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HomeMy WebLinkAbout0358DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -71 BOX 5 00167 - ,titi ef s = � : - . � r., T ljoL ir 00167 f ' f i 13. -- :Z 6 PUTNAM COUNTY DEPARTMENT OF HEALTH vision of Environmental Health Services, Carmel, N. Y. 10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR.SEWAGE DISPOSAL SYSTEM /C Lu m — h Trelesed _ Town or Village Located at ✓ SW A Al N0 A P Tax Map Block Owner f�� Lot / Job Separate Sewerage System built.by l CAS Address �L� A/ ' , v qA Conslsting of _Gal. Septic Tank and J ^L� '¢ /i ✓E�}�2 FC E% :�Fr�EGi� -S' Other requirements Water Supply: Public 'Supply From �'. Private Supply Drilled By Address Building Type r �A tR AA%E C No. of Bedrooms 2 Date Permit Issued Has Erosion Control Been Completed? �� S�E'1--,01A, fit! 16E���'l /ALE /�d ��l JiJjpiw��j X82 1 certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work (copies of which are attached), and in accordance with the standards, rules and regulations, plans filed, and the permit issued by the Putnam County Department of Health. Date L' Certified by P.E. R.A. Address IN 45, 0, 6 Ve, e /ryL i EWE1t VC %' /V y License No. Z2 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from -such usage. Approval of the separate sewerage system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the ,private water supply shall become null and void when a public w ter supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Commissioner of Health, such ovation, modification or change is necessary. Date I +�` _ �/ By ® Title __. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N.. Y. 10512 k DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Wf to Address _Armud "j NV; Located At ( Street CUSAMAoJ Sec. .14 k Lot / Indicate neares cross street) MZ,vak Municipality 7'0 wAr Or P0? t£ -AS'o d Watershed SOIL'PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run No. Start -Stop apse * Time Min. Depth to Water ' From Ground Surface Start Stop Inlcth�es Inches . a er we in Inches Drop in Inches -Soil Rate Min. /in drop J 1 A-32—P37 sm /.J l �! 9 % y J/N tAJ /V % 2 le 4(0-14% �/n//� . / /' l .g'� j J.. 31.:47 - 11`5-3 Al 5 At tj r 2 .2' 21 ° :. 37 9 M, PJ I : y �. zr 5 � 1-4 je 5 .. 1 2 Notes: 1) rates are for review .2) ,PUTNAM COUNTY REEL OF HEALTH Tots to be repeated at same depth until approximately equal soil obtained at each percolation test hole. A11 data to be submitted Depth measurements to be made from top of hole. TEST' PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION',:; "`' DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES- DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 6 ORw tj la .S'Q /L 12 " 18" 24" 3011 of 3611 42" 48" 0 A-M — oil A �r X'Tdxz 5411 60" k 66" 72�� tc cc r r 7811 84" INDICATE LEVEL; AT WHICH GROUND WATER IS ENCOUNTERED. INDICATE I;EVEL T WHICH WATER LEVEL RISES' AFTER BEING ENCOUNTERED TESTS MADE BY ,/Q fiC r L..S - • -Date 41)01* . '• ll�51 '1V Soil Rate .Used // Min/l "Drop: rl0_M.5C*V S.D. Usable Area Provided 70 FT Z No. of Bedrooms 1'awg_ Septic Tank �MZY ' %d 01D Gals , Type Absorption Area Provided By 3 ? L. width trench. Address - -11&r i1 44A41r_1e SEAL v THIS SPACE FOR USE BY HEALTH DEPARTME-NT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by 5 Date WELL COMPLETION RFcPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3 /7e. -. 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. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME z ' T y z Pi }1111 -7 & Elizabeth ADDRESS LENGTH (lest) 3 I: • DIAMETER(InchesJ r P?nC'rn J Front Street Pattersoi_ NeJ Yorlk 12563 LOCATION ' ? NO (No. 6 Street) (Town) (Lot Number) OF WELL Cu.,:.hraan road Patterson New York MAKE LENGTH OPEN To AQUIFER (feet)' BUSINESS ❑ ❑ ❑ PROPOSED DOMESTIC ESTABLISHMENT FARM TEST WELL USE OF FORMATION DESCRIPTION Sketch exact location of well with distances, to at feast two permanent landmarks. FEET to FEET 0 WELL ❑ ❑ ❑ OTHER Limestone SUPP Y INDUSTRIAL CONDITIONING (Specify) DRILLING EQUIPMENT COMPRESSED CABLE ❑ ROTARY AIR PERCUSSION El P PERCUSSION ❑ (S(Specify) CASING DETAILS LENGTH (lest) 3 I: • DIAMETER(InchesJ r WEIGHT PER FOOT 1 j❑ THREADED ❑ WELDED RI S O YES ❑ NO RYES CASING ? NO YIELD TEST HOURS G.P.M. ❑ BAILED ❑ PUMPED El COMPRESSED AIR C 1' YIELD (O.P.M.) G =; WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) 12 DURING YIELD TEST (feet) 200 Depth of Completed Well in feet below land surface: 244 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 (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at feast two permanent landmarks. FEET to FEET 0 20 C1ay.0 Boulders 5D Y RECEIVE DEC 17 1981- Q S1 PUT NAM COUNTY Y � DEPT. OF HEALTH 20 200 Limestone If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE 160 2 200 3 280 Fi %g 1L..uS}'MIA1.1 'R DWA DATE WELL COMPLETED 10/9/81 DATE OF REPORT 10/1,4/1 WELL DRILLER (Signature) ; n L 1(>. r : o�Gr T I � C;�V'# li Cn 0 Y- ZI • U Z'/I A.IY A L f re�� 7-`Ak AZ 4.1 Wtr Putnam County Department of Health -7- Division of Environmental Health Services Approv6d as noted for conformance with A I applicable HURS ---,d Fegulations of the Putnam County alth Department. ,4 Signatwe r7 7fe Dade r 7;-Y,ir Tie. S 3,,e,,;4 /%,t=,J Y Ne 4, Z,37 (),I P67YR °807.3 oil 9 LA u Lo 0 Ld AIr tl � _ � 000lll _.dL Y O _ Q _ - - � �Q N N 1 �o___ -- LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 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 Mr. John Lepler 266 "Joes Hill Rd. Brewster; NY 10509 Dear Mr. Lepler: ROBERT J. BONDI County Executive November 3, 2004 Re: Addition — Lepler Cushman Road (T) Patterson, TM # 13 -2 -71 This Department has 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 November 3, 2004. The proposed additions plans provide for two (2) additional bedrooms in addition to'the.two (2) existing bedrooms for a total of four (4) bedrooms. The existing subsurface sewage treatment absorption system was initially designed, approved and installed for four (4) bedrooms. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at 4 without prior approval by this Department. 2. The area of the existing sewage disposal system, and its expansion area, must be maintained. 3.. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets; etc. 4. The existing 1000 gallon septic tank shall be replaced with a 1250 gallon septic tank in accordance with repair permit R354 -04. Any other, permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Patterson. If you have any questions, please contact me at your convenience. Respectfully, Michael J. B zins i, E Director of gineermg MJB:km Cc: P. Piazza, BI, (T) Patterson ~ 76' 26' PUTNAAI COUP HOUSSjE- PLANS APPIIOVED FOR BEDROO;u COUNT ONLY, AL 1. SiT(33F?Ui3P ;T' fii:Y "I "IO ?:fALTI1RAT_TOPvS TO THESE HOUSE 1 LAMS ROUST -,E SUBMIT27 D 7.0 'I'I.L•' PC:DOIJ FOR APPROVAL 1 !/ DATE SIGNAI'U W-7L DATE I N cf fU V) fu tY • v� fs J f u) Q O CL O ai C Existing 1st ilnnr Dlmn ru O� pier Residence riichman Rel Scale 1/8" 10/6/04 !Y A DEPARTMENT OF HEALTH Division Of Environmental Health Services I Geneva-',Road, Brewster, New York 10509 (914) 278 -6130 HOUSE ADDITION /REPLACEMENT APPROVAL GUIDELINES I. The Putnam County Department.of Health must review all proposed additions, which will result in an increase in living area. A. Any addition which is considered a potential bedroom requires a formal approval of plans (Construction Permit) by the Department and plans are to be prepared by a Professional Engineer or.Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code, unless system is presently designed for proposed number of bedrooms. Plans will provide for the installation of additional and /or new sewage disposal area meeting present code requirements.. B. The determination of whether a proposed room addition to a house is considered a bedroom will be made by Department staff based upon: Location of the room in the house Size of the room 1. Accessory rooms such as Dens, Libraries, Studies, Computer Rooms, Offices, Sewing Rooms, etc. may be considered potential bedrooms. 2. Large bedrooms, which may easily be divided by a partition wall, may be considered two potential bedrooms. 3. Storage areas or unfinished portions of the addition may also be considered potential living area. C. Any addition which is not a bedroom will require the submission of a plan .prepared by the property owner (to scale) showing the entire house floor plan existing and proposed. The determination of what constitutes a potential bedroom will be made by Department staff, i.e., an office 8' x 8' may be considered a potential bedroom. Once the review has-been completed the plans will be stamped noting the number of bedrooms, including potential bedrooms. If the number of bedrooms remains the same as existing, no further expansion of the sewage disposal system will be required. If, however, it is determined that any. increase. in potential bedrooms is proposed then refer to "A" above. A letter from the Department will be issued indicating total number of existing bedrooms and no expansion of sewage disposal area will be required and any other permits or variances required are the jurisdiction of the Town. -2- II The Putnam County Department of Health will allow the replacement of an existing residence utilizing the existing sewage disposal and water supply for the following reasons:' A. Hardship due to fire or other catastrophic event. B.. Dwelling has become a'hazard and risk to human health or safety. C. Case by case request approved by the Director of Public Health. The applicant must comply with all of the following: (a) Septic system operating satisfactorily. (b) Potable water supply meets bacteriological standards. (c) Square footage of replacement essentially the same as existing structure. (d) Footprint of replacement essentially same as existing structure. (e) Same number of bedrooms as existing. Note: Definition of what constitutes a bedroom will be made by department staff.using same criteria in House.Addition Guidelines. (f) Approval by local town building and zoning laws. Note: Any increase. in square footage of dwelling or increase in number of bedrooms requires formal submission of plans from licensed Engineer or Architect meeting present code requirements. BRF /]P August 1995 Revised July '1996 houseadd, - i Y LORETTA MOLINARI Public Health Director ROBERT J. BONDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 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 PROPOSED ADDITION APPLICATION (R_FSTDENTIAL ONLY) STREET , C04,,c-oor, 1, TOWN eke r lonTX MAP # NAME (4-0 L.S7tr-t9- PHONE y 14 $Od - PCHD .# ' 3 yG - 0 si54 MAILING ADDRESS 2Z&t n DESCRIP'T'ION, OF ADDITION A�N i it oAJA-t &x-Y-4S O� r f� I� 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., 4 Geneva Rd., 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 #) * 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. /(�Tedroom opy of Cert. of Occupancy from Town or Certification from Building Dept. with legal count of dwelling. . OFFICE Comments rs�i Z $IPQO�C ` ia�s7atu.r `AIMS : 2 SAD �7ro�•4� T3s Po��1 ��t �9_ ,� �eFr S;E -�1c ?�•wc To i3�- Feb 98 LORETTA MOLINARI R.N., M.S.N. Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 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 COVER SHEET ROBERT J. BONDI County Executive PROJECT Owners Name): -��14� C� STREET:' PHONE #: MUNICIPALITY: �`� TAX MAP NUMBER DESIGN PROFESSIONAL: DATE: ❑ REVISION REQUESTED ADDITIONAL INFORMATION ❑ OTHER PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR SITE LOCATION C MMAA -�� TM# % , — — -7 OWNER'S NAME L PHONE r MAILING ADDRESS i PERSON INTERVIEWED PCHD Complaint # ame & Relationship i.e., owner, tenant, etc. DATE fte- T f -00! TYPE FACILITY S -- PROPOSED INSTALLER --:�® Hf3 C PL -l:re PHONE ADDRESS S ly._ 1,5> A2xi�1� REGISTRATION# Proposal (include 'sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system .Different location may require submittal of proposal from licensed professional engineer or registered architect. I, as owner, orrpprted agent of ow,aer agree to the conditions stated on this form. TITLE-0005e— DATE 101- Procurement of any Town permit, if applicable. Submission of as built repair sketch in duplicate showing: a. Owner's name b. Site Street Name, Town and Tax Map number. C. Location of installed components tied to two fixed points (e.g.,house comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e. Installers' name and number. System repair to be performed in accordance with the above proposal and conditions. 1/- 3 -0 4 White (PCHD); Yellow (Town BI); Pink (applicant) Application No ........ $ - $ ..................... .Permit No. ......... 8.' 81- 8 . tstuiding Department TOWN OF PATTERSON, N. Y. County of Putnam . Location: ;......Cushmann Road,_..Patterson .,..N: Y,........ Map No.: ..... .:....... ....... Section: .... 2................... Block:... ��,U...-- ...._........ Lot: ....... ........... ............... .. 13. -2 -71 Certificate of Occupancy No......, .. .. Date ....December :17 ...... 198J... THIS CERTIFIES that the building located at premises indicated above, conforms substantially to the approved plans and specifications heretofore filed in this office with Application for Building Permit dated. 8 - i o ......... 19.ai ., pursuant to which Building permit was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ... a . one f ami. i Y. dwe l.l.inc_E .. .............. . This certificate is issued to... Phi "2 ,l l pipckzkey , , , , , , , , (owner, lessee or tenant) - of the aforesaid building. Fee Paid $ iD..A.o.. . . BnlMW Inspector John N. Calbo i LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 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 Putnam County-Dept. of Health 1 Geneva :Road, Brewster,,NY 10509 ROBERT J. BONDI County Executive Re: ReslcWnce Tax Map. Town . To Whom It May Concern: According to records maintained by the Town, the above noted dwelling, IS IS NOT In compliance with Town code and the total number of bedrooms on record is This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER: i houseguidelines Building Inspector Y . C v.S.tiJhAn' C "o FL Putnam County Department of Health Division of Environmental Health Services Approved as noted for conformance with J CA : / " 4r Y applicable Hn1ES and. Regulations of the Putnam County �althDepart,, ent. /S T Cr�tJSr TAr'r!f `Fwa.. Signature � 56'.' .LJ ,'_'Po..AG y': T IW _,. •✓„1 C '..) Y.3 /r iyir� -�•f, ..�s. �../'. 7;—YA 7' ��+< <.:�Tfn+ ",j 1Al.:f%fC'i 0 L%�Y Ni ["9.: * .f.T . m x Ar6l.,)ANcF jVj7,V.�.UC! ��J;y.•' '�.. -• ..!J' %r:t !A.rt �r.'UF•":. .�•x.= ,�p� <, .... 6 �OT (f 12,-7-f* �, !ti'u.. !� ; ;. -_fir .�:i�:U /,f.,!rr� � �i•. 48C23 "F, V. COUNTY DEPARTMENT -O!F"HEA"LT,,H °' --,",�.-.", -.,W I Z41 IVIW4 of 'En' 40512 virpnmenraV Heialth, 6 ki CERTIR ,CQ RVCT(dh 'd�MPLI'ANCE,�,;,FOR,-:�SEVVA E.-vISPOSAL."SYST L-i't . d4n.:OF�l NST �EM '(n' or Village .7: Lqcated,at' Tax,, • Affy. Lot Owner 7777 'Separate :�!reraqe, Y; -�Address " . Z consisting o, Gal.Septic,, T n an(;;` J .0th6r. requirerri4'riis, Water Supply -* P Private - iS, Dr'il'l ie:1- By. ` v ^ ,' rt ..f 6611drg' Type ` IWO No p,B_ f;d FPO!" Date p ermit Issued , 6C i,v A _W1.11" eWS rosionContro _Been� Completed ia 16 !% "I.— 'd "t le"�66v��iiibrhisiii constructed- essential) -1 Certify that the sys em(s) kas: iste �Wrvjng , h were conStruc, -esiintialWai�lh the pl, try a tac' Ji 'hid)",�41niii .-in a6idi Putnain�_Xciunty.�'Depar me4��i6 �d s;,qu q�� r. .: D t R A 44 2 S, 771, W "V, N r License N Any pe _ rson . ., , occupying ,.�pren 'isecure rs:,se ,MJ, he above ' ' such s r 0 A e r a n itary con i ions rmnlnq from such Approval: e sewer age- ihAf Q�Ome null an void sanitary 9 c `� `and t ne 9!, tnq priyj e-wa er-supply s enul and, modkicatior richange :mh in the judgment tne,6rkW5ner, al necessary e dai�- Idle t t 4" to SAMPLE NO. 4702 SOURCE: Philip & Elizabeth Pinckney Cushman *Road Patterson, New York CO=CTED: October 9, 1981' BY: Mill Drilling, Inc. BACTERIOLOGICAL EXAMINATION F Coliform Count, MF Method r i Well 0 per 100 ml. Thir mull indicatti the rouirt of thr ramph war ` of ratirfarary taaitary quality whtn At ramplt war tollttttd. C E I VE DEC 17 1981 PU'TNAM COUNTY DEPT, OF HEALTH October 14, 1981 ` Hickwit P. E. • Dinctor r I r WELL COMPLE N TIO REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3%)1 �.° I 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. 0 REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME Pb11 l 1 & Elizabeth ADDRESS Pincknev Front Street Patterson New. Yorlc 12563 LOCATION ' (No. & Street) (Town) (lot Number) OF WELL Ci shman Woad Patterson New York - BUSINESS © PROPOSED DOMESTIC ❑ E TAB ISHMENT ❑ FARM ❑TEST WELL USE OF WELL ❑ SUPP Y El INDUSTRIAL ❑AIR ❑ OTHER CONDITIONING (Specify) DRILLING IPMENT ❑ ROTARY AIR PERCUSSION ❑ PERCUSSION El OTHER EQUIPMENT (Specify) CASING LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT D S O DETAILS 3! 6 17 IX-1 THREADED [I WELDED X YES ❑ NO YES NO YIELD HOURS G.P.M. YIELD (G.P.M.) El TEST BAILED ❑ PUMPED ® COMPRESSED, AIR s 61` 6Z, MEASURE FROM LAND SURFACE— STATIC(Specifyfeet) DURING YIELD TEST feet) WATER i Depth of Completed Well LEVEL 12 23.0 in feet below land surface: 2c90 MAKE LENGTH OPEN.TO AQUIFER (feet)' SCREEN DETAILS SLOT SIZE : DIAMETER (inches) IF GRAVEL Diameter of well including GRAVEL SIZE (Inches) FROM (feet) TO (feet) PACKED: gravel pack (inches): DEPTH FROM LAND SURFACE Sketch exact location of well with distances, to at least FEET to FEET FORMATION DESCRIPTION t 0 20 Clay & Bo I 20 230 Limestone -i If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE 150 2 200 3 280 6 2 CI ED DEC 17 1981 PUT NAM COUNTY DEPT. OF HEALTH DATE OF, REPORT I WELL DRILLER (Signature) 10,14 61 Robert M. mill, President-MILL D i.fSTA CO,, INC. Owner or Furcfaaser of Building S/ /Y 1 R x Me/. I AI c, Building Constructed by C Sd "/+W Location - 'Street "Ph 7%R 5oN Muni c ip al i.ty Section Block Alodyt %R 2 5,6*/ asty AAfeG, No, / Building T e Lot GUARANTY OF,SEPARATE SEWAGE SYSTEM I represent that I am wholly and .completely responsible for the location, workmanship, material, construction and drair_age.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 follow"ir_g the date of initial use of the sewage disposal system, or 'any 'sepa.irs :Wade 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 utilizing the system. The undersigned further agrees to accept as conclusive the de- termination, of the Director of the Division of Environmental Health Ser- vices of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this 3 day of E G 19 P1 Signature Title If corporation, give name i and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE,OF COMP,ETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Division of Environmental Healt IL - rV nam County Department of Health DEC 17 1981 PU T SAM COUNTY DEPT. OF HEALTH V� -c49' i•; -e PUTNAM COUNTY" DEPFAfRTMENT OF HEMtTffi, " , ` � r� _ FF � Diwsion ;of Environmental � Kealih Secviic�s CW 4105. 12µ ov ' CONSTRUCTIONPERMIT °FOR SEWAGE DISPOSAL SYSTEM �j�/ ,� Town or Village ga t ✓S Located t t2 L`_' Section rx '•i r Block .y... a�➢ `. y SUbdry islOn �'N 4. Ka "'�1►q�i� ® /Y 't- .,& �'�'r,'LOt �"•�r /a�/t`i e"y`:e /�1 �.1J :."'. ..5' d > // Owner ®Il1�� -�? ressx Mht k YTar -f i' /TC�at�i� ,a4s�� �a3ex,- L �..:_�` :'2 _ Build mg Types Lot Area r Number 'of Bedrooms �CYl9/Q z.� s xTotalHabdable Space �` Square Feg�) rr Y E Separate Sewerage System to =consist rof e%o� �� �� Gal SeptictTenk �� �� lineal feet X a i width arencl V", To be. tonstructed by } Address vt Water `SuPPIy Public SuPPIY From F� a .a .!'%{i ,�E� PO G /la..�%dA.IA7 Ti.'.rfi ,i 3-0 : x Private Supply toy be drilled by 3 � 55 e (jdi. A _ RS x K .� {� ��- "a'.. -,, -, L "� z.^i S i4.:`a, ✓ M e E,ru e y 'fir . - IL�r,+.. '` Other Requirements 1 r 1 & S Z �, r ax t «} ,. r r �. v it representfthat 1 am'whollykarid completely responsible for the.design and''location ;of the ;proposed- systerr(s) 1) 'that the separate aewage disposal.- ;system abovedescnbed will be constructed as shown on the approved amendment therae$torand m accordance wdh the standardsy rules:an ,regu- latiohs o t e u na ;` County +Department "`of Health, and that on?eomplet,on'thereof a Certificate of':Construction Wompliahce; satisfactory to the CommisiiorierLof Health;wil w 4_ r r , be submitted to the Department and .'a wr „tten guarantee will be�fum shed the owner his su cc a "ssors heirs or as$igns b`y the builder that said: builder -wil place ingood'opereting condition ariy part of,sald'sewage disposal system during the:perwd of two (2) yearslmmediately follow,ingtlieaate of,the issu• f Y ance 'of the rapproyal t the,yCertificate of Construction Compliance .of: the, original tsystem or any epairs thereto;; 2).6l ' fhe drilled well described, abod �. . ` willx:be located ,as shown on th'e approveg,, Ian a`nd' that said well will be installed , in; accordance with ;the standards, ,rules aod. r arY1 4 1 P 3 •� .Sa.+� -a .{ §. ss �'e;: c� 'cv,''i:. a _ ,zv,,,,;ara t.. .. _ e9ula i� Ons Ofo the Putn County Department of; Healthy i`�., 4 -Date A., ]I AQ al ,,3x"'�`.Tri ' x ' Address F License No i ,rfi Y ,).,y, `�. fis �"#C "�*>.,.� `e 'T .,x,c?. =^, APPROVED FOR CONSTRUCTION This approval expires one year from the date Issued unless struction of ahe budding has_tieen undertaKen and is revocable for cause orm y be amentled 'or modified whenconsf i dine essary by• the Commis n ofHealth ,. Anychange or a'Iteiation bf consfrucf Ion i requires a new permit gpproved for, disposal'of� domestic nit ry ewage Pr ate r b4 r. -, x i�� ? d �� Date eye r ` Title ", S'x*.J E d -w"kr e`ta K* -r '”, 4..j�r1" `- a.- .:+ay+a si,:Jp` 4" .�.sF""''h j a ,yx- _ y 'S. i I i L. i i I 0 •yf f t PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FI,L /E NO. Owner �e l C� © 11V+R A Addre s s 2021 EretJ'a N Al, Y> Located at ( Street CPSMMAAi Sec. -meek /9�i� Lot / Indicate neares cross street) Municipality 7'e wa 0/_ Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS 3 Notes: 1) rates are for review 2 .PUTNAM. COUNTY, D ETA OF HEALTH Tuts to be repeated at same depth until approximately equal soil obtained at each percolation test -hole. All data to be submitted Depth measurements to be made.from top of hole. Hole Number ;CLOCK TIME PERCOLATION PERCOLATION No. Start -Stop apse Time Min. From Ground Surface. Start Stop Inches Inches Water in Inches Drop in Inches "Soil Rate Min. /in drop 1 /"327:0k3 7 Sowiri 1 1 .9ti % �- o�lg"i/,41 % 2 %a' Yo —14 L N All j G P' % .941 `r lC /%?!. ��/ Al 4S / 5 5 3 Notes: 1) rates are for review 2 .PUTNAM. COUNTY, D ETA OF HEALTH Tuts to be repeated at same depth until approximately equal soil obtained at each percolation test -hole. All data to be submitted Depth measurements to be made.from top of hole. i a TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE 'NO.. HOLE NO. HOLE NO. G.L. 12" AEAU-j -!�t+vay &AA4 18 " 30" l� it ri 48 " L ._ (��.g 5411 er 60," .t 66" tt rc et. 7811 8411 � INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL T WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY ►/p !%E �iitr' L .S Date I X)oj�'. Soil Rate .Used I% MirVl "Drop: (Caiv5cmP S.D. Usable Area Provided 75i; ,Fr No. of Bedrooms' -0'009- Septic Tank Ca ty j0 fDO Gals Type Absorption Area Provided By 9 7e L. .x24"; X36" width trench. Aaaress i LLcsc_<c ' e- '-P THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date 1-181' 35.26 "E u62 • IS' . lz'*L loe Sr-,- Z3" \4j — I Ca oci CUSHAAAJ.J V-OAC::> Q&6?51'_5(a'Vj (:::)F-7- P;;10OPF PHILIP E.LI7_AI25E,-r-H P>IUC-V-QE.--r cmi llskT' III-.F>AMff-C> P:bz C5& pm . ST P— C> AAAP* 142K. Pt ec, 2-Z1 .T(- -TZ::>\LIU Cf7- FA>-r77E_2:4,(O1_J Pk-rrkAAA CO Q­lf' -7C,&LE- 1"=40' A4uUVST S 1981 O'l'i PEZD � 7�4e_ i _LCv ",lm kjC)jC,6Z HEOEc,,J 51bkJlP-Y' -r"-r 71,41h UkLAL7poe17r- A47-Eeolmokj oz AiDr-)Mo)lj 1:_04G U46 PEE_F>4ZE�r- 10 AJ:::COOC�,�E_ \,JIT)4 M*-- ti, A, VIOLA-nou Cr j5r�01�26, E_A,:7>WG CODE- or POA,-_FkLE Pef-, -r�.F_ UEVJ '4CP-V- 5-ATE EMx_t::4-Fic>J LA_\d. 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