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74.06 -1 -21
BOX 28
03579
L
03579
LORETTA MOLINARI
Public Health Director
DEPARTMENT OF HEALTH
1 Geneva Road, .Brewster, New York 10509
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648
April 2, 2004
Perillo
1 Park Drive
Putnam Valley, NY 10579
Re: Addition - Perillo, Park Dr.
No Increases in Number of Bedrooms
(T) Putnam Valley, TM #74.6 -1 -21
Dear Mr. Perillo:
ROBERT J. BONDI
County Executive
I have received and reviewed the plans for the proposed addition to the above - mentioned
residence. The proposal for the addition has been approved as per plans bearing the
.approval stamp from this Department dated April 1, 2004. The addition is approved with
the "following conditions:
1. The total number of bedrooms must remain at four without prior approval by
this Department.
2. The area of the existing sewage disposal system, and its expansion area, must be
maintained.
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.
Sincerely,
Michael Luke
Public Health Sanitarian
ML:Im
cc:BI (T) Putnam Valley
J�-'
BRUCE R. FOLEY
Public Health Director
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
L43 /0 Y
LORETTA MOLINARI RN., M.S.N.
Associate Public Health Director
Director of Patient Services
Environmental Health (845)278-6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Far (845) 278 - 6648
ADDITION APPLICATION (RESIDENTIAL ONLY)
STREET k 'RQVZ 'blz (Q T-- TOWN- RKtjP, LU- TX MAPi#
NAVM Vte-I _LO PHONE'9g5- `5Z-(o-t" -7 PCHDA j-
MAILING ADDRESS t �ftf -!� 1��i ,� V,A��I N`l 10� -75
DESCRIPTION OF ADDITION L 0 0 - 2CC)44 kvo W AIA -t f AuLTrD CC-tU Q L-5
n
NUMBER OF EXISTING BEDROOMS L�_PROPOSED # OF BEDROOMS
(FROM CERT. OF OCCUPANCY OR
CERTIFICATION FROM BUILDING INSPECTOR)
*Any addition which is considered a bedroom requires formal approval of plans (Construction Permit)
prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the
Putnam County Sanitary Code.
Please submit this form and the following to Putnam County Health Dept., 4 Geneva Road, Brewster, NY
10509, Phone 278 -6130.
1. Certified check or money or- ei foi $100.00. .
2. Sketches of existing floor plan (drawn to scale, all living area including basement)
*Non- professional sketches are acceptable.
\(3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map 9)
*Non - professional sketches are acceptable.
J4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of
installation if known. Label all wells and septic systems within 200 feet of the property line.
Contact this office with any questions.
�. Copy of Cert. Of Occupancy from Town or Certification from Building Dept: with legal bedroom
count of dwelling.
OFF7CE USE
Comments
Feb98 ' .
BFhouse;uidelines
f
F
BRUCE R. FOLEY
Public Health Director
DEPARTMENT. OF HEALTH
1 Geneva Road
Brewster, New York 10509
LORETTA MOLINARI R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845)278-6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648
3/18/04
Putnam County Dept. of Health
4 Geneva Road
Brewster, NY 10509
Re: 1 Parknri Sze
Residence
Tax Map 74.6-1-21-
Town of Putnam Valley
Gentlemen:
According to records maintained by the Town, the above noted dwelling
IS Xy.
IS NOT
in compliance with Town code and the total number of bedrooms on record is 4
This information has been obtained from:
CERTIFICATE OF OCCUPANCY: YY
ASSESSORS RECORD:
OTHER Health Dept. Approval
Building Inspe r
BFhouseguidelines
M
R> l..l �r�, 11
- - A
The attached floorplans and renderings describe the proposed single room addition.
The intended use of this addition is as a first floor Living room/Su n room with vaulted
ceilings and a center fireplace. The approximate size of the addition is 27.5'x 18.5'. This
would expand the first floor by 479 Sq. Ft. The addition would also result in a widening
of the Master Bedroom by 6 feet thus adding an additional 63 Sq Ft to the second floor.
This area would serve as a balcony directly above the existing basement stairs and
would overlook the new living area. An additional 36 sq -ft would also be added to the
existing second floor storage space.
No additior
unaffected.
SECOND FLOOR
PROPOSED FLOORPLAN WIADDITION
MARC & JANIS PERILLO
I PARK DRIVE
PUTNAM VALLEY, NY 10579
opo TAX MAP # 74.6-1.21
OF
gRQ
JpP
Rail
V
STORAGE
4-10
SA
11'-V Rail
MASTER
BEDROOM
-y
0 r
0�
0
Z-2*
di
V/N �l Z
BRIDGE
7- -2"
5 -10' Rail
OF fo BEDROOM #1
01
OEM-
Fi .1
OFFICE
4- BEDROOM #2
I
MUD
—I
N
i
i
g t.
a �
i
i
i
i
i
LIVING ROOM
0 STOVE
GARAGE
FIRST FLOOR
PROPOSED FLOORPLAN W /ADDITION
MARC & JANIS PERILLO
1 PARK DRIVE
PUTNAM VALLEY, NY 10579
TAX MAP # 74.6 -1.21
� a
4
l
r• � g
1
e �
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9
n
DINING ROOM
. �a
KITCHEN
2 STORY
FOYER
FAMILY ROOM
-- --- --- - 23'-0'
v
iUS: P4 `3r
r, a
! \ 0
iv a
i
27'.
16-T
, 15 -3•
SECOND FLOOR
EXISTING FLOORPLAN
MARC & JANIS PERILLO
1 PARK DRIVE.
PUTNAM VALLEY, NY 10579
TAX MAP # 74.6 -1.21
toto
to N
bo
FIRST FLOOR
EXISTING FLOORPLAN
MARC & JANIS PERILLO
1 PARK DRIVE
PUTNAM VALLEY, NY 10579
TAX MAP # 74:6 -1.21
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THE
THE RULES AND 1? GI j- %.I :!:..., ,.. V
0I:PARTDfI:N V OF I IEn
rut"aw UOULIT. Lejlar LWenL ul nbal"
Division of Environmental Health Servicee
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approved as noted for conformance with
%PPlicable Rules and Regulations of the
'utnam County Has th Department.. I
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rut"aw UOULIT. Lejlar LWenL ul nbal"
Division of Environmental Health Servicee
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approved as noted for conformance with
%PPlicable Rules and Regulations of the
'utnam County Has th Department.. I
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X9 89
PUTNAM COUNTY DEPARTMENT OF HEALTH
Rev. 3186 _
4 Dlyislon of.Environmeritel Health Services; Carmel, N.Y. 10512 t�
Engineer Mast Provlde i V . 9
P.C.H.D: Permit #. ,
CATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE'DISPOSAL SYSTEM 1 I�` 14 k
Town or Vlllage '
Located st To, Map 3 Block__4— 'Lot
Owner /applicant Name ' - LLy'l7i d1 'Z"{t7tJC Formerly Subdivision. Name Subdv. Lot N
Mailing Address -� �'� V— 14ar ZIP- Date Permit Issued -
. U'l A l'
Separate,Sewerage System built by Address i 'PreZ��IG ,hid .1 NA,n V SICc�,
+ of ' Z
Consisting Gallon Septic Tank and i ►� t` �F C°i Ll [ t rat
Water Supply: Public, Supply From Address
oil Private Supply Drilled by n, A►.1D�crA11a' i Address ► SZ,. � �(r� �.fi �yi`. pia l.l�ti
Bulldhi' Has Erosion Control -Been Completed?
H ,
Number of Bedrooms Has Garbage Grbide Been IpetaUedY
Otber.Regairemerits
I certify that the system(s) as listed serving the above pm iises were constructed essentially as shown on 'the pla a f he completed work ( copies
of which are attached), and in' accordance with the standards, rules and regulation in accords ce with a fiis n, nd the permit issued by the
Putnam County /jDe rtment f Health.
Date
` -1 [ Certified by, P.E.—RA'
Address l_I en"' Nor
Any person occupying premises served by .the above system(s) shall promptly take such 'actlon as may be necessary to to ra the correction of any unsanitary
conditions resulting from, such usage. Approval of the separate sewerage system shall become null and void as won as a pubs;: sanitary sewer becomes
available and the approval of the private water supply shall become null end void when ;& public water su ply becomes available. Such approvals are
subject, to modif tion or change when, -in the Judgment of the C mmissi r of H, ealth, such revocot n, modification or change Is necessary.
L./
Date / 2 / '74 By Title
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIROIFPAL HEALTH SERVICES
Own6r or Purchaser of Building
%___-
m - Street
Section Block Lot
Subdivision Name
icipality V Subdivision Lot #
Building Type
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
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 the building utilizing
the system.
Dated this day of 19_b Signature
i� Title
General Contractor (Owner) - Signature
Corpor ti on Name (if Corp.) /
Address
rev. 9/85
mk
7
Corporation Name U Corp.)
Address
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INORGANIC METALS' m MICRO
<:
Acidity
E
G GENERAL -AC -21. t I
Aik A 1 it i tv
T,
Chloride .
d.
D etergian MBA'S,
777 7�:: �,-77, .1_6
.Hardness:; i! 'i.' - Total
Nitrogen, Ammonia
E l
Nitrogen :tr&t
Phosphate,
ki. C14
_Total
Sul fatt!:-
7
S u I ft d La"
.7
Fecal CoiSi�i
S. U-1 it b
Fecal S t r ett
METALS m
copppr
7 7 7
Iron
Total
A 4
77777'
m a. ngan
e " aal".cdl fo
... .
.....
kp-rc.ury
Sodium
-KEY.' FOA..!Tzgxild
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MISCELLANEOUS
..,LT Less ,,T,12.4.
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NR Non react
Turbiditi N T U')
REMARKS/C0 E
•THESE RESULTS I ND ICATE
T HAT TH E WATER SAMPLE
SATISFACTORY SAN I TAR Y ..QUA
LITY ACCORDING TO "T
' '
STANbOMS, F6R THE PAR
AMETERS.TEST
,-
tHEpE'.RESULTS,t NDI CATE
*
.THAT THE,WATER.
.
SATISFACTORY -. :4CHEMICAL
QUALITY,STANDARIS ov"T
:. , THE
CQPEPj FOR THR,PARWTERSTESTED,
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WELL UUrirLh"11UN L'>nruml
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
STREET AOURESS: nWR7VlLLACd1CIIY TAZ GRID NUMBER:
b�� �� � �-� �•
QUELL LOCATION
WELL OWNER
NAME: ADDRESS:.
TS7,1' B IVATE
UBLIC
USE OF WELL
1 - primary
2 - secondary
9 RE IDENTIAL ❑ UBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
❑ BUSINESS O FARM ❑ TEST /OBSERVATION ❑ OTHER (specify)
O INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT gpm. /N0: PEOPLE SERVED —" —/ EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
O NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION
O REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH °2 �° d ft.
STATIC WATER LEVEL `�° ft.
DATE MEASURED °
DRILLING
EQUIPMENT
®-ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END.CASING. ® OPEN HOLE IN BEDROCK O OTHER
CASING
DETAILS
TOTAL LENGTH °2 ft.
MATERIALS: STEEL ❑ PLASTIC ❑ OTHER
LENGTH .BELOW GRADE 01 ft.
JOINTS: ❑ WELDED �21THREADED O OTHER
DIAMETER " in.
SEAL: ❑ CEMENT GROUT ❑ SENTONITE QDTHER
WEIGHT PER FOOT lb./ft.
I DRIVE SHOE)E�1tES O NO
I LINER: O YES ZNO
SCREEN
DETAILS
DIAMETER (in)
'SLOT SIZE
LENGTH (ft)
DEPTH TO SCREEN (f t)
DEVELOPED?
FIRST
❑ YES ONO .
HOURS
SECOND
GRAVEL PACK
❑ YES
O NO
GRAVEL
SIZE:
DIAMETER
OF PACK in.
TOP
DEPTH • ft.
BOTTOM
DEPTH It.
WELL YIELD TEST ; It detailed pumping
METHOD: O PUMPED. tests were done is in-
OMPRESSED AIR , formation attached?
O BAILED ❑ OTHER ;DYES ONO
IELL LOG ff more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
Water
Bear-
ieg
Well
Dia-
Meter
FORMATION DESCRIPTION
coot
tt.
ft.
WELL DEPTH
it.
DURATION
hr, min.
DRAWDOWN
ft.
YIELD
9Cm.
rface
Surf
Su
r
/0 '
WATER ❑ CLEAR TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? O YES ❑ NO
ANALYSIS ATTACHED? O YES O NO
STORAGE TANK: TYPE _
CAPACITY GAL.
PUMP INFORMATION
TYPE CAPACITY
MAKER DEPTH
MODEL VOLTAGE HP
WELL DRILLER NAME tf— oa E
ADORE 4�1 v "�j� li . SfGTJI�TURE
oi l e / � �
;AC���
J
a
PUTNAM COUNTY
HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
John M:.Simmons, M.D.
`. Deputy:Commissioner of Health - FIELD ACTIVITY REPORT -
Sheet of
INSPECTION
NAND ° G o �l
Orig. Routine
ct� U,z
�v �3~
Orig. Complain
Orig. Request
ADDRESS T
/
No. Street Town
21 No.
Canpliance
_
_ Complaint Canp
MAILING. ADDRESS
Final
P.O. Box Post Office
Zip Code
Group Illness
_
Construction
:TELEPHONE
i...'
Reinspection
PERSON 1N CHARGE
Field, Sampling Only
oR INTERVIEWED
_
Field Conference
Name and Title
Other
DATE :,. TYPE FACILITY
TIME ARRIVED // : 3 y TIME LEFT
% ! : cf 7
Explain
FINDINGS:n
C46 L E >J'
a
2 r �JiZ / ! U
l7V✓'t"J / �a�7
INSPECTOR.
Signature and Ti
PERSON IN CHARGE OR INTERVIEWED:
L.acknowledge this Field Activity Report.
-6/86:
AIVIA7,�—
wtizF.R0 19
TITLE:
TELEPHONE:
PUTNAM COUNTY DEPART OF HEALTH — DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
(Nac f Owner)
REVIEW SHEET — CONSTRUCTION PERMIT
DATE REVI WED: -23-8 Q,
C` n BY:
Mreet Location)
DOCUMENTS
Permit Application
Corporate Resolution
Plans - Three sets
Engineers Authorization
Design Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results (3)
30" Perc Hole
Other
House Plans - Two sets
If PWS - Letter
Variance Request
REQUIRED DETAILS ON PLANS
Sewage System Plan
Sewage System Hydraulic Profile - Grav-ity-F-low
Fill Profile & Dimensions.- Volume
r J Box;Trench /Gallery; Pump pit details
eptic Tank - Size, Detail
Well Detail, Service Line if over
Construction Notes
Design Data
Two --Foot Contours Existing & Proposed
(DrivewL aa'& Slopes Cut
Footing /Gutter Curtain Drains
Perc & Deep Holes Located
Representative of Sewage & Expansion Area
Expansion Area;shown; gravity flow,suffo size
If Pumped Pit & D Box Shawn & Detailed
House - Noe of Bedroans
Wells & SSDS's w /in 200 ft. of Property Located
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
20' to Foundati
100' to Well; 00' in D.L.0 , 150' pits
100' to Stream, Wa ercourse, Lake (inc. expan)
15' to Drains- Curtain,Storm,Leader,Footing
25' to Catch Basin
10' to Water Line (pits -201)
Septic Tanks
10' fran Foundation
50' to Well
15' Well to PL
ORAL
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Town /DEC Permit R & D)
Data On DDS Plans & Permit Same
Cyr tjp ,G7o.o.i. To
<I
j 1 /O13
f ,1 %art
f •
r
r•
/
0250�j11V
`. 1Co0'�.ILS t—T� Trz�L�C>,•.rs1'�
�r1� �G���
., t2 Sc7(a Ai McSotizz -c
a
' ScPTC. TA.aK
oi`z
Putnam County Department of Healta
Division of Environmental Health Service.
/-)� ae 7J,, L 7—
Approved as noted for conformance with
s.pplicable Rules and Regulations of the
Putnam County Health Department.
Slgnatuae 6 Tit
35_-0
- 5l-C.
15'
•oF Ew
P MICM,9C YO
Su Fes' . doe
i
I
G
91'
3co' o�
a
Putnam County Department of Healta
Division of Environmental Health Service.
/-)� ae 7J,, L 7—
Approved as noted for conformance with
s.pplicable Rules and Regulations of the
Putnam County Health Department.
Slgnatuae 6 Tit
35_-0
- 5l-C.
15'
•oF Ew
P MICM,9C YO
Su Fes' . doe
i
I
G
91'
3co' o�
V J
(�` Insp�•t_,,.,' by �
STZiF.r.T LC MON des ,/J 11'e6o-rc �i` r �fXiiz �1 UYN R —; : � a GU�/C"
_
PERMIT n �V ~ 7/- � TM Q OR SJBDMSION LOT ff %
z_
II
IV.
V.
vi.
1
YES NO
Q�
SnrMGE DISPOSAL AREA
a_ SDS area located as per armroved plans
b_ Fill section - Date of plac-e-rient
2.1 barrier. LOTH WIDTH AVG_DPTH
c. Natural soil not s "iced
d. Stone, brush, etc_, greater than 15' from SDS are_.
I.
I
e. 100 ft_ fran water course /wetlands..
IX
Saar-zx, DISPOSAL SYSTH
,a. Septic tank size - ,0 1,250
I
I
b. Septic tank insta-l-led level
c. 10' mini.T= from fcuncat? on
d_ No 90° bends, cleanout within 10 ft_ of 45° be-rid
Ix I
I
e. DISTRIBUTION BOX -
.
1. All outlets at same elevation - w-te_r testes - L
�' I
+UV/17
;) ---
2. Protected belcw frest
I I X,I
-_
3. Minim =- 2 ft. or_c—zzl soil betwee -ri box and trenches
Iv
f. JUNCTION BOX - properly set
-
q. TREN=
1. Length required - / CP a I,-ngth ins-tal-1 ed Ad&
I
I
2. Distance to wate_r=Ursa neasued . D..
I I
I
3. Lr s -celled acrdinq to Dlan _ _
I I X1
� I C
4. Distance celt°T to ce- Tter /s 04,
.TAid-'26
I i
I
5. Sloce of t__dch acceptable 1/ - I /32 " /foot_'
I X I
I ,
6. 10 feet free Drcze--ty line A
7. Depth of trance < 30 Limes from s-=face
I
8. Roam allcwed for e_Y- -m -cion, 50%
I 1
9. Size of gravel 3/4 - li" diameter
15Z I'
10. Depth of gravel in trench 12" minim= I
�
L . - Pipe ens capped I
�
h. PRMP OR DOSE SYST�.S (
1. Size of pug &.a-ub-r
I I
2. Overflow tank I
(.
3. Alain, vi sum /audio I
I
*(
4 P= easily accessible manhole to grade
5. First box baffle l'
I
6. Cycle witnessed by H =ea th Den_ artment
-- estimated flow per Cycle
HOUSE
a. rouse to -ted peer approved plans.
b. Nminer of be::roars
Pax, I
a. Well located as per approved plans
� I
b. Distance from SDS area measured 6o t- ft_ I
I
c. Casing 18" above tirade.
d. Surface drainage around well acceptable. I
1
OVERAII, WOM- mS"nIP
a_ cxes prcperl Qrcut -z
S ✓9 J aJ01;
�► p rUp
b. All Pines partially backfilled
c. All iDes; flue's with inside of box,
d. xr-kfill material contains stones < 4" in cianeter
e. Curtain drain installed according to plan
I
f. Cirtain drain out_a l protected & dir.to eY ;st.wate_rccurs�
I I
g. Footinq drains EscLarce awav from SDS area I
h. Surface water prot_c`.ion adecuate 5�
i. Errosion cant=o prcvided on slopes greater than 15 %. I I
1
4AAA -leV
Cc.olu
AGP-,�c -1
'.*d `1T j'4
C a wart
PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
r J j7
FIELD INSPECTION REPORT
&J4�3/K- . A �, - 11vve
( Name ,bf Owner) (Stroet Location)
INITIAL kTE INSPECTION YES NO
Wetlands on /or proximate to property ..............
Property lines or corners found ...................
Can estimate house location .......................
Willdriveway need cut .............................
Must trees be removed - note these ................
Deep holes representative of entire SDS area......
Additional deep holes needed..... ..........
Sufficient SDS area available considering driveway
cut, house location, separation distances,etc...
Adjacent wells/ septics .......................... ...
D.H. 1 Lot
Depth to G. W.
Depth to rock
Soil DescriAti
0 ft.
3 ft.
e"n L 6 ft. �
9 ft.
12 ft.
D.H. 2 Lot
Depth to G. W.
Depth to rock
boil uescr
Oft.F-
3 ft.
6 ft..
9 ft.
12 ft.
DATE: U
INSP. BY:
ca4a Nm
D.H. - Deep Hole
G.W.- Groundwater
D.H. 3 Lot
Depth to G. W.
Depth to rock
0 ft.
3 ft.
6 ft.
9 ft.
12 ft.
Soli
DATE:
FINAL SITE INSPECTION INSP.BY:
YES
NO
CQMMENTS
House SSDS located per approved plan .............
Length of trench measured
Width of trench average
Slope of tile line and trench acceptable.........
Roan allowed for expansion trenches ..............
Over 100 ft. fran watercourse ....................
Natural soil not stripped or SDS area
unnecessarly graded........... ..... ........
10 ft. maintained from property line and
20 ft. from house.... ........................
Distance well to SSDS (ft.) ......................
Number of bedrooms checks ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. from nearest trench ................
15 ft. of peripheral soil horizontally
fran trench ..... ...............................
Boxes properly set... ............
Could surface runoff fran driveway, roads,
ground surface, etc., channel near SDS area....
Does lot drainage appear OK in area of SDS.......
FINAL GRADNG OF SITE ACCEPTABLE..
PUTNAM COUNTY DEPARTT -= OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY SUBSURFACE SLVMGE DISPOSAL SYSTEMS
FIELD INSPECTION REPORT
&,\.Q
(Name of er) (Street t cation)
INITIAL SIrPE INSPECTION 2 Q is YES I NO
Wetlands on /or proximate to property.............. PC
Property lines or corners found.. ..................
Can estimate house location .......................
Will driveway need cut .......... .................... v
Must trees be removed - note these ................
Deep holes representative of entire SDS area......
Additional deep holes needed ......................
Sufficient SDS area available considering driveway
cut, house location, separation distances,etc...
Adjacent wells/ septics ............................
D.H. 1 Lot
Depth to G. W.
Depth to rock
D.H. 2 Lot
Depth to G. W.
Depth to rock
DATE: -
INSP. BY:
•� WTI ko i�
�;
D.H. - Deep Hole
G.W.- Groundwater
D.H. 3 Lot
Depth to G. W.
Depth to rock
Soil Descri tion Soil Descri tion
0 ft. 0 ft. 0 ft.
3 ft. 3 ft. �A - n 3 ft.
6 ft. 6 ft. 6 ft.
9 ft.� �. 9 ft.,-. 9 ft.
12 ft. 12 ft. 12 ft.
Soli Descri
DATE:
FINAL SITE INSPECTION INSP.BY:
YES
NO
COMMENTS
House SSDS located per approved plan .............
Length of trench measured
Width of trench average
Slope of tile line and trench acceptable.........
Room allowed for expansion trenches ..............
Over 100 ft. from watercourse ....................
Natural soil not stripped or SDS area
unnecessarly graded ........... ....... ........
10 ft. maintained from property line and
20 ft. from house... ........................
Distance well to SSDS (ft.) ......................
Number of bedrooms checks ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. from nearest trench ................
15 ft. of peripheral soil horizontally
from trench ..... ...............................
Boxesproperly set... .... ...................
Could surface runoff from driveway, roads,
ground surface, etc., channel near SDS area....
Does lot drainage appear OK in area of SDS.......
FINAL GRADNG OF SITE ACCEPTABLE.......... ..
Rev. 3/86 � 3
CONSTRUCTION PERMIT
Located at.
Subdivision Name
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer to Provide Permit #
on CERTIFIC F OMPLL4,NCE
SEWAGE DISPOSAL
Lot N
Owner /Applicant Name Lye4 i a °s
Meiling Address 6. -.) N • STr4Tr- 1 PoacL
Permit q i i1 IC
L-3 Town or. VNag
Tax Map `� -Block Lot _
Renewal_ 0 Revision ld'
Date of Previous Approval
Towufirl t ' IR 99&r-
V 9 rylp cx�� [�
Building Type I Is "S "147 r3 / Lot Area . f�. x(0:1 --/ 4 FW Section Only Depth Volume
Number of Bedrooms Design Flow G/P /D 8001��f��' -�� 0p4/) PCBs Notification is Required When FIB Is completed
Separate Sewerage System to consist of Gagou Septic Tank and !��� 1t✓ At d 014 e
To be constructed by Address
Water SaPPIr Public Supply Fro m r Address
or: _Private Suppl Drilled by Address
Other Requirements 1
represent that 1 am wholly an completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system
above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations of e Putnam
County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill
be submitted to the Department, and a written' guarantee will be furnished the owner,' his successors, heirs or assigns by the builder, that said builder will 1. place in good operating condition any part of said sewage disposal system, during the period of two (2) years Immediately following the data of the issu-
ance of the approval of the Certificate of Construction Compliance of:the original syste or any r pairs thereto that the drilled well described above
will be located as shown on the approved plan and that said well will Da' installed i cc with 't a stand a ule and u let iTf^ons oof the Putnam
County Department of Health.
Date o� Z. Signed P.E. q� R.A..
Address N' Icense No �n T�"
APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construe ion of the uilding has been undertaken and is
revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction
requires a new ermit. A/p /proved for disposal of domestic sanitary sewag�n�pr' wat�u� op
Date_����- Tit
(/
f Re 3186
v�
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services. Carmel, N.Y. 10512 Engln. eer to Provide Permit q
CERTIFICATE OF COMPLLANCE
on
b'
CONSTRI MORI pER10IiT FOR SEWAGE, DISPOSAL SYSTEM
Permit N ,1
fi,� Oalle,V
Located at ear
®e i ST.
r1D j�
0" _ ' 1" I /�.
nam
Town or Village
Subdivision Flame
i1 ra{ 14111
ar I Subd. Lot #
._ Tax Map Block Lot�—
Fa
�a ofle
Renewal_O Revision 0
Owner /Applicant Flame
r4 ffO Date of Previous Ap val
Me111ng Address
t
1 V . .�7
T�- � �
n a
+ �C.L` r� Town 1��18 i� i i V1 A r18i� Zip
Building Type , `�5 t. 3e n,_ Lot Area O Bd� f'+ Fill . Section Only Depth —Volume
Plumber of Bedrooms 3 Design Flow G /P /D PCHD Notification Is Required When FM Is completed
Separate Sewerage System to coriaiat. of — Ga11on.Septic Tank ats i
To be constructed by Address
Water Supply; Public Supply From Address
r or:. Frivato Supply Drilled by Adiroas - _ .
Other Requirements 1 l i—
represent that 1 am wholly an completely esponsible for the design and location' of the proposed..system(s); 1) that the separate sewage disposal system
above described will be constructed_as shown onthe approved amendment there to and in accordance with the standards, rules and regulations of e Putnam
County Department of.. Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill
be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will
Place in.good operating condition .any, part of said sewage disposal system during the period of two (2) years immediately following the date of the issu-
ante of the approval of the Certificate of Construction Compliance of 'the original system or any repairs thereto; Pt the drilled well described above
will be located as shown on the approved plan and that. said well will be.Installed in a cordance with the Vandards, r6les And regu aT ons oof the ' Putnam
County Dep rtmen of Health.
Date - Sig P.E.= R.AQ.
Address License No �+
APPROVED FOR CONSTRUCTION: This approval expires one year 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 necessill"ry by the Commissioner of Health. Any change or alteration of construction
requires a new rmit. Approved for disposal of domestic sanitary sewage, a for rivate water supply onty.
Title
Date�,�i /���
PETER C. ALEXANDERSON
County Executive
December 22, 1988
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
Thomas Daly, P.E.
P.O. Box 243
Shenorock, New York 10587
Re: SSDS Final - Ragone
Barger Street & Park Drive
(T) Putnam Valley
TM #63 -4 -1
�K
ENID L. CARRUTH, M.P.H.
Public Health Director
JOHN KARELL Jr., P.E.
Director
Dear Mr. Be13t%%4&;
A final inspection of the above captioned sewage disposal system was conducted by
Mr. Werper of my staff on December 15, 1988. The following observations were
made:
1. Unequal distribution of flows to galley absorption areas. This must be
corrected by piping.
2. Ten feet of galley less than 20 feet away from foundation. This must be
plugged for now and removes or relocated later.
When the above corrections are made, please submitt normal compliance materials
for approval.
If you have any questions, please contact Mr. Werper at Ext. 317.
V tr ly yours,
J ar .,
Director,
Environmental Health Services.
JK:pt
cc:JK
File
EC
ti
PETER C. ALEXANDERSON
County Executive
December 22, 1988
Thomas Daly, P.E.
P.O. Box 243
Shenorock, New York
Dear Mr. Belluscio;
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
10587
Re: SSDS Final - Ragone
Barger Street & Park Drive
(T) Putnam Valley
TM#63 -4 -1
ENID L. CARRUTH, M.P.H.
Public Health Director
JOHN KARELL Jr., P.E.
Director
A final inspection of the above captioned sewage disposal system was conducted by
Mr. Werper of my staff on December 15, 1988. The following observations were
made:
1. Unequal distribution of flows to galley absorption areas. This must be
corrected by piping.
2. Ten feet of galley less than 20.feet away from foundation. This must be
plugged for now and.removes or relocated later.
When the above corrections are made, please submitt normal compliance materials
for approval.
If ou have any questions, please contact Mr.
Ve y tr ly yours,
J ar
Director,
Environmental Health Services
JK:pt
cc:JK
File
EC
Werper at Ext. 317.
PETER C. ALEXANDERSON
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
T. Michael Daley, P. E.
P.O. Box 243
Shenrock, New York 10587
RE: Proposed SSDS
Ragone
Barger Street and
Park Drive
Putnam Valley, N.Y.
Tax Map # 63 -4 -1
Dear Mr. Daley:
JOHN SIMMONS, M.D.
Deputy Commissioner
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:
1. Show gutter and leader drains.
2. Add note that all electrical work in pump pit should
be to NEC codes.
3. Submit a revised design data sheet reflecting the
change to 160 LF trigalleys.
Upon receipt of a submission, revised to reflect the above
comments, this application will be considered further.
Ver4Ane4ittner
truly yours,
Asst. Public Health
Engineer
AB: pt
cc:JK
AB
File
110 OLD ROUTE SIX CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
t
60n4UZtln y Enyines2
0
0
Putnam County Dept. of Health
110 Old Route Six Center
Carmel, New York 10512
Atto Anne Bittner
Ref. Proposed SSDS
Ragone
Barger Street and Park Drive
Putnam Valley, N.Y.
TAX MAP # 63 -4 -1
Dear Anne,
(914) 628 -0507
BOX 243
SHENOROCK, NEW YORK 10587
January 27, 1987
Pursuant to your letter, I am enclosing (3) copies of the
revised plans and a revised design data sheet reflecting a 1250
gallon tank and 160 LF trigalleyso
I am also enclosinga "check print" with the revisions
highlighted in yellow.
If you have any questions, or require additional
information, please do not hesitate to contact me.
Very Truly Yours,
To Michael Daly, P,E
TMDpbh
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, .CARMEL, N. Y. 10512
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner L�e71la. K AC90 ,) b Address IE 'Fn)
nn7 beiABC uF-r- rAA4oa.
Located at (Streeter - P �� (o Block 4- Lot 1
indicate nea -street)
Muni cipality�� V ,_ = c Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME �{,' PERCOLATION PERCOLATION
Run Eiapse p o a er 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
jJ
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.
l-7
3
a-
1 9
19
l7
6 13
l
o
o-
zA
210
f 7
5
5-
z-O
1, -7 7,0
7
z
1
0 .-
19
5o IS S
3
2
?_
?
3
Z
4
0-
2(
Z(
j0 33
3
'7
z
5
0_
-
Z�
-3 3 3
3
7
2
jJ
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
DESCRIPTION OF SOILS ENCOUNTERED IN:TEST
HOLES
DEPTH ' HOLE NO. i HOLE 140. Z
HOLE NO.
J
G.L.
6" I
12" rTIS
18"
2411 r \i
3011
42'1 ,
48"
54"
6 11
72" �� ✓�
7811
84" '
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
K�o
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING
ENCOUNTERED
TESTS MADE BY -T'- �is� -�c
Date
DESIGN
-Soil Rate. Used �� 8 -10 Min/1 "Drop: S.D. Usable Area Provided -/-C 4,Qpp (j
No. of Bedrooms 4 Septic Tank Capacity t2-60 Gals. p �P
Absorption Area Pro ded By L.F. x24" b" X0,ft I r.DP411 e,
''`�- - --� ,.,nv �� in l:t-A -1 1_]1.:1 \�I�,�a�
�y n. , r'/ -. •'� /i
Name '� M; u� rti �A ti_ —�.� bignatiure_- r
Address SEAL`
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: .,
Soil Rate Approved Sq. Ft /Cal. Checked by Late
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner (f, Address 5 �, . �1- jr]lT,� f- 'M a�p
Located at ( Street )�(� ._, Bl ock Lot
nd! ate neare�/ cross s ree
Muni cipalityTLkDam li�le U Watershed
SOIL PERCOLATION TEST DATA .REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole -
Nu_mber CLOCK TIME PERCOLATION7K -* , PERCOLATION
Elapse
No. Time
Start -Stop Min.
o Water
From Ground Surface in Inches Soil Rate
Start Stop Drop in Min. /in drop
Inches Inches Inches
1 l d
�zo ;�
(
1 30 - 19
19
17 ao
�3d .33 3 7
4o v
av
2
1 50
'7 n2 o
�0.7
4
xz 30 33 3
�.3
ffte4
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 from top of hole.
a 4o
-fit
30 33 3 7
50
- _'2J aI
�3d .33 3 7
1
2
3
4
ffte4
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 from top of hole.
llE51G1V
Soil Rate Used $'-) a Min/1 "Drop: S.D. Usable Area Provided ti '/OyO
No. of Bedrooms 3 Septic Tank Capacity
DC)n Gals pe a 1r
Absorption Area Prodded By L. F. x24� o trench.
1,1,1 1. � . ;-1 ,., i-► . /1., /l , ._ � _ _ _ �.__ .. �.� ; ;.� fa r���� %� .. Vii,' � .9� ,,.
I I - M0 -
THIS SPACE FOR USE BY HEALTH DEPART?MT ONLY:
Soil Rate Approved Sq. Ft /Gal. Checked by
z
A
�c S510�
Date
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST
HOLES
DEPTH
HOLE NO. J HOLE
NO.-. o2
HOLE NO.
G.L.
Fc)n Rdz.k I CO_
4 �Cb
611
,1
A
18"
A
11
2411
n.
►�
30"
R
361f
►�
„
4211
48"
5411
►
►�
60"
�,
u
66"
,,
�►
7211
7811
,,
►,
1% u3at ' emAAn
INDICATE
LEVEL AT WHICH GROUND WATER
IS ENCOUNTERED
INDICATE
LEVEL TO WHICH WATER LEVEL
RISES AFTER BEING
ENCOUNTERED \
TESTS MADE BY r
Date
llE51G1V
Soil Rate Used $'-) a Min/1 "Drop: S.D. Usable Area Provided ti '/OyO
No. of Bedrooms 3 Septic Tank Capacity
DC)n Gals pe a 1r
Absorption Area Prodded By L. F. x24� o trench.
1,1,1 1. � . ;-1 ,., i-► . /1., /l , ._ � _ _ _ �.__ .. �.� ; ;.� fa r���� %� .. Vii,' � .9� ,,.
I I - M0 -
THIS SPACE FOR USE BY HEALTH DEPART?MT ONLY:
Soil Rate Approved Sq. Ft /Gal. Checked by
z
A
�c S510�
Date
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner �--'C :�r,tA�l,��x )� Address�7-2.� -�
Located at (Street (.3 Block Lot
indicate neares .cross street)
Municipality uTNAM- y A-►_ i- E;t4 Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number
CLOCK
TIME -ke-
PERCOLATION
5— -Y-
PERCOLATION
RM
No.
Start -Stop
Elapse
Time
Min.
Depth to Water
From Ground
Start
Inches
Surface
Stop.
Inches
Water Level
in Inches
Drop in .
Inches
Soil Rate
Min. /in drop
18
1 1
ZO
1 2
v -
z0
3
.
i 3
. _(7
z 0
c Z
-z-o
7
20
2 1
0-
.19
-Y so—
2- 2
10 -
-7, O
z C7
�p _
3 07)
7 — —
3
-7
Z 4
. Q —
CD
2 5—
Z
Z- 1—
72,
7 --
4".
10-7
•,
-r
—X_
C, A-) u�l��c�k-� .
Notes: 1) Tests to be repeated at same depth -until approximately
rates are obtained at each percolation test hole. All data to b
for review.
2) Depth measurements to be made from top of hole.
e0
equal soil
submitted
TEST PIT DATA REQUIRED
TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. 4
HOLE NO. 'Z HOLE NO.
G.L.
6"
1211 19 L?
1$" `(
i
24"
30" r
r
361
r
42ii
,
48"
5411
' 60,E i
r
72„
78"
'
84 11
INDICATE LEVEL AT WMCH GROUND
WATER'IS ENCOUNTERED
.INDICATE LEVEL TO WHICH WATE
EL RISES AFTER BEING ENCOUNTER
TESTS MADE BY _-- J
Date (J t�Z�
Soil Rate Used > -IU Min/1 "Drop:
GN
D I S.D. Usable Area Provided
No. of Bedrooms Septic
Tank Capacity 1 o00 Gals.
Absorption Area Provided By L.F.x24" V " re z 9
oath o
a.me --,- VIA-- - i "" A , ,I
Signature "
Address SEAL
THIS SPACE FOR USE BY HEALTH DEPARTM, T ONLY:
Soil Rate Approved Sq. Ft /Cal.
Checked by
Date
pUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
1W.L
4p
(e Owner)
COMMENTS
LF Bch provided —
required _
60 ft. max.
:�� 4 � :�'Yil � � MI ��'l•Y�1:�Y�1:� �+:�a ai.'i a, ^. ►:�N aI
REVIEW SHEET - CONSTRUCTION PERMIT DATE REV e
L2
BY:
(S t Location)
YES01 NO DOCUMENTS
Permit Application
Corporate Resolution
Plans - Three sets s/s
Engineers Authorization
Design Data Sheet (DDS) r SUBDIVISION
Deep Hole Log . Perc
Consistent Perc Results (3) Fill
30" Perc Hole cd
Other
House Plans - Two sets
If PWS - Letter if well/permit
Variance Request
REQUIRED DETAILS ON PLANS
Sewage System Plan
Sewage System Hydraulic Profile - Gravity Flow
:Fill Profile & Dimensions - Volume
D or J B=;Trench /Gallery; Pump pit details
Septic Tank — Size, Detail
Well Detail, Service Line•if over.
Construction Notes
sign Data
o-Foot Contours Existing & Proposed
riveway & Slopes Cut
Footing /Glitter Curtain Drains
Perc & Deep Holes.Located.
Representative of Sewage & Expansion Area
Expansion Area;shown;gravity flow,suff, size
' If Pumped Pity& D Bax Shown &Detailed
House -No. of Bedrooms
Wells & SSDS's w /in 200 ft. of Property Located
Property Metes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4 " /ft. 4 "0; Type pipe
No Bends; Max. Bends 450 w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake Unc. expan)
15' to Drains - Curtain, Leader, Footing
351to catch basin,stormdrain,piped watercourse
10' to Water Line (pits -201)
50' intermittent drainacie course
S -eP is Tanks
101 roman Foundation; 50' to well
15' Well to PL
GENERAL
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Town/DEC Permit R & D)
Data On DDS Plans & Permit Same
DAVID D. BRUEN
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
Mr. Michael T. Daley, P.E.
Box 243
Shenorock, New York 10587
Dear Mr. Daley:
October 14, 1986
JOHN SIMMONS, M.D.
Deputy Commissioner
Re: Proposed SSDS
Ragone
Barger Street & Park Drive
(T).Putnam Valley, TM 63 -4 -1
Review of plans and other supporting documents submitted at
this time relative to the.above- captioned project has been completed.
comment e offered as . follows:
4Application.and design data sheet should.be revised to
reflect design based : on.tri - galleys instead of trenches.
Upon receipt of a submission, revised'to. reflect the above
comments, thin application.will be considered further
Very truly yours,
Anne M. Bittner
AMB;pt Asst. Public Health Engineer
ccsJK
AB
File E,/
TWO. COUNTY, CENTER - CARMEL, N.Y.
10512 (914) 225 -3641
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Re: Property o
a
Located at
Date /3u ��
(T)I -� nAl2 Section Block Lot /
Subdivision of G/.� re L
Subdv. Lot # Filed Map # Date
Gentlemen:
This letter is to authorize
a duly licensed professional engineer v 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 provisions of'Article 145 or
147, Education Law,.the Public Health Law, and the Putnam County Sani=
tary Code.
Countened:
P.E. ,. , #
Address
Telephone
- �f`**Very truly yours,
S
Own r of Property
Address
Town
Telephone
PUTNAM COUNTY DEPARU4ENr OF HEALTH - DIVISION OF ENVIR0NMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
(/Z -,-(-( F/
(Nam" of Owner)
REVIEW SHEET - CONSTRUCTION PERMIT
D ATE
BY:
(Street Location)
REVIEWED:
DOCUMENTS
Permit Application
Corporate Resolution
Plans - Three sets
Engineers Authorization
Design Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results (3)
30" Perc Hole
Other
House Plans - Two sets
If PWS - Letter
Variance Request
REQUIRED DETAILS ON PLANS
Sewage System Plan
Sewage System Hydraulic Profile - Gravity Flow
Fill Profile & Dimensions - Volume
D or J Box;Trench /Gallery; Pump pit details
Septic Tank - Size, Detail
Well Detail, Service Line if over
Construction Notes
Design Data
Two -Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footing /Gutter Curtain Drains
Perc & Deep Holes Located
Representative of Sewage & Expansion Area
Expansion Area;shown; gravity flow,suff. size
If Pumped Pit & D Box Shawn & Detailed
House - No. of Bedroans
Wells & SSDS's w /in 200 ft. of Property Located
Property Metes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4 " /ft. 4 "0; Type pipe
No Bends; Max. Bends 450 w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
101. to P.L., Driveway, Large Trees
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. expan)
15' to Drains- Curtain,Storm,Leader,Footing
25' to Catch Basin
10' to Water Line (pits -201)
Septic Tanks
10' fran Foundation
50' to Well
15' Well to PL
GENERAL
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Town/DEC Permit R & D)
Data On DDS Plans & Permit Same
s®
w�
MM
REVIEWED:
DOCUMENTS
Permit Application
Corporate Resolution
Plans - Three sets
Engineers Authorization
Design Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results (3)
30" Perc Hole
Other
House Plans - Two sets
If PWS - Letter
Variance Request
REQUIRED DETAILS ON PLANS
Sewage System Plan
Sewage System Hydraulic Profile - Gravity Flow
Fill Profile & Dimensions - Volume
D or J Box;Trench /Gallery; Pump pit details
Septic Tank - Size, Detail
Well Detail, Service Line if over
Construction Notes
Design Data
Two -Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footing /Gutter Curtain Drains
Perc & Deep Holes Located
Representative of Sewage & Expansion Area
Expansion Area;shown; gravity flow,suff. size
If Pumped Pit & D Box Shawn & Detailed
House - No. of Bedroans
Wells & SSDS's w /in 200 ft. of Property Located
Property Metes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4 " /ft. 4 "0; Type pipe
No Bends; Max. Bends 450 w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
101. to P.L., Driveway, Large Trees
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. expan)
15' to Drains- Curtain,Storm,Leader,Footing
25' to Catch Basin
10' to Water Line (pits -201)
Septic Tanks
10' fran Foundation
50' to Well
15' Well to PL
GENERAL
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Town/DEC Permit R & D)
Data On DDS Plans & Permit Same
r ran
DAVID D. BRUEN rJl'4 + �+ JOHN SIMMONS. M.D.
County Executive �►l, �Q� Deputy Commissioner
�V F w r� Y
DEPARTMENT--; OF HEAL H �; , y _ {� t��,..�a -� �.
R T
r
` _Diyision'..Of Envlrorimental. Health
August 25, 1986
Mr. Michael T. Daly, P.E.
Box 243
Shenorock, NY 10587
Re: Ragone.SDS Constr. Permit Applic.
Barger St.. & Park Dr., PV, TM '63 -4 -1''
Dear Mr. Daly:
Review of revised plans for the above referenced project has
been completed. Items 2 and 3 of my June 24, 1986 letter have
not been addressed; specifically:
1': It has not been demonstrated that no sewage disposal
system lies within 100 feet east nor 200 feet southwest
of proposed well. If none exist, so note.
\,/2. Distribution box detail is lacking. Depth of frost
penetration in Putnam County is four feet.
Unequal lenghts of tri- galleys are being fed equal
volumes of sewage.
Additionally,
;,4�. Sewage disposal system is less than 20 feet from foundation.
5• Depth of-cover bver tri- gallery is not specified.
6:.' .;Dosage_ -volume .should :..be.: noted.. -to be•. based,: on.:an:',equivalent
pipe capacity as trenches are no longer proposed.
Upon receipt of a submission, revised to reflect the above
comments, this application will be considered further.
Very truly yours,
s S. Hod g ens
Assistant Public Health Engineer
JSH:amm
cc:. File
L. Ragone
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
��onau�tin� �nyuaEE2
T. MICHAEL DALY, RE,
0
(914) 628 -0507
BOX 243
SHENOROCK, NEW YORK 10587
/{ t
Sept. 29, 1986
Putnam Co. Dept. of Health
Two County Center
Carmel, N.Y. 10512
Ref: Ragone SDS.Constr. Permit Applic.
Barger St. & Park Dr., P.V., TM 63 -4 -1
Gentlemen,
Enclosed please find revised plans for the above mentioned
project. The changes requested in.your letter of Aug. 25, 1986
have been made. I have enclosed a copy of the drawing marked "FOR
REFERENCE ONLY" with the changes highlighted in yellow for your
convenience.
If you have any questiones or require additional
information, please do not hesitate to contact me.
Very trul yo rs,
r
T. Michael Daly,
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATION TO CONSTRUCT A WATER WELL
PCHD PERMIT #__
WELL LOCATION
Street Address Town Village Cit Tax
�3a
Grid Number
I3 --4 -1
WELL OWNER
Name n Address
L Ci a Ra qorc, 5 a
PC eilarrAP
�§dPrivate
o (O Public
USE OF WELL
1 - primary
2 = secondary
RESIDENTIAL O PUBLIC SUPPLY
❑ BUSINESS O FARM
❑ INDUSTRIAL ❑ INSTITUTIONAL
O AIR /COND /HEAT PUMP
O TEST /OBSERVATION
O STAND -BY
❑ ABANDONED
❑ OTHER (specify
❑
AMOUNT OF USE
YIELD SOUGHT `)ij 11 Jgpm /4� PEOPLE
�' —,
SERVED $ /EST. OF
DAILY USAGEgal
REASON FOR
DRILLING
MEW SUPPLY ❑PROVIDE ADDITIONAL SUPPLY
OREPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL
❑TEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
WELL TYPE
rZIKILLED
' ❑DRIVEN
aDUG OGRAVEL E] OTHER
IS WELL SITE SUBJECT TO FLOODING? YES 4--'NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 4R1.
Lot No.
WATER WELL CONTRACTOR: Name T'. t3,1� . Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: _ YES [/ NO
NAME OF PUBLIC WATER SUPPLY:
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:
TOWN /VIL /CITY
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
OON REAR OF THIS APPLICATION f]ON SHE
(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.
Date of Issue: j�e-,00� 19
Date of Expiration: 3 19 6% ermit Issuing ffici
Permit is Non - Transferrable
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