Loading...
HomeMy WebLinkAbout3768DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83. -1 -7 BOX 29 ., Ll J 7 ' l ',, ■T T , � r 6r, i iR.: Y I MAll[ COUM DEFAl7UM OF MALTH J` 'CD���a OFCO I�'!lIICAON !®!� lWI.SEWAOE D�[OSAL sYST®I[ Pasld r 14CM1111111 • -' �j / /- j Owayr /A it+it 14 /7 d f / GW j A 1, / `� Renewal O Revuest . O Dated Approval. Al.. ;7 �/l�l!/Gt 1d0 // /7 GG1lL Tow. ss 23p I=e Subdivision Approved 1-!5F:z7 Fee Enclosed Arnn,,,,f v3 &0 s++ns �rP• ��f 41W. e:�C Lot Ar.s 4! G C'G FM x.04. xttl :r d e. MMM vdme Detlsa Flow G P D G �S -PC® NetlMtlaa r �e4wed Wbaa Plll b.al"iatad Sapieab Sawmw syobm b e wmm d /06 0 Galle , Septic Tank �j O >� L-� Te be: 'by Atimen Water Supply: FAGc Sw* Fr,r Adhoes s� - FFdMW.S*W D~ by 011 lfaguils is G d�o lj 10. 1 mpreteet-that 1 am Wholly and eompNNly refponuble for tM ensign and , ion, of the proposed system($); 11 that the Separate few di sal gstem above described will be constructed as shown on the approved amendment theca to and in accordance with the standard; rules a rpu ns,o ream County D•partnielit, Of Hmkl% a" that on conroletion thereof& " Cerbfkate of Construction Compliance-' satisfactory to the _Coi+missbrw at Maalthwill be submitted to the Department 'and" a, written guarantee will ale. furnisliee the owner. his sucmewi, hairs or aallna tfy the buiwo►,,that Said bulkier will plree in .goon 9paratiflj eortolNbn, any part of said saw age dispoal syttem during the period of two,12),yews imme tely following tMdata of: the I=- mom of the approval of the Certificate 'of Conitiuctbn' Compliance of, the original fystem`or any, rapaars the►etq;.2 salad Will Aefcri0iie e6ove WW be located ais shown on the app►Oved plan and that said well will be lnstal " n acco/ryan with t i ftansderd �� ens of" IM" "Putnam County depart Of ►fwkh /h �/ /1 Jy Onto / 7' ` ' ddrea 2Z Y,7 G/ APPROVED FOR CONSTRUCTION: This approval expires revocable for ca se or "' be anreridad Lor mooif.led.when c '"uNea a new permi A owed for disooal..of domesi Rev. 10/88 ate er RA. r oar the date .isfu unless construed; f n undertaken and is Millry ay the Co ssioner of MNlth o tion of construction age. and /or or star supply only. Tit14+ n DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New.York 10509 (914) 278 -6130 Ai'I�L" If:AT'ic7Pv tC 'OCiItTSTRLTCT PCHD PERMIT # WELL LOCATION S reet Address Sri Town V llage Carty Tax Grid Number �� WELL OWNER / d / G �r �ili� y Address � f Y��� Private �% 0 Public USE OF WELL 1 - primary 2 - secondary RESIDENTIAL BUSINESS ® INDUSTRIAL ® PUBLIC SUPPLY Q AIR /COND /HEAT P O ABANDONED O FARM O TEST /OBSERVATION 0 OTHER (specify D INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT gpm /# E3 REPLACE EXISTING SUPPLY NEW SUPPLY NEW DWELLING PEOPLE SERVED /EST. OF DAILY USAGE ,d,46 gal ❑ TEST /OBSERVATION Q ADDITIONAL SUPPLY ® DEEPEN EXISTING WELL I 'REASON FOR DRILLING DETAILED REASON FOR. DRILLING WELL TYPE DRILLED DRIVEN ®DUG ® GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES brNO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: C,,fi Lot No. G WATER WELL CONTRACTOR: Name A/ ;o,-7 &ems ✓j a Address:. IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ENO NAME OF PUBLIC WATER SUPPLY: s— TOWN /VIL /CITY _._. bfSTANCE_ TO `PROPER.T ,: FROM. NEAREST. WATER MAIN.: LOCATION SKETCH) SOURCES OF CONTAMINATION PROVIDED BON SEPARATE SHEET � (da e) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. ` 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drillin operations be contained on this property and in suc //a manner as not to degrade or other i conta ate surface or groundwater. Date of Issue: G 19 7 Date of Expiration / 19 0 Permit Issuing Official Permit is Non-Trans ferr ble White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL. SYSTEMS ,c,.i�IE .J �I'fEET -%ii�'C'IiN�RUL•"�7iION-�l Iri,�`T.�::; : -:: -'. �..,' - STREET LOCATION NAME OF OWNER BY B. HEDGES R.MORRIS OTHER DATE /___/ TAX MAP # - DOCUMENTS. Y,IQ PERMIT APPLICATION _ 79 PC -1 WELL PERMIT = PW S LETTER = ENGINEERS AUTHORIZATION = DESIGN DATA SHEET(DDS) = CORPORATE RESOLUTION = PLANS THREE SETS = HOUSE PLANS - TWO SETS = VARIANCE REQUEST SUBDIVISION = LEGAL SUBDIVISION = SUBDMSION APPROVAL - CHECKED = PERC RATE = FILL REQUIRED DEPTH = CURTAIN DRAIN REQUIRED =STANDPIPES GENERAL = EX- APPROVAL SSDS ADJ. LOTS YN = EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE = IF PUMPED PIT & D BOX SHOWN & DETAILED = HOUSE - NO. OF BEDROOMS = WELLS & SSDS'S W/IN 200 FT. OF PROPOSED SYSTEM PROPERTY METES & BOUNDS = HOUSE SETBACK NECESSARY (TIGHT LOT) = HOUSE SEWER - 1 /4 "/FT. 4 "0; TYPE PIPE = NO BENDS; MAX. BENDS 45 W /CLEANOUT FILL SYSTEMS = CLAYBARRIER = 10 FT HORIZONTAL: SLOPE 3:1 TO GRADE = FILL SPECS = FILL NOTES = FILL CERTIFICATION NOTE = DEPTH GAUGES = FILL PROFILE & DIMENSIONS = VOLUME = FILL IN EXPANSION AREA = WETLAND ( TOWN/DEC PERMIT REQ ?) TRENCH = DATA ON DDS PLANS & PERMIT SAME = LF TRENCH PROVIDED =60 FT MAX = PRE- 1969 - NEIGHBOR NOTIFIFICATION = PARALLEL TO CONTOURS ER BI /7'EA.. ,. -:. _ . — . _ - _ _. _ � 100%a.EXPANSIQN _P_R.c�V m 1 h VR FT null FT.FVATTON REQUIRED DETAILS ON PLANS = SEWAGE SYSTEM PLAN - (NORTH ARROW) = SSDS HYDRAULIC PROFILE = GRAVITY FLOW = CONSTRUCTION NOTES (GRINDER NOTE) = DESIGN DATA: PERC AND DEEP RESULTS = TWO -FOOT CONTOURS EXISTING & PROPOSED = DRIVEWAY & SLOPES CUT = FOOTING /GUTTER/CURTAIN DRAINS = EROSION CONTROL; HOUSE,WELL, SSDS = EROSION CONTROL NOTE = PERC & DEEP HOLES LOCATED = REPRESENTATIVE OF PRIMARY AND EXPANSION SEPARATION DISTANCES SPECIFIED ON PLAN FIELDS = 10' TO P.L., DRIVEWAY, LARGE TREES TOP OF FILL = 20' TO FOUNDATION WALLS bJ 15' WELL TO P.L = 100 TO WELL, 200' IN D.L.O.D., 150' PITS = 100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) = 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER = 10' TO WATERLINE (PITS -201 ) = 50' INTERMITTENT DRAINAGE COURSE = 200 FT. RESERVOIR, ETC.= 150 FT. GALLEY SYSTEMS = 15'MINTO C.D. S= >5 %,20'- 4 %,25'- 3 %,30'- 2 %,35' -I %,100' <1% = 20' MIN TO C.D. DISHARGE /100' WITH 182 CONS DAY DIS. SEPTIC TANK =10' FROM FOUNDATION; 50' TO WELL COMMENTS: is) lel 0 ZZI, Ire) W573"g-ROINT N N 0 0; 1 -Ra to � W.-I 0- RI'm Lai FAQ SERA 'WIL . S - :::<.,. >,. . ..... DFZTr DT P SY T-W. ". . , �� ,N. D-NT SCIENSU, -E GF S FIL&W-). Owner Address Located at (Street) Sec. Block Lot 7 ( indi�efte nearest cross street) Of municipality_ Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre-Soaking 9d Date of Percolation Test &�� Y-1 HOLE NUMBER CIOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Frain Water Level No. Time Ground Surface In Inches Soil Rate Start-Stop Min. start stop Drop In Min/In Drop Inches Inches Inches 4 5 22:6 31 3 4 5 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 from top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNIMED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. •r•.s- Mia+Y.MY _. at e. �u ter+ -•a. -Y �6��• ewe °: �.':•• �. �.o... �: �w.<.: �_•v :u. e? �Z• a - �. ni,l ++�r-� @sf 'is•i. 'i W, r..�r�v.-v Vif �C���•ovsA °.; 'r�'a. a� per. .Gas. �c-.4 �:..... -a:� rt �: �3 •.�a � ,py. G.L. f� / f✓a� Of 2' �G�i� /7 /"Joy e 3' 4' INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: � y /��~ �l�� DATE: i X DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided �0et0l No. of Bedrooms Septic Tank Capacity %�/l' C' gals. Typed �- Absorption Area Provided By L.F. x 24" width trench Other 2 67�-a -' W. / . Name eT Af Address Signature THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: 1 " Soil Rate Approved �5�A PP sq.ft /gal. Checked Date PC -1 PUT NAM COUNTY D E PART M E NT OF H EA LT H ��tAf�/S •FOR ---V 6AA3T W AT EER= DISPOSAL...�1�`3j`'EM`.:.�. 1. Name and Address of Applicant: Ad �''� 2. Name of Project: 4. Project Engineer: License Number: Z v 3. Location T /V /C: w 5. Address: ,/�� a✓ Phone: 12' !qk' pr 6. Type of Project: L,," P rivate /Residential Food Service Commercial _ Apartments Institutional Mobile Home Park Office Building .Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEAR)? Type Status (Check One) Type I..' Exempt Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. A/0 9. Has DEIS been completed and found acceptable by Lead Agency? ........... 10. Name of Lead Agency 11 Is this project-in- an area under the control of local planning zoning _...- -- or�other officials, urdinances ? . .::.:.::...::: ::............................. 1.2. If so, have plans been submitted to such authorities? .................. 1/&V 13. Has preliminary approval been granted by such authorities? Date Granted:,,�99 Y' 14. Type of Sewage Disposal System Discharge...... Surface Water k" Waters 15. If surface water discharge, what is the stream class designation ?........ 16. Waters index number (surface) ................... .- ................ ..... 17. Is project located near a public water supply system? .................. Ale 18. If yes, name of water supply Distance to water supply 40Z AS 19. Is project site near a public sewage collection or disposal system ?..... Ale' 20. Name of sewage system Distance to sewage system 21. Date test holes observed: 22. Name of Health Inspector: 23. Project design flow (gallons per day) ....... 6.'. < ......................... 11/9.3...._.... -; 24. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. Mo 25.� Has SPDES Application been submitted to local DECT Office. ............`.. 26. Is any portion of this project located within a designated Town or State wetland? ................................... ..............................o 27. Wetland ID Number ........................ ............................... 28. Is Wetland Permit required? .............. ............................... A/b ..e Has application been made to Town or Local DEC Office? .................. 29. Does project require a DEC Stream.Disturbance Permit? '�V6 30. 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 _ 31. 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: 2. Ale IM 32. Is there a local master plan or file with the Town or Village? ........... 33. Are community water, sewer facilities planned to be developed within 15 years? ? 34. Are any sewage disposal areas in excess of 15% slope? ........................ //0 35. Tax Map ID Number ........... 0... .... ...... ...... ............. _. 36. Approved Plans are to be returned to: Applicant Al"' Engineer If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: 0� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES_- Date 2-2 Date 9'/ Re: Property of 6 lae j A0 Located at Section Block /. Lot__ Subdivision of �11�w,4 Subdv. Lot # Filed Map # 1-342L Date Gentlemen: This letter is to authorize rAd-4egeh" 'Y" j 47- a duly licensed professional engineer or registered architect (Indicate) to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner, . of the Putnam County Department of Health, and to sign all necessary papers on my behalf 4 in connection with this matter and to supervise the .con,struc,tipn-.,o.f-,said....... 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. Countersign e d:/C,,, P.E. egs ,!;7- lephone Very truly yours, Signed Owner of Property Address Oct- /0 Town Telephone - ;+ccs:e :.....: r -w•,. -4r -:..a ,�, .- ..:r it •; .. -.`e: `.. . _.-- ` .e:ti:•; :...... 1 . JOHN KARELL Jr.. P.E.. M.S. wuo4...Hial. h Qi4k. tor• -_ - DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 October 17, 1994 Frank Sullivan 2972 Ferncrest Drive Yorktown Heights, NY 10598 Re: Proposed SSDS: Padilla Angela Drive (T) Putnam Valley Dear Mr. Sullivan: Review of plans and other supporting documents submitted at this time relative to the above- captioned project has been completed. Comments are offered as follows: "The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local we_iands officials in this regard." 1. Standard well yield note is to be added to plan. 2. Erosion control measures for the hcuse, well and SSDS are to be shown on plan along with a note stating all erosion control measures are to be installed prior to the start of any construction,. 3. Fill is required to be installed in the expansion area. This is to be clearly noted on plan. 4. Plans and supporting documents must provide your legal address. Yorktown :.Heigiits = -,id- knot- accpable as a full -- across. Upon Receipt of a submission, revised to reflect the above comments, this application will be considered further. Very ruly yours, Robert Morris Public Health Engineer RM/jp z r Rev: 3.81 C - - -��e.x►rr�` Located at Ownei /applicant Name Mailing Address PUTNAM :COUNTY DEPARTMENT OF HEALTH ; Division of Environmental Health Serviced, Carmel, N.Y. 10512 Engineer Must Provide it fG P.C.H.D. Perm!"--= RUCTION-COM .LIANCE FOR SEWAGE DISPOSAL SYSTEM or e ., Tax Map Block Formerly Subdivision sme Sabdv. Lut if zip 1:%,� Date Permit Issued � ✓ • � � = Separate Sewerage System built by Address Water Supplyi Public Supply From `- Address . ors /� Private Supply Drilled by 1/!AVAOZ ��t a Address a Bultdtng Type / / l; 4 ; d �== —Has Erosion Control Been Completed? Number of Bedrooms Has Garbage Grinder Been Installed? ter" Other Requirements `" 407a% /—r I certify that the system(s) as listed serving the above premises were constructed of which are attached), and in accordance with the standards, rules and regulati Putnam Coun O He t D epartme alth. Date Q/ Certified by Address ��10 ' i�� 3 s Any person occupying premises served by the above system(s) shall promptly take su conditions resulting from such usage. Approval of the separate sevve ge stem s avallabie`'and the approval of the private water supply shall become n 1 0 oid w subject to modi ication or change when, in the judgment of the Co I ner of Date V211Y� BY 11 as shown on the "plans of the completed work ( copies r- " the fiklel plan, and the permit issued by the 1 P. E. R.A. JG AA, License NoZ��� *ee s to secure the correction of any unsanitary ...[d soon as a publ7: unitary sewer becomes becomes available. Such approvals are odificatlon or change Is Y. Title WELL COMPLETION REPORT Office Use Only DEPARTMENT OF HEALTH _ on Of'"Environinerital'Hea1Sh S'ervfces PUTNAM COUNTY DEPARTMENT OF HEALTH WELL LOCATION SIRE" DRESS: W TAX WO NUMBER: �- WELL OWNER E' ADDRESS: / PBIVATE �O O PUBLIC USE OF WELL PRESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED 1 - primary O BUSINESS ❑ FARM O TEST /OBSERVATION O OTHER (specify) 2 - secondary ❑ INDUSTRIAL O INSTITUTIONAL O STAND -BY ❑ AMOUNT OF USE YIELD SOUGHT I� gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE G © gal. REASON FOR ❑REPLACE EXISTING SUPPLY ®TEST /OBSERVATION ®ADDITIONAL SUPPLY DRILLING f0NEW SUPPLY (NL'W DWELLING) []DEEPEN EXISTINNG�� WELL DEPTH DATA 7-0 O COLORED ANALYZED? OYES ❑ NO ANALYSIS ATTACHED? O YES O No WELL DEPTH ft. STATIC WATER LEVEL __G�! ft. DATE MEASURED DRILLING ROTARY O COMPRESSED AIR PERCUSSION ❑ DUG EQUIPMENT ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED O OPEN END CASING (OPEN HOLE IN BEDROCK O OTHER �� / :Z S W i — GAI.. TOTAL LENGTH _ °�-� eft_ MATERIALS: STEEL O PLASTIC O OTHER CASING LENGTH BELOW GRADE ft. JOINTS: O WELDED READED ❑ OTHER DETAILS DIAMETER in. SEAL: ❑CEMENT GROUT O BENTONITE ,OTHER SIGNATURE '0 � WEIGHT PER FOOT Ib. /ft. DRIVE SHOE:J9YES ❑ NO I LINER: DYES NO SCREEN DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? DETAILS FIRST ... = SECOND.',:_ -.. — . GRAVEL PACK O YES GRAVEL DIAMETER TOP BOTTOM O NO SIZE: OF PACK in. DEPTH ft. DEPTH ft. WELL YIELD TEST !f detailed pumping WELL LOG if more detailed formation descriptions or sieve analyses are available, please attach. METHOD: O PUMPED *COMPRESSED AIR tests were done is in- , formation attached? DEPTH FROM SURFACE Water Bear- well Oia- O BAILED O OTHER i ❑ YES O NO ft. ft. ing meter FORMATION DESCRIPTION cool WELL DEPTH DURATION DRAWOOWN YIELD D °� ft. hr, min. ft. gpm. ffLandCe tilt 1 -!1 . WATER O CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? OYES ❑ NO ANALYSIS ATTACHED? O YES O No STORAGE TANK CAPACITY : TYPE Zd �� / :Z S W i — GAI.. PUMP INFORMATION TYPE �� CAPACITY g✓ WELL DRILLER NAME DATE / n , MAKER DEPTH �' 6 ADDRESS � r � .,�%� SIGNATURE '0 � MODEL "1 VOLTAGE HP PUTNAM COUNTY DEPARTMENT OF HEALTH &'1/0 a 4�/ / 0 1;1-1-f Owner or Purchaser of Building of Building Constructed by �tiod- Street Municipality Building Type Section Block Lot Subdivision Name Subdivision Lot #14 GUARW= OF SUBSURFACE SENAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, wor)ananship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as sham 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 immediately following the date of approval of the !�CrLificr:te -o €- Cc-- r. ic�.-Compliance" for the -_se rage disposal. system, or aray 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 day of 19Ye� Signature Tine General Contractor (Owner) - Signature e' 1424 o� Corporation Ndme (if Corp.) 411 d1s , 04�6 W Address rev. 9/85 mk Corporation Name (if'Corp.) Address I rap' rosant that l am aiholly bnd compbtaly responsible for?tho das n ond,tocation of tho propfotad syst®m(sj; l) that the iaparate :mar` o.disposal systom obono doscntiod mill bo eonatrutted as shoorn on tho,opprovod amendment there to and in acto�6ance mith.the standards, rules 'e regq ns',o o nom County ; l rtmcnt `oP, 60CaIth, 'and: that on coniplotion'thoroof o - .68rtificato oP Construction Compliaoieo" sotWactory -to_ the Cd'nniiaslone7 of, Hool¢hmill i s>Abrnittod to Oho Daprar¢mont ;aria o_ writton?guarontoo will . ®0 4ilvnishci� the orrnci; tits irs or, ow' ipns by the buiPtaci'that ;sol;a; ®uildw rriilt deice 8n paod op otiavq tonditlon any pavt o4 said. i rogo dispo�l systom during too VV 51 .rhly iatoly 4olkvo. cg tho®ato_of. tho imu- ip aaml of two afrproiral_ oP 2 h0 "'Cortifieota of Construction Complionco of 'tho i"inal .sy lrbv d Oto, 2) that the drilled well &2cracd 060vo Cri/t:b0 locate® as eh¢s�a on Q0q alOProv09 Plait and that said wo-I will bo Inatollet9. m actor p?; r too. and ►aquIa onsof tho Putnam Coite¢y Oopti nrinq , ? P4g1¢h. •.. % G . Addrom Lit No Al?pROVEO FOR COldSYRUCTIOPo Yni9 approgal_attpirob tmo yoors from the date i con u tho building has bc6n undortakon and is Moeablo, for cause or ,may Oe' ormmded or modified whon considoiod nc cesm' iy- by the Any change or alteration of. construction v4iluiros a rIQt7 permit., �+PPrO�f�.- for'dispotil of domestic sanitar aowago -° onto �a"� C Titb DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APP T ATIO?tdd `€ cCAi�IS' RI:TI'I' :<A.: WA-TER--WE L---' ��- PCHD PERMIT #u WELL LOCATION Street A dress Town/Village/City Tax Grid Number ri e , -Jr-7 WELL OWNER N Mailing Address / rivate 0 Public USE OF WELL 1 - primary 2- secondary JKRESIDENTIAL D BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION M INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify Q AMOUNT OF USE YIELD SOUGHT , '' gpm /# PEOPLE SERVED A /EST. OF DAILY USAGEOO' gal REASON FOR DRILLING EI REPLACE EXISTING SUPPLY 0 TEST/ OBSERVATION GE ADDITIONAL SUPPLY ANEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE j VDRILLED 13DRIVEN ODUG 13GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES ✓ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. �y WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES t,-` NO NAME OF PUBLIC WATER SUPPLY: —* TOWN /VIL /CITY DISTANCE - TO PROPERTY -FROM NEAREST WATER .MAIN: ei ..... LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET --�� (da e) (signature PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in sygh a manner as not to degrade or otherwise cont s roundwater. Date of Issue: « 19 Date of Expiration 19����Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller _ ...... _.- ..___. _ _BRUCE R;aFDLEX� • -F � - T :c Acting Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 June 13, 1996 Frank Sullivan, P. E. 2972 Ferncrest Drive Yorktown Heights, NY 10598 Re: Proposed SSDS: Padelli Angela Drive, Lot #6 (T) Putnam Valley Dear Mr. Sullivan: Review of plans and other supporting documents submitted at this time relative to the above captioned project has been completed. Comments are offered as follows: 1. Existing and proposed contours are to be shown in the V = 20' plan. -_ 2.. Expansion,trenches are to. be shown, dashed lines,are.acceptable...4'l _ ~rn .•_ 3. Minimum slope'of house sewei is 1%4 " %ft. •This is to be noted on plan. r µ y Upon receipt of a submission, revised to reflect the above comments; this application will be considered further. V truly yours, Robert Morris, P. E. Public Health Engineer RM/jP PC-1' • PUT NAM COUNTY D E PART M E NT OF H EA LT H ..,,, :r -. .: rr^tRr�Clirl? i�C3R= APRR�VAE OF'PLANS FOR < A.: :WASTEViATPRSPOALSIfSTMa:.:�:. ,.:t 1. Name and Address of Applicant: 2. Name of Project: �= 4. Project Engineer: License Number: Lj k15� Phone: 6. Tyae f Project: Private /Residential Food Service Apartments Institutional Office Building Realty Subdivision 1411/ 3. Location T /V /C: / w, �s /% 5. Address: �7�Z /�i. -�CrS ri v'LU ,l4/ Commercial Mobile Home Park Other (specify) 7. Is this project subject to State Environmental Quality Review (SEAR)? /1® Type Status (Check One) Type I.. Exempt Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. 1410 9. Has DEIS been completed and found acceptable by.Lead Agency? ............ 10. Name of Lead Agency 1.1..Is..this p.r-oject_.in _an area -under -the control.of- local- planning -, zoning, or other officials, °ordinances ?" `.... ..::,....... ......`.......... ....`........ _ 12. If so., have plans been submitted to such authorities? .................. Y4 13. Has preliminary approval been granted by such authorities? Vems Date Granted: 14. Type of Sewage Disposal System Discharge...... Surface Water k"'_ Ground Waters 15. If surface water discharge, what is the stream class designation ?........ - 16. Waters index number (surface) ................... -.................. ..... 17. Is project located near a public water supply system? .................. Ala 18. If yes, name of water supply Distance to water supply 19. Is project site near a public sewage collection or disposal system ?..... /VV 20. Name of sewage system Distance to sewage system 21. Date test holes observed: 22. Name of Health Inspector: 23. Project design flow (gallons per day) ..... .Z off'..... ..... ...... . v� . b 11/93 J" fl..` 4 "J (. 2. 24. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. ;Ale) • .. t.. ,q '_ -. a-a.v � -vu.. ... ..r .. .:. _. �. '.• .:'.t`••. e^..?m•.a. -.:;r w�barM -. tit'.<.. uy v. � ..., 'it :..'�..,. .� 25. Has SPDES Application,been submitted to local DEC Office? 26. Is any portion of this project located within a designated. Town or State, wetland? .................................. ............................... a 27. Wetland ID Number ........................ ............................... 28. Is Wetland Permit required? .............. ............................... AA1 Has application been made to Town or Local DEC Office? .................. 29. Does project require a DEC Stream Disturbance Permit? ................... �U 30. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, A16 landfilling, sludge application or industrial activity? ........ YES or NO 31. 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: 32. Is there a local master plan or file with the Town or Village? ........... 33. Are community water, sewer facilities planned to be developed within 15 years? 34. Are any sewage disposal areas in excess of.15% slope? ........................ A/0 35. Tax Map ID Number ............ u.-..�.. .. ... ............................ 36. Approved Plans are to be returned to: ................ Applicant ✓Engineer If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. Failure to comply with this provision may be grounds for the rejection of any submission. T hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the Penal Lair. SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: l' Game'. 5 �Y _ • it - Ka T K � s. 4ir� ���f i. gr Ef, - 3 1 Iv F..- ,.a_.._,,.�.,..,raY.i.....a.F l 2­- 4':e f., JI 2F+ 1 x 'rr%G. _•w- t±'+F.w- .. -,.-. -f• ..- -. „h Vic:_ r....•. 1 s'i�ly. t $} "This 16 to oertiYy th8�t the 8em8go (lisyoesl.gyetem was ? t co ee 1zud1aB8(1dt ole th18 DSBa sad that. the eyBirm� +. was inepeote8 bxy me t �tr�eore,itr wee oovered over fS ec system wag aongtnatea in aoeordanae with all etandard5 :; a rules arid regulat`SonBo`Y the Puiasm County Dep'8rtment roF.Gy� Health and'the °New York`S� ate Department o ek th." , �w� aJD -Q1V iF F ULIVAN p q ,rno rn niN f aEIGNTS. -'(SEW ^ YORK,