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HomeMy WebLinkAbout2444DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51. -1 -4 BOX 21 02444 ' , y ; NEI �, i , I 02444 PUTNAM COUNTY DEPARTMENT OF HEALTHC/ CI • Division of Environmental Health Services, armel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM PciTNAMl VAL_LEJ down or VillAge Located at aELL I- �oL�ow IROAb Subdivision K i cN ix- Ir f� Owner 1'y'D f PA— CASJD9 -14 D Building Type I r-Af4 L Ea - Lot Area de :241 AC"EES Number of Bedrooms . 5 Design Flow 5-ezi, Separate Sewerage System to consist of 1 Cn 6 Gal. Septic Tank To be constructed by SA F ' i EP tl C_ Tax Map / Block Lot _� /6 I- 2, Job 4 14-9 K-1- Address A R-4EIC-95 145f I LL- Total Habitable Space J.5 4M Square Fil and _333 4E• n a Vii gig Te C iA CH Address YnT .:w VA Water Supply: Public Supply From �A 71 Private Supply to be drilled by �0� T3 %IE'L -L 1l iZI .Legs,, ( Addresss Sa CAR MEL- Other Requirements -5 1 4 14-Y l� I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal syste above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regu a ons o e u na County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthw be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder w place in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following thedate of the iss ante of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described abo will be located as shown on the approved plan and that said well will be Installed in acct rdance the standards, rules and regu a ons of the Putna County Department of Health. Date v f Signed i P.E. R.A. — Address i �Q i g_ Sr E � A 9M L) IV � 6 0 51 Z- � License No. APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unle uction of the building has been undertaken and revocable for cause or may be amended or modified when c red ne essary by �acommi inner o Health. Any change or alteration of constructic requires a per 't Ap ov for disposal of dourest sun ry wa and rivd bpplentY- Date By Title Q PUTNAM COUNTY DEPARTMENT OF HEALTH Rev. '.3/86 l�' jt Divielon of Environmental Health Services. Carmel, N.Y. 10512 EnBlneer to Provide Permit it Q(( on CERTIFICATE OF COMPLIANCE��� CONSTRUCTION PERMIT FO WAGE DISPOSAL SYSTEM Permit N '' II �('� , / P_QTJAt-'1 � LL E `( Located at —Li— 001,_LOVAi mod. Fo1JAM VAL�JLEY 14Y Town or VUlage Subdivision Name I O 11: E Sabd. Lot lY /� Tax Map --�`� Block Lot K Jt i rr t PDL� �••Ot A I , �QO� Renewal_ ❑ Revision Owner /Applicant Name_ N /�' H j�1��f11 R D 2 W 1 E� RD. %0<6V_1LL Date of Previous Approval Matting Address s Town f F IL SLI L I� Zip _ I 05 Building Type- �3 i Lot Area 45 Fill Section G0� Only" Depth Volume Number of Bedrooms Design Flow G /P/D PCHD Notification Is Required When Fill is completed Separate Sewerage System to consist of D0p Gallon Septic and_ 333 L • O 4 el:;P APP Tank To be constructed by A 1.1 1 Ed.50fJ�✓ Address MA 14 oPA •1 Water Sapplj,: Public Supply From Address or: Private Supply Drilled by A oEfLSD ddreas PU A M VAL Other Requirements represent that I am wholly and completely responsible for the design and location of the prop Py 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in acc e0fee s ards, rules an regu a :ons o e u nam County Department of Health, and that on completion thereof a "Certificate of Co nstr be submitted to the Department, pplrgn� story to the Commissioner of Healthwill and a written guarantee will be furnished the owne his EL s i ,B u ns by the builder, that said builder will place in good operating condition any part of said sewage disposal system during t iQ y m ediately following thedate of the issu- ance of the approval of the Certificate of Construction Compliance of the original here t2J that the drilled well described above will be located as shown on the approved plan and that said well will be installed in acco a e t rds, rules and regu amens of the Putnam County Department of Health. ea Date SignedTV Qj . Address 0 O I. Q P. E. R.A. �2 ,) ' p' w License No ^I� �Y APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued the building has been undertaken and Is {',,.;.;•. revocable for cause or may be amended or modified when considered nerec -i• w.. •,.. r`....,:..i •a���•f - -• •• PUTNAM COUNTY DEPAMMMNT OF HEALTH J y Rev. 3186 Division of Environmental Health Servkvsg Camel, N.Y. 10512 nalneer Must Provide . P.C.H.D. Permit li CE]RTTMCATE OF Located at SYSTEM Town or V e Tax Map---&z= --Blocka Lot Subdivision Name Subdv. Lot q Owner /applicant Name - gyp_ Date Permit Issued Mama Address Address Separate Sewerage System built by Consisting of 1 cc) Gallon Septic Tanis and lb J Pabllc Supply From Address Water supply: �{- �? oe: Private Supply Drilled by f k t' iC �' %+� -, Address Building p ®� Has Erosion Control Been Completed? Number of Bedrooms Has Garbage Grinder Been installed? nN Ei�. Other Requirements I certify that the system(s) as listed serving the above premises were of which are attached), and in accordance with the standards, rules and Putnam Coun Of Health. � Certified by . Oats Any person occupying premises served by the above systems) shall promptly take such ahhll tion 05 nu conditions resulting from Such usage. Approval of the separate Sewerage system available and the approval of the private water supply shall become null and void when a public I subject to modification or Changhen, in the Judgment of the of H 14 Date VA Nf the completed work ( copies m. and the permit issued by the s` 1 ? P.E.. R.A. a: Icenso No. o corroctlon of any unsanitary pub:': sanitary eowo► becomes Fs avoiloblo. Such approvals are Ion or chango is nocossory. i � Title PUTNAM COUNTY DEPARTMENT OF HE�H.T�_ Permit # PV -14 -81 Division of Environmental Health Services, Carmel, N. Y. 10b12 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Putnam Valley Bell Hollow Road 23. Town or illage Located at 7 77�� Tax Map Block 3 Let P/0 3 - 2 I1 Subdivision Klondike Subd. Lot # Renewal _� _� �c Revision Owner /Address Adolph Casden $ NOrthri dQA peek k; j I i\T V Date of Previous Approval 5/8/81 1- Family Residence Building Type Lot Area 19.227 A('7'eS Fill Section only 13 ( Number of Bedrooms 3 Design Flow G /P /D 600 P.C. H. D. Notification Required Separate Sewerage System to consist of 1000 Gal. Septic Tank and 333 L.F. of 21 wide trench To be constructed by S=ic Address _KatoTlah , N y Water Supply: Public Supply From X Private Supply to be drilled by __Boyd Well Drlllp, Address Rt. 52, Carmel, N. 1057 Other Requirements See Dw9. H 149 K -2 I 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 en regu a ions of 75-- KUinam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a 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 the date 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 ir) accordance with the standards, rules and regu a pf the Putnam County Department of Health. Date —..July 22 , 1982 1- X Signed P.E. R.A. Ad 37 Fair St ro dress e License No. 38998 APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless ruction of the building has been undertaken and is revocable for cause or may be amended or modified when considered nece sary by the Commissi er f Health. Any change or alteration of construction requires a ne!& permit Approved for ' posal of domestic r age, / r riv to nly. Date6_ By Title Rev. 9 -81 XOIKLQ,WII 1vIculwl i.auuldLULY) A11L% LAn I r � - t 321 Kear Street Yorktown Heights, N. Y. 10598 Collection Station Used: (914k21S.1201 Carmel _ Peekskill Mt. Kisco Rev City _ Director: Albert H. Padosmmi AL T. (ASM P o. doX nj o h e j a-r .L 5D � _ 10 -I Date Taken: Ll 22y � _�- Q,'00 Date Received: ,3:0(D Date Reported: Collected By: Referred By Sample Source: , IUeLQ 71 LABORATORY REPORT ON- BACTERIOLOGICAL QUALITY OF WATER GENERAL BACTERIA V/ Standard Plate Count per 1.0 ml i;V) (Agar plate @ 35 °C) YEMBRATIE FILTRATION TECHNIQUE (MFT) -Total Coliform per 100 ml O Fecal Coliform, per 100 cal Fecal Streptococcus per 100 ml ?OST PROBABLE NUMBER TECHNIQUE (MPN) Total Coliform: MPN Index ner 100 ml Fecal Coliform: OTHER ANALYSES MPN Index per 100 ml THESE RESULTS INDICATE THAT THE WATER SAMPLE, OF A SATISFACTORY• SANITARY QUALITY ACCORDING WATER STANDARDS, FOR THE PARAMETERS TESTED, A Albert H. Padovani, M.T. ASCP), Director �-� k-en - f'ron't 1e 11 12_ I (WAS NOT) (NOT APPLICABLE) NEW YORK STATE DRINKING TIME OF COLLECTION. LEGEND RDS ■ Recommend Disinfect- ing Water Source < ■ less than TNTC a Too Numerous Too Count oa WELL COMPLETION REPORT 3/71 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report is to be completed by well driller and submitted to County Health Department together with laboratory report of analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NA /(� / C�/ 1 ?� AD^ 5 d� / 1!lQi� 17\d . '� �ce�sk/ /� .•�� 1✓t�.�'"� b LOCATION OF WELL j( (No. & Stree) �-�^ I �(To ) Q (Lot Number) el� l(OW-RA, ` l �-1 ►i we v0.I1''e X.07 /0� ( PROPOSED USE OF WELL BUSINESS U! DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL PUBLIC ❑ SUPPLY ❑ INDUSTRIAL ❑AIR ❑ OTHER CONDITIONING (Specify) DRILLING EQUIPMENT COMPRESSED CABLE OTHER ❑ ROTARY VN AIR PERCUSSION ❑ PERCUSSION ❑ (Specify) CASING DETAILS LENGTH (feet) l I DIAMETER(/ c' es) ( WEIGHT PER FOOT j �j IL�J THREADED ❑ WELDED DR S O LonJ YES NO CASIN LA YES 4 Lj NO YIELD TEST HOURS G.P.M. ❑ BAILED ❑ PUMPED COMPRESSED AIR YIELD (G.P.M.) WATER LEVEL . MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST [feet) ( 13 Depth of Completed Well ) �O in feet below Land surface: / SCREEN MAKE LENGTH OPEN TO AQUIFER (Feet) DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (Inches): GRAVEL SIZE (Inches) FROM (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET //0 0 6u���c �2J NO 4 C' �_;- -- �8 00 :J7 If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE EL C A�yTPLFD� �'/ / DA E F REPOT WELL DRILLER (Signature) Hzc--, F0 u 0 2 Owner or Purchaser o Building Section � Building Cons ructed by Block Location - S reet Lot VALLSi Municipality .w,AA Subdivision Name 'tECEI�'Eo Building Type f',�a,.. SubdV.YLot # '87 ASR 27 P 3 ;52 GUARANTEE OF SEPARATE SEWAGE SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his success- ors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of initial use of the sewage disposal system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determin- ation of the Director of the Division of Environmental Health Services of the Putnam County Department of Health as to whether or not the fail- ure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the syste Q Dated this day of r kl-" 19_y_? Signatur Y Title_ — A l A,(L. n _V7_ 7 Corporation Name (ifTcorp. in / i/TrtQt Address THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health cf a5 • F'IITNAM Cf`l`NTY D1'i'ART T \T nr TIf'i ull DTVT4Tn\ nr f A`r j"\W \TAT, 11FALTI1 ST'MJUS Rea Property of Located at Date O 1 1-416 It-0 OJ M I Section -2> Block 3 -Lot _1 Gentlemen: This letter is to authorized S 4C a duly licensed professional engineer V or reoistered' architect . (Indicate) to apply for a Construction Permit for a separate sewage system; to . serve the above noted property in accordance with the standards, rules or regulations as pro•mulagated 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 construe tion. of said system or systems in conformity with the provisions of Article 145 or 247, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. <E -S Countersi n d: Very truly yours, Signed aner o9 Property Address •N - C:oxk S��fi Telephone Address d Telephone II. IV. V. VI. ! I SITE INSPECTION Date (U l 7 Inspect by ;;CATION vim\ , OWNER TM # OR SUBDIVISION LOT # C2.3 c� _ - - -- CCMMENTS SEWAGE DISPOSAL AREA a. SDS area located as per approved plans b. Fill section - Date of placement 2:1 barrier_ LGTH WIDTH AVG.DPTH c. Natural soil not stripped d. Stone, brush, etc., greater than 15' from SDS area. e. 100 ft. from water course /wetlands. SEWAGE DISPOSAL SYS a. Septic tank sizo - 1,000 1,250 b. Septic tank installed- -bevel c. 10' minimum fran foundation d. No 90° bends, cleanout within 10 ft. of 45° bend t� e. DISTRIBUTION BOX 1. All outlets at same elevation - water tested 1 2. Protected below frost 3. Minimum 2 ft. original soil between box and trenches f. JUNCTION BOX - ro 1 set , tv g. TRENCHES 1. Length required - S Len installed 3(s -c _ 2. Distance to watercourse measured . acv ft. 3. Installed according to plan 4. Distance center to center 5. Slope of trench acceptable 1/16 - 1/32 " /foot: 6. 10 feet from property line - 20 feet - foundations 7. Depth of trench < 30 inches from surface 8. Roan allowed for expansion, 50% 9. Size of gravel 3/4 - 11" diameter 10. Depth of gravel in trench 12" minimum 11. Pipe ends capped h. PUMP OR DOSE SY4TEMS 1. Size of pumpi#nmber )-A Z 2. Overflow tank 3. Alarm, visual /au 'o 4. Pum p easily accessi a manh le to grade 5. First box baffled 6. Cycle witnessed by H th ent estimated flow cle HOUSE a. House located per approved plans. b. Number of bedrooms 4�LL a. Well located as ptr approved plans � Allpi' GL� b. Distance from SDS area measured -L- -/ 0 ft. c. Casing 18" above grade. , % d. Surface drainage around well acceptable. OVERALL WORKMA.SHIP a. Boxes properly grouted / b. All pipes partially backfilled c. All pipes flush with inside of box d. Backfill material contains stones < 4" in diameter e. Curtain drain installed according to lam f. Curtain drain outfall protected & dir.to exist.watercours,% g. Footing drains discharge away from SDS area h. Surface water rotection adequate i. Errosion controi provided on slopes greater than 15 %. 10 APPENDIX B PUTNAM COUNTY DEPART OF HEALTH - DIVISION OF HEALTH SERVICES =w ='` INDIVIDUAL WNTER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT 2 DATE REVIEWED: BY:^�S (Name bf Owner) (St reet,Location) CHI'S YES DOCUMEN'T'S Permit Application Corporate Resolution Plans - Three sets s/s Engineers Authorization Design Data Sheet (DDS) SUBDIVISION �.: Deep Hole Log Perc ✓ Consistent Perc Results (3) Fill Perc Hole Depth cd House Plans - Two sets Well permit; PWS letter Variance Request GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Tc wn/DEC Permit R & D) Data On DDS Plans & Permit Same LF trench provided IiL REQUIRED DETAILS ON PLANS required Sewage System Plan - (north arrow) 60 ft. max. Sewage System Hydraulic Profile - Gravity Flora Parellel to contours Fill Profile & Dimensions --0 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 extension 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 Proposed System Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe . No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees,Top of fi' 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expa 15' to Drains - Curtain, Lander, Footing 351to catch basin,stormdrain,piped watercour. 10'. to Water Line (pits -201) • 50' intermittent drainage course Septic Tanks 10' frcm Foundation; 50' to W11 151 Well to PL /� Wok( �CL1h1� t�ff1)- C-ATk0,'0 -- -- 9 Si[e Design ConsubNs Civil Engineers * Land Planners P.z Box '174°eoro Saw Mill River R" ad ° Yorktown Heights. New York 1o5oo [9 14]SS2-44o8 January 15, 1987 Dear Chrissy, Enclosed please find the revised plans and percolation data sheet. As explained in our phone conversation problems arose during grading. The contractor felt it more economical to use the existing fill on the lot instead of trucking in fill without consulting us. He also changed the slope of the grade as to eliminate a pump type system. After I was notified of these changes I made a site inspection. I observed that the absorption area had been cut into approximately 12"-20". I immediately contacted your office and explained the situation. You told me that you had visited the site and observed these problems a few days ����� We agreed that the best way to deal with this situation would be to retest the soil rate and redesign the system accordingly. We had both inspected the deep tests and decided no further test holes were needed. I have replaced the pump system with a gravity system. I feel that our new design is adequate. Please contact me if you have any questions. I also want to thank you for your help in rectifying this matter. Yours truly, Michael Doebbler PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services Mr. Thomas Perna January 26, 1987 2070 Sawmill River Road Yorktown Heights, New York 10598 Re: Proposed SSDS Polito Bell Hollow Road Putnam Valley, NY Tax Map #23 -3 -2 Dear Mr. Perna: F JOHN SIMMONS. M.D. Deputy Commissioner 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. Plans should show correct existing two foot contours and proposed grades. 2. Specify elevation of cast iron pipe. 3. Bottom of trenches cannot be installed more than 24" deep, otherwise percolation test must be run deeper. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very, trul-y yours, :A Anne Bittner Asst. Environmental Health Engineer AB: pt cc:JK AB File 110 OLD ROUTE SIX CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 Z, 'CO • _COUK-W1fEA= _z!bEP#JUMENT,,- 0_1 __1 1,110-ir Q DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons . M.D. 1% - Routine NAR 0 rig.- Rout Orig. Complain ADDRESS' I 4A � Orig. Request No. ,,.-Itreet Municipality (T)(V)(C) Compliance MAILING ADDRESS V Complaint Comp Final P.O. Box Post Office Zip Code. Group Illness Construction TELEPHONE Reinspection PERSON IN CHARGE Field Sampling Only...'. OR INTERVIEWED Field Conference Name and :Title Ii Other DATE J TYPE FACILITY TIME ARRIVED S TIME LEFT Explain FINDINGS: ve I- P oIC f L I <5 1A ch- A .61 A ­6 INSPECTOR, TELEPHONE: SignatAFe and Title PERSON IN CHARGE OR INTERVIEWED: I acknowledge receipt of a copy of this SIGNATURE: Field Activity Report.......... TTTT.E. 4 DAVID D. BRUEN . County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services Mr. Thomas Perna,P.E. Box 174 2070 Saw Mill River Road Yorktown Heights, NY 10598 Dear Mr. Perna: June 30, 1986 J JOHN SIMMONS. M.D. Deputy Commissioner Re: "Polito" SDS Constr.Permit Appl. Revision Bell Hollow Road, PV, TM 23 -3 -2 Klondike II Lot 2, PCHD Permit PV -14 -81 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: ` Il. Audible, and visible high level pump calarm.=is lacking. 2. .Dosed systems should feed entire field at the same time; accordingly, proposed drop box series is inappropriate. �Z 3. Details of pump chamber overflow pit are lacking, as are two foot contours in pit vicinity. It is highly recommended that pump pit be adequately sized to accomodate at least a one day sewage storage above high level alarm. This will assure appropriate discharge of sewage .following repair of non - operational pump.and eliminate the likelihood of non- maintenance of overflow pit and the commensurate reduction in overflow capacity. 4. Pipe ends have not.been capped. 5. Recommended dosage of disposal trench is 750 of pipe volume,or 22 cubic feet. 6. Force main must be located below frost level. o � Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Yours Qvery truly, /) James S. Hodgens Assistant Public Health Engineer JSH /JP cc: File TWO, COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 PUTNAM COUNTY DEPARTMENT OF HEALTH "DIVfSION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of K s Li ►JE'rd PO) 1+0 Located at �LL• Hoilovy R ci (T) F>u -r"A► AVALLRY Section Z3 Block 3 Lot 2- Subdivision of Subdv. Lot # Filed Map # Date 1 Gentlemen: This letter is to authorize ThomaS F Pe.r►�u. a duly licensed professional engineer i( or registered architect (Indicate -� to apply for a Construction Permit for a. separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersi Very truly yours Signe wner of Property 'c�:2;2 • Ad ess Town `7'3 "q �- 2 �0 V _ Telephone 962 - 44 S8 Telephone E ®pp �® r OU'VTY NEAL i'/j t va.iura INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSIMS FIELD INSPECTION REPORT f , DATE: I `L INSP. BY: INITIAL SITE INSPECTION (� `� - (, YES I NO Property lines or corners found ................... / Can estimate house location ....................... Will driveway need cut ............................ ;v Must trees be removed - note these ................ Deep hole 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. 2 Lot Depth to G.W. Depth to rock -- Soil Descri tio� 0 ft. 3 ft. 6 ft 9 ft. 12 ft. D.H. - Deep Hole G.W.- Groundwater D.H. 3 Lot Depth to G.W. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. Soil DATE: D.H. 1 Lot Depth to G.W. Depth to rock �- House SSDS located per approved plan ............. Soil Descri tic 0 ft. ;' 3 ft. care } C Width of trench average 9 ft. 12 ft. D.H. 2 Lot Depth to G.W. Depth to rock -- Soil Descri tio� 0 ft. 3 ft. 6 ft 9 ft. 12 ft. D.H. - Deep Hole G.W.- Groundwater D.H. 3 Lot Depth to G.W. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. Soil 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......... Room allowed for expansion trenches .............. Over 100 ft. from swamp, 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 ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench ................ 15 ft. of peripheral soil horizontally fran trench ..... ............................... Boxes properly set ............................... Could surface runoff from driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE..... .... ... rev /9/85 mk PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL MTER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS ' REVIEW SHEET - CONSTRUCTION PERMIT DA TE BY: (," cation) DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log REVIEW D: 'Z a 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 Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area;shown;gravity flow,suff. size If Planned Pit & D Box Shown & Detailed House - No. of Bedroans Wells & SSDS's Win 200 ft. of Property Located 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 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake Unc. ex 15' to Drains- Curtain,Stonm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' from 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 0� 0M MM - � �JMU �► ► =Wd J 1. mm . a • u A ©m mm mm �m IMII MM 0m NEI r � ME mm (," cation) DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log REVIEW D: 'Z a 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 Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area;shown;gravity flow,suff. size If Planned Pit & D Box Shown & Detailed House - No. of Bedroans Wells & SSDS's Win 200 ft. of Property Located 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 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake Unc. ex 15' to Drains- Curtain,Stonm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' from 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 C. 4 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF.ENVTRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING,- CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL�SYSTEM FILE NO. Owner Kc-- 1_1;JmTN Address RQ Z ALLEIU Risd 9EK5K.ILL IVY Located at ( Street F3 do[lo w RA Sec z. . Block 3 Lot n `i ca e nearest cross s ree Municipality. w'T4dA6M VALLEY Watershed UMOU RIVCA SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS o e Number CLOCK TIME PERCOLATION . PERCOLATION. Run apse -Depth-to Wat3r a er ve No. Time From Ground Surface in Inches Soil Rate Start -Stop ,Min. Start Stop Drop in Min. /in drop Tnnhae Tnrrhaa Inches Notes: 1) Tests r tq4 at same rates are obtained at colation for review. rly 2) Depth measurements to be made depth until approximately equal soil test hole. All data to be submitted from top of hole. 2 `D ZJ'� Z3� ► 3 " 5 5 v,s - �o « 2 �! '/ 1 40 2,0-11. Z. i� 3 . Q 2I, Il:36 Zplt_ 23P 31145 1 :Y3 Z // ' 3 5 ).'SD 12:01 l l ' ZV / 311 3" 38 1 I 2: 0 1,:21 2 &1 Z31/ 1 2: 12 '101 1 1. 20" Z 31' .311. 3.6 3 5 �A , Notes: 1) Tests r tq4 at same rates are obtained at colation for review. rly 2) Depth measurements to be made depth until approximately equal soil test hole. All data to be submitted from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLIOATION DESCRIPTION OF SOILS.iNCOUNTERED IN.TEST HOLES - DEPTH HOLE NO.. HOLE NO. 6" 12" �ouf'SG 4 Sit.T_.l.�W SC?.SAUp --T 18" 24" 30" couR5E9A.Rg 42" "TKA C,0 Df! 48" 54" HOLE NO. 60" / 7211 7"" 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER RISES AFTER BEINGENCOUNTERED � . TESTS MADE BY t i 1 ,� eo ��,�rh�1'S Date y, 7.o t DESIGN Soil Rate Used Min/l "Drop: S. D. Usable Area Provided S60O No. of Bedrooms 3 of tV Tank Capacity ®C)® Gals. Type Absorption Are L.F.x24" width trench, Other Address 4 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. ure SEAL Checked by Date DIVISION OF ENVIROMMAL HEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner ►�1 . K POL i To Address 2, Q IEdIR.d. Ras Located at (Street) S�L.t. 14aMoW �d� Sec. Block '-7;� Lot Z (indicate nearest cross street)' f Municipality AM VA Watershed �U(�So tJ r. JASI SOIL PERCOLATION TEST DATA RBOTMM TO BE SUBMITTED WITH APPLICATIONS Date of Pre - Soaking �+ I 7 Date of Percolation Test HOLE IV5 20 23 NUMBER CLOCK TIME PERCOLATION *-V94- 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 11�1�-1�32Iry 21 *�" -1-50 IV5 20 23 3 15 31 *-V94- j,:09 15 2 3 3 ; 9 5 11: "IS :1 :154- I Z 20 2 3 3 Q- 21 '129 - 1: P21 ►Z 20 2 ';5 q- .31: 5t 2 : oS 12 Z,o 23 3 4- '4 5 42 14 Z-D 23 2 1 4co= 2,o0 14- 20 1 3 3 4 5 NOTES: 1. Tests to be repeated' at same +depth uzitil approximately equal soil rates are obtained.at each percolation test hole. All data to'be svtmitted for review. 2. Depth measurements to be made fran top of hole: rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. p HOLE NO. HOLE NO. G.L. 1° 4ov�ii 5° 6' 7' 8° 9' 10° 11' 12' 13' 14' SAi D W C,OP-)fbLr=S .I .. . . ,. INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE'LEVEL TO WHICH WATER LEVEL RISES AFTER�BEING aMUNTERED DEEP HOLE OBSERVATIONS MADE M-151 -j. -TT-- IMF SICa Go jc o LTAJS DATE: joq DESIGN Soil Rate Used D Min /1" Drop: S. D. Usable Area Provided 'jam 0 No. of Bedrooms Septic Tank Capacity J Qp p gals. Type cdG. Absorption Area Provided By ;b'2jr� L. F. x 24" width trench Other Name 74 0k4&,2 PE FZ �Aa - Signature Address �o��-ro�y 6 Ds9Q, THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by I'dTTI�9AM COUNTY P �'PARTMENT OF IiEALT1i 1 ' DTVISTON. OF BNVIRONMENTAI, ICALTH 'SERVICES OU M. . OFEICE HUIIDIDIG, CARPjIEJ... loo Y. 10512 ° VZJ D.JTl SBW- 31�PARAT4 SO4AGI� USPOUL, aYST9M FI&I WQ • llNOGv.ru'ti' 61 ` Ad dP esO �, /� j �, �. �• • ��. �G.�, l.� ..,,. Deco d'3. �locl indicate nes ros cr6aa s rep F o rshed a�i " ICOI�TION TEST TA RE UTTt TO T3E SURNiIT'rEil 1�i1TIi ' ATP QWS '� G]GOCK � iE PERCOIATIOIi _ ®1A Y z � . appq p' o war er ' 'o oAd Surface a er vo In Inch ®ca st�1r$ -stay �: ���aq , Start Stop Drpto bra' IPf�n.d�o� .. Anchos Inches Inch ®z : 1 :.�oe c '�� ' Jam.. �����. •j � (� �"� �����1.�'� .. of ... {'lit 1''•70 , /J� � 1 i1 �• ,�.��..I ,•`�'�r + ,. • ' �,: ,,gip �`..,� � , ' �• � G.° � ; � .(o� �. a �Aa g ..g �• Rsts �q be rageatec at esnmeph' laaal�A�. es a a . • oac�^,dl1g.. �� obta.lmad 4t each pprcglBjt on tpot We Dopy h t i6a9.lal'elilsntq to be dp. j°$° � !L�$° hQ �Q P '.1 yy . ,� • �', ' 1 `FIST JYM, 1.1)1111ilj'�, Y?11;(')jj.[jii:1-) 11-1,: Al"I'Ll.W.1,10N ,;S CBJ. 1, j .1. E2, " -i": 1101j: DEPTH HO No. HOLE? NO. 11OLE NO. G.L. '611 .121f 2411 30" 36 4211 4811 5411 6011 6611 7211 7811 84" 1IMICATE U�TL AT WILDCH GROUK) WATER IS EDTC0'(Jf1THTR7-',-) INDICATE =L TO W�CH WATER 12VEL RISES AFTER PL INIG ENCOUNTERED TESTS MADE BY Date 4, Soil Rate Used 10 Min/1"Drop: S.D. Usable No. of Bedrooms —a_____Septic Tank Capacity Im Absorption•Area Provided By3 3 _135 L. F. x24 Name Signature Address SEAL' THIS SPACE FOR USE BY •1EAI;PJ1 DEflARTMENIT ONLY: Soil Rate Approved Sq. fit/Gal. Checked by Ll ESS V/ c-- 6, e A ckp Date