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HomeMy WebLinkAbout4378DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 84. -2 -38 BOX 33 I ro "A ,. �` ., 116 - rr T 04378 PUTNAM COUNTY DEPARTMENT OF HEALTH / Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer to provide on CERTIFICATE OF CO1YfjP permit N ��L(// CONSTR ON PERMIT FOR SEWAGE DISPOSAL SYSTEM - ^rY•'r. aK .. �. .i`.rn� � Pr 'tf .Ci 1:'R .q'T��••ti.'.a 0.. -.Ot• Qr. �. eI 'HMV h.tPO V pr'.. Subdivision Name ��G/ `�� Al-sm. Lot N �'3 Tu Map Block Int Z t/) Renewal_ ❑ Revision ❑ Owner /Applicant Name f / / 022 Date of Prevlone Approval Mailing Address �r-o A? Town Zip Bd1dlnli Type G3 % 4� �'l C�° Lot Area E, %.e y 4C'- Fill section only Number of Bedrooms Design Flow G P D UO PCHD Notification Is R Separate Sewerage System to consist of/U Gallon Septic Tank and ,rD D L F 2 f W i To be constructed by Address Water Supply: Pamlle Supply From Addreu _ oln Private Supply QAed by 1_5 . ��o%Address — Other Requirements I represent that 1 am wholly and completely responsible for the design and location of the p above described will be constructed as shown on the approved amendment there to and i IIIN County Department of Health, and that on completion thereof a "Certificate of A be submitted to the Department, and a written guarantee will be furnished th place in good operating condition, any part of said sewage disposal system 4FrIFW once Of the approval of the Certificate of Construction Compliance of the igi will be located as shown on the approved plan and that said well will be Install an; County De rtment of Health. Date ' i. Signed . wa/� r ,� APPROVED FOR CONSTRUCTION: Thi pproval expires two years from 1(e revocable for cause or may be amended 6r modified when considelelfriscesAry requires new permit Approved for disposal of domestic sari r ' s age, 1181 >ti Date By J Rev. 3186 Located bepth 2, f Volu squired When FIB Is W►' t4__ 0[/ ° (g r# e /Cr ; Dc3 C system(s); 1) that the .separate sewage disposal system Ind pds�los rules an regulations o e ry to the Commissioner of Healthwlll s by the builder, that Yid builder will diately following the date of the issu- ) that the drilled well described above and requ au ons of the Putnam 4/ P.E. _ R.A. License Nol V.? in�of the building has been undertaken and is th. Any change or alteration oetion IY• " , Title PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N.Y. 10512 Mast Provide rte, / I P.CrH:D:•Permit;N. —� r=—,i . - z .a• •o ?e ' - w o . � e... tee...• r+�- ...y ...,.: �J. � . � ' �~.,� .-{ - �(C.`: �....... _.wa .. . � s ,...,ya...r ,o?s'. �.r ...� �.. r..� +va• _... ..... � ..... •.� ems. . F CONSTRUCTION COMPLGINCE FOR SEWAGE DISPOSAL SYSTEM P�' (� /Yj 6! 1,711e. e. a4l%� /��� �G t✓ h )14 /"h ��G ¢! / Town or VlWtge p� ., - % Tea: Map Block�_Lot_- Owner /applicant Name ��� °ra f Formerly �` Subdivision Nemey�J, — Sabdv. Lot N Ong Address Z tzW y" 49-1- A? J zip fo-s 6d Date Permit Issued Separate Sewerage System built by ! Ce-'s'a �' h , Address W41-5 % 1 y Consisting of % Gallon Septic Tank and dtJ L Jo Water Supply: Public Supply From Address or: Private Supply Drilled by "g�Z �rv3 Address — B�� Type lq� S � �G as Erosion Control Been Completed? Number of Bedrooms 4, Has Garbage Grinder Been Installed? Other Requirements �`'% �� /^D I certify that the system(s) as listed serving the above premises were constructed essentiaO Y ans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulations, in a th a plan, and the permit issued by the Putnam County Department Of Health. �� t Date /�/ ��7 Cert ified Dy P.E. R.A. ' Address `W7� //� 1w L"/`r �" License No. ��v� n Any person occupying promises served by the above system(s) shall promptly take such action II a the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall becom di s a a publ;: sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public mes available. Such .approvals are subject to modification or change when, in the judgment of the Commkssionor of Health, such re. Ifieation or change Is necesary. SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner. of Health V RT J. BONDI RT MORRIS, PE r of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ADDITION APPLICATION RESIDENTIAL ONLY STREET 14. 14V 5: "r-0- k7P • ED TOWN 70-wt V*LICY. TAX MAP# Rd NAME PHONE gq 5 - g'o4� 3 PCHD# MAILING ADDRESS_ 1¢ YAK V_ t-�EjL r►a *W. Qa Pd1T1N+_M y 411/c rX J y n s-79 DESCRIPTION O • ADDITION j... YI'1EN1 Lty tW�s SGT NUMBER OF EXISTING BEDROOMS 4' ' PROPOSED # OF BEDROOMS 4- (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) "Any addition which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, ........; Brewster,lY _� 0509; Phone; n {RCS)• 77= -6130. _ .. __M . 4 . ._ ,... 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) 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 locations to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS 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 SHERLITA AMLER, MD, MS, FAAP C- LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 Town Legal Bedroom Count Re: COOK ROBERT J.BONDI (Owner's Name) Tax Map #: 84.-2-38 Address: 14 Mueller Mountain Rd. Town:— Putnam V;;1 I py Year Built: According to records maintained by the Town, the above noted dwelling, is XX in compliance with Town Code. is not in compliance with Town Code. /L This information has been obtained from: Certificate of Occupancy: 8/10/90 #90-144 attached Other: 4/24/08 ding InspectoA Date Environmental Health (845) 278-6130 Fax (845) 278-7921 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 R ate me District 19 �g TOWN OF PUTNAM VALLEY PERMIT � It- 1 11 89 876 89 December 11 ig TOWN OF PUTNAM VALLEY PERMIT RECORD COOKY BRIAN & AN _­Q Nuell., DREA 1_ Road Permit Work to start ---- - -,-,/No Deck t� 3 TM#120- 1-92 TM#120-1— 21-.1- One Family - -3 W/Deck PEDAZT I # 88-171 �� 51131188 CERTIFICATE OF OCCUPANCY- One Family /No De'ck'&'Garage Certificate of Occupancy No ....... .. .0 9.. ..71.. .4.. .4 .. ...... Application No..07171 .......88 .....-41 .. &..8.8.-413 Location of Premises .. �jt ...... PQ.a I .Q.•-1.- .':2.j ................................................ Brian.. &..An 'g.q.g ... qq!�� .................. of '%Q.. �g!;�i;po - Peekskill, ... i�-* y * ....... having .............. .... ...... Q. ............................ .. ...... heretofore filed an application for a building permit pursuant to the Zoning Ordinance, Sanitary J 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 ery 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 certfflcate of occupancy is hereby issued under the seal of the Town of Putnam Valley, this 1Q....... day of ................... 109 Not valid -unless signed in ink by a duly authorized agent. TOWN �!F L7NAN VALLE NEW :YORK _ .0 under v4m- a f .and er -tift. seal Of Jhe'T6­ '61- P�ti 'it �Villey. By... ........ . ............... Garage B. In Field Stone --�- 1 required Additional information a copy of surveyor's map This application must be accompanied by by the Zoning Ordinance and Sanitary Code of the Town of Putnam Valley wnul, Cost 30-00 Building Total Livable Area Fee 5) $ ----- TOTAL Rev. 1/85 BZS Sanitary Plumbing ,Well ter. $ Date Zoning Board Approval t SHEll81LITA AMIL.EP, MD, MS, FAAP Commissioner of Health Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster; New York 10509 January 22, 2009 Brian & Andrea Cook 14 Mueller. Mountain Road Putnam Valley, NY 10579 Dear.Mr. & Mrs. Cook: ROBERT J. B ®NDI County Executive Director of Environmental Health Re: Addition- A- 070 -08 No Increase in Number of Bedrooms 14 Mueller Mountain Road (T) Putnam Valley, T.M. # 84. -2 -38 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 January 22, 2009. The addition is approved with'the following conditions: 1: The total number. of bedrooms must remain at four 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 loin flush toilets; r- estrictors4or shower heads and faucets-etc." 4. The approval is for the proposed changes only. This approval does 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 (845) 278 -6130, ext. 2261. Sincerely, 15ne D. Reed Senior Engineering Aide GDR:kly . cc: BI, (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 Brian & Andrea Cook... 14 Mueller Mountain* 4t6ar Putnam Valley, New York 10579 -3313 845 528 -0493 Building Department Town of Putnam Valley 265 Oscawana Lake Road Putnam Valley, NY 10579 December 14, 2009 Re: 14 Mueller Mountain Road Tax Map # 84. -2 -38 Violation # 0638 - Dated Dec. 2, 2008 Dear Mr. John Allen, As per our discussion, I am submitting two (2) copies of a revised plan indicating the removal of partition wall — eliminating potential bedroom, removal of sink and stove. I trust this is the required information you requested. If additional information is required, please inform. If an- additional= Court - Appearance 4S required, please: inform rye of the date::..:.: p, z , Thank you for your assistance in this matter. Brian D. Cook cc. Mr. Reed, Putnam County Dept. of Health MCD: APPEARANCE TICKET TOWN OF PUTNAM VALLEY 265 OSCAWANA LAKE ROAD %b PUTNAM VALLEY, NY 10579 (845) 526-3050 TO: NIX> &:A LAST NAME FIRST NAME INITIAL 14 ly) KR /A N h f -1 7A I � � Auk N�Qyail' STATE ZIP YOU ARE HEREBY NOTIFIED to appear before a Justice of the Town of Putnam Valley, New York at T wn Court, Town Hall 265 0 �cawana Lake U _ w o'clock r Road Putnam Valley, NY at :k in I e fter noon � fore on iarEgeat' _QDn ja &S h�S20_D to answer a charge at you have violated the following: in violation of Section of the Town of Putnam Valley Violation Location PLEASE TAKE FURTHER NOTICE THAT UPON FAILURE TO APPEAR, A WARRANT MAY BE ISSUED F R YOUR ARREST. Issued bZTTV%�M�� Tit zw Date C' Served b Date :J92<- I C Brian .& Andrea Cook -_ %;", _ Z. 14 Mueller Mountain Road `} ~ Putnam Valley,.New York 10579 -3313 845528 -0493 Putnam County Deptartment of Health 1 Geneva Road Brewster, NY 10509 December 14, 2009 Re: 14 Mueller Mountain Road Tax Map # 84. -2 -38 Violation # 0638 - Dated Dec. 2, 2008 Dear Mr. Gene Reed, As per our discussion, I am submitting two (2) copies of a revised plan indicating the removal of partition wall — eliminating potential bedroom, removal of sink and stove, as per Putnam Valley Building Department. There will be no additional bedrooms. I trust this is the required information you requested. If additional information is required, please inform. Thank you.for,.your, assistance in this-matter.. ; � , ry r; y�, ....�.n . - ..��. .e : .,q... ...rr.. Brian D. Cook b � SHERLITA AMLER, MD,'MS, D'AAP Commissioner of Health - 1< O RE fA MOLINARI, RN, MSN Associate Commissioner. of Health ROBERT .I. BONDI ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT 'OF HEALTH 1 Geneva Road, Brewster, New York 10509 ADDITION APPLICATION RESIDENTIAL ONLY STREET 1419 OI-CL (z A1W Q t� TOWN �� i 1U*W 04L"/TAX MAP# 4.2 NAME, -.GJ Cc e , � V' 49-1 4 ,LMDP -r PITON E `945 5 Z �3 - c� c�cj PCHD# MA LING ADDRESS i 4- E LLZ 4 tno v nur,4 ( �Aj T 004A 77 DESCRIPTION OF ADDITION F,�v�S� AeASE014 5- /OT NUMBER OF EXISTING BEDROOMS + - PROPOSED # OF BEDROOMS 0 (FROM CERT.-OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) "Any addition which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam. County Health Dept:, -1 Genexa Rd; - - $ rewster-,: N --- 1'05(19; Ph-- one 44-5� 278 :6130.'° - 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) 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 locations to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS 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 SHERLITA AMLER, MD, MS, W. , =::a : n :. • , .: G ©rr rrissiorYer- q- .We`alth'y: _ LORETTA MOLINARI, RN, MSN Associate Commissioner of Health. DEPARTMENT OF HEALTH 1 Geneva Road,-Brewster, New York 10509 ROBERT J:- 'BONDI ;, County Executive Town Legal Bedroom Count Re: C DO f � (Owner's Name) Tax Map #: Address: V V l ��.- I� 0✓��� Town: T L4 T" NJ ,A A,\ VA L,f VJ Year Built: According to maintained by the Town, the above noted dwelling, is compliance with Town Code. is not in compliance with Town Code. The Legal Bedroom Count is: This information has been obtained from: Certificate of : Occu anc r y Other: ►a�gcis Building Inspector Date Environmental Health (845) 278 -6130 Fax (845) 278 -7921 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 664R SHERLJITA AML.ER, MD, MS, FAAP Commissioner of Health L ORETTA MOL.INARI, RN, MSN M Associate Commissioner of Health April 30, 2008 Brian & Andrea Cook 14 Mueller Mountain Road Putnam Valley, NY 10579 Dear Mr. & Mrs. Cook: DEPARTMENT OF HEALTH Geneva Road, Brewster, New York 10509 Re: R®RERT d. BONDI County Executive ROBERT !MORRIS, PE Director of Environmental Health Addition — A- 070 -08 14 Mueller Mountain Road (T) Putnam Valley, I have received and reviewed the plans for the proposed addition to the above mentioned residence. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons: 1. The legal bedroom count for the dwelling is four: The potential bedroom count of your proposed addition is six. 2. The four main rooms on the second floor, plus the separate room and kitchen in the basement gives the dwelling a sewage flow equal to that of six bedrooms. 3. The addition of a potential bedroom requires this Department's approval of a revised septic system_plsn fr6m1a professional=erigindtr 4. This determination is based on the proposed basement plan. Being a complete set of proposed plans have not been submitted, it is assumed that the set of existing plans reflects the intended proposal for the first and second floor. Please revise the proposed floor plans to reflect no more than four potential bedrooms, or have a professional engineer or registered architect design a sub - surface sewage treatment system meeting present code requirements. If you have any questions, please contact me at your convenience. Sincerely, R / !' Gene D. Reed Sr. Environmental Engineering Aide GDR:kly 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 C �� , -�i Wr.LL l.VP1rLL'.11U1V it!'arVitt a, DEPARTMENT OF HEALTH Sgrvices: ; y W 0 T PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION- STREET ADDRESS: TOWNIVILLACKIC11V TAX GRIO NUMBER: Lot #14 Muller Mtn Road Putnam Valley NY 464- c2 a WELL OWNER NAME: ADDRESS: Brian Cook 2010 Crompound Road Peekskill NY ❑ PgIVATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary IKI RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM O TEST /OBSERVATION ❑ OTHER (specify) p INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING [REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY NEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA ' WELL DEPTH 605 ft. STATIC WATER LEVEL. =2R. DATE MEASURED 02/05/90 DRILLING EQUIPMENT ® ROTARY XX COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED ❑ .OPEN END CASING 91 OPEN HOLE IN BEDROCK O OTHER CASING TOTAL LENGTH 33 ft- MATERIALS: ® STEEL O PLASTIC O OTHER LENGTH BELOW GRADE _ ft. JOINTS: ❑ WELDED MTHREADED ❑ OTHER DETAILS DIAMETER in. SEAL: X) CEMENT GROUT ❑ BENTONITE OOTHER WEIGHT PER FOOT 19 Ib. /ft. DRIVE SHOE OYES O NO LINER: DYES X1 NO SCREEN _ DETAILS DIAMETER (in) SLOT SIZE LENGTH (1t) DEPTH TO SCREEN (ft) DEVELOPED? FIRST O YES O NO HDURS.- _• .... SECOND _ GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH ft. WELL YIELD TEST ; It detailed pumping METHOD: O PUMPED 1 tests were done is in- t • COMPRESSED AIR formation attached? • BAILED O OTHER :OYES ONO 1�1�LL LOG )f more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear. ing Well Oia- In FORMATION DESCRIPTION CODE }t. St. WELL DEPTH It. DURATION hr, min. DRAWOOWN ft. YIELD gpm. Land 1 ' 11 in overburden clay & boulcl rs Hit r ck at 15' 6o5 6 585 5 1 in rock set casing, routed- 33 605 Dr. 11 ' g in rock granite "'" - - : ". 1 l:. 1 WATER ❑ CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? ❑ YES ❑ NO G� STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAME P.F. Beal & Sons , c T 8/3/90 ADDRESS PO BOX B SIGMMRE / Brewster, NY 10509 S /6V BROVSTER LA60RATORMS Box 224 - BREWSTER, N.Y. (99 4) 279-4945 . WATER ANALMS REPORT SAMPLE NO. 7773 TEST WELL SOURCE- Bryan Cook Muller Mt. Rd. Putnam Valley, N.Y. COLLECTED: 7-24-96 BY: P.F. Beal & Sons BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 0 per 100 mi. 1. This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. 7-26-90 C"! t 1i C/) PUTNAM. COUNTY DEPARTMENT OF HEALTH IVISIOiV' "OF ' 'HEAI;' t`fi•Sg�V.LCF.�"�'"`s.:,;".' -. ,.�' =�° a •��..d Owner or Purchaser of Building Building Constructed by Location - Street I/ y Municipality Building Type Section Block Lot Subdivision Name Subdivision Lot # GUARA UM 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 sham 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: , ..•vL/Ll .. FINAL SITE INSPECTION Date .4 7 /Z3/Z��c Insr-te3 by STP_L'ToGN :.(i�e `f`'� ;�:. _ ;+�• �i�,F� /r�i'Ii' "()�1Kr•, 10 1�1 PERMIT A Av -- / -- Q L1 r", OR SUBDIVISION LOT u /�(7 -- L ° %� U YE9 I3C1 f _ I. SE WAGE DISPOSAL AREA ` a. SDS area located as r anoroved plans I b. Fill section - Date of place-Tent, ? 2: I' barrier . LGTH W'Tff!'fi �' A . DPTH 2. Overrlcw tank I j , c. Natural soil not striped Pumas easily accessible manhole 5. d. Stone, brush, etc., eate_- than 15' fran SDS area. 6e I ; � e. 100 ft. fran water ccurse /wetlands. U. SEEN -GE DISPCSAL SYSTU4 a. Septic tank size - 1,000 d. BacJkf ill matert e. Curtain drain ii b. Septic tank installed level- c. 10' miniumrn fran foundation ► d. No 90° bznds, cleanout within 10 ft. of 45° bind '-?'` e. DISTRIBGI'ION MX 1. All outlets at same elevation - wale_'' testes 2. Protected belczw frost i IAI _ 3. Minim -m 2 ft. original soil bet:veen box and tr enches 1071 ) 2 I f. JUNCTION BOX - rrot>p--ly set g. maw rr S ' 1. Length r=euire3 - L.ncrt-h instated I I 2. Distance to watercourse f t 3. Installer according to elan I I c 4. Dis-...zr_ce center to Center r' _ 5. Slcce of trench acceotanle 1/16 - 1/32 " /fcot. 6. 10 feet fran prczp—T-vv line - 20 fe✓-t - foundations 7. Dencn of trench < 30 inches fran ssrface 8. Rom a.Lcwed for exransion, 50% .9. Size of gravel 3/4 - 11" diameter - _ -10.; DepEri. -of gra- ,�::1n',.trenen 12 "- minink n L . Pine e. ^.ds = nr,3 ( I v I I I (lvl I I - t . I I / h. PC2lP 1. OR DCSE SYSMAS Size of pump chamber 2. Overrlcw tank 3. Alarn, visaal /audio 4. Pumas easily accessible manhole 5. First box baffled 6e Cvcle witnessed by Health Depa estimated flaw IV. HOUSE, a. House located per b. Number of bedroom, V. WELL a. Well located as b. Distance fran S: c. Casing 18" abov, d. Surface drainaG vi. OVERALL 6yORRMASHIP a. Boxes prcperly b. All pipes partl c. All pipes flush d. BacJkf ill matert e. Curtain drain ii area measured 11v backfi with insid 1 contains f Curtain drain cutfall g. Footing drains dischai h. Surface water protect; awa ft s < 4" in diamete g to plan & dir.to esist.wa an SDS area r-_ DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER*- CARMEL, N.Y. 10512 (914) 225 -3641 7�PPt1d Ti0ii. TO`=7CON`STRUCT PCHD PERMIT WELL LOCATION Street Address v Town/Village/c, y Tax Grid Number WELL OWNER Name rV Mailing. a 20161 Address rivate O Public USE OF WELL 1 - primary 2. - secondary RESIDENTIAL O BUSINESS O INDUSTRIAL 0PUBLIC SUPPLY .3AIR /COND /HEAT P O FARM O TEST /OBSERVATION 0 INSTITUTIONAL O STAND -BY OABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT 1-gpm /# PEOPLE SERVED /EST. OF DAILY USAGE O!i gal REASON FOR DRILLING EW SUPPLY OREPLACE EXISTING SUPPLY O PROVIDE ADDITIONAL SUPPLY O DEEPEN EXISTING WELL - O TEST OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE M15RILLED DDRIVEN []DUG []GRAVEL. C] OTHER IS WELL SITE SUBJECT TO FLOODING? YES &--' NO IF WELL IS LOCATED IN A REALTY SUBDIVISION,'NAME OF SUBDIVISION: Nz s Lot No. '3 WATER WELL CONTRACTOR: Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _ ,/ NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST "WATER- MAIN': ` LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION ON SEPARATE SHEET / �� -O ON e) / i re) /j 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 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 per t. 3. Submit a Well Completion Report on a form pr 'de by a Pu C my Health Department. " Date of Issue: 19� Date of Expiration: 19 ermit Issuing Official Permit is Non - Transferrable White copy: H.D. File Yellow copy:. Building Inspector 2/87 Pink Copy: Owner Orange copy: Well Driller PUINN4 UUUNTY DEI'PRIMEWr OF t.i•ALIH DIVISION OF HEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTIN FILE RHO. Address Owner Q 1;w7 aX7 Located at (Street) Sec. �' /� Sec. /;o Block / Iota (indicate nearest cross street) . Municipality Watershed SOIL PERCOLATION TEST DATA RDQU RED TO BE SUBMIIM WITH APPLICATIONS Date of Pre- Soaking �`fi Date of Percolation Test HOLE NUMBER ClaM 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 4 1 /v /5-Ar /5 30 2�d 4 5 1 2 3 4 5 to Tests to be repeated are obtained at each for review. 2. Depth measurements to rev. 9/85 at same depth until apprcaimately equal soil rates percolation test hole. All data to'be suhmitted be made fran top of hole. ;? Z ��- �/ // v 4 1 /v /5-Ar /5 30 2�d 4 5 1 2 3 4 5 to Tests to be repeated are obtained at each for review. 2. Depth measurements to rev. 9/85 at same depth until apprcaimately equal soil rates percolation test hole. All data to'be suhmitted be made fran top of hole. TEST PIT DATA R1))UIRFD `1O B1 SU11411'1'1l) W1111 APPTJCATION DESCRIPTION OF SOILS ENCOUN!TERED IN TEST HOLES DEPTH HOLE NO. (.� HOLE NO.." 2 HOLE NO. . ..r76 .. rV.� •'r.1 \' ylr•���4'":.�� 1• -i -o sa• nY.w.. .. _..- h��•"�'cC i���•Y• *.'V \� ^�fr. �vb,Fa� "'4..-_ :1...1. - ..�.l.iM "..�.. •y 1 L) %� 2 I ae rn a,5�e 3' vt/`- owe G% w ym, 4' 5' 6 Z Yom" ri' p rA3 8' 9' 10' 11' 12' 13' 14' =Tt�ID CA =".I.;l;" TML AT..WHICH ,,GROUNDWATI R: IS:-F�NC�9U_Nz INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER` BEING ENODUNTERED DEEP HOLE OBSERVATIONS MADE BY:� //! ✓ DATE: Vxzlrd DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided 60 v 4::, No. of Bedroams Septic Tank Capacity /,;kS`U gals. Typellmfo,�ry Absorption Area Provided By S67 o L.F. x 24" width trench Other Name t///% Signature N� Address Y e1 1'*V Pyr1 / SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.f t /gal. Checked by Date (Name of Owner) (Street Location) DOC MvEMS . f I t Ltty -1 vKt — Permit Application 9 �A Corporate Resolution `' U Plans - -Three sets s/s - Z7.;f igrn xs oriza i'"on "'� Design Data Sheet (DDS) SUBDIVISION Deep Hole Log Perc (?r Consistent Perc Results (3) Fill Z. Perc Hole Depth cd House Puns - Two. sets Well ,/ permit; PWS letter Variance Request GII�AL Legal Subdivision Subdivision Approval Checked Ex- 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 arrow) Sewage System Hydraulic Profile - Gravity Flaw 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 (grinder rate) Design Data: perc and deep results Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footin /Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area; shown; gravity flow,suff, size If Po 'd .Pit &. D .,$�x .Shown - &.. Detailed - . .House °- -No."'of Bedroar -._. - Wells & SSDS's w /in 200 ft. of Proposed Systems Property Metes & Bounds House Setback Necessary (Tight lot) House Seger - 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 20' to Foundation Walls . 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains - Curtain, Leader, Footing 35'to 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 WAM �MM MM AMA . MA MAM WAM EMM provided LF trench required .0 ft rrax. Parellel to 00: exp. %L MMPAM I lrMur, MAM' AMN r � rim FILL SYSTEMS claybarrier 0� l I •.• �- - 200 ft. - - - M�GEM gym= DOC MvEMS . f I t Ltty -1 vKt — Permit Application 9 �A Corporate Resolution `' U Plans - -Three sets s/s - Z7.;f igrn xs oriza i'"on "'� Design Data Sheet (DDS) SUBDIVISION Deep Hole Log Perc (?r Consistent Perc Results (3) Fill Z. Perc Hole Depth cd House Puns - Two. sets Well ,/ permit; PWS letter Variance Request GII�AL Legal Subdivision Subdivision Approval Checked Ex- 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 arrow) Sewage System Hydraulic Profile - Gravity Flaw 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 (grinder rate) Design Data: perc and deep results Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footin /Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area; shown; gravity flow,suff, size If Po 'd .Pit &. D .,$�x .Shown - &.. Detailed - . .House °- -No."'of Bedroar -._. - Wells & SSDS's w /in 200 ft. of Proposed Systems Property Metes & Bounds House Setback Necessary (Tight lot) House Seger - 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 20' to Foundation Walls . 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains - Curtain, Leader, Footing 35'to 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 BY: (Name of Ownerr) (Street Location) DOCC AOUS %Il tit'iC. vl^ Perni.t Application Corporate - Resolution 3 Plans - Three sets s/s _ Design Data Sheet (DDS) SiJBDIVISION� Deep Hole Log Perc Consistent Perc Results (3) Fill Perc Hole Dept's cd `r I House Pizans - Two sets Well ,/ permit; PWS. letter Variance Request z Legal Subdivision Sub iw -sion Approval Checked E---c- approval SSDS Adj. Lots Checker Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Se,7age System Plan - (north arrow) Se4age System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Derail Well Detail, Service Line if over Construction Notes (grinder rate) Design Data: perc and deep results Two -Foot Contours Existing & Proposed Driveway & Slopes Cut FootinJGutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area; shown; gravity flow,suff. size If Ptuup 3 Pit & D Box Shcwn &,,Detai�e�l Bedroai�s Wells & SSDS's Win 200 ft. of Proposed SysteTL-- Property rtes & Bounds House Setback Necessary (Tight lot) House Seger - 1 /4 " /ft. 4 "0; Type pipe No Bends; Max. Bends 45° w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees,Top of fil 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, lake Unc. ear 15' to Drains - Curtain, Leader, Footing 35'to catch basin, stormirain,piped watercourE 10' to Water Line (pits -20') 50' intermittent drainage course Seotic Tanks 10' fran Foundation; 50' to well 15' Well to PL 9 PnAMOM 11M�1� • u. MM S �■ NAM s. - I .1 /.G VF�� a RIO . . r� rim SYSTEMS clavbarrier WOM - •- M . -. ._ �M m- 100 yr. flood k-lev. 200 ft. reservoir, - tc. ON •- M� M DOCC AOUS %Il tit'iC. vl^ Perni.t Application Corporate - Resolution 3 Plans - Three sets s/s _ Design Data Sheet (DDS) SiJBDIVISION� Deep Hole Log Perc Consistent Perc Results (3) Fill Perc Hole Dept's cd `r I House Pizans - Two sets Well ,/ permit; PWS. letter Variance Request z Legal Subdivision Sub iw -sion Approval Checked E---c- approval SSDS Adj. Lots Checker Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Se,7age System Plan - (north arrow) Se4age System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Derail Well Detail, Service Line if over Construction Notes (grinder rate) Design Data: perc and deep results Two -Foot Contours Existing & Proposed Driveway & Slopes Cut FootinJGutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area; shown; gravity flow,suff. size If Ptuup 3 Pit & D Box Shcwn &,,Detai�e�l Bedroai�s Wells & SSDS's Win 200 ft. of Proposed SysteTL-- Property rtes & Bounds House Setback Necessary (Tight lot) House Seger - 1 /4 " /ft. 4 "0; Type pipe No Bends; Max. Bends 45° w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees,Top of fil 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, lake Unc. ear 15' to Drains - Curtain, Leader, Footing 35'to catch basin, stormirain,piped watercourE 10' to Water Line (pits -20') 50' intermittent drainage course Seotic Tanks 10' fran Foundation; 50' to well 15' Well to PL 9 -ER-F- .-ON MaU &)MP04 -.'ES 7-19-rES'LF n_o). - I A( EOT776?K-c 9LE-:f—j,)-),,!--oF-Frcc- )9s C, ..N73 /7 O " L: -- P 0 -17, 00 8..0 0 PC .10, T-k .000, /Y' /9 IV 11 2..,ST.-/ F-A, GRRAGG' ;i R =-'3c, " 00, '0 MUELLER M00tirxff R-OA D NOTE: R hereon, for whom ;this survey was prepared and on their behalf to any title company, governmental agency, or lending Institution named hereon. Said certifications are not transferable to additional institutions or subsequent owners. Any alteration or,additlon to this survey Is a violation of SECTION 7209 of the NEW YORK t t STATE EDUCATIONiLAW. except as per SUBDIVISION 2. Co.Z. C- V1 LF T-RL COMER Peter D. Crank, hereby certify that the sury2y, on which his mop is based was completed on and this mop was completed W'-MrJqACj4 ' -f nd hot said survey was prepared In accordancP:Vthe current "CODE OF PRACTICE' of the NEW YORK STATE ASSOCIATION OF PROFESSION ALJLAND.SURVEYORS NYSAPLS). OF NEW 'ER,nRED TO, SC 04 9c.) 5" Jam/ Y LAND N K. S, JO 1.1 0 A, A Xj 0 V. 111� 6) 0 Co" - CL URVEY OF PROPERTY PREPARED FOR MUN-1-5-ANDREA CO SITUATE IN N. -OF .T-.UTj\i.A.M VA L L. Ey, Lpu -jk CO. N.Y. ALE: 1'= -.T(:! a -MR)Qr-11 14 2008 0 A, A Xj 0 V. 111� 6) 0 Co" - CL URVEY OF PROPERTY PREPARED FOR MUN-1-5-ANDREA CO SITUATE IN N. -OF .T-.UTj\i.A.M VA L L. Ey, Lpu -jk CO. N.Y. ALE: 1'= -.T(:! a -MR)Qr-11 14 2008 D S76 .0 Jp ') I �e r7 x� PIO 37 13 21 4-3 J4 1-41 f f Lr / "7 I 1 93 qj 123