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HomeMy WebLinkAbout3765DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83. -1 -4 BOX 29 1ps 1= 4 .. ,,i_� is a MA ., .�j ., -!!I. L. 1 03765 - o b � 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 ' :, ' 1 . '. . � .1 .1 . I . , - 4�. - . I . � �. . . ��k . . I . - � -, , - , � .-'� � :�� - : * I * , . - � . , , . . . I , k , � . ., , I .;, 1: . . I ;: . t - ; . r", ,-�� ,�" , � , ... .,*I *'-: � � . . � f: , . .'. . � ql F - � A , . . - I .. 1. . 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I I I 4 f H � X b I 6x8 BfAQO OVER = yo x qn ; , IL_--- - - - - -- -: -- - -- - I I *---- __- 1 �ORAll1,�C - -- - - -- - EQ] GLUE -LAm. wm 4- 2824SIfPPORT POST r 4' -9r B X a �.Oit " or rcc on t> , � PUTN d 'LUNTY H , ip �Y 8 Br 01iNfR. `� DEPARTMENT 0 F OUSE PLA i11 'r : r rPPOI �D FOR EDROOiI C Ui T OiiL'' 1 q_ 10 i H T n k y 3 -2810 Sre ignatu 6P -O, ' E 21'a• -� 8' -r�' 8' -8' ' 26' -0' , io 7 A 7 b i °; 8 an r �G VA .m f 1 =c t �r t: li r.� r. O wPShts I: il'II 0A a- s P P A r It �= �,�ebae+rd head' 1• ,1 r� PUTNIAIH COUNTY DEPARTMENT OF HEALTH ROUSE PLAINTS APPR0ITZ,D F7 t BEDP,00m coU,,:T ;t c } T t T p tie - •a fi • Sta,' ✓~ M4stiy cae�e ha I fwa+! lhft C dal d h MKIIFirr �= �,�ebae+rd head' 1• ,1 r� PUTNIAIH COUNTY DEPARTMENT OF HEALTH ROUSE PLAINTS APPR0ITZ,D F7 t BEDP,00m coU,,:T ;t c } T t T p tie - •a fi • a. .z l Ol-.6 i- -- - - - - -- -- - - - - -- ----- r- - - -- - -- J -' -- -------- -- "C'I Ct "sS;l -ii !',V :;A�lid � u11U11 1 1 I i •' � it 1; I 74 j a3NM0 AS 3LS , I 1 , NO 30YICLU i I 1 I t 30 NOt11/OOl I , �i-.9T , "romu 3F MIS 1 J — — — — — — — — — — — — — — — — — — — — — — — f I II' Ll I r�l10d3s1f- 9� 0 � t 1 �, ! ,i � -Al � 1 1% i is O i I I� 01 N3d0;� ` 1 I (f)! 2M= I M 1SOd 9x9 (•l) SSW ., . . I 13S ON Ut •,` � o D O/ O Y / 1� 1 RZ -- —T- ---- - - - - -- - - - - -- -------- - - - - -- --� 1 — -- '-- ---� - - - -- r.— -- - - - -- -- .6-S d -.9 7 .9-21 ei `i ,c p. V. .I' 'J l� ' ., wPShts .. l'IC(lfs�ll 7 Stns'✓ Mastt�r , � P ,.� r O. I C1ak'r' crb"c hulfwa.rl , T �T c�n+fal Va4. (a'.s hdo"d head' �GbIG PUTA1IiA1 COUNTY DEPARTMENT OF DEALT11 ` I'IOUSE PLANS APPROVED BEDIi00A1 COu::�' x+ R •` Y G F , Date: a 26' -d ! 6, 11f 3' -1° 5' -i 4' -1° -to' 3' -6° 6; -r 8' -d 3' -1' 5'-d D 1i4;H 6-0 .� 24/4 �' 4020 , r yo - - -- - - - - -- '`' Wq1 M SEAT 13 17 7 ROOM b' 3 9n 0 kj A a N GLUE 1Nd. 7 ARCH 20' -9 1 4° BEAM OVER i 9' -2 1 4° 5'-0 1 12' -d n A i 6x8 BEAM go 7 -- --------- - - - - -- - - - -- - �i \� - - -- - F-1 KF � u LOFT LINE 4T KCH � � UV a R (8) O SUO6x6 ° i8 POST (TYP.) �;, 6x8 ! OvER DO CUM ii UA-tAm. B£Am ` 8 Ak _ 6X6 SUPPORT N 4-2824 POST 4' -9r 11' -6° 4' -� X u hr►nai' o. 'h o f� C xr: w ow 'P FUTN I COUNTY DEPARTMENT 0 9 5'-d �• 10 U LS E PLA .r {, P,Pi'RO_VED FOR 4 f 3 EDROO;I C U:tiT O;IT i'; T 3 -28 P.T. RAW ' 20 r • U �C$� 66 -d ai(;T1ilturc & -Title 16' -d o - PUTNAM COUNTY DEPARTMENT OF HEALTH 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 g - 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.. ................ ------------- --------- ---- ----- ---- (Indicate North) Y CO > - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - (1) Indicate location of SSTS A. Size and type of septic tank 2 5 gallons ...... Metal OConcrete ®Plastid B. Type of absorption area 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 . . . ... . . . . . . .. , . - . - .4 . . � ., , .- -:•1: .. -- , v .. . .,�. - I 1; - � . I � 1 -4� " ��,i� +:- :L4,: =: --�r� .. ,.v , V., - �� � -"ON! 4j--.,:-&-,fi ,,-t� �b . . . . .. .. •.. - . 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Lot Aaaa v 7 o r F81 Sa tl 0e4 rarlms '. o r NWM&W of. a ., —f+a Deeiga Fbw'G P D PCHD Nedecatlee la When Fill d oomplobd v Sapa> • Snr op . � 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