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HomeMy WebLinkAbout2235DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.06 -1 -1 BOX 19 , I ,. IN , 46 , . `, , IN IN , , IN IN r JLNN , IN 1'6 r . IN ; IN r, OMEN Aj 02235 r _ ; . , IN h,1y. I , , IN IN r JLNN IN 02235 0 PUTNAM COUN'T'Y DEPARTKEtgr OF HEALZH _ - r . "DMSIULl" OF"E.NVIROiiNMERI�AT, H.FALTH SLRVICtS _.. „ _ ...... r gOVIZI,_ fargi G 114 Owner or purchaser of Building ate' �c3..� ✓ �`- Building Constructed by 72 0h-.e21.P6c NZ,(16, Location - Street 9 1. N Sect on Bloc Lot ZOUIAJU &o eg L AkE Subdivision Name Municipality Subdivision Lot # Building 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 the Putnam County Department of Health, and hereby guarantee to the owner;-his successors, -h ns,.to place in good operating condition any part of said system constructed by me whi6h`fa.ils to -operate for a. period- of_ .two years immediately !following the . date of appr.aua1 ... of the "Certificate -.of "Con,struct'ioYi Compliance for 'the"'�es� age disposal- sysfan-, '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 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 tYd builc4ng utilizing the system. Dated this ,6 _ day of �UGUs i ,19 Signature J/ 4 Title General.Contractor (Owner) - Signature M Corporation Name (if Corp.) 72, okrziwc vv vg- RrIV 7P? Address N, ` / lasts rev. 9/85 mk Co oration Name (if Corp.') - FDJ_ Eox 3 2-i o -s,�i- VAL Address ' Ay. a 1 r Bolt 224 - BREWSTER, N.Y. (914) 225 -2072 MWENd SAMPLE NO. 7016 SOURCE: Bob Chestnut hose bibb -well Oakridge ..Drive v Putnam Valley, NY COLLECTED: July 12 1988 BY: PoFoBeal & Sons, Inc. BACTERIOLOGICAL EXAMINATION Colitorm Count, MF Method bob clli;STNliT 0 per 100 ml. This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. July 16 1988 Roy Bi it P.E. Dirrtw I b WELL UUZ&LbT.LUN rZrUM1 ��, • '�� Office Use Only Q, :t DEPARTMENT OF HEALTH - Dive +lion Of Environmental Health _Services W Y PUTNAM COUNTY DEPARTMENT OF HEALTH STREET AD RESS : 1-OwNivi0cliCill TAX GRID NUMBER: WELL LOCATION Oakridge Dr. ,Roaring Brook Lake,Putnarn Valley,NY Lot #14 WELL OWNER NAME: AOORESS: Robert Chesnut 21 Peekskill H611 Tlike ltd. Put.Valle NY PUBLIC USE OF WELL 1- primary 2 - secondary ® RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED O BUSINESS O FARM 0 TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑. STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING M NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST / OBSERVATION O REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH • 305 ft. STATIC WATER' LEVEL ° • t' • ft. DATE MEASURED 6/1 88 DRILLING EQUIPMENT 0 ROTARY. ® COMPRESSED AIR PERCUSSION ❑ DUG O WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE .O SCREENED' O OPEN END CASING, ® OPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH ----32— fit. MATERIALS: (2 STEEL ❑ PLASTIC O OTHER LENGTH.BELOW GRADE 141 ft. JOINTS: ❑ WELDED ® THREADED O OTHER DIAMETER 6 in. SEAL: J] CEMENT GROUT O BENTONITE O OTHER WEIGHT PER FOOT i9 Ib. /ft. DRIVESHOE:IRYES ONO I LINER:OYES IRNO SCREEN ..DETAILS _ . DIAMETER (in) 'SLOT SIZE LENGTH (f t) DEPTH TO SCREEN (ft) DEVELOPED? FIRST O YES ONO i {O.U.BS. -.--Q- a —..: -: SECOND _ .._ ... _ :....:. _ GRAVEL PACK O YES L.0 NO GRAVEL SIZE DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH It. WELL YIELD TEST pumping If detailed METHOD: O PUMPED I tests were done is in- ID COMPRESSED AIR ,. formation attached? O 8AILED O OTHER i 0 YES 0 NO it more detailed formation descriptions or sieve analyses 1P1ELL LOG are available, please attach. DEPTH FROM SURFACE Water Bear- ing We1l Dia- meter FORMATION DESCRIPTION MOE, it. ft. WELL DEPTH It. DURATION hr. min. DRAWOOWN .ft,' YIELD 9;m. Surface 18 ril ing in overburden day & bldr it Irock at 18' 305 6 285 $ 32 305 Brilling in rock granite. 'I WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE WX 250- CAPACITY 44 GAL. WELL DRILLER NAME P.F. Beal & Sons Iny A 8 f 988 ADDRESS PO Box B stairltTUR Br a ws t e r , NY 1050 PUMP INFORMATION TYPE submersible CAPACITY MAKER Gould DEPTH 240 MOOEL :Z'EH 541-2 VOLTAGE 4¢.OP 1,/2 /e i.•.LNAL SITE INSPECTION Date Inspected by c4,j SUZ�T'ICCUATION 0 AI( �AI46&- P& OWNER. Cfi(crlr <.hl PERMIT O V— 114� U1 # OR SUBDIVISION LOT # Ii. W. V. VI. 1 YES tqd-- 7WAGE a. SDS area located as per approved plans b. Fill section - Date of pl nt 2:1 barrier - i�� -6 Ir3TH WIDTH AVG. DPTH c. Natural soil not strimed d. Stone, brush., etc., greater than 15' from SDS area. e. 100 ft. fran water course/wetlands. SEWAGE. DISPOSAL SYSTEM a. . Septic tank size ]j?1,02d 1,250 b. Septic, tank ins 'level c. 101 minimum fran foundation d. No 90' bends, cleanout within 10 ft. of 450 bend e. DISTRIBUTION BOX. 1. All outlets at same elevation - water tested 2. Protected below frost 3. Minimum 2 ft. original soil between box and trenches f. JUNCTION BOX - REaerlx set g- TREN= 1. Length required - Toength installed 2. Distance to watercourse measured'. ft. 3. Installed accordin g to plan - 4. Distance center to center r- 5. Slope of trench acceptable 1/16 - 1/32 " /foot. 6. 10 feet from propp—rt y line - 20 feet - foundations se 7. Depth of trench < 30 inches free surface 8. Rccm allowed for exnansion, 50% 9. Size of gravel 3/4 - 1j" diameter 10. Depth of gravel in trench 12"minimum 11. -Pi ends capped h. PW OR DOSE SYSTEMS 1. Size of pu chamber .2. - aTerf .1 dw -t ark 3. Alarm, visual/audio 4. Pmp easily accessible. manhole to.crrade 5. First box baffled 6. Cycle witnessed by Health Department estimated flow per cycle HOUSE a. House located per approved plans. b. Number of bedroans WELL a. Well located as per an-proved plans I b. Distance fran SDS area measured ft. c. Casing 8" above grade. d. Surface drainage around well acceptable. OVERALL WORK- SHIP a. Boxes properly grouted b. All pipes par-tiallv _backfillea c. All pipes flush with inside of box d. Backfill material contains stones < 4" in diameter e. Curtain drain installed accordin g to plan f. Curtain drain outfall Protected & dir.to exist.watercourse g. Footing drains discharge away fran SDS area h. Surface water Protection adequate i. Errosion controi provided on slopes greater than 15%. 1 Re. N PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Property of i1 V Located at LGN\�;�yE � I V (T) �AWwIm Section Block �- Lot l Subdivision of M&i7 y aA:� Subdv. Lot Filed Map # Date Gentlemen: This letter is to authorize i. a duly licensed professional engineer. '/ or - registered architect (Indicate to apply fora 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 co nformity with t ., .._......... _......- ..c he .. provisions of Art . i . cle 145or 147, Education Law, :the Public.Health'Law, and the Putnam County Sani- tary Code. Very truly yours* Countersigned: P.E. , R.A-. , # gy13 Address ,9 Telephone Signed 'Owner of Property Address ///,, e-0 Town 9�y�_a�� Telephone r DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 PCHD PERMIT #_N 72 -$ WELL LOCATION Str et Address D� ;� ame @�.� ice.. �,� Town 't Tax Grid Number ._ Z Address * y� rivate �_ �Ari 7- Sc6.r mde>vmil /e OPublic WELL OWNER USE OF WELL 1 - primary 2 - secondary e'RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP ❑ ABANDONED 0 BUSINESS O FARM 0 TEST /OBSERVATION ❑ OTHER (specify ® INDUSTRIAL t3INSTITUTIONAL O STAND -BY 0 AMOUNT OF USE YIELD SOUGHT 040-4 S gpm /# PEOPLE SERVED 7, /EST. OF DAILY USAGE 300 9 al, REASON FOR DRILLING EW SUPPLY ® REPLACE EXISTING OPROVIDE ADDITIONAL SUPPLY OTEST /OBSERVATION SUPPLY 0 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN ®DUG ® GRAVEL ® OTHER IS WELL SITE SUBJECT TO.FLOODING? YES I'NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: *0p 0 s$ 94'd1 0/464. pp Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: NAME OF PUBLIC WATER SUPPLY: Qy ) - -'DISTAi3CE T® -PROPERTY •FROM- NEAkEST -WATER •MAIN: YES V" NO TOWN /VIL /CITY LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ®ON REAR OF THIS APPLICATION BtN SEP ET (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. Date of Issue: Y 19 Date of Expiration: 19 Permit Issuing ff' ' -- Permit is Non - Transferrable J PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION. OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Located ai,. -N r (T) Section Block Subdivision of Ka, Subdv. -Lot .# Filed Map # `? Gentlemen: 1. v o 1?G C gFCO K� Lot &o t 0 Date This letter is to authorize ?t4,Z a duly licensed professional engineer C_�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' Countersigned: Owner of Property P.E. , R. A. , #3i3c Ca Sec©k Address 2 vt {tea - , -A - Address.; 2657 -'uorg Telephone /V Town 'Telephone. Division Of Environmental Hgalth Services TWO COUNTY CENTER - CARMEL, N.Y. .10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER.WELL TELL SITE SUBJECT TO FLOODING? YES /NO WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: H4 b I LOT NO.: y�g =R WELL CONTRACTOR: Name 40 bY- AekAm,,J Address: PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ENO " ME OF PUBLIC-WATER SUPPLY: TOWS /V /C :STANCE TO PROPERTY FROM VEAREST WATER. -MAIN )CATION SKETCH & SOURCES OF.CONTMIINATION_ - _ ..._ (date) 1 (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 Vew 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,iwell in accordance with.the requirements of the Putnam County Health:lDepartnient attached to this permit. 0 3° Submit a Well Completion Report on a form provided by the Putnam County Health Department. Date of Issue: 19 Permit Issuing 'Officia . Permit is Rion- Transferrable STREO ADDRESS. WNIVILLA J I v 1AX G&O NUMBER. LL LOCATION Qa`c�;d 'ELL OWNER NAME. • ADDRESS: i c, ,v EHEIVATE ❑ PUBLIC SE OF WELL _ESIDENTIAL Q PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDUNED - ''primary ❑ BUSINESS ❑ _FARM ❑ TEST /OBSERVATION O OTHER (specify) secondary ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ OUNT OF USE YIELD SOUGHT s gpm. /NO. PEOPLE SERVED 2 / EST. OF DAILY USAGE • !- gal. EASON FOR 9-NEW SUPPLY D' PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION DRILLING- O gEPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL YELL TYPE (DRILLED F-1 DRIVEN DUG Q GRAVEL a OTHER TELL SITE SUBJECT TO FLOODING? YES /NO WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: H4 b I LOT NO.: y�g =R WELL CONTRACTOR: Name 40 bY- AekAm,,J Address: PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ENO " ME OF PUBLIC-WATER SUPPLY: TOWS /V /C :STANCE TO PROPERTY FROM VEAREST WATER. -MAIN )CATION SKETCH & SOURCES OF.CONTMIINATION_ - _ ..._ (date) 1 (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 Vew 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,iwell in accordance with.the requirements of the Putnam County Health:lDepartnient attached to this permit. 0 3° Submit a Well Completion Report on a form provided by the Putnam County Health Department. Date of Issue: 19 Permit Issuing 'Officia . Permit is Rion- Transferrable -P,L OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES SUPPLY & SUBSURFACE;SEWAGE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT DATE REVIEWED: Je P' V, BY: t 4-4L S (Name of Owner) (Stree COMMENTS YES y NO r 1,Q.r rC� rr L� 1 7"11 Location) DOCUMENTS Permit Application Corporate Resolution Plans- Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 301''Perc Hole Other House 'Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS \\ Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump 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 Shawn & 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 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains- Curtain,Stom,Leader,Footing 251 to Catch Basin 10' to Water Line (pits -201) Septic,Tanks 10' fran Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same 10P 4 fy DAVID D. BRUEN County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services October 14, 1986 Frederick A. Zenz, P.E. 292 Main Street Nelsonville, New York 10516 JOHN SIMMONS, M.D. Deputy Commissioner Re: Proposed SSDS Frank Frascone Oakridge Drive,.Putnam Valley TM 9-9-14 - Dear Mr. Zenz: Review of plans and other supporting.documents submitted at this time relative to the above-'captioned project has beer' completed. Comments are offered as follows.: Well is downgradient in line of drainage within 2001 of SSDS. Well should be moved to 2001 separation from SSDS or location of well and SSDS should be reversed. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further, „ Very truly yours, Anne M, Bittner . AMB:pt Asst. Public Health Engineer cc:JK MB File TWO. COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 I PurNAM COUNTY DEPARTmENr. OF HEALTH - DIVISiON OF ENmoNwiy L HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS C� FIELD INSPECTION REPORT `14- -, Imo! Ul INSP. 'YES (Name of Owner) (Street Location) MMMENrS INITIAL SITE INSPECTION YES NO CCMMENTS Wetlands on/or proximate to property ............. Length of trench measured Property lines or corners found .................... Width of trench average Can estimate house location ....................... Roan allowed for expansion trenches .............. Willdriveway need cut ............................ Over 100 ft. fran watercourse .................. ' Must trees be removed -. note these................. Deep holes representative of entire SDS area...... Additional deep hole slneeded....... ..... ... Sufficient SDS area available considering driveway , W L n ,,.,., � J Natural soil not stripped or SDS area unnecessarly graded.......... ..... ........ cut, house location, separation distances,etc... 10 ft. maintained fran property line and Adjacent wells /septics...... . . .. ...... 20 ft. from house.. ... ........................ Access to proposed well location fordrillina ..... : Number of bedroans checks ........................ D.H. C Lot Depth to G.W. Depth to rock Soil Descripti on 0 ft. 3 ft. 6 ft �ca� 9 ft. cJ �� 12 ft. D. H Lot Depth to G. W. Depth to rock Soil Descri do 0 ft. 3 ft. 6 ft... 9 ft. 12 ft. �- GU D.H. - Deep Hole G.W.- Groundwater D.H. 3 Lot Depth to G. W. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. _.I .. 12 ft. 5011 DATE: FINAL SITE INSPECTION INSP.BY: 'YES NO MMMENrS House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Roan allowed for expansion trenches .............. Over 100 ft. fran watercourse .................. Natural soil not stripped or SDS area unnecessarly graded.......... ..... ........ 10 ft. maintained fran property line and 20 ft. from house.. ... ........................ Distance well to SSDS (ft.) ...................... Number of bedroans checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. fran nearest trench., ....... o ...... 15 ft. of peripheral soil horizontally .fran trench ..... ............ — ................ Boxes properly set... ........ ................... :ould surface runoff fran driveway, roads, ground surface, etc.;,channel near SDS area.... )oes lot drainage appear OK in area of SDS....... FINAL GRADNG OF. SITE ACCEPTABLE.... o.00 . PUTNAM COUNTY DEPARTMENT OF.HEALTH DIVISION OF ENVIRONIANTAL HEALTH SERVICES Date Re: Property of Located at (T) Pjv,&_,, �6Me Section Block ?— .Lot 1 l RR Subdivision of Nit A 04[ k��N � 1 Subdve. Lot # S4 Filed Map # 30t -T Date �lf Gentlemen: This letter is to authorize.., a duly licensed professional.engineer r 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, tary Code. Countersigned: P.E., R.A. # 3�3� Address t} Jci I OGab Te]lephon and the Putnam County Saii- Very truly yours, Signed ]Owner of P roperty Address n Town � �a 1.`TelepphJone I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF-ENVIRONMENTAL,HEALTH SERVICES. �'64i Date 1 � Re: Property; of Located at (T), Section 9 Block Z Lot Subdivision of, K01 Subdv.-Lot # Filed Map # Gentlemen: Date. This letter is to authorize 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 . I Department of Health, and to sign all necessary papers on my behalf in connection- -- with:-this ma•t-ter-and to supervise the construction -of - s-aid- system o I r systems in conformity with the provisions of Article 145 or 147, Education,L.aw, the Public Health Law, and the Putnam County Sani- tary Code. A� Countersigned: P. E. W*:K # Address N�S0-AVMf 0 t 265 19 Telephone Very truly yours, Signed,__ ock_— Z,4P c A--nziitykaia,)a3z Owner of Property ?,Q� _<YQLL POLLO-J T-FIZC Address Town ,5�. ?- - .? 11 3 Telephone DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 _ _M.APPLICATI0N TO CONSTRUCT A WATER WELL Arun VVPMTM # WELL LOCATION Street Address Town V 1 ge City Tax Grid Number WELL OWNER Name Maili g Address rivate O Public USE OF WELL 1 - primary 2 - secondary ( ESIDENTIAL ® BUSINESS ® INDUSTRIAL ® PUBLIC SUPPLY O FARM C3INSTITUTIONAL ❑ AIR /COND /HEAT PUMP O TEST /OBSERVATION O STAND -BY O ABANDONED ❑ OTHER (specify El AMOUNT OF USE YIELD SOUGHT c VCA Sgpm /# PEOPLE SERVED � /EST. OF DAILY USAGE-0 V gal REASON FOR DRILLING ONEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL ® TEST /OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE RILLED ®DRIVEN ❑DUG GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES --�NO IF WELL IS. LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: IA,i•5 c otit 4 Lot No. B WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: DISTANCE TO'PROPERTY FROM NEAREST WATER MAIN: TOWN /VIL /CITY LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ®ON REAR OF THIS APPLICATION ON A T S (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 per it. 3. Submit a Well Completion Report on a form pr ided by t e team County Health Department. Date of Issue: Z 19 , Cle Date of Expiration: 19 ermit Issui g fi — � . White Permit is Non- Transferrable copy: H:D. 2/87 Yellow copy: Building Inspector Pink Copy: Owner Orange copy: Well Driller F_ E. T. ER: rC...ALEXAN- 0,ERSQN�,_..:....,z. �_.._.�:,..;:... '......:..:._ .:.... County Executive DEPARTMENT OF HEALTH Division Of Environmental ;Health Services t January 19, 1988 Lawrence Shacter, P.E. 14 Susquehanna Road Ossining, New York 10562 Dear Mr. Shacter: Re: Chestnut Oakridge Drive (T) Putnam Valley TM #9 -2 -14 Deputy Commissioner Plans for the above captioned project have not been able to be located. Please send .to this office three copies for the design of the fill section, one copy of the plans showing the design of trenches in fill area; two sets of house plans, and design data sheet showing deep hole log and perc results. Yours very truly, y' Lawrence C. Werper Assistant Public Health Engineer LCW /jt 110 OLD ROUTE SIX CENTER - CARNIEL, N.Y. i I 10512 (914) 225 -3641 Rev. 3186 CONSTRUCTION P1 RUTNAM COUNTY DEPARTMEPTP OF HEALTH Division of Environmental Health Serviam Carmel. N.Y. 10512 Engineer to Provide Permit # on CERTIFICATE OF COMPLIANCE Permit a SEWAGE DISPOSAL SYSTEM Town or village Q` .,x ?.;,1oAsbd.L*t# q Black Tut Subdivision Nano Tax Map OL Renewd-13-1tevislon—ji ..:0wne,/Appl1.tN. Daeo(Prevfous; Approval— 1161-74 144 Walling Addrew Or Town 10516 rt f- Ae"-4- Buildi.8 Type— -Lot Area Secdolsonly Depth volume 4;72� Number of Bedrooms Design Flow G/P/D [Fill PCHD Notillention la Required When Fill Is completed Sep2raft Sewerage System to consist of —Gallon Septic Tonh and To h® constructed by z Addrea Water Suppir.--JOublic Supply From Ad&= an Supply Drilled by Other Requirements I represent that I am wholly and completely responsible for the design and location of tho proposed system(s); 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 and regulations .7 t 1urnirn 'County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill bct submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs of assigns by the builder, that sa id builder will place in good operating condition any part of said sewage disposal system durlrq the period of two (2) years Immediately following the date of the issu- ance of-, Construction Compliance of the 10 he sy rn 0 2) that t I b Install WVI. bo located as shcwqt-on-tha aplaroved plan and. that said well. will 'alnotall r n . IVrIO-W"I narn ance of the approval of the Certificate, of-, Con ruction I I sto 8 repair?/. hereto he drilled well described abovo I. ;;!!!rdancq with s' ' Is' .110 '"utalion; or. the ..Pmt �-J;. County Depalmentlof Health. P.E. __iz R.A. ► _TT t 96 Signed �Zll 10—i Ile License No— Address APPROVED FOR CONSTRU . CTION: This approve . I expires one year from the date issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissionor of Health. Any change Or alteration of construction requi►os a now pe►miL Approved for disposal of domestic sanitary ;Owego, and/or.p(Watilt• wator._wRp.ly only. TRIO Dater LP Z 07= 1 DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 - APPLICATION TO CONSTRUCT A WATER WELL PC14b PERMIT' 1 FV! 72 -A ELL LOCATION Strget Address d Town/ _ Tax Grid Number JAi •r - Z — i ELL .OWNER.:. M. ame y�•i �r[�... �.o.;�e Address rivate M_ Qlx�tt IZ : 4r�or N 1) �,P �Senv, c 0Public SE OF WELL °-- ...:. -. primary "' seconda .,�_ - . --':.e iESIDENTIAL O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP . Q ABANDONED -;O BUSINESS O FARM ❑ TEST /OBSERVATION O OTHER (specify 3 INUST O INSTITUTONL O STAND -BY p MOUNT OF _119k =,r=te -YIELD SOUGHT NPn S gpm/# PEOPLE SERVED+ /EST. OF DAILY USAGE 300 gal EASON FOR ..; °;': DRILLING : ' " :.: WM SUPPLY '-OREPLACE EXISTING OPROVIDE ADDITIONAL SUPPLY OTEST /OBSERVATION SUPPLY ❑ DEEPEN EXISTING WELL ETAILED REASON FOR DRILLING. ELL TYPE [ DRILLED 13 DRIVEN :DUG 3 GRAVEL C1 OTHER i WELL SITE°_SUBJECT TO.FLOODING? YES ✓NO ? WELL IS :LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 5,1 1. YAP of l�as���Z N /PoK - pp Lot No. y�9 kTER WELL CONTRACTOR:.,,::Name Jro \t 0�.��C�w►:w�� -Address: 3 PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ✓ NO 1E OF PUBLIC::4WATER SUPPLY: jl) TOWN /VIL /CITY ISTANCE.TO TROPERTY FROM NEAREST,WATER MAIN: K;1 DCATION SKETCH & SOURCES OF CONTAMINATION "[]ON REAR OF THIS APPLICATION (date) PROVIDED �SEPA�TE -Si . ET (signature) -'�— i 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 we'll 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. Date of Issue: 19 Date of Expiration: 19 Permit Issuing Official Permit is Non - Transferrable 8/86 Division Of Environmental HqaIth Services TWO COUNTY CENTER - CARMEL, N.Y.. 10512 (914) 225 -3641 1 APPLICATION TO _CONS TRUCT.._A ..WATER.- -nLL -= SELL LOCATION A00HESS. � f0WN/V1LL_A7E1C11Y lAX c;AiO NUMBER: P I WELL OWNER NAME • �n�M�� 4 ;,KSC0 ADDRESS: ti� � - J&P81VATE ❑ PUBLIC USE OF WELL 0" ESIDENTIAL O- PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP ❑ ABAN06NED 1 - primary ❑ BUSINESS ❑ _FARM ❑ TEST /OBSERVATION ❑OTHER (specify) 2 - secondary ❑ INDUSTRIAL ❑ INSTITUTIONAL 11 STAND-BY ❑ dOUNT OF USE YIELD SOUGHT L S gpm. /NO. PEOPLE SERVED --L_/ EST. OF DAILY USAGE ? °n gal. REASON FOR Q-NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION DRILLING• ❑ aEPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL WELL TYPE .DRILLED DRIVEN Q DUG a GRAVEL Q OTHER :S WELL SITE SUBJECT TO FLOODING? YES /NO F WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: - LOT NO.: 49 ATER WELL CONTRACTOR: Name Ao �� AUN""J Address: S PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES •'ENO - tAME OF PUBLIC•WATER SUPPLY: ln TOWN /V /C ISTANCE TO PROPERTY FROM NEAREST WATER.MAIN O% , DCATIOrI SXETCii; SOURCES •" OF-- COI3TArq'IiVATION . �_ ..__.... ,... .._ _. ... _ ...... _..__.........._..__. (date) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one mater. 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 thepiwell.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". Date of Issue: 19 c Permit Issuing Official Permit is Non — Transferrable P.T4 W.'s ; "ILI) DEPTH HOLE NO- t G.L. 1' 2' .30 4' 5' 6'' 7' EOLE N0: Z HOLE NU. 13' 3NDICATE LEVEL AT WHICH GROUNDWATER. IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFM BEING Ea900UN9ERED �-b - DEEP HOLE OBSERVATIONS MADE BY: F: i DATE: ",.r '0 9 DESIGN Z Soil Rate Used S.D.. Usable Area Provided.._.._s,tlod• . -No. of.- Bedrooms . 3 :.. ,_...,.__. Septic Tank Capacity.... •1 gals. Type .. ��.•� Abs tim Area. Provided.. - L.F....x. 24 "'. width trendy ..._ . ___..__ ...._. __... Other -- :..Signature Address 2 7 Z M"" S� SEAL ....... _... .- _�'•�t:..r .. GiiL:�:i�.:I..•`— �" _+.;.a.s ttr "`t4�h:s„! r�t7teic-: �. r� r (.a. :.• THIS SPACE •E OR USE •BY • H==.'' DIMARU4=1:ONGY °' "•: l . ' Soil. � .. .�,r �.:i„�G- ,'`�.. ���i.ri ��Gt ��.. •. r�;;; -T �i. „� �`•. c +r�T...' Rate Approved- z� sq.f gat- Checked by- - {(7) o till o T�'S� 4� repea tec c�81. a idepttL . 4Y.• odlAl a iC�oClYi te�.y e��ail: iY.. `, •'. � AIC� �3d SfG ®ci( S, 'YaO�,$ 086 Wit,. • Ole AU data to '.e ttlad . a •..� '�IIf1�3S�e�t : �O � �goi�d $� �f e rev. 9/85 P(Pl COONrY DEPART OF BEALTH. DIVISION OF ENVIRONMENIAL HEAM SERVICES DESIGN DATA SHEET!- SUBSUFACE SEWAGE DISPOSAL SYSTEM FULE ED. Owner 0,AL a5ce Address 2741 �pa.c5•c�X A4C p•nx Av- � + op Located at (Street) Q� I� c��� �e + M" . ok Block Z Lot Of (indicate nearest cross street) Municipality tg Watershed 14-µ� '- SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking S 130 b Date of Percolation Test ` s 30166 HOLE NUMBER CIOM TIME PERCOLATION PERCOLATION Run Elapse Depth to &dater From Water Level No. Time Ground Surface In Inches Soil Rate Start-Stop. Alin. Start Stop Drop In Min/In Drop Inches Inches Inches 1 ZZ.3 2y z, 3 3 I _ ,. Z. 1 25.E _ 2� 2 I 3 p b z 2- 2�; 24 = z7 3 23: �? _� 24'.. 2 3 9, Q 2y . Z,_ 3 q, 2 ::. 3 f .:.... ... �- : {(7) o till o T�'S� 4� repea tec c�81. a idepttL . 4Y.• odlAl a iC�oClYi te�.y e��ail: iY.. `, •'. � AIC� �3d SfG ®ci( S, 'YaO�,$ 086 Wit,. • Ole AU data to '.e ttlad . a •..� '�IIf1�3S�e�t : �O � �goi�d $� �f e rev. 9/85 . i. PUIN M COUNTY DEPART OF HEALTH. -DIVISION OF ' FY-U i SEFtiTICFS DESIGN DATA MEET- SUBSUFACE SB4AGE DISPOSAL SYSTEM FILE VD.- Owner s 1 tn5ce�•� Address 27111 �>e&c5j AC Qronx �y Located at (Street) Block Z Lot (indicate nearest cross street) Municipality �,� Watershed Nµ� s►� SOIL PERCOLATION TEST DATA RDOUIRM TO BE SUBMITTED WrM APPLICATIONS Date of,.Pre- Soaking S13oLb Date of Percolation Test 5) 3016S HOLE .:..•. .. . KHBER C[= TIME ` PRROOLATION PERCOLATION Run Elapse... Depth to Water Fran Water Level' No. Time Ground Surface ". In Inches Soil Rate Start-Stop Min. Start Stop'' Drop In Min /In Drop Inches Inches Inches 3_ _... q. . ^_ ► .3 . 30.0 4; .... . _ 71 3 I0. 14 2 27 :Z7• Z 2 3' 2.4 2 iv.•,.;, �� ti, .iii ; •.y ... ., n .. .. , : • ' Testese repeated aty same..depth until approacimately equal soil rates are `o'bta kh d'.at 'each percd ti la on test..hole. All data. to' svbmittmd .be for �ce ;. De, measurements " to be' Wade � fram top of hole. rev. 9/85 G.L. 1° 1 .. .... 0.".; R I."; V....e..... 74:11. a.. .................... .. �1 �• "Mike YID Y' .. r, • BOLE NO. MOLE NO. log 11 B. 12•9 INDICATE .'LEVEL AT WHICH GROUNDWATER IS ENCa TERED INDICATE LEM TO wuCH WATER LEVEL RISES AFTER BEING ENOOUN'iR DEEP BOLE OBSERVATIONS MOE BY: F - z DATE.* ZO 5� ' DESIGN Z - �.�....'........a S nog. Soil Rate Used : li.n/1 -Drop° ._._ .._..... ...- SeDe. IIsable Area i?rov�.de�3•-- ..___�. ... . itoo 6£':B6&ooms .....: 3' .. Se `c..Tank Capacity..- _... . P� pa ty...... o n..0 . . galso _.�.. Type .. re•..�. ..Absorption Area, Provided 333- ......•: •L.P....x..24 width trench ...... . rP � Other _......_.....__.._ Y Signature Address 2 7 Z 1►�u ?� ���, �'�-+', .. _..ca.w .sa1..:,+...ta• '.i.D•....rs,r:t,,.:1C.�i. !S " Vii•. �� THIS SPACE MR USE "BY: :�DEPARMMMa!`ONLY °, p" ��L.7•� ��{{. t0 60A -Rate •� � � � .. e i � �� �f.��.AL �t lZ ,+,r:y _t i> • �:• • a A•!ti LA ^T•�i3s�d P•• PCII�AM 00(JN'I'Y DEPARTMW OF HEALTH. .::.DIVISION OF HEALTH SERVICES:' DESIGN DATA SEUM -SMUFACE SEWAGE DISPOSAL SYSTEM FILE VD.- Owner t0. rfn5co+.t'' ! Address 12741 Located at (Str eet ) toa L (-�he Block Lot Of (indicate nearest cross street) Municipality �C', d ' ' Watershed SOIL PERCOLATION TEST DATA RDOMM TO BE SITFMITTED WITH APPLICATIONS Date of,•Pre- Soaking. 511-194 Date of Percolation Test 9)3016G HOLE. Numm CLOCK TIME PERCOLATION PERCOLATION Run .. No. Start.. -Stop Elapse ' Time Min: Depth to Water From Ground - Surface ". Start Stop'' Inches' Inches Water Level In Inches Drop In Inches Soil Rate Min /In Drop 3 :..:_.� 2 i .3 . ;.:. �io..o z:4.:. ; .......�.. �� 3 I.4 27 3 6 �.2 2G u` Zy 21. 3. Z4 27 2 Rj f i r1v F1,v ` w 1 NOTES ; �. Tess ::tq e� repeated at "saine"depth until appradmately. equal soil rates ". "• 4 `are'`b'b�tai i�d'.at each`peroblation test'. hole. All data-..to`be submittod • ,, for;,e�idw. Depth'veasurements to be made� fran top: of hole. `rev. 9/85 ._..._...__........_:... .. •I, _ . _....._..... ... . - .. TEST PIT DATA REQUIRED TO BE SM4ITTEQ WIT!H APPLICATION DESCRIPTION OF SOILS E90OUNTERED IN TEST HOLES DEPTH .• �O. I EPLE NO., HOLE NO_ _ .fir• - - - - �� � � - �. .10 ° 12 °.. -13' 14° - INPICAM LEVEL AT MICH GROUNIX4ATER IS ENCOUNTERED E -0 INDICATE LEVEL TO WHICH HATER LhiTF.L RISES AFTER BEING ENCOUNTERF2) S: -a DEED ROLE OBSERVATIONS MADE BY . o DATE. DESIGN Z Soil Rate Used:_ 1.7 1•)............ n/1-Drop: - _._ S.D.". Usable Area Provided.. -. s,.v_ob • .. - No. ot:. Bedrockns Absorption Area. provided. -By- 3.53__,_ L.Fo..-x..24" . width trench Other _ _........,.. _ - - Namecc�P.v< Signature _••. • Address 2 7 Zp :•� S�� SEAI, �! ` .,.c.1�... :.r'.� �..aru.� .;*a• .rt..;:cu.k ;. L i• trC a'.i. ��`!; :.,,',�'f,.. _ THIS NA-CF-20R. USE'`BY • AFALTFi`'DE.PA;'�1 T�'ONLYo'` �FO.PqOFEBS����4 �1�; �.'4Nd Y/v� � '..�'_� �.ri�. "• ...v. y�0���.N � �A.►�.wLG�A •.� wwr�.rr..�, ��+v Rev: ,.'3/86 0 J . PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Must Provide V 7 Z -��j P.C.H.D. Permit # rF>aFrrdtCATE OF CONSTRUCT] (4 1,o6 d f CO -FOA SEWAGE DISPOSAL Located at Owner /applicant Name 12- Ci.ej A 03� -Formerly- 12- gz Qca eralaµ Qs- r> Va Zip 10soci Malting Address Town or Village , Tax Map _Block_ -. —Lt Subdivision Name � gt— JSubdv. Lot # Date Permit Issued Separate Sewerage System built by 1 GU-V Address._. Consisting of t� C Gallon Septic Tank and 313 ' Water Supply: Public Supply From Address Private Supply Drilled by e- Address era__.-- ---- -- Has Erosion Control Been Completed? Building Type ---- *3 {� Number of Bedrooms -� Has Garbage Grinder Been Installed? Other Requirements - I ceitify that the system(s) as listed serving the above premises were nstructed a entially as shown on the plans of the completed work ( copies ofce ti are attached), and in accordance with the standards, rules an regulat i accprd with the filed plan, and the permit issued by the Putnam County Departm nt Of Health: lltj�\ 101 if;��b Certtiifod by P.E. R.A. Date �Z M 7�- A 1 d%`�i�G jl%. /0Slb 1373 Address /�/ License No. Any person occupying Premises served by the above systems) 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 sewerage system shall become null and void as soon as a publ�_ unitary 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 Commissioner of Health, such s11u�c1h /revvocation, modification or change Is necessary. Date v ` By �,� -� l ` L�l ✓y-� Title PUTNAM COUNTY DEPARTMENT OF HEALTH Hesttb Sauiyloes, Carman, N.Y. 10512 Engineer to Peovlaka Perasit N �. _, _ - aim CEVMCATE'OF COMPLIANCB '- CONSTBUCTI PERMfI_ FOR SEWAGE DISPOSAL SYSTEM Permit N V _1Z - ..Ioe tea at �` owe or e Sabdlv4ba Name 5 " p0 Tax Map Block z t I L OwnedApplicaot Name "" v� J h P.Q v. Renewal_ ❑ Re on + Date of Prqvious Approval ►s Pery I I ' `� Town v C e iul►dae Zip / UJ7 7 ftUdf Type Let Ara - 5 51 40t4- 2 Fill Section O* Depth Volume 2Z Number of Bedrooms 3 Design Flow G P D 6417 PCHD Noti9cation Is Required When Fill Is completed Separ to Sewerage System to oansiat of Gallon SM& Tank end To be constructed by Address Water'SapPly: /pdbpc Supply From 11 1 Address on / Pdvate Suppb Drilled by Art�l ti Other Reaalrements t represent that 1 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 amendment there to and in accordance with the standards, rules an regu a ens o e u nam .:.County" of Health, and that on completion thereof &. "Certificate of Construction Compliance' satisfactory to the Commissioner of Healthwill 0a%'su0mittad, to the Department, and a written guarantee will be furnished the ow his successors, heirs or assigns by the builder, that said builder will plate .iri'yooe operating condition any part of said sewage disposal system ng the Fled of two (2) years Immediately following thedate of the Issu- ance of the._approval of the Certificate of Construction Compliance of th orginaI syst or any repairs thereto; 2) that the drilled well described above will, located as shown on the approved plan and that said well will be Instal in at co ce ith J�f�•^�{{{... dares, rubs and redo aT o'ns pf the Putnam C06P y Depait nt of Health. V Date 1 S Sgned ✓ 1 ( • --I_ �7 A P.E. _ R.A. Address 4 &K - - 0 S license No �13 73 s� APPROVED FOR CONSTRUCTION: This approval expires t years from the dateed unless construction of the building has been undertaken and is �..MrAa on _...,me0ax11 ffi at Seavl�me, del, xr.1651? luevd to P>rav@�e Pea;sDls a mia CZ1M CATS' ®P' CGWpU MCE .,�msva>r8°70i SEWAGZ DLSPDSAb SYSTEM asg o .� SubdMdkm otsd or Name Raata.t WW. lot a (� Oer0ea /Appllcraat name Ro �f 5 4 �emoanaal____. ❑ &evt®toa Deft of Pnv�us Appvvd °R Ijaw �jt� ° \ w •�1tA �ewm . � o s79 Building Type rt:. it"— Lot Am 55-) cam. Fill see&, 0MY Depth Volume B)umber d Bet+l "ns9 �� Design Flow G P D _ rM) PC® RIaDWa4iin hi $equiaesl When Fill is ComspleW Sepaaate Seweaage System to consist of 1A n G And 333 a ii, t To b tsmstmeted by °s1 e &,Mg.W Addae9a Water Supply: Public Supply Fltom Age Ors P vaete Supply Drilled by �, .Add mw Daher Regolreutente 1 represent that 1 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 amendment there to and in accordance with the standards. rules an regu a roes o s u nam County Department Of Health, and that on completion thereof a ^Certificate of. Construction Compliance" satisfactory to the Commissioner o4 efoPutnai0 be submitted to the Department, and m written guarantee will ba,turnished the owner, his successors, heirs or assigns by the builder, that said builder trip ptoce in good Operating condition any part of said 'sewage disposal system during the period of two (2) years Irnmpoiately follow 4hedate of ih0 issu ante Of the approval of M® Certificate of Construction Compliance of system or any repairs thweto; 2) that the drilled well dosefibed above V41 be located os shown on the approved plan and that said well will be in ited In acco an with t standards, rufea and rev a�ilipna Of tt,n Putnam County Depa t of Health, ✓j_ Dote 7 �s Signed P.E.- R.A. Address 7-12 A& 1� � I rnsl License No 43731 APPROVED FOR CONSTRUCTION: This approval expires two years 'from th ate issued unless nstructfon of the building has been undertaken and is revocable for cause r may be $tended or modified when considered neeassar by the tkommi si If Health. kA y change or oration of construction requires a ne a rrtf . pp� f(od }or disposal of domestic sanitary sew ed /or privet ter wpp onl 187 Date By Title PMAM COUM DEPAMMM DP ="11� 9111191®0 et Bavhonmmtel seam Service©. Carmel, NX. Iasi? t AI U�U�1 UI ;OE SEWAGE DMOSA. SYSM1 Nr let d' OWW /App91crint 140me pI(SI Peov9tle Pon* 0 rW 4;1MMILAM Low s aeiraa aaruvs m 'Faso -�- iaa___� el ®teem ❑ `� Date o1 Affmal I lit, Toavu Aare S) �t _ Fill Sew Only � a� 'CUD embe cl Whmn M h3 eom111111 l ' { Rttlmbea at Design Flow G P D Gstllon Septic Tonh Sepnraitm Seweaagra Sylttem tt► tsrfashtt a &._._ -.-•- To ba construdW by WOW Supply: Public Stalpply Finamt i-Addirew oas____�Privtate Supply DMed by • "�1 Ath�+e9s tither it"pisssmeuta 1 represent that 1 am wholly and completely responsible for the design and location o4 the proposed syttem(f); )) 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 regu ens o e u nam County Department of Health, and that on Completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee wilt _be furnished the owner, his successors, heirs or assigns by the buil*v. that said builder will p1oc0 In good Operating Condition. any part of said sewage disposal ring the period of two (2) years immediately following the date Of the issu- ance of the approval of the Certificate of Construction Comptian of the or nut stem a y repairs thereto. 2) that Mo drilladl well described above will be located as sh0vrn on the approved plan and that said well will a inatailetl in ccor ante t standards, rules and regu a ems of the Putnam County Da itm nt of Health. J' Sin �.E._ R.A. _ Date (f /r ?� All License No Address %PPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless Construction of the building has beam undertaken and is evocable ter cause or may Oe amended or modified when C si red necessary by the Commissioner of Health. Any change or a)terAMOn of construction qui:ZE5i77_:�� no f al of dome is its y sewOl private water supply only, sto ev i P -- Title PUTNAM COUNTY DEPARTMENT OF HEALTH Engineer to Provide Permit N :x - Re V . 3186 Division of Environmental Health Services. Carmel. N.Y. 1051? CERTIFICATE. OF COMPLIANCE P� 6 P\� $ CONSTRUCTION PERMIT F SEWAGE DISPOSAL SYSTEM Located at 0- Subdivision Name�'0�` Town or Village Renewal— ❑ Revision ht�WL G1.4�►9e.�� owner /Applicant Name :r1 i0m• l 01At9t N - r Date of Previous Approval a IM Mailing Address �C VC ' Town �� Sel►v 1�{ % f�eh \�'PJtAf'Qi • 5SI dlt4'�4- Fill Section Onl �y22cy Building Type Lot Area Y Depth Volume Number of Bedrooms Design Flow G /P /D �� PCHD Notification is Repaired When Fill is completed Separate Sewerage System to consist of Gallon Septic Tank and To be constructed by Address Water Supp13: PdPdbllc Supply From Address- or: L/ Private Supply Drilled by 410 �&d eW-1 ddre.11 Other Requirements 1 represent that 1 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 amendment there t0 and in accordance with the standards, rules an regulations O 0 u nam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" 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 condition any part of said sewage disposal system du period of two (2) years Immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the ginal sys m ors ny repair here • 2) that the drilled well described above will be located as shown on the approved plan and that said well will be install in ac cord c a wit the he ar , r lea and ►egu ions of the Putnam County Depar ment of Health. Date Signed Y t P.E. R.A. t Address asr. yl License No APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and Is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction requires a new/(permi Approved for disposal of domestic sanitary sewage, and�or e �fsu y only. 1 s BY _ " Title Date _ _. - -_ .., PUTNAM COUNTY DEPARTMENT OF HEALTH J 3/ 86 Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer to Provide Permit N - % a� on CERTIFICATE OF COMPLIANCE �� ✓(// CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Peermitit b f/ m _..- ..:.... Located at Town or Subdivision Name In- J`iN:,tn� 171b�� Sabd. Lot # Owner /Applicant Name t-"�CB��Q. Mat, Address Z` if � PfUJ K?'L Tai Map —Block �- Lot.�_L_.� Renewal_ ❑ Revision ❑ Date of Previous Approval Town (�ranx Ny_ ZIP ) 0161 Building Type `e"a Lot Area , SS) ac= FRI Section Only Depth _ 3 Volume �ZZ Number of Bedrooms 3 Design Flow G /P /D 60 0 PCHD Notification is Required When FIB Is completed Separate Sewerage System to consist of Gabon Septic Tank and To be constructed by Address - Water Supply: c Supply From AAA—se or: Private Supply Drilled by Other Requirements 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 amendment there to and in accordance with the standards, rules an regulations o e Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" 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 condition any part of said sewage disposal system du r' Period of two (2) years immediately following thedate of the issu- ance of the approval of the Certificate of Construction Compliance of the o ginaIsyeirn or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed n acce slfith the nd s, rules and regu a�iions of the Putnam County De par a Of Health, lwm/ Date g ld` /� 1A1�L]inL,Signed ' ' P.E. R.A. _ Address : Z � "" ' Y – License No �j 3736 APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction requires saa�pnew permit. Approved for disposal of domestic sanitary sew d /or private water supply only. Date `r �� �i /� v V/ By,/�'Y Title I i S 19-49-30 N rn AF&EA' 0.5510 acres 0 This is to certify that the sewage disposal systelb woo constructed as indicated 'on this plan and that the ' system was inspected by me before it was cover- ed over. The system qas-constructed in accordance with all the rules and r6gulatioAs'of the Putnam Coun- ty Depart . ment of Health .* Q f NEW ro %klcx A Frederick A. Zenz 29?, Main St. '43 Nolhonville, N.Y I0516 to-LdM of Environmental Health Service. A—S no= Approved as noted for conformance with applicable Rules and Regulations of the Putnam County Health Department... mmmum 91anature & Ti Ta+7- 0000MISIMEMMMUN AS -QUILT SURVEY By J. S. ROMEO, L. S. SEPARATION DISTANCES IN FEET MMOMOMMEMIMMMMENOMEN =muumuu no= mmmum 0000MISIMEMMMUN MMOMOMMEMIMMMMENOMEN NEEMEMENNNOMMENONNE r. a _ a �k 3 YiY' n rt* -" � k \\ - / 111 � 1 � 1 I I u ", •f p � , s / r \ \ // 1 . � 1 A. i /toot - » ' 1 �C-A y _12 __ Is r 1°. 1 8. �� �� �." � � n /yam .• � n III I• s} r ••' ,1 I 9 to IT / M n \ f N , ti IN I.W N.CLL.. ZD O 41 . 2 0.51 IC N.G. \ . 1 �- _] i 0.00.1 ai - 26 - rok REVISIONS SPECIAL 01 -11CT INFORMATION I; LEGEND _ PRELIMINARY INiPO5E5 ONLY I .�,e ,a - er,u•....o= s�.rner ,o a_ �-{' MA 9 .......... TOWN OF PUTNAM VALLEY scuc I•. Iuo. ■1w�f,w:r; I.e I •I I n �I .or. .e.. w.o.o.> -- _ `.. —_'._ _ — arena +o, ee (r; .. .. au - . —.--.- I .u.....e ♦w. —___— I �"!_ _.___.__ _. __..._ __.__ _ PUTNAM COUNTY, N.Y. A