Loading...
HomeMy WebLinkAbout3459DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.18 -1 -28 BOX 28 03459 OR k �_: •"A tev. .0/88 P✓ W-1 PUINAM COUMT DEPARnma OF MUM CST ZZ D#Vbkm dift*4genteod BOOM &"b.m C." N.Y. 103n % P"�� # OF COMMANCE r Tma air Vubp sdawhign swbKLat # 2-L Tax MAP moeb lot OWW/AppNoWlIsm LIKY Ren.9—CW_%M"_0' Daft offtevionis Approval-1:1- MmftgAddress-2251 -7 T zip own L-N Clc- Z Date Subdivision Arig-rMed !9°5"o -Fluq> Fee EnclosedU Amnivnt- Bwmbg �51fl 6,L--Lot Area -� 2.7 Fill Sftdm 4- Numbeir d Reim®. 4- -:�> 0* Depth Volu. I — Design Flow G P D OO(L - Mmdm Is Reqdred When FM Is completed 11"Waft Sewerage, systins to Comm of 2tL7,'--GWhu Sepille Tank oW dDO I•R 0 E I Q-6 LZ R)r n --ZQ�,)c 4 eS To be Consivietted by Add 0\3(1 water Std; p ress Up* Flints Address an Zo -Ydvab &q,* Mind by 7111t���i Ad*. I 1 NA Yr,,M n-V, M Other Ree-Wmaeon -N� Q1)4;Xf-Z&,Yz I represent 'that I am Wholly and completely response le for the design and location of the proposed system($) - 1) that the separate Sawa" di="I above described will be stem , of as shown on the approved amendment there to and In accordance with the standards, rules and regulations of the Putnam County ospartmeri f Health, and that an completion thereof a '-Certificate of Construction compliance" satisfactory to the Commission of H"Ithwill be submitted to the O"artment, and a written guarantee will be furnished theowner, his successors, heirs or assigns by the builder. that Id builder will Place in good OPOrating condition any port of said sewage disposal system during the per lod of two (2) yews Immediately following the date of the lau. On" Of the aPPmal of the Certificate of Construction Compliance of the original IY5t0m or any f"Wirs thereto. 2) that the drilled well desCrib•d above will be I0CM8d 45 SIWWX on the approved plan and that said well will be Installed In accordance. with the standards. rules and rsg-U%TrO—n$Of the Putnam County Departrhent of Health. Dal a LP Signed P, R.A. Addre rise No (11) 92A License V APPROVED FOR CONSTRUCTION: This approval expires two years from the diid issued unless construction of the bUildingAINS been undertaken and is "NOC811118 for Cause Of May be amended or modified when considered neCespry, by the Commissioner of Health. Any Change OF alteration of construction Muir•s a now Permit. Approved for disposal of domestic4aniisr sll�ndfiii Whists-watef-supply only. lute By Title' I L; *"W/Apploo pin. Lea h Tsuhbp 18 Raw-9-0 wefts A&W= Daft of P*110♦0 AnnW --------- u division Town 6-17r&E- o=V.Xe ZIP 211111111ft 2IF" e6T Fee EnCIOSed'm Number of Lot Area Z'?�;S—A, "Maw Flew 0 P D C-20 PCRD URV 0 - WTo bkOned y 44* ante onPal s oomgsgd PA& Sap* FWas Odw. S-I* Mad by T;;;;-4s*n 'that I son .. ........... 060" whollys"sicor"01 tGIY responsible tot the design a 4, Co"fityd"C"ibed will be constructed as shown On the a 0"4"w4nt be sommad of "asitt% and that o Pproved amendmehl location Of the pro t there PO"d COMPlistion.therwill 10 and in accordance that the separate aft• in good toptWhoetIO"I'lift"t. and a written a "Certilisate With saw arm of Condition any pert of guarantee Of Constructl' the standards. rules the approval of .10 enrage be furnished the on COmPliancr- 4 requ nso All 6 stein Of the Certificate a disposal syste Owner. his Succeawso heIrs satisfactory to the Commis" wxl be located as shown an the approved I Construction In during the Period of Of Health will .County Dens Complis or assigns by the but of oftith, Plan and that aid wall will nc* 01 the Original two (2) yowl immedi'l that said but Date be Installed in system OF any repairs thweto, 2) tot will Coorsterics with the Stangards. usasft the the date Of the IsM. a well d*jW -1'4eA* ceil -�r7 Signed rule a reqU $ Of the Putnam Claire I � -�r APPROVED FOR CONSTR CA civ "Vocable fcowr so or ay a to"'. This approval expires two Y r from P.E.-X R.A. MQUIres a Plirml A Od Or modified when Consid 0 date issued unless CO ru n o t License No /9.i Date !Of disposal Of domestic sans sary by the CommIssi nor building has been undertaken and IS 800. and/r / /.wed Of Health. An ate water Supply only. Change or 13V LAY- �/ 6 . 0, - alteration Of Construction .p BRUCE R. FOLEY Uc__Hea1th- Director "' ' -_ LORETTA l- QUNARI..R.N.`. M.S.N. -- -- �` ""�"�"" Director of Patient Services DEPARTMENT OF . HEALTH . 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 . WIC (914) 278 - 6678, Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 February 22, 2000 Jason & Doreen' Cohen 1 Briar Ridge Lane Putnam Valley, NY 10579 Re: Addition - Cohen - 11 Briar Ridge No Increase in Number of Bedrooms (T) Putnam Valley TM #73.18 -1 -28 Dear Mr. &Mrs. Cohen: 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 of February 21, 2000. Based on the information submitted, the above mentioned addition is approved with the following conditions: 1. The total number of bedrooms must remain at four without prior approval by this Department. 2. The area. c..the._existing sewage. disposal. system, and .its. .,expansion- :area, ` must. -bo : « � .. • .. _.. P . r cr r. .......- �., ...�w.cna• -+a+- -..-.. «. «.� .-� ... . P -.- n w.. w,- .. ten.. -. ,+'r _ r r~�-+• S �1 ter•. - w..-. .. -..... 'm"aintained— `° ' 3. All plumbing fixtures must be updated with water saving devices, i.e., new low I. 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 your, William Hedges WH:jp Sr. Public Health Sanitarian cc: BI (T) Putnam Valley BRUCE R. FOLEY. R.S. Acting Public Health Director DEPARTMENT OF HEALTH Division Of Environinental Health Services 4 Geneva' Road, Brewster, New York 10509 (914) 278-6130 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Gentlemen: Re: Residence Tax Map � j �r / �� � ToNrm According to records maintained by the Town, the above noted dwelling IS IS NOT 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 /f SK . 5> Building Inspector i .f...•I+�a' -� Y.Y. •'�'.+]...�.i:�a�`.vs Rf.".� "Jry�4�... DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278 - 6130 Fax (914) -278 - 7921 BRUCE R. FOLEY �y- t�'�.y4FY �rfilie,E;ri�Fenhh':;�}e�Yor PROPOSED ADDITION APPLICATION (RESIDFNTIAL ONLI� STREET L"C TOWN jI TX MAP # —7 .I 9 4.21? NAME PHONE °1OPCHD #d --�3-oo ,,00. MAILING ADDRESS Orl&t 9 P °I DESCRIPTION OF ADDITION 6'n 56e 194jeeen+ �r �t�r i ®✓1 NUMBER 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 Putnam County Sanitary Code. _Please submit this•farm-and :the.,foli9v!t,rlg 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 Feb 98 I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES. __• ! ''w . :� :.'-, �- ._.' -- -.`•. r-^ �,r �::.+',roH. -'�fs� ::..e- .,. -.� :.. ...,... �,�t ,,.w �'...r :NCB.._ °.. .'... ', .','_'oa- . CERTIFICATE ' �F CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # PP- �CSeR RaE LANG Located at o . Mrzu _Y WAYetF_ Viz,ve ) (To::iRk^ r Village Mr t4kM \/a,t,t.,r,Y Owner /Applicant Name 37ez:rr w Pam QD e_c4zP Tax Map -7 t 1 R Block l Lot Z�_ Formerly Subdivision Name L I NC_ , R 2, Subd'. Lot # 2 2 Mailing Address -3 7 Caw g -12 � bSS t N I w N y Zip (0-562 Date Construction Permit Issued by PCHD ! 1- - c� a Separate Sewerage System built by 37 ctzo-row vAox RD omgP Address 4AE Consisting of i 25C3 Gallon Septic Tank and S2e L/1 '2' w t t7g •T-zE N cdCyS Other Requirements: `t'oo-.t c Y cs-r4gp F4LL 4- cz a.y a&Mz (9M Water Supply: Public Supply From Address u Pei -7- 4l ►" dK A t or: Private Supply Drilled by i3 hg- ¢. S,.,A1 � Address i3;Zr�wSZ�� t N y t ash Building Type Has erosion control been Geed? ,....: - Number of Bedrooms 4 *fiy�,t bgc,ta 11 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: 2- Address P.E. K R.A. t*,rEcrvdZX:,�C 'tuBS r2tr'72 �3FZswst�Ny�rac�vel Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the convection 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 revoc ion, modific �x at' n or change is necessary. � �-�Z- By: Title: _ Date: White copy - HD ile; w copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 L_ r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COM[PL]ETION REPORT Wel)( ]Map -7330 Block 1 Lot(s) 2G Well Owner: Name: Address: V.S. Cor ration, 37 Croton Dam Road, Ossinin , NY 10562 1<Jse of Well: - rinnaag 2- secondz ry 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 3_ft. Length below grade 42 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 'West _ Bailed X Pumped x Compressed Air Hours 6 Yield 5 gpm Depth Degs Measure from land surface- static (specify ft) 70' During yield test(ft) Depth of completed well in feet 540' 605' Well Log If more detailed information descriptions or Isieve analyses -...: please attach. IIDe tln IFrona Surface Water Bearing Well Diameter(in) ]Formation Description ft., A. Land Surface 5 Drilli in ove burden clay and boulders 5 Hit rocc at 5' Drilli in roc' -sits 605 Drillin in roc granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type su Capacity SgM Depth 560, Model 5GS1o412 Voltage 230 HP 1 Tank TypeM02 Volume 8 Date -w-ell Completed 12/22/98 Putnam County Certification No. 002 Date of Report 2/3/99 Well D ' ) al NOTE: Exact location of well with distances to at least two permanent landmarks to be prov' ed on a separate sheet/plan. Putnam Avenue Well Driller's Name Address: Brewster, NY 10509 V lbllKiMl V. ✓M.v ..r, �, r Perry al White copy: HD tle; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 NORTHEAST LABORATORY OF DANBURY CT Cert. PH-0404 ar 39-3 MILL," PAD 203) 748-7903 - FAX (203) 748-0652 LABORATORY REPORT -- WATER SUPPLY TESTING .REPORT TO: BEAL & SONS DATE SAMPLE COLLECTED: 1/27/99 4--PUTNAM AVENUE T11\4E COLLECTED: NOT STATED za`BREWSTER, N.Y. 10509 COLLECTED BY: NOT STATED DATE RECEIVED @ LAB: 1/29/99 TESTED BY: LAJ3# 11471 & 11301 REPORT DATE: 2/9/99 !�"!,SAMPLE SITE: V.S. CONSTRUCTION, LOT #22 WOODLAND EST., PUTNAM VALLEY, N.Y. LING POINT: HOSE BIB I mg/L as N STANDARDS FOR POTABLE. WATER) 11301- Nitrate N 0.33 UkCE: WELL -NEW ATMENT• NONE mg/L no designated limits Hardness - ------ -xl"e Qnated4iwnits-'' ST=PERFORMED RESULT: MAXIMUM CONTAMINANT LEVEL 0.30 mg/L Manganese <0.01 mg/L 0.30 mg/L 'Total Coliform (Bacteria)' 0 per 100 ml 0 per 100 ml ' d"PAYSICALS: [Note: Combined Limit for Iron plus Color 0 rr Odor ND Sodium 2.3 pH 7.49 no designated limit Turbidity 0.51 NTUs 5 NTUs wnerrDv- mg/L 0.015*** ESULTS BASED ON SAMPLES SUBMITTED: 1/27/99 MPLE, AS TESTED ABOVE: Nitrite N <0.005 mg/L as N I mg/L as N STANDARDS FOR POTABLE. WATER) 11301- Nitrate N 0.33 mgfL as N 10 mg/L as N Alkalinity 232.0 mg/L no designated limits Hardness - ------ -xl"e Qnated4iwnits-'' Iron <0.03 mg/L 0.30 mg/L Manganese <0.01 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium 2.3 mg/L 20 mg/L** Lead <0.001 mg/L 0.015*** ifil milliliter mg/L = milligrams per Liter ND = none detected NTU=Units 1*Notification Level ***Action Level ESULTS BASED ON SAMPLES SUBMITTED: 1/27/99 MPLE, AS TESTED ABOVE: OTABLE o r OT POTABLE D �.-(PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE. WATER) Laboratory Director [% iNORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828-9787 - FAX (860)829-1050 TOLL FREE WITHIN CT: 800-826-0105 •OUTSIDE CT: 800-654-1230 1 i PIJTNAM COUNTY DEPA.RTM1ENT OF HEALTH DIVISION OF ENVIRONMENTAIL HEALTH SERVICES _ .` '.. :'e`�'�.e%Y "..y .;,q 'v-iv: t'"•.. c,:E.�r sir -""�'• ��r�r' "'.'` -. = ..� �::.". -�`,�; v -,C n: i; c�- �- a.s��ay. Yi= �.•• -,._ ••-- _`'- _ry_"•c cT ^�.�`�••�. :t �-?- ..,,:.dLy. GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 37 cPoro,ter 'D.asa,- Rc�,jt.p Coma. 73.18 1. 28 Owner or Purchaser of Building Tax Map Block Lot 3 7 c R o ro tv `Daa nn Z o.�t� CCU �, PL T- v N I'vi V. L L 4 y Building Constructed by Town/Village 13 IA'R 92 10GF LANE &Z rC?M&d- 6/AY1VE Vii 4/JE L I Nc.4 R ar Location - Street Subdivision Name Lsr��rvr►,�z 27- Building Type 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 fora 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. The undersigned further agrees to accept as conclusive the determi atio � ; of .the P li Health Director of the gutnalCounty Department of Health as to whether or iot t, e failure Ale e system �; r�, � � to operate as causedR e willful or negligent act of the occupani of tl fie, bu tding ;utilizing the syst Da n Day Year $' Signature: Al i .�, Title: c ► c� s nir - Gene TCorkri or (Omer) - Signature Corporation Name (if corporation) Address: 3 7 A_ r.n 2 c:$,N_0 Corporation Name (if corporation) Address: State OS S , N !:N 6 . y Zip 10,5 - 2 State Zip Form GS -97 n , PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES : w F,lk•n ;..<- ,,. «w'.r.''1:ac. s':'i+ Z.1 Ill7l:l N E WAS; I Ar IEIT S S1 V' ' OP PERMIT # Located at 624*Z- r._1 P66_ �r Village _ il IN411 LE Subdivision name Subd. Lot # 21 Tax Map 73, J& Block _ I Lot �2& Date Subdivision Approved q-s=81 Renewal Revision Owner /Applicant Name 37 C ojbN 6A01 AoA0 CoW, Date of Previous Approval 8 -7- Vb Mailing Address 37 CA0rON &in "04 j ©SSIAJjNG A . Zip 10S-62 Amount of Fee Enclosed Building Type PPS I dFAIrIA IL Lot Area "433S& No. of Bedrooms Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED .. Separate Sewerage System to consist of 12YO gallon septic tank and .�0 ®G. � �' �✓iDE �So�2OTionl ?QEN u� � S Other Requirements: 900 C. Y ^ dfdE F/LL e CLAY Mk1?jF_& To be constructed by 37 CQoli d PAM Aaz Q CON. Address '5Ap1e. Water Sunnly: Public Supply From Address �_.._.___�".'` - Private Supply.I3riiledby.: UNO W -- _. - - Address.,:_(:+%dy _ 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: Address t' Date /0-3o 9$ License # �J93i APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new ermit. Approved for discharge of domestic sanitary sewage only. f� �P By: �`'`� �'` /"_ . Title: )&'A � Date: White copy - HD Fil ; Yell w py - Building Inspector; Pink copy - ner; Qnge copy - Design Professional Form CP -97 11111111FU IN Iill MIN BMIMMArM1111 Ill I ll '' I 9,41111UNVAIII[ra 0 1911111MIAMA11111111 Is a ..k, I. I Ulm] III) I % , F \� `�� X19 I �� 11 `oN. °PY " `� "'milli `Y/ 1 VT\. I r. N D 1PIEIMIIT # p N e; Located at �A`'f eJ6 D P j6PE5 6)wn or Tillage Subdivision name L-1 iJ4-4 P� Subd. Lot # `:Z-- Tax Map *7 3, le, Block I Lot Date Subdivision Approved 1— 6-0 7 Renewal Revision _X Owner /Applicant Name 37. C-go-M . iU rCo"- Date of Previous Approval 4 -31—? 1- Mailing Address `57 PAA, X0, Ivy Zip 1.06'4 L. Amount of Fee Enclosed �A Building Type fg5+oW111r?A1C Lot Area °'I �`lllo. of Bedrooms + Design Flow GPI i IFUR Section ODD _ Depth :' VdRume PCHD NOTIFICATION IS REQUIRED WHEN 1FIIILIL IS COMPLETED Seman° age Sewers= Eystem to consist of / Z. 5-0 gallon septic tank and Ob- A0 !;0irz-TW Other Requirement®® To be constructed by , 37 t-ff-2. Address -i5 lfry water Senn Public Supply From., Address on°r Private Supply grilled_ by �2 �:��?a�✓,a � :.Address ..._. Q —ry I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the seioarate 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: Address P.E. ° Date License # 6 ( 9 3 f APPROVED IFOR. CONSTRUCfiori: This appr a( expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. Approved for chcharge of domestic --sanitary sewage only. By: } T� Title: Date: Zf— � —%C White copy - HD File; X low �TPA B uilding Inspector; Pink copy - O er; Or copy - Design Professional Form CP -97 R PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please. point ortype- > _ PCHD - Permit -# :,. Well Location: Street Address: o illage Tax Grid # l �NEPX+Va- MapVs t$ Block I Lot(s) Z WeU Owner: Name: 37 cxo7w l pmt-7 Address: iQ-D • Cdr �� �7 G/'�.�oTT�iJ p,4� J� jj v yf t.-✓� .�j N � o � Use o Well: Residential Public Supply Air /Cond/Heat Pump Irrigation pri Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5'-- gpm # People Served 4 Est. of Daily Usage ffCQ gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No X_ Is well located in a realty subdivision? ...................................... ............................... Yes X No Name of subdivision LWCA?t '2> Lot No. -Z--L- Water Well Contractor: Address: Is Public Water Supply available to site? .............. Ye No Name of Public Water Supply: yy 1A Town/Village Distance to property from nearest water main: 4- Proposed well location & sources of contamination to te provided on separate sheet/plan. Date: Applicant Signature: PERMIT TO CONSTR A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam j County. Date of Issue k-7 Permit Issuing Official: A v" /alt — I Date of Expiration — 00 Title: Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller i Form WP -97 ENGINEERING,-, SURVEYING & 1, LANDSCAPEARCHITECTURE, P.C. LETTER ®F TRANSMI'T'TAL Brewster, New York 16569 (914) 278 -6392 a. A�•� -,. _:;,..;:��:. ���� � .:� �.� :tea: ... � r �:�:K, 7 DeLavergne Avenue (914) 297 -1742 Wappingers Falls, New York 12590 TO: �� C, H. Date: Z-I , DESCRIPTION Job No. q 11¢7, '5Z-Z-- Attn: Ap kvA 5v co El-! dq Re: L/ .,jc,6f GaT ZZ� Z- 3 -°%� � w�`i'j WE ARE SENDING YOU 4 Attached ❑ Under separate cover via ❑ Shop Drawings ❑ Copy of Letter ❑ Prints ❑ Change Order ❑ Plans El ❑ Samples the following items: ❑ Specifications COPIES DATE € NO. DESCRIPTION A15-1 A5 �- is u, -T- PICAwI N _ `GC -97 Gv�sTrzuc�Jo,� cor�l�u�,, 3 Z- 3 -°%� � w�`i'j G./�'Zc_ Cdr /GEY7c•✓ t - % -n Z/,0 9of .00 FCC THESE ARE TRANSMITTED as checked below: [� For approval ❑ Approved as submitted ❑ Resubmit copies.for approval ^�Q For your use �❑ Approved as noted/ ❑ Submit - copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return ❑ For review and comment ❑ REMARKS: COPY TO: SIGNED: J°"'°`� IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE LotWdot corrected prints /NS/ TE ENGINEERING, SURVEYING& LANDSCAPEARCHII-ECTURE, P.C. LETTER OF TRANSMITTAL Route t22 (914) 278-4990 7 Del-avergne Avenue (914) 297-1742 Wappingers Falls, New York 12590 TO: Date: /O -.7046 1 Job No. 1 f7, Attn: Ai9� ter, F-9>kFU^)q Re: 1,fvr,+ve_ T WE ARE SENDING YOU El"Attached ❑ Under separate cover via I--, ❑ Shop Drawings Prints; ❑ Plans ❑ Copy of Letter ❑ Change Order ❑ ❑ Samples the following items: ❑ Specifications COPIES = DATE NO. e DESCRIPTION /'V IF'S I PP-17 1) 03 C,,J 1) '5 T ------- ------- ........................ . ..... . .. ............... . .... .... ............................. - .......................... ................ . ............ . ................. .. .. .. . .................................. . ........ ................ ..... ............................................... . ........................ . .................... ............... ................... ................. ........... . ..... ....................... ........... ............................................................ .................................................... - ........... .......................... ............... ..................... ............................ THESE ARE TRANSMITTED as chocked below: or approval ❑ Approved as submitted ❑ Resubmit copies for I' ....... .... j a Vl3r-&V6d- i n8led� copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected:pdnts ❑ For review and comment ❑ I REMARKS: COPY TO: Lot98.dot SIGNED: (A M &,.;, IF ENCLOSURES ARE NOTAS NOTED, KINDLY NOTIFY US AT ONCE �E I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEAL .c :: ;��'S".s.`�i?4r'wvm, �..�wxarw'r9:rr. ,Q. a. se' + a9?'z .... Y •r,a. .. A o LETTER OF AUTHORIZATI ®N RE: Property of ? 0t&14 A-0 D Cry e P, Located at G✓, �J�' ��,� -r IOWA 61+(,c Tax Map # 73, 6 Block C Lot Z-e Subdivision of Subdivision Lot # 22, Filed Map # Z4-3.5h- Date Filed Gentlemen: This letter is to authorize insite Engineering, surveying & rands Architecture, P.C. (Jeffrey J. Contelm, P.E.; a duly licensed Professional Engineer x oix�=d)offehi=xxxxxto apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater ti in conformity with the provisions of Article 145.4p�//or..141 of. Law, .and th. _.R tna �irity'S-i t i �C A— Very truly; Countersigned: Signed: P.E.,1K ,k., # 5 1 (own r of Pi Mailing Address Insite Engineering, surveying Mailing Address: & landscape Architecture, P.C. id/or water supply,sy_.stprus ibrLti thP"Cibl'ic Health 37 Czeroi✓ D1f," Route 22� ",-_-der -New Merle 19595 State New York Zip 10509 State N 47 Zip f 6,5z,; Z_ Telephone: ( 914) 278 -4990 Telephone: 1/4- - ?3c? " 7 3 C, Form LA -97 i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 1. �a .. .• .. .�... ... .;KY.�r_T �a-%•rst l•:)r ^..+.:,, .. , .' ..: ....y�L.i�Tt^u'�.r.J.f r1.1),I'i :J�'}.��.ie3: ",a,�; -y %^ ....,., �- `m=.a�r- •;.+•. eir ..e..`v...�rr,.••,.,,,•v+..�� �/'o AFFIDAVIT r.,. - "CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: t^3 rA K v r_5 b I V I 5.t v ri represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: �l� �, Ce- �sr- rz,,Gc� C —Po -57 c�&7e,,� bij,., Yin cLo , r NC, Having offices at: j 7r Whose Officers Are: President - Name: V -kt, S,4r,v-r•"0CGr Address: j? Giza r&�J uAv-1 rL� rre, o -5-5 iv.• Y , Vice President - Name: Address: Secretary -Name: Address: i .F ` - H.�• � R . ... u.. -.-. '• -• YT. - �r,K•ic- •M.••�..w..�w.nr +�'..,�•.w-r fir• Treasurer Name: Address: and that I am and will be individually responsible for any and to the approval requested and all subsequent acts relating thf Signed;, Title: i Sworn to before me this l day of (month) (.year) No ary Pub i LAWRENCE KALKSTEIN Notary Public, State of New York Corporate Seal No. 014752767 Qualified in Westchester Co 1un�t�� Term Expires February 28G'�'"" Form CA -97 the. 0, poration with respect Fal Shown with optional two-or garage package and circle top window over front door. 1 70; y. ........... WE------ STCH ES TERMO-DUU-RWO-MES, INC. Q, A I ; E I I THE 2 T8 X 48' •2656 Sq. Ft. Second Floor 0E, 0 0 00 BEDROOM4 BEDROOM3 11' -0. x 9.. 7. IS-01 0 MASTFREDO ,BROM IT 2 IV_ a. BQyg -ROOM I - 2 16' 4 -z It 13 -0 48' First Floor 27'8' 48' STANDARD SCARSDALE 11 FEATURES • 4-Spacious; Bedrooms • Framingham Pediment on Front Door • 2%z Baths • Fireplace Options Available • Open Two-Story Entry Foyer • 'Boxed -out" and "Angle Bay" Options • Formal Dining . Room Available • Formal Living Room • Consult an Authorized Westchester Builder • Spacious Country Kitchen with Breakfast for a Complete List of Options Room and Pantry • Artist's renderings and Floor Plan Dimensions are approximate. All sperifications must be Written In the • "Cottage-Style" 3056 Lower Level Windows Contract No oral conditions. with Architraves on Front ESTCHESTER AODULARMOMES INC, P Z P.O. Box 900 * Dover Plains, NY 12522 (914) 832-9400 • (800) 832-3888 _ wS_.._.. �. .�5.���4:^u��+N•fa��S'h.:V w+.V.�_'.•.e•.l^+r -. DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva. Road, Brewster, New York. 10509 (914) 278 -6130 Jeff Contelmo Insite Engineering Route 22 Brewster, NY 10509 Dear 1&. Contelmo: Acting Public .Health Director December 16, 1996 Re: Proposed SSDS: Lincar Lot #22 Mayne Drive (T) Putnam Valley 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 engineers authorization letter is to be submitted. 2. One trench plan is to be submitted._ �: - _ -lost�oo; riieasue °for °tlie 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. Detail for all erosion control measures are to be shown on plan. Upon receipt of a submission, revised to reflect the above, this application will be considered further . V ly yours, . wb�(-4tivv Robert Morris, P. E. Public health Engineer RMjp DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New.York 10509 (914) 278 -6130 APPLICATION , TO CQNST tUGT .A__WATER. W.UL _ PCHD PERMIT #' WELL LOCATION Street Address Town/Village/City Tax Grid Number L., . -- 2g WELL OWNER" ' Name Mailing Address 1764-3 iJG Ll Vrivate O Public USE OF WELL - primary 2 - secondary AMSIDENTIAL D BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION CIINSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT S gpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE__gal REASON FOR DRILLING ❑ REPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION 13 ADDITIONAL SUPPLY )!64EW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN []DUG OGRAVEL • 0OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: LjL.c -69 -ttt Lot No. 22__ WATER WELL CONTRACTOR: Name Address: U1i4ko` IS PUBLIC WATER'SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: N /A TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: lc/ LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED 16N SEPARATE SHEET (date) NAlignaturW 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 thirt3, (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 r e ' s DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509. (914) 278 -6130 UCE_R...FOLEY, R.S. Acting Public Health Director Re:. Proposed SSDS: Dear 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." "You are referred to Article 128.1 of the official compilation of Codes, Rules and regulations of the State of New York, Title 10, relative to the need for approval of individual sewage disposal systems by the City of New York. You should contact city Officials in this regard." Upon receipt of a submission, revised.to reflect the above, this application will be considered further. RNVjP watershed Very truly yours, Robert Morris, P. E. Public Health Engineer PUW. -- -Ti COUNTY DEPARTMENT OF HE /?'H DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property of L�^'c =AR P r- ✓str�t'^'c� Cci'� Z Cj Located at I Ay 0o (T) j�U�n�.�„ -, VAU -y. Section 73- Block ( Lot �Z 3 Subdivision of Subdv. Lot f ZZ Filed Map # Zy33A . Date 5� 4' Gentlemen: This .letter is to authorize 6A)61.JC'ZCr4Ak -• S��'CY1,00' 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 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 kith.this matter and to supervise ih.e construction of said ck.. i47, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly your Signed Countersigned.- �E¢FREY S Gc:.•i � �•L in L• � PE . yN5�7 FiJFi.Jr wt• S�'r: V�Y1A, P� - ..,..Address_. r `1l`f - Z75-- (6ZGG Telephone er OZ r0 �I'Ly Z�( L[6CTt• 5 T7ttZy7" Address G/ r t r- tip.- f -76 il 3 Town - Telephone -� 1' � AM COUNTY DEPARTMENT OF HEALTH i ^ Division of Environmental Health Services / AFFIDAVIT - CORPORATE OWNER APPLICATION - A FOR PERMIT APPLICATION SUBMITTED TO , PUTNAM COUNTY HEALTH DEPARTMENT TO :. Commissioner of Health. .In the scatter of application for: ' L 1 10 C.A 1t J C:VEt.o Pr" EWT" (L "u CA-q _ff_- Sooj> I V. Zvi �� ID �ONq� -D �tt.Cl�rL represent that I acs an officer or employee ®f the corporation and &m authorized to ac_ for b,,)ctK Deye -a-er" 2;,.� C-o' ANC (Name of Corporation) - having offices at _r Ty S �. whose officers are: President: DONAc..a ame and Address Vice- President: (Name and Address) AZI /76y3 Secretary: !Name s res::). Trees -zrer: (Name and Address) r and fiat I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested sn� thereto. Saorz to before me this // day of tcvz G 19 9� f6ti `Public... `'ARLENE FAUSTINI :�OT4RY PUBLIC OF NEW JERSEY { 1i Comm;ssrsn Expires June 28.1990 F 's= Signed: Title: Corporate Seail ENGINEERING & INSIiF� SURVEYING, P.0 1849, Route 6 .(9114) 225-6200 Carmel, New York 10512 FaX (914) 225-6438 venue 7 Fe$f Tg" Z2505 TO 600,4T NYC 01F I > WE ARE SENDING YOU A4ALUched ❑ Under separate cover via- 0 Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ LGEUTEM VF UMMSOMMAL DATE Pe JNTTENT10t RE _51S DS F&a Cc 7- -(,-Z- I) CA,--, 5 L) i3,1> 11110 5 ( -0 CZ� C_ the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION C_ A Fr- A DA V iT- v T e_ a �-"TE- Le7rc_7Z vr- Iq /7--tyc;yr , zAl-to 1_1) Af oc- t c;---+­-,-r<5-Q 300.0c) 330'0--Oe � Wo THESE ARE TRANSMITTAL?_ as, .checked below:.- .. . .... IoLftr 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 19-0 PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO l _5 l-" SIGNED: it enclosures are not as noted, kindly notify us' n. � U 6..1 I _, Tv -- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL, HEALTH SERVICES }� _w .ii��..wi \_�.VTr`nrJ �\�\ ! ..,...�.._.. r.. ..�w.n+�.- .4_- �_.'P; ". -_ ..... _ .. r_.__ a�i .61,�-�r ���y ..�_ 1� /�.I i'1 .. .. ...'n + s.r- .•_wet -�-� - � __ _.� -._..� �•_ Re: Property of Mew - (�i.� _. CjC" Located at GJAY.�c--- De'luo- (T) PU'reJAni UA Ux-Y Section 7-- i S Block ( Lot °Z.E3 Subdivision of (..r'��r9R -� SuCi�ldrSrD� Subdvo Lot # ZZ_ Filed Asap # Z-`i 33A . Date 5 ) TI Gentlemen: This letter is to authorize 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 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 ."ciiP..,p- -3s_y� W.�r. dst .�.30�::'-�Y�r °''`9i ..4►�:c -r�,vi ci �. «�,.2�'_ Ar; t [ - -- - ..ems���,_.. 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned • PoE 9 D # �'EfFrtE� � 1.c7.,ir� c.. r►� L� � 6'� . Address Very truly yours J Signed r o u' lz /7 E Zti t(0(. Address peaty $ 7-9- &--&T L; r7- C �e-rr,�. y, /vim ( -76 y 3 Town Zv ! — y'-1G — Y 70 G Telephone Czcc) Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services AFFIDAVIT - CORPORATE OWNER APPLICATION F6k'Pikqff"AWLfCUATiWg Mftib—T. PUTNAM COUNTY HEALTH DEPARTMENT .1 TO: Commissioner of Health In the matter of application for:. L//'Jc-AK 'PC-Vez-oPm�o-r- .5oi3j>iv. evr Z (u AL-l> N"ctEL'_ represent that I am an officer or employee p ee of the corporation and am authorized to act for Doves -,e, en � Co, ::=NC (Name of Corporation) having offices at 7Z_a I �_j 13.e-r—TY S' rr(_(5: r6;e- Cy 7,(. V 3 'Whose officers are: President: 90,0Acr_> 1U4rCAt4_L. 7_0 I Cj13C7r_7-y A-r LsrrLr- Fe-Z17?, y) A and Address Vice-President: (Name. and Address) Secretary: ('lame _ ;an' Address) Tregsurer:. (Name and Address) and fiat I am and will be individually responsible for any and all acts 0.1 the corporation with respect to the approval requested and all su.bseq;,e "cts re lag thereto. Sworn to before, me this day of 19 ARLENE FAUSTINI NOTARY PUBLIC OF NEW JERSEV. My CoTisiion Expires June 24-1996 F E- Signed: Title: 0 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 # -(�, � � t .. n_.-e�14 t t3:.'.r w s. r v+w.r'•f`.•4.�r �N"G:. rr.r. ..` .a .•c+.= N'va'Yr 1 r 'f! v...r i., •— /,�", f r � WELL LOCATION Street Address Village City Tax Grid Number WELL OWNER Name Mailing Address ivate U'j m V.- Veroem.-vr" a9 :7;'JG 2101 coat-m 5 r. Urt A,�5- 17 6 ® Public USE OF WELL primary 2 - secondary SIDENTIAL ® BUSINESS ® INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP ® ABANDONED O FARM O TEST /OBSERVATION O OTHER. (spec if y O INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT _5 gpm /# O REPLACE EXISTING SUPPLY SUPPLY NEW DWELLING PEOPLE SERVED t /EST. OF DAILY USAGE 00 mal O TEST /OBSERVATION G ADDITIONAL SUPPLY ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN ®DUG ®GRAVED 0OTHER IS WELL SITE SUBJECT TO FLOODING? YES _2�,_NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. ZZ IfATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: % TOWN /VIL /CITY ✓� DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETh"PARATE RCES OF CONTAMINATION PROVIDED SHEET (d te) UV hig4atureV 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 manner as not to degrade or othe ise contaminate surface or groundwater. Date of Issue: 19 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 Pumm aXMN DEPARRMU OF HEALTH DIVISION of . HEALTH SERVICES &1410-Ar-ff C07- Z:Z- F. (ZIEW K - - , YM es -X 'rY -5T7t-,OT 7-0 C , Owner =uc Address L-17r4C re-x-MK M-,T. IW-q3 Located at (Street) �A D Z I O-E Sec. -r3, IS Block lot 7-6 (indicath nearest cross street) Municipality PvriUA-M VALkEK Watershed fij.,hSonl R4 V4X, SOIL PERCOLATION TEST DATA RBQUnM TO BE SUBMITTED WUTH APPLICATIONS Date of Pre-Soaking- /V ZA Date of Percolation Test 1i ZA HOLE NUMBER C= TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches s Soil Rate Start-Stop Min. Start stop Drop In Min/'In Drop Inches Inches Inches r 2 3 v/33,zz- 4 2 3 4 5 2 3 4 5 NUMS: 1. Tests to be repeated at saw 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. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. DZ .HOLE NO ' .✓�q�a M3 GOLO� ' , 1l I SAM q 3° 49 1 tit _ III =uI -51 IZoc�i, (2R 1� ' 6° 79 81 91 10' ill 12' 13' (- ojJ-7 c L� _ 1 ti : in R cc K 61 3.5 " 14° - ; -01C TE IMn,T `AT o'ri t;�`2t WNi7i l t ISJF[JOOi1NTERF�D` - ^l'tj� • 0 L INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED /tom d ,-Otf— DEEP HOLE OBSERVATIONS MADE BY: BALDLJtni �o1ZeJ ECG VS • `• DATE: /67 DESIGN Soil Rate Used Drop: S.D. Usable Area Provided 5F No. of Bedrooms Septic 'Tank Capacity / ZSt) gals. Type C ©�� Absorption Area Provided By. 500 L.F. x 24" width trench Ao& p Other F(CL ¢�� �r�����a '�E FFRfY S. Goa1T� (9rr C✓ Pt' ''' k Name --cNsfir vxvz /-&; �C, Signature ., - ;•p�''a� j, r Address I�ov?S' ZZ SEAL THIS SPACE FOR USE BY HEALTH DEPT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS -ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. e 21 31 41 51 61 71 81 91 10, 121 13' 141 1(t ver 1l( 7 70 HOLE NO. lit Lo," "Mc ' M _r. — AT-M Tai,GP,0UNTrX,27X M. T.1, _VKMJNTE1dNM. INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENODUNTERED DEEP HOLE OBSERVATIONS ME BY: 13ALM-)IIJ &XJCQVS PC- # DAM: /87 DESIGN Soil Rate Used 11-15— Min/1" Drop: S.D. Usable Area Provided 69:)J" !;iF No. of Bedroams • Septic Tank Capacity /7-6Z) gals. Type Absorption Area Provided By 5-DO L.F. x'24". width trench k POS 0 c c- eaPu(ree_,-- Other c SE jef ' CEY -r. hi Pt Name rr E'A)4-100 1,%X :5u, _-r_,PVSf xvcYl-x_; FL, Signature Address Z-Z SEAL _Fjz_ew57re_ allf. THIS SPACE FOR USE BY Soil Rate Approved sq.ft/gal. Checked by Date i/ APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REV "EW SHEET :cr CONSTRUCTION PERMIT - NAME OF-' OWNER ° iAMtoo- 6A� STREET C TION BY E° DATE 4+ TAX MAP ,�,N DOCUMENTS. APPLICATION PC -1 WELL PERMIT; PWS LETTER ENGINEERS AUTHORIZATION ESIGN DATA SHEET(DDS) DEEP HOLE LOG CONSISTENT PERC RESULTS (3) ERC HOLE DEPTH PORPORATE RESOLUTION LANS THREE SETS M HOUSE PLANS - TWO SETS M VARIANCE REQUEST GENERAL 9S'UBDIVISION LEGAL SUBDIVISION APPROVAL ,CHECKED �'PERC RATE I LL REQUIRED CURTAIN DRAIN REQUIRED MSTANDPIPES EX- APPROVAL SSDS ADJ. LOTS WETLAND (TOWN/DEC PERMIT R & D) DATA ON DDS PLANS & PERMIT SAME PRE- 1969 - NEIGHBOR NOTIFIFICATION LETTER BI/ZBA 10O YR. FLOOD ELEVATION aREO"IRED DE'fiAILJ ON PLANS WFT'l EWA GE SYSTEM PLAN - (NORTH ARROW) ) SDS HYDRAULIC PROFILE m GRAVITY FLOW D/ J BOX m TRENCH/GALLEY m P- PIT DETAILS SEPTIC TANK - SIZE, DETAIL `WELL DETAIL, SERVICE LINE IF OVER ® CONSTRUCTION NOTES (GRINDER RATE) EEDESIGN DATA: PERC AND DEEP RESULTS TWO -FOOT CONTOURS EXISTING & PROPOSED AY & SLOPES CUT FOOTING /GUTTER/CURTAIN DRAINS COMMENTS: DISCHARGE (OK) PERC & DEEP HOLES LOCATED ATIVE OF PRIMARY AND EXPANSION T. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE PUMPED PIT & D BOX SHOWN & DETAILED_ 1-LJ HOUSE - NO. OF BEDROOMS m WELLS & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM m PROPERTY METES & BOUNDS m HOUSE SETBACK NECESSARY (TIGHT LOT) ED HOUSE SEWER - 1 /4 "/FT. 4 "0; TYPE PIPE m NO BENDS; MAX. BENDS 45 W /CLEANOUT FILL SYSTEMS LAYBARRIER 0 FT HORIZONTAL: SLOPE 3:1 TO GRADE to SPECS uJDEPTH GAUGES FILL PROFILE & DIMENSIONS VOLUME TRENCH mLF TRENCH PROVIDED X60 FT MAX mAPARALLEL TO CONTOURS ED 100% EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED ON PLAN FIELDS 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL. 20' TO FOUNDATION WALLS 100 TO WELL, 200' IN D.L.O.D., 150' PITS m 100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) ® 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATERLINE (PITS -20') lfll'5O'INTERMITTENT DRAINAGE COURSE 200 FL RESERVOIR, ETCH 150 FT. GALLEY SYSTEMS SEPTIC TANKS =I O' FROM FOUNDATION; 50' TO WELL WELLS m 15' WELL TO P.L. to or h Re-1 PUT NAM COUNTY i DEPARTMENT OF HEALTH _ Iry _ _�• T7. ;1���''�{I�i._[� _ S �,�..�h.� -ia _w� .,,14 :�••_"•3; M+r.,,; yam_ _ _ r . _ y �,M,`_ :...... -. �r ��r .•.nLi� i11b'��i���L :t'vn..[�• il� ^�11�ii1N4�'V1 J' tr- '•- -�•�. i2Y L VIJ1 ^.. t'.: ��d' +p w�p•: •'1 • r. i`�Fi7i'v�t1'L�". r�- ••ivRi►/i`i�111 Y"L�' �Jvn�.,'.riv ' 1. Name and Address of Applicant: L j^'cAst Co. -) s'ivc . 7-6t 44aex y sr-. 2. Name of Project: SSDS Fog LircAc Dt- vFto�..►o�r <o�, �nrC. 3. Location T /V /C: PLPrN ,*M VAG9,CY 4. Project Engineer: _kore EiV &Ngpe1'V6 JoxvEY.v, P. c,5. Address: goarr ZZ QrcE�.s �c� "V f � yosyy License Number: Phone: 41q-7-781_110 6. Type of Project: _ X 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 (SEQR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted _ X_ 8. Is a Draft Environmental Impact Statement (DEIS) required? ... :......... No 9. Tlas DEIS been completed and found acceptable by Lead Agency? A-1 1A 10. Name of Lead Agency NIA t•h {5 pr�3Pct 1n,.a► -area „under-.th� contrti,i . fir �Cc�:� - plarnl-ng ZL'rong; �3La6.DEPT: or other otficia'Is, ordinances?” ............................... 12. If so, have plans been submitted to such authorities? .................. No 13. Has preliminary approval been granted by such authorities? N1A 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 ?........ NIA 16. Waters index number.(surface) ........... ............................... N /A 17. Is project located near a public water supply system? .................. A10 18.. If yes, name of water supply N /4— Distance to water supply N�A 19. Is project site near a public sewage collection or disposal system ?..... A10 20. Name of sewage system N 1A Distance to sewage system N�A 21. Date observed: UNKNe0a 23. Name of Health Inspector: 140'1S4 fi 24. Project design flow (gallons per day) ..... .............................. �� 20 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required?.. NO 26. Has SPDES Application been submitted 27. Is any portion of this project located within a designated Town or State ° wetland? CDO.DDODODDDO.ODODD O O O O 0 O D 0 0 O O O O O O O O O O O O O D D O O O O O D O O O O 0 O D 0 O 0 D O O O O D O pA 28. Wetland ID Number DDDDDDD DODDDOODOODDD.DDD DDDODDODODOOeoDOO000D000000DOoo A) A 29. Is Wetland Permit required? DD..DDDDDDDDDD DDDDDDD.DDDDDD..DDDDDDDDDDDDDDD A/O Has application been made to Town or Local DEC Office? DDDDDDDDDDDDDDDDDD IUIA 30. Does project require a DEC Stream Disturbance Permit? DD DDDDDDDDDDDDDDDDD N0 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? DDDDDDDD YES or NO N-0 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? DDDDDDDDDDDDDDYES or NO 1V0 DESCRIBE: f 33. Is there a local master plan or file with the Town or pillage? ......DO.DD YES b 34. Are community water, sewer facilities planned to be developed within 15 years? Alp 35. Are any sewage disposal areas in excess of 15% slope? D ... !.v. ... ....... .. 1P !S 36. Tax Hap ID Number DDDDDDy..DD.DD. DDDDDDDD.DD DDDD.DDDDDDDDD..DD.DDDD.......o 37. Approved Plans are to be returned to: D.00D.00DDCDD.DD 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. Y 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 & OFFICIAL TITLES: MAILING ADDRESS: Fi %{! /, ®so THESIL I-CSUALO 11 Second Floor .7 0 W, 0 O A' W 48' �1 fwct Flnnr DINING ROOM l 48' Up 27'8" X 48' • 2656 Sq. Ft. LIVING ROOM STANDARD SCARSDALE 11 FEATURES • 4- Spacious Bedrooms • 2%2 Baths • Open Two -Story Entry Foyer 6 Formal Dining Room • Formal Living Room • Spacious Country Kitchen with Breakfast Room and Pantry • "Cottage -Style" 3056 Lower Level Windows with Architraves on Front Y 27'8" ?7.8. • Framingham Pediment on Front Door • Fireplace Options Available • "Boxed -out" and "Angle Bay' Options • Available • Consult an Authorized Westchester Builder for a Complete List of Options • Artist's renderings and Floor Plan Dimensions are approximate. All specifications must be Written In the contract No oral conditions. ESTCHESTER ODULAR ff0 MES, INC. 11 11 I II P.O. Box 900. Dover Plains, NY 12522 L \ (9141832-9406'. (8001832 -3888 YY m> a Vi.2� Lxrr- AW� 77 -T�R *ix .76; to 09 Ilk .or LIP, K 99 '7 IL i . . . . . . . . . . $hove with optional two.-Car garage package and circle top window over front door. 'ODULARMOMES, INIC. JkFE S T 'CH E 7ST E RI; llhc IA 41 P. Ada A 17" *ix .76; to 09 Ilk .or LIP, K 99 '7 IL i . . . . . . . . . . $hove with optional two.-Car garage package and circle top window over front door. 'ODULARMOMES, INIC. JkFE S T 'CH E 7ST E RI; PUTNAM.CO.UNTY DEPARTMENT OF HEALTH DIVISION OF ENVIROI�IMENTAL HEALTH SERVICES ' 7 � t t`+i l cl "°F•, r' bJ ._ S . { , r. .,v .�. t :F 3,5.,^a DESIGN DA,T�4 I HEFT SiC SURlFI, `� -1 ;WAG 'i�R�rATM£+ NBC YS7C�' Mr A' ws.r n!n ti. =a... .c .i ,T•": .... .. 'r. n.'G�.Pry HOwner. Address 37 DA-w► r2P� o5sc�ca�j Located at (Street)' C3?- �_.Q -�L. `cz u ��-!'� _Taxlvlap 3,rsBlock"� ( Lot (indicate nearest cross street) IVlunicipality�rnf= t%t-c.c� -� Drainage Basin 6 so,) SOIL PERCOLATION TEST DATA Date of Pre - soaking ID (Z� i`� Date of Percolation Test Hole No. Run No. Time Start - Stop Elapse Time (Min.) D". th to Water Tom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate MimInch s.., P3 �- 2 �:�2- `(:07 15, (S !f- (svy 3 4 5 �4- 1 °o :41- 0, 4 3 :17 4 Y 5 1 2 3 4 5 ivvir.o: i. iests to oe repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 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 hole. Form DD -97 7 TEST PIT DATA DESCRIPTION OFS®ILS ENCOUNTEPS- b IN TEST HOLES -. :ir: `�►L ~`-b'+ �d '.4Lhq. .� '."r.,o :'mew.. s.. a'•a- vr+- .Riy`- r.7nu3ir a:.r.; ,i'�.F "s:.a is ALE Nom. HOLE NO. HOLE N0. G.L. 0.5' l .5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 10.0'/ . ;. Indicate a oundwat Indicate level at which mottling is Indicate level to which is encountered Es— after being ,2 o ��a N. C") e o servations made by: a Design Professional Name: Jeffrey J. Contelmo, P.E. _ Address: znsite & Architecture P, �, � �- , OF NE i�11)1 1:7$5` =route 22 Brewster, New York 10509 ,.. '451�p� Signature: VDesign Professional's Seal \-lA LOT 23 WELL 0 y A OQ O'��� �o v, 13' `o 84' A Jz !3 \ fA 6 v 7 yJ> ORD OWNER: 37 CR07 -ON DAM ROAD CORP. 37 CROTON DAM ROAD OSSINING, NEW YORK 10562 LOCATION: TOWN OF PUTNAM VALLEY PUTNAM COUNTY, NEW YORK TAX MAP NO. 73.18 -1 -28 RATION OF THIS DOCUMENT, UNLESS UNDER THE DIRECTION 1 LICENSED PROFESSIONAL ENUNEER, IS A NOLATION OF 7ON 7209 OF ARTICLE 145 OF THE EDUCATION LAW. V� Ok' / 1 NOTES: 1. THIS IS TO CERTIFY THAT 7? l£ SEWAGE TREATMENT SYSTEM WAS CONSTRUCTED AS INDICATED ON THIS PLAN AND THAT 77IE SYSTEM WAS OBSERVED BY INSITE ENGINEERING, SURVEYING AND LANDSCAPE ARCHITECTURE, P.C. BEFORE IT WAS COVERED OVER, THE SYSTEM WAS CONSTRUCTED IN GENERAL ACCORDANCE WITH ALL STANDARD RULES AND REGULATIONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND THE NEW YORK STATE DEPARTMENT OF HEALTH. 2 ALL FACILITIES EXISTING. UNLESS NOTED OTHERWISE. V PROPERTY LINE, HOUSE LOCA7ION, AND WELL LOCATION TAKEN FROM FIELDWORK BY INSITE ENGINEERING, SURVEYING & LANDSCAPE ARCHITECTURE, H.C., COMPLETED 1128199. LOT 21 SCALE. I NU. A B O'��� �.. 13' 2 84' . 4' _ ._{•yam•' 66' 4 87' 11.�c 5 x 74' 6 9.3' z AREA 95' 82' 0 42' 28' 9 Z a 2.735 ACRES t 10 \ 39' a ORD OWNER: 37 CR07 -ON DAM ROAD CORP. 37 CROTON DAM ROAD OSSINING, NEW YORK 10562 LOCATION: TOWN OF PUTNAM VALLEY PUTNAM COUNTY, NEW YORK TAX MAP NO. 73.18 -1 -28 RATION OF THIS DOCUMENT, UNLESS UNDER THE DIRECTION 1 LICENSED PROFESSIONAL ENUNEER, IS A NOLATION OF 7ON 7209 OF ARTICLE 145 OF THE EDUCATION LAW. V� Ok' / 1 NOTES: 1. THIS IS TO CERTIFY THAT 7? l£ SEWAGE TREATMENT SYSTEM WAS CONSTRUCTED AS INDICATED ON THIS PLAN AND THAT 77IE SYSTEM WAS OBSERVED BY INSITE ENGINEERING, SURVEYING AND LANDSCAPE ARCHITECTURE, P.C. BEFORE IT WAS COVERED OVER, THE SYSTEM WAS CONSTRUCTED IN GENERAL ACCORDANCE WITH ALL STANDARD RULES AND REGULATIONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND THE NEW YORK STATE DEPARTMENT OF HEALTH. 2 ALL FACILITIES EXISTING. UNLESS NOTED OTHERWISE. V PROPERTY LINE, HOUSE LOCA7ION, AND WELL LOCATION TAKEN FROM FIELDWORK BY INSITE ENGINEERING, SURVEYING & LANDSCAPE ARCHITECTURE, H.C., COMPLETED 1128199. LOT 21 SCALE. I NU. A B 1 28' 13' 2 84' 63' 3 85' 66' 4 87' 69' 5 90' 74' 6 9.3' 78' 7 95' 82' 8 42' 28' 9 44' 34' 10 46' 39'