Loading...
HomeMy WebLinkAbout3928DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.50 -1 -29 BOX 30 9Fro 'a T r IMF , ri r it i L r 4- , 03928 - - y -- ?! PUTNAM COUNTY DEPARTMENT OF HEALTH { Re 3 6 Dhialon. l EEnv_lronmental Healtb Services, Carmel, N ?:10512 i c r'" ;, l?ngineer Mast Piovide $ j Permit H 1 x Tchrn: Pi"' -tai afal day CF _TIFF TE OF,.CONSTRUCUON,CQM��LANCE FOJ SEWAGE DISPOSAlbfS I an 1 ew. 1 de Road f z -` Ta'wn oi- VOlage Located et Y Ta: Niap 185D clock '55 �t 2 & '238 37 FRANCES OTT Formed sabdlvtei MAn ``=in Snbdv; 8- 1, L 1 OwnerYappllcant-Name oa NameT Lot ao Y gA � ;541 ;Pelham Rd, .,New'RocheTle �P 1:0805 ' Date .permItlasaeii Separate sewerage System ballt by :Howard Gr'agert'' Address OS( c�wAnA �kP 'Rnari µ Piltnam ya 7 1 a�i NY' L- 378 ~linear feet 24 ch wide r nch ' Consleting of Gallon Septic Tsnk and Water' °SU*P Pdbllt Snpply'From Address 1 or XXX Prlvate,Sapply Drilled by Address Baudm 1 f a m i 1 y resident a l -gas E'"Id' Control Been Completed? s Number of Bedrooms 3 ` Has Gasbags Grinder Been IastalledY NQ w n 1 Other, Requirements l `` IS'certify that, the syatem(s) as'listed serving the. abovepremises. were constructed'ssaentislly as'shown on._the plans of the completed work` (- copies of which are attached) `and in accordance`vith the'standards rule£ and re n in ce'wi th filed lan and ahe' rmit issued by the Putnam Count Department c, Health c � y MA�f- HEW A NOU ELLO, P. E December 4, 1991 t Date Cat�fiatl by P E R A 1 _.N& thri dge.,. Rd , Peeksk i 1.1. NY ..10566: L)cenie No. "61145w:.- Any person occupying premises se►ved by tt a above'system(s) shall promptly take such'action as -may be rieussary2o NCYre, the co►rettion 'of any, �unpnita►y conditions. ►aful ;iriy from wch :usag "s. Approval ofahe separate „snveragesystini,sliatI become nuli'antl.vold atsoon as a pub uni or awa- bscomea f available and tfie approval ;of the p►Ivate water suDPly shall become null and'; void when a '.publle water supply_ :become; evallabN. Such apprevels are Change when in the judgment of the Commissiong[ of Nwlth eh revocation. modliiutlon or eAanpe Is h�eessary ; wb)eet to modifiestion Or2 I`� Oats f / �% Bye -�, ; Title �� -�i� W!?.LL 'l+VP1rLG11VLV L<LrVAl � a„ DEPARTMENT OF HEALTH ' `''�Diviac�n 'Of •Environtnental - Health ~Services :�'_' • �� PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only - WELL LOCATION STREET ADDRESS: wNi t 1 Y TAX GF110 NUMBER: 41 11P UA e WELL OWNER —4 NA 6 R-or e of A► h•, 1Qa( eA, v . 4e Ile I�18IVATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary al- RESIDENTIAL O PUBLIC SUPPLY O AIR /COND. /HEAT PUMP O ABANDON D O BUSINESS ❑ FARM O TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY O AMOUNT OF USE i - YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING []REPLACE EXISTING SUPPLY ®TEST /OBSERVATION [ADDITIONAL SUPPLY ANEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 3 o o ft: I STATIC WATER LEVEL ft. DATE MEASURED /v DRILLING EQUIPMENT E?96TARY ❑ COMPRESSED AIR PERCUSSION O DUG O WELL POINT ❑ CABLE PERCUSSION O OTHER (specify): WELL TYPE O SCREENED O OPEN END CASING O OPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH s ft MATERIALS:, 0- &T-EEL O PLASTIC ❑. OTHER. LENGTH BELOW GRADE ft. JOINTS: ❑ WELDED I2ZHREADED O OTHER DIAMETER ---L_ in. SEAL: ❑ CEMENT GROUT O BENTONITE &&HER WEIGHT PER FOOT Ib. /ft. DRIVE SHOE. O YES OM' I LINER: ❑ YES G*fr SCREEN - DETAILS..... :. DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (it) DEVELOPED? FIRST _ - _ _.... O : YES_ ❑ NO , .. °HOURS SECOND _.,. : , - . GRAVEL PACK ❑ YES O NO GRAVEL SIZE: DIAMETER U PACK In. TOP DEPTH ft. BOTTOM OEM It. o ' WELL YIELD Tf'T If detailed pumping _M�ETTH�HOD: ❑ PUMPED tests were done is in- 63-60MPRESSED AIR , formation attached? ❑ BAILED ❑ OTHER ❑YES ❑ NO It more detailed formation descri tions or sieve anal ses WELL LOG are available. please attach. p Y DEPTH FROM SURFACE water pear- ing well Dia' peter FORMATION DESCRIPTION poE tt. ft. WELL DEPTH IL DURATION hr. min. DRAWDOWN It. YIELD gpm. Surface %3 S.( r9<<.vL�G � 3 oLl � � 0o f n WATER ❑ CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS ❑ COLORED ANALYZED? ❑ YES ONO ANALYSIS ATTACHED? ❑ YES ❑ NO STORAGE TANK : TYPE CAPACITY GAL. WELL DRILLER NAME DATE ADDRESS 'v '�' � ceo r '� SIG f ` / 3 0.K G PUMP INFORMATION TYPE lt-- CAPACITY �,, MAKER �` " p4 DEPTH '' MODEL VOLTAGE � HP L PUTNAM COLUN DEPARTMENT OF HEALTH DIVISION OF ENVIRUIR=AL HEALTH SERVICES .?+.:�'...wr.- y.r�i�- v nf. fl` w M.a � >'.c ♦ -�- .. - i ._. s .I� .�.f� +r ti.�w�.:y�. — .a.., Kf.. wit p m � �.�s. C]�.• � .Y' .( FRANCES OTT Owner or Purchaser of Building GEORGE OTT Building Constructed by Tanglewylde Road Location - Street Town of Putnam Valley Municipality 1 family residential Building Type 185D -55 -237 & 238 Section Block Lot Map 80 Subdivision Name Block 1, Lot 1 Subdivision Lot # GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as shown on the apprcved 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 ____o_p.er.ating__ condition.._ any_ par_ t__ of— said_s_ystem -con structed_by me— which_failsto.__ operate for a period of two years immediately following the date of approval of the "Certifica,te_.of-Construction Compliance" for the sewage disposal system, or any -- - repairs made -by-me--to such - system, except wizere the failure to operate properly is 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 Environirental Health Services of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated t� 4th y of Dec. 19 91 General I Contractor (Owner) - Signature George Ott Corporation Name (if Corp.) 541 1 "' *; I:am Road New Rochelle, NY 10805 Address rev. 9/85 mk Signature Title Howard Gragert Co me ration Na (if Corp.) Oscawana Lake Road Putnam Valley, NY 10579 Address - - YML Environmental LAB NUMBER :32-0064261 S e ry 1 c e s DATE /TIME TAKEN / ®,T - Q' ..., _. :.....- ..• —.t_ w.•.— �.�.s. : � '.i.a. -•... • e..ti .: et� • -. .r ., ..:t. oy.: tin.e gh�Sl�= �5 " �D7#TE7'1i1�1ERC'D : �7��'- "�.�.- p.�"•'_ ELAP #10323 (914) 245 -2800 DATE REPORTED DEC. 0 9 1991 GEORGE OTT 541 PELHAM ROAD NEW ROCHEL LE, N.Y. 10805 COLD BY O Q NOTES X RESULTS OF ANALYTE RESULT UNITS T pH ALKALINITY S.U.. n-g/L PHOSPHOROUS AMMONIA mg/L mg/L SILVER CALCIUM mg/L mg/L SODIUM' CHLORIDE mg/L mg/L SULFATE.. COLOR mg/L Units SULFIDE CONDUCTIVITY mg/L umhos /cm —_ — COP_PER - - -- mg/L . - -- - TURBIDITY CORROSIVITY NTU LSI ZINC DETERGENTS mg/ FLUORIDE mg/L HARDNESS n-g/L IRON mg/L LEAD mg/L . SPC MANGANESE per 1.0 mL mg/L X170TALCOLIFORM MERCURY mg/L per'10* 100 mL NITRATE FECAL COLIFORM n-g/L per 100 mL NITRITE E. COLI mg/L per 100 mL ODOR FECAL STREP. TON per 100 mL SAMPLING 7A- � 4, SITE ,�¢, �ilLS/�i�J For Lab Use Only X Potable _ HNO3 _ pH LT 2 <4C _.Nonpotable _ NaOH _ pH GT 9. <20 >4C -HCl Na2SO3 _ >20C. STAT! _ H2SO4 — ZnOAc CQL IFC?RM NrTHCr L1SE X RESULTS OF WATER TESTING ANALYTE RESULT UNITS pH S.U.. PHOSPHOROUS mg/L SILVER mg/L SODIUM' mg/L SULFATE.. � mg/L SULFIDE mg/L —_ SUL- FI- TE - - -- -- — mg/L . - -- TURBIDITY NTU ZINC mg/ SPC per 1.0 mL X170TALCOLIFORM per'10* 100 mL FECAL COLIFORM per 100 mL E. COLI per 100 mL FECAL STREP. per 100 mL These results indicate that the water sample [WAS] WAS NOT] [NA] of 'a satisfactory sanitary quality according to the New. York State Sanitary Code, for the rame s tested, at the ti a of sample collection. These results indicate that the r a ple [WAS] [WAS NOT] [NA] of satisfactory chemical quality, according to the New York State Sanitary Code, _ r e parameters tested, at a ti of sample collection. NA = Not Applicable N = Not Present (Negative) SUBMITTED BY: P = Present (Positive) SA = See Attachment(s) = Also done because Total Coliform was present , Albert H. Padovani, M.T. (ASCP) TNTC = Too Numerous To Count Director > = GT = Greater Than < = LT = Less Than Kim cata Cy -- - DTI�•• r b_ == i 11 _;cam - ^Dam c� p1Gc_ =ZL %'rte r w" = �' _J 2 :1 CCL Y� = /:vC in- D� =-c=--c= Q - ^ fSV- c ..0 i i CC7 c'ter- fcr fir"- .r._C. r Jtic _c S - c---- �/" - - -_ -- - -- - - -- v. 4. E. CrC? - car cycle G_ 1 V- jv -•-• EDS L I _ cv_ _' KCRF C- -IRF _ C_ C_ C = =ra i 1 �._ '-- - =, c= - 1 i `-A cc: cr --; - -C to L'! 3 —'Z f. C=tain .: co- S!Czzmas >f f f I I f - �f f I I • �1 - CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTItIE Tt - THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY.. . }3r.• THIS INDENTURB made the i day of nineteen hundred and eighty-nine between i A!.' Mattew J. Florio and Eugenie Conway, both residing at 254A Tanglewylde Road; Lake Peekskill, New York, 10537 party of the first. part, and i Frances Ott,,residing at 541 Pelham Road, New Rochelle, New York, 10805 party of the second part, 1 • WITNESSETH, "6 f j c• that the *parties of the first part are the present owners in fee simple title of the following desribed parcels j ALL that certain plot, piece or parcel of land with the buildings and improvements thereon erected, situate, lying and being in the Town of Putnam Valley, County of.l Putnam and State of New York; known and designated as Lot No. 234 in Block 55 on a certain map entitled, "Lake Peekskill, Section G, owned and developed by McGolrick Realty Co.,' °_Inc. 1921; 255 West 34th Street, New York, New York, surveyed by Hudson Valley Engineering Co., Inc. Peekskill and Carmel, New York, April 1929," and filed in the office of the clerk of Putnam County on May 28, 1929; as File No...Jg8 ,_ Section G. and ALL that certain plot, piece of parcel of land, situate lying and being in the Town of Putnam Valley, County of Putnam Valley, State of New..York,_known and designated as Lots Noe. 235 and 236 :in Block 551, Sec. G. on a certain map-entitled, "Lake Peekskill, Section G, owned and developed by McGolrick Realty Co., Inc. 1921, West 34th Street, New York, N.Y. surveyed by Hudson Valley Engineering Co., Inc., Peekskill and Carmel. New York, April 1929" and filed in the Office of the.Clerk of the County of Putnam on May 28, 1929 under filed Map No. 185F.. AND WITNESSETH,;} that the party of the second part is the present owner in fee simple title of ;:the following described premisess • u ALL that certain plot, piece of parcel of land with the buildings and improvements thereon, situate, lying and being in the Town of Putnam Valley, County of Putnam and State of New York, known and designated as Lots Nos. 237 and 238 in Block 55, Sec. G, on ;a certain map entitled, "Lake Peekskill, Section G. owned and developed by'McGolrick Realty Co., Inc. 1921, 255 West 34th Street, New York, N.Y., surveyed by Hudson Valley Engineering Co., Inc.,: - Peekskill and Carmel, New York, April 1929" and filed in the Office of the Clerk of the County of Putnam on May 28, 1929 under.Filed Map No. 185F. WHEREAS, the respective parcela!as described above are adjcacent and contiguous and that there presently exists a dirt driveway situate partly on the southerly boudary line of the lands belonging to the party,of the first part and partly on the northerly boundary line of the lands belonging to the party of the second part, w , F- -- - - --- _a.,, -r_ AND V_HERSA3c dti it is the mutual desire of both the parties of the first and second part to henceforth establish, create and reserve to themselves., their respective legal heirs,- successors and or ' — assigns; -'a ireci-proeal eademeiit ' for •mvtoic• vehicle= and purposes over a certain striplof land situate partly on the southerly boundary line of the lands belonging to the party of the first, and partly on the northerly boundary line of the lands belonging to the party of the second part, the purpose of said easement being to gain access to and from Tanglewyde Road to and from the buildings erected on the respective parcels of the parties of the first and second part, said easement being more par.ticularly.. bounded and described as followsi ALL that certain plot, piece or parcel of land, situate, lying, and being in the Town of Putnam Valley, County of Putnam and State of New York, being more particularly bounded and described as followsi ! yl BEGINNING at a point on the westerly side of Tanglewyde Road distant 9.55 feet North 15 degrees 16 minutes 50 seconds East of the division line betweenilots 236 and 237 as the same is shown on a certain map entitled, "Lake Peekskill, Section G, owned and developed by by McGolrick Realty Co., Inc., 1921" and said map being filed in the Office of the Clerk of the County of Putnam on May 28, 1929 under filed Map No. 185F; RUNNING THENCE from said point of beginning North 49 degrees 47 minutes .00 seconds West, 125.40.feet to a point; THENCE North 52 degrees 36 minutes 00 seconds West, 96.76 feet to a point; THENCE North 72 degrees 05 minutes 00 seconds W9t, 45.00 feet - -to a.point; THENCE South 52 degrees 36 minutes 00 seconds East, 129.04 feet to a point; THENCE South 49 degrees 47 minutes 00 seconds East, 131.83 feet to.the westerly side of Tanglewyde Road; -. --THENCE along•t1reveSterly side- -'of Tangiekryde- Raad- Nbrtti degrees 16 minutes 50 seconds East, 16.54 feet to the point or place of BEGINNING. FOfl, THBSSPORB, . IN consideration of $1.00 and other good and valuable consideration, the parties of the first and second parts do hereby covenenant and agree as follows 1) That said easement is for ingress, egress and regress by foot and or automobile to and from Tanglewyde Road, 2) That said easment area as herein described is to be kept clean and clear of any and all obstructions and obstacles which would prevent the respective parties herein from exercising their respective rights in and to the easement, 3) That the cost of snow removal shall be borne by I a i 1 is' . ;1P sA i F 8 L. 9 4) That the cost of excavating, paving, maintaining.and or repairing said easement shall be brone by 'I 5) That the above described easement is to run with the land forever and is not intended to merge with fee.ownership of the respective, above described parcels, 6) That the above described 'easement is to be construed as a reciprocal easement for!the sole use and enjoyment of " the parties of the first part, their legal heirs, successors and or assigns, and the party of the second part, their legal heirs, successors and or assigns, TO HAVE AND TO HOLD unto the parties of the first and second part, their legal heirs, successors and or assigns, forever. AND the declarants in compliance with Section 13 of the Lien Law, covenant and agree that they will receive the consideration for this conveyance and will hold the right to receive such consideration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will apply the same first to the payment of the cost of the improvement before using any part of the total of the same for any other purpose. IN WITNESS WHEREOF, the parties of the first and second parts have duly executed _. = this instrument on -.the day _; and, yea r.%firat..ab.ove „written. _ - -- _• y _...._ . In Presence Ofi f Matthew J. Florio v. Eugenie Conway . • trances vac 1 • I .1 i A % PUTNAM COUNTY DEPARTMENT OF HEALTH Rev.: .3136 t Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer to Provide Permit H on CERTIFICATE OF COMP] b _ �— cd ONSTRUCTION PERMIT FOR SEWA DISPOSAL SYSTEM Permit q J Lo at T�ng.l.ew .de -Rol d own. or V cated e . _ Snbdivlsien Name . � d k e Peek `s Kl l Subd. Let # Z 7 - �3 Tax Map 8 U Block 1 Lot islon 0 Owner /Applicant NFc� n C e S 0 Renewal_ tt J� Rev Date of Previous Approval Mailing Address 541 Pelham Road New Rochelle, N.Y. Tewn Zip Building. Type M n d I I 1 A r Lot Area 45,650 + S F Fill Section Only 2C Depth ��Yohtme Number of Bedrooms 3 Design Flow G /P /D 600 PCHD Notification is Required When FIB Is completed Separate Sewerage System t o consist of _1000 Gallon Septic Tank and F i l l S p 1 t i n n0n1 V To be contracted by Water Supply ; PabBc Supply From Address or: x private Supply Drilled by -Anderson - Address Barger Street Putnam Val l y . N.Y. 10579 Other Requirements 7 ft curtain oral n and 3i ft min Of= WR qIl�,r,pd represent that 1 am wholly and completely responsible for the design and location of the proposed sxv I `IeL separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance WR regulations of e ruinam County Department of Health, and that on completion thereof a "Certificate of Construction C %R: Is 1p the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his sucges� o `�, °Vuilder, that said builder will place in good operating condition any part of said sewage disposal system during the period- ylli5r d�a Following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the original system o€ r it}91'hefj ) tha II drilled well described above will be located as shown on the approved plan and that said well will be Installed in accordance sta an ,!W a ions of the Putnam County Department Of Health, Date March 30, 19909 Signed �.'r7, ' E. R.A. Address 1 nort hri d e Road ekski l l N 05 License No 27846 APPROVED FOR CONSTRUCTION: This approval expires' WOjear from he date issued unless �n �L %uildiag has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner��f dN`�'d11� han$e or alteration of construction requires a ew permit, Approved for disposal of domestic sanitary sewagw, and /Or to water supe���l a,lie Date �� %e BY PDfNAA4 COUNTY DEPARTSUM OF HEALTH r} ED Dhdsbn-of �vlroamentel HeaNh Set!vlces Caemel. N Y.10511 Eng�seer to Provide Permit q s on CERTIFICATE OFO,P ' �Peemi4 N � COP1S 4 CTIOPI PERRHPI' FOR SEWAGE DISPOSAL SYSTEM �� � `' � " Putriam,;�Y t� 4 Located . `Tanlw�ag a Road` Town or Y,lla�e h 4 hake Peekskil l Subdlvleloa Name cabd Lot N Frances Ott _ Ta>i Pilap" Bloet; t Owner /Applicant Name Renewal ❑ ate of Pievions Approval _ 41 ::Pelham Rd' New: Rochelle �t® ion 5 5� z blsiliag Addre®a Town Zip, Putnam Val e y Bnutuog Type _ Moaulaxt Ares 9 00o s�'.. FID Section OaIY Dop* Vohtme Nt ®ber of Bedeooms Design Flow. G P D PCHD NotlBcatlon` Ia Regnired When Fill ht completed 1000 t� __F ff 2, renc Separate Sewerage System to consi ®t of GaOon Septic Tank aaa r :. Howaxd Grage'rt scawaxla . e To'tie conafidcted, by . Address F J water. S>tpPlp PttbHc Supply From r Address X _ Anderson x urger ree ,nam a „ or Private Simply Dp ed by Addeeee o c ° - Othee •Reoulreents ° �r days e - I reticesent theta am wholl and'completely`respons�6le for the desyn and location of th'" y � � ) @hetY the separate sewage tlo iposal system aboJe'descnbeQ :will be constructeG as shown on the Approved, amendmerit there =to and iA>a 'cewifl�' r rules an regu a ions o e u naM. County; Department ofr;Ho" and that "on completion thereoila ;CerLficate' Of Co��tr� - '�`o c t tort' to the Commissioner of Healtfiwill De wDmdted to the Department' and a wntten guarantee will be fuin� shed the ovyp' -fiso by tAe Du�lder that ss�d.buUder Will place: in good ; oDeratmg- conddion any part of said sewage disposalsyriem aturvn�;t r�odGGyjccgg' ear `diately follow mg thadaEs of the:assu- snce,.of the approval of ,the Certificate of Construct°onXomplisnce of tW:, oiigm ;$jt m or° aj� her t }3thaE the d►illedzwell doscribetl abOVe will be lopted _as shoarn -on the approved plan and that said well wl be Installed in ac i�n a wi daiC `Teti anG' iegu a, ions of 'the Putnam - County Date dept 2Oa �7s"OI Q'ar "sreried PEX ACd.ess 1 Northridge R e A . License No APPROVED FOR CONSTRUCTION Thisapprovai�ezpnes two years _rOm the date issued %le s , ofA{7l' besi0� ®of the building has been undertaken and is revocable for `cause or may be amended or:mod�hetl when conside►etl necessaryrDy the' Conim��t9Retp�fineA ith A ny change.or alter8tion of.coristruction repunes a n ..permit 'Approved for drspo al of domeille - sandaiy sewage and /or at ater w ,oni A. Rev. 2 FT I /ai r � _ kew. PUTNAM COUN TY DEPARTMENT OF HEALTH 3/96 Division of Envlronmental Health Services Cei;mel, N.Y. 10512 Engineer to Provide Permit q -on CERTIFICATE OF COMPLIANCE CTION PERMIT FOR SEWAGE DISPOSAL SYSTEM PGlt;Ylalll Valley Tnag , ewy a Rod Located at �, _ Town or ,Village _. e K]. _ Subdivision Name Subd. Lot N � Tax Map $ ® Block 'L Lot r l Frances Ott Renewal_0 —Revision ,_0 Owner /Applicant Name Date o vioa ` val 541 Pelham Road Vew RZF87 e e g MaWng Address Town Zip Modular 459,0 SF' Building Type Lot Area � 0UU Fill Section On1Y Doptb ,�Volame �� d 3' Number of Bedrooms Design Flow G /P /D PCHD Notifi; coif equlred When FIR 1s_com0lited ]:BOO Separate Sewerage System to cons of Gallon Se ti Tank an gow t'a OF a oa nam l ey o. N: To be constructed by,--., -" Address Water Supply: Public Supply From ddreee n arson War Iii' ers gar rep nam ey, NY ors X ap y _Address . ` audible & Vs l m . in.. garage 200 Gallons / wholly s y . Other Requirements e � nand location of to .fie �._61 %) °d) that the separate sewage :disposal system County, h rtmen ofH stn completely, on comnletion•thereofa meat there to and.m� t e'p+te aCs�isrds, rules an regulations .0 0.' Putnam above described 'Will be'constructed as Show n on the approved amend y O. pa t eal p Certificate of Coll cGinDA�ahce'.�satjifactory to the Commissioner of Health will be submitted to the Oepartment, and a written guarantee will be furnished the o ndQ� .�hcye._ssort, he`'irs p fisins by the builder, that said builder will place in good operating, condition any :part of said sewage .disoosai system durirlY o, �,? <tr(!2) y�rs3mroediately following thedate of the issu- an2e of the approval of the Certificate• of'Constructi.on Compliance of the origiRaf em r any repairs th eto; 2) that the drilled well described above wit be Count Department as shown; on the approved plan and that. said well will:be installed ,in a4c�s ce dti� thei�stsndar s rues and regu a r�s of the Putnam . ed tment of Health. Q Date Yloeat en }ember.. 3Oy 1.9V7 Sinned ®. a P.E:X z Address l NOl'tihri a o. a -a r t icanse No. �78 y � APPROVED -FOR. CONSTRUCTION This approval expires one'year .from the -date issue � r��q� tU�ii n, mf the building has been undertaken and is revocable for cause or may be amended or mod ified-whentonsidered necessary by the .CorRalii16iier►tbF HpplRii. Any change or alteration of construction Date 7 _ By vate NBrssEdb'Y only. - reouires a new permit. Approved efO�F disposal of tlomestic.sanitary� sewage Title- 91 �M COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL' HEALLni 5r�tcv.l I�f +�U1i�aTlf�� /YM�;�•7f)�a/►� / REVIEW SHEET - CONSTRUCTION PERMIT (Name of Owner) _ !`CSTeet- catr)• _ COMMENTS YES NO J DOCUMENTS 4 1 Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth tl s/s SUBDIVISION Perc (3) Fill cd House Plans - Two sets Well Permit; PWS letter Vari ce Request GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) . Data On DDS Plans & Permit Sam REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flow 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: perc and deep results Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter, Curtain- Drains' (discharge _OK)... Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If Pumped Pit & D Box Shawn & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Proposed Systen 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,Top of f 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. exp 15' to Drains - Curtain, Leader, Footing 351to catch basin,stormdrain,piped watercou 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' fran Foundation; 50' to wall 15' Well to PL 1 U-i ( •o. S NORMAN ANDERSON, INC. WELL DRILLING RD 31 BARGER STREET BOX 244 _. Ur PU;rNM _Y,ac.v.:: �sw� iioR t�79 LAKs :6APAo 8.8498 OCTOBER 101, 1987 TO WHOM IT MAY CONCERN: I,,NORMAN ANDERSON OF ANDERSON WELL DRILLING INC,, D0 VERIFY, THAT MY WELL DRILLING EQUIPMENT WILL BE ABLE TO REACH THE PROPOSED WELL SITE OF GEORGE OTT ON TANGLEWILDE, LAKE PEEKSKILL. NORMAN ANDERSON .. _..�.. -�r - - DIVISION OF HEALTH SERVICES ADDITIONAL DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. r:,....:..: FY'a71C� •..Ott 1., Address, -541 5 i -i'e ham. 4aaa:. New, Rochel.l; NY Owner Tanglewyd.e Rd.. Located at (Street) r. -, - Sec. Block Lot (indicate nearest cross street) Municipality Putnam Valley Watershed Peekskill. ,n � SOIL PIItC�OLAT•.LON TEST DATA REQUIRED TO BE smuTIED WITfi 16PLIcATIONS Date of Pre - Soaking Date of Percolation Test HOLE NLMER CLOCK TIME PERCOLATION PERCOLATION Run Elapse 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 .. 2 .3 .. 4 5 See 9 4 + 5 F 3 4 u J NOTES: 1. Tests to be.repeate6 at same depth until approximately equal soil rates are obtained at each percolation test hole.- All data to' be* submitti?1d for review. 2. Depth measurements.,to be made fran top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE. SUBMITTED WITH APPLICATION PROBE DESCRIPTION OF SOILS ENCOUNTERED, IN TEST HOLES 7 PROBE DEPTH HOLE NO. HOLE NO. HOLE NO. - 4a. ' ® Topsoil; loL s ilty9 sandy4oam s ilty9 sandy,.loa 1 some clay some clay 20 4 Rock Rock, 5' 6' 7' 8' 9' 10' . 11' 12' 13' r. INDICATE LEVEL AT WHICH GROUM ATER IS ENCO_ UNTFRED None - INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED None DEEP HOLE OBSERVATIONS MADE BY: Michael Perry (J. S. ROMEO) DAM: Jan 17'9 1988 11 -15 DESIGN 5000 SF + Soil Rate Used Min /1" Drop: S.D. Usable Area Provided No. of Bedrooms 3 Septic Tank Capacity 1000 gals. Type Masonry Absorption Area Provided By 378 L.F. x 24" width trench Other Romeo ® ®v R6 /��f ®® Name John S . Signature c.. 1 Northridge Road. Address SEAL Peekskill's NY 10566 e m s THIS SPACE FOR USE BY HEALTH DEPARDMT ONLY: ® Soil Rate Approved sq.ft /gal.'' Checked by Date DIVISION. OF MVIRCMEN1CAL HEALTH, SERVICES � ADDITIONAL - C' DESIGN DATA SHEET- SUBSUFACE'SBQAGE DISPOSAL SYSTEM FILE NO. pyne Frances Ott Y Address 51 Pelham Road New Rochelle, N Located at (Street)• Tanglewyd,e .Road. Sec. 80 Block 1 Lot 1 (indicate nearest cross street) Municipality Putnam Valley Watershed Peekskill SOIL PERCOLATION TEST DATA RSQUMED TO BE SUBMITM W= APPLICATIONS Date of Pre- Soaking Date of Percolation Test HOLE NC��BF.R CIACK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 3 4 5 NOTES: 1. Tests to be repeated.at same depth until approximately equal soil rates are obtained at each percolation test hole.. All data to•be submitted . for review. 2. Depth measurements to be,.made from top of hole. rev. 9/85 l.. 2. 3 4 .. • 2 3 4 5 NOTES: 1. Tests to be repeated.at same depth until approximately equal soil rates are obtained at each percolation test hole.. All data to•be submitted . for review. 2. Depth measurements to be,.made from top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE. SUBMITTED WITH APPLICATION PROBES for Deep DESCRIPTION OF SOILS ENCOUNTERED IN TEST HQIM DEPTH HOI S NO. 5 HOLE NO. 6 HOLE N0. " TY� o l.L _. - - - - - °� Tops o it ; 1, silty, sandy a1oam9 silty,sandy,loam same clay some clay 2° 3' 41 t 6' 7° 8° 9° 10° 11' 12° 13° INDICATE -LEVEL AT WHICH: GROUNDWATER IS - ENCOUNTERED ° None. . INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED - DEEP HOLE OBSERVATIONS MADE BY: Michael Perry (JS ROMEO Dom: Jan 179 1988 - DESIGN Soil Rate Used -11 -15 min /1" Drop: S.D. Usable Area Provided 5000 SF+ No. of Bedrooms 3 Septic Tank Capacity 1000 gals. Type Masonry Absorption Area Provided By 378 L.F. x 24" width trench Other o®°°°°® °O ©o 0 Name John S, RomPn Signature Address 1 Northridge Road. SEAL o O 20 Peekskill, NY 10566 0 27846 0 THIS SPACE FOR USE BY HEALTH DEPARZMENT ONLY: Soil Rate Approved sq.ft/gal. Checked by Date PUTNAM COUNTY DEPARTMERr OF HEALTH DIVISION OF ENVIRONMRMNI,. HEALTH SERVICES DESIGN DATA SHM- SUBSUFACE SFWAGE DISPOSAL SYSTEM FILE N0. Owner Frces :Ott Address'.' 541 Pelham ,Road New Rochelle, NY Located at (Street)' Tanglewyd.e Road 80 1 1 (indicate nearest -dross street) Putnam Valley Sec.- Block Lot Peekskill Municipality Watershed. �.� ongolm I C' 1W a -. - I RUN: _ WKW Date of Pre- Soaking Sept 22, 1987 Date of Percolation Test Sept 23, 1987 HOLE NUMBER C= TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches (2) 1 3 :25 3155 30 13.50 16.25 2.75 10.90 1 1 9 30 13.50 16.00 2.50 12.00 2 1 4131 .4901 30 13.50 15.75 2.25 13.33 3 4 5104 5 834 30 13050 15.75 2.25 13.33 5 (4)1 3120 3150 30 14.00 - - - -- 17.00 - -- 3.00 -__ - 10.00 - - 2 � -315.3 4s 03' .. -30 -_ x..:.14. 00 16.50 2. So - 12.00 3.4105 4135 30 14.00 16.50 2.50 12.00 4 5 (5)l 3131 4 s o1 30 13.25 16.00 2.75. 10.90 2 4107 4137 30 13.25 15.50 2.25 .13.33 3 4140 5slo 30 13.25 15.37 2.12 14.15 4 5s12 5s42 30 13025 15.37 2.12 14.15 5 NOTES: 1. Tests to be repeated'at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA RE1QUIRM TO BE SUBMITTED WITH APPLICATION DESCRIPTION_ OF SOILS ENCOUNTERED IN TEST HOLE5 Pere rerc DEPTH HOLE NO. 2- HOLE NO. HOLE NO. G.L. 411 Topsoil 41, Topsoil 41' Topsoil' 11 silty, sandy loam- silty., saridYv'loa'm silty, sandy, loam some -alay atay sollis clay 21 ---- 31 41 51 61 C".) 71 CL 81 cv C-1 91 10, 13 141- INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED None None INDICATE LEVEL To WHIM WATER LEVEL RISES AFM BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: John So Romeo DAM: Sept 239 1987 DESIGN Soil Rate Used 11 =15 min/l-, Drop: S.D. Usable Area . Provided 5000 SF 1000 Ma onry NQ. of Bedrooms Septic Tank Capacity gz�ls. Type, 420 _4sqrption Area Provided, By L.F. x-.,24!1:width trench P Dosing system all trenches fed equal] 41)tt N A Other ® Z John So Rpmeo Name Signature 1 Northridge Road % ' f 0 SEAL V ® a 0 7S, Address 2 &� PVA Peekskillp N.Y. 10566 w/1 tml \ of i'i Vt 0 0 0000000 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft/gal. Checked by Date a PUTNAM COUNTY DEPAR'IlMERr OF HEALTH DIVISION OF HEALTH SERVICES aHEET 2 , DESIGN DATA . SHEET- SUBSUFACE SF3tiTAG_E DISPOSAL SYSTEM FILE NO. Owner n ---- Frances Ott Address 541 Pelham "Road 'New -Rochelle, NY Located-at (Street) Tanglewyde Road sec. 80 Block 1 Lot 1 (indicate nearest cross street) Putnam Vallev Peekskill municipality Watershed Date of Pre - Soaking Sept 22, 1987 Date of Percolation Test Sept 23, 1987 HOLE NUMBER CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches (6)1 3 :40 4 :10 30 15.25 17.75 2.50 12.00 2 4 :15 4 =45 30 15.25 17.50 2.25 1333 3 4 :49 5119 30 15.25 17.50 2.25 13-33 4 5 1 3 5 -- ,1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained.at each percolation test hole. All data to'be submitted for review. 2. Depth measurements to be made from top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION ` Deep DESCRIPTION OF SOILS ENCOUNTERED IN TEST�HOLES l Veep 3 _..... _ .... erc 6 DEPTH HOLE NO. HOLE NO. HOLE NO. _ 5•► topsoil 3" Topsoil 4'° Topsoil r siltylsandy looff— slity,sandy loxff- sil � es a 9loam 11 some clay some clay. 2' 3' 4' . 5' 6' 7' 8' ri- $4 go c " .10' - �► 12' _ 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED None INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED None DEEP HOLE OBSERVATIONS MADE BY: John So Romeo DATE: Sept 239 1987 Soil Rate Used11� DESIGN 15 Min /1" Drop: S.D. Usable Area Provided 5000 SF No. of Bedrooms 3 Septic Tank Capacity 1000 gals. Type Masonry Absorption Area Provided By x'20 L.F. x 24" width trench Other ®�1�L Efl�G, /,�,�ba• Name John S° Romeo Signature Address 1 Northridge Road a� iv SEAL Peekskill,NY 10566 THIS SPACE FOR USE BY HEALTH DEPAMM ONLY: Soil Rate Approved sq.ft /gal. Checked by Date t r lam' ... 211111 W PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRODAERML HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SERGE DISPOSAL SYSTEMS - REVIEW SHEET - CONSTRUCTION PERMIT ' DATE v • (474_1 1 OTT '-tAp&� f. UYOE BY: (Name of Owner) (Street Location)" COMMENTS ENTS YES NO DOCUMENTS X13 u Pennit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth s/s SUBDIVISION Perc (3) Fill cd �� ���' House Plans - Two sets Well wit; P�JS letter Vari a Request GENERAL -•--s Legal Subdivision (' ` xeneh provided38 420 p �� requir�i�7 ) 70 60 ft. max. A10 Fib Parellel to contours_ _AID 100% expr..# Mspec. 200 ft. reservoir, etc. 150 ft. trigall /gall. �- Subdivision Approval Checked -` P-c- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit- R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - .(north arraa) Sewage System Hydraulic Profile - Gravity Flcw q i9l Profile & Dimensions - Volume or J Box;Trench /Gallery; Pump pit details -- — — Santir -Tank =.q Well Detail, Service Line if over Construction :Notes .;fgrinder rate.) Design Data: perc and deep results Two -Foot Contours Existing & Proposed Drive-way & Slopes Cut Footing/Glitter,Curtain Drains (discharge OK) Perc & Deep Holes Located h Re resentative of prit and ex an s. n Expansion Area; shown; gravi.ty flow,suff. size If Pumped Pit & D Box Shown & Details House - No. of Bedr P G`v A,. Wells & SSDS's w/i 200 t. of Proposed Systems 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,Top of fill x,320' to Foundation Walls x'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,piped watercourse 10' to Water Line (pits -20')- 50' intermittent drainage course Septic Tanks 10' from Foundation; 50' to well 15 Well to PL 9 DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT ­A 'WATER WELL PCHD PERMIT 4 WELL LOCATION Street Address Tanglewyd,e Road Town Villag /City Tax Putnam Valley 88 -1 -1 Grid Number WELL OWNER Name Frances Ott Address Wrivate 541 Pelham Road , New Rochelle D NY O Public USE OF WELL 1 - primary 2 - secondary ®RESIDENTIAL 0PUBLTC SUPPLY. ❑AIR /COND /HEAT PUMP ❑ BUSINESS O FARM O TEST /OBSERVATION ❑ INDUSTRIAL O INSTITUTIONAL O STAND -BY 13ABANDONED O OTHER (specify ❑ AMOUNT OF USE YIELD SOUGHT__gpm /# PFOPLE SERVED 4 /EST. OF DAILY USAGE 600 gal REASON FOR DRILLING @NEW SUPPLY O REPLACE EXISTING ❑PROVIDE ADDITIONAL SUPPLY SUPPLY ® DEEPEN EXISTING WELL ❑TEST /OBSERVATION DETAILED REASON FOR DRILLING New Home WELL TYPE XMDRILLED DRIVEN ®DUG 11 GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lake e e s 1 Lot No. - WATER WELL CONTRACTOR: Name Norman Anderson Address$arger .Street Putnam Va IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO -- NAME -OF- PUBLIC- -WATER SUPPLY: - TOWN /VIL /CITY D- ISTANCE...TO PROPERTY FROM NEAREST WATER MAIN: Ndhe _.. . LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED None / []ON REAR OF THIS APPLICATION ON SEPARAT9 S ET (date) Or (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. Date of Issue: —�° { 19 4 S' Date of Expiration: 19 �Q ermit Issui ff' _---- Permi t is Non-Transferrable e e 8/86 LVt M1 IVIV: I0I1Y1t;WYIW mu., I VV ouuuI VI 11VI uITTUY DESCRIPTION OF PROJECT: Construction of single family residence, driveway, well and /or septic system in a wetland or its controlled area. is fl i/7 V101 OV701lh/s-ordina=8 ?NO /s the wstlw�d %ssf�rcrn�rr� prolc�l�'hv the Town? YES /s the wetland /walerc�ursep�olecWby the Stale? YES /s the prooasad orojecl a regulatedXt /v/ty? YES Which other jurisdictions are involved in the review otthe proposal? PUTNA/Y COUNTY _ DEPT OF HEAL TI/ Field time: 0.5 hrs. Additional time: 05 hrs. Total time to date: 1.0 hrs. COMMENTS: Durin; a site inspection on 7/21/88 1 flagged the boundry of a wetland on this property with red - polka dot ribbon. This wetland is located along Tanglewylde Rd. and is at the bottom of the slope of the property. A 12" culvert drains the wetland to another wetland across the road. The wetland in question is a small wooded swamp with a thick muck deposit at the lowest elevation. A variety of junk has been deposited along the upslope edge of the wetland. While minimal.wildlife habitat is provided by this wetland, it does serve storm water detention and sedimentation functions. r' A survey dated 1/26/88 attached to the application shows a proposed'driveway crossing the wetland and the home constructed in the 100' controlled area. In order to complete a review of this application, the following: information. will be.required: all subsequent maps'should show the wetland as field determined as well as showing the proposed rations of. house, well and SSDA. if fill is proposed, the amount, type, and location_of fill,must.be specified 2 foot topography in `the wetland and 100' controlled area - control of erosion during and after construction must be described in detail. It should be noted that any fill in this wetland will likely increase run -off through the 12" culvert under Tanglewlyde Rd. in addition, reduction of the amount of permeable surfaces upsiope will also influence run -off volume as well as verity. Site drainer should address these . situations in order to minimize impact. INSPECTED BY: Michael Priano DATE OF REPORT: 7/21/88. NOIF- HE APPLICANT SHALL HAVE THREE MONTHS FROM THE DATE OF THIS REPORT. TO PROVIDE THE REQUESTED INFORMATION. AFTER October 21, 1988 THIS APPLICATION BECOMES- NULL'AND " _ VOID. THE APPLICANT MAY REQUEST AN EXTENTION IF NEEDED. .l /f ;4 " r q 'r �' : dV: p`Q• -cw' .r..::C 1 -� t •S �, r w �, a ha .v ark„ •,,,, u r g; �,'' ( < "< = PUTNAM COUNTY DEPARTMENT Of; HEALTH f Divlsron of REnvironment Hlth Services = t;arme/ N Y 150512 CONSTRUCTdON `PERMIT "FOR SEWAGE, ";DISPOSAL SYSTM.a tli Tl�Iq;M_ A l..i: E'F Town or Village ji tj> 43 Subdivision ��1C� YC�kSBGlf`L'. 1_d"iS. �3� ��✓�, If.ICL_ LotC�� / Job �y Owner" I . "_ ;:- drew' nllt4 , y A �r r Building TYPe Lot Area Z ± A C'� F5 Number of Bedrooms Trt.��. _:� Total Habitable Space I�dd Square Feet• :f ? Separate Sewerage, System_to consist of Gal Septic Tank lineal feet 'X width trench to be constructed bya}�V Address LL Water SupPIY Public $uPPIY From IV 1 z Private Supply .to be drilled by S ' � Address '; y ''�TA%.A�°�' -'a bllii..�•t`1 i iV 7'• t :. ,B,pP�v� Other Requirements° - • i e6�?� ; I •represent that I am wholly and completely responsible for'the desi" of :the aprsoposed systems) 1) that,ahe,'separate.aewage disposal „system above "described' will be constructed as shown`on the approved am " �n accordance with the standards rules'an , regula ions o e u nam County:`Department of _Health, and that on completion they ruction Compliance. •,satisfactory to the Commissioner of HealtfiwUl be submitted ta`the Department',and a ,_wrRun_'guaranfee' n his successors`hensor assigns by thebuilder,ahat said.•builder-w�ll' place in,'good operating; condition any ,part of said sew ` ei od of two (2) years irhmediately following the date, of the issu .`- e:drilled well tle5cribed above wiif be located as shown on.-the approvetl p an and thaf'sai ' origacc_ m`with the standards to rules and, egule i, ons-�of ;he Putnam county- Department of Health ={ - Date 2, I. i 1 -� y ° ne` R Y Address License No X (c j y: %.S's ..APPROVED FOR CONSTiRUCTION This :approval expires a > � d `unless eonstruetion of the' building, has . be n,undertaken and es ,>,- for cause or maybe amended or: modified wherr.cons� nQ� ;b Commissioner of Health - Any change "or alteration_,of rnnstr_ u�tion _ f -; equves a new perms Approved for disposal of'domestic san r;:pnv te:v afar supply only Date Po . /� =8Y Ci + _ Title F �IQ IE CiFC-K LIST INITIAL SITE INSPECTION Property lines or corners found Can estimate house location . . . . . . . . . . 4 Will dr-l-veway need.. cut . . . . . . . . . . . Mist ti7ees be removed.--note these . . . . . . . Is deep hole representative of entire SDS area Additional deep holes needed. . . . . . . . . . .Sufficient SDS area available considering driveway cut., house location., separa tion distances, etc . . . . . . . . . . . . . .. .. DEEP HOLE EftVll Depth: Water elevation: Rock elevation: ScAls description: Date: NAL SITE INSPECTION Insp. by: House located where shown on approved plan SDS located where aiDprmTed Width of trench average Slope bf.tile line and trench acceptable . . . R6om allowed for expansion trenches Over 50 f�- from swamp, watercourse soil 1 n- t stripped - ' r- SDS A" .�Na -ural oj- 0 0 re unnecessarily graded . . . 10 FL. maintained from prop.line and 20 ft. from house . . . . . . . . . . . . . . Separation of trench from house,. well etc. follows plan . . . . . . . . . . . . . . Number of bedrooms checks . . . . . . . . . . . Stones., brush., stumps,, rubble., etc. greater than 15 ft. from nearest trench 15 Ft. of peripheral soil horizontally from trench. . . . . * . . . . . . . . . . . . . . Junction boxes properly set Could surface run off from driveway, road6, ground surface., etc. channel near SDS area. . . . . . . . . . Does lot drainage appear I n area of FINAL GRADING OF SITE ACCEPTAME Date: Insp.by: IYes I No -- PZJ'�'�VA��.:COIA�Ttz'= DE�'�2�TP�I�i�' �8�'- HEAL•TH�� :. ....:.,�.. j......: . ,,........ DIVISION OF ENVIRONMENTAL HEALTH SERVICES t Date .J �--( 1a.n (Z e Re: Property of c 7 E L" er S i Located at — �I�•►� -� �.l �L D E !� D - �•-T+JAr•� IIA-0 go Block Lot le 'f;( .t- Gentlemen: / J. This letter is to authorize ,:. STALg�uER a duly licensed professional engineer if or registered architect ( IndicaTe-r- to apply for a Construction Permit for a separate sewerage system; to serve the above noted property in accordance with the standards, rules or regulations as promulgated by the Commissioner of the Putnam County iepa.r-+iiiiciit of ncU_LUil, mill to sign 8.11 rieuut36ary 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 1-47,V Education Law, , the -Public. Health. Lai ,.'_ and .the' Putnam..Gounty tary Code. ..l " C" igne P.E., TANL' J. LANDE (Seal A a . bDIX 267 n . 1. Very truly yours, Signed ,f 1� Owner o Property A dPess NO. 3 ---1— 4 2: � y ZeZI —Te ep one j :p PUTNAM COUNTY DEPARTMENT OF HEALTH..,,-,. v DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner i^ "o'0ELMe51 Address 229 '5r>(Z1Q6 'ST _CJS5itI(Q< -.' Located at (Street qr 6LZW ipf em ?50 Block 1 Lot 2 2% Indicate y n eares cross s ree / Municipality V A LLG- Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE S ©Qi (QAL_ —SCILr TED WITH APPLICATIONS 1101 Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to a er Water Lavel No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 2/1"573 11,-51 3rj;�z 17: tl.% f % 4-0 31/!39 11"46 5 2 3 4 5 Y Notes: 1) Tuts to be repeated at same depth until approximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. J Y' INDICATE LEVEL, AT. WHICH,GROUND.;WATER IS ENCOUNTERED A o 91,'9 7 INDICATE LEVEL TO WHICH WATER LEVEL RISES -AFTER BEING ENCOUNTERED— " " ..TESTS MADE BY. S Date Jez AjF 2, LP�r.J 11I1V t Soil Rate Used Min/1 "Drop: S. D. Usable Area Provided -,I 3-r---O Q' No. of Bedroomsl� kc Septic Tank Capacity 4?�O © Gals. Type 1$1,4-50AJR 1 Absorption Area Provided By L.F.x24 �j '— width trench. STANLEY I LANDER ' s, � /n Other- ignar,u Address THIS SPACE FOR USE BY HEALTH DE .l Soil Rate Approved Sq. Ft! CM >u by Date TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION -::. _ - -. •::,_:: r: -: ._ .DESCRIPTIQN, L2F: <SOILO ETi?CQU E:UD : IN..,TEST__. DOLES DEPTH HOLE NO. Pi HOLE NO. "z— HOLE NO. 1 G.L. . 1 �: P dat.rt� !a DiLr % p el 611 ri r r e.t 12" SArLID l /�A� Li�a� �a Tic Lt,�� Sliuy Ac° CLr��r 18" 3 fl 42 ' 48" ti �. 54 60" 66" 721, 78" INDICATE LEVEL, AT. WHICH,GROUND.;WATER IS ENCOUNTERED A o 91,'9 7 INDICATE LEVEL TO WHICH WATER LEVEL RISES -AFTER BEING ENCOUNTERED— " " ..TESTS MADE BY. S Date Jez AjF 2, LP�r.J 11I1V t Soil Rate Used Min/1 "Drop: S. D. Usable Area Provided -,I 3-r---O Q' No. of Bedroomsl� kc Septic Tank Capacity 4?�O © Gals. Type 1$1,4-50AJR 1 Absorption Area Provided By L.F.x24 �j '— width trench. STANLEY I LANDER ' s, � /n Other- ignar,u Address THIS SPACE FOR USE BY HEALTH DE .l Soil Rate Approved Sq. Ft! CM >u by Date DRIVE 33' 43" 35 30,, i ly f T- 36 LL -- 30 25 ' I B 3 BEDROOM DWELLING r r r j ► Al > > 24 �. 16+ i 9 22'2S25!27' -3S 33 v t J DISTANCE TO CORNER -OF HOUSE t i •� SEPT�� T�- 7i Ifi _ T 26.5 - v, x JUNC. i lit 1{ ! i F 26.W r 40.Y '' . •` a - .. - JtNC. ' ► ' . 32.2 43.1' -JUNC. .6 �1 + s y.c 'e ^ _ .. , ,n , , N 210- 57'- 50 15.44' N 52°- 36' -00" w 498.41 TTARI, P. E N 69°- 42' -00 "E 49.69' ,TANGLEWYDLE ROAD -0 S•�• S 52°- 36' -00" E 41 a 16' i yav / °= ' SCALE: 1 40 -.M lS�