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HomeMy WebLinkAbout2603DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 52. -2 -49 BOX 22 I�yL ■ Ir 1 T'' r VON I r I IN I I N! L ' 02603 Y r:iGT 'q'-_. .t. 77 rr...x.- .y�,$."]xr .. �R t"``+,.,- Li3`.aF„" *F'�YS':.Y.^Y p"'"v {?' 3C2 .rf'^*',9;." '' •2 '�.f 9rw""`y ,4 " �" 1. 4 ^'� ` � v R� ' 3 PUTNAM COUNTI''DEPARTMENT OEHEALTH F y Health Servlces._'Ctiin[el N:Y:10511. ` Englneer'to Provld`e` Permit H ` � ._ t' Y ' Go V 1 .Division of Envtroumentxl : on CERTIFICA� OF COMP CE -- ,{ . CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Putnam Valle Witco ee Road P Located at Town or Village P/0 3 ,. of n ' ..9 Sdbdtvlslon Name Wiccopee Estates snbd. 35' B`�ock 1 ' ,~ I T t t' Renewal_O Rip 6l��Sd,�lio/A�� Owned Appuc"tName'.Al .ESpOSltO Date of Pre vlo6e Approval g Address 8 z;�uln 5 St. James Terace Town' Yonkers �p ;10204 Bnual;og Tne 1 Family ResidenceIot '262 -'.Ac Flll,secdon only Depffi Yohtme Number of Bedrooms 4, Dealgn Flow G /P /D :800'. PCHD Notl9cxtion is Rcoidred'When Fill Is comple1W Se arate Sew . e S stem to consist of 1250 Gallon 400 LF of 21 wide trench ' P8 Y Septic Tank and To be coeshvoted by, to be. detendned ._ Address Water SuPP1J!: _ Pablle Supply From Address X -to be determn ors Private Sdpply Drilled by Other Regalremente represent t a 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 constiucted as shown on the approved amendment there -to and•.in accordance with.the.standards, rules an -regu a wns o e u nam County. De6aitment Of Health and thbt on completion thereof a ^Certificate of Construetion,COmpt�anee" satisfactory to the Commisslonei ot•Hea,lthwill be submitted to the - Department;' and, a written guarantee will be fu►nishedq the owner, his successors, -heirs or assigns by the DuJder, that said builder will place ingood.' operating - condition'- anypart.of. said sewage, disposal, systemduring_ theperiodof .two(2jyeardimmediately following theGate'of„theissu- ance of the ,approval of the CeOihcate of Construction Compliance of-the,origina6 system or:any re- irs'thereto 2) that the drilled well described above will' be 'located i sharvri on the approved plan andlthat said well will be.insta118d in accordance with the - stan rds, rule's and' regu aaTf'oni' -o' f .the,' Putnam County. De artme t o't Flea th - - , • > _ ///��� Date>� Signed P.E R A. - 7. X Cashin.Assocsates. PC.. 2; Carmel NY:1051 26008 Address ' �icense.No APPROVED FOR - CONSTRUCTION: This approval expire ..'ear from tha:- date.issuad `unless construction'of the building.has been undertaken, and is revocable for cause or may be amended or:'modified when considered.necessary,'by the Commissioner of ;Health ' "Any. charige or alteration of. construction requires a new permit.Appraved for ,disposaLof -- domestic sanitary 'sewage, arM /or 'vate wa r�ly: only. - ' �/„ o rd d �J Datq/" �'G1 7 -!.. // D / Title se II. xN IV. V. VI. APPEWIA l; FINAL SITE INSPECTION Date �"� �zl J a vi. -1� C`i J C �, OMER D ed TM # �R SUBDI ,$ION LOT # 11 SEWAGE DISPOSAL AREA a. SDS area located as per approved P1 � ra b. Fill section - Date of placement 2:1 barrier. LGTH WIDTH AVG.DPTH c. Natural soil not stripped & Stone, brush, etc., greater than 15' frcm SDS area. e.; 100 ft. from water course /wetlands. SEWAGE DISPOSAL SYSTEM a. Septic tank size - 1,000 1,250 Q b. Septic tank installed level , c. 10' minimum from foundation (. , A- ; del. No 900 bends, cleanout within 10 ft. of 45° bend ,e. DISTRIBUTION BOX 1. All outlets at same elevation - water tested Yq /�y 2. Protected below frost �- 3. Minimum 2 ft, original soil between box and trenches vc> f. JUNCTION BOX - properly set g. TRENCHES 1. Length required - 14a Length install A ✓ J C 2. Distance to watercourse measured: ft. -- �( 3. Installed,according to plan ". 4. Distance center to center 5. Slope of trench acceptable 1/16 - 1/32 " /foot. 6. 10 feet fran 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 - 1 " diameter 10. Depth of gravel in trench 12" minimum 11. Pi ends capped h. PUMP OR DOSE SYSTEMS i s --Size7- o - c- hamber- . .. ..._._ _ 2. Overflow tank 3. Alarm, visual /audio 4. Pump easily accessible manhole to grade 5. First box baffled . 6. Cycle witnessed by Health Department- estimated flay per cycle HOUSE a. House located per approved plans. - b. Number of bedrooms WELL a. Well located as per approved plans b. Distance from SDS area measured ft. C. Casin 18" above grade. d. Surface drainage around well acre table. OVERALL WORKMA.SHIP a. Boxes ro grouted b. All pipes partially backfilled c. All pipes flush with inside of box d. Backfill material contains stones < 4" in diameter #Z e. Curtain drain installed according to plan f. Curtain drain outfall protected & dir.to exist.watercours g. Footing drains discharge away from SDS area h. Surface water rotection adequate i. Errosion control provided on slopes greater than 15 %. 11 Yorktown Medical Laboratory, Inc. LAB # 32.00917 321 Kear Street /� /3��'% Time: &A*/ Yorktown Heights, N. Y 10598 c Taken: .._ Date. R, Time: (9141 24'5.1203 .,... _ ..__._ ., . :- w� Date Reported NOV.- 'J''61987 Director: Albert H. Padovani M. T. (ASCP) Collected By : )_49 S' 3'�dSJ 70 Referred By: SY7, -b j ���� D Sample Location: L Phone if JW - 31od9 Phone # Sample Type: Repeat Test? _ 1(check one) LABORATORY REPORT ON.THE BACTERIOLOGICAL QUALITY OF WATER GENERAL BACTERIA Standard Plate Count (CFU /1.OmL) (Agar Plate @ 35 °C) MEMBRANE FILTRATION TECHNIQUE (MFT) Total Coliform (CFU /100mL) Fecal Coliform (CFU /lOOmL) Fecal Streptococcus (CFU /100mL) MOST PROBABLE NUMBER TECHNIQUE (MPN) Total Coliform: MPN Index (per.lOOmL) _ Fecal Coliform: MPN Index (per lOOmL) OTHER ANALYSES REMARKS (For Laboratory Use) to V1 Potable _ Non - potable STP INF STP EFF Other: Sample Status: (check each) Outgoing _ Na2S203 Incoming ,-LE 4 °C GT 4 °C _. Other: KEY FOR TERMINOLOGY RDS = Recommend Disinfec- tion of Source TNTC= Too Numerous To Count CON = Confluent ( =TNTC) LT �. Less Than (.<)- GT = Greater Than (>) N/A Not Applicable LE Less than or eaual to THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS) (WASV T) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO TH NE ORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT-THE TIME OF COLLECTION. /x/ iA7 /' Albert H. Padovani, M.T. (ASCP), Director 12 /85(RvsdT /8T)RWE For Lab Use Only: _ H/C .to LAB OFFICE HOURS (Main Lab): 9AM -5PM, Mon. -Fri. 9AM -NOON, Sat. PU NAM COUN'T'Y DEPARTMENT OF HEALTH -: DIWSIO!q-. -OF ENVIRONMEN' dUL- HEALT4I SERVE -GES :. ; - ,44ze_p Owner or Purchaser of.Building Building Constructed by �D/ �1CGOQ�� TGoAD Location - Street Municipality Building Type 35 1 %/ 3 Section Block Lot \,dIGC.oI- E�_= ��TATES Subdivision Name g 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.: x// / /% Dated this ��day of 19' G Generat Co a o Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk Signature yX'� Title Corporation Name (if Corp.) Address .. .. _.._. �i.-....,.....—. �..:. w�:._ av�-. rr^ 3. v.. Nl ra3:+ r�rv,:-« a�: wtil..;: NC��ii: �:.: i'•�::�=n�,.:.:,:�:s�v.�:.,:�.. ... WELL,COMPLETiON REPOR -t — UhIII,LUJCUAII "" •"• DEPARTMENT OF HEALTHY Division Of Environmental Health Services — - PUTNAM COUNTY DEPARTMENT OF_.HEALTH ^` WELLLOCATIONJ STREET AOURESS: IOWN /VILLAGE /CIfY [AX GRIO NUMBER: 101 WI i PFE R()q.D PUTN -AH VAak� WELL OWNER IVATE NAME' ADDRESS: TIOTSLIC (�s (L t� `"t.� -aMFS �Y►�ttCP: � �i t � ")kQL13 USE OF WELL 1 - primary 2 - secondary .4 RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP .❑ ABANDONED ❑ BUSINESS O FARM ❑ TESTIOBSERVATION ❑ OTHER (specify) O jNOUSTRIAL O INSTITUTIONAL ❑ STAND -BY ❑ AMOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING ;ANEW SUPPLY = ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑ flEPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL ' DEPTH DATA WELL DEPTH 31 ft. STATIC WATER LEVEL 4 ft. r� DATE MEASURED I 7 DRILLING EQUIPMENT ❑ ROTARY CR COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED 0 OPEN END CASING. ❑ OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH D fL MATERIALS: lK STEEL ❑ PLASTIC ❑ OTHER i LENGTH.BELOW GRADE �-� ft. JOINTS: ❑ WELDED O THREADED O OTHER DIAMETER o_ in. SEAL: 0 CEMENT GROUT ❑ BENTONITE ❑OTHER WEIGHT PER FOOT Ib. /ft. DRIVE SHOEZ YES ONO I LINER: O YES ONO SCREEN DETAILS ....... _ ..._ DIAMETER (in) ' SLOT SIZE LENGTH (It) DEPTH TO SCREEN (ft) DEVELOPED? FIRST SECOND GRAVEL PACK O YES O NO GRAVEL SIZE_ DIAMETER OF PACK An. TOP DEPTH ft. BOTTOM DEPTH It. WELL YIELD TEST ' It detailed pumping METHOD: O PUMPED i tests were done is in- (a COMPRESSED AIR , formation attached? O BAILED O OTHER ;OYES NO ��� LUG If more detailed formation descriptions or sieve analyses I are available, please attach. DEPTH FROM SURFACE Water Bear- Ing Melt Oi- meter FORMATION DESCRIPTION C�oE it. It. WELL DEPTH It, DURATION hr. min. ' DRAVIOOWN ft. YIELD gFm. Surface I- WATER CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO I STORAGE . TANK : .TYPE _ CAPACITY GAL. PUMP INFORMATION TYPE CAPACITY MAKER DEPTH ' MODEL VOLTAGE HP WELL DRILLER NAME OAT C . w - L,�SSE t 10104-It-1 Ofup-v� '.� n�E`� ,` SIGTr3CfURE ENGINEER MUST \b PUTNAM COUNTY DEPARTMENT OF 'HEALTH H PROVIDE Division of Environmental Hwitl? SorWen, Carmel, N X 10512 PERMIT �# �-2 -87 11 CERTIF CATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM 'Pu-rxjAm V Au.EY Town 0P- 4Uage Located,-,at, - 1CGO�EE =- �aA� = r;R Tax &lock owner At_ E-�pt7g1 'TO / Formerly Tax Map Lot 4 �® O subs. Lot q 9 separate Sewerage System built by - W- 05AS'D ASP02-51'r' Address to 1 wice-opez RoAT] Consisting of 17-5o Gal. septic Tank and 400 l.. �. As4oiap-rion/ -'%alvcy/ other requirements 1;P,4M'P Pir ; �DLS'i1�18L.i'i /DA/ Box Water Supply: Public Supply From Private Supply Drilled BY C. W LAA -5MA1 Address MILL- &P--'ov^/A/ P_v^D JR EDr-0Qa y WY Building Type No, of Bedrooms '4 Date Permit Issued 3 ' 9 117 Has Erosion Control Been Completed? Has garbage grinder been installed? . fj o 2 certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standardsr rules and regulations, in accordance with the filed plan, and the permit issued by the Putnam County Department Of Health. A Date M • & • e7 Address P.E. '_ R.A. VO. Z6 00'& Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the: private water supply shall become null a vow when a public water supply becomes available. Such approvals are subject to modification or change, when, in the Judgment of the Cgrd—MISSI-O'Ver of Health, such revocation, modification or change Is necessary. Date BY ° '// j G'�°' r�� /��(.' ' r+Q°✓ Title 0 Rev. 6/85 ' Y 1• r � �..�,..- ._..__ �S � � Yom. � t -� .d ,• rr, ida,� � � � — --- Igr.j,'�a4 °v + 4 INP IM2 ! �Z . POTENTIAL V �p?N O t(r r� .RF9.ialr. i DR M Q n: n '► T�•T P,O ENTIAL�:� t d7 __ BEDROO�VIz fr ' -a l,s.,,.K a 6e0' � �} �� �,. vY.� ����� , �•. W/ � /►�. Vry � �I+B. 1. s: lm m CT` f "• PI%I I C�FSI[ kk V/2,. +ter i , � 5uI r Cz> xroa E� •,�-w P TE TIAL a � r Cz) rof! e+ -fir -o �,� , BEDROOM._ 4^ a BEDROOM I p it 29 p d N J tl A th r— Q _ r a'rs' /VO r rzcrosED C/44 6F-S I I— —303r i�il —3ogio ! _ X310 d i .p a� � 9S _ t �l r r4 . . ID 1T OF HEALTH HOUSE PLANS APPROVED FOR BEDPOCI COUNT.ONLY T BEDRGOMS.� _ ��� ~ l/ �► ALL. SUBSEQUENT REM10N, /ALTERATIONS TG THESE HOUSE PLANS MUST BE SUBMITTI' D ('0 TIE: PCDMi FOR APPROVAL LA A:a_ SIG ATURE & I11:JE DA . 1 r 0 LA :IZL ..o - -..:.. r4 . . ID 1T OF HEALTH HOUSE PLANS APPROVED FOR BEDPOCI COUNT.ONLY T BEDRGOMS.� _ ��� ~ l/ �► ALL. SUBSEQUENT REM10N, /ALTERATIONS TG THESE HOUSE PLANS MUST BE SUBMITTI' D ('0 TIE: PCDMi FOR APPROVAL LA A:a_ SIG ATURE & I11:JE DA . 1 r 0 r t :IZL ..o - -..:.. r t -cv; — -i•� a .w r 4� ._:o•:•',s. �r _ _ orf. -. _•..a'S�.4+,p �ir�c ^�. t`.. .�..- ..-.ow.:o :.�:.:..:,i -�.. �:� 8 1I 1 12� /z .Iu! 235 E5412 5? . a C I°11 247 t?* 2A5 1 u; • U, ' �- � ql "- •o5'-t3Ys'E 5 1 ...l . ^�PI°JrP•.IBUttG�,.1. uG�; ` 1� . i1 [ �,r i c?. Me >•.rys!.iI.i �� i` � :h-J .4Z'• 3�o "-OC:' "6 35. &- / i ti 54"" - c" a Yumr elf. �t / zz.z i' �: 42'- •Z' -moo' E iYSv COU . �.y . .Is Fri 1G j6.1.11G �� -- 1J Oo' _ �7' a cs" E 11 ,v. 01, Foci .oncI U.qa \ Q •. Y'U'TNAIri COUNTY' DEPARTMENT OF HEAL TM EN61 NEER MUSIT PROVIDE Division of Environmental Heald} Services, Cor ml,, M Y. 10512 PERMIT #j _. .CERTIFICATE OF CONSTRIiCTION COMPLIANCE FOR SEWAGE DISPOSAL SAS "T1 M r ,` r 1, il V,-1, a> Town or Village Located at v Wne•__�a. .:. :: }` t. rrirrl} : ... T•lx - ?ii .ice ?; -_ �,. �.r " ....�.. - separafa Sewerage ;ySYem built by _. `. -: � --..._:_ '_- . ,�: ::. _:_._:- - _ ---.. Ac!c4rzs Y:onsl ±ir *.g of Ga i. Septic Tank and ,: ----.. _• -_. _ _ __,__ —�. —. ... -_. -..__ - Other regUirements YJaY e.r Supply: .-.- blic Supply from - 'Pu _. _ -- - - - - - -- - - - -- - - - t Private SuPPly. Drilled By Address E'.tliS"M!; rype _ .. _ .-- _ - -.—_ :__._.--- ----- ------- .__ —__- No, of t3edrao:r�s— _-- _°--...�_—_. Date Permit issued --_--------_---..___-_-- Has Erosion Comrol Bacr). Completed? Z certify- that thy aYete[n(,) ai scr :nr7 A Y, c <x :.a t.2u : -ted s nt1311y a; zh,.an on :the of the completcd work { �, i•a of which are attached), and is accordonce with she s-andards, rules and re9uiatiors, in ac= ordancv with the fi.Ld rz_-.an, and the pei;i_t i hY ... Putnam County Department of liea:Lth. - r rh _ate _- -_ -___ Certified by..___ ) Date - - -- _. - --- - -- - -- - A:Edres License No.------- _. -____ Any person occupying premises served by .the above system(s) shall . promptly take such action as may be necessary to,secure the correction of, any unsanitary conditions`resultir; from such usage. Approval of tpgg separate sewerage system shall become hull 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 app, ovals are subject to - modification or change when, in the judgr, ent. of the Comrn SSsonar of t" ^alth, such revocation, modification or change is necessary, Date _�_ s _-- f - - -- -- - - -- BY _ >' si.?'�.. —. _�..._ tf _r .+. -- -- - -.. Title -_ i� - ��' F+.��r h i.81110mle FHtlf .�; Vt { � rd 1 7,U ICCO AP i 4' �' {� -��1 •� { y'.\ F1 � t.. 7`.:s fir. ":.. ; t r `C T X1[1118 COR19/8 � Cem 5 '® a C®r t Y r! r 1V. 1 Houseman 1 — Rest i s �� -� s..-1et � 9 $(x a 4 1 s g®� ax ° t x r a nr vS$ -�•. a., e r ha fl sy �q _ t u. �F T 1 F0579 z 'I 4` r .g 1 tenon `I $ Q o ff v.nAr�. 61i,.L °� ` HS,1 ' e'l .B Ser Ike v R ose MII Perk 7 Cem I � A ---7yvg--"Cy ;p9 6V _,141 ms's \ V- 3 ' CA ry '4111, . CILr rXly N V?d fo� 7.7 REBECCA WITTENBERG, RN, BSN Public Health Director Director ofEmironmental Health October 17, 2011 Alfred Esposito 101 Wiccopee Road Putnam Valley, NY 10579 Dear Mr. Esposito: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 $45- 808 -1390 PAUL ELDRIDGE County Executive Re: Addition- A- 119 -11 101 Wiccopee Road (T) Putnam Valley, T.M. 52. -2 -49 I have received and reviewed the plans for the proposed addition to the above mentioned residence. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons. 1. The rooms in the basement titled play room, kid's tv area and gym are considered potential bedrooms. 2. The legal bedroom count for the dwelling is four. The potential bedroom count of your proposed addition is seven. _.,. 3,..TIg.- addition p f`a potential hedroom..requires this D:epaftment' -s aproval of a revised septic system plan from a professional engineer Please revise the proposed floor plan to reflect no more than four, potential bedrooms, or have a professional engineer or registered architect design a sub - surface sewage treatment system meeting present code requirements: A copy of your plan has been provided showing walls to be removed in order to reduce the potential bedroom count to four. If you have any questions, please contact me at (845) 808 -1390, ext. 43261. Sincerely, ,tl� -1-D , <7.J Gene D. Reed . Senior Engineering Aide GDR:cw REBECCA WITTENBERG, RN, BSN Public Health Director .... ... - - -, - -AGBER IRWOJlirIA .Y' i . .....- .... - -. -.. •... Director ofEnvironmentd Health DEPARTMENT. OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 March 28, 2012 Alfred Esposito 132C Columbia Court Yorktown Heights, NY 10598 MARYELLEN ODELL Colon}' FmcwYw Re: Addition — A- 119 -11 No Increase in Number of Bedrooms 101 Wiccopee Road (T) Putnam Valley, T.M. 52. -2 -49 Dear Mr. Esposito: This Department has received and reviewed the plans for the proposed addition to the above mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated March 28, 2012. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at four without prior approval by this Deparfrnent. 2. The area of the existing sewage disposal system and its expansion area must be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc ... 4. The approval is for the modifications only and does not validate any construction shown as existing that has not obtained proper approvals from other agencies having jurisdiction. 5. This approval is valid for two (2) years and expires on March 28, 2014. Any permits or variances required under the jurisdiction of the Town of Putnam Valley are the responsibility of the applicant. If you have any questions, please contact me at (845) 808 -1390 ext. Respectfully, Gene D. Reed Senior Engineering Aide GDR:cw cc: BI (T) Putnam Valley ... �,. _.. a - . ,.. `� 1 i L•w e 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 ROBERT J. BONDI County Executive ROBERT MORRIS, PE ;»...:. Director ofEnvironmental Health Town Legal Bedroom Count & Proposed Addition Status Re: 8 ou (Owner's Name) Tax Map # 52.-2-49' Address: 101 Wiccopee Rd. Town: Putnam Valley Year Built:. 1987 According to records maintained by the Town, the above noted dwelling, is _XX in compliance with Town Code. Is not in compliance with Town Code. The Legal Bedroom Count is: This information has been obtained from: Certificate of Occupancy: CO #7009 - Dec. 31. 1987 Other: The plans for the proposed addition are considered: New Construction XX Addition to existing house only Teardown and /or re -build allowed under Town Regulations 9/14/11 ing Inspec r Date 6. Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care. Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention/ Preschool (845) 228 -2847 Fax (845) 225.-1580 4,,­ . , SHERLITA AMLER, MD, MS, FAAP ' Comm issionerofHealth LORETTA MOL.INARI, RN, MSN . Associate Commissioner of Health . ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road: Brewster, New York 10509 ADDITION APPLICATION RESIDENTIAL ONLY STREET �D / �l� CLD,0 TOWN �efAM TAX MAP # NAME Z) ,Posrr� PHONE �1 9d� A D A 1PCHD# � ..LL. t , MAILING ADDRESS k leal DESCRIPTION OF ADDITION �.�✓�lpf`�.SC611�a/i NUMBER OF EXISTING BEDROOMS. q PROPOSED #9F BEDROOMS (FROM-CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) "Any addition. which is considered a bedroom requires formal approval of plans .(Construction permit), prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, .Brewster, NY 10509, Phone: (845) 278 -6130. 1. Certified check or money order. for $100.00. "2: Sketche.s.of existing floor plan (drawn to scale, all living. area including basement, to be shown and dimensione6 and use of each room specified): (See Section 3:c of'Bulletiti HA -1) 3. Two sets of proposed floor plans (drawn to scale — with name, street and tax map #) * Non- professional sketches are acceptable and preferred. (See Section 3.d of Bulletin HA -1) 4. Copy of survey showing all well and septic locations on the subject property to the best of your knowledge. Include date of installation known. Contact this office with any questions. 5. .Copy of Certificate of.Occupancy from the Town or Certification from the Building Department with legal bedroom count of dwelling. OFFICE USE COMMENTS " o ilia 5. Environmental. Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 =5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 'T'•'*.': c..+x '�F' �� "' _ �� "{7lr -� t',n '� :'* 9 �^ 's �` '�' "' `�" i � s _> 'F`,� t� �u�`" � PUTNAM COUNTY DEPARTMENT OF HEALTIi eer to Provide Petmtit R Rev.. 3/ 6 Division of Eavlronmental Ii'eslth Services Carmel, N Y:10512 E4g� - • n CERTIFIC O • ATE _ F COMPLIAN CONS Permit N �i TRUCTION PERMIT FOR;, AGE'DISPOSAL SYSTEM Putnam Valley Located at Wiccopee Roa_ d Tswn or 'vivage _.. _.__. - Sabdivlelon l�iame pe. Sabd.;Lot N Tax Map Block Lot Owner /Applicant Name Al Esposito Renewal_ ❑ Revision ❑ Date of #r&1oas Approval ` Mailing Address 85" St. James Terrace " Towo 'Yonkers �p 10284 Budding Type amly Res.. jAt A"& 5.262 +/; 'Ac`. Fill Section-'Only Depth- Vohtme Number of Bedrooms 4 Design Flow G /P /D 800 PCHD.Notificatlon Is Regai When Fill is completed Separate Sewerage System to consist or 1250 - moo septi;Xaali anA " 4001F of 2' :wide" absorption trench To be constructed by to be determined Address Water SF-PPIy: - Public Supply From Address or: X Private Supply Drilled by `t0 be des . _Address' Other Requirements- '2! Ave. ROB fill.'.(345 f -i button Cox; Purrt� Pit w�abrM i 1250 Cal f9unr�'low Car�k , SpSORa-up I represent that l am wholly and'comDletely rasDonsilile for the dosign'ancf. of the proposet 4ystem(s); 1) that the separate sewage, disposal .system above described will be constructed -as shown on the approved amendment the're'to' and in accordance with the standards, rules an regu a ions o - e: u nam County ",Department of Health, and that on completion- thereof a 'Certificate .'of Construction.Compliance ".satisfactory tq�tha Commissionei of.;Healthwill be submitted to the Department, and b written guar, antee' will' be furnsshed "the. owner,.his successors, he 0 assyns by the builder, that'said builder will place in good operating condition any part of said sewage disposal system 'du_ring the period of ,two (2) years immediately following 'thediia 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 willbof instaIle_d in accordance .with, the standards, ules and regulations of. the' Putnam County Department of Health. I • _ X Date Jb., s Signed �iGC.e -�, P.E.- R.A. - 1 b I;,5: �. Cashin Associates, t. arme�:, 26008 Address License No APPROVED FOR CONSTRUCTION: ♦This.approval expires'•one 'year from the date issued unless construction of the building has been undertaken and is revocable for. cause or may be amended or modified when considered neces%ry by the Commissioner of Health: Any change or alteration of construction requires aannew permit. Approved' for•disposal" of domestic sanitary sewage,. and /or private' water supply - _. .• .• .. .}., ...•.._........♦- �. ._ v- n_...r...♦ ..r..rr•_.w �.- _.........a�.r..�... •.., i. .• .r -.. .._ ,•..-- ......._ -.... ..... -i.. -..r_♦ . n.... r_._._r.-- _...••..- ..e...+ -.... N DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 - ,7:AFPL'ICATT-ON-..70- CONSTRUCT' - A- =WATERz',WELL'::,_:._ PCHD PERMIT WELL LOCATION Street Address Wico ee Road Town/Village/City Tax Grid Number Putnam Valle 35-1-P/0 WELL OWNER Name Al Esposito Address 85 St. James Terrace .Yonkers 10204 )Private ❑ Public USE OF WELL 1 - primary 2 - secondary 0 RESIDENTIAL ® BUSINESS ❑ INDUSTRIAL ❑PUBLIC SUPPLY ❑AIR /COND /HEAT PUMP ❑ FARM ❑ TEST /OBSERVATION 0 INSTITUTIONAL ❑ STAND -BY 13ABANDONED ❑ OTHER (specify, AMOUNT OF USE YIELD SOUGHT S min gpm /# PEOPLE SERVED 1 Fam✓EST. OF DAILY USAGE 800 gal REASON FOR DRILLING ❑ NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ REPLACE EXISTING SUPPLY ® DEEPEN EXISTING WELL ❑ TEST /OBSERVATION DETAILED REASON FOR DRILLING Public Supply Not Readily-Available WELL TYPE LJDRILLED DRIVEN ®DUG ® GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:Wlcopee Estates I Lot No. WATER WELL CONTRACTOR: Name to be determined Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: N/A TOWN /VIL %CITY "D"IST"ANCE TO'-PROPERTY FROM NEAREST WATER MAIN: Greater than 1 mile LOCATION SKETCH & SOURCES OF CONTAMINATION ® ON REAR OF THIS APPLICATION oez (date) PROVIDED []]ON SEPARATES ET ee Plans (sig ure) 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. r1*1 Date of Issue: _ 2-, 19 V 7 Date of Expiratipry -� 2a 19_2�Permit Issui ffid Permit is Non - Transferrable R /96 DAVID D. 'BRUEN County Executive DEPARTMENT OF HEALTH - Division Of Environmental Health Services Cashin Associates December 24, 1986 Route 52, Seavey.Plaza Carmel, New York 10512 JOHN SIMMONS, M.D. Deputy Commissioner. Att : T.J. Canning r RE: Esposito i p �a Wiccopee Road t.. k. (T) Putnam Valley Tax Map # 35- 1 -P /03 /)Dear Mr. Canning: ' „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: Provide detail of pump pit I' Oversized pump pit with one day storage over high level O �✓ alarm should be provided instead of overflow. - tank.: ,. Add note that all electrical work in pump pit should be to NEC cod (/ Provide leiano t at bends in sewer .line w Show leader and gutter drains Provide baffle'in distribution box Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very rul yours. An a Bittner AB:pt Asst. Public Health cc:AB Engineer JK File TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 �� `� CA SHIN ASSOCIATES, P. C. Architects • Engineers • Surveyors Route 52, Carmel, Now York 10512 (914) 225-8088 CABLE" CASHASSOC MINEOLANEWYORKSTATE J anuary 6, 1987 Anne M. Bittner Assistant Public Health Engineer Department of Environmental Health 110 Old Route 6 Center Building 3 Carmel, NY 10512 RE: Esposito Wicoppee Road PV 35-1-P/O 3 Dear Mrs. Bittner: Please find enclosed four copies of the SSDS plans for the above referenced submission, revised to reflect your comments dated December 249 1986. With regard to cleanouts in the force main, we feel that this would esccessively increase the pump specifications to produce the required head and would suggest that limiting all. bends to 45' maximum would be sufficient. S h'6-u 1-d 'Y- U­K6V-e a tl'olhs—a'b6ut this- r' o 'any -f arth-er'-- questions or comments please contact me at this office. Very truly yours, CASHIN ASSOCIATES, P.C. by: John Canningl-----� JC/ci Enclosure PUTNAM COUNTY DEPARTmE dT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS _FIELD INSPECTION REPORT. '.. INSP. BY: (Name of er) (Street Ldcation) ` ( INITIAL SITE INSPECTION YES NO COMMENTS Wetlands on /or proximate to property.............. Property lines or corners found ................... Can estimate house location ...................... Will driveway need cut ............................... Must trees be-removed - note these ................ Deep holes representative of entire SDS area...... Additional deep holes needed...... .. ..... Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacentwells /septics ............................ AeePac to nrnnnsPA well location for drilling..... D.H. 1 Lot, Depth to G.-W. Depth to rock Soil Descri do 0 ft. 3 ft.`? t 6 ft. 9 jt. �. LL 12 ft. D.H. 2 Lot Depth to G.W. Depth to rock NO Soil Description 0 ft .$4 3 ftr�r tr?s?.. ' /C; Length of trench measured 9 ft. "- 12.. ft. ... _. ... 5W D.H. - Deep Hole G.W. - Groundwater D.H. 3 _ Lot Depth to G.W. Depth to rock 0 ft.' ;3 ft. i t 6 ft. 9 ft. 12 ft. 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 watercourse.......... ........ Natural soil not stripped.or SDS area unnecessarly graded.......... . .............. 10 ft. maintained fran property line and 20 ft. fran house ................................ Distance well to SSDS (ft.) ...................... Number of bedrooms checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench... ........... ; 15 ft. of peripheral soil horizontally from trench ..... ............................... Boxes properly set ............................... Could surface runoff fran driveway,.roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK-,in area of SDS::.....: FINAL GRADNG OF SITE ACCEPTABLE::...[ (Name of Owner) cmem (Street Location) YES NO DOCU-0M Permit Application Corporate Resolution Plans - Three-sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log .�h ?ice 3jd1l0 4�1 3 Consistent Perc Results (3) 30" Perc Hol Other _.. House P ans - Two sets If FWS ter Variance Request REQUIRED DETAILS ON PLANS r^ Sewage System Plan a Sewage System Hydraulic Profile'- Gravi v Flcr� Fill Profile & Dimensions - Volure D or J Eox;Trench /Gallery; Pump pit detaills Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtin Drains Perc & Deep Holes Located Representative of Sewage & Expansion Ares, Expansion Area';shakzi; gravity f ow,suff. siie If 'Pumped Pit & D Box Shcwn & Detailed House - No. of Bed.roans Wells & SSDS's w /in 200 ft. of Property Lted 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 (inc. expan). 15' to Drains- O=tain,Stozm, Leader, Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fray 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) j . Data On DDS Plans & Pemni.t Same r. ....w,_. ... .. ... ,L -L'�e f . �' _a� ar'•k i4 rv.r.. �`i.� r'���`����- '•�q�p'9P fT •' •...ti..{. k. •+.-yu -..i. �w.�t+� = =.1 .G ' SSDS -S REVIEW SF D r a. 1.- .:Cltlet 2 ".-I -e cw inlet g 1 / gp of a�sir>g 18 ab gnuYi, - -- 2. .. , _. Z ' ' ? i b,3 M 3. t t it i de¢-h c£ 14id: 4' - 3 3. M Minimm 2A' casing of stet cc'wm#t- iirn: ` 4. T TFmt-h - muw= Brice wl&h to nammnTA fair 4 4- -10' a aunimm gcaYt irto rcck _ tirres width. 5 5• O O+Iet 4' blaa O.G. nun. 5. M M�6=12" crux. 6 6. S S?nitaty smis . 6. I Ir..caticn stake_ 7 7. Q Qm2-4 Sz5ad a+ay ficm ell. - 7. M M?� - cpa ling - mininm 20" in shorter _ dke -Eim - . e e. QRI O Io7 rE= 8. T T�P-fr1e eta-3 20% cf liciid dq-,d abate l ? ai 1 1- O OAmfM to aUcd f©r settl ing: 4 "-6' level (&4', b=10", c-=5' ,b -12 ") - 2 2. 6 6" -12" ragal soil. mill. 9. I If 3e rjth G.T. 9 feet - use 2 anrcer�. 3 3. U Utreatai hAiding peer. 1D. M Mirrinzm tack qty 1000 cr31/*3 man; 1200 4 4 • X X11 lit" clan 92t2? Cr store_ gW4 b&om:134 co b±m;161 cf/4 b:Im 5 5. M Min. V p?tfcz7-�te3 pipe_ 11. A A attic coating fcr iei.rf=Ed coxrete. P Pipe incest 611 - cH bcit -cm 12. i inlet te,-/ba..f, f�l^e 16" be1pw f Lcw line- 7 7. 1 18" - 24" write trams. 13. C C tI s t e + �-L e 18" hE u f1u,* line. 8 8. D D%th mate. 14 R Rnlet pine slope :" Fe-- foot nun. (2%). 9 9_ S SEamtkn Em 55:6 area 15' min. 15. I Inlet pir-e cast ircxt, 4'Ytdn_ f f. IAk CR JUI= BUS rE lAnS lb. n n*1 Pt Dire sicpe 3/8" per foot ndn. (1 %) . 1 1. F Fermable }xx axes. . 17- ( (�tlka3 faints fray sini tazy tom. 2 2 Q . �rl. 1- is o • :r •sal. 1- Inlet knErt rrdn. 2" abaae a tlet kmrL 2_ All aitlets at el-_�Ztiaz_ 3. 0 ttl 1" to 5" ab7.n t<nk inttart_ 4. Minimm 12" be35irg Clem sarri ar pm cruel_. •- a - 3. Laterals ft,2�i with hDtoa_ 4- TiGht jairtts pipes babam .b=x- - 9. Sltpe az`J ets at ft- 10. Frost gotmtin«. : - - -• via 2. ' a• M - C• • - • e z - ag,=egake- 3. 4".mLnfi= lateral aiaTeber. 4. 1 1 -••L� O;er laberal. 5. • 1 1 -••1 e•- /- •- - • ■ wl e• • • • pmer •� •1 sbr. q • e aggm9ate- 7. • 1 m -- • •-dam 8. • J•1 /• allcw fcr seuaihg, / 1 • mn trench •OU •• •a • r- 9.-2d-- Mmrrh -•ea • 1 . • ■ o • amxn:tea laberal •. nustt be • ••c• ••eF nim 101 •- •• •o• n •s:/ • - border. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property of L Date 042(- 10 C/n Located at U Q (T) ru-:- &,,,k ����eu Section_ S Block Lot Subdivision of Wicopee EsVo,fe, Subdv. Lot # Filed Map # 2l! r� Date 1an� (31 t95� Gentlemen: This letter is to authorize_ ('�shf 11SCUC ICf��S C 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, the Public Health Law, and the Putnam County Sani tary Code. Countersigned:' P.E. , -. -A—., , 2643 COAL-V�- O-A'A OCR �RA f c . Address i 5 Z Telephone Very truly yours, Signed N ,T> 4Owne oroperty (c -e Address Town Telephone \. Ar 1 dlSfrt�JUtlO/t � ti i r, � � �� \ ' a �cl box ''�.��, '.:`c-�'•.' %. s ' 0 , Pit 14 1 =_ < Wdo W. Np � \ y fir► •. s� � ?:: � .. . z�,- � Z J'+d► b ,tic .• �,�,��►►,�••.,, �; ' „� ;i.� o � �s Pt m TAN cp Ito 4,d" 6c>6,41 OK,, •:ak; «i� Z.r tY S,tr TANK t � r Y • T-rcneh lat{oui- fro p p JJ V a 12 35- I - P/o 3 I ail nnv� � , }• - �►- O S2. 7, ARCrl 3 ,` As PUZNAM COUNTY DEPART OF HEALTH - DIVISION OF ENViR0I34ENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS . :.. _ 10 REVIEW SHEET CONSTRUCTION PERMIT / AME LF trench provided _ required _ 60 ft. max. YES NO DOC[MENTS 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 30 ".Perc Hole cd Other House Plans - Two sets If PWS - Letter if well/permit Variance Request REQUIRED DETAILS ON PLANS Sewage Systen 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 Pumped. Pita &.:.D,.Box Sham & = Detailed House - No: of Bedroans Wells & SSDS's.w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 1'0; Type pipe No Bends; Max. Bends 45° w /cleanout SEPARATION DISTANCE'S SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains - Curtain, Leader, Footing 351to catch basin,stormdrain,piped watercourse 10' to Water Line (pits -201) 50' intermittent drainage course Se tic Tanks 10 ran 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 . W.. 9 • r• •• a a�• • • � iy • � . y e •• • � e• • is v iy _ �- «�. DESIGN DATA SHEET- SUBSUFACE SSgAGE DISPOSAL SYSTEM FILE W. Owner Oa Address 9,E 9- w� I e rr � r-Q / Located at (Street) : cjtcoa�E- Q0," Sec. 3 S Block Lot (indicate nearest cross street) [Municipality na 1kkeK Watershed RJ50k) r SOIL PER0p=CN TEST DATA REQUIRED TO BE SUBMrrnO WITH APPLICATIONS Date of Pre- Soaking s C- �? 19 g-C Date of Percolation Test Dec c 9 /,?V6 Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches 'Soil Rate .:.Start -Stop Min. Start Stop Drop In Min/In Drop Inches Inches Inches '3 2 2 9': 3 2- 9:4 ( ' 2 Z -2 3 3 24 3 S 5 3q-42- 4: S4 12- 21 2,d 3 4 4 9: sS- t0,(0 1 S— Z1 24 3 S 5 1 o: U -10 -1-1 ( S 2.0 2 2-3 3 2 H :OZ- Ii : 19 1z -3 3 If =2a -I1 3S lS 2- .: 411:3 _1( :S 27- 2S 3 511 1 2 3 4 - - -- 5 NOTES: 1. Tests to be repeated' are obtained.at each for review. 2. Depth measurements to 9/85 at same depth until approximately equal soil rates percolation test bole** All data to' be..suhAtW be made fran top of hole. b TEST. PIT DATA REOUDM TO .BE G.L. 1' 2e 3' 4' 5' 6' 7' 8. 9' 10' 11' 12' 13' HOLE M' INDICATE LEVEL AT WHICH GROUMMTER.IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING EN00UNTERED --- DEEP HOLE• . CBS ERVATIONS MADE BY: ��— DATE: �.11 . Z Ph' DESIGN Soil Rate Used �_ Min /1" Drop: S.D. Usable .Area Provided s No. of Bedrooms 4 Septic Tank Capacity I 2�� gals. Type MnsoqR Absorption Area Provided By 0 L.F. x 24" width trench. Other v C. Q0 �� 13 4,� CY _ z, so 6qL Name Cis nw� 3ccc P C Signature Address Rt S QLt fo'a SEAL �r 4 N Y ( o v� THIS. SPACE -FOR USE BY. HEALTH .DEPARTMENT ONLY: Soil Rate Approved sq:ft /gal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 ION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM ENGINEER MUST PROVIDE PERMIT_�.�__'�_� _.-- .- -- -. ..Town or-- Village Located at 'I'.Ax Nap L't d Sukx9. Tat d ' Separate Sewerage System bunt by ,Address -J-1L" e Consisting of �`:'____ (,al. Septic Tank and Other requirements ,•..- Y - ;.; --- --- ------ --- ..�__._-__ i Water Supply: ----- Public Supply From--- - -- - -- __.- --- ...__._ -..- --- --- ------ ---- -- - -- - -- -- ._-- - - - --- •� Private Supply Drilled By Address Building Type No, of Bedrooms___ -T __ -__.._ Date Permit Has Erosion Control 13een Completed? I aertif'y that the system (s) as listed serving the above premise; worn constructed` essc,ntially as shorn on the plans of the complot,d wcik.( of which are attached), and in accordance with the standards, rules and regulations, in accordance -with the filed plan, and the., permit issue3 by`t., Putnam .County Department Of Health. .t Certified by r pSr -__�` �� P. E. Address - :_ -- --- _- -_ --------- ': _— __ _ _.._- -- License No. Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resultir, from such usage. Approval f the separate sewerage 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 Commissioner of H ^.alth, such revocation, modification or change Is necessary, Title . .rr z .,.. '. ._._..,. _:_.,.._�..:., ._.::..,_ .- .._::aL`.a::� . ;.�:,,.,..Y_x- :. -'.- • ..,...._..,:_:.,,,.,+- .,.3„- «� ,.,.e,,..�,,.- ..� _ �.�_;i= rs.a�...,-'�pY - ..,...a.,aM ;:. _ <si