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HomeMy WebLinkAbout2549DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51.19 -1 -35 BOX 22 } ^� T I L !�L• •, qPr , 9 IN ,` t, , I. .t I f ; i r { . r �J ` 02549 l l 9- j - 3J l IS PUTNAM COUNTY DEPARTMENT OF HEALTH ENGINEER TO PROVIDE PERMIT I ON ON CERT FIC 0 ANCE. Division of Environmental Health Services, Carmel, N. Y. 10512 PERMIT CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM S V VN 0_ V*,X_ Vct Ve + k % Tow ilia Tax ,Map d, Ma Ay, 91'ocl : .► Subdivision Sulxl. Lot It Renewal _ ❑ Revision _ ❑ i i n „ Owner /Address rl I Ce r e. L \ i ( a I I s'% l9 �� Date Of Previous Approval Building Type ` ' Lot Area"{ Fill section only ❑ Number of Bedrooms Design Flow G /P /D P.C. H. D. Notification Required Separate Sewerage System to consist of �X JdOV !90/ do r'K Z Gal. Septic Tank and �� 0 � f't/«+e To be constructed by -� Address Water Supply: __ Public Supply From —_ Private Supply to be drilled by _rte /�� ` ��� / ry ��� r��w,w� .f�►/rls r+ C-7 Address Other Requirements r 1DRA 0 C rE � ©F SEE is I A K,% 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 an regulations or e u nam se r County Department of Health, and that on completion thereof a "Certificate of ConstruL�ibn.(;omp,�iance" satisfactory to the Commissioner .of Health will kf `' B be submitted to the Department, and a written guarantee:.will be furnished the owner(, h9 surbefFSSOr, =. sirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage •disposal system during 3lte,per'l Z>f,tin)b years immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the ox gI 1 1.sysSaml oM)br►y Pg it hereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed in ac -ante °atan ds, rules and ►egu as :�f the Putnam County Department of Healtp. :, _ a b or e Date S Addre;or s '�� i2 APPROVED FOR CONSTRUCTION is approval expires one year fr the revocable •tor cause or may be amend or modified when considered necessary requires a new permit:, Approved disposal of domesti sanitary sews Date B Rev. 6/85 j b � e�rW��scen� r-. is :r 1 P.E. - �R..'A. License No. a d/ on of the building has been undertaken and is Ith. Any change or alteration of construction only. q POE Title /[`� PUTNAM COUNTY DEPARTMENT OF HEALTH, Division of Environmental Here /th Swi toes, Calm% N. Y. 10512 J Permit # t F. MIN -COMPLIANCE SEWAGE DISPOSAL-- SYStIEM Town or Village r � ,sue% Located at%%�� y 0111e° /, c` s Tax Map 73 � &lock A� Owner ��L'� r - - r +e .1jJ' / Formerly Tax Map Lot # I �°- subd. Lot # Separate Sewerage :System built by aw,ft�ejc P, Address Consisting of kyzs Gal. Septic Tank and � � P• 24 ,y���� Other requirements .� Water Supply: ubllc Supply From Private Supply Drilled By f ,� Y Address � Building Type "� No, of Bedrooms Date Permit Issued Has Erosion Control Been Completed? I certify that the system(s) as listed serving the above premises were constructed essentiallY�ss,rsiigv on the plans of the completed work (copies of which are attached) , and in accordance with the standards, rules and regulations, in aaf �'d Y "`�s�,,, filed plan, and the Putnam County Department Of Health. g c:4e p Pert issued by the i ` 6 �_ ate C lifted by 1 = - P.E. R.A. \� Address �" - t rf� F�" % License No. 7� occupying premises served by the ove system(s) shall promptly take such as Iictl " rt►b; pg y _ _ :tieeesnry,tt2'sIcure the correction of any unsanitary vulting from such usage. App rval of the separate sewerage stem shall"'peicome.."ull aed void ali'sbop as a public sanitary sewer becomes ve approval of the private water supply shall become null void when's `itutilic wirate{S:finpply pbeomss available. Such approvals are (cation or change when, in the judgment of the Co stoner Hea revgps h; 1ri r focation or change is ne nary. cCC��� By Title SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MO:LINARI, RN, MSN Associate Commissioner of Health Chizzik 649 Oscawana Lake Rd. Putnam Valley, NY 10579 Dear W. Chizzik: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive April 25, 2005 Re: Addition - Chizzik, 649 Oscawana Lake Rd. (T)Putnam Valley, TM #51.19 -1 -35 I have received and reviewed the plans for the proposed addition at the above mentioned residence. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons: 1. An existing bedroom cannot just be relabeled to be another type of room. 2. The legal bedroom count for the dwelling is three. The potential bedroom count of your proposed addition is a minimum of four. 3. The addition of a potential bedroom requires this Department's approval of a revised septic -- - - - -system. plan from- a professional . engineer. 4. Any large room, such as the one proposed, that can be easily made into two or more rooms " 80 square feet or more, will be considered to have at least two additional potential bedrooms. Please revise the proposed floor plan to reflect no more than three potential bedrooms, or have a professional engineer or registered architect design a sub - surface sewage treatment system meeting present code requirements. If you have any questions, please contact me at your convenience. Ve Y Yo , obert Morris RM:Im Senior Public Health Engineer Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 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 Public, Health Director '.-"-...°";• LOR`E`T'T"A- .1GtC)LINAItY�k.N.; M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF - HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 =6130 Fax (845) 278 -7921 Nursing Services (845) 278 o 6558 WIC (845) 278 - 6678 Fax (845) 278 - 8 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 27 - S ADDITION APPLICATION (RESIDENTIAL ONLY AP STREE? S �.` TOWN , TX MAP# C' NA. CSI ?_? �!l P ONE�d� �5 PCHD# .3 -n 15 MAILING ADDRESS D w C/ J /or Lj D 4, �cc 7_.�e ESCRIPTION OF ADDITIONn► 5 C NUNMER OF EXISTING BEDROOMS PROPOSED # OF BEDROOMS (FROM CERT..OF OCCUPANCY OR CER'T'IFICATION FROM BUM DING 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. ....� .... .. -.._ �_.... ...... �.... _.. _. -. .... .,.......4..a. ..- cam.... -... 6.... � . .. ............ .. ..�. w.... ..... .r— ..._. ... .... .-._.. -.... _ .. ..... � .-. _.. -..... .... ..._ s -.. � -.. ._. _.. _. .. .. ... y. 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... 2. Sketches of existing floor plan (drawn to scale, all living area including basement) . - *Non- professional sketches are acceptable. 3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #} *Non - professional sketches are.acceptable. 4. Copy of survey showing well and septic 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. 5. Copy of Cert. Of Occupancy from Town or Certification from Building Dept: with legal bedroom count of dwelling. OFFICE USE Comments Feb98 BFhouseguidelines A MOLINARI 1 Director 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 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Putnam County Dept. of Health 1 Geneva Road Brewster, NY 10509 To Whom It May Concern: ROBERT J. BONDI County Execrative Re: C=N 1 Z Z l ol<- Residence Tax Map ( 9 ' — � S Town N M V411L L 1:� According t records maintained by the Town, the above noted dwelling, IS NOT In compliance with Town code and the total number ofbedrooms on record is. This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: Building Inspector houseg .del nes 3 eh•-.,f•7 I i I � C 4, C 41 2 Z's. � SFIERLITA AMLER, MD, MS, FAAP ... Commisyi.Q;ner of Health y „ LORETTA MOLINARI, RN, MSN Associate Corninissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 April 6, 2005 Chizzik 649 Oscawana Lake Rd. Putnam Valley, NY 10579 Re: Proposed Addition, Chizzik Oscawana Lake Rd. (T)Putnam Valley, TM #51.19 -1 -35 Dear Mr. Chizzik: ROBERT I BONDI County Executive Review of plans and other supporting documents submitted at this time relative to the above- regarded project has been completed. Comments are offered as follows: The creation of a room with the minimum ceiling height of 7.5 feet and with a dimension e, ual to or-greater. than 80 square feet will constitute. a potential bedroom. The creation q. -- _ of a staircase and the proposed sheetrock also reinforces the determination that apotential bedroom is being proposed. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. ce ely, RM:lm Robert Morris, P.E. Senior Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 i Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Earlv Intervention/Preschool (845)278 -6014 Fax(845)278 -6648 SHERLITA AMLER, MD, MS, FAAP -Commissioner of Health _. _ ...,. . LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Chizzik 649 Oscawana U. Rd. Putnam Valley, NY 10579 Dear Mr. Chizzik: ROBERT J. BONDI County Executive February 28, 2005 Re: Addition - Chizzik, Oscawana Lk. Rd. (T)Putnam Valley, TM #51.19 -1 -35 I have received and reviewed the plans for the proposed addition at the above mentioned residence. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons: 1. The finished attic is considered two potential bedrooms. 2. The legal bedroom count for the dwelling is three. The potential bedroom count of your proposed addition is four. 3. The addition of a potential bedroo-m" °requires this �epartirierit's approval�of a revised -`�'` - septic system plan from a professional engineer. Please revise the proposed floor plan to reflect no more than three potential bedrooms, or have a professional engineer or registered architect design a sub - surface sewage treatment system meeting present code requirements. If you have any questions, please contact me at your convenience Sincerely, ML: lrn Michael Luke Public Health Sanitarian 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 %sro" % NIX ti co ....... ... .......... . . 9'10"2 13'2------- . ....... - .. ................... ......... ------ 32'10"3 ........... --- ---- 9'10"2 Mar 22 05 09:16a Paul Swansen 'LORETTA MOLINARI - Public HeaUh Director e45- 526 -2376 p.2 DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 ROBERT- J. BONDI County P.x"Utive EnvironmeDW Kenn (845)278-6130 Fax(84S)278-7921 Nursing Serylces (845)279-6558 W[C (845)279-6678 Fax(845)278-6085 Carly lntervent OW?reschoSl . (843) 278 - 6014 FOX(845)278-6648.,. PROPOSED ADO= APP STREET TX MAP # NAME C} l G I 1 P1iORTE' J 0 � PC14D # MAILING ADDRESS C DESCRIP'ITON OF ADDITION _, ;�, ' NLJMBER OF EXISTNG BEDROOMS PROPOSED # OF BEDR0011IS C- (FROM COLT. OF OCCUPANCY OR - CERTIFICATION FROM BUMMING 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 Coanty Sanitge Code. _. Please submit this folm•and the following io Putnam County Health Dept, 4 Geneva Rd.; Brewster, -NY -10509, Phone 278 -6130. .1. 'Certified check or inowy order for $100.Om 2.:Sketches of existi;%,Aoor plan (drawn to scale, all living area including basement) :'' Noniproftissional skewhes are acceptable 3. Tw6 sets of proposed floor. plan (drawn to scale, -with name, street, and tax. map #) * Non = professional sketches are acceptable 4.'Copy o (,•survey showing well and septic location, to the best ofyour knowledge. Include date- ....; finstallation if known: Label'all wells and septic systems within 200 feet of the property line. 'Contact 6&'office with` any:quesdons.. 5.'04&6f` Cert.`-of Oecuparicy from Town or Certification from Building Dept with legal oedroom count of dwelling.. Comments Mar 22 05 09.15a Paul Swansen March 22, 2005 To: Mike Luke/Dept. of Health :From: Paul Swansen / Chizzik job 'TM #51.19 -1 -35 IRE: attic renovation ]Dear Mike, 845 - 526 -2376 p.l L T Please look at revised sketch. They have changed lower bedroom into office <md moved bedroom upstairs. ]Please 16t me know your thoughts. Thanks, Paul Swansen 1 "e11- 914- 260 -7948 146i�e -- 845 -526 -2376 ac is ii // storage 13'2 32'10"3-- --- ---------------------- ---- -- --- 401 -- - - --- - - storage 401 storage Fold down staircase UP Existing ZY) r. Mar 22 05 09:17a .Paul Swansen B45- 526 -2376 p.4 r _ � I t7 , J142 • N. } vo �. r •-M`^w...... •v�f+ .rc.0 •� -. ¢`.'v4 ' -Yr. v.. ...... .• wNavVf .. � .+..•rw.. - .-,.. r a.n rr ' , ' �� off' p�' 0�' . p � ,,,•r - n h o S Mar 22 05 09:16a. ..Paul Swansen 845 -526 -2376 Ill. \0 e 4 4 ;. 1:: . , ; .. � • °gip vin - 7ii:1 n j I f . _7 p.3 TA PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES I , Owner or Purchaser of Building Section Block Lot Building Constructed by Location = Street Municipality tJi� %'- � � � �/� Y �' %�rr�° � � � -•��- mil/'/ /l�1 Building Type Subdivision Name Subdivision Lot # GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed'by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate. of Construction - .Compliance" for, the- sewage disposal_ system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environinental 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 i %' day of `-1 ,,,�p4..- 19 Signature Title General Contractor (Owner) - Signature _Corporation Name (if Corp.) %.-. Address rev. 9/85 mk Corporation Name (if Corp.) Address Yorkt�owr Medical Laboratory, Inc. LAB N - 86.000498 - 321 Kcar Street ! �- Yorktown Hcights,N.Y.10598 Collection- Station Used: Carmel _ Peekskill (9 -14) 240203 -._ -_ - -< _ -. _. , .__. :_ Mt _ -. .. C _ Director: Albert H. Padovani M. T. (ASCP) - • Kisco _ Ne . City LL/ 6 3 Date Taken: Date Received: eb •;'*A;7 Date-Reported: o Collected By: Referred By: J Sample_ Source: - LABORATORY REPORT ON BACTERIOLOGICAL QUALITY OF WATER GENERAL .B.ACTERIA _ StELndard Plate Count .per 1.0 ml (Agar plate @ 35 0C) MEMBRANE' FILTRATION TECHNIQUE (MFT) L Tot a-1 Coliform Der 100 ml Fecal Coliform Der 100 ml Fecal Streptococcus per 100 ml MOST PROBABLE NUMBER TECHNIQUE (MPN) Total Coliform: - MPN- Index per 100 m -1 -- _ Fecal Coliform: . MPN Index per 100 ml OTHER ANALYSES THESE RESULTS INDICATE THAT THE WATER SAMPLE OF A SATISFACTORY SANITARY QUALITY ACCORDING WATER STANDARDS, FOR THE PARAMETERS TESTED, -Bert: Padovani, M.T. P), Director /(WAS) (WAS NOT) (NOT APPLICABLE) TO TH NEW YORK STATE DRINKING T T TIME OF COLLECTION. LEGEND RDS = Recommend Disinfect- ing Water Source < = less than TNTC = Too Numerous Too NORMAN ANDERSON, INC. , WELL DRILLING RD 3 BARGER STREET BOX 244 PUTNAM VALLEY, NEW YORK 10579 LAKELAND B•8698 JUNE 18, 1986 MR. JOHN CORELLI rre: well at old school house OSCAWANNA LAKE ROAD, PUTNAM VALLEY, N. Y. . Gentlemen: Mr Norman Anderson checked the well for Mr John Corelli It is one hundred foot deep (100) with seven.gallons a.minute. SINCERELY YOURS, q. aldz'001� y PUT'NAM COUNTY DEPAR'IlW OF HEALTH - DIVISION OF ENVIROI24MAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVLEW_SHEET - CONSTRUCTION PERMIT (Name of Owner) (Street Location) DOCCIl4EMS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets r If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fil file & Dimensions - Volume or J ;Trench /Gallery; Pump pit details .-,'Sep is ank - Size, Detail ✓Well Detail, Service Line if over Construction Notes Design Data -Vwo -Foot Contours Existing & Proposed Driveway & Slopes Cut --Footing /Gutter tain Drains Perc & Deep Ho es. tea Representative of Sewage & Expansion Area Expansion Area; shown; gravity flow, suff... size If Pumped Pit ' & -D- Box Shvwri House - No. of Bedroom ells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) douse 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, ige Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains- Cartain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fran Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approv, Checked Ex- approval SSDS AQjr, Lots Checked Wetland (Town /DEC it R & D) Data On DDS Plans & Permit Same ©m mm ®= Mm AJ� MM Rat i` • _m RM + ► �� NEI ©M DOCCIl4EMS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets r If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fil file & Dimensions - Volume or J ;Trench /Gallery; Pump pit details .-,'Sep is ank - Size, Detail ✓Well Detail, Service Line if over Construction Notes Design Data -Vwo -Foot Contours Existing & Proposed Driveway & Slopes Cut --Footing /Gutter tain Drains Perc & Deep Ho es. tea Representative of Sewage & Expansion Area Expansion Area; shown; gravity flow, suff... size If Pumped Pit ' & -D- Box Shvwri House - No. of Bedroom ells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) douse 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, ige Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains- Cartain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fran Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approv, Checked Ex- approval SSDS AQjr, Lots Checked Wetland (Town /DEC it R & D) Data On DDS Plans & Permit Same PUrNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIELD. •INSPECTION REPORT _ - E�� INSP. BY: (Name of Owner) (Street Location) INITIAL SITE INSPECTION 6M11 YES NO COMMENTS Wetlands on /or proximate to property .............. Property lines or corners found ................... I 5,7QUEE WA L-L, Can estimate house location ....................... ve Will driveway need cut ............................ Must trees be removed - note these................. 100" Deep holes representative of entire SDS area...... W, b c - 4T qM66 Additional deep holes needed.......... ... ..... "' 2-A VLc Sufficient SDS area available considering driveway°°'` cut, house location, separation distances,etc... Adjacent wells /septics ............................ D.H. - Deep Hole G.W.- Groundwater D.H. 1 Lot D.H. Q Lot D.H. 3 Lot Depth to G. W. Depth to G.W. Depth to G. W. Depth to rock Depth to rock Depth to rock Soil Descrivti 0 ft. FINAL SITE INSPECTION INSP.BY: Y YES N 3 ft. OA 6 ft. CV 9 ft. 12 ft. Soil uescri i 0 ft. 3 ft. 6 ft. s �� 9 ft. 12 ft. 0 ft. 3 ft. 6 ft. 9 ft. -..12 ft. Soil Description I DATE: FINAL SITE INSPECTION INSP.BY: Y YES N NO C COMMENTS f C CV Width of trench average 5�,� ,1- -� Slope of tile line and trench acceptable......... � �� S%L-t 5 0 ft. 3 ft. 6 ft. 9 ft. -..12 ft. Soil Description I DATE: FINAL SITE INSPECTION INSP.BY: Y YES N NO C COMMENTS f C CV Width of trench average 5�,� ,1- -� Slope of tile line and trench acceptable......... � �� S%L-t 5 Roam allowed for expansion trenches .............. IK Over 100 ft. from watercourse .................... I X Natural soil not stripped or SDS area X 10 ft. maintained fran property line and 20 ft. from, house......... .. .. . Distance well to SSDS Number of bedroans checks ..................,.. 5 Y°,l' �s •� Stones, brush, stumps, rubble, etc., greater 5 than 15 ft. fran nearest trench ................ 15 ft. of peripheral soil horizontally fran trench .................................... S S �� (7 Could surface runoff fran driveway, roads, ( X . .6 h 0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Located at Q�AW -41'W j (T) ��a c t i o n 3 Block z Lot •2, Subdivision of 7__-_VI Slubdv. Lot # Filed Map # Gentlemen: Date This letter is to authorize a duly licensed professional engineer 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, c alth Law, and the Putnam County Sani- tary Code. n ne �g ;.t,: -yfery truly yours, �yso seas P SN�� HEAq.9'i� Fll,f Signed � �6�� � Q�� � �e - e�ro�er Counte,sa,ed:reo� �pwn �dt & e a yKt °r} e q d Address A'L e s Addressd "0.05 " 9a Town l V� �d r Telephone Telephone PUI'NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - , • - COUNTY ° OFFICE-:$UILDING; - `CARMEL; `N: - DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NCO. Owner c/7rJ C�a %'!°i /// Address Located at (Street ©� Sec. Block Lot /.-- In grest cross s ree , Municipality Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS R-07 _e Number. CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Water v-e No. Time From Ground Surface in Inches Soil Rate Start- Stop Min. Start Stop Drop in Min. /in drop Tnnhaa TnrehPa Inches DEPT. ®F 11EA_LTH 5 Notes: 1) Tuts to be repeated at same depth until approximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. 3 //o v i/ 3u 3..0 21 j Z� DEPT. ®F 11EA_LTH 5 Notes: 1) Tuts to be repeated at same depth until approximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DES P,TA REQUIRED TO BE SUBMITTED WITH APPLICATION T-T)MT01\T n-r, --r)TTO, -!-,TTor)TmTrrrr,,1:)vn TAT MV--nl TJr)TVq • HOLE NO. -3 DEPTH HOLE NO. HOLE NO. 2— G. L. 6.1 1 1211 Or 18" 2411 3011 8411 INMICATE- LEVEL AT WHICH -GROUND :_WATER IS ENCOUNTERED 1110,e 4e_ IMLVG WHICH -WATER IZVEL RIS S-- AFTER-- -BEING -ENCOUNTERED TESTS MADE BY Date 97 DESIGN Soil Rate Used_,V Yiin/l "Drop: S. D. Usable Area Provided ZOO,? No. of Bedr6oms,5 Septic Tank.Capacity 000, Cals. Type Absorption Area 'Provided By,:::j�aj�oL.F.x24". g�A trench. Address THIS SPACE FOR USE BY HEALTH DEPARtPENT ONLY: Soil Rate Approved Sq. Ft/Gal. Checked by Date t .,t WAWA < rt s h a .a i � V r. Y , r K ry Y �� �f�, tl.�' "� rt •r }.yf � f�� ;.ft ai 3 #.f wf E 0 'V; !I® Potaas County Department oR Heal% ' DSy vieion,�? Health 8sstiose p�prpve�r /Qas n�aeaLe�at�s with �F `F sal & =Q2atiatm or the x Title Datie oz Z, - .C.INa� J qaw rT yfrr�rr' F3 K.4 `We C oa' z Y 4 �f .. /O° , 94 3 S9 r 9 d 91. `6 ` J06 49 ., Jo t /a I Potaas County Department oR Heal% ' DSy vieion,�? Health 8sstiose p�prpve�r /Qas n�aeaLe�at�s with �F `F sal & =Q2atiatm or the x Title Datie oz Z, - .C.INa� J qaw rT yfrr�rr' F3 K.4 `We C oa' z Y 4 �f 1 $A /ir> G• r �9•q1 / / %/ �1 b�Pte `t n � // go wts ! I O o a-Y a //brs 71.11 �. a. ° 3 Did l�pm