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HomeMy WebLinkAbout2680DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 61. -135 BOX 23 :� k.Oi IRi In I ■' ; I , r , :f T iORETTA' IvIbLINARh`R1 Pv(`S:N. Public Health Director BONDI ' .:..., ...� County Executive DEPARTMENT OF HEALTH I. Geneva Road, Brewster, New York 10509 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 Trodden 4 Rock Meadows Putnam Valley, NY 10579 September 26, 2003 Re: Addition — Trodden, Rock Meadows No Increases in Number of Bedrooms (T)Putnam Valley, TM #61 -1 -3 5 Dear Mr. & Mrs. Trodden: I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated September 29, 2003. The addition is approved with the following conditions. 1. The total number of bedrooms must remain at four without prior approval by this _ - -- `2. - " Trie °area of the exisfiiig sewage disposal-*system; and its expansion area, ^must 6e ._.. 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. I . Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley. If you have any questions, please contact me at your convenience. Very truly yours, Michael Luke ML:Im Public Health Sanitarian cc:BI BRUCE R. FOLEY "Public Healtti Director DEPARTMENT OF HEALTH - LORETTA: MOL1NATt1 RN., M.S.N. Associate Public Health Director Director of Patient Services I Geneva Road Brewster, New York 10509 Environmental Health (845)278-6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 ADDITION APPLICATION (RESIDENTIAL ONL)D STREET Rte( (`{� TOWN _0 -3S NAME T-r-adden PHONESg5- 5?,g -.31gy PCHD# MAILING ADDRESS DESCRIPTION OF ADDITION &CCL- eRloef NU\4BER OF EXISTING BEDROOMS__q_PROPOSED # OF 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., 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 •� I -f i I I I ; , , 1 I � , i- ' ' i '': 1�► 1 1 i ' -I I -i - -1 H^� -i PUT NAM CCUN 1f DPATMNT; C1F IEAI.TH T Ik i-`-` � � -� � --- - - �--- �-- �— �----- ---F', ! •+----- �-- ��c � ..wza�r,�nrn�w>�iz.p.�ty: - --- -- I L---- tit of I —4 PVDlAM-GQUNVftEPMTMENr- OFHEALTH P RqVED FOR -BEDROOMS"i - y6 T & ate signaturt"A 1 1) 60 i 5 b)F A-d-DUJ5 _x 4,4na atke n �-4 -4- j\1 U CON DdPA ,NT 6F ttALTiH __4 --A PLm tt nR11 v J_ BEOUbm, signaturt"A 1 1) X - �1 a > lo 1. �' ����,. ,,i'. %;ti � �+• _ ,+� :. :: ......... :.�.. ._� ., __ .-`�.. __..._ �_ ._ .. //_' ��. r9��, _ ✓ ._ ;..,! " bi :ti:,': '�.;� Yip• " % `'�;�,i, • � `�..__.. � ._:.�:._..._.....4 ..... Y. f'F CIO \ ,. S BRUCE R. FOLEY Public Health Director . LORETTA MOLINARI R.N., Iv1.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 - 6558 WIC (845) 278.6678 Fax (845) 278 - 6085 Early Intervention (845)278-6014 Preschool (845) 278 -6082 Fax (94 5) 278 - 6648 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 8/22/03 Re: 4 Rock Meadows Residence Tax Map 61--l-35 Town of Putnam Valley Gentlemen: According to records maintained by the Town, the above noted dwelling - � ..._....... e IS NOT in compliance with Town code and the total number of bedrooms on record is 4 This information has been obtained from: CERTIFICATE OF OCCUPANCY: xx l' ASSESSORS RECORD: OTHER BFhouseguidelines Deputy Zoning Inspector --------- L -A LJ.1 T--j Q p I t kliv t4 fil I T- .71 , I - , Al, -- I -- I K - ! ik-- =- -_- t I _ T-7 I ' ---- '- i 1 I I i i, i I -'- : • ----------- lype? - -------- 5t 83:x' LAP 1!(Z6bD -4-- 4- • 5 -- -- ------ rl - - ---- ---- - -- - - - - - ----------- -17 JL 41- YT, poo- 7- -.-r T q, PuTNAM COUNTYDEPARTMENT OF 11IE' I Rev. 61a Q, i1lMsidn of Environmental Health SkrAice6ii' daim6l,'N.Y. 10-512 Engineer Must Provide PZ H.D., Permit # ,8 Ct CERTIFICATE CONSTRUCTION COMPLIANCE FOR SEWAGEDISPOSAL SYSTEM S.9 Located a< T� Map Block Lot LZ 'Af 0 C, -OA9. O;i,,,,r/ t Name Form Subdh4slon Ni applican Date, Permit Issued Address Ft 94 e rl f, -t —zip- gA, Peeksk i X1 Y 44 Ogiate Sewerage :System built by Tr© d d'h ®h Addresi.. d 0 Gallon Septic and 410 L. -F Pum J3 12,1:� a Aar M Consisting of V Water Supply: Public Suppl*-Frow— Address or:— • Privet, Supply Drilled by An df"CAA Addries 4'. AK 1110V Building Type FeA 7 a S7T Has Erosion Control Been-COMPIPted.?. Number of Bedrooms 4-� —Else Garbage Grinder Been Installed? Al Other Requirements 7 i certify that the system(s) as listed serving the above . premises were . . constru cted essentially as shown . on the plans of the completed work copies of which are attached)', and in accordance with the standards,. rules and regullatio k7 in •iaccordanc t plan, an th pros. he f ad d the permit issued by the Putnam Of Health. Certifletl by County Depabent R.A.— P.E. X— Date xv, License No. Address Any person occupying premises served by t he'a6ove, system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such . h . usage. Approval of the saipa'rite sewerage void as soon as a pubt,-. unitary sower becomes available an the approval o I of k1% When a public water. supply becomes available. Such approvals are the private water supply S6611 become null and vo he '' i ' f " ' - "' sl Subject to modification or change when, In t judgme t. qz :the 'Commis oner of HoeIW such r Ion, modification or change Is necessary. Date 117, 0 { TT . T T il/%T.rtnT TT T T IIAT In'On ^ 10M WELL LOCATION WL.LL l+VrirLr111VLV nr.rU".L DEPARTMENT OF HEALTH ._ Division ..Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH+ Office Use Only STREET ADDRESS: Nlvll 1 lfY TAX GRIO NUMBER: /`' WELL OWNER WE ADORES BIVATE MRUBLIC USE OF WELL .1- primary 2 - secondary A RESIDENTIAL ❑, PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS O FARM ❑ TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT �� gpm. /N0. PEOPLE SERVED /EST. OF DAILY USAGE gal, REASON FOR DRILLING ❑ NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH -2 -I / ft. STATIC WATER LEVEL d ft. DATE MEASURED �� DRILLING EQUIPMENT OTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG O WELL POINT O CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE 0 SCREENED ❑ OPEN END CASING. 9OPEN. HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH � fit MATERIALS: STEEL O PLASTIC ❑ OTHER LENGTH.BELOW GRADE )-t JOINTS: ❑ WELDED ,THREADED ❑ OTHER DIAMETER >'� in. SEAL: ❑ CEMENT GROUT ❑ BENTONITE AOTHER WEIGHT PER FOOT IS' lb./ft. DRIVE SHO YES ONO LINER: ❑ YES ,9 NO SCREEN DIAMETER (in) 'SLOT SIZE LENGTH (it) DEPTH TO SCREEN (it) DEVELOPED? DETAILS -.._ :_.:FIRST . _ ._. _...... . - _ - -_ . - _ ... OYES .ONO ."HOURS-- .SECOND .. .. ......._. _ ._._. ,. - .. ..:. � _ . _ - _._..- .._ _ -:... _.. _ .. ,.. . GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH It. WELL YIELD TEST If detailed pumping P P 9 METHOD: O PUMPED i tests were done is in- .COMPRESSED AIR , formation attached? O BAILED O OTHER ❑ YES O NO It more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. DEPTH FROM SURFACE water Sear- ing Weli Dia- Deter FORMATION DESCRIPTION COLE, ft, (t WELL DEPTH It. DURATION hr. min. DRANlOOWN It. YIELD gym. Surntace 37J'' WATER ❑ CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE/ ` , ,%ie CAPACITY J MAK DEPTH MODEL -41"' 3 Y `� VOLTAGa n HP WELL DRILLER NAME oft' . OA7E ADORES ��$ �, • L� slcirAiURE �1 Yorktown .Medical Laboratory, Inc. CAB # 321 Kear Street Date Taken: 11/8/89 Time: 6:30 PM Yorktown Heights, N.Y. 10598 Date Re l d : 11/8/89 Time: 12:30 (914) 2452800- :,; Aate Rep,o:rt:ed NUV .3198.9 �, P- Director: Albert H. Padovani M. T. (ASCP) Collected By : M. DONNER Referred By: F Sample Location: HOSE: WATER TANK IN TRODDEN MR & MRS M. BASEMENT 2 4'DONNER PATH PUTNAM VALLEY, NY 10579 L J LABORATORY REPORT ON THE QUALITY OF WATER Phone # 769 -2291 _ Phone # I Sample Type: Repeat Test? _ (check each) INORGANIC NON- METALS mg /L F MICROBIOLOGICAL CFU /lOOmL _ Acidity Alkalinity _ Chloride _Detergents, MBAS Hardness, Total Nitrogen, Ammonia Nitrogen, Nitrate _ Phosphate, Total Sulfate Sulfide Sulfite METALS (mg /L)� _ Copper _ Iron _.Lead Manganese _ Mercury _ Sodium _ Zinc MISCELLANEOUS _ pH (units) _ Color (units) _ Odor (TON) Turbidity (NTU) GENERAL BACTERIA Standard Plate Count (CFU /1.OmL) MEMBRANE FILTRATION TECHNIQUE Total Coli form V Fecal Coliform — Fecal Streptococcus MOST PROBABLE NUMBER TECHNIQUE Total Coliform Index. - Fec-al Coliform Index KEY FOR TERMINOLOGY CFU = Colony Forming Units CON = Con-Fluent (q.v. TNTC) LT = < = Less Than GT = > = Greater Than N/A = Not Applicable S/A = See Attached TNTC= Too Numerous To Count REMARKS /COMMENTS (For Lab Use) i '" i _✓ Potable Non- potable STP INF STP E F F Other: Sample Status: (check each) Outgoing HNO3 _ HC1 -- H2SO4 NaOH ZnOAc Na2S203 Other: Inc o.m-i_ri- g::...... ..�::::... ✓'LE 4 °C GT 4 °C _ pH LE 2 _ pH GE 9 pli GE 12 _ Other: ELAP ' No'. 10323 THESE RESULTS INDICATE THAT THE WATER SAMPLE Was)) (Wasn't) (N /A) OF A SATISFACTORY SANITARY. QUALITY ACCORDING TO TH NEt ORK STATE PUBLIC DRINKING WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE COL ION. THESE RESULTS INDICATE THAT THE .WATER SAMPLE (Did) (Didn't) (N /A)' MEET THE SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK PUBLIC DRIN NG WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE COLLECT . L X/ 161 � / y` i Albert H. Padovani, M.T. ASC`P_)., Director 2 /86(Rvsd7 /87)RWE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Owner or Purchaser of Building Md #f,,,, 77z0 -b A Clu Building Constructed by p / /D4'7 I-If '2 Location - Street P4ltuAwr VW1161y Municipality O/ r 1--4 /4l L Building Type S7 31 61.7% seetieft- Block Lot 7-91 n►# p LO C Maoc(C -v s_ Subdivision Name Subdivision Lot # GUARANTEE OF SUBSURFACE SE4MGE 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 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 Environmental Health Services of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. 0, — Dated this 02S day of lUrA.1 19 9"y Signature 7 d&L_ Title General Contractor (Owner) - Signature Corporation Name (if Corp.) y /)& /7/1 ,CfZ R4 rW Address �,4 rev. 9/85 mk Corporation Name (if Corp.) Address John M. Simmons, M.D. PUTNAM _(AUNTY .HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES Deputy Camnissioner of Health - FIELD ACTIVITY REPORT - Sheet of INSPECTION NAME - 'i�- G ``'' Orig. Routine 4 4W� Orig. Main ADDRESS _ g. Request No. StdAtut 10, Town TM No. — Canpliance AzAg's ®0 ® Final laint Canp MAILING ADDRESS Fina P.O. Box Post Office Zip Code Group Illness 4 Construction TELEPHONE 0 Reinspection PERSON IN CHARGE Field, Sampling Only OR INTERVIEWED Field Conference Name and Title AO iris ®� of Other DATE J4 TYPE FACILITY , V) 0 INSPECTOR: to Signature and Title PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. n TITLE: p 0 S'T.F =T ICCITION ' / ONE£ �/}d Cw-NFR /,7 P-=iMST a �^ � 24 a OR. S—zD-IVISIaN LOT Or Y�.S NO I _ SzTwA.GB DTSPOSA -L- -AREA, a. SDS area locates as - t <:a =rove3 p_ lays V- 1 1 b. Fill si---'i.on - Date of placement 2.1 barrie~. I= 6v= AVG.DPTE 6Z I i c. Mural soil not s tri =.ed I I d. Stone, brush, etc-, Create_- titan 15' fram SD.S are?._ I e. 100 ft. from wate_*- course /wetlands. I I I II. vim., --E DISPOSAL SYSTHMI a. Sentic tank size - 1,000 ,250 I I b. Septic tank inst�11ed levelI� •I i C. 10' minim = from fcureaL-icn P T-1 d. No 90' be_nes, cleancut within 10 f _. of 45° be-rid IQ I I e. DISTRT U TICK BOX I I 1. All cutlets at sams elatat; on - water testes i b. Ivor of ben=t i 2. Protected te? cw f: cst a. Hall lc--t- as a =-roved olars 3. Minim= 2 f= crier. =..7 soil between box and t== -lees (?� b. Distance f_an SDS area ff=sure3 _160'r ft. f. JUNCTION PDX - orooe--=v se= I cl I 1. rte ^ u;, -e? - Yx� I. -mgth in_st 7led C ! I 2. Distance to wat_rc-cLSe measL T-e - o :,, ft. 3. L*zs_ a�raL a to elan r 4. Dist2mce C LeY to Center iv 5. Slone of t=ench acceota:r-,le 1/16 - 1/32 "/foot. Iv. V. 6. 10 fee= fram orcze�,r line - 20 fit - feur-- 5aticns Ire 7. Dcmth of t=E-mch < 30 inches f_aa s- =--ace I Q I 8. Roam -' awed for ex. a lion, ze,%c- / 6 v 6Z I i 9. Size of cravel 3/4 - 1i" diameter I I 10- Death of crrvel in trencZ 12" MLA = - III. •Pipe. ends c I l I h. _Pw _ w OR DOS' SY.gT�S 1. Size of -m i 3. Alarm, v su ? /audio I I I 4 Purnn e=_5' V accessible ffanhOle to 4 cQe I i I 5 . FLSt b0c bas =1�_ 3' --� GUb(IJ %y .-J g4 6. Cvcle by FSZ-11 th Derma:: nt estima t= flew Per cv- el e MUSE a. E^use lec--,Lea' Der acaroved owns. sz b. Ivor of ben=t i I a. Hall lc--t- as a =-roved olars b. Distance f_an SDS area ff=sure3 _160'r ft. c. Casa nq 18" above trace. d. Sar=ace d--mace a--cur:--- weU accentable. VIE. CV 2,UL itiORKu? �"aIP a. Ecxes Drcrzly crrcut=: b. A_i..]. pines rz--dall y ba 6 it lea c. A? 1 pikes flush with iriside of bax d. F--ckfill wai, erial contains stones < 4" in diameter fJ e. 0* -tin drain ins � Lied accordi.nQ to plan f. Crttai.n & a i n outf -a vrotec t-e-i & d; r. to ax; st- wate_rcoursd g. Footing drains dis._harae away from SLS are. h. Surface water urot_e— Lion adezuate i. K.;.oszon Crn=o vrovic- cn sleces CTea -st=ar than 15% Separate Sewerage System to conAstt�of Gal S�e�ptfc�TaLok To be constructed by ' - bU OP, Watgr SiAPPt) ' PtibllC JUPPly'From ' ort Private Supply DrWed.by �.: ,Other Reoi remente I repiesent. that I am wholly '.and completely responsible for the desig :above described will be constructed as shown on th"e approved ainendi `County � "Department �o['Nealth; -and that on-completion thereofe be.•wbmitted. to the _Department . and a: written_guarantge. will De t place, m good, operating condition any •part of said sewage, dispo anCe `Of' the approvar cif the, Certificate ,Of COnstruction:,COnlpllar will'be located ss ihown on the approved plan and _tfiat sa;dtweltwill ;t County Department of` Heath. Date S�grie Address JJT APPROVED FOR CONSTRUCTION :Thisapprovai, eipirestwo i reyouble for• cause'or,may, ;be amenoed or modified w hen �COnfidere' .. req•ukes.a ne permit. • Appr d or disposal of 'domestic ss " a 1/87 Oate Qi I w. and .location;bU the -pioposetl system(s).,, 1);that;the:' separate 'sewage disposal system J brat there 3o and in accoidance with'.the standards, ;uses and, regu a ions O e U nam - { ert�LCata •o/ Cons`truction'Compliance satisfactory to the Commissioner ot,Healthwill. - urnished'.the owner hIs.wccesso�i ;.- he{rsor assigns by the builder, that said builder Will ` I .system .during lihe period; of two-(2) yeersimmediately following the date of, ;the isw- e of the on al system or ?any repairs4hersto 2) that the drilled well described abovb. installed '' ccordance ;with "t andards ;' "r Is and 'requ a ons of ",the" ,Putnam P.E from the: date .issued unless -,construction, of the building has been undertaken and Is ;ices y by t Commissio er f Health Any change or alteration of constructeo age an p' a e w Qly r Tine• .� ., , 'i DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 ' APPLICATION T.0 CONSTRUCT A WATER­WELL Q PCHD PERMIT #�J WELL LOCATION Street Addres fT own Village /City Grid Nuoer r9 /Tax i WELL OWNER N me Address rivate O Public OF: WELL RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED - primary CTE O BUSINESS O FARM O TEST /OBSERVATION ❑ OTHER (specify 2 - secondary O INDUSTRIAL O INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT gpm /# R SERVED 48tEST. OF DAILY USAGE _gal REASON FOR NEW SUPPLY ❑PROVIDE ADDITIONAL SUPPLY OTEST /OBSERVATION DRILLING O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED ®DRIVEN ®DUG ®GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES %--'NO IF WELL IS LTD <N A REALTY SUBDcVISONA�ME, OF S ��VISION: M QnVJS 5219! Lot No. WATER WELL CONTRACTOR: Name OF, pg "'wOEED Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES u---1�0 NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: _ LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION ON SEPARA HEFT (date _ (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 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 form provided e P tnam County Health Department. Date of Issue: 19 Date of Expiration: 19 ermi ssuing fficial Permit is Non - Transferrable I) %-, 2( l APPENDIX B PUD�-^_ C --1Ui' "I CEP F K -EW OF HEILTH - DIVISICN OF aJNJ- CA- 'T7ML EE'ay- DOIV T-, TA_L Sv- =� SuPDL7 & SuE-c:iIRFA(✓ Sr vI-- DISPC.. ,L SY8Tf4c RET—E E— „rc” �-T - CGLISI='.L ICN PFRMIT ' . DATE k_ - C= „CME,rc YEP. �LNO I DCCLm%- - 60 LZ. r F :rile_ t= 10 0 E� Pe -*-zit A.npl i cr t i cn Car, -crate- Rescluticn Plans - Three setS Encino -s ��utncriz_t_cn Design Data DAP Hale Ccrsisten• Pe -c able S r' l:ee LI-C �MPerc Deo h ficuse Finns - Two Wei -,-, FGA z; Van.an cs Rs~'uest C=7 zrZ A r. L�l 5�.ci��isicn la -�- C-1 S/ /I (DDS) I SurDlv��c1C�. (3) ci l C” SuLdiv-1 sicn A -ccrcval C-`_k_ a _and (Tc. L_ /DEC Ps=i = R & D', Dam Ca DDS P l ar z & Ps__ i ` c _ S =.iaga Systam P_an - (ncrt -h a__:: ) SYNC'..'- Cvp 4an Evd"c;i =C 7. - + Cc'Ctic Tank - SiZ-, D✓r =i l Weil CeT- i i -e_ vi ca Lira_ if Cvz C^as`-LCticn vot.s (cringer re) Design Data: ana c=._o resui_= TTri� FCC CJn SOIL .,x15 t' :1C & D= _ CS= ^ . Dri ve.Yav & Slcces Cat FcoL�zjCat_er,C��� =i Drains (c__�_zarg2 C. {) Perc & Leo LcleS L^c=t Reorese- rit-ative of Dr_rvary air= e=- ansicn E:,c-- a_'isica AT= —; sncc,- n;CravltJ f cwt-s ]f -. Si m. I= P`mm:ea Pit & D Ecx - chcw-ft & Detmilec Hausa - No. cf Ee�x,--Ncms Weds & SSDS's w /in 200 ft_ cf r oPOSed Sys=. Pr cce_Tr Metes & B, -trres Hausa Serac:t "CaS41-5- - 1 t) Hausa Serer _ o SEPD�RA -'ICN DIST:`�1C�c CV P-r: tN Fie_1CS 10' to P.L_, Drive:vav, Lame T_- =i,Tcg cf 20' to Foundaticn Walls 1001 to Well; 200' in D.L.O.D, 150' Pit= 100' to St -ems, Wat__-c- curse, Lake (iIIc- E.;- 15' to Drain-s Curt✓iz, Leada- Fcotinc 351to C`'tc:: �cSin,S�Cr:TOSc1I"i,:l" WGt= 10' to ►Vat°__ Line (alt -30' ) 50' inta=a tzent dr_ i r -Qe Seotic Tanks 10' f=an Fcund`t_cn; 50' to ;,z1 a 15' we-Ii to PL o�Lr �coJ� d�dt� PUTNAM COUNTY DEPARTMENT OF HEALTH APPENDIX K nTVTSTON OF ENVTRONMENTAL HEALTH SERVICES Date T Re: Property of.���Id GI!/ //f �r6 c��?•� Located at , Y � (T) f"W-t an Block % Lot Subdivision of Subdv. Lot # '� Filed Map # /olYZIeD Date Gentlemen: This letter is to authorize bin / e a duly .licensed professional engineer or registered architect (Indicate rr to apply fora 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 'o-r- Arfcl'e "145" or'"' 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, Signed /� Gc r r ^�l �i�' - C.-c- C'2. Owner of Property Countersigned• - r J f _ P.E., R.A., ## d Address Address Town 1�rr�:��.�.� �� � �� f- %9i.�di✓� /Sly Telephone 92 / " PJTJ Telephone scale Dv' G Sir Do,-$ S,OD I VIVOV C' i PAN OAJ T Apj -711 INV T!'k,"!.5 •O `celflfy +.W fhe Sew.46,- dis posy 1 as. construct ed, 5, 6 C,-Nn fJoflv- as on - h,s p.1gn on Ihe sv. s -fe rn oi'. �Pec-*d'hvrne before back'Pj' r 4de' 'Stur%ley by Rtch"ri a orr, L. S. /,;��o E ALL M ERS kPB /n ENTS 74 AjCcu,t4iy OF. TAPE ME.aS�REM6�+tS