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HomeMy WebLinkAbout0402DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13.3 -48 BOX 5 I rm : 1 J T ir OL 1� T Is 6 00211 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health John & Mary Ellen Debonis 369 Cornwall Hill Road Patterson, New York 12563 Dear Mr. &.Mrs. Debonis: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 April 17, 2006 ROBERT J- BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Addition — Debonis, A- 111 -06 No Increase in Number of Bedrooms 369 Cornwall Hill Road (T) Patterson, TM# 13. -3 -48 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 April 17, 2006. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at three 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. This Department recommends you contact your local Building Department to ensure setbacks and other current codes can be met. 5. This approval is for the proposed changes only. This approval does not validate any construction shown as existing that has not obtained proper approvals. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Patterson. If you have any questions, please contact me at (845) 278 -6130, ext. 2261. Sincerely, 04L'- V -1 Gene D. Reed Senior Engineering Aide GDR:cj cc: Building Inspector, (T) Patterson Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY 'BEDROOMS ALL SUBSEQUENT REVIStONIALTERATIONS TO THESE HOUSE PLANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAt St NATURE & TITLE DATE I i - � , , , . .� ) z• h � ,� `gin ( tYl Y�I � < I . 3817 11 e_ei p p > j KITCHEN I': 6FTH DIIJIkG AREA IQO.TH FAMILY RJ00A N d 5 j O 1 / \ze6e � um (_3312 2 30i I .r I I^ Ed 2668 � � I; iii it BED1�oor� . ! ; I. LMAIG 1Foon — • BEDROOM -2 i I BEORacK .3 i 3' a 1/2.1 13' 7'.3 /a -I �• .o: ' _. 2 %6x'6 3/ :. _ —.F '.C' I I'JI CTUCI� y; .11 i1/� a5 3 I 4 r Zo'7• le 1 /Z. i .. 2XfiXa1 3X6xal ' 3 1/2 I ice' 0- II •, ••5' '•!L 10' 6 1/2- 18' S 1/2" ffia �.�__ 56' •' I. I. J SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health 1) DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 House Addition/Replacement Guidelines ROBERT J. BONDI County Executive 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 ro osed number of bedrooms. Plans will provide for the installation . of additional and/or new. sewage disposal area meeting rp esent 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 unfmished 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. Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Iaterventiow?reschool (845) 278 -6014 Fax (845) 278 -6648 e. i 2) 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 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. Revised May 2005 • ti .SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health' DEPARTMENT ':OF HEALTH 1 G R d B N Y k 10509 eneva oa , rewster, ew or ADDITION APPLICATION 11 � ROBERT J. BONDI County Executive 0 STREET /WN/,,=�,1, TAXMAP#/S.-&-er' NAM PCRD# i MA19G • �► DESCRIPTION OF ADDITION ,4 1 V NUMBER OF ELSTING BEDROOMS PROPOSED # OF BEDROOMS__ (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING.INSPECTOR) tAny addition which is considered a bedroom requires formal approval-of plans "(Constriction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, Brewster, NY 10509, Phone: (845) 278 -6130. 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) 3. Two sets of proposed floor plan (drawn to scale - with name, street and tax map #) * Non - professional sketches are acceptable 4. Copy of survey showing well and septic locations to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line: Contact this office with any questions. 5. Copy of Certificate -of Occupancy from Town or Certification from Building. Dept. with legal bedroom count of dwelling. OFFICE-US E COMMENTS Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC(845)278-6678 Fax(845)278-6085 Early Intervention/Preschool (845)278 -6014 Fax (845) 278 -6648 4 ,, SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Re: Tax Map #: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Town Legal Bedroom Count 0 OF W, 0.,, 11wamm, MK � ROBERT J. BONDI County Executive )wner's Name) Address: Town: Year Built: 9(g� - - According to records maintained by the Town,-the above noted dwelling, is in compliance with Town Code. is not in compliance with Town Code. The Legal Bedroom Count is: _3 This information has been obtained from: Certificate of Occupancy: Other: /Z4 Building * cto� Date Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 76648 --• —_- ' IS L HEN : L1J .1 �. �!Nj NG RRER LJ II l i� -- r BtliH 826 -:ae z 826 -106 FRM''..Y R0015 2068 NG R cm Ir I' II BECR00M „r 1; p t-'— `-- -j; -- °Z - � 1 BEDROOM - -- - - _ • 3- _8 1 /2'X1 la' 7,3i: X 3 s �x 2XfiX "'ti Jib . __ a- /. �..' n �X J 1 I ;e� --'' a: 7. pItT i W�NOOy7 2 31/2- " 1X6X,1 _ I I ' ii 1 I }1eN Rtr /ty Carla, I � � N N � k r, .-f �..� .- S'1.3 NT i•-� _ � _ -- •L�m -•-LL� _ /��r p gyp /� � ^� ir I - O TocW� »F AATt'f1itS0l3 GG�tki,oivr`�Oti�u't`�n NY •( ;'. 5 '; �' - - - ' I.� _ StAtE . r' �O' J9iVuAl2Y r7 • I %S9 ' � V _ `g ! mpr ?T 6fe .Crvor o.+ �e � I' .. 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CONSTRUCTED TO THE REQUIREMENTS OF >,•s�j ` \' THE BUILDING CODE ZONING ORDINANCE AND LOCAL LAWS OF THE TOWN OF PATTERSON, NEW YORK :AND MAY BE OCCUPIED AND USED AS One Family- Dwellin Q�with wood Building Permit Dated Permit No..:XQ4.3... Application No. ,463;,,_„ ;_ SECTION 1 ........ BLOCK 6 7 8 SD Loth 1 ,�; i ................ LOT........ (.... ) 1: FEE $ 15.00 _ �1 Qom.• ryl(r �. E BUILDING INSPECTOR ee* . •...:.., , , , e e e aerardare ....r . n e e,me+e,a• nre e'en' re=awrarer erer 'wren ane• a ,e *ere*e,s ere,arenare,., rrrr — ae carer' , a•:::•z•:sar'r,as'na ranr,arerenarenarcee*ewar a 'sua "r'r r r ,a *arsmm ;T� .•�.+. ` .•n "*. k. :E. .1,[ s . w ,a,i. , . •.. #fi :��r\ " '::.y } +e..=:f• .•v.• ✓*.:.. i n:�...r.4h. .r. .�.r.rs w,t'... ..� +i.. ,5. /. re•' ,. 1. 3.:= . "v \1 - t ,§M ' r: +t•. .g,, ti;: ..,...!A\,0.... i. ..�..' +,,r,,r +. 'Yk %:. - t,.ii't',.�3.:r. ';7' ':i €1ri/•^•yr" t - • J •4'M. - :;.;t_ s, •hl,` :•,:l` f:• �� +•;. ••:•; `k("/ l .,7t,. •!•!. ., i.". : +' VM.I. � i•i:' i,:` ,J. �•'• R i:L.i ';::[•' i ../ tic ! :ti. ' �r i•:. r t •t r R• �r..r 'f I . -Ar... '.rr. f 5 I ti • t }� f \5 r r 'u i r"t f.• 'ham. •, 15 rt •i `b'� :l'• i. .Y••• frvh •f s: k+ nom# h' •A .!• `r o't th•" .! •:r +.�� ✓•� f i 'iS•. rr '.�.. .r• a .t;e✓" .,f'; .;• ",;= r �. h.- .,. / .t• f !,:• I I • t 1 :•/ r. ! •� 1 / / r. ;i J n. I1. IV. V. VI_ FINA 'T1 CN L SITE INSPEL Date Insperti by -;6TIGN I . - . I I - 1 DISPOSAL AREA a. SDS area located as per a=roved plans b. Fi I I section - Date of placement 2:1 barrier . IGM W-= AVG.DPM C. Natural sail nct st--inced d. Stme, brush, etc., greater- than 15' fzcxn SDS area- e. 100 ft.- fzcm water course/wetlands. SZV- =-- DISPOSAL a. Sentic tank size ;7f,000-,--" 1,250. b. Ser)tic tank in517-4 - le -yell c. 101 minims fzm foundation I- d. Nb 90' bends, c-leancut within 10 f of 450 beend I-- e. DISTRIBUTICN BOX 1. All outlets at spume elevation - water test-ed 2. Protected below frcs-;L-- 3. Minim= 2 ft. cricripall sail betiee-ri -box and t---e-nc;--ir--, - f. JUK71OU EOX --crcce--1v set- q. Z? 2M 1. Le-mct--h remaired =, e: 1,---nc-th ins zal-led ( �'"- ` 2. Distance to watarccurr-se measured ft. "4- 3. Instal-1 ed ac=rd-Ling to plan 4. - Distance cerit-ar": to cente-r 5. Slcrua of - t=EaL-i accent=-le 1/16 1/32 " /fact. .6.- 10 * feet Frcin line - 20 feet - foundations 7. Den-En cf t--Ench < 30 inches frarL s-=face -ce S. Roan a-11cweE fcr exmansicn, 50% °. Size of cmve-1 3/4 - I!"' diarmtsz 10. Denton of aravell in tr-emch 12" udmimm 1-L Pine -Erg . h. Pero OR DOSE TZS=,-S 1. Size of pmm Chra-mbe-ar 2. OverJ:----1cw tank 3. Alm, visual/audio 4. Puma easilv ac--e--sible manhole to arade, 5. Firs-t- bcx La-z-fle—A 6. Cycle witme-sS=--i by Health Deze--t-m-lit estimated f:,.cw Rf=-, cycle HOUSE a- E--Lse lcx---t--a t a=oroved plans. `� �� b.. of hearoans WEL a. Weill 1cca-ted as per acDroved plaps b. Distance from - SDS area measured e) ft. c. Casinq 18" andve grade- d. SL--:ace drainage aroused w-eLl. acce=tz-hie. MT-�- -M WORMASHT-P a. B---,e-s pEcce-rilv grouted b.. AU pices part-Lailv baddilled c. 2ices flush with inside of box d. matariall contains stones < 4" in diameter, e- C----ain dmin installed according to plan Ole) C-,-`,-ain dra-in cutfall protect-ed & &r.to exist.watex-ccuri� /J I F--ctinq drains d-isdiarae awav fran SL "IS area- S=.---ace water protection ademmte r--zcsi-on conr=-L prov-ided en slopes areater- than 15%. YQrktown Medical Laboratory, Inc. 321 Kear Street Yorktown Heights, N. Y. 10598 (914) 245 -3203 Director: Albert H. Padovani M. T. (ASCP) r KEY REALTY 93 GLENEIDA AVE. CARMEL, NY. 10512 L 1 J LABORATORY REPORT ON THE QUALITY OF WATER . 93. t 3� �.=.920 LAB # Date Taken: 2/10/89 Time: 8:20am Date Rc'd: 2/10/89 Time: am Date Reported: FEB. 14 1989 Collected By: H-Mcglasson Referred By: Sample Location: Kitchen Tap Lot 13Cornwall Rd. Pahterson,NY. Phone # 225 -1357 Phone # I Sample Type: Repeat Test? _ (check one) INORGANIC NON- METALS (mg /L) MICROBIOLOGICAL (CFU /100mL) _ Acidity _ Alkalinity _ Chloride Detergents, MBAS Hardness, Total _ Nitrogen, Ammonia Nitrogen, Nitrate Phosphate, Total Sulfate _ Sulfide Sulfite METALS (mg /L) _ Copper _ Iron _ Lead Manganese Mercury _ Sodium Zinc MISCELLANEOUS pH (units) _ Color (units) _ Odor (TON) _ Turbidity (NTU) GENERAL BACTERIA Standard Plate Count (CFU /1.OmL) MEMBRANE FILTRATION TECHNIQUE X Total Coliform Fecal Coliform Fecal Streptococcus MOST PROBABLE NUMBER TECHNIQUE Total Coliform Index Fecal Coliform Index KEY FOR TERMINOLOGY CFU = Colony Forming Units N/A = Not Applicable LT = Less Than (C ) GT = Greater Than (>) TNTC= Too Numerous To Count CON = Confluent ( =TNTC) NR = Non - reactive X Potable Non- potable _ STP INF STP EFF Other: Sample Status: (check each) Outgoing — HNO3 _ HC1 H2SO4 _ NaOH ZnOAc _ Na2S203 _ Other: Incoming X LE 4 °C GT 4 °C _ pH LE 2 — pH GE 9 _ pH GE 12 _ _ Other: REMARKS /COMMENTS (For Lab Use) IELAP #10323 THESE RESULTS INDICATE THAT THE WATER SAMPLE WASP (WASN'T) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO TH YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTI- THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DIDN'T) (N /A MEET THE SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STA D NKING WATER CODES, FOR THE PARA .4TERS TESTED, AT THE TIME OF.COLLECTION. Albert H.. P*dovani, M.T. (ASCP), Director 2 /86(Rvsd7 /87)RWE CO�� WELL COMPLETION REPORT Office Use Only �aC a DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH STREET ADDRESS: WN /v1 1 ITY TAX GRIO NUMBER: WELL LOCATION Co,e.•�w N /L.1- NAME: D/C� /-) C C>- 445 ADDRESS: IVATE WELL OWNER ,C�Ey �2�`7�A:T 2� e ,� M• U 5/ NIP BLIC USE OF WELL WRESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /CONO./HEAT PUMP O ABANDONED 1 - primary ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION O OTHER (specify) 2 • secondary ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /NO. PEOPLE SERVED 3 / EST. OF DAILY USAGES -1Z gal. REASON FOR ONEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION DRILLING ❑ REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 3 U y ft. STATIC WATER LEVEL � ft. DATE MEASURED DRILLING ❑ ROTARY OKCOMPRESSED AIR PERCUSSION ❑ DUG EQUIPMENT ❑ WELL POINT O CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE 0 SCREENED ❑ OPEN END CASING. WOPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH ft- MATERIALS: gSTEEL ❑ PLASTIC ❑ OTHER CASING LENGTH.BELOW GRADE (o 2 ft. JOINTS: ❑ WELDED 19THREADED ❑ OTHER DETAILS DIAMETER in. SEAL: IgCEMENT GROUT ❑ BENTONITE ❑ OTHER WEIGHT PER FOOT 1b./ft. DRIVE SHOE. YES ❑ NO LINER: O YES WO DIAMETER (in) SLOT SIZE LENGTH (it) DEPTH TO SCREEN (ft) DEVELOPED? SCREEN DETAILS FIRST O YES ONO SECOND HOURS GRAVEL PACK ❑YES GRAVEL DIAMETER TOP BOTTOM ❑ NO SIZE: OF PACK in. DEPTH ft. DEPTH It. WELL YIELD TEST It detailed pumping It more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. METHOD: ❑ PUMPED If tests were done is in- DEPTH FROM water 'Nell ,tktOMPRESSED AIR , formation attached? SURFACE Bear- Dia- FORMATION DESCRIPTION CDOE, O BAILED ❑ OTHER :OYES ONO it. ft. in9 meter WELL DEPTH DURATION DRAWOOWN YIELD Land Surface `3 �N 11 ,E%f'f}%l � It. hr. min, ft. , 9Cm. -7V, r,4 L_ 0 6 rE C.ii�E' L 11n�S70 J&" r A- PMr-TcIPES ~ 75"1 //0 /o�D '13 WATER ❑ CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? ❑ YES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE PUMP INFORMATION - CAPACITY GAL. TYPE CAPACITY WELL DRILLER NAME DATE p MAKER DEPTH ADDRESS. a/ S(Gh1XTURE ,.► MODEL VOLTAGE HP calz��i - a' PUTNAM COUN'T'Y DEPARTMENT OF HEALTH DIVISION OF ENVIR0'1'Z=AL HEALTH SERVICES Key Realty Corp. Owner or Purchaser of Building Owner Building Constructed by Cornwall Hill Road Location — Street T. Patterson Municipality Modular Building Type 1 6 7/8 Section Block Lot Garrison R. S. Subdivision Name Lot #1 Subdivision Lot # GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as 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 disposal system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. " The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environinental Health Services 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 buil. in utilizing the system. Dated this -:: -" 21,1 day of Feb. 1989 11661 Contract '( er Signature Key Realty Corp. Corporation Name (if Corp.) 93 Gleneida Ave., Carmel, NY 10512 Address rev. 9/85 mk Signature v Title tPresident Q��sW lei) Key Realty Corp. Corporation Name (if Corp.) 93 Gleneida Ave, Carmel, NY 10512 Address "p'k"'^- ...cr•r r ry\�1 , zPUTNAM COUNTY DEPARTMENT OF HEALTH n + r to Provide Permit N = ?� Division d EnviromnentalMealth Servkee Carmel N Y 1l .Bin " on CERTIFIC TE OF COMPLIANCE Permit p {P57 "'86 C STRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM f T:`. Patterson (S':'0 ;2419) Cornwall ' Hi I I ' Rd . Town ou I- Village C E & JL Gar,r.'i son 1 1 6 Lot 7/8 Sabdivia on`Name Sabel Lot N Tu Block 4 P F 1. , Renewal_ O • Revision Ow- ner %AppOr�at Name . Key � Realty Corp D Appro C 1, P.. E . Provtoas val 8/ J R .� ate o by FO E' 13/86 ( 1 hett MOB Add 93 ,Gl.enei da Ave'. }Town C' armel ; NY 06.10.5.12 • t Babd� �Pe Modular Lot Area 69131 _$� F FW Section Only NIS: Depth Volume ,: Three , 600t PCHD Notification le Regalred When T111 rnmpleted Number of Bedrooms • _, Design Flow G P D T. , Separate Sewerage,•System to rnnslet of ' 1000 Gallon Septic Tank ana 500' x 24" .Wide X 18" Dee�Ldterdl5. To be constructed by`'0t?r: Address Above i' 'Water Sapp1) Public Supply From Address or: X Private Supply DrWed;by Boyd Artesian Well - anddreas Rte 52 Carmel NY 10512 i . ... _ Common-;`Granular Fi11.to level area Other Regairemente - f 1 represent that I am ;wholly and, {completely responsib le for the design' and IocaUon o1 the proposed systems) 1)" that these partite" sewage' disposal . ty stem \above described will,be constructed'as shown on the approved; amendment there :to and`�n accordance w,ith,the standartls rules an ;regu a ions o e u nam - ` County Y Department "o, 4' ealth; antl ihit,on completion thereof a "Certificate, of Conitruction'COmDlianea satisfactory'to ahe Comm�ssiOner`.of Mea'IthwilL De' wbmitted to -the Depa►tmerit Eand a written guarantee'W�It De furnished .the owner his successors, heirs of assigns Dy,the builder, that said builder will place m:gidd� operating.cdndiiidn any part ot•saitl sewage tl�sposal system dunng °the penod of two'(2� years immediately following thedate of .the isw• foes of, .the apPro4al -iof the ,Certiticete of Construction Compliance of the ongmalsystem or; any repairs thereto; 2►• that the drilled well described above wilt'be located'.as shown on the approvetl plan and that said well will be installed• accordance with the •sfsndartls 'wles; end regu a ions of, :, the, Putnam ' Date rtment of iHealth count 17 J 3r r , , Y D une 1987 signed ' /�. P E _)ir R A. Address '.RD9'Fair St Carmel., License fvP ?a'9nF APPROVED.FORSCONSTRUCTION This approval expuestwo years';from the` date �s'sued unlass construction of,Vthe'building,.has been undertaken and•ts re3oeaDle for cause or °may be emantlid Ormotl�fied when considered.neeessary,. by'the Comm!"ioner of­ Health Any change or•alteritiorn ;of construction .. requires new permit. Approved "for.disposal'of domestic sanitary fewayei 1 %d /or,"prrv' ate ply only :`•, - - `' Rev. �� __r� 1/81 OatSaJ �� /U �,/ 8 = Ti Plumber of netlrooms - . Separate Sewerage System to consist of j-QC-10 -Gallon Sepdc Tan)tabd� i,j 14 . Torte rnnetrgcted:by Addreee Water Supplyi Public Supplginin Address or Prtvate Supply DilUed by 1QQr � D� �+� 1 ihfii 9 `Y —: A,de. 7 ell Other Regblieuiente I represent triat.I am wholly and - completely responsible for the design an location of the proposetl systems) 1) that the_ separate, sewage disposal system -. above .desoribiid will be constructed is shown on the approved amendment thereao "and in accordance with the standards, rules an regula, ions o e u nam County Department_ of :.Health, and that on completion thereof a "Certificate, of Constructian`Compliance,' satisfactory to the Commissioner of 1-lealthwill be submittedao the .Department, antl`a wntten, guarantee will be. furnished the owner, hi'' successors; heirs or sssign's;by the builder, that said builder will place ..in good operating condition any, part of. sa'id.aewege. d�spo'sal; system.dunng the perioy of two (2j y once of the aooroval.of :trie_Ce'rtificate "of Construction Gom Iiance'o( the;original. Sys tam or. ayt�h� 1 will be located as shown on the a_ ppro4ed plan antl.that said well will be insta ad accordance wit_ h d County"De partment of Hlth. Oats �j 5i9ned i���''t`-� •. /T Q r v Address APPROVED FOR .CONST GTION .This approval.ezpires; one -yea t a date Y Zzi. revocable for.caus o`r ma�� f /�/1L'�e mended .or moditied, when consitl ce yby t reAuiies a ne�y �blrry�i;ly T, rovetl for disposal of tlomestic sariita- i age,; antl% �ni er pl Date z.$/sLV'a' By, .'fl S Immediately following the data of the )siu• , �ato; 2) that the'drilled will described above s, rules and regu a ions of 'the Putnam P. E. R.A. License No, of the building has been undertaken and is Any change or alteration of construction _ Title D PuTNAm COUNTY DEPARTMENT OF MUTE JOHN M. PRENTISS, P,E, DIVISION�OF - MALTH SERVICES RD9 FAIR ST 914- 878 -6170 CARMEL YORK 10612 D] ' iIGN DATA SHEET- SUBSUFAACE SMAGE DISPOSAL SYSTEM FILE No.* p y" a :7ier / U l- E� Address l.,./A LL_ I,.:.ated at (Street) Co=W4L k� ILL F-P. TzT, 31 I sec. / Block, , G Lot l�ol�s IN4 I% (indicate nearest otoss street) waicip►al.ity `��TTE i Gat�.,� Watershed C.�oTOr:j SOIL PERC0LA9.'ION TEST DATA REQUIRED TO HE SUBMITMD WIIii APPLICATIONS D, ; to of Pre- Soaking 411816 (6, Date of Percolation Test '4119) 81= 3 +.OLE N1 iMHER CLOCK. TIME PERCOLATION PERCOLATION', Fun Elapse Depth to Water From Vtter Level lo, Time Ground Surface In,Inches Soil Rate Start-Stop Min. Start Stop Drop In Mi,n/ln.Drop L 0 7- Inches Inches Inches _ 155- 1 Z" i s .15 Z 1Z;�t- z:o� 115 18 Z4 19 Z 1 -r/4 a' ...34Z- ¢;04- 3 Z 7.,'l 4- 4- �;�' 12.,►� -Z�oB III- Z¢. Z8" � ��- = .ZB... 2 3 q r:MS: 1. Tests to be repeated'at saw depth until approximately equal soil rates - - are obtained at each percolation test hole. All data to' be snbmittod . for review. .2. Depth measurerents to be made from top of hole. 1 :v. 9/85 .. It TEST PIT TO BE,. i SUBMITTED VTM i.,EPTH HOLE NO. HOLE NO. 1 tQAM is Swry LOPA i j , trn w 1 312.4 " CL-(-\Y L xn A ran 71 �7,0 .QT i ,�o$i SILK SAN e ay, 3' i Of . 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDRATE2 IS ENCOUNTERED _ INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: J►�� FOI.C� ET t' ( DATE: ¢ l9 8e0 �G°aI G�t�1P" DESIGN Soil Rate Used Drop: S.D. Usable Area Provided Soar T No. of Bedrooms Septic Tank Capacity _ oa o gals. Type ,P, C, C Absorption Area Provided By L.F. x 24" width trench i1z�l =l...l --t a :ry Other,?, �� �� � � �� =�'vi ( Arva Name J , 'Fo LC i-(L-. ' T" l a c- .. Signature � y • Address ? O T-Xy'X %( SEA;'j THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: fur Soil Rate Approved sq.ft /gal. Checked by Date Is PLO DJ 'iIGN DATA SHEET-SUBSUFACE SEWAGE DISPOSAL 'SYSTFM FILE ICU. a,aer C.E. .S:t , _ p►9-,•,�)SVLJ Andress CC)rNk,,4Al..l.. TA;mted at (Street) COUWALL F(iL.L IL'P. .Z-r. 311 ' Sec.. / Block.. G Lot 447 Is (indicate.nearest c±oss street) M mdcipaiity Watershed C�oTOti1 ki Me— I� tte of Pre- Soaking 411818 4= Date of Perool.ation Test 4.119 8Lo . 3 I i.OLE NtAM CIACR. TIME PEROQIA7.ZC1N PERCX)r, CU > Run Elapse Depth to Water From Prater Level 110. Time Ground Surface In Indies Soil Rate Start-Stop Min. Start Stop Drop In Min/In.Drop z4 19 12.,1 Z, 08 114 2 8 Z8 V, 1 ?2 Zo /y 1 . 2 3 4 5 r .'.YMS: 1. Tests to be repeated• at same. depth until approximately equal ..soil rates are obtained at each percolation test hole.. All data to' be. submitU d . for review. 2. Depth measurements to be made fram top of hole. z .w. 9/85 TEST PIT DATA REQUIRED To. B&.s BMITTED vam APPLICATION DESCRIPTION OF SOILS fmsi. HALES DEPTH HOLE NO. HOLE. NO. HOLE NO. SILTY CLAY L,-)Aril Sl rY LgAtA s«T Co M :3 0 IZ'31► ��t-� t.o�M "7' ? Z o AT ? � ,ioa� S 1 LT'S' 9' ' T Lam. 9h °1 All AT 7�-z 11' 13' 14' INDICATE LEVEL AT WHICH GROUNDD+ AM IS.. ENOOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENOOUNTERED DEEP HOLE OBSERVATIONS MADE BY: -�70 LC�(6T 71 Dom: 19 8gc� "� I o•l DESIGN Soil Rate Used 31 -45 Min /1" Drop: S.D. usable Area Provided Soon No. of Bedroans 3 Septic Tank Capacity _ ooze gals. Type Absorption Area Provided By !o ©ca L.F. x 24" width trench Other 2 0 %M . irk L- Name J , "Z, *Fo LC 1 -(L-.T T" l ;� AS- eEy . • Signature Address ,�?D , �v�C S 4 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. SEAL � r Checked by Date PUTNAM COUN'T'Y DEPARTMENT OF TH - DIVISION OF HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS C (Name of Owner) REVIEW SHEET — CONSTRUCTION PERMIT DATE REVIEWED: BY: (Street Location) DOC[II�YrS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other ' House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Pr ravity Flow Fill Profile & Dimension .Volume D or J Box;Trench /Gallery; Pump pi details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes. Design Data T-wo -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc.& Deep Holes Located Representative of Sewage & Expansion Area Expansion Area;shown;gravity flow,suff. size If Pumped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains- Curtain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' from Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same A S BU I l-: D A T,A ' t K W, ir,•ucture'located from survey by surrjey:ar noted peloa® y oli locoted py: Su[veyo'rs survey. `t ;WeH ;drilFOr i reyort . ► 1_, _x ;.✓ /F'`�1 6MQr✓ x ,T _r f ..En Lnejo �oauran{ental]. Tank, boxse, pt4s,.gall0rles d laterals loia,tediby. :Lontroct,I Y F N74 t k« ;.. r } 4 r i • i 9 Q }'. • _ t 1 s K 3 9pe by sp.t �, do o' n n j o©p t.r �_ .: -- - . �. :,•:•�.���•�l- ,��f�iT._' �� IG I„) - ° - - n' �n`aanoor �.c:.t,� �- �.'i%�� } Rloi'd In ttlo i d . "i;b,'F�l��1,:� %I �, cv" o � ,,: . � `� '� � 4" _G. ✓'' .. � � �' � _ is . J t . r c �ect,ify #hrt4, - -the t,L•z.* -"x,gt •, ,a _ I. - -11.. .'{l G/ BOO "-� '" L� ��1� " 'l N -_ to • ? f.� r.., t < dd ,. sY sUem -.:as cac�stiut rd', asIl . r r 1 .t a'`{.'N.: I'll kdared oii' thie plan and rhot1'rhr.: s °j,'��'' - ;e {,. j J • : »ay.� � ^_ system wa'� "o-nsJiecGed ¢y,.me -• '.FU. '- L- Jn,_.,:,..•:- - ..� ' -:L/ - - .:,0,5 ,i.. _ .•aan bvered OVer. The .5.Y6C rti'.was j r4� �� f 'Ganet':Ci1e d if I - ' Il � �, 1 -r �l t� c a��o� dHnce ui_tG•'•ull ,' ..- _`Etandard- %�rvl.n.:and l�oCions o1 ".i...� � ._. • •: - . .. �. Yj,.-., • :: �� , ' ��t � :- �' - .. - - - r 4he N_C..}i "..D, lti laiK' N. Y_ S•.:U.H.. " I' . _ -- -- -- V D1WENSIONS� •f.'- A C a_3�T.70 7P - C a_✓ QU �` 7 IC i �07- r A. - @ ti_'.�vYg~ I... A - F i2r- -7 - F flt A A- ti c2- a_ H a if - rutnam County Department oY hbalzL on of Environme ta. Health Service. roved as notod for conTormanoe with licable Rules and Regulations of the. .. namm.CouuntyyHHe IttthDepartment. S,5ANITAR " S X STE' M �D —ES —IG `A•S5UILT° LOCATION Street: Town:�%��-�Q�-,/N/ Couniy: =�_� tote Block'. _ — — LOT Ns_ - �r - - - - -- ��� - - - -- eutlder:���19L�7-— CQ/�.�— — — — — — — -- Surveyor:_1LlAl�4.�GL/_%— — — -•— - -- D-rown: D.��Q• Dote: /O -oJI" Scale: // JOHN H PR ENTISS PE 9' e 1.5- qi* dZ Z' 00,151 W 9 17 C11- 96V C) -14 'A"VL -.1i-LdT5 1,41:) Qc)cl vi 01 ;gig j SIBS 1Z Y09 Noll nr 10. 101 o y A 'A"VL -.1i-LdT5 1,41:) Qc)cl vi 01 ;gig j SIBS 1Z 90 9 'A"VL -.1i-LdT5 1,41:) Qc)cl vi 01 ;gig j SIBS 1Z