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HomeMy WebLinkAbout2341DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.11 -1 -4 BOX 20 02341 .. �. ��h. me ., r �. .r 16 me r 1 1 'r r 02341 BRUCE R FOLEY Public 14"ealtii 'iiireclor - "` DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509. LOR . M ETTA.OLINARI .R.N., M.S.N_ . Assoc 6le ­A lic' Health birector - Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 March 24, 2000 Mr. Vazquez 128 Pudding St. Putnam Valley NY Re: Addition- Vazquez - 128 Pudding St. ro Increases in cumber of Bedrooms (T) Putnam Valley Tax # 41.11 -1 -4 Dear Mr. Vazquez: I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp form this Department dated March 23. 2000 .The addition is approved with the following conditions: 1. The total number of bedrooms must remain at Thre e .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, William Hedges WH :kg Senior Public Health Sanitarian CC:BI DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 - Tel. (914) 278-6130 Far (914) 278-7921 PROPOSED ADDITION APPLICATION' (RESIDENTIAL ONLY) BRUCE R FOLEY Public Health Director STREET 51 TONS' '?u TX MAP # `//. —/ - `/ NAME ' U 4Z a u L Z PHONE S l //SYPCHD # MAILLNIG ADDRESS_ S'l - `PtA7'- !67/ 10,5? r DESCRIPTION OF ADDITION c194 c,/�/ �r °� t�.���1< �� �cnsF1' t 7u/.3 NUMBER OF EXISTING BEDROOMS 3 PROPOSED # OF BEDROOMS (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING LNSPECTOR) *Any addition which is considered a bedroom requires formal approval of plans (Construction Permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam.County..S,ani_tary Gode.., _ Please submit this form and the following to Putnam County Health Dept., 4 Geneva Rd., 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) rn 1,c e c o f -1 * Non - professional sketches are acceptable /3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #.) * Non - professional sketches are acceptable ^""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 Feb 98 BRUCE R. FOLEY. R.S. Acting Public .Health Director DEPARTMENT OF HEALTH Division , Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 3 13 IN Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Re: LQ ¢ ,a� Z Residence Tax Map 'f Gentlemen: According to records maintained by the Town, the above noted dwelling IS NOT 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 Gca J -� vr-4 0 ki SURVEYED & PREPARED By ALEXANDER BUNNEY LAND SURVEYOR• P.C. I qms^%Am ont rrr . 1 17 0 ff 7- N y0cl, 4. vaiic� Aww. bwAmw� ti -- N 0 ki SURVEYED & PREPARED By ALEXANDER BUNNEY LAND SURVEYOR• P.C. I qms^%Am ont rrr . 1 17 0 ff 7- N y0cl, 4. vaiic� Aww. bwAmw� ti T691 DISTWBUTED BY Bfumbwg�xcelslor, Inc. meo;va �.. . '.. NYC 10013 CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT —THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY THIS INDENTURE, made. the, ter y of ., ,�F • BETWEEN party of the first part, and '7 party of the second part, Am WITNESSETH, that the party of the first part, inconsideration of Ten Dollars and other valuable consideration paid by the party of the second part, does hereby grant and release unto the party of the second part, the heirs or successors and assigns of the party of the second part forever, ALL that certain plot, piece or parcel of land. with the buildings and improvements thereon erected, situate.. lying and being in the qv. d 3 '2 L2 4. TOGETHER with all right, title and interest, if any, of the part), of the first part in and to. any streets and roads abutting the above described premises to the center lines thereof; TOGETHER with the appurtenances and all the estate and rights of the party of the first part in and to said premises; TO HAVE AND TO HOLD the premises herein granted unto the party of the second part. the heirs or successors and assigns of the party of the second part forever. AND the party of the first part covenants that the party of the first part has not done or suffered anything whereby the said premises have been encumbered in any way whatever, except as aforesaid. AND the party of the first part, in compliance with Section 13 of the Lien Law, covenants that the party of the first part will receive the consideration for this conveyance and will hold the right to receive such consideration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will apply the same first to the payment of the cost of the improvement before using any part of the total of the same for any other purpose. The word "party" ghall be construed as if it read "parties" whenever the sense of this indenture so requires. IN WITNESS WHEREOF, the party of the first part has duly executed this deed the day and year first above written. IN PRESENCE OF: 6411f 6,1z r 11/96 g! . a a Yoj� B1( 1 413 PG O 131 PUTNAM COUNTY RE, CORDING AND ENDORSEMENT ]PAGE (THIS PAGE FORMS PART OF THE INSTRUMENT) RECORD & RETURN TO: (Name, Address, & Zip) No- tau �� � �I YIiCp�t �lt zgLf�� /a g 446 471 GT .6 i asp �! TYPE OR PRINT IN BLACK INK ONLY GRANTOR MORTGAGOR C /V"gx&F5 -i IV441,4n i/7 Fe- o" S:7. DO NOT WRITE BELOW THIS LINE INSTRUMENT TYPE: DEED V MORTGAGE SAT ASMT PAGES RECORDING FEES _ ..... _.... -RCD ".FEE. _ . STAT CHG 5.00 REC MGMT 5.00. CROSS REF .00 CERT /COPY c.)o TOTAL p DEED TRANSFER TAX 3 CONSIDERATION $ c L- RECEIVED I u js 34.aG TP -584 ( ) $5.00 REAL ESTATE I I 43474 I ITT# I E&A ( ) $25.00 TRANSFER TAX I PUTNAM COUNTY I I I ML- MORTGAGE TAX MTX AMOUNT TOTAL TAX SERIAL NUMBER AFFIDAVIT FILED ( ) OTHER RESERVE FOR TIME STAMP w c L- u ML- PUTNAM COUNTY CLERK'S OFF /ICE RECORDED ON LIBER { -1 1 ` ✓ AND EXAMINED. SE L. PELOSO, JR. PUTNAM COUNTY CLERK MORTGAGE /DEED TAX DISTRICTS: TOWN OF CARMEL TOWN OF KENT TOWN OF PATTERSON TOWN OF PHILIPSTOWN TOWN OF PUTNAM VALLEY TOWN OF SOUTHEAST UNAPPORTIONED MORTGAGE TYPES: A COMMERCIAL7VACANT LAND B ..,. --=2-- F -AMILY _.... -__ - ._ ._..: . C UNDER $10,000 D CREDIT UNION /PERSONAL MTG E 3 - 6 UNITS N EXEMPT State of New York County of yuFCC�[� SS.: t On %I C1gy 4hgrle q% before me, the undersigned, a Notary Public in and for said State, personally appeared H unYkiclIa 5 rk'11c1. 111 zcl' Y1 I lcri,n'0 personally {mown to me or proved to me on tfie basis of satisfacto- ry evidence to be the individual(s) whose name(s) is (are) sub- scribed to the within instrument and acknowledged to me that he /she /they executed the same in his /her /their capacity(ies), and that by his /her /their signature(s) on the instrument, the individ- ual(s), or the person upon behalf of which the individual(s) acted, executed the instrument. (i3ht-w�,c�h.�hu�Y4 (si r e and oa�rr a -of 0irsd)i' 'mg acknowledgment) BKA649 ACHAR`%A NOTARY PUBLIC, State of NewYork No. 5002965 Qualified in Suffolk County Commission Expires 10.13 -2�S" State of New York County of SS.: On before me, the undersigned, a Notary Public in and for said State, personally appeared personally known to me or proved to me on the basis of satisfacto- ry evidence to be the individual(s) whose name(s) is (are) sub- scribed to the within instrument and acknowledged to me that he /she /they executed the same in his /her /their capacity(ies), and that by his /her /their signature(s) on the instrument, the individ- ual(s), or the person upon behalf of which the individual(s) acted, executed the instrument. (signature and office of person taking acknowledgment) jDargain anb bale ]Deeb WITH COVENANT AGAINST GRANTORS ACTS TITLE NO. TO BI( 1 bs 13f G0 133 State of New York County of SS.: On before me, the undersigned, a Notary Public in and for said State, personally appeared the subscribing witness(es) to the foregoing instrument, with whom I am personally acquainted, who, being by me duly sworn, did depose and say that he /she /they reside(s) in (if the place of resi- dence is in a city, include the street and street number, if any, thereof); that he /she /they know(s) to be the individual(s) described in and who executed the foregoing instrument; that said subscribing witness(es) was (were) present and saw said execute the same; and that said witness(es) at the same time sub- scribed his /her /their name(s) as a witness(es) thereto. (signature and office of person taking acknowledgment) SECTION BLOCK LOT �l•aL<t. c COUNTY OR TOWN RETURN BY MAIL TO: Zip No. ..... ... .�.. ._... ` _. .. .� .i - .... ,..-. •. v:.,N.r! +Y'F . �turu - .ryh�n.M+w.f+:: xr:.K ��... .77777, 77, CERTIFICATE OF OCCUPANCY Certificate of Occupancy No..8145• •••••••••••••••Application No.84- •52.91 •••••• e� Location of Premises P.Udding••Street -F ... u•trtam-• Ve lwl ey......... TM...# k ..6,•:7._lp .................... i Manuel & Linda Vasquez of Pudding„ Sheet, PRV• „ having ..: ................... ...... heretofore filed an application for a building permit pursuant to the Zoning Ordinance, Sanitary Code and the Laws in effect in the Town of Putnam valley, Putnam County, New York, having paid the ' required fee therefor and the undersigned having by personal inspection ascertained that the applicant has subsequently proceeded with the erection. or improvement .of the. proposed struc- ture in ' compliance with the requirements of the Jaws as aforementioned, and that the said work and. materials met every requirement of the laws as aforementioned and that the premises have now been fully completed and are ready for occupancy pursuant to the provisions of law,' Now, therefore, this certificate of occupancy is hereby issued under the seal of the Town of Putnam ............ :......................... Valley this �.20.th..... day of Au ust �17 Not valid unless signed in ink by a duly authorized agent TOW UTIVAM V !YORK of and under the.seaI of the. Town of Putnam Valley. V rBy ............................. .. �. .......................... 3 wfy*.cnna•�:�a!avF w,�?!V,;rm.. ^FLR: ^n:r�- wkhc?^ ::r4;:w- > P�;^; r, i=srt"'1�"::PG:ry+''�s.�G,#q�� -, _ . m FA ART AiA QV em �built'-by V LE 7. -Ott i—if- uice yp ` ° ~ TOWN OF PUTNAM VALLEY WELL DRILLERS LOG AND REPORT This report is to be completed by well driller and submitted to Bldg. department, together with laboratory report of analysis of water sample indicating water is of satisfactory bacterial quality. Well Location Tax Map Street % Sec. B1. Lot Well Owner Well Driller /, Name CASING_ DETAILS__ Length Ft.l Mailing Address Mailin " Address YIELD TEST i WATER L _Bowled ! Measure _Pumped Hrs.lStatic: I or Town Tel. # City or Town/ EL I SCREEN DETAILS rom land surface Ft.I Make: When Bailed ; Slot Diameter: �,'Inches I Yield: GPM I or Pumped Ft Length Ft.Size Kind: 10TAL DEPTH OF WELL Feet WELL LOG Diameter In Depth from Give description of formations penetrated, such Ground Surface as: peat, silt, sand, gravel, clay, hardpan, shale, sandstone, granite,.etc.. Include size of diameter and-sand (fine, "medium; coarse , color of material, structure, (Lose, packed, cemented, soft, hard). For example: O ft. to 27 ft. fine, packed, yellow sand; 27 ft. to 134 ft. gray granite Feet to Feet Formation Description 'Date Well Completed/?// Date of Report Well Driller EZS 1 -77 �- Signature fRKTOWN MEDICAL LABORATORY INC. P.O. Box 99 321 Kear Street LOCATIONS: Yorktown Heights, N.Y. 1059 ❑ 321 KEAR ST., YORKTOWN HEIGHTS, N.Y, 10598 245 -3203 g ❑ 201 BUTTONWOOD AVE., PEEKSKILL, N.Y. 10566 737 -87.77 .- ,,_.�1. _a . . ; ... .; - g .,....,,.c. -.n.. .._�.r- a.:wrs. .es ,.,a+o..w<ra. ,•: .a': v -- _. - _. - - -- . e..v rr«_. - ... a 245 "323 ©'�9� NIAI N`S�`.; Ml °.`ICISCO,'N:Y:'`�U5'�!3''666- `3335 " - - -�" ` • � • �` '°` it7 Rl 1 ❑ STONELEIGH AVE. (NEAR HOSPITAL), CARMEL, N. Y. 10512 278 -9330 RESULTS OF EXAMINATION OF WATER )WNER DATE RECEIVED MANUEL VAZQUEZ 2/27/81 3 P.M. :ITY, VILLAGE, TOWN VOR NAME OF SUPPLY DATE REPORTED ;A IN I STORAGE TANK 3ACTERIA PER ML. (Agar plate count at 35. C). 4 COLIFORM GROUP (Most prbbbble No. /100th1.) O /MFT HARDNESS, TOTAL -ppm )ETEFIGENTS - mg /L NITRATES (as N) - mg /L - IRON, TOTAL - mg /L .MMONIA, FREE (as N) -mg /L pH= CHORIDES - (mg /L) COLLECTED BY: M. VAZQUEZ 'hese results indicate that the water was YES of a satisfactory sanitary. quality when the sample was collected. A. H. PADOVANI, M. T. (ASCP) Xe4 P1. Owner or Purchaser of Build ng Municipality Building Constructed b Section Location - Stree Block 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 'orf, the system- -to-operate was -caused by- the willful or negligent act of the occupant of the building utilizing the system. Dated this j day of ��'far�,:i 19'1 Signature Title If corporation, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE, OF DATE OF FIRST USE OF SYSTEM. - - - - - - - - - - - - - - - - - - - - - - - - - - - - Division of Environmental Health Services, Putnam County Department of Health c --x — —.p- r - z-rn �s i Y t PiJTNAM C ®LINTY I)EPEItTMENT OF 'I�E�i,TH - �,r on of Environmental Health4Servrces, Carme% N Y 10512 <, CONST.R_UCTIOIV PEFiMIT_ FOR SEWAGE 'DISPOSAL SYSTERA Town or Village L'o`tefed of / _ i3" " "� "' Tax IWIdP �° ^' °61ock r� y Lot �•� JOb' �, , Subdivision•. ' Owner `�/� i G�'/ ��"' �►° Cam. Address Bullding Type Lot Area Number of Bedrooms Design Flow �� Total Habitable Space guars Feet Sepaiate= Sewerage ::System 'to consist 3of Gal Septic'Tenk= and r To' be const ructed by t ?. Address x r Water SuPDIy Public „Supply From r « r Private Supply to be drilled by Address p >: Other Requirements C 1 represent that I am wholly' antl eompletely responsible for the tlesign and location of :the proposed syste )fp4i �o ppe s w disposal system age ; atiove described will, be constrted as shown on the approved amendment thereto and rti accordance with t 'st ` rules ggul ons o s e u nam 'Mc e ,. County Department of Health, and that on completion thereof a Certificate;' of "co mp ha Jyhf act ` `£ o th m sorier'of °Heatthw�il be'subm�tted to the Department :and a w�tten' guarantee will be furnished the owner his "successors;' t3Tr as ne' Ar at said builder will e _ place m.good operating contldlon any part of said sewage'' >d�sposal' system dunng ills period of two ) s;i rfo wmg'thedate of the issu ance of.' th`e approval of the Certificate of 'Construction Compliance; of the.original, system or any re !to, e►eto he,rJri�l ell described above will be l9e5ted as shoavn on the appiovetl plan and that' -said well will be installed : in accord nce; with the,' ds reguo ,. of the Putnam County Department of Health J o r looe F ,,y a r J Date � - - ' -�... : � ,•�. . �; x :"�rSignedf`' �� a P E. R A - r % _ APPROVED FOR CONSTRUCTIONp This approval exp�res'one year .from the- = issued unless constru ion of the building has beeW,undertaken and-is - revvocable for cause or may be amended or modified when corisidered necessa `by th ' Commissioner of. HealtFi. An "y change or.' alteration of construction repwres a 'new permitApproved for disposal of domesti nitar °sew private water supply only ... Tit le q. ,000000v JOSEPH F. SULLIVAN, P.E. .1foniuttin9 Enginzzt .1911 FIiRNdRE!3YbRiV'e' YORKTOWN HEIGHTS, N. Y. 10598 (914) 962-4248 PUT"1`i Cr('NT)" DFMRT` 71\'T OF 1117MMI MIUMN _07 -1 IRAM-1 t'. r I C FS Date Re: Property of Ila, .7- en _U e Located at PV. AA 11 a1 4 I's k e- - Section 6 Block Lot Gentlemen: This letter is to authorize 70 i'duly licensed professional engineer or registered architect 0. (Indicate) to apply for a Construction Permit for a separate sewacre.' system; to C31 serve the above noted property in accordance with the standards, rules or regulations as pronuilacrated 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 ✓ 347, -Educati-on Law,. .ttie -Pub lic -He al t1r* LwW,- '-and the Putnam County Sani- tary Code. Countersigned: P.E., R.A., 74' '?wY 7,-> - Address , en Very truly yours, Signed- Wnerl-Orpioperty <_. IAJ Address 40 Telephone WMQM� Telephone 0 -,. T' Z ., PUTNAM COUNTY DEPARTMENT OF HEALTH' Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEMS Subdivision Owner Z* �� ::�- ���C'r.�'... -,..:_._:.::.:�,.:,.,".� �_ ..�o�.:.'Fa.+i =M3f�. "�"_._� • � ; own or Village - •--J __ _. Lot % Job A A ,4 4i Building Type ;zk 47 7 r ca c•r >�r r (. r Lot Area - r— Number of Bedrooms Design Flow Q f Separate Sewerage System to consist of Gal. Septic Tank To be constructed by Water Supply: Public Supply From L� Private Supply to be drilled by Address Or Total Habitable Space j- - Square Feet and Address Address sr Other Requirements, ,� 4 �!k .� Jr, ,�`/ ! j .:� t%r �i i •':/ /,��+�-r`.`''r✓?j'' . _ Viz' /9 �F ✓. - �-° 1 I represent that I am wholly aril completely responsi eor the design and location of th proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and i accordance with the standards, Kyjgs an regulations o the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfa� fory,fofhe,Commissioner of Healthwill .i'�' r 1 ti 4 be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirspQ- assijks bj thelbsr11oer, that said builder will place in good operating condition any part of said sewage disposal system during the period of two (2) ears,im,— a(ply, fAp*ing thedate of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repair's thereto,,V) tfi'a� :too d ill g well described above will be located as shown on the approved plan and that said well will be installed in accordant wit a s ;ands' it rules and r gulatior�s of the Putnam County Depart rent of Health. '� + �? - 1z, o a J ~ Date! Signed `� y n PEE. 2, R.A. Address 2I't License NA }:a,�^ Ion ; APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless nstr , ti "of the Wlilding'haS been undertaken and is revocable for cause or may be amended or modified when consid ecessar b the ommissioner o ea1Lh. c,Arw. change, or, alteration of construction requires a new per it, Approved for disposal of domestic Sa itary ew �e, a o to w upp,ly "`ry Date 4S By Title Re: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL.HEALTH SERVICES.­ Property of Located at Section,_ Block Lot /6� 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 C� or regulations as promulagated by th e Commissioner of the Putnam County Department of Health, and. to sign all nece.5sary papers on my behalf in W-LL*fl Otis maLL'ev and to. supervise the construction of said system or systems in conformity with the provisions of Article 145 or Education Law, the Public Health. Law,. and-.the Putnam C - ounty Sani- tary Code. Countersigned: P.E., 2'�7 z / Address ye 1�4 Telephone 0, (,I , k U . V W� Very truly.-iyours, Signed ff A Ad Wlis Telephone A/1' 7 y / 5w'e- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 1051 DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. dressy XV llalle- ss Owner5X1 Located at (Street Sec. e Block Lot /0 '1ndicate�;-_neeaesjt cross street) Municipality- l'-1i"1401117 e,.,V Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Water v e7 No. Time From Ground Surface in Inches Soil Rate Start-Stop Min. Start Stop Drop in Min./in drop Inches Inches Inches 0 114,-_'2o6710 -k . j 7 2 1& 3 31 4 5 2-1 Notes: 1) Tuts to be repeated ated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH -.HOLE G.L. 611 18" 24 3011 3611 4211 4811 5411 60 6611 7211 78 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED s -WATER.. RISES AFTER.BEINGENCOUNTERED - en INDICATE LEVEL TO WHICH L -5' 0 TESTS - MADE- . .7 - - 'Date Soil Rate Used _Z min/1"Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity Gals." Type Absorption Area Provide By LiF.x2411 36" width trench. Other ure Address ,,- THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY, Soil Rate'Approved Sq. Ft/Gal. Checked by-- p� 0 f m { I +'IELD CHECK LIST Giro ®n lli Date : • r INITIAL SITE INSPECTION Yes No Comments Property lines or corners found. . o Can estimate house location . Will driveway need cut . Must trees be removed -note these . . . Is deep hole representative of entire SDS area Additional deep holes needed. . . . . . . Sufficient SDS area available considering driveway cut,house.location,sepa.ration .._ distances, etc. . . . . . . . . . . . . . . DEEP HOLE DATA Depth: Water elevation: ,�<L Rock elevation: Soils description: 4 :C6 Date FINAL SITE INSPECTION Insp..by: House located where shown on approved plan. ST1S' l oo?.ted where ap-iprover . . . . .. Width of trench average Slope of the line and trench- acceptabl_e,. Room allowed for expansion trenches . Over 50 ft. from swamp. watercourse .. , ` Na "tural soil- riot `stripped or ` SDS area unnecessarily graded . . . . . . . . . l0 Ft. maintained from prop.lin° and: 20 ft. from house . . . . . . . Separation of trench from house; well. etc. follows plan . . . . . Number of bedrooms checks . Stones, brush, stumps, rubble, etc. greater than 15. ft. from nearest trench o . 15 Ft. of peripheral. soil horizontally from trench . . . . Junction boxes prope�,ly. set - Could surface run o1:':i from driveway.,. roads, ground surface, etc. channel near SDS , area. . . . . . . . .. . . . . . . Does lot drainage apnear.O.K. in area of SDS FINAL GRIADING OF SITE ACCEPTABLE R'nh- -W CI-L]CK S=T P, Bew-SM C>m o>7 e >� r;�: s, (arc 8r�iz Meets Std. 1 Remarks P,ddr 9 "� Yes No DOCUDEMS, House plans 0. K. Y .Design data sheet Peres resoaked? Mina 30" .perc test depth I ✓ Const. results for 3 runs I I D. Hole log 0. K. ! ! Corporate Affidavit for other than individual ; N. O - ! Authorization for engineer i 7 Letter from Water Supply if applicable ; ' I'4, I If variance requested -such noted on plans & apps., g'A. j DETAILS i if charge is proposed,) Existing contours. shown .k,show new contours) i Slopes for driveway cuts; etc. shown Water service line location Footing.. drain, etc. location- Top slope, bottom slope of fill ! ; ✓ ! _ Percolation tests and deep test pit location. i i ✓ _ Septic tank size and conformance to std. - ! ✓ ! _ 3 B.R. house minimum .House setback shown J l�_rQ I �' _1i'� -: ! 4 I 1 11 1 t. I. tS • "-'el ow 1 .L '..IJ U ..__ ........ ._ -__... _.__ ... FILL 1+7c1 Gu e W1 UILL11 jv l U . Vi . _i%i 011vwii f Plan and profile SrS All other wells and SDS closer 200' shown or reference_ made Property boundaries (metes and bounds - clearly shown ) i SEPARATION DISTANCES S SPECIFIED ON PLAY 10' to P.L. 20' to Foundation walls ! i L00' to Nearest well 50' to stream, march, lake; etc. incl.expansion 15' to Curtain drain 10' to water line (pits -20' ) ! u,ia• 15' to storm.drain ! 10' to large trees ! i 10' from foundation to septic tank ! ✓ i 5' to .pipe from leader drain & foo ing drain 7,A — __ , • 1 PUTNAM COUNTY DEPARTMENT OF HEALTH .,::. r__::. ._ _.. �_:: �-; r�. :._:�:,.:•.- ..�,= .::�,IJI�TIS` ION=.. OF�" EI�' fT.[ RONMENTALHEA� ;�H`SE�t`V��LS`�,�� ;, x; ��: .;�= „�.�..:._._.yw.....U.�__< Date Re: Property of eO&e- -Ni t_%MaiJG- E,-"t Located at :P0D0%o &- Section-TM Zo Block 1 Lot Gentlemen: its This letter is to authorize a duly licensed professional engineer or registered archi eet (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 uw11JrC Liu„ wi i n Lids ma L Lea• anu to. supervise i.ne construe ciun of said system or systems in conformity with the provisions of Article 145 or - -- = 14..7, • Education. Law; -. th'e Public - Health Law,"'and--the ;Putnam County SAni= tary Code. Very truly yours, \0111111111111/., \`��.�P�E fN✓ �',,� Signe c,�` f` �R9q • o ', Owner of Pr perty Countersigne ” ,• Address P of ., R.A .,., r {���°• �F3Sl0 ,�► Telephone aaaress Telephone PUTNAM COUNTY DEPARTPiERNT OF IC;ALTH _ .DIVTST.O>VT_• .OF- ETATROT•?MENTAL I EALTH COUNI`Y OFFICE BUILDING, CAPHCIL; N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner �T -svc «cry= �_.r Address - n�r'�M v>�.T -� Y Located at (Street) Puoi -,ro G 5•rr -,E i sec. Block Lot- (indicate neares cross street). Muni cipality T 2 ,y fan. V )C%L4_ Zr y Watershed N &\,j yok G%r j SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse . Depth to Water Water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches .,Inches 5 2 5 1 2 3 - - Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. AI__ data to be submitted for review. 2) Depth measurements to be made from top of hole. THIS TEST PIT DATA REQUIRED TO . BE, SUMITTED WITH APPLICATION BY 1MI12H DEPARTI ; T DESCRIPTION OF SOILS NCOt NI'j.' ;RED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. Checked by. 6" -- . 12 "ii Lo.d� -t 18" _ 2411 ,011 .361, 42" 4811 V\/%7- R 54,� -� 60" _ ,.6641 _ 7211 _ - - . ..... __. . r7Q.Pf f (J -� 84 11 , _ INDICATE LBM, -A :,k�iTDH = GROUND WATER IS ENCOUNTERED IIVICATE" LEVEL; `TO, W�17:Cii WATER LEVEL 'R.TSES-`AFTER �BE,1NG- ENCOUNTERED - TESTS MADE BY 6= s' -�° v. Date DESIGN Soil Rate Used -/Z / -Ydn/l "Drop: S.D. Usable Area Provided No. of Bedrooms Septic 'Tank Capacity Gals. Type .Absorption J?� =i Area Provided By width trench. 1= Other Name igna ure _ Address D SEAL THIS SPACE FOR USE BY 1MI12H DEPARTI ; T ONLY: Soil Rate Approved Sq. Tit /Cal. Checked by. Elate r 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 Address OQCOio �- Located at (Street r,7e Sec.TM (p Block % Lot V'j n Bares cross street) Municipality, -iP0 i\)pXR Vj AL_t-L y Watershed N-Y. ' CATY SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH.APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Water Level No. Time From Ground Surface in Inches Soil -Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 1 1 a.= 172-12 (,o %0 ► l � � 1 ` `D , Q 2 1 L +-b'a- %'X'5-0 8 %%" 3 11 �� — 12�c� to 1�` 10.0 5 1 2' 3 4 5 Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. App data to be submitted for review. 2) Depth measurements to be made from top of hole. \0 lit 3 11 �� — 12�c� to 1�` 10.0 5 1 2' 3 4 5 Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. App 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 0. HOLE NO. HOLE NO. 6" 12" 18" - 24" 30" . 36 if 4211 48" W 54 60" 66" 72" C> 78" EN INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY '[ Date Soil Rate Used ��� L- S Mi � 1 Dro " .p . S.D. Usable Area Provided r�-? No. of Bedrooms Septic Tank Capacity, o Gals: Type 3 Absorption Area Provided By ?,, L.F.x24" � �j' � a width trench.: F,i,r�ther r Name Signature 12 Address THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: 043 •. �, �� �' ✓yk Soil Rate Approved Sq. Ft /Gal. Checked.Y�y �4� "�� +� "��` Date