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Home My WebLink About2492DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51. -1 -51 BOX 21 loom 6;Lj ! �, ,` 116 mr i , lon 02492 iii) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AP PICA please print or type ,P,,ck6 Permit # Well Location Street Address: Town/Village :� Tax Map # U S C Ate' *x./ i4 LA Map 1. Bloc Lot(s) / Well Owner: Name: Address: Phone #: �, i✓E wf J ok.,r 5A-t t' S�r,z� Use of Well: Residential _Public Supply Aidcond /heat pump _irrigation 1- Primary Business Farm Test/monitoring _Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield Sought pm # People Served Est. of Daily usage gal., Replace Existing Supply Test/Observation Additional Supply Reason for Drilling New Supply (new dwelling) ___L_ Deepen Existing Well Detailed Reason► -. - -- �_____� _ for Drilling Well Type Drilled Driven Gravel Other Is well site - subject to flooding? ....................................................... ............................... Yes _ No iswell located in a realty subdivision? .................... ............................... ................... Yes' ' No: Name of subdivision Lot No. NR. .'.i Water Well Contractor: 6lltt$► -- p,4-- fkjqj�%;�j C�,_ Address: Is Public Water Supply available on site ? ....................... Yes ,v No :. Name of Public Water Supply: Town/Village Distance to property from nearest water main:_ -- x z•�7= �s - -�: - Proposed well location & sources of contamination to be provided on separate sheet/plan. �„� C--c Date:_ - , Applicant Signature:_ �c �! ..- ✓t ..y N PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form•provided by the Putnam County Health Department. 4Y The welt: duller:.- shall;abrde:byiallcondo asf th:jzefrnit�5) During alell dr:.illrgoperatrpn$ thewell;drrll.twshall take appropriate action to assure that any and all water and 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. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam C,bunty. Date of Issue i Permit Issuing Official: '` Date of Expiration Title: V: 1(/ 4-` Permit is Non - Transferable 1 White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Rev.. 3106 e a _. YML ENVIRONMENTAL SERVICES 321 -Keay Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovani, Director LAB #: 1.800360 CLIENT #: 60597 NON STAT PROC PAGE: 1 of 1 SUKUP, EDWARD DATE /TIME TAKEN: 01/25/08 07:00 PO BOX 543 DATE /TIME REC'D: 01/25/08 09:00 PUTNAM VALLEY, NY 10579 REPORT DATE: 01/28/08 PHONE: (845) -526 -3605 SAMPLING SITE: 646 OSCAWANA LAKE RD, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE TREATED PRESERVATIVES: NONE COLD BY: ED SUKUP TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF N N N N N N N N N N N N N N N N N N N N -------------- N N N N N --- N N N N N N N N N N N N N N N N N N N N N N N N N -------- DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 01/25/08 MF T. COLIFORM ABSENT /100 ML ABSENT SM 18 -20 9222B COMMENTS: MFTC THESE RESULTS INDICATE THAT THE WATER (WAS) (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDI HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. SUBMITTED BY: Albert H Padovani, M,T.(ASCP) Director �a W 0 N ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES z Ii�F'ernitr` >�uh xxaam.•.x.twswxa..n.. r�:.4 WELL COMPLETION REPORT Well Location Street TownNillage: Tax Map # R's GAddress: f �SCU r't! ` ' 70 rAh0 a/� Map Block Lot(s) qljf, Well Owner: Name: Addf ess: A � � d iv� Use of Well: esidential _Public Supply Air cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring —Other(specify) 2- Secondary Institutional Standby Drilling Equipment ��Industrial 4to�� tary _Cable percussion _Compressed air percussion Other(specify) V-,' a.d.rd / Well Type Screened _Open end casing i Open hole in bedrock Other Total Length ft. Materials: Steel Plastic Other Joints: Welded Threaded Other Casing Details Length below grade _ft. Seal: Cement grout Bentonite Other l� GQ Diameter in. Weight per foot _lb/ft Drive shoe: Yes _ No Liner: _Yes No Diameter in Slot, Size Length ft Dept to Screen ft Develo ed? Screen Details First R I _Yes No Hours Second I Well Yield Test _Bailed Pumped ("Compressed Air Hours) Yield SU gpm Depth Date Measure from an su ace -static spec) ft During yie test ept of completed well In ft. Well Log Depth From Surface Well Diameter If more detailed Water Bearing in Formation Description ft. ft. information Land Surface e cl r % ww, I DD descriptions or -.. _ . aa-� sieve analyses are available, please attach. If yield was tested Feet f449Aq.Pq Minute Pump/Storage Tank Information ge. UQ Ls Pump Type , kwrsr • Capacity JD at different depths during drilling Depth Model i 01S D 1 list: Voltage s HP_U_t Tank Type Volume N G1M" fik, k.. Date,WeiiICd* pleted 'w. F'kVVk t Cpr. ..` .. .x 3 ^'r :4x4 W"x 'LY. , 111'R7 M1fY'u 41�,1� WeCll Driller FSC Certificate # r o �i NY�State # � p � / � Date of Re ortu ....+F4r."%k/ ka5 .' R� '�,�ry, :A x3£..� T: }.+I 1 x!. R i xfx`:b',y+K. �^�eb: �'c 'r^t:C 'lil r* 4i�1�; •.JIY �I + 7 +iik t��tv. t, , 'i. ' S.x S x Cat { saX 'x+,v� d _ a,�x'� r -,.F 4s .r •+ S�`,. xl ,� �n �, , /,� Purnp`YnstalleiPC Eertiflcate #.I�;:: !�!`NYState #� � tWel DrjIle,1 Name 8 WIi? dk 1, Elf { { D ,� P�i2 '�. f .d Perri ` InstallerkNane` &yAddress.� ° s Ai °`4'v t \ur�"� Pu'm Installe�x s nature\ 1 . p� �U, NOTE: Exact Location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3106 ��o o98N�7aa190 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO (;ONS7kUCT'A WATEft'WELL p lease print or tYP a W44 Nt Well Location Street Address: Town/Village• P, V Tax Map # 1-A-K �^ Map ^gym Bloc Lots) Well Owner: Name: Address: Phone #: L4� .Svk-,.,O Use of Well: Residential ^Public Supply Air /cond /heat pump Irrigation 1- Primary Business Farm Test/monitoring — Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily usage gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drilling New Supply (new dwelling) �_ Deepen Existing Well Detailed Reason LIP L1 to for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes _ No Is well located in a realty subdivision? ........................................... ............................... Yes _ No Name of subdivision Lot No. Water Well Contractor: Al AM 4V &.-►Sh)taL , Address: Is Public Water Supply available on site? ....................................... ............................... Yes —NO Name of Public Water Supply: Town/Village Distance to property from nearest water main: l) 1 4 well location & sources of contamination to be provided on separate sheet/plan. ,Proposed Date: r Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and 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 or their designated representative 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. 3) Submit a Well Completion Report on a form provided by the Putnam Countv Health Department. take appropriate action to assure that any and all water and 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. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by.the Commissioner of Health. Any revision or alt ration of the ap roved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam unty. Date of Issue In —1 q-01 Permit Iss Date of Expiration 0 Title: Permit is Non - Transferable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owifer; Orange copy - Well driller Form WP -97 Rev. 3/06 Kra A 7'A ll, IV isic CER Tific ATE,�, CONSTRUCTION tl .4 �X'N st' ' ibuilt- bY.: �Cjq O'si st I ri%. 10, S Other,_';requirehlents.�� Water Supply -,'-��r'Zl "Public ,' upp y Froi 7777777�7 h. ti58 Control Been ,CorfipiiDted?,,�-'—' nd in 5pr ance Address',_�, 8iiC6iIyin'g,,p,remises - �,sery . ed J'b'y-,Ahe�al wtl:,.,iiin',r;.I.irl�.m:lc�i't,'h.,,�'iis'a,d,a,"-, -4�.in4n,`w- In A� 'J Z, HEALTH .7, _E E w Block e, D Date Permit A iitidd j" A i)diiri- the $l6hs'of,'the completed work (copies oi)which are ",q by _q, l Putnam County Department of Health K, N, M-Nit` 'Flo" License Nq nay be rliiil,�iijh . &Vbldi's 1; oon as a -!p I ubllic46hiiy *•sewer 6eo6inei",. water pply becomes available ,. ,S"u,Ct'i, approvals -are M ti fific ailo n-or change "Is,necessary Title z AC-tPRVAIPER 00ail DETERGENTSppm� NITRATES (as N :p � , �JRON,Z :n So X v e/7 IAM VA Z_ wner. or ..urchasera .o u Iding Cons ruZted by Sgotl on il,4AIA 1,olee- ;9�b . CV Location - Street Mock �.4i✓CAJ WuMdlng Type r RE GUARANTY OF SEPARATE SEWAGE 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 guaranty to the owner, his succes- sops, 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 initial use of the sewage disposal system, or any repairs :Wade by me to such system, except where the failure to operate properly is caused by the willful or negligent. act of the ocou- pant of the building utilizing the system. The undersigtzdd further agrees to accept as conclusive the do- termination of the Director of the Division of Environmental Health Ser- vices 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 th® acaupan-t- of t-he -`bui- ldi-ng_.uti.l i,zing _.the eyst m. Dated this �'t��- day of � 1971� Signature - Title (If c c or oration, "Me name and address) - - - - - - - - - - - - - - - - THREE (3) COPIES ARE RZ4UIRED WITH THniE (3) COPIES OF FINAL PLANS. BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED.. GUARANTQR T5, E Q VILE OTIU, OF DATE QF FIRST USE OF SYSTEK. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Division of Environmental Health Services, Putnam County Department of .Health �K RUN., ON. L L 19 I Nr DE H D ON OF - C.0 u, 090NMENTAL HEALTH SEW % REVlS,1bNs:,. .77 14 k, 'AA Jd V :P "401 Gi''* 14 Wu 1, NEER 1, Y "I M SOW AWl-to STA MJ UTN A -T P D* Y of Vito IV ision CONSTRUCTION "PERMIT -FQ9 ' SWAGE `DISPOSAL SYSI rt "BUiming'Ti"PO - Lot Area m's" _', Sy i Design 'Flow R Seiiiiate Sewerije stem o consist of: 0; To be !conftraieo'-i S 'Supply : From _Water Supply Pub iic, � ;V_, Private -.Supply' to .be-drilled by ,;Address. z 2 6ihir. Re4_dli I represen6liat ItbW wholly ,and comple t ely responsible for,the design a abo've ' described' will ,,bedcon r t - - amending Courty Department 'of 4"Ith, indthafon com ple ion thereof i%,1Cei be submitted -baia�ril ra n t, and . a' written, _iU ;,place_ 'in good. 60eiaiing'cbriclition any par, of -_said sewage disposal the approval of'thi:Ceftificate of Construction Compliance �,";-will,'be located,as,show o I n n.the approved plan . arid tWit said well will be i tm eni_o4 Health. M., Date Signede b . Address -APPROVED FOR'CONSTRUCTIOW This approval iixpiriii a year cause or-ma --_bia-:4�46cie�` 6i�m difi y 9 he eKe i St a Approved, for 6!sRosa Y. Date R-- CT, 60t, f, I."', tills accord. MAhle :date wage -t y to th ' ommissloner-ftAl? . althwil s n y 1h e der that se i er w II o - I telyifoll t f the Issu, v, 2 rs mm i..epaIr.i!th4e0;- t he 'r I ribed above �e 0 Putnam, stand 4d S-'.�!U he P.E.' R..A. License e ion, of the building change has been undertaken. and IS ealth Any eration of construction _ ge,or, alteration ply ,:only Title -- 77, 751 — . . 11 ..v I . —, Z. 7 Town or, Village _1_f"ax Block ,- . . . . . . . . Lo t Job ti Addiess 17 F js puare. ee t Septic Tank, r t re s V. A, A Aa 7 '04 K f tills accord. MAhle :date wage -t y to th ' ommissloner-ftAl? . althwil s n y 1h e der that se i er w II o - I telyifoll t f the Issu, v, 2 rs mm i..epaIr.i!th4e0;- t he 'r I ribed above �e 0 Putnam, stand 4d S-'.�!U he P.E.' R..A. License e ion, of the building change has been undertaken. and IS ealth Any eration of construction _ ge,or, alteration ply ,:only Title -- 77, 751 — . . 11 ..v I . —, W PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date :r0NjC_ 8 19'1(p Re: Property of MR. Located at �h,kj& 1 AIG_= i Section Ti j 33 Block 2- Lot Gentlemen: This letter is to authorize C hi A. 1.6ALX ^Lb,� '?,16. — 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 pro- visions of Article 145 or 147, Education Law, the Public Iiealth Law, and the Putnam County Sanitary Code.= Very truly yours, Signed Owner of Property Address 1-t111�i;fd- y Countersigned: P.Ee, R*Ao, # Address "'- AFC SS i ijci Q� ;' Ci 14 - ?-ZS- - 95�' Telephone Telephone . i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner \{t/ `vi7iL�1� Address 05GL\W9*J 1,410 P_00�0 Located at (Street Sec. 'bA Block Z Lot 6dicate neares cross s ree Municipality'_P \ VALCi-_ -y Watershed 14'q.C. SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION apse Depth to Water a er ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 13- to -- Z°ys 5 25 � 2 5 IS - '622 1 24;' 21" 3 3:22- - 337_ to 21 �,: i'' 10 534Z - 352 10 7_7� 201 1 3 4 Notes: 1) Te' :ts 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. _ ,M I TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DtPTH HOLE NO. I HOLE NO. 2. HOLE NO. 3 611. 1211 or IL 7i 18" M lAA&I\ 2411 3011 CLAY 361f �v 4211 4811 5411 6011 66" 7211 78 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED, TESTS MADE BY - ; y. Date `jt �, tq'11, DESIGN a�zl Rate Used - -110 Ydn/l Dro ' S. D. Usable Area ProvidecT No. of Bedrooms 3 Septic Tank Capacity R00 'Gals. Type ;5 Absorption Area Provided By SbO L.F.x2411 36 width trenc . Other .� � crier w . a, � .� _ . e _ • a lvame GEE42GF— /&_ i.,�a�- �t�i.�� Signature �br �e�Feu�►,,.. Address` s 5Z SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked 7y, `�.aF� "R��'''¢ %te S t t �, S ;� � , ypF 4�.��',� y�. •dnl '� Z t 4 - , � a �„e 1 " t ( 1t S F R }. � k 'Y s .%r 8 • �I (��' �'x,F � ny,1 �, 4 T�+ x�o A �. •, W 'to i u 1' x i s r_>•e . "f � y i �' fiL i.31tk A ' "WT Ni �,Y . tip+ t a 1 '+ _ a � y � 1-.�? ]r '{' .Z "%�• , a}Y "t., *Ae. 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