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Home My WebLink About2881DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.13 -1 -73 BOX 24 egos !7N 1 oil T r IN = L .�' .� 11woolool q \� px, )EPARTMENT : OF 'HEALTH ee /th - SvWces, !:arms/, N Y. 40512, Permit e - !'. V -3- P WAGE DISPOSAL SYSTEM 'Town or Village ..... _. .... .�+'! ' -i-:1 - .,iy v7y,1 • _ "-3L-:.�1� -? �.t. _ .... '.�e yea . r . - . Rl .c: / Located at ' LJ Owner ,. I J- /. Formerly _ Tax Map Lot p q. �, - subd. Lot 9 Separate Sewerage System Duilt Addis by , Consisting of Qal.,. Septic Tank and • '�`� Othe/ req6irements Tk Water Supply. Public Supply„ From ` ' pRIV' ts' Supply ill By /+ Address' ' - Building Type `.ILBn/I No. of Bedrooms_. Has Erosion Control Been Completedt I certify that the,system(s) as listed serving the above premises were constru tad essentia: of which are attached), and in accordance with the standards, rules and're ns, in'ac Putnam County Department fHealth.. .t. - . Date Certiiletl by / LU Address Any person occupying premises'served'by the •above system('s) shall Riomptly` take such action a conditions resulting from ;`such usage 'Approval.of the •separate; sewerage system shall become available and She approval. of the, °private water, supply shall become null endsvold when: a -publl subject to modification or. change when, In the judgment of the Com, I f Health, suc Date Rev. 9 -81 - m n o .the pians of the completed work ( copies h ejiled plan, and the permit issued by the P.E. R,A. ` License No.' issary to secure the correction of any unsanitary Id'as soon as-.a public sanitary ewer becomes sl> becomsts avallabW Such 'approvals are ,0` TOWN OF,PUTNAM VALLEY WELL DRILLERS LOG AND REPORT - - WELL COMPLETION REPUK'1' " This report is to be completed by well driller and submitted to Bldg. department, together with laboratory report of analysis of water sample indicating water is of satisfactory bacterial quality. Well Location Tax Map Well Owner N Street Mailing Address Sec. B1. City.or. Tel. # Lot Well Driller Name / Mailing_,4 dress City or Town f _ CASING DETAILS YIELD TEST ' WATER LEVEL SCREEN DETAILS Bailed Measure from and surface Length Ft. or "�" x Pumped Hrs.�Static: Ft... Make: /��; When Bailed Slot Diameter: 6-/.,Inches I Yield: S GPM lor Pumped Ft: Length Ft.Size � e Kind : Diameter In. TOTAL DEPTH OF WELL Feet -- Depth from Give description mf formations penetrated, such Ground Surface as: peat, silt, sand, gravel, clay, hardpan, shale, sandstone, granite, etc. Include size of _ gravel . (diameter) -and sand (fine, medium, coarse)*, color of material, structure, (Loose, packed, cemented, soft, hard). For example: O ft. to 27 ft. fine, packed, yellow sand; 27 ft. to 'Date Well Completed BLS 1 -77 . -COUNTY DEPT. OF ntAL 1 n! ._...._.. Date of Report Well Driller, . Signature Owner or Purchaser o Building Y Municipa i.ty Building Constru6ted by Aw4,4 ;a/ 24),w L - ocation - Street Building e ,2*14i4t,* e10 -e7l _2 -le-1 Section Block Lot GUARANTY OF SEPARATE SEWAGE-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 guaranty to the owner, his succes- sors, 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 initial use of 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 occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the de- termination of the Director of the Division of Environmental Health Ser- vice,s of the Putnam County Department of Health.as to whether or not the failure oz' the system to operate- was- c*ausau -01:- negligent-- - act of the occupant of the building utilizing the system., Dated this ^ ': day of ; ?< 190, Signature Title f corporation, give name and address) ------------------------- THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health X3....4; — .— . A e %'I—# Owner or Purchaser of Building Section ... 1d3._i`yC '- 'Tl�;?'.3 IA/ 6-s 7- �7/_l V-0 Location - Street Municipality Building Type q.1Z. Lot Subdivision Name Subdv. Lot # GUARANTEE OF SEPARATE SEWAGE 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 success- ors, 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 initial use of 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 occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the..determin- ation of the Director of the Division of Environmental Health Services :,f t.ie °Putnu f County- rye +. „t:. ±`r.�! "th.:a.s:..to_.whether.-or _not---- �-_ -- ure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. st Dated this_ day of S,--V 7` 19 Signature Title nt:CEIVED Corporation Name if corp. /V L� --1 e SEP 11993 Address - - - - - - - - ��3� IVA THREE (3) COPIES ARE IxE� WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health ORKTOWN MEDICAL- t_ABUKA IUKT tnnl,. P.O. Box 99 321 Kear Street Yorktown Heights, N.Y. 10598 245.3203 LOCATIONS: k321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245.3203 ❑ 201 BUTTONWOOD AVE.. PEEKSKILL,.N.Y. 10566 737.8777 ❑ 495 MAIN ST., MT. KISCO, N.Y. 10549 666.3335 ❑ STONELEIGH AVE. (NEAR HOSPITAL), CARMEL, N. Y. 10512 278.9330 1 L �zco Z3Z0 J' LABORATORY REPORT mg /L LAB # A (V 1 DATE TAKEN: gp�7�� -8$ ;_ DATE RECEIVED:s2_._..s.." DATE REPORTED- '9-1(- ((_' SAMPLE SOURCE:�Z REFERRED BY: eras Iw.a COLLECTED BY : yvi(-, iia(Pe� ❑ ACIDITY .................. ............................... ❑ ALUMINUM ................................ ............................... ❑ A , ALINITY .................. ❑ ANTIMONY . ................................ ............................... BACTERIA, TOTAL /mL .. ........�.il! .................. ❑ ARSENIC J ....... ............................ ............................... ❑ BOO.5 DAY ................................... I............... ❑ BARIUM ....................................... .........................:..... ❑ BROMIDE .........:......... .............................:. ❑ BER:YLLIUM ................................ ............................... ❑,CARBON DIOXIDE, FREE .............................. ❑ BISMUTH .................................... ............................... ❑ BORON ............................... .............................:. ❑ CHLORIDE ................... ............................... ......... ❑ CHLORINE .. ............................................... . ..... .......................... .... ❑CADMIUM , . ........ ............................... .................. D CALCIUM .................................... ............................... ❑ COD ......................................................... ❑ COLOR ........................ ....:......I...............'... ' ❑ CHROMIUM Itot.) ............................ ............................... ❑ CYANIDE.' ................................................... ❑ CHROMIUM (hexavalent) .................... ............................... ❑ DETERGENT. ANIONIC ... ............................... ❑ COBALT .................................... ............................... ❑ FLUORIDE .................... .............................. ❑ COPPER .................................... ............................... ❑ HARDNESS ................... ..............:................ ❑ COLD ........................................ ............................... C] MAN COLIFORM COUNT/ 100 ml ... ........ 0 IRON T COLIFORM COUNT/ 100 ml .........: .............................. ............................... ❑LEAD ❑ CONFIRMATORY TEST .................................... ❑ LITHIUM .................................... ............................... ' 0 NITROGEN. AMMONl.A ..................................... ❑ MAGNESIUM .............................. ❑ NITROGEN. KJ�LDAH`L ............... `...... D ,.;:. ?:•C:.NSSE v.. _..� <,_..- .1+. .r•. ie`e ,•e' _. -._. _. ❑'NITROGEN. NITRATE ... .......................... ❑ MERCURY .................................... ............................... ❑ NITROGEN. ORGANIC ...... ............................... ❑ NICKEL .........................:.............. ..................:............ ❑ ODOR ....................... ............................ .... ID PALLADIUM ................................ ............................... ❑ OIL & GREASE .... ............................... .... 1 . ...... :❑ POTASSIUM ❑ pH ........................... ............................... :0 RHODIUM ................................ ............................... ❑ PHENOL,.... ............................................. 0 SELENIUM ............................. ............................... ❑ PHOSPHATE (ortho) ....... :.......................!...... :❑ SILICON .................................... ............................... ❑ PHOSPHATE ( condensed). ... ............:.................. ❑ SILVER ............. ............................... .......... ❑,PHOSPHATE (total) ..... ............................... ❑ SODIUM .............. : ............ . • ......... ........l!.��l!..... ❑ SOLIDS. SETTLEABLE, mi /L .... ❑ TIN .............................. RlFt'. � .......................:....... ❑ SOLIDS. SUSPENDED ... ............................... ❑ ZINC ............................:.............. ............pp................. ❑ SOLIDS. DISSOLVED ...................................... , .,o .............................................. SE-p ..... I.1 %Q3.............. ❑ SOLIDS. TOTAL ........... .............. .................. ❑ ...................................... ............................... ......... ❑ SOLIDS. VOLATILE ........ ...... ....... .................... ❑; REMAR KS: .............. ............PtfiT(�AItA::CADUNTY ......... ❑ SPECI'F:IC CONDUCTANCE ............................... ❑ ........................................... DEPy:••0F'•MEA►LT•H.......... ❑ SULFATF ........................................... .........1 ❑ .................................................... ............................... ❑ SULFIDE ................................................... 0 .................................................... ............................... ❑ SULFITE .................... ............................... ❑ ...............:.................................... ............................... ❑ SURFACTANTS ...................... .................. ❑ ............................................. ............................... ... ❑ TURBIDITY ................ ............................... 0 .1 .. ........ ..... ............................... _ ._ _....... THESE RESULTS INDICATE THAT THE WATER WAS F A SATISFACTORY SANITARY QUALITY WHEN THE SAMPLE WAS COLLECTED, THESE RESULTS INDICATE THAT THE WATER DID MEET THE SATISFACTORY CHEMICAL QUALITY OF NE14'YORK STATE ADMINISTRATIVE RULES &,REGU TIONS, DRINKING W R STANDARDS (PART 72) FOR THE PARAMETERS TESTED. , nTRFRT N PADOVANI M.T (ASCP), DIRECTOR: Charles P Winter /Architect Route 9W /Grand View/Box 441 Nyack NY 10960/914-358.-3577 7 SHE IZmSIC>f!NCE Orr �44-2' -P,(Dy VOLPE L4>\1A=—I' �z sHorzz, rzz>. Wel-L PL,TrN�M V4L.LEy EXKTI W49 tsi^MA'acr RECE9VED SEP 11983 ' PUTNAM COUNTY DEPT. OF HEALTH 0 -k# ,23A -4 EWA ExicaTING Nye .o 0C • FLOOF- F-1-1. 106.06 0 7�P of CoNG Sic r tu < U td IL P al I- W 7Z 6*0 CI. < .1 Charles PWinter /Architect Route 9W /Grand View /Box 441 Nyack. NY 10960/914- 358-3577 7..:.+..... I � f ► EXISTING 0 MAP I- Ike • �• fsl N . G �111fl11,1111111 ;IN Iun.nr-,■ acr WILT LoCAnotJ q= Coic• Pi ST raAES r� Q '9 Y re ,.- by To aF 5LOM LWVOL- t oU,-r SOIL EXISTING APP¢OVeD R.o.p, FILL i3V I LT 4°' RECEIVED S EP 11983 VoLPF- PUTNAM COUNTY A,-C7 gV 1 (,T . DEPT. OF HEALTH 68? 98�� 4 ��j• rth8 BS QCISTINC I`I N. arZAOE S 4 NTY" �DEPA HEALTH A it TMENT �16V, T ..,.,PUTNAM" Division -t' -k;i vir6ilih 6h`61 ,Health" Services, Germ 4- V w SEWAGE DISPOSAL SYSTEM -V if )wn, or, Rage 7� 7, via S'u-26diiiii1c, Own� 47 0.1 Vfz ��'j&j, Building :Type Lot ,'Area , �.kabita b ie �:s pace rr Number oUSedfocins 911 OW Total Squird,',�Feet Separate A, ewerage�,SystemY,.#d";qbnsiii I _,Se tic, Tank zi, I ,�.,.,,,,, e. . O�,�De cons rucvpu� by m , C�, SUPPIV 4'Fr Water� Supply: Z b- r i e Private S e y T. :7 -71 Xt Requirements W R_ Other , -psible hi)' separate sewage i.,�iI W pp -sal.`,systern' pcifticp�,tpe!! maccordance , , d 11 6,6�6.,sta i.- I�s�anSlrregy ibovC' bea, ki"I r! 1 _ , p: 0.,p App', - ,CRUW y Department of Health, and ' ' � - .- .'- ' 7V Health will be' ju bnittid�t6 the Department;,0nd�a *r PL �qh- ' ,j4a�int6e� ;, _Fn hed�heowner_ qsMcqe ssorsihens or y th6:bi buId6r-WiII pt d 6periinj-i� any pewAge disp em id d'Of.twc , ?)-yefrsirpe Iiiiely foifo� thedate:of-thel si �:-4n6e'Vf ;ti.he `40provaI . , "W 5rf4c - 5�1 C orp'Jp" a ncp-qf mq, req pa.lrs hat -' t , he '(r,il l m will be 1pcSx pq.a s, T qy n on approved p an-arad4titsiid well will a in co dance `standads,, rules; and r9gy!a loop C y epartment of Health , cN f fM P E A."A 4 41. APPROVED FOR CONSTRUCTION This:approval -e* ires one ,, year. the' date, issued ,-.unless to ruction of the b uj I ertaken and. is 1 �of �cqpjm.ruction isio H n. I Any _change 1!'e j z `6r. n4j�� 0 or-modi sar .or., considered= isp f. I k4 ij irik' A 4161�f pUrrnii� sa FOY ;W r7 Title ` Z L ; Notes. -;1) Te`ts to.be repeated at same depth until apppproximatelyy equal soil rates are obtained a,t each percolation test hole.. All data to be submitted for.: review,,i 2)o. Depth measurements to be made from top of hole. PUTNAM COUNTY . DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES °CaiilV'1'Y `U+'r�1C "]3ITTLIIVG, `CAIMEi;;' 1V. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner .....- J,;.:., ° ✓oGP�' Address .an✓�c.s �fieK - PcrrivAM i/•acGEy Located at. (Street � Sec. 47 Mock Lot ca a n earest cross. s ree ...... Municipaltg,.... ..Watershed _....,. SOIL PERCOLATION TEST DATA .RE UIRED TO BE SUBMITTED WTTH.APPLICATIONS Hole Number.... 7�.. CLOCK.:..TIME . PERCOLATION .. _ PERCOLATION Run Elapse Depth to Water a er ve ., No. .. ..::..........:....:::.:.::.. ". Time From Ground Surface in Inches- -... - =. Soil Rate Start -Stop ` Min. Start Stop Drop in Min. /iii drop :. Inches Inches Inches 1_ ...... :37 4 : a, .. . 1 3 Notes. -;1) Te`ts to.be repeated at same depth until apppproximatelyy equal soil rates are obtained a,t each percolation test hole.. All data to be submitted for.: review,,i 2)o. 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. G.L. L.. . 6" y U 12" / F F C 0 6 19�i 1811.. •c. PUTNAAA � CC TY } 2411, , ..::....._._. .... �,....._... . L ®F CEP t�e�aLrr� 4211 y 48" �. 541 WH. 60f' 0� 1 66" sr 72 - .......... .. it 78" 84 �► rzocc l� r.,E INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE -1:= •TO• WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED ce %fo TESTS MADE BY C AjZ4C —C WIAIj IL Date Ut _ - -..r. _._.._ .... _ .,._ .w.... _ ... Soil Rate Used - . /S ° Min/1 'Drgp:. S.D. Usable Area . Provided No J7 p Capacity i000 Gals of Bedrooms - Se tic Tank Ca ,CONC2�rE Absorption Area Prov de By ?.80' L.F.x24' 3b". iVame *4< bigna.ture ju Address T'9N/ SEAL } % d °-p 6.8 9 a Zl THIS SPACE FOR -USE' BY "HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal Checked by I Date 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. Owner .�..,:.. ✓o[.�E Address A/3eL-E �-}rAK . pc 'ti.¢rt/i ✓'.4444 Located "a' t (Street GV, f,? s% r v2 Sec. 47 Block / Lot ca eK neares cross. s ree ........ Municipalit Watershed . TEST DATA REQUIRED TO BE SUBMITTED WITH'.APPLICATIONS Hole Number`.!,.. CLOCK.. ...TIME . PERCOLATION PERCOLATION HIM apse Depth Eo Vater Water Lovel,, No......,:;....... Time From Ground Surface, in Inches... ...Soil. Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 2 3 2 5 . Notes o 1) Te`,�ts 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 N G.L. /��, nEr ea igQ:i --- 6" h PUTNAM ®FPT;. of HEALTH 48" 5411 J 6 0 it .� w RID 66 AV 72 �► el-AV X®AAJ 78 rr « 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO- WHICH WATER LEVEL-RISES AFTER BEING.ENCOUNTERED TESTS MADE. BY . C Date /to .._ _. DESI GN . Soil Rate: Used 45" Min/1"Drpp: S.D. Usable Area Provided-, '70"x 40 No o f Be drooms Se p tic Ta nk Capacity � � Gals. Absorption Area Prov a By,2 **® L. F. x 2" e Address THIS SPACE FOR USE BY -HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH Hole. Z Number.•....CLOCK..TIME PERCOLATION... PERCOLATION No. ..... ::.;,.;::<v :.::::" Start-Stop ;, . _....,.. Elapse Time Min. Depth to W&ter From Ground Start Inches Water ve Surface in Inches Stop Drop in Inches Inches . :Soil Rate Min./in: drop /7. I /.b 71/ Ir /tr :. rz G Notes: l) Te t� s to be repeated at same rates are obtained *at each percolation for.:reviewo_'.., .:, . . `2) Depth measurements, to be made depth until a roximatelyy equal soil test hole. All data to be submitted from top of hole. 1 TEST.PIT DATA REQUIRED TO-BE SUBMITTED IIITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. . G.L. 4AjA:: -Azv" F®d-d- .611 �Fu 0 61992 12" . .; .. ®1 N'41A CoUjyT y 1811 241' 42 Cr49~0d. 48" 66" 72" 7g" sa 84 If INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVELTO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Ce�1s�$' //�� Date J U4Ae ®a_ Area Provided--?0'6: * 40, -® DESI Soil Rate Used � - ®51- Min/1' Drpp: S. D. Usable No.-of- Bedr6oms_ - Septic Tank Capacit Gals: Absorption Area Prowd�ed * L.F. x24 , . enc l�Tame C_—s/a "r AV IC _ ®TV-,�,CP 1Mmm u I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENV IRON .MENTAL'.'.EAT:'?i�_E�VIGES ` Date Rea Property of � ' L t (7 V 4f Located a t !,I ✓4,(f � 1 Section �{� w Block J Lot? Gentlemen: This letter is to authorize a duly licensed professional engineer or registered architect V (Indicate) to apply fo.r a Construction Permit fora 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 Departmdnt 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 r T�f -o.rr --i w.L cir the provisions of Article 1!}5 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigne ° P.E NY4. *�oKP> rer, qW WACKr 0• Y. (seal) Ad ress 160 s 1;17 g Telephone Very truly yours, Signedjf Ovfner cVf Pro rty Address Telephone :r, uharles P Winter /ArchiteCt Route 9W /Grand View/Box 441 Nyack NY 10960/914-358-3577 CLtIVED m HOC . I. - [ 0 ea 0 61982 P Z40MF COUIVI. y HEAL-rkj 2 6'rhcV.1es P Winter /Architect Route 9W/Grand View/Box 441 Nyack NY 10960/914-358-3577 XECEIVED nF*C 06 1982. PUTNAM COUNTY DEPTA OF arZA=02 TO .01vilmr/., HEAL TH ....... tA % .......... . . ...... • .4S ... . ....... -Tor oi= . ........ fLA-4 45.5 LW F-T VOCMLS/CW� r_T_ P*1 E;ICA Ip LCEVVL,�-" P-XI4r*nNCP ISILTrL=7 rZO.b, FILL -6 A P. 6898 Yutnam County' Department of Health .�'I Division of Health Services J ;Ii- r! '� :-� - r I 070- ,.,o-I_-Corr,.a,'.ico with 1 -0 the �4 Oils 01 S"W-nature 41 Data Q PUTNAM COUNTY DEPARTMENT OF HEALTH r.. DIVISION _OF'11Ts�,T•R?s^�yR'_A_�,- H.o.SF Z.CFS COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner %�� %' J t . dt�? ..�aIf-e Address We'r Located t . ( Streetr�c See. 't /% Block Lot 1 n ca a neares crass street) .. Municipality...... p-:_ �` _ ,.. . ' Watershed.. .. .... -.:: ...:. :..SOIL.PERCOtATION TEST DATA UIRED TO BE SUBMITTED WITH,.APPLICATIONS 4 3 Notes: 1) Tests to. be repeated at same rates are obtained at each percolation for.review, .. ''2) .Depth measurements. to be made depth until approximatelyy equal soil test hole. All data to be submitted from top of hole. oe Number ..._.CLOCK..TIME. PERCOLATION PERCOLATION Run Elapse No. ...:...............:.:.,.'.: Time, Start -Stop Min. .... .. D-epth to W&ter From Ground Surface Start Stop Inches Inches a er. L§vei in Inches Drop in Inches • . Soil Rate Min, /in drop 4 3 Notes: 1) Tests to. be repeated at same rates are obtained at each percolation for.review, .. ''2) .Depth measurements. to be made depth until approximatelyy equal soil test hole. All data to be submitted from top of hole. TEST PIT DATA REQUIRED TO-BE SUBMITTED WITH APPLICATION DESCRIPTION OF' SOILS ENCOUNTERED IN TEST HOLES ?aFPT?? . HOLE: NO,- 1;,,,0 "012 '.NO.� G.L. 611 T ®P Address SEAL �►- j - -(a� THIS SPACE FOR USE BY'*HEALTH DEPARTPZENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by Date Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services 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 September 26, 2002 Doris & Gary Carney 93 West Shore Dr. Putnam Valley, NY 10579 Re: Addition - Carney, 93 West Shore Dr. No Increases in Number of Bedrooms (T)Putnam Valley, TM #64.13 -1 -73 Dear Mr. & Mrs. Carney: 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 25. 2002 The addition is approved with the following conditions: ' L The_ total number of bedrooms must. remai at il?IT - >— tiith��a } -YIiC� aFprvL'ai ' .. by this department. 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. 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 William Hedges WHIM Senior Public Health Sanitarian cc: BI BRUCE R. FOLEY Public Health Director _ ... DEPARTMENT OF HEALTH LORETEtk )WI.rNA,.RT ? Iti:, Af: .W. 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 ONLY) STREET73 WW 9P915 OR-107- TOWN Fib` 1V#f VALWI X MAP# (off % 3- I -73 POPS &QW-1 NAME C~ OR,! PHONE &IT "5�74' 3 ASu PCHD# MAILINTG ADDRESS q3 t/F- PU 1/ " LEY /V y 10 7 DESCRIPTION OF ADDITION f�X i �;WV t<_ i T c= j-WA NUMBER OF EXISTING BEDROOMS_ 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 suh !it `pis fo^:: and +,hc fcilc,ovilt 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 0 BRUCE R. FOLEY LORETTA MOLINARI R.N. M.S.N. Public Health Director �� t�� . A�sociute; - 4P..:5lrc, .%J.altt: D1:ect6P' .. '" - Diirector 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 (845) 278 - 6648 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Gentlemen: Re: p 3 14" ,Pt? y� ' o Residence Tax Map Town According to r cords maintained by the Town, the above noted dwelling IS IS NOT in compliance with Town code and the total number of bedrooms on record is This information has been obtained from: CERTIFICATE OF OCCUPANCY: L� ASSESSORS RECORD: MIAMI uilding Inspector BFhouseguidelines �°�