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HomeMy WebLinkAbout3136DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 63. -4 -25 BOX 25 lirs .. I IL L' L is �.. T YL Tr 03136 + . n _ BRUCE R. - FOLEY_ ��� -~ �h� '•-= ruific "— fieaitn``[iirector" °"`y'"'"'''°'""°�`""'"" _ ' ' Robert Trepp 5 Richard Dr. Mahopac, NY 10541 Dear Mr. Trepp: DEPARTMENT OF HEALTH " 1 Geneva Road Brewster, New' York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Associate Public Health Director Director of Patient Services February 25, 1999 Re: Addition- Trepp- Richard Dr. No Increases in Number of Bedrooms (T) Putnam Valley Tax # 63 -4 -25 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 form this Department dated February 25, 1999 The addition is approved with the following conditions. 1. The total number of bedrooms must remain at Four without prior approval by -- -• .. �. -... - thi�;departnaen +, _:- _ �.:_�"-- .�..:_.-.._r_�._ ... -:t .:. :.::.' ". - _:`: _..- ..�...__...:° ..__ ..:: :�..;,._ 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 yqurs, � William Hedges WH:kg Senior Public Health Sanitarian cc:BI _ I - II ,... II - tlfl V„ Llt, uL11L111 i•nn irv, 1JIYLIUIJLI r. i .o DEPARTMENT OF HEALTH Division of Environmental Health SePvices 4 Geneva Road Brewster, Now York 10509 Tel. (914) 278 - 6130 fax (914) 278.7921 - 01 ROW0 Wel ft :. �ubc Hea ?tft- Director p � !G � p1,t;N,�ca U1'�' �3 STREET � O'(�!7 nil U6i TOWN X MAP # :5"90-,6L31 Noot,- NAME ��!c,�PW OtS 'CP�r 1V PHONE 4531.x- io�-PCHD # / -` , MAILING ADDRESS 5 P�'14c2 44 , t"t" f4 l- tit y 10'+1 DESCRIPTION OF ADDITION rlW�09& PhgrO�621rl'� 10G1t &rh *lq (f1,�i ' a DEPARTMENT OF HEALTH Division s Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Re: Residence Tai: Map Gentlemen: BRUCE R. FOLEY, H.S. Acting Public ,Health Director According to records maintained by the To�Nm, the above noted dwelling IS y IS NOT in compliance Nvith Town code and the total number of bedrooms on record is r�U C4 This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER Building Inspector ll� -Zl9f vpAN is RzmAm ye cappet e-.w. T-Q "Mito T-"'A-ST--'WCOFFMK KVJ- T6 96MAIM 50y- our Exicf. pms Lw cau., fwmAtm maylpa AC465C S"Ur-OFF, I ST' , - LALLY COLUMr4S 'Y,15,y- GYF. fib. WA - II I $MT. Lei WIT FI)LTur-P., DTI✓ GTE Ir. L 0, tu L i. ti L 0, tu L z 0 C) tz O LO Lij 0 di tj _j a3 § 2f Z -it dY'M 2— 0. z < 0-03 013 00 z ir (D < < It a w m 0. U- C) I:X, 0 oz O Ld 'CL co to L tu tz O P PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL ADDITION/ REPAIR FORM SECTION A. GENERAL INFORMATION Name of Projecti Year of Construction Size of Parcel SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. Milly Molling OSteep slope ❑Gentle slope r1lat r" 2. OE"vidence of wetlands Clow areas subject to flooding DBodies of water Mrainage ditches ❑Rock outcrops Y NO 3. Property lines evident? ❑ ❑ 4. Water courses exist on, or adjacent to parcel? 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 M'G�entle slope OSteep slope B. OWell drained Moderately well drained ❑ Some' what poorly drained nPoorly drained C. Area available for SSTS. (Primary. & Reserve) r' nExtremely limited OSomewhat limited ❑Adequate ft x ft 4 J • �. - ._- • ._ - ..�.vu.. n ,vc+F�a+. ry r. ..•. '�. _ r, .w..y: . w u.e D. INSPECTION Date Inspector LLIKo evidence of failure DEvidence of failure ®Evidence of seasonal failure `'-adicate North) HOUSE H (1) Indicate location of SSTS A. Size and type of septic tank (L j �� gallons Metal OConcrete OPlastic, B. Type of absorption area 1. Fields I ft. 2. Pits 3. Gallies ft. `t.. � (� , -- i_2� rTiJic: tP sefb;ic ! :, ,f„ oiit Ci:i.ect, bac. -.yFr -!; ai--3 si'G yard (�1T11PililiiTSS (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 Individual we ll Mrilled Mug 13Casing above ground COMMENTS: i .-A) It k 11 o.. t. I GERTI IE .. NOAL L< ER .... .. ... - .......... _.... •• ... - ��'-:.. ;: - . R AE •. i 9a 4s °�aF~ c t. - IN ACCORDANCf Wiry+ THE FVS FING .COOL „” FQA=1ICE FOR LAND SURVEYS ADOPTED-By ME NEW TURK SI,::E .ASSOCiATICN -JF PROFESStOriAl LEND 'S!•RV�••Gw't { ( L. } CERTIIICATION$ S"U RUN _ONLY 10 :HOSE IN(i!vi:`IrAt.S AND I.SIITUjIONS SHOWN HEREON UNDER T"E PO LK t •F Q z } r NUMBER SHOWN ABOVE. SAM .. :i9111 ty: AT! ONS AaE -4 :1! ➢ - , L.� �3 Q _ !f c: MANSF E RA St f s• ZD �'. �, O$ 5AA At, for � i • L� = -� -��� u �' i �:. Ldp // i��. 375'•' j , AREA = .' 45 81 S.F.... •._ . 1.035-AC: Lp � 3 , M 51.E a► W •- �E pIC 40 `PREMISES SK4WfJ NERLOIJ 6EING LOT i I A� � � %l iF- NORTH i 2 E � c SHOWN ON "5UQQIViSION MAP b 606, bb sKRES; SAID.f!1APFILED JN THE PL1?%tAM " .. UNTY CLEEiKS O�FiGE ON MaFSCH i96i t LOT MAP 13_' _ t • 51 T suvEY o0: RT f; i niJq L:, pw n a i.,•' -:_, f'.F TUA E IN THE ft' o•- !.,.., Cry .. ., �, .cn.S. ne •a< «.• t t..ri,,.:; - ; • qi it.:. ri,p,t• ,•�� TOW' OF� PUTNA1"� V�;�►LL.EY SURVEYED & PREPARES) BY �j. - . r UTNAM � COUNTY, MEW �� °..OR!''� . BUNNEY ASSOCIATES LAND. SURVEYC)RS - SCALE= Iii ? 50' DATE.: LSyL- 7. -1987 .RURAL ROUTE t2 FIELDS LANE gIZOUC;I {T Tp Nov. JO, 1988 NORTH SALEM. NEW YORK 10360 C�KT_i 40DEb DL:sC I , 1988 1: i I its I j dr 27= 19/, w - -llvmlvl uuulV I YDIPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR SFDROOt,j COUNT CPjiy; signatu" & . Date 10 al wool V: D A 0. 2q, DRAWING TITLE:- FLOOR Ft A, ALAN M; BURY ARCHITECT 646 UNION VALLEY ROAD MAHOPAC N Y 10541 PROJECT TITLE M USEMEW7- P-ENOVATION N PUTNAM V4LLF-Y 14.y 7 PROJECT NO. ISSUED FOR: SCALE* DAM REV. DATE: REV. DRAWING NO. ,f a 'Rrti�l/!.P'j� +r' t +Ir 11' N"�i,•�• ` la+{Y, r irw lI Pr: �� 4 •� r � .i .S• A,l 11 � "�� .+L'Hi.�Xi�•'.v. �.den'� " t, ". W Mme. sl �. v � r'.•y Sf'. d =. � •C `� IA +4 I r; .µ.IFV ` �� 711 +�',��r�„�SY J�t ' '� +.�t;l� ;i�r..•. + "���� Iii •iRll9i�P � � ! � � � jMiY1w.u1411Ew1tyj�+If2.:Wi,:, lire '�:i'!2+s`P�CvSP:vx`.t�d11�. +�•..�i'l1!�r'r � : ^y{}i�'�h, rM � 1 }7� . UN-AM-45k..; Mj6 fL `4•'41f, �1mfa���7,h•V '{i �•. Tj��JIG�. M1 1 r i.• 11i. 4 ++e``h ", �W�' �r'r. �'4 y�,I'k�y�jl(�►, l�t`v ✓Y ;"' ". yy� G. ,f'1 Mtf;.]x�rl'y�iM:� Y�`k J� tY�i'i,•� �� i'� „. her av � `�•, g �..Y. .KID ♦� 7i pew J.iniii,. t`ww�.•� IJ.YA_ Y _t i it `. + ar�,�l;ir a y " "�'�' P � l'' 51: G �'r21 > i ,1 �4 �'A�1, tiff •y }ltyr. 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A p f -M, X tz 0 -- 4q ,pro -CIE tbai the sewage 'd disposal system was. this plan and 'that the system ,Aef6re it was covered over The ,ed in...accordance with all standard . dard 'Of State Putnam County Department of )rk 'State Departirent of Health. tYstem design hereon does not p I rovide for Such Installation requirei' Itnam County Department of Health. .��()UnLy 1, neuitLI Servicee L7 n Fi 'es tY Hoag pz ,s of the — .4'Pea. V, -Sys. �I�r AS- BUILT LJB­DI V. A;r, N, DATE L VAN p JOS E P H r. Sift E, ,N �HWffst NEA �ya YOR T O , , X :7 17 71 7y7 4 A p f -M, X tz 0 -- 4q ,pro -CIE tbai the sewage 'd disposal system was. this plan and 'that the system ,Aef6re it was covered over The ,ed in...accordance with all standard . dard 'Of State Putnam County Department of )rk 'State Departirent of Health. tYstem design hereon does not p I rovide for Such Installation requirei' Itnam County Department of Health. .��()UnLy 1, neuitLI Servicee L7 n Fi 'es tY Hoag pz ,s of the — .4'Pea. V, -Sys. �I�r AS- BUILT LJB­DI V. A;r, N, DATE L VAN p JOS E P H r. Sift E, ,N �HWffst NEA �ya YOR T O , , X :7 MMEN Rev. 3186 -COUNW- DEPARTMENT OF HEALTH „' DIVWQ;notkiiv6 ehtsdkeift cii Cifinil, N.Y 105112�` 4:M[iWtP*dV1 e 43. -nnv Pn%"T1APJVW- It UP DISPOSAL SYSTEM —7 nV 1rnVQ`1W1rTf Located at Owns; /applicant N 'We Y AV 4z -blaffin Address, .0" Zip- Ui Mai, ;Bloc 4t Lot # :S.ibdj,. Le Date Peirmlt, Issued. Separate, Sewerage System, bufft by Addre 0- uslitin g t A—) Gaon Seiitic tank4tud water Supply: F%% hnc Supply From Address or: uPP S iy Drilled by Address in lieted? "-Erosilon:'Control Been'Co -Buildin V 9 Number of Bedrooms Ha9,GAA'a'g'e'Gr1nddr Been Installed? Other Requirements I certify that the s4stikeW A6 --listed serving'the -,above,,. wii.-Conetructed essenti, of the completed work copies i re' ­1 "ti 1i the I of which are ittacheid), and -in accordance siith'the,stanaards, rule ..and qu, a o in d-' n, and the permit issued by the Puin" C I oun I ty,Depa r on 10 Hea -'t f' Ith. tortiflid P.E. R.A. bate J- Y License No�. Add!,, es I! .. PTOMP;I. Ytiki such action as re the nroctlon of any unsanitary Any person. occupying Forni"s Carved t conditions resultirili fro4vi such. 'uWe.:,Aopi�dval of the sepa(A 6,119WOrl" system shall 6ecorl nu 06% as, a publ,-. sanitary lower becomes -�itend--,�,4'old�:.wh6h a P as available. Such approvals are ipi9val.of the 0 liic6r4 n �;kwsl av liable and the so U, am U ;"tfii�,Com I rn I I gner " 'h .r m" 01cition'or thanige Is necesu►y. 'Subject to mod f Icat Ion or chang's' whiri.� in the �judoniont,df $1 10-14"Ith, Su revocation; Cate L Z, Title In . . . ....... PUT'NAM COUN'T'Y DEPARTMENT OF HEALTH ..,. -, .- .....�»:: .�- _ ,•'s'�:. ..,sue. �..,; _. .. - _ .+e•Qr• .. .+:.. ;w.w— ..nc -+p •,wa_,. .,G. .. a r _ .a- — • .. ri.. _ ,�;. .+'- .-..� _..,- ? U � Owner or Purchaser of Building Building Constructed by Location - Street 1ru /J- Municipality / Building Type Section Block Lot %,2o y 0"-O ""j Subdivision Name Subdivision Lot # GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the �:_.._:_:'!ra� i 5 -:M: ��- ,�__ -i,. �t r,� �= �r�__ „�� fi•ir anrp',._.:,,_ Y;..� ...Y.._.___ :f . - - c `- C'> - - - f'. =_ia _._.� �,y ...a..- �ci..__.:��i'P ,,�+%�c�ef:,� -i.: ,;.ic�a�..:����Rii•� ��,.r3z3 �- repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environinental Health Services. of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building u ing the system. Dated this 2-1 day f IQOQ 19 eR t� i General Contractor'(Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk Signaturer:.2�) - , //-Xt Title ©L41/o�A, Corporation Name (if Corp.) Address WLLL U1J1`1rLL11%JV MMrUAI ty -0. DEPARTMENT OF HEALTH —DIvision. Of- Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION TO IVILLAUICHY TAX GRID NUM ER: WELL OWNER ESS: Xr?BIVATE LP PUBLIC USE OF WELL 1- primary 2 - secondary OKSIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP ❑ ABANDONED 0 BUSINESS ❑ FARM ❑ TEST/OBSERVATION ❑ OTHER (specify) C3 INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY ❑ AMOUNT OF USE Y I IELD SOUGHT gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE Qd gal. REASON FOR DRILLING NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA _0 I WELL DEPTH —ft.1 STATIC WATER LEVEL :?Eft] DATE MEASURED DRILLING EQUIPMENT � OTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE. PERCUSSION ❑ OTHER (specify): WELL TYPE 1 ❑ SCREENED. ❑ OPEN END CASING. _XOPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH tL MATERIALS: 5KSTEEL ❑ PLASTIC ❑ OTHER LENGTH.BELOW GRADE ft. JOINTS: OWELDED J93,HREADED OOTHER DIAMETER in- SEAL: ❑ CEMENT GROUT 0 BENTONITE XOTHER WEIGHT PER FOOT Z Ib./ft, I DRIVE SHOE, ES ONO LINER:OYES §(NO SCREEN DETAILS .--.,Sr DIAMETER (in) 'SLOT SIZE LENGTH (11) DEPTH TO SCREEN (ft) DEVELOPED? FIRST T tin" . GRAVEL PACK 0 YES 0 NO GRAVEL SIZE. DIAMETER OF PACK —in TOP DEPTH —ft. BOTTOM DEPTH it. WELL YIELD TEST If detailed pumping )H 00: 0 PUMPED tests were done is in- COMPRESSED AIR formation attached? 0 BAILED 0 OTHER 10YES ON 0 It more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. DEPTH FROM SURFACE Water Bear- ing Well Dia- Meter in FORMATION DESCRIPTION A coce. It. it. WELL DEPTH it. DURATION hr. min. DRAWOOWN It. YIELD gpm. Land Surface 0 At 40 WATM 0 CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? OYES ONO 0 0 ANALYSIS ATTACHE ? 0 YES NO I STORA T GE TANK TYPE' CAPACITY z -GAL. WELL DRILLER NAME /jo!�_ ffdllro:o� Qc� " ADDRESS SIG? E 6W - - oa- PUMP INFORMATION TYPE CAP CITY MAKER DEPTH MODEL TA _ HP Yorktown Medical Laboratory, Inc. LAB # q3 93- 321 Kear Street Date Taken: �/ %Z �" `� Time: jor,3 0 Yorktown Heights, N.Y. 10598 Da't e_. Ra-! d °� W 6' Time f.F /.wv , `e> Re ed . Director: Albert H. Padovani AR T. (ASCP) Collected By: ro�,/d�,� Referred By: r ( Sample Location: k;7' �0 VC1. i te y i o LABORATORY REPORT ON THE QUALITY OF WATER Phone # Z H 9ZZ5 Phone # I Sample Type: Repeat Test? _ (check one) INORGANIC NON-METALS (mg /L) MICROBIOLOGICAL (CFU /100m.L) Acidity _ Alkalinity Chloride Detergents', MBAS _ Hardness, Total Nitrogen, Ammonia _ Nitrogen,_ Nitrate Phosphate; Total Sulfate Sulfide Sulfite GENERAL BACTERIA _ Standard Plate Count (CFU /1.OmL) MEMBRANE FILTRATION TECHNIQUE "/Total Coliform < Fecal Coliform _ Fecal Streptococcus METALS (mg /L) MOST PROBABLE NUMBER TECHNIQUE Copper _ Iron Total Coliform Index Lead Mercury _ Sodium KEY FOR TERMINOLOGY _ Zinc CFU = Colony Forming Units MISCELLANEOUS pH (units) Color (units) Odor (TON) Turbidity (NTU) N/A = Not Applicable LT = Less Than ( <) GT = Greater Than ( >) TNTC= Too Numerous To Count CON = Confluent ( =TNTC) NR = Non - reactive REMARKS /COMMENTS (For Lab Use) ,/Potable _ Non - potable STP INF STP EFF Other: Sample Status: (check each) Outgoing HNO3 HC1 _ H2SO4 _ NaOH ZnOAc _. Na2S203 Other: ing Inc /ow _✓ LE 4 °C _ GT 4 °C _ pH LE 2 pH GE 9 _ pH GE 12 Other: ELAP #10323 THESE RESULTS INDICATE THAT THE WATER SAMPLE QASW (WASN'T) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO TH YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DIDN'T) (N/A MEET THE SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STA INKING WATER CODES, FOR THE PARAMETERS TESTED, AT.THE TIME OF COLLECTION. Albert H. Padovani, MoTa ASCP Director 2 /86(Rvsd7 /87)RWE '_ a FINAL SITE INSPECTION Date Inspe:-,.ed by L SST IOGr1TION kt Q t tym 1/ OWNER /01�0 b-i PERMIT I�V L�` "�� TM v OR SUBDIVISION LOT n:.►1i:4iLLL'L1rJi,. a. SDS area located as per approved plans b. Fill section - Date of placement 2:1 barrier_ LGTH WIDTH AVG.DPTH c. Natural soil not strivued d. Stone, brush, etc., greater than 15' fram SDS area. e. 100 ft. from water course /wetlan I Ti. SEVZA E DISPOSAL SYSTEM a. Septic tank size- 1,000 1 b. Septic tank instal-led level I c. 10' mininmm fron foundation d. No 900 bends, cleanout within 10 ft. of 450 bead I e. DISTRIBUTION BOX I 1. All outlets at same elevation - water tested 2. Protected below frost 3. Minimum 2 ft.. original soil between box and trenches- f. f. JUNCTION BOX - properly set g. TRENCHES 1. Length remii red - u Length. installed .Q v 2. Distance to watercourse nea cured : ft. . 3. Installed according to Ulan 4. Dlstanc° center 'to clz lter ' 5: Slone of trench acceptable '1/16 - 1/32 " 6. 10 feet from prcce —tv line - 20 feet f 7. Denth of trench < 30 inches from surface 8. Roan allcw-ed for ex- -carsion, 50% . 9. Size of gravel 3/4 - 1j" diameter 10. Depth of Cravel in trench 1211. miniiman L . • Pine ends caused h. PoMP ' OR DOSE SYSTE S - 2. Overflow ~tank -" ..,_�,_.._ 3. Alarm, visual /audio 4. Pump easily accessible rranhole to grade 5. First box baffled 6. Cvcle witnessed by H =.lth Department estimated flow per cycle. IV. HOUSE, a. House located per approved plans. b. Number of bedrooms V. W-LE L a. Well located as per a =roved plans b. Distance from SDS area measured ft. c. Casing 18" above grade. . d. Surface drainage around well acceptable. VI. OT ZAII. WORKNASrl-u a. Boxes properly grouted b. All pipes partially Lack=illed r .. c. All pipes flush with inside of box d. Badkfill material contains stones < 4" in diarrete e. Curtain drain installed according to plan f. Curtain drain outfall protected & dir.to exist_wa g. Footing drains discharce away fran SDS area h. Surface water prot -tion ademmte i. lion control provided on slopes greater than 1 kPUTNAM COUNTY DEPARTM] NT OF HEALTH Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer to Provide Permit q on CERTIFICATE OF COPermit # CONST, ON PERMIT FOR SEWAGE DISPOSAL SYSTEM to J� f1 l L_ _ � /G � �� �r i.[✓t� -- ____ . -- _ :.� Tout nr._Y fie... ;AA, <. Subdivision, Name ®� c� e �i'°r Subd. Lot N Tax Map Block Lot f, _ %d, Renewal_ ❑ Revislon ❑ Owner /Applicant Name off' cF Mailing Address 9f t Building Type ' Lot Area/ 4 O 34c_ Number of Bedrooms , Design Flow G P D Separate Sewerage System to consist of Gal Septic Tank and -: To be constructed by Address Water Supply. Pub llc Supply From Address or: Prlvate Supply Drilled by —Address, Date of Previous Approval Town Zip Fill Section Only " Depth Volume - PCHD Notification is Required When Fill Is completed Other Reouirements 7 i � � ,,- •n n a'n, -, ",,2 1 represent that I am wholly and completely responsible for the design and location of the proposed above described will be constructed as shown on the approved amendment there to and in accordance County Department of Health, and that on completion thereof a "Certificate of Construction C be submitted to the Department, and a written guarantee will be furnished the owner, his su t place in good operating condition any part of said sewage disposal system during the Perio of ance of the approval of the Certificate of Construction Compliance of the original system n will be, located as shvn on the approved plan and that said well will be Installed in accordance It a County Department of Health. Date �/ , Signed f �T� 4 yryrr� l::;,,-: APPROVED FOR CONSTRUCTION: This approval expires two years f on, the date .revocable fose r may be amended or modified when considered ecessar by t requires e j6& pe it. Ap for disposal of domestic sanit y w e, and/ 1/87 Date z By ii` the separate sewage disposa'A ystem h an bs s an regU a ions O e nam 6el'csa0ieta &!o the Commissioner of Healthwill I � wi builder, that said builder will ij_years im $tely ollowing thedate of the issu- irs to; 2 )$hat th drilled well described above s ruler44d*r u a ions of the Putnam ° P.E.- R.A. se NO o ' e,fg has been undertaken and Is R 0AA9iv lYha04ge or alteration of construction Y9,A 9oa " T itle r eP ll T , DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL �YC�ill 'Y'B;'1tNlTT- #� WELL LOCATION Street Address Town Village Cit Tax / .c / -0 ) re �, �� ,,� � s = Grid Number Z�T 1� �.� > WELL OWNER Name Address Q�Ffivate O Public USE OF WELL 1 - primary 2- secondary M<ESIDENTIAL O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP 0 BUSINESS O FARM O TEST /OBSERVATION 13 INDUSTRIAL U INSTITUTIONAL O STAND -BY O ABANDONED 0 OTHER (specify 0 AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE gal REASON FOR . DRILLING Q4EW SUPPLY []PROVIDE ADDITIONAL SUPPLY O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL OTEST /OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE RILLED DRIVEN E]DUG aGRAVEL C] OTHER IS WELL SITE SUBJECT TO FLOODING? YES ko' NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: '/2e- a "- 0 Lot No. 1/1 WATER WELL CONTRACTOR: Name /�' ��"�.�rr3�� Address:Qr� 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 date)r� PERMIT ® ON SEP T HEET 10 ( gnature 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 pro 'ded by t�e Putnam Cou Health Depa /rtm nt. Date of Issue: ( d ZZ 19 Date of Expiration: 19 /M-ermit Is5Ving Ufticia Permit is Non - Transferrable l/ M. y JOSEPH F. SULLIVAN, P.E. _ .. __ .. �a �\� � ..- _ _ _. _ _ G.DYtStLLtL129 �R.�lI10ES _ .. _ _ __ — _ YORKTOWN HEIGHTS, N. Y. I0598 (914) 962-42413 111EII'll, flN -f fE, P 1 :34 o� 1 APPENDIX INDIVIDUALWA= SUPPLY & SUBSURFACE SEWAGE tl DISPOSAL SYSTE L - �: REVIEW SHEET - CONSTRUCTION PERMIT ,p _ ,14,.v3'••e;q! -_r, air' ' L. ., ...... �• . . . , ..... _, ..r.',. .o� ...w••ro r.. .re._.e.. -i•. �'-'TT �..I,T�_.�. o. ..,r.•.�:.i BYl t ( Name of Owner) ( Street Location) COMMENTS MEM, top aim= OEM � L' -UMM a ` �r►�� trench LF provided required 41 7J4&VM§MPPR= 60 r��� Parellel .. ■ M �V of MENEM EAM / • . !1 Vr).......' GMM1_ =_ •m ME MMII% E. OCL]MWS C 7L-- ( / Permit Application (�) a Corporate Resolution Plans - Three sets s/s Engineers Authorization Design Data Sheet (DDS) SUBDIVI Deep Hole Log Perc l SI Consistent Perc Results (3) Fill Perc Hole Depth cd House P s - Two sets Well permit; PWS letter Vari e R ceguest GENERAL Legal Subdivision Subdivision Approval Checked. Ex- approval SSDS Adj. Lots Checked Wet'-and (Tcwn/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 ---Pill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over .Construction Notes (grinder notes) Design Data: perc and deep results •°T`w;.•- a:w�'wi.���.:o ••.•iS�iii�-`�,c-"Fiu�iuotSt"Y __ .. <_. _. _.. Driveway & Slopes Cut Footing/Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Ecpansion Area; shown; gravity flow,suff. size If Pumped 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. 4:10; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees,Top of fill 20' to Foundation Walls :Z:0' to Well; 200' in D.L.O.D, 150' pits 0' to Stream, Watercourse, Lake (inc. expan) 1051 to Drains-Curtain, Leader, Footing 351to catch basin, stormdrain, piped watercourse 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' fran Foundation; 50' to well 15' Well to PL �, .. ��,� � �!• � 'ili 1�!' ' . • ! !`t: I � _ ! �I /' •T : '1�1 ' Y' :I . � ': ."!9i• . r� -- Il�DNV;DUAL, SUPPLY & SUBSaul 7 '..' _ ( Name of Owre,r ) t .F: IDim WRZ- r11%op" RIVD-u41i RENT_ON SMET — C ONSTRCi 10N PEBM.TLT ? _ . _ _.. ....... DATE l -- -__. BYj (Street Location) YE W D='N'S _ � Peanit Applicat.icn Corporate Resolution Plans - Three sets _ Engineers Authorization _ I Design Data Sheet (DDS) ' Deep Hole Log Consistent Perc Results Perc Hole Depth (�)U 56- 0 � s/ s J SUBDIVISI N�. Perc Ij (3) Fill cd House Pans - Two sets Well 1 pE_*mi -; PSvS letter Vari ce Re�uest Gr'�IERAI, + gal Subdivisicn uEdivision .Approval Checked. - apptoval SSDS Adj. Lots Checked Wet -land (Tcwn/DEC' Permit F. & D) ",ata On'DDS Plans & Permit Same ftEQ(i= DETAILS ON PLANS Eewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flew --Fill Profile & D--nensions • Volure Q or J Box;Trench /Gallery; Ptarp pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes (grinder rotes) Design Data- perr and rlFep result—c Too- -ra:,t ioutalus Existi:ig & 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 Pmvped Pit & D Bex Shown & Detailed House - No. of &drodns .Wells & SSDS's w /in 200 ft. of Proposed Syst -T__- Property Metes & Bounds House Setback Necessary (Tight lot) Louse Sewer - 1 /4 " /ft. $" 0; Tyne pipe No Sends; Max. Bends 450 cVcleanout SEP RATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Di',iveway, Lax°ge Trees,Top or fi.1 20' to Foundation Walls `' 0' �.o Well; 200' ins D.L.O.D, 150' pits 00'o Stream, Watercourse, Take (inc. ern; _> 15' to Drains- C.'urtain, L- _=der, Footing 351tc catch basinf,stormdrain,pi :Ed watercourSE' . � 10' to 4 ter Line (pits - z;)' ) 50' i ate,..- ,utter:0t drainagE, course 'ae tzc '1 n} 10' Iran . coundacion; 50' to well 15' Well to Pa 9 .s e .. 3� °au .F: IDim WRZ- r11%op" RIVD-u41i RENT_ON SMET — C ONSTRCi 10N PEBM.TLT ? _ . _ _.. ....... DATE l -- -__. BYj (Street Location) YE W D='N'S _ � Peanit Applicat.icn Corporate Resolution Plans - Three sets _ Engineers Authorization _ I Design Data Sheet (DDS) ' Deep Hole Log Consistent Perc Results Perc Hole Depth (�)U 56- 0 � s/ s J SUBDIVISI N�. Perc Ij (3) Fill cd House Pans - Two sets Well 1 pE_*mi -; PSvS letter Vari ce Re�uest Gr'�IERAI, + gal Subdivisicn uEdivision .Approval Checked. - apptoval SSDS Adj. Lots Checked Wet -land (Tcwn/DEC' Permit F. & D) ",ata On'DDS Plans & Permit Same ftEQ(i= DETAILS ON PLANS Eewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flew --Fill Profile & D--nensions • Volure Q or J Box;Trench /Gallery; Ptarp pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes (grinder rotes) Design Data- perr and rlFep result—c Too- -ra:,t ioutalus Existi:ig & 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 Pmvped Pit & D Bex Shown & Detailed House - No. of &drodns .Wells & SSDS's w /in 200 ft. of Proposed Syst -T__- Property Metes & Bounds House Setback Necessary (Tight lot) Louse Sewer - 1 /4 " /ft. $" 0; Tyne pipe No Sends; Max. Bends 450 cVcleanout SEP RATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Di',iveway, Lax°ge Trees,Top or fi.1 20' to Foundation Walls `' 0' �.o Well; 200' ins D.L.O.D, 150' pits 00'o Stream, Watercourse, Take (inc. ern; _> 15' to Drains- C.'urtain, L- _=der, Footing 351tc catch basinf,stormdrain,pi :Ed watercourSE' . � 10' to 4 ter Line (pits - z;)' ) 50' i ate,..- ,utter:0t drainagE, course 'ae tzc '1 n} 10' Iran . coundacion; 50' to well 15' Well to Pa 9 PUTNAM COUNTY DEPARTMENT OF HEALTH •DTVIS2 ON .. ._ v-- ....�.�.,- ....... :;ti= 's..+•.1.f ", OF- EN.T_V..._I... R ..O.. N.M- -rEte V � .Ps�!I_*�— _ H:E,,QL.:vTH .tic+eaS m .R-V•.e.�T...RGxa.Ev S� vr.�::y�ti .i� :iw.:e%- ':.�.v.•:�r.�r..r 0`rs.,.....�: �..�r..= Date Re: Property of Located fat (T) /'a140,g7 !/ Iq Section /3 Block Subdivision ofd✓ Subdv. Lot # �/ Filed Map # �� ,fi Date G Gentlemen: This letter is to authorize�� ' a duly licensed professional engineer or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in _cornec-. x to::—a a vise -the system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. 3 `0- - Z' �' 0 0 U-.. Countersigne P.E. - 9 A dress Telephone �a�9 O i�J c 5 � las._►�+ Very truly yours, op" a Signed ptb OF N6, 4 p Owner of Property ®'per Rrn Gc-x pt4 Address N. .-7f f Town 128 G/W Telephone t'Ul[11111 u.Ahil t I I1 J 1,V lcl1:11. 1 . . r I tv.rill DIVISION OF EMIMEERML IiEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE SSIAGE DISPOSAL SYSTEM FILE NO. .� , r'vnii�...� ''�''' <' /'y.;j V' �f�- r: >' /. �'.(.n.L- ::.,�r-c� }-=d`= •'r �. ".�i3'.JY l i�`'��, _ri- .r,• -> y_:$.'. a ?� .y Located at (Street) � 1 � �� t7 i�� `f �' Sec. s Block (indicate nearest cross street) Municipality `�;'`;? : Watershed . SOIL PERCOLATION.= DATA RBQM TO BE SUEMI= WITH APPLICATIONS Date of Pre- Soaking a a%�� Date of Percolation Test HOLE NUMBER CLOCK TIME . PERCOLATION PE RODLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min, Start Stop Drop In Min /In Drop Inches Inches Inches 213 3 4 5 3112, f 5 NOTES: 1. Tests 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. 20 Depth measurements to be made from top of hole. rev. 9/85 TEST PIT DATA Rl-- )UIldl) TO BE,, SUI MITI'l-D _.0111 APPI,I.CATION ' DFSCRIPTION OF SOIIS ENC.OUN'i'EERE1) IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. 1' 3' i 4° ' f 5' 6° 7' 8' 1 9' 10' 11' 12' 13' 1 141. INDICATE LEVEL TO WHICH WATER LEVEL RISES. AFTER BEING ENMUNTERED zh DEEP HOLE OBSERVATIONS MADE BY:r �'' DATE: DESIGN Soil Rate Used �� Min /1" Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity /' jam gals. Type A/1:�15v " I/ Absorption Area Provided By a(J L.F. x 24" width - trench Other Name �' v �/ �n�=�� Signature ��P.;* ''�''a Address 7Crr���� e �� • AL THIS SPACE VOR USE BY HEALTH DEPARIMENr ONLY:,,,,;;pL �;.• lrear.Jrr�r• Soil Rate Approved sq.ft /gal. Checked by Date SL M 4 zzp-p Jr"(,"R, 0, q Zy P D /V V arty 'Y V,­ ,F N UN R, %' M- 1 ;t& 7" P_- 0 ' -Z d, e— A S, BUILT S E WA - DISPOS�� :A tify that,the-8ewage disposal system was ndicated on this plan and,th at the system )Y me be fore pit was. ' covered over. T­ trusted in accordance �4 with all standar�A' tions of the Putnam County Department SUB CqV - A ew York State Department of Health. ..... ... Isposal system designt,hereon-does not Provide fo r .. ........ T of a garbage grinder. ,Su6h:in6tallation reqjiijes: of the Putnam C ti 77 7 �77- Putnam C.nuo�$%,EpWnij�4, -_�&IUffilth'. Division of Ravironmsntal Health Servioet 'JO S Approved as noted for-c6nformanoe with RUM E applicable Rules. ?nd. P 1 c s.ot the Putnam Cc unty Health Il L3 &"a )-At77.77 -:�:,A-S'SHOWN,