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HomeMy WebLinkAbout3626DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.13 -1 -2 BOX 29 rr �.`;f , IF r - i - or A IL .% . 03626 ,.� ..: .. .. .. ., r.. � .,.ri'_�.. 4'+Y�+`6;PP . .Gj �1. .���. ? � . ✓Jerch.'. _ .'c�3r. f + w� f • PUTNAtM COUNTY DEPARTMENT ..OF HEALTH' Division of Environmental. Health Services Carmel N Y, 10512 r CONS.TRUGTION PERMIT FOR SEW *4E 'DISPOSAL SYSTEM ..�7- Located at wn or ViIlage SIC � Subdivision Lot .Job Owner— I�IGL. ht's C(; .- Building Type :9— .' . Lot Area. Address Number of Bedrooms Total Habitable Space ��%/� . Square Feet ' Separate Sewerage System to c nsist of �` Gal. Septic Tank% lineal feet X 3 g trench �� �L�.�tf . To be constructed by %�(J� ill _ /width Address _ 7-A-10 04 `11 fz 45' Water Supply: Public Supply From ✓ Private Supply to be drilled by y��fiSra.i✓ Address�i �✓ tic, %�L /V '�1 ° " Other Requirements I represent that I am wholly and completely respo 1 above described will be constructed as shown on t County Department of Health, and that on co be, submitted to the Department, and a writ place in good operating condition any part .�i se ante of the approval of the Certificate of C str ctio will be located as shown on the approved plan a sal County Department of Health. Date �..< Address`�r' -s�'1 f� APPROVED FOR CONSTRUCTION: This approval expi om revocable for .cause or may be amended or modified when considered n,'ecese requires new permit. Approved for, disposal of domestic sanita y.sew Date 0 223 By vion of the proposed system(s); 1) that the separate sewage disposal system oand in accordance with the standards, rules and regu a ions,o :'t e:, ,u nam,_ f'Construction Compliance" satisfactory to the Commissioner of'Healtliwill. ". owner, his successors, heirs or assigns by the builder, that said. builder Will.' ing the period of two (2) years immediately following thedate of the issu t e' inal system or any re irs thereto; 2) `that the drilled.well descr.ibedabode .. f i accordance with t standards, rules and regul' ons:'of';'4he Putnam." License -Not:' the date issued unless construction of the building has been. undertaken and.',s ary by the Commissioner of Health. Any change or alteration of con'stru'ct _on ge, an" private ater supply only. Title ! iUii�t� v�' Ci�i / , ' iii -i *A- RT- M- ENT - 4DF-- HE-A- L-TH-- _ Division of Environmental Health Services, Carmel, N. Y. 10512 CERTIFICATE. OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM /0+*160 0 Town or Village Located at Section Block ;1 i' . G Z: # Lot Owner __� ��!p {� Separate Sewerage System built by /� - fj S T yx* F j� � Address Se lineal Feet X width trench c,,,i Consisting of � ® Gal. ptic Tank Other requirements ,�''�' Water Supply: ublic Supply From Private Supply Drilled By s Address �. t Building Type iii �,j''itf No. of Bedrooms „J Date Permit Issued Has Erosion Control Been Completed? ` I certify that the system(s) as listed serving the above attached), and in accordance with the standards, rL Date °-�— 7 E 1 Address Any person occupying premises served by the above conditions resulting from such usage. Approval of available and the approval of the private water supp subject to modification or change when, in the ju nti ")as shown on the plans of the completed work (copies of which are d the permit sued byrthe Putnam County Department of Health. . C — P.E. �/R A. License No. 72;L21, c' ce h action as may be necessary to secure the correction of any unsanitary e shall become null and void as soon as a public sanitary sewer becomes when a public water supply becomes available. Such approvals are of Health, such revo modification or change is necessary. •w d� ss Owner or Purnhaser of Building Mtinici.pality Building Constructed by Location - Street Building Type Block Lot GUARANTY OF SEPARATE SEWAGE 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 guaranty to the owner, his succes- sors, 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 initial use of 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 occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the de- termination of the Director of the Division of Environmental Health Ser- vices of the Putnam County Department.o.f Health as to whether or not the - ---- .- _.f- fxi�are -of�� c�l�- --s -st-err•to°-o -er-ate- �aas'na:u:se"�3. � _� .__ _ y p ., �- �Yie -wilif uZ� or riegl- igeri� __ _..- _ _- - -•. act of the occupant of the building utilizing the system. Dated this % day of 19 Signature .��n��:1 Title If corporation, give name anc� address) _ ,'�/_ _ f��/(s':7�"�� _ �R✓",y'� G /��°, �E�.s.�'iL� /1 °- _��';Y j °err ��N��j l/�9G1�9 �. THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE, OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF, HEALTH- 3/71 a Division of Environmental Health Services COUNTY OFFICE .BUILDING • CARMEL,. NEW YORK This report is to be completed by well driller and submitted to County Health.Department.,together With laboratory_ report of a:r lysts o voter sample eartifieate ofconstrIieODi i uahy 01i6wiedli Issued :." REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL .COMPLETION OWNER NAME �'h C1..a�. e:o En elbracht ADZ ItOWYl RCl� >a RD V25 '. Brewster N.Y. 105091 FROM (fee- t) C14feet) � LOCATION (NO. a Street) (Town). (Lot Numbel) OF WELL Bwr E7, r Street, Putnam Valleys New York 14:579 BUSINESS Q C ❑ ❑ ❑ PROPOSED DOMESTIC ESTABLISHMENT FARM TEST WELL USE OF WELL ❑ ❑ INDUSTRIAL ❑ CONDITIONING ❑ OTHER SUPPLY ) ROTARY. ❑ A R PERCUSSION ❑ PERCUSSION ❑ OTHER EQUIPMENT p (Specify) CASING LENGTH ( feet) 'G DIAMETER(InchesJ WEIGHT PER FOOT (j ❑ E YES ❑ tA3TfT ?- DETAILS 20 L 6 inch 19 1bs o u THREADED WELDED NO YES NO YEL HOUR O.P.M. ❑BAILED ❑PUMPED YIELD (G.P.M.) Tl6gT LJ COMPRESSED AIR 1, lq,c WATER . MEASURE FROM LAND SURFACE — STATIC(Specifyfeet) DURING YIELD TEST / feet) Depth of Completed Well 500 feed LEVEL In feet below Land surface: MAKE LENGTH OPEN TO AQUIFER (feet) SCREEN DETAILS SLOT SIZE DIAMETER (inches) If GRAVEL Diameter of well including GRAVEL SIZE (Inches) FROM (fee- t) C14feet) PACKED: grargl pack (Inches): DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two Permanent Flan0narks. FEET to FEET 4 in overburden 0 : ;' -::. and boulders 1 ! c -rock at x"tive feet 2C` -a_n in rock, setting 5,_..: outeci _. 500 Drilling in rock - granite 20 -v If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELLCOWUltu ATTF_OJpnRLEPORT WELL DRILLER (Signature) i .•� .f – _�i. o. .r.. _ ..+•.vim b a .• u nB..xRE�WSTE R LABORATORIES i`4' -` B9 C.n VTEy; N *.-'Y -' . : i. .. F. <u... ^.Yr .YY• > ��• ua.tt. .. �..F �ba� yCr.' .cC 're . WATER ANALYSIS REPORT SAMPLE NO. 3184 184 SOURCE: Charles Engelbracht - hose bibb well supply Barger Street Putnam Valley, N.Y. COLLECTED: May 9j, .1974 BY: P.F.Beal & Sons, Inc, BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. May 11,, 1974 1 0 per 100 ml. oj Bickwit P. E. Director / i i r _ TU=AM 'CO"'�1''TY - PARTM1'NT' OF' =TH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date " 2_f:23 Re: Property of L YgqgLt-'s Located at.i'Gr �S -T °YV4) - �tlf. H& seatd= &8 Block Lot Gentlemen: This letter is to authorize STANLEY I. LAN®ER a duly licensed professional engineer or registered architect (Indical—eT- to apply for a Construction Permit fora separate sewerage system; to serve the above noted property in accordance with the standards, rules or regulations as promulgated. by the Commissioner of the Putnam County iepai tment of neaitll, and to slLgn all necessary papers on my behalf in ,connection with this matter and to supervise the construction of said system or.Fpy tems in conformity with the provisions of Article 145 or _147-,- -.:Educativrr-L -aw; -- ihe--Pub-1-i-c- H6a-lt-h am-, and- �Yhe---Putrrar;- eounty-San -_ -.. _..- _._.__ ._. tary Code.. Couritersighed P.E., 3., STANL J. LANDER (Seal) A r UX, Zb/ awwpv S o A X45 °2fij 5 Telephone Very truly yours, Signed � • c, f� Owner of Property Addregs ` Telephone RE'JI V CHECK :SHEET . House plans O.K. Design data sheet Peres presoaked? Min. 30" pert test depth Const..results for 3 runs D. Hole log O.K. Corporate Affidavit for other than individual Authorization for engineer Letter from Water Supply if applicable If variance requested -such noted on plans & apps.! (Meets Std. Remarks I I i I es No is ! " ! dam. DETAILS if change is proposed,) Existing contours shown.kshow new contours) Slopes for driveway.cuts, etc. shown Water service line location Footing drain, etc. location Top slope, bottom slope of fill i Percolation tests and deep test pit location Septic tank size and conformance to.std. 3 B.R. house minimum i House setback shown t uU161.1 L,u�_.fu ..- _LkUlow ..... fr_ort__ All water within -50 ft . of PL shown 1 Plan and profile SUS All other wells and SDS closer 200' Property boundaries (metes and bounds- clearly Shown I i SEPARATION DISTANCES SPECIFIED ON PLAN'-` 10' to P. L. 20' to Foundation walls 100' to Nearest well i 50' to stream, -march, lake, etc. incl.,expansion 1 15' to Curtain drain 10' to water line (pits -20' ) s 15' to storm drain I 10' to large trees i 10' from Foundation to septic tank_ 15' to pipe from leader drain & footing drain ' � b ... .... __ _ _ . . _. �r •. .r :,,,.: ..;�...,. ,s�'c cx:• ...- .-s..: p...e _�... .�.n e•. �,. m,.. e•,.a., ..�.-�w -..1 .- .... ca�e,� -. oay. ..a �. S,ir .. .:., .'. ..'�i �—. .. v -. ., ..., >:. ea .., ua.: s .. - .,.. .;q;i,:. -,—a mdr'+� LE���.P/�i( G�/1./�Gfiil�s'� �. l� PETER C. ALEXANDERSON County Executive Q JOHN KARELL Jr., P.E., M.S. Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services November 29, 1990 110 Old Route Six Center, Carmel, New York 10512 Lowell & Rita Smith (914) 225 -0310 27 Barger Street Putnam Valley, New York 10579 Re: Proposed Addition Smith, Bergen Street (T) Putnam Valley Dear Mr. & Mrs. Smith: I have received and reviewed the plans for the proposed addition to the above mentioned residence.' The plans indicate that an IS' x 14' family room will be added to the existing residence. The survey indicates that sufficient area exists to expand or repair the sewage disposal system, should it become necessary in the future. Therefore, based on the information submitted, the above mentioned addition is APPROVED with the following conditions: 1. The total number of bedrooms- must remain at 2 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 replaced or updated with water saving devices, i.e., low flush toilets, restrictors for shower heads and faucets, etc. Approval is granted for sewage disposal only. 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 trul ►_yours, William Hedges Sr. Public Health Sanitarian WH /jp cc: BI (T) PV form addition y � 1 PUTNAM COUNTY DEPARTMENT OF HEALTH . U�ISION•`:OF' �1�i�Rb1V1�1vrAT� I•iEP,I,'T'H ��?�ICES - COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner` 4g /.ei Address)e4Pt -3 /� <<��,r�v �`� �1 ���/ �f' �i,v y K,,c F= Located at (Street ' Block "Z- Lot indicate neares cross street) Municipality, 4,L_ V Watershed Lxye11_4 }71,-z o w -4 Gj(- SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK .TIME PERCOLATION PERCOLATION Run apse Depth o a er Water ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches 2 i� 3n jv. j.3 A Z -- 2 /0- 2 4- /0 3 j 7 /6 / 204 �~ 3 /0,33 Ia, : lT 2v -3 2 i� 3n jv. j.3 %% 20 5 1 l 3 4 5 Notes: 1) Teets to be repeated at same depth until aroximately equal soil rates are obtained at each percolation test hole. All pp data to be submitted for review. 2) Depth measurements to be made from top of hole. Address THIS SPACE FOR USE BY HEALTH DEP Soil Rate Approved Sq. 32! Date •1 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION.s �c+r, rPm f T e• ^•TT° r�rij, TriEr-, -, , r_ -.57.r01T� I 01� OP- a� . S �,.. (,T. P.1 t �D �.Ta TE .. _ : ��... . DEPTH HOLE NO. 121 HOLE NO . %P-)-- HOLE NO G.L. �v05 4- ' A/wa IXAKI-11 Awe �Z� a,4-ie, 18 "% 24" 3011. h fi I 3611 0 422" 48" 5411 �l 60" 66" - -- 7211 (�` 78" 8411 � 7X TDICATE. LEVEL AT WHIT H GROUND WAmrR._IS ENCOUNTERED_ T INDICATE LEVELrTO WHICH WAFER•LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Y, Date �- f� l Soil Rate Area Provided �jj31 —d' DESIGN Used­Z�2__Min/l "Drop: S. D. Usable No !;of Bedrooms Septic Tank Capacity Qo Gals,/ Type �ec -o j, ° Absorption Area Pro ded By L.F.x24" dam' width trench. OTA R1,AA r%r A A A IASnrn Other /,' A Address THIS SPACE FOR USE BY HEALTH DEP Soil Rate Approved Sq. 32! Date APPROVE Y !WT 41974 }U C UN LNi. OF HEAL .I D DIVISION Of IRYIRQ C,1'iTAj HMN FAM PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 105 KATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM ��►+' ='`'...��s�: %;' Q, �. i CERTIFICATE F Town o, Village —�� Locate Owner Separate Sewerage System built by - ° Consisting of �� Gal. Septic Tank Other requirements water Supply: ublic Supply From Private Supply Drilled By b(d i l AA,101 -iP ¢� ' Section Block �— Lot lJO! Address: lineal Feet X width trencl Address Sfi��{' s No. of Bedrooms Date Permit Issued Building Type d O _. Has Erosion Control Been Completed? I certify that the system(s) as listed serving the above attached), and in accordance with the standards, n Date ` �'' ti — Address _ Any person occupying premises served by the abov Sr ate conditions resulting from such usage. Approval o available and the approval of the private water suppl f subject to modification or change when, in the judg Date By -"-L'0N-Ti'Hl)CTiON PERMIT FOR Located at Subdivision Owner y as shown on the plans of the completed work (copies of which are the permit j ;sued bye Lhe Putnam County Department of Health. P.E. R.A. License No p 7� . eh action as may be necessary to secure the correction of any unsanitary shalt become null and void as soon as a public sanitary sewer becomes when a public water supply becomes available. Such approvals are of Health, such rev modification or change is necessary. Title PUTNAM`COUNTY DEPARTMENT OF HEALTH _ Division' of. Environmmenaa/ Health. Services ...Carmc ,- f . Y. '10512 DISPOSAL: Building Type >fD (mil- Lot Area Number of Bedrooms Separate Sewerage System to c nsist of 0✓ Gal. Septic Tank To be constructed by,�! :iTy,,V_� Water Supply: Other Requirements Public Supply From Private Supply to be drilled by Address t' °r 1 represent that I am wholly and completely respo f�r' i At p cL-, : 'gym! ion of the proposed system(s); 1) that the separate sewage disposal systerr County Department of Health, and that on co f d and in accordance with the standards, rules an regu a ions o t e':� u nam wn or Village f Construction Compliance" satisfactory to the Commissioner of Health will w n s o lan se yst n Block.. will be located as shown on the a f system or any repairs thereto; 2) that the drilled well described'-'above Lot Job Address XU '� it%o�1A v� J• 4' L��1T V., . Total Habitable Space% /Trz Square ±Feet` iT 0 ?lineal feet X width trench Address�i 1 represent that I am wholly and completely respo f�r' i above described will be constructed as shown on t men d ion of the proposed system(s); 1) that the separate sewage disposal systerr County Department of Health, and that on co f d and in accordance with the standards, rules an regu a ions o t e':� u nam be submitted to the Department, and a writt w f Construction Compliance" satisfactory to the Commissioner of Health will w n s o owner, his successors, heirs or assigns by the builder, that said builder will se yst n ng the period of two 2 will be located as shown on the a f system or any repairs thereto; 2) that the drilled well described'-'above M /z Owner o'r' Pure aser o�Bur-i d ng M nlity Building Constructed by Location - Street Building Type t Block Lot GUARANTY OF SEPARATE SEWAGE 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 guaranty to the owner, his succes- sors, 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 initial use of 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 occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the de- termination of the Director of the Division of Environmental Health Ser- vices of the Putnam County Department of Health as to whether or not the __.._ r'ai.lure, of the: sys e.m tci_.on�r..te.. t ,,ra.s_._oa.v e.d..ny._t�ae...wi 11:.ful _.ar .neg1 igent.. -- act of the occupant of the building utilizing the system. Dated this day of AV 19- Signature Title tct �- If corporation, give name and address) J 7 V THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP,ETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH • 3(71 i Division of .Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK Th s-aePort ts_.to he complPtPd hv.well tiriller.ane� submitted.t0 County Health D.e+partment toPether with laboratory report of analysis of water sample indicating water is of satisfactory bacterial quality�before certificate of construction coinpliarice ued REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION. OWNER NAME G1 "'. tr7 O:O E;elbracht A`iltown Rd. , RD9. Brewster ®. N.'Y. 105081, LOCATION (No. & Street) (Town) (Lot umper) OF WELL nar. -o-r Street, Putnam Valley, New York 14:579 BUSINESS a PROPOSED lJ DOMESTIC ESTABLISHMENT ❑ FARM a TEST WELL C LfWELF SUPPLY � INDUSTRIAL � CONDITIONING � � OTHER DRILLING j COMPRESSED CABLE EQUIPMENT 0 ROTART C) A R PERCUSSION ❑ PERCUSSION � OTHER (Specify) LENGTH (feet) DIAMETER (Inches) WEIGHT PER FOOT ,�j- CASIMG ��;,_ THREADED F WELDED YES ❑NO TES L_JNO DETAILS 20 :�- u !, 6 inch: . 19 lbso. YIELD HOUR G.P.M: YIELD (G.P.M.) TEST El BAILED PUMPED I_J COMPRESSED AIR WATER MEASURE PROM LAND SURFACE —STATIC (Specify lee!) DURING YIELD TEST (feet) Depth of Completed Well LEVEL in feet below Land surface: 500 feed MAKE LENGTH OPEN TO 'AQUIFER (toot) SCREEN DETAILS SLOT SIZE DIAMETER (inches) IF GRAVEL Diameter of well including GRAVEL SIZE (Inches) 'FROM (feeQ TO, (feet) PACKED: gravel pock (inches): DEPTH FROM LAND SURFACE Sketch exact location of well with distances, to of least FEET to FEET FORMATION DESCRIPTION two permanent landmarks. in overburden 0 and boulders rook-at five feet 2 er in rock setting 20 500 Di- illing in rock - granite s . c:a If yield was tested at different depths during drilling, list below .FEET GALLONS PER MINUTE DATE aW /L�L Z 1,7�'TED AT . REPORT WELL DRILLER (Signature) BREWSTER LABORATORIES -sox WATER ANALYSIS REPORT SAMPLE NO. 3184 SOURCE: Charles Enge.lbracht — hose bibb -• well supply Barger Street Putnam Valley, N.Y. COLLECTED: May 9, 1974 BY: P,P.Beal & Sons, Inca BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. May 11, 1974 0 per 100 ml. RbsW Bickwit P. E. Director 1, f I �I i I 'j Gentlemen: P, li`Al i CCU�`TY DEPARTMENT ' OF HE1 ALT1i DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date _ 6 r 2-fl-73 Re: Property of L('5 alGC j f 6�L,�t�- Located at ,&W-64! . 2_ ,/ oVYV 0/_1 Block Lot ; This letter is to authorize STANLEY L LAN®ER - r�- a duly licensed professional engineer or registered architect (IndicaTe7- to apply for a Construction Permit for a separate sewerage system; to serve the above noted property in accordance with the standards, rules or regulations as promulgate. by the Commissioner of the Putnam County D epart iiiciit of He8itil, cL1111 tU slil all necessary papers On my behalf in connection with this matter and to supervise the construction of said system or;,gy tems in conformity with the provisions of Article 145 or :_ .._.. - :447�._E- :,- +ic i- ?-sri; - the•Pur•11C Health Iak; .and the. Put. -a - - ob-'r _ tary Code.. / v Col tersigned .l f P.E., ., X31.7 STANLEY I SANDER -(Seal) Addras X 267 TelepTioon�e 4 Very truly yours, Signed �. -c.. , .% tf Owner of Property Addre s Teieptione r PUTNAM COUNTY DEPARTMENT.OF HEALTH DIVTSOId OF ENVrRONMENTAL COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner[ //Af,,tej- AddressR,04 Located at ( Street 6dicate �4_"g - , f• 41v 6 Block Lot . neares cross street) Municipality axo o1= =,-i3. G / Watershed_ /LXS; icG �10'y SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK .TIME PERCOLATION PERCOLATION Run Eiapse Depth to Water Water Levei No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 3 17 5 3 !'vim % ' /4 / ' �� 4 ¢ -- 1 , 3 4 5 Notes: 1) Te'gts 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. ROTIEN CHECK SHEET ' r (Meets Std. Remarks Yes No House plans 0 >K. Design data . sheet j Peres presoaked? i Min. 30" perc test depth { Const. results for 3 runs D. Hole log O.K. 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 j show new contours), Slopes for driveway . cuts, etc. shown --r Water service line location I Footing drain, etc. location Top slope, bottom slope of fill s Percolation tests and deep test pit location ; B/ Septic tank size and conformance to std. i B/ 3 B.R. house minimum House setback shown i Distl ibutioli uu _.ft..._,.e1.ow.....fr_ost.._.. All water within -50 ft . of PL shown ...._...... - Plan and profile SUS I" f All other wells and SDS closer 200.1 ... _ _ shoT r�ti_ - fer: ncG - grade... Property boundaries (metes and bounds- clearly shown SEPARATION DISTANCES SPECIFIED ON PLAN 10' to P.L. 20' to Foundation walls 100' to Nearest well 50' to stream, march, lake, 15' to Curtain drain 10' to water line (pits -20.' 15' to storm drain 10' to large trees N' from foundation to septic 5' to pipe from leader. drain c. & f .expansion — I i ! tell t i I� i a ! .. .. .... .... .... �,. .. _ .�. - o .. ._ .. .. ,. - ... ...� �� ..: v ...: s�.x. 0 - � _____� PETER C. ALEXANDERSON County Executive Q JOHN KARELL Jr., P.E., M.S. Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services November 29, 1990 110 Old Route Six Center, Carmel, New . York 10512 Lowell & Rita Smith (914) 225 -0310 27 Barger Street Putnam Valley, New York 10579 Re: Proposed Addition Smith, Bergen Street (T) Putnam Valley Dear Mr. & Mrs. Smith: I have received and reviewed the plans for the proposed addition to the above mentioned residence. The plans indicate that an 18' x 14' family room will be added to the existing residence. The survey indicates that sufficient area exists to expand or repair the sewage disposal system, should it become necessary in the future. Therefore, based on the information submitted, the above mentioned addition is APPROVED with the following conditions: 1. The total number of bedrooms must remain at 2 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 replaced or updated with water saving devices, i.e., low flush toilets, restrictors for shower heads and faucets, etc. Approval is granted for sewage disposal only. 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 trul ► yours, William Hedges Sr. Public Health Sanitarian WH /jp cc: BI (T) PV form addition