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HomeMy WebLinkAbout3415DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.17 -1 -21 BOX 27 03415 14 ME 1 IL ,, I� r, 0 1 . i 03415 v CON RL Subdivision PUTNAM COUNTY DEPARTMENT OF HEALTH Permit 0 Division of Environmental Health Services, Carmel, N. Y. '10512 -TION PERMIT FOR SEWAGE DISPOSAL SYSTEM V" 11 Town s.-.= _'_._. _.e...._.a.... A Building Type Lot Area Lot a 46 f Renewal _ ❑ Revision _ ❑ _ Date Of Previous Approval Fill Section Only ❑_ Number of Bedrooms Design Flow G / %P /D y2r®O � P.C. H. D. Notification Required yd %// Separate Sewerage System to consist of ! �-✓ 0 Gal. Septic Tank and - -Ao® G""r "IyiA -s 1'+ To be constructed by A07- Address Water Supply: Public Supply From A40-7— 1�1� rvvyy..•����/�� A— Private Supply to be drilled by 6 MCI) Address Other Requirements I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations of e Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill \ be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will \,place in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following thedate of the issu- snce of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above gill be located as shown on the approved plan and that said well will be installed in accordance wit the standards, rules and regu aeons of the Putnam aunty Department of Healtt1 [ 1 Signed �l,V P.E. R.A. Address License No. Q 02 OVED FOR CONSTRUCTION: This approval expires one year f m the date issued unless construction of the building has been undertaken and is tike for cause or may be amended or modified when considers nets ry by the Commissioner of Health. Any change or alteration of construction a new permi App r ed for disposal of domestic saniJj ge,,a /nd/ rvate water supply only. 7/ By ^ l�`� / °!�'/ Titleds i PUTNAM COUNTY DEPARTMENT OF HEALTH Rev. 3166 Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Mast provide 1 7­9 P.0 JD Pelppflt.N _ '��", - moo.- �..,y..... w-.. .-r: �v —.�... o, «_ ., .....•rte. ,- ..e..�..... -„' o�.; o.ev -._ .�.- � ... � ..,......,..�aM.- +r- .— +— tm..... o «_ ....... �...�..�....,. - o r.: CATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM, 1 -�/ A�o.� �+i��•r„� Located k � � .JX Wk L- � lr k V � -y 7� ' Town k Village Z p/J Tax Map /7 Block � Lot I Owner /applicant Name : /�;,`f'�I c Or Formerly G; Subdivision Name /,Y /�Sabdv. Lot tY Melling Address ��riG�C� f -,-% Road —Zip ✓ r Date Permit issued Gallon Septic Tank and Water Supply= Public Supply From Address on K Private Supply�,� sad by Address Building Type�' "^ rC�`L Erosion Control Been Completed? Number of Bedrooms Has Garbage Grinder Been installed? Other Requirements 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 re g ations, in accordanM with the filed plan, and the permit issued by the Putnam coon y apartment f Re;lth. Dates �'� Certified by r P.E.X R.A. c�..� /�cQ 13�'�.�,�,.��_'��'-�� Atldress "'�`^1N No. Any person occupying premises served by the above systems) 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 pubt %. sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes avallebw Such approvals are subject to modification or change when, in the judgment of the Commissioner of Hesl such revocation. modification or change Is necessary, �' ;2 / Date v '` �� / �/ By Tug CAII le, 24 C-a I f`= b_ Fi I T se `iC_I - DEL-- cf Fi`r� =nC 2:1 E -C i'-E-r1 13 E_ !u0 ftz_ f nc=_ C=U-= =arc ='ter c Cf TT i 1 1 c'C- at Sz--- a E! =ic_C 1 - ttic==- i=CEC_ arc -• _— f - ? _ H:N -CN KX C. r� -- -- - c_� I I I I I I I I I I I C� c C.Z. L132 /. Lam= C� -`� i-r - — _c`-= I I I E. ! U _ r,=-Li c- C -- -E i--- t:-=—=*-' 12", , h C3 DC—S = c �`_ �•-� Lam\ ice_ =��• - ca c:C-", e Mv0M �L� ECLZE WEL c= CrCvc= Di?-,c fz'= c tz ar == Wa i ^tom? C_ ,_' 1'cS f ''Q i `Z 1 ^c_Ce cf b= vi=es I I C_ �= lc -=i11 Ii._ =_ - ^mil C= !':�'=��1° SC.�..nEc_ � d'• in G? = - =r_ �1I =C: �I I. `L"_ —._� "� C. C "-� . l 1 L•,r- •L =.=� }. C;' C_' - -:1 L= .,v.0 == C- S!C=ec C.7== a `._n 2. 5 �_ DEPARTMENT.OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 �' r-_. v_�s.t`_.. _ __ '• °w_. y ___ u, � ,� ..� `.�-.�� "• _'.- .c.•..._.L�^ua_� �'�..'i: —..:.. .f.,�`.. .�...u3o.._�: .._.__...o APPLICATION TO TO CONSTRUCT A WATER WELL PCHD PERMIT # No WELL LOCAT %ON Street Addr� gss LUICTG RD W-V Toren ear Tax Grid Number MA wok f�JTkIA-M VALLC- T5.1 -1 - 0 WELL O[W]NER Name I Mailing 'Address 'LUB 0 . rivate ftD, Por. VA, LLeY OPublic USE OF WELL - primary 2 - secondary OR RESIDENTIAL ® BUSINESS ® INDUSTRIAL O PUBLIC SUPPLY O FARM U INSTITUTIONAL 0 AIR /COND /HEAT PUMP ® ABANDONED 0 TEST /OBSERVATION 0 OTHER (specify 0 STAND -BY AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE &��al ® REPLACE EXISTING SUPPLY O TEST /OBSERVATION 13. ADDITIONAL SUPPLY NEW SUPPLY NEW DWELLING1 ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED ® DRIVEN []DUG 0 GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES ' NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: ® 9LAMPQ Lot No. ` HATER WELL CONTRACTOR: Name o/ Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO WM E OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY 'DISTANCE "TO PRUPERTY° FIkOM LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON SEPARATE MMM PLAM /0 -/7 7? (date) (signature) i j 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 ! third! (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 I Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Departr. During all well drilling operations, the applicant shall take appropriate action to assure t!l I any and all water or waste products from such well drilling; operations be contained on this/ property and in such manner as not to degrade or otherw a contamin to surface or groundw � r t Date of Issue: Date of Expiration j,'.� 19 Perm lit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner ; ! 3/89 Yellow copy: Bldg. Insp. Orange copy: Wellr� PUTNAM COUNTY DEPARTMENT OF HEALTH NO. 558-93-19 COMPLAINT OR SERVICE REQUEST RECORZ TOWN' DATE -REFERRED' fo­­" r fA .eAKEN BY BH TELEPHONE CALL- X IN PERSON LETTER CONFIDENTIAL REQUEST FROM Christie Orlando TELEPHONE 528-3245 ADDRESS Luigi Drive, Putnam Valley ENVIRONMENTAL HEALTH:. Home Sewage Refuse Public water Food Service Migrant Camp other COMPLAINT OR REQUEST Keeler on Luigi Drive, built SDS in non-approved area. Th refore Orlando must relocate well 10' off approved area. p ZD/ ClrL7er* 2 e;_� DATE FINDINGS DATE FINDINGS PROBLEM ABATED 1 -7-- 1 DATE PERSON NOTIFIED ESTIMATED TOTAL MAN HOURS SPENT 77 APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS _REVIEW SHEET for CONSTRUCTION PERM T NAME OF O ER 2 -�_ .� �. -STREET LOC BY DATE %l TAX MAP # DOCUMENTS. yw UJ DISCHARGE (OK) PERMIT APPLICATION S PC -1 �PERC &DEEP HOLE LOCATED REPRESENTATIVE OF PRIMARY AND EXPANSION WELL PEWIT; PWS LETTER SUFF.SIZE ENGINEERS AUTHORIZATION EXP. AREA; SHOWN; GRAVITY FLOW, IF PUMPED PIT & D BOX SHOWN & DETAILED DESIGN DATA SHEET(DDS) HOUSE - NO. OF BEDROOMS DEEP HOLE LOG WELLS & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM CONSISTENT PERC RESULTS (3) PROPERTY METES & BOUNDS PERC HOLE DEPTH HOUSE SETBACK NECESSARY (TIGHT LOT) CORPORATE RESOLUTION HOUSE SEWER - 1 /4 "/FT. 4"0; TYPE PIPE --��,, PLANS THREE SETS NO BENDS; MAX. BENDS 45 W /CLEANOUT _Jc1 HOUSE PLANS -TWO SETS FILL SYSTEMS VARIANCE REQUEST Cl/ YBARRIER GENERAL' m 6 FT HORIZONTAL: SLOPE 3:1 TO GRADE LEGAL SUBDIVISION FILL SPECS SUBDIVISION APPROVAL CHECKED EPTH GAUGES PERC RATE LL PROFILE & DIMENSIONS FILL REQUIRED CD VOLUME =CURTAIN DRAW REQUIRED =STANDPIPES TRENCH EX- APPROVAL SSDS ADJ. LOTS [aJLF TRENCH PROVIDED WETLAND (TOWN/DEC PERMIT R & D) �1:160 FT MAX DATA ON DDS PLANS & PERMIT SAME m PARALLEL TO CONTOURS PRE -1969 - NEIGHBOR NOTIFIFICATION 100% EXPANSION PROVIDED LETTERBUZBA SEPARATION DISTANCES SPECIFIED ON PLAN .::.°=i- _*YkFL6DD.E U Wti - LDS:_ - -- REOUIRED DETAILS ON PLANS 10' T T P21 - 2-° - -�- O P.L., DRIVEWAY, SEWAGE SYSTEM PLAN - (NORTH ARROW) M 20' TO FOUNDATION WALLS SSDS HYDRAULIC PROFILE = GRAVITY FLOW 100 TO WELL, 200' IN D.L.O.D., 150' PITS D/ J BOX = TRENCH/GALLEY = P- PIT DETAILS 100 TO STREAM WATERCOURSE LAKE (WC.EXPAN) SEPTIC TANK - SIZE, DETAIL 5,0' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER WELL DETAIL, SERVICE LWE IF OVER 10' TO WATER LINE (PITS -201 CONSTRUCTION NOTES (GRWDER RATE) = 50' INTERMITTENT DRAINAGE COURSE DESIGN DATA: PERC AND DEEP RESULTS = 200 FT. RESERVOIR, ETC.= 150 FT. GALLEY SYSTEMS TWO -FOOT CONTOURS EXISTING & PROPOSED SEPTIC TANKS DRIVEWAY & SLOPES CUT M 10' FROM FOUNDATION; 50' TO WELL = FOOTING /GUTTER/CURTAIN DRAINS WELLS =15' WELL TO P.L COMMENTS: �I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ..- _�: .-� zS`'1'�i � - • .. ... C Pm .N ` ,.wi : .� ."Y . y ..,. ... ..-. �!;`r7 -.: .. ..i.. • f-� . -. .ry_'�;y,�ee;� .' `llfv4. .i: -� ..q -� *it' the provlslons of `Article 145 or~ Date p. Re: Property of /'/,1, -&1 ile OI-44 Located a t &/G j , k o . a4l(w (T) i/' 2 lK VAC / Section %, /* Block Lot Subdivision of��� Subdv. Lot Filed Map # Date Gentlemen: This letter is' to authorize j97.1 V , 7Ui/!v W 4,0",,/v C'cv' /�! ygwee� -g a duly licensed professional engineer (Indicate to apply for 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 connection with this matter and to supervise the construction of said system or systems i`n "conformity *it' the provlslons of `Article 145 or~ 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned: h ��cz P . E . , l•rar. , # Very truly yours, Signed Owner of Property Addres s 1/ / Z 1✓ -64- l,21 YCl..l Address Town Va Telephone Telephone i r D'AQUM and DONAHU E CONSULTING ENGINEERS John . D Aquino, P.E. ❑ Daniel J Donahue P.E. j .~. V©$recl enridse_Foad� - r Putnam Valley, N.Y. 10579 Mahopac, N.Y. 10541 914 -526 -2039 914- 628 -7576 TO I C H D. .— FefowQ- 4 0,e4- r--) , Pawk._ WE ARE SENDING YOU X Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints Plans ❑ Copy of letter ❑ Change order ❑ L�EEMEM OF DATE DATE ATTENTION ��• � � ^ /{ 6>A 20 V1?_L�' J IJ 0 p Io po g� ss D s p� S k Ss7�.,s .� WCC LuIC ► Pox(-) u v V�,Ue ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION 6>A 20 /o l p� S k Ss7�.,s .� WCC -,V /3 ;V 5� rA eel 3 0 a /z c, n4 e, 62d� ,. rn AWRI r- Z P61, �a tKsr6_ D4 s�� /�i4 D� ,�,� ssys PJ)L 7V Co�tl57, UCi- 1014- � -- 2: % �Z Lz--'r)Y -2e NSF ,4�72YOel-�T/o1V / - l �e57� 70 73Zb z�.s/° - �%� /?S- & ")G, Zrrr /Q ° / - COPY TO IVo....�r . THESE ARE TRANSMITTED as checked below: I�For approval • For your use • As requested ❑ For review and comment ❑ FOR BIDS DUE REMARKS ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ 19 ❑ Resubmit copies for approval ❑ Submit -copies, for distribution ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US 6>A 20 7�y' /�G/ 2KC� c >n/ - 3 o - 9� � y -,V /3 ;V COPY TO SIGNED: It enclosures are not as noted, kindly notify us at once NX co 4* - 7iNr ,•PETER '6.'AIEXANDER50N `' • r ,: r'c '/�; ` :��� QQ� JiEARE6� :Jr:."P:E.: County Executive, �i�j �QS Director ; DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York .10512 . (914) ' 225 -0310 Building Inspectors/ Code Enforcepe�-n_t Off' r Town of. q!" 7slfr!&+!�:V 4�_ New York Zip- -I C Re: Ovne Stre TM # Town 'br. Dear Sir: nn An application to construct a �1�4 e _ d!S C5 I�X is being submitted for review to the Putnam ounty Health Department. Th'e above = mertion�d parcel ice' ;not' part of a of - Approved subdivision. - -: Therefore, the following information is requested prior to our reviev. 1. Does the proposed project conform with existing land use as officially adopted? 2. Is the above mentioned lot considered a legal building lot? The above must be submitted to this Department prior to our review. Approval of this information is for the creation of property lines only. The project must conform to all health department requirements and all local ordinances. If you have any questions, please contact me at your convenience. Very truly yours, "i4 11am Sr: Public Health Sanitarian WH /jP REGISTERED HAIL RETURN RECEIPT REQUESTED U Date �" -- r1 Building Inspector HALL ® A- 20 ----------------------- d S Dear Re: Construction Permit for single family residence - 8 0 A dence Street!_ Town _� _ ����- - - - - -- TN 4 `jM,I P _� -- - - - - -- - This Firm (I am) submitting an application to construct a sewage disposal system serving a single family residence on the above captioned property, to the Putnam County Department of Health. In order to process this application the Health Department requires that the following information be obtained. from your office: 0 1. Prior to your issuance of a building permit A)' Is Zoning Board approval required for any variances? Yes _ _ No B) Is any portion of the parcel located within a regulated wetland or its control area, and if so is a wetland permit required? Yes - - - -- NO --- - - - - -- C) Is any other local permit or approval necessary? Yes. ____ —__ __- -' - -_ _, _ .. ti-. .-� u.:,r ... J ... 1— . -. is �•_c. If the answer to any of the questions above is yes, please contact the Health Department in writing or by phone, 278 -6130 within 15 days of the date of this correspondence. If the answer is no, you need not respond to this correspondence. Very truly yours, Name Pb5_ bneats_ Health Department Inspector ngineer, U��-P JK %jp wetland bh CONSULTING ENGINEERS _314.Qscavya�a�_#�R?a� 200 Breckenridge Road 914-526-2039 914-628-7576 TO ~_ WE ARE SENDING YOU O Attached O Under separate cover vim 0 Shoo drawings 0 Copy of letter O Prints O Change order O IEUTEM OF MUSEDUML DATE the following items: O Plans O Samples O Specifications 01 COPIES DA'rE NO. DESCR LfflON O Rosubmit-_-_--uopimo for approval For'your use ' O Approved as noted O Submit-copies for distribution O As requested O Returned for corrections O Retum___-con*cted prints O the following items: O Plans O Samples O Specifications 01 COPIES DA'rE NO. DESCR LfflON O Rosubmit-_-_--uopimo for approval For'your use ' O Approved as noted O Submit-copies for distribution O As requested O Returned for corrections O Retum___-con*cted prints O For review und comment . O O FOR BIDS DUE 1g O PRINTS RETURNED AFTER LOAN TO US ^ii; � : O For approval [] Approved as submitted O Rosubmit-_-_--uopimo for approval For'your use ' O Approved as noted O Submit-copies for distribution O As requested O Returned for corrections O Retum___-con*cted prints O For review und comment . O O FOR BIDS DUE 1g O PRINTS RETURNED AFTER LOAN TO US COPY SIGNED: /r""=m,"rg" are not °, noted, kindly notify ""atonce. REGIgTERED MAIL RET.UF?N RECEIPT REQUESTED 0 Building Inspector 33, Re: Construct, residence Applicant Street Town T114 Date 0 m °° -InnEC PYWER () ("T 11 1992 • .G • __ .r .: M ion Permit for singleBB family This Firm (I am) submitting an application to construct a sewage disposal system. serving a single family residence on the above captioned property, to the Putnam County Department of Health. In order to process this application the Health Department requires that the following information be obtained from your office: 1. Prior to your issuance of a building permit A) 'Is Zoning Board approval required for any variances? Yes X No -- - - - - -- --- - - - - -= B) Is any portion of the parcel located within a regulated wetland or its control area, and if so is a wetland permit required? Yes________ No --------- ° ". Q .Is any other local permit or approval necessary? Yes" Na If the answer to any of the questions above is yes, please contact the Health Department in writing or by phone, 278 -6130 within 15 days of the date of this corr-spondence. If the answer is no, you need not respond to this correspondence. Very truly yours, 4 eo Na me------------------ Health Department Inspector ngineer, , we -Ll3nd bb l 1 -r No Information submitted Bui ing & Zoning Inspector IBM C CN WELL COMYLETIUN r%k,rur-.l DEPARTMENT OF HEALTH Division Of EWVroln­mieni af -Hea PUTNAM COUNTY DEPARTMENT OF HEALTH office Use Only /0 WELL LOCATION UIUCHT STREET AO0 ESS: r TAX GRID NUMBER: Luigi Rd. Putnam Valley, NY WELL OWNER - NAME: ADDRESS: Westchester Modular Homi 9s,1nc.Box'29lO,PattersonqNY ❑ PBIVATE 0 PUBLIC USE OF WELL 1 - primary 2 - secondary :Q RESIDENTIAL. 0 PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED- 0 BUSINESS ❑ FARM 0 TEST/013 ' SERVATION ❑ OTHER (specify) 0 INDUSTRIAL ❑ INSTITUTIONAL 0 STAND-By 0 AMOUNT OF USE YIELD SOUGHT gpm.I NO. PEOPLE SERVED _/ EST. OF DAILY USAGE — gal. REASON FOR DRILLING ❑REPLACE EXISTING SUPPLY ❑TEST/OBSERVATION ❑ADDITIONAL SUPPLY r3NEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 605 ft. STATIC WATER LEVEL ___3_8 ft. I DATE MEASURED 3/11 1 /94 DRILLING EQUIPMENT :91 ROTARY (2 COMPRESSED AIR PERCUSSION 0 DUG 0 WELL POINT ❑ CABLE PERCUSSION 0 OTHER (specify): WELL TYPE 0 SCREENED ❑ OPEN END CASING 91 OPEN HOLE IN BEDROCK 0 OTHER CASING DETAILS TOTAL LENGTH 32 ft. MATERIALS: MSTEEL OPLASTIC OOTHER LENGTH BELOW GRADE - 31 ft. JOINTS: 0 WELDED GTHREADED 0 OTHER DIAMETER 6 in. SEAL:':M CEMENT GROUT OBENTONITE OOTHER WEIGHT PER FOOT 19 Ib.1ft. I DRIVE SHOE 13 YES 0 NO I LINER: 0 YES 19 NO SCREEN BETA., 1. DIAMETER (in) 'SLOT SIZE LENGTH (it) DEPTH TO SCREEN (it) DEVELOPED? FIRST OYES ONO GRAVEL PACK 0 YES 0 NO GRAVEL SIZE: DIAMETER OF PACK. In. TOP DEPTH —ft. BOTTOM DEPTH It. WELL YIELD TEST 11 It detailed pumping METHOD: BUMPED i tests were done is in- ❑ COMPRESSED AIR formation attached? 0 BAILED ❑ OT . HER ❑ YES 0 NO If more detailed formation descriptions or sieve analyses WELL LOG are available. please attach. DEPTH FROM SURFACE I j"t" pear- Ing Well 'a - meter FORMATION DESCRIPTION CODE ft. ft. WELL DEPTH ft, DURATION hr. min. DRAWOOWN I ft. YIELD 9pm. La nd sw mace 15 Dx ill Lng in overburden clay & boulier� 14it vhnk, at 151 1 605 6 540 8 15 32 DxillKng in rock, set casing, grou:edL '12 fjQ:L___DXij1 ing in rock granite. 2/2,8/91. H3-drcfracked Well WATER 0 CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? ❑ YES ONO STORAGE TANK: TYPE WellXtrol 302 CAPACITY 8k_ GAL._ PUMP INFORMATION I TYPE sub e rsj-bl6 CAPACITY 5 a Gould MAKER DEPTH 560 MODEL 5ES10412 . VOLTAGE2-3-0 HP 1 WELL DRILLER NAME P.F. Beal &S I c. DATE oon§* I ADDRESS 4 Putnam Ave oy ?AV�1/94 SIGNAT f Brewster, NY 10509 3189 Lam 1—, , r­: :j r9 PUTNAM COUNTY DEPARTMENT OF HEALTH S10N OF , 2EN Off. NI :HEALTH_ SERVICES . �! �Cs1cte\ r�V Owner or Purchaser of Building Building Constructed by Locati n - Street PO �� Cl Municipality c Ue�dao�X Building Type , 3. 17 ( 01 Section Block Lot 141A Subdivision Dame 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 feziod of two years immediately following the date of approval of the "Certificate :of oristruc�fidn': Cr�i� 1Unce" yf`0`r-.ttie. "age, disposal—.m 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 Environiental 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 #za day of 19 911 General Co tractor (Owner) - Signature Corporation Name (if Corp.) J7ro /? -r Address rev. 9/85 mk Signature Title Corporation Name (if Corp.) ess f- �,. DIVISION OF ENVIRON14ENPAL HEALTH SERVICES Jotin M. Simmons, M.D., Deputy Cammi.ssi;oner of Health - FIELD ACTIVITY REPORT - ADDRESS No. Street Town TH No. MAILING ADDRESS P.O. Box Post Office Zip Code Sheet of Orig. Routine Orig. Complain Orig. Request _ Compliance Complaint Comp Final Group Illness Construction Reinspection PERSON IN CHARGE — Field, Sampling Only OR INTERVIEWED Field Conference Name and Title Other DATE �� - �E FACILITY TIME ARRIVEQ F TIME LEFT Explain FINDINGS: ••� INSPECTOR: TELEPHONE: PERSON IN CHARGE OR INTERVIEWED: `=- I acknowledge this Field Activity Report. SIGNATURE: \ 6/86 TITLE: sb . ... -r.v..y .•�l`i��_�. S� �-... r.. _..tea. _- xr. +i'�x--- -�- ,..'.1 f''' -'4' ♦ ..iF 4. "l..r " ADDITION APPLICATION RESIDENTIAL ONLY STREET ;AW/1 a ✓L TOWN 4 /4r1n 1AiIf TAX MAP # NAME PRONE 99'rS -ZJ 946 -1' PCHD# MAILING ADDRESS �/► c DESCRIPTION OF ADDITION S c 'e- -�� .� NUMBER OF EXISTING BEDROOMS '4 PROPOSED # OF BEDROOMS `I. (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) "Any addition which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer, or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, Brewster, NY 10509, Phone: (845) 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, to be showii and dirhdrisioned-and use-ofeach room- specified). (S-3�e- Se6tion_3:.c -of $ull%in,. -. HA -1) T i'4-o Sets iii proposed ffooI� planes ldh-, vn �to sc- le� -' Wifl -, naai�, t:['f✓l i uncl lay n.: ,q) Tti on-()rol'es'iio112tl sketches are ?iCi'eptable 2111E preferred. (See Secti , ni -`.0' U(, 1'�ul!C —! 11'I HA- ) 4. Copy of survey showing all well and septic locations on the subject property to the best of your knowledge. Include date of installation known. Contact this office with any questions. 5. Copy of Certificate of Occupancy from the Town or Certification from the Building Department with legal bedroom count of dwelling. OFFICE USE COMMENTS s. Town Legal Bedroom Count & Proposed Addition Status Re:— KEELER (Owner's Name) Tax Map # 73.17-1-21 Address: 31 Irma Drive Town: Putnam Valley Year Built: 1999 According to records maintained by the Town, the above noted dwelling, is XX in compliance with Town Code. Is not in compliance with Town Code. The Legal Bedroom Count is: 4 T attQA has been-obtained from: -�hisjnform Certificate of Occupancy: CO#1999-170 Other: The plans for the proposed addition are considered: New Construction XX Addition to existing house only Teardown and/or re-build allowed under Town Regulations 10/28/10 Building n s ector Date 6. . Sherlita Amler, MD, MS, FAAlP Commissioner of Health - ...�I$ ®be?�f'��rr9Sy' °fir F Director of Environmental Health November 17, 2010 Robert J. Bondi County Executive liepa°tment of health 1 Geneva Road, Brewster, NY 10509 Thomas Keeler 31 Irma Drive Putnam Valley, NY 10579 Re: Addition-. A- 165 -10 No Increase in Number of Bedrooms 31 Irma Drive (T) Putnam Valley, T.M. # 73.17 -1 -21 Dear Mr. Keeler: I have received and reviewed the revised 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 November 17, 2010. 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. All plumbing fixtures must be updated with water saving devices, i.e.,.new low flush ~-- teilets ;- nstFtr- ,tcirc.for'sho�vg heads7and-faucefsztc�. -- - 4. The approval is for the proposed changes only. _This approval--does,nrt-validaie construction shown as existing that has not obtained proper approvals 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 (845) 808 -1390, ext. 43261. Sincerely, . �r ene D. Reed Senior Engineering Aide GDR:kly cc: BI, (T) Putnam Valley Environmental Health 045) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845)..225 75418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing / dome Care agency (845) 278 -6085 MC (845) 278 -6678 Early Ifatervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 R6 ERTIFICATIFE'd. IC'Eur Cr% C" OMPLIANCEHO CC.UPANCY CERTIFICATE NO.: * 1999- 170 YAU: 73.17"1-21 LOCATION: 31 WIA DRIVE ISSUED TO: ORLANDO NUCHAEL PERMIT NO.: 1997-1094" DATE: August 03, 1999 This Certificate covers the. construction of: New Cons, Struction-Miscell. I Fami1y., Year Round Above Ground DECK The'-appl.icant havina heretofore.filed an application far a building permi.t pursuant to the Town Code, Sanitary Code, the. Uniforrri J Building & Fire Code and the Laws in effect in. the Towli of Tutriatri Valley, -Putnam -County, -NY, having paid the required fee. thet'efor' .=-d the under5igned.having by personai in3pecti' ascert ained, -1`hat tion the, applicant . has - subsequently proceeded with the erection or' improvement of the proposed '-structure in compliance 'with the requirenient2 of the lawa a3 aforementioned; that .UKe said work mkt- Pyrary rPrwjr4:,mPni- `,f, f thp- and that the premises . have.now been fully completed and are ready .. for ,occupancy. pursuant to the P ov isions of law. Novi, therefore, this certificate,�of compliance/ occupancy is hereby issued under the Putnam Valley. seal of the To�qn .0. 'f TOWN OF PT-TTNAM VALLEY, X Y. CODE FAFORCMMT OFFXCE Mn APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM ;_�lare:aad= l�n'�f -,rip aG2A (os 2. Name of Project : (`�11� �4L1 (Cx 0 3. Location T)NEX: 4(f O�?-f l 4. Prcjec:. a Engineer: :]kA T Uukc) 5. Address:3 0 �- plil+ % . Ny1 U 5 7 License Number- 5b4-02-- Phone: 6. Type of Project: X _ Private/Residential Food Service Apartments Institutional Office Building Realty Subdivision Commercial Mobile Home Park. Other (specify) _ 7. Is this project subject to State Environmenttal Quality Review (SEAR)? Tvice Status (Check One.) Type I.. Exempt Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. �o 9. t;as D_ =S been completed and found acceptable by Lead Agency? ......... 9. Name cf Lead- Agency �J/A 1. 3s Chis project in an area under the control of local planning, zoning, or ot`.er officials, ordinances? e`j ?. Ii` SO, ave -ps KrTt- ':a o ..:::::::.. 1 3. Has Preliminary approval been granted by such authorities? Date Granted: 4. Type cf Sewage Disposal System Discharge...... Surface Water X _Ground Waters j if c'�r- a o e c stream designation? !!� ._c, water discharge, what is the s�,eam class designation......... / Waters index number r - (surface) ............................................ Is prciect located near a public, water supply system? ... �0 If yes, name of water supply Distance to water supply ?S t "cject site near a pub*' i C se aC- or e- c-,os-= � cy= ter.' ... . N•© se,-..,*E_e systejm Distance tC sew'ag=- sy-st -em i Data- c:servec':l ��Z-- 23. i�eme of ?nspecto-: -Y� I"iBYYiS �� �g2 SSDS ©t� . Prci� ,design flow' (gallons p day) ................ ......... ......., 2. . Is State Pollutant Discharge Eliminaticn System (SPDES) Permit required ?.. _ hi=s S °PD.ES =Appa a cat on. -been ;s. bm meted :to Local. DEC Off i ce? .. . . Is any portion of this project located within a designated Town or State wetland:' .................................. ............................... ��t JQC) . Wetland ID Number ......................... ........................... �. (T1 . Is Wetland Permit required? .............. ............................... Qsc¢�?(re."r Has application been made to Town or Local DEC Office? .................. . Does project require a DEC Stream Disturbance Permit? ................... Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? YES or NO N� Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or ►! any other potential( known source of contamination? ........�.f. /.... YES ( or NO r N� DESCRIBE-- 151 GY 0r(�0 vii f-i t l A /' c Is there a local master plan or file with the Town or Village? ........... j Are community water, sewer facilities planned to be developed within 15 years? 0#° (� e Are any sewage disposal areas in excess of 15% slope? ...... .....�..V. 't `5 6 Tax Map IDYTPIumber ......:.. °....': ......:.. .....:: ° ::...............3 % - �'- Zf' Approved Plans are to be returned to: Applicant Engineer the application is signed by a person other than the applicant shown in Item 1, the lication must be accompanied by a Letter of Authorization. Failure to comply with this vision may be grounds for the rejection of any submission. .T hereby af, irm, under penalty of perjury, that information provided on this for, ' 7 is true to the best of my knowledge and .be 1 ief. False statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the Pena 1 Law. 110-6/- qA'I UI. � O,rIC =;! TITLES: -ING ADDRESS: 113' r IP 0'0 7Qoro UUUNT1 Uh-eAKI'MEINT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES a A Owner. _ fj . Address W141 ®. PLMjAM UA (,g," Located 'at Street MS' �- ( � Sec.,�.�7 Block � Lot Hdicate -n eares cross street) Municipality' ;; A M Watershed RIVCR® SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS 5 . PM'- w mA�Lk- OF 7ftrs i o -to- Qg Hole . 1 Number,. CLOCK TIME `;PERCOLATION .4 Is. lla PERCOLATION Run apse Depth o a er Water ve No., ` Time From Ground Surface, in Inches Soil Rate Start -Stop Min. Start Stop Drop in ",Min./in drop Inches Inches, Inches ®9► 2 12: 08 12 3 92 : 9S. I _I I' 5 Pte; 2 0� ,�o �r� 4.5 2a, 1 .4 Is. lla 23 Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. App data to be submitted for',review. 2), Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO._ HOLE NO. 611 i 12 t 24... Ln4M V 3011 3611 4211 MODE&ATRK'LY 4811 5411 6011 66" 7211 7811 0 8411 INDICATE LEVEL AT =H GROUND WATER IS ENCOUNTERED OCT INDICATE LEVEL TO WHICH LEVEL RISES AFTER BEING ENCOUNTEIXD TESTS MADE BY :JSkA Tfum" Date DESIGN - , e _Provided - S-D-VP4bl' Area Dr No. of Bedrooms Septic Tank Capacity ls CAS 7- C-00ic 16 Absorption Area Provided *efoo L.F.x2411 ch. Ir Address F4 0 THIS SPACE FOR USE BY HEALTH DEPARTIMI T ONLY: Soil Rate Approved Sq. Ft/Gal. Checked bi- Date 6 ljo Date AS BUILT MEASUREMENTS OF SEWAGE DISPOSAL SYSTEM Building Corner A $gilding Carner B Junction-Boxes JB1 50' nl+{ IN5'8" JB7 54'1" .78'5" JB3 -98,51, 1., 5,E JB4 6311" ;84'7" JB5 681.5" 8819" P3 OFi 2012" North Trench; Ends 1 41.4" X47' 2 4713" -',49500 67 r 3 51'8" i8' 4 5711. 644' 5 6417" Will South Trench Ends 1 8216" a: 13' 2 - • J81 3 89' Pi8 +-� b8 ,_ 9816" r, —5 n ` "�4 Q pvjc . plpE . --- _ - -- --- _ - gallon 3epht A 'j • QD \� 180 �,� - - �W6LLI N OFESSIO.Mq� NOTES. %10 0 -e- 1. This ruis to certify that the sewage disposal system was constcted as indicated on this plan and that the system was inspected by.me before it was covered over. The -- '' r o system was constructed in aCCordance with all standards, rules and regulations of the Putnam County Dept. of ` 06040' 8l lF Oi RE'A �R Health and the NYS Dept. of Health. �. 2. The as -built location of 'the .house was obtained from \ . survey prepared by eedey and Watson,, latest revision i 1>11tn8m County t ll art e Of H881t6 ' February 24, 1994. Oivieion of En *Aron eta He th ServiOe. \ 3. As -built measurements on March 2, 1994 were made during SO''" inclement weather and 6 to 12 inches of snow and ice MIN16roved as `D.OtOd 01 'Con Orman With I cover making precise measurements difficult. i .1yplicable Rules d .egu ations O e - 4. The southerly trenches were covered by snow and ice and -� Putnam County Re . only approximate ends of trenches covered by filter p ent.. th Oe u fabric were observed and measured on March 8, 1994. _ 5. This plan shows the absorption trenches and junction i I �427C6 ds d'1.t7-' boxes as proposed. Actual locations as installed are -I , similar but as -built measurements should be used rather than scaled measurements. 3� . �•. �;,� 6. Backfill between trenches was frozen and contractor was, la o advised to exercise caution when backfilling to preclude damage to absorption trenches. r' r' �t AS BUILT MEASUREMENTS OF SEWAGE DISPOSAL SYSTEM 1 AS BUILT PLAN OF SEWAGE DISPOSAL SYSTEM AND WELL LOCATIOz4 MICHAEL ORLANDO' LUIGI ROAD -AND IRMA:j?RIVE W PUTNAM VALLEY, ! SECTION 73.17, BLOCK 1ILOT 21 MARCH 8, 1994' . SCALE 1" = 20'lh 1 i� i Building Corner A $gilding Carner B Junction-Boxes JB1 50' nl+{ IN5'8" JB7 54'1" .78'5" JB3 -98,51, 1., 5,E JB4 6311" ;84'7" JB5 681.5" 8819" Septic Tank (Center) 2012" North Trench; Ends 1 41.4" X47' 2 4713" 5,316" 3 51'8" i8' 4 5711. 644' 5 6417" Will South Trench Ends 1 8216" a: 13' 2 86' 5'6" 3 89' Pi8 4 9816" {016" —5 95' - 10116 - 1 AS BUILT PLAN OF SEWAGE DISPOSAL SYSTEM AND WELL LOCATIOz4 MICHAEL ORLANDO' LUIGI ROAD -AND IRMA:j?RIVE W PUTNAM VALLEY, ! SECTION 73.17, BLOCK 1ILOT 21 MARCH 8, 1994' . SCALE 1" = 20'lh 1 i� i