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Home My WebLink About2301DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.10 -1 -18 BOX 20 02301 T 16 9, �+ . R. L t 186 3{ , 02301 L } PUTNAM COUNTY DEPARTMENT OF HEALTH \ Services, Carmel, N. Y 10512 L� Division of Environmental Health Se fees, Ca CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Putnam Valley Town o Village Located at Spur Road . Subdivision Roaring 'Brook Owner Sarah ThlgnwGnn Building Typal f Amily residence Lot Area 23.400 S . F . Number of Bedrooms —3-- Design Flow 600 GPD Separate Sewerage System to consist of 1 IF 000 Gal. Septic Tank To be constructed by nnt SA1 Ar_fied Water Supply: Public Supply From * Private Supply to be drilled by not selected Address Other Requirements Tax Map 12 -1 -2 Block Lot Job Address 355 Jericho Turnpike SYo s s _ _ New York 11791 Total Habitable Space ] ' son Square Feet and 360 L.F. of leaching trenches Address 1 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 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 during the p �-00- of two (2) years immediately following thedate of the issu- ance of the approval of the Certificate of Construction Compliance of the original sys r 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 in accord with the Stan ards, rules and regulations of the Putnam County Department of Health. Date _8/3/79 Signed +-" P.E, R.A. Address License No, I I C;Ci- APPROVED FOR CONSTRUCTION: This approval expires one ye fro the /thle ssuetl unless tructio the building has been undertaken and is revocable for cause or may be amended or modified when considered scary Commis oner f Healt Any change or alteration of construction requires a new permit. Approved for disposal of domestic sane wage�d,Cvate ater pAly only_ PUTNAM COUNTY DEPARTMENT OF HEALTH ReV . 3186 %l Dlvlsion of Environmental Health Services. Carmel, N.Y. 10512 L.Y DISPOSAL SYSTEM Located Subdivision Name ROARING BR. LK o Subd. Lot # Engineer to Provide Permit ff on CERTIFICATE OF COMPLIANCE Permit N TOWN OF PUTNAM VALLEY Town or Village Tax Map 12 Block 1 Lot 2 Renewal Owner /Appllcamt Name C. PENCOLA _ Revisi° ° p Date of Previous A rove! Mailing Address 540 r TUCKAHOE ROAD Town- YONKEF.' , NY zip 10 710 Building Type ONE FAM . RES. Let Area 2311400110-FT F(Q Section Only I ' Depth Volume Number of Bedrooms 3 Design Flow G /P /D 6 0 0 PCHD Notification Is Required When Fill Is completed Separate Sewerage System to consist of 1000 Gallon Septic Tank and. 360LF OF LEACHING TRENCHES To be constructed by R. FIORENTINO Address LAKE SHORE ROAD WEST., PUT . VAL . , NY J. Water Supply; Public Supply From Address 10 5 7'. or: XXXX Private Supply Drilled by NORMAN ANDER gA. BARGER ST , , PUTNAM VALLEY , NY10 5 79 Other Requirements 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 th the standards, rules an regulations o e Putnam County Department of Health, and that on completion thereof a "Certificate of Construction C, liance" satisfactory to the Commissioner of Health will be submitted to the Department, and a written guarantee will be fu n" hod the owner, his suit rs, heirs or assigns b the builder, that said builder will place in good operating condition any part of said sewage dizpo syst during the perio of wo (2) years immedj tely following thedate of the issu- ance of the approval of the Certificate of Construction Compliant of th original system r a repairs thereto; 2), at the drilled well described above will be located as shown on the approved plan and that said well will be i tall in accg ante wit standards, rut and regu a wns of the Putnam County Department of Health. Date MARCH 30, 1987 Signed h P.E._ R.A. xxx MUSCOOT NORTH FD ,BX48 r PAC NYC 4e1 11056 Adtlress r is nse No APPROVED FOR CONSTRUCTION: This approval expires from th date is ad unless construction of the ilding has been undertaken and is revocable for cause or may be amended or modified when considers n cessa by a Commissioner of Health. Any hange or alteration of construction requires a ew- permit. Approved for disposq of domestic sanitar rivate water supply only. `, �AAn d f .7 , 1�1 ... - f .:t' t: PUTNAM COUNTY E,n iR MEA OF HEALTH Permit' N J/3.11 ��(' Division of Environmental Health Services, Carmel, Y. 10512 CONSTRUCT, N PERMIT FOR SEWAGO,,,DISPOS L SYSTERfl Putnam Valley Town or Village Located at Spur Road Tax Map 12 Block 1 Lot 2 Subdivision Roari ni gook Lake Subd. lot R Renewal _® Revision _[] Owner /Address Ca Pencola_._, 540 Tuekahoe Rd, Yonkers , NYDate Of Previous Approval Building Type (1) Family Res a Lot Area 2340OLF 107F114 Section Only ❑ Number of Bedrooms 3 Design Flow G /P /D 600 P.C. H. D. Notification Required Separate Sewerage System to consist of 1000 Gal. Septic Tank and 360LF of_- %Leaching Trenches To be constructed by R Fi orentino Address Lake' Shore Road West Water Supply: Public Supply From Putnam Valley,NY 10579 XXXX Norman Anderson �' Private Supply to be drilled by Address Barger Street Putnam vallev,NY 10579. 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 to and in accordance with the standards, rules and regulations of o 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 during the period of two (2) years immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the original system 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 install i accordance th the standar rules and regulations of the Putnam County Department of Health. Date 3/10/86 Signed P.E. R.A. XX Address License No. 11056 APPROVED FOR CONSTRUCT +ON:' This approv expires o ear r the ate ued unless consfin ction of 164 building,,, as been undertaken and is revocable for cause or may be amends or ified when Cori ed ne s ry y Commi sinner o Health. Any change 0r \alt ration of construction requires a new permit. Approv for disposal of domesti ary wage nd r ►ivate stet wY only. VrLv1 /xS,- t� /�rtL�°_ Date �� `" By Title Rev. 9 -81 J \ /, PUTNAM COUNTY DEPARTMENT OF HEALTH �} 6 3/ 86 Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Mast Provide ' \ �T+ P.C.H.D. Permit # -- CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Located at �; pb` f� RO Owner /applicant Name «.– V I-TI i v' ``- r'ormerly Mailing Address - fit; '�"�yt(- zip Separate Sewerage System built by Consisting of Gallon Septic Tank and Town or Village �- Tax Map % Z Block�Lot 2ce_f, 03, bd .1 Subdivision Name n v. Lot q� Date Permit Issued a i ^r- zl 11 iv Water Supply: Public Supply From Address or: Private Supply Drilled by 2-0^ Address Building Type rt.0 , -, Has Erosion Control Been Completed? Number of Bedrooms Has Garbage Grinder Been Installed? Other Requirements 1 certify that the system(s) as listed serving the above premises were con tructed esa ntially as she on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and re ulatio n ac rdA�� i a filed plan, and the permit by the Putnam count D par ent Of Health. Date Certified by n J P. E. �f• R.A. Address Z Mats �- 3�tVjI, /" License No. • � � Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to Secure the cor►oction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon 04 a pub:': sanitary ower becomes available and the approval of the private water supply shall become null and void when a public water supply botomos available. Such approvals are <„hiart to modification or change when, in the judgment of the Commissioner of Health, such revocation, modification or chango Is neceamry. JIUN -22 -2004 16:02 PUTNAM COUNTY duH-*v -eMg4 i : 29 FROM: PUTNM C0OL14TY W-279-7901.> R�1 845 228 0261 t. 01/01 PAGC 81 To %%. 354149 YiCt']>iJJJ. $Aar Putn� Cau6ty Clark • p►�bllc l�Eorm�iEar� Ui�foet liaat�nl� for Pub��oce.>� � ltexar,�i� . To: Fiacards Aoaeee OffiaeP NIMO of ApeRty 113 1 will hand dall"it Mall Please "mil th tAo avW' fled j Addraas ��t fOr his 1 K1rRE9Y•APPLY 7Q INSPECT THE FOLLOWING RECORD: A ipant siong wfe SJ2ur, W.1'ti ui e . *14074.- 0407rd 40 V, 44M"X �' 'W-8 ek.6 1 X300. ' ,r�.4., r•�+cL4 a+ �%„ .�/�4?.dVdd� r�Q ^ .i.r! rr�w'od o r� Ap pilont 8I nature � ' I;i d d' AV APPiiCd�t _ (P L1/) ` J Dmm �iti �. Representing / . P1jb11C 1nf6rmAa ! ILiw��_:�� , Wiling Addresa APPROVED 4M y�• ��: -- L: rIPIAL USE 0NLV1, 11OR Aa19WCX USE Oft 11/ DENIED Record of which thlm Agency Is Legal QftkaUn cannot bm found. . RGCOrd It not maintained by thte Agency. , Signature _' 1f1..IJM_` Datw ' • • ' . NOTICE .,, YOU FINE A RIQN11 `M APPUL A DEMAL OF THIS APPLICATION 'TO ` THU PUTNAM COUNTY EXECUTIVE' MY11111 9YSlnans ApQfd� WNO MUST 1'ULLY GXPLAIN MIS REAWNS FOR SUCH MW IN VWITINO Stl.'VEN PAYS 00 1119 61P.T IR 11N, APPEAL I HEl RRY ApPliAL: Algnrturo Qa1! , JUN -22 -2004 TUE 15:51 TEL:845 -278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 I 1 ,I .I To: Page 1 of 1 2004 -06-28 19:59:20 (GMT) 18456223507 From: Roy Tellier JUN -28 -20@4 15:01 FRW-. PLJTN,V1 CO 14TY DEPPRT M-. 278 -7921 T0: 46r 7 .. Den,& J. Sant r . ' •,� Putoam Oounty Cleric • ' Aepikstiom for public Accaw to Records TO: toords Access Weer ® 1 will hand deliver myself Name of Agency Plea subhnit do #4' tied AddrM do t ror I HEREBY APPLN TO tNSPECTTHE FOLLOWIHO'RECORD: sture` F-1 T T1 .mil ..= .itl�� ,r r •� P:i1i Date POR OF>Er 0AL USX ONLY; %APP . s►D Date: nt (PRINT.CLEARLY) R'Pre eating . Dennis J. Sant G� cf.4 k'�vSc?. • Public. InfotmetIon Officer M,alal�lnd Addle — — .,,..7 — 77. .u. ` T01 AURNCY USE 01q.X APPROVED DENIED Ramrd oiwhich thla Apetmy Is Leal CustWien wridbe totem. Record is not mWnblined by INS Apermy. 1. N071C>w, YOU HAVE A RIGHT TO APPEAL A DENIAL OF THIS APPUCATiCN TO • THE PUr" COUNTY UMVTNE. Nsrrle -7 gazes— AddMa WNC MUST FULLY EXPW N HIS IiUMONS FOR SUCH DENIAL IN WRITING SMN DAYS OF ROMPT OR A►X = APPFAL.. I NEFtwy APPEIAL . - - - - :mature 1 i i { I I 1 i ..,> ' > ' "r.� .,,m;,?T.^Ty'�;5+.'_,i�w;�'::r x�. l' Ti; �; 7' s". R? 5,: c5' FSfcAN, 2dI�r�J: 92i?J' ? ?f.'• Y' �i ?,iRi ^.yDm,,;r�,nP<T1.,P.'.,• . .... ........ >'n^ 7?! t" s' ytiu"' s' �:; r.^.",.".•; Z:z�cu''.',�,;�i`.'��Sl'JS•�s �•< y"' id^' "< C: bl' �' (aS4R%',s <�ic,lk¢Y:i�:>Y?P%3"+' SNkiRGF3:?'.i,ic, r?,iat:'t'v3F'31::': ':i:�2. ,.L"a. JUN -28 -2004 MON 15:57. TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 Yorktown Medical Laboratory, Inc. 321 Kear Street Yorktown Heights, N. Y. 10598 (914) 245 -2800 Director: Albert H. Padovani M. T. (ASCP) r PENCOLA, CHARLES B10, SHERMAN AVENUE PEEKSKILL, NY 10566 L 1 J LABORATORY REPORT ON THE QUALITY OF WATER �AB # 32.02 5598 Date Taken: egg_ Time: ). ,In pm Date R c' d: 6!' �$ g_ Time : 3-:-3U pm Date Reported: W 1 A 1989 Collected By: MR- PF.NCnT.A Referred By: Sample Location: cp -pllg ROAD, PUTNAM Ny, KTT('.NF.N TAP Phone # - Phone # Sample Type: Repeat Test? _ (.check each) INORGANIC NON- METALS Fm_g_/TF MICROBIOLOGICAL CFU /100mL _ Acidity _ Alkalinity _ Chloride Detergents, MBAS Hardness, Total Nitrogen, Ammonia Nitrogen, Nitrate _._. Phosphate, Total Sulfate Sulfide Sulfite GENERAL BACTERIA Standard Plate Count (CFU /1.OmL) MEMBRANE FILTRATION TECHNIQUjE Total Coliform '� 1 Fecal Coliform Fecal Streptococcus METALS (mg /L) MOST PROBABLE NUMBER TECHNIQUE Copper _ Iron _ Lead _ Manganese _ Mercury _ Sodium Zinc MISCELLANEOUS pH (units) _ Color (units) _ Odor (TON) Turbidity (NTU) Total Coliform Index _ Fecal Coliform Index KEY FOR TERMINOLOGY CFU = Colony Forming Units CON = Confluent (q.v. TNTC) LT = < = Less Than GT = > = Greater Than N/A = Not Applicable S/A = See Attached TNTC= Too Numerous To Count REMARKS /COMMENTS (.For Lab Use) Potable Non- potable STP INF STP EFF Other: Sample Status: (check each) Outgoing _ HNO3 _ HC1 — H2SO4 _ NaOH _ ZnOAc Na2S203 Other: Incoming LE 4 °C _ GT 1t °C _ pH LE 2 _ pH GE 9 _ pH GE 12 Other: ELAP No . 10323 THESE RESULTS. INDICATE THAT THE WATER SAMPLE (Was) (Wasn't) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO THE ORK STATE PUBLIC DRINKING WATER CODES; FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE COLLECTION. THESE RESULTS INDICATE THAT THE WATER SAMPLE (Did) (Didn't) N /A) MEET THE SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK PUBLIC RI NG WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE COLLECTIO . 2 /86(Rvsd7 /87)RWE Albert H. Padoviani, M.T. (ASCP), Director It PUTM COUNTY DEPART' DV OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Owner or purchaser of Building h Building Constructed by 0 _ Location — Street ucipal.ity Building Type t � 2 Section Block Lot M Subdivision Name Subdivision Lot # GUARA= OF SUBSURFACE SEWAGE DISPOSAL SYSTEM i represent that X am wholly and completely resgonsible'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 dfimer, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage disposal systen, 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 systen to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. 4 Dated t4is clay. of ' Lu t 19 S1 General Contractor,•(Owner)- — Signature Q ox 13 Corporation Name (if Corp.) C'4R4'^Ez PY_ f�5iZ MM rev. 9/85 Mk Signature Title c9waedl Corporation Name (if Corp..) Cf1 R M cz'y /oS1Z ZERTess •t WELL UU 1rLhT1Uty tcLrUtcl DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only n s ST VIL T I Y TAX GRID NUMBER: WELL LOCATION WELL OWNER oo s ` �d 5j , USE OF WELL 1 - primary 2 - secondary JPUBLIC I RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIRlCOND./ T PUMP ❑ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED f _ -/ EST. OF DAILY USAGE gal. REASON FOR DRILLING -0 NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA `WELL DEPTH _ ft. STATIC WATER LEVEL �� ft. DATE MEASURED DRILLING EQUIPMENT AROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH ft MATERIALS:. STEEL ❑ PLASTIC ❑ OTHER CASING LENGTH.BELOW GRADE 00 ft. JOINTS: ❑ WELDED ,®- THREADED O OTHER DETAILS DIAMETER •� in. SEAL: ❑ CEMENT GROUT ❑ BENTON)TE AOTHER WEIGHT PER FOOT �— 1b./ft. DRIVE SHOE. % -YES ❑ NO LINER: ❑ YES RNO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (It) DEPTH TO SCREEN (ft) DEVELOPED? FIRST ❑ YES ONO SECOND HOURS GRAVEL PACK O YES ❑ NO GRAVEL SIZE_ DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH It. WELL YIELD TEST If detailed pumping METHOD: O PUMPED i tests were done is in- COMPRESSED AIR , formation attached? O BAILED ❑ OTHER i ❑ YES ❑ NO 1PIELL LOG if more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE water pear. ing We11 Dial meter FORMATION DESCRIPTION CODE, ft. It. WELL DEPTH ft. DURATION hr. min. DRAWOOWN It. YIELD 9Cm. Surf ace Surface /f s i WATER ❑ CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ❑ NO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY L• PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELL ORII NAME�" .j,�l�ryjs.�.isi DATA/ . ADORE may" -" "'�"�" SIG?9TURE W �r y' FINAL SITE INSPEC'T'ION Date y Inspe ='t b STREET, IC`CUATION � U � CWN E R ��C U � /� —� PERMIT v z � /--- a L TM v OR SUBDIVISION LOT -- �..-- I. II IV. V. VI. 1 YES NO CU^- ESYrS S-E v GE DISPOSAL AREA a. SDS area located as per avroved plans b. Fill section - Date of placement 2:1 barrier. LGTH W-= AVG.DPTH c. Natural soil not strived d_ Stone, brush, etc_, grater than 15' fran SDS area. e. 100 ft. fran water co wetlands. SEWAGE DISPOSAL SYS a. Septic tank size -klW 1,250 b. Septic tank installed level I c. 10' minimmsm from foundation d. No 900 bends, cleanout within 10 ft_ of 45° bend e. DISTMUTION BOX 1. All outlets at same elevation - water tested I 2. Protected below frost - I `; 3 . Minimum 2 f t. original soil between box and trenches f. JUNCTION BOX - properly set I - g. TRENCHES 1. Le--1 remii red - G v Length instal—led Q 2. Distance to watercourse measured'. ft. 3. Installed a=- rdinq to plan 4. Distance center to C:_°_Tlt° -r I . 5. Slone of tench acceptable 1/16 - 1/32 " /foot. 6. 10 feet. from prone_r tv line - 20 feet - foundations 7. D nth of tzench < 30 inches fran surface 8. Rocm allowed for e- xrarsion, 50% I 9. Size of gravel 3/4 - 1j" diameter I 1 I 10. Depth of qravel in trend 12" minitnian L. • Pine ends came3 I NA I h. PaT OR DOSE SYS'EmS 1. Size of v mm char -bar I 2. Overflow tank 3. Alan, visual /audio 4. P= easily accessible manhole to grade 5. First box baf -flea 6. Cvcle witnessed by He.=—lth Dena_rtment I. estimated flora per cycle I I HOC,TSE a. House located per a proved plans. ' b. Number of bedrooms a. Well located as per avroved plans b. Distance from SDS area measured 4f t. c. Casing 18" above grade. d. Surface drainaae around well acceptable. Fr-)I OvmkIL WOM090riIP a. Boxes prod y grouted I b. All pioes partial1v hack -filled f c. All pipes flusih with inside of box d. Badkf ill material contains stones < 4" in diameter e. Curtain drain installed accordin g to plan f. Curtain drain outfal1 vrotected & dir.to exist.watercours I g. KZEing drains discharge away from SDS area I h. Surface water Protection adequate i. Erroslon control provided on slopes greater than is %. 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 PCHD PERMIT WELL LOCATION St et Addr s To V lage C Tax Grid Number i t '1 vy, c� ,= ,,' WELL OWNER me . � Mail' Address 5 (.d [ C d--# - rivate "'ililY10710 O Public U OF WELL qprimary _--secondary RESIDENTIAL BUSINESS ® INDUSTRIAL ❑ PUBLIC SUPPLY O A /COND /HEAT PUMP O ABANDONED O FARM 0 TEST /OBSERVATION ❑ OTHER (specify C7INSTITUTIONAL O STAND -BY . AMOUNT OF USE YIELD SOUGHT �� gpm /# PEOPLE SERVED /EST. OF DAILY USAGE gal REASON FOR : DRILLING EW SUPPLY ❑PROVIDE ADDITIONAL SUPPLY ®TEST /OBSERVATION ❑REPLACE EXISTIN SUP ELY ®DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED ❑ DRIVEN ®DUG []GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES "Y' NO IF WELL IS OCATED IN S BON, NAME OF SUBDIVISION: 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: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED -5/_ ON REAR OF THIS APPLICATION ON� PA E 1, 1'.2k4p -,, (date) (si natu 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 provid by the Putnam County Health D partment. Date of Issue: -� 19 Date of Expiration: l 19 e 1t Issuing fficial Permit is Non- Transferra e White copy: H.D. File Yellow copy: Building Inspector 2/87 Pink Copy: Owner Orange copy: Well Driller 3 t PUTNAa M COUNTY DEPARTMIl�TT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date August 3+ 1979 i Re: Property of g,rah piignwgpn Located at Spur Road Tax Map ACOWNiM 12 -1 -2 Block Lot Gentlemen: This letter is to authorize Joel ,reenbez:g a duly licensed professional engineer or registered architect (Indicate) to apply for a Construction Permit fora separate sewerage system; to serve the above noted property in accordance with the standards, rules or regulations as promulgated by the Cormnissioner 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 the Public Health Law, and the Putnam County Sani- �SFkSD qQc tary Code. v\g��R6N(e GRF�'Si� a r do o� e it N E Cd t rsiR ed: # RJ8, Muscoot North (Seal) Address Mahopac, New York 10541 L•�iGls• .. ; • • Very truly yours, Signed Owner of Proper 355 Jericho Turn ike S osset N.Y. Address 516 -921 -7130 _ Telephone s PUTNAM COUNTY`' DEPARTMENT OF- HEAL�fii DIVISION OF ENVIRONMENTAL HEALTH SERV:fC'FS Date 3/10/86 Re: Property of— Charles Pencola — Located at Spur Road (T) Tax Map Section 12 Block 1 Lot 2 Subdivision of— Roaring Broo _Lake_______._. ,. Subdv. Lot # Gentlemen: Filed Map # This letter is to authorize —T__ Joel L. Greenberg —. Date ..a duly licensed professional engineer --or registered architect xxx (Indicate) to apply for a Construction Permit for a separate secvage system, to serve the above noted property.in accordance with the standards, rules or regulations as promul agated by the Commissioner or 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 Heath Law, and the Putnam County Sani- tary Code. �aE0 q� Countersign P.E.,R.A., _Mus_coot North Address _7 �RFCL Q > n ,o �'jof 11056 FD #2J Bx 488 Mahopac, NY 10541 6.286613 Telephone Very trul ours Signed _ _ . Property B 40 Fuck -jjme_ -Road_ Address Yonkers,New York 10710 _ Town - - -v�- 737 -7564 Telcph;., ^_�� PUTRkM COUNTY DEPARTMENT OF BEALTH. DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY. OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM PILE NO. O. Owner Sarah DuQowson Address 355 Jericho Turnpike, !Sygs , N. Y. 11791 Located at.*. (Street 12 -1 -2 Block Lot dica -e near; cross s ree Municipality Torn of Putnam. Valley Watershed HudGOn Rives; SOIL PERCOLATION TEST DA.TA.REQUIRED TO BE SUBMITTED.WITH,APPLICATIONS Hole Number ........ .... . CLOCK-TIME . PERCOLATION PERCOLATION Run hUapse Le p o Water Water Level. No.._..:: :_.. Time From. Ground Surface in Inches— Soil Rate Start -Stop Min. Start Stop Drop in Min. /in.drop Inches Inches ..Inches 1 -1.12 :00'-12-:':30 : 30 16 19 3 .-M 3 = 0 2.12:31- ....1, 01 30 16 1.9 3 30/3 = 10 3 - 1:0,2- 1 -:-32 30 .16 19 3 30/3 = 10 Notes: 1) Te`ts to. be repeated at same depth until apppproximately equal soil .rates are obtained at each percolation test hole. M data to be submitted for review.. 2) Depth measurements, to be made from top of hole. z TEST PIT DATA REQUIRED TO-BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED TN TEST HOLES DEPTH HOLE NO. 1 HOLE NO. 2 HOLE NO 3 G.L. Top -Soil Top Soil Top Soil � 0�0 P . Y' v 0. This is to certify that the sewage disposal system was constructed as indicated on this plan and that the system was inspected by me before it was cover- ed over. The system ,mos constructed. in accordance with all the rules and regulations of the Putnam Courr ty .Department of Health." "0 KEN }� %CK �lP Nom. 4373V �ac> \\Q� l y�u Frederick A. Lenz 292 Main St. Nelsonville, N.Y. 10516 X07 15? .rte_ J, r 32/ 97" '' 1 AS -BUILT SURVEY BY J. S. ROMEO, L.S. SEPARATION DISTANCES IN FEET MR iii i■ Diuiii ■i� ■i■ 11 / V O� rutnam County UeparwueA'C -1 naa ;, 11vision of Environmental Health Servlc< approved ae noted for cLo formanoe with %pplicable Rules and Regulations of the Putnam County Health Department.. SiQaatute a TS AS —BUILT SEPTIC PLAN prepared for Ga PENCOLA SPUR ROAD SCALE: I"= 40' TOWN OF PUTNAM VALLEY 6/20/89