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HomeMy WebLinkAbout2376DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.14 -1 -69 BOX 20 02376 Is TY 1� 6 •' �T� { k. IL III I Ior �L 02376 CER7 Located at_ Mailing PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel;.N Y 10512 Engineer Mast Provide �% J P.C.H.D. Permit q 1 R ATE. OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM U`� UA . ..�/al.,l.r'1✓_r .. Toav�;uar:�tllagc. > W-oU 1LS ( t� (a . r ��1-3 U S� �'. Map' ` Block Lot �' Name 1� 1 �- .0 kP2j Nj SA t- rmerly 2+� !`� W) LL' y Sabdivielon Name R6 &(ZiA Subdv I:ot N Z �S (LCX)k S yG�Iz %rK�_ Zip- Date Permit Issued I ".'8 3 Separate Sewerage System built by P� 1 (— -�' �'L-►� C� Addressyy� Consisting of 1 b U Gallon Septic Tank and 3 0 Z L 11 F, CT__ j::1 EA-Pr- Water Supply: Public Supply From Address or: i� Private Supply Drilled by 96�f /� , � `� ' V64L Address R—T 5 Z CA2WLd-- Building Type 'jEfj-�l p IT4 -n4�3 Has Erosion Control Been Completed? Number of Bedrooms Has Garbage Grinder Been Installed? Other Requirements I certify that the system(s) as listed serving the above premises were construssentshown on t: lans of the completed work ( copies of which are attached), and in accordance with the standards, rules an 7t3oaj with th�filed la n, and the permit i ued by the Putnam County Dep rtment fHealth. Date 1 Certified by P.E. `_/�RI.`Aj.' C� Address i• V. iJG%� 7 ? r3�Nd�K' 1� , l 1 W f 1 Llcsnsa No.. cot) `t ` 1 T Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and Vold as soon as a pubic: sanitary sewer becomes available" and the approval of the private r 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 Commissioner of Health _ h r&vvoution, modification or change Is necessary. /���// Date / / / �_ *� ���� —�� ?It,le _"C ncom Of Envir nm oeOr 4T4 r Z, 31".111- m C-161, v 1 „gESIOENTIAI 0 PUBLI,. .! S S OBSE UST 'PT INS UP kff-0 (NEW DWEtMT -G) DEEPEN P cqy- OTHER', rYR -o 501:� ,76TALIE W m a BELO JOIN ;:LENGTH VGRAO� �q'C � :ti-P QTHER,”! DIAMETE in v SEAU, . M J& -T-00, A �EIOHT-. PER FOOT E 6 YE 7,777 0 LENGTH (1 3. DIAMETER (in) .:,:' SL T SIZE 1) 3 FIR , RS U ;ECON R IT GRAVEL NO SIZE- F fA K DEPT" Q.. If. more detailed *doq. �Scriptjq� .`6 1;v n4l, 6-� detailed puinping L I z I W L �:gq,4,vavab available, pleas attach: M tests were done is in- OUT FRO Gear OUT attached . --ormatjon . SURFAV;,�*;- 1"ei 018 ono v meter 4, c3-.YES,:,(3 NO'' Land 4 YIEt 0 uj ce jN bli-AbOWN S a ft. 15 A V-1 54 i aw. .,�HARONESS ,';,ANALYZED? 0 YES ONO 11YES 0 0 STO TANK V, a r5 CAPACITY WELL DRILLEI Wf CAPACITY I NAMIE::; 0 V6�UG'E HP v mf AJU 6 `PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL ADDITION / REPAIR FORM SECTION A. GENERAL INFORMATION Name of Projec s� (T)(V) TM# Year of Construction Size of Parcel SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. illy Molling ateep slope Me ntle slope nFlat 2. ClEvidence of wetlands ODrainage ditches 3. Property lines evident? OLow areas subject to flooding Mock outcrops OBodies of.water YES NO Water courses exist on; or adjacent*to parcel? 5. Existing individual wells within 200ft of the existing SSTS? ❑ SECTION C.. EXISTING SUBSURFACE SEWAGE TREATMENT SYSTEM (SSTS) 1. Physical character of existing SSTS area. A. OLevel mentle slope OSteep slope B. OWell drained I �oderately well drained . OSomewhat poorly drained nPoorly drained C. Area available for SSTS. (Primary & Reserve) ClExtremely limited nSomewhat limited MAdequate ft x ft x D. IN SPECT inspector Date � Inspector D dence of failure 11viden c e of failure E vidence of s e s nal failure - -r; -- vew ----------------------------------- (Indicate North) CA H HOUSE (1) Indicate location of SSTS A. -Size and type of septic tank gallons Metal OConcrete OPlastic, B. Type of absorption area J. Fields ft. 2. Pits 3. Gallies ft. _ ' > (2) Indicate setbacks, front street, .backyard, and side yard dimensions (3) Show location of well (4) Show location of driveway (5) Note physical features (steep slopes, rock outcrops, streams /wetlands) SECTION E. EXISTING WATER SUPPLY DPWS ®Shared well Individual well [36.1 ®Du M/Casing �above - ound g COMMENTS: MAHOPAC SANITATION SEPTIC, INC. Septic Tank Service 217 Kennicut Hill Road MAHOPAC, NEW YORK 10541 628-4526 Joseph A. Mantovi Af All 0 4 - wov oil 311qq6 0 -�8 IOR USE W/TN 771 DUOI�U ENVELOPE F NAM ADDRM'N-11% _ W'THUPP6RTT FOLD AT LOWER -r .00UC' - JETSE W 6 E.1 1 U 11N SS MV "'0'0 ',."S. 01471 t I (j 1 � ' ,.nee.,. ,........., ...r.. ...-- ....._.- .....��........... ; � � v ) k 4A A ., (�• ` ",.. _,_.III?- _ �,.� ? 1 ,;, `�._ '� � � `^ S� 5 o s 6 r C'J`s �, � ������ . �'i.��C�7 "�i r- .��•�n rnl —.., y ._, ti stw Ict.tCiis "HOUSE PL YEP:!! }�I�lM COUNT � d U i? ` ; BRUCE R. FOLEY Public Health Director Philip Salerno 15 Short St. Putnam Valley, NY 10579 Dear Mr. Salerno: LORETTA MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 . March 23, 1999 Re: Addition- Salerno- Short St.. No Increases in Number of Bedrooms (T) Putnam Valley Tax # 41.14 -1 -69 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, 1999 The addition is approved with the following ..... conditions. 1. The total number of bedrooms must remain at Two 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 Vallev. If you have any questions, please contact me at your convenience. Very truly y William Hedges WH :kg Senior Public Health Sanitarian cc: BI ---o- Lp F --1 16 00 -� � 6 i I I ---o- UU: T .:lENT OF HEALTH HOUSE PLAN'S -AIPPROVED FOR BEDROOM COUNT ONLY, S(nor+ SF EDROONIS ,7 Pl( Signature & Thle ... ......... Date I s-teel St i !IF I,W�w - 1% so- Lp 16 00 -� � 6 i I I UU: T .:lENT OF HEALTH HOUSE PLAN'S -AIPPROVED FOR BEDROOM COUNT ONLY, S(nor+ SF EDROONIS ,7 Pl( Signature & Thle ... ......... Date I s-teel St i !IF I,W�w - 1% so- DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 PROPOSED ADDITION APPLICATION (RESIDENTIAL ONLY) BRUCE R. FOLEY Public Health Director STREET /L TOWN �' ° TX MAP # NAME ' �v PHONE PCHD # MAILING ADDRESS DESCRIPTION OF ADDITION1 1 %? i:5 ,� %UGC NUMBER OF EXISTING BEDROOM PROPOSED # OF BEDROOMS__��. (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) *Any addition which is considered a bedroom requires formal approval of plans (Construction Permit) prepared by a Professional Engineer or Registered Architect in accordance with _.._ appli-ca'ble-sections- of-the Putnam County-Sanitary Code.--,---.- - 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) * 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 Rev. 3186 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N.Y. 10512 _ Engineer Must Provide _> >� ` 'j P.C.H.D. Permlt #--- -� - - -- CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Located at y U Owner /applicant Name Ell I L- A �!!�i2j 1-1 '21'1 a_1 Ii rmerly. k6I N2.✓ `-1 [J 1 Lt,.111 iz� ��..►��_t.�, ►z1 Town or Village Tax Map L' Block Lot �`- i Subdivision Name FUp"ri L)l Subdv. Lot.# I r7 MaWngAddress k�IZCXJI- Sloe -c- /miltom. Zip- Date Permit Issued psi r>� L nc, L.rr- u . `r Separate Sewerage System built by t�l 1 1 ( n 1 C —. tZ i 1(� Address Consisting of 1 Dir) U Gallon Septic Tank and -� O -7 �- Ur- jet G • -�_) �- NK. Water Supply: Public Supply From Address or: �� Private Supply Drilled by U`Q'r 12 Z-1111 r- LILI!L Address (ZT 5 Z C / -1 l: r.. L�. !J• �� Building Type J�—: 4° .S 11z 12! 1- JT11-- --- Has Erosion Control Been Completed? Number of Bedrooms Z— Has Garbage Grinder Been Installed? _ Other Requirements 1�')00 0 I certify that the system(s) as listed serving the above premises were constructed assent all a shown on the -plans of the completed work (- copies of which are attached), and in accordance with the standards, rules and.- regw1ations -j -in• n e with the filed lam, and the permit i red by the Putnam County Dep rtment Pf Health. Date et) I e t Certified by Address �U &'x Vii`% 1 > l�E i,iUl- (1C.fL IJ,`i� `175 �1� License No. 1 �� cI Any person occupying premises served by the above system($) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a publ;_ sanitary sower 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 Commissioner of Health, such revocation• modification or change is necessary, Date — '- By'. .._........._.., .- -.... _ Title serving; the above described property, and that LC has been construct as shown on the approved plan or approved awendme:✓nt tt)urel.u, and in accordance with the - standards, rules .and ., req,ulations.of. -_tie ,Putrlam.County Department. of.. Health, and hereby guarantc -e-Lo EI1��UwneL, hLs-sl1ccessULJ, IlCLrJ g5r assLgns,- tr�-pl�..e 'n good operating condition any part of said systern 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 saiage disposal systEm, or any repairs made by rre to such system, except where the failure to operate properly is caused by the willful or negligent act of the cccupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Enviror rental. Health Services of the Putnam County Department of Health as to whether or not the failure or the syst em to operate was caused by the willful or negligent act of the occupant or building utilizing the system. - i - t7r" <� • / - _, Dated this day of - 19 - -- SLgllatuL� - - - - -- // Title C Gen al Co tractor (OFmer) - Signature Corporation Name (if Corp.) Corporation Name (if Corp.) ess �����,�,:�, X% Address n /o c, PUTNAM COUN'rY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES � kct, .c h aser of Buil( '00001, 00ir, '14 / 7gl- ing Section Block Lot 0 Buildiifg Constricted by Location - Street t1,C? Y ,tip' l05 1; Municipality Wilding 'Ripe ry dam;., 1�-� ���� ��•e� subdivisi Name l � — / —e::;; 7 Subdivision Lot # GUARANTEE OF SUBSURFACE SESvt-_GE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, worlananship, 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 t r y guarantee -ta— the - c er-r -h -is - sa3ccessor-s,...hiirs -- or- -ass igns, to-- pl&�4 ; : good:_: .__....._.. operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage disposal system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environirental Health Services of the Putnam County Department of Health as to whether or not the failure or the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. )-Z 5�7 1 Dated this /z day of �/ 19 Signature • � Title General Contractor (Owner) )- - Signature Corporation Name (if Corp.) Address 05_;1j rev. 9/85 Corporation Name (if Corp.) PAdress 08/.21/1997 12:01 19142258420. BOYD ARTESI , AN WELL C FPO M NORTH.EAST LAB--OF DANBLlRiC'–" 1914M$42C 'NORTHEAST LABORATORY I of D4wzURY --YF6rmerlv TarlionEnvironmental Labwwtorv) '"-3 MiLL PxAm Ro^D . DANDVItT, CT 06911 . . : (203) -748 -"oa . rAx mc3) T4&-o6s3 PAGE 02 P. CT Cori: PH44(A TORY! REPORT WATER SUPPLY. TING LAAft*A' 90YID AR 1 WELL CO.. DATF-SAMPLECOLLECTED., 8; 18,97 RL -r9D. 12 -0o P N4, TIME COLLEC CARMEL. kV-",-'*l2 - COLL. ECTED $Y. H. BOY 0 DATE RECEIVED@ L#P 8;.1 U97 DATE(S) -MST9D-- 8f. 18/97 TESTED ]IT-, LAB# 11471 R•PORT'DATE. &20 i9'7 15 SHORT STREE.T, PUTNAM VALLZV, NX. NOTSUTED WELL TnAr -MON F T AZ=HEN"2 LIMIT* it r>in (Hacttmia), 0 per 100•ni1 0 per 100 ml .:CWcOne Residoal ND rng/L ND - noncAsuim"' RESULTS'BAftV ON SAMPLES SUBNHTTED-8118/97 SAMPLE, A-9 11=12 ABOVE. MOTABLE or aOT POTABLE (PLM STAR &74M YftK DEPT OF HEALTH SERVICES STANDARDS FOR POTABLE WATUR) Laboratory Director -w0P-;"&' '91 LA85RA7T612 2411(TLI—CTiFp iERJ.TN.XT 060379(860)828-97R7-r-AX(91501829-1050 TOLL FRES WITHIN. CT 800-826-0105oOl.!TSIDFCT.30"4;4.)lli) I 031 A M 'M T- (IT r- I "This is to certify that the sewage treatment system was constructed as indkated on this plan and that the system was inspected by me before it was covered over. The system was constructed in accordance with all standard rukv and regulations of the Putnam County Department of Health and the New York State Department of Health. IS CC) P CD 0 'ri 0 9; 0 7 ID 0 CI � P 0 Z pow fi t -9. Oe / va im t C, o (D CD JL tr O Vi ZI C4 > P t : . i . . . !: C 0 Z: r in V) 0 CO ro < -3 ---------- Li -44-1 rri I. ii: 4 v J 5400 0 SOUTH S TEMMOHS FRNYY'. OENT ON TEXAS 78 ?OS 17) 497 -7070 ERE Pwo��d �mo f LA IN .172M. 0. -P. uw w,6A t-ke. Me - I. socdm x. Sw , 17 .7 k ANCHOR BOLTS _ 4 ANCHOR BOLTS 2' N'pr12'M /2- SiF1'.: e• -o• ro B' -0• TO SET iVD LINE .NOON SE 10' - - LME ' CENTER LINE gNTER UHE HOOK 10 W CONCRETE N CONCRETE _ OF NEXT COL W NEX' COL.. r Ty I y# C" : I i I � STUD- n L': 1 LINE 3' j STEEL LINE Y 99 _Ai— 3' ANCHOR BOLTS \ I `S7LEl ",..I 2'W/ ANCHOR B I UNE HOOK SEY 10' SE N • IN CONSREI< HOp( SE l/10' 1 AHOIOR BOLTS WtA2'W /2' ENDW.LLL IN CONCRETE HOOK SET 1JIN CONCRETE f S WD UNE CENTER O IN31 RNER © gm��COLUYN © sIDEWALL O CORNER ��cmm�Hlwr `mfflo TN oaclvsra (.mluiTPNNt.NPtE. 1 II �� ���III - E ; Y Y 4 P»RD4.Gt.EhJ4(BE}JN¢. I r�TUn.n N.o.w1rA[SEU� i' y {@@gg �.�: • 'cwr urn � QJi GA<K N. YNlf /CEIW4rn.r ec tlNt. Bb' e`o• Ip wua..«t4'mrt'i u.ue..e.l S��;� • s..vi I8: 08 g. 1I .ar ey. X.S. nu ___.. AB. LAYOUT`.' ENT LAN s i AI t NI F ( 1' t C' p• i PLUMBING FIXTURE SCHEDULE: ITEM Immm EW NS DESCRIPTION 5.5. V. C. W. H.W. WATER' CLOSET R ��" uau >m nusu uNU couvl[,E r I/=• A , ear ws a"o an-e[F wL,rs LAVATORY s0F -'m Wn[ous Ox".5 ca1r1[i[ w/ 1 1/. I, /t a/e• J/r O�[i • N, m 10"-VI wAS,C ,ND SHOWER Dm8GN52 Ab— 1. UNIT w/ µy _• ,1 a/e• ]/e' d DT^"u .1H0 uOUMD -W SOAR HpD[A. TUB neuaAn e[wraerzo IR4T w/ ALL sow "euxA. SINK wr x u• znr -eau nwnASS srza "a aro aro I WATER HEATER ]/° so w+- ncc lOx -eaov v/ W4 MI N.l J /{• J /.• 5 KR TO [wawT ,/9 R61R vµvE as iov -arr oAAw AOH m avrsmc WASHER CONNECTION ° "[uaam Pusne Am[zuu sox h A J /.• _• ] /.• OOU"tL1E 9/ Nl 1NU .ND [iTnHC2 MECHANICAL NOTES: I. MECHANICAL CONTRACTOR SHALL PROVIDE ANY REQUIRED DRAWINGS AND CALCULATIONS, ETC. OF HEATING AND AIR CONDITIONING SYSTEMS FOR PERMITS. L ALL WORK IN THIS SECTION SHALL CONFORM TO LOCAL k UNIFORM BUILDING LODE OR GOVERNING 84ILDINC CODE AT THE PROJECT LOCATION. 3. PROVIDE FIRE DAMPc7TS FOR ALL HEATINC DUCTS PENE- TRATING FIRE WALL., 4. PROVIDE APPR ovEp, VENTS FOR ALL CAS APPUANCES. 5. PROVIOE AN APPRbtpD CAS SHUT -OFF VALVE CONSPIO- IOUSLY MARKED AT OUTSIDE OF BUILDING. B. REFER TO MECHAN14L ORAWINCS. ELECTRICAL NOTES: 1. CONTRACTOR SHALL PROVIDE ANY REWIRED LINE DIA- L GRAMS. DRAWINGS, LOAD CALCULATIONS, ETC. FOR PERMITS. 2. THE ELECTRICAL CONTRACTOR SHALL VERIFY EXISTING SITE CONDITIONS, SERVICE REOUIREMENTS AND EXACT LOCATIONS OF SERVCE FACILITIES._ 3. THE ELECTRICAL CWTRACTOR'SHALL CHECK WITH OTHER TRADES FOR THE LOCATION OF EQUIPMENT WHICH REQUIRES ANY HDOV: UP, DISCONNECT SWITCHES, RELAYS, ETC. PRIOR TO AMYISTART OF WORK. - 4. THE ELECTRICAL CONTRACTOR SHALL VERIFY WITH THE MECHANICAL DRAWINGS FOR CONTROL MM14C QIACRAMS. EXACT LOCATION AND SIZE OF EQUIPMENT. : 5. LOCATIONS SHOWN ON ARCHITECTURAL DRAWINGS TAKE PRECEDENCE OVER ,I}ECTRICAL ORAWINCS. 6. ALL ELECTRICAL INSTALLATIONS SHALL COMPLY WITH THE APPROVED EDITION OF THE LOCAL ELECTRICAL CODES AS AMENDED AND ADOP -ED. ELECTRICAL SYMBOL LEGEND, 0 DUPLEX CONVENIENCE OUTLET -�- CUUNC MOUNTED LIGHT 0 ' SWITCH- CONTROLLED L OUTr Q,, WEATHERPROOF OUTLET : ¢ .LIGHT W/ PULL CHAIN OUTLET ABOVE COUNTER' 0 JUNCTION BOX WALL MOUNTED LIGHT O' SPECIAL LOAD OUTLET ' 0 EXHAUST FAN $ TOGGLE SYATCH .. 1 Q. -SMOKE DETECTOR . THREE -WAY SWITCH • j' V TELEPHONE JACK w . GROUND FAULT INDICATQR 0: NEMA DISCONNECT SWTCH O HEATER CSC1 ELECTRICAL PANEL :G I: 1� p. I F- - - - - -- - - - - I r ----------- r-I�C,o[f - --- - � I - - �- T -1- If[ a PT , L rwArvT HorOV�IT eAU =sv_ c 7 <�: '. .' a; •�;s I m �N. e c L,:":_i y •XD. - 44aa(( R,m UM{T 1 f BFI I Rlr E b0 - j I W Z 5555556. : -. TO -� - I I I I I W x- i i• i I- 6 - -I-- � I � t.—� . <- 1 �c� R' ' . a.,A.e a _•. •- .,a,.. :.e.. ?� . ELECTRICAL,. MECHANIQAL, PLUMBING PLAN--..-- LAN -.. . I ECanl /M NPI L91 �' EMPr11 �Ifk 7 , ,� i e I PLUMBING FIXTURE.SCHEDULEL ITEM CON99MIONSI DESCRIPTION ss. V. c.w. w. � i..:1.. •IODA upWRD nU9, TAaR CWr,tTL I WATER CLOSET f T. ,R' x.A r/ n.unNwyNA pi, SLAT. crns� I .. • e ' C.rs .ao Wi-Dir vu sz _ , � y •• -�'• 1>, •. ,• •n sLV —m NVCaus oaN. coarlcrz N/ • Fi u:v::_I ,:�:; LAVATORY , /as, ,/a s/f s/e• ai—a roe,u.[s, rOP-Vr rAS¢ AxD;•ie,.:. � •y= De[ARAet ROWtlICCO UNi a/ N1 •. - .:. .. SHOWER r ,n in• an• neuawn Aawoeu0 u,er N/ wLL , Y NB nnwcs. 'j' T 1" r , a /e• yn• ,ew, cAee a � ra -ua � � � � - .' . ' _,. SOUK D/e• Da' sur -.w si.wusy srzn I I I I ,•�S " ,n D /e• • • >D L,.L 11EG LM •WATER HEATER p/� aA a/f a /a• •ry -Aas' Dui..o ii.w ro avrsm� I . DR I ( ( I — AO.ouKD ruznc eiussm eox WASHER CONNECTION y. xA . a /a. �unETE r/ AIL ,wa Mn nmwcz L'1t�IFF I � ' I Ala -11N Rm% MECHANICAL NOTES: liI�1,1 I. MECHANICAL CONTRACTOR SHALL PROVIDE ANY REWIRED OR AND CALCULATIONS, ETC. OF HEATING AND NR CONDITIONING SYSTEMS FOR PERMITS. /I I 2 ALL WORK IN THIS SECTION SHALL CO9FC+iM T'•,+ ! OCAL h I r\ .. •. UNIFORM BUILDING LOGE OR COVERNWC 3V ?.7NG CODE I,� • : \ I I m • I.� AT THE PROJECT LOCATION. 1. PROVIDE FDTE DAMPERS FOR ALL hE1.7!NG DUCTS PENE- ------ --- w. -� ' ________J__I__ ____ __ ?�LR/•DE -_ ____ �.N - �•�' • TRATINC FIRE RE WA �_ _ __ ____ ____ ._ - -_ ___ _ ___ _ ___.__ __ __ 4, PROVIDE APPROVED VENTS FOR A.!. CAS•- PPLIANCES. - __` 5. PROVIDE AN APPROVED CAS SHUT -CY-F VALVE CONSPIC- -W IOUSLOUTSIDE Y MARKED AT OU OF BUKCiLU. S. REFER TO MECHANICAL DRAWINGS. zo ELECTRICAL PLOTES: tn; -a 1. CONTRACTOR SHALL PROVIDE ANY RE +l:REC LINE OIA- ^, c Y ., GRAMS. DRAWINGS. LOAD CALCULAr,iIS. ETC. FOR V/ f +. .. PERMITS. I I I I I - .1•J' IOU-. ���`:'. 2 THE ELECTRICAL CONTRACTOR •SH.AU, rMRIFY EMSTINC j_. SITE CONOI7IDNS. SERVICE REOVIREME'TS AND EXACT sr� XT5 . LOCATIONS OF SERVICE FACILITIES. E L:r °CK 'M7H O7HEft S. TH TRADES FOR THE LOCATION ^F ZOUIPMENT MICH - I I I I I I ,LVI r '� REQUIRES ANY HOOK -UP. DISGONHSCT - WITCHES. RELAYS, I •'` ; ETC. PRIOR TO ANY START OF WOf'!i s. THE ELECTRICAL'CONTRACTOR SJTALL '+ERIFY WTH THE MECHANICAL DRAVANGS FOR CCNTF:,X. WRING DIAGRAMS. EXACT LOCATION AND SIZE OF.EOU!PKENT: 5. LOCATIONS SHOWN ON ARCHITECTURAL DRAW7NCS TAKE PRECEDENCE OVER ELECTRICAL DRAWINGS 6. ALL ELECTRICAL INSTALLATIONS SHALL COMPLY WITH THE APPROVED EDITION OF THE LOCAL ELECTRICAL CODES AS AMENDED AND ADOPTED. • 3 - - 1 ELECTRICAL SYMBOL LEGEND, . p DUPLEX CONVEMENCE OUTLET - CEILING MOUNTED LIGHT ELECTRICAL MECHANICAL PLUMBING PLAN SWITCH- CONTROLLED OUTLET . a. WEATHERPROOF OUTLET "¢ LIGHT W/ PULL CHAIN .. .. �" OUTLET ABOVE COUNTER E4' M.eNP1umD14n '0 .UNCTION BOX WALL MOUNTED LIGHT O SPECIAL LOAD OUTLET O EXHAUST FAN S TOGGLE SWITCH Q SMOKE DETECTOR fl TH REE -WAY SWITCH TELEPHONE JACK EM P.. 1L _. 2:' GROUND FAULT I N C WI NEMA DISCONNECT STCH ' O HEATER CS3 ELECTRICAL PANEL - -'. %',:: If, -. ®' GARBAGE DISPOSAL UNIT -- .• - i . .I , I A.. ' Laos% d ot- M111 M Pima base of rj MP I represent that, Vern wholly and completely responsible for the design a . nd locatiorf of the proposed systim(s); 1) that the separate _Idl!gl above d*Wib." will be constructed as shown on the approved amendment there to and in accordance with the standards, rules anlreou County Deportment Of Health and.thSt on complation'iheMof a "Certificate -of Construction Compliance" satisfactory to the Commissioner of Hoolthwill be submitted to the Department and a writt" guarantee will be furnished the owner. his successorsheirs or assipris by the builder. that mid bulkier will place in good operitirtill COMItion. any part of said - disposal system during. a Immediately following thodsto of the issu. ar4o of the approval of the Certificate of Construction Compliance -of the of any rq*iFs ther kp; 2) that the drilled wall deso Mad above WM be located as sh� an I the appe oved plan and that, said well will In a h It eta rules and rooUSTOn—sof t d Putnam county De"r)*A# of Health. Addro— License No APPROVED FOR COMTRUCTION: This approval expires two t� frq�m the data I unless construction of the building bas been undertaken and is isvockboo for cause or be mwm*d of modiflodwhon con Wwi� normly by the stionei of Health. Any change at alteration of construction ' — - --- - 8�v. -- Title lO/B8 *'* B« _---_�____--__--_ __--__----____------_ -_-_- = \� ` 31115 gym 2t-r1 Y7�t- +/a1_ - &�i AEq �, ISL IP® hr tla�smo XWOOM ad Madx=cs % Dccb3 Wxv 60 IP 1D— PVC Mulfflw9m to Whose FM Is comolobd 8b F:o IW 'iL {1T D.tQ,cwiC rTilxrit tit Odw 1 n w want tows I ena vj"iiy ans tAmWotaly, vati:onflibl© for the des*n ang Location of the yroyoud aytteen(0). 0 that the is &to eswapa ditteoe I system ab"o E� will ma conadructcd as M=n an tho apswavcS awAndonc at thcro to and in accordonco with the stanlbvat8. rules a rahlll o - oowaty, t tWAM 09 RMA64 a" to" on etgngetw theme a ••cc7aigwte of Constructioo Complienar aticlectory to the Commissioner of H"Ithwill the adwantm t® the D=KWOM. ova 'a tram c"Onow win Ito eurniches the ownw. his t 8. 0=95". p s ®y the tnetlder, that sold builder will h11a0o In �AM es iaW_am East oe GOW Como* ®it l GVQQ a durb* tho perms "f*IWWIM thedate of the MM1- anee of tMe Of tt4 CGtioi0ate of Coactructi= Corntt Banco of the orb roy 02 D that the d►nMd won deterlMd e6oue wnl N ao t C2 tta �0 OM OW twt onto won will (Do Installer t �ao ac�l ro�u ono OP tiro Putnona Comity DW-'Vtt Go temp. coo ° ®Y to S ®.&. R.A. AMC7oCti 1 y% F9n CT. AJ. `Z I CJ� �ieonsa wo �i AOV"VZD ROW COMTAUCVDONZ TM cpzwoccl oa®bo6 etto vgrzk fragn tho Moto Issuca unews eonsVucjIoR of tho 0uIt ing has Dean undertaken and Is rovemes for aeuee or vway @3 ova== or 6te3R" when con ry by tho Coonmissionw of HWIth. Any 6han�ao/r /r a /lteration of construction Maim a Aa B3% �... Aims fd7 a of G1aFROCM y and/ we w02C7 C11800lr only. REV.. ` ®V TRLs io/$6° PC �LTTNAM COUNTY D E PART M EN T O F H EA L TH 4PP CAT T'1ON1°FOk APPRCVAI -0E-gg- P LAN S° `FOR - : *_- W*STEWATER�- O•FSPOS L 1. Name and Address of Applicant: />e(ft u t,✓ � Z.L�I C, 2. Name of Project: CJ' ALA 4 > 4 3. Location /C: PUT; y 4. Project Engineer: �?n - _L` �- ( �' - 5. Address: 1103 (�AL-_ .'ST, i%aaC. License Number: 7.4 4 Phone: 7_4'- o� Y4 6. Type of Project: Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEOR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted 8. Is a Oraft Environmental Impact Statement (DEIS) required? ............. 9. Has DEIS been completed and found acceptable by Lead Agency? 10. Name of Lead Agency 0 & - 1 I. Is aii "s projec.t.._i.n :_._.an area., under the control-:.of 4,oca -1-- planning, ­zoning, or other officials, ordinances? .......... .............................." 12. If s), have plans been submitted to such authorities? .................. 13. Has preliminary approval been granted by such authorities? Date Granted: 14. T y pe of Sewage Disposal System Discharge...... Surface Water Ground Waters 15. If sirface water discharge, what is the stream class designation ?........ 16. Wat5s index number (surface) ........... ............................... 17. Is project located near a public water supply system? 18. If ys, name of water supply U-7.� Distance to water supply 19. Is project site near a public sewage collection or disposal system ?..... 20. Nameof sewage system1 Distance to sewage syst�e ' 21. Dateobserved: al -z' 23. Name of Health Inspector: /m� 1120yW- - "?4. P rojct design flow (gallons per day) ....... . .............................. �C� v 2. 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. Vv b 26: °•�a�s� :Si?DE£ = -, app- 1�oati: on .:-6ean:._subm- 2t.,ie- d._.to: local := D.EC_.O:ff:is�e?t .�:.- ,_,•�. ,,�- .,..•� ,:..,._.; .__ .... - -- �� . 27. Is any portion of this project located within.a designated, Town or State wetland? .................................. ............................... 28. Wetland ID Number ........................ 29. Is Wetland Permit 'required? .............. ............................... Has application been made tC Town ;or Local DEC Office ?. .................. 30. Does project require a DEC Stream Disturbance Permit? ................... 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ........ YES or NO 32. Is project located within 1,000 feet of existence of abandoned landfill; hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or NO v DESCRIBE: 33. Is there a local master plan or file with the Town or Village? ........... 34. Are community water, sewer facilities planned to be developed within 15 years? :IJ-D 35. Are any sewage disposal areas in excess of 15% slope? ........................ 0D_ 36. Tax Map ID Number ....... .....::.... ................................. 37. Approved Plans are to be returned to: Applicant -Engineer If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter.of Authorization. Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form..is true to the best of my knowledge and belief. False statements made herein are punishable as a Clash A HddpRmeanor pursW� ection 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: -CA -y4vrr _1J�`f • Lo Z -- 1 �V -m_5[i n�jSSU_�C._':.S� v 1)TSPOSF�k,:,a`'XS?�, . , ,..,: _�.<_...n _FILE Owner bv1 f,k7_V1 (,J I LA--k4 Address 2 P -ter r i✓ lsh rssa� �✓ `� Located at ( Street) 't avz !mss i ae AU • Sec - 4l - 14 Block _� Lot Co (indicate nearest cross street) Municipality F Watershed SOIL PERCOLATION TEST DATA REOUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking 5 E, I a '� Date of Percolation Test 51 1 l 4 � SOLE NUMBER CLOC;R TIME PERCOLATION +/4 13.3 PERCOLATION Run Z�-t i�`{ Z,� ley Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In.Drop Inches Inches Inches 2 II!3 - iZ,! (-3 3V Z4 tie Z ��z iz 3 �Z:Ut - i2.3i' is Z4 Z!o Z Ile- l2 4 iliyu- 1;.iu )U 5 (/`±- ._..._.:,_.. 2 +/4 13.3 3 iZ�•v� 1z, zc- 7 v Z�-t i�`{ Z,� ley t Z �� [� . 7 NOTES: 1. Tests to be repeated'at same depth until approximately equal soil zates are cbtained.at each percolation test hole. All data to'be submitted for review. I / 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA RDQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOD'S DEPTH HOLE NO. HOLE NO. HOLE NO. i. -u3i� w I Gila -i.J 3' 41 L C;-;A-1 I 51 8' - b' 9' 10' 11' 12' 13' 14' . _. �EMIrATE.. LF'VEL_AT .WIC H. GROUNDWATER IS ENCOUNTERED _ � � U " INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED 0,-0 � DES HOLE OBSERVATIONS MADE BY: )'��'� bV� L`f'��+� I�.Ty DATE: 4 Z__t i�3 DESIGN Soil Rate Used 1 -t� Min /1" Drop: S.D. Usable Area Provided No. of : Bedrocbs'- Z Septic Tank Capacity j cry v gals. Type Ahsorptiori Aiea'Piovided By ZC�O L.F. x 24" width trench Ober `1z OF NEty Nacre Signature +� Adiress v �t� r, Z ST- SEAL R M` GAF- kA ��-- iJ ,�7 • (cal Z ��A76 74 '0 �. TFS SPACE FOR USE BY HEALTH DEPARTbIFM ONLY: V Shc Rate Approved sq. f t /gal . Checked by Date i r P 074 127 778 P 074 127 777 Receipt for Receipt for _ Certified Mail Certified Mail w No.lnsurance Covers a Provided I - �m No Insurance Coverage Provided Do not use for International Mail . .S,,,,E Do not use -furIntarnationai Rtaii (See Reverse) (See Reverse) c C 7 O O 00 M o` LL rn CL SP ^r to -1 G Nv t �1- 2a�.tc25 G ma Street and No. l �qle P.0 P Stat and ZIP Code . PC-�C gl,tl�b 3 Y- Postage Special Delivery Fee Certified Fee Certified Fee Special Delivery Fee Restricted Delivery Fee Special Delivery Fee Return Receipt Showing Return Receip o E� Restricted Delivery Fee to Whom & ate De Return Receipt Receipt wing. hom, Da Id 4 eN Retu ecei g to hom a TO L P age & T 7A Date, an s s Ad r e�tur eceipt Showi 1lom, Ce. n es e' A QF TOTAL P sl tK. & Fees !' 0 Postmark P rk c c 7 C O I O I (h I E 0 I LL N CL m to c c C O 00 (+9 E 0 LL rn a Sent to IZ.oS� 1 �•�� Street and No. f 3rC¢.Cj (/7L .Llr "Lie P.O., State and ZIP Code P.0 P Stat and ZIP Code . _ $ ^ L Postage ` Special Delivery Fee Certified Fee Special Delivery Fee Special Delivery Fee Restricted Delivery Fee Restricted Delivery Fee Return Receipt Showing Return Receip o E� to Whom & Date Delivered to Whom & ate De Return Receipt Receipt wing. hom, Da Id 4 eN Return Re eipt owing to TO L P age & T 7A Date, an s s Ad r N. TOTAL P sl tK. & Fees !' 0 Postmark P 074 127 781 Receipt for Certified Mail �• No Insurance Coverage Provided U DSTATES Do not use for International Mail eOSTAI SEWtE ISee Reverse) Sent to �J&" Streei,arid No.-_ x)2.4 V 'TVi Vito - P.0 P Stat and ZIP Code . Postage $ ^ L Certified Fee Special Delivery Fee Special Delivery Fee Special Delivery Fee Restricted Delivery Fee Restricted Delivery Fee Return ipt S Return Receipt Showing to &D to Whom & Date Delivered Ret n Re . ipt Showing. to Return Receipt Receipt wing. hom, Da Id 4 eN Da (a91 A ssee's eq"�r TO L P age & T 7A TO .L'• stag &Fes; N. Postrhark.'o" ate 0�,� >✓ " to m m C 7 C O 00 M 0 LL N a c c 7 C ..O 00 M E 0 LL rn IL P 074 127 779 Receipt for Certified Mail . No Insurance Coverage Provided . " O TIES, not- u`se "fo- -fnternationaf Mail (See Reverse) Sem to �l�Pld W�VR.ISM�G� Street and No. 6 6 Le, (c>z 2( �- P.O., tale and ZIP Code bbi ) %-aC— N•`(, lostF Postage Certified Fee Certified Fee Special Delivery Fee Special Delivery Fee Restricted Delivery Fee Return Receipt Showing —_ to Whom & Date Delivered [ Return Receipt Receipt wing. hom, Da Id 4 eN $ TO L P age & T 7A /► N. P 074 127 780 Receipt for Certified Mail No Insurance Coverage Provided UNTED STATES Do not use for International Mail (See Reverse) Sent to Tovkw t &.cr Street -and No. - - P;O„ State.and.ZIP Code liqk (on Lt, viLlLn4.r= ti• Y Postage $ J\ Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt. Sko to Who;A Date Deliver —_ Retur ReF" ow m, Datg artld d ee's A TOiAI:. l5st' $ Pos ark qr Da �� N. DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 Paul Lynch Cashin Associates RD #6 Route 22 Brewster, NY 10509 Dear Mr. Lynch: JOHN KARELL Jr., P.E., M.S. Health..Qirector May 18, 1993 Re: Proposed SSDS: Willig Brookside Avenue (T) Putnam Valley Review of plans and other supporting documents submitted at this time relative to the above- captioned project has been completed. Comments are offered as follows: 1. Percolation tests are to be witnessed by a representative of this Department. 2. Verification of neighbor notification (certified receipts, etc.) has not been submitted. iJpon Receipt of- a. submission, revised to reflect. the,_ above .comments_ , this application will be considered further. Very truly yours, fl Robert Morris Assistant Public Health Engineer RM/jp FORMAT Date NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT Re: Department of Health Review of Proposed Sewage Disposal System for property: Name: Address: Town: Tax Map: 1. 4 - I — & Dear CN%�—C> Please be advised that an application for a Construction Permit relative to...th,e. cons.tru.ction.of a sewage system and/or well proposed for the captioned. -W0,p.ert�?-hag been, ade-to- the PuEnarn County -DeparLleftt.of-.'He.a --Iih * Attached please find a copy of the latest site plan. If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call Mr. Hedges or Mr. Morris of the Health Department-at 225-0310. Very truly yours B Title RECEIVED BY: Address: Tax Map: j K; ci ,rtn,ZT A I , 14 - ( - (/" 9 '7 9 o4 19 A v-e .r� 91,14 -1 -e6 6-7 KAM, ....... .... Jm� BUJ ) L'o A�x rl 4P 13 15 _k, i�� ICI: ., SHORT VIII /SIX 202 III \ \� \ F o4 a I ., 1.612 AC. A kn- 10— 0-3- 14 20 2.27 AC. CAL 12 ----------------- 19 fit 47 13 Is 15 14 19 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ....... -: - a .. ...e: ::.:. .....: v..•....ui+vss r•w ... a :.. .. .. .w... -. - . P °..+ -. e-: s c. ....'... :.- ..__ .. - . -... ♦ .• .si i._.. .. r..ry .0 -.van s.w..v.. av w .. .. ! ^:.2'ti .. - p Date Re:. Property of ,�2Vtl.� (.,I L L,( Ca Located at D IGS I >E- (T) ,lxGLVy Section a 1 Block Lot Subdivision of . Subdv. Lot # Ij? Z Filed Map # 7UY /4 Date itz lie Gentlemen: �r , This letter is to authorize a duly licensed professional engineer or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the -Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or` systems 'in "conformity with` the provisions -of Article 145-`ok" -" 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersi P.E., to -� T::A_, Z Address CA -(a-tV_C ki , Telephone Very truly yours, Signed Owner of Property a y N PQ H Address Town Telephone a REGISTERED MAIL RETURN RECEIPT REQUESTED Date _- �� - - -- .....�.:<.... Buildiing Inspector .. �..:. -.. _.... _�.....:�..,:. -s.. �,.. ... ...- .._- ......_...... _ . _ tAj ---------------- - - - - -- _ o s��•w�� __ Li��c�.__ •tom. c, PUT-1-71Ir— V/ -- -LJF>y hj, y Dear --------------- - - - - -- Re: Construction Permit for single family residence Applicant - - -- - -- Street - - - - -- ---- - - - - -- Townj_ ---------- - -- T1ff ot� - - - -i k — - �_- - - - - -- Li I. IZA l - G9 This Firm (I am) submitting an application to.construct a sewage disposal system serving a single family residence on the above captioned property, to the Putnam County Department of Health. In order to process this application the Health Department requires that the following information be obtained from yaur office: 1. Prior to your issuance of a building permit A) Is Zoning Board approval req Yes -- - - - - -- No - - - -- B) Is any portion of the parcel control area, and if so is a Yes-- - -_ - -- No - - - -- C) Is any other local permit or Yes- - - - - -- No - - - -- uired for any variances? located within a regulated wetland or its wetland permit required? approval necessary? If the ansver to any of the questions above is yes, please contact the Health Department in writing or by phone, 278 -6130 within 15 days of the date .'oi this correspondence. If the answer is no, you need not respond to this correspondence. Name Health Department Inspector JK /jp wetland bh Very truly ours Engineer, 'rehi ee APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET for CONSTRUCTIOIN, PERMIT NAME OFOWNER STREET LO TION - BY DATE �� TAX MAP # UMENTS. AffT APPLICATION 1 LL PERMIT;L -U PWS LETTER UNEERS AUTHORIZATION_ IGN DATA SHEET(DDS) ! 1 I DEEP HOLE LOG Tj C NSISTENT PERC RESULTS (3) PERC HOLE DEPTH CORPORATE RESOLUTION _PLANS THREE SETS HOUSE PLANS - TWO SETS =I VARIANCE REQUEST GENERAL LEGAL SUBDMSION az,641 SUBDIVISION APPROVAL CHECKED PERC RATE FILL REQUIRED CURTAIN DRAIN REQUIRED =STANDPIPES Tl EX- APPROVAL SSDS ADJ. LOTS WETLAND (TOWN/DEC PERMIT R & D) ON S PLANS & PERMIT SAME PRE- 196-NlIGHBORNOTIFIFICATION R BUZBA LZ� 100 YR. FLOOD ELEVATION ...RE RED" DETAILS 'SEWAGE SYSTEM PLAN - (NORTH ARROW) 'SSDS HYDRAULIC PROFILE = GRAVITY FLOW D/ J BOX m TRENCH/GALLEY = P- PIT DETAILS SEPTIC TANK - SIZE, DETAIL (YELL DETAIL., SERVICE LINE IF OVER CONSTRUCTION NOTES (GRINDER RATE) DESIGN DATA: PERC AND DEEP RESULTS TWO -FOOT CONTOURS EXISTING & PROPOSED I f I DRIVEWAY & SLOPES CUT FOOTING /GUTTER/CURTAIN DRAINS COMMENTS: gp'DISCHARGE (OK) PERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY AND EXPANSION �EX... AREA; SHOWN; GRAVITY FLOW, SUFF. SIZE IF PUMPED PIT & D BOX SHOWN & DETAILED HOUSE - NO. OF BEDROOMS WELLS & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM PROPERTY METES & BOUNDS USE SETBACK NECESSARY (TIGHT LOT) KjlHOUSE SEWER - 1 /4 "/FT. 4 "0; TYPE PIPE En NO BENDS; MAX. BENDS 45 W /CLEANOUT FILL SYSTEMS h�UCYAYBARRIER 0 FT HORIZONTAL: SLOPE 3:1 TO GRADE 07FILL SPECS EPTH GAUGES LL PROFILE & DIMENSIONS VOLUME TRENCH � LF TRENCH PROVIDED 60 FT MAX PARALLEL TO CONTOURS 100% EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED ON PLAN FIE S 10' TO P:L.; DRIVEWAY, LARGE,.TRF<F.S TOB QF:FILL, - 20' TO FOUNDATION WALLS 100 TO WELL, 200' IN D.L.O.D., 150' PITS 100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER '10' TO WATER LINE (PITS -20') 50' INTERMITTENT DRAINAGE COURSE 200 FT. RESERVOIR, ETC.= 150 FT. GALLEY SYSTEMS SEPTIC TANKS El 1l V FROM FOUNDATION; 50' TO WELL WELLS 15' WELL TO P.L DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APP.LIICA,TION _ TO _. CONSTRUCT A WATER WELL >PCHD...PERMIT WELL LOCATION Street Address Town/Village/City Tax Grid Number -5(z_0e%f61 vE lire Pv - -- 4-1 WELL OWNER Name Mailin Address rzoTti V4 1 LLIG Private A LD 1sorf K1.1 Q T7 2D O Public USE OF WELL 1 - primary 2 - secondary RESIDENTIAL O PUBLIC SUPPLY 0 BUSINESS O FARM O INDUSTRIAL []INSTITUTIONAL O AIR /COND /HEAT PUMP O ABANDONED O TEST /OBSERVATION O OTHER (specify O STAND -BY Q AMOUNT OF USE YIELD SOUGHT MIFF• S gpm /# PEOPLE SERVED FAM /EST. OF DAILY USAGE 4z Sal REASON FOR DRILLING 13 REPLACE EXISTING SUPPLY O TEST/ OBSERVATION 16 ADDITIONAL SUPPLY NEW SUPPLY NEW DWELLING1 13 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE I DRILLED ODRIVEN ODUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 'O &L-- IrJG 'Sr &C t- "KC, Lot No. -12 WATER WELL CONTRACTOR: Name I-C> tT.sE �'i' • Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ,.K( NO NAME OF PUBLIC WATER SUPPLY: Iv 'A TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKET & SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET (date) (signatu PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well dr.illi g operations be contained on this property and in suc a manner as not to degrade or otherw se contaminate surface or groundwater. Date of Issue: V/ / , 19 Date of Expiration{ /"� 19 ng Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PC HD iPERMITy WELL LOCATION Street Address Town illage City` Tax 2e�tJ iG i 4w,- Z+ �h V Grid Number WELL OWNER Name Mailing Address K4AC 1ij f..%i �.► iss,,jj vats Public USE OF WELL - primary - secondary RESIDENTIAL ® PUBLIC SUPPLY ® BUSINESS O FARM ® INDUSTRIAL D INSTITUTIONAL O AIR /COND /HEAT PUMP O TEST /OBSERVATION O STAND -BY O ABANDONED O OTHER (specify AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED _ /EST. OF DAILY USAGE . gal ❑ PLACE EXISTING SUPPLY ❑ TEST/ OBSERVATION LIADDITIONAL SUPPLY NEW SUPPLY NEW DWELLING D DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING 'Pcrmnup- WELL TYPE DRILLED DRIVEN ®DUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: az'Af u +4 C1o"jL L_M'a-� Lot No. 107- WATER WELL CONTRACTOR: Name 'w f3 r- Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ><K0 NAME OF PUBLIC WATER SUPPLY: P-/.- TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: �f LOCATION SKETCH ,4 SOURCES OF CONTAMINATION PROVI I ]_ ON SEPARATE SHEET PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirt3• (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County'Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or of rw se contaminate surface or groundwater. Date of Issue: 19 q Date of Expiration 19 ) Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ..,.....,. -r. .. Date �. Re: Property of ,4 Located a t b jj 1c� (T) i�.l��-. A -ZL,VY Section �� �� Block Lot Subdivision of :csti(2cGI��r� Subdv. Lot # I z Filed 9-Ap h Date 7 2, Gentlemen: This letter is to authorize a duly licensed professional engineer V or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145* or 147, Education Law, the Public Health Law, and the Putnam County Sani- tart' Code. Countersign P.E., R.A., cress i C (J-r'? Telephone 61 L4 -Z 416 4b6t,,, Very truly yours, Owner of Property Address; Town qUW' 5LI,�- CjGi ISr Telephone F- yu"1.Yq V1%-=1.-1- 6X lST1 �1 4.{o use- _0 �xls-n �4 0 jJ 41 I i i Z 1 Q}Z.oPnS�A 1 nWV -�ta� lov `�Sx �. Iv �Nlc 1^tu R = Z2g.o� l M1�1� I? 1� / �: 3u+.>ci►cF� Isar ' 1 / V- � � 10 � 4 90,00 '� -zoz ��KSIp' that the sewage disposal em. was Gated on this plan a at the system was SSDS PLL Q (D E-Aksmucl W[=LL- ?FSZG1�t..la -t1 ou SST Q NEAP FAo L)F-