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02403
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
- I
Owner e-41
Address 5-'Z 044 eel o� k"vl-
Located at (Street) A0',w&' Tax Map it 7- Block &3 Lot 2- d
(indicate nearest cross street)
Municipality 11"e '011eq Watershed
SOIL PERCOLATION TEST DATA
I
Date of Pre-soaking:
9Y
Date of Percolation Test zez ?V
If V
.. ........
..... .......
....................
.. ............. ...........
.............
.............
....
.
........... .........
Depth o:: Vt?ater
Water
........ -
... ....... ............ .
.......
0 Ground ....
Percolatzan
.... ..... xx,
... . .........
.....
.....
..
.. .... . .. .
.. e:
Ala se T,
.......
0 No
... ..........
Run �0*.'�i,.�.,..,�:]�]�:]�:..-..-..�
..............
tafV'. ��std.'
St o
Inches
73a , 5
A 11-4,
-3
2
7
3
4
5
2
-7
2-5
3
4
5
2
3
4
5
NOTES:
1. Tests; to be repeated at same depth until appro,ximately equal percolation rates are
obtained at each
percolation
test hole. (i.e.
:5 1 min for 1-30 min inch, :5 2 min for 31-60
min/inch) All data to be
submitted for review.
I
2. Depth measurements to be
made from top of hole.
Form
DD-97
DEPTH
G.L.
0.5'
1.0'
1.5'
2.0'
2.5'
3.0'
3.5'
4.0'
4.5'
5.0'
5.5'
6.0'
6.5'
7.0'
7.5'
8.0'
1-1
9.5' ;.
10.0'
TEST PIT DATA % . � 2
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
LES
HOLE N0.
HOLE NO. 2-
HOLE NO. --75
Indicate level at which groundwater is encountered _
Indicate level at which mottling is observed
�r
`6
Indicate level to which water level rises after being encountered
Deep hole observations made by: Date -!�ZZ22F
Design Yrotessional Name:
Address: _ �u (I , ✓�t/I
Signature:
Design Pnrofessional's Seal
PU NAM CDUNTY DEPARTMENT OF HEALTH .
DIVISION OF 'HEALTH SERVICES
DESIGN D,ArTA /SHEET -/SUBS UFA�CE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner Ald/lv41 ;--ee rl. f 'f A�dress
/ j Located at ( Street re 4 -41f Ir �`l 111v11: -✓' 1;2 sec. - � y Block 0-3 Lot --Z� .
(indicate nearest cross street)'
Municipality 1,�ar Watershed
SOIL PERODLATION TFST DATA RDQUIRED TO BE SUBMITTED WITH APPLICATIONS
Date of Pre - Soaking - Date'of Percolation Test
HOLE
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
i
Inches
2 Jv,.� 1��v i .�
A�
4
5
1 '
2
3
4
5
NOTES: 1. .Tests "to be, repeated at same depth' until approximately equal soil rates
are obtained at each percolation test hole. All data to be sutmitted
for review. - .4
2. Depth measurements to be made frcm'top of hole.
rev. 9/85
t
r
TEST PIT DATA RBQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. HOLE NO. HOLE NO.
2'
3'
4'
5'
6'
7'
8'
9'
10'
11'
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.s ", ..-go; ' DATE:
'DESIGN y
Soil Rate Used 3 / — t < Min /1" Drop; : S.D. Usable Area Provided
Noe of Bedroans -3 Septic Tank Capacity la o, c/ gals. Type Has r
Absorption Area Provided By ®C/ L.F. x 24" width trench
Other
Name n
a Address g w
a �.
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved sgeft /gale Checked by Date
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster', New York 10509
(914) 278 -6130
APPLICATION TO CONSTRUCT A WATER WELL
PCHD PERMIT #�1
WELL LOCATION
Street Add r
��C/
s Town Vill ge C ty Tax Grid Number
WELL OWNER
Name
Maa' / l�,` c
izr
rivate
D Public
USE OF WELL
1 - primary
2 - secondary
ARESIDENTIAL
0 BUSINESS
13 INDUSTRIAL
O PUBLIC SUPPLY O AIR /COND /HEAT PUMP
O FARM 0 TEST /OBSERVATION
O INSTITUTIONAL 0 STAND -BY
0 ABANDONED
0 OTHER (specify,
O
AMOUNT OF USE
YIELD SOUGHT gpm /# PEOPLE SERVED &V OF DAILY USAGE Z&C /gal
❑ REPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION 13. ADDITIONAL SUPPLY
JKNEW SUPPLY NEW DWELLING 0 DEEPEN EXISTING WELL _
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
WELL TYPE
ODRILLED
DRIVEN DDUG GRAVEL.
C] OTHER
IS WELL SITE SUBJECT TO'FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No. �r
WATER WELL CONTRACTOR: Name /"' aj 0��P- 5v 'o' Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES bo' NO
NAME OF PUBLIC WATER SUPPLY: r-- TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:l;��
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
PION SEPARATE SHEET
ate (signat re
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.
During all well drilling operations, the applicant shall take appropriate action to assure that
any and all water or waste products from such well drilling operations be contained on this
property and in a manner as not to degrade or otherwise contaminate surface or groundwater.
Date of Issue: suc '/2 19 "5,3Z'
Date of Expiration 19 % / Permit Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
., PU TNAM CC;OUH7'Y DEPARTMENT OF HEALTH
APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM
1. Name and Address of.Applicant:
PAP
4.
,r.
1
Name of Project:
Project Engineer: / /✓�
License Number: Phonegb2 -Z -�
3. Location T /V /C:
5. Address: �f�7.�Jl'rc5 %�%i•
6. Tyge f Project:
Private /Residential Food Service Commercial
Apartments Institutional Mobile Home Park
Office Building Realty Subdivision Other (specify)
7. Is this project subject to State Environmental Quality Rediew (SEAR)? A161
Type Status (Check One) Type I.. Exempt
Type II. Unlisted
8. Is a Draft Environmental Impact Statement (DEIS) required? ............. i✓ d
9. Has DEIS been completed and found acceptable by Lead Agency? ...........
10. Name of Lead Agency
11. Is this project in an area under the control of local planning, zoning,
or other officials, ordinances? ......... ............................... G�
12. If so, have plans been submitted to suA authorities? .................. _ k��
13. Has preliminary approval been granted by such authorities? Date Granted: l_�
14. Type of Sewage Disposal System Discharge'.—,.b Surface Water k/Ground Maters
15. If surface water discharge, what is.the strewn class desi,gnati*on......... AIIAX
16. Maters index number (surface) ...... ...................vale .e....e...
17. Is project located near a public water supply system? ...e .............. /L%d
18. If yes, name of water supply Distance to water supply
19. Is project site near a public sewage collection or disposal system ?..... /!/y
20. Name of sewage system
Distance to sewage system /Y�
21. Date test holes obt6rved: 22. Name of Health Inspector:
23. Project design flow (gallons per day) ............ 4�.9 d ...................
11/93
M 2.
24. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. �(/y
25. Has SPDES Application been submitted to local DEC Office? ...............
26. Is any portion of,this project located within a designated Town or State
wetland ?........, ..... ................... ........... c� 5
27. Wetland ID Number .. ... ...
... ............................... ... ....... ...
28. Is Wetland Permit required? .............. ............................... Ale
Hasa application pp been en made to Town or Local DECIOffice? ..................
29. Does project require
e a DEC Stream Disturbance Permit? ...................
30. Is or was project'site used for agricultural activity involving application
of pesticides to' orchards or other crops, solid or hazardous waste disposal,
landfilling, sludge application or industrial activity? ........ YES or NO
31. Is project located, within 1,000 feet of existence of abandoned landfill,
hazardous waste site, salt stockpile, landfill, sludge disposal site or ��
any other potential known source of contamination? ...............YES or NO
DESCRIBE:
32. Is there a local master plan or file with the Town or Village? ........... 4—
33. Are community water, sewer facilities planned to be developed within 15 years?
34. Are any sewage disposal areas in excess of Ift slope? ........................
35. Tax Map ID Number ,.........4. ' ............................
36. Approved Plans are to be returned to: ................. Applicant �ngineer
If the application is;signed by a person other than the applicant shown in Item 1, the
application must be accompanied by a Letter of Authorization. Failure to comply with this
provision may be grounds for the rejection of any submission.
I hereby affirm,,under penalty of perjury, that information provided on this
form is true to the best of my knowledge and !be I W. False statements made
herein are punishable as a Class A Misdemeanor pursuant:to Section 210.45 of
the Pena 1 Law.
SIGNATURES & OFFICIAL TITLES:
MAILING ADDRESS:
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date�Jj�?
r
Re: Property of 411, 61/ f��
Located at
(T),eCl Section 42 Block a 7i Lot 2 .,4
Subdivision of / 'r re,
Subdve Lot # ,Filed Map ## Date
Gentlemen:
This letter is to authorizes
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 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 Heialth Law, and the Putnam County Sani-
tary-Code.
Countersigned:
PeEo, RoA*
��
r� rif
ess
19 G s, �- G
Telephone
Ver trul
�, y
Sign
st
. Y.
er ofZProperty
oe / 51'-
Aaaress
Town
Telephone
J
THE HARRISON .
SSeecond Floor
y
BEDROOM 2
16' -0" , 10,- B-
DN IJ ' f III�JJJ /// t
7130- BEDROOM 3 BEDRMASTER BEDROOM
13' -8" X 13'•0' 106' 14' -2' X 18'•10'
27'8"
First Floor
44'� ,
27'8"
27'8" X 44'o 2434 Sq. Ft.
BEDROOM 2
13' -4" X 10' X 8"
1 x'60
.-_
BEDROOM 3 MASTER BEDROOM
13' -8" X 13' -0" 18' -2" X 16' -5"
BKFST;
ovno•n
I
KITCHEN
I
I6' -B'. 13' -O"
IY -9 , 13' O"
44'
1 '
1-70
B
O 1
1
[.
OO
LIVING ROOM
27'8"
First Floor
44'� ,
27'8"
27'8" X 44'o 2434 Sq. Ft.
BEDROOM 2
13' -4" X 10' X 8"
1 x'60
.-_
BEDROOM 3 MASTER BEDROOM
13' -8" X 13' -0" 18' -2" X 16' -5"
BKFST;
ovno•n
I
KITCHEN
Ii11[RAC[
FAMILY 'ROOM
I6' -B'. 13' -O"
IY -9 , 13' O"
T777>
DINING ROOM
LIVING ROOM
13'•6" X 13'-0"
P
16' -11" X 13' -0"
27'8"
First Floor
44'� ,
27'8"
27'8" X 44'o 2434 Sq. Ft.
BEDROOM 2
13' -4" X 10' X 8"
1 x'60
.-_
BEDROOM 3 MASTER BEDROOM
13' -8" X 13' -0" 18' -2" X 16' -5"
44'
STANDARD HARRISON FEATURES
• 3 or 4 Spacious Bedrooms ! Framingham Pediment on Front Door
• 2%2 Baths • Fireplace Options Available
• Open Two -Story Entry Foyer 13 Bedroom) • 'Boxed -out" and "Angle Bay" Options
• Formal Dining Room. Available
• Formal Living Room • Consult an Authorized Westchester Builder
• Spacious.. Country Kitchen Features Island for a Complete List of Options
with Real Butcher Block Top and Pantry • ArusCs renderings and Floor Plan Dimensions are.
"Cottage-Style" 3056 Lower Level Windows approximate All specifications must � Written in the
•
Contract. No oral conditions
with Architraves.on Front
ESTCHESTER MODULAR HOMES, INC.
ti II II 30 Reagans Mill Road Wingdale, NY 12594
REV. 3/95 )914) 832 -9400 (800) 832 -3888
I I
44'
i
KITCHEN •OKF9T FAMILY ROOM
le' -e•x 1!'-0• • -' 17' -e'x 13'•O•
DINING ROOM
LIVING ROOM
L—T-
13' "6" X 13'•0"
18'•2" X 13'•0"
u
44'
STANDARD HARRISON FEATURES
• 3 or 4 Spacious Bedrooms ! Framingham Pediment on Front Door
• 2%2 Baths • Fireplace Options Available
• Open Two -Story Entry Foyer 13 Bedroom) • 'Boxed -out" and "Angle Bay" Options
• Formal Dining Room. Available
• Formal Living Room • Consult an Authorized Westchester Builder
• Spacious.. Country Kitchen Features Island for a Complete List of Options
with Real Butcher Block Top and Pantry • ArusCs renderings and Floor Plan Dimensions are.
"Cottage-Style" 3056 Lower Level Windows approximate All specifications must � Written in the
•
Contract. No oral conditions
with Architraves.on Front
ESTCHESTER MODULAR HOMES, INC.
ti II II 30 Reagans Mill Road Wingdale, NY 12594
REV. 3/95 )914) 832 -9400 (800) 832 -3888
I I
1FUTNAM[ COUNTY DEPARTMENT T O F HEALTH
DEWSEON OF IENWR®IVIViTIENTAIL HEALTH S E1R VffC ES
GUARANTEE OF SUBSURFACE SEWAGE V A`,.UIE TR EATMIENT SYSTEM
Owner or Purchaser of Building Tax Map Block Lot
![
Building Constructed by
Town/Village
Location - Street Subdivision Name
Building Type
e
Subdivision Lot #
I represent that I am wholly and completely responsible for the location, workmanship, material,
construction and drainage of the sewage treatment system serving the above - described property, and
that is 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" for the
sewage treatment system, 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 Public Health
Director 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.
% G 3
Dated: Month Day Year Signature.
f ��
Title:
General Contractor (Owner) - Signature
Corporation Name (if corporation)
Address: 57 /
State �� Zip
Corporation Name (if corporation)
Address: e—
State
Zip
Form GS -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT
Well Location
lWell,Owner:
S 'et Address:
n/Villag •
Tax Gri
Block j Lot(s),:�<�
Map #
ame;:
Address:
Use of Well:
1- primary
2- secondary
Residential
Business
Industrial
Public Supply,// Air cond/heat pump Irrigation
Farm Test/monitoring Other(specify)
.Institutional' Standby
Drilling Equipment
"711 Rotary
Cable percussion Compressed air percussion Other (specify)
Well Type
Screened
Open end casing Open hole in bedrock Other
Casing Details
Total length ft.
Length below grade / Yft.
Diameter in.
Weight per foot 16 lb /ft.
Materials: X Steel _ Plastic Other
Joints: _ Welded Threaded . Other
Seal Cement grout _ Bentonite Other
Drive'shoe: Yes _No
Liner _ Yes xNo
Screen Details
Diameter (in)
Slot Size
Length(ft)
Depth to Screen (ft)
Developed?
First
_ Yes—No
Hours
Second
Well Yield Test
Bailed _
Pumped Compressed Air
Hours �
Yield o gpm
Depth Data
Measure from land surface- static specify ft)
�0
During yield test(ft)
Depth of completed well in feet
Well Log
If more detailed
information
descriptions or
sieve analyses
are available,
please attach.
Depth From
Surface
Water
Bearing
Well
Diameter(in)
Formation
Description
ft.
ft.
Land Surface
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump /Storage Tank Information
Pump Type 3, Capacity o
Depth *X- '>' o Mode °S
Voltage Y3 v HP
Tank TO a s a Volume
Date Well Completed(y
Putnam County Certification No.
Date of Report
Well Driller (signature)
NOTI�: Exdct location of well with distances to at least two permanent` landmarks to be provided on a separate sheet/plan.
Well Driller's Name�!ir, G��aL' Address:
Signature: �A Date: ' ?� /04 7,q
White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC -97
' � 8
'r'ML ENVIRONMENTAL SEFi'v I CES
32: rear- Street.
Y;;)rkt.cwn Heights, N.Y. 1�r598
( 914) 24S-29('--%l
Albert H. radovani. Uirec *.or
LAS 0: 32.809685 CLIENT #: 671r NON STAT PROC PAGE 1
HOLLOWBROOK HOLDING C DATE /TIME TAKEN: 12/09/98 03:00P
56 SCHOOL ST. DATE /TIME FEC'D: 12/0x/98 03:30P
CORTLANDT MANOR, NY 10566 REPORT DATE: 12/09/98
PHONE: (914)-528-3071)
SAMPLING SITE: 1030 PEEt;Sk';I1_L HOLLOW ROAD SAMPLE TYPE..: POTABLE
PU1 NAM VAL I..EY , NY PRESERVATIVES: NONE
COLD BY: STEVE AUTH TEMPERATURE—:
NOTES...: COLIFORM METHS N/A
iv--/.rw/n- -- ---- .----- n----------- -n.Nn/ N--- -- n----- r--- - ---- -- -- -- ---- --
DATE FLAG PROCEDURE RESULT
12/09/98 IRON (Fe) 0.20 MG /L
COMMENTS:
fax to 328 3282
NORMAL - RANGE METHOD
CJ-0.3 mg: l 2037
COMMENTS-
Fe/Nn If both iron and manganese are present, them- total value
combined shall not exceed 0.5 mg /L.
SUBMITTED L V : _ _
Albert H. F'a olvani, M.T. EASCF`.
Di rector
ELAP#i 10323
.ML ENVIRONMENTAL SERVICES
321 Kear Street `
. �
Yorktown Heights, N'.Y. 10598 '
�>
� (914) 245-2800
' Albert H. J�adovani, Director
' .
'
32009589 CLIENT #: 8710 NON STAT PROC ' PAGE 2
,�~~~~~~~~~�~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ �~~~~~~~~~~~~~~~~~�~~~~~~~~~~~~~~~~~~~~
� � . �
:H LLOWBROOK HOLDIN*G'C DATE/TIME TAKEN: 11/27/0 12:30P
^56 SCH |L ST. ' DATE/TIME NEC'D: 11/27/98 01:00P
ACORTLAWDT MANOR, NY 10566 REPORT DATEv. 12/03/98
PHONE: (914)-528-3070
'
SAMPLING SITE: Y030PEEKSKILL HOLLOW ROAD SAMPLE TYPE..: POTABLE
PUTNA VALLEY NY 10579 PRESERVATIVES: NONE
OL'D BY: STEVE'AUTHI. � ' TEMPERATURE..:
`J TES...: GARDE nS 'FROM SUPPLY TANK . COLIFORM METH: MF`
~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~�~~~~~~~~~~~~~~~~~~ ~~~�~~~~~~�~~~~~~~~~
^ �
. ' DATE FLAG'PROCEDURE RESULT. NORMAL - RANGE METHOD
,Hd TOTAL HARDNESS IS DEFINED AS THE SUM dF THE CALCIUM & MAGNESIUM
CONCENTRATION ,i 80TH EXPRESSED AS CALC'UM CARBONATE, IN MG/L. THE
HARDNESS MAY RAMGE FROM (/ TO HUNDREDSjOF MG/L, DEPENDS ON THE
SOURCE AND TRIATMENT TO WHICHTHEWAT|R HAS BEEN SUBJECTED.
` SOFT WATER: 6710 MG/L VERY HARD WATER: ABOVE 300 MS/L'
_ MODERATELY HARD WITER. 70-140 MG/L � MG/L = MILLIGRAM PER LITER
' HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L)
`
SUBMITTED BY: |
Al&A H. Padovani, M.T.(ASCR)
, Director
ELAP# 10323
`
YML ENVIRONMENTAL SERVICES
321 Kear Street `
' �orktown Heights, N.Y. 1059B
. (914) 245-2800
Albert H. Padovani, Di'ecto�
LAB #: 32.809589 CLIENT #: 8710 NOW STAT PROC PAGE 1
~~~~~~~~~~~~~~~~~~=~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
`
HOLLOWBROOK HOLDING C
_ I��� l�KEN: 11/27/98 12:30P
56 SCHOOL S/
. DATE/TIME REC'D: 11/27/98 01:00P
CORTLANDT MANOR, NY. 10566 REPORT DATE: 12/03/98
` PHONE: (914)-52B-3070
^SAMPLING
SITE:
1030 PEEKSKILL
HOLLO� ROAD
SAMPLE TYPE..:
POTABLE
:
PUTNAM VALLEY
NY 10579'
PRESERVATIVES:
NONE
COi- 'D BY:
STEVE
AUTH
TEMPERATURE.�:
NOTES...:
| . =~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
GARDEN
HOSE F�OM SUPPLY
TANK
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~..........
COLIFORM METH:
MF
DATE FLAG PROCEDURE
RESULT NORMAL _ RANGE
'
PUTNAM CNTY PROFILE '
' 11/27/98 LEAD (I MS) <1 ppb 0-15ppb
11/27/98 NITRATE NITROG 1.75 MG /L
' 11/27/98 NITRITE NITROG 0.02p MG/L N/A
11/27/98 IRON (Fe) 0.949 MG/L 0-0.3 mg/l
11/27/98 MANGANESE (Mn> 0.032 MG/L 0-0.3 mg/l
11/27/98 SODIUM (Na) 68.7 MG/L N/A
11/27/98 pH 6.3 UNITS 6.5-8.5
11/27/98 HARDNESS,TOTAL 7O.0 MG/L N/A
11/27/98 ALKALINITY (AS 60.0 MG/L N/A
11/27/98 TURBIDITY (TUR 4.2 NTU 0-5 NTU
COMMENTS:
.Pb /Cu LEAD limits for public schools are set at 151 ppb.
EPA Lead & Copper Rule for Public Systems requires that no more
than 10% of their distributiun points have a LEAD vaIue of more
than 15 ppb and a COPPER value of 1.3 mg/L, else water
treatment must be undertaken to reduce the waters corrosive
potential.
Fe/Mn If both iron and manganese are present, their total value
combined shall not exceed 0.5 mg/L.
`Na No limits for Sodium are proscribed. Suggested gUidelines state
that forpeople on a sodium restricted diet,the water should
� contain no more than 20 m�/L of Sodium. For those on a
_ moderately restricted diet, a maximum of 270 mg/L'of Sodium
is suggested.
'
pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS'ONE OF
. THE IMPORTANT AND FREQUENTLY USED TESTS I WATER CHEMISTRY.
WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND
FIXTURES. THE NORMAL RANGE OF pH IS.6.5 TO8.5.
`
METHOD
9101
9139
9146
2',37
2037
9043 '
i
a
Y Vi Ei'• V I RONME1' 1TAL SERVICES
321 Kear Street
Yorktown Heights,!N.Y. 1059S-
(914) 245—EBOO
Albert H. Padovaniy Director
L.AB FIB z *32 009 2 WENT #: B71 0 ON ;TAT P F:O' PAGE 1
HOLLOWBROOF:: HOLDING C DATE T i OE TAKEN: 12 /01 , 98 1 c'i ; iic_ A
SCHOOL ST„ DATE /TIME REC' D: 12/01 /18 1100A
ZORT'L ANDT MANOR, NY . 10566 REPORT—DATE! 12/03/98
PHONE: 014)-52B"3070
:.,, SAMPLING SITE: 1 OS F `EEF:: SK I LL HOLLOW RD., PU'TNAM VALLEY SAMF'i_E TYf-'O a : POTABLE
PRESERVATIVES: NONE
1POL ` D B'Y: STEVE RUTH TEMPERATURE . o
NOTES ,! , n :,GARDEN HOST C 1L I FCR 1 METH: MF
hINNNNNNN _ NNNn.NhJ .VM1N. .0 n. N.v ns N.v .•.V nfNN .•YNNJV nINNIV Nf 4•. V:nJN.T•hINNN.uNNllln.•NN.•'.V .V NN NN.'\f N! \I Jl'IV .1•J\I
DATE FLAG PROCEDURE RESULT NORMAL -- RANGE METHOD
12/01/98 HF= T. COL I F ORM ABSENT 10 i ML ABSENT 1 008
Cf:li`iMCMNT S o
,, PAC1` THESE RESULTS , INDIC:ATE THAT THE WATER ' i:. ?JvAS) a WAG NOT) OF 'A
`'.
SATISFACTORY SANITARY QUALITY ACCORD: l ! � T j HE NEW YORK STATE
AND EPA ,= E DE PL. DRINKINS WATER STANDARDS, F OR THE PARAMETERS
TE:: TED 4 . iA`I" THE -TIME OF COLLECTION.
SUBMITTED SY2
x..11 L\ S i'i'e F"'c \;.i6 •:iii 1 v M o T u f ASCp )
Director
ELAP# 10323
II" l I\ •� � 1 ((1> l\ I 1 II) I I" •� I'l I� 1 i\ I (1> I III •� I I I I
SIDN OF IENWRONM]EN7AL IHIIEALM S ERWCIES
D
j a ONST]I UCUON PERMIT FOR SEWAGE TREATMENT SYSTEM
P>ERMI[T #
Located at �G �/��1r` /% ,1� //d ``tea Town or Village
Subdivision name �l'�i r✓ WP�'rsh/3 Subd.
Date Subdivision Approved
Owner /Applicant Name
Mailing Address S-4
Amount of Fee Enclosed
Lot # 0/
Tax Map -4�z Block 0-5 Lot 2 .6
Renewal Revision
Date of Previous Approval
Building Type -'e' Lot Area No. of Bedrooms Design Flow GPD
(Fill Section Only '10° Depth Volume
PCH)<D NOTIFICATION IS RE URR EIlD WHEN IFffLL RS COMPLETED
Separate Sewerage &stem to consist of /&& v gallon septic tank and
2-1(" h,-, 4r,, ) r 1�,71 e�,f
Other Requirements: ,PH rm �� e��k T j
r
To be constructed by okow W Address
Water' Su aly Public Supply From
o1r: k' Private Supply Drilled by
Address
Address
I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the
separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion
thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will 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 treatment system during the period of two (2) years
immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original
system or any repairs thereto.
of NEtq/\,,
Signed: P.E.
Address 1s
APPROVED FOR CONSTRUCTION: This approval expir s two y e<ars from the " y�e� construction of the
sewage treatment system has been completed and inspected by the PCHD and is revoca e ' r 'o r may be amended or
modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires
a new p rmit. Approved for discharge of domestic sanitary sewage only.
By: Or e.�c.- Date: II 3n
White copy - HD Fill Y to copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CP -97
r of PiTi�' ,PAPA! bFSEALTH r • tt.
°' "' Dldlde� d lYivh�:a msti! Hblttth Services. Caasd. N.Y. 16512, 5 '° Houbsoor to Provide Pemit
` t �; : eta CEQTTIFWATB OFC _
�rl CONSTRUCTION PZFAW FOR SEWAGE DISPOSAL SYSTEM . 1 i = r ;Peed i -
jj Ale /�j f /lj Ivy '.i.? jrl .`i �r ��'•� lYr�s y! Town Or Villegi
Subdivision rieme ���� / 1 / r�` ° !'l: =�= •� G
trAd: Let / Tax MOP Block '3 tea
Owner/ I Naas �'�. U % V r't �,:��• r .� .i`i'C %� �-% i l is . �``�'j :z g r
Dane of Previous Approval
;~`� L.�, ii:�. / } f ✓� ! Town c ,�:,;r1 f! llll••y�'. /a 4'i 11
�r
Mmmas Address
l; Date •Subdivision Annroved �/ % `� ors
A-" .Gr,vr _� Fee Enclosed.�1 Amrnmt
1 ;! . r' P -" f i � (,f:'
1" B hPe Lot Area FD! Section Ody ti Depth' votlste �r`J
Nmbfr.of Bedrooms Deslp Flow G P D y ' PCHD Nottlicadon 4 lftegahed When Fill Is aontyleted
Smparate Senses$. sptata °to consist of ��: Gallon Septic Tank end i r' • /
To be-constsacted by Adler
Water supply.--- ` pstbl{c Supply Etas Address
Supply Dried by _Address
/771 / / 77 f..
Other Requirements • o i , T i , / l �,! /. i . 'r? % / / / %
1 rf resent -that 1 am wholly and com I* at re / ' - -
P Y D Y fponsibb for the design and location of the proposed cyst ) �[� lit pasts sewage disposal system
above described will be constructed as shown on the approved amendment there to and in accordance wi reou sons o — e - nam- - -
- - -. - - -- - - County Department -of - Heeith,-and.that on-completion-thereof a- TTCortif-"to of Construction Corn isfac Commissioner of Healthwill
be submitted to the Department, and a. written guarantee will be furnished the owner, his succe 01 ns td o ildfr, that said builder will
place in gn. operating condition any .part of said sewage disposal system during the period of o y 1 lowing thedate of the issu-
once of the approval of the Certificate of Construction.- Compliance of the original system or an If t rilled well described above
will be located as shown on the approved plan and that said well will be installed - -in accordance with nda a Ons of the Putnam
County Department Of Health. "' ; ;•
Date Signed
P.E. R.A.
y
Address
Icons* No
APPROVED FOR CONSTRUCTION: Tnis approval expires 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 necessary by the Commissioner of Health. Any change or alteration of construction
raquires a new permit. Approved for disposal of domestic sanitary sewage, and /or. private., water.. supply only.
Rev.
! '
10/88 Date By
r, Title
4.
DE'PAifl:MENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
Q�. �V 6
APPLICATION TO CONSTRUCT A WATER WELL'
PCHD PERMIT
WELL LOCATION
Street Addr ss / Town Village City ' Tax Grid dumber
�.W / � /' .�� OV) its '1 f �•3Qrr> Y �'��� — 6 3 - 6
WELL OWNER
Name' c'%
r. // i {' .rjs' =o%
Mailing Address f JkPrivate
c if , JJ1G' ' Ali .Srf�G6 �. %�fi7HG O Public
USE OF WELL
1 - primaryj
2 - secoriddry '' '
RESIDENTIAL
�` ® BUSINESS
INDUSTRIAL
O PUBLIC SUPPLY Q AIR[_dOND /HEAT PUMA' J ® ABANDONED
O FARM 0 TEST /OBSERVATION ❑ OTHER (specify
0 INSTI��JTIONA,� ; 0 TAND -BY. ®.
AMOUNT OF USE
YIELD SOU6HT j1 gpm /46 PEOPLE SERVED /EST. OF DAILY USAGE /4 gal
0 REPLACE EXISTING SUPPLY ❑ TEST/ OBSERVATION 13. ADDITIONAL SUPPLY
WNEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
WELL TYPE
DRILLED
®DRIVEN
[]DUG
®GRAVEL
®OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No. G
WATER WELL CONTRACTOR: Name /!>' �r�y,ciSUi% Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES dam` NO
NAME OF,PUBLIC WATER SUPPLY: -- TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
ON SEPARATE SHEET
d
a e)
a ,
(signature)
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted.under the provisions
of Subpart 5 -2 of Part 5 of the New York State Sanitary Code', and provided that within
thirty (30) days of the completion of water well construction, the applicant shall:
1. Pump the well until the water is clear.
2. Disinfect the well in accordance with the requirements of the Putnam County Health
Department attached to this permit.
3. Submit a Well Completion Report on a form provided by the Putnam County Health Department.
During all well drilling operations, the applicant shall take appropriate action to assure that
any and all water or waste products from such well drilling operations be contained on this
property and in such a.manner as not to degrade or otherwise contaminate surface or groundwater.
Date of Issue / 1
� 9
Date of Expiration 19 / Permit Issuirg.-Official
Permit is Non - Transferrable
White copy:
HD File
Pink copy: Owner
3/89
Yellow copy:
Bldg. Insp', -.;
Orange copy: Well Driller
Coe
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PREPARED BY
JAMES W. SEWALL COMPANY
147 CENTER STREET , OLD TOWN. MAINE
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COUNTT LINE
TOWN LINE
VILLAGE LINE
BLOCK LIMIT
PROPERTY LINE
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REVISIONS SPE(
FOR ASSESSMENT PURPOSES ONLY
°
NOT TO BE USED FOR CONVEYANCES
PREPARED BY
JAMES W. SEWALL COMPANY
147 CENTER STREET , OLD TOWN. MAINE
L
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COUNTT LINE
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I
::MARIANNE 8. OINATALE
Mateo Public, State of New Yo* ;
No. 0115020567 ;
Quatifiad in Westchester' Cpunt�yy
%MMAS:on ray.res Nov. 22 ,199
I�
--'r- x�-- -^--'- .T rr-�- ;-: ---�- fir,- -= -' - . .,.-- �-- c- �^� -^'� -, - <• -,--. .. - - -- - T - - �--� -- __ ._ ._..- _. _ ..
r vj P1TMM CODM'Y DEPARMIMIN OF SBA M
Dhbka d Howbenseatd HeoNb SWVkoo Coalael, N.Y. 10512 to PrVryWe Pea s111
w CBR1fF[CATS 0 M ICE
Mdbs Adilressi St -5
Tlaf -a 0iikd4A7ic4nn AninrnvPd % P 9 Z _-rule_ 3
Pgs'le r
gore
TM MW 4 :& d 3 W 1,e(
Renewal —.O Reviden o
Dote of Pr+evim Approval j
Town�7� /cuf'�9yy�T
?AA
BWMbi� Lot Area• `+ J "v' in SecHort Oeb Depth J Salome tJ
Naanbee d RO&O M IL8 Deaf Flow G P D ('� !% PCHD NotlDeat{on Is Required Wbea FM Is competed
Separate SoweeaRe System to c"Wilt d r` LGAU- Sepdc Tout god � � U e v r �� ' •✓ !•!� io'�'
To be aeatebctad by Ad&vn
Pic S Fros Addrear
pr®gd by
1 r"presanC.that 1 am wholly and,con{�ately r pontibls for the deiign' and location of the proposed ryrtam(s)i 1) that the separate few dis cal • stem
above described will be constructed .if shown on the approved amendment there to and In accordance with the standards, rules a regu ns o nom
County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commisstoner of .H"althwlll
be submitted to the Oepartm"nt; and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said bulkier will
Plata in good operating .condition jany part of saw sewage disposal system during the period of two (2) years immediately following the "to of the Issu-
once of the approval of the Certificate of Construction Compliance of the original system or sny repair$ thereto; 2) that the drilled well'"Scribed above
wNl a Ibtat"d "s shown on the apprand plan and that said well will be Ins Ad-W accordance ith the andard r Is and rpu Mon$ ' of the Putnam
County Depaartmentt of NMIth.I
oat" . n"d P. E. R.A.
� Addi"ss
Y Y, License No
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 necessary by the Commissioner of Health. Any change or alteration of construction
require a "w permit.; Approved for disposal of domestic sanitary sewage, aa _ w9r"D,eDW only
ReV • oat" By Title
.LV[00