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t PUTNAM COUNTY 'DEPARTMENT OF HEALTH r
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Division of Environmental Health Servioee Carmel N Y 10512 Engineer to Provide Permit N
on CERTIFICATE OF COMPLIANCE .'
•,
f
-.
P/et N.
TR ON' PERMIT FOR
I
;
SEWAGE DISPOSAL'.SYSTEM
/r /mit
or Vlllege
Subdivision Nam O%e Su6d.z Lot xa .7 loc
s:
o
;, �-:, :, -" "`. =,. Renewal_❑ Revision
•'; OwnedAppllcant "Name
..�..
>... fDate of Peevioas`A' royal -
MaWng Address ����1/ . ✓fir Town MO/✓i: Y• Zip /0 � ' (i
r•
1
Typ/oo
Bfdiamg Lo Area JS
L
` „
FM Section Only Depth >�voiame _C+
Number of Bedrooms ' - Design Flow G
Notification is Required When Fill Is completefl '
i
_
Se Sews le S stem' to coualet of Gallon tic Took an0 : ��• EL�
paste rib Y� T
To be constructed by;/A.4 " �* !!► 'Kddiees /✓�i�
3
Water.Sa 1 _
PP J Pablic.Sapply Flom Address
f -
Supply EAL= Address
orivate Dellled`by
.Other Requirements'
1 represent that :l am woolly and `completely >respogsiblp for the desrgn,antl location ot;the=- proposed syst_em(s) lj "::that the separate'.,sewage ;disposal ".system
1
above tlescribeil will be constructed'as show'n'on the. approved.`amendment thare,to and in`accoidance with the standards, iules an regu a ions o '• e- ,u nsm
County�'Depi tment. of, kealth,-, and that on.cgmplehon,'thereof a = 'Certifrcate'of Construction _Compliance^ satisfactory. to; tie Commissioner of HeaRhwill
be submitted ,to the Department; anti a wrrtten'quarsntee well be furnished the owner ;his- successors heifz or,assiyns by the•burider; that said buitdeV yfirll
!
_.
- .place in gootl:"Operatinq;.conadion any ;part of,- �ssid. `sewag`e_'tlrsposal systelri:dunng�- the;period;.of two,(2): years. imriieCiatelyjtollowing;thedate of,the`issu `
ante of the..approval of "the Ceitifrcate -of Construct,on Compliance- -of the-- origmaf(syitem orany repays_thereto;.2) that Me drillsd:walf described . above .
will be.'Iooatedaas shown on the approvetl plan and that said wellrwrll be "installed"'' 'n th .the stantlards riules and iegu a ions of• .ahe
,Putnam
` County Departme of ,H` Ith •� _.I
Date
Address ' - �cense No �G fir?
APPROVED FOR CONST�RUCTI:ON Thrs,approval�expues two years :,from t " .pate issued unless ;construction of -the bu ding has 4been undertaken and rs `
.revocable. fOr;caUSe or may be amended or modified when considered- fiecessary,',by the Commissioner - Of:Health =Any .Change' or ;alteration O,f;;COnstructi6n
_ ..
requires,a new,,permrt,ADprodetl for dispCSal Of °COmost resamtacy.- 'sewage anti /or iprivate•ywater Supply; Only
87 _ Date - gy iTrtle
'
I
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATION TO CONSTRUCT A WATER WELL
PCHD PERMIT #
WELL LOCATION
Street Address Town Village Cit Tax Grid Number
WELL OWNER
Name Mailing Address
3'. varntlacA 31; oA A, A&r
X(Private
LIXRublic
USE OF WELL
1 - primary
2 - secondary
EKRESID ENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP
® BUSINESS ❑ FARM O TEST /OBSERVATION
® INDUSTRIAL U INSTITUTIONAL O STAND -BY
❑ ABANDONED
❑ OTHER (specify
AMOUNT OF USE
YIELD SOUGHT,5 gpm /# PEOPLE SERVED L+ OF DAILY USAGE IL
REASON FOR
DRILLING
NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY
OREPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL
® TEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
d0w V
WELL TYPE
DRILLED
O
DRIVEN ®DUG
® GRAVEL
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES 1/ NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: ftC9&y-;pA& UnDer< G- r< t��F
yv% Lot No .
WATER WELL CONTRACTOR: Name S(rr4 L Address: `SP, 0Go 15 I-LzrP
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO
NAME OF PUBLIC WATER SUPPLY: //mod TOWN /VIL /CITY Al
_. .. .. _. F _ .._ _ ... ... .. .._.. ... .... __ <. _. .. .. . .... .. .. ... ... .. . -� ... .. ... a ..._ .. .. . -..._. ... . ..... _._ e-.. .. ..... a .._.._.... .. ...- .. .- . _.
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: 6V -Ao
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
®ON REAR OF THIS APPLICATION ON SEPARATE SHEE a
Q—q— q 6
(date)
r
3!!! /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 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:
Date of Expiration:
Permit is Non - Transferrable
2/87
19
19
Permit Issuing Official
White Dopy: H.D. File
Yellow copy: Building Inspector
Pink Copy: Owner
Cb-antra t-nmr- Wcl l Tlri l l cr
PUINAM a JNW DEPARTKMr OF HEALTH 02 a J Z
DIVISION OF ENVIRCMWM HEALTH SERVICES
DESIGN-' DATA-SHEET SUBSUFAEE::. SEKIAGE:: DISPOSAL- -SYS.TR4 .
Owner Ue 49 aloe e. Address 3.-3/3 �'�P dam. -✓v4-
A 6^e f;V r- ,d'eo ok Bic o.v x IV.
Located at (Street) ,4 5.�,�oQE' >A. Sec.._ Block �_ Lot api:q
(indicate nearest cross street)
Municipality
1-,tey
Watershed �a•9� %✓� Gieae•f .
214 •rw-
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WrTH APPLICATIONS
Date of Pre- Soaking _� 1,Z Date of Percolation Test 9-131
HOLE
NU4BM QiOCR TTME
PERC4LA,TION
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
fir z��
5
2.
3
1. Tests to be repeated'
are obtained at each
for review.
2. Depth measurements to
rev. 9/85
at same depth until approximately equal soil rates
percolation test hole. All data to' be subnittid
be made fran top of hole.
w "T11MT1r%TV T
PUTNAM COUNTY DEPARMORr OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES "
DATE:
RE: Property of ; A-�-r ✓ ��4-G :� /-�
f �
Located at e gka- �� .0 aA
(T) �ct �'b1 Gc.r V (, ` Section 1 Block / ' `. Lot
Subdivision of 6me.b' ®o-�r- i'rn_ra
Subdv. Lot 4. 3 G .7,
Gentlemen:
This letter is to authorize
Filed Map # -S 6 LO Date T c. /sit Lq ca-G
-Ito. . r- I - P- •- PC
a duly licensed professional engineer ✓� or registered architect
(indicate)
to apply for a Construction Permit for a beparate sewage system, to serve the
above noted property in accordance with the standards, rules or regulations as
protnulagated by the Ccianissioner 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 Sanitary Code
TH0,p, ry truly yours,
..
fined:.:' a..
Countersigned:. y ®. .064 Vrr of Property
P.E., R.A., # �w 7� 9 Address
io s Sa,'II R
' Address Town
(a 5q: 0-7 $
Tdlephone
Teleon i
19
RnMM OXWY DEPARU= OF - HEALTH
DIVISION OF ENVIRCNMERML HEALTH SERVICE
w._DESIGNrt: DATA,- -SHEET-rSLJBSUFACE_.,SEKTAGE,.DISPOSAL,--SYSTEM.;I�:;;;,,,, zFILE -;NO.
Owner y ),'q ar.�ee,4 Address A I/X;-VV4•
Located at (Street) Sec. Block Lot
(indicate nearest cross street)
MMunicipality 41 Z- / - e Y .
Watershed eadiel;a exogt
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITrM WITH APPLICATIONS
Date of Pre-Soaking /,P*_ Date of Percolation Test 5r131
HOLE
2
NUMBER C= TIME PERCOLATION
PERCOLATION
Run Elapse Depth to Water From
Water ' Level
No. Time Ground Surface
In Inches Soil Rate
Start-Stop Min. Start stop
Drop In Min/In Drop
Inches Inches
Inches
4
6i
3
5
NMS: 1'.
2.
rev. 9/85
Tests to be repeated'
. are obtciined.at each
for review.
Depth measurements tc
at same depth until approximately equal soil rates
percolation test hole. All data to*be submitted
be made fran top of hole.
2
3
4
512/11
5
1g2, • #,0 A' 0
'P. 3
2
3"y
3
5
NMS: 1'.
2.
rev. 9/85
Tests to be repeated'
. are obtciined.at each
for review.
Depth measurements tc
at same depth until approximately equal soil rates
percolation test hole. All data to*be submitted
be made fran top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
4' 6ee p eoc,k � 4r T
5' Gw� 31
6'
7'
8'
9'
10'
11'
12'
13'
14'
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL SES AFTER BEING ENCOUNTERED 5
DEEP HOLE 'OBSERVATIONS MADE BY: / �jL%j¢�P/ ATE: .� o
DESIGN
Soil Rate Used Min /1" Drop S.D. Usable Area Provided JO o d
No. of Bedrooms Septic Tank Capacity / d Oo gals. Type d�0 AIC
Absorption Area Provided By DU L.F. x 24" width trench„
Other ���a° oo�T �' 3, .� ' v� �. `Z. v,
Name
Address / o !o .S ����A �01' SEAL �Rl �� '
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved sq.ft /gal. Checked by Date
DESCRIPTION OF SOILS- ENCOUN'IMRED IN TEST HOLES
DEPTH
HOLE NO.
HOLE NO. e.2-
HOLE NO. '3
G.L.
e-
1'
T1�S
14
2'
S14 7-Y ",f ;of
s /pry ���
s.Lry 10,4;07
3
4' 6ee p eoc,k � 4r T
5' Gw� 31
6'
7'
8'
9'
10'
11'
12'
13'
14'
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL SES AFTER BEING ENCOUNTERED 5
DEEP HOLE 'OBSERVATIONS MADE BY: / �jL%j¢�P/ ATE: .� o
DESIGN
Soil Rate Used Min /1" Drop S.D. Usable Area Provided JO o d
No. of Bedrooms Septic Tank Capacity / d Oo gals. Type d�0 AIC
Absorption Area Provided By DU L.F. x 24" width trench„
Other ���a° oo�T �' 3, .� ' v� �. `Z. v,
Name
Address / o !o .S ����A �01' SEAL �Rl �� '
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved sq.ft /gal. Checked by Date
PETER C. ALEXANDERSON
County Executive
October 3, 1990
Vincent Ettari
1065 Spillway Road
Shrub Oak, NY 10588
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
Re: Construction permit
Mary VAcirca
Lake Shore Road
Putnam Valley, NY *7 -1 -20
Dear Mr. Ettari :
JOHN KARELL Jr., P.E., M.S.
Public Health Director
I have received and reviewed the plans for the construction of a single
family two bedroom residence on the above mentioned parcel.
Pursuant to Article III of the Putnam County Sanitary Code and Part 75 of the
NYCRR, the application is denied for the following reasons.
1. The proposed well is 100 feet of the proposed sewage disposal system and
.. the.._ existing _ eer:age _ - disposall system to the southeast. `:Since "these
sewage disposal systems are considered in direct line of drainage, 200
feet is required.
2. The proposed sewage disposal system is /80 feet from Roaring Brook Lake.
A minimum of 100' and possibly 200' is required.
3. No expansion area shown 100% required."'/
r,
The plans also require some technical revisions (copy with notes enclosed).
If you have any questions, please contact me at your convenience.
Very truly yours,
William Hedges
Sr. Public Health Engineer
WH /jp
cc: Mary J. Vacinca
3313 Perry Ave.
Bronx, NY
,1
t
i 90
i e
92
94
96 '
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t 107.5'/ t -
5 ROARING BROOK ,LAK� EX187'• SDA
do�6
ELEV. OF WATER 89.08 1,3'
c •� "�
B 77S oYpo"w IOP,
ROO .
FT. - XIST IWQLL
M H.
I
S 76.47'00"
207.5't -'
u rs
73• t02 60"E
229.91.
92 s ° OP _2!� ".BED
iiDW G_.
BS T -`
89 IO•. /F t 104 /
2 SEPTIC
L /
TANK
P 21'/
'too' 7DRIVE.
PROP,
PROP. 24„
t CMP'
EXIST. 3DA
tv
ol
/ 3
/ I 04
h 96 st / 102
5'4 22 I BA
98 .I 30`. M' . -- eln
' _ • 7e.97' � '
100 `
/ INSTALL NEW 1•
GARBAGE BIN -- s t 718" CMP
V (TO BE RE D
^
MA g, a I IB" CMP
D (TO �
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BE REMOVED) �,