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HomeMy WebLinkAbout4182DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.75 -1 -44 BOX 32 lirs 1 91 r ,. I,yL ri .. ME J 6 6 16 4 IN rL I �. ke 04182 R BRUCE R. : FOLEY- Public Health Director Michael Doebbler 102 Hewitt St. Lake Peekskill NY 12537 Dear Mr. Doebbler: DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA.: MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 April 30, 1999 Re: Addition- Doebbler- Hewitt St.. No Increases in Number of Bedrooms (T) Putnam Valley Tax # 83.75 -1 -44 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 approval stamp from this Department dated April 30, 1999. The addition is approved with the following conditions. 1. The total number of bedrooms must remain at Three without prior approval by this department. arua.,of the existing sewage.disposal syst m;:and:its expansioni 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. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Vallev. If you have any questions, please contact me at your convenience. Very truly yours /_ Z� Michael Luke ML:kg Public Health Technician cc:BI DEPARTMENT OF HEALTH Division of Evtvlronmental Health Services 4 Geneva Road Brewster. New Mork 10509 Tel. (914) 278-6130 Fir (914) 278-7921 BRUCE R. Public _Xealrh F�LEY R.irector. ; { i s STREET ITT_ST TOWNP V. TXlYIAP # 6335-1-44- NAMEMIGtAL F—>Q�P�BI'ET PHONEZ- ]I-PCxD# q mAIL1NQ ADDRESS I D� N F I r-r' ST: L�Ir.. PE�IGS►.I LL I�`( 1053 DESCRIPTION OF ADDITION F 11 IS ED b sssa dl A kA NUMBER OF EMSTING BEDROOMS 3 (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) PROPOSED # OF BEDROOMS t S *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 Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 4 Geneva Rd., { - $ rewster, NY 10509, Phone 2,78 -6130. _ i `I P1. Certified check or money order for $100.00 ; a�f ,Ap 2. Sketches of existing floor plan (drawn to scale, all living area including basement) t * 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 i of installation if known. Label all wells and septic systems within 200 feet of the property line. G e, oy1( Contact this office with any questions. `x015¢ — S. Copy of Cert. of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. QEFX USE, Comments t Feb 98 a 1 Acting Aublie ,Health Plreetor DEPARTMENT OF HEALTH, Division., Of Environmental- Health Services % 4 Geneva Road, Brewster, New York 10509 i (914) 278 -6130. 1 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 PoEBL-3,LE Re: IbZ ewITT ! T, k— t 16kI Residence Tax Ma 83.-75 -1- 44 TownEff Gentlemen: According to records maintained by the To1N17, the above noted dwelling ` IS IS NQT- in compliance with Totim code and the total number of bedrooms on record j is This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: T ��✓�j � HER �,. -2 Building Inspector ' 6 4 � , �r . . ._. _ __ ���f�iG ®��� '�iv�P� 7_�l- 11��.�7� Rev. 3/86 PUTNAM COUNTY DEPARTMENT OF HEALTH r Division of Environmental Health Services, Carmel, N.Y. lOS12 Engineer Mast Provide P.C.H.D. Permit I► " — _ .:. ;ATE'OF CONSIITONCOPLIACE FORF AGE DISPOSAL SYSTEM. -:: v - Y � a CERTIFI � , :::•-•;: -:- Town or Village A _ Located at r -! ^ °' U a= �'- Tax Map __L �' Block Lot t�+' ¢ t c' l , l + e Formerly Subdivision Name . 1 Sabdv. Lot 8 Owner /applicant Name �—r-� pp ,,,, .,r ;t --9 • ,'� Zip :_ `- ?' #- Date Permit Issued Separate Sewerage System built by Consisting of Water Supply: Public Supply From Address "> a .. ? r. e:: Address � � i. or :.. Private Supply Drilled by T,— # �T Building Type �/z, �1 ' i'; "' Has Erosion Control Been Completed? } -- 3 Nubtber of Bedrooms Fr= Has Garbage Grinder Been Installed? Other Requirements — I certify that the system(s) as listed serving the above premises were of which are attached), and in accordance with the standards, rules an Putnam County Departzm^elnt Of Health. Date —t, �, ics.,� f— — Csrtified�tiy Address construgte3 essentially'as shown on the plans of the completed work ( copies d rec�uiations, in atirdal,ce with the filed plan, and the permit issued by the V.E. k R.A. License No.– r Any person occupying premises served by the above system($) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a pub(': sanitary sower 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 of Health, such revocation, modification or change Is necessary. J� .Date BY Title .. ....::y -_. �..��, ..... sou... ..:::..........: � _:.:,.:;.c�..:,.....:u:�:.,.:.� " `stands, 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 „._..._ __...�"Certi- ficate -of Con- struction.,Cornp3iancera for •the sev(-agc- disposal - systi�n, 'ot any repairs made by me to such system, except where 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 Environmental 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 buil ' ng ut . iz . 9 the system. Dated this day of I'L 199 General Contractor owner) - Signature J /A Corporate Name (if Corp.) -7 2 LLF)t,_5, t,L P611. r�Y. F'%!1 - rev. 9/85 Ink i� . A t. r ► Address 0 CERTIFICATE OF OCCUPANCY - One Family W /Garage C.ertificatQ. of Occupancy:No::;.. :.917 :2.9 Application..Na...:,.�,90,916 Hewitt Street - TM 110 -3 -21 Location of Premises ........... .......... ............................ ...........�............ .-.... .................- ........ -.... ... ichael -- Doebbler .. .. ....... ....... . . .... of 72- .Lake Dr. E. Lake_ Peekskill,- N.Y., having ............... heretofore filed an application for a building permit pursuant to the Zoning Ordinance, Sanitary Code and the Laws in effect in the Town of Putnam Valley, Putnam County, New York, having paid the required fee therefor and the undersigned having by personal inspection ascertained that the applicant has subsequently proceeded with the erection or improvement of the proposed struc- ture in compliance with the requirements of the laws as aforementioned and that the . said work and materials met every requirement of the laws as aforementioned and that the premises have now been fully completed and are ready for occupancy pursuant to the provisions of law, Now, therefore, this certificate of occupancy is hereby issued under the seal of the Town of Putnam Valley this .............. day of ...... ....February.......... 19...91 Not valid unless signed in ink by a duly authorized agent TOWN OF PUTNAM VALLEY, NEW YORK of and under the seal of the Town of Putnam Valley. r� f B b PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVUDAL ADDITION/REPAIR FORM SECTION A: GENERAL INFORMATION Name of Project /0 — 4 (T)(V) �V TM# Year of Construction Size of Parcel SECTION 'B. TOPOGRAPHY (Please check all appropriate boxes) 1. oil 'lly ❑Rolling Steep Slope L '1Gentle Slope ❑Flat 2. ❑Evidence of wetland []Low area subject to flooding ❑Bodies of water ❑Drainage ditches ❑Rock outcrop YES NO 3. Property lines evident? 4. Water courses exist on, or adjacent to parcel: 5. Existing � individual wells within 200ft of the existing SSTS? SECTION C. EXISTING SUBSURFACE SEWAGE TREATMENT SYSTEM(SSTS) 1. Physical character of existing SSTS area. 13/Gentle Sloe []Steep A. []Level G p ❑ p slo e p B. ❑Well drained L73Moderately well drained ❑Somewhat poorly drained ❑Poorly drained C. Area available for SSTS. (Primary & Reserve) ❑Extremely limited []Somewhat limited equate ft x ft �. ,r5 v� - :cr. -.� � s -'hr: .- a 'rr_r,.'1�- s' -., .n%w•��. .��.w ""T': �;rr .,. +r � ..-'ids -. ,r ,.- '. a 'wp. ,, .�...- p''!.. x .:, D: INSPECTION Date Inspector `~ \o evidence of failure I Evidence of failure ®Evidence of seasonal failure ML t 71 - - - - -- =_-- -------=-----------=------------=---------- - - - - -- I - - - - -- - -- p- �r ( ndicate North) (1) Indicate location of SSTS A. Size and type of septic tank ®Metal Concrete B. Type of absorption area 1. Fields ft. 2. Pits gallons OPlastic 3. Gallies ft. 'C25 Indicate setback`s;' front 'street,f backyard, and side yard`dimensions (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 ®PWS [IS hared well L Individual well COMMENTS: REPAIRS ONLY: As Built Inspection Required: Status: ClDrilled clua L46asing above ground As Built Submitted: As Built Inspection Done: Inspector: -1 8� �S � Fijz,-5TF-(,:,� (91!wls4a! V�C 30 ] , 5 I —736 41- J) r. C W C- 2 D.W. Akl\l E,- W/ T-A M \j L) P, w 5 W R �o k/( EA D a) (',-A' T KITCHEN DINING PAN-1 P.)( 212 EE Vo POR 0!9-�Lg Poft T -M, ILRAWROVED FOR BE MOM COUN-T ON,, ate. e9A q' CIA' ii lup BY 149, �j 6 CL t �Y- - f � 7' 5- IV loy It T- Z-ou 0- L15]7 D T HERM41 GIRDER: L _j I P, E I .PULL D.0. A- I 1 h 1c ST n 1;z S Y, Y, -j (1) EACH HALF HOUSE PLAN A* v Fnrn:,-4,A BEIDPIO p VVE-D - FOR'4tyqe olm 'y' 2A ve ''TER BDRM ,. o3-'A z B1 (4) 20"DEEP LINEN 1 S H El V E . S lo u C)R o 'PHONE LLJ o Thes! 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Y.,. ..�ai•C•4;+v:rt.'s�ka�&.����� : «E tY0:26.�; PUTNAM COUNTY DEPAR'11VMT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES r' Owner or Purchaser of Building Building Constru tea by Hevvi-F-1% Location - Street Pu -_r�Atvi \/A1_L1P_� Municipality a �t� P.-f :r=P.1�4 Building Type Ji© -3 Section Block Lot Li, Subdivision Name 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 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 " Certificate. of Construction "Compliance" for ..the.. sewage, disposal system,.. or; any. _.. `� " repairs: made 'by-ineo 'sine " systeii, - except • where 'the- failure - to -operate;-properlyy 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 of the building utilizing the system. Dated this of 192 .Signature General Contractor (Owner) - Signature CorporateName (if Corp. ) Address rev. 9/85 mk Title J/A Corporate Name (if Corp.) ess �_:� c�c:�== !_17�� l Yorktown Medical. Laboratory Inc. LAB # Date Taken: 1 -21 -91 _ Time: 8AM 321 Kear Street Date Rc' d . 2 Yorktown Heights, N. Y. 10598 Time -Date Reported,: - ._P. -a,. e' sign, Inc-.*-" - ---..n v Director: Albcrt H. Padovani M. T. (ASCP). PO /Client # + Referred By: Sampling Site: a •oom a Michael Doebbler 102 Hewitt St, Lake Peekskll , (2 Lake Drive East Lake Peekskill, NY-10549 L -1 REPORT ON THE QUALITY OF WATER Phone ( ) 962 -4488* INORGANICS (mg /L) MICROBIOLOGICAL —Alkalinity Chloride _ Copper — Detergents, MBAS — Hardness; Calcium — Hardness, Total _ Iron Lead Manganese — Mercury _ Nitrogen, Ammonia — Nitrogen, Nitrate Nitrogen nTitrite _ Standard Plate Count (CFU /1.0 mL) Coliform & Related Organisms Circle Method MPN P/A /Total Coliform Al Fecal Coliform Fecal Streptococcus 1 E. Coli Phosphate, Total — _ Silver Sodium KEY FOR TERMINOLOGY Sulfate LT = < Less . Than ..._- Sulfide . _ ... ...... ........� G,T- .. _ -_ - Greater Th6 i" _ Sulfite NA = Not Applicable — Zinc SA = -See Attachment(s) TNTC = Too Numerous To Count PHYSICAL MISCELLANEOUS P = Present (Positive) N = Not Present (Negative) .pH (S.U.) * = Also done because To- _ Color (Units) tal Coliform Positive _ Conductance (ohms /c) Odor (TON) _ Turbidity.(NTU) REMARKS COMMENTS Lab Use (For Lab Use) SAMPLE TYPE: (Check One) Potable Non- potable OUTGOING: (Check Each) HNO HC13 — H2SO4 — NaOH ZnOAc _ Na2S203 — Other: INCOMING: (Check Each) �,L. __ _:4 '0C ,. ✓ GT 4 /LE 200C _ GT 200C _ pH LE 2 _ pH GE 12 — Other: NYS ELAP #1.0323 THESE RESULTS INDICATE THAT THE WATER SAMPLE WAS)) (WAS NOT) (NA) OF A SATISFACTORY. SANITARY QUALITY ACCORDING TO YORK STATE PUBLIC DRINKING WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE COLLECTION. THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DID NOT) (NA MEET THE SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STATE C DRINK- ING WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE COLLECTION. 7 /87(Rvsd1 /90)RWE A n -Trnr» M FV . i rcnt nT WESTCHESTER COUNTY DEPARTMENT OF HEAL'T'H Division of Environmental quality / �/-6 — S;�, WELL COMPLETION REPORT is r o to be compl "F*ted' be well dr %]le "r "`and °nubmitt�d` tcrAifea`ltii'`77i I3n�tnth7st, °icsther"wi °tli-' 1 r°bor,,ifx)ry report of anal.ynis of water sample indieating wnter i, of satisfactory bacterial quality, before certificate of construction compliance is issued. Well construction to bn in accordance with Hullettn SD--6? . "RULES & REGULATIONS RELATING TO INDIVIDUAL WATER SUPPLIES" LOCATIONt MUNICIPALITY: Lake Peekskill SECTION :_ BLOCK: LOT: WELL OWNER: Michael Doebbler, c/o Site DesiamjPO Box 423,Yor wn Ht.� ame Street A'Tc. dress i ,y —and mown LOCATION: Hewitt St. Lk Peekskil.l,NY WELL DRILLER: P.F. Beal & Sons Inc. P Box B. Brewster. NY 10 0 Name. Street Address City and Town _ CASING DETAILS YIELD TEST ° WATER LEVEL ° SCREF.P1 DETAILS Bailed '(measure from land surface) Length: 31° Feet; or ;_X_Pumped 6 Hours statics lot Feet; Makes ;When o ;slot Diameters 6 Inches ',Yield: 25 G.P.M.;or Pumped 265 Feeta Length: Ft.;Size Heavy.Duty , ° Kinds Seamless Steel; ; t Diameter In.; T(7PAL DEPTH OF WELL: 285 FEET WELL LOG Depth From ; Give description of formations penetrated, such ass peat, silt, sand, gravel, Ground Surface ; clay, hardpan, shale, sandstone, granite, etc. Include, size of gravel (diam.) _ w ,. .. o: grid sand .(t1-- ne,.<.medieim, ,coarse), ..colo:r. ;,�.txuctur _ (loose, packed cemented, soft, hard). For example: 0 ft. to 27 ft. fine, packed, yellow sand. 27 ft. to 134 ft. gray granite. 0 Ft to 15 Ft-: Drilling in overburden clay and bouldPr-q ° iwf fn Ft:_ _ Ni t rock at 15' 15 Ft.to 31 Ft., Drilling in rock,set casing, grouted. 31 Ft.t028 Ft. ° Drilling in rock granite.--- Ft. to Ft.' Ft. to Ft.' ° Ft. to Ft. ° Date Well Was Completedt 11/29/90 Date of Repor Well Drillers STEM PIT AND PUMP ZZUIP1 -n= D=A= Finished Well: Check Pit with 4 —inch Gravity Drain to Grade -ty Drain to .Basement wt nch.. ravi � X Pitless Adapter - Casing Min. 12 inches above grade Other: Describe Pump: Make Gould Type Submersibi a Capacity 1/2. h G.P.M. 7 Storage Tank: Type Well Xtrol 250 Capacity 44 Gal. (42 Gal. Kin.) DIAGR M SHOWING LOCATION OF WELL ON PREMIISM Indicate location of house, well and sewage disposal system with distances. Also indicate direction of slopes and direction with distances to all wells and sewage disposal systems within 250 feet. I certify that the individual water supply indicated above was install as per the rifles and regulations of Bulletin SD.62 of the Westchester qty 4epaptm of Health. Sworn before me this., ay of 19C . Notaf7 Public-9 unty. PAULINE ,chz;ni Nota'Y �' ji0° °t Naw York in,Putnn+'n C,ountY Commission ExPires g3ptember 2, )% U -DEPARThU . ..... � NT-Y-' z / --DlAiWid-Eivieomnen Mcei Carmel .�- Wwe Wi t CONSTRIICTIO PE FOR SEWAGE DISPOSAL SYSTEM .2 TQ'Wn--,*' VH I&Cb 'AT-T.' W Tii m sib• Owloor /Appllceat Name CL L Date P A- Approval EFS ES L f Address S. M"� --r— '11253 -pm Handing Lot Area Moth, flob I&ROquir w -ed Nuz�6r, of When C, oil* Sewerage erage' System to 001181st d' Gs�oii.S.ep& TsAk -aidL. 7 To be Co"&ucti6d by Addree Y:L C UP Y2 Addie OT Aj ddroes P o i. vaft:*!ippYJvWed b - Ad 0 re 7 that I �jrn -Whoiiy, and con I stem rn(s);� ) jhat.,�'the,'separate, 0 -'sif above de4ciibidl will bex'bnitiuciia'a-S466�in eta' -'ad amendmirit'there'to: and:i ?n,tti� Wov. ljpdards� ruies.ancljogy let ions of.7-the. Putnam County. to ian tisfaaoey�to 6�,,Cc Hpilthwill t q!r, will tie' 'b Ti i ng Y� 011OWing place in good -doerating -'anX;par(:o,ft­dI �-iWaqe; disposal,: sy if W- 0 t ante' of -the, re the tliiii4m4'weii'diici.i6s�j'above • '�gplill!�'OnV -ih6 w#11 ba,!qcated-as ."p,. in the 'approved plan ing-that said, installed r ov, I ,and _4 X w, VOR Y,fr LPutnam COUnty Date 7, :"aie' s' 1,4 w A'L " Li6einse-!,4o APPROVED •FOR CONSTRUCTION Th+s apprjoval expires two years from the `Ca l�rs he-b'uildin9:ha%-,b"n undertaken and is u mesi-ca ry i ca f 31' iLLLL ISSI -6 a or I of Consiruction revo ay on necessary revocable - for _-p4i eiL - 1 9, !a Ic it r mit. � pprove 's sal 6 Yo a W. RnF es'i new permit. "d f*-',, di 0. requires 3A Rev. 1/87. Date n PUTNAM COUNTY DEPARTMENT OF HEALTH Y V • Rev. 3/86 Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer to Provide Permit q on CERTIFICATE OF C0115LL CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Permit N a �-' Rif M Located at own _ , or Village. Subdivision Name t —K— j:'� faV,I LL' i Sabd. Lot N_� Tax Map 'Block I Lot Owner /Applicant Name M j� A �L pbE� Renewal_ ❑ Revision ❑ ;, Date of Previous Approval Mailing Building Type Lot Area _ Number of Bed qow G /P /D Separate Sewerage System to consist Of }±.Galion Septic Tank To be constructed by Fill Section Only Depth Volume PCHD Notification is Required When Fill is completed Water Supply: public Supply From Address or: _Private Supply Drilled by Q — Address AL l - F Y —T. Other Requirements represent that 1 am wholly and completely responsible for the design and location of the proposed s s): 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accorda v{IfF 1t0E arils, rules an regulations o e Putnam County Department of Health, and that on completion thereof a "Certificate of Constructs � tory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, re s by the builder, that said builder will place in good operating condition any part of said sewage disposal system during the t r(! m lately following thedate of the issu- ance of the approval of the Certificate of Construction Compliance of the original sys n er�to 2} hat the drilled well described above will be located as shown on the approved plan and that said well will be installed in accord r IRs and regu a�f ons of the Putnam County Department of Health. 2 � U 1 r_ Date Signs P.E.- R.A. APPROVED FOR CONSTRUCTION: This approval expires One year from the date issued u �s� �stfi0�' },G revocable for cause or may be amended or modified when considered necessary by the Commis ' nipj � ttA.:, requirrees_j new permit. Approved f /orb disposal of domestic sanitary sewage, a rivate water supply. only. DaNS 71 building has been undertaken and is change or alteration of construction Title !� .. :'J �. .. - - r v .. -. r. ...... � l.e- - -. 1 • `-.w •+r .� s� '� 'sH .�. � _ �_.- � f.. Y— .' � r ♦i!y r. .�. 4. :..` -..�' 1: ' r160, {✓ i f' � ^ ^ o — — ' � cv u� -------------------' — _ '—' '_-___-- 1 •' Z JLtm t• •' 10, kN A Y• •1 24 SIALTA •i3;. DESIGN - -U&TA-ZHM, - SUBSUFAC-E-, S'&,MM DISPOSAL. = `�YSTF1ei FII;E NC3: Owner j�/ Ir IA J Ij- T Elyaa Address 1 Located at ( Street) HI =- yV l T T T R. Sec. _ Block _ Lot (indicate nearest cross street) Municipality RQT�AKA A LA,0: t Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre - Soaking A" ® Date of Percolation Test-4-19 ° I � HOLE I4- 11:4 -4-o Za 21 b NUMBER CLOCK TIME PERCOLATION 3o PERCOLATION Run Elapse Depth to Water Fran Water Level '�W No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches ,I I =%- I rig1 b 2,0 Z5 3 � 211`195-11.41 I6 2.3 3 (�o 3I 1,' 4.5 -IZ-'o3 I& ZLYD 2 a) 3 6 4 5 21140- I Z :oq- '11�- 2.0 2-5 3 (9 23 - 4 5 lI i I4- 11:4 -4-o Za 21 b 21 1:50-1Z :W 3o ZQ 10 '�W '20 2.:a ra 10 4 9 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 : -DEPTH "H :, �::: HOr M. G.L. e"? -S Aiii 5 s 1'. 2' 3' 4' 5' 6' 7' 8' 9' 10' 11' 12' 13' 14'. INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH DATER LEVEL RISES AFTER BEING ENCOUNTERED Q DEEP HOLE OBSERVATIONS MADE BY :cs ! � i 6! ' ` is DATE: 0 , DESIGN Soil Rate Used a Min /1" Drop: S.D. Usable Area. Provided 5000 -5r, No. of Bedroans Septic Tank Capacity 50 gals. Type Go Absorption Area Provided By �i L.F. ; 4" .•.;,a }h }rcnrh Other f' RL =�..q T•�- �" j21 ' �� LL. �`i THIS SPACE FOR USE BY HEALTH DEPARM14FM ONLY: Signature SEAL a°• 64431 �r Soil Rate Approved sq.ft /gal. Checked by Date �:�;�:.:.. 6-_..,.. 1�£ ��Gi+ 1�: LaA ,�.. &- SUB�LIF'�,Cs�.,:SkY�F I?Z ,S•P��AL::S�l€S'!'F�i >.. .. _ .�.:.F�,E =d�� - •.,,;; �_ - -;:;::.:.. - ;::... Owner M • 010631 Located at ( Street) E W I = ST (Z � E-1-Sec. _v Block .3 Lot Z I ' t ,- H (indicate nearest cross street) Municipality Purr AM VA Li.-E - Watershed • • • :1• �• •' Y�. • • W. 's 52.9,311 a 5• • -.7 1 my �� • • • Date of Pre- Soaking 1 % •�cp• Ca Date of Percolation Test 4 5 3o ?_ o Z3 23. 1 o 211 �QQ -1 I:30 HOLE NCMSER CLiOC'FC TIME 30' PERCOLATION 311 • ;DS -1 2-.05 PERCOLATION Run No. Start -Stop Elapse Time Min. Depth to Water From Ground Surface Start Stop Inches Inches Water Level In Inches Drop In Inches Soil Rate Min /In Drop Z-3 3 210:47 -11:14- Z 20 Z 3 3 311:10 °11:47 27 10 Z3 3 4 5 311 '30 -12 CC) 30 4 5 11a ZS� 1o••ss 3o ?_ o Z3 23. 1 o 211 �QQ -1 I:30 210: ss- I 1 ZS 30' 2-0 311 • ;DS -1 2-.05 30 311 '30 -12 CC) 30 4 5 11a ZS� 1o••ss 3o ?_ o Z3 3 1 o 211 �QQ -1 I:30 30 20 23 3 10 311 • ;DS -1 2-.05 30 10 4 5 NOTES: 1. Tests to be repeate at same depth unti d l 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 RBQUnM I TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE C I G.L. 01 L- e Ot E 1 LoA MM TI&E LA-f 21 31 41 6' 71 81 91 10, ill 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED oNF INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERE ' D � t4CR DEEP HOLE OBSERVATIONS MADE BY: ( - LTA DESIGN Soil Rate Used IC'? Min/1" Drop: S.D. Usable Area Provided Sc No. of Bedrooms Septic Tank Capacity gals. 11,W Absorption Area Provided By L.F. Other Address Signature 21V SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft/gal. Checked by Date Z rri rn rn oNF INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERE ' D � t4CR DEEP HOLE OBSERVATIONS MADE BY: ( - LTA DESIGN Soil Rate Used IC'? Min/1" Drop: S.D. Usable Area Provided Sc No. of Bedrooms Septic Tank Capacity gals. 11,W Absorption Area Provided By L.F. Other Address Signature 21V SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft/gal. Checked by Date 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 WELL LOCATION S reet Address Town Village /City Tax Grid Number }� v .. - WELL OWNER Name M )K! RESIDENTIAL BUSINESS 0 INDUSTRIAL Mailing Add ess , L ❑ PUBLIC SUPPLY ❑ AYR /COND /HEAT PUMP O FARM 0 TEST /OBSERVATION O INSTITUTIONAL O STAND -BY rivate O Public O ABANDONED ❑ OTHER (specify El USE OF WELL �%- primary. 2- secondary AMOUNT OF USE YIELD SOUGHT 15 gpm /# PFOPLE SERVED. 3 /EST. OF DAILY USAGE &OD gal REASON FOR DRILLING P41EW SUPPLY ❑REPLACE EXISTING SUPPLY O PROVIDE ADDITIONAL SUPPLY ❑DEEPEN EXISTING WELL ❑ TEST /OBSERVATION DETAILED REASON FOR DRILLING "(' WELL TYPE ADRILLED DRIVEN EIDUG ❑ GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY S B VISION, NAME OF SUBDIVISION: (Ax.r_ PEr-k.��Gli_l, e)aMOO A Lot No. 3 WATER WELL CONTRACTOR: Name Q t.1D�iz.� W jr!!�Lt. L b2 =Address : IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES V--"* NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN : 14/A LOCATION SKETCH & SOURCES OF CONTAMINATION OON REAR OF THIS APPLICATION (date) PROVIDED 0 SEP( SHE (signature) rut W.XW 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 s.hall: 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 719 q �7 Permit Issuing f cia Date of.Expiration: 19 Permit is Non - Transferrable copy: H.D. File ' Yellow copy. Bw 1 cling Inspector ? /R7 Pink Copy: Owner- a App =11:c 3 - CF E-71-1- DIVITSIQI OF FN'v=.CRM=-L =U= 's EIECIVI-,-=,a, SUPPLY & SZ �SUREM-, aNA—r-- DIspr-=- SYS-MIE (;:!are of 6u� 4 (:� 5- LZ 10 f--.,\, c: L^_ cau-cs= 1 77-1 2,20 f-z- resarvciz, et-E. 1fo f Dccl-:M— ME P e --,u - t A-- z) I is . t- --' c n C-•xCrat-= Aso -lat--Crl Plans - aii-- Encimears: Authcriz-=zicn ceen Ecle Lcc * Perc C C -t- =r! Ps--c FF-le T PN i-.77 5, cn R 's: Cri ans =LEI-ic CST C cl: ,7Z ----------- D cr J Sax ;T =—?ac�-/Ga" erv; F, ciz- dizt=: c Ttr� WeLl 1 Ce+--= Ll'-7-1-e i` CV=r Cesl.cn Datz--: perc anr- ce=c Cent CurS Ex--*--z=c & Driveway & Slcc=-s Cat Fcctiac C:V, Perc & Deec E-cles Lcca--=�- RsorEsa:l itave cr ar e x a s I c If P-mn-ed Pit & D B--x Slacwr, & Lti t=iles Hcu--P- - Nc;. cf EedzrocrLE Weis is & S' 0 S w / In 200 f c f r c r-c Prccer�tv Me4zz5 & ' ur:,—:s Ecusse Set-::ack Nec2ssar-j- (T-ichlz ict) Ecuse Seer - 1/4"/-f-,-. 4"0; 'ZTce No Ben5s; Max- Brands 437' SMIRAT'ICTN DISC -ti=:, C-- praN F -4 e -I r-;c 10' to P.L- , Dr-Eveiav, Tra-z-s,Tcg cf: 201., tica Walls Wk-Ol in ID-L.C.:), to E- (:nc. E:- 13' to Dry_- ins-Car-t-airl, Fcctinc-T 35",z 10' to t ar Lin.-- c Ttr-`zz- Z - I . Z= 11 PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services February 2, 1987 Thomas Perna 2070 Sawmill River Road Yorktown Heights, New York 10598 r� JOHN SIMMONS. M.D. Deputy Commissioner Re: Proposed SSDS Dimauro Hewitt Street Putnam Valley, N.Y. Tax.Map # 110 -3 -21,22 Dear Mr. Perna: Review of plans and other supporting documents submitted at this time relative to the above captioned project has been completed. Comments are offered as follows, submit well permit application submit_.2_..copies of- Mus-e lap's. perc rate of 16 -20 min /in for a bedroom design requires 429 L.F. trench or 171 L.F. tri- galleys l �a Q� although field work has not been done due to the snow cover, contour lines shown indicate that a swale may be necessary. J. revisions need not be done until after field work is conducted and review is complete. Another letter will follow after field work is complete. Ver tr 1ly yours, C. �'� �'�� %f ]�� .- Anne ittner AB :pt /j 1 Asst. Public Health Engineer cc : JK File 110 OLD ROUTE SIX CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 i I i!! i- I I i I. DZIM41 11 IMMOW08 01' i •' • •'.�' 1�1 Y• :1 is •1. I• • P /• 71' 1' •1 /• !! • ' •N • 0 (Name of Owner) ( Street Location )���' INITIAL SITE INSPECTION t NO Wetlands cn/or proximate to property.. .......... Property lines or corners found.. .............. Can estimate house location ....... .................. Will driveway need cut.......... ................ Must trees be removed -.note these....... ....... Deep holes representative of entire SDS area...... Additional deep holes needed ................ ..... Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacent wells/ septics ............................. Access to nr000sed well location for drilling..... D. H. 1. Lot D. H. 2 . Lot Depth to G. W. Depth to G. W. Depth to rock Depth to rock Soil 0 ft. 3 ft. 6 ft. 9 ft. ,.Soil Descril 0 ft. 3 ft. 6 ft. 9 ft. 12 ft:i a •.._ :.12 fte FINAL, DATE: INSP.BY: House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Roan allowed for expansion trenches .............. Over 100 ft. fran watercourse .................... Natural soil not stripped or SDS area unnecessarly graded ............................ 10 ft. maintained fran property line and 20 ft. fran house ...... ......................... Distance well to SSDS (ft.) ...................... NLnber of bedrooms checks ........................ Stones, brush, stuffs, rubble, etc., greater than 15 ft. fran nearest trench.. ............ 15 ft. of.peripheral soil horizontally fran trench ..... ............................... Boxes properly set ............................... Could surface runoff fran driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE AC =ABLE.... ' DATE:LJ INSP. BY :,"- -• Ctrs - D.H. -.Deep Hol G.W.- Groundwate D.H. 3 Lot Depth to G. W. Depth to rock Soil Descri 0 ft. 3 ft. 6 ft. 9 ft. PUTNAM COUNTY DEPARZ24EAlT OF HEALTH - D SIO OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL wATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIELD INSPECTION REPORT P (� DATE: (Name of Owner) (Street Location). INITIAL SITE INSPECTION YES NO CATS Wetlands on /or proximate to property.............. Property lines or corners found ................... Can estimate house location ....................... `- Will driveway need cut .............................. Must trees be-removed - note these ................ Deep holes representative of entire SDS area...... Additional deep holes needed..... .. ...... ..... 14 Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacent wells /septics............................ D.H. - Deep Hole G.W. - Groundwater D.H. 1 Lot. D.H. 2 Lot D.H. 3 _ Lot Depth to G.W. Depth to G.W. Depth to G.W. Depth to rock Depth to rock Depth to rock Soil Descr 0 ft. 3 ft. 6 ft. 9 ,ft. 12 ft Soil Descri 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. DATE: _ SITE INSPECTION INSP.BY: House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Room allowed for expansion trenches .............. Over 100 ft. fran watercourse.......... ........ Natural soil not stripped or SDS area unnecessarly graded.......... ... ........ 10 ft. maintained fran property line and 20 ft. fran house .... ......................... Distance well to SSDS (ft.) ...................... Number of bedrooms checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. fran nearest trench ................ 15 ft. of peripheral soil horizontally from trench ..... ...................:........... Boxes properly set ............................... Could surface runoff from driveway, roads,' ground surface,.etc., channel near SDS area.... Does lot drainage appear OK•,in area of SDS::...... FTMAT. r_►aAhmr- op STTF. Aff=ABLE :................. Soil 0 ft.' 3 ft. 6 ft. 9 ft. 12 ft. PLTI'NAM CO(JN'I'Y DEPARTMENT OF HEALTH l tiq �f DIVISION.OF ENVIMMMENM HEALTH SERVICES ' DESIGN r)ATA S=- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE N0. ' D 1�1 �i Vi M&XaAdress Ai, xi Owner ►:� l RRA T� t� K Located at ( Street) a W 1 T — Sec.: -1 i v Block Lot 2 Z ( indicate nearest cross street) Municipality PQ T�A M VAL.L�`� Watershed' HQPZ7,�>,J �AS9 SOIL.PEROOLATION TEST DATA REQUIRED TO BE SUBKIT M WITH APPLICATIONS Date of Pre-Soaking -Date of Percolation Test I %. -% • g �o HOLE NL24BM CLOGS 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 1 1:35 (� BIZ 1 /2 21 S : V09 1VZ 2� 3 Z•. I •- 2 :yam �d 20 ZI 4 5 11 IX 3 1- 49 Z o 213/4 ( '5/4- I q -4 5 2' j � X19 `2119 Z© 21 rlb I % 18. 5 32 :2 .- Z:3 30 20 5 NOTES: 1. Tests to ' be repeated' at same depth' °until .app�rmcimately, .e=aj soil rates are obtained at each percolation test hole. All data to' be submitted for review. 2. Depth measuremnts to be made fran top of hole:. rev. 9/85 DEPTH G.L. , 2' 31 4' 5' 6' 7' 8' 9' 10' 11' 12' 13' TEST PIT DATA RDQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. HOLE NO. .�Aryi v�l .T�AI�S o � �L�`(• ; . Q � 14' INDICATE LEVEL AT WHICH = GROUNDXhTER PIS ENCOUNTERED- INDICATE LEVEL TO WHICH • WATER LEVEL RISES AF TER - BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: `"7l °rte SIG �.! (,.)"oL- mdrDATE: i I -7• v j (a DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided r-7000 +,-Sr- No. of Bedroans Septic Tank Capacity _ gals. Type P Absorption Area Provided By L.F. x 24" width trench Other F N Name 7�4 D M M i r C ER f A Signature] Address 10 D ��% I I..L RI�I5_1?� SEAL 2 • � 00 ROFESS10141, THIS SPACE FOR USE BY HEALTH DIE r= •IARTMENT ONLY: Soil Rate Approved sq.ft., Checked by Date 7 C> T{E No MWSLL LOe T'Q LOe - Tso 'A TIE C) j- :1 CULL jo tAJ jov V7 7 C> T{E No MWSLL LOe T'Q LOe - Tso 'A TIE C) :1 CULL jo tAJ jov V7 F- 7 Io L r--,v EX Al. TO Z OD IT AT 1 0 M'I t l .j APPL Ip�i� tot. RATE /QA'f 40-F qAU LF bah a yvi