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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.81 -2 -43 BOX 32 i, *I; a mom !� m 16 r 04242 P N �J UT AM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES s PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR. Y NO Internal Use .Only PERMIT # ❑ Repair Permit issued in last 5 years ©"N6t In Watershed ❑ LLB Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION �- D�G�(�t" TOWN Po/►1l101M^VA4iM # 3.81'— 2 - f-3 OWNER'S NAME /S LO G PHONE # MAILING ADDRESS APPLICANT L ep Gut... r t C[ p . Name & Relationship (i.e., owner, tenant (10 r ct DATE �, 'i, FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER ZebA- Cc--idi 9(—. �0/1 PHONE# 91tl �q0 3SS,K ADDRESS REGISTRATION /LICENSE # 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 system) NOTE: The Department may require submittal of proposal from licensed professional depending on the I ,3 I, as owner,agree to the conditions stated on this form SIGNATURE TITLE DATE (owner) - 1,-th-e septic.installer, agree to comply with the�conditions of this permit for the septic system repair SIGNATURE T TLE (,y (�_/ DATE L �77 I 1 (installer) Proposal approved with the following conditions: 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. No completed work is to be backfilled until authorization to do so has been obtained from the Department. INTERNAL USE ONLY Proposal r ved Pr po Denied ❑ 41;% CAM Inspe or's Signature & Title Date Expiration Date ,Repair proposal is in compliance with applicable codes Yes a No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 Page No. of Pages LEONARDO & SON- CONSTRUCTIO 9 INC. OWNER.- LOUIS LEONARDI :..... 6 C- AR t3LYIS6�-l3R IVE- e *C- Ok.iL- ANDT.MANCR•NY 10567..-., DAY TIME CELL .(914) - 980 -3554 ' OFFICE X914) '736 -9 81,0 LIE,`. #WC- 3112 -H90 a W.C- 3EP"TIO LIC #00067 ® ILIO. #fiO -560 (CERTIFIED)' PROPOSAL SUBMITTED TO PHONE DATE STREET JOB NAME CITY'STATE and ZIP CODE p Q JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: t IT I �- rl 3 y�.�lnlu Z — 32-1 -S Z ' en �l 5 -1 '35 l g PLEASE .NOTE.- ALL PERMIT FEES TO SE PAID BY CUaI' ;MER. *SYSTEM LONGEVITY IS NOT GUAiiANTFED UNLESS DESIGNED BY A LICE94SEiD PROFESSIONAL, ElNG,1NEER.* *TANK TO BE PUMPED BY OTHERS AND PAID SEPARATELY.* *NO LANDSCAPE RESTORATION, OTHER THAWGRADING DISTURBED. . AREAS, IS INCLUDED UNLESS SPECIFICALLY STATED IN THE PROPOSAL* P FCOPOSP hereby td furnish material and labor -- complete in accordance with above specifications, for the sum of: ` dollars ($ ). Payment to be made as follows: A FINANCE CHARGE OF IV2% PER M014TH WILL BE ADDED TO AUL UNPIUD 5!:I.ANCES. ALL DISPUTES ARE TO SE SETTLER THROUGH 31N�IW£; ARBIsRRTIOod. All material is guaranteed to be as specified. All work -to be completed in a workmanlike Authorized manner according to standard practices. Any alteration or deviation from above specifications Signature involving extra costs will be executed only upon written orders, and will become an extra g charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Note: This proposal maybe Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not.accepted within days. Acceptance o4 Proposal— The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to &Utg a ''S a AWgjyj,%0Pjy0 ` PY914� o` AN61 l"pl %I&MACT. Date of Acceptance: Signature Putnam County Department of Health, Division of Environmental Health Services SSTS Repair — ]Final Site Inspection Date: 'L 2 Inspected by: Mb L Installer: LOS. L e6;4A ,-A Street Lo-cation: ee. f— er S Owner :o _ enau I. Type of System: Conventional ❑ Alternate 9f Comments: 1n i,' 14r.- o r 2. Septic Tank Yes No N/A Comments a. Septic tank size — 1,000 ... 1,250 ... other ..... b. Septic "tank installed level ...................... c. 10' minimum from foundation ......... . ....... . d. Distribution Box —5 AFIC. JWA i. All outlets at same elevation (water tested) .: . ii. Protected below frost ............................. iii. Minimum 2 ft. Original soil between box & trenches h f ' e. ,function Box — properly set .......:................... f. Trenches i. System completely o ened for inspection ii. Length required Length installed_ i x id. Pipe slope checked ............................. iv. Installed according to plan ..................... v. 10 ft. from property line — 20 ft — foundations ... vi. Size of gravel' /, - 11/2 " diameter clean ......... vii. Depth of gravel in trench 12" minimum ......... g. Pump or Dosed S stems 3. Sewage System Area a. SSTS Area located as per a roved plans b. Fill section — c. Distance from water course /wetlands 4. Overall Workmanship a. Boxes properly grouted and installed correctly ........... b. All pipes flush with inside of box .......... . .............. c. Backfill material contains stones <4" diameter ......... d. Curtain drain & standpipes installed according to plan e. Curtain drain outfall protected & dir to exist watercourse f. Footing drains discharge away from SSTS area ......... g. Erosion control provided ............................ Additional Comment's: RF'SI Rev - 011312 . �� � r'� p� � f ......... .... PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL-SYSTEn REPAIR OFFICIAL USE ONLY SITE LOCATION' OWNER'S NAME _ MAILING ADDRESS TM# 93,81 --a —V...3 PHONE 5a6 - YYS 7 PERSON INTERVIEWED PCHD Complaint # ame Relationship (i.e., owner, tenant, etc. n e T / D _7 �3 V TYPE FACILITY INSTALLER t ,,.I r &0 5 <- PHONE R Lf S S'� & - d S REGISTRATION# ILC l S� Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system .Different location may require submittal of proposal from licensed professional engineer or registered architect. 4ACI . 0 7 T-P-P S7 E E -14- (-e k- w 11 If PezE w �---- A- a-" M o r 14-N Y C, LCI'J 41r�-A 1 E�Y- IV 6 kJ it;, G L- -- v IS- "Ic V gas ovv e:,�- )Z,7 rted- a$�i;t. of owi�ei:.agiee -to• the conditions stated -in- s ih� -. /'� SIGNATURE TITLE e t'Z DATE �� /7 / D v 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 (e.g.,house corners). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Proposal approved_ Inspector's Signature & Title ATE COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99NE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES please print or type PCHD Permit # 0:3 Well Location: S e dress: TownNi ge Tax Grid # qq e (J Map $3. '� J Block o2- Lot(s) q3 Well Owner: Name: LAddress- 41-1 & M-b �i 16, Use of Well:, Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason L Lila 410-A for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ...................au-P&O ...... ............................... Yes No � Is well located in a realty subdivision? ............ ......... ...................... Yes No Name of subdivision Lot No.� Water Well Contractor: Address: V� Is Public Water Supply available to site? ...... �.,1.... .Y..d4......Q..n ..............: Yes No Name of Public Water Supply: Town/Villa e Distance to property from nearest water main: DO Q Proposed well location & sources of contamination to be provided on separate sheet/plan. - ..Applicant Signature. i ..`.c e�✓1 Date. PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and 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 or their designated representative 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. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a wate well driller certified by Putnam County. Date of Issue 3-&-0 3 Permit Issui fficial• _ Date of Expiration -!o 0 $ Title: Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 NEW YORK STATE DEPARTMENT OF HEALTH Specific Waiver ;: Bu %aaU:di CornSnu ity,,Sanitatior49 Food. Protection-- . . -from Requirements of Part 75 and Appendix 75- A,10NYCRR ' - 'for Individual Hous' �f�6f d�euva��FreatrnentSysterris , :�.':.� -.� 1. Reason why she does not meet 10NYCRR Appendix 75 -A (check appropriate box(es)): Separation distance cannot be achieved. Excessive slope. High groundwater. Inadequate depth to bedrock or impermeable layer. Soil unsuitable. Other(explain) ................................................................................................... ............................... ......................................... ............................... 2. Proposed design or conditions of waiver: ...` M..Folk ............W.C. � �-.........�D.......f?�! .. ......�.......r�!�..o....`� ` �...... A�. D .. ...............:............... v...... 1�.......r�°�'!- ....fay!. ...... ii . L........' S��!........... ............................................................... ............................... - JA � t.a�v th:_...a, ..... ! ±- ....:fR& �:fF.:..4! ra.Nc4.... .4?�:l.e.a� _....,...v_ . . . . . .. . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. The proposed design may have the following limitations (check appropriate box(es)): Increased risk of well or spring contamination. Increased risk of surface water contamination. �J Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. Other(explain) ........................................................... ....: ........ ................................................... ............................... Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. in accordance with New York State Department of Health Administrative Rules and Regulations, Part .75.6 (b), a waiver is hereby granted. This waiver may be revoked by the issuing official for a change in conditions for which this waiver was granted. �'. �FiEPFiESENTA7IV�� � F COM �I §� .................................... ORIGINAL - Local Health Agency COPY - Applicant/Design Professional .................................................................................. ............................... DATE // CAI _4 Vz91 PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 July 26, 1990 Robert Winter 189 Peekskill Hollow Rd. Putnam Valley, NY 10579 Re: Proposed well Winter, 44 Becker St. Lake Peekskill, NY TM 101-1 -17 Dear Kr. Winter: JOHN KARELL Jr., P.E., M.S. Public Health Director I have received and reviewed your application to construct a well on the above mentioned parcel. The dwelling is presently served by the existing summer water supply. Based on a field inspection by James Luke P.E. Assistant Public Health Engineer, the proposed site is 60 feet from two existing sewage disposal systems. Present code requirements require a minimum separation distances of 100 feet. ;_ :_'. Therefore; •a8. <per `Article tliTee afrthe Putnam °Caunty^S -anitary CodD, your.._ application to construct an individual water supply isdenie If you have any questions please contact me at your convenience. Very truly yours, William Hedges Sr. Public Sanitarian WH /pl cc: BI (PV) _ PUTNAM COUNTY HEALTH DEPARTMENT,_, DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Commissioner of Health NAME ADDRESgq No. Street MAILING ADDRESS Municipality (T P.O. Box Post Office Zip Code TELEPHONE PERSON IN CHARGE OR INTERVIEWED Name and Title l DATE /� `'� TYPE FACILITY TIME ARRIVED ! TIME LEFT FINDINGS: INSPECTOR: �v Signatu' a and (Title I PERSON IN C GE JR' INTERVIEWED: I acknowledge receipt of a copy of this SIGNATURE: Field Activitv Reuort .................. Sheet of INSPECTION Orig. Routine Orig. Complain Orig. Request _ Compliance Complaint Comp _ Final Group Illness Construction _ Reinspection _ Field, Sampling Only Field Conference Other TELEPHONE: Explain DEPARTMENT OF HEALTH Division of Environmental Health Services 110,. OLD... ROUTE, SIX CENTER, CARMEL, N.Y.. 10512 .(914) 225 - 0310 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # _ WELL LOCATION S reet Address � �- To Villa a Cit S s Tax Grid Number WELL OWNER 8°°e IdId9p, Mat' , Add e s S / � 142 rivate O Public USE OF WELL 1 - primary 2 - secondary 9LRESIDENTI AL ® BUSINESS.. ® INDUSTRIAL .O PUBLIC SUPPLY O AYR /COND /HEAT. PUMP ® ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify O INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT gpm /i/ .PEOPLE- SERVED /EST. 19 REPLACE EXISTING SUPPLY O TEST /OBSERVATION O NEW SUPPLY NEW DWELLING) ® DEEPEN EXISTING WELL a - L OF DAILY USAGE___gal ADDITIONAL SUPPLY G REASON FOR DRILLING DETAILED REASON FOR DRILLING zw WELL TYPE ILLED ®DRIVEN DUG 13GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES _ i L- NO IF WELL IS LOCATED IN A REALTY SUBDIVISJON, OF SUBDIVISION: Lot No.. WATER WELL CONTRACTOR: Name , ��,. ' Address: % /✓ �_ IS PUBLIC WATER SUPPLY AVAIL T , TE: `YES NO NAME OF PUBLIC WATE UP Y: / , TOWN /VIL /CITY '• I J � _ _.� � . r1.. a.i•.. b •. ......+D- Y 'v • yq- tiiN Sal DISTANCE TO . PROPERTY ST WATER aMAIN: LOCATION SKETCH & SOURCES-OF CONTAMINATION PROVI ®ON SEPARATE SHEET (date) ��� � (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 such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: 19 Date of Expiration Permit is Non - Transferrable 3/89 19 Permit Issuing Official White copy: HD File Pink copy: Owner Yellow copy: Bldg. Insp. Orange copy: Well Driller PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225-0310 Ms. Kathleen Figueroa 62 Sherwood Road Peekskill, NY 10566 July 26, 1989 L� ENID L. CARRUTH, M.P.H. Public Health Director JOHN KARELL Jr., P.E. Director Re: Well Permit - Feldman Becker Street (T) PV - TM #101 -1 -19 Dear Ms. Figueroa: It has come to my attention that the above - mentioned well permit application was previously submitted to this Department on September 23, 1986 for review. The enclosed letter dated October 28, 1989 from this Department indicates that it was denied. 'if you "h'ave' any questions, '- pl-ease c,6ntac;t me, at- -your convenience:" LCW: jr Enclosure Very truly yours, Lawrence C. Werper Assistant Public Health Engineer DAVIO D. BRUEN County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services October 28, 1986 Hyman Feldman, Esq. 115 Broadway, New York, New York 10006 Dear Mr. Feldman: JOHN SIMMONS. M.D. Deputy Commissioner Re: Proposed Well Construction Becker Street (T) Putnam Valley TM 101 -1 -19 - Well Application 38 -86 Please be advised that the fact that the sewage system on this property is at a lower elevation than the proposed well does not mitigate the minimum 100 foot restrictive distance between a well and sewage system. As such,approval of your well p4opopal cannot be granted. r,,,,.._... .,.. .. _ _. VnnK y J e , Jr ., P.E. Director, JK :pt Environmental Health Services cc:JK File TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 6 DEPARTMENT OF HEALTH Division of .Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 A( APPLICATION jO CONSTRUCT'` A WATER -WELL' ,, � PCHD PERMIT # 1�t1'%� 75 WELL LOCATION treet ddress Town illage City Tax Grid Number WELL OWNER Raine Mail i g Add r s jo ate D Public USE OF WELL 1 - primary . 2 - secondary RESIDENTIAL 0 PUBLIC SUPPLY 0 BUSINESS ❑ FARM 0 INDUSTRIAL 0 INSTITUTIONAL Q AIR /COND /HEAT PUMP ❑ TEST /OBSERVATION ❑ STAND -BY 0 ABANDONED ❑ OTHER (specify, p AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY. USAGE_^gal REASON FOR DRILLING 0! VPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION G4 ADDITIONAL SUPPLY WONEW SUPPLY NEW DWELLING) Q DEEPEN EXIS ING WE ` DETAILED REASON FOR, DRILLING WELL TYPE DRILLED DRIVEN DDUG GRAVEL. C] OTHER IS WELL SITE SUBJECT TO FLOODING? YES 4�0 IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NAME OF PUBLIC WATER SUPPLY: 0(cA4V_1 --TOWN /VIL/`CITY U DISTANCE TO PROPERTY FROM NEAREST WATER MAIN : ' LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED , ON SEPARATE SHEET r W,A (date) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted %" der the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam.County Health Department. Date of Issue: 1 19 Date of Expiration: 19 Permit suing Official Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector Rev. 10/88 Pink Copy: Owner Orange copy: Well Driller 9 1, . bb; 11117 PRIMED ON NO. IOOON CLEMtPAINT �.I 10 n i � 4 V-A '� N DAVID D. BRUEN County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services October 28, 1986 Hyman Feldman, Esq. 115 Broadway New York, New York 10006 Dear Mr. Feldman: JOHN SIMMONS, M.D. Deputy Commissioner Re: Proposed Well Construction Becker Street- (T) Putnam Valley TM 101 -1 -19 Well Application 38 -86 Please'be advised that the fact that the sewage system on this property is at a lower elevation than. the proposed well does not mitigate the minimum 100 foot restrictive distance between a well and sewage system. As such,approval of your well.p opo al cannot be granted. Vv J I n Kare , Jr., P.E. Director, JK:pt Environmental.Health Services cc:JK File TWO. COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 TA L o T 19 .. • . -w .� .•... . r♦ •.- - - V Lo•rs lc.v- /G7 - -_... ••eeoo °•O® • Pkopex-rY OF. 1 -IYMRN FOLD lvrA!•r EN6 /NFF9 •.. R., ,E CX- a A s T f?- E f r, L !,A- ! z , �� : >✓ i o s 3 -r $. RO�/lc �O APPROVED IM DRAWN 13Y 6CALS e a :H l TG _ r lAif • DATRt PV f.. 141196a REVI6ED p U T H q P°I C 0Z/ /✓. 7 y, 1Y 7 ° v OF NEW ���`� •` P,2e pp1A -do % y : j o NIi 5. �' Ot l.f. o, p& e L S DRAWING NUMBZR i i. l C j Iv i V A G 0904 r' r I� 111211 >«aiiwr�iRY �q ffiA,. I**wow 1'A 19 LFiAc� WrF St. A.P Is g. for. !��!- r67 u i n V i . i i 4 i i PkoPtv*ry of'. 5 a cx 9 A s T P-,E f r L F- Pt e' X- e. Pi :r P OS 5-7 n: o �e.Ptos nws�aaovffa ®v� O't` s 0 SfA.. C Aw4, '14 05& DRAWN BY DAVU, •� reevissn (r�.❑ 0 Q ® O. %1.4 J t..,E y W" ca r P u N s p o � p ar rN A P� � raw rr, •�. r..� •� Prat► piu-, o- J * 14H �+. h cr. -r,� �a P& le C. 's DRAWING mu�n�ea PlOS7P4 t3rQ eia k'A P86'C..a.c.t 44 4 r MAN FELDMAN 115 BROADWAY NEW YORK. N.Y. 10006 TELEPHONE (212) 862.2262 October 6th, 1986 Mr, John Karell, Jr, P.E. Director Enviromental Health Services Two - County Center Carmel, New York 10512 Re: Proposed Well Construction Becker Street (T) Putnam Valley TM .101 -1 -19 Well Application 38 -86 Dear Mr. Karell: This will acknowledge receipt of your letter dated September 29th, 1986 wherein you inform me that my application for permit to construct a well on my property is denied. I respectfully request that you reconsider my appli- oation, taking into consideration the fact the report of John S. Romeo, P.C. dated August 15, 1980, .clearly states that my septice s.ystmm._ia at : a lower..elevatiom th i. aria; t�, � Q 4d,...w ®7.1.D..th(�. se.pti.c.: ' �� 'syetem " -of' "the ad scent property t0 my east is likewise at a lower elevation than the proposed well, and importantly, the proper` across the street from my, property is vas and the direction of the flow of that land is easterly and not on to my property. In view of the aforesaid, I respectfully submit that the minimum distance of 100 feet should and can be waived as the Town, of Putnam Valley did in granting me a varianceby Decision and Order dated September 10th, 19800 Thanking you for your kind reconsideration of this matter, and awaiting your further advoces, I am, HF:C Sincerely yours, FEL.DMAN r s t ., y ,-., ww- � . "fwr✓; �`'^i +t•w ay ...rxvY �:!...:t'�"i�g. �vx�..4a�'��z��x �xu;o-a ; <.r�r,xa"x ,.� jS4r`r.�.• �r ct y� t��ta �' w�,;fi� r �,-vK_�«+s «z�t�"s ��• n'K t"�' .a t s J DEPARTMENT OF HEALTH... „->u yes �.,o ; Division Of Environmental Hgth Services TWO. COUNTY CENTER - CARMEL, N.Y..10512 -., (9,14) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL WELL LOCATION STREEI AUORESS. ,/'jam- 1UW" ! 01 AG I Y 1AX GRiO NUMBER. /�rti1. WELL OWNER NAME. • ADDRESS: ” � /� ��7Jf'?�� � / ' x' ' �,��SS�fc/U �{7� ��`��7�",�����lJn'L ✓ 3 PSIVATE ,J- ❑PUBLIC USE OF WELL 0 RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED 1 - primary ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) 2 - secondary ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY Cl MOUNT OF USE YIELD SOUGHT 9P mJNO. PEOPLE SERVED EST. . OF DAILY USAGE REASON FOR ❑ NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION DRILLING ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL WELL TYPE M DRILLED F-] DRIVEN IS WELL SITE SUBJECT TO FLOODING? DUG F_� GRAVEL F-1 OTHER — YES Y NO 1k' WELL 15 LUCATED IN A EEALTY SUBUIV151UN, NAME OF SUBDIVISION: X/ LOT NO.: WATER WELL CONTRACTOR: Address IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: � YES _ NO � 444 NAME OF PUBLIC - WATER. - SUPPLY: /" 0 -�T - DISTANCE TO PROPERTY FROM NEAREST WATER -MAIN . .- LOCATION-SKETCH & SOURCES OF CONTAMINATION (date) �. I (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 2. Disinfect the of the Putnam permit. 3. Submit a Well the Putnam Coy Date of Issue: until the water is clear. well in accordance with the requirements County Health Department attached to this .Completion Report.on a form provided by inty Health Department.:. 19�_ ffi, JOHN S. ROMEO, P.C. i NORTHRIDGE ROAD .-.. o. ri °.s' 7 ...._. �� ��,.- -.- .- ;i- 'en'�p.;.a �. •e+w.»;:- ;i »�:' r "i.pEEKSl�_I�I..�.:I�I� . r1QS �,.. " "..; _rte...., ..-r: i• .pia. : »i. •,.. .«. �:+ .i, "..�': 914. 737 -1056 August 15, 1980 1 "r. Hyman Feldman Becker Street Lake Paekskill, it•k. 10537 'Re: Proposed well installntion on property known as `.lax slap 101 i Bloc? 1 - Lot 19 Dear Mr. Feldmans � Z have reviewOld the •propos3ed well installation for the above noted 6roperty. 11feel that a well can be installed as shown on the accomp M sketch, that should function satisfals tork`,ly and safely. The property is locsatedl on the northerly side of Becker Street. In Lake Peekskill.! The adjacent owner to the � ast hassel well installed In close proxi.mlty,to your easterly line, near the edge of Becker St. His septic system to behind the housse,at a lower elevation. with the direction of floe sway from the proposed well installation: The' property a cross the street is of that.land is easterly. Your own ssrentLe system is located elevation than theiproposed well. Your from the propose Droll installation. vacant, and the direction of flow behind your houses at a lower qtr system Is sspixtu rimtley 60 ft. The, provisiono of the !gown of Putnam Veley Ordinance dated bray 17, 1978 must be fully; complied with, 1.e. to be double eased. with ±= `- l -kVpr.:tQat_:to_ ade-'o-inatre..- potable Water' eas�ngs to be a minimum of 10,ft. into�be rocks �. If for some uhf then additional meis' a ohlorinsator and/or i a" JS R : c r rseen reason, the bacteria count becomes excessive. res must be employed, such as the installation of filtration system. very truly yours • hn Romeo cc: ;l'r. 41111am 4hitehill e building Tns ector with enclosed sketch ° °000esoe• e ®���Al EN6 /�r��� v,• @� �S.RO� • e • 278 6 of New ro�'� •'' PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR OFFICIAL USE ONLY TM# PHONE 5 a PERSON INTERVIEWED - PCHD Complaint # I. _ / Name & Relationship i.e., owner, tenant, etc. INST LER_t .;2 1 re ).5 + TYPE FACILITY )NE Y `f.- rO-6 -o-?S FS- TION# c- l �U" Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system .Different location may require submittal of proposal from licensed professional engineer or registered architect. F_ 9 C M" iogo rd-c (,��G. cAe,G a- sii n-e_ Ai W'e0- O& Tt-tff 900s4: I; as -6' W -n-e-r-, reported agent of owner igre e Iudt r: eonditions- stated' or`-t1iS, form: SIGNATURE TITLE —6 4&&_f 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 DATE b. Site Street Name, Town and Tax Map number. C. Location of installed components tied to two fixed points (e.g.,house comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Proposal approved Inspector's Signature & Title COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99NE / Z-- ATE LORETTA yMOLINARI R.N., M.S.N. Acting Public Health Director Director of Patient Services =,..�_ .. ROBERT J. BONDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Richard Hansen 44 Becker Street Lake Peekskill, NY 10537 Re: Proposed well Hansen 44 Becker Street (T) Putnam Valley Tax Map No. 83.81 -2 -43 March 6, 2003 Dear Mr. Hansen, The application to drill a new well at the above referenced lot was approved at this Department's February 6, 2003 waiver meeting with the following stipulations: 1. A minimum of 60 feet of casing must be provided for well protection. 27 --The prcrp'sos - a,.ell loca ior�� list osr c r b �i€e 1s -� es �- `_' --dak Staf land' surveyor; the location must be confirmed by a representative of the Putnam - County Health Department prior to the well construction. As -built plan, Well Completion Report (WC -97), Well abandonment, if applicable, and water quality analysis shall be submitted no later than 30 days after the well completion by the permittee. Please contact the writer at (845)278 -6130 ext.2235 if you have any questions. Very truly yours, �/444Vl ZW Daniel Hadden Public Health Technician cc: MJB, DH, Norman Anderson, file f 91 n1li r6 eAev- SAveek 911 1 ' PIT NAM COUNTY DEPARTMENT OF HEALTH IDIVISION OF ENVIRONMENTAL HEALTH SERVICES �- APTLIC.�'TION --TO ,C� ,NS- TRLTCT:A- 'I' I�i< ...a , — please print or type PCHD Permit # `W- O Well Location: StTeet dress: To illage Tax Grid # qqMap S5, a' Block o2 Lot(s) q3 Well Owner: Name: Address: A A0-'b ` � � � T Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served • Est. of Daily Usage ,gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well 'Type Drilled Driven Gravel Other Is well site subject to flooding? ........................................... ............................... Yes No in Yes No Is well located a realty subdivision? ................... ..... Name of subdivision Lot No._ Water Well Contractor: W,Address: Is Public Water Supply available to. site? ....... ..( ..... � ................ Yes No Name of Public Water Supply: .L �� Tonilla e g Distance to property from nearest water main: U -�- 0 Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: " Appli�arit`Slgnasre: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and 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 or their designated representative 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. 3) Submit a Well Completion Report on a form. provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. `APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless ►,construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a wate well driller certified by Putnam County. Date of Issue 3-& °0 -3 Permit Iss ' fficial: Date of Expiration 34 ro �5- Title: Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Forth WP -97 BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 S C.-J- -0� -,:,-3 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAVIER NAME: 1C L( -AAA1) C. M, lG14rr,U.'e. 4MI S" ADDRESS: LA4 Bece " 'Vfte-,r UC A 6141! 01-1 1of3 t SITE LOCATION: S AWE L DATE: STAFF PRESENT: Rob M., Mike B., Gene R., Ag , Bill H., Joe P. pAA K - SPECIFIC WAVIER REQUEST: ?rapoS" V AZ- OKrarf4-S 20 3 sets &r- .. t� . AlJlO N.1. T DOES THE PROPOSED VARIANCE REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? YES NO WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? YES NO DISCUSSION REQUEST APPROVAL OR DENIED ROV � DENIED RF,ASON FOR DENIAL • DATE 2 -6- -03 DIRECTOR DF (SPECWAIVER) 14.18 -4 (2187) —Text 12 ..PROJECTA.O. NUMBER _ State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project Sponsor)- 1. APPLICANT /SPONSOR 2.. PROJECT NAME. Fa �� 3. PROJECT LOCATION: Municipality �g County PV .4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) ..a 5. IS PROPOSED ACTION: 0 New 0 Expansion 0 Modification /alteration 8. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ❑ Yes 0 No If No, describe briefly `4•: i 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? " O Agrieu�a � �`HeBideri3T "° LiliUTiiG marcial� 0sV-pea, - cpp Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAU? 0 Yes C No If yes. list agency(s) and permitlapprovals 11. DOES ANY ASPECT OF THE ACT,:H HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes 0 N, If yes. !Ist ac envy name and permitlapproval t 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? [Dyes 0 No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicantisponsor name: __ - Date: Signature: If the adt`Ion is'in the Coastal Area, and you are a state agendy' domplete. the_ Coastal Assessment Form before proceeding with this assessment OVER 1 I 0005 �g,76 49 a ! !t ! 1 20 18 N 0 0o s41 �1 ss t �T t t 1 1 t 00 1 1 691 jo 70 t t "V qw bo, a � ( ! ! T3 t 74 T5 t r6 t T11 T9 6�� I 8Q 18 1 60.28 80 00° 46 /5 1 41 a l 1 42 SS I 1 1 t 1 ! t I o t $, 143 t ► t I t 1�� 44 ► 1 t .00 1 6 0 1 I t It t t ! ! t 1 � 100.00 I t 1 1 I I I r2r 91 iatreet I 49 I I I 48 LA Li 6 go' � }�„� � 5ed �# _uci ssDS Z 6._VVI � L s +. � C, S3 �1 s WL P'(� a (r) (-) C ^-ice NEW YORK STATE DEPARTMENT OF HEALTH Specific Waiver Bureau of CommuFlity SanitaUon and Food Protection from Requirements of Part 75 and Appendix 75- A,10NYCRR for Iritlivldual'i-iousehold Sewage Treatment Sjrstems r - .r = Reason why site does not meet 10NYCRR Appendix 75 -A (check appropriate box(es)): :uI Separation distance cannot be achieved. Excessive slope. High groundwater. Inadequate depth to bedrock or impermeable layer. Soil unsuitable. Other (explain) ........................ 2. Proposed design or conditions of waiver: Q ?1(pTOS ... ..... ..........• w....... .n.......'rNJ..O........!�T .% ...... A AD . ............................... ............ v....... ......1119.12 ..cV leo ...... AA..a ........ °5 1 ... ............................................................... ............................... 3. The proposed design may have the following limitations (check appropriate box(es)): Increased risk of well or spring contamination. Increased risk of surface water contamination. Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. Other(explain) ............................................................... :............I................. ........................................................................................................................... ............................... Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be. revoked by the issuing official for a change in conditions for which this waiver was granted. (� ►, 40PWREtSENTATIV F COM IS ONER OF HEALTH ORIGINAL - Local Health Agency —� COPY - Applicant/Design Professional .................................................................................. ............................... oaTE MP -1521 0 0 - 60• - -00' 16 r 1,3e J: WHAM ON THIF � TOWN. OF • PUT NAM VA L -L EY • PUTNA•41- COUNTY - /V. Y. J , SCALE 1 1N.: 1 D FT. 79 ? i I i o i / � 9.8 I Mi • p !� I 9a q% 1 - L. APCNAW It OORA the ' t9 4 �� �• e 1 : I � o .ate. � 73ac. that �. >� .-•�s- INs aurwy Ass been prepared in s000edanes whh The sxf dAV Code of Or arrtfoe !or Land Sumvpe � �% � ., 1o•%✓yu�owe� � r ♦. . 0yC7•%ataS.seeef .?L 1 Y'S�Y�r. YA Ur- Na aW M i 1 .rar�as.1 t - f rroras q t. A1Nnthnp o/ tope eba+rtnynt. aixeept hr a rtaenaed Land Surveyor.1a ltfepel. Z AA *wMeagom are va Illd note Ihfe map end t:optse IMraof oft 11 Rre geld nup or • i �t OsK ►• � i a S. PrMI*$ fbdeY LsuL.t!1j1�!'.!i/i i�t �-a/ �r .t 1• uM uup Red onl'f 4 121 1n the County ChWg fLl W as No No. f e � O � � o W Al 1 . i .,I�af'ICI1��R i STRATt°a' Ar a ASSOC. vavtaroAS EAS J441C 7k` El— di rNSPE SP°'1 A. 6ATELC WHAM ON THIF TOWN. OF • PUT NAM VA L -L EY • PUTNA•41- COUNTY - /V. Y. J , SCALE 1 1N.: 1 D FT. 79 ? i I i o i / csrt�PfFO Toil sa�sP.r - ��l�gry�. 6 ° �'ew.,o•ede✓e0 /r13'.4s. ✓eve/ GS••..'�sa•. . - L. APCNAW It OORA the anonwper who mode this snap, eerl(y thar the swvw shmm hereea was oaatptared by rvo a on .ate. � 73ac. that ' rws asfed er a ae a r INs aurwy Ass been prepared in s000edanes whh The sxf dAV Code of Or arrtfoe !or Land Sumvpe adopted by The New Yak State AaeoafeAoA of Preleeelonat Lang t'urwyom AtCHARD H. OOAA . 0yC7•%ataS.seeef .?L 1 Y'S�Y�r. 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Address: Located at (street): TM 4 Section: Block Lot N4 unicipality: Watershed: SOIL PERCOLATION TEST DATA Witnessed by: _ Date of Pre- soakiatg: Date of Percolation Test: 1 Hole No. Run No. Time Start — Stop. Elapse Time (min.) Depth to water from ground surface (inches) Start - Stop Water level drop to inches Percolation Rate noin /inch 1 � 3 f 5 I Z 3 4 1 � � z 4 f 4 5. I 3 4 Notes 1. Tests to be repeated at same depth until approximately equal percolation rags are obtained at each percolation test, hole. (i.e., < 1 min for 1 -30 min/Inch, < Z thin for 31 -50 mini'mch ). All data to be submitted for review. 3. Depth measurements to be made from cop of hole. Form DD-9!,p2 I ;)r'_ TEST PIT DATA DESCRIPTION OF SOIfS ENCOUNTERED rN TEST HOLES ... ^.'.Ff.' l - ' Yr � -� J"� : e. ... . a ..-. s.^ . � _ . !. .. _ . "' +YFi'+ 1 Cr' : - � . � .._ i'7`•' ��.: .-K. _. ^� .- f � � T DEPTH HOLE # HOLE # HOLE # HOLE # HOLE # G.L. 0,. 5' S 1.0' Locw . 2.0' C 2.5' Lm�M 3.0' 4.0' 4.5' is 5.0' 5.5' f nn^ 6.0' 6.5' LVI 7.0' 7.5' 8.0' 9.� 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Date Design Professional Name Address: Sipatize: Design Professional = Seal FLOORPLAN File No. 112922 gun c— C) C ,e4\ rl 6, 07C 1 CA ILI 16.5' zoo 8.01 DINING ROOM 14.0' BATH KITCHEN BEDROOM 28.0' eP FPL. 24.0' LIVING ROOM BEDROOM-... ENTRANCE CL CL. 4.0' 17.0'/� pr f 13.5' 3e r_ r 0 se 0 C3ee.\,4e,r (?rc,?,,5ec9 To fo h VTO?OSGCA well —\0 C 0 'A gun c— C) C ,e4\ i Cor 68 y a3' _ -- N4cL FaOW �,ow of iaa.�� MAP ISSA 8 aC.w- �S ® Lors Lf•7o DI.y� c,io.. OF i�ow \ M 1 ENB/,y�q •�� •�c E�p�,l 5 pOM • i p't'� pd T�' qV • �• . i W !J�-�� OF NEw r . 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