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HomeMy WebLinkAbout2263DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.06 -2 -39 BOX 20 .. i oil . ir -� 02263 PUTNAM COUNTY. DEPARTMENT 'OF HEALTH Permit i1 3 Division of Enwronmenta/ 'Health Services, Carmel N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Putnam Valley TO W 11 or , cage located at Birch Road Tax` Map : 7 Block 2 i.ot `. 3 subdivision: R ar n $ro .k Likv subd IqA L 3` O Renewal _Q Revision _Q o Owner %Address an act a i l '� Date Of Previous Approval Building Type Lot Area (1) Fam Res 0.5 AC;, Fill Section only ❑ ,. Number of Bedrooms 3 Design Flow G /P /D 600 P.C. H. p j tigirjqtion Regotrea Separate Sewerage System to consist of 1000 ; GaL Septic Tank and Of 2 wide eachin `trenches . .. . e -ev _ 9 . To be constructed by R FlOrent3n0 - Addra« ll paf Va zT Water Supply: public, Supply,. From XX Private Supply to be drilled by ,Norman Andersen . Address B arge•r St. Put Valley, NY 10579, Other Requirements 3 ft of bank, rl_tn' fi 1 I represent that I am wholly and completely responsible for the tlesign and location of the proposed system(s); 1) that the separate_ sewage disposal_ iystem above described will be constructed as sgown.on the approved amendment there to and in accordance with the standards; rules an .regu a ons o e u nam County Department , of Health, andthat on completion thereof a 'Certificate' of Construction Compli ce" satisfactory to the Commissioner of.Heaithwill be submitted to the Department, and a written guarantee'will'be furnished the owner, his successor ears or'assigns by the builder, that said builder will place in good operating condition'.`any. part oi-said sewage -disposal system during the _period oft o 2)y ears immedlately following the 11 of the issu- ance of, the approval of the .Certificate of, Construction - l:ompironce of riginal system or any re iris thereto; 2) -t t the-drihed well described above will be located as shown on the approved plan and that said well will tie'inst ied i 'accordance with dards, rule ,and ►egu a� O of the Putnam County Department of Health. Date 7/1/83 ned P.E. R.A. XX uafio °ac N 105 11056 Address Lic nSe No. APPROVED FOR CONSTRUCTION.: This approval expires:.one year from. he to issued ruction of the buildin has been undertaken and is revocable for cause or may be amended or modified whemconsidered neces 7y.: y'.the C missione► o ealth. Any change or alteration of construction requires a new ermit: Approve for disposal of domestic w e, nd/ i t e nly. 7 Date �" ^.� By Title Rev. 9 -81 . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Jurk�..6., .1983;_..:..: Re: Property of Tablinsky`& Hecht Located at Birch Road (T) 7 Section Block 2 Lot 3 Subdivision of Roaring Brook Subdv. Lot # 330 Filed Map #. Date Gentlemen: This letter is to authorize Joel Greenberg a duly licensed professional engineer or registered architect XX (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 systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned: P.E., R.A., # 11056 Muscoot North, RFD #2. Bx 488 Address Mahopac, NY 10541 914 628 -6613 Telephone Very truly yours, Signed Owner of Property 155 Duckpond Rd. Nrth. Address Wantagh, NY 11793 Town Telephone 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 R. Tablinsky Address 155 Duckpond Rd. Nrth., Wantagh, NY 11793 ..0 Located at (Street Birch Rd. Sec. 7 Block Lot 6dicate nearest cross s.ree Municipality Town of Putnam:,Valley Watershed Hudson River SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION No. Start -Stop apse Time Min. Depth to Water From Ground'Surface Start Stop Inches Inches Water Levei in Inches Drop in Inches Soil Rate Min. /in drop 1 1 9:30- 10i.00 30 16 18.5 2.5 30/2.5 =12 210.01 -10.31 30 16 18.5 2.5 / ?,5 =19 310:32 -11:02 30 16 18.5 2.5 30/2.5 =12 411:03 -11:33 30 16 18.5 2.5 30/2.5 =12 5 2 1 9:35 -10:05 30 16 18.367 2.367 30/2.367 =12.67 210:06710:36 30 16 18.367 2.367 30/2.367 =12.67 310:37-11:07 30 16 18.367 2.367 30/2.367 =12.67 411:08 -11.38 30 16 18,367 2,.367 30/2.367 =12.67 5 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. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. 1 MOLE NO.: 2 HOLE NO. G.L. Top Soil Top Soil r 6" - Silt, Stones & Clay Silt, Stones & Clay 1211 . 18" 24" 3011 36ft 42" 4811 5 60" if 66" 7 7811 � 84" it INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED None INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED /A TESTS MADE BY Joel Greenberg Date 5/31$3 DESIGN S61l -Rate Used 11 -15 tn/1 "Drop: ' S.D. Usable Area Provided 50000 SF No. of Bedrooms 3 Septic Tank Capacity, 1000 Gals. Type Pre =cast concur Absorption Area Provided By 400 L.F.x24" X 5b" width trenc . Other 3 ft. bank run fill Name Joel Greenbergf Signature Address Muscoot Nrth, RFD #21 Bx 488 SEAL Mahopac, NY- 10541 THIS SPACE FOR USE BY HEALTH DEPARTM-11T ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH Division `of Environment:/ Hey / ' Services, .Carmel, N. Y. 10512 Per x PV-37 — 8 3 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR, SEWAGE DISPOSAL SYSTEM Putnam Valley. E Town or village Located at Birch .Road. - _ 1 Tax'map '7 - - Block '2 Owner R.. TS}J1i11Sk�7. Formerly e! -.� Tax e�ap Lot.O. suba..rgt,a 330 3 Separate Sewerage System built by M: •AmoroSano Address BX 431, Shrub' Oak NY 10588 consisting of 1000 Dal. Septic Tank and 40OLF of 21-011 wide leaching trenches Other requirement: aft. Barik run' fill Water Supply: Public Supply From. XX Private supply trilled By Norman Anderson Address Barger `Street, Putnam 'Valley, NY 10579 Building Type One F .. Residence 1VO. of Bedrooms 3 Date Permit Iswed • 7/11/83 Has Erosion Control Been Completed? . I certify that the system(s)Ias listed serving the above.premiaee were 'Constructed essentially, own on the plan o£ +'the completed work ( copies .of which are attached), and in accordance with the standards tales an`d equlatione;'in accord oe' ith the filed an 'and the permit issued by the Putnam County Department of Health e' ? *' y s a 1/18/85 tr XX Date r f' Cert�fted by � PE RA. Add auMu'scoot' Noy:` RFD 4 4, Maho c NY ,10 , „e No 11056 - - Any person occupying premises servetl by the above system(`!) shalt promptly ~yak suc dionas may be nemsery to secu►i th eonection of any unsanitary conditions resulting from such usage. Approval..of the separate sswerage.i�y s all become null antl vo {d_as soon is a3 blk sanitary sewer becomes available and the approval of• the private water`.fupply shall'beco when a `public water suppt becomes av IabN. Such approvals are sub{ect to modification or change when, in the judgment o, th Commi;slon of:- Health; inch reioca n,' if{ cation or change isnecessiry. Date®r� CM ; t BY TftN Rev. 9 -81 Robert Tablinsk Owner or Purchaser or Building Michael Amorosano Building Constructed by Birch Road Location - Street Town of Putnam Valle Municipality 7 Section 2 Block One Family Residence 3 Building Type Lot GUARANTY OF SEPARATE SEWAGE 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 succes- sors, 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 occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the de- termination of the Director of the Division of Environmental Health Ser- vices 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. .41-'9 . Dated this 15 day of January 19 85 Signatures -`�-r Title Contractor If corporation, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPT,ETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County e tige�it. Health PUiNAM COUNTY DEPT, OF HEALTH WELL WOMPLETION REPORT . PUTNAM COUNTY UtPAfK 1 Mtn i vr nco%u s r. 3/71 d a Division of Environmental Health Swvicss COUNTY OFFICE BUILDING CARMEL" NEW YORK This report is to be completed by well driller and submitted to County Health Department together with laboratory report of artplysis of water sample indicating ter is of satisfactory bacterial quality before certificate of construction compliance is issued. REPORT MUST BE $ WTT�D WITHIN ?30 DAYS OF WELL COMPLETION I t OWNER NAME ADDRESS LOCHN OF WILL (No. a Street) jz:2�� (L Number) ®DOMESTIC BUSINESS ❑ plot0� ED ESTABLISHMENT FARM TEST WELL USE AF WE 'k SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ OVER) ® COMPRESSED ❑ CABLE ❑ OTHER ❑ EOUI ENT ROTAR ROTARY. AIR PERCUSSION PERCUSSION (Specify) CAS C IENGTM (feet) - DIAMETER (inches) -r WEIGHT PER FOOT j� ❑ N U DET lS � ry EN THREADED WELDED YES NO YES NO — Yf ❑ BAILED HOURS ❑ PUMPED © COMPRESSED AIR' G.P.M.. YIELD (O.P.M.) S Ti • WA R MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST fleet) j Depth of Completed Wall t in feat below land surface: —t MAKE LENGTH OPEN TO AQUIFER ;(foot) sc IN OET l5 _ SLOT 512E DIAMETER (Inches) IF GRAVEL Diameter of well including GRAVEL SIZE (Inches) FROM (last) TO (toot) PACKED: gravel pack (Inches): DEFTH F M LAND SURFACE FORMATION DESCRIPTION Sketch exact locat /on of well with distances, to at heat two permanent landmarks. FE to FEET + 1 s t i If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE _ PU e ,fie He? °,.,r DATE Ell C PLVECY DATE OF REPORT WELI�ORILLER (S' titre) 1 i' P..O. Box 99 321 Kear Street ; LOCATIONS: ❑ 321 KEAR ST„ YORKTQWN HEIGHTS, N.Y. 10598 245.3203 Yorktown Heights, N.Y. 10598 ❑ 201 BUTTONWOOD AVE.. PEEKSKILL. N.Y, 10566 737.8777 245.3203 O 495 MAIN ST., MT, KISCO. N.Y. 10549 666.3335 ❑ STONELEIGH AVE. (NEAR HOSPITAL), CARMEL. N. Y. 10512 278-° -' LAB # —� DATE TAKEN- F— TA,5 LIN Ky " H�CT77 DATE RECEIVED: DATE REPORTED: —.,-- 1 SAMPLE SOURCE: REFERRED BY: COLLECTED BY : J)�u, -P LABORATORY REPORT ' mg /L ^. ❑ ACIDITY ...... ........ ❑ ALUMINUM ..................... ........... ........................ ❑ ALKALINITY ........ ,.........: D ANTIMONY .................. &6ACTERIA,TOTAL /mL ... .•....................... ❑ ARSENIC .. ............................... ... ..:yWam .. .......... s ' x y•.• .� BOD.5 DAY .................. .............................. D BARIUM ........ ............................... .............., ,. . . . ... ❑ BROMIDE .... ............ ........a...................... ❑ BERYLLIUM ...` : . ................... .O CARBON DIOXIDE, FREE ❑ BISMUTH .................................. ....•.... .... 5... K ❑CHLORIDE ............... ............................... D BORON ....... j 4 ❑ CHLORINE ❑CADMIUM ....................:.......® .17017 0a". qq.'' ❑ COD .: ..... ............ ............................... ❑ CALCIUM .... ❑ COLOR •. ...................... ............................... ❑ CHROMIUM;101.1 ......T,,�y. OCYANIDE . ......................... ..................... D CHROMIUM (hexavalent) .................... ..... ................ =" 0 DETERGENT, ANIONIC ... ............................... ❑ COBALT .................... ............................... ............,.: ❑ FLUORIDE ................... ............................... O COPPER ....................:" ❑ HARDNESS .. ....... ....................a.......... •_ O COLD ...................... ............................... .......... ❑ MPItCOLIFORM COUNT/ 100 ml .... j'j O IRON ................. ............................... ...... ...... • . WTCOLIFORM COUNT/ 100 ml ..J............ ❑ LEAD ..................................... .............................. ❑ CONFIRMATORY TEST ... ............................... O LITHIUM ............................... ............................... ❑ NITROGEN. AMMONIA ... ............................... O MAGNESIUM .............................................................. (2 Ff F40GEN, KJELDAHL ❑ MANGANESE ......•• •` `' • NITROGEN. NITRATE ❑ MERCURY ❑ NITROGEN, ORGANIC . ... ............................... ❑ NICKEL ..................................... ...........:................... • DOOR ..................... ❑ PALLADIUM ...............».............. ............................... • OIL A GREASE ............... ............................... ❑ POTASSIUM ................................. ............................... '. .. ❑ pH' .......................................................... ❑ RHODIUM , ❑ PHENOL ....................... ............................... ❑ SELENIUM ............... ............................... ... ....... ❑ PHOSPHATE (orthol ....... ............................... D SILICON .............. ............................... ................ DPHOSPHATE (condensed) ... ............................... O SILVER ........................ ............................... ............ ❑ PHOSPHATE (total) ....... ............................... ❑ SODIUM . .. SOLIDS. SETTLEABLE. m1 /L . .......................... ❑ TIN ....................... ............................... .. »......... - ❑ SOLIDS, SUSPENDED , ❑ SOLIDS. DISSOLVED ................................... ❑ .............. ................................... ............................... _ • SOLIDS. TOTAL ........... ............................... ❑ ........................ o ................................. ... ..................; • SOLIDS. VOLATILE ..... ❑ REMARKS: .....?!:�.C(..S.i. ... ....Q .............. ...' ..... ... ..... • SPECIFIC CONDUCTANCE 0 ...... ... . ... ' ❑ SULFATE .:................. ............................... ❑ .......5e. .. ......... .. .. ............................... ❑ .... s. ❑ SULFIDE ' ................................................... ................................ ............................... ...............:u ❑ SULFITE .................... ............................... O .............. .. ......... ........... ............................... 'f._ .. ❑ SURFACTANTS ............ ............................... ❑ . ........................... ............................... .................... ,0 TURBIDITY ............... ............................... ❑ ........ .............. ........................: ».._.. _._ ....... p THESE RESULTS INDICATE THAT THE WATER WAS OF A'SATISFACTORY SANITARY QUALITY WHEN THE SAMPLE WAS COLLECTED, THESE RESULTS INDICATE THAT THE WATER DID ViliHEET TILE SATISFACTORY CIIDIICAL QUALITY•OF NEW YORK STATE ADMINISTRATIVE RULES & RECU TIONS, DRINKING TER STANDARDS (PART 72) . FOR THE PARAMETERS TESTED. ALBERT H. 'PADOVA��I i M, (ACp )P s .IRECTO . �'i` �L IV COUNTY BOARD OF HEALTH RAYMOND S. JONES President S. DANIEL SELDIN, D.D.S. Vice President PAUL CHANG, M.D. ALFREDO F. GARCIA, Jr., M.D. BEVERLY TAYLOR GERALDINE A. ZAMOYSKI, M.D. HON. DAVID D. BRUEN County Executive Putnam County DEPARTMENT OF HEALTH County Office Building Carmel, New York 10512 *I. vjW-,/ �? 91425;3641 JOHN SIMMONS, M.D. Deputy Comnisiioner J. ROBERT FOLCHETTI, P.E. M.S. Director Of Enviroivriental Health Services ELAINE K. KRUEGER ~R.N: MA. Director Of Patient Services May 5, 1982 -3 Mr. John Prentiss, P.E. R041D RD #9, Fair Street $; RCA Carmel, N.Y. 10512 RE: Duminski Request for Variances Dear Mr. Prentiss: The Board has reviewed your request for waivers.from code pertaining to the above named applicant. The request has been granted with the following conditions: (1) The property must be surveyed and the well staked out. (2) The proposed well shall be double cased and cement grouted; the well log shall so indicate this. (3) The plan shall show that the crawl space in the basement of the house shall be a maximum of two feet. (4) That the owner of record shall furnish a "hold harmless" statement idemnifying Putnam County in the applicant's request for waivers from the Putnam County Sanitary Code. A form is enclosed for your convenience. Upon receipt of amended plans and a duly signed and notarized affadavitj a construction permit will be issued. Very truly/ yours, Ra d Jones Pres' dent Put m County Board of Health R7 /ph bcc: Robert Tutoni I THIS DECLARATION, made this day of , 19 , by (names of parties making declaration), residing at (street address, city /town), New York (Zip code), WITNESSETH: WHEREAS (names of parties) are the record owners of real property located at (street address,.city /town), New York as described in a deed for such property, dated 19 , Page on ,.19 in the office of the County Clerk, Division of Land Records, County of Putnam, State of New York, and further described as follows: All that certain plot, piece of parcel of land, with the buildings and improvements thereon erected, situate, lying and being in the Town of , County of Putnam and State of New York, bounded and described as follows: (insert metes and bounds description). WHEREAS, we are desirous of obtaining a construction permit from the Department of Environmental Health to allow for the construction of a two bedroom dwelling on said lot; and WHEREAS, the Putnam County Sanitary Code and Rules and Regulations for the Installation of Small Individual Sewage Disposal Systems and Departmental policies state: a. That there shall be 100 feet separation between wells and sanitary sewage disposal systems; b. That there shall be a minimum three bedroom design criteria used for.the basis of approval for all residential sewage disposal systems. WHEREAS, we hereby apply to the Putnam County Board of Health for waivers of the said requirements, in the following respect: a. 75 feet separation distance between owner's proposed well and proposed sanitary disposal system; b. Sanitary Sewage Disposal design based on two bedroom proposed residence. NOW, THEREFORE, in consideration of the Putnam County Board of Health's approval of requested waivers, the party or parties declare and agree that they will: a. Double case and cement grout the proposed well; b. Resubmit house plans showing and noting a maximum of 2 feet in the crawl space area. c. Well and sewage disposal area to be staked in field by surveyor prior to any installations. AND in further consideration for said approval and waivers. (names of parties) , declare and agree that this covenant shall run with the land, and shall be a burden upon said subject premises forever, and agree for ourselves, our legal representatives, our heirs, successors and assigns, to hold the Putnam County Department of Health, the Putnam County Board of Health, the employees and members thereof, and the County of Putnam harmless and waive any and all rights that we now have or may acquire hereafter against said Department, Board, employees and members thereof, and County by reason of the issuance of the approval and waivers hereinbefore referred to for said subject premises, knowing that it 5 o , does,not conform to said Department of.Health's requirements or its Rules and Regulations, and we, (names of parties) further agree to indemnify said Department, Board, employees and members thereof, and County and hold them harmless from any claims or suits arising out of the issuance of said approval and waivers and out of +1any construction performed in accordance therewith. This Declaration is being executed, delivered, recorded, and cross- referenced to e th deed as aforesaid in the Office of the County Clerk, Division of Land Records., County of Putnam, State of New York, knowing that the Department of Health, the Board of Health and the County of Putnam rely upon same in the issuance of said approval and waivers. This agreement shall not be released except by a duly recorded instrument bearing the authorization of the Putnam County Department of Health and Putnam County Board of Health. IN WITNESS WHEREOF, we have hereunder set our hands and seal this day of , 198 (Signature of each party making declaration) STATE OF NEW YORK ) SS: COUNTY OF PUTNAM ) 9 On this day of 198 before me personally came to me known to be the individuals described in and who executed the foregoing instrument, and acknowledged that they executed the same. PUTNAM COUNTY DEPARTM NT O HEALTH S0.1.955 FILL' :SfC -T,TAN ONLY Division of'Enwronmental Heilib Services Carmel N Y{ 10512 CONStRUCTW - PERMIT FOR SEWAGE DISPOSAL_ SYSTEM Rwtnam :Vdl ley ' ° Town or Village Located at B' rch `Road a 7 µ 2 Tax Mp 81ock - F- ` Subdivision :Roaring Brook Subd. , Lot #330 Lot:':3 : ,ob S01955 owner Mr & 'Mrs . `,Wahter . DUMIbs k�' -4411 '_Desoto: C� rcl e Frame 22181 ' Address Building -T.ype Lot Area l� P ns. AL 35126 . Two °400 Gal 988 Number of Bedrooms Design Flow Total,; Habitable Space' Square Feet separate. Se w erage :system. to consist of 1000 Gat septic Tank; and 222 L.,F.- x 24 ". Width Trench To e constructed by - Atldress Water :Su ; pp y Public Supply From " :•. ;X Pnvate Supply .t o. be tlnlled by i Address Fill Section; 35'x55x36 Dee 306 Yd' other Requirements p. (. . )rPrimary Area) & EfflM ht - Pit & P 7 represent that 1'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 theapproveg_amendn ent thereto and in. accordance with the standards, rules an -re a ions o ,t e u nam . C 3 County Department of :Health and that,on com ietion thereof a !Certificate' of Con'strucUOn Com.pliance'•satisfactory to fh'e Comm.issionei'of",Healthwill p be,submitted_to;Yhe Department = ;,and. a wr�ttem;guarantee -'will be, furnished the owner his, successors, heirs or. assigns by the'b.uilder; that said buiiderwill place in -good opgratiri condition- any part of said• sewage disposal system•during the period of.two (2)_yearsimmediately,following , thedate of =the issu ance of the approyai.of the- Certificate of'Constructidn Compliance - f'ttie originalsysteiri or' any, repairs: thereto; 2) that .the drilled well described above witl be located as3hown`on the approved.plan'and..fhat said,wellwill be:iristatled in accordance with the standards; rules and regula i� ons :of .the' Putnam Bounty Department of.Health 28 September. 1981 -- - X Date, Signed P E. R A Address .R D 9 Fai r Stree >: armel_ NY =105. No 29206- : License APPROVED FORCiCONSTRUCTION ThisapprovaI :dx0ires one year,.from the date issued unless construction of the building -has. been undertaken and is - revocable for cambe mendedormodified. when c nsideredmi'dessary-by. the :Co issioner of Health,' Any change.or alteration of_ construction requires a new perinit. Apprpr}o ed:for disposal of domesti sewage, a d /or pry at water supply only, Date w ( d B Y cjl`{'v G� Title PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date September 1981 Re: Property of Mr. & Mrs. Walter Duminski Located at— Birch Road, T. Putnam Valley Section TM 7 Block 2 Lot 3 Gentlemen: Roaring Brook Subd. - Lot #330 This letter is to authorize John H. Prentiss, P.E. a duly licensed professional engineer XX 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 V V1111CL L11/11 W 1 LIi Luis ma L Lev ailL i to. supezw:i.se 1.nP_ curlstruc ciun of said system or systems inconformity with the. provisions of Article 14S or 147, Education Law, the Public Health Law, and the Putnam County Sani- R,R. 9, Fair Street Address Cam*1, W 10512 91 4- 878-6170 Telephone ry truly yours, gne d Owner of Property 4411 Desoto. Circle Pinson, AL 35126 Address 205 -896 -6773 Telephone f G � :. 1 S E P 3 0 1981 PUTNAM COUNTY DEPT. OF HEALTH FUTNAM 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 M A1c.j-1,� D&miftJJAddress &0:-4 ie tie, -� Located at Street �•y � 4 ',( � �. Hlock Lot 3 t d �- n ica e nearest aross s re Cz' Qadl'iN (Lo-E-�k 1 .7 0) Muni ipallty P /i14 Watershed, SOIL PERCOLATION TEST DATA RERUIRED TO BE SUBMITTED WITHIAPPLICATIONS Hole Number _CLOCK. TIME PERCOLATION PERCOLATION Elapse p o Water Water Level- No. ...: w... ,..:... _:..,_.:..::." Time From Ground Surface in Inches .:.:Soil Rate Start -Stop Min. Start Stop Drop in min. /in drop Inches Inches .Inches /0�-3 Notes; .1) Tpi�ts 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 L DESCRIPTION OF' SOILS ENCOUNTERED IN TEST.HOLES, DEPTH HOLE NO. HOLE NO. HOLE NO. .� G.L. rev 12" Address- THIS SPACE ° F'OR USE °BY "HEALTH DEPARTMENT ONLY: Soil Rate, Approved . Sq.. Ft /Cal . CY Date JOHN H. PRENTISS. P.E. CONSULTING ENGINEER R.D. 9, FAIR STREET CARMEL, N. Y. IOS12 (914) 878.8170 9 November 1981 Putnam County Board of Health. County Building Carmel, NY 10512 Att.: Dr. John Simmons, Asslt. Commissioner Re: Proposed Sanitary System Design (Our Drawing No. 1, Job No. S.O. 1955) for M/M Walter Duminski, Birch Road,.Roaring Brook Subdivision, Lot No. 330 T. Putnam.Valley (Tax Map 7 -2 -3) To the Board: Submission was made with authorization, "fill" permit application, soils data form, two proposed house plans and three subject drawing prints. Mr. Robert Tutoni, EHT has informed me that your approval of a two - bedroom dwelling and a 75 foot well separation is necessary for issuance of a permit; and, further, if such approval is granted it must be filed on the County Clerk=s Miscellaneous Land Records prior to such issuance.' The Contract Vendee will file this document if approved by you. May I request that you place this matter on your 17 November 1981 meeting agenda. Very truly yours John�H. Prentiss, P.E. JHP /pr cc: J. Robert Folchetti,.P.E., Director /Environmental Health Services Douglas Holly Real Estate File �� EXV 12 1981 PUTNAM COUNTY DEPT, OF HEALTH C I t 1. 4 � 1 3Qfl1"C� t _�� x ,t cn any CEC BEER x 170; b {4 . ^a r r FppY�i a I Job f . S A 1 �Ss /� }� 4fJ{~Q� Subdidist�ng L�i4 6i 3 ►�b �r: t dr at ng: pri s 41%'. Er,. �tarir�v�� t�$ • �� inn- ��Qree�' . , L ©T -,,BS-7 a+ . 14/ -� c r l h4 o d' } i s ?ED :25e0 ELL� Lp-r 3s I Lod' 330 ',,Sir- 4ir=,,a IT, 4745.E " 0.- 307aGeed 0 4 44 400 LF D F LF- N Ar-W 4 FIELD ©> Y- 011O.G�Wl 3' of:: BAN it. IZurs Cs,2Aur=L Ft LL.-- r--k ►sT -r ri FmG EX: 0 C� o' 0 49N E- F—Ana t Iwo o N '1 EX>'APi `� 1 DI.J ARE A i r 1 l i t t +'4 N; �1 s'± `i ►i } o' NU --2e "r►e,g- loo' LOT 6 a,Q N/f flOzr -�47No 1 r` r roQO 4:LA� CON C EX►�iT 11 1� rrx• �01J�7E 6x.Wt1 t4 led. ,sal �rd- :he -nmental 0 GPD :.V/ .V/ AREA MAP A5 V>i-iiL-T Loe&Tior-jy A -56, 1 &S 12 6o ?' 0 5 73 r-) 4 80' o 4 114-' 7 to I IIV 6 V6, 0 0 Vz FAMILY CF=G I D C- N C i-- .4 oon A 1b... -, O E: I-J a E. C- K- e, r= PT TAH K- 1z 5 0 4 7 Lr- Lii--,6" I r-M.LP4 1 A Fo I 12-C- 14 V-4,& V A 0 Ll