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Home My WebLink About2221DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.05 -1 -13 BOX 19 'IfEll r u I I 1 0 ' III I N 1 0 r J TI J ■ 1. r 6 o I ' , ' 1 .1 �;I � r o m m L. 02221 PUTNAM COUNTY HEALTH DEPARTMENT �f DIVISION OF ENVIRONMENTAL HEALTH SERVICES YES N - Internal Use Only PERMIT# ❑ Repair Permit Issued in last 5 years ; 19- Not in Watershed ❑ Repair within Boyd's Corners, W. Branch or Croton Falls Res. Delegated ❑ Repair within 200 ft. of a watercourse or DEC- mapped wetland ❑ Joint Review SITE LOCATION Lks 01-k- R►Ang, Qr_ TOWN TM # OWNER'S NAME oh �� ; any_ 'Pa nI �I:°► PHONE # MAILING ADDRESS tAc � 05`1q APPLICANT P��O.c�,►�,;�r,= �,craJta'�i'1G ('e'�cr�c�ot^ Name & Relationship (i.e., owner, te�t contractor) DATE I C) FACILITY TYPE ('per, �p�C'L PCHD COMPLAINT # PROPOSED INSTALLER �r��;;pn�, }�,iPHONE #S ="13 -051 ADDRESS REGISTRATION /LICENSE # 10 Q Q Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the nnh irn nnrl cvtnn4 of fkn rnnnir ' I, as owner,agre to the con ions ate n�this form SIGNATURE TITLE ; DATE (owner) I, the septic installer, agr to com wit a conditions of this permit for the septic system repair SIGNATURE TITLE Pre P �- DATE y - jp--I (installer) Proposal approved with the following conditions: 1. Procurement of any:Town Permit, if applicable. t 2.. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be 'performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. No completed work. is to be backfilled until authorization to do; so has been obtained from the Department. INTERNAL USE ONLY Proposal Approved Proposal Denied ❑ 2- U /o /,-;- n Inspector's Signature &Title Date Expi ation Date ,Repair proposal is in compliance with applicable codes Yes O No COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 Joseph and Carol Paolillo 45 Oak Ridge Drive 5 Putnam Valley, NY 10579 (845) 528 -0434 Town of Putnam Valley Tax Map: 41.5 -1 -13 Installer: Philip Leonforte (License #1022) Precision Excavating Inc. 3 Rochambeau Road Garrison, NY 10524 (845) 736 -0571 Description of Repair to System: Installation of 4ii',of Infiltrators With 1 %" Washed Stone for Fields ,C� r N® 0 Lr 0 "/ L' '( I i ti WL �i �I I I I I I I I� I. I I 1 I 1 I ' J a P'mp 7 I RD Y 0 3 I Qyo 3 CL a �P ADAM lmomeownear: Joseph and Carol Paolillo 45 Oak Ridge Drive Putnam Valley, NY 10579 (845) 528 -0434 Town of Putnam Valley Tax Map: 41.5 -1 -13 Philip Leonforte (License #1022) Precision Excavating Inc. 3 Rochambeau Road Garrison, NY 10524 (845) 736 -0571 Description of Repair to System: Installation of 40'44nfiltrators With 1 Y2" Washed Stone for Fields Sag qr-1 Ste' f 1/6 oaok''94 Pouse. 1p . 6J c df, -PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES YES NO Internal Use Only PERMIT# ❑ ❑ Repair Permit issued in last 5 years ❑ Not in Watershed ❑ ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated ❑ ❑. Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION -its p;,,k R �. Arlo. ( TOWN TM # OWNER'S NAME M �h �� Q; a ��. (�anl, ��;� PHONE # � -�� _O-A � MAILING ADDRESS C)aK R.r-� . ,4nac, '�JA -'1o" f Ivy; i 0.5 -1 APPLICANT Prp.c�,: ��-�r, Cerra J�'�S �G or),� -A C- �o r Name & Relationship (i.e., owner, tenarit, contractor) DATE y yo . FACILITY TYPE '('p�,; aR.nG� . PCHD COMPLAINT # PROPOSED INSTALLER PHONE # ADDRESS �3 (�onl- ,an,�u (�j (� REGISTRATION /LICENSE # () Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed, system) NOTE: The Department may require submittal of proposal from licensed professional depending on the nntiirc nnA nvtnnt of 0ti rnnn;r I, as owner,agre to the con Ions date n this form 1 � � SIGNATURE ��GL TITLE 61W44 DATE. (owner) I, the septic installer, ag to om wit a conditions of this permit for the septic system repair SIGNATURE " TITLE !- , g, p �- DATE (installer) Proposal approved with the following conditions: 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. No completed work is to be backfilled until authorization to do so has been obtained from the Department. INTERNAL USE ONLY Proposal Approved ❑ Proposal Denied ❑ Inspector's Signature & Title Date Expiration Date Repair proposal is in'compliance with applicable codes Yes ❑ No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 �Vvjjk'n PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR OFFICIAL USE ONLY SITE LOCATION F cO 1J N `' V E, TM# d °"'l OWNER'S NAME PHONE 2$ 0 .3 MAILING ADDRESS PERSON INTERVIEWED PCHD Complaint # Name Relationship i.e., owner, tenant, etc. DATE '7 t 5, e. � TYPE FACILITY PROPOSED T LER �'a_.,,L �b 644 a Ew� PHONE ADDRESS V„ ^t— �c-H -A. �)y l� L L� , �� R-, REGISTRATION# C-1 Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original`sewage disposal system .Different location may require submittal of 'proposal from licensed professional engineer or registered architect. An -_ =;W , _ - RV.olA -c_e V L U(; 6E O CLA-y -TJ&f ice r Grp 50¢ iu q— I, as owner, o reported went of owner agree to the conditions stated on this form. SIGNATURE TITLE Ps C, 6 DATE r c 3 Proposal approved with the following conditions: 1. Procurement of any. Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name b. Site Street Name, Town and Tax Map number. C. Location of installed components tied to two fixed points (e.g.,house comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Proposal approved Inspector's Signature & Title DATE COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML ]FUTNAM COUNTY DEPARTMENT 07 HEALTH IIDRVffSffCN OF lENVERONMIL+ NTAIL HEALTH S ERW(CIES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # V Well Location: Street Address: Town/Village Tax Grid # 41.5-1-13 45 Oak Ride Drive Putna°n Valley Map Block Lot(s) Well Owner: Name: Address: Alice Armao 45 Oak Ridge Drive, Putnam Valley, NY 10579 Use of Well: X Residential Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5 -10 gpm # People Served Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) X Deepen Existing Well Detailed Reason Existin • well is for Drilling Well Type �_ Drilled Driven . Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Lot No. Water Well Contractor: P. Fa Beal & Sons, Inc. Address:4 Putm -a lkp—, Brewster, NY 10M9 Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & 'sources of contamination to b prov' d n eparat sheet/plan. Date: 1/10/02 Applicant Signature: /t c MalcoLtt T.\ Beal Jr e PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and 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 or their designated representative 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. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED _IFOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director y revision or alteration of the approved plan requires a new permit. Well to be constructed by a watdwel driller certified by Putnam County. Date of Issue 1 Id/04 I Permit Issui ial: r Date of Expiration 0 Title: Permit is lion- Transffcrn a bll White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Alice Armao PUTNAM COUNTY DEPARTMENT OF HEALTH _ DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: 45 Oak Ridge Drive Towri/Village: Putnam Valley Tax Grid # 41. 5-1 —13 Map Block Lot(s) Well Owner: Name: Address: Alic--e Armaoo, 45 Oak Rid— e Drive# :Putnam Valley, NY 10579 Use of Well: 1- primary 2- secondary X Residential Public Supply Air cond /heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary Cable percussion X Cotiipresstd air percussion Other (specify) Well Type Screened Open end casing IX Open hole in bedrock Other Casing Details Total length ft. Length below grade ft. Diameter in. Weight per foot lb /ft. Materials: Steel Plastic Other Joints: Welded Threaded Other Seal: Cement grout 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 X Pumped X Compressed Air Hours 6 Yield 5 gpm Depth Data Measure from land surface- static (specify ft) 30' During yield test(ft) 260' Depth of completed well in feet 325' 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 Drilled existing well det?" or from 1001to 325' If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 7.�:_zi Depth 230' Model713SW 412 Voltage 230 HP 3/4 Tank Type Volume Date Well Completed 1/22/02 Putnam County Certification No. 002 Date of Report 6/7/02 Well Driller (signature) parry t,. Deal. Ivu re:: txact Location of well with distances to at least two permanent ianamarxs to De proviaea on a separate sneevptan. Well Driller's Name t'- �'•! bea1, & Sons, Inc. Address: 4 Altran Avta., a ster, wY 10509 Signature: Date: 5/7/02 Perry L. Beal White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97