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BOX 1
00014
Rev. 3/ 6 / PUTNAM COUNTY�DEPARTMENT OF HEALTH
Division of EnvironmentalrHealth Services, Carmel, N Y.,10512
it- vl
Engineer Mast Pro de 87
0�+ - P.C.H D `Permit q 7,77, — —
CERTIFICATE 0 •CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL;SYSTEM
Town or Vlllage Q
Located at M a Y10Y :tc O a,J f K i n g S way Tax. Map I Block Lot /
Falryrew► l�
Owner /applicant Name I'OM 2' 2 . Assoc. Formerly Sabdigision Name
manor Sabdv Lot '#
Malllng Address, R ®. Box Z S S Zlp_ 105794- Date Permit Issued I
y%3o /�7
YLt orn W Oct , ICI Y
' E.1 Address o a c Al
Separate Sewerage System built by e k 0. ib
- Consisting of 1 Z S'C� Gallon Septle Tank and g _� O L F k Z4= i e Jci5
Water Supply: Public Supply. From `•. +_ ;, Address
or: X Private Supply Drilled by
To r I S Address A r i* -o," k J Al Y,
Ballding Type S �! I / Fd Has Erosion Control Been Completed?
Nnmber'of Bedrooms: Has Garbage: Grinder Been Installed?
.Other R09.
. airementa 2 E, 11 C Y
y
. i certify—, that the s etem(s) as listed s'erving,the, above premises were eonstruetedesaeptially as shown on the plans of the - completed .wor)c( copies
of wliigh are .attached),.and in accordance with the standards, rules and regulafiona, in accordance with :the..filed plan, and the permit issued by the
Putnam Couht Depar en Health.
Date Certified by P.E. R.A. 17 7
Address g Zi...�' , leeese No
Any person occupying,. premises served by fhe,abovesystem s shall promptly fake such actionss may De necessary to secure the correction of.any unsanitary
�)
conditions resulting from such usago 'A' pproval ,of the separate „sewerage, system, shall become null and void as soon as a pubv. sanitary sawsr becomes
available and the.appioval,.of the private water suDD)Y shat(Decome null and 4 i when a public water supply becomes available. Such approvals are
subject to modification or khange when, iri "the judgment of the Commissionef of Health; su revocation, modification or change is n %ecessary�
Data S.
.���� Title
WLLL VvrirLLiivV Zzrvat
fL .e DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
WELL LOCATION
STREET ADDRESS: wNly I Y TAX GRID NUMOM-
,� < ✓y �,,, /,,,�
WELL OWNER
N E: I ADDRESS:
f ✓,
O PUBLICS
USE OF WELL
1- primary
2 - secondary
'®.RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT e— gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
'S NEW SUPPLY ❑ PROVIDE ADDITIONAL'SUPPLY O TEST /OBSERVATION
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
.DEPTH DATA
yyELL DEPTH -�� ft.
[STATIC WATER LEVEL ��! ft.
DATE MEASURED
DRILLING
EQUIPMENT
❑ ROTARY _'.COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION 0 OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING. �'O.OP EN HOLE IN BEDROCK ❑OTHER
CASING
DETAILS
TOTAL LENGTH' ft.
MATERIALS: 5 -STEEL O PLASTIC 0 OTHER
LENGTH.BELOW GRADE -� '" ft.
JOINTS. 0 WELDED )6 THREADED ❑ OTHER
DIAMETER in.
SEAL: ❑ CEMENT GROUT ❑ BENTONITMOTHER
WEIGHT PER FOOT Ib. /ft. -
DRIVE SHOE 0 YES VINO UNER: 0 YES ❑ NO
SCREEN
DETAILS
DIAMETER (in)
SLOT SIZE
LENGTH
(It)
DEPTH TO SCREEN (it)
DEVELOPED?
FIRST
o YES ONO
SECOND
HOURS
GRAVEL PACK
O YES
O NO
GRAVEL
SIZE:
DIAMETER
OF PACK in.
TOP
DEPTH iL
BOTTOM
DEPTH It.
WELL YIELD TEST It detailed um in
P P 9
METHOD: O PUMPED ; tests were done is in-
`&COMPRESSED AIR , formation attached?
O BAILED O OTHER O YES ❑ NO
UI�LL LGG if more detailed formation descriptions or sieve-analyses
are available. please attach.
DEPTH FROM
SURFACE
Water
Bear-
Icy
WC11
013-
Ineter
FORMATION DESCRIPTION
CODE,
tt,
tt.
WELL DEPTH
It.
DURATION
hr. min.
DRAWOOWN
It.
YIELD
gCm.
Land Surface Surface
WATEA�CLEAR TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? O YES ONO
ANALYSIS ATTACHED ?'WES O NO
STORAGE TANK: TYPE1jQ0 JM6 L-
CAPACITYkAtt4 11T'4L .2,46 GAL. 1-
PUMP INFORMATION
TYPE � A CAPACITY
MAKER Q ><9 la_ DEPTH '
MODEL 5t � 51 VOLTAGt S Hp
WELL DRILLER VAME
A�U ESS O D 5 RE
Yorktown Medical Laboratory, Inc.
321 Kear Street
Yorktown Heights; N. Y. 10598
(914) 245.3203
Director: Albert H. Padovani M. T. (ASCP)
F
TORLISH WELL DRILLING
PO Box 271.
Armonk, NY
10504
L
PEI
LABORATORY REPORT ON THE QUALITY OF WATER
LAB 11
_��� 3v
Date Taken: Time: �%
Date Rc.'d: —a Tim-e
Date Reported:,(- „2.�'-%
Collected By: Duane Torlish
Referred By:
ample Location:
,' h1
i XS
Phone H 273-3448
Phone N — i Sample Type:
Reheat Test ?. (check one)
INORGANIC NON - METALS (mg /L) MICROBIOLOGICAL (CFU /100mL)
Acidity
Alkalinity
Chloride
Detergents, MBAS
Hardness, Total
_ Nitrogen, Ar.'-onia
Nitrogen, Ni.rate
-Phosphate; Teal
Sulfate
_ Sulfide
Sulfite
METALS (mg /L)
Copper _
_ Iron
_ Lead
Manganese
Mercury
_ Sodium
Zinc
MISCELLANEOUS
pH (units)
_ Color (units)
_ Odor (TON)
Turbidity'(NTU)-
GENERAL BACTERIA
_✓Standard Plate Count `J
(CFU /1.OmL)
MEMBRANE FILTRATION TECHNIQUE
Total Coliform
Fecal Coliform
Fecal Streptococcus
MOST PROBABLE - NUMBER TECHNIQUE
Total Coliform Index
Fecal Coliform Index
KEY FOR TERMINOLOGY
N/A = Not Applicable
LT = Less Than (< )
GT = Greater Than ( >) -
TNTC= Too Numerous To Count
CON = Confluent ( =TNTC)
NR = Non- reactive
REMARKS /COMMENTS (For Lab Use)
+/Potable
_ Non- notable
_ STP IMF
_ STP EFF
Other:
Sample .Status:
(check each)
Outgoing
H "1103
HC1
H2SO4
NaOH
ZnOAc
— Na2S203
Other:
Incoming
_ LE h °C
SGT 4 °C
pH LE 2
pH GE 9
_ pH GE 12
Other.
THESE RESULTS INDICATE THAT THE WATER SAMPL (WAS) WASN'T) (N /A) OF A
SATISFACTORY SANITARY QUALITY ACCORDING TO T W YORK STATE DRINKING WATER
STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION.
THESE RESULTS INDICATE THAT, THE WATER SAMPLE (DID) (DIDN'T) .(N /A) MEET THE
SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STATE DRINKING WATER
CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION.
2 /8.6(Rvsd7 /87)RWE
)qLj%/f51 -T JSS0C, yi re wC
Owner., orLL urchaser of Building
Building Constructed by
Rat
Location - Street
f>iiTrtf'_IsOA__� A .
Municipality
5MAC -lF F -rlti•t i 1`i
Building Type
Section
Block /
Lot
Subdivision Name
Subdv. Lot #
GUARANTEE OF SEPARATE SEWAGE SYSTEM
I represent that I am wholly and completely responsible for the
location, workmanship, material, construction and drainage of the sewage
disposal system serving the above described property, and that it 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 success-
ors, 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 initial use of the sewage disposal
system, or any repairs made by me to such system, except where the failure
to operate properly is caused by the willful or negligent act of the occu-
pant of the building utilizing the system.
The undersigned further agrees to accept as conclusive the determin-
ation of the Director of the Division of Environmental Health Services
of the Putnam County Department of Health as to whether or not -the fail-
ure of the system to operate was caused by the willfuY)orl egligent act
of the occupant of the building utilizing the system / L \
Dated this y _ `� g ��—
�.. day of 19 � Si nature
i
Title
/ HEKLA CONSTRUCTION INC.
t Excavation • Trucking • Equipment Hauling
• Septic Systems Specialist
Top Soil • Fill • Gravel • Black Top
Buckshollow Rd. RFD 9 Box 474
- - - - - - - - - - - - - - - - - - - Mahopac, New York 10541 (914) 628.5738
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES 0 • RE
CERTIFICATE OF COMPLETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department of Health
PUTNAM COUNTY - DEPARTMENT OF HEALTH
Division of Environmental' Health Services Carmel, N:Y.10517 Engineer to vide P_ ermlt N
"Pro
I ,on CERTIFICATE OF COMPLIANCE
CONSTRU N PERMIT FOR,SEWAGE DISPOSAL ,SYSTEM Pernilt ..M / / I
Located at i�f�DhL KVA �% /\ .S �i�ll -Town or Village
1i11i
Subdivision Name lie V, �lQN� Sabd. Lot "A /:� Tax Map % 111'
lock ' Lot
Renewal p Reision p
Owner /Appicnt Name ;rA /JeV�� yf� ����0 K
Q Q Date of Previous A pproval '
MaWng Address /,�7. /1t°t o�i�tJ Town %I6'w%�(Iyo�r ���l 7jp' /O✓r�T_.
Bulldtn S/I G GMIL "�
Lot Area %£ 2QGk' :5
B Type Fill Secdon Only Depth Volume
Number 'of Bedrooms —!V. Design Flow G P "D 00.9 PCHD Notification is Required When FW is'completed '
lca? L.
Separate Sewerage'System to consist of 1691t Septic Tank an
To be
construe
To - Address .
Water SuPply. Public S,npply From Address
or: "Vale Supply Drilled by Is
Other Renufremente
. 1 represent that '1 am`wholly -and com6l6tely_.rosponsiblef6r thetlesignand location o the' proposed systemis); 1) that theseparate sewage disposal..system -
above' described will,be constructed, as shown on'the approvedarriendmerii "theie..to and iriaccordance with the standards, rules an regulations o -- e u nam _ -
County Department °oi_`Health, ;arid that`on completion thereof a 'Certrtwati_ ,o/ Construction Compliarice" satisfactory to the Corniriissionei of HealtAwill
be'•wbmitted : +,to' the. Department, and a;:written - guarantee' will .be' furnished'the owne'r,..his wccessors, heirs or assigns by the builder..'that said builder %Vill
place n,good. operaEing' :condition any, part of• said - sewage. 'tlispo'sel,.s'ystem.during, the period of two (2)•yors Immediately following thedatCof the iisw
ante of the : approval .of the Certificate `dC Coirstruct�on.'Compliance`af the'original system.or: any repairs thereto; 2) that the drilled woll.,described 4bove
W; Da'located'ss shown on the a
pproved Ian. and.ttiat said weltwJl be,nsial ed m accordance with the standards, rules and r,egu aaT'1'ons oof the Putnam .
� County�gDe part ment of,:Flealth '
Oate,��cs.,� - . "Synod t7� �fi/ . -P. �... R.A. —
Q C' Address .• :. •
37Ucense 9/
-.c
r APPROVED FOR CONSTRUCTION This approval ex ires,tw' years..f' :t "� date issued unless construction of the building has been undertaken and is
cevocablo 1or.cau3 'or may ti - mantled or: modified when co i_d e s y 'the Co 1 'o r "f Health. - Any change or" alteration "of .construction .
repuires a new , ' rmif. 'r ed for - disposal. of "domori' ni .iew o r or uppl Y•
Rev.
S1/87 Data .. Tit e By
i
i
'o .. . .
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 #
WELL LOCATION
Street Address
'
To Village City Tax Grid Number
,'V D, Ki � s vcir�
I r sCAJ
r A
WELL OWNER
Name
Mailing
Address !'n gex ,05
GlPrivate
' A)pP_
d
7' N D !J iU�
O Public
USE OF WELL
® RESIDENTIAL
O PUBLIC SUPPLY
Q AIR /COND /HEAT PUMP
D ABANDONED
1 - primary
O BUSINESS
D FARM
O TEST /OBSERVATION
O OTHER (specify
2 - secondary
® INDUSTRIAL
d INSTITUTIONAL O STAND -BY
AMOUNT OF USE
YIELD SOUGHT
t gpm /#
PEOPLE SERVED /EST. OF DAILY USAGE *0 9 al
REASON FOR
13NEW , SUPPLY
O PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION
DRILLING
OREPLACE EXISTING SUPPLY
ODEEPEN EXISTING WELL
DETAILED
"% :5
lAe M/L .
CE
REASON FOR
DRILLING
WELL TYPE
®DRILLED
DRIVEN
ODUG
®
GRAVEL
® OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
01,0VIO J M&AOR Lot No.
WATER WELL CONTRACTOR: Name fly I�IM /� Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES 5< NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST-WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
[]ON REAR OF THIS APPLICATION ®0 SEPARATE SJJEET
(date) O (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 permfit.
3. Submit a Well Co pletion Report on a form provi d t utna C u y
Health Departme t.
Date of Issue: 19�
Date of Expiration: 19 rmit Issuing Official/
Permit is Non - Transferrable
2/87
White copy: H. D. File
Yellow copy: Building Inspector
Pink Copy: Owner
Orange copy: Well Driller
r.
:.e
"r5
�x
: *t
r
pit • 2101 ►D Sul
• PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIROMENTAL HEALTH SERVICES
AFFIDAVIT- CORPORATE OWNER APPLICATION
FOR PERMIT APPLICATION SUBMIZ m TO PUTNAM OOUNTY=HEALTH DEPARTMENT
TO: Cammissioner of Health
In the matter of application for:
lid % / JA' 16 n"'- A [iE'�/�� wAj
I, Anthony J Ami ucci
represent that I am an officer or employee of the corporation and am authorized
to act for Fairview Manor Development Group, Inca
(Name of Corporation)
having offices at P.O. Box 185
Thornwood, New York 10594
Whose officers are:
President: Daniel A. Amicucci, P n Bau 18,5- ,— ThePnweed -,NY gr 4
(Name and address)
Vice - President: Anthony J Amicucni, P.O. Box 185, Thnrnteinnd, NY 10594
(Name and address)
Secretary:
(Name and address)
Treasurer:
(Name and address)
and that I am and_will be individually responsible for any and all acts of the
corporation with respect to the approval requested and all subs equ t acts
relating thereto.
Sworn to before me this day Signed
Of 19 Title:
BE FY L. ESPOSITO
Notary Public, State of New York-
No. 4526303
Qua!ified in Putnam County p
Commisslon Exp;rss April 30, 19.f,
Corporate Seal
20
-.211 :
• t ►` r 0 t 91• ' •rr 19! • :! • K I ► • t• • I� Y• :� `t9i• •19•.
i
rr ' J�
(Name of Owner)
■ v DID# • Y• M • • 91•
(Street Location)
DOCUMENTS
Permit Application
Corporate Resolution
Plans - Three sets
Engineers Authorization
Design Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results
Perc Hole Depth
' Y NATI 91•
BY:
House Pips - Two sets
Well permit; PWS letter
Variance Request
GENERAL -
L-ml Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Tcwn/DEC Permit R & D)
Data On DDS Plans & Perini' Same
REQUIRED DETAILS ON PLANS
Sewage System Plan - (north arrow)
s/s
SUBDIVISION
Perc _ -
(3) Fill Z-
cd
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 (grinder notes)
Design Data: perc and deep results
Two-Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footing/Cutter,Curtain Drains (discharge OK)
Perc & Deep Holes Located
Representative of primary and expansion
Expansion Area;shcwn;gravity flow,suff. size
If Pmped Pit & D Box Shown & Detailed
House - No. of Bedroans
Wells & SSDS's w /in 200 ft. of Proposed Systems
Property Metes & Bounds .
House Setback Necessary (Tight lot)
House Sewer - 1 /4" /ft. 4 "0; Type pipe
No Bends; Max. Bends 450 w /cleanout
SEPIARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees,Top of fill
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. e_xp n)
15' to Drains - Curtain, Leader, Footing
351to catch basin, stormdrain, piped watercourse
10' to Water Line (pits -201)
50' intermittent drainage course
_Septic Tanks
10' fran Foundation; 50' to well
15' Well to PL
LOCATION c
A -C
46.0
B -C
44.5
A -D
105.0
B -D
66.5
A -E
110.0
B -E
70.0
A -F
111.0
B -F
75.5
A -G
114.0
B -G
81.0
A -li
118.0
B -H
87.0
A -I
121.5
B -I
93.0
A -J
126.0
B -J
99.5
A -K
130.5
B -K
106.0
A -M
68.5
B -M
88.5
A -N
105.0
B -N
119.'0
A -P
179.0
B -P
128.0
A -Q
159.5
B -Q
96.0
R -W
49.0
5-W
qt.O
mi