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03705
._
03705
1
SITE LOCATION
PUI'NAM COUNTY HEALTH DEPARTMENT (j
DIVISION OF ENVIRAL HEALTH SERVICES Q
PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR
Lhr, f-60LK& q 1-14ce
KXA(rl.
owner,
DATE
V
PHONE 64 52!2/
TO 21i. l q-- I '3dq
Kt4Z4/r PCHD Complaint #
ant, etc.)
TYPE FACILITY gg�;
PHONE
REGISTRATION #
Proposal (include sketch locating all adjacent wells):
NOTE: Repair must be in same location and of same type as original sewage disposal system.
Different location may require sutmittal of proposal from licensed professional engineer or
registered architect.
Proposal approved Proposal Disapproved
Inspector's Signature &
tle
Date
Proposal approved with the following conditions
1. Procurement of any Town permit, if applicable.
2. Submission of as built repair sketch in duplicate showing:
a. Owner's name.
b. Site Street Name, Town and Tax Map number.
c. Location of installed components tied to two fixed points (e.g.,house corners).
d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' deep
drywells surrounded by one foot + gravel).
e. Installer's name and number.
3. System repair to be performed in accordance with the above proposal and conditions.
I, as owner, or reported agent of owner agree to the above conditions.
SIGNATURE TITLE OATS
OMM: WAte (PCID); YeU cw (fin HI); Pink (k#iamt)
7`17 .. :. :.; a - _ :; s _ �°+r:?;.,� 3"��•,*�''•'$ .�--- -,az:. sue'°. .A�w,- .,,. —�• 4rr- �. mss.^ �^r-... Q ..-- -;. -••-• �---ry w ��. ;y"'-�'^^•�.s�rt�.:.,' .�,. _..-
PUTNAM-COUNTY;DEPARTAZEPTT,OF. HEALTH
Rev 3. 86 ' Dlvtslon ofEnviroediental Health Services, Carmel, N:Y:10512 Provld
Enaiaeer mmist e
p P C.H D Permit N – —87
CERT�JCATE of cONSTRUCrION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM - PlatnamVal l e
Town or�dt121age _ t
Lo�area.a� P.artr.i dge Lane - Somerset Lane Tas 69 <_ ;mot 8.
Luce - Petr l l,o; utnam cres
PP
Owner /applicant Nsme Formerly Sdbdtvleton'Plime - Sabdv Lot Nom_
Matltng Address
RD.. ��3 ; KatOnah, �N Y 10536.:::�p Date Permit hasued a
Separate Sewersige System;bullt by , I ii(?P R PPtr1 1'1 n Address
same
Consisting of 10.00 Gallon Sep 566 380 LF. of . 24?i Trench
Water, Sapplys Palillc, Supply From Address .:
or: X Pr>ratP�sapply nrtnea by Anr1Pr ".enn ' WP.11 ;Ilr Aaareasl.5 Barger Street Putnam -Nall ear , NY
1 stor frame Yes
Building. y Has Ei�oston Control Bein Completed? -
Namber'of Bedrooms 3 -Has Garbage Grinder Been Installed? a a
M1, nA mum : of ,2 , ft . of ROB :' i n Se tic, area ' `, �'
Other Regoirements _
I certify that the system.(s) as listed serving the above 'premi"s..were constructed:essp _ gigs -a tii'o1K�ct e��aAa of the completed work ( copies
of which are attached) :and in accordance with the standards rules and regulati na e!lno rfdan ':with• e� led�'p3an, and the peimit issued by the
yffi
Putnam county Depaitment'Of Health
j' ®
Date Feb ,4;,: 1.5,9Q. ce►tifled by �x �` a P.E.X it.A. 11
Address 1 Northridge ad Pee k�; 1, LltoneeNO 27846
:. ?8Rb
Any person occupying premises served by the above;system(p) shall promptly take such act 4o u►o the correction of any unsanitary
conditions resulting from such usage Approval of the separate ssweroga system shall barn 1 i oa a pub '. sanitary sewer becomes
avatlbbls and the approval'bf the private vvbter supply shall become null and.void when a publ `"comes available.'': Such 6pprovals are
subject to . modification or, change..,when , in the judgment -of the Commisaidnar , suc v R IdFl,,mmodification or chango is necossory.
�j
:Date /i�.lrs —G�1'f
BY `� T ltte
LAB y .- - , s7:_:1, =1= Gov - 6 - $ 7 :
Yorktown Medical Laboratory, Inc. -
321 Kear Street- Date .Taken : -,'S- Pd Time: /
Yorktown Heights, N. 9
Y, 1058
_
«}; (914)245 -28004 Da'teReported.
Director: Albert H. Padovani M. T. (ASCP) Collected By: e -ejmg el -2 -F�
Referred By:
T- , Sample Location: / / he
IT6i AIHhell 70/
,J Phone # 23:_ -,Tka
Cl( Phone # Sample Type:
J Repeat Test? _ (check each)
LABORATORY REPORT ON THE QUALITY OF WATER ,Potable
Non- potable
INORGANIC NON- METALS mg/L ) MICROBIOLOGICAL CFU /100mL STP INF
_ STP EFF
Acidity GENERAL BACTERIA _ Other:
_ Alkalinity
_ Chloride _ Standard Plate Count
Detergents, MBAS (CFU /1.OmL) Sample Status:
Hardness, Total
(check each)
Nitrogen, Ammonia MEMBRANE FILTRATION TECHNIQUE
Nitrogen, Nitrate_ Outgoing
_ Phosphate, Total v Total Coliform
_ Sulfate — _ HNO3
_ Sulfide Fecal Coliform _ HC1
_ Sulfite _ H2S014
Fecal. Streptococcus,.,. NaOH
METALS (mg /.I,) ZnOAc
MOST PROBABLE NUMBER TECHNIQUE _ Na.2S203
Copper _ Other:
Iron. _ Total Coliform Index
Lead -
Mangane _ Fecal Coliform Index Incoming
Mercur
_ Sodium. KEY FOR TERMINOLOGY ZLE 4 °C
_ Zinc CFU = Colony Forming Units - GT 4 0 C
CON = Confluent (q.v. TNTC) _ pH LE 2
MISCEL1ANFOU9.. LT = = Less Than _ pH GE 9
GT = = Greater Than _ pH GE 12
,pH ( units) ,'k N/A Not Applicable _ Other:
olorRaits )Ig j S/A See Attached
_ 'c
`99Odor 4;! /
TNTC= Too Numerous To Count
Turbid!Fd iq, REMARKS /COMMENTS (For. Lab Use)
_ _ q ELAP No . 10323
THESE RESULTS INDICATTHAT THE_WATER SAMPLE Was) (Wasn't) (N /A) OF A
SATISFACTORY SANITARA QUALITY ACCORDING TO THE ORK STATE PUBLIC DRINKING
WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE COLLECTION.
THESE RESULTS INDICATE THAT.THE WATER SAMPLE (Did) (Didn't) U/A)j"
MEET THE
SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK PUBLIC NG WAT ER
CODES, FOR THE PAR RS fSTED,.AT THE TIME OF SAMPLE COLLECTION.
x 2 /86(Rvsd7 /87)RWE
Albert H. Padovani, M.T. ASCP), Director
LL LOCATION
WELL COMPLETION REPORT Office Use Only
DEPARTMENT OF HEALTH
t: Div -ision Of::Environmental .:Hea1�_In.:Ser�ice__s;.-�.� - _ -
PUTNAM COUNTY DEPARTMENT OF HEALTH
t a A TAX GRIOpNUMBEd: ,T E5T A0 0�SS.
WELL DEPTH DURATI N 01 QO YIELD
It. hr.* min.N ttR' . 9Cm-
•s:..
to
WATEP O CLUB
.QUALITY ❑ CLOt Y, . HA DNESS
O COLORE6' :,.,,ANALYZED? . ❑ YES ONO
ANALYSIS ATTACHED? O YES O NO
PUMP INFORMATION
TYPE CAPACITY
MAKER DEPTH
MODEL LTAGE HP
I Ar-/ r 1-, 1 I I 1 A.. .2 11 : I I
STORAGE TANK:. TYPE
CAPACITY GAL.
WE L 1,%L NAME �
ADDRESS SIGMA URE
7
4
WELL OWNER
� PBIUATE
O PUBLIC
USE OF WELL
;1 RESIDENTIAL O PUBLIC SUPPLY O AIR /COND. /HEAT PUMP O ABANDONED
1 - primary •
0 BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify)
2 - secondary
O INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY O
MOUNT OF USE
YIELD SOUGHT 4' gpm. /N0. PEOPL'E'SERVED ---, / EST. OF DAILY USAGES oo gal
REASON FOR
)6-NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION
DRILLING
O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL
DEPTH DATA
' WELL DEPTH 9-P-0 ft.
STATIC WATER LEVEL ft.
DATE MEASURED S�
DRILLING
9-ROTARY O COMPRESSED AIR PERCUSSION O DUG
EQUIPMENT
O WELL POINT O CABLE PERCUSSION O OTHER (specify):
WELL TYPE
O SCREENED O OPEN END CASING. ,OPEN HOLE IN BEDROCK ❑ OTHER
TOTAL LENGTH + ft-
MATERIALS: VSTEEL O PLASTIC O OTHER
CASING
LENGTH.BELOW GRADE ft.
JOINTS: O WELDED ZHREADED O OTHER
DETAILS
DIAMETER in.
SEAL: O CEMENT GROUT O BENTONITE. %DTHER
WEIGHT
PER FOOT �� lb./ft.
I DRIVE SHOE:0-YES ONO LINER: OYES &10
DIAMETER (in)
SLOT SIZE
LENGTH
(ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
SCREEN
:. •...:.:
<.. DETAILS.
FIRST •
-
-
❑ -YES :. ❑ NO
SECOND
-
-
.:HOURS
GRAVEL PACK
❑YES
GRAVEL
DIAMETER
TOP
BOTTOM
O NO
SIZE;
OF PACK in.
DEPTH ft.
DEPTH It.
WELL YIELD,��EST
If detailed
1 pumping
It more detailed formation descriptions or sieve analyses
I�LL LOG are available, please attach.
METHOD: O P! FED ; tests were done is in-
DEPTH FROM
Water
Well
COMPRESSED AIR
,formation attached?
`'" ONO
suRFACE
Bear-
' "g
Dia-
FORMATION DESCRIPTION
CgOE.
❑ BAILED ❑ OTHER YES
ft.
ft
Inter
WELL DEPTH DURATI N 01 QO YIELD
It. hr.* min.N ttR' . 9Cm-
•s:..
to
WATEP O CLUB
.QUALITY ❑ CLOt Y, . HA DNESS
O COLORE6' :,.,,ANALYZED? . ❑ YES ONO
ANALYSIS ATTACHED? O YES O NO
PUMP INFORMATION
TYPE CAPACITY
MAKER DEPTH
MODEL LTAGE HP
I Ar-/ r 1-, 1 I I 1 A.. .2 11 : I I
STORAGE TANK:. TYPE
CAPACITY GAL.
WE L 1,%L NAME �
ADDRESS SIGMA URE
7
4
.e • r,
PUTNAM COUNTY" DEPART OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Owner: or, Purchaser of Building Section
1101:9 G 9 7
Block Lot
Lu.,e & lle,Wi 11 o
Building.Constructed by
Part r�d�z La; e _ `naerc tit Lane Putnam Axcres section A
Location - !'Street` Subdivision Name
thatt. r'a1•:1'ey Z .
Municipality.. Subdivision Lot #
i.. Stony Frame
Building Type
GUARMME OF SUBSURFACE S&QGE DISPOSAL SYSTEM
4V
esent that.I am wholly :.and =completely:.responsible for the location,.,:;,,.:.....:.__„
wor ship.; :material, construction and drainage of the sewage disposal system
sery ... "a ae :a ove described property, and that it has been constructed as shown' on
the aproved plan or approved amendment thereto, and. in accordance with the
stand rds. 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
op�i2 "`condition any part of said'�'system canstrueted by 'me which fails
operate- for a period of two years immediately following the date of approval of the,.'.
.Certificate.of Construction Compliance" for the sewage disposal system, or any`
repairs mad. by me to . such system, .except_ where the failure to operate properly Is-
e
caused,'by..the willful or negligent act of the occupant of the building utilizing
the. system,
The.undersigned further agrees to accept as conclusive the determination of
theD.irector.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
cawed by the willful or negligent act of. the occupant of the building utilizing
the system.
Dated this day of F b MO `Signature
4 Title
General Contractor (Owner),- -Signature
Corporation Name (if Corp.)
Corporation Name (if Corp:..):: =' .
' Address
Ji
Address
rev. 9/85
mk
PUTNAM COUNTY DEPA21MENT OF HEALTH
L
Rev. , 3/86 ' V - Division of Environmental Hedth Services. Carmel, N.Y. 10512 Engineer to Provide Permit #
�, zr on CERTIFICATE OF COMPLIANCE
CONSTRUCTION YOR S...F GE DISPOSAL-SYSTEM Permit .H ���C�
Valley
Located
Partri e .Lane Putnam
Located a Town or Village _
SdbdivisionName PUtY1sI71 - Acres' Sec - "�_. _.:, c _ a A� :: ,r; 69:. :._.
abd. Lot # Tax Map Bloch Lot
Luke Petrillo. Renewal— ❑ Revision ❑
Owner /Applicant Name
RD #3 Kat onah e . N e Y • 10536 Date of Previous Approval
Mating Address Town Zip
Modular 1 a 2 Aefe8
Building Typ- Lot Area Fill Section Only Li Depth Vohtme
Number of Bedigime 3 Design Flow G /P /D 600 P Notification Is Required. When Fill Is completed .
Separate Sewerage Sy,.. m to ceneist of 1000 Gallon Septic Tank and. } 0 Q LF o r enC -
To be censtrv4ed by Howard Gragert Ace Oscawana Lake Rd Putnam Valey, NY
water Supply: p tilic'Supply From _ Address
or: X lmvat Anderson Barger Street Putnam Valley, NY D.Wd t .
Other Requirements n S�P�Y2t, o . B Gravel to level area, and drain to be relocated
I repre58nt that I am wholly and com etely responsible for the design 61Ya tiOtTAOStao 3yS the separate sewage disposal system
above described will be constructed as sawn on the approved amendment there to and in accordance with the standards, rules an regulations o e Putnam
County Department of Health, and th._
be submitted to the Department, and ,aoncompletion thereof .a "Certificate, of Construction Compliance satisfactory to the Commissioner of Healthwill
vrttten guararitee . will be furnished the owner, his successors,. heirs or assigns by the builder, that said builder will
place in good operating condition any Wt 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 o Construction Compliance of the original system or any repairs thereto; 2) that the. drilled well described above
will be located as shown on the approved pl?.
County Department f Health. -
and that -said well will be installed in accordance with the standards. 'rules and regu ads of the Putnam
tment (]
Date August ,30, 19$- . Signed / `. P.E. X R.A._
Addle 10
kenseNo `L'71j,Ej
APPROVED FOR CONSTRUCTION: This a rovai expires one year from the date'issued unless construction of the building has been undertaken and is
revocable for cause or may be amended or m ,ted when considered necessary by the Commissioner of Health. Any change or alteration of construction
requires a new permit. Approved for dispox.of domestic sanitary sewage, afflVor 'vale w e%rc�pply only.
DateZG�f"G / �� BY 'i /!G .� Title
NPARTMENT OF I -IE L I -I-I
Division Of Environmental. Hqz th. Services
" `?= CARMEL,., N.Y.. 10512 (914) 225 -3641
TWO COUNTY CENTER
APPLICATION TO CONSTRUCT A WATER WELL
1
1
WELL TYPE 0 DRILLED F_� DRIVEN E DUG F-] GRAVEL OTHER
IS WELL SITE SUBJECT TO FLOODING? YES N0
IF WELL IS LOCATED IN A R.ETY SUBDIVISION, NAME OF SUBDIVISION: Putnam. Acres Se6 A
LOT NO -:
WATER WELL CONTRACTOR: Name Anderson Address : Barger nam Valley
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO
NAME OF PUBLIC -WATER SUPPLY: None TOw1I /V /C
: DISTANCE D :PROPERTY.. �_ROM..:N.E.AR:EST' WA.TER�.MAu N`
77
LOCATION SKETCH & SOURCES OF CONTMI.INATION.
,August 30; 1986
(date)
PERMIT
TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is
granted under the provisions of Subpart 5 -2 of Part 5 of the New
York State Sanitary Code, and provided that within thirty (30)
days of the completion of water well construction, the applicant
shall:
1. Pump the well until the water is clear.
2. Disinfect the well'in accordance with the requirements '
of the Putnam County Health Department attached to this
permit.
3. Submit a Well Completion Report on a form provided by
the Putnam County Health Department.
Date of I s s u e �2 �.z- -��5— 19j
Permit Issuing Official
STREEI A GRESS-
- 10M VILLAGE ICIIY fAX GRiU Ut16ER.
WELL LOCATION
Partridge
Lane. Putnam Valley
69 --2 -8
WELL OWNER
NME. • AOORESS:
Luke Petrillo -
(9 P$IVATC
_
❑ 2USLIC
USE OF WELL
C2 RESIDENTIAL
❑ PUBLIC SUPPLY ❑ AIR /COND- /HEAT PUMP
❑ ABANDONED
1 - primary
❑. BUSINESS .
❑ FARM ❑ TEST /OBSERVATION
❑ OTHER (specify)
2 - secondary
❑ 1NOUSTRIAL
❑ INSTITUTIONAL ❑ STAND -BY
AMOUNT OF USE
YIELD SOUGHT
5 600
Rpm. /N0. PEOPLE SERVED /EST. OF DAILY USAGE � gal.
REASON FOR
0 NEW SUPPLY
0 PROVIDE ADDITIONAL SUPPLY
❑ TEST /OBSERVATION
ORILLING
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
1
1
WELL TYPE 0 DRILLED F_� DRIVEN E DUG F-] GRAVEL OTHER
IS WELL SITE SUBJECT TO FLOODING? YES N0
IF WELL IS LOCATED IN A R.ETY SUBDIVISION, NAME OF SUBDIVISION: Putnam. Acres Se6 A
LOT NO -:
WATER WELL CONTRACTOR: Name Anderson Address : Barger nam Valley
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO
NAME OF PUBLIC -WATER SUPPLY: None TOw1I /V /C
: DISTANCE D :PROPERTY.. �_ROM..:N.E.AR:EST' WA.TER�.MAu N`
77
LOCATION SKETCH & SOURCES OF CONTMI.INATION.
,August 30; 1986
(date)
PERMIT
TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is
granted under the provisions of Subpart 5 -2 of Part 5 of the New
York State Sanitary Code, and provided that within thirty (30)
days of the completion of water well construction, the applicant
shall:
1. Pump the well until the water is clear.
2. Disinfect the well'in accordance with the requirements '
of the Putnam County Health Department attached to this
permit.
3. Submit a Well Completion Report on a form provided by
the Putnam County Health Department.
Date of I s s u e �2 �.z- -��5— 19j
Permit Issuing Official
DAVID 0. 'BRUEN
County Executive
Mr. John Romeo
1 Northridge Road
Peekskill, NY 10566
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
December 15, 1986
Re: Proposed SSDS
Petrillo
Partridge Lane,. Putnam Valley
:TX Map # 69-2-8 P.V.
Dear Mr. Romeo.-
Review of plans and other supporting documents submitted at this
time relative to the ab6ve'captioned project has been completed. Comrents
are offered as follows:
Trenches should be.redesigned so that-35' separation to piped
watercourse is maintained.
Show detail of piped water ,course under driveway.
Upon receipt of a submission, revised to reflect the above comments,
this application will be considered further.
Very truly your!5'
:Anne M. Bittner
Assistant Public Health Engineer
AMB/jp
TWO COUNTY. CENTER CARMEL, N.Y. 10512 (914) 225-.3641
PUTNAM COUNTY, DEPARTMENT OF HEALTH
DIVISION OF ENVI11ONMENTAL HEALTH SERVICES
DESIGN DATA -SHEET-SUBSUFACE SEWAGE DISPOSAL SYSTEM - FILE NO. -
i;'
Luke Petrillo Address RD #3 KatonaCh N.Y. 10536
Owner -
Palrtr�fte'-Lan�p r,69, 2 8
4 BICa , - � Lot
-Located at (StrPet) -7-7- •
.(indicate nearest. -cross street)
muhi . cipalify
....Putnam Valley (T)
Watershed Hudson River
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WIM APPLICATIONS
of pre-soaking August 79 1986 Date of percolation Test August So 1986
HOLE
NUMBER CLOCK TIME PERCOLATION PERCOLATION
Elapse
Run Depth to Water From Water Level
No. time Ground Surface In Inches Soil Rate
Start-Stop Min. Start stop Drop In Min/In Drop
Inches Inches Inches
(1)1
2s22
202
30
18.25
21.00
2.75
10.91
2
206
3s26
30
18.25
2.0..50
2.25
.13-33
3
3t29
3 09
30
18.25
.20-37
2.12
14.15
4 4,02 4.132 30 18.25 20.37 2.12 , .. .14.15
5
(2)-1
2s28
2158
30
190 00
21-50
2.50
12.00
2
3sO4
304
JO
.19.00
21.25
.2.23
3,39
4-: o9
30
19.00
21.25
2.25
13.33
, -- t
4
.5.
2
3
4
5
NOTES: 1. Tests to be repeated at same, depth until approximately equal soil rates
are cbt&inbdat''ea'dh percolation test -hole. All data. t6 be submitted
for review.
2. Depth reasuremnts to be made from top of hole.
rev. 9/85
TEST PIT DATA RE
!UIRED TO BE SUBMITTED WITH APPLICATION
OF SOILS ENCOUNTERED IN TEST HOLES
41
61.
71
81
go
.10,
12
13'
.141
INDICATE. LEVEL AT WHICH G�RWNMTER IS ENCOUNTERED r one
INDICk7. JZVEL To WHICH qq,TFR LEVEL. RISES AFTER BEING ENCOUNTERED None
DEEP HOLE OBSERVATIONS MADE BY: John S. Romeo DATE: August 79 1986
DESIGN
Soil Rate Usell-15 Min/1" Drop: S.D. Usable Area Provided 5000 SF
3 1000 Masonry
No. of Bedrooms Septic Tank Capacity gals. Type
Absorption Area Provided By 380 L.F. x 24" width trench
Other
Name John S. Romeo
Address I Northridge Road
THIS
Pekkskill, N.Y. 10566
r-E FUR USE BY HEALTH DEPARDOU ONLY:
Signat,
SEAL
Soil Rate Approved sq.`ft /gala Checked by
Oyu 2 0.
t7
PF .L_
nr .0
Date
Pere
Pere 2
p 3
Deep ol
.4
DEPTH
HOLE NO.
HOLE NO.
HOLE. NO.
G.L.
Topsoil,,
Topsoil
Topsoil
'T_ppq.
Topsoil
-
TOPS 0 I-L .'' —
.
Topadit
_ 4
jyV0U_L_1_
Top oil
1''
sandy0siltyv- loam
sandy,silVvloamp-,
sandy,siltyq
sandy,
29
some Targe.
with jravel
SIOM-G-18TVS. S U01180,0
with gravel
1 9
laPame stones
y 0
loam, some
w ith gravel
large stone
with gravel -
41
61.
71
81
go
.10,
12
13'
.141
INDICATE. LEVEL AT WHICH G�RWNMTER IS ENCOUNTERED r one
INDICk7. JZVEL To WHICH qq,TFR LEVEL. RISES AFTER BEING ENCOUNTERED None
DEEP HOLE OBSERVATIONS MADE BY: John S. Romeo DATE: August 79 1986
DESIGN
Soil Rate Usell-15 Min/1" Drop: S.D. Usable Area Provided 5000 SF
3 1000 Masonry
No. of Bedrooms Septic Tank Capacity gals. Type
Absorption Area Provided By 380 L.F. x 24" width trench
Other
Name John S. Romeo
Address I Northridge Road
THIS
Pekkskill, N.Y. 10566
r-E FUR USE BY HEALTH DEPARDOU ONLY:
Signat,
SEAL
Soil Rate Approved sq.`ft /gala Checked by
Oyu 2 0.
t7
PF .L_
nr .0
Date
PUTNAM COUNTY- DEPAR74EW OF HEALTH - DIVISION OF ENVIROI MML HEALTH SERVICES
TUn- nnnrlhT. WATER& SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
of Owner)
REVIEW SHEET - CONSTRUCTION PERMIT
BY:
(Street Lo ion)
ffocumm
Permit Application
Corporate Resolution
Plans - Three sets s /s.
Engineers Authorization
Design Data Sheet (DDS) SUBDIVISION
Deep Hole Log Perc
Consistent Perc Results (3) Fill
30" Perc Hole cd
Other
House Plans - Two sets
If PWS - Letter if wellfpermit
Variance Request
REQUIRED DETAIIS.ON PLANS
Sewage Sys-an Plan
Sewage System Hydraulic Profile - Gravity Flora
Fill Profile & Dimensions - Volume
D or J Box;Trench /Gallery; Pump pit details
Septic Tank - Size, Detail
Well Detail, Service Line if over
Construction Notes
.Design Data
Two -Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footing/Gutter Curtain Drains
Perc & Deep Holes Located
Representative'of Sewage '& Expansion Area
Expansion Area ;sh(ywn;gravty flow,sidff. size
If Pumped Pit I& D Bax Shoran & Detailed
House - No: of Bedroams
Wells & SSDS's w /in 200 ft. of Property Located
.Property Metes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4 " /ft. 4 "0; Type pipe
No Bends; Max. Bends 45° w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
.10' to P.L., Driveway, Large Trees
20' to Foundation Walls
100' to Well; 200' in D,L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. expan)
15' to Drains - Curtain, Leader, Footing
351to catch basin,stormdrain, iped watercourse
10' to Water Line (pits -201)
50' intermittent drainage course
Se tic Tanks
ran Foundation; 50' to well
15' Well to PL
GENERAL .
Legal Subdivision
':Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
:.Wetland (Town /DEC Permit R & D) -
;Data On DDS Plans & Permit Same
DAVID D. BRUEN
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health. Services
Mr. Robert Benedict
Lakeview Drive
North Salem, NY 10506
Dear Mr. Benedict:
May 14, 1986
JOHN SIMMONS, M.D.
Deputy Commissioner
Re: Luce Petrillo SDS Const. Permit Appl.
Sumerset Road, PV, TM 69 -2 -8
Putnam Acres, Lot #28.
Review of plans and other supporting documents submitted at this
time relative to the above - captioned project has been completed.
Comments are offered as follows:.
1. Application and authorization are incomplete. Authorization
is returned for completion.
2. Required trench length for 15 minutes per inch of soil is
375 lineal feet, not 325 as proposed. Expansion area should
also be increased accordingly.
,3. Field inspection of site conflects with submitted data;
:-_-:.specifically.
a. number of deep test holes
b. topography
C. location of stream on lot
d. location of culverts discharging onto lot
4. Title block lacks name and address of designer.
5. Plans lack:
a. Required notes
b. Sewage disposal system component details
C. Well detail
d. Swale detail
e. Design data: deep test and percolation test results and
their locations.
f. Two foot contours
g. Location of existing sewage disposal system and wells
within 200' of property line.
- continued-
TWO. COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
R. Benedict G
L.Petrillo, Putnam Acres 5/14/86
5. h. Property metes and bounds.
i. Footing drain discharge a. minimum of 15 feet from
sewage disposal area. -
6. Percolation test .holes were not evident, accordingly, please
make arrangemanet with the writer to witness repercolation
of soil.
7.. Two sets of house plans bearing a title block have not been
submitted.
8. Minimum separation of 100 feet to.a stream has not been
demonstrated.
9. Details are incomplete or incorrect:
a. Septic tank bedding is lacking.
b. Specification for box is lacking. Slopes such as those
encountered dictate drop boxes rather than distribution boxes.
C. Maximum trench length is 60,.not 75 feet.
d. Septic tank inlet and outlet pipe slopes.
10. Separate "Fill Placement Plan" should not show sewage disposal
system components in plan, or their details.
Generally; separate specifications may -6. e submitted,Mthough the
required information exclusive of compenent details must also be shown
on plan. Enclosed for your reference is a copy of the Department's
"Program Review and Policies ... for Single Family Residence ", which
governs submission. Your attention is directed to pages 1 -4 and
Appendices A -M.
Upon receipt of a submission', revised to reflect the above comments,
this application will be considered further.
Very truly yours,
CJ-emes S. Hod n
ge s
Assistant Public Health Engineer
JSH:amm
Enclosure
PUTNAM COUN'T'Y DEPAR24M OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEDGE DISPOSAL SYSTEMS
REVIEW -
HEFT . -_.CONSTRUCTION PERMIT
DATE REVIEWED: -15-12-6C 1 �J• BY:
( of Owner) (Street Location)
DOC[II4ENTS
Permit Application
Corporate Resolution
Plans - Three sets
Engineers Authorization
Design Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results (3)
30" Perc Hole
Other
House Plans - Two sets
If PWS - Letter
Variance Request
REQUIRED DETAILS ON PLANS
Sewage System Plan
Sewage System Hydraulic Profile- - Gravity Flow
Fill Profile & Dimensions Volumes �� �'A\ r�
D or J Box;�f� . Pump pit de ils
Septic Tank - Size, Detail
Well Detail, Service Line if over
Construction Notes
Design Data
Two -Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footing /Gutter Curtain Drains
Perc & Deep Holes Located
Representative of Sewage & Expansion Area
Expansion Area;:shown;gravity :flow,.suff..'size,
If Pumped Pit & D Box Shown & Detailed
House - No. of Bedrooms
Wells & SSDS's w /in 200 ft. of Property Located
Property Metes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4 " /ft. 4 "0; Type pipe
No Bends; Max. Bends 450 w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
00' to Stream, Watercourse, Lake (inc. expan)
(!15o Drainsrtain,Storm,Leader, ooti
' to Catch Basin
10' to Water Line (pits -201)
Septic Tanks
10' from Foundation
50' to Well
15' Well to PL
MEGENERAL',�1"
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Town /DEC Permit R & D)
Data On DDS Plans & Permit Same
�
®e
0�
■
DOC[II4ENTS
Permit Application
Corporate Resolution
Plans - Three sets
Engineers Authorization
Design Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results (3)
30" Perc Hole
Other
House Plans - Two sets
If PWS - Letter
Variance Request
REQUIRED DETAILS ON PLANS
Sewage System Plan
Sewage System Hydraulic Profile- - Gravity Flow
Fill Profile & Dimensions Volumes �� �'A\ r�
D or J Box;�f� . Pump pit de ils
Septic Tank - Size, Detail
Well Detail, Service Line if over
Construction Notes
Design Data
Two -Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footing /Gutter Curtain Drains
Perc & Deep Holes Located
Representative of Sewage & Expansion Area
Expansion Area;:shown;gravity :flow,.suff..'size,
If Pumped Pit & D Box Shown & Detailed
House - No. of Bedrooms
Wells & SSDS's w /in 200 ft. of Property Located
Property Metes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4 " /ft. 4 "0; Type pipe
No Bends; Max. Bends 450 w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
00' to Stream, Watercourse, Lake (inc. expan)
(!15o Drainsrtain,Storm,Leader, ooti
' to Catch Basin
10' to Water Line (pits -201)
Septic Tanks
10' from Foundation
50' to Well
15' Well to PL
MEGENERAL',�1"
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Town /DEC Permit R & D)
Data On DDS Plans & Permit Same
PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL DATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS
INSPBCT-ION REPORT
� T9 IoM E - " ''A -P, t V,
(Name of Owner) (Street tion)
INITIAL SITE INSPECTION -2 K 127- YES NO
Wetlands on /or proximate to property.............. Y 2-
Property lines or corners found ...................
Can estimate house location .......................
Will driveway need cut ............................
Must trees be removed - note these ................
Deep holes representative of entire SDS area......
Additional deep holes needed...... .. .. .... p
Sufficient SDS area available considering driveway
cut, house location, separation distances,etc... ►�
Adjacent wells /septics ....................... >....
Access to proposed well location for drilling..... .�
DATE: w
INSP. BY:
CANTS
FINAL SITE INSPECTION INSP.BY:
YES
NO
COMMENTS
D.H. - Deep Hole
D.H. 1 Lot
D.H. 2
Lot /_
G.W. -Group ter
D.H. 3 Lot c�
Depth
to G.W. 4
Depth
to G.W.
Depth to G.W.
Depth
to rock
Depth
to rock
Depth to rock
Soil Descri tion
Soil Description
Soil Description
0 ft.
0 ft.
0ft-.
it�
6t�Jt°'3`f''
3 ft.
r• 3r�t
10 ft. maintained from property line and
ft.
6 ft.
6 ft. _
9 ft.
Distance well to SSDS (ft.) ......................
9 ft.
9 ft.
12 .ft.
: ^ .- .-
- E :ft.
...
_�.
_ -12-f t^ q
than 15 ft. from nearest trench ................
FINAL SITE INSPECTION INSP.BY:
YES
NO
COMMENTS
House SSDS located per approved plan .............
Length of trench measured
Width of trench average
Slope of tile line and trench acceptable.........
Roan allowed for expansion trenches ..............
Over 100 ft. fran watercourse ....................
Natural soil not stripped or SDS area
unnecessarly graded.......... .... ........
10 ft. maintained from property line and
20 ft. from house... ........................
Distance well to SSDS (ft.) ......................
Number of bedroams checks ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. from nearest trench ................
15 ft. of peripheral soil horizontally
fran trench ..... ...............................
Boxes properly set.. . ................ .........
could surface runoff fran driveway, roads,
ground surface, etc., channel near SDS area....
Does lot drainage appear OK in area of SDS.......
FINAL GPMNG OF SITE ACCEPTABLE,,,,. ....
._
r
DETAILS AND SPECIFICATIONS FOR THE COUNTY HEALTH DEPARTMENT PERMIT
ISSUED TO: ° %r�� sly, / L�'at
LIST OF DETAILS:
1. Absorption trench detail
2. Absorption sytem "typical"
3. Concrete septic tank detail.
4. Distribution box detail.
5. Drop manhole detail.
6. Serial distribution detail.
7. Typical well detail.
8. Curtain Drain detail..
9. Addendum XX
(All of the above items become part and parcel of the Health
Department Permit issued on the aforementioned project, and all
rules and regulations, details and specifications governing those
items shown in the plan and only those items approved in the plan
in their exact locatio` - '�'rictly follow these specification.)
_.. -.Certifi:ed by:
�� rt /Yn4
obeWt egb'6�i:: 5V, R-. A.
J'>s
'• y '115 4?' U� y�`3
OF Nj
architects & engineers
LAKEVIEW DRIVE, NORTHSALEM, N.Y. 10560
f-
TOP $OIL FOR SETTLING
51
6 M MIN
12" EARTH BACKFILL
NOTE: Do not install trenches in wet soil.
Rake sides and bottom of trench prior to placing gravel.
End of all distributor pipes must be plugged unless interconnected.
FIGURE 11
ABSORPTION TRENCH DETAIL
19
UNTREATED BUILDING PAPER OR STRAW
0 o
O Q Qa mr o : a Q ®
p0 a 1 aO 8 m by 41
On
. a Q
®
Q O
a DISTRIBUTOR PIPE
V b a ® O
PERFORATION
JOINT
Ir MIN
a IS
a
a b° 4 a ®b
o a o
®.
�, p o a d�p
t d to a
o 4 4 v
.0. ® o
o a r rr O p
b o Q
® o ®
c+ p
Oil O v
® SLOPE - PER FT.
1e
®
A ® G ®
ep p 6a
o
o Q � Q
0 0 32
®8 a
qP
a 0
Q 000 A p a b a
o e
o o O S o Ja ®0
24„
SPACING OF
CRUS14ED STONE - r TO I r
r
YMIN
ABSORPTION TRENCH WASHED GRAVEL r
B, O.C.
GROUNDWATER, BEDROCK,OR IMPERVIOUS LAYER
CROSS SECTIONAL VIEW
LONGITUDINAL VIEW
1T MAX
B'MIN�
UNTREATED BUILDING PAPER
OR STRAW
DpOOa
AIN'
G9 o
p p e p 4 o ®
0° 4
o a ®O C, O O Q apIDa a
FLOW
ppo
Q p d Q� p QGoo Bel
V O n
O p° a DIG O� cr
a
p o °a O o ° p a d d
v a° a o
o a 0-4
SLOPE TRENCH BOTTOM 1_ - LM FT:
11 32
TRENCH
PROFILE
NOTE: Do not install trenches in wet soil.
Rake sides and bottom of trench prior to placing gravel.
End of all distributor pipes must be plugged unless interconnected.
FIGURE 11
ABSORPTION TRENCH DETAIL
19
. Q
.STREET
15" IN.
lj WELL
1 I
I
I I
I
i
l DRYWELL I WAY.
1
I
(Roof i
Footing
Drainage)
2 BEDROOM
HOUSE l
I
7GARAGE PROPERTY
1 LINE
10' MIN. HOUSE SEWER C.O. LAUNDRY WASTE
r-------- - - - - -- - - -- -T
LIMITS OF SEPTIC TAN I ' SEPTIC TANK AT
FILL 1 LEAST 50' FROM
' I DISTRIBUTOR PIPE TIGHT JOINT WELL AND 10'
— — — — — — — 4" PIPE ION FROM HOUSE
SLOPE F
I 2V - - -- — -- 1/8.1 14
MIN. 1
D STRIBU�ION BO6C
Sir
� I
I MIN.
MIN. 1
L — — — — — — _ — — _jLIMITS OF FILL —! — I
4
--- ...._. __ ...,. -.... .. �► sue, �_ ...
PLAN
TAPERED PERIPHERAL is" to T4" - `—
,4_ ORAINAOE y SLOPE SW PER PT
STRIP
Tight clay toll, hardpan, or
SECTION A — A
C NATURAL
•TAOILIZE 7 OIL L GROUND
4
!READ IN AYERS, _ LEVEL
Utilize all available natural topsoil.
Adapted From: Salvato, J.A., Jr., Environmental Engineering and Sanitation, Wiley — Interscience,
New York (1958, Revised 1972).
FIGURE 15 E�v- Ir
EVAPOTRANSPIRATION —ABSORPTION SYSTEM
28
FIGURE 6
TYPICAL CONCRETE SEPTIC 'TANK
12
LOCATION
GROUND
SURFACE
STAK E
MANHOLE COVER- j
12 "t
MANHOLE COVER
w
(— SEAL
.ASPHALTIC
INVERT OF INLET Y' ABOVE
® °
INVERT OF OUTLET
INLET
—�
LIQUID LEVEL
— OUTLET
CAULKED JOINT
o to
°
CAULKED JOINT
A
°
SANITARY TEE
It
- - — - - —
18" -
•
SANITARY TEE
•,.
BAFFLES MAY BE USED
e
o
INSTEAD OF SANITARY TEE
: -'
a
48" MIN - 60" MAX
=_
o' •
LIQUID DEPTH
6" MINIMUM-
-_
a •,
WALL THICKNESS FOR
POURED IN PLACE
® 6A
CONCRETE
SECTION - VIEW
I
ASPHALTIC I
e •v.
SEAL I I
' •'
o '•
r t-i
I
20" MIN I
'
INLET
1� N�`
i
-o
RING I O
OUTLET
_�
I
i. I- - t'
BOLTS
! I i
•
.
'm man
♦ O p. II .b.
'V .0
.
PLAN VIEW
FIGURE 6
TYPICAL CONCRETE SEPTIC 'TANK
12
.a
Ir
OUTLETS
--0- IN
w _ OUTLET .:.
)UTLETS
1 t
PLAN VIEW
NOTES:
1. Pipe joints to be sealed with
asphaltic material or equivalent.
2. Invert elevations of all outlet
12" MIN. REMOVABLE pipes must be equal.
ER
••• 21W. • • • ••• 3. The slope of outlet pipes between
the distribution box and distributor
INLET = BAFFLE INVERT laterals should be 1/8" per foot.
• 2" MIN. ELEV. OUTLET
—�-
1'# TO 5"
17 f �� CLEAN SAND or
12" MIN. PEA GRAVEL
FIGURE 8 E'-.W
DISTRIBUTION BOX DETAIL
15
r
.� :;•. " as - o'al top of - ..._.°.,. o _ °a °ol~ -
I c
Open joint farm l o o . o v, over op iy o pipe 1*. 0 0 000:
tile, perforated, ' °, ° o c.o l when farm tile is used o 0 0 00 ooq
I° O.°0 p °� coo l
or bell and spigot 4" to .4 I °�000 -= oo °Ogl
pipe Lis 0 °°
Tight Slope S,e" per ft
Hh I ('/,: "with dosing tank)
24"
Tight joints
From septic tank
or dosing tank
24" Space laterals, at least 6' on centers with
• 24 " trench.
roams a aaE-- Gravel limits of file field- �°f�;o° ogod
Length of. lateral
601 to 751. May loosOvo° _� a o °O;I ( `�i i=� �l.�i.[ j I'o, - 000�
be 100' with to °0 0 0•l Woo. �°e of
dosing tank I °° a I'° °d'
° e,
I eo oo° op°
Trench
width
Plan
-r - Berm or ditch upgrade..., ° • - ... - _. . �_ _ _ _ _ .
to divert surface water
Removable cover
preferred `
12" ravel o,00 ; o °• o
foogng -�Q iia ? "� i.;IQ -4" poured concrete; 8" brick 1" 4
masonry; 6" or 8" concrete
block; clay, concrete,or
cement asbestos pipe cut to '
specifications, or precast Below frost doe o000 0
Section on It 2" reinforced concrete Laterals flush° -0000
with bottom
From: Sal vato, J.A., Jr., Environmental Engineering and Sanitation, Wiley- Interscience, New York (1972).
FIGURE 10 ;I;r�
DROP MANHOLE DETAIL
17
Distribution boxes may be. constructed in. place . or
purchased prefabricated. The drop between inlet and outlet
inverts should be at least two inches. Boxes with baffles
help prevent short circuiting (see Figure 8).
Serial Distributors
Unlike distribution boxes which evenly distribute flow
among laterals, serial distributors fill individual trenches in
sequence. Serial distribution systems may be used for soils
with variable absorption rates and in sloping terrain.
The serial distributor is designed to allow a trench to fill
to the full depth of gravel before discharging to the next
successive trench. Distributor lateral sections are connected
with tight joint pipe and should be placed in undisturbed
soil (see Figure 9).
Drop Manholes
A reduction in the velocity of sewage flow often must be
made for absorption fields on steep sloping grades.
Excessive velocity will hinder even distribution in the
subsurface absorption field. The velocity of flow can be
reduced by use of drop manholes as illustrated in Figure 10.
Dosing Devices
Dosing tanks are chambers which store septic tank
effluent and periodically discharge to a large absorption
field or sand filter. The use of dosing devices permits the
rapid charging and distribution of effluent throughout the
disposal system followed .,by a period. during which no
effluent enters the system.
Household sewage disposal systems rarely require dosing
units. When indicated, it may be preferable to arrange the
plumbing so as to divide the flow into two separate systems
and avoid dosing complications. However, sometimes they
are made necessary by large sewage flows combined with
semi - impermeable soils. When dosing is necessary, a
professional engineer or registered architect should be
engaged to design the system, supervise construction and
implement startup.
In absorption fields, single dosing units are required
when the total trench length exceeds 500 feet. Alternate
dosing units are used when the length exceeds 1,000 feet.
Automatic dosing may. be performed by automatic
syphons, or pumps. Manually operated devices are not
recommended. Among automatic devices, those operated
hydraulically and by gravity flow are preferred because
they have no moving parts to mechanically fail and will
operate during power failures. Alternate dosing devices have
two units of equal capacity with each dosing half the field.
All dosing devices should be easy to inspect and should
include a gravity overflow line in case of failure.
Upon installation, new syphons should be primed with
water. If hydraulic bell syphons are used, they can be tested
for leaks by covering with water and inspecting for air
bubbles. Mechanical float valves should be tested and
adjusted. for correct. discharge level. Pumps and float
controls should be readily accessible for servicing.
From septic tank _ (rA
., r. Tj .Ta'" �""rZ lei•.,. . TT : � �7 s .-_
Vol trwKh, bottom level Undisturbed
such between
trenches
Distributor lateral laid level
C
\ Invert at least 4• lower than
Berm or ditch Ell invert of septic tank outlet
upgrade to Tee
surface water
S• : p
Tight Joie
Tee
1
minimum • •
tr
:1.. minimum
All
From: Salvato, J.A., Jr., Environmental Engineering and Sanitation, Wiley - Interscience, New York (1972)
FIGURE 9 f�- , V1
SERIAL DISTRIBUTION DETAIL
16
FINISHED GRADE
ToPSo+ c,
PA,9E]?-
e . 24-64-IEIJ
Tot
LEAP
7Z� [;'AX-L6"-r
Foo-r1KI6 wwem REePUIMEV Vck-fT
Ot-rrS (VIC C4t,4#J & OW- CV-1
Hc:u ' To See W 6CeAi-Eo- 7-
e&e A- PUDDF-D e-,LAy
lk- J OF &o' IF' sE--=V-dcr -
AiZo
"OTC :K-JO PERP•17-rC-r:>
r
r
N-EDIC.-T-ASS-0C TES
DETAILS AND SPECIFICATIONS.FOR THE COUNTY HEALTH DEPARTMENT PERMIT
ISSUED. TO: Z -�-
LIST OF DETAILS:
1. Absorption trench detail
2. Absorption sytem "typical"
3. Concrete septic tank detail.
4. Distribution box detail.
5. Drop manhole detail.
6. Serial distribution detail.
7. Typical.well detail.
8. Curtain Drain detail.
9. Addendum XX
(All of the above items become part and parcel of the Health
Department Permit issued on the aforementioned project, and all
rules and regulations, details and specifications governing those
items shown in the plan and only those items approved in the plan
in their exact location s "V-t' 'ctly follow these specification.)
Certificd;by:
Rober
C)S
e ': At
9TH. �125A,
OF N
arehiteets & engineers
LAKEVIEW DRIVE. NORTH SALEM, N.Y. 10560
TOP SOIL FOR SETTLING
w. B MIN EARTH BACKFILL
!r• M
UNTREATED BUILDING PAPER OR STRAW
d® 14 ® o .® 4 B p os p O O p 0 ®® v0 V D p
O m 81 o p d p '0 O
o® ® o o v.
DISTRIBUTOR PIPE
4 PERFORATION JOINT .
tr' MIN � ® O ® 3 ° ° ®4
0 0 ® a ®as�a e® oa ° o ®a ®AO ®a 0 Sp own 4 p.0
O b O O r es. Y a a o O W tl® p1 SLOPE 1! - tt PER FT. Q Q
d
o s D °o° Q a o C o o a o a°
• SPACING OF ± 1'
CRUSHED STONE - _ TO 1
rMIN ABSORPTION TRENCH WASHED GRAVEL 4
s• D.C.
GROUNDWATER, BEDROCK. OR IMPERVIOUS LAYER
CROSSSECTIONAL VIEW LONGITUDINAL VIEW
1r MAX '
r MIN
UNTREATED BUILDING PAPER OR STRAW
O OQ ® uo0 0 d
d� ® 0 0 O0 O 4 D ®Op0 p i� a p p0 A o 0 440 p Q® p aaOa d rMIN
- FLOW
Q Q p d :13
®® p o ,p o p19 d g' d a ®04 a 0 a ®onOo d s o
SLOPE TRENCH BOTTOM_ - I_PBR FT'
Is u
TRENCH PROFILE
NOTE: Do not install trenches in wet soil.
Rake sides and bottom of trench prior to placing gravel.
End of all distributor pipes must be plugged unless interconnected.
FIGURE 11
ABSORPTION TRENCH DETAIL
19
TAPERED PERIPHERAL 18' to 24"
STRIP �— DRAINAGE SLOPE %" PER PT � t NATUPAL
_ — w - • — — _ �. — , �,.�. , .. _ VISP iTASILIZE FILL GROUNO
kDINf7.AyERS. LEVEL '
dodo I
YTOP SOIL -12"' T01S' MIN. EXISTINp
24" MIN.
Tight clay soil, hardpan, or rock-O" Utilize all available natural topsoil.
SECTION A — A
Adapted From: Salvato, J.A., Jr., Environmental Engineering and Sanitation, Wiley — Interscience,
New York (1958, Revised 1972).
FIGURE 15�
EVAPOTRANSPIRATION —ABSORPTION SYSTEM
28
STREET
• - .,,�.,: .••...... • - .: - -._ ..... ter- ..
.15,E -- --
- ..� �
WELL
1 I
I
1
I
1
ORYWELL I
DRI-
1
1
I
WAY
(Root��
Footing
Drainage)
2 BEDROOM
HOUSE
I
GARAGE
PROPERTY
1
LAUNDRY
LINE
10' MIN. �+
LAUNDRY WASTE
HOUSE SEWER
C.O.
I
1
LIMITS OF
SEPTIC TAN
1 SEPTIC TANK AT
I I
LEAST 50' FROM
I DISTRIBUTOR PIPE
TIGHT JOINT
WELL AND 10'
_
1 — — — — —
— —
4" PIPEION
FROM HOUSE
1 �— — — — — —
— —
SLOPE F
1 29' — — — — — —
'M _ _
MIN. I�--
— — 1/8" PE� FT.
STRIBUIrION B&
JD
58'
I
( I MIN.
I
LIMITS
_MIN.
OF FILL
_ J
4
PLAN
TAPERED PERIPHERAL 18' to 24"
STRIP �— DRAINAGE SLOPE %" PER PT � t NATUPAL
_ — w - • — — _ �. — , �,.�. , .. _ VISP iTASILIZE FILL GROUNO
kDINf7.AyERS. LEVEL '
dodo I
YTOP SOIL -12"' T01S' MIN. EXISTINp
24" MIN.
Tight clay soil, hardpan, or rock-O" Utilize all available natural topsoil.
SECTION A — A
Adapted From: Salvato, J.A., Jr., Environmental Engineering and Sanitation, Wiley — Interscience,
New York (1958, Revised 1972).
FIGURE 15�
EVAPOTRANSPIRATION —ABSORPTION SYSTEM
28
LOCATION GROUND SURFACE
STAKE
MANHOLE COVER Ixi 12"±
'o •'•. p•• 4p, .4 ':B/ 0:
I ASPHALTIC
SEAL "
•e , e
r ) 120" MIN N
O OUTLET
INLET li t� RING I
J BOLTS
g
• O o: C n •v A � �. -p
PLAN VIEW
FIGURE 6 � Ic
TYPICAL CONCRETE. SEPTIC TANK
12
%•
V-- SEAL
a:
.ASPHALTIC
INVERT OF INLET 2" ABOVE
® o
INVERT OF OUTLET
INLET
+
LIQUID LEVEL
- OUTLET —i-
CAULKED JOINT
o 'p
°
16
CAULKED JOINT
A
- - - -- - - —
18'• -
SANITARY TEE
.e• r
SANITARY TEE
o
••"
BAFFLES MAY BE USED
o
°
INSTEAD OF SANITARY TEE
_-
q 0
•Q
48" MIN — 60" MAX
LIQUID DEPTH
m
61• MINIMUM
_"
° • •
WALL THICKNESS FOR
_
q
. •
POURED IN PLACE
-
®' .t. ,�,.
• „•. ® o ; �. o �• o. ,• _ :'.. = ®� 4,'
o
CONCRETE
- .C. .a e'. .
o •� v . •.: sue. -�.. . p,; . ' o
a1
SECTION - VIEW
'o •'•. p•• 4p, .4 ':B/ 0:
I ASPHALTIC
SEAL "
•e , e
r ) 120" MIN N
O OUTLET
INLET li t� RING I
J BOLTS
g
• O o: C n •v A � �. -p
PLAN VIEW
FIGURE 6 � Ic
TYPICAL CONCRETE. SEPTIC TANK
12
• .
y OUTLETS u
1
m
'OUTLET
PLAN VIEW
NOTES:
1. Pipe joints to be sealed with
asphaltic material or equivalent.
..���nH� • �'1i� 7� /� !•.// ira►�i� r�iiN���'' + 2. Invert elevations of all outlet
12" MIN. REMOVABLE pipes must be equal.
_. .
•' "• '
jNERT 3. The slope of outlet pipes between
BAFFLE the distribution box and distributor
INLET � 2•• MIN. OUTLET laterals should be 1/8" per foot.
V. -0- � /// 1" TO 5" ,.,
I r-
12" MIN.
)UTLETS
CLEAN SAND or
PEA GRAVEL
FIGURE 8
DISTRIBUTION BOX DETAIL
15
.� -� • _r - -^ �� Open joint farm lo°
tile, perforated, o l
or bell and spigot 0 0
pipe i_oo
1011M
6"• tarp'apeVstAp'.:.:.....
o� a 1— over top % of pipe
p c
p'; I when farm the is used
go
c
— 34" to
,
° _O d
Slope 5,s" per ft _
Tight
g j
(yi:" with dosing tank)
24"
R• �
'i
From FSep 1C an E
or dosing tank
24"
row
Length of lateral o0
60'to 751. May Ira;
be 100' with I°
dosing tank
o �
Trench
width
Tight joints
Space laterals, at least 6' on centers with
24" trench,
-Gravel limits of tile field
( S EC pLA., 0, )
•al
s�e_
va
of
.�0,
Plan
Berm or ditch upgrade -
to divert surface water
Removable cover
preferred `
12" ravel O,osl.o < ��Io00
footing �0 6 °0 0 ? "� i,;t� –4" poured concrete; 8" brick 1 4
masonry; 6" or 8" concrete 0
block; clay, concrete,or °•
cement asbestos pipe cut to Below frost 'o' o °o° °
specifications, or precast o, o 00
Section on 2" reinforced concrete Laterals flush° s° e 00
with bottom
From: Salvato, J.A., Jr., Environmental Engineering and Sanitation, Wiley- I nterscience, New York (1972).
FIGURE 10 V. 7:
DROP MANHOLE DETAIL
17
0
Distribution boxes-may be, constructed- -in place or
purchased prefabricated. The drop between inlet and outlet
inverts should be at least two inches. Boxes with baffles
help prevent short circuiting (see Figure 8).
Serial Distributors
Unlike distribution boxes which evenly distribute flow
among laterals, serial distributors fill individual trenches in
sequence. Serial distribution systems may be used for soils
with variable absorption rates and in sloping terrain.
The serial distributor is designed to allow a trench to fill
to the full depth of gravel before discharging to the next
successive trench. Distributor lateral sections are connected
with tight joint pipe and should be placed in undisturbed
soil (see Figure 9).
Drop Manholes
A reduction in the velocity of sewage flow often must be
made for absorption fields on steep sloping grades.
Excessive velocity will hinder even distribution in the
subsurface absorption field. The velocity of flow can be
reduced by use of drop manholes as illustrated in Figure 10.
Dosing Devices
Dosing tanks are chambers which store septic tank
effluent and periodically discharge to a large absorption
field or sand filter. The use of dosing devices permits the
rapid charging and distribution of effluent. throughout the
From
Berm or ditch
upgrade to dive
surface water
disposal system followed by a period during" which no
effluent enters the'sy'sfem: `
Household sewage disposal systems rarely require dosing
units. When indicated, it may be preferable to arrange the
plumbing so as to divide the flow into two separate systems
and avoid dosing complications. However, sometimes they
are made necessary by large sewage flows combined with
semi - impermeable soils. When dosing is necessary, a
professional engineer or registered architect should be
engaged to design the system, supervise construction and
implement startup.
In absorption fields, single dosing units are required
when the total trench length exceeds 500 feet. Alternate
dosing units are used when the length exceeds 1,000 feet.
Automatic dosing may be performed by automatic
syphons, or pumps. Manually operated devices are not
recommended. Among automatic devices, those operated
hydraulically and by gravity flow are preferred because
they have no moving parts to mechanically fail and will
operate during power failures. Alternate dosing devices have
two units of equal capacity with each dosing half the field.
All dosing devices should be easy to inspect and should
include a gravity overflow line in case of failure.
Upon installation, new syphons should be primed with
water. If hydraulic bell syphons are used, they can be tested
for leaks" by covering with water and inspecting for air
bubbles. Mechanical float valves should be tested and
adjusted for correct discharge level. Pumps and float
controls should be readily accessible for servicing.
From septic tank rr A
2...,
A4 A
bench, botEom 1e11e1 Undisturbed
earth between
trendies
Invert st West 4' kwa than
invert of septic tank outlet
Salvato, J.A., Jr., Environmental Engineering and Sanitation, Wiley- Interscience, New York (1972)
FIGURE 9 . Vi
SERIAL DISTRIBUTION DETAIL
16
0
9k E ,
r
rn G
I`
\m
1
1
d
o
�•h
t.
ri
tn
-�
rn
f•'
�r
r:
3.,
rr
e
PUTNAM COUNTY DEPARMW OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL %MTER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS
_._...
FIELD U= F-XIUN REPORT
� 4*11. L
(Name of Owner) (Street Location)
INITIAL SITE INSPECTION YES NO
Wetlands on/or proximate to property ..............
Property lines or corners found ...................
Can estimate house location .......................
Will driveway need cut....... ...................
Must trees be removed - note these............ ..
Deep holes representative of entire SDS area......
Additional deep holes needed..... ... ... ....
Sufficient SDS area available considering driveway
cut,-house location, separation distances,etc...
Adjacent wells/ septics ............................
D.H. 1 Lot
Depth to G.W.
Depth to rock
Soil De,
0 ft.
3 ft.
6 ft.
9 ft.
12 ft.
D.H. 2 Lot
Depth to G.W.
Depth to rock
Soil De.
0 ft.
3 ft.
6 ft.
9 ft.
12 £t, .,
DATE:
INSP. BY:
D.H. - Deep Hole
G.W.- Groundwater
D.H. 3 Lot
Depth to G.W.
Depth to rock
0 ft.
3 ft.
6 ft.
9 ft.
12 ft.
Soil DeSCr
DATE:
FINAL SITE INSPECTION INSP.BY:
YES
NO
COMMENTS
House SSDS located per approved plan .............
Length of trench measured
Width of trench average
Slope of tile line and trench acceptable.........
Roan allowed for expansion trenches ..............
Over 100 ft. from watercourse ....................
Natural soil not stripped or SDS area
unnecessarly graded.......... ..... ........
10 ft. maintained from property line and
20 ft. from house... ........................
Distance well to SSDS (ft.) ......................
Number of bedroans checks ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. from nearest trench.. ...... ...
15 ft. of peripheral soil horizontally
fran trench ..... ...............................
Boxes properly set .. . ....... .......... .........
Could surface runoff fran driveway, roads,
ground surface, etc., channel near SDS area....
Does lot drainage appear OK in area of SDS.......
FINAL GRADNG OF SITE ACCEPTABLE ..........
—�
—�
PUTNAM COUNTY 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 -off > /Z
Addre s s % fCdc -a�a
Located at ( Street Sec. /�- Block Lot - - -'
kindica e nearest cross street
Municipality y`�c iJ2atrf �i
Watershed
.
SOIL PERCOLATION TEST
DATA
REQUIRED TO BE SUBMITTED WITH APPLICATIONS ,
T67
Number CLOCK TIME
.5
PERCOLATION PERCOLATION.:
Elapse
Depth to Water a er Level
No. Time
From Ground Surface.in Inches Soil
Rate,,.
Start-Stop Min.
Start Sto p Drop in Min: /in
drop"
Inches Inches Inches.
2 % �. � 's}
a C19.5
/
3 1121
7
5 �a
J,
5-
�_
5 f 3 z,2
?
2
1
`NF
.
-3
.5
t
Notes: 1) T6\�ts 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.
.6011
6 It
6.
t
721I
11
78: 1
84
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
T fT,
jhrDIG-ATE* VET WHICH WATER LEVEL- . RISES -AFTER- BEING- ENCOUNTERED
TESTS MADE BY Date o 3 - /-7 -e6
DESIGN
Soil Rate Used 4✓ b1in/1"Drop: S.D. Usable Area" Provided e•o -0
No. of Bedrooms Septic Tank Capacity %2 5o Gals. Type
Absorption Area Provided 'By lz25 L.F.x2411 V_ 37— width trenn
Other
6w heg _'dea� '4
Mi- Slanature lk'A
A ddress.
j 141A_,__rA lq,7 A10 -47, A), V /V 6
THIS.SPACE
FOR-.,:USE
BY HEALTH DEPARTMENT
ONLY:
Soil,,,R&te.Approved
Sq. Ft/Gal.
Checked by
012V�o
12
"
4�4,
OF
,7 1 -7
Z
I i o' i 4'? 7, " Q ?
1� A 'K IR J'.�j " S �'"l
Vw'!CE R. FOLEY, H.S.
I
A-;`-n� VlaJ!-'h D;'Rc',Or
ifixyaental
4 ceftemq
19-114)
3
Ir TX MAr' 19
5-f
AdG (AT
?f V
r G AD
'D
//V
/Z¢ x2I ONE
t i 1p Z"
11 EL
Art
I
4
Cou
AR, i
infor6
Ce r r i ed
an
S'Y of
6ir�iltiii :5 1a
cK) r
Q-1 'or-op--L -"
your
lrvev We
s A -iy
:1 'd ni;
of
of
p rttt,l
i cat k on
AU9USt
July 1998 (Revised}
DEPARTMENT OF HEALTH
Division of Environmental .Health Services
4 Geneva Road
Brewster, New York 10509
Tel. (914) 278-6130 Fax (914) 278-7921
Jacqueline Lynnfield R.A.
25 Evergreen Road
Putnam Valley NY 10579
Dear Ms. Lynnfield:
BRUCE R. FOLEY
Public. ,Health_. - Director.: - -
September 9, 1998
Re: Addition - Christian and Carma Luce, 8 Partridge Lane
Increase in Number of Bedrooms
(T) Putnam Valley, TM# 74.17 -1 -39
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
September 9, 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= nui fiber of-bedrooms - must - remain- -at-four without piior approval by this
Department.
2. The area of the existing sewage disposal system, and its expansion area, must be .
maintained.
3. All plumbing fixtures must be updated with water saving devices, i.e., new low
flush toilets, restructures for shower heads and faucets, etc.
4. The sewage disposal must be installed as shown on the plans prepared by Jacqueline
Lynnfield, R.A., dated September 8, 1998.
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 truly y---- --- --�
William Hedges
WH:tn Sr. Public Health Sanitarian
cc: BI (T)
AM COG
PUTNAM COUN'T'Y HEALTH DEPARTMENT
* * DIVISION OF ENVIRONMENTAL HEALTH SERVICES C' o
E..[il 4.. _ - .... __ - .
PROPOSAL FOR SF�]P,GE DISPOSAL SYSTPM�.�3EFA�R,<
mm's NAME (,ki YI S 'clam �' t:Ol Vn?,G� L t4 CPi PHONE % 2-6 50
SITE LOCATION P2 PPE �kTiyAw td . TM# 2t. l '"3
MAILING ADDRESS � /All / 012M
M
PERSON INTERVIEWED Ih� L Vl PCHD Canplaint #
Name & Relationshi i , owner,tenant, etc.)
DATE TYPE FACILITY g:6 DiCT
PROPOSED INSSTALUM 1)0 �6 PHONE
REGISTRATION #
Pro (include sketch locating all adjacent wells):
NOTE: Repair must be in same location and of same type as original sewage disposal system.
Different location may require submittal of proposal fran licensed professional engineer or
registered architect.
Proposal approved Proposal Disapproved —
Inspector's Signature &
Date
proposal approved with the following conditions:
1. Procurement of any Town permit, if applicable.
2. Submission of as built repair sketch in duplicate showing:
a. Owner's name.
b. Site Street Name, Town and Tax Map number.
c. Location of installed canponents tied to two fixed points (e.g.,house.corners).
d. System description (e.g., 1250-gal. concrete septic tank, three precast 6' &am. x 6' deep
drywells surrounded by one foot + gravel).
e. Installer's name and number.
3. System repair to be performed in accordance with the above proposal and conditions.
[, as owner, or reported agent of owner agree to the above conditions.
;IGNATURE TITLE ` DATE ll/ ' L l
TES: Flute (PQ:D); YeUc w (Tom BI); Pink (Applicant.)
DPARTMEN7 OF 1-11ALTI-I
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(9.14) 278 -6.130
Putnam County DcpL. of Health
4 Gencva Road
Brewster, NY 10509
BRUCE t!: 6'oli Y; 6
l s.
Acting Public Health Uur•,;igr
Rcsidcncc�q �� V-
"Tax M ap -7 V, 17 — -r'
�l own a
According Lo records maintained by the Town, Lhe above noted d\vcllili5
1S J
1S NOT
in compliance with Town code and the total number of bedrooms on record
This information.has been obtained from:
CERTIFICATE OF OCCUPANCY:
ASSESSORS RECORD:
0TH I -, R TI i
' L r
luilding, In color
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
;..DESI I =DATA SHEET : SUBSUR FACE- °S ,WAGE'TREA`I`ME'NT 1SYSTElVI:
Owner ti
1
� i�(/y (�� Address 9
Located at (Street) 7 Tax Map Nock Lot 3
indicate nearest cross street)
Municipality VgAA1 Watershed
SOIL PERCOLATION TEST DATA
Date of Pre -soaki
Date of Percolation Test & /4f-'/4
IIepth to Water Water
From Ground Level Percalahott
Time Ela se Time Surface (Inches) prop In Rate
Bole No Run No Start - Stop �iVliri) Start Stop IndiesfififInch
20 5 err. SEc 1 N
2 Z CL 3 �5��►
3 3D 5CG
4 17: se c- 3 kG /N
3
4
5
1
2
3
4
5
NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each
percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be
submitted for review.
2. Depth measurements to be made from top of hole.
Form DD -97
Located at C %i'ri�— 10 14 T tJfbl yA1/Lt5L-f
TN Tax Map # o Block _ Lot
Subdivision of
Subdivision Lot # Filed Map # Date Filed
Gentlemen:
This letter is to authorize . J-64 (i 6 ti &a� GYP F 16U
a duly licensed Professional Engineer or Registered Architect ✓to apply for the required
wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance
with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam
County Health Department, and to sign all necessary papers on my behalf in connection with this.
matter and to supervise the construction of said wastewater tretment and/or water supply systems in
conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health
Law, and the Putnam County Sanitary Code.
Countersigne
P.E., R.A., #
Mailing Address
State
Telephone:
- -' - J••••�vIrYY11.
25 Ever��e� fad
�D579.20
Zip
Mailing Address: 6 rAoV /10!T3K, 1^4"-
rPlt�vtk�n, Vkti'i,(�v►
States Zip_
Telephone: �I Z
Form LA -97
��tD ARC
G�5 �E 1,AREIy \�
. y#
APPENDIX C r� of N
CONSTRUCTION NOTES FOR SUBSURFACE SE GE RE STEMS
& WELL WATER SUPPLIES SERVING SING - FAMILY RESIDENCES
The following notes shall be provided on all plans for individual SS S and well water supplies.
Basic Required Notes
1. All trees within 10.feet of the proposed subsurface sewage treatment system (SSTS) shall be removed.
2. SSTS to be inspected by the Licensed Design Professional and the Putnam County Health Department after
construction and prior to backfill.
3. The SSTS area.shall be staked and roped off so that no trucks, machinery, building materials, nor excavated
earth shall be allowed in the SSTS area.
4. All erosion control measures shall be installed prior to the start of any construction.
5. Construction of SSTS to be in accordance with these plans, any revisions thereto, and the rules and
regulations of the permit issuing governmental agency.
6. The well is to be a drilled well, constructed in accordance with New York State Health Department Bulletin,
entitled "Rural Water Supply ", pump tested fora minimum of 6 hours and have a minimum safe yield of
5 gpm. Yields less than 5 gpm. will be immediately reported to the Putnam County Department of Health.
7. The SSTS design shown hereon does not provide for installation of a garbage grinder. Such installation
requires . additional design and the approval of the Putnam County Department of Health.
8. Putnam County Health Department approval is based on the location of the SSTS, well, building, setbacks,
and driveways as shown on the approved drawing. Modifications are to have prior Putnam County Health
Department approval. Unauthorized modifications made to this drawing after the date of Putnam County
Health Department approval voids said approval.
9. Cut or fill is not permitted in the SSTS area, except if so specified on this plan..
10. After backfilling the system, the SSTS area shall be covered with a minimum of 6 inches of top soil, seeded,
and mulched.
11. Occupancy of this structure will not be permitted until the Construction Compliance Application has been
received and approved by the Putnam County Health Department and forwarded to the Building Inspector
of the respective municipality as part of the Certificate of OccupancyApplication.
12. This plan is approved for sewage treatment and/or water supply only, and all other required permits and/or
approvals are the responsibility of the permittee.
13 . The Putnam County Health Department approval expires two (2) years from the date on the approval stamp
and is required to be renewed on or before the expiration date. The approval is revocable for cause or may
be amended or modified when considered necessary by the Department.
/ - fTjcr �,,:: -c_..- ..*• -;rte it) .+ -- ¢:..r.,; 'si5s.: "rs.;�:: .. ._
Jacqueline L ntield, Arch .
f z Evergreen Road
Putnam Valley, NY 1p579
'v ,. �}.•� ��.,+�
' Yr ip' �;��A•}� :'+S
j.i: T�3'_i `�4::.
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_ 6EDF,^ ;
`'v'� �! w I �I ON JacquelinegLrynfield, Arch.
I/] / _ L / �� ,�] /� / t 1 Putnam Valley NY 1a0579
l2' 1 D C� `I 1 p V / 7- V � I/�rj� �, �/ Phone(FAX 914528-0068
M AIAP AtI
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Ir
C-CILI
9A Am I-
PUTNAM COUNTY- DIP WMENT OF HEALTH
HO E PLANS APPROVE R
BED OOM COUNT ONLY; 41 - a
-BEDROOMS
Sig iature
eL
-Al
2
3m
52
14( IA
M ykDw
Mlve-
Z--Vwo)�—,
v t--�
v ` � J'vv �/ `� �D I �� 0/\/ Jacqueline Lynfteld, Arch.
&
25 Everggreen Road
Putnam Vall NY 10579
^/ I / ey
P 0 7/ V I/�lj� U�r �/ Phone/FAX 914-52 &0068
s..b:
• t i. -
6A -rH
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DoEN BASEMENT m� W — /NL Xxex,4TED 3NEErgoLK
" NI ON t✓4LL, � ci �L/NG � II
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0 A(/.VDRY Iy �I A
— — r gyFi GRLLV,�oc I wI i N i
W /2 h z2 57-CFL BEAn
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$0 i8p _- ^$O �" -_ �:.. •„ � y+ .';- j.. 1 � � � .rte LON r/NUOVS G°,JG, Fool /N C+ -_ _ -- J. I 1
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SOA4EHb: L-�
'W"d = /. oqo ,lceEs
CERTIFIED TO:
.lES /Gi✓.OT /DA/SEei.
"'PKE.N/SE'S Sf/OWN fsH6.2EON.BF✓NG;LOj- -
H° � aq;s spcis/N ON -:I aA/.IP.ENTiTLE
_SEC i0A/:A off' io[7.✓./M../ccES "'S.IiO' "�II.lP '
G.AQ.MBL.
SURVEYED: /vLY 17. /9B6
Certifications hereon are valid for Bank,
Title Co. & Owners for this transaction
SURVEY OF PROPERTY
l'
BROUGHT TO DATE /�AY 7. /989 Ci.i�osa�G.at
only: Certifications are not transferable to
FOR
twice
BROUGHT TO DATE '���•��•�, L �E
subsequent Bank, 'Title Co, or Owners.
�
���, ��t®
n LfiL.z7.H7a£Ltsyz
O be / !
All certifications hereon are valid for this
JOHN SALVATORE ROMEO
map. and copies thereof only if said map or
copies'. bear the impressed seal of the sur-
SITUATE IN THE
Consulting Engineer & Laud Survcyur
veyor whose signature appears hereon.
%OMAI 01I R&MWAf V,?.Z4EY
1 NOR ROAD
"It is hereby certfied that, this survey, was
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prepared in accordance with the esisting
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