Loading...
HomeMy WebLinkAbout4629DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.09 -1 -17 BOX 35 �. r II �. r I s # Rr I I kQ i'6 r 6 - . � a,.,..�. 6 6. Big ILL 04629 e PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 y CERTIFICATE OF -CONSTRUCTION CCU PLiANCE$ 0GR 'SEW'AGt`bISPOSAL SYSTEM Town of Putnam Valley Town or Village Located at _Finnerty Road Tax Map Block Owner Miller and Sons Assoc Inc Lot Job 79 -211 Separate Sewerage System buihtby L_ ' 'Mal luZZa Address Somerset Lane, Putnam Valley , N.Y. Consisting of 100 .Gal. Septic Tank and 360 LF of 2 ° wide leaching trenches Other requirements Water Supply: Public Supply From * Private. Supply Drilled By – Norman Anderson Address Barger ,Street Putnam 5Z;;11 eV. N Y 10579 Building Type_1 =.family residence No. of Bedrooms 3 Date Permit Issued 8 /11 /80 Has Erosion Control Been, Completed? I certify that the system(s) as listed serving the above premises were constructed essentially as attached), and in accordance with the standards, rules and regulations, planifAed, and the Date June 19, 1980 Certified by Address on the plans of the completed work (copies of which are issued by thel, Putnam County Department of Health, P,E. R.A. License No, 110 5 6 Any person occupying premises served by the above system(s) shall prom ti take such action as may be necessary to secure the correction' of any unsanitary j conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a public sanitary sewer 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 Commissio r of Health, such �revocan, modification or change is necessary. Date BY Title ,t1 _ D TNAM COUNTY 'DEPARTMENT' OF HEALTH �-�i 0 Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Located at '������T FARM Subdivision m /" r+ ^ M Owner J act - 1C Building Type I IVM • 9ES• Lot Area 44. 0 S.P. Number of Bedrooms 3 Design Flow Gcc 4 PD Separate Sewerage System to consist of 1404040 Gal. Septic Tank To be constructed by hi 0 T 5 S L F—G.TS0 Town► of PUTNAµ VALIY Town or village Tax Map `�� Block Lot Job Address 7 u y4 u (s^ N A vim' y I j(�G/ ?ZQ G 1-t Ert tom, � N► . / 0 8 0 / Total Habitable Space aZGGd Square meet and 366 L F OP %Pr. WDE 326y Address Water Supply: Public Supply From Private Supply to be drilled by NOT f2GLJk-T_ED Address Other Requirements E ENCE 1 represent that I am wholly and completely responsible for the design and location of th sed st s) , 1) t separate sewage disposal. system above described will be constructed as shown on the approved amendment there to and in co dente ardd, rut an regulations o e u nam County Department of Health, and that on completion thereof a "Certificate of Const 4i n Co sfact y the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner is cce ssig % the builder, that said builder will place in good operating condition any part of said sewage disposal system during th e d o im ad' ely following thedate of the issu- ance of the approval of the Certificate of Construction Compliance of the original sy reps s thereto t the drilled well described above Nill be located as shown on the approved plan and that said well will be I in accordan a �tan �s and regula— o� n� of the Putnam County Deep rtmentQ�of Health. 01t�� 4 Date •�u� Signed P. E. R.A Address License No. \PPROVED FOR CONSTRUCTION: This approval expires one yea fro the date ued unless con tion of the uiiding has been undertaken evnrahle fnr rauce nr may he amended nr mndified when ennvel. eswru by . �— — ' - 0 I(TOWN MEDICALLABORATORY INC. P.O. BOA 99 321 Kean Street LOCATIONS: t t XR 321.KEAR ST., YOR,KTOWN,-HEIGHTS N..Y._10598 245 -3203 Yorktown. Heights, N.Y. 1 598 O 201 BUTTONWOOD AVE., PEEKSKILL, N.Y. 10566 737 -8777 245 -3203 0 495.-MAIN ST.,,MT.,KISCO, N Y, 10549.666-33.35 #•07664 0 STONELEIGH AVE. (NEAR _HOSPITAL) CARMEL, N. Y. 16512 278- 9330 DATE COLLECTED 1 RESULTS ,OF EXAMINATION OF WATER ; 6 8 1_ (140014) ,j OWNER DATE RECEIVED NiIL`LER,; 6/8/8'1. .(12 a 40) CITY, VILLAGE, TOWN 6 /OA NAME OF SUPPLY DATE.•RE PORT ED SAMPLIN G7 POINT, BACTERIA PER ML:. (Agar plate count "at 35 C). COLIFORKGROUP (Most probable No. /100ml.) HARDNESS, TOTAL - ppm DETERGENTS-- •mg/l, NITRA .(as, - mg/L IRON, TOTAL - mg /L AMMONIA, FREE (m N) -mg /L pH= CHORIDES - (mg /L) COLLECTED BY J.'GORMAN These results indicate that the water was YES of a satisfactory sanitary quality when the sample was collected. i ADOVANI, M. T. (ASCP) EN BEALS, M.D., J.D. Commissioner of Health ROBERT-MORRIS; PX;,- lViTff Director ofEnvironmental Health DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 Phone # (845) 808-1390 Fax # (845) 278-7921 Mr. Steve Ferreira PO Box 1047 New Milford, CT 06776 Dear Mr. Ferreira, October 2, 2013 MARYELLEN ODELL County Executive Re: Field Inspection - Casin 10 Finnerty Place, (T) Putnam Valley, TM # 85.9-1-17 The above referenced separate sewage treatment system can be backfilled. There are n?.qpei� comments to be addressed at•this time i.n-referencelo,this Departinent's-6 -e'ri.-�Ai6ik-"."m-"'s"-pec*ti'on. p If you have any further questions, please contact me at (845) 808-1390 ext. 4261. Sincerely, V, S-ze� Gene D. Reed Sr. Environmental Health Engineering Aide GDR/jmg 10/01/2013 15:16 9147371655 TOWN OF CORTLANDT PAGE 01 �.:.�- OW wvm . -♦ All i dontation must be fully completed prior to any 'Trenches Y X inspections being made. PCHD Oonstn=tion Permit # ,Located: 10 Finnerty Plate._ _ . (T) (V) Putnam Valley Owner /Applicant NaMe: Esaban_Casin. , - - TM ,- Bloch _I Lot -�- Formerly: Subdivision Name: Subdivision Lot # Is system fill completed? Is system complete? _ Yes Is system constructed as per plans? _ ye5 Is well drilled? N/A Is well located as per plans? _N /A Are erosion control measures in place? _Yes Date- Date: 11- 24.1_ Date: I cextlfy that the systems), as listed, at the above premises bAs been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and Ppzmved slas>s, and the .$% clards, Rules and Regulations of the Putnam. County Department of Date: 10- 1 -zo13 Cer0ed by: .� FE x RA LDesign Nofessional ,address: P.O. Box 1 047 Lie.. # 076793 Comments: (Minor Chan 2e with Tank Arrangement as Discussed with Joe P. ) 6 '412 Form FIR -99 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # / J ' �� (o ` 3 Located at /© �_,-NN � 5 Gam- Town or Village Lqv Va'al- Sub4ivUXntt1nr4a`me d . Ifc Q :ly- Subd. Lot # Tax Map Block l Lot Zi- Date Subdivision Approved Owner /Applicant Name oli- m) Mailing Address Amount of Fee Enclosed YJ S od � ed Renewal — Revision Date of Previous Approval 17/14n. r,2�1 Building Type s• 1'-'- 0— Lot Area Z6- 9 , � No. of Bedrooms Aax-, Zip -A3-7f. &9 �o Design Flow GPD 00 Fill Section Only Depth Volume 1 PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED ......,a... •.emu., .. -.- - r,.. _ U. -.. �.P _ __- __w.':.�....._ _. _. .. ...�:1:. ^'!s. ....,......,.saw . Separate Sewerage ^System to consist of gallorrsepticrtank. and 0 Other Requirements: a6p §d' `-T'o G9091"l 4 To be constructed by p'—. - Address Water Sup AIv: Public Supply From Address or: _ jL/"* Private Supply Drilled by -57, xt SJ -IA/4 GvYf. Address 1 represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatmentsystem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Director /Commissioner will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the -date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date � / License # o76 ?i 3 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by.the Director /Commissioner. Any revision or alteration of the'approved plan requires =M "anew-perr 4- .,- _Appro_.ve l ,f dilchargze of domestic sanitary sewage only. os . _.►3-t-_ 4itec _:lla%° .. lJ �_. - H D File; Yellow copy - Buildin Inspector; Pink copy - Owner; Orange copy - Design Pro ssional Form CP -97 ALLEN BEALS, M.D., J.D. 4 �ioner .Pf ROBERT MORRIS, P.E., MPH Director of Environmental Health August 30, 2013 DEPARTMENT OF HEALTH Esteban Casin 10 Finnerty Place Putnam Valley, NY 10575 Dear Mr. Casin: Geneva Road, Brewster, New York. 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 MARYELLEN ODELL County Executive Re: Addition — Approval — Casin Increase in Number of Bedrooms with new SSTS 10 Finnerty Place (T) Putnam Valley, T.M. 85.9 -1 -17 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 August 30, 2013. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at six without prior approval by this Department. 2. All plumbing fixtures must be updated with water saving devices (i.e. new low flush toilets, restrictors for shower heads and faucets, etc ... ). 3. Approved SSTS must be constructed according to the approved plans certified by Stephen J: F�rreira,.P:E:--Any deviation from :the plan requires. a revision be submitte4 to ..... _ this Department. _ ......_ . 4. SSTS must be inspected by this Department before any backfilling. 5. 'A water test for bacteria only is to be submitted before compliance is issued. 6. The house must be inspected for bedroom count before the compliance is issued. 7. Once SSTS has been inspected and backfilled, a construction compliance package must be submitted for review and approval before operation of the new SSTS. 8. 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 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) 808 -1390 ext. 43157. Re ectfully, oseph S. Paravati, Jr., P.E. Assistant Public Health Engineer JSP:cw cc: BI (T) Putnam Valley Stephen J. Ferreira, P.E. ALLEN B ' EALS, M.D., J.D. Commissioner of Health Director of Environmental Health June 27, 2013 A41ARYELLEN ODELL County Executive DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 Phone # (845) 808-1390 Fai # (843) 21827921 Stephen J. Ferreira P.E. PO Box 1047 New Milford, CT 06776 Re: Proposed SSTS Addition — Casin 10 Finnerty Place (T) Putnam Valley, TM 85.9-1-17 Dear Mr. Ferreira: This office has received and reviewed the most recent set of plans for the above-mentioned project and offers the following comments for your consideration. 1. The existing septic tank needs to be upgraded to a 1,750 gallon tank (minimum). This can be accomplished by providing a tank in series to meet the minimum. Please refer to Appendix 15-A and NYSDEC '88 Design Standards for requirements for two tanks in series. Please provide a detail. t 3. Please correct the road name in the title block. This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at ext. 43157 if any questions arise. JSP:cw 0 V truly yours, Joseph Joseph S. Paravati, Jr., P.E. Assistant Public Health Engineer �ALJMDEALS, M.D., J.D. $ honer ofHmkh ROBERT MORE, P.E. Direct 0fBnoit+o lHesltit - 05PARTMENT'OF HEALTH 1 Geneva Read, Brewster, New York 10509 Telephone: (845) 80&1390; Fag: (845) 278 -7921 MARYELLXN OD&L ADDITION APPLICATION RESIDENTIAL ONLY o STREET lD Afial, /'L A-- TOWN PV TAX MAP # NAME 9,Cft Q O% 01f/Od PHONE PCHD# 4` V—*44 - : MAILING ADDRESS DESCRIPTION OF ADDITION A/14/19^ f4 -A-ria Id *NUMBER OF EXISTING BEDROOMS NUMBER OYPROPOSED NEW BEDROOMS * (FROM CERT. OF OCCUPANCY OR C TIFICATION 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 s Sanitary .Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, Brewster, NY 10509, Phone: (845) 808 -1390. C r 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement, to be shown and dimensioned and use of each room specified). (See Section 3.c of Bulletin HA-'l) 3. Two sets of proposed floor plans (drawn to scale - with name, street and tax map #) * Non - professional sketches are acceptable and preferred. (See Section 3.d of Bulletin HA -1) 4. Copy of survey showing all well and septic locations on the subject property to the best of your knowledge. Include date of installation known. Contact this office with any questions. 5. Copy of Certificate of Occupancy from the .Town or Certification from the Building Department with legal bedroom count of dwelling. OFFICE USE COMMENTS 5. «a A ALLEN B EtLS , M.D., J. D. Commissioner of Health ROBERT MORRIS, P:IE. Director ofEnvirnnmentnl Non /th DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 Town Legal Bedroom Count & Proposed Addition Status Re: E STi7BAN (Owner's Name) Tax Map# , 85.9-1-17 Address: 10 Finnerty Place Town: Putnam Valley- Year Built: .1999' According to records maintained by the Towii, the above. noted dwelling, is xx in :compliance with Town Code. Is not,.. - izcompliance-with Town Code.,.. The Legal Bedroom Count is- 4 This information has been obtained from: MARYELLEN OBELIL _ ._.County Executive , CertificateofOccupancy: CO #1999- 228,One Fam -Res.; CO #1999- 229 - Deck &. Screened Porch; CO #2002- 286- Finished Basement Other: The plans for the proposed addition are considered: xx , Addition to existing house only Teardown and/or re -build allowed under Town Regulations 2/22/13. B4ding Ins pector - Date 5. PUTNAM COUNTY DEPARTMENT OF HEALTH w .,. ..,�r:,: �.'� ��F ENVIRONMENT'ALMEAL�E' SRRV110E�., -, , -...r. •, LETTER OF AUTHORIZATION RE: Property of /,% Located at 44927GAG,L TN V 7"N V ax Map # Block l Lot /7 Subdivision of Subdivision Lot # Filed Map # ` Date Filed Gentlemen: This letter is to authorize IM a duly licensed Professional Engineer_ or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in con €or ty wit :t��e prov opus s 'Article,' 145` mid/:gr:14 o:ftheEdu.cation.Law;.the Publib Health- u Law, and the Putnam County Sanitary Code. Countersigned: - P.E., R.A., # v % Mailing Address 10, 0 1� UX C7-- State .7 - Zip 0(7a Telephone: 6 1" o) 3n --'7(-(9J Very truly yours, Signed: (Owner , roperty) Mailing Address: /0 %Sr', 114C State_ y``/% Zip Telephone: '71 SSr% i�f Form LA -97 PUTNAM COUNTY DEPARTMENT 07 HEALTH DIVISION OF ENVIRONMENTAL HEAL'T'H SERVICES i>ft"AT�'4 T S Y ST>EI�I �. Owner f f r✓l � iw Address /,0 Located at (Street) /0 ia�vC Tax Map Block I Lot _ (indicate nearest cross treet) Municipality y� ( Watershed ,yV a S9,y 42-1 v.rE SOIL PERCOLATION TEST DATA Date of Pre - soaking 5- / 2u i.3� Date of Percolation Test S Zi / Zcl/ 3 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. 5 1 min for 1 -30 min/inch, <_ 2 min for 31 -60 min/inch). All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 Pg. 1 of 2 fA�. '.. ham." �yV f.? X. lZ `2 S' 5 ` M^ 1 1' Yv"k r sr xk a s` 4 v;4 .ycnTV? _ h 4bepth to'ater Water �£ �y< From Grounds 1<,evel w L'ercolahon� E1pseTume� Surface (Inches) Ind Rate _, °,T►mev Start kStop ;Drop Inches x s Mm/Inch loo "h f �Yd x+ l ''.^� ?i �� 3�" ��--�' �.& dF "N""V� Z. �' � ��s. ltd I � ,,�C:. � ..,. xi .. ... .. _ ... . ........ r. Z.., .✓i �k�„4 ...8.a ., ✓'llt' ,7�� � a. vw n� a'Y @ ral� ✓,. "�.� .::. v:_�n,. 10 'C::_ 3r.1 $ P ��"¢`v ss 4� �n j 1 I Z' I - It' 25 .� 2 12, 26 - 12.;y 1 3 4 5 —2, ... _ -. ..�.. 3 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. 5 1 min for 1 -30 min/inch, <_ 2 min for 31 -60 min/inch). All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 Pg. 1 of 2 PUTNAM COUNTY DEPARTMENT OF HEALTH -DIVISION O r`a - .°�,✓t i�,w .may• t CERTIFICATE OF CONSTRUCTION COMPLIANCE f TREATMENT SYSTEM F PCHD CONSTRUCTION PERMIT # 6- f 9 Located at A n i � e-e, T Town or Village Owner /Applicant Name Ak4r o TaxMap Bloc /7 Formerl Subdivision Name Subd. Lot # Mailing Address i4' 141- h G Zip,/ ,V3 - 1 Date Construction Permit Issued by PCHD Separate Sewerage System built by 0 W PI Z::�r Address S e Consisting of 1 Z 3'—CJ Gallon Septic Tank and #d ® Other Requirements: Water Supply: Public Supply From Address or: `` Private Supply Drilled by / a /' I•'gi7 ��o r! Address es »a d /i/�` �t,/. t/, Building TyLe - -- -las,eroslon-conV61 been completed .y Number of Bedrooms Id Has garbage grinder been installed? Ala I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department . s*. Date: "Jj?,.0 Certified by at d2 Address 2- R.A. A Any perspon occupying premises s by the ove systems) shall promptly tak may be necessary to secure the correction of any unsanitary conditions resulting from such usage. App of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer 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 Public Health Director, such revocatio mod' icati or a is necessary. By: Title: Eft- Date: -e l White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 a IPUTNAM COUNTY 11YE PA][ TM]EIaT OlF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT..., W- Wilwntiaoa- Street Address: - E' "a rcc' Town/Village: U :' . Tax Grid # Map Block Lot(s) Well Owner: Name: , Address: ec- r Use of Well: I- primalry 2-secondary _,"Residential Public Supply Air cond/ eat pu p Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby )[Drilling ]Equipment Rotary Cable percussion � /Compressed air percussion Other (specify) Well Type Screened Open end casing /'Open hole in bedrock Other Casing Details Total length r/ ft. Length below grade eft. Diameter in. Weight per foot 12__1b /ft. Materials: /Steel Plastic Other Joints: Welded ✓'Threaded Other Seal: ,:,-Cement grout ^ Bentonite _ Other Drive shoe: Yes —No Liner: Yes No Screen Details Diameter (in) Slot Size Length(ft) IDepth to Screen (ft) Developed? First Yes—No' Hours Second Well Yield Test _ Bailed _ Pumped j Compressed Air Hours Yield Zr— gpm Depth Data Measure from land surface - static (specify ft) During yield test(ft) Depth of completed well in feet 3,0.9! Well Log If more detailed Information descriptions or sieve analyses - are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface /S., If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type , Capacity _ Depth . vcj Model Z►i� Voltage,, HP Tank Tymik o- 1 Volume 6 Date Well Completed Putnam County Certification No. Date of Report 9— Well Drill . (signature) 4 Crc N(DTE: ExAct location of well with_ distances to at least two .permanent lanatilarks to be proviaea on a separate sneettpian. Well Driller's Name a'° 4 Address: 4,(_ i�4441e Wj,4,,cc ­ k Signature: ' Date: /" / -2 �j White copy: HID File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 �. / YML ENVIRONMENTAL SERVICES | ' 321 Kear Stree� ^ Yo k ght N.Y. . Albert H. Padovani, Director #:33.908096 LAf}-------------------- CLIENT MON STAT PROC PAGE ` 1 ~#:~~~114 ---- -- ~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 08/05/99 LEAD (IMS) <1 ppb TORL'SH & ^ SONS DATE/TIME TAKEN: 08/04/99 01:30P BOX 271, 45 MAPLE AVE. DATE/TIME REC/D: 08/05/99 10:20 ATTINTIUm: DWAYNE TURLIKI-i REPOR7 uATE: 08/05/99 MANGANESE (Mn) <0.010 08/16/9'' 0-0.3 mg/l ARMONK, NY 10504 08/05/09 SODIUM (Na) 19.6 PHONE: (914)-273-3448 N/A SAMPLING SITE; MEOLA : PUTNA COL'D BY: D. TOR[IS- NOTES...: TANK ' ~~~````~~~~~~~~''~~~~ HOMES VALLE\ ~~~~~~^ DATE FLAG PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C� COLIFQRM METH: MF RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILI..: 08/05/99 MF T. COLIFOkM ABSENT /100 ML ABSENT 100s 08/05/99 LEAD (IMS) <1 ppb 0-15 ppb 910� 08/05/99 NITRATE NITROG 2.91 MG/L 0 - 10 913� 08/05/99 NITRITE NITROG <0101 MG/L N/A 914� 08/05/99 IRON (Fe) <0.060 MG/L 0-0.3 mg/1 203� 08/05/99 MANGANESE (Mn) <0.010 MG/L 0-0.3 mg/l 203� 08/05/09 SODIUM (Na) 19.6 MG/L N/A 08/05/99 . pH 7.5 UNITS 6.5-8.5 9043 08/05/99 HARDNESS,10TAL 187 MG/L N/A 08/05/99 ALKALINITY (AS 84.0 MG/L N/A ' 08/0509. ` _TURBj8ITy (TWR . _<1 NTU ' GACT COMMENTS: THESE RESULTS 1NDICATE THAT THE WATE!q ;!(WAS NOT) UT A SATISFACTORY SANITARY QUALITY ACCORDI HE NEW YORK STATE AND.EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for public schools are set at 15 ppb. EPA Lead & Copper Rule for Public Systems requires that no more than 10W of the!- distribution >oints have a LEAD value of more than 15 ppb and a COPPER value of 10 mg/L, else water treatment must be undertaken to reduce the waters corrosive potential. Fe/Mn If both iron and manganese are Presen�, their total value combined shall not exceed 0.5 mg/L. .Na . No limits for Sodium are Proscribed. Suggested guidelines state . that for people,on a sodium restricted diet,the water should conbelo no mdte�Qh!^n 20 /L of Sodium. For those on a ' ` moderately r 'rictid^dietl7a maximum of 270 mg/L of Sodium ' ` is swggesbed� \ \ ' \ ` ' \ sit., ,�..: �:�a°Ko,C,.i :� „4 _.n.. nc,:n[;.'.. � �..:. qj° - :.51..- .a.. .,... �E-a �{ �. .�w,'w�i � ,�;�. -;� sa- %g�%,'+-°C•asr¢ i' . moo.. � - v, q..o =' en. �. .e� i �+:• -, i' '3"'�• i•.' ,r,��+',..'�"+o�f""#_�.gs• ..w`:. TiME Vi=ac RT cpaS - t E��T� .. -. —mac. i'^'% t ..+ ` 0I ,., j •` r j'y �- �ER VA, ... 1—g-- �..S .tj.,' y t F•i Ste' t..i i`'tji�„`.t. „Y ; • ._ �,�. e�„i'�.+� �°' ^" s -`": jN _.. RA j•„1ti1 1 ` N iy N y ir+ t � i -r) C •L.� ' � s+/ r/ N - � l \l��.i 3 i NA NNN C.4f ._ .. •� i..} a T.. 1 �i ` tT:�_ '1 AND 1;h ,L , Lli" Y R." 4 ?�' �•r i [ti{ '{� •('j Y�—=WDS SL- IBJD- .,� 4aF ER r �ii V �� � F -ViA s7,2 •P aL ���.'j.}j`l�•� t��.s.: l �i -•l ti -} �ffj��,, �'-• .t,i...�'�,, -.r`_' f 7.r� - • _ .. �. _ �t�j -lit l?,a�t""�,' y �z tl 4.j� : 4 -} � -j -- .. .... _ . . - .-. -.. - ' - -- .oar.'- se- ...�,._ .. „F �L��r�`'r,�"' ...rr -�G,� a�- -:�.�. .;;.. -�� w >:.- �.,.rv.y•s-- ,.�: -.. _. ., _.. _ .. ....:..�. � _�..:.4- .. �..- ..a: --m•- •o.. -: PUTNAM COUNTY DEPARTMENT OF HEALTH - wDYN__OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE T1&'AVVILE T —SYSTE Owner or Purchaser of Building Tax Map Block Lot Building Constructed by TownNillage Location - Street Subdivision Name y� I Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above- described property, and that is 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 treatment 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 occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of ' the'`Public 'Htial,th.,._ , Director 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: Month Day Z5 Year 9f Gener Contractor (Owner) - Signature 0W4G� Corporation Name (if corporation) Address: State Signature: W,,� 4K,-"a Title: ® W. ,w &-el Corporation Name (if corporation) Address: j4, 90 ";0, f� 'Aee Zip State N Zip */ If Form GS -97 YML ENVIR�mMENTAL SERVICES ' 321 Kear Street ' Yorktown HeighLs, N.Y. 10598 (914) 245-2800 Albect H. Pado"aniq Director LAB #: 33.908096 CLIENT ~#:~~~114,`.~~~ NON STAT~PROC~~ ~~~.`PAGE 2 TORLISH & SONS BOX 271, 45 MAPLE AVE, ATTENTION: DWAYNE TORLISH ARMONK, MY 10504, DATE/TIME TAKEN: DATE/TIME REC`D: REPORT DATE: PHONE: (914>-27� 08/04/99 01:30, 08/05/99 10:26 08/16/99 2448 FIXTURES. THE NORnOL RANGE OF Q­; IS 6.5 TO H.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRAT1ON BOTH E:�RES��ED AS CALCIUM CARBCNATE, IN MG/L, THE HARDNESS MAY �ANGE FROM 0 TO HUNDRE�S OF MG/L, DEPENDS ON THE SOURCE AND TR�^ ATMENI T� - WHICH THE WATER HAS BEEN SUBJECIED. VERY HARD WATER: ABOVE 300 M[�/L SOFT WATER: 0-70WMG/L 70 14� MG/L MG/L = MILLIGRAM PER LITE;­., MOD��ATELY x��� H|�x: - | �� �7 2 MG/L) �--- 140-300 MG/L (1 grain/gallon = . | HARD WATER� - - � | � Albert �� I ~' - ' � ` ELAP# 1003 SAMPLE TYPE..: P POTABLE SAMPLING S SITE: MEOLA HOMES P NONE : PUTNAM VALLEv PRESERVATIVES: N T�MPERATURE..: < < 4C COL'D B BY: D TORLISH M C0_[F8R� METH N Mil"::' NO! ca��.i~TANK~~~~~~~~~~~~~~~~~~~~~~~~~ ~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~,~~~~~~~~~~ ----- ----------- N NORMAL RANGE M METHOD DAT� F�AG PROCEDUR� R � p SCALE IN WATER RANGES FROM 1 1-14. MEASUREMENT OF pH IS ONE AF pH � p�� S MI^�lBF C C" �RR - . SOON PYRES-AND WATER W | � Albert �� I ~' - ' � ` ELAP# 1003 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .._k.... .; ;.�_ EI.N FI\AL SITSPECTION .. Date: Street L6cation _ ` 17 .� S Town TM # 1. Sew aae Svstem Area a. STS area located as per approved plans ................... b. Fill section - date of placement 3:1 barrier Lgth: Width Avg.Dpth. c. Natural soil not stripped .......... ............................... d. Stone, brush, etc., greater than 15' from STS area. e. 100' from water course / wetlands ..................:......... II. Sewage System a— Septic nk size - 1,000 ....... , 50... ..other...... b. Septic tank installed leve ....... .....• ......................... c. 10' minimum from foundation . ..................::........... d. Distribution Box .AAll outlets. - at same elevation -water tested........ 2. Protected below frost ........ ............................... 3. Minimum 2 ft.Original soil between box & trt e. Junction Box - properly set ............. :.................... f. renT nc he Lengtn required �ength installed 2'. Distance to waterco se measured Ft 3. Installed according to plan ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot... 5. 10 ft. from property line - 20 ft.- foundations. 6. Depth of trench <30 inches from surface......... T. Room ,allow:ed.for expansion 100% ....:::.::::... - 8. -`Size of gravel 374 1' /2'' diameter clean........... 9. Depth of gravel in trench 12" minimum.......... 10. Pipe ends capped .............. ............................... g. Pump or Dosed Systems Size ot pump chamber ...... ............................... 2. Overflow tank ................... ............................... 3. Alarm, visual /audio ......:................. 4. Pump easily accessible, manhole to grade...... 5. First box baffled ........................ ...•.......:.......... 6. Cycle witnessed by H.D.estimated flow /cycle III. Hoase�Build�ing arouse located per approved plans ...................... b. Number of bedrooms ........................... ........ IV. `Nell a. Well located as per approved plans ...................... b. Distance from STS area measured n c. Casing 18" above grade ....... ..................... d. Surface drainage around well acceptabl.... V. Ovtrall Workmanship a. Boxes properly grouted ......... ............................... b. kll pipes partially backfilled . ............................... c. kll pipes flush with inside of box ........................ d. Backfill material contains stones <4" diameter... e. Curtain drain & standpipes installed according ti f. Curtain drain outfall protected & dinto exist wal g. 'footing drains discharge away from STS area.... Inspe . ted by: Owner .�i Permit Subdivision Lot #.�,�_ PUTNAM COUNTY DEPARTMENT OF HEALTH y : DMW5RO Y --ZIP IRS 'N ENT-AL-HEALTH S ERV- ff C E cCONST]1 U CUON PERMIT F , ATM ENT SYSTEM PERb�UT f73�� 5 Located at rl n , e-✓ "I-x i Town or Village 1?1� 171,0•e Subdivision name Private Supply Drilled by �/, ,� �d �r v Subd. Lot # Tax Map /5- 9 Block f Lot /Z Date Subdivision Approved Owner /Applicant Name lqlAar /� a 41 Mailing Address Renewal . Revision Date of Previous Approval /V Z ire / Zip Amount of Fee Enclosed 300 Building Type ijen Ge Lot Area 2,5';01- No. of Bedrooms 4 Design Flow GPD_.Zo U Fill Section Only Depth Volume PCH D NOTIEICATIION IS REQUIRED WHEN (FILL IS COMPLETED Senzjrate Sewerage System to consist of 2 1:-'<Z gallon septic tank and � o v Other Requirements: To be constructed by a "-n Cd` Address Water SattmtDlv..':. .:.: Public-Supply From �._ ... - � � +�,.� Address o1re Private Supply Drilled by �/, ,� �d �r v Address n l— /11' ai I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that,on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: r,cvu^ P.E. R.A. Date .2%4y/q1 Address '2 9,7.:.- Me License # 2- y q�s APPROY)ZPOR CONSTRUC oval expires two years from the date issued unless construction of the sewage treatment system has been comp inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Ap roved for disc ge f domestic sanitary sewage only. By: Title: � Date: d� d White copy - HD File; Yellow copy - Bui ding Inspector; Pink copy - Owner; Orange copy - Design Pro essional Form CP -97 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New.York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT' "A' 1WAhe1t`1WELI;' -- _ .. _. •_ PCHD— PERMIT # ai WELL LOCATION S / reet Addr ss L , - , t; 'e, L) � , �; Town Village C t Tax Grid NumbeJr WELL OWNER Name ailing Address ` /'Cidc7 InZlCi 13G �1'/ %�i? Pr. /��✓ l XPrivate G O Public USE OF WELL 1 - primary 2 - secondary A— O PUBLIC SUPPLY O AIR /COND /HEAT PUMP D ABANDONED O BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify 0 INDUSTRIAL O INSTITUTIONAL O STAND -BY .O AMOUNT OF USE YIELD SOUGHT_ gpm /# PEOPLE SERVED /EST. OF DAILY USAGE O0 al REASON FOR DRILLING ❑ REPLACE EXISTING SUPPLY XNEW SUPPLY NEW DWELLING ❑ TEST /OBSERVATION 13 DEEPEN EXISTING WELL Lt ADDITIONAL SUPPLY DETAILED REASON FOR DRILLING WELL TYPE RDRILLED DRIVEN E]DUG 0 GRAVEL O OTHER IS WELL SITE SUBJECT TO FLOODING? YES /' NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: v //1► Lot No. WATER WELL CONTRACTOR: Name 41`✓Jd w7 Address: gevr-�� IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _ ,/' NO I NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY g ::... DISTANCE T6" MRITY -'FROM NEAREST -WATER -MA LN - LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED Z ON SEPARATE SHEET 4 1 2zd date (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirt3, (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in sich a manner as not to degrade or otherwise contaminate ur ace or groundwater. Date of Issuer q 19`!?�_ Date of Expiratio 19 Of Permit Issuing Official Permit is Non- Transferra le White copy: HDIFile Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller 14164 (2197) —Text 12 PROJECT I.D. NUMBER _ �9�.a9 _ SE®R c9enll ,, .. .�,!' x' ,.. � :r'.�.•: :74 �... St(. =..' u �pdi (� State Environmental Oudity Review SHORT. ENVIRONMENTAL ASSESSMENT FORM F ®6 UNLISTED ACTIONS Only PART !—PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR �o 2. PROJECT NAME. r /t%r, -fl 3, PROMunicipa LOCATION: J �� 0.077 Municipality � Q County 4. PRECISE LOCATION (Street address and road intersections, pforninent landmarks, etc., or provide map) �i'�J ��� ��'���" � mod' �� ✓, j ��'" �� ��� � 5. IS PROPOSED ACTION: XNew 0 Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: l Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 9Yes ❑ No If No, describe briefly ..9.-.WHAT-IS PRESENT LAND 0SE1N VICINITY OF PROJECT ?._ esidentiall Industrial_9�. °Commercial uA ricullufe 0 Pa rWFordst/Opan- space' — tJe0thrsr - - Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? • 2 j�Liyl �/,�y�j�' �Y��a�� Yes ❑ No if yes, list agency(s),an: d permlVapprovais 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes qNo If yes, list agency name and permlVapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑ Yes No /I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name C7� ' G" Date: 7 , 7,� Signature: Of the action Is In the Coastal Area, and you are a state agency, complete' the Coastal Assessment Form begore proceeding with this assessment PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES_ LETTER OF AUTHORIZATION RE: Property of Located at /. J7 ,.7 C e-5� y T/V /��rlurrl /u`� Tax Ma r # Block / Lot / % Subdivision of Subdivision Lot # Gentlemen: Filed Map # Date Filed This letter is to authorize v-. a duly licensed Professional Engineer or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam., ,County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in :.• conformity..with.the.provisions of.Article,,1.45 and/or .147 of the Education Law, the Public Health Law,�and the Putnam County Sanitary Cone. Countersigned: P.E., R.A., # _jT��, a State Telephone: y-j Z y x Very truly yours, Signed: (Owner of Property) Mailing Address: y Od x✓c 0- e- 4*. v State Al- Zip lad / -T Telephone: 1 !�e- Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH . DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRCC7ION PERINIIT- STREET LOCATION r I Nta I" NAME OF OWNER REVIEWED BY RNI, GR, AS MB, BH DAT n TAX NIAP # Y N/ 1DQCUMENTS Y APPLICATION GEI,I,_PERMIT �l PWS LETTER LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) 60RPORATE RESOLUTION SHORT EAF PLANS - THREE SETS HOUSE PLANS - TWO SETS eARIANCE REQUEST l.& mt SUBDIVISION LEGAL SUBDIVISION SUBDjjY.ISION APPROVAL CHECKED P AKRATE REQUIRED DEPTH 10 t AIN DRAIN REQUIRED TA PIPES GENERAL ��ATED IN NYC WATERSHED LNS SUBMITT ED TO DEP EGATED TO PCHD EP APPROVAL, IF REQ'D DfiirP TEST HOLES OBSERVED FRCS TO BE WITNESSED h&�,'i. EX- APPROVAL SSDS ADJ. LOT ETLANDS (TOWNIDEC PERMIT REQ'D ?) r.. . T`... ON DDS.PLANS &PERMIT SAME A PRE 1969 NEIGHBOR NOTIFICATION LfiTTER BI/ZBA 00 YR. FLOOD ELEVATION OTHER REQ'D PERMIT(S) WAGE SYSTEM PLAN - (NORTH ARROW) DS HYDRAULIC PROFILE :AVITY FLOW NOTES EROSION CONTROL:HOUSE,WELL, SSDS PERC & DEEP HOLES LOCATED 'REPRESENTATIVE OF PRIMARY & EXPANSION LOCATION MAP 'EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE IF PUMPED, PIT & D BOX SHO ETAILED HOUSE - NO.OF BEDROOMS WELLS & SSDS'S W/IN 200' OF P OSED SYS. PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER -1/4" FT. 4 "0; TYPE PIPE NO BENDS; MAX.BENDS 45° W /CLEANOUT FILL SYSTEMS CLAY BARRIER lt,QT. HORIZOI ,LOPE 3:1 TO GRADE FILLS FILL.NOTES FILL CE ICA TE PROFILE & DIMENSIONS FILL IN EXPANSION AREA TRENCH LF TRENCH PROVIDED 60 FT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED ON PLAN - FROM SSTS 1200'/500'RESERVOIR, 0' T.0 P.L., DME�✓AY, i:.A.R,GE TREES; TQP'OF TILL 0' TO FOUNDATION WALLS _15'WELL TO PL 00' TO WELL, 200' IN DLOD, 150' PITS 00' TO STREAM WATERCOURSE LAKE (inc. expan) 0' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 0' TO WATER LINE (pits -20') 0' INTERMITTENT DRAINAGE COURSE ETC. _150' GALLEY SYSTEMS 15'MIN to CDS= >5 %,10'- 4 %,25'- 3 0/o,30'- 2 0/o,35' -1 0/o,100' - <1% ESIGN DATA: PERC & DEEP RESULTS ®20'M IN to CD discharge /100'with 182 cons day discharge ONTOURS EXISTING & PROPOSED SEPTIC TANK RIVEWAY & SLOPES, CUT Q610' FROM FOUNDATION; 50' TO WELL FOOTING /GUTTER/CURTAIN DRAINS `"` !'ELL SOIL TYPE BOUNDARIES DIMENSIONS TO PROPERTY LINE TITLE BLOCK; OWNERS NAME,ADDRESS E LOCATION OF SERVICE CONNECTION TM#,PE/RA; NAME,ADDRESS,PHONE# 91 DATE OF DRAWING/REVISION DATUM REFERENCE. LOCATION OF WATERCOURSES, PONDS IZ6LAKES AND WETLANDS WITHIN 200 FEET PROPOSED FINISH FLOOR AND BASEMENT EL. COMMENTS: WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 4 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report is to be completed by well driller and submitted to County Health Department together with laboratory report of Analysis •of- water sample indicating water is of satisfactory bacterial .quality before, certificate of construction compliance is issued.. I REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION I OWNER t7A E ADDRESS LOCATION OF WELL _ (N .`8 Street) To n) (Lot Number) PROPOSED USE OF WELL ® ❑ BUSINESS ❑FARM ❑ TEST WELL DOMEST ESTABLISHMENT ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (S(Specify) DRILLING EQUIPMENT IPMENT 2 ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION ❑ Ope E y ) CASING DETAILS LENGTH (teat) 9. DIAMETER(Inches) WEIGHT PER FOOT /S� THREADED ❑ WELDED D I O MES ❑ NO X G YES T NO YIELD TEST HOURS G.P.M. ❑ BAILED ❑ PUMPED �JCOMPRESSED AIR / YIELD ( (G.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specifyfeet) [teat) DURING YIELD TEST l Depth of Completed Well in feet below Land surface: SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (Inches): GRAVEL SIZE (Inches) FROM (test) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION , a Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET PUTNAM COUNTY DEPARTMENT Of HEA130 COUNTY OFFICE BUILDING CARMEL, NEW YORK 1051 JUN 2 4 1991 I t/ If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED ��``i DATE OF REPORT WELL DRILLER''(5 ture) s w� .: SON& Owner or. Furcnaler of .Building, LOUAS RA 0 Fulilding Constructed. by 0 �...�� I bTMM, LLE'V. Municipality Section Location Street Block / FAM'. R-E51 Building. Type Lot GUARANTY OF SEPARATE. SEWAGR SYSTEM represent that I am wholly- and.- completely resp-onsibl.e for the. location, workmanship, material, cons-truc-tion 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 guaranty to the owner, his succes- sors., 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 rep-airs made, by-me to such. sv:st,em,-..-. except where they- failure to operat'e. prop:erly i,s: caused, by the, willful or.- negligent act of the occu-, p,ant-.:.of, the.- building uti.li.;.ing--the system. .The. unders:gped further agrees to accept a7s conclusive the de- the Dirvctor_.E�f the.- Divi.sio n' of . a-lv-*.-.r.,orimen.:cal-,.HealJh, Ser-, ter, ti 6n, o f mina r _1%T6a-1tH fh�,r o'" e vices .Coon Department 0 d Y fo, W6, r no 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 day of U E 1.9,11 Signature1w, Title M corporation:, givename and.addre-ss) 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 :FIRST "US,_E'.:O.F -SYSTEXS. - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - . ntl* . Division:. of Fftvironmenta�., Health; 3.6rvitaes' Ptultinam County Depar time .-d P -COUNTY OFFICE Bb"ILDING CARMELP NEW YORK 10512 JUN2 4IIJ h PUTNAM COUNTY DEPARTMENT OF HEALTH J).; .>_a,Q !F�.L *'.yT.l�o *�`1aTAr ;I'�1r, F y Date 7//4i s 6 Re: Property of Located at Fl NNEZTY RJ P es°r /3)q Block Lot Gentlemen: This letter is to. authorize Joc-i- a duly licensed professional engineer or registered architect-4- (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 l:V1111Cl: L.LUJJ w1i.Il LItib maLLez- anti to. supervise the construe -ciui1 of said system or systems in conformity with the provisions of Article 14S or .=1.47, Educati;or,.. Law, -the Public . Hearth . Law, and. the Putnam County Sani- tary Cod Counters Very truly yours, Signed Owner of Property 70 VAa N A1/&, Address P .E ., R.A ., # AIE W 2,6 CA ELF l�•�: /a So l Izz*a mllsCcoT NOR.'tl4 X14. 116 -� • O�'�'/ ' Telephone Address MA4oMt., At -Y 1 oS4 9/4 Telephone JUI.31 1980 RUTNAM COUNT!' VEP.�. OE REAALtiit�i BRUCE R. FOLEY Public Health Director 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 (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 March 20, 2002 Meola 10 Finnerty Pl. Putnam Valley, NY 10579 Re: Addition - Meola, Finnerty Pl. No Increases in Number of Bedrooms . (T)Putnam Valley, TM #85.9 -1 -17 Dear Mr. Meola: 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 March 19, 2002. The addition is approved with the following conditions: 1. The total number of bedrooms must remain ate wlt ut 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. 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. ML:lm cc: BI(T)Putnam Valley Very truly yours, Michael Luke Public Health Technician Public Nealtii Director DEPARTMENT OF - HEALTH 1 Geneva Road Brewster, New York 10509 5!I0L1N:A -RJ-: t Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 6558 WIC (845) 278 -.6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 ADDITION APPLICATION (RESIDENTIAL ONLY) STREET. "-; ✓jv ArZ ),'2t r'I C ,�c TOWNPct N /VK v6 " ,Ff TX MAP# a NAME l4zrfl�kOo HEOLA PHONE gc S 5`2&1;. t-7f2.3^ PCHD# .A �a MAILINIG ADDRESS /0 FIA416 R EX. Pc. PceT�v ,4 ,L/ va c c E Al V /aS" 7 9 DESCRIPTION OF ADDITION r -j v1 jk,E,o 0 gs 9 w�^ N I BER 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. y Please submit this form and the following to Putnam County Health Dept., 4 Geneva Road, Brewster, NY - - 10509, Phone 278 -6130. 1. Certified check or money order for $100.00.. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) *Non- professional sketches are acceptable. 3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map 9) *Non - professional sketches are acceptable. 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Cert. Of Occupancy from Town or Certification from Building Dept: with legal bedroom count of dwelling. OFF7CE USE Comments Feb98 BFhouseguidelines I N- BRUCE R. FOLEY �1 L ORETTA MOLINARI Pn(!: �iC _fv <. a�'t . ii'$,.Cf,�i+' �:. �.;. ,� .. � :.4s.Oci tE ��d:JiiC•: '' r - ifea— Director Director of Patient Services DEPARTM ENT. OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 2,28 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 12/27/2001 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Re: 10 Finnerty Place Residence Tax Map 85.9-1-17 Town Putnam Valley Gentlemen: According to records maintained by the Town, the above noted dwelling IS 1S NOT in compliance with Town code and the total number of bedrooms on record is 4 bedrooms This information has been obtained from: CERTIFICATE OF OCCUPANCY: 1999--228 (9/i 8/ 9 9 ) ASSESSORS RECORD: OTHER Al tit` /j," BFhouseguidelines uilding Inspector O 1 CERTIFICATE OF COMPLI -A-W OCCUPANCY CERTIFICATE NO .-:.1999- 228 TNW. 85.04-17 LOCATION: 14 FINNERTY PLACE ISSUED TO: MEOLA ALFREDO This certificate covers the construction of: PERMIT NO.: 1999- 575 DATE: September 18, 1999 New One - family Residence /NO DECK 1 Family Year Round Four. bedroom : The applicant having heretofore filed an application for a building" permit. pursuant to the Town Code, Sanitary Code, the Uniform Building & Fire Code and the Laws in effect in the Town of Putnam Valley, Putnam County, NY, 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 structure in compliance with the requirements of the laws as aforementioned; / that 'the said'`wbrk :and+i�ater_ia1- s_1roe >t:- .every ;requirement of the laws as aforementioned; _ and that the premises have now bedrr fully completed and are ready for occupancy pursuant to the provisions of law. Now, therefore, this certificate of compliance /occupancy is hereby issued under the seal of the Town,of Putnam Valley. TOWN OF PUTNAM VALLEY, N. Y. i By: CODE ENFORCMWT OFFICERI J: F .. { 1 ' lx .d ''2 1 ..:• �- '- �u''ta�`�:.`5`f:!L.4h+? :�..17� ��!. . -'.,� ° ,�y� 3'+�ta�...LY'#'�',°.�... !. -- x L ; ;,, � � ° ` :. �'q, .. 9 t.,. : \: t _ 1� , Y PUTNAM COUNTY DEPARTMENT OF HEALTH WELL COMPLETION REPORT cation �. ell Owner: Street Address: Town/Village: Tax Grid # 3T. / -/ J Map Block Lot(s) Name: Address: O Residential Public Supply Air con eat pu p Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Use of Well: I- primary 2- secondary Drilling )Equipment Rotary Cable percussion _Compressed air percussion Other (specify) Well Type Screened Open end casing _&/'Open hole in bedrock _ Other Casing Details Total length a / ft. Length below grade 4�g ' ft. Diameter in. Weight per foot _lb/ft. Materials: Steel _ Plastic _ Other Joints: _ Welded _- Threaded _ Other Seal: � /Cement grout _ Bentonite _ Other Drive shoe: Yes _ No Liner:_ Yes _ No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield 'Kest _ Bailed _ Pumped g Compressed Air Hours (A- Yield Ir gpm Depth Data Measure from land surface static (specs ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed •infdrniation' ' :. - descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameteron) . Formation Description fft. fft. Land 'Surface J. k- $Qy / v g'� If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type �" Capacity _7_ Depth a e-j_ Model 49-�62- 9L Voltage &,Zo HP 3-14 J Tank Typq ;do-® I Volume 6_ Date Well ompleted ZZ t Putnam County Certification No. vat Date of Report Well Drill (signature) h t/ 1 NO TT: E ct location of well with distances to at least two permanent landmarks o be provided on a separate s ee p an. Well Driller's Name $. e L S' ®"i � Address: J �� �� s Date: 2 3/ Signature: - _/ c�PVTINN,k..M,COLIN TYIDYEIIEPARTMIE N-_T--,,.a0Fi:-.H- BALZT-u IVISION OF ENVIRONMENTAL HEALTH SERVICES 1-i" ,CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRICTION PERMIT # P Z% 9 3 /0 4 'C' ,ri e-, V Town or Village Located at� J�4' e— 7 'e Owner/Applicant . Name Tax Map Block Lot Formerly Mailing Address I" Subdivision Name Subd. Lot# Date Construction Permit Issued by PCHD Separate Sewerage System built by e7 Address -5 19,111 Consisting of l 2 5'C) Gallon Septic Tank-and 4d<1 A. � d,14- .94" 6'. Other Requirements: Water SUDDIV: Public Supply From. Address _7 Ad -dress- - Zip./,P Building Type A� ;, / Has erosion control been completed? X e---4 Number of Bedrooms Has garbage grinder been installed? Ala I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: Certified by ZL=; ry w✓^ R.A. Address 21 ?72- yelr /7 AV O-A/ hl-- getb Any persoccupying premises sr by the 4v ve system(s) shall promptly AR be necessary to secure the correction of any unsanitary conditions resulting from such usage. %' eparate sewage treatment system shall become null and void as soon as a public sanitary sewer beco e and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject t a d ifil �Rc4tion or change when, in, the judgment of the Public Health Director, such revocatio mod* icati 0' By: W. Title: Date White copy - HD File-, Yellow copy.- Building Inspector; Pink copy- Ownier;. Orange copy -Design Professional r u i nAlvi l: V u iN l x mj&rALxi-iv"_uN "i ujr tLLAi;jL'ti DIVISION OF EN RON ENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: Inspected by: Strepeyt+Location /moo 6' wa_r±V 'iPla._e Owner �.."�Q ��3t�V�!�� ��.�i��y"!., . -.q �- ..Y-.. V.:�'..�•..`: i„`''".'F%[c/ ��1..� Y:�1, :� •-,tom •, - ..r. ..:.k =: TM # Ol °-- / 7 Subdivision Lot # I. -Sewage System Area a. STS area located as per approved plans ..........:................ b. Fill section- date of placement 3:1 barrier Lgth. , Width . Avg.Dpth c. Natural soil not stripped.....: ..........:.. ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course /we# lands ...... ............................... IL Sewa e S stem a: Septic tank s ..:.....1, 250 .........other ............... . b. •Septic tank evel ......... ............................... c. 10' minimum from foundation ........................................... d: Distribution Box 1— cutlets at same elevation- water.tested ................. 2. Protected below frost ..........:....... ............................... 3... M,lnimum 2 ft. Original soil between box & trenches e. Junction Box properly set .......... ..............................: 6. 'r_ en es 1..Lmgth required Length installed 2. Distance to watercourse measured 4-- I oo Ft.......... 3. Installed according to plan....................................... 4. Slope of trench acceptable 1116 - 1./32" /foot ............. 5. 10 ft. from .property he - 2.0 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. r Boom allowed for expansion, 10.0% ......... :............... 8. 'Size of gravel 3/4 -1'A" diameter clean .. ................ 9. Depth of gcraavvel intreach 12" minimum......:............ 10. Pipe ends ca ed......... ............ ............................... 1. Size of pump chamber ... ............................... .........: •2. Overflow tank .... ......:........... ............................... . 3. Marro, visuaUauclio ...:....:.......... ............................... 4. Pump easily accessible, manhole to-grade .................. 5. First box baffled .................:......... .......... ....I................. 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Buildinia a. douse located per approved plans .... ............................... b. Number of bedrooms......,.,. ............................................. IV. Well We located as per approved plans . ......:................... ...... b. Distance from STS area measured ' • ft ........... c. Casing. 18" above grade ............................. t................. d. Surface drainage around well . acceptable .....:................. V., Overall Worlmzanshin . a. Boxes properly grouted .................................................. b. All pipes partially backfilled .......................................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall -protected & dir.to exist watercourse g. Footing drains discharge away from ar STS ea ............... h. Surface water protection adequate.....-: ........................... i. Erosion control provided ................. ............................... Rev. 12/02 cts .Y. - .. r - . y � ... ..,.• .,s w. p -. r • W' •.. -.. ,.., � Qom'• 1 • �'i•.�a ,. �. . - Q a ... ..q ...., w-. .e - -. r .N-'.... � . 4��.: ; • _• SITE ]NSPECTION FOR FILL PA Date: Inspected by: Fill pad located per the approved plan Fill Pad Length Required Length Fill P ad Width . Required Width Fill Pad Depth Required Depth Rim-of-Bank Fill Quality Slope.from Top to Toe Impervious Layer Installed Etosion Control Installed Sieve Test Results (if applicable) AAddiuon?aI G6mz ants Reserved for Field Sketch if ARp icable I'!; - - PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ... .�. - .� .. .. _ .•',i�,..i �. ivr - ,. .,..•.:.,'aCV . .- r._. -.. .. : -. _. .... � ..:...i.... .. ..;i . "•:.may"•. :'6.,.. .. ,.... ;+s.►: >. a; �s'. APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: 2. Name of project: .Sf7' 3. Location TN: 4. Design Professional: �y��i`�/ti y 5. Address: 2 I4'Z2-- 6. Type of Project: V--"Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subidvision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEQR)? /Va Type Status check one Type I Exempt Type II Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ......................... Ala 9. Has DEIS been completed and found acceptable by Lead Agency? ............... 10. Name of Lead Agency .c.' ... - •:'ir. y- ..ac.; .Z.. -;r ._ -..,.. —+ate.. - .. -: .., -�. ._--.. 11. If this projeci is an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... �s 12. If so, have plans been submitted to such authorities? ........ ............................... y e�.5 13. Has preliminary approval been granted by such authorities? Date granted: 14. Type of Sewage Treatment System Discharge ................. surface water _groundwater 15. If surface water discharge, what is the stream class designation? .................... 16. Waters index number (surface) ........................................... ............................... 17. Isproject located near a public water supply system? ....... ............................... 18. If yes, name of water supply Distance to water supply`?% 19. Is project site near a public sewage collection or treatment system? ................ AXo 20. Name of sewage system Distance to sewage system �% /, �. 21. Date test holes observed 22. Name of Health Inspector Form PC -97 23. Project design flow (gallons per day) ........... ... .... Irl ............ ............................... "" `' l s State-l'ollutanf 17i scfiarge timuiation Systeifi (SPI) ),l &i if required ?.`.. 25. Has SPDES Application been submitted to local DEC office? ........................: 2 26. Is any portion of this project located within a designated Town or State wetland? e� 27. Wetlands ID Number ........................................................... ............................... �/� 28. Is Wetlands Permit required? .............................................. ............................... Has application been made to Town of Local DEC office? ............................... �s 29. Does project require a DEC Stream Disturbance Permit? .. ............................... Ala 30. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No 31. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ... ...... .I I ........................ Yes/No DESCRIBE: 32. Is there a local master plan on file with the Town or Village? ......................... 33. Are community water and/or sewer facilities planned to be developed within �o 901- 15 years in or adjacent to project site ? .............. 31. Are any sewage treatment areas m excess of 15% slope? . ............................... 35. Tax Map ID Number ............................. ............................ Map L7Block / Lot .1 36. Approved plans are to be returned to ..... Applicant a/' Design Professional )lithe application is signed by a person other than the applicant shown in Item L,the application must b accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision nay be grounds for the rejection of any submission. I hereby affirm, evader penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Renal Law. SGINATURES & OFFICIAL TITLES. 7Vj/ 1-222,; r-if Nailing Address Zz-/ PUTNAM COUNTY .DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner I.P/keel /I&o f-W Address 1,4 �i G�` �r• A41eae V/. Located at (Street) /��/iC��"`/�� Tax Map J5? Block Lot 17 (indicate nearest cross street) Municipality A O'w Watershed SOIL PERCOLATION TEST DATA Date of Pre -soaki Date of Percolation Test l 1 5 1 NOTES: 1. Tests to be repeated at same equal percolation rates are obtained at percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 J 3 4 5 2 2 /S' 2ev 3 3 4 5 1 2 3 4 l 1 5 1 NOTES: 1. Tests to be repeated at same equal percolation rates are obtained at percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 J TEST PIS' DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLIES Indicate level at which groundwater is encountered Indicate level at which mottling is observed A4' e e of Indicate level to which water level rises after being encountered "I Deep hole observations made by: Date Design Professional Name: T,6 s Address: 7 Signature t v"a Design Professional's Seal 'HOLE G.L. low 5<y r l ;re.n _�10 F f 0.5' 1.0' _ 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' , 7.5' 8.0' 8.51 9.0' _ 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed A4' e e of Indicate level to which water level rises after being encountered "I Deep hole observations made by: Date Design Professional Name: T,6 s Address: 7 Signature t v"a Design Professional's Seal PUTNAM COUNTY DEPARTMENT OF HEALTH -DIVISION.,, O.F. -M. O.F.-M. rIROMMENT41, HEALTH SERVICES .:•COUNTY. .'OFFICE BUILDING, - CARMEL, N. Y. 10512 DESIGN DATk.,Sj1EET-SEPARATE SEWAGE DISPOSAL" SYSTEM Ftl±:N0. Owner J O F-L' rIz 41 Address 7e VAaadti "IV ftgE(.L. tVL. 10801 Located at (Street F1NAIEU Block Lot �.Tna; care neare s t cross street) Municip.a.lit LWatershed _.:.SOIL.'PERCOIATION TEST DATA.MUIRED TO BE SUBMITTED WITH,APPLICATIONS hole Number -CLOCK TIME PERCOLATION PERCOLATION Run Elapse----- . D-epth to Water Vater Level.. No. Time From. Ground Surface in .Inches •Soil Rate Start;Stop Min. Start Stop Drop in Min./in drop Inches Inches Inches .3, jg_ 9.1; 16) .3, jg_ 3 16) -PUTNAM COUNTY. DEPIT6 OF, HEALTH Notes: 1) Te "sts to.be repeated at same depth until a roximately 'equal soil rates are obtained at each percolation test hole. Aff data to be submitted for review,. Depth measurements to be made from top of hole 4 :% TEST PIT J)4TA REQUIRED TO- BE SUBMITTED WITH APPLI`;ATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES.. DEPTH HOLE 110. HOLE N0. HOIE NO. _ G.L. rip 5 ,061- 7-np Solt—, TbPSO6L 72,} 73„ 8411 ly , INDICATE IM L AT WHICH GROUND WATER IS ENCOUNTERED ° NONE INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTE d NOME TESTS MADE BY.. Date-.4/210/20 DESIGN Soil Rate - Used 0 ` 44 DtWl "Drop: S o D. Usable Area �rov ded No: oP Bedrooms ` Septic' Tank Capacit 5r�� Absorption Area Pr o L.F.x24" '� REso.E trench . A. %r�Q2' THIS SPACE `FOR USE BY :HEALTH DEPARTMENT ONLY: Soil Rate-.Approved Sq. lit/Cal. Checked by Da-. -te i O `' �•• ,,,,, .�....�...---- - -..._. cam. . y LM 4R . C 'kft- MCC s SIVA! fa7ywl— an "JI ............................ .... . . . . . . . . 69 UP, 407 4. .............. lot -mr -4t'. M RIO! -t- 1, "35 off W-Q!, .1 "' " LA 1W