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Home My WebLink About2386DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 42.3 -4 BOX 21 i Z ' yti : ,, Dr � -. Tr ' 6 R ��LL f, 02386 Tr ,L 02386 NAM COUNTY DEPARTMENT OF HEALTH r Rev. 3186 Dlvisl Environmental Health Sonices. Carmel, N.Y. 10511 Engineer to Provide Permit• 2 on CERTIFICATE OF COMPLIANC)r ` Permit # CONSTRUCTION PERMIT FOR, $E AGE DISPOSAL SYSTEM vi T/0 Putnam Valley ' Located at 4.15 - 5e? ffer; Lane Town, or village Subdivision Name Subd. Lot # Tax Map 18 Block 02 Lot 7 Renewal`0 Revision-0 Owner /Applicant Name Kl uhni nk , nPnn i S & Maa i kP Date of Previous Approval Malling Address 415 : S.e i f f e r t Lane Town Putnam Valley zip 10579 Building Type Residential Lot Area 6.306 Acres, FIII Section Oniy Depth volume Number of Bedrooms 3ll SS { Design Flow G /P /D 6 0 0 PCHD Notification Is Required When Fill Is completed Separate Sewerage System toEco ' Gallon Septic Tank and 1 4 0 T Y ' F x i s +' 1 9 3. T.'P- P rc) p 24 ° i- r r- n e h To be constructed by UnknOWn' Addreslt N/A Water Supply. Pdbllc Supply From Address ors X' Private Supply.Drilledby (EX'Xi sting) _Addresa N/A . Other Reonlrements 1 f _ 0 n ; 'R. 0, . B : I represent that I am wholly and com above described will be constructed ai County Department of Health, anc be submitted to the Department, a place in good operating condition i ante of the approval of the CertifI will be located as shown on the approll County Department of Health. Date 5/12'/8 -7 )letely responsibie for I" esignend location of .the• proposed system(s);'. 1) that the separate sewage disposal system shown on! the approved amendment there to and in accordance with the standards, rules and regulations of e Putnam that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Health will d a written guarantee will be furnished the owner,, his successors, heirs or assigns.by the builder, that said builder will ny part of said sewage disposal system during the period of two (2) years immediately following the date of the Issu- ate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above ed plan and Chat said-we'll wili be installed ;h . a ordance with a standards, rules and regulations of the Putnam Signed " P.E.—X._ R.A. _ Bat9pv & ,w License No Fi -SAS APPROVED FOR CONSTRUCTION'. This approval expires Midyear from the date issued unless construction of the building has been undertaken and Is revocable for cause or may be amended or modified when considered necessary by. the Commissioner of Health. Any change or alteration of construction reQuires a "ne w permit. %Approved for disposal of domestic san' y se and /or private water supply only. Date / - by, Title 1 4— 10 I< ry 70 d9'&Q o 6"D 10- I< ry 70 d9'&Q o 6"D JI - 195-, cool —ac? Q0. 57// 15 39, % 3s► JI - 195-, cool —ac? Q0. 57// 15 39, APPENDIX; B PUTNAM COUN'T'Y DEPAR3MF U OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL VA= SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS J�a eAof Owner) CMENTS IF trench provided 3 DIU required 60 ft. max. Parellel to contours SH= - CONSTRUCTION PERMIT DA I BY: - (Sl, et Location) YES NO DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth s/s SUBDIVISION Perc (3) Fill cd House Plans - Two sets Well permit; PW-S letter Variance Request GENERAL Legal Subdivision Subdivision Approval Checked _ Ex-'approval SSDS Adj. Lots Checked Wetland (Tcwn/DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETALL.S ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench/Galley; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design rata: Perc and deep results . Two- -Foot Contours Existing.& Proposed Driveway & Slopes Cut Footing /Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located !Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If Pm ped. Pit & D Box Shown & Detailed House - No. of Bedrecros Wells & SSDS's Win 200 ft. of Proposed System Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 "0; Type pipe . No Bends; Max. Bends 45° w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields i 10' to P.L., Driveway, urge Trees,Top of fi' 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expa 15' to Drains - Curtain, Leader, Footing 351to catch basin,stonndrain,piped watercour. 101. to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' from Foundation; 50' to uell 15' Well to PL 1AJ�f4K :A Tw;�t 9 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMEWAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS {� P FIELD INSPECTION REPORT DATE: INSP. BY: (Name of Owner) (Stre6& Location INITIAL SITE INSPECTION YES NO COM14ENTS Wetlands on /or proximate to property.............. Property lines or corners found ................... Can estimate house location ....................... Willdriveway need cut ............................ Must trees be* removed - note these. . .............. Deep holes representative of entire SDS area...... ,Additional deep holes needed...... .............. Sufficient SDS area available considering driveway cut, house location, separation distances,etc... ,Adjacent wells /septics .................. ...... Accp =s to nrcocsed well location for drilling..... D.H. 1 Lot- Depth. to G:W. Depth to rock Soil Descriptic 0 ft. 3 ft. 6 ft. 9 eft. 12 ft D.H. 2 Lot Depth to G.W. Depth to rock Soil Descriptio 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. D.H. - Deep mole G.W. - Groundwater D.H. 3 Lot - Depth to G. W. Depth to rock . 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. Soil Description DATE: FINAL SITE INSPECTION INSP.BY: YES NO CU MEIM House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable.......... Roam allowed for expansion trenches .............. Over 100 ft. fran watercourse .................... Natural soil not stripped or SDS area unnecessarly graded.......... . .............. 10 ft. maintained from property line and 20 ft. fran house .............................. Distance well to SSDS (ft.) ...................... Number of bedrooms checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench ................ 15 ft. of peripheral soil horizontally fromtrench ..... ............................... Boxes properly set ............................... Could surface runoff fran driveway, roads,' ground surface,.etc., channel near SDS area.... L Does lot drainage appear OK,iri area of SDS:o..... FINAL GRADNG OF SITE ACCEPTABLE.';' .. .... � - -A COUNTY DEPARI11EN'r OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES FIELD `INSPECTION REPORT DATE: , j��c.t,�iht s -� INSP. BY. Marre7 of Owner) (st-rMi Location) INITIAL SITE INSPECTION YES NO COMMIS Wetlands on /or proximate to property............ Property lines or corners found ................. Can estimate house location ..................... Willdriveway need cut.... ...................... Must trees be, removed - note these ................ Deep holes representative of entire SDS area...... ,Additional deep holes, needed ...... ... .... .... Sufficient SDS area available considering driveway cut, house location, separation distances,etc... .. ,Adjacent wells /septics ...... .... ....... ..... Access to nronosed well location for drillina..:.M I r /r� D.H. 1 Lot - Depth to G.W. / Depth to rock Soil Descriptioi 0 ft. 3 ft. 6 ft. 9 eft. 12 ft. D.H. 2 Lot Depth to G.W. Depth to rock Soil Description 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. D.H. - Deep Hole G.W. - Groundwater D.H. 3 _ Lot Depth to G.W. Depth to rock 0 ft.' 3 ft. 6 ft. 9 ft. 12 ft. Soil Description DATE: FINAL SITE INSPECTION INSP.BY: YES NO OZ'S House SSDS located per approved plan.......... . Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Roan allowed for expansion trenches .............: Over 100 ft. fran watercourse .................... Natural soil not stripped or SDS area ..... ............ . unnecessarly graded.. . 10 ft. maintained fran property line and 20 ft. from house ........................... Distance well to SSDS (ft.) .................. Number of bedroans checks...... ........... . Stones, brush, stumps, rubble, etc., greater than 15 ft. fran nearest trench ................ 15 ft. of peripheral soil horizontally frantrench ..................................... Boxes properly set ............................... could surface runoff fran driveway, roads,' ground surface,. etc., channel near SDS area.;... Does lot drainage appear M,iri area of SDS'.-.;...... FINAL GRADNG OF SITE ACCEPTABLE, ..... , i .� PUTNAM COUNTY DEPARTMENT OF HEALTH APPENDIX K DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date April 9, 1987 Re: Property of Klubnick., Dennis & Maaike Located at Seiffert Lane (T) Putnam Valley Section 18 Block 02 Lot 07 RECEIVED Subdivision of Subdv. Lot # Filed Ma•p' # Date '87 APR 10 P1 :25 Gentlemen: This letter is to authorize John P. Delano a duly licensed professional engineer X or registered architect (Indicate) to apply fon 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 1:ealth.Law, and.the.Putnam.County .Sani- tary Code. ` Very truly yours, S i gne d Countersigned: �� Owner of Property 4 15 Seiffert Lane P.E.,XtXiX, Address r BA.D •Y & WAT S ON Address Surveying & Engineering, P.C. Route 9 501 Spring, NY _10516 (914) 26 5 -9.17 Telephone " Putnam Valley, NY 10579 Town (914) 528 -0576 Telephone IVIVAti CUAII-Y 01-AImIlli, DMSICN OF 114VIMM- UAL vr Imfuji, 11111 SERVICES DESIGN DATA SHEET-SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO.'" Owner Klubnick,'Dennis, F. Mazaike, Address 419 sej f fp_rt Lanp., Putnam Valley. Ny Located at (Street) 415 Seiffert Lane Sec. 18 Block 02' 10t 7 Undicate nearest cross stre6t)0m,:�->Vjt-L- �Oup\m IZOAD) Municipality T/O Putnam-Valley.. 'Watershed Peekskill Hollow Brook • SOIL PMCOLAZIGN TEST DATA RBOUIRED W BE SUBMI= WITH APPLICATIONS Date of Pre-soaking 3-26-87 Date of Percolation Test 3-26-87 110LE, NUMBER CIDM TIM PERCOLATaON PERCOLATION Run' Elapse Depth to ,Water` Frcxa Water Level .No. Time Ground Zurface , • in Inches Soil Rate Start-Stop Min.• Start S top Dro Jn 4in/ln Drop Inches inches Inches 1:22-1:52 30 22 25 3 10 2 1:52-2:22 30 22 25 3 .10 3 2:24-2:54 30 22 25 3 10 4 5 2 -1 1:07-1:37 —30 22 .25 2 2 1:43-2:14 30 22 -24--75 2-75 3 2 .3 2:15-2:45 30 22 2r. 3 in 2 4 2:48-3:18 30 22 25 3 Cd 5 r' rry 2 3 -A 5 NOCES: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data.to'be submitted for review. 2. Depth masurarents to be made from .top of hole. rev. 9/85. DEPTH Gq L. 1' 2' 3° 4° 5° 6° 7' 8° TEST PIT D11'1'A Ef-iQUIUD TO BE SM1117 'ED TIT111 APPLICATION DESCFZ:I:MON OF SOILS ENCOUNIT1 EL) IN TEST HOLES HOLE NO. 1 HOLE NO. HOLE ND. Topsoil 4" Loam (Bout-gev"'5) 11° 12° 13' 14' INDICATE LEVEL AT WHIC-1-1 GROUNLMN2M IS ENCOUNTERED' INDICATE LEVEL TO MUCH WATER LEVEL RISES ,AFTER BEING ENOOWIEPM 41-6.11 a^ . DEEP HOLE OBSERVATIONS MADE BY: John P. Delano DATE.. 5/11/87 .s .. _ s cam' —__•_^ DESIGN Soil Rate Used 10 Min /1" Dropi S.D. Usable -Area Provided 2,000 sf Existing No. of Bedrocros 3- SepticrTank Capacity 750 gals, Type `concrete 140 if existing Absovption Area Provided By 333 L.F. x 24" width trench -- if proposed Other 1 -ptt -d •$. VILL., - - -- Name John P. Delano, P.E. _ Signature % BADEY & WATSON Address Suze SEAL Eri p Route 9 Cold Spring', 1 0516 '1TiIS SPACE FOR USE BY HEALTH DEPAR'IMEN'1' ONLY: ._ dell /l2.it{t.1>>b` Soil Rate Approved _ sq.ft /gal. Checked by Date i PUTNAM COUNTY DE- FARTillbNT OF HEM DIVISION OF ENVIRONMENTAL HEALTH SERVICES PPENDIX K Date April 9, 1987 Re: Property of Klubnick-, Dennis & Maaike - "Located at Seiffert Lane ,tnam Valle 18 02 07 � ±` y Section Block Lot ,Irt� Subdivisiori� "of $7 Filed Map �# Date Gentlemen: This letter is to authorize John' P. Delano a duly licensed professional. engineer X or registered architect (Indicate) to apply for a Cons tructi on" Permit for a separate sewage system, to serve the above noted. property in accordance- with the standards, rules or regulations as promulagirited by the Comniissioner of the Putnam County Department of Health, and to sigh all necessary papers on my behalf in coiuiection with this inatter and to supervise the construction of said system- or systems in conformity with the provisions of.Article-145 -or 147, Education haw, tlie_ Public Health, Law, and. the. Putnam. County .Sd'ni- tax:y Code !� Very truly yours, r Sighed Owner of Property /C Countersigned: YYY 415 Seiffert Lane P•.E. ?50S Address BADEY & WATSON Address Surveying &Engineering, P.C. • Route 9 Cold Spring' NY 1051.6 (91.4) 265-9217 Telephone r' Putnam Valley, NY 10579 Town (914) 52B -9576 Telephone I I �tu.Lli��r� �t,aitr.c:t t,r•:�n.trlrLrz;'r1 ur n�:r�rr1. . DIVISIUM O I —ML ftEAV -111 SERVICES DESIGN DATA- SUM r- SUBSUEAC E SEIIAGE DISPOSAL SYS'i'kM gIM NO.' Ow►ler Klubnick,L��is rG Maaikp Address 4.15 SPifferf"Tangy Putnam Valley. NY Located at (Street) 41_5 Seiftezt-Lane_.._ Sec. 1g Block � Lot :� (indicate ncmIrest cross street)0p1w�L- Not -tow � MruAeipality ..,,�.0 ??utnam Valli. Watershed Peekskill Hollow Brook EPIVl R i)h!'P;F "<i'AL '•,r. , 1_iu ,9O1!L' 15MC01A2'IC U 'TEST INVEA RI)UIRM TO LAC , SUa] 1rrjD WI'I'It 11PPLICATIC NS Date of ) rle- g p?,3�,2 6 -81 Date of Percolation Test 3 -26 -87 IM 2 1 NU PER EIt CLOCK TDI _ PEE20=IC)N PERCOLATTION Run' Elapse Depth to .Water. fYan `dater Level No. Tin» Ground Surface , In Indies Soil Rate Start -Stop Plitt., R..art Stop Drop In Min/In Drop Inches Indies Inches 1 1 1:22 -1:52 30 22 25 3 10 1 27=52 -2:22 30 22 25 3 10 1 3 2:24 -2:54 �30" 22 25 3 10 4 5 2 1 1:07 -1:37 -30 ?2_ A 2 2 1:43 -2:14 _ 30 22 24 •75 9-7c; 11 2 .3 2:15 -2:45 30 25 1 1f 2 4 2.48 -3.18 30 22 tx7r15: 1. Tests to be reLc\ltcd at: -.any -A depth until approacimtely equal soil rates are obtained• at each percolation test hole. 1111 data to' be subinittbd for review.. 2. Depth measurarenLs to be n>ade fran .top of hole. rev. 9/85. DEP'S11 G, L. 1' . 2 3' 4' 5' 6 °�- 7' >3' 9- 1 10' 12° 13' 14' `ZEST P.1_'1' 1)11'.1Y1 MIJU111 U `1'0 BE SUI'lU.' fFL) WIT11 AP PLICJI`t'ION UE'SC111.11':ICIIJ Of S0.1JZ ENWUM!E1U:D IN TEST 1101ES 1101E NO. HOLE NO. HOLE ISO o r, pa.I INDICATE LEVEL A'1' MIMI GR0U11LkV1'1'11t IS ENOOUNTERE ). INDICATE LEVEL TO W111C11 VIN1211 LEVEL RISES ,J1- YER BEING ENMUNTERED pp D1' EP HOLE OEGERVA'1'I0N5 h111DE BY: -1-0�\ �j n n DATE: � d ► �, DESIGN Soil Rate Used . 10 Min /_l." Drop: S.D. Usable.Area Provided 2 ►000 sf Existing Vo. of BedrpaiLs 3,• _ SepLisrTank Capacity 750 gam, Type `concrete 140 if-existing Absoj�ption Area Provided 13y 333 L. F. x 24" width trench 193 if proposed ; Other -Name John P. Delano P.E. Signature % BADEY & ' WATSON a Ad&ess Sreyil� & ,Igj Ce�ri n7 SEAL r- :1- •.�� .� f ' . Route 9 CO d Spri ng , NNY 10516 i US SPACE FUR USE. BY RE[W111 DEPA1t1M N1' ONLY: ��ieu1i;11►ttti��d�' , Soil RiLe Apprc iml -- -- - -- sq. fL /gal. Checked by Date ODUIfly MON OF ENVIPMaML OF HEALIITI DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Klubnick. Dennis K Maai Address 4.1.9 Seiff r L=e. Ruti m valley, IX i Located at (Street) 415 Seiffert Tine Sec. 1$— Block 0 2 Lot 7 (indicate nearest cross street)'(ph5e�,wZL Houww Ro Municipality T/O -Pztnam Valley. Watershed Peekskill Hollow Brook SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WI'T'H APPLICATIONS Date of Pre- Soaking 3 -26 -87 Dateof Percolation Test 3 -26 -87 HOLE NUMBER CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Elam Water Level No. Time Ground Surface In Inches Soil Rate Start =Stop Min. Start Stop Drop In Min/In Drop Inches Incites Inches 1 1 1:22 -1:52 30 22 25 3 10 1 2 1:52 -2:22 30 22 25 3 10 1 3 2:24 -2:54 30 22 25 3 10 4 5 2 1 1:07 -1:37 30 22 25 in 2 2 1.43 -2:14 30 22 24-7-S 2.7� 2 3'2:15 -2:45 30 22 25. 3 In 2 4 2:48 -3:18 30 22 25 3 70 5 �7 2 4 o to NOTES_: 1. Tests to be repeated are obtained .at each for , review. . 2. Depth measurements tc rev. 9/85 at same depth until approximately equal so il. rates percolation test hole. All data to'be submitted be made fram.top of hole. s TDS`J' PIT DNrA 1Z17ximm TO BE SUBr'Smm WI'T'H APPLICATION DESCRIPTION OF SOIL; MIKM IMED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 1' 2' 3' 4' 5' 6--_ . 7' 8' 9' ' 10' 12' J 13' 14' INDICATE LEVEL AT WHICH GROUNDWrM IS ENCOUNTERED' INDICATE LEVEL TO WHICH WATER LEVEL RISES,AFTER BEING ENCOUNTERED e DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used 10 Min /1" .Drop: S.D. Usable.Area Provided 2,000 sf Existing No: of Bedrooms 3. Septic,•Tank Capacity 750 gays, Type concrete 140 if existing Absorption Area Provided By 333 L.F. x 24" width trench 193 if proposed Other Name John P. Delano, P , E. Signature o BADEY & WATSON SEAL Suryeyiag & EWi npPri ng P Route 9 Cold Swing, ng,_ NY _M 516 THIS SPACE FOR USE BY HEALTH DEPAR`DIENP ONLY: Nil Rate Approved sq.ft /gal. Checked by Date