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34. -2 -35
BOX 13
01447
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01447
Wan SUPPIYe PbbUc Sgpply F5rom :' . Address
OP Private SoPPiY: d by P j= P-- �,y 'one. Address P ('9'e L3r, R. 3 rr,.�c -�.'M `t. '.1 Ok-6 q
Bis"M Type .
Lot Size H.as Erosion Cnnit-nl Roan Cr,mnleYnA9
Namba of Bedrooms Hea.Garbagat Griinde ;'Been installed? 6
Other Regidremerits
I certify that the system(s) as listed serving the above premises were,constry ted essentially as shorn on the plans of the completed wrk f copies
of,which are attached),. and in accordance w th'the standards, 'rules.and regal ions, in accordance with the tiled plan, and the permit issued by the
Putnam County De tment of Realth.
Oats / / Cailifted by F.E. IRA.
Address Liana No :54f3R i
Any person occupying promises saved bythe above system(i) shall, promptly take
conditions resulting from such usago._ A,ppioval.of the•;taWa ie laweraya'sy m
available and the .approv 1 of the private watsr; supply shah beconmi null and . old
wbjoct to modif lion or Change when- in tM juilgi"M of the.Commi-
c
Oats By.
3/89
I
Lk hOctio n as may. be necessary to secure the.correa tlon of any unsanitary - —me null and void as soon as a pubti: sanitary sewar becomes
a public supply becomes available. Such approvals we
Health; ion; modification or change Is
' TRIO
sl`� CO,.
_
WELL UUMYLL'11U1V AZrVA1
- DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUINAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
WELL LOCATION
STREET AOORESS: TOWNIV10alelly TAX GRID NUMBEit:
Fair St. Carmel, NY Lot #29
WELL OWNER
NAME: ADDRESS:
Windsor teaks Assoc.,83 S.Bedford Rd.,Mt.Kisco, NY
❑ PRIVATE
0PUBLIC
USE OF WELL
1 - primary
2 - secondary
® RESIDENTI <1 ❑ PUBLIC SUPPLY O AIR /COND. /HEAT PUMP 0 ABANDONED
O BUSINESS ❑ FARM O TEST /OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL O INSTITUTIONAL ❑ STAND-BY. p
MOUNT OF USE
YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE
_ gal.
REASON FOR
DRILLING
.QREPLACE EXISTING SUPPLY ®TEST /OBSERVATION []ADDITIONAL SUPPLY
®NEW SUPPLY (NEW DWELLING) O DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH 510 ft.
STATIC WATER LEVEL 6o ft.
DATE MEASURED 12/13/90
DRILLING
EQUIPMENT
XX ROTARY ® COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT D CABLE PERCUSSION O OTHER (specify):
WELL TYPE
O SCREENED ❑ OPEN END CASING I.X OPEN HOLE IN BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL LENGTH 41 ft.
MATERIALS: L3 STEEL ❑ PLASTIC O OTHER
LENGTH BELOW GRADE 40 ft.
JOINTS: O WELDED f9 THREADED O OTHER
DIAMETER 6 in.
SEAL:. ® CEMENT GROUT O BENTONITE OOTHER
WEIGHT PER FOOT 19 lb. /it..
I DRIVE SHOE. ® YES ❑ NO
LINER: D YES ®NO
SCREEN
DIAMETER (in)
SLOT SIZE
LENGTH (ft)
DEPTH TO SCREEN (It)
DEVELOPED?
DETAILS
FIRST
O YES ONO
HOURS
SECOND
GRAVEL PACK
❑ YES
❑ NO
GRAVEL
SIZE:
DIAMETER
OF PACK in.
TOP
DEPTH ft.
BOTTOM
DEPTH It.
WELL YIELD TEST It detailed pumping
METHOD: O PUMPED i tests ere done is in-
were
I
)DECOMPRESSED AIR , formation attached?
O BAILED ❑ OTHER ❑ YES O NO
WELL LOG if more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
Water
Bear-
in9
N!e1I
Oia-
meter
FORMATION DESCRIPTION
cone
ft
It.
WELL DEPTH
It.
DURATION
hr. min.
DRAWOOWN
It.
YIELD
gFm.
Surlace
23
Drilhng
in overburden clay & bld
s.
H
t 4ock
at 23'
10
6
485'
6
23
41
_Drijing
in rock set cawsi.ng grouted,
.1c granite-
WATER O CLEAR TEMP.
QUALITY ❑ CLOUDY HARDNESS _
❑ COLORED ANALYZED? ❑ YES ONO
ANALYSIS ATTACHED? O YES ❑ NO
STORAGE TANK: TYPE Well Xtrol 203
CAPACITY 32 GAL.
PUMP INFORMATION
TYPE G i hm a r G i h l a CAPACITY 5_ _
MAKER Gould DE?TH 460'
MODEL 5ES07412 VOLTAGE 230HP 3/4
WELL DRILLER NAME P. F. Beal & Sons c ATE 2 1
AOORESS PO Box B SIGs
Brewster, NY 10 509
3/89
�r
APPENDIX I
PUTNAM COUNTY DEPARTMENT OF HEALTH. .
DIVISION OF ENVIRONMENTAL HEALTH SERVICES.
VJtf\ (_
LAA_
I(9 ASSC)C
Owner or Purchaser of Building
(DOSS Assm.
Building Constructed By
"S,
Location - Street
Section Block Lot
L1/
Tax Map Number
fou m 'I V V S 1 DI/A
Subdivision Name
?Ockx- s O
Municipality Subdivision Lot #
SJ"& f:-1
n AA 1 1 6 f 9
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,
.rul.es...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 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
utiltizing the system.
The undersigned
determination of the
Services of the Putn
or not the failure o
or negligent act of
Dated this - day
enteral co
further agrees to accept as conclusive the
Director.of the Division of Environmental Health
am County Department of Health as to whether
f the system to operate was caused by the willful
the occupant of the building uti izin the sy "te
of }� 1911 S i g n a t- i_r_e:._
44--uhu' vl�e Pr csi0 w Title
E
wner) - Signature
Fo ey Dev. of Patterson Inc.
W'ndsor Oak Associates
Corporation Name if Corp.
83 S. Bedford Rd. Mt. Kisco, NY 10549
Address
S.A.F Septic Systems Inc.
Corporation Name if Corp.
P.O. Box 141 Cross River, NY 1051E
Address
,......_.. -- . BREWSTER LABORATORIES.. --
Box 224 - BREWSTER, N.Y.
(914) 279 -4945
- WATER ANALYSIS REPORT -
SAMPLE NO. 7945 TEST WELL
SOURCE: Windsor Oaks Lot #29
Carmel, N.Y.
COLLECTED: 1/23/91
BY: P.F. Beal & Sons, Inc.
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
0 per 100 ml.
This result indicates the source of the sample was
of satisfactory sanitary quality when the sample was collected.
:/25/91
O wetli 'Doom - oi1t "''01 Ilwfilj, M1i1 thi M convemtign,t1
M tiMwNtN to-. ties Oepsrbwent. aim a- written "Mann
gilace ; ilY :pnd aiafatlilg ennitlNnl tirjir : hart of •w° a..i
anq of ,the grnwN • qf the CertUtcati of coeftilidion .
wM N locate/ f){ Mown M tM app►oirM•psen aM tgat saW �
Cowety Qe1MtwAWA O/ A. ..
� direst
A/MMVE0 iOil CON Ti etucTl6ki TMs Npie"l gOirM
gsauMse foI it be driynM/ or in"Ifted whin'
wwi.ea • /neww, �Awrdeatt te. "As
n'
Oete AV
assign aid location ,of the proposed systanr(p: 1) .that the =Altil sewage di sped ."awn .
Iandinant than to and in accordance with the standards, ruses am n1u ..
f a "Certo"is, at Conitiuetidh - Cenlvliatloe" tatisfaetory to the t:amniMlOwar M ksealthwill
Y be furnished the owner, his *ICearOrs, Mtrs or, easlgns tiY eM twNdo, tbN Old builder will
IUYCgI sytnm during the ps►1e0 of two (!) vows hnimaiii q following.thedate'N thi'tww
psence of the original sysarn or.aft ngrirs tawatos Z) that tM drNled wall deeotitM aiese
iH tN Instal a00onOnes witip tow standards, ruses and 1`41-0110 ef :, the; 'titMn1
frot 0
eM Oetn.issuae unless construction of the building has eani undnrtakan and is
MOasO►y ;Oy t -MACofn q►ipioner of Minh. Any Mange Or afterotion of .construction
y WIT a ivati water supply onty. D
TRIO
Q. COG 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 # P4ry
WELL LOCATION
Street: Address / - Town/Village/City, Tax Grid Number
�l®iv 2,
1�
►Siva .
WELL OWNER
Name
Mail ' ng � 'SOW
r;r3a 'IS
�Wrivate
FDe DE
/_ -Q� o �v P �
O Public .
USE OF WELL
ORESIDENTIAL
® PUBLIC SUPPLY Q AIR /COND /HEA OP
0 ABANDONED
- primary
® BUSIHESS
O FARM O TEST /OBSERVATION
O OTHER (specify
2 - secondary
® INDUSTRIAL
O INSTITUTIONAL O STAND -BY
AMOUNT OF USE
YIELD SOUGHT gpm /# PEOPLE RVED /EST. OF DAILY USAGE__�al
O REPL.kCE EXISTING SUPPLY ® TEST /OBSERVATION Q ADDITIONAL SUPPLY
REASON FOR
DRILLING
NEW 'SUPPLY
NEW DWELLING ® DEEPEN E IST NG WELL
DETAILED
,I {P
Sug ie t'9
REASON FOR
�-
'DRILLING
WELL TYPE
DRILLED
®DRIVEN
ODUG
®GRAVEL
® OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: ► . SU13 D)v S)
Lot No. aj:21
WATER WELL CONTRACTOR: Name •Tg Address : D� s
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _NO
NAME OF PUBLIC WATER SUPPLY: T�/VIL /CITY PC, g0V1
DISTANCE.. TO- -PROPERTY FROM.' NEAREST WATER t�f�elN: 4.41
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
N SEPAR1.,TE SHEET
l (date) (signs
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 sha a appropriate action to assure that
any and all water or waste products from such well filling perations be contained on this
property and in such a manner as not to degrade or oth a contam a surface or groundwater.
Date of Issue: /2 f— 19 Q-0
Date of Expiration /2-/4!- 1912, Permit Issuing Official
Permit is Non - Transferrable White.copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
APP —7\D _TX 3
P"-7--\_..M C-CLTI\'7'.v Cf_ == CF F_-E=iLM - D1VII-SICN CF
TIH SL.: _a:
Su?P_Ty & SUF_cURF�A=z SHW-z =-- D---SP=--r S'YS7:-ys
I-ed
0 C.
HE
YF_5` I NO DMMIE�,-TS
Per-m-it A7,01ication
Co:rocrate Resolutilcri
pians -
EnC7; ==-'s
Ees-Iguil Data Szheeat (DDS)
Eole Log
COnSzzerlt Perc. Res' s
P=
__-c sole Deoth
C/S
rCN
Cad
Holse plans - Two Sets
Wall
va r; e s
7-S -al Sub divls I on
SUbdivision Am-or-Oval Check=_j
Lx` ' OPrGVal S; S Pdj. Lots Checkad
R & D)
an DDS Plans &
na
REQU= D=E-.-A_ILzS ON
sewa::7_3 Sjrsta-tl plan ar.--CW)
a"e Svs am Hy te =LL.1;c _V
_i C
Vol=
D or i
Sez)-tic - slze'
7•-:-,= Over
rat
EeS'-', -an
Tlwc�-Fc'ot conto'_s & Proocsa
Dri-verway & S_I oLj.t
w" -
F00—, ng//Gjtter, Oar— in Drains (d_iS&__=-:7e c-:c)
& Deeo "E-C.Ies L.-- -= =?_''
ReepreSeatative oF z)--- a:-
y and
Flay, =-.Ze
II P=-ed Pit & D Zmcx S"
n & Deta i= ed
House No. of Bed-roa--s
Wells & SS:DS'S wlin 200 -ft. of proocc=,4
-
prooertv [fetes & Boun is
Necessary
tolls-
House Sewer
C_ �
No Ban as; IMay . 450 W4__eE_11 C)L:-
S E RA�t= 0 N' D T C: r- S7 E)=1_1___I) ON PL.__N
F 4 ald s
P.L., Dri-.7e�wav, =-ge Treesj'Ttc cr Llf
-C) Well; 2001 in D.L.O.Dj 1501 is
�o St-ream, Watercourse, L=-_j:e
Dr=
ca-tch has in,
10' to rater Line (ors -29')
50' int_-_-mittent co-=se
Se:)tic Tanks
10, f_rQii Foundaticn7 50, -0 we,,l
1-i Well to Kr
PUTNAM COUNTY DEPARTMENT OF HEALTH
.Division of Environmental Health Services .
APPENDIX L
AFFIDAVIT - CORPORATE OWNER APP1iICATION
FOR PERMIT APPLICATION SUBMITTED TO
PUTNAM COUNTY HEALTH DEPARTMENT
TO: Commissioner of Health
y -i-�c l ►� -* ee:4- Su G�c m
si oh
In the matter of application for: ``'�
�h�IVIC�U�i D 5 41�C� t/Uc, �et^ Sur���y -or L0+ oV 0.�..
a•
Secretary: _RDIe
_ (Name
Treasurer:
��u(7oi�y
Y
represent that I am an officer or employee of the corporation and am authorized
to act for Ve o qh .CU. p e44-4- eeso,, _15-7C.
Name of Corporation).
having offices at �3 3 -: 50L, �. 3ec%Fnel leC7G.d
Whose officers are:
President:
Vice- President: SPYMwe
e .r._,
ami and Address
:O e
ame hnd Address
9-_
SOu-F -%t �GCI�OrC� �OriC�
%� +• k'1 Sc v l�l�l l it tC-1 �7
and Address)._ -.
Tr !'L!� -, �lScv M-� fosq�.
-and Address):-4
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 sub's Q_uent acts-relating -'
thereto.
i
Scorn to before me this WS day Signed:
of Lv�L 19 7v. Title: Id"
�,�
Notary Public
R
MARIA HARD04AN
Notary Public, State. a Now York
No. 49344;41
Qualified in Westcheker County-)
Commission Expires May 31,.1 !
8/84
Corporate Seal
PUIMM COUNTY DEPARTMENT OF HEALTH o-r
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
P-4 i4e .
.... DESIGN .DATA .SHEET- SiTBSITFACIE DISPOSAL SYSTEM . FILE -W.
F,ojey DPVejCP;"e, -1+ Gv. _ - �-
Owner c4 + ,eeSeg.? 10 hic., Address,? W K;S t--
Located at ( Street) �h v1 ��' 17r� Q l 1 Y S-} Sec. 7 (0 Block Lot 14-
(indicate nearest cross street)
Municipality Rcj .441'SD h L—r Watershed
SOIL PERCOLATION TEST DATA RDQUIRED TO HE SUBMITTED WITH APPLICATIONS
Date of Pre - Soaking Date of Percolation Test
HOLE
NUMBER CI,OC;R TIME PERCOLATION
PERCOLATION
Run Elapse Depth to Water From
Water Level .
No. Time Ground Surface
In Inches Soil Rate
Start -Stop Min. Start Stop
Drop In Min /In Drop
Inches Inches
Inches
1.
3
4
5
1
2
3
4
5
1
2
3 N.
- Q
4
NOTES: 1. Tests to be.-repeated at same depth until approximately equal soil rates
are obtained at each percolation test hole. All data to'be submitted
for review.
2. Depth measurements to be made from top of hole.
rev. 9/85
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH - HOLE idO. - - HOLE NO.
G.L.
. HOLE
1'
2'
3' _
4' �Q
51
71 it So dq o ri 01
s'
go
-/
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 d Mi./," Drop: S.D. Usable Area Provided
b3:
No. of Bedrooms �`� Tank Capacity ' 6 gals. Type
Absorption Area Provi &41B� L.C��, L.F. x 24" width trench
Other Q, . Z11 �L?Q pF PI E W �a
APW
Name Signatur
Address C U SEAL
`10 05col
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: %%.. -e.
Soil Rate Approved sq.ft /gal. Checked by Date
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GENERAL NOTES
"t
® I Q
1. ALL SURVEY INFORMATION WAS TAKEN FROM SURVEY PREPARED BY BADEY
a WATSON, SURVEYING
& ENGINEERING, P.C., COLD SPRING,!W.Y.
2. 'AS- BUILT' MEASUREMENTS WERE TAKEN OFF THE EXISTING;: BUILDING ON
1/9/91 BY BARRETT,
LANZISERA, BECKMAN i HYMAN ;CONSULTING
DRAINAGE EASEMENT
- - 3 15 02
ENGINEERS AND LAND SURVEYORS,
MALVERNE, N.Y.
,' c
1
b AREA = 40,880 SF.
POINT
= 0.94 ACRES
STRUCTURE
A B
C
tu
=
SEPTIC TANK D
15.0' 45.5'
54.5'
-
DOSING TANK E
17.6'
1 1�
DISTRIBUTION BOX F
25.3' 66.8' -
JUNCTION BOX G
25.4' 70.0'
y
JUNCTION BOX H
27.4' -
58.5'
•s r° X r
_ JUNCTION BOX I
30.0' -
55.0'
°
JUNCTION BOX J
33.4' -
50.0'
o
JUNCTION BOX K
37.6' -
45.0'.
JUNCTION BOX L
42.0'
42.5'
c
JUNCTION BOX M
_
45.5'
39.0'
JUNCTION BOX N
51.0' -
35.5'
DISTR /BUT/ONBOX
JUNCTION BOX O
55.5' -
31.6'
':
�+MN °
JUNCTION BOX P
60.4' -
29.0'
DOSING TgNK f ° ~/ ✓ P OROPBOX fTYP.J POINT Q
•84.0' -
5 114.5'
POINT R
84.5' -
111.6'
/000 GAL. SEPRC
POINT S
85.0' -
108.8'
TANK
POINT T
84.5'
105.7'
54• FRAME
POINT U
65.5' -
1102.7'
DWELLING ae
POINT V
87.0' -
100.5'
POINT W
88.4'
y 98.0'
31
POINT X
_
88.0'
93.0'
POINT Y
89.9'
89.8'
O
POINT 2
_
90.8'
t 87.0'
OeJO, ^
Putnam County Department of Health
m ° N
Division of Environmental Health Services
t
_
WELL.
Approved as noted
for conformance with
r
150.00 S9-38' • W
DESIGN INFORMATION app Rules and Regulations of the
;
H/GHV/EW DRIVE
Foablu
3 BEDROOM HOUSE CO'n�
PERC 'RATE= 40 MIN. /INCH
ealth Department
/�`{_���
is
is
LATERAL LENGTH REQUIRED= 600 , }_nature & Title
D to
LATERAL LENGTH PROVIDED= 600 LF
FILED MAP• P/94, FILED /211q186
ONE REVISION tE Y
O�
FAIR STREET sum mow
yqP
JOS Eph
LOT P9
yA
TOWN OF PATTERSON
. NEW Y04K
cl)
MAI. N.Y.
15/ej 39 9 -766.V
THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WAS CONSTRUCTED AS
.
eti R /OQE• N.Y. 11961
•'^ --• --• •w - ^^ (7/Q/.9Y7 -7270
INDICATED ON THIS P�AN AND WAS INSPECTED BY A REPRESENTATIVE OF OUR
�i^ eV NO.: 6939 DANJAN.
O,oq 9$ '/
/99/ E�
OFFICE BEFORE R WN(g Z`Q�� �DDS:OVER THE SYSTEM WAS CONSTRUCTED IN
�,
�6
_50'
/ I
ACCORDANCE WITH ALL STANDARDAUL'ESPAND REGULATIONS OF THE PUTNAM COUNTY
°f rA
"AS- Bl//LT " SSDS a WELL
DEPARTMENT OF HEALft*p xmr; ;N_EW.'(OAK STATE DEPARTMENT OF HEALTH.
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