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631- 589 -8100
73.08 -1 -3
BOX 27
a gill
k.5.
LE
03365
Public Health Director
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Associate Public Health Director
Director of Patient Services
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648
August 2, 2001 .
Tony Misuraca
5 Tyler Rd.
Putnam Valley NY 10579
Re: Addition - Misuraca - 5 Tyler Rd.
No Increases in Number of Bedrooms
(T) Putnam Valley Tax # 73.8 -1 -3
Dear Mr. Misuraca:
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 August 2, 2001 The addition is approved with the following
conditions:
The total number of bedrooms must remain at-Two without prior approval
by this department.
iit area ;�f tht e stiii se�h g�° isY szl�sys tsm.:_arri: U xmit�aic,if —'a ; ;,'t:r:Up.:_
_ _ r_...
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.
ML:kg
cc: BI(T)
Very truly yours,
Michael Luke
Public Health Technician
Anthony gisuraca
Tyler Road
Putnam Malley, MY 10579
Dear Mr. Misuracas
P—
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
Geneva Road, Brewster, New York 10509
(914) 278 -6130
July 28, 1992
Res Proposed addition - Hisuraca
Tyler Road
(T) Putnam Valley
JOHN KARELL Jr... P.E., M.S.
Public Health Director
I have received and reviewed the plans for the proposed addition to the above
mentioned residence.
The plans indicate that the first floor will be renovated to one 15' 60 x 12'
bedroom, one 6' x 8' bathroom, 16.' x 11' kitchen and 15' 40 x 15' 811 living room.
The proposed second floor will be 15' 40 x 20' 61 bedroom and a 23' x 15' 61
unfinished attic.
The survey indicates that sufficient area exists to expand or repair the sewage
disposal system, should it become necessary in the future. Therefore, based on
the information submitted, the above mentioned addition is approved with the
follovina_ conditions r - - - --
1. The total number of bedrooms must remain at two 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 replaced or updated with water saving devices,
i.e., 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.
Very truly yours,
�FbZ jgMio
Robert Morris
Assistant Public Health Engineer
RM /jp
cc: BI (T) Putnam Valley
BRUCE R. FOLEY
.<. s���. -. �L'. tIrr..,•. Ki' +. .t.ti�aL: aeo, ....- .tis• .�:•..r .
LORETTA MOLINARI R.N., M.S.N.
.. ,:s'... — .;i::t:t....� M'tS: t'i:Yi�: ":Jl� c�i�7.. ,- .. � . .•....n':t.
Director of Patient Services
DEPARTMENT OF HEALTH
I Geneva Road
Brewster, New York 10509
Environmental Health (845)278-6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 NVIC (845) 278 - 6678 Fax (845) 278 -6085
Early Intervention (845) 278 - 6014 Preschool (8.45) 278 -6082 Fax (845) 278 - 6648
ADDITION APPLICATION (RESIDENTIAL ONLY)
STREET (ti/ T0` IN ; V, TX MAP;r %3• � _ �� �
rr
t
NAIL fa,, M f .sa rQcf. PHONIE S ?50 2 PCHD"
MAIL NIG ADDRESS
DESCRIPTION OF ADDITION
NUMBER OF EXISTING BEDROOMS Z- PROPOSED 9 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.
._ _.- . -...r. �...r. .., T. ... _.• 1: �. _ .. lY " • T• ... ..1T -,1.� 1'x ..� .... /1 -..
rTE SC SUUitlll 11iI$ 1vIIl1 CI1LL tl1G i011Gw111 iU r UUkU,t '%,UU11LV 11LQ1LLl LGI/ly �SGTiGYa r \V C[LL�''U1wVJx1, "lx 1 `
10509, Phone 278 -6130.
1. Certified check or money order for $100.00. .
2. Sketches of existing floor plan (drawn to scale, all living area including basement)
*Non- professional sketches are acceptable.
3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #)
*Non - professional sketches are acceptable.
4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of
installation if known. Label all wells and septic systems within 200 feet of the property line.
Contact this office with any questions.
5. Copy of Cert. Of Occupancy from Town or Certification from Building Dept. with legal bedroom
count of dwelling.
OFFICE USE
Comments
Feb98
BFhouseguidelines
SECTIOPJ,61, BLOCK I, LOT 3
.N / F
n,OSCOWI TZ
�6oAg 00,E
� N
Ll
N
IV'/ F
MOS,,,'lOWI TZ
'� o LOT # 3
Ftow ..
'�- °��- - -- <0 < HGIL LOW ROOK
W41-,,r - y CRNPA r` B
T9 -� - K--
aA °24120 E-
N N! 16hi-
(V q�K W4), n
M V' STEPS`
N
DRAINAGE EASEMENT
OWLI
N
h tv! i N
N yI N LOT #' 3
Z
LOT #2
I20.17L 129.60'.
U.P.
FND• S53 °37'20� W N/ F 261.67 I U.P�� 4
AD! E
LOT # 3 1 LOT # 2
r ( SURVEY .OF PROPER'1"' "Y
+ 1 �✓ FOR
vv fi 1. vc,
110WN OF . PUTNAM VALLEY PUTNAM COUNTY, N.Y.
SCALE I - 50 MAY 7, 1992 AREA = 0.8914 ACRES
REFERENCE BEING A PORTION OF LOT No. 2 AND LOT No.3 ON MAP ENTITLED "SURVEY OF -PROPERTY
FOR TYLER REALITIES, INC." FILED IN THE P. C.C;.J. ON MAY 16, 1950 AS MAP No. 551.
I
t CERTIFIED TO: NANCY LIBERATORE, ANTHONY MISURACA, E--',''ATE OF ANNA RUTTER AND STEWART
TITLE INSURANCE COMPANY, TO BE CORRECT A14D ACCURATE. UNAUTHORI'ED ALTERATION OF, /9—
THIS DOCUMENT, IN ANY WAY„
CONSTITUTL S A VIOLATION OF
THE NE YORK STATE
EDUCATION-1 LAW 7209 (2). LIC• 49087
COPIES OF THIS SURVEY NOT BEARING THE EMBOSS- ? JAMES A. D 1 L L I N
! = ED SEAL OF THE LAND. SURVEYOR SHALL NOT BE , PLS.
I .
,P VALID. GUARANTEES OF CERTIFICATIONS ARE NOT
TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR
PROFESSIONAL LANG SURVEYOR
°:A SUBSEQUENT. OWNERS. GO S H E N , NEW YORK
b
if
-7 -3.
PuTw"!lm COUNTY OEPARTMEN r*OFffJ5ALT'H.
HODUSE PLA� S AWROVED FOR
,."MINVIT ONLY;
Signature Ve
Date
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SECTIC �I 61 BLOCK I L6T 3
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l � ENCA: in
t4
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+ ; DRAINAGE EASEMENT
3 N L. 979 P. 130 ;r
in g IVO
MO »cow�rz _� OWLG: . �• 0�'L
1,7 O
LOT-4:3 LL
N �,�� .� I S 9QN@blA
OD, LOT *# 3, MAC • 3y9 alb t
WELL M dt
i 1 M
LOT Yr 2":.
}J M A 3ff�. S45 If ,
aeoN 20:1
r FND.I 7
FN°n: S53'37�20� W N/ F '�. 26(.67 uPV r
ADIE S' 15 rye,
k SLOT # 2 }
LOT' #3 � )
„u4 SURVEY OF: PROPERTY,
t ' f
i ( FOR
ON
RE
TH
y. MISURArz
I7°
1. Q OWN OF PUTNAM, VALLEY PUTNAM COUNTY, N. Y.
SCALE 1 = 50 MAY 7, 1992 AREA = 0.8914 ACRES
REFERENCE: BEING.A PORTION OF LOT No. 2 AND LOT No. 3.OPI MAP ENTITLED "SURVEY OF -PROPERTY
FOR TYLER REALITIES., INC. FILED IN THE P.CJfi.O. ON MAY 16, 1950 AS MAP No. 551.
ti CERTIFI ED TO; NANCY. LIBERATORE, ANTHONY MISURACA, EATATE OF ANNA RUTTER AND STEWART
TITLE INSURANCE COMPANY, TO BE CORRECT AND ACCURATE.
bNAUTH0 ZED ALTERATION OF,
(/
1S DO6. MENT, IN ANY WAY„ 't
CONSTITU;rES A VIOLATION OF
1
-THE NEW YORK STATE f
"'EDUCATIOJsI LAW 7209 (2), LIC. 49087
r COPIES OF THIS SURVEY NOT BEARING THE EMBOSS-
ED a JAMES A. D I L L.I iil p PLS.
3 SEAL OF THE _LAND, SURVEYOR;' SHALL. NOT BE ;
=T' VALID. GUARANTEES OF CERTIFICATIONS'ARE NOT PROFESSIONAL LAND•SURVEYOR
TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR +
2 ie V:'. SUBSEQUENT. OWNE RS. GO S H E N , NEW YORK.
-t
... -:.. �,� :.:,:� .�,:,,a4,- .�.,Y,_�, �, �•�.,�...._�- :.,_�.:�..�.�.:4,. _ .�. ,.,.,.�,� ..- T_,.�:.�� -r-o. ,rte
Anthony Misuraca
Tyler Road
Putnam Valley, MY 10579
Dear Mr. Misuraca:
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
Geneva Road, Brewster, New York 10509
(914) 278 -6130
July 28, 1992
Re: Proposed addition - Misuraca
Tyler Road
(T) Putnam Valley
JOHN KARELL Jr., P.E., M.S.
Public Health Director
I have received and reviewed the plans for the proposed addition to the above
mentioned residence.
The plans indicate that the first floor will be renovated to one 15' 6* x 12'
bedroom, one 6' x 8' bathroom, 16' x 11' kitchen and 15' 40 x 15' 8" living room.
The proposed second floor will be 15' 4" x 20' 6" bedroom and a 23' x 15' 6'
unfinished attic.
The survey indicates that sufficient area exists to expand or repair the sewage
disposal system,. should it become necessary in the future. Therefore, based on
the information submitted, the above mentioned addition is approved with the
tIn?ts. _ ...
1. The total number of bedrooms must remain at two 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 replaced or updated with water saving devices,
i.e., 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.
Very truly yours,
6z i gp�w
Robert Morris
Assistant Public Health Engineer
RM /jp
cc: BI (T) Putnam Valley
Located
3186, PUTNAM COUNTY DEPARTMENT OF HEALTH.
I. ; ; Division of Environmental Health Services, Carmel, N.Y. 10512
i . Engineer Mast Provide
P.C.H.D. Permit M
'n3,0g -) --3
Owner /applicant Name
Town or Village
Tax MaP in -L Block _Lot 19 3
Subdivision Name A0,73n -x ubdv. Lot # 3
Date Permit Issued :z7u L_ j4 (.'1966
Separate Sewerage System built by 1202-404 M2�a6Q_1>r a1J i Address '�MMC=_tl
Consisting of Z S0 Gallon Septic Tank and �� �-(� ®1— 1 qA, L. A2U
Water Supply: Public Supply From Address
or: ✓ Private Supply D rilled by. 0 P_ -166 Address >< Z7 /v�E�IJIptJiG. l�
Building Type (7 c—I'I �a Has Erosion Control Been Completed?
Number of Bedrooms Has Garbage Grinder Been Installed?
t
Other Requirements �? P ra Z -T7� t a Tab 11 A
I certify that the system(s) as listed serving the above premises were constructed essentially as shown on t lane of the completed work ( copies
of which are attached), and in accordance with the standards, rules and regulations, in accordance with a it d p an, and the permit issued by the
Putnam County Department Of Health.
Data,G i0. ���t �--. Certified by �% P.E. R.A.
Address es X4.3 &I . d/, Licence NO T`�
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary
conditions resulting from such usage. Approval of the .separate sewerage system shall become null and void as soon as a pubr-. unitary sower becomes
available and the approval of the private water supply shall become null and void when a public water supply become available. Such approvals are
subject to odification -or change when, In the judgment of the Commissioner of Health, s ch revocation, modification or-change Is necessary. �
Date�G /2 / f3 /C Title
WELL COMPLETION REPORT
DEPARTMENT OF HEALTH
Office Use Only
' .® 4
WELL LOCATION,
LJ LV 1..71VLL Vl a+aL V 1L VLLLLLCaa a.a+ ascaic. as ua.a • +......+ -
PUTNAM COUNTY DEPARTMENT OF HEALTH
Si Ei ADDRESS: WN /VI 1 Y TAX GRID NUMBEd:
-E—e 1
WELL OWNER
NAME. eo,e ADDRESS:
o tl� d CT w !4 `� �j'�S
❑ PBIVATE
❑PUBLIC
USE OF WELL
1 - primary
2 - secondary
`& RESIDENTIAL O PUBLIC SUPPL ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
❑ BUSINESS ❑ FARM O ' TEST/ OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND =BY ❑
MOUNT OF USE
YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST / OBSERVATION
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH
ft.
STATIC WATER LEVEL ft.
DATE MEASURED 18
DRILLING
EQUIPMENT
❑ ROTARY ) COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING *S OPEN HOLE IN BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL LENGTH O ft.
MATERIALS: STEEL ❑ PLASTIC ❑ OTHER
LENGTH. BELOW GRADE 10 fL
JOINTS: O WELDED THREADED ❑ OTHER
DIAMETER in.
SEAL: ❑ CEMENT GROUT O BENTONITE ",OTHER
WEIGHT
PER FOOT 01 Ib. /ft.
DRIVE SHOENSIYES ONO LINER: ❑ YES ❑ NO
SCREEN
DIAMETER (in)
'SLOT SIZE
LENGTH
(It)
DEPTH TO SCREEN (ft)
DEVELOPED?
OEiAILS .
�.��
_.
: �}7 V. r,;,.+ ,
1 J p �.J -
HOURS
SECONO
GRAVEL PACK
❑ YES
❑ NO
GRAVEL
SIZE:
DIAMETER
OF PACK in.
TOP
DEPTH tL
BOTTOM
DEPTH It.
WELL YIELD TEST If detailed pumping
METHOD: O PUMPED i tests were done is in-
COMPRESSED AIR , formation attached?
O BAILED O OTHER ; YES ONO
It more detailed formation descriptions or sieve analyses
WELL LOG are available. please attach.
DEPTH FROM
SURFACE
water
Bear-
ing
Well
Oia-
Ineter
FORMATION DESCRIPTION
voce
ft.
iL
WELL DEPTH
IL
DURATION
hr. min.
DRAWOOWN
it.
YIELD
gpm.
Land
Surface
WATER CLEAR TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? O YES O No
ANALYSIS ATTACHED? O YES O NO
STORAGE TANK: TYPE
CAPACITY GAL.
PUMP INFORMATION
TYPE
MAKER
MODEL
CAPACITY
DEPTH
VOLTAGE HP
WELL � +L 2� 15 �
A E9 1 StGf RE
M0 }� IU
PUTNAM COUNTY DEPARTMENT OF HEALTH
PIyI,SION. OF ENViRONLZ9MAL HEALTH SERVICES
<F.: -+�F :.�.':.:.�:�+ -... ...5.� -ay.�: rr =�F: a�3a.a Y=,._ ,�.. a.;.- ;�`"::;fi..:: �wiw� -� 5,r., -. .......: �o.rVe- �a.:ge.,:...G+a :a.'.• -- - - -•-•o= Asa F.: wii '� =.:. ..� ....... � , �= is::,.+�+:+c:.��...� -:: _ ...
Owner or Purchaser of Building
WEE^_ T
Building Constructed by
IY1, LLAE:M,�
Location - Street
&-1, 19414.3
Seet4=_ Block Lot
TM
Subdivision Nann
Municipality Subdivision Lot •J
l =�i fi1Ac
Building Type
GUARAWEE OF SUBSURFACE SFAGE 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
n�'2r j. •atP,'Gf' ��ii1i' action= Compl�xn;.c," for=.:th¢_:sg, age- disposal - :Jr an-
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 %d day of '15C/ 19 fir
eral Contractor (Owner) - Signature
Q Ck,-q& -- AU7x4w A,-Y. Asoc,
Corporation Name (if Corp.)
ess
rev. 9/85 V
mk
1(91507b�
Signature _11�ji
�/' /Title � % � (�✓� � ' y1LZf0
byvg-, - A4xqof /JPv- Arce,
Corporation Name (if Corp.)
k� 2�_-
AdUress
/Ppr
,.,:� . c u_y:_:� 9
Yorktown Medical Laboratory, Inc. CAB —_
321 Kear Street Date Taken: 12/7/88 Time: 12pm
Yorktown Heights, N Y 4059$ _ Date c.' d: 2 �lm� 77
.�,;; : e _ p : _... 9 ���.. _ ... ,
��13ate a orted�'
Director: Albert H.PadovaniM.T.(ASCP) Collected By: im Uarney
Referred By:
r , Sample Location: Fose BibE ►m qP
STEVE ADAMS PLUMBING & Heating Devon Develo ment• eeks it o ow
P.O. Box 459,INLAND RD. Putnam Valley, NY. 10
CARMEL,NY. 10512 Phone # S —qo
Phone 11 I Sample Type: -
L J Repeat Test? _ (check one)
LABORATORY REPORT ON THE QUALITY OF WATER
INORGANIC NON- METALS (mg /L) MICROBIOLOGICAL (CFU /100mL)
_ 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 TECHNI.UE
1-Total Coliform
Fecal Coliform
_ Fecal Streptococcus
METALS (mg /L)
Copper
Iron
Lead_. _
_..M:ari"ge:ne3e
_ Mercury
_ Sodium
Zinc
MISCELLANEOUS
PH (units)
Color (units)
Odor (TON)
Turbidity (NTU)
MOST PROBABLE NUMBER TECHNIQUE
Total Coliform Index
_ r'ecal` Coliform" Index
KEY FOR TERMINOLOGY
CFU = Colony Forming Units
N /A_= Not Applicable
LT = Less Than ( < )
GT = Greater Than ( >)
TNTC= Too Numerous To Count
CON = Confluent ( =TNTC)
NR = Non - reactive
Potable
_ Non - potable
_ STP INF .
_ STP EFF
Other:
Sample Status
(check each)
Outgoing
_ HNO3
_ HC1
_ H2SO4
_ NaOH
ZnOAc
_. Na2S203
_ Other:
wInc�oming _
LE
4 °C
_ GT
4 °C
_ pH
LE 2
_ pH
GE 9
_ pH
GE. 12
Other:
REMARKS /COMMENTS (For Lab Use) IELAP #10323
THESE RESULTS INDICATE THAT THE WATER SAMPLE WAS (WASN'T) (N /A) OF A
SATISFACTORY SANITARY QUALITY ACCORDING TO TH W 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 STATE INKING WATER
CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION.
Ix /
Albert H. Padovani,
,T. (ASCP), Director
2 /86(Rvsd7 /87)RWE
II.
IV.
V.
4Z.
FINAL SITE INSPECTION Date G.
Insert b
CWNER
4 TM E- OR . SiED=TCTN IIJT
' Jam...[• �� �`ai�L�' V::�c�i� 271W�ii� -. ;:_,:.� •. ' - .:��� rv. Y
a- S-uS area lcca.te as per a=rcve3 plans
� .
b. Fill section - Data of placenent
2:1 barrier _ LGTS W'IDT'H AVG.DPTE
c. Natural sai not stripced
c'
d. S�ne, brush, etc., eater than 15' fran SDS area
e- 100 ft_ fran water course /wetl '
SE:u= DISPOSAL SYSTE-I
a. Septic tank size - 11000
I
b. Sectic tank installed level
I -
c. 10' mininnsn f =an fcundation -
d. No- 900 bends, cleaneut within 10 f `. of 450 be_nd
e. DTSTRIETi-MGN EQX
1. All outlets at same elev ti cn - wet =- tested C�OW
2- Protected b--1 cw. frost
3. M-ir imtm 2 ft. criciP -! .Soil bet-ge ='1 box 'and trenches
f. j UNCTION BOX = crcce 1v se
-
_.
a. 0_11 c5 . ..
1 Lenc`h r�r - Ip=`n inStall i .
2. Distance to .watarcc --a measured - ft.. .
3. Installed ac=rdi nc to plan
4. ° Dis=' Ce -center" to cente_r..
5.'. S1cre of t=�nez :accent: ble :1 /l0' - 1/32 " /fcct. ' .
I ..
6. 10 fzt f_cn prc rid line - 20 feet - fcurcaticns.
�.
7. Depth cf tzencz < 30 inches from s-urace
I
I
8. Roan -0la er for e�nsicn, 50%
( I
9. Size of crryel 3/4 - 1�" diameter
10. Demt_h of cravell in treanch 12" m i n i mmn
11.' pice eT_�s
h. kUA-D OR DOSE. SiSTE�S _..
2. Overrflca tank
3. Alain, vi sual /audit
4. puma ea_=ily accessible manhole to .aide • .
5. First bcx bc=e^
6. Cvc1e wit e_- = by He T inn Depa tote ^_t
I
estimate flaw cw T cycle
HOUSE
a. Ecuse located per amroved plans-
I x
b. IAA -icer of berrocros
Wr L
a. Well locates as per acprved plans
b. Distance fran S,DE area measured ft.
c. C�_=incr 18" accv a erade . I
I
d- Sp=ace drairace .arcur_d well acceptable_
OV PAEL WORI{iA_UynL°
a- Ecees rely arcute3
ilolt I
b. AT? pizes -* = "a11v back-filled I
c. All pices flush with inside of box
_>
d. Backfill mat =ria1 contains stones < 4" in diameter
I
e. C'.,- ,.,.ain drain installed according to plan
f. C',*�,-ain drain cut= all protected & dir.to exist_watarceursC4_
a. F-cciting drains discharge awav fran SDS area
I
h- SL =ace water prct__'ticn adequate
i_ E_ -cszen control provider on slopes greater than 15 %_
M., T T:VWT-TT- r,?F51V W7,YZD�Z-7m
R�
7' \�
:PMANCOUM,D
D1Ws164& 1012
oK;CM:`rMCATROFt6�LL4NtE.,
-PERM IFORIEWAGE W�
Cd
SYSTEM.
V0.:
q
7
Subdhidon Nume �p I" Sida. W.. 0 Tim Nlaip
n] -
Renew ❑ evlalon
V./A.H.t N.. 12 NIQ d J LQ__R_rAM,1j-_
DWe of'Previlous 4proval
Addnn !Z4 w
A p6l FH,4ecdOi OJOY Pe —P
th Voluie -
Number of Bedroom PI) PCHD lqudficsWon i® Required Whim FIR 1e completed
7 -
Selwaftlowerage syom to Coz," of SOP& T
To be captructed Addnm
Addreca
He SoPPU From
Sa000
P.11 od by,",
I represent that I am wholly of the proposed system(s); 1) that the separate,.sewaje dikposal, system
above desdnbetl will be' constructed as Shown and
,onth tp,and in accordance with the standards; rules and 15941at�ons of the , Putnam
County Department of HeaRh,;.antl !on thiiii6f a "Certificate of construetion Compliance,' satisfactory Ao.the Commissioner of Healthwill
De _
subniftid to the I e,,,fM,r, .3A owner his ijit heirs of assigns b the builder that sj id,builder will
guarantee - i n,!,z e ow cesslirs, y
place in q6od. ' operating . cd6iiiti(in 4ny',"lia i dis0iisal" system;Auring. the period ,of two "Ij- years Immediately following the date of the issu-
if the appro4al. of the Certificate or any repairs the that the drillod�weli described above
once 9
an with' t1 S,
ldcatedas,sh t;t " I i' Ne-:06� �,;t ulptiens the OiAnw"
will be n; an th#�4 I t lled 'acco
b
6f'.Healtti.
Date 4i� P.E. R.A.
Lu
Addres-'L. dg5,ef
— A .� icense, N
� /H wilding 'Aate�'issued unless con
APPROVED F6Fi itof4ST - RUCTION: This'approOfil'expires two year-s-frorn the str t�-Z_ Of the u ng has been undertaken and is
revocable for cause or May. be, amended. ended. R� tig. the Commissioner' of Any change or alteration of construction
requires no may, p!ovia: for dliii6sal w 0 1 f domestic , 1 1 sanitary sewage, and I. /6F Oriji�ja water s��nl
1/87 Date-
Rev.
as•;k. ; z. 'r-xtrc,mA xt iz +✓-!FK *` F`d,.- a'K.sT mt;.: A •+ 4i'C.i+f ., t` ',v`@- • .+ ;%, �4a'',pv - ,. .._
���. a, c;��5t,,ax n�•� M: �w "1`w{j �"`' ^�'Y�. ��`�•�` y "s'kx� x,.. �,i." ?.4�q'�`G - -. �'i" " \
-r •'4`'' 2�?#.' F d .;
L- k Ka
I� z• k' t PDTNAM�COUMVEPABTA�NTOFHEALTH i k
1^ ' ` � ' Dfi�On `ot P:nvbroomental Health Serves, Carmel; N Y 10511. � 'Engtoeer to Provide Permft tl, r l
r V ` \ ,,• % _ CEIITIF[CATE
\ Y \ �' t } _ � � A 3 x• ? `i � "tr�Fi �y � \t'x 3" a. '.
�w1''�t�7a;,b ��4�� ���'� -re ..�.�S.w�ia•_�rn.ww�.s:.o � �i t ....r..rz „- -::e> rt .rt .5,,,. �? �' "7 , .r A
\4 as �, ca L t i fi iX�t c t m •
Pyrinbditilabn'NamO"' . K1DbCs,.S�C✓t� Cabd "'Lot�N
r °:1 f�'
a t L l y ,,; lA t #<< ♦' p L (,,� / isenewal 7 � ❑ �z {a.1.� Ilevlal0 4 Rl r.1 ❑ t 34en "i,.+ � . t. �1 \ L
! � OMner /AppUcan "t�N tame' Ai Vf71Y a �bV �) ry�� ���1•c/ � "v r �..-� � T \r h"S..y � l `+..9 x i w�' ,vx 4 1
C 1 x " 'r{ i! ! .1+• i 1 .Date OI: Prevbae
rov
,. ;; t 3'. r r'`', .=�s tG- ,:."'fir .',' st t i• t P } .•
+oe'`�tir� 'D:U6iZ�DOK COAAMq�✓ ROGtIAPIb'f b & <'T YDCLKZ Wa.l: uE%IoITSz 1b596 `
• � ,:_ �,, ;� � �• l : � �l own t
Bull rri,. �,..s�' L��IV 1V l Y�� 'c r3 r *W1� r ,� Y `�r�\ n ✓1 ,n ��y� t j, - , i�L�,� "
S ���r Y fD�tb ", n\VVrYWO x S 1SY �! L t
Number of Balroome %���' ��' '� Des)p Flow �G P D ��l` PCHD Notl�catlon�ls Itegaired When.F)D le completed ` :•
u:. c l tt k'? r- L t �� t R..4 �. ✓r �� 4 '. k 'i t R 7 1 S t ,.
Separate Sewerage Systemtto�oonslat oiGallon SepticsTaok an r"
• 1 u } Yl,..c�y Fir �a�ir t xg,,
TO'68 OOnet 6—A by. T�
r. U '� `x rxYR txt ,. t"gcs 5S Kit 'itz•< rr „��u �`rtk� i?a x} tk._ �,``'T��"�°° K t P 'y..t t t a \.. 1 �' # a ��1+, ♦ S '
Wafts Sup 4 Pa�Uc Supply From
onPrivate Supply Dipled by t p•`Addreee '
t
. s .a t '.
Other Requirements
'I' represent tnat�l am wholly a ^o,completety +responsible fo he design and locat,on t he pro systems) 1" the .ieparate „sewsge,dipoW system
..Z(✓Yf.%, •.nf, ri 1 '
above described wlll be construc4ed asshown on the apDro :amen Montt in�accor hce wrtn the standards rules an regu a ions o • ,,q nam'
fr. 'ri.'v' nav }t... rrt W.• ^y`i r W .ti: %,. _..:Tt - ..,to
County�Qepartment of,aHealth and thafon,completio ^thsreot a wCert�(�cate of n'structi n;_Compliance sstisfactory,t the Commissioner of Healthwill
bs submdted; "tocthe'De''stment and` °a iwntter% uarantee'wul befuin�shetlalie wnoi his succeswrlieiri or "ass ns b... "aha Guilder that iiW,builde %'will i
.r, ..'•t: ,+* �s., su-n., ;;,:n <�s�,.... ,d,. ..z?t�: ch. .r^ :.r.9 t,.h. ,.;z,.. x 5: �:....a- '.: n.�.�,. z ,aa s'.,�..�- t p Y:.; , r
Place .�n good coperatmgs condition any part ,ot saids sewage disposal system,du ing tthe perrod:of two,(2),yesrs mma lately following thadat• o/�theufsw
SvrY..� L 4%
anee' of ,the app►oval'kof the; Ce►Ufuate�jof Constructwh Compliance of'the o►igfnal tystemlOr any rspairs¢heret hat- tAe ;drilled..well'geseribsiAlabov e
,..ul ns ti „.' R:h .. <i ywt!1 pY
vrflldbe loutedas shawn•onthe approved Pbn and3tnat said well will'De Instslled.rm :see rate . i_th t standar '
u s and regu a ens ofL the Putnam n
County Oepartmsnt ofhHealtn Art 11 r a V vi 101 F4,t
la¢ :`� V7 •-.s. tfr 1 4'.+an,.. � ; '.` -� ,rr.+1 "'+ 3 ixt w � " ( t ., t , i , ,
Signed PE ✓' RA \= `t..
x z rAddress :�S✓iC# .;�33 ,S 4 a 4 si icanse. N0iAYI. .
•. J'-z 3•Z .sY x. . �'' f* �, v f �•.,."
APPROVED fOR COfVSTRUCTION This,approval expires two years rtrom the date issued unless eonstrucUOn ',ot th wilding has been undertaken and ,is_
revoeaDle fo► cause ou may be amended or,modified when considered` necessary �y the 'Commissioner of Health Any change or alteration of, construction'
l t L, t 3
requires Jl wr permit ` Approved (or disposal of,domestic sane ary, sewage and /orMpri water suppiy ly i
/�
�`� /���
I
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3041
.n. __. s - - >TC -- "y -• -._" _. ..- _ - eo�a,:..... .. ~c�.G�sy._+G?. .�1'- ... '. .. .. c.��:a a-CG+X..� -_-.. ...:s . �,.r. .. .:
APPLICATION TO CONSTRUCT A WATER WELL
PCHD PERMIT #
WELL LOCATION
Street Address
m1I.1,6ft KOAD
Town/Village/City Tax Grid Number
FLAJI�AM VAwI- l8 t V
WELL OWNER
Name Mailing Address
DroVOW p�VeWpgW ICC,. ApT 14:9 oVarq ooK tZNwn vvjs YoRKTotkW P1.
Private
0 Public
USE OF WELL
1 - primary
2 - secondary
19 RESIDENTIAL
® BUSINESS
0 INDUSTRIAL
0 PUBLIC SUPPLY (D AIR /COND /HEAT PUMP
CIFARM ❑ TEST /OBSERVATION
O INSTITUTIONAL 0 STAND -BY
0 ABANDONED
(3 OTHER (specify
AMOUNT OF USE
YIELD SOUGHT
�j gpm /4� PEOPLE SERVED /EST. OF DAILY USAGE lvod gal
REASON FOR
DRILLING
MNEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ® TEST /OBSERVATION
®REPLACE FXISTIN G SUPPLY ®DEEPEN EXISTING WELL
DETAILED
REASON FOR
DRILLING'
u �'
WELL TYPE
DRILLED
® DRIVEN ®DUG ® GRAVEL
® OTHER
IS WELL SITE SUBJECT'TO FLOODING? YES NO
IF WELL .IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: JA" kAC J?-Q&P 6EGTI4I
Lot No. 3 '
WATER WELL CONTRACTOR: Name Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
O ON REAR OF THIS APPLICATION ON S
J UA40 -1 f /9ZZ ✓
(date) (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 Dep rtment. �:
Date of Issue: 19 `25Y �`
Permit s-uing Gff T cia
Date of Ex ration: 19 nZ
Permit is Non - Transferrable Mite COPY: H.D. File
Yellow copy: Building Inspector
Pink Copy: Owner
2/87 Orange copy: Well Driller
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
5r27
DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner MOO 9Wr--W PM --r WC, Address AFT OV"OK DQN6 'Y09A4x12V4A [AM�TS, i14,Y,
Located at (Street) A44 ROAD Sec. I- B'l'ock 'Lot
(Indicate nearest cross street)
Municipality 1"14TWA/A ;,Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Role
Number
CLOCK TIME
PERCOLATION
PERCOLATION
Run
Elapse
DeptH
to Water
Water Level
NO.
Time
From Ground Surface
in Inches
Soil Rate
St&rt-Stop
Min.
Start
Stop
Drop in
Min./in drop
Inches
Inches
Inches
2
Aj :45 -4:05
`V
19
3
10 • [-P,30
19
4
5
3 -1, L rZ
5
1.
2
Notes: 1) Tests to be repeated at same depth until approximatel� equal soil
rates are obtained at each percolation test hole. All data to e submitted
for review.
2) Depth measurements to be made from top of hole.
11 iq 52
-7,4
iof
3 -1, L rZ
5
1.
2
Notes: 1) Tests to be repeated at same depth until approximatel� equal soil
rates are obtained at each percolation test hole. All data to e submitted
for review.
2) Depth measurements to be made from top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. C HOLE NO.
HOLE NO.
G. L. 10F5011,
2-11
.3011
,3611
42"
4811
5411
60"
66
72!t
%t4o`( WW LA66D WjrR S7MMA, 0WOW-5 Aa,6-'iT-!ACr0,5 Of' CLIA-`
7811
8411
INDICATE LEVEL AT WHICH GROUND WATER 1S ENCOUNTERED
m-rnAT D • F.�_ T T() CH; IVIATER LE V.F.T, -RTSES M-FTER BE-111"rG . M-1-01711may-im Nt�,P-.
TESTS MkDE BY T t>4[-*'-': Date
DESIGN
Soil Rate Used 8-(0 Min/1 "Drop : S. D. Usable Area Provided
No. of Bedrooms Septic Tank Capacity 12-So Gals.
Absorption Area Provided By F.x2411 6" the
q'�k
L vim- Mc
41 r
-7' CtAK]Mlt l Alit
Name MIcAsi, DAL-Y Signat::
Address EpA 7,43 SEAL
0 4 6 A
THIS SPACE FOR USE BY HEALTH DEPARTPENT ONLY:
Soil Rate Approved Sq. Ft/Gal.
Checked by Date
APPE"Vi DIX B
PUIl Mlri COUNTY DEP_ARIME T OF HEALTH - DIVISION OF FT]�TIRO Ar• HEALTH S�VICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SZ AG" DISFOSAL SYSTEMS
v ..:. DATE REV '.v'cED: 9'
(Name of Owner) (Street Lecaticn)
CGM ii'S YES I NO DCaMaM
Pe`°-ait Application. ✓%
Corporate Resolution
Plans - Three sets
�--'' Engineers Authorization
Design Data Sheet (DDS) SuEDIVISICN
Deep Hole Log Pero /G
Consist -nt Pero Resa?tc (3) Fill
I_. Perc Hole Depth ca -7
Lam=' trend provider G71'9e 9e
rem i rea Git1�
Z/ 60 ft.
Parelle! to contours
�100� et-p.
SYSTEMS
notes
new
t. reservoir, etc.
0 ft. trigall /gall.
Hgg lans - `I`.vo sets
We< pe_nut; P;vs let�eY
dance Request
L 1 Subdivision
Sui ivision Approval Checked
Fx- -approval SSDS Adj. Lots Chec:caf
Wet and (Tow-n/DEC Permit R & D)
Da.a On DDS Plans & Perm t Saab
REQU= DELI= ON PLANS
Se.age System Plan - (north arrow)
Sewage Systan aydraulic Profile - G_avit_, Flc
Fill Pr file & Dimensi cns - Volu -ne
D ;Tr;nch /Gallery; Purm of _ de .ails
jSep tnk - Size, Detail
Well Detail, Service Line„_i:r,ov„
°� I TC�cnstruction Notes (S' minder rte) `
- -.i ....LTCi jP -��+w•: ' �.w C: "C�:iu t� -..C: �yL °r C��L:. ::
71 Two--Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footing/Cutter,Curtain Drains (discharge OK)
Perc & Deep Holes Located
Representative of primary and e- x-- ansicn
expansion Area; shown; gravity ' flc w, suff . size
If PXmjed Pit & D Box Shown & Detailed
House - No. of Bedroans
Wells .& SSDS's Win 200 ft. of Proposed Syste
Prcoe_rty motes & Bounds
House Setback Necessary (Tight lot)
House Sever - 1 /4 " /ft. 4 "0; Type pipe
No Bends; Max. Bends 45° w /cleemout
SEPAMMON DISTANCES SPECIFIED CN PLAN
Fields
10' to P.L., Driveway, large Trees,Top of f
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Take (inc. e�
15' to Drains-C'urtain, Leader, Footing
35'to catch basin, stonmdrain,pioed Watercou
10' to Water Line (pits -20')
50' intermittent drainage course
Sentic Tanks
10' from Foundation; 50' to well
15' Well to PL 9
El
PUTNAM COUNTY DEPARTMENT OF HEALTH
Re: Property of /U
Located at Pei
M PL"7-4
Subdivision of
Subdv. Lot
ction Block _a Lot
Gentlemen: ��1
This letter is to authorize e���`'/ /
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
U p 4: d
system or systems inconformity with the provisions of Article 145 or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Very truly yours
igned
Owner of Property
Countersigne
00- /11v
P.E.7 RoAo,
Addres*
0'0' " '4M
y0gr-192WAJ
Town
41q)
-,T-e- 11 phone
Telephone
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services Y
Y..i�7 . T �+t.Y l_+Fn,►'alc�'•.T•• vl� .hA•C. `4r�i .... .. _ �. �'. ... n.._;... .Yi:• 4� - a . '•M .: .f/ vi... n. }'I.0 .Y.�•1 /. sl7 w.rPkrr. ♦ .. _
^AFFIDAVIT - CORPORATE4NNER•APPLICATIOiV .,•�I
FOR PERMIT.. APPLICATION "SUBMITTED TO
PUTNAM COUNTY HEALTH. DEPARTMENT I,
TO: Commissioner of Health
In the•matter of application for:
AIM11- ID e49411d �U&
12 .11117-14k,
represent that I
am an officer or employee of the
corporation and am, authorized
to act for [1)
evd K1 ' � T �� %%%
Ae lcoleotwao
,
having offices at -
Whose officers are:
President: 9/L s
Vice- PresidentAw.
Treasurer:
0014 AV// Zlelgey
(Name and Address)
(Name and Address
Name and Address)
/y
�1 \GILLG 6llU CILLUL GJJJ ��
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 subseque t acts relating
thereto. AA - I 1
Sworn to before me this /� K^ day Signed: �J 7��Utz —_
of �2-c.J 1999 Title:
Notary Public, State of New York
h �. 474Z•051
Qualified 11 t' :stchester Coun
Term Expires March 30, 1
8/84
Corporate Seal
OD 5E , WWk, Awr> MVOV*,Y WQ&mo 45
* mr- 5uzjev w( ;:MwD 4 - W."New-f
Dwmp
r7
two 4?w, "S"Kiv-,f 5fmc rA,JN-
1(79 LF OF 1EI. 40uel,6
7' POW w4T-&,tJ DFZAIQ
.',MkCAPAAA
kmive To'
\�ME1JT
tA5C�+QW�P TO C. S.
IT
J'
AS F
nt'l-E.
pt
01, N.�
BOX
- 1(.5 VF CP
-vztm GAt,Lp-yr.
IN "I
TANS -70 a
L,2r:3T- 95t.^
Lvision of Rnvironm,.*)htal Health .S
-pproved as noted fo.:-,"conformanoe-,,
5w,
pplicable Rules and{Iegulations".o:
TANS -70 a
L,2r:3T- 95t.^
Lvision of Rnvironm,.*)htal Health .S
-pproved as noted fo.:-,"conformanoe-,,
pplicable Rules and{Iegulations".o:
'Utnam County
,qwn.t.11r. JL 'Pi+.f.
� W i LT 9A, f-I I c -5yst,
L,OT ff3
FAJ\-TLI(,, 7M? COV 11 184
OF f � cit4m,\ ULU
AM CV.,
1 0
r:
foy
ON 04