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DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road
Brewster, New York 10509
Tel. (914) 278-6130 Fax (914) 278-7921
BRUCE R. FOLEY
' edlt '_ Director-`. _
PROPOSED ADDITION APPLICATION (RESIDENTIAL ONLY)
STREET /`1 n•��` �!' u TOWN��'"�MU���z9TX MAP # 3 — y
NAME- L -SS� �ssel ,f-c PHONE `- Ddb- _7 6 8$PCHD# 0
MAILING ADDRESS A r��`� �t i v� �U� l.�a�� -���, ��. ��. iU S 7
DESCRIPTION OF ADDITION__ __� �� s�. d�,z,1.�,�� I„� s� �,•���
NUMBER OF EXISTING BEDROOMS PROPOSED # OF BEDROOMS
(FROM CERT. OF OCCUPANCY OR
CERTIFICATION FROM BUILDING INSPECTOR)
*Any addition which is considered a bedroom requires formal approval of plans (Construction
Permit) prepared by a Professional Engineer or Registered Architect in accordance with
applicable- sections of the Putnam County. unitary Code..., ..
'Please submit this form and the following to Putnam County Health Dept., 4 Geneva Rd.,
Brewster, NY 10509, Phone 278 -6130.
1. Certified check or money order for $100.00
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 plan (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
line.
Contact this office with any questions.
5. Copy of Cert. of Occupancy from Town or Certification from Building Dept. with legal
bedroom count of dwelling.
OFFICE USE
Comments
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road
Brewster, New York 10509
Tel. (914) 278-6130 Fax (914) 278-7921
November 6, 1998
Joseph Kesselmark
26 Angela Drive
Putnam Valley, NY 10579
BRUCE R. FOLEY
.Public ?Ycal:h. - I3irectc?r. .
Re: Addition - Kesselmark, Angela Drive
No Increase in Number of Bedrooms
(T) Putnam Valley TM #83 -1 -4
Dear Mr. Kesselmark:
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
November 4, 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 three. without prior .approval by
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.
Approval is granted for sewage disposal only. Any other permits or variances required are the
responsibility of the applicant and the jurisdiction of the Town of Putnam Valley.
If you have any questions, please contact me at your convenience.
truly yours,
Bruce R. Foley
ML :jp Public Health Director
cc: BI (T) PV
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DIVISION OF ENVIR0NIVIENTAL HEALTH SERVICES
INITUL INDIVIDUAL ADDITION / R FO M
SECTION A. GENERAL INFORMATION
Name of Project Z-6
Year of Construction i Size of Parcel c S
SECTION B. TOPOGRAPHY (Please check all. appropriate boxes)
1. Offilly Molling 77Stee slope ❑Gentle slope OFlat
2. DEvidence of wetlands ❑ areas subject to flooding O.Bod'ies of water
Dbrainage ditches Mock''
outcrops
YES N'O/ '.
3. Property lines evident? ❑ u
4. Water courses exist on, or adjacent to parcel?
5. Existing ndividual wells within 200ft of the existing SSTS? ❑ LJ
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SECTION C. EXISTING SUBSURFACE SEWAGE TREATMENT SYSTEM (SSTS)
1. Physical character of existing SSTS area.
A. 11evel Mentle slope OSteep slope
B. CIVell drained 0-M-oderately well drained
OSomewhat poorly drained CIPoorly drained
C. Area available for SSTS. (Primary. & Reserve) '
nEx-tremely limited OSornewhat limited Adequate ft x ft
Date., Inspector
111N/o evidence of failure ®Evidence of failure ®Evidence of seasonal failure..
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A. Size and type of septic tank 2 5 gallons
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Metal OConcrete ®Plastid
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1. Fields R. 2. Pits 3. tallies ft.
Indicate setbacks, fxont.s et, backyard -and side -yar&&�ibns 1. * - --
-"-(3) Show location of well
(4) Show location of driveway
(5) Note physical features (steep slopes, rock outcrops, streams /wetlands)
SECTION E. EXISTING WATER *SUPPLY
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v
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of %caU roe.Sptl Tnk d Symum traera
Ti M oa d; Addmm
Water S** - Priori Sao* Ftwa Addnm
oil ✓' y.t. e. 4* DrMed br
OdW
I represent "that) am wholly;aM eompMtey nsponsibN foF tM:deslgn and location of, the proposed system(s)..1) that the separate levn di sal stem
above describes will be constructegas ;shown owthe approved ami�dmerit'there to and in accordance with the staindards, rules a regulations o Mm
County, Depattrnent .of 'IN Kti, and that on eon+pNtfonahereof a �•Cirti /kite 41 Conitruetfon Compliance" Ytistaetory ,to the'CommiNloMr.ot Health will
be subniltted to the DaPartnn nd a whttan quarik"' will be furnished the owner, his fucce So►s, Ae s by the builder, diet said builder will
t> a iA pod. oOMatirq:eoodHlofl My :pert, of .said Mwais disposal system during the period of ) tely following thedate of the Im-
ance of; the.app►aral of the'.do-kificaH of Construction CornplNnce'of the ordinal systein'or any r,. t the diiiNO well 4etpWed above
tMMI•be IOCatflO as sllarya:on the appowd pm 'n ana,tnat fakl well will M Inst n acco nCe w tA, t rpu amens: of the Putnam
County Ofapirtnwiit /of/ylleltl►
Dab 17 7 Signed I * P E. R j_
Address—. � ,� erase No mss% 1f
L _ 4.S i,
APPROVED FOR CONSTRUCTION: Thl pooial expires two years f om the. date f ed unless constru e. t ing has been unde►takM and is
mocable for CAIute,or may be amended o.► rnodifled when,to ry. by TM Commissioner of P or alteration of construction
mQuires anew pwmit.q aved for disposal of do liter /or ate .water supply tom'. -
ReV . wte ./OC
R.77 ° Title
10/88
s
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
APPLICATION TO CONSTRUCT A WATER WELr`_ ~'
PCHD PERMIT #.��'�3 b
WELL LOCATION
Street Address To Villag'e /Cit
Tax Grid Number
WELL OWNER
N e Mailing Address
� j ,i• &,A-
�� ca d
gfi, �, ri Private
P O Public
USE OF WELL
1 - primary
2 - secondary
RESIDENTIAL ® PUBLIC SUPPLY
® BUSINESS O FARM
® INDUSTRIAL U INSTITUTIONAL
O AIR /COND /HEAT PUMP O ABANDONED
O TEST /OBSERVATION O OTHER (specify,
O STAND -BY
AMOUNT OF USE
YIELD SOUGHT gpm /46 PEOPLE SERVED �, /EST. OF DAILY USAGE �oagal
13 REPLACE EXISTING SUPPLY 0 TEST/ OBSERVATION 13-ADDITIONAL SUPPLY
NEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
WELL TYPE
DRILLED ®DRIVEN
[]DUG
®GRAVEL. .0 OTHER
IS WELL SITE SUBJECT TO FLOODING? YES A-,O' NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 6 %i A 0-0110"
Lot No.
WATER WELL CONTRACTOR: Name % fr. Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _�Z_NO
NAME OF PUBLIC WATER SUPPLY: `°° TOWN /VIL /CITY 0
DISTrdNC O -PROPERTY FRO:�.-N,=0ET . WA'-ER MAID: " --
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
ON SEPARATE SHEET
(da e) (signature)
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
thirties (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 drilli operations be contained on this
property and in such a manner as not to degrade or othe contaminate surface or groundwater.
Date of Issue: 19 q r
)ate of Expiration r 19 `r Permit Issuing Official
ermit is Non - Transferrable White copy: HD File Pink copy: Owner
/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
PUTNAM 100'Yffirl DUteY-*-a2AT OF HEALTH
DIVISION • ENVIPDNMENTAL HEALTH SERVICES
DESIGN D�ml%, CHEET-SUBSUFACE-S5MM DISPOSAL SYSTEM FILE NO.
Address
Owner Ile
Located at (Street) p sec. Block Lot
L;
inocate nearest cross street)
Municipality ep-w Watershed
SOIL PERCOLATION TEST DA T?e REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Date of Pre-Soaking Date of Percolation Test
HOLE
KbMM Cl=
TIME
PERCOLATION
PERCOLATION
Run
Elapse
Depth to Water Fran
Water Level
No.
Tim
Ground Surface
In Inches
Soil Rate
Start -Stop
Min.
Start stop
Drop In
Min/In Drop
Inches Inches
Inches
01
0
>,
2033T
2'r
4
5
4
5
1
2
3
4
5
NUM: 1. Tests to be repeated at same depth until'apprcximately equal soil rates
are obtained at each percolation. test hole. All data to' be SU13dtted
for review.
2. Depth measurements to be made from top of hole.
rev. 9/85
TEST PIT DATA REIQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNMUED IN TEST HOLES
->r
G.L. O
1'
2' �.
3'
41 .
5'
6'
7'
8'
9'
10'
11'
12'
13'
14°
INDICATE LEVEL AT WHICH GROUNDRAM IS ENOOUNTERF.D
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENOOUNTERED A,�,p �-
DEEP HOLE OBSERVATIONS MADE BY: DATE:
i
DESIGN
Soil Rate Used 10 Min /1" Drop: S.D. Usable Area Provided 41oy
No. of Bedrooms —3 Septic Tank capacity Io4y gals. Type
Absorption Area Provided By 340 L.F. x 24" width trench
Other i_ ,/j
Name ;;I , �4 �!e �/ / 9
THIS SPACE FOR USE BY
Soil Rate Approved
Signature
_•aw- ire -�i
r �
sq.ft /gal. Checked by Date
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New.York 10509
(914) 278 -6130
APPLICATION TO CONSTRUCT A147ATER ;+JELL
PCHD PERMIT # 1 /
WELL LOCATION
Street Address Top Village Cit Tax Grid Number
,ri�'G � �'�? - ;73./
WELL OWNER
Namde
q% �'
M iling Address
„/ 1"
gPrivate
O Public
USE OF WELL
1 - primary
2- secondary
MRESIDENTIAL
O BUSINESS
0 INDUSTRIAL
❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION
U INSTITUTIONAL O STAND -BY
O ABANDONED
O OTHER (specify,
O
AMOUNT OF USE
YIELD SOUGHT, 5 gpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE _Sal
O REPLACE EXISTING SUPPLY O TEST /OBSERVATION 13. ADDITIONAL SUPPLY
jgNEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
WELL TYPE
DRILLED
DRIVEN []DUG OGRAVEL
0OTHER
IS WELL SITE SUBJECT TO FLOODING? YES P' NO
IF WELL IS WCATED IN REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No._
WATER WELL CONTRACTOR: Name A 6/7 //�e�Y10� Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES i� NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:.A)';,A�o
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
_VON SEPARATE SHEET ��
// ''
(da e) (signature)
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 of a se ontaminate surface or groundwater.
Date of Issue: ,� ( _19f3
Date of Expiration 1 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
0
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
.. Dote
Re: Property of C CC LI/ K
Located at
(T
Subdivision of.
W tiosa Block Lo t
Subdde Lot Piled Map Date
Qoatl ® ®� 8 •
This letter is to ovthorlse
e duly licensed professional ongineer'° ;,--,,or registered a chitect
Indicate '.
to apply for a Construction Permits for a separate sewage system, to
serve the above noted property in accordance with the standards, rules
or.regulations as promulapted 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 t® supervise the construction of said
system �or� systems in conformity wit � ®tih® pt° ®vfai® a�" ®f` Ai•ti�cle� "145 or -
147, Education Law, the Public Health Lawg and the Putnam County Sani-
tary Cod.®
Countersign a
PEE•, R ®, y.. N III
m
Very truly yours,
Omer of Property
5z,�. rs
•
Address
Town
Telephone
sl
'^s. ��. - +"a ,.4 °';*"+.'wan -,� ."`^' ; ^ „r” , �w<:.., x'Y'^� ^R's =w--Y" —s..,n ^s' Yy ��t_."T_'�. " "." 57
4
P.UTNAM COUNTY; DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N.Y. 10512 -
Engineer Mast Provide . V)/
P.C.H.D. Permit #— -
AGE
Own. llcant Name 'S '�' `n �y Cgs G ormerl
Mailing Address�r7
Separate Sewerage System built by 0 Add
Consisting of E'' a Gallon Septic Tank and
..� ��
' To
Tax w "
Tax Map 22. % Block Lot
Subdivision Name to r vIlt Subdv. Lot #
Date Permit Issued % 9 9-3
AJ
Water. Supply: Public Supply From r Address p� ,fir y
or: /_� Private Supply Drilled by Al- �� d Gr 0a 42 Address / ° r l 412
Building Type / / e,_4 /,,d L' w Ce Has Erosion Control Been Completed?
Number of Bedrooms Has Garbage Grinder Been Installed?
Ather Renairements Z
I certify that the system(s) as listed serving the above premises were constructed essential F film on tW6 i)) of the completed work ( copies
of which are attached), and in accordance with the standards, rules and regulations, in acco ml� h a fit and the permit issued by the
Putnam County Department Of Health.
Certified by P.E. I� R.A f�_
Date ��✓,%'
s. i License No.�`� d 9S
Address .
Anyiparson occupying premises served by the above system(s) shall promptly take such action as may a , ►e the correction of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage system shall become null an n as a publi: unitary sewer becomes
available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are
subject 'to modification or change when, in the judgment of the Commissioner tion, modification or change Is necessary.
Dated �� �- ` �! By Title
Al-Sam CDU, TTT,T T AALRTIT T...TA1T T1TT1
�ti - ��
�, .. ;..
�
� - ®O
W Y
WALL VVL'lr LLr11VLV itLr VAl
DEPARTMENT OF HEALTH _
Division Of Environmenta l Heal>tFi Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
._.
3
WELL LOCATION
STREET ADORESS: 9� SiUe NEVI 1 1 TAX GRID NUMBER:
c ` ii �! t
//' .3 131o& I Lk Y
WELL OWNER
NAME: AOORES
-9 �-
81VATE
rop UBLIC
USE OF WELL
1 - primary
2 - secondary
d6f RESIDEN Al_ ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT P MP ❑ ABANDONED
O BUSINESS O FARM ❑ TEST /OBSERVATION O OTHER (Specify)
❑ INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT 9pm. 1N0. PEOPLE SERVED -/ EST. OF DAILY USAGE � °O gal.
REASON FOR
DRILLING
.[]REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION []ADDITIONAL SUPPLY
®NEW SUPPLY (NEW DWELLING) D DEEPEN EXISTING WELL
DEPTH DATA
° WELL DEPTH SO D ft.
STATIC WATER LEVEL _$LC ft.
DATE MEASURED f ie
DRILLING
EQUIPMENT
® ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT O CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
O SCREENED ❑ OPEN END CASING JRI OPEN HOLE IN BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL LENGTH ! ft-
MATERIALS: J9 STEEL O PLASTIC O OTHER
LENGTH BELOW GRADE ft.
JOINTS: ❑ WELDED ED THREADED ❑ OTHER
DIAMETER in.
SEAL: !-CEMENT GROUT O BENTONITE 0OTHER
WEIGHT
PER FOOT _ 6 1b. /ft.
DRIVE SHOE: BYES ONO I LINER: O YES ONO
SCREEN
BE T 'S :
DIAMETER (in)
'SLOT SIZE
LENGTH (It)
DEPTH TO SCREEN (ft)
DEVELOPED?
•
J -
1E_ ❑Fa
HOURS
SECOND
GRAVEL PACK
❑ YES
O NO
GRAVEL
SIZE:
DIAMETER
OF PACK In.
TOP
DEPTH tL
BOTTOM
DEPTH it.
WELL YIELD TEST If detailed um in
p p 9
METHOD: ❑ PUMPED tests were done is in-
OMPRESSED AIR , formation attached?
O BAILED ❑ OTHER i ❑ YES 0 NO
/ELL LOG
ff more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
Water
Bear.
in9
Well
pia-
peter
FORMATION DESCRIPTION
CODE
ft.
ft.
WELL DEPTH
It.
DURATION
hr. min.
DRAWDOWN
It.
YIELD
gpm.
5 mace
WATER CLEAR TEMP.
QUALITY ❑ CLOUDY HARDNESS
❑ COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? O YES ❑ NO
� _
STORAGE TANK : TYPE Ae -)e
CAPACITY GAL.
WELL DRILLER NAM ppTE�
Ao0RE5S� Y SlGftkTURE 3
O
PUMP INFORMATION
TYPE 3� CAPACITY
MAKER DEPTH
MODEL VOLTAGE 230 HP
J/ ov
YML ENVIRONMENTAL SE*YlCES '
321 Kear Street '
Yorktown Heights, (N.Y. 10598
(.414) 245-2800
Albert H'
LAB #: 32.4228:3b CLlENT #: 7549 NON STAT PROC PAGE
KESSELMARK, JOSEPH DATE/TIME TAKEN: 05/13/97 08:25
66 CROSS STREET ' � DATE/TlMEREC'D: 05/14/97 09:�`,0
BEACON, NY 12508 REPORT DATE: b5/16/97
PHONE: (914)-831-6482
SAMPLING SlTE: 26 ANGELA DRIVE SAMPLE TYPb..: P'UTABLE
PUfNAM VALLEY PRESERVATIVES: NONE
CUL'DBY: JOSEPH KESSELMARK TEMPERATURE—: .< 4C '
'
NOTES...: ` COLlFORM METH: MF
DATE FLAG PROCEDURE RESULT NORMAL --RANGE .ME[HUO
`
COMMixNTS:
.BACT THESE RESULTS INDICATE lHAT T NUT) OF A
SATISFACTORY SANITARY QUALITY ACCORDI 071 THE NEW YORK STATE
AND EPA FEDERAL DRINKING WAlER STANDARDS, FOR THL PAHAME'TERS
TES[EU, A[ THE TIME Of: COLLECTION.
SU8MlTTED BY:__ -���__---z-=��___
A|be�t H. Padovani, M.[.(ASCP)
Directnr ELAP# 10323
PUTNAM COUNTY DEPART OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Owner or PuYchaser of Building Section Block Lot
�l
Building Constructed by
�` o 11,2r; ✓�
Location - S t
Municipality
. 1 A�
Building Type
Subdivision Name
Subdivision Lot #
GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM
I represent that I am wholly and completely responsible for the location,
worknanship, 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 date of approval of the
... -..- "Cerfificate..of Construction Compliance" -for- .;the. sewage disposal system,,-or any.:
'-repairs -made° by `me` to such systerft, -i=ept Where tKO. failur 6'f6- dp-d-j:aEd " properly-1s
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
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 f the building utilizing
the system.
Dated this % .day of = -- �y - 19�
` �►1,nR
GE&xaV Contractor (Owner) - Signature
Signature
Title
Corporation Name (if Corp.)
Address yps�
rev. 9/85
mk
Corpo ion Name (if Corp.)
1-9 t, 0 "wa,,4 UtI<e RooA
Address M$ VOA ley (V.%
+f•s, TRW r ca ien Gc_ Aae , S9 /} 0* Lj values
Ntibidr.�[ Bak�saaa - Design Flow G P D
fib► P(� Noll�dao 1s Rala4ed'Wba6 Pm "b o ple�sd
Ssplaab Saweeyip Syseaals to "M 410 9f7 `� Ga9w Soptle Tank aad
To bw ilAi. 0, 1 by Address
wabtr sir: Ptirc sib Phew Address
,.//
aa+. !'_Pal•aos Sorb DddY.dl, by
114 ✓
1 repe"Cthat l am wholly and. comobtely responsible for "the dspn seal location of the proposal system(s); 11 that the separate sawage di al stem
e...
e0oile Aefc►itieA will tN:oonstructed ai frown on`tlie approved amena'meht then to and,in accorGnp with tM.stanAarat; rules arm rrpu ns:o. M
C"rity`Departmsnt of Naetth,'_and that on completion thereof a.•'Catificata of Construction'Complianc .10'tisfaetory to the COinmisetoner of Mealthwill
be submitted to the Opactmwtt; and a written quarentse will w furntsliad tha owner, his ayccaaoois, hairs or assigns by the bulkier. that aid buildw will
glace M ;two0 oOMating eonAltlon any. part oi; lekl awape dispoal system durirp the par f two, (2) years IinrlNdiably following the Oat* of the tau-
an0a of the 'Spparsl'of tlie'CertifkaWif. Cohftiuction `Compliance . of the"' oryiiial�syst - - ir$ ifNretos.2) that. the dillle0.well described above
wga be located.as aA-am on the'epproved-plan- and' that aid well will be insts in acco h rds, rules and inuMUns of the PutMm
C M rtma d of tfosRli R� F
P.E. R.A�_
Da 1 / 1 d s+. "'d
Address .G�ACC Lieena No0��
APPROVED FOR CONSTRUCTION: This approval expires _two Veal Uom the dater 0 pstr' of t building has been undertaken and is
revocable for ua or.may be amaided`or modified when con, eeesary by, th m 1 of Any change Wn of construction
require$ a pre► t. ., o"d 'for. disposal of domasfk ` ni pre, and r 2 ly.
0%88 Data BY %t' , ��th° toy Till.
i .
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date_' /����
Re: Property of TO _S <'o 17 K Q�
Located at 49 10 0,0-1 y, tf
(T) ��D'r►?Va.I ` Section Block Lot
.Subdivision of 12ev+
Subdv. Lot Filed Map # Date
Gentlemen: q 6
This letter is to authorize'
a duly licensed professional engineer &/4 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 145 or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Countersigned:
OF
P.E. , R.A. ,
ess
Telephone
Very truly yours,
Signed
)±O%et/ of Property
RC�1�1e-,k
4+-Address
as— Town
IILj- 3� -a►`I-7
Telephone
APPENDIX 3
PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
-- - - REV W SHEET for CONSTRUCTION PERM
- -
NAME OWNER b G .�! c c` --
�� STREET LOCATION
BY Str DATE I , '� TAX MAP # 03,)
�' I
DOCUM TS. �
Y _ J MDEEP GE (OPMTT APPLICATION 1PER HOLES LOCATED
PC -1
WVELL PERMIT;Ml PWS LETTER
ENGINEERS AUTHORIZATION
►N DATA SHEET(DDS)
HOLE LOG
PERC RESULTS (3
L'LJ PERC HOLE DEPTH
ORPORATE RESOLUTION dil
PLANS THREE SETS
HOUSE PLANS - TWO SETS
m ARIANCE REQUEST rf A
/; GENERAL
SUBDIVISION
'ISION APPROVAL CHECKED
L
"'PE C RATE
REQUIRED
CURTAIN DRAIN REQUIRED mSTANDPIPES
- APPROVAL SSDS ADJ. LOTS
gyVETLAND (TOWN/DEC PERMIT R & D)
TA ON DDS PLANS & PERMIT SAME
- 1969 - NEIGHBOR NOTIFIFICATION
R BI/ZBA
YR. FLOOD ELEVATION
'•' :rsl:•. A F3 E. f-hA7 -E7 = 7AF�
WAGE SYSTEM PLAN - (NORTH ARROW)
DS HYDRAULIC PROFILE CD GRAVITY FLOW
J BOX = TRENCH/GALLEY = P- PIT DETAILS
M. C TANK - SIZE, DETAIL
LL DETAIL, SERVICE LINE IF OVER
)NSTRUCTION NOTES (GRINDER RATE)
:SIGN DATA: PERC AND DEEP RESULTS
iO -FOOT CONTOURS EXISTING & PROPOSED
DRIVEWAY & SLOPES CUT
FOOTING /GUTTER/CURTAIN DRAINS
COMMENTS:
REPRESENTATIVE OF PRIMARY AND EXPANSION
EXP. AREA; SHOWN; GRAVITY FLOW, SUFF. SIZE
It PUMPED PIT & D BOX SHOWN & DETAILED
HOUSE - NO. OF BEDROOMS
WELLS & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM
PROPERTY METES & BOUNDS
MOUSE SETBACK NECESSARY (TIGHT LOT)
OUSE SEWER - 1 /4 "/FT. 4 "0; TYPE PIPE
NO BENDS; MAX. BENDS 45 W /CLEANOUT
FILL SYSTEMS
ec,70L, AYBA RRIER
FT HORIZONTAL: SLOPE 3:1 TO GRADE
LL SPECS
GAUGES 41A
FILL PROFILE & DIMENSIONS
VOLUME
TRENCH
F TRENCH PROVIDED
F91 9 FT MAX
``�LLEL TO CONTOURS
% EXPANSION PROVIDED
U' TO P.L., DR1 T Y WA , LARGE TREES, TOF OF i ILL
K'pTlovlu O FOUNDATION WALLS
0 TO WELL, 200' IN D.L.O.D., 150' PITS
T TO STREAM WATERCOURSE LAKE (INC.EXPAN)
0' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER
TO WATER LINE (PITS -20')
50' RMITTENT DRAINAGE COURSE
2 RESERVOIR, ETC.m 150 FT. GALLEY SYSTEMS
SEPTIC TANKS
FROM FOUNDATION; 50' TO WELL
WELLS
15' WELL TO P.L.
44 4
'FIT h -
r"
� .� -r, U.I a s 2Cy .,� a�'S�#„�P �s�� -+w� iz2. • �c '3: ;.;�;. - `r
f�✓�B'ksf /�`� .� '.�:� i � :'phi -`-� .F' Y
-- a:
i;4o Her'.,m Spr " -en
} t2oi 14.1-
' .. � 'aar�- ,�5°i�it' iza:n;ii� •i?9�.,�et-a�t 3E ftai[i�'k..,.
i,L`.1.
WIC
fir
�KOPOS AGE OSAL 1STBV�
`1
,�( `SUB AJ
r ria�'a �$ni8 lleparZmenL of xeai".
eion;o.f Envirorimental Healtli ";5er*iooe.
oved as noted ?or corforaance With
icable .Rules and HegIIatione of the
am County e'alth „Department;,
. YORK��WN HEIGHTS; A NEW YQRK
PffSiz..1-�1.:3
y
SCALE _ AS,� .IJOT�D`� ' :fOB NO