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HomeMy WebLinkAbout3663DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.14 -1 -29 BOX 29 03663 Ir .. i .-9 r . it . OAP 03663 J (y� PUTNAM COUNTY DEPARTMENT OF HEALTH ([0 1 Division of Envbuamental Health Servloea, Carmel, N.Y. 10512 Engineer Must Provide PV__ '[LA:E OF I SY" NZ IN ii:, ;e FG2WWAG iplSi NAL SYSTEM ffa- Tat: Map �4 Let iOtrfter /alppV=t Name PAU L N 0 Vo T jy i Formerly Subdivison Name Melling Address /02. Lanni o .04-tee M** w4-t- no / o rY Subdv. Lot # 3 Fee Enclosed ® . Amount aUj) Date Permit Issued Separate Sewerage System built by PUS /li GOKC t/�T/d /y Address 4�47'1" moo, ^4*Y94'0'W- lji Consisting of Gallon Septic Tank and 1723 L . F N C 10V Water Supply: Public Supply From Address on Private Supply Drilled by J "Tate Ll d l j: Address d �Tti =M.aK Building Type . _.&9 Gh4 Lot Size . /o� �7 Has Erosion rnntrnl Rpan rump l otpri 9 n% U Number of Bedrooms _ ? ; Has Garbage Grinder Been Installed? IV o Other Requirements /j+ / o y I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regale , in accordance v the fi,e an, and the permit issued by the Putnam Coun�t^yDeepartment f `Health. r /l ��� bate �1�; °a =�j�`� Certified by Address 91WO e,,e N t — P.E. -4 R.A. License No. �IP Yel Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a publ;: sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes avallabla. Such approvals are subject to modification or change when. In the Judgment of the Commissioner ,e! tiesl %:5iQch revocation. modification or changa Is necessary. /89 Oats _` -LG�I / By f r PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services. Carmel. N.Y. 10512 to Provide Permit N PERMIT FOR SEWAGE DISPOSAL SYSTEM Located at t? JAI o Subdivision Name fY' oy oT N f o Subd. lot x " on CERT -9 F COWLI NCG Permit Town oY Village TAX � f Block Lot Owner/Applicant Name P4()/- App / UG At 0 VO TW 1r Renewal— ❑ Revision ❑ �y Date of Previous Approval MaWng Address1dL�_ -/°� �G Town ZIP Af 4 to to 4Z cat. Sf ,/ Q rat Building R ,) 9� G/y Lot Area Flll Section Only Depth volume Number of Bedrooms Design Flow G P D 6 -0 PCHD Notification b Required When FIE Is completed Separate Sewerage System to consist of "!t'9Gallon Septic Teak and 113114151 O a *JM 7'I�6iY�t To be constructed by %d �� D 091" WN" Address Water SuPPIY: PdbRe Supply From Address ort _PH at. Supply DrIDed by ?d -Address At6ar Ranvimn.anta 1 represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regu ions o e user 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 thedate of the issu- ance of the approval of the Certificate of Construction Compliance of the Origin system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed i ordance wi the rt dards. ► es and regu a— l�llons of the Putnam County oepartlnent f Health. Date �O Signed P.E. R.A. B/tv r % Address �� License No�V ! � _ APPROVED FOR CONSTRUCTION: This approval expires two years fro the date issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when considers Bees ry by the Commis }loner of Health. Any change or alteration of construction requires a new permit. �pp►oved for disposal of domestic sa ' ar� ag6, and /or or iv dater supply only. - /e 7f, ly- �. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date 117zao /q2 Re: Property `of ��,� ` 6VCA -0 „, Located at Lc.i �•o ���+.� f' 1A'(6 Pd-k.- �I Y Io s' fl (T) ayTIUffil.' Section Block Lot Subdivision of Subdv. Lot # J Filed Map # ate Gentlemen: This letter is to authorize %I�” � Vr-h, LA e_. a duly licensed professional engineer 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'f45 or .., 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very tru y yours, Signed Countersigned: Owner of Prop e ty P.E. , R.A. , E !x ne /w)-o 4(s-C R� Address Telephone lz Gib '(A /d - J ,4-1i9T-4 Address Town '?( ( - -7(1 Hd' Telephone No ME, 'Rim, � ��. -.~ ~-^ -' 914526-2039 014-628-7570 TO WE ARE SENDING YOU ~Y ��Attoohod O Under separate cover viu via- 0 Shop drawings O Prints O Plans O Copy of letter Q Change order O___- ~ ~� ^ LIEUTEM VF AMO D ``.L JOB NO. ATfEX.0N 6( 0 Samples the following items: 0 Specifications COPIES DATE NO. DESCRIPTION • As requested O For review and comment O FOR BIDS DUE_-____ xFor approval • For your use • As requested O For review and comment O FOR BIDS DUE_-____ REMARKS • Approved as submitted • Approved as noted • Returned for corrections 19 _______ • Rusubmit__--__unpies for approval • 8ubmit___copkes for distribution • Return —cor,rected prints 0 PRINTS RETURNED AFTER LOAN TO US \ �� COPY TO If enclosures are not as noted, kindfy notify us at once. THE BRENTWOOD 27'8" X 40'9 2,146 S q . Ft. 26' X 40' 40' op, o"a, hropfcc, MASTER BEDROOM ID'- 9' X IT'- I' BED 00V3 BEDIIOOM2 12' -21/9' "X11' -0' IP'-2/2'X11' -0' �- 26' vUN!"'y l:i: ?ART1101T OF HEA . FAMILY R KITCHEN 23'-10�/P'X 13O'- OO SIy �2. 9' -8' X 13 =0 /2' Hn;,JSE P- LANS AFFROVID FOR 13EDROOi}1 '0`10T ONLY; DRO ]date r. a ur e Si Ti' le Optional Master Bath ne _jj U L_ LIVIVS ROOM, DINING ROOM IT' -0 /2'X13' -0/2' 15' -0' X IP' -O /P' 40' I STANDARD BRENTWOOD FEATURES . 3 Spacious Bedrooms . 2 Y2 Baths . Luxurious Master Suite Features; Dressing Table, 60" Vanity, 60" Shower, and Walk -in Closet . Boxed -out Living Room with Reversed Gable . Spacious Country Kitchen Features Island with Real Butcher Block Top G • "Cottage- Style" 3056 Front Windows • Fireplace Options Available • Consult an Authorized Westchester Builder for a Complete List of Options • Artist's renderings and Floor Plan Dimensions are approximate. All specifications must be Written in the Contract No oral conditions. ESTCHESTER MODULAR HOMES, INC. 30 Reagan's Mill Road 9 Wingdale, NY 12594 (914) 832 -9400 a (800) 832 -3888 27 r8 rr APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DMSION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS IRFVIEW SHEET for .EON_STR_UCT� PERMIT � NAME OF O ; . STREET ON .CL% BY DATE �iY" TAX MAP # /.l4 +� 6 DO MENTS. Y ISCHARGE (OK) PERMIT APPLICATION PERC & DEEP HOLES LOCATED PC -1 m REPRESENTATIVE OF PRIMARY AND EXPANSION WELL PERMIT; PWS LETTER M EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE fPERCGINEERS AUTHORIZATION (]] IF PUMPED PTT &'D BOX SHOWN & DETAILED SIGN DATA SHEET(DDS) m OUSE - NO. OF BEDROOMS HOLE LOG WELLS & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM NSIST'ENT PERC RESULTS (3) PROPERTY METES & BOUNDS HOLE DEPTH �'HDOUSE SETBACK NECESSARY (TIGHT LOT) m' CORPORATE RESOLUTION PLANS THREE SETS � -HOUSE SEWER - 1/4 "/FT. 4"0; TYPE PIPE LTJ NO BENDS; MAX. BENDS 45 W /CLEANOUT HOUSE PLANS - TWO SETS f FILL SYSTEMS LU VARIANCE REQUEST GENERAL LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED L� P I TE _REQUIRED STAIN DRAIN REQUIRED MSTANDPIPES EX- APPROVAL SSDS ADJ. LOTS . z ETLAND (TOWN/DEC PERMIT R & D) DATA ON DDS PLANS & PERMIT SAME m PRE -1969 - NEIGHBOR NOTgTFICATION CD LETTER BI/ZBA iR FLOOD Ei. EVATIGN SEWAGE SYSTEM PLAN - (NORTH ARROW) SS DS S HYDRAULIC PROFILE m GRAVITY FLOW J BOX m TRENCH/GALLEY m P- PIT DETAILS SEPTIC TANK - SIZE, DETAIL LL DETAIL, SERVICE LINE IF OVER � ONSTRUCTION NOTES (GRINDER -RA. DESIGN DATA: PERC AND WEEP RESULTS ]TWO -FOOT CONTOURS EXISTING & PROPOSED ..DRIVEWAY & SLOPES CUT ® FOOTjNG /GUTTER/CURTAINfAINS COMMENTS: CIIAYBARRIER L6 FT HORIZONTAL: SLOPE 3:1 TO GRADE FILL SPECS DEPTH GAUGES FILL PROFILE & DIMENSIONS VOLUME TRENCH TRENCH PROVIDED 'L U66 FT MAX w PARALLEL TO CONTOURS m 100% EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED ON PLAN FIELD TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL '20' TO FOUNDATION WALLS 100 TO WELL, 200' IN D.L.O.D., 150' PITS 100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) 1TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 1,20.0 0' TO WATER LINE (PITS -20') 0' INTERMITTENT DRAINAGE COURSE 0' FT. RESERVOIR, ETC.M 150 FT. GALLEY SYSTEMS SEPTIC TANKS 11�101 FROM FOUNDATION; 50' TO WELL WELLS 15' WELL TO P.L C-R I YES Nizi l=t=—,4 as P;-=r a—t--rc:veH clans b- FJ i sz--lcn - Da`e cf p ac= �=nt 2:1 Eax—.ler I C-1 H w lujiH C_ bTa-z-arz-1 scil ncz E_ CCU--=— /w-a- I ar-E--- D::,-c-=-CSAL tazlk 51,•-= LT;G - fr i F =- b. t z- - ------------ C- 11, nriz-1-L—ium ,2.- Wi C- is 7 ZZ T--- T-- r —,, 7r ALI r,--.- 4.at- 2- �cw- frast- -PrC-k*-=-----:--="--- 2 L -F� - Tn,= ZZ f-.ye C L/32 0/Z.CG- I /T I .-Io 20 7. Dam th. C Z7 < 3 0 CC'S 5. SiZZ C--:!, cz-av-EL, 3/A Eiaza� 2.0- r Cf =-=-al i-r., ii- Pi :a E=EG h- CR DC-'z-= e C-W tmzik v:'.-=--= I pu=,j 1% 1 iii _ ECz_. - I � I ' -car a=rz:-,7iR�j h- C- c7--c-4m-C 18" L=—,7a crar-2-=- WE.L L C_ ALI ri-ces flim::-, wit-h ins-ide cf hcx f Y, ri-atEliai c= -T= < V E_ C=7=rj C & (air-to C Z, * `Cr, nc - Z arce aj.sv f.=-CM h. C:--Eat� t!7 15 1 GPTsO ti;9� _ r of /ory/J»!/p� ✓u9, ed �, �p/✓0 aC I� �( Z dach f / �/B � 2�f r' ' � � � • •• �pr,��fl' /r6� � 1 6zcdfiierl- �5urf�e O a= V,7171e ,/reach GEN rER �l,�Ga9AL �.� S�cTioN � Eso�y � f � % /L� � /EL05 + � � ORS ✓� of 5 LOG,4T / ®� �1.4P ScA4E eyafio� ov„ e � a�� S,ECTioni,4G pG q� DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 ... .. w- ..ti-_�4 ..,u s• .. .._ •tea -•. ..•�. .... M. APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION Street dress Town/Village/City �il�'/ Tax Grid Nu er WELL OWNER Name Mailing Address 0I/D /X y �� L 1011140 .4 /ge OrPrivate d 0 Public ,&SE OF WELL - primary 2- secondary RESIDENTIAL O PUBLIC SUPPLY BUSINESS O FARM 0 INDUSTRIAL M INSTITUTIONAL O AIR /COND /HEAT PUMP D ABANDONED O TEST /OBSERVATION O OTHER (specify, TAANND -BY O S� O AMOUNT OF USE YIELD SOUGHT— � MAW PEOPLE VEU- J /EST.• OF DAILY USAGE.4 Ob Sal EI REPLACE EXISTING SUPPLY O TEST /OBSERVATION 13-ADDITIONAL SUPPLY IftNEW SUPPLY NEW DWELLING 13 DEEPEN E ISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING =6 rprev a &W45 XAFI Izn WELL TYPE DRILLED DRIVEN []DUG OGRAVEL 0 OTHER IS WELL SITE SUBJECT TO.FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. -- WATER WELL CONTRACTOR: Nam€7-6 %� F_; !78'l�R h!g/6� Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES. _K_NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY .T,/1� .^.1 q- 'C�..f ICY ♦YL AR i'�+T, Vin 'TiR -AfA W • .�' D .. .. ._....... .«.. •••....•..._iJ1J lel'LV Cai "a'V"PZVa iZT'a a a\a/i a'� L�..._ ��.+a7 � .. . ///��� ,. _ ... � •. . LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET a Wade) (sign ure) 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. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or other se contaminate surface or groundwater. Date of Issue: ///2-. r 19 a L_ Date of Expiration 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller WELL LOCATION WELL OWNER USE OF WELL a - secondary COUNT OF US REASON FOR DRILLING DEPTH DATA DRILLING EQUIPMENT WELL COMPLETION REPORT DEARTMENT OF HEALTH ice se Only TFL iJ i Division of L'nvironmental Health Services a PtTTNAM COUMY _ DEPARTMENT - OF HEA1,17F_ _.. st iooais's: ,� 73, rnz uMeEA 4; PIee_ A � ,17-- A 04./ _/iIi-C] PUBLIC RESIDENTIAL O PUBLIC SUPPLY C] AIR /COND. /HEAT P MP d ABANDONED BUSINESS 4 FARM d PEST /OBSERVATION ❑ OTHER (specify) Q INDUSTRIAL 0 INSTITUTIONAL C1 STAND -BY ❑ YIELD SOUGHT gpm. /N0. PEOPLE SERVED __ �/ EST. OF DAILY USAG () gal. []REPLACE EXISTING SUPPLY TEST /OBSERVATION ®ADDITIONAL SUPPLY NEW SUPPLY (NEW DWELLING) D DEEPEN EXISTING WELL WELL DEPTH ft: STATIC WATER LEVEL '.,,, ft. DATE MEASURED - 0 ROTARY KCOMPRESSED AIR PERCUSSION D DUG Q WELL POINT d CABLE PERCUSSION _ _ 0 OTHER (specify): WELL TYPE � 0 SCREENED 0 OPEN ENO CASING OPf3d HOLE IN BEDROCK n OTHER TOTAL LENGTH CASING LENGTH BELOW GRADE DETAILS DIAMETER WEIGHT PER FOOT SCREEN DIAMETER Cn) DETAILS r1RBT SECOND OuVEL wK raw Slz>o WELL Y)ELQ TEST If detailed pumping ME7MOD: ❑ PUMPED tests were done is in- 0 COMPRESSED AIR ; formation attached? 0 BAILED Cl OTHER ', Q YES 0 NO WELL OEi'TH DRAWOOWN YIELD fL n. it ?WATER 0 CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? 0 YES - 0 NO PUMP INFORMATION TYPE - CAPACM MAM DEP'fEl - MODEL VOLTA HP -�--- i d ft. MATERIALS. 14 STEEL .''© PLASTIC 0 OTHER - JOINTS: 0 WELDED 'THREADED 0 OTHER in. SEAL: CEMENT GROUT 138ENTONITE.- ❑OTHER -- _17-- lb. /ft. DRIVE SHOE: YES ❑ NO I LINER: O YES Q NO 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (it) DEVELOPED? 0 YES OHO - TOP BOTT041 OF PACK In. IDEITH _tL DEPTH - It. WELLLOG if more detailed formation descriptions or sieve analyses i�L. G are available, please attach. DWater welt gar Darr FORMATIO N DESCRIP"f!<IN WK STORAGE TANK: TYPE CAPACITY - - - -- _CA7, - MAY 20 )Vic tid. woaJ 5 PUTNAM COUN'T'Y DEPARTMERr OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LUL �lav6�/YY Owner or Purchaser of Building Building Constructed by Location – Street Municipality RX A& f� Building Type Section Block Lot JV U yU .;Ni Subdivision Name 3 Subdivision Lot # GUARAN= 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 elate of approval of the "Certificate of Construction Compliance" for the sewage disposal system, or any .repaik i Cie by ,:e to such system, except where the failure to operate properly is caused by the willful" or " negYigent auc 7 of t;a- w�.:.:p.^ - ^f - *_fie .hIai lc?.ng._uti.lizi�g._ 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. Dam_ � C-� day of 17 Gen aer 1,Contractor (Owner) —Signature /mac Corporation Name (if Corp.) rev. 9/85 wk Signature Tit le - -� — Corporation Name (if Corp.) Andress ^ YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 ~ _ t a00��]�����l�rs�t±;r_ LAB #: 93.007664 CLIENT #: 1296 STAT PROC PAGE 1 AESTHETIC BUILDERS DATE/TIME TAKEN: 05/20/93 10:00 PO B8% 977 DATE/TIME REC'B: 05/20/93 10:19 MAHQPAC, NY 10541 REPORT DATE: 05/21/93 PHONE: (914)-628-4817 . SAMPLING SITE: LAINQS PLACE OUTSIDE SPICET SAMPLE TYPE..: POTABLE : PUTNAM VALk-EY, NY PRESERVATIVES: NONE CGL'D B1/: KEN LAUR8 TEMPERATURE..: { 4C NOTES"..: COLIFORM METHS MF DATE FLAG PROCEDURE RESULT NORMAL — RANGE 05/21/93 MF T. CQLIFORM ABSENT /100 ML ABSENT COMMENTS: BACT THESE RESULTS INDICATE THAT THE W�TE NOT) OF A SATISFACTORY SANITARY QWALITY A[�CORDI��-��THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. SUBMITTED BY:__ ___________ Albert H. Padovanii M.T.(ASCP) Director ELAP# 10323 -PC -1 P UTNAM C O UN TY D E PART MENT O F H EAL TH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: l f&/- Na VzI7-x/ 2. Name of Project: r1iSlG1,e rr140Rx1'A& 3. Location T /V /C: ,��T�S/�1�'►' 4. Project Engineer: LwAll 5.. Address: %tea ' G- �A '��'i�G,� License Number: "! A- 'L Phone:g2' 6. Type of Project: Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? !'SAD 9. Has DEIS been completed and found acceptable by Lead Agency? ........... , /V,/�4e 0. Name of Lead Agency p.GQ;;�r,.�L:.�n_ �.:. r.�%� �n�iar ihF_._�rsrrnl n� !c1G�yT:_,p- annjng or other officials, ordinances? .......... 'r 2. If so, have plans been submitted to such authorities? 3. Has preliminary approval been granted by such authorities? Date Granted : 4. Type of Sewage Disposal System Discharge...... Surface Water Ground Waters 5. If surface water discharge, what is the stream class designation ?........ 4- 3. Waters index number (surface) ........... ............................... 4 T. Is project located near a public water supply system? D 3. If yes, name of water supply Distance to water supply 3. Is project site near a public sewage collection or disposal system ?..... AL ). Name of sewage system Atyl l {�lT".�" Distance to sewage system . Date observed: 23. Name of Health Inspector: . Project design flow (gallons per day)............. .�f.`.� ................ 2. 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required?,.. A10 • L.'s_ - .- ,..- r.n.. ,.'r�:.e, -... .p .♦ .. W z. ...< y..r wY c -. _. .�.;r•:.t srt -.w-. .. . --:._ .a.+rwr '.5. Has SPDES Application been submitted to local DEC Office? Lf% ?7. Is any portion of this project located within a designated Town or State wetland? . ............................... .. .............................fU 8. Wetland ID Number ........ ............................... ........... ak 9. Is Wetland Permit required? ............................................. Has application been made to Town or Local DEC Office? .................. Z4- 0. Does project require a DEC Stream Disturbance Permit? IV 14 ?1. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ........ YES or NO Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill; sludge disposal site or any other potential known source of contamination? ............... YES or NO No DESCRIBE: Is there a local master plan or file with the Town or Village ?'' ! .4. Are community water, sewer facilities planned to be developed within 15 years? D 5. Are any sewage disposal areas in excess of 15% slope ?. JA/V d. Tax Map I'D Number .. ........ ............................... ............ � 7. Approved Plans are to be returned to: ................ Applicant Engineer the application is signed by a person other than the applicant shown in Item 1, the pplication must be accompanied by a Letter of Authorization. Failure to comply with this rovision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my 'knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the Penal Law. GNATURES & OFFICIAL TITLES: Rr AILING ADDRESS: eerz - Ul2r/ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES S, - -a -D SIC UZM-.,�,�SFIEMT Sr--�SUFACE-S7- -1-DISPOSff�-�- ".r EL -0--' Owner P. A(g.,,viliy Address I 1 4 Located at (Street) N-#4 1-f Sec. B -kkY Lot (indicate nearest cross street) Municipality PLIVV4" ix,11-1-olf Watershed PXellIklil 11?11,rl 17-460t SOIL PERCOLATION TEST DATA RBQi= TO M SUBMITTED Wrl-ri APPLICATIONS Date of Pre-Soaking Date of Percolation Test HOLE NUMBER Clam TDIE PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Tin-#-- Ground Surface In Inches Soil Rate Start-Stop Min. Start-. stop Drop In Min/In Drop Inches Inches Inches 1 2 3 4 5 Cn 2 3 4 5 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 fran top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE HOLE NO. G.L. 1� - c7 2' m 3, GaR� 4' 5' �l+ 61 7' ` \ 8' JR 9' (� 0 10' Al 12' 13' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used 11C)_ Min/1" Drop: S.D. Usable Area Provided I 6VJ S /- No. of Bedrooms -7 Septic Tank Capacity 1619!) gals. Type elRt 6 -dJ- Absorption Area Provided By � 2-� L.F. x 24" width trench Other Name;_ IJ-v:fAl-aA Signature Address / �d�G -eey of f P.& a�di SEAL tj THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: ;.a Anpdbc, &X Or Irdu"O'lir Soil Rate Approved sq.ft /gal. Checked by Date 1167 -3 LAND. OF THE STATE.__gF.NEVP.YOPK.rT yv;G_ 'y.r;�YF•ii tl< Lw) &? 15s'�K ... ; /�� _. .w... ... ....., .... o. .. =� CONC. MON. FOUND - •___ 9.9• W. N. 17' 14' 18" E. 1 254.24' 7. ROW OF OLD LOCUST POSTS WITH REMANIS Ii OF WIRE GENERALLY- ALONG LW 0: W l7 2 f cr 'U a z wF 0 = O _i o Y V D. .a O� Z t+J aCO J J w W F ir 0 LL a' O 3 O 2 N c N m It N O M I� Z t ly � n -- �• nio AREA –= -4 ,,575 sq. I I. 1.023 ac. FOU04TON RABEDI DE 69.0• dY FOND4TbN bn� STEPS .. STONE IEt, WALL G • OVERHANG NOT TANGENT f OVEHOW 1 u 1 Q STEPS ! CIC O AT tD CAP .� FOLYDATAIN 3 to J g i v a C co /W r z o / t O //r o _ r4• r0, '^ 2 Q F' '•R A 91 A L'•'71a tt U, ELEi BOUNDS RON PIPE No �— 176.15' SURVEY.. •' ,1 �_':::. :ET AT CO R. - I �1 44• Yd.' 176.70'MAP Q,.•Y _ I O -4 NOW OR FORMERLY MARIE SERNATZ um N :•:'w IUSER 754 , D. 9. 1002 a CL Q Q J I i Fntaam County Department DY Ream nvision of gavironmental Health Service, pproved as noted for conformance with o OO S 1 RE ,pplicable Rules and Regulations Of the W mutnam COUIIty Health Department. SURVEY O F PROPERTY SITUATE IN THE r` SEWAGE DISPOSAL TIE -INS (BY TAPE) UNIT A B C SEPTIC,TANK 52 20 J.8. 11 41 57 02 47 62 •3 53 67 •4 59 72 #5 64.5 77 46 70 62 i7 7 5 _ e7 END OF TRENCH#- 813 110 4 S3 tll S$.5 S4.S X12 67 6a 113 6 66 C14 7�.5 69 415 S�,S 99 •16 7 94.5 •17 7 90 f16 67 BS.S 119 6 S S1 ego 51' 76.s X21 5 73 THIS IS TO CERTIFY THAT THE SEWA6E DISPOSAL SYSTEM RAS CONSTRUCTED SUBSTANTIALLY AS INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS INSPECTED BY ME BEFORE IT WAS COVERED OVER. THE SYSTEM WAS CONSTRUCTED SUBSTANTIALLY IN ACCORDANCE WITH ALL STANDARD RULES AND REGULATIONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND THE NEW YORK STATEMENT OF HEALTH. 'OPERTj'._(ZF _4'__N0VOT14 Y ,,AND +S PJ-hCE pwrtigm VALIFY '+' n d.1.G/ J nnnl AHL r•. P. F. S/dL19,3 TOWN OF PUTNAM VALLE` PUTNAM COUNTY NEW YORK SCALE : I" = 40' SURVEYED : APRIL' 27, 1992 AMENDED TO SHOW PROPOSED DWELLING & DRIVEWAY :1/21/92 FOUNDATION LOCATION JAN. e, 1993 —" w.LDHO LOCATION 1. DRTVEWAY MAY 24, 1993 ROLAND K. LINK 16 SPRING BROOK DRIVE • MAHOPAC, N. Y. 10541 1914%1628 -- 585[77 Q NEW YORK STATE LICENSED LAND SURVEYOR NO. 04422e