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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 24. -1 -20 BOX 8 1 jj--6 rL 00743 1 �t PUTNAM COUNTY DEPARTMENT OF HEALTH � DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIAN y , PCHD CONSTRUCTION PERMIT # (OG 4'(0 Located a ' C-0 oy I-W /�-e AD Town or Village _ Owner /Applicant Name �D09,4 x&614 /g Tax Map Formerly Subdivision Name Subd. Lot # VV-E TREATMENT SYSTEM I T Sa A) (7-) _ Block Lot 2-0 Mailing Address !Yf Co Vk-rp -Y 41 L(_ R,,,4 A-, '01z&Ws %e7L /V Zip Date Construction Permit Issued by PCHD q —q — q Z Separate Sewerage System built by ktCLAMM I ULM Address W &2or— �) J 12-S-71 Consisting of (,S © Gallon Septic Tank and S�?v L-1- — IET T7Z.-tUJ0- Other Requirements: 2 �1 C U '( TA//V h /Z_A/ // � 6 O Water Supply: Public Supply From, Address or: Private Supply Drilled by UV Address O� /u 9 % 17r --Building Type W LW O "& Has erosion control been completed? 4es Number of Bedrooms 1 Has garbage grinder been installed? 00 I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- duilt 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 Address .I Z 4e-1-1— P. E. /\/ R.A. ZAI 7 License # S_ 3 2-7 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 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 revocation, m dification change is necessary. By: Title: Date: &107 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 rjjMIMIMiI V. VIUfMdd 1A1MIMIMIeS�IMIMSMd/ 1/. IV. lA1Mf MtMIRA7 1U1 MIMIM[ MtM.II A: MIMeMIM[ Md/ IAIMIMIMIMI! lA1RN6AG .U.�YM1��N�irt�lll�IMIMIN�LM 1 y r - / y ® is / ® ® ® � ' e e '■ ® � '� liiid1111: II4NV11f ildl/!11/yNdtilHOdlfblGtilHy7yti1' �i " s�/HiYHdWifdNl- 1(1171(H;:NI'i6� �fllll:il111i11111dyTHi/1' "/ iiVIVlNll vl-' 1V�111 11C1iti1i111' 1£ Y/ y` iYVf� lNR1/V.� ® "�1NV1N�/v1"/IH111 11 AUG -18 -00 SAT 8:54 AM PUNAM CTY ENV HEALTH FAX N0, 19142787921 D PUTNAM COUNTY DEPARTMENT OF HEALTH- -- DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building r, Cam . t Building Constructed by C , u, Location - Street Building Type Tax Map Block Lot Subdivision ame 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 fora 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 fiirther 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. Day '� Year _&0 1 Corporation Name (if corporation) Address: LOOT— I�c�"�.-/ 1A1L, g State �QC I�l.___r_ Zip i Q� Signature: Title: i JT Corporation Name (if corporation) Address: State Zip - Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Co ,'�1 f�/ Town/Village: ��s'w, -7 Tax Grid #� Map Block Lot(s) Well Owner: Nam" e:: Address: /) AN Use of Well: 1- primary 2- secondary Y, Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing JC Open hole in bedrock _ Other Casing Details Total length 1/l ft. Length below grade �O ft. Diameter & in. Weight per foot Imo% lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded X Threaded _ Other Seal: JL Cement grout 3( 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 Test _ Bailed _ Pumped Compressed Air Hours Yield %S gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) T / Depth of completed well in feet 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 - - - - — If yield was tested at'different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth Model Voltage HP Tank Type Volume Date Well Completed Putnam County Certification No. v rate of Report Well Driller (signature) NOTE: Exact location of well with distances to at least two permanent landmarks to be prima on a separate sneevptan. iosz/ nt 5Z Well Driller's/Name kud A-t- S `oc �O Z17C Address: C/ mE' AJ V X66 - Signature: rte' Date: White copy: HD File; Yellow copy - Building•Inspector; yPink copy - Owner; Orange copy - Well driller Form WC -97 .UCE R. FOLE tie yedth Director LORETrA MOLINARI R.N.; M.S.N. Anoclate P•I.btA- U9411h Dircomr Dlrectar of Pa.'ient Samcas DEPART1ViENT OF HEALTH 1 Geneva Road Brewster, Now York 10509 1wa*a0aiesa1 Haalt6 (914)278-6130 Fax (914) 298.7921 Nvr-la2 9er dca ('914) 27$ - 6558 WIC {514) 278.667! F=014)271-6095 Xsrly laterveatlae (914) ?78.6014 Presckaol (914) 27840n Fax (914) x78 - 6648 OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS: TOWN: AMORIZED TOWN OMCIA1,: (Signature) DATE: 2 l 4 The ,Putnam County Department of Health wall not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (69 1 I VEREluwij 4� dcc y -a/gex, !nt7:R _m- zL-,Aen !CRf1!R'AbLA `nnlTUa -OTCW4 1=11AIW . 41) MALI iuec A N� . NORTHEAST LABORATORY OF DANBURY f 39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404 (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 LABS INTERPRETATION OF LABORATORY RESULTS �ii�' In New York, the Department of Public Health QDPEO uses a combination of standards and advisory levels to help consumers interpret their water test results. Their excess does not necessarily mean that the water is harmful, but it might indicate that the source of the problem be found and corrected. For specific questions concerning your analysis, or any treatment your are considering, contact the Laboratory or your local Health Department. Coliform Bacteriological Test): This test is made to detect organisms of the so- called coliform group, found mostly in the intestinal tract of man and other animals. The presence of coliforms indicates the possibility that disease- producing organisms may also be present in the water. Limit: 0 /100 ml. Color: Color may result from iron, manganese, humus, plankton, weeds, or industrial wastes. No designated DPH MCL limits. Odor: Odor is a subjective evaluation of acceptability of the water. Not to exceed a value of 2 on a scale of 1 to 5. PH Value: pH defines the hydrogen -ion concentration in water and represents the aggressiveness of the water toward pipes, etc (a low pH being more corrosive). Recommended Limit: 6.4 to 10.0 range. Turbidity: This test measures the light scattering property, of solids in water as compared to a standard clay suspension. Limit: 5 Units. Nitrogen Constituents: These may indicate sewage or other nitrogenous organic contamination. Nitrate Nitrogen in excess of 10 mg/L is potentially dangerous, particularly for infant feeding. Limits: Nitrate: 10 mg/L as N; Nitrite: 1 mg/L as N; Alkalinity: Alkalinity is a measure of alkaline substances such as hydroxides, carbonates and bicarbonates with capacity for neutralizing acid. No designated limits Hardness: Hardness is primarily a measure of calcium and magnesium in water and is related to the soap - consuming power of water. No designated DPH MCL limits Iron: Excess iron results in color and trubidity. Iron stains laundry and fixtures orange -brown and promotes iron bacteria which can impact a taste and odor. Iron can be removed with a water sofener, iron filtration or I ion exchange. DPH MCL:0.30 mg/L Manganese: Manganese causes black stains on laundry or fixtures. Manganese is removed with a water softener, iron filtration or ion exchange. DPH MCL: 0.30 mg/L Iron plus Manganese: DPH MCL: 0.50 mg/L Sodium Persons with high blood pressure, hypertension, congestive heart disease or persons on a low salt diet should consult their physician before consuming a source with a high sodium level. DPH GUIDE:20 mg/L for people on a severley restricted sodium diet. 270 mg/L for people on a moderately restricted diet. Lead: Lead is a metal formerly used in soldering joints in plumbing systems. It is now prohibited, but many houses still have lead in their plumbing systems. Lead can build up gradually in the body and can have effects on the brain and nervous system. Action Level: 0.015 mg/L. Note: mg/L = Milligrams per liter N= NitrogeN ml= Milliliters NTU= Nephelometic Turbidity Units DPH = Department of Health N� NORTHEAST LABORATORY OF DANBURY 39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404 j,A$$ (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 4TH •> > LABORATORY REPORT REPORT TO: MR. & MRS.. PECCHIA 31 COUNTRY HILL ROAD BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLE POINT: SOURCE: TREATMENT: AS ABOVE KITCHEN SINK WELL NONE TEST PERFORMED RESULTS BACTERIAL: DATE SAMPLE COLLECTED: TIME COLLECTED: COLLECTED BY: DATE RECEIVED @ LAB: TESTED BY: LAB LD.# REPORT DATE: • Total Coliform (Bacteria) 0 per 100 ml PHYSICALS: • Color (Apparent) 0 • Odor ND • pH. 7.68 • Turbidity 0.55 NTUs CHEMISTRY: METHOD # SM 9222B EPA 110.2 EPA 150.1 EPA 180.1 • Nitrite Nitrogen <0.005 mg/L as N EPA 354.1 • Nitrate Nitrogen <0.20 mg/L as N SM 4500D • Alkalinity 99.0 mg/L SM 2320B • Hardness 107.0 mg/L EPA 130.2 • Iron <0.03 mg/L EPA 236.1 • Manganese <0.01 mg/L EPA 243.1 • Sodium 5.9 mg/L EPA 273.1 • Lead <0.001 nig/L EPA 23912 3/8/2001 9:30 A.M. F. PECCHIA 3/8/2001 LAB# 11471 NY -018 3/14/2001 MAXDIUM CONTAMINANT LEVEL (MCL) OR STANDARD 0 per 100 ml 15 3 Units No designated limits 5 NTUs 1.0 mg/L 10 mg/L No defined limits No defined limns 0.30 mg/L 0.50 mg/L Combined limit for Iron plus Manganese = 0.50mg/L 20.0 mg/L ** 0.015 mg/L * ** ml= milliliter mg/L=milligrams per Liter ND =none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count * "Notification Level ** *Action Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: MOTABLE or UOTPOTABLE RESULTS BASED ON SAMPLES SUBMITTED:3 /8/2001 w 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 Before a Certificate of Occupancy for a dwelling is issued by the local Building Inspector, a Certificate of Construction Compliance for the SSTS must first be issued by the Department. The Department must be notified before the system is backfilled in order that an inspection of the completed system can be made. Open work inspections may be omitted only at the discretion of the Director or his designated representative. In order for the Department to issue a Certificate of Construction Compliance, the following must be submitted: (Note: All submitted Department application forms shall contain adidnat signatures (no photo copies)). Crtificate of Construction Compliance. (See Appendix K) Pe cc-, 1� a. The Construction Compliance Permit is to contain the assigned "E 911" address issued by the respective municipality. The "E 911" address is to be provided at the "Located at " section on the permit form. The followin f� �k* telephone numbers are offered for the agency assigning the "E 911" addresses eq within the municipality: Carmel: Building Department Philipstown: Building Department 628 -1500 265 -3929 Kent: Building Department Putnam Valley: Town Planning 225 -3900 526 -3740 Patterson: Town Planning Southeast: Building Department 878 -6319 279 -5698 A Construction Compliance permit will be issued without the current "E 911" address. ' t2. Three (3) copies of a two (2) year guarantee, signed by the installer, and/or general contractor, or the owner. (See Appendix K) 3. If the water supply is from a drilled well: /gym G Satisfactory results of a water analysis, for the parameters in Table I below, conducted and reported by a NYSDOH approved laboratory under the "Environmental Laboratory Approval Program (FLAP)." 1� �PX A$L ly � 1:x�H�!,�.d�.� �artp< � . CONTAMINANT MCL (1)(4)(5) Coliform bacteria Any positive result is unsatisfactory Lead 0.015 mg/l (15 ug4) Nitrates 10 mg/l as N Nitrites 1 mg/1 as N Iron 0.3 mg/1 Manganese 0.3 mg/l Iron plus manganese 0.5 mg/l Sodium No designated limit (2) pH No designated limit Hardness No designated limit Alkalinity No designated limit Turbidi 5 NTU 3 NOTES: (1) Maximum contaminant level. (2) Water containing more than 20 mg/l of sodium should not be used for drinking by people on severely restricted sodium diets. Water containing more than 270 mg/1 of sodium should not be used by people on moderately restricted sodium diets. (3) NTU means Nepbelometric Turbidity Units. (4) mg/1 means milligram per liter. (5) ug/1 means microgram per liter. Boyd Artesian Well Co., Inc. R. D. No. 5 Rte. 52 Carmel, N.Y. 10512 (914) 225 -3196 PAUL PECCHIA EG_ CONTRACTING 107 FAIRWAY DRIVE CARMEL, NEW YORK 10512. WELL LOT. #4 COUNTRY HILL RD. PATTERSON, NEW YORK NOVEMBER 10, 1999 MOBILIZATION $ 200.00 DEPTH: 305' @ $8.00 /FT 2440.00 CASING: 41' @ 9.00 /FT 369.00 DRIVE SHOE 75.00 YIELD 15 GPM TOTAL $3084.00 TERMS: Full payment due upon completion of drilling — . A Well Completion Report signed by the well driller, including the results of at east a 6 -hour pump test (See Appendix K). A minimum well yield of 5 gpm is required. For yields less than 5 gpm see Appendix F for procedures on performing a 24 -hour well pumping test. The results of the 24 -hour pump test are to be submitted to the Department for review and a determination will be made regarding utilization of the well for supplying potable water to the dwelling. If the new well is found acceptable, then the procedures for determining the minimum potable water storage requirements, located in Appendix G, are to be utilized. If the water supply is from a public water supply, satisfactory results of a coliform bacteriological analysis of a water sample taken from the service connection, performed by a laboratory approved by the NYS Health Department "Environmental Laboratory Approval Program." Three (3) sets of "as- built' plans, signed and sealed by a. Design Professional, licensed and registered to practice in New York State. These plans shall be to scale (minimum 1 inch to 30 feet horizontal) and shall include: a. Surveyed house location with respect to property lines. The plan shall make reference, by note, to the source of survey. b. Metes & bounds description of property lines. c. Actual locations of installed SSTS and water supply improvements. 'd. "The distances necessary to locate the septic tank, distribution boxes, junction boxes, ends of the SSTS and well from two fixed points, preferably the comers of the building. e. The plan must include a legend, which reads as follows: "This is to certify that the sewage treatment system was constructed as indicated on this plan and that the system was inspected by me before it was covered over. The system was constructed in accordance with all standard rules and regulations of the Putnam County Department of Health and the, New York State Department of Health." The "as- built" plans must also include a title box, giving the information required on the original design drawings. Minimum size of "as- built" plans should be 11 inches by 17 inches with a minimum scale of 1 inch to 30 feet. g. Space for Putnam County Health Department approval stamp (minimum 3" x 5 ") preferably at the lower right -hand portion of the lan. Fee - See Appendix I. After the Certificate of Construction Compliance Permit is issued by the Department, a copy of the Certificate of Construction Compliance Permit, Well Completion Report and approved "as- built" plans should be brought to the local Building Inspector for processing the Certificate of Occupancy. The local municipality should be contacted for their particular requirements for a Certificate of Occupancy. zx, Z 9G Date wC -_�?- ______, , 9 BUildirvg Permit No. Office of Building Inspector TOWN OF PATTERSON PUTNAM COUNTY. N. Y. 878 -6319 APPLICATION FOR BUILDING PERMIT _ t Application No. 2448 Zone District _.1 — -- Variance Case No.. Application is hereby made to erect >' alter ( ) remove ( ) repair ( ) demolish ( ) addition ( ) pursuant to the New York State Building �Construction Code. Location of Premises— Street or Road Tax Map Number Z4 °' ZQ —_ Frontage ®l____ Depth _ 0 Rear 400 OWNER ��Vi CF A ° ADDRESS l�� &A PHONE No. I Name of Contractor __ ��1� ��, � � `�;`� ADDRESS FAt P_�I-" RNONE No. U_33 Plumbing Contractor's Putnam County License No. A Electrical Contra Use: EXISTING No bulding shall be occupied or used in whole or in part for any purpose what a'Certificate of Occupancy shall have been ,granted by the Building Inspector. PLOT DIAGRAM Is made for and DIMENSION OF BUILDINGI Width Depth Stories X x Existing X x Proposed X x With Add. Estimated Cost ........$ .............. Application Fee This application must be accompanied by two sets of complete plans and specifications and ail Information required by the Zoning Ordinance and such additional information as may be requested by the Building Inspector. I, knowledge the applicant, construction. does Total F e = (� ? ignature of Applicant Receipt Approved ❑ Disapproved C3 Reason Remarks: certify that the above statements are true to my mw Zoning Ordinance Low or Regulation. Lease, I ng Inspector FNDTNS. BASEMENT ConstrueHon . _ INTERIOR ADDITIONS Stone Part Wood Rooms Rooms Concrete Blocts Brick Full Cement Floor Finished Steel Brick" Concrete Apt$. _No. Baths Bedrooms _ Porch Garage Bath Garage Stone PLOT DIAGRAM Is made for and DIMENSION OF BUILDINGI Width Depth Stories X x Existing X x Proposed X x With Add. Estimated Cost ........$ .............. Application Fee This application must be accompanied by two sets of complete plans and specifications and ail Information required by the Zoning Ordinance and such additional information as may be requested by the Building Inspector. I, knowledge the applicant, construction. does Total F e = (� ? ignature of Applicant Receipt Approved ❑ Disapproved C3 Reason Remarks: certify that the above statements are true to my mw Zoning Ordinance Low or Regulation. Lease, I ng Inspector x ' i 1 11 � So So � 0 a '1 lot*. 4a So 50 5o 9 Iy 1' n 10 .1 Q N l S CA�Lf� 101 A LO l 5 OAS BUILT rl MEASUREMENTS - i3 14 )52; tLf 3 NO A 1,50'le $ REMARKS 11 .,Lf t �(o' C, Nov T v, to 1 -5Ocj*• COti1 C, S� 1G RNlL 3 I t 1 3g `�� IT80 x 2� T(P\ 1 coZ Ito? 171 8 5 L79 l� 101 A LO l 5 rl 1-7 rr i3 14 )52; tLf 3 170 16) 13 15,E 3 3 v, I Lo). I q4 v - IWO is 2� t G � .... . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: / zze a Street Location - ��,c /'7 �7 Y �f�� � Owner � Inspected y: - 7E r %� .�� ,,QZ �q 7Z��n L T-Y Town FF',�a ZI c r1-5 ,L' Permit # 'p - l e, g TM # 2,q _ Subdivision Lot # -f 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. eptic tank size - 1,000 .......7T 25� ........other ................ b. Septic tank installed level .::: :::...... ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1 outlets at same elevation -water tested .............:... 2. Protected below frost ........:......... ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... ............................... f. Trenches T�ngth required Length installed 2. Distance to watercourse measured .7 �anFt.......... J. 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 ...............:.. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 1 %2" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................:.. _10. Pipe ends capped ......................... ... ..................... g. Pump or Dosed Systems. Size o 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. House/Buildin a. House located per approved plans .. ......................,........ b. Number of bedrooms .................... /?` ...,, !'�!t.........:. IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured /,!!2U ft........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship 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 STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 6/97 r vrm .5 1 -.3 v ov, e ION == .. MM% .M r vrm .5 1 -.3 v ov, e FUTNAM COUNTY DEPAR22EM OF HEALTH \ DtrYaR et Srkoaidl Hei116 Sesdiee, Carttwl. N.Y Ii1612 M Ps�alde Feandt CO Iv F FOR SEWAGE DI4F01AL SYSTEM Lee�tad it lse . ' ewa ar v ®I Set oYw Tai MP __ _jk . - � t� 0 e older /s�o.it ere Re"Id'" ❑ e.f Pf*VI a M�ias ABAw Z TA Town ZIP Date subdivision °Apnrlved Fee - _Enclosed amn;int Darts 1YPe f�r'T_72r Lot Are. l �i o �, b� Fm %cim 0* Nlta�berd it3 tab . a vd o m d WbPCHNoUdatl a Fm is o.� pDe Deft Fk- G , P D S� w$1111 Sr►eees_ sydia ti o mt 41 auoe S pec T et and—,'- , ' Te 6e owr4tacbd bj Adlhon Water Sw*. // Ftlbec Sep* Fromm � Addteea aei u patvite Sglpb D'r*" by r ' _Ad I i�prsnsnt' that I am wholly anA compNtely responsrbb foi tM de}ign and location of the proposed system(s). 1) :that the separate aw ' di al stem abovb described will be'oonit►ucted as °shown on the approved airiendmentthere to and in accordance with the standards, rules ano regu ns or nam County Oapait' * of Heelti -- and ;that on:compNtan tf a►eot a Cartificats of Const►uctioq,Comolianp': satisfactory to the Coenmiaionar,of Nealthwill be "mitNO to tM':peparte nt' and i written: guarant�a. will tia furnishiri tM owoar,'his sucasaors, Mkt quip bY.tAe buikter, that Yid builder will pMCe in 'pooA oparatinp condition MrY, pert` of said iiirrale'dispossl tystam during the period Of two;(2)..yaar$ l lab following tindate of the Isau- anOp of -the apprOwl .of the Certificate of Cgnstructbn; Compliance of.toi piginal' stem ;or an y• irs.t t be drilled well described a6oire well a bceied as'awaawn on tM'a_ op►ow0:plan and that said well willtre Installed in .a "` :with ;t. ' a d 'equSligns of 1 the Putnam Ceunty' RnNrlt of HMlth: _ /� Date 1v` Si/naA P.E. v R.A. _ "fir Address IclOnse No APPROVED FOR CONSTRUCTION TINt approvil expires two yeais ore. hp date, issued unNss construction of t buiktirry .hit been under ken and if rewou ie.for cause or may be nreri0�d or moAineA when consider ry -by the mmissione► of Health. Any change of alteration of construction "quires -a .M Per it. Approved for dilp Ul of domestic sae ;and/ irate water Supply only. . Rev. 1088 *at- By ' Title I 0 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New.York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL l> PCHD PERMIT #�%i�1`7�' WELL LOCATION Street dress U-y o Village City Tax Grid Number ."• WELL OWNER Name V Ahill Address © Of rivate D Public E OF WELL 1 primary - secondary RESIDENTIAL D PU LIC SUPPLY O AIR /COND /HEAT PUMP 0 BUSINESS O FARM O TEST /OBSERVATION 0 INDUSTRIAL CIINSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify, O AMOUNT OF USE YIELD SOUGHT gpm /# O PPLACE EXISTING SUPPLY ffjNEW SUPP N DWELLING) PEOPLE SERVED /EST. OF DAILY USAGE &a: gal O TEST /OBSERVATION 12-ADDITIONAL SUPPLY 131-DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE MdILLED DRIVEN DUG 13 GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Garr, / 6U--"' 7C Lot No. 4- WATER WELL CONTRACTOR: Name T;;> 1-o' Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES L,-'NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH .& OURCES OF CONTAMINATION PROVIDED PA TE SHEET V 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 mariner as not to degrade or othvqse con minate surface or groundwater. Date of Issue• C 19 1 -�- I Date of Expiration 19 PeGit Issuing Official Permit is Non - Transfer able 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 Re: Property of��(L�l Located at Subdivision ofc� til ock Lot O Q Subdv. Lot # Filed Map h Date Dr. MICHAEL DALY, P.E. Gentlemen: CONSULTING ENWNE0 P. 0. Box ?A3 This letter is to .authorizew_ sM9096RN���T__� a duly licensed profess*onal engineer Sol or t (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 mks promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in conne.cti,on with *his 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. Countersi P.R. , fit..* Very truly yours, Address Q. jgCHAEL DAFT, p.6. COKSULTING EKGMEER p. a nay 30V &HjMOROCC, N. T.! 14507 i Telephone r 0 V r .. rasa I Otis Yequireftemb . . ur_ c r r . ur_ 1 i1 gr l► Ljc�nn r r v 1 represent that'l, am wAO11Y.and.compNtely iesponabN fa ten dasgn send location 'of, the propose system(s); 1) that the.separate sews e, aft otal system above described will be constructed .1 shown on'tho eppro�ied arnendment there to and in accordance with the standard; rules an —Q a ions o e n county Dopartment of os*A i, and that on eompNfion thereof a•:Certificato of Construction CompliancN' satisfactory to the Commissioner of ""Ithwill be submitted to the Oep rtmonli -and a written ,guarontoi-wiii.be, furnished the owner, his succomors, heirs assgns by the bulkier, that sew buikler will Wee, kt good, opengrlg eon0ltbn my part` oI `w W, awago 'diS"es' system during the perk►d of two (2) s Immediately fo110wirig tMdate of ten isau- soce of ten. approval of the Certificate. of Construction Compliance of the or or a repair eto; 2) that the drilled well described above win be lotsted t on the approved plan and that'sekl well will be Instal wi the b ruNs and rpu a�Ti n ; of . the Putnam County O menu 67 , Oita ®` Q Signed P.E..V-- R,A..� A�Cldrou License No- APPftOVEO FOR CONSTRUCTION. This approval ompires two yeaia from the data issued unless construction of the building has been undertaken and is fevocable for cause or may he amended or modified when considered necesyiy by • the Commissioner of Health. Any change or alteration of.comtructbn gquNes new„ permit Approve for disposal of domestic 'senita,ry "sewage, and/or ate water supply only. r g Mile Title 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 #P- (v(O-;P)b_ WELL LOCATION Street Address T� Village City Tax Grid Number z O WELL OWNER Name 5 Z * Mailing Address drPrivate O Public USE OF WELL (D- primary 2- secondary (RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION U INSTITUTIONAL O STAND -BY 0 ABANDONED 0 OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm /# 13 REPLACE EXISTING SUPPLY QNEW SUPPLY NEW DWELLING PEOPLE SERVED 8 /EST. OF DAILY USAGE CcO _gal 0 TEST/ OBSERVATION 13 ADDITIONAL SUPPLY O DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE —ffDRILLED DRIVEN ODUG GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES �-'NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: II.L Lot No. WATER WELL CONTRACTOR: Name 6 : [D Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ✓N0 NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATI N S ETCH b SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET (d 4t (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 su .c h a manner as not to degrade or otherwise conta inatg_surface or groundwater. Date of Issue: lii 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 .,9149625837 PUTNAM COUNTY DEPAKrMENT ().b- .1W, ALTI.-I DIVJCS'ION OF EN VIRONM.ENTAL HEAL' 'I'J11 . SERVICES Date Re: Property of Located at ezx'-)t� ILIJ 001-� (rr 5 J31 * 0 Lo t Subdivision of Subdv,. Lot # filed Map Date P.E. Gentlemen : co"j(- "NSINEER m jr!"i 5 This letter is to au-tlwrize a duly licensed professior.aJ <.-.-Tigineer v--' Or Undic;;;l to apply for a Construct loti Porml.t. for '-a s(�pa.rot-e sewage s ys t. e rn I o se;i7ve the above noted property In accordarco tho standards, P Or2 or regulations as protmAlagiaLod by 'Lhe. Commi.,i,,-�iotior of the Putiiayii Cwta-,ti.tv Department of Health, and •.-c.) -sign all nec.es-z,,a,-1y papers on my behalf 0-i connection–xi.t.h. this me•f.--ter W10 tb supervise '..he construction of -iiai.vt system or systems in conforri-i.ty w:ttb the prow: 4--i-lons of Articlo, 147, Education Law, the Pub.'Itc Jjr,,a.jth. Law, zinc (.'fte Puti-tam County tary Code. 7 Countersigne c P.. B R A. , # Address 1. N10i AM P-A L*, P.E. CONSULTING FLNGINEER. P, 0. BOX 243 Telephone Very truly i gne d 7N owil" • —of _pXr4pe'rty A,J ,J r s s T%oic•i Tel.ophone -, 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 #f-610-86 WELL LOCATION Street A ress ► rTowiWVillage 4 City Tax Grid Number Z -1 - zo WELL OWNER Name 1 Mailing .O. Address /� a5 XXj v � c.. WF. QPPfivate 0 Public USE OF WELL 0- primary 2— secondary OKESIDENTIAL 0 BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION M INSTITUTIONAL O STAND -BY 0 ABANDONED 0 OTHER (specify O AMOUNT OF USE YIELD SOUGHT _ xgpm /# ❑ 4EPLACE EXISTING SUPPLY NEW SUPP Y UEW DWELLING ) PEOPLE SERVED /EST. OF DAILY USAGE 600 gal ❑ TEST/ OBSERVATION LI ADDITIONAL SUPPLY 0 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED DDRIVEN DDUG 13 GRAVEL. 0 OTHER' IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Go(j y -< JA Lot No. dq. WATER WELL CONTRACTOR: Name - ' r"?>;c Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES L--'NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE - -TO- PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED N SEPARATE SHEET �' r (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 thirt, (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 any and all water or waste products from such well property and in such a manner as not to degrade or Date of Issue: - 2Z* 19 - Date of Expiration 9 shall take appropriate action to assure that drilling operations be contained on this otherwise contaminate surface or groundwater. y. 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 a. DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of 52- Located a t Cio u nrz-�( k l'L' V- OAA-) (T) ?PrKeA&50K) Section Block Lot Subdivision of CADIJ011A� qA tA..,, Subdv. Lot # !�z Filed Map # Date T. MICHAEL DALY, P.E. Gentlemen: CONSULTING ENGINEER P. 0. BOX 243 This letter is to authorize SHENOROCK, N.Y. 10587 a duly licensed professional engineer or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said 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 Countersigne P.E., R.A., # 6 b T. MICHA Address CONSULTING ENGINEER P. 0. BOX 243 SHENOROC& N. Y_ insA7 Telephone Owner o PV6perty- --- /. -- - f-0- f�L/�' Address ��ff Town Telephone orb Oil 1ta�aThdia.ri I r•prMNit that 1 • am ,wholly. Mid ianWatilY 1`!WoosNN fw AM L' above dosui0od srilh be aonstiydod at;a non thi ippr i pwlty Oopa!tnlint , de NMRh. ansl that on eompNtbn ;lain M "66ditad .ta! INS Oapwtowet, arid, a wriltin silanntai rt Maoa' M tt •:OPMIW aoi�/Mloii, env port M falb wwiM :anco of tM ;apNwN of tM CortNkaN' of C.0"ructloi� Ca sill be " atoll N a m" on tM approrM plu� aM that aid' Dias Cewlty'OaMrtntaht 01 IpaMli. APPROVED ioftt CONSTOkUCTION, Thb aaMOiial ax twe /ouOiMN fo► caws or M'aelwMr a rnodMiad whpl.corr wnut►ai; pa►ni A»rowd 'for dwiseei of donwst i6v, r MI iiYn ii-k of 6h0' proposed systam(f)i.._1) th. I•tM sa air sna dl sal s stem idil oMtrMaro to and In atcoidniai with the,546ili'rds;rum rqu ns o i ••Cartffkab of: Construdbii CorhWNnea" iatlsficiory to the Commin6o' r of MooNhw ll a funiahod tM.ownar:. his d icessarf; 1141 ,or assilos bY:tha builder. that said buiow,win 1; syitaM a iiq thin oario0�of f" (2)'YOaii Mr- -diatay •fOilawMl� tro date, of the 1sau. lerni -of ill" SysIOM of aMi raplri fIMIRto he A ills/ wont rise ram afbw N•ba Mstilled in aces tha andaid ; o , regulations • of the . putmon nad PC, 5.' ORD L'• N t_ has :48 No 4b8 ars the data Inded unless construrtNn,of the sioildhq has been -undertaken and is l�j //Y bY'rt C)onlnifplonoi ref MMtt11 Any ManN or aKOratioe of construdlon 1 a " l�w watw iiipOty, only � � 1 Title D 0 DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT WELL LOCATION Street Address Town/Village/City Tax Grid Number OPQ 41 W 1zV 0,3 WM Z -I - g.. 0LV 15-4- 19 WELL OWNER Name Mailing Address 6 2— PLAZIA E-Et,T Atoo "mr (LU 2- 1<A -roNA4 rivate O Public USE OF WELL (P USE �2 - secondary RESIDENTIAL O PUBLIC SUPPLY (] AIR /COND /HEAT PUMP BUSINESS O FARM O TEST /OBSERVATION 0 INDUSTRIAL M INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify, O AMOUNT OF USE YIELD SOUGHT S gpm /# PEOPLE SERVED b /EST. OF DAILY USAGE 600 gal ❑ REPLACE EXISTING SUPPLY ❑ TEST/ OBSERVATION 12 ADDITIONAL SUPPLY Mao SUPPLY NEW DWELLING 0 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING NEW 140y5t� WELL TYPE RILLED DRIVEN QDUG []GRAVEL O OTHER IS WELL SITE SUBJECT TO FLOODING? YES _ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: coU✓1TF .Ni w E 5 ?prES Lot No. L/ 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: LOCATION SKET H SOURCES OF CONTAMINATION PROVIDED QN SEPARATE SHEET - 2,A) Q � el� (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 dril ng operations be.contained on this property and in such a manner as not to degrade or o e se contaminate surface or groundwater. Date of Issue: 19� Date of Expiration �' Z� 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 I DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT WELL LOCATION Stre t Address Town/Village/City Tax Grid Number WELL OWNER Name �, aili_ }1g Address D 2- Al, c-Private 1 O Public USE OF WELL 1 - primary 2- secondary ErRESIDENTIAL 0 BUSINESS O INDUSTRIAL /0 PUBLIC SUP P Y O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION U INSTITUTIONAL O STAND -BY O ABANDONED 0 OTHER (specify) O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED fj /EST. OF DAILY USAGE 44100 gal REASON FOR DRILLING WREW SUPPLY OPROVIDE ADDITIONAL SUPPLY OREPLACE EXISTING SUPPLY ODEEPEN EXISTING WELL OTEST /OBSERVATION DETAILED REASON FOR' DRILLING WELL TYPE OV DDRILLED DRIVEN DDUG GRAVEL a OTHER IS WELL SITE SUBJECT. TO FLOODING? YES t-' NO WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name 12 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: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED DON REAR OF THIS APPLICATION � HE (d te) nature 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 s.hall: 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 artment. Date of Issue: De 19�, 19 -— Issuing Date of Expiration: 19 ermit lc1 White Permit is Non- Transferrable copy: H.D. File Yellow co Building Inspector 2/87 PY• Pink Copy: Owner Orancra mny- WA11 , nri 11 Pr a o� � ties PDTNAM COUNTY DEPARTMENT OF HEALTH F 1 F Di,. gut I�tvhonmenfbl Health Serylrea : Carmel. o N Y lOSl? Engineer to Provide, Petmlt,iY- J 7 on cE1tMCATE MP CE / le A Peemtt', N COP MUCTI PERMIT FOR ,SEWAGE DISPOSAL SYSTEM �b. ,oat.0 — :.per on ` own o - r V e SubdMdoul NumOD, 1.46 di`Lot IY Tu Map ) Hloch It Renewal_ It n p 6,ii�Applkattt Name ` AM ('� (� Date of;Previoae:Approval• , MaWngAd�ess Zip ICiJ� l Bulldllsg Type: Lot Aeer .,C) ts� Fill Section 014Y Votimie Number o[ Bedrooms >ii,6 i r in G P. D '��. PCHD Notl6catlod Is Baequleed When FW is oompleteii / Separate- Sewerage,.Syttem to eonslat of l_ y- 1(1Won Septic Teek ".d l � /✓G�1 -- To be obndructed by `,(°5 Address Water su"Ip. Pabilc Supply.From Address or: Pri�va�te,SapP,ly, Drilled by Addeeu Other Requirements' I represent that 1 em wholly: tl com lately responsible for the d sigwand location of. the proposetl system(s); 1) that the separate sewage disposal system _ above d*ribed will be. COisstructed as shown on the approved amendment there to and In accordance with the standaids, rules an regulations o e u nam County Department of Health, •'arid that on completion thereof.a !,Certificate, : of Construction ComDliancs" satisfactory to the Commissioner of Health will De submitted.to the Department •an0 s.wrstten yuarantee_wul be,:furnsshed: he owner his•successors;.heirs or ssisigns by the builder, that siid'builder, will place �n good operating condition :any part ofp saitay sewage - tlisDosail system 'during the period'o1 two (2) Years Immediately following, thedate of the issu- ance of thi approval ;ot the Certificate of Construction Compliance o, the 9, ►fginal systerrl•or a y repair eto; 2) that the alrfllaid ell described. above wilt be looted as shaven On the approved plan and that seed' well will tie installed'= a a:o► ante .wi the a s, rules and r"—u a one ot,„ the Putnam County Department .of � Health Date Spned.:. �G P.E. R.A. — Address • License No QC9C. "! APPROVED FOR CONSTRUCTION Th .� ` _ s r if appr vas�expues two years from the date issued unless con truction of the building has been undertaken and if revocable for cause or maybe amended Or motld,ed when considered necessary by the,Commissaoner . of. Health.' Any change or alteration of construction requires a new permit. Approved lor, disposal Of' dome ,tic sanitary, sewage, Nate w sup ly only. Date t3 –Title 0 n, PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONME171AL HEALTH, SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT DA TE (/ BY: LTIiame of Owner) (Street Location) COMMENTS YES NO DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log REVIEWED: Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Zlz-91Iy3 I �. 0 Sewage System Hydraulic Profile.- Gravity Flow Fill Profile & Dimensions.- Volume D or J Box;Trench /Gallery; Punp pit details Septic Tank - Size, Detail Well Detail, Service Line if over -Construction Notes Design Data Two -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 45° w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 201.to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains- Cartain,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 Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit.R & D) Data On DDS Plans & Pennit Same PUTNAM COUNTY, DEPARTMENT OE;HEALTH Rev. 3/86 1 Division of Environments! Health Services. Carmel N. :. Y:10512: Engineer to Provide Permit q — / �yn/ .C�\ on CERTIFICATE OF COMPLIANCE6 �6 .� \ Penmif q CONSTRUCTION PERMIT FO S- • AGE DISPOSAIi SYSTEM Located at �1.-. Town 'or: VWege Subdivision Names Sabd. Lpt:q Tai Map Biock G4"_ Let S �. / Renewal - Revision ❑ Owner /Applicant Name Date of Previous Approval lyallln'g Address -T Z1- 'PJ O)C Town _��nf 1Z Zip Ballding Type ��� 1 1p E�T �` - Lot Area Z • 3 � AL' L Fill Sectloa Only L Depth volume Number of Bedrooms 4 - p�Design Pow. G /P /D • BO d PCBD Notification Is Required When FIB is completed Separate Sewerage System to consist of ,r iauon Septiel"k To be constructed by Address Waiter. Supply. . Public Supply From Address . . or: privete,Supply Drilled by i �?' �' _Address Other Regnirements -- I represent that I am wholly and .completely responsible for the design and location of the proposed systems) if that the separate sewage disposal system above described will be constructed as shown on thebpproved amendment . there to and in accordance,with the standards, rules an regu n ions o e u nam County Department of Health,. and.that on completion thereof a "Certificatq of Construction.6inpliance 'satisfactory to the Commissioner of Healthwill 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 contrition any part of said sewage` dISOIosal system guring the period of two (2) year ;immediately following thedate of the issu- ance of. the. approval of the Certificate. of . Construction comp liance ' of -the original system or any repair; they o; 2 at th drilled well described above will be located as shown on.tne approved plan.and tfiat said well will be installed 'in ccordan with t stands r s nd u anions — of the Putnam County Department of Hal alth. Signs P,E. R.A Date, � L 3. 1 �8� R.A. s "r; ess - © ;tense No APPROVED R CO STR TION:h This approval' expires o e ea rom the da o s ed 'unle s uc o of the building has been and taken and is revocable for use Y y e amended or modified when cons ed ecessary by t Its H Ith: Any change or: alteration o construeti requires a m' , p oved for disposal of domestic ' t swage, and jCn vat w ts 1 0 Date – BY Title r = bivision Of Environmental H %aAh Services TWO COUNTY CENTER - C, •Mn �N•Y.. 10512 (914) 225-3641 APPLICATION TO CONSTRUCT A WATER WELL IS WELL SITE SUBJECT TO FLOODING? _ YES _/ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:C- 0oaip2,� VkLx_ -_ 7i LOT NO.: 4. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: _ YES ✓ NO NAME OF PUBLIC-WATER SUPPLY: TOv,1 /V /C DISTANCE TO PROPERTY FROM NEAREST WATER.-MAIN LOCATION-SKETCH & SOURCES OF CONTAMINATION. — (date) (5:ignature) 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 W 11 Completion Report on a f rov d by the Putnam C it ty Health D artment. ,r Date of Issue: 19 Pe 4i Issuing Official Permit is Non-Transferrable - I IUWNiVILLAG f I I Y IAX ViU NUM6ER. 'TELL LOCATION �u� «�. To,;;, '�,> -�So►� ,� _ _ NAME. • ADDRESS: tQ�PSIVATC WELL OWNER -�� �Z ���,� _ �;tz •�: O PUBLIC USE OF WELL ('RESIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND. /HEAT PUMP ❑ ABANDONED. . . 1 - primary ❑ BUSINESS ❑ _FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) 2 - secondary ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY Cl MOUNT OF USEI YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED 8 / EST. OF DAILY USAGE OO gal. REASON FOR [NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION DRILLING ❑ gEPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL WELL TYPE I aDRILLED F-1 DRIVEN DUG GRAVEL E] OTHER IS WELL SITE SUBJECT TO FLOODING? _ YES _/ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:C- 0oaip2,� VkLx_ -_ 7i LOT NO.: 4. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: _ YES ✓ NO NAME OF PUBLIC-WATER SUPPLY: TOv,1 /V /C DISTANCE TO PROPERTY FROM NEAREST WATER.-MAIN LOCATION-SKETCH & SOURCES OF CONTAMINATION. — (date) (5:ignature) 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 W 11 Completion Report on a f rov d by the Putnam C it ty Health D artment. ,r Date of Issue: 19 Pe 4i Issuing Official Permit is Non-Transferrable - I Putnam County Department of Fleal th Division of Environmental Sanitation AFFIDAVIT - CORPOJLITE C><+1NER APPLICATION FOR PULMIT APPLICATION '.SUBMITTED TO PUTNAM COI,INTY HEALTH DEPARTMENT TO: Commissioner of Health - In the matter'of application 'for construction ,permit for separate sewage system— _ I, Jerry Weissman _V. Pres.— —;— — _ _ — — — — _ — _ — _ represenp that I am an officer or employee of the corporation and .am authorized to act for '-? = = - -- ame o corporation— ) having offices at Rt. 22, P.O. .Box 377 Brewster, N.Y..10509 Whose officers are - - — — — — — President — Robert Freg _ osi _ - - -- . 7Name `and Address`) — Jerry Weissman Vice- President . . — — — .— .�_..........�_.,. (Dame and Addre. � ss) Secretary — — — — _ (Name and and Treasurer 7: - ...... "7' ....r.. (Name and Address) *and that I am and will be individually responsible for..any or all acts: of the corporation with respect,to the apilrov ested ano 11 sub-.' sequent acts relating thereto. Sworn to before me this day S' of Le 19 Tit1 Notary P&Wlic Notary Putblic,•State of NeW V40 Rmirh . is 1. x -'wnd CD=ty_r Conunis y:rue 'Corporate Seal • PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner . ,ter �l ��•t 4- s ddre s s Located at (Street Block q- Lo. t 5-,4 �Indicatetearest cross street) Municipality�,� -=°� ,� Watershed , cal -Cp !!srp I -P-. az SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME - PERCOLATION PERCOLATION Run No. Start -Stop apse Time Min. eeppt o a er From Ground Surface Start Stop Inches Inches water Level. in Inches Drop in Inches Soil Rate Min. /in drop l 2 0" ..3® 1 3 0 1 0 - 30 ?_ -3 Z C Z 4 `/Z 1 `w Z0 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 submitted for review. 2) 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.�«�3 611 i( 12 11 lZec2� l 1$" 2411 `1 30" 3611 4211 4811 C)'11 .r 660T 1t 0 66" i 1 7211 78" . 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED rt ` INDICATE LEVEL TO WHICH-WATER LEVEL RISES-AFTER BEING ENCOUNTERED TESTS MADE BY i=7 . ( X51 Date RA2,Si!ExC DESIGN Soil Rate Used I - ZDMin/l "Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity Z 5Z3 Gals. Ty �9 Absorption Area Prov.id BY5JA_ L.F.x2411 ,fib wi o Ma—me 7igna ure „- Address SEAL Q4 8.1 ..43 �� SS10i3t�� THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date r- PUTN:AM COUNTY DEPARTMEN OF HEALTH ;c -Division .of En'vironmenfa/ Hea %th Services Carmel N Y--10512 �0 3 f+ "CONSTRUCTfON !PERMIT 'FOR SEWAGE DISPOSAL '.SYSTEM ^ ;.Pa n Town or �I lage Located at East Branch -Road ,(A1K1A boon kb `r Rw , Tax Map a. tig„ ,.,;:.look Subdivision CCounty .Highway No; 65] . Tax Map Wit.# 8 &9.. S,�..#. S:O:,..2027 owner M/M Robert ;Conklin Address ,: Rd .3=256 .LaReshore..Drive" gr -wcter Frame 21:'253 -Acmes . + Building Type —_ Lot Area Four 800 2110. + Number of Bedrooms __ Design flow Total Habitable Space Square Feet Separate Sewera e S stem to consist of 1 250 333 9 y Gal. Septic. Tank and ft. 2' trench X ) leaching pits. To. be constructed by Address _ water Supply: _ Public Supply From Private Supply to be 'drilled' by Address __... —..__ Other "Requirements -I represent that I.am wholly and completely responsible for the design and location of the.proposed,system(s); 1) that the separate sewage . disposal system above described will be constructed as shown on the'approved attachments hereto ,and in accordance with'the'standards, rules and regulations of the Putnam .County bepartment•Of Health; and* that on completion thereof a "'Certificate of Construction' Compliance" satisfactory to the,Commieaion- er of Health will be submitted to the Department;'and a written guarantee will be furnished the owner, "his successors, heirs or assigns by the build-• er, that said builder will place in good operating condition any part of said sewage disposal 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; 2) that the drilled well described above will be'looate'd as shown on'the approved plan and that said well will be installed in accordance with the Stan- dards, rules and regulations of the Putnam County Department Of Health. n Date __January 1983 Signed P,E_ R.A. Address RD 9. - Fai.r S,t.. el N. Y License No. 2920:6• APPROVED FOR'CONSTRUCTION. This approval expires one year from the date "issyed,.unless Construction of the building has been undertaken and is revocable for cause or maybe. amended or modified when considered necessary -by the Co is 'oner of.Health. Any change or alteratio/n�of const 'ction requires a new permit. Approved for disposal of domestics ' ar sewage andjor, pri ate w1y —•< i / Data" By Title' ro. Gentlemen: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date . 12 October 1982 Re: Property of Mr. & Mrs. Robert Conhlin Located at East Branch Rd., T. Patterson Section 69 Block 2 Lot 8 -9 This letter is to authorize John H. Prentiss, P.E. a duly licensed professional engineer XX or registered architect (Indicate) to apply for a Construction Permit for a separate sewage system; to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all -necessary papers on my behalf in LviliieQ LiV11 W-L girl Ul-L5 nta L Lev anLi to. supervise the construe ciuri 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. signe .E.9 R.A ., # 29206 R. D. 9, Fair Street Address Carmel, NY 10512 914 - 878 -6170 Telephone Very truly yours, J Signe d � j ,,;A (yner�of 'e-, e ty 256 Lakeshore Drive - RD 3 Brewster, N.Y. Address 279 -9682 Telephone RED V FEB -1 1983 PUT WA.,srl C0UCiiY DEPT, OF HEALTH,, ..I Gentlemen: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date . 12 October 1982 Re: Property of Mr. & Mrs. Robert Conhlin Located at East Branch Rd., T. Patterson Section 69 Block 2 Lot 8 -9 This letter is to authorize John H. Prentiss, P.E. a duly licensed professional engineer XX or registered architect (Indicate) to apply for a Construction Permit for a separate sewage system; to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all -necessary papers on my behalf in LviliieQ LiV11 W-L girl Ul-L5 nta L Lev anLi to. supervise the construe ciuri 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. signe .E.9 R.A ., # 29206 R. D. 9, Fair Street Address Carmel, NY 10512 914 - 878 -6170 Telephone Very truly yours, J Signe d � j ,,;A (yner�of 'e-, e ty 256 Lakeshore Drive - RD 3 Brewster, N.Y. Address 279 -9682 Telephone RED V FEB -1 1983 PUT WA.,srl C0UCiiY DEPT, OF HEALTH,, PUTNAM COUNTY DEPARTMENT OF HEALTH.- DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM 'FILE NO. Owner �,1 Address &1- 8rr v,cL PJ. (4LLxlg De Located at (Street )l &&a. (..dam . Ma 69 Block 'L Lot ica a nearest cross s rep Municipality Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole ;Number CLOCK TIME PERCOLATION PERCOLATION Run .apse p o % a er a er ve No. Time From Ground Surface in.Iriches Soil Rate Start -Stop Min. Start 'Stop Drop in Min. /in drop Inches Inches Inches, 10,14 11,;14 21L� 1 L3 '+ 4 PUa6-,,1A0, WUN 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 submitted for review. 2) Depth measurements to be made from top of hole. DESIGN. Soil Rate Use' d 0_� YirVl "Drop: S. D. Usable :Area Provided MO ' No. of Bedroomsr Septic Tank Capacity ls. .Type 1�yy Absorption Area .Provided By 33:. L. F. -x24 10NAi width trenc — — g o PRE Other o Address. C _ R "i Y I �'j �c MA-IRD's Ulu THIS SPACE FOR USE BY HEALTH DEPARTMENT ON Or stA� Soil Rate Approved Sq. Ft /Gal. Checke r `_- - / V g01 d T lrbrra Sal ors °Sar_ ✓ey OF_��A� e J+�y,r.R - -` ..dam'' f}-- �. • � s ��c- � . d� yam,.,.- ._ _..�. -, - � r, t �. �_"�`...__..__.,, iwr1lSl�9J2•L.�c2•J .•�V_32fvHu�.�.e� p: �,R••-- ^` "Y�,,,••��•. +. `. ¢� -� ar,Y' P .�•� � l � "r • Lei ,.-- . ��,. �- may-"'' ✓ 1 r . gal ! � � sel,✓ !''ye • � � l ,fa.✓. �sfsw4ls -�"'" �,�,++`'l f,;,,�y- Qn�4�y° I .. o" m LO CA Town 9UBD t1 c p Sigel �ciats:�na _, Build ig�Oa �� Pq,<\� %,,y�\ �1•CV 1 Ora vi \ 1 t :1 f \ iL _ _ f, .'} i. i` .i; r. k ; � a.' .. ,��� -;�, 1"�1 �l'i�.t �L {�Lli•,�I�h }rL }rHfit Q2Tiii Ui'a� %Ol PI r r.. zt - y,. _ / �. -- •er,x t: - ..j • <r �` 1.