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HomeMy WebLinkAbout2293DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.09 -1 -18 BOX 20 02293 IL ' ,'I. F . L h ' h 02293 r PUTNAM COIINTY DEPARTMENT OF HEALTH Division of Environmentol Health Services, Carmel, N.Y. 10512 / Meer Must provide P.C.H.D. Permit li &U. f"EBTIFYCATE OF CONSTRU ON COMPLIANCE FOB SEWAG DISPOSAL SXST$11S . - - -.- f 01� . .._ Town or Vie � at Tax Map, S Lot /applicant Name �O r /. �t� i iRtfrd6dy --1 Subdivision Name 1' -1' <. ro`r Address S i�� zyz e2' 1:f- A,-'Vl Subdv. Lot # 2-,9 �1 Fee Enclosed Amount -2- 69 ��, j-'/ 2-: Date Permit Issued r Separate Sewerage System built by 7 Address; d%r /� o �� �✓ / /d� ��� Consisting of j ©� Gabon Septic Tank and -- 3 /� L ze� Water Supply= Public Supply From Address on )"o" Private Supply Drilled by Ze' —Ie l �/ `' Address 23 / e-- 19�5� A /I 'Zf BuddingType Siz e 3 73/� Has Erosion ennt�rni RPp„ Cmm331atpd? Number of Bedrooms Has Garbage Grinder Been Installed? Otber Requirements I certify that the system(s) as listed serving the above premises were constructed essential) of which are attached), and in accordance with the standards, rules and r y the completed work (copies Putnam County D partment Of Health. °tom in accoz �Mthe 1 and the permit issued by the Data /, ^� ,��-✓. Cwtifled by P.E. �Rr►, Address -2,7e� ' "�G�ri rG° na No-�!c� Any person occupying premises saved by the above systems) shall promptly take such sdfon as may conditions resulting from such usage. Approval of the separate sewerage system shall become null available and the approval of the private water supply shall become null and void when a public wi Subject to modification or Mange when, in the Judgment of the Commissioner of Health-AuCK —re 3/$9 ^o corrsctlon of any unsanitary a pubt.z sanitary sawer becomes available. Such approvals are I or change Is rue any. Title t, p !Quill[ CDUM DWAR3NM OF NZAIM `a-- DlsYsn dlmaekarlis•sassi BooMh 8sevbs. C>.ss•ai. lI.Y.1161? uszkow a Pervue )trr®It ds iaRMIFICATE OF .. - ..�._ DMOUL STSM T. Putnam Valley _.. ;, _ ........_..._ ..._. -.. ,,,d,dat akeshore Road & Cove Road 7WE er valow lti�lrsr llamas Roaring Brook w++_ Lee l 428 & 429 Tae M0p � 11 Block 2 W 14 >4e..w.t ❑ Rte bliss ❑ OmewlAjfreutllama M/M Robert Kohl Daft dhow AM—Ad 8/80 MailgAdieo P.O. Box 122, Katnnah, NY 1M36 Town Tip Date Subdivision A22roved Fee Enclosed ® Amntlnt -041- y Typ Frame W Ana k Acre + pm Sactio. o* Dwa 24" vabms 423 c yds . Number d Bob Three Des1Es Flow G P D 600 PCHD Notblcauw h Requited Wbsr FM Is completed Sspsaa/s Sawseap S>rsg� la writ d 10 0 0 rr... SOP& Timis 3751 Lateral s T. be.aon4ueMi b ? Add law Mater So>suh7 war. Sop* Fns Address an X gale Suj* Drilled by ? Mar Raar None �sssle 1 represent'.that 1 am wholly and completely responsible for the design and location of the Proposed systom(s)1 1) that the separate saw di sal stem above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a regulations o m County Deportment of Health, and that on completion. thereof a "Certificate of Construction Complana" satisfactory to the Commissioner of Healthwill be submitted to the Department. and a written "grantee will be furnished the owner, his wcaaon, hairs or assigns by the builder, that said builder will pap in good operating, condition any part of Yld sewage disposal system during the period of two (a) yews immediately following thedate of the issu- ance of the approval of the Cartifkate of Construction Compliance of the original system or any repairs thereto: 21 that the drilled well described above will be located as shoava on the approved pan ale that old well will M Metalled accordance with tM arsdarde, rules and rpu sans of the Putnam County Dpsrtaaat of Health. Date 16 November 1990 signed P.E. X— R.A. _ t Address RD9 -Fair. Street Carmel, N.Y. 10512 License No 29206 APPROVED FOR CONSTRUCTION- This approval expire% two years 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 necefYry by t COmmisfioner of HNlth. Any change or alteration of construction zeV requires O perRit /l ad Mdomeetk Nnite at• we eyppitt_on1y. ., ,.... Dal. it � � " ! MAM COUPfff DEPARTNIM OF HEALTH CB=4 N.Y.1 to Paevlde Bbadt / NYINUMON MUM FOR Se FAGS STn= � @ TB OFCO11�IdANCI��` /��� D_ Isere Eat aK 4� A�(y.. s t rc. D P S+ab�dabia mot_ fic.rG IL�Lc •-�. cat a - -�� ¢2.q Ootasr /ApplaaSt Neesstle- ,n H jzC R —*cad ' F°Wd0e ❑ Meiliq Atbbraa r' . YJ c9�c ?�L Daft o1 PeeoBwa Apprwd a/60 1 t 2a p Taws zip- Date Subdivision AD=yed Fee Enclosed ® Amn „nr adlilat Type I�t Asmm i c, f- Secf�a lib Naaabar a i Hem �E bl��?Z3' Dashp Heir G P D - UO PCHD Ned0catloo bl _Yak eas w, p, lilegaba:l Whoa FM b oosepieled sep.aaft se$r«aae s,>aas d aesdlot at O ©'O � soPlll: Teab eas�L- .3�,5—/X 24 "►,/' Jr Z 8 " �- ,--�.� To be oeadeYaftd by Addrm Water $ate: / P Sages p� Adder an w PAvnta Seppb Dahl by Z A d Otbar IleQas 1 represent that 1 am wholly and completely responsible for the design and location of the proposed system($); 1) that the So rate towage disposal system above d""Ib•d will be ConstrUCted as shown on the approved amendment there to and in accordance with the standards. rules a regu ions o n m County Department of Health, and that on Completion thereof a "Certificato of Construction Compliance” Satisfactory to the Commissioner of Hwlthwill a abmated to the Department, and a written guarantee will be furnished the owner, his sucCassors, heirs or assigns by the builder, that seal builder will PIKII in good operating condition any part of Said low"a disposal sy$tam during the period of two (2) yews Immediately following tledate of the Isar an ce of the approval of the Certificate of Construction Compliance of the original system or any regir$ thereto; 2) that the drilled well desoribed above will be located as shown on the approved plan and that said well will be Installed in accordance with the standards, rules and raga Wh% $ Oaf the Putnam County Department of Helth. Date 1717 3 Signed N A114 P.E. X R.A. Address 'vti✓ 9 — 1C 2 T F3Z.� c 0 3"- License No-2-I'7­66 APPROVED FOR CONSTRUCTION: This approval expires two seers -from the date issued u loss Construction of the building has been undertaken and is relrOCap'a for Cause of may be amended Or modified when considmednitemry by if �COmmissioner Of Hearth. Any Change Or alteration Of Construction rhquke6 a new /p /ermji} Approved vov disposal of domestic Ian an'y /sMPOage, all 1M ,ate/ water supply only. �eV,f Oate � j�1� � Title � LO /88 r By 0 PUTNAM COUNTY DEPARTMENT OF HEALTH ;:. Div /si_nn_of• Environmental Health- Services; ,Carmel,. N. -Y: f0�.12 CONSTRUCTION PERMIT FOR SE=WAGE DISPOSAL SYSTEM / Ui/✓�� ��'L �'/ Town or Village C ,+ 6� d,l�E Tax MaP Block Located at L Subdivision �` 'Loth �� Job Owner '•t���• — — Building Type "' C" /% Lot Area Zsf od" Number of Bedrooms `� Design Flow 1 00 04L 24 If Separate Sewerage System to consist of Gal. Septic Tank To be constructed by �o 43E �TJ��Q Address Total Habitable Space Square Feet and Address Water Supply: Public Supply From ��s , / Private Supply to be drilled by T� �� �E' e5L, i�i�/�� Address .r, ✓ r tJ A_Je Other Requirements �� " — - - ` — — I represent that I am wholly and completely responsible for the design and location of the proposed above described will be constructed as shown on the approved amendment there to and in accordan County Department of Health, and that on completion thereof a "Certificate of Constructio o be submitted to the Department, and a written guarantee will be furnished the owner, hi place in good operating condition any part of said sewage disposal system during the p to ante of the approval of the Certificate of Construction Compliance of the on st 1'b will be located as shown on the approved plan and that said well will be installed ' orda It County Department of bfealth. Date v' Z v Z a — a:gne Address" APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued un revocable for cause or may be amended or modified when considered necessary by the Com requires a new permit. Approved for disposal of domestic ni ry wage, red /.or s ; 1) that the separate sewage disposal system arts, rules anregulaations of the Putnam tory to the Commissioner of Healthwiil s by the builder, that said builder will diately following thedate of the issu- he that the drilled well described above and and regula ions of the Putnam P.E. R.A. IS 91/9B�U . License No. 4 � the building has been undertaken and is :) Any change or. alteration of constructio r Title / I 4�M CO � 0,4 WLLL L0VrLr1jL11V1.V ME.-rVRi DEPARTMENT OF HEALTH fi� Y PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only % (� WELL LOCATION STREET AOURESS: TOWNIFILUCILICHY TAX GRID NUMBER: Cove Road, Putnam Valley, NY 9 WELL OWNER NAME: ADDRESS: DeBar Construction, 57 Hillside Rd, Carmel, NY 10512 ❑ PRIVATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary ® RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED O BUSINESS O FARM ❑ TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY O MOUNT OF USE YIELD SOUGHT gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING .REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY ®NEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 245 ft. I STATIC WATER LEVEL �Oft.ATE MEASURED 5/30/96 DRILLING EQUIPMENT Q ROTARY @ COMPRESSED AIR PERCUSSION ❑ DUG O WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED O OPEN END CASING ® OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH 31_ tL MATERIALS: ® STEEL O PLASTIC ❑ OTHER CASING DETAILS LENGTH BELOW GRADE 30 ft. JOINTS: ❑ WELDED 0 THREADED ❑ OTHER DIAMETER 6 in. SEAL: (0 CEMENT GROUT ❑ BENTONITE OOTHER WEIGHT PER FOOT 19 Ib. /ft. DRIVE SHOE ® YES O NO LINER: G YES ONO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (it) DEPTH TO SCREEN (ft) DEVELOPED? FIRST O YES ONO OUf15. SECOND GRAVEL PACK ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH K. WELL YIELD TEST If detailed pumping METHOD: ❑ PUMPED tests were done is in- t � O COMPRESSED AIR , l ormation attached. ❑ BAILED ❑ OTHER ; ❑ YES ❑ NO WELL LOG ll more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE 'water pear- Inp well Oia' In FORMATION DESCRIPTION C0011 ft ft WELL DEPTH It. DURATION hr. min. ORAVJ00'NN It, YIELD gFm. Surfa ce 16 Dr 11 ' n in overburden clay & boulders 16 Hi r ck at 16'.• 245 6 hr 140 20 16 31 Dr 11'ng in rock, set casing, grouted 31 245 rock granite WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE Wa 1 1 Xt- rn 1 WX #250 CAPACITY GAT,. 44 PUMP INFORMATION TYPE c;17hroarc i h1 a CAPACITY 7 CjjaTn MAKER (' 4013 1 d G DEPTH 16 Q , MODEL - 7t.RC1S41 VOLTAGE 23A.HP WELLDRILLER NAME P.F. Bea1 & Sons, Inc. IPATE 7�q 7/96 ADDRESS 4 Putnam Avenue SIGNATURE Brewster, NY 10509 J/ OV Petry L. Beal' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property of Located at f:.� r� Yz° (T)g 1 Section Block ____j Lot Subdivision of Subdv. Lot # - d= �'J�f� Filed Map # Date Gentlemen: This letter is to authorize de--% 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 promulaga "t-ed 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. 16�ute e OF NEy�: P.E., R.A., # '; at "lam Address • 9z' Li >-- 1� �- Telephone Very trUl3k Nurs Signed ` Y e - f Property Address Town Telephone R PUTNAM COUNTY DEPARM41?P OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH q tW to Ind Owner or Purchaser of Building Section Block Lot P/ Building Constructed by Corr lab d Location - Street o� Municipality Building Type Subdivision Subdivision Lot # GUARAI4M 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, 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 ",e for the sewage .clispgs .... _ .. y, ..� . _. ...... ._.._ .. ... _.�- _......a _..... _. 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_ Qf- :F-nvi- ronirerita -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 the building utilizing the system. Dated this day of 19 Signature l� . 's 9AY"� Title General Co ac ( er) - Signature GX &- /- e Y 5� or pv- Corporation Name (if Corp.) �AXel AI, 5 -4� am rev. 9/85 mk 601 L✓!'l Cam' . OW Corporation Name (if Corp.) Address i 7 VVIN H Covent DWA3B M of 1MALM �.r...r�.r....r.�..�see..�... la...�. w.v. ��u so w�. Pena 0 • 130! tons G' /� �• A I /, - '/ U L7 c "MW FM :OwAM DEPONAL UUM ,maw d L f, �ra�.. o_ �� ,p �� 1. rVT�r� �4L I & Y : To Mv- - - X s..w. ❑ AC1 E f "- Dote of [toyfebo Anteovd c- Town k H A H� it b i L 5 �3r 2 Date Subdivision Annroved Fee "Enclosed ❑ Arnmont F- Salt Tpte r-11 .It-r t & W Am i. /Q .. + c1.'1_v kW '1.2 jC L, s. !A Seedes OIL t! j pp& slob.. � 0eit saes_ r� r Dulp Flow G P D P® Netlela.u� 9l twliM Wines !3 >, ggpmft blfutlp 14 �-N 0.bum d jou o per ggp& Tuft a®A 3� To be setwo tiled b rliAieo waaep $up* [es Alludes alo.. 1 represent that 1 ern wholly end completely fafpeonslbee for the dessen and location of the prepe•ee rraemtyi 11 than the or r .•re seer 411 ri Gen. soa detwlead wilt be constructed as Mew" on the approved anpndmont there to and in accordance with the standar s..woes a raga n$ o County Depertro ent Of MMith, and that on COmpletsan thasaef G "COAIfkOto of Construction Compliance" letldactory to the COntMiUionw at sieGMhwill be submitted to ten OaMrtwrenl, and a written Weranloe will be furnish0d the owner, his tUccaleert, hoes or aallgns by the bulkier, that said better woos place In pole owstwq oo"nion any past of said aswsps disposal 0lfclsm during the period of two li)1ya«e MnwudialNy following Ihsdate of the Im- sn" of the appal of ten CastNlcate of Construction Compliamo of the Orlgklal systom or any regalrs thereto; 2) that the drilled wall 41ewlte l obese wood be located as Rtaoan en tip spprOUed Olen and that said wall W01 be InstOnad in &CUW awoG with the MandGfdai rules Good raIMUT Mrs of tow p1AMrn County O"Woo end Of NNRR. DeeeZ It Sighed P.C. x M.A. —_ AdMOfs �L y - Ic T /' // ' L LlcanM NO 2-2 A/MOVCD FOR CONSTRUCTION, This Gpprerel aspires two joes"ern the date i ul►lest <construction of the building has Olen undertaken end Is M/OC OIO for tA11M of nay be afnanded or on"Itipd when ton rlecoayfy by enlmilelorler of H"nh. Any change Or an «elan of Oenatruttlen ""worse ""worse a new wm Approved for 4110601 of dOrneNk a wet« wlwh/ .ew1y.' Rev. ed ` r cyst em waa ri this plan and that the cystom it was cc?.;t> e .. sac �i over. ,..tern was in accordance with all standar3 pules and reguia,. io;m-1 of -1h,e Putnam County Department of Health and the !`c ti I' -i -k State Department of Health -ll 1. PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Commissioner of Health - FIELD ACTIVITY REPORT , Sheet of INSPECTION NAME. E :.-y.� %(� Orig. Routine ADDRESS d �/ (��.. t�"%7i�rlcfr��'s''- Orig. Request - g• 4 No`. GStreet Municipality (T)(V )(C) Compliance MAILING ADDRESS d" �• .��� ''`� �i� Final P.O. Box Post Office Zip Code Group Illness Construction TELEPHONE l J Reinspection PERSON IN CHARGE l p���! iY:.Gt%� Field, Sampling Only OR INTERVIEWED !tom' G �, /°-a ✓`- iC ` f�f`.�i ! �'Field Conference Name and Title t �' DATE �r�y'''; TYPE FACILITY TIME ARRIVED TIME LEFT Other FINDINGS: l "� �, �? X., eop Explain PERSON IN CHARGE OR INTERVIEWED: I acknowledge receipt of a copy of this SIGNATURE: Field Activity Report .................. TITLE; PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Commissioner of Health - FIELD ACTIVITY REPORT - Sheet of INSPECTION NAME 45 !-1 %% Orig. Routine Orig. Complain ADDRESS �+Y �``�"7 r'''c� Orig. Request No. Street Municipality (T)(V)(C) Compliance _ Complaint Comp MAILING ADDRESS Final P.O. Box Post Office Zip Code Group Illness Construction TELEPHONE Reinspection PERSON IN'CHARGE � r Field, Sampling Only OR INTERVIEWED Field Conference Name and Title DATE 16J1 3,,`%� -// TYPE FACILITY TIME ARRIVED FINDINGS: g .- , ' e-11 TIME LEFT vv r 2 o� Other INSPECTOR: TELEPHONE Signature and Title PERSON IN,.CHARGE OR INTERVIEWED: I acknowledge receipt of a copy of this SIGNATURE: Field Activity Report .................. TITLE: Explain ^� '���' ter• �� ve,e 1m ,' �S�a ��r'�i�'�,+'�"• ' �?''�~��' John M. Simmons, M.D. PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES Deputy Commissioner of Health - FIELD ACTIVITY REPORT - Sheet of r el ` "'s �° %yk , '�` INSPECTION NAME Orig. Routine Orig. Complain ADDRESS �---' C C'' Orig. Request No. Street Municipality (T (V)(C) Compliance _ Complaint Comp MAILING ADDRESS �' C! U" -' "' - %`fF� Final P.O. Box Post Office Zip Code Group Illness Construction TELEPHONE PERSON IN CHARGE OR INTERVIEWED Name and Title DATE r' SFr °, '/' TYPE FACILITY TIME ARRIVED r- �'7 TIME LEFT Reinspection Field, Sampling Only Field Conference Other Explain F INSPECTOR: TELEPHONE: Signature and Title PERSON IN CHARGE OR INTERVIEWED: I acknowledge receipt of a copy of this SIGNATURE: Field Activity Report .................. TITLE: FINDINGS: T-77-7 f �c F INSPECTOR: TELEPHONE: Signature and Title PERSON IN CHARGE OR INTERVIEWED: I acknowledge receipt of a copy of this SIGNATURE: Field Activity Report .................. TITLE: John M. Simmons, M.D. PUT,N1M �-Q-JMVYi---HEAL-Tfl�,DEPARDEW -,< UIVIbIUN UY ENVIRUMENEAL HEALTH SERVICES Deputy Commissioner of Health -FIELD ACTIVITY REPORT - Sheet Of INSPECTION Orig. Routine Orig. Complain ADDRESS Orig. Request No. Street Town TM No. Ccmpliance Complaint Cmip MAILING ADDRESS fv. Final P.O. Box Post Office Zip Code Group Illness Construction TELEPHONE PERSON IN CHARGE OR INTERVIEWED Name and Title DATE 1114el-��l TYPE FACILITY TIME t; TIME LEFT �Reinspection Field, Sampling Only Field Conference ,,Other INSPECTOR: TELEPHONE: Signature and Title PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. SIGNATURE: 6/86 TITLE: Explain IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION., NAME OF SUBDIVISION: rX01Z Lot No. WATER WELL CONTRACTOR: Name N. A-, Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _giNO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY - -- i- 10TSTANCL:.4.1!6'tROPERTY FROM :NEAREST WATER MAIN: - LOCATION SYNCH & SOURCES OF CONTAMINATION PROVIDED See Dw'� �Jo b Ey SON SEPARATE SHEET JJ4h14, pr" -&i5_5 P��9�6 2� l7 1 33 (�' rgirs`r ' (date) (si ture) 6'f.-rh eii N Y 110511-04 4-84B -G 43-0 PERMIT TO CONSTRUCT A WATER WELL This permit 0 construct one water well as set forth above is granted under the provisions of Subpart 5 -? of Part 5 of the New York State Sanitary Code, and provided that within thirt3•. (3 O) iays of the completion of water well construction, the applicant shall: 1. Pump �ie well until the water is clear. 2. Di s in?ct the well in accordance with the requirements of the Putnam County Health Depajm�ent attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all- v11 drilling operations, the applicant shall take appropriate action to assure that any and a3_1 iater or waste products from such well drilling operations be contained on this !property aizain such .a manner as not to degrade or othhexwise contaminate surface or groundwater. Date of I s S,y: I �/ 190, ate of ExpationJ,/r 19 4, Permit Issuing Official �rmit is Na— Transferrable White copy: HD File Pink copy: Owner 9 Yellow copy: Bldg. Insp. Orange copy: Well Driller b ` :I-n `1 I 15 I CO r U r to • ,n s G] Alnl ^ I I� I N� �G . I r . i, I• I 0 FEW 1i 9 • c f� r tJ Ow PIUAMLXBXMCXW - - — mrr�ua., — • .� AI'A�Lw GN 42.bce 00 Lpti ti J _ t,• 3 fA kzz g , It? °� I« XN ZIS 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 # WELL LOCATION Str et Address Town/Village/City Tax Grid Number WELL OWNER Name bailing Address p 4 -Ozrivate O Public USE OF WELL (:Y primary 2- secondary SIDENTIAL D BUSINESS D INDUSTRIAL 0 PUBLIC SUPPLY 0 AIR /COND /HEAT PUMP 0 ABANDONED O FARM 0 TEST /OBSERVATION 0 OTHER (specify d INSTITUTIONAL 0 STAND -BY O AMOUNT OF USE YIELD SOUGHT 4!::;--gpm /# PEOPLE SERVED 3- EST. OF DAILY USAGE 581 REASON FOR DRILLING EI REPLACE EXISTING SUPPLY 0 TEST /OBSERVATION P&W SUPPLY NEW DWELLING DEEPEN EXISTING WELL 13- ADDITIONAL. SUPPLY DETAILED REASON FOR DRILLING P WELL TYPE DRILLED ❑ DRIVEN ®DUG ❑ GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 1(-e Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _�NO NAME OF PUBLIC WATER SUPPLY: /`'°✓ TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST— WATER "MAIN: f�° - -• - -- LOCATION SKETCH SOURCES OF CONTAMINATION PROVIDED + 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 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 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. During all well drilling operations, the applicant any and all water or waste products from such well property and in such a manner as not to degrade or Date of Issue: 19� Date of Expiration 19� shall take appropriate action to assure that drilling operations be contained on this otherwise contaminate surface or groundwater. Permit Issuing Officials -�`— Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 . Yellow copy: Bldg. Insp. Orange copy: Well Driller • _ /7'- xnao F o ra. _*ow,•:n. -.:.'7 �;•. :-.:. a. .:•� ..�: e..,- _. e� ._ ..� ....,�YSa:<.,� _... :. •,+ .rns:+ci - _.a - . L..c. .e._.,,..>. -. - `... -. .. -_a �: __ Qe SITE INSPECTION REPORT TOWN CODE 24 C FRESHWATER WETLANDS AND WATERCOURSES ORDINANCE SECOPOD REPORT kc CW, ..6107191, APPLICANT/ SPONSOR: Robert Kohl DATE: 6/27/91 ADDRESS: PO Box 41 ' Yorktown, NY 10595 TELEPHONE * 962 -4754 TAX MAP'S I 1 -2 -14 SIZE OF PROPERTY: 36,180 sq. ft. LOCATION: Intersection of Lake Shore Drive and Cove Road in Roaring Brook. DESCRIPTION OF PROJECT: Construction of a single family home, driveway, well and septic system within the controlled area of the wetlands. Is this Iry xrtq Who in /s the AV the rv*»' Mrs /s t!x AV /s the YES 10&A Oft'r jvri.Adiitiv�s ass imnla is tie iea oP tlloc pr»,000w�/ ? �aaiaag 8oera+ di Field time: 0.5 Additional time: 0.2 hrs. Total time to date: 0.7hr. COMMENTS: In order to complete a review of this application, the following Information is requi red: - the type, amounts and locations of all proposed fill material, - e detailed erosion control plan designed to mitigate potential erosion from all disturbed soil until stabilized with vegetation, -details regarding the construction of the well including the dimensions of the temporary access, erosion control for fill and drill slog, and how and where these materials will be disposed, -amp detail showing the limits of machine operation. C.J,1CHAE1L PRIANO DATE OF REPORT: 6/27191 PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 )November 21, 1990 Environmental Conservation Board Town of Putnam Valley Putnam Valley Town Hall Oscawana Lake Road Putnam Valley, NY 10579 Attn: Bike Preano Dear Mr. Preano: JOHN KARELL Jr., P.E., M.S. Public Health Director Re: Proposed residence Kohl, Cove Road & Lake Shore Road 308H Roaring Brook Lake Lot #4 TM #11 -2 -14 Enclosed please. find a site. plan for the proposed single family residence on the above mentioned parcel. The lot includes a portion of a controlled wetland. As indicated on the plan, this particular lot was previously approved by this Department in 1980. However,- ahe permit has since expired. I have briefly reviewed the plans and my concerns are noted. It appears a wetland permit will be required for the expansion area of the sewage disposal system within the 100' buffer area. I would appreciate the opportunity to discuss this application with you at your earliest convenience. Please contact me at ext. 319. WH /jp Very truly yours, William Hedges Sr, Public Sanitarian L /y d � PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property c Located at Section /` Block o2 Lot a.I a7.07 Gentlemen: This letter is to authorize a duly licensed professional engineer or register ar tect (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 ne.ce$sary papers on my behalf in �:wui�� 4iv1� wl i.Il U"6 ma C i.Ct• a1W to. supervise the construc ciun of said system or systems in conformity with the provisions of Article 14S or 147, Eduoation Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned: P .E ., R.A ., .So7 ��io\�498� ss Telephone Very t y rs, Sign d Owner of Froperty Address Telephone i I I 11J � L EG EN O Tl M• ®..... %nec.'ca /cf• Iran ,[o;r+ rnarReat _ �, N � p,..... /na•cates Cre�s•cutor► 62eca.. „� D.. -•• /no('Ca�sf Cancrefc Monulv+•cn� O 'gir REFEREW-6 a CSI NOT FOR TITLE PURPOSES; NOT P►zS;'O :` � �•, .. : FOR ERRORS OR OMISSIONS FOUR `.EttEJ. TACONIC SURVEYIi�C & EI�G1�!iw °1i ►0, P. C. 18 '° iy - 13 OLENEIOA AVE_ CHIMP_ PY AIAP OF SURVEY Lor NQ. dao n M ►; a (° ( Z R04R/NG aRook L4&6 v �(Aled TOWN OF AUTiVA41 Y'•4L LEy!.- � COUNTY OF x::)or x/14 A4 NEW YORK. N ®r r® eca/, scScale: 1 In. = 40 Ft. March 2:3 1964 I eerti /y that this map was made /rom an acute! ��' /n ♦dnym. �•• —e�j� survey of the.property. oV6.0 Survey completed on 44iircli z3 , 196e Alap completed on 4 0,-r -h - Z3 ► 19()C W� Certified to: The r,'f /e Gclaranfe -s C'e�pnn /N JV/�ifc P /A�ns T,'f /t /Y�• 9402G�t' ICdr3" =0/Sovrr- 1510deal) OCiaP.� .'Gu3fa»teed to the Title gtjsrantee Company BURGESS & BEHR in accordance vri:h r;iimitrum standards p►nftiiioRal F_n,Ri�e�rin� �"' 1.rxJ .ianYtiax JN Sor title survcy5 of the Nel v York State land and title aS306ation. 1Pt3 G1rv68a. Av ►nue . Carmcl, N. Y /A ca 7 Tile Na.�:. N _ i' ..... 37707 . PUI'NAM.COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM 'FILE NO. Owner N%? JV /ty ep, 4-0///_ Address C Yc i�yA 7411 'NRP Located at - ( Street �Z4A-e 1, ,ee- gp. 5ac . Block 2 Lot 2, indicate nearest cross street) Municipality. arA.I/A4 V%LLE'� Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS 5. Notes: 1) Teits 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. ".'Hole . Number CLOCK TIME PERCOLATION PERCOLATION Elapse No. _ Time Start -Stop Min. Depth to 76-ter From Ground Surface Start Stop Inches Inches Water Level* in Inches Drop in Inches Soil Rate Min. /in drop 1 2 �56 - i0-,9S` �3 s �✓d /'� 310.'05 - — 4 /D.,10 `, Ae_._. 3 /&367 5. Notes: 1) Teits 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 S.OIIZ- ,ENCOUNTERED`IN TEST HOLES DEPTH HOLE . NO. HOLE NO. HOLE N0. G.L. 6 12tr 18" 2411 30. 3 42" 48" 5]+ It 60" 6611 W41 -6 e " 72. 78" 8411 INDICATE LEVEL AT WHICH: GROUND. WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS .MADE_ BY, /✓J S', . Date ., . J, -V7 i4 DESIGN Soil Rate Used / / - /.' Min/, "Drop: S.D. Usable Area Provided ,7000 No. of Bedrooms Septic Tank Capacity Gals. Type Absorption. Area Provided :By �� L. F.x24 ".. X �wr c /✓.Ati/A- �c/A/ -,fit L: .JET 7� c�.� J.- Address THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: £SSIONP�` Soil Rate Approved Sq. Ft /Gal. Checked by Date J��F�IjKow IN b � - ..'IROWAVOW DESIGN DATA SHEET-SMUFACE. M DISPOSAL SYSTEM FILE NO. owner )L-%e--4Mjee.0'. )?--06497."60dress 4pvl& rwz> � 1-4*& '511,0AS IZOAJ> Located at (Street), Sec... Block Lot (indicate nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre - Soaking 0 Date of Percolation Test as41-2 9 0 HOLE NUVIBER CLOCK TDIE PERCOLATION PERODIATION 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 5 ai —41200-/Z&- 4!!9 _21 - - . to .5 5 NCYI!ES 2. rev. 9/85 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. Depth measurements to be made fran top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. /®" O ° HOLE NO. HOLE. NO. G.L. .� Pj O 3' 44 4' .� 5° A) 6' .: 7 APO 9:::;k� s1 9' 11' ® off 12' 13' 14' INDICATE LET AT -WHICH CR20UNDWATER IS ­ ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: s DATE: DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided _ No. of Bedrooms Septic Tank Capacity `_ gals. Type MA.49 lz� Absorption Area Provided By 375 L.F. x 24" width trench H. Name R09RFAIRPST 914 -87P 6 Signature YORK 10512 Y} Address S Qr Q G 29%6° THIS SPACE FOR USE BY HEALTH DEPAPMFM ONLY: ES Soil Rate Approved sq.ft /gal. Checked by Date k NORTH AMERICAN LA ORA QRIE 9 INC, CERTIFICATE OF LABORATORY ANALYSIS LAB ID NUMBER: 96 -6668 CLIENT: P F Beal & Sons 4 Putnam Ave Brewster NY 10509 SAMPLING LOCATION: DeBar Bldrs, Cove Rd, Putnam Valley COLLECTED BY: MTB DATE COLLECTED: 09/27/96 TIME COLLECTED: 10:30 AM DATE RECEIVED: 09 /27/96 DATE OF REPORT: 09/30/96 ANALYTE RESULT* UNITS MAX CNTMT LEVEL "* METHOD ANALYZED Total Coliform Absent Must be "Absent" SM18(9223) 09/27/96 E. Coli. Absent Must be "Absent" SM18(9223) 09/27/96 -- - -This. sample, .as- submitted- to the laboratory, and as compared to the New York State limits for drinking water quality for the tests performed, was: ACCEPTABLE. NOT ACCEPTABLE. NYS ELAP #11218 CT Lab Approval #PH -0171 * Underlined results are unacceptable according to health department and /or US EPA codes. *"Maximum Contaminant Level (maximum permissible concentration allowed by health department and /or US EPA codes). 618 Clock Tower Commons, Brewster, NY 10509 -9241 / 914- 278 -7600 / Fax 914- 278 -7754 ei North American Laboratories, Inc. warrants, to the best of its knowledge and belief, the accuracy of the analytical test results contained in this report, but makes no other warranty, expressed or implied, especially no warranties of merchantability or fitness for a particular purpose. By the Client's acceptance and /or use of this report, the Client agrees that North American Laboratories, Inc. is hereby released from any and all liabilities, claims, damages, or causes of action affecting or "wiiicii may affect the'Client as regards to the results contained in this report. The Client further agrees that the only remedy available to the Client in the event of proven non - conformity with the above warranty shall be for North American Laboratories, Inc. to re- perform the analytical test(s) once at no charge to the Client. The data in this report are for the exclusive use of the Client to whom it is addressed, and the release of these data to any other party, or the use of the name, trademark, or service mark of North American Laboratories, Inc., especially for the use of advertsing to the general public,, is strictly prohibited without the express, prior written consent of North American Laboratories, Inc." .. _.� .. Y .. .. .- ._.... .. a w, . ,,i'�t� '°?ta rh-a t�x'� '4.ea�.�a.,, ✓"n",�,a� 'i � N�� Y: c_r, -r C vnai. }�°+� i'e ov gLtilnn?p�1C.ir, ?i ;irC' .L �3 LPi QaiL .i T. ,453i�L ttl ':;i p w' at E; lT.•.i :.{!: ".ii. Y' J. 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