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HomeMy WebLinkAbout2174DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 30.18 -1 -13 BOX 19 I r .. I.tiL 1•. ly I. r fir. L� ��� I� ■ 02174 1 PUTNAM COUNTY DEPARTMENT OF HEALTH ENGINEER MUST Division of Environmental Heielth Services, (;arm% N. Y. 10512 PROVIDE P RM IT # CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Town or it Located at 1.t Tax Map - Block M Owner t' -t / Formerly / Tax Hap Lot 4 Subd. Lot R K Ally. Separate Sewerage System built by y �+�t`�^�i C Address Consisting of I rK0 Gal. Septic Tank and )r� r�� �� A w'+i� Other requirements Water Supply: c Public S�,....:., — :z Private Private S Address Building Type r- Has Erosion Control Been Completed? ' No, of Bedrooms 3 Date Permit Issued. Has garbage grinder been installed? Ni; I certify that the system(s) as listed serving the above premises ware constructed essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulations in Putnam County Department with the filed plan, and the permit issued by the DepJj1ent -1 Of Health. Date Certified by i ■�� .. . P.E. •./ R_o_ Address 27Z ' ��v - _ 5t ik Ity, /051, License No '%`3731 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage 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 Co ssionsr of Health, such revocation, modification or change Is necessary, Date l L BY Title Rev. 6/RS 'ID ENGINEER TO PROVIDE PERMIT # PUTNAM COUNTY DEPARTMENT OF HEALTH ON .. _.__.._.a ....< _. CERT FI F P Division of Environmental. He a lth .Services . Carmel N. Y. 10512 PERMIT LA CE. . __..._ ..__._.. .. ..._...... - _.._. CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM nn nnrr t7, own or it e Located at LAY's s'� x r Rte A,> Tax Map r V - o .lock � Lot Subdivision IEV E(_4 N � L- 0 6L 0 6 155-Subd. Lot k PC) Re ewal p Revision G1Ei�QEfNE HotItES 264 Tar�1GW 1�e R� _ ski Of Previous Owner /Address n _ � c� Date Of Previous Approval Building Type Lot Area /h • Q0S 0-ales Fill Section Only ❑ Number of Bedrooms Design Flow G /P /D 600 P.C. H. D. Notification Required \ Separate Sewerage System to consist of 10100 Gal. Septic Tank and 11; 1 ?-if" IU�de altlS- To be constructed by n0 6, eGS`oh tt7 Address Water Supply: -7. Public Supply From ► t� Private Supply to be drilled by Address Other Requirements -7 Jo N 1 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 approved amendment there to and in accordance with the standards, rules and regulations of e 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 system during the period of two (2) years immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be install in accordance with the standards, rules and regulations of the Putnam County Department ofilH Ithr. Date ZI o �ID Signed P.E. I/ R.A. Address 2q2 ' `a��- Iy1�:111� _ 1516 License No. APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction requires a new permit. Approved for disposal of domestic sanitary sewxrge, a / private water supply only. A n,'r Date �S -7_9� By r 1� 7, � Title �FYcrG PUTNAM COUNTY DEPARTMENT OF HEALTH Rev. 3186 Ivlsion of Environmental Health Services. Carmel. N.Y. 10512 Engineer to Provide Permit N on CERTIFICATI�0 C O� Lt CE CONSTRUCTION PERT [IT FOR SE ISPOSAL SYSTEM Permit N Located.at_ _stl ��� _ -- - - -_ - - or village - Subdivi®loa Name E4 Ad 6-5 5Subd. Lot N — S � r �4Tax Map Bloch t I Owner /Applicant Name S�� CA �� co.- Renewal_M4 Revision [y_ �� . Date of Previous Approval .�P Mailing Address 6se, Town PITON. QA A Mp 65 Building Type Uym"yt Lot Area A05 C),M,5 FM Section Only . Number of Bedrooms Design Flow G /P/D (0000 PCHD Notification Is Separate Sewerage System to consist of GaIIon Septic Tank and — 311 To be constructed by- lab mun- t, = — Address Depth Volume teoulred When IS is completed Water Supply: Public Supply From Address fin, ors if Supply Drilled by �2:�— Address Other Requirements 7 d y'y'C 'b oull; 1 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 approved amendment there to and in accordance with the standards, rules and regulations of e 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 system d 1 the,period of two (2) years Immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the rigi I system or any r pairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be Install in ordan a with t standar rules and regulations of the Putnam County Deq3rtmqnt of Health. Date /////SSS.y}p� ��yp�� `pSigneydA. s }�q��_}`e 17� �`/�'Q P.43731 E.._!! _ R.A. _ AAA.... ?A7- IV 4A & '/' '7V "�`v `�l� .�..y 1 {e Anew Nn APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by Ili Commissioner of Health. Any change or alteration of construction requires a new permit. Approved for disposal of domestic sanitary sewag4a andjo4 private water supply only. _ a PUTNAM COUNTY DEPARTMENT OF HEALTH .Diyisi ;t °�; - Eriir;ir�mE�nfa1 Mealth Se�lr;�es =Ca>mel; -lid: 1/. - -10592 .. r._ .. . _ CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL_ SYSTEM Located at hake Shore Road Subdivision P,'.a'p of Evelyn Bleyer Owner— Frank Gr611i Building Type Raised. Ranch Lot Area 1 Acre + Number of Bedrooms - 3 Separate Sewerage System to. consist of 1000 Gal. Septic Tank To be constructed by Rudolph Valentini Putnam Valley (rr) Town or Village Section 8 Block 1 Lot 14 Job Address RD # l . Box 340 Putnam Valley, N.Y. 10579 Total Habitable Space 1200 + Square Feet 150 In r If tx Address ea ee 20 Woodland Blvd 3611 width trench Water Supply: Public.Supply From Peekskill, N.Y. 10566 X Private Supply to be drilled by Anderson Well Drillers Address BargQr Street - r�i�,�I� Putnam Valley, N.Y. Other Requirements T)nmin.S r TTs f? � y ' t Oa °00060 11 ®vOo 1 I represent that 1 am wholly and completely responsible for the design and location of the proposed system(s);' 1) VQI tl w@ a dsal system above described will be constructed as shown on the approved amendment there to and in accordance with the stancIft nv0 ispoe u nam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" sate °sfra i t¢q Agr of Health will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs oo #iW9 it said builder will place in good operating condition any part of said sewage disposal system during the period of two (2) yefrio e i I I ing t"Atte of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs tl6er b 2) t ascribed above will be located as shown on the approved plan and that said well will be installed in accordance with the standaod=r les { Ions ethe Putnam County Department of Health. ® = $a "� ° October lg 1974 d � 0 Date ° 6 Signed P.E. Address 1 Northrid r Ron Peekskill N.Y. 10566 �° �� eyp��`.00027846`' 0 APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the IRIIgQ) "eha0 seen underta�kon and is revocable for.cause or may be amended or modified when considere�leces by the Comm! o er of Health. Any change or alteration of construction requires a new permit. Approved f9r disposal of domestic sanitary swig' an or rivet er suooly only. -- .. t r� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .. ,_i+ a..vr. ..K.c_.w n. __, ... .._ -' _ .. 1 r .. K¢ .mve.- ..f+!saTwr_uMa`.rcn••:a (MIUKI C4S56_&19 Owner or Purchaser of Building R166-�_2 FvOMES Building Constructed by L A-KBE 514-o R-f DO-WE E Location - Street Pty A-4& I-Gy A)_y- Municipality Building Type Section Block Lot ( oXZ106, G"K ilEi -Y.� Lt 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 made -bye -to-such-- system,-=exeept 4h ' failure to. operate. properl r:: 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 1 %, day of Od 19 F7 Signature Gefier d ll Contractor } - Signature Corporation Name (if Corp.) Address / 6,0 rev. 9/85 mk Corporation Name (if Corp.) I,L. �t, 12t AL. ess WELL UUMYLETIUM Kr,ruti,1 ... �e DEPARTMENT OF HEALTH Division 0 Environments. HearErlq $ery ces°""" PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL`LOtCATION STREET AOORESS: WN�Vf I I Y TAX GRIO NUMBER: Lake Shore Drive, Roaring Brook Lake, Putnam Valley, NY ..'.- ,.. WELL OWNER NAME: 45-0 ADDRESS: �. Aieger Homes, Inc., Box 1=6, , .NY 1A 1:0 .PRIVATE 0 PUBLIC USE OF WELL 9. ,primary 2.7:4econdary M RESIOENTIAL ❑ PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP .❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUN, T, OFUSE YIELD SOUGHT 5 gpm. /NO. PEOPLE SERVED 3 / EST. OF DAILY USAGE 30%al. REASON FOR: DRILLING :E] NEW SUPPLY 0 PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH: DATA.. WELL DEPTH 365 ft. STATIC WATER LEVEL _20 ft. DATE MEASURED 7/15/87 DRILLING EQUIPMENT ° O ROTARY �1 COMPRESSED AIR PERCUSSION ❑ DUG '0 WELL POINT O CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE. 0 SCREENED ❑ OPEN END CASING. OPEN HOLE IN BEDROCK O OTHER CASIPIG D TAILSa,; TOTAL LENGTH 40 fL MATERIALS: E] STEEL D PLASTIC D OTHER LENGTH.BELOW GRADE ft. JOINTS: 0 WELDED 0 THREADED ❑ OTHER DIAMETER 6 in. SEAL: 5CEMENTGROUT OBENTONITE ❑OTHER WEIGHT PER FOOT 19 Ib. /ft. DRIVE SHOE ®YES ❑ NO LINER: OYES ❑ NO DETAI LS, DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST , o _.. .__.._r... - - - - - - . _ E0, : YES. SECOND HOURS ','GRAVEL PAM O YES ❑ NO GRAVEL SIZE DIAMETER, OF PACK in. TOP DEPTH tL BOTTOM DEPTH It. ;,YELL YIELD TEST. ; pumping If detailed P PMETHO. ,O PUMPED i tests were done is in- .t COMPRESSED AIR ,formation attached? `0 BARED; ';' O`:OTHEA i 0 YES 0 NO It more detailed formation descriptions or sieve analyses l�iELL LOG are available, please attach. DEPTH FROM SURFACE Water Bear- ing Well Oia' meter FORMATION DESCRIPTION CODE It, ft WELL DEPTH ;. DURATION hr. min.. DRAWOOWN ft. YIELD. 9Cm• Land Surface 15 no 10 Clay, hardpan & boulders 15 365 yes 6 Hard grey & black granite 200 .: 'l.-, 30 200 2 - 300 6 r= WATER .,; CLEAR TEMP. QUALITY.. :.O CLOUDY HARDNESS . O COLORED ANALYZED? YES ONO ANALYSIS ATTACHED? 15 YES O NO STORAGE TANK: TYPE dial hrarTm CAPACITY 62 GAL. 12 PUMP INFORMATION TYPE .- ,submersible CAPACITY 7 MAKER ou S DE,P�F� 3 f�00EL' VOLTAGE` u HP g� WELL DRILLER NAME Mj. L DRILLING 0 / 16/8 7 ADDRESS Pu� Ave. SIGI7 TURE Brewster, Nexa York 10509 N. Mu. 11 . ; 8'.7. t��t 56.1 '1 Yorktown Medical Laboratory, Inc.. LAB. _ � 321 Kear Street 0 AW Yorktown Heights N. Y. 10598 Date Taken: d° � Time: !�• =' Date Rc d: Time: �.,:.,�.- ..94�as =�2� .. ... __. x. <.�..b a�t=a°°R e p o i�t-c1: Director: Albert H. Padovani M. T. (ASCP) Collected By : C2i�h r -�. Referred By: ��SC�L,lf- �-� -•�� Sample Locati�n: 1-A �,. Phone �L71✓� ���% Phone # Type:. J L Repeat Test? _ isample (c `ck one) LABORATORY REPORT ON THE BACTERIOLOGICAL QUALITY OF WATER GENE AL BACTERIA Standard Plate Count (CFU /1.0 .mL) (Agar .Plate @ 35 °C) MEMBRANE FILTRATION TECHNIQUE (MFT) Total•Coliform (CFU /100mL) _ Fecal Coliform (CFU /100mL) Fecal Streptococcus (CFU /100mL) MOST PROBABLE NUMBER TECHNIQUE (MPN) Total Coliform: MPN IndexA per 100mL) Fecal Col Porn? -MPN" IncCd -2 OTHER ANALYSES REMARKS (For Laboratory Use) rol Potable ,.Non- potable STP INF STP EFF Other: Sample Status: (check each) Outgoing Na2S203 Incoming LE 4 °C _ .GT 4 °C . _ Other: KEY FOR TERMINOLOGY RDS = Recommend Disinfec- tion of Source TNTC= Too Numerous To Count CON = Confluent ( =TNTC) LT. = Less Than (C) GT = Greater Than (>) N/A = Not Applicable LF. = T.Paa than nr enual to THESE RESULTS INDICATE' THAT THE WATER SAMPLE (WAS) (WASN'T) (NIA) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO TH NEW ORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT- HE TIME OF COLLECTION. /1 For Lab Use Only: H/C to x C 6 Albert H. Padovani, M.T. (ASCP ), Director LAB OFFICE HOURS (Main Lab): 9AM -5PM, Mon. -Fri. 12 /85(Rvsd7 /87)RWE 9AM -NOON, Sat. i APPF.rL' IDIX C F SITE INSPECTION ' TION v.i ( ✓ ,/ Q OWNER �k TM ,T. SJE � 012 DIVISION �- Al II, IV. V . xr'ted b YF5 NCl CCU Sc�?vA� DISFOSAZ, AREA a. SDS area located as per a proved plans b. Fill section - Date of plac --mnt 2:1 barrier. LGTH WIDTH - VG.DPrH I C, c. Natural soil not stripred f d. Stone, brush, etc. , greater than 15' fran SDS area. e. 100 ft. fran water course/wetlands. - SFNA DISPOSAL SYSTEM a. Septic tan'{ size -/'1,000 1,250 b. Seotic tank ins- led 1 el I� C. 10' minirman fran fbmidStiton d. No 90° bends, cleancut within 10 ft. of 45° bend e. DISTRIBL'TICN BOX 1. A.11 outlets at same elevation - watar tested I 1 2. Protect=--; below frost 3. M1nimL-n 2 ft original soil between bc.Y and tre_*�ches f. p. Jb -ION BOX - roperly set c. TF=HES 1. Lz'zGt-i re .mi red k3 'pFj Lar&L irstall 2. Distanc= to watercourse meys'arrec =r, I 3. Installer acccrding to plan t�d A. Distance center to c- anter 5. Slone cf trench acceptable 1/16 - 1/32 6. 10 feet f_cm roperty line - 20 feet - fcurdations 7. Depth cf trench < 30 inches fran sur =ace 8. Roan allcwed for e_xransion, 50% 9. Size of Gravel 3/4 - 1 " diameter 10. Depth of cravel in trench 12" min?ma-n h . 11. Pine e__, -xs -app_ 3 - P'T OR hGSL SYSTEMS 1. Size of pL*� chamber — 2. Overflew tank I I 3 A1ar_n, vi s-,:.al. /audio 4 PLnD ea=sily accessible manhole to c =_de 5. First bcx baffled 6. Cycle witnessed by Hea.l-_h Derar�`men.. estinate~ flaw per cycle :_Ouse 1cc3tec L—er anorcved plans. ' ✓ Well lccate' as e_ Plan-s- \ ? c. Di stca ce 'LrmL. GDS -_-- m :sured = _ i �.. r� a c. Casing 18" aimve c-ade G. Surface dra' race around well acc_°DL.-_`_ =. I I CVERA ,L WORE S I—P a. Boxes prccceri v cr c'ut d ! b. A11 pipes - rtia' ? y c. All pipes flub, w, ; -i inside of bcx I i C. Fackfill mat�ricl ccnt?ins stones < 4" in diameter I e. Cumin drain installed, accordinc to plan f. Curtain drain cut-fall rotected & dir.to exist.watercours Q. Fcoting drains discharge away fran SDS arm I L Surface water Drotecticn adequate i. F=osion c--nEc- prcvided on -mes cre ter L.-an 15 %. PUTNAM COUNTY HEALTH DEPARTMENT .., o. ....i --.e _ �.' ( -�i .. e+.... xk.N.a..sf _> • S.V. !... ..:.•-.e -ay . -a+a. •s. �......:. .. 'a+.r- •..vw..n- -..: -_ r: .:- ...- ...- rx.w w.. -.� .... ........... .. .. �. -... .... ..• .�.. DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy 'ssioner of Health — FIELD ACTIVITY REPORT - Sheet of �, INSPECTION NAME Q _ Orig. Routine ADDRESS Orig. Cmiplain Orig. Request No. tree Town TM No. Canpliance — _ Complaint Comp MAILING ADDRESS Final P.O. Box Post Office Zip Code _ Group Illness Construction TELEPHONE — Reinspection PERSON IN CHARGE r Field, Sampling Only OR INTERVIEWED �� �-� ' �� I — Field Conference Name ac}d Title / � - f�� 7 Z- Other DATE l i� V TYPE FACILITY � 2 — TIME ARRIVED �� TIME LEFT Explain Min RI= ;Mot WE WNTAW-M "M, D ■ INSPECTOR: `J `j J / \\ PERSON IN CHARGE OR I acknowledge this 6/86 ture - --- f--- -�1 -`° TELEPHONE: Report. SIGNATURE: TITLE: 0- c DIVISION. :OF.ENVIRO0M, AL HEALTH'SERVICES John M Simmons, M.D'-:; Deputy 'ssioner of Heal - FIELD ACTIVITY REPORT - '. Sheet of - MSPWT-ION I NAM b Orig. Routine -_ O gri . Compl ain brig. , Request No. S t Town TK No, Canpliance rp Complaint Comp MAILING, ADDRESS= _ Final ; " P.O. 8QK Post Office Zip-,Code . Group Illness Construction TELEPHONE 7 Reinspection PERSON IN CHARGE Field, Sampling Only OR: 'INTERVIEWED - Field Conference Name and .Title Other r ,DATE [ '' E FAC ^. � TIME Al IME LEFT - Explain ��AM FINDING: j 1 • � • ' � �..�� f e­ . COY ! k • D1• • M n i •' DID a d r _ !a►ZS�_�r.� rp ImMi�TJOUK AM 7 +a�� ��AM o 1 • � • ' � �..�� Lam. � •. • D1• • M n i •' DID r I I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date 9/Z Re: Property of r/2,wig C*A31CZ1)q Located at L,\,L, (T)- Section* Block Lot 14 Subdivision of IFVJy"\ Subdv. Lot # 6 Filed Map # Date Gentlemen: This letter is to authorize a duly licensed professional engineer' V/or registered architect (Indicate to apply for a Construction Permit fora 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 -c-onformkty-wi�ih­tho- provi,s-i:on-s -o-f ­Art icl e­,145-- -or--­­._­ 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned: P.E., R.A., # 43736 ­- 2CQ_ M411 Address Telephone' Very truly yours, Signed Owner of Property Address Town V i PUTNAM COUNTY DEPARTMENT OF HEALTH Noo —40 &�/o COMPLAINT OR SERVICE REQUEST RECORD JWN Date Time REFERRED TO. R). TAKEN BY ] �`I TELEPHONE CALL IN PERSON LETTER CONFIDENTIAL) REQUEST. FROM _ d ADDRESS CS d�'i 8 TELEPHONE ENVIRONMENTAL HEALTH: Home Sewage dents Refuse Public Water Food Service Migrant Cam Other COMPLAINT OR . -e- -4-- ---1',1) <7 S Y.� -5� & , �-�' ACTION TAKEN BY /J ^%�j DATE FINDINGS S. /� � �y ��. j (//' >��'/ %lam✓ L -?.JS �� ..� .O / °y -.� �i / !° ci�e� .�'� �.�'..���'y.�' 7z`� � �- � C% t3 d ✓off! �, PROBLEM ABATED DATE PERSON NOTIFIED ESTIMATED TOTAL MAN HOURS SPENT 77 Division Of Environmental Health Services TWO COUNTY CENTER CARMEL, N.Y..10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: A(L1kYr RaEK LOT NO.: F-VC-LY LC-qE WATER WELL CONTRACTOR: Name }o %,>e Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ✓ NO NAME OF PUBLIC -WATER SUPPLY: 30, - TOW`1 /V /C DISTANCE TO PROPERTY FROM NEAREST WATER.-MAIN LO TION SKETCH & SOURCES OF - CONTAMINATIQN, . _pSC� Se^ l�y_m See _. .. tT _ ...- __. _ _.__..r _._.._ r.. g (date) r (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;iwell 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 Issuer 1g 8� e it Issui49 Official !� Permit is Non - Transferrable ` SiREEI ADDRESS. WNwIu.a / l Y TAX GRiO NUMBER: VELL LOCATION LAK£ 5NoRE• VD. f'v VUR1 \)PROF -4 -t' WELL OWNER NAME:. F aK CASi_LLR ADDRESS: �-PBIVATC p PUBLIC USE OF WELL 93-tESIDENTIAL ❑. PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED 1 - primary .❑ BUSINESS ❑ _FARM O TEST /OBSERVATION ❑ OTHER (specify) 2 - secondary p INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY 0 MOUNT OF USE YIELD SOUGHT 02� S gpm. /N0. PEOPLE SERVED 3 / EST. OF DAILY USAGE 3°r' gal. REASON FOR (2-"NEW SUPPLY '❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION DRILLING- ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN.EXISTING WELL WELL TYPE DRILLED DRIVEN ED DUG GRAVEL E] OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: A(L1kYr RaEK LOT NO.: F-VC-LY LC-qE WATER WELL CONTRACTOR: Name }o %,>e Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ✓ NO NAME OF PUBLIC -WATER SUPPLY: 30, - TOW`1 /V /C DISTANCE TO PROPERTY FROM NEAREST WATER.-MAIN LO TION SKETCH & SOURCES OF - CONTAMINATIQN, . _pSC� Se^ l�y_m See _. .. tT _ ...- __. _ _.__..r _._.._ r.. g (date) r (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;iwell 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 Issuer 1g 8� e it Issui49 Official !� Permit is Non - Transferrable ` V COMPLAINT: 4f_ e'7 j 5 r- DIRECTIONS: T � i s� 45" r _/ TAKEN BY: REFERRED TO: DATE: -35 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services AFFIDAVIT — CORPORATE OWNER. APPLICATION. FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner, of Health In the'matter of application for: represent that I am an officer or'employee of the corporation and am authorized to act for t0_ (Name ofi Corporation) whose otticers are: President: J4?,05k (Name and Address) Vice — President: (Name and Address) N�5 Secretary: (Name and .Addres_�.)4 . > ....:. _... a :. .... . Treasurer: (Name and Address) and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and,all. subsequent acts relating thereto. Sworn to b ore me this day Sig Of 19 0� Title: y ub1ic BFP.NARp DORMAN ' Notary Pvblic, .Stato of New Y-r r� ; Na. 24-073300 qugll flad in Khrr ;s County N� c6 CoRifl::a'2 fl(cd In ',iJ�,tchuswr Cou commiulan Explroa Marsh 30,, t$'�� r� d� •� 8/84 i.orporaLe ea: f PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION,OF EN`/IRONMENTAL HEALTH SERVICES Re: Property of Located at (�( Gle�bec��. �vw�e s L P V (T)-- y�L'�5ection Block o t _ Subdivision of Subdva Lot # � Filed Map # �5�� Date dd�?_ Gentlemen: This.letter is to authorize a duly licensed professional engineer or registered architect c ( Indic e 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 oysteem�.o�:.,systeins- in conformity with the provisions of Article 145. or 147, Education Law, the Public Health Law, and the Putnam County ,Saxii- tary Code. ign Countersigned: Very truly yours, P.E., ROAC, # 4 C Z% Z - Address 5 Telephone Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIR0NMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEMGE DISPOSAL SYSTEMS REVIEW SHEET - CONSTTRUCTION PERMIT DATE (Street Location) DOCUMENTS Permit Application Corporate.Resolution Plans - Three sets <Ehgineers Authorizati -o-A Design Data SDDS) Deep Hole Log Consistent Perc Results 30" Perc Hole Other REVI ED: Z- 7_02& (3) House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Propfile & Dimensions - Volume D orTP ;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 Area Expansion Area;shown;gravity flow,suff: size If Pumped Pit & D Box Shown & Detailed �. . _House ._Nd... of: Bedr �Prop�erty Wells & SSDS's w ' 200 ft. o-Located Property Metes Bounds House Setback Neces o House Sewer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max-. Bends 45° w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to,Fo Walls 100' to 1; 200' in D.L.O.D, 150' pits 100' to ream, Watercourse, Lake (inc. expan) 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 0� • c, NO ©v s FAM ©M MM on NWAM MW /mm MM MM M�m MEMM DOCUMENTS Permit Application Corporate.Resolution Plans - Three sets <Ehgineers Authorizati -o-A Design Data SDDS) Deep Hole Log Consistent Perc Results 30" Perc Hole Other REVI ED: Z- 7_02& (3) House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Propfile & Dimensions - Volume D orTP ;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 Area Expansion Area;shown;gravity flow,suff: size If Pumped Pit & D Box Shown & Detailed �. . _House ._Nd... of: Bedr �Prop�erty Wells & SSDS's w ' 200 ft. o-Located Property Metes Bounds House Setback Neces o House Sewer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max-. Bends 45° w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to,Fo Walls 100' to 1; 200' in D.L.O.D, 150' pits 100' to ream, Watercourse, Lake (inc. expan) 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 PUTNAM COUNTY DEPARR4ENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SE kGE DISPOSAL SYSTEMS \ FIELD INSPECTION REPORT (Name of Owner) (Street Location) INITIAL SITE INSPECTION (, J /'� F 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 Descriptii 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. D. H. 2 Lot ~� Depth to G. W. Depth to rock Soil Descri tia 0 ft. 3 ft. 6 ft. 9 ft. , NO DATF;o ..- . � .-•�" _, :tea' °� �,:; INSP. BY: COMMENTS D. H. - Deep Hole G.W. - Groundwater D.H. 3 Lot Depth to G. W. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. .12. ft. -I _ I 12 ft. Soil DATE: FINAL SITE INSPECTION INSP.BY: YES NO CATS House SSDS located per approved plan ............. Length of trench measured 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 unnecessarly graded.......... ... ........ 10 ft. maintained fran property line and 20 ft. fran house.... ........................ Distance well to SSDS (ft.) ...................... Number of bedroans checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. fran nearest trench ................ 15 ft. of peripheral soil horizontally fran trench ..... ............................... Boxes properly set ............................... Could surface runoff fran driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... r —� FINAL GRADNG OF SITE ACCEPTABLE.. ..... i •RI }rRf '' 9• 1 • () +•\ ., ' / 13 Ili n Nn ao uu : !w ac cap / \ 114 • . ° 0 29 30 N 25 a 32 7 ,\ 'A ' /pPE / ., 27 s !?r• Oa� a 3s: 2 _ is ,•� _ I _ /ice I {• I % O ,� ° ''�../ / 3.2 13 / \ ' 7 3 (r l e to a 39 LAKE 3 - - -' - 0,7009 s. =i 2 3 POOPING Ocp[D - REVISIONS SPECIAL DISTRICT INFO MAT1pN ' A LEGEND I FOR TAX PURPOSES ONLY _ ._. ._. _. _,,..., < ,: _ PRELIMINARY I` • Z .If _Ta J.11. _ - -�- - > Nr•.. 4,lTTa' - �RLtTt YR frli[ YK YiOR Ofiett l.r �f(}.+ UGC• t'M. Q . 4fT TO eC VSED r(/f fXiMYfTaMCt - --^ _ __ ___ -- y, _ - -. y.- pwD.Y 1Ol Wl •�••__•- Wwr. �lK "4 Of iwR Y.t �• w.Ot R �.wt. w IG,19.��x �_ �.. .x --_- �.�_ __- _.�r�'. �� .� fir,• btiKr 1Y ���_ IR[D \OC. .rd.• - afrfroeaM a•9 uMTl,DrC i • - - - - -- - -- --- - —' ---' -- - I �---- uar rar.cT ua —�— arD fm .:eR• TOWN OF PUTNAM VALLEri.� x j,._ _ � �_. �.. ___. _ i- -. -- ..- .- _�-- --t-�I .faro.D ws,.cr twt ������ w b4,FTY.nr - -•.� , DTfD br �•.�•.... PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION.OF ENVIRONMENTAL.HEALTH,.SERVICES Date October 19 1974 Re: Property of Flank Grolli Located at Lake Shore Road .(Roarinig Brook) Section 8 Block 1 Lot 14 " Gentlemen: . This letter is to authorize John S•a Romeo a duly_ licensed professional engineer x 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 Department of Health, and. to sign all nece$sary papers on my behalf in 1.V1111C1: 41Ud1 w1 - Lis 1.11.1b 111ciLLei• culu LL). 5UpC111V1Se L1 ?e C'UI1SLVUQ'L'10I1 UL said system or systems in conformity with the provisions of Article 145 or f} 1.471 Education Law,,;.the. Public Health Law, and the- -Putnam, County: Sani= tary Code. Very truly yours, Signed -Owne of Property Countersigned' ountersigned '7846 Address ®, °�8s m p gA / P.E., R.A., # � 1 Northridge Road ®p g RD Telephone Address a ,, �o N. / _ Peekskill, 'N.Y. 10566 737 _ 1056 Telephone 1•� � ' �Z•- tea.'+' -,: :,3. •i:J^ �� ^• -.'J• r- �_�...r.� !` b PMIAM COUNTY DEPARMW OF HEALTH - DIVISION OF ENVIRONMEMAL HEALTH SERVICES INDIVIDUAL VWER SUPPLY SUBSURFACE SEWAGE DISPOSAL.SYSTEMS FIELD` INSPECTION `REPORT ...:,:, ... _.r..... -: :., DATE: INSP. BY: (Name of Owner) (Street Location) INITIAL SITE INSPECTION YES NO CCMMEN'S 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. 12 ft D.H. 2 Lot Depth to G.W. Depth to rock Soil Descrintio 0 ft. 3 ft. 6 ft. 9 ft. .. 12 ft. 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: FINAL SITE INSPECTION INSP.BY: YES NO CCMMEN .'S House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable.......... Roan allowed for expansion trenches .............. Over 100 ft. frari watercourse .................... Natural soil not stripped or SDS area unnecessarly graded............ ... ........ 10 ft. maintained from property line and 20 ft. from house.:. ... .... .... ........... . Distance well to SSDS (ft.) ...................... Number of bedrooms checks...... ................ Stones, brush, stumps, rubble, etc., greater than 15 ft. fran nearest trench.. ........... 15 ft. of peripheral soil horizontally fran trench ..... ............................... . Boxes properly set ............................... Zould surface runoff fran driveway, roads, ground surface,.etc., channel near SDS area.... Does lot drainage appear OK•,in area of SDS:':..... ,. L FINAL GRADNG OF SITE AOCEPTABLE: ..... * -- .- _.�_t .,..��.__v...�w. :: . 4 :h+: 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Glerloetne Domes Address 264 0- �>eekskl) W_ Located at (Street l.akes�ort Qs_,P„ . �k\1e Sec. Block �lndicate nepxa�ryps croossS� s re- 150' VJOcl1 QggT Wes{ Sk. Lot 14 Municipality � &\k Watershed tkJ50w SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Role , Number CLOCK TIME PERCOLATION PERCOLATION Run apse. Npth to WaEer a er ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches � 1 3q � $ z1 3 ►3. o 2 4.1 1� 2► 3 �3 i 1 3 41.4 1% z, 3 13.`� 4 4) .4 $ 21 .3 13.9 5 2 1 39 3 13.0 2 2 Ito �... _ . 1� 21 3 4L 3 1 42- 1 21 3 14 0 5 re.1�1?� 5 �QEpt. of tiCHL• e e a Notes: 1) Tests to be repeated at same depth until approximately 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. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. 2 HOLE NO. G.L. - _. -... � -. _..., _. ....... _.. -.,. . - .. .. r_.. ,.v . ..., ., . Sq. Ft /Cal. Checked by 611 1211 1811 2411 � r S AME As 3011 gotti .3611 " X1.2" 4811 w ;a� docks 54 11 60" 66" _ 7211 84" INDICATE LEVEL AT WITCH GROUND WATER IS ENCOUNTERED - �- INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED -c " TESTS MADE BY V.zENZ Date t�z'$6 Soil Rate Used Iq MW1 "Drop: �D .I N _ S. D. Usable "Area Provided s,p00 No. of Bedrooms 3 Septic Tank Capacity )o d o Gals, pe r� �ont�ie Absorption Area Provided By ZIV L.F. x24" �'— en t i. Name F. A _ ZCNZ bignnature Address 2\z M,\,, SEAL Nelso�� ik , QS_ )0516 THIS .SPACE FOR USE BY'HEALTH DEPARTMENT ONLY: �9F� PRJf'SS�O,aP�'� Soil Rate Approved Sq. Ft /Cal. Checked by �_'.�. Date PUTNAM COUNTY DEPARTMENT OF'HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING,._CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE-NO. Owner Wank Grolli Address RD #1 Box 340 Putnam Valley 10579 Located at (Street Lake Shore Road Sec. 8 Block 1 Lot 14 6dicate nearest cross streeTT Municipality Putnam Valley (T) Watershed Peekskill SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS o e Number CLOCK TIME PERCOLATION PERCOLATION apse Depth to Water 7a-ter LeveI 110. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches (1) l 5:19 5:23 4 21050 22.50 110 410. 2 5 :24 5:28 4 21.0 22,50 1.5 2.z Z 5:30 5:34 4 21.50 22.50 1.0 4.0 4 5 (2) L'r5:21' 5:23 4- 17.50 lg.5o x.o 4.0 2 ,5623: 5:26 3 18.50. 19.50 1.0.. 3•o....__ . 3 5:26. 5:30 4 19.50 20.50 1.0 4.0 5 3 4 5 IVo as; 1) Tests to be repeated at same depth until approximately equal soil aces are obtained at each percolation test hole. All data to be submitted br review. 2) Depth measurements to be made from top of hole. .. 2 3 4 5 IVo as; 1) Tests to be repeated at same depth until approximately equal soil aces are obtained at each percolation test hole. All data to be submitted br review. 2) Depth measurements to be made from top of hole. DEPTH G. L. 611 1211 1811 24" 3011 361' 42 r1 48" 5411 6011 6611 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONir' DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. 1 HOLE NO. 2 ­­Topsoil .; _ 711 Topsoil 611 Topsoil sandy gravelly loam t- arge boul ers sandy gravelly loam 7211 . . 1 811 8411 HOLE NO. 3 Topsoil 411 Topsoil sandy gravelly loam sandy gravelly loam INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED None i INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED None TESTS MADE BY John S. Romeo Date October..29 1974 DESIGN' Soil Rate Used 0-5 'Min/l "Drop: S. D: Usable Area Provided `5000 SF + f No. of Bedrooms 3 Septic Tank Capacity- 1000 Gals. Type i�asonry I Absorption Area Provided By 150 L.F. x2411 36" x width trer��b,., o� Other °...n. FNr!1a, o °mo gna Address 1 Northridge Road SEAL Re-PFskillp N.Y. THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by - -O o 0 R. • � P p� ��, 218A6 .Y �'OQI� ° . Well CAS.N ' T" LANK CINAI Drop P,pe- S,,D.e,s1blt Pump ---- 4— mmi... 20 ml grl 1— —log 10, 11"j— Dro1 l"T, look Liwy ..I. Top• of wilog Z' above MWL of •QtArfight �BSORFTiON - 14' ROARING CROSS TR.1 sg.,irq UnconnK DIS* ELE' PCAA Mc Dii of INLtT EANrtARr rte SECTION VIEW INLFr I fl, -11 r II PLAN VIEW LAKE SHORE RUAU IALTIC 92AL ri — RT Of IftLiT r A0011 r1T ­. T G1 OUTL LWK, &A.11-1 lit EEhllnD SSOS lit Is" mIN - W'"X' IroYA[b IN race U—D .0— SECTION VIEW INLFr I fl, -11 r II PLAN VIEW I GOO AREA 1 01. a , PONDI LAKE SHORE RUAU &A.11-1 lit EEhllnD SSOS IroYA[b IN race N/F DEINZER I GOO AREA 1 01. a , PONDI ....� ..Y -4r ZGybN eb .. '. "PEI3OL? ': MO N TEST HOLES V 4-.-.DEEP TEST POOLE , l;SEPTiC" TAhK M • f t. SYSTEM PROFILE ? I - IOf S 4 d' 0 gg S �A , f I41 IVII " y�� S � A INC° ACR Es' "ROARING BROOK 1 � 90 E a2 n q� r � 4.- w a 9 F9DRM 7 pjk6P09E0 y x i RE91DE1a / 128 N/F GOODMAN " (((( 116' •�' ExW" SSDS 114 108 , f ' , IOd C: a 60 "9' ooD4eolop A0 Ft oar :t L • �* loe' o � 00 0' 4RE4 .TO ,8E FILLED TO 1019 'TO' PREVERT t c 4 ��k,.Y t �'�,; r,y' �� Ga �• _ je o- -'LAKE .SHORE ROAD- 4 q .. ,, x ,� � _. _" .. t ..:. ,_4`�' a,. c..�l .,� .4'.;: ..:.,., � , � ., e, .i.:EU. - . �. .:?#... ,. 1�-�� ,... ,�..Si. � .. .. �-� 7 w kcr. A- s^` ':?' � . .. " �.. �5. ... --n .......__.... ... ..�_ . ..... ,..e • } r f "This ls' •to certify "that.. thie sewage disposal system woe `constructed ;= cs;►ndiccted ,'on thispian .bnd' that, 'the system was inspected by Me before J 0''was�- •cover ®d over The' system was;•constructed tn'accordonce :vrith all y >;the ,'pules an,d � re,gulafiont, of- the ,, fuPn*, Cowr tY.. Depdrtmenf of f'Healtti" �•pf NEp m,; 9; � r� •IS' '.4 ex .. i ��tA • .• * Fredenck A- Zenz Nelsonville; N Y 105 _...___.- .........,... _.._ ......� ..�_._, ... i l �sif p 4313,,Pt • - ._ -- _. _- w �� PROFESS�A a �...1 - i 1 As Built ;survey' by D W61den, L.'S. Y ' r � SEPA'RATIDN , DISTANCES IN' FEET • . ( j'. Ill 1 1 2 1 s � t dPBroved as noted Yor'donYormanoe ®1th applicable I{ul'es and gegulations oY the t i.^ a1tL He Department. .;,County.; a" � ISRR1'!}Ir!'RRPI BUILT SEPTIC PLAN' �' 1 p�repored';� fors 1 ',,,FRANK . CASELL`A LAKE ° SHORE ROAD 't` ':SCALE 1• =40 TOWN OF,PUTNAM VALLEY 10%19./87 ' Rl1TNAM:000NTY, N Y' MB,_I__ L' ! L .. _ ... _ ✓• Lvtr w '. ' M Tw.t, ,r!k±t +. -.�s rb µ .Mw wsrw ,, s. L4 SENN m® ® ® ®0®Mo�R �,,T} IOTit; �����j1j ?.�.Yiri � t dPBroved as noted Yor'donYormanoe ®1th applicable I{ul'es and gegulations oY the t i.^ a1tL He Department. .;,County.; a" � ISRR1'!}Ir!'RRPI BUILT SEPTIC PLAN' �' 1 p�repored';� fors 1 ',,,FRANK . CASELL`A LAKE ° SHORE ROAD 't` ':SCALE 1• =40 TOWN OF,PUTNAM VALLEY 10%19./87 ' Rl1TNAM:000NTY, N Y' MB,_I__ L' ! L .. _ ... _ ✓• Lvtr w '. ' M Tw.t, ,r!k±t +. -.�s rb µ .Mw wsrw ,, s. L4 ! 1 z} A 1 l f 3 l 4 1 . ... ',. 165.Dc; l4 y ' 42 3p E N 2b • I o E '905ocres i i 2= 225.00 i •. '1:92.00„ m me11t .• . . mJif•xK D LAKE .SHORE ROAD 8 Y 1 1 < 1 F i 1 I - 1 z} I 3 1 4 12 l4 y I i o E i i 2= 225.00 i •. '1:92.00„ m me11t .• . . mJif•xK D LAKE .SHORE ROAD F i