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Home My WebLink About1530DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34.-4 -26 BOX 14 01530 r .� r' . i Lq 01530 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 - Te!. (914) 278 - 6130 F= (914) 278 - 7921 BRUCE R FOLEY Public Health Director PROPOSED ADDITION APPLICATION (RESIDENTIAL ONLY) CTRF.F.T T r mil (� NN l N i�1.AP # `7 , - e& NAB G'� °�, ° G -7 . PHONE y� i PCHD r MAILLNIG ADDRESS 2(:� . DESCRIPTION OF ADDITIO\ I �YIB N BEDROOMS , PROPOSED. OF BEDRO0 iS 1 TT UMBER OF EXISTING BE R� (FROM CERT. OF OCCUPANCY OR CERTIFICATION; FROM BUILDING LNSPECTOR) . *Any addition which is considered a bedroom requires formal approval of plans (Construction Permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. ; Please submit this form and the following to Putnam County Health Dept., 4 Geneva Rd., Brewster, NY 10509, Phone 278 -6130. . Certified check or money order for 5100.00 *-2. Sketches of existing floor plan (drawn to scale, all living area including basement) Non - professional sketches are acceptable 3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map * Non - professional sketches are acceptable ;�S'4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 'Copy of Cert. of Occupancy from Town or Certification from Building Dept. with legal / bedroom count of dwelling. OFFICE USE Comments =7 Ca I� I I T �.wAIMIM!MIMIMIMIMIAAI IUIM IAA IAA IM ANAA YMIAA eMPMIMIMiM!M; MIMIMiM 19A1MTM11 V NMSl1AIMIA. ME —2 1 1A Ai wlMl!U1 P4,%,X" J! � Y- % r 12- -t IS i vi l7tf4o FIXL4- CAi,'A;,D V-A*Y- 4 rZ-7' t PUTNAM C-11.,.-7y OFMALTH LTUSE PLAT' ilgnatum,&Title P4,%,X" J! � Y- % r 12- -t IS i i v i T-A, Ohs" t rr^ff V L L i erbrJ Cover - P� Z c. y <'L [(-i If 0K-1 4— L,-,vwa,y ME"-eq I PUTNAM COUNTY DEPARTMENT OF MnTE HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY; -56EDRGOMS-- Fol6A e-o4 BRUCE R. FOLEY -- , r � - �_.P�i6lic" •, �Nealtfi Direc %r . —... s*� ^.�,t ..... . - ,.�, -. _... „ LORETTA MOLINARI RN., M.S.N. •� --- � - �` °Associa'?e•'�ir= �ezrlth =-Director - -- �--- " Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 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 January 17, 2001 Michael Civitano 16 Clifton Court Patterson NY 12563 Re: Addition- Civitano- 16 Clifton Court No Increases in Number of Bedrooms (T) Patterson Tax # 34 -4 -26 Dear Mr. Civitano: I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp form this Department dated January 16, 2001 The addition is approved with the following conditions: 1. The total number of bedrooms must remain at Four without prior approval by this department. _ - 2. The area_of the existing sewage disp d-5y -stem, -and- its_expansagrl ~ D Q maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Patterson. If you have any questions, please contact me at your convenience. Very truly o�,Il:s; William Hedges WH1g Senior Public Health Sanitarian cc:BI PUTNAM COUNTY DEPARTMENT OF HEALTH 3/86 { Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Meet Provide 02 P.C.H.D. Permit ll - -- CATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOS :d SYSTEM k 7' lea ,repw Town or Village Tai Map 7J'3'1/ Block Lot_,__ a /applicant Name �LrC%Yf>7fL C,•t!! ; %JA, erly Sabdl,,, Name �v Sabdv. Lot # ug Address s 7 '02tUr Zip Date Permit Issued Szczey'/? rate Sewerage System built byZ6 &2 /' tl'y -r `-�h � LAddress A9- '7lyF_!Z!` 12(} Consisting of X000 Gallon Septic Tank and - --o 'title 0/' 7' /2/Fl/Ci f Ny 70 6 0/11%1 •"9'F_/L % :er Supply: Public Supply From / Address or: Private Supply Drilled by /�' /�L L lilZi LLi.,i(tlddress __ 81zcwf 7xL' _ Ading Type Cd ilrri Has Erosion Control Been Completed? =her of Bedrooms �� Has Garbage Grinder Been Installed?(? her Requirements ,ertify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies which are attached) , and in accordance with the standards, rulee and regulations, in accordance with the filed plan, and the permit issued by the tnam County Department Of Health. )to /�Q /r 0 Cart iifflled by C, G/gC �� , f �i�r�^— P.E. `'�7�i /t,A. /' IF Address ✓� �'^�, /.7��.L- ---_T� 65 `� License No. O� u� v �*° ny person occupying premises served by the above system($) shall promptly take such action as may be necessary to secure the correction of any unsanitary )nditions resulting from such usage, Approval of the separate sewerage system shall become null and void as spun as a pub!% sanitary sewer becomes '&liable and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are tb)ect to modification or change when, in the judgment of the Commissioner of Health, such revocation, modification or change Is necessary. By Title OIL. Z:: 4. N.v Z Ia_c ' T.TVT T rnMDT VrrTnNT PVDnVrP Jl fV a- 7 -' V . - w I —— `_"' . _ DEPARTMENT OF HEALTH _..;.Division -OL. Environmental Health Services......... PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET AOORESS: TOWNIVILLACLICIFY TAX GRID NUMBER: Clifton Court, Bullet Hole Road Patterson, New York WELL OWNER NAME: ADDRESS: Michael Civitano, Crest Drive, White Plains, NY 10607 PRIVATE PUBLIC USE OF WELL 1- primary 2 - secondary RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) O INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED ?� EST. OF DAILY USAGE 250 gal. REASON FOR DRILLING i9NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 900 ft. STATIC WATER LEVEL 20 ft. DATE MEASURED 9/20/86 DRILLING EQUIPMENT O ROTARY XCOMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED O OPEN END CASING, OPEN HOLE IN BEDROCK ❑ OTHER CASING TOTAL LENGTH 20� ft MATERIALS: XSTEEL ❑ PLASTIC O OTHER LENGTH.BELOW GRADE 19? ft. JOINTS: WELDED 0 THREADED ❑ OTHER DETAILS DIAMETER 6 in. SEAL: CEMENT GROUT ❑BENTONiTE OOTHER WEIGHT PER FOOT 19 Ib. /ft. DRIVE SHOF -,MES ❑ NO I LINER_ O YES ❑ NO SCREEN DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? - DETAILS �.. - FIRST _ ... _ HOURS SECOND`- -- — -.. ,. ,., ,., . - - - . _..... GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH tL BOTTOM DEPTH ft. WELL YIELD TEST -' If detailed pumping METHOD: 0 PUMPED 1 tests were done is in- I • COMPRESSED AIR , formation attached? • BAILED Cl OTHER D YES ONO WELL LOG If more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear- ing Well Oia- meter FORMATION DESCRIPTION CUE. ft. ft, WELL DEPTH ft. DURATION hr. min. DRAWOOWN ft. YIELD gF m. Surta cc 4 Silt & clay 440 2 440 3 500 6 450 5 WATER XCLEAR TEMP. QUALITY O CLOUDY HARDNESS ❑ COLORED ANALYZ D7 YES ❑ NO 41 ANALYSIS ATTACHED? YES ❑ NO L STORAGE TANK: TYPE Di anhra=L_ CAPACIT 86 GAL. 26 PUMP INFORMATION TYPE stihTr>PrGihl P CAPACITY C;_ MAKER GOULDS DEPTH 440 5ES07412 230 3/4 MODEL VOLTAGE HP WELL DRILLERINA Ljnmur4u, IN TE PUTNAM AVENU Aooal s BREWMR, N.Y.1 j 1 e mi kj ZeT 07 �rX 4011WINW140. AIA71. T.9 ru� ,1,1m cu,-.Lcy Liepartment or Health )Ivision of Environmental Health Serviopt &,)proved as noted for 0611fOrMafloe With ,pplicable Vules and tegulations Of the Putnam County Health Department.. 4? A TI 1o.7 :: is Z-3 -:? 7, 7" 7..7 70 R3 ru� ,1,1m cu,-.Lcy Liepartment or Health )Ivision of Environmental Health Serviopt &,)proved as noted for 0611fOrMafloe With ,pplicable Vules and tegulations Of the Putnam County Health Department.. 4? A TI 1o.7 :: is T;R- 43 vt f C) 400 ZV Vy/ 7 c C- AP '7-7 I L _:y �' W 04 WELL UU1'1rLL11UN A LrUAI DEPARTMENT OF HEALTH Division Of "Environmental Health- Services: PUTNAM COUNTY DEPARTMENT OF HEALTH ' Office. Use Only »-- STREET AOURESS: WN1y1 / I I Y TAU GRIO NUMBER: - Clifton Court, Bullet Hole Road Patterson, New York WELL LOCATION WELL OWNER NAME: ADDRESS: Michael Civitano, Crest Drive, White Plains, NY ` 10607 rPUBLIC BIVATE USE OF WELL 1 - primary 2 - secondary XRESIDENTIAL . ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL 0 STAND -BY p MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED 2—/ EST. OF DAILY USAGE 250 gal. -AEASON FOR DRILLING NEW SUPPLY D PROVIDE ADDITIONAL SUPPLY ❑ TEST/OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH SO, ft. STATIC WATER LEVEL 20 ft. DATE MEASURED, 9/20/86 DRILLING EQUIPMENT ❑ ROTARY XCOMPRESSED.AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. OPEN HOLE IN BEDROCK ❑ OTHER CASING TOTAL LENGTH 20 z ft. MATERIALS: Xin& 0 PLASTIC O OTHER LENGTH.BELOW GRADE 19? tL JOINTS: WELDED ❑ THREADED ❑ OTHER DETAILS DIAMETER 6 in. SEAL: CEMENT GROUT ❑ BENTONITE ❑ OTHER WEIGHT PER FOOT 19 lb./ft. DRIVE SHOE:fES ❑ NO UNEA: ❑ YES ❑ NO DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? SCREEN - - DETAILS FIRST -- - OYES 1, ONO - -- HOURS SECOND GRAVEL PACK O YES O, NO GRAVEL SIZE.. DIAMETER OF PACK in. FTOOE6 ft. BOTTOM DEPTH it. WELL YIELD TEST !f detailed pumping t METHOD: O PUMPED i tests were done is in- O COMPRESSED AIR , formation attached? O BAILED O OTHER ❑YES NO If more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. DEPTH FROM SURFACE Water Bear- ing Well Dia- Deter FORMATION DESCRIPTION pOE. (t. ft. WELL DEPTH ft. DURATION hr. min. DRAWDOWN ft. YIELD gpm. Land Surface 4 Silt & Cl a . Hard 440 2 440 3 500 6 450 5 WATER CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZ D? YES O NO ANALYSIS ATTACHED? AYES O NO STORAGE TANK: TYPE Di_apbrar��_ CAPACIT 86 GAL. 26 PUMP INFORMATION P TYPE sn hmrGi hl p CAPACITY 5 MAKER GOULDS DEPTH 440 MODEL 5ES07412 VOLTAGE 230HP 3/4 WELL DRILLER , ADDRESS ��P A U I �° N.Y. 1 i TE — - - -- F:'' PUTNAM COU1J'1'Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL 1 TII SERVICES -BUILDING, -- CARMEL; - DESIGN DATA SILCET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. , L 6 4 c ►6 Owner Henry & Blanche Burdick Address c/o Heelan Realty, Root Ave., Brewster, NY Located at (Street 1t H01� Sec. 73 Block Lot 11ndicaie nearesE cross street) Mwiicipality Patterson Watershed 1 SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Lot 7 11016 Ilumber CLOCK TIME PERCOLATION PEIiCOL11TION IF91 Elapse Depth to WaUer Water LeveI Ilo. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in bLln. /iii drop Inches Inches Inches 118 -58 40 24• 28.75 4.75 8.42 258 -93 35 24 28.00 4.00 8.75 X33 -67 33 24 28.00 4.00. 8.25 !l 5 l 17 -57 332 -66 ll 5 1 40 33 34 26• 30.00 . 4.00 10.00 _. 2.6._ ._ :.... _2 9 : 2 5 •.. 3.2 5 1.0 1 S.... _ T 26 29.25 3.25 10.46 2 3 ` ' Cry "C. Q3• 1;l.:�tt ! Ilotea: 1) 'Pests to be repeated at same depth until ap roximately equal Boll rates are obtained at each. percolation test hole. All data to be submitted ..for review. 2) Depth measurements to be made from top of hole. f _ TEST PIT DATA REQUIRED TO BI E SL,1I1•:_TTTED I:ITH APPLICATIOII DESCRIPT 017 01 SO?L,", i_.NIPOTJiT1�F;F.D II' VEST HOLE.3 )EPTF, HOLE NO. 6A HOLE 1�0. 6B HOLE NO. 7A J.L. la .2" .811 ,4 it ;' J,1 -6" 2'' .811 411 '2" '$n A11 rock y ,-clay, e e 0 1 stone TS sandy,clay large stones 2'0 r-eek 4511 rock IMICATE LEVEL AT VTHICH GROUDID WATER IS ENCOUNTERED NDICATE LEVEL TO WHICH WATER LEVEL�RISES AFTER BEIIIG ENCOUNTERED Y �� T 'ESTS 14ADE BY Date— DESIGN ,oil Rate Used Min/1 "Drop: S.D. Usable Area Provided o. of Bedrooms Septic Tank Capacity Gals. Type bsorption Area Pr deivo d By L.F.x24" jb�'— width trencTi. Other ame Signature ddress 'HIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: oil Rate Approved Sq. Ft /Cal. SEAL Checked by Date %/his A� N IJ / o /Y /� J1907. (I v N ,7 7q V CEJ07, ,007# )r 012 L f v. /L PI-2 2 y U %" Y646 E j / r S'A140 W/Y/ 6"' �/�PrJ s/.`C7ioN• OF T�L�3� SG�M/ l F17 %��.�,EWiT� -- DESIGN'DATA Sl=- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Henry & Blanche Burdick Address c/o Heelan Realty, Root Ave., Brewster, NY Located at (Street BBa�llet Ho Rd Sec. 73 Block 6 Lot 1 6idica e-nearest cross street) hl►uiicipality Patterson Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICAT1014S Lot 7 1101e Ilumber CLOCK TIME PERCOLATION PERCOIAT100 —Ituii Elapse Depth to Water Water 1,evel flo. Time From Ground Surface in Inches Soil hate Start -Stop Min. Start Stop Drop in blin. /iii drop Inches Inches Inches 118 -58 40 24, 28.75 4.75 8.42 258 -93 35 24 28.00 4.00 8.75 333 -67 33 24 28.00 4.00 8.25 5 117 -57 40 •26• 30.00 4.00 10.00 2 59 -92 _... 33 . ...................__...2..6 _...2.9..25.., 3..25 10.15 .. . A 332 -66 34 26 29.25 3.25 10.46 5 �L J� � .i� • --�; ko 2 �,� ;•a val Notes: 1) 'Pests to be repeated at same depth until app roximately equal soil rates are obtained at each.percolation test hole. All data to be submitted ..for review. 2) Depth measurements to be made from top of hole. T TEST PIT DATA REQUIRED TO .gE ST3hi•:TTTED WITH APPLICtITI0N Dr- ,SCRIP�'.�.O.d Or- SO...?,� . �:.,• ,JOT�T:,.�,.,F,D- :I- i.- ..: -E. }_ �It�L�o� -- _ �.R. PTY. HOLE P:0. 6 A HOLE h 0. 6 B HOLE NO . 7A 7211 y -clay, e e 0 1 stone TS sandy,clay large stones 2'0 reek 4511 7011 ' rock rock ,.*I% a •DIDICATE LEVEL AT-WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS I4ADE BY Date DESIGN Soil Rate Used Min/1 "Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity Gals. Type. Absorption Area Pro dery d By L.F.x24" width trenc . Other Name Signature Address SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date A107C - j /J(is Yu 9M/ 714 L I /N 5— 1917p 2 ov4,0 ID D O %V 1-'012 L b wl'rt P,* /L y O)c 76(6, j / r 5',Vp wig/ 6"' gy 1w PUTNA'M COUNTY 'DEPARTMENT OF HEALTH ; ` ENGINEER TO PROVIDE PERMIT # . t ON CERT:F OFiSOMPLI N CE Dnifsion of,. Enwranmental, 'Health..Serwces Canr►el N Y 10512 PERM I T CONSTRUCTION RMIT FOR SEWAGE DISPOSAL SYSTEM /3'T7/�:'fL�Oi�� ` R Town or T/�Ilage • - r Ll� Located at '�+ �� G `�! Tax Map �.l /f7o.v ��s� . _ Ala Subdivision ,�C/2��1� v' Od /� Subd. Lot R / Renewal Revision ❑' w Owner /Address - - - - Date Of Previous Approval Building' Type / Lot Area A J ' Fill Section only ❑ /4�'+� •`Number of. Bedrooms — Design Flow G /P /D v v O P. C. H. D Notification Required` ,Separate Sewerage System /tto,.consist' of. QQ Gal. Sept Tank. and .To be constructed 'by�� N4� �' — ' !'iJ% p Address ` A7 �a .. rs E , A✓ . i. t zii Water Supply: Public. Supply From Privaie'• Supply to be, drilled by Address ;Other Requirements `'I represent that I -am wholly.and.completely responsible for.the design and location of the proposed _system(s); 1) that the separate'sewage disposal system !'above described . will be constructed as shown -On the'8pproved amend e,nt It •io and In,acc,ordance with -the standardi.,r61BS ' an ,,regu a ions _of a ,- Putnam County Department of Health , "and that:on completion thereof a ',Certificate of Construction Compliance . satisfactory to the Commissioner of'Healthwill . ., be submitted `to the - Department, and a •written; guarantee:will•be furnished the owner, his. successors, heirs or assigns:by the builder that said builder will place in good, operating condition, any .part of`said, sewage:-disposal :systeni,during :the period of two (2) yearsammediately folio' ing'It edat 'of -the issu- ante of the approval. ;of tho'Certificate of Constiuctiori;.Complu►nce�.of .the;'original.system.or any:repairs'thereto; 2) that the drilled well desc►itied above 'will be located as shown onthe approved plan�and that'said well will,be'inIstalled in : accordance. with the standards, rules 'and regu a ions of the Putnam ,County Dippartment of.-Health. / Gate e� /U/yE G Signed `-� P E..A. .. _ T T- _ Address 2 � � License f lo- 0 / °: APPROVED.FOR C STRUCT N This'.approyal;expires : one . yearlro th issued un ss constr et' n oi' he building has been undertaken and is revocable for use may be a d or modifiedjwhen'coniidered net y y the Co s ' n o , H h.. . ny change or alteration of construction requires a ne per p v or disposal of domestic, sanitary end /or 'pri a at' n ,Data BY Title •Rev. 6/85 _._�:- _'.'__'._.., ---'- - ._. -- ---= —' - -- _. - J Box 224 - BREWSTER, N.Y. (914) 225 -2072 - WATER ANALYSIS REPORT — SAMPLE NO. 6335 SOURCE: Mike Civitano well Burdick Woods Patterson, NY COLLECTED: October 6, 1986 BY: Mill Drilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. October 9, 1986 0 per 100 ml. Ugec[or C. MILTON WILSON LICENSED, PROFESSIONA.L.-.:E-NGINEER- Mar-, 1321 1987 Putnam: Co ant y Health Dept,., 110) Old Rt.: 6 -- Center Bldg.. #3 CarmelL,.. I34-Yo Re: Civit-a= Project Clifton Court U .Patterson, N,.Y* Att.,-,, William Hed,;,gea Dear. Bill.: Attached hereto is certificate of construction compliance data for this project.- Kent I)um;)2Tb told, -.9-& that 'Ji-oij had checked out axid a�r-,-,'oroved the Littallation before the system had been beckfill.ed.--- I allso checked the s-L-.i:,-stem wh-Ile it was still, open for in- mz)ection. 1-like Civitamo,,, :the young ovmcn, of the com pleted house,; field, a;id is going to be married in t-,,-m-ifi,eeks and would. like to get your approval as soon as possible so we can file s,q2,iie with our mutuaX,friend Calbo at Pa-ttersc-n wlio vvill '. im-,,jied- iately issue the C.O. Best rega--.-ds, eton -'�"ai—son P.E. C. 111i ozi 1,'1ilso 0--nw/* encs*,. c-.,c. Civitan& I LAKESHORE DRIVE R2 BREWSTERt NEW YORK 10509 Tel: (914) 669-5290 SEPTIC AND WATER SYSTEMS HEAT AND POWER CONSERVATION PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF E1qVIRO1%=AL HEALTH SERVICES Owner or Purchaser of Building uilding Constructed by Location - Street /Z - A- S a Municipality Building Type %2 3 // Section Block Lot f�Gir- [�' l� C �7� L / ✓G r� `TES Subdivision Name Subdivision Lot # GUARANTEE 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 Environinental 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 day of��'��'�19 Signatur� c Title General Contractor (Owner) - Signature Corporation Name (if Corp.) z•_• _ rev. 9/85 mk PUTNAM COUNTY DEPARTmEar OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES. INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FMD INSPECTION REPORT f DATE: INSP. BY: (Name of Owner) Mtredtl Mocation) INITIAL SITE INSPECTION YES NO C CMME TS Wetlands on /or proximate to property . Property lines or corners found......'. Can estimate house - location .......................: Willdriveway need cut :........................... Must trees be removed note these................. Deep holes representative of entire SDS area...... Additional deep holes needed ...................... Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacent wells /septics............................ D. H. 1 Lot - Depth to G.W. Depth to rock Soil Descri tion 0 ft. 3 ft. 6 ft. 9 ft.1 4 12 ft. D. H. 2 Lot Depth to G.W. Depth to rock Soil Description 0 ft. 3 ft. 6 ft. 12 ft. DATE: -/& - FINAL SITE INSPECTION INSP.BY: House SSDS located per approved plan .:........... Length of trench measured "� S Width of trench average Slope of tile line and trench acceptable......... Roan allowed for expansion trenches .............. Over 100 ft. fran watercourse .................... Natural soil not stripped or SDS area unnecessarlygraded............................. 10 ft. maintained fran property line and 20 ft. fran house .............................. Distance well to SSDS (ft.) ...................... Number of bedroans checks ........................ Stones, brush, stuaps, rubble, etc., greater than 15 ft. fran nearest trench ................ 15 ft. of peripheral soil horizontally frantrench....... .......... .............. Boxesproperly set ............................... Could surface runoff fran driveway, roads,. ground surface, etc., channel near SDS area.... , - I^- armo=r OTC in area of 9;n.q_ D.H. - Deep Hole G.W.- Groundwater D.H. 3 Lot Depth to G.W_ Depth to rock Soil Description 0 ft- 3 ft. .6 ft. 9 ft. 12 ft. YES NO CCMMENI'S r_ (` �V I\ G �I DAVID D. BRUEN County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services June 13, 1986 Milton Wilson, P.E. RR #2 Brewster, New York 10509 Re: C i v i t a n o Burdick Woods Lot #7 .Patterson(T) Dear Mr. Wilson: Review of plans and other supporting documents submitted at this time relative to the.above project has been completed. Comments are offered as follows: 1.. Fill notes are not provided 2. Fill.profile does .not show a clay barrier 3. Property,metes: and bounds are nqt provided .4.. The sewer line from the house -to the septic tank "and septic tank to the fields must not have a bend. If. a bend is necessary.a clean-out-must be provided to grade. at each bend JOHN SIMMONS, M.D. Deputy Commissioner 5. How will flow be provided to the expansion area without trenches in excess of 60 feet resulting? 6. A profile of the sewage.system from the house to the septic tank to the 1st trench is not provided 7. The sewer line slope must be shown,a minimum 1/4" (ft). Upon receipt of a submission, revised to reflect the above comments, this application will b c nsidered further. ou s v r 1 , ohn Karel Jr. , P.E. Director, JK:pt .- Environmental Health Services. cc:JK File TWO. COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 PUTNAM COUNTY DEPARTMENT OF-HEALTH 0 DIVISION OF ENVIRONMENTAL HEALTH.SERVICES Date �.� /�, %� Ana e ; Re: Property of //C,c/ie9�e / _//// r 4wh ��5 /f0-'�f�__ _ -- Located at K Mggt �4,9p - 73- 4- ISection Block Lot Subdivision of 4841/2n /C /G Subdv. Lot # Filed Map # Date �007�/ /�n��d 71 Gentlemen: This letter is to authorize a duly licensed professional engineer -�' or registered architect (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 1 Department of Health, and.to sign all necessary papers on my behalf in connection with this matter and�.to supervise the construction of said r system or.-Systems, irAconformity with the,_grovisions- of ,Article .145 .Qr..z..,. 147, Education Law, blic Health Law, and the Putnam County Sani- tary Code. ,p `�j�, G X51 Very truly . yours, Countersigned: P.E. , R:A. , # 0 /'1 6 It 6 Address Signe Owneir of Property. Address 66? Telephone Town 279- 7 tr jr/ Telephone t. i r: "1 a; o s ucucuu luuucy depart °ant oT Health lvieion of Environmental Health Serviopc ,ry iZ >yrovod as noted Yor un oonformanae with applicable Hulee and 'Regulations o egulatenY the Putnam Coty Health Departm f +t it . .� - n - - aenaturn A Tt?1P :•r 9 Q s i