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631- 589 -8100
85.05 -1 -67
BOX 34
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• 1 L '
ILL �'�'■ .� �rI I
f
04571
Er�
T)af , p S bd:
Rev.'
10/88
will
`811114114'br the bulkier -thsUsaWbulkler will
ISPA-
th that t he d ri I i a6m,
-walUdew"
77
7:
Woo - Putnam
outhi,buildin 9
-has-been, undertaken and is
Any charism or aheraii"411 c4itstruction
0
Title
'A
r.
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New.York'10509
(914) 278 - 6130..
.. •lLti. ..'J. ?..:.•-- '. t^ >.-f V t.. i ._ ^,':. R.: . .._ _. _
..C...}n -�. fiL•
.. �qy,.�•V -.. }_ -� '- .T may?
APPLICATION TO CONSTRUCT
A WATER
WELL
q
USE OF WELL
1- primary
2- secondary
RESIDENTIAL
0 BUSINESS
0 INDUSTRIAL
PCHD
PERMIT 6. -1O 1 �.
WELL. LOCAT ION
Street Address
Town V llage City Tax.Grid Number
b^A _Urrz aa-- 815,C>5- t-
WELL OWNER
Name
n D
Mailing Address /
kris V b
Xt rivate
O Public
USE OF WELL
1- primary
2- secondary
RESIDENTIAL
0 BUSINESS
0 INDUSTRIAL
® PUBLIC SUPPLY Q AIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION
0 INSTITUTIONAL O STAND -BY
D ABANDONED
O OTHER (specify,
Q
AMOUNT OF USE
YIELD SOUGHT tilO 6 gpm /# PEOPLE SERVED ( f%M /EST. OF DAILY USAGE Sal
REASON FOR
DRILLING
O REPLACE EXISTING SUPPLY 0 TEST /OBSERVATION LZ ADDITIONAL SUPPLY
NEW SUPPLY NEW DWELLING dl DEEPEN EXISTING WELL
DETAILED
REASON FOR
DRILLING
WELL TYPE
DRILLED
DRIVEN
ODUG
OGRAVEI.
QOT$ER
IS WELL SITE SUBJECT TO FLOODING? YES X NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION,' NAME OF SUBDIVISION:
-eFf • "IHBMAS P(,ACA�? e,6f -ACr Lot No. c�
WATER WELL CONTRACTOR: Name-l'
ame - ' �3 P Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: / YES X NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
FDISTAI: E "TO -PROPE-RiY FROM' NEAREST "HATER MAIN -����,
LOCATION SKETV SOURCES OF CONTAMINATION PROVI
ON SEPARATE SHEET
(date)(s
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 -y (30) days of the completion of water well construction, the applicant shall: .
1. Pump the well until the water is clear.
2. Disinfect,the well in accordance with the requirements of the Putnam County Health
Department attached to this permit.
3. Submit a Well Completion Report on a form provided by the Putnam County Health Department.
During all well drilling operations, the applicant shall take appropriate action to assure that
any and all water or waste products from such well drilling operations be contained on this
property and in such a manner_as not to degrade or otherwise c irface or groundwater.
Date of Issue:
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
PUTNAM ENGINEERING, PLLC Letter of Transmittal
102 Gleneida Avenue
Carmel, New York 10512 _ - Date:.....
Fax: 914 - 225 -2955
To: bl L t-
ckV.
WE ARE SENDING YOU -,& Attached
the following items:
RE: -T . g- ftymPts Pwd/e
. �iTkTr-'S -I, Qt + I
Under separate cover via MOD ML.
Shop drawings _ Prints _ Plans _ Samples _ Specifications
_ Copy of letter — Change order _
Copies Date No. Description #
`i
It (9 -7 'c5 -1 AS- W l Vr 5-15-D. 5.
200.00 MVNP- � ORpE('
3(z�9b_ G.UAR/��1Tt✓E
REpvK,-r-
-- 2I26�gpj - WA-TM shm rye -iw,,T t e6ot,-rs
C94zt. °f- CoNiTILVoTlalJ c•Mr(W WC-F-
THESE ARE .TRANSMITTED as checked below:
X For approval _ Approved as submitted — Resubmit _ copies for approval
_ For your use _ Approved as noted _ Submit _ copies for distribution
As requested _ Returned for corrections Return _ corrected prints
For review and comment _ Other
FOR BIDS DUE , 19_ _ PRINTS RETURNED AFTER LOAN TO US
REMARKS:
COPY TO: tWvr- Lytdw1 SIGNED:.
If enclosures are not as noted, kindly notify us at once.
YML ENVIRONMENTAL SERVICES.
w - -- -- - .-- -321keti� Street.. -
Y��t E t awn H i gh_ts 4 LV Y l 598
Y±;m .. �.. � _....— .,.�- a. r � . .• .-. � ,Z � sr��•v� ..vs ' •o•w� R i� e»'. � 3'�,' N <aw t" '`<
cam, ; o�•v- .� � wv.,.� s, +e .:r `:. :✓is'::p -r g,, C� f+�F'.) L�F.1 =��i 1f %
Albert H' ; F'ad;ivani <', Director'
LAB. ; ## 32..801061.. CLIENT* - #k 8599 NON' STAT' , F ROC
xM N.vNN NN 'NNNNNNN'N N.v N'N NNA.•NAi N,N N'NNNN.NN Nti•N NN IV /VNN N iY'NNtvN xNNr(Nx JYNNfVNNN
ST THOMAS 'ASSOC /STEV. DATE lT I ME-. TAF :EN . 02,/20 r 98 -07.tl 00itA
21 PE EF SF:: I LL . HOLLOW RD e DATE /T3 ME REC ' D U2 /2� /98: '.09 : QOA
F'UTNAM .VALLE`!, NY 10579 REPORT `DATEo .' ta212Er /S?8:
`
PH ONE (9.1' - 528. 5448. .
AMF'L LNG S I TE e' LOT #9.; GARDWEER : RD . _ _ SAMF LE TYRE POTABLE'
e: ST, THOMAS'.EGTATES', PUTNAM VALLEY F` ESE:FVAT;IVES: NAIVE
COL1D. "BY. STEVE LEAFiD I' . TEMPERATURE
iV[)TES :' e.. F::I'TCHEN .TAP .. COL T FOFM '1`iETH MF
N,AfNN NNNNN'NNN.N NN
-- ----------- NNN NMNN NNAINNMNNIV ivMNNNNN NNIV N.'IVNNNNN' NNNN
DATE , FLAG F FOCEDURE .RES'LJ,LT NORMAL RANGE
F'UTNAM CNTY PROF I-LE '
.. tl2 (2i 7 -/98 MF T .: COLJ FORM ABSENT ' / 1 c50 ML ', :ABSENT
c 2/20/98 :. LEAD.::'(IMS) :; <1 b,: ci 1� .ppb 12345
pP
t x2./20 f98 NITRATE, N I TROD , 0-.20. MG./L, 0. .10 9.1,,,39
02./20:/98 /98 N.JTk ITE N I TROD ,' . ::.: c :y . tj 1 MG /L. N,/A: 9,146 ' ..
0:2 %2.:0./98. , IRON . (Fe ).' , tj , ty6 � MG /L 0-0.3 mg t`l 2637-
_ i2 /.Zc y /98 MANGANESE (Mn). 't1, -084. MG.-,/L �� c . 3 mg`/ l La037 ' ' -
.02/20/98 SODIUM. (Na'? 2.3 HG'/L'. N/A
02/20/9,8 PH 6.8 UN ITS 6.5 =8:..5 ?043
02 - /26/98` HARDNESS., TOTAL 108. MG /L N/
62'120 /98 ALKALINITY. (AS, 13� � MG /L N/A:_
02/20/98 TURBIDITY (TUR 1. ,NTU ;_C� � NTII': -
COMMENTS,` "
EfACT THEE•.. RESULTS I;ND I CATE_ THAT THE WATER WAS) {,WAS » NOT) OF-: A
SATI.SFAC.TORY.SANI'TAFY QUALITY.ACCORDIN; THE ':NEW YORK, STATP
AND: EPA. FEDERAL: DRINKING WATER.'STA.ND4R65' FOR' THE-1. F °AFAMETERS
TESTED, AT THE TIME OF COLLECTION..'
'b /Cu ,LEAD limits•'`f6r public schools.are .set at 15 ppbe
EPA Lead- Copper Rile f6 Public Systems requ res that no mere.
than .1014 bf their distribution points have a LEAD,-value 'of more
than 15 ppb and a COPPER value of 1..3 mg /L,..' else water :
treatment` mast be undertaken. to reduce the waters' .:corr -osi; e .
entia'l
Fe /Mn.If both iron ..and* manganese are present, -their total value
...combined shall hot exceed 0.5 mg /La
Na No l mit•s .for ,tedium are proscribed. 'Suggested. guidelines - 'state
that jor people,,pn a sodium restricted .diet, the water. should
Conta'dn ',n.d., moi e than::2�t_ mg' /L -.6f :Sodium.°' ..For 'these Ln"a
moderately' yeti - zt sd. diet. a max imum of : 270 mg /L of . Sodii.tm .
IS S.Uggest•ed
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS
REVIEW SHEE T F OR CON STRUCTIO N PF RMIT _
�
c h.. :i h ".,;jv5ia :,y'j �t �"` ^» •'�d�r Sm:e + c +.: rl : -a" . �,. .. L.; 9. .t -ei . .:_ .K:^,ja,,',:1e'P'S a'.t :x`��;.. .: .a .r».: 'L t- rs7.
STREET LOCATION _ ®r / �� `°'� �" NAME OF OWNER �O Q' 'e- a/ _
REVIEWED BY ..'� DATE 5
�` � � ./� TAX MAP # w�
DOCUMENTS Y N
PC -1
T APPLICATION
PERMIT., PWS LETTER
* OF AUTHORIZATION
N DATA,SHEET (DD$ - -
IS - THREE SETS
>E PLANS - TWO SETS
SUBDIVISIOIN
G-AL SUBDMSION
BDIVISION - APPROVAL CHECKED
PC RATE "-Sq
.L REQUIRED EPTH
RTAIN DRAIN REQUIRED TANDPIPES
GENERAL
CATED IN NYC WATERSHED
6DIS-SUBMITTED TO DEP
PCONTROL:HOUSE,WELL, SSDS
EEP HOLES LOCATED
TATIVE OF PRIMARY & EXPANSION
N MAP
7-215;. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE
.r ED, PIT & D BOX SHOWN & DETAILED .
OUSE - NO.OF BEDROOMS
& SSDS'S W/IN 200' OF P OPOSED SYS. '
IPRgZB..RTY METES & BOUNDS
SETBACK NECESSARY (TIGHT LOT)
H EWER - 1/4" FT. 4 "0; TYPE PIPE
NO BENDS; MAX.BENDS 45' W /CLEANOUT
FILL SYSTEMS
-LAY B ER
10- FT. ONTAL;SLOPE 3:1 TO GRADE
FI 'ECS FILL NOTES
ILL CERTIFICATION NOTE
DEPTH GUAGES
FILL PROFILE & DIMENSIONS
LEGATED TO PCHD FILL M EXPANSION AREA
r,7 PROVAL, IF REQ'D ✓C, �+�� TRENCZ
ERZEST HOLES OBSERVED ' F CH PROV ID ED 3°60 FT MAX.
Rj S,,W.t `NESSE D, F.RFQ'*D .... !: P -EL 0,C,0NT01JIIs'
- APPROVAL SSDS ADJ. LOTS 00% EXPANSION PROVIDED
.,TLANDS (TOWN/DEC PERMIT REQ'D ?)
.TA ON DDS PLANS & PERMIT SAME
E 1969 NEIGHBOR NOTIFICATION
ITER BUZBA
I YR. FLOOD ELEVATION
HER REQ'D PERMITS)
SYSTEM PLAN - (NORTH ARROW)
DRAULIC PROFILE_ GRAVITY FLOW
:UCTION NOTES
DATA: PERC & DEEP RESULTS
)URS EXISTING & PROPOSED
•AY & SLOPES, CUT
3/GUTTER/CURTAIN DRAINS
COMMENTS:
ON PLAN - FROM SSTS.
P.L.; DRIVEWAY; LARGE TREES, TOP OF FILL
TO FOUNDATION WALLS _15'WELL TO PL
0 WELL, 200' IN DLOD, 150' PITS
0 STREAM WATERCOURSE LAKE (inc. expan)
50' TO. CATCH BASIN, 35' STORMDRAIN, PIPED WATER
10' TO WATER LINE (pits -20')
INTERMITTENT DRAINAGE COURSE
00'/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS
5'min to CDS= >5 0/o,10'- 4 0/o,25'- 3 0/o,30'- 2 0/o,35' -1 0/o,100' - <1%
20' min t CD discharge /100'with 182 cons day discharge
SEPTIC TANK
10' FROM FOUNDATION; 50' TO WELL
FORM ST-2
P
PUTNAM ENGINEERING, PLLC
'102 Gleneida Avenue
Carinel, New York 10512
914-215-3069-
To: P;?( 2? Mov&us FF-
P - <-_ - H
Letter of Transom i
Date: -71011-7 -
RE
WE ARE SENDING YOU Attached Under separate cover via
the following items:
— Shop drawings L.Prints — Plans
— Copy of letter — Change order
ranies Date No-
Samples Specifications
Descrintion #
ARE M as checked belo
TME JR
ANSM=
— For approval — Approved as submitted — Resubmit — copies for approval
— For your use — . Approved as noted — Submit copies for distribution
— As requested — Returned for corrections — Return corrected prints
X For review and comment — Other
FOR BIDS DUE PRINTS RETURNED AFTER LOAN TO US
REMARKS:
COPY TO
SIGNED: 4f if-A
If enclosures are not as noted, kindly notify us at once.
-711 1'T?
Cotj51V_u<wt,) PoWIT OaLL, P k--_V_MCT
711 -1 *7
Aun-mz& rtaJ
ARE M as checked belo
TME JR
ANSM=
— For approval — Approved as submitted — Resubmit — copies for approval
— For your use — . Approved as noted — Submit copies for distribution
— As requested — Returned for corrections — Return corrected prints
X For review and comment — Other
FOR BIDS DUE PRINTS RETURNED AFTER LOAN TO US
REMARKS:
COPY TO
SIGNED: 4f if-A
If enclosures are not as noted, kindly notify us at once.
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTK-.SERXICES.
Date st-h-IL-.1 I , 129-7
Re: Property of �7e:-VIFE L- r--4 9-L) I
Located at
Section 55-0:j.Block Lot &-7
Subdivision of Tj-k;-HA.S
Subdv. Lot T Filed Map it 2462 Da . te 5117/90
Gentlemen:
This letter is to authorize
a duly licensed professional'engineer aie or registered architect
(Indic
to apply for a Construction Permit for a separate sewage system, to
serve the above noted property in accordance with the standa rds..,-rule-s
or regulations as promulagated by the Commissioner of the Putnam County
Department of Health, and to sign all necessary papers on my behalf in
wi
connectioxi -th--this -.-mat- te
system or systems in conformity with the provisions of Article 145 or
t i o,0�1'
147, Educa F�W pu is Health Law, and the Putnam County Sani-
tary Code.
f�
Very truly your
O
744 Signed
Countersigned. pSa1 Owner of Property
44& la MIL -LSr�- RD.
P.E., R.A., 0& -7 - Address
102 C-Lt-:Na1DA A\/e
Address
L N y o S 112-
Telephone
(QXT J4AA, \/ALLZ
Town I
Telephone
PUTNAM OXWY DEPAiR'Il+ENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN,DATA.;5HE CIF: -SENAGE,DISPOSAL SYSTEM-
Ow e r Address..
w
Located at (Street) Sec.. �' Block lob Lot
(indicate nearest cross street) •. I
Municipality 1q17A.0'N-
✓,citts� CTS
Watershed
ydasaJi2
'SOIL PERCOLATION TEST DATA °REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Date of Pre - Soaking 7/z9/ -
Date 'of Percolation Test
7/30
HOLE
N( ,DM CTACiC TIME
PERCOLATION
PERCOLATION
Run, Elapse
Depth to Water Fran
Water Level
No. Time
Ground
Surface
In Inches
Soil Rate
Start -Stop Min.
Start
Stop.
Drop In
Min /In. Drop
Inches
Inches
Inches
�r .1 ;y
3c
Z/
23 /l2
3 2J2r 30
2l
93
3T a. v
30 r, 3 2 -7,6'07 ,o Z 2s� 3 v
4
:,..1
5 l
l yZ 2°� Z� �/ 3 . 9 0
3v" 2 93
3
F11
5
NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates
are obtained at each percolation test hole. All data to be submitted
for review.,
2. Depth measurements to be made from top of hole.
rev. 9/85
PC -:
F UTNAM C O.UNT.Y D E PARTMEN T O F HEAL TH
APPI:ICATIOrJ FOR* APR(1VAL" OF FLANS FOR A WASTEWATER DISPOSAL _SYSTEM'
1. Name .and Address of Applicant: STE/'>✓
2. Name, of Project: 5T.1WMAS PL-,ACC- 6�- WT 9 3. Location T /V /C: c.F'T►JAM
4. Project Engineer: PUTN'A" i✓nt61WsJs nom, 5. Address: 102 QLQJM(01 1-%A—
Gartr�lt< -L. NY fo5t2
License Number: do -7 44 (e Phone:. 2-'Z-'S
6 . Type of Project
CX Private /Residential Food Service Commercial
Apartments Institutional Mobile Home Park
Office Building Realty Subdivision Other (specify)
7. Is this project subject to 'State Environmental Quality Review (SEAR)?
Type Status (Check One) Type I.. Exempt
Type II. Unlisted X
3: Is a-- Draft Environmental Impact -Statement (DEIS) required? .............
�. Has DEIS been completed and found acceptable by Lead Agency? N/A
is Name of Lead Agency N/b.
Is-thi rjoect in an area under the control of local planning, Zoning,
?..tQ
or other officials, ordinances ......... ...............................
.'If so, have plans been submitted to such authorities? ..................
N/iS
• Has preliminary approval been granted by such authorities? Date Granted:
• Type of Sewage Disposal System Discharge...... Surface Water _Ground Waters
If surface water discharge, what is the stream class designation ?........
Watersindex.number (surface) ........... ............................... i�lA
Is project located near a public water supply system? .................. NO
If yes, name of water supply Distance to water supply I•MIu
Is project site near a public-sewage collection or disposal system ?.....
�tvEi(L h+a..J
Name of sewage system I'6' Distance to sewage system 1. McU�-
Date observed: 23, Name of Health Inspector:
Project design flow (gallon.s per day) ....... . ........ ....................... Soo
2.
25. Is State Pollutant Discharge.Elimination System (SPDES) Permit required ?.. IJ2�
26. Has 513 E5 Application °been' submitted to local DEC 0`ice?
... ..
27. Is any portion of this project located w- ithin-a designated Town or State
wetland ?............... ..............•... ...... ...............
28. Wetland ID Number ..........:...:.... ... N
.....
29. Is Wetland Permit required? ........`...... . ..:.......................O
Has application - been made to Town or Local DEC Office? ..................... ly
30. Does project require a DEC Stream Disturbance'Permi`t? ................... (�i0
31. Is -or was project site used for agricultural activity invol.vi;ng.appl;ication
of pesticides to orchards or other crops, solid or hazardous waste disposal,.
landfilling, sludge application or industrial' activity? ........ YES or NO N�
32. Is project located within 1,.000 feet of existence of abandoned landfill,
hazardous waste site, salt stockpile, landfill, sludge disposal site or
any other potential known source of contamination? ..............YES or NO iJ D
DESCRIBE:
33. Is there a local master plan or file with the Town or Village?
34. Are community water, sewer facilities planned to be developed within 15 years?
35.:= -any- sewage d-i- sposa- l•Pa�-eas ifl- ,ez.pes�. of,.. 1.5� sJ�!pe/._ ..- - _ _ _.., _
36. Tax Map ID Number ........... ............................... is.-I -(e% ~.
37. Approved Plans are to be returned to: ................ Applicant X_ Engineer
If the application is signed by a person other than the applicant shown in Item 1, the
application must be accompanied by a Letter.of Authorization. Failure to comply with this
provision may grounds for the rejection of any submission.
I hereby affirm, under penalty of perjury, that information provided on this
form,is true to the best of my knowledge and belief. False statements made
herein are punishable as a C l ass A Wsdemeanor pursdant to Sect io 10.4 of
the Penal Law.
SIGNATURES A OFFICIAL TITLES: i1
� r
MAILING ADDRESS:
..1
u
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF 'ENVIRONMENTAL HEALTH SERVICES,,
INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION =FORM
SECTION•A" GENERAL, INFORMATION
1Vame of Project 571? i° -e rr (T)(V) County ~
Site Location e!�' Q f-< Oet
F
Building construction begun :` Extent1 -�/'
Is property within NYC Watershed? ................
SECTION B. TOPOGRAPHY (Please check all appropriate bones)
1. . 0 Hilly , �2 lling Steep slope 0 Gentle slope 'Flat
2. Evidence of wetlands
_ Low_area subject to flooding Bodies of water '
Fl Drainage ditches a Rock outcrops
3.- Property lines or-corners evident ............................................................ . Yes , a No`
-
4. Do water courses exist on or adjoin the property ? ............. Yes', ' No
5. Will these affect.the_desi ?:..::....... - Yes � No
_ gn- design sewage system facilities.
6. Do watershed regulations apply in this development ? ......... ::............ t. Yes No
7 Will - extensive grading be necessary ?..: :....:.. ::..:..:.::.. Yes l
NO
0 I
° :$:..:Wall - extensive .fli. 'be r�ecessary�for S '� .... :Yeg. - i. "_�•a , .
9. Do filled areas exist within the SSTS area? .....:... ............................... 0 Yes No
If yes, what is the condition of the fill?
SECTION C. SOIL OBSERVATIONS/"
10. Appearance of soiland Gravel Loam Clay 0 Hardpan , _ e
11. Observed from: ED Borings Bank cut F Backhoe excavations
12. Soil. borings/excavations observed by S 4aCl- on t Fw �
13. Depth to groundwater -on .
14. Depthsto mottling on
15. Are test holes representative of prim reserve areas ...... .............:::............... =Yes 0 No
16. Soil percolation tests made by ..r. _. ��__...... _on . _._... -... .
17. Soil percolation tests witnessed by on
SECTION D (on back)
Form ST -1
. 3
SECit`ION D. DRAINAGE. ,
18. Will proposed`grading materially alterthe natural drainage in thus or adjacent areas? F Yes to
19. Will groundwater or.surface drainage require special considerat •ion? :::.: L... ,:.. Ye��ie
20. Will _gullies' ditches, etc., be filled and watercourses be relocated ? ......................... Yes. E]--No
SECTION E. REMARKS
21. If a comirion water supply is proposed, has an inspection been made of the
existing or proposed source and facilrties� ..... �a ?.. . � Yes No.
Inspection data. -- `
22. Do adjacent, wells and/or sewage;systems exist ?....:::... r®
......�...... Yes No
23. Additional comments
24. Site observet- 4spector: and..title
25. Date(s) of observation(s)irispection(s)
_ TEST_PIT PROFILES 7`- 0/��:._ : q%• x , _.. i
Hole # Lot # Hole # Lot # Hole # Lot:# .
Depth to water Depth to water Depth to water
Depth to mottling tomottling _ _ _Depth tq mottling
.. - f
Depth to roc limp.- Depth to rock/imp. Depth to rock/imp. j
G.L. G.L. G.L I
0.5 0.5
1.0 ` 1.0
3.0
4.0
5.0
6.0
7.0
8.0
.N
8.0
9.0
8.0
9.ff ,
10.0 10.0 10.0
l44. 0
5.0
5.0
6.0 .
. 6.0
7.0
8.0
9.0
8.0
9.ff ,
10.0 10.0 10.0
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOI1S.':EN00L—TN-M—EPMIN TEST HOLES
DEPTH HOLE NO. LyT 9 HOLE NO.
HOLE NO.
G.. L..
Aeov clopfAo al 00 Aejvl✓w
21 TO fib S.nel4r
3'
4'
50 solvx C"'4 F -rf4 caj AT
61 S;r&-4r-r
71
8'
91
10,
-----------
12'
----------------
141
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
.-'iN-D'I-CATE LEVEL It WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY:-- ('4/d/3a
DATE:
/� DESIGN
Soil Rate Used Min/11' Drop: S.D. Usable Area Provided
No. of Bedroorns Z/
Septic Tank I Capacity 1400 gals. Type
Absorption Area Provided By 5'00 L.F. x 241- width trench
Other Of N EV,,
Name
Address nt. 22 & Hri-&�orabb;!-p Rd.
Croton Falls., N.Y. 10519
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved sq.ft/gal.
SEAL
Checked by Date
TITLE NO.s
TOWN TAX YAP DATA1
Section 85.03, Block I, Let 67 '
�lt� N/F GUGLIELMETTE and DeSISTO _ _� __ - � _
OPEN SPACE PARCEL —LOT 11 ,—
-
"w.7 _ Tar. eriy
e
312.0Of TO 30 .. street -
Cu ve AtnBOn Filed
4 --N— Mat' r°o 2482.
PARCEL SHOWN HEREON KNOWN AS LOT No. 9
ON.SUBDIVISION MAP ENTITLED 'ST. THOMAS
PLACE ESTATES, FILED IN THE COUNTY CLERK'S
OFFICE ON AUG. 17, 1990 AS MAP No. 2482.
SUBJECT TO ELECTRIC AND /OR TELEPHONE CO.
EASEMENTS, IF ANT, FOR OVERHEAD AND /OR
UNDERGROUND SERVICE.
SURVEYED AS IN POSSESSION, (No Unes of Possession
Other Than Indicated).
SUBSTRUCTURES AND /OR THEIR ENCROACHMENTS
BELOW GRADE, IF ANY, NOT SHOWN.
HOUSE OFFSETS TAKEN TO SIDING OR TRIM.
PROPERTY CORNERS STAKED.
THIS SURVEY IS HEREBY CERTIFIED ONLY TO:
I. ST. THOMAS ASSOCIATES, LTD.
2.
3.
I HENRY CARPENTER & CO.
LAND SURVEYING & 'MAPPING
YORKTOWN HEIGHTS, N.Y.
we: J. "my Carp. to t Co. O. IMikr cwl", Thal on Ne.. 24. 1997
a S
urv.r e1 r- Pia, d Sho— Il.r.aa'Woo Me& and Thal Thf.. Mep
M Yad. m Aeeardo— Wft The "Od NP. of Sam Suety.
S65 "57 00 E
27.44'
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No.: 15336 -9. FILE: 15586/
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CERTIFICATIONS INDICATED HEREON SIGNIFY THIS SURVEY '
WAS PREPARED IN ACCORDANCE WITH THE EXISTING CODE
OF PRACTICE FOR LAND SURVEYS ADOPTED BY THE NEW
YORK STATE ASSOCIATION OF PROFESSIONAL LAND
SURVEYORS, SAID CERTIFICATIONS SHALL RUN ONLY TO
THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND
41
ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL
.ti
AGENCY AND LENDING INSTITUTION USTED'HEREON, AND TO
m
THE ASSIGNEES OF THE LENDING INSTITUTION, CERTIFICATIONS
ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR
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SUBSEQUENT OWNERS.
SURVEY OF PROPERTY
PREPARED FOR
a
ST. THOMAS ASSOCIATES, LTD.
LOCATED IN
�®
A
TOWN OF PUTNAM VALLEY
51
PUTNAM COUNTY, N.Y.
An Co ln.e6mM N.nen an VaNd far ThM May and Th.r.of
T1r. k^P^"..d 5.01 0/ iM SWVaror
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Woro". of Thl. Mop On— Th- by a LM.n..d lend' Sm..f.r h 10.9at.
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�hI.SCALE:
•Dy-
1"= 50' ATEada: 1. DEC. 4. 1997
No.: 15336 -9. FILE: 15586/
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PUTNAM COUNTY DEPARTMENT OF HEALTH
r DIVISION. OF .ENYIg(QNIVIENT +HEALTH SERVICES
� _ i �� -.-k_ c ter. r'4rC m1.•�C� - 4. -- -
Cc ICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM
PCHD CO STRUCTION PERMIT #
Located at 6A-o I N e�K 20 0 Town or Village IP'UTM A- VA L,
Owner /Applicant Name 5TF'V'1= L EA&D 1 Tax Map 8S, 05 Block �_ Lot
Formerly Subdivision Name 'ST,, TI' QM ArS PL ACE S"r•
Subd. Lot #
Mailing Address f-0- P�DX Q'M EUTNArM 014 9L\L N1 Zip
Date Construction Permit Issued by PCHD S
• 21 P�EKsKl�1. >•�Cx,��+J i�
Separate Sewerage System built by ST. THoKAS A555oc,.. (,TV Address MAm VAuaL 4 UX 105119
Consisting of 1250 Gallon Septic Tank and 1*00 t I l=, or 210 W 1 DE
��on;pTJ Of\I TIz�NGH
Other Requirements:
Watir Supgby: Public Supply From Address
15z I�ARve�L �t
or• C Private Supply Drilled by NoRMANI AtJOF LS000 1 N1G Address NT MA VA-1, EL%% N y
_ ..13ting ``�'�r~�..``. °�
Number of Bedrooms 'Of Has garbage grinder been installed? N
I cerify that the system(s), as listed, serving the above premises were constructed a Bally shown on the as-
builtplans (copies of which are attached), in accordance with the ' u action Pe it and approved
plan and the standards, rules and regulations of the Putnam County p He
Date is M*CJ+_K& Certified by PMY L j1A LYOCH P.E. _X R.A.
(Design Professional)
Adctss Awl & 1W& V,, License # 6&'7444
162 CA'V -TJ e1 b/1 AVE, cNimet, N1 10,912-
An- yerson occupying premises served by the above system(s) shall promptly take such action as may be necessary
to sauce the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage
treanent system shall become null and void as soon as a public sanitary sewer becomes available and the approval
of -6 private water supply shall become null and void when a public water supply becomes available. Such
appevals are subject to modification or change when, in the judgment of the Public Health Director, such
revQation, modification or change is necessary.
323 `�9
Title:
Date:
W1hi copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CC -97
C.
WELL,. COMPLETION ,REPORT
Office Use Onlyi' • ;
y :.e DEPARTMENT OF.. HEALTH
Division Of.- Eiavir n.rhental.Health- Services
PUTNAM. COUNTY :'•DEPARTMENT OF HEALTH
STREE OUAESS WNJ Cl d. 7 9 TAX GRlO NUMBER:'
WELL LOCATION
.r r
E. m AODRE
WELL OWNER PBiVATE-
- , 'O .PUBLIC..
1 ' USE. OF WELL RESIDENTIAL O PUBLIC SUPPLY O: AIR /COND.I.HEAT PUMP 0; `ABANDONED
1 primary BUSINESS I] FARM �;', O TEST /OBSERVATION O,:OTHER( specify)
2 - secondary p INDUSTRIAL O INSTITUTIONAL TAN0 BY p
MOUNT OF USE YIELD SOUGHT S� gpm. /.NO PEOPLE SERVED % EST. OF DAILY USAGE
g..
REASON FOR 9; NEW SUPPLY O PROVIDE ADDITIONAL ;SUPPLY D TEST /OBSERVATION
OR }LLFNG D REPLACE EXISTING SUPPLY - O DEEPEN: EXISnN.G_WELL; .
DEPTH DATA ,►o :.?. .
WELL DEPTH 3D0 „ ft STATIC WATER LEVEL ft. DATE MEASURED
DRILLING g ROTARY , 0' COMPRESSED AIR PERCUSSION ❑DUG
EQUIPMENT 0 WELL POINT '0 CABLE PERCUSSION ❑ OTHER. (specify);
WELL TYPE O SCREENED O OPEN END CASING: ® OPEN HOLE IN. BEDROCK` . O OTHER
TOTAL LENGTH fit. MATERIALS: ,:STEEL, O PLASTIC O,OTHEA
CASING LENGTW.BELOWGRADE .2-1 y. JOINTS: :.O.WEL•DED 9THREADED OOTHER:
_...._....DETAILS -._:.. - -- - - - - - --
O.IAMETER in. SEAL •2,CEMENT GROUT O BENTONITE -` OOTHER '
WEIGHT PEA.FOOT 16.7ft.: URIVESHOE�fYES NO LINEA:O�YES;6�t�10
>.
DIAMETER (in) SLOT SIZE LENGTH (1t) DEPTH To-SCREEN,(iq DEVELOPED?
SCREEN.
QTAILS FIRST
HOURS-
GRAVEL PACK o YES GagvEL DIAMETER pop Bo7roM
0 NO SIZE OF PACK in DEPTH. , DEPTH it fL
WELL YIELD TEST ''If. detailed. um in
It avalab elealease attachdescriptians or sieve; analyses .
M 00: ❑ PUMPED 1 tests.were done is n�� L�'G P
DEPTH 'FROM Water well
MPRESSED AIR fOffndtl0n Stt2Chl:d? SURFACE g��- Oia- FORMATION DESCRIPnON CODE,
O BAILED I7 OTHER ; O YES ONO . tt- 1L ing' . meter
WELL DEPTH DURATION ORAWOOWN YIELD Surface I3
IL hr. min. It.. 9Cm-
7 10
. 3f 6
f
t
�r
WATER CLEAR TEMP.
QUALITY O`.CL000Y. HARDNESS
O COLORED AN/1CYZE0r , . b YES ONO,
_.
ANALYSIS.ATTACHED?.,O,YES.NO . STORAGE .TANK: TYPE
PU MP. INF RMATk0N Cam• CAPACITY GAL.
TYPES CAPACITY `� WELLbRIILER NAME OA
7
MAKER 1A DEPTH Ado Y � SlGfrkTURE %j
I3 VOLTAGE_ HP
J
PUTNAM COUNTY DEPARTMENT OF HEALTH.
DIVISION OF. ENVIRONMENTAL HEALTH SERVICES
OF SUBSURFACE SEWAGE TREATMENT SYSTEM
05,05 7
6+ 7kbM05 Lod ?dr-S ( oT
Owner or Purchaser of Building Tax Ma p Block Lot
t/-)' FaTNAM
Building Constructed by TownNillage
Location - Street Subdivision Name
Building Type S division 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---w.hich-- fails to --operate for a- period -bf tft__Y6ars
immediately following the date of approval of the "Certificate of Construction Compliance" for the
sewage treatment systern, 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 Day � Year
General Contractor (Owner) - Signature
ST Jh=X-2LS
Corporation Name (if corporation)
Address:
State -rwy &&�i v'vv" izip 1 675
Signature:
Title: (Z)E-%3 �i
64 ThomA5 & o-L i s . LTA
Corporation Name (if corporation)
Address: 91 PPi_-iCSIC1LL Pm loo wkb
State U"wt 11Zip . 106
Form GS-97
FLA�
AS-5U ILT tvlEAS'Uf;RFD-lENTS (IN FEET)
REV ISION5
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