HomeMy WebLinkAbout3423DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
73.17 -1 -31
BOX 27
I
i I
a,
.�
::
!F-Mill
j
ler.
,
of
his
l
,
IN
I
I,
I ,
, ■
IL
g
1�
03423
1 � PQ11�iA� 00D[?1Y D1 Al it 0F:1�ALTH` ,,,r,
rrt�'//// DNridae d®rvMesaaW HetlO Sect loe�. arYd. N.Y.1�SU ae C.MTW T8 OF co
� 9 PMM FOR SNWA6M DISPOSAL ST_STM
Lflcaa�d at �' � r'i YZ_ ar
sees... ..._ _.._._
+"
._l Ta:.n 73.-j 7 inaat ,�• �L-
_...�.�
We of Previous wppew,l /9 9 Al
A"ase �9 Town /a+rr /`ii Q min
natc Subdivision Approved Fee Enclosed O amn„nt
TRW Lot Am sew
Depth vsb>me
Nober of bedroom DWP Flew G P D `l% U PCSD NolMastim Is !leached When M Is completed
S"Olob S mmV Syslost to oosaM d 1d .9 Gsl1m Sgdc To* and <.5 O v A 49 ' W i dt_° if"►'Yi +l G/7 '.7
To be ouishucted by Address
Water c Supply FedY Add<eee
Gel mss- Sstpob Dtlild by sda.rw.e
Other Regademeote
1 represent-:that 1 am wholly and COmpletely responsible for the design and location of steel proposed system(s); 1) that the separate I s stem
above described will be constructed as shown on the approved amendment there to and In accordance with the standards, rules a regu Mn s o m
County Department of . !With, and that on completion thereof a *CertlfW&te of Construction Compliance" Satisfactory to the Commissioner Of Mealthwill
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
plate in good operating condition any part of Said sewage disposal system during the period of years Immediately following thedate of the IBM-
Ones of the apparel of the Certifk;ate of Construction Compliance of the original system o; 2) that the drilled well described above
wHl be located as shown an the approved plan and that Said well will be installed in a rdance 'rules and regulations of the Putnam
County Depart owe of Health. Signed b P.E. RA
�' .:
Date f
ce
Add a9 %rr�c.� /� Li
ers nse No
APPROVED FOR CONSTRUCTION' This approval expires two
revocable for cause obe.amMded or modified when COnsi
requires a peer Appoved fo r disposal of domestic s
Re V . /�i'
10/88 Date By
.. 7, liaagiai
rr f► m the dat0 i ion building has been undHtaken and Is
ed ry Oy the C net eeh change or al ation of construction
.and /or or
Title
Mf1Ai[ COQ[fR DQ�ef�Rt Oi1l�Alsllg
Dhddm4d111rsr mWmo Y Roulsb Se rvlilm CaRrl.14 T.14111? r oo pmwYg Feslt o.
or
�ASli »lODAL f!!!f0[ Frts�lt 1
Las c f Tax map ,led I/ 1A 3J
air OwedApprealtt ligstg _ o >aswtl_ O O h> Abi !! Y /
Der Of Apprwr
zl, e
Date Subdivision Approved 4W Fee Enclosed Amrn,nt 'S Ole
y�.i��J�liil7C'� . Let Argo /'� F1 Saeum
ale Lj Depth Yghva
hailer d Daibgig .3 Dad& Flow G P D d O o PC®NeIMnitlw b hassled Wbw FM b errpbbd
stGPloar safldl ivi 30811• lo oumm d OG Sspdo Tmk —d r2O o
To lowendre dsd,b Addrass
wear sow _b F,.. Address
on. Sap* DIld by
pillar D.�g.rw '�.
1 npreNntanat l arm whony wed eandlwtely .Gpwnsible for the design and location of the posiofmd syStiP*Qi 1) that the Se rate YMN a "di OYI' stem..
above desc►IOad win.be constructed as shown on the approved sow n"nnt there to and M'aCCOnUnc* wnh the standards, ►uNS ar10 ►aguY[TOn o a Me
OlslM►ty OapofttMnt a• ,NMRh. wed flit one, We'iontlrereo a "CMtllicaN n Compliance- Satisfactory to the Commissioner Of MMRhWIN
M WAMR%d to ,the pGpertfiwr1.. and a written gruantss will a furnbhG core. heksor assigns by the builder. that said buUdw win
place M flood .O/eratblg ol1MRNrn. any ant of Yid savrage disposal two (!) yaps MlmadlatGly fO110wiflg thedat* of .the t11Y�
aaoa
Of the appftilra Of the C6111106 MG Of COnagtsctfon Compliance of raprks tharstoi 2) that the drpied well deserRled s6oee
WE M W&W wl O Mr11 M the apMevad DIM and Mf uid wen will be In n stwwWds. rulas rand fee Oi1s -of the Putna/R
COOKY aaMR Of te"ROL
cam 9. Signed R,A:
Adds W
Lkenee
AMROVEO FOR CONSTRUCTIONS N approval expires life s r a A:O"OrYttlOn Of the building has been undertaken and is
rwoomble for cam a may be er medMled when con of HUM. Any change or alteration of construction
fewires s �� rgAl foe diwoYl of dorrnatt y ear suopb onus
Rev.
i0/88 °iti °T' Or TRIG
.'.�"."z^•s- 'zcf nY•.r �::.`' } -.,k• . � r C1 ;+i ins �'�S av� to alt .f s 1 a s,
-:. / .. _. � .�..t� ._,_ �_....,.� . �._ ...,..aw3k�_,..��r' �. r.`' -..off. ,..a3•. `" 3".a yv. , Cf" t�7''.:'kt.^.
-
th,Rv,
2
Ail
Yr>F6� ^r
r Dat e
M
�x
=fie t��fi�y
Wa�ar'Slt
a "w wa ti•.
s14�rp�►�a�n
OPyfYMnl
n11t� �,k►
Manor °�7t1
�wIM M lol
APPROVI
nv`oeaba"
npui►aa a
leV e
a LO /88'�ata
K.
I
s �� } �`2iYwr+•rR�4s'y1 tk� G�'.Y -7d� �3� �����
—
'•,a' �1�. . �} �t t t�=ta t r'}�$ �."'�„'q��k'3q ��yA'�%Vxyae�' - . '
H,6" " - e".��''�{- *zs�,a
{' ,vyN��D�L� R'Th Nye
Data 0%PlOYkMV. .
7 '
tTa!lr007t{ r. w ��ryic� h q s,-�y .'
Foa ;4Fnnlnaori:�:ur�__
S r .. R�3 -�>F aL,t�e�fi,.w; a .:,�+. N;?_•A,s.¢:^:'a�`,.'�.BJ?..�i ,g
t` I
ae.�, , •ry1 x �i� ,sr � ..
tlhatrtM p rabaaaw --"disposal am
; rd ruiaka Ireguationol. the, Pordw
wfory t�o,tM ComniiplonM of NMltliwitl
bY. ",tM buil0 ►r tMYYid baNder'wiN
fiy f-I tMAste M the .kW-
s )fit � t�t,McdNtNO watt s.wibad aiow
a�0 rpYTa�Ons of the ' PutoNm
1fi� -with 1 b N P E' R.A. _.
tM bYiginy has tiavnsuedertakan and is
�_.
►ny chanya a an►atio� of ooratruttktn
.4y JS
F (�
� YitN
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVI.RONMj�N�' _ -, H 5E 12VI — I -
CERTIFICATE OF CONSTRUCTION COMPLIAN E TREATMENT SYSTEM
PCHD CONSTRUCTION, PERMIT #
Located at _20;-M-7 Town or Village
Owner /Applicant Name ri� Tax Map 73• i 7 Block / Lot 31
Formerly d ef% Subdivision Name 2�-nva 611 vely
Mailing Address
Subd. Lot #
.irryd _ I re ')aa4we.
Date Construction Permit Issued by PCHD
/4z
W Z r Zip 1®_-5"7Y
Separate Sewerage System built by ® h, ,,v eyo Address :�v,ov e
Consisting of ).do es Gallon Septic Tank and _31a el 2_.,4" y,i le
Other Requirements:
Water Supply: Public Supply From Address
or:_, K Private Supply Drilled by Address A/- A1-0LI
Bui'din y�}?e - � -.► ��.e-�f Has• rosion control '.beeri.complFted ? =:
N rnber of Bedrooms 9
..3 Has garbage grinder been installed . Aid
-••4i certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as-
built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved
plans and the standards, rules and regulations of the Putnam CoiuUyJkg&hnent of Health.
Date: Certified by P.E. )"' R.A.
(De ' n Profes a� Gar
Address �% Z ,��r o y -�`/'C < I nse #
�y y:,
Any person occupying premises served by the above system(s a such action as may be necessary
to secure the correction of any unsanitary conditions resulting ge. Approval of the separate sewage
treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval
of the private water supply shall become null and void when a public water supply becomes available. Such
approvals are subject to modification or change when, in the judgment of the Public Health Director, such
revocation, modificatio or change is necessary.
By: G � Title: Date: - 2
White copy - HD Fi ; Y? to copy - Building Inspector; Pink copy - caner; Qge copy - Design Professional
Form CC -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT
NQ.D">('lE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate sheettplan.
Well Driller's Narns, P o F o ns, Inc.. Address: 4 Putnam Avenue, Brewster, NY10509
Signature: Date: 5/20/02
—Christopher-Beal
White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC -97
24 Irma Drive
,ovvii/t...
Putnam Valley
Map�3l'z Block I Lot(s) 0
Well Owner:
Name: Address:
James Ea Rosenfield, 24 Irma Drive, Putnam Valley, NY 10579
Use of Well:
1- primary
2- secondary
X Residential Public Supply Air cond/heat pump Irrigation
Business Farm Test/monitoring Other(specify)
Industrial Institutional Standby
Drilling Equipment
X Rotary Cable percussion x_ Compressed air percussion Other (specify)
Well Type
Screened Open end casing X ' Open hole in bedrock Other
Casing Details
Total length 42 ft.
Length below grade 41 ft.
Diameter r,. in.
Weight per foot 19 lb/ft.
Materials: X Steel _ Plastic _ Other
Joints: Welded X -Threaded Other
Seal: _X_ Cement grout _ Bentonite Other
Drive shoe: X Yes No
Liner: Yes X No
Screen Details
Diameter (in)
Slot Size
Length(ft)
Depth to Screen (ft)
Developed?
First
Yes No
Hours
Second
Well Yield Test
_ Bailed X Pumped X Compressed Air
Hours 6
Yield 5..-- gpm
Depth Data
Measure from land surface- static (specify ft)
30°
During yield test(ft)
5051
Depth of completed well in feet
545"
Well Log
If more detailed
information
descriptions or
sieve analyses _
are available;
please attach.
Depth From
Surface
Water
Bearing
Well -
Diameter(in)
Formation
Description
ft.
ft.
Land Surface
10
Drilling
in over
den clay and boulders
10
Hit rock
at 101
�.J
42 .
Drillincf
in rock,
set caein - routed-
42,
545
)killing
in rock
sfiiie
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump /Storage Tank Information
Pump Type brn Capacity ApW
Depth q5b' Model V/ 0-S1
Voltage 40 HP
Tank Type Volume "r�(
Date Well Completed
11/15/00
Putnam County Certification No.
002
Date of Report
5/20/02
WZistopher.Beal r in
NQ.D">('lE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate sheettplan.
Well Driller's Narns, P o F o ns, Inc.. Address: 4 Putnam Avenue, Brewster, NY10509
Signature: Date: 5/20/02
—Christopher-Beal
White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC -97
7�
BRUCE R. FOLEY LORETTA MOLINARI R.N,, M.S.N.
Ic a
Public Health tDirecior �As,�b i4'Pab1` Jfe Wf- Dir'
Director of Patient Services
DEPARTMENT OF REALTH
I Geneva Road
Brewster, New York 10509
Environmental Health (914) 278 -6130 Fax (914) 278 - 7921
Nursing Services (914)278-6558 1 VIC (914) 278 - 6678 Fax (914) 278 - 6085
Early Intervention (9 14) 278 - 6014 Preschool (914) 278-6082 Fax (914) 278 - 6648
L _11 ADDR VERIFICATION FURN/1
ONAWEAS NAME-.
TAX HAI) NUMBER:
1',9 .1 A t DDRESS:
T'0WN:
) . i
A.U'1A-J01:,.JZED'*F0WN 0E
r1%
r
ThC I'Ll'(1114111 County Departniellt Ot'llealtil. Vitt 1101 iSSLIe 4`1 Certificate of
("onstru Cd oil a 11 1
I C0 11.1 1.4ij lice ulif ess till A ove to rni is co mpteted, i.e., a legal E9 t I
address B assigned b -ized town offic' I Ti ` f' rin 's to be submitted
y al), .13- .. Ills 0.1 1 1,
lVith the application rol• 11 (..'erti.ficaie of constniction Compliance.
., I
� YML ENVIRONMENTAL SERVICES
� 321 Kear Street
|
Yorktown 598 ---- -
| ' "�'` '' ' ''`^ ' ^
Albert H. Padovani, Director
LAB #: 32.204383 CLIENT #: 55201 N
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
NON SSTAT PROC P
PAGE 1
ROSENFIELD, JAMES A
ATE/TIME TAKEN: 06/19/02 0
07:50
24 IRMA DRIVE D
DATE/TIME REC'D: 06/19/02 0
09:05
PUTNAM VALLEY, NY 1
10579 ' R
REPORT DATE: 06/26/02
PHONE: (845)-526-8632
SAMPLING SITE: SAME S
SAMPLE TYPE..: P
POTABLE
: KITCHEN T
TAP P
PRESERVATIVES: N
NONE
COL'D BY: JAMES ROSENFIELD T
TEMPERATURE..: <
< 4C
NOTES"..: `
` C
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
COL11"---ORM METH: M
MF !
DATE FLAG P
PROCEDURE R
RESULT N
NORMAL - RANGE M
METHOD
PUTNAM CNTY PROFILE
06/26/02 M
MF T. COLIFORM A
ABSENT /
/100 M
ML ABSENT 1
1008
06/26/02 L
LEAD (IMS) <
<1 p
ppb 0
0-15 ppb 9
9101
06/26/02 N
NITRATE NITROG 2
2.56 M
MG/L 0
0 - 10 9
9139
08/26/02 N
NITRITE NITROG <
<0.01 M
MG/L N
N/A 9
9146
06/26/02`'' I
IRON (Fe) <
<0.060 M
MG/L 0
0-0.3 mg/l 2
2037
06/26/02 M
MANGANESE (Mn) <
<0.010 M
MG/L 0
0-0.3 mg/l 2
2O37
06/26/02 S
SODIUM (Na) 8
8.5 M
MG/L N
N/A
06/26/02 p
pH 6
6.2 U
UNITS 6.5-8.5 9
9043
06/26/02' H
HARDNESS,TOTAL 1
104 M
MG/L N
N/A
06/26/02 A
ALKALINITY (AS 5
58 M
MG/L N
N/A
06/2002 T
TURBIDITY (TUR.�_ .
<1 N
NTU
075
_
��~ ='�
--_ ~
. <
COMMENTS:
PICKED UP 6/26/02
COMMENTS:
BACT THESE RESULTS INDICATE THAT THE WATER ,(WAS NOT) OF A
SATISFACTORY SANITARY QUALITY ACCORDING-TO THE NEW YORK STATE
AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS
TESTED, AT THE TIME OF COLLECTION.
Pb/Cu LEAD limits for public schools are set at 15 ppb.
EPA Lead & Copper Rule for Public Systems requires that no more
than 10% of their distribution points have a LEAD value of more
than 15 ppb and a COPPER value of 1.3 mg/L, else water
treatment must be undertaken to reduce the waters corrosive
potential.
Fe/Mn If both iron and manganese are present, their total value
combined shall not exceed 0.5 mg/L.
� YML ENVIRONMENTAL SERVICES
321 Kear Street
` ^ Yorktown Heights, N.Y. 10598
Albert H. Padovani, Director
LAB #: 32.204383 CLIENT #: 55201
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
ROSENFIELD, JAMES
24 IRMA DRIVE
PUTNAM VALLEY, NY. 10579
.
NON STAT PROC PAGE 2
DATE/TIME TAKEN: 06/19/02 07:50
DATE/TIME REC'D: 06/19/02 09:05
REPORT DATE: 06/26/02
PHONE: (845)-526-8632
SAMPLING SITE: SAME SAMPLE TYPE..: POTA8LE
: KITCHEN TAP PRESERVATIVES: NONE
COL'D BY: JAMES ROSENFIELD TEMPERATURE..: < 4C
NOTES.~.: ' COLIFORM METH: MF
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~=~~~~~~~~~~~~~~�~~~~~~~
DATE! FLAG PROCEDURE RESULT NORMAL - RANGE METHOD
,
Na No limits fbr Sodium are proscoibed. Suggested guidelines state
that for people on a sodium restricted diet,the water should
contain no more than 20 mg/L of Sodium. For those on a
moderately restricted diet, a maximum of 270 mg/L of Sodium
is suggested.
pH pH . SCALE IN -WATER ]RANGES'EROM 1=14. MEASUREMENT OF pH IS ONE OF
THEIMPORTANT AND FREQUENTLY-USED'TESTSJN -WATERCHEMISTRY,
WATER WITH A LOW pH MIGHT BE CORROSIVETO-METAL'.PIPES AND
FIXTURES. THE NORMAL RANGE OF pH IS 05 TO S.5.
`
Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM
,^`. '-.[�ONCE ATIQ BO �
EXPRESSEDAS�CALC�UM�CARBONATE, IN MG/L;. THE'
- - - HARDN�SS-����'-AkbE'PROM 0 TO� HUNDREDS OF MG/L, DEPENDS ON THE
SOURCE.AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED.
SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L
MODERATELY HARD WATER: 70-140 MG/L MG/L v MILLIGRAM PER LITER
HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L)
SUBMITTED BY: 'a'aAvaz',A
Albert H. Padovani, M.T.(ASCPT
Director
v
Inc � �
oo
�;`10�� I
'`~ T
^'
ELAP# 10323
� YML ENVIRONMENTAL SERVICES
321 Kear Street
Yorktown Hei ht
Albert H! Padovani, Mrectpr
LAB Q 32.201339 CLIENT #a 55201. NON STAT PROC PAGE
ROSENFIELD, JAMES DATE/TIME TAKEN: 02/25/02 00:000
24 IRMA DRIVE � DATE/TIME REC'D: 02/25/02 03:05P
PUTNAM VALLEY, NY 10579 REPORT DATE: 02/27/02
PHONE: (845)-526-8632
SAMPLING SITE: 24 IRMA DRlVE PUTNAM VALLEY,NY SAMPLE TYPE..: POTABLE
: KIT TAP '��= �— K�� _ _ _ PRESERVATIVES: NONE
COL'D BY: JAMES ROSENFIELD TEMPERATURE..: < 4C
NOTES"..: CQLlFORM METH: MF
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~"~~~~~
DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD
02/25/02 MF T. COLIFORM ABSENT /100 ML ABSENT 1008
COMMENTS:
BACT THESE RESULTS INDICATE THAT THE WATER WAS NOT) OF A
SATISFACTORY SANITARY QUALITY ACCORDINilT� THE NEW YORK STATE
AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS
TESTED, AT THE TIME OF COLLECTION.
SUBMITTED BY:
ELAP# 1032:3
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner or Purchaser of Building
Building Constructed by
73 -/7 3/
Tax Map Block Lot
/��y
TownNillage
Location - Street Subdivision Name
Building Type
Subdivision Lot #
I represent that I am wholly and completely responsible for the location, workmanship, material,
construction and drainage of the sewage treatment system serving the above- described property, and
that is 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 "Certificate of Construction Compliance" for the
sewage treatment system, or any repairs made by me to such system, except where the failure to
operate properly is caused by the willful or negligent act of the occupant of the building utilizing the
system.
The undersigned further agrees to accept as conclusive the determination of the Public Health
Director 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.
Y
Dated: Mon Day dO Year X0-2
-2
r
Ge al Cont ctor (Owner) - Signature
Corporation Name (if corporation)
Address: �`7��'k= �`` ✓�'
State Zip
Signature: 1AW1 /I P0001
Title: w 4—L14 Ve
Corporation Name (if corporation)
d
Address: qr�'+ 4''�t'
State V r
Zip /0:1) ?5
Form GS -97
JOSEPH F. SULLIVAN, P.E.
:1 `• ....�- ', fir; t2972-FERNCREST'DRIVE'..
YORKTOWN HEIGHTS, N.Y. 10598 �7 1
60a,
(9 1 4) 962-4248
Ar '3�ao 15'd '
If 8., Wrx' // /B awls lalr?
(7:) PPw A,os-n ?,,w' Iley
,�rcc %,� • l7 / le /V
we, // / -dc�w AJa, �,,
fro lyd ss A'� /� /.5 e- 1-o Ile, lo, —� 1�4
tz P-e-p-�5 e I -**Iel / i
1-"2, dl
{ PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
�•, • ... ... •t .� . ... .. .. .;d. u� { -.i ��,. •�\ 1�.: `. .. • ,. ..�M ,,. •ni:���.Y..�. v.t a.r :1 --�lL. pt:.� �i 1•.� ••
� �: :. �i'w •.J .. "'l1i .f`�i{�.�r- ..:.y,i..1.. •..�. :k.£4. Fes: �ip�/'9 Ia Av... .. N'� '..I 1^ ..
CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM
PERMIT # 2.
Located at 17''-rxy ,6%s+�r t'f
Subdivision name1 yma 6z� Subd. Lot #
Date Subdivision Approved
Owner /Applicant Name / "Iy z a le,
Mailing Addresses .•�
Town or Village s /C;V# /,r? ) 0111/ �
Tax Map Jt7 Block / Lot 3
Renewal '� Revision
Date of Previous Approval
ohly
Ziple-- y`1/
Amount of Fee Enclosed
Building Type G i VGam' Lot Area No. of Bedrooms —3 Design Flow GPD.;o,100 a
Fill Section Only Depth Volume
PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
in to consist of
4- ,
Other Requirements:
/o c'v
gallon septic tank and 3 o e dY'
To be constructed by Address
Water Supply Public Supply From Address �►
"or: - -. ;r:. '_Primate Supply - Drilled by _ :_ =A� rd`ess �n���1' ®i �=
I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the
separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion
thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will 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 treatment system during the period of two (2) years
immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original
system or any repairs thereto.- �„�,.�
✓f "
Signed: 4P P.E.
Address 2Y,72
s4 e.
NEW
APPROVED FOR CONSTRUCTION: This approval expires two yeairs from th s construction of the
sewage treatment system has been completed and inspected by the PCHD and is revoca a or may be amended or
modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires
a new oved of domestic sanitary se age only.
By: Title: �i VTi Date: iJillqq
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Profess oval
Form CP -97
4..
P1{ TNAM COUNTY DEPARTMENT ENT 07 IFIIIEALTIHI
DMSffON OF 1ENWRONMEN 'AIL HEALTH S ERW CUES
APPLICATION TO CONSTRUCT. A WATER-WELL
please,prin['ortype PCHD Permit # ^r ?,q 1
Well Location:
Street Address: Town Tax Grid # ,
///Village �
Zrtnq "�- �' Z° P> 1 q % , Map 7Block / Lot(s) 3
Well Owner:
Nwe:
Address: f
Use of Wen:
Residential Public Supply Air /Cond/Heat Pump Irrigation
I- Primary
Business Farm Test/Monitoring Other (specify)
2- secondary
Industrial Institutional Standby
Amount of Use
Yield Sought -57 gpm. # People Served Est. of Daily Usage 4e eal..
Reason for
Replace Existing Supply Test/Observation Additional Supply
IIDrffing
t,/New Supply (new dwelling) Deepen Existing Well
Detailed Reason
for Dro]Rag
Well Type
d/' Drilled Driven Gravel Other
Is well site subject to flooding? ................................................. ............................... Yes No ate°
Is well located in a realty subdivision? ...................................... ............................... Yes No
Name of subdivision 1' cl 6'e-1 cyn0'V Lot No. f 4-
Well Contractor: /I,"' . Address:
Is Public Water Supply available to site? .................................. ............................... Yes No
Name of Public Water Supply: •-t Town/Village -�
Distance to property from nearest water main:
Proposed well location & sources of contamination to be provided on separate sheet/plan.
Date: % °' -,Applicant Sign4ture:1J`" - . • , -
_ .
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the
Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided
that within thirty (3 0) days of the completion of water well construction, the applicant or their designated
representative 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. 3) Submit a Well Completion Report on a form
provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or
well driller shall take appropriate action to assure that any and all water and waste products from such
well drilling operations be contained on this property and in such a manner as not to degrade or otherwise
contaminate surface or groundwater.
APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless
construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be
amended or modified when considered necessary by the Public Health Director. Any revision or alteration
of the approved plan requires a new permit. Well to be constructed by a water well driller certified tV r County.
Date of Issue z 141 Permit Issuing Official:
—
Date of Expiration i (i•ZI ; I y I Title:
Permit is Non- T>ransffer>ra
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well dr
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
—' C0 CT ION PERM WAGE TREATMENT SYSTEM
e
PERMIT #
Located at r ql- a
Subdivision name dr`o-rvcdo Subd. Lot # %�
Date Subdivision Approved
Owner /Applicant Name ah42 �' h'✓> e,,lG
Mailing Address
36 A ,
Town or Village /?„157 erwy, cx�ey'
Tax Map V. 17 Block ! Lot
Renewal ✓ Revision
Date of Previous Approval lfi?
lye? AV Zip
Amount of Fee Enclosed 3042
Building Type t "e- Lot Area 14r-kNo. of Bedrooms -3 Design Flow GPD f0"0
Fill Section Only Depth Volume
_PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Separate Sewerage System consist of lee o
gallon septic tank and
.r,14�-o
Other Requirements:
To be constructed by Address
Water Supply: Public Supply From Address
3,0 G, .4F
I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the
separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion
thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will 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 treatment system during the period of two (2) years
immediately following the date of the issuances �,Of the Certificate of Construction Compliance of the original
system or any repairs thereto. �P��4��roc,s �0
R
Signed: .3� , F. ✓' R.A. Date
t Iq
Address , L �i��'- ° � '� ,lt 1 License #
APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of
sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amen'
modified w en considered necessary by the Public Health Director. Any revision or alteration of the approved plan►' /
a new i Appro f d' h e o omestic sanitary sewage only. r
By Title:_ Date:
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Prof, �'
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
_�. APPLICATION'TO'CONSTRUCT•'A ~WATER WELL
PCHD PERMIT #a
WELL LOCATION
Street Address
Town/Village/City Tax Grid Number
WELL OWNER
Name
a irk
Mailing
;_
Addre s ,�y
a Ar ,U G✓ �7��1d' 1 � `'
rivate
0 Public
USE OF WELL
1 - primary
2- secondary
RESIDENTIAL
0 BUSINESS
0 INDUSTRIAL
0 PUBLIC SUPPLY ❑ AIR /COND /HEAT PTR
U FARM 0 TEST /OBSERVATION
0 INSTITUTIONAL 0 STAND -BY
0 ABANDONED
0 OTHER (specify
0
AMOUNT OF USE
YIELD SOUGHT gpm /#
0 REPLACE EXISTING SUPPLY
ONEW SUPPLY NEW DWELLING
PEOPLE SERVEDLd _ /EST. OF DAILY USAGE gal
0 TEST /OBSERVATION 13. ADDITIONAL SUPPLY
® DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
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:
Lot No.
WATER WELL CONTRACTOR: Name '� �-�'J��f��r� Address :YaA,,7 '1V
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES �,4 NO
NAM OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
. _DISTARTCE. T0. PROPERTY FROM NEAREST WATER: MAIN: --
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
ON SEPARATE SHEET
//1 7�7
(da e) (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
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
Department attached to this permit.
3. Submit a Well Completion Report on a form
requirements of the Putnam County Health
provided by the Putnam County Health Department.
During all well drilling operations, the applicant shall take appropriate action to assure that
any and all water or waste products from such well drillin operations be c nta'ne on this
property and in such .a nner as not to degrade or oth ' L e contam' to u ac o roundwater.
Date of Issue: Q' 19_45?T y
-7
Date of Expiration j'z Gip Permit Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
., WRLICATION-: T.O CONSTRUCT,..A�_ WATER. WELL
wM PCHD PERMIT 4
WELL LOCATION
Street Address
Town/Village/City Tax Grid Number
WELL OWNER
Name Mailing
/�� /�� ' �/+ G
Address / l
��` !/.f ct �fa�0�7 ���
)(Private
O Public
USE OF WELL
1 - primary
2- secondary
$;RESIDENTIAL O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP
0 BUSINESS O FARM p TEST /OBSERVATION
0 INDUSTRIAL U INSTITUTIONAL O STAND -BY
O ABANDONED
0 OTHER (specify
Q
AMOUNT OF USE
YIELD SOUGHT gpm /#
PEOPLE SERVED /EST. OF DAILY USAGE p > al
REASON FOR'
DRILLING
E] REPLACE EXISTING SUPPLY
AtEW SUPPLY NEW DWELLING
❑ TEST /OBSERVATION Gl ADDITIONAL SUPPLY
O DEEPEN EXISTING WELL
DETAILED
REASON FOR
DRILLING
WELL TYPE
[RDRILLED
DRIVEN
DUG
GRAVEL.
0
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No. / ¢-
WATER WELL CONTRACTOR: Name
0 d%r
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
a�ON SEPARATE SHEET _ i �; �,9, (��1
(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
thirt;• (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.
During all well drilling operations, the applicant shall take appropriate action to assure that
any and all water or waste products from such well drilling operations be contained on this
property and in such ma er as not to degrade or of w se con nate surface or groundwater.
Date of Issue: C l2 19 ' ,J
Date of Expiration l 19 Pe mit Issuing Official
Permit is Non- Transfe rable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New .York 10509
(914) 278 -6130
- -- APPLICATI.ON-mO_ CONSTRUCT_ .I•WA R: idELL :: r.�;.
PCHD PERMIT #
WELL LOCATION
Street Address T Ci
Toown Village ty Tax Grid Number
J/r 7_9,i7--
WELL OWNER
Name
;1 o fl 1-7
Mailing
Address
a-e . / C; 7'L7r,
Private
bl is
USE OF WELL
1 - primary
2 - secondary
RESIDENTIAL
® BUSINESS
® INDUSTRIAL
O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION
C31NSTITUTIONAL O STAND -BY
® ABANDONED
®.OTHER (specify
AMOUNT OF USE
YIELD SOUGHT gpm /#
® REPLACE EXISTING SUPPLY '
- NEW SUPPLY NEW DWELLING
PEOPLE SERVED / /EST. OF DAILY USAGE to al
O TEST /OBSERVATION 13. ADDITIONAL SUPPLY
O DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
t�IELL TYPE
DRILLED
® DRIVEN
®DUG
®GRAVEL
O
OTHER
IS WELL.SITE SUBJECT TO FLOODING? YES. '✓ NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:. SrrnCl
Lot No. /..
WATER WELL CONTRACTOR: Name �� / % � <-z �, Address
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES y" NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
OON SEPARATE SHEET - •-�/-7 �y
(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 Department.
During all well drilling operations, the applicant shall take appropriate action to assure that
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 other, s contamina surface or groundwater.
Date of Issue: 19 L/
r
Date of Expiration j 19 Permit Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
DEPARTMENT OF HEALTH
Division of Environmental Health Services
COUNTY CENTER - CARMEL; N.Y. 10512 (914) 225 -3641 /
:SAP -_P- I- CATI -ON -TO'CON'STR7JCT-A -- WATER WELL
99r
PCHD PERMIT
WELL LOCATION
Street Address Town Village City Tax
Grid Number
1-3
WELL OWNER,
� M ili g Address
�k� la �- /!�
Private
O
k
TO
Public
USE OF WELL
RESIDENTIAL OPUBLIC SUPPLY OAIR /COND /HEAT UMP
0ABANDONED
11- primary
BUSINESS O FARM ❑TEST /OBSERVATION
❑OTHER (specify
2,- secondary
0 INDUSTRIAL O INSTITUTIONAL O STAND -BY
O
`::AMOUNT OF USE
YIELD SOUGHT_ rgpm /'# PEOPLE SERVED 2 /EST. OF DAILY USAGE �a gal
.'TREASON FOR
ANEW SUPPLY OPROVIDE ADDITIONAL SUPPLY
OTEST OBSERVATION
-: 'DRILLING
UREPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL
����DE,TAILED
L. Pump the well until
REASON FOR
2. Disinfect the well
DRILLING
County Health Department
attached to this permit.
3. Submit a Well Completion Report on a form pro a by the Putnam County
N` WELL TYPE
QDRILLED
[]DRIVEN
ODUG
[]GRAVEL
Date of Expiration: Ia
OTHER
Permit is Non - Transferrable
—J
White copy; H.D. File
Yellow copy: Building Inspector
2/87
Pink Copy:. Owner
Z_S WELL SITE SUBJECT TO FLOODING? YES ✓ NO
n ,
F2: WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION :� p y Q
— Lot No. ✓.�
$a
I ` WATER WELL CONTRACTOR; - Name - Address : A0 0% e-
,
"I' PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ✓NO
'.;.NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
4DISTANCE TO PROPERTY FROM- NE:ARES:Y IUAATER.-
LOCATION SKETCH &SOURCES OF CONTAMINATION PROVIDED
OON REAR OF THIS APPLICATION ZON SEPARATE SHEET
gr
n'
PERMIT
k
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
KKtk:
provided that within thirty
(30) days of the completion of water well construction,
the applicant shall:
E1
L. Pump the well until
the water is clear.
2. Disinfect the well
in accordance with the requirements of the Putnam
County Health Department
attached to this permit.
3. Submit a Well Completion Report on a form pro a by the Putnam County
Health De artment.
Date of Issue:
19 Iq L
Date of Expiration: Ia
Permit suing fficia
19r
Permit is Non - Transferrable
—J
White copy; H.D. File
Yellow copy: Building Inspector
2/87
Pink Copy:. Owner
Orange copy: Well Driller
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Re: Pro
Loc
(T)
Sub
Subdvo Lot # Filed Map # Date
VDate z
Gentlemen:
This letter is to authorize �yh 9
if
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
connection with this matter and to supervise the construction of said
.:.„..�Yte!_9X,wY_.e�s _i �onf.�aaa'a,�i:13 =10 poihs•- oo:i�le'�.;�F.;r:�r:
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Very truly yours,
Signed'�
Owner of Property
Addr s
Town
.y�, =.,ice
.��
Telephone
Telephone
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
LETTER OF AUTHORIZATION
RE: Property of
Located ats" m �✓ % r'
T/Vi � Tax Map #�./ Block % Lot
Subdivision of
Subdivision Lot # Filed Map # Date Filed
Gentlemen:
This letter is to authorize
a duly licensed Professional Engineer 4"or Registered Architect to apply for the required
wastewater treatment and/or water supply permit(s) to serve, the above -noted property. in accordance
with the.standards, rules or regulations as promulgated by the Public Health Director of the Putnam
County Health Department, and to sign all necessary'papers on my behalf in connection with this
matter and to supervise the construction of said wastewater tretment and/or water supply systems in
conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health
Law and the Putnam- County_:Sanitarv- Cade. -
Very truly yours,
Countersigned: °� NEW r�. Signed:s����p
P.E., .)., # ,;?,v * (Owner of Property)
Mailing Address r� Mailing Address:
State Zip / ��-% 1 State. 1�iA Zip
Telephone:/ //,4' 9� �� G� Telephone:
Form LA -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
--DIVISION OF ENVIRgPLMENTAI,.- HEALTH -SERYITCUT.—,
Date Z 49— dt
Re: Property of
Located at
(T) 1'4,1P I Section 73. /' Lot 3
Subdivision of 'Lo'
Subdv. Lot # 14 Filed Map # Date Zi 7,Z
Gentlemen:
This letter is to authorize
a duly licensed professional engineer or registered architect
(Indicate)
to apply for a Construction Permit for a separate sewage system, to
serve the above noted property in accordance with the standards, rules
or regulations as promulagated by the Commissioner of.the Putnam County
Department of Health, and to sign all necessary papers on my behalf in
connection, ,with.. this- matter- and tp...-sup.-prxi,se. the- cons.tr.uction-of. said
system or systems in conformity with the provisions of Article 145 or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Very truly y/purs
Signed
Countersigned: Owner of Pr6perty
e Me X--";
/
P.E. OF , R -' - , / A j Jam-1; a Pal
Address
9.7
Address Town
V0
Telephone
Telephone
BRUCE R. FOLEY, R.S.
• .. _ ,--., -. _ ....... � .- �1ri��g;. FuyI�Q _Nc�lth ,D ?rotor ,.
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
May 30, 1996
Frank Sullivan
2972 Ferncrest Drive
Yorktown Heights, NY 10598
Re:.Proposed SSDS: DiMichele
Irma Drive
(T) Putnam Valley
Dear Mr. Sullivan:
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:
"The construction of this sewage disposal system may be subject to local wetlands
regulations. You should contact local wetlands officials in this regard."
s�
1* . Contour lines are-to be shown-on the 1" = 20' plan
/2. Expansion trenches are to be shown on the plan. Dashed lines are acceptable.
3. A current engineers authorization form is to be submitted with each renewal.
4. Plan is to note site conditions are comparable to those at the time of the
original approval.
5., slope of the sewer line is to be noted as a minimum of 1/4" ft.
,.
Upon Receipt of a submission, revised to reflect the above comments, this
application will be considered further.
RM /jp
Ver truly yours
Robert Morris, P. E.
Public Health Engineer
JOSEPH F. SULLOVAN, PA.
2972 Ferncrest Drive
Yorktown Heights, New York 10598
(914) 962-4248
May it 199+
Department of Health
Division of Environmental Health Services
4 Geneva Road -
Brewster, New York 10509
Gentlemen:
Enclosed please find. plans and .'application forms for a. proposed
renewal of a design of the Sewage Disposal System for Mr. Dimichele's
lot on Irma Drive in the Town of Putnam Valley.
This design was qyed by ;your qur #p.art.m-e.nt..in 1�9.2:(Yqyr File No.
From a field inspection of this lot, there have been no changes to
adversely affect this design.
92-37
Very truly yours,
Joseph F. Sullivan, P. E.
6
;L. i:: '�;, ... .:�t:w:%�'"�as, r .:.5 � ; -. (+Yi �.:i...:,P. .a ,_.�i. .;.rte. v...d.: ..... . -. .4 -; ... ..... �. :i+sdiv'r`b:ic.•'s.':. „.;.r:;= a;Fv `i :±1.io e:IV• ;1 ...�,- .
JOSEPH F. SULLIVAN, P.E.
G�w�u6iceiirccy �r�gi�.e -ems
2972 Ferncrest Drive
Yorktown Heights, New York 10598
(914) 962 -4248
May 1, 1994
Department of Health
Division of Environmental Health Services
4 Geneva, Road'
Brewster, New York 10509
Gentlemen:
Enclosed.please find plans and - application forms for a proposed -
renewal of a design of the Sewage Disposal System for Mr. Dimichele's
lot on Irma Drive in the Town of Putnam Valley.
This design. was approved by your-department in 1992 :(your file No:
From a field inspection of this lot, there have been no changes to
adversely affect this design.
G3-81A
Very truly yours,
V
Joseph F. Sullivan, P. E.
�tr
ii
_.!• � �`' _� Uhl =-_:1 L.Y
& Si?� "vti �C c=am ?C D_S ma=r, S'�c� jS =
PC -
Pre -1969
R -itbor notificattion
12. trench or-ovided
r.�valr-
z-d I
60_ X11 =1 to cc- =a._rs
tae% Eta. I
6
r �IL, T
10 i �.
fill r:ot =s
new sec.
`rl ca, -, =s
Z-lOcd elev.
. reservoir, etc.
(Stec Lccca�lc")
Ca:cperG�e ��sclut_cn
pl a:-l5 - 1 .ree sa'-S
`/S
i�e:) Ho - ' cig
.
COns_SCr^:t p rc 5
( Fc01
°_ Eeot :-1
�--
d
'l r
olase _ _ans - l;ao se*S
S..xl V S O 1 -PrOi a 1 C` -ec {_Z
-a_ Ord _7 SSOS A:di. its C, —
Wet and (='7-/SEC _ ` ? t & D) ca
Data On DDS Plans (� 5�-e
EQU! � iTn . CV 21::�Ns '
J—S;Fwage Sy ._�ra:.`l'C
77 11 Y.Ol i 1 S &y
D or
over
�•'� -' l_� ::C i ! 1... •� \ V l.�•J •' � , •�. -..G'Y � ... mow+ +. ....
�_'✓:l L.0 ..._. = 'l^�.�G:� Ceeo _. =SUI 5 yr o
Dr_ve-way & S_oa=s 0
a _-ed Pit r& D Scx SIO.,,:l & Deg.. i' -.
.L rocr's
J7 i•�`'' i &
s SjDS' /i_
J ^' n `200 --. OF ? =�JCS� _•eta,
�- ck 'Necessary (Ti~ lot)
C_a8?nT OTT' T, c _ACS Sp `1 -. ON - • =`:
Fields
10' to ?. L. , !7i'1 Tom; =_l', !.large Ti ces, o ,11 .
20' to Walls
100' to W-'-i1; 200' in D.L.O.D, 150' s
100' to st-ream Wale: ou--
1G' to Water Liner
�(1' 1P_t�1,.T`tt°'1t
S °_=.plc Tarll;s
10' Z.r= FOV- lG3tlon; 50' to k�I j
1l' Well to pT 0
juzmrn auL.Llv"N
I P r
F NAM COUNTY DEPARTMENT OF HEALTH.
1) iSl d& F E N V 1. R N&W rWU HEALTH SERVICES
ATTENTION XADAM
I _EQ R FINAL INSPE(710N
_
All information must be Fully completed prior to an}
inspectioivi being made.
0 CENT:
For: Fill
Trenches —
Pc",HD ('011I.StFLIWO11 PeriniL
Lucate&
(.1 (V)
Owner/Applicant. Name-. o e -4 eli -rm l3/ Block Lot
Formerly.- -------A m4'- Subdivision Name:.
Subdivision Lot
Is �Y.irem fill completed? Date—
Is system complete? Date:
Is System constructed as per plans?,
Is vVellk,ii-014?
Date.
Is well located as per plans?
,6u-c erosion control measures In pffice? 4
PAGE 01
I certify that the system(s), as listed, at the above' premises has been constructed and I have inspected
and verified their corrip'letion in acc.ordatic,ewIth thu-M-5ued PCHD Construction Perxw"t and
approved plisrs and the Standards, Rules and Re 1,
gulations of the Putnam 'County Department of
Health.
Datei Certified by- PE Pf R
Addrcss:
C :ur.,rnetits: ��/7 �s'is'� �!;��:z.- �G� ?L--'�
ror►n FIR-.99
PUTNAM COUNTY DEPARTiYENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
FINAL SITE INSPECTION (1
Date:
Owner , �:
Town Permit 4 -
TM # q3, l -1 - 1 Subdivision Lot #
1. Sewage System Area
A..STS area located as per approved plans .......................
b. Fill section - date of placement
3:1 barrier Lgth.- Width Avg.Dpth!
c. Natural soil not stripped .............. ...............................
d. Stone, brush, etc., greater than 15' from STS area.....
e. 100' from water course / wetlands . ...............................
H. SeWAge System
a. Septic t c e -1 ...... 1,250 ......... other..........
b. Septic tank ins a ed level .......... ...............................
c. 10' minimum from foundation .... ...............................
d. Distabutiog Box
1. All outlets at same elevation -water tested...........
2. Protected below frost ............ ...............................
3. Minimum ft,Original soil between box & tren(
e. Junction Box
- properly set ...... ...............................
f.
- -� - -~ 3. I sta
I. p
. 10'ft
0 6. Dept
7. Rodj
j� 8. Size
9. Dep-
g. Pu o;
i required Length installed _
ce to watercourse measured Ft...,
ed according to plan ... ...............................
of trench acceptable 1/16 -1/32" /foot......
from property line - 20 ft.- foundations...
of trench <30 inches from surface...........
allowed for expansion, 100% ..................
f gravel 3/4 -1 %Z" diameter clean .............
Hof gravel in trench. 12 "_minimum ...........
,nds.-capped ..' -. - . : ::. ::.... .
ize or pump cnamber ........ ...............................
!Y2. Overflow tank ..................... ...............................
Alarm, visuaUaudio ............ ...............................
Pump easily accessible, manhole to grade........,
5. First box baffled ........................................ ::......
_ 6.. Cycle witnessed by H.D.estimated flow /cycle..
1H. Ilouse/Buildin "
a. House located per approved plans .........................,
b. Number of bedrooms .............. ...............................
IV. Well
a: Well located as per approved plans .......................
b. Distance from STS area measured ft..
c. Casing 18" above grade .......... ...............................
d. Surface drainage around well acceptable ...............
V. Overall Workmanship
a. Boxes properly grouted .......... ...............................
b. All pipes partially backfilled .. ...............................
c. All pipes flush with inside of box .........................
d. Backfill material contains stones <4" diameter.....
e. Curtain drain & standpipes installed according to
f. Curtain drain outfall protected & dir.to exist wat(
g. Footing drains discharge away from STS area.....
h. Surface water protection adequate ........................
i. Erosion control provided ....... ...............................
Rev. 6/97
PUINAM COUNTY DEPARTMEmr OF. HEALTH
DIVISION OF ENVIPmUNMI, HEALTH SERVICES
DESIGN DATA SHEET-SUBSUFACE SEWAGE DISPOSAL
SYSTEM F= ND.
✓Owner W-411 Vlllwe� &h l!,'�e� Address )?,. 21
Located at (street) sec. 73J7 Bi
ock Iot
(indicate nearest cross street)
mmicipaiity
Watershed
SOIL PER)OLATION TEST DATA REQUI11ED TO BE SUBbUTIM WITH AppljCATICNS
Date of Pre- Soaking Date of Percolation Test
NLMER
- CLOCK
TIME
PERCOLATION
PERC0=ON
Run
No.
Start-Stop
Elapse e
Time
Min.
Depth to Water From
Ground Surface
Start stop
Inches Inches
Water level
,In Inches
Drop In
Inches
mtiiii�ttl�
0;
9
-33
4
5
4
5
A
4
5
NOTES: 1. Tests to*be repeated at same depth until apprcDdmately equal soil rates
are obtained at each percolation test hole. All data to'be submitted
for review.
2. Depth measure ants to be made fran top of hole.
rev. 9/85
j