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02338
PtTNAM.COUNTY, DEPARTMENT OF HEALTH
41,
.RevA DI-AsloitofEi2vlronni46i2talHealth S4ihices,Carmel, ,N.Y .10512',
huj;lnoer Must Provide
P.C.H.D.... Permit
CER ATE, OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM
LOCR . K 1: Tam Map
Lot
Owner /applicant e '0tVeW11 Formerly S.bdlvl8Jod&r- g4v.
Lot # 12 Ll
Date Permit Issued
Mailing Address zip
Separate Sewerage System built by —& Address
J
Consisting of Z —Ga. Septic Tank and
Water Supply: Public Sapply'From Address
v .5 on Address
or:__Ae�f Private Supply Drilled b3AXAO" &&C
Building Type Has Erosion Control Been Completed?
Number of Bedrooms Has Garbage Grinder Been Installed?
Other Requirements LL
I certify that the system(s) as listed serving the above premises were constructed ease
of which are attached), and in accordance with the standards, rules and regulations, in
Putnam County D tm,nt Of He!th.
Date '7 Certified by
Address
UFA
Any person occupying promises served by the above system(s) shall. promptly take such action
condltlons resulting from such usage. Approval of the separate sewerage system shall beco
available and the approval -of the private water supply shall become null_ and 'void. when a P'l
subject to modification or change when, in the judgment of the Commissioner ot-Haaah..
d Date By
-4
plans of the completed k ( c'p
"'
piano, and the it..u.dbythe
L
Icon" No. 2 41
a the correction of any unsanita;y
s a publz unitary sawer becomes
avallable. . Such approvals are
Ication or change Is noc"ury.
T It Is
a. -o,
4c a*
W Y
WLLL _0Ur1rLG11U1V 1xzrvl\1
DEPARTMENT OF HEALTH
Division of En°vircf�;ie_n a-1 Health = Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
WELL LOCATION
SiAE" AOURE55: � WN /VIL I �, � TaJC GRto NUMBER:
;/
WELL OWNER
ADDRESS:
&PRIVATE
❑ PUBLIC
USE OF WELL
1 - primary
2 - secondary
0 RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /CONO. /HEAT PUMP ❑ ABANDONED
❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify)
p INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
'YIELD SOUGHT S gpm. /N0. PEOPLE SERVED /EST. OF : DAILY USAGE _:E0_' gal.
REASON FOR
DRILLING
[]REPLACE EXISTING SUPPLY ®TEST /OBSERVATION ❑ADDITIONAL SUPPLY
®NEW SUPPLY (NEW DWELLING) ®DEEPEN EXISTING WELL
DEPTH DATA
' WELL DEPTH ft.
STATIC WATER LEVEL WSJ ft.
I DATE MEASURE
DRILLING
EQUIPMENT
ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG
WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING XOPEN HOLE IN BEDROCK O OTHER
TOTAL LENGTH r2 1 ft
MATERIALS: R.STEEL ❑ PLASTIC ❑ OTHER
CASI NG
DETAILS
LENGTH BELOW GRADE ft.
JOINTS: ❑ WELDED THREADED ❑ OTHER
(:
DIAMETER �r in.
SEAL: [3 CEMENT GROUT ❑ BENTONITE DOTHER
WEIGHT
PER FOOT _ Ib. /it.
DRIVE SHOE R YES O NO
LINER: 0 YES Z NO
SCREEN
DETAILS
:. ...:.
DIAMETER (in)
'SLOT SIZE
LENGTH (ft)
DEPTH TO SCREEN'(ft)
DEVELOPED?
FIRST
❑ YES- 010..
HOURS
SECOND= -._
. ; . -. _.__ ._
_;
:.. - . ..... , .
. . • -- ._ .....,.. -
GRAVEL PACK
o NUS
GRAVEL
SIZE:
DIAMETER
OF PACK In
TOP
DEPTH tL
BOTTOM
DEPTH ft.
WELL YIELD TEST ' It detailed pumping
METHOD: ❑ PUMPED I tests were done is in-
t
• COMPRESSED AIR formation attached?
• BAILED O OTHER ❑ YES ❑ NO .
WELL LOG
tt more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
Water
Bear-
ing
Well
Dia-
meter
In
FORMATION DESCRIPTION
CODE
ft.
ft.
WELL DEPTH
ft.
DURATION
hr. min.
DRAWDOWN
ft.
YIELD .
gFm.
lan,
surface
/%
d
WATER CLEAR TEMP.
QUALITY ❑ CLOUDY HARDNESS
❑ COLORED ANALYZED? ❑ YES ONO
ANALYSIS ATTACHED? ❑ YES O NO
STORAGE TANK: TYPE — Ji r ,1w
CAPACITY GA3�.
PUMP IHF MATI(W �✓
TYPE _ CAPACITY
MAKER DEPTH 24"
MODEL VOLTAGE HP '
WELL DRILLER NAME DATE .
A4141 SIGFJytTURE
,�
PUTNAM COLUfY DEPARTMENT OF HEALTH
.. _ - .. ...DIVISION._OF. -- E9VIRO rAL HEALTH_.. SERVICES.. -•-
�.�.rv�, v r.:..... rrr.•�.:rc.nur r.z".�a'L:e�!�. +wY. f•!'. .NY.. ,• - -� •��. .... _
Owner or Purchaser of Building
it
Building Constructed by
Location - Street
Municipality
Building Type
Section Block Lot
Subdivision.
Ndme-
Subdivision Lot #
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, 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
Ger •,ti #iC.&te-- o£-- Con�.tiuction. Compliance" for the .sewage disposal_ systESn;..ox .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 Environinental 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 bu. ding utilizing
the system. ��//
Dated this �;� day ofG&p- 19 47 Signature
�; r Title
r
~General Contractor (Owner) - Signature
-- 'Corporation Name (if Corp.)
Address
rev. 9/85
mk
Corporation Name (if Corp.)
Address
---__�
'
^ �
' YML ENVIRONMENTAL SERVICES '
_
' 321 Kear Street .
YorktomnHeights, N.Y. 10598
(Y14) 245-2800
--A-4ber-t^~��.�!a�ovar����I��re��o���`' 2-
'
F1ORENTlNO, RONALD DATE/TIME TAKEN: 06/25/97 08:00
60 LAKE SHORE DR DATE/l'IME REC'D: 06/25/97 01:50
PUTNAM VALLEY, NY 10579 _ REPORT DATE: 06/30/97
' PHONE: (914)-528-2708
�
SAMPLING SITE: 97 PUDDING STREE[" PUTNAM VALLEY _ SAMPLE TYPE..: pOTABLE
�
HOSE BID PRESERVATIVES: NONE _
COL 'D BY: PAULSCHMITTMAN ` ` _ _ TEMPERATURE. { 4C
NOTE-S...: COLIFORM METH: MF
DATE: PROCEDURE RESULT NORMAL - RANGE METHOD
' �
`
06/30/97 MF T. COLlFORM ABSENT /100 ML ABSENT
'
COMMENlS:
BACl THESE RESULTS lNUICATE THAT WAS T' ` OF A
~
SAT ISFACTOHY SANITARY QUALITY ACCOR Dl lHE NEW-YORK ' STATE
AND EPA FEDERAL DRINKING 'WATER STANDARDS, FOR THE PARAMETERS
[ESTEU, A [ THE TIME OF COLLECTION.
»
. .
-
SUBMITTED BY:_ _______________ _
A|b�r't^F�~ Padovani, M.T.(ASCP)
Director ELAP# 10323
`
Number at Bedwomr _ DesiRs Flow G P D _
jd a'
S4—,.W Sewera(le System to ooneist of o Gallon Septic Talk and
To be constrticeted by
Water S. Pdmllc Snpply Isom
or: �Prtvste;Snpply bribed by ` `
I represent that I am wholly and completely rosponsible for the detlgn and
., aboveaescnbeG will be cgnstructed of shown on theapp►ovedsmendment
County Oepar`tment 'of; Meatth -`antl the; on comoletlorl theieof a "CerUl
b. sutimdted'-to the Department; and a'. written quaiantee will be' urn
plisse'lin good.?o' 'ating eohdnt{on'any part of:Uld sewage d`
sposal sy
ance 'of the aokOV&I Of the t:e td�cate 'of ConsfrucUOn Compliance of
' will,be loated;as shown On the approvedplan antl that said well WWII be insi
County Oa ►t_ment Of H Ith
Oats = Sgned
APP..ROVED FOR CONSTRUCTION T �s'spproval,expoes twb years''frot
►evocable-- for'cause or Tay be:ameno or:.modified.When'consldefed, nets
requires a new ermit Approved or diiposal of Comestis sanitary sm
1/8) Date. By
//G� �% PCHD Noll Hon:le Re4Wred When FM is completed
Address
_Address _
location of ;the proposed !yiitST(s); 1),that the separate sewage, disposal system
here: to nee with the standards, rules and,-regu,a -ions o e
4 u nom,
cat ` �� rt jy - "mpliaoe6 satlsfactory "to the Comm{sslo ler of Nealthwill,'
rs, ,h'eNs or assigns tiY the builder, that.. so builder will
rtfNe., e i dr 'o (;);years immediately following thedate of the {ssu-
ha•' lbgini m oY pairs thereto; 2) that . the drilled weil`deScribed :above
stis dards; rubs an0 riegu {Tons t .;)the Putnam
5 'PEN(/ RA.
,
f , License.No.
Itstruetlon.of the building has 'been underiaken,,and is
say.iltat e► of.Heilth., Any change or alteration, of construction '
ago an at wpPI only.
Title -,.
k
AT)T)'P'Pq.q:
Sheet of
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIV A
JSIOX-0F ENV-1R0,NME-.N-T-AL-.-.HE TLIUSERVICES,-.. 714;
FIELD ACTIVITY REPORT
Street' u Town State zip
PERSON IN CHARGE
C)R TNT1R.RVtF.W-P.T)-.
Name and Title
TYPE OF FACILITY:
FINDINGS:
L2
9v,�;;' -
/��-
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPL-ICATI.ON . T. O- wrONSTRUC-T.:..A�- WAT- E£`�WELL
PCHD PERMIT #yI�/
WELL LOCATION
IS WELL SITE SUBJECT TO FLOODING? YES ✓ NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: o hr-Atpq /vim /J
Lot No. !,Z V
WATER WELL CONTRACTOR: Name 01$�o �irl�S 0'07 Address: 1AVY001
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ✓ NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE ..FROM_.NEARES.T WATER MAIN.:... -
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
40 nroON REAR OF THIS APPLICATION O ON SEPARATE SHEET
(date) rvtl g
PERMIT
TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the
provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and
provided that within thirty (30) days of the completion of water well construction,
the applicant shall:
1. Pump the well until the water is clear.
2. Disinfect the well in accordance with the requirements of the Putnam
County Health Department attached to this permit.
3. Submit a Well Completion Report on a form provided by the Putnam County
Health Department.
Date of Issue: �r/c� 19 V
Date of Expiration: 19 —G�-- Permit suing fficia
Permit is Non-Transferrable M-te copy: H.D. File
Yellow copy: Building Inspector
Pink Copy: Owner
287 Orange copy: Well Driller
Street Address
% f, dTo V llage City Tax Grid Number
WELL OWNER
Name
v/ a,
Ma . ling Address
do e f-.
a?rivate
O Public
USE OF WELL
1 -'primary
2 - secondary
SIDENTIAL
(3 BUSINESS
(3 INDUSTRIAL
O PUBLIC SUPPLY O AIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION
O INSTITUTIONAL O STAND -BY
❑ ABANDONED
O OTHER (specify
1
AMOUNT OF USE
YIELD SOUGHT
S'o gpm /# PEOPLE SERVED .4 /EST. OF DAILY USAGE d oO gal
REASON FOR
DRILLING
EW SUPPLY O PROVIDE ADDITIONAL SUPPLY
OREPLACE EXISTING SUPPLY ODEEPEN EXISTING WELL
O TEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
WELL TYPE
635RILLED
DRIVEN
ODUG
GRAVEL
O
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES ✓ NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: o hr-Atpq /vim /J
Lot No. !,Z V
WATER WELL CONTRACTOR: Name 01$�o �irl�S 0'07 Address: 1AVY001
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ✓ NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE ..FROM_.NEARES.T WATER MAIN.:... -
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
40 nroON REAR OF THIS APPLICATION O ON SEPARATE SHEET
(date) rvtl g
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: �r/c� 19 V
Date of Expiration: 19 —G�-- Permit suing fficia
Permit is Non-Transferrable M-te copy: H.D. File
Yellow copy: Building Inspector
Pink Copy: Owner
287 Orange copy: Well Driller
L
APPENDIX $
PC�I'�1P�4 CCUN"I f DE2 .1. = OF =ALT HT - 0I71ISIC_I OF ETW=C�AIF ?ML HEUM SZRViC S
LNDIVIZLE1 L NA= SUPPII & SuE_cuJi.FA_C✓ SEvit.� DISi-r SAL SYST�S
cc rrs
REIN S: - "CS'C "_C7_P r'"
NO.1
DATE Ric
BY:
(NarrE or Cv ar)
(Street
Lccai ica)
cc rrs
YES
NO.1
1 1
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pTcv_c_c ! 2v
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6� r�::��..
y Pa_ mil= to crnt:,urs
_ 100°
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c1lal,tarrrier
10 f t.
fi1I notes ,,�
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G_D_ th c L'ces
I
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�
I
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100 vr. flccd elev.
5 -n
2'(10 ft. reservoir, t-c.
lEO ft. t_ica_' ; all.
I
I
D=O- 4 `TI'S
Per-Tut Fcclication
C- -=rat-- Rescluticn.
Plans - Three s`ts s/s
E.icir_ rs Authorizaticn
Desicn Bata Sineet (DC-Sc
D rDrr_s
�� ac le Lcc � M
Ccr.=_st zt Perc Re=_ f is
Perc Bole Dept- I c
House P'_Gris - T� c S` _c L
Well
Vs; lance Re✓uest
���acc_vi =.icn
Sur-; °r sicn A=rc'
=r vc'_ C:=_ —'
C.
Wet-2, an-d (Tc',v -ti/DE-C _ R & D)
Data Cn DCS Plans & Pe=i `
RiYG �, DES? , 1 c CN ' AN
S .vice S_sta.-i H%rd,auIiC
Profile =& Dime-- - V'-D ell r J Eex; c
ce_ ils
. __rlC Tani Si�sr De—
Wei' 1 Derail, SerViCe Li d if Chic
r Des_cn Data : perc an
Tt- c-Fcct Contours Existinc & P,;_rese
Drivegav & Slo_ces Cut
FcoL?n /Gatte*-,C irt n Drains (c_schar• e CK)
Perc & Deeo Holes Lccatw
Represamt`tive cr prim=-I and ex.,ansicn
E �nsicn Araa -; she m; cravit r flaw, saff . size
Pit & D Bcx Si awn & DeT=i1--3
Hcuse3 No. of Bedroaas
Wells & SSOUS's w/-in 200 ft. cf Prorosal Svs=
Pr :der Ly i•+� tes & Bourds _ -
Hcuse Setback Necessar/ (Tight lct)
House Sa er - 1 /4 " /ft. 4 "0; T_Te pipe
No Bends; M.--%. Ean�;- 45' w/c e recut
SEP R CN, DISTANCE=. SPECLF = CN PION
Fields
10' to P.L. , Dri vevav, Ea_-ae T,- _ s,Tc_c r
20' to Found aticn Walls
100' to Well; 200' is D.L.O.D, 1.5. 0 Pi
100' to Strearn, Wat= r-courSe, T, -<e lrC_ E't:
15' to Drains cur _- i n, Laader, Fcctinc
35'tc catch h` �._r_a:
S1n,SLt�ir�+rrG?n,L��.'.�..e�. WGL:� ..L
10' to '►eater Line (pit = -20')
50, intemmtt arail-i-zce C__ rse
S :2ctic T-nk-
10' fmn Found: ticn; 50' tc ;,;ejl
1. Svzl
to PL
0
Supervisor NRit1M �AIIEY
SALl1E SVPMtiR MVATORE• SANTAMOR!
(91.4) 925 -212,1 ceuuoitwm
>... ,..,
ciiki� HOWARD D. ARONOVY
PATRICIA PETTERSEN �• * ; ,.,.. 2euieilwoi " "" " • -- _, ._,..,., ...
,.(fU► °,.629- l9,,�Q ' 4.:..,'.
° JOSEPH MARRO
Two "wormy TOWN OF PUTNAM VALLEY cewwilwru
HERMAN TAUS
19141 "tlaO =soEO" TOWN HAIL 9aucE E. JOHNSON
is
265 Oscawana Lake Road Cau,crtwru
Putnam Valley," New York 10579
y
TOWN BOARD METING SEPTEMBER 6, 1989
Presented by. Councilman Santam4rena,:
RESOLUTION lit 263
WHEREAS, the Planning Board granted a .wetlands permit to•Ronald
Fioreattao for t:he lot" designated as TM #.15. -6-6 on May 1, 1989,
%Uch permit was filed in the Town .Clerk's office on June:�21,1989 ;and
WHEREAS, said wetlands permit laid down certain conditions among
which was the restriction that a house to be built on the lot
�i shall have no mare than two beftoomst and
WHEREAS, the owner of said lot has appealed to the Town Board, in
II accordance. with Section 24C -9 of the Town Code, that the above
mentioned limitation to two bedrooms be removed from wetlands
permit and from the dead restrictions to be filed pursuant to that
lretlands"pezmm "i.1 and
WHEREAS, the Town Board reviewed the inform'ation and argument in the
owner's appeal', the minutes of the Planning Board, the reports of the
Wetlands Inspector, and.the report of the Environmental Consultant
engaged by the;'awneri` "and.
WHEREAS, the"planned septic system has received approval from the
Putnam County. Board of Health for a house with three bedrooms, and
WHEREAS, the Town Board has noted the practical difficulty of con-
trolling the actual use of rooms within a house after the structure
.._ -_ �. EFOREBE- IT: RESOLVED
h -- lsa0[�THER - w._Boand. nullifies the re-
4ptriction to two bedrooms as contain e3 iq'ttie "wetlands psrrat- issued
i
�. on lot 1115 -6 -6 and instead requires that said,h6use may contain no
more than 2400 square feet of living space aia shown in the sketch
submitted to the Town Board" and no more than three bedrooms; and
1 FURTHER RESOLVED, that all other conditions laid down in the wetland
permit shall stap4 and.
FURTHER RESOLVED, that prior to the issuance of a building,permit,
the owner of subject property shall present to the Building Inspector
evidence that the wetlands pozmit.and this resolution have been
filed in the office,of the Putnam -Cou►ty Clerk.
seconded b7t co%Adilman 'aronowl unanimously 0= 441L ;
z
.�•• 8TA.M OF,,NEW YORK
COUNTY 4!PUTNAM ss..
:
TOWN OF° PUTNAMVALL EY
y
,
corn red1r.p eceding or annexed dopy of
RESOLUTION #R-267 TOWN BOARD MEETING SEPTEMBER 6
1989
with the original filed in this office and DO HEREBY CERTIFY the same to be
a corrsct #SjmKXipt. ttWefrom.and of the whop. of such original.
IN TESTIMONY WHEREOF, I have hereunto subscribed
_.
my name
effixed:ttle,seala�se its m:thls.
and
SS'
27th
Y of SEPTEMBER
19 89
,q
Town Clerk, Town otPutnam Valley
.
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES_._ _
Date �f/ 7/ e�
Re : Property of
Located at / is d i "" a
Section �5� Block Lot
Subdivision of 1A70O. - ;r7 q
Subdv. Lot # Filed Map # Date
Gentlemen:
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
Department of Health, and to sign all necessary papers on my behalf in
connection.with._this . ma,t.t.er 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.
Counters
Very truly Xot7s,
Telephone
Signe
7 - Ow�f Property
ddress
!� ,I:,r ?
Town
Telephone
C. /"/-. 'C7
JOSEPH F. SULLIVAN, P.E.
conlatting Engines
.2972 F q!jR
YORKTOWN HEIGHTS, N Y. 1059e
(914) 962-424e
W aje
C -ji re
A)74
PUTNAM COUNTY HEALTH DEPARMAENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
John M. Simmons, M.D.
Deputy Commissioner of Health FIELD ACTIVITY REPORT - Sheet 1 of
INSPECTION
NAME 11--ld A CA-I-rl'oj 0 Orig. Routine
Orig. Complain
ADDRESS
Orig. Request
No.
067
MAILING ADDRESS
P.O. Box Post Office Zip Code
OVDIM:ft
PERSON IN CHARGE JL)f 41j
OR INTERVIEWED 6 JV-,CA_,,7:) - 0
Name and Title
DATE
TIME ARRIVED
LS
TYPE FACILITY
TIME LEFT /'0: v
FINDINGS: -
-7 L (.,; U 66-7
Compliance
Complaint Camp
Final
Group Illness
Construction
Reinspection
Field, Sampling Only
Field Conference
Other
.Explain
fl) 42� 14
ue-
---3 U U c_, -f A-.-., / 7- " ej --j& tt-- Z 0 (' r '-) , A J dvA L- 0 r- r n ".
INSPECTOR: r,
Sianature aricrTitle
PERSON IN CHARGE OR INTERVIEWED:
I acknowledge this Field Activity Report. SIGNATURE:
6/86 TITLE:
TELEPHONE:
PC-TER C ALEXANOERSON
County Executive
DEPARTMENT OF HEALTH
Division Of Environmegtal Health Services
110 Old Route Six Center, Carmel. New York 10512
(914) 225-0310
September 20, 1989
Joseph Sullivan, PE Re: Construction Permit - Fiorentino
2972 Ferncrest Drive Pudding Street (T) PV
Yorktown Heights, NY 10598 TM #15 -6 -6
V�.
ENID L CARRUTH. M.P.4
Puctic Health Direc;pr
JOHN )(ARELL it„ p =
Direczar
Dear .Sir
Review of my Tiles indicates no activity on the above captioned project fur scse
time.
Please advise the writer as to the status of this project without delay.
Failura to receive a response by October 16,1989 will result in the file being
returned to you, DISAPP40VED.
Very _truly yours,
Lawrence C. Werper
LCW:jr Assistant Public Health Engineer
CC: Owner: Ronald Fiorentino
60 Lake Shore Drive
Putnam Valley, NY 10579
CC: JK
CC: File
PETER C. ALEXANDERSON
County Executive
a f W
ENID L. CARRUTH, M.P.H.
Public Health Director
JOHN KARELL Jr., P.E.
DEPARTMENT OF HEALTH Director
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
December 7, 1988
Mr. Frank Sullivan
2972 Ferncrest Drive
Yorktown Heights, NY 10598
Re: Proposed SSDS -
Fiorentino
Pudding Street
(T) Putnam Valley
TM 415 -6 -6
Dear Mr. Sullivan:
An inspection was conducted by this writer on December
6, 1988., on.the above captioned -lot. The following
observations were made:
1. Standing water and stream less than
100 feet away from proposed disposal system.
.2. Soil_• has_ been. moved -to create. dee.P ..test holes -
that appear deeper. ..
3. House appears to be proposed on or next to
ledge.
Upon receipt of a submission, revised to reflect the above
comments, this application will be considered further.
Very truly yours,
Lawrence C. Werper
Assistant Public Health
Engineer
LCW:jr
IO r s• • 24• • -4c IN •
DIVISION OF HEALTH SERVICES
DESIGN - DATA;:S'HEE11= SUBSUFACE7S E DISPOSAL- .SYSTEM
Owner oll os" i�'/�O Address
Located at (Street) �� c:5�'r't°i� Sec. Block
y Lot
nearest cross street)
(indicate
Municipality ,/" w !f/ Watershed
SOIL PERCOLATION MST DATA TO BE SUBMI= WITH APPLICATIONS
-REQUIRED
Date of Pre- Soaking �� / ®e _ _ Date of Percolation Test
HOLE
N[flKSM CLOCK TIME PEIICOIATION
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
v�—
--3
4
5
3.
2 70'� 9
4
5
1
2
3
4
5
-
NOTES: 1. Tests to be repeated* at sare 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.
rev. 9/85
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOURrERED IN TEST HOLES
DEPTH__ .HOLE NO._-._ % HOLE NO.._ � - - - - -._ _ .HOLE NO..
` /
3'
4'
5'
6'
7'
8'
9'
10'
ll'
12'
13'
14'
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED `-
DEEP HOLE. OBSERVATIONS MADE BY:' � / / / DATE •
DESIGN
Soil Rate Used _� Min /1" Drop: S.D. Usable Area Provided
No. of Bedrooms Septic Tank Capacity OGYJ gals.
Absorption Area Provided By L.F. /x..*4- widthtreneh
Other � � %3U3
Name
Address
)IM111 4 _71
THIS SPACt FOR USE BY HEALTH
ONLY:
Signature
PtE OF Nz
ION t
Soil Rate Approved sq.ft /gal. Checked by Date