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HomeMy WebLinkAbout4436DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.14 -1 -9 BOX 34 04436 .. '� �. 64 lw all r 04436 SHERLrTA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health January 20, 2006 Adeline Polisena 11 Cindy Lane Putnam Valley, NY 10579 Dw Ms. Polisena: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Addition — Polisena 11 Cindy Lane (T) Putnam Valley, T.M. 84.14 -1 -9 ROBERT J. BONDI County Executive I have received and reviewed the plans for the proposed addition to the above - mentioned residence. Bayed on the information submitted, the above mentioned addition cannot be approved for the following reasons: 1. Creation of an accessory apartment with three private rooms and second kitchen. 2. The legal bedroom count for the dwelling is three. The potential bedroom count of your —proposed addition` -iS ve € - _ - �.F _ =� —M, ° -�c•R" ..__ > _. v— - - . ' — T _ —_ �:r 3. The addition of a potential bedroom'(s) requires this Department's approval of a revised septic system plan from a professional engineer. Phase revise the proposed floor plan to reflect no more than three potential bedrooms or have a professional engineer or registered architect design a sub - surface sewage treatment system meeting ptsent code requirements. Ifyou have any questions, please contact me at your convenience. Sincerely, oseph S. Paravah Jr. Assistant Public Health Engineer Y: cw Building Inspector, PutnMiY Ytal Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (84S) 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 Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 REQUEST FOR FIELD TESTING ROBERT J. BONDI County Executive All information below must be fully completed prior to any scheduling. DATE: ENGINEERING FIRM: cQ Iii VC., PHONE PERSON TO CONTACT: pwu ❑ NEW CONSTRUCTION ❑ REPAIR PROGRAM >�ADDITION PROGRAM REASON: DEEPSA PERCS�: ❑ PUMP TEST: ❑ ROAD /STREET: / TOWN: a u SUBDIVISION: OWNER:_ h'`' �d�����'I 9 J TAX MAP #: f '� .1 Y'—" _ �? LOT #: NYCDEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING YES NO -_a.::.;s;� ::;��:�::;_: �: E�olarisP�' SS�SSVithi�tli��; jrain, �g►. �tsi�1. ��"4�`.tB��.eh'�.yd�,�Ok�E�B�.x ---- _�_- __..:.:....�_ Croton Falls Reservoirs. ❑ i� Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. ❑ ,'� Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ )2< Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. ❑ AC Proposed SSTS for a Commercial Project. It is the responsibility of the design professional to provide the above information prior to soil testing. The Department will determine the NYCDEP project status (Joint or Delegated) based on the response. if you answered ves to any of the questions, NYCDEP must witness the soil tests. This Department will coordinate a mutually suitable time for field testing with the Design Professional and NYDCEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil tests, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. FOR COUNTY USE ONLY DATE: TIME: COMMENTS: REQ. FOR FIELD TESTING: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 (843) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 j 5 r w>w ',,,�'�", �8" 1, - -'`' � 3 + °s�':s+. • �v, •� � e•�c �s ''o p?�r�.m' � a �-� a� PQ A. ma � , qy x ' .� .e-1 Y �' =z 37 t(y t i tneri rr .--- eve Ao.,d t A ``)�gr'. .� � s �C`+k!'.•�k+�eJ�f,'AS .' wa�. Io��tfl Cllr a x, _ �. PQ A. � , qy x W, qs fr ' 37 t(y Wa r � rim } rig, 8 d we_ r 3 st�,Y ,�a •tom' y ` fi a, .. ••- •- .�._,.�,:,�..<v —� .,s" ......... SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ADDITION APPLICATION RESIDENTIAL ONLY -I IWI M In STREET r1 TOWN AX MAP# Me NAME -.92- to PCHD# a 0 I, - U MAILING ADDRESS N -1q -aC-i DESCRIPTION OF ADDITION P'c�SO NUMBER OF EXISTING BEDROOMS PROPOSED # OF BEDROOMS_ (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) "Any addition which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of.the Putnam County Sanitary Code. Please submit this form and the following to. Putnam County Health Dept., 1 Geneva Rd, Brewster; �]Y - .....:.. 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 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845):278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 J SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF -HEALTH I Geneva Road, Brewster, New York 10509 PUTNAM COUNTY DEPT. OF HEALTH 1 GENEVA ROAD BREWSTER, NY 10509 Re: 11 Cindy Lane Residence ROBERT J. BONDI County Executive TAXMAP# 84.14-1-9 TOWN of Putnam Valle- To Whom It May Concern: According to records maintained by the Town, the above noted dwelling, T ­_��I-N`COMP- IANCE-W_IT_H_-- -0-"�;7CODE.-;*;.i-�l.--"-"�" IS NOT IN COMPLIANCE WITH TOWN CODE LEGAL BEDROOM COUNT IS This information has been obtained from: CERTIFICATE OF OCCUPANCY: xx.- see, attached OTHER: Assist. Building Inspector John W. Allen Date 1/4/06 CERTIFICATE OF OCCUPANCY lm Water Supply Section (845) 225-5186 Fax (945) 225-5418 Environmental Health (845) 278-6130 Fax (845) 278-7921 Nursing Services (845) 278-6558 WIC(845)278-6678 Fax-(845)278-6085 Early Intervention/Preschool(845)278 -6014 Fax(845)278 -6648 POLIS BERNARD 111 lly -4 -4 SAP One Fi�mlly w /deck PERMIT # 84- 7406 - 5/21/84 :ALTH YORK PAPERS: —, of p`�� <INS BL'ULT; - Z '�; •S FIIVEit 1FS: td: _mNDATION� CERTIFICATE M CUPAN CY Certificat e' of. Occupancy Nib -C9..:........•••.Application, No .84. 74(lfi .... 1 EA2�tILY'WITH DECK Location of Premises :CINDY.. T-A ............ . BIWARD POLIgENA of PUTNAM VALLEY having Heretofore filed an- application � for a building permit pursuant to the. lorung Ordinance,: Sanitary Code :and the Laws in effect m the Town of Putnam Valley, Putnam County, New York, having paid the required fee: therefor and the undersigned wing by :personal inspection ascertained that <�. she: <apphcant has subsequently :proceeded with the erection. or improvement .of the proposed struc- ture �. compliance : with th&4egWreme . of the laws as aforementioned and that the said work `d materials :met.. every ..requirement ,.of the laws as afor'ementioned'`and° `that `the premises `have o been fully :completed and. ars. ead� for "occupancy pursuant to' the `provisions of law, Now, er$fore, this'. certificate of occupancy is. hereby issued .under the seal of: the; Town of Putnam. Valley this. .2nd day... of } .. 19.4y . :. q'Not valid unless signed in ink by a fluty' authorized agent TOWN OF. NAM VALI. W- RK 0f and under- .tile seal 'ot the Town of Putnam Valle y - B FEET 70 _Z _�-c DA ield wos tested of different depths during drilling, list below FEET GALLONS PER MINUTE c Ompi EYED DATE OF REPORT W RILLER ignat e) IAU permenem 0.11.11 ...... ..u' .. '- ,-'�.. �,wc -..� xt,.... ^,s.T;W+p,.� }'xtaok.. .. ::�7 °Y (t ti�r•.�", "" , e'- . - _.,s,.1._._.. -.. — _r,... _ .._ -.. __ _ ...__ ...._.. ` t CERTIFICATE.OF OCCUPANCY - Shed Certificate of Occupancy No ..... 9. !nD ........... Application No......85 -•723 Location of Premises .. Cindy Lane..-...TM #84.14 -1 -9 Adeline Polisena of 11 . Cindy. Lane - Putnam V &Ilex ,a�Y .having .... heretofore filed an application for. a building. permit .pursuant-_to the Zoning Ordinance, Sanitary Code and, the. Laws effect in the Town of Putnam Valley; Putnam County, New York; having t. 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 furs m '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% read; for: occupancy. `pursuant to the provisions of law,: Now therefore, this certificate. of :occupancy as: hereby; issued under the seal' of`, the. T own of ,Puthani Valley this ....1 g .... day of March Not v4d•.4nless signed in mk.:by a dWX authorized agent TOWN OF 1? VALLEY, RIB of and under the seal of the Town of Putnam Valley. ........ ... y' v, E 0 : PRO)ECT' CD. Ht)rAitER NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION • DIVISION OF REGULATORY'AFFAIRS State Enrlmnmental Quality. Renew SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART i Pmltct Information (To be completed by Applicant or Project sponsor) 1. Applicant/sponsor 2. Project Name Nov LC �5� Yl J. Project location: Mueklpality ' In—'.,ty �. Is sed action lJ New ❑ Expansion l`s Modifiutbnlalteatbn . S. Describe project briefly: G. Precise location (road intersections, prominent landmarks, etc. Of provide map) ti I low '60), G / l 0 fms -Frvmy .�t S �rrLCr- �kCrj wGL rd( ,P.v. HS . 7 Amount of land affected: Initially acrei Ultimately acres a.. Will proposed action with existing zoning or other existing land use restrictions? a if No. describe briefly �1 r e4o 9.,whIt ti 'n ier't lind`ersi fn'vlccin` of projectt,� Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Parklandlopen space ❑ Other �Des ctibe - 1-�luuse. � R�►d.:� Cam. �� -}-0 Involve a permlt►approval, or funding. now or ultimately. from any other governmental agency (Federal, state or local 10. Does act � ) ac Llel yes ❑ No If yes, list agency(s) and permittapprovals wn -1bYJ � C v)A V) cur) V) i h� . 600L "l r CAP roU 0_1 a►^c�, m 11. Does any aspect of the action have a currently valid permit or approval? ❑ 12 Yes No If yes, list agency name and permit/approval type 17. As mull of proposed ❑ Yes d actksn will existing permit/approval require modification? taJ 'NO 1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDG1 Applicant/sponsor name: 1 Date. -A 10-5 10 to Signature: ' If the action Is In the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment ...��. ,,moSAY,t':rekt.iS ��• M !,Ly'.:•ti3�`.'.::•,a..- .aeyah.. ..:1 _ ,tom,,...: r.. _ .___ _ PUTNAM COO.UNTY . DEPARTMENT OF HEALTH Division of Environmental Heehh Services, Carmel, N. Y. 10512 Permit • CERTIFICATE OF CONSTRUCTION COMPLIANCE' FOR' SEWAGE DISPOSAL SYSTEM = '•tr'�rn T X7.1 "�i `" ' Town or Village Located at Iv.1j1dy .�.�: -one Tax Map Block _' er na r d r O 3.1 s e n8. Formerly t Tax Map Lot • Subd. not • Owner Separate Sewerage System built by ^Ianue.i '?Oi?t`c �ivakez street ";!oheglarx - Address - 1000 333 ;,r' of 24" Trenches - Consisting of Get. Septic Tank and Other requirements �Jcne Water -Supply: Public Supply From x_ Private Supply Drilled BY V 'dOr i�a i "idez'SCLffi i '? Address {trh : ? t rh 1t -ivur. Valley, r r-av . -;;: �Edroom �ric?c Building 'type No, of Bedrooms Date Permit Issued t Has Erosion Control Been Completed? Yes I certify that the system(s) as listed serving the above Fremiises were constructed essentially as shown on the plans of the completed work ( copie of which are attached), and in accordance with the standarda, rules and regulations, in accordance with the filed plan, and the permit issued by t Putnam County Department Of Health. March 20, 1985 Date � Certified by •' � t.� P,E. ?dorthricle�e d ? e -Skill, NY. 1 ,r:;(, 7,7P�.— Address Llcense No. Any .person occupying premises served by the above systein(i;) �Ahall promptly take such siaton,as'may be necessary to secure the correction of any ununitai conditions resulting from such usage. Approval of the separate sewerage system shall become null and void :as,soon -as a• public unitary sewer become available and the approval of the private water supply shall hacome null and void when a public witei supply bebomes.avallable. Such approval`s m subject to modification or change when, In the judgment aoe tlje Commifsloner of Health, such revoca%;Ion, modification or change Is necessary, Date \,. ,� By .. 'r, 1�w.._i �t . `• Title Rev. 9 -Bl t' t� , i .` : u a O Y•. � I W� I _� SUNKt N 42 i (—T 1 (1i I 4,2' O I; BEDROOM 1-.. ® BATN!t'g;`p••Tu13 1 /NK 12.9WGE j'� 7 W2 / fx FA.+. N G ROO/vl PR BIROLD S L. d. to sMWR � ,_ � � • WA BK•RS.T_.. 1 `-y I}c i TN R R A P p10, Ar- ^. t T PR. & RoLD © © 5 y RA /L� 63 W. I. y 1°U SS 2' 1 � Nv LJ _ -.PR . BI FOLD � - T r • L C p � 2Q .• �t . ..:. t r i y.: TO BE LOCATED AS DIRECTED By OWNER. DCXJBLF- SILL AND USE LEDGER OVER ALL BASEMENT (:)pe ALL BASE SASH SO"AALL BE IB/20 2-LT. S' -3 7 /6" 3420 H.S. 2Z 'ro Jrx'r Ia. GARAGE 0 FI-;3,9!SOD6 GYP. 80. WALL C� A F A, vi kk S TOM - Its lq z - - - - - - - - - - These Duns aie Qesig +. Standards of the Vv Adrnim;lnjjon and ,L„ h6Wes• ?6 ft?- suilabili: delt,.mined by the age vi 4 0 i- w p — -- SUNKEN -f]" BEDROOM 1.. ... _ =s ® BATH �5-'a 17_7- pm ' ti Wp _ . 3 /N!t 2rtNGE M — �`TCN. O /NI/VG RD OA; PR A — IO SHWR tt zO� � II � WP To 2 Nf �a ARER 1 6 2 o: 4 Cn LL X10 -4 Teu ss 2 - j. 5O PFt 130FrOL.0 r, / L 5 — e. ftv U 40 LIVING !ZOOM p • D �- , w O 1 c 2110 •• ;, . } � j. YO i AWN MEDICALIABORATORY INC.' 'P.O. Box 99. 21 i ar Street LOCATIONS:...: ❑ 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245-32013... Yorktown Heights, N.Y. 10598 p�201BUTTONW000AVE :;PEEKSKILL,N.Y.105667376777 245"3203 N ST.; MT KISCo, N Y :10549 666.3335 ❑ 495 MAIN - _ . , . _ - ��• ❑- STONELE.IGH AVE (NEAR HOSPITAL) CARMEL, N Y. 10512,,218-9&V. DATE TAKEN: DATE RECEIVED: pD L�S E N�}- G�,:�,.c� DATE REPORTED; r SAMPLE SOURCE' ' A_-L ::: REFERRED BY: % / j� COLLECTED BY: LABORATORY REPORT mg /L ❑ACIDITY ....... »........ .. ................:.........:.... ❑ALUMINUM .........:...........:..:....... ...:..................::....:.. ❑ ALKALINITY ......... ❑ ANTIMONY ... ................ ..... ............................... � ff fi4-8ACTERIA,TOTAL /mL .............. ❑ ARSENIC ..... ............................... ....... ❑ SOD, 5 DAY ................... ............................... ❑ BARIUM ........................ : ......... :................................... ❑ BROMIDE ................... ............................... ❑BERYLLIUM ..:.................... ............................... ❑ CARBON DIOXIDE, FREE ....................... ❑ BISMUTH .......................... .. ............................... ❑ CHLORIDE ................... ............................... ❑ BORON :......................... ............................... ❑ CHLORINE ................... ............................... ❑ CADMIUM .............. ............................... ❑ COD ........................... ............................... ❑ CALCIUM .................................... ............................... .❑ COLOR ....................... ............................... ❑ CHROMIUM (tot.) ............................ .........................:..... ❑ CYANIDE ........ ............ .........:..................... ❑ CHROMIUM thexavatent) ......................... ❑ DETERGENT, ANIONIC ... ............................... ❑ COBALT .....................:............. ............................... ❑ FLUORIDE .......... ❑ COPPER ❑ HARDNESS ..... ❑ GOLD ..... .. ............................. .......... ........................................ ............................... ❑ MPN COLIFORM COUNT/ 100 ml .... ❑ IRON .................. ............................... .......... ... MFT COLIFORM COUNT/ 100 ml ...... ❑ LEAD ❑ CONFIRMATORY TEST ................................... ❑ LITHIUM .................................. .. :.............................. ❑ NITROGEN, AMMONIA .................................... ❑ MAGNESIUM .. ........ ................... ... • '"0 NiTAOG�b ;'K3EL ®F:HL—. ° ....:.........:.- ... ..:;�- s;: . �AN&SE• .....<. .....�..».........,.:=,..r� e�•. ,...e..,.ea_,._ :.,,. ❑ NITROGEN, NITRATE. ... ............................... ❑ MERCURY .................................... ..........................::... ❑ NITROGEN, ORGANIC :...:........ :................. ❑ NICKEL ...........:............................ ............................... ❑ ODOR ...................................................... Cl PALLADIUM ................................................... :........... '❑ OIL & GREASE ............... ... ............................. ❑ POTASSIUM ................................ ............................... ❑ PH ........................... .. .............................. ❑ RHODIUM ..................................... ............................... ❑ PHENOL ....................... ............................... ❑ SELENIUM .................................... .......... ...................... ❑ PHOSPHATE (ortho) ....... ............................... ❑ SILICON .................................. ............................... ❑ PHOSPHATE (condensed) ... ........................:...... ❑ SILVER ...::................................... .::............................ ❑ PHOSPHATE (total) ....... ............................:.. ❑ SODIUM ................................. ............................... ❑ SOLIDS, SETTLEABLE, ml /L ❑ TIN ............................................ ............................... ❑ SOLIDS, SUSPENDED ... ............................... ❑ ZINC .........................................:.. ............................... ❑ SOLIDS, DISSOLVED ... ............................... ❑ .................................................... ...............:............... ❑ SOLIDS, TOTAL ..... :..................................... ❑ .................................................... ..................:............ ❑ SOLIDS, VOLATILE ....................................... ❑ REMARKS:..................................... ............................... ❑ SPECIFIC CONDUCTANCE ❑ ...................:................................ ............................... ❑ SULFATE ................... ............................... ❑ .............:....................................:. ............................... . ❑ SULFIDE ..................... ............................... ❑ .................................................... ........................ ........ ❑ SULFITE .................... ............................... ❑ ........................................ ............................... ❑ SURFACTANTS ............ ............................... .............. :............. ........ .. ............................... ... Cl TURBIDITY ................ ............................... ❑ • .... ........... ............................... ....... THESE RESULTS INDICATE THAT THE WATER WA OF A SATISFACTORY SANITARY QUALITY WHEN THE SAMPLE WAS COLLECTED. THESE RESULTS INDICATE THAT THE WATER DID ME THE SATI ACTORY CHEMICAL QUALITY OF NEW YORK STATE ADMINISTRATIVE RULES & REG 0 , INK G A STANDARDS (PART. 72 FOR THE PARAMETERS TESTED. ALBERT H. PADOVANI M.T (ASCP), DIRECTO / �� Berha_i c0 P,oiisena ,Owner,'or Purchaser of Building Section Bernard Polisena :: Bui :ding Cons truc Block ' Thu is ve.,+d, .. "j}a p;-,a sa - . .%sv -;.:a «pt:..�5 .." "q'ei�: io :- '�sa�Ra:. Y%Y � eo �u e..a .= - .-:'�N r..=. — -... ..;r: ;.y::�::�y�Y,iy�:' v.-;:: sp.•': —c+�+ 'Cindy's Lane Location Street Lot Putnam Valley (T) Geyersburg Municipality.. Subdivision Name 2 Story brick Building'Type' Subdv. Lot .# GUARANTEE OF SEPARATE SEWAGE SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material,- construction'and drainage. of the sewage s 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 success- ors', 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 initial use of the' sewage disposal system, or 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 occu- pant of the building,utlizing the system. The undersigned further agrees to accept as conclusive the determin- ation of the Director of. the Division of Environmental Health Services of : the r �'a.tnam - County Department of Heal -t-h as to whether_ or,_rot .the .:fail ure ofT the system to operate was caused by the } willfu�Ror negligentT a`ct of the occupant of the building utilizing the system. Dated this 20 day of March 19 85. Signature THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health PUTNAM.COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFI(E?BUILDTNG, -CARL '," N. Y: 10512 '"` DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Qwner Bernard J. Polisena sAddress 3206-Lexington Avenue Mohegan.Lake, NY .•_ Q .. ,: -. .. leap ' •" - Y " _..17ogated1 at (S reef:- Cindy's Lane See.__ Block. �' Lot - �' `` n .ica e neares cross s ree Putnam Valley (T) Peekskill Municipality Watershed :SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS J, i1 1009 ll s 04 ` 25:,., 36.25. 39.2.5 ..3.00.. 8.33 1'0 a 1,37 .27 ....36:25 39.25 3 .11 s 41 1208 08 27 36.25 39.25 3.00.. 9.00: .. 1 2" 3 n . 5 Notes: 1) Tuts to be repeated at same depth until approximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. Hole Number C CLOCK TIME P PERCOLATION P PERCOLATION Run a apse D Depth to % a er .. W Water Levei Soil Rate (1) 1 1 10 ,32 t to s56 2 24 3 344-75 3 37.75 3 3.00 8 8.00 2 1 11101 1 11926 2 25 3 34: -75 3 37:75 3 3.00 8 8033 3,11130 1 11156 2 26 3 34.75 3 37.75 3 3.00 8 8067 4 1 12sO2 1 12s28. 2 26 3 34.75 3 37.75 3 3.00' 8 8.67 1009 ll s 04 ` 25:,., 36.25. 39.2.5 ..3.00.. 8.33 1'0 a 1,37 .27 ....36:25 39.25 3 .11 s 41 1208 08 27 36.25 39.25 3.00.. 9.00: .. 1 2" 3 n . 5 Notes: 1) Tuts to be repeated at same depth until approximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. Notes: 1) Tuts to be repeated at same depth until approximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. 30" 36" 42" 48" 8411 _ INDICATE .LEVEL..AT ,WHICH GROUND WATER IS...ENCOUNTERED 921 r INDICA!PE Imo_ 4zEgO ,W-IICI WATER I,.�'VEI�.'FxSES AF'EF� I3Ei1VC;�Ti?�3'EI3 -,... 'TESTS .MADE_ BY John S. Romeo Date. . April 11:, 198 —ffE- IGN 8 =10- 000 SF + . Soil Rate Used Min/1 'Drop: S.D. Usable Area Provided 5 3 1000. Masnry No. of Bedrooms Septic Tank Capacity Gals. ,,,.Type Absorption Area:-Provided By 333 L.F.x24.' X — i®t�renc . Name ,Tnhn q, Romp-6 Signature Address 1.- Northridge Road SEAL o Peekskill-, N.Y. :. THIS TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION ONLY: Soil DESCRIPTION OF SOILS.ENCOUN`I'ERED IN TEST HOLES _ --(7..:' .. `�- •.':..cus�..ti.: -rte ' 72 1 NO. DEPTH HOLE NO. HOLE , HOLE NO. G.L. Topsoil Topsoil Topsoil Topsoil 6" 12" sarridy, silty, sarfdy,rs i1-t y, sandy, silty, sandy -, silty, gravelly loam _ gravelly loam gravelly-loam gravelly 18" 30" 36" 42" 48" 8411 _ INDICATE .LEVEL..AT ,WHICH GROUND WATER IS...ENCOUNTERED 921 r INDICA!PE Imo_ 4zEgO ,W-IICI WATER I,.�'VEI�.'FxSES AF'EF� I3Ei1VC;�Ti?�3'EI3 -,... 'TESTS .MADE_ BY John S. Romeo Date. . April 11:, 198 —ffE- IGN 8 =10- 000 SF + . Soil Rate Used Min/1 'Drop: S.D. Usable Area Provided 5 3 1000. Masnry No. of Bedrooms Septic Tank Capacity Gals. ,,,.Type Absorption Area:-Provided By 333 L.F.x24.' X — i®t�renc . Name ,Tnhn q, Romp-6 Signature Address 1.- Northridge Road SEAL o Peekskill-, N.Y. :. THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved_ Sq. Ft /Gal. Checked by pie 4 APR 2 5 1884 PUTNAM COUNTY DEPT. OF HEALTH Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES . ..�.: -_. - -� = �- _,r ._ __.d ..- . -: ... �.w'_ . _- • -- .. :E:, .. :•;.- <._. _.._ ,. .. -�.� . _ �_ ......:. .ter:, -. _.:. Date April 5, 1984 Re: Property of Bernard J. Polisena Located at Cindy °s lane Putnam Valley (T) Putnam Valley Section Block Lot Subdivision of Geyersberg Subdv. Lot # 4 Filed Map # 14.54 Date 7/l/75 Gentlemen: This letter is to authorize John-S. Romeo x 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 ;stenl::or__sy..s- t�z►ns =a? oonfUrir `ty °wi$i t e provis on -of Article •'145- ors` 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. . Very truly yours, Signed Countersigned: Owner of P operty 7 V P.E. , ��X # 2 846 0 •o•. • 0000ee Addr s s - 1 Northridge Road e �� S. Ro��� •• Address ;�� �N. ® Town , Peekskill, N.Y. 10566:1, =0 le 737 -1056 0 27$46 : Telephone % e Telephone e. .•• .e0 "o.oes V