Loading...
HomeMy WebLinkAbout0362DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -75 BOX 5 MINN 9 INA. I . { , I. T ' I'6 ♦', P1 ' `' p ., 1 .I ■� ■ . I { Sir IN 00171 PVb UTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTA CERTIFICATE OF CONSTRUCTION MPLIANCE PCHD CONSTRUCTION PERMIT # �2 _ �3 Located�at� Owner /Applicant Name d4 Formerly Mailing Address Town or Village01bl ±ES SYSTEM Tax Map Block Lot 75— C . _. Subdivision Name Subd: Lot # l ZipaAK Date Construction Permit Issued by PCHD _ Separate Sewerage System built by �Gti¢ �� Address /�1�'1 Consisting of ��� Gallon Septic Tank and Other Requirements: Water Supply: Public Supply From, Address A ° or: ✓ Private Supply Drilled by #111f 1 111 Address Po� utl., dw- &t.4d /t _ -, Building Type RgSIOA,1170- Has erosion con of been completed? ( " Number of Bedrooms Has garbage grinder been installed? X60) 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 th s dards, rules and regulations of the Putn C ty e artment of Health. Date: "� Certified by P.E. R.A. Address %� ' (Desi rofessio License # ;71& Any person occupying premises served by the above system(s) sliall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval 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 ar subject to modification or change when, in the judgment of the Public Health Director, such revocatio , o ification hange is necessary. By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 - * PUTNAKWUNTY, HEAVTH 0I�M (111I11A111111l11i 1/N 31lNi1/11:1(Y %V1l Y/116`Iti1111N 511�'Iiyy3 Y11F 1/11 t� -3. 5 n S Custom Homes Af fan Y. Finn 15 West Ho(Iow?Zgad Genera(Contr"tor Brewster, New york,10509 ROVA , d& Construction Management LA-P �11 f4.,fS-01) (25 C,&1,4 J&,� r-e a�Q a.7 9 (914) 279.1339 faX (914) 279 -3304 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Omer or Purchaser of Building Buiding Constructed by Ic�cx.v� eAJ & Locttion - Street Buffing-Type Tax Map Block Lot . V TownNillage �> 6 Subdivision Name -4 / OrL, Subdivision Lot # I relresent that I am wholly and completely responsible for the location, workmanship, material, consruction and drainage of the sewage treatment system serving the above - described property, and that i has been constructed as shown on the approved plan or approved amendment thereto, and in acct dance with the standards, rules and regulations of the Putnam County Department of Health, and herely 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 operae properly is caused by the willful or negligent act of the occupant of the building utilizing the systen. The undersigned further agrees to accept as conclusive the determination of the Public Health 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 S Day Year General Contractor (Owner) - Signature Corporation Name (if corporation) nn Address: ) 9N+_) U State 60-4_AJs,;44 Zip 10 5-4 Signati Title: Corporation Name (if corporation) Address: State Zip Form GS -97 i NB NORTHEAST LABORATORY of DANBURY CT Cert: PH -0404 LABS 39 -3 MILL PLAIN ROAD - DANBURY; CT 06811 NY Cert: 11471 '(203) 748 -7903 - FAX (203) 748 -0652 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: MILL DRILLING,, INC. DATE SAMPLE COLLECTED: 7 /8/99 & 7/30/99 75 PUTNAM AVENUE TIME COLLECTED: 4:15 P.M. & 12:30 P.M. BREWSTER, N.Y. 10509 COLLECTED BY: RUSS & ROB MILL DATE RECEIVED @ LAB: 7/8/99 & 7/30/99 TESTED BY: LAB# 11471 REPORT DATE: 8/5/99 SAMPLE SITE: DORSET HOLLOW BLDRS.; LOT #12; RIDGEVIEW ESTATES, PATTERSON, N.Y. SAMPLING POINT: BOTTOM OF TANK SOURCE: WELL -NEW TREATMENT: NONE TEST PERFORMED RESULT: MAXIMUM CONTAMINANT LEVEL BACTERIAL:7.30 /99 . Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml PHYSICALS: 7/30 -Color 0 Odor ND PH 6.99 no designated limit 7/30- Turbidity '036 NTUs 5. NTUs CHEMISTRY: Nitrite N <0.005 mg/L as N 1 mg/L as N Nitrate N <0.50 mg/L as N 10 mg/L as N Alkalinity 149.0 mg/L no designated limits Hardness 166.0 mg/L no designated limits 7/30 -Iron 0.058 mg/L 0.30 mg/L Manganese 0.081 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium 4.2 mg/L 20 mg/L Lead 0.007 mg/L 0.015*** m1= milliliter mg/L = milligrams per Liter ND = none detected NTU =Units * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED:7 /8/99 & 7/30/99 SAMPLE, AS TESTED ABOVE: MOTABLE or AMNOT POTABLE (PER NEW YORK STATE;DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) y Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 wi Viii -r e. Z.- o"I be w111 N Ttov 13 en CS�IC n OF-CoagplLAM A717 77, , 4ev 'A "m ja pp ZIP. i6 16 6 ed ?I114*f OWN v6si4 Ai Y1 -is on i6it"Y'Allowwom4ote ecom, fie Rim E. "R.AL eorr ruction A, , of ~4 of MNAih."`-Al 4 coiafiuetloh tM iuoOb o^b /'v �' Any -Tlt6 PUTNAM COUNTY DEPARTMENT OF HEALTH N� DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Z Re: Property of 6121, /('Z9C,9 '/U5o Located at C P T�� r r+ (T )i9i-Tf�So�t/ Block_ Lots Subdivision of Subdv. Lot # Filed Map # Date Gentlemen: This letter is to authorize a duly licensed professional engineer for r.3g rt_red __4t44 ^+ (Indicate T—. to apply for ,a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours Signed Countersigned: 0 of Property P.E. , R.A. , # 7 ! (o _ �7r,, ,/ Address AL), Address Town ,S �p&xj�, /L Y s�7 9iy - -226 ' 5-773 Telephone 91�1- Dy - �esss Telephone L tiJ 0 � 1 e A / ,�)e DEPARTMENT 'OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 rpl !O1 dl 77R . /, l Z(1 For 19141 ?7R.1921 Sean Daly Box 243 Shenorock, New York 10587 Dear Mr. Daly: BRUCE R. FOLEY Acting Public Health Director November 3, 1997 Re: Proposed SSDS: O'Hara Lot 12 (T) Patterson Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: "The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." "You are referred to Article 128.1 of the official compilation of Codes, Rules and revelations of the State of New York, Title 10, relative to the need for approval of individual sewage disposal systems by the City of New York. You should contact city Officials in this regard." Engineer's Authorization has not bee signed by the property owner. 2) Trench cover is to be noted as geotextile. 3) Erosion control measures are to be shown and detailed for the house well and SSDS. J Furthermore, a note is to be added stating all erosion control measures are to be installed prior / to the start of anv construction. J 4) Plan has not been signed and sealed by the design engineer. Upon receipt of a submission, revised to reflect the above, this application will be considered further. R�Umh watershed Very truly yours, ��-,vgow Robert Morris, P. E. Public Health Engineer DEPARTMENT OF HEALTH of Environmental Health Services Road, Brewster, New.York 10509 (914) 278 =6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT WELL LOCATION Street ddress �io—W To Village City Tax Grid Number \i WELL OWNER am e i Mailing Addre� _ " '� C.Ptivate 0 Public SE OF WELL 1 - primary 2- secondary �0 Q1- RESIDENTIAL 0 BUSINESS O INDUSTRIAL O PUBLIC SUPPLY ❑ AIR /COND /HEAT PUtIP O FARM O TEST /OBSERVATION M INSTITUTIONAL O STAND -BY O ABANDONED 0 OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE ;CC al 0 REPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION 12-ADDITIONAL SUPPLY Erlm, SUPP U (NEW DW4LLINGj ❑ DEEPEN EXISTING WELL _ REASON FOR DRILLING DETAILED REASON FOR DRILLING 1 WELL TYPE ILLED DRIVEN DUG OGRAVEL OOTRER IS WELL SITE SUBJECT TO FLOODING? YES_ "NO IF WELL IS LOCATED WATER WELL CONTRACTOR: Name, Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES l,tO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION I e6N_SEPARATE SHEET PERMIT TO CONSTRUCT A 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: Pump the well until the water is clear. , Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. Submit a Well Completion Report on a form provided by the Putnam County Health Department. a all well drilling operations, the applicant shall take appropriate all water or waste products from such well drilling operations be y and in such a tanner as not to degrade or otherwise Of Expiration' 19 is Non - Transferrable Permit Issuing Official action to assure that contained on this %*9_ =_orr groundwater. t White copy:.HD File Pink copy: C Yellow copy: Bldg. Insp. Orange copy: '' !Qt'NA11[ CODiMiT L>�Ai�T!` OF>6�ALTH � . �'- t Dlelgiw ei HaOh SeedeeO, Cae�tel. I+i Y 1N61? ��' b PwvWe`P�wolt i a clZrOII AIR OF 00 lE�OT FO)t SISiYAeE DIBlOSAL.S]fST®1[ Paoatk ' et �X "m .01r., •m11Fe: '�btlyMa� 11a�e Lot N �' Tas.MapHbek ot bL ❑ Date at Apptm�l Mifte Adi�ee ' O • O Teve' % t'TTU: � 1 ZiJ Fe -End1osed bdiv sin`" rt KJ i'Ui /, L-t, Lot Area r A . FIp Sectlea Depdt Vabttas Ntiabee e[. HeieOttls DtlalQn Flow G 'P. ,D 1' PC® Nousti. a is miquiled Wtiea Pm b omplee d G. Septale to ma* d a9ee'Saptk Tank.- ' Wabtr S"!pb' PtiOe Frei A�leae t>tss- Drilled fir l reprpentahat I im wholly arM completely responsible for the design and location of tM, proposed system(s); 1t, that the.separats sew disposal system above described will.ei eonstrudOd as sown on tM approved amendment there to and in according witR tM shndards. rules a repu a net o • n County Osipartmeet "01 FlMlfh, and `that on completion thereof a `Certificate of Construction :Compliance' satisfactory to the,Commi"!* of Health will _,t a >,lbmtte:d to °;ttrt.Opartnlerct,•and' a wr {ttgi'tlNirantN will:W fufni" tM owner his =succewois, heirs assgns by the bulkier. that said builder will Ware w -flood Operating 'condmin any pert of; aald sewage disposal cyst rh dump tM period of two ('2► s hemedlitely following, tMdate of the {seu- Once of the',app foul of th%Certificate of ,Construction Compliariu "of th orginal system.o► OnY r t .21 that the drllled.weli described above will M located ai shOwn on th 'asipoved plan and.that iaio44 will tie Instal in n with rules and rpuTa%ns of the' PutMm County Deal me et f Mealth. ✓/ Dote 'Q �'g.C;9�3j sgnsd p E _ RA. Addre License No APPROVED FOR CONSTRUCTION: This appoval ,expMef two years from the date issued unless constructio of the building full been undertaken and is revocable for ciuse or' may N'smaldad or rrio0ifind when conside!ad nomse by the •CommiWonar of Meaah. Any change or alteration of construction requires a new {i milt Approvid or' isp�jo I of domestic Wk&ry se_- �e'a ri water s pply only. Rev. Date ?�i �! _ 811/x..... TRle 10/88 —' . . Lerr 4- m- PUIMM . COUNTY DEPARTMENT OF HEALTH DIVISION OF •' •' ' ly Y• L HEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. �7 1 '' II A � .- Owner r �T�� 6k14�Z1� ,ass, U.laVK 2A 7r 'P&Ttoy g`!94 / -� TvI Located at ( Street) 31 l (_17� � � 10 Block 2. Lot l (indicate nearest cross street) Municipality ��-y- �-'�1j G„XJ� Watershed�>� SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTID WITH APPLICATIONS Date of Pre- Soaking 18 4BC Date of Percolation Test ( 9 SOLE NUMBER CI0CR TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level- No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 1 Z :o L -3 78 Z y 1� 2 "3 .5 Z1.1 , 2 :; ; I8 `00"48 "310 ee lB z 1 /8 1411 3 3!`{b q: l b .?O zq 25' #s l Z ;Zo 4 5 2 1 r-3 2 -'3-J-7 tj z 3'1 3 4 5 6 �4 NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be suYmittod for review. 2. Depth measurements to be made from top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS IN TEST DEPTH HOLE NO. I''Z HOLE NO. HOLE, NO. G.L. 14 2' 3' 4' 5' 6' 7' 8' 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED kill INDICATE. LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: T,o '�!>` DATE: DESIGN Soil Rate Used I- 4 5 Min /1" Drop: S.D. Usable Area Provided 100DO No. of Bedrooms CQU,Z- Septic Tank Capacity gals. Type Absorption Area Provided By _ oF L.F. x 24" width trench Other Name T. MICIIAEL P A I.-v, • ..F,. CONSlli -TINT_ rntr.�,l Signature ►-. N , a r a. r. 0. rox 213 Address SEAL ,` �� '9 4C cNENnRI�CKrN Y LA 1. <sk: �� i) All THIS SPACE FOR USE BY HEALTH DEPARDffTT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT #_ {� WELL LOCATION Street Ad ess 2zG2Q I, a wn o Village City Tax Grid Number •::�6 --.-x. — WELL OWNER Name ` 0 Mailing Address pPrivate O Public SE OF WELL 1 - primary 2- secondary G- nSIDENTIAL 13 BUSINESS 0 INDUSTRIAL 0 PUBLIC SUPPLY Q AIR /COND /HEAT PUMP 0 ABANDONED 0 FARM 0 TEST /OBSERVATION 0 OTHER (specify U INSTITUTIONAL 0 STAND -BY O AMOUNT OF USE YIELD SOUGHT 45- gpm /# REPLACE EXISTING SUPPLY Er EW UPP Y NEW DWELLING)- PEOPLE SERVED 8 ' /EST. 0 TEST/ OBSERVATION 0 DEEPEN EXISTING WELL OF DAILY USAGE WO gal Q ADDITIONAL SUPPLY REASON FOR • DRILLING DETAILED REASON FOR DRILLING 0 ' T- WELL TYPE UDRILLED DRIVEN 0DUG 0 GRAVED 0 OTHER IS WELL SITE. SUBJECT TO FLOODING? YES L--'NO IF WELL IS LOCATED JN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ✓" NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: / 1 LOCATION SKETCH & OURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET i `'l.� (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 thirty (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 such a manner as not to degrade or others' g. contaminate surface or groundwater. Date of Issue:� 19 Date of Expiration 19. / Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date I Re: Property of D_ - tl1`Z4 Located' at TQ32 4„r V1F t7 02LMG (T) t &e e it i eii Block. a Lot Subdivision of 0 Subdv. Lot # 1 Filed Map ate T. MICHAEL DALY, P.E. Gentlemen: CONSULTING ENGINEER P. O. BOX 243 This letter is to authorize SHMOROCK�N Y, inSgy a duly licensed professional engineer —or (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and-to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, ned Countersign Owner of Property P.E., R.A. , # `Z/"__ Address T. MICHAEL DALY, P.E. � -� C - � 0 1\0 'Y. 12 -56 } CONSUE .1% Address Town P. 0. BOX 243 SHENOROCK, N. Y. 10587 a 4- Telephone Telephone le- YC-1 F UTNAM C OU N TY D E FARTM EN T O F HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWAJER DISPOSAL SYSTEM 1. Name and Address of Applicant: �• a� ltAt��4 17- 9 (Q 2. Name of Project: '111 - 3. Locatio�V /C:,��'�Tft."���.I 4. Project Engineer: 7, 5. Address: WOK O�Qr-)Z q D 1 License Number: Li"� Phone: 6. Tyke of Project: f Private /Residential Food Service I Commercial., Apartments Institutional Mobile Home: Park Office Building Realty Subdivision, Other (specify) .. 7. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (Check One) Type I... Exempt Type II. Unlistled .� 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. K A 9. Has DEIS been completed and found acceptable by .Lead Agency? A IN 10. Name of Lead Agency 11. Is this project in an area under the control of .local planning, zoning; or other officials, ordinances? ....... ....:.:` "' .................... •,^�+ • w_.�pT . ,h 12. If so, have plans been submitted to such authorities? .................. , 13. Has preliminary approval been granted by such authorities ? Granted: ''Date 14. Type of Sewage Disposal System Discharge.,6.Jr>,5v - Surfaoe Water Ground Waters 15. If surface water discharge, what is the stream class designation ?........ 16. Waters index number (surface) ............ ............................... 17. Is located project 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 disposal system?* ..... ?0. Name of sewage system Distance to sewage system M. Date observed: 23. Name of Health Inspector: >.4. Project design flow (gallons per day) .......... t�5.CRO ....................� 2. 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. 26. Has SPDES Application been submitted to local DEC Office? 27. Is any portion of this project located within a designated Town or State wetland ?... . 28. Wetland ID Number ........................ ............................... 29. Is Wetland Permit required? ........ .. .... ............ ....... ... ......... Has application,been made to Town or Local DEC Office? ................... . b 30. Does project require a DEC Stream Disturbance Permit? ................... 31. Is or was project site used for agricultural activity involving appl,fcation • of pesticides to orchards or other crops, solid or hazardous waste disposal, f� landfilling, sludge application or industrial activity? ...... YES.'or N O N 32. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal !1ite'-.or any other potential known source of contamination? ....�.........;.YES or NO DESCRIBE: 33. Is there a local master plan or file with the Town or Village? ........... 34. Are community water, sewer facilities planned to be developed within "t5 years? b 35. Are any sewage disposal areas in excess of 15% slope? ti r ...... r . 36. lax Map ID Number ............................ 1:� .. •. ... ......... 37. Approved Plans are to be returned to: ................ Applicant `""Ehginear If the application is signed by a person other than the applicant shown in Item 1',tthe application must be accompanied by a Letter of Authorization. Failure to compay with this provision may be grounds for the rejection of any submission.. I hereby affirm, under 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, o Section 210.45 of the Penal Law. ' SIGNATURES & OFFICIAL TITLES: e4l) MAILING ADDRESS: T. MICHAEL DALY, .� .E. BOX 243 SMOROC.K, '9.Y.' 4 BEDROOM COLONIAL'_ SINGLE FAMILY RESIDENSEE L R P m Y 0, G G Oo* FAMILY L. L. ROOM PUTNAM COUNTY DEPARTMENT OF HEAT HOUSE PLANS APPRM,'�D. MR BEDROOM COU`,.T uLl"IF; BATH C, BATH L. BATH c) Room BORM #1 GL. GL. HALL 25 MA5TER BDRM #2 BDRM #5 SDRM 5ECOND FLOOR 1/511 if-oil EATING, K AREA N ITCHE STUDY LIVING ROOM PINING, FO"rER. Ploom L. GL. C FIRST FLOOR -e? , PUTNAM COUNTY DEPARTMENT OF HEALTH /J (DIVISION OF ENVIRONMENTAL HEALTH SERVICES g/ INAL SITE INSPECTION C% Date: 7/10/"' �. Inspecte y: G, ;ee- Street Location "Prp64 V«%,e "Dr, Owner (9IYA raA Town 'Pwrre7z 5,y y Permit # P — 5� — 9 3 TM # 13 — 7-6- Subdivision Lot # j2 "� �Ae yew 1. Sewage 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 tank size - 1,000 ........1,250 .......other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. out ets at same elevation -water tested .............. 2. Protected below frost .................. ............................... 3.. Minimum 2 ft.Original soil between box & trenchgs e. Junction Box - properly set ...... ............................... f. Trenches 1. engt required 9 ©O Length installed $ 00 2. Distance to watercourse measured Ft.......... 3. InA4 rrgnch ' to 4. a e tabl 1/16 - 1/32" /foot.5. 1 ft. prop y line - 20 ft.- foundations.......... 6. Depth of trench <30'inches from urface .................. 7. Mon:,a Vwe or x ns' °/ 8. 4 /z" ame r le ................ 9. o i tre h 12" m inimum ................... 10. Pipe ends capped ........................ ............................... g. Dosed Systems 1 . Size of pump chamber ................ ............................... 2. Overflow tank .............................. ............................... 3. Alarm, visual/ audio .................... ............................... 4, Pump easily accessible, manhole to grade. ................ 5. First: box - baffled ........... ................. ............................... YES I NO I COMMENTS tom+ 4v. r- -a Dralaaye III. House/Building`� a. Ho use ocated per approved plans ... ............................... b. Number of bedrooms., ..................9...`�V.. eM................. IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured + / o o ft........... . c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted .. ............................... <--Vp b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ..............................0 d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area... ....... h. Surface water protection adequate . ............................... i. Erosion control provided ................. ............................... Rev. 6/97 1_7ii orm 51- c�G �� n�.ae PVTNAIVI `DIVISION 3w T- s _ COUNTY DEPARTMENT. OF ENVIRONMENTAL FIELD ACTIVITY�REPORT Sheet OF HEAL TH <. HEATLH °SERVICES ' of ;. NAMF• Street _ _ Town . State Zip PERSON IN CHARGE ;• OR, n.TTCD-7T'F`IJp ". Name -and Title TYPE. QF FACIT.IT.Y . .. .... . . e. _ ..... FINDINE�S. , 1. • is � .. 3^ - . INSLEC'''(lR TFY ; Signatur.e and Title "nL�CU3T RF( FTC "TF;TI RV• I acknowledge receipt`of this report SIGNATURE: F 02/96 = True; 2 z LL-Rev. - Jz OT 12 4 /4N.O� NO WN =LL !O'. M(N. o Pi Wl TH1 N 100 5 NN r \ \ Dr3 a E F O TLi E G k GAL. MAS Y Si HON 411 NK 1/4 "/FT. pF'oP. (4) E3�DooM HouSLr� %YELL Q \ NO 55DS 1NITHIN 100' _W 1!J rU , I m 48c