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01440
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OUTNAM COUNTY,
QEPA4iMiNtOvHFALTH
twl"otgii vbvnmeafalji esiltb Sesvlcea, cie" N.YO;11 12
�4
SYSTEM
Town *WFbap".
S4
- Nun
P.-Mid-Kap 'is
.9 SUMV. -.Lot
edn'g ITO 'Tank em -7 ZQ
digon S�idc
L-; U-, L-a; -tegicA
W111,W SIMPlyi PtiWs
. Supply Address'
b7 C-
on— -kv� Supply DMed Addrm P6. ox 19 Az"9-�
Mddb. 51,11 -Has
Typ, �-Lot Si S14F Eros ioA Cantral
RPPn rnm�j t-�Pd 17 %e�s
Nmibe El.=,Garbfte Gftdw Been-instaned?
Otbar R"Wimments
I certify that the system(s) ai essentiali y as shown- an the plans of the'completed work copies
ps.., in
of which are attached), and in accora"ce°with.tfie standards leg. and r accordagrj9p
'Ith;;* pe, c:.
with plan, and
with filed a the permit issued by the
Putnani Dew-t" t Of As&
`76 201 7" 0
Date Cartiffid b y
Address
LT
L 1" no No. 05
occupying premises ser"d-by I ti� - *,.Ib mcii sition:,as onay_ba npcasssry t ' o secure the correction of any unsanitary
Any person P!dmqtl
conditions r 'Itinj f0orn such usato;- AP00481,of, thi,sipirsti'swOr syst shill boOcir6e-null and-vold as'soon as a pu!2�?-. Unitary sewer becomes
esu
's6p
wailabN and the approval of this private i4itir.: iuvply, siuill'becolne. nu and, v wheri 'F4b
:water pi y becornes available. Such approvais w*
subXt t tio or change when, in the judgment of theA; rmnmi of in..--
9�77'f k 0 7, D�
revocation. nmdlfkMWn or chanOa Is nagessery.
Date By
Tit
3/.89
WELL COMYLE'ELON "- -rUtcl
DEPARTMENT OF HEALTH
Divisian Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office UsLely
STREET AODRE55: WNW 1 TAX GRID NUMBER:
Windsor Oaks Fair St. Carmel NY Lot #3
WELL LOCATION
WELL OWNER
NAME: ADDRESS.
Windsor Oaks Assoc., 83 S.Bedford Rd.,Mt.Kisco,NY
❑ PBIVATE
❑ PUBLIC
USE OF WELL
1 - primary
2 - secondary
XXRESIOENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
REPLACE EXISTING SUPPLY ®TEST /OBSERVATION [ADDITIONAL SUPPLY
NEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL
DEPTH , DATA
WELL DEPTH 285 ft.
STATIC WATER LEVEL 30 ft.
DATE MEASURED 8/23/90
DRILLING
EQUIPMENT
OCROTARY )0 COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING nCOPEN HOLE IN BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL LENGTH 41 ft.
MATERIALS: ® STEEL ❑ PLASTIC ❑ OTHER
LENGTH BELOW GRADE 40 ft.
JOINTS: ❑ WELDED ® THREADED ❑ OTHER
DIAMETER _.5— in.
SEAL: aCEMENT GROUT ❑ BENTONITE ❑ OTHER
WEIGHT PER FOOT 9 1b./ft.
DRIVE SHOE: ® YES ❑ NO I LINER: ❑ YES UNO
SCREEN
-- DETAILS
DIAMETER (in)
'SLOT SIZE
LENGTH (ft)
DEPTH TO SCREEN (it)
DEVELOPED?
FIRST
_ _ ..
❑.YES. 0 NO
HOURS
SECOND
GRAVEL PACK
❑ YES
❑ NO
GRAVEL
SIZ
DIAMETER
OF PACK in.
TOP
DEPTH fL
BOTTOM
DEPTH It.
WELL YIELD TEST I It detailed pumping
METH00: ❑ PUMPED tests were done is in-
® COMPRESSED AIR , formation attached?
❑ BAILED ❑ OTHER ; ❑ YIS ❑ NO
WELL LOG )f more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SuaFACE
Water
Bear.
ing
well
Dia-
meter
FORMA71ON DESCRIPTION
cDOE
ft.
tt
WELL DEPTH
ft.
DURATION
hr. min.
DRAWDOWN
It.
YIELD
gpm.
Land
25
D rillLng
in .overburden clay & bldr
IEH
t
.,rock at 25'
2851
6
265,
6
2
411
Irill-ing
in rock,set casing,grout
d.
hi
9R C�
Ir-il-Ling
in ruck granite,
WATER ❑ CLEAR TEMP.
QUALITY ❑ CLOUDY HARDNESS _
❑ COLORED ANALYZED? O YES ❑ NO
ANALYSIS ATTACHED? ❑ YES ❑ NO
STORAGE TANK: TYPE WeliXtrol 203
CAPACITY 32 GAL.
PUMP INFORMATION
submersible 5 g•
TYPE Gou CAPACITY
MAKER DEPTH __.,r
5ES05412 230 z
MODEL VOLTAGE: HP
WELLDRILLERNAME P.F. Beal & Sons AT Inc
s ��12� O
ADDRESS PO Box B SIOATURE
Brewster,NY 10509
{
APPENDIX I
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Owner or Purchaser of Building Section Block Lot
Building Constructed By Tax Map Number
Location - Street Subdivision Name
Municipality Subdivision Lot #
Building Type
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 tfie:Putnam County Department of. Health,'
and' hereby, guarantee to the owner, his successorst heirs, or .assigns,
to place in good operating condition any part of said constructed
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
utilizing the system.
The undersigned further agrees to accept as conclusive the
determination of the Director of the Division of Environmental 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 building utilizing the syste
Dated this ay of 19LO Signature
Title V j
pfieral C tact Owner - Signature
f�Onr QLbG�O /tea►( %_�O• Ot' J4^f '
Co pora ion Name if Corp.
83 N. Ake,5
Address 16006
Corporation Name Mf Corp.
PC) l�(
Address
l
f C) ��
BREWSTER LA
Box 224 - BREWSTER, N.Y.
(99 4) 279 -4945
- WATER ANALYSIS REPORT -
SAMPLE NO. 7 819
SOURCE: Windsor Oaks Lot# 3
Carmel, N.Y.
COLLECTED: �) - 6 - 9 0
BY: P.F. Beal & Sons
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
TEST WELL
0 per 100 ml.
This result indicates the source of the sample was
of satisfactory sanitary quality when the sample was collected.
m
Once of -tow.
WN, be N, WAIft.
Date
i"OVIED
fovol�i for
Rev.
10/88 Date
In
r of Health will
lW1306ifigi will
it et thi im-
*sWilled above
'the Putnam
R.A.
Inl4i".6";.alon of the bull0knobas. been undertaken and Is
Rismatm Of H"ItIL Any Chen." Qf'AltfrSti0ft Of COhlIfUdiOn
I witef SUP06 Only.
Title
DEPARTMENT OF HEALTH
Division of Environmental Health Services
110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310
1,PPLICATION TO-CONSTRUCT A WATER WELL Q
PCHfl PF.RMTT A
WELL LOCATION
Street Address Town Village City Tax Grid Number
o„ <�.,d <jL46.chviSton - Lz f
WELL OWNER
USE OF. WELL
1 primary
2 - secondary
Name Mailing Address
°� r►-1eh - o: p* ,4kesz"r7 t -4 L ;sc iW
)R RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP
® BUSIVESS ® FARM O TEST /OBSERVATION
® INDUSTRIAL b INSTITUTIONAL ❑ STAND -BY
' 1
Private
0Public
® ABANDONED
OTHER (specify,
AMOUNT OF USE
YIELI) SOUGHT S'5 gpm /# PEOPLE SERVED /EST. OF DAILY USAGE__gal
0 REPLACE EXISTING SUPPLY O TEST/ OBSERVATION 13. ADDITIONAL SUPPLY
' NEW SUPPLY NEW DWELLING ®DEEPEN XISTING WELL
- V vo C. wee r- ` ti r^ F�� w2 ��
ht Si/ /visi&''
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
WELL TYPE
DRILLED ®DRIVEN ®DUG ®GRAVEL
0 OTHER
IS WELL,SITE SUBJECT TO.FLOODING? YES NO
IF WELL .IS LOCATED IN A REALTY SUBDIVISION., NAME OF SUBDIVISION:
Lot No. L'-OT> U► V
° 8 O �� iDs o r
WATER WELL CONTRACTOR: flame RF �� "% Address: Bre: -jam
IS PUBLIC MATER SUPPLY AVAILABLE TO SITE: _ YES No
NAME OF.- PUBLIC WATER SUPPLY: �� TOWN /VIL /CITY j' "��0i'1 (T
DISTANCE TO PROPERTY-FROM-NEAREST-WATER MAIN: A/4
LOCATION-SKETCH & SOURCES OF CONTAMINATION PROVIDED
`JON SEPARATE SHEET
(date) (signat )
PERMIT
TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted tinder 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 proviO4 by the Putnam County
Health Dep rtment.
Date of Issue:_ 19
-�--- TeRhit Issuing c a
Date of Expiration: la- 19 copy.- H. D. File
Permit is Non - Transferrable Yellow copy: Building Inspector
Rev. 10/88
Pink Copy: Owner
Orange copy: Well Driller
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental. Health Services
APPENDIX Z
AFFIDAVIT — CORPORATE OWNER APPLICATION
FOR PERMIT APPLICATION SUBMITTED TO
PUTNA.M COUNTY' HEALTH DEPARTMENT
TO: Commissioner of Health
In _the matter of application-for: i—Gcir �ji-I�e2,F S(I�JC11UlSlocl
Jndlold(4et [ 55/D S 01tid (t4 -�e.r Su �• _. Or Lof A/o,
I) t-10 (-r /' t—o to V . 1r_
represent that I am an officer or employee of the corporation and am authorized
to act for V- p f h •�- CO . p �G f-�-PrSo• -� l'? C
Name of Corporation)
having offices at �3._. SOc/��. �3-ec/TO -d )Z44
M-�-. Kisco AJV lUSy!
Whose officers are:
President:
Vice— President
Secretary:
Treasurer:
(4l
S-
al•eY J r' —
;Nam and Address)
PVML4eI tole
8 3 SOL44 -L7 �cd�Yd 12o�c{
4 SC O /\ /,i 1110.%'1
.(Name rand Address)
' (Name land Address) g _Sou-- _ 64d. 111_ OCr -d.-. :...
pct L41 � FO
-and
and that I am and Will be individually responsible for any 'and all acts of the
corporation with respect to the approval requested-and all subsequent acts- relating
thereto.
Sworn to before me this day Signed:
of 190 - Title: /2G�S%���•r
Notary Public
. MARIA HARDMAN
Notary Public, State of Now Yo*
No. 4934641
Nolified.in Westchester Cowrtv,
C.'&titt. tssion Expires May 31, 192
8/84
Corporate Seal
APPEOIX B
PLT-_-'1R CGUNTY L :E":A�—L-I+'T OF F- EALTHH - DI4ZSICN OF EM LT Sr-R4i
L��IVZ!I -.L inT� SUPPLY & SUBSURFACE _q'- GE DISPCvrr, SYS_S CES
of L� r)
cue S r J
CCNS_'2UCTTCN P,:—, SST
;;Y:
(Street Loco -lion)
I YF- S I DOMA -SITS
Pernit Applica=tion
Corporate Resolution
Plans - Three sets
Engineers Aut-hori zaticn
Design Data She`t (D )
Deep Hole L,-)g
Consistent Perc Res-alts
Perc Hole Deoth
Pre -1969
Neighbor notification t
Lr^ trench provided _
required
60 ft. Max.
Par?1le1 tc
100% exp.
e
FILL SYSTj S
_10 ft.
fill notesVi-
new spec.
death sauces
100 yr. flood elev.
200 ft. reservoir, etc.
50 ft. uric =11 %,Hall.
^orr�tou_r3
D
s/s
Su_�:.v SIGN
Per;.
(3) Fill �-
cd ----
House Plans -Two sets
well p'�t; R S lett;.r
Variance Remuest
Legal Subdivision
Subdivision P -oproval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Tcrw-n /DEC Pe-rui t R & D)
Data On DDS Plans & Pei :nit ,rte
REQU=- - DFLA-1:1S ON PLA_NIS
Sewage System Plan - (north arrow)
SE-gage System Hydraulic Profile
_Fill Profile & DL ensi cns - Vohr:e,
F1 CW
D or J Bax;Trencn /Gallery; aa-np pit c_- ils
Septic Tan.' - Size, Detail
Well Detail, Sergi ice Line if over
Construction. Notes •- (•grinder rate)- -
Design eta: Perc and deep results
I T'wo -Foot Con tours his ting & ProDOS
Drive °aa _
I Food C Gutter fain Drains (dischar• e OK)
Perc & Deep Holes Loo=ted
Representative of pr?1-n;.ry and e_x ansion
Expansion Area ;shorn ;gravity flaw,suf_. size
If Pub Pit & D Box Shoran & Detailed
House = No. of Bedrooms
Wells & SSDS's w /in 200 ft. of Propes_ Systers
I Property Metes & s
House Se=_pa Necessary (Tig lot)
House Sue - 1 /? " /ft. C" C; ype pipe
I No Bends; I�`ax. gas _o w /cleanout
SEPARATION DIST =.NOES SPECIFIC ON Pll' -�:
Fields
10' to P.L. , Drivewav, 1,:--ge Trees,rzp of fill
20' to Foundation Wails
100' to Fell; 200' in D.L.O.D, 150' pits
100' to Str -ate, jtia }e_coL2 Irse, L2Jce (_:.c. et an)
15' to Dra i _^. S L
�- �.ir�. -.i , Leader, Foot._ -!7
35'to tca sin,sto= -r,:ain,aio� w�- s-cosrse
10' to Water Line (pits -20')
I 50' intermittent drairace course
Septic Tanks
10' from FoLndation; 50' to well
15' Well to PL 0
PUIMM •• [JNTY DEPARIMENT OF
DT
DIVISION OF ■• •' ' 1N Y• L HEALTH-SERVICES
.....DESIGN DATA.- SHEET SFWAGE, DISPOSAL SYSTE- K,.._..__.,.
._ .:_:. = -1 "gin ._ -.
217 '
ley eve Q� �� S. Owner. j2r, -f-� ch , 1 H c Address ���-d �, 1-0-41. JUI W 16'S 5
Located at (street)Aibviec-� /'>�/ r*,.- f�- sec.7(p Block Lot/
(indicate nearest cross street)
Municipality 'R, Or Watershed
Date of Pre- Soaking
Date of Percolation Test
HOLE
NUMBER CLOCK TIME PERCOLATION
PERCOLATION
Run Elapse Depth to Water FYoa
Water Level
No. Time Ground Surface
In Inches Soil Rate
Start -Stop Min. Start Stop
Drop In Min /in Drop
Inches Inches
Inches
1
2 Pert Tej Moo I )OCL
4 "Qr °'1p1�''U ✓�� �rj�JG(IUfSIa� -, '�jgh 1PY%�1�PG'%
1 `
2
3
5
1
2
3
4
5
6 CJ aJ '
NOTES: 1. Tests to be repeated',�at same.,depthl until approximately equal soil rates
�
are obtained at eh� 6Al Lon• test hole. All data to' be submitted
for review. IN 0 ' , ":w °' }_, '3 .
2. Depth measurements _to -_b- ;made`, fran top of hole.
rev. 9/85
s,
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.
1'
2' ppIt Res l
3'
4'
6'
7' QyC SLf�+/ISl�h g� S�PUQ �.r
81 l��,h
9'
10'
11°
12'
13'
14'
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: DATE:
DESIGN
Soil Rate Used 1�D Min /1" Drop: S.D. Usable Area Provided
No. of Bedroans _ i' Septic Tank capacity 12_ '� gals. Type
Absorption Area Provided By _72- t% L.F. x 24" width trench
Other
Name _�VQ�l AAkHrino PE , Signature
Address -5,4 U L/e ,y — S� i M SEAL
elo n Awl A tAl
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
OF NEW
f
ty �
Z
\CFO ry °• 059$$x' G�
Soil Rate Approved sq.ft /gal. Checked by Date
JUNC770N BOX
I
LAND NOW OR FORMERLY OF LUEW'G
107.86
5 3'3311- W S 3.08'49" W 9.82'
- f9.16� AREA
.40
,009 S.F. S•
0.92 AC. 3
i�
a N.
M -4 a1
1 �• //I / � DISTRIBUTION BOX
VG TANK
GAL. SEPTIC rANK
GENERAL NOTES-
1. ALL SURVEY INFORMATION TAKEN FROM SURVEY PREPARED BY BADEY &
WATSON, SURVEYING :. ENGMEERING, P.C., COLD SPRING. M.Y.
2. 'AS- BUILT' MEASUREMENTS WERE TAKEN 0/14/90 BY BARRETT,
LANDSBVA BECKMAN 6 HYMAN CONSULTING ENWJEERS AND LAND
SURVEYORS, MALVERNE, N.Y.
1
STRUCTURE / POINT
SEPTIC .TANK C
DOSING TANK D
DISTRIBUTION BOX E
JUNCTION BOX P
JUNCTION BOX G
JUNCTION BOX B
JUNCTION BOX I
JUNCTION BOX J
JUNCTION BOX K
JUNCTION BOX L
JUNCTION BOX N
JUNCTION BOX N
JUNCTION BOX O
JUNCTION BOX P
JUNCTION BOX Q
POINT R
POINT S
POINT T
POINT U
POINT V
POINT M
POINT X
POINT Y
POINT Z
N POINT AA
POINT BB.
POINT CC
n�QQ,� DESIGN INFORMATKNN
HICPH o4/YeLItfS 4 BEDROOM HOUSE
Division;of Environmental Health Services PERC RATE- 80 MINJINCH
LATERAL LENGTH REQUIRED- 667 LF
Approved as noted or conformance with L/ATHIAL L.1= K 9H PROVIDED' 720 LF
app t ble Rules and Regulations of the i ;
to County Health Departme OAS T 9 JOSEPH yOg4
t�lAG
q-. .� 3
Signature & Title t ~ s
. � z
THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WAS CONSTRUCTED AS y
INDICATED ON THIS PLAN AND WAS INSPECTED BY A REPRESENTATIVE OF OUR m�
OFFICE BEFORE R WAS COVERED OVER. THE SYSTEM WAS CONSTRUCTED IN
ACCORDANCE WITH ALL STANDARD RULES AND REGULATIONS OF THE PUTNAM COUISTY �OFESSIONP�
DEPARTMENT OF HEALTH AND THE NEW YORK STATE DEPARTMENT OF HEALTH.
"A.
19.0'
31.8'
24.0'
24.0'
24.5'
27.0'
29.5'
34.0'
38.0'.
43.0'
48.0'
53.0'
58.0'
63.5'
69.0'
85.0'
84.3'
85.0'
86.0'
89.0'
90.3'
91.0'
93.5'
96.0'
98.3'
101.5'
104.6'
CONTNOL PAINT
66.0'
63.0'
58.3• 1
53.7' !
49.5'
45.4'
42.5'
39.1'
37.1' ;
35.8'
35.5'
36.0'
37.8'
110.4'
106.6'
104.8'
103.3'
102.2'
101.2'
97.8' i.
97.7'
96.1'
95.6'
96.1'
96.0'
FILED MAP / 2194, FILED 1211PI86
"DD"
15.9'
29.4'
FAIR STREET sum V /S /ON
LOT 3
TOWN OF PATTERSON NEW YORK
MALVERN--• N.Y. 11563
eev fB /Q1099 -36,v
.
R /DG£,• PAY. 1196
'99.19 "0c ,1990
/Of/
;4S- BUILT" SSDS 8 WELL i
�i
�T