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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.18 -1 -27 BOX 28 ILI J • kai T . ` '. r �3 Ir In in 03458 ; PDINAM COIIN'1'Y DSPA>l'11YDM OF HEALTH V DhW= d Boor sneaaW Hatllh Servloee. CumaL N.Y. 10512 onCERTSWATEOFICOMPIZANCE C014NWCMN PEl11U1' FOR SSWAW DWWAL SYSI= Poole / WV .iS�.�llE Q�l-C li �'11llLltCL/l. VO'� �•r-� . � riBllQe - :-�: -� , .; l..I V�l"CrJ�I'L -.'�' _- :.� � � � i. - ;�...� ,;� -� -�� ice• .7-: __ •• :�.7 _ ow.edApPYoe Nate a UW AQ n-Qg!C)Q& Qa, T rQ - I C R=ew4 --l- R vWim 0 Date Of Peeviam Approvd - (- MaRbtF AdAten l - Towlil: I rru t: FFOQ y JJT tip _ fi tfn,4 Date Subdivision Approved q Fee Enclosed ❑ Amnl,nt RINWINS Thm L' f OCLM /di-- Lac Anil ! 1 ` to hC FW Section Onb Depict Velome Neltlber of Bedrosma Desip Flow G P D 6 PCHD NodBud an Is Regahed When Fm Is ooaupleted Sepfleaie SewenFe S7rtar a esedat d GeBoa Septle Taaik e" >r� /� �n2P [ (o (J TSZE1\iC-y ES To be comb eeted by Ad&,o uN K 9v oa-r , N Water sop*: SuMb Fraser Addeese ort 10 n t.-f- Stgmr DAW by 1M { 1Q-2' h% Add, o. Otber Revaheaeena it Pp(? o, x 4 o o c,( 6 •rr j�)tsfz c, t 1 reWS Mt'.that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the u ►ate sew dIS sal s stem above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a rqu of o County Department of Hulth, and that on completion thereof a "Certificate of Construction Compliance•; satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will pace in goal operating condition any part of said sewage disposal system during the period of two (2) years Immediately following thedate of the issu- anp Of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed in accordance with the standards, rules and r qu ens of the Putnam County Department Of Health. Date �� �� Signed P.E. R.A. APPROVED FOR CONSTRUCTION: This approval expires two years from the date revocable for cause or may be amended or modified when considered necessary by d requires a new per it. Approved for disposal of domestic unitary sewage,_and /i 10/88 cat a license No �� ` ? k unless construction of the building has been undertaken and is F iMMr- 1-J3 Rh. Any change or alteration of construction Title PUTNAM CODPRY DEPARTMENT OF HEALTH j I Dbirw d Haltb See+loeg. (del. N.Y.1l6U g� CATS OF Puatrlt d to _ • CO !V.P F ".SmAOE,DISPOSAL SYMMI[ P� p 1:....s..1 ❑ RevhMa ❑ o..sdAppreant Natal L /g Deyezc��lrr Cv, -r,0( C.-I Li El�T y -.,,r. Date d Prevlo0a Approval V M.fts Ad rma L/ r�GE dt% j �7 (c N Town ZIP �narp Subdivision Aunroved `� S l ��fa� Fee Enclosed Amn„nt R++�e h'Pe )�ES i b �—�t) -24( .Lot Area F® Sectim 0b 2. $ vahtme G Nobar d aaiesr � Dedp Flow G P D PCHD Nod&sd= Is Raphed Wben FM IS Como d SspanM Seweeap S>aeo a eanit d /25r/ 'GaBw So * Table aloe Te be:ew4totod 62 1,(,V ` A)04.1ij'' Afllhtns GC `'✓ k,sy a t.2in) Wagr Sgpbrr Fob sop* F"M Address an �Pdvaes Sam DdW M t �i�fi✓Ot�J L C .j Kit pry c.� - otb.r Raq.h...nla _E�pP� v X •Oct ` y, 6TH[ F"icvc. GL� JU �c4A�2 1 reprauntihat 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the u_RPaiat* "We" dl _spout ost*M above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules anor gula ntio 710 —i Ii—i Fu��j County Department Of NORls, and that on completion thereof a ••Certificate of Construction Compliance" satisfactory to the Commissioner of Health will be submitted to the Department, and a written guarantee will be furnished the owner, his successors. heirs or assigns by the builder, that uld builder will pWo in good .Operatllg Condition any pet of said sewage disposal system during the period of two (2) yowl Immediately following thedate Of the hat- ~ of the approwl of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled "I described above WW be located as shown On the approved plan and that said well will be Installed in accordance h the standards, rules and rqu s of the Putnam County Departwe Of NMRh. � �ro�v ..1• Dt�e +� iK� TL�NGI+� iL�ned it t a ZL ��Lkemso No 6 I C1 -S i Address APPROVED FOR CONSTRUCTION: This approval expkK two year am date saved unless construction of the building .hat been undertaken and is revocable for cause or may be amended or modified when consider by the Commissioner of Health. Any change or alteration of construction t?ato muk" a row %p�rm�. A pWOVad for disposal of etmestk can a and/or ate water suppler only' Title �� Rev. ,j/ In /QA �y °' '.i . ..... ... a .,1, , ic-4` . sit -�.• . 1'C,t. _ — �. LORETTA MOL' INARI R.N., M. S.N. Acting Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 :�,,.w.•,ROBERT J. BONDT, .. ..,: County Executive Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 June 3, 2003 Catherine L. Bomba 3 Briar Ridge Lane Putnam Valley, NY 10579 Re: Addition - Bomba, Briar Ridge Ln. No Increases in Number of Bedrooms (T)Putnam Valley, TM #73.18 -1 -27 Dear Ms. Bomba: I have received and reviewed the plans for the proposed addition to the above - mentioned residence. . The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated June 22003 The addition is approved with the following conditions. 1. The total number of bbedfooms must remain aV our�wlthout'prior- approval b. this, =: . department. 2. The area of the existing sewage disposal system, and its expansion area, must be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley. If you have any questions, please contact me at your convenience. Very truly yours, Michael Luke ML :Im Public Health Technician cc:BI Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 ADDITION APPLICATION (RESIDENTIAL ONLY STREET f or �; L n 4 TOWN�J40,zm W4, TX MAP# 73A` )- 0-7 p ff NA1ME�i4 � b� PHONE e yS :Sa 6.0'Q i � PCHD# - 18 R -03 MAILI�TG ADDRESS 3 8f ar R i La,, DESCRIPTION OF ADDITION_ &4�-o t\ I�e�•e., \TU:IIBER OF EXISTING BEDROOMS-�—PROPOSED # OF BEDROOMS (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) *Any addition which is considered a bedroom requires formal approval of plans (Construction Permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the _._.PAitnam. un Sanitary. Code: Please submit this form and the following to Putnam County Health Dept., 4 Geneva Road, Brewster, NY 10509, Phone 278 -6130. 1. Certified check or money order for $100.00. . 2. Sketches of existing floor plan (drawn to scale, all living area including basement) *Non - professional sketches are acceptable. 3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #) *Non - professional sketches are acceptable. 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Cert. Of Occupancy from Town or Certification from Building Dept: with legal bedroom count of dwelling. OFFICE USE Comments Feb98 BFhouseguidelines 4 BRUCE - R. FCIS)aj h µ►r- ... -i -. ti Public Realih'Dlr; cior .'LORI TT}1- :'dMOL-II11AItI - .1 iv1`S:t�I°°""" -;"'' Associate Public Health Director Director of Patient Services DEPARTNMNT, OF HEALTH I Geneva Road Brewster, New York 10509 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845)278-6014 Preschool (845) 278 -6082 • Fax (845) 278 - 6648 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 O -^ Re: 11' Residence Gentlemen:, Tax Ma 13 . A —.I " 1� Town L L 6-1 According to records maintained by the Town, the above noted dwelling IS y / . .... ...... ....<�.. :...Y•1J.•. ..:r•.. •:r- :.. - -. _ h+ .wa ♦♦ • .-wV S 4 c IS NOT V� in compliance with Town code and the total number of bedrooms on record is This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER BuiMing Inspector BFhouseguidelines \,\j 90, e- ic_- N H(DLA S (?_- PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPRUVED FOR BEIMoom COUNI, OWY. Date Sigpature & Title V-j BT-1,2-r i:: �" t Dk- -------------- -P4- J r PUT'NAM COUNTY DEPARTMENT OF H= E.ALTH •` i V ��l • iAJ� V i ry�Y \�MiJTAiI•���L a� JIL 'Jl.i'�C�I��M'F'•:^- J�...iNyMi V�: ,. •• _• ==PERMIT# NSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM i Located at ,vim n2, .y r Village 19v -T- N Ar-, A "e-1!j Owner /Applicant Name . V kLP40 SA7JIV Cc-( Tax Map -13 (G Block i Lot 1,7 Formerly Subdivision Name Subd. Lot # 2 ( Mailing Address 31 ' C- orrt V^-i Zip 10:5/Z Date Construction Permit Issued by PCHD Separate Sewerage System built by 3-/ C-�tvfv-fJ OA-P" i(&,tV ca�dddress ff;,ihM6— Consisting of Gallon Septic Tank and 6.?-b I-F 7- ` w qa, n� cFl i Other Requirements: Water Supply: Public Supply From Address or: Private Supply Drilled by F r�M ;� 5 � 5 t Address 62ew5T Building Types -Has erosion control been completed? Number of Bedrooms f d C3 16� Has garbage grinder been installed? ro ° 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: Certified by P.E. R7A-- - Address rJ4111;� , ,u.K,L.%icense # & ( t 3 14.95- /xv: 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 modification or change when, in the judgment of the Public Health Director, such revocatioP, modification or change is necessary. copy - HD File; Y nJ` Title: �'"' � Date: Z - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUT NAM COUNTY DEPARTMENT OF HEALTH DIVISION ION OE ENVIRONMENTAL HEALTH SERVICES p• . - =zee: ,..� =°,� °.. _._.__.._...:. ._ILL.��I11..�'1��;�»- �]E�'_'lC .. �::._ 14 c./0-IC-Ax 3 "7r Z l Well ILocaltiom Street Address: Kramers Pond Road Town/Village: Putnam Tax Grid # Svis. 6r 7-4 t �-� Map 73, f'Block d Lot(s) 22 Well Owner: Name: Address: V.S. Corporation, 37 Croton Dam Road, Ossining, NY 10562 Use of Well: I- 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 44 ft. Length below grade 43 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 Weill Yield 'hest Bailed X Pumped X Compressed Air Hours 6 Yield 12 gpm fljib IIDaltal Measure from land su ace - static (specify 6) 40' During yield test(ft) 240' Depth of completed well in feet 305' Well Log If more detailed information descriptionsor,:-.. -:_ sieve analysesryY • are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description. ft. fL Land Surface 26 Drillini in overburden cia and boulders 26 . Hit roc .. at._26' _ �26" ,44:,�. Drillin 44 305 Drillin. If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 7gpm Depth 260' Model 7GS07412 Voltage 230 HP 3/4 Tank Type WX302 Volume 86 gal. Date Well Comp ete 8/26/98 Putnam County Certification No. 002 Date of Report 10/30/98 Well 0'e e) e 1 Ira n'z: rxact location or well wrtn arstances to at Well Driller's Name P. Signature: T permanent tanamarKs to oe prov}yrea on a separaRc sneGUp►a►i. Address: 4 Putnam Ave. , Brewster . NY 10509 Date: 10/30/98 White copy: HD File; Yew copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller . Form WC -97 .. LABORATORY OF_DANBTJRY,._.. 394 MILL PLAIN ROAD - DANBURY, CT 06811 NY Cert: 11471 LABS (203) 748-7903 - FAX (203) 748-0652 'LABORATORY REPORT WATER SUPPLY TESTING REPOAT'io: P.F. BEAL'& SONS DATE SAMPLE COLLECTED: 10 /20/98 4 PUTNAM' AVENUE TIME COLLECTED: P.M. BREWSTEF, N.Y. 10509 COLLECTED BY: M. BEAL' DATE RECEIVED @ LAB: 10/20/98 TESTED. BY: LAB# 11471 & 11301 REPORT DATE: 10/26/98 SAMPLE SITE: VS CONST.., LOT #21, PUTNAM. VALLEY, N.Y. SAMPLING POINT: TANK SOURCE: WELL-NEW TREATMENT: NONE TEST PERFORMED RESULT: MAXIMUM CONTAMINANT LEVEL BACTERIAL: T otal oh C 1.f0q,n (Bacteria) 0 per 100 ml 0 per 100 ml PEIYSICALS'- pH 7.07 no designated limit Turbidity 3.0 NTUs 5 NTUs Odor I-HYDROCARBONS CHEMISTRY: , Nitrite N <0.01 11301- Nitrate N 1.3 Alkalini 121.0 14aidness 144.0 Iron 0.252 Manganese <0.01 Sodium 3.6 Lead <0.005 mg/L as N I mg/L as N mg/L as N 10 mg/L As N mg/L _wdesignated iiigx --n(i 'designated- limits;-,_ mg/L 0.30 mg/L mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese =. 0.50 mg/L] mg/L 20 mg/L** 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: 10/20/98 SAMPLE, AS TESTED ABOVE: 0 OTABLE or rF]�NOT POTABLE (PER NEW YoRk'STATE DEPT.'OF HEALTH SERVICES STANDARDS FOR POTABLE WATER)' 'Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828-9797 - FAX (860)829-1050 TOLL FREE WITHIN CT: 800-826-0105 e OUTSIDE CT: 800-654-1230 0%z l [ GINEE/?ING,.. SUf/V €Y /t� yyyy I A:�; „ Route 22 (914) 278 -4990 Brewster, New York 10509 (914) 278 -6392 7 DeLavergne Avenue (914) 297 -1742 Wappingers Falls, New York 12590 T®: P, C, ( l , D, Date: 11 ' S 'i8 Job Pao. Ott 14 7, 3; Zl Attn: AVkv" sT1f6C6 --j Re: /irnjr,A-jL 3 4-7' 2t c P u WE ARE SENDING YOU Attached ❑ Under separate cover via the following items: ❑ Shop Drawings [Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of Letter ❑ Change Order ❑ — THES RE TRANSMITTED as checked below v or approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ REMARKS: COPY TO: Lot98.dot ❑ Resubmit - co -pies for approval 1 -:I ❑ Submit copies for distribution ❑ Return corrected prints P.01 NOV -03 -1998 10:10 � 1 Loci Owns going Ddwb Ser Is De/sils >Q Y Id U PO m If more detailed ittfa:tttation or analyses ym Was "Ma dditnat depths ft drilling, POTN %m COYJNTY DEPARTMENT OF HEALTH rP MSION OF ENVIRONMENTAL HEALTH SERVICES mp ON $Famere Poi Boad TawnNillage: Tax Grid tt pBlock Lot(s) ll Name: Address: TVs. �r lion, 37 C.Mcm pct P.C2el, Cali .: +'!! 113U x Residential Public Supply Air oonditat pump ' Irrigation Husittess Farm Ttwmonitoring Other(specify) ladusbrial Iestitutional Staadby x Rotary Cable pacumior! X Compressed air percussion Other (bVecily) Scn*ftd Open end casing . X Open hole m bedrock _Other Total length 44 ft. Maderiais: Steel Plastic _ Other Lath blow grade d-3 ft Joints: WeldedL TLneaded Other Diameter S in. Seat: ,.Canew Smut Beamite Other Weight per foot 19 !bJ$. Drive shoe: k Yes ` No Liner•. _ Yes X No Compt sed Air Homo Yield tt) During Fula teatO NO of cmapleed wa i 40' 2401 305' ft Hennas waaft4ia) DcscN face 26 all 14- iAt -den cia a9d. bmaden 26. :Hit r .. e: 261 44 Dt'W .ia ' , syye��t c6sir�„ a+ � uted ]] ��qq Type -"Lb Capacity 750— 250' Model 7040 1412 4 Type SW2 Volme g j&& • Pam= Goom araefon we!! Q, a�as✓� taea :c�3brJ� �:x. �. �i iaeatroa yell to at two peeeaaaau jandmaft to be, p"Ided Qn a seperme stmvVWao. ell Mlees Nana P . a, sa pw Uc. Address: 4 °mss Ava. , ur aster f Wi L k):N w igaatttte: Date: 1W3W93. cagy: HD F'tie; Yellow cap • Btuldit 10"vcW Ptuic cop)' -Owner; Orange copy • WeU driller Form WC -97 P.02 NOV-03-1998 10:11 a ccpcu* Celt. 11471 & SORB DATE SAWLS COLLECMD: 4 MIN AVENUE Tva COIJAW FT.X SIRME Fl xy IC609 COLLBCM BY- kc Bv�- WIT DATE RECRIM @ L": 10/20M 7MIM IM-LAW) 1471 a 11301 REPORT 90AMI MW AZZ0,31 WfTll. M r W INZ I (t' 1c. " ry w"t -o pis 100 Ml 0 pw too IW Op 7.07 wavauvj . Z.V NCR WAMOCUBM 4.01 WWL es H 1.3 mg& es MWL <0.01 ra 6sipma link 5 I Mgt wBi IQ VOL aq M in "S@dw Hudu no daipaw lilaits 0.30 aOWL. 0.30 wgIL CIS awwq sodium 3.6 OWL 20 JAA.. 00 Iie <0.005 mVL Msul# Rom O.NL uW4041 -'ti QUBOAA Amap-Aulsoiya AIRLE w C34M MADLE TOLL FM W6THIM CT. MXM&0105 OU TIS Fl� Cr--, 1050 TOTAL P. w P TTNAM COUNTY DEPARTMENT OF HEALTH I SION OF ENVIRONMENTAL HEALTH SERVICES �; }:-•'r_ w. <,��� citi•. r. .. -, .r�,+'� -i -' -«.,. . �„ wi, fi�r�cp:dF >��s...ew:iv+�.w.+�:: �.irc;.•'.••:.�ti +_ -++�►i � �.�. r�� � J.�'.� � .- :.�7:.'�:�� gym. 'l .. ::..,d .:. :: .: Y-�'+ . r -' c it .'=T - •s -..,.: � PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at j4/AY�� d� /U� (OMAIL 21 P(IC tAfJ6) .�. Subdivision name LINIcAk -M--- Subd. Lot # L j_ Date Subdivision Approved Owner /Applicant Name V' E lel O SM iu C,C I Mailing Address .37 gQTdN &A 4491, &5INING J Amount of Fee Enclosed Building Type RrSllIEN OA I- Lot Area .g c No. of Be 1 ° Village &EMM VALLEY Tax Map 7118 Block I_ Lot 27 Renewal Revision . 10 - -Z.-9 Date of Previous Approval J -� Zip —/()L6;t ;drooms _ Design Flow GPD' _ Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of U.0 gallon septic tank and 00 L� 0209 U 066 TREwcµPs Other Requirements: bppgox 4&0 r i( vtgatz Fill C fAY 6hm)a To be constructed by UN f, Al Address unK NO WAI Water Suably: Public Supply From Address or:�d_ "Private Supply drilled by UN'1;1 y Address' 0 �°'" I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: P.E. 1 _ ' R.* -- Date 3 Address INCE Nr, . SURVE sc c*i r 4_4,icense # 6I 93J ldS-oq APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed a440spected bX the P Ly D and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. revision or alteration of the approved plan requires' a new p rmit. Approve=orischarge of domestic sanitary ewage only. !, By: -Title Date: / 'bite copy - HD Fi ; Y flow py - Building Inspector; Pink copy wner; ge copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SI'T'E INSPECTION Street Locatio _.� �+r�= a 'wrier „ c :Trnm�ft - - ` Permit # TM tl 73. 119 2-7 Subdivision Lot # 1. Sewage Svstem Area a. STS area located as per approved plans ...:................... b. Fill section - date of laceWent i 3:1 barrier Lgth. 10o Widthj Avg.D the 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, 250 ... ..... other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribtuion Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches Junction Box - roperly set ................... I -�ngt required -,13&0 Length installed 2. Distance to watercourse 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' /z" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped .............. ............................... g. _P._u_m�or Dosed ._S. s�tem_s ..:1..- �6 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/Buildina 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 & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 1/97 .. orm t011 /NS/ T E. ENGINEERING, SURVEYING& L L ANDSCAPEARCHITECrURE, P.C. LETTER OF TRANSMITTAL Route 22 (914) 278-4990 V, 7 DeLavergne Avenue (914) 297-1742 Wappingers Falls, ,New York 12590 TO: WE ARE SENDING YOU ❑ Shop Drawings ❑ Copy of Letter Date: I hb j I job No. 9( (�7 -_3 -Z Attn: 57 e ve-t Re: I-,1,;cAa_ -S tICT -Z1( 19er-,-t e f F- ❑16ached ❑ Under separate cover via ❑ Prints ❑ Plans ❑ Change Order - ❑ COPIES i DATE NO. DESCRIPTION D D V -t CIO-17 C,&-,,v 5 T7C U C-J-Z. ............................... .................... .......... . . . ........................... . ....... ...... . ................... ................................................................................................................ . . .. .................... . .... . .. ..... ............ . . . ............................................... .......................................... . ......... .......... . . . ............. . ....... I .............. ........................... ... I ........................................................................................... I .............. . I ................................. . ........................................................................ the following items: ❑ Samples. ❑ Specifications THE5f,ME TRANSMITTED or approval _For your use ❑ As requested ❑ For review and comment REMARKS: as checked Wow: ❑ Approved as submitted ❑ Resubmit copies for approval ❑ Approved as noted -E]'Submit copies for distribution ❑ Returned for corrections ❑ Return corrected prints El COPY TO: SIGNED: IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE W98.dot DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914)-278 -6130 APPLICATION TO PCHD PERMIT # - 8 -94 WELL LOCATION Street Address _ 2.1 VE Town/Village/City Tax Grid Number ';F,. t g _ I -- Zi WELL OWNER ame i, iL)= QE0&gAjrC6.)oC. Mailing Address VTy r7&43 Wrivate 0 Public USE OF WELL 'j- primary 2 - secondary ARESIDENTIAL ® BUSINESS 0 INDUSTRIAL 0 PUBLIC SUPPLY 0 AIR /COND /HEAT PUMP 0 ABANDONED 0 FARM 0 TEST /OBSERVATION 0 OTHER (specify U INSTITUTIONAL 0 STAND -BY AMOUNT OF USE YIELD SOUGHT 5 gpm /# 0 REPLACE EXISTING SUPPLY SUPPLY NEW DWELLING PEOPLE SERVED 4 /EST. 0 TEST /OBSERVATION ® DEEPEN EXISTING WELL OF DAILY USAGiZ&2C2_gffi1 G ADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE MRILLED DRIVEN ®DUG ®GRAVEL. OOTHER IS WELL SITE SUBJECT TO FLOODING? YES i< NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: L ` Lot No. 2 STATER WELL CONTRACTOR: Name L �i � IN(j1�1 � Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: Oy� "_Owg TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: . IACr:�TIOtd, SKE`_ 1CHr 3 "_.TOURCES' OF CONTAMINATION PROVIDED a!! EPARATE SHEET ` �O•-� (date) ( ignat re PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. 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 urfac roundwater. )ate of Issue: . -� 19 i )ate of Expiration 19 -,==, v Permit Issuing Official 'ermit is Non - Transferrable White copy: HD File Pink copy: Owner �/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller FUT.,-M COUNTY DEPARTMENT OF DIVISION OF ENVIRONMENTAL HEALTH SERVICES te. Re: Property 'of C-, Loc.a'ted at 6JA )�,v c. 4/ 4-25- W_ Section 73.16 Block Lot 7-7 Subdivision Of Subd v. Lot # Filed Map A 1 Date- Gentlemen: This letter is to authorize Z051 TC a duly licensed professional engineer or registered architect (Indicate) to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules -egulations as promulagated by the Commissioner of the Putnam County or r ]Department of H6alth, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction Of said _sy.4:tpM. or, systems .in conformity with the, ,pr.ovisi,on s of Arti:cle • 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly your Signed Countersigned r, erty V37; Address :y N5 17r- f ticylA, i r77Z_ r , c- reey, lv-j V76 q Addres,9,,.,-_:_.. Toi,-n lkrf -6- 64k,17cz.. Z-C 1 `1 "YO 'Y 7C o Telephone '/'--'Z C"C) Telephone COUNTY DEPARMNI OF HEALTH Division of Environmental Realth Services r AFFIDAVIT - CORPORATE OWNER APPLICATION T0 "` , N. n. ...... .?.. u . PUTNM COUNTY HEALTH DEPARTMENT •0 T'0: Commissioner of Health In the matter of application for; L l to cA K Peilmo Pm � ; I Dor0 AL -D Inc- cct <'rL ` a represent that I am an officer or employee of the corporation and am authorized to act for Li"7c_'tK DeyECoPry (Name of Corporation) having offices at: -e-81 Ll13e-F_TY Lr rr-�c r`ex--iz y 'rl5 ! "7 K, Y 3 whose. officers are: President: poNftc.a %L)AtcKCL.I Z� UL3e-P-77/ 5� v7r`Lr- FE7Z!4Z ,)A(y /76Y3 and Address Vice-President: (Name and Address) Secretary: (Name and Address). :.�. __ .. • w Treasurer: (Name and, Address) and fiat I am and will be individually responsible for any and all.acts of the corporation with respect to the approval requested and all subse ent acts sting thereto. S:orn to before me this day of Rotaiv Public J ARLENE FAUSTINi x PUBLIC OF NEW ,1EFtSEY MY Comfrnssion Expires June 24.1.9% � F •s= Signed: Title: 0 Corporate 'Seal PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .- `rj .. �. �.. +;�.T.�i,�~..� .a +ISeN:�.:..►;,.w,nm:. -i..r ..w.�DQ �C Y -,�� 11 't �,rr� �"- i i Re: Property of L'v)CG.y, Located at /0.44 la.p- VP- (T) �ctir ,� �a l e -/ Section ~73. Subdivision of Subdv. Lot # a Filed Gentlemen: �,n y,n P � �- C o ��-. L • . 1 Block ) Lot—), rl ivisi 0 V Map # a, 433 14- Date This letter is to authorize Insite Engineering & Surmey;ng, P. c a duly licensed professional engineer x cX�trX�i (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 regula,tions 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 ^ _sy.s.tem.; or systems' `in conformity with the provi�sioiis'^of "Article 1 45 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, , Signed Countersigned: off' r erty Jeffrey J. i<�i ll �•i P.E. 1 I x, #i 61931 C� dd Address Insite Engineering & Surveying, P.C. I, Address Route 22, Brewster., NY 10509 278 -4990 Telephone Town Telepho e. ra t- v3oo " Y i! ?kiC:f .Y 3� 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: Troposed SSDS: Lincar Lot #21 Wayne Drive (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." Curriit- engineers authodzation 16tter is to be submitted. 2. All existing and proposed wells are to be labeled accordingly. 3. Erosion control measurtes for the house and the well is to be shown on the plan along with a note stating all erosion control measures are to be installed prior to the start of any construction. 4. Details for all erosion control measures are to be shown on the plan. 5. One trench plan is to be submitted. Upon receipt of a submission, revised to reflect the above, this application will be considered further . Very truly yours, R16ml /&- Robert Morris, P. E. Public Health Engineer RMIjp APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET for CONSTRUCTION PERMIT, STREET LO F A N BY DATE TAX MO 5V g — 2_ � OCUMENTS. FmESIGN � DISCHARGE (OK) C-1 APPLICATION PERC & DEEP HOLES LOCATED -1 REPRESENTATIVE OF PRIMARY AND EXPANSION ELL PERMIT; PWS LETTER EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE NGINEERS AUTHORIZATION IF PUMPED PIT & D BOX SHOWN & DETAILED DATA SHEET(DDS) HOUSE - NO. OF BEDROOMS EEP HOLE LOG WELLS & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM CONSISTENT PERC RESULTS (3) PROPERTY METES &BOUNDS PERC HOLE DEPTH HOUSE SETBACK NECESSARY (TIGHT LOT) CORPORATE RESOLUTION HOUSE SEWER - 1 /4"/FT. 4 "0; TYPE PIPE PLANS THREE SETS m NO BENDS; MAX. BENDS 45 W /CLEANOUT HOUSE PLANS - TWO SETS FILL SYSTEMS VARIANCE REQUEST CLAYBARRIE GENERAL R 10 FT HORIZONTAL: SLOPE 3:1 TO GRADE LEGAL SUBDIVISION FILL SPECS UBDIVISION APPROVAL CH KED DEPTH GAUGES PERC RATE I F REQUIRED 7�� FILL PROFILE & DIMENSIONS VOLUME CURTAIN DRAW REQUIRED EDSTANDPIPES TRENCH - APPROVAL SSDS ADJ. LOTS LF TRENCH PROVIDED LAND (TOWN/DEC PERMIT R & D) 60 FT MAX ATA ON DDS PLANS & PERMIT SAME PARALLEL TO CONTOURS PRE -1969 - NEIGHBOR NOTIFIFICATION ®100% EXPANSION PROVIDED LETTER BI/ZBA SEPARATION DISTANCES SPECIFIED ON PLAN 100 YR. FLOOD ELEVATION FIELDS K • UIRED DETAILS..ON- •PLANS ...... : _ . __......:<.... >. =, .... 40' -TO P :I::,- DRI�E��A�','LARGE'`TREES, "TOP OF FILL`- -' SE�VA�1r S'YSTE11%I PLAN - (NORTH ARROW) 20' TO FOUNDATION WALLS 213 SSDS HYDRAULIC PROFILE m GRAVITY FLOW 100 TO WELL, 200' IN D.L.O.D., 150' PITS ID/ J BOX M TRENCH/GALLEY m P- PIT DETAILS 100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) SEPTIC TANK - SIZE, DETAIL 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER WELL DETAIL, SERVICE LINE IF OVER 10' TO WATER LINE (PITS -20') CONSTRUCTION NOTES (GRINDER RATE) 50' INTERMITTENT DRAINAGE COURSE DESIGN DATA: PERC AND DEEP RESULTS m 200 FT. RESERVOIR, ETCH 150 FT. GALLEY SYSTEMS TWO-FOOT CONTOURS EXISTING & PROPOSED SEPTIC TANKS D'.DRIVEWAY & SLOPES CUT 10' FROM FOUNDATION; 50' TO WELL D FOOTING /GUTTER/CURTAIN DRAINS 1p WELLS OMMENTS: m 15' WELL TO P.L. IN SITE SI T SURVEYIN�NG&� ;i r849, Rtnete 6 (914)22 i-62oo C4mid, New York IOgra Fax (914) 225.6438 7 Delavergne Avettue Wiz. Wa itigersFallrp,�NewYerrk' 1340 _'_':_:(Q'4)-2Q -1741— ._ I TO n-Imm bvEu DeFr, or t� r,TFI i DATE DATE ,AT,TENTIO - jay+ /+,¢�•y=�_.yt.. _ - -_ �_,_ RE: t�_t �JC.4 -g: � �v •t�i� 1 V t Si ©s'V CST 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 PC- 1 vir OF Coz&ej (� H uir eeC . 3 (44 RLZ_ _f_�.6 ( a¢ 3300 .ad . 3 (v °/ � 5T-F& C'Tz C ,i ,Cvc�� THESE ARE TRANSMITTED, as... checked .below:.. . . 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 TO SIGNED: It enclosures are not as noted, kindly notify us at once. PUTNAM. COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property of A)r-A rk D v c 4,ro r r" c w cJ C— Located at 6JA Yrvc,- Dz- I vie- (T) PU'rA;A,,l VAUACY Section 7-3,iE; Block Lot Subdivision of L—iJAR v 5. 1 r1/1) Subdv. Lot # Filed Map # A Date 5 Gentlemen: This let . ter is to authorize �05►TC fic, a duly licensed professional engineer or registered architect (Indicate _ to apply for a Construction Permit fora 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 system or systems in -o_:t�A3AiCTer,Vf5-,6 r __cqnformity . wl-t-h- the, 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly your Signed, Countersigned: (::P:.—jE An-9. # Address Jf," "t 0? -1-, Z, C11 C) Telephone j�,er.71Dr F prerty ,a :5 M CE•r Address e; r77- 67 /z/-j ( -76 q Town ZVI Telephone 1PUTNAM COUNTY DEPARTMENT OF REALTH Division of invironmental Health Services AFFIDAVIT - CORPORATE OWNER APPLICATION _ •,ter•: �,:....��. `tOR' PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT •^ T0: Commissioner of Health In the matter of application for: ' L l'o" YGV6L0 PM eWT' 6-, =/v c- . (0.J G,+t? = Sv az+ d. Co-r- Z. IIa �OrV.gt -D �c.l,Ct�e`L . $epresent that Y tam an officer or employee mf the corporation and am- authorized to act for D'svSC -0-P117 (Name of Corporation Lo,, �n=�. having offices at Z-01 y 's-7— LrT7-Cc-' ���y, �� 17(�4/ 3 16,hose officers are: � Pre sident° 90/0Ac.a / nn vadCKC4_.� Z$ CaC3e7C.7 -y 3�'r, u'Pr-c c FE'Z:tZyI/(T /76y,3 and Address Vice- President: (Name and Address) Secretary: _ .. _... .(;lame 4.pd_Addxes) Treasurer: (Name and Address) and that y am and will be individually responsible for any and al corporation with -respect To the approval requested and all subs these =o° Sworn to before we this day of 19 9V �(otaiv Public Aj31 :,N F FAUST1N1 y Commissuon�Exp es Suns 24 SEA Y - F •s= Signed: Title: ,acts of the ent acts4iilating Z' I° PUMAM COUNTY DEPAnIlKENr OF HEALTH DIVISION OF amnam uAL HEALTH SEfmas DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL . SYSTEM FILE N0... owner A/ /-/3 EyF Located at (Street) �� n1E iJE` Sec. 73. /£, Block / • Lott -7 (indicate nearest cross street) Municipality PUT7UA -m V,4 c_t.E y Watershed Hub soN R�LLsJ2 SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking N LA Date of Percolation Test N HOLE NUMBER CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /in Drop Inches Inches Inches 1 3 E?li m Fi C-6-D Zy,3 3 4 5 3 4 5 1 - 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained.at each percolation test hole. All data to' be submitted for review. 2. Depth measurements to be made from top of hole. DEPTH 1° 2° 3° 4° 5° TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPILTCATION DESSCRIPTION OF SOILS ENCOUNTT;M IN TEST HOLES HOLE NO. 1 HOLE NO. D Z BOLE NO. L-0 A-nq m ROCK VA i21t3 FXOM i11S111.=1ti_ 81 ROCK C. 7 9° 10° 11° 12° 13° 14° INDICATE - izv E 4 A7; -_wq (:H ..GROUNDV,TAM - IS . ENCOUNTERED .._. ..... .. ,Q K - - - INDICATE IMM TO WHICH WATER'LEVEL RISES AFTER ]BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided 6'odc) S, , No. of Bedroans' -/ Septic Tank Capacity / S� gals. Type CZ5' _ Absorption Area Provided By ��' L.F. x 24" width trench. Other Name srwscr Eac- ,v, , svirvtyla&: pC, Signature Address 7 tyv7r ZZ SEAL /05 �9 /s',. n< - 4 THIS SPACE FOR USE BY HEALTH DEPARZMENT ONLY: Soil Rate Approved sq.ft /gal. checked by Date DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT WE LL .LOCATION Street Address To Village City Tax Grid Number WELL OWNER Name Mailing Address *},(Private WC Zi1 1-4ffj2 5T /761/3 Public SE OF WELL primary - secondary �SSDENTIAL 0 BUSINESS O INDUSTRIAL _0 ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify O INSTITUTIONAL O STAND -BY Q AMOUNT OF USE r YIELD SOUGHT S— gpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE_22!2jal EI REPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION 13•ADDITIONAL SUPPLY &NEW SUPPLY NEW DWELLING) O DEEPEN EXISTING WELL REASON FOR . DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN DDUG .❑ GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES bZ_ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: c_/oo c ftir, Lot No. -z'� WATER WELL CONTRACTOR: Name &,Vijn�V6r-) Address: u ^)ikl0 at.J.J IS PUBLIC WATER SUPPLY, AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER ,SUPPLY: ��✓/r,�{ TOWN /VIL /CITY ;DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: _._�- LOCATION`SKETCH -& SOURCES OF CONTAMINATION PROVIDED"`' PARATE 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 thirt7 (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 drillin operations be contained on this property and in suc a manner as not to degrade or other i contami a surface or groundwater. ;Date of Issue: 19 4- Date of Expiration 19, Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner j3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller Go%e- k � ----------------- HOLAS 77 do r. 4-7 4 '7 -P4- 0 1 rA 0 0, 6.1 N 6F R L t1L)0A-,oq 77r- Gam✓ fr 'L J PiJTNAM COUNTY DEPARTMENT OF' HEALTH -, i,. _..Y.:� - _. �- " -.. .'-o; .:.b i.• •- .r +� u l•C 1n ;n. '_ : -.,:.' n. ,. . .. .. :. .'..:' APPLICATION FOR APPROVAL OF PLANS FOR WASTEWATER fir. DI. SPOSAL SYSTEM I.,, Name and Address of Applicant: L'ac-Ajq X7,11V . Z 8 f 4 aEZsy ST . 2. Name of Project: SS0S fox 604Az Pevftor�,aor- Cm "mac. 3. . Location !/V /C: PorW.AK VALAey 4. Project Engineer: Siv.�r� E�v�.y�oen✓� �av w_T f�c,5. Address: 9oa7r ZZ. License Number: 01131 Phone: ` lq-Z-7& 440 . 6 Type of Pro ect: X_ Private /Res'idential Food.Service Commercial Apartments ' Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 7. Is this project. subject to State Environmental Quality Review (SEQR) ?. Type Status (Check One) .Type I.. Exempt . Type II. Unlisted 8'. Is a Draft Environmental Impact Statement (DEIS) required? ...:......... NO 9'. Has DEIS been completed and found acceptable by Lead Agency? XJ A 10'. Name of Lead Agency NIA under - the° contro -5:.;- 6f:;l�kat7pjlannirig, - zori'ngj _ as� °6' -:® . or other officials, ordinances? ........................fox a •Fe,n,r _ 12. If so, have plans ;been submitted to such authorities? .................. No 13. Has preliminary approval been granted by such authorities? Date Granted: ` 14. Type of Sewage Disposal System Discharge...... Surface Water X Ground Waters 15. If surface water discharge, what is the stream class designation ?........ N A 16. Waters index number (surface) ........... :.............................. VIA . Is project located near a public water supply system? .................. 0 ',,`18. of /V 1A N�A If yes, name water supply Distance to water supply :1.9. '.20. Is project site near a public sewage collection or disposal system ?..... Name of sewage system N �a Distance to'sewage system N�A 21. Date observed: UNK00104 23. Name of Health Inspector: 14^4,04 A) 24. Project design flow (gallons per day) ...... .............................. 2. 25. Is .S -tate Pollutant Discharge Elimination System (SPDES) Permit required ?.. NO 26. Has SPDES Application been submitted to local DEC Office? ... ........eoeo. /0 /A 27. Is any portion of this project located within a designated Town or State wetland? ............ a0000e.o. o 0 0 0 0 0 o e o e o 0 0. 0 0 0 0 0 0. o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0. o e o, o 28. Wetland ID Number ....ae.......o...e... ... .......o.a000000000e00000..... 101A 29. Is Wetland Permit required? .............. ............................... NO Has application been made to Town or Local DEC Office? .................. N1A 30. Does project require a DEC Stream Disturbance Permit? ........... o....... SIP 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 Iye 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 _ NO DESCRIBE:, 33. Is there a local master plan or file with the Town or pillage? ........... b'ES 34. Are community water, sewer facilities planned to be developed within 15 years? A10 35e -'Are. -any -: sewage, d i sposal. areas-in- excess of 15X..slope? .. .. a rcw ... �... y..., .... a,+. � c u v . n .. w .. .. ....r ,. ... � �..... +. .. 0... r+o.• - . Ks... i•• w+o..f� v-. t. r "4'.. s •. w.. .. .-... 36. Tax flap ID Number ............ ................... .......................�3.��-�- 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. % 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 Pena 1 taw. SIGNATURES a OFFICIAL TITLES: MAILING ADDRESS: Kook Zz measrE-Z /(!/. �msoI AAR �t rESTCHESTERl FIODULARKOIiIES, INN. job Second Floor 27'8" X 48' o 2656 Sq. Ft 48' I 48' 27'8" STANDARD SCARSDALE H FEATURES • 4- Spacious Bedrooms o Framingham Pediment on Front Door • 2%2 Baths o Fireplace Options Available ° • Open Two -Story Entry Foyer o "Boxed-out" and "Angle Bay" Options • Formal Dining Room Available • Formal Living Room o Consult an Authorized Westchester Builder • Spacious Country Kitchen with Breakfast for a Complete List of Options Room and Pantry o Artist's renderings and Floor Plan Dimensions are • "Cottage-;Style" 3056 Lower Level Windows approximate. All specifications must be Written in the Contract No oral conditions. with Architraves on Front ESTCHESTER MODULAR OMES, M. P.O. Box 900 o Dover Plains, W 12522 19l4)832-9400.(800)P3?-?PPP UTNAM, COUNTY DEPARTMENT 0F HEALTH S�WC 10N;oV; -,'',NTAL HEAL DMS N bh G X, .0 .NTA :HE UB RY WA A -T ME 0 er VM Address. 7 Czorry=� 19A7--1 It Ay Located at (Street) v— Tax Map '773 1 Block' t Lot ..(indicate nearestbross. street) Municipality Drainage Basin M v P 5e,-" M I d SOIL PERCOLATION TEST DATA Z r—(LJ- . 7 A . > ,ES Date of Pre-soaking q Date of Percolation Test 7-Z —98 Hole No. Run No. Time Start - Stop 'Elapse Time jMin.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 17, 7,7 2 et zo -s:9 1 3 .3' 4 5 3 �'.'07— 9.31 0, 4 5 2 .3 4 5' IN V I NX 1. 1 es.tS to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test h6le. (i.e. - I mirv1p 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of We. Form DD-97 2.0' 2.5' 3.0' 3.51 4.01 4.51 5.01 5.5' 6.01 6.5' 7.0' 7.51 8.01 8.51 9.51 10.01 Indicate leve at which groundwater is encountered Indicate I el at which mottling is observed Indica level to which water level rises after being encountered De hole observations made by: Design Professional Name: Jeffrey J. Contelmo, P.E. Address: - insite pnx jng, surveying & iandscape Architecture, P 154 -Roilte .22 Brewster, New York 10509 Signature: Design Professional's Seal Date OF NE1,v J. co A, J- 61 3 pROFESSVO�`�P�