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HomeMy WebLinkAbout4411DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.11 -1 -16 BOX 33 1 rm I J 1 „ 4, A 19 04411 DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914.) 225 =3641 ..'' -Q.w, .,... ... _ . �t ... '.. •G 1�. v.. .'Y 'ip �'.%�N: P'+.. �.` ... •. .e r�•'�. ..�... :4. Ct l.�. .... .. rw.t. .. - APPLICATION TO CONSTRUCT A WATER WELL r /f PCHD PERMIT WELL LOCATION Street Address // ,7 Town Vi lage Ciity Tax Grid Number �en'A1 0 a✓ 01M 44 /9'-.3� 3 WELL OWNER, Name Mailing Address f� �O�'vx 77 s�iYrtv3/'Y- A- rivate OPublic USE OF WELL 1 - primary 2- secondary tS9IESIDENTIAL O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP 0 BUSINESS O FARM O TEST /OBSERVATION 0 INDUSTRIAL U INSTITUTIONAL O STAND -BY ❑ ABANDONED O OTHER (specify, O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE.:$70& gal REASON FOR DRILLING U& SUPPLY O PROVIDE ADDITIONAL SUPPLY OREPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE DRILLED []DRIVEN ODUG GRAVEL C1 OTHER IS WELL SITE SUBJECT TO FLOODING? YES A-0"-NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: zde.3 L v. -G .A'a e'Af AGr'dL5 Lot No? ��r> v Address:— tf 1/z, WATER WELL CONTRACTOR: Name %� J7 /°� IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN;`' LOCATION SKETCH & SOURCES OF CONTAMINATION .PROVIDED []ON REAR OF THIS APPLICATION 3ON SEPARATE SHEET ?7 ( ate) 1 natur �p 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 S,tate.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 provide by t P nam County Health De a/rtment. Date of Issue: l � � 19 Date of Expiration: 19 er Issuing Official Permit is Non - Transferrable 2/87 White copy: H. D. File Yellow copy: Building Inspector Pink Copy: Owner Orange copy: Well Driller PUTRIAP/I COUIVT�' DEPAIiTAgENT OF B�ALTH I�B q '10512.; r F ®ep t� Provla®repmit a . Divlslon of Enviromnentel_ Health Services Caemel RI 'Y +� �f��J /" - - `oti CERTIIFICATE OF COMP- CE • F. '? ...:. a � J. ;� � ..Permit f/ x OPISTRUCTItDid PEItAgIT FOR SEWAGE`,DISPOSAL SYSTEM 44 ry_ at r/ ..�'��� /� // /' /' /� f✓ �� y Cy ... _ ,or VlOage _ Town }� Sabdivielon Name. �S r`"� ��°��,� Sabd. Lot q � Taa_Rgap Block —� Lot � ~, Renii*A ❑ Revision ❑ wnee /Appllcaat Piame ns APpro Date of Prevlo v g ptgdres®, . Town Zip Btd181ng Type, Iot Area FID:;Section Orly De th Voltune 4 > ' P Plum of Hodiooms Design Flow'G P D b �% PCHD Notid -flAn is'RegWriDd When byll is ctiinpieted` Separate Sowaieage System to co"Ist of / GaDon Se do Tank an �' ® 4i To be constract®d, by t Addrees PVat®e SnPpll s . Pdbllc Supply From Addreea Oil Pelvete Supply .Dellled by _Addrese ✓e Othee;Eenalre ®ante G r ": % l � ,,. 1 re It that, I am wholly antl;comple(ely responsible for the design and location o p'o{ y�m(s); 1) that the.separata sewage, disposal: system ' abOVe, %deSCnbBd WIII be COnS(IUttetl a5 ShOWn on theta I9y". endment there a0'.. C�CBjdaflC� Wd Stalldartl5, rUICS,an f u a �011Sb ' e '1 . u nam PP Couhty Oeps_rtment 'of Health, "and that on coTpletion thereof s Certificate': C satisfactory to the Commissioner'of Health will be'wbmdted "to the Department and a ,wnttenvuarantee)'ill be,turn{shed. a o o his we s eh Ir r assigns by the builder that said builder Will place, .an goodjoperat ng eondrt�on any ;part of laid sewage tlisposal system r•iri� ,e pe d of t �) y s. immediately following the date of the issu- ance • of the ;approval >of the Certificate :p! ConstiucUOn' Complisrice of th iig Sys ny�sAh reto; 2) that the drilled• well described .above will be locateliis Showmgn`the approved pian ahE,that said well wJl`be install " rd the da rules and regu as ii'f'ons of the .Putnam COUnfy ,D(efartmenI of. .Health, C/��� o PE' R.A. Oate igned _ L t' d �� Address �® License No _ 'Arevocable ED car ONSTRb TIOndedhis motlNial when cons dared nr essa[Y by t ' n salt df Any change ohs; been undertaken and is ro 9�.b$r teration of co'struction requires a ew rrm /d7n for disposal of :domestic aerate► 'Sawa antl/ ly ly. 2 Rev:. 1/87 ' Date By Title r 1. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM S & S Development, LLC Owner or Purchaser of Building S & S Development, LLC Building Constructed by 278.Peekskill Hollow Road Location - Street Residential - Single Family Dwelling 84.11 1 16 Tax Map Block Lot Putnam Valley, New York TownNillage S &'S Development Subdivision Name 3 Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam.County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system... The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month July Day 6 Year1998 6Yeneral Contractor (Owner) - Si ature Corporation Name (if corporation) Signature: Title: Corporation Name (if corporation) Address: 421 Route 6 Address: State New York (Mahopac) Zip 10541 State Zip Form GS -97 07/10/1998 13:41 9142453170 YML EN Albert; -AS #z 33.406361 CLIENT #s 11: VNNNN----- 0 --------- A°------- NNE rORL I SH & SONS :SOX 271 iTTENTIONO DWAYNE T'ORLISH aRMONK p NY 10504 YORKTOWN MEDICAL LAB IRONMENTAU SERV I (:'E =;S PACE. 02 1,. Keay' St.r-e.t ( 914) 245-2800 4. Padovani, Director STAT PROC PAGE E -NNNNN NN NNNN NNN NN N NAIIVNNNN/N--- ----NN NN -------- DATE/TIMF- TAKENs 07/06/98 03s00P DATE /TIME REC'D8 07/07/99 11sa0A REPORT DATER 07/10/98 PHONES (914) -273 -3448 ;AMPLING SITE: S & 5 DEVELOPMEN1 SAMPLE TYPE..s POTABLE g PUTNAM VALLEY PRESERVATIVESs NONE 'OL'D 'OLID BY s D. TO{4L % 514 TEMPERATURE . . B TOTES...e TANK COLIFORM METH: MP' N - - - - - - - - - - - - M - - - - - - - -- N - - - - - - - - - - - N N N N N ' DATE FLAG PROCEDURE RESULT NC)RM6�L -- RANGE METHOD la No limits for Sodium are roscribed. Suggested guidelines state that for people on a sod,i m restricted dietnthe water should contain no mere than 24 fW /L of Sodium. For those on a moderately restricted dial, a maximum of 270 mg /L of Sodium is suggested. IRMITTED DYa ''t- -O` 41�IIW Ylwh°µ.wij AI rt H. Padovani Director .T.(ASCP) t ELAP# 10323 YML E IRONMENTAL SERVICES 1 Kear Street Yorkto' n Heights, N.Y. 10598 (914) 245 --2eoo Albert]H. Padovani, Director LAB #a 33.406361 CLIENT #; 1'14 STAT PROC PAGE 1 N NNN NMNMMN------- MMMMAI-- -- -MMM -- ---- -- NNNNNNNNMNMM- MNN/V NN NIVNNM MVNN NNN NN NNW MIYN TORLISH & SONS DATE/TIME TAKEN: 07/06/98 03:OOP PDX 271 DATE /TIME REC'D-i 07 /07/98 11e30A ATTENTION1 DWAYNE TORLISH REPORT DATE: 07/10/98 ARMONK, NY 10504 PHONE: (914) -273 -3448 SAMPLING SITE: S & S DEVELOPMENI SAMPLE TYPE..: POTABLE : PUTNAM VALLEY PRESERVATIVES: NONE COLD BYs D, TORLISH TEMPERATURE,.o NOTES... = TANK COLIFORM METHt MP DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD FACT PUTNAM CNTY PROFILE 07/07/98 MR T. COLIF RM 07/07/98 LEAD (TO ppb 07/07/96 NITRATE NIjROG 0.33 07/07/98 NITRITE NIY! OG .07/07/98 IRON (Fe) N/A 07/07/98 MANGANESE 01n) MG /L 07/07/99 SODIUM (Na � •:0.014) 07/07/99 pH e037 07/07/98 HARDNESS,TIJ AL 07/07/98 ALKALINITY AS 07/07/98 TURBIDITY 4 UR COMMENTS: FAX TO 273 -•8204 ABSENT /100 ML ABSENT 1008 <1 ppb 0--15 ppb 12345 0.33 MG /L 0 - 10 9139 :0.01 MG /L N/A 9146 x'.0.060 MG /L 0-6 3 Mg/1 2037 •:0.014) MG /L 0 -0.3 mg /l e037 16.3 MG /L N/A 8.0 UNITS 6.5 -8.5 9043 20.0 M8 / L N/A 98.0 MG /L N/A 1 NTU 0--5 NTU COMMENTS: THESE RESULTS INDICATE THI T.THE WATE (WAS .(WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD' THE NEW YORE: STATE AND EPA FEDERAL DR1NF-.IN0` ATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF CO LECTION. *b /Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and .a treatment must be potential. ublic sC ools are set at 13 ppb. Rule for- Public Systems requires that no more district tion points have a LEAD value of more COPPER alum of 1.3 mg /L, else water undertaken to reduce the waters corrosive =e /Mn If both iron and mangane.s are present, their total value combined shall not exceed 0.5 mg /L. r� " 4• M COUNTY ' I , OF A.j A }li } 1453 `w 1 ®7 } } ` } }!; O .i,a N } A I } I l } } 9 }' } S J CERTIFICATE OF CONSTRUCTION COMPLIANCE FORS MENT SYSTEM HD CONSTRUCTION PERMIT cated at -spa s-L._ &kyLx p% . p­p Xp Town weibiqM ux *9 wner /Applicant Name S .5 pnscjT Tax Map &A-Al Block t Lot 0 to Formerly Subdivision Name Lqy1, YV5L�V-'®A. C-R-G-,S PC Lo O Subd. Lot # J Mailing Address 41 P-T (P kA w' Zip I ® &41 Date Construction Permit Issued by PCHD $ g 1 Separate Sewerage -System built by W r i L fig �° Address M C-, W �• Q ��� Consisting of J ®®0 Gallon Septic Tank and ,� �50 X 2A6° Other Requirements: Water Supply: Public Supply From Address or: !/ Private Supply Drilled by -('mo & <&oti S Address Buildinyp� t:it►b.- Has erosion control been completed? Number of Bedrooms Has garbage grinder been installed? All I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of a Putnam County partment of Health. Date : Certified by P.E. Zazir;!�_ (Design Professional) Address '91 NE- o,5A Z License # Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification-atchange_is necessary. B Title: Date: v White copy - HD File; Yellow copy - Building Inspector; Pi copy - Owner; Orange copy - Design ofess/hal Form CC -97 PUTNAM COUNTY DEPARTMENT OF 14 -EALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: _..� - - - : • -: ..r_ , a-_-- - _ �Inspeet�dab�:d: .�•ti.' =Street t6iati6 - �� Owner Town f Permit # !/ TM # Subdivision Lot # , I. Sewaee Svstem Area a. STS area located as per approved plans ...........::............. b. Fill section - date of placement 3:1 barrier Lgth.' ' Width Avg.Dpth A c. Natural soil not stripped .......... .......................... :............. d. Stone, brush, etc., greater than 15' from STS area......... e. 100' from water co ds ..... .......... ...................... II. Sewage System 4 a. Septic c si 1;000 ......1,250......... other .............. b. Septic tank insta evel .............. ............:.................. c. 10' minimum from foundation ........ ............................... d. Distribution Bo outlets at same elevation -water tested ............... 2. Protected below frost ................ ............................... 3. Minimum 2 ft.Original soil between box & trench( e. Junction Box - properly set ........... ............................... f. Trenches T- Length required ,3 Length installe,320 2. Distance to waterco se measured Ft......., 3. Installed according to plan ........ .............................., 4. Slope of trench acceptable 1/16 - 1/32" /foot........... 5. 10 ft. from property line - 20 ft.- foundations........ 6; Depth of trench <30 inches from surface ................ 7. Room allowed for expansion, 100 % ....................... 8. Size of gravel 3/4 - 1 %2" diameter clean .................. 9. Depth of gravel. ia1rench.l ?,':.minimum .................. =10 -Wipe rnds cappe .- ...... -- - ..........._ g. Pump or Dosed Systems 1. Size o, pump c am er .............. ............................... 2. Overflow tank ........................... ............................... 3. Alarm, visual / audio .................. ............................... 4. Pump easily accessible, manhole to grade. ............. 5. First box baffled ....................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........ III. House/Building a. House located per approved plans . ............................... b. Number of bedrooms ........................................... IV. Well a. Well located as per approved plans ................... . b. Distance from STS area measured �7tft......... c. Casing 18" above grade ................. ............................... d. Surface drainage around well acceptable ..................... V. Overall Workmanship a. Boxes properly grouted ................. ............................... b. All pipes partially backfilled ......... ............................... c. All pipes flush with inside of box . ............................... d. Backfill material contains stones <4" diameter...:........ e. Curtain drain & standpipes installed according to plar. f. Curtain drain outfall protected & dinto exist watercou g. Footing drains discharge away from STS area ............. h. Surface water protection adequate ............................... i. Erosion control provided ............... ............................... Rev. 6/97 Form ST-3 IPUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT WORV bel idd ^ . �Street-AiIdre9_s:T' - - . �' - 011..0 W T cfwi'iy�illage.' ' '' ' `" j , A U Tax Grid'# //" Map�L%�$lock Lots) Well ®wner: Name: Address: S*S igL o C. mdp Residential Public Supply Air cond/heat pump I igation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby llJse of Well: fl- ri>mna 2- secondary Drilling Equipment Rotary Cable percussion --_zh Compressed air percussion Other (specify) Well Type Screened Open end casing­—_...x Open hole in bedrock Other Casing Details Total length ft. Length below grade ft. Diameter in. Weight per foot lb /ft. Materials'. Steel _ Plastic _ Other Joints: WeldeZfi---, Threaded Other Seal:--., Cement grout _ Bentonite Other Drive shoe Yes _ No d Liner _ Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield 'Pest Bailed _ Pumped Compressed Air Hours Yield A gpm HDepth Data Measure from land surface- static (specify ft) 23 During yield test(ft) �® Depth of completed well in feet '5� Well Log If more detailed information descriptions or sieve:analyses. are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft.- Land Surface L �_ :�o d U 0,5aujim- __ _(0:_ If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type, Capacity Depth Model of Voltage ZW HP fA° _ Tank TypdL. ' BwLVolume Date Wel Co eted Putnam County Certification No. Date of eport Well riller signature) NOTE: Exact location of well with distances to at least two permanefSt landmarks to be provided on a separate heet/plan. Well Driller's e ' l f+/ Address: kml E V mowk Signature: Date: White copy: ' HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUM M CX1LW Y UE11AIQME14L' CAL' HLAL,TH DIVISION OF ENVIRONMENTAL HEALTH SERVICES b- DESIGN DATA'SHEET- SQBSUFACE SFWAGE DISPOSAL SYSTEM FIDE NO. Owner /,0lti�s�"-�. Located at (Street) /�i/,�.5 %� /��'''�� Sec. %/ Block .. Lot (indicate nearest cross street) Municipality 11,24, Watershed SOIL PERCOLATION TEST DATA REIw= TO BE SUBMiT m WITH APPLICATIONS Date of Pre - Soaking L7 Date of'Percolation Test HOLE NL24BM CLOCK TIME . PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop / Inches inches Inches (J% �/a �w ?� y� 3Ile 3' 5 r• 4 5 1 2 3 4 5. NOTES: 1. Tests to be repeated at same depth until approximately soil rates are obtained at each percolation test hole. All data to'be submitted for review. 2. Depth measurements to be made fray top of hole. rev. 9/85 G.L. 1° 2° 3° 4° .5° 6° 7° 8° 9° 10° 11° 12° 13° 14° TEST PIT DATA REQUIRED TO BE_SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. % HOLE NO. 2 HOLE NO. zxl n2 `E7L AT AHE Ct03INDICATEL iD;qATER IS -E[,MUNTERED -, %�•`'G ra t' ___ ..... _ . INDICATE LEVEL, TO WHICH WATER LEVEL RISES AFTER BEING ENODUNTERED DEEP HOLE ,OBSERVATIONS MADE BY: ; DATE :.3 DESIGN Soil Rate Used Min /1" Drop: S. D. Usable Area Provided 4 Noe of Bedroans Septic Tank Capacity % gals • Typea��h y Absorption Area Provided By 05V L.F. x 24" width trench / Other /qe /3 /Ci // d`'1 a , n 4 , h /s"`J e Name m Sig s4 Address fl ;�X Ca- 7'� THIS SPACE FOR USE BY HEALTH DEPARZMErl.0 ONLY: Soil Rate Approved sq•ft /gal, Checked by Date Re: PUTNAM COUNTY DEPARTMENT OF HEALTH .DIVISION_ OF :..ENVIRONPJENTAL' HEALTH-.. SERVICES Property o Located at Date � 12 2 J 9 7 Section // % Block .3 Lot Subdivision of ZO : -e J7-- ems' Subdv. Lot # ..3 Filed Map # Date Gentlemen: This letter is to authorize 7U15, - h a duly licensed professional•engineer or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and•to sign all necessary papers on my behalf in - c6nutiec.A.kui` to tla::th�,s- ..ma:tter and ' to=.. suFeriris .e,.:.;the:c�nstruc.�a.ori._of' "'said system or systems,in.�conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. . �► 4 Countersigne� P.E. , R.A. , Address �� /� J L� �d�R Nr v.4•.s7 � r Telephone Very truly yours, Signed Q,, %•SkW4-6„ Ownef of Property 7,10 •r30u 72' Address 'RA ", �- A) 0- Town Telephone PPE DD PUTNAM COUNTY DEPAIMIENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES (Name of Owner) E•�`'f Il :L9I�;J �i.�M �7 a, ^r.�tl � N �y sr "�:� M REVIEW SHEET - CONSTRUC.TION PERMIT< J DATE . BY: p (Street Location) DOCUNWTS t'n—It, rm Peit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth s/s SUBDIVISION Pere (3) Fill cd House Plans - Two sets Well permit; PWS letter Variance Request GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland.(Town/DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flora Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes.(grinder..notes) Design Data-. Two-Foot Contours Existing & Proposed Driveway & Slopes Cut Footing/Gutter,Curtai.n Drains .(discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If Pumped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Proposed Systems Property Metes & Bounds . House Setback Necessary (Tight lot) House Sewer - 1/4" /ft. 4 110; Type pipe No Bends; Max. Bends 45° w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees,Top of fill 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains - Curtain, Leader, Footing 351to catch basin,stormdrain,piped watercourse 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' fram Foundation; 50' to well 15' Well to PL DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 _ __(914) 278 -6130 _ APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # "( ! WELL LOCATION �fSe*-0-iLLLi Street Address Town VEilGNK A—"* Tax Grid Numb r CW r - (� WELL OWNER Name Mailing Address f $ �• ��� �-- 1 0 5 % 'KPrivate O Public USE OF WELL 1 - primary 2- secondary RESIDENTIAL 0 PUBLIC SUPPLY O AIR /COND /HEAT PUMP O BUSINESS O FARM O TEST /OBSERVATION 0 INDUSTRIAL M INSTITUTIONAL O STAND -BY O ABANDONED 0 OTHER (specify 0 AMOUNT OF USE YIELD SOUGHT _gpm /# PEOPLE SERVED /EST. OF DAILY USAGE__Jgal 0 REPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION Q ADDITIONAL SUPPLY NEW SUPPLY NEW DWELLING O DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING Z W eL WELL TYPE MDRILLED ODRIVEN []DUG 13 GRAVEL .O OTHER IS WELL SITE SUBJECT TO FLOODING? YES _IZ"O" NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:Lt)UE- G• -,4ZjL-&S Lo t No. a WATER WELL CONTRACTOR: Name -Mtp Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES­ _ No NAME OF PUBLIC WATER SUPPLY: 'DISTANCE Tb `PROPERTY`" FROM ... NEAREST WATER- MAIN`: ' _ N. LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED OON SEPARATE SHEET (date) h D er 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 thirt, (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. i 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 suc a manner as not to degrade or otherwise con roun wa er Date of Issue:—,O 19 Date of Expiration 1 "Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp: Orange copy: Well Driller y -.;�. aWrr - h- .�ei,Y.n.^'!.. ty..y� �� r �` m''* �® ��.f!ju/4�- .— m...+.:W^- -�• -.'2i ...w i?� E . ^.,R'^er. t �Ye1e, 8i�•i1p:Sye�Y�mk � � D®® � T6 be.a wift � r � W + <,_.:: ,,,�'eMMMIC wNeny�ane tave00ate1N, �aa�oeeelh/e,A flee dodyn aia i00eie s®eea:Des wAl�bs oae�lietod.os Neon oeotRO.Opeovee •AeadWneeie¢ r� � •x OaMety DoOafbnMt�N tOMItA, awtl tAat fire e�n091ti0e,tMreof aCvd M wlwgll�l9 N ttoe O•®OfM1•elt;tsao • Wit", tsaer altee wla;®o f_yee r � Nl•e aw pas ...«aw eonsMioh awy earl of Yla sirrp 111�ota1 g s ali•e N tM anereYM N ihe. Cwtpleate N ryL'"Wow 41oW Canplionoa< • .. - ,/w�lon.�N..lseiten;N'/nYMw eeT Ne 0< tWSt rt0 will will N Nn HIi mss` W1. h jC T APi1tQ1K0 R01t t06V9iTA(JC7 /ONfllm spore" anoi�aa two yea►t fr® y' :;�- ; h11B�MIM,,1p yYM'Oi N101[ ®B •01°0119 eN'1Ya0mKteea wRBll OBIIN60700'He01 h •�, :'new perenlL AOp► 00 40 of PJ0/w0itk fanllary `!� ® Neitiao. PSes•e9. 14 SAM M.ltiMi tiYlt e V� F i Fee iEnclosed Amnnnt' r iwt ;r i, that tla aN Yw am oil i d a tle a th t tta G%,PW—MM rMY i ab ftr n•ir� Y! setory to tM ConelnlNloleer at" NMMhvnill ib I by the 64now1 Ow Yid boinser will eM�¢e igyl e+,. !D tely fobowim ;tkidim of the mw ° U. ° � '. era'. t t1 fleet tIN d.IIIN'virell Ono►1t1N ate' � -: tt ruNs�ans re01Zi�'lloiei<�'Sf tM '. trutMen : ) �! V(r the bat® Ctlaie oP th0"!buiklhe• 1Me been `4"dioukM •ntl' 16 Ir�y"t10rCa(Q= 6N°OReV4 hWigh. 6�ny eMOOp or amerstbn of oonstrYetmol t71a- aAA/OR �'a r �mr f1elY•Bi Doty : -` . °, rujawsm wururx Lr t'AKIMWr OF HEALTH DIVISION OF ENVIRCNMENML HEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE Nb: � _.... . - ..�?e����',��;;;; �,��� l.-J .�'��� �--= 'A�e�s - -�.G % =. i.T';.'�r��.;'t`,pia���_�t'� `�.• rb 5� J Located at (Street) tee S� U, t oOt, .yuJ P-0 Sec. Block 1 Lot (indicate nearest cross street) Municipality -Vu T t,14k l Watershed 5 �2 l:ao 3 a��� a�43 a� ay g 4 Pg i 49 " - -2- -a -' y - 4 5 NOTES: 1. Tests to be repeated'at same depth until approximately equal soil rates are obtained.at each.peronlation.test hole. All data to'be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 SOZ PERCOLATION TEST DATA REQU M TO BE SUBMIT'rM WI'T'H APPLICATIONS Date of Pre - Soaking I5 Date of Peroolation Test HOLE NUMBER CLOCfC TIME PERCOLATION PERCOLATION Run Elapse Depth to Water.F7rcm Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 2 1:33-. 4 o d7 a,�3� a 0? 5 �2 l:ao 3 a��� a�43 a� ay g 4 Pg i 49 " - -2- -a -' y - 4 5 NOTES: 1. Tests to be repeated'at same depth until approximately equal soil rates are obtained.at each.peronlation.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 RDQUIRED TO BE SUBMITTED WITH APPLICATION DEPTH HOLE. NO. Z" Vk ,Br .. HOLE M. 1- " Z . . HOLE M i. �° 2 r �l� rJ " Li 4 F t �� sr�N>4 WRA 3° . 4 °. ®�' P'10 tavb� e_P-t 5° F_1P6E_'N tAeDjV0 ., Lo&n Vj/ Pr of: .S i L:1 I.T GoSOLeS SoNIE cm6 Ld=SS —. . 14° INDICATE LEVEL AT WHICH GROUNDWATER IS ENODUNTERED y_ f�0/1% 1IVDICATE- IEV6-TO'WHYCH G+iA EtY�EVE'L'XNJES_AFi�ABEING — EN70ClN`IERED A#ONE- DEEP HOLE OBSERVATIONS MADE BY: 5AW Lt2 jLr_ t pJ ra ce si mo QEA L� DAB DESIGN. Soil Rate Us m p 'n/1°° Drop: S.D. Usable Area Provided S• . Noo of Bedr -' Septic Tank Capacity 000 Type C. Absorption Area Provided By J�J L.F, x "24" width � 0 :1 V. •Y, �" "Other ° p y� �e Nam LV 4jy M 1� . �l l 9.19 Signature Address $ C-E,4N AD SEAL THIS SPACE FUR USE BY HEALTH DEPARTKEW ONLY- 8oil'Rate Approved sq. ft/galo Checked by Date "A1LJ'1L'6AX"AV-L DIVISION OF ENVIPLNMENM HEALTH SERVICES. DESIGN DATA SHEET-SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Omer 5 t> _LoPM" Nd Located at (Street) jAg1,.L1DW V_ C:) Sec. 06 Block Lot (indicate nearest cross street) Municipality 'vu.-FtAAWA Watershed SOIL PERCOLATION TEST DATA UQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre-Soaking Y 5 Date of Percolation Test HOLE NUMBER C= TIME PER00=(m PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Pate Start-Stop Min. Start Stop Drop In Min/In Dr . Op Inches Inches Inches Iq A O?q 30 2 3 3. ,.5� i ' . 3 55 4 011 0?� i - 5 P2_ fg 30« V4 2- L.: 3 9 *45 .4, 2 0 C1� ay 3 `� —.3 Q:1911: . Ol q °► 4 0 C2 4 a 3 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'b,e submittW for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 PIT `TO BE SUBMITTED WITH APPLICATION IS. ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. T W A4, HOLE. NO. ` I- " Z - HOLE Pte. - .: i� .S• . \. i!. ._. -.- i. ^��. +��.'�.�L� ' rite.! - T�v� \ = -• -oA` .Y,aM +s - : \.v. , y1.`.� -H 4 . _ _.��yt . �Zi -:.... — 1° 29 3° . 40 t�61 51 �►�1�� t- o+uF�1 Sa4evD�l Loin w S RoJU `� t.oe4 w �621� tc? p 4-1 t- 71 60 mac_ o F S t l:t' �o ran Co�B;I. 79-.. 0'd ® Pock 002 W 9° r - INDICATE LEVEL AT .WHICH GROUND6lPiIM IS ENCOUNTERED �0 IMICA 'LEVEL- DEEP HOLE OBSERVATIONS MADE BY: G tutno ALA Dom. 51 Ig DESIGN Soil Rate Used 8.1() Min/1" Drop: SeD. Usable Area Provided -7000 S Noo of Bedrocans Septic Tank Capacity I oo C) Type Cp C . Absorption. Area Provided By 33 L.F'e x 2411 width 01 V. v ' Other Natne LV��o� 1i. vu l�A Signature - � Address o o G /4 $ N � ��p _ SEAL, �,yS�D �d►l ��a THIS SPACE FOR USE BY HEALTH DEPAR21EM ONLY - Soil Rate Approved sgeft,/galo (flecked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALT SER LC S��• =;;. _ . INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION ,o Name of Project 5 '(T)(V) 1 County Site Location Building construction begun Extent Is property withiri•NYC Watershed. Yes a No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. 1 F--] Hilly, F--] Rolling Steep slopeQentle slope 0 Flat 2. .Evidence.of wetlands " Low area subject �to•416oding 0 Bodies of water Drainage ditches 0 °Rock outcrops 3. Property lines or corners evident ..................... ,.:..............:........:.... C/ Yes 0 No , 4. Do water courses exist on or adjoin the property? ............................ a Yes P:;� No 5. Will these affect the design of the sewage system facilities ?.......... ... F7Yes • o 6. Do watershed regulations apply in this development ? ....................... 0 Yes. No 7 Will extensive grading be necessary? ..........:...... .......... ...................... F--J Yes �No 8. _ Will etensive .fill _. •, - be necessaryf�x SSTS� �, :,�.,..�._.�. ,� =Ves 9. Do filled areas exist within the SSTS area ? ............... ........... Yes No If yes, what is the condition of the fill? SECTION C. SOIL OBSERVAT N ,,Z----_,. ; 10. Appearance of soil: Sand Gravel L��4oani Clay Hardpan Mixture 11. Observed from: F--J Borings F-� Bank cut, ❑ Backhoe excavations f 12. Soil borings /excavations observed by ,T1' " /� on . 7 13. Depth to groundwater 01�� on 14. Depth to mottling on- Z *L �J �Y 15. Are test holes representative of primary &reserve areas ....... ............................... s No 16. Soil percolation tests made by on 17. Soil percolation tests witnessed by SECTION D (on back) on Form ST -1 2 SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? 0 Yes �No 19. Will groundwater or surface drainage require special consideration?.<.. ........ ��-es F--JNo 20. Will gullies, ditches, etc., be filled and watercourses be relocated? .......................... MYes F--] No SECTION E. REMARKS 21. If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities? ............................................................... r3 Yes No Inspection data 22. Do adjacent wells and/or sewage systems exist? .......... ........................................... es No 23. Additional comments 24. Site observer/inspectorand title_ 25. Date(s) of observation(s)inspection(s) TEST PIT PROFILES Hole # Lot # Hole # Z----Lot # Hole # Lot # Depth to water Depth to water Depth to water Depth to mottling n 0 Depth mottling Depth t mottling nip. Depth'to rock/imp. Depth to rock/i Depth to rock/imp.,: G.L. G.L. G.L. �f -- i 0.5 1.0 2.0 3.0 4.0 5.0 6.0 7.0 0.5 1.0 2.0 3.0 4.0 5.0 6.0. 7.0 0.5 J.0 2:0--- 3.0 4.0 '5.0 .6.0 7.0 8.0 8.0 8.0 Wo 10.0 9.0- 9.0 10.0 10.0 AMM062ijimpol 64 mm)(61"re 3573177111,7-, Ty�,l DESIGN DATA SHEET-SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Own er Address ai p (V, 05� Located at (Street) Vs;asY_A LL_ - %�oU_,DW PLO Sec. Block 1 Lot (indicate nearest cross street) municipa-Lity PUT-LAA-M Watershed SOIL -PERCOLATION TEST DATA RBQUIRED TO BE SUBMITIED WITH APPLICATIONS Date of Pre-Soaking Date of Percolation Test HOLE NUMBER CL= TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start Stop Min. start Stop r Drop In Min/In Drop Inches Inches Inches 2 -1'33 011 3 , 55 a, a 4 a+�� a.�3$ a - '1 5 v 4 1 L .1 ..- %­­...."....C... 3 ai� a a` a�E °� 4 15 k;1 NOM: 1. Tests to be repeated at same depth until approximately equal soil rates, are obtained.at each percolation test hole. , All data to' be suhmittt!d for review. 2. Depth measurements to be made from top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. T W ,6r HOLE NO. T H HOLE NO e GeLo � 7T0 �S�7,1 1. O F74 \lr 1° 29 3 °. 40 m� Edo t�G 5° Fi:ts�to M�-�uM sfl�l l.ol�✓n w 5 ��o � u�� w - r- 12►�.c.�, o� s i L � 61 Soy�1,� c.�C3 trS - 7 ° a No Igo p R (N A'" o� rs--- 8° 10°. 12° 13° 14° - INGiCATE:'MM AT - WH iWXXff1%= :15 E[QQOUHTr'E'�EQ. INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING MMMTERF,D /J0 IVE- DEEP HOLE OBSERVATIONS MADE BY: 5Al..V m Er= V-) 0 A Cyst vin o ALA L p_ DATE * 5 1 qz DESIGN Soil Rate Used 8-1.0 Min/1" Drop: SeD. Usable Area Provided . No. of Bedrooms 3 Septic Tank Capacity OO O Type _CC G . RIV Absorption Area Provided. By J3 L.F. x 2411 width OR V. •iT,+'f --y v Other /' l�� -�i� �1 )b TIC( P.) ��2(3t(@�� �� y 4 Name -57a L_V L— o F=L V=A 1 to t�, Signature v `� o Address o LEONE- pip SEAL F�`�f� � V►l ��a� L ©S f c THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLYe Soil Rate Approved sq.ft,/gal. Checked by Date PUTNAM COUNTY. DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH , INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS ,.._.. _:._ ... _..._. _._. _.._._ - - TI?UC l PERMIT e • -.. • -r_w . . _ - , _, .. STREET.LOCATION � � � NAME OF OWN R REVIEWED BY DATE �` TAX MAP #l�? y// I Y DOCUMENTS ERMIT APPLICATION PERMIT _ PWS LETTER ;R OF AUTHORIZATION N DATA SHEET (DDS) )RATE RESOLUTION - THREE SETS PLANS - TWO SETS "FEE SUBDIVISION EGAL SUBDIVISION SG�DIVISION APPROVAL CHECKED PERC RATE PF DEPTH R; TAIN D IN REQUIRE NYC WATERSHED [ITTED TO DEP TO PCHD I I JFILL IN EXPANSION AREA APPROVAL, IF REQ'D TRENCH V—Tg&T.—HOLES OBSERVED _ LF TRENCH PROVIDED :Z__-,;Z0 FT MAX. ; Y N EROSION CONTROL:HOUSE,WELL, SSDS• P_ERC & DEEP HOLES LOCATED REPRESENT,A— TIVEOF PRIMARY & EXPANSION ` 2 I MAP EO EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE IF PUMPED, PIT & D BOX SHOWN & DETAILED HOUSE - NO.OF BEDROOM_&__r BLS & SSDS'S WAN 200' OF PROPOSED SYS. PROPERTY METES & BOUNDS SSE SETBACK NECESSARY (TIGHT LOT) �SE SEWER - 1/4" FT. 4 "0; TYPE PIPE NO BENDS; MAX.BENDS 451 W /CLEANOUT CLAY BARRIER 10- . HORIZONTAL;SLOPE 3:1 TO GRADE ILL SPECS FILL NOTES ANDPIPES FILL CERTIFICATION NOTE DEPTH GUAGES ILL PROFILE & DIMENSIONS ARCS WITNESSED, IF kEQ'D ARALLEL TO CONTOURS r EX APPROVAL SSDS ADJ. LOTS O% EXPANSION PROVIDED WETLANDS (TOWN/DEC PERMIT REQ'D ?) SEPARATION DISTANCES SPECIFIED D�O DDS PLANS & PERMIT SAME - ON PLAN - FROM SSTS: PRE 196 IGHBOR NOTIFICATION 10' 0 P.L., DRIVEWAY, LARGE TREES, TOP OF FILL I /ZBA 20' TO FOUNDATION WALLS TO PL FLOOD ELEVATION _15'WELL ' TO WELL, 200' IN DLOD, 150' PITS OTHER REQ'D PERMITS) 0'-TO STREAM WATERCOURSE LAKE (inc. expan) REQUIRED DETAILS ON PLANS 0' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER SEWAGE SYSTEM PLAN - (NORTH ARROW) 10' TO WATER LINE (pits -20') RAULIC PROFILE GRAVITY FLOW 50' INTERMITTENT DRAINAGE COURSE CONSTRUCTI�NOT& 200'/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS DESIGN D AEEP RESU LTS 5'm' oo, 0'- 4 %,25'- 3 %,30'- 2%,35' -1 %,100' - <I% 2' CONTOURS EXISTING & PROPOSED min o isc arge /I00'with 182 cons day discharge DRIVEWAY & SLOPES, CUT SEPTIC TANK FOOTING /GUTTER/CURTAIN DRAINS AFROM FOUNDATION; 50' TO WELL COMMENTS: / 17 CG l/ FORM ST-2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Located at V\,pL-LOu_) 'eoAC> PUMAM VALt-e-V (T) FDT-NAYY) Section —Block -Lot Subdivision of L OVA Subdv. Lot # Filed Map # Date Gentlemen: This letter is to authorize 5A L V-2-1s.�TvR-F- V, _� I I N P, a duly licensed professional engineer t rx-,gXAeXecYanh-Aq;%rt_ (Indicate--p) to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commiss-ioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction - of s - aid system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, S i gned Countersigned: 0N � �,, weer of Proper flF C P. E. , XAV # Address Address Town CAP,M&t_ Telephone Telephone I PVI'NAM COUNTY DEPARDEM OF . HEALTH DIVISION OF ENVIROMWM HEALTH SERVICES AFFIDAVIT- CORPORATE OWNER APPLICATION - -- ':•.:.:1' •_:�,_- :�.::. -; _::.:.:y. .-ai.=- ,::;:::� >� -i. --. _. ... FOR PERMIT APPLICATION SUBMITTED T6- DEPARTMENT* COUNTY HEALTH DEPARZMENr .. -, TO: Cam issioner of Health In the matter of application for: 1IL-C. I. J AVVV -S 0 J represent that I am an officer or employee of the y�orpo4ation aAd am authorized to act for s 5 b(2- J e, P "V-V` (Name of Corporation) - having offices at -_ 43 1 �L j Whose officers are: President: J (Name and e (Name ,$) M Secretary: (Name and \address) -- Treasurer: ... w _ ...._ _... A _ .. , - ............_ .... a (Name and address-}- - and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Sworn to before me this day Signed: 4�--A C of 19 Title:4 -,�.5� Notary Public moo_' orate seal 20 0 N o' V 0 Md✓vw�� iOHNO 4pyrigM by David L Odell. P.LS& Land Surwyl" Company 2204 Kingsway Carrel, N.Y. 10612 (1114) 226-0106 gaaMd w dwo"Som Is a "AtIM or spou"wa .. ', .. 7✓ /Fc..�,Kii✓G " �ilY/ Qd �GE��T6FCY : .. � -.. �. � :. ... ' ., �.�.. ,. ��� e r»°ir'nn °"/ 76.f4T' S-51 5-4- '&;1 -Al i ' P6E.�S </G L h'a L L o ►✓ AS .✓i oc,✓EO� iPU,.7 O MOM ICa 0 Certifications Indicated hereon signify that this survey was prepared In accordance with the existing code of practice for Land Surveys as adopted by the New York State Association of Professional Land Surveyors. Said certifications shall be valid only to the party for whom the survey was prepared, and on that party's behalf to the tide company, governmental agency and/or lending Institution listed hereon, and to the assignees of the lending Institution, for mortgage purposes for said party for whom this survey was prepared. Certifications are rot transferable to additional Institutions or subsequent owners. - Only copies from the original of this survey map bearing the signature and an original of this Land Surveyoro Inked or his embossed seal shall be considered to be true and valid copies. In addition, unauthorized alteration or addition to a survey map bearing a licensed Land Surveyor's Seal Is a violation of Section 7209, Sub - division 2, of the New York State Education Law. The location of underground Improvements or encroachments hereon, if any exist, are not certified. Certified to: sass va.,�o a ,m�.a� i L.,c.w n oc.a GPUiC.ab v scac� Field survey performed: ✓�0.✓!%4eY ZB /9ry® and map prepared: J4N!/!leY 16, /99B -X+ -71 4, %-P%-b rnaro e.Q...,.Q., '3-,r 4, �qy0 David L Odell, P.LS., N.Y. State Ucansed Land Surveyor NO. 050074 SURVEY OF PROPERTY PREPARED FOR 5 & 5 OEVEL OPMENr L. L. c. �E/N6 LOt3 A55HOWNON ACE MAIN MAPENfi i LED, 'SVMV51ONMAPKNOWA5LOVE-PEk W6,ETG1; SAiDMAP�i�EDW fNEG1ltNAMCouNrYCLEKKS OF�cE NovEn�6ER 14,1986 A5 DIAPNUMBE,p 2186. �OWN 51 ruWPONAM ArE /AN 7 •C 1 VALLEY PU MA M COON rY' UC W Y09K 5CALE / "- 30' i� O _ C 97 -14Z . o i r W. ( `l . s N iv nam County Deyartaent of 8 sion of Envir onmeatal wealth. •ipyroved ae noted for oonformanoe �ffCt' =1 ipDlioable Hines and Eagulat10n8 l 'utnam. Conn epartment.. 'tanatnro .6 Ti fl w • �; b •t °n � � goo ' �a � 5 3� �_' RECEIVED PUTNIAlr•9 CCUNTY ENV 98 JUL 10 Pl"l 3: 13 W. ( `l . s N iv nam County Deyartaent of 8 sion of Envir onmeatal wealth. •ipyroved ae noted for oonformanoe �ffCt' =1 ipDlioable Hines and Eagulat10n8 l 'utnam. Conn epartment.. 'tanatnro .6 Ti fl w • �;