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HomeMy WebLinkAbout2206DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 39. -1 -7 BOX 19 m or ., I,y7. I 16 ' IrMrrm 02206 Rev. 3186. CONSTRUCTION PERMIT FOR SEW, Located at PUTNAM COUNTY DEPARTMENT OF HEALTH' Division of Environmental Health Services. C"el. N.Y. 10512 Engineer to Provide Permit # on CERTIFICATE OF CONTLIANCE )Qll�,e 17/ Permit # DISPOSAL SYSTEM Town or V Tax Map— Bloc Lot Renewal— 0—Revision-0 Owner/Applicant Name 0-11:141 Date of Previous Approval Mailing Address oCM -Town- r zip /d Building Type Lot Area Fill Section Only Depth Volume Is Required When Fill Is cominleted her of Bedrooms M Number Design Flow G/P/D le4949 PCHD Notification Separate Sewerage System to consist of Gallon Septic Tank and To be constructed 'by Address Water Supply: Public Supply From Address ors Private Supply Drilled by Other Reautrements M 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 approved amendment there to and in a ' ccordance with the standards, rules and regulations of the Putnam �/' " - � i'" ' " Commissioner of Health will County Department of Health, and that on completion thereof a "Certificate of. Construction 'Compliance'! satis actory:tqj the �;om be submitted to the Department, and a written guarantee will be furni<00 hiv- trj his . successors; 'h'eir'sor''a"s"s'�'n"sl.'b t" 16uilder, that said builder will ­�', during riA­.1 . . - 1 1, . . I .. _y. place in good operating condition any part of said sewage disposal sysilo I " lthe,� period Of (2),y6art:immediately.,Iigiio�Ning theclatis of the Issu- ance of the approval of the. Certificate of Construction Compliance of original system or any repairs thereto; 2)•that jl� aiillod well described'ibove lat, o,, will be located as shown on the approved plan and that said well will be Installed'. .-, ' I acc da e with the standards, rules a d"r —uraffo—nsof the Putnam Ila t4� , y epa rn 0 0:7sep%? Count D t t f Health.' r q Sulk Date Signed g '7 P.E.— R.A. ►lurna-70t tiff ,or Address Ynrk+QIUP License No APPROVED FOR CONSTRUCTION: This approval expires one year from the ,date `issued' unless' of the building: has been . undertaken and Is revocab le for cause or may be amended or modified when considered necessar y;. by the`: 6 om m fisionel of Health. • "A ny 'change � or alteration of construction requires a new permit. Approved for disposal of domestic nitary sewage . d? ter supply' A P Date By MQM COU M DEPART OF HEALTH - DIVISION OF IIt1VIRONMENTAL HEALTH SERVICES INDIVIDUAL WER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS (Name of Owner) REVIEW SHFF-T- 7. C0NSTRUCTI0K.PE.PWT:__. DATE REVIEWED: (Street Location) DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request RDQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions. - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing Propos Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion. Area; shown-; gravity f low, suf f . size*.. . . If Pumped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS °s w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains- Curtain,Storm,Leader,Footing 25' to Catch Basin 101 to Water Line (pits -201) Septic Tanks 10' from Foundation 501 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 MrH SWAWAM mm MM _ LN M�M_ r � rJ� DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request RDQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions. - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing Propos Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion. Area; shown-; gravity f low, suf f . size*.. . . If Pumped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS °s w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains- Curtain,Storm,Leader,Footing 25' to Catch Basin 101 to Water Line (pits -201) Septic Tanks 10' from Foundation 501 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 DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of a A-7-51 Located at /��G' jel/ Section ____Z Block j Lot/' % Subdivision of %� �jLt�%'�:Sh C Subdv. Lot # Filed Map # Date Gentlemen: This letter is to authorize ;7, ` . C� z�J � <,, &I 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 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-'syst-em•s- in -c-onformi'ty--witih'-th'e - provisions -'of 'Article' or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersi ne �" �• P.E., R.A., # � :k� Address Telephorfe Very truly yours,' Signed L. Owl r of Pr erty a,3 Cam- w t4-,VA- Address Town Tel orte ,� 3, L,> �....e _ Q O+ Ct CkJ Zq d PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services AF -FI6i -1T,_ ;�-- CORPORATE - OWNER -- APPLICATION ..... FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of.Health In the matter of application for: I , 19#1 CA 77 Lk' j72 represent that I am an officer or employee of the corporation and am authorized to act for 17jmes Name of Corporation) having offices at 0sc4.,A, 4 L�� _ � �� 6J / l 0j'7 j Whose officers are: President: Vice-president: 9 T7kA LIE - c)Sc��� (Name and Address) Name and`Address .y Secretary: .Lc �� r7' u /-i? & o &i -k? - " (Name an -Ad`dresa') T -x�ca su -r-er : (Name and Address) an! 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 th:reto. Swfrn to before me this day Signedic , C� of Wit• 19L, Title: Aelde -Z- ®r/P ic Lisamarie Bernazzani Notary Public, State of New Yoe( Qualified In Westchester Coua►sy NO. 4815725 Term Expires March 30, 19 834 I„ Corporate Seal •® v a i Co PUN• M •• WY DEPARIMENx OF HEALTH DIVISION, • IRONMENTAL BEALTH E• ME. DESIGN DATA SHEET-SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. .' .: C 0 w n e r Address _(7zo; 7e .Located at (Street) Sec.. Block Lot (indicate nearest cross street) municipa.Lity Watershed SOIL PERCOLATION TEST DATA TO BE SUBMITTED WITH APPLICATIONS I i Date of Pre-Soaking Date of Percolation Test HOLE NLZ,= C= TIME PERCOLATION PERCOLATION Run Flapse No. Tilm Start-Stop Min. Depth to Water From Ground Surface Start Stop Inches Inches Water Level In .. Inches Drop In Inches Soil Rate Min/In Drop 2 3o 40 4o' 4 5 4 5 2 .NOM: 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. rev. 9/85 4 5­ mo .NOM: 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. rev. 9/85 I d TEST PIT DATA RDQUIRED.TO BE SUBMITTED %M APPLICATION DESCRIPTION OF' SOUS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE. NO. 1° 3° 4° 5° 6° 7° 8° 9° 10° 11° 12° 13° 14° CATE LEVEL AT INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: X DESIGN Soil Rate Used ­ 7/--_,k/Min/1" Drop: S.D. Usable Area Provided p No. of Bedrooms Septic Tank Capacity gals. Type Absorption Areea� Provided By e W L.F. x 24° width trench ,•� Other �✓'>r % �S`,r li Z,�o Name 4:7� r . �,� i Signatur Address � %�L %/ • SEAL `� 0 THIS SPACE FOR USE BY HEALTH DEP"VM ONLY °3t • ^ °' ° OBSa• ^jO Soil Rate Approved sq °ft /gal° Checked by Date �Y " - I:OR`1 TTA MOLINARI R.M, M.S.N. Acting Public Health 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/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Haines P.O. Box 32-0 Cold Spring, NY .10516 Dear Mr. & Mrs. Haines: ROBERT J. BONDI County Executive June 23, 2003 Re: Addition - Haines, 701 Rt. 301 No Increases in Number of Bedrooms (T)Putnam Valley, TM #39 -1 -7 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 from this Department dated June 20, 2003. 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 disposal system, and its expansion area, must be 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 Putnam Valley. If you have any questions, please contact me at your convenience. Very truly yours, Michael Luke ML:Im Public Health Technician cc:BI f BRUCE R.- FOLEY Public Health Director V LORETTA MOLINARI R.N., M.S.N. Associate Public Health 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 ADDITION APPLICATION ('RESIDENTIAL ONL)) STREET -I&% TOWNquTwkm vPtutzyTXMAP# 2ct - l - ? NAN1EMy_%*& —y LAgcr.N wP,,ntt:sPHONE CHD# i f -03 MAILING ADDRESS 96 SoA 3Q . c-oc.® S PR•nw rV`t .e�st6 DESCRIPTION OF ADDITION C"m0gays "y Qcpr,, OILA -%A49 Q:rpM^ Ltv►W_,a*UrK h1V0 NTUNIBER OF EXISTING BEDROOMS L,�lPROPOSED # OF BEDROOMS t _ (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) *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 Road, Brewster, NY 10509, Phone 278 -6130. 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) ' *Non- professional sketches are acceptable. 3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map 9) *Non- professional sketches are acceptable. 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Cert. Of Occupancy from Town or Certification from Building Dept: with legal bedroom count of dwelling. OFFICE USE Comments Feb98 Khouseguidelines •t BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. .,�.. - ..,,.Qa,•�Y.- <_A3s_'o_ dale.._ Evb lic..Kealtb•= Diricror' °°..�.` . "' ..._,.... Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmeutal Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845)278-6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Re: 90, Residence art ja/ Tax Map�� / r Town C/1 ` Gentlemen: According to records maintained by the Town, the above noted dwelling IS � in compliance with Town code and the total number of bedrooms on record is This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER ll f !ow,k uilding Inspector BFhouseguidelines e;i 3186 S _CERTIFICATE OF Located PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N.Y. 10512 , 4 , tr' Engineer Must Provide P V – T V `$ P.C.H.D. Permit # - -- 5q, I 301 FOR Owner /applicant Name 'iZ' Formerly F- � �� Malling Address \ CA& � rill-% – Zip Town or /Wage Tax Map ( Block l Lot Subdivision Name P 't ' Sabdv. Lot N Fft Date Permit Issued G i � —97 Separate Sewerage System built by IZ_ Address i-A 30 i ' S N i Consisting of Gallon Septic Tank and -5 l0 0 o Water Supply: Public Supply From Address / or: Private Supply Dewed by `�` i3N5 Address (? tM "SiTti., C Z� Building Type Has Erosion Control Been Completed? Number of Bedrooms Has Garbage Grinder Been Installed? Other Reouirements I certify that the system(s) as listed serving the above premises were of which are attached), and in accordance with the standards, rules an Putnam Count D�j�°rtment Of Health. Date 41 Ii $� Certified by Address :�sentially as shown on the plans of the completed work ( copies s in cccrda ce the filed plan, and the permit issued by the P.E." R.A. rnyl11L yZ'�. i (K�� t.iconso No. %3134 Any person occupying premises served by the above system(S) shall promptly taste such action as may be nocoswry to mcuro tho correction of any unonitary conditions resulting from such usage. Approval of the separate t3werage system shall become null and void as soon 04 a pubt% wriltary mWor bocomos available and the approval of the private water supply shall become I and void when a Dlic water supply bocomos ovallablo. Such approvals are subject to modif cattiion or change when, in the Judgment of the C missio er of oa , ch r boot n` modWIc,tion or chango Is nocosenry. Date 41-101 8y' Title , PUTNAM COUN'!'Y DEPART OF HEALTH DIVISION OF ENVIROREWAL HEALTH SERVICES .r .i .�sMC>n�vl,..Yrr.,�,.. ... .. r.... ..r �- .�.•io.. � � ...e .... .... w...... <'. . -. .. �.• . -sr i-• �w�. e.r . 't � r • a .� .w • ae....p .O. .1. .. ..., rR;.. .. _. ... . r •. .t n..... ..... ✓.M...<. Y . .r .ems.. ✓.� . ILOC 1 Owner or Purchaser of Building 9_ . Qvv_ti, O Building Constructed by 1 +-" Jk -30) Location - Streets Municipality Building Type Section Block Lot ?V"\ h AWI 0 0 1u {y �y�[ Subdivision Name _ 2 Subdivision Lot # -.GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, wor)amnship, 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 "Certifica-te of- Construction Compliance" for the sewage disposal. system, or any repairs made by me to such system, except "where -the` failure to` operate' properly,-is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environmental Health Services of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this (2 day of AFA 19 mss$ Signature Title General Contractor (Owner) - Signature Corporation Name (if Corp.) eke Address rev. 9/85 mk Corporation Name (if Corp.) � CAC 3oI (J/ r my_ Address I oslb �� =C ` �� WLLL �vPirLrJltviv na,rvL.i DEPARTMENT OF HEALTH Division Of.Environmgntal Hsalth Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET AOURESS: TAX GRIO NUMBER: rL -So O- WELL OWNER NAME: OGRESS: �14 �0 e . e . FLc UI O PBLC USE OF WELL 1- primary 2 - secondary RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD SOUGHT S gpm. /N0. PEOPLE SERVED _ / EST. OF DAILY USAGE gal. REASON FOR DRILLING NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION O REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA `WELL DEPTH / ft. STATIC WATER LEVEL ft. DATE MEASURED DRILLING : EQUIPMENT O ROTARY COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ .CABLE PERCUSSION O OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. f:7 OPEN HOLE-IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH fit- MATERIALS: OrfTEEL O PLASTIC ❑ OTHER LENGTH.BELOW GRADE -7-0 ft. JOINTS: WELDED THREADED ❑OTHER DIAMETER in. SEAL: Dr EMENT, GROUT ❑ BENTONITE ❑ OTHER WEIGHT PER FOOT Ib. /ft. I DRIVE SHOE PfES O NO LINER: O YES ONO SCREEN - DETAILS-- DIAMETER (in) 'SLOT SIZE LENGTH (it) DEPTH TO SCREEN (ft) DEVELOPED? FIRST YES O NO . _ . HOURS' SECOND SECOND GRAVEL PACK ❑ NO GRAVEL SIZE: DIAMETER OF PACK In. DEPTH f . BOTTOM OEM -It. WELL YIELD TEST If detailed pumping MEIN00: O PUMPED tests were done is in- COMPRESSED AIR , formation attached? O BAILED O OTHER :OYES ONO It more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. DEPTH FROM SURFACE wacer sear• ing V, Dia' Deter FORMATION DESCRIPTION CODE. it. tt WELL DEPTH It. DURATION hr, min, DRAWDOWN ft, YIELD gpm. VvL] A G� a 6 0 tip � e Wa,,n,,d %�{��/, WATER IdCLEAR TEMP. QUALITY O CLOUDY HARDNESS 0 COLORED ANALYZED? ❑ YES 0 No ANALYSIS ATTACHED? O YES ONO ' STORAGE TANK: / TYPE`jtjajc' LIJ /�' CAPACITY GAL. ,/G PUMP INFORMATION TYPE S ib ' . ' r Si � �'e CAPACITY 7 ocf L� MAKER DEPTH "� MODEL jd /�© I I VOLTAGE 22C2 HP WELL DRILLER NAME DATE/ // ADDRESS �� L L 13`� %�J� `6IGt A 0 a Yorktown Medical Laboratory, Inc. LAB # _ . 321 Kear Street Date Taken: 8g8-- Time: 1 Yorktown Heights; N. Y. 10598 Date .Rc' d.:., Time.:. (914')245 =3WY :. _ _.. Date Reported:— 61948 —. == ..._�.. Director: Albert H. PadovaniM.:T.(ASCP) Collected By: Roessel. r-ROESSEL; Lisa Route 301 Cold Spring, NY. 10516 L -� Referred.By: Sample Location: 7 c e Tap Phone # - Phone # Sample Type: Repeat Test ?_ _ 1(check one) LABORATORY REPORT ON THE BACTERIOLOGICAL QUALITY OF WATER GENERAL BACTERIA Standard Plate Count (CFU /1.OmL) (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 Index (per 100mL) PGecal 'Colfform: MPN Index (per 100mL') OTHER ANALYSES REMARKS (For Laboratory Use) Q X Potable Non- potable STP INF _ .STP EFF Other: Sample Status: (check each) _ Outgoing _ Na2S203 Incoming X LE 4 °C GT 4 °C KEY FOR TERMINOLOGY RDS = Recommend Disinfec- tion of Source TNTC= Too 1�umerous To Count CON = Confluent ( =TNTC) LE Less Than or Equal to GT = Greater Than. N/A = Not Applicable THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS) (WASN'T) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO TH NEW ORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT-TIrE TIME OF COLLECTION. For Lab Use Only: H/C to e PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 June 8, 1987 Fredrick Zenz 292 Main Street Nelsonville, New York 10516 Dear Mr. Zenz: JOHN SIMMONS, M.D. Deputy Commissioner JOHN KARELL, Jr., P.E. Director RE: Proposed SSDS Ruessel - Route 301, (T) Putnam Valley Tax Map 1 -1 -1.2 Review of plans and other supporting documents: submitted at this time relative to the above =cap tioi�ed project has been completed. Comments are offered as follows: l. Standard note 5 not "ribteci dh'plans" (fefeeerice to­ garbage -. grinders). 2. Existing and proposed contours to be shown on plan. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Yours very truly, bec K, NPI-11L.-i Robert Morris Environmental Health Technician 16 IV V. Vi. .711 APPENDIX C FINAL SITE INSPECTION Date J In OWNER �e5 �k -SUBDIVISION m NO COMM ENTS - DISPOSAL AREA a. SDS area located as per aplorove ' d plans b. Pill section - Date of place-rent. 2:1 barrier. LGTH wim AVG. DPIH c. Natural soil not stripped d. Stone, brush, etc., greater than 13' from SDS area. TTI e. 100 ft. from water course/wetlands.-.-,-,-�� SFA-A-GE DISPOSAS, SYSTEM a. Septic tank size - 1,000 1(250.) b. Septic tank installed level c. 10' minimum -fran foundation d. No 900 bends, cleancut within 10 f:,'-. of 45° bend e. DISTRIBUTION BOX 1. All outlets at same elevation - water tested 2. Protected belcw frost 3. Minimum 2 ft. original soil betwee-ri bcx and trenches f. JUNCTION BOX - properlv set g. =NOTES 1. Len gth rE-quired Le-iqth install 2. Distance to watercourse meastt-=c. ft 3. Installed according to plan 4. Distance center to center A 5. Slore of trench acceptable 1/16 - 1/32 "/foot. 6. 10 feet from pro ,-,ty line - 20 feet - foundations 7. Depth of trench < 30 inches frm surface 8. Roan allowed for expansion, 50% 9. Size of gravel 3/4 - 1" diameter 10. Depth of gravel in trench 12" nunim= 11. Pipe ends canced P12vT OR DOSE SYSTEMS 1. Size of purp chamber NN 2. Overflew tank 3. A-la--n, visual/audio 4. Pump e-=silv accessible manhole to c`ade 5. First box baffled 6 6 Cycle witnessed by Health Deoarttment estimated flew per cycle -Z 'souse located per ammved, plans. N-Unizer of be :_reeve Well 1ccated as cer a_ == zVed plans b. Distance fran SDS: measured c. Casing 18" above d- Surface &-air-ace arc I -well acce �AIL WoPnA _P CVEP a. Boxes prcr-e-rily arc,_,z:ec: t.. All pLpes 2-,r ialiy c. All pices flush .w-i-Li inside of box I*r d. Bac-kfill material contains stones <.4" in diameter e. Curtain drain installed according to plan f. Curtain drain outfall prote--ted & dir.to e-,disj%---.watercoursr=_ 9- Footing drains disc�narge _awav from SDS area, -X h. Surface water nrotec . icn adequate i. Y-Hosion cr-,HEIOI rovided on slopes are ter than 15%. L>(1 m i� - ':.... i a s •: €. .y .. .. k y is i t .p ,i ,. .c',. G i PUTNAM COUNTY, DEPARTMNT OF HEALTH Rev 3/86 Dlvl ®ion of Envleonmental Health Services Carmei, NiY 10512 Englneee to,Provld ®Permit li. onCERTIAbATE:OD COMPUANt9' -. o- .. CONSTRUCTCON PE POR SE GE DISPOSAL SYSTEM.' „Peemlt �N7sp61�s ^ Ntd _ hecsita+d at Town Sabdividon Nam Solid. Let Rgap Bloch Lot- _ Renewal p Owner /Applicant Nam ®0�- �$��., — Revision p A f Data' of Pievions Approval Town . Zip Mulling Address Ballding Type Lot Area �' Q� FW Section Only D ®ptlt Volume Number of ,Bedrooms _ Design Flow, G /P /D ' 100 PCHD Notification Is Repaired Wben Fni-1s completed Sepaiate Sewerage SYetem to consist of : l ZOO , Gollonqp �S®O,de Tank end � �' To be constricted by- Address. _. VYater SaPPIJ': Pabllc:Sapply.From Address oil t Private Supply DelIled_by ^Address �. Ot6ei Requirements represent ;tna I am' wholly and- comple(ely responsible:for tfiedesign,and location of.,.the.proposed system(,);, i) that the'sepaiate.:sewage�disposal'system above describetl will be constructed as shown on the approved amendment thereto and, in accordance with the standards, rules an regu a ions o e Putnam County. , Department of Health,; and that on completion tfiereof a 'Cert�f�cate = of Construction Compliance saiisfactory;'to the Commissioner of. Healthwill be submitted' to the Department and., a ;written- guarantee` will 6e ;fumished,,the owner, his syccessors, heirs or, assigns;by the'buildei that.sa{d•builder will place in good operating' - cond;fion" 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 orAff ab m or.an repairs thereto; 2) that the _drilled well described above will be located as shomvn ;on the approved pi ri�and that said well will be = installed:" accordan '.with he 's nd r rules and regulations of •'the Putnam. County Depart ent f Health bate {� yy Signed P E. qp A. — o Address �• 6 ... �. �6AdirlrP: sense No APPROVED FOR CONSTRUCTIOW This approval expire yearfrom the. date issued unless construction of the building has been untlertaiien and is revocable for cause or may be amended or modified when:consi red necessary by the :Commissioner 'of'Health. Any change or alteration of construction requires a new /pyyp`ermitt..; .Approved for disposal ,of'.domest' sa try;sewaq d /or,:private water - supply only. Date �a(��r BY : (/Vr ' vim"' Title In PUTNAM COUNTY DEPARTMENT OF HEALTH ,.:. D..IVISION::. OF...:ENUI-RONMENTAL-- --:HEALTH. SERVICES .::.: ,:,�. ;:.-- ::.-.,:;::..•::: Date JI j9-7 Re Property of �k�y�� 4 Tot65le Located at� rAt - 3o (T)—U...- A'SeLi _Section j Block Lot 1, Z Subdivision of Subdv. Lot , # Z Filed Map # 2.r 7 Date 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 Department of Health, and to sign all necessary papers-on my behalf in -5. :matter :axxcl.;to. sup.ervi ae . tb-e ,constructi-dn'' o.f:'said- :........ system or systems inconformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, Signed Countersigned: Owner of Property P.E. , R.A. , 2y 2 low, - Address Telephone Address Town lxo"s'— , ? ,q Y i Telephone REVIEW SHEET - CONSTRUCTION PERMIT DAT BY: ' (Name of Owner) (Street- Location_) _ COMMENTS NO DOCC]MENrS VV Permit Application Corporate Resolution Plans - Three sets Engineers Authorization -it Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth s/s SUBDIVISION Perc (3) Fill cd House Plans - Two sets Well permit; PWS letter Variance Request GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flora Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes (grinder notes) Design Data: Perc and deep results Two -Foot Contours Existing & Proposed Driveway & Slopes Cut _ Footing/Gutter,Curtahl Drains (discharge "OKY Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown; gravity flow,suff. size If PmT)ed Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's Win 200 ft. of Proposed Systems Property Metes & Bounds . House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 110; Type pipe No Bends; Max. Bends 459 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees,Top of fill 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains - Curtain, Leader, Footing 35'to catch basin,stormdrain,piped watercourse 10' to Water Line (pits -201) 50' intermittent drainage course SepticTanks ° 10' from Foundation; 50' to well 15' Well to PL 9 � • •;- � �•,� i5 v a�+• r: tip• tea. DESIGN, DATA SHF - SUBSUL�ACE SEWAGE DISPOSAL SYSTEM FIZ,E ICU. > DPI ..._ :.. ... �r Owner h5c.l � .. i2 _ , ' . _ ... . d Address Located at (Street) Rc 301 �.� �:1t. E v� ajSec. i Block Lot 1.2- f; (indicate" Barest cross street). Municipality P^a^^ ' �u��+M Watershed SOIL PF DOLATION TEST DATA RwnmED TO BE SU'B'MITTED D WITH APPLICATIONS Date of Pre- Soakin g S 2 S 7 Date of Percolation. Test _ s z d HOLE NUMBER Cr= TIME PEROL1LATION PEROOLATION faun Elapse Depth to Water From Water Level No• Time Ground-Surface. In Inches Soil Rate Start Stop, _ Min. Start Stop " Drop ' In Min/In Drop Inches Inches Inches i 1 3c 3 �. , 2 1 .3 34 2q zC7�q 2 %y il..•0 1-4 z'�y L 3 30 :Z 26' J 13.3 2 4 . ;v. :?y y Z f 13.3 2 3 NC ns. , ti .. Tes"ts J&­ repeated at same depth until approximately equal soil rates `obttaihed -.at� 'each ' percolation trest. bole: All data: t�o`.be sutmi.tt�d •1; > for Xevx we 2:'w- .Depth measurements to be made fran top of hole. rev. 9/85 no a a T Yj id 0i *I D HOLE No. HCLE NO. DIEM Horz No. G. 1° 20 V 30 40 60 70 99 12' 14' INDICATE JAVEL AT WHICH mmmumm IM WHICH WATER LEM RIM AFM BEING ENOMUEM INDIO= IBM 4 DEtp DOLE OBSERVATIONS MDE BY: 5 DATE: — DESIGN Al .__S.D..0 . sable Area. Provided. Soil Rate Used mirV. "--,Drop:- -No. of .-Bedroans Septic' Tank Capacity -P gals,_'. Type - ,Absorption Area. proviaed..By_���,,-L_F..--x 24 vidth trench - Signature Ac1d1ress ZA? S m BEUM SPA�M TMOR -A ME Soil Rate Approved. by .�al DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION __$$treet Address t 3� i Town V llage City Tax �X o .o Grid Number, — 1.Z WELL OWNER Name V_ Nei M4,ailing AOdress � afrivate O Public USE OF WELL 1 - primary 2 - secondary SIDENTIAL (3 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT. PUMP O FARM O TEST /OBSERVATION C]INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify AMOUNT OF USE YIELD SOUGHT_ gpm /# PEOPLE SERVED__ /EST. OF DAILY USAGE U gal REASON FOR DRILLING W .SUPPLY OPROVIDE ADDITIONAL SUPPLY OREPLACE EXISTING SUPPLY 0DEEPEN EXISTING WELL ❑ TEST /OBSERVATION 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: :r' Lot No. ,a_ WATER WELL CONTRACTOR: Name 6.2 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES �0 NAME ,OF. PUBLIC WATER SUPPLY: {(I /,A- TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: P /jo- LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED []ON REAR, OF THIS APPLICATION 0 EP TE H (date (signatu e 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 s.hall: 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 pro by the Putnam County Health Department. Date of Issue: L - 19 �_ ermit Issuing Official Date of Expiration: � — 19 mite copy: H.D. File Permit is Non - Transferrable Yellow copy: Building Inspector Pink Copy: Owner 2 87 Oranoa mnv! WP11 T)ri 11 or a -�" �_, r", �_ ... r ,,�,: ,. �_ x;fr . �' T , , � �. �s