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HomeMy WebLinkAbout0015DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 1 -1 -15 BOX 1 I ` F�6i . ' 00015 Sepni to Sewerage System built byRQ Me6 try- 7''Se�" Ad&.0 Con lstlng of ? d Gallon Septic Tank and CJ %� wipe-, AB (C i ENC� Water Supply: public Supply Flom Address nn ^ pt on — Private Supply Ddlied by Tb2.� '+ DNS Address.. �l�AL guffillngTM, �fP�.►1G > Lot.Size 1-&If Has Erosion rontrnl .Rua Number of Bedrooms Hass Garbage Grinder Been metalled! N �.. r l I eertiFy. that tha.eyatem(s).as listed serving the above premises were constructed ebaen ly a shown on th plans of the campAete4:6 9k— �ecooppies of which are attached_), and in aecordance' with the standards, rules and requlatio i co a with the led plan, and the'permi<idffU6d�y th Putnam County /.tie ment Health.. Date Certified by CpE, G") Address A G ZS l.lp0ee Any person occupying promises saved by the above systems) shall promptly take such action as may be necessary to segue the_oo►►edbn of any unsanitary conditions resulting from such usage. Approval of the separate aswaage system shall become null and void as won as a publ.: sanitary saw becomes available and the approval of -'the private water supply shall become 0411 and void when a lic water supply beCOrrleS available., Such approvals we Subject It m00 tk1n 01 Mange when, in tha.lgrtgme}t Of the COMMIS OSier,of h revoeat M or Change It 3/89 'a Tltle ' l 11 P� 1250 G,P-LLOI`� OV�f�L�'W TPh'K r P\O r 1� r m YML ENVIRONMENTAL SERVICES 321 Kear Street ^ Yorktown Heights, N.Y. 10598 ` (914) 245-2800 Albert H. Padovani, Director LAB #: 32.308985 CLIENT #: 114 NON STAT PROC PAGE 1 TORLISH & SONS DATE/TIME TAKEN: 12/24/93 08:00 BOX 271 DATE/TIME REC'D: 12/24/93 10:50 ATTENTION; DWAYNE TORLISH REPORT DATE: 12/28/93 ARMONK, NY 10504 PHONE: (914)-273-3448 SAMPLING SITE: FAIRVIEW MANOR TANK SAMPLE TYPE".: POTABLE : LOT #17 PRESERVATIVES: NONE COL'D BY: D. TORLISH TEMPERATURE..: { 4C NOTES...: HOMESITE ASSOC COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE 12/28/93 MF T. COLIFORM ABSENT /100 ML ABSENT COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. SUBMITTED BY:____-_____________ Albert H. Padovani, M.T.(ASCP) Director ELAP# 10323 6 WELL GUMYLETIUN KtXUnl * ;t DEPARTMENT OF HEALTH Divisi on 0 f Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTHY Office Use Only WELL LOCATION STREET ADDRESS: TOWN r TAX GRID NUMBER: . ° ✓:.LJ va-z ` ' `. - S',I.V WELL OWNER N E. RE �' ' �J`'. t%^ eir ❑ P8IVATE ❑ PUBLIC USE JELL 1 - ri 2 - secondary "4RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND./HEAT PUMP ❑ ABANDONED O BUSINESS ❑ FARM O TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGES -9? gal. REASON FOR DRILLING OREPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY NEW SUPPLY (NEW DWELLING) ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH �%� �� ft. STATIC WATER LEVEL ft. DATE MEASURED 9 DRILLING EQUIPMENT ❑ ROTARY COMPRESSED AIR PERCUSSION 0 DUG ❑ WELL POINT KCA PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED O OPEN END CASING ` OPEN HOLE IN BEDROCK O OTHER CASING TOTAL LENGTH _ fit. MATERIALS: STEEL O PLASTIC ❑ OTHER �S LENGTH BELOW GRADE ft. JOINTS. O WELDED THREADED ❑ OTHER DETAILS DIAMETER in. SEAL: CEMENT GROUT ❑ BENTONITE 0OTHER WEIGHT PER FOOT 2 1b./It. I DRIVE SHOE', 'YES O NO I LINER: OYES O NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST O YES ONO HOURS SECOND GRAVEL PACK O YES O NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH It WELL YIELD TEST If detailed pumping METHOD: ❑ PUMPED ' tests were done is in- COMPRESSED AIR ,formation attached? BAILED ❑ OTHER ; (] YES ONO WELL LOG if more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE. water Bear- Inq Well Ola- teeter FORMATION DESCRIPTION CODE It ft. WELL DEPTH it. DURATION hr. min. DRAWOOWN It. YIELD gpm• face -- -Sur � J - WATER CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS ❑ COLORED ANALYZED? "R(YES ONO ANALYSIS ATTACHED? YES ONO STORAGE TANK: TYPE CAPACITY :p�°S 0 GA],. PUMP (NF NATION �, TYPE, 9 CAPACITY 2a MAKER DEPTH MODEL VOLTAGFs HP' �r� WELL DRILLER NA E GATE A00 Ese SIGN TUBE yya y PUrNAM COUNTY DEPART= OF HEALTH DMSION OF ENVIRONL E AL HEALTH SERVICES Owner or Purchaser of Building Building Constructed by Location - Street II 'F - °='N Municipality Building Type 12 _ (- ),5' Section Block Lot Subdivision Name - 17 Subdivision Lot # GoARAN= OF SUBSURFACE SF&-,%GE DISPOSAL SYST24 I represent that I am wholly and completely responsible for the location, wor.3ananship, 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 caner, 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 lame- diate?y following the date of approval of the "Certificate of Construction Compliance" for 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 occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environmental Health Services 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 this 4 day of '�/a.Rj 19� eral Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk Signature Title A% S, L�DwlCSi TP /-�SSDl, ��� Corporation Name (if Corp.) Z;e.i cobble �bcld1 %Lci- Address _ PMWAM CbDPRTb>WAYIWW OF MALTS C DNbiwdandrew lbalHti"Serdwll.Csessel.N.T.low Ensomew in Pope Permit M CMRTRWATS OP COIDUANiCB CO MMW PO! SEWAGE ONFOSAL STST®IR ,' owe w Vm ie p S.bdl.bb,. rti.e F,,� rev i 1' S bd- W i i Tex MoP g., CDC A,prtw.e 'Dots d Peevinv 1.3 Mtar� Adieas 4,2 % 4?v� i b l� ii To" .. n�tn C„1�A i�ricinn A_nnrnvarir Fee Enclosed❑ Amn„nr- TAIS C — Let I Am 1,<94 AC M Soma. Humber d H Design Flow G P D _12CCL�r� PCHD Ned0onfi m is Whets FM b oomplded Sapsrals Ssw"Mige Sydm a Gomm ] . GsOw Sepdc Took .ode To be .by ?0 �F i i'r l Adtheas Weller Std: PdA0 Ssfftr Fts11111 A � X s•�, y 'f Ate.. on Paivaas Dtoad by .��-,. .... ! .,.-. . ! n - - - .. n �• /. _ /r ...:.•. _ f .r, . i l!' 2 CA i 1 65i -1-'i /tA 1 � G ✓ %G4': e 0di r ItsgWirssaesds - 1 represent that 1 am wholly and completely responsible for the design a location of the Proposed t (s); I that saw 1 stem above described will be constructed as shown on the approved amendment there to and in accordant* with the $5n6ards. rules &no regulations or n m County Department ' of Health,' and that on completion thereof a " Certificah of Construction Co liana" satisfactory to the Commisi of Heelthwill be submitted to the OepaRnsent; and a written guarantee will be furnished the owner, his ca s, amnd the builder, that said builder will plats in good operating condition any part of aid aMwaga disposal system during th f wo 2ely following thedate of the iasu- ins of the approval of the Certificate of Construction Compile reel st r the drilled well davWed above wo be located as shorn on the approved plan and that mid we11 will be stal in a rdan reguWZhs of the Putnam County O rtm, /ant, of Health. Ooh .� �/ f 7� /1 Signed / PE -X R. . Aaere.� •���� CP License No APPROVED FOR CONSTRUCTION %This approval expires two years from the date issued unless construction of the building .has bean' undertaken and is revocable for cause or may be amended or modified when considered necessary b the Commissioner of Health. Any change or alteration of construction nQuires a new apermit. Approved for % disposal of domestic sanitary e, a /or h water onl ReV . h �6/ /� /� BY Title 1088 Dot R u, S e:o co -J Rlimm mz= DEPAmma of ElEALm DIVISION OF amUm4mm HEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYS!MM FILE NO. Owner Address `t2 '�4D V4j4 r(f � Located at (Street) I WJ4;)r- Sec. o Block I Lot (indicate nearest cross street) Municipality �._�� 1�at�j�S Watershedcf_20�cDt SOIL PFRCC=ON TE/5'r DATA RDQUIRM TO BE SUBKr= WITH APPLICATIONS Date of Pre- Soaking 81 Date of Percolation Test I Z9 SOLE I2� t S 18" 22%Z:, 442- NaMBM CLOCK TIME 4P2.44-- l �o PERCOLATION 0 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 � 2 1 Z (2 :3o 312 I2� t S 18" 22%Z:, 442- 4P2.44-- l �o 15- 0 2i 13 5 5 2 /0! l2 �?� IS 3121 12.4�j t� I �" 2I 3 5 1 2 3 4 -_ 1. Tests to be repeated' are cbtained.at each for review. 2. Depth measurements to at same depth until apprcximately equal soil rates percolation test hole. All data to' be submitted be made fran top of hole. . FBI �`�t � V4,�c=F— L-oT * 1-7 a 04 r• V • �• -�r �a • : y r: • • �- •: �� :iy �: �- •ice. DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. —� —� Owner Address 4 - Wk i r6 F�44 tf Located at (Street) Sec- o Block I Lot 1 �� (indicate nearest. cross street) Municipality,a-t'���aCf� Watershede,'T�dV SOIL PION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking �Ig ! Date of Percolation Test I Lq 3 HOLE NUMER CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level 1S No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /in.Drop Inches Inches Inches 2 �Z:�S P2:30 t 5 �� 2�,� �•S 3�2 X045 �-5 18�� ���Z•, /2- 412`46= 1 �0 15- 5 �22 2 /2`0 I'Z: 1S 3)234 I2"41 5 1 2 3 4' 5 NOTES: 1. Tests to be repeated at same depth until apprcx;mtely'equal soil rates are obtained -at each percolation test hole. All.data to'be suimi.tted for review. 2. Depth measurements to be made from top of hole.. Fairview Manor Lot #17 Manor Road Town of Patterson 3. -1 -15 GUARANTEE OF FILL SECTION I certify that 3' of run of bank fill has been placed in six inch lifts and mechanically compacted to a density equivalant to the undisturbed underlying soil on the above referenced lot, in accordance with the Approved Plans, Construction Permit and Putnam County Health Department Requirements., DATE THIS DAY OF _� 19 q 3 SIGNATURE TITLE �nesr0ew� CORPORATION NAME e Srrt 45 sxt"Vrc51Nc. ADDRESS y,1 9.t. A,141 Te PGwl,u 5"a y iv G os- (� PUTNAM COUNTY DEPARTMENT OF HEALTH l Dmdm dzsvbessW soda S C mwL N.Y lodl? R to P�ivl� Plwtilti 1 on CERTIP CATR OF COMMANCE PERMIT FOR SEWAGE DISPOSAL SYSTEM rang ' � -77 � "..4 �y+`�' `r{/�� (� .• , ^O •/►�] eves e< veins Srbi.kdlis N• r' (V & 1 _ AJG 1�- saw Wit '-7 Tax M BI. ad / Ida Ow..r /Apprt..e Names n2? f `�i�S Cr �5 �'•[ Renewal Redd= Date of Prevbsa Approval rus Address �O x C� Tows�K•P111�UC51'� N — zjP l 0 5 G} Date Subdivision Approved ,j x ,. Fee Enclosed ❑ Amn„nt R++rs 'ljp.�—y) IJGI�i �� Let Are. I : �'"[' A( -- FM Seetios Only LXJ Depth 3 vow.653G� Ndtae d Hedeusss Dodge Flow G P D �� O PCHD Notification Is Regrked Wbes Fm Is comNa/ed Sepaemta S.WMW Systems Is eesskt d I !�EO GaSw Septic Task &ad To be. by TO 2K • Addrees Water Supply. Pie Supply Fr Address an Pehato Supply DAM by�0 'R M ' aadr... Otbss R.gstonssk 1 repressnt:thst 1 am wholly and completely responsible for th design and location of the proposed system(q; 1) that the separate TXL di eel s stem above described will tie constructed as shown on the approved amendment there to and in accordance with the standards, rules a requ ens o M County .-Deportnsent _ of MesRh, and that on completion thereof a: "Certificate of Construction Compliance" satisfactory to the Commissioner of HeeKhwill be submitted to'the'Depertnient, and a writyn;quarantee will be furnished the owner his fu .ors, heirs of assigns by the builder, that said builder will Nate in good operating CondRbn any start of said aavyage disport .system duri per1041101 (2) -years imm"lately following thadate of the Inu- once of the approval of the Certificate of Construction Compus, o i st any repairs theretot.2) that the drifted well described above wo be located as sliainn art the approv plan and that sold. well will M lnst tied in tCO th t starldard s and ►pu aiiToAS of the Putnam County Dwarkn o Health: s Date �, �. Signed ` '' {7 // b-r'✓ ►�]n�Li P.E R A. - Address V� t "� b APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the building .has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any Change or alteration of construction nouires a� Permit Approved for disposal .of dom,"ic sanitary saw"e, and / private water supply only. Rev. ,�-�-- ��� —�'� —� 10/88 Date 0Y TilN �- DEPARTMENT OF HEALTH. Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL `':z., PCHD PERMIT #?-' 1� WELL LOCATION Street Address F1�tJ�(� -v Town Village City Tax Grid umber rJ -6. -� 'I' WELL OWNER Name Mailing Address fir"t -51M Asec wtsS b Wrivate `'s- rkWNCoV "i O Public USE OF WELL 1 - primary 2- secondary RESIDENTIAL D BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O FARM M INSTITUTIONAL O AIR /COND /HEAT PUMP O ABANDONED O TEST /OBSERVATION O OTHER (,specify, O STAND -BY O AMOUNT OF USE YIELD SOUGHT G+ gpm /# PEOPLE SERVED L f-AM /EST. OF DAILY USAGE OO gal E3 REPLACE EXISTING SUPPLY O TEST/ OBSERVATION LIADDITIONAL SUPPLY XNEW SUPPLY NEW DWELLING 0 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 LO ATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: M,4 ►-J©K Lot No. I "] WATER WELL CONTRACTOR: Name `L'r(UI.( Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ENO NAME OF PUBLIC WATER SUPPLY: PIA TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETQHA SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET (date) (signatur PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. H Date of Issue: = 19_� ��..__� 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 �p FUMAMCOUMBWAlnUROFERAM " V\' D�ia.t6t�a�.w � aeoYee.. Camel. @lg. liBHt . lE so OF COIMMU AMM A-1 IE22T91= octet VIN UWAM DAs. XM! P -1 ( 1 repro nt'.thit 1 am wholly•ana completely responsible for the design and,kieation of the proposed systemlsli 1) that the se air Mw di sel ftNn abo" dwvWeO artll tea ottintruet�d as shown an the approwiA amendment there to and in accordance with the ttandarda, rules a M ant County Dapnt w of a uRk and that on cernobation thereof a "Certificate. of Construction Con *. ianee'• satisfactory to.tM Commissioner 01 Heekhwlll M uslath tin to the Department. and -a written "--tN will be furnished the owner, his sueaaera..hetn or assigns by the builder. bat said builder will thew in tiood..oMradM'eowOttlon any Cons of* aid alwage aispdUl, system during the period of two 12► Yeats immediately sellewtri�thedate Of tM'iseu- SPAR of the appreal at the Certificate of .Construction Compliance of the original system or any repairs thereto: 2) that the drilled was ~OW 06ow taint be WA M as ehaaw M 60 app►owd Wen No that saw will will be installed . 1p accordance the Stan arils, rules Gild reg amine Of the Putnam Signed - DIM CMnity9LpanR f Ia�,MT ,A. Add►eel4E�t�►wi paCAA 5tL license Noai9� APPROVED FOR CONSTRUCTION :_Thh ape- o' "i expires two s from data iafued u loss construction of tin building has boon undertaken and Is mviscabis for awe er may be,amended or modified when eon y by - Via C of Health. Any change orAlt tion of construction Pmuires MOW � %ns Apprgre0 for disposal of domed an a to y only. �V • Oete �l' ®tl Title DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # - 'S0k WELL LOCATION Street Address Town/Village/City Tax Grid Number t_1%4. 6l z D.fl PArre�zSc� tii I - I - Ict WELL OWNER Name MA�a Mailing Address Prec, Po. Evg 105 Tip Private. O Public USE OF WELL 1 - primary 2- secondary RESIDENTIAL 0 BUSINESS O INDUSTRIAL 0 PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY O ABANDONED 0 OTHER (specify, O AMOUNT OF USE YIELD SOUGHT O�P gpm /# PEOPLE SERVED I rte,VIJEST. OF DAILY USAGE80p gal REASON FOR DRILLING E] REPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION M ADDITIONAL SUPPLY NEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN ODUG OGRAVEL OOTHER IS WELL SITE SUBJECT TO FLOODING? YES V" NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: FACE- VICV-4 t- .AOOl- Lot No. -7 WATER WELL CONTRACTOR: Name 1r0 r_- 'Demgt- nLt-16 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES L.-�NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: GSA -�g� LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED r '' s' },• �`^ `. RON SEPARATE SHEET i (date) (signature)" 77 ^ l7/'f\57 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 thirti� (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 a appropriate action to assure that any and all water or waste products from such well d " ing perations be contained on this property and in such manner as not to degrade or t w con: Me surface or groundwater. Date of Issue• 19 Date of Expiration I 19�_ ermit Is Of icial Permit is Non - Transfer able White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH DlvWoe o[> vhoomenhl Hodtb Services. Calnud, N.Y. 165,12 ew to Provide PeemN M. on CERTIFICATE OF COMPLIANCE CONSTRU N PERMIT FOR SEWAGE DISPOSAL SYSTEM -L ' reps at N_ I.i,_A � e. Rorsl-> Town or Village: Subdivision Name- V/alrz,t 1l d {�"Ia+Nbi;' ,�abd Lot N 1'l T".Map - rut -1�- -- Renewal_ ❑ RevWo5 ❑ Ownw /Applicant Name_ srrla— _Date of Previous Approval M1119148 Address �. 222-A ISM Town— Zip__IOSIJj I iae !cam t . 8�4 .e.c . BoOdIng Type Lot Area Fm Secdon Only Depth 3 Vdame 6.33 cY N u m b e r of Bedrooms q Design Flow G P D 600 PCHD Notlticadon Is Required When FIR ls�completed Separate Sewerage System to cons of I2SO Gallon Sepik Tack snd eon f—. P To be eowdracted by To. IE!> inl6D Address; Water Supply. PaNk Supply prom Address ors Pdvate Supply DdRed by -IM f3 E Address OitberReoahomenta - islzIEau=t' 16 P do'A 1 represent that _I am wholly anil completely. responsible for g the,desn' and location of the proposed system(s): 1) that the separate sewage disposal system above described will be const utted as shown on the approved amendment there to and in accordance with the standards. rules and regulations O e Putnam County Department of - . Health, ,and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Health will be - submitted to. the Department, and a written guarantee will,be furnished the owner, his successors. heirs ovassigns by the builder, that said builder Will place in good operating condition any pirt 'of -aid sewage disposal system duffing the period of two (2) years immediately following thedate of the issu- ance of the approval of the :Certmcate.•.of construction .Compliance of the original system or any repairs stn; 2) that the drilled well described above will be Iocated.as'sAOwn-on'the approveaplsni and that said well will be installed in accordant h the st ards, rules and regu as siions of the Putnam County Department oft Health. Date 1 .,yt ca /, I Signed . _ P.E. R.A. - Address `- �a6F11M ��e�G. iz• 6Z <n- L ijy License No Zr°myS APPROVED FOR CONSTRUCTION This approval-expires two years from the date issued unless construction .of, the building has been undertaken and is revoniable for cause or may be'amanded or modified when eonside►el neces y by the Commissioner of Health. Any change or alteration of construction requires a new permit, ved for disposal of dome, can' ►y -only. 1/87 Date �� �� By Title /V' -� 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 4 [—I' WELL LOCATION Street Address Town/Village/city Tax 1zca z Grid Number V- I -19 WELL OWNER Name Mailing Address F1 go 65 IMPrivate O Public USE OF WELL 1 - primary 2 - secondary RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O BUSINESS O FARM O TEST /OBSERVATION ® INDUSTRIAL []INSTITUTIONAL O STAND -BY O ABANDONED 0 OTHER (specify AMOUNT OF USE YIELD SOUGHT ",,j s gpm/ # PEOPLE SERVED j Spry /EST . OF DAILY USAGE g Do gal REASON FOR DRILLING NEW SUPPLY [)PROVIDE ADDITIONAL SUPPLY ❑REPLACE EXISTING SUPPLY ODEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING / Est ENri,a Su WELL TYPE DRILLED O DRIVEN ®DUG ® GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES '>:�, NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 'P ., P-Vt V__V/ M,anto�-_ Lot No. n WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES "�e_NO NAME OF PUBLIC WATER SUPPLY: rlI / TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: -�2 LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED 4N, UPON REAR OF THIS APPLICATION � (date) 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 Yutnam County Health Department.. Date of Issue: ? �./ 19 Date of Expiration: 2-, —& 19 f tit Issuing Official White copy: H.D. File Permit is Non- Transferrable 11 ldin e oW Cppy. Bui Y g Inspector Pink Copy: Owner 287 Orange copy: Well Driller Putnam County Department of health Division of Erivirorimental Sanitation AFFIDAVIT - C0RP0MTE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HDILTH DEPARTMtNT TO: Commissioner of Health - In the matter of application for — ^(�71+� �rG+� —C L{ .r.` — — — — — — — — — — — — — — — — — — — — represent — — — ' that I am an officer or employee of the corporation and am authorized to act for T -P550� %GAS (name of corporation) having offices at — /D PL L41 TA Q�`(��(J•_L /_ --- _...--- .__-- __--- --- --- - - - - -- Whose officers are President — %��9iv�21 . l��— ie,,,e c-r _ 10"40_1 �_ — o _ (Nfame and Address) _7k-e 1S , Vent 1% iu9�10N .Y_.J_"rcNe�- o?3%�r9y/3eMv�M lye 11o01�c /:�/ Secretary — _ — — — — — — (Name and Address) Treasurer _ _ _ _ _ _ _ — — (Name and Address) — — — — — — and that I;.am and will be individually responsible for any or.all acts of 'the corporation with respect to the approval requested and all silt- sequent acts relating thereto. Sworn to before me this day Signed of, f 19�LJ Title / j — C------ - - - --- KELLY H. WILSON NOTARY PUBLLIC, NEW YORK STATE N. QUALIFIED IN DUJCHESS COUNTY COMMISSION EXPIRES 71211U Corporate Seal e� �� �25G GPLLU OVC�FFLfww rs K �ORcEM.�lrJ 'ri�NGl-I� �i'YOUT ­?UTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES SSDS/WS REVIEW SHEET - DETAILS � a. SRMC MM IE,IIS 1. 0- tlet 2" belcw inlet 2. Minh= 3" bEd of peel gravel 3. Minimm depth of liquid: 4' 4. Isxth - minimm twice width to urOMM far times width. 5. Mmdmm 12" o0ver. 6. Iocati m stab. 7. M3i> ice - c1pen1ng - mlllfi= 20" in d-rxtPr dinensicn. S. Baffle Pcterl 20% of lig,id nth above lig,id level. (C17-41, b=10 ", &5-,b-12"). . 3. if lerxlth G.T. 9 feet - use 2 aarfarbumts. ). minimm tark caEacity 1.000 T1/3 bedroan; 1200 gal/4 b93roan:134 cO bcrn;16L cf/4 bd= L. Asfhaltic antin3 fir reinforced ca=et:e. 2. Inlet tse/b ffle 16' belcw flew line. 3. Qitlet teq/baf Ele 18" belcw f Lcw line. I inlet pipe sl_cQe I" per foot min. (2%) . 5. Inlet pipe cast iron, 4'h-in. S. 010.et pipe sloe 1/8" per foot min. (1 %) . ]. ClalulkEd joints fcr Sanitary bees. 12et invert min. 2" above cutlet invert- All cutlets at sire elevation. 612ets 1" to 5" above tank b0d33U. Nhr1II m 1122 b�3irrj clew mnd o pm gramal. . r role baffle. Mmdmm 12" car. Ferrxrahl e cover fcr coo s. SFehd pipe jain: s (as;Efaltsc or equal). Mcpe cutlets at 1/8 Wft. (1 %) ). Fist protecticn. Mcpe 1/16 in. /ft. to 3,/32 in. (0.5% to 0.25$). '.. 3/4" to 1l" sbae or wa�3 c pzwl ate. 3. 4" minimm lateral diaxni-ar. t. 2" minimm aggregate over tat ral. i. 6" minimun aggtxate ter lateral. i. Ultleatcd building or 2" cif st nw over ate. '. 6" minimm, 12" nBxi IIn earth bail .. 3. Overfill to allow for settling, 4" .-6 ". I. 21 miniurun flan tr l bottrm to water-5f t. go& I. 5'min.from trerx:1 bottrm to irqxxvrinu 7 ft. grade. Mcenciu spacingm n.6'O.C.(24 "trarh). '.. Lb=r4cted lateral girls mast be plugggai. t. Fill. - 2:1 s1ppes min. 10' belai3 t rerrh. dq:th:3j`m3x.cver xak+;2`m3x.cver water RTe mmble bps. 1. kp of aLsing 18" above gmixL 2. 'Itp of casing 21 above HeL or �.atatight. 3. Minirmm 201 casirxg of st-d or wrought 4. 101 minfi= gnit into .. 5. Outlet 41 below O.G. 6. SmaitaLy 1. Overfill .o allcw fcr settlirxg: 4"-6" • xr- -• •. 3. ._ -_• building • 4. Ill to 1111 clean gravae cr sta-e.: perfcratEd pip-- 6. P •- fimert 6" off bottcm. 7. : .- treach. 9. Sqmmticn f3= SSM nrEa 151 min. 1. c • _ i5 - b3c cover. 2. •• o •• cutlet 11" above - _ ter. cLtlet. er. fLuEh with •••■■• Tight 4. • pipes bah am •••L- • RPP ' Y PTr DEMIES ••s• i - cover • • line - freezing •: ••- ■ - - to • • • • _ .- Dos pipe nluTe. .- ..it to well. �- .. - fI 1 s ■i n• ••• .: ••• ••• 0 Rffkaulic infcaTatim )-qperating levels pk. -gLm vs. head p-up with curves. 11 cashin associates, p.c. design professionals route 52 A. carmel, new york 10512 (914) 225 -8088 110 o t> 12ouZh' 4:, al7Ae Q L.D G 3 lj Y 1 02.12. LETTER OF TRANSMITTAL DATE •3D�8 JOB. NO. ATTENTION RE: L-, 1-7 o Lrr WE ARE SENDING YOU Attached ❑ Under separate cover via ❑ Shop drawings Prints Plans ❑ Copy of letter ❑ Change order ❑ the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION o Lrr u n-t P CeV �- `f' ►3 .815 eofao�� sus p 6 �s D THESE ARE TRANSMITTED as checked below: "$'For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO: nn �7 SIGNED: _r Q� If enclosures are not as noted, kindly notify us at once. G. 1250 -f I�HC I-F I -�YOUT rAli -Vi�,W `Nod . a FT�'I'LP;a CCIJ -N "r D=== OF E F=111 - DIVISIM OF EVVZKCDP 7Z~l, "z' Vi�S ENDIL ' ED0M Wla= SUPPLY & DISPC<_ yL SiST -T-�s RE'J -rT7r .,rte -1 - CGNSM=ICN P_RMIT (Di`-ne of C',,vne_r) (S��r Lcc Ica) &4�/ Y=- 1 1 Peter zit Pxpl ica ticn - y`.�ok_ i 1 Cor=crato Rescluticn 1 ,✓j` I Pion=_ - Thr=z sL-s ---- -- /f�6$i1 6D �i2s� Enci e n A2_-LZCrizaz c:l DeSi' DcL SITE ('CE) Deep Hole Lcc , P__c t 7 1C.' = n si -'I Psrc c'-' = s 7` j 3 Pe_rc Eo.Le Deptn C" L Eic-= P'_c.ns - T6. o setzzz We-'!. Cdr. La=a c r_sicr_ ;�ccrovz_ C_ mss__ TE-z spercva ES-CE Pte-_- Lct_ c C e=_ e' =- _` and (Tc-w _ 'E)E.0 PC__:t_ _ R & D i RE;�pt' == D Cc^ E= r c_ CN P_' : N-� S=aa__= CLs t�-a E rcr -ul ic V. .'�c Fill Prof -Lie & Di -_�S V _cns - c_._..- _ D cr J .P'— CD SEn.i1C TtrLi - S iz e, De a; I we? i E)e I i cervice L1-= i= cve_ Ccnst,-acticn Nots-S (crinder rc- =) Ce s ' cn Data: perc and C°-° -o r as,_- DiV =c_-t CCrll -.r, E` iStin-c & P=:.::CSed Drive-Yav & Sl oces Cat J (_`1 r If 0--t-a-I.-i ins n-r ^^ n.r) Psrc & De =_o Holes Lccat_=, Reor__E_.Ztative or prix. =v e-._ ex- -ands ca {_.c1S?Ct2 Pra ;s'riClNil;�r��_ti i'_C`i,S�L_. Si:c IL Plz=ed Pit & D Ec:{ Shcwn & De.T.- i ied House - No. cf Ee =rcans Wells s & SSCS r S W /lA 200 f :_ c_ Propose Sys _ Prcce_Tt Me _es & Scur_d - Hcuse Set�zack Necas = a''-_v (T-Lch t lC t l House SEve?;- - 1/4"/f t. 4"0; -T;,._ pipe No Bends; Renf;s 45' SrPRIkaSICN DTST, Tc .c_-LrT7%l CN ?sN F-4elds 10' to P.L., Drivg--av, Ler_ 'r-a-zs,Tcc c; 20' to Fcun-r-- ' '% ail - 100' to TNEi1 U .L D.L.O.D, 150` pit= 100' to S `r- - __r=ur =e, Eac= (inc. E`- 15' to Drains sir` iz, La.L_r, Footing 35'to C?'tc- �cSiIl,SiCr'flrc_:i,^?" Wc� -r`c 10' to `vat_r Line (pit = -201 ) 50, ZIlt`'iL teen L Seot_c Tank-5 10'�Tf_cn F:,uncyt cn; 50' to 15 ' we l to PL . PLl:. jr ?141 . I'm i �j • E . IMI 0_ArA _ MR. IPPI -a MWArd 1 DeSi' DcL SITE ('CE) Deep Hole Lcc , P__c t 7 1C.' = n si -'I Psrc c'-' = s 7` j 3 Pe_rc Eo.Le Deptn C" L Eic-= P'_c.ns - T6. o setzzz We-'!. Cdr. La=a c r_sicr_ ;�ccrovz_ C_ mss__ TE-z spercva ES-CE Pte-_- Lct_ c C e=_ e' =- _` and (Tc-w _ 'E)E.0 PC__:t_ _ R & D i RE;�pt' == D Cc^ E= r c_ CN P_' : N-� S=aa__= CLs t�-a E rcr -ul ic V. .'�c Fill Prof -Lie & Di -_�S V _cns - c_._..- _ D cr J .P'— CD SEn.i1C TtrLi - S iz e, De a; I we? i E)e I i cervice L1-= i= cve_ Ccnst,-acticn Nots-S (crinder rc- =) Ce s ' cn Data: perc and C°-° -o r as,_- DiV =c_-t CCrll -.r, E` iStin-c & P=:.::CSed Drive-Yav & Sl oces Cat J (_`1 r If 0--t-a-I.-i ins n-r ^^ n.r) Psrc & De =_o Holes Lccat_=, Reor__E_.Ztative or prix. =v e-._ ex- -ands ca {_.c1S?Ct2 Pra ;s'riClNil;�r��_ti i'_C`i,S�L_. Si:c IL Plz=ed Pit & D Ec:{ Shcwn & De.T.- i ied House - No. cf Ee =rcans Wells s & SSCS r S W /lA 200 f :_ c_ Propose Sys _ Prcce_Tt Me _es & Scur_d - Hcuse Set�zack Necas = a''-_v (T-Lch t lC t l House SEve?;- - 1/4"/f t. 4"0; -T;,._ pipe No Bends; Renf;s 45' SrPRIkaSICN DTST, Tc .c_-LrT7%l CN ?sN F-4elds 10' to P.L., Drivg--av, Ler_ 'r-a-zs,Tcc c; 20' to Fcun-r-- ' '% ail - 100' to TNEi1 U .L D.L.O.D, 150` pit= 100' to S `r- - __r=ur =e, Eac= (inc. E`- 15' to Drains sir` iz, La.L_r, Footing 35'to C?'tc- �cSiIl,SiCr'flrc_:i,^?" Wc� -r`c 10' to `vat_r Line (pit = -201 ) 50, ZIlt`'iL teen L Seot_c Tank-5 10'�Tf_cn F:,uncyt cn; 50' to 15 ' we l to PL • PUMAM COUNTY. DEPARM41 P . OF BMMJ . DIVISION CF'ENVXPU14ENIAL HEALTH SEMCES DESIGN DATA SH ET- SUBSUFACE SEWASE ' DISPOSAL SYSZg!'.. FILE NJ. Owner �o� -t�rt� Address f- 18e, I w,yA woof 0-f- Located at (Street) 1�•- C>,Q. izC>,oz, , Sec: ' 1 Block 1 Lot �g (indicate nearest cross street) • c�� I� Municipality �'�-, -rte >.J •Watershed• C' ,✓ 50M' PtR00 =CN TEST MM , - To BE Si 'PIED WI'TFi APPLIO1TICrIS Date of Pie - Soaking 9 • ii 88 Date of. Percolation Test 9 • l3 • e4S HOLE NUMBER C1= TIME' PERCOLATION PERCDIATICQ� , . Run Elapse Depth to Plater FSrcm r • Water. Level .. No. ''Time Ground Surface In Inches Soil Rate Start-Stop Min.. ' Start stop Drop In Min/in Drop Inches Inches Inches - 1 q : oo - `Y: 30 3o z'I 1 2q 3 � •o 2 r 3 o• 33 - t t - 09 3(.0 z-t z9 Z 4 lt:o� -• 1.1 4S 3CQ 2`1 zq 3 12 5 yj :4s iz zA 3to:ig- to;�o• ACT 2'1 r Z�l 3 12 • 5 2 5 -' — 1. • masts to be repeated' a t same depth until apprcoc ima tely equal soil rates axe ' obtained ,at each percolation test hole. All data to' be . suttnittlad TjE�T PIT DATA RowiRED To* BE 'sLmmr 1ED wrm APPLICAmw DESCRIPTION OF SOILS IIJC70UNTERED IN TEST BOLES DEPIU HOLE -NO. 1 HOLE NO. • Z HCLE NO. G.L. .•.:. , 1' --1 of �o i L ors 4' 5' 6; .. 71 10' 12' 13' 14' -. INDICATE LEVEL AT WHICH GROUNDWATER IS E OUNTE= o�(E INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENO xRnEm rj �a DEEP' HOLE OBSEMTIONS MADE BY: ' ,,;Q z "AP DATE i DESIGN Soil Rate Used 1-z_ Min/1" Drop; .• ' S.D.. Usable Area •Provided 500o Qi. No. of Bedroams Septic Tank.Capacity gals • Z7'Pe r ►�-r- Absorption Area Provided By e0Q ,. L.F. x 24" %Adth-trench Other & 3 Fs CV . YDs) I �,S't{Zl Tt 6,\ Name Signatur Address SEAL gL n -. JJ y Z PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date- SEA t°.. I , ties, w . Re: Property of Z-22ori'e5l T-f 45S D«,0'j re,5 uc Located at se", •Sec.ti.on iff Block 1 Lot �9 Subdivision of Subdv. Lot # I"j Filed Map.# Date Gentlemen: " This letter is to .authorize �G95 /�iiu / SOC /G 7,e5j A L, a duly,licensed professional engineer - r registered architect (Indicate , to apply for a Construction Permit for a s.eparate sewage system, to 1 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 conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. �--� , i Countersigned,o\ P.E., R:A., # Address �r•.,�!�I,L th cIL a. 760�� ; L�►g� zzs -SoeB Telephone 1 7 1 . Very truly yours, \ f� Signed .Owner of Property 22 -J11gox IfN Address TA o e,U coo y /v - y /o 9 Li Town Y 7fl &13D6 Telephone $C D 11 le-A -- I Z50 c,- -otj -/ StrPf1G T/ t-� K F'lut -IP PIT 1250 GPLLOtJ oJ�rzFf,�/ TPh'K 2" �11G :. 0 7 ' N *1"Et wC �.� ,. , � � • 'w'13w A 0 5 r m, 72;t 8 j� :75 Ot -�1 7 _. s is tee certify that the sewage', disposal system was 5tructed�as= indicated on this plan and that the system was This design engineer has inspected the ROD fill material on ected'aby ;Cnshln Associates, P.C. before It was covered over. to sys`ten wds constructed in accordance with nU, >stbndnrd - certify, that such material has', been . ptaead and stabilized in aft s'gnd "�regutgtions of the Putnam County Department of th and the New York State Department of Health, requi e'senta of the HI'S Dept. of BNlth, the Putmaw Couiftr Dapn spprabed fill plan. The material itself has besa.testid and SSDS consists of th , following 12� gallon precast suitable for use in a subaurfsce. swage disposal System. rete septic tank,�l.f. of 24' wide absorption settled fill based on percolation tests, after stabiiiia ch , additional requirements / / /�_ _ -1