Loading...
HomeMy WebLinkAbout4361DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -2 -10 BOX 33 me I r in 1■■�, :6 ,r te ) 60I m a mr 04361 .,., r. ".+' i •r?n .w.rr. w, >m c-., .;;: apt ^ ", i� R. UTNAM OUNTY DEPARTMENT OF HEALTH Pe=mit 7/' Division 'of Environmental.. Health Services, Carmel, N. Y. 105122 CONSTRUCTION PERMIT, FOR SEWAGE blSPOSAL SYSTEM !/ �y�'� Je!i /�� ✓� � �� Town or illage Q Located. at /i /S� /1���/ G,'� p - Tax Map '_ Block Lot /�{a Suti-' ic' „ I ?Oilly%i /! / rn A'ij Subd. Lot q . � Renewal Revision rJtvision . � 3 —❑ —❑ Owner /Address Date Of Previous Approval Building Type G� Lot Area Fill Section only ❑ Number of. Bedrooms 13 Design Flow G /P /D v P.C. H. D. Notification Required Separate Sewerage System to consist of / Da C/ Gal Septic Tank and . . 3 a 7 �,f e. 4'YrJ(t4., To be constructed by Address i Water Supply: P lic Supply From Private Supply to be drilled by Address Other Requirements 1 represent that 1 am wholly and completely responsible for the design and location of :the proposed. system(s); 1) that the separate sewage disposal system above described'will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations of e Putnam _ County Department of. Health, and that on completion thereof a'•Certificate of Construction ComRJiLnaejaj.Satisfactory to the Commissioner of Health will be submitted to the Department, and a written guarantee will beJuirnished the. owner,. his w c4e.� 's,fhaI,'. assigns by the builder, that said builder will place in good .operating condition, any part of said sewage disposal system during'the peAig`d` f t oP(��oyear.sfiirri ediately following thedate of the issu- once of the approval of the Certificate of Construction Compliance of the original syst ergt ol- agy`iepae�s thereto that the drilled well described above will be located as shown on the approved plan and that said well will be.)nstalled in accordance`wit�i the' standards rules and regu awl obi. ni of 'the Putnam County ent o Health.' ` a i o fr' Date Signed �`+ P•.yE. � R..A. Adtlress * *' -vin License No. APPROVED FOR CONSTRUCTION: his approval expires one'yea►fr, he. date issued Idss constructionyof,`the„building. has been undertaken and is revocable for cause or may be amen d of modified when.considered necessary by the' Co: ii i$nerlbf Mealtih.a °Any-; change: or alteration- of construction requires•a ne permit.. Approved for disposal of domestic ry swag and or riv "� I only. j'� ..��s�lpi1� Ya Date Lam/ ^ V /.� By 0= � I P:.ra Title - •�`'�� Rev. 9 -81 .. Rev. 3 186 � PUTNAM COUNTY DEPARTMENT OF HEALTH , Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Mast Provide1 c� (/ P.C.H.D. Permit IY -- _.. ._�. d CERTIFICATE OF CONSTRUCTION COMPLLINCE FOR SEWAGE DISPOSAL SYSTEM � ►�� <'' / `/ /,�e,� 4 / �! / /" a / �r J Town or Village,-' %.7 Located at �''' ��JJ / L �� /,� Tax Map Block It Owner /applicant Name .4,�, V ,-I ,/,- Formerly Subdivision Name r'' L� "Q8ubdv. Let N a G e' � e e. Sly i f s e JylL G -4 —/7 B 1� Mailing Address ? � fJ'K'f / �� Date Permit leased Separate Sewerage System built by °-'� AddressG ll/l� Consisting of /G� C Gallon Septic Tank and --Y -3U ` '� y %)` 1 de, r `y c /� Water Supply: Public Supply From Address �1 or: _7 Privatee Supply Drilled by /r �G e,/­­ e'er ,!P Address _ e/� Building Type /,'�� i Gf? G' C Has Erosion Control Been Completed? Number of Bedrooms � Hoe Garbage Grinder Been Installed? r1 r1 . lr(:F! Other Requirements `�l�. NYC OQ'1 al AL I certify that the system(s) as listed serving the above premises were constructed essentially shown do the p'lafis of th completed work ( copies �..� -. of which are attached), and in accordance with the standards, rules and regulations, in accordance r�{!�i• the Piled pl' nn and the permit issued by the Putnam County Department Of Health.' `> % �' Ffi Date �� � -� Certified by AtldresS �� // !lrr/ ✓ r rey '° •` No. j V� i ♦ �. v1' 3, i n� c� ,. rr±�ww Any person occupying premises served by the above systems) shall promptly take such action as may be pecos"O.t¢iseii at ii �jrnttion of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null andrvoli`aaa4onrai.ka"pyd :: sanitary lower becomes available and the approval of the private water supply shall become null void when a public water suprply#'bscOfrie64,villoble. Such approvals are subject to odiiffication or change when, in the judgment of the minis nnelr offHHealth, such revocation; rm4dlf(QLtttin or change Is neeesm►y . nat. l T UTI � BY I��LN Title - 1) SHERLITA AMLER, MD, MS, FAAP Commissioner of Health Associate Commissioner of Health ROBERT I BONDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 January 24, 2006 Myra Bleyer 200 Peekskill Hollow Road Putnam Valley, New York 10579 Re: Addition Approval - Bleyer No Increase in Number of Bedrooms 200 Peekskill Hollow Road (T) Putnam Valley, TM# 84 -2 -10 Dear Mr. Bleyer: 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 the Department dated January 23, 2006. The addition is approved with the following conditions: 1.. The total number of bedrooms must remain at 3 without prior approval by this Department. 2. The area of the existing sewage disposal system and its expansion area must be maintained. 3. All plumbing fixtures must be updated with water saving devices (i.e. new low flush toilets, restrictors for shower heads and faucets etc.). 4. Please be advised that approval for the room above the garage is granted because there is no access to the garage from the second floor and the existing septic system meets current code requirements. If access from the second floor becomes available, the area will be considered a minimum of one potential bedroom and a revised application will have to be submitted for review and approval. _ -. 5_...: The approval is for the . proposed changes, - goly_., This., ap roval_doe$ ;not, validate any construction shown as existing that has not obtained proper approvals. 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. Sincerely, aoseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj cc: Building Inspector, (T) Putnam Valley Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 e� BUILDING SKETCH PUTNAM COUNTY DEPARTMENT O% HEALTFI . S��J T✓.PI:, :A;dS APPI�OVEI? 'OR .EDP.001. COUNT O1�LY, tj1�117 ?'. ALL SUB- sEQtTIEN _...., ..r.. 1'j?4S To TI•YESil HOUSE PLA S MUS'L 11 -1 ....._...i::(.` I'C:i),X3 ?'JlI APPROVAL C -R1 A Ti 1 T P R. TT'P'F .F. MYR A RI F R ATE 200 PEEKSKILL HOLLOW RD PUTNAM VALLEY, NY 10579 TAX MAP # 84. -2 -10 36.0 FT SCALE 1 " =12FT PROPOSED CL BATH BEDROOM 9.6 FT PROPOSED FINISHED ROOM H LL W OVER GARAGE O � BATH Q N BEDROOM BEDROOM �-- u- 2ND FLOOR 36.0 FT 36.0 FT 1!2 BATH F- u_ O LIVING ROOM c N 1 ST FLOOR 24.0 FT NO BASEMENT 24.0 FT L 0 N N I1DCY CM��I�DC qM qLq D05D •wNgM..r •wwN lL O O KITCHEN 9.6 FT 2C GARAGE CL MUD RM DINING H ROOM u- 24.0 FT 6.0 FT L 0 N N I1DCY CM��I�DC qM qLq D05D •wNgM..r •wwN SHERLITA AMLER, MD, MS, FAAP Commissioner of Health �T. �L• ORETTA-IIi':OUNA -'R1<, `R1�F; MSN Associate Commissioner of Health Myra Bleyer 200 Peekskill Hollow Road Putnam Valley, New York 10579 Dear Mr. Bleyer: ROBERT 1 BONDI County Executive ..�,� ..... r- • � u. .ea .... � v .s vn 0+� ) I p.af��:. '�. 1 b . • T. DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 January 24, 2006 Re: Addition Approval - Bleyer . No Increase in Number of Bedrooms 200 Peekskill Hollow Road (T) Putnam Valley, TM# 84 -2 -10 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 the Department dated January 23, 2006. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at 3 without prior approval by this Department. 2. The area of the existing sewage disposal system and its expansion area must be maintained. 3. All plumbing fixtures must be updated with water saving devices (i.e. new low flush toilets, restrictors for shower heads and faucets etc.). 4. Please be advised that approval for the room above the garage is granted because there is no access to the garage from the second floor and the existing septic system meets current code requirements. If access from the second floor becomes available, the area will be considered a minimum of one potential bedroom and a revised application will have to be submitted for review and approval. 5.. • �.Thc ap�i gyal ..is. £cam; the prg�osPrJ _ ;changes': onlj . ;This - approvar does =ncit = validate any - construction shown as existing that has not obtained proper approvals. 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. Sincerely, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj cc: Building Inspector, (T) Putnam Valley Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (843) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 r BUILDING SKETCH PUTNAM COUNTY DEPARTMENT OF IIEALT11 E!.Otl E.J'i��ANS APPI3.OT� p ?,(. llpr'00M COUNT ONLY, _ i ALL sv33E(7 ;:,'ri TO TIJESL ROUSE PLA kNA'TFlUJJr,E ST DE' Vi i .:'.:... ':'. i? ' ii:1? I'C:U'�lI �';�lt APP OVAL' fst Tt:iI:E MYRABLE R ATE SCALE 200 PEEKSKILL HOLLOW RD 1 " =12FT PUTNAM VALLEY, NY 10579 TAX MAP # 84. -2 -10 PROPOSED 36.0 FT CL BATH BEDROOM L9.6 FT PROPOSED FINISHED ROOM H L OVER GARAGE O ' BATH BEDROOM BEDROOM t— u- 2ND FLOOR 36.0 FT 36.0 FT 12 BATH H u- o LIVING ROOM t0 N 1ST FLOOR 24.0 FT NO BASEMENT 24.0 FT H LL 0 0 KITCHEN `- 9.6 FT 2C GARAGE CL MUD RM DINING ROOM O LL 24.0 FT 7h 6.0 FT L 0 �DFY CMU1111OC WI ALP DOfiD A.N , LL O co 04 P I'T TNAIW COUNTY UYIEPARTNIENT OF 11EALTH ROUSE PLANS APPROVi"l) COUNT ONLY, J-5 A Ll S 1PE31 TO TI-IESE 110USE PLANS J1E 5 TO F011, APPROVAL L,3 Lo ' 'N NAWRE & TITLE DATE Y M JBL EY E R SCALE 200 PEEKSKILL HOLLOW RD I"=12FT PUTNAM VALLEY, NY 10579 TAX MAP # 84.-2-10 36.0 FT CL I BATH BEDROOM 9.6 FT LL F� BATH BEDROOM BEDROOM _CL 2ND FLOOR 36.0 FT 36.0 FT 1/2 BATH U H 0 LIVING ROOM co 04 1 ST FLOOR 24.0 FT NO BASEMENT PROPOSED PROPOSED FINISHED ROOM OVER GARAGE 24.0 FT LL 0 6 KITCHEN Irl 9.6 FT 2C GARAGE CL MUD RM DINING ROOM u- 0 24.0 FT 1 ti 6.0 FT rL 0 V .� GO 3o 1-F `( t(, " Jo Ll All M } /°e` , e-- 1r. t: ...�_..��• -•• �'.a+'w'M•�s�.:.^ai +r.w�n.t. _xr. -5r ...ye._.'v�. �+1 �kf+'�. _.W+GV.^..#iu L' +Nw ' �cz." �!',A//'LM'��Wt.h�a!:!.RXIRYYw� ii/i.ti,M ^+1�'w+lUrynv _,r'ttt... .d .rn+.+.v u w�_ , .. � A�V+ r v .v�� l+. �� F - : Y, DEC -22 -2005 10:15 FROM:PUTNAM COUNTY DEPART 845 -278 -7921 SHERWA AMLBR, MA, MS, FAAP Commissioner ofXealth LORMA MOLLNARI, RN, MSN Associate Commumomw of Health Re:—Mr Tax Map k Address:__,� Town: I? Yea Built: DEPARTMENT OF HEALTH 1 Geneva Rand, Brewster, New York 10509 TO:96223764 County &WHIIw 'Tn�gal iledpopA Count ever (Owner's Namc) ,?)q 0 Accord' to records maintained by the Town, the above noted dwelling, ♦ jg P �n compli:�n�,� with Town eme:. - Is not in compliance with Town Code. The Legal Bedroom Count is: This information has been obtained from: Certificate of Occupawy: Other: S► l.e, . kL4 W L- Building Inspcetor Dat is WNW. CERTIFICATE OU ANCY "A ....... 90 C"B64 d-_'oc6pimcy No ......... . t ppi-16u6n.14O.. ; Wli_ .. ..... .......... .............. 2 Teeldiki;'. X4 6 . ......... ! ............ tiled an a plicstbn for a building *pemiif"-l*iA­ii Code 'and ,.the laws to the Tb*b a Putnam Valwll:putuam thCle' required qu arid W: undeidped - oiw hii Ulm tly �Prorc Wi_ d 'Wr h the arktivo. w, ZMvem pro * 0 *UC com lb uisnefta, the laws' 18 BfOrelneIItiOned "Ibe 4W work the ; haV6 met. now iii Amid lor occu y PMMUAM to the ri)iW' of law. Now. ajerefore,'.�; 4'heieby� Vi Putcam this ts.'ot occupancy C ood&.�uqder tbo" Town,: r ............ valley , thb;'!i. 119.'..".�::..' Any" ot�ung Not valid 40iiw dpw in b* iduly- and wrind sput TOWN NAN V YORK of and under tm ind of Oki Iftm at Nitsm valley By ............... I ... 4 . ... .. ....... ... . . .............. i �. • � v V n. • I ' 0♦ • 0 iM .. _ • ... � -. . • �. � " Y+� •...• r. • -ter r r. - • - •.e•�• ..� v .. . . _ .. .� .-. . • ... .. . .- r r� s ':i , , 'I'o'c' Owna Nur -to '4Wat fi S" 1 re; aboi oul 'Plat COYI C)jt4 .'APP favo, ` <' o - 4 ; u S. 'stom(q jA)"I it A e v 0,1 sposa "Systom—vO, 10 `the standards, rules .r to cans/ettory I t smonqi-& maalth'wilr'' ;diet or, assigns , 4" the 6ulltloi; that sola blu'lld'ar, w-lli. that the drilled well described ODOW Rin�ard rules 43 r u a a n h-,*, Putnam P6 L-C'01 nls4'a-- 0 fheibulldlng has been,,undt irta -ird. is lfjP on IV., DEC -22 -2005 10:15 FROM:PUTNRM COLNTY DEPART 845 - 278 -7921 TO:96223764 P:3/4 Commissianer of Hmlth LORMA MOLINARI, RN, MSN Associate Commissioner QfHwkh STREI V MAIL] ,ADDR . �.M.. � �ew.tr ..�.0 Y.: H�`Y��A• �• — JIYi \'�a �r r — �.w v V+� •C�, r,.M'ISl'O; t County &&Wdve I DEPARTMENT OF HEALTH 1 Geneva Road, $rcwster, New York 10509 APP.1MO-N APPL CATTON RESMENTTAL O1V NFWX WA% iuo &-VA .1 O DESCRIMON OFf ' �Sh ADDMON NUMBER OF EMT, ING BEDROOMS3PROPOSED # OF BEDROOMS (FROM CERT. OF OCCUPANCY OR CHRT1RCATION FROM Wa DING INSPECTOR) "Any addition which is cnneidered a bcdrwmregnirea formal approval of plans (Construction permit) pmpamd by a Pwftsional Engiuoer or Registered Atebitect in accordance with appheabla socticm of the Putnam County Sanitary Code. Please submit this f m iwd the followiDs to Putnam County Health Dept., l Geneva Rd, Brewster, NX 10509,:PhoAe: (845) 278-'6A I. Certified check or money order for $100.00. 2. Skotches of existing floor plan (drawn to scale, RU living area including basement) I Two sets of propoaod floor plan (drawn to scale — with name, strcct and tax map #) *Non-professional sketches a v acceptable 4. Copy of mlvey showing well and septic locations to the best of your knowledge. Iu ude date of installation if latowtl,, Label all wells and septic system within 200 feet of the property line, Comaot this office wits any questions. 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE I�$E COIV90WS EnvimaMoubl Health (845) 278.6130 Pax (945) 278 -7921 Naming Services (845) 278-6558 WIC (845) 278678 Fax (849) 27&6085 Eat1y Inten t.ndow?re dml (845) 2786014 Fax (049) 278.6648 0 MYRA BLEYER 200 PEEKSKJLL HOLLOW RD PUTNAM VALLEY, NY 1D579 36.0 FT CL BATH BEDROOM 9.6 FT u— F- u- 0 BATH (6 SCALE 04 BEDROOM I"=12FT BEDROOM CL 2ND FLOOR 36.0 FT 36.0 FT 24.0 FT 112 F— LL BATH KITCHEN 9.6 FT 2C GARAGE CL cfi LIVING ROOM C14 MUD RM DINING ROOM 0 u— 24.0 FT ti 1 ST FLOOR 24.0 FT NO BASEMENT 6.0 FT hocy M Aoc O C O .wJIM1 — A...dl /��• ya y .t * r * W1JLL l.vrtrLztiviv AT�rvni DEPARTMENT OF HEALTH.,—_ t,- �'rDivision`of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office_ Use Onl 1/ V WELL LOCATION SIRE" ODAES wN/ � TAX GRID NUMBER r NAME- AOORESS: PUBLICS ❑ UBLIC • WELL OWNER USE OF WELL 1- primary 2 - secondary ESIDENTIA ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED EST. OF DAILY USAGE �� gal. REASON FOR DRILLING NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST / OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH .boa ft. STATIC WATER LEVEL __14� ft. DATE MEASURED DRILLING EQUIPMENT - ,ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION O OTHER (specify): WELL TYPE • ❑ SCREENED ❑. OPEN END CASING. )(OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH fL MATERIALS: VVEEL ❑ PLASTIC ❑ OTHER CASING LENGTH.BELOW GRADE c JOINTS: ❑ WELDED THREADED O OTHER DETAILS DIAMETER CIA in. SEAL: ❑ CEMENT GROUT 0 8ENTONITEVtTHER WEIGHT PER FOOT hC Ib. /ft. DRIVE SHOE: i S O No I UNER: O YES NO . SCREEN ' DIAMETER (in) 'SLOT SIZE LEN.GTH,(tt).:.:.:: -.: ;DEPTH Td SCREE;t (;t) DEVELOPED? 4 O YES ONO HOURS SECOND GRAVEL PACK O YES O NO GRAVEL SIZE:. DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH It. WELL YIELD TEST If detailed pumping METHOD: ❑ PUMPED i tests were done is in- • COMPRESSED AIR , formation attached? • BAILED O OTHER 1 O YES ONO w�Fi�. LOG ff more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear• ing well Dia' Meter FORMATION DESCRIPTION G7tIE. tt. ft, WELL DEPTH It. DURATION hr, min. DRAWOOWN It, YIELD gpm. Land Soo S- `WATER CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? OYES, ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE W :X Z D CAPACITY GAL. !MP IHF MATLON E CAPACITY � t-A DEP,,��T��H,,��t� L A ' VOLTAGE v &HP WELA7-"— ME ADO ��� SlGiff URE l/ Q �Y Vol 5. Yorkt' wn. Medical Laboratory, Inc. 321 Kear Street Yorktown Heights, N. Y. 10598. Director: Albert H. Padovani M. T. (ASCP) . T_ L C v G -,� ���-ry 4- �I y 22 0o Pee%r /-; /i ,d6/ /— X,C LAB / - . 0 04'1274 Date Taken: // /� /� Time : In_ °a_77j Date. Rc'd:- Date Reported: Collected By: -� Referr.ed By: Sample Location: Phone # J Phone # Sample Type:. Repeat Test? _ (check one) _LABORATORY REPORT ON THE BACTERIOLOGICAL QUALITY OF WATER GENERAL BACTERIA _V Standard Plate Count (CFU /1.OmL) (Agar Plate @ 35 0C) MEMBRANE FILTRATION TECHNIQUE (MFT) �! Total Coliform (CFU /100mL) Fecal Coliform (CFU /100mL) _ Fecal Streptococcus.(CFU /100mL) MOST PROBABLE NUMBER TECHNIQUE (MPN) 250 _ Total Coliform: MPN Index (per 100mL) _ "Fecal �Coliforim: MPjC! 'dex' (pe'r 100mL) ^� M OTHER ANALYSES REMARKS (For Laboratory Use) Potable _ Non- potable _ STP INF _ STP EFF Other: Sample Status: (cheek each) Outgoing — Na2S203 Incoming C/ LE k °C _ GT k °C _ Other: KEY FOR TERMINOLOGY RDS = Recommend Disinfec- tion of Source TNTC= Too Numerous To Count CON = Confluent ( =TNTC) LT = Less Than (�) GT Greater Than (>) N/A Not Applicable LE = Less than or eaual to THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS) (WASN'T) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO THE E YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS. TESTED,.,AT'THE TIME OF COLLECTION. For Lab Use Only: _ H/C to �'. LAB OFFICE HOURS (Main Lab): 9AM -5PM, Mon. -Fri. �t2 /85(Rvsd7 /87)RWE - 9AM -NOON, Sat. 1 PUTNP.M C OU91 Y DEPAffIMINT OF HEUTH DzVI IOkv OF ENVIRONMF.,WAL. HEALTH SERVICES owner or chaser of Bui ing q Building Constructed by Location - Street, Municipality Building Type 19 o 17. � Section Block Lot Subdivision Name Subdivision Lot # GUARANME OF SUBSURFACE SEWAGE DISPOSAL SYSTIN 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 'ICerf.ifica'e= of- Col�srutoi3, Coimpliance "k:�for:. -the seavage'dispol = systn; = oranji refairs 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 ,stem to operate was caaised by the willful or negligent act of the occupant of the building utilizing the system. Dated this j day of 19-q Signature loy ,• � ���� �� J Title Gereral Contractor (Owner) - Signature _ 'g, /�� V Corporation Name Of Corp. ) Ac3�ress reN. 9/85 ra}c Corporation Name (if Corp.) Address Nil I Corporation Name (if Corp.) Address 0 ` PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date 15 -' •• I J V ^ T Re: Property of , Located at i` i%�/S /� i`�/ Jj�'1�0ty, 1JGc Gl Section �/ Block Lot Subdivision of����,�- y`%�> /�iyj r/�C- ✓�11yj Subdv. Lot # Filed Map # Date Gentlemen: This letter is to authorize " sw /f J j� a duly licensed professional engineer 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 -systemor. systems in cenfor•ni.ity- r tl : .tlie :prcv .sf ons;..olf Ar ±14--Ye : 14 5::a�r, ...y,.•1.. r .. .. .. w ..• 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, Signed � t p,a 0 er of ProAprty C ountersig e AU � , °4Lavb P.E. ' ' ' Address Address 4 "o T.owri0A -2 �GJ Telephone T el epYon a i" L'VI CIII;CK SI(I, ,T DOCUP s `ITS House plans O.K. D,--sign data sheet Peres presoaked? Kin., 30" perc test depth Const. results for 3 runs D. Hole log O.K. Corporate Affidavit for other than individual Authorization for engineer Letter from Water Supply if applicable If variance requested -such rioted on plans apps. DETAILS Rhow f change•is proposed,) Exists ng contours shown new-contours) Slopes for driveway cuts, etc. shown Rater service lire location Footing drain, etc. location Top slope, bottom slope of fill Percolation tests and deep test pit location S °Dtic tank size and conformance to std. 3 B.R. house rminmum House setback shown Distribution box ftg. below frost All water within 50 ft. of PL shown Meets Std. LYes No WIG �fl Remarks K)or GA `r7 WIA 7ZA I i . 1 _ Pj an and .profile SDI, _ I . )...... .. . - - it.-OnmE weans" shown or reference made Property boundaries (metes and bounds - clearly s n C�AECK2'b 'SUF3b(U(W)O H2O,p - 0.1� . V SFPAR4TION DISTANCES SPECIFIED ON PLAN 10' to P.L. ?0" to Fotuidation walls )0' to Nearest well j0' to stream, march, lake, etc. inc: L5' to Curtain drain 1-0' to water line (pits -20 .5' to storm drain C?' • to larc -c trees .0' 1'110m foundation to sc ?ptic tank .5' to pi.1 ?a f'ro►n leader drain & , i'o �l%Ci �2C Fell CVF CC_,, .expansion ng oru i i %0 / ' 00 IEX� / i /Or o /y� i I Ci\ L/iY I - vr+� V v J v lJ !-� ' V ` `•� � V � • . r TNTTTAL ST '1'r T I I PECT1��i' IYcs�I T10 I Comrnc�nf ,Propert•y lines or corn�:rs found . Can estimate houcc; locc.ti-on . . . . . . . . : . Will 'driveway need cut . . . . . . . . . . . . Miurit trees be re —moved -note: these Is deep hole represenuat -i ve of entire SDS area Additional deep holes rseded. . . . . . . Sufficient SDS area available considering driveway cut; house location, separation . distances, etc. DEFT' MOLE DATA Depth: 7 .1-later elevation: Rock elevation: IJOA) E, Soils descri- )tion: SrWT)c' LOftx lid Ut:�: FINIAL SITE rNSP} C`? IG1, Insp. by: House located ul -jer.- shot•rn on-'a- Pp roved plan SUS Located 1r r3 approved . . . . . . . : L=3th of trench moa s ure d • Width of trench avera .rz Slope of tile line and trench. acceptable . . . Room allowed for _expansion .trenclaes- - -. - fiver -C-'t: fi vrc;� s?;it5; t �tercourse Patural soil r_ot. stripped or SDS area lnu-iecessa,rily graded 10 rt. maintained from prop-line and 20 ft. from house Separation of trench froi;i house, well -- -etc. follows plan :Itunber of bedrooms chocks . . . . . . . . . Stones, brush, • sti"Imps, rubble, etc: greater than 15 ft. from nearest trench 15 I't • of peripheral soil horizontally from trench Junction boxes. properly set Could surface rttn off from driveway, roads, ground surface, etc. cha mzel near SDS . area. . . . . . . Docs lot dr. a.innf,,e an near O.K. �i.n area of SDS riNAL GPMDING OF SI`T'E ACCEIMBLE i 0 d PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES -` _- COUNTY OFFICE- BUILDING; CARMEL, N.'-- Y.-: 10512. DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner AXV/� "_* :Y6 V rim Address "fD, -g®x -43 Located at (Street Municipality i/� e c . /% 9 Block nearest cross street) Watershed 'A i .7- Lot / 7 SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run apse Depth to Water Wate-FlFv3l No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches aV 5 Notes: 1) Te'�ts 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. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO.-- HOLE G.L. 611 1211 181t 2411 4. 3011 Itj 3611 4211 48 5411 6011 6611 7211 7811 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED e- 44D-TCATE', LFU-1L`Z0:-WCH- LMI�,L,�RISE,5 AFTER. -ZaQ- EUQQjJNjEFJ&-7 WATER� TESTS MADE BY a 7, / * Kr,-1 Date DESIGN Soil Rate Used ,..�Min/1 "Drop: S.D. Usable Area Provided No. of Bedrooms 3 Septic Tank Capacity V Gals. Type A�--50* 1, 0t;tjI.M.11tzwidth trencli. Absorption Area Provided By_�O�L.F.x24 7*: -., LE Address 'Ply/* 4 JAS Vit` \ u Q THIS SPACE FOR USE Y HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft/Gal. Checked by C e1i I ee. 40G 'go 8V CO(J, lye Date LE i J. A fd(2, lo' rc-,."i, 2,9 1 -o.. N All /Yl wa With of t b. 00 C/, 5a/ 15Y'Sle,yv V, 17;w all- Scale a F. Ja 3: S: s t• z. Qom. 8i . tea. o � � ,� t l � � � � , • ....� As �•r e. `p. ,, ] r G. •r y u 1 r' 4 y; 3 I.1 ,t I 1. ;e. t'