Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
3245
DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73. -1 -34 BOX 26 rm ., ilm # blLIL. -INN� ri .r. , 03245 PUI'NAM COUNTY DEPARTMU9 OF HEALTH - DIVISION OF ENVIRONMEN`T'AL HEALTH SERVICES INDIVIDUAL WATER SUPPLY /SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIELD INSPECTION REPORT DATE: INSP._ ..BY:.. r — INITIAL SITE INSPECTION YES NO CCMMENTS Property lines or corners found ................... Can estimate house location ....................... Will driveway need cut....... ................... Must trees be removed - note °these ................ Deep hole representative of entire SDS area....... Additional deep holes needed ...................... Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacent wells /septics ............................ D.H. 1 Lot Depth to G.W. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. 12 ft Soil Descri tior. LT-- D.H. 2 Lot Depth to G.W. Depth to rock Soil Description 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. D.H. - Deep Hole G.W. - Groundwater D.H. 3 Lot Depth to G.W. Depth to rock -O CD 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. Soil Descri rev /9/85 mk FINAL SITE INSPECTION INSP.BY: YES NO COMMERrS House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... _ Roam allowed for expansion trenches .............. Over 100 ft. from swamp, watercourse ............. Natural soil not stripped or SDS area unnecessarly graded ........................:... 10 ft. maintained from property line and 20 ft. from house .............................. Distance well to SSDS (ft.) ...................... Number of bedrooms checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench.. ..... ..... 15 ft. of peripheral soil horizontally fram trench ..... ............................... Boxes properly set ................................ Could surface runoff from driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE.... ..... rev /9/85 mk PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES r.- �- �:.�,.;���:. ,x,,..,,.:..�.,� � �.�. °- -��,...•,� -.. _.� _- -_ f.< ... - - -- - .. - - .ter- _.. �9; J_. _ _ < - -- -„ - , -_ . Date Re: Property of Located at �is'J/��c �i) c%✓�• (T) Section 160 Block - Lot Subdivision of J�,°t� �' %�'�Pur✓f.j7 s��//` Subdv. Lot # Filed Map # 7� � .Date Gentlemen: This letter is to authorize r7e v!frZ � %iii � 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.promulagat.ed by the Commissioner of the Putnam County Department of Health, and to.sign all necessary papers on my behalf in connection with this matter and -to supervise the construction of said _. -.�.. ... .a. . .... ..r- ...-.. .^ •. .__C— a.i.a-. ..r.- .. -s ._ .r-.. a... .. ... .i c...^ss T. .. ...i ... ... ...._..�._.� -.. �. . - -.I —... ..._. �._..� _.w.. � -..... m...v v system or systems in with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County.Sani- tary Code. .v.., "ZZ- ,.,iA- Very .truly s, Signed Owner of Property ddress Town P. Telephone Aaaress Joseph F. Sullivan 2972 Ferncrest Drive varktowR , Telephone JOSEPH F. SULLIVAN, P.E. YORKTOWN HEIGHTS, N. Y. 10599 (914) 962-424B 7 ld-1 PUTNAM COUNTY DEPARDIENT OF H7 :ALTH - DIVISION OF R VIROMMML HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS l�v� 1� h✓ REVIEW SHEEP - CONSTRUCTION PERMIT Name of-Owner v P, , - p ax i��a _,r StY°u6t L'oca`t - DOffbIRUS r- t i 1� DATE REVIEWED: q1 Permit Application _ Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile- Gravity Flow Fill Profile & Dimensions - Volume D or J Box Detail Septic Tank - Size, Detail Well Detail, Service Line if 0t Trench /Gallery Pump Pit Two -Foot Contours Existing & Proposed Slopes for Driveway Cuts Footing /Gutter Curtain Drains. Perc & Deep Holes Located Representative of Sewage & Expansion Area _.Expansion Area; shown; gravity flow If Pum ea Pit &,,D Box . Shown & Detailed - Wells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary 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 Trees 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, Storm, Leader, Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fran Foundation 50' to Well 15' Well to PL COAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same Well Permit M MM w� SWAM 'MM EXAM mm MM IMAM MM DATE REVIEWED: q1 Permit Application _ Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile- Gravity Flow Fill Profile & Dimensions - Volume D or J Box Detail Septic Tank - Size, Detail Well Detail, Service Line if 0t Trench /Gallery Pump Pit Two -Foot Contours Existing & Proposed Slopes for Driveway Cuts Footing /Gutter Curtain Drains. Perc & Deep Holes Located Representative of Sewage & Expansion Area _.Expansion Area; shown; gravity flow If Pum ea Pit &,,D Box . Shown & Detailed - Wells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary 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 Trees 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, Storm, Leader, Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fran Foundation 50' to Well 15' Well to PL COAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same Well Permit - _,�s��.'-r2�.e_�. �-s'.� v x.�..,,.,... "- ,+�xti:�.'.�,' -.yam_✓ ,�v.+Ma'�•a' a's r+�iir c�::arh: L T r..eo.,:,.�,'y".,'`a�+ n!. M. � - r � �A .s•T1 r-['a. _rora. R..t..�n,..�.4�+vp�..� .,.w- -v..�. +. � i, �. __. DAVID D. BRUEN County Executive DEPARTMENT OF. HEALTH Division Of . Environmental Health Services September 24, 1986 Joseph F. Sullivan, P.E. 2972 Ferncrest Drive Yorktown Heights, New York 10598 Re: Proposed SSDS Charles Anderson Tax Map #60 -1 -53A (T) Putnam Valley Dear Mr. Sullivan: . . JOHN SIMMONS, M.D. Deputy Commissioner Review of plans and other supporting documents submitted at this time relative.to the above - captioned project has been .completed. .:Commentsare offered as follows: i. 1. Include "hydraulic'.. prof ile x 2. Specify= -10',. minimum `separation distance from end ; of trench '; °_to solid °curtain drain /.leader drain; 151 minimum to - perfo `rated drains. 3. Specify minimum distance from end of trenches at. property line 4. Submit..3 copies of well permit. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very my ,yours, An e Bittner AB:pt Assistant Public Health Engineer TWO ..,COUNTY:.-,.CENTER CARMEL, . N.Y. 10512 (914) 225 -3641 DAVID D. BRUEN County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services September 24, 1986 Joseph F. Sullivan, P.E. 2972 Ferncrest Drive Yorktown Heights, New York 10598 Dear Mr. Sullivan: JOHN SIMMONS, M.D. Deputy Commissioner Re: Proposed SSDS Charles Anderson Tax Map #60 -1 -53A , (T) Putnam Valley Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: %_/l . Include hydraulic profile 2. V ,1 , J4. Specify 10' minimum separation distance from end of trench to solid curtain drain /.leader drain, 15' minimum to perforated gains. Specify minimum distance "t °rom end' of'"trenches at property' line`. Submit 3 copies of well permit.. Upon receipt of a submission, revised'to reflect the above comments, this application will be considered further. Very trulyyours,. An e Bittner AB :pt Assistant Public Health Engineer TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 DEPARTMENT OF HEALTH ' = : Division Of Environmental H%aAh Services TWO COUNTY CENTER — CARMEL, . N.Y.. 10512 (914) 225-3641 . r.. ..�- ..-.. _a _ r. ,v— •- +.--�:X �L.L�.rhlll:/lY i., c.. tl`;:t' ti "-WATER WELL . P� WELL LOCATION c a j �,�, IUWnVIILAGt1GlIT (aX GRW NUh18EA. ®;, 'P�V4'v ale ex®-- WELL OWNER Aht �1�/ ADDRESS: �? Jy ��O� -e /�.�'�S° I VATC ❑ PUBLIC USE OF WELL OESIDENTIAL ❑ PUBLIC SUPPLY ❑ -AIR /CONO. /HEAT PUMP ❑ ABANDONED 1 - primary ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑OTHER (specify) 2 - secondary ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF-USE YIELD SOUGHT gpm. /NO. PEOPLE SERVED 42'_/ EST. OF DAILY USAGE w gal. :REASON FOR AF NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY D TEST/OBSERVATION DRILLING ❑ gEPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL WELL TYPE DRILLED DRIVEN DUG E] GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: ,6 LOT NO_: WATER WELL CONTRACTOR: Name Address : ede/ ey/' IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NAME OF PUBLIC•WATER SUPPLY: TOWN /V /C. DISTANCE TO PROPERTY. FROM 'NEAREST - WATER-.'kAZN.., 1 - . LOCATION SKETCH & SOURCES OF CONTAMINATION, — r-1 (da ) I� (signature) PERMIT - TO CONSTRUCT A WATER WELL This permit to construct -one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. Date of Issue: 19 7^ Permit Issuing O fis' . Permit.:is .Non - Transferrable LOCATION ,. II. IV. VI. APPENDIX C FINAL SITE INSPECTION Date Inspected by c -d ✓ OWNER rm # OR (SUBDIVISION LOT # �. (� �' 1. .l SEWAGE DISPOSAL AREA a. SDS area loca ted as approved plans COMMENTS 1, m b. Fill section - Date of placeent 2:1 barrier. LGTH WIDTH AVG.DPTH c. Natural soil not stripped d. Stone, brush, etc., greater than 1 from SDS area. e. 100 ft. from water course /wetlan SEWAGE DISPOSAL SYSTEM a. Septic tank size - 1,000 ,2 b. Septic tank installed level c. 10' minimum from foundation d. No 900 bends, cleanout within 10 ft. of 45° bend e. DISTRIBUTION BOX 1. All outlets at same elevation - water tested 2. Protected below frost 3. Minimum 2 ft. original soil between box and trenches f. JUNCTION BOX - properly set 9. TRENCHES 1. Length required - ". Lenqth install -/—S6 2. Distance to waterco&rse measured. ft. -� 3. Installed according to plan 4. Distance center to center 5. Slope of trench acceptable 1/16 - 1/32 " /foot. r G� 6. 10 feet from property line - 20 feet - foundations 7. Depth of trench < 30 inches from surface 8. Roam allowed for expansion, 50$ -C ' , 9. Size of gravel 3/4 - 1j" diameter 10. Depth of gravel in trench 12" minimum _ _, -- - �._..i.:7_ - ..�,Ta an��c rar��%1 _ _._ .._'_ - -_ r_ ,:«- •�.;, �Y_ v- ... __pT�� h.}PL24P OR DOSE SYSTEMS 1. Size of pump chamber 2. Overflow tank 3. Alarm, visual /audio 4. Pump easily accessible manhole to gr,=de 5. First box baffled 6. Cycle witnessed by Health Department estimated flora per cycle HOUSE a. House located per approved olans. c, Number of bedrooms a. Well lccated as per auarc .:_ -glans `l j b. Distance -r.m SDS area me_-s ed p o ft. � c. Casinq 13" arove rade. f d. Surface drair-aae around we 11 acceptable. �, w OVERALL WOP -;24= SHIP a. Boxes prccerly grouted b. A11 ices cartially bac' _!led g c. All ipes flush with inside of box d. Backf ill material contains stones < 4" in diameter e. Curtain drain installed according to plan f. Curtain drain outfall protected & dir.to exist.watercours g. Yco---tEng drains discharge away from SDS area h. Surface water protection adequate i. Erros.icn conr-roi provided on slopes greater than 15 %. 66 i . Yorktown Medical Laboratory, c. 6ratory, In... LAB I 87 006 1 321 Kear Str.cet Date Time: lao- (9.14) 245-3.203 IYUV Date .. 2 1 1987 Director: Albert H. Padowni M. T. (ASCP) Collected By: Referred:. By: Sample. Location: V_-� 6-9-j-DAJ rI6e d. q Phone .# 723-3070, Vfu_c�-, Phone # Sample Type:. L J Repeat Test? .(check one) LABORATORY REPORT ON THE BACTERIOLOGICAL QUALITY OF WATER -4 GENERAL BACTERIA VStandar& Plate. Count- (CF l.OmL) (Agar.,'Plite. 8 MEMB,RANE FILTRATION TECHNIQUE (MFT)' V. Total Coliform (CFU/lOOmL) Fecal Coliform (CPU/lOOmL) 'Fecal Streptococcus (CFU/lOOmL) MOST PROBABLE NUMBER TECHNIQUE (MPN) _Total, Coliform:_MPff Index J.P-p-r- w I Potable Non-potable STP INF' PTF EFF 'Other: Samplestatus: (check .each) Outgoing N a2S203 Incoming LE 4 °C GT 4 °C Other: Fecal Coliform: MPN Index (per lOOmL) OTHER ANALYSES KEY.FOR TERMINOLOGY RDS = Recommend Disinfec- tion of Source TNTC= Too Numerous To Count REMARKS (For Laboratory Use) -.60N = Confluent (=TNT.C) LT = Less. Than -GT w Greater Than >) N/A = Not Applicable LE = Less than or equal to THESE RESULTS INDICATE THAT THE WATER SAMPLE WAS) (WASN'T) (NIA) OF A* SATISFACTORY SANITARY QUALITY ACCORDING TO TH. NEW 'YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT' TIME OF COLLECTION. For Lab Use Only:- H/C to L Albert H. Padovani, M.T. (ASCP)g Director [LAB OFFICE HOURS (Main Lab): 9AM-5PM, Mon.-Fri. 12/85(Rvsd7/8T)RWE 9AM-NOON, Sat. Is , ` \' office Use Only DEPARTMENT OF HEALTH fovi PUTNAM COUNTY DEPARTMENT OF HEALTH kATION STREET ADD HESS: W'GRIO NUMBER: WELL OWNER NAME: ',ADDRESS: 1,C] PSIVATE 0 PUBLIC S'E`.flf.',Yi ELL: 0 RESIDENTIAL 0 PUBLIC SUPPLY, 0 AIR/COND.IHEAT PUMP 0 ABANDONED A 7'. prim ary 0 BUSINESS 0 FARM 0 TEST/OBSERVATION 0 OTHER (specify) A MIJ OF USE YIELD SOUGHT gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE gal. N.'* F'O R -.0 NEW SUPPLY 0 PROVIDE ADDITIONAL SUPPLY 0 TEST/08SEERVATION D91tLING 0, REPLACE. EXISTING SUPPLY 0 DEEPEN EXISTING WELL DATA �_ �ft- WELL DEPTH ft STATIC WATER LEVEL DATE MEASURED 0 WELL POINT 0 CABLE PERCUSSION -WELL'T.YPE 0 SCREENED 0 OPEN END CASING. OPEN HOLE IN BEDROCK 0 OTHER TOTAL LENGTH fL MATERIALS: ER 4,,CASING LENGTH.BELOW GRADE ft. JOINTS: 0 WELDED `0 THREADED 0 OTHER DIAMETER in. SEAL: 0 CEMENT GROUT 0 BENTONITE 0 'EL THER WEIGHT PER FOOT 1b./ft. DRIVE SHOE: 0 YES 0 NO LI ER:OYES El,'NO DIAM IETER (in) -SLOT SIZE LENGTH (ft) DEPTH To SCREEN (it) DEVELOPED7. FIRST GRAVEL PA K c 0 YES GRAVEL DIAMETER IinDOEFTH P BOTTOM 0 NO SIZE: OF PACK -ft. DEPTH It. WELL 11ELD TEST I If detailed pumping WELL LOG it more detailed formation descriptions or sieve analyses are available,'please attach. METHOO.-_`O PUMPED 1 tests were clone is in- 0, MPRESSED AIR formation attached? suRFAH'E' Bear- Dia FORMATION DESCRIPTION COGE ft. it. 0: BAII.E67: �O OTHER :OYES ONO Ing mete In 'DURATION ORAWOOWN Land WAT -.'COLOREO ANALYZED? /OYES ONO STORAGE TANK: TYPE CAPACITY F-UMPA' CAPACITY WELL DRILLER NA ME E DEPTH _SIGihtTbRE VOLTAGE - HIP PUTNAM COUNTY DEPARTMENT OF HEALTH �:o::,v+k `.:;.= n -. > -�: . �..._. -_ r• ` il.'T tv-' ty� .'r:'.c,��n'i•,�E4F"k.�A� -�?1 C.' m` n�.' w «i+_:�-`s4'�..'._'`- �.',._'F`.� f_ �x. wiz r �:i�_ :::.i �. rv- .:��+�:..'e.�'..w.a•.�is.::. -� Owner or Purchaser of Building i/ Building Constructed by Location - Street Municipality Building Type Section Block Lot SubMvision Name Subdivision Lot # GUARANI'EE 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 fora period of two years iurmediatel.y following the date of appr_caval, _off.: tk�e,. _ rc•n t :- a. _ r n .,. it -�.. ",�._ r - -^ .- .`r .. c. _ . ` - t , "j :: �l l`l:ti%� �Jl' \ oliJ :ri 4� t.lvaa �.Vi�i Jl1dC1(�C lOY tii� Wage, Cll`�UShc S L�[l, (jZ"�Ilj� • µ 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 day of 19 �� Signature 5�,� Title General Contractor (Owner) - Signature Corporation Name (if Corp.) FIM- - rev. 9/85 mk Corporation Name (if Corp.) Address OCT-22-1999 09:11 P.02 PUTNAM COUNTY DEPAKTMENT OF HFALTH PROVIDE Divisfon of EnvOmmmmi Me" Smvicm& Q~. N. Y. 1012 PERMIT # CERTI&TE Of CONSTRUCTION COMPLIANCE . FOR SEWAGE DISPOSAL ML0 4:7 v lf , " K4 Town of V 4.6cilted- at -1 7r-cfc LW Formerly Tax Nap Lot god. ta% 9 separate Sewerage system built by awry mrro- Address CQnststing of-/2--VV Gal. SepUcTank and Other reaulrellonts Wow Supply= Building Type Ptablie Supply From P"s Erosion Control Sion CQMPW*d? uas, 9*rWqQ grinder, O"n I certify that the 8YOZ40(m) im listed serving the above premises were constructed essentially as shown an the plane of the goVL4tad work ( copitt, of which are attached), and In accardance with the standards, rules and revulstImm, in acCOmdance with the filed plan, and the p*Mlt ts*u" by Lim fttn= County Davacbmat Of ff"Itik. Data C led— go[ P.C. RA. Any Person occupying Meshes served by "Prabove systmn(s) She" prginptiv take WCIf may to he commlion of any mosanizary m : ruilliam r4nuftlaq from such UU94L A0WO"t Of tiro. MWilte -- -111 {yftarll shah null Palk Unitary now bmmn imialillble and the 4WOvOl Of the P&Ate water supply ftll ft i —nm pull *W wow wlNn Rabin, Such 4 pp -' ft We subioct to mod of manse when, In the Judgment Of the c4mmummimomm of of Is vioussary. Date � y t TRU 2=�T:N- TOTAL P-02 I P61TNAM COUNTY DEPARTMENT OF HEALTH HOUS-'P: PLANS APPROVED FOR BEDR. IM GOUNT ONI-'�, & 73, -/- L ',' .Fk t. i ul .q ru DEC EL I a15° OH' I r% I I C, a TA-.0 6.M Yjr N\ 90) AID 0 5,AT-m PO -4AEXv c-,P,,V 147-X.-7 E-' 4 O LAN SURVEN Mlkp PREP AREO 7 tip- a OF S3 %Yr %%ft I f of HEIV Vo; I I VX L\A z 100 V VIES T Pt POkk %4 E.7 Ir-L 10 u 'I M L"RIMM& I TZ b OLU-%",G S, pF No 049a4a SZRZE ON 91 sick E-%Sl t+AVV-T—'T 'S-T. Pd\\%-k" SLVL, W-1. Ck\'A - 167(a --1H23 SEP -24 -99 SAT 1:26 PM PUNAM CTY ENV HEALTH FAX ISO, 19142787921 P. 1 DEPARTMENT OF HEALTK Division. Of Environmental Health 5ervices 4 Geneva" Road, Brewster, New York 10509 (914) 278 -6130 Putnam C6unty Dept. of Health 4 Geneva Road Brewster, NY 10509 Re: Residence Tax Map Town Gentlemen: BRUCE A. FOLEY, A.S. Acting PWIc ,Health oirector According to records maintained by the To -.Nn, 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 front: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: -zFa. Building Inspector 09/18/1999 11:14 914 -8.38 -1356 HUDSON VAL SUNROOMS PAGE 04 i -..0. _ _a. -..- _ r ..�'s�s�a t.cy',. .... .�....• -.. •. ...-- �...:: r... [. ... ..: ..ee.._.. r.. c.i. s..> -r.-.s �.� -A ....y. 2•.wn..• ... ..e. ...^+.ti' •- 7 IN 12 PffCPi 5 3/4 IN 12 PITCH 3 1/2 IN 12 PITCH r -e W-11 7/16' 1 -a 5N r ALL HEIGHT 22 1/4° EAO ROOM UNDER TRUSS = 9' -11 7/16' SASEWALL HEIGHT = 22 1/4" HEAD ROOM UNDER TRUSS = 9' -5 7/16" NOTE: 92 3/8° TO UNDER SIDE OF EAVE. //7 IN 12 PITCH I:Vlr BASEWALL HEIGHT = 22 1/4" HEAD ROOM UNDER % TRUSS = 9a -11 7/16" f BASEWALL HEIGHT = 22 1/4" HEAD ROOM UNDER TRUSS = 8' -5 7/16" 5 7/8 IN 12 PITCH 3 112 IN 12 PITCH m 9' -I Ile - -� 424ALL'HEIGHT - 22 1/4" HEAD ROOM UNDER TRUSS = 9' -5 7/16" : 92 3/8" TO UNDER WE X SAVE. 1o• —s EWAkk. HEIGHT - 22 1/4" HEAD ROOM UNDER TRUSS = 8' -5 7/16" SYSTEM 4 CONSERVATORY ELEVATIONS 72 as a -10 POIX2 16 -11 -96 OF 1 T 8*-Ir 7 IN 12., PITCH ,, /f W-11 711 lr� L ALL HEIGHT = 22 1/4n EAD ROOM UNDER TRUSS - 9'-11 7/16' W-3 I BASEWALL HEIGHT = 22 1/4' HEAD ROOM UNDER TRUSS = 9'-5 7/16, NOTE: 92 3X TO UNDER SIDE OF EAVE, i IN 12 PITCH .5 7/8 IN 12 PITCH BASEWALL HEIGHT = 22 1/4" HEAD ROOM UNDER TRUSS = 8'-5 7/16' 3 1/2 IN 12 PITCH Jim j! f I L 7' A 'A I ONVeW -7 Wyk 22", KE*KN--f .22 4 HEoq 22 1/4'„ 61 H ROOM "pi UNDER Ek. j1W -r(OOM UNDER ^%ly MEW.R00W M 7i 10 S 92 3/8' TO U SYSTEM 4 CONSERVATORY ELEVATIONS ko. dc—* 72 r/. RC or cm cm SYS7 M 4 CONSMATORy KMVM 3' uW uw - ve low_ &a mmm &V'm am rmx w =m 5" 0400" MODEL MODEL. --40meam ON uLfx SIRE 1308 & 1508 WA m 6f 1300 & 1511 owuu.al of-$ 5/r 45--1 1 31116 Is .-I- �l v UW • W-1 31e Ir uwr • 16--10 3H - 4 SAYS. woe Of 7. MODEL �1314�=&1617�- v ma - ll•-r K we a W-11 1/2° mom sm 1319 & 1523 NONE REVISION,;" E 0 FOUR SEASONS SOLAR PRODUCTS CORP. REVISION* I in am 4 02 60" TgTwtuo USUMAL luiA TOTAL P.02 10-08 -1999 11:34AN FROM FOUR SEASONS WESTCNESTER TO 2459057 P.02 SYSTEM 4 CONSERVATORY PLM VIF. 5 Uhf ■ g-9 �/8' 1c uwr . r-e vr 't' ,ear s' . it-go ' $ oIw v To NOW* *aOMM *W 10 GVU FA" OF QGM SU am Y' I 10 IRE M MODEL MODEL 19 1+ MODEL �Q1/O�IMM Urt UICR --y Dim rum T A wrotr+ 08 uillrr — 1306 & 15 �•��•' 2 rw; • � �. j 1308 & 1511 �- __ `�'- .rr►�•_..�• we of urar• '1 \S� -�aru R II t V UW ■ 14' -1 3/4' - -2 w UNIT W-10 Ile 3 BAY$ 3 -) �y jf 4 SAYS mom MODEL SIZE SUE '— 1314 811517 1312 & 14 s' UW :. W -a 3/a' 5' uW Isr -3' 19' —IQ 7/8' —+6' 1MwT ■ u' -11 I/2' 'w loo- 5 BAITS 681'15 MODEL MODEL SI2F SLZE 1317 $1520 1318 81523 - • r- 'T.. •.i • 'iw RC NONE FOUR SEASONS SOLAR PRODUCTS CORP. Rt_viSiON..; . son wr►ew�ISr vclrQ±±r�._�nR�nr�+r <� �- _ �:� ,��.: � 1 3 -6 -06V .�r 1 ,..1 a10e Ift AND KWWAC IM OF roue SUWNS SIMMrs _ - ' s_ TOTAL P.02 =I j 1308 & 1511 �- __ `�'- .rr►�•_..�• we of urar• '1 \S� -�aru R II t V UW ■ 14' -1 3/4' - -2 w UNIT W-10 Ile 3 BAY$ 3 -) �y jf 4 SAYS mom MODEL SIZE SUE '— 1314 811517 1312 & 14 s' UW :. W -a 3/a' 5' uW Isr -3' 19' —IQ 7/8' —+6' 1MwT ■ u' -11 I/2' 'w loo- 5 BAITS 681'15 MODEL MODEL SI2F SLZE 1317 $1520 1318 81523 - • r- 'T.. •.i • 'iw RC NONE FOUR SEASONS SOLAR PRODUCTS CORP. Rt_viSiON..; . son wr►ew�ISr vclrQ±±r�._�nR�nr�+r <� �- _ �:� ,��.: � 1 3 -6 -06V .�r 1 ,..1 a10e Ift AND KWWAC IM OF roue SUWNS SIMMrs _ - ' s_ TOTAL P.02 Minerva Santos, M.D. 17 Spruce Mountain Drive An ' 9*528-2157 E-mail: MinzoQ 1 QBM.NET October 18, 1999 Dear Mike; I have enclosed the requested information for my sun room addition. You stated I did not have to send in the cert. of occupancy. I copied the floor plans from my appraisal but they did not have the basement included because it is unfinished. I sent the plans from four seasons. If you have any questions or need any further info please call me work # 245-1900. Th g you in ady ou MA e r Santos 7879j 4-99 SAT 1: 2'1 FbI PUNAM CTY ENV HEA' TH FAX NO. 19142., t / P. 2 L*PARTWNT OF UZALTH Divfirkff of Enviroaftn"d jreaLfk Services 4 Geneva Road Eft am New York 10509 Tel, (914) 21S - 6130 Fax (914) 278 - 7921 76,79) 51-1*7.1153 STMT_ flj,,� TOWN PJ TX " # PHONE `?-IT7FCHD4 MAU-NO ADDRES! , DESCRIPTION OF ADDITION SU4x--- AXYYvl Public Health Dbwror NUMER OF EXISTING BEDROOMS 4 (FAMVEW. OF OCCUPANCY OR __ PROPOSED # OF BEDROONIS_� CERTMCATION FROM auum4G ImwECTOR) *� A&W& 41cb is Sowide*d a bedroom requires formal .approval of pins (Construction Permit) prqtl '00 by a PbWK*6j0n%b1 Engineer or Registered Architect in accordance with applicible s&dons of the Put )= County Sanitary Code. Brewil NY 10509 Phorie278-6130. 1- CaW* check or money order for $ 100-00 2. Skew-40 ofaisting floor plan (drawn to scale, all living area including basement) Non-professional sketches are ac.ceptable 3. Two sets of proposed floor plan (did m to scale, with name, street, and tax map * Non-professional sketches are acceptable 4. Copy of survey showing well and septic locaftn,,, to the best of your knowledge. Include date of installation if Imowm Label all wells and Peptic Vj3t=s within 200 feet of the property line. Contact this office with any questions; S. Copy of Cert. of Occupancy from Town or Catifination from Building Dept with legal bedroom count of dwelling. Feb 98 NEERim PUTAIAM COUNTY DEPA OT kALT'H , PROVIDE -«- - ) Division of Environmental Nev3lthItin ,, N Y ft75i2 . r PERMIT 1 tt is CERTI ICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE t�ISPOSAL SYSTEM tY rt ICJ l i I. 'Town .or Village , , c ; s t l.oeated at C J J fi i r /mil �'r l G, ,v ': ' Tax Nap Block f; f GG </ ' owner: e, r7 / Formerly Tax Nap Lot /,y � Sub& Lot # r'JS -Y" r'> '•� �_ t7 .%� ate.- L✓':'� ,*�' r et" We Separate Sewerage System built by "� Address r r ^ r Consisting of t'/, Gal. Septic Tank and / `�� ` o' '� C— A7 AZ 4 Other, requirements c tr !" �� 6Y i 6(. dy►/ d. �r. t wets. Supply: Public Supply From t. AX Lit Private Supply Drilled BY 11 bBu110ing TYPe �' y { ` fr N� nr' ea �drooms _—.-- "Oats" Permit Issued } Ha :Erosion Control t3een ComPleted7'Has gba a grin�er�beeninstalled?_ Z certify that:;the syatem(s) assliated:serving, the above remises were,constrticted essential atlown on the lens of. the c leted wrli (copies w ; of which are >,attached).aand. in accozdance with t:he,st:anda=1s, _ivies aril rj3guleitions,'in.accordance with the'filed plan, and the permits issued; by the putAam ty,DeparftTtk OP Health +F.; Date ��� 4 s + qtr ,. ra : RpN _ .®. .Ce► itied by � a Address ' y —�. License Fdo qmi Any.'pprson occupying Premises,serve4_bY th above systems) shall, promptly take, ch:a i0it s ms` eeeisi ,to eth t a eomction of an unan to Y Y, h.. �`r = eohdit ons resulting •from such' usage. ;Approval: of the'separate'ff are getsystemxtt tall eeo s�"nu_I void;as Soo as o: +Pubite'ainitary t6we/ beo0tlros. -• • �vailpblernd; the aDP►ovat of the.pitvate water supply`shatl Decode null'gnd tloi`vYSfiep pt `6� avatlabla.- Sueh a ro6tila ar "' tit wbjeet to 3moditieatlon' or change whoa, "in ther,Judgment of the.Commissione►fj HOA 1 Mfr oca ;bn m 6 :o► change to necessary }. oats ' eY 1 ';;, tb i G> '�►6F Npt. . Title ,.. gyp'. �i p rii t i� ANDERSON, CHARLES & SHARON TM#60 -1 =53 Spruce Mt . Drive ' n ,;Family W /Deck PP�fi # 87 -1426 _._._. "_ -_ - - -- - -�- - - 3/ 20/87 x -- l� Y,-iy Tj7. ,,id . 4 :777'. r�'�li i�;L'� u �.. , . • ., .. , .. .. ... .. �, CEitTIFICA7'1' OF OCCUPANCY - ONE FAMILY W /DECK � h Certificate of Occupancy No.....88 -53 Application -:No ............................. hoctiion of }es Spruce Mt Drive TM j0 -1 -53 ............................................ ....... ............................. ..............................i t u` 'CharlesiShar`on Anderson ofPO. Box 612 - Putnam Valley,NY' "vg � . heretofore ;, ed 14^application fora buildinr1 permit pursuant to the Zoning Ordinance, Sanitary °< a Coded and tithe# Law'in effect the Town of i Putnam ° vaAey; Putnam Couaty, New York, having . paid the re aired fe therefor`' d the unde (agned having .by personal'inspection ascertained that - -the applicant has subsequently roceeded wRh the erection or improve ment`of the proposed struc- `tune," „ complialiCS- --With the req ' ements of` the laws as aforementioned and that the said work : and . mate "rlals,�mdt. every requirement of th(' 'laws as aforementioned and that the premises have pit now:`-beew4ully., mpleted and are reader fo` occupancy pursuant to the provisions of • law, Now, therefore, this' certificate of occupancy is h reby issued under the seal of the Town of Putnam ,YaIIey. this - ... day of ........ AP•r � I:. .......... 1954.. i " ... Not valid unless signed in ink by a duly authorizel, agent TOWN OF NAM VALLE , NE YORK of and under the seal of the. Town- of Putnam tV•alley. yl . By �.......... �.. ........ ........... k 4 t Ml- 1 'jP LORETTA MOLINARI Public Health Director u -.rt.;� +v .+.�s,ias- ,-ro'bv .. .ccra;. —w.x.' ,n`. ^'w•..: . u�: u-.0 ROBERT J. BONDI County Executive 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/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Putnam County Dept. of Health 1 Geneva Road Brewster, NY 10509 To Whom It May Concern: Re: Residence • OM According to jrecords maintained by the Town, the above noted dwelling, tuvp is L) IS NOT C 10 it-IN In compliance with Town code and the total number of bedrooms on record is 1-f This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: • -'I Building Inspector houseguidelines iv 'LORETTA MOLINARI Public Health Director ROBERT J. BONDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 d Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 o O Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 85 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 PROPOSED ADDITION APPLICATION , (/R1 E�ID NTIAL ONLY) 1 t Y 1 -. T C. b(I �(-TOWN I TX MAP # STREET C NAME -M! v I ! (�Y`JS PHONE PCHD.# 'D MAILING ADDRESS 1 -7 V © S DESCRIPTION OF ADDITION de C 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) yprepared by a Professional Engineer or Registered Architect in accordance with }iT11�1CA�7�? SPrTi�!iS ofiW�Q�u., Please submit this form and the following to Putnam County Health Dept., 4 Geneva Rd.; Brewster, NY -10509, Phone 278 -6130. 1. 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 Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #) * Non - professional sketches are acceptable Copy of,•survey showing t well and septic location, to the bes of your knowledge. Include date- of installation if known. Label all wells and septic systems within 200 feet of the property line. Zontact this office with any questions. Co'pyofCerf.of Occu P a.n. fr.. om Town or Certifi.c. ation from Building Dept. with legal bedroom count of dwelling. OFFICE Comments Feb 98 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health L;IiI Al`tl Iiv; Ni8*N Associate Commissioner of-Health Santos 17 Spruce Mtn. Dr. Putnam Valley, NY 10579. Dear Ms. Santos: ROBERT 1 BONDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 January 24, 2005 Re: Addition — Santos, 17 Spruce Mtn. Dr. No Increases in Number of Bedrooms (T) Putnam Valley, TM #60 -1 -53 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 January 24, 2005. The addition.is approved with the following conditions. 1. The total number of bedrooms must remain at four without prior approval 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 """"""""" " " """' -' Wll�+'W, l�i5irlCtVi� 1Vl jl�VVVt+l lri�tll5•tL1lU`laUGGIJ� GLG. r. Any 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: lm cc: BI (T) Putnam Valley Sincerely, C Michael Luke Public Health Sanitarian 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 BRUCE R. FOLEY -. LORETTA M_ Oi.-WART. R ;N-., - `' Associate Public' Health Director Director of Patient Services DEPARTMENT OF HEALTH 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 October 26, 1999 Minerva Santos 17 Spruce Mtn. Dr Putnam Valley NY 10579 Re: Addition- Santos Spruce Mtn. Dr. No Increases in Number of Bedrooms (T) Putnam Valley Tax # 73. -1 -34 Dear Ms. Santos: 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 October 25, 1999 .The addition is approved with the following conditions: I - 1-7) 1. The total number of bedrooms must remain at Four without prior approval by - thi -Dep quit 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 Vallev. If you have any questions, please contact me at your convenience. Very truly yours, Michael Luke ML:kg Public Health Technician cc: BI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New . York 10509 Associate Public Health Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 218 - 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 26, 1999 Minerva Santos 17 Spruce Mtn. Dr Putnam Valley NY 10579 Re: Addition- Santos - Spruce Mtn. Dr. No Increases in Number of Bedrooms (T) Putnam Valley Tax # 73. -1 -34 Dear Ms. Santos: 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 October 25. 1999 .The addition is approved with the following conditions: The total number of bedrooms must remain at FFoou witbo,tt.nri.or.anprev2l. b,� ::- ._._....:_ _ .V- ..._,_._._ •--- tii "s'iyepartmenf. °.�____.._._.. _._... -`.... ...�.. _.__ 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 Vallev. If you have any questions, please contact me at your convenience. Very truly yours, Michael Luke ML:kg Public Health Technician cc: BI PUTNAM COUNTY DEPARTMENT OF HEALTH „ Rev. 3186 6 Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer to Provide Permit # IN ll on CERTIFICATE OF COMPLIANCE �et Q� CONSTRUCTION PERMIT FOR AGE DISPOSAL SYSTEM Permit N U Jr,cated atT _ Town or Village .._. -._e ,"' �' L. :. :'r.. -..- .,i - �:.....� -...c - �t..:4,.is. ^o. N•': s�-. -... .. ...: Y'•i.n y.. -. Subdivision Name -� �'� 'jam, ba. Lot q Tax Map Block Lot :: Owner /Applicant Name .%� q z � ;2 � Renewal_ ❑ Revision ❑ �.»f - % t /�J l Date of Previous Approval Mailing Address J- -le ��� 4 o-� `'� Town ZIP Building Type . Lot Area ®� FIB Section Only Lj Depth Volume Number of Bedrooms Design Flow G /P/D PCHD Notification Is Required When FIR is completed Separate Sewerage System to consist of Gallon Septic Tank an : z ; /^ r`�7 ✓ To be constructed by Address Water Supply: He Supply From Address or: ate Supply Drilled by p� _Address Outer Requirements a. -^ 1c` e I represent that I am wholly and completely responsible for the dejio kan1}Eloc =a AA 9R -rbR proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved art�pfi"ent trtItf to arb Yq dgcordance with the standards, rules and regulations of e Putnam County Department of Mealth, and that on completion there �'qer.tif; `gM� oU,Shnstru°dtion Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee ill bf4pfriished the Aer,. hid successors, heirs or assigns by the builder, that said, builder will place in good operating condition "any part of said sewag dispaOW sy",, durinn All Pe od of two (2) years Immediately following thedate of the issu- ance of the approve, of the Certificate of Construction rap e qJ t., �FY{�=gInaF_ am or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said w 11 wlli a int ' alh acc once with the standards, rules and regu a' a ions the Putnam County Depart m nt of Health. Date P.E. R.A. `i Address F � G. " License No APPROVED FOR CONSTRUCTION: Th' approval expires one fl' tom_ 81�s66 unless con uction of the building has been undertaken and is revocable for cause or may be amended r modified when coo Were Com Sinner of Health. Any change or alteration of construction requires a new permit. Approved f disposal of domestic sanitary ptiivat water sup ly only. Date r By ,��r Title In CERTI Located at P TY'NAM COUNTY DEPARTMENT OF HEALTH ENGINEER MUST PROVIDE _ Division of En_vironmentqL..Health Swims, ,C0rnma4l, .N Y 105,12..; f� E _ - - .. sTE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM / � /7a'� r _ Town or Village Separate Sewerage System built by Consisting of 12-3 _& Gal. Septic Tank and Other requirements 7 2,4tr vo, -�,� Water Supply: Public Supply From _ Private Supply Drilled By Address Building Type Has Erosion Control Been Completed? Tax Map__!!! �40 Block Tax Map Lot g X -3 Subd. Lot i Address A o wigs A " A, %r- 07 44 J3 O 4- G%_ %% 1/. A/ tf. No, of Bedrooms Date Permit Issued Has garbage grinder been installed? I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulations, in accordance with the filed plan, and the permit issued by the Putnam County Department Of Health. Date. Cer died by Address Any person occupying premises served by trKabove system(s) shall promptly take such a conditions resulting from such usage. Approval of the separate sewerage system shall available and the approval of the private water supply shall become null and void when subject to modification or change when, In the Judgment of the C mmissioner of H Date ey D r 6lol P.E. R.A. �b License No.Z 9 10'x_ to urree he corredlon of any unsanitary Boo s public sanitary sewer becomes as vailable. Such approvals are di or change is necewrr�, 1, Title TEST PIT G. L. ci / 1' 2' 3' 4' 5' 6' 7' 8' 9! 10' 12' 13' 0. BE SUB Ae. %,, 141 INDICATE LEVEL AT WHICH GROUNDRATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: �j i� DATE:Z DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided No. of Bedrooms - Septic Tank Capacity gals. Type����► i�f Absorption Area Provided By -9 L.F. x 24" width trench Other Name M` �r..r• •..or: FJ r.���R�£I: rG • 0 Address SPACE FOR USE BY HEALTH DEPA92-E NT ONLY: Ift Soil Rate Approved sq.ft /gal. Checked by Date DESIGN DATA ,SHEET- SUBSUFACE SEWAGE DISPOSAL`SYSTEH FILE NO. owner Located at (Street). ry U z Sec. Block... Lot`�� (indicate nearest cross street) Municipaiity / G� %'�`% 1 -1 Watershed SOIL PERCOLATION TEST DATA RDQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking - -- ✓T�� 7 Date of Percolation TestTa HOLE - NUMBER CIAO TIME PERCOLATION PERCOLATION 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 4 5 4 5 ;�_>_7 " 2 3 4 5 NOTES: 1. Tests to be repeated at sacs depth until approximately equal soil rates ....::are obtained at•'each• percolation.. test hole. All data to' be sukmi.tw for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 PUTNAM COUNTY DEPARTMENT OF HEALTH =. L DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVUDAL ADDITION/REPAIR FORM SECTION A: GENERAL INFORMATION Name of Project 17 ��� %��� (T)(� r V TM� Year of Construction Size of Parcel SECTION *B: TOPOGRAPHY (Please check all appropriate boxes) �IHiY Molling entle l Flat 1. t ee Slo a 1G o e 2. ❑Evidence of wetland ❑Low area subject to flooding Modies of water. ❑Drainage ditches Of ock outcrop YES 1� Prope�v 1 ; ^es evident? ❑ !�� �` ❑ 4. Water courses exist on, or adjacent to parcel: 5. Existing individual wells within 200ft of the existing SSTS? Lam' ❑ SECTION C. EXISTING SUBSURFACE SEWAGE TREATMENT SYSTEM(SSTS) 1 Physical character of existing SSTS area. A. ❑Level C Gentle Slope ❑Steep slope B. ❑ Well drained Moderately well drained ❑Somewhat poorly drained ❑Poorly drained C. Area available for SSTS. (Primary & Reserve) C3 Extremely limited ❑Somewhat limited. O-Adequate ft x ft D. INSPECTION Date Inspector M-ol"evidence of fa'ilu're ClEvidence of failure f1vidence of seasonal failure y HOUSE � ,, / ( (1) Indicate location of SSTS A. Size and type of septic tank gallons ❑Metal C ®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 AMNI CIA's ❑Shared well L-Aindividual well Grilled Mu0 cr CON19AENTS : REPAIRS ONLY: Status: As Built Inspection Required: As Built Submitted: As Built Inspection Done: Inspector: asing above ground r Tr ------------------ 7-7� ---------- (1) Indicate location of SSTS A. Size and type of septic tank gallons ❑Metal C ®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 AMNI CIA's ❑Shared well L-Aindividual well Grilled Mu0 cr CON19AENTS : REPAIRS ONLY: Status: As Built Inspection Required: As Built Submitted: As Built Inspection Done: Inspector: asing above ground Q NT 0 1 l r: C V✓Q'r'i t� } 4 N- r l r- hvtl f Y}a tyt J lg -4i r w � 4 �L T- ro�P�G FgPMciS. G g10Fi$$toNPt� is c at tho 8%z3t8i� L It yr cre� 'over $ x ^; ©� ft Qr`O jj./'%O'�'!G�J3• ....2 arc s _ K. %' _, 'bu �.? d x. .n 02 iL6iiZt.tl. ro - s `, .:ftY" err' `"' pg,•� ,GV,;?"'- ��.q�X? �e�7+.;�j��. .,, /' 0"' 4 u: 4;" Patnem Comity Department of Health aion of l Environmenta Health Services /1 9 + �►dlir��3 oved as noted fwc nformance With icable Rules and Re gulationa of the 4 ;S "tP z 34 -� - am ounty ealth Department. i� f' I: PE. LA yFlj9 GG ':P�1+A'.< +/q'¢au� . f.LLA 21140 (,v3 Zi r; 1o" e Ise as (il m avFf \ \IOA. Ifs on. w4 4 46 At CA —I r -t /. db 1' I rLLLA I i pfLLA i xue'A. s4Aee� p' i(p%fovn i i (P/dwe) II s 1 3{ h_LLn I L4 a ;� A7T1� i" t -- 7i t; i 7 I I Mv. �"fEfC P)5PWOM Tf fN i p�t,q Z V PIITldAvi COUNT`l DEP RTiYiEftT Of HEALTH HOUSE PLANS APPROVED FOR 8EDRO0 UUNF ONLY; �/ f /1L yle Signature& Title Me ,t. 4) N44 X00 4r°Z J o - a :A" 41 s , a .p \ s N db N Off' o'4A AL S OO r > LIB. ' . Zi r; 1o" e Ise as (il m avFf \ \IOA. Ifs on. w4 4 46 At CA —I r -t /. db 1' I rLLLA I i pfLLA i xue'A. s4Aee� p' i(p%fovn i i (P/dwe) II s 1 3{ h_LLn I L4 a ;� A7T1� i" t -- 7i t; i 7 I I Mv. �"fEfC P)5PWOM Tf fN i p�t,q Z V PIITldAvi COUNT`l DEP RTiYiEftT Of HEALTH HOUSE PLANS APPROVED FOR 8EDRO0 UUNF ONLY; �/ f /1L yle Signature& Title Me ,t. rp IE I i. elk PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM (,'O,"jlqT ONLY, bEDROOMS ��� Z—/., , PH s llz { /mss Signature & Ptle Date I sl . A- PUTN;ul ": Ct UN ;` DEr ^H;;TP,iEIVI OF HEALTH �% S� %GrC� %��. �/ • p "uR 4 / HOUSE PLANS , %t- EEDRC,Url i hl PRll,_D rr 011 blgnature & rifle Plw- PCa4b 0004-C'6 s _ � # MT�tI — '�FIfi1.0 IAGNiEi � 4 O l0 9' -2n 0' iW 3G' 4u i I o jY lO' I N I W T 6* 10 w h _- lo l1 je i - t 1� 1% At JD 2T- 11 IS of 4L . ,i, & Dc fg .7 11.7 Z: -Z' I a t 1� 1% At JD 2T- 11 IS of 4L . ,i, & Dc fg .7 11.7 te _ I I'S S - I ib I i,9;El co b of b .� I I r I I " � ............ -... . p9 E/s, \ y%•pl� 7 Y !v' II _g �._ 157 - 9 p �� C71E x>ro _ -.. fY J- TV! J� 1 us J - - -- 1. *------ q L