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83.08 -1 -28 & 83.08 -1 -29
BOX 29
03795
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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
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Will
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COMMENTS: —LJ —v«
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pamas 1. McNamara, @r. 1468
30 Lrjucnln Ot., Box 236
Putnam Talletg, 10575 z z 099
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CITIBANK. N.A. BR. ON `
330 MADISON AVENUE AT 42ND STREET
NEW YORK, NY 10017 • . `
+1:0210000891: 1 2634895'1'. 1468
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1603 Commerce Street • Yorktown Heights, New York 10596
41 Waters Edge Way • Ridgefield, Connecticut 06677
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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
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41 Waters Edge Way • Ridgefield, Connecticut 06877
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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
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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 <'
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