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HomeMy WebLinkAbout3795DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.08 -1 -28 & 83.08 -1 -29 BOX 29 03795 PL J � ' L _' 1 J'� k 4L _s� 1' ' 03795 pUIMM CaWY DEPARnVM_1,T_nTL_HFATTR DIVISION OF •' •' ' M Y• L HEALTH SERVI—� _ 1,ESIGN DAM: - SHEET- SUBS U17BcF . s9 Wilp- .T) S P..x� . Xv t : _ z ; • r = 0wner Address h9y Z3_ (ice fork nit ✓ r itlt� N 10579 Located at ( Street) /.e�V AjtA q,,,n L4Aj4$- �-p . Sec. �_ Block Lot �_1 t9 (indicate nearest cross street) �, .:. :.: R'MA4A6 .r. Watershed SOIL PERCOLATION TEST DATA - REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre-SoakiAq Date of . Percolation Test . (�• ("� --`�4- 07 -77 2 l( A- IZ•• off; 22 Z 3 7 3 HOLE NUMBER CLOCK TIME PERCOLATION PERCOLATION Run Elapse No. Time Start-Stop Min. Depth to Water From Ground Surface Start Stop Inches Inches" Water Level In.Inches Drop In Inches Soil Rate Min/In Drop 1 �� • (�'���17<P (` Z10 . %ice 2 (1 31- I ( �� �� 0 2ti7 �• r2. 'O .2 I��OZ'(7i'�(j 4 4!�,•0 5 Cy 07 -77 2 l( A- IZ•• off; 22 Z 3 7 3 z 5 r2. 'O .2 I��OZ'(7i'�(j �?7 4!�,•0 Cy 5 NOTES; 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to'be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOMMMED IN TEST HOLES DEPTH HOLE NO. HOLE' G.L. D�Jo t �G6G Ci 2' 3' Name �O - - -�,- li . �i ! ►�q- Signature Address ,,�7p c- r��,t�(�� .�v".� . SEAL Ile THIS SPACE FOR USE BY.HEALTH DEPARTMENT ONLY: - i Soil Rate Approved T sq.ft /gal. Checked by Date PUTNAM COUNTY DEPARTMEV DIVISION OF I' O' ' E Y' BEALTH SERVICES ACE, ..9FE nTSPOSAL : YqT -RA,. Owner' fW, AI �99WIAtL- Address _Z 2, PUTS W LA-,w r' fj .t' . 101377 Located at ( Street) 1Ay-gb- IA . Sec. �_ Block Lot LQZ J A (indicate' nearest. cross, street) nmicipaiity . `��,� ��(,,�,v� t .r -p Watershed SOIL PERCOLATION TEST,DATA REQU= TO BE SUBMITr-ED WITH APPLICATIONS Date of Pre- Soaking ��• (�j •. � Date of Percolation_ Test (Q• �4-' - HOLE . NUMBER CLOCK TIME PERCOLATION PERCOLATION Run. Elapse Depth to Water Fran. Water Level No. Time Ground Surface In Inches Soil Rate y. Start -Stop .Min. Start. Stop Drop In Min /In Drop Inches Inches Inches 2 lI 3�- �l �� �� Z';!2 _. 3 11 �� -�Z•I-7 [°► Zo Z3 �, �•� 4 5 2 L(:Q- iZ••0e9F 22 v 4 203 3 8.0 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 frccn top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES - DEPTH' HOLEI NO. f :. -�: HOLE NO. Z/. = :.HOLE NO. : _ .... . G. L... o! ✓ �I'oo�oc v. . -8' 9' 10' ,_11.x.... .... _. . 12' "9 Name gip!, G.1 /�A- Signature Address SEAI, T � THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Cni 1 Rat-A Annr�R�cvi cn fit- /.,�1 !"F,o..L�l 1,R r..s =,� PC -1 P.UTNAM COUNTY DEPARTMENT OF HEALTH 17: 1. Name and Address of Applicant: 2. Name of Project: 3. LocatioOV /C: ECTI AA k111 -P Engineer:- �� ��- i -1 - -- - - -- __5. Address; 4�D� - G��.t�.rirs'`�' , License Number: Phone: 8' 6. Type of PrPiect:.`; 'vate /Resi'dential 'Food 'Service •,Commercial �C :.r 1 ApartmentsInstitutional Mobile Home Park Office�Building Realty Subdivision Other.(specify) 7. Is this project subject to! State Env ronmental .Quality Review '(SEAR)`? ,` Type Status :(Check One); Type I.` x Exeit Type N. Unlisted 8. Is. a Draft Environmental Impact Statement, (DEIS) required? �o Has'DEIS been completed and found acceptable by. Lead Agency? .... ... �► 10. Name of Lesad Agency r-- 11; Is this project in an area -under the control of local planning, zoning, _ or. uther.offi:ciais, ordinances? .................. ..... 12. If.! so, Have :been submitted to such authorities? ... i ... 13. Has preT °minary.,approval.been' granted by such authorities? "' "_Date Granted: 14. Type of Sewage Disposal System ;Discharge:..:. . Surface Water ' Ground Waters 15. If surface water discharge, what is ther stream class '`designation ?..`.. 16. Waters index number (surface) .......... . ............................... 17.. Is project located near a publ is water supply system? 1-i0 18. If yes, -name of water supply Distance to water supply -- 19. Is project site near a public sewage collection'ar.disposal system ?..... �A 20. Name of sewage system '"' Distance to sewage - system 2. Date observed: 23. Name of Health Inspector:lr 24. Project design flow (gallons per day) ...... ............................... 500 2: s tate Pot Miin kiirrr s there a local master plan or file with the Town or Villa gel N re community water,. sewer facilities planned to be developed within 15 years. o re any, sewage d– isposal areas in excess of 15% slope? .. ... ... .. _ ax. Map ID_ Ryhber . Approved Plans are'.-:to be, returned to: :. :Applicant X .Engineer. e application is signed by a:person other than the, appli :cant ;shown in Item. i, a`he.r cation must be accompanied by a Letter of Authorization. Failure to comply with this sion 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. TURES NG AD —70. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIROMMAL HEALTH SERVICES DESIGN DATA SHkET SiJRSUFACE SFS%TA ,F DISPOSAL. SYSTEM . =. .. Fn E. - •• =a -++i.. -srw . -r ^ ..., - a, . .. ,. .. ... _ ,. - ..cs. ..+.�-%. - n -. :a. LMyJ.�.,.- - - - . :,. o. -.. Owner �z � Address �rjfC 7.3ri . Pv7 ✓Ar ttJ-f- rJ. 1095?9 Located at (Street)��u,,nrac- Sec. �_ Block Lot .. (indicate nearest cross street) Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In.Inches Soil Rate Start- Stop.;.Min. Start ,Stop Drop In Min /In Drop Inches Inches Inches i .�� • I�'ll��ly t S - 2� ?� �. o 2 3 1-7 Z 92. 4 4 iZ 5 2 q-�• (Z•.o� 22 Zn Z� 3 7.3 0 NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to*be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 42 LP9 lip Z 92. 4 0 NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to*be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN 9' lob 12► . 13' 14' Name THIS Soil Rate Approved sq.ft /cral. Checked by Date PC -1 PUTNAM COUNTY DEPARTMENT OF HEALTH ,�CncoTtAH"0I�35SA�' 1. Name and Address of Applicant: 2. Name of - Project: 3. LocatiorowC: •� ti ---- 4-= Rr-6jeat Engineer: - << pima 5: Address: '4D� - G�i�.t,r� 1 License- Number:�� - Phone: 6. Type of Pr;6ject' --,4 Rr.ivate /Reside.ntial '-'Food`Service Commercial' ,''' Apartments Institutional Mobile, Home "`Park Office Building Realty Subdivision. Other (specify) 7. .Is this project subject to State'Envi�ronmental Quality Review (SEQR)? T.ype.Status (Check-One)­ Type I.. 2 Exempt' Type II. Unlisted 8. Is a Draft Environmental Impact Statement. (DEIS) required? �o Has DEIS been completed and found acceptable.by Lead Agency? ........... I 10. ...Name of Lead Agency. 11 Is this project .i.n..an_ area under the contro.] of local planning; coning, - or: other oFficials; ordinances? . .............. _ ... ........ ... No 12. Sf so,'_ have ^:0l:ans,beenys1ubmitted to such authorities ?................. .. 13. 'Has`preliminary approval been granted by such authorities ?. Date Granted: 14. Type of Sewage Disposa1-System Discharge....... Surface Water.° -,.=*Pe Ground Waters 15. If surface water discharge, what is the- 'stream class designation ?..:.: .: 6. Waters index number (surface) ........... 17. Is project located near a public water' supply system? 18. If yes, name of water supply -- Distance to water supply. '_ 19. Is project site near a public sewage collection or disposal, system ?..... 1­4o 20. Name of .sewage system : "' Distance to sewage system 2... Date observed: 23. Name of Health Inspector: 24. Project design flow (gallons per day) .................. 8 OD 2. 'Y StRe' 1561 TUt -ght 'i'scnar e `El�im °inatlnin s?ce -(iSROES- . Has SPOES Application been submitted .to. -local DEC Office? WA& Is or was project site used for agricultural activity involving application... of pesticides to orchards or other. crops, solid or-hazardous waste: disposal, 1andfi1ling, sludge- -applicati:on or industrial activity ?. ........ YES or N0 Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt, stockpi_]e,; landfill.,; sludge disposal site or; ti any other potential known source of „contamination ?..':. :.YES or. NO. DESCRIBE: -=- Is there a local master plan or file with the Town or Village? ........... NCO f` Are- community.w.ater, sewer facilities planned to be developed within 15 years? Are any „ sewage disposal areas in excess of 15X slope? ............... Tax .Map_. ID _ Number .......... .. 1-7. .. ... :�•:�' 'Z Approved'Plans are to be returned to:,..:............... Applicant,t. X Engineer ,r the application is si pried, by- a person-. other . than the;;:applAcant . shown; i n. Item 1 , the )l.ication must be accompanied by a Letter of Authorization. Failure to comply with this. )vision. may be''g rounds, 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 Pena 1. Law Y , 3NATURES & OF [LING r.9, n1W PC -1 PUTNAM COUNTY DEPARTMENT OF HEALTH E��PLIrEiTZOnI- rFOF�Ar'':= riit. �P.: rA' i": S" EOK "A'iT €f�47t "DI�rt�8N�''rSTEF1 ,- :...... 1. Name and Address of Applicant:''kl %��e' 2. Name of Project: j*)'� Taoee �y'P�' 1 3. Locatiory/C: .�. I) Idof 4. - - P- r-ojerzt- EOgineer: mow rJ 44 License Number:�� Phone:° 8 6. Type of Project: _ C : Pkrivate /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other .(specify) 7. Is this project subject -to State Env__ironmental Quality Rev i ew. (SEQR)T Tvpe Status (Check One) Type -.I.:' _;= Exempt Type II.' Unlisted 8. Is a Draft Environmental Impact .Statement (DEIS) required? ...... �4a Has, DEIS been completed and found acceptable by Lead Agency? ........... 4J LAI 10: Name, o.f Lead Agency T— 1-1. I s7 this,. project in an area under the control of local planning, zaniny, _ ory 'other ofri'ca'I's', ,:ordinances? - .......... ............. hso 12. If; so 'have plans been submitted tb such authorities? ........ -r-- 13. Hasr'prelmi =nary approval been granted by such authorities? —' Date Granted: 14. Type of'Sewage Disposal System '.,Discharge.,.*...'. Surface"Water- 'Ground Waters 15. If surface water discharge, what :.s the stream class 'designation ?. 16. Waters index number (surface) ........................................... 17. Is project located near'_a public water supply system? f1i 0 18. If yes, name of water supply Distance to water supply —' 19. Is project site near a public sewage. collection or disposal system ?....., 40. 20. Name. of sewage - system 2. Date observed: 23. Distance to sewage..system Name "of Health Inspector: 24. Project design flow (gallons per day) ...................................... gD0 2. 25. I State P f l dtaU t' 16'7 sc;r�ar e "'E °l i mi nd 7 on °system �SPI EB =) weer r. i t - requ i= rezfr �: .r ? �. r -r�, ,.:: �v 26. Has SPDES Application been submitted to.local DEC Office? - 27. Is any portion of this project located within a designated Town or State wetland ?.... ............................ .............................. ti's 31. Is or was project site used for agricultural activity involving application of pesticides to orchards .or other crops, solid :or.:.hazardous waste, disposal, landfilling, sludge application or i ndustri.al_ activity? ...... .. YES or NO iy0 32. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site; .,salt -stockpi,le, landf -ill,. sludge disposal site -or> any "other potential known source of contamination ?. .........:......YES. or. NO DESCRIBE: -- 33. Is there a local master plan or file with the Town or Village? ....... No 34. Are - community water, sewer facilities planned to be developed within 15 years? 35. Are any sewage disposal areas i,n. excess of 15% slope? ;,.. ....... 36. Tax Map . .. .�5.f ' 37. Approved Plans are to be returned to:• ....... .; ;Applicant X Engineer If the application is signed,by a:person other than the,;applicant.. shown. in, Item 1.:j.;the application must :be accompanied by a Letter of Authorization. Failure to comply with this provision may -be grounds for the; rejection.of any submjssion. I hereby affirm, under penalty of perjury, that information provided on this form is true, to the best of my knowledge and. bet ief� Fa Ise.. statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the . Penal Law. SIGNATURES & OFFI F S: '- Y MAILING AD PC -1 PUTNAM COUNTY DEPARTMENT OF HEALTH __.._.. Q !;�I•C�7j1�td'Fi :' �i }CFA+ F1 LAN6`+O 'A--*t-S` 1. Name and Address of Applicant: ' �Y'C►.�a. � \ �pat.� -�' �..1,� -rte i r'��'j� 2. Name of:..Project: 3. Locatiorov/C: E(iJ,AA 1)&U,0 -P _ 4. _ - Prajeat Engineer: - --- — - � - ' License Number: . _�L�I��J1 Phone: ` 8' 6. Type of Project: Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Real.ty.Subdivision Other (specify) 7. Is this project subject to St -ate" (SEAR) ?: T:vpe:Status (Check One) Type I.. :_ Exempt Type: II. Unlisted 8. Is a Draft Environmental Impact Statement (D EIS ) required? . t40 ;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 p1annin6; zoningi ........ ....... 12. If soy'.have`.plans been submitted to such authorities? ................... 13. Has`'prel`iminary approval -been granted'by such authorities? Date Granted:, 14. Type of Sewage Disposal System Discharge::..,. 'Surface Water 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? .. ................ 18. If yes, name of water supply -- Distance to water supply.;—,. 19. Is project site near a public sewage, collection or disposal system ?..... �o 20. Name of sewage system Distance to sewage system - 2. Date observed: 23. Name of 'Health Inspector: 24. Project design flow (gallons per day ) ...................................... o0 2. 25. Is St ateo`�lutani'° disc" name`'E1iroindt °hUfi ` rstem = "('S�s� �.-. 26. Has SPDES Application been submitted to.local DEC Office? 27. Is any portion of this project located within a designated Town or State wetland ?............ ......................... ...................... } 28. Wetland ID Number ...:....:: ..... ............................... 29. Is Wet1_and Permit required? ... ......................... ...:......... Has'application been made to Town or Local DEC Office. . .. 30.' Does project require a DEC Stream',&isturbance Permit? .. .... .. 31. Is or was project site used for agricultural activity involving application, of pesticides to orchards or other crops, sol1d; ,or , hazardous waste disposal, landfilling, sludge ,application or industrial. actiwit:y? ........ 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 a36 DESCRIBE: 33. Is there 'a local master plan or file with the Town or Village? ........... N o 34.: Are community water, sewer facilities planned to be developed .within .15 years ?. Kit) 35. Are any sewage disposal areas, in excess of 15% slope? .... _ 36. .Tax Ma6 ID -Number .... . i :. .. ..,..... .....53.'Z8'L� 37. Approved Plans are to be returned to: Applicant X :,Eng;ibeer 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. submssi:on. I hereby affir7n, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made her are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES .& R MMUMM _ ME Ai' 1a", `%Ls � °• 6443E `�(``v F� pROFESSI4NP���G � APPENDIX 3 zr � � � •, PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIV IDFAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS ..- ......,,., r , . , - .: - ; : r: - :�E`v'i� o '° SF-IEE�I= 5fcr "rK•CO+Irrs'I RUC�I(�N= PER'�II"F= r,.� ... .. �...- .. -_ . �. STREET LOCATION NAME OF OWNER4�� BY B. HEDGES R.MORRIS OTHER DATE �--7J f4 TAX MAP # - - DOCUMENTS. �4;;�CATIO PC -1 LL PERMIT PWS LETTER ENGINEERS AUTHORIZATION 44 DATA SHEET(DDS) CORPORATE RESOLUTION m PLANS THREE SETS NCE REQUEST SUBDIVISION M LEGAL SUBDIVISION M SUBDMSION APPROVAL- CHECKED FT-1 PERC RATE m FILL REQUIRED DEPTH m CURTAIN DRAIN REQUIRED OD STANDPIPES Y m EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE m IF PUMPED P &rB-B OWN & DETAILED m HOUS - O.�IBBEDRO S m WELLS FT. OF PR OPOSED SYSTEM m PROPERTY METES & BOUNDS HOUSE SETBA SARY (TIG LOT) m HOUSE SE WA- 4 "/FT. "0 E PIPE m NO BENDS; MAX. BENDS 45 W/ OUT FILL SYSTEMS m CLAYBARRIER m 1 ONTAL: SLOPE 3:1 TO GRADE m fiLL S FILL NOTES m IIMMF _RTIFICNTION NOTE DIMENSIONS GENERAL EITTiLLIK-7-XPANSION AREA _ m EX- APPROVAL SSDS ADJ. LOTS ¢AA. m WETLAND ( TOWN/DEC PERMIT REQ ?) H m DDS PLANS &PERMIT SAME m BE�PRO ED m60 FT M AX PRE�1969 EIGHBOR NOTIFIFICATION m P OURS BA 100% E XPANSION PROVIDED, 100 YR. FLOOF) F.i.FVATION V vow^ 1!6REQUIRED DETAILS O S sEWAGE SYSTEM. 1 TH ARROW) SSDS HYD_RAU C PROFI m GRAVITY FLOW VCl( ON STRUCTIO S (GRINDER NOTE) ESIGN N DATA: PERC AND DEEP RESULTS a ffnRilVEWAY O -FOOT CONTOURS EXISTING & PROPOSED LOPE S CUT m F WDEEPHOOLLES' URTAIN DRAINS m E ; HOUSE,WELL, SSDS E OSIONOTE C & LOCATED REPRESENTATIVE OF PRIMARY AND EXPANSION SEPARATION DISTANCES SPECIFIED ON PLAN FIELD m ' TO P.L. RIVEWAY, LARGE TREES TOP OF FILL ED 2 NDATION WALLS fti 15' WELL TO P.L m 100 TO WELL, 200' IN D.L.O.D., 150' PITS m 100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) m 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER m 10' TO WATERLINE (PITS -20') m 50' INTERMITTENT DRAINAGE COURSE m 200 FT. RESERVOIR, ETCH 150 FT. GALLEY SYSTEMS m 15' MIN TO C.D. S° = >5%,20'- 4 %,25'- 3 %,30'- 2 %,35' -1 %,100' <1% m 20' MIN TO C.D. DISHARGE /100' WITH 182 CONS DAY DIS. SEPTIC TANK m 10' FROM FOUNDATION; 50' TO WELL COMMENTS: i DEPARTMENT OF HEALTH Division of Environmental Health Services WO COUNTY CENTER - CARMEL., N.-Y. 10512.(914) 225 -3641 ..,c•vh..- .- •...:_..., Asa.._..,. e;• ..:_: r..,. 1 ,.y...., ;.,..v- ,.wa. +:_..n..ar N. }_-r .u. •....-:+ -' .:�i-{�1- ,a.r.. .. . .., n..� -a.: ,;n}. .; ,. .�.wK APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION St,reet..Address" To illage City Tax Grid Number WELL OWNER Name ''rte rtes �' Mailing . Address M XPrivate O Public USE OF WELL 1 - ..primary -2 - secondary X RESIDENTIAL (3 BUSINESS 13 ..INDUSTRIAL ❑ PUBLIC SUPPLY Q AIR /COND /HEAT PUMP... 0 FARM 0 TEST /OBSERVATION - '.0 INSTITUTIONAL 0. STAND -BY ❑ ABANDONED 0 OTHER. (specify AMOUNT .OF. USE YIELD SOUGHT�gpm /46 PEOPLE SERVED, �`* /EST. OF DAILY,- :USAG& gal REASON FOR .. DRILLING NEW.SUPPLY O PROVIDE ADDITIONAL SUPPLY ❑ REPLACE EXISTING SUPPLY. 0 DEEPEN EXISTING WELL ❑ TEST/OBSERVATION DETAILED REASON FOR DRILLING . ;. WELL TYPE DRILLED ❑DRIVEN []DUG ®GRAVEL ❑OTHER` IS WELL SITE SUBJECT TO FLOODING ?. YES DC NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. O 2 -I J'9 WATER WELL CONTRACTOR: Name11L�rz] ,Address :��,� IS PUBLIC WATER,SUPPLY AVAILABLE TO SITE: YES X NO 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 wel -1 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 Permit is Non- Ttansferrable 2/87 ermit Jssuing Official White copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner PUTNAM COUNTY DEPARTMENT OF HEALTH 4 Geneva Road, Brewster, N.Y. 10509 _ _ ,. ..r �..q +. '^4. e.�_� _c• t f.: n _.: .. a x. .. r' a._..J t' _.. . y . .. .. . .. 'S.i - ... S �.wG: ` q •t .. .'7./�-: ry- .t y..,. ^.t: ... .� u .t - . Date '' + Will FROM: — - For your information For signature For your files Referred for handling _ Attached as requested Returned as requested Please see me Read and return — -- COMMENTS: —LJ —v« r t t b pamas 1. McNamara, @r. 1468 30 Lrjucnln Ot., Box 236 Putnam Talletg, 10575 z z 099 �� ✓tom _ $ 3 r I , e _ .A . CITIBAWO° CITIBANK. N.A. BR. ON ` 330 MADISON AVENUE AT 42ND STREET NEW YORK, NY 10017 • . ` +1:0210000891: 1 2634895'1'. 1468 S i re Des i.an C _ _ o -.-. ... :.'�:� r%>.w -. .. � is a:a • ..:,.s'. _�- .:.. .. - ..- -.i ."" .. ....r ... ...... .. .,..: • oa ,^ " '�Civli �ngifieers �`Lahtf Fslanner`s "` - �I1i% � ►v.�'..F�JV1�2oi•J�.T(,c.`'{t�' ��IICf�� TM �k 114 -2;'-1 ,A.-ti> 1-7 Me. '`ms's I. -row rLeV ate- -►�0-413ts U4AO, -rd uAIII� arty wu.-r �,,rsia� aaY us ��rT' �r,�►.,o --�o �. vr.�oace�Tg� . ems- CW-Fa! ►J Nc;' 7a, W11; 1603 Commerce Street • Yorktown Heights, New York 10596 41 Waters Edge Way • Ridgefield, Connecticut 06677 � Sire DrtCivil Engineers,' Land.Pianners a- - March 15, 1996 Mr. Bruce Foley Putnam County Health Department 4 Jeneva Road Route 312 Brewster, NY 10509 Re: Thomas and Beverly McNamara Town of Putnam Valley Section 114 Block 3 Lots 1 & 17 Dear Bruce: Please find enclosed two sets of plans for the above referenced project. We are seeking a waiver with regard to slopes in the SSDA. We are showing a fill section to bring the grade to.20 0/0. Please review for your comments. If you have any questions or concerns please do not hestitate to call. Thank you. WA/cm Enc. 1803 Commerce Street • Yorktown Heights, New York 10598 A2 41 Waters Edge Way • Ridgefield, Connecticut 06877 rMA i1 � it AMM f0r171 nrJ1 OCr11A C.... r04 Al OOO 7r MM a Q PUTNAM'COUNTY DEPARTMENT OF HEALTH Dat • Re: Property'of Located at (A NAM YAI-1-5�61,iection Block v?Y-I! -29 Lot-3' l OR -'I .Subdivision of �eEej ea,A.)-r P-AAkI) Subdv. Lot Filed Map #:-g-3 ate Gentlemen, This letter is to authorize a duly lic.ensed'professional engineer or registered architect (IndicateT_ to apply fora Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated.by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in ion wi - matter .and -i o--s- -up e r v i s e e construction of 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 i Code. Countersignekd P.E.., R.A­_j, # Address "M W- o■t T41e-pho'n-e Very truly yours, Sig Owner of Property ess Town S Telephone in PURM COUNFY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL BEALTH SERVICES DESIGN DATA - SHEET- SUBSUk'ACE SF IAGE DISPOSAL,SY.STEM FILE M,, _ Owner �A Address �losl Z,3li , PU-��, ,L ✓ utttT ry Located at (Street),�q�VA3AAI;��a Lj*g4�- Q..p . Sec. Block 7,3t Lot =_jA (indicate nearest cross street) • • • �1• •• •' Y• - �• jo A 0 v 51• • : 4 1 V if Y011 • j • • Date of Pre - Soaking �•. j� �- Date of Peroolatiori' Test f? -' 4-- _- HOLE z 2l(A'� NUMBM CLOCK TIME PERCOLATION PERCOLATION Run Elapse.. Depth to Water Fran Water Level No. Time Ground Surface In. Indies Soil Rate Start-Stop Min. Start Stop Drop In Min/In Drop Inches Inches Inches -7, 4 5 Zo Z V2. D 3 7, f2:341 e) 20 Z 92 22 �o 0 4 G NOTES: 1. Tests_ to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. . All. data to be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 - z 2l(A'� 4 � 7i :?� � . `� "G(V 7i 20 �i 3 8.0 5. Zo Z V2. D 3 7, f2:341 e) 20 Z 92 22 �o 0 4 G NOTES: 1. Tests_ to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. . All. data to be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 a 9' .10' ...11� . 12' INDICATEILEVEL AM WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENOOUNTERED DEEP HOLE OBSERVATIONS. MADE BY : &eW< L/og/ c-, DATE: DESIGN ., Soil Rate Used Min /1" Drop: ...S.D. Usable Area Provided' No. 'of Bedrooms Septic Tank Capacity Novo gals. Type�r -a Absorption Area Provided By L.F. x 4" width trenchI�� Other Name I kj1 Signature - Address 61�9( a&fv� ­�ZFT- SEAL <' 0 r-A �ni 1 Rata Anr�rrx�ari �t r _ ft /rta 1 ('hcnlrc.a }-dy nn -o ' Li ow cl mo / �