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HomeMy WebLinkAbout2737DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 61.08 -1 -24 BOX 23 -T - , . - .,� .. AL 1 02737 y.,x «.... ... �a-- ,- rv,'r•{r- ...-r- - �r-rv. ., s..5,e.,..�� ^.rr.-'.^'nY'..- a -.C�,p ?t. .- }'- er,•- '^•- ^t^.'. 1 "Rev. 3/86 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Hesltb �Sevlcex Carmel . N:Y 10512 ' ' ghee M r "pet Provide ., 97 $ 2 C:H D Permit q • tX � - _ RTMCATE OF CONSTRUCTION COMPLLANCE FOR SEWAGE DISPOSAL SYSTEM V ,.> u Tawn of Y Located at \ (LQ t t � j�E T" Map Z � Block _�_ Lot —•� _ Owner /applicant Nim- 1- :F,r - /r;�`� y ea re— Formerly 64? Z V Subdivision Name " Su v. Lot q �_ Mailing Address `t b tf�s5. J �'ltFi? Zip �O- Date PerInk Issued Separate Sewerage System built by 16 AVY0.1. Address C� D S 11 . : Consisting of Gallon Septic Tank and Water Supply: Public Supply From Address or: `- Private Supply Drilled by �2 & � � Address �f t% ✓�ird iMo 1 _ Q� a� A Building Type Has Eroelon Control Been Completed? Number of Bedrooms J Has Garbage Grinder Been Installed? tit? Other Requirements I certify that the'system(W as listed serving the above premises were c 'ae eho on the plans of the completed work ( copies of which are attached), and in' accordance with the standards, rules and ulati rdance i a sailed plan, and the permit issued by the Putnam County Depth tent f Health.. / z t' J Date Certified by P.E. R.A. - Address A) f 4-.4 /[t — � OSn /G License No, W ?d 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 ►eiulting from, such u,49e. Approval-of the "separate sewerage gntem'sheq become null and void as soon as a pub( ?: sanitary sewer becomes aJailaDle and the approval of the private water supply shall tiecome null. and V0W' when° a, puDllc watts supply becomes available. Such approvals are subject to modlfleation or ,ch'ahge when, In' the Judgment 'of" the CommlisiOrier of^MealtA; s revocation, modification or change Is necessary. Oats � 9 is .. y M WELL COMPLETION REPORT Office Use Only DEPARTMENT OF HEALTH Division Of Environmental Healtls'Services -° PUTNAM COUNTY DEPARTMENT OF HEALTH MOUNT OF USEI YIELD SOUGHT 7 5-0 gpm.lNO. PEOPLE SERVED_/ EST. OF DAILY USAGE cfo gal. REASON FOR 0-16W SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION DRILLING O REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH $ I ft. I STATIC WATER LEVELS r JDATE MEASURED 5 Ao DRILLING @'IOTARY ❑ COMPRESSED AIR PERCUSSION ❑ 7DUG EQUIPMENT ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. IR OPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH 40 fL MATERIALS: BITEEL O PLASTIC ❑ OTHER CASING LENGTH.BELOW GRADE 3 %s ft. JOINTS: ❑ WELDED frHREADED ❑ OTHER DETAILS DIAMETER in. SEAL: ❑ CEMENT GROUT ❑ BENTONITE C1 OTHER WEIGHT PER FOOT lb./ft. I DRIVE SHOE ❑ YES 0.0- LINER: O YES GRM- DIAMETER (in) SLOT SIZE LENGTH (It) DEPTH TO SCREEN (ft) DEVELOPED? SCREEN._ _.... - - DETAILS FIRST _ . - ...... �,_ _.. _,__. ....� ...__ .e. _._ ... OYES ONO SECOND HOURS GRAVEL PACK I 0 YES GRAVEL DIAMETER TOP BOTTOM 0 NO SI79- OF PACK in DEPTH ft DEPTH WELL YIELD TEST METHOD: GQ PUMPEO 0 COMPRESSED AIR 0 BAILED 0 OTHER WELL DEPTH DURATION It. hr. min. If detailed pumping tests were done is in- formation attached? 0 YES 0 NO ORAWOOWN YIELD. ft, gpm. WATER 0 CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? OYES 0 NO PUMP WFORMAT10N TYPE CAPACITY MAKER DEPTH MODEL VOLTAGE HP WELL�O� It more detailed formation descriptions or sieve analyses to /LL tlV are available. please attach. DEPTH FROM water H!etI- SURFACE 8ear- Dia' FORMATION DESCRIPTION ft. IL ing meter In Surface} 6 rl p i ) $!� gi-A r iMk- C STORAGE TANK: TYPE CAPACITY GAL. WELL DRILLER NAME /3j2o - DATE6 f gy ADDRESS SIGf1MRE o 0io -- U 6 ft. CODE. STREET AOURESS: wN /VI 1 IIY AX GRIO NUMBR- WELL LOCATION PA) 110Gl,Ey —� —, WELL OWNER NAME 5- v�Yt J�or- ADDRESS: ATE O PUBLIC USE OF WELL ©- RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED 1 - primary ❑ BUSINESS O FARM ❑ TEST/ OBSERVATION O OTHER (specify) 2 - secondary O INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USEI YIELD SOUGHT 7 5-0 gpm.lNO. PEOPLE SERVED_/ EST. OF DAILY USAGE cfo gal. REASON FOR 0-16W SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION DRILLING O REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH $ I ft. I STATIC WATER LEVELS r JDATE MEASURED 5 Ao DRILLING @'IOTARY ❑ COMPRESSED AIR PERCUSSION ❑ 7DUG EQUIPMENT ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. IR OPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH 40 fL MATERIALS: BITEEL O PLASTIC ❑ OTHER CASING LENGTH.BELOW GRADE 3 %s ft. JOINTS: ❑ WELDED frHREADED ❑ OTHER DETAILS DIAMETER in. SEAL: ❑ CEMENT GROUT ❑ BENTONITE C1 OTHER WEIGHT PER FOOT lb./ft. I DRIVE SHOE ❑ YES 0.0- LINER: O YES GRM- DIAMETER (in) SLOT SIZE LENGTH (It) DEPTH TO SCREEN (ft) DEVELOPED? SCREEN._ _.... - - DETAILS FIRST _ . - ...... �,_ _.. _,__. ....� ...__ .e. _._ ... OYES ONO SECOND HOURS GRAVEL PACK I 0 YES GRAVEL DIAMETER TOP BOTTOM 0 NO SI79- OF PACK in DEPTH ft DEPTH WELL YIELD TEST METHOD: GQ PUMPEO 0 COMPRESSED AIR 0 BAILED 0 OTHER WELL DEPTH DURATION It. hr. min. If detailed pumping tests were done is in- formation attached? 0 YES 0 NO ORAWOOWN YIELD. ft, gpm. WATER 0 CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? OYES 0 NO PUMP WFORMAT10N TYPE CAPACITY MAKER DEPTH MODEL VOLTAGE HP WELL�O� It more detailed formation descriptions or sieve analyses to /LL tlV are available. please attach. DEPTH FROM water H!etI- SURFACE 8ear- Dia' FORMATION DESCRIPTION ft. IL ing meter In Surface} 6 rl p i ) $!� gi-A r iMk- C STORAGE TANK: TYPE CAPACITY GAL. WELL DRILLER NAME /3j2o - DATE6 f gy ADDRESS SIGf1MRE o 0io -- U 6 ft. CODE. l . VO4 J.-:9,M49T1QN fIgPQFfT 3i]1 PyTNAM COUNTY DEPARTMENT Of • iolvlelon of Environmental Health Gavlove COUNTY OFFICE BUILDING • CARMEL., NEW YORK This report I1 to be pomplated by well driller and eubmltteq to County Health Deppftmani together .with..Iaboratory.toport:uf.• -: 0lp;pf,w#TOT �rnple indicating wati3r fis'gt*sgtiis�tictory'bactia'tial duality tiefora �certificete, of construction compllanq ja 1"Nd, • ... ,.. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION QWr� NAME ..... Scotty Moore ADDRESS . Mark Mead Road, South Salem, N.Y. &OCATIOP) of Wtµ tra, A Furst alto 091 hump of Trail of Naples, Putnum Valley F40POSRQ psi 01 WPB BUSINESS l=N POMP. IG I...J EA14BGISNM4NT ❑ fARIA L,..1 114T WELL, . PUBLIC AIR OTHER ,SUPPLY l„J INPIISTRIAk ❑ CONDITIONING L.1 (tiipaciFy) DRILLING EQUIPMEN7< COMPRESSED ❑ ROTARY AIR PERCUSSION q CABLE OTHER PERCUSSION ❑ OpeclfA NO DETAIL; LENf;Tt) (100, . 4 0 DI/ AETER(lnchea) 6 WEIGtIT PER FOOT 17 • ►.�li THREADEPEI W15LDED UYIES NO N. DY94 — NA YIELD TE ;1 ❑ OA1LM I_J � HOURS ".141 PUMP9Q I. �L COMPRESSED AIR 6 YIELD (Q.P.I)f,) 100 WATER {xVE{ WI AS.4RE fRW4 LANte tiURFASE— STATI4(Spoclly fool) 40 4URIN4 TIEID TEST (loeU 185 Depth of Completed Well In foot Ilelow Land surface, 18 5 $CRUM f?ETAIti ht !(p None LENpTH QPFN TO AAIIIfBR ((get1 None SI,pT Six@ None pIAMETER (inohtfa None IF GRAVEL PACKED, piameter of well Including gravel pock (Inches): GRAY k �)ZE (IecdPf) FROM (f0rt�0 0!QU' � None None None >ErTH FROM LAND SURFACE FS?RMATION DESCRIPTION Sketch exact location of wgll With dlebnfes, to at /t(Aal two permanent lendmarks. FEET to FEET 0 20 Soil Casing•is exposed '18" above grade 20 185 Granite & Mica If yleld was festod of different depths during drilling, list below FEET GALLONS PER MINUTE ATE WEAL C0104(l(l? 5%5/$8 DAT OF Kt�' f ;T 5/5/ ? �ragg �0 .. W� HILL SI n04r �y t r I I Yorktown Medical Laboratory, Inca i LAB # - . 0291' 7--; 321 Kear Street Date Taken: /0- -,26 -I Time: Yorktown Heights, N.Y. 10598 Date Re' d :— Time: / 914.)- 245• - 2800:2 - - ;v -..1aat'a--Re c rtes . ti ZJ � Director: Albert H. Padovani M. T. (ASCP) Collected By f� Referred By: T— —1 Sample Location: /:6r eC Phone # S' S' 6�' / r2=3Z� i" /a J / Phone # Sample Type L J Repeat Test? (check each) LABORATORY REPORT ON THE QUALITY OF WATER INORGANIC NON- METALS mg /L MICROBIOLOGICAL CFU /100mL Acidity Alkalinity _ Chloride Detergents, MBAS __.. Hardness, Total _.e. Nitrogen, Ammonia Nitrogen, Nitrate Phosphate, Total Sulfate Sulfide Sulfite METALS (mg /L) Copper Iron Lead Manganese "^ "Mercury _ Sodium Zinc MISCELLANEOUS pH (units) _ Color (units) _ Odor (TON) Turbidity (NTU) GENERAL BACTERIA Standard Plate ( CFU /1. OmL ) Count MEMBRANE FILTRATION TECHNIQUE •Total Coliform_ Fecal Coliform Fecal Streptococcus MOST PROBABLE NUMBER TECHNIQUE Total Coliform Index Fecal Coliform Index KEY FOR TERMINOLOGY.-, r CFU = Colony Formi ng; llni is CON = Confluent (q.v. TNTC-) LT = < = Less Than; GT = > = Greater Tha'h N/A = Not Applicable S/A = See Attached TNTC= Too Numerous To,Count REMARKS /COMMENTS (For Lab Use) ,Potable _ Non- potable STP INF STP EFF Other: Sample Status: (check each) Outgoing _ HNO3 _ HC1 H2SO4 NaOH ZnOAc Na2S203 Other: •'Incomdng - • 1 LE k °C _ ::�- GT 4 0C pH LE 2 ..r_ pH GE 9 pH GE 12 Other: ELAP No . 10323 THESE RESULTS INDICATE THAT THE WATER SAMPLE (Was) (Wasn't) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO THE EW" YORK STATE PUBLIC DRINKING WATER CODES, FOR THE PARAMETERS TESTED: AT THE TIME OF SAMPLE COLLECTION. THESE RESULTS INDICATE THAT THE WATER SAMPLE (Did) (Didn't) N /A) WET THE SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK PUBLIC NG WATER CODES, FOR THE PARAMETERS TESTED,'AT THE TIME OF SAMPLE COLLECTION. Lxl %GZYLe- !'.2 -� ^ 2/86 (Rvsd7 /87 )RWE Albert H. Padovani, M.T. (ASCP), Director PUI'NAM OOURN DEPARTMDV Or HEALTH • DIVISION :.OF- -EN UrIROi Owner or Purchaser of Building F-QA- N('i,? - ,40o2C Building Constructed by Location - Street Section Block Lot Subdivision Name Municipality Subdivision Lot # c�r5If) f_7V f Building Type GUARAI<IrEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM r I represent that I am wholly and completely responsible for the location, worlmr#ip, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as shewn 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 operatiftg 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 :$I Certi 3cate:._of - Construction _�Coznpliance= ::.for .the- seEaage .d sposal s stem, ter- any -° repairs made by we 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 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. •: Signature b1^�'l4 i6�itili� Dated tkis 2 l day of Oc � 19m Title Genera}. Contractor (Owner) - Signature Corporation Name (if Corp.) C ko55 r J7Z �l Address /0 rev. 9185 l mk 1 t Pd 130X ¢ Corporation Name (if Corp..) c- -495-5 r JL iL al y . Address 1 OS T FINAL SITE INSPBCTION Date STREET IX-ATION-2", Or 7�vc 14,*- PERMIT t 0 V TM # OR SUBDIVISION LOT IV. V. Vi. I OWNER 60 spected by NN -SENAG&n aISPOSAH-'AREA: a . SDS area located as per approved plans b. Fill section - Date of placement 2:1 barrier. IGTH WIDTH AVG. DPTH c. Natural soil not stripped d.- Stone, brush, etc., greater than 151 from SDS area. e. 100 ft. from water course/wetlands. jQ SEWAGE DISPOSAL SYSTEM a. Septic tank size '1,000 � 1,250 -A� b. Septic tank instal evel -A1 c. 10' minim= fran foundation d. No 90' bends, cleanout within 10 ft. of 450 bend e. DISTRIBUTION BOX 1. All outlets at same elevation - water tested 2. Protected below frost 3. Minimum 2 ft. original soil between box and trenches f. JUNCTION BOX - properly set /JUT g. TRENCHES 0 W- 7ef-64u < 1. Length required - 11 Length installed 2. Distance to watercourse measured, ft. 3. Installed according.to plan 4. Distance center to center 5. Slope of trench acceptable 1/16 - 1/32 "/foot. 6. 10 feet from property line - 20 feet - foundations 7. Depth of trench < 30 inches from surface 8. Roan allowed for expansion, 50% 9. Size of gravel 3/4 - li" diameter 10. Depth of gravel in trench 12" minimum 11. -Pipe ends capped h. PUMP OR DOSE SYSTEMS l.' Size of.pump chamber. —2w, Over -flow -tank- 3. Alarm, visual/audio 4. Pump easily accessible manhole to gLade 5. First box baffled 6. Cycle witnessed by Health Department estimated flow per cycle HOUSE a. House located per approved plans. b. Number of bedrooms WELL a. Well located as per approved plans b. Distance from SDS area measured ft. c. Casio Fl8" above grade. d.- Surface drainage around well acceptable. OVERALL WOPJ0QMIP a. Boxes Fr- qpe1 grouted b. All pipes partially backfilled c. All pipes flush with inside of box d. Backfill material contains stones < 4" in diameter e. Curtain drain installed according to plan f. Curtain drain outfall protected & dir.to exist.watercourse g. Footing drains discharge away from SDS area h. Surface water zotection adecruate i. Errosion control provided on slopes greater than 15%. NN PUTNAM COUNTY DEPARTMENT OF HEALTH Rev. 3186 , Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer to Provide Permit # on CE CA F_ ,CO IM Permit q �j iONSTRUCTION PE FOR SEW ISPOSAL SYSTEM p Located at Town or Village - — — 4•C �•. a•_.nl.- e..r.n. -.: V.y �i.:w ....as. D.;v..w. ...t .:� C. �.�V��� •'. ev. .a. 's•,y ':l e.a_�.n. ... � . �-a+ir ¢� r.. ... ... �. L�•: N'•.V.1 •.��... •.. r� Subdivision Name ` 1VfSpV t bd. rLot III Tax Map Block Q —Lot f /' Renewal— 0- Revision ❑ Owner /Applicant Name '''+��� Date of Previous Ap rove! r Mailing Address�e�d Town —A�65 %Fs'tcc'a", Bmfiding: Type T Lot Area Fill Section —my Depth Volume Number of Bedrooms Design Flow G /P /D PCHD Notification Is Required When Is comple Separate Sewerage System to consist of Won p Tank a�� � P To be constructed by Address Water Supply: �Pdblic Supply From ' � Address ort_Private Supply Drilled by 4 W" ���" "'�'mddress L Other Requirements 1 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 amendment there to and in accordance with the standards, rules an regulations o e u ham County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished t her „ his Successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal syst during he period of two (2) years Immediately following the date of the Issu- once of the approval of the Certificate of Construction Compliance o the origl system r any re 'rs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will De in t actor nceth e t Bards, rules and regu aTfidns oof thq Putnam County Depart�ertent.of Health. 1 Date j 1'�� {/�'� + � Jj(J/ /Jt Signed _ P.E.- �r 1 R.A. .1 y + Address °r �' v v � t� �' License No "X APPROVED FOR CONSTRUCTION: This approval expires o year from the date issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when co sided necessary by ttge Commissioner of Health. Any change or alteration of construction requires a n per /mit. proved for disposal Of domestic Sa � rty sewage ana/fry rry Sur swvV�7 —11y. V r�`�� Date T ` [ By ((J�a+ V, _"a /�/ 7 Title �J County Department of Mealtn :,ana tnat _on cum Pieuon inere� a be submdted`,to, the�Depa'tment; and a.'wntten guarantee vv�ll be fui place. in good of 'said sewage_ disp9sal. ahce of the approval'of.the Certificate of Construction Compliance Will be. located as shamvn on the aDProved an a4that said well will be in County DeDa "rt ant f F/ealth n Date... , 2l —^_ by Si9netl ; Address C ; APPROVED. FOR CONSTRUCTI.ON This,approval��exp�res one year fr revocable .for cause or may be amended or:modified.when corisideretl n` requires a new - permit: Approved for disposal of dome. I1r: ndary' Wale\ ificate ,of Construction Compliance satisractory to ine s.pmm1ss1prror, P r,gana wn1 nos ne, his wccessors heirs or assigns by 'tlie builder; that said,builtler will sy em dunng he perio0 of two (2), years immediately following tAedaEe of the issu• o the'ougi e 'br an tAereto; 2) Ertel the Grilled well described above s acc ra I with tlards, rules and regu a ions of the Putnam Y �8 P.E. _ R.A. — P�viw t/ license No U3 3 AM om the'date issued unless construction of ;the building has been undertaken and is ecessary by the`Commljsi -ner of Health. `Any change or alteration of construction sewage bn private wat wpply only. ti Title Private. SuPPIY,to be drilled by _ _ ... Address - -Other Requirements represent, that I. am wholly and'completely responsible for the design and location of above`descritied will:be construct'e "d,as shown on the approved amendment there to and ;;County, Department of .Healfh,. and that on coinpletion ihereofa "Certificate 'of Co be `submitted to the Department; and -a written guarantee :will,!be, furnished :thd,ow place in good operating condition' any part of said sewage disposal system during: -ante, of the',,dpprovaj ,.of the yC'ertificat_e of Construction ,Compliance of :the origiria ,_.,•i. T will be located as.shown,on,the approved plan and that said well will tie installed m act County Department` bf. H,e Ith :bate 8/15/93- d; IN Y Mu coot '`N�i0 4 ° Address . Ma opac;' APPROVED FOR.CO,NSTRUCTION: This approval expires fid year frorpjhe da- 'i n ca le for',cause;or' may be amended :ormodified -when co e ed' ec -s ry by.; wres a new er tt Appro e for disposal of domestiane a' se ge and /off v 1 \ O r ey `i. .;, his successors, �1 e:'period of two istem or any rep. lance ",wit h the sj; 1) that the separate sewage disposal system standards, {rules and regulations of. the .Putnam satisfactory to the ,commissioner of :Health will s or assigns by the builder, that said builder will years immediately following the date of the issu- thereto'2)`that the drilled well described above Jards rules: d' regulations of the Putnam . .' 'P..E. R.A.. XX i Lit nse IV o. 11056: ue ` s ,construction of the buildi g has been undertaken and is ommis` ner: of ,Health. Any Chang or alteration of construction Title. v , 'PUTNAM CO LINTY DEPARTMENT OF HEALTH Health _ Division of Environmental Services Carmel N: Y 10512 = V m CONSTRUCTION PERMIT 'FOR SEWAGE DISPOSAL SYSTEM '. Putnam. Valley . z v �..r� _ ..M sec iin -z 25 � - o €..�ttte t Town or • village .•ESlock.:- 4 "L'ocat8'd:'at s�rai3: ,•�!a�3�'e:s. -• Lot - 1- Job 4 � Owner...- • Keating Jrt. address OGCataana _ :, T.ak Read .P �A Building Type One _ - Fa.Iit Res Lot Area` 20 000 =SF Putnam Vallet� _ NY 10579 r _ ' Number of Bedrooms _ Total Habitable space 1500 square Feet 100.0 420 linear feet x- 2', FT width trench Separate Sewerage. System: to consist of - Gal Septic Tank *Putnam Don. Hd,a.dy Address .Valley :;NY. 10579 T,o be torts ;rutted by _ -- Water SuPPIY Public Supply From Y >XX Norman.Anderson Putnam Vallev. NY 105.79 Private. SuPPIY,to be drilled by _ _ ... Address - -Other Requirements represent, that I. am wholly and'completely responsible for the design and location of above`descritied will:be construct'e "d,as shown on the approved amendment there to and ;;County, Department of .Healfh,. and that on coinpletion ihereofa "Certificate 'of Co be `submitted to the Department; and -a written guarantee :will,!be, furnished :thd,ow place in good operating condition' any part of said sewage disposal system during: -ante, of the',,dpprovaj ,.of the yC'ertificat_e of Construction ,Compliance of :the origiria ,_.,•i. T will be located as.shown,on,the approved plan and that said well will tie installed m act County Department` bf. H,e Ith :bate 8/15/93- d; IN Y Mu coot '`N�i0 4 ° Address . Ma opac;' APPROVED FOR.CO,NSTRUCTION: This approval expires fid year frorpjhe da- 'i n ca le for',cause;or' may be amended :ormodified -when co e ed' ec -s ry by.; wres a new er tt Appro e for disposal of domestiane a' se ge and /off v 1 \ O r ey `i. .;, his successors, �1 e:'period of two istem or any rep. lance ",wit h the sj; 1) that the separate sewage disposal system standards, {rules and regulations of. the .Putnam satisfactory to the ,commissioner of :Health will s or assigns by the builder, that said builder will years immediately following the date of the issu- thereto'2)`that the drilled well described above Jards rules: d' regulations of the Putnam . .' 'P..E. R.A.. XX i Lit nse IV o. 11056: ue ` s ,construction of the buildi g has been undertaken and is ommis` ner: of ,Health. Any Chang or alteration of construction Title. v --1 �1 g N A'IV� CO[J1�T'�'�l ®SPAR �'ME1�1 H ®� ���a9. H �1[ Permit a P V o 4.7 -8 3 sfon of, En`vrronmenialA� ' lih'Services Carmel lV `Y 105.12 Devi COiVSYRl1CTaoy PERM T FOR- SEUVAGE DISPOSAL ,SYSTERA P,Utnam V,al'lev 'Town Village Located at ^ TrailrS� *Of t1Z�s�1Jl�S �']�Subd Lot q Renewal Revision subdivision _y. ,owner /Address Daro ,Consl r F aMt _V2rrion Date of Previous Approvai 8/!31/8:3 M. One amll Res 20000 YSF'' { F S , y Builtling `Type% Lot A►ea 1 Section "Only ❑ " —t NUTDef Ot BedfO6fT15 ,Deaign Flow o /P /D 6O�Q P C H. i Notification Required - separate Sewerage. system to consist of 1000 Gal Septic Tank and 420 LF Of 2 f t, Wilde tk6ncleS ;To 'be-cons tructed~by <" r - y$ ` " Address CamL7llS rI01lOW R08C� r Water supply Public Supply From Putnam - Valley, :'NY 1056:6 7. „x`'P,nvate supply to. be dulled by = i�Tnrman `An�PrSpn -'.. Atldress B`arQer rStreet, Putnam Valley+ NY ° 10579 _ Other Requirements 9,represenf -that I 'am wholly and completely espons�tile for ttie design and location of the proposed systems) _1) that the separate- sewage disposal system - atiove described vrill be.coristructed.as showfii;on the approved amendment there to and' m• accordance with the- `standartls, rules an regu a �ons:o a u- nam- ,County Department of - .Health, 'antl :that on completion thereof a Cart�ficate;.9, GonstrucLOn:. Compliance . satisfactory "to the Commissioner of Health will. be,wbmdted to; -the Oepa- rtment' ,and .a :written guarantee .w ill be`turnished'ahe owner his successors,;heas;or assignsDy the buiider,.fhat said:builderwilF. place W,g'ood operating condd!on, any part of sa�q sewage "disposal'system -dung the period of two {2) years immediately following fliedate,of the issu -' ance of the approval of `the CerE ticate of °sConstruction Compliance: of,the ong�nal " ystem or, any reppaors. thereto 2) tfiat the drilled well described above will be located ni sti6in on the approved plari.and that said well will be'installed wn accordance with the: standards, rules and'r'egula��Fns of_. the Putnam County Department of Health z Date 8/2 M 's�gned2.. R.A X rrr Address M�iGCAAt 1�TortY � Mahc c� P3Y 105y41 License :No.-- APPROVED F,OR CONSTRUCTION: This`approval_expves pne year -from the -',tl to issued unless construction of -the building liar been :'undertaken and is 'revocable,f.or cause :or maybe amended or modified when considered'nec Sary ,Dy the'Co issioner of Health.'. Any change •or tfon'of construction ' requnes a new ermit Approv 1 r isposal of domestics a wage /or pi to w t supply only. 4 i Date e� � r 8y , H >���''�.. � Title Rev 9 761' PUTNAM COUNTY: DEPARTMENT OF •HEALTH q Rev. 3/86 Dlvlsfoo of Edvironmentsl Health Services Cnimel, "S 10511 ' `Engineer to Provide Permit , on CERTIFICATE OF COMPLIANCE; CONSTRUCIP P FOR AGE DISPOSAL SYSTEM Permit p �� Located at �� �./ d �L`' �-� Town or ,VtUag .�..- v.t{y..iYUr. •.W. :. V.._..! •.. -� "J. i. .•"4D'�- .p,, -.�- . tix: raw .ei,,,d W-11 Y�) 4.< • .. /L1 ... .... _.`... _ Subdivision Name Sttbd.3LOt q Y :Taz Map+�Block lot ' Renowal_ Revislon ❑ Owner /Applhxat Name f ; f� to Date of Previous Approval Mulling Address / ! J� J�( J; d y Town - Zjp Jr Building.-Type Are Lot Area— Section Only Depth Volume QCd✓• Number, of Bedrooms Design Flow G /P /D lmis Required When Is completed Separate Sewerage System m to consist of �L_ Gallon Septic Tank an To..be eonstencted by Address L WaterSuppl�;. bllc Supply:From z " aAddress L A or: Private Supply Drilled by' _Addreseh Other Regnlremente I represent that Cam wholly, and.completely responsible for the design and location e above described .will be constructed as shown on the approved,amendment there to an County Department of Health, and that on completion thereof a ' Certificate • of C be .submitted to the Department', and,.a written guarantee will belurnished,the o place 'in good- operating condition any. part of said sewage, disposal system duri ante of the approval of:the'Certificate of •Construction Compliance of the'orig will be located ai shaven omthe,eppioved: plan and that said well wiiCbe installed..`n Al County Departm nt of ealth.` Date i9nad /o. , , Address /� I ` APPROVED FOR CONSTRUCTION: ' T s apprdval expires one year from the 4ate revocabie'�for cause.or may be amends or. mode} iedwhen'considered;necessary.by t reauirei`a new e mit, ppro�Cfor d sp6sal of domestic samtary.seWage; Date �� the` p ty°'9tystetn(s); 1) that the''separato sewage. tlispo&a1, system in n wi &tire standards,'rules.an regu a ons o e Putnam ore6ompdL�nce satisfactory to the Commissioner of Healthwill ar, Fe t rs or:assIgns by the builder, that said builder will th d, of tw6';(2) years. mmodiatelyf01 low Ing the date of the issu- �` s °or.ar ApaiAs thereto; 2) .that the drilled well described above ihce h _y aiid M s,, rules a d regu aTfions `ot the Putnam P.E. R.A. • License No T iye�'on . the building has been undertaken and is HQi t�t0• Any change or alteration of construction rDr 1 nly. Title DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 ..�_...... .... �_... _...... ,y.... _ __- •.._.APPLICATIOrd:. TO.:'CONST- 'RiiCl .�A<..- �71�'I'ER WELL�;�-- �;-= �....., . ., F -. _�._ �:�. -.,- :. _ PCHD PERMIT #�-' WELL LOCATION Str et hodre s � e�( C j Town V©illage /Ci y Tax Grid Number �� 6s"`"'�"``S;j� WELL OWNER Name fi'f iS �%1O Kl' Addre ivate +�� 4'S ,. v O Public , �-tA• (� N' USE OF WELL 1 - primary 2 - secondary VRESIDENTIAL ® BUSINESS ® INDUSTRIAL ❑ PUBLIC SUPPLY Q AIR /COND /HEAT PUMP 0 ABANDONED O FARM O TEST /OBSERVATION ❑ OTHER (specify 0 INSTITUTIONAL ❑ STAND -BY AMOUNT OF USE YIE D SOUGHT gpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE A% gal REASON FOR DRILLING W SUPPLY ®REPLACE EXISTING SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION ®DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE RILLED DRIVEN ®DUG ®GRAVEL ® OTHER IS WELL SITE SUBJECT TO.FLOODING? YES -----NO IF WELL IS LOC TED IN A R LT SUBDIVISION, NAME OF SUBDIVISION: �.� � �.ti 0'vk �'� Lot No.' WATER WELL CONTRACTOR: Name °6 10.e Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: N TOWN /VIL /CITY -DISTANGE�• TO PROPERTY- -FROM NEAREST- WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED -T 1 ) lro�j ®ON REAR OF THIS APPLICATION 9ZN__*`SEP (dat ) I (signature 04 h 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 pro"the County Health Department. Date of Issue: � ° %/ 19 rz Date of Expiration: ' // 19 � 1 rmit Issuing Official Permit is Non - Transferrable 8/86 PUTNAM COUNTY DEPARTMENT OF-HEALTH D lYI $ I ON: OF, ENYTRQNMENTAL •:HEALTH.: = SERVICES . u Date 7 Re : Property of R q f 5 . nz Located at, °`f-RA;t OF Tf }E Mf1,PI_I.S (T) P�a�. ya1lt.�L. Section zS Block Lot , Subdivision of Subdv. Lot # so Filed Map # 13TH Date 1 0 Gentlemen:. This letter is to authorize a duly licensed professional engineer registered architect (Indicate to`apply for a Construction Permit for a separate sewage system, to serve the above noted property in: accordance with the starida.rds, 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 c °onnect:.or .. •7lt13- .thia- mat-ter.-..-.and.'-.to- super -vi•se the- cons truction- -af' 'sa' ci system or systems in conformity, with the provisions of Article 145 or 147, Education Law, the Public Health Law,'and the Putnam County Sani- tary Code. q j 4=�' Countersigned: .5 P.E. , R.A. , # Ll32 xC Z I Z 1 .1. 4V .. Address ; INc \y.c��< 265 - yo�g Telephone Very truly yours, Signed Owner of Property Address I A.Y, Town ^ Y Telephone DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION `T0 CONSTRUCT `A WATER WELL "' PCHD PERMIT # ," WELL LOCATION Street Ad ress *rT&: Town /Villa City Tax Grid Number �S " If - l WELL OWNER Nam Vj i,2v Ad r s RR,, rivate �4,'S �� - ra oaf I% 13 Public USE OF: WELL 1 - primary 2 - secondary id.'RESIDENTIAL ® BUSINESS ® INDUSTRIAL ® PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION ❑ OTHER (specify, U INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST: OF DAILY USAGE 0 gal REASON FOR DRILLING RNEW SUPPLY OPROVIDE ADDITIONAL SUPPLY ®TEST /OBSERVATION ' ®REPLACE EXISTING SUPPLY ®DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED ®DRIVEN ®DUG ®GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES ✓ NO I% 1 411- IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME.OF SUBDIVISION:' A. 1h V44& Lot No. { WATER WELL CONTRACTOR: Name �, Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: QJ TOWN /VIL /CITY DISTANCE "M PROPERTY FROM NEAREST WATER MAIN:" " LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED /f ®ON REAR OF THIS APPLICATION ON SKEET (da e) (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. Date of Issue: AR, ,, 3 19 Date of Expiration: 3 19 da-F Permit Issuin icial Permit is Non - Transferrable i i ai II ------ -- - -- -7s f-As - - --------- I ��- !tea -��. ... .�...:.�:`..: .«.�.....— �w��...rwwww.Y __y.�...F.u.A:._wJlJ: Aid► i .:tiL.'L:�::.�i/eL.+:at"_��±r. :�� iw. j PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENV'IRONMERM HEALTH SERVICES ',• INDIVIDUAL WATT ZZ I'S �4meO-wn—er) ( COMMENTS IF trench proviaea — rewired _ 60 ft. max. REVIEW SHEM CONSTRUCTION PEMIT / r• W J • (Street{ YES VNO nation) DOCUAK9TS Permit Application Corporate Resolution Plans - Three sets s/s Engineers Authorization Design Data Sheet (DDS) SUBDIVISION Deep Hole Log Perc Consistent Perc Results (3). Fill 30" Perc Hole cd Other House Plans - Two sets If PWS - Letter if wellrpermit Variance 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;gravit,y flow,suff. size - l' ._ _. If Pumped Pit t& : D Boot Shown & Detailed House - Noe 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. 4 110; Type pipe No Bends; Max. Bends 450 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 (inc. expan) 15' to Drains - Curtain, Leader, Footing 35'to catch basin,stormdrain,piped watercourse 10' to Water Line (pits -201) 50' intermittent drainage course Se_Ptic Tanks 10 tran Foundation; 501 to well 15' Well to PL CORAL Legal Subdivision `Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same l J) 0 on ItAA.T ' 4- R•I• 075 1•7F"' is M"o V'N on; 15,75 04 loo. DESIGN DATA SHEET-SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE ICU. Owner VA t7o Ad& Located at (Street) -i('*'%A VIA J/a d Sec. 235 Block Lot' (indicate near&-st cross street) ?3� Watershed Municipality SOIL PERCOEMICN TEST DATA RBXM D TO BE SM%E= WITH APPLICATIONS Date of Pre-soaking 5 Date of Percolation'Test ' HOLE NUMM CU)CK TIME PERCOLATION PERCOLNTICN Rtun Elapse Depth to Water From Water .1evel No. Tim -Ground-Surface In Inches Soil Rate Start-Stop Min. Start Stop Drop, In Min/In Drop Inches Inches Inches '�D 70 2� y% z 2 .3 14 13.3 4' 5 "3' z '%2 �2 _ z�% 1 � -� -'5 repeate• at same untfl-apbroximateiy equal soil rates A=;-. d - each ' perobla. ti o n test.*b0le... All data. to'' be submitted 2- ts to be made frog top of hole. rev. 9/85 ..3o 2.3 "3' z '%2 �2 _ z�% 1 � -� -'5 repeate• at same untfl-apbroximateiy equal soil rates A=;-. d - each ' perobla. ti o n test.*b0le... All data. to'' be submitted 2- ts to be made frog top of hole. rev. 9/85 a° 3° 4° 5° 6° 7° 8° 120 13° 14 °. _ GROUND , S -ENCOUNTERED L.VL t'v'�8- INDICATE LEVEL TO WHIG$ wATE'R LEVEE, RISES AFTER BEING ENOOUNTERED N DEEP BOLE OBSERVATIONS MADE BY. �6��0�1,ZPa,� DATE. - - DESIGN Z Soil Rate Used ...1.1.7 15 sabl a Area Provided. � pe0N/ p S.D.. -- No • of Bec rocns Tank capacit gals. ....Type d Absorption Area. �. . Other .... ... . o. Ham& — Signature �� r d Address `�q 2 Ada ; - SEAL 0 " �'.rr . .. . _ ..a.N.:.d �• -.: �.c. �..1.. cxrs " a:Td'�:.✓�t . F.tli�::fC � _ ....:. •�li =-'''' �. i� �(�f : •.�.. �<V �.�r,t .. . THIS SPACE FOR USE --BY • BEAUM 'TEP T'`ONM.; _ . �® �p• ..LE Soil Rate Approved �� ��.�. ��j ^^ttn� - .•T ' p� •'�'!?lw?A'f:�I:�/: '4^t� 'Z,�o'��galo i.dd.�%:.i.f.w:S'�16 >�- k.0���.'�'.aF.::�;K. � . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF. ENVIRONMENTAL HEALTH SERVICES .. INDIVIDUAL RATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIELD INSPECTION REPORT .. DATE:' INSP. BY:�;u may° (Nam'oCOfier) (Street Location) INITIAL SITE INSPEON �' YES*_ NO C�NIlKF�YrS CTI Wetlands on/or proximate to property .............. Property lines or corners found ................... Can estimate house location... ............... ... Will driveway 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. 1 Lot 9.H: 2 Lot Depth to G.W. Depth to G. W. Depth to rock Depth to.rock Soil Description Soil Description I . 0 ft. D.H. - Deep Hole G.W.- Groundwater D.H. 3 Lot ' Depth to G. W. Depth to rock 0 ft. �f 3 ft., 6 ft. 9 ft. Soil uescriotion DATE: FINAL SITE INSPECTION INSP.BY: YES NO cmmm House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Roan allowed for expansion trenches .............. Over 100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded.......... ... .......... 10 ft. maintained fran property line and 20 ft. from house .............................. Distance well to SSDS (ft.) ...................... Number.-,of bedrocros checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench .: ............. 15 ft. of peripheral soil horizontally fromtrench ...................................... Boxesproperly set ............................... Could surface runoff from driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK--..ih'area.of SDS::...:.:. , FINAL GRADNG OF SITE ACCEPTABLE:'::' :....:......... PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ... .............�,, - 1 `.. � Date tiio,► iC I� Re: Property of . p G_i ZZ o Located at col n� �o�e4- (T) p Section 2S Block 4 Lot 1 Subdivision of CEU Subdvo Lot .# 3b Filed 'Map # Date 7 2 3a Gentlemen: This letter is to authorize a duly licensed professional engineer or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property.in accordance with the standards, rules. or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and.to supervise the construction of said system or-systems-in 'cbnformi`ty with °tlie provisions of Article .145• or 147, Education Law, the Public Health Law,.and the Putnam County Sani- tary Code. Very truly yours, Signed Countersigned• --•"` i4 <' Owner of Pro ty r P.E. , RoAe , # 4, 136 Address Iol07 Address Town Z.b S-4Gi`� Telephone ..771- S�20 Telephone ,, DAVID D. SRUEN County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services November 26,.1986 Frank Sullivan,'P.E. _ 2972 Ferncrest Drive Yorktown Heights; New York 10598 RE: Thomas Sherwood Trail of the Maples Putnam Valley TM 47 -83 Dear Mr. Sullivan:, JOHN SIMMONS, M.D. Deputy Commissioner It has come to our attention that an existing sewage disposal system is within 100 feet of the proposed well on the above mentioned•property. The existing-sewage disposal system in question is on the Xiques property, located.to the southeast of the Sherwood property. , Therefore,.the above mentioned permit, PV 47 -83, is suspended. The plans must be'revised to accurately.show the location of the Xiques sewage disposal.area in relationship to the proposed well. Upon, .receipt. of- ••the- above- ment-ioned7-revi-81bns1 ' tfie reinstatement of this permit will be considered. Very truly yours, William Hedges, Jr., Environmental Health Technician WH:mk cc: T. Sherwood M. O'Dell, BI PV TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225-3641 PUTNAM COUNTY HEALTH ..DHPARTKENT: DIVISION OF ENVIR0WENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Cammissioner of Health -NAME 11• &-1] 07 - FIELD ACTIVITY REPORT - MAILING ADDRESS P.O. Box Post Office Zip Code TELEPHONE -� l PERSON IN CHARGE OR INTERVIINED Name4dd Title . r DATE a ✓ S TYPE FACILITY TIME ARRIVED ,� Goa Q TIME LEFT FINDINGS.- _.e — _ ®i.� - -- ,j Sheet of INSPECTION -- ___. Orig. Routine Orig. Camplain Orig. Request Ccmpl iance Complaint Camp Final Group Illness Construction Reinspection Field, Sampling Only Field Conference Other Explain -- - -- - -"- _ —ae Ala o i a ✓J� G j .i .,a i mood / .; .� r° q �� s G �/ �a -� T v� !!7 H n�� c`11' .� % ,� .�►''"�tj° X t `fA' O1'�9.�.. ,i.I %`�� (t �3` b�'" ear ��"'�i fw� �v .�9,��wa�.°'`:4- -.t INSPECTOR.- "'� TELEPHONE: Signature and Title PERSON IN CHARGE OR INTERVIWED.- I acknowv edge this Field Activity Report. SIGNATURE.- 6/86 TITLE.- DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL .... �. , a „ . ......... PCHD PERMIT' # ." WELL LOCATION 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 1d'� Address: og-*a/{, ex' IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES J,--' NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH &'SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION SON SEPARATE SHEET (date) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump'the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. Date of Issue: /�`; 5� 19 Date of Expiration:o /-_% 19 Permit is Non - Transferrable :. Permit Issuifflg OL c-i-dl A dre // Town VV 1 age /City Tax Grid Number �h, 7-Street /c'9 �'!/ WELL OWNER N me Address Q.Pfivate �d��f ��� O Public USE OF WELL, ���Q. 2'RE��!SIDENTIAL []PUBLIC SUPPLY []AIR /COND /HEAT PUMP 0ABANDONED 1 - primary 0 BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify' 2- secondary 0 INDUSTRIAL O INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /# PFOPLE SERVED 6 /EST. OF DAILY USAGE �� gal REASON FOR. EMEW SUPPLY OPROVIDE ADDITIONAL SUPPLY []TEST /OBSERVATION DRILLING OREPLACE EXISTING SUPPLY []DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE CKRILLED 13DRIVEN DUG 0GRAVEL Cj 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 1d'� Address: og-*a/{, ex' IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES J,--' NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH &'SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION SON SEPARATE SHEET (date) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump'the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. Date of Issue: /�`; 5� 19 Date of Expiration:o /-_% 19 Permit is Non - Transferrable :. Permit Issuifflg OL c-i-dl PUTNAM COUNTY DEPARTMENT OF HEALTH, DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of 21v- Located at "/j ; / evf-- Z��G (T) )Idl'e-V - Section Block_ Lot Subdivision of Subdv. Lot # Filed Map # Date Gentlemen: This letter is to authorize Gt/ // �Q V 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 v system= or systems° in-conform-L,ty-wi-th*"thd-- provisions 'of` Ait"16A'e' 145- or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned;/'*-%t P a E Telephone Very truly yours, Signed Owner of Property &XIor Address 1 1 Town Telephone • �• r I� v ly tom. �,- aa. DESIGN. DATAiSHMT- S(JBSUFACE S3gAGE DISPOSAL • SYSTEMR Gamer d-) _ Address � %f �- Lv Located at (Street) �o�e Sec. Block l Lot (indicate Aearesk cro s street) Municipality Watershed SOIL PERCOLATION TEST DATA P3Q(T.U2ED TO BE SUBMITTED W rH APPLICATIONS Date of Pre- Soaking Date of Percolation Test o HOLE NU4M C= TIME PERCOLATION PE RCOLAT ON Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start-Stop Min. Start Stop Drop In Min/In Drop Inches Inches Inches 2 5ls'j _ /U 2 4 5 4 3 5 4 2 3 4 5 NOTES: 1. Tests to be repeated'at same :depth.until'.approxiimately equal soil,-.rates are obtained.at each percolation test hale. All data to'be suhrdtted for review. 2. Depth measurements'to be made from top of hole. . rev. 9/85 DEPTH G.L. to 2' 3° 4° 5° 6° 7° TEST PIT DATA RDQUnM TO BE SUBMITTED WITH APPLICATION DESC.'RIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE No. HOLE NOe 13° 14° INDICAfiE'I,W.M.AT V�fiiC�i GROUNMaTER IS' � UNTrD .. Y' INDICATE LEVEL TO WHIc,H'EATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY : D �r� DATE: DESIGN -- - Soil Rate Usea I� Min /1" Drop: S.D. Usable Area ProvidedUU No. of Bedrooms _3 Septic Tank ' Capacity ��� _ gals. Absorption Area Provided By L.F. x 24" width trench Other rOObuophDf... Name g aQ� Si of Frf.;, ^En Address O V e, THIS SP#CE FOR USE BY HEALTH DEPAR ONLY*. Soil Rate Approved sq. ft/gal . Chec _ Date JOSEPH F. SULLIVAN, P.E. 2972 FERNCREST DRIVE -Yd0K'-T'DW--*N HEIGHTS, N. Y. losge (914) 962-4248 §7-,3 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date... -, ...August 5, 1983 Re: Property of P. Keatinq Jr, Located at Trail ;of the Maples (T) 25 Subdivision of Subdve Lot # Gentlemen: Section - Block 4 Lot 1 Filed Map # This letter is to authorize Joel Greenberg Date a duly licensed professional engineer I or registered architect XX (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 .syst -ems- in_.conformity with the .provisions._of or- 147, - - -- 147, Education Law _ (EcPiA c Health Law, and the Putnam County Sani- tary Code. Countersign( P.E., R.A., Very truly yours, Signed 6. OwteUof PropIty( Oscawana Lake Road Address Muscoot North, RFD #2, Box 488 Putnam Valley, NY 10579 Address Town Mahopac, NY 10541 >26 -3743 &�' lephone 914 628-6613 Telephone Cdr; a; PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY. - OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE.NO. Owner P. Keating -Jr. a Address Oscawana Lake Rd.. Putnam` Valley, NY 1057 Located at (Street ap �es Bloc1- 4 Lot_ (�c nearest ross s ree Municipality "::.'.:::Town , of Putnam Vallay Watershed Hudson RAyEik -SOIL PERCOLATION-TEST DATA REQUIRED TO BE SUBMITTED WITH,APPLICATIONS Notes:- 1) Te is to.be repeated at same depth until ap roximately 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. Number , . , :...: CLOCK.. TIME PERCOLATION - ... PERCOLATION Run apse .......... Time Time - Start -Stop Min. Depth to Water From Ground Surface Start Stop Inches Inches Water ve . in - Inches Drop-in . Inches. .. .. ..- .'Soil Rate drop 33 16 19 3 .'..33/3 =11 2...::.8.:.3.4. - x0.7. ; 33 16: .19 .3 - 33/3 =11 -9 ,41-..: 33 16 19. 3_ 3.3/3=11 =- .10,:15 33. 16 19 3 :: 33/3 =11• . 5 PTH21:.;..8•:05- 8:.38' :'' 33 16 1.9 3' '.' 33%3 =�11 2 8139 =.9:12 Y33 �1 16 19 3 33/3 =11 ...9..13 -9:46 33 , 16 19 3 33/3_11 947= 10`.2A. ::33:.. .16. 19 3: 33/3 =1T Notes:- 1) Te is to.be repeated at same depth until ap roximately 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. TEST PIT DATA REQUIRED TO-BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES, DEPTH HOLE NO. DTH #1, HOLE NO. HOLE NO. G.L'. Top Soil 8411 INDICATE IMTEL AT WHICH GROUND WATER IS ENCOUNTEREDNone INDICATE LEVEL-TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED None TESTS.KADE BY,. Joel Greenberci Date August 7 83 DESIGN Soil Rate Used}1 15 Min/1 "DrQpa S.D. Usable Area'-pr ovided 5;000 SF - e Noe of; Idrooms` ^8 Septic Tank Capacity 1000 Gals: Type Pr' -cast g, Absorption Area Prov e By 420 L. F. x24 3611 width tre Other' Name -Joel - Greenberct Signature Address Muscoot North RFD #2 Bx 488 SEAL - Ma opac, NY i0541 THIS SPACE.FOR USE EX HEALTH DEPARTP i'NT ONLY: Soil Rate Approved Sq: Ft /Gal. Checked PUTNAM COUNTY.DEPARTMENT OF HEALTH DIVISION 'OF ENVIRONMENTAL HEALTH SERVICES Date August 21, 1984 Re: Property of Daro Construction Corp_ Located at Trail of the Maples (T) 25 Section Block . 4 Lot 1 Subdivision of Subdv. Lot # Filed Map # Date Gentlemen: This letter is to authorize Joel L. Greenberg a duly licensed professional engineer or registered architect XX (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 system -s.- in,- conformity with the provisions. of Article,, _145. or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. 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