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HomeMy WebLinkAbout2704DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 61. -2 -13 BOX 23 91 111115 1 j y X64 T -' �` : -: . 02704 M. 'JW12 -9110.' t6 pUTNAM'COQNT1f,DBPARTMENT OF 96Am. Cmimiol, X. IN i2m PIQVMS P0101111 S T, 7 Nal*�J,6,"E,d A62� _11':;' _`7 4— P Applicant Nam 16.16.41.1 now El A0`1119- A' irm! .16 Date , pp •101119 -Adtimis 4b, Ro TOVIU'<f a' ZIP BWldtn rype Izg4bl—A Ce., iot: Aiea 1 t5. A/S 'Fib So d�- oitb'. Depth Vollizzi ID Number d, Bedrooms . D.1 P'D:A�I� NatdI666flip- Required When FIU,ls completed, _ moyste0a eon ist of to �O� P-11 0 To* cofistm Addreos 1witir V.&I ort E eIvate tiipk poij Addirin Ilthor gog.u1minenti M - ------ represent that i am Wholly and corriplitily la�;ol -t hie,ties!q n,apo -.,ipcat ion. ., o. the proposed,systern(s); 1) that the separate a sewage disposal's Xstem -there toarid'in'accbridanc ;with the'standards,l rules and,," Sumorn n a ulat Igns Or :,tpe, I .above, described will bi dnitruited as'sho�h'o� thi4ji�ioved arritindinint of actory- the • Co ,lco-uinty pepartment 'Certificate, ,o,i.,cpn ruc on , _and that on completion qerao,.�, j� ca e it I I"'"' to rnmisslonpi of,H16111.11ftwill hw., Sul o"A nd oWn6r;'4ist successor ho�rs o,,fsiiqni by the build :to-q_,thi,,6..­ rno!jt.,�` "written qtiiiintei wili-bti-46hiktiad� the I or, that sold b4i!dor will ce In 209i $1 iitily foil6winj thed ti'of th _ i . :. - yeat's IfrmeO a ls'lssu- par :0 Se. 9 gulp, I , , 'f ­ I ' ' " llanceY,6jl:Ifie. ­ - I 'i therield; 2) t a disallbod above 4niS Of 'the SpprO4jl_jjf' thj�LCojt'jifCjte 0 Cpns�rucItqn,!j:or"0 hit, th' drilled well locat" as ihawr� on,the,appr6yed'pian-anis iiih an th­ li� dair;d�i. ree—uTaTo—ni.of 'the_ F14triar" in I r 0 r p4n! pat t 0 1 Data P.A. —License NO fS APPROVED FOR CONST RCfl6N T�ls approval expires t _U,: wo iim from the d 4 ued -uniess,construction, u of the building has been undertaken' and is revocable for ca6 1. ja or m ay W amended or"Mqdifiod when Bred ­­� sary Health. Any Change or alteration of construction requires a - 'disposal of -do 'me, c itaiy ­ On AWL iy: 1/87 Title In +^ r+..,. t..^' rec--.- a+t pv. �.' .'w +v:.,,....,p..•-- ....+r..n.. .mac- ...ve>„...- ..- +wa..cz +•> +rer._<'�ay" "s'.' ..... °"", ±;Fx T"� ^ 7V— PUTNAM COUNTY;DEPARTMENT OF HEALTH Dlvlsio of eee'to Provide Permit # 1!!CE'V. n F�tvlronmental'Healtb Seivlcee. Carmel Nlf 1051? Page on CERTYFIC OF 0A4PLIA`I ® �� O TRUCTION PERMIT FOR SEW SYSTEM ralGG�dt�0�4TJ LG - tea bt - Town or e Slvislon Name Sabd Lot # -Tai MgepBlockLot GL�TLd�/t?T'`8,. �9 C_ h�i�s /? L.�s �%s�►�"71 %�'�, Owa®r /Appllcagt Name `F:2� F'.FZL / e vowel ❑ Revisloa : ❑ �yP� Date of Prevloa® Approvsl' ,��' A(faWng Ad&e ®e Town_d�C �%' -Jit✓ Zip %d Banding Type�� Lot Area Fill Secdoa ®nly De tb Vol>mno, P ... Number of Bedrooms Design Flow,G /P /D ��� PCHD Notification le Reslalred Wben D?IIl ii complet®d Sepaeate Sewerage System to comilit of A/ Galloa Septic Taak -an `��° �• •% % ?`���R1Cr To be- bjrd ate'd1/1 /ASF°7. Addiee® Water Suipply: Pdblic,$apply From Address ort_�Prlvste Supply Drilled b '��/ Q Other Regair®mente ' e�� a r d represent tha -:.1 am: wholly and,,completeiy responsible fokthe deugn;antl location :of .the proposetl .systems) I that the separate `sewage. disposal system above :desciibid will: be constructed as shown on'. the approved amendrr ant there "to and in accordance with the standards, rules and regulations of e Putnam :. County Department ofa Health ;4and,that..on completion thereof a . Cert�f�ca6,, of Construction: Compliance satisfactory to the Commissioner ot,•Healthwill be submitted to the Department 'and a 4ritten:'guarantee will be d :the owner his successors, - heirs.or assigns °Dy the builtler, that said builder will place.,+n good::bperatnig cond+fion any part of said sewage tl�sposat. system during the period`,of of-two years - Immediately following 'theda4e.of -the issu- ance .of the approval of the •Cert+f+cate:'Of Construction Compliance of am or or any rspairs there{ ; 2) tlist the`dritled. well tlescritied above will be, located "as shoWn'on the approved plan and that said well will be,instalied -in accordance with the standard' rules and regula —f ons of 'the .Putnam County Department of Health Date /. Sianed'. P.E. R.A. T ®v License No Q Address f9t% APPROV1. F.OR CONSTRUCTION �Tliis ­ approval; expires'�one yea; from the date .issued unless onstruction .ot .the, building has been. undertaken, and is revocable for cause or may be amended or modified when considered necessary `.by the` rCommiss onor of Health Any change or alteration of constru�ctfion requires a new permit. Approved for•disposal oi,domestie sanitary s nd /or . YWate water supply only. ��/ ,�r/J0...rof 0 r Date 8y.......... Title a0ow dare►iOaA will bi Construdad as tt•own On` tM app►owd amaeWn+ant that to s n0 an aetwdanp with the, standiros, rums a , :►pu p; a am Comity DsYNtnwit _of . NMlth, 'and 't" oii conipNm'6 '6 t Cehificat� of ConstruIglj ;fomplfan.* Ytisfsdory,to.the Coenmialonir of.mes"hwill M . subrnittw- to aM OsOartmant, and .a writtan fluarantsia will;M furni~ tM 'owna► hl! fifco ifgs, MNa or anip►s by thli butlsla►, that Yi0 Ou1Mai will Qlop, Ni- p00 operatiog .cowdltion any part. of smid sawaaa AMPOSaI; iyfNm AurbiO tM fM!iod of two (_) Yes ImpwdiatNy followtny tMlMta Of tM Ifsu- anoa of the approval'.of t1» Caitifkate of Construdion :CoTpMnp o any !,pairs thwotoi "2� tMt tM dri1N0 wNt si.>oefro.e above wMl.be M"t" as shgwh 011 tM'ipp►OVadjplan aM1 tMt saW wNl will M InftalNa hl /damp w�Nh t%M andaidi<; rubs .insl n/u aii%ns of, tha, " PutMT .? Y Cei1MY ftnnlit o< Maalth OaN Sip1b O.E. =t� RSA{. AdA►aM 'ASSbC.I 52 , Lieomo No 3599 v r. ArPROVEO fOR, CONSTRUCTIONi ThN apporal axpMSS two yaau fioT fM Data Iquad unless Canstrudfen of tM buildins has bNn ul,ifartakan ind is fw04bli for;Causo,oc'nNY Ora11Ni�0�0 or h10ANNO whan:COesWMi011apfnry by ' the: Commissionei'ofcMMIIN Any Chaego or'slisiatWe of.'construttion pper,.,, faOYNN. t •Mw pa►mit. Approsa0 "f0r `dhpoYl -ot doTMk sanita�y sawap; an i., to water supply .only. Data V.QI mil. �Y L � —�TitM 10/88 _ .. „ s 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 PCHD PERMIT WELL LOCATION Street Address Town' Village City Tax Grid Number GA 0FL,'S ®u-0 WELL OWNER Name Mailing Address 9&rivate 0 Public USE OF WELL 1 - primary 2 - secondary RESIDENTIAL ® BUSINESS ® INDUSTRIAL 0 PUBLIC SUPPLY ® AIR /COND /HEAT PUMP E3. FARM . 0 TEST /OBSERVATION U INSTITUTIONAL 0 STAND -BY ® ABANDONED 0 OTHER (specify AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED t/EST. OF DAILY USAGFL o gal 0 REPLACE EXISTING SUPPLY ® TEST /OBSERVATION 13. ADDITIONAL SUPPLY WNEW SUPPLY NEW DWELLING) ® DEEPEN EXISTING WELL REASON] FOR DRILLING DETAILED REASON FOR DRILLING ­` WELL TYPE ADRILLED El DRIVEN ®DUG OGRAVEL. [3 OTHER IS WELL SITE SUBJECT'TO FLOODING? YES 1'K__NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: e's 14 11 �t 96 Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: T��. TOWN /VIL /CITY 'DISTANCE TO PROPERTY FROM NEAREST WATER AGAIN: ���.`E� Ta}P�P -b. Or lc MIS LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET �0 /•a tin .,, r (date) (s gnatup PERMIT TO CONSTRUCT A WA This permit to construct one water well as set forth above' -i4s <•grant,dA u /rider the provisions of Subpart 5 -2 of Part 5 of.the New,York State Sanitary Code; and_:pidVided that within thirt; (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 19 5 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller W13"ILOV.10m.1173 tiff. DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSALy SYSTEM Y -FILE:W.. Omer rZ� ' Address 177 Af7 y4i2 /L�I,JN Located at ( Street) 4gA10 � Ate) 947-) Sec. Block Lot (indicate nearest cross street) municipality Watershed WITH Date of Pre - Soaking Date of Percolation Test 2 /0/:3 laZ 5 HOLE 3 /UAL -- 4_3 REBER CI= TIME PERCOLATION PFRCOIATICN Run Elapse Depth to Water FYom Water Level No. Time Ground Surface . In Inched -Soil Rate Start -Stop Min. Start Stop Drop In Min/In Drop / Inches Inches Inches 4 /63/ 2 /0/:3 laZ 5 /Gel/ 3 /UAL -- 4_3 l 4 /63/ 5 /Gel/ 4_3 l 2 3 4 5 5 rev. 9/85 1. Tests to be are obtained for review. repeated-at same depth until approximately equal soil rates at each percolaticn.test hole. All data to•be•submitted 2. Depth measurements to be made from top of hole. TEST PIT DATA MUIRED TO BE wns APPLICATION _. DEPTH HOLE ! _ r __ .. - 'r -N0. l r - HOLE ND. FiCliE : NO. G.L. A" jx 4' 51 61 tcrt 7' 8° 9' 10' 11° 12' 13° 1;' INDICATE LEVEL AT WHICH GROUNDWATER IS ENOOUNTE ED iVDrJE INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENODUNTERED N01%) DEEP HOLE OBSERVATIONS MADE BY: DATES DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided Sao No. of Bedroans Septic Tank Capacity OC C) gals. Type Absorption Area Provided By j L.F. x 240 width trench Other u��T,q /ry ��2A��cl ML 3. Name c-4sl"lli 45500-1'y� Signature d ` �1 e - V7 � , �� G9j'�E'L /U SEAL. Address , L • ZZ • O,c Tll F STN` �; ���" THIS SPACE FOR USE BY HEALTH DEPAR'IMTM ` OMY: Soil Rate Approved sq.ft/gal. ChecW by Date a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 7Z 7--- - Date Re: Property of Located at (T) ?�3M,*W LC.G Sec' t ion Block Lot Subdivision of -0 Subdv. Lot # -Z— Gentlemen: .Filed Map # Pate 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 t' ri-"-s!yifems . 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., # Address Telephone Very truly yours, Signed Owner of Property 1-775 fzn�'ki—/ Address YO 12 A-1, Town Telephone Utr'AK I MUN i yr t" AL I rl Division Of Environmental Heajdh Services a TWO COUNTY CENTER - CARMEL, N.Y.. 10512 (914) 225-3641 ,. ��, . .: �,._ ,'.. �� .-. .° .- .. ..... s ` a :- " i�'..a:..u.. ..a .., •- -.:. =... ,..,..._.: "s'o•' o-.+^ ....- . r.�. -.<. ^b' : y :.a.� r:c"':V'. u. >. APPLICATION TO CONSTRUCT A WATER WELL / WELL TYPE IG] DRILLED DRIVEN Q DUG ED GRAVEL [-] OTHER .S WELL SITE SUBJECT TO FLOODING? YES NO .F WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:k� LOT NO.: +ATER WELL CONTRACTOR: Name-7oC6 L61725�Nll, Address: .S PUBLIC WATER SUPPLY AVAILABLE TO SITE: _ YES _�5 NO TAME OF STREEI AuokLss. JUMNIVI LAG T 1AX GAsO NUM80. $� ELL LOCATION jl/jj� yoGr c� � �� ;�A44A11/ftG� �� 'JELL OWNER NAME. • 6 AOORESS: 1; PSIVr.T[ 0 EUSLIC JSE OF WELL RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED I - primary ❑ BUSINESS 0 _FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) 2 - secondary 0 INDUSTRIAL ❑ INSTITUTIONAL ❑ aTAND -BY 0 MOUNT OF USE. YIELD SOUGHT 5 Of'N gpm. /N0. PEOPLE SERVED EST. OF DAILY USAGEC-�� gal. REASON FOR 7K NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY 0 TEST /OBSERVATION ORILLING ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL WELL TYPE IG] DRILLED DRIVEN Q DUG ED GRAVEL [-] OTHER .S WELL SITE SUBJECT TO FLOODING? YES NO .F WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:k� LOT NO.: +ATER WELL CONTRACTOR: Name-7oC6 L61725�Nll, Address: .S PUBLIC WATER SUPPLY AVAILABLE TO SITE: _ YES _�5 NO TAME OF PUBLIC -WATER 'SUPPLY: 141 TOW -N /V /C TO .:Fnnn EZm Y FROM— - N i -Ern E� r mi F.: .. .-•.:. - -, ^" _ - OCATION SKETCH & SOURCES OF CONTAMINATION � ter-' �� °, _ '• � � (date i`� (s ature) J PERMIT f 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 2. Disinfect the of the Putnam permit. 3. Submit a Well the Putnam Col until the water is clear. well in accordance with the requirements County Health Department attached to this Completion Report on a form provided by inty Health Department. Date of Issue 19_� Permit Issuing Official._ Permit is Non - Transferrable CERTIFICATE' ALM. v _.seweraw Sydo Water 3,Ipp ly ;X eulldlnv'� Typo ,. 1:0ertift". that`- `of rhioh.at�,!4ttaehad)rr'i Putnaw ti M HEA.- LTH Rn ENT OF airmel'••N. y "i0512 Pinut RUCTA MP'LfAN* E-� FICIA. 9El ON'CO' n .6 WAGE Di*SF;6SAL SYSTEM Putnam Valley ................ Town or %iiii 57 0 Tax map Lot pubcs. to 0 .6.2 t dd, JZ2 C*mle A '72;.Pt YdrktOwfi Hts N Y .4 , Tank in Ci ...... . . . . ---------- .... ... ......... IIJ arStreet - . . .... . .................. .... Yor N'. idt ---------------- r M --fit . r;:: 777 NO-�Of:'Bedoo PeOrn Nuod �'42/ VAL-- W.. above aeg-'ror, constructed essential with','-the 0'2=108 and regulations LA accord on. lara of the �c.Tlated work copies :4 ce -the f ed plan,. with. and )the permit issued by the L W by. K C X RI._ 14-Y .b nab No. thi., OMOtty take Such action as May 'Wit , - 1. be i emary to secure ihi': WO*wWaiii, lyltv� omit bacon- correction Of any Ununita►y water , sup go Ih igna,.Vold as w06 al • 'Me Id when , pu pp Y� bftoM,,...,,,publW Unitary "We, becomes Ib 0 Such SPIWOV818 are of Health.. Ahe ry. su Nf M.; st I nern bed .'ib6ve -1. Putnam 1''A: iW and Is DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT #M-51­8'S WELL LOCATION Street ' Address G.4 c?us Town /Village /City Tax Grid Number - 1 - WELL OWNER Name GGeAw" Mailing Address 7-16 'i`�. 4 � iAIb' AlY Private O Public USE OF WELL 1 - primary 2 - secondary RESIDENTIAL ® BUSINESS ® INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify 0 AMOUNT OF USE YIELD SOUGHTHId 5 gpm /# PEOPLE SERVED I4" /EST. OF DAILY USAGE �cw gal REASON FOR DRILLING XNEW SUPPLY O PROVIDE ADDITIONAL SUPPLY OREPLACE EXISTING SUPPLY ®DEEPEN EXISTING WELL ® TEST OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE DRILLED ®DRIVEN ®DUG OGRAVEL OOTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: P� it-p- . Lot No. Z WATER WELL CONTRACTOR: Name -� Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:�,•>-rerhZ LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION �ON EPA SHE (date) (s nature) 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 s.hall: 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 pro=by Put County, Health Depart-'nt. e Date of Issue: . 19 Date of Expiration: 19 Permit ssuing fia c Permit is Non - Transferrable White copy: H.D. Fi e Yellow copy: Building Inspector 2/87 Pink Copy: owner Orange copy: Well Driller I I 1 ' '1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION`OF ENV IRONMENTAL.HEALTH SERVICES w: + "G�.a >:.c :..:t :. an-w•�••+- ±i•'= Y'S:nM••/ »'• .—�.. T -: .: _x.i. -.fie:. .�..ecx�el.`w :•v+.•.- ai.��r.+. .w.•. :r =..•s. .•wa.•s.. -, r..rnc.= w:...r�e .a ..cs o....�sn....►. ..ew++: t swla.�q :.iLr. =w ^.r •+t (Date /1-( °--) 1� Re: Property of 10"o McG,eAV�j Located at Y. Section . 1 15 Block I r Lot 6 z.._ Subdivision of \,Je&C jV -AL-T-2' R,•,z�sr Co . Subdv. Lot # 2 Gentlemen: Filed Map # Date This letter is to ,authorize C�sr -1�r•1 ��Ci.�- i'ES,� �. 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 eanneCtiq .yit thi4 ratter and.to SUperV se - -the• cons- truction• of .sai.d• .. _... - _ w.... _... _ .... . 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. 1 1 •. Countersigned: P.E. , R:A. , # li" �.sscx�is. -mss' �• C. Address Very truly-yours, Signed Owner of !; Address 014 2zs - 80 88 Telephone /NV 1 1 I • Property qq U SroZ.b Ny o 5 23 Town Telephone u I v - 'CONSTRUCTION,: ERMIT:POOK" S ' Subdivision L Bul I d ing- TyPe Number of Bedrooms nestyn Separate - Sewerage Sisierri to. consist _.­oi T :O:.P�,cq�Structed "b -75 Water SuPPIy 'Ppblli, ;9ther':ReQuIr merits ,ion Di Env#'6nMi9hf4V., 140- E-.::DISPOSAL, SYV YJ ':4 riprisint1kat U am wholly, and coirililetily� riisp6�ii6l�-f�r-�t�e;"�ign.�and_lo�atiofi'ro hG:prpposed--syit9m i, stem co , (S)VI 'that the separate; sewage d spoul s 0 m -a iescri6e�_Wih be.' nstructid asiho' .,(in the �awove;d.aniindineni iiiiii to and In accordance with the standards, ruies and re — _gulationsof the Flurnam beiiartment of 'it - that n6liaA�e'­ satiifactor ' io,64i dominissioner of. Health will, PQU.nty� -�I Hq8 ^ �and An 41 of ConstructipA Compliance y ;,,4rp_kOpO,,-the own or,- his sU cce sso!s�,, .,!a rs,gr . builder, that said builder will ,'�be submittiod'-;i6-the'�Dep�rtment.. ikno,,41,'i4eitieri,idirantii:�iiii� be f' 6 ' h 'i ; I . , - - - condition x , p 1 -1 - - assigns by thC ;place p_*$C-pd -piieriiini 'la , 4 - - ' `f '2).,y�arsiminiediately'ic�li"i'rig Ahe date of - th6:lssu_- I t of s9Wa4j.. di, �G� ijit66,d`6ring'46e period' PY -per m ;br­ w_6 , descr .,'ance pf;-A ;she f 2Aw"original isyste - - __ _4 thereto, ihai160`di filed- I ii ibed 6 apy;r9paws-, above wilt 'be"lo-c-At6ii as "",So ioawp, p accordance the utnarn. '691;arth�­ 't", f it '4 punty p Hea ll� .'Y -7, AY SS L N, Addre' Icense,' 0. 'APP1kpVED'FO R, CONSTRUCTION This one .y ­'ear from .the -date issued " u co"n st ru ti on..,of the building has been mL ndertake ' n and is rev 0afile or cause or may be amended P�jM�4ifibOW16n�MI ders necei sary. 4i the Mi ► :o4 .Health.., n hange o era t Ion 0 j -construct ion requires a new, permit . prov�f isposal of ctis on Mate • .9-81 W1 ., N -, PUl'NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRON[�[JTAL HEALTH SERVICES ' Date: July 30, 1983 Re: .Property of Lois Wege Located at Town of Putnam Valley Tax Map 57 1 6.2 Section Block _ Lot Gentlemen: This letter is to authorize Cashin Associates, P.C. a duly licensed professional engineer, to apply for a Construction Permit for a separate sewerage system; to serve the above noted property in ac- cordance with the standards, rules or regulations as promulgated 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 super- vise 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 Sanitary Code. Countersigned: Cashin Associates, P.C. 37 Fair Street Carmel, New York 10512 (9 14) -225 -59J �,,,•i SEAL Very truly yo , Signed e-- 0wn.-&`of Propdrty 149 Orchard Road Briarcliff Manor, N.Y. 10510 Address (914) 962 -4551 Telephone RECEIVE AUG 111983 PUTNAM COUNTY DEPT. OF HEALTH �JTRIAM CO�JN'T�l IDEPaRT'ME1�1'a OF AI'f DWlsion of- Environmen"ta/ Health Serviges, Camel N. Y. 90512 ' CON8TRUCTIOft! PERRrg9T ,FOR SEWAGE, DISPOSRL SXSTEN➢ Tow or V�Ilag n e t:uGa ed ai�t"�L S�•i��.'* " "8 " "..r...,yau�rs %- -..ter, idR ly�ap _ -� ' Tu'iO�.it' -�.. Subdivision Lot _ r • � Z . Job .owner Address n Budding Type '���� Lot Area ���� { C�,'(,O IVumber of Bedrooms Design :Faow �� °`� S Totals Habitabie space Square Feet ` Separate' Sewera "ge System; to consist of', r', ` C�.e -� Gal Septic Tank and ; " S = -� r ,'il ' is ' tZ �. t ��— :i -�is To be.constructad by Address Water',Supplyc = Public supply From „.. "Prix te'°SuPply to .be drilled by, Address Other Requirements `t represent that I am wholly and completely responsible for ttiedesign ;andlocation of ,the pi roposed' systems) ;'1) that 'the' separate sewage disposal system. " "above described will be constructed as shown on'the approved amendment there to and in accordince: with the standards, rules an regu a ions.o _, the Putnam. .County Department of Health,` and that on compieti6n; thereof a "Certificate, .of 'Construction Compliance" satisfactory -to the Commissioner of Healttiwill be submitted to the Department, and a written.guarantee will be furnisKed the owner his "succes sor; heirs_or assigns by the builder, that said builder will place in, good operating 'cond�t�on any, part of said 'sewage disposal system during, the period of two.(2)" years immediately following , thedate -of the issu- a&e "of.1he approval ;of _the Certtficate',of; Construction Comptiarice of the orngtnal `ssystem or any repairs- thereto;.2) that the drilled well.described' above will be located as shown on,the approved pl5n and that said well wUb be; installed n `ccordance' wdh t'(6 , standards, rules: and regula ions. of .the Putnam County`Departmerit of Health ` _ Date 5�9nefd�` P R.A. Address ( . �1� l �— CZ1� \ tC:L4 L'cense No APPROVED FOR CONSTRUCTIC+N. Thts'approgal expir ea0rom'tlie date' issued - Unless, construction 'of the building has been, undertaken and is = revocable',for cause or maybe amended'ormodifii dw` consider nece issioner of ,Health.. Any',-or alteration. of construction regwres a new permit Approved; for disposal of me n ry wage and %- :p iv a :water supply • only. f Date _• /► ►— ± Title . 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. 7806 Owner L- v i s Address �( /� I-{� }�,�, C_ , Located at ( Street GS n(c�!'v I-�G C)W !��_ ,Sec. ,5'% Block Lot �Tndicate nearest cross streeET Municipality N%t� Watershed T- k, �t L,(ouow SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION No. j Start -Stop apse Time Min. Depth to Water From Ground Surface Start Stop Inches Inches Water Level in Inches Drop in Inches Soil Rate Min. /in drop 1 5 19 2 C) i3 line - t9 3 10 Z-1 4 C) ' y1 2i Z2 �of� 5 W! 41 io 1 3 5 1 2 3 5 Notes: 1) Tuts to be repeated at same depth 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 from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST'HOLES• DEPTH HOLE NO. HOLE NO. HOLE NO. f ' 6" �� <« 12" 18" 2411 30 �N 3610 t` 42" C� 48'1 r , 54'1 U v 6011 66" 72 78 �► 84 INDICATE "LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY C.� i _ Date Soil Rate Used k Min/1 "Drop: S.D. Usable Ar C) 6Ci No. of Bedrooms Septic Tank Capacity ';�b 0 Absorption Area Prided ByL.F <x24 2 0 dth� c _ .`' .'"l .. 1 R. Tame U w!s rz is o� L- -r SiRna ure Address r3 �= �� S i �z_= SEAL 98 S e, V, �r THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft/Gal. Checked by Date NY z v 0), rN All, _ J�) / lG.`'✓953 7��,,,! "'' � ; 1 � j //j I p �( � % � i % I %i' ; ; � '� ---•' /�%e.,� /' �� I_/ �'i'�- \ f.. �� U ,,.: W. 47, L 4586 0 1, �O o �/ � �/ a �— O / .; 111 . flo 25 ad rx/ u 1585 (000 4584 510000 0 FEET 11 M 06to -w 4583 x 752 Cb 4582 I`I 'v 24 a IL 4581 A I 0'1'11�rVf JL V PUTNAM COUNTY bEPARTMET T OF HEALTH it:r,a" Date Re: Property of L._C 15 -y' t�= Located at Section Block Lot,._.. Gentlemen: This letter is to authorize ±1 ,W A > J� _KKILY 71K, a duly licensed professional engineer or registered architect (Indicate) to apply for a Construction Permit for a separate sewerage system; to serve the above noted property in accordance with the standards, rules or regulations as promulgated 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 1479 Education Law, tary Code. Countersigned -SI +ess elep one the Public Health Law, and the Putnam County Sani- /RpFESSIp °• !v40 P� A. KFC O -11i ^v" { Very truly you�s, Signed Owner of Property A dress Te ep one S�'IJ ?LT) CITECK. LIST Date:. �l _n.. r•.. �+� ..:_n -..i .•Y.v� �.. .1:'..v�.:.T �:Y�°.'L!.�m .�.rr..nr'u".... -.•rr l INITIAL SITE, INSPECTIOPT Yes No I Commerits Property 1.1nes or corners found . . . . . . . . Can estin -vate house location %0 Will driveway need cut d Must trees be removed -note these . -: V Is deep hole representative of entire SDS area -7 Additional deep holes needed. ' Sufficient SDS area available considering driveway cut,house location, separation . distances, etc T)FFP HnT.F TA TA Depth.: ©1/.� �� Z ,Water elevation: o ' j/S Rock elevation:.'? Soils description: Dat . FIML SITE INSPECTIOiti Insp. by: Howe located where shown,on approved plan SDS located where approved . length of trench measured Width of trench average Slope of the line and trench acceptable Room allowed for expansion trenches. . Over 50 ft. from sjramp, taatorc.Q.- arsek__ I soil -riot �u -�o�� Wunnecessarily graded 10 Ft. maintained from prop•line.and. 20 ft. from house Separation of trench from house; well etc. follows plan . . . 'Number of bedrooms checks . -Stories, brush, stwnps, rubble; etc : grea 'ter than 15 ft. from nearest trench . . . . .15 Ft. of peripheral soil horizontally from trench Junction boxes properly set Could surface run off from driveway., roads., ground surface, etc. channel near SDS area Does lot drainage appear O.K. in area of SDS FINAL GRADING OF SITE ACCEPTABLE' F�L II.TvT C11ECK SHEET' Cots Std.. ! es . I No ' li o use plans 0. K. - D---ir,n data sheet ! Parts presoaked? f NLin.6 30 perc test depth Const. results for 3 runs I D. Hole log O.K. i Corporate Affidavit for other than individual Authorization for engineer ! Letter from Water Supply if applicable If variance requested -such noted on plans &'4PNs.': DETAILS I Rhow f change is.prcpcs d,) Existing contours shown near contours) Slopes for-driveway cuts, etc. shown I Water service line location Footin& drain, etc. location I Top slope, bottom slope of fill. Percolation tests and deep test pit loca.ti'Qz 1 I i Septic tank size and conformance to std, 3 B.R. house minimum House setback shown ! .! f'tr• ll �•ur frq�' !� All water wlLnln "u I L . 'ol' rL shown I / Plan and P rofile SDS .....�: All other ..we11 s._ -a.nd :SDS.:..closer 200' .. �c�vc:li.._.ur � zsercreric� �ma.ae- - -- -• � ! � .,� t � i Property boundaries (metes and bounds- clearly shown)1. I SEPARATIO -\I DISTANCES SPECIFIED ON PLAN- 10 1 to P. L. _ ! 201 to Foundation walls 001 to Nearest well ! 50' .to stream, march, lake, etc. inc1. expansion 15' to Curtain drain 10' to water lire (pits -20' 15' to storm drain 10? to large.trees 10' from foundation to septic tank 5' to pipe from leader drain foo ing ar pro Remarks r- ear. r �1e,