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HomeMy WebLinkAbout3563DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74. -1 -46 BOX 28 03563 1 loom I III J L: : iL ' T jt6r 1 ''. 161 9 fn IN L is W 16' In 03563 PUTNAM COUNTY DEPARTMENT OF HEALTH t Permit s PV -2 -82 /C Division of Environmental Health Services, Carmel, N. Y. 10512 : ONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Putnam Val 1 P r- .- ^Wood • -.., _ ... .� .. .. .._.... ,.... ...< .. _,� .a��a`cr�'�Ti��- .. ?. ' ! Located at qtr P t - Tax Map '� dock Z Lot ^ / 3 / Subdivision Subd Lot !f Renewal Revision Owner/Address - Steve Kaqq Date Of Previous Approval e. Building Type Residents a1 Lot Area 19'� acres Fill Section only ❑ Number of Bedrooms Design Flow G/P /D 600 GPD P.C. H. D. Notification Required Separate Sewerage System to consist of 1000 Gal. Septic Tank and 429 Lin Ft @ 2411 Tr. To be constructed by Roger Mayes Address POnuaque Water Supply: Public Supply From X Private Supply to be drilled by Beal Address 'Rrpwqfpr Other Requirements 1 represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage dis *sal s stem above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regu a ons o e u nam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Health 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 disposal system during the period of two (2) years Immediately following thedate of the Issu- ance of the approval of the Certificate of. Construction Compliance of the original sy tern or any repairs th eto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed in accord I" ce with the sta da da, rules and regu aT o� ns of the Putnam County Department of Health. Date 9/16/83 signed , s ��` P.E. _X. R.A. Address BOX 243 Sh _nnrock., N.Y. License No. 48468 APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued un ss construction of the building has been undertaken and is revocable for cause or may be amended or modified when consi ne essary by the Com _ loner of Health. Any change or alteration of construction requires a new ermit. Approved fQrSdisposal of domestic ni�j ewa r riv water supply only Date_ b �/ By 7✓ Title Rev. 9 -81 6 9� 3!86 .. PUTNAM COi7NfY DEPARTMENT OF HEALTH Provide Permit q Dlv!sten of Envlr_�nmenial Hedtb Services. Carmel, N.Y. 10512 Engineer on CERTIFICATE Oi! COMPLIANCE _ . Permit q I V '-ZG- PERMIT FOR SEWAGE DISPOSAL SYSTEM OCK$ _P_13017- K a Subdivision Name Subd. Lot # PurN A4\A VAa,l. Town or Village. Tax Map Block — Lot Renewal— ® Revision Zip ❑ Owner /Applicant Name ST�V • E of Provious Aproal � V Vq I 5 n � -Ar P v Mailing Address K V I C BOY Town � Building Type Lot Area It &C- Fill Section Only Lj Depth Volume Number of Bedrooms Design Flow G /P /D !�q©0 P�nNotification is Required When FIB is completed Separate Sewerage System' to consist of n0 Gallon Septic Tank and 4 7-4 L 1 u ET Q � ft -rR P- N W To be constracted by — D Address Water Supply; Pdbllc Supply From Address or: Private Supply Drilled by D — Address . Other Requirements —represent that 1 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 an regu a ans o e u nam 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 lmmediatjLy following the date of the Issu- ance of the approval of the Certificate of Construction Compliance of the original system or any re irs there ; 2) t he drilled well describe above will be located as shown on the approved plan and that said well will be installed i cc th th andar , ule n rag a ons of th Putnam County Department of Health. Q(�//�� Date -S\!Nr '� jq& Sign P.E. R.A, - lid Qnv -7ft7 !LU:11IA7VVV 1 /1Q1GQ ­ APPROVED FOR CONSTRUCTION: This approval expires a year from t da issued unless co struction of the buil .ng has been undertaken and Is revocable for cause or may be amended or modified when c*dered�ecessa� b�fie Con)(nissipner f of Health. Any change or alteration of construction � I ( LLL at \-yo—oy Town or villm Sabdlvislon.Name _ % Sub&Lot # .. _ 1Z, . - lot;. -" X has a p ok .._ �,. .. Renewal_ ❑ Revision Owner /Applicant Flame' '�i �t= \/ 1= i�-1 -i Date of Previous App., --e MaWng Address —Mt' C> td 1?Cog 'k Town kA-14 ;PAC— V Zip ,.9 Ci54 I Building Type Z '5TOiZ Y L.cY ;4-u jgE' Lot Area / . Z 5 C Fill Section Only Depth Volume Plumber of Bedrooms Design Flow G /P /D & PCHD Notification Is Required When Fill Is completed Separate Sewerage System to consist oofs,'� Od Gallon Septic Tank and � Lg Lir d� Tat CA t —LEA.\ E To be constructed by e c4 sr Mau Address OL6 W Water SuPP131 Public Supply From Address or: /^ Private Supply Drilled by _Address Other Requirements 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 Put ram 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 the date of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed in accordance with th st Ards, rules and regu aeons of the utnam County Depart ent of ealth. ✓ /�P Date Signed P.E. R.A. Addre, 2YRO 14 At 110 4 G License No %:.�9 t APPROVED FOR CONSTRUCTION: This approval expires one year from the to issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when cons red ne ssary the Co m 'ssioner of Health. Any change or alteration of construction requires a n permit. pr d for disposal of domestic 7n swag / v er PPIY only. �'" Dim Date By Title _ i PUTNAM COUNTY DEPARTMENT OF IfEALTH Zv. 3186 Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer to Provide Permit # /� / J on CERTIFICATE OF COMPLIANCE /L+,y — INSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Permit III �i Kr P� 1PUTNAM COUNTY DEPARTMENT OF HEALTH ENGINEER TO PROVIDE PERMIT # ON CERT FICATE OF COMPLIANCE, Division of Environmental Health Services, Carmel, N. Y. 10512 PERMIT � PV -26 -82 CONSTRUCTION PERMIT FOR SEWAGE nISPOSAL SYSTEM _— nnu -Tn 11x11 v - ..r ._ 'Located at Wood Street Tax Map 36 Block 2 lot 13.1 11��Oe Subdivision Subd. Lot A Renewal _0X_ Revision _[3 owner /Address Steven Kass _ _ Date Of Previous Approval Building Type Residential Lot Area 19+ ac. Fill section only 13 Number of Bedrooms 3 Design Flow G /P /D 600 _GPD P.C. H. D. Notification Required Separate Sewerage System to consist of 1000 Gal. Septic Tank and 429 Lin. ft. @ 24° trench To be constructed by Roger Mayes Address Poquaque Water Supply: Public Supply From Private Supply to be drilled by Mal Address Brewster 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 an regulations o e u ram 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) ears immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or any re vs t veto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed I ce Ith stand rds rules and regu a ons of the Putnam County Department of Health. t )1& 1 i j 7— Date 7/9/85 signed z P.E. X R.A. Address Z License No.48468 APPROVED FOR CONSTRUCTION: This approval expires on ear from the date issued unles ruc ' n of the building has been undertaken and is revocable for cause or may be amended or modified when consi e d n essa by the Commi ion f Ith. Any change or alteration of construction requires a new ermit. Approved for disposal of domestic nit r sewag a /or privet er supply only.` ---� Date ~7�4 By Rev. 6/85 Permit it # P UTN X -AM0 Divisi-oh. of : Environff iekta H0, Ser Carmel W. 10612 CONSTRUCTION PERM IT FOR SE`W'kdV6106SAL SYSTEW. _77 Town or lags Tax Ma Bloc Lot -k. b 7 Date Of Pr64iOUS Approval- Zr • .Owner /Address -C s� Only 0 Fi I.Sec�tio re-a Sullding. typo Lot. A- H..-D.'6otificaticn,-Required .4i f 'Beclrddins -,Design �low /P/D V /a Septic Tank' Number co 7 jjj "tyst6ril to Address - 'be constructed od 16y W To , ct, "er, SuPply:.: �,:LL--P.tific Supply, From jate; tu-pply to be drilled, by,. Address r. other Requirements 777 ' sewage disposal system ion 'of -0, d systern(s) 1) that the separate so he design anci'locat o sTions OT ('represent that V;iim wholly Arid comPlOtilY responsible i�r. t � amen&niht, there to and i6'accordance with the standards, rules —a—n-d reguT ruthern above described W'J�il be constructed as shown on the approved . . anceill satsfactory to the Commissioner of.Healthwill completion thereof a "Certificate Of .-Construit Ion Cornoll at said builder will County Department of, �Hfialth, and that on d th - owner;_ hl igns. by the builder, th ient�e wil be furnishe e, successors. heirs oriels nt and -gua foiloviiing the date of the Issu- `,be - submitted ,to the DiPartryie d a writ on lo, d of,tWO-r(2),years Immediately dui.ing'i,the 1p, drilled .weli described above, operating; ci;'ridit f* said _sewage disposal ii;Ite Or� 'd Ion any part 0. ig rape t' the place in..goo Wctidn Complia6ia",dlf�the'�,lor,gI ,-ir's',thiereto; 2!)Aha of ;�the­ 'Put once, so �well,wlll�be.insta'i �8'of the approval of the certificate' of,'Const sand r�yl-tlO marn with the an aros.�, ry) will'oe P R, plan and th id ed 'I I installed In a 10caiiia'astshoWn on.the.ap rov ..a County Departure tt:� of alth P.E. R.A. 'Address 66 �, -RUOiON: This approve expires one rorri .�year� revocable v or cau5e.or,maY up-men a 1-o requires anew,permit. Approved I Or. disposal. sal of domestic sun wage, a Rev. 7, L TNAM COUNTY DEPARTMENT nip. wpui Name Mailing Address _Sewerage System: built by Consisting of tense. the b ilding,has been undertaken and is inGe Or .aitaiation of construction Title 17H 1051.2, 7 P.C..H.D. Permit 0 4 K FOR SEWAGE DISPOSAL SYSTEM —Formerly Zip- Town or Village T- MAP— Block Lot Subdivision Name —Subdv Lot Date Permit issued P V_ 9 -4 I 1 9 —q 4- A i- Gallon Septic Tank and -A Z 71 1 I-Ij 4t"6�::s Watei'S ply: Fo —Public Supply From Ad ss Oit, Orlvate Supply Drilled,by- Address Bul1dl.g4h,1W0/:-) Has Erosion Control Been Completed? Number of Bedrooms ✓ Has Garbage Grinder Been Instailmii & Other Requirements I certify that the system (a). as listed serving the above premises were constructed essentiall I y..as shown on the plans of the completed woric copies of which are attached), and in accordance with the standards' rule's and " i' re ions in ac dance h b - d plan, and the permit issued by the Putnam County rpaAnt Of Health. cem f Date Certified y P.E.X— R.A. Address Opp Z dJ License No. ',T 3277 71' Any person occupying promises served by the above system(s) shall promptly take such action as may, be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage .iysteilmi n shall become null and void as soon as a public unitary sower becomes available and the approval of the private water supply shall become null a void when a public water Supply b4COm66 available. Such approvals are lub)ect to OdI171WU lion change when, in the judgment of the Corqrnlsqot)ar of Hoalt� th revocation, modification or change . I 4. necessary. ;�-7q 4, W, A I&R.140 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY -QFFC CARIL, Y' 1.Q12 ..... ....... ............... .. T7I TT �7��J NC 1T` .r �[Y -. t .. n. ..O.St .�.� .Mr •'tN.�r - ^".�"Y�:'Y ��!•. •V,R'� rN.. DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner �-) �,� Address Located at (Street : ,Sec. Block Lot 6die,-ate pear s- cross street) Municipality SOIL PERCOLATION TEST DATA REC Watershed �ti 7 TO BE SUBMITTED ITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run apse Depth to Water Water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 10— `" _T l i9 ~i 2 n :Z____— `z 0 3 '± o 5 0 — 9 5z 1� zC7 2 1 �.........:z 7 2_ 5 © - (O ) O 2 W% on ON ro CA Armift 1 DEPT. 9F NEA6TH Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 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 I)ESCRIPTION OF.SOILS ENCOUMERED IN TEST HOLES Dn -PTii - ...I GL•E -T?V0 -: {� ; .. +'C : T; :;P : _ �_ �i�1L�J��i'? . G.L.��oti_ 6" t 12" 18 11 �e �) (. �O ✓� wt 2411 3011 , 3611 r S 42" 48" C 541 �r 6o ' � 1�© 7211 1, 78 << t 84,E ` INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED I STS- 'M — DESIGN Soil Rate Used Min/1 "Drop: S.D. Usable Area Provided 0S(551Z 4-2 000 No. of Bedrooms -j Septic Tank Capacity � (.Gals. Type Absorption Area Provided By 429- L- F.x24" i width trench. Other Name -.K, igna ure Address mx ELF; =3' SEAL THIS SPACE FOR USE BY HEALTH DEPARTPENT ONLY: Soil Rate Approved::,;.; Sq. Ft /Gal. Checked by Date' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Owner or Purchaser of Building Section Block Lot Building Constructed by Location - Street Subdivision Name p /J Municipality Zo 4 n,-, W, "p 2 Q Binding Type 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 period of two years immediately following the date of approval of the "Certificate.of Construction Compliance" for the sewage disposal system, or any -to... such- Czjsterr !,._ecept.wh,QrP_th?�fa��re to.:operaf�::properlv�.is..... ~caused by the willful or negligent act of the occupant of the building utilizing ~ the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environmental Health Services of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this day of 19,�6 Signature Title General ,:ontractor (Owner) - Signature Corporation Name (if Corp.) 2 7 7 ti0tTa (Z y Address /l1-4- (jW/) _tA/ rev. 9/85 mk Corporation Name (if Corp.) 17 / t / / E�✓ ©t� Kddress r-Lr, ez) I JLb2l6u FROM EXEC HTGE SVCS T-762 P.02 WDLL. uV111rbr11jL%,;L1 ME!.rVML t)EPARTMENT OF 1117ALrH bivision of Fnvironmental. Heilth Services U "NT W ;HEAL i -fr Office Use Only WELL LOCATIO N TAX 010 NUMBER: I[- I - (/� 00 6W WELL OWNER NAME; 4 A HESS: ewt 0 i�4s& 1�,Jqs _Tj t _U M�%OeAC, 0 PRIVATE 1 0 PUBLIC EJIF- W E L L I - primar - Sec ina r y 'XRESIDENTIAL 0 PUBLIC -SUPPI Y h AIR /CO PUMP ❑ ABANDONED 0 BUSINESS 0 FARM 0 TEST/OBSERVATION 0 OTHER (specify) 0 INDUSTRIAL 0 INSTITUTIONAL ❑ STAND-BY 0 AMOUNT OF USE YIELD SOUGHT gpm./NO. PEOPLE SERVED _/ EST. OF DAILY USAGE — gal, REASON FOR DRILLING [jREP1,ACF, EXISTING S1UPPt,Y 01 ' 'ES1 ' '/()BSERVATTON [ADDITIONAL SUPPLY NEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH ft. STATIC WATER LEVEL �ft, DATE MEASURED. DRILLING EQUIPMENT 0 ROTARY ri(COMPRESSED AIR PERCUSSION 0 DUG C1 WELL POINT fiNABLE PERCUSSION D OTHER (specify): WELL TYPE C1 SCREENED 0 OPEN END CASING XOPEN HOLE IN BEDROCK El . OTHER CASING DETAILS SCREEN DETAILS TOTAL LENGTH ft. MATERIALS. STEEL 0 PLASTIC 0 OTHER X LENGTH BELOW GRADE tt. JOINTS. OWELDED XTHREADED OOTHER. DIAMETER in. SEAL: X CEMENT GROUT OBENTONITE OOTHER WEIGHT PER FOOT DRIVE SHOE_-? ES Ej NO LINER: Q YES 0 NO DIAMETER (in) 'SLOT SIZE LENGTH (h). DEPTH TO SCREEN (11) DEVELOPED? 0 YES 0 NO HOURS FIRST SECOND G RIA V Ri F A Cf K- ❑ No GHAV SIZE. OF PACK in, OP DEPTH K. BOTTOM OEM WELL YIELD TEST It detailed purnping MFTHOO: 0 PUMPED tests were done is in- COMPRESSED AIR formation attached? 0 BAILED 0 OTHER i D YES 0 NO It more detailed formation descriptions or sieve analyses LO WELL LOG It available, please attach. — orpi� - SURFACE ""' Se2f- Ing �tll 0'a• FORMATION DESCRIPTION OOE WELL DEPTH ft. DURATION hr, rdirl. DPAVIOOWN it, YIELD gpm- Land VY Ea,_YL�4 _2 to . WAtCA 0 CLEAR 1EMP, QUAUTY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? DYES ONO ANALYSIS ATTACHED? ❑ YES ONO STORAGE TANK: TYPE CAPACITY GAL• - PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE — HP A C WEL Alit-LEORIAM E 7/1.yl 4'row-r Sr Al M0 3169 1 ENVI'RONMENTAI_ SERVICES 3 21 Kear Street Yiarktown Heights,." N.Y. 10598 .(914).245 -2800 All�er�t .H. Pa.rJ.ava.ni, Director t.-AB #: 93. t7 i. 2289 Cl I ENT # o ti i 204 N�7N 'STAY PROC PAGE ]. IJ IJ IJ NIJ IJ IJN IJ IJ IJ IINNIJN IJNIJNNIJNNNIJNNMNIINNNNIJNWN ------------------ NNNNNNIJ IINNIJ NIJNIJ IJNNII I•I IJ KASS, . ANAL DATE /TYNE TAKEN:' 04/`23/96 09: 00 277 N. WOOD ST D'ATF. /TTMF... RF.C'D: 04/2,-x/96 09: :;c'� MAHOPAC, NY 105 1. REPORT' DATE: 05/25/96. PHONE: ' ( 914) -528 -5497 SAMPI. TNr .SITE:. SAMF. /KTTf HFN TAP ! SAMPL.F TYPE..: POTA131_E t! PRESERVATIVES: NONE C 01.' D PY a AN KASS ` ` �'f ..' : _ TEMPERATURE—: t 40 �1 FS. T1� AMI, 11'�r� X M1i {!t3 1r ;, tf�ei'''$wr•v'i�i a�,�i'f {u!i '�4 Ii �,3la h'. �i� N OT ES. �,;,; ; , t .•r „,;� •: f t , r, `POL:TFORM MF..TH:. MF NNNNIJ IJ IJMIJN NNIINNFJNNN NNIINNNIJNNMNNNNNN N'NNN ••NN NNNNIJ--- W--- N------ NIJ--- IVN ----N N N NIJ NIJ DATE FLAG . . t t - c74/1/9 MFr�'F. CCllk TFCIRM ' `ABSENT : / i nci MI. ABSENT COMMENTS= PACT THESE... RFSUI .TS I NTI T CATF�� THAT ` THE_ `WATER WAS , ( WAS '' -NOT) OF A' SAT t SFAGTORY, SAN T,TARYy;UAI iTY Ar rnRD I _ THE NEW YGRK . STATE AND EPA'`' FEDERAL ; OR T NK T NG '.WATER 'STANIIARDS, FOR THE': PARAMF.. TF:RS TESTED,, ': AT ;THE . TIZ MF 'aaF `ri3I,L:FCT T ON: r s d 7 •- I i�1 11 iy 1G1 . +7>.i Yi S.iji { !y r'n :.F { lfA • h1 �..,- �..m+.' r•.e•.c .w -: '.i ' .-F y:.x xii iti ^''cv� -k 5. i-i '. -'•'T r... -� ., .._ _. .. .... ...;'.'— .::'�... ..�..._....,,- Y 1 n� i IMF I i I' art t � J 1 1 I I z s r i i vii r t f .f f SLIBM I TTFD BY ^ — Al bpr'tt :H Director, ' It; M i 1a �hi�rL#,..tiru�'1�t'F. +; 1 ir, ��T +s ?!'{ �` ate: h ik. ti, .. . to • , r� `kt *uu t , I a : ` y EI .AP# 1032 3 ; x L RE: Property of �SS Located at��� (T ) A'111 IM y Section Block Lot Subdivision of Subdv. Lot # Filed Map # Date Gentlemen: This letter is to authorize ja lI� a duly licensed professional engineer eht -ert (indicate) 'to:.. apply for a Construction for a separate sewage system, to serve the a bove' noted property in accordance with the standards, rules or regulations as promulagated by the Cmm issioner 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 px_ovis i cr.s -_f- ArticIa 14.5 "31 -i:4 i i" Edui cat M yaw; t1ie' 'M51ic -RealtYi Laws and the Putnam County Sani ve • - -•.P 9'O� Countersigned. °:: P,E., R.A., /U raaress �z Y- i7 3 v Telephone Very truly yours, Signed: z--� Owner of Property /* v--,( 33 a Address Town Telephone s J a BRUCE R: FOLEY, R.S. Acting Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 June 11, 1996 John Karell, Jr., P. E. PO Box 644 Carmel, NY 10512 Re: Proposed Compliance Kass Wood Street (T) Putnam Valley Dear Mr. Karell: 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: J. Tri_ galleys are-usually installed in 8' lengths, therefore,.the 30' LF of tri. galleys is. probably incorrect. 2. Recalculate required absorption area on plan. Use old absorption rate of 5.0 sf/lf. You can allow 14.0 sf per end section. 3. Tri galleys under drive must be certified for H -20 loading. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, Robert Morris, P. E. Public Health Engineer RM/jp .. . -., (` r uvr.L �ltr, uvJrit.i'1UtV Date Inspect bye ST�J=L XCATION PERMIT` $ L � 6 A'✓ IM Q OR SUBDIVISION LOT $ Si TKA W+. . DISPQSj� - �.•., •, �•v aa.. L—ARF .. h '[ L.. - . .,sv n..a. . f ..i Y •? a. SDS area located as per approved plans b. Fill section - Date of placement 2:1 barrier - LGTH WIDTH AVG_DPTH c. Natural soil not.striv d. Stone, brush, etc., greater than 15 fran SDS are=_. I> e. 100 ft. fran water course/wetlands. I5� II. SEW&. E DISPOSAL SYSTEM a. Septic tank size 1, 1,250 ba Septic tank insL ed level c. 10' minimum fron foundation i d. No 90° be-rids,.cleanout within 10 ft. of 45° bend e. DISTRIBUTION BOX I 1. All outlets at same elevation - water tested 2. Protected bellow frost I 3. Minimum 2 ft. ina orictl soil between box and trenches I f. JUNCTION BOX - proce—rly set g -� nx-RF� 1. Len reou? red - / Ie.*� h uzs taLled 2.. Distance to watercourse ineasured: ft. 3. Installed according to plan 4. Distance cent-_± to c_- enter O i 5e Sloce of trench acceptable 1/16 - 1/32 " /foot. 6. 10 feet from proms* `v line - 20 fit - foundations 7: Deenth of trench < 30 inches fran surface 8. Rear allowed for e carsicn, 50% 9. Size of travel 3/4 - 1j" diameter I 10. Depth of qravel in trench 12" minimtan 1.1 a Pipe ends capped h. PLTMP OR DOSE SYSTEMS 1.. Size of yunm chambex._.— . 37 Ala=, visual /audio 4. Pup easily accessible manhole to arade 5. First bax baffled 6. Cycle witnessed by H =e= th Department estimated flow per cycle IV. HOUSE. - a. House located ver approved plans. 01P b. Number of bedrooms I V. W EL a. Well located as per approved plans b. Distance fran SDS area measured j DU' ft. C. Casing 18" above grade. . d. Surface drainace around well acceptable. VI. OVERALL 6u0RKMA9nIp a. Boxes properly grouted b-, All pipes par- ,ially badkf illed I C. All Pires flush with inside of box da Backrill material contains stones < 4" in diameter e- Curtain drain installed according to plan f. Curtain drain outfall vrotected dir.to exist- watercours � g. Footing drains discharge away free SDS area h. Surface water rot_ection adequate i- Errosion control vrovided on slopes areater than 15 %. i I I 1 .DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512.(914) 225 -3641 • :;APBLIGAT:TON-- T0..CONSTRUC— ::A.. WA.T F PCHD PERMIT EMU WELL LOCATION _Street Address Town/Village/City Tax iikt�i7 'jT�c ^ ^Efi' 9u vJ � Grid Num WELL OWNER Name 6reqeo VA'af, Mailing Address afzo 10 50A E) V4(*40 ?AC ►J Prvrivate O Public tl�GE OF WELL l% - primary 2- secondary RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL [)PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION 0 INSTITUTIONAL O STAND -BY ❑ ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT —7--1 gpm /# PEOPLE SERVED /EST. OF DAILY USAGE gal REASON FOR DRILLING UnEW SUPPLY O PROVIDE ADDITIONAL SUPPLY OREPLACE EXISTING SUPPLY WEEPEN XISTING WELL , ❑ TEST OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE MRILLED DRIVEN EIDUG C3 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 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _ -NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTAKE TO PROPERTY FROM 'NEAREST . WATER MAIN:-''- LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED f� O ON REAR OF THIS APPLICATION N SE E SH 81lPA . Z�4 .iu 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 s.hall: Date Date 1. Pump the well until the water is .clear. 2. Disinfect the well in accordance with the requirements County Health Department attached to this per it. 3. Submit a Well Completion Repor on a form pr vid by' Health Departmen of Issue: —' 19 of Expiration: 19 Permit s Permit is Non - Transferrable White copy: H.D. File. Yellow copy: Building Inspector 2/87 Pink Copy: Owner Orange copy: Well Driller of the Putnam •' • •' �' i 1�' Y� •i .+ 011 rn DESIGN DATA SHEET SUBSUFAC.E SBgAGE DISPOSAL SYSTEM FILE NO. Owner Located -at (Street) `t /. , %�1 � Sec. 3W Block ✓ Lot h I� (inc3ica�est cross street Municipality LuIllum LWIT W atershed SOIL, PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre-Soaking Date of Percolation Test HOLE. NUMBER C!LOM 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: ®� ° �3;• �� 3n °6 EP2 C� 2 3 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately dual soil rates are obtained at each percolation test hole. All data to be sub fitted for review. 2. Depth measurements to be made fran top of hole. APPMMa B PUMU11A CCr=_ OEPARM= OF HEALTH - DIVISION OF ENV]--RCNMENML HEALTH- SERVICES RMITIDUAL WATER SUPPLY & __SUB_SURFAC✓ SZw-IC-=-: DISPCEAL SISTERS RE'=9 S= CONSr-=ICN P_EqM_IT BY*: (Nane of Ownex) (Stir LC=-tics) Ca%2-AI'S YES DCCLZ=_ Permii'L: Anplication /_ rpora te Resolution Plans - Three sets A Z Ay 1 _,4-- 1 Engineers Authcrizaticn AA I -4 1 Design Pat--- Sheet (ICS) EmOrIT-SICY4 AJ v y /V., I I I Deep Hoie Lcc Perc &ELL I L. IR /Af I I I I Corsi Stilt Perc Result S (3) Fill I AP" Uf 'Ado .4, I I I Parc Hole Dept-i C" F2 House Pins - Two sets Well ,f v 7 1 Lance Reciaest- G A-' La3al Sub-Hvisicn. SubdivIsicn. Acorvmal Ca✓=k-ad LI F_x-_=czrcva_"I SECS kd- LctS C h e c k:-= ---- We=? and (Tcw-p./DEC Pezmi-t R & D) Data Crn OCS Plans & Per nit Saz:a PEC �=-_ED D= =1 S CN PL:I_NS SzY.q.-ga Systz-m Plan (.nort-h a.=4) L Evd -1 _ull ic Pr file - 0 Z rte:. _-Saace S v=ta_ -C Parall to contours F;11 Profile & Dimsr:Sicns Vc-,V!Tr.= 100a� D or J ..P=zap pit det-ils _--i—Septic Tank Size, Ceet--il Ie f Wei! Detail, Service Lj. n i cver C-1a: 10 fil r_- YST-1-1111S imrr I: e-- . ficcd r, etc. 1 =0 f t. C--nstnayctim Notes (grinder rte) Design, Data: perc and d.e=p..resuz.,, � F_ Drive.iav & Sloces Cut )Fcotjna/7C Drains CSC ) Perc & Deen Holes Reorasentative of prim =ay and expansicn Excansion A_re_=;shcw­n;gravitv size If Pmred Pit & D Box Shcwn & D-z+--=-iled House - No. of Bedrcans Wells & SSCS's w /in 200- fl.-.. of Proposea Sys to Property fetes & Bounds House Setback Necessary (Tight, -lot) House 'Sewer - 1 /4 " /Lt. 4".0; Z�a pipe No Bends; Mac. Bands 45- w/clean-cut SEPR=ON DISUINCE—ES SPECT71= CNI PI_A_N Fields ds 101 to P.L_ Driveww/,, Loge Treess,Tco of E 20' to Fomrq,-ticn Walls 100' to We 1; 2001 in D.L.O.0, 150' Pits 100' to Stream, Watercourse, LZ<a (inc- elc_-E 15' to Dra-l-ris-Curt-aLi, Leader, Footing 35'to mtch V--tE-c2a: 101 to Water Line (pits-20') 50' inta--mittent drairaae course S -_ 0 t i c .Tanks 10' f_rcm Foundation; 50' to wall 15' Wel! to PL DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICAT'ItON ' TO CONSTRUCT: A" `MATER WELL PCHD PERMIT 0 WELL LOCATION reet A re �j Town Vill C Tax Grid Num er WELL OWNER a e S Mailing 16 Address rivate O Pub 1 is USE OF WELL 1 - primary 2 - secondary 0 RESIDENTIAL ® BUSINESS 0 INDUSTRIAL 0 PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP 0 FARM 0 TEST /OBSERVATION O INSTITUTIONAL [) STAND -BY 0 ABANDONED 0 OTHER (specify ® AMOUNT OF USE YIELD SOUGHT_ j— gpm /# /1 PEOPLE SERVED_ /EST. OF DAILY USAGE �A'1 REASON FOR DRILLING MW SUPPLY ❑REPLACE EXISTING SUPPLY [)PROVIDE ADDITIONAL SUPPLY 0DEEPEN EXISTING WELL ®TEST /OBSERVATION DETAILED REASON FOR DRILLING S• 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 WATER WELL CONTRACTOR: Name �j Address: tK Cq r n4 r IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _ NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY` FROM NEAREST WAT '2R MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION ®ON REAR OF THIS APPLICATION ,Ee � /0 Z4-, -7 A(date) ' PROVIDED N SEPARATE SHEET (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: Date of Expiration: 19 ermit Issuing � cia . -_- Permit is Non - Transferrable 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 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM Owner Located at (Street) e Municipality SOIL PERCOLATION TEST DATA Address FILE NO. Sec. 13(01 Block ��` Lot e•st cross street) Watershed QUIRED TO BE SUBMITTED ITH APPLICATIONS Hole Number CLOCK TIME - PERCOLATION PERCOLATION Run Elapse Depth to Water Water ve No. Time From Ground Surface in Inches Soil Rate .Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 2 ::Z °Z O 3 0 r 1 5 2- 5 a — ( O - i 2 DEPT. QF HEALTH, Notes: 1) Tests to be repeated at same depth until approxmately.equalsoil rates are obtained at each percolation test hole. A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. 3 a- li z:0 -- Z 4 cR 2- 5 a — ( O - i 2 DEPT. QF HEALTH, Notes: 1) Tests to be repeated at same depth until approxmately.equalsoil rates are obtained at each percolation test hole. A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REWIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO.-­ TIOLE NO. HOLE NO. G.L. 0 611 1211 18" faV%A 2411 3011 3611 42" 48ft [=N-CA 5411 to Lt 6011 Ll 6611 7211 7811 8411 INDICATE . LEVEL AT WHICH GROUND WATER IS ENCOUNTERED 1-F,41XQ`H'QA�CE5._ =-. 1EL.- h7NCOMITTERED -- 0 TESTS MADE BY ----- t ---- I- _,,n, e 2— DESIGN Soil Rate Used _LG-ZoMin/1 "Drop: S.D. Usable Area Provided Kp L�z_ X00 No. of Bedrooms . _-3 Septic Tank Capacity ILc(DGals- Type 94��d 1#� Absorption Area Provided By,42j,-1-_L.F.x2411 37­ width trench. Other Name It, _t-at G 5ignature Address ---IF SEAL THIS SPACE FOR USE BY HEALTH DEPARVENT ONLY: Soil Rate Approved Sq. Ft/Cal. Checked by Date, 153 i /mac 4fv= /6 -2z ,+,* cl c4P,f,v 0, 7 a-o ,w --os¢ = 858FT2- /NS)r, L EZ1 77V/C� fi -214-5 S.O Fr 2-Ij -F = ��0 FTZ- "T.-is is to certify that the sewage disposal systems was constructed as indicated on this plan. T!J"5 P4 +-q /S 6A-SgC UAJ" MV LJSQ�aN ON 5 -30-44 Y-T tUH!6H VO4& rt/F OP4PZFVry awNI-'R exr rv,,-nD 77A- 7Xi C7,4u.ey -cWOI D -,30X 4W10 SEPTIf TANK. i LO. -ra /Ng ,�;�' Putnau County Department of Health vision 'of Environmental Health Servioes Approved'ae noted for oonformahoe with j app icatile Rule and Regulations of the n3m Co y He al�th Departure t. r 7-1 LO - W nature do Title ate 51 �' N 'I lq.So' GtJO4o � ssas �,,,�, ayr -F�c� SSQS1W.5WaV&D by-rZ 5 -3p -9 S' { 6- 5- WiX�D s7�il�T Pv��y vQtL�.y :Wr .z. z" F�20� f z d C• fY- b`• � G I I�ote4 - 94 . V vi wru. 11.50c, 2 z5 34 3 14-1 ZZ S f�l 73 �1 c- -113-7 o Fq T, 0, 1 • 75V 9 5719" fo �3 3 it Z 1<?� �2 �3 6- 5- WiX�D s7�il�T Pv��y vQtL�.y :Wr .z. z" F�20� f z d C•