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HomeMy WebLinkAbout3287DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73. -2 -10 BOX 26 .. low I IN 11 1 r -U oil '9 r. r +.. IN r 03287 Yey. 3186. PUTNAM CoU q Divlelnn of EnvhronmE i =�EItTIFICATE+ CONSTRUCTION COMPLIAP Located Owner/ Resat Name Ad d /: n -- � Mailing Address � Z N 4 0 F F a `; 1 / Separate Sewerage System built by ' J Consisting of l a Gallon Septic Tank and zip �� Date Permit Issued 1 Water Supply: Public Supply From Al.-CM Address or. " = ' Private Supply Drilled by Al. -Cq 9-:2 ZPIIA " !!� Xddress _ 156 4'- 6:( /�� {� ♦��� f'' Building Types �'/ C� "�� ee Has Erosion Control Been Completed? •�' Number of Bedrooms 44 Has Garb a Grinder Been Installed? � Other Requirementb 1. I certify that the system(s) as, -listed serving the above premises were constructed_esse aalC� n the plans of the completed work ( copies of wtiich are attached), and in accordance with the standards, rules and regulations, filed plan, and the permit issued by the Putnam. County Department of itealth. Date. "� I Certified by * P.E. - R.A. Address Any person occupying premises served by the above.system(s) shall promptly take such a conditions resulting from such Usage. Approval of the separate sewerage system'shall b a aliible `and 'the -approval of the private water supply shall become null and void when a subject to otlificatfori or change when, in the judgment of the Commissioner of Heslth Date ? e of License No � � S IVI (gyp► o secure the correction of any -unsanitary d soon as a publi: unitary sewer becomes no becomes available. Such approvals are modification or change Is necessary. �1° Title J� a WELL CUMYLET1UN tcr.rvtci DEPARTMENT OF HEALTH Division Of Environmental `Health `Se vit:es' PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only T" WELL LOCATION STREET AOURESS: WNJVILLAG1X4Y TAX GRID NUMBER: , WELL OWNER NAME: ADDRESS: a-PBIVATE O PUBLIC USE OF WELL 1 - primary 2 - secondary I� RESID IAL ❑ AIR /COND. /HEAT PUMP O ABANOONED ❑ BUSINESS ❑ FARM O TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /NO. PEOPLE SERVED `� —% EST. OF DAILY USAGE _��Lo gal. REASON FOR DRILLING 0] _PLACE EXISTING SUPPLY ®TEST /OBSERVATION []ADDITIONAL SUPPLY EW SUPPLY (NEW DWELLING) ® DEEPEN EXISTING WELL DEPTH DATA c�o WELD DEPTH ft. STATIC WATER LEVEL ft: DATE MEASURED DRILLING EQUIPMENT R ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION O OTHER (specify): WELL TYPE ❑ SCREENED O OPEN END CASING 0 OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS . TOTAL LENGTH _ _ it MATERIALS: O STEEL O PLASTIC ❑ OTHER LENGTH BELOW GRADE ft- JOINTS: gWELDED THREADED ❑ OTHER DIAMETER in. SEAL: CEMENT GROUT O BENTONITE OOTHER WEIGHT PER FOOT / Ib. /ft. DRIVE SHOEgIES ONO I LINER: ❑ YES ONO SCREEN z DIAMETER (in) SLOT SIZE LENGTH (It) DEPTH TO SCREEN (it) DEVELOPED? FIRST o YES ONO SECOND- GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE_ DIAMETER OF PACK In. 70P DEPTH ft. BOTTOM DEPTH IL WELL YIELD TEST ' If detailed pumping METHOD: O PUMPED i tests were done is in- COMPRESSED AIR , ` ormation attached? O BAILED ❑ OTHER ; Cl YES O NO WELL LOG If more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear- ing Well DIa meter FORMATION DESCRIPTION coot ft. ft. WELL DEPTH It. DURATION hr, min. DRAWOOWN ft. YIELD Land Soo WATER . LEAR TEMP. QUAU O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES ONO STORAGE TANK: TYPE CAPACITY GAJ, PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAM DATE "l � j�� SIGNAT ADDRESS/ S`-' URE GcG� 3/89 U If ~ YML ENVIRONMENTAL SERVICES ^ f' ` � 321 Year Street Yorktomn Heights, N.Y. 10598 (914)'245-2800 Albert H. Padovani, Director ` LAB #: 87.304091 CLIENT #: 2745 NON STAT PROC PAGE 1 VADO-CORP , ' DATE/TIME TAKEN: 12/17/96 128 PUDDING ST DATE/TIMEREC'Dk 11/17/96 10;40 'PUTNAM VALLEY, NY 10579 ' REPORT DATE: '12/19796 PHnND (914)-528-1108 SAMPLING SITE: 468 PEEKSKILL HOLLOW RD SAMPLE TYPE-.: POTABLE : PUT VALLEY ` PRESFHVATIVES: NONE COL'D BY: MANUEL VASQUEZ ^ _ TEMPERATURE..: Q4C NOTES.,.: ' ' COLIFORM.METH: MF DATE. FLAG PROCEDURE RESULT ' NORMAL - RANGE METHOD ` ABSENT 12/17/96 MF 1. COLIFORM; /100.ML ABSENT COMMENTS: BAS THESE HES0&S IN�D�ICA]E THAT THE WATEH ,(WAS NOT) OF A ' SATISFACTORY SANITARY QUALITYACCOHOING TO THE NEW YORK STATE. AND EPA FEDERAL DRINKING WATER STANDARDS, FOR TH&PAHA.ETERS TESTED, ATTHEJIME OF COLLECTION. - � - ' SLUBMITTED BY _ _ _ ___________ . Albert H_ Padovani, M.T.(ASCP) . Director B-AP# 10323 . `r PUTNAM COUN'T'Y DEPARTMENT OF HEALTH _ DIVISION-OF - - _..._._�........,; - _ ��t -.., �... AL HEALTH - SERVICES -: Owner or Purchaser of Building �— Building Constructed by Location - 'Street Municipality Building Type � 2. rl5- `�f Section / Block Lot - ) Subdivision Name Subdivision Lot # GUARAFPI'EE 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 "C_e_rt_ificate 'o_t- CQn t uct _ori.-Complfiance" f_qr the_sewage:di:s isaT` system, - "or _`a:ny, > -:�- _c 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 day of Aje-d 199�1 General Contractor er) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk Signature Title _ �/�' //� S i L) V IV T Corporation Name (if Corp.) Address :f i !. r 4 �. r ya � r 4+ M- 'fl � y, •+�t , y � 1 z , F � T� h S J. .0- tx � - i� K 4• l•n) i » s (� :�F -°,3.. s h Of K<v ;s � r 4+ M- 'fl � y, •+�t , y � 1 z , F � T� h S J. .0- tx � - i� K 4• l•n) i » a / 4;7G`'LFof J " Xr ".7ki18 1'e,, ytJ C8 Fsi j e &Tid � " M". � �,.. 1.. � L JZi�i'LiJIF4•L Cf1��y M`Tp� �y�f3�.+�tYy9, , t• "� .� 2 � � � r' 4 J j.1 8"�l�(j Vry iv: F: T7 y�9'�r�]I 3 £te�"Ma3 h-1ti rt' i. ar 2'eyta...at 3?3.6f .. Yutinam Courity'Department'of Health' ivieion of- vironmental Health, Service ` proved ae noted Yor aonYormance witb � �",, � r�` t .tpli.cablekRulea and Regzlatione of rthe r a s `'� � imam County H[efilth Department �14i.?lre 1k Tit1e � „ WAN F a E6 W Y; Z :�F -°,3.. 8 pa MAW ,d�Cl, k 1 '.�y�A toy r/ W 0. l . • Y � i �` Iii -.� a / 4;7G`'LFof J " Xr ".7ki18 1'e,, ytJ C8 Fsi j e &Tid � " M". � �,.. 1.. � L JZi�i'LiJIF4•L Cf1��y M`Tp� �y�f3�.+�tYy9, , t• "� .� 2 � � � r' 4 J j.1 8"�l�(j Vry iv: F: T7 y�9'�r�]I 3 £te�"Ma3 h-1ti rt' i. ar 2'eyta...at 3?3.6f .. Yutinam Courity'Department'of Health' ivieion of- vironmental Health, Service ` proved ae noted Yor aonYormance witb � �",, � r�` t .tpli.cablekRulea and Regzlatione of rthe r a s `'� � imam County H[efilth Department �14i.?lre 1k Tit1e � „ WAN F a E6 W Y; WAN F a E6 W Y; PZMW MR =WAGS o..ad.piresild FVINAN CODL'f!Y DBTAR' WWrOF HMM ="M dR vbemmmmm Rsa11111 s r 9bm Cant NL N.Y. low b p"NUM P"" t on CIR RISC ►TS OFCO - STSTM Fait / N .S.id. Let 0 T" KV Ca Z Big& Lee An& L4, 4, Sevemb SSWGMV Symbols to Comm of I lag aeYw Spa Teak • w 44'4 L I AJ �T(t) -ZA "—Mat e- t' To be aealidae- b –F� -6' 1) Addleae warm Pddk SM* Way Add ien on :5W a . Sw* DldRed bYr: i ,J Addis.. C�"711 1 represent that 1 am wholly and completely responsible for the design and location of the proposed systern(s). 1) that these rata sew dt sal scam above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a regu ns ream County Depertmant of Health, and that on completion.thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of "with will be submitted to the Department. and a written guarantee will be furnished the owner, his successors, hairs or assigns by the builder. that said buNder will Place in pod .operating COndRion any part of seed to . disposal system during the period of two (2) yews Immediately following the date of the l au- anp Of the approval of tho Certifir s of Construction Compliance of the original system or any repair t o; 2) that the drifted well daacribed above W N be lasted as s1 11 on the approved plan and that Yid well will be Instal nos wilth the r s and rall'u ns oof the Putnam County D f rtmeflt of Date ff }}CC��,, (-' syned P.E. R.A. Address License No APPROVED FOR CONSTRUCTION: This approval expire two yews from the data issued unless construction of tre building has been undertaken and is revecable for cause Of may be amandFd Or modified when considered nWGMrX by the Commissioner Of HeRh. Any change or alteration of construction .O/$8 � lees . /Nwr� mi� A�ditPOY�of :onestk sanitary sewaN. an Pr eta water yply only. .:...i: r.<.„.,..,,,, •re+::•r - «�;-"- -,..,. „...,...,. _ r... 2° >F.^c ,.d' s^. Y r, t r;4. -z •a�"`'- ,�'"'-�."-•- ct�'S• g., c ., ......:r F6miiM 000N iY D�l�l1 OF O�.AL�H k y ti DIsYw ait 8tsteaala`Itl' SaeAlaaa. teal. N.Y SY3U C is Ftmvlda Fawttt! F CO�AM(� • w :, TS O ap _ Yd FED FOO;S�WA� DISlOSAL SYSlS�1il r i pot 9 i/f' rTaa Bop` 3 • yak �' tea _�!: - �Ct �1 es l�y t1 /� 4 Gov A/ Reotowgl �ovleiee Om m /�An■eaot l�s p Date of @revkaii'Appaoval Addee. C v..�%J717 O �' u°Z / y Town /'cfrl . l�a // �P . / d = ✓7 9� Harp Subdivision Approved ��' %,n. Fee Enclosed ® a,nn „rit lyp G; ' lot Airoa / 3. i 9 fL` F� Smdlee oebr Depth vatome_ �.at Heroes : ; Dealgn Flow G• P. D ....5� �G P,CHD;Nof�oUoQi Ii 8aq�e4 W6en'FID b oaspiq>ri Sepwaits SawmW Sloam M f O oepatoi e[ Ga9ae Sapaec Task wig ®Ya6er fib'~ Falbde Fidrd Addreas an y.fa.ee Sew hY •A&m . ®Iran Riq�hstale•' `ice i/7rGt ✓r+ 1_►epresent' that 1 am wholly intl,complataly nspon'tibN for,ths tlaspn aotl location of the propoiatl systfrm(s) !) ,that thm eopara4e :Nw tlispolel stem avow dast►i0b will mt tonst►ucted at shown on the'approwrl,"iinlant there. to,and in accordance witty eras, rules a rpq . ns na County Oepsrtmant Of. tNanh,'and that on comONtion thereof a CSM Nciita of Construction Com ry to;tho Commissioner of Health will � tubmnta0 ;to tM bpartnlant, ane a writtM euannteo will ba lurnishatl the owner, his sucoet s„ ' by tho builA�►, that ssio builder will , OYca` ih pOO:;OPafatilp eondnlon any port pP ssid sawaaa tlisposal system alurifle the pa.iotl of ttly followinS tMd•ta of the issu- Or1ia o/ tM appaNl of tM CeKnkata Of ConsCiudion COmpllanci of tM orginal system hM t this drilNd will AeuriOad above win M iocatetl as Mlawn on tM approvlo p1Gn and that taitl israll will ba,Instelled in a i4ince ith �, reA aTiions of itio Putnam CouHealth' nty Adtlrs .;: ,, ,/. .: .M!' :. ; • �, `' IRA. Lcense No Data Pro % z R,”' OVED FOR CONSTRUCTION Th approval expires two years o the. data issuetl less c lading has been undertaken and is revocabla•fo► ass or y boa or_r"i!"::Wheii eonsida► y by the CO omr q1;_ Y ehaiga of alteration of construction reeuiroi a M parmi Oath f0► 'dl epOYl Or domistk MM[ a1W /01, Or at supply orA�/. Rev. Gate �, �[ By / Title _ 10/88 W DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New-York 10509 (914) 278 -6130 ._:APPLICATION_ TO — ON.STRUCT .'A: WATER —,- ,WELL =. PCHD PERMIT # WELL LOCATION Street Address Town Village Cit Tax Grid Number WELL OWNER Name }''ailing Address { fly". Z Private Public USE OF WELL .1 - primary 2 - secondary RESIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP O BUSINESS O FARM O TEST /OBSERVATION O INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED_ - /EST. OF DAILY USAGE Soy gal O REPLACE EXISTING SUPPLY O TEST /OBSERVATION M ADDITIONAL SUPPLY NEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE ODRILLED DRIVEN EIDUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES k' NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: // Lot No. WATER WELL CONTRACTOR: Name A1 Address: �l� nJ r✓ �'`' 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 & SOURCES OF CONTAMINATION PROVIDE ON SEPARATE SHEET 7 (da ) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. 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 anner as not to degrade or othe se contaminate surface or groundwater. Date of Issue: 0 1/. 19 Date of Expiration 1 19 Permit Issuing Official Permit is Non- Transferr ble White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller a rv^c +:.r.. _: v..:s :.::rtr ,.. .- ;:._ s;•�i' : �acr -:..x .a :.-._ � _. (•-`^ . _. �— _- �'--- ...�.. w..,.nr o.......:,�4,,.. ,r .., ..-x. . .:r-n.. ii .. = vr�.cer.a-s.w.•s. i�,c: _-- JOSEPH F. SULLIVAN, P.E. CutaEEta�.ti� ;n,P,?h 2972 Ferncrest Drive Yorktown Heights, New York 10598 (914) 962 -4248 July 30, 1994 Putnam County Health Department 4 Geneva Road Brewster, New York 10509 Gentlemen: Enclosed please find a construction permit for a Sewage Disposal System for Vado Construction Company's lot on Peekskill Hollow Road in the Town of Putnam Valley (Lot No. 14 Hunting Ridge Subdivision). Also enclosed, please find an application for a water well for the same lot.. The construction permit for this lot was approved in 1988 (Your File No. PV 21 -88). From a field inspection, there have been no changes to affect this design. Very truly yours, ,Joseph F. Sullivan. P. E. 88 -104 4 l t � 'r ark`- �K _ �' '4s� } t xi-st wwr I CODIf1 Y Sanisas. Coal. t lQliiAl[. DEt OF DNYM d)� "irw�taltl BM11� ` w C�l1FiC.ATS OF 00 c "" FO�l,FOlt>�ABE D16lOi�L><!al'•Ei1[ .��� X .,.. ' !. i. } •• 1. " +' n a.%arltla. ut r� Tam t.k. - Date aI 1iwWaa D l a1 11iis Aaia><a++ - , Tows , Subdiwis:ion ,Any robed Fee 'Enclosed ❑ Amr;,,Tt_ 5"m6 0* Valoa Q-' Abe : PCHD N�atlM b tared PtD b o+:M+ted F)ow G P D _�w!Pp.S7 n traa�it a[ Sa lle Talk, odd ly'ia aaaa4�eW b � rJ, —�' Adlhau. Ratele PltYls Sa!!�I F►r o �1 ✓tl.t..�. � Dtid k' �'�• r -mss - Otltalt 1 rp►is+„t tliait 1 am wholly a►nd eompNtay nsponsit►» for tM Wsi/nind on-9 Ma proposed systam(s)i 1) tMt tM ' ab sew di YI stani' , aCOrp dsaaiWA�w111,Ofa corstruatsst as shown on tM approw0 an,and,m,at thpl,to and ,M aCCO►Gnw wttn tM stanWrds, ru»f a r ns o m �. 'oouKy WpMttnMlt,,o1,'`NMkA; "an0 tAt?on Con�pMt»n tliMiadf a!1C�iti /icata ";;of Co��t►udbe Compllinp' Ytidactwy to °tM CommiYloeNr of wlll M ,tilOfnleta0';to tM'WpNtnlMt +nd wrRtM ta,aarantM'wtll M furnishaA;tM O,NM! his sucpwon, s aftipnt t►Y; tM OulkUi th+t 21116 OuUAM w111 plat'- iw`peA, opwathl� oofWitbn any Dart of .YW Ywa/+ Aispot+l ,:Yfbn1 -dwk,� t11a parklat'of two' _ I Y f MmmOiatNy f011owin� tMAKd Of tM'tYw MN ,Of tM ypfoval' of tM GrtMicat� `01 Conriru,;tbn Ganpl»nei OI tM Ml/inil ofn :any r Ns t of Z) thot'tM -diNNd wNl'Cisakn0 above ssNl M IOCabd as llblw On tM aoprarM Yl+n an0 tUSt saki will will hri`» nei 'ith t M><; 'r »s •ifid rNuTai Oros Of lM PYtM111 f:O11MY Oap�rt M, tlaalth. �, 5 P E, i Ll insa No ApPROVEO }fOR'CONSTRUC,TION: Tt►it'.aop►ewl;a ■ pMat twe years :from tM' dab ,Ipuad un»st conihurtbn of M tiulktina t,as :ta.a„ uiWtartaksn atiM is fNOCauN toi -fJ11N a nHY e� anw,daa er ,r,odMlaO whm'eonsidMfaO nKasYry, Oy _tM', COe,rnistiOnar of NaaiRh. Any Change or alta►atgn of oofptru,:tk,n i pimak a w parmR . AOpreiiad f0/ Iitpowl ot- donwstk s.nR ry tawa1 an0 /or . Waits wale w00b , MY•. 11 M REV. TROB Date 10/:8.8 _ 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 # #,N WELL LOCATION Street Addr s Town Village C ty Tax Grid Numb r J�v Z- i l� . l,1 ta- WELL OWNER Name 'i Mailin Address . 1 9 1�! 7 OPrivate O Public USE OF WELL 1 - primary 2 - secondary RESIDENTIAL ® BUSINESS ® INDUSTRIAL O PUBLIC SUPPLY O FARM O INSTITUTIONAL Q AIR /COND /HEAT PUMP O TEST /OBSERVATION O STAND -BY O ABANDONED O OTHER (specify AMOUNT OF USE YIELD SOUGHT S .gpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE ��,gal O RVLACE EXISTING SUPPLY. O TEST /OBSERVATION M ADDITIONAL SUPPLY B-NEW SUPPLY (4EW DWELLING ® DEEPEN EXISTING WE LL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE GRILLED ®DRIVEN ®DUG OGRAVEL ® OTHER IS WELL SITE SUBJECT-TO FLOODING? YES ✓NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: ,100 —M.Q l Lot No. f �. WATER WELL CONTRACTOR: Name- v i�:� Address: 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 & WRCES OF CONTAMINATION PROVIDED SEPARATE SHEET wz/" w-, (date) signature) /7 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 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:�G��% Date of Expiration 19 Permit Issuing Off cial Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller _ •it1... t. _. ... ... a �� .: _►•ii- —•2 �_' -Sow r•��•• '+�' �.Y/Oa.rt.� '1f�Y.i�:i'iili�i:1! .. ._ .,. �.7.: � �.:.T1 PUTNAM COUNTY DEPARTMENT OF HEALTH �- 3kivs:sian .,o f-. Envaron�aentl- etbr�Serrrsices- ...- ,- :.�._e_�,.;;,r.,.... tea.. -•- — AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PEL41T APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health In the matter of application for: VA- represent that I am an officer or employee of the corporation and am authorized to act for Name of Corporatic having offices at 7J l`�u �-7( n1G, �CiTt�t�t. Whose officers are: President: Name and Address') Vice - President: -(Name'-and . Address').:__._'_... Secretary: (Name and Address) Treasurer: I" 0 Name and Address and that I am and will be individually responsible for any and all acts of the. corporation with respect to the approval. requested and all subsequent acts relating thereto. Sworn to before me this _ day of 19q Notary ub is Nagy. itC, $teie Of 18W Ndfdt - ! Nb: 4878911 bualitied 1n.Westchester County pmCniRSior+ Exr)..irps Noupr,her 11) ' A9V h c/o/. Signed: Title:�st f- Corpbralue Seal r r i PUTNAM COUNTY DEPARTMENT OF HEALTH - -- _. y.I - � I ON.:0.1♦, _EN - - VI120 -= ?fib' fl:- :�R�IFs��a- .- .:��:;.F.- _ •�. _:.,.;.- - c.�.. -..-. � „ .... ?` T Date V Re: Property of 1//, -2Cn �&Cp Located at (T177i31_1) AYx V4CL (0 a Block Lot Subdivision of Subdv. Lot # 4- Filed Map # Z7-16 Date T. MICHAEL DALY, P.E. Gentlemen: CONSULTING ENGINEER This letter is to authorize P. 0. BOX 243 � N.B. 20387 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 `thi =s matter and to..supery _s'e . tYie. =_c_�o is_ ruc:.ti'on. o.f._.s.aisi__, t _ . 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, > s) gn e d �i ^' 'Owner of Pro ert Countersigne�� p }' P.E. , R . , # 7 7L�' Ad • Add , ess T. MICHAEL DALY, P.E. ONSITINI C ENGINEER t- l/c s 7 �as� . Address P. 0. BOX 243 Town SHENOROCK, N. Y. 10537 Telephone Telephone` PUTNAM C0= • E• • r = OF DIVISION OF ENVIRONMENTAL EEAIAH SEMCES DESIGN DATA SHEET- SUBSUFACE SFWAGE DISPOSAL.SYSTEH FILE NO.. r:; .3eK--- •- ^CS•. : "%z �.4 ��'_t:= .:- .e..:.� ,- `�'<; t,.;= ,'.��'T.s,-�.. .. . >s :. .. .:••:- '�,..;,,�.: s.-... aa��: y�:- � .,.:...n..r..- er—_r- ..+c -,... r. .nc ,m -v... .r .. >< Owner rl a n� �Gt"� S Address a ^ ii 7 iS /y Located at (Street)'?-K', Ki ;_L lda��r ` 4 . S� � Block _� Lot jt1lZ (indicate nearest cross street) municipaiity Watershed,,5wsx,/ - d�- y iP�.�l S SOIL PERCOLUION TEST DATA RBQUII2ID TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking Date of Percolation Test HOLE - /ASS' NUMBER CZ= TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 153 .j 2 1/40 -/rx-5' .s J0 a3 3 F. "' . j 3 -40 ,013 3 if 4 5 1 le —, - /ASS' -20 i 5 1 2 3 4 5 NOTES: 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 from top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES. &Y%YT LLr iLl AVLY: LVL/ IIVLLi~NOo -Ci —1VlJ. G.L. 2' 3' ,� v 41 5' a �� 6' r, M 7' 8; 9' 10' 11' 12' 13' ,14' INDICATE LEVEL AT WHICH GROUNDWATER IS.ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED aaer 9 DEEP HOLE OBSERVATIONS MADE BY: - DATE: jo � DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided 60,00 '¢ No. of.Bedroams 3 Septic Tank Capacity % 000 gals. Type N19,S,017 y Absorption Area Provided By :3-?3 L.F. x 24" wi N �y ti� r.1Ci-I,C�C� 0,4 Other -71 f l i niAl wAi n1 Name ! iii mss_ a i. Y Sig e Address S 0 048 �� F. P�OFE S S 1n� �~ nd�nU,K Al I/ AO50 7 THIS SPACE FOR USE BY HEALTH DEPARUTM ONLY: Soil Rate Approved sq.ft /gal. Checked by Date DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APP LOCATION TO CONSTRUCT A WATER WELL , + � Drun D,. Dwrm u WELL LOCATION Street Address Town/Village/city Tax Grid Number ar✓� q le, q 45�a - l% -%d /? WELL OWNER Name Mailing Address `a /,tlo 4,1 rivate O Public .SE OF WELL 1 - primary 2- secondary: RESIDENTIAL ❑PUBLIC SUPPLY ❑AIR /.COND /HEAT PUMP. O BUSINESS O FARM O TEST /OBSERVATION 0 INDUSTRIAL O INSTITUTIONAL O STAND -BY ❑ABANDONED O OTHER (specify Q AMOUNT OF USE YIELD SOUGHT_ gpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE�G'�7 gal REASON FOR DRILLING EW SUPPLY O PROVIDE ADDITIONAL SUPPLY O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING En LL TYPE BILLED DRIVEN DUG ® GRAVEL ❑ OTHER IS WELL SITE SUBJECT TO FLOODING? YES i,,-' NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name /ifrx. Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES A*�NO NAME OF PUBLIC WATER SUPPLY: DISTANCE TO PROPERLY ~FROM'NEAREST WATER MAIN: TOWN /VIL /CITY LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED n oN REAR OF THIS APPLICATION ON SEPARATE SHEET ( at ig e) 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 requ' ements of the Putnam County Health Department attached to this perm t. 3. Submit a Well Completion Report on a form prov ded y th P t unty Health Depar ent. VA Date of Issue: 19 Date of Expiration: 19�_ Pero Issuing Office Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector 2/87 Pink Copy: Owner rw-m -- - T.7-11 r%__­1 1 __ JOSEPH F. SI` LLIVeANe P.E. &niQdi W4 &*PLB" 2972 Ferncrest Drive Yorktown Heights, New York 10598 (914) 962 -4248 July 30, 1994 Putnam County Health Department 4 Geneva Road Brewster, New. York 10509 Gentlemen: Enclosed please find a construction permit for a Sewage Disposal System for Mr. Perry Victor's lot on Barrett Circle West in the Town of Kent. I have also modified the design plan to conform with the regulation of a minimum of 100 linear feet of 24" wide trenches per bedroom. Also enclosed, please find an application for a water well for the same A construction permit for this lot was approved in 1985 (Your File No. K 2 -85). From a field inspection, there have been no changes to affect this design. 84-226 Very truly yours, _�. -..... �....... • �...r . s _ . .._� ., .. _...... � � , .� ._ . _ ... .. APPENDIX B PUI -NAM CCUN Y DEP_AR`M= OF HEALTH - DIVISICN OF &WnRCNMENTAL HEALTH . SrRVICES IN DWIDUAL WATER S'JPPUi & SUB-cMM CE WAADISPOSAL SYSTIIvS. REV= .,.S'r1EE'1'. -- CQNS=CQ`ION.'.PERNlIT _ .. n ....... ! l�..�.. p 7.�� BY: (Name of Cwne --) (Street Lc mticn) CCM-M. YES [,-NO I I, I I I i I I I I I i i I i I' Lt' trench prOVLde^_ re—ui: - 60 ft. rm::. _ Parallel to ntours 100% e-,= i r I i' I I I I r i FI✓ SYS • S I , clav ier (� 10 ft. f L not is ne:v sue. depth gau es I I 100 vr. fltSd elev. 200 ft_ rese_ oir, etc. 150 ft. triga i /call. DCC[J =S L. Pe=dl- Application l Corporate Resoluticn ( j Plans - Three 's`ts (Z _ i Engineers Authorizati cn Desicn Data Sheet (DC�) Su7 Dr1ISICN Dew Hole Lcg parc Consistent Perc Res-.is (3) Fi11 --_ Per Hole Depth a x Ily Hcuse Pl- s TWo se S - _ Well Fe mic; F,Y� 1e- t =r Variance Reauest C�-L La-c-al SuLdivisicn Subdivision Aonroval Fx -a_ p rcor 1 SSDS Pd-� L :Ls Ch rcer WET' and (Tcw --/DEC Pe ii t R & D Dam Crn DDS Plans & Permi` c- REQL -= DMI TT c CN pry _ =cS .vcge System P'an rw) Servace System Hydraul ? c -F-i-1-1 Profile & Dimensicns - Vc-L �. D or J Eox;TrenGZ /Ga11_ry; _P�.�� pi. der: its Septic Tank — Size, De*-=-,l We-' ! Detail, Service Line if ever Ccnst�-ucticn Notes (crinder rte) _.��1CI1 I)dL�:,l prr ariC�GS J resU• =L Two -Foot Contours Existing & P_oresed Drive ay & Slopes Cat Footi n /Gutter, Curta i n Drains (discharge CK ) Perc & Deep Holes I,ccated Representative ' of pr; wry and ex_...ansicn Expansion Area; shoran; gravity flcw, s'uf= .. size If F,mu)ed Pit & D Box Shcr-n & Detailed House - No, of Bedroans Wells & SSDS's w /in .200 ftC.. of Proposed Syst`- ProperLy bites & Bounds House Setback Necessary (Tight lot) House Sever - 1 /4 " /ft. 4 "0; T_�ce pipe No Bends; Nix. Bends 45° w /c_eancut SEPPIRATION DISTAL'3C�'S SPECIFIED D CN P12 -IN Fields 10' to P.L., Driveway, I rge T: as,Tcp of f: 20' to Foundation Walls 100'. to Quell; 200' in D.L.O.D, 150' pi- 100' to Stream, Watercourse, Lake (inc. e-'K 15' to Drains- CA=' --in, Leader, Footing 351to mtca basin, StOm rain,cipei Ovate -'ccu 10' to Water Line (pits -201) 50' intenn.ittent drair-age ccurse Semtl.c T:aiks - 10' fran Foundaticn; 50' to we:,.' 15' Well to PL 9 WP .hy.-mako, juglogy'nowwom • It •' • � •- •' 1� Y• •1 D1• Mme. rn�,= F.SIGN_".SS!TAGE::DISPCISAL SYSTEri - FILE .NJ Owner Address f, Located at ( Street) ,��5 /ii/% h4Acj vtJ &ec - Z-2 Block /% Lot 4 5 1 /l� V 4 5 1 2 3 4 _ 5 NOTES: 1. Tests to%be repeated are obtained�at each for review'. 2. Depth measurements tc rev. 9/85 at same depth until approximately equal soil rates percolation test hole. All data to'be submitted be made from top of hole. (indicate nearest cross street) Municipality IC7c4 � �111e- ,;e Watershed SOIL PERCOLATION TEST DATA REQUMED TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking i _ Date of Percolation Test � f � HOLE NUMBER CIDCR TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches a 2-7 2���ry� 4 5 1 /l� V 4 5 1 2 3 4 _ 5 NOTES: 1. Tests to%be repeated are obtained�at each for review'. 2. Depth measurements tc rev. 9/85 at same depth until approximately equal soil rates percolation test hole. All data to'be submitted be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES ---DEPTH - H9T,�E .et- _ aw•a:.. . - _ .. ._ -.r �- :.+!: rsc�:.,+.e:••Mc _. r. -.. n -: -..: ••et. _ cu-..a s++ -tisr_ :.�� +s r.�►.o G. L. 2' 3' 4' 5' 6' 7' 8' 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED' INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: ;%��/ DATE: DESIGN Soil Rate Used �_ Min/1" Drop: S.D. Usable Area Provided���'� No. of Bedrooms Septic Tank Capacity gals. Type����'� Absorption Area Provided By L.F. x 24" width trench Other i Address 7i 6f,, THIS SPAPE FOR USE BY Soil Rate Approved Signature, v a FRANC/ s A11V WI-7 DEPARDTM ONLY: `"p#OFfS`S N sq.ft /gal. Checked by Date # »: ,• b�V �1 ®F ®� . ®� �� {�WUYT i1i �Y_1 ty>' } �t51.19VtiVCC® X A6,$rraND , V ���� 4�4\ fix 4F •.� ,Q,ccATro� , � FORq► {PER.HIT, ABf}k.I ��p M ily �- r` ±� "a •-rti= •vn..:i wv+%u.sm ....: a,.. .'C V�7 �'�1/L� s"�4'r . *`.u.siv r.+A�. n -.w.. .-q9 •-rs ission of Health 3S , TO: Comm er �tig5 ?yty�t err Gus S L 4 ra r a in `.the matter of 41PPIlcati f ,> X11 y �;` ' ,ty, i Y i i authorized ,'• rem to eet�.e� kr fie` rat�.on sand a� represent that I am aa.'officer 0 P Y 3 to adtt #or oration e rP 14 am of Co having offices At r Whose officers are' P ;Asident: (N u . ame and .Address) .. .. ' Vice- President v (Name and Address) Secretary: (Name.'and Address) Treasurer srnd Address _ '• - ' «- - - --- -' - r and that I am.' m' .and will b e: individuahy responsible for any and'all ,acts ;oi the. }t corporE'ion with .re'spect.'to the approval.Yequested and all subsequent acts relating Y } µ ry thereto. r Si ned Sworn to before me this day $ Title: Of l r ' Notary �r§�{ ' z j t'7��,OWs rYa��� Vof 3 yy Li 'Y�1kC1-'' ry {, 3i P 1', 1 LY 4 i d{ 4!- �'•S .I t Ek �7`.y. `r^ J\ „. ?r -` 6ty-sr .EIS •]'^t: 'h hHYsyas.. r xr + •' l"'d'S'�`yY�'?"ckita +x^tt,.';s„ tit .v •..' � '� 3 •., M' y" � � 'S' +., i ''�„P rM Y ",k ��4 � 5 "5..4 _- Y JC �tA � �C 4� •:; { 3r 4 Q,yvrL... df t4 t{ t✓SA cbrr ?1 * ix, yW"�i 8184 v y u 1.� Rtr R!N�a,X�, kx dSy"3'r IV c;} ssi'tc's�`'fi r,. �r+„•- John M. Simmons, M.D. ;P V,il` M' `�^ 5!� �' i.,r� �t � Y,L'.W . PK� DIVISION OF ENVIRONMENTAL HEALTH SERVICES Deputy Commissioner of Health - FIELD ACTIVITY REPORT - Sheet ► of l /l�I � INSPECTION NAME /1U��� /�(i / tl�� 5-ol • _ Orig. Routine _ // f� / / Orig. Complain ADDRESS��5'/�/ / C �'TaL� ®!,� �(/�• (J�L ��� Orig. Request . Town MAILING ADDRESS P.O. Box Post Office Zip Code Gylppf;C"I PERSON IN CHARGE OR INTERVIEWED Name and Title DATE 0 ®Y V TYPE FACILITY i :cc 1O R TIME LEFT FINDINGS: i Canpliance Complaint. Comp Final Group Illness Construction ZZ/ Reinspection Field, Sampling-Only Field Conference Other Explain INSPECTOR: Signature "and Title PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. SIGNATURE: 6/86 TITLE: TELEPHONE: