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03626
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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
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tell
t
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.. .. .... .... .... �,. .. _ .�. - o
..
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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