HomeMy WebLinkAbout3126DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
63. -4 -14
BOX 25
I I r m .,
IN6 , ;�
MA hilmi } I m
I-6 .� � I �� .� I I
I I ,
po
, '� R
03126
a " PUTNAM COUNTY. DEPARTMENT OF HEALTH
Rev : 3186 Division of Eovirommenw Health Se vicar, Carmel, NY 10512'
x lEu&6er Mast Provide
P.0 H D Permit k
rr
CEE!IF[CATE OF CONSTRUCTION COMPLIANCE ,FOR SEWAGIS DISPOSAL SYSTEM R J �t�/?� Z
. _ - lc
Locatal .at G i G i� 2. Tn: Mai Block�Lot
` OMner/ llcant N ' e 1i � ' rmg 4Sitbdlvlslon:Nam rP abdy. Lot M�
Ip
}{'J� F o
MaWpg Address.. f��'T�_!�''']�41� _ �Z(p % Z7.�c�, �� Date Permit Iseaed
Separate Sewerage Syatem ball# by Address
Conalatleg of Gallon Septic Tank and
Water Sapply: Pablic supply From' as /
or: t� - Private Sapply Drilled by /-� 1��i1.S�l.1 Addeeas!`19'VI Give
B� ' 4 /fi t:�- Has Erosion Contro l Been CompletedY
Number of Bedrooms / Has Garbage Grinder. Heen Ins edY i
Other :Require
ments
I certify that the eyatem(s) as listed serving the above'premiees were 'cone ese tia y shown the plane- 'the completed work ( copies f
of. which are aftgched), and'in "accordance with,the,standarda, _iulee and re a_ na, in ac 'rC a wi a filed plan, and the,permit,iseued by the
Putnam county partme t Of Health j
Oats I Cwilflstl by P.E. R A i
Addreu LIan,. No.
?"
!Any' occupy)np premlaf ssrvid by the above system(tl shall promptly taki such actbn'as may tie neptory, o tatu►e the correction of any unsanitary
': -- - _ .r •r. :......�. rr...:......,d..w dolt luenn�., n,J1'aed veld ae Ioon of '� Publ;: unitary YWer 'becomes ,
y'4 'Com i Sivailabla. 'Such approvaq are
jMdifiedtion'o► ehanpa;la. rieceuary•
Title
P[3nm C XNfY DEPARTMENT OF HEALTH
Diyiaiu v OF E!ZrLF ZZI,,: �:T, i'1Pa -ux4
Da "/ F- -, j P- o V. T' &5 4 14
Owner or Purchaser 6f Building Section Block Lot
1?j0q'q'0'
Building Construct by
ZC-144 .r.> Dal ve
Location - Street
eJT -i
Municipality
12A /5(ga l�i4lJG�
Building Type
-D®UVroor-> 4 �
Subdivision Dame
_ B
Subdivision Lot #
GUARANTEE 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
o a' -e for a paril-A- -f two years i7mediately following the date of approval of the
"Certificate of 1.Construct on. Compiiance" for the sewage systE«, 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 building utilizing
the system.
Dated this .3Q day of ZAO - 199 Signature
Title
General Contractor (Owner) - Signature
Corporation Name (if Corp.)
Address
rev. 9/85
mk
Corporation Fame (if Corp)
4J:S-Tl"-j '
—` ess
'1'�
. :, - . - = 8.- r.;s• -�.. J�.)- - COUNTY DEPAFM%fl= OF HEALTH
DIVIS1W `Uk` :EW1i1.AW�; Fr ;` •sib �C`:?' s ;�, = - _ _
4 14
Owner or Purchaser 6f Building Section Block Lot
2C-4A 90 Aj1J 4j t-j 9L0 M 4
Building Construct by
Location - Street
PJVAH \14LI -cl
Municipality
12�isrgr.� eA�G�-I
Building Type
Do(2y/ n 4 CjZ-E-S
Subdivision Name
Subdivision Lot $
GUARANTEE 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
eai_:s- i=ediatel.y fol.lQwing .the date of approval of the
"Certificate of Construction Compliance"` for the 5,vdy` uI;.1� %sra�; '�_jy `:
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 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.
Dated this 3o day of -T-A"E -1995 Signature
Title
General Contractor (Owner) - Signature
Corporation Name (if Corp.)
Address
rev. 9/85
mk
.J 1 ni
Corpora ion Pame (if Corp.)
&SITIM D
ess
VCC: R. FCLEY. R.S.
._,sv._. _•... � _ ° ^- ;Ac�u�g_ ?,tC�ic Heait�h,�0�rec;zr -
DEPARTlv1ENT OF HEALTH
Division Of Environmental Health Services
4 Ceneva Road, Brewster, New York 10509
CERTIFIED RETURN RECEIPT RE(LESTED (914) 278 -6130
February 22, 1995
Mr. Davenport PLEASE REFER CORRESPONDENCE TO:
8 Richard Road NAME: Robert Morris, P. E.
Putnam Valley, NY 10579 TITLE:: Public Health Engineer
PHONE: (914) 278 -6130
OFFICIAL NOTICE OF NON COMPLIANCE
YOU ARE HEREBY NOTIFIED that non - compliance with Article III Section 4 of the Putnam County
Sanitary ;ode where evidence of sewage, discharged onto the surface of the ground was found at
your residence, by a representative of this Department on January 25, 1995.
It is. believed that you are responsible for correction of this condition. If you are not
responsible, you are requested to notify immediately the inspector above indicated.
Please be advised that appropriate steps must be taken immediately in order that the sewage
overflow cease by arranging for the septic tank to be pumped out and maintained pumped until the
proper repairs are made to the system.
Approval of proposed repairs must be obtained from this Department prior to any alteration or
rebuilding of existing disposal systems. An application is enclosed.
ra_l ;; iJ t)ump -'irl� 32 tank uy= Q J1:' uary 24, U.I_ L er, .Ln orrpct this col {_ ton
'
March 2, 1995 will make you liable for additional peria`Ilfles-'provideii uy -law,~ r;'ludii�y' t `«
prosecution on a charge of committing a violation punishable by a fine or imprisonment, or both
such fine and imprisonment, as prescribed by law, in addition to such other action as may be
prescribed. A reinspection will be made.
It is sincerely hoped that the above mentioned further action will not be necessary and that you
will cooperate by securing the correction of this condition.
For The Public Health Director
V y ru y rs,
uce R. F y, R. S.
Acti ng'%bl.i c Heal Di rector
Iced'. (-;111G2�
BF /RM /jp By: Robert Morris, P. E.
Enc. Permit Application Public Health Engineer
cc: BI (T) Putnam Valley
X
DIVISION OF ENVIRONMENTAL, HEALTH SERVICES
COUNTY OF PUTNAM - STATE OF NEW YORK
IN THE MATTER OF THE COMELAINT AGAINST,
Mr. Davenport, Richard Annunziata,
Roy Fredricksen
Respondent(s),
Arising out of the Alleged Violations of the
Public Health Law of the State of New York,
the Sanitary Code of the State of New York,
the Sanitary Code of the County of Putnam,
and Administrative Rules, Regulations and
Standards Promulgated Pursuant Thereto.
TO: Mr. Davenport Roy Fredricksen
8 Richard Drive PO Box 950
Putnam Valley, NY 10579 Mahopac NY 10541
Richard Annunziata
Austin Road
Mahopac NY 10541
NOTICE OF
HEARING
CASE NO: 90 -95 -19
PREMISES: 8 Richard Drive
(T) Putnam Valley
PLEASE TAKE NOTICE THAT CHARGES have been preferred against you to the effect that
you have violated the health laws as more fully set forth on the reverse side of
this notice:
YOU ARE HEREBY SUMMONED TO APPEAR at a hearing to.be held under the provisions of
the Putnam County Sanitary Code and Public Health Law of the State of New York
before Earle Warren Zaidins, Esq., an Administrative Hearing Officer of the
DEPARTMENT OF HEALTH of the County of Putnam on the 5th day of April 1995 at 10:30
AM., in the Hearing Roan, located at Route 312, 4 Geneva Road, Terravest Corporate
Park, Brewster, New York, at which time the charges will be informally discussed,.'
_.._rarerr►i a,ci' iir�_�F<cs c�afi,Q�rr�"� nQ .de.lgr��-:�.
n.
I r l!
AT ALL TIMES YOU WILL HAVE THE RIGHT to be represented by counsel and the right to
deny the charges, in whole or in part, following which the matter will be
rescheduled to a date certain and a Formal Hearing will be conducted thereon, and a
record of all the proceedings will be made, witnesses will be sworn and examined
and cross examined, and documentary evidence may be offered and received, and you
may produce witnesses and evidence in your behalf;
IN THE EVENT YOU WISH TO ADMIT TO THE CHARGES, the Hearing may be terminated by
written stipulation of discontinuance provided the violations have been corrected;
UPON YOUR FAILURE TO APPEAR, a warrant compelling your appearance may be issued or
an Inquest Hearing conducted and adetermination made;
CIVIL PENALTIES up to $500 for a single violation, per day, may be assessed against
you, and such further orders may be made herein as the circumstances may warrant;
THE BOARD OF HEALTH may issue a warrant to any Peace Officer of the County,
pursuant to Section 309 of the Public Health Law, to bring to its aid the power of
the County.whenever it shall be necessary to do so, with the same force and effect
as if such warrant had been issued out of a court of record.
DATED: March 16, 1995 BY:
Brewster, NY 10509
P NTY BOARD OF HEALTH
i .
B uce R. FoWy, R.S.
Acting Public Health Director
i..-,= . +ra. , x.;... ^w.� t. .. . �'.c-^• =^ - i::�+.:o'._..<v'wu � _.. .�- `.i.•.w..�•:..+a ��� � -v ..m Vii_ -v �:...:.. vw:..rcns: .e a � - -_ .: ca+�: ~ _rc-xwrw�a. s� �...... _ ,._:.xa<+�.:..:
STATEMENT OF CHARGE
IT IS HEREBY ALLEDCED THAT THE PERSONS HEREIN BEFORE NAMED RESPONDENTS are charged
with violations of the Health Laws of the State of New York and the County of
Putnam as follows:
PUBLIC HEALTH LAW OF THE STATE OF NEW YORK:
Violations of any and all provisions of the Public Health Law of the State of New
York and the State and County Codes and Administrative Rules and Regulations
promulgated pursuant thereto - which shall be found to constitute a NUISANCE,
particularly, and not limited to the provisions of Article 13 of -the Public Health
Law.
PUTNAM COUNTY SANITARY CODE
ARTICLE ill, SECTION 4
Sewage on the surface of the ground.
March 14 & March 15 1995
SANITARY CODE OF..THE .STATE OF NEW YORK
ADJOURNMENTS: Public Health Law violations are serious. They affect or may affect
the health, safety and welfare of the community. They cannot be permitted to.go on
e� !i ?i�e?f i �to7�i ? 7e is �I�r�l!Y�t�Y?.�+ilfc ��r.. I'.ac, i.w��> ? j 1 :Fo bra tea - •yrs.. >; ^.S fc
adjournments must be made in person or by counsel to the Hearing officer at the
time set for hearings, except for legal excuses. Persons operating an
establishment, business or facility, for which a permit is required - without such
permit- will not be granted an adjournment. Health matters are involved and the
Public Safety is a paramount consideration.
cc: B. Foley
R. Morris
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
CERTIFIED RETURN RECEIPT REQUESTED
Mr. Richard Annunziata
Austin Road
Mahopac, NY 10541
Dear Mr. Annunziata:
r
BRUCE _R: FOLEY. R.S.
_. .,� .1 - •rZ � �.. r....'
Acting Public ~Health Director �L
January 27, 1995
Re: Davenport
8 Richard Drive
(T) Putnam Valley
This correspondence is to confirm our telephone conversation on January 25, 1995
in which it was agreed that when the soil on the above referenced lot is suitable
to cross, i.e., a frost or dry period, the septic system on the above referenced
property will be repaired. The repair will consist of the replacement of the run
of bank fill and the raising and replacement of the lower trenches.
p ^r.iod'.priul"-.
~� to prohibit sewage effluent from discharging to the surface of the ground. _.._.•_.._.__T
If the septic system is not repaired by February 25, 1995 this Department will
begin legal proceedings and a hearing will be scheduled at the earliest possible
date.
Very truly yours,
.Robert Morris, P. E.
Public Health Engineer.
RM/7P
cc: .Davenport, 8 Richard Drive, Putnam Valley, NY
Marvin' O'Dell, (BI) Town 'of Putnam Valley
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
CERTIFIED RETURN RECEIPT RE(1JESTED
March 14, 1995
Davenport PLEASE REFER CORRESPONDENCE TO:
8 Richard Drive NAME: Robert Morris
Putnam Valley, NY 10579 TITLE:: Public Health Engineer
PHONE: (914) 278 -6130
OFFICIAL NOTICE OF NON COMPLIANCE
YOU ARE HEREBY NOTIFIED that non - compliance with Article III Section 4 of the Putnam County
Sanitary Code where evidence of sewage, discharged onto the surface of the ground was found at
your residence, by a representative of this Department on March 14, 1995.
It is believed that you are responsible for correction of this condition. If you are not
responsible, you are requested to notify immediately the inspector above indicated.
Please be advised that appropriate steps must be taken immediately in order that the sewage
overflow cease by arranging for the septic tank to be pumped out and maintained pumped until the
proper repairs are made to the system.
4pproval of proposed repairs must be obtained from this Department prior to any alteration or
rebuilding -o:f ex _stj;ng:._disposal,..systems.. An application is enclosed.
Failure to pump the septic tank by March 20, 1995 and further, to correct this condition by
olarch 25, 1995 will make you liable for additional penalties provided by law, including
arosecution on a charge of committing a violation punishable by a fine or imprisonment, or both
Buch fine and imprisonment, as prescribed by law, in addition to such other action as may be
3rescribed. A reinspection will be made.
[t is sincerely hoped that the above mentioned further action will not be necessary and that you
vill cooperate by securing the correction of this condition.
1K/R M/] P
inc. Permit Application
:c: BI (T) Putnam Valley
For The Public Health Director
Frutruly yours,
e R. F ey, R. S.
Act"10nPublic health Director
By: Robert Morris, P. E.
Public Health Engineer
�i
PUTNAM COUN'T'Y DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH- SERVICES.
-. '. :S= c..- :."`- iv`°:�.- ws.+:,� .... ."i....':m:±e:;:c'. ..-. .... .�� , n _ ..,. -:... - --• .� _ .�a• . +- .:..r ."""i.+v:;..:.. _' '.w'..:y�•.r:✓..... ........�, -. .... �... r ,..
41-4t,J
Owner or Purchaser ot Building
iJW. -ui-A - 4A'T -/4
Building Constructed by
Location - Street
,
Municipality
. _b , - L� A
Building Type
&' 3,0 / 14_
Section Block Lot
Subdivision Name
W` (`
Subdivisi nn Leo #t #t
GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM
I represent that I am wholly and completely responsible for the location,
worknanship, 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
..,�• -`_r t- if-icwte..of • Cop. strLctian -.0,om _iance " -f-o - ,ytitan or anccr:;:
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 building utilizing
the system.
Dated this /4- day of 19 5/4
General Contractor (Owner) - Signature
— o G"51.
Corporation Same (if (torp.)
Rd.
ail
rev. 9/85
mk
Signature- ;r,�in /..�^�f,�.;, ,� ✓� _ `___' .
Title
,_J� v --
Corpordtion N (if rp.)
NJ 4 V�1
Adclfess'
8P?CCE R. FOLEY. R.S.
DEPARTMENT Of HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
CERTIFIED RETURN RECEIPT REQUESTED (914) 278 -6130
February 22, 1995
Mr. Davenport PLEASE REFER CORRESPONDENCE TO:
8 Richard Road NAME: Robert Morris, P. E.
Putnam Valley, NY 10579 TITLE:: Public Health Engineer
PHONE: (914) 278 -6130
OFFICIAL NOTICE OF NON COMPLIANCE
YOU ARE HEREBY NOTIFIED that non - compliance with Article III Section 4 of the Putnam County
Sanitary Code where evidence of sewage, discharged onto the surface of the ground was found at
your residence, by a representative of this Department on January 25, 1995.
It is believed that you are responsible for correction of this condition. If you are not
responsible, you are requested.to notify immediately the inspector above indicated.
Please be advised that appropriate steps must be taken immediately in order that the sewage
overflow cease by arranging for the septic tank to be pumped out and maintained pumped until the
proper repairs are made to the system.
Approval of proposed repairs must be obtained from this Department prior to any alteration or
rebuilding of existing disposal systems. An application is enclosed.
, a �;4n�
March 2, 1995 will make you liable for additional
prosecution on a charge of committing a violation
such fine and imprisonment, as prescribed by law,
prescribed. A reinspection will be made.
?95 %r:d i.iriY;dr -..fin.rr�r_roi�f th` r .vrlit;.... -
penalties provided by law, including
punishable by a fine or imprisonment, or both
in addition to such other action as may be
It is sincerely hoped that the above mentioned further action will not be necessary and that you
will cooperate by securing the correction of this condition.
For The Public-Health Director
V y ru y rs,
hi-uce R. F 1. y, R. S.
Acting P+ b1A c He Director'
BF /RM /jp By: Robert Morris, P. E.
Enc. Permit Application Public Health Engineer
cc: BI (T) Putnam Valley
JAtJ 17 ' 94 14: 4- FP1JP1
YML ENVIRONMENTAL SERIV I C
Yorktown Heights, NAT-111907 .:• .
(114) 245 -2a00
Albert H. Padovani, Director-
PAGE 02
LAB W 93.002492 CLIENT 0: .2 011) STIT PRi C PAGE i
ANNUNZIATA, RICHARD LA. /TIME TAKEN: 01/14/94 08 :30
AUSTIN RD DA E /TIME REVD: 01/14/94 1000
MAHOPAC, NY 10541 RE ART DATE: 01/17/94
FHt NE; ('914) -6 1-- 60TO
SAMPL I N5 SITE: S RICHARD RD WAT�R TAN.;
C.CLID BY! R08ERT FANNY
NOTES...
fI •r + rye"+.'- +•'+v'+NY!/VNMNIINNf.•fl flN fJ flflf+Nr+. +v-J .er /l v+rNll NIJ N..IN fII'I fI ff 11 f!^+N^'+v'V
DATE FLAG, PROCEDURE RES UL
SAMPLE TYPE..: POTABLE
PRESERVATIVES: NONE
TEMPERATURE..: < 4C
COL I F ORM METH: MP
v..l.Jf+IJN/J rJNIINNIJ fIN fJ f1 /I fl f /fII'IMMM. -.•N
NORMAL — RANGE
01/17/91 MF T. COL11F10Rr i ASSENT 11q0 ML ABSENT
COMMENTS;
FACT ,THESE RESULTS INDICATE THAT THE WATER WAS IWA5 NOT) OF A
SATISFACTORY SANITARY OUALI TY ACCORDING t D T E NEW YORK STATE
AND EPA FEDERAL DR I NK I NO WYTER STANDARDS, FG=Fi THE PARAMETERS
TESTED, AT THE TIME O COULLCT I ON .
SAM I TTED LAY: ------- ---------------
Albert H. Pad vani. M.T. (a:_CP)
ELAPi 1OS23
®vtleel Neap_
I,ropress t that 1 am wholly. and completely rorponsible for, the design and :location of tho proposed system(s); a) that the separate saw di OI stem
above described will be constructed as shown oe the approved aanendmentahero to and in accordance with the standards, rules a regu sons o na
County Department of NMlth, and that on completion cheroot a °Certificate of Construction' Co liance ", satisfactory to this Commissioner Of Health will
be submitted to the Department, ands written thiaranteo wili_pe iu"misMd owner,, his su ' s; heirs or, assigns by the builder; that said buildor will
Place in ,good .opwaiting cendition,any, port of fold Esevago disposal sySte , d in, this of (2) y Imaadiately fohowliq thedetikof the Issu- 11 once of that approval of ttN Certifkate of {oalstructfow Compliance oP T o Iginal. st tepaire t ; ato; Z) that the drilled well described abot*
w1M be located as shown_ an the &Pwpved.plon and that fa!® well will be In 11®d n a dance Wine rube and regu ns of Putnam
Cdtenty 'Depart 01 lth
Sioned
AdAresa - —Ucoaase No
APPROVED FOR CONSTRUCTION: This approval elapire5 two years from the slate i unless construction of tho 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
veo"ai a now permit., 'Approved 'for-dispoaal Of domestic saniteryc-sowage; and iva water supply only.
Rev. Det® jz-2 7 _ GDy b . ��e�
10/88 " ��'
P
WELL UUMrl-LIJUN K1!,k'UKi
DEPARTMENT OF HEALTH
's±on 0f.-En!,vixoome P!_..H,
ryF 0 PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
( i`�!' LJ ��i
WELL LOCATION
-STREET AOURESS. TOwmrflLLACLJCIry_ TAX GRID NUMUM
WELL OWNER
NAME ADDRESS:
2 1 _7 iA_7 j L;�
GAIVATE.
0 PUBLIC
USE OF WELL
1 - primary
2 - secondary
[3/RESIDENTIAL 0 PUBLIC SUPPLY 0 AIR /COND. /HEAT PUMP ❑ ABANDONED
0 BUSINESS ❑ FARM 0 TEST/OBSERVATION 0 OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL 0 STAND-BY 0
AMOUNT OF USE
YIELD SOUGHT gpm.1N0. PEOPLE SERVED _/ EST. OF DAILY USAGE — gal.
REASON FOR
DRILLING
❑REPLACE EXISTING SUPPLY ❑TEST/OBSERVATION ❑ADDITIONAL SUPPLY
EIM SUPPLY (NEW DWELLING) EIDEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH ISO __fL1
STATIC WATER LEVEL 1-0ft.1
DATE MEASURED lit
DRILLING
EQUIPMENT
9-hTARY 0 COMPRESSED AIR PERCUSSION 0 DUG
0 WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
1 0 SCREENED &-OPEN END CASING 0 OPEN HOLE IN BEDROCK 0 OTHER
CASING
DETAILS
TOTAL LENGTH I ft.
MATERIALS: G MEL O•PLASTIC OOTHER
LENGTH BELOW GRADE tL
JOINTS: OWELDED O-THREADED OOTHER
DIAMETER in.---
-SEAL: 9-aMENT GROUT 0 BENTONITE DOTHER
WEIGHT PER FOOT 1b./It
I DRIVE SHOE. 0 YES Q1 W
I UNER: 0 YES ENO
SCREEN
DETAILS
4
DIAMETER (in)
SLOT SIZE LENGTH (it)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
0 YES ONO
Hou
GRAVEL DIAMETER TOP BOTTOM
SIZE: OF PACK In_ DEPTH I'L DEPTH — IL
SEC OND
0 YES
0 NO
GRAVEL PACK
WELL YIELD TEST If detailed pumping
— METHOD: 0 PUMPED i tests were done is in-
P4MPRESSED AIR formation attached?
0 BAILED 0 OTHER 0 YES 0 NO
it more detailed tormation descriptions or sieve analyses
'WELL LOG, are available. please attach.
DEPTH FROM
SURFACE
Walef
Bear-
ing
I
Well
Dia-
in melcr
FORMATION DESCRIPTION
CNI
—
it.
ft
WELL DEPTH
IL
DURATION
hr. min.
DRAWOOWN
It.
YIELD
d
S Lanurface
WATER 0 CLEAR TEMP.
QUALITY 0 CLOUDY HARDNESS
0 COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? 0 YES 0 NO
STORAGE TANK: TYPE
CAPACITY GAI..
PUMP INFORMATION
TYPE
MAKER
MODEL
CAPACITY
DEPTH —
VOLTAGE HP
WELL DRILLER NAME DATE
ADORE Al, (NA
0 V, (�' /��,,� '��" , J.1
(All
9 -,,1
k
.rA*N 1, 1.94 14:47 FF,.0 Mi
L' i. e C Ty t f— . i r9 '� ! "' t T
A i C C f' t H' r' ;-( d `4' a rt i ! i r• c-!-- t o
LAF. ft; S. 00 :1? 49 5 CLIENT 0 Ck S., i AT , 'din_
PAGE 02
ANNiONi IATA, P IC -HARD DA , .!TIME TAl:EN: 0 / 14!'�4 E7$: SO
Pu%-:;TIN RD L -EA E /T'TME 01114/ 14
iIAHE..iPA :, NY 10541 DATE: o / 1 ; /94
SAMPLING SIT,:!-: c. f' fii! WA I °EFL TAN," SAMIL-'LE T Yi F , .. PE -1 TABLE
i'!i3 fs BY. P'!;!:EEER -T PAAiNY �'-MPE.nATURE... < 4C
7 H. 'If=
r .• -.. r �•- _.�. +."J ✓J rJNA •r rJ!V Nf:rr.'r rr -. ♦ r���_.���.- �._....v N/J fW l.a .r rJM Fr lr rv:<r Jr'i •'+r +-�.-- ��+� +�_ :.vIJw.VrJ/WIIrr lr rr rr rr rr rr r: r: nr rrrJrrM Mh+rr
1:1A T E Iv? -A1`i ='t`;E_ii r D1, :F,
a.1.. 1; f•14 NI T. (-+SISEN7 /Lik ML Ap •_•citt
BAEI:T THESE R'58 _ L T S I Nr' l C :ATE TL;
PO_ 1
pX3TNAM COUNTY DEPARTMENT OF HEALTH
�`•°.~ ...._ ° - .. `f+Fr L�Gfi'i �'Ci`P' �17�'-`�iPFPGV�,t t1� P���VS�'rtlhn"r-; ^�ii'�o i �i�A'`CK�''uI�i -CJh� . __. _ .. _
t . Name and Address of Applicant:
W
/Z L— > A61 J
Name of Project: 1�%( 1c 3. Location T /V /C: CAR4416wC.--,.
Project Engineer: t7 � 5. Address: �a�C ,�
J
License Number: Phone:
T oe Protect:
P rivate /Resi dent ial Food Service Commercial
Apartments Institutional Mobile Home Park
Office Building Realty Subdivision Other (specify)
. Is this project subject to State Environmental Quality Review (SEAR)?
Type Status (Check One) Type I.. Exempt /
Type II. Unl fisted
. Is a Draft Environmental Impact Statement (DEIS) required? .............
d
Has DEIS been completed and found acceptable by Lead Agency? ...........
. Name of Lead Agency
.tt r -'' -h -� S D- o �@Gt..: -y .. or ��'P_ o 9 S i� �?1 �P^ -• ; �^.. - - - -
_ ._.._. �.•...� r n u. r t -nP . , n. i n -... : 2d11 ........r.. _..__ �.- .r.- ,.._._�.:
or other officials, ordinances? ......... ...............................
If so, have plans been submitted to such authorities? ...................S
Has preliminary approval been granted by such authorities? Date Granted:
Type of Sewage Disposal System Discharge...... Surface'Water Ground Waters
If surface water discharge, what is the stream class designation ?........
Waters index number (surface)
Is project located near a public water supply system? ..................
If yes, name of water supply �— Distance to water supply
Is project site near a public sewage collection or disposal system ?.....
Name of sewage system c —, Distance to sewage system
Date observed:
23. Name of Health Inspector:
Project design flow (gallons per day) ...... ............................... �2o d
! ^2.
5. Is. State .Pollutant Discharge Elimination System ( SPDES) Permit required?..
i. Has SPDES Application been submitted to local DEC Office? ...............
r. Is any portion of this project located within a designated Town or State
wetland? .................................. ...............................
3. Wetland ID Number .......................................................
�. Is Wetland Permit required? ................... 141,,eF01-
Has application been made to Town or Local DEC Office? ..................
1. Does project require a DEC Stream Disturbance Permit? ...................
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
Is project located within 1,000 feet of existence of abandoned landfill,
hazardous waste site, salt stockpile, landfill, sludge disposal site or
any other potential known source of contamination? ..............YES or NO
DESCRIBE:
. Is there a local master plan or file with the Town or Village ?�-
Are community water, sewer facilities planned to be developed within 15 years? -
a:r zinv sou.' disoe��a �r��__ ^- �xce�5_u._= '`- ''`�e'.�_
. Tax Map ID Number ......................... ...............................
Approved Plans are to be returned to: Applicant ✓ Engineer
the application is signed by 'a person other than the applicant shown in Item 1, the
plication must be accompanied by a Letter of Authorization. Failure to comply with this
avision may be grounds for the rejection of any submission.
I hereby affirm, under penalty of perjury, that information provided on this
form is true to the best of my knowledge and belief.. False statements made
herein are punishable as a Class Hisdemea r pursuant to Section 210.45 of
the Penal Law. i'1 M n
JNATURES & OFFICIAL TITLES:
'LING ADDRESS:
PUTNAM COUNTY DEPARTMENT OF HEALTH
�� -' �._ ,• -��-. . -_ ; -r. - -T �., -- IS. �: O, ri_- �J. F.-:- F- r�r {rr}2���1iP�1E.l`�T. ^ -.:U :±�,�h`.E`ru_ S#,+.:jt`w =1:�-�.�...�__-:-. ,.... , �... �---
Re: Pro perty of I�-- 'e_—W4 e'C>
Located at t i
Date M& ZD /9 !3
, -r--: > P, r 6) 1E"- --
(T) UIaxy Section Block Lot
Subdivision of
Subdv. Lot # Filed Map # Date 3 fp
Gentlemen:
This letter is to authorize
a duly licensed professional engineer L"- 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
corm c ri:_ rit.Ei_ _th "s` rc►a..ctsr. and. to supervise' `the.:c.c �azr»,rt .��n of'. aa.3.d
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.
Countersigned:
P.E., R.A., #
`t0 Gox 9L-
Address
d V IDS-4L
Telephone
Very truly urs,
Signed /1/Lt�44f
Owner of P operty
AddreA
T wn
628-6a(3o
Telephone
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
i^ _ "'�77'`!!.�r+ T!-'� '^T� ��!! t -n'.j' .- �'����',�j�`�� �� M�l�il .�L'LLwc •. �r.++.i av: � � . a. � - .acs
arc a. :i a1LM iL:'i V�.11 :51^�{'.••LV ;t.'l'i`il \17 �..� �li �' � C�
PCHD PERMIT # y� `
LOCATION
treet Address
To Village Ci v Tax
Grid
.WELL
,
rber
WELL OWNER
ame
M fling Addre s
pz `
ivate
s
f
O Public
USE OF WELL
IDENTIAL
O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP
® ABANDONED
1 - primary
® BUSINESS
O FARM O TEST /OBSERVATION
O OTHER (specify
2 - secondary
® INDUSTRIAL
U INSTITUTIONAL O STAND -BY
AMOUNT OF USE
YIELD SOUGHT___tG,_�_gpm /# PEOPLE SERVED /EST. OF DAILY USAGE gal
REASON FOR
O REPLACE EXISTING SUPPLY O TEST/ OBSERVATION CI ADDITIONAL SUPPLY
DRILLING
U4EISUPPLY NEW DWELLING ® DEEPEN EXISTING WELL
DETAILED
REASON FOR
p
DRILLING
WELL TYPE
ORRILLED
®DRIVEN
®DUG
®GRAVEL.
® OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
a
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: S
Lot No.
WATER WELL CONTRACTOR: Name ���yyp��. Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES c,,--'0"NO
NAHE OF PUBLIC WATER SUPPLY:
TOWN /VIL /CITY
�DISTi41d�E_TQ, PROP.ERTY_EROM T NEARES� Td:.ATrpr
LOCATION SKETCH & SS URCES OF CONTAMINATION PROVIDED
94 SEPARATE SHEET
(Gate (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
thirt- (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:
Date of Expiration 19 _ Permit Issuing Offi j
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
WELL COMPLETION REPORT Office Use Only
y DEPARTMENT OF HEALTH
VFW �j 0 PUTNAM COUNTY DEPARTMENT OF HEALTH
STREET AOURESS: TI)WNIVILLACLIC11Y TAX GRID NUMBER:
WELL LOCATION �►, eh ,,D Pvt,cl
NAME ADDRESS:
WELL OWNER
USE OF WELL
1- primary
2 - secondary
MOUNT OF US
REASON FOR
DRILLING
DEPTH DATA
DRILLING
EQUIPMENT
WELL TYPE
CASING
DETAILS
SCREEN
.DETAILS
O,$QIVA I r
�c1,-led 4r v,+ 21ArA9 .4✓3f.n/ / 0 syiaL,o�ac Newt' —,� 0 PUBLIC
la'RESIDENTIAL. D PUBLIC SUPPLY O AIR /CONO. /HEAT PUMP O ABANDONED.
❑ BUSINESS O FARM ❑ TEST /OBSERVATION O OTHER (specify)
O INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY ❑
YIELD SOUGHT �L gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal.
[]REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION []ADDITIONAL SUPPLY
UY9W SUPPLY (NEW DWELLING) ❑ DEEPEN EXISTIN�"G�' WELL
WELL, DEPTH _ ft. STATIC WATER LEVEL _ ft. I DATE MEASURED (
OTARY ❑ COMPRESSED AIR PERCUSSION O DUG
O WELL POINT O CABLE PERCUSSION O OTHER (specify):
❑ SCREENED I9-VEN END CASING O OPEN HOLE IN BEDROCK O OTHER
TOTAL LENGTH
LENGTH BELOW GRADE
DIAMETER
WEIGHT PER FOOT
DIAMETER (in)
FIRST
WATER O CLEAR TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? O YES O NO
ANALYSIS ATTACHED? O YES O NO
PUMP INFORMATION
TYPE CAPACITY
MAKER DEPTH
MODEL VOLTAGE HP
I tL MATERIALS: aWtEL O PLASTIC D OTHER
ft. JOINTS: ❑ WELDED C!- TNREADED O OTHER
--L—in. SEAL: Qt�MENT GROUT O BENTONITE OOTHER
Ib. /it. DRIVE SHOE O YES 13IM'- LINER:OYES (340
SLOT SIZE LENGTH (It) DEPTH TO SCREEN (11) DEVELOPED?
O YES ONO
' DIAMETER TOP BOTTOM
OF PACK in. OEM tL DEPTH IL
'W1� /ELt LOG . 11 more.detailed formation descriptions or sieve analyses
ELL L t] are available. please attach.
DEPTH FROM VYater well
SURFACE ear. Dial FORMATION DESCRIPTION COOS
meter
ILI it linglIn I
WE
STORAGE TANK: TYPE
CAPACITY GAIL
WELL DRILLER NAME kercLnl 121%W OATS r /!
AGO tA q � S f
PLfol.,
GRAVEL PACK
O YES
GRAVEL
O NO
SIZE
WELL YIELD TEST ; If detailed pumping
METHPO: O PUMPED i tests were done is in-
G�COMPRESSED AIR ; formation attached?
O BAILED O OTHER ; O YES O NO
WELL DEPTH
DURATION
DRAWDOWN
YIELD
IL
hr. min.
It.
gpm.
A
WATER O CLEAR TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? O YES O NO
ANALYSIS ATTACHED? O YES O NO
PUMP INFORMATION
TYPE CAPACITY
MAKER DEPTH
MODEL VOLTAGE HP
I tL MATERIALS: aWtEL O PLASTIC D OTHER
ft. JOINTS: ❑ WELDED C!- TNREADED O OTHER
--L—in. SEAL: Qt�MENT GROUT O BENTONITE OOTHER
Ib. /it. DRIVE SHOE O YES 13IM'- LINER:OYES (340
SLOT SIZE LENGTH (It) DEPTH TO SCREEN (11) DEVELOPED?
O YES ONO
' DIAMETER TOP BOTTOM
OF PACK in. OEM tL DEPTH IL
'W1� /ELt LOG . 11 more.detailed formation descriptions or sieve analyses
ELL L t] are available. please attach.
DEPTH FROM VYater well
SURFACE ear. Dial FORMATION DESCRIPTION COOS
meter
ILI it linglIn I
WE
STORAGE TANK: TYPE
CAPACITY GAIL
WELL DRILLER NAME kercLnl 121%W OATS r /!
AGO tA q � S f
PLfol.,
k• • 5�l � l •e <b;IDi lv,.. _��+•. '� `1'11.[:
OMMIS MWE �A) c/ex) f 4r
/� - /6 2 - 9r
SITE I=TION 40 Z)12 I'- 0`f- A)JyAn. J1A1 -V J TH#
WRILIM ADDRESS
PEA INTERVIEWED Pty Complaint
Name & Relationship (i.e,, owner,tenant, etc.)
DATE (� �� Ar TYPE FACILITY
•;� ��a. X11 � �• .: �a�;�:
REGISTRATION #
(include sketch locating all adjacent walls):
ROTE: Repair must be in same location and of same type as original smage disposal system.
Different location may require submittal of proposal from licensed professional engineer or
registered architect.
iMA r
IMPIUM-1 ME
..- .. -•.... .- ...-ia. M. +er a-.1^+. r. -.. rra .._ �_ .. .F ..es � .. .ry -... .. ........_•��. ..n.�. r. _...•.e.x -- .- .r.- ,:..w. s w.- '�'iur �. -.- wP -.e .. — _ _
Proposal approved Proposal Disapproved
Inspector's Signature &
(, Z/ 1�,e-
Date
proposal approved with the following conditions:
1. Procurement of any Town permit,, if applicable.
20 Submission of as built repair sketch in duplicate showing:
a> Owner Is name
bo Site Street Name, Town and Tax Map numbers
ce Location of installed components tied to two fixed points (eogo,house corners).
do System description (e.g., 1250 gal. concrete septic tank, three precast 61 diamo x 61 dip
drywells surrounded by one foot + gravel).
e. Installer °s name and number.
3. System repair to be performed in accordance with the above proposal and conditions.
I, as owner,, gent of owner agree to the above conditions.
SIGMURE TITLE MTE 6b
DPI: Vtdte (PAID); YeUcN (fin EI) g Pink (ARliamt)
rl
DEPARTMENT OF HEALTH
D_ ivision Of Environmental Health Services
4 Geneva Road, ,Brewster, New York 10509
(914) 278 -6130
June 14, 1995
Charles & Dina Davenport
8 Richard Drive
Mahopac, NY. 10541
Re: Addition - Davenport
(T) Putnam Valley
Dear *Mr. & Mrs. Davenport:
I have received and reviewed the plans for the proposed addition to the above
mentioned residence.
The-plans have been approved as per plans bearing this Departments stamp and
dated June 13, 1995.
0
Hesith Director
The survey indicates that sufficient area exists to expand or repair the sewage
disposal system, should it become necessary in the future. Therefore, based on
the information submitted, the above mentioned addition is approved with the
following conditions:
1. The total number of bedrooms must remain at three without prior approval by
this Department.
2 ._T•he - area of the exi.stingmsewage-._d.i•sposa ! -- system- and- ,a- ts;,expansiony ar_-ea,- :must
be maintained. ..__..._._.__ .....,..�.�...�..- .._ .-._
3. All plumbing fixtures must be replaced or updated with water saving devices,
i.e., low flush toilets, restrictors for shower heads and faucets, etc.
Approval is granted for sewage disposal only. Any other permits or variances
required are the responsibility of the applicant and the jurisdiction of the Town
of Putnam Valley.
If you have any questions, please contact me at your convenience.
RM/j P
cc: BI (T) Putnam Valley
Very truly yours,,{
Robert Morris, P. E.
Public Health Engineer
1!2
WIN
L ow.
q
P j"7
V. m X "'0 1: "1
Ull
nrA "2
a i d I
WM
i t
-3
Q::i 5
I __1
lei
06
F7, L
0
z.
t j
a,
o