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03434
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�' TNAM COUNTYDEP�ARTMENT OFrHEALTH
PU ,
e a
K a _ ; 4 pivrsion of Eniiir`onmental Health Services, .Cam% N Y 10512 _ `
x �•;
�Tf
:t'}iV1�'p�ti�`i0 - 00filt" '�1111��� FOfi `J��1��C^'����r�i^°� � .. •c
,�.v Town or- 'Village'
' ...
`3. �.
Other requirements•
Water Supply 4- ubUc Supply From
� -
> Private 'Supply DnlledGBY �'�'_e
:sc•a"5+,y mt,6• '� .,,�, y xt x'- x.. may,. •�' e _.
dress
Building -.Type, �° �►' _ ...
c x 2 f
s
Has Erosion Control Been Completed
I certify, that the system(sj tas Iisteil serving the $ `
attached) and-! !in accordance with the stands V
: -
--11��
r
r ti QAddres
3�� +d
Imeai *aFeet X, width trench
No of Bedrooms J Date Permit' 1'ssuetl
es5entlally " Shown 461064'p lans oft completed work (copies of which are
led'and a permit issue y th Putnam Courtfy Department of',Health..
VA License., License fVo. %+Gs
(1p y take such action as maybe necessary�to secure the correction of any unsanitary
system shall become ri'ull and is soon as •-a public.sanitary :.sewer becomes
Arid void'When a public water's ply becomes`,availabie' Such "'approvals are
im)fsoner t Health; such{ rev n modFflcation or change is necessary.
6 `
r
w Title;..
WELL COMPLETION REPORT PUTNAAA (COUNTY DEPARTMENT OF HEALTH
lit Did lion of -Environmental Hoalth Sarvices
COUNTY OFFICE BUILDING • CARMEL, NEW YORK
`[bit report i's to be completed by well driller and sLI: . :sited to County Health D41irtmew together with laboratory. report of
i .a „ "...: ':. ; , :�sizo�av $tom :��iiplc'i�Eti a7if�g v�btei o�o( r3�aci r� bacterial•' cqualitV- b6f ore- certificate of-eor►structiomcompliance is= issued:
REPORT PdIUST BE SUBMITTED V11THIN 30 DAYS OF WELL (COMPLETION
OWNER
pf
ADDRESS
dad
(No. 6 Street)
f (Town)
(Lot Number)
QOCAYION
OF WELL
p i
a d � T a�•. o
0 BUSINESS
® TEST WELL
PROPOSED _
DOMESTIC
ESTABLISHMENT
FARM
414E OF
YfdEll
a
CONDITIONING
® OTHER )
SUPP Y
INDUSTRIAL
DRILLING
[0
COMPRESSED
�
CABLE
� PERCUSSION
® OTHER
(Specify)
[EQUIPMENT
ROTARY
AIR PERCUSSION
CASING
LENGTH (feet)
I DIAMETER (inches) WEIGHT PER FOOT
� ❑ WELDED
DRIVE SHO WAS 45ING G %O T
® YES NO YES CD NO
DETAILS
0
C
THREADED.
— _R�
HOURS
G.P.D-IL
YIELD (GY.M.)
YIELD
VEST
BAILED
PUMPED ®
COMPRESSED AIR
WATER
FROM LAND SURFACE- 5TATIC(Speclfy feet)
DURING YIELD TEST fleet)
Dcp& of Complelad W ?11
LEVEE
/1
�✓.
in Qoet below Land surface:
MAKE
LENGTH OPEN TO AQUIFER (feet)
SCREEN
DETAILS
SLOT SIZE
DIAMETER (inches)
If GRAYEL
Diameter of w ell including
GRAVEL SIZE (inches) FROM (last)
70 00
PACKED:
gravel pack (inches):
NPTH FROM LAND SURFACE[
FORMATION DESCRIPTION
'I
a
<-c✓
i
V
4 0
a
Sketch exact location of well with distances, to at least
two permanent landmarks.
&Z—
If yield was tested of c0erent depths during drilling, list below
FEET GALLONS PER MINUTE
00 p
a
M
DAIR Witt JOMPLETED DATE Of REPORT WELL D ILLEn
SEP 23 7982
OF HEALrH
6 ner or Purchaser of building
w
zu/ c
Location - 'Street
Building Type
a
f;a1L:;• ..
Municipality
Block
1
Lot
GUARANTY OF SEPARATE SMIAGE 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 -t.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 guaranty
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 tc��o
years imi,iediately following the date of initial use of the sewage disposal system, or
any repairs made by me to such system, except where the failure to operate properly
is caused by the willful or negligent act of the occupant of the building. utilizing
the gvci -nm
The undersigned further agrees to accept as conclusive the determination
of the Director of the Division of Environmental Health Services of the Putnam County
Department of Health as to whether or not the failure of the system to operate was
caused by the willful or negligent act, of-the occupant of the building utilizing the
Dated; this day of 19,&- Signature 1 �.' Cam✓ a
Title A/4
(if corporation, give name and address;
----------- ---- a--------------------------- .---- .-------------------------- -----=-------
Tf*IREE� (3) CQPIES -ARE REQUIRED WITH THREE (3) .COPIES OF FINAL PLANS BEFORE CERTIFICATE
OF COMPLETI O;1 • SILL BE ISSUED.
GUARANTOR IS - REOUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. �
. - .- - - -- ---,------..------------- e------------------------------------------- �
Division of Environmental Heal'th.'Services., 'Putnam County Department of Health
:E
CE, I W
pEPT, QF i-iF i; :i�
.0. Box 99 321 Kc Street
Yorktown "Heights, N.Y. 10598
245 -3203
LOCATIONS:
I I :171 KI:AII :T., YOIIKTOWN iiriciii.rs. N.Y. 105911 :•15.3203
U 201 BUTTONWOOD AVE.. PEEKSKILL. N.Y. 105GG 737.8777
111 405 MAIN ST., MT. KISCO. N.Y. 105.10 6GG•3335
I. I STONELEICII AVE. (NCAII IIO :r ITAL1. CAIINIEL. N. Y. 10512 771
V ?�!w �sttlJ ' <p'NL9v".vbn`� "YNW46l.- • >.49Y CP� .��l,�'FT���Y.A "?'ASTi�`�4'T ^'F M�r,;fM i�.t'TAVt 9�FA•^.I'Y'F'
ORCAODD
PuTlifim
L
1
J
LA130RATORY REPORT
mq /L
DATE TAKEN: _
DATE RECEIVED:
DATE 11121'01"ITED:
SAMPLE SOURCE :,
1`1EFEnnED 0 Y:
COLLECTED BY :- P. OeLil&- 7 0
❑ ACIDITY ............................ ............................... CI ALUMINUM
... ...............................
❑ ALKALINITY ........................................... :........... CI ANTIMONY ............................ .................
XBACTERIA, TOTAL /mL ...............//....... .. ....... CI Af1SENIC .................... .............................• ..............
BOD. S DAY ...................... ............................... .. CI !IAnium ....................................... ...............................
❑ BROMIDE ........................ ........... CI ocnYLL1UM ................................ ...............................
OCARBON DIOXIDE. FREE .............................. .... L.I IIISMUTII .. ........... . ...........................:... ...........
OCHLORIOE ............................................................. 1.1 MORON ................. ............... ...............................
❑ CHLORINE .....................:...... ............................... CI r :ADMIUM .................................... ...............................
OCOO ....................... . ........ ............................... . L.1 CALCIUM .. ............................... .............................
OCOLOR ............ ............................... ................ CI f :I'InOMIUM (tot.) ...........................................................
❑ CYANIDE ........................................................... Cl CHROMIUM (hcnavalent) .................... ...............................
ODETERGENT, ANIONIC ........................................... Cl COBALT .................................... ...............................
OFLUORIDE . ........................................................... Cl corpm ..................... ............ ...................... ..........
OHARDNESS ................. ........ ............... ....... CI GOLD ........................................ ...............................
MPN COLIFORM COUNT/ 100 ml ........ CI Incr ......... ............................... ...........................
H T COLIFORM COUNT/ 100 ml D ....................... CI I ra,C .............................. ...........
/ CONFIRMATORY TEST ............ ............................... 0 LITHIUM ....................................................... :...........
ONITROGEN, AMMONIA ........................................... O MAGNESIUM ................................ ...............................
O k�TROGEN. KJELOAHL ............ ............................... CI MANGANESE ... .
O ROGEN, NITRATE ... CI mEnCUnY' ............................ .............................. . ROGEN, ORGANIC ......:.................... . ...............`C) NICKEL' .:....::....:.......................... ...............................
❑ ODOR ' . ....... ........................ .. 0 I`ALLAOIUM ............................ ...............................
❑ OIL & GREASE ....................................................... O POTASSIUM ...............................................................
❑ PH •• ............................ ........................... n- I10DUM ............ . ' .. ........ . ............ . .......... . ............................... .
...........................
❑ PHENO C ;. .. .................. ELENIUM
❑ PHOSPHA (ortho) ................ ...............................
0 : :ILICON ..... .. .....:.......
❑ PHOSPHATE (condensed) ........................................... ❑ ,ILVEn ........................................ ...............................
❑ PHOSPHATE (total) ................................................ CI nOOIUM ......................................... ...............................
❑ SOLIDS. SETTLEABLE, ml /L ............... CI rIN. ............................................ ...............................
C} SOLIDS. SUSPENDED .. ............................... ..... Cl /.INC .......................................... ........ ..:
Ell
❑ SOLIDS. DISSOLVED .......... ............................... CI ................. ...............................
...� :
O soLlos, TOTAL ..................... ............................... n .................................. ....................... .....:.. .
0 SOLIDS, VOLATILE ..................... 1..,,, ........ ,..,......... Cl r1r: MAnKS: ............. .........................
.5 ...........:...........
® 3PECIPIC CONDUCTANCE ......... ............................... CI ........................ ....... . ..... ... ... . .......,.,.�5,4,,..,,.�►,,,,.,.
OSULFATE ...................... rI ... ..................�f'd... .... .................
OSULFIDE ............................. ......... 0 :. p
...
❑ SULFITE ....... ....................... ............................... Cl ..............:.........: ......................pr...�':�
❑ SURFACTANTS ..................... ............................... .CI ................................................... ...............................
❑ TURBIDIT.. ...... ................................................... (.I ............. ................... ..................:... ..... _. ........
THESE RESULTS INDICATE THAT THE WATERMASLka OF A SATISFACTORY SA�4ITARY QUALITY WHEN
THE SkrPLE WAS COLLECTED,
THESE RESULTS INDICATE THAT THE WATER DID _ mr.0 THE SATISFACTORY CIIEIdICAL QUALITY OF
NEW YORK STATE ADMINISTRATIVE.RULL:S & RI:GUI \'[TONS, DRINKING 1JATF;R STANDARDS (PART 72)
ALBERT N, PADOVA>\'I Pi, T (ASCP) , DIRECTOR: %4
G2 Ae
:`P hllc�Stj
5.
pg-
fock
ldib
M04 Y
A eel
sa
or,, bd well. described.above
Putharri
License
Sf
. .
119
F I I E LT) C I U!, CK LTST.
Date:o
Insp. by:
INITIAL 'SITE INSPECTION
Yes-
No.
Comments
Property lines or corners found o 0., 0 0 ..0
Can estimate house location o 0
Will driveway need cut . . .. . . . . ... .
Must trees be removed-note these o o
Is'deep hole repi-esentative of entire SDS area
Additional deep holes needed. a 0 0
Sufficient SC)9 area available considering
driveway cut house location,separation .
driveway
distances., etc. a 0 0 . 0 0.
DEEP HOLE DATA
Depth:
Water elevation:
Rock elevation:
Soils description:
Date:
FINAL SITE INSPECTION Ins p. by:/--)
House .located where shown on approved plan-
ST.)S loo;l?,ted i•There spprove . . .
Width of trench average 3'
..Slope of the line and trench acceptable.
Room allowed for expansion :trenches
--Over_ 59 Lt.. from swamp ,,,Tatercoursje,,_..
?Ve mural soil not C) --- or; - 7
stripped S a( 3 area - dr 7
unnecessarily graded . . . . . . 0 0. 0, a 0
.10 It. maintained from prop.line and
20. ft from house o 0 C* 0 a
Separation of.trenchfrom house., well
etc. follows plan e . a a 0
Number of bedrooms checks 0 0 0 0
Stones., brush, stumps., rubble, etc &eater
than 15 ft . from nearest trench a 0 0
.15 F. of peripheral soil horizontally from
trench 0... 0 0 0 Q� 0.. 0 .0* 0 0
Junction boxes prope-L-ly set
Could surface run of'L ' from driveway, roads
ground surface., etc. cr znnel near. SDS
.area.. o o
Does lot drainage appear 0_.i. :*in** area of SoDS'
'FINAL. GRADING OF SITE ACCEPTA=
XACI
a4e
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
4...� i :,i1". Ts,;- •e.•.vG. cr=.. �.s� 4 -?i'•. .. ._ ;r:;t�es:t- "rte,:.. .:wf. :y':: : _..:.faun ,:.y>s. ' i ...,.. _ ..+ti«'+;- %.:.� 1 .Y ' .3' .•n. .
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA; SHEET- SEPARATE SEWAGE DISPOSAL, SYSTEM FILE NO.
Owner R0,Yi 'jG/G �7��a�v� Address._/RA'6 �le
7.x%
Located at (Street / /G/ �11� .
% Block Lot
Indicate street)
nearest cross
Municipality T";" �� �, A11" 1 :zz Watershed �islr�r:c 7
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
17Z
Number CLOCK TIME
PERCOLATION
3 /:2
PERCOLATION
_
,Run Elapse
Depth to Water
Water Level
7.3
No. Time
From Ground Surface
in Inches
Soil Rate
Start -Stop Min.
Start Stop
Drop in
Min. /in drop
._..
Inches Inches
Inches,
1. %* 10'-';?j f-' 2. `'
WN
4�"
5
Notes: l) Tests to be repeated at same depth until ap.proximately equal. soil
rates are obtained at each percolation test hole,. loll data to e submitted*
for review.
2), Depth measurements to be made from top of hole.
17Z
7-3
3 /:2
/ °,a
te
i74
3
7.3
1�
r
3 /e- 2
/P' 9
4
5
2
3
5
Notes: l) Tests to be repeated at same depth until ap.proximately equal. soil
rates are obtained at each percolation test hole,. loll data to e submitted*
for review.
2), Depth measurements to be made from top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
fOT°N0. • ��,�'���.
G.L.
6" g g
12" 7,4 q toi�- q�v- ��
2411 �1 �
30 a
36"
4211
4811
5411
60"
66
72 1r
7811
Ar
'i
4
0
K
�1
.:'INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED rive.
:INDICATE LEVEL TO WHICH WATER L RISES AFTER .BEING ENCOUNTERED
.TESTS MADE BY �i�D�i� Date OcT,
DESIGN
Soil Rate Used % Min/1 "Drop: S.D. Usable Area Provided j,
No. of Bedrooms Capacity .��'� Septic Tank Ca ��rczr�
P p y Gals . Type
Absorption Area Provided By %7? L.F.x2411 width trench.
Other ZI
I
Address
I-THI8 SPACE FOR USE BY HEALTH
ure
Soil Rate Approved Sq. Ft� eked by _ Date
@I
M
PUTNAM COUNTY DEPARTMENT.OF HEALTH
Date. /loll- /%%
Re : Property of ko A/' o 11 e—:
Located at ZUjC�l h94Z)
A Al A,--
q
_._-Block -Lot
41A,
TI-A
Gentlemen:'
LEY LMDER
This letter is to, authorize;
STAN
a duly licensed . professional en gineer LIZor registered architect
(IndicaT_e7_,.
to apply fora Construction Permit for a separate sewerage system; to
serve the above noted property in accordance with the.standards,,'rules
or regula'tionsas promulgated by.the Commissioner of the Putnam County
't of Tlealth - -A 40 s ign all nQ-c,-.qj3Cs,—.LY pa,,,--.,,s — r" b el— I -P In
nt�partrijel _L UI.J9 CIIIU U W" LIT
connectionwith this matter and to supervise.-the construction of said
I$y: tem or,,'..* sy§�qms -_:9,qnformity with -the-provisions of Article 14 or. .,
.5
147, Education law, the Public Health Law.,..and the. Putnam County Sani-
tary Code.•.
Col ersignIe...
P.E.
Very -truly -yours
Signed 4xw&
-.'Owner of Property
Address V
9 35"-
e ep one
IPUTNAM COUNTY DEPARTMENT OF HEALTH
DffWSRON OF ENWRONMENTAL HEALTH H SIE11 VE CIES
APPLICATION TO CONSTRUCT A WATER WELL
r:
Wen ILocadoans
Street Address: � Town/Village Tax Grid #
26 Luigi Drive Putnam Valley Map Block Lot(s)
Wen Cwmea°e
Name:'
Address:
126
Ronald Orlando
Luigi Drive, Putnam Valley, NY 10579
Use of Wen:
x Residential Public Supply Air /Cond/Heat Pump Irrigation
I- pnimairy
Business Farm Test/Monitoring Other (specify)
2- secoandmiry
Industrial Institutional Standby
Ammou not of Use
Yield Sought gpm # People Served Est. of Daily Usage _gal.
Ressom ffoir
Replace Existing Supply Test/Observation Additional Supply
IIDniflftmg
New Supply (new dwelling) Deepen Existing Well
IIDett fled Reasons
.r 11, dls h
to; V0 4,kc,-t b vv�
for IlDrflUimg
Wen Type
X Drilled Driven Gravel Other
Is well site subject to flooding? ................................................. ............................... Yes No
Is well located in a realty subdivision? .................. Yes No -L
Name of subdivision Lot No.
Water Well Contractor: P. F. Beal & Sons, Inc. Address: 4 Rt=Ave., Bmwster, NY 10509
............................ �. �.�...a....... p.......... Yes No ?1,
Is Public Water Supply available to site? . "
Name of Public Water Supply: Town/Village
Distance to property from nearest water main:
Proposed well location & sources of contamination to be pr i e at eet/plan.
Date: 10/20/98 Applicant Signature:
- PERhUT TO CO N UCT A WATER WIEILL
This permit to construct one water well as set fo above, is granted under provisions of Article 10 of the
Putnam County Sanitary Code and 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 or their designated
representative 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. 3) Submit a Well Completion Report on a form
provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or
well driller shall take appropriate action to assure that any and all water and 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.
APPROVED *FOR CONSTRUCTION: This approval expires two years from the date issued unless
construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be
amended or modified when considered necessary by the Public Health Director. Any revision or alteration
of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam
County.
Date of Issue L - �r �% Permit Issuig Official: �-
Date of Expiration Title:
Pea°mmit is Non- TransfferrabRe --�
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
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