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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.11 -1 -22 BOX 33, 04417 r 16i 90; T 'J6 r ,r .. 04417 PUTNAM COUNTY DEPARTMENT OF HEALTH I IQ 01K.,E IHQ I [ ' ' � :' ' E1 I ES.:. CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCIID ONSTRUCTION PERMIT # t3 6 �f Located at _) %f '/� ;f %lo e,1 f�� � Q el Town or Village e 1la %le- Owner /Applicant Name A rf,,:!�e T�i y C� Tax Map 7y. V Block 1 Lot-22 Formerly Subdivision Name 2m 1-6 110e of Mailing Address ,%.X- Date Subd. Lot # % Construction Permit Issued by PCHD '% �/ i ' N Zip w !�- 7 Separate Sewerage _System built by Address r <C/O `djGra ��irC� Consisting of / y c-.� Gallon Septic Tank and 3 d A �= %3�" %i'" �� 1�L� Other Requirements: /�Cl.. Water Supply: Public Supply From. Address or: y` Private Supply Drilled by Al A4 1 �.$e g Address cr j ' "Ias`e'rosion control f6eericompleted? ... ... Number of Bedrooms 3 Has garbage grinder been installed? Ale 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 the Putnam County De2agrtm`ent of Health. Date: V7- z YS— Certified by Address L (Design Any persowoccupymg premises se d by the aboye system(s) P.E. io" R.A. Z9.1-14r- action as may be necessary to secure the correction of any unsanitary conditions resulting from "� .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 or change is necessary. By: Title: Date: A,319e, White copy - HD Fie, Y w co - Building Inspector; Pink copy - caner; age copy - Design Professional Form CC -97 1 J a" PUTNAM OOeNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES a WELL COMPLETION REPORT e ion - 96&f 7C -� .�^ r✓ e- "awnill Tax Grid # Map Block Lot(s) Well Owner: Name: Address: Use of Well: I- primary 2- secondary '>< Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling ]Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length ft. Length below grade 5k, Pft. Diameter , in. Weight per foot / lb /ft. Materials: - Steel _ Plastic _ Other Joints: _ Welded _)� Threaded _ Other Seal: ?Cement grout _ Bentonite Other Drive shoe: ,<—'Yes No Liner _ Yes, >4---No Screen Details Diameter (in) ISlot Size Length(ft) Depth to Screen (ft) Developed? _ Yes No Hours First Second Well Yield Test Bailed _ Pumped °Compressed Air Hours Yield/,o gpm l[Dep>th )[Data Measure from land surface - static specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses-- are available, please attach. Depth Fro unn Surface Water Bearing Well Diameter(in) (Formation Description fft. ft. Land Surface ► �� :.. -_. If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Capacity Depth a Model ti '-�r`- / f Voltage 7-30 HP 6 ' Tank Typ4111..�XA Volume Date Well Complei7ed Putnam County Certification No. Date of Report lllsx?e Well Driller (signature) 7 u !r: exact tocanon or wets wttn atstances to at least two permanenranaffarxs to be provtdeci on a separate sheevplan. Well Driller's Name /1 ''�yc �'sf, G� �= Address: Ai ' �'.!%( ���• A'F.2y; ✓/, Signature: Date: ? M 5F,- a' White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 om �:�,.- a�. -.. DIVISION OF ENVIRONMENTAL HEALTH. SERVICES GUARANTEE OF SUBSUIdACE SEWAGE TREATMENT SYSTEM W9 AI _ Owner or Purchaser of uilding Tax Map Block Lot Building Constructed by Town/Village Location a Street Subdivision Name P,415 .EJ�) Building Type Subdivision Lot # I represent that 1 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 properdy�is caused by.the._willful or negligertt:acxTof the, occupar_t 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 Day j Year General Contractor (Owner) - Signature �' ���'IdZwe9TF�r �9 ✓�b7 -rnl�i Corporation Name (if corporation) Address: „ih j4 Aaaj,_ e A g& F_ State &W,4/n �A tt e ii/� �� Zip �9 7, 'd ��. L�LZ•NPW ; 'ON XVi Signaturei—i-F 1 Corporation Name (if corporation) Address: State Zip _ Form GS -97 Hy7V3H ANZ Al'i WdNAd WV 3111, 8F -' 7 -'1A ' Q 5 A ell, JOSEPH F. SULLIVAN, P.E. 2972 FERNCREST DRIVE YORKTOWN HEIGHTS, N.Y. 1 0598 191 4) 962-4248 7/7- RnMM qa=Y DEPAR'n4ENT OF HEALTH A bV tION 01?:'ENVIfUVERML HEALTH SE's CES .DF_SIGN DATA_ - SHEET_SUBSUFACE SEWAGE DISPOSAL SYSTEM - r ,.. ;i ,.� -•i": �'.x •„. z. !.'�.-- .. .:mow.- .. - o .,.' .r�':�-•- • -:.'w ..: fir.: �e• r i..e .r �o .,'bra .- o Owner �J"e/ ce �' Address a X, Located at ( Street) �'% /�i/ �a/� Sec • Block Lot (indicate nearest cross street) Municipality 5?_ Watershed SOIL pERa LuION TEST DATA RDQUIRID TO BE SLMMIT ED WITH APPLICATIONS Date of Pre - Soaking �/ ��_ Date of Percolation Test��� HOLE NL14BER CLACK 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 Z 3// 2, 12W-3 4 5 5 ° f 3 6F 4 �r Lsa�r' 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 subnittod for review. 2. Depth measurements to be made from top of hole. rev. 9/85 TEST PIT Dl" `,1 REQUIRED TO BE SUHMITTID Tn1IM- 7PLICATION DEPTH p. HOLE NO. y a:.'1V c r � Y- r. �. ..c r Zr 5T.^ f..'�. 4�.`l•• .�,'¢ —• �� i .� G.L. 21 4 4-- fn 1° 3' 4° 5° 6' 7' 8' g' 10' 11 11129 13' OF HOLE NO. Z HOLE D. .F .�. 9� v .'4 � --w :..., -o-'.e. f�. •ID'; �' •�b':� -• �J� (!±�: ^; ¢ -~• .. Yn.�r.. 1 i'I� v� . � 14' ' INDICATE. LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED - / INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: %/ DATFY-/N9 /� DESIGN Soil Rate Used 5r Min /1" Drop: S.D. Usable Area Provided No. of Bedroams Septic Tank Capacity 101670 _ ga . Type Absorption Area Provided By L.F. x 24" width trench Other WPM MA Address 11 )VO THIS SPACE FOR USE BY HEALTH DEPARZ Soil Rate Approved 00 a NT ONLY: a °maeAec°eoppb ` sq.-ft/gal. Checked by y� Date f } C ` PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date lap Re: Property of/^�� Located at �P�t° l> r �� AvA&W Section // ,�7 Block Lot Subdivision of ��� �'t` %�� e, Subdv. Lot # Filed Map # cO /f,6 Date Gentlemen: This letter is to authorizeU.� ..- -. • a du -1y-- 1- icensed pnofessi-onal- •en�ineer-,,?O,/- .. o-r rle5i_stered...arcIi t'ee -t.� ...... (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 connection with this matter and to supervise the construction of said system or systems in co r tm.ity with the provisions of Article 145 or 147, Education Law, the Publ-�, Ith Law, and the Putnam County Sani- tary Code. �y Ip r, w.• 0 �} Very truly yours, Signed C ert ountersi e�4�,�� �N �� Owner of Pr p y P.E., , g �< ;L b Address Yl Address Town - - r Telephone:.: v:.. Telephon. PUTNAM Q ,UNTY DEPARTMIEN'l ( F HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES RE: Property of LETTER OF AUTHORIZATION 5X4 C el //?Y,� Located at 1)lo et/ a04 6 /- T/V ���� Tax Map Block 1 Lot 2-2 Subdivision of Subdivision Lot # Filed Map # Date Filed Gentlemen: ....- ,:..:This letter,is_to_au ±horize. `: - .. .:_ _'... -. -._ �. �.�►' - . a duly licensed Professional Engineer or Registered Architect to apply for the requited wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary -papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and /or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Very truly yours, Countersigned: Signed: yv�,_� P.E., R.A., # (Owner of Property) Mailing Address State Telephone: Zip Mailing Address: %_3'f.�' 2..' '- zI- State Zip 14-r Telephone: ,:a` Form LA -97 � ., ' YML ENVIRONMENTAL SERVICES , 321 Kear Street ^ Yorktown Heights, N.Y. 1)598 (914) 245-2800 Albert H. Padovani, Director , LAB #: 32.806151 CLIENT #: 1775 NON STAT PROC PAGE 1 RYAN, BRUCE DATE/TIME TAKEN: 07/1508 10:00A PO BOX 251 DATE/TIME REC'D: 07/15/98 11:03A PUTNAM VALLEY, NY 10579 REPORT DATE; 07/17/98 PHOWE: (914)-526-2952 . � ` SAMPLING KITE: 260 -PEEKSKILL HOLLOW RD. SAMPLE TYPET. : POTABLE : PUTNAM VALLEY , PRESERVATIVES: NONE / COL'D BY: BRUCE RYAN TEMPERATURE..: NOTES...: KITCHEN TAP- COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 0705/98 MF T. COLIFORM ABSENT 000 ML ABSENT 1008 ' - ..��._� �~�� BACT' -THESE RESULTS INDIC'TE THAT THE WA`E NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDI )THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME'OF COLLECTION. SUBMITTED BY: ' ] E�AP#`{�}328.-'���'-, � ' ' � .. / YML ENVIRONMENTAL SERVICES ` 321 Kear Street_ ^ Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director /LAB #: 32.805960 CLIENT #: 1775 'NON STAT PROC PAGE 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~=~~~~~~~~ RYAN, BRUCE PO BOX 251 PUTNAM VALLEY, NY 10579 SAMPLING SITE: 260 PEEKSKILL HOLLOW RD : PUTNAM VALLEY, NY 10579 COL'D BY BRUCE RYAN NOTES...: KITCHEN TAP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE DATE/TIME TAKEN: 07/07/98 11:30A DATE/TIME RECD: 07/08/98 12:53P REPORT DATE: 07/10/98 PHONE: (914)-526-2952 SAMPLE TYPE,.: POTABLE PRESERVATIVES: NONE TEMPERATURE..: COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD . . Fe/Mn If both iron and manganese are present., their total value combined shall not exceed 0.5 mg/L~` 1 9139 9146 2037 2037 9_(543 Na No limits for Sodium are proscribed. Suggested guidelines state | that for people on a sodium restricted diet,the water should | ntaLin.�no than . . ! � PUTNAM CNTY PROFILE 07/08/98 MF T. COLIFORM ' PRESNT /100 ML ABSENT (}7 � . 'LEAD���I�S)�' .�^� � ��.S�_dc����� ^~-� ,-� �� �(��1�� p-- ' \07)}8/9b ' NITRATE NITROG 0.50 MG /L 0 - 1 ' 07/08/98 NITRITE NITROG 0.026 MG/L N/A ' 07/08/98 IRON`(Fe) <0.060'MG/L 0-0.3 mg/l 07/08/98 MANGANESE (Mn) <0.010-MG/L 0-0.3 mg/l 07/08/98 SODIUM (Na) 6"67 MG/L N/A 07/08/98 pH - 6.9'UNITS 6.5-8.5 07/08/98 HARDNESS�TOTAL 200 MG/L N/4 07/08/98 ALKALINITY (AS 174 MG/L N/A 07/08/96 TURBIDITY (TiJR <1 NTU 0-5NTU 07/08/98' MF FECAL COLIF ABSENT 10 0'ML ABSENT 07/08/98 COLI (CO.FI ABET 100/ML ABSENT , COMMENTS: . BACT THESE RESULTS INDICATE THAT THE WATER (WAS) ' SATISFACTORY SANITARY QUALITv ACCORDING TO K STATE, AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED., AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for public schools-are set at 15 ppb. EPA Lead & Copper Rule for Public Systems requires that no more .than 10% of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3mg/L, e/lse water treatment must be undertaken to, reduce the waters corrosive potential. | ` ' . . Fe/Mn If both iron and manganese are present., their total value combined shall not exceed 0.5 mg/L~` 1 9139 9146 2037 2037 9_(543 Na No limits for Sodium are proscribed. Suggested guidelines state | that for people on a sodium restricted diet,the water should | ntaLin.�no than . . ' YML ENVIRONMENTAL SERVICES J21 Kear Street Yorktown Heights,. N.Y. 10598 (914).245-2600 Albert H. Padovani, Director LAB #: 32.805960 CLIENT #: 1775 NON STAT PROC PAGE 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ . RYAN, BRUCE DATE/TIME TAKEN: 07/07/98 11:30A PO BOX-251 ' DATE/TIME REC'D: 07/08/98 12:53P PUTNAM VALLEY, NY 10579 REPORT DATE: 07/10/98 ' . PHONE: (914)-526-2952 SAMPLING SITE: 260 PEEKSKILL HOLLOW RD SAMPLE TYPE..: POTABLE : PUTNAM VALLEY, NY 10579 � PRESERVATIVES: NONE COL'D BY: BRUCE RYAN TEMPERATURE..: NOTES...: KITCHEN TAP COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ �~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE.. FLAG PROCEDURE RESULT. NORMAL - RANGE METHOD | ' moderately restricted diet, a maximum of 270 mg /L' Sodium � � is suggested. � ` ' � � . | � � � � SUBMITTED BY; Albert H. Padovani, M.T'.(ASCP) � 0. DEPARTMENT. OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 1.0509 Tel. (914) 278-6130 Far (914) 278-7921 FAX COVER SHEET Date: '7 z! 1 118 To: P- D N it (Z lriq ,4 0y0'z'+'*'4q' Ec . From: Aa Adam B. Stiebeling Asst. Public Health Engineer For your information For your review ZAAs disciissed Fax#• Z7 -7-SZ76 No. Paae�..- (Including over s 'eet) BRUCE R. FOLEY Public Health Director Please respond _ /Please as requested Please call NotesliNlessages C-ru iq V'4*-LT*4L C is S T7 C. V In the event of transmission /reception difficulties, please contact this office at (914) 278-6130 ext. 157. PUTNAM COUNTY DEPARTMENT OF HEALTH v�Z DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: r Inspected by: Street Locati �c�5 cc c,Gx.c.o�.J Owner Rfoqq Town Permit # TM # all % -Z Subdivision Lot # i 1. Sewage System Area YES a. STS area located as era roved plans ........................... i section - ate of placement 3:1 barrier Lath. Width AvR.Dotlil . rr-_ ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. eptic tank size - 0500 ......... 1, 250 .......... other ................ ns alled level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribtuion Box L. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & tre ches Jun-) p� ly set .................... ............................... engt� ired 3,Tb Length installed Z — i ce to watercourse Ft........ 3. Installed according t . an ..............:. .................... 4. Slope of trench table 1/16 - 1/32 foot........... 5. 10 ft' from p p line - 20 ft.- foun tions...... .. 6. Depth of tre ch 30 inches from surfa ............... . 7. Room allo ed f expansion, 100 % ....................... 8. Size of gra el 3% - 1 %" diameter cle .................. 9. Depth of avel in trench 12" minim ................. 10. ipe en s aDDe ............................. ...... I ............... g. r os § d Nvstems Size ot pu p c am er ............... ............................. 2. Overflow ........ ......... 3. Alarm, vis 1/ audio........... 4. Pump easil ccessible anhole to grade.. ......... 5. First box baf ..................I 6. Cycle witnessed by H.D.estima ow /cycle........... III. House/Build'n a. house located per approv s ... ............................... b. Number of bedroo ..... ................. ............................... IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured ft........... 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 in d according to plan.. ': f..-'- iCurtairi drain�outfali pro &. dir.to exist watercourse` f g. Footing drains disc a away from STS area ............... ce a er pr equate ... ............................... i. Erosion nt rovided ...... ........ .............................. COMMENTS & /t4l" IT- k% qu PUT NAM CCU. aJN7 Y DEPARTMENT, ..,IF HEALTH �j IIVIISII (DIET (DIF IEI\TVHR6NM1EN7AL H-H1EAIL7 HI SIEIR VHCCIES . cC®NS'll RU C'li RON IFERMRT FOR SEWAGE TREATMENT SYSTEM PIZERIN � o �� Located at e,114dl "d B#/' /� ,0�J`,/ Town or Village /��'/ Subdivision name �'� /�SSubd. Lot # Tax MapOly Block I Lot 2�2 Date Subdivision Approved ��� Renewal Revision Owner /Applicant Name 131e# s-lP 1-? Date of Previous Approval / 9 9` 9!5; Mailing Address 0 3` /� 6' A `J - Zip Amount of Fee Enclosed Building Type e Lot Area 1AANo. of Bedrooms 3 Design Flow GPD � 1FM Section Omlyv Depth VoReme IFCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Selgairate Seweu°age _System to consist of 10061 gallon septic tank and 3-31W 11 J4f Other Requirements: :2 " /3 trZ3 To be constructed by '°'° Address ele W�tte� Sanwa Public Supply From Address or: tW Private Supply Drilled by �llawa 9? 1012 Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the Marate sewage treatment ystem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. NE of _ Signed: /i� Address .2 !� 721- &1 r p j APPROVED YOR CONSTRUCTION: This R. A. Date License # J1,7 YA°' from the date issued unless construction of the sewage treatment system 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 c new pr ' t Ap roved-foudis arge o omestic ,sanitary ..sewage_on,y..-„ By: Title: Lj $a.�c �� GNG- Date: White copy - HD File; Yellow copy - El ilding Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 ' PUTN1`' R COINTY DEPARTMENT 07- HEALTH DIVISION OF ENVIRONMENTAL HEAL fI SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # Well Location: Street Address: Town/Village Tax Grid # X' Map 8.i, f j Block i Lot(s) Z L Well Owner: Name: Address: Use of Well: Reside al 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 6"' gpm # People Served .4� Est. of Daily Usage _!Le gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling 1L-"'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 Is well located in a_realty. subdivision?.... ..... ..... .. .............. .. ............... _..Yes., _. ra . No.. _ Name of subdivision �e � ��,�,�' ���rr,� Lot No. Water Well Contractor: M G�r�a%a�r ,ark Address: 43eka rfy Is Public Water Supply available to site? .................................. ............................... Yes _jw, No Name of Public Water Supply: Town/Village Distance to property from nearest water main: ,V," I .. - - Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: Applicant Signature: 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 water well driller certified by Putnam County. Date of Issue d I Permit Issuing Offi ' �,. y. .- ,__:�:dDate:of.- Expiration.:a. z =p: ,�,, ..�..� Title:�.��:, .�,,� :��.G ►.�, ..,.._.�,� --.i.: ,�, o . Permit is Non- Transfe ab e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Joseph F. Sullivan 2972 Ferncrest Drive Yorktown Heights NY Dear Mr. Sullivan: DEPARTMENT OF B EALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509. TeL (914) 278-6130 Fax (914) 278-7921 10598 January 22, 1998 Re: Lore Peek Acres Lot #9 Bruce Ryan _(T) Putnam.Valley I- L, L. ( G (ey ;tf �t 2 -, c 6 BRUCE R. FOLEY Public Health Director This department has received and reviewed the most recent plans for the above mentioned project and would like to offer the following comments for your consideration. Please also reference enclosed sections of current PCDOH procedures and policies for subsurface sewage treatment. a ,Submission of short environmental assessment from (EAF), as required - ection 4 (PCHD, August 1997). L2 Ze proposed house plans submitted December 1986 still current for proposed residence.'�� Please show any proposed /existing wells and SSTS within 200 ft of lot, or. state no wells or SSTS within 200 ft of proposed lot." Plan should show all metes and bounds of lot, north arrow, and reference source of survey. 5 Proposed and existing contours (2 feet) should be shown on both plan and rofile over entire area of lot. Accurate location of all deep and Perc test holes to be shown on plan. &,esign criteria should be organized and shown together. "ace to be provided for PCHD approval stamp. GO ation map, showing area of project to be shown. �ri p pit design/detail to provide all information required in PCHD specification (August 1997) Section 4R. It1appears, as though area of SSTS exceeds maximum slope requirements r h 0 Joseph F. Sullivan - Re: Lore Peek Acres Lot #9 -2- of 15 %. Area may be filled in accordance with PCHD SSTS specifications section 3H steep slopes, page 9. This would require "Fill' in area o roposed expansion and providing ten feet (10) center to center spacing of absorption trenches in primary. This will require a grading plan. Is location of proposed well feasible in regards to being accessible by a drilling rig; as well as for servicing. If so please provide verification from well installer. Please also show proposed house service connection from well, as well as required separation distance from PL and area of SSTS. 3 Please show more detailed description of pump pit as noted above (comment #10) in details, to be used to install. Upon completion of the above, this department will continue its review. Kindly advise us if there are any questions. Adam B. Stiebieling Asst. Public Health Engineer ABS:tn zw I. y.. 'wry^ .._... ... �._��..�'_•"0:_ _ � .. ...... �9.... Z:'..�� -��«� ...as..��r. sw. :�.�.._.. :.. ��_....1 '�.� °_. .. ., .... �9... .�_.'. 't ..y'•.`t_I rZ� cf.(;q-rte - _ �--- G"-.. NL -cp FYr }� a( _S "�','LFi�vi.�(v��' � 1�- '�t��i€ervG:- � c °�"Y�.._ - " "'Y.cl�`f`_ �c�p�c.+f?�F� -i"�°" .:�t••$�!'�9.3, .. ' � (titer �"a�(,o,.�rn�.�- - COM.ul�h..ri'(j . �-�Or2 , 7"av✓t. �..Qfic_�!r_t��r��-✓�: °i'ZOti,(` - � _ _..... . _... .... .. /l��t'va►v �_. �o�r6sr.._. Gs,_..$_,_ _._.121► -,, c.l I ►tSiG.ni_ ._�_!Z eTK.dd'iE R ....._��e..ri7 E�-.. ��.(a- o�- t�.r��✓.? �e�G-'r�v7¢�'�+�. s-° _ . CIP7ACA00, �a viFv�±a i.►.t ....._.�L L. 5��.�.trc.#•r1oFtf .... GA _ M7�_ SS- EX444,pl. tt _ 'ti V' i.,•'FpZr 1 � �.._ 6 ��'Y e rt 4 /'. 4 .r!`'! ^r 5 . C?Gt.t�Ct�- .- .__...�' _____.____ —_._. ______.---- �-- ��a651�/j_ -• -- �, ��? �.. �. ro!\ L_____'�__-- _��N.lt?Lni(f._.•._ \,tv4�G _. F'aaT":_ . C �a i..G�c- nc77�,..�.,.�• --_ tr.s'ri r �" _. ��...... .l.+r:<��,►�-- '-- .!'.cc.?r�.... _.Y�£.�n..bec- c,d1M'E.or�f. ..._._. �.1,��+C. -._.. _ .....���:- _ _-- - -`�'° -. _ - �,�°'- �� �/Zo_ .. sue._ __'. .crt,�f �.t-� ..... _ ��vtict�•�•°r~i�t�.l_. _ kit thy• 4.0 CONSTRUCTION PERMITS Prior to any construction of a SSTS, plans for such system must first be approved by the Department. There are generally two types of construction permits reviewed by the Department; those requiring 2 feet of fill or less, and those requiring greater than 2 feet of fill. The submission requirements for each type are specified below. n Construction Permit Submission Requirements For Lots Requiring No fill or Fill Two -Feet Deep or Less 1. Construction Permit Application. (Appendix K) 2. Letter of Authorization for Design Professional. (Appendix K) 3. Application for Approval of Plans For A Wastewater Treatment System. (Appendix K) 4. Corporate Resolution (if corporate ownership). (Appendix K) 5. Short Environmental Assessment Form (EAF).(Appendix K) 6. Design Data Sheet. (Appendix. K) NOTE: All submitted Department application forms shall contain on 'pal signatures (no photo copies). 7. Three (3) sets of plans bearing the seal' and signature of a Design Professional, licensed and registered to practice in New York State. These plans shall be to scale (minimum 1 inch to 30 feet horizontal and 1 inch to 10 feet vertical) and shall include, as a minimum, the' following: a. Property survey with metes and bounds descriptions and major physical features. The plan shall make reference, by note; of the survey source and in the case of lots not subject to a -filed map, a certified copy of a survey shall be provided. b. A datum reference is to be provided (i.e., National Geodetic Vertical Datum 1929, or assumed/other).:: c. House location with proposed finished floor and basement elevations specified. d. Plan and profile of the SSTS, . to include 100 percent reserve area, construction details of absorption system and components. including septic tank, distribution or junction boxes, pump pit, dosing siphon, etc. e. Location of.driveways. f. Location of well or public water main and house service connection. g. Two -foot contours of the property. If ground is to be cut or filled, both existing and proposed contours must be shown. h. Location of any watercourses, ponds, lakes or wetlands on, or within 200 feet of proper V. i. j �.. k. 1. m n. Accurate location of all deep test holes and percolation test holes. Omission ' of soil testing on lots--in recently approved subdivisions will be at the discretion of the Department. Location of all existing wells and SSTS within 200 feet of proposed SSTS and wells. or a note stating that 1ggqe exi "st.:within 200 feet. Title box indicating name and address of property owner; parcel tax map identification number; property location, including street and municipality; name, address. and phone number of Design Professional; date of drawing, including dates of any revisions; and scale. Location and discharge points for gutter, footing, storm and curtain drains. Design criteria on plans to include number of bedrooms, soil percolation rate and deep test hole soil information, and sizes of SSTS components. 4 Construction notes pursuant to Appendix C. o. Space for Putnam County Health Department approval stamp (minimum 3" x 5 ") preferably at the lower right hand portion of the design plan. p. Location map (minimum scale of 1" = 2,000'). 10. Well Permit Application, if required. (Appendix K) . 11. Applications for Construction Permits for lots created prior to 1969 will not be reviewed until such time as -the Department is provided` with proof that notification of the application for construction was made to all property owners contiguous to the property in question. A location map, showing the contiguous properties along with the property owner's name and tax map number, must also be provided to the Department. Notification shall mean receipt by each contiguous property owner of a copy of the notification form in Appendix E along with a copy of the latest site plan. Proof of receipt of notice by contiguous property owners can include either of the following: L Copies of registered mail receipts. 2. Copies of the notification form signed by the contiguous property owners. Failure to provide the Department with adequate documentation of the performance of the notice will result in delaying action on the application until proper notice is executed. Transmittal of., this notification- shgu -ld:be -sent to the: contiguous �rope.�.},y owners -= .by'the Design Professional. 12. Fee - See Appendix I. B. Construction Permit Submission Requirements For Lots Requiring Fill Greater Than Two Feet in Depth 1 -6. Same as Section 4.0 A. - 7. Same as Section 4,.0 A.;' except for d. d. Two separate plans will be required; the title box for both plans must contain the statement, "Preliminary Design For Fill Placement Only" - !.•'• .A SAC= the wetlands location. If the property contains a locally regulated wetlands, and a wetlands permit is required, it is to be obtained from the municipality prior to project approval by the Department. H. Steep Slopes Sites with existing natural slopes not exceeding 20 percent may be modified to meet the maximum slope requirement of 15 percent by placement of ROB fill if the in situ soil percolation rate is less than 30 minutes per inch. Absorption trenches may be sited and constructed on existing natural slopes up to. 20 percent provided the minimum horizontal separation distance between parallel absorption trenches is 8 feet (i.e., 10 feet center -to- center spacing) and the minimum vertical separation distances to groundwater and/or ledge rock/impermeable layer are maintained. I. Garbage Grinders Whenever garbage grinders are proposed for new construction or are anticipated in the future, the septic tank shall be designed in accordance with the requirements of 10 NYCRR Appendix 75 -A. J. Pump Systems Gravity flow systems are the preferred design.,for SSTS installations, although pump systems will be allowed where lot constraints prohibit a gravity system. See Section 4.0 for design requirements. .. .. _ .. . .. .. ... ,- ' v ... ,rte.- .. .. .... ... ... .. "K. ®tfier*Requked'Perinits If the proposed construction requires permits by other agencies, i.e., stream protection (NYSDEC), wetlands (Army Corp of Engineers), etc., the Department will require all other agency approvals to be secured prior to project approval. L. Final Inspections The Department must be notified prior to backfilling of the SSTS in, order to schedule an inspection of the work. No completed work is to be backfilled until authorization to do so has been obtained from the Department. Final grades of trenches, length of trench or other field conditions may or may not be checked, as the prime responsibility for this rests with the Design Professional supervising construction: .: __,.. .. - ,: • . s „ate a,,::: �.. Goulds Submersible. �_.. hff von Pump lisp 3885 � r us 140 °F (60 °C) intermittent. • Fasteners: 300 series stainless steel. *Capable of running dry without damage to components. Motor Single phase: • h HP. 115 V. 200 V4230'V, 60 Hz, 1750 RPM: Y: HP, 115 V, 60 Hz, 3500 H PM; A HP —1'rz HP, 230 V. 60 Hz, 3500 RPM. *Built-in overload with, ' automatic reset. • Class B insulation. Tlree phase: o'h HP -1'/z HP 200/230/ 460 V, 60 f-lz, 3500 RPM. Class B insulation. METERS FEST r ecI 25 2c W � 1s r n a 10 r• . sc i j. ....L. SHIES- W15 I 0 10 20 30 40 50 EO 70 80 90 10u 110 X120 130GPM 0 10 20 30 Wih CAPACITY (V995 Gould% Pumps, arc. EflOctfva May, 11.496 �' T'd t.�,i,il'I� iti ;a -' r� i,6 _ _'T ';J'•. IJt H1P3115 ��] ✓'U1 Cie �t y �`hi /�G/7!!'lrl'� Y4' %��� sh"IJ %w% 4// "!�o -fd APPLICATIONS • Cvc.,'oad protection must smooth operation. Silicon can be operated continuously Specifically designed for the be provided in starter unit. bronze Impeller available as without damage, fallowing uses: • Shaft threaded, 400 series an option. p a Bearings: Upper and • Homes stainless steel. ■ Casing:.Cast iron volute lower heavy dub, ball bearing • Farms • Bearings: ball bearings type for maximum effi; lencyr. construction. • Traller courts upper and lower. • Power cord: 20 foot 2° NPT discharge adaptable a Power Cable: Severe duty • Motels standard length ,optional for slide rail systems. r rated, III and water resistant. • Schools IF agths available,. r m Mechanical Seal: SIL.COW Epoxy sea„ on motor end • Hospitals Single phase: CARBIDE VS. SILICON ,orc des secondary moislure • Industry •, HP —16/3 SJTO �A wad CARBIDE scaling fogies• barrier in case ;,f outer jacket • r Effluent systems F �rlth i1�• V or 230 V three 7C �o', metal Stainless st„ of meal (+ ins, , damage arld to prevent oil prong plug. BONA -N elastomers. , wicking. SPECIFICATIONS • 1 /a -1;;. HP —14/3 STO wit m Shaft: Co; ro ;ion- r�,;istant n 0 -ring: Assures positive Pump bare leads. stainless steel. Threadrd sanding against contaminants • Solids handling capabilities: Three.phase: design. Locknut on three and oi' leakage. ;" maximum. • % -1 Y. HP —14/4 STO phase models to guard • Discharge size: 2" NPT. with bare leads, On CSA against component damago AGENCY LISTINGS • Capacities: up to 125 GPM. listed models -- 20 foot length 'SJTW on accidenml rr;verse rotation. ---r- -- - -- ---- -- �_ Canadlzn 5iandarr' hswc� :dint • Total heads: up to 123 feet and STW a Motor: Fully submry ec in TDH. arc standard. high -grade turbine oil for Meehan cal,seal:.ai,iicon. _... , -- lubrication and efficient heat �` Underwtden 1.aGor3tnrirs carbide -rotary seat/si :iscn Pti:AiURES - - transfer: carbide - stationary seat, 300 IN Impeller; Cast ;roll, seml- ■ Geslgned for Continuous series stainless steel metal opei;, 11Q11-clog with pump- Operatlan: Pump ratings are parts, BIJNA -N elastomers. out va ^es lur mechanical seal within the motor manufactur er ; *Temperature: 104 F '40 C) cont'nuo prctrc;ion• Balanced for recommended �:;orking limit; , � r us 140 °F (60 °C) intermittent. • Fasteners: 300 series stainless steel. *Capable of running dry without damage to components. Motor Single phase: • h HP. 115 V. 200 V4230'V, 60 Hz, 1750 RPM: Y: HP, 115 V, 60 Hz, 3500 H PM; A HP —1'rz HP, 230 V. 60 Hz, 3500 RPM. *Built-in overload with, ' automatic reset. • Class B insulation. Tlree phase: o'h HP -1'/z HP 200/230/ 460 V, 60 f-lz, 3500 RPM. Class B insulation. METERS FEST r ecI 25 2c W � 1s r n a 10 r• . sc i j. ....L. SHIES- W15 I 0 10 20 30 40 50 EO 70 80 90 10u 110 X120 130GPM 0 10 20 30 Wih CAPACITY (V995 Gould% Pumps, arc. EflOctfva May, 11.496 �' T'd t.�,i,il'I� iti ;a -' r� i,6 _ _'T ';J'•. IJt H1P3115 PARTS ..E; ®R1 No. • rlescriptinn- -,_ --' - _ j 1 Impeller --I{ - 2 - - Casing _- .._.._.__.._. 3 Mechanical seal — - 4 i Shaft 5 _ i_Motor_ _J 6 i eearir,gs.- utipAr X11:1 I lower r 0. 'r cable 0 8 0 -nng ., 2 MODELS (Order No, rt{� roar' phAS� '.-F And RFhi ' 3a tf ?� :e! st, arwt: tas. WE031IL i 115 9.4 _ T - WE0312L _.'.z0 n.7 1 L �t1Q _ 4. 1153. 56 115 - 9 �WEii3i2M _ ?g0 -1 1 t., N;A wH�� r - -- E0512H �?,J zoo_ _ ' _._1.4 WE0538H 200—~ 3.9 __, WEO �21 230 _ 3 3,4 _ K:2 INEn 3.iH 460 - k.?1- f0 r st, ' _ 115 4.5-7 60 WE0512HH- 230_ ! !, N/A WF:053RHHJ Y32_ OGEIJ�1 ;rr1 _ WE0534HH - - 16: WE0712H 0 iti.0 NIA I WE ? �8H_ Ve ~27a _ —_I f.2 _ 1K i irJED732H +250 3 v5C0? WEG7�3 N 4'6 _ _ 70 WF1012 3(_ _12_3 NIA VIE10184 "_200 14A VJCID3�JH _ .J_; 200 ' _ n ia3 WE1032H 1 X10 ^ i•y w I �._� ...,... �.5 _ ...I WEAK D ? 80 : - . P11A_._. _ —_K50 For $75 V wisult factory. MFTERS ,za U. 5885 as iIM ZE:" S0005 100 7 r • , 1 I . 1 20 Q} ! t. . .. r ;... J. 1 l •, t 1 I ....1... i W ...1 L s01Q++K •... t , i... PERFORMANCE RATINGS (gallons per minute) DIMENSIONS (A)I dimenSlons are in 100hes, Do tint use for construction purposes.) D' f, �, 3% and t HP =15' except for model WE0712H and 'NE1012H - 18';1Y2HP =18' �. _ _._...12,x, .. - - - --••1 I r ROTATION �- KICKBACK EFFLUENT EJECTOR SY STFM a _1 Effluent elector system i Package Includes: ' offers ease of ordering SuwarsiNe Effluent Pump WE031tL �- ;- I - +MI -' I - { and installation. A single 12l orWE031tPA,12M, Wr "C511HN,12HH ?q' 'n i sc ao �c 1 eo' 50 ordering number speatles { N18Chanlcal Lev►,I Control Switch r A2-5 (115V), A2.6 (230V) 0 w a complote system des: „nett 1' ('' Irl Basis AM 8015, Bos1n Cover A8.1822 —._ —._ _ _- , -... _ o ,o ?+7�-' nafh for llloSfrE9idAntlal0t ! Iil II GheCk Volvo A92P CAPAMY commercial sump and ( Order No,: SWE0311L, SWE0312L, f-� effhJent purr;p apn!icatipns. r SWE0311M, SWE0312M, .Cap GOULDS PUMPS. INC. SVJE0511HH,SWF0512881 $F "t5!,A F.]t�1 h:�'•U ';;;t1.r, 301 SPECIFICATIOP43 ARE SUBJECT TO CHANCE WITHOUT NOTICE. PRINTED IN U.S.A. .I 1 -1.J. -II ,C. JLU I.J"- C: * ^il LL.J'^C • 7T Qi: - r..IN i' �- TWEA511H WE1512M W10611HN WE05121111 1VE1512HR Order ' �WFQ512H•WE0712H WF0534 �WED731H WE1o12M WEICSS14 WE1MH MOM WEI"04N No, WEUM WE0312L WE0311Ma wEd912M' WE0532M WE0732H WF0631H WFOf54H WE1032H Wei"AN W11E32H WE, 534H wEo604MH WE0534HM W08320 WE153411H WE°S1Al WE031am WE0515H I WET/! Rif WE101oH WE0519HH _ _ a - - - -- ANA 1750 1750, 3500 3500 5500 3500 3500 3500_ I 10 ' 80 65 -� - - - 56 84 15 20 25 i 36 II + 45 25 ti9 60 50 90 8.3 ro 104 _ 8a 92 128 _ 122 116 53 _ 48 45 82 77 75 2 30 1 - -- 38 26 1 6 58 85 78 109 102 40 35 72 70_ �+ 35 40 15 47 70 94 30 _ 67 6-2 jS 64 n 5 55 0 25 52 42 77 67 16 12 60 1 58- A 60 LO -- ------ Ll. 8 32 21 56 _ 3 54 51 _47 11 35 � .a vtzr - _.. 25 1 — - L — 43 -- To 24 �7 - . 1 - — . 110 _ 1�5.. -- 120 DIMENSIONS (A)I dimenSlons are in 100hes, Do tint use for construction purposes.) D' f, �, 3% and t HP =15' except for model WE0712H and 'NE1012H - 18';1Y2HP =18' �. _ _._...12,x, .. - - - --••1 I r ROTATION �- KICKBACK EFFLUENT EJECTOR SY STFM a _1 Effluent elector system i Package Includes: ' offers ease of ordering SuwarsiNe Effluent Pump WE031tL �- ;- I - +MI -' I - { and installation. A single 12l orWE031tPA,12M, Wr "C511HN,12HH ?q' 'n i sc ao �c 1 eo' 50 ordering number speatles { N18Chanlcal Lev►,I Control Switch r A2-5 (115V), A2.6 (230V) 0 w a complote system des: „nett 1' ('' Irl Basis AM 8015, Bos1n Cover A8.1822 —._ —._ _ _- , -... _ o ,o ?+7�-' nafh for llloSfrE9idAntlal0t ! Iil II GheCk Volvo A92P CAPAMY commercial sump and ( Order No,: SWE0311L, SWE0312L, f-� effhJent purr;p apn!icatipns. r SWE0311M, SWE0312M, .Cap GOULDS PUMPS. INC. SVJE0511HH,SWF0512881 $F "t5!,A F.]t�1 h:�'•U ';;;t1.r, 301 SPECIFICATIOP43 ARE SUBJECT TO CHANCE WITHOUT NOTICE. PRINTED IN U.S.A. .I 1 -1.J. -II ,C. JLU I.J"- C: * ^il LL.J'^C • 7T Qi: - r..IN i' � pp _W0RD. GF ..PHIONE QONVERSATION Time: Date- Person calling: -D �ojc_v,�Xhone Reason ( ) Deeps and/or Peres: Scheduled Field Meeting 1.) Time'. Date: Y N Tentative/to be confirmed Town- 7�vt Road/Street.- Tax Map 9: cql,. I Comments: 464-M o Co Ord A44 -TI C_ (ile" f2, tvd t-- Ip as PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT -STREET = LOCATION' :�GKSiL�it� `►";� LGj� NAME OF OWNER re •- :�sa.. REVIEWED BY 6"~ DATE 0/41011 TAX MAP KERMIT APPLICATION PERMIT PWS LETTER R OF AUTHORIZATION N DATA SHEET (DDS) )RATE RESOLUTION JJ A LANS - THREE SETS OUSE PLANS - TWO SETS ARIANCE REQUEST .-- SUBDIVISION LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED P_ERC RATE / FILL REQUIRED 21 DEPTH CURRAIN REQUIRED STANDPIPES GENERAL LOCATED IN NYC WATERSHED PLANS SUBMITTED TO DEP DELEGATED TO PCHD DEP APPROVAL, IF REQ'D tA 114 DEEP TEST HOLES OBSERVED . EX- AIPROVAL SSDS ADJ. LOT, WETLANDS DS (TOWN/DEC PERMIT REQ'D ?)� DATA ON DDS PLANS .& PERMIT SAME `) K S PRE 1969 NEIGHBOR NOTIFICATION +A` �, LETTER BUZBA t-k( h 100 YR. FLOOD ELEVATION�(A OTHER REQ'D PERMITS) TN A WAGE S QS4AX.RAULIC PROFILE _ GRAVITY FLOW` )NSTRUCTION NOTES :SIGN DATA: PERC & DEEP RE CONTOURS EXISTIN OPOSE UVEWAY & SLOPES, . )OTING /GUTTER/CURTAIN DRAINS Y cbnti t7n�*.t Y & DEEP HOLES LOCATED & EXPANSION LOCATION MAP EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE IF PUMPED, PIT & D BOX SHOWN & DETAILED HOUSE - NO.OF BEDROOMS �Ssy,u WELLS & SSDS'S & BOUNDS NO BENDS; MAX.BENDS 45° W /CLEANOUT CLAY BARRIER 10- FT. HORIZONTAI,;SLOPE 3:1 TO GRADE FILL SPECS ,� F L NOTES FILL CERTIFICATION NOTE hi D�TH GUAGES FILL PRO TILE_ irJIMLEhJIIyIFlEILLEI3JIMENSIONS qA C' - 'o-a(i. AnLllt�n r ' LF TRENCH PROVIDED 60 FT MAX. �fl ( PARALLELT_O.CONTOURS..; _ - 100 %- EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED '10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS _IYWELL TO PL 100' TO WELL, 200' IN DLOD, 150' PITS `100' TO STREAM WATERCOURSE LAKE (inc. expan) iC 51, ' STORMDRAIN, PIPED WATER 10' TO WATER LINE (pits -20') ,1 �N 50' INTERMITT INAGE COURSE U 2007500' RESERVOIR, ETC. 150'' GALLEY SYSTEM 15'min to CDS= >5 %,10'- 4 %,25'- 3 %,30'- 2 %,35' -1 %,100' - <1'14 20'min to CD discharge /100'with 182 cons day discharge ,10' FROM FOUNDATION; 50' TO WELL TO l ► —gyp �i �/� tits u FORM ST-2 L Co j2'q 12 i. T.. ns C. e • �;l.:..�.4`^ . .0 :.a � . ..� {' . ,{�r�c��/{ /�}.�. � x+ p . tr. �?l Y +, t- � a 1'�. ..• ..Ait°^., as SS...nC'� . i � r �. yY '11 '1 :ti ®© - PUTNAM COUNTY DEPAmima M1 we HALTH DGvlelaa d BivlrsmesW Heath Sarekei. Cai®el N Y.14S11 Enaeoer to Ptaovlde PON N , �� .� a�CS411PICATB00 CB•/ NSitQCIiOPi Pam FOR SEWAGE DISPOSAL SYSTEM PsoK` ��+�/ Renewal e � : �tlo''�''Q�^a'��%'��!"�` 4'��� J- ��y� .... ; rc , v f'.... t•' ., iG `^'7z 5+�7i l''' +cam egos ft c. r + i s+ � ri ...v+ Osf�ar /Apprrat Name E ��%� Date of Prevk►pa Approval Addtiew 13 a A `'l?% �°M ° Y s / /"4-V Alay Alay Ali ap BddkaS Type �" 7 �'� G' �'` Lot Area i' ✓ Tz.� Fm . Secdm Only. Depth Yolame Nober. d'Bedraom Dedp Flow G P D G' PCHD Nodfleadon la Begohed Wbeu Pill laoompkted Sell" SewenFe Syatae b eenum e, Ga ply sep& Tank -? z° 4 "YY:,u�C r+tvsCi�Cf To. be o•n hutted by Addnm Water Supply Pwm supply From Addreue �®Pda an w Supply Deed by Aadma odwr I represenuthat l am wholly and completely responsible for the design and location of the - proposed system(s14611_j Uth• separate sewage di ul s stem above described will be constructed as shown on the approved amendment there to and In accordance with 4Uh1�}ardiyles a regu ns o nam County Department of Hulth, and that on completion thereof a "Certificate of Construction Com tlifYdtor the Commissioner of H•althwill be submitted to the Department. and a written guarantee will be furnished the owner, his succ• @RIA• C. o builder, that said builder will Place in good operating condition any part of said 96 • disposal system during the period o s Im following th•date of the Issue arc• ,of the .approval of the Certificate, of Construction Compliance of the original system or a s t o; • drilled well, d•solb•d above will be located as Shown on the approved plan and that said well will be Installed in accordance' wit a N ulations Of the Putnam County Department of Health. O Date Signed G'TZ /J y. fl 6�1 % x P.E. R.A. - _ / % 2 Y �'i ► % G '�f - �rJ►''G % Address ens• No APPROVED FOR CONSTRUCTION: This approval expires two ears h m the date isfu gloss con }+ �Iding has been undertaken and is rerocaibl• for use may be amended or modified when cons; sary by the lssioner of, ►atluir•s i for disposal domestic - - .;?, - cMrlgs teratlon. of construction Rev . /�pp►OVed Of t gage, /w • 1 1 f IV Only. ,S (C/ 10/88 oat. er. .. __..._.. Title k,. VV' . r DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION -TO CONSTRUCT: ;K fiA` Egt: WtLt PCHD PERMIT OA l/ WELL LOCATION Street Address Town Vil age City Tax Grid Number WELL OWNER Name r4t'e_le, 14? Mailing Address 9i. 'fA 2-1-1 4rYJ e ;'rivate A1Y ® Public USE OF WELL 1 - primary 2 - secondary 0 BUSINESS 0 INDUSTRIAL Q AIR /CND /H T P ® ABANDONED O FARM O TEST /OBSERVATION 0 OTHER (specify 0 INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED It 13 REPLACE EXISTING SUPPLY ® TEST/ OBSERVATION NEW SUPPLY NEW DWELLING)- 0 DEEPEN EXISTING WELL OF DAILY USAGE 440 6 gal G ADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED ®DRIVEN ®DUG ®GRAVEL. 0OTHER IS WELL SITE SUBJECT TO FLOODING? YES a-**' NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: - A rG Lot No. WATER WELL CONTRACTOR: Name Al • o4PL;* �rz,,;% Address: —n r IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTAPICE .,TO . t"', ROPERTY FRO14 NEAREST. WATER-MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION _ RON SEPARATE SHEET date PROVIDED 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. y During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drill $ peration be contained on this property and in suc a manner as not to degrade or oth w' contami a surface or groundwater. Date of Issue: 19 Date of Expiratio 19 Permit Issuing Official Permit is Non - Transf rrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller g . PQIPIAM COUM DSFA i.OF SSALIS R Dh1i0 dw0easseeitW Hao9eA Seevloee. 0004 N.YASS3? Rogbow b Pf'" Penh / . TS OF: 1�R1lUCl i Plat FOR SEWAGBDMPOW:SY9TM ' as Mlii s�W 0 ! Tax bLp Reyklenq Owar /A iltat NaA. y� /,W c e- D' Date. of Pievboa, Appaevtl Town .. _ MlIfte X1 Aei. /as`7f Date Subdivision Approved ...Fee -- Enclosed - []. Amniirit— "M1119 IYr IM Sectloi Oeb D416 valpoa Nttaber nit Be�ewtr 3• Daeipu Flow G. P D' .. Q �! PC® Not &Wm to Daii>*d WbM Pm b MMM,6d L. Se W86 Uw*Mv Syd= to aealldet of /© cc/ r_,° Septic Tank ••:a �T� � � �'!� i✓Ii� �rm�[sP"� To be ar4 taii.b7 Addnrr - Wl" Spa �cP .sup* groom Ad*mw' an "DrEed bY Oslo« I represent that tvm wholly, Spit completely, ra0onsible for tit dsiiyn_ and location ofthe propofad ayst.m(Q ll that tha'sepa►ab taws a di oral s stem Cabo described will be constructed as shown on the ipp!ovod amenimn nt their to S* nd; in accordance with standards, rules an resu a ons'o • m Department of mealth, ,and thaton completion thereof a Idertilicate of Construction'c actory to the Commissioner, of Meolthwill be submitted to the OepaftiiNnt, ond.o written.ousiantee will be furniv;ed the,.oiwner, hii. - _.h. .,, - t ,� by.,the builder. that said builder will plece m •ooA operating condition:My' part of Yid'swieye Aisposil system during fho following tit ate of tit Ipu- ape of the approval of the',Castifieate of Construction Compliance of.. the original system - t Mt that the drilled "I described above VAN be located ai sho" onIhe applow0 plan aeA that iaid 'woll will be Installed in iccadan and rpu aMns of the Putnam County Department of Health. �. P.E. RA. Date Slene • . Adilres '° Lkense No Z S i APPROVED FOR CONSTRUCTION- T 4, approval ;r as tvvO late om.the date issued u s't building .has been undertaken and is ►evocable for cause or may be amMdeO O / modified when con sid _ ed Wry, -by, the, o issionei 'fy'f: w ny charge or alteration of construction "Ouiree • permit . pproved ton - tlisposal of domestic " and %or to water suprlty�orrtq: ZeV . Oats �� Br" 6�1 Title Qf F7 DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 "�• ipPL�CATTON TrG( CC`11TST�'FOC"T A ELL? PCHD PERMIT MLL LOCATION Street Address To Village Cit Tax Grid Number WELL OWNER Name Mailing Address 2 -;'-/ /� A131 APrivate ® Public USE OF WELL 1 - primary 2 - secondary gRESIDENTfAL D BUSINESS D INDUSTRIAL ® PUBLIC SUPPLY - ® AIR /COND/HEAT PUMP . O FARM O TEST /OBSERVATION E31NSTITUTIONAL O STAND -BY ® ABANDONED O OTHER (specify ANOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE 60 � �ffi1 ® REPLACE EXISTING SUPPLY ® TEST/ OBSERVATION 0 ADDITIONAL SUPPLY NEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR 'DRILLING WELL TYPE DRILLED []DRIVEN ®DUG ®GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION• Lot No. d STATER WELL CONTRACTOR: Name IV&-a�'JG�% �ly �O� Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NM E OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTAkE TO PROPF•RT i' FROM - NEAREST :"WATER` Fj,114 : LOCATION SKETCH & SOURCES OF CONTAMINATION. PROVIDED AON SEPARATE SHEET 9.L17z . (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 thirt3c (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 othqai e contaminate surface or groundwater. Date of Issue• /-3 19 `t Date of Expiration 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller C , JOSEPH F. SULLIVAN, P.E. a . )1 , .a�• .. ti. � S_.. '^ < ' st • y . A.�..u" . n _i .� :M. 'r �. � � 9 .,r. -• .K �' • d".a,- �. • hat's n ~i 'M. .�'.,. � r F. .._'.:� ..':qf � ��.. �... h_..i"-.�.a' Y I�.R P h r �Yr 2972 FERNCREST DRIVE YORKTOWN HEIGHTS, N.Y. 10598 (9 1 4) 962-4248 September 7, 1993 Putnam County Department of Health 4 Geneva Road Brewster,'N.Y. 10509 Re; Lot No 9 hove Peek Acres Peekskill Hollow Road Putnam Valley N.Y. (TM 84.11 -1 -22) Gentlemen, Enclosed please find application forms for the proposed sewage disposal system for the above Lot. This lot was approved by your department originally in 1986 (Your Yile No PV 91 -86) From a field inspection of this lot there have been no changes in this lot or surrounding properties to adversely affect this design, Very truly y urs n, Joseph F. Su livan P.E. W.U. Icau •■ 017 COMPUM= V. VMM76mft�� OMER] V421/7 cl PWVLM Aupo�— Al vem z� DA g-S4dLyjsion-Ap-RKgygd or ee Enclose E3 Ammint LJ ocA e=t, ib. r. ip D 2CM '`:92r2= b UC=DM4 WE= PM Is RED234 2b to =:ii�_r -two tv C38 Mucco tv *3r 0. rcwO=82 toot I Ofa rMony Ow C�mDcotalv r000nswo f07 tho Mosegn oew tocotion of tho proDoms svuaopn(Qi 1) that the c3parato di!wl OOM CUM mew 1501 Mo consaructc3l O4 an tho Opswovos Onle"mont thwo to a" In accovanco tulth tho stongordo. Furm 0"romman.l 01 PWROM 00MMY Dc=qw---A 09 V=Mck Ow u" an emp=w thercol 0 "CC72ifitot. 01 co- ace* MtWeactocy to the commism"M of "coshwils Do U=Mcg to Q= 0c=qG=z2. ORD a =QW2 C=Owgco 'Zin Do IUMMA tho V OMEORS by 200 DUI=. MM CUS WNW WHO =W in 9=0 0=nMo =MMQ, am C= ev COM C== lslr e ZV=M dwrkzo 2 a 1MV-1:01320V feltmire the asto 09 tw omi- C= 00 =3 C=GUN w 2= cuaculacao 09 co="Daw COMMIOMICO of tfoo 0710mal t 21 Mot 2610 arm" we" Wwow ab= W m3c= Go cQ ecto C=Guc:n pm Ow tcmQ MW won val w M rum OU4 7cz—)UNMrs-01 tPlo Putoorn so. - 0=MM. ze Q.A. LICORDO WOL of tho Equiwwm has D= uluft7"Nea arm ic a"Q0v(d® Pl0Q COMTQUCVQGmt 1=1.11 011pell twa V=G two 0020 1 pwp gcn=to 9C7 ca= e7 MOV M =610 faujifts own coasl*ucm poy by tho n6. Any ckavco or o0ic?6teon of coravectew vczubm a a= VMCL, AC 967 (3km W 000=t: MOCIOr pit, O Rev,i. c3v TWO Iwo 11:10 DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 ;�. .r -.. A7PI;rCATI01�7 `'PO "G(iI�ET�tiJGT'' ,i.- ;�n1ATER`.AWELL PCHD PERMIT $ WELL LOCATION treet d re s / Town /V lla a ity Tax Grid Number WELL OWNER Name Mailing o 3' Addr s / r/ �/ ✓1 rivate D Public USE OF WELL 1 - primary 2.- secondary XRESIDE AL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY Q AIR /COND HEAT UMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY. D ABANDONED O OTHER (specify Q AMOUNT OF USE YIELD.SOUGHT gpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE dVO gal REASON FOR DRILLING D PLACE EXISTING SUPPLY N EW SUPPLY NEW DWELLING ❑ TEST /OBSERVATION G6 ADDITIONAL SUPPLY D DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN DDUG C] GRAVEL 0OTHER IS WELL SITE SUBJECT TO FLOODING? IF WELL IS LOCATED IN A WATER WELL CONTRACTOR: Name YES A/ NO SUBDIVISION, NAME OF SUBDIVISION: 4=yv o- Lot No. Address n IS PUBLIC WATER SUPPLY.AVAILABLE TO SITE: YES 4,-`0' NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY . .:- DIS.IANCE- TO..EROFERTY.:F$OM .NEAREST::WA.TER._MAIN: - + ,. - - __... :__ __ . __......__.............._.. -• . ,• LOCATION SKETCH OURCES OF CONTAMINATION PROVIDED AON SEPARATE SHEET ( ate ) (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. 2. 3. Pump the well until the water is clear. Disinfect the well in accordance with the Department attached to this permit. requirements of the Putnam County Health 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 s'uchh`aamanner as not toc.ddegrrade or otherwise cont =nate surface or groundwater. Date of Issue: ''T 19� Date of Expiration % 19- 2 Permit Issuing Official Permit is Non - Transferrable 3/89 White copy: HD.File Pink copy: Owner Yellow copy: Bldg. Insp. Orange copy: Well Driller !7.5 Ua&, V- 0UVrY DEPARTMENT' OF HEALTH - DIVISION OF ENVIRONMERrAL HEALTH SERVICES INDIVIDUAL, WATER SUPPLY & SUBSURFACE SEWAG REVIEW SHEET - CONSTRUCTION (Na* of Owner) (Str Cmmm YES V 140 LF trench provided required 60 ft. max. ..,,-DATE BY: nation) DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results 30" Perc Hole Other S/S SUBDIVISION Perc (3) Fill cd L House Plans - Two sets If PWS - Letter if we111 22!Elt Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow 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. Design Data Two-Foot Contours Existing & Proposed Driveway & Slopes Cut Footing/Gutter Curtain Drains Perc & Deep Holes Located Representative'of Sewage & Expansion Area Expansion Area;shown;gravity flW,suff.. Size --- af. -Pumped- Pit I& "D Box Sh6wn.'& -Detailed House - No*. of Bedrooms Wells & SSDS's w/in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1/4"/ft. 4110;.Type pipe No Bends; Max. Bends 45* w/cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 101 to P.L., Driveway, Large Trees 201 to Foundation Walls 1001 to Well; 2001 in D.L.O.D, 1501 pits 1001 to Stream, Watercourse, Lake (inc. expan) 151 to Drains-Curtain, Leader, Footing 35'to catch basin,stormdrain,2iped watercourse 101 to Water Line (pits-201) 501 intermittent drainage course Septic Tanks 101 tran Foundation; 501 to well 151 Well to PL GENERAL Legal Subdivision 'Subdivision Approval Checked Jac- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) ,.-J Data On DDS Plans & Permit Same -J 9 JOSEPH F. SULLIVAN, P.E. YORKTOWN HEIGHTS, N. Y. 10598 (914) 962.424B October 3, 1991 Putnam County Department of Health 110 Old Route 6 Carmel N.Y. 10512 Re; Lot 9 Love Peek Acres Owner Mr. Bruce Ryan Proposed Sewage Disposal System Gentlemen, Enclosed please find plans and application forms for the proposed sewage disposal system for the above lot (TM 84.11-1-22) This lot was approved by your department in 1986 (Your file no PV 91-86) From a field inspection of this lot there have been no changes in the surrounding properties to adversely affect this design, Very truly yours Joseph F. Sullivan P.E PUTNAM COUNTY DEPARTMENT OF HEALTH ,-. :,��,� ... - ,....... -•D �i%I��i)�'-�`Oi +" =�NV3`i2C'�NMEN`t'AT�: ° �- �HS',4T:`PF- i�s�FT�F�]"rr`Fi,� :- - . - . ,. -��= ._ ..- ....�t,�,:�.:�.- Re: Property Located at Date (T) e f Section J;/ Block % Lot 2 Subdivision of Subdva Lot # Filed Map # 'T Date Gentlemen: This letter is to authorize 6167.15� 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 - -� - corixiect3Gii with 0, L -jmatt-e -.-aced, to, np v se -the- construct ori°of` saki*"° 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, Signed Countersigned: Owner of Property g� PaEe , ReAe , # �w e �Al Address Address Town 5 Telephone Telepho e Revi•. 3 PUtNAMC6bM DEPARTMENT OFEW.UTH I Division of Environmental Health Service ;-Cirniel. N.*.465b', on Cl UWA" GIE DI erm DISPOSAL SYSTEM i- -r VW age Upocated at J T Us g e_: Sabdivielon --4- Nii e-- ubd. Let # Tax map Block ii Rene*j ❑ Revision, 0 Owner /Applicant: Name Date Malling-Addiiss Town :z A Flft,Siciiiidiai Building Noth - Ty" Number of ge" beslign Flow G/P/D ze:e,, .'PCHDNotiffeadonls,Re4uhvd,Whi§n'F[U'Ii completed , -7- Seilarke Sewerage System to consist of sla Til'be- con" snuked by Adi&ss" Water Suppb;. Pablic -S y F<om 'Address or._Firfvate Sipoly Drilled by Other Recinlreinefits % ,rreRresent'that� I-am'Wholly, and c.9 ri� n' stem(s), ;Jk �that the .seParat a', wage disposal system t i"�4 'ito 8V W. v a bed will ii� the standaid rules an regiTaTions 5T a u =na rn above d:scri' Ili be constructed as�shoA ri IoIA a N :County Department of Health, - ind It hat'o ri'completion: thereof a -Ceri I �Ostr,u Bppll ce." satisfactory to the Commissioner•of Health will be submitted to the &Pirtrnent,' and a.w!it.teri gbaiantee'wili e u Wh a ow his SU ears or assigns by the builder, that said builder will 1 %44 d 9% w9 place in good: ;operating- condition - " 'any piart'of'.�iia� sewage, *, "it`' i Y Uri .040'linmedlatel*y following- thedati of the issu- ance: �irs theretoj i). that the a riie,', of 11 of ^`rig I 'Por, r dillied w811 clekribied above t.�e'�e.rtifjc�,ta:, of will',6e4ocated as snown,on the approved plan that.said.well will e'l in �wit �'Ajt%j�'a ridir'di rules and :regulations '�Of the Putnam y epa� 't . . i _1, .,., � .. . I " " , , .11.� �. . ; "I. � �L , Count alth . n of 01 0 Date 1g'n'ed R.A. Addiess ens 0, License N' APPROVED FOR- c6NSTRUCTION .This aOp r?va y i0m.'"e:: construction the building has been undertaken and is :,. revocable for 'cause .or, may be arniiitded or`moclifi.ecl whjn co dered necessary, � , neceisi *,M : ,i si - i o ' ne r (, f "H*iu'lih. Any change orialte1 ra' t., i o�, n , o , f construction requires new ierm!t.+ Appro ad for disp9iii 01dqmeiii niter ,wag /or 1,ate.W ter $up? i 'only. —I Date'— CO BY title 0 A. - r DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER, WELL?__• PCHD PERMIT 0 WELL LOCATION Street Address Town Village City Tax G °rid Number '. 'G G c9 C WELL OWNER Name Address ✓G/ f e- 2 .', f / A gF rivate O Public USE OF WELL 1 - primary 2- secondary M/RESIDENTIA 0 PUBLIC SUPPLY ® BUSINESS O FARM. 0 INDUSTRIAL O INSTITUTIONAL 0 AIR /COND /HEAT PITO 0 TEST /OBSERVATION 0 STAND -BY 0 ABANDONED 0 OTHER (specify 0 AMOUNT OF USE YIELD SOUGHT t -5 gpm /# PEOPLE SERVED_ � /EST. OF DAILY USAGE eda t� gal REASON FOR DRILLING 03EW SUPPLY 0 PROVIDE ADDITIONAL SUPPLY OREPLACE EXISTING SUPPLY 0DEEPEN EXISTING WELL 0 TEST /OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE ®DRILLED DRIVEN ®DUG GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: � d Yc i�CCi!` e2e- Lot No. WATER WELL CONTRACTOR: Name /� �J��7/% /t/%�i�/S l/� Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES !f NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY -FROM - NEAREST - :WATER MAIN: /y✓%j /G_3 - LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION OON SEPARATE SHEET _ (da e) _..._ _ (Ogna0AP.), ,./, 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 pro ided by the Putnam County Health Dep tment. �i L� Date of Issue: 19 Date of Expiration: c• 19 Permit Issuin ffi 1 , Permit is Non - Transferrable M-1. - %i'.. --� . .. Lv � _- . .. —" � � r � ..: ..= o- - °rr�a -�. c. :4. .., i. •ems; - !"' , :_ r -'. ' s ❑'; � ` .... i rs z a.r1 • .... � h JOSEPH F. SULLIVAN, P.E. &nduet 4 ir*weh 2972 Ferncrest Drive Yorktown Heights, New York 10598 (914) 962 -4248 Putnam County Health Department 4 Geneva Road Brewster, New York 10509 Gentlemen: ,January 19, 1995 Re: Lot No. 9 Love Peek Acres Peekskill Hollow Road Putnam Valley, New York (TM 84.11 -1 -22) Enclosed please find application forms for the proposed Sewage Disposal System for the above lot. This lot was approved by your _ dep tr Ent ariginally in 98ti (Yodr File :No. PV 91 -86): From a field inspection, there have been no changes in this lot or surrounding properties to adversely affect this design. Very truly yours, Joseph F. Sullivan, P. E. J FS /ats WWAR' -Ass x mmy wuw 0,16 RL; My"W" MIN- �w Puy, A=" J1. . . . . . . . . . . . V� "VAMN I fr, , 'tj _N -44'. Wo— Kv. a Zvi WEER, n 70 Inn v V4 MAU Ail A . . . . . . . . . . k,N TON, jaw: 0 e� 41 W {"RjM 4 , 14, IQ- 41 QU _14,z w"S.00 '01, 77 5; !,J kC , vm Ty, . Pew; 7"N LOA' Ile ,r J ftl"- i d If <iC.rrd . :0s. frd Fop !fi..4.- .. �._. _.._._...__�..r...:.� r- •......_.. _._`. �,.._,........., -_ . —••�. f1 NL(YIR (OW�LY YY1M�1 LiYYi 02 1k►44 �. - ii,':3 IBC 1.� � ��I`',.���]F_{` �1f12'O�/D� �Nl� �•RT14�� 4 kFaroved RPD11oaD1. 8n1•• •a! %pastime of t!. th D•x"sswt. Ef +ri L'.'1�'.r f i9 iR.1 T i --- �=3^c •� ;- r� � �,,,r� �j �- � � arrd`� ra_• a, Y�,i4' �: � �.� jr YSTI AIX •� - 1 - T-M No 1'L3f2KTQIIIl�i p �.