Loading...
HomeMy WebLinkAbout2471DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51. -1 -37 BOX 21 I ru 91 Ir Ti n I ly, i , ., ' IL L me so LA.19 I is or �r L 02471 VV 1 6qERO PUTT Y DEPARTMENT Off' HEALTH y�'��■ `p(]yp CT■ �I��7 '�gT►'p� 1 ►�s1'1 V'El-F •7C'AL'�EA'L Y HA.7E�'Y' Y�E�e....._.".= ..- ...__.. �_.... CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # & 144 -3 Located at JO&JI //&f/ /?C" d rL Town or Village P/ l"71 0.01 xa f %mss/ Owner /Applicant Name , -1411 /mod Tax Map 39 Block / Lot 37 Formerly, Mailing Address Date Construction Permit Issued by PCHD / ?? 1� Subdivision Name Subd. Lot # Zip Separate Sewerage System built by o, Address Consisting of /do, D Gallon Septic Tank and S2_3 _J tx':- v 7 /2. Other Requirements: Water Supply: Public Supply From. Address or;, Private Supply Drilled by Av rMag AA /tryo � Address pt a !/ �►J /� . Building Type i' p �'! G �" � ' `Has erosion control 'been com- leted . Number of Bedrooms 3 Has garbage grinder been installed? /✓f I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putn epartment of Health. Date: 3 Certified by 4'If s P1. R.A. (Design " io v %% Address % 7 7— C'i't'� ��%rJ rte. 6 Lic se # Any person occupying premises served by the above syst slsp R �fnptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public 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 Public Health Director, such revocation, modification chane is necess yt g ary. C te: Pink copy - 0 r; Oran j opy - Design Professional Form CC -97 IM White copy - HD a� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: f wn/Village: Tax Grid # Map Block Lot(s) Well Owner: Name: Address: IIJse of Well: fl- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby llDrilliug ]Equipment _� Rotary Cable percussion Compressed air percussion . Other (specify) Well Type Screened Open end casing -X, Open hole in bedrock Other Casing Details Total length L/5' ft. Length below grade -'/3 Diameter G `` in. Weight per foot �lb/ft. Materials: Steel _ Plastic _ Other Joints: _ Welde Threaded _ Other Seal: Cement grout _ Bentonite , Other Drive shoe: Yes No Liner Yes 7--,No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second We11 Yield Test Bailed _ Pumped itompressed Air Yield I00 gpm IIDepth Data Measure from land surface-static (specify 9) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation )[Description ft. ft. Land Surface G « !: _::..:� :._ ....� _.c_._._:. : _, .:::_ _ If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type 3,cws,-!.c- Capacity _S- Depth ;2-" Model ,!rr O 7- /X' Voltage 2-30 HP —f� Tank Type�X-TWVolume / 2- o -# >d'a DateWe I Co p ettteed , Putnam County Certification No. � Date of Report �y Well Driller (signature) h1Q.➢vk;: 1Exact location of well with distances to at least two peimanr iancimarxs to be proviaea on a separate sneet/pian. Well Driller's Name Address: Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown He,i qt�.tE�, (914) 245-2800 Albert H. Padovan.1, Director LAB #: 32,804427, CLIENT #: 9108 NON STAT•PROC PAGE I ADORNOp JOHN J.. DATE/TIME TAKEN: 05/21/98 12:30P 146 CORDIAL RD. DATE/TIME REC'D: 05/21/98 01:35P YORKTOWN HEIGHTS, NY 10598 REPORT DATE: 06/03/98 PHONE: (914)-962-2966 SAMPLING SITE: 1*02 BELL HOLLOW RD. SAMPLE TYPE..: POTABLE :,-PUTNAM VALLEY, N.Y. PRESERVATIVES: NONE COL'D•BY: JOHN J. ADORNO TEMPERATURE..: 4C NOTES...: WELL COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL RANGE METHOD PUTNAM CNTY PROFILE 05/21/98 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 05/21/98 LEAD (IMS) , <1 ppb 0-15-ppb 12345• 05/21/98 NITRATE NITROG 0.34 MG/L 0 - 10 9139. 05/21/98 NITRITE NITROG <o.olo M(31L N/A 1146 05/21,/9e IRON (Fe) <0.060 H81L 0-0.3 mg/l 2037 05/21/98 MANGANESE (Mn) <0.010 MG/L 0-0.3 mg/l 2037 .05/21/98 SODIUM (Na) 4441 Mb/L N/A 05 /21/98 pH 7..0 UNITS 6.57,8.5 * 05/21/98 HARDNESSjT0TAL 50 MG/L N/A .9043 05/21/98 ALKALINITY (AS 44.0 MG/L N/A 05/21/98. TURBIDITY, (TUR­ ..NTU 0-5 NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO THE NEW YORK*STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE..PARAMETERS TESTED, AT•THE TIME OF COLLECTION. Pb/Cu LEAD limits for public 'schools are set at 15 ppb., EPA Lead & Copper Rule for Public Systems requires that no more than 10% of their distribution points have a LEAD value of more than 15•pob and a COPPER value of-1.3 mg/Lpelse water treatment must be undertaken to reduce the waters.corrosive potential., Fe/Mn If both iron and manganese are present, their total value combined.shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. S ' uggested guidelines state that for people on a sodium restricted diet.the water should contain no more than 20 mg/L of Sodium. For -those.on a moderately restricted diet,, a maximum of '270 mg/L of Sodium is suggested. YML ENVIRONMENTAL .SERVICES 321 gear .Street awn* Hgights;Q.,NpY..- ..10598 (914) 245 -2800 Albert Ho Padavaniq Director LAB #0 320804427 CLIENT #0 9108 NON STAT PROC PAGE 2 NNN N N N N N NNNNNN N N N N N N N N N N N N N NNNN N NNNN N N N N NNNNN N N AI N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N ADORNOgiJOHN J. DATE /TIME TAKENe 05/21/98 12o30P 146 CORDIAL..RD.. DATE /TIME RECD: 05/21/98 01035P YORK-TOWN HEIGHTS9 NY 10598 REPORT DATE: 06/03/98.. PHONEo (914)- 962 -2966 SAMPLING SITEo-102 BELL HOLLOW RD. SAMPLE TYPEoes. POTABLE o PUTNAM VALLEYS N.Y. PRESERVATIVESs. NONE COLD BYa JOHN Jo ADORNO TEMPERATURE..: < 4C NOTES...s WELL COLIFORM METHo MF N N N N N N N N N N N N N M N N N N N N N N N N N N N N N N N N N N N.N N N N N N N N NNNNNN N N N N N N N N N N N N N N N N N N N N M N N N N N N N N DATE FLAG PROCEDURE RESULT NORMAL — RANGE METHOD SUBMITTED . BY o (.a�uz U Albert Ho Padavani9 M.T.( Director ELAP4 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM , e/ 14 Owner or Purchaser of Building ldin Constructed by ✓/ -31 Tax Map /Block Lot Town/Village Location - Street Subdivision Name Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that. is 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 treatment 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 Public Health Director 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: Month 0/1 Day 04Year qr- General Contract.Qr- wner) - Signakure - 7), vd�) —Ie- , n-, az 4 1 � _/__ __/__ C - I — Corporation Name (if corporation) . Address: State ��.v�„ -, �,���j� Zip Signature: Title: Corporation Name (if corporation) Address: State Zip Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Inspected by: 10:T Street Locati Owner QQk,,jQ Town Pen-nit # PV-1V-f"_3 TM 4 0.— Subdivision Lot 4..- A,111q 1. Sewage System Area a. STS area located as per approved plans ...................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpt4_ c. Natural soil not stripped ............................................. d. Stone, brush, etc., greater than 15'from STS area..... e. 100' from water course/wetlands ............................... 11. Sewage System I a. Sep-tic tank Sl' z � ........ 1,250 ......... other .......... b. Septic.66 -ins level ......................................... c. 10' minimum from foundation .................................... d. Distribution Box 1. All outlets at same elevation-water tested........... 2. Protected below frost ............................................ 3. - Minimum 2 ft.Original soil bet ween box & tren( e. Junction Box - properly set ....................................... f, Tr—en—cFe—s 1 - Length required Length installed. 15 2. Distance to watercourse measured Fi7. 3. Installed according to plan ................... ; .............. 4. Slope of trench acceptable 1/16 -1/32" /foot....... 5. 10 ft. from property line - 20 ft.- foundations.... 6. Depth of trench <30 inches from surface ............ 7. Room allowed for expansion, 100% ................... _._& -Size of gravel 3/4, 1 V" dianRer c le an;..,.; . ..... 9. Depth of gravel in trench 12" minimum .............. 10. Pipe ends capped .................................. I ............... g. Pump or Dosed Systems 1. Size of pump chamber ......................................... 2. Overflow tank ...................................................... 3. Alarm, visual/audio ...... : ................................. 4. Pump easily accessible, manhole to grade.......... 5. First box baffled .................................................. 6. Cycle witnessed by H.D.estimated flow/cycle .... III. House/BuilgdWng a To a . ousecated per approved plans ... ............... b. Number of bedrooms ....................... ....................... IV. Well a. Well located as per approved plans. b. Distance from STS area measured c. Casing 18" above grade ............................................ d. Surface drainage around well acceptable ................. ............ V. Overall Workmanship a. Boxes properly grouted ............................................ b. All pipes partially backfilled .................................... c. All pipes flush with inside of box ............................ d. Backfill material contains stones <4" diameter....... e. Curtain drain & standpipes installed according to p f Curtain drain outfall protected. & dinto exist waters g. Footing drains discharge away from STS area........ h. Surface Water protection adequate ........................... PUTNAM COUNTY DEPARTMENT OF HEALTH -'� - .-DIVISION OF ENVIROIMNTAL - HE`AETW' SERVICES Date 'Tti'O Re: Property of `:To H i�ptLl��c7 Located at 5V..L, kfo (1 p") 1?4_)r¢p M.PtAV-1401 VAllU Section g/, p Block Lot Subdivision of Subdv. Lot # Gentlemen: Filed Map # Date This letter is to authorize% a duly licensed professional engineer V or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in conri�ctzorr with -this- -nrc-tter 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. Countersigned:' P.E. , R.A. , #�� Very truly yours, Signed 0� of Property Oc) Ad /drJess (/ Address Town �' (?/ y ) 1160< �6 Telephone - Teleph e PUTNAM COUNTY DEPARTMENT OF HEALTH ,,eComplaint NOo 490 -97 -19 COMPLAINT OR SERVICE REQUEST RECORD y `WN F �. PUTNAM VALLEY DATE 10/27/97 REFERRED TO TAKEN BY BH TELEPHONE -CALL IN PERSON LETTER XXX CONFIDENTIAL REQUEST FROM Town of Putnam VAlley TELEPHONE ADDRESS ENVIRONMENTAL HEALTH: Sewage Nuisance Chemical Emergency Public Health Nuisance Individual Water Other COMPLAINT OR REQUEST Basement being constructed as liviable space at 102 Bell Hollow Road, REsidence of Adorno A y2 ACTION TAKEN BY FINDINGS g)'rl 0' .FOLLOW UP INSPECTION (s)­ DATE FINDINGS DATE DATE FINDINGS PROBLEM ABATED DATE PERSON NOTIFIED ESTIMATED TOTAL MAN HOURS SPENT 'C -CR MARVIN O'DELL Bldg. inspector JOHN MAHONEY Deputy Zoning Inspector TOWN OF PUTNAM VALLEY BUILDING, ZONING, AND SANITARY DEPARTMENT I October 10, 1997 Putnam County Board of Health 4 Geneva Road Brewster, N.Y. 10509 Att: William Hedges TOWNHALL PUTNAM VALLEY, N.Y. (914) 526 2377 BETTE STOCKINGER Bldg. Dept Clerk Re: Finished Basements (lower level) Dear Bill: I enclose copies of correspondence with owners of two (2) new homes under construction with Putnam:.Valley for your information. Please advise should ypu..have comment. Yours truly, MARVIN O'DELL Building & Zoning Inspector MO'D:es enc. ! ■ i % MARVIN O'DELL Bldg. Inspector JOHN MAHONEY Deputy Zoning Inspector TOWN HALL PUTNAM VALLEY, N.Y. �... (914) 526 2377 BETTE STOCKINGER TOWN O F .:PVT N A M VALLEY. Bldg. Dept. clerk BUILDING', ZONING, 'AND SANITARY DEPARTMENT October 8, 1997 John & Rima Adorno U 146 Cordial Road Yorktown.Hgts., N.Y. 10598 Dear Mr. & Mrs. Adorno: Re: Ai 'fhe sement Pursuant to recent inspections of your home under - construction, it has been observed that the lower level,-shown as unfinished basement on your plans is being completed as livable space. As we have previously discussed this expansion of your home. requires permits from this office and that such permits are subject to, approval of the Putnam:County Board,of Environmental. f Health. To avoid further necessary action by this office which may delay ..progress -on your. ' homey please_ rom tl bring, our property into - -. compliance with 'all"Town 'and County regulations. Should you have questions.regarding above, contact this office forthwith. Sincerely, cow 0 e O MARVIN 0 DELL Building & Zoning Inspector MO'D:es APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS - ,......._., REVIEW SHEET for CONSTRUCTION PERMIT NAMEOFOWNTR,, STREET LOCATION BY DATE TAX MAP # bbU*fNTS. / UVff APPLICATION 1 LLPERMIT;LLJ PWS LETTER RNEERS AUTHORIZATION ;IGN DATA SHEET(DDS) T HOLE LOG PERC RESULTS (3) HOLE DEPTH ORATE RESOLUTION If[ PLANS THREE SETS f HOUSE PLANS - TWO SETS M VARIANCE REQUEST GENERAL SUBDIVISION 'ISION APPROVAL CHECKED PERC RATE FILL REQUIRED CURTAIN DRAIN REQUIRED mSTANDPIPES X- APPROVAL SSDS ADJ. LOTS CD WETLAND (TOWN/DEC PERMIT R & D) S PLANS & PERMIT SAME 9..LlMETlT;RT17R RE -1 IGHBOR NOTIFIFICATION A ` YR. FLOOD ELEVATION ` RE OUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NOR TI ARROW) SSDS HYDRAULIC PROFILE [ GRAVITY FLOW []:I'D/ J BOX m TRENCH/GALLEY m P- PIT DETAILS SEPTIC TANK - SIZE, DETAIL WELL DETAIL, SERVICE LINE IF OVER CONSTRUCTION NOTES (GRINDER RATE) DATA: PERC AND DEEP RESULTS OT CONTOURS EXISTING & PROPOSED AY & SLOPES CUT FOOTING/GUTTER/CURTAIN DRAINS COMMENTS: /-,o - &O D6 =DISCHARGE (OK) PERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY AND EXPANSION eEXP. AREA; SHOWN; GRAVITY FLOW, SUFF. SIZE -IF PUMPED PIT &'D BOX SHOWN & DETAILED ,HOUSE - NO. OF BEDROOMS JELLS & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER - 1/4 "/FT. 4"0; TYPE PIPE NO BENDS; MAX. BENDS 45 W /CLEANOUT FILL SYSTEMS lrYBARRIER HORIZONTAL: SLOPE 3:1 TO GRADE FILL SPECS _ )EPTH GAUGES FILL PROFILE & DIMENSIONS, TRENCH PROVIDED 5-b-0 Ll,J60 FT MAX EPTARALLEL TO CONTOURS ED 100°x6 EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED ON PLA FIELDS 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS 100 TO WELL, 200' IN D.L.O.D., 150' PITS 100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATERLINE (PITS -20') 50' INTERMITTENT DRAINAGE COURSE m %200 FT. RESERVOIR, ETC-ED 150 FT. GALLEY SYSTEMS SEPTIC TANKS 10' FROM FOUNDATION; 50' TO WELL WELLS 15' WELL TO P.L. DAQUINO and DONA H U E . - jI I� j��j1� jl� Y � � ®1 `�,�tLl ��Yl Y<Y �1 �Y.11��.� -I Yt1 ll John V. D'Aqulno, P.E. 314 Oscawana Lake Rd. Putnam Valley, N.Y. 10579 914 -526 -2039 Mr. P9� 1 Morris ii 4 Geneva Road Brewster, NY 10512 Dear Mr. Morriss Danlel 1. Donahue, P.E. 200 Breckenridge Rd. Mahopac, N.Y. 10541 914- 628 -7576 June 21, 1993 RE: Lennon Bell Hollow Road Putnam Valley I have been advised by the property owner that the town is requesting that the sewage.disposal system be relocated beyond the 100 foot setback from their local wetlands delineation. I further understand that the wetlands have been delineated as close as the shoulder of the road. Referring to the plans submitted; the sewage disposal area is situated in the only area on the lot where your department's slope requirements can be met. The slopes upgradient from the area Proposed exceed 35% and the area of the lot for which actual topographical information is not shown further exceeds 35% slope. Please indicate if your department 'would' aTloui `a "relocation -off' ihe' - ' " °- _...__...._- - - - - -. the enclosed plan.- Please recognize also that -the area of the ;property situated to the north and east not shown on the enclosed plan have greater slopes than those illustrated. Your prompt response will be appreciated. Very truly yours, John V. D'Aqui o, P.E. Site 0 Sanitary C Environmental li t DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL rCHD rERMIT WELL LOCATION Street Ad �jes To Tax Grid Number wa �I a ,-�,� yt�.v�. 1� Z — WELL OWNER Name Mailing Address c�;41de- �.�,viNOV� (� �i� [�cx�, fc vt«v-,1[tt @(Private 0Public SE OF WELL 1 - primary - secondary RESIDENTIAL 'O PUBLIC SUPPLY O AIR /COND /HEAT PUMP 9BUSINESS O FARM O TEST /OBSERVATION 0 INDUSTRIAL b INSTITUTIONAL O STAND -BY ❑ ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED 0 JEST. OF DAILY USAGE GJ� Sal REASON FOR DRILLING 13 REPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION 13-ADDITIONAL SUPPLY VNEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING L WELL TYPE MDRILLED DRIVEN ODUG CIGRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES _ S NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name �' o-l- s9,eekJ Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _�C NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY "" " "D'ISTANCE TO PROPERTY FROM NEAREST 'WATER MAIN: LOCATION SKETC&ONSEPARATE & SOURCES OF.CONTAMINATION PROVIDED SHEET date) 6t�- /'_6 siRriatare PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty. (30) 'days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or "waste products from such well drilli operations be contained on this property and in such a manner as not to degrade or oth w e contaM3nate surface or groundwater. Date of Issue• 19,, Date of Expiration 19� Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller/ i APPLICAT -TON FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Nay and Address of App l i cant: PAS ` U-WA H CIA L� U Y, I o cS^7 q 2. Name of Project: J�Q� 3. Location T /V /C: PUT VAL LE Y --fit 4- �scAwv� Lam, 4. Prcject Engineer: .1 � V,� UI C7 5. Address: , License Plumber: r5c) Phone: 6. Type of Project: _Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) ►. :Is this project subject to State Environmental Quality Review (SEAR)? Type Status (Check One.) Type I.. Exempt X_ Type II. Unlisted s. ,Is a Craft Environmental- Impact Statement (DEIS) required? ............. /�tb Has D =IS been completed and found acceptable by L e ad Agency ? ......... eI /Ilk Fume cf Lead Agency ` Is this project in an area under the control of local planning, zoning, Nks or ether officials, ordinances) ..._........ ................. If so, have plans been submitted to such authorities? .................. • Has preliminary approval been granted by such authorities? Date Granted: • Type cf Sewage Disposal System Discharge...... Surface Water Ground Waters If s:.'rface water discharge, what is the stream class designation ?........ PIA Waters index number (surface) ........... ............................... —I` Is prc?ect located near a public water supply syster ?� If yes, naime of water supply Distance to water supply Tc . �rL� =Ct s "i to near a public se- ace cC . ie. Flon o' C'• ="'Os? � Sv" -eG....... Iy� ha_:._ c- system Distance to Sewaaa- sv -steim Cam_ c:__r. e d, Cam, -2— h_m o-1 He--`r moepals Prciec, design flow (gallons per day)....k:� -. X ...� ..:- .. %o0 day) 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 Building Inspectors/ Code Enforcement Officer Town of J?� _PUT��1AM_ , New ork Zip �OS'%C e Re: Owner Street SELL I_�_O_�LoW 12oAD TM -- -- Town L AM Zt VALL:t_•� _ Dear Sir: An application to construct a' Rf_V7z� N_ i-O U SC is being submitted for review to the Putnam County Health Dep rtment. ' r i 1 JOHN KARELL�Jr•, P.E. Director I, E , ►he-•dbode-'srentiored- pa cL*l- is -not . par ±:.of'..a:_P.0 am- - Cpi:n, y_.Approyed subdivision. - -• Therefore, the following information is requested prior to our review, 1. Does the proposed project conform vith existing land use as officially adopted? 2. Is the above mentioned lot considered a legal building lot? The above information must be submitted to this Department prior to our review. Approval of this information is for the creation of property lines only. The project must conform to all health department requirements and all local ordinances. If you have any questions, please contact me at your convenience. Very truly yours, 2 b4c s -RD'. Public Health WH /jp D'AQURNO ,gnd DONAHU E CONSULTING ING ENGINEERS ❑ John V. D'Aquino, P.E. ❑ Daniel J. Donahue, P.E. 6 314 Oscawana Lake Road 200 Breckenridge Road �' Putnam Valley, N.Y: 10579 Ma}iopac, N.Y. 10541" - ` 9`14 -526 -2039 914- 628 -7576 TO Jr - 1/ WE ARE SENDING YOU YAttached ❑ Under separate cover via_ ❑ Shop drawings ❑ Prints X Plans ❑ Copy of letter ❑ Change order ❑ DATE NO. . ATTEN TIO � /� +j���F ✓7 + / V /`• �•�T RE. {� following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION {� okl THESE ARE TRANSMITTED as checked below: KFor approval ❑ Approved as submitted • For your use ❑ Approved as noted • As requested ❑ Returned for corrections ❑ For review and comment ❑ _ • Resubmit copies for approval • Submit copies for distribution • Return corrected prints ❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO� %L/d� SIGNED: If enclosures are not as noted, kindly notify us at once. REGISTERED HAIL r' RETURN RECEIPT REQUESTED Building Inspector eUL6- _ o�O A LV-. P--b- -------------'-/--------- Dear M—_6 Od__I0 aDate Re: Construction Permit for single family residence pp Applicant _1�71zIC -- -------- o�! Street 'OK _`I�_ q Town _1�.'`'_�- v +.�'Y -IoS7 I Thy► This Firm (I am) submitting an application to construct a sewage disposal system serving a single family residence on the above captioned property, to the Putnam County Department of Health., In order to process this application the Health Department requires that the following information be obtained from your office: 1. Prior to your issuance of a building permit A) Is Zoning Board approval required for anX variances? Yes No l� -- - - - - -- --- - - - - -- B) Is any portion of the parcel located within a regulated vetland or its r control area�)'and if so is p vetland permit required? Yes_ j/ No C) Is any. - other. local.permit or approval necessary? Yes - no .............. If the answer to any of the questions above is yes, please contact the Health Department in writing or by phone, 278 -6130 within 15 days of the date of this correspondence. If the answer is no, you need not respond to this correspondence. Name Uonl— A ---------- / Health Department Inspector JK /JP vetland bh 6 - 93 ��1 Very truly yours, ?gaineer, A ehst ct, Owner FORMAT Date`s NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT Re: Department of Health Review of Proposed Sewage Disposal Sysgem for property: Name: Address: Town: R&77VW-Y Tax Map: 57-1-37 Dear -, Please be advised that an application for a Construction Permit. relative to the construction of a sewage system and /or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached _ - please- find - - a_. opv .of. the. 1 atest site p?an. If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call. s mr Mr. Morris of the Health Department at 225 -0310. Very truly yours, By !! , Title w4� Tax Map : X11 4 FORMAT NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT Date 57— '�r- (?3 Re: Department of Health Reviea of Proposed Sewage Disposal System for property: Name: Address: 13 ,541— lk4Z -OW ^' '0'4�3 Town: Ra77 14A4 V01445)""' Tax Map: 57-1-37 Dear Please be advised that an application for a Construction Permit relative to the construction of a sewage system and /or well proposed for the captioned :...- p.roper-t)•. has been made to the Putnam.-tnent of Health. Attached please "Ti -hd "a copy - o'f t e- latest' 1-te -Plan. _.. ....___.___..._.._....__.....__ If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may ca11.I�r --Hes or Mr. Morris of the Health Department at 225 -0310. Very truly yours, RECEIVED Address: Tax i"ap: J Y.; c,] ti Vi r• � J i s i t t i 0 -D'AQWNO and DONAIH U E John V. D'Aquino, P.E. C1 Daniel J. Donahue, P.E. - 3:1.4Q .pxana Lake Road 200 Breckenridge Putnam Valley, N.Y. 10579 Mahopac, N.Y. 10541 914 -526 -2039 914 - 628 -7576 TO l� C/_/ Z) WE ARE SENDING YOU X Attached ❑ Under separate cover via LETTEM @F UGD3QMSEDUM2AL DATE JOB NO. ATTENTION RE. 1i00"40Sg-;D ' %x'93 - -- , i��l �- ,�` �'%�' • = �-� following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order p(. -:ii_,e_�dc�cr� COPIES DATE NO. DESCRIPTION ' %x'93 - -- , i��l �- ,�` �'%�' • = �-� or .4v7 hfo2 /� •4-7 R/ 5116_%' O, Af vacxnav 7th coAtsTR.,cKir wc- � 9 7- ?3 a T%Al A'-o,e- AAA 01 Ai_ Off° AL *U-C s�20 c770AI F2_AA1 S A - -_ . _ � -,e ,��7.�_. - . �� . Z-0. 7_ _Zy� . THESE ARE TRANSMITTED as checked below: D, ,38A_0 1Av,,� �OOje- R'For approval ❑ Approved as submitted ❑ Resubmit copies for approval xFor 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 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS i r COPY TO A r ^ ( C SIGNED: 010 If enclosures are not as noted, kindly notify us at one ." PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Located at (T) I /W am I Q ( Section 5 Block Lot � Subdivision of Subdv. Lot # Filed Map # Date Gentlemen: ja-;4 � / �ti /e2- o��✓/�?� This letter is to authorize �iQ-QU /✓!c7 < c<2 (.ErytSE�� &I-Ic 's a duly licensed professional engineerQ (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-Articie "145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Vj P C tersigned: ✓ P.E. eAWA9. , # Address Telephone Very truly youpt, Signed Owner o P operty : / 2 Address Town Telephone L...... DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 2kP15LT0A9iif)m-:n1n- Crimcw nt-rf` A WATER WEI,T;- i., .. _.. .. . PCHD PERMIT # - /4- rj FALL LOCATION Street dr ss To illage Cit Tax Grid Number WELL OWNER Eoa'4_4 ame fl Mailin Addres ®ate ® Public USE OF WELL 1 - primary 2 - secondary & RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL ® PUBLIC SUPPLY ® AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY ® ABANDONED 0 OTHER (specify AMOUNT OF USE YIELD SOUGHT �;_ gpm /# ® REPOT ACE EXISTING SUPPLY &NEW SUPPLY NEW DWELLING PEOPLE SERVED /EST. OF DAILY USAGE,Sal O TEST /OBSERVATION 13 ADDITIONAL SUPPLY O DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING _ C, WELL TYPE O&KLED ®DRIVEN []DUG ®GRAVEL. � OTHER IS TELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. HATER WELL CONTRACTOR: Name 71) PV- &"04 -x Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES yF�S NAME OF PUBLIC WATER SUPPLY: - - - - -- -- DFSTAwr,V, TO,PROPERTY FROM, NEAREST. WATER..MAIN:. TOWN /VIL /CITY LOCATION SKETCH & S CES OF CONTAMINATION PROVIDED SEPARATE SHEET .3 1.--a' 0.- CVA_� (dat ( gnat re PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirt3, (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: Date of Expiration Permit is Non - Transferrable 3/89 19 19 Permit Issuing Official White copy: HD File Pink copy: Owner Yellow copy: Bldg. Insp. Orange copy: Well Driller 9i i95-4 J TOWN OV I'V*rNAM VAI,.-C.TE�Y IUMMING WMD1 WUM LAXE ROAD P�J VAUM, HY 1 07 9 UEA'k-,„,* " "TRIM TWO $I Flu esll-/165-3/505 I Ir 14 11WEM, a-berif= has twllod fur -I 'lot. 1Jm Vh.np4o IXAW4;ai� U-cs, two Alone plamirr 3rd fvv4 -aotsrmir�;-,A Itlizo clmm,-Na l c',ann .10tL l ti r ix VIM tz bv' a 1,-udldabl, v lot., w4 4itlOx UP,) u%X1 44t1w-TAs coltzollo It 44xui�g tO N thS Ofay' teazible ON, and U* hxv a jJ1pU pr1c1. P O"WO . ct b e" o h4 a�w sd tOhse perimwy 1wlaa Mwpxtai e rt" i1c(=wtlmilied cAn reta, qtlwwlij. s aro" to Hollcv Rvid; 11(kilm-pill"IM, Rg' 'It R3OLVM) THAT, VfitlArdu pot: flirt lx.-,- ":!UA 13 hart"11,71 in ,Nxvrdanc�a tath tho &xW1Uv a ubmitted sArel aw a"nift iii ierfAii:m control. �w-vmiruu NA;V in pts-cod dur-111rq Ilk,;. j, to O-A &1tista&A-,m of. U4 1hd1dim 1A.-Opw-tor. r, I i! i DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 May 3, 1993 John D'Aauino 314 0scawana Lake Road Putnam Valley, NY 10579 Re: Proposed SSDS: Lennon Bell Hollow Road (T) Putnam Valley Dear Mr. D'Aquino: JOHN KARELL Jr.. P.E., M.S. Public Health Director 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 split system design is not permissable. Redesign with a straight drop box system utilizing the right side of the shown split system as the primary and the left side as the expansion. 2. Neighbor notification is required (guidelines enclosed). 3. Footing /gutter drain discharge has not been shown. 4. Remove proposed alternate well location. Upon Receipt of a submission, revised to reflect the above comments, this application will be,gonsidered further. Very truly yours, Robert Morris Assistant Public Health Engineer RM /jP t. DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO, 'CONSTRUCT A 6ATATER WELL f� � ) PCHD PERMIT # WELL LOCATION Strjet Address / �p C'i Town Village City Tax Grid Number sr G c4 d —I-3Z WELL OWNER --Name G. Mailing c Address f �G° /� rivate 'O "Public USE OF WELL 1 - primary 2- secondary 'RESIDENTIAL 0 BUSINESS [)INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION b INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT ,5'- gpm /# O REPLACE EXISTING SUPPLY Aww SUPPLY NEW DWELLING PEOPLE SERVED 4- /EST. OF DAILY USAGE ,dc'G gal O TEST/ OBSERVATION M ADDITIONAL SUPPLY 0 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL :• TYPE EIDRILLED 13 DRIVEN ODUG [3 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 A/ 4p, cle-2fl Y,1 Address: ISP.U$LICWATERSUP,PLY AVAILABLE TO SITE: YES_NO `_,NAME OF PUBLDIC':WATER :SUPPLY , ` TOWN /VIL /CITY . - k, .. Wt DISTANCE;° 7 fir, PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETGH`& SOURCES OF CONTAMINATION PROVIDED "itY;r .RON SEPARATE SHEET , dill T }k< dat ' (signature) 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 % of the New York State Sanitary Code, and provided that within thirti, (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 Department attached to this permit. 3. Submit a Well Completion Report on a form requirements of the Putnam County Health provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drill operations be contained on this property and in such a m nner as not to degrade or oth wis contam to surface or groundwater. Date of Issue: 19 �b I Date of Expiration -� I' 19 Permit Issuing Official y P' rmit is Non - Transferrable White copy: HD File Pink copy: Owner 389 Yellow copy: Bldg. Insp. Orange copy: Well Driller Re: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date y Property of �,, �j � adal p_ © Located at (T)—/-'. Section, . U Block ____Z Lot 37 Subdivision of Subdve Lot # Gentlemen: Filed Map # Date This letter is to authorize a duly licensed professional engineer Y100-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. ersign e =-� Eft P. E. , RaA. , # 2�1 Address Telephone Very truly yours, Signec Aaaress Town 76a -a�� Telephone DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 April 9, 1996 Roy Fredricksen PO Box 950 Mahopac, NY 10541 Re: Proposed SSDS: Adorno Be11 Hollow Road (T) Putnam Valley Dear Mr. Fredricksen: R. Acting Public Health Director Review of plans and other supporting documents subm'itted.at this time relative to the above - captioned project has been completed. Comments are offered as follows: "The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." 1. Plan is to .note site conditions are comparable to those at the time of initial approval. 2. Plan is to note all erosion control measures are to be installed prior to the start of construction. _..._ ._ ..._: _....a,: E,<.pl ai•n- how - -the. well and:.b6L4ndary. rot point... locations., 4. Proposed contours are to be shown on plan. Upon Receipt of a submission, revised to reflect the above comments, this application will be considered further. Ver truly yours, Robert Morris, P. E. Public Health Engineer RM /jp Patrick J. Lennon 122 Bell Hollow Road Putnam Valley, NY 10579 June 29, 1993 Mr. Jack Rarell Director of Public Health Department of Public Health 4 Geneva Road, Route 312 Brewster, NY 10509 Dear Jack: Attached are a letter from my engineer, John D'Aquino and copies of strategic information regarding the septic plan for my property on Bell Hollow Road in Putnam Valley. I will send the full outline via Federal Express over- night. However, I thought it would be helpful for you to have this in front of you as quickly as possible. I met with Robert Morris yesterday and he informed me that his office was unwilling to write the requested letter referred to in John D'Aquino's request. He also stated that there was no reason for me to leave this letter and septic layout with him. Last night I spoke to John D'Aquino and he informed me that he would be speak- ing with you today and that I should get this informa- ___.._ ....:_ _:.t.ion- over -: - -to you as . q.uickl.y. as_ possible.,. hence r_he _ fax and Federal Express backup. For what it is worth Robert Morris agreed that the proposed septic layout is the only place on the property that can be approved. However, he stated that your office is unwilling to "get involved" in writing a letter stating this obvious conclusion. It seems a reasonable request to put a few sentences together simply stating what he said by word of mouth. I have been attempting to get this approval since January and would appreciate this slight consideration. Thank you very much for your help. Very truly yours, Patrick J. C Lennon ; e l 4EJ, RD H K F f WI CCOPEE SV �L � 3 z Jt( vp ��Q P N ° RESERVOIR PUTNAM V � o 04KOR�� NORi}I SH ORE _ Q Sao �WacO Q A SAC w v ? ♦ �., L a cs Q 1 Q`' c X c a u °� ��� „�► St W) `WATSON N . g H �IAWATH A WAY 99 RD .._ Wit_ _ all rn � O O a 6 RD Q�'�1` Ss O W y O C Q CAVE EASTERN RD O ) ° O VERGREEN RD _ ROCK HILL RD v 2¢ 3 5 U E RELAO HAMPTON RD �QaP = ,`�. 9 r0 rn j 0 LAU LA �_ WOOOLEIGH ROp p 0 9�� p w� O y 0 06, CROSS RD It P Gp,Nq, O < 0 Y 0 % SU SET RD �► US ti 4 SUMMIT ��'' . ( /��j� O� MEYER r`G CANOpUS AV 5� ! p �� ��,�- DOE OR bL i 2 SOUTH AV ��Q% m 6 �� g< < Ma° OR 90 USUNS HILL -. Z ��Or� L SOURD E�ti kFR y x j� P O W W O v yi DRURY Z p LEf pQ.P INDIAN LAKE 9 LA Q S TA 1(,�'OG� CAYUGA RD ai►0 K'FS� O O� 1 !y p �AOILLA RD 9 •� O Q 0 a L P <G SENECA RD C Q' < W �� CY 1 QLoF�3�GrPAAR�RD o uj a • 9 p O ly 3 2 c7 J SUMMIT 'L' CAMP v _j cot RO LOOK �4 0 Ov 0 NI R `.. "'Lt OPT AAU JE �Oh MAPLF AVR `1 l P 0 IV 171 INDIAN ?0 a0 C Y O�� 9.9 C )OP 8Rr < IMARRON 2 m m QO 9J [`}1vPGN 22 O Z PINE J Z 9 G f ' 0 20 RD O p E � � C �5 � mP - . y �P�t QPA pC� . y`._. r '.: ....•.v •.'. -t rN.m.. a: v tVR V,: ..;. �a•:a. _ _; +J rl4• +au c-j a:t•ss. O,i TRI KAAMERS ..PON O p = QfT i SCHOO � Q y a 'A P ELOS ROAD C O, J` O �` ski wA O 101 Zv ,Ir.a -C.0 6 Vi 00 AS M&�M we re!pj. 1 y D?VA-D(eAjU-r 41140 SUPPAIX, . u sc .SSOS AF* i3pi-F 904 �TZAd LL,wj jZaA ptv.m4 Av H, VA UAY -neq s � — � —S7 l 71,5 I `� DIVISION OF ENVIRONMENIAL HEALTH SERVICES DESIGN DATA SHEET- 1SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Address Located at (Street) `� Sec. Block Lot (indicate ndarest cros street) municipality JUT04A14 VALbCy• . Watershed CM6106S Book SOIL PERCOLATION TEST DATA REQUIPM TO BE SURKETTED WITH APPLICATIONS Date of Pre- Soaking of Percolation Test hs q?. HOLE NUMBER C= 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 1 Z � $ /0 4- zs. /c�3 I --w", 5 zz 2 Z6 3 / 17- 040 2,4_ 2,s- 4 5 1 2 3 4 5 NOTES: . 1. Tests to be re ted•at same depth pth until approximately equal soil rates are obtained at each percolation test hole. All data to•be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED DESCRIPTION OF SOILS ENCOUNTERED M APPLICATION HOLES f DEPTH HOLE NOS) /' 4� 3 HOLE NO. HOLE NO.� ' G. L. 1' 2' v 4' 5' G 6' 7' 8' 9' 10' 11' 12' 13' v r" 14' _.'.: �. - ^ .: -. .:: - '.. :: .. - .. _ - ! .w .. o .. �- _ems.•.... _.:._._...INDI-C A' -LEVEL- •A2 °WR1 -CH- € ROUNBWATER-IS EN —UN'i INDICATE LEVEL TO WHICH WATER LEVEL RISES BEING ENCOUNTERED ., /O AA5 DEEP HOLE OBSERVATIONS MADE BY: V Fldf u 4e," DATE: -. ,qZ. . V DESIGN Soil Rate Used -36) Min /1" Drop: S.D. Usable Area Provided 4�(5000 No. of Bedrooms Septic Tank Capacity. `Q 0(-') gals. Type T re- - dt ,5 Absorption Area Provided By 5-00 L.F. x 24" width trench C2mCLe Other Name rf ��� Signature LI Address e4M..e)dK&. SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved, sq.ft /gal. Checked by o 050402 sT ATF OF NEW Date PC -1 PUT NAM COUNTY D E PART M E NT OF H EA LT H � :°-N•"-• " -- -'. APPL3'CATIOU' FOR: 'APPROV°AL��OF-"PLANS-- FOOR- -,k WASTEWATER' -DISPOSAL- - SYSTEM - '' 1. Name and Address of Applicant: 2. Name of Project, 3. Location T /V /C: 4. Project Engineer: _, �j 5. Address: B� License Number: U�Q�� Phone: (o 6. Type of Project: Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEAR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. 9. Has DEIS been completed and found acceptable by Lead Agency? 10. Name of Lead Agency 11. Is this project in an area. -under the control of, local planni.ng., zoning, or of he' otfic fals ordinances ?' ................. 12. If so, have plans been submitted to such authorities? ..................' 13. Has preliminary approval been granted by such authorities? Date Granted: 14. Type of Sewage Disposal System Discharge...... Surface Water ✓ Ground Waters 15. If surface water discharge, what is the stream class designation ?........ 16. Waters index number (surface) ............... ............... .......... 17. Is project located near a public water supply system? .................. 18. If yes, name of water supply Distance to water supply 19. Is project site near a public sewage collection or disposal system ?..... 20. Name of sewage system Distance to sewage system 21. Date test holes observed: ?22. Name of Health Inspector: 23. Project design flow (gallons per day) ...... ............................... G CDO 11/93 I 24. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. 25. Has SPDES Application been submitted to local DEC Office?� ............... 26. Is any portion of this project located within a designated Town or State wetland? ..................................... ............................ _*-h 27. Wetland ID Plumber ........ ...... .... LA 28. Is Wetland Permit required? ................. 0 Has application been made to Town or Local DEC Office? .................. 29. Does project require a DEC Stream Disturbance Permit? ................... 30. Is or was project site used for-agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ........ YES or NO 31. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or NO DESCRIBE: 32. Is there a local master plan or file with the Town or Village? ........... Y—C S• f '1't' 1 d t be develo ed within 15 ye2rs9 t_6 33. Are community water, sewer ac i i ies p anne o p . 34. Are any sewage disposal areas in excess of 15% slope? ........................ 35. Tax Map ID Number ........................ ................................ %f7 -- — 3 36. Approved Plans are to be returned to: Applicant Z Engineer If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. Failure to comply with this provision may be grounds for the rejection of any submission. % hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A sdemeanor pursuant to Section 210.45 of the Penal Lau. /_ the n ' SIGNATURES & OFFICIAL TITLES: PJ PUTNAM COUNTY DEP - Dlvlakn of En 1 OF HEALTH w Health serYke, • Carmel. N.Y. 10.412 Englill to Pi,ovlde Permit N uCTION- p an CERTIFICATE OF PERMIT FOR SEWAGE DISPOSAL SYSTEM at �� Permit N 3'ti6divlsbn Name Town / /� ubd. Lot N ' j Tax Owner /Applicant Name C� ¢rrc� Renewal �L- L— Blodc�_Lot MaWng Address . &// /D`Cr" � °f previo /us Approval f ? Building Type -�.,- - ,��� -/ �m t Ares Number of Bedrooms - Fill Section Only Design Flow G P D _ p� Notl6cagon !o R Depth Volume Separate Sewerage System to consist oI t�C% egrtlred When Flp k completed �Gapon Septl��c�Tank sed_�_ To be �ncted by a �? ':%/ye:/'" ' Water SuPPn': Addeees Ptwk Supply From Address ort_,X--Ptivste Supply bellied bys/�Addrese Other Renulrementa _-Z. —Address represent that I am wholly and completely responsible for the design and location of the above described will be constructed as shown on the • County Department o} H pPr °ved amendment there to and in accordance wiff�i f e standards, rules an r ( ). 1) that the 'separate sewage disposal system be submitted tm ealth, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner O} Health will the OeDartment, and a written ego a ions o Place m gdOtl operating condition an guarantee well be furnished the owner, his successors, heirs or assigns by the builder. that Said builder Will ante of the a y art Of said sewage disposal system during the approval Of the Certificate of Construction g period of two 2 will be located as shown on the approved plan and that said well will be Installed in accordance with the stn s there rules and r u a Compliance of the original system w any repairs thereto; le that the drilled well describad above ( 1 Years immediately following thedate of the Issu• County Department o/ Health. /,/'' g etl `W . Y .Y� /�%�f. "�f of the Putnam Si n APPROVED F Address .[ P•E•„K R.A. OR CONSTRUCTION: This approval expires two �T� / � G � revocable for pow or me Y be amentletl or mOdifietl when con0 s from the License No � i a? reouires a new date issued unless construction of tfa building has Deen undertaken and is D it .APprovstl' /Or tlisPOSaI Of n efsirY by t OmmissiOner Of Health. An (7 33 domestic err sewage, and rivals water y change or alteration o} Date suPPly only, construction ev /41Jx f Title `y PUnUM COUNTY DEPARTMENT OF tItBALTH 3eS1? CER11F1CA - Pass • Dhhlw den Rem Services. ' CE iq �• Pssk N AGE DEPOSAL SYSTEM FOR SEW .. Id PBRMQT .. .. .� ... Name Ane of '37 . lot N TeX Map es= —Block Renewal_❑ 1l"Wou ❑ / Maine ry�1J17 of Prev'o Addaeae ��U L ` ) Town y ✓ri✓� Ztp A....,- r.,,ori Fee Enclosed � All+r++snt Y% S 1 E%hC °l oc A. - % jJ °� _�- 171, Fm Only Depth V -1110" B� �e /D U Namau w b Redpared When h► co4eted Nanber d Bedrooms DeWga Flow G P D "77 .0) � Sepu, Sevreeage Spies is Comm d Z4_?& , Gnlloa Septic Took and f To be ownbuded by Address water Soppb'•______ —Fawk SuPPI From Address �r ` oaP'a9te SaPVb' Dr9led IS , �� �v G e✓� G -7 °1�'� C J J wholly and completely responsible for the design tad location of the Pf °P°N, sY:tem(a); 1) that the separate sewage dispoW system I esentR� to hab�e am in 16 tofaCpnstructi nun above described constructed As and that on completion thereof aaCe►titicate iince•' Satisfactory to the COII'1mIOlOner of Heanhwill om airs or assigns by the builder, that said bulkier will County Depart �t a submitted to the Department. and a written guarantee will be furnished the owner, of said sawage disposal system during t ripjF� s Imnwal�tey fOlbwing thodats of the III thit•the drilled well described above place in good operating condition any part elol2) at the Certificate of Construct in Compliance the orginel h , r Ms*and regu a ns of the Putnam >..'..','.., one of the approval ll will be I st wtlt,pe located as shown on the approved plan and that Old well will M Installed i c * a ; County a of IMalth. p,E. DaterSlgnW Nom% H JS and��' Address �, APPROVED FOR CONSTRUCTION: This ePP►oval explrestwoYear,fi the date -t eonA,, ry4, doe of the building Ms been undertaken s, h. Any change or, 1 lion of conitrucltY / revocable for -ci Or may ame�eed ,rorr'modifiwI 1 11 .. Onled *fO /fdrspOsa1 O Ndomest 10�a h) �' �. -• reo As, a < i4. j Pp► n✓ , : Rev. " r: /. b 1.� y 'it, .may y8� only. p `/ � . Title , o `` IL L ►v�N I N / O/ •fir . 5l 31. Ali ltj N I T Z VL 10 AJ Os- C - °l _ - yl .NE p+A iC- rp?ate' Al �. 5. r - - - .- �,' ,�, /ice _ � .� _ �- -•-- -- Z 5 I . 19' S. 6�'S5'o8`W � I ° o I 193.75 S. X00° 3'. 18 W ! � 183 Xo � •, jy1 Sy i j: f—i -- f- _). - - , r 'pj;vo!;Ov ;.A no t 6rrtr oQfxorm&we with ippil bl gul and Regulations of the 'Ila I t �c ty Health Dotrtaont. bc z e ewl-V f A title ^ Date 7 i r `'�- cG+r►t*� -.rte =r r -%' _fri,F �.�.• —_.— ..._ '' t�tTAibb kL i ML ...... ------ •s �.x • .fit (, 'D ro G f 9L CY? C: < r Wit. -------- ,-��•� - -- -- _- -