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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC.. www.scanyourdocs.com 631- 589 -8100 73.18 -1 -17 BOX 27 1. IN 11 /A PCHD . i TNIAM COUNTY DEPARTMENT OF HEALTH ISIC)N .OF ENVI.RON ME �T�'�.IaB T H1.������� ' _:./,::;:y.�a:.r•._v .r.w..e i ?,.,�.. - . +. _ ,.,ra.- .,.... a...... -•:.. .. ,..� a:....r ., a ia•,•ar, :: �. .TE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM ZUCTION PERMIT # PV-10-CI-3 UR t,4-iz A t w r&O A-D Located at , �F� e., r,Zh gJ c� �� Tza,tv sc �rn Town r Village P0rv�^ lisr u Owner /Applicant Name' Vk "�to SA���1c� f Tax Map 73, I S Block _L_ Lot 1� Formerly Subdivision Name 3 Subd. Lot # 10 Mailing Address 37 C�fa)J DAv1 /Le" osswr ate, Ny Zip Date Construction Permit Issued by PCHD )0--Z-1-97 Separate Sewerage System built by 3 e/ t�1 1� , CW,. Address S Consisting of Gallon Septic Tank and -•t+ W Other Requirements: Water Suppli: Public Supply From Address o : 'Private Supply Drilled by rl �e%� j5° i'JG, Address %59ezJ2(E- �y rofv� Building Type ;..�. f431 D T? _ II ro. i tr plP. ". - �N as c s o ,d n ol:been..ccrii ..,tea,_". •• .^ - r- ---- -- - - ) M' Number of Bedrooms `�'' =� ���N Has garbage grinder been installed? f-) O 4 certify that the system(s),''as listed, serving the above premises were constructed essentially as shown on the as- Ibuilt plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules, and regulations of the Putnam County Department of Health. Date: Certified by Address P.E. X R.*-- License # (0119-5 Any person occupying premises served by the above system(s shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such Approvals are subject to i modification or change when, in the judgment of the Public Health Director, such revoca on, modification or'chanke is necessary. gy: LL Title: Ap ©i i Zpy White copy - HD File; elo - Building Inspector; Pink copy - Owner; - Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT W6111,ocn<ion Sreet ATdresi: ;— Kramers Pond Road Jddodland. Estates Tnilla ge. Putnam Valley to - Taz # t o� d Map 73t 18 Block 1 Lot(s) Well Owner: Name: Address: V.S. Corporation, 37 Croton Dam Road, Ossining, NY 10562 Use of Well: 1- primary 2- secondary _ X__ Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling ]Equipment x_ Rotary Cable percussion. X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 42 ft. Length below grade 41 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: X Steel Plastic _Other Joints: _ Welded X Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: X Yes No Liner _ Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes—No Hours Second Well Yield Test Bailed X Pumped X Compressed Air Hours b Yield 60 gpm Dept Measure from land surface- static (specify ft) 50' During yield test(ft) 140' Depth of completed well in feet 205' Well Log If more detailed information descriptions or aiev ,analyses .. . are available, please attach. Depth From Surface Water Bearing Well Diameter(in) (Formation ][Description ft. ft. Land Surface 7 Drilling in over urden clay and boulders 7 Hit rock at 7' 7 42 - Drilling — iii rock; s: = =c s -routed_ 42 205 Drilling in rock aranite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 7cfrm Depth 160' Model 7GS05412 Voltage 230 HP Tank Type WX302 Volume 86 cal . Date Well Comp eted 8/20/98 Putnam County Certification Nb. 002 Date of Report 10/30/98 Well it M., mu'i'z: bxact location of wen wim distances to at ieast.two permanent landmarks to be prov d on a sepadate sheetiplan. Well Driller's Name P. Be o s Inc. Address: 4 Putnam Ave., RrewstAr� tvY 10509 Signature: Date: 10/30/98 erry White copy: HD File; low copy- Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 .r y PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES -� .. r., 4 ♦ .- .'lily "r �i �� .w _'.. -.dv - <:i'• J .. ..'�:�...yr rra.. ..rte �: S:c�:�i•.. suC.a.i R:.i�,y GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM v/�.LE.3�i� Sa'NTucci Owner or Purchaser of Building i 3761 mc,roH -p�kN4 rao.&.n Building Constructed by Ntwt tu- Ra. T 7:;,Ma%tr C ,Ae-9 ilia- Ft 5 ©or44) Location - Street 12�S +��rcTl�a 1. Building Type 73, I8 1 17 Tax Map Block Lot TownNillage L&NC_A.rz 1a Subdivision Name to Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is 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 "Certificate of Construction Compliance" for the sewage treatment 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 system 1 ;t. .tl .. M" - .....0 :.r�.....�.. �. •D �sC rye•.. w-. :1� -i_... _.. -.. , c - •t+...... ...ow.yy.....s �.... .. _.i. .-.. ^fir ,.�. -_ _..<- .t...- tw__�.- ..s_.._. --r -. The undersigned further agrees to accept as conclusive the determination. f t Publi 1H0alth Direct of e Putnam , County Department of Health as to whether or nct, th failq re of t Atem to o eate as c se b the willful or negligent act of the occupant o the' builmg ut hzmg the p Y p �r �■flr;TIN Day ,> Year 579- Signature: W A Title: 1?R P_ 5 Gen ral �6fi dactor'Vwner) - Signature Vl1 tt Rio .5A t r0cc i Corporation Name (if corporation) ./a 37 cRar 6c-A VA PA ROAa > coR P Address: 1 7 C2 D rU N `C,>A -NN, VOA.f7 State O 51 N N a N Zip 1 05 G 2 1—= r-4-- Corporation Name (if corporation) Address: State Zip Form GS -97 . ' `a. iNSITE NG RING 'S�URVEYIZ & eCTU'9 P.C. . E 'kE R&I ".C. ---M�LAND�SCA5�A LETTER OF TRANSMITTAL 74 k6dfe 22- 4 a no a.'; Brewster, New York 10509 .(914) 278-6392 7 Del-avergne Avenue (914) 297-1742 Wappingers Falls, New York 12590 TO: e'C'ff-P' WE ARE SENDING YOU ❑ Shop Drawings ❑ Copy of Letter Date: / I Job No. t (47,3 1 o Attn: 4V4?-1 Re: t,,,,ace9vZ 3 e,&I- I o 6co., . . . ............... . ...... L l -30 - 6, cov &VVY :zw 7 it a-Attached ❑ Under separate cover via 2Prints ❑ Plans ❑ Change Order ❑ the following items: ❑ Samples ❑ Specifications COPIES I DATE I NO. DESCRIPTION z -98 :16c-17 C . . . ............... . ...... L l -30 - 6, cov &VVY :zw 7 it zoo .0 ........... .................. ..................................... . .. ......... ......................... J .. ........ ........ . ......... . .. .................................... . . ......................................................................... . ............... . ................ ... ............................. . .............................. ............................. ....... . ..................................................... ...... . .. . ......................... .. . . ... ..... . .............. . ....... . .................. . ............................................ . ................. THESE ARE TRANSMITTED as checked below: Er%prapproval EAppoved as submitted, ❑ Resubmit -_-opp .!94 fg .rpppr9val. ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned; for corrections ❑ Return corrected prints ❑ For review and comment ❑ REMARKS: COPY TO: Lot98.dot SIGNED: IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE 0 e,-. i NORTHEAST LABORATORY OF DANBURY i CT Cert PH -0404 30:3°'M1LL-FVA!i'907 - 'b'ANBViiY CT- 0681'1"° " NY Crert. "'11471" (203) 748 -7903 - FAX (203) 748 -0652 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: P.F. BEAL &SONS DATE SAMPLE COLLECTED: 11 /10/98 4 PUTNAM AVENUE TIME COLLECTED: 4:00 P.M. BREWSTER, N.Y. 10509 COLLECTED BY: W. MAYERS DATE RECEIVED @ LAB: 11 /11/98 TESTEDBY:LAB #11471 & 11301 REPORT DATE: 11 /30/98 SAMPLE SITE: V .'S. CONSTRUCTION, LOT #10, WOODLAND EST., PUTNAM VALLEY, N.Y. SAMPLING POINT: HOSE BIB SOURCE:' WELL TREATMENT: NONE TEST PERFORMED RESULT:. MAXIMUM CONTAMINANT LEVEL BACTERIAL: Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml PHYSICALS: pH 7.06 no designated limit Turbidity 1.6 NTUs 5 NTUs CHEMISTRY: Nitrite N <0.01 mg/L as N 1 mg/L as N 11301- Nitrate N 1.3 mg/L as N 10 mg/L as.N Alkalinity 98.0 mg/L no designated limits Hardness 116.0 mg/L no designated limits Iron......_ <0.03. mg/L 0.30 mg/L. . -. -)Vlangaiiese -- —'<0.0 I mg[L .. 0:30 [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium 2.9 mg/L 20 mg/L**, Lead <0.005 mg/L 0.015*** ml = milliliter . mg/L = milligrams per Liter ND = none detected NTU =Units * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED: 11/11/98 SAMPLE, AS TESTED ABOVE: OTABLE or 1OT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Laboratory Director -NORTHEAST LABORATORY, 129 MILL STREET, BERLIN; CT 060379 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800- 654 -1230 PUTNAM COUNTY (DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION �Date: �l d Street L- -ocatl ri" �:r�, 7'-..- o .n.:;�, �� =. :.eT1Zu �.i.6U'-U i:•r " .�.�:_, ;'1t r "" (t,<< ' �y . Owner 1\4 cry Town y Permit # P \[ , )a— q-3 TM # '13, - 192-1 Subdivision Lot # / , y 1. Sewage System Area a. STS area located as per approved plans .......................:... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/ wetlands ...... ............................... II. Sewage System a. Septic tank size - 1,000 ......:1,25 .....other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ...................:........... d. IDistribtuion Box out ets at same elevation -water tested ................. 2. Protected below frost .......... : ................................. ..... 3. Minimum 2 ft.Original soil between box & trenches Junction Box - roperly set ....................... ............................... — I . Length required Length installed 2. Distance to watere6uisd measured Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 -1/32" /foot ............. 5. 10 ft. from property line 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 1%" diameter, clean .................... 9. Depth of gravel in trench 12" minimum ................... .: capped.. ...._ _� .. ........:.:.::. ti ::.: ' < �__9 Ir'tini u� osed' "sI' ifis _� : a = 1. Size ot pump chamber ................ ............................... . 2. Overflow tank ............................. ............................... 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Buildin a. House located per approved plans . ............................... b. Number of bedrooms ................ ............................... . IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured ft........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 1/97 Form - i IFUTNAM COQN/Y'T DWAMTMM OF IMALTM r Dlwblom d BONN servleme. Ca EWL N.Y. 1A412 Ptvvl3e ` DO PEUM ]FOR NWAOE DEPOSAL STS'M Lxatetl .i'B f C t ( �- �- �cl? :50L, 2 _ _ oar or _ •ty !'l,•ry'... ..�•�'`�/a A. �'k. �.•^Fq�'.�OOLie�.!; •.'�/ L.;�S/•:L.f 'w. w{f I btibdivldw Nimo u . Let W t O T. map -7 P� Bbds [ Ios l 7 OwaedAppacwa Mi m Qt-X. /k� G�'.>, cLc. )Pivlg -iOf C.c�./ I' lk4c . E —� $off } Date Of Prevloae Approval r Gx g 0 tl Mdba Adtbmae '( 1-i� �i �. Town 4 T.Ip Date Subdivision Approved+ ril Fee Enclosed ❑ Amne,nt BM1MlM4 Typ, i2 ,--,5 N'M /I?- lot Aron I Co � AC Fm Seedom 0* LJ N®ber of Beeoama Depth Yohlnle�_ Design Flow G P ID PCHD Notification b Aegateed Wbea FM b oompbted separate Sewokee syosm to d � GWS= Sepd. Tarn and -444 L.F `z" Vii . l f (� To be contracted by Uf�1 KNC'1'(�l sdaA UL {UWD1rtl IL Water pdMl9 sullpty Film Address orl >0 Sapp4y Deed byl.ilJ IC�1rl�!\l N -- Adameen lJ N KlL1j!>> L CQ other Reotlhemente '��i L)" � �4 i �a r 1- t el.. 1 represent that I am wholly and completely responsible for the detign and location of the proposed system(s). 1) that the separate sewage disposal fystem &bow described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules On regu ems o N norm County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the COrnmi$liOnar of Healthwill be submitted :to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assign$ by the builder/ that said builder will place in good operating condition any part of aid. sewage disposal system during the period of two (2) years Immediately following thedate Of the Istu- Once of the approval of the COttificate of Construction Compliance of the original system or any repairs thereto. 2) that the drilled well desaraw 060" will be located as shomm on the approved plan and that aid well will be Installed in accordance with the standards, rubs and ragu a� o� ns of the Putnam County Department of Health. lr On GI -7 Signed P.E. R.A. Addrenl11,1617 U4 1r.G_Pn' - License No i APPROVED FOR CONSTRUCTION: This approval empires two years from the date issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction "Muires aaf nneew' permit. Approweedd for disposal of domestic lanit&sirsalrao0 a _p_& ivate water supply only. �+ 0/88 By '""� Tltto'1 C �j \ , I "..��L,A'�' `e. i'2' Y. t" .r` DEPARTMENT OF -HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 1009 Tel. (914) 178 - 6130 Fax (914) 278 - 7921 FAX COVER SHEET Date: y 6 To: Fax N: 14_S j-r;- No. Pages (Including cover sheet) From: Adam B! Stiebeling Asst. Public Health Engineer --y espond!�-- atioll, -our inform.'... For your review Attached as requested ' �A,As discussed Please call Notesfflessages; tf C, V4-a r f z>62!ic 0 V1, 7�b 7-1 L,(- l "&C C q-e� In the event of transmission/reception difficulties, please contact this office at (914) 278-6130 ext. 157. r�& C'O TS BRUCE R. FOLEY N DEPARTMENT.OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 1.0509 (914) 278 -6130 `-.APPLICATION TO "CONSTRUCT °'K•"WATE''R 'WELL" PCHD PERMIT # R V 10-93 WELL LOCATION Street Address 5O T Town/Village/City ?S Tax Grid Number -P lb — `— / WELL OWNER Name Mailing Address Wrivate O Public USE OF WELL primary 2 - secondary SIDENTIAL BUSINESS ® INDUSTRIAL _® PUBLIC SUPPLY O AIR /COND /HEAT PUMP Q ABANDONED O FARM O TEST /OBSERVATION 0 OTHER (specify, CD INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED + /EST. OF DAILY USAGE ,7�jga1 REASON FOR DRILLING ® REPLACE EXISTING SUPPLY 16EW SUPPLY NEW DWELLING 13 TEST /OBSERVATION ® DEEPEN EXISTING WELL GI ADDITIONAL SUPPLY DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN ODUG ® GRAVEL O OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: //i>Ci�f2 Lot No. l () WATER WELL CONTRACTOR: Name Address : IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _2NO NAME OF PUBLIC WATER SUPPLY: 1 TOWN /VIL /CITY AJIOjA DISA�C.,TQ PROPERTY :FROM AIEAREST,WATER'MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED PN SEPARATE SHEET (date) 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: 19 �"— Date of Expiration 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 PCHD PERMIT WELL LOCATION 'Street Address Town/Village/City Tax Grid Number WELL OWNER Name acsf2 Get. Mailing Address yirrt.E ,r -emde j y N3 private I,VC% '7 C,lff 1-76 O Public E OF WELL 61 primary 2- secondary RESIDENTIAL (3 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP ❑ ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify M INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE 3Dpga1 REASON FOR DRILLING O REPLACE EXISTING SUPPLY D TEST /OBSERVATION 12. ADDITIONAL SUPPLY XNEW SUPPLY NEW DWELLING) © DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN DUG 13GRAVEL OOTHER IS WELL SITE SUBJECT,TO FLOODING? YES NO IF-WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Z_ /NC.,-f-/C .4W- Lot No. / Q WATER WELL CONTRACTOR: Name U10114164 Address: �!/�/K %�(JG✓/c/ IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _NO NAME OF PUBLIC WATERISUPPLY: A) ,� TOWN /VIL /CITY DI CF„ T PROPERTY FROM:- .NEAREST. -WATER MA IN: - LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ! M ON SEPARATE SHEET 6-t?-95- (date) (s g ature) PERMIT TO CONSTRUCT A WATER WELL This permit A o 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 thirt3- (30),days of the completion of water well construction, the applicant shall: 1. Pumpithe 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 I roperty and in such a manner as not to degrade or oth wLpcon;? ate surface or groundwater. Date of Issue: 191 , Date of Expiration 19 Permit Issuing Official Permit is No'n- Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 �x..._.:.:.:. �% i�:-'- �Pfli. IC�Tl© N��" C" �JPTS' T�' C�'F'�'"D��'�'WE��,�.b.= �: =;�: �;�. - .....� -,/ •. , ....�. , PCHD PERMIT # %� WELL LOCATION Street Address Town/Village/City Tax Grid Number 5112C_i 4 I-11 I, -t._. P0,4D SokJT�4 �- iTt�l/�'1 �JI�11✓�'( -' 3: 6� - � - ! � WELL OWNER Name .Nailing 0W_AF• Oa\).cc. Address NPrivate I iwc, qz" itiT +_E + +�.1 1 61=3 Public USE OF WELL- 0 primary a - secondary &RESIDENTIAL ® BUSINESS ® INDUSTRIAL ® PUBLIC SUPPLY QAIR /COND /HEAT PUMP ®ABANDONED 0 FARM O TEST /OBSERVATION 0 OTHER (specify U INSTITUTIONAL O STAND -BY 13 AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED 4 /EST. OF DAILY USAGE fl gal ® REPLACE EXISTING SUPPLY ® TEST /OBSERVATION 12-ADDITIONAL SUPPLY fijNEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING TELL TYPE DRILLED DRIVEN ®DUG ®GRAVEL ®OTHER IS WELL SITE SUBJECT TO FLOODING? YES IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: I_i�.'•C,�1= S+�iF�Di�!►SK�I�1 Lot No. 10 WATER. &RELY. CONTRACTOR: Name Address: IS PUBLIC MATER SUPPLY AVAILABLE TO SITE: YES nC NO NAM OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY � I✓� DISTANCE: TO -PROPLRT ,TROM: NEAREST WATER MA114 :_.�j.��. _ _.. LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED %�� ON SEPARATE SHEET 3 i2 5 (date) si atur PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirt;• (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such manner as not to degrade or othe i e contaminate surface or groundwater. Date of Issue: (p 19 Date of Expiration 13 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller rM LINCA9 M - W 10 . ' PUT;NAM 'COUNTY DEFARTMENT OF HEALTH A L"ICATION FOft °�APWOVAL "DOE P , _ L`ANS "FOR A` wASTEWATE*R' I'SPOSAL'' SYSTEM 1 Name and Address of Applicant: UNCA? b VaZPIytENf CO WC 2. Name of.Project• 95P5 FoR LItJCAjZ. C<rYEl6PME,Nt 3. Location T /V /C: R.It9411 VALLEY 4.i Project Engineer: 1140ite ef4INE,M t�Ya FWD DESIC�t�lr�5. Address:iagq. `i�t•�e C696EL Sly, 10512 License Number. Colq?il Phone: 414-225'l�L� 6. Type of ' Proiect: Private /Residential Food Service Commercial Apartments Institutional Mobile,Home Park., Office Building Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEAR) ?. ;Type Status ,(Check One) Type I.. Exempt Type II. Unlisted - 8., Is'a Draft Environmental Impact Statement (DEIS) required? ... hb 9.�Has DEIS'been'completed and found acceptable by Lead Agency? ........ :.: NIA 10. Name of {Lead Agency WA i !7.15.,thIt.. - ._O.taiitirag,_. Qntng .�- or, . other: officials,. ordinances ?,. ...... ................... ... ... . 131.04• PUMIt 12.' If so, have plans'been submi.tted,to such authorities? NO 13. Has preliminary approval been granted by such authorities? WA Date Granted:�,1� 14.,Type of Sewage Disposal System Discharge.. Surface Watery X Ground Waters 15. If surface water'disc,harge, what is the stream class designation ?........ BIA 16. Waters index number (surface) .:,: X6 17.Js project. located near. a - .publ_i c water .supply system? ., ..... . . t`10 t 18. If yes; name .of.. water supply N/A Distance to water supply N A 19. !Is -project site near."a public.sewage,.collect.ion or disposal system ?..... 110 20.!Name'of sewage system NSA Distance to sewage system N 21. 'Date observed: 23. Name of Health Inspector: URM45a(j�_ 24. Project design flow (gallons per day) ..................................... BW GPI) .T ,25. Is State_.Pollutant Discharge Elimination System (SPDES) Permit required ?.. NO 26. Has SPDES Application been submitted to local DEC Office? ............... 27. Is any portion of this project located within a designated Town or State wetland ? .............e................ ...o........................... hb 28. Wetland ID Number ......................... ...........0........... _ 29. Is Wetland Permit required? ....... >. ...... Has application been made to Town or Local DEC Office? .................. MIA 30. Does project require a DEC Stream Disturbance Permit? ................... go 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ..... — YES or N0 32. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or NO ND DESCRIBE: 33. Is there a.local master plan or file with the Town or Village? ....e.,..., Y 34. Are community water, sewer facilities planned to be developed within 15 years? NO 3.5 7-:A;re.- ny.- sewage -disposa--1 afea-s .in:-- excess of.15X ,slops 36. Tax Map ID Number ............ o.> ........ ..............0................ 37. Approved Plans are to be returned to: Applicant Engineer If the application is signed by a person other than the applicant 'shown in.Item 1, the application must be accompanied by a Letter of Authorization. Failure to comply with this provision may grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is.. true to the best of my knowledge and be 1 ief. Fa Ise statements made herein are punishable as a Class A Hisdemeanor.pursuant to Section 210.45 of .the Pena l Law... . SIGNATURES'& OFFICIAL TITLES: MAILING ADDRESS: Fill 1 10512„_ ING:24 C.C(2EY (;:-2 � 1!a, , r CIF LZ1 LIU DIVISION OF . P. ili me a-7r.,AL .HEAL-m S"'Zylas' ! DESIGN CAT.i' SHEET= SiJBSUFACE SFArAGE DIS L S`1STM FILE Caner Ut.1GA,R PE'JEIOPtttNT GD.,1NC.: Address L►TTLS rtZe.Y . i tJ 1'°t(o43 Located,,,at (Street)' 6% ;Z 16 � V4it -L ROAD _C,6 Seca 13:x$ Block.' 1 Lot (indicate nearest cross street) tllllClpdhty �fA1A�"j - yAL,L�Y Wat M ersfie� SOIZ PERCOLATION TEST DATA RJQ(= TO BE SUR-fr TTID WITH APPLICATICNS Date of Pre :-Soaking I A Date of Percolation Test r N A HOLE NL24BM . ; C LCC K = PERCOLATIG N Run Elapse Depth to Water Fran Water Level No. + Time Grourd Surface In Inches -. Soil Rate -. Start -Stop Min... , Start Stop: Drop In Min/In Drop Inches Inches Inches 1 2. Ar I DES1CaN PE RC,O TI.Ot 4. P..A,TF- <PF i0 "MAW I$ T�iK�t�l FY�DM TlaE FI`Lr_D, M-AF a ZA-S3$ F4LeF> 9 T / 3. . 5 1 2 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 sutndtted for review. 2: Depth measure ants to be made from top of hole. rev. 9/85 13° 14, IND CA UMM AT. _WHIM uROURji7��h.���t INDICATE LEVEL TO WHICH MTER LEVEL RISES AFTER BEING E,N UNTERED DEEP HOLE OBSERVATIONS MADE BY: PC. DATE: DESIGN Soil Rate Used Min/1'. ° Drop: S.D. Usable Area Provided 5T-0 Noe of Bedrooms q' Septic Tank Capacity gals.. Type ®. Absorption Area Provided By L.P. x 24" width trench Other Name twstyF_ 4 DEStG Jj C— Signature Address l409 �LyYe !o SEAL SS � - �c�V 8193'• 'a� ' `� THIS SPACE MR USE BY HEALTH DE:PAR`Ti+TI+lI! ONLY Soil Rate Approved sg.ft/galo Checked by Date APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DMSION OF ENVIRONMENTAL HEALTH. SERVICES i INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET for CONSTRUC ON PERMIT / -A1AME O FD I R l,.0 STREET I.o . TIO }.. BY wt l< DATE TAX MAP # DOCUMENTS. Yw- APPLICATION i PWS; LETTER I DESIGN DATA SHEET(DDS) [DEEP HOLE LOG (-CONSISTENT PERC RESULTS (3) PERC HOLE DEPTH CORPORATE RESOLUTION PLANS THREE SETS MOUSE PLANS - TWO SETS VARIANCE REQUEST / GENERAL LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED -PERC RATE v jf FILL REQUIRED DISCHARGE (OK) PERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY AND EXPANSION EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE GE IF PUMPED PIT & D BOX SHOWN & DETAILED ® HOUSE - NO. OF BEDROOMS Imo] WELLS & SSDS'S WAIN 200 FT. OF PROPOSED SYSTEM PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER - 1 /4 "/FT. 4"0; TYPE PIPE = NO BENDS; MAX. BENDS 45 W /CLEANOUT FILL SYSTEMS CLAYBARRIER .10 FT HORIZONTAL: SLOPE 3:1 TO GRADE LL SPECS DEPTH GAUGES FILL PROFILE & DIMENSIONS It VOLUME CURTAIN DRAIN REQ mSTANDPIPES TRENCH EX- APPROVAL SSDS ADJ.' LOTS WETLAND (TOWN/DEC PERMIT R & D) =LF TRENCH PROVIDED =60 FT MAX DATA ON DDS PLANS &PERMIT SAME =] PARALLEL TO CONTOURS PRE -1969 -NEIGHBOR NOTIFIFICATION =100% EXPANSION PROVIDED LETTER BUZBA ! 100 YR. FLOOD ELEVATION SEPARATION DISTANCES SPECIFIED ON PLAN FIELDS r ,. Et tiIREi3 DE�FAgI S ON P7L•Afi13 _ �:. -.; : ,. �_ . - .-.m -1�0'i P:L *, DRIVEWAY; 'LARGE- REFS; IOP OF'F` LL"'" SEWAGE SYSTEM PLAN - (NORTH ARROW) = 20' TO FOUNDATION WALLS SSDS HYDRAULIC PROFILE = GRAVITY FLOW = 100 TO WELL, 200' IN D.L.O.D., 150' PITS D/ J BOX CD TRENCH/GALLEY = P- PTT DETAILS I = 100 TO STREAM WATERCOURSE LAKE (LNC.EXPAN) SEPTIC TANK'- SIZE DETAIL = 50' TO CATCH BASIN, 35 STORMDRAIN, PIPED WATER �i WELL DETAIL, SERVICE LINE IF OVER = 10' TO WATER LINE (PITS -20') III CONSTRUCTION NOTES (GRINDER RATE) = 50' INTERMITTENT DRAINAGE COURSE ,DESIGN DATA: PERC AND DEEP RESULTS = 200 FT. RESERVOIR, ETC.= 150 FT. GALLEY SYSTEMS ,TWO -FOOT CONTOURS EXISTING & PROPOSED SEPTIC TANKS 20 DRIVEWAY &!SLOPES CUT =IO' FROM FOUNDATION; 50' TO WELL 'FOOTING /GUTI'ER/CURTAIN DRAINS WELLS m 15' WELL TO P.L: ;OMMENTS: PUTNAM COUNTY DEPARTMEW OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 7_ Date Re: Property of LANC-AR INC. Located at JB4KrA HIL-L- 1 p� 12 SouTR (T) Lot A�A VALt-c Section Block Subdivision of L1kC_.A.1z_ Subdv. Lot # 10 Filed Map Date' Gentlemen: This letter is to authorize. Insite Engine ri . na & Surveying, - P.- C - - a duly licensed professional engineer x X9 ,b4x�c (Indicate) to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction 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 t Signed Countersigned: < Jeffrey J. Conteimo,'_ P. E. MQ*x, # 61931 Insite,Engineer-ing &_Surveying, P.C. Address Route 22, Brewster, NY 10509 278-4990 Telephone 091 Address Town' 7.O/- 440- 4 70 0 Telephone ,N COMPWICUON-PEMM M ION SBWAGH DWgsn 731 Tnt FUT44M. 7 25 Rev Revhko O Ownw/App8=0 Nsinle M110118 A Town- 6 ------ ZIP i' patc SubdivisionApRroyed j Fee Enclosed d 1:3 77 RESIBIRB I+r— — IM A'5 D� 'Pa vodme N=&W d _��Dedgzs Flow G P D PCEM NoWkedois hs RigWred When iM b co6ipbted Up"M uwiefql� -SYdM C�"" 't Qdko Sep& Tmkd 444- IF of en Te olll!111�i Ad&m U#XAVC;W,it/ Waftr SW*- hosis Adclrew -Ad&,. CAW Olileir CO:uLtyrn place in' 604 an" of t6e+ will be lociii County Doi Date App, \Re IV - Date to/88 1� -I - - ___ a 4 rat any. part of 0!s64*i.%syi novel. of - tis! Civiif6to of Construction Compliance' of i`i*�Ii o plan Andtruit Id Well will 60 6 stl if �Health, � 7 wene Address t C This'.POroiolll Upiri Is t�vo Y"rAIftn "a or may 'be* amended. or modified when consldn' �wMj. � Apprionil -for, disposal of dorrim 2 By Dlcatio,n of the proposed system($); 1) that the separate. ini-divIA n 0, n;! iere to and in accor4ance' with lhe standards. rules arm regu m :ai49",.of Construction,l;ompIia"- . -, "tisfictory to the Commiuloner of H"Ith will liotl the owner, his succanors. heirs or assigns by the bulkier. that said builder will .am during the period of two (2) y4ars,immedlately following thedate of the lau- the-original system or any repairs, thereto, 2) that . the drilled well described above ised in accordance with the standards, rules and reg—uMMnsof the Putnam P.E. LQR.A. . ' F z lksnse No t 4ite, I saw - &StruIc'Awn of t e buikiing bas been undertaken and is airy. "y t misiionir of Health. Any change or a a son Of construction Doe t rater .supply only. I . a Title q� ENGVINEERING P.C. S Y .0 IITE- SURVEYING, PC. (914) 278-4990.. Brewsii�r. Ne—WiW`1)bd0§- 7 DeLavergne Avenue (914) 297-1742 Wappingers Falls, New York 12590 TO: -,PC �1 D LETTER OF TRANSWTTAL WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items: 'Shop drawings C1. Prints ❑ Plans ❑ samples ❑ Specifications ❑ Copy of Letter ❑ Change order ❑ THESE ARE TRANSMITTED as checked below: Jon r4o. ATTEN'nON HoL3 yn0Fg_1.5>- RE: R�YEWA& ❑ Approved as submitted ❑ Resubmit copies for approval WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items: 'Shop drawings C1. Prints ❑ Plans ❑ samples ❑ Specifications ❑ Copy of Letter ❑ Change order ❑ THESE ARE TRANSMITTED as checked below: ,�Eor approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit — copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FOR BIDS DUE 19—[] PRINTS RETURNED AFTER LOAN TO US REMARKS: � ... I . I ...................................... .. ............. .............................. .................................. .................. ........... ... ............................................. .......... ........ 11 ............. COPY TO trfc SIGNED: It eaddswes are not as noted, kin* nodly us at once U �-k �°`� .,�Fa�LEC� :Fee .E 7�1 % ss 1 7=7 Sed tint, - CoTWNna' tsUttaetory to IM 'Mm4"n4i',bf - Health will Of two t21 Y.f'.011OW any4eoirCtftoW4Aoj-2) that the drilled well, d W F 86"0 It d Fav—UWZn—vW`,,t t nom ?p "16t No Is, t he 'building Ms,bofan uneatakai and Is fo�Nr :�of, o4samth.- Any of-*convtruction "PIPS, Of only., Title ��p} 6 2 sp etieF: at Subdivision �A� 'T, Dti 7 �-k �°`� .,�Fa�LEC� :Fee .E 7�1 % ss 1 7=7 Sed tint, - CoTWNna' tsUttaetory to IM 'Mm4"n4i',bf - Health will Of two t21 Y.f'.011OW any4eoirCtftoW4Aoj-2) that the drilled well, d W F 86"0 It d Fav—UWZn—vW`,,t t nom ?p "16t No Is, t he 'building Ms,bofan uneatakai and Is fo�Nr :�of, o4samth.- Any of-*convtruction "PIPS, Of only., Title at Subdivision �A� I'M Dti t2 #AMW -4, -Comity n `01 FIMRh. ,;devwn A 9!�Ov"..Pr It �-k �°`� .,�Fa�LEC� :Fee .E 7�1 % ss 1 7=7 Sed tint, - CoTWNna' tsUttaetory to IM 'Mm4"n4i',bf - Health will Of two t21 Y.f'.011OW any4eoirCtftoW4Aoj-2) that the drilled well, d W F 86"0 It d Fav—UWZn—vW`,,t t nom ?p "16t No Is, t he 'building Ms,bofan uneatakai and Is fo�Nr :�of, o4samth.- Any of-*convtruction "PIPS, Of only., Title PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date 3 93 Re: Property of LINCAR MVPLOPMENt CO. III. Located at BIPZA HILL gp. fa IV (T)-BLIh6t )JAUEY Section Block Lot _11 Subdivision of LINC-Ag -A.- 5-UMMUI Subdv. Lot # 10 Filed Map# 24 Date q] �21N Gentlemen: This letter is to authorize IN51jr, &LU M5r2t4 VC. a duly licensed professional engineer--) —or registered architect (Indicate to apply for a Construction Permit for aseparate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in -connection with this matter and to supervise the construction of.said system or systems in conformity with the provisions of Article. 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly your Signed- Countersigned P.E. Addre s s CW.T"O -..F AND DE%� FC LM FE .Address Town W I =1 X-9i Telephone W - 440 - 41 oo Telephone Co. I IW_. Treasure:: (Name and Address) and that I am and will be individually responsible for any and all corporation With respect to the approval requested and all subsequ thereto. ARLENE FAUSTINI NOTARY PUBLIC OF NEW JERSEY My Commission Expires June 24.19% i • i Q'S_ I Signed: Title: qb Corvorate Seal aq,tfof the acts rel ti / ` lw THESCA, RSDALE 11' i Second Floor 0 BO 27'8" X 48' • 2656 Sq. Ft BEDROOM4 BEDROOM3 W-O' x 9'-'T" I0' -0*x IV-cr MASTFR'EDROOM B�QROO�R IT -2n x IV- 8* 16 -02 x 13 -0 480 First Floor j 27V 48' STANDARD SCARSDALE. If FEATURES • 4- Spacious Bedrooms • Framingham Pediment on Front Door • 2V2 Baths • Fireplace Options Available • Open Two -Story Entry Foyer • "Boxed -out" and "Angle Bay" Options • Formal Dinin' g'Room Available • Formal Living Room • Consult an Authorized Westchester Builder • Spacious Couh try . Kitchen with Breakfast for a Complete List of Options Room and Pantry • Artist's renderings and Floor Plan Dimensions are • "Cotta ge-Style- 3056 Lower Level Windows approximate. All specifications must be Whtten In the Contract No oral conditions. with Architraves on Front NESTCHESTER MODULAR HOMES, INC. P.O. Box 900 * Dover Plains, NY 12522 rye. 1 (914) 832-9400 • (800) 832-3888 43 46nshe Engineering a Design, P.C. 1849, Rt. 6 Carmel, NY 10512 ♦ .4.y. _ Phone: :(914)225-6200 Fpx:_(914) 225 - 8. ... ,_ ., w..r.. . h. �q. �..• A�'►, WV'.ti We' w'- wf�Y" 43s ..I.."'q�1fW{�r.�J.� +i�•�. -- -� ._. e,�.A ri -j1�V �:i�'4��.O�.t�:� LIEUTEM ors MUSOMMAL DATE > WE ARE SENDING YOU Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION -� Ft:I4D Fol?'1 PC,- � > WE ARE SENDING YOU Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION -� Ft:I4D Fol?'1 PC,- � 613/73 - L-�Ei"C R of ,�UTt- 4G'(Z1Z..��TIQN � � � 53 -- A��FI 7,��1 l`iT c.�czP��l?A� c��.1t����H ►P /Z3hi3 F_='RM1T & P0(Z�TjC)j- 4 i.. h3 e -I ��sTR�c i ►oN � i ►\►� �$ 93 33S .QZi (/P,4 r 87:7,ft, Abe;-. bo 4k - O411-ISSE E ARE T RANSMI:11I26'a6 " For approval ❑ Approved as submitted ❑ Resubmit —copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution > ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FOR BIDS DUE _19 — ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY SIGNED: U01,1K It enclosures are not as noted, kindly notify us at once. i .�. ''�•.i_t" t �_� vx r�_"r.� �?t .. .`.' �- > .. .r. ..- „_ - ri -r.,. :�'�� "' .iT_3 c�'- >. .. 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