER Length Width Depth sand Sand must be from an approved source; Must be inspected before and after placing sand. Provide for diversion of surface water where necessary. REMARKS All pipes must be supported to prevent setting. All solid piping must be SDR 35 o