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42.-3-32
BOX 21
02407
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14
02407
LORETTA MOLINARI
Public Health Director
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ROBERT J. BONDI
County Executive
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
September 9, 2004
Raimondo
947 Peekskill Hollow Road
Putnam Valley, NY 10579
Re: Addition — Raimondo, Peekskill Hollow Rd.
No Increase in Number of Bedrooms
(T) Putnam Valley, TM #42. -3 -34
Dear Mr. & Mrs!, Raimondo:
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 September 8, 2004. 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 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.
An ermits or variances required are the responsibility of the applicant and the jurisdiction
Any permits �, q P tY PP J
of the Town of Putnam Valley.
If you have any questions, please contact me at your convenience.
i
Sincerely,
Michael Luke
ML:lm Public Health Sanitarian
cc: BI (T) Putnam Valley
BRUCE R. FOLEY
Public Health Director
DEPARTMENT OF HEALTH
LORETTA MOLINARI R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
1 Geneva Road
Brewster, New York 10509 Q
Environmental Health (845)278-6130 Fax (845) 278 - 7921 ' a
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278_- 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648
ADDITION APPLICATION (RESIDENTIAL ONLY)
STREET -f'7 9 " - le-'k -It, �/ j,Q 1U TOWN 4 0,g al TX MAPS Y� - 3-
NAME !o f 441/`:ll PHONE , j',T - 5%6 `.��63 PCHD>r o? Y -
f6u il?o/!
MAILI\TGADDRESS
DESCRIPTION OF ADDITION � ,ferd, S6,1 26•r it r G&- A6,1011Ah -vti
NUMBER OF EXISTING BEDROOMS PROPOSED # OF BEDROOMS -3
(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., 4 Geneva Road, Brewster, NY
10509, Phone 278 -6130.
1. Certified check or money order for $100.00.
Sketches of existing floor plan (drawn to scale, all living area including basement)
'Non- professional sketches are acceptable.
Two sets of proposed floor plan (drawn to scale, with name, street, and tax map)
*Non- professional sketches are acceptable.
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.
Copy of Cert. Of Occupancy from Town or Certification from Building Dept. with legal bedroom
count of dwelling.
OFFICE USE
Comments
Feb98
BFhotueo tdelines
a
r
4
LORETTA MOLINARI
Public Health Director
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New. York 10509
t
Environmental Health (845)278-600 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
Putnam County Dept. of Health
1 Geneva Road
Brewster, NY 10509
ROBERT J. BONDI
Couryty Executive
Re: Ro"i 61 bfj 0
Residence
Tax Mpu�nctw 42.— 3— -3 q
Town V A 11 e
To Whom It May Concern:
According to records maintained by the Town, the above noted dwelling,
is
IS NOT
In compliance with Town code and the total number of bedrooms on record is
This information has been obtained from:
CERTIFICATE OF OCCUPANCY:
ASSESSORS RECORD:
OTHER:
2
Building Inspector
houseguidelines
SITE
" U
11 1k01
R -ge -9/v
PHONE
TKO
PERSON INTERVIEWED PCHD Complaint
Dame & Relationship (i.e, owner,tenant, etc,)
DATE 14 4 TYPE FACILITY
PROPOSED INSTALLER S, 6' 2 PHONE
Pro (include sketch locating all adjacent wells).
MM: Repair must be in same location and of same type as original sewage disposal system.
Different location may require submittal of proposal from licensed professional engineer or
registered architect.
Proposal appro 1
Title
Jj-2L?-C
Date
Proposal approved with the following conditions.
1. Procurement of any Town permit, if applicable.
2. Submission of as built repair sketch in duplicate showing.
a. Omer ° s name.
b. Site Street Name, Town and Tax Map number.
c, location of installed components tied to two fixed points (eog.,house corners).
d. System description (e.g., 1250 gal. concrete septic tank, three precast 61 diam. x 61 deep
drywells surrounded by one foot + gravel).
e. Installer °s name and number.
3. System repair to be performed in accordance with the above proposal and conditions.
I, as owner, or r rted agent-of-owner agree to the above conditions.
3IGNATURE TITLE DATE,
'IES. Tit be MD); YeUcra ( ED; Pink (Ag cmnt.)
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster,' New York 10509
(914) 278 -6130
May 7, 1996
Mr. & Mrs. David Anderson
980 Peekskill Hollow Road
Putnam Valley, NY 10579
Re: Addition -
Dear Mr. & Mrs. Anderson:
BRUCE R. FOLEY, R.S.
Acting Public Health Director
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 latest
revision date of May 8, 1996 and this Department's approval stamp.
Based on the information submitted, the above mentioned addition is approved with
the following conditions:
1. The total. number;of bedrooms must remain at five 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.
4. The addition of 150 linear feet of absorption trench to the existing septic
system.
Any other permits or,variances required are the responsibility of the applicant
and the jurisdiction,of the Town of Putnam Valley.;'
If you have any questions, please contact me at your convenience.
Sin erely,
hga Row
Robert Morris, P. E.
Public Health Engineer
RM /jp
cc: BI (T) Putnam Valley
BRUCE R. FOLEY, R.S.
Acting Public Health Director
DEPARTMENT OF HEALTH
Division Of Environmental Health Services -
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
f ADDITION APPLICATION - (RESIDE/NTIAL ONLY
STREET: Pef jc k, 11 �1Q�� � TOWN PO tt') Ui1 Y -TX MAP #
NAME:iI.V 4 Mybed PHONE 5_)6-35_6(o PCHD PERMIT # -------
�'
MAILING ADDRESS 90 0 Pefj�5jq jgc� k3 • I pJN4� (411ey ®"' !. /o��� .
Description of Addition Ar` "'i t 16'r �/�r�i�i
Number of existing bedrooms 3 -Proposed number of bedrooms
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 DEPARTMENT,
4 GENEVA ROAD, BREWSTER, NY 10509, Phone 278 -6130 with the following information.
1. Certified Check for $100.00.
2. Sketch of existing floor plan (all living area including basement, if any)
Non- professional drawing is acceptable.
3. Sketch of proposed floor plan.
Non professional drawing is acceptable.
4. Copy of survey showing well and septic location, to the best of your
knowledge. Include date of installation if known.
Include all wells and septic systems within 200 feet of property line. Any
questions please contact this office.
OFFICE USE
Comments and /or conditions
application
August 1995
Yorktown Medical iLaboratory, Inca
321 Kear Street
Yorktown Heights; N. Y. 10598
(914) 245 =2800
Director: Albert H. Padovani M. T. (ASCP)
l
L
At 32/
ABORATORY REPORT
/Yy J
ON THE QUALITY OF W
INORGANIC NON- METALS mg /L-
i
Acidity
_ Alkalinity
_ Chloride
_Detergents, MBAS
Hardness, Total
Nitrogen, Ammonia
Nitrogen, Nitrate
Phosphate, Total
_ Sulfate
_ Sulfide
Sulfite
METALS (mg /L)
Copper
_ Iron Total Coliform Index
Lead
_ Manganese
_ Mercury
_ Sodium
Zinc
j
LAB # '. '32.02;: : :4V I4
,Date Taken: 9 JV Time:
,Date Rc' d : c:— Time
Date Reported: OCT. 021989
Collected By: ble, .BAUD JaAJ
Referred By:
Sample Location:
Phone(�S'— �S
Phone # I Sample. Type-
Repeat Test? _,Z (check each)
MICROBIOLOGICAL CFU 7100mL
GENERAL BACTERIA
_ Standard Plate Count
(CFU /1.0mL)
MEMBRANE FILTRATION TECHNIQUE
ATotal Coliform
Fecal Coliform
_ Fecal Streptococcus
MOST PROBABLE NUMBER TECHNIQUE
MISCELLANEOUS
_ pH (units)
_ Color (units)
Odor (TON)
Turbidity ( NTU)
_ ✓Potable
_ Non - potable
STP INF
_ STP EFF
Other:
Sample Status:
(check each)
Outgoing
_ HNO3
HC1
_ H2SO4
_ NaOH
ZnCAc
_. Na2S203
_
Other:
_ Fecal Coliform Index
Incoming
A..,-LE
4 °C
KEY FOR
TERMINOLOGY '` ' '
CFU =
Colony Forming °Units_,•
._ GT
4 °C
CON =
Confluent .(q v ' TNTC)
= PH
LE 2
LT =
C = Less Than
_ pH
GE 9
GT =
> = Greater >Thah�
pH
GE 12
N/A =
Not Applicable .'
_ Other
S/A =
See Attached `
TNTC=
Too Numerous To', Count
REMARKS
M
/COMMENTS (Fo•r Lab. Use)
ELAP No. 10323
THESE RESULTS INDICATE THAT THE WATER SAMPLE (Was) (Wasn't) (N /A) OF A
SATISFACTORY SANITARY QUALITY ACCORDING TO TH NEW ORK STATE PUBLIC DRINKING
WATER CODES, FOR THE PARAMETERS TESTED,�AT THE TIME OF SAMPLE CO CTION.
THESE RESULTS INDICATE THAT THE WATER SAMPLE (Did) (Didn't) (N /A MEET THE
SATISFACTORY CHEMICAL.QUALITY STANDARDS OF THE NEW YORK PUBLIC DRIN NG WATER
CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE COLLEC
x - 2/86(Rvsd7/87•)RV'
Albert H. Padovan i M.T. ASCP Director ,'
/�' *k• 'lt; /ji WILL UULvLrLL 11.ULN r�ZrUAI
Office Use Only
a, •G DEPARTMENT OF HEALTH
Division Of Environmental Health Services
0 PUTNAM COUNTY DEPARTMENT OF HEALTH
ST
VZ "T AO ESS WN /VIL (Y TAX GRID NUMBER:
WELL LOCATION {.
e ADDRESS: PRIVATE
WELL OWNER o PueLlc
USE OF WELL
1 - primary
2 - secondary
1WRESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND.IHEAT PUMP ❑ ABANDONED
❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT J� gpm. /N0. PEOPLE SERVED EST. OF DAILY USAGE y gal.
REASON FOR
DRILLING
it NEW SUPPLY, ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
` WELL DEPTH 360 ' ft.
STATIC WATER LEVELS ft.
DATE MEASURED 3 1&2
DRILLING
EQUIPMENT
19 ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING. J2 OPEN. HOLE IN BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL LENGTH . a I ft.
MATERIALS: ;3 STEEL ❑ PLASTIC ❑ OTHER
LENGTH.BELOW GRADE �7 eft.
JOINTS: ❑ WELDED JB�THREADED ❑ OTHER
DIAMETER �"__ in
SEAL: ❑ CEMENT GROUT ❑ BENTONITE OTHER
WEIGHT PER FOOT % Ib.lft.
I DRIVE SHOE.-�OYES ❑ NO
I LINER: ❑ YES .UNO
SCREEN
DIAMETER (in)
SL07 SIZE
LENGTH (ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
DETAILS
FIRST
❑ YES ONO
HOURS
SECOND
GRAVEL PACK
O YES
O NO
GRAVEL
SIZE:
DIAMETER
OF PACK in.
TOP
DEPTH ft.
BOTTOM
DEPTH It.
WELL YIELD TEST If detailed pumping
M HOD: O PUMPED 1 tests were done is in-
COMPRESSED AIR , formation attached?
O BAILED O OTHER ; ❑ YES ❑ NO
tions or sieve anal ses
WELL LOG are available, please attach. p Y
DEPTH FROM
SURFACE
Water
Bear-
Ing
Well
Oia-
meter
FORMATION DESCRIPTION
CODE,
ft.
tt.
WELL DEPTH
ft.
DURATION
hr. min.
DRAWOOWN
ft.
YIELD
gpm.
Surface
WATER ❑ CLEAR TEMP.
QUALITY ❑ CLOUDY HARDNESS
O COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? O YES O NO
STORAGE TANK: TYPE
CAPACITY G
PUMP INFOR TION - rr/
TYPE APACITY V
MAKER DEPTH
[fDEL �.1~/7� / 3 VOLTAGEZ3-0 HP •�.
WELL DRILLF�t NAME 0
AODRES, .. SiGfTATURE
1
P
JOEL LAWRENCE CRanner RG LIEUTEQ OIL UG°�QII�SE�UM
Architect •Town Planner
Two Muscoot North • RFD #2
MAHOPAC, NEW i YQRK 10541
(914) 628.6613 • FAX'(914) 628.2807 DATE ' °B " °
Town Planner • Putnam Valley, MY 10/30/89
(914) 526 -3740
TO BILL HEDGES
PUTNAM COUNTY HEALTH DEPARTMENT
OLD ROUTE 6
CARMEL, N.Y. 10512
> WE ARE SENDING YOU C* Attached ❑ Under separate cover via the following items:
❑ Shop drawings CX Prints ❑ Plans ❑ Samples ❑ Specifications
KI Copy of letter ❑ Change order ❑
COPIES DATE NO. DESCRIPTION
i
THESE ARE TRANSMITTED as checked
��10 -86 -351
ATTENTION
RE: DAVID ANDERSON
PEEKSKILL HOLLOW ROAD
PUTNAM VALLEY,..N.Y. 10579
TM 18 -4 -3
P.C.H.D PERMIT # PV -57 -87
For your use
> WE ARE SENDING YOU C* Attached ❑ Under separate cover via the following items:
❑ Shop drawings CX Prints ❑ Plans ❑ Samples ❑ Specifications
KI Copy of letter ❑ Change order ❑
COPIES DATE NO. DESCRIPTION
i
THESE ARE TRANSMITTED as checked
below:
KI
For approval
❑ Approved as submitted
❑ Resubmit copies for approval
❑
For your use
❑ Approved as noted
❑ Submit copies for distribution
> ❑
As requested
❑ Returned for corrections
❑ Return corrected prints
❑
For review and comment
❑
❑
FOR BIDS DUE
19 0
PRINTS RETURNED AFTER LOAN TO US
REMARKS
ENCLOSED PLEASE:FIND
AS BUILT DRAWINGS FOR FINAL APPROVAL.
i is
i
1
PERMIT Q
I.
II
�v J
C tip_
V.
VI.
Ins p---
TM a OR Su'BDIVISION LOT 4
i
YES NO
a-WAGE DISPOSAL AREA
a. SDS area located as per approved plans
b. Fill section - Date of placement
2:1 barrier. LGTH W-= AVG.DPTH
c. Natural soil not stri
d. Stone, brush, etc., grs- ter than 15' fran SDS area.
e. 100 ft. fran water course /wetlands.
{
S5-rE DILPC§AL SYSTEM
a. Septic "ze - 11000 1,250
b. Septic tank installed level
I
c. 10 °_,minimum from foundation
d. 'No 90° bends, cleanout within 10 ft. of 45° be-rid
{
e. DISTRIBUTION BOX
1. All outlets at same elevation - water tested
I
I
2. Protected below frost
I
3. Minimum 2 ft. oricinal soil bet-wem box and tren(±ies
I I
I
f. JUNCTION BOX - vrocerly set
I
I
.9- EzFnZEE .
1. L,—n required - Len th installed to&
{
2. Distance to water-course
3. Installed according to plan
4. Distance cent_- to ce_*iter
I
I
5. Slone of trenc� accentrble 1/16 - 1/32 "/foot.
I
I
6. 10 feet from prcop tv line - 20 feet. - four..,HPticrs
f I
I
7. D-mth of trench < 30 incries fran sJr"ace
8. Room al-1 awed for er.,arsion, c
9. Size of gravel 3/4 - 11" diameter I
I
I
10. Depth of aravel in trench 12" mi ninnnr+ I
L. • Pire ends capped
h. PUMP CR DOSE SYSTEMS
1. Size of pug chance -r
�I
{
2. Overflow tank I
I
9 Alain; visual-/audio I
.
4. Pump easily accessible iranhole to grade
First box baffled
6. Cvc1e witnessed by Health Demp--unent I
I
I
estimated flow r cycle I
I
f
HOUSE I
a. Eduse located per approved plans.
I
b. Number of bedreans {
a. Well located as per approved plans
b. Distance from SDS area mp-a-sure3 ft.
c. Casing 18" above grade.
d. Surface drainage around well accepta=ble.
OVER AIL WCRKMASHIP
a. Boxes properly grouted
I
b. All p ipes r�art.ially bac filled
c. All pipes flush with inside of box
d. Bar -kfill material contains stones < 4" in diameter
e. O=tain drain installed according to plan
f. Curtain drain outfall protected & d.ir. to exi stwatercours�
{ �
g. Footinq drains discharcre away from SDS area
I
h. Surface water Prot_ -ction adenuate
i. .Eirosion c--ntro vrovi.de....,' on sloces greater than 15 %.
i
PUTNAM COUNTY DEPARTMII T OF HEALTH
DIVISION OF ENVIRO'i' I rAL ' HEALTH SERVICES
DAVID ANDERSON 18 4 3
Owner or Purchaser'of Building Section Block Lot
DAVID ANDERSON
Building Constructed by
PEEKSKILL HOLLOW ROAD
Location - Street Subdivision Name
TOWN OF PUTNAM VALLEY
Municipality I Subdivision Lot #
ONE FAMILY RESIDENCE
Building Type
GUARANTEE OF SUBSURFACE SEVQAGE DISPOSAL SYSTEM
I represent, that I am whc-rl-ly= -a-rr Lple_tely 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 for negligent act of the occupant of the building utilizing
the System .Y u�r'((., it,•, "� n- r.' >rs�n.- ;t � �r •. ,� /C�'. {' /iriyL' 7' L1l L:L - i �_ �'rl_ �/
/� ti I .I i.(i it .i i V1�: t✓ -, i
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.
Dated this y ( day of :y`' 19 U Signature
Title
General Contractor ;(Owner) - Signature
Corporation Name (if Corp.)
195 CHASE AVENUE
Address
YONKERS, NEW YORK 10703
rev. 9/85
mk
Co poration Name U1 Corp.)
- v- . #.(.(( r2�P
��fe 6S')
Address
d1J
V
vn
I:'aclmowledge this Field Activity Report.
SIGNATURE°
TITLE-.
TELEPHONE-.
PL TNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIROAL HEALTH SERVICES
:, °._JOhn -M .Simmons,, M.D.
bepuhy "Commissioner of Health - FIELD ACTIVITY REPORT -
Sheet of
INSPECTION
NAM '� /' S ,,1
Orig. Routine
A�attl AAL
_
Orig. Complain
AD13RESS , (1,J
Orig. Request
No. Street Town TH Noe
Compliance
Complaint Comp
MAILIM ADDRESS
Final
P.0. Box Post Office Zip Code
Group Illness
Construction
1
Reinspection
PERSQN IN CHARGE «-
Field,, Sampling Only
OR INTERVIENED L` A� eaA
Field Conference
Dame and Title
Other
DATE F "� TYPE FACILITY
TIME ARRIVED J TIME LEFT J � < y�
Explain
1i / V/ A r rr— i
d1J
V
vn
I:'aclmowledge this Field Activity Report.
SIGNATURE°
TITLE-.
TELEPHONE-.
PETER C. ALEXANDERSON
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
May 20, 1988
Mr. Joel Greenberg
RR #8 Muscoot North
Baldwin Place Road
Mahopac, New York 10541
Dear Mr. Greenberg:
ENID L. CARRUTH, M.P.H.
Public Health Director
JOHN SIMMONS, M.D.
Deputy Commissioner
JOHN KARELL Jr., P.E.
Director
4Q t4T 0"j
Re: Proposed SSDS - n
(Peekskill Hollow Road
(T) Putnam Valley
TM #18 -4 -3
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) A revised construction permit must be submitted to indicate
a pump system.
2) StandpiPes should be on tank side of curtain drain.
Upon receipt of a submission, revised',to reflect the above comments,
this application will be considered further.
Very truly yours,
Lawrence C. Werper
Assistant Public Health Engineer
LCW:jz
TO
tl@96b bPl00 YCb93Qlb �0 \bb1967b0 \qA
Architect o Town Planner
Muscoot North o RFD #2 Box 488
MAHOPAC, NEW YORK 10541
(914) 628 -6613 (914) 526 -3740
Town Planner o Putnam Valley, NY
WE ARE SENDING YOU Attached ❑ Under separate cover via_
❑ Shop drawings 12- _Prints ❑ Plans
❑ Copy of letter ❑ Change order ❑
LrE TTIE[B OF
I �
DATE J /J / V6 `y
JOB NO.
ATTENTION i
1 41 .
v
't r . )A. R �l 7 G
the following items:
❑ Samples ❑ Specifications
COPIES DATE NO. DESCRIPTION
THESE ARE TRANSMITTED as checked below:
For approval ❑ Approved as submitted
• For your use ❑ Approved as noted
• As requested ❑ Returned for corrections
❑ For review and comment ❑
❑ FOR BIDS DUE 19 ❑
REMARKS
COPY TO
PRODUCE 240.2 Inc, Gmtm, man ow
❑ Resubmit copies for approval
• Submit copies for distribution
• Return corrected prints
RETURNED AFTER LOAN TO
.1" i &Zu
PUTNAM•COUNTY DEPARTMENT, OF HEALTH
r
COMPLAINT OR SERVICE REQUEST RECORD
TOWN L DATE 0 - -Pp REFERRED TO
TAKEN BY ia'' TELEPHONE CALL IN PERSON_ LETTER
�J
CONFIDENTIAL _ 1
REQUEST FROM �' h�Ea S TELEPHONE��'� Z�
ADDRESS
ENVIRONMENTAL HEALTH: Home Sewage Rodents Refuse Public ate ood Service
Migrant Camp Other / (,
i
c
.� ,, � ' • � _ , , l i� fir% 1 L
ACTION • ��
FOLLOW UP INSPECTION (s),
DATE A - 16 ` P3 E
DATE
PROBLEM ABA
DATE
v
PERSON NOTIFIED
�I
/ETIMATED TOTAL MAN HOURS SPENT
e,
PETER C. ALEXANDERSON
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
June 21, 1988
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Cherry Pickers Inc.
P.O. Box 424
Yonkers, New York 10710
Rusty,
ENID L. CARRUTH, M.P.H.
Public Health Director
JOHN SIMMONS, M.D.
Deputy Commissioner
JOHN KARELL Jr., P.E.
Director
Re: Anderson Oil Spill
Peekskill Hollow.Rd, PV, TM #18 -4 -3
D.E.C. Spill No. 88 02205
PCHD No. 347 -88
As stated in telephone conversation held 13 and 20 June 88, as the.
party responsible for spilling petroleum products at the subject site,
Cherry Pickers must remove and appropriately dispose of all oil contam-
inated soil and debris at a licensed disposal facility. Any off -site
transport of contaminated material must be performed by a licensed hauler.
Enclosed is the requested waste hauler inventory provided by the D.E.C.
Please notify the writer at least one day in advance to allow for
on -site inspection to verify the adequacy of contaminated material
removal at the time of removal. Expediency in contaminated material re-
moval is necessary to prevent its spread and possible contamination of
ground water. It is expected that this material will be removed no later
than 1 July 88.
If there are any questions please contact the writer at ext. 321.
Very truly yours,
mes S. Hodgen
Assistant Public Health Engineer
JSH /jz
Enclosure: Waste Hauler Inventory
cc: w/o Enclosure: John O'Mara - DEC NP
File
V C
° The Reporter Dispatch
11 FAIR STREET
Westchester Rockland Newspapers CARMEL, N. Y. 10512
(914) 225 -5503
June 15, 1988
John Karell;'Director
Putnam County Department
110 Old Route 6 Center
Carmel, New York 10512
Dear Mr. Karell:
of Environmental Health
Under the provisions of the New York.Freedom of Information
Law, Article, 6 of the Public Officers Law, I am hereby requesting
department records regarding an inspection of a crane accident
in Putnam Valley.
Building Inspector Marvin O'Dell said fuel leaking from the
toppled crane may have an environmental impact. The site is on
Peekskill Hollow Road, north of Seifert Lane, at the David Anderson
residence.
A Mr. Jay Hodgens from your department told me Tuesday that I
would have to,file a Freedom of Information request.
As you know, the FOI law requires a public agency to respond
to a request within five days of receipt. I would appreciate hear-
ing from you -as soon as possible.
Sincerely,
S veLali,
r Staff Writer
r 40J
4
[A o+ A
GAMIEf
•wa�nawrsum
WMR1 NIf00M f1y. llf
11
R
1�
� p�
4V%R&O. dreanuoavoaQse a71nr =lvomnu
Architect o Town Planner
Muscoot North o RFD #2 Box 488
MAHOPAC, NEW YORK 10541
(914) 628 -6613 (914) 526 -3740
Town Planner oo Putnarrn Valley, NAY
TO
4
WE ARE SENDING YOU Njj Attached ❑ Under separate cover via
• Shop drawings ❑ Prints
• Copy of letter ❑ Change order
LLETTIEQ @[F QQU1�t1W
DATE `^�
w
JOB NO.
ATTENTION `"
RE:
,/j /
e
y/.f� Vo . `
I i/
i
the following items:
COPIES I DATE NO. DESCRIPTION
THESE ARE TRANSMITTED as checked below:
For approval ❑ Approved as submitted
❑ For your use ❑ Approved as noted
❑ As requested ❑ Returned for corrections
❑ Fo view and comment ❑
FORBIDSDUE 19
REMARKS /'i41 rf _ ') i '._ �14l !Jfi"
COPY
PRODUCT 20.2 es Inc, WK Mm 01071.
• Resubmit copies for approval
• Submit copies for distribution
• Return corrected prints
❑ PRINTS` ETURNEEDD AFTER LOAN LOAN TO US
SIGNED: N
It enclosures are not as noted, kindly notify us at once.
DAY,PHONES NIGHT PHONES
914 965 -0470 914 779 -8565
914 965 -0440 914 476 -7950
0
212 562 -8677 '"'63� §SC ;
TRUCK CRANES - HYDRAULIC CRANES - HYDRAULIC TRUCK CRANES - CONCRETE PUMPS
P.O. BOX 424, YONKERS, NEW YORK 10710
July 22, 1988
Dept. of Health
Division of Environmental Health Services
110 Old Route Six Center.
Carmel; New York 10512
Att: ;James S. Hodgens
Re: Anderson Oil Spill
Peekskill Hollow Rd.
P . V . , TM X618 -4 -3
D.E.C. Spill No. 88 02295
PC 4D No. 347 -88
Dear James:
In,response to your letter dated June 21, 1988. Enclosed
please ;find a copy of the receipt from Chemical Pollution Control
Inc., for the contaminated material.
When Chemical Pollution Control Inc. actually disposes of
the material, they will send me a receipt of disposition. When I .
receive the receipt I will forward it to you immediately.
Very truly yours,
CHE YPICKERS, IN .
Georg, "Rusty" Meinel
Vice President
GM/ kp
Enc.
Certified Mail - R.R.R.
For A Saferr EwpAronm.epag Permit 0
EPA- NY0062765429
120 SOUTH FOURTH STREET N.Y. D.E.C. IA -042
BAY SHORE, N.Y. 11706 N.J. D.E.P. 5371AL
(516) 3M4333 Conn. D.E.P. CTHW 163
Mass. 159
r` �, i ► �-�� Date: % B
�J �
Q f_ Sd iJ fM i IL Jt 1 UFR !�� • Customer P.O. v: _-
Q �j �) IV ' 0-7/6 Manifest 0,
L -1 Terms: Net _,Days
TERMS ARID CONDITION& MET 30 DAYS
Interest will be charged at the rate of I'i, % por month on past .
due accounts. In the event of any default on poynient you shall - ._ Driver:
be liable for reasonable attorney lees and cost of collection.
QUANTITY REMOVAL A DISPOSAL: DESCRIPTION AMOUNT
3 q l. cii Ev s Jb° CcAI7 a p
N �
Pd //'j (2 h
--V
c,
V / j
WC.
REFERENCE
DATE
A,%1OUNT
DISCOUNT
DEDUCT
REMARKS
NET AMOUNT
�d Alo. 3
-o 41
,e
TOTALS
CHERRYPICKERS, INC.
- 1015-SAW MILL RIVER -ROAD-
YONKERS, N.Y. 10710
_moo Scarsdale National - - - - - -
s�M� 0003543
rt W Tf" Ca�mq .
smwd4 MY wo 50.10191219
DATE CHECK NO. AMOUNT
7/1 S/rf 3_5 Va
PAY�
ORTHE •
ORDER OF • '
SUM .� •6
�jo
11800 3 54 3u'- 1:0 2 L9 1,049 51: u' 3 11 6000 300 Sun
.4b
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 Address Town /Village /City Tax
Grid Number
PEEKSKILL HOLLOW RD. PUTMAN VALLEY 18 -4 -3
OWNER
Name Address
:IPrivate
.WELL
DAVID ANDERSON 195 CHASE AVE ,Y0ffj-<ERS , NEW .YORK
O Public
OF WELL.
® RESIDENTIAL ® PUBLIC SUPPLY O AIR /COND /HEAT PUMP
O ABANDONED
primary
® BUSINESS 0 FARM ❑ TEST /OBSERVATION
❑ OTHER (specify,
- secondary
® INDUSTRIAL 0 INSTITUTIONAL ❑ STAND -BY
AMOUNT OF USE
YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE 300 gal
REASON FOR
11NEW SUPPLY ❑PROVIDE ADDITIONAL SUPPLY
❑TEST /OBSERVATION
DRILLING
OREPLACE EXISTING SUPPLY ®DEEPEN EXISTING WELL
DETAILED
REASON FOR
NEW RESIDENCE
DRILLING
WELL TYPE
DRILLED
®DRIVEN
®DUG
®GRAVEL
®
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES XX x NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name N. ANDERSON Address: BARGER ST, ,PUT "VA7.,N�
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE:
YES XXX NO
NAME OF PUBLIC WATER SUPPLY: N/A TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: N/A
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
7/20/1987[-] ON REAR OF THIS APPLICATION N PA
(date) ( ,ignat
PERMIT `
TO CONSTRUCT A WATER WEL2
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 prov' ed by the Putnam County
Health Department.
Date of Issue: 0 19 fJ 1
Date of Expiration: 196g Permit Issuing Official
Permit is Non - Transferrable
..
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date 1h, )Lo
Re: Property of DAVID ANDERSON
Located''at PEEKSKILL HOLLOW ROAD
(T). PUTNAM VALLEY Section 18 Block 4 Lot 3
Subdivision of
Subdv. Lot # Filed Map # Date
Gentlemen:
This letter is to authorize JOEL L. GREENBERG
a duly licensed professional engineer, or registered architect XX
(Indicate
to apply for Ia 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 iu
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, Public Health Law, and the Putnam County Sani-
tary Code. `'� Sy tW E
Very , truly yours,
Counter igr�c��i' ��Iq � / 0. P NE..
P. E. , (R. A. �/ ' 11056``-z__
MUSCOOT NORTH, RFD #2,BK 488
Address
MAHOPAC, NEW YORK 10541
628 -6613
Telephone
� iSigned ,
I/ Owner of Property
195 CHASE AVENUE
Address
YONKERS, NEW YORK 10703
Town
965 -2586
Telephone
PETER C. ALEXANDERSON
County Executive
r
JOHN SIMMONS, M.D.
Deputy Commissioner
DEPARTMENT OF HEALTH JOHN KARELL. Jr., P.E.
Director
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
September 16, 1987
Mr. Joel Greenburg
Muscoot North, RD #2, Box 488
Mahopac, NY 10541 Re: Proposed SSDS Anderson
Dear Mr. Greenburg• Peekskill Hollow Road
(T) Putnam Valley, TM 18 -4 -3
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. Comments transmitted on August 21, 1987 (see attached).
2. During field inspection by this writer on September 14,
1987, ground water was recorded at 1 foot and 4 feet
in deep hole 1 and 2 respectively.
3. The above captioned application for an SSDS was received
by this office on July 29, 1987 and field inspections
were conducted on June 8, 1987, August 3, 1987 and
September 14, 1987. No attempts have been made to
escavate the test holes deeper, nor were revisions
proposed addressing the problem of shallow test holes.
In regard to your comments, the deep test holes have filled
with sediment. It is acknowledged by this Department that deep test
pits have a tendency to fill in after a period of time. But, if the
deep test holes are dug a substantial period of time before this
Department is notified and a reasonable estimate of the original
depth of the deep hole cannot be determined, the test holes are to
be escavated to the depth as indicated on the design data sheet.
Upon receipt of a submission, revised to reflect the above
comments, this application will be considered further.
very,truly yours,
Robert Morris
Environmental Health Technician
RM : amm
Enclosure
s
PETER C. ALEXANDERSON
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
August 21,'1987
Mr. Joel Greenburg
Muscoot North, RFD #2, Box 488
Mahopac, NY 10541
0
JOHN SIMMONS. M.D.
Oeputy Commissioner
JOHN KARELL, Jr., P.E.
Director
Re: Proposed SSDS
Anderson, Peekskill Hollow Road
Dear Mr.'Greenburg• (T) Putnam Valley, TM 18 -4 -3
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. A field inspection by a representative of this Department
recorded deep holes at a depth of 5 feet and 3 feet to
ledge. This was not recorded on the design data sheet
nor taken into account in the SSDS design.
2. Weil detail missing.
3. Standard note 5 not noted on plans.
4., Footing and gutter drain discharge not shown.
5. Location of percolation holes not shown on plan.
6. Deep test holes are not respresentative of expansion area.
7. Expansion area not.shown.
8., Al.l' wells within 200 feet of the proposed SSDS and all
SSDS within 200 feet of proposed well are to be noted or
a note stating none exists.
9. House sewer to be noted as sloping a minimum a inch /foot.
10. An explanation is requested'on how the first junction box
invert is noted as approximately 7 feet below existing
grade.
Upon receipt of a submission, revised to reflect the above
comments, this,application will be considered further.
Ve_rZ truly yours,
6.&/v
Robert'Morris
RM:amm Environmental Health Technician
15i-A
i
COUNTY DEPARDENT OF HEALTH - DIVISION Ur' ENVIRUWEXIAL ffi!A1 ,1H 5r tcvll'M
INDIVIDUAL WATER SUPPLY &
SEWAGE DISPOSAL SYSTEM
REVIEW SHEET - CONSTRUCTION PERMIT
• --
-- -,
N
�
�
-
DA
BY:
TE
Iff
REV 41 "�-
cation)
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 &e4 permit; PWS letter
Vari e Request
GENERAL J
Legal Subdivision
Subdivision Approval Checked �U
E�x- approval SSDS Adj. Lots Checked
Wetland (Town /DEC Permit R & D)
Data On DDS Plans & Permit Same
REQUIRED DETAILS ON PLANS
Sewage System Plan - (north arrow)
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: 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;shcwn;gravity flow,suff. size
If Pumped Pit & D Box Shown & Detailed
House - No. of Bedrooms
Wells & SSDS's w /in 200 ft. of Proposed Systems
Property Metes & Bounds
--House Setback Necessary (Tight lot)
House Sewer - 1 /4" /ft. 4 110; Type pipe
No Bends; Max. Bends 45° w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees,Top of fil
20' to Foundation Walls
100' to Well; 2001.in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake Unc. expan
15' to Drains - Curtain, Leader, Footing
351to catch basin,stormdrain,piped waterccurs
10' to Water Line (pits -20')
50' intermittent drainage course
Septic Tanks
10' from Foundation; 50' to well
15' Well to PL
9
10
PUTNA.M COUNTY DEPART OF HEALTH - DIVISION OF ENVIRONMENMU HEALTH SERVICES
INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS
4.-
FIELD INSPECTION REPORT
I' DATE:j
No t5- o _ ���CG1�l�I��LG %� ]NSP. BY:
(Name of Owner) (Street Location)
INITIAL SITE INSPECTION YES NO OOMM&NM
Wetlands on / or p roxima. to to property .............. 5 A/A :> io6 7 f�osn dP S�1Z'
Property lines or corners found ..................
Can estimiate house location ............... .....
Will driveway need cut."........... . ...............
Must trees be•remve3 note these ...............
Deep holes representative of entire SDS area.......
A6ditional deep holes need .....................
Sufficient SDS area available considering driveway' 7
cut, house location,' separation distances,etc.:.
Mjacent wells /septics.... d.
D.H. 1 Lot -
Depth to G-.W.
Depth to rock ^=
0 ft.
3 ft.
6 ft.
9 ,.ft.
12 ft
Soil Description
SkJb
D. H. 2 Lot
Depth to G.W.
Depth to rock
0 ft.
e 3 ft.
1 i
6 ft.
9 ft.
12 ft.
Soil Description
su, b
3
a
D.H. - Deeo Hole
G.W.- Groundwater
D.H. 3 Lot -
Depth to G.W.
Depth to rock'"'!
� Soil Description ,
i
0 ft.
3 ft.
t ° 6 ft.
IT
ft.
2 ft.
5eT
L0ft
s n� cam
"CX
DATE:
FINAL SITE INSPECTION: INSP.BY:
YES
NO
CCl'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
unnecessarlygraded .........................
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.... ..........................
Poxesproperly set ...............................
Could surface runoff fran driveway, roads, -
ground surface, etc., channel near SDS area....
L
'
Does lot drainage appear OK-,in area of SDS:•:......
FINAL CRADNG OF SITE A- =:TABIIB . a ..
i
Rev, 3186
J�\\ W�
OF
Located at
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N.Y. 10512
Engineer Must Provi _ 5 7 — 8 7
P.C.H.D. Permit # —tV
COMPLIANCE FOR SEWAGE DI!
SYSTEM PUTNAM VALLEY
Town or Village
Tax Map 1 8 Block 4 Loth_
Owner /applicant Name DAVID ANDERSON Formerly Subdivision Name Subdv. Lot N
MaWng Address 195 -HASP• AVFNUF Zip 10703 Date Permit Issued 5/26/88
YONKERS, NEW YORK
Separate Sewerage System built by TYNDA .T, SEPTTC SYSTEMS Address TVY HILL ROAD i. RFbJST.ER.r_ N v .
Consisting of 0 Gallon Septic Tank and S71 T.F OF T P A CH T TG F T FT D S 1 0 5 Qq_
Water Supply= Public ,Supply From -Address
ors XX Private Supply Drilled byNnRMAN ANnPRSnN Address RARrRR ST .� PTITNAM VAT T FV r
Building Type ONE. PAM. Has Erosion Control Been Completed? YES N.Y. 10579
Number of Bedrooms 4 Has Garbage Grinder Been Installed? NO
Other Requirements PUMP C-14AMR-PR
I certify that the system(s) as listed serving the above premises were constructed assent ly a shown on the lens of the completed work ( copies
of which are attached), and in accordance with the standards, rules and tions, in ac with the f ed plan, and the permit issued by the
Putnam County Department Of'Health. D
Date . 1 0 / 2 3 / 8 9 Certified Is P,E. R,A.XX—
Address 11.icense No._ 13 0.5b
Any person occupying premises served' by the above systems) shall prompt to wch action as may be necessary to incur the correction of any unsanitary
conditions resulting from such usage.' Approval of the separate
sewerage . tam shall become null and void as soon as a pub:': sanitary sewer 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 "Ith Is revocation, modification or change is necessary.
Date "✓ /a��'�— �S ay�
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer to Provide Permit p
on CERTIFICATE OF COMPLIANCE
\ CONS CTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Permit N PV-57-87
--`T PtTTtQAM STALLFV
locatlocated , at PEEKSKILL HOLLOW ROAD Town or Village
Subdivision Name Sabd. Lot N Tax Map Z8 Block Lot 3
Renewal_ 0 Revision —t
Owner /Applicant Name
DAVID .ANDERSON
Date of Previous Approval
Melling Address 19 5 CHASE AVENUE Town YONKERS NY Zip 10703
Building Type ONE FAM , RF.S , Lot Area Q0 7RA AC Fill Section Only Li Depth Volume
Plumber of Bedrooms 4 Design Flow G P D 800 PCHD Notification is Required When Fill Is completed
Separate Sewerage System to consist of . Z...Q. Gail on Septic Tank and S 7�F ^F T F ruTWC FIELDS
To be constructed by DON HEADY Address CANOPUS HOLLOW RD,, PUT. VAL o ,NY 1057!
Water Supply; Pdbllc Supply From Address
or: XXXX Private Supply Drilled by N o ANDERSON Address BARGER STREET , PUTNAM VALLEY , NY 10579
Other Requirements 7 FOOT Ci1RTAIN T)RATN 7 FT OF RANK RTTN FTT T FY PIIMP C_T-LAMRF.R`
1 represent that I am wholly and completely responsible for the design and location of the pro po d system(s); 1) that the separate sewage disposal system
above described will be constructed as shown on the approved amendment there tc and in accord c with the standards, rules an regu a ions o e u ham
County Department of Health, and that on completion thereof a •Certificate of ConstrI to C mpliance" satisfactory to the Commissioner of Healthwill
be submitted to the Department, and a written guarantee will be furnished the owner,. his cc ssors, heirs or assigns y the builder, that said builder Will
place in good operating condition any part of said sewage disposal sy during the peri d o tt o, 2) years Imme ately following thedate of the Issu-
ance of the approval of the Certificate of Construction Compliance f the iginal system r rti`y re 'its t ereto; 2) at the drilled well described above
will be located as shown on the approved plan and that said well will be in ailed in accordance wi th n �► , ule ndliegu7aTlons of the Putnam
County Department of Health.
Date 5/24/88 , Signed P.E.- R.A.
Address MTTCOOT NO
C" I_IC nse No 16
APPROVED FOR CONSTRUCTION: This approval expires two Years the ate i u �n ction of the buildi g has been undertaken and Is
revocable for cause or may be ar+lgndetl or modified when constdared sary� the m i her o Health. my change or alteration lo'f''' construction
- - - -L.:• a.t.,�aGLnjror' disposal of domestic sanity ay P/� iv e w er IY o
PUTNAM COUNTY DEPARTMENT OF HEALTH
Rev.' 3186 Division of Environmental Health Services. Carmel, N.Y. 10512
CON9T]RUCTION P RMIT FORS AGE DISPOSAL SYSTEM
ac :PEEKSKILL ALLOW ROAD
Subdivielon Flame - Subd. Lot q
Ownlae %�.ppueantPTame DAVID. ANDERSON
rt�awn8 Address
1.9 5 CHASE AVENUE
Engineer to Provide Permit q
on CERTIFICATE OF CORRPLIARTCID
Permit Al
PUTNAM VALLEY
Town or Village
Tax map '18 Block 4 Lot 3
Renewal_ ❑ Revision - ❑
Date of Previous Approval
Tom .YONKERS , NY ZIP 10703 ,
Building Type ONE 'FAM o RES. Lot Area 9.784 AC Fill Section Only Depth -Volume---
Plumber.of Bedrooms 4 Design Flow G /P /D 8,00 PCHD Notification Is Required When FIII is 6ompleted
Separate Sewenge System to con sist of 120 Gallon Septic Tank and 5 71LF OF LEACHING FIELDS
To be constructed by DON HEADY Adllrese CANOPUS HOLLOW RD i PUT o VAL o , NY 0579
Water SpPP1J': Pdbllc.Snpply From Addr i
or: xxxx private Supply Drilled by N ANDERSON ARGER STREET , PUTNAM°-VALLEY , NY105 79
Other Requirements aur-ml o . ZVAi .
represen that I am wholiy•arid completely responsible for the design and location of the prop
above described will be constructed as shown on the approved amendment there to and in accords
County Department of Health, and that on completion thereof a "Certificate of Construction
be submitted to the. Department, and a written guarantee will be furnished the owner, his su
place in good operating condition any part of said sewage disposal system during the peril
ante of the approval of the Certificate of Construction Compliance of the original system d
will be located as shown on the approved plan and that said well will be Ins Iled accordan w
County .De artme t of///���Health.
Date o i Signed.
/// Addre
APPROVED FOR CONSTRUCTION: This approval expires, a fr the ate
revocable for cause or may be amended or modified when co ide► d c scary y t
requires a new permit Approved for disposal of domestic sa and %/i
Date 9 a��J /� By (/
system(s); 1)' that the separate sewage disposal system
with the standards, rules and regulations of the Putnam
pliance" satisfactory to the Commissioner of Health will
rs6thgandards, heirs or assigns by the builder, that said builder will'
2) years imme0iately following the date of the issu-
irs thereto; hat the drilled well described above
rune and regu aTrons — of the Putnam
unless construction of the bui
missioner of Health. Any cha
P.E._ R.A.XX
rse No
has been undertaken and is
or alteration of construction
a��
e a�r�j,/w�pDly only.
Title V�'
134 23 sub f.R "OF KENT E.
tOWN c' S P � —TN A W---V —AL —LE,
TIJW N
19
14 M-
7 alt ajz
Till
ic
0
to
3
30
17
19
as
c I'S
24
2 2
m 145
of
..12 Of
FOR TAX PURPOSES ONLY REVISIONS
NOTE - Ixt 18. 8 1-,
NO
PRELIMINARY..:
TCW'; OF F,; NAM VALLEY
r;
S ONLY
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4 1.25 4 144
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6 111 6 130
7 104 7 123
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9 90' 9 . 108
10 82.6 10 101
11 76 11 94.6
12 1'33.6 12 156
13 126 13 151
14. 121 14 147
1S T16.6 15 142
16 112 .16 138
17 106 17 133
ts. 101 18 126
19 93 -19 120
20 129 20 141.6
21 123.6 21 135.6
22 .117 22 129
23 112 23 122
24 104 24 114
25 98.6- 25 108.6
26 89.6 26 102
C- 1 16.6 D- 1 49
C- 2 24 D— 2 52.
Putnam County Department of Hea1tL
Davis �
on of Environmental Health Serviooe
ipproved as noted for conformance with
applicable Rules and Regulations -of the
- .utnam County Health Department:
=1anatura X T1 . o !'
TO CMTIPY 4i814�. !1418,= SSUA4E' D1380SSi.- SYST M bA8 CGN-
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6 111 6 130
7 104 7 123
-8 -99 -8. 1.16.
9 90' 9 . 108
10 82.6 10 101
11 76 11 94.6
12 1'33.6 12 156
13 126 13 151
14. 121 14 147
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16 112 .16 138
17 106 17 133
ts. 101 18 126
19 93 -19 120
20 129 20 141.6
21 123.6 21 135.6
22 .117 22 129
23 112 23 122
24 104 24 114
25 98.6- 25 108.6
26 89.6 26 102
C- 1 16.6 D- 1 49
C- 2 24 D— 2 52.
Putnam County Department of Hea1tL
Davis �
on of Environmental Health Serviooe
ipproved as noted for conformance with
applicable Rules and Regulations -of the
- .utnam County Health Department:
=1anatura X T1 . o !'
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Putnam County Department of Hea1tL
Davis �
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applicable Rules and Regulations -of the
- .utnam County Health Department:
=1anatura X T1 . o !'
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PITrNAM COUNTY DEPART OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS
P FIELD INSPECTION REPORT
( �
DATE: G $
AilMPsyJJ �yc.i L 4 9V[1 L/ t1,.J 1'� INSP. BY:
(Name of Owner) (Street Location)
INITIAL SITE INSPECTION. YES NO], MKIE TS
Wetlands on /or proximate to property............:..
Property lines or cornets found ...................
Can estimate house location ....................... LAAS
Will driveway need cut .. ......................... ' - ®L NvT
Dist trees be-removeff, , note these ................
Deep holes representative of entire SDS area...... AID G Ns
Additional deep holes needed ............... /V 0 4AiTS
Sufficient SDS area available considering driveway
cut, house location', separation distances,etc...,
Adjacent wells %septics . ..... .......... ......
AccPSS to nronos,-a wPll'lnration for drilling_____:
Q.H. 1 Lot.
p G:W.
Depth to rock
0 ft.
3 ft.
6 ft.
9 eft.
12 ft.
Description
Q -tLot
o G.W.
Depth to rock
12 ft.
Soil Description
�IDWr� c,vu.w.-
7YZ
r•
D.H. - Deep Hole
G.W. - Groundwater
ID. H. Dt�o Lot ° G. W.
Depth to rock _�C '
Soil Description
0 ft.
ft.
6 ft.
9 ft.
12 ft.
S� L
ROCK
el
C
S�
DATE:
0 ft.
FINAL SITE INSPECTION INSP.BY:
-YES
NO
CC'S
3 ft.
6 ft.
Length of trench measured
Width of trench average
9 ft.
Slope of tile line and trench acceptable...........
12 ft.
Soil Description
�IDWr� c,vu.w.-
7YZ
r•
D.H. - Deep Hole
G.W. - Groundwater
ID. H. Dt�o Lot ° G. W.
Depth to rock _�C '
Soil Description
0 ft.
ft.
6 ft.
9 ft.
12 ft.
S� L
ROCK
el
C
S�
DATE:
FINAL SITE INSPECTION INSP.BY:
-YES
NO
CC'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. 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 bedrocros checks ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. from nearest trench ................
15 ft. of peripherallsoil horizontally
fran trench...... ............................'
Boxes properly set..', . .. ........ ......... .
Could surface runoff fran driveway, roads,-
ground surface,.etc;, channel near SDS area....;
Does lot drainage appear OK•,ih area of SDS::....
(i
FINAL GRADNG OF SITE ACX:E P'r'AR ...
�i i.
N�, f
tx
Roof
0
3 I
i
PUTNAM COUNTY DEPARTMENT OF HEALTH
DTVISTON OF ENVTRONMCNTAL HEALTH SERVICES
COUNTY OPPICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA'SHEET- SirPARATE SEWAGE DISP94L SYSTEM FILE NO.
OWne DAVID ANDEASON
Address 195 'CHASE AVE , YONKERS ,
NY- 10 70 3
Located at (Street
EKSKILL
HOL. RD-See. 1$ B1o�'k 4 Lot
3
r�n d 3ca a nearesf cross s rep
MuniCipality •PUTNA.M VALLEY
`''" Watershed -HUDSON RIVER
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole-
Number CLOCK TIME
PERCOLATION
PERCOLATION
Run
' M apse
p o a er
PEW Le ve
No.
Time
From Ground :Surface
in Inches
Soil Rate.
Start-Stop
Min.
Start Stop
Drop in Min. /in drop
Inches ,Inches
Inches
PTH #1 1 3: 00 3:30
30
16 i7.75.
1.75
30/1.75 =17.14
2 3:31 4:01
30
16 17.75
1.75
30/1'75 =17 14
.4 4. Gina
30
�6
,,
5
•
PTH #21 3:05 3:35
30
16 17.625
1.625
30/1.625 =18.46
2 3:36 4:06
-: 30
16 17.625
1,625
30/1.625 =18.46
- 3 4:07 4:37
30
16 17.625
1.625.
30/1.625 =18;;46
# 4:38 5:08;
30
16 . 17,.625
1.625
30/1.625 =18.46
Notes! 1) Tests to be repeated'at same depth until'approximatelt equal soil
rates are obtained 4t,each percolation test hole. A11 data to a submitted
for review.
2) Depth measurements to be made 'from top of hole.
r
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HODS
DEPTH HOLE NO. 1 HOLE NO. .2 HOLE NO.
G.L. TOP SOIL T OP SOIL
1° SANDY LOAM & SANDY LOAM &
20 SOME CLAY SOME CLAY
it
3° „
5°
6°
% ° " I I'
B°
9°
10°
11°
12'
13'
14°
INDICATE LEVEL AT WHICH GROUNDWATER IS ENOOUNTERED N.0NE1c
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING EEt0001MEIM NONE
DEER HOLE OBSERVATIONS MADE BY: JOEL L. GR:? +,>T!3?RG DATE:
DESIGN
Soil Rate Used 16-20 Min /1" Drop: S.D. Usable Area Provided
No. of Bedrooms 4 Septic Tank Capacity 1250 gals. Type PRECAST
—
—=NC.
Absorption Area Provided By 571 L. F. x 24" width trench
Other ER E,— °
Name JOEL Lv GREENBERG signature �
MAHOPAC, NEW YORK j'��• .. • _�
THIS SPACE FOR USE BY HEALTH DEPAMifM ONLY:
Soil Rate Approved
sq <ft /gal.
Date