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Home My WebLink About3531DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74. -1 -9.15 BOX 28 ., 03531 no mill I 8 ■ IL a, I T 61 .t 'T ` 16 �'� 1 1 I �� 03531 7. PUTNAM COUNTY DEPARTMENT OF HEALTH 318 Rev. 3 2-4-2 —1 — W W on a en Services, Engineer must Provide PV-1-2—H P.C.H.D.PerwAt#____ OF CONSTRUCTION COMPLL4,NCE.FOR SEWAGE DISPOSj PUTNAM = VALLEY Tax Map _3 4 1 Block 1 Lot 9 O.ner/applicantNam CHRISTOPHER JUMPERFrm, y 291 BARGER ST. PUTNAM VALLF Np I 0 r, :Z li .-. 9 Mailing Address NEW YORK Subdivision Name JUMPER - Subdv. Lot # _5 Date Permit Issued 749,96 Separate Sewerage System bufft.by G.H_ 'K.ET.I.V - & SON Address NORTH IRT.Tly L—M=ORL CERTIF T. QF T,PACHI-NG CT. 06776 J Located at2.2 on a en Services, Engineer must Provide PV-1-2—H P.C.H.D.PerwAt#____ OF CONSTRUCTION COMPLL4,NCE.FOR SEWAGE DISPOSj PUTNAM = VALLEY Tax Map _3 4 1 Block 1 Lot 9 O.ner/applicantNam CHRISTOPHER JUMPERFrm, y 291 BARGER ST. PUTNAM VALLF Np I 0 r, :Z li .-. 9 Mailing Address NEW YORK Subdivision Name JUMPER - Subdv. Lot # _5 Date Permit Issued 749,96 Separate Sewerage System bufft.by G.H_ 'K.ET.I.V - & SON Address NORTH IRT.Tly L—M=ORL Consisting of 1250 —Gallon Septic Tank and 51195 T. QF T,PACHI-NG CT. 06776 J FIELDS Water Supply:. Public Supply From Address or:— X Private Supply Drilled by P.E_ RRAT, Address 4 PUTNAM AVP_,, -RR EWSTER,_NY BuIlding-Type ONE FAMILY RES. —He. Erosion Control Been Completed?. YES 10509 Number of Bedrooms 4 Has Garbage Grinder Been Installed �O Other Requirements 1.5 FT*. OF BANK RUN FILL— I certify that the system(s) as listed serving the above premises w a const c ' ted as ent cted as ent wqO ly as a plans of the completed work copies of which are attached), and in accordance with the standards, ruin an regul io 6 d.4ce filed plan, and the.permit issued by the Putnam County Department Of Health. Date 2/24/97 Certified b y P.E. R.A.--Y- Address 2 MUSCOOT RD. OR H, AAHOPAC, NY 0 5 41 License Mo. 110 5 6 Any person occupying premises served by the above system(S) shall promp Vtak' su action as may be necessary t secure the correction of any unsanitary �hen conditions resulting from such usage. Approval of the separate sewerage a. all become null and void as n as a pub'%. sanitary sewer becomes aval6ble and the approval of the private water supply shall become null and void a public water supply ecurnes available. Such approvals are subject to modification or change when, in the judgment of the Com.mlssloner o val o tion. modification or change Is I necessary. Data By Title Z5 6% -ce WELL COMPLETIUN "2rUkC1 DEPARTMENT OF HEALTH PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION SiREEi ADDRESS: wNrw TAX GRID NUMBER:. N. Meadow Lane, Lot #5, Ratnam-Malley, NY WELL OWNER NAME: ADDRESS: Christopher Jumper, 291 Barger St., Putnam Valley, NY ❑ FBIVATE ❑ PUBLIC USE OF WELL 1- primary 2 - secondary 01RESIDENTIAL 0 PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP C1 ABANDONED 0 BUSINESS 0 FARM ❑ TEST/ OBSERVATION 0 OTHER (specify) 0 INDUSTRIAL 0 INSTITUTIONAL 0 STAND-BY ❑ AMOUNT OF USE YIELD SOUGHT 5 gpm./NO. PEOPLE SERVED _/ EST. OF DAILY USAGE gal. REASON FOR DRILLING []REPLACE EXISTING SUPPLY []TEST /OBSERVATION []ADDITIONAL SUPPLY E]NEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 245 ft.1 STATIC WATER LEVEL�Oft. DATE MEASURED 11/20/96 DRILLING EQUIPMENT I@ ROTARY CR COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT 0 CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE 0 SCREENED 0 OPEN END CASING Ea OPEN HOLE IN BEDROCK 0 OTHER CASING DETAILS TOTAL LENGTH 41 — it MATERIALS: 0 STEEL 0 PLASTIC 0 OTHER LENGTH BELOW GRADE 40 ft. JOINTS: ❑ WELDED @THREADED ❑ OTHER DIAMETER 6 in. SEAL: @CEMENT GROUT ❑ BENTONITE 0 OTHER WEIGHT PER FOOT 19 1b./It. I DRIVE SHOE. El YES 0 NO LINER: QYES EINO SCREEN .. DETAILS DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (it) DEVELOPED? FIRST 0 YES ONO t GRAVEL PACK 0 YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. I TOP DEPTH ft. BOTTOM I OEM — IL WELL YIELD TEST If detailed pumping 1 METHOD: 0 PUMPED 1 tests were done is in- * COMPRESSED AIR lormation attached? * BAILED ❑ OTHER i ❑ YES 0 NO it more detailed formation descriptions or sieve analyses 'WELL LOG. are available, please attach. DEPTH FROM SURFACE Water Bear- inq Well oil- meter in FORMATION DESCRIPTION coal tt. ft. WELL DEPTH ft. DURATION hr, min. ORAWOOWN ft. . YIELD gpm• Land surface 2 DrlliN in overburden clay & boulders 2 Hitiroc'... at 21 2451 6 hr. 1801* 12 2 41 Drilling in rock, set casing, grouted 41 245 Drilling in rock granite WATER 0 CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? OYES, ONO ANALYSIS ATTACHED? 0 YES 0 NO STORAGE TANK: TYPE Well Xtrol WX#251 CAPACITY GAT,. 62 PUMP INFORMATION TYPE submersible CAPACITY 1Ogpm MAKER Goulds DEPTH 200, MODEL 10GS07412 — VOLTAGE 23_0 Hp 3/4 WELLORILLERNAME P.F. BeTl & Sons, Inc. DATE 3/1 97/ ADDRESS 4 Putnam Avenue SIGNATURE Brewster, NY 10509 9.* 0, - ma4mim/1'. Beal,( LIT, JIM GREENBERG TWO MUSCOOT ROAD NORTH MAHOPAC, NEW YORK 10541 914 628-6613 FAX 628-2807 PRINTS SPECIFICATIONS SHOP DWGS El SAMPLES OTHER APPROVAL tOVA. -YOUR -tJ-b--E- 0 REVIEW COMMENTS Ji COMMENTS: ENCLOSED PLEASE FIND "AS BUILT" FOR YOUR APPROVAL. JUC-1 GR9C-NBERC, TO: I..a .. w•ata r�. :.C'4•_�•.O'rt a..r 1�- jY r. .�. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMErAL HEALTH SERVICES - - ;.. .._ v .. ' o. t': .. . ..: i.ta+a •.4 +n_f'LC a r r.. CHRISTOPHER JUMPER Owner or Purchaser of Building OWNER Building Constructed by NORTH MEADOW LANE Location - Street TOWN OF PUTNAM VALLEY Municipality ONE FAMILY RESIDENCE Building Type 74. 1 9.15 Section Block Lot" JUMPER Subdivision Name 5 Subdivision Lot # GUARAb1TEE 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 TEN years immediately following the date of approval of the r _. "Certificate of Construction Compliance" for the sewage disposal system, or any __i"3 TitadG '�)y'Iu2":tti 'lIZ`h ~ystEaity �n�cPt where ule� a�ui4iLC'v° iipE r3`..e irCpf9r y" 1S' 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 11 day of MARCH 19 9 7 General Contra for er) t Signature HOME OWNER Corporation Name (if Corp.) 291 BARGER STREET Address PUTNAM VALLEY N.Y. 1 0 5 7 9 rev. 9/85 mk Signatures 1 k4l as Title OWNER G.H. KELLY & SON Corporation Name (if Corp.) 1 NORTH KELLY MOUNTAIN ess NEW MILFORD,CT. 06776 203 - 354 -5440 A NORTH AMERICAN LAB ®RATI�� -. RIE N m 4 �� :�t.\- �CA�.. ...� - +..'�i'i.. n�c•1 c �.:T.". -: R' � � ... _' � .. .• V 1 M.n•iYt` <w\ � CERTIFICATE OF LABORATORY ANALYSIS LAB ID NUMBER: 97 -0089 CLIENT: P F Beal & Sons 4 Putnam Ave Brewster NY 10509 SAMPLING LOCATION: Chris Jumper, Lot #5, Putnam Valley COLLECTED BY: MTB DATE COLLECTED: 01/07/97 TIME COLLECTED: 10:30 AM DATE RECEIVED: 01/07/97 DATE OF REPORT: 01/09/97 ANALYTE RESULT* UNITS MAX CNTMT LEVEL ** METHOD ANALYZED Total Coliform Absent E. Coli Absent Must be "Absent" SM18(9223) 01/07/97 Must be "Absent" SM18(9223) 01/07/97 This sample, as submitted to the laboratory, and as compared to the New York State limits for drinking water ,quality for the tests performed,, wa s la...... _..... _!`....ACCE1 TABLE " r w�_:._ ,. _..�o. ..,wivOI ACCEPfi 13[E::.. NYS ELAP #11218 CT Lab Approval #PH -0171 * Underlined results are unacceptable according to health department and /or US EPA codes. ** Maximum Contaminant Level (maximum permissible concentration allowed by health department and /or US EPA codes). ,618 Clock Tower Commons, Brewster, NY 10509 -9241 / 914 - 278 -7600 / Fax 914- 278 -7754 / E -mail: NoAmLab ®aol.com 22 APPENDIX C FINAL SITE INSPECTION DATE: jh �� Inspected by: (Ar _, _ _ STII!E _ P OCAT:"..'+� ?✓, - t9E J - PERMIT '12 6 TM OR SURD I V I S I ON LOT 1. SEWAGE D I SPOSAL AREA a. SDS area located as per approved b. Fill section - date of placement 1). 1 4,--- 4-- 1 l-Tu c. Natural soil not stripped d. Stone,brush.etc.,greater than 15' e. 100 ft. fran water course /wetlands 11 SEWAGE DISPOSAL SYSTEM a. Septic tank size - 1,000 b. Septic tank installed level c. 10' minimum from foundation d. DISTRIBUTION BOX 1. All outlets at same elevation - 2. Protected below frost 3. Minimum 2 ft. original soil bet YES I NO I. OOMMENTS e. JuNUT ION BOX - properly set f. TRENCHES 1. Length required - 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 feet from property line - 20 feet - foundations 6. Depth of trench < 30 inches from surface 7. Room allowed for expansion, 100% 8. Size of gravel 3/4 - W' diameter clean 9. Depth of gravel in trench 12" minimum g . PtJ�P OR DOSE SYSTEMS 1. Size of PL= chamber 2. Overflow tank 3. Alarm visual audio 4. Pum easily accessible manhole to grade 5. First box baffled 6. Cycle witnessed by Health Department T i _ ,_ L _. 1 1 1 . BOUSE a. House located per a roved plans b. Number of bedrooms IV. WELL a. Well located as per approved plans b. Distance from SDS area measured ft c. Casing 18" above grade d. Surface drainage around well acceptable V. OVERALL { ORKMANSH I P 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 installed according to plan f. Curtain drain,outfa.11..protected & dir to exist g. Footing drains discharge awa� from SDS area h. Surface water protection adequate i . Erosion control provided watercourse i _. /i, ' I p�YwdOwrw�wlr 6 MMwt. �1. N T lMU M CO�IQ tco l l d w• �IJAl�= , parr olr WWAM ti steal P' ` ti PUl'1VAM VALLEY r, 1 NORTH NIE,ADOW LANE'' ,r ."s JUMPER PROPERTIES �'..� �... 9.5 CHRISTOPHER 7UMPII2 t....tl =b+idM 79 . r a DEPARTMENT OF HEALTH Divisizon 'of Envir_" nnnental Health Services 4 Geneva Road, Brewster, New York 10509 (91�4) 278 -6130 APPLICATYUN TO' CUNSTRUCZ ;- '6 9 R.' WELL PCHD PERMIT # WELL LOCATION Street Address Town/Village/City Tax Grid Number , NORTH MEADOW LANE TOWN OF PUTNAM VALLEY 74, =1 -9.5 WELL OWNER Name Mailing Address CHRISTOPHER JUMPER 291 BARGER ®Private ST. , PUTNAM VALLEY ®Public USE OF WELL primary 2 - secondary ?2 RESIDENTIAL 0 PUBLIC SUPPLY ® BUSINESS ® FARM ® INDUSTRIAL O INSTITUTIONAL Q AIR /COND %HEAT PUMP ® ABANDONED 0 TEST /OBSERVATION p OTHER (specify 0 STAND -BY AMOUNT OF USE YIELD SOUGHT 5 gpm/ # PEOPLE SERVED 5 EST. OF DAILY USAGE 375 Ral, 0 REPLACE EXISTING SUPPLY 13 TEST/ OBSERVATION 13 ADDITIONAL SUPPLY 43 NEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING NEW HOUSE WELL TYPE ®DRILLED ®DRIVEN []DUG ®GRAVEL. ®OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: JUMPER PROPERTIES Lot No. 5 HATER WELL CONTRACTOR: Name NORMAN ANDERSON Address: BARGER ST . o PUTNAM T.TT T T T1T)_ N.Y. IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO RAM OF PUBLIC WATER SUPPLY: N/A TOWN /VIL /CITY - NC�? :T . O- PP- .Oz?EIIY EROM, _N3iAR:?eT ':?;A_ LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED (, ` 5/31/96 UON SEPARATE SHEET 1 (date) (sign u PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, thirty (30) days of the completion of water well construction 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements Department attached to this permit. granted under the.provisions and provided that within the applicant shall: 4.r of the Putnam County Health 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: �C:f 197 - - ---z -- V Date of Expiration 19� Permit Issuing Ofi Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller F[ TrNAM CWt�'rY DEPARIMENr OF HEALTH SECTION I t , LOT-' 5 DIVISION OF MWIMUMML HEALTH SERVICES M8IGN DATA SHEET- SUBSUFACE SEWAGE DISEQSAL SYSTai FILE NO. ' • =- ��Gr�3��•ii�t�,- uih'�1�E�i=- ,; �� - - ��%3'cr�s' EEC `SIi.E= ��t�tfi�`Ni�Ni�i7A�1:,�Y °•ly�'•: `�10'S�t�.•3�. -: tested at (Street) BARGER STREET' _ Sec. 74. Block 1 Lot 9.5 (ind -irate nearest cross street) M&icipality TOWN OF PUTNAM VALLEY Watershed HUDSON VALLEY SOIL PERCOLATION 71r'Sr DATA REQUIRED TO BE SUBMUTIED WITH APPLICATIQNS bAtA .of Prt- -Soaking 1/7/93 Date of Percolation Test 1/8/93 HOLE TIME Roh Elapse Depth to Water Fran Water Level. 1.75 Not Time Ground Surface In Inches Soil Rate - ' Staxt -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches T- 9:22 -10:52 30 23 25.125 1:'75 30/1.75 =17.1 H 10 :53- 11:2330 23 25.125 1.75 30/1..75 =17.1 z.:3 11:24 -11:54 30 23 25.125 1.75 30./1.75 =17.1 11:55 -12:25 30 23 25.125 1.75 30/1.75 =17.1 .5 CT: tt 9:24 -10:54 30 23 26.75 1.75 30/1.75 =17.1 H , ?. -. .1 0 5:5.<m1,1.- .251 = � - 2 3.: ..-. _ -: 26., ?w5__ .. �,. _:1: ?:5 _ r' .s i . 3,0,E 1a, 7 5� 1.7 `1 - w 311 °.26 -11:56 30 23 26.75 1.75 30/1.75 =17.1 - X11;57 -12:27 30 23 26.75 1.75 30/1.75 =17'.1 2 NM'ES: 1:. Tests to be repeated' at same depth.,.until approximately equal, soil rates are obtained at each percolation test hole. All data to'be subaittlad tot review. 2. Depth nnasure merits to be made fron top of hole. rtm 9/85 bi ii HOLE NO. DTH #1 HOLE NO. DTH #2 HOLE, No. o FINE SILTY LOAM WITH SMALL TRACES OF CLAY 41 lit' .10, FINE SILTY LOAM WITH SMALL,-IRACES OF CLAY m IF NONE -,11NOICATP, LEVEL AT WHICII GROUNDWATER IS ENCOUN'T'ERED LEVEL TO WHIM WATER LEVEL RISES AFTER BEING NMUNTERFD NONE bEtP HOLE OBSERVATIONS MADE BY:JOEL'-0=4tERGf R.A. DATE: 2/8/93 .......... . .. DESIGN boil jqAte Used16-20 Min/I" Drop: S.D. Usable Area Providr-_-rJ51000 140. of Bedrooms 4 Septic .Tank CbPacity 1250 gals. Type. CONCRET; kgor'ption Area `Pir 6vided By .672 L.F. x 24" width trench Oder i FT, 6 R fq V-- Z0 IJ 6 RA VS L NIT Ar;A :;,Waffia —.-JOEL dMENBER(�j R.A. Adcttess TWO MUSdOOT ROAD NORTH MAFTOPACI NEW YORK 10541 ......... . , THIS 'SPACE P10A USE BY HrAVrH DEPARIMENT ONLY: S ighat, R 0 n kit: Soil Rate Approved sq. f t/gal. CheckeYb/ . Date PUTNAM COUNT- Y'.DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES „ -ti _.�i.ii.. •.:ct�•,µ�1cr2T �,.'��.Y.. ";,�,. � ^ ^er>,rv- •"�a".e.� -fti:i .' •�.i•.u:7'n- ,iiz�'..�2- �..�ti.: .:.!•�:: is �•+c�.:••�,.�.a�i -� �•.- :,�,= ,ter-- 'w..rv:+w�� -�:T� !••.} -- .. y�` Date 5/31/96 Re Property of CHRISTOPHER JUMPER Located at NORTH MEADOW LANE (T) PUTNAM VALLEY Section 74• Block 1 Lot 9.5 Subdivision of JUMPER PROPERTIES Subdv. Lot # 5__—Filed Map # 2617B & C - ___Date 5/6/96 Gentlemen: This letter is to authorize JOEL GREENBERG a duly licensed professional engineer__ or registered architect X' (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 ~�-•--co•��ne•ci: ion -- with° •i:hzs- matt-°er-`dilu- •�.ci••° supervise 'th� °wcnristru'cfion`of "said` �"'-`�'' ' . a system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. �tEaED QRc �6��EN�E F � O n o" Counter✓si P. P . E . , R. A. , #_ 11056 - - -- TWO MUSCOOT ROAD NORTH Address �~ MAHOPAC, NEW YORK 10541 (914) 628 -6613 Telephone ___ _ —� - - -- Very truly yours, S 1 er of jPropeYty • :' : H:i: 71yG N,11 Address . PUTNAM VALLEY, NEW YORK10579 -- Town - - -- — 628 - 528 -8762 Telepheee - - -- HUZ'NAM COUNTY n��,,.�'�'MLI�TT' C7F I3FALTI�I APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM ... .. a. .. .. . .. .r r .._. . rr :"4• ^I' •;t ,' r v .,.. t -. •t7't0 ! .. . . .`� ;rl ..n 1. Name and Address of Applicant: CHRISTOPHER JUMPER 291 BARGER STREET PUTNAM VALLEY, NEW YORK10579 2. Name of Project: NEW RESIDENCE 3. Location T /V /C: OF PUTNAM ARCHITECT VALLEY 4. Project E9yWffr:. JOEL GREENBERG, R.A. 5. Address. TWO MUSCOOT ROAD NORTH MAHOPAC, NEV, YORK 10541 License Number: 11056 Phone: 628 -6613 6. Type of Project: ._ Private /Residential Food Service T Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 7. Is this project; subject to State Environmental Quality Review (SEAR)? Type Status (Check One) Type I.. Exempt Type II. Unl i sted X 8. Is a Draft Environmental Impact Statement (DEIS) required? ..... ......... NO 9. Has DEIS been completed and found acceptable.by Lead Agency? .....:..... N/A 10. Name of Lead Agency N/A 1. Is this project In an. area under the control of local planning zoning oL ii.er. o:f..f {�`ia..: -S�- hrCf. ?haPres? :.....:.. ..:... ..:....:........:....::.. .� ...r ... ._ _ }. 2. If so, have plans been submitted to such authorities? NO 3. Has preliminary approval been granted by such authorities? N/A Date Granted: 4.'Type of Sewage Disposal System Discharge...... Surface Water*** Ground Waters 5. If surface water discharge, what is the stream class designation ? ;....... N/A 6. Waters index number (surface) ............. ............ .................. N/A 7. Is project located near a public water supply system? ................... NO 3. If yes, name of water.supply. N/A Distance to water supply 3. Is project site near a public sewage collection or disposal system ?..... NO ). Name of sewage system N/A Distance to sewage system i. Date observed: 2/8/93 23. Name of Health Inspector: MICHAEL BUDZINSKI 1. Project design flow (gallons per day) ...... ............................:.. 1 800 2. 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.,NO 26: I as Sf�bES -Apol`ic6ff 'been submit dd t`o `coca ID•EC" D'ffi'c ?' ::-......:s :.:.. 27:. Is Any portion of this project located within a designated.Town or State ... .. NO wetland ?......... 28. Wetland ID Number ......... ........................ ........ N/A 29. Is Wetland Permit requfired? ............................................. NO Has application been made to Town or Local DEC Office? .................. N/A 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. disposaI,. landfilling, sludge application or industrial activity? ........ YES or NO - NO 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 Village? YES 1 34. Are community water, sewer facilities planned to be developed within 15 years? NO 35....Are_ any .Sewage. disposal are excess of 1.5% s_l. - . _ - . .. .., as i n .exce ope? sE •.. :�.._..v v'... w• .....v. ...... �.�.. -...n ... .-� ....L .+... - Ar w. _.�. <....- �..^.+� -.s es..,.•t {. — .._........ w.a •- ._.�,L ._�.�... vv v'.� r ....� -.. .+. �.-.. ..4 ... ...•.Y S.._m.•.. .�r...+i....a -. i. .w__� .Ir3 •.w. 36. Tax Map ID Number ......................... ............................... 74.- 1 37. Approved Plans. are to be returned to: ................. Applicant X XKK4XXW ARCHITECT If the application is signed by a person other than the applicant shown in Item 1, the applications must be accompanied.by a Letter of Authorization. Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my know7edge and belief. False statements made. herein are punishable as a Class A Misdeme r pursua t to Section 210.45 of the Pena 7 Caw. (I� 1� � SIGNATURES & OFFICIAL TITLES: ROAD NORTH BAILING ADDRESS: --+MOPAC, NEW YORK 10541 N26'13'30" E so,7 a• ' 2•(1,3:1- 'ltL �•t _ � . i, t1 111- 1-:,0.0 a' uL 9 .PIt�Gs _5.T_ GOhiC/ } 134.42' e s3�-zo•:>o•• a2 4 AS.eui T L0 'T10&%. Ih A 691 301- 3 90'° (020 G 112? 8H 7 p 142, o Imo. 14-5 `' 130 z 148 105 a G 75231405 • E4 f5S° 1 a J ltis' °.1503 K q3° ° L 1956 1 1700 M 0/86 too• N 1978 172° O 1036 10'30 L991 1,150 4 1096 1090 R 2026 (770 T 2029 1781 �► 1434 134° V 176° 16 — VV tv u .0 y N Putnam County Department oY Health V� Y rid J livieion of Environmental Health Service: V� f m .r ??roved as noted for :onforoance with � /� U rclicahle Hules e.r:u ctt• l.etions of the ~N 'utnam County Hea to Department. A I! 3.3Z,.6-4.°l. SF :o¢ 7.635 � nq .ra Y t Irnatura R Tit7.4 Q N r. ;.oe OR 4. _ t-. Dvj ..�� I 63.2r t� ` � V• � Z '(_ •'S16•<1'aC>'•vl 3"7!9' � � �� 512•:SCi1G "W w � �� Lo,,C .i P oe N � _ THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WAS .CONSTRUCTED AS INDICAT -D F4 ON THIS PLAN AND THAT THE SYSTEM WAS INSPECTED BY 'ME. BEFORE IT WAS COVERED 'OVER. TyE SYSTEM HAS CONSTRUCTED IN ACCORDANC$ WITH ALL STANDARD RULES AND REGULATIDNS ' "a )'.. ^-,F TMV PUT. COUNTY DEPARTMENT OF HEALTH t,. '/\ •f"7 _ I f , •.t 6 Ih {Fyaj O �c6 w z� <, W�O//0� z 8�� U) �11 N W 0 VV tv u .0 y N Putnam County Department oY Health V� Y rid J livieion of Environmental Health Service: V� f m .r ??roved as noted for :onforoance with � /� U rclicahle Hules e.r:u ctt• l.etions of the ~N 'utnam County Hea to Department. A I! 3.3Z,.6-4.°l. SF :o¢ 7.635 � nq .ra Y t Irnatura R Tit7.4 Q N r. ;.oe OR 4. _ t-. Dvj ..�� I 63.2r t� ` � V• � Z '(_ •'S16•<1'aC>'•vl 3"7!9' � � �� 512•:SCi1G "W w � �� Lo,,C .i P oe N � _ THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WAS .CONSTRUCTED AS INDICAT -D F4 ON THIS PLAN AND THAT THE SYSTEM WAS INSPECTED BY 'ME. BEFORE IT WAS COVERED 'OVER. TyE SYSTEM HAS CONSTRUCTED IN ACCORDANC$ WITH ALL STANDARD RULES AND REGULATIDNS ' "a )'.. ^-,F TMV PUT. COUNTY DEPARTMENT OF HEALTH t,. '/\ •f"7 _ I f , •.t