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BOX 22
02570
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02570
JOSEPH F. SULLIVAN, P.E.
Ifon,"ItLagEnginzet
2972 FERNCREST DRIVE
W'-N-- -FiE. 16HTS, N. 10598 , .......
(914) 962.4248
September 14, 1989
Putnam Co3anty Department of Health
TIO Old Route 6
Carmel N.Y. 10512
Gen t-1 em en . V
Enclosed please fiiid p1ams and application forms for a
praposed - sewage disposal system for Mr. and Mrs Huzar's lot on
Osaawana Heights Road in the town of Putnam Valley(35-2-7.14)
Lbt No 4 Joseph. Yadgoroff Subdivisii m)
This system was approved for Trident Land Developement
Corporation iin 1987.
There have been no changes made in this lot or surround-
j-tg lots to adversely affect the location of the proposed
--.---------,---vellor�e-this----propased,-sewage-,d.:L,sposal--system.-__.--_.,
V6ry truly yours
ose h F. Sullivan P. E.
Y
PUTNAM COUNTY DEPARTMENT OF HEALTH
r
'HEALTH SERVICES
Date
Re : Property of d eae /i a t-,
Located at 4:�SC�#,7,-OW 0,
Section Block Lot -
Subdivision of e���. /U
v /
Subdv. Lot iled 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
r o. ®._.._�Qx�._.w_, __.hi�a_ mstaer.. and to..a upervise ;...the...,constructi:on .of .said:.
system or systems in conformity with the provisions of Article 145 or
1479 Education Law, the Public Health Iraw, and the Putnam County Sani-
tary Code.
P.E.,
i
Telephone
s
e� yo
Very truly - yours',
e_
Signed
Owner of Proper%y
Address
Town
Telephone
DEPARTMENT OF HEALTH
- -- Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
ry: _ . . APPLICATION, TO . -A „,WATER .WELL. :.
PCHD PERMIT #�'.
WELL LOCATION
Street Address
own Vil age City Tax
Grid Number
WELL OWNER
e Mailing Address � . i �
/ ® �/o� �� c. �r� ✓e- ✓� '�'
QPfivate
0 Public
USE OF WELL
1 - primary
2- secondary
RESIDENTIAL
0 BUSINESS
O INDUSTRIAL
❑PUBLIC SUPPLY ❑AIR /COND /HEAT PUMP
0 FARM O TEST /OBSERVATION
b INSTITUTIONAL 0 STAND -BY
❑ABANDONED
0 OTHER (specify
O
AMOUNT OF USE
YIELD SOUGHT
,jam gpm /�� PEOPLE SERVED -�t' /EST. OF
DAILY USAGE Y'06 gal
REASON FOR
DRILLING
12VEW SUPPLY O PROVIDE ADDITIONAL SUPPLY
[]REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL
O TEST /OBSERVATION
DETAILED
REASON FOR
DRILLING .
WELL TYPE
ODRILLED
13DRIVEN
E]DUG
®GRAVEL
®
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: - /Ir-
/f Lot Ko.
WATER WELL CONTRACTOR: Name or. -Mcb7 Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES W.' NO
NAME OF PUBLIC WATER SUPPLY: '-”' TOWN /VIL /CITY
DISTANCE TOE PROPERTY .FROM NEAREST WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
O ON REAR OF THIS APPLICATION BbN SEPARATE SHEET
(dat„�.Plge
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 s.hall:
l.. 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: 0 X 19 c��1 ��
Date of Expiration: d-1 19 'Permit -Issuing fficia
Permit is Non - Transferrable White copy: H.D. File
Yellow copy: Building Inspector
2/87 Pink Copy: Owner
Orange copy: Well Driller
B
CC__T!_ C� 7'- UA— 0 EILUI - OWITSI�! OF r- IG-7qCL fi -T �.�L�ri 5� ��!
LD?Ti -7UL WATER SUPPLY & SUESUr.F C Sr:P= DISP U SYS=
r, wr n a r
RE-,=i S: T - CCNSIK=1CN PEPMIT
it
•(,� EY
DCC'Y'="fI'S
P =_r ai_t R�pclicsticn
Cor- --cra Hesclutica
Plans - Trr=e sai-- s /'s
EiCi ^_C°''3 t'11.IL'10r? 2. =_i.? Cn
Desicn Data Sheet ( 'CS) S
�rDiY_S =CLi
De=: acle Lcg _
-rc
C:r,cista ^.t P_rc Re_•ul== (4) 1 7z-.1
Para Dole Deoth I c-
r._m s —
to
1002Z E=.
_
F= SYSTEMS
Cl aVCcrri_
l0 f
note=
new sz --.
C°_riLR ca Ces
1.0 Vr. flced e1c7.
t. reservci =, etc.
t =-tail =al
fic =e Plate -7 T�;O S= —=
Well WO, �e_riLi- r1:
va= -Lance F.wUcS t
C-=-- - c r
LSi. Pncrcva_
T- L ..: ecka�a
j We__a (Tc-,-, /DEO Ps —__ R & J)
Data cri [)C-(z Plans & ps=i t -
I I I S�.Yac- S st✓T � Irdr-�.iL_c P_.;__e - 0 _-;__;
:cur_ I I I Fi11 Profile & Di-re._c_cns - 4;,1=
I D cr J _ _ = ce
i I t_c Tar!:K - S:a=, re _
We_'! j,`e+--= i l , Se: liC-= Li e if chi.^_
Ccr st_ru&icn Notes (Cr =nd r ra te)
_ (
A-
d
--p r`G . =
I I i Twc -Fczt Ccn`Curs Exi_tiac & Pic ccs=,;V - -
i 1 Dri,;egv & Sloces CcL
I I I Foot= nc/Gatttar,Carta; Dr ins
arec.{
I I i Perc & Deed Holes
Reoresa^.=- Ve cf prim�r1 a_rd er -ansi cri
I Ex-a IIsiCa f.la ,suf_. si_^.E
I ( If PIm n --,; Pit & D Ecx Shcvm & Det ile^_
I ( I House - No. of Eedror_=
Wells & S DS' s W/i ,. 200 Lt. of
& &^,unds
I I I Hcu=� Se k. Necessar,i (Tight. lct)
I I ► Houce Saver - 1/411/f --. 4"0; �rze dip e
I I j NO ac= ; Mc.Y. Ee_ncds C] W/ C__r..cut
S2M RA-L C-N. DISTANME S Sr =..T ^ =- Cat PT.]Tj
Field--
10' to P.L., Dricc.Yav, L=rae T= es,TcD of i
I ( 20' to Foundation Walls
f i 100' to We-11; 2001 in D.L.O.D, 1 =0' Pit-
1.00' to Stream, jtia. ` nrCJlL =e, Lc{ ( inc. E`t:
II I 15' to Drains = fir = R, Ire. dar, F-- ct'_!lc
I I� 35'tC C.._'tC1 _ °iII,S�C??%^�c�R,O1C� SNGt =T•C�
10' to avatar Line (pit = -201 )
I I I 50' inta-r rut -te_nt Arai: =ce cc•� -s=
I I I Sectcc Tank.
10' r_an Foundt_cn; 50' to
o
1z. + to P ',ve? 1 L
PUTNAM COUNTY DEPARTMENT OF HEALTH
DESIGN DATA SHEEP- SUBSUFACE SEWAGE DISPOSAL SYSTEM
FILE NO.
��i L!1�I1 �i
%�.
Owner r'i Address
✓�i
Located at (Street)
Sec. 36 Block
� Lot
(indices .nearest cross street)
/ O
Municipality u
Watershed
SOIL :PERCOLATION TEST DATA RDQUnM TO BE SUBMITTED WITH APPLICATIONS
Date of Pre- Soaking a Lo( Date of Percolation Test 7 �s
SOLE
NU BER CLOCK TIME PERCOLATION
PERCOLATION
Run Elapse Depth to Water Frcm
Water Level
No. Time Ground Surface
In Inches
Soil Rate
Start -Stop Min. Start Stop
Drop In
Min /In Drop
Inches Inches
..Inches
v
a o-r
T)y
4
5
92,19 �ID 7W
2
vin' s_
_- vry
NOME'S: 1. Tests to be repeated' at same depth until; approximately equal soil rates
are obtained at each percolation test hole. All data to'be submitt>d .
for review.
2. Depth measurements to be made from top of hole.
rev. 9/85
DEPTH
G.L.' :.
1'
2'
3'
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH
DESCRIPTION OF
HOLE NO.. HOLE NO. HOLE, NO.
IF
9'
10'
11°
12'
13'
14'
AfiE, LEVF ,::AT MUC�i -C 2C?UD1 iATER - - -IS - ENCOUNTERED:._;_
INDICATE..LEVEL TO WHICH WATER LEVEL RISES AFTER. BEING ENCOUNTERED°
DEEP HOLE OBSERVATIONS MADE BY: a y%'J DATE: 7/ �7
DESIGN
Soil Rate Used % Min /1" Drop: S.D. Usable Area Provided e O
No. of Bedrooms Septic Tank Capacity -
gals. Type /%r-;0;0n ®-q'
Absorption Area Provided By L.F. x 24" width trench
Other r c;//
Name So � � Signa
Address ?i Z e✓ C �/ 6� 4 ,mode S
4/X )�-.
THIS SPACE FOR USE BY HEALTH DEPART ONLY:
Soil Rate Approved sq.ft /gal. Checked by Date
1 .
• PUTNAM COUNTY DEPARTMENT OF HEALTH . ENGINEER IC PROVIDE PERMIT #
ON CERTIFICATE .�F C MP I/�NCE.
�'I : Division of Environmental Health Services, Carmel, N. Y. 10512 P;gr �*� „_� ¢,/_
122
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM `'
Town or Village 7 ,r
Located at F���/ a I' °" Tax Map 3� clock Z, lot ( , 1 `�'
Subdivision y)� ��
owner /Address �/ / "��1 //6/yl - )111 Al Date Of Previous Approval
Building Type G�0 Lot Area _mow, `a Fill Section Only ❑
Number of Bedrooms Design Plow G /P /DS �d P.C. H. D. Notification Required
Separate Sewerage System to consist of / Gal. Septic Tank and .37--5 � o Z4 "wide
To be constructed by
IF Address
Water Supply: Ppplic Supply From
t/Private Supply to be drilled by
Address
Other Requirements
'r J:.. C'�/ 'n ,021 iI?
I 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 amen "lie_re_ to,ind in accordance with the standards, rules an regulations 07 e u nam
County Department of Health, and that on completion thereo �@ ,��er ificaleit6bf4Cpnstruction Compliance" satisfactory to the Commissioner of Healthwill
be submitted to the Department, and a written guarantee 46 g. his successors, heirs or assigns by the builder, that said builder will
place in good operating condition any part of said sewa dis�o'salJ �Fq g. ainnet�e period of two (2) years Immediately following the date of the issu-
ance of the approval of the Certifi ;ate of Construction omgl�ice of the oF`�g1nal stem or any repairs thereto; 2) that the drilled well described above
will be located as shown on the approved plan and that said &Al **e installed in ra *o 11 ce with the st nd s, rules and regu a ions of.' the Putnam
County Department f Health,,
Date F-- —'
Address
APPROVED FOR CONSTRUCTION: is approval expires
revocable for cause or may be amend or modified when cc
requires a new permit. A ed for disposal of domesti
Date J� By j
i
a P.E. _w —IlC R.SA.
a� L • License No
ued u s construction of the building has been undertaken and is
Co iss'o er of Ith. Any change or alteration of construction
r a d r Jpoy only.
Title �'L
Bunaing Type 1 ?e>,o;a ew C a' Lat Area �3 � �, ' Fm Section
�y Depth volume
Number of Bedrooms 4- Desip Flow G P D� ZV41 PCDD Notfilmdon Is Required When FAD �Is completed
Separate Sewerage System to consist of -6—��Ga . Septic Tank and 6`� f�
To be constructed by Address
Water Supply: Pdbllc Supply From I Address
or:— Private Supply Drilled by p' Ada
Other Requirements r L4:21:f
I represent that 1 am wholly and completely responsible for the design ;and location of the
above described will be constructed as shown on the approved amendment there to and in a
County Department of Health, and that on completion thereof a "Ci)rtificate of Constn
be submitted to the Department, and a written guarantee will be'furnished the owner
place in good operating condition any part of said sewage disposal system during th
ante of the approval of the Certificate of Construction Compliance of the original s
° will be located as shown on the approved plan and that said well will be in ailed in actor
County D® ment of Health.
Oats _ . _ ��7 / �• �'�./ /v7 /1!�r k� 1`i.
of
1) that the separate sewage disposal system
j�l�ards, rules an regulations o e u nsm
Iioactory to the Commissioner of Healthwilt
,.fl ••iPns by the builder, that said builder will
im edlately following thetlate of the iasu.
r to;' ) that the drilled well described above
dE ru s and regu a� ons of the Putnam
P.E. °
R.A.
- - - -� c+ License No
APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued O!t V f tho building has been undertaken and is
revocable for cause.or may be amended or modified when conssd necessary by the Commissi h. . Any Change or alteration of Construction
requires a w ermi Approved for disposal of domestic ni y. se�w/a�ge� d rivals water supply only.
87 Date T�� / BY 'J „'r /���r Title
°a
Si
i
1
p�
n\`�l
�7
OW/7 r r
PUMAM CORN Irt DEPARTMENT OP EWALTH
DlvMm of De2M Services. Carmel. N.Y 10512 �bew to Provide Pwmlt p
—
on CERTIFICX-7-77b
✓ 2
NSTRIICTION PERM FOR SEWAGE DISPOSAL SYSTEM �-' / 0
11
Pet�lt p
Lacated at t� a /7 G?
/�/�. /JrOB �
nbge X00,
wn '
own ar
,,��//''
Subdivision Name �y 471al-e P—
d. Lot p Ta: Map
S� Block r °t
% �/
Renewal_
❑ Revleton ❑ / _4 rlo! � 1 hf'n +��
Owner /Applicant Name / c/ G%
°�'
elo
/', a�/.�r�i'�
�j Date of Previous Approval 1,9017
Malling Address / . CY l,v
e, o�i'10' L " Town
Zip
%,
Bunaing Type 1 ?e>,o;a ew C a' Lat Area �3 � �, ' Fm Section
�y Depth volume
Number of Bedrooms 4- Desip Flow G P D� ZV41 PCDD Notfilmdon Is Required When FAD �Is completed
Separate Sewerage System to consist of -6—��Ga . Septic Tank and 6`� f�
To be constructed by Address
Water Supply: Pdbllc Supply From I Address
or:— Private Supply Drilled by p' Ada
Other Requirements r L4:21:f
I represent that 1 am wholly and completely responsible for the design ;and location of the
above described will be constructed as shown on the approved amendment there to and in a
County Department of Health, and that on completion thereof a "Ci)rtificate of Constn
be submitted to the Department, and a written guarantee will be'furnished the owner
place in good operating condition any part of said sewage disposal system during th
ante of the approval of the Certificate of Construction Compliance of the original s
° will be located as shown on the approved plan and that said well will be in ailed in actor
County D® ment of Health.
Oats _ . _ ��7 / �• �'�./ /v7 /1!�r k� 1`i.
of
1) that the separate sewage disposal system
j�l�ards, rules an regulations o e u nsm
Iioactory to the Commissioner of Healthwilt
,.fl ••iPns by the builder, that said builder will
im edlately following thetlate of the iasu.
r to;' ) that the drilled well described above
dE ru s and regu a� ons of the Putnam
P.E. °
R.A.
- - - -� c+ License No
APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued O!t V f tho building has been undertaken and is
revocable for cause.or may be amended or modified when conssd necessary by the Commissi h. . Any Change or alteration of Construction
requires a w ermi Approved for disposal of domestic ni y. se�w/a�ge� d rivals water supply only.
87 Date T�� / BY 'J „'r /���r Title
°a
Si
i
�\,# Rev_ �3/ 86 Division of Enviionmenfal Health Services Carmel N Y 10511EnBloeel to >'rorWe Permit }1 3^
a Y r r r s on CERTIFICATE OF COMPLLANCE
CONSTRUCTION PERMIT FOR AGE DISPOSAL SYSTEM J ti
a } I.ACCitted'Bt a /� " ✓� �• w "i' '`u `�� Tdwn O! VIIIaQe
i " t
x Subdivlslon Name y r �' nbd Lot q Taa Map tBtock Z Lot ��
Tv
✓' c .e h t ' ,� ,�> �', ` i 0. { i y s:7 �.'r� u: ;;. -a y y �., ar E ,C r a y 4
>, , °'.` t i .. F.. r � � ; ,,�`�.�,i Jl � h f r� `� rd` ° � Renewal "'�' ❑ � � 1Revl6lon � �/ �,,n r -1 ! a
Owner /Applicant Dame
4 r j Date of Prevlons Approval
`s MaWng Address C t r ss v Town
.,
L 3 !+
BWlding Typeli+ -� Lot Area 3 �� FW Sectlon Onl ; h
r .�. A ••, s `k` ` z Y s D epttiby3` VOlUmti �r -!
' " j� !!r/ , .r 1?CHD NotlBcatlon l Required Wben Fill is completed ,
Namber of Bedroeme ` ' Des FIow:G /P /D i
Separate Sewerage System to coaeist of Gallon SepHc,Taakitud
ti r:
Water SaPp13 _ s `bllc Sapply From f Address ` T { aY
or Private Sapply DrWed by '" C � Addrose g `' ` ` � I
M1 M1 : t G t1..- Y F.'' tt� • � � 'Y f�. '3 Y" �'S'Q,i Y T ,.L � .� C
t 1 Y :;ria i� �7 ` �GJ /i!% -s -•.s'' ��'i'$% �w. 'n' < .F 's ; s g +F -^a. ; t : °i ,'•`s�! W ...r l
a Otber.':Regairement6 . o
1 abre r - 'Se, wage'.-- disp_ ozal„iysCem rn(s) 1) that the sepaae press an regu ao4eaec ga _ standatls, pule e u d E
r
a ,;`• County, Departme nt of '•`'Health 'antl thaC on completron thereof a -. Certlf lcate' of - - p, actory to >.the Comm i wneYaif Nealtry -w111 r
a _
be sutiimtteda.to thegOepartment and a 'wntten guarantee wJ1 Det'urnlshed f' o r assyns bythe�DUllder' that sai0 builder' will yn
Aplacet''in good operat�ng!condltipn� any. part ot'saiq sewage,disposal'syriem rinpenod of " °y s Immediately following the GaYe of the isw -
t _ - - -
anco' bi the approval of'the Cdrfif ate of 6onrirucUOn Compllancelof the- '" i ste _ �Y c -- a 2) that- Ehe`diilled',well tlescrlbed above ,
wJl beiocated:50 ,pawn on the approved plan and that said well will be installed n a" a ar rules -� ku aTfidns f ;4he Putnam ,
t County Depart ant of alth%
4{
� s,: -: APPROVED FOR CONSTRUCTION This- pro ab'expuesrone yeaifromt e,da u, Fil_ s; eaaptsir"(t'Qtvn of ,the Du�idlhg has Deen' undertaken and is 14 ,;�
i
rev- ocatile for -cause orrmay be amendetl::o - �modAled'viheri'corislderod necessary:`tiyirt AAbr f. Ith wAny change Or -n ,o
5 requires acne /y�/,�yerm�t "A proved for ds osal oi3domeriicTSanitary`'sew a ands/ - 5ir1i$Ionly �`� kty ""� /
ti
'. DEPARTMENT OF HEALTH
= Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATLON. TO_ CONSTRJJ .CT-.:A_;:WATER.:WELL.:. ; ..:..: .:.....
PCHD PERMIT #
r
Street Address Town/Village/City Tax Grid Numbc
rWELL LOCATION cy /• S°"--
Y° WELD TYPE : �RILLED DRIVEN ®DUG ®GRAVEL ® OTHER
IS WELL SIT -E SUBJECT:TO FLOODING? YES NO
IF,�WN.LLk;:I$,.,3LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
WATERNWELL CONTRACTOR: Name Gr✓�'%G�rJ �� 13 Address • �� ,i��
I'S PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES d� NO -
s
NAME�OF_,PUBLIC.WATER SUPPLY: TOWN /VIL /CITY
DISTANCE i0:.PROPERTY •FROM NEAREST• WATER -- MAIN: -_ 4;1
LOCATIONSKETCH & SOURCES OF CONTAMINATION PROVIDED
, C)ON REAR OF THIS APPLICATION BOON SEPARATE SHEET
(date)"
-:arz�xr
r PERMIT
al
t f4`
TO CONSTRUCT A WATER WELL
! � wr<
Yi Y
This "permit to construct one water well as set forth above is granted under the
t°prov`ision.s of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and
prdvided, that within thirty (30) days of the completion of water well construction,
the';:,appl i cant shall:
1. Pump the well until the water is clear.
Disinfect the well in accordance with the requirements of the Putnam
�Sf County Health Department attached to this permit.
p p p y the Putnam County
Submit a Well Completion Report on a form provided
Dep tment .
u` {Date of.Issue: 19
sr: Date of .Expi.ration: _-'119 —Permit Issuing Official
v - Permit i.s Non- Transferrable
_ e
,N�zy.8/SS6••
Name `, // yy- Address
rivate
JER
�`G•o>>�h/e /G�
y /�� %��
D Public
YELL
RESIDENTIAL ❑PUBLIC SUPPLY
❑AIR /COND /HEAT PUMP
- ABANDONED
ry
Q BUSINESS 0 FARM
0 TEST /OBSERVATION
❑ OTHER (specify
dary
0 INDUSTRIAL 0 INSTITUTIONAL
0 STAND -BY
)F. USE
'kt
YIELD SOUGHT -. gpm /# PEOPLE
SERVED j'O/EST. OF
DAILY USAGE�rJ� gal
tom. OR
EW SUPPLY ❑PROVIDE ADDITIONAL SUPPLY
®TEST /OBSERVATION
JG
0REPLACE EXISTING SUPPLY 0DEEPEN EXISTING WELL
FOR
Y° WELD TYPE : �RILLED DRIVEN ®DUG ®GRAVEL ® OTHER
IS WELL SIT -E SUBJECT:TO FLOODING? YES NO
IF,�WN.LLk;:I$,.,3LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
WATERNWELL CONTRACTOR: Name Gr✓�'%G�rJ �� 13 Address • �� ,i��
I'S PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES d� NO -
s
NAME�OF_,PUBLIC.WATER SUPPLY: TOWN /VIL /CITY
DISTANCE i0:.PROPERTY •FROM NEAREST• WATER -- MAIN: -_ 4;1
LOCATIONSKETCH & SOURCES OF CONTAMINATION PROVIDED
, C)ON REAR OF THIS APPLICATION BOON SEPARATE SHEET
(date)"
-:arz�xr
r PERMIT
al
t f4`
TO CONSTRUCT A WATER WELL
! � wr<
Yi Y
This "permit to construct one water well as set forth above is granted under the
t°prov`ision.s of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and
prdvided, that within thirty (30) days of the completion of water well construction,
the';:,appl i cant shall:
1. Pump the well until the water is clear.
Disinfect the well in accordance with the requirements of the Putnam
�Sf County Health Department attached to this permit.
p p p y the Putnam County
Submit a Well Completion Report on a form provided
Dep tment .
u` {Date of.Issue: 19
sr: Date of .Expi.ration: _-'119 —Permit Issuing Official
v - Permit i.s Non- Transferrable
_ e
,N�zy.8/SS6••
PUIW M COUNTY. DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
Name of Owner)
COMMENTS I Y
T - CONSTRUCTION PERMIT
.__ _ ... DATE
BY:
iet Location)
No DocUMarrs
Permit Application 3
Corporate Resolution
Plans - Three sets
Engineers Authorization
Design Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results (3)
30" Perc Hole
Other
House Plans - Two sets
If PWS - Letter
Fiance Request
REQUIRED DETAILS ON PLANS
Sewage System Plan
Sewage System Hydraulic Profile - Gravity Flow
°-Fill. Profile & Dimensions.- Volume
D or J Box;Trench /Gallery; Pump pit details
Septic Tank - Size, Detail
Well Detail, Service Line if over
Construction Notes
Design Data
Two -Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footing /Gutter Curtain Drains
Perc & Deep Holes Located
Representative of Sewage & Expansion Area
Expansion Area;shown;gravity f_low,suff. size
If Pumps "Pit &Vn Box Shown & Detailed
House - No. of Bedrooms
Wells & SSDS's w /in 200 ft. of Property Located
Property Metes & Bounds
-'House Setback Necessary (Tight lot)
House Sewer - 1 /4" /ft. 4 "0; Type pipe
No Bends; Max. Bends 45° w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake Unc. expan)
15' to Drains- Curtain,Storm,Leader,Footing
25' to Catch Basin
10' to Water Line (pits -201)
Septic Tanks
10' from Foundation
50' to Well
15' Well to PL
Legal Subdivision
- Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Town /DEC Permit R & D)
Data On DDS Plans & Permit Same
PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS
FIELD INSPECTION.. REPORT
INSP. BY:
(Name of Owner) (Street Location)
INITIAL SITE INSPECTION YES NOI COMMENTS
Wetlands on /or proximate to property ..............
Property lines or corners found ...................
Can estimate house location .......................
Willdriveway need cut ............................
Must trees be removed - note these ................
Deep holes representative of entire SDS area......
Additional deep holes needed..... ...... ....
Sufficient SDS area available considering driveway
cut, house location, separation distances,etc...
Adjacent wells /septics.............................
D.H. - Deep Hole
G.W.- Groundwater
D.H. 1 Lot D.H. 2 Lot D.H. 3 Lot
Depth to G.W. Depth to G. W. Depth to G. W.
Depth to rock Depth to rock Depth to rock
0f
3f
6f
9f
12
Soil Descri.
0 ft.
3 ft.
6 ft.
9 ft.
12 ft. -
0 ft.
3 ft.
6 ft.
9 ft.
Soil Descr:
DATE:
FINAL SITE INSPECTION INSP.BY:
YES
NO
CAS
House SSDS located per approved plan .............
Length of trench measured
Width of trench average
Slope of tile line and trench acceptable.........
Room allowed for expansion trenches ..............
Over 100 ft. fran watercourse ....................
Natural soil not stripped or SDS area
unnecessarly graded........... . .... ........
10 ft. maintained from property line and
20 ft. fran house....... .....................
Distance well to SSDS (ft.).., ............ o ......
Number of bedroans checks ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. fran nearest trench ................
15 ft. of peripheral soil horizontally
from trench ..... ...............................
Boxes properly set........ . .... ................
Could surface runoff from driveway, roads,
ground surface, etc., channel near SDS area....
Does lot drainage appear OK in area of SDS.......
FINAL GRADNG OF SITE.ACCEPTABLE.. ... ...
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services
AFFIDAVIT — CORPORATE OWNER APPLICATION
FOR PERMIT APPLICATION SUBMITTED TO
PUTNAM COUNTY HEALTH DEPARTMENT
TO: Commissioner of Health
In the matter of application for:
*e ei-f)
n - ,
represent that that I am an officer or employee of the corporation and am authorized
to act for
j Llavu� �t��f °P
Me
(Name of Corporation)
having offices at T) I5y RA. V`T1)oni �� ��?, /V,0 )05 r%•
Whose officers are:
President:
Vice — President:
N067 0,W 19ys C►�uRQA AR
ame and Address
Res GN I91M
ame and Address)
Iu5�5
J '
Secretary:_ &S% _DZ-?r0 -b A, C:heRAI? STN 1r,)" Orallty �`? )05?5
- (Name and- °Address)_ _
Treasurer: RZ>,T (bw N14. C,hHh gje rr�1eY
(Name and Address)
and that I am and will be individually responsible for any and all 'acts of the
corporatli:on with respect to the approval requested and all subsequent acts relating
thereto.
Sworn to before me this IZ25 7 - day
OR
Notary Public
PATRICIA ANN UNGER
Notary Public. State of New York
No. 4806887
Qualified in Westchester County
•Term Expires March 30, 1986
8/84
I
t
Signed: ¢�,n.,Q V)
Title:
:):rporate' Seal
0*. �, Cpulo
®F HP�4LTi,
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Dater 7/
Re: Property of /
Located at
(T) &Zmg�
Subdivision of
N
Lot l
Subdv. Lot. Filed Map # Date
Gentlemen:
This letter is to authorize /
a duly licensed professional engineer 4--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
s ice 1 or..- ...._..
....._ _..._ ..s�- s- t-em - --or- system-- -in- eonforr.:-ty- with the �- provi.�i�on�� of .:r -t' c,.. 4.5 - --
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Q` 4 BGp Ff� 4G Q
`�:a.::• re•
Count - n l:: "2%
P. E.
Address
Telephone
Very truly yours,
Signed�_ti.?
Owner of Property
'A n 9 " �� rc-&?d
Address
Town
Telephone Z',�,
P1jr'VA14 1,70b
<`� U' QTY
C' XLEWDERSON
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
March 11, 1987
Joseph F. Sullivan, PE
2972 Ferncrest Drive
Yorktown Heights, NY 10598
RE: Proposed SSDS
Trident Land Develognent Corp.
0scawana Heights Road
(T) Putnam Valley TM 35-2-7.14
Dear Mr. Sullivan:
JOHN SIMMONS, M.D.
Deputy Commissioner
Review of plans and other supporting documents submitted at this time-relative
to the above-captioned project has been canpleted. Comments are offered as
follows:
1. Septic system_ detail shows -.505-LF of 'n-*-�h,'-�-'--pl--&n-s.;--and-a;Dplidat-ion- Call.
. .. ... - for only 500 LF. Revise detail to show 500 LF.
Upon receipt of a submission revised to reflect the above comments, this
applicalVion will be considered further.
Very y yours,
Anne M. Bittner
Asst. Public Health Engineer
APMB:mk � N � 6
1,144
110 OLD ROUTE SIX CENTER - CARMEL, N.Y. 10512 (914) 225-3641
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Approved as noted for conformance wi'l
'e't -.r a de applicable Rules and Regulations of tt
Putn fiounty Health Department.
am
— Tt-4",
Signature &Title
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