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HomeMy WebLinkAbout0322DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -22.2 BOX 4 I,y7. IN r or �i I 4lA -; �ti1 ; I!' 1 - Ilk h LL 00131 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIAN GE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # / f - V �' ?,o.-ty Located at / (4.Yor�/{,5M) Town or Village /W �sd 1 � Owner /Applicant Name/3U /94 K�D lA.� •�� / Formerly 1 �J 0 TrQ Mailing Address -7 7 L /�6 (% TC .3// , A Tax Map 13 Block .,,2- Lot -2--2,ak Subdivision Name Subd. Lot # M/ /A % Zip 12-J -63 Date Construction Permit Issued by PCHD 12 1--- ff Separate Sewerage System built by T "YA'ILh45AI " Address C�. ✓L �% Consisting of 12- 5.0 Gallon Septic Tank and � zC&AzCzx/= Other Requirements: Water Supply: Public Supply From &)111-) Address L�% /V f✓ or: Private Supply Drilled by Address Building Type M W lt� IWC Has erosion control been completed? Number of Bedrooms 3 Has garbage grinder been installed? A/d 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 regulat' ns of the P tnam County Department of Health. Date: Z- d Certified by��i' P.E. R.A. (Design Profession`al�) Address 12 li�% License # 32 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals ar bject to rRodification or change when, in the judgment of the Public Health Director, such revocatio='* n hange is necessary. By: Title: IMIX White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Date: /41) Orange copy - Design Professional Form CC -97 BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 C LORETTA MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 March 26, 2001 John Karell, Jr., P. E. 121 Cushman Road Patterson, NY 12563 Re: Proposed Compliance Budakowski Route 311 (T) Patterson TM #13 -2 -22.2 Dear Mr. Karell: Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: If percolation tests were not witnessed by a representative of the New York City Department.of Environmental Protection on this lot, percolation tests. must be witnessed by a representative of this Department. The minimum of 3 sets of plans must be submitted, preferably 4. The plans should only be printed on one side. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ve t ly yours, Robert Morris, P. E. Senior Public Health Engineer RM/jp a i . .. .. -.,r.. _' . .. aY'ai. ..'l .. ✓. ... ., /' � ( i K a, -S FscT'� Y`"i :: `. .i PUTNAM COUNTY DEPARTMENT OF HEALTH. DIVISION OF ENVIRONMENTAL HEALTH SERVICES y WELL COMPLETION REPORT Well Location Street Address: 7y R+ 31 i Town/Village: Pt<+erscn Tax Grid # Map Block Lot(s) Well Owner: Name: Address: J -ohn BLda.kptisKI 95 Pd r r+ue CT_ 04$ /0 Use of Well: 1- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment x Rotary Cable percussion _ Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 2- 2- ft. Length below grade Z 1 ft. Diameter lc in. Weight per foot ��lb /ft. Materials: Steel Plastic Other Joints: _ Welded —X Threaded _ Other Seal: j( Cement grout Bentonite Other Drive shoe: Yes No Liner _ Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test Bailed _ Pumped \ Compressed Air Hours & Yield 5a gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet I Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Ik S . Pump Type Capacity % W Depth lAn Mode Voltage , V HP Tank Type rAWtF 5)' Volume Date Well Completed -1 -10-00 Putnam County Certification No. 003 Date of Report 12_-S--60 Well Driller (signature) 11 NUTS: Exact location of well with distances to at least two permanent landmarks to be prod on a separate sheet/plan. Well Driller's Name d e WC-1 I Cb M-. Address: I U y f;t Si ar-me -1 N `� l as► Signature: Date: White copy: iFile; Yellow copy - Building Inspector; Pink copy - Owner; Orange co PY - Well driller Form WC -97 f,yr' BUILDING PERMIT. Town of Patterson, N. Y. Permit N °_ 2900 Permission ,is hereby granted to: to This Permit must be kept on the premis authorized work. Ong Inspector until completion of all the Note: The holder of this permit is required to familiarize himself with all ordinances under which this permit is granted. Any violation of these provisions will result in immediate revocation of this permit. I 13 17, XPI HAT 'tA ?Ost dX-3 OQ 17 -AS -BUILT MEASUREMENTS- 3 J o suov�vTr& e0ugW03u00 ices lqq.TeeH U REMARKS CQt4C. �, =.44 -t5 51 6 100 141 ID rL V! 3 J o suov�vTr& e0ugW03u00 ices lqq.TeeH U BRL:CE R. FOLEY Public Bealth Dlreacr DEPARTNMNT OF HEALTH I Geneva Road Brewster, New York 10509 LORETTA MOLINARI• R.N., M.S.N. AiJociate Public Health Director Director of Pattant Services Eorirenmental Health (914)278-6130 Fax (914) 278 - 7921 Mirsinti Services (914)270-6558 WIC (914)273-6678 Fax (914) 278-6085 Early intervention (914)2"18-6014 Prochool (914) 218.6082 Fix(914)278-6648 owvElz,s NAME: yo h,� 17 �u -�.�kv wsi�- TAX _riAPNUMBER: /.�. - a `-z�• -� E911 ADDRESS: % % % 'o'f TOWN: p/f vA1 AUTHORIZED TOWN OFFICIAL: (Signature) DATE: The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E91 I IVERaM,I � +. �`?' 4 ti 4f�rs �ov>;�[, lz;r�� �,,:::.. �,;i :` �.•':,I...> l� •lt�.-,�.�r'; F eye. ?:Y. .34n � .. :y. ,s-� r� C PUTNAM COUNTY DEPARTMENT OFIHEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES , CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT #- d'` Located at S—r. �M2 #ms_ Town -r Village ?47-z Subdivision name Subd. Lot # -- Tax Map 1— Block Z. Lot `Z,, . Date Subdivision Approved Owner/ Applicant Name O 4 ,O Mailing Address Amount of Fee.- Enclosed -3 oo o OD Ole Building Type 401AFAC1,09.- Lot Area Renewal Revision , Date of Previous Approval _/_z AT No. of Bedrooms Design Flow GPD Zip Fill Section Only �' Depth ° Volume Yo PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED •:Separate Sewerage System to consist of /000> gallon septic tank and T. 2-L/ Other Requirements: '�t� 1 �P� ?1of-a —'�'-• To bx constructed by p a Address Water Supply: Public Supply From Address or: 'Private Supply Drilled by°"B A Address I repesent that I am wholly and completely responsible for the design and location of the proposed systems) and that the sepaate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in acccrdance 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 Deprtment, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said buider will place in good operating condition any part of said sewage treatment system during the period of two (2) years imrrEdiately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original systm or anv repairs thereto. Sigcd: A&ess R.A. Date License # APROVED FOR CONSTRUCTION: This approval expires two years from the date issued. unless construction of the sevvge treatment system has been completed aril inspected by the PCHD and is revocable for cause or may be amended or ,moaned whenlconsidered necessary by the Public Health Director.. Any.revision or alteration`of the approved plan requires a nw Pe charge /Approv or discharge of;domestic; i 4 A Y PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH.SERVICES APPLICATION TO CONSTRUCT A WATER WELL olease print or type PCHD. Permit # / �® Well Location: Street Address: To illage Tax Giid # r; - ci < ;.': . � ryNS o ca,U Map 13 Block L Lots) Z Z . Well Owner:` Name: Address: .. J Y MIL I N 5 Use of Well: esidential Public Supply Air /Cond/Heat Pump Irrigation primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm ' # People Served Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling llew Supply (new dwelling) Deepen Existing Well Detailed' Reason 5S A for Drilling Well Type Drilled Driven Gravel Other Is:well site subject to flooding? ................................................. ............................... Yes . No ... ............................... Yes - IS.well located in a realty subdivision? .... ............................... No . Name of subdivision Lot No. Water Well Contractor: 8 Address: Is Public Water Supply available to site? ................................... ............................... -Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well . location & "sources of contamination to be provided on separate sh t/pl Date: Applicant Signature: , PERMIT TO CONSTRUCT A WATER WEL 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 welli 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 watl., 1 driller certified by Putnam County. Date of Issue Permit Iss fficial: Date of Expiration / ! 2,1 n Title: Permit is Non - Transf r able. -.. White copy - HD file; Yellow copy -. Building Inspector; Pink copy - Owner; Orange copy Well driller Form WP -91 AUG -18 -00 SAT 8:54 AM PUNAM CTY ENV HEALTH FAX N0. 19142787921 P. 3 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Building Constru y Location - Street Building Type QQ r '11lock Lot. TownNillage Subdivision Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Year f_cn (Owner) Signature Corporation Name (if corporation) Address: State Zip Corporation Name (if corporation) Address. �. State A ZiP Form GS -97 N� NORTHEAST LABORATORY of DAN$URY 39 MILL PLAIN ROAD DANBURY, CT 06811 CT Cert: PH -0404 lr�$i$ '• (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 NA2MEM CONTAMINANT TEST PERFORMED RESULTS METHOD # LEVEL (MCL) OR STANDARD BACTERIAL: • Total Coliform (Bacteria) 0 per 100 ml SM 9222B 0 per 100 ml PHYSICALS: • Color (Apparent) 10 - EPA 110.2 15 • Odor ND - - 3 Units • pH 6.97 - EPA 150.1 No designated limits • Turbidity 2.2 NTUs EPA 180.1 5 NTUs CHEMISTRY: • Nitrite Nitrogen LABORATORY REPORT mg/L as N REPORT TO: • Nitrate Nitrogen 0.62 mg/L as N MR. JOHN BUDAKOWSKI • Alkalinity DATE SAMPLE COLLECTED: 2/9/2001 774 Rte. 311 • Hardness TIME COLLECTED: 1:30 P.M. PATTERSON, N.Y. 10563 • Iron COLLECTED BY: J. BUDAKOWSKI EPA 236.1 • Manganese DATE RECEIVED @ LAB: 2/9/2001 EPA 243.1 • Sodium TESTED BY: LAB #11471 EPA 273.1 • Lead LAB LD.# NY -011 EPA 239.2 REPORT DATE: 2/15/2001 SAMPLE SITE: AS ABOVE SAMPLE POINT: WELL TANK SOURCE: WELL -NEW TREATMENT: NONE NA2MEM CONTAMINANT TEST PERFORMED RESULTS METHOD # LEVEL (MCL) OR STANDARD BACTERIAL: • Total Coliform (Bacteria) 0 per 100 ml SM 9222B 0 per 100 ml PHYSICALS: • Color (Apparent) 10 - EPA 110.2 15 • Odor ND - - 3 Units • pH 6.97 - EPA 150.1 No designated limits • Turbidity 2.2 NTUs EPA 180.1 5 NTUs CHEMISTRY: • Nitrite Nitrogen <0.005 mg/L as N EPA 354.1 • Nitrate Nitrogen 0.62 mg/L as N SM 4500D • Alkalinity 226.0 mg/L SM 2320B • Hardness 272.0 mg/L EPA 130.2 • Iron 0.247 mg/L EPA 236.1 • Manganese <0.01 mg/L EPA 243.1 • Sodium 4.3 mg/L EPA 273.1 • Lead 0.003 mg/L EPA 239.2 1.0 mg/L 10 mg/L No defined limits No defined limits 0.30 mg/L 0.50 mg/L Combined limit for Iron plus Manganese = 0.50mg/L 20.0 mg/L ** 0.015 mg/L * ** ml= milliliter mg/L=milligrams per Liter ND =none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count "'Notification Level ** *Action Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: MOTABLE or UOTPOTABLE RESULTS BASED ON SAMPLES SUBMITTED:2 /9/2001 qa Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)$28 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 -654 -1230 _ k -S s y. r� xt !. f31{ It_ Y — +i • - - _ - f rtiNL 1�' V'+Zrv.�% ��Cf"' : `6.11. _ '�kv. : •�, �4 :'!r q`k 1R `(ty . ' i .Y 'r"• ;Y#l.F => �.,c, ?' r+•,-w wi .! w t ; J,.' G` T'.•,R..,SC . . � �- t� . S, ,. .�- ._:.t, , •,. -., s.. .... .- •�.. �, F,r h\ .:F >... yam•,:. ?ga`f.7+� 4+:'' }c: .'b� `P9 ',.�✓"a'f,°"i 1 \ - t * 4 � : PRo'P' 'loo To ` t � t . : • . 4� I� � PUTNAM OOUN Tr DEPARTld�TP OF HEALTH IDbMan •i 1 Hod& Sa.vIF, CNMA N.Y.1PSU to Piwid• Put i I� vim/ - CO�IICMN PIWW FOR SEWAGE DISPOSAL SYSTEM Imaged at SlbdyMas Natse Lst i �' Owsar /AffRcont Nara r31'°A a CERTR ICATE OF COMIUANCE Patalt i y� Tows or VFN T11z wP 1 �?T t�Zz ltesewal Rhea ❑ Water Sop*: p Sm* Fran Address ge ✓vl..e. SdDclBd b7 ` — Ad�eea 1 represent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sew di sal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards. rules a regulations o • ruinam County Department of HMKh, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Heashwill be submitted to the Department, and a written guarantee will be furnished the owns', his successors, heirs or Vftns by the builder, that Yid builder will pIK• in good operating condition any part of Yid Sawa" disposal system during the period of two (2) Y 1 lately following thedate of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or a repair that the drilled well described above located be cat•d as shown on the approved plan and that said well will be Installed i r co wi tha rd , s and rpu n of the Putnam County Department of Health. Date " �,� . ���— Signed P.E. License R.A. Address License No APPROVED FOR CONSTRUCTION: This approval expiref two years from the date issued unless construction of he building his been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissoomr of Health. Any change or alteration of construction requires a now permit. Approved for disposal of domestic sanitary sewage, and/or private-;water-supply only. 10 /88 Data 1� BY /� ~�.L..�..� _ _Title j PUMAM CODNTT DWART=NT OF HEALTH _ 1� D atISet�leri.esld 1 Sae.bn. t%eseal. N.Y. ITSU im his 87 OOURWAM FOE /SWAM DEPOOAL SYSTEM P°R i — Z 2.3 ward at % O f� . vq� err vologis wrMa. ' �` La! / 3 S T. Map ! Welk Z — W 19�z / 11IM 4 Rawwa ° Data 1 how Mss Abboud S@ftS Adhis a � Twill, R'7✓',--XSo1 1 L/ qP Date Subdivision Approved Fee Enclosed ❑ Amrn,nr IVF aft Type S/ Lst Area Z 7i / cn For Sedlas Osb Dap* Vablr r G t Nosier of Bdr Dodos Flow G PD PCID Nedb admi la Ratldred WM FIS Y asslplsMi =apma" Swamp byabo a alit a1,0 := a Rae Soptie Twit .nd ( 7 To be Imodindoll b /� , iJ i Athena SuM ssv* Pte WaMr an ° , S +orb Dd d b9 T ; Tai i2, as ,m Otbar RalleirrgsitgL/ 1 Isprism t that 1 am wholly arld coalplately, responsible for the design and location of the proposed system(s); 11 that the sate sewage disposal system above described will be constructed as drown on the approved amendment thereto and in accordance with the standards. rules gnu rqu pMnity Deport ewe of Health. and that on complatlon.thereof a "Certificate of Construdion ComplianW satisfactory to the Commissioner of HMRhwill be eMcnRt" to the Dopertmen% and a written rAwanteo will be fumid" the owner, his sueassors. Wain or assigns by the builder. that said buNdw will ~ In goad .aiplintang common. any pert of Yid aawa a disposal system during the period of two (2) years bnnladistely followltlg the date at the Isew area of the approm Of thoCoWtHkate of Construction Compliance of the original system or any repairs thereto, 2) thA the drNNd wssl down" a=ver who be IOOetM at M apprevM Plan and that Yid well will be Installed In accordance w the standards, ru r s of tM m County Oapart Of IL Data Signed ` RE., .A. Adllr.sf Z y3 /Y� N % iefmse N 3 APPROVED FOR CONSTRUCTION: vh% opprowi expires two years from the t• Issued un to%, on of the buildhtg has t=een undertaken and is fMOdble for err be i n o dad or rrladUled when considered the Com M IWItW. Any change or Itwaton of construction IaouNaa a now mi). /Pppreval for dismal of dowwstk IMlltery a or p star supply only �,�.� Dolls of P- Approval t Adblam C n fk zMIHIq at Subdivision Approved Fee Enclosed ❑ - Amrnint, Bolu[ Type ` Lot Aces FM Section Ody DPI _�VW _ � � Nobor of Bodro�e _ Design Flow G P D % PCHD NotlReatbs V Required Wbm FM In aapieted S"lisli a Saweeaip SpatM to clogim of ( Go3:2, O. SSsptic Tsnt ma � ^�+ +. , �r O'� 4 "' CH To be oesaf cooled by— ` ' V5 Ad&m Water Sop*: p Sm* Fran Address ge ✓vl..e. SdDclBd b7 ` — Ad�eea 1 represent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sew di sal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards. rules a regulations o • ruinam County Department of HMKh, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Heashwill be submitted to the Department, and a written guarantee will be furnished the owns', his successors, heirs or Vftns by the builder, that Yid builder will pIK• in good operating condition any part of Yid Sawa" disposal system during the period of two (2) Y 1 lately following thedate of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or a repair that the drilled well described above located be cat•d as shown on the approved plan and that said well will be Installed i r co wi tha rd , s and rpu n of the Putnam County Department of Health. Date " �,� . ���— Signed P.E. License R.A. Address License No APPROVED FOR CONSTRUCTION: This approval expiref two years from the date issued unless construction of he building his been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissoomr of Health. Any change or alteration of construction requires a now permit. Approved for disposal of domestic sanitary sewage, and/or private-;water-supply only. 10 /88 Data 1� BY /� ~�.L..�..� _ _Title j PUMAM CODNTT DWART=NT OF HEALTH _ 1� D atISet�leri.esld 1 Sae.bn. t%eseal. N.Y. ITSU im his 87 OOURWAM FOE /SWAM DEPOOAL SYSTEM P°R i — Z 2.3 ward at % O f� . vq� err vologis wrMa. ' �` La! / 3 S T. Map ! Welk Z — W 19�z / 11IM 4 Rawwa ° Data 1 how Mss Abboud S@ftS Adhis a � Twill, R'7✓',--XSo1 1 L/ qP Date Subdivision Approved Fee Enclosed ❑ Amrn,nr IVF aft Type S/ Lst Area Z 7i / cn For Sedlas Osb Dap* Vablr r G t Nosier of Bdr Dodos Flow G PD PCID Nedb admi la Ratldred WM FIS Y asslplsMi =apma" Swamp byabo a alit a1,0 := a Rae Soptie Twit .nd ( 7 To be Imodindoll b /� , iJ i Athena SuM ssv* Pte WaMr an ° , S +orb Dd d b9 T ; Tai i2, as ,m Otbar RalleirrgsitgL/ 1 Isprism t that 1 am wholly arld coalplately, responsible for the design and location of the proposed system(s); 11 that the sate sewage disposal system above described will be constructed as drown on the approved amendment thereto and in accordance with the standards. rules gnu rqu pMnity Deport ewe of Health. and that on complatlon.thereof a "Certificate of Construdion ComplianW satisfactory to the Commissioner of HMRhwill be eMcnRt" to the Dopertmen% and a written rAwanteo will be fumid" the owner, his sueassors. Wain or assigns by the builder. that said buNdw will ~ In goad .aiplintang common. any pert of Yid aawa a disposal system during the period of two (2) years bnnladistely followltlg the date at the Isew area of the approm Of thoCoWtHkate of Construction Compliance of the original system or any repairs thereto, 2) thA the drNNd wssl down" a=ver who be IOOetM at M apprevM Plan and that Yid well will be Installed In accordance w the standards, ru r s of tM m County Oapart Of IL Data Signed ` RE., .A. Adllr.sf Z y3 /Y� N % iefmse N 3 APPROVED FOR CONSTRUCTION: vh% opprowi expires two years from the t• Issued un to%, on of the buildhtg has t=een undertaken and is fMOdble for err be i n o dad or rrladUled when considered the Com M IWItW. Any change or Itwaton of construction IaouNaa a now mi). /Pppreval for dismal of dowwstk IMlltery a or p star supply only �,�.� DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION Street Addres own Village City Tax Grid Number WELL OWNER Name . Q Mailing Address i . g)-P'Yivate O Public SE OF WELL ]- primary 2- secondary SIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY O ABANDONED (3 OTHER (specify O AMOUNT OF USE YIELD SOUGHT_ gpm /# O REPLACE EXISTING' SUPPLY UWfW SURPLY 4NEW WELLING ) PEOPLE SERVED_ /EST. OF DAILY USAGE CpCO gal ❑ TEST /OBSERVATION E3. ADDITIONAL SUPPLY O DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE OrRILLED DRIVEN E]DUG CIGRAVEL U OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: CJ` Lot No. WATER WELL CONTRACTOR: Name =[= P-'* Address: IS POLIC WATER SUPPLY AVAILABLE TO SITE: " YES 6-116 NAME DF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTAQCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATLON SKETCH & SOURCES OF CONTAMINATION PROVIDED N SEPARATE SHEET �s (die) s gnature PERMIT TO CONSTRUCT A WATER WELL This parmit to construct one water well as set forth above is granted under the provisions of S ubart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thir t, (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. Duri-xii all well drilling operations, the applicant shall take appropriate action to assure that any ad all water'or waste products from such well drilling operations be contained on this pro p icy and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date f Issue: 19 Date f Exp 5r ti n 19 � � Permit Issuing Official Perr:cri is Non-Transferrable White copy: HD File Pink copy: Owner 3/8 9 Yellow copy: Bldg. Insp. Orange copy: Well Driller r� Al4 ati Division 4 Geneva DEPARTMENT OF HEALTH of Environmental Health Services Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # j /// WELL LO'ION Street Address TOK s qa Village City Tax Grid Number - J2 WELL OUTM Name , Mailing �� X Address Wrivate OPublic USE OF W.111 NIL primaxl - secondiy �ff CK SIDENTIAL O BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY 0 ABANDONED ❑ OTHER (specify, 0 AMOUNT 01 USE YIELD SOUGHT �J— gpm /# PEOPLE SERVED /EST. OF DAILY USAGEC9�a1 REASON FD DRILLING 13 REPLACE EXISTING SUPPLY CKEW 5UPPLY (NEW DWELLING ❑ TEST/ OBSERVATION GE ADDITIONAL SUPPLY O DEEPEN EXISTING WELL DETAILED REASON AR DRILLIiG WELL TYPE DRILLED DRIVEN DDUG GRAVEL OTHER IS WELL SITI SUBJECT TO FLOODING? YES ✓ NO IF WELL IS 'DCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL ONTRACTOR: Name Address: IS PUBLIC WZ ER SUPPLY AVAILABLE TO SITE: YES C_­_ NO NAME OF PUB$ C WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SRRCH & OURCES OF CONTAMINATION PROVIDED N SEPARATE SHEET (date) TS7 ignature 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 Department attached to this permit. 3. Submit a Well Completion Report on a form requirements of the Putnam County Health 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. Date of Issue: ,1� --{� 19� �--- Date of Expiration 195 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 COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # Well Location: Street Address: - To illage Tax Grid # '--, VCX' 'ate Map I "� Block Lot(s) Z ,"S Well Owner: Name: Address: p. O ,?> o t, z01 F e- 0' 4�P-F_A I PAJT9-RSo /`f- Use of Well: esidential 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 __5 gpm # People Served Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type rilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No G� Is well located in a realty subdivision? ...................................... ............................... Yes 6— No Name of subdivision Q ` 144 A A Lot No. Water Well Contractor: �'� ,� . Address: Is Public Water Supply available to site? .................................. ............................... Yes No �- Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed 11 location & sources of contamination to be provided on separ e s et/plann.. °' F Date: 47 Applicant Signature: v PERMIT TO CONSTRUCT A WATER 4LL 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 iller certified by Putnam County. ; Date of Issue Permit Issffici ati �J Date of Expiration Title: /i Permit is Non -Trans rabl White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller- Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # / �`�— %/ Located at S Subdivision name a Subd. Lot # Date Subdivision Approved Owner /Applicant Name E., Mailing Address Amount of Fee Enclosed Building Type S1A!W171Z, . �0 Village Tax Map / 3 Block - Lot 2-L i Z Renewal Vii'' Revision Date of Previous Approval Zip [�� Lot Area:; No. of Bedrooms E3 Design Flow GPD 600 Fill Section Only 1--"' Depth Z- ' Volume C, Y. PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of /Poe--, gallon septic tank and-53 3 f Other Requirements: ' ,� i3. I L i�'`�G- Y, To be constructed by :n i3, 0 > Address Water Supply: Public Supply From Address or: 1 /Private Supply Drilled by 7, -6, Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system 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. Signed: Address I If R.A. Date i A701 A-11 License APPROVED FOR CONSTRUCTION: This approval expires two years 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 w considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe p74,; fr discharge of domestic sanitary sewage only. .. By: 4 Title: Si— Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # J e I Well Location: Street Address: Town' illage Tax Grid # Sr, -T&,�tn15 f,A & c: a Map 13 Block Z, Lot(s)LZ,Z„ Well Owner: Name: Address: YD . A 6 11rrri ! �� Use of Well: esidential Public Supply Air /Cond/Heat Pump Irrigation primary Business Farm Test/Monitoring Other (specify) 2- secondary Industri al Institutional Standby Amount of Use Yield Sought 5r' gpm # People Served 5- Est. of Daily Usage A6VO gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling /IQew Supply (new dwelling) Deepen Existing Well Detailed Reason yc� for Drilling Well Type Drilled 1 Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes o Name of subdivision Lot No. Water Well Contractor: "]—.r Address: Is Public Water Supply available to site? .................................. ............................... Yes No C/ Name of Public Water Supply: Town/Village Distance to property from nearest water main: > 4a.1 Proposed well location & sources of contamination to be provided on separate sh t/pl F Date: Applicant Signature: , V PERMIT TO CONSTRUCT A WATER WEL 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 wat 1 driller certified by Putnam County. 11P r, Date of Issue f M7ef- Permit Iss ' ><cial: Date of Expiration ., Title: LrA Permit is Non- Transf r able White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Sent By: TOWN OF CARMEL ENGINEERING; 9146287085; JUN-16 -00 SAT 9 :07 AM PUNAM GTY ENV HEALTH Sep -19 -00 20:05; FAX N0. 19142787921 PUTNAM COUNTY DEPARTMENT OF HEALTR DIVISION OF ENMONM NTAL HEALTH SERVICES AT MTION 13 ADAM GENE - 9Fo =T FQR FrN 1. IN _CTION For: Fill All information must be fully -completed prior to any Trenches x inspections being made. Page 1/1 P. I PCHD Conwwon Permit # Located: 11 -5-t ,kll ti h (T) (v) Pa4rse Owner /Applicant Name: NJ D wl E I TM t 3 Block Lot as ' ;L Formerly: Subdivision Name: Subdivision Lot # Is system fill completed? u{ S Date: If( Is system complete? s ll Date: l d b �l Is system constructed as glens? 1.1 PT jiS t iDatc: Is well drilled? T/ Is wall located as per plans? Are erosion control measures in place? _ i A I ceriiiy tlyat the gstem(sj as lured, at do a_ _bone/ premises has beea constmeed and I have inspected and v+ri S -their completion in accordance with the issued PCHD Construction permit and approved plans and the Standards, Rules and Re cations of t e Putnam County Department of Health r l� r e I A I Date: A � Certified by: Address: l �' PE-)(— RA ifin Professional IAOt� lies. # �y 3 Z? 2 t1Sb) . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: 9 /;z i o� Street Location 5 }� ,Td���sd.� n Owner T2ic� Ian pe®te y: 2Een Town P.¢rT6rz so.y Permit # f'- i -5 - q/ TM # /:5 - ? - 1. ;2- Subdivision Lot # -- 1. Sewaize Svstem Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................................... *. *' ...... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. Sewage Svstem a. Septic tank size - 1, 0 ......... 1, 250 ......... other ................ b. Septic tank instal ed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2.. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & ,trenches e. Junction Box - properly set ........... ............................... ff, Trenches T-E—en-gtth required 3 Length installed 3-33 2. Distance to watercourse measured -!- io,:P.Ft.......... 3. Installed according to plan ......... ..............................: 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft, foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 1 %" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ........................ ............................... g. Pump or Dosed Systems Size ot pump chamber ................ ............................... .2. Overflow tank ........................... .................................. 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Building a. House located per approved plans ... ............................... b. Number of bedrooms ...................... 3 .... :F, X .............. IV. Well 2 C�'X / -�'/v w 't 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 installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 6/97 rd , '-.111., PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Located at V ' FA WS0AJ Tax Map # Block Lot o Z Subdivision of Subdivision Lot # Gentlemen: Filed Map # Date Filed This letter is to authorize 1✓� S, 1 -L a duly licensed Professional Engineer, or R%i 9 aos. to apply for the required 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 tretment 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. P_ Very truly yours, O.,C ntersigned: % Signed: ,���� �'' # 2iZ � ' (Owner of Property) Mailing Address 0, Mailing Address: State /V Zip /Q5_b7 Telephone: Ca o OSV% C 0, /� P, / �' e�' / Stat Zip Telephone: Form LA -97 Z� Jf 719 iJ P PUTNAM COUNTY DEPARTMENT OF HEALTH. DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner �-1-- Address mAO DP10e- Located at (Street) VT . 30 Tax Map Block Z. Lot (indicate nearest cross street) Municipality Drainage Basini SOIL PERCOLATION TEST DATA Date of Pre - soaking �;-1 a,q ! q, J Date of Percolation Test Hole No. Run No. Time Start - Stop Ela se Time (pMin.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate, Min/Inch 2 0, ,. 2-7 zz- z4 7 3 ar'Ys'� i,`i7 �Z ZZ 2- 4 �` rte' 3 27 ZCP 5 1 v'o 111),2, 2,3: Z l Z- 3 2 1f)"2711 Z 1 z 3 0 � s3liJ ' z3 3� z l z " " 3 iv 4 i/JzV. 75 Y 3D Z, i Z " 3 i0 5 2 � ,�srp o� 3 m TAW/ 4 51-� ( q� 5 %OFES \��P NOTES: 1. Tests to be repeated at same depth until "aplTrt3giihately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, < 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 11 it W{�+ Dhbi.n�Havbq COUNTY Hoch Seedoe.Saedoe�. OCarowl. N Y 14612 908how to Piles PwNlt IF \ X�3 m CERTIFICATE OF CO � CE CONSTTZucnoN PERMIT im SEWAGE DEPOSAL SYSTEM 1��� A tnI r%�I�)�-h � A07-3 Taws W mote Nero Ot Subd Lot / Ter: Mapes-_+ Block Ova f i ppiat Naf•g �. d /��__�d0. Renewal_ ❑ Devldm ❑ Date at Approval M+r s Aa6. V2504 -Z-6 Z Town i 7 Gra pat Subdivision _A.RRroved Fee Enclosed ❑ '7-b w 110110111 y Lot Ann. Fm S Day Deptb volume F Nobs d Hei� 9 De.iv Flow G P D, PCHD NodGesdan Is Required Wisest Fill In ampk/ed Sepamta Se Moo SYMIN to ow=let d Guild Septic Took . W � 1 t-- 4 t 1 1 Te be o.udNet.' by .T ej . ►7 Addre.. Water Supply: Pwwk Supply Fk �+ ^ AdieN an ✓ Pra.eaw Supply DOW br l ` ��!, y Addmn Ode d �' ... 0. e) . �7 `S' l Lx, 1 represent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate fear di sal stem above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a rogu erns o naR County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissionor of Woalthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs a a s by the builder, that sold builder will blare in good operating condition any part of sold sewage disposal system during the period of two (2) year in lately following thedate of the issu- anp of the approval of the Certificate of Construction Compliance of the original system or any rope t eto; ) that the drilled well described above win be located at th rrh on the approved plan and that sold well will be Instal s r ce w the s, r les d r gu aWgn of the Putnam County Dabs men? of Wealth. Date j[ Signed P.E. = R.A. loe Address U " License No APPROVEO FOR CONSTRUCTION: This approval exphe two years from the date issued unless construction of Ifif building .has been undertaken and is revocable for cause or may be Smarmiest or modified when considered necessary by the Commissioner of Wealth. An change or alteration of construction requires a new permit. �Ap�owedd for di sal of domestic sanitary ,sewage, prier t at supply only. O/88 Data 0 -P� � !� 8Y �^ Title r—�- -- PDOIAIf[CODNtRDEPARDOI TOFMALMS _ Dhid=dMmdnmNwld P).dr SardW& C uwk N.Y. 10811 =Cm 0 COPQIJAlICi C0I01190C ! P!111111iff M UWAO: DEPOSAL:YS:EN Ltl.aM� er aa,�q—, T❑rty'o,� Town a T1111101, a�alild..Ib.r gie Lit / T. lop 12) we& a ••• O,.,dAppRg.Pt 11,.. � . �' ��. R...wsi m� >b 2 ❑ Der .N. Appreed 11aiiR Adiwai�3 �_ - - -- -- Tow•. _ err .+list iy�r �i Let Ave Zn d-Y *� m SedMn o* 6eJ Daplb _Z—vai.»f"—, Nobs d 1ai.�Na .D@A Flow G P D PCBD N.IMratl.w Y R¢M 4Ybw Pt• Y /.pmmb sw w aria b en dd d 1 E n.s Saptb Tact Lila m+1411 U bar'sman td 1w 1js 1 �w watefr �p4b:. suadd.Pb at &4d,4aa Sop* Dallied by I --n-Y Cn 1 Is -0 t that 1 asn wholly air aompl tNy responsible for the deign and location of the proposed 9ystem(q;'1) that the N .rate Nwa , di osol s stern above decribed WIN be constructed as ~non the approved erna110merK there to and in accordance with the standards, rules n r u COUlnty Depertownt N ""I% and that on cosnowl".thereof a • Certificate of Construction Compliance" satisfactory to the Commi 11 nar W WoeNhwin be adwoNtar to the Oepertul.nt, am a wrNtasl VAaraM., well be fumblod the owner his suaeN 16 Mina the buNN. that said WNW WIN gA.be in gale .dP.ratbq e.Irrtllos. say Dart of aid sessepe dbpeal sy" dwbq the paled of two (2) years Nnq6r4tW follswkq tow date N the New crap M the approval of the CertNlate of Constnogion Compliance of the origisel any Ir$ t 2) the drilled we dells ter mono "a be leeeted a Mors so the appvvw plan air that Nld Well well be Installed In h t a roguTi ail Ss f the Putnam Cowtty Osbert nl "UM Dote 1' 6® steed P.E. - ....... X� J Lkergo No APPROVED POR CONSTRUCTIONi This approval expire two years from the date iausa0 Yn1aN co nbuctlon of building has been undertaken air Is Iaestable for aUN a nn.y N afhannr.r a mOdlfle/ when eonsld.ro0 a WNNf. ny ctlerlge w alteration of construction rewbea � aeyfML A- .rarer fa dapeal„�.seslelle NnNar Nww �Y��ppb mob. %d DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL 1-024904 PCHD PERMIT # I I WELL LOCATION Street Address d ©�y a Town illage City �a. Wit. Tax Grid Number 3 .2, 22 WELL OWNER Name Mailing Ad ress 0- rrivate O Public E OF WELL primary 2- secondary --ice``_ O'ItESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND HEAT PUMP 0 ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify O INSTITUTIONAL O STAND -BY 0 AMOUNT OF USE YIELD SOUGHT 6-- PEOPLE SERVED_ /EST. OF DAILY USAGE ob al REASON FOR DRILLING 0�, /REPLACE EXISTING SUPPLY Er NEW EWS PL (4EW DWELLING O TEST/ OBSERVATION O DEEPEN EXISTING WELL C[ ADDITIONAL SUPPLY DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN DDUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES L/ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: -- Lot No. WATER WELL CONTRACTOR: Name 'jr, am Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES j,,,tJO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH 6 SOURCES OF CONTAMINATION PROVIDED SEPARATE SHEET 2i (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 thirt3, (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 contai.'nate surface or groundwater. Date of Issue:_,] Qf 1� 19__� Date of Expiration ej �,G1��,3 19 Permit Issuing fficial Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg., Insp. Orange copy: Well Driller \ DIeWs dDMlr�awawlal BsddY SeevlsM. Cam" M.T. 1012 M laevlie UANC / • ZE OlOO1�UAlI1Ci POSE M WHAM DOPOSAL STS M / � 16 —9 ` Ssillvlbin YAW /� 1 ' �+/ tat Tg Map V ?,3 iii 'Z Let Z, L 0. /Apprwae Yl �ti� . Dap d heviw A�ravd •`` ^, MWOS A/haaa �Pin�2K TOWN -_ k N VI ap f Z �lD� Date Subdivision Approved p Fee Enclosed ❑ Amnnnnf- N�aa d Dairy - Design Flaw G P D i PCDn NsfSIM1Ma k sa4deed Wtlw PSI Y eawpMMd Sepwrp sw my 93 - p await d i � tier Sepik TMA 1 �f 1--L ki . T'T GD_ To M aeaaraeld by ;M, AdinM watts SW*3 •+R• 9 Pbv � DOW IN wt V rn b..a. SMppEt i �, era.... - - - - 1 npnaenl that 1 am wholly and completely n10- fisible for the design and location of the proposed system(gi 1) filet the separate sewage diesel system above described will M constructed aS shown on the approved amendment there to and In accordance with the standards, rues awn nju o County Deg artmIers of Hisank. and that on c, III Holsthersof a *C"ficate of Construction CompliamW' satisfactory to the Commissioner W MMRhwlll be siubfnMpd to ten Ogertment. and a written guarantee win be furnished the owner. his succo00re, hairs or assigns by the bonder. that Old b6"w will platy II pen .rparNing aalldssipe any on of said sewege disposal system during the period Of two (2) WWII Immediately following thadete M the NOW saw Of the o"MON *I the CartNkele Of Constructions Compliance of the original or array r It t) that the drmw wall dome" above wo be located as shown on the approved plan and that said wan will be Installed in ah t pare and erg Oars of the Putasm County mss" of MNRk. Oats ?i SNd P.E.�R.A Address License NO APPROVED FOR CONSTRUCTION: This approval expires two yens from the date issued unless construction of ten building has been undertaken and is fevo"ble for cause Of may, be amwlMd M modified when considered neeetsary by'still, Commissioner of Health. Any change or alteration of construction melee! a..- A revel for disposal of domestic senaary to or fu b only. Rep.. �9, � Tess f �/ �O /VY. Osgo � P� Delia dBnvbrawwil S od& Suvkarr CMEWL II-T- I I w !E OIPwvmo Paaallb / Terms tD mak 2',!�, to ✓' � 'oL•17, Yeaewrl_ O b.we: o is o a . v ._ Amniint- IV Mils Tip. n %A=1 \(W � Lat Ave, w / /LJ ,_/ -a..r = s«tw Oar U Dsp& Vdi lltaiar d Slshmma I Dodge Flow G P D PC®Nalleedtlea Y leoird WMa M k eawpiid Sepw.p SWWMV SIsM= to a mm e(A Oun6ass, Sepik Ttaak - LA lKA ----� .t To b esa kwiled by o weiw Sappb Address an �ti asap S1I11* by OtLae lid�MYrsewM 0 1 ►prewar that 1 am wholly and completely raspensibN for the design and location of the proposed gstem(pi 1) that se at !aw di sal s atom above described will be constructed as shown on ten approved amendment there to and In accordance with the standard, rules a ngu M or County Department of MaaRh. and that On completion. thereof a "Certifscale of Construction Compliance" satisfactory to the Commissioner of MMahwill be a10aaes" to ten Oeprtnlsslt. and a written guanntM Will be furnished the owner. his sutcessen. heirs or awgne by the builder. that said buMder win ~ io geed .opuatbg Oat "IM any part M said Swap dispose) system during the period of two (t) yen Imm e"tellr following thadate W ten New sage of the approves of ten Certificate W Construction Compliance of the original system or any repairs thanto )that the drnled wall dewIM above wIM be located as d aarh on the approved plan and that sell well will be Instal In nos Rh ten Ise and repusl l of the hAham Coul ty limb Of y"Mal Date l %✓ T'�1 1 Signed RE. .A.- Addrels x License N APPROVED FOR CONSTRUCTION: This SMMPa1 explse try from the date sewed unless construction o t buildIng has been undertaken and is nvg,Mis for cause or may be af1NnM0 or modified when co sNNred ry bny�the Commissioner of HUNK ray change Or alteration of construction Rev., wwlree .' now ' permed.( ppreved for dNOeW or aexvesik can //n i! U V) i��/�/7woob Only. rl /1 �j 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 #Aoeyl WELL LOCATION Street Address Town/Village/City �ax id N ber �—� — WELL OWNER Name ailing Address k3iFlivate �J 2, D Public G4dSIDE AL OPUBLIC SUPPLY ®AIR /COND /HEAT PID6 ❑ABANDONED 0 BUSINESS 0 FARM O TEST /OBSERVATION O OTHER (specify 0 INDUSTRIAL U INSTITUTIONAL O STAND -BY O USE OF WELL a - primary 2- secondary AMOUNT OF USE YIELD SOUGHT 15—gpm /# L] REPLACE EXISTING SUPPLY M-NfW SVPPLY (NEW DWELLING PEOPLE SERVED_ /EST. O TEST /OBSERVATION- ® DEE EN XISTING WELL OF DAILY USAGE gal D: ADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE WRILLED ❑ DRIVEN ®DUG ® GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot 'No. -- WATER WELL CONTRACTOR: Name j : C� 7 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED 9M 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. 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 o erations be contained on this property and in such manner as not to degrade or otherwi e c ntaminate surface or groundwater. Date of Issue: 13 19I Date of Expiration 19 Permit sluing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller PC -1 PUTNAM COUNTY DEPARTMENT O F HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM „aril 1. Name and Address of Applicant: 2. Name of Project: 3. Location T /V /C: 4. Project Engineer: , KjC.kia,-Kz_ :K:_ l . �� 5. Address: �-(��aX Z43 License Number: `--tom' 422 6 Phone: 6. Type of Project: private /Residential Apartments Office Building Food Service Commercial Institutional Mobile Home Park 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 8. Is a Draft Environmental Impact Statement (DEIS) required? N1a 9. Has DEIS been completed and found acceptable by Lead Agency? ........... 10. Name of Lead Agency 11. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? .... L .......... ........................r'��ti"D 2. If so, have plans been submitted to such authorities? .................1�� O 3. Has preliminary approval been granted by such authorities? Date Granted: 4. Type of Sewage Disposal System Discharge...... Surface Water Ground Waters 5. If surface water discharge, what is the stream class designation ?........ 6. Waters index number (surface) ........... .....................-......... 7. Is project located near a public water supply system? .................. 8. If yes, name of water supply Distance to water supply 9. Is project site near a public sewage collection or disposal system ?..... a 0. Name of sewage system Distance to sewage system 1. Date observed: 23. Name of Health Inspector: 4. Project design flow (gallons per day) ....... e. SPOT? qTD- Ccrff"&- (!D— f"6;'c q -P'D , 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. 26. Has SPDES Application been submitted to local DEC Office? ............... _ 27. Is any portion of this project located within a designated Town or State l �I wetland? .................................. ............................... 28. Wetland ID Number 29. Is Wetland Permit required? ........ ............................... .. ti Has application been made to Town or Local DEC Office? .:................ 30. Does project require a DEC Stream Disturbance Permit? .................... R) 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ........ YES or NO LL O 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 DESCRIBE: 33. Is there a local master plan or file with the Town or Village? ..........:- 2. 34. Are community water, sewer facilities planned to be developed within 15 years? 35. Are any sewage disposal areas in excess of 15% slope? ................. 36. Tax Map ID Number ......................... .....,......................... R 0.-23 - 4J,z. oaf 37. Approved Plans are to be returned to: ................ Applicant 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 be 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 Class A Misdemeanor pursuant Section 210.45 of the Penal Law. /, / SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner ��[iii4T t� �P-�, AddressT T Located at (Street) p lk �S �� aZ_ t D Block 3 Lot e+ � • 1CO (indicate nearest cross street) -,7Z, ) Municipality Watershed SOIL PERCOLATION TEST DATA RBQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre - Soaking Date of Percolation Test HOLE NUMBER CZOCR TIME PE RCOLATION 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 1 1 to:`i� 2 t0 - t t'• 1'L 12 �� '27 3 C,/ 4 5 2 o49 ^tl -o7 18 4 2 3 5 1. Tests to be repeated are obtained at each for review. 2. Depth measurements tc rev. 9/85 at same depth until approximately equal soil rates percolation test hole. All data to'be submitted be made fran top of hole. r TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH — HOOLLE' NO.. HOLE NO. �2+ HOLE NO. off 1' ''�1 uJt.� SAwlO(a �/gfVh R� a or/ rU!�'N✓/ 2' � 3' 4' 5' 6' 7' 8' 9' 10' 11' 12' 13' 14' �j Sao INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED I INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used 1— ( Min /1" Drop: S.D. Usable Area Provided pJ=-�Q � No. of Bedroans 3 Septic Tank Capacity LQQC) gals. •Type ti Absorption Area Provided By S90 Other 0 L.F. x 24" width trench O C. Name "",� --� tC.l14�r " —���( �.�Gr' Signature m m THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved �oF N! � Q48Q8� E S S 10h% sq.ft /gal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DateC� -(-- Re: Property of Located at (T) S C) Block -3 Lot 13 Z 2. Z . Z Subdivision of Subdv. Lot # Filed Map # Date Gentlemen: T. MICHAEL DALY, P.E. CONSULTING ENGINEER This letter is to authorize P. 0. BOX 243 QdiiYKlAiGa►ln K N as 1058? ${�deq�'�IaTAV a duly licensed professional engineer or- regJq +PrarI arc1,14;pwt (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 conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, S g ed Countersign�3"' caner of P operty P.E., R.A., # �T. MICHAEL DALY, P.E. Address P.O. B®X2�3 M#WOROCI{, X Y. 10597 � 1�%z'lq 0'(�-D 7 Telephone cAAdddress c, Town Telephone