Loading...
HomeMy WebLinkAbout3636DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.13 -1 -13 BOX 29 ;. rl L 03636 Water Supply: Public Supply From rr �s�l,, v Private Supply to be drilled by TM Address fir/ ,& . G Z-%� Other, Requirements 4� I represent that I am wholly and completely responsible for.the design and location of the y O ) separate' mx� 9 proposed .'s stems ; 1 that sewage disposal sy_E, above described' will be constructed as shown on the.approved amendment there to and in accordance with the standards, rules an regu at ons o t .,e , u na County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory'to the Commissioner of`rHealth�will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said tiuiltler will place in good operating condition any part of .sa!6,sewage disposal system during the period of two (2) years immediately following the date of the sw r ance of the approval of. the Certificate of Construction _.Compliance of the original system or any. repairs th eto; 2) that the drilled well descried above r will be loeated`as shown on the proved plan and that said well will be installed in accordance wi the nd r and regula iions of `thee Putnam County De0artmei7t f Heal t Date ! d Signed P.E. Address License No a� g _---x ' . _ , APPROVED FOR CONSTRUCTION: This approval ce pproval expires one year -from the date issued unless construction f the building has been undertaken rand. is revocable for .cause or may be amended or modified when considered necessary by the Com r ner of Healt . Any change or alteration of constructwn requires a new permit. /Approved for disposal of domestic sa Z;age a r pr va w supply only. DateBY d Title _ e y �y 3" r PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 y�s� e4hll2',rZ�. G " CONSTFiUCT101V _pERM1T' FOR'-SEWAGE DISPOSAL SYSTEM /� ✓f - r4lr i "own or Village Located at cJ�eCL�C .vi�dt�y Sion Block " AT r Subdivision Lot Job o Addres Owner s s �tS /.�i Lot Area �� S $� Building Type —� Number of Bedrooms Total Habitable Space Square Feet Separate Sewerage System to consist of Gal. Septic Tank lineal feet X trench A464 j �i1e�'• Address L' Ciy '�rirC'r To be constructed by ' Water Supply: Public Supply From Private Supply to be drilled by Address Other Requirements : s I represent that I am wholly and completely responsible for s� I Orr. of t posed system(s); 1) that the separate sewage disposal sy iem above described will be constructed as shown on the approv 8?h nd trC� t i : in dance with the standards, rules an regulations o t e u nam County Department of Health, and that on completion t reo a "C fTjfinate;f''n uc n Compliance" satisfactory to the Commissioner of Healthwill '+\! be submitted to the Department, and a written guarante vo be Urr rsrted �N 91i wn f;h' successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewa di o +av�tA g erp !od of two (2) years immediately following thedate of the issu ance .of the approval of the Certificate of Construction pl of'tY+ �` sys or any repairs thereto; 2) that the drilled well described above ; 1 will be located as shown on the approved plan and that said we le��rf► O d e with the standar s, rules and regulations of the Putnam , ! County Department of Health. OF 0� p j ,,� j( Date �' Signed P.E. " A ! Address � � U License No. 3 APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and. 1 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 permit. Approved for disposal of domestic Sanitarg sewage, and /or private,_water supply only. q� / — � �`t !. I BY r rr3 ' 51's , Title a PUTNAM 'COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel,. N. Y. 10512 CONSTRUCTION PERMIT FOR, SEWAGE DISPOSAL 'SYSTEM _ uTOw n vi or I lage .... •.� Subdivision _ -�..: Bloc -,c'.: -- Lot Owner - 1.-%: i/rdh✓lC�'� Job dX .M P !�,jp-��5 Address�`/f Building Type-� J✓ Lot Area /��"%�+ /L� ✓ir jr Number. of Bedrooms Total Habitable Space Separate Sewerage System to consist of Z°e c) ey T�U Septic Tank 0 lineal feet X » w To be constructed by „/ Al cd/✓J/�/i Aadrese 'P��!/�' � 7ALL 6,�: ,;D .� Water Supply: Public Supply From rr �s�l,, v Private Supply to be drilled by TM Address fir/ ,& . G Z-%� Other, Requirements 4� I represent that I am wholly and completely responsible for.the design and location of the y O ) separate' mx� 9 proposed .'s stems ; 1 that sewage disposal sy_E, above described' will be constructed as shown on the.approved amendment there to and in accordance with the standards, rules an regu at ons o t .,e , u na County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory'to the Commissioner of`rHealth�will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said tiuiltler will place in good operating condition any part of .sa!6,sewage disposal system during the period of two (2) years immediately following the date of the sw r ance of the approval of. the Certificate of Construction _.Compliance of the original system or any. repairs th eto; 2) that the drilled well descried above r will be loeated`as shown on the proved plan and that said well will be installed in accordance wi the nd r and regula iions of `thee Putnam County De0artmei7t f Heal t Date ! d Signed P.E. Address License No a� g _---x ' . _ , APPROVED FOR CONSTRUCTION: This approval ce pproval expires one year -from the date issued unless construction f the building has been undertaken rand. is revocable for .cause or may be amended or modified when considered necessary by the Com r ner of Healt . Any change or alteration of constructwn requires a new permit. /Approved for disposal of domestic sa Z;age a r pr va w supply only. DateBY d Title _ e y �y 3" r PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 y�s� e4hll2',rZ�. G " CONSTFiUCT101V _pERM1T' FOR'-SEWAGE DISPOSAL SYSTEM /� ✓f - r4lr i "own or Village Located at cJ�eCL�C .vi�dt�y Sion Block " AT r Subdivision Lot Job o Addres Owner s s �tS /.�i Lot Area �� S $� Building Type —� Number of Bedrooms Total Habitable Space Square Feet Separate Sewerage System to consist of Gal. Septic Tank lineal feet X trench A464 j �i1e�'• Address L' Ciy '�rirC'r To be constructed by ' Water Supply: Public Supply From Private Supply to be drilled by Address Other Requirements : s I represent that I am wholly and completely responsible for s� I Orr. of t posed system(s); 1) that the separate sewage disposal sy iem above described will be constructed as shown on the approv 8?h nd trC� t i : in dance with the standards, rules an regulations o t e u nam County Department of Health, and that on completion t reo a "C fTjfinate;f''n uc n Compliance" satisfactory to the Commissioner of Healthwill '+\! be submitted to the Department, and a written guarante vo be Urr rsrted �N 91i wn f;h' successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewa di o +av�tA g erp !od of two (2) years immediately following thedate of the issu ance .of the approval of the Certificate of Construction pl of'tY+ �` sys or any repairs thereto; 2) that the drilled well described above ; 1 will be located as shown on the approved plan and that said we le��rf► O d e with the standar s, rules and regulations of the Putnam , ! County Department of Health. OF 0� p j ,,� j( Date �' Signed P.E. " A ! Address � � U License No. 3 APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and. 1 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 permit. Approved for disposal of domestic Sanitarg sewage, and /or private,_water supply only. q� / — � �`t !. I BY r rr3 ' 51's , Title a 0v;rior or l � r :� r - }1 1�? I :!�il�ti I�u zl ic;. })al:r.t}r b _ ' �1:3u� J.da.n Corestruc i;E,d by, :;e;ct).or� _. }:.vocation - - Street -�._..._ . TM!"i7ii LT]r�' 'Type Lot GUARA I_f'Y OF Sr_,1. ARP.J.E, SIEWAGE SYSTEM I represent that I am wh.oll.y and colrnp].c:tel y respo:lsiblc for the _.location, worRt,ianship, material, construction and dral.r_a:rre of the sci.m;e ...:..di.spossl sy stem serving the above descr ibed property, and that it has been constructed as shot:n on the approved plan or approved amendment thereto, and in acc.o odance :•.ith the standards, rules and regulatiions of the Yutnam County Departm ^pit; of Health, and hereby guarar_ty to the o;n?er', his succ :s- sors, h °.•irs or assigns, to place in good opercting conditiol, any :.art of said system Constrl'.ctCd by me vrhich fails to operate. for a period of two years irmediate -ly the date of initial use of Gh''. sewar:' disposal system, or any repairs made by to such system, except where the failure to operate: pz'operly is caused by the ,aillf.ul or ne;lioent act of the cccu- pant of the buildinv utilizing the system. Ut:I'S1 (Yr'ieCi u1.'L:1: af',rees to accept as conciusive the de:- terrii.nat_.on cf the I'Dilrector of ttl's Division of "hviron-nient;al Health S ?' V3.0es of `:he Pui:na:n County Donartmii t of Health as to l:Thether or not t -n.e failure of tI_e s,r e- t s 7 � , St Ire to JTi �r "(? :i.> C�ili5 �� by lle 1•�i],_fltl. or Il'vq;1:Lgt:11;, _act. of. tll�_: occupa� of .the buildillg utili.za.n- thf sys.tell. - - r ... -' Dated this ._..��_ day Of �RN 19-(% Signat:urte-• .-'' =t -�-- -- 'Title corporation, give na.m,e and address) THREE (3) COPI S ARE R EQUIRDr) 1,11T THREE (�) CQPIES OF F CiiAL PLl:ivTS i3 � �'�iZE CERTIFICATE OF CO'­!P��ETION WILL BE ISSUED. GUARANTOR TOR �S R?;QU F : r I' I ,; N r, � DATE r_ F,._� - � r S S9'EM �. I.��J 7.C) 1_,t� :�t)`11C � 0�. DA, �, 0 1 ,S•.. US_� Q.. ��.�•,. rl. - - _ - - - - - _ I)iv?.lion of Environmental Health Services, Putnam. County D:pavtl:ent of licalU -. PEEKSKILL MEDICAL LABORATORY Peekskill, New York 10566. PE 7 -8777 IL3715 DATE COLLECTED RESULTS OF EXAMINATION OF WATER 12 1S/75, OWNER DATE RECEIVED Klarer 12/18/75 CITY, VILLAGE, TOWN & /OR NAML OF SUPPLY DATE REPORTED Sh..�amrock Drive, Putnam Valley 12/20/75. SAMPLING POINT., Well BACTERIA PER ML. (Agar plate count at 35 C). i1 COLIFORM GROUP (Most probable N6. /100ml.) less than 202 HARDNESS.- TOTAL -ppm DETERGENTS - ppm NITRATES (as N) - ppm IRON, TOTAL - ppm. A L � TOWN OF PUTNAM :V1 `WZLL DRILLERS LOG AD?D REPORT WALL DOCATION stri WELL GWNER name WyZLL D R I L L M rare section 197 �k Mi addrbssii address P` city or town I . t .., cizY or town CAGING DETAILS YIELD TEST WATER TSVEL SCR wEN DETAILS Bailed Measure From 1 d surface ^' z.engh: `/� � feet or (v Pumped��H Static: eft Make When Bailed -.::. -. _ plot. Diameter:- h-= -- Inches -T_ -Yiel- -= =--GPM r= Pumped--._ _ft Kurd: Diameters -- - In._______ � JT'AL DEPTH OF tvELL a Feet Depth from Give description o- forma-Aon penetrated, such as: peat, Ground Surface..',..' 'silt, sand, 'gravel,' clay, hardpan., shale, sandstone, ranite, etc. Include size of gravel (diameter : and - sand fine, medium,-course), color of material, structure (Loose, packed;_` cemented, -- soft,., hard)..(Ex `' -Oft: _to :27:-. f L_ �. fine ` acked el�law ° sat ; _:2` _ 1.34 ft gray. �rani to ) Peet, Formation Descri td:on - __Skc._tch- exact - ..location .of..zvell to at_ least :two permenant.Landmarks )ate Well Completed Date of Report Well Driller f�' •�ivm --- r signature PUTNAM COUNTY DEPARTMENT OF HEALTH a µ .,...DIV;IS1Ct?. (?F _;ENIVIRONK:'WTYiL :M� = SERVICES �s H{ Date Re: Property of R111111e Located at'5#19 Ieak 6 —s �7764fr 7"t1 /U. "r� j'• � r f J Section Block_ Lot Gentlemen : / ,� ®. _ This letter is to authorize a duly licensed professional engineer - or registered awh (Indicate) to apply for a Construction Permit for a separate sewage system; tec t 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 witn this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 1.47, Education Law, the Public Health Law, and the Putnam. County Sani- tary Code. Very truly yours, Signec Countersigned- J ae P.E., A. # • I -) �J Roe. - g -�-,1 3 _ Address Telephone Telephone t 1 J is A'. J.: BRUCE R. FOLEY, R,$ Acting Public Heai;h DEPARTiMEN i . OF HEALTH Divis O Envi;c-., entai Health Services R02 Z, 6-"..:er, NE%V York 10509 (914- 270 -6130 R =SID =NTIAL 0;' Y) �rDS7 ' J .S'►� sue. > i��T.► 3 T: Ac v TX P -.� PCFJ PR 1iT r A /'/0°'� 'AILii;- ADDRESS _SffiP- AS ft4vaf„ Description of Additi :n A.CWC- LOW Nj b of existing frog: CartiflCcic of C� -up- .1 o- Certification from E•_.ldir,: Lead Z' % Ftvt e- =roceszd number of bedrerams L �:,y a =di Lion V;hich i_ COnS..crcC c bE=. C_' rEyUlrcS formal approval of plans (Construction Permit) a Pr.-essicnal Engineer or Registered Architect in accordance with of tie Putnam County Sanitary Code. IeZSS submit CCU i TY- ", TH DEPART ME' IT r;. 1050, r; _ 27c =5190 with to -ol n g information. 1 . Cert i f i ed Ch=---'K z1 o.- Y1 & x.00 . S:;_tch of existir, Tlac- plan (ali living area including basement, if any) Non- professional crawin is accept_' le Sketch of proposes f1GC7 plan.",[,, 11 Non professional draNin- is acceptable . 4. Copy of survey she -ring �: =_11 and septic location, to the best of your -knowledge. Include date of installation if known. Include all wells and septic syste ::is within 200 feet of property line. Any questions please contact this officd: Copy of Certificate of Occupancy f rc :- Tovin or Certification from Building Department of legal bedraam count of dwelling. OrFICr USE Comments and /or conditions application August 1995 July 1996 (Revised) 40001 !I i f DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 June 3 0, 1998 Stephen Prychlak 12 Shamrock Drive Putnam Valley NY 10579 Re: Addition - Prychlak, Shamrock Drive Increase in Number of Bedrooms (T) Putnam Valley, TM# 74.13-1-13 Dear Mr. Prychlak: BRUCE R. FOLEY Public Health Director I have received and reviewed the plans for the proposed addition to the above mentioned residence. The proposal for the addition has been approved as per plans bearing the latest revision date of June 26, 1998 and this Department's approval stamp. Based on the information submitted, the above mentioned addition is approved with the following conditions: 1. The total number of bedrooms must remain at four without prior approval by this T epart rent. 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. WH :tn cc: BI (T) Very truly �urs� -- - - - - -- -- William Hedges Sr. Public Health Sanitarian GO /G4/177tl Gy: j[ y145262130 TOWN OF PV PAGE 02 JuN- 4°88 THU 9:J6 AN PUHAM M RV HBAL H FAX NO. 1914278791. BRUCE A. FBLI;y Public di►�lih D1r�eto. DEPARTMENT OF : T H 'yiadon of Seavia'ommenral mosith Serweaff 4 Geneva RW Brewster, Now York (0909 Tel. (914) 278.6130 &g (914) 7* -7921 Dam G 4Y To: --+!l D P. V, &T, T, From OLi �.A L,,, L hmam Lout" l atvismtattal Hearn g 1 aT ? � �. 13 B \1o. Pages -2— (Including cover sheet) _ Natt91A►I� eB�Q In the ~ of UftemisioWRemdou ddScultieae platy COBW this ofte. Axt- ge 0 m-, :r � g p DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Far (914) 278-7921 Date: 6 A09 V To: f%t e, I- Vl 1 d oc. l U. 9. From: E t Putnam County Environmental Health Fax . TM ,5-2� No. Pages Z (Including cover sheet) �- BRUCE R. FCL;EY _' Public Health Director Notes/iMessages o Q s -f-(n s q r, -e L� CA, V C,- a R U or Sp e— C✓ teems 4 �� ✓�� v r, 2 2 �.-, r e� a �( -/1-1 to 0;,� his In the event of transmission/reception difficulties, please contact this office. GO/ GJ/ 177tl' 14: n.i `!145262130 TOWN OF PV PAGE 02 ;».. c . .:.. , ., 4 "- -,�- -' may. `. . ♦. �...,, _ • - x -'. ++.... ..n.'�.... ..: BRUCE R. FOLEY, P.g Acting PYb►iC k 041th O.re]to. DEPARTMENT Of HEALTH �. Division Of Environmental Health Services 4 Ceneva Road, Brewster,. New York 10509 (914) 278 -6130 f d JUH I " Putnam Count} Dept. of Health ..; 4 Geneva Road Brewster, NY NY 10509 - - 6C Residence Tax Map *7 o 13 a! Toe�n Bey-,w Gentlemen: According to records maintained by the Town, the above noted dwelling is IS NOT, in compliance NyltkTown code and the total number of bedrooms on record This information has been obtained from: CERTIFICATE OF .00CUPANCY: ASSESSORS RECORD., OTHER Ld r„ft�— �Building I Spector �TeQ'yketo �t�VSc�LA -K I ? Sri 9-0C.g- dg-. I UTNk4t1 Y 14LLE�� N V I O$7icl Y gang /a'X 16'4'/ CLOSE ct o `%' /iC 9' B6[�RO�M rUT-a" Cow my UtlYttt 1.lJtirl�. vx dba1L1: 9lvision of Environmantal Health Service: '•pDrovrad as 0'r-ad for conformance with �ylicsble Huies and Rog ilations of the '?stnam Coon '► . artment. Sco-6 -SAC � FuaarcE RM S'(o' /x 9 1 U I riti 11-1 sCALE- 1 /g'/ = t' (Pozmo�.� _ _ Ll3 N0 o�{PtJ�e�S i CAe. obrGy ..Fft( 1Z? -root r s4FQolLrze.�o� 6e�4 -rr1 T 2 YutiltaW l.UklLLty LCpki vt i }bA1f.L •ivision of Environmental Health Servicb: Sppr ed as noted for conformance with. applicable Rules and R.,ilations. of t?,is ?utnam .County Health Department. f (+„'S'irrn 9• T_ v-. B ttcK � o HOME O �FFZCE. W4-LL- A- (LE-A x a,T uP /fla CLOSET RECREA-rKON ROOM FRo T/ t�ZoPosEn Ago= -c•.�� �gove a(2tiA�p— /ui„rcy IFUIZUAC�_ CERTIFICATE OF OCCUPANCY .. Certificate of Occupancy No ..... � ...... ...Application No.... -y a-2 4 1y) Location of Premises' 'Lot '10, 6h1.L ;ruci;_ -r, �AocC Mor -i kcres ...?`.arba:mi Y lxrer.....of ........ } :utiiair:..,� thew°,...`' 01 .• .......................... having ... ............. ......... heretofore, filed an application for a building permit pursuant to the Zoning Ordinance, Sanitary Code and the Laws in effect in the Town of Putnam Valley, Putnam County' New York, having :< paid the required fee therefor, and the undersigned having by personal inspection ascertained that the applicant has subsequently proceeded with the erection or improvement of the proposed struc- ture in compliance with the requirements of the laws as aforementioned and that the said work and materials met every requirement of the laws as aforementioned and that the premises have now been fully completed and are ready for occupancy pursuant to the provisions of law; Now, therefore, this certificate of occupancy is hereby issued under the seal of the Town of Putnam Valley this ....' r day of ........ Jlan is x� :............... .......... .19..7E i Not valid unless signed in ink by a duly authorized agent TOWN OF PUTNAM VALLEY, NEW YORK of and under the seal of the jown of Putnam Valley. x - ByB ....................... - ......... .. ............. ...................... - f LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509' Environmental Health (945) 278 - 6130 Fax (945) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6679 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 279 - 6648 Red Brook Builders, INC. c/o Route 6 Mahopac, NY 10541 Dear Sirs: May. 4, 20.04 ROBERT J. BONDI County Executive Re: Addition - Red Brook Bldrs., Inc., 12 Shamrock Dr. No Increases in Number of Bedrooms (T) Putnam Valley, TM #74.13 -1 -13 I have received and reviewed the plans for the proposed replacement of the above - mentioned residence, which was destroyed by a fire. The proposal for the replacement has been approved as per plans bearing the approval stamp from this Department dated May 4, 2604. The addition is approved with the following conditions: 1. The total number of bedr6&iis must remain at- fourrwithout prior approval~by this f 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, William'Hedges ML: lm Senior Public Health Sanitarian cc: BI (T) Putnam Valley APR -30 -2004 13:39 FROM:PUTNAM COUNTY DEPART 845 -278 -7921 TO:96285989 LORETTA MOLINARI Public Health Director DE- PARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 P: 1'1 ROB13RT J. BONDI County Executive Environmental Health (845)278-6130 Fax(B45)278-7921 Nursing Services (84S)278-6558 MC (845)279-6678 Fax(945)278,6085 ]Early Intervendon/Preschool (845) 278.6014 Fax(845)278-6648 MPOSED ADDITION APPS, AUON ( Fl`I]J L ONLY) S'T'REET M 5�i �;iz12� JC - TOWN— Tx "# 7q0 13 J —14' V& //t NA 4 V&Z PHONF-4)S - 10 lo PCHD # - MAILING ADDRESS 7/ 4 R r-6— 6 Vh Iq h 6 go ac N P f O 5-'// DESCRIPTION OF ADDITION NUMBER OF EXISTING BEDROOMS PROPOSED # OF BEDROO S-- (FROM CERT, OF OCCUPANCY OR CERTWICATrON FROM BUMDING INSPECTOR) *Any addition which is considered a bedroom requires formal approval of plans (Construction Pcrrttit) prepared by a Professional Engineer or Registered.�rchiteat in accordance With i aplicable's'ec {ions o'tbe Putnam County Sanitary Code. Please submit this form. and the following to Putnam County Health Dept., 4 Geneva Rd., Brewster, NY 10509, Phone 278 -6130, A1111141, Certified check or money order for 5100.00 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 plaza (drawn to scale, with name, street, and tax map #) * Non - professional sketches are acceptable 4. 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 litre. Contact this office with any questions. S. Copy of Cert. of Occupancy from Town or Certification from Building Dept with legal bedroom count of dwelling, OFFICE USE Comments • � C.6 OQ • 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 #Z �� Address /8 7 /Y/ �y �, 5 / /L Located at ( Street c.&� DI? Sec ..6 Block j�Lot /'Z, kn ica e nearest cross street) Municipality. Watershed 0_IL PERCOLATION TESL DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse 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 Inches / 2 b 2 3 19 '/i' .I,, /7 4 KA Z- S 0 a -Y / 77 Z 0 3 / P +4, r 4 . ,7 5 , Notes: 1) Te;ts ato be repeated at same depth until approximately equal soil rates are 61% ned at each percolation test hole. All data to.be submitted for review..: 2 ).`h Dept °h measurements to be made from top of hole. TEST.PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION. _.- DECCRIPIION `OF S03i �'£vUOUN`IERFl} I'V _'PEST DESIGN .Soil Rate Used/j -22C n/1 "Drop: S.D. Usable Area Provided. _5—o - ©o No of Bedrooms Septic Tank Capacity 124> c) Gals. Type Absorption Area Provided By L. F.x24 J/00 w,-4th trench. Address 1,30 2 & SEAL a 2/ 01e 5,r� a ' THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: R Soil Rate Approved Sq. Ft /Cal. Checked by. _.: De � a x }~ �4 r� DEPTH HOLE NO. HOLE NO'. HOLE NO. G.L. 18 2411 � f 3011 l�, r�� S/ v�lLo �r✓� 361 ,r 42" �r 48" u 54" of 60" 66" �r 72" 78" , t 8411 , . M—) LEVEL AT .=H. GROUND ` WATER IS ENC OUNTER.ED� - -7 INDICATE TESTS LEVEL TO Wg„i H WATER LEVEL RISES AFTER BEING MADE BY ENCOUNTERED Date DESIGN .Soil Rate Used/j -22C n/1 "Drop: S.D. Usable Area Provided. _5—o - ©o No of Bedrooms Septic Tank Capacity 124> c) Gals. Type Absorption Area Provided By L. F.x24 J/00 w,-4th trench. Address 1,30 2 & SEAL a 2/ 01e 5,r� a ' THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: R Soil Rate Approved Sq. Ft /Cal. Checked by. _.: De � a x }~ �4 r� PUTNA`I COL'T`c' DE2z?T�T OF �E' -LTH DIVISION OF E�VIRO_��rLTAL "HEALTH SE_?L�CE'S DESIGV D�Ta SzEET - SEPARATE SE; GE DIS ?OSaL SYSTL_I FILE NO abler , fo,% :5 Address Located at . (Street). ij ,e SCie _ Block .3 Lot (Indicate nearest cross s tree,.) Municipality TW1 ,44ecVv:atershed SOIL PERCOLaTIO` TEST D?TA REOUIPED TO '3E SUET'! QED P7ITH .aPPLICaTIQ�T Hole , Nkirhe ^. CLCC r TINE PERCOLATION PERCOLATION Run Elaose. Deot- to [•rater Slater Level - — No. Time Fro.:; Ground Sur ice in Inches Soil Rate Start Stop 'min . Star t Stoo Drop in *Min/in . dro.p Inches Inc- es Inc'hes . 14 17 cnex rnu$'� 3e, n'i2'lla9�n 2 /.'�� %. °�� 130 7 X, 1,5- 3 5 4 - 5 3 4 `r 5 - — Notes: 1) Tests to be repeated at $ame, de-oth L'1t11 approxImstely equal sOi1 rates are ob- tained at 2c'_ch percolation teSt dole.. All data to be submitted for rzVie::7. 7l T1o�+ -'.-, ma =c,,r,m -pntS to be flade from t0O Of hole. /, N ame BOX' 267 Address AMAWALM 1Ma a o PUTNAM COUNTY DEPARTLIENT. OF HEALTH Soil Pate approved Sct. Ft. Aa1. E Checked by Date , 77 TEST. PIT DATA REGUIR�D - ., .. .- .a- n ,,.. -.:: .0 �E SUB FITTED -.• r.. - -. .. .. _. i : :Ifi' -! aPPLICaTIO .... - .r DESCRIPTIO�i OF SOILS E`:�OU-1TERED I`: "'EST HOLES DEPTH HOLE,: NO HOL .: \0. HOLE> N0 .' G.L. Zara _ /4. _ 70w lot/ r� ley 6" 12" Brio --CS T a�/ ;� r5' .d - c G4 ..eWA 18'T �r 411 2 4,. 3 0'' 3 6t1 ell, . 42" 17 48 tt 5.4" 6 0" 8 41f I.NDICaTE - LF.VEL` AT t,MICH GROUND Tq -ATER IS. E`;COU \'TER-D INDICATE LEVEL TO WHICH MATER LEVEL RIS =S AFTER BE -I`:G ENCOUNTERED TESTS LADE 'BY - - 4V4L u J 'Date S-,3> -7/ ll *6. _ \.. Soil Rate Use f �Iin /1` Drop : S.D. L'sa -le area Pro -? ed � ' Igo. of Bad- s � Septic _ Tank Ca - ' " �Wr Gals— Type Absorption Area. Provided By Sari L: ccidth trench. 0'Cner N ame BOX' 267 Address AMAWALM 1Ma a o PUTNAM COUNTY DEPARTLIENT. OF HEALTH Soil Pate approved Sct. Ft. Aa1. E Checked by Date �l r- ;owe V -- 33075/`90 P Cad-- Ns• pC /e737 "G /o cn rrrorr•n 19cres Section A S 5-2°=220 "E'22e.66' Z � c a 0 ,r �4 0 f ,m c - � o \ > Z o � J 4 Lod' /o 43, 38 Z sq. 1 � 1� d t)- uj n 0 NLs'SO oo' - o pe �O pRIVE o G Q � m �o Pr�/ni�es hcrec" as/ny Get /o as -hewn on a map anfit /G d, St/bdivrsiM Maf+ of .Sent /on 'e'G /oearnorrq Acres; fi /ed in 20'he. pufl7a" County C /er E's Ors {,GC en ✓u /y Zu, /97, as/.1n/o 4/9'/ZZZA. SURVEY OF PROPER7 -Y Ruara stead to Stephen ¢ e 1iia6efh I , pA? PE O FOR prysch/ok, Col -,w6ia EeuiYies, [ TO., reviselCc,CS Abstraof Corp. 0,,d Nnt/cn5 Tf /e /ns.�rnnceCo.+vogn of STEPHEN ^�o EL /ZABETH New yor k /ne. • '- aceerdance . rh P R Y S C H L A K II/e /rJ.i�i/nurn Standards ferT.'f' /e Landes t/e AssoCeiaf�'onsta TOW%V OF PUTNAM VALLEY Pu rlvAM Co. - /V--W YORK .SCa /e: / " =40, Au9usf_23l /994 - _Su/'vey�od as 7r/- Pos,4essio/7 -- .. . Albin A• /r/azaocut Sheet 7Q. /3 Acd Ali //s Lic.Survec�/or N-- °•aCS667 6 /ock / /7o hop ac, IVY Lot /3 r- 0 n n h h N