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Home My WebLink About3133DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 63. -4 -22 BOX 25 ru sl ' 4r' ., '� wo ` LI T 1 �,■ i Ar , ■ 03133 .r Public Health Director DEPARTMENT 1 Geneva Brewster, New LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services OF HEALTH Road York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) %fiber 16,1999' Pauline Ciano 15 Rchard Drive Putnam Valley, NY 10579 Re: Addition -Ciano, Richard Drive No Increase in Number of Bedrooms (T) Putnam Valley TM #63 -4 -22 Dear Ms. Ciano: 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 latest revision date of November 16, 1999 and this Department's approval stamp. Based on the information submitted, the above mentioned addition is approved with the following conditions: 1. The total number of bedrooms must remain'at three without prior approval 6y1his 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. Approval is granted for sewage disposal only. 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. ML-jP cc: BI (T) 'Putnam Valley Very truly yours, Michael Luke Public Health Technician Y BRUCF R,-, FQj.FY - - Public _Healthh Director t..,... - Associate Public Health Director Director of Patient Services OEPARTIVMNT OF BEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax'(914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 Pauline Ciano 15 Richard Dr. Putnam Valley, N' 10579 Re: Dear Ms. Ciano: October 22, 1999 Addition - Ciano - Richard Dr. (T) Putnam Valley Tax # 63 -4 -22 I have received and reviewed the plans for the proposed addition to the above mentioned residence. The plans indicate that the proposed addition will consist of the following: A finished basement apartment. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons: 1. The office, den, kitchen and bedroom in the basement are considered four potential bedrooms b�, nop r ,c _art nt. _. 2. The legal bedroom count for the dwelling is wee. The potential bedroom count of your proposed addition is seven. 3. The addition of a potential bedroom requires this Department's approval of a revised septic system plan from a professional engineer. Please revise the proposed floor plan to reflect no more than lr g potential bedrooms, or have a professional engineer or registered architect. design a sub - surface sewage treatment system meeting present code requirements. If you have any questions, please contact me at your convenience. ML/JP Very truly yours, mG--� Michael Luke Public Health Technician �z1Z% A m w� NKM In" Im.; BRUCE R FOLEY I -- ' " ? 'hlic' �4e-d ' Uirec'tor - -- LORETTA . Mn4T".ART..:R_.1v'. M.S.W. Associate Public Health "Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914)218-6136 Fax (914) 278-7921 Nursing Services (914)278-6558 WIC (914)278-6678 Fax (914) 278-6085 Early Intervention (914)278-6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 October 22, 1999 Pauline Ciano 15 Richard Dr. Putnam Valley, NY 10579 Re: Addition - Ciano - Richard Dr. (T) Putnam Valley Tax # 63 -4 -22 Dear Ms. Ciano: I have received and reviewed the plans for the proposed addition to the above mentioned residence. The plans indicate that the proposed addition will consist of the following: A finished basement apartment. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons: 1. The office, den, kitchen and bedroom in the basement are considered four potential bedrooms by this Department. 2. The legal bedroom count for the dwelling is egg. The potential bedroom count of your proposed addition is seven. . 3. The addition of a potential bedroom requires this Department's approval of a revised Septic system plan from a professional engineer. Please revise the proposed floor plan to reflect no more than }fir potential bedrooms, or have a professional engineer or registered architect design a sub - surface sewage treatment system meeting present code requirements. If you have any questions, please contact me at your convenience. Very truly yours, Michael Luke ML /jp Public Health Technician .•; v. -.� ^. '� ,yro•;r�.,• -•-_m. at n.u+i, °.: r:.•,. . .. .-n, t' - � +a:. :, L,; �:. o - � -! ,... .. m. ..v... .., ,-�, _ ^a• -' � ,.,. ..�.4: �m.oc m.:a.v. . � _, _c.'�. ,p,.. ...Kj � n �. • PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVUDAL ADDITION/REPAIR FORM SECTION A: GENERAL INFORMATION Name of Project ( T)(V) T V TM# Year of Construction Size of Parcel SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. Hilly 6Rolling' • Cleteep Slope 36ent1e Slope []Flat 2. ❑Evidence of wetland OLow area subject to flooding ❑Bodies of water ❑Drainage ditches MR- ock outcrop 3. Property lines evident? 4. Water courses exist on, or adjacent to parcel: YES NO, Ly" ITP U 5. Existing individual wells within 200ft of the existing SSTS? O SECTION C. EXISTING SUBSURFACE SEWAGE TREATMENT SYSTEM(SSTS) 1. Physical character of existing SSTS area. . A. OLevel UGentle Sloe UStee e P P slope B. O Well drained L'Moderately well drained OSomewhat poorly drained [Poorly drained C. Area available for SSTS. (Primary & Reserve) OExtremel limited OSomewhat limited Adequate ft x ft Y Q _ _ D. INSPECTION Date Inspector 10 <'T oeviden'Ce of failure DEvidence of failure I)EN-ridence of seasonal failure ML ME i HOUSE (1) Indicate location of SSTS A. Size and type of septic tank gallons ®`9eta1 OConcrete ®Plastic B. Type of absorption area 1. Fields ft. 2. Pits 3. Gallies ft. (2) Indicate setbacks, front street, backyard, and side yard dimensions (3) Show location of well (4) Show location of driveway (5) Note physical features (steep slopes, rock outcrops, streams/wetlands) SECTION E. EXISTING WATER SUPPLY ®PWS ®Shared well LAndividual well CONiQvENTS: REPAIRS ONLY: As Built Inspection Required: As Built Inspection Done: Status: ti� i`llled ODug' Ltkasing, above ground As Built Submitted: Inspector: IJI DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 PROPOSED ADDITION APPLICATION (RESIDENTIAL ONLY1 -r1.�, n T T"r Public Health • Director STREET /1 TOWN TX MAP # 4 NAME / 4 41 d PHONE Z, 6 -.319 fPCHD # MAILING ADDRESS /S f i c k-eN �-cl_ 0 e i V DESCRIPTION OF ADDITION V��L -S'-4 NUMBER OF EXISTING BEDROOMS ,3 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.: _ _ . .. . .. .. ... _ y 4. r.- .�w�a .. .......... .. _.�.t ... oc +.N .-.. -. .we.. -_.� -. .....w....4.. .... _. ... .. .: -.. ....•n...._b .w ...- a- _.... +� -.. ._.s. ... .._. _.�.cs.r w+ .w w. a..... ....... ��..4w+.w...I.- ...........w. !- .... +r -..r Please submit this form and the following to Putnam County Health Dept., 4 Geneva Rd., Brewster, NY 10509, Phone 278 -6130. L. Certified check or money order for $100.00 Sketches of existing floor plan (drawn to scale, all living area including basement) * Non - professional sketches are acceptable .--3-Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #) * Non - professional sketches are acceptable 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. Copy of Cert. of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE Comments Feb 98 ullUCL• It. I "OLLY, 11$. Acting Public llrtalth l)ur•r.inr DL•f ARTMGNT Of HEAI'rl-I . Division Of Enviroommud Fleal.th Services 11 Geneva Road, tlrewster, New York 10509 . (910 278-6130 hl1tIU1111 County I)cht. of I•Icaltli 4 Gcncva Road Drmstcr, NY 10509 �j `le Residence Tax Male TO%V n Gentlemen: Accord.irlr, to records maintained by the Town, [lie above noted d\vcllinS is 1 S N OT w `I itT� - ill collll)lialice with Town cocle and the total number of bedrooms on record This information has been Obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER 13uildinrg Inspector i ' ^ /f7 v It Xt VF UINAM I AN Ms ^ /f7 v ld ICI LOT PREMISES SHOWN HEREON ?)EING LOTS A.S: 5HOW ON "SUDDIVISION MAP OF DOGWOOD ACRES" SAID MAP FILED IN THE PUTI`\JAMT, COUNTY CLERK'S OFFICE ON MARCH c', 1987, A5 MAP Na_ 2213. G) co _j r---: j LLJ z cr) 00 cc cc LL 7 Qlm 0 A W uj cc LL SURVEY OF 51TUATE It\ TOWN OF PUT PUTNAM Cnq RK c.'TArE :LE P011111-1 3. MI ccif I. r ADDIT(ON' l LICENSED`" N 2, OF -ON L.Avj,,,;' and cop-es e impressed :.I ors herecri ld ICI LOT PREMISES SHOWN HEREON ?)EING LOTS A.S: 5HOW ON "SUDDIVISION MAP OF DOGWOOD ACRES" SAID MAP FILED IN THE PUTI`\JAMT, COUNTY CLERK'S OFFICE ON MARCH c', 1987, A5 MAP Na_ 2213. G) co _j r---: j LLJ z cr) 00 cc cc LL 7 Qlm 0 A W uj cc LL SURVEY OF 51TUATE It\ TOWN OF PUT PUTNAM Cnq I RESIDENTIAL BUILDING SECTION SWIS/SBL/CD # BUILDING STYLE i . i 01 RANCH 07 MANSION 13 BUNGALOW STRUCTURE CODES 02 RAISED RANCH 08 OLD STYLE 14 OTHER 03 SPLIT L LEVEL 09 COTTAGE 15 TOWN HOUSE 04 CAPE COD q r 10 ROW 05 COLONIAL LOG CABIN 06 CONTEMPORARY 12 DUPLEX 13, ------ - ------ ------ - - ----- 1 ....... ----- GARAGES R- Gl ATT I STORY RG2 ATT 14: STORY STORY HEIGHT RG3 ATT 2 STORY RG4 DET 1 STORY RG5 DET 1 -h STORY EXTERIOR WALL MATE91AL 01 MOD 05 CONCRETE FIGS DET 2 STORY - --------- 02 BRICK 06 STUCCO 03 ALUMINUM/VINYL•- 07 STONE POOLS — 04 COMPOSITION LSI STEEL VINYL LS2 FIBERGLASS -- ------ -- YEAR BUILT LS3 POURED CONCRETE LS4 GINITE NUMBER OF KITCHENi LS5 ABOVE GROUND ---------- :7 --- --------- — ----- -- -q NUMBER OF BATHS BARNS FBI 1 STORY DAIRY FB2 Ilh STORY DAIRY F63 2 STORY DAIRY NUMBER OF BEDROOW4? U FIREPLACE r FB4 I STORY GEN F85 1'/z STORY GEN F66 2 STORY GEN ------ - ------ L ------ -- -- HEAT TYPE I NO CENTRAL 2 HOT AIR 3 HOT WATER/STEAM I. 4 ELECTRIC FB7 POLE FB8 HORSE FUEL TYPE I NONE 2 GAS 3 ELECTRIC 4 OIL 5 WOOD 6 SOLAR 7 COAL MISCELLANEOUS RCI CARPORT CENTRAL AIR BLANK = NO I = YES GH2 GREENHOUSE TC1 TENNIS COURT BASEMENT TYPE I PIER/SLAB 2 CRAWL 3 PARTIAL 4 FULL .. .... ------- .. ...... CANOPIES CP5 ROOF ONLY CPS WITH SLAB BASEMENT GARAGE UPACITY CP7 SLAB/SCREEN CONDITION I PorjR 2 FAIR 3 NORMAL 5 EXCELLENT GRADE A EXCELLENT 8 GOOD C AVERAGE 0 ECONOMY E MINIMUM SHEDS FCI MACHINE F 2 ALUMINUM FC3 GALVANIZED Z_ 4 FG4 BAKED ENAMEL -- ------ --- GRADE ADJUSTMENT MOBILE HOME ATTACHE CITY 0 GARAGE Cr RM5 MOBILE HOME MHI MOBILE HOME BASEMENT ......... . . ...... PORCH TYPE AREA MH2 MOBILE HOME ROOF MHS MOBILE HOME 7X 12 ROOM MH7 MOBILE HOME 7X24 ROOM ------ L4 ?":Z -- ------- - MH8 MOBILE HOME TIP-OUT RM MH9 MOBILE HOME V400D ADDON ....... ... RESIDENTIAL BUILDING AREA SECTION FIRST STORY AREA C6 I PORCH TYPES RP1 OPEN _0 SECOND STORY AREA RP2 COVERED c- RP3 SCREENED RP4 ENCLOSED RP5 UPPER OPEN PIPS UPPER COVERED R 7 UPPER SCREENED RP8 UPPER ENCLOSED - ------ - --------- ------ -- -- ------ ADDITIONAL STORY AFJ;A HALF STORY AREA IMPROVEMENT SECTION iTRUC THREE QUARTER STORY AREA CO m c DIMENSION'l DIMENSION 2 QUANTITY i GR CD YEAR BUILT FINISHED AREA OVER 61AAGE IMPROVE MENT-CODE S L FINISHED ATTIC AREA.•j I URE CODE MEAS I DUANTITY 3 SQUARE FEET 2 DIMENSIONS 4 DOLLARS FINISHED BASEMENTA.EA _3> UNFINISHED HALF STQ[j's FLUOR AREA GRADE A EXCELLENT 0 ECONOMY B GOOD E MINIMUM UNFINISHED Y AREA C AVERAGE UNFINISHED FULL FLOOr -AREA CONDITION SQUARE- FOOT OF LIVINC, AREA 1 POOR 4 GOOD 2 FAIR 5 EXCELLENT FINISHED RECREATION ';IIaM AREA 3 NORMAL News 1101 'f® 118, ®'ml ■mmmm m® 86 PMAN COVKW DEPARTA MT F D� 41M y . C Divlslon bf Envfi6i mental Ilealth Services, C06 el, N.Y .'10512 Engineer 'Must provide P.0 D Peemit a I.-- -._..- - Located ah' Owner /applicant Name Melling Address. jUa -u!QN CQM—P aews� FC.g Q .WA -F DISPOSAL,SYSTPM ! ��s1 /,! C? / Z_% t a fld � r t° T&F Map Flock Let -3;! c,;:r�.3 i t�ilL "yormeely' Sabdivt®ion'P1sme a� Snbdv:.lat N 2Ip -g Data Permit Issued I - U Separate Sewerage System built by d �'� Address Consisting of % tB ep ri Gallon, Septic Wank and 4*1 ty . W.2 Water Supply: c Supply From Address or: /00, Private Supply 1DiWed, by -$":2 Address _"S'`' Ball 4W G Has Erosion Control Been Completed? ' Pe . Number of Bedrooms Has_'GarbaSe :GelndeaBeen Installed? OFEM! YO Other Requirements I certify: that the system(s) as- .listed serving the, abova premises were con of which are attached), and in accordance with'the :standards, rules and, re Putnam County Department Of Health. .. Date Z Sz certifle by a Address Any person occupying premises served by the ab ve systems) shall On conditions resulting from such usage Approvzil of the operate .sm available an'd the approval of the private water supply shall becorni m subJect to modi4 cation or /change• when, in the judgment. 04 the_ ,Cc By— Date BY C- M Lam,... rte v flyu :S, ,�q� o the plans of the completed -work ( copies ce ° °L tha filed plan,, and the permit issued by the P.E R.A. l License No secure the correction' of any unsanitary a anon as a pubs: sanitary sewer becomes ly becomes available. Such approvals are 4ton, ,modification, or change Is necessary. " l fc nc , nano Iab's, i - h ROBINSON LANE, R D. 6 r V I. "uINAPPINGERS FALtS,`N Y 1'2590 O. \' s . 014) 221 2485 r. •" ter: .w .... qY. r DATE RECEIVED NAME ,ADDRESS:'. S�AMPL'ING ADDRESS � \C1-i A>.42� �r �� — TREATMENT: CH-LO R[ ATE 6)(t PPM►; SOFTENiED ❑ OTHER ❑ " - ;SOURCE: DRINKING WATER WASTEWATER EFFLUENT ❑OTHER '1 COLLECTED BY: HcG�W c: _l� t TIME, . 2 0 0= .. . `,` P.M.. DATE 3 $ b APARTMENT COMPLEX PRIVATE RESIDENCE `. O.SCHOO;L" •❑ SEWAGE; TREATMENT PLANT 'O BEACH O'RESTAU_RANT OSWIM POOL, OOTHER - �$TOTALCOLIFORM COUNT M F.T: PER 100 M L. ❑TOTAL COLIFORM'COUNTM P N �� PER 100 M.L. O FECAL.COLIFORM,000NTM.F:T. PER 100 M _L_ ❑ FECAL COL`•IFORM COUNT M.P.N.; PER 100 M.L. ❑'FROZEN DESSERT PLATE COUNT.. ❑ AGAR -PLATE COUNT PER 1 M.L. LABORAT CRY <TECHNICIAN :: DA ;RE ED LABORAT DIRECTOR wr��uu�i�aa ��srl�u•r��uu �.i��•rru.rc�� .��.f�� r � ��•��u� �� r_��►a r 'z • J �... - � � �-C- � • . -. 544,. ., l •C .- r .� s o- HEALTH >DEPT 0 PIfl'NAM COUMI'Y DLPAItrIME NT OF I11 UIE 1T 'T C "f Il [Y [AT(]7'Ti!'\ \Th /'3Z NTI f_ IYn t•T,f - - V _..ice. ..lti � — — — —' N .:i.��:r_-a• Owner or Purchaser of Building Building Constructed by Location - Street Municipality Building Type Section Block Lot po 4 wo '� SubdiviTion Name Subdivision Lot # GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmk-inship, 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 _- or.)erate. for a_,period of .t�,,e..bears :L-Agate y. following the date, -of approval of the "'Certificate of Construction Compliande "'f6k 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 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. Dated this Z 2- day of d 19 Signature Title General Contractor (Owner) - Signature Corporation Name (if Corp.) Address . rev. 9/85 mk Corporation Name (if Corp.) Address WELL COMPLETION REPORT DEPARTMENT OF HEALTH •- ,D.i'v_ision. Of Environmental Health Services Z PUTNAM COUNTY DEPARTMENT OF HEALTH fice Use Only �3 oM ST E "T ORES ; TOWN /YILLAG[1C11Y TAX GRID NUMBER: 11WELL LOCATION �'"�� Q Pµ L L, NAME: ` AUUK05: WELL OWNER C k Almon � (�,;;� 0 PUBLICS USE OF WELL 1 - primary 2 - secondary MOUNT OF US REASON FOR DRILLING DEPTH DATA DRILLING EQUIPMENT WELL TYPE CASING DETAILS SCREEN -.DETAILS RESIDENTIAL. ❑ PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP 0 ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) O INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ YIELD SOUGHT gpm. /N0. PEOPLE SERVED % EST. OF DAILY USAGEy gal. A NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL WELL DEPTH �GD ft. STATIC WATER LEVEL '�10 ft. DATE MEASURED 5��7 ROTARY O COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): ❑ SCREENED ❑ OPEN END CASING. I' OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH ft. MATERIALS: 9 STEEL ❑ PLASTIC ❑ OTHER LENGTH .BELOW GRADE o Z-1-ft. JOINTS: 0 WELDED aTHREADED ❑ OTHER DIAMETER ("'—in. SEAL: ❑ CEMENT GROUT ❑ BENTONITE BOTHER WEIGHT PER FOOT ! 7 lb./ft. DRIVE SHOE::gYES ONO LINER: ❑ YES �ZNO DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ftj DEVELOPED? FIRST _ O YES ONO �r!`.�►!L...w��°- -. "_...�. �._. -. � _ . _..,..1..._ a .. .:...... ..._. __. - ._� _�... -- ..�. -.»�., . ': °:F?Q�AC -.^ -� %_ GRAVEL PACK O YES TOP GRAVEL O NO DEPTH I tL SIZE WELL LOG If more detailed formation descriptions or sieve analyses WELL YIELD TEST ; If detailed pumping METHOD: O PUMPED t tests were done is in- 0 COMPRESSED AIR ; formation attached? 'O BAILED O OTHER ; 0 YES 0 NO WELL DEPTH DURATION DRAWOOWN YIELD It. hr, min. Deter It. gpm. WATER ❑ CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS' ATTACHED? O YES O NO PUMP INFORMATION TYPE CAPACITY MAKER // DEPTH / fr MODEL -�, A ld YOLTAGF!�G HP STORAGE TANK: TYPE �.G��' �( +—r__9 W ?i�-o CAPACITY Z 0 GAL. / 7'10 WELL O ILL NAME n� C DATk Aoo ri uRE I DIAMETER TOP BOTTOAi i OF PACK in. DEPTH I tL I DEPTH ft. WELL LOG If more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM Water. Well SURFACE Bear- ing Oia- FORMATION DESCRIPTION CAGE tt. ft. Deter STORAGE TANK: TYPE �.G��' �( +—r__9 W ?i�-o CAPACITY Z 0 GAL. / 7'10 WELL O ILL NAME n� C DATk Aoo ri uRE FINAL SITE INSPECTION Date Cl1la� �12. 1' Inspect by `' d1 STREET LaCATION OWNER /tA J V PERMIT # PV~ 3-- TM # OR SUBDIVISION LOT # _.- .. ..- .- ,. ' _ - - s��R vo .:s.e+»r" -_ �<� 1' -" SEWP,GE YDISPO.SAL AREA a. SDS area located as per a roved plans a b. Fill section - Date of placement "s 2:1 barrier. LGTH WIDTH AVG.DPTH c. Natural soil not stripped ' d. Stone, brush, etc., greater than 15' from SDS area. e. 100 ft. from water course /wetlands. II. SEWAGE DISPOSAL SYSTEM a. Septic tank size - ,00 1,250 b. Septic tank installed level c. 10! minimum fran foundation d. No 900 bends, cleanout within 10 ft. of 450 bend e. DISTRIBUTION BOX 1. All outlets at same elevation - water tested s 2. Protected below frost 3. Minimum 2 ft. original soil between box and trenches f. JUNCTION BOX.- properly set g. TRENCHES 1. Length required - Length installed 2. Distance to watercourse measured: ft. .:i R" �1�! 1es?'+s�ir '.•ac..Cr -r �.i t']L`1T.LV rs .a - 3. Installed according to plan 4. Distance center to center 5. Slope of trench acceptable 1/16 - 1/32 " /foot. 6. 10 feet fray pro _perty line - 20 feet - foundations 7. Depth of trench < 30 inches from surface 8. Roan allowed for expansion, 50% 90 Size of gravel 3T4-- 1 " diameter 10. Depth of gravel in trench 12" minimum 11. - PiLm, ends capped h. PUMP OR DOSE SYSTEMS -r -2—.O-v- eflow tank 3. Alarm, visual /audio 4. easily accessible manhole to gLade 5. First box baffled 6. Cycle witnessed b y Health Department estimated flow per cycle IV. HOUSE a. House located per approved plans. b. Number of bedrooms V. WELL a. Well located as per approved plans b. Distance from SDS area measured fl6d ft. c. Casing 18" above grade. _ d.- Surface drain e around well acceptable. VI. OVERALL WORKMASHIP a. Boxes pEgpezly grouted b. All pipes partially backfilled c. All piLDe=s flush with inside of box d. Backf ill material contains stones < 4" in diameter . A e. Curtain drain installed according to plan - f. Curtain drain outfall rotected & dir.to exist.watercours g. Footing drains discharge away fran SDS area h. Surface water Protection adequate i. Errosion control provided on slopes greater than 15 %. 10 r " ` PUTNAM COUNTY DEPARTMENT OF HEALTH ..'r , Dmillon d Environmental He" Semees. Carmel, N.Y. 10512 Engineeir to Provw Permit N I on CERTWCATE OF CO Permit N 08 CONSTBII N PERMIT FOR SEWAGE DL4POSAL SYSTEM ,/� j 1 /� .. .. O . C Located at / % ///d�i^ % Town or village Subdivision Name �dG 1�✓c!� Graf gubd. Lot N Tax MapJBlodlLot Renewal_ ❑ Revlelon ❑ Owner /Applicant Name d _i Date of Previous Approval / Mailing Address ✓ Town yip &dmtog Type df % 6 tGl7 O er Lot Area % � , FIR Section Only Volume Depth Number of Bedrooms Design Flow G P D PCHD Notification is Required When Ftli Is completed Separate Sewerage System to consist of " v Gallon Septic Tudi an � F �'� �� ►' G To'be constructed by Address Water SuPPb'- _Pdbltc Supply From Address ors__A" Private Supply Drilled by ' _Address Other Reguilrements I represent that I am wholly and completely responsible for the design and location of the s®$ s1Ai> ( aI that the separate sewage dispose$ system above described will be constructed as shown on the approved amendment there to and in n jTh e rds, rules and regulations or e u nam County Department of Health, and that on completion thereof a "Certificate of Con oia c$ tory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the ow r, h 1° ssors, h an s by the builder, that said builder will place in good operating condition any part of said 'sewage disposal system Burl he of. tw (2) im diately following the date of the Issu- ance of the approval of the Certificate of Construction Compliance of the origin '9y or i►s t ®; that the drilled well described above will be located as shown on the approved plan and that said well will be Installed in a o w nda ru and regu s off the Putnam County De rtment of Health. Date f a7 Signed P.E. _ R.A. � Z y Q� Address license No APPROVED FOR CONSTRUCTION: T approval expires two years from the date issu on the building has been undertaken and Is a revocable for cause or may De amend or modified when considered ne9lkssary the Co Any change or alteration of construction requires a new permit. pr ad disposal of domestic sanitary swag nd /or pr ly. , Rev. 2• (L7 1/81 Date By ��- Title �A� \�DEPARTMENT OF HEALTH elv Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 HYYL1l.A'1'1VLV '1 "V l.V1VJ "1- i(Vl. "1" H WH "1 "1",tC WALL PCHD PERMIT #v. WELL LOCATION Strget Address Town/Village/City " Tax Grid Number WELL OWNER Name Mailing Address rivate O Public USE OF WELL 1 - primary 2 - secondary TrRESIDENTIAL ® BUSINESS ® INDUSTRIAL O PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify L3INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT gpm / #, PEOPLE SERVED /EST. OF DAILY USAGE eOa gal REASON FOR DRILLING INEW SUPPLY OPROVIDE ADDITIONAL SUPPLY ®TEST /OBSERVATION O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED ®DRIVEN ®DUG OGRAVEL ®OTHER IS WELL SITE SUBJECT;TO FLOODING? YES A-" NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: _-90' 9 We.-d Lot No. R WATER WELL CONTRACTOR: Name 11;�F4_4r;.-roV7 Address: e%ev',4�•00 -� IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY - - -- - - - - DISTANCE TO- PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED O ON REAR OF THIS APPLICATION EffOoN SEPARATE SHEET " (dat ) (s ture 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 pr ided by t Putnam Mounty Health De tment. ..Date of Issue: 19 e mi t s u n M Ie of Expiration: 19 is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner d7 Orange copy: Well Driller t 6 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION -OF ENVIRONMENTAL-:. HEALTft-.SKRKT.r,_FiS.., Date Re Property of akii Lt> Located at 2k0ffA90 l)r dim'JAM VAU.4--mv 0 _q• (T) Section 5_ Block 4. - Lot 3Z Subdivision of Subdv. Lot # 45 Filed Ma p Date Gentlemen: This letter is to authorize 37y S &—:P j/ 5,, 'RAJ a duly licensed professional engineer t,/ or registered architect (IndicateT_ 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 -porsnection _with..thi s: !iaat ±.er -an i s e - the.- c-onstruc ti or: --of-s c gd: L 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. Very truly yours, COW o 7 L; % Signed uoyner y 61 4, U. Counter P.E. 12 7- 2/9 Address Address Town a. Telephone Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services AFFIDAVIT /'nPAORATF FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health In the matter of application for: C'0NS"'1_C0CT toN OF For represent that I am an.officer or employee of the corporation and am authorized to act for I Name of Corporat having offices at Y. Whose officers are: President: 1C1- t}�< �1Oe4�cA✓�l�c 1.�?b�sZ V1�1/1ratP/�c', Nay, (Name and Address) Vice — President: c-S PA cc-' A ✓ 45 4' g_04.1 (Name and Address) l /j, 29M,9P24C-1<'_ DL and Address) Secretary:✓I C 1nr ��?��Ct1l'C Treasurer: ] C' To r, (Name and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. 1 Sworn to before me this _ day Signed: _. of 19ry Title: 4 Nota ub 'c lu '10900fteendX3 U0189►ww03 n00 j9jt94otseM UI PeljIleRC) 096LLLV 'oN WMAMON 3o e}e3S'olignd NeaoN ®HHVS V W3NdO1S1UH0 8/84 �f Sv APPENDIX B PUI'NAM COUNTY DEPARIV= OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SE.RyICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SgaM DISPOSAL SYSTEMS tW V LL:,C.1 . — _ w_.n_, •�: –.n.- r�.:....i._........ i.. _ ..W�: .. / 'a "i.:vlVj'1xUCITUiv� rr�rtlrll'i' !M (� DATE R=Nr""D: Z (o t \ fr BY: (C- (Name of Owner) (Street Location) EMKI ANTS Permit Application Corporate Resolution Plans - Three sets ---..' s/s Engineers Authorization Design Data Sheet (DDS) SUBDIVISION Deep Hole Log Pere J' Consistent Perc Results (3) Fill Perc Hole Depth c-d House Plans - Two sets Well pe_rrmi P`NE letter Variance Reauest GEI�FtAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Check; Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Swage System Plan - (north arrow) Swage System Hydraulic Profile - Gravity Flcw Fill Profile & Dimensions - Volui? D or J Box;Trench /C-allery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Cronstructior, Nintes- Design Ihta: Perc and deep results Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Fcoting/�Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion . Expansion Area; shown; gravity flow, Buff . size If Peed Pit & D Box Shown & Detailed House - No. of Bedroans Wells & SSDS's w /in 200 ft. of Proposed Systems. Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 110; Type pipe No Bends; Max. Bends 450 w /cle -anout SEPARATION DISTANCES SPECIFIED CN PLAN Fields 10' to P.L., Driveway, Large Trees,Top of fil 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. ern 15' to Drains - Curtain, Leader, Footing 35'to catch basin, storndrain,piped watercours 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' from Foundation; 50' to well 15' Well to PL 9 1 dp % , . WIN tl FrM . re se Permit Application Corporate Resolution Plans - Three sets ---..' s/s Engineers Authorization Design Data Sheet (DDS) SUBDIVISION Deep Hole Log Pere J' Consistent Perc Results (3) Fill Perc Hole Depth c-d House Plans - Two sets Well pe_rrmi P`NE letter Variance Reauest GEI�FtAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Check; Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Swage System Plan - (north arrow) Swage System Hydraulic Profile - Gravity Flcw Fill Profile & Dimensions - Volui? D or J Box;Trench /C-allery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Cronstructior, Nintes- Design Ihta: Perc and deep results Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Fcoting/�Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion . Expansion Area; shown; gravity flow, Buff . size If Peed Pit & D Box Shown & Detailed House - No. of Bedroans Wells & SSDS's w /in 200 ft. of Proposed Systems. Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 110; Type pipe No Bends; Max. Bends 450 w /cle -anout SEPARATION DISTANCES SPECIFIED CN PLAN Fields 10' to P.L., Driveway, Large Trees,Top of fil 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. ern 15' to Drains - Curtain, Leader, Footing 35'to catch basin, storndrain,piped watercours 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' from Foundation; 50' to well 15' Well to PL 9 M APPENDIX B PUTNAM COUNTY DEPART OF HEALTH - DIVISION OF ENVIi20MMTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE S3QGE DISPOSAL SYSTEMS _ . _ .. ...... %(E,VlESV "HEETr - CONSTRUCTION PERMIT �� vy� 1 / DATE REVL�YVM : A. r V BY: (Flame of Owner) (Street Location) ca mV'rs YES 0 DOCUMENTS Y 6 C? W Permit Application / Corporate Resolution Plans - Three sets --- --s /s Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) Perc Hole Depth House Plans - Two sets i SUBDIVISION Perc C Fill— cd Well_ permit; PW--S letter Variance Request GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) 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 CXjaSt; lotion .11ct�s fari. ,far rata' Design - esign Data: perc and deep results Two-Foot Contours Existing & Proposed Driveway & Slopes Cut Footing/Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If Paq)ed Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's Win 200 ft. of Proposed Systems Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Treees,Top of fil 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 35'to catch basin, stormdrain,piped wTatercours 10' to Water Line (pits -20') 50' intermittent drainage course Seotic Tanks 10' fran Foundation; 50' to well 15' Well to PL 9 , 'MA�i r1rd M 1 MOM ism _ LF trench _• provided •�� .0 AMA - -%1 00 - M = M M 1 MM rteM �M �/M WI MM so Maim - `IM 200 ft. reset-v 150 ft. .. )��Mmm ism y� House Plans - Two sets i SUBDIVISION Perc C Fill— cd Well_ permit; PW--S letter Variance Request GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) 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 CXjaSt; lotion .11ct�s fari. ,far rata' Design - esign Data: perc and deep results Two-Foot Contours Existing & Proposed Driveway & Slopes Cut Footing/Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If Paq)ed Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's Win 200 ft. of Proposed Systems Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Treees,Top of fil 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 35'to catch basin, stormdrain,piped wTatercours 10' to Water Line (pits -20') 50' intermittent drainage course Seotic Tanks 10' fran Foundation; 50' to well 15' Well to PL 9 9 .1- ' 12 0141 EVER x ff; . -, . Owner A/ ;/4Aos�> 7W70 Address IrT3 - r - Located at (Street) -e— Sec. -3.,Ir Block. 4t- Lot Lo 2.31,, t32' (indicate nearest` cross street) Municipality "'� l'-p9a A7�? ae- Watershed '23 U4510*1 -.1511, 11 Fil 11 m ED 31-5 mm F., 13 X Date of Pre-Soaking Date of Percolation 'Pest HOLE NMSER CLOCK TIME PERCOLATION. PERCOLATION Run Elapse Depth to Water Fran Water level No. Time Ground Surface In Inches Soil Rate Start-Stop Min. Start stop Drop In Min/In Drop Inches Inches Inches 4 2 2AAV 7,�3f- /� .> 3 - 3� -z� .7-1a ?-.3 --5 � 4 NOTES: 1. Tests to be repeated at same depth until approximatel TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES. G.L. 1° 2' �4l� l�JVrs'I 31 3Ae�N G�Q 4° 5° 6° 7° 8° 9° .12° 13' JAI aD INDICATE LEVEL AT WHICH GROUNDWATER ` IS , ENOOUNTERED _ -d -._ /t/ ,7 e INDICATE LEVEL, TO WHICH WATER LEVEL RISES AFTER R BEING EN00UN DEEP HOLE OBSERVATIONS MADE BY: z4 54,111, ✓009 DATE: 6-41-8- Jr- DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided v oo No. of Bedroans Septic Tank Capacity lea � gals. Type Absorption Area Provided By 3 4F-� L.F. x 24" width trench Other MON 130, "- 'HA 6w L ft d 9e J'N' P1 I N An iii ip