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BOX 26
03250
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03250
PUTMM COUNTY ORFARTMENT OF HEALTH
Mislim d anvirstm Clow Biwa Servkes, Caamel. N.Y. 14512 Enablier to Pa i vWe Raudt g
IN PROM FOR SEWAGE L SYST1Sl1[
Ovaier /Alpi1asstNiesnSUNSeT 1-II LC - Pi5l3'r K 1'/ g--r .o,.1
ea CZrlg CATS OF CO
>lto�
(T_) 'P OJT'- AJA13i IIA., t-
owR per � —
Renews — ❑ Revteien ❑
MaYbgAdlileea (S'$ .S'atv.ce=
T N ! Zt �D Date d Previous Ap�ry
Towo�:�}/9J''•r V/9 LL G-`V�a V ��_� � °7 �.
Date Subdivision ADnrnVpd Fee Enclos d � �'3�c;,
Amn»n t
a- TAM S i"tG ---G€ �GV i�e f Lot Area 2122 A r' _
Fm Setdlon
Number d Hs�eosa 4- Deaigo Flow G P D �� P N dNeaden b Regaleed wisest P1p lebd
SOPS Seweegge System to 0-MM d �_c oaa Saptle Tank .nd-4 to Q L . F cs J= 24 " G R'� LC e- C k
Te be osiskeded by C 10 4 TN t t' E'JP`IC�E fe�oCl r�i `Ij TrZ
water, Sob�p�c S%0* , Ftes 1569 4, Aaate.s p p1.r Spb Dgd by an
Other Rapdaessents
1 represent that 1 am wholly and completely responsible for the design and
above described will be constructed as shown on the approved amendment
County Department of Mukl% and that on completion thereof a •'C
be submitted to the O Mart ment, and a written guarantee will be fu 1
place in good operating Condition any art of mkt sewage disposal
ante of the approval Of ten Certificate of Construction Compliance 'of
tells 00 IOCstsd a$ shown on the approved plan and that mid well will be
County Dsartmerk Of Health.
Date = rs d i Silnetl
APPROVED FOR CONSTRUCTION: This approval expires two
fevoable for Cause or may be amended o► modified when consi
ev.
requires a new salt, p Oved for disposal of domestic s
0/88 Dace By
RICATE OF C
NEW
tfla. syst the separate $Ouse a di! W!
in actor ith t stendartls, rules an rpu a erns o e YTMf11
istru ion C p' satisfactory to the Commissioner of HaHthwill
Or s by the builder. that said buil0oii will
e I of two ) s mediately following thedate of this ipu-
hY O; 2) t the drilled.wNt described above
h ds, r d rpu liiTons' of the Putnam
= P.E. R.A. A p_._
License No -g L 6y
pan ction of the building .Ms been undertaken and is
f Health. Any Charge or alteratk►n Of conttrutlkln
supply only.
Title
pUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Enviroumental Health Services, Carmel, N.Y. 10512
IUCTION COMPLIANCE FOR SEWAGE DEPOSAL SYSTEM
` gRRY LAND -
Lacated .ts
OwUW/OPPHC at Neme$ihySc i' N! tL PRt3P� KT iE'S Form siy - - -
Ma01ng Address
Fee Enclosed'
Amount *2
Separate Sewerage System built 43
C,=&tbg of
(T) PUTIAHM V'q LEY - --
Town or Village
Tax Map 73 . Bloch I Lot 41. 12
gE "VjSjIVlSIS�N QGT H l- prOP.k�)�+T /ES )JC,
Suildlvlaion Name
Subdv. Lot # 2 F1
Date Permit Issued
(C o /O C) Gallon Septic Tank abd 4 0 Q L r o a= Z 4" C 9n VEL- TK E N C W
Writer Supply: Pubifc Supply From Addrm -
ors_ X Privae Supply Denied by N09MA/ IJ DE K 10 3
NEW
Building 1,MMSINGLE- F-)J ILV Lot Size 2 -.00 He, Has Eros •
Number of Bedrooms Q" Has Garbage Grinder Been In 7
Other Requirements
I certify that the system(s) as listed serving the above premises were
of which are attached), and in accordance with the standards, rules and
Putnam countyl Department of Health.
Date S5 r Certified by
Address 2- TL->HN WAL..Sg Q
0
Any person occupying promises served by the above systems) shall prom p take such set fnaj
conditions resulting from such usage. Approval of the $Operate saw pe em Shall beWm
available and the approval of the private water supply shall become n Wf; en a pub
Subject to irf�iclitbn o%r /change when, in the Judgment of the Co M 0. r
i p i of the completed work ( copies
p an, and the permit issued by the
W
P.E. X R.A.
License No. 62980
i sgwre the correction of any unsanitary
qrs soon as a pubt ,': sanitary sewer beconas
Y becomes 8vallable. Such approvals are
modification or Change is rp"ry.
CRONIN ENGINEERING PE PC
The Lindy Ruitding., Suite 200
2 JOHN WALSH BOULEVARD
PEEKSKILL, _ NY 10566
(914) 736 -3664 FAX (914) 736 -3693
Too Robert Morris
Assistant Public Health Engineer
Putnam County Dept, of Health
Dept, of Environmental Services
#4 Geneva Road
Brewster, N.Y. 10509
WE ARE SENDING YOU Attachad
II . I IwIWh d) I l l� . NUM1111 I11".010
DATE JOB NO.
ATTENTION ROBERT MORRIS
RE, SUNSET HILL PROPERTIES INC.
LOT 2A
CERTIFICATE OF CONSTRUCTION
COMPLIANCE PACKAGE
CHERRY LANE
PUTNAM VALLEY
COPIES
DATE
NO.
DESCRIPTION
3
AS —BUILT SEPARATE SEWAGE DISPOSAL SYSTEM' PLAN
3
CERTIFICATE OF CONSTRUCTION COMPLIANCE
3
GUARANTY OF SEPARATE SEWAGE DISPOSAL SYSTEM
1
FOUNDATION LOCATION SURVEY MAP
1
WELL COMPLETION REPORT
1
WATER ANALYSIS REPORT
1
$200 CERTIFIED CHECK FOR APPLICATION FEE
THESE ARE TRANSMITTED For approval
REMARKS WE WOULD LIKE TO HAVE THIS APPLICATION REVIEWED AT YOUR EARLIEST
CONVENIENCE. SHOULD YOU HAVE ANY QUESTIONS OR REQUIRE ADDITIONAL
INFORMATION, PLEASE DO NOT HESITATE CONTACTING ME.
ONCE CERTIFICATE OF CONSTRUCTION COMPLIANCE HAS BEEN ISSUED,
PLEASE HOLD AND CALL ME AT THE ABOVE NUMBER FOR PICK. UP.
THANK YOU FOR YOUR TIME IN THIS MATTER.
SIGNED
a ,
LJ
PLTI'NAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
S Lt /J S E T H i LL PF�GP6 -K-r t ES i rJ C
Owner or Purchaser of Building
SL) ,0S &-T HILL WC,
Building Constructed by
CHEF;Xy Lx1i\Le-
Location - Street
Municipality
S i O G L it roq M L_ y 'CAE S iD 6-)-� C
Building Type
Section Block Lot
jzC.svQUlv�Si4� cat= LC�T�
Sur!SE T H iLL Pri81E -T7E -C IMC,
Subdivision Name
2../*
Subdivision Lot #
GUARANME 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
operate for a period of two years immediately following the date of approval of the
re�E `�i c:dte of _ %unstL'scl_i0r, ° Ccr:pli arse" for the sewage disposal. GVStan, or any
repairs made by me to such system, except where` the tailure 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
!CF H day of _ 19_2fL Signature
Title
General n
actor (Owner) - Signature
Sum s -r-
yIiL -L wQP� .r/)TloS I /iC.
Corporation Name (if Corp.)
l52
Vu- -NnM
imLL(v v 10 5 7 9
rev. 9/85
mk
6405"ZI-4 41Lk- A�-IPC E4. OZIL
Corporation Name (if Corp.)
ess t/Lrfi,,Ait V+t-Lq tiU7 /0,r V
YML.ENVIRONMENTALSERVICES
321 Kea& Street
Yorktown Heishts, N.Y. 10598
(914) 245-2800 '
Albert H. Padovani, Director-
LAB --
_/.
ANTOINETTE, ROBERT J. ' ' DATE/TIMETAKEN: 08/19/96 10:00
158 SUNSET HiLL RD DATE/TIME REC'D: 0��/19/96 11:1O
PUTNAM VALLEY, NY 10579 REPORTDATE: 08/20/96
PHONE: (914)-526-2226 `
,
`
SAMPLING SITE: 22 CHERRY LANE SAMPLE TYPE.,: POTABLE
: PUTNAM VALLEY NY 'PRESERVATIVES: NONE
COL'D BY: ROBERT ANTOINETTE TEMPERATURE..: { 4C
NOlES...: KITCHEN TAP - COLIFORM METH: MF
DATE FLAG PROCEDURE RESULT NORMAL — RANGE
08/19/96 MF T. COLIFORM ABSENT /100 ML ABSENT
COMMENTS:
BACT THESE RESULTS INDICATE THAT-THE WATER (WAS NOT) OF A
SATISFACTORY SANI[ARY QUALITY ACCORDIN[—~mTHE NEW YORK STATE
AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS
TESTED, AT THE TIME OF COLLECTION.
SUBMIlTED BY:_________________
A|bert H. Padovani,
Director
ELAN 10323
4' WELL CuriYLL 1 iuv tcrxuni
DEPARTMENT OF HEALTHf
Division, Of- iiea i 5E'vices
0
PUTNAM COUNTY DEPARTMENT OF HEALTH
office Use Only
v ' I
WELL LOCATION
STREE1 AOURESS: TAX GRIO NUMBER:
�� �j, , a�7 q SEC ?3 8 4.rillr
WELL OWNER
NAME. ADDRESS' /� ���t�i
o�°Uf/ �{b (' f Jr8 .Sc1NSt:T �,�t vAN
WPBIVATE
Q PUBLIC
USE OF WELL
1 - primary
2 - secondary
JR- RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED
❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT _ gpm. /N0. PEOPLE SERVED — / EST. OF DAILY USAGE 0� gal.
REASON FOR
DRILLING
.(]REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY
CONEW SUPPLY (NEW DWELLING) ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH D ft. I
STATIC WATER LEVEL 3 Q ,ft.
DATE MEASURED
DRILLING
EQUIPMENT
J& ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION O OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING a OPEN HOLE IN BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL LENGTH _ 'k
MATERIALS: ®-STEEL O PLASTIC ❑ OTHER
LENGTH BELOW GRADE ft.
JOINTS: ❑ WELDED 8THREADED ❑ OTHER
DIAMETER `,� in.
SEAL/lEIZEMENT GROUT 0 BENTONITE -ETHER
WEIGHT
PER FOOT. / 7- Ib. /it.
I DRIVE SHOEAYES ❑ NO
I LINER: CJYES MNO
SCREEN
DETAILS
DIAMETER (in)
SLOT SIZE
LENGTH (ft)
DEPTH TO SCREEN (it)
DEVELOPED?
FIRST
❑ YES ❑ NO
Kom
GRAVEL PACK
❑ YES
O NO
GRAVEL
SIZE
DIAMETER
OF PACK in.
TOP
DEPTH fL
BOTTOM
OEM ft
WELL YIELD TEST It detailed pumping
METHOD: O PUMPED tests were done is in-
t
COMPRESSED AIR ,formation attached?
❑ BAILED O OTHER ; 0 YES O NO
'WELL LOG If more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FR011i
SURFACE
ling
Water
Bear-
Well
Mat-
meter
FORMATION DESCRIPTION
coal
ft
It
WELL DEPTH
It.
DURATION
hr. min.
DRAWOOWN
tt.
YIELD
9Cm_
Land
Surface
q
it
r
WATER KLEAR TEMP.
QUALITY ❑ CLOUDY HARDNESS
O COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? O YES ❑ NO
STORAGE TANK: TYPE
CAPACITY G
PUMP INFORMATION
TYPE
MAKER
MODEL
CAPACITY
DEPTH
VOLTAGE HIP
WELL DRILLER NAME OATS /,
�7V l�Q
AooaESS �S �� SIGNATURE
C��~ 4'
3/89 1 — ' P,
JUL -18 -1996 10:06 D J DONNELLY 914 962 2209 P.01
Now' or
a Area— 87,1,e2 Sq. R,
M .2.0001 Acmes
M o
b
h
L Spre ovW p9v
'6475'50 "E 1016.05'
pole
r $_. ow
N _
2 N6872
N
W .
E '
d �
a
w
it
lid-
2 Story t A
overhon Frame Fovnd.
60.3 Dwelling U/C
U/C
I 63.4' N
8
I
O�]
1 h�
162.53 Mor�u° ed,,
molt 94.03 N62°51'90 "A� o grorau ••
�n :.
Cb
ow
ow
ow overhead Wrea GW poll
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
A ICAi110N o coil iSTiiUCT A Wri`lE!'t W'B;i,i.
PCHD PERMIT
WELL LOCATION
Street Address
tF HEW ti c
Town/Village/City Tax Grid Number
;, ;� V tE '3 - - 1. 1'z--
WELL OWNER
Name Mailing
So,via' Mit -L'P c E2 Nc.
Address 1.V8 4L +44 Hitc. 20
UPOLtE id IU.S-7 '
Wrivate
0Public
USE OF WELL
1 - primary
2- secondary
.RESIDENTIAL 0PUBLIC SUPPLY QAIR /COND /HEAT PUMP
O BUSINESS O FARM O TEST /OBSERVATION
O INDUSTRIAL M INSTITUTIONAL O STAND -BY
OABANDONED
O OTHER (specify,
O
AMOUNT OF USE
YIELD SOUGHT gpm /#
PEOPLE SERVED — /EST. OF DAILY USAGE _$ gal
REASON FOR
DRILLING
O REPLACE EXISTING SUPPLY
ALNEW SUPPLY NEW DWELLING
O TEST /OBSERVATION Gl ADDITIONAL SUPPLY
13 DEEPEN EXISTING WELL
DETAILED
REASON FOR
DRILLING
WA TE2 -s'o F P L Y Fa 'P-
N EFL -)
WELL TYPE
j
DRILLED 13 DRIVEN
ODUG
D
GRAVEL
❑ OTHER
IS WELL SITE SUBJECT TO FLOODING? YES pl-' NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:�rfu ZUiutdjoN ();=
su "iXe7' 1�i[L �izUP�1�1 1�..f 1N C. Lot No. �p
WATER WELL CONTRACTOR: Name'1,N• �cXJC J'ON Address:Fc3., Ook 15i T tee
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X_
NAME OF PUBLIC WATER SUPPLY: TO IT
2 �
I:,T�NCE..TCi 1�Tlivey::T _.F O'r_I.idrAFcESi WATER MIAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDEDw't ":.,r'"
BON SEPARATE SHEET
(date) (si e) 629$0
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.
During all well drilling operations, the applicant shall take appropriate action to assure that
any and all water or waste products from such well drill ng operations be contained on this
property and in such a manner as not to degrade or of � 'se conta' ate surface or groundwater.
Date of Issue• j0 /�Z 19 ,1
Date of Expiration l( 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
CRONIN ENGINEERING PE PC
The Lindy Budding, Suite 200
2 JOHN WALSH BOULEVARD
PEEKSKILL, NY 10566
:. .. .� .w .[ -. r. . r.�.. � .• •.W.� e..r K - !` r c4 0 -'.... < c.. .., �r..oPr v.� uc.
(914) 736 -3664 FAX (914) 736 -3693
TO, KILL I-1 D 6� �
Assistant Public Health Engineer
Putnam County Dept, of, Health
Dept, of Enviromental Service
#4 Geneva Road
Brewster, N.Y. 10509
WE ARE SENDING YOU Attached
I 1A I py I W1V I D11 RIN611101 *** MIN -
DAT ��Lzi I 1--c
JOB NO.
ATTENT113N
RE, SUNSET HILL PROPERTIES INC.
MICHAELS WAY .CORP.
LOT 2A
SSDS
CHERRY LANE
TOWN OF PUTNAM VALLEY
COPIES
DATE
NO,
DESCRIPTION
3
PLOT PLAN & SEPARATE SEWAGE DISPOSAL SYSTEM
2
HOUSE PLAN
1
CONSTRUCTION PERMIT APPLICATION
1
APPLICATION FOR APPROVAL OF PLANS
1
LETTER OF AUTHORIZATION
1
CORPORATE RESOLUTION
1
SOIL DATA SHEET
1
WELL PERMIT APPLICATION
l I
I
I
_.! .r �:ii - �7. A.,r�t..i _n r , .mss _r.r -
L� �L'v�\ ! {J!1 nr r L!CI-� Y IVIN i' LL
THESE ARE TRANSMITTED For approval
REMARKS
Putnam County Department—of Health
Division of Environmental Sanitation
AFFIDAVIT -. CORPORATE-OWNER APPLICATION
FOR PERMIT -APPLICATION SUBMITTED TO
PUTNAM .COUNTY HEALTH DEPARTMENT ,
Vice-President _ _ _ _ _ _ _ _ _ _ _ _
(Name and Address)
Secretary ------- - - - - --
(Name and Address)
— — -- — — — — — (Name and Address)— — - -
and that I am and will be individually responsible for any or all acts
of the corporation with respect to the approval requested:and all sub-
sequent acts relating thereto.
Sworn to before me this Lh day Signed — — — — — — — — — —
of 19 Title — it&Sof -- — — — — — — — —
o to ry Pabow itPtltilii -S�sEe oil' ew york
No. 4923313
QualMed in Westchester County
Commission Expires March 14,199
Corporate Seal
PUTNAM COUNTY DEPARTMENT'OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date
Re: Property of Su,�Sc -T- �-� 1 LL f'►O SET 1 J' nJ .
Ll4��
Located at CH6 XX , AWN aP; IRvr. Ajqr -I IAoi_ Cc- 4i
U:accF�/ Section '73 Block. I Lot 4- 1. VZ-.
Subdivision ofK6jWXut V iJ'aaN ar. Car 2 Fc:Ft SCwjcTHicL. Pr!�O'P, zr e-4, i T
Subdv. Lot # Z Filed Map # o &657 Date c�- a 2 q6
Gentlemen:
This letter is to authorize -7'
a duly licensed professional engineer or t
(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.
0r .v t w _YORfr
C" 'O
� N
Countersigned:
(P:_:E�_) R . A.,
�o Z ) S-0 � ,,S', 6:2980
-t E ZoV614 gole-DI nl
Address Z Tc)yN l,1AeJ
Very truly yours,
Signed
Owne3ko f Property
Address
Town
(914-)
Telephone'
Telephone
i
1
THE
KS
1
:Sid
i � 'sib'" �y ~t�'''; • L J� s° 1
14L
i 41
St
Re.! (ONi"C. tr
! (L.
Pita P��t7ir•���nrt.
�M�Y La:•rt�
i
1
I
,
i
1l
L
q
met
M
y
i
i
Shown with optional porch package.
`.Irw
,
'. Shown with optional two -car garage and porch package.
i
■
ESTCHESTER ODULAR OMES, INC.
7 Z�
i
THE
Second
-;:I ;.
27'8"
YORKSHIRE
27'8" X 40'; 2240 Sq. Ft.
Optional Master Bath
40' ---
PUTNAM COUNTY DEPARTMENT OF HEALTH.
First
Floor T BED
F".M...
FAMIj.Y ROOr1 KlTCME .r�i1IfFe9T / / 11 Ell
27,8x,
LIVING ROOM DINING ROOM
L• - :'x la• -o• Iz' -a•x la' -o•
lim—WI
-. - ONiiurial Kitchen
40'
STANDARD YORKSHIRE FEATURES
• 4 Spacious Bedrooms
• Framingham Pediment On Front Door
• 2 1/2 Baths
• Fireplace Options Available
" Open Two -Story Entry Foyer
• "Boxed -Out" and "Angle -Bay" Options Available
• Formal Dining Room
• Consult An Authorized Westchester Builder For A
• Formal Living Room
Complete List Of Options
• Spacious Kitchen Features Breakfast Bar With
• Artist's renderings and Floor Plan Dimensions are
Radius Overhang Top
approximate. All specifications must be Written in the
" "Cottage- Style" 3056 Lower Level Windows With
Contract No oral conditions.
Architraves On Front
ESTCHESTER MODUM HOMES, INC.
M
30 Reagans Mill Road • Wingdale, NY 12594
Rev. 10/94 I (914) 832 -9400 • (800) 832 -3888
Ir 1
Is] VP 11.4 IM RejW N IV I• •; el RRPI, 4•1 • S • Lei
j)ESTr
.7N -DATA-SHEET-7,5[7.BSMCE S3qAGE DISPOSAL-SYSTEK- FILE NO..
OWner.Q1V.S6--t iAii.L 'P140?cK-rj6-,r Address PjT-Ajql%l %M44cX t4V 10-C 7i
Located at (street) C14CKKY L191JC Sec. -13 Block I Lot 4-1, tz-
(indicate nearest cross street)
municipality LIP C Watershed flvbxo� 91-V-g-g-
&0 - NmfthN --ffP7-,Nv,1m m -.4 Fypi �snj m 4 *, ff�l U V A
Date of Pre.-Soaking
Date of Percolation Test S-Lt'-s /1 1C
3jo 10
HOLE
4 1 1.04 2,(
NUMBER CLOCK .TIME
PERCOLATION
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
11-
-20
4-
2
Li
3jo 10
4 1 1.04 2,(
5 0:1- Jt
2
3
4
—5
NOM: 1. Tests to be repeated at same depth until approximately eqml soil rates
are obtained.at each percolation test.hole. All data to'be submittod,.,
for review.
2. Depth measurements. to be made fran top of hole.
rev. 9/85
Li
4 O-r7 2--1
10
5hY,1
2
3
4
—5
NOM: 1. Tests to be repeated at same depth until approximately eqml soil rates
are obtained.at each percolation test.hole. All data to'be submittod,.,
for review.
2. Depth measurements. to be made fran top of hole.
rev. 9/85
TEST PIT DATA RDQUIRED TO BE SUBMITTED W.I`m APPLICATION
DESCRIPTION- OF -SOILS ENCOUNTERED IN TEST HOLES
DEPTH, HOLE NO. D,1 f D'-oD ¢ D HOLE NO.. Q HOLE NO.
u.-- i,..i. ,+..._ .ur ��i-. -:se,. a... r..•,,v. Naci .""i.i -c:.v �-o .. o .. <o+rc:a.«- >..,.v �.:ti.,.� ._nsar' �a�.,a:; .. :.e% a« �_ :«::.r::n.o:- as.�'6- �e` -•�w. ire :�- erw"u�.�aco :.� .a
G.L. —'� P ,C i l rTo tom''s
1' SXl�DV L nrgb
2' CKA vL
ti
3'
4
5' - It.
b,
7, r�
8'
9'
10'
11'
12'
13'
14'
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•• •• •••• -.• IiYlJil'l�i hl "�i131411�U+`l�i�JL�✓ /11i11:u �� -:LS�� uLll'lJ�iliL la.+r � �vU�.Va('�'� {`/v ��V L+��! C i��S�e d•. • .- •. .... ..••...•v
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED Aj
DEEP HOLE OBSERVATIONS MADE BY: T% r 10ij TKU L . C i<ONrh/ 1. DATE: .S 4 3 �1
DESIGN
Soil Rate Used Min /1" Drop: S.D. Usable Area Provided o o
-No. of Bedrooms 44- Septic Tank Capacity I 2 SCE als. Type h, fo,✓
'F NEW y0R
Absorption Area Provided By t�0 U L.F, x 24" width C,{
Other
Nameri rL i gT�-I tz Signatur ` w
T Address y go' r o a r •� 6; J'v t� -. o o SEAL �, 62 0
2 _ —04H.J JFO PROFESS "�P\•
PE�If ✓'<!l G t, At e t-i yo frW 104--t6(-
THIS SPACE FOR USE BY HEALTH DEPARTMFM ONLY:
Soil Rate Approved sq.ft /gal. Checked by Date
.tl t- - -
a U t 2'1T "5N1M C1� O 1<J W'y it I-') ✓' A1.4� it 1v 2.a z° Q Ip --1H A 1. =1
_._,. APPLIPATiO -h FOR. APPRaVAL_.OF PLANS FOR A WAS TEWA.T- Eg-- GI�?QSA:!";
.,.. ._ -.. _.. �_ r. . _. � _ - .t. r Y , z p �. fill's...- .. l"p•:l �Tt u Lf'�Y xi-- L'.1x; ... .
1. Name and Address of Applicant: Su J S e T N Ic(- P i L �•� �
��'T�b/h VAZtE AJY )OS'-%
2. Name of Project: 3. Location &v /C: wmtjoi-, UACLcy
THr cruoY I iLa iJ1 i;
4. Project Engineer: lino HY C. C <0,,jIJJ -T 5. Address: Su{TC Leo
7 --TC7 H J 1,JA Lilt( ir0Q L, 4J41Zj
- P67C K- K 1 L z, N d'i Y3 PL K i a x (� .
License Number: 062I�?0 Phone: (914)'73t °36 4
6. Toe of Project:
L/,'- Private /Residential Food Service Commercial
Apartments Institutional Mobile Home Park
Office Building Realty Subdivision Other (specify)
7. Is this project subject to State Environmental Quality Review (SEAR)?
Type Status (Check One.) Type I.. Exempt y''
Type II. Unlisted
8. Is a Draft Environmental- Impact Statement (DEIS) required? ............. ti 0
9. Has DE'S been completed and found acceptable by Lead Agency? ......... 'y A
10. Name of Lead Agency AJ %p
11. Is this project in an area under the control of local planning, zoning,
or other officials;. -ordinances?.
12. If so, have plans been submitted to such authorities? ..................
13. Has preliminary approval been granted by such authorities ? Date Granted:
14. Type of Sewage Disposal System Discharge...... Surface Water Ground Waters
'S. If surface water discharge, what is the stream class designation ?........ 'v
6. Waters index number (surface)
7.' Is project located near a public water supply system?
8. If yes, name of water supply AJ
OUy
Distance to water supply N lO
�. Tr prCj=Ct site near E public sewage Coileztion or d"3poscl syster;7..... i40
Na.-me c+ sewage system ti tN Distance to sewage system .v
Gate c:se 23. game of Health Inspector: a ✓�14
. Project design flow (gallons per day) ...... ............................... Soo
2.
'.i :. _,T.c,Stzta._Fa.11utant _Discharge Eii.mination.System (SPDES) Permit required?..w
<. r+. ..... -. -. .. :... a..r .? c . .. , wi :a .rev w r ...Ma 'r• ..a ..+ »t..._ .y._ ..:.. :.c :r,,. �.r, i r_ yq _ s
25. Has SPDES Application been submitted to local DEC Office? ........:...... i0
27. Is any portion of this project located within a designated Town or State
wetland? ....... ............................... .........................
/-/V
ZS. Wetland ID Number ........... .............................._ a
?9. Is Wetland Permit required? .... ............................... ........
Has application been made to Tewn or Local DEC Office?
30. Does project require a DEC Stream Disturbance Permit? :.......
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 AIy
32. 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 N
DESCRIBE:
;2. Is there a local master plan or file with the Town or Village? ........... Y c-r
I
4. Are community water, sewer facilities planned to be developed within 15 years? X10
_Ilre any r`rr?yP,'r'..7.S�o52 •'� ° ?�- 'r. a_Xcess�of 15. "i." .? /✓o -.
i6. Tax Map ID Number ................... ............................... .... . 7X- I - 41. it
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
.pplication must be accompanied by a Letter of Authorization. Failure to comply with this
irovision may be grounds for the rejection o "__. _ ubmission.
EW yon
`p A L. CKQ
I hereby affirm, under penalty o Llry, thar'p = at ion provided on this
form is true to the best of my o ag -7 False statem6Rts made
herein are punishable as a C as -A His s; 't ua t to Section`Yi0`:45 of
the Pena 1 Law.
_^ti. i UR=' £ L=ET., -"�_ T_ T __S.
'f` ° T-K , \w `G
I- F C /a3D Ja c Sao ' ICU i 7'Cr 200
'L '3"08.0 I- JAZJ'N - ��E•v�P— D
AT! IN3 ADDF;ES:: Ca✓ Yorzr< 10 5'4"C
Lot 2A
ins- zoo Amw
Z
*13LF.-4*0 C.I. PIPE —
(W/ 45' BEND AS REQ'D)
.0 GAL CONIC SEPTIC TANK
*181-F-4"0 PVC PIPE
(W/ 22• SENDS AS REO-0)
'AiNCTION BOX (TYP)
400L.F.-4*0. PERF PVC IN -------
24' GRAVEL TRENCH
(ENDS ARE CAPPED)
I>
-'a I Q - .-
-,cccEss f:
EXIST DIRT
tiJiy� -
EXISTING WELL — :-g
ROOF-LEADER
FOOTING DRAIN (T)p)
cil
EXISTING WATER SERVICE X
0
7-
Y
UllkT. 4 BDRM
RESIDENCE
0.3,
A z
614' VFW y
c
D
17'
H
100%
EXPANSION
AREA
fo•l
aeU/ L31
C.B.
CHERRY LAAJ
--7mc—caldom C,
T
Titr---SE-V Ms-PO 1_ E A
SCALD 11 = 30'
UJUt,h I 1UN LAW,
4. LOT SHOWN HEREON IS KNOWN AS LOT 2A OF SUBDIVISION KNOWN
AS 'RESUBDIVISION OF LOT 2 FOR SUNSET HILL PROPERTIES INC.'
FILED IN THE PUTNAM COUNTY CLERK'S OFFICE ON FEBRUARY 29,
1996 AS MAP #2665.
57.5' 50
J 62;5' 50.5''
Putna County Department of Health
Division of Environmental Health Services VQIL LOCA71W
Approved as noted for mfl&rwinft it"M I Y z —
spfl�oeble Rule and Regulations of th@ X 1 62.5' 81'
apartment
gignatnre & Title
CERTIFICATION OF CONSTRUCTION COMPLIANCE
THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WAS
CONSTRUCTED AS INDICATED ON THIS PLAN AND THAT THE SYSTEM
WASINSPECTED BY ME BEFORE IT WAS COVERED OVER. THE SYSTEM
WAS CONSTRUCTED IN. ACCORDANCE NTH ALL STANDARD RULES
AND REGULATIONS OF THE PUTNAM COUNTY DEPARTMENT OF
HEALTH AND THE NEW YORK STATE DEPARTMENT OF HEALTH.
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SEPARATE SEWAGE
DISPOSAL SYSTEM
CONSISTS OF k 1250 GAL CONC
SEPTIC TANK, 400L.F'.-4"0 PERF
PVC IN 24" GRAVEL TRENCH.
SEPARATE SMAGE SIM W.
amm at
PUTNAM CONTRACTING
SUNSET HILL PROPERTIES INC.
-19 CHESTER PL.
168 SUNSET HILL ROAD '
LAKE PEEKSKILL N.Y. 10537
PUTNAM VALLEY, N.Y. 10579
TIAM SUPPLY-
m7m SHM.
PRIVATE WELL BY:
HUDSON RIVER
NORMAN ANDERSON INC.
152 BARGER STREET
PUTNAM VALLEY N.Y. 10579
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