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(1tlmdA~ r� Li NC/SE D�YEt<o`�(�.l f' C'�►, .
Drib of Plow Ajpgraval
)i - 113Eaff, sh Tow.Lifitl.i✓
A----.. —A e4irml9a 6;L -8r0 FAA F.nr•1n%%P"
D++rs Tr gESi Ni1AL [A Am i .1 AL I' [iiS1,01.0* LJ DWO ' Vd.r
thl•bar d Nadia ■ s =3 .Dam Flow G P D �-� P ®Nfl�ratlr b=a�M WYE I� b atapMMA
Sopmet. Sow~ S,.t.. r OWA t Of Icy Slip& Tnb .-a F.
To bwaainifti ded.lp UNfCNOW 4
walar sbmain S"* F"Nk Adhm
an X '`-� S�wb Dori h111J tJOiAIP� A ftess
olbrr dgltir�sda Pvn') /° /r'TT
i re0 88 - :th.t l am whony ane comomoy raponsais for the dawn and location of the PropOnd sy.t-410i t) that the
. a as save a du osel s scam .
Move dace a" win,be aorlllruded as dawn an the approved amendment than to and in aeeordana with the standards, Fula TI M o
eaunty oMMtmaat of helps, aM that on ComIII at»n.o weof a "Certifkate of Construction Compllehce" satisfactory to the Commhelorar of IWlthwill
M submMtM t0 tit OapMbllMl% aM a smitten "Won" win be furnia" the Owner. his sutaabwa6 Nabs or assigns by the builder, that old builder win
g1MCa N 98M. p -W4 COMMON My pR of laid uWaN d"MM system during the period of two (2) years bnhledNWIF followin tMdata Of too hau-
alas of tit agpravN' of tit CwtMka a of Comtrottlen Compliance of the orMinal systMn OF any Capin tlleratai !) that the drUkd well desorll" a`OIN
ww as faceted as illunia as tit spprovW PON sad that am WON will be Installed In with the Kandards. rules and rpm the Putnam
cawlty 040dMt .""t.
°'' sa P.IL _j(
P A.
16 l
IGN • 06 �i
A*dmn IS,
LiNnN No
APPROV90 FOR CONSTRUCTIONI This adOFOgI eMF the date Issued unless construction at the build»/ figs been undartaltMl and le
1wacMN for Cause or may be au s"" or modified by the Isatorla► of Health. Any Change Of alteration of Construction
sawing . for adage of a e w supply Only. Rem,.YM»
ILO/. 80
.
Rev. 3
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division d Environmental Health Services, Carmel, N.Y. 10512
Engineer Must Pro
« .r. .-.. ...... .4'.. ..., ¢...•. ...+. �... v +v..�.r�.Ort.r. +.:_�.V'+�Y ^..o ♦ •.were..
CE ATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM PvrlyAm LALi—Ey
U2C, Town or Village
Located st Tax Map '7 , l 8 Block Lot —�
Owner /app Name AD%rj,/- C�2 - ?ryC ' Formerly Subdivision Name AQ - Subdv. Lot N �-
MaWng
I"- . 4-/MA FG•s%lO AAT Zip l7 0 -1 Date Permit Issued
Separate Sewerage System built by Idah '✓rS �Qd�A Address _ 17 2- Ae kk __i* La • t•-4 .,«t /!D 4 lZSgt
Consisting of 1QV0 Gallon Septic Tank and SooG •f Flgr_o s!' pe'M`13 P/T•
Water Supplyt Public Supply From' Address
or: X Private Supply Drilled by AyA09k-_z0^1 Address
Building Type 44E /6&yTI/9y Has Erosion Control Been Completed? tiy
Number of Bedrooms Has Garbage Grinder Been Installed?
Other Requirements
I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies
of which are attached), and in accordance with the standards, rules and regulations, in accord a with the filed plan, and the permit issued by the
Putnam County Depar ant Of Health.
Cate Z Certified by P.E.�R.A.
Address !/v G License No. K 3
2T z'�- /3512- iOSv
Any person occupying premises served by the above systems) .shall promptly take such a tlon as may be necessary to secure the correction of any unsanitary
conditions resulting from such usage. Approval of the separate saws r stem shalt become null and void as soon as a pubs;: unitary sewer becomes
available and the approval of the private water supply shall become nul and void when a u Iic water supply becomes available. Such approvals are
subject to modificatio% or change when, in the judgment of the Co sr of Heal eh revocation, modification or change Is ne ' ss►y.
h /9.T /41V -.. Title
GCT 20 '94 15110 FROM
PAGE 02
YML ENVIRONMENTAL SERVICES
45trV ?t
N.-Y. 1 0519c ( 914) -�i` °J c�i�� '� •`s" _ ter` 1 n : `
Albert 1.1. peldovani, Dir -e tQ
LAB #: ?L. 403: S9r CLIENT 4259 .
/yN IJ IJ /JN II + /fy wJ /J fy /J /JJy NfJ N�!J l +IJN ✓y /J!f /I ry I+ ✓J I+Y�•N /! /JI +3V II l.• +J
De RGINDA - DENNIS
KRAMER S POND RD
P tTNAM VALLEY+ NY 10579
SAMPLING SITE: CHURCH RD PUTNAM VALLEY
! KITCHEN TAP
CoLeD By: D. LeRONDA
N0TES...s
NNf/MNryIV �✓N /J NIJ wI NIJNryw1 /rNNIJN✓'y Iy NII M✓ /+IJN/ +N/ +w✓f+ /✓N!I
MATE PLAQ PROCEDI.-IRE
NON STAT PR+ fir: RAGE i
wJNMJ/•�/JN/' +✓' /N/. /NI /MJN wJ.JM /J /I�'I /+�J IJNNfI ► /IJ PI IJ / /MN MfJ .V PJ N.
DATE /TIME TAKEN: 10/14/94 11:40,
tlATE /T I ME RE C' r3. 10 / 14 /94 12. 1 211 (
REPORT DATE: 10/19/94
PHONE:
SAMPLE TYPE..; POTABLE
PRESERVATIVES % NONE
TEMPERATURE. , a <{ 4C
r_ OL I PORM METH I MF -
NwI +J wIYJryN NII Nfy Nfy /I n +MNN N /+NMNNA•✓'JN /Dry NNwy IJ N.J Nfy l4r
RE'_ 3_iLT NORMAL
10/17/94 MF T. C,;3_ILIFORM AS tN*r / 100,1iIL. ABSENT
cOMMENTS: •
BAIT THESE RESULTS INDICATE THAT THE 4,lATE : (4.`A.:: + (WAS NOT) C1f= A
SATISFACTORY BAS! I'CARY QUALITY ACCORD _: THE NEW YORK STA ; E
l�11?i1 EPA FEDERAL DRINKING. WATER
STANDARDS, FOR' THE PA�i�;l'�4 T�ftiS
JESTED, AT THE TIME O
-
Albert H. �•adnaarri
Dir4e ctnr
EL.AP*l !
PUTNAM COMM DEPARTMENT OF HEALTH
ITTNA _- IL!95FR` CFS
Lope MlivE oeV Elt- -41 Co. tAt C_.
Owner or Purchaser of Building
Building Constructed by
Location - Street
Municipality
P-E 5A C > e- P- " `c&'V-=
Building Type
-7 a. « 1 9
Section Block Lot
W Y. I
Subdivision Name
Subdivision Lot #
GUARANM OF SUBSURFACE SEWAGE DISPOSAL SYSTEM
I represent that I am wholly and completely responsible for the location,
workmanship, material, construction and drainage of the sewage disposal system
serving. the above described property, and that it has been constructed as shown on
the approved plan or approved amendment thereto, and in accordance with the
standards, rules and regulations of the Putnam County Department of Health, and
hereby guarantee to the owner, his successors, heirs or assigns, to place in good
operating condition any part of said system constructed by me which fails to.
. operate for a period_of..two years inanediately following the date of approval of the
- 8`Tertlrlcate �Ul t:UTrS iilC:i:iVli° �.UTll lictil%E° fir i 16;:setiage disk—,sa sy* zt na ` 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 determination of
the Director of the Division of Environinental Health Services of the Putnam County
Department of Health as to whether or not the failure of the system to operate was
caused by the willful or negligent act of the occupant of the building utilizing
the system.
Dated this sb day of 19 e4_ Signature
p {� Title
General Contractor (Owner) - Signature
17z 62-F04,657-
Corporation Name (if Corp.)
rev. 9/85
mk
Corporation Name (if Corp.)
Address
.CO�,� WELL .COMPLETION REPORT
J Office Use Only
lyre DEPARTMENT OF HEALTH
't 0 TisL�T cliv.YoimenLa `fteal`f:n "'J`�e`tvlcea ' -' "y`4 �! ci4. x,'.;,' *c':iY'xo* .'4
�Fw YOB PUTNAM COUNTY DEPARTMENT OF HEALTH
SiREZT AOURES S:,,'' , WNIVIL u / 1 Y. TAX GRID NUMBE�
WELL LOCATION
WELL OWNER NAME: ADDRESS:
1—P$IVATE
I v O PUBLIC
USE OF WELL ESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /CONO. /HEAT PUMP ❑ ABANDONED
1- primary ❑ BUSINESS O FARM ❑ TEST /OBSERVATION O OTHER (specify)
2 - secondary ❑ INDUSTRIAL O INSTITUTIONAL O. STAND -BY ❑
MOUNT OF USE YIELD SOUGHT S� gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal.
REASON FOR []REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY
DRILLING w SUPPLY (NEW DWELLING) ❑ DEEPEN EXISTING WELL
DEPTH DATA WELL DEPTH a ft. STATIC WATER LEVEL ft. I DATE MEASURED
DRILLING O_RBTARY O COMPRESSED AIR PERCUSSION ❑ DUG
EQUIPMENT ❑ WELL POINT ❑ CABLE PERCUSSION O OTHER (specify):
WELL TYPE O SCREENED UDPEN END CASING ❑ OPEN HOLE IN BEDROCK O OTHER
' TOTAL LENGTH ft MATERIALS: O -STEEL O PLASTIC 0 OTHER
CASING LENGTH BELOW GRADE i �►a ft. JOINTS .'0 WELDED &T1%IREADED O OTHER
DETAILS DIAMETER in. SEAL: C 1eKtNTGROUT, 0BENTONITE ❑OTHER
WEIGHT PER FOOT Ib. /ft. DRIVE SHOE: O YES U� Wj LINER: DYES CM
SCREEN DIAMETER (in) SLOT SIZE LENGTH (It) DEPTH TO SCREEN (ft) DEVELOPED?
<.I?AILS FIRST - _ _ _ _ Y
T JL'V V171/•.. ,._.. ...w .. - .�-... w{ .y e.. .-. ..v.w.ai. V..e... h.+.r - u,:+.rnr•.•...r c.vw..... .- ...-- ter.... -. r�r-.. - .�.. o.. ..Orrr .
GRAVEL PACK o Nos GRAVEL DIAMETER FDE.OTMH BOTTOM
SIZE: OF PACK In. It. OE, iH It.
WELL YIELD TEST IYdetafled pumping VEIL LOG If more detailed formation descriptions or sieve analyses
METHOD:- O PUMPED tests were done is in- are available, please attach.
I DEPTH FROM Wale, Well
�RESSEO AIR , formation attached? SURFACE. Bear. Dia- FOR +dATtON DESCRIPTION p0E
O BAILED O OTHER 0 YES ❑ NO ft fi in9 Inner
WELL DEPTH DURATION ORAWOOWN YIELD Surlue Fi a i
ft. hr. min. ft, gym.
S )--ad ; s
WATER O CLEAR TEMP.
QUALITY ❑ CLOUDY HARDNESS
O COLORED ANALYZED? ❑ YES ONO
ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE t, /j � r - y — I Ye ( a Sn
PUMP INFORMATION CAPACITY GAL.
TYPE s I, � �,r �C l�l< 'CAPACITY WELL DRILLER NAME DATE
MAKER 2 1'wti. d LS DEPTH ADOREs� Vu u c '" ' st
MOOEI VOLTAGE , �'HP �` Ux
Cam, 711f�J,f
r
= 1- _'SC'f✓IJT?Y �'� := ="'I' C: F'_ -Jl - Ll . _r1C.r CF
G =Y � L
Cr.�_•':�� t � � _._.- ;,�s�cl i � sic: �
6•J �. a r•
ex-
C--rperale Resole. -cn
Z :re°_ sa'-s - --
_-i Ji n"rs •�'.;.1_']Gr_Zct -? Cci
_
Den' HGl�
?c:C FGle 0°Jth
(3) r --
Ca
0152 1?r'g -
Two scams 1
IS
Well rerma
V=Iri ance Win^ -_Lec `
Ds
R & D)
��h Z.^i•� vr3:.. ill ? G'1 — \: �= C_"1 C_ --.i w
C
G_ _
D Cr J Ecx i•- _. -
_ i =r� _ca __�� ; = over
val =il, _
CO
-------- & J_00,=S l��t
r a 'D:]__:5 (•C ch v1)
�Gres....- Lam:'... 0—F V_.l �j C Z� ��� ��
T tea_— Pit & D Scx S ,7--a & D-=
i
j';� =?s & SS�S'_ �; /in 200 __. G= �= _xs= s�e:s
C C - _
cawer
S C7L- . ON D_-Y
1.01 La=e
20'
100, to i-ll; 200' In D.L.0_D,
to stz-n�am/ jti=L�= �'i -�n/ Lase (_ _` �:l)
,tL/�G •,•^i-c5iil/c�7= :r�c_II,Gl"'_ ^=-_"'''_ =_
JJ L✓ G 6'•6'••
i 01 -G water Line
30' il:l�?_Tt= = = =-lt G.c '?"°
101 ir=L
1 1 well r.G ?r
DEPARTMENT OF HEALTH
Division of Environmental Health Services
110 OLD ROUTE SIX.CENTER, CARMEL, N.Y.. 10512. (914) 225 -0310
�. ..- r . y ^ . _ . .._ . t q. at .ate.• w! u q • 4 . .
APPLICATION TOrCONSTRUCT.�A.WATER WELL
PCHD PERMIT #
WELL LOCATION.
Street Address
CNu
Town/Village/City
, VALLEY
Tax Grid Number
15., 0- 19
-WELL OWNER
Name
LINCh Dr_- ELLS
Mailing _ Address
ENt CO. INC. M UbEAZt'5t- LI-t
MfPrivate
tj 0 Public
USE OF WELL
- primary
2- secondary
RESIDENTIAL
0 BUSINESS
0 INDUSTRIAL
D PUBLIC SUPPLY 0 AIR /COND /HEAT PUMP O ABANDONED
0 FARM 0 TEST /OBSERVATION 0 OTHER (specify
0 INSTITUTIONAL.. O STAND -BY O
AMOUNT OF USE
YIELD SOUGHT . j. gpm /11 PEOPLE SERVED /EST. OF DAILY USAGE &CO _gal
REASON FOR
DRILLING
O REPLACE'EXISTING SUPPLY O TEST/ OBSERVATION'
ONEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL
G ADDITIONAL SUPPLY
DETAILED
REASON FOR
DRILLING
WELL TYPE
DRILLED
ODRIVEN
ODUG
GRAVEL
0
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES `X_No
IF'-WELL IS LOCATED IN A REALTY SUBDIVISION, NAME'OF SUBDIVISION: LWOW 2 510D1 53
Lot No. 2
WATER WELL CONTRACTOR: Name LA04JOW lU Address:
E
IS PUBLIC WATER SUPPLY AVAILABLE.TO SITE: YES __)�__NO
NAME OF PUBLIC WATER SUPPLY: WA TOWN /VIL /CITY
[iLsll�rlLE ' U Pk PBRT FRG --r ivEAREST MATER XAIN-c
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
O ON SEPARATE SHEET
s
(d e) gn ture)
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
thirtir (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 drill operations be contained on this
property and in such a manner as not to degrade or of rwi contaminate surface or groundwater.
Date of Issue•
4P11 L 19 2 i /41�4
Date of Expiration 19 7 7 Permit Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
toll
-4 ENGINEERING
11 & DESIGN, P. C.
Pump Pit Design for SSDS for Lincar Development Co., Inc.
Lot 2 of the Lincar 2 Subdivision
Design Flow = 600 gallons per day
Use.peak hourly flow 10 times average daily flow
Opeak = 00)(16� = 4.2 gpm
(24)(60)
Static Head = ± 14 feet
C = 150
d = 2"
L = ± 120 feet
GPM = 30 gpm
Equivalent L (Bend & Valve Losses) ± 50 feet
Total L = ± 170 feet
C d
Total Dynamic Head (14 feet + 3 feet) = 17 feet
Use Gould Pump model # 38714/10 HP (or approved equal)
This pump will pump 30 GPM with a total dynamic head of 17 feet
X I r849, Route 6, Camel, New York 10512
❑ 7 DeLavergne Avenue, Wappingers Falls, New York 12590
Fax: (914) 225-6438
May 14, 1992
(914) 225.6200
(914) 2971742
3871
r-
� .r
FEATURES
SPECIFICATIONS
MOTOR
Impeller: Thermoplastic Semi-
Pump:
• Single Phase: 0.4H P, 115 or 230
Vortex design with pump out vanes for
• Solids handling capability:
Volt, 60Hz, 1550 RPM, built in over
mechanical seal 'protection.
3 /a" Maximum
load with automatic reset.
Casing and Base:,Rugged
• Capacities: Up to 55 GPM
• Power Cord: 10 foot standard
thermoplastic design provides superior
• Total Heads: Up to 24 feet
length, 16/3 SJTO with Nema 5 -15P
strength and corrosion resistance.
• Discharge Size:1 1/2' NPT
3 prong grounding plug. Optional
Motor Cover: Thermoplastic cover
• Mechanical Seal: Carbon -Rotary
Head /Ceramic - Stationary Seat,
20' length, 16/3 SJTW with Nema
5 -15P 3 prong grounding plug.
with integral handle and float switch
Buna N Elastomers.
• Fully submerged in high -grade
attachment points.
p
• Temperature: 140 °F (600C).
turbine oil for lubrication and efficient
Power Cable: Severe -duty rated
Maximum.
heat transfer.
oil and water resistant.
• Fasteners: 300 Series Stainless
... < :..�.a......:.. ri o;.,y: I?rn� /lrJG�,f;nciti. \; lV .�OM�IY�y, = :.�.�.;
�..��!�?i]i _ `_,^.� ._.A:... ... ...._.:i- ...._ATV....-
......,.e , w.,.. .. ... �.. ! ...... � `•� -� ...... v,+
No gaskets to replace during
• Capable of running dry without
Available for automatic and
maintenance.
damage to components.
manual operation. Automatic
Stainless steel fasteners.
models Include Mercury Float
Switch assembled and preset
at the factory.
APPLICATIONS
Specifically designed for the
following uses:
• Effluent systems
• Homes
• Farms
• Heavy duty sump
• Water transfer
• Dewatering
Pumps inc Effective December. 1991
•e
t
10 - _
8 ---__
6 ---�"
9
5
4
3 -
1 ---�
2 ✓
PARTS
1. Impeller
2. Rugged thermoplastic base
3. Rugged thermoplastic pump
casing
4. Mechanical seal
5. Ball bearings
6. 0 -Rings
-c ..7. - ::PQWeF
�,• •�` -mil 1`III8C1 (1101'01' "`•... '._V >.- .. `•.,. �j
9. Cast iron. motor housing /stator
assembly
10. Thermoplastic motor cover
& r r I I:
i
a
�,.fk ,'�Tyy 4a`i.a+w Iq�•ei.i aK ''����":
1
b
4
DIMENSIONS
(All dimensions in inches. Do not use for construction purposes.)
PERFORMANCE RATINGS
Total Head
Gallons
(FT of Water)
Per
Wis.
Minute
5
53
10
46
15
36
20
21
24
0
DEL
J
MODELS
Series HP
Volts Phase
Max. RPM Solids
Power Cord
Wis.
Amps Handling
Length
(lbs.)
EP0411
115
12
10'
20
EP0412
230
6
10'
E P0411 A 4/10
115 1
12 1550 114,
10'
21
EP0411F
115
12
20'
20
EP0412F
230
6
20'
20
EP0411AC
115
12
20'
21
SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. PRINTED IN U.S.A.
MODEL: 3871
SIZE: 3/4" SOLIDS
V
RPM: 1550
METERS FEET
8'
25-
7-
LIJ 6- 20-
2 5-
< 1 5
Z
4-
-j
3- 10
0
2-
0- 01 1
0
10 20
30 40 50 GPM
0
2 4
6 8 10 12 m3/h
-CAAAMY-
[QGOULDS PUMPS, INC.
SIRCKA FAILS NEV YORK 13148
Effective October, 1988
01988 Goulds Pumps, Inc.
SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE PRINTED IN U.&A
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services
FOR PERMIT APPLICATION SUBMITTED TO
PUTN,kM COUNTY HEALTH DEPARTMENT
.1 TO: Commissioner of Health
In the matter of application for:
Ooo�&
YVAZI/0 llliZA
represent that I am in officer or employee of the corporation and am authorized
to act for
Name of Corporation
having offices at 1Z?>j UBE42*y 5f
a
Whose officers are:
President:
Vice— 'resident:
A"Ve-'Ne-L— -
Name and Address
(Name and Address)
(Name and Address)
Treasurer:
(Name and Address)
and that I am and will be individually responsib
corporation with respect to the approval request
thereto.
Sworn to before me this day
0 f I 190
'Notar' Public
ARLENE FAUSTINI
-,,NOTARY PUBLIC OF NEW JERSEY
M,, Commission Expires June, 24, 1996
C 'S'
si�
Ti
Corporate Seal I
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
I .. s.; - a,.1°�x`` %.;`_ .;y: .':` ,SR ai�_:�'v;.'i*•a�e..w•;s .s :ri ::r`•i�<'.... "h e <.
Date._
Re: Property of. Ot4M I'_\l��l.bMEA'4i W. WC.-
Lo c a t e d a t Cku WA
(T) 15A13-1-9, Section Block Lot 9
Subdivision of LINGAL 2 `3i.IWN60N
Subdv. Lot # 2 Filed Map # 2205ft Date _
Gentlemen:
This letter is to authorize 11451- F-1461KE90 N4D LEjaU-_
a duly licensed professional engineeror registered architect
(Indicate
to apply fora 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
system or systems Yin conformity with the provisions of Article
147, Education Law, the Public Health'Law, and the Putnam County Sani-
tary Code.
Very truly
Signed
Countersigned;:
P . E . , 1?4--.-:A
de J. coNt�l.MD p�
1N�11� �-Aun w_, AND GSIGN .
Address
&NR
CA�P'l�L► N�( ►t�l?
q4 -2 1=51& oo
Telephone
er'2 property
OD. wc.
Address
Lk tl. - MEL ILA 11(v4�)
Town
'?- 0 J 4-.0 •- 47 d 0
Telephone
VVm Oat)
mm
DESIGN DATA SF T- SUBSUFACE SSTAGE DISPOSAL SYSTEM - FILE NO.
ie -::pr > „�'r rC'r�:d.a: • c: ddr., 3,. s. ..�'fx`.'v`r,oi'=r:',°•: "r.c�.: f,.,e�. '�. r:�y •_ .- :�.e�: "�`'.+.sr - »�s :^r� .w ;.i..a c. • .::i... +..:- 9`+- :..�o�e ... ........:...:. ',f,, . .-. ..
Owner G �Acm ,ogniA7_a P& I w. . Address "7-A IT r40AY
Located at (street) CHtiI 90, Sec. > ,/ Block % Lot
(indicate nearest cross street)
[Municipality PLT ,0 ✓,jM t -A j L L51 Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Date of Pre- Soaking Date of Percolation Test
HOLE
NUMBER CLOCK TIME
PERCQLA oN
PERCOLATION
Run Elapse
Depth to Water Fran
Water Level .
No, Time
Ground Surface
In, ;Inches Soil Rate
Start -Stop Min.
Start Stop
Drop In Min /In Drop
Inches Inches
Inches
1
2
3
4 - - -.4 �L��'il +t/ / LGo1.�17'lpYt✓ IzA32E Or-
1
2
3
4
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 fran top of hole.
0 /O^
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
IN TEST HOLES
Ad t,r�.i• R.�,�^,�.- Y1��",j -D �. Vii:, �. c ^y" - � ''^ �'ii� -' ._ a.. T' :�e.•.� �- ,.�r`��•:H`...... V 4 ._.
UEF'iH
G.L.
1'
2'
3°
4°
5°
6°
7'
8°
9°
10°
11'
12°
13°
R,,Y� 5:S
ft C:> , 0- S
Ao4K & 7 "
INDICATE LEVEL AT WHICH GROUNDWATER IS ENOOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: dd ,afP4 Z11&5*k,1 sZ AI,S. DATE: /
DESIGN
cgoigRate Used _ Min /1" Drop: S.D. Usable Area Provided S �,
Lt )o. ,`of Bedroc�ns 5 Septic Tank Capacity ! 40c,>o gals. Type
0 L' - .bsKption Area Provided By SC0CD L.F. x 24" width trench
, cthez R ! 1✓L. p1/.► -r!i� /Jl gE �rl�'r
F�ignature ,
Address /� 1"��" 6' SEAL
�,•q�m�.3? /' ✓� ltd; /-Z- % A
gloO
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved sq.ft/gal. Checked by Date
PC -1 •
PUT NAM COUNTY D E PARTMENT O F H EAL TH
a•�.r+ ...' e•w..��..t7.� _ S. _y'o- i'.��wn.
�'rC' ��)F `�.r.: ���, .�.. •w Ly �.�i .. .. o• .. :v.
111'iYL1Zl'11 lvl� �`�ii \`�hr"� ��li`�n� v'i . .:ti.'i.�"�Q v`�.rf'��..^ti.. '�+'.�,�. ro'�..a�. .�a.:L.:a,• �r ..
1. Name and Address of Applicant: UNCAVV 1EyF:.OPM%f CD, INC.
� -IttL� FERRY+ N�. ►�7(og3
2. Name of Project: f�6Db Vc? Ut4CK- MYU}a15141 3. Location T /V /C: Rl13k1 ALLEY
4. Project Engineer: !N01* RhUI EP O AOD I 1C 1.5. Address: ifl4q Pte. (v
P G CAP -MEL, iCEi2
License Number: 010131 Phone q 4- 225-&2n0
6. Type of Project:
Private /Residential food Service Commercial
Apartments, Institutional Mobile Home Park
Office Building Realty Subdivision Other (specify)
7. Is thi.s project subject to State Environmental Quality Review (SEAR)?
Type Status (Check One) Type I.. Exempt
Type II. Unlisted_
8. Is a Draft Environmental Impact Statement (DEIS) required? .............
9. Has DEIS been completed and found acceptable by Lead Agency? ........... WA
10. Name of Lead Agency
1:1, J- <dis: i�roje;.L� it -i _aft �s�ca ��der the coiitrcl cf lsxa? planning, xo "i "�,+ 2i.Df�. i✓EPF• fOR
or other officials, ordinances? .......... ..............................
12. If so, have plans been submitted to such authorities? .................. WD
13. Has preliminary approval been granted by such authorities? 0IR Date Granted: PJA
14. Type of Sewage Disposal System Discharge...... Surface Water _Ground - Waters
15. If surface water discharge, what is the stream class designation ?........ N
16. Waters index number (surface) ........... ............................... N
17. Is project located near a public water supply system? .................. 1`b
18. If yes, name of water supply WA Distance to water supply NfA
19. Is project site near a public sewage collection or disposal system ?..... trip
20. Name-of sewage system N1k Distance to sewage system _iA
21. Date observed: UNKNOWN 23. Name of Health Inspector: 1Jt4Y-1`a9N
24. Project design flow (gallons per day) ...... ............................... .Zarn G'PD
2.
25. Is State Pollu't ant "Oiscnai=ge-1 iiminati "1Cin "4S-yti:i4r (�pwS; ��• �� ���• _ °�•� = =-
26. Has SPDES Application been submitted to local DEC Office? ...............
27. Is any portion of this project located within a designated Town or State
wetland ? ................ ................ ............................... No
28. Wetland ID Number ........................ ............................... NVA
ems,
?9. Is Wetland Permit required? .............. ............................... y ��
Has application been made to Town or Local DEC Office? ..................
30. Does project require 'a DEC Stream Disturbance Permit? ................... No
31. Is or was project site used for agricultural activity involving application
of pesticides to orchards or other crops, solid or hazardous waste disposal,
landfilling, sludge application or industrial activity? ......... YES or NO NCB
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
DESCRIBE:
33. Is there a local master plan or file with the Town or pillage? ........... YES
34. Are community water, sewer facilities planned to be developed within 15 years? No.
35. Are any sewage disposal areas in excess of 1'5X slope '.... . ".... e
..
36. Tax Reap ID Number ......................... ............................... 118-179
37. Approved Plans are to be returned to: Applicant _X_ Engineer
If the application is signed by.a person other than the applicant shown in Item 1, the
applic igq,must be accompanied by a Letter of Authorization. Failure to comply with this
pro .0bn Way be grounds for the rejection of any submission.
�A
w _J va
0 -,.- 7
6,r'herLbby affirm, under penalty of perjury, tat information provided on this
LUrs true to the best. of my &noodledge belief. ]se statements made
: _Z: here i are punishable as a Class A K* anor p t to Section 210.45 of
``= tie Pena 1 Law. _
SIGN 'RE &Z& OFFICIAL TITLES:
`i
4AILING ADDRESS: 2tl ubp_gj -i Cjf.
LIME FAY, N j 1-1&43
1
LOT 3 128-36
N 8636'24 E I N 83'34'59' E
76.16' 99.76' N
__: WELL
DNT kA
SWI� LOE
�Vllll LOT 2
AREA
1.142 ACRES
V
Der-K Aar>./E
f
�w
CO""�67S
M OA/ L+ 4! A1T
LOT I
CATION OF THIS DOCUMENT, UNLESS UNDER THE DIRECTION
LICENSED PROFFESSIONAL ENGINEER, IS A VIOLATION OF
ON 7209 OF ARTICLE 145 OF THE EDUCATION LAW.
A
AS —BUILT MEASUREMENTS
NO.
C
D
REMARKS
1
10'
gA
PtiL iM.iK
2
2S
29,5'
PUMP PI}
tJO.
A
REMdW{h
3
Is3'
-
obt. eox
9'
IAo'
13'
END tRE.xH
S
�oA'
115'
u
94'
l03'
q
7
III'
i3'
i
Putnam County Department of Health
Division of Environmental Health Services
Approved as noted for conformance with
applicable Rules and Regulations of the
Count sith Department Qy
t
S gnature & Title o
RECORD OWNER: LINCAR DEVELOPMENT CO. INC.
281 LIBERTY STREET
LITTLE FERRY, NEW JERSEY 17643
TOWN OF- PUTNAM VALLEY
PUTNAM COUNTY, NEW YORK
TAX MAP NO. 73.18 -1 -9
NOTES;
1. THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM
WAS CONSTRUCTED AS INDICATED ON THIS PLAN AND THAT
THE SYSTEM WAS INSPECTED BY INSITE ENGINEERING AND
SURVEYING, P.C. BEFORE IT WAS COVERED OVER. THE SYSTEM
WAS CONS7RUC7ED IN ACCORDANCE WITH ALL STANDARD
RULES AND REGULA77ONS OF 7HE RJI 9 COUN}Y
DEPARTMENT OF HEALTH AND THE NEW YORK STATE
DEPARTMENT OF HEALTH.
2 ALL FACIL177ES EXISTING, UNLESS N07ED 07HERWISE.
J TOTAL LENG7H OF FIELDS REQUIRED 500 L.F.
TOTAL LENGTH OF AELDS PROWDED SW L.F.
b rn
cn
c' _ m
N m
2 <
cn _, m
N
DATE I REMON
rP 7-7 E
INSTI 1 SUR
1491 Route 22, Brewster, New York 1050£
PROJECT SSDS FOR
LINCAR DEVELOPMENT
CO. INC.
LOT NO. 2 LINCAR 2 SUBDIVISION
DRAWING:
AS -BUIL T DRA WING
PROJECT 92135.'bo2 PROJECT JJC
BY
N0.
OF NEW YO
V J. rON,-,
DRAMNG NO. I SBEET