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HomeMy WebLinkAbout3402DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.08 -1 -47 BOX 27 1N% I f r ' JL � T -. IN IN L . . . - �. 6 1 ' ` F T, L I - 1 1 - IN I 03402 nerlappllcentName Wag ,j state Sewerage System Cd -1 S f Ater Sapply� #SI tin , Ildhi& Type 1 X -.TLAA ni k3',V 4. "A Block Lot �� lock ' So bd*.-L(W# 7, Mm .—A ".rArit A nni Oiection,"bf sny : unsanitsry =Such tiM 'OPP hange, s'�nsmuf, V PUTNAM COUN'T'Y DEPARTMU OF HEALTH DT_VLSION OF Eb V O ENTaA HEALT_.H .- SERVTCFS K, F\\,30 Gwncr or Purchaser of Building ©E\J ciJ ' -UEUCtc pv"eO'I / PFYE25m) Building Constructed by Location - Street 66 r 72- Section Block Lot Nv,o-�,�)G Subdivision Name Pr Municipality Subdivision Lot # ESNttE40CE Building Type GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM f .I represent that I am wholly and completely responsible for the location, wor)amnship, 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 t canstruct on LQmplian e, "afar. tho_. eti?ag a posal= ssystanI or. 4ny, 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° s: y 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 buildin3r-u�ilizing the system. Dated this i b day of PVA 1911 Signature Address rev. 9/85 mk Title Corporation Name k* Corp. Address' _SREVJSTER pip p pQ Box 224 - BREWSTER, N.Y. (6 14) I['OYAU, .855 -1930 - WATER ANALYSIS REPORT SAMPLE NO. 7986 TEST WELL SOURCE: Michael Finn - Miller Rd. Putnam Valley, N.Y. COLLECTED: 3-7-91 BY: P.F. Beal & Sons BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 0 per 100 ml. This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. • I 3 -8 -91 I ho pas M i i C UN TV OF PLAT 'NH�I TEL No . :t WELL LOCATION WELL OWNER USE OF WELL 9 - primary 2 - secondary MOUNT OF USE REASON FOR DRILLING DEPTH DATA DRILLING EQUIPMENT Hpr 15.:1 11 1! 3 No .001 F.0 WELL COMPLETION REPORT Off ice Use Only DEPARTMENT OF NDALTFI r .. .... . .,: C "a :..,q ir4' 1.:a 4M1...eLL•tiTw�r ..... ;,`.iy.j. Division Of Environmental Health Services PUTNAM COUNTY- W2ARTMENT OF HEALTH TAX GRID NUM fa: P81VATE O PUBLIC J3- RESIDENTIAL 1/ Q PUBLIC SUPPLY 0 AiR /COND. /HEAT PUMP O ABANDONED O BUSINESS 0 FARM D TEST108SERVATION a OTHER (specify) 0 INDUSTRIAL a INSTITUTIONAL 13 STAND -SY p .- YIELD SOUGHT _. gpm. /NO. PEOPLE SERVED '-N6. /EST. OF DAILY USAGE *: O ygal. []REPLACE EXISTING SUPPLY ]TEST /OBSERVATION [3ADDITIONAL SUPPLY NEW SUPPLY (NEST DWELLING) C} DEEPEN EXISTING WELL i WELL DEPTH ft. STATIC WATER LEVEL.. TftDATE MEASURED XROTARY ❑ COMPRESSED AIR PERCUSSION O DUG O WELL POINT 0 CA8L5 PERCUSSION _ ❑ OTHER (specify): WELL TYPE I3 SCREENED ❑ OPEN END CASING OPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH CASING LENGTH BELOW GRADE DETAILS DIAMETER WEIGHT P-cR FOOT SCREEN . DIAMETER (in) -- .. WATER 0 CLEAR TEMP. QUALITY D CLOUDY HARDNESS 0 COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? 0 YES 0 NO PUMP INFORRATION TYPE CAPACITY , MDOtEI �s VOLTAGE t3_0 HP'S _ ft. MATERIALS: 'ZSTEEL 0 PLASTIC 0 OTHER 9 f. JOINTS: ® WELDED )5,THREADED 0 OTHER in. SEAL: 0 CEMENT GROUT O BENTONITE "THER Ib.lft. I DRIVE SHOfw -,YES ❑ NO LINER: G YES BVO 'SLOT SIZE LENGTH (it) DEPTH TO SCREEN (ft) DEVELOPED? HOURS DIAMETER TOP 00770M OF PACK - in. DEPTH -_..,_fL OEM ft. W1 It more detailed formation descriptions or sieve analyses YY L.L Ul7 are available, please attach. UPTx FAN WSW Well SUAFAGE Rcan MOO FOA MAnON DESCAMION �ppg it. tL 4 In // n .h- _ 0 STORAGE TANK: TXP CAPACITY _ /0 %;w GGAgY�r - �s�.. DATA GRAVEL PACK ® YES GRAVEL L 0 NO SIZE: WELL YIELD TEST ht detailed pumping METHOD: 0 PUMPED tests were done is in- ' 0 COMPRESSED AJR ; formation attached? !' 0 SAILED 0 OTHER ' : a Q YES 0 NO WELL DEPTH DURATION DRA'NOOWN YIELD It. hr. min. it. 9pm. WATER 0 CLEAR TEMP. QUALITY D CLOUDY HARDNESS 0 COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? 0 YES 0 NO PUMP INFORRATION TYPE CAPACITY , MDOtEI �s VOLTAGE t3_0 HP'S _ ft. MATERIALS: 'ZSTEEL 0 PLASTIC 0 OTHER 9 f. JOINTS: ® WELDED )5,THREADED 0 OTHER in. SEAL: 0 CEMENT GROUT O BENTONITE "THER Ib.lft. I DRIVE SHOfw -,YES ❑ NO LINER: G YES BVO 'SLOT SIZE LENGTH (it) DEPTH TO SCREEN (ft) DEVELOPED? HOURS DIAMETER TOP 00770M OF PACK - in. DEPTH -_..,_fL OEM ft. W1 It more detailed formation descriptions or sieve analyses YY L.L Ul7 are available, please attach. UPTx FAN WSW Well SUAFAGE Rcan MOO FOA MAnON DESCAMION �ppg it. tL 4 In // n .h- _ 0 STORAGE TANK: TXP CAPACITY _ /0 %;w GGAgY�r - �s�.. DATA muUC - 1 Q VOLTAGE Le _v HP V --- - - - ---- - - - - - --------------------------- - - COUNTY �� F '!Ai^ � E_ No hpr 15 - 91 11 `?..� No . i)O i F .0-35 ;r:»:.:..; - cam::: ".rw:y, -_ , .:,,�. _,. �_ .,-.. _..... -. .� <;;s, »f::.. -.�. ..G= r:aa- .:,�= w:;.:.: = a:,:•:� : ,.,.... ter..— _ _ ._.. ..,,_, r...., - .., - ;,;., sJ. ..- .. . 7 WELL C011PLETION REPORT Office Use Only DEPARTMENT OF HEALTH Division .Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH STREET ADDRESS: -TOWNIVILLAULIG1Y TAX GAIO NUWER: TELL LOCA710N pu M f. - 1d WELL OWNER HA E: , - ADDRESS: - Q-f IVATE F 0 PUBLIC USE OF WELL M-RESIOENTIAL O PUBLIC SUPPLY ❑ AIRICOND. /HEAT RUMP p ASANOONEO I - primary Q BUSINESS O FARM ❑ TEST /OBSERVATION O OTHER (specify) .2 • secondary , 01 NOUSTRIAL O INSTITUTIONAL d STAND -BY O HUNT OF USE YIELD SOUGHT —YO— gpm. /N0. PEOPLE SERVED __'Z_1 EST. OF DAILY USAGEI. gal. REASON FOR ORBPLACE EXISTING SUPPLY OTEST /OBSERVATION []ADDITIONAL SUPPLY DRILLING CaNawluppty (MV DWELLING) ❑DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH D ft. STATIC WATER LEVEL 7 ft. DATE MEASURi~O / DRILLING A ROTARY OO C RfSSED AIR PERCUSSION ❑ DUG EQUIPMENT O WELL POINT ABLE PERCUSSION ❑ OTHER (specify): WELL TYPE 10 SCREENED C�EN END CASING TOTAL LENGTH CASING LENGTH B: LO.s W -.G.�RAD�E. r.r .. va-EfAiLS — . oA TER _ ?= WEIGHT PER FOOT .� SCREEN OIAMEETER tin) '$LOT SIZE DETAILS FIP,5T WATER 9;-CE-EAR YEMP. A-1 QUALITY O CLOUDY HARDNESS —. 0 COLORED ANALYZED? t�"�ES o N0 ANALYSIS ATTACKED? UL.VS' 0 NO PUMP INFORMATION O OPEN HOLE IN BEDROCK 0 OTHER fL MATERIALS: 0,8 EL ❑ PLASTIC Q OTHER L .jt._. _JOINTS: .. ❑ WELDED t f FADED• - :- Q OTHER —in. SEAL: 93-ti�OUT O SENTONITE ❑ OTHER lb,/It. DRIVE SHOE: d NO LINER:GYES 0-NQ LENGTH (It) DEPTH TO SCREEN (A) DEVELOPED7 DYES C LSO DIAMETER I TW I 90t70A1 OF PACK - In. DEPTH K. DEM It, l�Ll. LOG It more detailed tormation descriptions or sievesEeve analyses are available, please attach. DEPTH FROWitcr Walr SUaFACIH star• filelct FORMA110N DESCRIPTION C4 of it. 'n9 In !Z d STORAGE TANK: TYP CAPACITY .. I. J GRAVEL PACK I o � GAAVELy SIZE: WELL YIELD T If detailed pumping METHOD: IAPED tests were done is in- . O COMPRESSED AIR ; formation attached? O BAILED O OTHER © YES O NO , WELL OEM I DURATION I ORAWOOHN YIELD I It. hr. min, It. Qpm, WATER 9;-CE-EAR YEMP. A-1 QUALITY O CLOUDY HARDNESS —. 0 COLORED ANALYZED? t�"�ES o N0 ANALYSIS ATTACKED? UL.VS' 0 NO PUMP INFORMATION O OPEN HOLE IN BEDROCK 0 OTHER fL MATERIALS: 0,8 EL ❑ PLASTIC Q OTHER L .jt._. _JOINTS: .. ❑ WELDED t f FADED• - :- Q OTHER —in. SEAL: 93-ti�OUT O SENTONITE ❑ OTHER lb,/It. DRIVE SHOE: d NO LINER:GYES 0-NQ LENGTH (It) DEPTH TO SCREEN (A) DEVELOPED7 DYES C LSO DIAMETER I TW I 90t70A1 OF PACK - In. DEPTH K. DEM It, l�Ll. LOG It more detailed tormation descriptions or sievesEeve analyses are available, please attach. DEPTH FROWitcr Walr SUaFACIH star• filelct FORMA110N DESCRIPTION C4 of it. 'n9 In !Z d STORAGE TANK: TYP CAPACITY .. I. J PUTNAM COUNTY . DEPARTMENT OF HEALTH .(p3gry�.�pryry�.�ppe.�gyp, .� }�,.ypy.{p�.�.n. [�y_ry�� U 9d1i0it6V/Y®61�8V/3®0bVLl4' ^.Lo Date: From: Subject: X°%�`�� xa, 74�s� ( ) I WILL HAND VZLIVLK MaLLr (•) PLEASE SUBMIT TO THE SPECIFIED. DEPARTMENT_ FOR ME SIGNATURE -FOR PUBLIC ACCESS TO RECORDS w ..;..,.�k�., -..._ .....Y., TO: RECORDS ACCESS OFFICER. Name of Agency .Td-dress DATE: JOSEPH L. PELOSO, JR., PUBLIC INFORMATION OFFICER I HEREBY APPLY TO INSPECT THE FOLLOWING RECORD: l l Mj 01 Name Business Address WHO MUST FULLY EXPLAIN HIS REASONS FOR SUCH DENIAL IN WRITING SEVEN DAYS OF RECEIPT OF AN APPEAL. I HEREBY APPEAL: Signature Date 1 MV1LL anav "z"vZZL rllazjLr ( )' PLEASE SUBMIT TO THE SPECIFIED DEPARTMENT FOR ME SIGNATURE - C3iV'`FOK'I'ITfSLZC'`ACCESS 'TO REOU WS TO: RECORDS ACCESS OFFICER ame of Agency ddress DATE: JOSEPH Lo PELOSO, JR., PUBLIC INFORMATION OFFICER I HEREBY APPLY TO INSPECT THE FOLLOWING RECORD: Signature Representing Mailing Address S ?0 -g FOR AGENCY USE ONLY APPROV Date 1 DENIED _..: Record of which _this agency .is Legal Custodian cannot.be found. Record is not aintained by this Agency Signatur Title D� e NOTICE: YOU HAVE A RIGHT TO APPEAL A DENIAL OF THIS APPLICATION TO THE PUTNAM COUNTY EXECUTIVE, Name Business Address WHO MUST FULLY EXPLAIN HIS REASONS FOR SUCH DENIAL IN WRITING SEVEN DAYS OF RECEIPT OF AN APPEAL, I HEREBY APPEAL: Signature Date R r - r r PETER C. ALEXANOERSON County Executive ; bt cr . DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route' Six Center, Carmel, New York 10512 (914) 225 -0310 DATE COPIES ARE SUPPLIED TO YOU, AS PER YOUR REQUEST, AT A COST OF 25c PER PAGE, LETTER SIZE AND 50q PER PAGE, LARGE SIZE COPIES RE: TOTAL NUMBER OF LETTER SIZE COPIES �r @ 25q each= .'� TOTAL NUMBER OF LARGE SIZE COPIES @ 501; each= Q • 0 O TOTAL DUE: • MAKE CHECK OR MONEY ORDER PAYABLE TO THE PUTNAM COUNTY HEALTH DEPT. MAIL TO ABOVE ADDRESS, ATTENTION: EILEEN ENID L. CARRUTH, M.P.H, a<. ; Public; Heatth,'Oiroctor,' >• JOHN KARELL Jr., P.E. Director COPIES RECEIVED BY: COMPANY NAME C' ADDRESS: /_J Y arc i 2eP%r rnG� /!� Y, /v�7� J' REPRESENTATIVE , THANK YOU FOR YOUR COOPERATION. I:DfEDIATE PAYMENT WOULD BE APPRECIATED. | Punam County Dept. of Health: In regard to the new house being completed on Peekskill Hollow Road and Hunting Ridge, in Putnam Valley (large white house on corner). We have invested our life savings in buying a home in this area, which far exceeds +odays market. It is devastating to see people living in an uncompleted, � untidy home, where the contractor Steve Stauder and the engineer brought to our attention that a yard of gravel was used and not the three or four yards of gravel, that is required per section of galley. With the systems thus far that have failed in this area, how can this house be occupied or even approved. As concerned residents of the area we put the County on notice for allowing this to happen and degenerate our neighborhood. PUTNAM COUNTY DEPARTMENT OF HEALTH MEMOMMUM Date: To: / e 1 From: Subject:fG Vol 1'. s . r a , � . | Punam County Dept. of Health: | In regard to the new house being completed on Peekskill Hollow Road and Hunting Ridge, in Putnam Valley (large white house on corner). We have invested our life savings in buying a home in this area, which far exceeds todays market. It is devastating to see people living in an uncompleted, ^ untidy home, where the contractor Steve Stauder and the engineer brought to our attention that a yard of gravel was used and not the three or four yards of gravel, that is required per section Y galley. With the systems thus far- 4. 1- -.1- L-`'^~ �- - ` - -1 - -- ��- - - - - - - — - - - - I- -- - I - �� ^� -- - ^ ~ u or nc ns * PQ11 M CUUM DFIA!! MM OF MCAL'lII �� DIs116fe d Metdtl�ab1a19edib seede,a. Card. II.Z. IM8 �� w Pbwli llMtalt / OF COMMAtM PIVe! M MWAM MMOMb Yieldm YAM OwndAAinot noon roils AA&M 2 i 7,119-7 T= m" K6 MIk l ( 2Z Ddee d A--ea..I r Z r zoo. l: U' B. `05l +'Pp Enr_lnspd 1:1 e,.,.,,,.,t` %014 r�// ��,('� ab .. I Dep16 cross. M&W d �� DwI p Flotr G P D � PCHD M6IMaMr is Zegbbd Wr M b easiWldd Sopiods Sera p spins is on it d t Z�iO Septle itidi Z r - i �c (✓ AAA - wmr stub Fab sMlb Pr<.. Adhein .e, y Dtia by Adhess \5,v 1 olr.e >fdgie.e.le 1 reis lot that 1 am wholly am completely ra llonsiblefor the desien and location Of ins p►Opond systamipi 1) that tit M rata snnr dl nl stern above described will be constructed as shown on the approved amendment there to and In accordance with the standards. rules a M— of o County Depaetamnt'of MmUh. and that on eon*WI ro.thenof a "Certlfieate of Conssruetion C~18ace" atisfaetory to the CommissloMr of Nealthwil be 11 tod to the 00artme nt, and a written ewran»e wiu �fu his suca n ers, hers or NOW by tit builder. that sN/ builder WIN ~ in pat .d/aratblp Muni", array hart Of raw sewaee d stan during tit kid of l) yens InimedNtey tolklwMp thedato of tit idew ~ Of tit epprowt of tit Certificate of Construction Compilf tit Original sy or a r heratoi 2) that tit drilled well denribed aiow WIN be hwand as M tit approved pun and that aid wall will illed ee wed It rds, rules and ny�ns —� Putnem cow" overt Z' Newly ' SlMned �,�.e��' n/ p.H.li2,2II /A. Address (2,q Z so, y` * � ../— C516 L ahaa Ns J L-3 G APPROVHD FOR CONSTf1NCT10114i Thu approval expkee two yews from the dote issued unless construction of tit' buiodine has been undertaken and is revocable for Wyse or in",be i nnnded or medMkld when considered necessary by the COmmisNonw of Nselth. Any ehanpa C alteration of construction wwlrso/ a new ypterrffll . /'1pprOvsd for dMpew of domestic sealtltaarry- iewga, a lute water su plv only i�A2i�p. Q Oafat d LL., r��� lir Title "�G:of 'tho 1=1- low gol"*.D Watt '4ilWwVI'de%Wlll" C60VO u oni P.E. L�1conw, P40 Y.Cmano or-olimatton ol.,ewnstruction TitC3 PUrI'M QOUN'1'Y DEPAi2RM�T OF HEALTH DIVISION OF Mr1R0R4WM HEALTH SEMCES wye a DESIGN DATA SWMT- SUBSUFACE SERAGE DISPOSAL SYSTIM _ FILEn No. Owner _.� 1�! Address Located at ($treet)t;l':�..t : >�� . Sec. �G Block I, LOt 22 (indicate nearest cross street) Municipalit Wat er shed �c125r SOLI, PERCOLATION TEST DATA RDQ(T.UtED TO BE SUaMITTED WITH APPLICATIONS' Date of Pre - Soaking 3 `I r , Date of Percolation Test.' ' r" HOLE NU -sm C= 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 Drop Inches. Inches Inches 2 I7/9 ,6. a -b zi 5 3' t� ' 4 NOTES:.':T: "Tests to be repeatei at same depth until approximately equal soil rates are obtained .at each percolation test hole. All data to' be submjtt�d for review. 2.. Depth measurements to be made fron top of hole. rev. 9/85 DEPT`fi 1° 2°` 3° 40 5° .. TEST PIT DATA RMUIRM TO BE SUBMITTID WITH APPLICATION DESCRIPTION OF SOIIS ENCOUNTERED IN TEST HOLES HOLE NO. ( IiOI►E NO. Z. Hoq NO. Ve 8° 9° IVC9 WaAIL 12°. 13° 0 141 _ ..... , INDICATE MML- AT WHICH GROUNSAM IS MMUN-'1`ERED � � L' � • ; . _ INDICATE %=I To Waal &MATER LEVEL RISES AFTER BEING ENOOUN' MED. DEEP BOLE OBSERVATIONS Mt BY:" -L 22 6 DATE: DESIGN 2 Soil Mate Used Min/1 " Drop: S.D. usable Area Provided�oy No. of Bedrooms Septic Tank Capacity �?,50 gals. Type Absorptiori Area Provided By " . '� , L.F. x 24" width trench i Other 224° o �R G� �LF.� Name .. 2 ►z Signature . Address SEAL A) J- ) �0• 43.736 • THIS SPACE, MR USE BY HEALTH DEPARTMEM -ONLY: Soil bate Approved Sgoft /gala Checked by Date PUTNAM COUN1Y DEPARTMERr OF DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET SUBS DISPOSAL SYS F�ILE NO. UFACE SEWAGE DIS Cwner Address co • Vie, lr Z 1: - 1 Located at (Street) -See-. (2, 6 Block I k Lot (indicate nearest -cross street) Municipality Watersh �C� SOIL PERCOLATION TEST DATA RDOUIRED TO BE SUBbUT11D WITH APPLICATIONS Date of Pre- Soaking Date of Percolation Test 6 /P/8 1 1 1510 - Ewes w4m 0, - =C1601VAJIM1111 Run Flap No. Time Start -Stop Min. 1 10 Depth to Water. Fran Ground Surface Start Stop Inches Inches In Inches Drop In Inches Soil Rate Min /In Drop 2 0 5 1 0 -30 1 ail 2 o 3 v- 3 D 30 i 4 5 1 i 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 G.L. c� L- I OrIB 2° 3° 4° 5° �r 6° �r 7° 8° \� 9° 10° 11° 12° 13° INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: �� e�/ DATE: V -- - DESIGN Soil Rate Used �(p-ZC� Min /1" Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity — gals. Type Absorption Area Provided By LeF, x Of , . Other r .' � -aUQ AJ Name Signat Z. lip C Address SEAL �04 n 04tikF�O THIS SPACE FOR USE BY HEALTH DEPARD ENT ONLY: Soil Rate Approved sq -ft /gal. Checked by Date EF� n. SUP ---------- CZJ —E— of C. — NO -M A-� I 1 -=4— A C- !e 17 E:c Data Ca C Tank Wei i ceta L L-i _ZI c EmEsicm -a: Drivaiav C Z Ora; perc: Cee= cl: -z. Pit & D 2 Nc- (T-Lcht .27-= Nc F i T Tr=:EE,T• ::C; C� Wall- 201 to 100 t:z in 3E't= Ily t-:: waLL C-7= Ccns P Re= 7 f I C- -M A-� I 1 -=4— A C- !e 17 E:c Data Ca C Tank Wei i ceta L L-i _ZI c EmEsicm -a: Drivaiav C Z Ora; perc: Cee= cl: -z. Pit & D 2 Nc- (T-Lcht .27-= Nc F i T Tr=:EE,T• ::C; C� Wall- 201 to 100 t:z in 3E't= Ily t-:: waLL PUTNAM COUNTY DEPARTMENT OF HEALTH fl. of,_,Efjviforim ntarjl, He,4 th -..Ser­vices,, AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION. SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health In the matter of application for: I, represent that I am . an officer or employee of the corporation and am authorized to act for 0 (Name of Corporation) having offices at Whose officers are: President: (Name and Address Vice-President: ind. Address)' Secretary: (Name and Address) Treasurer: In- (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 al subs quent act-,s relating thereto. o Sworn to before me this day signed: of 1919 Title: Notary Public Corporate Seal 8/84 LAW OFFICES OF . POST OFFICE BOX 308 - PARKSIDE CORNER - ROUTE 202 YORKTOWN HEIGHTS, NEW YORK 10598 Telephone (914) 736 -6500 Fax (914) 736 -6581 MARC L. SAIDEL Of Counsel . LORETTA BENEDETTO MARVEL DAVID A, GUTOWSKI* *Also admitted in Connecticut April 24, 1991 Mr. John Karell, Jr. P.E. Public Health Director Putnam County, Dept. of Health 110 Old Route Six Center Carmel, New York 1051.2 Re: Hunting Ridge Subdivision Miller Road - Lot #1 TM# 62 -11 -20 Dear Mr. Karell: Pursuant to our conversation this date regarding the above property., I have enclosed herewith the relevant portions of the former.owner's (Putnam Acres, Inc.) tax filing (.TP -580) prepared in anticipation of its sale of the property in August 1987. .Please note that the Capital Improvement Schedule shows. Mr. Anderson was paid by Putnam Acres, Inc. in January of 1987 for the well in question. This will also confirm the advise from Bill Hedges this morning that a permit :f well was.issued- ori'- DOcember I also reiterate to you that the present contract of sale is a "time of the essence" contract with a closing date of April 30. 1991. It is my understanding that the contract vendee - Mr. Finn - must have all. necessary documentation submitted to his lender by tomorrow in order to meet the closing deadline. If the purchasers are held in default I would fully anticipate that the Health Depart- ment will be hearing from their attorney. Very truly yours, MARC L. SAIDEL - �ccL1v �C� J� cc.�ca DAVID A. GUTOWSKI DAG:sm Enclosure P�J MARc L. SAIDEL ATTORNEY AT LAW 1890.COMMERCE STREET _..�_..... _..._... _ YORKTOWN ;Hik!GHT,S,1jF,WIYOR&1A 9,8 ..__. _ TELEPMONE(914)245-8205 OF COUNSEL LORETTA BENEDETTO MARVEL BRENDA W. FEDER July 1, 1987 New York State Department of Taxation and Finance Po 0. Box 5045 Albany, New York 12205 Re: Putnam Acres Inc. Gentlemen: Enclosed herewith please find form #TP -580, Contract of Sale, dated June 18, 1987, Schedule of Capital Improvements, Affidavit from Morris Miller, form #TP -581, regarding the above captioned matter. Please forward a Statement of No Tax Due at your earliest conven- ience. Very truly yours, MARC L. SAIDEL MLSotad Encse i SCHEDULE OF CAPITAL IMPROVEMENTS --------------------------- - - - - -- 1. Construction of new entryway December, 1986 - $875.00 paid to P. Fassati, Putnam Valley, New York. 2. Drilling & Installation of new well and.water pipes - January, 1987 - $5,599.20 paid to Norman Anderson of Putnam Valley, New York for drilling and connections $1',600.00 paid to McLean.Enterprises of Putnam Valley, New York for trench excavation. TOTAL OF CAPITAL IMPROVEMENTS EQUALS: $8,074.20 .. .. -a., .a...... _ .. ..ra - . ... . -v. ..�.. z_ .�..... :;�:, v- -s. . r ,.r...:...w�.... �.. ..........- ......:p. . �... .. ... .a r. .. e. .'re �y•�r.- r 0 1 1, STATE OF NEW YORK ) COUNTY OF ) MORRIS MILLER, being duly sworn, 'deposes and says I reside at 78 Vaughn Ave., New Rochelle, New York. I am the President of Putnam Acres Inc; The property which }; rt °a the corporation is now selling was purchased on June 30, 1970. There is no statement or contract of sale available from that purchase transaction. The corporation acquired title from Walter A. Scheiber, Josephine Scheiber and Sarah Ann Malone. The consideration paid was $ 91,000.00. ------ ----- MORRIS MILLER Sworn to before me this 19th da of June, 1987. ;�:arvy Public ROBERT L. CECERE weary f Termbpkft q7I /� 7 F R: -- 5 T H U 9 :53 SA I DEL =DE'-.-'ON P 0 1 I ItA/ Apeld've It MAW' L. SAIDE1. DAVID A. GL7DW * NF V ,also admitted in Connecticut TO: FROM: DATE: RE: OF MARC L. SAIDEL, Parkside Corner Route 202 Yorktown Heights, New York 10598 telephone (914) 736-6500 Fax (914) 736-6.581 Of Counsel LORETTA BENEDEI'70MARVEL BREn�A W. FEDER t falso admitted in Ohio Total pages being Faxed (including this page): TELEPHONE # a7 S r d azo FAX 4 76 g / COMMENTS: PLEASE CALL oAND CONFIRM WHEN FAX IS RECEIVED LV. LAW OFFICES OF MARC L. $AIDEL _ POST OFFICE BOX 308 - PARKSIDE CORNER. - ROUTE 202 YORKTOWN HEIGHTS, NEW YORK 10548 Telephone (914) 736.6500 Fox (414) 736.6581 NIARC i SAS; DAVID A. IAdso otarg:fr. 1 . . . ;;: ,. VIA FAX A'M MAIL Mr. John Karell, J'r„ P,C, Public Kealth DireCtor Putnam County, Dept, of Health 110 old Route Six Center Carmel , Nf!w York 10512 Dear Mr, Karells L0RE7A f••i ''4i 11(* MARVEL April 25, 199-: Re: Hunting Ridge Subdivision, Miller Road - Lot #1 TM- 62 -11 -20 This letter is being sent as a follow -up and for clarification purposes Of my April 24, 1991 corragpondenCe concerning the Hunting Ridge 8ub- .d.ivlaican i.n.- the Town of Putnam Vailey,....,.Th.e, documents that werf, ncl'u f %Il-jatax -is�g Schedule of Capital Improvements refer to the one existing we11 which was located on the subdivision property prior to the property's sale by Putnam Acres Inc. which was also prior to the subsequent sub - division approval. As you will note on the filed sub - division. map #2276, the existing well is shown on Lot #1 and it is the only existing well shown, ors tht enc ire parcel. I hope this provides the necessary clarif i:-ation in connection with this matter. Thank your for your cooperation and assistance in this matter. if you have any questions please feel free to call at your Convenience, Very truly yourE , MARC La, SAT tip T DAVID A, GUTOWSKI DAGsdjp MARC L. SAIDEI DAVID A, GUTOW.SKI• %so admltton in c*s;(inm -trout 1 Y _ LAW. OFFICES OF MARC L. SAIDEL POST OFFICE BOX 308 - PARKSIDE CORNER - ROUTE 202 YORKTOWN HEIGHTS, NEW YORK 10598 Telephone (914) 736 -6500 Fox (914) 736.6581 FAX COVER SLIEST P . El 1 )I i. purr (1l L0RET;A BF*F;FTT() MARVEL _ r Y ,. FROM.M � o%"o.4 . III N /II.Y Wry .I,Y WW.fY�Y�� YY ��.Ir,l. '•1 DATE: L ,r.) _ �. R$:. T ^ ( .�.I � is L � . � SJ , . �'v'C Iv � V fl l t � • i'� v ,vx,f t JJ �` �= ,s� D ++� � ur. t. s, � �' ,�... �. Total pages being Cransmittedt including this page: Telephone No: J ` Q ICS Paz No: o�o?J 7�f r Comments: PLEASE CONTACT THIS OFFICE IMMEVIATELY IF YOU DID NOT RECEIVE ALL OF THE PAGES BEING SENT. I w OF COuNSBL LOACYTA ORNEOCYTO MARVEL BAENOA W. FEDEA A13k- I Al2%01 A"VANCY AT LAW 1890 COMM EACE sra¢ET YORKTOWN F16191 V6, NCW YORK 1051)e 5'f5LM ON8 (9141 849 -820$ July 1,1967 New York State Department of Taxation and Finance P. 0. Sox 5045 Albany, New York 12205 Rea Putnam Acres Inc. $>. Gentlemen: P . 0 Enclosed herewith please find form #TP -560, Contract of Sale, dated - June 15, 1957, Schedule of Capital Improvements, Affidavit from Morris hiller, form #TP -5610 regarding the above captioned matter. 4 Please forward a Statement of No Tax Due at your earliest conven -� ience. Very truly yours, ... _... r _. MARC L. SAIDEL MLS:tdd Encs . MARC Snit FAV1 A (",trr: 'Aj$Q LlorIOff'? : r!' hrut LAW OFFICES OF MARC L, SAIDEL POST OFFICE BOX 308• : PAR KSIDE.CORNER = ROUTE�46'i" YORKTOWN HEIGHTS, NEW YORK 10598 Telephone (914) 736.6500 Pox (914) 736.6551 Mr. .loin Kar. E�11, Jr. P.E. Public 114,a l r h Director Putnam t,lo tni. y, Dept. of Health 1.10 ()111 1l(;,{ +. c Six Center Carru, t , ra +!bv York 10512 Dear Mr . z,ctrell,: LORETTA tf .ct ! .! rr; tiiM April 24, .199: Re: Hunting Ridge Miller Road - TM# 62 -11 -20 S;11)(1 i Visic ..W; 0 1 Pursti a.nt. !1c our conversation this date regarding the above pro p(� rt-.y, I have i ?nv.l used herewith the relevant portions of the former ownei + s- (Putnam Acres, Inc,) tax filing (Tp -580). prepared in anticipation of its sale of the property in August 1987. Please note that thc.! Capital.t.rlpr.ovement Schedule shows Mr. Anderson was paid by Putnam Acres, Inc:, :n January of 1987 for the well in question. This will also confirm the advise from Pill Hedges this morning that a pertn.i'. for i.h i <; was issued on December 30, 1986. _^ : :.. a- 1!t:irl' trc'- t:arate- t'a you that the present contract of sale is .i ''time of' 1he essence" contract with a closing date of April 30. It is my understanding that the contract vendee - Mr. Finn - mu!.;( have all necessary documentation submitted to his lender by tomorrow in order to meet the closing deadline, if the purchaser: are held in default I would fully anticipate that the Health Del ?arr• - ment will I)v hearing from their attorney. DAG : sm L'nclosi.J r'r• Very truly yo) i r >: . MARC L. SAIDEt, DAVID A. GUTOWif, - •+:' =:�t _�.w"i. gip. z>� ..._k._syi� - +`n._tt .. 1 ®- - e2- ..:.�_h A,RR -124 -9 1 WED 13 a 31 SA I DEL= DEVON -.® 4 SCHEDULE OP CAPITAL IMPROVEMEHTS to Constructlon.of new enteyway - December, 1986 o $875.00 paid to Pa Fassati, Putnam Valley, Now Yorke 20 Ocilling & Installation of new well and rater pipes o Januacy, 1987 $5,599-20 paid to _Dorman Anderson of Putnam Valley, New York for drilling and connections $1,600.00 paid to McLean Enterprises of Putnam Valley, New York foc trench excavation. TOTAL OF CAPITAL IMPROVEMENTS EQUALS: $SiVC20 I i COUNTY OF PUINANI Jim Gordon cKAIRMAfl Jean C. LFPere CLERK Anthony G. Maccarini colms¢L TEL No. Apr 15,91 11:23 o P.01 THE PUTNAM COUNTY LEGISLATURE - Two County ` Ceniep Carmel, New York 10512 Barbara X Murphy Div. I 914 -225 -3641 Jim Gordon DIST.2 Gregory T. Quinn DIET. s I� C(j� Michael K. Semo Jr. DIsT. , Clifford G. Wer DIST.5 Victor G. Grossman asT. s Lillian R. Imes DIST.7 William & Dell DIST.8 Regina C. ?4orini MT. s FAX # (914) 225 -0715 DATE: To: FROM: Putnam County Legislature REa # OF PAGES INCLUDING COVER SHEET ea /)IF-SsA Gi- — NcH0K wFL-L- -- koG J.oC,/AT /01� 0 i•�'1"?VA[1 C0'NTY rTH .DEF,'..; .. .DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Commissioner of Health - FIELD ACTIVITY REPORT - ADDRESS e'- i No. M 1_6�" S c-� No. MAILING ADDRESS P.O. Box Po fice Zip Code TELEPHONE PERSON IN CHARGE OR INTERVIEWED Name and Title Sheet of _ Orig. Routine Orig. Complain Orig. Request Compliance Complaint Camp Final _ Group Illness Construction Reinspection Fields Sampling Only Field Conference Other DATE TYPE FACILITY TIME f 2 G' TIME LEFT . ~, 2 5 ��-, Explain FINDINGS: 95 GA G l/'O /r, `� ��f W vim. �, / P INSPECTOR: Signature and Titkg -- PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. SIGNATURE: 6/86 TITLE: .I �� A �. ...... _s :..,,r ..v.s ��:., _ J� -rvr. . ,.r �;`.:.,[',,:�/'" e,� ... ..._ r. �..:y.' r. . -i _ .�. Jaav+�. .<.. `v`. �.t.. c`• ..L er - 9 el �k e.CLCe r,k k ". q cz - 32O3 . .......... ---------- - --------- - ------ ------- - 1-7 ........ . . .......... ---- ------- ----------- ---------- .......... - - -------- - ------------ -- T 365—m"h 0.4 M"W" " Awn N' &N PNW' 1. W - W"R NYCII0012 LIEN' LAIV 11) the 101h W Q have .1-17 (Ij The nanex aqd =Qwe: of Ae um.0 . ..... beug, 00 se pAryal Place td bwous is C.L.AquAWAIIAn. ...... ....... F40 uw" Uri alkem of 1%eny2outorneY, Any— . ......... ..... (a, Se oun- 1.', 10 red pmpv4 A oil ofman a. Ni w me teal propwry. The naT? Mun 4 Ohm' the persor, '.0 the W (am) to pejewry (are, to pejoruz projeWaGWrOu The name '0 the nhorn th, contract wasm=de is —Rovard Yhe name (V me payon #:)r 'u.A"­n . tt i1. '''. .ii'`{ �b, r'�t .... ... .. .... ....t .. .. ... � ^,H .....,. ..., is ��� �.... .. .. ,... ._ _. .. ... .. - ,. ,. .. ... ., ...' . red delivel ed f 0 rhe "d plaperty a V. M 0AE jo 01 the 4d :'170T per!'0i"Irled an a xWe rht....... ... .. ........ 7. ?Aj,. jQyQuj 3f the QuWal The 5joe3 :cc jor .... ........ Ism! agaid, p0s tabue and I m AroAdIG the f .......... .... ..... th" the amaiv ;7-am-w'f ar' Gd?i.y mil lot tut not WIFed 10 the Tom! �m`;OtP�! Was—, . . .... ...... ....... Igm ol uvrk was wi,,lelf t WW.._ t�1'14 _ _ 12-1 Wai.. ......... . ... - - Tile Jfas? ilem oj,' work t vas juryLvIled, was ........ . .... .. .. . 121 The prqu", w the Uri; 's o�luuled il{ f p,t,a, V,11ey Coutty of putnum 4umh0d lor and fmcf'i' thr"? Me 56- imm Me pu pey"If- 4' R 10,' dexrAW That 4 manthr 117!p,), i�r :i !ht, si4fe the rampodan 01 the Conuar; or owe me At pupwWma Q Ir e it h fh' 010" March 27 1991 Tile ru,f! I.Igned rrlusi 'k, All, Y LAW.OFFICES OF MARL L. SAIDEL l_. POST OFFICE BOX 308 - PARKSIDE CORNER - ROUTE_ 202 ✓✓ YORKTOWN HEIGHTS, NEW YORK 10598 Telephone (914) 736 -6500 Fax (914) 736 -6581 MARC L. SAIDEL Of Counsel DAVID A. GUTOWSKI* LORETTA BENEDETTO MARVEL *Also admitted in Connecticut VIA FAX AND MAIL Mr. John,Karell, Jr; P.C. Public Health Director Putnam County, Dept, of Health 110.01d Route,Six Center Carmel, New York'10512 Dear Mr. Karell: April 25, 1991 Re: Hunt"ing R�idgeSubdi'visi`on N�il�l exr Road Lost # 1 . , This letter is being sent as a follow -up and for clarification purposes of my April 24, 1991 correspondence.concerning the Hunting Ridge sub- division in the Town of Putnam Valley, The documents that were_. -.iri laded: th iiy alcove~ - -oor- respondence,* specfical -1y pertaining- to- -t•he, Schedule of Capital Improvements refer to the,one existing well which was located on the- subdivision property prior to the property's sale,-by Putnam Acres Inc, which was also prior to the subsequent sub- division approval.. As you will note on the filed sub- division map #2276, the existing`well'is shown on Lot #1 and it is the only existing well shown on the "entire parcel. I hope this provides the necessary clarification in connection with this matter. Thank your for your cooperation and assistance in this matter. If you have any questions please feel free to call at your convenience. Very truly yours, MARC L. SAIDEL DAVID A. GUTOWSKI DAG:djp PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH Division Or Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 TELECOPY COVER S3Er'T Date: To: From: Putnam County Department of Health Fax it 914- 225 -7531 Division of Environmental Health Services 110 Old Route 6 Carmel, New York 10512 Attentiou: - Number of Pages to be transmitted (including cover sheet) NOTES /MESSAGES: � %L y cv / -ev In the event of transmission /reception difficulties, please contact our office at 914 -225 -0310. JOHN K 1RELL Jr.. P,E, M.S. Public Health Director �gyW1. ,N,% Cpl E•4UCE R. FOLEY, F.$ DEPARTI`1E\ T 0= HEALTH Divi_ 1, 01 Enviror,:-:,n;al Health Services Cenlz - Roa-", 6re,rter, New York 10509 (914% 270 -6130. -,., - -- �.:�IT_�•, r.: _ - MN _ (ESID_VT I A L ONLY c �ES I %n7,JtrL,,,_d T:i,� ?; :f" C1. TX M "P y . ('.cP j L t ri n p -0•; =_ �. 1� ��y� P11HD PE, MIT r h C;escription of Adj JitL r, Onset i N-xnber of existing = ro_osee number of bedro(-�,is 'ro- Certificate of or v�rl i i 1Cat10n i fC"t C'.. 'ald•i ri_ ?nS���tGr �_^iy a�di ti0n Y 11 C'1 iE CO'iE'.� °rEC c �:�.'-:4 rE:;tllreS fOriTlal approval Of p1.anS i (Cons ruction Permit) pre: ed t; a Pro`_ssicnal Engineer or Registered Architect n accordance with se-:7icn -5 c- the .Putnam County Sanitary Code. 4 leas_ s'je:ni t this f•cr,:. ant the fol lc�; _ to P,,F1 K*i CCUKry HEAL TN_.D.= PAR_TME� _._,:••: T ; ' �::� :! `� R0.AD,. o,R3 STH?,,..'�s' 1t1S��,, ; :�; �.21c -V1 -VAth � "TW76wona information. Certified Cnec�: for Y1C:.00. i %. S' troll Of existin: f iG,r plan (all 1 i'•iing area including basenent, if any) Non- professional is acc�pta�la. 3. sketch of proposer floor plan. fit' e Non professional drarain: is acceptabie '-' .� 4. Copy of survey shi.: -, ing well and septic location, to the best of your -knowledge. Inclu-.te date of installE ion if kno6n. Include all wells and s -ptic systems within 200 feet of property line. Any questions please contact this office. 5. Copy of Certificate of Occupancy frcm Toe-,n or Certification from Building Department of legal bedroon count of dr{el l ing . OFFICE USA Crrrents and /or conditions application August 1993 July 1995 (Revised) b DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 May 15, 1998 Michael Finn 2 Miller Road Putnam Valley, Re: Addition - Finn, 2 Miller Road Increase in Number of Bedrooms (T) Putnam Valley, TM# 73.8 -1 -47 Dear Mr. Finn: nN�_ BRUCE Public Health rrector I have received and reviewed the plans for the proposed addition to the above mentioned residence. The proposal for the addition has been approved as per plans bearing the latest revision date of May 14, 1998 and this Department's approval stamp. Based on the information submitted, the above mentioned addition is approved with. the following conditions: 1. The total number of bedrooms must remain at four without prior approval by this Department. 2. The area of the existing sewage disposal system,_ and its .expansion area, must be �- -maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors. for shower heads and faucets, etc. 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. Very truly yours, �f WH:tn cc- BI (T) William Hedges Sr. Public Health Sanitarian ;at the sewage disposal system was iicated on this plan and that the :cted by me- before it was cover - :tam was constructed in accordance ind regulations of the Putnam Ccurr- Health. r OW r, 1� o . n ri T N G W O O ' n h N .e t - t• r. i• r Y - r � � � 16 LS is S5 si WS \G\ A � C C' /2 ✓/ AS W O � O ' O n N 1• N ` ` SEf ARE:-: iat the sewage disposal system was " iicated on this plan. and that the acted by me before it was cover - Aem was constructed in accordance ind regulations of the Putnam Coun- Health. ,s .y I I I J 16 t5 t8 o SS j$ S5 4B c �6 G lap il 2 -.57-- e� I . t ' �q l•�G 4�OV�� �, 1'r.1�'F'�%1?� -"C:> 1nI�•i.i_ 1L7'.�la`�U..i IT i. gor_cz} h Mgt �\_7 'TDv.ltij of �i�Ttilcrl l(o�LCti -P�rra n r.n Go . N MICHAEL, DALY P.E. sHErrvo. P.O. BOX 2439. SHENOROCK, N.Y... 314 W�TKnt 320 e� I . t ' �q l•�G 4�OV�� �, 1'r.1�'F'�%1?� -"C:> 1nI�•i.i_ 1L7'.�la`�U..i IT i. gor_cz} h Mgt �\_7 'TDv.ltij of �i�Ttilcrl l(o�LCti -P�rra n r.n Go . N MICHAEL, DALY P.E. sHErrvo. P.O. BOX 2439. SHENOROCK, N.Y... G 10 AREA: 1.0445` acres M zT s sw 33 \ 4B• N 3e -09 -8e E N 36 -09 -00 E 49.64' N 46.- E 34,44' ��- PEEKSKILL HOLLOW ROAD I f SEPARATION DISTANCES IN FEET \ A I H• g0.00 rutnam county Department oT llealtb Q Uviel n of Environment 1 Health S'er>vioee 3 Q pproved as noted for conformance with tpplioable Holes and Regulations of the lutnaamm County Health Department.. 1 �." AS —BUILT SEPTIC PLAN prepared for (FINN RESIDENCE MILLER ROAD SCALE: 1 " =30' TOWN OF PUTNAM VALLEY 4/12/91 PUTNAM COUNTY, N.Y. M 66 B 11—L 22 ! T J • J 0 7 $1 9 10 1 11 11 !J 11 IJ 16 17 IL 19 A 16 zS i8 36 'F4 52 17 91 95 90 D' SS j$ 55 `3 13 13 65 1 4S 15 C \ A I H• g0.00 rutnam county Department oT llealtb Q Uviel n of Environment 1 Health S'er>vioee 3 Q pproved as noted for conformance with tpplioable Holes and Regulations of the lutnaamm County Health Department.. 1 �." AS —BUILT SEPTIC PLAN prepared for (FINN RESIDENCE MILLER ROAD SCALE: 1 " =30' TOWN OF PUTNAM VALLEY 4/12/91 PUTNAM COUNTY, N.Y. M 66 B 11—L 22 DEPARTNIENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 70509 (914) 278 -6130 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Gentlemen: Residence BRUCE R. FOLEY, P.S Acting Public Health owaz(o• Tax Map %'3 Town __P - ,, According to records maintained by the Town, the above noted dwelling IS NOT in compliance N ith Town code and the total number of bedrooms on record This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER i t ._.1 Building In pector ' C� O1i. ­ ---ATM a„ ►� r�� Y WILL L L)rlrLL11Uly AX,rUnt DEPARTMENT OF HEALTH DizLision �?£_Environmental...Health. Services_.. PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET AOURESS: WNIVILLAGAICHY TAX GRID NUMBER: - 145k P n h WELL OWNER NAME: ,. - ADDRESS: Y &p IVATE O PUBLIC USE OF WELL 1- primary 2 - secondary M- RESIDENTIAL 0. PUBLIC.SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED ❑ BUSINESS O FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY ❑ . MOUNT OF USE YIELD SOUGHT _ .gpm. /N0. PEOPLE SERVED -- -/ EST. OF DAILY USAGE gal. REASON FOR DRILLING . ®REPLACE EXISTING SUPPLY ®TEST /OBSERVATION [ADDITIONAL SUPPLY Ep0r,SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA �{ 00 WELL DEPTH ft. `- STATIC WATER LEVEL ft. DATE MEASURED f DRILLING EOUIPNIENT ❑ROTARY O COWKSSED AIR PERCUSSION ❑ DUG ❑ WELL POINT CD-- ABLE PERCUSSION ❑ OTHER (specify): WELL TYPE. 0 SCREENED "EN END CASING ❑ OPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH , _ ft. MATERIALS: WTCEL 0 PLASTIC O OTHER LENGTH BELOW GRADE :J' `�-- ft. JOINTS: O WELDED Z-TREADED ❑ OTHER DIAMETER in. SEAL: 6iiMENT GROUT ❑ BENTONITE ❑ OTHER WEIGHT PER FOOT lb./ft. DRIVE SHOE: ❑ NO I LINER: DYES CM0 SCREEN DETAILS - DIAMETER (in) SL07 SIZE LENGTH (1t) DEPTH TO SCREEN (1t) DEVELOPED? FIR AT O YES QA SEC rvD.. - - _ - GRAVEL PACK ❑ NO j. GRAVEL SIZE: DIAMETER OF PACK in. T DEPTH ft. BOTTOM DEPTH 11. WELL YIELD T r If detailed pumping METHOD: MPED tests were done is in- O COMPRESSED AIR , formation attached? O BAILED O OTHER i 0 YES 0 NO LOG If more detailed formation descriptions or sieve analyses are available, please attach. NWELL FROM FACE water Bear- ing wen 0i, meter FORMATION DESCRIPTION cace (t WELL DEPTH It. DURATION hr. min. ORAWDOWN It. YIELD gpm. Surface C d 4"M p D s �kd C, /A V }d AJ Y ❑ CLOUDY HARDNESS ❑ COLORED ANALYZED? ES ❑ NO ANALYSIS ATTACHED? ❑ NO [MAK81 EAR TEMP. r STORAGE TANK : TYP FP GAL . INFORMATION S l� ] CAPACITY /_ `© �' % d S DEPTH O ,� d S • VOLTAGF� 3 HP - ' WELL DRI EA NAME A J �� -� StGFlkTtlpE C �C� /i/10 /�•`' 3/89 Vi--Z. C"e- -- /` Lv' PJ /- "-y- / -- IJ . DEPARTMENT OF HEALTH Division.of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 73641 APPLICATION TO CONSTRUCT A WATER WELLQ1f1� ♦ r- 6f���. ._yw \M �.� ryY it• .ors �f '•r• . t:1 R;f 7 .a ..... r �P�M'P. -.tn n n .. t\ -: - � �CHD PERMIT �•' WELL LOCATION Street Address. Town/Village/City Tax Grid Number WELL OWNER Name Address -18 VALj&jkj OPrivate Public USE OF WELL 1 - primary 2 - secondary RESIDENTIAL O PUBLIC SUPPLY, (J AIR /COND /HEAT PUMP ❑ BUSINESS 0 FARM • . ❑ TEST /OBSERVATION ❑ INDUSTRIAL b INSTITUTIONAL ❑ STAND -BY 0 ABANDONED' ❑ OTHER (specify O AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED /EST. OF DAILY USAGE *"'P .gal REASON FOR DRILLING 0 V SUPPLY EPLACE EXISTING . ❑PROVIDE ADDITIONAL SUPPLY SUPPLY ❑ DEEPEN EXISTING WELL ❑TEST /OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE WRILLED 13 DRIVEN E]DUG ® GRAVEL OTHER IS WELL SITE'SUBJECT TO FLOODING? YES C­/ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:. 1yo Lot No. WATER WELL CONTRACTOR: Name' �� Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _ ZNO NAME OT PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM.NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED N REAR OF THIS APPLICATION (date) _ signat re) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days -of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. Date of Issue: 3,57 19�:� Date of Expiration: _3�1 19 td 15 P m t Issuing Gfficidi Permit is Non - Transferrable MR