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Home My WebLink About0519DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 15. -1 -40 BOX 6 IN :I; I w;!.N--: A li V. IN' 1! N 7-- IN I a 0 , j . , IN `� ., so I """' I IN L I I ki : a IBM IN 1 2 6 ,• I Imo' 'L me IN I , r r it 00519 Laealad ad r l v - v: / 1 g. r —%-- v - .... .. .J...1W V Sabdlvlalsw . Y:1V✓1 �7 . Lot i Tax Map Mack C td Il r'1 •� l Renewal ' Q11,1" D O�px /APpYeaa>< Nave Date of Previom Approval NlIIh$ Addmn patg ubdivision A nhrn ed Fee Enclosed Amhiint Type � Lot Area P111 Seetlop' Oall<y .. Dop Valtime Ntl,bae of Hed<� Deatyn Flow G P D PCBD Notletatlm b Regatioil W6ep PIS b oompbted SePeeals SeweeaLo.S7rtos a own" d 2� Gam SWft Twk To be oae11haded by Addrem Water Sup*t _ PtA &-SM* Ptos Add— Other b gm I %.— . 1 represent: that 1 am wholly ale completely responsible for the'design and location of the above described will be constructed as shown on the approved amandmerit there to and in a County Department of Naalth, and that on completion thereof a "Certificate of Constr be submitted to the Department, and a written guarantoe'wpl be furnished th owner, place in good Operating condition any art of said sawage disposal system ,d rino th crop of iM a0p►ovaI of the Certificate of Construction compliance . of the Igiel s will M loriated a snosyn on tho app►owd Pun and that said well.will bid installed creep County Depart Ith. ate / APPROVED FOR CONSTRUCTION: This approval expires two years from the dat revocable for cause or may be amended or modified when consider ed neceuary the t nOuires a new rmic. App► r sal of domestic sanitary serge and/or p Rev. 10/88 pace Y ev -- the the Commissioner of Nealthwill he builder, that said WNW, will ip following theate of the isau• he drilled well deieribad above reou a�Tirns - of the Putnam P.E. RA. leehee No " 2�) ling as been undertaken and is 9i 'or alteration of construction 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 # &'73 0 WELL LOCATION Street Address Town Villa a ity gam/ :5- /�4-r � Tax Grid N m er s= i �- WELL OWNER Name : �- ✓�(Z. Mal ',,ling, Addr s >CA,i~j7crv0 (U 1 ZS .b c�fvate O Public USE OF WELL 1 - primary 2- secondary EkESIDENTIAL D BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP D ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify O INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE__,gal 0 REPLACE EXISTING SUPPLY O TEST /OBSERVATION D: ADDITIONAL SUPPLY STEW SUPPLY NEW DWELLING D DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE LED DRIVEN []DUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES 011—N6 IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 6tzj Lot No. WATER WELL CONTRACTOR: Name �i�w'l Address:. IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES 04--NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: ? / �( Pee� LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ❑ON SEPARATE. SHEET da e) (signatu PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirt, (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 cont�� surface or groundwater. Date -of Issue: GA� 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 r• •• r �• •�i is • : y r. • • �• • i� v •i31,214V:87-fa - tea. DESIGN DATA SE=- SUBSUF/ACE SEWAGE DISPOSAL SYSM4 FILE NO. Owner ` Address SGGti�ly c�� f �Z�'� evL 7 �J i z� Located at (Street) -Y L M S -F-c -YLZ a `-�Yq Sec. l Block 1 Lot D (adi.cate nearest cross street) Fun.icip3lity el - Watershed J� • ■ • �• •• r y • v ■• �� • : na• v • Date of Pre- Soaking H&114 Date of Percolation Test HOLE NUSM a= TIME ZCO=CN PER(i.,}' LATION 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 2 3 - - - - - 1 2 3 4 5 1 2 3 4 5 I/, -el( _VW NOTES: 1_ Tests to be repeated at same depth until approximately equal soil rates are obtained.at each percolation test hole. All data to* be submitted for review. 2. Depth measurements to be made fran top of hole. TEST PIT t • Y• RE• t Mt TO BE SUBMITM WITH APPLICATION DESa=_ON OF • ■ :1 •• • :1' :tt nq TEST HOLES ECIE NO. :• • ROLE NO. t • U22 In ON DI ' • t • /• MR, WMI DI •• t No Y:1. 71t ■ • Y DI • :■ /• Y:1• :1 VIM= t DEEP HOLE OBSERVATIONS MADE BY: DATE: DFSI&N Soil Rate Used E� Min/1" Drop: S.D. Usable Area Provided No. of Bedroans Septic Tank Capacity I Z gals. Type Cow C�- Absorption Area Provided By L.F. x 24" width trench Other ��-- e Nam GI �--�1 /�G i � g Si nature:r •; Address ( SEAL 14• THIS SPACE. FOR USE BY HEALTH DEPAEM_gM' ONLY: Soil Rate A.proved sc_Tt /gal. aec!ced by ra te PC -1 PUT NAM COUNTY D E PART M E NT OF H EA LT H APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: 1-H cw -��Ns /mss 2. Name of Project: ,��E"L�l� 3. Location T /V /C: 4. Project Engineer: /� /L�LI/�Z- 5. Address: I'''0 900 �4 cf ber: License Num 2.7% Phone: Z?S /73a- 6. Type of Project: , _A Private /Residential Food Service•- Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Othe*r'(specify) 7. Is this project subject to State Environmental Quality Review (SEAR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted X 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. 9. Has DEIS been completed and found acceptable by Lead Agency? ........... 10. Name of Lead Agency /JO 11. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? .......... ............................... 12. If so, have plans been submitted to such authorities? .................. 13. Has preliminary.approval been granted by such authorities? . Date Granted: 14. Type of Sewage Disposal System Discharge...... Surface Water -K Ground Waters 15. If surface water discharge, what is the stream class designation ?........ 16. Waters index number (surface) ........... ............................... 17. Is project located near a public water supply system? Ai U 18. If yes, name of water supply Distance to water supply 19. Is project site near a public sewage collection or disposal system ?..... %U 0 20. Name of sewage system Distance to sewage system f 21. Date test holes observed: 22. Name of Health Inspector: 23. Project design flow (gallons per day) ....... ............................... 11/93 2. 24. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. 25. Has SPDES Application been submitted to local DEC Office? ............... 26. Is any portion of this project located within a designated Town or State wetland? .................................. ............................... 27. Wetland ID Number ...............:........ ............................... 28. Is Wetland Permit required? .............. ............................... Has application been made to Town or Local DEC Office? .................. 29. Does project require a-DEC Stream Disturbance Permit? ................... 30. 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 31. 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: 32. Is there a local master plan or file with the Town or Village? ........... 33..Are community water, sewer facilities planned to be developed within 15 years? 34. Are any sewage disposal areas in excess of 15% slope? ........................ 35. Tax Map ID Number ......................... ............................... 36. 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 to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: 2. 25.. Is State Pollutant Discharge Elimination System (SPOES) Permit required ?.. [o. Has SPOES Application been submitted to local DEC Office? ............... 27. Is any portion of this project located within a designated Town or State N Q wetland? ........ : ............................................ ............ 28. Wetland ID Number 29. Is Wetland Permit required? .............................................. 6k Has application been made to Town or Local DEC Office? .................. r-- 0 30: Does project require a DEC Stream Disturbance Permit? 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, ,� 1 landfilling, sludge application or industrial activity? ........ YES or NO Dv 32. Is project located within 1,000 feet of existence of abandoned. landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or N 0 any other potential known source of contamination? ..............YES or NO DESCRIBE: . Is there a local master plan or file with the Town or Village? ........... 34. Are community water, sewer facilities planned to be developed within 15 years? Q 35. Are any sewage disposal areas in excess of 150 slope? 0 36.. Tax Map ID Number . ............................... .... 37. Approved Plans are to be returned to: ................ _ X 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 pun ishab 1 e a., the Penal Law. SIGNATURES & OFFICIAL TITLES: M, TI_ING'. ADDRESS :: F. ... .–MINAMCOUNIT Salt xd. dam. FY3 b PVaa Pest ➢: Datc Subdivision Annroved Fee Enclosed ® Amniln*t- a a Bet AMC FM Selma ®ady 0 Depth 1—Vdlamm� N abeir of Medwam. Dadom Floes G P D PCHD 14690ciation Is Relisdred Wben FM Is coumblied S11,11611111111111 SeWMP Syi ilm to emakk d Toetr TO he O=z&C:dQd b7 -AM Addiew Wow Sqpply- Pali: St Addrom Sap* 01 1 rapresenu -that 1 am .wholly and eompietely responsible for the design and location of the proposed system(s); 11 that the separate sewage diva system above dowibod, will be constructed as shown on the approved amendment there to and in accordance with the standards, rules anTragulations o nam County Deportment of Ofealth, and tnaVon completion thereof a "Cortificate of Construction Complianco'i satisfactory to the Commissioner of Health will be =mated -to the Department, and a %vritten.quarantee'will be furnished the owner, his auccessors, heirs or. assigns by the bulkier, that said builds will piece in good operating condition any part of said sewago.oispowl system during the par I" of two (2) years immediately following the data of the Islam• ante of the approval of the Cortiticato'of Construction Compliance of the • iginal system or any repo s her o12) that the drilled well dascrilled above will be located as gumn on the approvod plan and that said well will be Instal in a nce th a rules and rsgu� omens of the Putnam County OopaR nt "With. Date Signod P.E.— R.A. Address License No APPROVED FOR CONSTRUCTION: This approval empires two years from the date issued unless construction of the building .has boon undertaken and is revocable for cause or may be amt r modified when consldared necessary by the Commissioner of Health. Any change of alteration of construction requires a na1B erma.. ppr or d posal of domestic sanitary sewage, a. Ler— p►ig$S water�pply only. Rev. —�� 10/88 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 # � -�3 yV WELL LOCATION Street Address MS dtJ1& Town Village City . . Tax Grid Number S0/V CZ) 1x--J- q U WELL OWNER Name U M a-1 1 ' ng Address dL j) dvpe LL GI.Private Q p(,iC q *G '5 0Public USE OF WELL 1 - primary . 2- secondary M.RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP 0 ABANDONED O FARM O TEST /OBSERVATION 0 OTHER (specifq U INSTITUTIONAL O STAND -BY 0 AMOUNT OF USE YIELD SOUGHT q6PMgpm /# PEOPLE SERVED /EST. OF DAILY USAGE E gal ❑ REPLACE EXISTING SUPPLY O TEST/ OBSERVATION 12 ADDITIONAL SUPPLY JaNEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE SDRILLED DRIVEN ODUG OGRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES oC NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES I"', NO NAME OF PUBLIC WATER SUPPLY: r--- TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: 7 7 ION SKETCH & SOURCES OF CONTAMINATION PROVIDED O ON SEPARATE SHEET Au (date) s PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within 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. Date of Issue: �L2 !L j/�'c- 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 1 W io 11.x' I � \ \ \ 2y8 / • . 0 \ 1 f \ CsNG 4 ` •.\P7 K G1, AO 1„ • ' E :7 �, R• soo.bf' 1` 0 LCi4ST W 7W 6N 1 11 pop"- Ql U bSa e Del i Q 0 $10 . AbtA« f/,eA N &4V Avj wow. `-� LCi4ST W 7W 6N pop"- Ql U bSa e Del %XXXXX\ S) L'i DDS /GN DA a-/0 MIN. < 10'- 32:112. -�'_ EXIs7 /N� 50 HIL M ,j PUTNAM _ COUNTY. DEPARTMENT.OFHEALTH 'r V . 386 Division of Environmental Health Servkes el, N:Y.10512 Engineer to Prdvide Permit li Carm b on CERTIFICATE OF COMP _CEj Q Permit IY CONSTRUCTION PERMIT FOR SEWAGE: DISPOSAL SYSTEM Located at or, 'Village Subdivision Name Sabd. Lot q - 1 Tax Map Block tut .1,3 T Renewal_ ❑ Revision ❑ Owner /Applicant-Name o Date of Previous Approval Mailing Address .Town Zip' Bdllding Type r 'A%i �T .. Lot Area l FW Section Od SO y Depth Volume Number of Bedrooms // Design Flow G /P /D 6+��o� /PCEED Nototificatlon is Required When Fill Is completed Separate Sewerage System to consist of Gallon Septic Tank and To be constracted.by' Address' Water Supply: ` Publlc' Supply From Address or: x _Private Supply Drilled by Address' Other Requirements I represent that.l am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage .disposal system above described will be constructed as shown on the 6pproved'amendment there to and in accordance with the standards, rules and regulations of e Putnam County - Department of Health, and that on completion thereof a "Certificate 'of Construction Compliance " .satisfactory to the Commissioner of Healthwill 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 disposal system.during the period of two (2) years immediately following thedate of the Issu- ance. of the approval of the, Certificate of Construction Compliance,- of the original syste or any repairs thereto; 2) that the drilled well described above Will be located as shown on.-the approved plan and that said well will De Inst in, ac rda with the stud ds,. rules and regu aTf ns of ithe ' Putnam County Depart nt f Health. Date Signed -, /mil, �G P.E. R.A. — Aw Address AL -4 License No APPROVED FOR CONSTRUCTION: This approval expires one yearj m the date- issued unless construction of the building has been undertaken and Is revocable for cause or may be amended or modified when_corisidered necessary by the Commissioner of. Health. Any change or alteration of construction requires a w :permd— approved for ''disposal of ,domestic`saniiiiy' ii4iije, and r hate water supply only. ' Date 'ii ? % /`�!� C �%�9. y � � Title PC-1 pUTNAM COUNTY DEPARTMENT +OF HEALTH 1 APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: _ nik 2. Name of Project: h P�l�oc( 3. Location T/V /C: ,Pe 4-64 o l �U 4.. Project Engineer: �G � (/L �� (( �Y 5. Address: & o x .LZSrl7 Y CG•� ✓%Q, l du� License .Number. 21 1 Phone._ 6. Type of Project: _ Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEAR)? Tvoe Status (Check One) Type I.. Exempt Type II. Unlisted °C 8. Is a Draft -Environmental Impact Statement (DE?S) required? ..............d S las 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, orother officials, ordinances? ......... ............................... nJ 0 12. If so, have plans been submitted to such authorities? ................... r- 13. Has preliminary approval been granted by such authorities? Date Granted: 14. Type of Sewage Disposal System Discharge...... Surface Water A"s, Ground Waters 15. If surface water discharge, what is the stream class designation ?........ 16. Waters index number (surface) 17. Is project located near a public water supply system? .................. %V O 18. If yes, name of water supply Distance to water supply 19. Is project site near a public sewage collection or disposal system ?..... 0 20. Name of sewage system Distance to sewage system 21.�ate observed: 23. Name of Health Inspector: ' 7 QrQ S 24. Project design flow (gallons per day) ...... ............................... `� • / Y r• •• � �• • -fit, ly • :t:►• Y: / I' � i /' •' ' i� Y• :ty Y: `tic• r� DESIGN DATA SdEErSUBSUFACE SBQAGE DISPOSAL SYSTFri FILE N0. Owner Y1 Ad 6wc-- Address , Q) G�VC 2 2, Located at (street) Sec.. + S Block j_ Lot (indi to nearest cross street) Municipality Watershed V �-- SOIL PERCOLACION TFST DATA RBOL= TO BE SUBMITIED W= APPLICATIONS Date of Pre--Soaking Date of Percolation Test HOLE NUEM CLOCK tCOLATION PERCOLATION Run Elanse Depth to water From Wate- Levu No. Time Ground Surface In Inches Soil Rate Start Stop Min. Start Stop Drop In Min/In Drop Inches Inches Inches 1 ' 2 1 2 3 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to* be submitted for review. 2. Depth measure ants to be made fran top of hole. 2. 2-51. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. Iv a 26. Has SPDES Application been submitted to local DEC Office? ............... 27. Is any portion of this project located within a designated Town or State N wetland? ........:......................... ...................6........... 28. Wetland ID Number ....................................................... 29. Is Wetland Permit required? .............. ............................... Has application been made to Town or Local DEC Office? .................. 30.' Does project require a DEC Stream Disturbance Permit? ................... 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 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: . Is there a local master plan or file with the Town or Village? ........... 34. Are community water, sewer facilities planned to be developed within 15 years? 6 35. Are any sewage disposal areas in excess of 15,00' slope? 35. Tax Map ID Number . ....* .......................... ...........l. .... ! „ .. U 37. Approved Plans are to be returned to: ................ /K 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 C1a s AH isde anor�► �pq Section 210.45 of the Pena 1 Law. �f �,��, 1 YO^ SIGNATURES & OFFICIAL TITLES: M ,"LING ADDRESS: Co TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCXxT YMW IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 1r 2' 3' t k � V Vu V 61 4' r 5' S01 ^�T �6 O UrC� 6' ?' 8' 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WfiICH GROUNDMTER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used ' f� Min/1" Drop: S.D. Usable Area Provided No. of Bedroans _ Septic Tank Capacity I Z ,FP gals. Type 0921 C,- Absorption Area Provided By =L= L.F. x 24" width trench t Other %fi A/, Name h b—ol f Signature _ ,s Address % SEAL 5?01 ' ^�1 THIS SPACE FOR USE BY HEALTH DEPARDIENT CNLY: Soil Rate Approved soft /gal. Checked by Date cdrstt � =ettt� APR -25 -1995 10:23 FROM CARMEL TOWN HALL TO e7e7025 P.01 Purim COONTY DEPARDSM CF HMVM Di�T1SICRI of ERMT 3 SER71C S - i RE: Prqperty of _IPo L LQ C J5,- to ted et 909 F,= N E (T) Section ✓r � Block - I lot Subdivision of &I f-,srgjr£ S l Subdv. Lot $ �. Filed Map # Date Gentleman: E This letter is to authorize a duly licensed professional engineers regifteved-emehi beet (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 f t' promulagated by the Cmvdssi.oner of the Putnam County Dent of Health, 'and to f sign all necessary papers on my behalf in connection with this matter and to f supervise the construction of said s stein or # . y systems-in conformity with the provisions of Article 145 or 3.474, Education Law, the Public Health Law, and the Putnam County Sanitary Code. Very truly yours, signer Counters oe ' $ Owner of Property D 6 , Quo er. 2 i P.E. •'` Address Sla - ess TCWA Tel phone TOTAL P.01 i19 Ott � " t:$ ( � .r i.l � / p r %jF i�1 �� f Wit• u"c a ".,n. q21 �� {'fit �, � • "} �` ` , .. `:` ` r •� r. . )IJ ts: ZY colic, Oz"3 Ji Poll, nu ,.,' , ; _ . • �y" _��• �y - 93.2 8 ;•-- owl wA Se-A L • � r. '1�^ , S If�,,;i�..�t� 1 ! � y r�F;i ► `..� �.;•4s.'.� 'T:� C�, .�.r. . , f.t I f. m ml qr j In till G„;y �i ,•�`;tt i� try gg � d1 � j i1 n S / .iii '` (1 i i 1 4 � 1 �.�: fi'ti, i� `j' +� +.. !Ct j �,,� �� . • 'i� �p+SC4��r •t k .t n t 't �F':: 5� i _ -�C' i Fr �/�, • ' ri, }%S S` ` �... / +dam •! ax I ..�.� it �ij, ,;' , 1 r+►rrr.:r..i....c�.. .,,�.r� •!��. •�. ` _1 �� .ice t` ' 'gyp �� y5 ,-• I �, �iuoy, � J �. r�l I7 (�. '+�, i ,J.k:r.. .l. u. i � iM .` _ � �• , r 7 .� �� 11\ �t 1 a 1 .� :•el�� 1b. i ersL 32 : 112 v • ::' • � : . J�•' = /0• �l9 "j� L = 93.2 6' -� ! '—` "•'S'' _"�'g �;7 • , :'V,; 4+.. .y,q. �:•.vi fiV„ +' •i �t �.' .l * �''r��"£ dY;I� 1C. ' � . A !� j., + j � v ail �. .j '� +iii �1 y h.• � 6 �' � � � .t� \S� ; , J� 1, +''t rn i.R1 'h • 'r- r` � : .ON! •t:'�. �� t ?�Sr j• �P•i!(i�+ � #• �i 3 I,�1 7 r• . • I� t444j Mly + �,1 , .+ , ,' ,•' Vf �7�, it is1 �r `�.�.. , All,��, � 1il� 1" r � .,� ) +� rr i �� ;t. r s ! y� ➢`�`s� ` �` : r r S r ' ' �>r. �j}�+�F �{f8 •� �` � �y;� P 1 1. t � 5: I �, \ .P :,2 _ :i � ........... rl all 'o 0.00 I(K Nov- �''1, • I1 I 1` }, y7 t I •" 4 32 '12" i ��1,�., i 1' . �� /�yR /I ��ppI } -�•�I t ��yrl. i La ,i' ' j1�j�.. • �� ..O" �'1: • � �+ . 1 ' `';+�-c•7P�� y oN E • ®= PERG. TEs7 .. • � _WEEP /f °aE TES"1 rya � .o f� l "Nl °- 21 =53�J ROAD SeALF- /" -yon /000 GAL. CQx/C s,5p7, 1G TANK y qs --5-o4/ ,p P/ ?,E: 07W. 7'Ah a .0 a�xE�s ,�'ooF GL�AD�kS F- Co711-16 TOR of 2 /Z 7 ,�08 F1LL SEGT. (12) 3O Fr Z-ATEZAC 5 GA�._AL.L ANDS' SPX ExYAN5i--1,11 Ar--A CRANK -z;� ANNuNZIATA SOME95 , N,, y F. •• / D1• . 1 li / / t' 0 � /• t' 1� Y• '1 �• Oly. DESIGN DATA SHEET- SUBSUFACE S&gAGE DISPOSAL SYSTEM FILE NO. Owner ZL)�c9�Address Az/, ; Located at (Street) ii'IJ%Z�2 CC- 0, S.C. Block � Lot (indicate nearest cross street) Municipality � � Watershed w: SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATfCNS Date of Pre- Soaking .`/ Date of Percolation Vest HOLE NUMBER C= TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 4 5 2 3p 3 ; 53 �� Z .�2 5- ��, 3/y 4 5 4 5 1 Nam: 1. Tests to be repeated at same depth until apprmimately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 2 16 3 3 r 4 5 2 3p 3 ; 53 �� Z .�2 5- ��, 3/y 4 5 4 5 1 Nam: 1. Tests to be repeated at same depth until apprmimately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITIED WITH APPLICATION DESCRIPTION OF SOILS 2M)NTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 21 VV 3' 41 61 71 81 91 10, l _fC, 1 � 40 -7 Sc Y/3 D 6?1,o1,;; r7o V 121 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING, ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DAM: DESIGN Soil Rate Used Min/1" Drop: S.D. Usable Area� Provided No. of Bedroans Septic Tank Capacity /00 _ gals. 7yjx K Absorption Area Provided By `3 6o L.F. x 24" width Other Name Signature I Address SEAL THIS SPACE FOR USE BY HEALTH DEPAMIEW ONLY: Soil Rate Approved sq.fVgal. Checked by Date I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ,/--Date Re: Property of �I U N CZ 1� . ?xn) cz Located at�� (T)PA =P,'�ON Section � Block 2 Lot 1 31 Subdivision of \ Nj r-Av�>-rnN 'ES -M-T2 Subdv. Lot # I Filed Map # 1 bJ 1 Date ^ I "S Gentlemen: y� w This letter is to authorize Gt�1/�- �, %j/�!/� A a duly licensed professional engineer --or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in 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. CountersicY,, - -- �; t 4!L� P.E., R.A., # / Xx- Dg: Address Telephone Very truly yours, Signed Y aZll%11 �`� • - ..- R (;�- Address ( RRELo Town Chi i57 (K- SCI )S ok Telephone DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION Street Address To V'lla e /City. Tax Grid Number WELL OWNER N e . Address aPrivate 0 Public USE OF WELL - primary 2 - secondary RESIDENTIAL 0 BUSINESS ❑ INDUSTRIAL 0PUBLIC SUPPLY ❑AIR /COND /HEAT PUMP O FARM ❑ TEST /OBSERVATION O INSTITUTIONAL ❑ STAND -BY ❑ABANDONED CI OTHER (specify AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED /EST. OF DAILY USAGE-1-00 gal REASON FOR DRILLING 13 NEW SUPPLY [)PROVIDE ADDITIONAL SUPPLY ❑ REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL ❑TEST /OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE LM DRILLED D DRIVEN ®DUG ® GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL LOCATED IN A REAj,TY SU IVISION, NAME OF SUBDIVISION: zm , I � Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES )( NO NAME OF PUBLIC WATER SUPPLY:- DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: TOWN /VIL /CITY LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED r ❑ON REAR OF THIS APPLICATION SEP T SHEET (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 Putnam County Health Department. ~ Date of Issue: 19 "C- J�r ---- Date of Expiration: 19 Permit Issuing 0 i -a1 Permit is Non - Transferrable a PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS A_r-PROVED FOR BEDROOM COUNT ONLY; P DP,OOMS )Signature & Titre' UP - COVERED TERRACE OPEN I TI - C bON 110 x 12r- BAT STOR. A STUDY LlI .1 1r ? � ' F CL. QUP GARAGE 188 x 254 x wer 46- O DECK 200 x ICP ON. DINING RM. BATH MASTER 100 x 118 EATING RANGE BED RM. KIT. Z 13° x 116 134 x 116 �' a O 3 BATH itPANTRY 6 CL. REF G d LIN. CL 11CL. CL FAMILY RM. 210 x 126 LIVING RM. 194 x 156 U�' N CL. I CL. ~ JENTRY JRM. p BED RM. BED 110 x 100 100 x UP F/I AM COUNTY DEPARTMENT OF HEALTH N OF ENVIRONMENTAL HEALTH SERVICES CERT OCATE OF CONSTRUCTION COMPLIANCE PCHD CONSTRUCTION PERMIT # /0— 1-3-15�51 FOR SEWAGE TREATMENT SYSTEM Located at iS P- r M S-To N 1k, 1-) LL. 1204P Town or Village PGi #-e* s d AJ (-3- Owner /Applicant Name TOSS KO j p L Tax Map / S Block �_ Lot Formerly ®OL.i'i0 ct- Subdivision Name Subd. Lot # Mailing Address Lf-® 6 e /w S'/ N i�G� �Gl-f Ui✓ t % Zip /Z J� Date Construction Permit Issued by PCHDo��5� Separate Sewerage System built by L,XXY 3WIr l Address X, Consisting of % Z 50 Gallon Septic Tank and 41J '-O 1-74 Other Requirements: Water Supply: Public Supply From, Address or: Private Supply Drilled by � d1 rely- C Address 1-G} rre4i?CQh%e- NY z.r y v Building Type fWelQ C I(-- Has erosion control been completed? -e -! Number of Bedrooms �i Has garbage grinder been installed? k 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 regulations of the Pu County Department of Health. Date: � LZQ&d"- Certified by P.E. R.A. (Design Professional) Address '3 5 6Q � �56� N X 7 I J� f License # 5.32-72 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 th private water supply shall become null and void when a public water supply becomes available. Such apprkivals are subject to modification or change when, in the judgment of the Public Health Director, such revocation o ification or change is necessary. B y: Title: r/ G� Date: Whit; copy - HD File; Yellow copy - Building Inspector; Pink copy- Owner; Orange copy - Design Professional Form CC -97 PATTERSON, NY 12563 REPORT DATE: 04/22/98 PHONE: (714)-878-7894 SAMPLING SITE: BRIMSTONE RD. PATTERSON SAMPLE TYPE..: PbTABLE : PRESE~VATIyES: NONE COL'D BY: JOHN KARALL TEMPERATURE..: <4C NOTES...: KITCHEN TAP COLIFORM METH:'MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ � DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD ' ` ` SUBMITTED BY: H1bert M. Paoovanz, �1.i.(*b��/�� Director ELAP# 10323 " ^ YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director - LAB ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ #: 93.800155 CLIENT #: 8466 NON STAT ~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ pROC PAGE 2 KARB-L, JOHN DATE/TIME TAKEN: 04/15/98 09:30A | 335 CUSHMAN RD. DATE/TIME REC'D: 04/15/98 10:20A PATTERSON, NY 12563 REPORT DATE: 04/22/98 PHONE: (714)-878-7894 SAMPLING SITE: BRIMSTONE RD. PATTERSON SAMPLE TYPE..: PbTABLE : PRESE~VATIyES: NONE COL'D BY: JOHN KARALL TEMPERATURE..: <4C NOTES...: KITCHEN TAP COLIFORM METH:'MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ � DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD ' ` ` SUBMITTED BY: H1bert M. Paoovanz, �1.i.(*b��/�� Director ELAP# 10323 / � , YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10593 (914) 245-2800 ' Albert H. Padovani, Director LAB #: 93.800155 CLIENT #: 8466 NON STAT PROC PAGE 1 KARELL, JOHN DATE/TIME TAKEN: 04/15/98 09:30A 335 CUSHMAN RD. DATE/TIME REC'D: 04/15/98 10:20A PATTERSON, NY 12563 REPORT DATE: 04/22/98 - PHONE: (714)-878-7894 SAMPLING SITE: BRIMSTONE RD. PATTERSON : COL/D BY: JOHN KARELL NOTES...: KITCHEN TAP ~~~=~~~~~~~~~~~~*~~~~~~~~~~~~~~~~~~~~~p DATE FLAG PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~=~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE PUTNAM CNTY PROFILE 04/15/98 MF T. COLIFORM ABSENT /100 ML ABSENT 04/1098 LEAD (IMS) 5"8 ppb 0-15 ppb 04/15/176, NITRATE NITROG 0"22 MG/L 0 - 10 04/15/98 NITRITE NITROG <0.01 MG/L N/A 04/15/98 IRON (Fa) <0.060 MG/L 0-0.3*m /l 04/15/98 MANGANESE (Mn) 0.044 /L 0-0.3 mg/l 04/15/98 SODIUM -/Na) 6.49 MG/L N/A 04/15/98 pH 6.6 UNITS 6.5-8.5 04/15/98 HARDNESS,TOTAL 98.0 MG/L N/A 04/15/92 ALKALINITY (AS 88.0 MG/L N/A 04/15/98 ` TURBIDITY (TUR <1 NTU 0-5 NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDIN E NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu-LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. ublic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduco the waters corrosive Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium .that for people on a contain no more than moderately restricte is suggested. are proscribed. Suggested guidelines state sodiud.restricted diet,the water should 20 mg/L of Sodium. For those on a I diet, a maximum of 270 mg/L of Sodium METHOD 1008 12345 ' 9139 9146 2037 2037 9043 .Wr,LL 1,U11rLr,ltViv �rUtti -�C a DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTHI J Office Use Only WELL LOCATION STREET AOURESS: 741 W / HY TAX GRIO NUMBEdC + I 7 ! 7 U j WELL OWNER NAME: ADDRESS:. /4-(// prh Z !vl . %i X1 PSIVATE O PUBLIC USE OF WELL �2primary - secondary ('RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP H ABXNDO ED ❑ BUSINESS ❑ FARM, C1 TEST / OBSERVATION ❑ OTHER (specify) O INDUSTRIAL ❑ INSTIUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED C / EST. OF DAILY USAGES 0 L) gal. REASON FOR DRILLING NNEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL c)d- ft. STATIC WATER LEVEL ft. DATE MEASURED _'I i!:� %t✓ DRILLING EQUIPMENT ❑ ROTARY (J(COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify)-,' WELL TYPE 1 ❑ SCREENED ❑ OPEN END CASING. /OPEN HOLE IN BEDROCK ❑ OTHER CASING TOTAL LENGTH dQ ft- MATERIALS: STEEL ❑ PLASTIC ❑ OTHER LENGTH.BELOW GRADE / fL JOINTS:, --/P-WELDED ❑THREADED ❑OTHER DETAILS DIAMETER in. SEAL: P dMENT GROUT O BENTONITE ❑OTHER WEIGHT PER FOOT �� lb./ft I DRIVE SHOE [�YES ❑ NO LINER: ❑ YES ❑ NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE.____ ENG tt . DEPTH TO SCREEN (ft) DEVELOPED? FIRST O YES ONO SECOND /! HOURS GRAVEL PACK O YES O'90 GRAVEL SIZE DIAMETER ' OF PACK in. TOP DEPTH fL BOTTOM EPTH It. WELL YIELD TEST ' If detailed pumping t METHOD: O PUMPED i tests Were done is in- O(COMPRESSED AIR , formation t ched? O BAILED .O OTHER ' O YES . NO - ._ _ .: _ It more detailed formation descriptions or sieve analyses Yy are available, please attach. WELL L0. G DEPTH FROA1 SURFACE Water Bear. ._ . _ Well Dia- meter FORMATION DESCRIPTION CODE, it:� _ WELL DEPTH It, DURATION hr, min. DRAWOOWN ft, YIELD gpm. Surface ,210 r / WATER ( CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ' ANALYZED? OYES .k.ONO ANALYSIS ATTACHED? O YES ONO t7 STORAGE TANK: TYPE CAPACITY GAL. j WILMRM GATE WELLDRILLING INC. �' ADDRESS C18pr� H111 Poo .;) SIGtTTURE ' I r LaGrangeviile, N.Y. 12540 PUMP IN 0 MATICN TYPE ► M a- 6 '^ CAPACITY °`- MAKER 6mi)(d - DEPTH � MODE _- VOLTAGENP J �t+-CCJ-J3 /O PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Buildi g Constructed by 15c /, /i0 Loi * Tax Map Block Lot Town/Village 9n Location - Street Subdivisio Name Building Type / 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. ... _ - -- . __ . ._ .. . , ...._ Dated: Month t% Day /�. Year� Signature: Zvz 20� °' Title: OA✓WFAI General Contractor (O*mer) 11 Signature /Y //,v /Y/ice Corporation Name (if co oration) Corporation Name (if corporation) Address: ��Okc Address: State UA Zip State Zip FormGS -97 D MAY -27 7 -98 '30PM TOWN OF CARMEL 914 628 2087 WE, . cmamemw rmw roe ana maw" RUN .._ameba, ti! e j P4 1 0CG UtM&S Ad*m l Z Z P. 03 soft 4e• Les Assn P9! 3eatlem o* YJ Depm Lad i of d De% Htem 0 H D _ Hf�D NeMBmgad to Dasptbda whdo H� b remae" ftmy Rom ea attem It is SgftTask ma yCf tiG Z +rT 7�,yitf /� 29 be Wdb Htea Wrong - -hbear Sepilq meted by ob i raonegq-thit s am *how am osmpbtary naponst0tafor the maps am balion of the p" O" sYStowKtit 1t that tots mpsnte fomaee difpsW�N "bore dammed Will be ovnmmm so tAOam oa the aW&W annndmotit than to Said in amend a Wits tfM UVidefft rwa ONMY DoOiaba i" of H@*N , Snd that 4m eempMtim thfhM a "cortniCate of cOMtrualon Como"~, slltid/Ctory to into comWhtIOnN of Naaoowm Do SWMd ltd to top Opertm.M. a1110 a WFU M punaatat will be fueeidhsd 1110 MOW. 10 "COeMMM babe or Sa at by a* bupday that am OupdR ttpt (MIN 4 "W dtw►NanO ma"llmom door an of mid Sm" dimeat eyttom durbg the perled of two it) Veen imm"Idohr folowinp ImisaN of too iota• Saw of the oppmo of too Certiflomo of cont"Kum co ww" of the Hind sawn qesay r !t that the drilled Well described a"" erid be tofatsd as tbarm on the aopnead plan ad tbu sold Wall Wilt be btRe M "" Sam '8e tba Putnam 'r e:oimb aaeottu Hato siensd P,tl.- N.A. APPROVED FOR CONSTRUCTva�i atrpromm oapon twro rend trum tha data atfaad anlett ronNauction of the building has bom undsrhhen and is reeoeable for eomin or any be .= dt ageltied W4aa contiderae a►Sensly by tho Coaunlasioaeeer.�off 04MUM Aar change or aaaration of eoaRwaga fifguim s seal•, rmm p br prmn oe i"ostk "mart' saw aps, � OW. REV • Tale .P u A r. h s� IKE w O to 4 N Z y v 0 yon CE72i, C 77'x- YML, Inc. -- Environmental Services PO Box 99, 321 Kear Street .,, •: ; Yorktown Heights, NY 10598 -0099. ; • .. OFFICE HOURS: 9AM to 5PM, Monday -Friday SAMPLE SUBMISSION DEADLINE: 3PM, Daily AST CALL SLIP IMPORTANT! Keep this reference slip available if you wish to obtain verbal results on a sample. This information on this slip will be needed to obtain results or information on your sample. Thank you! 93 . eO )1.55 LAB # DATE:_ % 5 ACCOUNT NAME: ADDRESS OF PROPERTY— CLIENTS REFERENCE No.: TESTS REQUESTED: eb-11001Yk- OA) To check on the current status of a sample, or for verbal results, j please dall, ONLY between 2PM and 5PM, weekdays. The lab staff are able to provide such information only during this time. To obtain. any information over the phone, you MUST provide the lab number as it appears on this receipt. No information will be released without this lab number. Please be certain that the quoted analysis time has elapsed 'before calling, else your sample results may not be available. Thank you for your cooperation and your patronagel FOR RESULTS CALL (914) 245 -2800 between 2PM and 5PM. Date of Expiration 19_22p -- Permit Issuing-Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller TOTAL P.04 APR -15 -1998 07 55 FROM TERRY BERGENDORFF COLLINS TO 6287085 P,01 af: N. u, •ors , -. Z' g g d �f 2 ONYX F 2 AREA = 1.9 29 ACRES f .M. eT.eo Fm smfir eaas, rauff (U.a) O.N.- n. I I POL!• Cd / o H sos ef, °a 3 �- IRON PIN FOUND IROM PIN FOUND Np�1 p, s9. TT BRIMSTONE HILL R fill rw SURVEY OF PROPFRTY PREPARED FOR JOZEF KOZIOL _ "_ PD6E BEING LO r NO. 1 AS SHOWN ON MAP OF BRIMSTONLE' F,STATES, FILLED MAP NO. 1839, FILED 10 -9 -81 AS SHOWN ON TO#'N OF PATTT'RSON J% TNAA( CO., N Y. M.4 IS >" = 50' . JULY 22, 1995 4ANMW 30. ►996 (UPDATE) TOTAL P.01 J Bl.3o' ' G rM S 7W MWE C R � t 1 ALL-- Zv 4tuN` 4 l 50 O y /COO/ l -93.28� N 910'49 "£ - s�. > > > BRIMSWNE .•1 i t2-�G Coo �I SPnp y G '�htJIL 'o �O o\ . A ` �. 13 • 14 15 / ew V m 0 o� "This is to certify that t'le sewage disposal syste-n was constructed as indicated'on this plan and :.that the system was inspected by me before it was covered over. The system was constructed in accordance with all standard rules and regulations of the Putnam County Department of health and the New York { ^� State Department of Health." --! tAS= BUILT; ",t.s -- MEASUREMENTS=- °'- b No A`_° t.. :.- -: $• REMARKS GI .{ rL r, ND 2 -75 I lti 5CI;LE- V-730 I DATE, -1`x-9$ DQO. eye G l05 33oic: Jo 2 v e. 33 S nJ I—O tp 9L - F 10 jftlk 5 10 J I1 7 z 6 l 0 f ZZ J>'i0X LOO Iq a coo Putnam County Department of Health Division of Environmental Health Services Approved as noted for conformance with i.c appl e Rules and Regulations of the F. Cozen Health Departure t.. J i Rna +nrn R. Ti +lam n.. 4., ALTEU-TIGN OF THIS DRAWING, E:(C &'T BY A LIC3ISc�•. P.E. OR ..s.RaH EcT OR LIMsM LuP SURVEYOR IS ILLEGAL. MY' '/� /� ALTEW110H By A P. E.: ARMI- AL 0 3 W GO(M/0,A770/V SVAI/eY /3y 1 ICATEO M�OMBLARUHIS SEAL. HIL L R L X22 �3 �7END02�,�CG[G/N SiTEMTIE AND GATE-OF ` %� , �5. i 96 ALTE.;ATION. � PLAI-1 ti f}ej.- *V1L;e1 se C)5 PREPARED FOR b GI I 105 .�•��Q,INTTER5,01J r, ND 9 -75 I lti 5CI;LE- V-730 I DATE, -1`x-9$ DQO. eye to P20JEC Jo 2 v e. 33 S nJ I—O tp n-4� NY�lz563 II -13z lZ1 2 13q t35 I4 11}rj 1`t Is 1�-( -� •150 � v ALTEU-TIGN OF THIS DRAWING, E:(C &'T BY A LIC3ISc�•. P.E. OR ..s.RaH EcT OR LIMsM LuP SURVEYOR IS ILLEGAL. MY' '/� /� ALTEW110H By A P. E.: ARMI- AL 0 3 W GO(M/0,A770/V SVAI/eY /3y 1 ICATEO M�OMBLARUHIS SEAL. HIL L R L X22 �3 �7END02�,�CG[G/N SiTEMTIE AND GATE-OF ` %� , �5. i 96 ALTE.;ATION. � PLAI-1 ti f}ej.- *V1L;e1 se C)5 PREPARED FOR - 'co501� K onto L gj?,IMytbN k, 41u -MAe0 (7) .�•��Q,INTTER5,01J PREPARED BY JO14hj KA•RELL SIR. 914 - 8� 7 ?-7 &-9y s Eh4l . ng � 5CI;LE- V-730 I DATE, -1`x-9$ DQO. eye I cKa Ew, P20JEC Jo 2 v e. 33 S nJ I—O tp n-4� NY�lz563 1�•Y• t1C .