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Home My WebLink About2618DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 52. -3 -7.2 BOX 22 J61 L It v jr 02618 Rev. 3./86 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Mast Provide -9 C) P.C.H.D. Permit # -- ` sa. , 11, t E i!!] C ATI:; OF CO1VS`iRUCTI()PI`66Mit,IANCE; F01(- SEI'AGE DISPOSAL SYSTEM Owner /applicant Name JOSG H MOWA114D "'Formerly Mailing Address Gl ' ` ,&fPL9-- RiLL zip_ Taw Map To r Village pD Binek -LotT� Sabdlvision Name- - - `t'' Sub�dv. Lot # Date Permit Issued tU% 22 1119 1 Separate Sewerage System built by �"+�1� GOIJ Address p VCK✓ HOU.4,W RD 1" Consisting of Gallon Septic Tank and Water Supply: Public Supply From w�•� r� Address pp� or: - Private Supply Drilled by t*1` M M952r4 Address 0 Ri 054 ni %1ALA � Building Type Has Erosion Control Been Completed? t/s Number of Bedrooms 3 Has Garbage Grinder Been Installed? N O Other Requirements I certify that the system(s) as listed serving the above premises were constructs sse i 1 s s niledpla La2nd mpleted work ( copies of which are attached), and in accordance with the standards, rules and o s, in rid, a th e permit i ssued by the Putnam County Departm nt Of ealt7h. V Date y Certified by C QD,,�' f ( 6-74-4G R.A. Address l..i��M /��. '�"'`� r`" ��i ZZ�►5t'E�, N 1 License No. " Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage em shall become hull and void as soon as a pub(': sanitary sewer becomes available and the approval of the private water supply shall become nul n v id when a public water supply becomes available. Such approvals are subject to mo��ddddiffi�ic tion or change when, in the Judgment of the C n r of Health, revocation, modification or change is nnne es Date �_J�s3� ey Title • "�'! '-�. nkt"doodnoWn"nod&&nft&cavmwL X. t. low t3 . _ r»r MR UwiIN iii, ati L.l� Fy . . N "m F. %,J l a42056 C&T _9K 1111111110L Ian . 0Lumd4lfn" Nona A26EEIA 9 • MD MT -10 (111111 s ijpa ��Y mss. W AM �i.-� 3 G p„ soc" alb EJ Depth Vahm Nodw 1 Miowns Deafte II+Law G P D d9 O >r® Natlfariab in Ro4whod Wbm M IS osmpbMa M� 'y.teo t. aa.tiet i 1000 easm s"o Tub mia 616 i-L o F 2' "ice wake 8Qaabrt fife So* n° -- -moo � -- Adkm �a � � Sapptp DefW lay t�rt��"II NEi� �aa... Oise )a�aata I psis us W.1hat 1 am wholly and completely responSlble for the design and location of the proposed system(s): 11 that the se�araft ..wawa diva sya«n abort daacribad will M constructed as shown on the approved amendment there to and In aeowd no* with the Standards, ►uleS anM►qu eWA ty pdtMetwAnt Of FlMlth, std that On cwnplatklh.theraof a °Cartifk:ata of Construction C~Iana" satisfactory to the Commissioner of Haalthwill M alllimnatad to tIN Daprtnssmt. and a wrath puarames will M furnished the owner. his successors, heirs w asdges by the bulkier. that said builder will ~ in /odd .dpwatblg oobdRloh any part Of said sawep disposal system dwky the period of two (a) Vows Nnmedlately followktg thodtato at tlo isau- OW oI fha opprooal of ten CareNlate of Construetlem Compliance of the orip 1 systwn or any rapers therstoi p) that the drilled wall deswsaed stow afw M -- - - 1 N *AWN M the appowd pan and that tale wall will be instal in nce w t rules a rap ens of the rAm County DOW W IL Data Signed F.E. R.A. AddnMC-.E Irk Assam G - 5Z Licence Nb ��A9� APPROVED FOR C( '01 PPCTIONs This apprOVal aspire two VOWS from the data issued unless Construction of the building has been undertaken and is roaoable for cause or mnay be ananded or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction moulm a now sera. Adorared for disposal Of domestic Sanitary MNW%Jlmdf sate water supply Only Y-17 DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL S_;:P?1_3 PCHD PERMIT WELL LOCATION Street Address �o EE Town Villa a City Tax �a�lE — Grid umber — c . a WELL OWNER Name Mailing Address O 1 MAf.FN1LI. M MAIkv?A,_ rivate O Public USE OF WELL 1 - primary 2- secondary JWRESIDENTIAL 0 BUSINESS 0 INDUSTRIAL D PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY O ABANDONED 0 OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm /# . PEOPLE SERVED /EST. OF DAILY USAGE oo(0 gal O REPLACE EXISTING SUPPLY ❑ nST / OBSERVATION: M ADDITIONAL SUPPLY jMW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL. REASON FOR DRILLING DETAILED REASON FOR DRILLING - WELL TYPE DRILLED DRIVEN ODUG ®GRAVED 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES = V' NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: CS'rX-MS -ur— Lot No. 2 WATER WELL CONTRACTOR: Name -ra Epe, Address: IS PUBLIC WATER SUPPLY AVAILABLE TO.SITE: YES ____I�NO NAME OF PUBLIC WATER SUPPLY: IJILPc TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH A SOURCES OF CONTAMINATION PROVIDED a ON SEPARATE SHEET ,JMag 5?� d, (date) (s PERMIT TO CONSTRUCT A WAT _ c This permit to construct one water well as set forth above is aferY' under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within third! (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 ?-.2 19 Date of Expiration 194z :3 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller /Q► _ C0li. ��ti r�i a. ►� _ WlrLL lVP1rLJr11V1V tCC,rvltl DEPARTMENT OF HEALTH - D visibri� Of- Eirvironmefifa `He °alth` Services PUTNAM COUNTY DEPARTMENT OF HEALTH office Use Only -, .x .,. - WELL LOCATION SiREEi AOURESS: W7v-i 1 Y TAX GRID NUMBER: 0�a W CCei WELL OWNER N E: Aa0RESS: ve +1�a�KO� h1k �e !�; II r`Iv�� ❑ PUBLICS USE OF WELL 1 - primary 2 - secondary ESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT S� gpm. /NO. PEOPLE SERVED / EST- OF DAILY USAGE - gal. REASON FOR DRILLING . []REPLACE EXISTING SUPPLY ®TEST /OBSERVATION OADDITIONAL SUPPLY W SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA ` WELL DEPTH �o ft. I STATIC WATER LEVEL ft. I DATE MEASURED 3 - DRILLING EQUIPMENT Q-ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED BEN END CASING ❑ OPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH' ft_ MATERIALS: ® -STEEL ❑ PLASTIC ❑ OTHER CASING DETAILS LENGTH BELOW GRADE ft.. JOINTS:.. ❑ WELDED - - El- THREADED ❑ OTHER DIAMETER �_ in. SEAL: ❑ CEMENT GROUT ❑ BENTONITE 06THER WEIGHT PER FOOT 1b./ft. DRIVE SHOE ❑ YES aNO LINER:OYES &NO SCREEN DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (it) DEVELOPED? DETAILS .� • - FIRST < ... . -.- . .: : - .Q- YES-13 NO - - .... _..._ . HOURS `SECOND"' GRAVEL PACK o NO S GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH it. BOTTOM DEPTH It. WELL YIELD TEST If detailed pumping METHOD: O PUMPED tests were done is in- OMPRESSED AIR , formation attached? BAILED O OTHER ; ❑ YES O NO WELL LOG It more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear- ing well Dia- meter FORMATION DESCRIPTION CODE ft. it. WELL DEPTH It, DURATION hr. min: DRAWDOWN ft. YIELD gpm. 5 Mace I.d.• OV e i e S D [WATER O CLEAR TEMP. O CLOUDY HARDNESS O COLORED ANALYZED? O YES ONO NALYSIS ATTACHED? O YES O NO STORAGE TANK : TYP E CAPACITY GAk. NFORMATION CAPACITY DEPTH VOLTAGE HP WELL DRILL�ERR NAME q DATE ADDRESS I " ® Q ~ �af1& SIGP7ltTURE o �a X (p, Y , "' J i • r• �• � �• . •�� is •i• : y r. � •• •i a �• • r� v •�y �: _ �• tea. DESIGN DATA ' SHE ET- SUBSUFACE SEWAGE DISPOSAL SYS E14 FILE NO. Owner Address'�I,tc�c��M�s AVe. Vaukkt-A t�l -Y poems Located at (Street) , je- &f>FCE. Sec. 19 Block I Lot 1 &.07 ( indicate nearest cross street) L--T- Municipaiity � 3 rr.1� M �i� -.L� _EY Watershed t� r� :> tom; SOIL PERCOLATICN TEST DATA REQU= TO BE St KMM WITH APPLICATICNS Date of Pre - Soaking Date of Percolation Test S 2-i ?O 2-:5 3 I G 4 1 o44- -ifICO HOLE 5 NLi4HER CIACR TIME PEPCOLATICIN PF.ftCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Indies Soil Rate Strart -Stop Min. Start Stop Drop In Min,/In Drop 20 22 Inches Inches Inches �)3�1 -9s2 Ig 2G 'i 3 ►Cry, - � � ?O 2-:5 3 I G 4 1 o44- -ifICO G 5 3� SO -- i IUD 20 2 3 3 ) d 3G 20 22 2 I 1 5 'i N=:., . 1. Tests to be repeated at same depth until apprcaimately equal soil rates are obtai.ned.at each percolation test hole. All data to'be sulmitted for review. . 2. Depth measurements to be made fran tap of hole. rev. 9/85 Name le -E�I�� Signature Address iZ:r.. S'L SEAL Y S 38998 � Y. � c� � r 2 Tare OF h EY2 THIS SPACE FOR USE BY HEALTH DEPARDIENP ONLY: Soil Rate Approved sq.ft/gal. Checked by Date TEST PIT DATA REQUIRED TO BE SUBMITI'ID.= " -YION DESCRIPTION OF SOILS ENCOUNTWM IN" DEPTH. HOLE -NO.' ....._1.... _ .,. = HOLE ND. 2 . No. - d- r, 1' ' 2' 3', 4' Lc�r•'1 p fry --l. L.DA •lG, Irl �S %L 5' 6' !Z 71 8' 9' 10' 11' ' 12' 13'. 14 INDICATE LEVEL AT WHICH GROUNDWATER IS ENODUUMM INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENOOUNTERFD DEEP HOLE OBSERVATIONS MADE BY: PJZ DATE: DESIGN Soil Rate. Used 11 -1` min/1" Drop: S.D. Usable Area ProvidedSC�� No. of Bedrooms • _ Septic Tank Capacity /OUCv gals. Type��-Nv-_� Absorption. Area Provided By '575 L.F. x 24" width trench Other (o Gv ►�C'H�►� '—�:+ ti ► o A. KE. < Name le -E�I�� Signature Address iZ:r.. S'L SEAL Y S 38998 � Y. � c� � r 2 Tare OF h EY2 THIS SPACE FOR USE BY HEALTH DEPARDIENP ONLY: Soil Rate Approved sq.ft/gal. Checked by Date APPENDIX B PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT (Name of Owner) DATE REVI -74-ED : (Street Locs ori)° CCYN`I'S YES NO x LF trench provided _j3quire3 �r"6`0 ft. max. W" - contours ifo% e� p - FILL SYAEMS clay6arrier 10/ ft. fill notes ew s /depth gauges 1100 yr. flood/elev. 200 ft/. reservoir, etc. 150 ft. trigall /gall. " f _ DOCUMENTS �j t ��l f ' cy� .via -4: '-'00 Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth Plans - Two sets Well permit; PWS letter once Request Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland ( Town /DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - ( north arrow) Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - VolLmte D or J�Box;Trendh /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Can.struction EI to , - ; grin - er - rate ] _ Design Data: Perc and deep results Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing/Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If Punped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft.: of Proposed Systems Property Metes & Bounds House Setback Necessary (Tight lot) House Seer - 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,Top of fill 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains - Curtain, Leader, Footing 35'to catch basin,storrrdrain,piped watercourse 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' fran Foundation; 50' to well 15' Well to PL 9 s/s SUBDIVISION Per - (3) Fill cd - DEPARTMENT OF HEALTH Division of Environmental Health Services ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION Street Address Town/Village/City Tax Grid Number WELL OWNER Name we"I ;'C.O O Mailing Address M . 'V c.. PTrivate . ic:m5 O Public USE OF WELL 1 - primary 2 - secondary RESIDENTIAL 0 BUSINESS ® INDUSTRIAL ® PUBLIC SUPPLY O AIR /COND /HEAT PUMP ® ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify []INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT rJ gpm /# PEOPLE SERVEDI �. /EST. OF DAILY USAGE649c=)jjal REASON FOR DRILLING ® REPLACE EXISTING SUPPLY ® TEST /OBSERVATION jaNEW. SUPPLY NEW DWELLING) ® DEEPEN EXISTING WELL GY ADDITIONAL SUPPLY DETAILED REASON FOR DRILLING WELL TYPE DODRILLED ODRIVEN ®DUG OGRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES �NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:. Lot. No. WATER WELL CONTRACTOR: Name -M P,-� Address: IS.PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES V NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE- fi0°PROPERTY . FROM --NEARES-T-- WATER-'MAIN:- A SOURCES OF CONTAMINATION ON SEPARATE SHEET 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 thirt3c (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: !199 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 PUTNAM COUNTY DEPARTMENT OF HEALTH : �.,...,_:,. .. >.:_,..�.�L�..:-- . .:... ...... :.- _ _ .,..:. _ :__..• I31�iISJi�i•; OF. .rEN�3RONME�FAIy��iEALTH ==3ER� -ICES .> . ... _.�...rx «.;.._....., - ......�- ,.= ..T.._T......... "Sv�ep1 -, I , M oAaw0 Owner or Purchaser of Building Wo2.cT f �'C"r -c se- Building Constructed by lour). W4- LOPte. RA Location - Street sa 3 -7.;), Section Block Lot WiLwpee_ gslm, is Subdivision Name vRil -e,/ Lo+ a Municipality Subdivision Lot # e 'df,, Woo\ rx-ame. Building Type GUARANTEE OF SUBSURFACE SEMMGE 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„ "Certifica�e_of-Construction' ComplianceIn'fUr ° -the tewage disposal:'system;- 'or-any= repairs made made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environmental Health Services o t e Putnam County Department of Health as to whether or not the failure o sysitem to operate was caused by the willful or negligent act of the occupant of 7e�uilding utilizing the system. Dated this day of 19 Signa Title Gerofall Contractor (Own - Signature Corporation Name (if Corp.) 0 Mao 4L Ny I05-YI Address rev. 9/85 mk � � v Cj , Corpora ion Name (if Corp.) ss a- i� S�9- �/? 7 = 4 YML EnvironmentaY. Services . x p3 1 iCear 5treet,Y6rktown Heights; NY'10598 FLAP #10323 (914) 245 -2800 Joseph Montano Wicopee Road Putnam Valley, NY 10579 COLD BY James Carney NOTES 1 RESULTS OF WATER TESTING X ANALYTE RESULT UNITS ALKALINITY mg/L AMMONIA mg/L ARSENIC mg/L CHLORIDE mg/L COLOR Units CONDUCTIVITY umhos /cm COPPER mg/L - - DETERCE FLUORIDE mg/L HARDNESS mg/L IRON mg/L LEAD . mg/L MANGANESE mg/L IMERCURY SPC mg/L NITRATE n-g/L NITRITE mg/L ODOR TON pH S.U. • LAB NUMBEi �ac7GU7U i DATE /TIME TAKEN 9- .11 -92 9am _ DATE /TIME RC'D 9 -11 -92 loam DATE REPORTED SAMPLING Same SITE Well Tank For Lab Use Only x Potable _ HNO3 _ pH LT 2 <4C _ Nonpotable _ NaOH — pH GT 9 _ <20 >4C _ HCl _ Na2SO3 _ >20C X STAT! H2SO4 ZnOAc 1� r MF N P/A RESULTS OF WATER TESTING X ANALYTE RESULT UNITS PHOSPHOROUS mg/L SILVER mg/L ISODIUM SULFATE mg/L SULFIDE mg/L SULFITE mg/L TURBIDITY NTU ZINC rng/L SPC per 1.0 mL TOTAL COLIFORM per 100 mL FECAL COLIFORM per 100 mL E. COLI per 100 mL FECAL STREP. per 100 mL These results indicate that the water samp (WAS [WAS NOT] [NA] of a satisfactory sanitary quality according to the New York State Sanitary Code, for the etc tested, at the time of sample collection. These results indicate that the water sample [WAS] [WAS NOT [NA] . a satisfactory chemical quality according to the New York State Sanitary Code, for the parameters tested, at a of sample collection. Applicable N = Not Present (Negative) SUBMITTED BY � "��'�'f' //?% (Positive) SA = See Attachments) ne bec ause Total Coliform was present Albert H. Padovani, M.T. (ASCP) TNTC = Too Numerous To Count -Director > = GT = Greater Than < - LT = Less Than V/ 1 system was that the system was . it was covered dance with all m County Department i of Imealth. gallon precast wide absorption of Chf :) C I "ATI ES, PC. ITECTS - PLANNERS ii 'J. ['iI�t-L5 Ok SmPTICS WrT"�Q UIJLA��, PU': r j Putnam County Department of Health Division of Environmental Health Servi( Approved as notid for conformance wit apqlioa�' Rules I And Regulations Of t' 7 /CQUnq' alth Department. -) S11frature & Title A Date H;Z.-rA*4EZ:' FOK'- L-&'T C; "2T 155' C,1' G-7' 75' -19' 80' PU': r j Putnam County Department of Health Division of Environmental Health Servi( Approved as notid for conformance wit apqlioa�' Rules I And Regulations Of t' 7 /CQUnq' alth Department. -) S11frature & Title A Date H;Z.-rA*4EZ:' FOK'- L-&'T -/I CV a ( Ce,-1 .,j .max. IC71