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HomeMy WebLinkAbout3544DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74. -1 -19 BOX 28 03544 im T �rNm "r6 , ` ` �., ,z , 03544 ..�anarrva VC s16�t1,Tf1 m, €ti• ` I . `� , _ , .YI X ", y - - -3, \n U ( „ blvlafon of BovhoomeaW He�tfh Seevber, Grind, N.Y 10511 P.C. D Mp Pi` P.C.B.D. P.V. —51-85 Loaded at . �.,' "'Oiiner %pplli�lat��iame ._sue MaRhrg Ades Z u I•s b w H: i .) , R) Fee Enclosed E2 Amount or vubw Subdlvwon Name BOSWEL_L . ESTIA.TES 9 Subdv. Lot # 25 Date Permit Issued 1'.;) �1RA Separate Sewerage System built byJ014N OT,AM Aaaa AME AS ABOVE Consisting of 1000 Gallon Septic Tank and - - 2 0 0 LE TR T r A T T F R I E S water sip*: Public Supply From Address on * private Supply Drilled by NORMAN ANDF.RSQNAddreesl 52 BARGER ST a , PUT . VAL. N. Y 1 'PAM _ RF.S Lot Size u/9 g'yPe ( ) 1 .006 ACR$as Erosion f:nnt•rnl RPpn CrImnlotoA9VF,5 Number of Bedrooms 3 Has Garbage Grinder Been'hrstatiod! NO other Regolrementa BANK RUN FILL (3FT ) _ I certify that the system(s) as 'listed serving the above premises were constructed essential a shown on the pl of the cc�plated, work (copies of which are attached), and in accordance with the standards, rules and r one, in ccc a with the fil 1 Putnam County Department Of Health, the permit issued by the Oats 1 1/ 9/90 Certified by P.E. R.A. Address tkenonof 1140.11056 Any person occupying premises served by the above system(%) shall promptly t h act as nay be necessary to secure t rection of any unsanitary conditions resulting .from such usage. Approvall of the separate sewerage system gall becona null and void as soon as a . tanitary sewer becomes available and the approval of the private water Supply shall become null and void when a public water supply becomes wallabN. Such approvals are Sublect to modification or change when, in the Judgment of the Commissioner Qf_Naalth, such revocation, modification or change Is Ier wry. '89 Date - 17-1 ell zz 2 PUTNAM COUNTY DEPArrmE,NT OF HEALTH Provide Permit N to CERTIFICATE Division of Environmental Health Serrloew Carmel, N.Y. 10512 OF / Permit CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM M._ � own at Village at.. S a Name o5w Eu., �-� _Tys Subd. Lot N �� Ta= Map 61 Z M Block 10 _Lot M_fAZ—Q—LV Renewal Z164 © r P TL owner /Appikaut Name val Dae o Previous Appro Mailing Address cot Town �/tb?.1K CAS � � 0It D Mdhtg Type �� -Lot Area a FIU Section Only Depth __Vohrmlj�IeW Number of Bedrooms Design Flow G P D PCHD Notification Is Repaired When FW Is com Separate Sewerage System to consist of Gallon Septic Tank sad To be constructed by' call �� Address Water Sapph•' 9. Public Supply From . Address on veto Supply Drilled by �dd�� >ddeaa Other Req*emeate 1 represent that I am wholly and completely responsible for the design and location of the proposed system(Q; 1) that the separate sewage_ disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations o e u ham County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Heaahwill be submitted to the Department, and a written guarantee will be furnished the owner, his succeaor heirs or assigns by the builder, that said builder will Place in good operating condition any part of said sewage disposal system during the period of (2) years immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of th final system or a r pairs thereto; 2 that the drilled well described above will be located as shown on the approved plan and that said well will be install in Gordan with t standards, ► and regu a ons of the Putnam County Department of Health. p,E //! /.A. r. Date ��� /i(J / ��i//��( �L San� ll6�R� Adtlress�y C'� ° © . Q t license No APPROVED FOR CONSTRUCTION: This approval expires two years from he ate issued unless construction or the Duping nas Dean unaerca Ken ano ,a revocable for cause or may be amended or modified when considered nec , essaU by the Commissioner of Health. Any ch nge or alteration of construction requires a new permit. Approved for disposal of domestic sanitary sewage, and / t water supply � —'—'� TiTitle , Date � [• / , By •G AL Private Supply.: to be',drrlled,;by` Addre 's _ !her Requirements E T. 44'` epresent•.that I am_wholly and completely ►esponsrbl 'f-"- th ovedescribedwilr: constructeda `sshown;ontheappio`ved; suomr[ tea, to.,tne 'uepertment and a- written guarantee, W' ij be furnished the ;o sce in good operating .condition any part of ;said sewage disposal system durir ce_pf.:the- approval,ot the ;Certrficate:,of Construction Compliance of the origir II be.loeated as shiawn'On the approved plan avid that said well will De i felled in .a� iunty'Departrnent of Hbaltfi. 4 3 ite Signed "Address -` )PROVED FOR CONSTRUCTION This approval expires one ye fro the da vocable for cause or, may be amended or modified when.c ere nec nary fl wires a new permit. Approved for disposal of dome is sa d a e andj( Q�. gns.by the-builder,_that said builder-will mediately "following:thedateto4 the ;,issu- 2)_ that .the drilled? -well 'described above ules and regu a..rons of. the Putnam P.E. R. Lke- nseMNo. he. building has been undertaken and is. nvry._ ^ ° rro4. :►ion of construction 24 i000 GhL _ 200 L>r of .GALL r-21c -o. ... to • L 6 •° ,r3 M °P � d pjrl6 1 '• '^�� c9rio7 5c, Pf. 1.004 GGItS•�(, • 1.>i' jai -rte � � 11 •I' _ A 4"r- g . ".i._ D�ST(LIisUTI °l.l a / 6 W 5 U iT SO / 6kPq,K • r W Conc. Mon. . / O Fl. N• l i'• Go' oo" E 13 -5!ee. d. G. Berm .7--7 w r --- IZ�h 2 c ai Ilu e • b. i .. '�kl.s,IS T0,CERTI'FY THAT THE SEWAGE DISPOSAL SYSTEM WAS CONSTRUCTED AS ZNDICAT: I ON THIS PLAN AND THAT THE SYSTEM WAS INSPECTED BY HE BEFORE IT WAS COVERED OVE 4' f`RE SYSTEM WAS CONSTRUCTED IN ACCORDANC$ WITH. ALL STANDARD RULES AND REGULATION'S PF THE42UVw - COUNTY DEPARTMENT OF HEALTH AND THE NEW YORK STATE DEPARTMENT OF�i HEALTH. ti v.. rl0' 3 <: I S' F d i m 3 39' 24' y to q 5 41' 3l r ! . 50' 3°) ! -7 9 7' $o' c al 32' E I a m I O W 'an n W .O ; to rutnam uouuty llaparLV. i:. sprra� c t "c• f:. mp J ?.I.R.. "oc� t f 4. � Z �I,i I LT SS o S I ivi , ":40.00' '1 r F- a 0= :: [GW •• WZ w, Z4 • WJ • Wa" • c 0 0 Z � • VD ZF- ►• W WU _•_ ow ii t;t p+ c 11 i i alth ' Director John &Lucy Olam 20 Boswell Rd. Putnam Valley NY 10579 Dear Mr. & Mrs. Olam: :19A TTY - - MOL.INART Associate Public Health Director 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 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 April 9, 1999 Re: Addition- Olam- Boswell Rd. No Increases in Number of Bedrooms (T) Putnam Valley Tax # 62-10 -4- -- I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposat.for the addition has been approved as per plans bearing the approval stamp form this Department dated April 9, 1999 The addition is approved with the following conditions. 2. 3 -- The tt�tal: umber of bedrooms must remain at'r`" ree without prior approval by this department. The area of the existing sewage disposal system, and its expansion area, must be maintained. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley. If you have any questions, please contact me at your convenience. ML:kg cc: BI Very truly yours, Michael Luke Public Health Technician 1 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278- 6130 Fax (914) 278-7921 PROPOSED ADDITION APPLICATION (RESIDENTIAL ONLY) STREET . I>CZ w F4-t_ k bb . TO. WA R VAUSYTX MAP # - - v4 did AA . b L-A m / NAME/,w t✓Y C-7. at-4.,K PHONE-610' (36' °5' PCHD # (� Public Health Director MAILING ADDRESS 20 5it�_5WJELt- DESCRIPTION OF ADDITION 15�71 A-) t S t4 F-b NUMBER OF EXISTING BEDROOMS PROPOSED # OF BEDROOMS O (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 form and the following to Putnam County Health Dept., 4 Geneva Rd., 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 r riw:r:'r . , :h����:.�� �,.• . >` -7� '.,. •.r- .. - :..� .. . .i. v^e. -.m. c� ":.:� ._ - �: " -.:;: �,v�..c ,i•",,'�.... K , `."r.` , a � e .'e� .. PUTNAM COUNTY DEPARTMENT OF HEALTH s DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVUDAL ADDITION/REPAIR FORM SECTION A: GENERAL INFORMATION Name of Project Z- 0 &° S'r (T)(V) TM# Year of Construction Size of Parcel SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. 06 y ❑Rolling ❑Steep Slope entle Slope ❑Flat 2. ❑Evidence of wetland Clow area subject to flooding Modies of water ❑Drainage ditches ❑Rock outcrop 3. Property lines evident? - 4:'Watei'cou Fs- es exist'on; or`adjacent`to pac14 �" ".'""' °"� "" "� "'� ❑ "'" ' ° "'� " " " " ""'""I 5. Existing individual wells within 2 00f of the existing SSTS? Lam" ❑ SECTION C. EXISTING SUBSURFACE SEWAGE TREATMENT SYSTEM(SSTS) 1. Physical character of existing SSTS area. , A. ❑Level Gentle Slope Steep slope B. ❑Well drained Moderately well drained ❑Somewhat poorly drained ❑Poorly drained C. Area available for SSTS. (Primary & Reserve) ❑Extremely limited ❑Somewhat limited dequate ft x ft QEPARTMENT OF HEALTH Division ; bf Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 Putnam County Dept. of Health' 4 Geneva Road Brewster, NY 10509 Re: U �. Residence Tax Map 1 q _ - ) - 1 �t Town BRUCE R. FOLEY, R.S. Acting Public .Health Director Gentlemen: According to records maintained by the To`tim, the above noted dwelling LS ✓ _ _ a.. IS NOT in compliance with TO«m code and the total number of bedrooms on record is This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: ✓� OTHER 'L�\c0113 P1/9 IV 26v; Building nspector CERTIFICATE OF OCCUPANCY - One Family/No Deck --Certificate of occupancy No ....9 ...........Application No ..... ��-596 Location of Premises ... John ... q�am ................................................ of..2.0..Bo§�Tll Road Putnam Vall heretofore filed an a lication for a bujlding pernuit ........... qy.2.. N.Y. having Code and the L, p Pursuant to the Zoning Ordinance Sanitary Laws 9 eifect in the Town ofd tnam -Valley, Putnam County, New York, having paid the required fee therefor and the undeiil6ed having by personal inspection ascertained that the applicant has subsequently proceeded with the erection or improvement of the proposed struc. ture in Compliance with the requirements of -the laws as aforementioned and that the. said work and materials met every requirement of the laws as aforementioned and that the Premises have now been fully completed and are ready for occupancy pursuant to the provisions of law, Now, therefore, this certificate of occupancy is hereby issued, under the seal ..... . ...... day of ...... pecember of the Town of Putnam Not valid unless signed in ............................... ink by a duly authorized .­.of and under the seal of the Town of agent Putnam Valley. TOWN 0 NAN VALLEy," NEW YORK By....... ........... ........ r, .......... ............. IN GIs ilk yZto r P trtt i. PUTMAN COUNTY DEPARTWOM OF EMALTE1, - Dividen of Zuvhowaental Health Services, Camel, N.Y. 10512 Enebseer mug POWAde oil 'P.C.H.D. Permit -6 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSIEA9 Town or V, Located at Taz P&p RIC& Owner /applicant Name Fom Subdivision ZIP Subdv. L o t Mailing Addraza Fee Enclosed E3 Amount 0,'!"! .'0 Date Permit Issued Separate Sewerage System bat by C-naladne of Gallon Septic Tank and water Supply: Public supply From l Add. Z7. Y- - 71-- or: Private Supply Drilled by l- I 79 e ri Boding TYIP, I Lot Size C_ -Has Erosio ntrnl ReAn rnmpl,-t -7 Number of Bedrooma —Elm Garbage Grinder Been Installed? 7 Otber Requirements I certify that the system(s) as listed serving the above premises were constructed essentially as sham on the plans of the completed work ( copies of which are attached) , and in accordance with the standards, rules and regulations, in Ipcoidar.6-o with the fil", Pan, and the permit issued by the Putnam County Department Or Health. Coto Cartifled by R.A. Address'- P4... Any person occupying promises swvod by the abovo syotom(Q shall Promptly taIx(L24ch o"bdn aj may be nocomrV to secure the correction of any unsanitary .conditions resulting from such usage. Approval of the separate sewerage sy"em $hall becomp null and void as soon ao o 'Pubv: sonitary's9wo b0comm ovallabla and tho opprovol of the private water supply sMIJ become null and void rih<m a publk water supply becolrAs ovallable. Such approvals ore subject to modification or change. when, In tho judgment of tho Commissioner of Memith, sukh rovamaition, modification or chanV3 to etocoaaary. F 3/89 Cot 0 By i` _r...:_„ : ,.,..x, „ ,. ; ,L, . _ P,[T'NF1M COU1�T1'X.:DEPP►t2'IlT�' ,OF -HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICE'S JOHN OLAM Owner or Purchaser of'Building JOHN OLAM, Building Constructed by 20 BOSWELL RD. Location — Street TOWN OF PUTNAM VALLEY. Municipality ONE FAMILY RESIDENCE Building Type 62 II 10 7 Section Block Lot <6 S� BOSWELL ESTATES Subdivision Name 25 Subdivision Lot # GUARANTEE 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 ate for°-a: ° `iod of- at��ao- ears= �ixned9.ate1" ` fol lchvirl. e., to of_ a pp roval -of the..... "Certificate of Construction Compliance" for the sewage disposal 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 determination of the Director'of- the Division of E,nvironinental 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 7 day of Nnu_ 19Q_ Signature -OWNER Title n al Contractor (Owner) Signature Corporation Name (if Corp.) Address rev. 9/85 mk Corporation Name (if Corp.) 20 LEY, Address N.Y. 10579 I do Gv O4 WELL UUMrLhT1U11 rtrxumi DEPARTMENT OF HEALTH. D'ivisi'on Of'En* v - i f6nmentAl HeAlr tel�v164 PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET _AOURESS.: WNIVI 1 TAX GRID NUMBER: Boswell Estat6S­­­,'Putnam VA11eX_._ NY /7- WELL OWNER NAME: ADDRESS: Olam 8 Hoover Road Yonkers, NY 10710 Q P81VATE 0 PUBLIC USE OF WELL 1 - primary 2- .secondary 6 RESIDENTIAL 0 PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP 0 ABANDONED ❑ BUSINESS 0 FARM ❑ TESTIOBSERVATION7 r .:p )OTHER (specify) ❑ INDUSTRIAL 0 INSTITUTIONAL 0 STAND-BY 0 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 ONEW SUPPLY (NEW DWELLING) ❑DEEPEN EXISTING WELL DEPTH DATA WiLL'OEPTH ftl :20 STATIC' WATER LEVEL ft. DATE MEASURED!' DRILLING EQUIPMENT ❑ ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE 0 SCREENED OX OPEN END CASING ❑ OPEN HOLE IN BEDROCK 0 OTHER CASING TOTAL LENGTH 19 _ 6 ft- MATERIALS: 113 STEEL ❑ PLASTIC 0 OTHER LENGTH BELOW GRADE 195 ft. JOINTS: 0 WELDED 0 THREADED 0 OTHER DETAILS DIAMETER in. SEAL: O CEMENT GROUT 0 BENTONITE 13 OTHER WEIGHT PER FOOT lb./ft. J.DRIVE SHOE. DYES 0 0 LINER: DYES 6 46 SCREEN :-, -DETAILS. , DIAMETER (in) SL07 SIZE LENGTH (11) DEPTH TO SCREEN (it) DEVELOPED? FIRST 0 YES ONO. HOURS GRAVEL PACK 0 YES ❑ NO .,. GRAVEL SIZE: DIAMETER OF PACK — in. TOP DEPTH tL BOTTOM DEPTH — It. WELL YIELD TEST 1, If detailed pumping M�THOO: 0 PUMPED 1 tests were done is in- OCOMPRESSED AIR formation attached? 0 BAILED 0 OTHER 10 YES 0 NO -It more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. DEPTH FROM SURFACE water Bear- ing ' V oa -FORMATION DESCRIPTION CODE tt It WELL DEPTH It. DURATION., hr. min. ».DRAWIJOWN YIELD gpit'. Land sufla ce 6,1 Fill, tf _lBr� '710 6 C lim6sftone 5 WATER 0 CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? 0 YES 0 NO STORAGE TANK: TYPE Well—X—Troll #250 CAPACITY GAL. PUMP INFORMATION TYPE pE 'SUbmerRible CAPACITY - Grundfos 600 MAKER OEP��H - - 537 _10 - �2 2 Ju 'I MODEL VOLTAGE — HP WELL DRILLER NAME DATE 7/24/90 Nom. an Anderson Inc ADDRESS 152 Barger St SIGOMRE Putnam Valley, NY 3/89 I-A Yorktown Medical Laboratory, Inc. 'B # 321 Kear Street Date Taken: �- �' ��% Time: Date Rc d . Time: sa ^ Bath (914) 245 -2800 Collected By: ,M ,-..,f1.� Director: Albert H. Padovani M. T. (ASCP) PO /Client # T" , Referred By: 0 TUB Sampling Site: It r 7n, "_ 7 ' ri /V y Phone ( I/ ) 7 T �i 6 _REPORT.ON THE QUALITY OF WATER jG 3....' 2= INORGANICS mk/L) MICR5BIOLOGICAL Alkalinity Standard Plate Count Chloride _ (CFU /1 ML) `— Copper Detergents, MBAS Membrane Filtration Method -` Hardness, Calcium Hardness, Total Total Coliform Iron __.. Lead — Fecal Coliform _ Manganese _ Fecal Streptococcus Mercury Nitrogen, Ammonia Most Probable .Number Method w Nitrogen, Nitrate Nitrogen, Nitrite - Total Coliform„_ — Phosphate, Total Fecal Coliform Silver -- Sodium ....._.,.._�._ ..:, Fecal Streptococcus. —_ Sulfide •Presence /Absense (PA) ± Sulfite - - Zinc Total Coliform P A PHYSTCA17MISCELLANEOUS KEY FOR TERMINOLOGY PH (S.U.) CFU = _ Color (Units) IT = Conductance (uhms /c) GT = Odor (TON) NA = Turbidity (NTU) $A = TNTC Colony Forming Units < = Less Than = Greater Than Not Applicable See Attached Too Numerous To Count (For Lab Use) ;&AMPLE TYPE: (Check One) ✓Potable. ... -' _ Non - potable OUTGOING: (Check Each) ENO —_ HC13 _ H2SO4 NaOH — ZnOAc Na2S203 — Other: INCOMING: (Check Each) _. GT 4 /1E 200C GT 20oC. _ pH LE 2 pH GE 12 Other: NYS FLAP #10323 - -- REKMSMOMMENTS or Lab se THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS .(WAS NOT) (NA) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO YORK STATE PUBLIC_ DRINKING WATER CODES, FOR THE PARAMETERS TESTED, AT THE IKE OF SAMPLE g0JACTION. THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID)-_ -(DID NOT) (N MEET THE SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STAA�COLLECTION- z.xz DRINK - ING WATER CODVS, FOR THE P _S TESTED, AT THE TIME OF 2 J 7 /87(Rvsd1 /90)RWE "s DEPARTMENT OF HEALTH ` Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914). 225 -3641 '`: ":`APPLICA7*ION'TU CONSTRUCT` A WA3'ER-WELL- • T ::~` -` PCHD PERMIT # WELL LOCATION Street Address e � Town /Village /Cit Tax Grid Number Ry_T0A M VA, (,3,7 . WELL OWNER Name C)iA -t,!. i_A M Address t0rivate OcZ4 Ep— V-cl• kA S iffj i () ❑ Public USE OF WELL - primary 2 - secondary .RESIDENTIAL ❑PUBLIC SUPPLY ❑AIR /COND /HEAT PUMP 0ABANDONED BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify ® INDUSTRIAL 0 INSTITUTIONAL ❑ STAND -BY 13 AMOUNT OF USE YIELD SOUGHT �j gpm /# PEOPLE SERVED .4 OF DAILY USAGE gal REASON FOR DRILLING ;OEW SUPPLY ❑ REPLACE EXISTING ❑ PROVIDE ADDITIONAL SUPPLY ® TEST /OBSERVATION SUPPLY ❑ DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING go NBUC SQ! & NVA-WABLE FOR b4AQSIG SE WELL TYPE DRILLED DRIVEN ®DUG ®GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES —NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Z05WU— ., 5 S-tA -T LS Lot No. WATER WELL CONTRACTOR: Name M©T SELECT D Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY - DISTANCE" TO' PiROPERTY -FROM- NEAREST `WATE-R°'MAIN,: -- --, .,- T LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED 1141 [:]ON REAR OF THIS APPLICATION N SEP ( ate) Asif6ature 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. Date of Issue: 19� Date of Expiration: 19 ermit Issuing Of icia Permit is Non- Transferrable o• a a a "� fiPUTNAM COUNTY HEALTH: DEPARTMENT � S ?, d {'m §' _ � - n F y�v"I L r y yrt�,,,.k§. 4'"� # �.alN •!;. aP`�''� �'4Y`4+,, e1 ^ " � 'S. 'S ,3„ ; N c . "', + �a� ♦ . < t '� "'.'? ` � i+R •et '' q� S DIV .-ISION OF ENVIRONMENTAL'HEALTH SERVICES" r W John M. S'immons;: M D • • y ,{:fi Sheet' of Ileput Commissioner of Health -FIELD ACTIVITY REPORT .NAME .- Orig. Routine Y °ri 7 w Orig, Complain ;�ADDRE$S Orig. Request No. Street Municipatlity (T)(V)(C) Compliance - _ Co plaint `Comp MAILI -NG ADDRESS �JZ '� d s Final 5 P.O. -Box Post OffLCe Zip;Code _, Group Ilhness Construction #TELEPHONE. x r rx j Reirispection PERSON IN CHARGE Field`,,' "Samp1 "ing. Only ORt :INTERVIEWED Field .Conferen'ce ^ .. Name and Title •- Other ,PATE �^'(`�% TYPE':FACILITY TIME ARRIVED :JZ TIME,LEFT�,' Explain r "•`FINDINGS: ;, �. �. i� - „_ _ r .n , L _ a. n u F , - r. 0 , n, 3 r S € r i ^ p, 7a a4 u f , r INSPECTOR �d� TELEPHONE: ' ,IN 'C INTERVI-EWFD I: acknowledge receiptF-of a :'copy :of this SIGNATURE E Field: Activity Report i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ' Y • . v. _ -i . _.mot_, . • / - r .... 1 l.'i -rt•. -,? '': 4�� .. .,.7• ' -•-i. j,L . , V • .V.y...y ..-r ! �.- :. ,.....3 + ,COUNTY OFFICE BUILDING, CARMEL, N., Y. 10512.,• DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL >SYSTEM FILE N0.' Owner FRANK 'P&gTr= `Address 2665" VILLAGE gD, Szewat-a w, ia- •off Located at (Street ` CdCq' .c jZ• ' Sec.�21L Block IO Lot _ _.... w::P,: imlicate neare$ cross. s ree MunicipalityC�. Z. WatershedCID',�tJ G� :..SOIL PERCOLATION TEST DATA MU I�RED.TO BE SUBMITTED WITH, APPLICATIONS, Hole . Number..::.....CLOCK..TIME PERCOLATION PERCOLATION stun Leptin Lv wavur watier Level.. No. . ...:.......... .....'. :. ;:... Time ' .. From. Ground., Surface in Inches Soil Rate Start -Stop -Min. Start, Stop .Drop in 'Min. /in drop Inches Inches ..Inches. PT1i#1 ..- ]...9:45' 10:15 30 •15 17.75 2.75: :: 3012:75 =11' 2....10 :.19'• . -. -. 10:49 . 30 15' 17.75 .2.75 30/2675 =11 11:23 30. 15 17'_ 75 '2 _ 75 30/2.75 =11 ,1...9:..:50, 10:,20 30,1,¢ 16 _ __19 3._- 30„L3 =10 _cr.'•a'L .-<.. �.v - - -.. .•. � � .. w�,•s C -:+... y„-.. ....7wc -.�F. wGn_.PP..�`i rn. .. .�.��. .2...:10 •.2.1 '.•. .•y...•• •..... r r . .. ° .... •;..,.�.. ..•n� �. _ . 11:.22 30 16 18.75 2.75 • 30/2..75=11' R ■ , Notes: ,1) T§Ats to.be repeated at same depth until s roximatelyy 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 HOLES NO. DTg,--h�f HOLE NO. 73Z { ''rC f OT fG:'�:': =i G.L. _lQP 5,01 L_ E .SorL 6Rt4 1Py AT L \\j 5Ar4D'y Nt,AT1.L 6 S•TCN s G L.4 4, C iii 24" 36" 42" 48" 5 11 60" 66" 72" 78" 84 _ :10ICATE:_L IM A _ ICH GROUND WATER IS ENCOUNTERED 3L o � - w _ ._ 1T1'MIC'A�Ez1f5_MM- ­TO -W r , :.RSSES AETEB® IC; ElliCi OLJrN_TEREt3-�,.1..: •y. _;.. _._ .�... TESTS MADE BY ase-5 Date DMIGN Soil Rate Used ((- t Min/1 "Drop: S. D', Usable Area Provided 5� a o p �J No. of Bedrooms 4_ Septic Tank Capacity M-0 D Gals. Type? e", Absorption Area Provided By ov.L.F.x24 —" . enc . N E GR -game. Joel Greenberg - Architect Signat 'e Nuscoot No. /RFD N2 /Bx 488 O A Address Mahopac, NY 10541 S �. A THIS SPACE FOR USE BY HEALTH, DEPARTMENT ONLY: "N NE`N Soil Rate Approved Sq. Ft /Cal. Checked by Date I •' • la 316VALIP'NIMO 009P Y 04• Mme. _ DFBIGN DATA SHF2:'1- SUBSUFACE SEWAGE DISPOSAL SYSi 4 µ FILE 'NO.+ - - .Owner John Olam Address 8 Hoover Rd., Yonkers, NY 10710 Located at ( Street) B o sw e 11 Rd . Sec. 6211' Block 'LO Lot 7 (indicate nearest cross street) Munici Fai. � 1 Putnam Valley Watershed Hudson River .tY SOIL PEROOLATION TEST DATA RDQUnW TO BE S[MMITIHD WITH APPLICATIONS'.. Date of. Pre - Soaking 10 /08 Date of Percolation Test 10/12/88 HOLE NU&M CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start-Stop Min. Start Stop Drop In Min,/In Drop Inches Inches Inches l 2:40 -3:10 30 19 20 1 30 min /inch 2 3:10 =3:!40 30 19 20 1 30 min /inch 3 3:40- -4:10 30 19 20 1 30 min /inch 4 5 l..'_2`.4 -; -1,5 '30 201 "f2 - - ?1 _l %2 i _ -30mirr /'inch':.... :'<: •. _ 2 3:15 -3:45 30 20 1/2 21 1/2 i 30min /inch 3 3:45 -4:15 30 20 1/2 21 1/2 1 30 min /inch 4 5 1 2 3 4 5' NOTES: l.. Tests to, be repeated at same depth until appradmately equal soil rates are bba ained.at each percolation test hole. All data to* be submitted for review. 2. Depth measurements to be made from top of hole. rev. 9/85 i YDWOO�Vff lyl%m;7Li DESCRIPTION i DEPTH HOLE N0. T-1. G.L, Tnn �ni 1 1° Sandy Loam 20 & Clays 30 Stunes 4° _- 5.g 65 7° 8° TO BE SUBMITTED WTM APPLICATION IIIS ENCOUNTERED IN TEST HOLES HOLE NO. T-2 HOLE N0. Sandy Loam & Clay w/ some Stones 9° 10° 11° . 12° 13r_ .mr.�n..w � Y : • �w,........ - ._ Sy..sc - .— m-i .... ..:. 1°Q INDICATE LEVEL AT WHICH QDUNMTER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTEM DEEP HOLE OBSERVATIONS MADE BY: Joel Greenberg DATE: -- DESIGN Soil Rate Used 21-30 Min/j°° Drop: S. D. Usable Area Provided 5. 0 o n s F No. of Bedroams 3 Septic Tank Capacity 1000 gals. Type r n n r Absorption Area Provided By L.F. x 24°° width trench Other 200 L.F. rri-- Galleries _ .,QED e4 Name -- - - - - -- -- - - -- Signature Joel GreaneArchitect.. . Muscoot No IFiPo #2 Box M.ahom MY 10541 Address _J SEAL THIS SPACE FOR USE BY HEALTH DEPA! ONLY: Soil Hate Approved i. ft /gal. 0- o,y�ked h�.), _ �1 C Date