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HomeMy WebLinkAbout3450DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.18 -1 -19 BOX 27 �'y ~� � I � � I r f � T • � ti 'I� �� ■ J T i •� � ti ' L ' I 03450 I t ' PUTNAM COUNTY DEPARTMENT OF HEALTH D VISJON O_F.EN 1 ONJV�E T'�'�►�., HEA,i�TH_ ERVICES - r o;.-, w- .... -�..., a : ,.i •.. ,,. • � . i- .. -_.: ' a . +r. i� -.... w ... "... .. r • -. -e ..... _, o, -p. ,. a. r .., rJ.:. < � _ . CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR AT NT SYSTEM PCHD CONSTRUCTION PERMIT # 9p 13'R St 14 1 Located at (FoVk tAMLV adke-µ Pit-t- 17P so,,�u� 2 A or Village 7u-rN ar--k yp•i-,�c". Owner /Applicant Name V,4 Tax Map 7 3, 18 Block Lot � °1 Formerly Subdivision Name I Subd. Lot # t Z Mailing Address 3 7! e Z p3 a v ;zbA -fl ass , N f ouc_ { '( Zip 1 05 6 z Date Construction Permit Issued by PCHD /d -Z I -' -7 Separate Sewerage System built by d5 Co y>T;? ae7-1 v ji -o Q a Address 3A M E A s h ao a � Consisting of 12 So Gallon Septic Tank and 41gd LF o1= :21 -J,PE A3se1?T-(0uJ �iZEnlcrlEC Other Requirements: Water Supply: Public Supply From Address or: OC Private Supply Drilled by PF ?4:A L. Address Z/ ;7&r V A-i JF �swstF�t �► �;>3uildi e:_ES:r•'�► i i, _ :fias'esosion= con#rolbeen: pus :y�say X3'1? I �I Number of Bedrooms Zt Has garbage grinder been installed? I certify that the system(s); as listed, serving the above premises were constructed essentially as shown on the as- built 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: 4"" Certified by i Address._-zi, P.E. License # el 4 31 (y as 7?e a2, i32E0571eQ; IJ 105.0 Any person occupying premises served by the above systems) 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 modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. J�j 3 B Title: � 0� Date: S White copy -14D File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 t, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL lE1lIEALT]H[ SERVICES WELL COMPLETION REPORT e C fiton - Street ddress: ° To i+n°°yQillige: ►nljod]and Estates, Kr Tiers Raid Putnam Valle Map -77310 Block 1 Lot(s) Well Owner: Name: Address: V. S. Corporation, 37 Croton Dam Road, Ossining –NY 10562 -- .- .- . -.. -- Use ®ff Well: - rimary 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 33 ft.' Length below grade 32 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 -souR Hours 6 Yield 5 gpm Depth Data Measure ftom Md static (specify ) . 40' During yield test(ft) 305' Depth of completed well in feet 345' Well Log If more detailed information descriptions or steve-analDTse.... s� are available, please attach. Depth From Surface Water Bearing Well Diameter(in) ]Formation Description ft. ft. Land Surface 5 Dr ' 1 ' 5 Hit rock at 5' 331 ,�i'i -:. - - - :.s dam:: ..- ::y.. --•.:. 33 345 Drillinq in rock granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 5=m Depth 300' Model 5GS07412 Voltage 230 BP 3/4 Tank Type WX302 Volume 8_ Date Well Compete 12/29/98 Putnam County Certification No. 002 Date of Report 2/3/99 Weli D ' e NOTE: Exact location of well with distanceTons, least two permanent landmarks to be pr7441> on a separate sheettplan. utnam Avenue Well Driller's Name . F. & Inc. Address: Brewster, NY 10509 Signature: Date: 2/3/99 P a White copy: HD Fil , Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 )RTHEAST LABORATORY OF DANBURY CT Cert: PH -0404 _ is= �`lils %iN -ROl ,IipNBiJRY�` =CT ®68111 °� <" '1NY.Cert: -1*1471µ ' (203) 748 -7903 - FAX, (203) 748 -0652 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: P.F. BEAL & SONS DATE SAMPLE COLLECTED: 3/2/99 4 PUTNAM AVENUE TIME COLLECTED: 1: 15 P.M. BREWS 'ER, N.Y. 10509 COLLECTED BY: CHRIS S. i DATE RECEIVED @ LAB: 3/3/99 TESTED BY:LAB #1 1471 & 11301 REPORT DATE: 3/15/99 SAMPLE SITE: V.S. CONSTRUCTION, LOT #12', WOODLAND'EST., PUTNAM VALLEY, N.Y. SAMPLING POINT: ; HOSE BIB SOURCE:.' WELL -NEW TREATMENT: NONE TEST PERFORMED' RESULT: MAXIMUM CONTAMINANT LEVEL i .BACTERIAL: Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml PHYSICALS: 'Color 0 Odor ND pH 7.30 no designated limit Turbidity 0.29 NTUs 5 NTUs CHEMISTRY: Nitrite N <0.005 mg/L as N 1 mg/L as N 11301- Nitrate N 0.66 mg/L as N 10 mg/L as N Alkalini 25.0 mg/L no designated.limjt� _,.....�;_ �_:.: �� •. - T�rdness- -. `:•23 0 �... ...._....... �_.rro'ztigr�te�t'tli1~iST: Iron m0..03 mg/L, 0.30 mg/L Manganese <0.01 mg/L 0.30 mg/L j [Note: Combined, Limit for Iron plus Manganese = 0.50 mg/L] Sodium 4.3 ma, 20 mg/L ** i Lead <0.001 mg/L 0.015*** m1= milliliter mg/L milligrams per Liter ND = none detected NTU =Units .* *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED:3 /3/99 SAMPLE; AS TESTED ABOVE: OTABLE' or [E] POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) MaWu <d 'Laboratory Director •NORTHEAST LABC T1, TORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 IDIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM /A,L r=7 IZ io _5^ N T Jcc i Owner or Purchaser of Building 3% Csot'os\1 VaM :RoADCoiZA 73. i[3 l Tax Map Block pvTN t,--N\ Vti w-r_y Building Constructed by Town/Village 13Atp.¢uILL 170 MWLY g1 tzc14 11,LL1Z0_scu0'F, N e_ A� Ta. Location - Street Subdivision Name i,2 Building Type Subdivision Lot # I� 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 The undersigned further agrees to accept as conclusive the determination of e P lic Health Directo of e Pu am County Department of Health as to whether or of t ' f ure 'the system to pe to as ca by the willful- or negligent act of the occupant f th, b Ri�din tilizing the b D5: � O's J o Day 5' Year Signature: a , Title: FREs t' N- Gen al ' o acto '(Owner) - Signature VkERro SANrucc r Corporation Name (if corporation) Corporation Name (if corporation) 'e% 3-7 CRO-M N px t_ R Address: -37 c izcro,cc ��r� `e�oa� co�2? Address: State CAS 5 t N I N G,, N y' Zip I nS (,2 State Zip Form GS -97 ENGINEERING; SURVEYING & QMf $fFHIT AF., . Pt _r. IFETTER. NNW I 7-T-AL-z &a TR, PEJ Route 22 (914) 278-4990 Brewster, New York 10509 .(914) 278-6392 7 DeLavergne Avenue (914) 297-1742 Wappingers Falls, New.York 12590 TO: C, H. p, Date: NO. Job No. al 14-7 . 31 -L- Attn: A 9.4k vA ST i e- rs EL/ .AEI Re: I� c,*2,r 3 to 5 -919 65-17 WE ARE SENDING YOU Attached ❑ Under separate cover via ❑ Shoo Drawings ❑ Prints ❑ Plans ❑ Copy of Letter ❑ Change Order ❑ the following items: ❑ Samples ❑ Specifications COPIES i DATE NO. DESCRIPTION 3 to 5 -919 65-17 6 c1.4XA--J7`"E-C C-Je Cv-f /Ccr7olld x - Fer ........................ ............. ........................ . ...... . .... . . . ................................................. . ................... ............................................................. ..................... I ......... . . . ...................... . ................ I ................................ . ........ ................ I .............. I .............. .. . . . . . . ..... . ...... . ..... ........... THESE ARE TRANSMITTED as checked below: .............. ------ []1-AbPr6vbd E-]- Resubmit:-. ❑ For your use ❑ Approved as noted ❑ Submit ❑ As requested ❑ Returned for corrections ❑ Return ❑ For review and comment ❑ REMARKS:' ............ . . . ......... . ......... COPY TO: Lot98.dot SIGNED: %'"'" J IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE copies for approval` copies for distribution corrected prints �bl�I ............... co rAPPROVEM — 1-1— 1 0"Wocablo fol Rev. 10/88 111,9r Tl;"R,--'-!kl- lau any-ropows thwetm 2) Mat th0 4ri16i'woll doi&iw atom PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION T {♦ r{.- '�.`.,x?�� -s:. o.....•.arr `.�..".; :*:.F� �- ..o- -Y- :+eea::r.^. ^,,'_••"" = fV".... ..z. ir'.;.�l. tat Inspected y ~ Street LontiG t1wGiAm / Owner ��. Town Permit # T1v1 ri 73,4 ^I —� Subdivision Lot 1. Siwage 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, :......other ................ b., Septic tank installed level ................ ............................... C. 10' minimum from foundation .......... ............................... d. Pistribluigh Box L All out ets at same elevation -water tested ................. 2., Protected below frost .................. ............................... 3. Minimum 2 ft. Original* soil between box & trenches Junction Box - properly set .............. .... :.......;.................. .. ensth required Length h installed. C � 2. Distance; to waterco�asured 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 - I V2`diameter clean .................... 9. Depth ofigravel in trench 12" minimum. _-� =i 0:" Pipe endss capped " ::..: " —"." ... ". —.... ...................... g. 'Pum or Dosed Systems ize o P, ump c am er ................ ............................... 2. Overflow tank ............................. ............................... 13. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box ibaffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. Holusefflujl&� a. itiouse located per approved plans ... ....................:........... b. '.Number of bedrooms .................... :................................. IV. a. Well located 'as 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 ... ....................:........I' d. Backfill material contains stones <4" diameter .......:...... e. Curtain drain & standpipes installed according to plan.. f. Curtain drain', outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... .. tr,ol provided ................. ............................... - Erosion con 7777 J (='CXWHr&CATE OF 44� 77, -AVIJIL W-- 4 4 r;I A-CAA­ 6 y. -n Sun ­41 _'2 Dit 0/88 vine X_ Lievense NO CM I d i t6e bUildi4 ,, s S, m strUlon o Abeen vW►taken and is tY tw AW r1limioner of "with. Aly chmnee orafteration of constriction sWii4fi e.uOplIf only. Title I DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New.York 10509 (914) 278 -6130 APPLICAThON• -TD ;CONS TRUC-T' pr - WELLL. _.- ., :....,. J,.;,.,,• PCHD PERMIT # rte'- 2 -`�4 WELL LOCATION Street Address Town/Village/City Tax Grid Number 1 WELL OWNER Name Mailing Address 196'3 -' Private O Public USE OF WELL primary, i2 - secondary RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP 0 BUSINESS O FARM O TEST /OBSERVATION 0 INDUSTRIAL O INSTITUTIONAL O STAND -BY ❑ ABANDONED O OTHER (specify O AMOUNT OF;; USE YIELD SOUGHT _gpm /# .PEOPLE SERVED 4' /EST. OF DAILY USAGE .25C7�-_Ral i] PLACE EXISTING SUPPLY O TEST/ OBSERVATION L1 ADDITIONAL SUPPLY AMEW SUPPLY NEW DWELLING 0 DEEPEN EXISTING WELL REASON FOR DRILLING' !DETAILED REASON FOR DRILLING WELL TYPE' DRILLED DRIVEN ODUG O GRAVED OTHER IS WELL SITE SUBJECT TO FLOODING? YES j�Q NO IF WELL IS LOCATED IN ;A REALTY SUBDIVISION, NAME OF SUBDIVISION: LItC➢C' 42- Lot No. 2, WATER WELL CONTRACTORi. Name Address_: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES �NO NAME OF.PUBLIC WATER SUPPLY: %b TOWN /VIL /CITY 9 Ia .DISTANCE: TO PROPERTY. ' FROM NEAREST WATER MAIN: ! - • -.: - -• , LOCATION SKETCH SOURCES OF CONTAMINATION PROVIDED AN SEPARATE SHEET is �-g -9 (date) ignat 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. I , 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 urface 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 i I i 81 .-SIAM COUNTY DEPARTMENT OF HEALTH Davie( ibn of Environmental health ServaL:( s AFF ID AV IT - CORPORATE OWNER APPLICATION FOR PEAlMIT APPLICATION SuitlldTTED TO­ — " PUTNAM COUNTY HEALTH DEPARTMENT •^ `10:' Commissioner of Health, In 'the matter of application for: u.JcA -r I C> OtoAL-D Nr._Gl <'rL J D represent that I am an officer or employee of the corporation and am authorized to act for Lwc�t)Z //E i er —aer'7 E;N Lo �nT� (Name o Corporation having offices at y S i,- L� rTLC F zy � 5 1 7 (-V 3 V, ose officers are: Pres Gent' P0A>AC_p 1 �dICKEL., Z8 I 1�8�7�/ 1 (_jzrz.r_ FEIZrZX)A�T 17613 ame and Address) / Vice-?resident: (Name and Address) Secretary: . - ti... .-. .. � _ �eSS µ� -.... Kam.. ..o- ...w.. u ... � V A s.y t.r.n � J r • Trecsurer: (Name and Address) and twat I am and will be individually responsible for any and all acts of tie corporation with respect Ito the approval requested and all subsequent 8 -ts' ielat thereto.. Svora to before me this / / day of 19 T Notary public., ARLENE FAUSTIN{ NOTARY PUBLIC OF NEW JERSEY .,p cVr»mission Expires June 24.1996 Signed: �,• / `/ Yitle:' / 0 Corporate Seal r PUT', - =M COUNTY DEP"TMEh7 OF HE/ '`H DIVISION OF ENVIRONMENTAL HEALTH SERVICES �:�'.::.:w4. .:.:N•��:r '- IxX';,�,.,.'.%�:y- .,:]:" - ::•.�'«rS'.� %v:.�..ai�r p., ••y=9 _ .f•�'a1a l.�er'� :•:. ipw, �.:: s-':.' �•.,' K:. i. �F:;. t .`.;�.- .:.:�- :.y- :..•.'.'.'n:w �w�i*:t�;r:.�, -'; '�.: �. .. Re: Property of Lr :.aR Rr-yr`coP.R +c�� CO_)i _ 0C._ Located et / /Zc q A/1 ti. tC7. P-1 Scaur;y (T) f 0•rfJ,gn7 VALA -e= Y Section 73 !s Block � Lot % q Subdivision of �"��� SuC3a;vrSrt� Subdv. Lot A! (Z Filed -Map #f Zy-33A Date -k 5 )T-7 Gentlemen: This letter is to authorize c 6.06r.JE�T'nt- a duly licensed professional engineer or registered architect (Indicate to apply for , e Construction Permit for a .separate sewage system, to serve 'the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said �s�s ems-In -e-ml rm +y- -w = Ya -:tfie - pro..v sio.Tis.�tif =Art cl j 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours;'/ Signed /,�3 o t Countersigned : r f V�d 1'l�t%ra2 ��-C, r,._,C Address yN51 E1L)6 ► e? -WWf'• 5''r; yeyrA, P.0 - LiT'L fe72',ey 1v -,T !76 r/3 Address Town *. C• g , :r Ct l ry f is y r Z . Z-0 (- `�'`�G - 51 %C G Telephone (-'Z CC) Telephone GRUCE''R; r6LEY; R:S: = - Acting Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130. December 16, 1996 Jeff Contelmo Insite Engineering Route 22 Brewster, NY 10509 Re: Proposed SSDS: Lincar Lot #12 Birch Hill Road (T) Putnam Valley Dear Mr. Contelmo: Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: "The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." 1 Current engineer authorization letter is to be, submitted. �2 Erasiori c6nt -ol_ measure for the well istesiie shoWin oin fEie plan: Furtlierriiore, anote is to be added stating all erosion control measures are to be installed prior to the start of any construction. 3. Details for all erosion control measures are to be shown on the plan. Upon receipt of a submission, revised to reflect the above, .this application will be considered further. V yours, J� Robert Morris, P. E. Public Health Engineer RNVjp DEPARTMENT OF HEALTH rA P_. Division of Environmental Health Services 4 Geneva Road, Brewster, New.York 10509 (914) 278 -6130 �:. - 'APPLICATION TO -CONSTRUCT A � "WATER :iWftb =:� .4: �' y; -;= - PCHD 'PERMIT # WELL LOCATION 'Street Address Town/Village/City Tax Grid Number N i" Imp S."al 1Ica: 73, g.. WELL OWNER Name Mailing Address L�tic,R,z & 0 F 5%. li'�'ce��� F /'76 rivate Public USE OF WELL' 1 primary 2 - secondary X RESIDENTIAL O PUBLIC SUPP Y Q BUSINESS O FARM O, INDUSTRIAL O INSTITUTIONAL O AIR /COND /HEAT PUMP O TEST /OBSERVATION O STAND -BY O ABANDONED O OTHER (specify O AMOUNT OF USE !YIELD SOUGHT 5 gpm /# PEOPLE SERVED /EST. OF DAILY USAGE 30Q .gal O REPLACE EXISTING SUPPLY 0 TEST/ OBSERVATION 13-ADDITIONAL SUPPLY &NEW SUPPLY NEW DWELLING 0 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING ' i WELL TYPE []DUG CGRAVEL 0 OTHER IS WELL SITE SUBJECT�TO FLOODING? YES _ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: L /Nc Lot No. /' WATER WELL jCONTRACTOR: Name Address: L21dit,/V IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER ,,SUPPLY: /(ifs TOWN /VIL /CITY �. DISTANCE TO PROPERTY -FROM - NEAREST WATER MAIN: w .� - y V4 « ;• i !LOCATION SKET H SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET -s4 (date) (s gnatur ) j 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 -y (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 maste.products from such well drilling operations be contained on this property and in suc ai'manner as not to degrade or otherwi,8flcontaminate surface or groundwater. Date of Issue: Z 194 I Date of Expiration 19 16 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 ! Yellow copy: Bldg. Insp. Orange copy: Well Driller APPENDIX -3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS Z��Z_R VIE °!.:SS-I'NAME OF ER � Cs� STREET ATI N � � BY DOCUMENTS. PERMIT APPLICATION PC -1 WELL PERMIT;m PWS LETTER ENGINEERS AUTHORIZATION DESIGN DATA SHEET(DDS) DEEP HOLE LOG CONSISTENT PERC RESULTS (3) PERC HOLE DEPTH CORPORATE RESOLUTION PLANS THREE SETS I 'i W HOUSE PLANS - TWO SETS ED VARIANCE REQUEST DATE �� TAX M4g% SV /6ol &'12- DISCHARGE (OK) & DEEP HOLES LOCATED ATIVE OF PRIMARY AND EXPANSION EXP. AREA; SHOWN; GRAVITY FLOW, SUFF. SIZE L4J IF PUMPED PIT & D BOX SHOWN & DETAILED HOUSE - NO. OF BEDROOMS WELLS & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER - 1 /4 "/FT. 4 "0; TYPE PIPE ®N BENDS; MAX. BENDS 45 W /CLEANOUT FILL SYSTEMS LAYBARRIER E6GENERAL 10 FT HORIZONTAL: SLOPE 3:1 TO GRADE LE SUBDIVISION FILL SPECS SUBDIVISION APPROVAL CHECKED DEPTH GAUGES �P RC RATE c� l FILL PROFILE &DIMENSIONS LL REQUIRED VOLUME REIX-APPROVAL URTAIN DRAIN REQUIRED mSTANDPIPES TRENCH SSDS ADJ.--LOT-S - -'�LF TRENCH PROVIDID WETLAND (TOWN/DEC PERMIT R & D) M 0 Fr MAX DATA ON DDS PLANS & PERMIT SAME ARALLEL TO CONTOURS PRE- 1969 -NEIGHBOR NOTIFIFICATION 100% EXPANSION PROVIDED LETTER BUZBA' SEPARATION DISTANCES SPECIFIED ON PLAN 100 YR ELO_OD ELEVATION FIELDS - - - RE .UIRED Y)ETAILS ON PLANS .. z. :,. �:.:�;_ ... � . .....:. ,_. ..,- ..6 " -::� •. 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL '� 1 SEWAGE SYSTEM PLAN - ,(NORTH ARROW) 20' TO FOUNDATION WALLS �SSDS HYDRAULIC PROFILE m'GRAVITY FLOW 00 TO WELL, 200' IN D.L.O.D., 150' PITS ID/ J BOX m TRENCH/GALLEY m P- PTT DETAILS J501 00 TO STREAM WATERCOURSE LAKE (INC.EXPAN) SEPTIC TANK - SIZE, DETAIL TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER WELL DETAIL, SERVICE LINE IF OVER 0' TO WATER LINE (PITS -20') CONSTRUCTION NOTES (GRINDER RATE) 0' INTERMITTENT DRAINAGE COURSE DESIGN DATA: PERC AND DEEP RESULTS CIS 200 FT. RESERVOIR, ETC.m 150 FT. GALLEY SYSTEMS TWO -FOOT CONTOURS EXISTING & PROPOSED SEPTIC TANKS DRIVEWAY & SLOPES CUT MI O' FROM FOUNDATION; 50' TO WELL FOOTTNG/GUTTER/CURTAIN DRAINS WELLS m 15' WELL TO P.L. COMMENTS: I � INST rl-► ENGINEERING & , 1 1 SURVEYING, PC. I I 1849, Roue 6 (914) 225b200 C411rm*el,, New York 10312 Fax (914),225-6438 fgjiCllyCre.+i'�F�; a'i':� 7 E ��s�, .. .. vll�K 1'�.•� u.v e�.�_ Wappinge s Falls, New York 12390 (914) 297 -1742 j I To P AM Cov:U r D� ©f WE ARE SENDING YOU Attached ❑ Under separate cover via_ ❑, Shop drawings ❑ Prints ❑ Plans ❑; Copy of letter ❑ Change order ❑ ' I ILIVVEQ VF MK960MOVUL DATE JOB No.Q1 17 7 ...1 I 1•Tren :t ...�. .. ,n.. 0l3 /" t�2jL1 RE: &o-T- /-Z- _':&S ®S d ; :� .. • _ _: - , - . c VIP 1'C9/a/7 PC - J ❑ Approved as submitted the following items: ❑ Samples ❑ Specifications COPIES I DATE NO. DESCRIPTION d ; :� .. • _ _: - , - . c VIP 1'C9/a/7 PC - J ❑ Approved as submitted ❑ Resubmit copies for approval 6.)1j_STRvcTioA) RFe/na- PFuc&vo-.\� 17 .--- copies for distribution L�iit"TZ ©F �vT�r`orZ!- �s(770 1- �r - --- �qF F I DAW OF 60 F— PDX47 C vim .,0 67Z,s t I ❑ 1 2 S 19 ❑ !j ELL P E;ctn i '% A P PP�-i Gay' i v :'; AFTER LOAN TO US / I .4 3t�0- 00 FOE M OF 3300.40 CK X/q4 I 'C*i- r . THESE ARE TRl�NSN1ITTED as checked below: -° :� .. • _ _: - , - . For, approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use I • ❑ 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 TO { SIGNED: If enclosures are not as noted, kindly notify us n G. 2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL, HEALTH SERVICES _ ._ � � e ....._ �.,:.,'5�.:" ;'�'�..L .v...e , .. i _ , ,� ,� ..,.5. , ._r'. •�.� n:V.`ai Vii^ _ � Date '. •c •+i.:. � &3 &tee Property of Z- Vec.GPM —W Located at J/ 2. f /-/, GC. 11�014-1> 5C7 U7* (T) Py VAUXt -Y Section 73 , lS Block Lot* Subdivision of Subdvo Lot # (Z. Filed Map # V13`;�>A Date s Gentlemen: This letter is to authorize �NSjTC 6-N6,.1CVTuvC: `f 5umyepm -t l ic, a duly licensed professional engineer or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serene 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 �... ; ° sys`t�eri`mr system °s `iii`�orioymi$y `i@'h e 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code Very truly your Signed Countersigned: CiD-E rC Address �'i T 6? C'.4 •=rr1CZ . ivy a5'r ? q1q - ZZS- C-Zoc, Sellephone Town / 70 c Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services AFFIDAVIT CORPORATE OWNER APPLICATION 4. FOR PE%%iIT APPLICATION SUBMITTED TO P.UTN&11 COUNTY HEALTH DEPARTMENT TO: Commissioner of Health In the matter of application for: L;IOC-AK PC-Ve7_0PMe-,*VT- 60- =/-,)C-. 41 represent that I am an officer or employee of the corporation and am authorized to sc for (Name of Corporation) having' offices at —I r/ n5- FrfT-1rZ /0;:57 W,ose officers a'-,e: President: r-k4C-L (-j L3e7P_a rr-LE- 76Y3 -(Name and Address) Dice - 'resident: (Name and Address) Secretary,: S Treasurer: (Name and Address) and that I am and Will be individually responsible for any and all acts o.` tie e ."0 e cor2oration with i respect to the approval requested and all subsequent s,/relating thereto .A. Sworn 6 before me this day Signed: . . . . . . . P a f I-P 6A_eJ,,1 i 19 q4 Title:,, No t a r-. Public ARLENE FAUSTIINI NOTARY PUBLIC OF NEW JERSEY MY.. Corn6sslon Expires June 24,1996 Corporate Seal I _o%, k4 COUNTY DEPARTMENT OF HEALTH ...`::t•;. �+'.9�. a ....:v- :a:i.�s w....., .••.� :..- �ar::r ::.:1'.,. ...y15n.• --^.: :x.• - ::;i -^i :'. w= .rrv.ti -= w�.....:: iss: i• .'f,..�.C::r�:�:.'�w:.���v - = = -• APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1: Name and Address of Applicant: L iac.AJK E�op+ -�E.oT Go•� -T-,vc . 7-C 4aEZry sr.. . Larry F�,erz y� N.S. / 7 6 ys 2. • Name of Project: SSD,S fox 6044e Pevererwoor coy KC. 3. Location I/V /C: PurwAM yACA..-Y i 4. Project Engineer:.17ko 6v&,tWVtfW6 (0XV wF .c,5. Address: lZoom Z.Z. . i � 13rrEwsr�� /1/f �•yowY License Number: Phone: RJy-Z7B-&4Zc 6'. Type of Pro ect. X Private /Res.i dent i al Food Service Commercial - Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (spec.ify) 71 Is this project subject to .State Environmental Quality Review (SEAR) ?. Type Status (Check One) Type I.. Exempt Type II. Unlisted X 8. Is a Draft, Environmental Impact Statement (DEIS) -required? ...:......... No 9 Has DEIS been completed and found acceptable by Lead Agency? ............ 1 100 'Name of Lead Agency i N A fit: -lrs t is p�ojec in°an area under °the i:or�trnl' of 'l al�pTaririi zon�i;ig ;_::� 6:!:- T or other officials,; ordinances? ............ ............................rvf 6cor.Amn'r + 12. If _so, have plans been submitted to such authorities? ................... t40 13 Has preliminary approval been granted by such authorities? 4A Date.Granted: P A 14. Type of Sewage Disposal System Discharge:..... Surface Water ! Ground Waters 15.'. If surface water discharge, what is the stream class designation ?........ NIA 16. Waters index - number'(surface) : ......:..............:... 17! Is project located near a public water supply system? ....:............. A/0 18. If .yes, name of water supply N A ,Distance to water supply. N�A i 19 Is project site '.near.'a. public, sewage coll,e.ction. 0r.,disposal. system ?..... M0 20, Name of sewage system N�a Distance to sewage system NIA 21; Date observed: UNKND0a 23. Name of Health Inspector: 4^40,00) 24: Project design flow (gallons per day)...... i 2. :1?ol•agtaaxt,:Di scharge El i:ni nstifln System: - 26. Has SPDES Application been submitted to local DEC Office? ...........o... 44 27. Is any portion of this project located within a designated Town or State wetland?.... ...................... ..............o................ 9� o 28. Wetland ID Number ......... ............................... 0 ............... 29. Is Wetland Permit required? %Vo Has application been made to Town or Local DEC Office? .:................ 101A 30. Does project require a DEC Stream Disturbance Permit? ................... NO 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ........ YES or NO N6' 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 /V4 DESCRIBE: 33. Is there ,a local master plan or file with the Town or Village? ........... YCS 34.. Are community water, sewer facilities planned to be developed within 15 years? A/P _ -1,5'.—Are any °sewage - e . 36. Tax Map %D Number .........,.< .............. ............................... 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 be 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.belief. False statements made herein are.punishable as a Class A Misdemeanor . pursuant to Section 210.45 of the Penal Law. SIGNATURES a OFFICIAL TITLES: MAILING ADDRESS:. .j PUTNAM OOLWT'DEPAR' MENr OF HEALTH DIVISION OF HEALTH SERVICES LOi i SHEI RMUFAC.S�SMCE DIS�POSAr "SY§W° FILE N0. err s r �z�-- Owner ,1,/,)6ta %FVEzpp"Arr Co -,sUc Andress Un-c- re; /r4ry , iV.Z. t -76 y3 1 Located at (Street) Q IMP NIL.(— A0A4 10411P sec.-' 73.t9 Block . / Lot (indicate nearest cross. street) Municipality - PU r v&4 VA 4_C 6)/ Watershed 14j.1l)56w A-/Um i SOIL PERCOLATION TEST DATA RBOUMED TO BE SUBMITTED WITH APPLICATIONS Date of Pre - Soaking N /A Date of Percolation Test N HOLE Run No. Start -Stop, Elapse Time Min. Depth to Water From Ground Surface Start Stop Inches Inches Water Level In Inches - Drop In Inches Soil Rate Min/In Drop 1� � 2 �A D�6� ��kno� �.� 8��0 ►�'^ /� �s 3 7—�K 6;;--J IY? " F��� -� ���tP Zy,33,. 4 5 2 3 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 veasurenents to be made fran top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE . ' +.a..k . w:..l�' :,.• ,_ �.d�7®.- ..e.o =. r�,a�n:..•yu, • '.+i..+. • w�.. m.a �:a,�sc G.L. 1° 2° 3° 4° 5° 6° 7° 8° 9° 10° 11° 12° 13° F4x.tc W i LoR/'!'� LOA/n w/ fH _ /�rxlz 7 .I- n ♦ r -- �Rv'r..ov. .. .... .. .. �.. .r ...v ....w.. ... .. F rap..- �.-. _�+Kyr�p...�.+♦.vw .y. r -♦ ^�Y°..+onr._... .. .. +....,� -. ....... INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED NO" s INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENOOUNTERED DEEP HOLE OBSERVATIONS MADE BY: &LrVQ 1,0 DATE: ll DESIGN Soil Rate Used 9-/0 Min/1" Drop: S.D. Usable Area Provided 6 000 5 . No. of Bedroans Septic Tank Capacity 1>--56__ gals . Type C� Absorption Area Provided By L.F. x.24" width trench Other %/ • i�,,,. Name Sueya/ab, PL Signature 11 f SEAL Address address S; f " �7r THIS SPACE FOR USE BY HEALTH DEPAR2MIT ONLY: Soil Rate Approved sq.ft /gal. Checked by. Date ,w ..— r , Af: -hr" W z E_ H raj C L7 ti ' 'j-I F-4 11t: 14 Q O Cr FIR 12110 150:11 1�1 i 27'8-.X 48'.0 2656 Sq. Ft. 48' 1 First Floor - , UU . - -- --j olo I _j KITCHEN ii BREAKFAST 112' -0 "x 15.0" I 6' -5" x 13' -0" i I 1 to �� c. U r OLI � f.•.1 "DINING ROOM° i up I FAMILY ROOM 20' -0% 13' -0' 'UV-INC ROOM-­ IV- 9"x IS 0' 48'. 1 27'8" 27'8" S JAW R SCARSDALE 18 FEATUIPRES 0 4- Spacious Bedrooms o Framingham Pediment on Front Door 0 2%z Baths o Fireplace Options Available . m Open Two -Story Entry Foyer o "Boxed -out" and "Angle Bad" Options o Formal Dining Room Available © Formal Living Room 0 Consult an Authorized Westchester Builder o Spacious Country Kitchen with Breakfast for a Complete List of Options Room and Pantry o Artist's renderings and Floor Plan Dimensions are o "COtta a -S a "' 3056 Louver Level Windows approximate. All specifications must be Written in the g �yi Contract No oral conditions. with Architraves on Front ESTCHESTER ODUEAH HOMES, INC. P.O. Box 900 © Dover Plains, NY 12522 (914) 832 -9400 0 (800) 832 -3888 kJ Llu BEDROOM BEDROOM3 11' -0' x 9'- 7" 10' -0' x 13' -0" O MAST�R BEDROOM BEQROOM2 IT' -2iz x 16'- 8" 16' -4 z x 13' -0" 48' 1 First Floor - , UU . - -- --j olo I _j KITCHEN ii BREAKFAST 112' -0 "x 15.0" I 6' -5" x 13' -0" i I 1 to �� c. U r OLI � f.•.1 "DINING ROOM° i up I FAMILY ROOM 20' -0% 13' -0' 'UV-INC ROOM-­ IV- 9"x IS 0' 48'. 1 27'8" 27'8" S JAW R SCARSDALE 18 FEATUIPRES 0 4- Spacious Bedrooms o Framingham Pediment on Front Door 0 2%z Baths o Fireplace Options Available . m Open Two -Story Entry Foyer o "Boxed -out" and "Angle Bad" Options o Formal Dining Room Available © Formal Living Room 0 Consult an Authorized Westchester Builder o Spacious Country Kitchen with Breakfast for a Complete List of Options Room and Pantry o Artist's renderings and Floor Plan Dimensions are o "COtta a -S a "' 3056 Louver Level Windows approximate. All specifications must be Written in the g �yi Contract No oral conditions. with Architraves on Front ESTCHESTER ODUEAH HOMES, INC. P.O. Box 900 © Dover Plains, NY 12522 (914) 832 -9400 0 (800) 832 -3888 F7 .4 VJ, FZ PA V I lit I 7 w. s 's 6 77777 4, A o.: 'HA T j ..,7250 SAELON' 21 ."10 ­DY 1BUT70N fox OF: 41 TAKEN OF TRENCH .4 VJ, FZ PA V I lit I 7 w. s 's 6 77777 4, A o.: .4 VJ, FZ PA V I lit I 7 w. s 's 6 77777777 A ..,7250 SAELON' 21 ."10 ­DY 1BUT70N fox OF: 41 OF TRENCH .4 VJ, FZ PA V I lit I 7 w. s 's 6