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02212
'Rev.- 3 PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Camel, N.Y. 10512
Engineer Most Provide
P.C.H.D. Permit#
Located at
OF
lVelan Nva
SEWAGE DISPOSAL
Pvt own -
va UA
Tax Nyack Lot 21V
1--j IC6 j?/ )e - (,� 0, —4 0112 "-61fA AJ(Subdv. Lot # ldi
Owner/applicant Name Subdivision N
Malling Address e ZIP Date Permit Issued
Separate Sewerage System built by 14 —Address fforakl )761,101tv
Consisting of
Gallon Septic Tank and
,4/ V.
Water Supply% Public Supply From Address
or: —Z - Private Supply Drilled by 141014,01 eAll e,-1< Address C&v6=
Building Type e" G' e- Erosion Control Been Completed?
Number of Bedrooms A41 Has Garbage Grinder Been Installed?
g C4
Other Requirements -4 o ry v
I certify that the system(s) as listed serving the above premises were constructed essentially 4sy,lih ans of the completed work copies
of which are attached), and in accordance with the standards, rules and regulations, in ccor , da lan, and the permit issued by the
Putnam County Department Of Health.
Date Certified by P.E. R.A.
7— – --I'
V, 9
\1,4 OV
.1,4 )� Li .60 No.
Address
Any person occupying promises served by the �1111-- —1y1t--(s) shall promptly take such action re the correction of any ununitary
conditions resulting from such usage. Approval of the separate sewerage system shall become null's as a pubt'-- unitary sewer becomes
available and the approval of the private water supply shall become null and void when a public orator, mss available, Such approvals are
sub ect to modification or change when, n, In the judgment of the Commis Or 'thongs is necessary.
,-5 a oioo
WELL COMPLETION REPORT
Office Use Only
DEPARTMENT OF HEALTH
^. �._;Di° vision=.. Of- �nvironaentahHea� >� #�Se•�- uic�s'- ;- ;.:=� -�, ,.}..��,.- ,.-...�: •-.b , -• =.,`
PUTNAM COUNTY DEPARTMENT OF HEALTH
SCREEN
-DETAIL&. - - -=
�t-
GRAVEL PACK ❑ YES GRA L DIAMETER'�� TOP `--�— BOTTOM�.,�
❑ NO SIZE: OF PACK in. DEPTH tt. DEPTH It.
WELL YIELD T ' If detailed pumping �� L LOG if more detailed formation descriptions or sieve analyses
VU
are available, please attach.
METH00: MPED I tests were done is in- DEPTH FROM Water Well
❑ COMPRESSED AIR formation attached? SURFACE Bear- O'a- FORMATION DESCRIPTION CODE
• BAILED ❑ OTHER ; ❑ YES O NO ft It ing peter
WELL DEPTH DURATION DRAWOOWN YIELD Surface
It. hr. min. It, gpm.
L�
WATER QX6R TEMP. 11
QUALITY ❑ CLOUDY HARDNESS
❑ COLORED ANALYZED? 1594is NO'
ANALYSIS ATTACHED? ❑ YES 040
PUMP INFORMATION
TYPE S V p CAPACITY h
MAKER 0 U DEPTH
MODEL VOLTAGE HP 1
3/89
STORAGE TANK: TYPE cf-A M` 4-ff
CAPACITY GAS �
WELL DRILLER NAME G n
ADDRESS A? j� j sl
DATE AP /
41
STREET AOUAESS: TOWN lVIILAGElCIfY TAX GRID NUMBER:
R�
WELL LOCATION
WELL OWNER
NAME /r AODRESS:
4 i�
( IVATE
O PUBLIC
USE -OF WELL-
ESIDENTIAL ❑ PUBLIC SUPPLY . ❑ AIR /COND.IHEAT PUMP ❑ ABAN00 ED
1- primary
❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify)
2 - secondary
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
AMOUNT OF USE
YIELD SOUGHT --l— gpm. /N0. PEOPLE SERVED _/ EST. OF DAILY USAGE gal.
REASON FOR
.REPLACE EXISTING SUPPLY ®TEST /OBSERVATION [ADDITIONAL SUPPLY
DRILLING
ESNEW SUPPLY (NEW DWELLING) [,DEEPEN EXISTING WELL
DEPTH OATH
WELL DEPTH i ft.
STATIC WATER LEVEL ___,Z_ ft.
DATE MEASURED
DRILLING
O ROTARY ❑ CQ�ILPRESSED AIR PERCUSSION ❑ DUG
EQUIPMENT
❑ WELL POINT ABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED EN END CASING ❑ OPEN HOLE IN BEDROCK O OTHER
TOTAL LENGTH ft.
MATERIALS: EEL O PLASTIC O OTHER
CASING
LENGTH BELOW GRADE' --1t.
JOINTS: ❑ WELDED 94<READED ❑ OTHER
DETAILS
DIAMETER in.
SEAL: 6ZMENT GROUT ❑ BENTONITE ❑OTHER
WEIGHT PER FOOT 1b./ft.
I DRIVE SHOE P4tg— ❑ NO
LINER. O YES &14d
DIAMETER (in)
SLOT SIZE
LENGTH 00
DEPTH TO SrREEM410
DEVELOPED ?�
SCREEN
-DETAIL&. - - -=
�t-
GRAVEL PACK ❑ YES GRA L DIAMETER'�� TOP `--�— BOTTOM�.,�
❑ NO SIZE: OF PACK in. DEPTH tt. DEPTH It.
WELL YIELD T ' If detailed pumping �� L LOG if more detailed formation descriptions or sieve analyses
VU
are available, please attach.
METH00: MPED I tests were done is in- DEPTH FROM Water Well
❑ COMPRESSED AIR formation attached? SURFACE Bear- O'a- FORMATION DESCRIPTION CODE
• BAILED ❑ OTHER ; ❑ YES O NO ft It ing peter
WELL DEPTH DURATION DRAWOOWN YIELD Surface
It. hr. min. It, gpm.
L�
WATER QX6R TEMP. 11
QUALITY ❑ CLOUDY HARDNESS
❑ COLORED ANALYZED? 1594is NO'
ANALYSIS ATTACHED? ❑ YES 040
PUMP INFORMATION
TYPE S V p CAPACITY h
MAKER 0 U DEPTH
MODEL VOLTAGE HP 1
3/89
STORAGE TANK: TYPE cf-A M` 4-ff
CAPACITY GAS �
WELL DRILLER NAME G n
ADDRESS A? j� j sl
DATE AP /
41
W '-.
PUTNAM COUNTY DEPAR'IIM OF HEALTH
DIVISION OF ENVIMNMNEAL HEALTH SERVICES
... ... ,s. -..., ,.•,...�-. ,- .,z,.. ,;, t- .,- :'•..- •w:. ^+,�.:- ...,..�. �..:�+.. _- rr- ,- �•.r�+., "•... yr +.r, .,.•..w.. ..ao ,...r :. v.nn.•: c.. ..�... ..ago... .x... µ a.vo- ..r- •.r�.,.+a•'- .,as.<_o-•.v,. .... .....,.•,...�.
C14 eqfLieS d-- Kaaetj C IsA biariC✓N Y %
Owner or Purchaser of Building Section Block Lot -�
Building Constructed by
Location - Street
eQ4 -w.rn^N
Mudicipality
Building Type
Subdivision Name
5�19
Subdivision Lot #
GUARANTEE OF SUBSURFACE SEDGE DISPOSAL SYSTEM
I represent that I,am wholly and completely responsible for the location,
workmanship, material, construction and drainage of the sewage disposal system
serving the above described proPerty, and that it has been constructed as shown on
the approved plan or approved amendment thereto, .and in accordance. with the
standards, rules and regulations of the Putnam County Department of Health; <.:d
hereby. guarantee to the owner, his successors, heirs or assigns, to place in' good
operating condition any part of said system constructed by me which fails to
operate for a period of two years immediately following the date of approval of the
"Certificate of Construction Compliance" for the sewage disposal system, or any
repairs. made ... by rye to. such - -- system,- except where -. the-- failure - to- operate•- properly ,is - - - -- •.
caused by the willful or negligent act of the occupant of the building util.i :
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 he building utili-, :'ng
the system. 1
Dated this day of _ 19f Signa
Title
G �
General ODntractor (9ows) - Signature
Corporation Name (if•Corp.,)
Address
rev. 9/85
Hilt
Corporation Name (if Corp.)
ess
YML ENVIR0NMENTAL SERVICES
321 Kear Street
Yorktown Heights, N.Y. 10593
(914) 245 -2300
,.., _.. .. �•:... .- ,.- ;....s.,, ,.. :�:.- ., . °�Al r +�•t - �tar:Pad�iv��ia-�" Di�recfinr .� . .... ,.. ..
LAB ##: 32.401436 CLIENT 4094 NON STAT PROC PAGE 1
---------- ----------------------- ---- - ivr+.r. r---.. r.r.r.r. r. rr.. r-r. -iv,.. -r. -.r--- iv.,..r-«.,..,.r..,.... w.
CASARIANCA, CHARLES & DATE /TIME TAKEN: 09/08/94 11:00
5 OAKRIDGE DR DATE /TIME REC'D: 09/08/94 13:30
PUTNAM VALLEY, NY 10579 REPORT DATE: 09/09/94
PHONE: (914)- 724 -3839
SAMPLING SITES SAME AS ABOVE WELL TANK SAMPLE. TYPEo.9 POTABLE
: PRESERVATIVES: NONE
COI_'D BYa BARRY SANDHAUS TEMPERATURE—: < 4C
NOTES ... S COLIFORM METH® MF
I---- ---- -- I-r.I rI rINMrI I.I rJ---- --11 -- V--- ---- -- ----------------- ~ ----------------------
. DATE FLAG- PROCEDURE RESULT NORMAL – RANGE
09/09/94 MF To COLIFGRM ABSENT /100 ML ABSENT
COMMENTS'
BACT THESE RESULTS INDICATE THAT -tiE WATFh (WDHE WAS NOT) GI= A
SATISFACTORY SANITARY l)UAi TY ACCORD t � NEW YORK STATE
AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS
TESTED, AT THE TIME OF COLLECTION„
SUBMITTED BYS - - - - -- – ---------------
Albert Ho Padovani, M.T, (ASCP)
Director
r
ELAP # 10323
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lLIV71d /C!
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- ) .� oas•aafd Boar M.lew. Ca•1.11.4.1 anowar to lwd& romb 0
apj1�Clf0l1 !'OIAt 10t �� D/lOYL $!$lS7� Asasil � '�� � � _ d�
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Dar of Pigs dwa A�rwr>r
Yttfg Adiw �GQ7j 1//JV L� ?era All
Dade Subdivision ADnroved Fee Enclosed ri Amn„nt
1s�iss; ijp %�' �G ,7 GG Lot Aaea ZZ3 5710 P® seets•a 0* Depth
6 O Vab
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so. Pk$ od
Nti•e d . n
$soar SweaaP $Yom to MUM di!� V rC/ Goan seple ?ea tee? O 1 � � i Z ti' W 1 -�e
To be emokuaaad by Addnmo
Rata* Fe -7 /t Add ar dw So* Ddied by via
Olbr eel �� � �i �� / � L ✓/ i `J, ,�.✓Qi /�J
1 rpr-- ('that 1 am wholly lens completely, responsible for the design and location of the proposed systems); 1) that the saparate sse.a di Osal • Itt•m
above described will be constructed as shown on the approved amendment there to and in accordance with the standards. rules an regu a ons o •
celanY Department Of Mattis, and that on completion thereof a "Certificate of Construction CompllenCe" satisfactory to the CommiWonnr of Heafthwill
be submitted to the Department, and a written guarantee will be fumbhed the ownter , his sucasers, helm or assigns by the bulkier, twat said bulkier will
91M in pod "Wall" cott011110n any part of aid sewage disposal system during the per led of two (2) yews Immediately following the date of the hau-
asa of the apprewl of the Certitkat• of Construction Compliance of the original syste s tltaralol2) that the drilled wall described above
arw be loc led lee shorn ea the apprn ve. plan and that Old well will be Installed aced itOfetl�t aM ules and reguZia oi�e Of the httnam
pate 3 �ft.
►.E R.A.
T AA&Z N��f ! talons N• 9 yy-
APPROVED FOR CONSTRUCTION.-PI; apposal e:piea two Yens from ten date i can ru pf the building has been undertaken and Is
revecoats for terse or may be a or modified when considered necessary by thy; i Any change or alteration of Construction
Ieeuires a new permit. Approved for disposal of donwstk sanitary sewage, and /Of pr t Iltat = /etHpO h�.
Rev. ` Vim`
10/88 ate �r .:.�.���..� . Title
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
Geneva Road, Brewster, New York 10509
(9:4) 278 -6130
February 25, 1993
Joseph Sullivan, P.E.
2972 Ferncrest Drive
Yorktown Heights, NY 10598
---
} Public Health Director
Re: Application, Oakridge & Moon Rd., PV
Casabianca
Dear Mr. Sullivan:
Your application is being returned to you or being held by this department
for the following reason(s).
( ) Fee should be paid by Certified Check or Money Order only.
( ) Fee is not enclosed or incorrect amount.
Fee . due :.i s :
(.New Tax Map designation should be provided. 4
( ) Incomplete application. Please provide:
A review of your application will resume upon receipt of these items.
Very truly yours
Christine Johnson
Intermediate Clerk
JOSEPH F. SULLIVAN, P.E.
eonsultfn9 fnyuieet
297 "l ' FERNCRES
"Y0R1 .., ...
YORKTOWN HEIGHTS, N'. Y. 10598
(914) 962.4248
i February 23, 1993
Department of Health
Division of Environmental Health Services
Geneva Road, Brewster, New York 10509
Re: Renewal of Design for
proposed sewage disposal
system
Property. of Charles Casabianca
Oak Ridge and Moon Road
Town of Putnam Valley
(Sec. 9 Block 1 Lot 20)
Gentlemen,
Enclosed please find a construction permit, well permit, authorization
form and required design plans required for the above proposed sewage
disposal system.
This design was originally ap roved by your department for Mr. Arthur
Fowler (your file no PV 14 -84
From a field inspection of this lot, there have been no changes to
adversely affect this design.
Very truly yours
Joseph F. Sullivan P.E.
93 -13
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 #R/44
FALL. LOCATION
Street Address
,
Town V llage Cit Tax Grid Number
}'
ow �` : e, °j — z6,
WELL OWNER
Name
:5�✓
ailing Address gTrivate
i A -���� /��d'� d/ Ot$ 41 Z O Public
USE OF WELL
1 - primary
2 - secondary
RESIDENTIAL
® BUSINESS
® INDUSTRIAL
0 PUBLIC SUPPLY 0 AIR /COND /HEAT PUMP 0 ABANDONED
0 FARM 0 TEST /OBSERVATION 0 OTHER (specify
O INSTITUTIONAL 0 STAND -BY
AMOUNT OF USE
YIELD SOUGHT c gpm /# PEOPLE SERVED IV /EST. OF DAILY USAGE dyo gCl
® REPLACE EXISTING SUPPLY ® TEST /OBSERVATION 13. ADDITIONAL SUPPLY
NEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
'DRILLING
WELL TYPE'
®DRILLED
®DRIVEN
[]DUG
0GRAVEL ®OTHER
IS TELL SITE SUBJECT TO FLOODING? YES P-' NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: C�iled,?
Lot No.
MATER WELL CONTRACTOR: Name �✓ �� ���� �n Address : 1P111 101W
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES P--' NO
NAHE OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM DEAREST WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PRO
N SEPARATE SHEET /;�
(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 shall take appropriate action to assure that
any and all water or waste products from such well drilling operations be contained on this
property and in such a manner as not to degrade or othe, i e'contaminate surface /or
,,groundwater.
Date of Issue: 19,13 �/ xp! /�a...
/
)ate 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
I�
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
... �.r•,. ., v• eJ.. r. a r A' - %� en ._. .o I .. Y �.a„t. a. .. .. ....r • •... ... a. .a. .n •.. ..w . .N V ••. ...0 � ..N �.••. •�••. .:+Sr r..t 1
Date.- /3
Re: Property of (.i/7��'/ ��_ _(�/ fSn �; aH G or d- klp re) a ,A')A -AJCd
Located at.
(T) ,ems Section 9 Block / Lot
Subdivision of �jD� �'i/!` l i���/ Z74 _.s -�,�__
Subdv. Lot ♦ Filed Nip k Date
Gentlemen:
This letter is to authorial m
a.duly licensed professional enginee'• or..registkred a5rchitect�_
(Indicrate
to apply for a Construction Permit for i separate sewage system, to
serve the above noted property in accordance with the standards, rules
or regulations aas promulegoted 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.
Counters /igned:
P. E . , A.9 1i
Addre /sus �
:Telephone
Very truly yours,
Cam'
Signed
C1scCc.,.
Owner of Property
AV e-tj /e
`7
Address
Town
Telephone
4
a7
f
F g t
�,gtixoved Fee;. Enclosed An;� „nr
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IIIaAIte all -
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s�� d151 OP be'. aBOiFteeY ava,� /os tie
8d TWO
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DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
6F Chelsea Ridge Dr
Owner A. Fowler. & M. wso Address Wa= ningpr Fat uv 191q(
Oa ri ge oad & TM
Located at (Street Moon Road 9 Block 1 Lot 20
i
�Indeat6 nearest cross s ree
.Muni.cipality Town of Putnam'Valley Watershed Hudson River
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
310:05
-10:35
30
.16
17.25
Hole'.
30/1.25
=2.4,,
4 10:36.
-11:06
Numbr CLOCK TIME
PERCOLATION
17.25
PERCOLATION
Run apse
Depth to Water
5.
Water Level
No. Time
From Ground
Surface
in Inches
Soil Rate
Start, -Stop Min.
Start
Stop
Drop in
Min. /in drop
30/1.27
Inches
Inches
Inches
30
16
17.27
1.27
30/1.27
=23.62
PTH #11 9:03-9i33 9:33 30
16
17.25
1.25
3011.25 -24
1:27
1.27
30/1.27
30/1.27
=23.62
=23.62
5
2 9:34 -10:04 30
16
17.25
1.25
30/1.25 =24
310:05
-10:35
30
.16
17.25
1.25
30/1.25
=2.4,,
4 10:36.
-11:06
30
16
17.25
1.25
30/1.25
=24
5.
. .
PTH #21 - 9:08- 9:38
30
-16
17.27
1.27
30/1.27
=23.62
2 9:39
- 10:,09
30
16
17.27
1.27
30/1.27
=23.62
3 10 :10
410:41
-10:40
-11:11
30
30
16
16
1727
17.27
1:27
1.27
30/1.27
30/1.27
=23.62
=23.62
5
3 FEB 31984
4 PUTNAM COUNTY
5 DEPT. Or
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. 1 HOLE NO.' 2 HOLE NO.
G.L.
6"
12"
18"
2`t"
30"
36"
42"
4811
.5411
60"
6"
n6
72"
Top -So-ii - Top Soil:
Clay, Small Clay, Small
Boulders & Sand Boulders & Sand
78
T
84"
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED '21-0"
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED 21-0"
TESTS MADE BY Joel L, Greenberg Date 11/14/83
DESIGN
Soil Rate Used2j-30 Min/1 "Drop:. S. D. Usable Area Provided 5000 SF
No. of Bedrooms 3 Septic Tank Capacity 1000 Gals. a Precast Conc
Absorption'Area Provided By 500 L.F.x24 * enchi.
\�� �RENC G
4 ft Bank Run Fill and Curtain Drain - 7ft ,A F. -x
tip
A • • • • • 14�)�1 �i•i
—ga—bopac,
THIS SPACE FOR. USE BY HEALTH DEPARTMENT ONLY
V, y v' 0110`1- 40-
Ole N VO
Soil Rate Approved Sq. Ft /Gal. Checked by Date
DEPARTMENT OF HEALTH
Division of Environmental Health Services
i
110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225. -0310
APPLICATION.TO CONSTRUCT A WATER WELL �U `
PCHD PERMIT #
WELL LOCATION
Street Addxes
Q P e _ O
Town Village City
.
6o 0 & fac�
Tax Grid Number
WELL -OWNER
N
P
Mailin Address
%s�vr+irr,,�
�"� jWrivate
ri ✓� /very/ -1V a A/ y O Public
-USE OF WELL
1 - primary
2- secondary
ARESIDENTIAL
0 BUSINESS
O INDUSTRIAL
O PUBLIC SUPPLYI
O FARM
M INSTITUTIONAL ,
0 AIR /COND /HEAT PUMP 0 ABANDONED
O TEST /OBSERVATION O OTHER (specify
O STAND -BY O
AMOUNT OF USE
YIELD SOUGHT - gpm /# .PEOPLE SERVED___��_/EST.
-O REPLACE EXISTING SUPPLY O TEST /OBSERVATION
XNEW : SUPPLY NEW DWELLING)- 13 DEEPEN EXISTING WELL
OF DAILY USAGE zao gal
GI ADDITIONAL SUPPLY
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
WELL TYPE
DRILLED
DRIVEN
ODUG
QGRAVEL
0OTHER
IS WELL SITE SUBJECT TO FLOODhNG? YES' X NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name & A,7 cYe'..S e7 ✓J Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO
.NAME OF PUBLIC WATER SUPPLY: "' TOWN /VIL /CITY
DISTANCE TO-,PRO PERTY FROM- NEAREST- WATER ' kKIN_. )4ti/��
LOCATION SKETCH S SOURCES OF CONTAMINATION PROVIDED
RON SEPARATE SHEET
(d te) (signature)
PERMIT TO CONSTRUCT A WATER WELL
'his permit to construct one water well as set forth above is granted under the provisions
f Subpart 5 -2 of Part 5 of the New York.State Sanitary,Code, and provided that within
hirt;r (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
Department attached to this permit.
3. Submit a Well Completion Report on a form
requirements of the Putnam County Health
provided by the Putnam.County Health Department.
Lring all well drilling operations, the applicant shall take appropriate action to assure that
.y and all water or waste products from such well drilling operations be contained on this
operty and in such a manner as not to degrade or otherwise contaminate surface or groundwater.
to of Issue: s� /'S 19 ... .. ......
to of Expiration 19 Permit Issuing Offic al. --
_mit is Non - Transferrable White copy: HD File Pink copy: Owner
19 Yellow copy: Bldg. Insp. Orange copy: Well Driller
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIROlVNENTAL •HEALTH SERVICES'
Date 4Z����
Re: Property of ��tpi �11✓
Located at ��/% ri'r� �U�� j ?od' 4
(T) 4V Q% Section Block ___/ Lot v�0
Subdivision of 4w r1
Subdvo Lot Filed Map # Date
Gentlemen:
This letter is to authorize rc)
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
4�
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.
Countersigned:
P.E.;Z/' e, #
v!
Address N
R
Teleph
Ve
Si
Address
Y /rd� &64�
W Town
9 /y) - S( A/
Telephone
JOSEPH F. SULLIVAN, P.E.
eonsu� tiny �n9tneec
•2972 FERNCREST DR1VE-- - --
YORKTOWN HEIGHTS,1N. Y. 10598
(914) 962.4248
pril 8, 1991
Putnam County Department of Health
100. Old Route 6
Carmel, New York 10512
Gentlemen:
!Enclosed please find plans and application forms for a
proposed Sewage Disposal System.'for Mr. Arthur Fowler
on Noon Road in the Town of Putnam Valley. These plans
were approved in 1985 by your Department (PV 14 -84).
From,a field inspection, there have been no changes in
this property or surrounding properties to adversely
JFS /ats
-88 -144
Very truly yours,
Joseph. F. Sullivan, P. E.
it
PUTNAM COUNTY DEPARTMENT
Division of Environmental Health Services,
CONSTRUCTION PERMIT FOk SEWAGE DISPOSAL SYSTEM
Located at Oakridae Drive & Moon Road Ta
Subdivision — r Br4 Lk sum. lAt # 509
Ren
aneraa8> -ess K °�� rg ert'r�
Building Type (1) Fare Re ,� Lot Area 28, 35 7 SF Fil
Number of Bedrooms 3 Design Flow G /P /D EOG P.0
Separate Sewerage System to consist, of .1000 G.I. Soptic Tank and
To be constructed by R_ F i ,A r A n i- i nn Ads
Water Supply: public Supply From j
i.
YF HEALTH Permit p
me% N '1Y 10512
Putnam Vallee
[] own or Village
— �1
Map 9 Block .l lot 2+D
ral _❑ Revision _❑ -
of Previous Approval
Section only ❑
H. D. Notification Required
i00 LF of 2 t Wide Leaching Fields
Lakp Share Road West-'
Putnam Valley NY 10579
XX private Supply to be drilled by x4' AnAt -br86n .
Address Birad'r St. Pu$Plam Valley, NY 10679
Other Requirements 4 ft Bank Run Fill and Curtain Drain 7 ft.
1 represent that 1 am wholly and completely responsible for the design and location of the proposed system($); 1) that the separate sewage disposal system
above described will be constructed as shown on the approved amendment there to and In accordance with the standards, rules a regulations o e nam
County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of 4tealthwill
be submitted to the Department, and a written
guarantee will be fyinishe0 the owner, his successes, heirs or assigns by the builder, 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 thedato of the issu-
ance of the approval of the Certificate of Construction Compliance of the original system or any repairs ther ; 2) that the drilled well desdribed above
will be located as shown on the approved plan and that said well will be installed in accordance wi the standard . rules and egu a� oirns Hof five Putnam
County Department of Health. �
date o Sign 1 2 7 34 / n , P.E. A.A..u�
;c
ot NQ d box
Address !O aC + r 1 1, ° ! ucen IV.1 110 5 C
APPROVED FOR COIVSTRUCTIOW: This approval expires one year from the date issued u41.#n0,truq(0n of the building s been undertaken and is
revocable for cause or may be amended or modified when co ed necessary by the Co f Health. Any change or.. alteration of Construction
requhes a near mit. Approved f disposal bt domesti rani ry sewage a /or a supply only.
CIS
qj�!
Date _.� TRio _
PUTNAM COUNTY DEPARTMENT OF HEALTH'
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date, 1/27/84
Re: Property of A. Fowler and M. Lawson
Located at Oakridge Drive & Moon Road
(T) 9 Section - Block 1 Lot 20
Subdivision of, Fifth Map 'of Roaring Brook Lake
Subdv. Lot # 509 Filed Map # 308 -I Date 7/1/49
Gentlemen:
This letter is to authorize Joel L. Greenberg
a duly licensed professional engineer or registered architect XX
(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 thP, t aEO-o supervise the construction of said
system or systems in confo�rr�ty with the provisions of Article 145 or
FEB
147, Education Law, ublic44ii�� alth Law, and the Putnam County Sani-
UNTj
tary Code.
Countersignegr:
P.E., R.A.,
0
7
of N5-
Muscoot Nrth, RFD #2, Bx 488
Address
Mahopac, NY 10541
914 628 -6613
Telephone
LTH
10 Very itr
Signed
urs,
r of Property
6F Chelsea'Ridge Drive
Address
Wappinger Falls, NY 12590
Town
914 831 -5976
Telephone
I
i
'w 8 Dr
f Al. 4
c ..� t 14.? oTs1, 4 .- 5(i t F �, t �`u n
d .a?•te .rtr.s`'_T'"r�(, C. ,.s'- 'T, a. Ai'`_.'aF° -wac¢; yy sy�- r'�ia:S�{ IO,y�/I.� 4 �J� •.>
xPUTNAM ,COUNTY,SDE'PARTMENT OFHEALT�H
zr' ,+ y.,yM•'iK�."'
VV
�$ Drvfsfon of Environments! Healtti }*,Wces Carmel N Y 10512 •
CO ST RUCTION PER 0 F -OR SEWAGE DISPOSAL SYSTEM 1 w x x, > �� u nam'_Valley
orhv�,...; lags
�Y �y atn�i a i%a�Sx 1d� riJr� VP" rry Moen R�G1Ad ' ?r. S Tea �iapvst +
a.• a r Sloch P u1 txlot -, x%�
aq t _ . ,s; N u �. a" s a s'„P �.� r m $� ..� f r.• t t .A
Subtlivislcn ' 1T1 'r B o S'.� 9 i. en¢ 1 F+Revision []
�Subd „ t H Rpwa
-yq,Jr K
"ON, J_ x' a��% �. " .:y °_o- ,`'!. �. e� r;'o Z ir'Afiyf '` �f."'rbi.'' �uast s r- a�, s 0� V:- j1_"( f
�, - a� ,...,�,1.TtTE..: • r y,i w. ap..{ "y,^'',"r .ci"tN'u :'�'� ti t x y use
Owner /A3dresa �.Z nl�e r. a '' .�7 a.ly ii '� � .a s«�. Of4Previousr App oval`s
4
�.. u r ° 'L-
` °:euudin ;T (1) Fam Res 28 357 SF��
4 9, YDe " LOt Area: � ? � Fi11�Section`"Only ❑'� - � i
s'� �.., .;v r y0. rd• i'M „y+ ` > T S..t> 5 yr,r i '�` # i d `"Zr�a` a'� •y a ?i fi fi_ R
,' �,.: � �_` Jar .y .: h ,...., w 8 r, yCr r..�i ,TF
'•iNUmber�ofx BBd ►OOTS��•' "3 f. Design ;Eiow G /P /,D3s� '6�� '” !" P C� H �D Notification'GRequ3red r :
S t»¢nc. m;+ Cckn` al.' y w, to •'d
rr QO�a �5p0�L�F "2a0� ide °Le °achin '`'Fie'lds,
'Separate <Sewe ► age System to consist of 1� +Gals Septic Tank.,and: — Ofa i t�W - g
�° ?TO be constructed by,w R 'I pY':PT1 kd&ess�
V
ti�� Water Supply gP 105'79dblic Sup ly Fro *
�
X Xr Y r s.?sh; ( . Pr� s i,v. a{tit e N . R .si , u3pd ti p ly i �1 fu o Dt e t d- - rJle�tl^xL ti a ' b wy p tit . . z� S AnC b 66" "+ t r° r+R ` nr? 7 Aaw; w c
r .
�
�--
'` . l s3 z,i,c g"r�"' aK
s...,;Add►BSS.,, i ....> d; t�t� Pxu - mr Ukall'eyLN �s <
arger S Etna Y 10579.
.�. vY •y -`t Q G., -f c rs2 _,s`i'c:., r. "zs
�,snres�W.: ?ti.�,
w•`S_+. ti ''^p°a t "
other Requirements - 4 fit. Bank Run Fi l and CurtainDrain� 67�f,'t. n :_
..
r t::.l represent - that I yam wholly anG ,completely responsible for^the design and location: oY.the proposed +system(s) 1) that =the eparate'seMiaye� disposal "system
h �' ^above described;'will be constructed as shov!n on thew ' '
pproved.A nendment th tv to andain accordance w@ the standards 'rules an r
�: +;�; �. m....^s, .,.. .,r. -,, r. #._,; r.....,,; u..�,..s. x:_a ^ ^ -�rS•r dw,_4,;a.��+u &a�y�..... r{; rx�..... ;- $�a:.. ,?�: .,. �S `. e94 a'OASO 8 .Y -nDm�_
„r KCounty 'Departm8nt rof., (Health - :and3that on" completion thereofka ±Certificate'oi Cbnstruction Compliance wsat�sfactory�to th'o +COmmissloner ot;Health,wi
-.:.a„ . • „c.�.. ,e•r ="x ?^_a >rx,. ,:r;}.•r ti . .. - zrr_R. , ;
,subm'itted to:'_the�Qepartmeht`.,and `a_inntten guardritee wilt be ,furnished the' owners 'hiscwccesso ►s;,�hel►s�or_ n "s�,by the builder that said'.b.ullder'wlll`
lace in: ood'•o eratin ;condition?,; n it of'sbid sews a disposaI.-'s, yst m duriAg theme rod Hoftvio 2 �ears}iminetliatel ;followih ^thedate'Of.fhe.issu
P g. p a 9'� YQ? z 9 _ 9 _ p@ ( I Y,i Y„ 9; a ;
4ance;of. the approval• of�,the CeFiificateyof Constr:uctionyCompliance ofahe ongtnatsystem o►�artyi►epairs� there 2):het t; edrilled. well descNbetl above
... , F'l :` .t,•, . ...:m `� .^O� �. �r, fsy`. '.. J ct.�ty.t y. .... .
�` =will be located as,lshawn'on the approved;plahand that said:well will "tie Installed in accordanceawi hehstsndard , rules'.and egu aT4lonsw, of ,the "�(?utnam;,
d'`.... ��� o- o 'a be � yule, �. ¢ s.i ," t
ro County lDepartment ofHealth k ,r
vi S+„y„ c"i� � 3 � *� ,�E •P^�' t
�, a �s'`� w°' { ..% ��i lxli.//� � p ry r �, j.. r 1. ', Y•,,�"Y� �' �` "'.- �a4f.' �.r�`�" �F �� "� �... ..' 1s T, "�'�" �,`.`t ,t � s � E * `,': • .' T `.''
x 4
Dete f � tq7� � 3J. 7��7 , Sign , � . � _ �'.�• u ^� P R A
U COO 1.. {1V i p A a yw, r*..L O �1 '''� ��c .'�' h�'i�•;A tt^f� 4�S�`”: .. ,r j V
f�1 r 's S . t "fir xbp� .r Addreu k« s, a �'� 2�' ne"'?ie'E' +t.� .a x -,n� +.x r:�•.4t^3
4une Licons rJ6x.;?,.. ,.._ . 4 ,YAPPROV,ED FOR,CONST;RUCTION i7his approval expires:oneyeacirom�Ehe date 3ssuedc nstru onof,thebuilding} s beeh•vndprtaken antl is ified whemco ed necessary, by the�Co r, orHealth Any change equires a new ermit' : °Approved f ;disposal of,mf sane y waa /or_ er supply�orlof �7ii��.. s et 4r-.�.
d atBs �, sr ,.,.�`i+��.a=�' � � `sa ' ^ti?tr^ ri.+Y 'nW�`9K`'§ "t•.� {�Sgy.';%�' '2i 4��. � .�d r�'a•'.�y � h 'xE✓,,�¢„i:c,;.4 �T� t 8b��'� s, a 1! s i� •�
YY', r _"-, wr.♦ +stT— '^ s x .f, . f �s•:c. vF .c ytyr
2' '•i.'i:3° tt-^v i_. '$'''°'ar _•`'i�.tafii"�f'�6. -9c ?i 5, -k t C4 ,?r :
Rev 9 .81' ' e:* �°+"k ;+1` ;"� �,. L": i•s q:; 'k:& •E t Z.Y ^ss, «:n �ic kea
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