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631- 589 -8100
74.06 -1 -17
BOX 28
1 IN
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NMI NO
03577
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR
YES NO Internal Use Only
❑ ❑ Repair Permit issued In last 5 years ❑ Not in Watershed
❑ ❑ Repair within Boyd's Corners, W. Branch or Croton Falls Res. ❑ Delegated
❑ ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joiflt Review
SITE LOCH'
OWNER'S IS
MAILING X
APPLICANT
DATE
PROPOSE[
ADDRESS
Proposal (include a separate sketch locating the house; property lines, all adjacent wells within 200
feet of repair and the location of existing.and proposed trenches)
S.
NOTE: Repair must be in same location' and'of'same type as original sewage disposal system.
Different location and proposed pump systems *ill require submittal'of proposal from licensed professional
engineer or registered architect.
I, as owner, or reported a nt of ner agree to the conditions stated on this form
SIGNATURE TITLE DATE
Proposal approved with the following conditions:
1. Procurement of any Town Permit, if applicable.
2. Submission of as built repair sketch in duplicate showing:
a. Owner's name
b. Site Street Name, Town and Tax Map number
c. Location of installed components tied to two fixed points
d. System description (e.g., 1250 gal. Concrete septic tank, etc.)
e. Installers' name and phone number
3. System repair to be performed in accordance with the
above proposal and conditions.
Proposal Approved Proposal Denied
Inspector's Signature & Title
Date
1410-1 -
flcr)�L65
Ul� l�s QUi LAS �,
COPIES: White (PCHD); Yellow (Town BI); Pink (Installer), Orange (Applicant)
PC -RP 99ML
Rev. 8/05
IUD KU CK EXCAVA TNG, WC.
P.O. BOX 395
Mahopac Falls, New York 10542
To whom it may concern, June 12, 2007 914 - 2486148
Prior to requesting this permit I had received a telephone call
from Robert Cibelli who resides at 125 Bryant Pond Road. He discussed
his concern with me that his current septic system was not functioning
properly. In order to determine the exact problem I had to dig test
holes at.the site indicated above (this took place earlier this spring).
The test results determined that water tables were high at this
location. I also exposed one of the fields and found that it was sitting
on ledge.
My proposal at this time is to install a curtain drain and a new
septic tank approximately 2 1/2 ft higher than existing tank. In addition
approximately 1ft of bank run will be needed as well as new infiltrators
in gravel to complete the new septic system.
If anyone would like to meet out at this site to go over what I
have proposed please telephone me at 914 760 6606.
Thank you,
Edward Kuck
y
PUTNAM COUN'T'Y DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES.
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner Address .� /�/✓ i /���
_
..Located-at (Street)--.-- — — - - - =- - - - =- -- =- -__. -- - — - -- T -ax4 ap-% (� - $lock- ..... J - — hot..... 7_. _..._..._ ._ . .
(indicate nearest cross street)
Municipality Watershed
SOIL PERCOLATION TEST DATA
Date of Pre- soaking Date of Percolation Test
1
2
3
4
5
A
2 1
tC
.4
5
1
2'
3
4
1 1 5 1- I I I I I
NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each
percolation test hole. (i.e. s 1 mini 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
DEPTH
G.L.
0.5'
1.0'
1.5'
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'
9.5'
10.0'
TEST PIT DATA
DESCRIPTION OF SOILS IENCOUNT ER ED.1114 TEST HOLES
HOLE NO. (T64
D 3'
jLM LV AM
SivTy to l
' Gel
HOLE NOQ
ZoAr)
HOLE NO.
Iry -
fjkrwN Sid A�
a1T��
row SP,1191 (HIV)
Indicate level at which groundwater is encountered - NOA(6
Indicate level at which mottling is observed AleI'le
Indicate level to which water level rises a bein encountered A
Deep hole observations made by:
Date 201/07
Design Professional Name:
Address:
Signature:
dDesigm
2
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR
❑ 19
❑ ❑
❑ ❑
SITE LOCATION
OWNER'S NAME
MAILING ADDRESS
APPLICANT / I!
Internal Use
Repair Permit issued in last 5 years
Repair within Boyd's Corners, W. Branch or Croton Falls Res.
A
Not in Watershed
❑ Delegated
Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review
Name & Relationship (i.e., owner, idna
DATE XL LL. FACILITY TYPE
contractor) PC H D COMPLAINT #11f1t*00
PROPOSED INSTALLER F9 Y C&Lj l-AQ 14L PHONE# IAm deW 6P
ADDRESS
2
-0, S 11REG /LICENSE # C /D
Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200
feet of repair and the location of existing and proposed trenches)
NOTE: Repair must be in same location and of same type as original sewage disposal system.
Different location and proposed pump systems will require submittal of proposal from licensed professional
engineer or registered architect. ; 1 _ • _ If _
/,4& wells e��� y�i,� " /oo-P '4
I, as owner, or reported a nt of ner agree to
SIGNATURE
the conditions stated on this form
TITLE DATE
Proposal approved with the following conditions:
1. Procurement of any Town Permit, if applicable.
j y 2 )Submission of as built r pair sketch in duplicate showing:
a. Owner's name
b. Site Street Name, Town and Tax Map number
c. Location of installed components tied to two fixed points
d. System description (e.g., 1250 gal. Concrete septic tank, etc.)
e. Installers' name and phone number
3. System repair to be performed in ccordance with the
above proposal and conditions
Proposal
spector's Signature & Title
Proposal Denied
��(/ fit- .S �' b �.,.�' f-;>✓ z..•,f
-71,!r o&.:
Date
COPIES: White (PCHD); Yellow (Town BI); Pink (Installer), Orange (Applicant)
PC -RP 99ML
Rev. 8/05
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Mahopac P.O.
alls, New York 10542
�rj/2007 914- 248 -6148
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DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
August 3, 1994
Larry Elkan
125 Bryant Pond Road
Putnam Valley, M' 10579
Re: Addition -
Dear MIr. E1 kan:
JOHN KARELL Jr.. P.E.. M.S.
Public Health Director
I have received anc reviewed the plans for the proposed addition tc the above
me=cr:ed residence.
The ola^:s have been approved as per plans bearing this Departments s.amp and
daiec August 2 1994.
The surrey indica-es that sufficient area exists to expand or rapair the sewage
d-s 'Cosa. system, should it become necessary in the future. Therefore, based cn
the information submitted, the above mentioned addition is approved with the
follcwing conditions:
1. -he `otal numoer of bedrooms must remain at four without prior approval by
th?s Department.
2. -ha area of the existing sewage disposal system, and its expansion area, must
be maintainer.
3. All plumbing fixtures must be replaced or updated with water saving devices,
low Push toilets, restrictors for shower heads and faucets, etc.
Approval is granted for sewage disposal only. 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.
Ver truly yours,
h" 4,;.
Robert Morris
Public Health Engineer
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- - - - -- - i - -- - �- -- -
_ M_r.Robert Morrid
,Dept.of Evironmental Health
j4 Geneva Rd. _
Brester, NY 10509 7/5/94
Dear Mr. Morris,
Hello! Per our conversation today plea
----- - -- - -- se-- fi -nd -- copies - - -of deed- ,approx;.location- -o'
;well and septics and other paperwork
---- - - -. -- !required -- for -- your- -of -f- ice - submi -tting - -a- - - -
letter to Putnam Valley Zoning Board
_Jattes.ting_ -.to ._the - adequacy_of.- -our- septic -s'
system.
.In_27_ years we _ -have. - never - had_- a._proble
,Our septic is cleaned every year(see att.
4_•____________i4ndour_ water isalso -- checked_.on_a _reg-
ular basis. The anticipated usage will
astill- use less water than the .house .was.
;initially intended for in 1964.
H._ ___._Any.__questions - please- call - -- either
myself or Lenore Elkan (in the
.:Putnam.. County__.Distr.ict_.Attys - office)... -__ _
Please forward this cert.to P.V.
toni 9___Clerk__Ms. Fran.- Houghton._ ASAP_!_ .. _
Her # is; (914) 526 -2439.
Check_ #815 for $100.. _.is__- encl.. ...___.
,Thank you very much!
i
Yours tr ly,
;i
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OF ':o0il/O v /E -/-t/ AGES '
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SURVEYED & PREPARED
BUNNEY ASSOCIATES
ENGINEERS & SURVEYORS
156 KATONAH AVE.
KATONAH, NEW YORK
- -- SURVEYED AS IN POSSESSION
N. Y. S. Li C. No. 28694
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SURVEYED & PREPARED
BUNNEY ASSOCIATES
ENGINEERS & SURVEYORS
156 KATONAH AVE.
KATONAH, NEW YORK
- -- SURVEYED AS IN POSSESSION
N. Y. S. Li C. No. 28694
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YML ENVIRONMENTAL SERVICES
321 Street
Yorktown Hoights, N.Y. 1Q598
(91-4) *2245-28-00
Alber-1. H.-Padcivani-, Director
LAD #:
9S.0084,,:D6 CLIENT #: 2 5 1
INON - STAT PRO: PA GIE
P11111-111,_4 ___
ELK.AN,
LENORE
1_1111e_._______ I—
DATE/TIME TP4-,`EN'
(D11103/94
125 SR.WIN-11
FIDNE, PD
-DATE/TIME REC"D:
PUTNAM
YALLEY, NY 14") 55 7'.31
REPORT DATEt
31,106/94
PHONE,. (,-,,14)-52S-,1:_�:.142
i, -,� -I
SAMPLINC.3 SITE' AVz"�' ASfDVE K., "CHEN
BY; L.E4"40RE ELK'AIN
NOTE $.. .
DATE PLAG ppf"Df.:E111jRE
TAFF TYPE. . • PID"TABLEE
PRP-:, EF0,,1AT_11v'Es: NONE
COLIFORM METH: MF rr
RE-SUL T NORMAL - Arr
(.') I / ; /9 4. MF T. C`f-Jk._,-F!_DRM; AB-_ _;ENT /100 MIL, A 8 1:1' E N T
0 P1 M E NT
WAS N()T) OF A •
BACT THESE RE.E_;ULT!_-_= INFIJICATE THAT Ti-iE', WATE 1:-V:_;)
'�IANITARY QUALITY Ai: *r-QRCill�41 :--:1^Ei-,"Tf-1,E OJEW YCIR,-,' S11-AT7E_
AND rEPA FEDERA:, DRIN11-,"ING WATER f=JANDARD�-:.,, FOR THE PARPe METERS
T
TESTED, ATI TIME OP COLLEG_
SUBMITTED
Albert H. padcIvan-L,
D i r. c- c t,-- f,
7. S , .� _� o �; {.,..: t � S'.;" a.4 !.... d : Y"' ..r , ya ,,•, �� t' .w
3FA•'Z OF NEW YORK, C®iiR7'fY OF Putnam �� � STATE OF NEW Yom{, COY OF ost
Oa the 29 .day, of June 19 91 before we On the day of 19 , befam me
Y personally cam I persopudly ciune
T,E URE ELKAN
to me awn to be the individual described in aad v ht,
executM the forma oirig histr meat, and ad=wvledgw, tham
Y /pM L
A4019q Public, S a c of N#W
No: 4929020
ia?Sifie-d in putnam Critmt.'j'p
*zrm EXpires Awrii 4S
STA'8'r.'. OF NEW 'Q`-Oitchy COI -WTY OF
"t
On the day of 1 9 me
persona-fly e:. me
say thhat ... ;_i1h;; -ac k4o.
that he is 01-�
of
in amd tialisLin cxer-uted the foregoing instrument; that he
knows the seal of Bald corporation, that die sea, affixed
to said inilrttme nt iy such corporate heal; that it wu so
affixed by order ' ° ':::ard of dircttoss of said dc,►pi}rst
tion, aid that 1'z 1 11 17=14 thereto by lie or&-,
WITH COVF;NA.ha l�E`:.,, i;tr f7 "r'r�.l�itY!�� AcT$
TITLE No.
LEMORE ELXAN"..'
LEN10"RUE and
NEW YORK BOARD C)E',.Il'I,i3 (,is`iCiEPNVRi?TERS
Distt'ihated by
Lawyers Tithe Insurance CUrp?i`atio
'i') die known to be t1w individual dexrltd In and who
xticuted the foregoing in;>;ttre rntnnt, wid w1wowrledged thmt
execrated the amt.
ST : b c OF a i.w YORK, COURry OF
US
On the fay of 19 rrie
l e. 4)nally cwme
the sub s $sipq wiwess to the foregoing. !nitsuinent, with
whom r Sit: persanall argaainted, who, beiag by we duly
swofn, did depose andysay that he mides is No.
that he knows
to be the individwal
descs - bed in and who txecuted dlie foregoiDg iwt: uatsrnt -.
t1vat he, said subscribing vvf<itnevs, drag pre3 xit and saw
execuu! the mme, a.C1d that tip`„', said witTims,
at the s=e time subsc;ibed h cea=s=e as wit,nem thereto.
.L
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RETURN BI-11, IE'4 :.-11.x. 0..'
�8re n%,, bpi 10569
ci Q
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DEPARTMENT OF HEALTH
Division Of Environmental Health Services
O PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
WELL LOCATION
StREET ADDRESS: WNIVIL TAX GRID NUMBER:
Butterfly Lane, Putnam Valley., NY
WELL OWNER
M ADDRESS: X
kobert Cib`el 1 i, 1717 St. Peters Ave o, ,Bronx, NY
PRIVATE
o Pueuc
USE OF WELL
1 - primary
2 - secondary
KXXRESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED
❑ BUSINESS ❑ FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT 5 gpm. /NO. PEOPLE SERVED 2 / EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
[]REPLACE EXISTING SUPPLY . ®TEST /OBSERVATION ®ADDITIONAL SUPPLY
[]NEW SUPPLY (NEW DWELLING) EEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH 300 ft.
STATIC WATER LEVEL 10
JDATE MEASURED 12/6/95
DRILLING
EQUIPMENT
O ROTARY XXX COMPRESSED -AIR PERCUSSION ❑ DUG
O WELL POINT O CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
O SCREENED O OPEN END CASING XMPEN HOLE IN BEDROCK O OTHER
CASING
DETAILS
TOTAL LENGTH fL
MATERIALS: A)�TEEL O PLASTIC O OTHER
LENGTH BELOW -GRADE ft.
JOINTS: ❑ WELDED O THREADED. ❑ OTHER
DIAMETER in.
SEAL: ❑ CEMENT GROUT ❑ BENTONITE OOTHER
WEIGHT PER FOOT Ib. /ft.
DRIVE SHOE O YES O NO LINER: ❑ YES ONO
SCREEN
DETAILS
DIAMETER (in)
SLOT SIZE
LENGTH (it)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
O YES O NO
HOURS
SECOND
GRAVEL PACK
_ ° YES
O NO
GRAVEL
SIZE:
DIAMETER
r OF PACK in.
TOP
DEPTH ft.
BOTTOM
DEPTH R.
WELL YIELD TEST If detailed pumping
METHOD: O PUMPED i tests were done is in-
UCOMPRESSED AIR , ! ormation attached?
O BAILED O OTHER ;DYES ONO
tl'd �LL LOG If more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
Water
Bear-
ink
Well
OIa-
In
FORMATION DESCRIPTION
coot
ft
V.
fL
WELL DEPTH
ft.
DURATION
hr. min,
DRAWOOWN
".
YIELD
5 itac.
300
Har grey & Nock ranite
BUT
WATER XO CLEAR TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? O YES ONO
ANALYSIS ATTACHED? O YES O NO
STORAGE TANK: TYPE,
CAPACITY 86 GAIL. 23
WELL DRILLER NAME MILL -DRILL I NG., r /8/95
ADDRESS Putncm .Avenue . SIGraATU
Putncm .Ave, Brewster �,
PUMP INFORMATION
TYPE Subm rs i b l e CAPACITY 10 _
MAKER DEPTH
MOOELIOGSD7 VOLTAGEZ3O,. HP _V14-
-3/tsy
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 #
WELL LOCATION
treet
Ad re s T Village C #ty Tax Grid Number ul LAS n'-44» / ! %e
WELL OWNER
—fame Mailin Address
g � /-, LL ;
`Private
O Public
USE OF WELL
- primar
2- secondary
X RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP
0 BUSINESS O FARM O TEST /OBSERVATION
0 INDUSTRIAL 0 INSTITUTIONAL O STAND -BY
O ABANDONED
O OTHER (specify
O
AMOUNT OF USE
YIELD SOUGHT _<
13 REPLACE EXISTING SUPPLY
O NEW SUPPLY NEW DWELLING
PEOPLE SERVED /EST. OF DAILY USAGE_gal
O TEST /OBSERVATION G6 ADDITIONAL -SUPPLY
* DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
we ZZ, Z.Vez! 0 WOO
WELL TYPE
I 10i
DRILLED
DRIVEN
DUG GRAVEL.
O OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name M;I-�- , D —rd f"wgj -5 7A1c- Address : �egj4 yr /gvf_
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES V NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED /J
/7- '`/- g�ON SEPARATE SHEET r �Lt/.JD
e;na Ida /b'/a - 6 C
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the,
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 dri operations be contained on this
property and in such a nner as not to degrade or o w' te s urface or groundwater.
Date of Issue: i 19
Date of Expiration 19 / Permit Issuing Official
Permit is Non- Transfe rable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller