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HomeMy WebLinkAbout3542DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74. -1 -17 BOX 28 T { Lis r `' i G i r i, ' - g i a T 03542 F�kE Add.. nc l . L, D1vlslon aITP�vh+o m�411 L�1�0 SAL Y ,: -.. ,:� • � .:. W , `r •: ,,, , .... - . --___ $silo F � Seevlcer, Gomel, N.Y. 1 051 P =Pz& N -���r� "Nucn0 COMP . ` LIAN FOR SEWAGE DISPOSAL SYSTEM Foemerly Ta: Maip 1-} _ Ablimm NJ r v Separaw Amount 2ZIP Se Subdv. Lot 11 wm'$e System bout by Date Permit Issued Gnslatbtg of NO Address S 0 Gallen Septic Task and S WSW Sup*' �-- '------_Publlc Supply > om BuIldleg Ty. Of? ,'�-� ---- Private Sap Pb Drilled by �-AddeN ���t�� Lot Size i�3 6c0j Z AddleN i Number atBWMMa 3 Has Erosio Odler 8e4shementebaBe.Gtin gt,w 10"W? / QC. I certify that N b OX which the syeteID(a) as list are attached ed serving Putnam are pre rtmentap itaalth °=dance with the standards, sea were Data �V rules and on the he Plans of the Meted Plan, and the Permit rkuedcopies ,Zq Z w vY +wui1� �b by the Address ' 1p.'J`1t,� ' \ Con Parson suit occupy, ce PramlNS - kv� P P•E•— contlitbnS result �� by the above s slam avalleble antl the Y from Such usage Approval of (s) shall Promptly LICOnN No. 73%3 approval of the he Separate take Such solo as Sublact to Iflfjtbn private water Supply shall becornef yllag& ryR� SMII �Y M n ee ►Y to r change when, In the v bKOnle null and void as MCurs the Correction of any unanftary Y 1Oate judgment of the Co sap eAPublic water boWnWs avatlabl sanitary Nora b�� supply �, FevoeatkM. fnotllflcatbn ore nge Such aPprowla are By rY. I � , #46�N Title C011U1><UCi10N Flo PUIR M DOUINT DWA§2?M fr OF EXAM DNl n st met! MONOW BM11114 aeee. CailoeL N -T.10W BF4SUM to l lVwMlt 1 I= UWAM 00lOM ST� eo CESTWOUTE OF CO PeltalAl 8 P �.- ��• Let / Z3 Tat Map 6i ELM& OiuoM /ANioaot IIaMa ` . _ S'^K''(" >imeaai_❑ .lteMaNa ❑ Daft et Ptet'inn i�3- /Y/ MWlkg AdieM 13 y - TO" Date Subdivision ,Rnroved 3. p"61 Fee Enclosed E� Amnnnt ■tML TIM L IAt Am ! .0 ac rt•- F® Settles o O Only Deptb vakadum N of Eeieeeae 13 Damp Flow G P D PCHD Nadi ed s Is ll agsbed Wbw FS Is campMled Se*aetla Seweesp S7aMM M esstlat at 10 R2 raft. Ink Ned -37,51 2't i 1 TO be. onsibu ed by d0 be i Addle WAAW Ss111111tr.jaft Sap* Fraim AddteN eel 1%Au . Sod * Ddll- y O tit+ Udine. Now 1 reprennt':that 1 am wholly and. completely responsible for the design and location of the proposed system(s); 1) that the rate Sever di al stem above described will be constructed as ~non the approved amendment there to and In accordance with the Standards, Fula a Fpu ns o m County Department of Hm*l% and that on Completlern,thereof a "Certifkate of Construction Compliance" satisfactory to the Commissioner of Health will M submMW to the Department, and a written guarantee will be furnished " his successors. heirs or assigns by the bulkier. that sold buUder will place in good operating condition, any part of said swage disposal syst durin41ps�riod of two (2) years bnmedletely following the date of the issu- ance of the approval of the Certificate of Construction Compliance oft origin any repairs thereto; 2) that the drilled well described above wIN he bated as sf�orvsn on the approved pion and that old well will N Insta os ith the It e, rules and rpuTa obi of the Putnam County De rt n Of "With. Daft igned V.E.— R.A. 27 Z MN. — _ , AAo:7✓i19t lyJ_ /oS/` License No Y3731 Address , APPROVED FOR CONSTRUCTION: This approval expires two yeah from the date Issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Mealth. Any Change or alteration of construction requkw a now permit. Approved for disposal of domestic sanitary sewage, and /or private xptw supply only. LO/88 Date' TI�Y� _ E. III J '�•'''M�•!'?°F"S" .ter,.• -"_ rr ,s- -- "'r- x..s,-- ^. �.Fe"""'-°--^ '..^ -rr. ^—rr .-- °n -'rF'- "- •- *--- ^--'•° -^ -r;Y^ i•- -�'t"'^.y �T�,�.: p,�,p ,�•� +t :: g yea` p,gx�+p7 t 9191' 'L�J17� AtRITT iA'i'il�� - ;' N Dfvis�on of 3Enwfonmental Health Services, Carme% N Y 10512 r ' NSFR ,CFO, R! �PEEtfl�IIT „EORk SE=WAGE ;`DI,$PdSAL„ $1(S rEfVi � -� Y Town or Villa e � ,r ,a Ros! &�G w Located at �^ ae° Subdivision > 1 •' c Number of Bedrooms Deslgn Flow Ey VV Total. Habitable Space Square�Feet SePeatB$eWeray�'$Y e sfem`to consist oft Gal $eptEO Tank and , To be constructed bye �'la,.�r�r/� Ad dress a � ksJ '�Y,✓ m �' t �'#: i.* F .. °t;,, U x 1 Yt8" ,n t tie 4 t - 4 fi r Y dt •�+ -S yj Water ,$uPPly PublEC Sgpp1Y From t t r' f ,>`er r a -� r L Privets Supply at0 be'� drilled by x ' K ' � � � ;� _r �iY�40s✓ /��` i7 /�� /c�"s .� 00 ��6aa�P .,rm i. 3 '1 �i'-`� f a"W, ->z'r .rW nx 4 z M 4 z t r µk t,r ^ ^'''•. �'i r� }., ., x,kn ', r.. _ >.�b= a ..- 's' .f I °;represent that Iram wholly and�completely'responsiblefor the design and IocaLOn ofrthe�`prgposed systems) �1) that the separate sewage, disposal _system stove descrEbed will be c n tructedas shown on the:approved:;amendrrient there to andin accorGance with the standards`-rules an �regu a ions o e �u nam <Gounty :Department of .Fealth,:and that on completion` thereof a'CerLf�cate of Construction Compliance sat�sfacf6ry to ihei.Comrti53fonerof,Healfhwill 6e submitted to:'the :De rtment and a '.written guarantee ":will be _furnist^ hed the owner <h�sauccessors, heirs or assigns by the builder,rthat saEd �build'er,,will ,;`r:.;., .,;. r.' :''.�',w .. ....!9'• , 3 �. .. :..c �. axv, „,.;:?; .., -_:. ,s:: -^ F ,n.:,;:. . ,. ,,,;.... ,a.: - ?place.m good?operating condition, any .part of said sewage disposal. system during; she- period�of yearsimmediatery 'foilowmgsthedate,of��the ^issu � as+;, ?, ..T�. _. ,x,...a:.- •,., T , r�r.. -..'• �,. -.. ,. a. � . ,. ; -,� , - ..... -rx .,::.,;,.� - ..z,_., -u, :. >.d. . , _ ante .of the approval of•the Certificate ".of, Construction Compliance of the ouginal. ysterri;or any_repairs thereto 2}�that the "drilled well descibedatiove iiNill be�located`as shmvn.o'nrthe:a roveda'lan antl:tfiat -said well will be Installed Eui� o dance.wdh the standards rule`s and kegula —f o of�,;fhe ;Futnami PP P Count rDe ertment of Health p n 7 i r4 v v fi b g� + i F a fi $i9ned a PE �' R A a �,+..wb tL+ s>�t ' r� •,� `t,,.ar� `` k ,t.tr,.�r, "E -.a... .,+, n. ',,.wK..xo4 ^rk...+v' .r'- *w ve- a- .-`"`"" g+�.e ism- m.-+ 7 •.. 1.,. v, `± r rj �y � Y ° s�k �„ ci, t" �AddreSS .v ��•� '�� �. rc, � � rLicenseS NO ®��i��u .':fi i1PPROVED cFOR:CONSTRUCTION` Thisapproval;expv s one year,tromftfief, F assuedunle construction. of the bwidmg „has been undo► taken ,and is ;. ! �, ?S.c .x' ^a a:'. , i3::L•+ t ....,,,;.. Sn ur.,.. 2 _ -t ..,__n.F , .t' :Sx .lsihr:'J ,..`.. .x..... ,.;a: , . �firevocable for cause or maY'be amended or:modrfied,whe .cons Bred necessary y' h �o r of Health Any:,chang aor alteration of construction regwres a w p rmit Approved forrdisposal of do sandary sews /or prry w e supply onSy r Y !k . �5 L7 � �.- ,p -g.sw q k1” x y .".tom St .G. lF `-/” :` !4 r,.�. •.Q" �� ���. 9 -�L.�,.^��.�t�,� -• �`' .�s":._..._..,�.s.� �,.u'�:_�.._.ii' -r� _�� - °,sx� �� � -r, � � �1s.,....- _�.._�.a_<._nc.�.« c,.- •'Y ._,.J..._.:t.� r . YML Environmental LAB NUMBER '32.004564 Services I DATE /TIME TAKEN 7-14-92 BiTAM Q... 321._Kear. Street, Yorktown Heights, NY 10598 DATE l FiME.R P-1 -92 9 = 20AM -914) 245 2800.,._: ,::,_ a _ _. ELAP #10323 r ' _ L. T7 199 F DATE REPORTED, 1 71992 Kitchen tap COLD BY same LNOTES RESULTS OF WATER TESTING X ANALYTE RESULT UNITS P ALKALINITY n-g/L AMMONIA mg/L ARSENIC rrg/L CHLORIDE n-g/L COLOR Uni is CONDUCTIVITY un-thos /an , COPPER mg/L DETERGENTS mg/L : HARDNESS n-g/L IRON mg/L LEAD rrg /L. MANGANESE rrg/L MERCURY mg/L NITRATE n-g/L per 100 mL NITRITE. FECAL COLIFORM rrg/L per 100 mL ODOR E. COLT ', TON per 100 mL —1pH FECAL STREP. S.U. per 100 mL SAMPLING SITE For Lab Use Only Potable — HNO3 , pH LT 2 , <4C _ Nonpotable _ NaOH , pH GT.9 <20 >4C _ HCI , Na2SO3 _ >20C _ STAT! H2SO4 ZnOAc we 9.1 O M ® MF MPN P/A RESULTS OF WATER TESTING X ANALYTE RESULT UNITS P PHOSPHOROUS mg/L SILVER mg/L SODIUM rrg/L SULFATE mg/L SULFIDE mg/L SULFITE rrg/L TURBIDITY NTU ZINC . mg/L SPC per 1.0 mL TOTAL COLIFORM per 100 mL FECAL COLIFORM per 100 mL E. COLT ', per 100 mL FECAL STREP. per 100 mL These results indicate that the water sample WASj WAS NOT] [NA] of a satisfactory sanitary quality according to the New York State Sanitary Code, for the p ram l Irs tested, at the time of sample collection. These results `ihdicate'that t e w ter sa iple [WAS] [WAS NOT] INA] a satisfactory chemical quality according to the New York State Sanit y C ie,.for the parameters tested, at t e tinof sample collection. NA = Not Applicable N = Not Present (Negative) SUBMITTED BY: P = Present (Positive) SA = See Attachments) ' = Also done because Total Coliform was present Albert H. Padcrvani, M.T. (ASCII') Also Director > = CT = Greater Than . < = LT = Less Than P�UTN�A'{M COUNTY DEPARTMENT OF (H]E�A1�LyT)(H7� ,.',:ic_,. "aa �iiri'W'.+t�.': ��Yari i.-.�yiy.,..'k .� R_ -. 'D1'{/-1L�D� ✓AY �l1F L�li���ki1i •1FrtYtiL:iJ•a$li'.diLlTii�• �.i.[.�CF9(:tY��' L -.. �•i •'�y -r••d •:t. .� � .. Owner or Purchaser of Building A.6 Building GoEstrijbted � Eby ( Goy w'6) 1""\ Location - Street Pw vim) Municipality Building Type 7g_ I i I Section Block Lot i a ► %7 r Subdivision z� Subdivision Lot # GUARAN= OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to ,. _....:operate.for. a Period-, .years immediately following the date of approval of the ~" �`�"" �ertifcafe "'o " "f °Co�istrui�tT''Contpiance forKthe°�sewage e3sposa systafii-,- `or any - R 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 Environinental Health Services of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of e building utilizing the system. Dated this day of -`-- -- 199,2 Gen al Contract (Owner) - Signature Signature Title Corporation Name (if Corp.) Corporation (' f e) / v gz� s , j 4.,2 Al T Address Address l� 4 -79 rev. 9/85 mk M WELL LUMYI.IJ'11Uly ttrrUlct DEPARTMENT OF HEALTH '� " -�, ,', ,TJi�i�.s -i�it` Of• �Env��arrineiita3�Healt rh=�fierv�ces, _ -.H• HIV Y�� PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only - c. z STREET ADDRESS: MWNIVIELACLiCITY TAX GRID NUMBER: jil, 1-s1�AT'es �%� . � '7q- —1— � WELL LOCATION WELL OWNER A ORESS: N E. � �� E3-PBIVATE O PUBLIC USE OF WELL 1- primary 2 - secondary iiRESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM 0 TEST/ OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL 0 STAND -BY ❑ MOUNT OF USE �� YIELD SOUGHT 9pm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING []REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY QNEW SUPPLY (NEW DWELLING) {] DEEPEN EXISTING WELL DEPTH DATA ' WELL DEPTH �')'U ft. STATIC WATER LEVEL �10 ft. I DATE MEASURED k/4 DRILLING EQUIPMENT Q-*kTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED (I6PEN END CASING ❑ OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH —. ft_ MATERIALS: Q,8TEEL ❑ PLASTIC ❑ OTHER LENGTH BELOW GRADE 79',S ft. JOINTS: O WELDED 93-TWREADED ❑ OTHER DIAMETER in. SEAL: ❑ CEMENT GROUT ,❑ BENTONITE I99HER WEIGHT PER FOOT Ib. /ft. DRIVE SHOE. ❑YES P40 LINER: OYES G-NO SCREEN 4 . ...D9., . ETAILS DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? - FiAST:- - - -_ �rO YES : •NO..__ hOURS. ., ., SCOND. ........ _: ,.�. ...., .... "_ . -.; .... _.... �.- _�.. .. _. .. GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH ft. WELL YIELD TEST If detailed pumping METtj00: O PUMPED tests Were done IS in- OMPRESSED AIR , formation attached? O BAILED O OTHER ; ❑YES ❑ NO )f more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. DEPTH FROM SURfaCE Water Bear- in9 well D'a' Inter FORMATION DESCRIPTION CODE ft. I it. WELL DEPTH It. DURATION hr: min. ORAWOOWN It. YIELD 9PM_ Land w U U U 0 y r 4- a. D (p •I— WATER ❑ CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? O YES ONO ANALYSIS ATTACHED? ❑ YES NO STORAGE TANK: TYPE ()., /I - X TrrII CAPACITY GATE. PUMP INFORMATION TYPE 5 /k1�%'4-r 1�e CAPACITY MAKER .i0 �•,- �i -5 DEPTH 0° MODEL VOLTAGE . HP WELL DRILLER NAME A DATE L ADDRESS I" °'^^ o` I I �11i �IGWtTUK S f�c' x If '-f k AA o- 3/89 I,;t_ DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTERS CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION , 0� 6b gtS 'gtCJ "VA'1 k'` :a-.. r-:q ;o.. .. r.. �/' �/, .Q�,_.,,.•. PCHD PERMIT # WELL LOCATION Street Address own Villa City Tax Grid Number 6Z - /0 - S WELL .OWNER Name F- Mailing Address , / °339 El""I �cwJ�,�,�� r vats 13 Public USE OF WELL 1 = primary 2 - secondary ®R SIDENTIAL ® BUSINESS ® fNDUSTRIAL ® PUBLIC SUPPLY. Q AIR /COND /HEAT PUMP 0 FARM ❑ TEST /OBSERVATION 0 INSTITUTIONAL ❑ STAND -BY ® ABANDONED ® OTHER (specify AMOUNT OF USE YIELD SOUGHT ovrt S gpm /# PEOPLE SERVED,L /EST. OF DAILY USAGE 96T gal C] REPLACE EXISTING.SUPPLY ® TEST/ OBSERVATION ADDITIONAL SUPPLY B<Ei SUPPLY NEW DWELLING 93 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL. TYPE BILLED DRIVEN UDUG ® GRAVEL U OTHER IS WELL SITE SUBJECT TO FLOODING? YES. �0 IF WELL IS LOCATED_IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Coos /Z3$ Lot No. z3 WATER WELL CONTRACTOR: Name 4e 4k,� Address: IS PUBLIC WATER SUPPLY AVAILABLE TO.SITE: YES -__�NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY ~ DISTANCE TO—PP PROPERTY FROM LOCATION SKETCH & OURCES OF CONTAMINATION PROVIDED' ON 'SEPARATE SHEET �' 4- J. �¢ 12 fo (d te) (signature) PERMIT TO -- CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. Date of Issue: 19 4�N�:7 ��ts �� Date of Expiration. 19—- erm�su�n g is a Permit is Non - Transferrable �� copy: H.D. File Yellow.aopy: Building Inspector Rev. 10/88 Pink Copy: Owner Change copy: Well Driller PUTDZM COUN `Y DMIRMA— ' OF HEALTH - DIVISION OF ENVIRONW-i%vrAL, HEALTH SERVICES INDIVIDUAL, wti= SUPPLY SUBSURFP_a SEk-Dj2E DISPOSAL SYSTR S ,FTEM .I�Ii SP�7CTICN PEPGRT V . ? ...b �r4 - �-. v, mss^. itC..CV �,i :.`.�b.......Y...•.r :�,: j.- :-.T., „�.• y� - •-�:. •3 .k• �y, W I ICJ INSP. BY: (- of Owner) (S treet Lcciticn ) INITIAL SITE INSPKTION YES NO CCRAIE I5 Twetlands cn /or proxirrate to property .......:...... Prcce*ty lines or corners found ................... can esti*nat-- house lc ati cn . ..................... . will drive av need cit ............................ Iq v_ must trees be- rzovEd - note these ................ Deep holes repres=entative of entire SOS area...... Pddi.ticna deep holes needed ........ _ . • .. ....... ai I I Sufficient SOS area avlable considering cut, heu=_e location, separation dis Inc`=, etc.. . AdjacE.ht walls/ septics ............................ , .Arr-c= to nrcrosed well location for dri 1? i rc..... R 1 D.H: 1 Lot, Depth to G.W. Depth to rock e uv 0 ft. 3 f t. 6 ft. 9 ft. e 2.,ft 3 Soil De-scrintian D. H. 2 Lot Dep to to G.W. Depth to rock L cam, Sail DescriLtcn �h D.E. - De °_D Ecle G.W.- Grcuncwate - D.H. 3 _ Lot Depth to G.W. Denth to rcck 0 ft.' 3 ft_ 6 ft. 9 ft. Soil Cescriaticn - DAB: '0 ft_ nA. ccn t,, 3 .f t. 6 ft. 9 ft. Slope cf the line and trench acceptable......... Sail DescriLtcn �h D.E. - De °_D Ecle G.W.- Grcuncwate - D.H. 3 _ Lot Depth to G.W. Denth to rcck 0 ft.' 3 ft_ 6 ft. 9 ft. Soil Cescriaticn - DAB: FINAL SITE DZPECTION INSP . BY : W NO ccn House SSDS located per approved plan ............. Lenath of tre.hch up—asured Width cf trench average Slope cf the line and trench acceptable......... Roan ailcwed for elision trenches .............. Over100 ft. from watercourse .................... Natural soil not stripped or SOS area unnecessarly graced ............................ I 10 ft. maintainei fran property line and 20 ft. fran house ............................... Distance well to S`-"DS (ft.) ...................... Ntmiber of hedrocros cheCkS ........................ Stones, brush, sbmms, rubble, etc., grater than 15 ft. fran nearest trench ................ 15 ft. of periphe -al soil horizontally frantre_hLh . .. . .... . ............... . .......... . I '?axes prope*_-ly set ............................... \V1 d rarface runoff frc ndriveaay, r,.zds, ' �rcurd surface, etc., channel nest SOS area.... .lot cl- rainage appear OK•,iri area of SOS.:..... 1 CuArtiG OF SITE A_0=PML E'.. F �i �� a 1 9 pO ' Q C05 O ® Lb 43, S6 ,3 t � - �: e,s..'�►�. .r1�l.,r,.�� .�''.'�* s sa •0..; ,a �'u -.�. +Z J .,'�.�.� ;;.x ... ..:,-. _ 'i:: I - � � I I I i I 4`! I 1 � � I I @ X--*, 4,3, 807 • 4 1 I f t =. .... _ • ... -.- ...._ _.:..1�� ---� -_ _%i.. .. :�.�._ _....;�;•; "::.�:.��•.:.ai.:.I:a_. c.,�'.J..� � �^ t- l,:.ai�i..� ;'_'.:., =. 3. ,- .�- i,.... �,�`�T�'. rq:..`atl tb �o r I!� \ \ `gyp ox r N Q ra ! 00 W / A j , . 000 w o' o `w l 71 � vO< r g ` MOOD If ,00 3/ � � ��� � � 4a i ► 1 ,�w i� 1 1 gc, \ ��O � �' • � tbw01 � D �' �� 0 / f �� /•'� � ln�' /`9Q r ,�+ !� r' /'�V �� �W ' i J + r�' o t. \O ii o ^` r/ �A0 I �' O f° /� ✓ i+. -� _„�(_ OQ' r+ \ nr O j y O r -Plop .S� ewe ' 2 0 . /�s � � r 440 � d °n`, rb If o�Lsi` 11 n0 I, ti ., 161, � 9� A 1.0 0 ON.- n w PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMF.NM HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SAGE DISPOSAL SYSTEMS • ;.�- ..: <:- .7.:. -�. ,: -a- �-- �•:.�.�:��`. � RBI "ENi°`SI�''1':,:tiCG''�7SiJ�T�bN PERMIT...'. �:�.._:,'.:� <:� m,w .:t= : =��� .d�:._.... =: DATE REVIE%v 7 BY: (:Name of Owner) (Street Location) DOCTJMaITS �� 2 Parellel to contours SWISS - M M� claybarrier 10 ft. fill notes _ depth ga 150 ft. �r . _ .. worm Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth s/s SUBDIVISION Perc (3 ) Fill cd 5� HC�- -r Plans ;Two sets permit; PNS letter Variance Request GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System hydraulic Profile - Gravity Flow Fill P file & Dimensions - Volume D.o J ;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction­1otes: -4grinder-. -rate) -„ -Design -5i a:� perc -and deep results Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing/Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If Ptmt�ed Pit & D Box Shown & Detailed -House -No. of BedroansIs Wells & SSDS's w /in 200 ft. of Proposed Systems Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 "0; Type pipe No Bends; Max. Bends 45° w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees,Top of fill 20' to Foundat' L�ia1, 100' to Well 200' in D.L.O D X150' pits 100' to Stream, �rcourse, Lake (inc. expan) 15' to Drains - Curtain, Leader, Footing 35'to catch basin,stormdrain, iped watercourse 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' fran Foundation; 50' to well 15' Well to PL 9 provided LF trench Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth s/s SUBDIVISION Perc (3 ) Fill cd 5� HC�- -r Plans ;Two sets permit; PNS letter Variance Request GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System hydraulic Profile - Gravity Flow Fill P file & Dimensions - Volume D.o J ;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction­1otes: -4grinder-. -rate) -„ -Design -5i a:� perc -and deep results Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing/Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If Ptmt�ed Pit & D Box Shown & Detailed -House -No. of BedroansIs Wells & SSDS's w /in 200 ft. of Proposed Systems Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 "0; Type pipe No Bends; Max. Bends 45° w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees,Top of fill 20' to Foundat' L�ia1, 100' to Well 200' in D.L.O D X150' pits 100' to Stream, �rcourse, Lake (inc. expan) 15' to Drains - Curtain, Leader, Footing 35'to catch basin,stormdrain, iped watercourse 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' fran Foundation; 50' to well 15' Well to PL 9 1 t , PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES a . :.J :; .:y'.,..: h : ,« a<. .. sa,&F•u*. .. _ .. .. - t • , r , . � .... r .. — � ,- . »�.:. ,.� :, �_.1,- .�- :-,- a..= ...%G.. ,c - ...a...... ... a • .+� �. �� y . a .... r S-m ` J Date . Re : Property of Mr. & Mrs. Joseph L u p i a r. Located ,at ' Section Block Lot Gentlemen: This letter is to authorize G p n r g p A_ Haijqhnpy a duly licensed professional engineer X 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 system or systems in conformity with the pro- visions of Article 145 or 147, Education Law, the Public Health Law, and the _. Putnam County Sanitary. Code. • Very -truly yours, Signed er 6f Property Address •��tlrrll , Countersigned: P.E. R.A.,�,##�`� Of'q:.• �I: Telephone Route`;' `` L Address Carmel , 'N °,�Y•.� �1050.1�2���,� ( 914) 2 2 5 294341Y Telephone . I • y b ;TI•J,,fi�T� S: T ff�'�..•�.��� ?j''1Gff.�.���1- -.'.. _ Prop;r. ty Bales or cor.•ner.s found . o , , , Ca» est:i_m,,A : ho":.1c location . . , , , P . V il:l. drivet;,ay need cut . e e o G P P P , rust trees be removed -note these Is (Icep bolo reps esent ative of ant_ir. e SDS area l.d.d:i_i;:i.ona.l dc;e_n hole needed. .. P . . . , SDS area available conSiderii) SuJii.cient dx,:i_vei•Tay cut, house, location, separation • • e distances, etc. . . . . . , , , . , . DE - *FI 110M D.1-11111A ' Depth: ' i•later elevation:' Hock elevation:. Sails descri rtion: • .uate FINAL SITE rNSPECTION Insn. 8 .M Mouse located :.There show*. on approved plan SM loca.ted''where approved . .. P . -• s • . Slop.° 'of: ti .le I I ' and' trench acceptable Room allowed for expansion trenches e e e e , Over 50 ft • from swa1m), watercourse P o Natural soil not striloped or SDS area ,unr- cessa.rily.._ rGded o ri;a:�d rom prop e line and 20 ft. from douse . . ... P , . e , , , , , Separation of trench from house, well etc. folloirs plan e e . . .. , . , , , . G _ Nwliber of bedrocros checks e . P , 0. 0 0 6.0 Stenos, brush, stumps, rubble, etc. greater than 15 ft. from . nearest trench e . e . . .o 15 �� L e of peripheral soil horizontq;lly from .trench e e . e . •• O P P . O . O O 0.0 O O O O Junction boxes properly set could surface run off from driveway, roads, ground surface, etc. channel near SDS , area . . . . . . .... - , s . . s o o C e . , 11'—s lot draina.F;e anrear O.I . in area of SDS UIRL GRADING OF SITE ACCEPTABLE , 0 N.i, 1: }4d CiL�'CK S_ i a T e PE Mcets Std V , , es TINE DOCUMENTS. House plans O.K. Design data. sheet �_ i Peres presoaked? i Min. 30" perc test.depth Const. results for 3 runs I D. Hole log O.K. i Corporate Affidavit for other than individual Authorization for engineer .Letter from Water Supply if applicable If variance requested -such noted on plans & apps.: .DETAILS if change is proposed,) Existing contours. shown show new contours) _ Slopes for driveway cuts, etc .. shown -1! Water service line location Footing drain, etc. location Top slope, bottom slope of fill Percolation tests and deep test pit location Septic tank size and conformance to std. 3 B.R. house minimum I House setback shown I Wool ')j strlb''tjn„n �n-v fii a A-LI water wltnin )u I t . •oi� f Srio'W11 ^��I Plan and profile SDS All other wells. and SD3 closer. 200' shown_ or reference made_. Property boundaries (metes and bounds - clearly shown i SEPARATION DISTANCES SPECIFIED ON PLAN 10' to P.L. 20' to Foundation walls 100' to Nearest well 50' to stream, march, lake, etc. incl 15' to Curtain drain 10' to water line (pits -20' 15' to storm drain 10' to large trees 0�'from foundation to septic tank 5 to pipe from leader drain & fo`571—n .expansion)r 1 ks " M f� DEPARTiti1_ti T 0; HEALTH .6RUCE R. FOLEY, R.S i,ctir,9 Public Health Division Of Environ;'ne -ntal Health Services 4 Geneva Road, 6revrster, Nei v York 10509 (914) 278 -6130 P;O ='JS_D A-20 TI0`J APP' Tr"TICN' _ (R =SIDEI ILL ONLY) STREET F (�)OS TOti'f�� v�'Y�: r�L_ TX KIP rn � 1 �. 1. =.I LI ING ADDRESS _ I l � jSy�i � % ��) Y� l� l'1/�In VI-S fled L O Y. . t Description of addition ) hct A )�rn jc N,jm.ber of existing be.ro -:.s . r000sed nui,ber of bedrora iis from Certificate of Occupancy or Certification from Building Inspector kny addition which is considered a bedrecci rcgUires 'formal approval of plans (Construction Permit) prepared by a Professional Engineer or P,egistered.Architect in accordance with aJplic bl e sections of the Putna.'ii County Sanitary Code. Please submit this form and the fol l cwi n ; to PLFM.H 00U\r1`Y HEALTH DEPAUMEW 4 G_ ENIEVA ROAD, BREIST =R,_ j Y 1050 , P; �: n_f L7E -5130 with the > follow n9„'. orl tjQn: T. _ i. Certified Check, for $100.00. 2. Sketch of existing floc- plan (all living area including basement, if any) Non- professional draning is acceptable, 3. Sketch of proposed floor plan.t 11 Non professional drawin: is acceptable " 4. Copy of survey showing Drell and septic location, to the best of your -knowledge. Include date of installation if known. Include all yells and septic systemis within 200 feet of property line. Any questions please contact this office. 5. Copy of Certificate of Occupancy frcn Tana or Certification from Building Department of legal bedroom taunt of dwelling. OFFICE.USE Comments and /or conditions application August 1995 July 1990 (Revised) ......, _' :T cam:. r ...r... .... .. . • .. - DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 . Tel. (914) 278-6130 Fax (914) 278-7921 July 17, 1998 Rosemarie Sinapi/Tatulli 14 Boswell Road Putnam Valley NY 10579 Dear Ms. Sinapi/Tatulli: BRUCE R. FOLEY Public Health ,pirector - Re: Addition - Sinapi/Tatulli, 14 Boswell Road Increase in Number of Bedrooms (T) Putnam Valley, TM# 74 -1 -17 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 latest revision date of July 16, 1998 and this Department's approval stamp. Based on the information submitted, the above mentioned addition is approved with the following conditions: 1. The total number of bedrooms must remain at three without prior approval, by this .Depaitmeiit 2. The area of the existing sewage disposal system, and its expansion area, must be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley. If you have any questions, please contact me at your convenience. Very truly yours, William Hedges Sr. Public Health Sanitarian WH:tn cc: BI (T) r 4 DEPARTMENT OF HEALTH Division Of I.IIVIfC)nnicntal Health Services 4 Geneva Road, tifewSLCr, New York 10509 (91,1) 278--6 "130 Plltntlill County I)CIA. of hlcalth Ll Gcncva Road Brewster, NY 10509 Gen0cillen: unuce n. FOLLY, 115. Aclinfl Public Health Ln<<•,:��„ Residence / il 13 Tax Mall 141. —/—/.7 According l0 records mainlaincd by tllc Town, the above noted dwe'llinS 1S IS NOT ill co11 pl/l'illlcc \VIt11 '1' n cock and the total number of bedrooms on record is This information has bccil obtained from: CERT1F1CATE OF OCCUPANCY: ASSESSORS RECORD: OTHER t 1.3uildillr� In cctor Owner Sih�sUBSOF aA SEWAGE'DISPOSAI;- SYS'1M�:"`- Address Located at (Street) Sec. Block Lot (indicate nearest cross'street) Municipality Watershed a � • • Date of Pre- Soaking Date of Percolation Test HOLE NCECER . CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate- Start-Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 1 2 3 4 5 2 3 3 4 5 NO'D'S: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to'be sutmitto3 for review. 2. Depth measurements to be made fray top of hole. r i TEST PIT DATA MOIRED TO BE SUBMITTED WITH APPLICATION �rs3W - !� DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES a 7 ' DEPTH _ - HOLE .1110. TAO. HQLE.:NO. _ p . _ - Y. ... .el±•.. (F` 5' z .. - . -. C':.. G.L. n -T--- 1° s� � 2' S1 �, 3° 4° X61 5° 60 71 g° 9° i 10° 11° 12° i' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED i INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used Min/1" Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity gals. Type Absorption Area Provided By L.F. x 24'° width trench Other Name Signature Address SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY.- Soil Rate Approved sq.ft /gal. Checked by Date r• •• 01k, 0 WA • DO VO • IWO a@ 1. • mg go) P FOR I v 01. r Sit « i�TA. SHF�SIJC IFAAC`,- SE�J1.D�ISP7SL_S=S,_ �Fz� .� r ,:.,� •.I Owner - �a 4 R V; Address 33 y t /„,V.I 4LA--4- Located at (Street) °' �' Q Sec . �? Block ° Lot S (indicate nearest cross street) Municipality �"�`"``- `�"� Watershed /�S— SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre - Soaking `r 3 Date of Percolation Test _ 9 3 0 HOLE NUCER C.I= TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches t 1 3© 10_0 2 30 I 3 jo 14 20 r/Z 2�z 12 -u 4 5 Z 2 jv 1$ �'Iz 2 3 3a r Zo'�y z %y 13 3 2 �� �� �'ly z/y i3 -3 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated'at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to'be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH, HOLE NO. 1 HOLE NO. Z HOLE NO. e- d -,.-.. �.�. .r+w.trj�- ..-r.. "- ,- "'°r.`v:r..- rrw-�.•w'•'.;+;n ., - .'. ••'m^++ -- Zj.w.� ... v... r- . :..etrfGQi'4FYCY.T.- �$- r"L.T�; s.-.. 0 6° 7° 8° 9° .10 ° 11° 12° 13° 14° INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED` INDICATE LEVEL M WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED Nk- DEEP HOLE OBSERVATIONS MADE BY: �_ Ze.-z- DATE e� - DESIGN 2 Soil Rate Used II Min /1" Drop: S.D. Usable Area Provided No. of Bedrooms 3 Septic Tank Capacity ► ce-, gals. Type Absorption Area Provided By 3 7 L.F. x 24'° width trench Other. 4 0f NEW r Name z < ,.Z Signatur Address z r SEAL .; ��? fib 5 ?, v :1,1• . �J!� _ 1051 c'sl` No. v THIS SPACE FOR USE BY HEALTH DEPAR24EM ONLY: Soil Rate Approved sq.ft /gal. Checked by Date PUTNAM COUNTY T)T,PARTNtT?NT OF J1Jsrl1,T11 DIVISION. OF F? - ,VTR0NT,1ETITAI, IIFALTII SERVICES -G51 ' ►..- �3:.r.� .... ._ _a'.: ,.. DESIGN DATA SlIT' IT- SEPARATE SEITVAGE DISPOSAL SYSTEM FILE, NO. Owner �/i��i/i��%% [JoJ'E �,�voraAddress ,� ®SiVELL4A� Located . at ( Street Sec . "'X Block Lot o?3 6dicate nearest cross street) Municipality, /l/T/l1.dM Y,4144rY ` Watershed A.4k/ ) ,At SOIL PERCOLATION `PEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole ' Number CLOCK TIPS; PERCOIATIOId PERCOLATION air Elapse Depth. to V.,ater Water Level No. Time From Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 2 o?.ao - VO ao 4:o ®- 3: 5 .3 3.ws 3: as 1 - • 2 3 4 ' Notes: 1) Te,;ts to be repeated at same depl:h' until app r.oximately equal soil rates are obtained at each percolation test hole. A1y data to be submitted for review. 2) D:opth measurements to be made 'from t•op of hole. DEPTH 6" 12' 18' 24' 30' 36" 4211 4811 5411 60 66" 7211 7811 84" TEST,' PIT DATA REQUIRED TO DE SUBMITTED WITH APPLICATION DESCRIPTI014 OF SOILS I ,;ICOUP�'.CI,PI,n IN TI,S)T HOLES HOTR Nn_ / HOLE N0. �_ HOLE N0. rl INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEI14G ENCOUNTERED TESTS 14ADE BY Date • (�®O . Soil Rate Used6-7,0 DESIGN Min/1 "Drop: S.D. Usable Area Provided . No. of Bedrooms P_ Sept' anic Capa.cit •lgre� "-,'. Ga�,Pt9ItIIII p 4Aodaru Absorption Area Provided By &-O F. x2411 � "^ot�` G Rb��,���i71 trenc ]Name �r�,�an I 4ki „n ik.# o I • i�i1a ure- ' s rz,%,. Address - . '' • :............: a�. 0` THIS SPACE FOR USE BY HF..ALTH DEPAR`. I,,1ENT 014LY: Soil. Rate Approved Sq. Ft /Cal. Chcciccd by Date . of NEW Yom I �VaCK i. PLO jf� i> 4o. 43'136 art' FgFO PROFESS"Ot�� _1 _ 'This is to certify that the sewage disposal system was � � 3� constructed as indicated on this plan and that the Frederick A. Zer system was inspected by me before it was cover- .'a. ed over..- The system was,.constructed in accordance Z ^idtafrr=St w �> : -° with allj tKh ^'ru -f63 0n`d-'re'gtitolrons��rrf #fie��Pu�ricuiv- 'Coan •Nelsonviiiee NA 'tom? ty Department of. Health." BO.SLUCGG G.`.ST.Q>G.5 "' / /LSO ✓FItiC/.O.eYe /976!!.9 "/�C�JP� /2 -�?B N�f "G CN�'eeGY/ -17,Ze �7 .�ez,�,�.noxr • x 78.27' /ta•✓.t�o..st/ s3.oa . 0 ^. A •9q /.SAD .00wfy �) .✓ L �....` y hh 10 \ u an L _ I Z... y.. . rs - a 1b�s 7 .err 4,,�..�%• � i i �\ V .450,54VELL ,e0.4L Putnam County Department of Health Division of Environmental Health Services SEPARATION DISTANCES IN FEET A"roved as noted for conformance with _ , , S e r e i 10 11 12 1' 14 17 1e 17 1e le applicable Rules and Reaulations of the 1q nt i17 11g 1b'113o 137 iys %6 44 wo 1ol 114 1U It7 O&T Health �ADlepartmen . S 93 too lob 1r3 1zo PI7 134 104 1& Ito riS 13. f ;7 r /,Q� at C mature AS -BU ILT SEPTIC PLAN prepared for .4S'13UILT SURVEY Dy J. K SEA9oLDT, �-S- SINAPPI RESIDENCE BOSWELL ROAD SCALE I" • 50' TOWN OF PUTNAM VALLEY 9/5/92 PUTNAM COUNTY, N.Y. M 74. 0 1 L 17