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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.05 -1 -37 BOX 19 02232 " l�6 'ti JL I T j '` -. 02232 o TNAM COUNTY DEPARTMENT OF HEALTH DIVISION 'OF ENVIRONMENTAL HEALTH SERVICES %Z �. CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEMy \ \ \^ \.'' PCHD CONSTRUCTION PERMIT # ' /00 Located at L4yte Town or Village _ "v'77/h'-7'I Owner /Applicant Name UlCli f � (A/IC Tax Map '�� 0 J Block Lot 3 Formerly Subdivision Namepr¢;� -�/Ul Subd. Lot # Mailing Address Z/ Zipl /ooze Date Construction Permit Issued by PCHD A ?o , / Separate Sewerage System built by per' �� C'A Address ---,T— 6P • AW / S% 'Ar Al Consisting of (F /tiJ!' Gallon Septic Tank and Other Requirements: Water Supply.: Public Supply From Address or: Private Supply Drilled by 577/li Address - - Building .Type OQ(�'% jG- Has erosion control been completed? Number of Bedrooms Has garbage grinder been installed? �® I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putn County Department of Health. Date: ��� Certified by P:E. '1 R.A. -Si 9. ) Aesa Address Z (4icense # 32 g Any person occupying premises served by the above systems) 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- sewage treatment system shall become null and void as soon as at public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. B I�� ,o�. -� - Title: Date: L,9, Y• Whi a copy - HD File; Yellow, copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional i Form CC -97 f� YML ENVIRONMENTAL SERVICES | 321 Kear Street ) Yorktowo Heights N Y 10598 � ' . . ' - (914)'245-2[()0 ' Albert H. Padovani, Director BRIGHAM, WILLlAM A. DATE/TIME TAKEN: {0/l0/05 196 LAKE SHORE ROAD DATE/TIME RE(-,'D: 10/{0/05 04:35 PUTNAM VALLEY; NY 10597 �EPORT DATE: 10/13/O5 PHONE: (845)-526-�919 SAMPLlNG SITE: SAME AS ABOVE ' SAMPLE TYPE..: POTABLE : BATHROOM PRESERVATIVES: NONE COL'D BY: WlLLIAM A. BRIGHAM ' - - TEMPERATURE..: < 4C NOTES...: DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD � � /1�� NF' T. COLIFORM ABSENT /100 ML ABSENT 1008 r� C BACT THESE-REGULTS INDICATE THAT THE WATE OF A SATI CTORY SANITARY QUALITY ACCOR HE NEW YORK STATE `AND pA FEDERAL DRINKlNG WATER STANDARDS, FOR THE PARAMETERS AT THE TlME OF COLLECTION. SUBMITTED BY: Albert Fl./Paclovarii, ELAP# 10323 Oct 25 05 09:43a BUILDING DEPT 9145268806 SHERLITA AMLER, NID, N1S, FAA Commissioner of llealdt LORETTA W)LINA)0, 1 , NISN .4ssociate Commisstoncrr vi Health ROBERTJ. BONDI 4: C-oumy Executive DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 EoviranWnlal Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Scrviccs (914) 278 -6558 WIC (914) 278 -6678 Fax (914) 278 -6085 Early inkrvcntion (914) 278 - 6014 Crrschool (914) 278.6082 Fan (914) 278 - 664 8 E911 ADDRESS WI 1CATION.EQRAA Ow NERS NAM WILLIAM A. BRIGHAM TAX MAP NUMBER: 41.5-1-3.6/3.7/38 _ .196-Lake Shore Road existing address E911 ADDR.>k;Sti: g TONVN: Putnam Valle AUTHORIZED TOWN OFFICIAL: Ov (Signature) DATE: _ 0/25105 The Putnam County Department of Health wriIl not issue a Certificate of Construction Compliance unless the above form.is completed, i.e., a lega1,E911 address is assigned. by an authorized town official, This form is to be submitted with the applicatioD. for a Certificate of Construction Compliance. (E911 VERfRM) P.1 OF P. JAN -4 -2000 TUE 1:2:0e', TEL:845- 278 -7921 NAME:PIJTNAM COUNTY DEPARTMENT 1 DIVISION-OF E NMENTAL HEALTH SERVICES GU EE OF SUBSPACE SEWAGE TREATMENT SYSTEM A., /l.Vs- Z 3 37r3F Owner or Purchaser of Building Tax Map Block Lot Building Constructed by o;ation*- Street TowntVillage Subdivision Name Subdivision.Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such systems, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month Day 29 Year X00.- Signature: Title: Gene (al ontractor (Owner) - Signature IAIC- Corporation Name (if corporation) Corporation Name (if core ration) Address: S . /- /A/ .fir!" Hr k S-ro Address: 120 11191_)k/es go A&%e3- ,State Zip SY State Zip ) Form GS -91 �t <"C= cn 171 SHERLITA AMLER; rVII MS; F,t A—r -' - Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health n .- r ROOBERT ,I.. BONDI A __ County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 September 21, 2005 John Karell, Jr., PE 121 Cushman Road Patterson, New York 12563 Re: Construction Compliance — Brigham 196 Lake Shore Road, (T) Putnam Valley TM # 41.05 -1 -36, 37, 38 Dear Mr. Karell: This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your review and consideration. 1. Please provide E -911 form. 2. Please provide a water test for bacteria. This office.will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. JSP: cj Sincerely, CJoseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health August 3, 2005 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive John Karell, PE 121 Cushman Road / Patterson, New York 12563 Re: Field Inspection — Brigham 196 Lakeshore Road, (T) Putnam Valley TM# 41.05 -1 -36, 37 and 38 Dear Mr. Karell: A site inspection was made for the above referenced project on August 2, 2005. The following comments must be corrected in'the field. ®„Y The gravel used for the trenches is dirty. A further inspection will be made by this / Department to determine whether the gravel needs to be replaced. The first trench is only 34 feet in length, not 40 feet as specified on the approved plans. ?4 3. Please verify where the footing /roof leader; drains are discharging. 4. There is a large roll away container on the existing SSTS area. Heavy objects should not _...._.., _._r be ..placed_9nt9p,9f,septic.areas. If you have any further questions, please contact me at (845) 278 -6.130 ext. 2157. gjt,;,h oK d JSP:cj Sincerely, Joseph S. Paravati, Jr. Assistant Public Health Engineer Water Supply Section (845) 225 -51!86 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early InterventiowPreschool (845) 278 -6014 Fax (845) 278 -6648 Street Location -77 TM# Uk ALA-L'Ut DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: Inspected by: .4- Permit 4 iWAR . f 0-tal Subdivision Lot # - A Ziuo',,-4 1. Sewage System Area a. STS area located as per approved plans .......... * ................. b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth_ c. Natural soil not stripped .................................................. d. Stone, brush, etc., greater than 15' from STS area....:..... 6. - 100' from water c6urse/wetlands ................................. II., Sewage System ..'a. Septic, tank size - 1,000 ........... 1,250 .......... other ................ b. 'Septic'tank installed level ..... : .......................................... c. 10' minimum from foundafion...* ......................................... d. Distribution Box 1. All outlets at same elevation-water tested.......:...: :.:.. 2. Protected below frost.. 3. .. Minimum 2 ft.Original soil between box & trenches e. Junction Rom - properly set ......................................... 6. Trenches I.: Length required Length installed 2. Distance to watercourse measured 3. Installed according to plan .......................................... 4. Slope of trench acceptable 1/16 - 1/32"/foot .............. 5.' 10 ft. from property fine - 20 ft.!- foundations.......... 6.. Depth of trench <30 inches from surEce .................. 7. Room allowed for expansion, 100% ...................... 8. Size of gravel 3/4 V/2" 'diameter clean ................... 9. Depth of gravel in trench 12" minimum ....... ; ........... 10. Pipe ends ca pped ....... ....................... ....................... b. -Pumn. e-, D-osed, Systems 1. Size of pump chamber ........................ . 2. Overflow tank..; ........................ ......... 3. Alarm, visual/audio. 4. Pump easily accessible, j� le to grade....**...*..' 5. First box baffled ..... * ................................................ 6. Cycle witnessed by H.D.estimated flow/cycle ............ I.11-House/Buildin*g -St a. House located per approved plans........... b. Number of bedrooms ....................................................... lv.� Well hV5 Well located as per approved plans.......:............... if" b. Distance from STS area measured ft........... c. Casing. 18" above grade ................. d. Surface drainage around well acceptable ....................... V. Overall Workmanshin . a. Boxes properly grouted .................................................. b. All pipes partially backfilled ........................................... c. All pipes flush with inside of box ............. ; .................... d., BackM material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan f. Ai.-.l 0. Xr " ain drain o __exist waterc.A&� FOotLne dr ias 0; schuge.away from . vW1111.9vulld h. Surface water protection adequate ........ : ........................... i. Erosion control r 0 vided ................................................ Rev. E102 SHERLITA AMLER, MD, MS, FAAP Commissioner o Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health July 18, 2005 Mr. John Karell, Jr., PE 121 Cushman Road Patterson, New York 12563 Dear Mr. Karell: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive Re: Request for Final Inspection at Lakeshore Road, (T) Putnam Valley Please be advised that any changes made to an approved subsurface sewage treatment system (SSTS) design require the approval of this Department. The PCHD Construction Permit form clearly states that any revision or alteration of the approved plan requires a new permit and the standard notes specify that unauthorized modifications made to'-the approved plan voids said approval. The request for final inspection form submitted for the above property indicates changes were made to the system design and installation without the approval of this Department. Please submit a revised plan and permit in accordance with the above. Also please. -be advised that future requests for final inspections submittals shall comply with the ectfully, Michael J. B Director of F MJB:cj Cc: S. Amler, MD, Commissioner of Health J. Paravati -� R. Morris Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 2787921 Nursing Services (845) 278 -6558 WIC (845j 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 I SHERLITA AMLER, MD, MS, FAAP - Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health July 18, 2005 Mr. John Karell, Jr., PE 121 Cushman Road Patterson, New York 12563 Dear Mr. Karell: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: ROBERT J. BONDI ..:.County Executive Request for Final Inspection at Lakeshore Road, (T) Putnam Valley Please be advised that any changes made to an approved subsurface sewage treatment system (SSTS) design require the approval of this Department. The PCHD Construction Permit form clearly states that any revision or alteration of the approved plan requires a new permit and the standard notes specify that unauthorized modifications made to ',the approved plan voids said approval. The request for final inspection form submitted for the above property indicates changes were made to the system design and installation without the approval of this Department. Please submit a revised plan and permit in accordance with the above. Also please be advised-. that future requests for final inspections submittals shall comply with the Michael J. B Director of F MJB: cj Cc: S. Amler, MD, Commissioner of Health J. Paravati R. Morris PE Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 2784921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 66'IJi3 UUod hzs �-fl �Woy �i Sys W) iZ. { ssarpPd Fmomov Am V-4 34 :6q p C) �Q Avw 3o warundoa Wino,) UX' Mn j MR 3o saon> CnA PW w 'MMU%g -'V pUV stMjd p2noiddu Pug limrad ttop suoa (ifiad p0499.1 Mp tp + MOP== 00t .101dW00 JiM POU14A pua paloadsut *AVq i pua palonasum uaaq.sagsm . 6"m0mvp go 10=39As atp pm 4T.ta3 I llMS"0 b samseam jo�ttoo uo�soza axW -- LsMd ad a palBaot Jim si :algQ , . LpatitoP Bann si pugd and sa pnm4woo uusAs si 4 MIG 40121dutoo tualsAs si :aIva Lpalaidwoo jig ut ncAs sl owl IM -Y,f Zf7W 491 T" Toil 0'/ JN:I. :OWN }unit"dwamwp tA1 W # lmaiad a0n. m4sua0J GHad •apetu Supq suotlaadsm sW4suul Aar of jsd pwl*m 41M aq waau auotgta ioiut [id IPA :jog MIUMaMlyma 403 ISM � wear MOLLbULLV TARS ILLTf 2m 'IVIABO MAM Rio NOI'SM(a JUL -12 -2005 TUE 13:01 TEL:845- .278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P Apr 07 2005 9:51AM RJ Stahl Architect, PC 914-251-0990 07/02/2004 12:495 -12@762388 MkRlOh CLIFFdRD -wee mm CMOY-owWT LOUVA MOLM" DEPARTUM-T (W NBAIe7H I G"mId*4 "WIN, ow T" low NOWOONNOWNW& (Boom -dbw F"JOI)M-100 rom wwm*%wf 011204'414* ftm fits) m-w4ffi p.2 PAGE 02 Ram*x 11 somy P; aft ALI 60tevAad to ob, - oundmd fkff twedw WWW91M dZApL 230, 2M. famprovOwadw fog mmoligni: of bo&wm mm rmdm AAWwWout Pdar mpmal by Ws 10 1* N—A Niue 46 1[ dJ[t1i�i0s T, MO own., mist bis li& widw twism: &9viom Lie.. RM bw Apr 07 2005 9:51AM RJ Stahl Architect. PC 914- 251 -0990 p.1 8000 wofthader $venue, purftw, row yoAt 10577 94 hiawatha road tb putnem valley new york 10579 April 7, 2005 RE: Brigham ' Residence 196 Lakeshore Road, Putnam Valley, New York 10579 Mr. Joe Paravati Putnam County Departrwnt of Health 1 Geneva Road Brewster, NY. 10509 VIA FACSIMILE 845.276.1921 Dear Joe.,. Enclosed are the'followirng items:.: : s6raia on 9 0 06'.M04-: 1 Letter For your review Joe, here Is the letter I have in my files. If you have any questions or concerns, please W free to contact me at 914.572.0366. Sinoerely,.Yourt , K KE. Molnar ergonomic design Ilc Q LORETTA MOLINARI Public Health Director ROBERT J. BONDI County Executive 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 Brigham 110 East End Ave. NY, NY 10028 Dear Mr. Brigham: June 30, 2004 Re: Addition- Brigham, Lakeshore Rd. Increase in'Number of Bedrooms (T) Putnam Valley, TM#41.05 -1 -36, 37, 38 I have received and reviewed the revised plans for the proposed addition to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approvarstamp from this Department dated April 30, 2003. The addition is approved with the following conditions: - 1.. The. total number of bedrooms must remain at three without prior approval by this _....._:_ -.... ,.._....._ _ __.,,..._.department.` . .. ......._ ._ _ __....... > _ � ____._ . .......�.. ro...:.._.____ ....,.._� .. 2. The area of the existing sewage disposal system, and its expansion area, must be constructed as shown on plans prepared by J. Karell Jr., P.E. R- 100 -03. 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 William Hedges WH:hn Senior Public Health Sanitarian cc:BI(T) Putnam Valley LORETTA MOLINARI R.N., 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 16014 Fax (845) 278 - 6648 Brigham 110 East End Ave. NY, NY 10028 May 2, 2003 Re: Addition - Brigham, Lakeshore Rd. Increase in Number of Bedrooms (T)Putnam Valley, TM #41.05 -1 -36, 37, 38 ROBERT J. BONDI County Executive Dear Mr. Brigham: 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 April 30, 2003 The addition is approved with the following conditions. 1. __ The total number of bedrooms must remain at two without prior approval by this 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. ML:Im cc:BI Very truly yours, Michael Luke Public Health Technician CD 1• - . • _ °� NOV ro Ul or 7. ICY PI • _ t. re Alm pia AMW Iqr4pw i CD Ago _ S cp CD ease O r • t • N r • s:T . zoo IDA ro VI FKI Or - .. `,�:.t�. .�5. b! •• - ., `— �.:,.,_��__ - - � -fit` cam--. �� • . j.. , �� _ - .� s ro �e �_ • _ ;ss+�r.. -: � -.: ire it �rt Itsk- ��� , m Sent By: LLL; 234567 ; Jun-29-04 3:47PM; Page 2/2 lb • v 1 A-.I �• • i "• P t • ` i pug � • � , � e ' i . ' IT • � O • � •y/ Q -', •� ,, � tit �' �• ° ••1 , 1 +••' • ��, VI •1 ! 0 op • r Is s � • _ P Oleos •' • I e� � �p 1 • 1 r ate, -oe. r. -.,,. •P�.•° +�.. i.� •.r' •, •,•••• .p �. .- `7 ' ••�'��Q } • ' , ' ~•• -. •• 'w�— • •. b • � . • •� . Gib �•A/I• � �. • . i a d1•fj .. e..� • !. 1 •� 3L, p e • ;o JUN -29 -2004 TUE 15:13 TEL:845- 278 - 7921... NAME:PUTNAM COUNTY DEPARTMENT OF P. 12 i cli aj CL IL H U. cn N f - CE �/% �/T ,. , }y ♦ ' yip '� : Z EK LO ru CM rr •*I'� " ` '� '�i.� ` • In co :sib. 000 r) LLJ ru i 0 Z m , - - � b BRUCE -& FOLEY PWblte Htalth •-1 irmlar• LOREITA MOLINARI RN., KSdd. Assoclas Public Health Dhgctor DiP #q . of Patitlw8 sStmees 1 Geneva Road Brewst ®r, 'New York 10509 £avlraansental Health (8$5)278.6130. Pie(8 45) 278 -7921 Nursing Servtces (845) 278.6538 WIC (145)170.6678 flax (863) 278.6085 Bony Intervaatlon (86S)278.6014 Prudaol (145)278.6032 Pa(843)278 -6648 ADDITION APPI,IC&MN S G � STMT TOWN �� Lxe M�W woleic- NAs W ILL1 A< DESCRIPTION OF ADDMON U Q _ 6 ,01U4 III o�lY — �3�1371 3 9 P Y EL I oo 2.e WJNSBER OF EXISTING BEDROOMS PROPOSED I OF BEDROOIMS (MOM CERT. OF OCCUPANCY OR CERTMCATION FROM Ht MDING INSPECrOR) *Any addition whack is considered a bedroom requires folsnal approval of platy (Construction Permit) prepared by a Professional Engineer or Registered Architect in accordance Math applicable sections of the Putnam County Sanitary Code. Please submit this -fornn =d-thP following to Putnam County Health Dept., 4 Geneva Road, Brewster, NY ' 10509, Phone 278 -6130. 1. Certified check or money order for $100.00. . i Sketches of existing floor plan (dmwn to scale, all living area including baserment) "Non- professional sketches are acceptable. _ 3. Two sets of proposed ilaor plan (drawn to scale, * vid wane, iiiet and lac map 0) *Non professional sketches are acceptable. 4• Copy of survey showbS %Q and septic location, to the best of your kmowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property lute. Contact this office wrath any questions. 3. Copy of Cert. Of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. ®ff C,t" USE Comments Feb9� l3Fhotbsegul9ellaes . 4 •ter trl 'AI' Vuj �. A, BRUCE R•FOLEY ..,, Mlk Health. Director DEPAR'T'MENT - OF 1 Geneva Road Brewster, New York I LORBTTA MOLINARI RN., M.S.N. drsociote Public Health Dh+rctor ��� :Dkdor o f _. Patfert Ssrrices I 10509 8nvlroncnental italth (145)278.6130 Fa(84S)271 -7921 Nursing &xvlees (84S)279.63S8 WTC (845)278 -6678 Fa:(84S)278 -6083 Ear17 1ntervendcn (84 $)278.6014 Preusoel (143)2784082 Fax(845)278 -6648 ADDITION APPLICATION [ItES�FNTIA %ONLYI C %V �� �fl 05 -1 STREET Tr�(�E -�f '�Y�O�U TOWN ��7n�9�9 MAP; o�2� - l- NAME W lL�l g < () )� wPHONE ?n) MAIL TING ADDRESS -30-1132r DESCWnON OF ADDMON QAf Q 0 NUMBER OF F.MSTING BEDROOMS PROPOSED A OF BEDROOEctionP=ho)' (FROM CERT. OF OCCUPANCY OR CERTffICATION FROM BUILDING INSPECrOh) Gj *Any addition which is considered a bedroom requires formal approval of plans ( prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. PltasEiutbmit_0,form,and the following to Putnam County Health Dept., 4 Geneva Road, Brewster, NY' 10509, Phone 218 -6130. _.. 1. Certified check or money order for S100.00.. 2. Sketches of existing floor plan (drawn to scalp, all living area including bas=mt) •Non - professional sketches are acceptable. . _ - 3. Two sets �of proposed floor plan (drawn to scsl;,%-AA,name, sheet, sad iax map #j •Non professional sketches are acceptable. 4. Copy of survey showing well and septic location, to the best of your l nowlcdge. Include date of installation if known. Label all wells and septic systems vrltbin 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. 0 CF, 7 E USE Comments Feb98 BFhoaserddeilties 4 - - - -- • - '' r�rrnrot rrt 'nv vv.T ' ,UtIVU A117 1101 mvvn r my r7.r• nn► to 7 ?nr C® PUTNAM COUNTY HEALTH DEPARTMENT ETV�IIRONIVIEIVTAL HEALTH SERVICES- PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAID OFFICIAL USE ONLY SITE LOCATION OWNER'S NAME_ MAILING ADDRESS Lc,Ve sAar 2d //a r ( P- V' /' TM# Y/,, nS" / 3 G, 3 -7, 'S y PHONE .(L, z) 83" 2 - 3 5-9/ L1 /O 0 2-� PERSON INTERVIEWED Cat ylQ i PCHD Complaint # Name & Kelationstup i.e., owner, tenant, etc. DATE TYPE FACILITY PROPOSED INSTALLER PHONE ADDRESS REGISTRATION# Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system .Different location may require submittal of proposal from licensed professional engineer or registered architect. I, as owner, or reported agent of ownejagr SIGNA �0" -1 4:71z� ?hd' 'ons stated on This form. DATE PLgjposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name b. Site Street Name, Town and Tax Map number. C. Location of installed components tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Proposalapproved Inspector's Signature & Title COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99M L, constructed id 4,t by r,Supp y; ;!pPubljc:,Su`poly From PUT NA ivision 0.thvtr0*j R UCTI QN _PERMIT FOR, SEWAGE :DISPOSAL "Address L -Vive"..1-0. 4 ty AU. Owner t .Building Type Lot Area' AT '0 constructed id 4,t by r,Supp y; ;!pPubljc:,Su`poly From rivatet,'Supply., o_ be drilled "Address L resent Ahat,l am wholly' pnd,comp,ietply -r,i.iS,P,O,niibie.f.or.thp, design -,,ar' ,e' Wli! I qe'constructed - h' ,Pdicribe as.,s oWjn..onthe.@pp�(?ye, 6�6bfidffiiiii . - 1..." 5 .11 11 ..,, 1 1-W ilyJ.Dboartment of Health and,ihait'--06.6'0'niOl4tion'.t'h"'e'reof-'&.'!Ce��i written guaran ee.willi Obike-8 i6'ihe. pepartmen't'a,n,,�a_` be', u-V' n ;400d' oi�erating scondi ion'any 'part of*.`siid,sewa dt"'zi SIP !Sppsp o :ih 'Ahe. Sj f` ,the ap'proval'L of Certificate :o Construction pli6fiee e belocat6d as show 'h�6filhe`,aPiii6ved pianjindAhAt said -wel l' vvill'b "e in ity,',bep`akrnent o Mealth_' ;June _1974- Lane, ROVED FOR �CON'ISTRUCTIONi-�T,.hi!;.:approvai',expires one ',yepy.46 ratile f4r.cause oririay.be amended ,or m6di44when consideied:ne( gyres nevy_perm! Approved 6_ vecI foi,disposal of. domestic '.sanitary EPART11fENT OF --_J-MALTIF 41 Vid ----- 777:' 40. CV-08)"' J0019. Total GOO.' re 'Feet Septic Tank �F X5125 lineal feet X 36 ! .1 Square -width. `trench,�- M on T 21 S t et-, location of the proposed3ystem(s);�1) P tV that the ,seli6e6te sewag6',;disi56sa*l','syitem here torand in accordance with the staritlards rules:an - regulat .ions '.of. the Putnam i caii.�of Construction .,C ompliance"satisfactory to the dommissi6ner`of Health will shed ' - the owner -at,"sil cf f4rii.bVl'lie 6�1'lder' that i builder will stem Aurinq.the jperiod .6f, two (2) :'year' 49"the4atd,,of the Issu, ;ir*i1ther6to',2) that ih6 original" system -'or; any ,. repairs the`drllled)Well.descrlbed above slled in. c n rU ' jes, 6dgu1aT=ns7i :,thd i� Putnam'. i •g V, 'R A. :!-,7608 1 14533 License No, 7 14, is-construction 1 I the ,_4,n! �:, I "o . f. the; '� has-been undertaken and -is jte t t *�Assibridi7of Healtli. ,AAy change or. iiiteieiioif of con'struj�ion ;sa f e and/t supply only - e } Y.f� PUTNAM COUNTY DEPARTMENT OF HEALTH ..... :.. .. D1VYSxtiN' Ot `EIV�iI %f�ONM NTAL - HEALTH SERVICES' Date P4 A `f Z 8 197 Re:' Property of FIVE G. EA1_-r 0 C Located at ;,AOA41NC c04! XAleg pvrAW44 yW "EIr'., Section Block VS-A& P44P Lot 399 31?e 39Y Gentlemen:. This letter is to authorize; ":3>Ad a t G y e SE 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 k:UA1,ieQ Liva, w.L Lr1 Liiis ma c per ailii to. supervise the constmuc ciun of said system or systems in conformity with the provisions of Article 145 or 36*n °Law; t ►e� Publ -ic ;L--a1th Law,• and •the- - %t asim' County° Sani _ tary Code. ,RV V ARCS 0� E AR(, �T �� `O G F 80 OF THE STF10 OF ° Countersigned: Very truly yours ,_12 d Signed r Property ZY® wa s P rl Cr. A). y e. _ Address P .E ., R.A # 1&0 Address ®RVf &creAe Al. r. Telephone Xf/ b 8131 Z/I J u 6 e Af f7 ®® Telephone PdELL CONTLETION .13"EPORT PUTNAM COUNITY DEPARTNICtJT OF HEALTH x)71 Division of TnWlArrrTQnLQI Fl�vltrh Services % COUNTY OFFICL• BUILDING - CANMIL, I.L111) YORK This report is to be complelodJ by well driller and submitted to County Health Department together with laboratory report of analysis of water sample inclicating water is of satisfactory bacterial quality before certificate of construction Cofit)iliarue is issued. REROR °r I'��US7 BE SIt�,JfIT7GD y'JITI SIN 30 D�1Y5 OF Ir�IELI CU "?`��•�`(0 OWNER NAME,, _ —_ FIVE G HEALTY TN ADDRESS �� — ,� •��� West 250 57th Street New York 10019." LOCATION or WELL _ (No. b Street) (Town) (Lot Number) SHORE ROARING BROOK) LAKE PU.TNAM VALLEY •398. `PP.OPOSED USE OF WELL SLAKE' jDRIVE., _ BUSINESS UX DOMESTIC' l_J ESTABLISHMENT D FARM LJ TEST WELL � • PUBLIC y AIR OTHER 0 SUPPLY El INDUSTRIAL CONDITIONING (Specify) DRILLING EQUIPMENT COMPRESSED CA.6LE OTHER kOTARY ��-ti1R+EF::.USS'ION a -PERCUSSION (Specify)' CASING DETAILS LENGTH (feet) DIAM�LTEP,(lnches) Y /EIGHT PER FOOT MX. THREADED 0 WELDED Dta E'RHOE RX YES [I NO WAS CARING (;FF,�Pk; ?- ® YES l—J NO YIELD TEST HOURS G.P.M. LJ BAILED (,J PU)APED X COMPRESSED AIR five fifteen YIELD (G.P.M.) . GPM — WATER LEVEL SCREEN ____13 MEASUPE FROM LAND SURFACE— STATIC(Specifyl DURING. YIELD TEST f leet) . Depth of Completed Well 20 in feet below Land surface: MAKE LENGTH OPEN O QUA IFER (feet) DETAILS SLOT SIZE DIAMETER (Inches) IF GRAJL GRAVEL SIZE (inches) FROM (loot) TO (loot) Diameter c well including I grovel pack (!Holes): DEPTH FROM LAND SURFkE FORMATION DESCPIPTION Sketch exact location of well with dislancos, to of !oast two permanent landmarks. FEET to FCET 0 10 (Drilling in overburden — cla and boulders .... ... ,. - i HIT SOLID'ROCK AT TEN FEET 10 20 ,. Drilling. in rock.--.setting 20 170 Drilling''in rock _' granite If yield was tested of different depths during drilling,.list below FEET GALLONS PER MINUTE —UATE WCII COMrlE1CD )Al'I: 01' flu.oitl 7/16/74 FE:L.L I)riILLCR (Siynatutu) ; . .. �.iz� DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner 'FIVE G. IREALr`( WC Address t5® !A_ Located at ( Street axve $N`aff • 1>0.1u g " Sec. Block Lot 3M 398 e 3 9 Indicate nearest cross s ree Municipality 9y -r63,%aA VAI- .El Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water a er Levei No. Time From Ground Surface in Inches Soil Rate. Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 5 2 3 5 Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. 2 3 zig 5 2 3 5 Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. DEPTH TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES— f/t 9,0 41,,00 Q 4E,10*4.4 -fe HOLE NO.- f HOLE NO. L HOLE NO. bn— ...- �- ..�.�- __..xro�.. A... ,. -. �-.. �, _.,�.....m..- .-?..- ....�- r..wr. m .. ..o v+...,.u.. :.. a.,,. w... a..�._....w- ...w.,• :- ..w. -:.... <. ,..�_w. -. ,m.e .r..., � :ne.,- .:.�.- r_= .s..,.or_..n••.. .:n.. ..s.�w...a...�.:. 6" 12" 18" 24 "' 0 i 30" 361 4221 4 if 601 66" 7'2" 78,. 84" AmEA PAwci -va of CIO INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO,.WHICH WATER.LEVEL RISES AFTER.BEING ENCOUNTERED 417 TESTS MADE BY -;p�A%oi to C+t.Nt SE Date 1 A,t ♦7 }cj/ - -�- ._.,�- ---._ � � :. ... . .._.- - -.:_. .. _.- ._DESIGN ------- •-- '•- - - -_._ _ . __.. . - :..__ .. ,__... _._ .._�_.�: _...._.._ ...:_ . . Soil Rate Used Z L , -MirVl "Drop -S D. Usable Area Provided oust S000 SQ,F r, No.,of Bedrooms oj�E. ;Septic "Tank..Capacity /��o Ga.ls... �' ° q. I�A.S_ Absorption Area Pry By /2 5 L.F.x24" Y Address. FARGo : ti,&Pq- �RV THIS .SPACE FOR USE BY .HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. R /Cal. Checked by Date 'owner 11i �A G .4e8;LY-,. Inr- Building Type -Ranch Number: of eeilrooms 3" . ...... wl consist of 4 Separate Sewerage. SysteOn';16 T -o'!be constructed bY-' `Supply From; water Supply: t ate Supply, to Aess dqress -Other Requirements id Urtid I represent thatA' am wholly afid'-dompleti§19- rest iicive•dekribed will pecpna ruc!ed' as show ' n-ori" County 66pariment,"Of e Health, a66'ttiat" o ,n'c6 be submitted for the -I&epit- t d men . .an _ a- :writb o0eratirig condition - any"parl, 0 ,p Age in good - 0 f Anqe,of the iapproval of'-,thi Cbrtificattit Co will be located 'as,showpRn.'tqe-appf9ved plan a4i County bepartmb'nVio "Health Vat - is L:E -i -6. 'Address APPROVED FOR CONSTRUCTION .:This ;apps ' � may be amended or i revocable fo r cause or requires a- new ipermit.",W-kpproved for disprosa A "'0 zi AM,COUN Ca V Area' J-A tiled "by� :Barger r--'7c etion thereof a" uar,antee will be id' sewage -dispoi Tres one n' considl test Ic "'"i OEPARTMENT'.0f. HEALTH ,-Health- Services, 'Carmel; IV.- Ive 11ey(T) TO& iere to and in #ctpirdincewith the l Town .Or-VJI!Age 6.0 :ate:- of-Constructio .dom flanc y n 4OR Mi ioner of 9 -j 7 I� Job Lot 7 rOjthAt said, I T94the date 250 west 57th Street a -dr all described ,Address 5��'of t % N&.1 Y6rk, 1VeY. 10019 x 18M -- "bial ,Habitable. Space SF + Square Feet Septic Tank lineal `6 width trench Stevenson eve kold14�,N.Y, rbet-• N. Y® A%L n fjhe._� 0 iWaftle sewage c proposed system($) lisp, iere to and in #ctpirdincewith the l gelations of L tI 6.0 :ate:- of-Constructio .dom flanc y n 4OR Mi ioner of . he'dr the, owner,. his successors, hdlr n am during. thiii- per i bd'oi two rOjthAt said, I T94the date - the original o� any rep�wr r 0 a -dr all described -wi -h 'da s lied . in '- accordance e gta 5��'of t 0 x Healthwill builder will of the Issu- ribed above he Putnam OL- R.A. S 21846 T001011444-'14Y.- 1025—"w ru the.dite issuecCuriless 6onstructi n- 0 05s been undertaken and -is ary by, the- Commissioner issioner of Health. 149 6-handb or Alteration of constrqdLjn Ige 0 , fig Tr p supply only - 4* ;. > PITTNAM 'COUNTY DEPART:MENI T OF IE,ALTIi DIVISION -OF ENVIRONMENTAL IEALTH SERVICES COUNTY. OFFICE. BUILDING; CARMEL, N. Y. 10512 DESIGN DATA SHEET_, .SEPARATE SM4AGE DISPOSAL` SYSTEM FILE-NO. Owner " Five G'. Realty Inc. _ Address ." 250 West 57th Street N.Y. N.Y. 10019 Located at 'Street 'Lake Shore Drive Map 308G ( Sec. Block_- Lot 397,39$,399 n.fca e neares-,cross s;ree- Mun cipality, Puttam Valley (T) Watershed Peekskill SOIL . PERCOLATTION .TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK,TIME PERCOLATION PERCOLATION nu.n Liapse ueptn to water, water Levei No. Time From. Ground, Surface in Inches Soil. Pate Start -Stop Min. Start Stop, Drop in Min. /in drop Inches Inches Inches (1) 1 "Hole filled with water to 19" Depth 2 _ .4 Hole Filled with water to ..18. " Deephh .... :.:. Notes: 1) Tests'to by repeated at same depth until approximately equal soil rates are .obtained at each percolation test'hole.. All data to be submitted for review. 2), Ippth measurements to be made from top of hole. y . TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS isNCOUN :['EKED IN TEST' HOLES DEPTH HOLE NO 1 HOLE NO.- 2 HOLE N0. 3 G.L. 611 Topsoil 611 Topsoil 6" Topsoil s.. 6" sandy gravel Sandy gravel sandy gravel 1211 with traces . of with traces of with traces, of _ 18" silt & clay silt & clam silt &.clay 2+11 — r 30:n 3611 42" 48 511 6o" 66" 721.1 ,T8f► 8411 18P1 IlVDTCATE LEVEL AT YMCH GROUND .WATER IS ENCOUNTERED JINDICATE ..LEVEL TO WHICH WATER. LEVTa ,__RISEZ', PdG _EIVCOUNTEFiF'D' ° , _ - TESTS MADE, BY James Romanelli Date August '49 1973 �— DESIGN 5000 SF Soil Rate Used Min/l "Drop: S.D. Usable.Area Provided No. of Bedrooms 3 Septic Tank Capacity 900 Gals. Type Ma ®h Absorption Area Provided By L.F.x24" `– O width tr Y& LIFO FF a. . -to -be determined after' fill placed and tests made° Other s R AQV, , Fo y Address 1-Northridge Road Peekskill, N °y I MAk 0 grna ure a ° ,, O � ®� a ® -v ' ° SEAL o- - 0 27846 °° 0 — ®gat NEW �O� °°° o THIS SPACE FOR USE BY HEALTH DEPARTP T ONLY: _ ° °ooO°° Soil Rate Approved Sq. Ft /Gai . Checked by ..Date F' . . Pti+nw.. ra. -...e. a..q.. v.•.c .w+.,w.t. ...y..yy i � -' - Tn .C: ..r. :.r mTn .r...,._..w. PUTNAM�COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date J0t,Y Z4- ¢3 Re: Property of FIVE Cam.; -R -FA GT?' /,v C, La�eA re Located at - RoAR/NG 'b tooA A& K. ru� Apd VA 44 � Map 308G I � t, �ti w A� Section Block Lots 39'7 , 3 9 84 3 C/ Gentlemen: This letter is to authorize John S. Romeo a duly licensed professional engineer x or registered architect (IndicaTe"T- to apply for a Construction Permit for a separate sewerage system; to serve the above noted property in accordance with the standards, rules or regulations as promulgated by the Commissioner of the Putnam County Tla•.ra. y1- w...a. �- 01" TT... � l 11 7 1 _ S all a1 IDepa,l 11 ent- V L Meal -h, and o sign all n,euessary papers on my behalf In connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147', Education Law, the Public Health Iaw, - -and the Putnam County Sani= tary Code. Countersigned: P.E., R.A., # 7%6 1 Northridge Road (Seal) Very truly yours, Signed Own o operty 2 s� �✓c sT � 7 s?' Address ,Vj�_w YaA-K N.Y. 100'q 7/Z Jv6 y7 ►O e ep one p°••.•• Peekskill, N.Y. lo566 ® �L 0S EN6�afr9 :. s. • o F�: PE7 -1056 o y• Telephone o w • f tJ°f ?7846 s ®° 7 Of NEW ••..s• `.Located at RQAkil4p: B1 Separate Sewerage System bwlt` by ���++d Gll ig Consisting of. 1 4. Xo0Gal Septic_ T�enk Other., recluirernents'' 6iA �tiY B p �x Water Supply A V` Public'Supply;'Froms X = Private\Supply Drilled. =By Be; Address Bre Buildih9 Type }7 iz a Fam ?Has Erosion Control Been Compl x l carfify that, sydtem tfie (s) as listed 'attached) a nd in accordance with ;aDate Any person occupying,.premises se -conditions re a "vailable._ and subject 'to m S ,�40ate from such :us >proval of the> tiorr'•or, changE R, tLiWGL�i rving the "above premises wereconst e. standards, rules ;a -nit regulations, � Certified i d-by the above A p Proval c vate - water. sup iheh, ,n the ji = ByiL u1,o� ?SPAR'TMENT :OF_ HEALTH` 'alth Services Carme %; M, Y '105f2 VV "'ACiO ,DiSFe� I►1 YSTch� PUtUdM Valley Town or Village J)rive' Map 08G ._( I Sect,o n Block Lot JF�*30.84 37 Job' Jt:• _1�._ lrvingt ©a, �T•_ Address An* Feet X. 3C-4 width trench v s- Yt� No oti :Bedrooms` one bate'!Permit issued I ed esserit,ally `shown on the plans of the completed :work (copies of which are CIL filed, an he `perrTjdt is by the: !Putnam- .county Department of Health, R.A. X ;viQ License !No , ptly take such action as may be necessary to'secure the correction of-any unsay Nry, §e system shall become null and void as soon:, aS: a'.public :sanitary sewer h t and void ,when a m 'public ,water supply becoes available, Such apr' 6' siiohe:r.,oi AeA lth:j7 such`° revocation 'moc!Rication:.or .change is necesr Y Ma � r j c Tit le I �(Vv-- G RR ALTt IuC...._ ►jwnci, L)r Wrciias,er oL i3ui.Lding �. t v. G ... R EA Lt Y' I N C-. buil.01»g Cons tructed„by, Location - Street p�IV &TIC 'RrcSlb�'NC,. ., Building Type Municipality ,MAP. . 3a8G :.... ..:. ...... Section", Block 39 7 3q� 3yi'. Lot GUARANTY OF' SEPARATE SE[VAGE 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 guaranty 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 initial use of 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 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'will ful or'negligent act of the occupant of the building utilizing the system Dated this day of 19. Signature Title (if corporation, give name.and address THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COM LETION IVILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST-USE OF SYSTEM. - - - _ •- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Divis icn of Environmental Health Services, Putnam County Department of Health BREWSTER LABORATORIES Box 2.24 - ..BREWSTER, N. Y. WATER ANALYSIS REPORT SAMPLE No. 3227 SOURCE: David Gutse ( ?) — hose bibb — well supply Lake Shore Dr:. Putnam. Valley, No Y. COLLECTED: July 11, 1974 BY: P.F.Beal & Sons, Inc, BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method Q per 100 ml. 1r1- This, result indicates the source of the sample was of satisfoctory sanitary quality when tht sample was collected. July 13, 1974 y Bickwit P. E. Director i s...:.. C;oYei alb • • - . Pd /or Pote 2.5'out 0.5'ou a,t S5070'00 'E Stone MosaarY Wol/ Face Woll 0. . Face 0.3in of Cor. / ;4 d P,n & Cop 'Found" y OJ ou —_ 1.9 n I' .pe F . 0.6S0 6 'W i Crow Lbly +j O � � _ J. '� 1�1 a PEI s Po% E/e .Po — h 3in tl` 100 w .. Ll9hts 4[7 g J 4 41 ,�►v <$ ° BoX b � D � o 64.2 ° 200'+ tope V- I 6YoWit Drlw _ ... .. .. ESP h(LE � 3 I 399 �W \06 °Ga Drop Inlet Q R to N [� ti Conc.Pad ISO 0.3'ln I 00-P inlet Pipe Found ry Pipe Found Pipe & Conc. Found O.Jin 0.2 out ge9,Stock.rence O.1�out ' Stockade ce ie200' 7�ao,.O&nk Fence 0.4 but I 2'W V507000 "W J.2'oul 1 Jou t µgod S ock Pne i ain. Manument0. ouut I I tX 5Sb5 IZS�� -- 'PARK" of Roar/n9 Brack Lake .... rvhkh was Red y the '., . PRoP- SSA, ZYQL� � or d f947 os Map Na ,jDe -H._ fourth Mop See Putnam County pant's office on Febru .Y S�Lf • � .� . r, i A Putnam County Department of Health Division of Environmental Health Services SSTS Repair — Final Sitee Ins pq�tion Date: e/7 / / Irispected.b . � {IGe�)C Installer: C, Street Location: 926 2 k--e— skoru 7zd Owner: ; �1 Town: - cvi'a`s� i%af+e% : Repair Permit #: 7Z : D .2-:6 —1 �! TM # 1. Type of System: Conventional O Alternate O Coaiments:,� 2. Se tic Tank Yes No N/A Comments a. Septic tank size - 1,000 ... 1,250... other ...... b. Septic tank installed level ...................... c. 10' minimum from foundation .................. d. Distribution Box Ii. All outlets at same elevation (Water tested) ... I I I I I ii. Protected below frost ............................. iii. Minimum 2 ft. Original soil between box & trenches e. unttio x —..ro erl set...................... ...... .� E Trenches i. SystctiDofiipletely opened for inspection ii. Length requ�red Length installed iii. Pipe slope checked .......... .... ....... ............: iv. Installed according to plan ..................... v. 10 ft. from property line — 20 ft — foundations ... vi.. Size of gravel % - 1 '/a " diameter clean ......... vii. Depth of gravel in trench 12" minimum ......... viii. Ends c ed .... ............................... R. Pump r DeAM Systems 3. Sewa e S Area a. SSTS Area located as per a roved plans b. Fill section— c. Distance from water course/wetlands i 4. Overall Workmanship a. Boxes properly grouted and installed correctly ........... b. All pipes flush with'inside of box .... ........... c. Backfill material contains stones <4" diameter ......... d. Curtain drain & standpipes installed according to plan e. Curtain drain outfall protected & dir to exist watercourse E Footing drains discharge away from SSTS area ......... g. Erosion control provided ............................ Additional Comments: RFSI Rev - 011312 Cv G ✓f�!' i -�- -Fo �yCt� c � r� ,c7,,-eJ ssTS �r��,o �� pla,4 d4d 14,4- G& AeC-e4 4-o r", k �� %� �� ®ice 2tf . Putnam County Department of Health Division of Environmental Health Services SSTS Repair - Final Site Inspection Date: �- / Inspected by: 'zde e / /4 installer: `!%o �z EEJr�a�ye `e Qwn r._- ......... Shot L _ tion,� -_ 5 lam.. .L�s,a►,: ~ 'R :. _ .. TM # 4//. � - � 3 7 Town. , Repair Permit #. -046 --14' 1. Type of System: Conventional O Alternate O Comments: 2 c Tank Yes No N/A I Comments a. Septic tank size 4,1 W. . 1,250... other ..... , �- b. Septic tank Instal, led level ...................... c. 10' minimum from foundation .................. d. Distribution Bpi, i. All outlets at same elevation (water tested) .. . ii. Protected below frost ............................. iii. Minimum 2 ft. Original soil between box & trenches e. Junition Box - bidperly set ... f i i. S co inpletely opened for inspection ii. Length required . Length installed iii. Pipe slope checked ... ............................... . iv. Installed according to plan ..................... V. 10 ft. from, property line - 20 ft - foundations .. . A Size of gravel % -1 %" diameter clean ......... Depth of gravel in trench 42' -'. minimum viii. Ends pamwor Dowd It. IRS 3. SyNkIN Ana a SSTS Area located.as per approved plans b. Fill section - c. Distance flnm water coursetwetlands 4. Overall Workmanship a. Boxes properly grouted and installed correctly ........... b. All pipes flush with inside of box ............. ............. c. Backflll material contains stones <4" diameter ......... d. Curtain drain & standpipes installed according to plan Wit. - �e'r'1% +At 9 e. Curtain drain outfall protected 8c dir to exist watercourse j N14n f. Footing drains discharge away from SSTS area ......... tSet{ -I�►� m c�s� -+'n Pain e ax << /.a " a g. Erosion control provided ............................ Co.tcr c {,e ./o a l eh ks Additional Comments: i RFSI Rev - 011312 PUTNAM COUNTY HEALTH DEPARTMENT S DIVISION OF ENVIRONMENTAL HEALTH SERVICES f� t?-�;�?.k- :._ -__.. OPOSAL- -FOIE SEWAGE- -REAT ilENTYSYSTEMAREPAIff3:::..._. . I mov Internal Use Oniv PERMIT # .,1Z — ® Z U I ✓I Repair Permit issued in last 5 years Lid' Not in !Watershed ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. @ Delegated ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION i iTOWN ' TM # OWNER'S NAME P ONE # Car S .1 MAILING ADDRESS ®S" APPLICANT ' Name & Relation: DATE - 1A�ell ' PROPOSEDI ADDRESS (i.e., owner, tenant, FACILITY TYPE PCHD CORPNT # % .� If PHONE # = a ICENSE # 10S Proposal (include a separate sketch locating the housb, property lines, all adjacent wells within 200 4wt of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the . nature onri octant of the rcnnir cr► n cat e: es,Q =vi sa at- -1 -i-wro r V%. ca r -0. ! Vt , I, as owner,agree to the conditions stated on this form SIGNATUR 14��, TITLE 1�711 .AWA- DATE (owner) _... -- 1; the septic installer; nee to co ply it the condition's of this pei it for tfie septic system repair SIGNATURE TITLE NN)cftAa -� DATE 3 ,A5 ► 4 (Installer) Proposal approved with the followi q conditions: 1. Procurement of any Town Permit, 0 applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. No completed work is to be backfilled until authorization to do so has been obtained from the Department. .0�M&A A I �&fi v 1191 QnfmP4L VJIC VRILY Proposal Approved Proposal Denied ❑ z h: Inspector's Signature & Title Dafb ExpiratioK Date Repair proposal is in compliance with applicable codes Yes No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 qj,ul Kou 15 f co Ir T(A nQllft V� tk �tw .7, n. 1547 4. OF V a` AWho /f I if an AOA HOe 4E UN b i� \ cr; ,L - Cb ��P aide 5 P °ot� � ,�b i � _ .. .o . jo}S a� °U° \ Ma not }oP,00, j ✓Y :� / ] A �J/�I�° t" , H 3 � O-N Page 1 of 1 Subj:, ,- ., , 196 Lake Shore, Road Septic System Repair ° -- ""` �aite`i"`�" �7�5%2`U�'4 6.32: P:1Vi. 1= asfem`l�aylighf Time From: wabrigham(d,)aol.com To: leslian n. giraino(cbputnamcountvny_gov Lesliann: The contractor who built my septic system nine years ago was here today. He believes he has identified where the leak is coming from and has proposed the repair described on the attached. His proposal reads as follows: "Trench 4' deep on South side of septic between fields and drain pipe to lake. Install poured concrete to within 6" from surface to stop septic from leaching into stormwater system." Also attached is his drawing of where the trenching would be done. It is highlighted in yellow as is the approximate location of my well. He told me that he could do the job this week if you approve his plan. Please let me know about this as soon as possible. If I need to do anything further, please also let me know. Bill Brigham 196 Lake Shore Road Putnam Valley, N. Y. 10579 (845) 526 - 1919 i bLi� , �•� 4 Thursday. March 27