Loading...
HomeMy WebLinkAbout2405DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 42. -3 -30 BOX 21 02405 'PUTNAM COUNTY. DEPARTMENT OF HEALTH ENGINEER TO PROVIDE PERMIT # ON CERTIFICATE OF COMPLIANCE, (� Division of Environmental Health Services, Carmel, N. Y. 10512 PERMIT # h�� ��•_ � CONSTRU TION PERMIT FOR SEWAGE DISPOSAL SYSTEM LfG'bc 1 p+ a t E Town or ill P" t., at �' �• I� 1 +Ij Tax Map 0 C� Block lot SubGlyliiQ(1 Subd• Lot N Renewal �_[] Revision owner /::ftm � S= `C9 �1��A� j � iQf+(S? V ate Of Previous Approval Building Type UNS to 16 vt I a Lot Area Number of Bedrooms Design Flo . G /P /D Separate Sewerage System to consist q,[ To be constructed by ;� -., 5 �))IC QC k S, w 44 C t-yc Water Supply: Public Supply From ?i Private Supply, to be drilled by o Address Other Requirements 12 %Z,_ , Fill Section Only ❑ P.C. H. D. Notification Required Septic Tank and. "TtLE EtE.L. 1 Address )i'' � �-- I 1 represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regulations o e u ram County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Health will be submitted to the Department, and Is written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any, part of said sewage disposal system during the period of two (2) years Immediately following thedate of the Issu- ance of the approval of the Certificate of 'Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed in accordance with the standards, rules and regu as %Mons oof the Puttt//f111am County Department of Health. �� 7 7 / Date 1� �j P "`� l.. � Signed P.E. R.A. Address ti' L License No. � � / 7 APPROVED FOR CONSTRUCTION: This approval expires one year 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 new permit. �� Approved tbr' disposal of domestic sanitary se age, and /or private water supply only. ' l Date 7 -6 -6G BY fwr>Q� A Title Rev. 6/85 Rev. 3 86 OF Located at C K 5 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Mast Provide p 4 9 —66 P.C.H.D. Permit # --- / v-- COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM PurNA'AI% u I-AT4 M Town or VW e —4 V4�l Tax Map � Block Lot � Owner /applicant Name Ep WAQ 'Y ►1C (Vi4N6 Formerly Subdivision Name Subdv. Lot q Mailing Address R re � � OX :303 ZIP_ Date Permit Issued 7 Separate Sewerage System built by T f2BrG,� /ovl �oasJ�• Address .y 0✓r1// Consisting of /OP C7 Gallon Septic Tank and L.//✓gS' 1 4 Water Supply: N 0 Pabllc Supply From Address or: Yes Private Supply Drilled byChn, J a• 1,45Sell Address I'M I LLe rl b"I Za . f5ecl4ta rd 1 y Building Type 15x0 Fln1 Has Erosion Control Been Completed? Number of Bedrooms Has Garbage Grinder Been Installed? 0 Other Requirements I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulations, in accordance with the filed plan, and the permit issued by the Putnam County Department Of Health. � / /— 2-97 Certified by P•E.� R.A. Oats , ' Address r"cl9�6 �� /6�N�- N�' /aOZO, License No. 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 void as soon as a publ': unitary sewer becomes available and the approval of the private water suDP1Y 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 o Healthy Such outlon, modification o► change Is necessary. �� 1, SHERLITA AMLER, MD,'MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner. of Health RO County Exec ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ADDITION APPLICATION RESIDENTIAL ONLY 66 STREET qqO . ?�KIU, k0tabi Qp TOWN' cMV3WVAi,I_.y TAX MAP# 42.330 NAME.. 1'FIT' %acac-'("�� PHONE G% 3k6S PCHD# ( � MAILING ADDRESS., A$ Asa-t i DESCRIPTION OF S ADDITION , : A fZTIST s-ru VSO ,Z GA 9_ C"AC � + Z&W NUMBER OFD EXISTING BEDROOMS 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 applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, Brewster, NY 10509, Phone: (845) 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) 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 locations to the best of your knowledge. f/ 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 Certificate of Occupancy from Town or Certification from Building. Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool(845)278 -6014 Fax(845)278 -6648 '08 -10 -01 14;28 FROM- BRUCE R. FOLEY Public Health Director Gam. Y DEPARTMENT OF HEALTH 1 Oeneva Road Brewster, New York 10509 T -125 P002/002 F -225 LOR.MA MOLMARI R.N., M.S.N. Associate Public Health Director Director of Patient Services � 273 •- r�92i ATTENTION: ❑ ADAM STIEBELING AENE REED All information below must be fiui,Ix completed prior to any scheduling. DA.TIE (� 1 ENGMI ER OR F11b'V1: 90N!N /1/(t 1 Nl� i2rnr PHONE 9: REASON: DEEPS: x I PERCS: ❑ PUMP TEST: o ROAD /S'T'REET: V197,T z ) < &w TOWN: ���'► V�u� TAX Va V": � •' � .% SUBDIVISION: �/UI%.�idlOo#� p[�.5 �c��cc (% - LOTS: �j�.� zt 117 OWNER: f l t..y r-m oor-0 Cram lV KDEP CRITERIA FOR,I -01NT RE'�CE�V .��`� WET ��SSING OF SOII, TES, TTc�G YES NO ❑ ❑ Proposed SSTS within the drainage basin of West Branch or Boyds Corner Reservoirs. ❑ ❑ Proposed SETS within 500 feet of a reservoir, reservoir stem or control lake. ❑ ❑ Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ ❑ Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. ❑ ❑ Proposed SETS for a Commerical Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the :response. If you answered �s to any of the questions. NYCDEP must witness the soil testing, This Department will coordinate a mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. FOR COUNTY USE ONLY DATE: TIME: corm- mm-mm (FIELD'iES-r) i '08 -10 -01 14;28 FROM- T -125 P001/002 F -225 a , BRUCE R. EOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPA.RTNENT OF HEALTH 1 Geneva Roads,! p Brewster, New York 10509 �a 273 R_ EOUXST OR FI L XH G ATTENTION: ❑ ADAM STl; MLING AENLE REED All information below must be f4 completed prior to any scheduling. DA.TE� t IUtN N ENGINEER OR FIRM: ,t2t� � � I N1n�, -- - PTdgivE 9: REASON: DEEPS: PERCS: ❑ PUMP TEST, a ROAD/STREET:'� -ruom RvRp TOWN. pamo U4u.F-\4 )� SuBDIVISiON: ;N ucWoP v(0 lyoT�: 41-& A 3 �t D OWNER: M—V [ orz f 0 i- o -rrvhl N�- C'DEP, QR1TERIA FO -JOINT REVIENV AD WITNESSIN OF SOIL TESTING YES NO o . ❑ Imposed SSTS within the.drainage basinof West Branch or Boyds Corner Reservoirs. 0 ❑ Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. ❑ ❑ Proposed SSTS within 200 feet of a watercourse or a DEC wetland. 0 ❑ Proposed SSTS design flow greater than, 1000 gallons /day or SPDES Permit required. ❑ ❑ Proposed SSTS for a Commerical Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response, If you answeredy -es to any of the questions. NYCDEP must witness the soil testing. This Department will coordinate a mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design orafessional to schedule re- witnessing of the soil testing with NYCDEP. FOR COUNTY USE ONLY OXTE: TIME: CONVMENTS: (MDTEST) SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORE'f g'A MOLINARI, RIB, MSN Associate Commissioner of Health Trevor Spearman 753 Warren Avenue Thornwood, NY 10594 Dear Mr. Spearman: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health September 5, 2008 Re: Addition — A- 151 -08 990 Peekskill Hollow Road (T) Putnam Valley, TM # 42. -3 -30 I have received and reviewed the plans for the proposed addition to the above mentioned residence. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons: 1. Due to size, the room titled Artist Loft is considered two potential bedrooms. Please be advised that the finished basement was not constructed according to this Departments approved plans. Therefore, the room titled workout room is considered a potential bedroom. 2. The legal bedroom count for the dwelling is three. The potential bedroom count of your proposed addition is six. 3. The addition of a potential bedroom requires this Department's approval of a revised septic system plan from a professional engineer Please review the proposed floor plan to reflect no more than three potential bedrooms, or have a professional engineer or registered architect design a sub - surface sewage treatment system meeting present code requirements for four bedrooms. GDR:kly Sincerely, Gene D. Reed Sr. Environmental Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool(845)278 -6014 Fax(845)278 -6648 1, it SHERLITA AMLER, MD, MS, FAAP Commissioner of Health I i LORETTA MOLINARI, RN MSN Associate Commissioner of Health. DEPARTMENT OF HEALTH I Geneva Road,' Brewster, New York 10509 ROBERT J. BONDI . County Executive Town Leeal Bedroom Count Re:, (Owner's Name) I Tax Map #: - 3 b Address: 10 . AY IaUJYY IV-tljek) / &-L i Year Built: , According to records maintained by the Town, the above noted dwelling, i , is incompliance with Town Code. , , is not in compliance with Town Code.. The Legal Bedroom Count is: This information; has been obtained from: Certificate of Occupancy: i Other: ZL.� S/ ( Buildin g P Ins ctor Date , I I i i Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax x(845) 278 -6085 I 1 � r e(-5 0� - T CERTIFICATE OF OCCUPANCY — 9NT FABILYPTO Certificate of Occupancy No......... 3 .......... Application!No .......86-1110 ...................... UcatiomC'of Pteniises PepJz.sLill...I-Iol.low.. Road ..—..UI#18-4-1 .............................................................. ......... .......... ...... ...... ....... .. .. ..... ! .............. ...... B dwar.d..McGra . ie ...... of ..... ]3ox..30.3..—..Austin..P\jd...—IlaboDec, "HY ........ having ........... .. .... . .... .. .. .............. .... . ..... ...................................... ..... ...... I ............... heretofore -filed an AD'blication for a building permit pursuant to the Zoning Ordinance, Sanitary , fij7 effect Code and the Laws in the Town of Putnam Valley, Putnam County, New York, having paid the required feelherefor and the undersigned haviig by personal inspection ascertained that the applicant has suk4quently proceeded with the erection or improvement of the proposed struc- ture in compliancetiv.ith the requirements of the laws as aforementioned and that the said work and materials met "eiery requirement of the laws as aforementioned and that the premises have now bed t and are ready for occupancy, pursuant to the provisions of law, Now, therefore, =�.cceorg!etWeof occupancy is hereby issued under the seal of the Town of Putnam Valley this ......... 5.... day of .......::arch 07 * ................................ 1 19... Not valld unless signed I In Ink by a duly authorized agent TOMWMITNAIN V �L ORK of and under the seal �of the' of Putnam Valky. By.............................. .. ....................................... Apr 14 08 01:49p Comerstone Associates 914962-0330 I P•1 I A)1� ti (p ► ►�� [1 11 ! 1 i [ F l k� l ifl (il ll\ US 1E) l� ( ►1 1ti111,ti �( ►{} ►:tillV'(�'ll }i:l Ilti�' 1[I(f)'� .11,�1��1 i( �1 IIt1)ti Tax Map #: � �j Tman WdWad hsp=W i!' 1;,f%lIIYI _..\ �(R! USE L.11►a. A_IYlI(I) w;�F Based upm the mfommdm submined and bapoOm of ft si1Ee, it is doumned that a WM be cemmW to vwa&y 69 a w9and pemmai$ wM be regmm& EAimated : lb-. applcmd bas ocaftaod a wedaud dcbn=um 1be.ds:Mmeation mwt be veQ'ified by the Irma Q IDlEs ) ytiwd ]fnspeacs Sag Dane: Rt I� sl? 4E 11!'t # U► f ;� l� '1 �� OF -� I � f . � ( FlilStE ti I � � i01 r ti,4ll um�t Elul = ia�fla!'' I`i r' I'.�iruj �_,._x � E� III ][t' i • Y � �{IIfl 41 LfIF1! Ij gpF.I - f���• {�1 M i SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Mr. Trevor Spearman 752 Warren Avenue Thornwood, NY 10594 Dear Mr. Spearman: ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH Geneva Road, Brewster, New York 10509 October 2, 2008 Re: Addition- A- 151 -08 No Increase in Number of Bedrooms 990 Peekskill Hollow Road (T) Putnam Valley, T.M. # 42. -3 -30 I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated October 1, 2008. The addition is approved with the following conditions: 1. A repair permit from this Department is obtained for the relocation of the septic tank. 2. The total ,number of bedrooms must remain at three without prior approval by this Department. 3. The area of the existing sewage disposal system and its expansion area must be maintained: 4. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets etc. 5. The approval is for the proposed changes only': This approval does not validate any construction'shown as existing'that has not obtained proper approvals 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 (845) 278 -6130, ext. 2261. Sincerely, Gene D. Reed Senior Engineering Aide GDR:kly cc: BI, (T) Putnam Valley Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 —� Rev. ,3 86 1PUTNAM COUNTY DZPARTMEPIT OI��BAIfr . Division off Environmental Health Servlcecs,ormel,.Y.10512 Engineer Must Provide P.C.H.D. Permit ATE OF CQiPdSTRUCflYOR1 COMPLIAN CE FOIE SEWAGE DISPOSAL. SYSTEM �Gv %A,l q ,�� ! ls;; fit. y Q "7:• s 1,11 Town or a gt IImrnted a8 e k : :� 1 ( f -l/ C.) !. 4. r'1 ' e�C lJ : ,� t ''eJ G Tas Map ` Flock Lot �6 Dwwner/eppltennt Rtam® E� Formerly Subdivision Flame Subdv. Lot # tit 3 ' Il6(ntung AddreaD R 7 I U � � x ") 3 Zip I y :' ' � � Date Permit Issues � + %Y ' �' �� � C f n /,y4 /tea Sepsxate Setrerage System built by , C7.'%. /. rGi.: I. i +, Jr. Adclreo® �� G i'�Pub �'�a : /i . �'`• 1.' '�!/ � m y t' Conoisting of _ /_ c -_ - - - - Gallon Septic Tanis and 7 '1 Water Supply, t ! Public Supply From Address or, % - ..+ Private Supply Drilled by'.: J +n' Id : % ri ; ; r �1 Addreae It t I I _ I_„ , jr, M1 Building Type %T f r' rr'+,= Has Eroslon Control Seen Completed? i • Number of Bedrooms Garbage Grinder Been lnotrilled7 Other. Requirements. ,I certify that the system (a) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the atandards, rules and regulations, in accordance with the filed plan, and the permit issued by the Putnam County Department Of Health. :•_ Data / r� certified by L: 41' r "7f tt ��� rr.' ...i:!r t.� P.E. _R.A. t Address l_,1 .� << "� %�.c_i >�� z. . ?/• r`7�G�;.' %�.:1. �- E:- .lti/ Licen6oNo. 2� '//Q/- '�pGip r"b_ m ny .porson occupying promises sorvod by the abovo systems) Shalt promptly totto such action as may bo noeosenry to coeuro tho correction of any unsanitary " eonditlons rosulttng from such usage. Approval of the separate sowworago aystom shall boeome null and void as coon as 'a pubs!: esnitary 00wor bocomas avitllabfo and the approval of tho private Water suPPIV shall become .mold when a public aratc7 Supply boWn►os OvailM" Such approvals Oro subjoct to modification or change when, In the judgment of the Commissionor of Health, suet, rovoeatton, ' or ehango to noeooeary, Y - t4w b 'Igo� F SHERLITA AMLER, MD, MS, FAAP Commissioner of Health I LORETTA MOLINARI, RN, MSN Associate Commissioner' of Health J, Rodney James 990 Peekskill Hollow Rd Putnam Valley, NY !16579 Dear Mr. James: ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 April 2, 2007 Re: Addition- A- 061 -07 No Increase in Number of Bedrooms 990 Peekskill Hollow Road (T) Putnam Valley, T.M. # 42. -3 -30 I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated April 2, 2007. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at three without prior approval by this Department! 2. The area of ;tlie 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. 4. The approvalis for the proposed changes only. This approval does not validate any construction shown as existing that has not obtained proper approvals I Any other permits or, variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley. I If you have any questions, please contact me at (845) 278 -6130, ext. 2261. II Si . V Gene D. Reed Senior Engineering Aide i GDR:kly cc: BI, (T) Putnam Valley Environmental Health (845) 278 -6130 Fax (845) 278 -7921 j Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Far (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool(845)278 -6014 Fax(845)278 -6648 i li ; SHERLITA ANTLER, MD, MS, FAAP . Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONIDI County Executive ADDITION APPLICATION RESIDENTIAL ONLY STREET PCCKbX(�L HCjLW,J TOWN (VTP,) Arn V A c,(- TA1X MIAP# NAME �n�1J r � m C � PlE ONEE '�4 S - !�'ZS, S3 -1-DPCH D# '�, . - �e� MAILING Q ADDRESS f �0 PC- t"V 6 91 UL { 0 L_W Q DESCRIPTION O� '� 1 ADDITION OIY N S AS �►Yl NUMBER OF EUSTING BEDROOMS PROPOSED # Off' 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 applicable sections of,the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, Brewster, NY 10509, Phone: (845) 278 -6130. ,�l. Certified check or money order for $100.00. /2. Sketches of existing floor plan (drawn to scale, all living area aincluding basement) /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 locations 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. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS,I FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPAR'�WENT OF HEALTH 1 Geneva Ro. d, Brewster, New York 10509 Town Legal Bedroom Count ROBERT J. BONDI County Executive Re;Anl e s (Owner's Name) Tax Map #: a=. — - S O Address: C N O Pf5 a:-ie--S 1--( L-L- 1ADLL- OW l. Town: ?tk'TN P^\ V PIL L Evj Year Built: I c g Accord' to records maintained by the Town, the above noted dwelling, is incompliance with Town Code. I is not in compliance with Town Code. The Legal Bedro om 'Count is: 3 This information has been obtained from: Certificate of Occupancy: Other: I _.. 2-1 p Building Inspector Date Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 (Rd G1 ')'752 -rAI A 9— NA N Y79-AAAR Ii 6 r I SHERLITA AMLER, MD, MS,I FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPAR'�WENT OF HEALTH 1 Geneva Ro. d, Brewster, New York 10509 Town Legal Bedroom Count ROBERT J. BONDI County Executive Re;Anl e s (Owner's Name) Tax Map #: a=. — - S O Address: C N O Pf5 a:-ie--S 1--( L-L- 1ADLL- OW l. Town: ?tk'TN P^\ V PIL L Evj Year Built: I c g Accord' to records maintained by the Town, the above noted dwelling, is incompliance with Town Code. I is not in compliance with Town Code. The Legal Bedro om 'Count is: 3 This information has been obtained from: Certificate of Occupancy: Other: I _.. 2-1 p Building Inspector Date Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 (Rd G1 ')'752 -rAI A 9— NA N Y79-AAAR Ii 6 ev. 3 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N.Y. 10S12 ,t 'f Engineer Must Provide FV 119 —96 (� P.C.H.D. Permit #----- --- - -- ATE OF CONSTRUCTION COMPLIANCE FOR SEWA( Located at VE C k_- 5 b/1G. DISPOSAL SYSTEM %/f/ Al (fdf // U TNEFrn Town or 17e 04,0 V4!L / Tax Map Block Lot Owner /applicant Name G'U wff'U fKIC (arA'NC Formerly Subdivision Name Subdv. Lot Mailing Address R 5` %f / '3 OX -40-3 ZIP 10'�/ Date Permit Issued 7— E-962 ,4 057'/N �Ao 4 414be l /-�# c 1, ✓t1.L . Separate Sewerage System built by �•-0-T_ ��'rC� /yrf �n s/• Ad ese�° °! 1D�/� C' My, /0 Consisting of O b Gallon Septic Tank and` C 4 Water Supply: N C Public Supply From Address / `' 1/ or: Y1A Private Supply Drilled byCtiArlPti 44455 -n Address M I LLerianl Ed . F3�4),,4 N � Z Building Type Number of Bel Erosion Control Been Completed? ye—:5 Other Requirements 9 4X4 -_0_ eW02 tIOX c,&--A > car JIA_;p '"�, C2 IC zc_-y J- ;'e1 s I certify that the syatem(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the s andards, rules and regulations, in accordance th 10 filed pI n, and the permit issued by the Putnam County Department of Health. - 13uJ` lx rj �jaG9 " ✓ (,Uxef Date 7` 9 7 Certified y- Y !1.__ R.A. Address 1AA �gG'G.O//1G� 575 A %41-4 /1-Q/ a, Y iaa% License No. Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to socuro the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as noon ao a pub!% sanitary sowor becomes available and the approval of the private water supply shall become null and void when a public water supply DOCOMOS available. Such approvals are subject to modification or change whenn,, in the judgment of the Commissioner of He�altth.�!s _C�� ov�atiion�modiifi- cation or change Is nocossaary. Date Title -/ - UIMIVILI III .... - -. ._. .. �...�... ....��. ro. . ....... ........ .. ....... WEIGHT PER FOOT - Ib. /ft. DRIVE SHOE Q-YES O NO I LINER: OYES O NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (it) DEPTH TO SCREEN (ft) DEVELOPED? FIRST O YES ❑ NO HOURS SECOND GRAVEL PACK ❑ YES O NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH ft. WELL YIELD TEST It detailed pumping METHOD: ❑ PUMPED I tests were done is in- COMPRESSED AIR , formation attached? ❑ BAILED ❑ OTHER O YES ONO if more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. p Y DEPTH FROM SURFACE Water Bear. in9 Wdl( Dia- neter FORMATION DESCRIPTION GOOE• ft ft WELL DEPTH tt. DURATION hr. min, DRAWOOWN ft. YIELD 9Gm. Land Surface ----' yn ':�' I tic � •�:. WATER ❑ CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? ,YES ONO STORAGE TANK: TYPE.-. S yK� CAPACITY Iga GAL. PUMP INFORMATION 10 9•PM TYPE SuF?,MEI� CAPACITY MODELMAKER 4 ° u "Q DEPTH 3'40 ra►t MODEL 7E 0741;L VOLTAGE `?3d HP _11q WELL DRILLER NAME ���� 1.r�itt!S�E'1+� ATE ., C. ADDRESS `�' \�.. C'_ =qf , � � SIG? RE - , l P '1 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health i LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Rodney James 990 Peekskill Hollow Road Putnam Valley, NY 10579 Dear Mr. James: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI . County Executive ROBERT MORRIS, PE Director of Environmental Health March 29, 2007 Re: Addition — A- 061 -07 990 Peekskill Hollow Road (T) Putnam Valley, TM # 42. -3 -30 I have received and reviewed the plans for the proposed addition at the above mentioned residence. Based on the information submitted, thel above mentioned addition cannot be approved for the following reasons:. L. The proposed rooms in the basement titled training and baby play room, office, and wardrobe are considered by this Department to be potential bedrooms. 2. The legal bedroom count for the dwelling is three. The potential bedroom count of your proposed addition is six. 3. The addition ,of a potential bedroom requires this Department's approval of a revised septic system plan from a professional engineer. Please revise the proposed floor plan to reflect no more than three potential bedrooms, or have a professional engineer or registered architect design a sub - surface sewage treatment- system meeting present code; requirements. If you have any questions, please contact me at your convenience. Sincerely, Gene D. Reed Sr. Environmental Engineering Aide GDR:kly Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 ' Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool(845)278 -6014 Fax(845)278 =6648 DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION Street Addr s .. Town Village ,C�'ty . Tax u n iV. A, 3AV970 Grid Number WELL OWNER Name e '� `61611VIF Ad ress 1V5.r1y4_ JdPrivate ❑ Public USE OF WELL 1 - primary 2 - secondary _V J9 RESIDENTIAL ❑ BUSINESS ❑ INDUSTRIAL ® PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION 13 INSTITUTIONAL O STAND -BY 0 ABANDONED 0 OTHER (specify AMOUNT OF USE YIELD SOUGHT_(? gpm /# PEOPLE SERVED 3 /EST. OF DAILY USAGE Q 0 gal REASON FOR DRILLING JZNEW SUPPLY O REPLACE EXISTING SUPPLY O PROVIDE ADDITIONAL SUPPLY ® DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING EW V C;5 WELL TYPE KJDRILLED DRIVEN ®DUG ®GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES No IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name rill; 'd C �,4W /�y' S' %� Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED []ON REAR OF THIS APPLICATION C ! ON T H�T 'V fife) gn e) 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. Date of Issue: 19 Date of Expiration: 19 Permit Issuing Official Permit is Non - Transferrable a� .t FIB ��4 Wr,LL �,Uru L� 1 iviv i�i�i vi°i DE PARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM' COUNTY DEPARTMENT OF HEALTH Office Use Only .a STREET ADDRESS: ,; TAX GRID NUMBEa: ' ��, i 16"(1, WELL LOCATION WELL OWNER NAME: '" , /� ADDRESS: +�/ ® PRIVATE O PUBLIC USE OF WELL 1 - primary 2 - secondary M RESIDENTIAL O PUBLIC SUPPLY O AIR /COND. /HEAT PUMP O ABANDONED ❑ BUSINESS : O FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL '❑ INSTITUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOP.L'E SERVED._/ EST. OF DAILY USAGE gal. REASON FOR DRILLING fm NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA ' WELL DEPTH � - -ft. STATIC. WATER LEVEL �' + _ft. DATE MEASURED 12 -3 -8k DRILLING EQUIPMENT O ROTARY) COMPRESSED AIR PERCUSSION O DUG ❑ WELL 50INT ❑ CABLE PERCUSSION O OTHER (specify): WELL TYPE .❑ SCREENED O OPEN END CASING 00 OPEN HOLE IN BEDROCK O OTHER CASING TOTAL LENGTH ft. MATERIALS: STEEL . O PLASTIC O OTHER LENGTH.BELOW GRADE ) ft JOINTS: b WELDED E51THREADED O OTHER DETAILS DIAMETER in'. SEAL: O CEMENT GROUT OENTONITE OOTHER . WEIGHT PER FOOT Ib. /ft. DRIVE SHOE p'YES O NO LINER: O YES ONO SCREEN DETAILS DIAMETER (in) SLOT SIZE LENGTH (1t) DEPTH TO SCREEN (ft) ' DEVELOPED? FIR57 O YES ❑ NO HOURS SECOND GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK An. TOP DEPTH tL BOTTOM DEPTH It. If detailed um in WELL YIELD TEST p p e�L� METHOD: O PUMPED 1 tests were done is in- COMPRESSED AIR , formation attached? O BAILED ❑ OTHER ; ;YES O NO L�� 1f ;more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE water Bear- ing well Oia- meter FORMATION DESCRIPTION coot. It IL WELL DEPTH It. DURATION hr. min. DRAWDOWN ft.' YIELD gFm. Land Jurface WATER ❑ CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS' O COLORED ANALYZED O YES ONO 'ANALYSIS ATTACHED? )LYE'S ONO STORAGE TANK: TYPE S 1)4� L CAPACITY �� GAL. /8100 7 PUMP INFORMATION TYPE 50136162.. CAPACITY ID S.PM MAKER G ° u I_ o DEPTH 3 `40 rDA j X30 351 MODEL 2E 07 4 1 VOL7AG.E HP WELL DRILLER NAME WATE AD C 3 I DRESS �t, e � �L I'll- � j . E � . ` � ``9 � �2ti1,( Y�. lto &tbwn Adledic.al Labor lory , Ind, LAD 0 —CA. 003541 { 331 #Gear Street Yorktown Heights, N.Y. 10592 Collection Station Used: (9fl4xa4�ga ®g Carmel Peekshill _ Nt. Kim o Neu City Director: AThcre H. Padomae X T. (A $qj —° 11 Date �'gken:. { Date Received: e.fc:S•k�..� �o �1 �� �. Date Reported: ' Collected By: ,, J Referred BY: C I r " y �C� �7� Sample Source : ; 4, ,5 LABORATORY REPORT ON -BACTERIOLOGICAL QUALITY OF MATER GENERAL BACTERIA- . Standard Plate Count per 100 ml (Agar plate @ 35 °C) YEMBRA1iE FILTRATION TECHNIQUE (MFT). Total Coliform per 100 ml Fecal Colifora: per 1.00 ml Fecal Streptococcus per 100 ml XOST PROBABLE 1 ;UMB'FP. TECHNIQUF. (MPN) - - -: -- . "i _Total Coliform: MPN Index per 100 ml FecaI- Gobi. form: M.PN Index per 100 sal OTHER ANALYSES THESE RESULTS INDICATE THAT THE 'PATER 'SANPLE. VAS (WAS NOT) (NOT APPLICAP OF A SATISFACTORY SANITARY QUALITY ACCORDING TO T Z NEW YORK STATE DRINKINC WATER STANDARDS, FOR THE PARAMETERS TESTED 9 AT RBB TIME OF COLLECTION LEGEND Albert H. Padovan$o N.T. ASCP)o Dlre@%or RDS Recommend Dioinge Ing dater Source a leso than, QIITC Too Numerou@ Too -- Count - I PLTI'NAM COUN'T'Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ED //C Owner or Purchaser of Building Building Constructed by /13 L % Section Block Lot Location - Street Subdivision Name Municipality Subdivision Lot # /ST e-y Building Type GUARAN'T'EE OF SUBSURFACE SEWAGE DISPOSAL 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 guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage 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 Environmental ;Health Services of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the' occupant of the building utilizing the system. 4neral this % day of 19� n tor( er) - Signat e Corporation - j, rev. 9/85 mk Signature i Title %i i Corporation Name (if Corp.) Addre�� /may 9 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIELD INSPECTION REPORT illk (Name of Owner) (Street Location) -i.V INITIAL SITE INSPECTION YES NO Wetlands on /or proximate to property .............. Property lines or corners found ................... Can estimate house location ....................... Willdriveway need cut ............................ Must trees be rived - 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 ... .. .... .. .......... D.H. 1 Lot Depth to G.W. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. 12 ft soli uescrlDt D.H. 2 Lot Depth to G. W. Depth to rock Soil Descri do 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. llAl'� S FINAL SITE INSPECTION INSP.BY: - YES NO r CP {: DATE: INSP. BY: COM 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> 5011 CCMMENTS i 1� 1 1 •..L: _. L.�i.. 11.1`:.. - 1 % ., r� �, ( . h) ,DIVISION OF ENVIROMMM HEALTH SERVICES DESIGN DATA SHEET—SUB SUFACE SEWAGE DISPOSAL SYSTEM FILE NO. /o.� � Owner L'pw�e orlc t�rive_ Address R"s��N d 8exL3 M&fPoP*t.� Ny Located at (street), yeeLelw, lj 4011 cw cQ M �p des,, $ Block 4 Lot 1 ( indicate /nearest cross street) Municipality �vN pr,w V a) !ey Watershed SOIL PERCOLATION TEST DATA. REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre - Soaking 1. - 1$ -- Date of Percolation Test b -) 4 SL HOLE NUMER CL= TIME PERCOLATION PERCOLATION Run 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 1 z:35 3:d v a7 �3 �• 9.0 23 :D3 313Z Al 3 3;83 4'62, A5 A3 024, 3 ! (v G 4 1 /o: 01. /o.� � c3� 23.5 ZG • S 3 /0, to � 2 lot-lr //-/a 35" 23.& 3 8; 30 9:o11' 3 4 5 2 8 :Ss' 9•'G 3 / :� 3 zd /d• 33 9 R' ° m 5 PUI'NAM Cod L ry I)1:d3�'.. i' , , NOTES: 1. Tests,. to be repeated at same depth unti��06 Li— tel.y equal soil rates are obtained at each percolation test hole. All data to'be submittl�3 for'review. 2.. Depth measurements to be made fran top of hole. oAm TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: A�L ®' 0j,; y7 G DATE: DESIGN Soil Rate Used. 11.,5*- Min /1" Drop: S.D. Usable Area Provided %Sy 5.,; No. of Bedrooms 3 Septic Tank Capacity 1 C7e5o gals. Type Cosy C , Absorption Area Provided By 375' L.F. x 24" width trench Other , ::ti, dTMZ .,m ,, -. T . _ ° ...WmMn&, ° ° Name �.�� ,{/. ��� Signature„- Address /a a "ae z;C Ewa 64. SEAL °q ``_ 4 0 �'�.. m r 0u '' d� ice' o Slot %o° 41 A 0 01 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft/gal. Checked by Date DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. Z. HOLE NO. G.L. Y,So 1' 2' L-04 M r Gel 3' 5i mss°- L n �a ac 4'•�k�- 6' 7' 8' 4/0 A/6dY 1dI0 1a& Irm R g��4a 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: A�L ®' 0j,; y7 G DATE: DESIGN Soil Rate Used. 11.,5*- Min /1" Drop: S.D. Usable Area Provided %Sy 5.,; No. of Bedrooms 3 Septic Tank Capacity 1 C7e5o gals. Type Cosy C , Absorption Area Provided By 375' L.F. x 24" width trench Other , ::ti, dTMZ .,m ,, -. T . _ ° ...WmMn&, ° ° Name �.�� ,{/. ��� Signature„- Address /a a "ae z;C Ewa 64. SEAL °q ``_ 4 0 �'�.. m r 0u '' d� ice' o Slot %o° 41 A 0 01 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft/gal. Checked by Date : PUTNAM COUNTY DEPARTMENT OF HEALTH e APPENDIX K DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of` L`C��,i l ii CT --1 / / "� C �1 /s Located at A �fd2a) 07/r (T) Section ` Block ��6; Lot Subdivision of Subdv. Lots# Filed Map # �j Date . Gentlemen: This letter is to authorize,^ ��V► T a duly licensed,professional engineer'- HI- or registered architect (Indica e ` to apply for a Construction Permit for a separate sewage system, to i 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 LL C� . system or systems in con ovty with the provisions of .Article 145,. -:or, .. 147, Education " . ^� Law,. -the. Putnam. County..Sani- Law the' ubl ' I��ealth :L :... ,.. ...._ ..:.::..... .:..., .. .� .... ... tary Code. o{Cq�Q i 0�a Very truly-yours, ! � 1;37.7 % .. Signed Countersigned: �3 P E R A # Owner -of P/iflpltr'ty + ' + 7ddressv' Address Town + Telephone Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENPAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SE GE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT (� i\- - DATE REVIEWED: L� - I ? BY: Location) DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions.- Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Cur ins Perc & Deep Hole Located , Representative f..._Sewage�& Expansion Area Expansion Area;shown;gravity flow,suff. size If Pumped Pit & D Box Shown & Detailed House - No. of Bedroans Wells & SSDS's w /in 200 ft. of Property Located 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 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains- Curtain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fran Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same (Name of Owner) CAS (Street YES I NO �^ C. ><1 3 ✓ --- ©C OU; S tvai x' Ram, 9CE ® .i ✓ N C LAC I I DAVID D. BRUEN County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services June 30, 1986 Mr. Richard H. Greer 122 Edge.Comb Street Albany, New�York 12208 Re: Edward J. McGrane SDS Const. Permit Application Peekskill Hollow Road Putnam Valley Tax Map 18 -4 -1 Dear Mr. Greer: JOHN SIMMONS. M.D. Deputy Commissioner Review;of plans and other supporting documents submitted at this time relative.to the above - captioned project,'revised in response to June 13,.1986 comments, has been completed. Comments are offered as follows: 1. Well detail is still lacking. 2. Profile is lacking. X3. Proposed distribution box is inadequately sized. --X4. Trench length conflicts between.plan'and design data sheet. Application form also lacks indication of proposed - trench length. _,--`5. Property metes and bounds a're still incomplete. Due to parcel size, a small scale of entire parcel showing required information is suggested. 6. Distribution trench details are. incomplete. Please refer to previously transmitted requirements, Appendix C., The following items are lacking: tea) pipe ends must be capped'. ,/b) minimum depth of gravel under pipe: 6 inches. / c) gravel size: 3/4 to 1 1/2 ". 7. Distribution box footing must be frost protected. / 8. Septic tank bedding is not specified, nor is maximum tank'cover depth specified.'. See Appendix C. / 9. Steel septic tanks are not approvable. j`10. Location of exposed ledgerock is still not shown on plan.. Ledgerock east of percolation test holes 2 and 3 indicate proposed system will not be installable as shown. Plan must show exposed ledgerock.. TWO.'. COUNTY CENTER - CARMEL, !N.Y. 10512 (914) 225 -3641 .._ .. .._.. .. .. .� . ...... .......... ..... .ar..._.. ...�. _,_ ��_,.... �_ 1.'.. s._.._.,....... �._.. L. c...._a.....w..::�._,e.....n�s1 _:. r. G.................... �.._ �.>.:'' �-.'..,. t.... r.,. e.. .�s:�aa.,;.:ba......,_.�._'_•_. ____.�. � .. .. .. _.u._ o-z DAVID D. BRUEN County Executive Mr. Richard H. Greer 122 Edge Comb - Street Albany, NY Dear Mr. Greer: Review time relative Comments are t/ 1. �2. It. t7� . 3 . ✓6, ./7 . -✓11 . DEPARTMENT OF HEALTH Division Of Environmental Health Services JOHN SIMMONS, M.D. Deputy Commissioner Re: Edward J. McGrane SDS Constr. Pemit,:Applic. Peekskill Hollow Road. PV. Tm 18 -4 -1 of ,,,plans and other supporting documents submitted at this to the above - captioned projectk/has been completed. offered a s follows: na cs:.a Q %v` �o yv� t (�� (1, r78b C&OW.Ii Application is incomplete: applicant, address and lot area are lacking. Design data sheet.is incomplete: a. deep test hole findings ✓ b. percolation tests were not performed in accordance with .Putnam County Health Department procedure. Please provide ..at least two., days 'advance notice to witness re- = percolation.tests by Departmental representative. o+= 2-1 -` 6 , a3 -86 6 The design data, i.e., soil percolation rate and deep soil information, is not.noted on plans. - Tretch length.is inadequate.,. .ofile conflicts with plan. Plan layout is not understand - ab,l e :% System comp no ent details are lacking. See appendix in document referenced below. Construction notes are lacking. Topography observed in field varies from plan in that rock outcroppings in vicinity of sewage disposal system are evident and contours conflict. Trenches are not parallel to ground. Deep holes are mislocated. Percolation test holes are not evident.: - continued- -2- R.Greer Edward McGrane,Peekskill Hollow Road 6/13/86 /1,12. Expansion area location is lacking. ,/'13. Adjacent well is mislocated. c--14. Reference to other wells or sewage disposal system within 200 feet of proposed systems is lacking. 15,1 Property metes and bounds is incomplete. Enclosed for your use is another copy of "Program Review and. Policies ... for'Single Family Residences" which explains in a detailed fashion what the submission requirements are. If you have any questions pertaining to the above, please call meat 225 -3838 or 225 -3833. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. j7 Very truly yours, me's S. Hodgens Assistant Public Health Engineer JSH:amm i cc: File Q . 07W r. l� C PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIELD INSPECTION REPORT (Name of Owner) (Street Location) INITIAL SITE INSPECTION IYESI NO Wetlands on /or proximate to property .............. Property lines or corners found ................... Canestimate house location ....................... . Will driveway 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 ............................ D.H. 1 Lot Depth to G.W. Depth to rock1`L Soil Descri tion 0 ft. 3 ft. �L-- w� 6 ft. 9 ft. 12 �r T— %1 D. H. 2 Lot Depth to G.W. Depth to rock -- Soil Descr 0 ft. 3 ft. 9 ft. 12 ft. DATE: INSP. BY: COMMENTS 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 Descr DATE: FINAL SITE INSPECTION INSP.BY: YES NO COMMENTS House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Rom allowed for expansion trenches .............. Over 100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded ............................ 10 ft. maintained from property line and 20 ft. from house.... ........................ Distance well to SSDS (ft.) ...................... Number of bedrooms checks ........... o............ Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench.. ........... 15 ft. of peripheral soil horizontally from trench ..... ............................... Boxes properly set ............................... Could surface runoff frcan driveway, roads, ground surface, etc., channel near SDS area.... L Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE ................... —�T I o I � TO\ 1 \ Low 1 \ 0 3� �I 1 \\ I \\ O\ O \\ . -QV• ID_ I I�W,NOQWQ' I \ L I 1 } ► I / gig 6EDRoom ;� 1 LAWP�) N f F OF �R t .�rrrrN --