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HomeMy WebLinkAbout3122DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 63. -4 -7.4 BOX 25 03122 Ti be .aoati�apd b� G - "AW aw sb Ada sib �t.. DOW by f 1 represent that 1 am wholli aetl Completely responsible for the tlis a0pue'pUstribad 'will be constructed as shown on the approved amen r County Deportment of Meet ii,< and that on completionahaaot t M su0mletid `te the 'OpartnNint. and a- writtan quarant ,will" t 11111140 in flood operatlnt condition any part: of sold ',fsw&' dw ante. of the approval at t14 Cartifkata of .Construction c*' MPI& Win fir beat as shown on the approved Wen and.thet n d.w ll.will Ceulity Down Wilesit of ft. r ^, ,t Data,- •,:, ., - syn -APPROVED. P,OWCOfe9TROCTION: This approval erp{rectwo yal rerocabWfor -i1YN or may be arewtOeA ormOdifiee wheweofsWen requires a new- pirmit. Appro f0►`Aifpowl.of domistk san'lt 0 88 Date �r.4 7 bra .Qr��siC AJY': and location 'of the proposed jystem(s)i.l) that the se rata sew tli sal stern sat there to antl'in attorI nce with the Standards, rules a rayu ns p srtificab of ConstrudbnComWiana '•'satisfactory ' to the Commisabrrarof'NMlthwill', umfihoi i4ipwnir, his 's is masers, .hales co assiqin�i'tiy the t►utlde►, that sold OY {Ides, will I system i urNfpA the paipd of two (2) yen Immid{ately:followins thodato of the Isau. I ,of the oripkiil system or any repairs, thereto; 2) that the d►Illed well destaibed above in <a ace with YM sf Ms.' r uillell, and rga Y ns of 'the Putnam , a v.tz. It A. License : No frorq the date Inuod unlessrcon uCtion or the buiWirq •has been unde►taRen and is i accessary,; by; the :Commisflonar of Hi@KK•` :. Any' change' or `altafatioq-of. Construction, tewa e;• a tOY ivele it or soppy only. ��� C �G=� Title 'r 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 PCHD PERMIT )7/-/—/ IS WELL SITE SUBJECTJO FLOODING? YES &0-' NO IF WELL IS LOCATED IN A RF.ALTY SUBD VIS ON, NAME OF SUBDIVISION: �. " !2 Lot No. MATER WELL CONTRACTOR: Name �3 Ica 'uoJ —Ad dress: /ig0Ly'��6��'r- aC IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & OURCES OF CONTAMINATION PROVIDED ` [YON SEPARATE SHEET f 1 o (date) (signatur 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 thirti� (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 othergise contaminate surface orr—> groundwater. Date of Issue: Date of Exp' ation 19'7 Permit Issuing Officia - Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller Street Address Town Villa a City Tax Grid Number WELL LOCATION p a� � / Name Mailing Address Private WELL OWNER 1. 110 %, 0 Public USE OF WELL SIDENTIAL 0 PUBLIC SUPPLY 0 AYR /COND /HEAT PUMP 0 ABANDONED - primagy� 0 BUSINESS 0 FARM 0 TEST /OBSERVATION 0 OTHER (specify' a 2 ::-secondary secondary 0 INDUSTRIAL U INSTITUTIONAL .0 STAND -BY AMOUNT OF USE YIELD SOUGHT �' gpm /# PEOPLE SERVED, If/ /EST. OF DAILY USAGE f.2(rJ gal 0 LACE EXISTING SUPPLY 0 TEST/ OBSERVATION D ADDITIONAL SUPPLY REASON FOR DRILLING EW SUPPLY NEW DWELLINGI ® DEEPEN EXISTI G WELL DETAILED C: 4Mt Wa- ,4,hey REASON FOR DRILLING WELL TYPE DRILLED DRIVEN ®DUG []GRAVEL 0 OTHER IS WELL SITE SUBJECTJO FLOODING? YES &0-' NO IF WELL IS LOCATED IN A RF.ALTY SUBD VIS ON, NAME OF SUBDIVISION: �. " !2 Lot No. MATER WELL CONTRACTOR: Name �3 Ica 'uoJ —Ad dress: /ig0Ly'��6��'r- aC IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & OURCES OF CONTAMINATION PROVIDED ` [YON SEPARATE SHEET f 1 o (date) (signatur 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 thirti� (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 othergise contaminate surface orr—> groundwater. Date of Issue: Date of Exp' ation 19'7 Permit Issuing Officia - Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller t r, --t Cc__ r�l L a- EDS are I CC= as b_ E= 1 11 saccti cz - Dam C_ .c.`�^.. ^• °� �.r•�L= E =C_ , C =_G ='' ���'1 J...] t f= u C:C �r =_ b_ E =C is ta- -ti C_ 1,31 R nm C__•G:Uz Gi_ �c= harr C_ i T �, r1- -.- - L wa J_ J 5. Rc=. a c�� _Cr Er-.— -.c 5u` I I y ; __ c- C—=-: ELI 3/. _ IT" d -__ -_ I �I iL pi =a E_ =- c =; C-, —_Y I I. maz_hcls to F—= E. CTC? w=- _ - = -_ —= h— E =.1 r_;_� `mot G_ r"'LC� ?CC.:— L�r Gfa_.Ti•vG� t— �_ V_ wal jr C_ C=c_sC 13�� c_� +c cra— == I I I b- 1_1 �`i -c5 Lam: "c! i -TG� i 1 1=•; I- C_ a -1 Ci C_c5 f ''� i WT `-1 Inside cf ]_CC C_ �-Tk =i l 1 r` =- -- -1 C ^r=- i nc SCCnes < 4" ; n Eia _r=- E_ C_ —L=iA C.' =,: iGc`1 1 _.; EC --,: �'' ^_C rr0 V, -,I Z. C�- -� =?_! C.. C�� =11 Cr.,La�:i+ G' -.t0 ee C- _rc- =' =. I -- ?- _� _ t7 C^ SPCC C =_�= `.= 1_�_ A- e O PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES �f Date Re: Property of "Tolle e Located at ��Gi- 60 (T) A;7, C)tf4j tA(,t„��Section Block "Z— Lot tjl Subdivision of ;1� �JtF/ /�• c 7 Subdve Lot # Filed Map # `L4 Q Date d' Gentlemen: 7 This letter is to authorize /Gn-- a duly licensed professional engineer or registered architect (Indicate) to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, igned ��` Countersigned: ✓2 �y��,,.• L �"L,•i Owner of Property P.E. , : , # �'�% Address 46 Address o` Telephone Town Telephone or "� DESIGN DATA,.,Stc=- SUHSMCE. SFIVAGE..DISPOSAL SYSTEM FILE IAA.- .._ �a..ci��.:.e _� _� .rive :. �.n- �r- +.�_.._ .. , .. ... T. _ -_ . .............�.r •a ��c_r . . Owner - pfd'( ,ya�ly�l l�¢T% Address .a) /a G /� Located at (Street) T Z4W6r— d , �%� _3 6 Block Z, Lot (uidicate nearest cross street) Mnnicipaiity Avg .'uLy Watershed Date of Pre- Soaking Date of Percolation Test HOLE NL'_.�.ER CIAO TIME PERCOLATION PE RCOLATICN Run Elapse Depth to.Water FrarL Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches -/fad FleOAI s'�Gc % /d'�a� 1115W 2 &;u r 7-( 6-rb �C Erd S �u�^.- l S� %fk9AJ'6,4GGr lad - 4- 3 4 5 to P? 2 3 4 5 NGTFS: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained,at each percolation test hole. All data to'be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA RE7QU= TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NOe _ HOLE NO. _ HOrE_N0. G. L. �'� a�'.�� *�'1 �1 i;�t�lU�yf%p+'✓ . 2' 3' 41 4' £.> 5' 6' 7' 8' 10' lI' _ 12' 13' 14' - INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED Al 0 AfC INDICATE LEVEL TO WHICH MIER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY:, NcG`L DATE: DESIGN Soil Rate Used /- / Min /1"- Droo: S.D. Usable Area Provided 4 000 �`f= No. of Bedrooms 3 Septic Tank Capacity l t o D gals. Type ee 'C' 7"Zr" Absorption Area Provided By 37T"' L.F. x 24" width trench other ll�ci Name /L c ��tZC'_ �''— Signature 2 F. \ Address , rfC(Js /C �? SEAL �PM THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: �� N a1 ,"` . r�y� p.2$ �G� t.. sfa Fr;�, S 000, Soil Rate Approved sq.ft /gal. Checked Date ='E r c: —.ate L - - .- ..,. --• c ---cr c mac-- r�r-c'r'•�r'• DL_ L _ r" - -- I I I I I I ( � I I I � i I Ir i cc cr I 1•- I i oC.= I I A i . t Z., _ ...... .4." .. �. C_^r_�c t1LGz ' Ste:_ =1,c C70 c cG_= :,-,.c arc c ✓�-'^ .:__c : =_ _C 6 - ___ ( ^cam:: �` =-- - =_ —• -- _ � - an _ S-= =- C �_ Ce :.- C= -rvics L•_ _ E:t_=`c SISCeS Cat Lim cix -:' 1::r =- - c T � /_n 200 - T+ - --G_ O - AN cE 201 t-I t C.D 1 np , tj (� �1; 2r,�,� 1 : D_ -r. - r 100, to L_-- tf 131 �'� 7rinc— '�ir`_ -�f r., T .-_. o� b 4 � � q � a �Q .a �?ao� g a J 3 1; �U A � � O W \ V b a �e e e W N dA� /r.✓/►� N �� �ppZ yp \ V MAN \W qb o�y V k n9 D -Iv c v? W V v N N �e � v � I i N dA� /r.✓/►� N �� �ppZ yp \ V MAN \W qb o�y V k n9 D -Iv c v? W V v N N is 1 :IL •c C Q 'n I� I I I I I I �[1 SOLID ROOK; I �5 l i/2 MIN GROUT �? SEAL - •- •.�;--- THICKNESS \� E4t i 4 { �• I I Is'slli i I; 1.i WELL CASING • .I. CASING 20 FT. MIN. LENGTH UNDER ANY CONDITIONS. USE CLAY PUDDLE CORE BET w£EN CASING AND DRILL HOLE. ----; I I I ASPHALTIC SEAL G ( RING INLET �I� p +II I BOLTS CONCRETE SEPTIC TANK ,ICI L Iu�J SLABS POURED IN PLACE I! I I ARE DESIGNED 70 SUPPORT A MIN. LOAD OF { — .. .300 P.SF. I! .... _. _ - _._ _.. PLAN - .. LOCA'ION STAKE,•--- -a_o(I REMOVABLE MANHOLE, SA RS, 6 ` OIC. 20` MIN.-OPENING 7 0 IL 1 CAST IRON PIPE, WITH ASPHALTIC SEAL ^ z INVERT OF INLET TIGHT JOINTS . ' I 3 "ABOVE INVERT (1 V41 FT. MIN. SLOPE — INLET 1 1,IN OF OUTLET CAULKED JOINT CASING, 10' MIN. IN ROCK SANITARY TEE SANITARY SEAL ON WELL CAP �— SCREEN VENT WELDED SLEEVE IP TYPE COUPLING FROM PUMP TO PUMP �a BUSHING . 1 i II II 1 /PICi�i�L SLITION F -- LIOUIO EVE, i hT1 I I��„/ BAFFLES MAY BE USED INS -EAD i '1 OF SANITARY TEES L 2 la 1 W zI o I • CEMENT PARGING <I p ON INSIDE O" 5• -0" 12 .. MIN. -n`- REMOVABLE MANHOLE, 20" MIN. OPENING 36" MAX. � 4'. SOLID PIPE WITH TIGHT / JOINTS_ GRADED 1/8 `/FT. MIN. OUTLET �^ CAULKED JOINT — SANITARY TEE 6" MIN. WALL THICKNESS FOR POURED IN PLACE Ifi r CONCRETE jr (r y PEA GRAVEL OR I e SECTION CLEAN SAND 10 Q0 GAL. CONCRETE SEPTIC TA NK SEPTIC DETAILS I' prepared for j 1 G 7R�ii R G /�3U FlU ° /ifTi1� OF NEW Rt Y0 .:.t1 F. >,f +� a prepared by WILLIAM F. ZEILER 'Professional Engineer & Land Surveyor Concord Road - Mahopac -New York 10641 (9141•628-4764 - 5 Z,43 sFV PROFESS `�' IONP -,f 710,Al ta -Z e-0 7- tF3e7-1 C .-C -B-CXF7LL —5 0 f tz =-S 2. S to 'Ce 1:-V the deS4 an:i t=; VII. - ti- r a:!-.ar ca P-rd Z;== zz h- cic:. I I 7. 'W'H J ror e:=—',at- YIH. --0--pVc WA -:) OR CRUSHED D IS S A L I NLE Fenncyec.�-'- - . Corer . . PPOFiLf GRcUHo HL -'ZR. L, , — -crts re- at�ic- t�ia se=a L--uL-q -s ol- -e=L zo'r7C-w C.;' t2 -MIN. lw-.Ll- 'v,-' e Id of 5 C' ":W, _ii 7.' 60' 1H. to the of -: -7 5. The sewer system design shown hereon does not provide for the,4nstallation TRENCH' - DETAIIL INSTALL. 8"" ON i. TUMCTLJON. BOX o a gar age grin er,- auc nsta at on requires t e approva. -,p t e utnam County Dept. of Health. to stz 4 1 -- f6�- 60 to SO !--vs 1:7 P==.F-= DaT:Z�--r= cf Fea-1t::-. fc-r zricr-'= 2*---s--a!-1=-t=-7: of t�� szv,;-.c-- s,'=zan." * Laze of 2- : a---1 0f shal -I he suitzble for se"Face a�:= I=-- fi-se C-t f---:es or S., im'-e-an, rate . 5'zM.!;4 1 C- at e---,-' tz ts t Ln t-le saill t- m req2-1-= enqLneer/a= S'-`1 pezfo=- F F;­1 tz-T-- the aftar f; r' ay 1- a eanse cave." so;! L='—L'e or -o . zawa ace aL--ar-pticn cn-ca- ty 7 ; Depth gauges will be requi-ed iz the fil- section, one at —r h corner, top of.slope and one in the center of the fill pad. 5. rill suitable f6r se,.•,--ge absorption should 'contain no more than 5v and preferably no more than 21, fines by weight. Fines are clay and silt particles that pass a[ 200 sieve and, no more than 101, by weight, of the E'll material should pass a Vo sieve. SEPTIC DETAILS prepared for Zrepara,4 DV Z= rn=,*n--- S. Tand Suz-,revc: - noses -'a fc-% 1/87 PUTNAM COUNTY DEPARTMENT OF REALTH J\, Dlvlsba d Environmental Roalth Serviesc Carmel. N.Y. 10512 E ar to Provide Penult N CO on CERTIFICATE F CO \ U ON PERMIT FOR SEWAGE DISPOSAL SYSTEM Permit Ld:N-dtod at / / it -� _ �..� _ ; olrn or v e � y Subdivleloss Name ti t t'l cubd. Lot IY % ` Tax Map •, t Block T _ .. '" • Lot Renewal_ ❑ Revlelon— Owner /Applkant Nam—„ t i-t �& ,sr J� if � Date of Provi Approval / Milling Address Town—ei/ /�l �►df �si /'L' `� ZIP L Building Type Lot Area ;� " � � � FIB Section Only Depth Vuhmte Number of Bedrooms Design Flow G P D b PCHD Notification Is Repaired When FIB Is cot Separa Sewerage System to oonslst of te Gallon Septic Tank sn / of C,7 X04 G' f To be constructed by Address Water Supph: Public Supply From Address or: _Private Supply Drilled by — Addresst —C +v J Other Requirements 1 represent that I 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 reguRion�—1 • lt nam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Health will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition. any part of said sewage disposal system during the period of two (2) years Immediately following the date of the Issu- ance of the approval of the Certificate of Construction Compliance of the originst4tern or any repairs thereto; 2) that the drilled well discribed above will be located as shown on the approved plan and that said well will be installed in ' dance with the d r nd regu s ons of the Putnam County Ospart end •of Health. �' Date �n� Signed Q f P.E. .IG_ R.A. Atltlfeu 40 91-i' �a e"4Z 1 r +lam 1 L License No i APPROVED FOR CONSTRUCTION: This approval expires two years from he date issued unless construction of the building has been undertaken and Is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction requires 'a new pAermi . Approved for dispo I tlomeslic sanitary sewag an r' ate water supply only. Date�lfy .L. / / g� Title 7 v. I L41 �., PUTNAM COUNTY DEPARTMENT OF HEALTH Rev ,..-'3186 Division of Environmental Health Services, Carmel, N.Y. 10512 \ , Engineer Rust Provide V_ IV ?� .C.H.D. Permit N � ,4 CATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM ._ _ '>i'odrri or dwa�g ®" Located at � � l vet% Tax Mapil _ r_ h Lot Owner /applicant Flame e� P16 S � � � � d Formerly Subdivision am � Sabdv. Lot N Mailing Address S O M a Q c Fs Y L o*a Zip- / 0 S-.1 Date Permit lamed u rAl kM Vii �.b.& Separate Sewerage System built by �� L �+%'��°� Z (� ! Address -a '? ' / 09 By ev'? 10 /V Consistbtg of D tio:.on Septic Tank and eS-0 6 al + ink !! V f d R P 776►P Cy le JAL S'. ,Q .¢• Water Supply: Public Supply From Address or: Private Supply Drilled by 4 d�erJ'dY1 Address Building Type C D1- 06 1 L Has Erosion Control Seen Completed? a O Plumber of Bedrooms Has Garbage Grinder Been Installed? Other Reguiremento C 4J R 1'&/AI DIB &s M $6 D 2.6 JET, OF R, I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulations, in acc a wi a filed plan, and the permit issued by the Putnam County Health. r Data 9 2r c Certified by ./ p.. R.A. Address r e ieA / e_ 0 r� d,�� `v� `� `dy �j0 Q License No. Any person occupying promises served by the above system(s) shall promptly take such action as may be nocosmry to cOcuro the co►roction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as coon as a pub;,: sanitary wwor becomes available and the approval of the private water supply shall become null and void when a public water supply becOmCS availablo. Such opprovals are subject to modification or change when, in the judgment of the�C.o-mmmis�sh"wr of Health, such revocation, modification or ehango Is nocassmryy..j /7,� Dote�`�� 83� -� F - iron O& set :Z 0 U �rrAI C p se/ In maple N v U 1 SS 'EA i c sin •i , N• 05 °07'00, f _ a,o's` =�`r`, _ :. . - 23/. p8'• � InonL foand, :> _.-. .- . � .. ._� � ... -. ". ..'�' ".. :.' . . . ►. � ., •�e// Cap pdnaio //y �sel onn / /net f ear LOT 4,F114 2480 a, prop, corner 2. ± C. . /4/8 A , ho' ;o D R. 50.00' L.= 63.67 Q '• S. 85 033 'W. f 28.00 , i �7 -- 5.02 ° /6i4, Co /d spr /np I O 7n pins set on //ne rITF PL/4A1 O IV 2 W ^i SS DS -U E .._1N.S ....._...._... uN rr dt1 !R .I - __ Afji..P 3 _. _ -..... 3.S ...... f 7 86 4* i b p ; Iv ..6, s --ZS.. 1-7..P.... _... J. . /QS -- No7Eo7'iEiNS �1F,9SU�'ra �,.,�rl • v SAG.��'rt "nR "U face .o // ` ": l 295-52, 7TH/,5 is TD CERTI FY THAT -roe SP, w4L.E D /SPe.r,94L SVCTFH WAS C014S7RULTrD 1�05'74 NT "9"y " /NDicq'IF) ON THIS PLAhl AND TygT rNE S'/ -r7net •.vqJ /NJ PrL -rFa aY/7E gordrC ITw,). Ce VER6D. - YE SYSr6A•1 WAS c6NS7RUe-re0 So DS7.4 NT /ALLY !N A—OPO4AICE Wlrn 4L[ A}PPI- ILgGLE 9'UCF,S -4ND RSGbLgTrovS 9F- ..T.NE..P•C,N,p, AND THE N, Y, S.D•N• a MU County Department of 'Ai"th gieie of 8�n roamento H th Servioe �� lDPraaea as noted for oonformanoe with applioable Mules and Regulations of the %t" County Health Department.. �.�1t�tlM � T � ♦ MME -_�S. BU,ILT,PLA_IV._ ;SFwf�c� ,D /aPaSgL S_YSTFAJ L07 �4 SCHO1y6ALLA RS. ..ALQF_RT LA NF PvTN41-1 VALLEY -I, OPeRT.Y of hq.si C-LL n dacA• ors -. FA. '`/OUSE I � eAiAn, D w MO B n irv• ' i �APaNC /onl �ttT ro �sel onn / /net f ear LOT 4,F114 2480 a, prop, corner 2. ± C. . /4/8 A , ho' ;o D R. 50.00' L.= 63.67 Q '• S. 85 033 'W. f 28.00 , i �7 -- 5.02 ° /6i4, Co /d spr /np I O 7n pins set on //ne rITF PL/4A1 O IV 2 W ^i SS DS -U E .._1N.S ....._...._... uN rr dt1 !R .I - __ Afji..P 3 _. _ -..... 3.S ...... f 7 86 4* i b p ; Iv ..6, s --ZS.. 1-7..P.... _... J. . /QS -- No7Eo7'iEiNS �1F,9SU�'ra �,.,�rl • v SAG.��'rt "nR "U face .o // ` ": l 295-52, 7TH/,5 is TD CERTI FY THAT -roe SP, w4L.E D /SPe.r,94L SVCTFH WAS C014S7RULTrD 1�05'74 NT "9"y " /NDicq'IF) ON THIS PLAhl AND TygT rNE S'/ -r7net •.vqJ /NJ PrL -rFa aY/7E gordrC ITw,). Ce VER6D. - YE SYSr6A•1 WAS c6NS7RUe-re0 So DS7.4 NT /ALLY !N A—OPO4AICE Wlrn 4L[ A}PPI- ILgGLE 9'UCF,S -4ND RSGbLgTrovS 9F- ..T.NE..P•C,N,p, AND THE N, Y, S.D•N• a MU County Department of 'Ai"th gieie of 8�n roamento H th Servioe �� lDPraaea as noted for oonformanoe with applioable Mules and Regulations of the %t" County Health Department.. �.�1t�tlM � T � ♦ MME -_�S. BU,ILT,PLA_IV._ ;SFwf�c� ,D /aPaSgL S_YSTFAJ L07 �4 SCHO1y6ALLA RS. ..ALQF_RT LA NF PvTN41-1 VALLEY -I, OPeRT.Y of hq.si C-LL n WbLL UUFirLtT1VV r�LrUr%-1 DEPARTMENT OF HEALTH 4'. &a-1, PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREE�er t � A � URkSS: TOwN/ViLLAITITY TAi GRIO NUMBER: 46 kVIA 4 &?aL / /V�— — ff , WELL OWNER NAME: / 0 4a e r/. a� c Ei-nIVATE 1 0 PUBLIC USE OF WELL 1 - primary 2 - secondary O'RESIDENTIAL 0 PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY ❑ AMOUNT OF USE YIELD SOUGHT gpm./NO. PEOPLE SERVED —/ EST. OF DAILY USAGE — gal. REASON FOR DRILLING .[]REPLACE EXISTING SUPPLY ❑TEST/OBSERVATION ❑ADDITIONAL SUPPLY ffNEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH a ft. I STATIC WATER LEVEL ft. I DATE MEASURED DRILLING EQUIPMENT [R/ROTARY 0 COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT 0 CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE 0 SCREENED &fPEN END CASING ❑ OPEN HOLE IN BEDROCK 0 OTHER CASING DETAILS TOTAL LENGTH A 0 k MATERIALS: V-SEEL ❑ PLASTIC 0 OTHER LENGTH BELOW GRADE ft. JOINTS: ❑ WELDED L01HREADED ❑ OTHER (f in. SEAL: ❑ CEMENT GROUT ❑ BENTONITE UDflfER —DIAMETER WEIGHT PER FOOT lb./ft. DRIVE SHOE OYES aNO I LINER: OYES OM SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (It) DEPTH TO SCREEN (It) DEVELOPED? FIRST ❑ YES 0 140 C iA 11. GRAVEL PACK ❑ YES 0 NO GRAVEL SIZE: DIAMETER OF PACK In. I TOP BOTTOM DEPTH —ft. DEPTH — It. WELL YIELD TEST If detailed pumping METHOD: 0 PUMPED tests were done is in- COMPRESSED AIR formation attached? 0 BAILED [I OTHER ❑ YES ❑ NO it more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. DEPTH FROM SURFACE 'Water pear- ing Well Dia- m in ete l 11 FORMATION DESCRIPTION cace It. I WELL OEM It. DURATION hr. min. ORAWOOWN It. YIELD gpm. Land Surface o lie se 4 (4 O'd f -1 St A ;St WATER ATER 0 CLEAR TEMP. T QUA Q r UALITY 0 CLOUDY HARDNESS A U ❑ COLORED ANALYZED? OYES ONO ANALYSIS ANALYSIS ATTACHED? 0 YES ❑ NO [W STORAGE TANK: TYPE. Lyf,11 V---.rtj/ CAPACITY GAIL. PUMPP PUMP INFORMATION TYPE 5% (0 11 Lf CAPACITY TYPE R DEPTH lob MAKE MODEL VOLTAGE)-Z-0 HP 'ILI Mot) L WELL DRILLER NAME DATE ADDRESS r&G?-IftRE 3 1161-- 0 ),A J/89 j , I P';w *:-. -, y -q/ YML Environmental �,AB 1�iLJMBER :32.001,436 Services I DATE /TIMETAKEN 3/5/92 11:50 a.m. . > 321 Keay Street, Yorktawn_Heights; NY 10598 _ ..�:. - _ y. _ �... Y..T?ATF;� ELAP #103231 r (y14)145 -1$00 DATE REPORTED Kitchen Tap COL'D BY Michael Lipson — STAT! _ H2SO4 _ ZnOAc X SAMPLING RESULT UNITS Lot 4 Albert Lane pH ALKALINITY SITE mg/L Putnam Valley, NY PHOSPHOROUS AMMONIA For Lab Use Only n-g/L Potable _ HNO3 _ pH LT 2 _ <4C _ Nonpotable — NaOH _ pH GT 9 X <20 >4C SODIUM HCl _ Na2S03 — >20C COL'D BY Michael Lipson — STAT! _ H2SO4 _ ZnOAc X RESULTS OF ANALYTE RESULT UNITS .,,.. pH ALKALINITY S.U. mg/L PHOSPHOROUS AMMONIA rrg/L n-g/L SILVER CALCIUM n-g/L mg/L SODIUM CHLORIDE n-g/L mg/L SULFATE COLOR mg/L Units SULFIDE CONDUCTIVITY mg/L umhos /cm SULFITE COPPER n-g/L mg/L TURBIDITY CORROSIVITY NTU LSI -.rTi.". ... _ FLUORIDE mg/L HARDNESS mg/L IRON mg/L LEAD mg/L SPC MANGANESE per 1.0 mL mg/L TOTAL COLIFORM MERCURY per *100 mL n-g/L FECAL COLIFORM NITRATE per 100 mL mg/L E. COLI NITRITE per 100 mL rrg/L FECAL STREP. ODOR per 100 mL TON OFUI.M Iv�ETI -iQD USE7m� X TER TESTING ANALYTE RESULT UNITS pH S.U. PHOSPHOROUS rrg/L SILVER n-g/L SODIUM n-g/L SULFATE mg/L SULFIDE mg/L SULFITE n-g/L TURBIDITY NTU 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 sampl WAS [WAS NOT] [NA] of a satisfactory sanitary quality according to the New York State Sanitary Code, for the p ameters tested, at the ti e of sample collection. These results indicate that the water sample [WAS] [WAS NOT] A] a satisfactory chemical quality according to the New York State Sanitary Code, for the arameters tested, at th me of sample collection. {--- 1NA 1,x. =Not Applicable N =Not Present (Negative) SUBMITTED BY: ,(�S( P — Present (Positive) SA = See Attachment(s) ` =Also done because Total Coliform was present Albert H. Padovani, M.T. (ASCP) TNTC = Too Numerous To Count Director > = GT = Greater Than < = LT = Less Than P�1A - COUNTY DEPARTMENT OF HEALTH LFi' Owner or Purchaser of Building Building Constructed by Location - Street (,T- Municipality Building Type Section Block Lot Subdivision Name Subdivision Lot # GUARAN= OF SUBSURFACE SEWAGE 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 rror :i fni:.. � s� .�T_; twC �vears...i n; :i t iv. fc;iiLra nng. t;hc_g4te _of- aRpr yal o_ f- t -he_ "Certificate of Construction Compliance" for the sewage disposal system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the-determination of the Director of the Division of Environinental 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 bu' Zing utilizing the system. Dated this G y day of A6_1 19 �%7� Signature j Title General Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk Corporation Name (if Corp.) 93 �nrll Address % f. represent that-I On wholly ind'.c6rrigi above distribe0'wi:'il,be"c'onstrucied"as-I County -Department. of .,,,Health, .and, I bo.sut;mlttGd.-'tdJhe Oepar ment an( PtIC6 -on, good , operating �condition an shce, of�-Ilhci a p . pr . ov I a I I I of Ihe , Car , t z i , fic , a trill be lo8ated as shaven on-the appiova County Deportiniml: of: Health ." Dato. -A -'Address-62,7, APPROVED FOR-CONSTRUCTION- T revocable for'cause� or may bii irnilidei requires' new .1 �, . .4 �, , a new permit. pproved',fo tev. /87 Date his 4 ,.By an of pro , posai k d system(IS). 1). that, t , hi i . wa , ccordan w ce: with it . h 't he"iiawdardi, ruials* of.conitruction, Cormllarc,Q!' Wisf t "actarylt-0 rumaq!w w Ing, rums ano-raguimions-or,. ine w-uynam ' P.E. RA -1-lee'n-e No 'fIr.omAhe:dati Issued un ess construction of the building:.has. been' undertaken and Is necessary by the birn"I,s , si6nar- of Health. 'Any Change or alteration of , construction v'sawage an r rivote water ,supply .o'!!Y- Title _ I represent that 1 am wholly and completely, responsible fort he design and location Of- the prc .. above described will be constructed as shown on the spproved amendment thereto and an`iiioI County Department of -�Heafth, and that on completion - thereof a "Certificate' of Const►uctk be submiiii4 to tNe'.Department, arid- a' written guarantee will be' furnished -the owner, his place in• good, operating condition any -part 'of said sewage :disposal system during. that pei. once Of the,app►oval;of the "Cori ifiate of Construction Compliance of'theor 1'systen ed will be located as shownpn the,approved, plan and that siWwell will be >Installetl accordance County Ode+ /pe )men /O�t Mealth. Data 11 �%f Son De V87 t V APPROVED FOR CONSTRUCTION: This approve) expires` two years from the date issued .unit revoabie for cause or "may, be amended ;or;modified wheri.conside ed neeessary.'by toe ;COmr lisl requires /a�T➢ /pw permit, i4pproved Jor' disposal of domestic sent ary'sewa�e; and /o .pr IV to ;'A Date � ✓ � 2 �/ / By �J- SO system(,) 6 that the separate sewage disposal 'system with the standards, rulerand regulations of., TFW. u nam ripliance" satisfactory to'the Commissioner of.Healthwill sors,,,helrs;or auigns Dy the Duiltler, that slid builder will two`(2j' years lmrnediately following, the date of the issu- y re rs thereto .2) that the drilled welt.tlesc►ibed above nd rubs sngerspu'aTi%ni of .toe Putnam µ., P;E. R.A. License No :!07z. Kjt/ Onitruciion :of the. building has been undertaken'and is v oi- Mealth• . Any change or alteration of construction plynly. ,�O/ / S DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 --.. .- .. .. ^. r._ n .. ... rr:._ r. i I'�. .s r... -.nn • � .a T• . .. � . -. .. r.. s .n - r - APPLICATION TO CONSTRUCT A WATER WELL A rCHD rERMIT # WE LL LOCATION Street Address Town/Village/City k� - 7- G -A`Ne— A)V/ 41 // Tax Grid Number L ��� WELL OWNER Nam M . i . dress rivate Public USE OF WELL primary secondary RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT P ® ABANDONED BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify © INDUSTRIAL O INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT__jC�_gpm /# PEOPLE SERVED /EST. 13 REPLACE EXISTING SUPPLY O TEST /OBSERVATION NEW SUPPLY NEW DWELLINGI ® DEEPEN EXISTING WELL OF DAILY USAGE4ed gal 12. ADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR •DRILLING d/ A% J?j0 > dJA7&e- WELL TYPE DRILLED ®DRIVEN []PUG ®GRAVEL rl OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. HATER WELL CONTRACTOR: Name wi cl 9 Address: &e- IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY e7iSTt�IduE' '1'0 PROPEirii FiLori-ivEAUSi WATER MAIN: LOCATION SKETC& SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET (date) (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 Department attached to this permit. 3. Submit a Well Completion Report on a form requirements of the Putnam County Health 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: .2 j-" 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 zz C= = - 1) . c F C-7 A -:y 00, /,6 C: cf C*--,2-J' NTS YZE NO Plans szits cr =i:7c-! Dez:ca rz F v—_. cc 0,0 V==: EC C_ W7� Fes- Plans S =_= ��� I �I- 1 c:_- It 0 40 .4frV'dr .Oo C� rzt- Cn -- lz C::7 7 C I f 7 D c-r 104 e st�mt- C Tank E Eets "P A adot 1, t:, 1. r e—' -* I 7.:7-:= i C-,T= J zn-st -r- n:�c.. r on c -z.:7 C 3 Z:C_ -- =c == cr C�l T P & D cx ow,: & il- S z-- wlin c Z Prc=_-,taE & :;-Cn-- ic 4"0; .:z--- Pe T- i SEPARAZ= -..7ZjT_L.N,= --,I =72,7 L C_: L; f-:- 1001 to Ka-7-1; 20,01 f P, 100' t_ C. t. 1:j F7. 13' to Z)r= 3 10 t Z a z r L J: e E 2: v PC -1 PUTNAM COUNTY DEPARTMENT OF HEALTH _. _.-. .. �. .... _ :�- _.. _ _:..r. -._ .es• .. r.J•..- 'it... � ,r. -F•Y• a — ��.•.. �' .t+'..-.u, •_. .... ... �....a}f-+n. 1 -i ......a ..- ..,..... � .�.. �.�. .,: "'•. -_..i fir, •; - `APVL:rATfff'fd'A APPROVAL OF PLANS FOR A NASTEWATER�DISPOSAL SYSTEM 1. Name and Address ' Applicant: 1,.r 2. Name of Project: Sf D J i���,' f 3. Location T/v /C• ' ✓'An a.•r %4//� 4. Project Engineer:. Ad41'e �, y a2C- /tip 5._ Address: r�r�o'��►�. �i { �°a� 4Lti .4,, mac. Iv. .7- License- = Number:8/ Phone: 6. Type of Project: _ Private /Resident Apartments Office Building 7. Is this project subject .Type Status '(Check One.) ial Food Service ' -: , _.Commercial Institutional Mobile Home Park Realty Subdivision -Other (specify) to State Environmental Quality Review (SEAR)? Type I.. Exempt Type II. Unlisted .8. Is a Draft Environmental Impact Statement (DEIS) required? ............. 9. Has DEIS been completed and found: acceptable by -Lead Agency ?_ °...:.. 10. -Name of Lead Agency i, et -i'' thi ^project n ar area "under: the -_­ T CU �G� . °.O. 7UCdl , .td�r1r�C z }cnyn� ~i T LZ "'or oth&r b-fficials, ordinances? .... ................ ... _ -. . 12. If so' I -'have "plans `been s_ubmltted to such authorities 13. Has y approval been °grantediby such authorities? I. Date Granted ],t •' ,. 7 ;,. T T E'.y i.a k„F{ ! ' 14 Type Wof} Sewage ,Disposal System Discharge.. M Surface` Water Ground Waters :lx... 15. If surface water discharge, what is the 'stream class designation ?........ 6 Waters index number .(surface) ., •; ,;, , +'� 3J Y Ya. '•. .." 1 ....va. �k� V5 $,S ? . -� fit. "r ,.s :F: i 7 wIs project located near a,public water suppIy•system� r' Ai0 p •'..`..I•: „ ,. ♦S 1•• _ mil. A ;sh G;9t4almt Lti"a 8. If yes, 'name''of water supply Distance to water supply 1 '- 9 Is project site near a public `sewage collection or dis osal s stems p Y L1 � ., � a s 1.' T •" i t y ? ?k Ta' .s sf j a J' . 1 '�-•� [ 4 i 0 Name of sewage 'system *� �.._,�. Distance to sewage system ai 1. `bate observed °'23. "" j i:s,r Name +o f Health Inspector it 4 Pro3ect tlesign flow (gallons per day) t "a"h n�� - f - - t i i l r ;s9 i , ♦ •IT..�+q fF sT r r , ^ � h• i s,: W�'�i r } F t :'� _ _ " , "m lk ,.: f • ?µ yr' %0 1 ECEE ND 2. �v 25, Js Stag Pol I ut,44L MAe'16411-a 44,41L JN-Mg nation-Svs-tem (SPOW.- Perm-i-t-recort 26. Has SPDES Application; brepn L&ft�ed to local DEC Office? ............... * 27. Is any portion of this project located within a designated Town or State wetland? ...................... ........................................... . Ye'r 28. Wetland ID Number.. ............... ..................................... 29. Is Wetland Permit required? ................... ............... Has application been made to Town or Local DEC Office? ................... 30. Does project require a DEC Stream Disturbance Permit? ................... 410 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ......... YES or . NO Al 0 32. Is project located within 1,006-feet.of existence ce of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ...... ........ YES or NO DESCRIBE: 31.-Is there a local master plan or file with the Town or Village? ............. 34.. Are community water, -sewer-facilities planned to be '.developed within -15 - years? 3 _ .5 *ra and Waq_QL_1. d 36. Tax 'Map 'ID Number ................. .......... ...................... 17. Approved Plans are to be returned to: ............... Applicant Engineer 'f the,application is signed by a person other than the applicant shown in Item 1, the Letter of-Authoriziti'o" F .pp 1 i cat i on­i�Usif'be A6compan*i ed by 'a ti..-_z. al 1 u re to comp.y with `this ,r6-vision may be-grounds' for the rejection of submission.. I hereby affirm, under penalty of perjury,; that information prodded on this form is true to the best of my knowledge and belief. Fa Ise .statements made 7 -a Class A Misde�� t ' Sect 7on -of here in are 'punishable as pursuant . 7 0 the Penal Law. 7, T, 7 rGNATURES & OFFICIAL TITLES: A D.. . V. PUINAM COUNTY DEPARTMENT OF HEALTH DIVISION OF'ENVIRONMaMkL HEALTH SERVICES Owner R Q 4 114 Address V Located at (Street) J--ree"'a-r Sea. Block lot (indicate nearest cross street) Municipality n► 1A Ile y Watershed SOIL PERCOLATION TEST DATA RBQUIRED.T0 BE SUBMITTED WITH APPLICATIONS Date of Pre-Soaking J&le 9 Date of Percolation Test Af A HOLE NL14BER CI= TIME PEIICOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start-Stop Min. Start stop Drop In Min/In Drop Inches Inches Inches 24)"-/,4y' ?Q ad C2, Ar 4 5 2D, 3,a Yrl / 1 30 4 5 1 N=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 suhmitUd for review. 2. Depth measurements to be made from top of hole. rev. 9/85 ;ELFIN E TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION ouNIFY DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES C' A NO 59 �r® I.L. 21 31 cyp 41 51 61 71 81 91 10, 12' 13' -t- cee6 .0 L I 6 It 114 INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED A16Mg-' - INDICATE IMM To WHICH WATER IBM RISES AFTER BEING ENCOUNTERED M�e- DEEP HOLE OBSERVATIONS MADE BY: /)dh,0 DATE: ,f 9 DESIGN Soil Rate Used IS— Min/1" Drop: S.D. Usable Area Provided J--6 doe) No. of Bedrooms "? Septic Tank Capacity 16 QQ gals. Type 'e- e-QJ4� Absorption Area Provided By Name &44jf,1 J.- 4-60 L.F. x 24" width trench Address Ot 2S-S,--jed W 1)14 /ga A c IY �f /6 THIS SPACE FOR USE BY HEALTH DEFAFMIIEM ONLY: Soil Rate Approved sq.ft/gal. Checked by Date