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Home My WebLink About0565DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -1 -29 BOX 7 00565 NNE J F m j IN IN L .ti T go let IN 00565 \°> �� PUTNAM.COUNTY DEPARTMENT OF HEAL Divielon of Envlroruneatal'Hedth Servlcea :Carmel-1 CON. TRUCTIO, RM1T FOR SEWAGE DISPOSAL SYSTEM Located at C e ll. Hl�C; --Z, 6, Stibdlvleioa Name Dt 1iA/1aLt_ i LZ✓ �A7 abd. Lot N 2� Tar m Rene« Owner% ticant Named �7.tJJI/�l..G -:'; �ti✓[- CS"°�%T�C � (�.�C . , APP J: ';Date e Milling Address Balldiug Type 'CI L�Lot Area °_� Q�O� �sCCZ�S FID Number of Bed come Demio Flow G P DL Separate Sewerage System to conelet of 2 -O Gallon Septic Tank it Tote conetidcted by jO OF�°t'EtZs` -t I O.fF� Address wmue avca�a County epa Oate APpROVEb' ' reVOCSDIe•f i requiiV Rev. 1/87 Data 0 iat tnersepardte diwaye Disposal system is rules'an regu a• ions o - e .> u nam _torJ`toah6COmmisionirof, Health will Title �PE n8e No g har been untliitaken- and is or, anirrat ion' of.contlluct ion PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services AFFIDAVIT — CORPORATE OWNER APPLICATION, FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health In the matter of application for: RECEIVED Cornwall Hill Estates, Inc. SFR\ ''a T, I, Kenneth Emerson represent that I am an officer or employee of the corporation and am authorized to act for Cornwall Hill Estates, Inc. (Name of Corporation) having offices at . 223 Katonah Avenue Katonah, N.Y. 10536 Whose officers are: President: Edward H. Emerson, 223 Katonah Ave., Katonah, N.Y. 10536 (Name and Address) Vice — President: Kenneth Emerson & Martin Diano, 223 Katonah Ave., Katonah, N.Y. (Name and Address) Secretary: Janet G. Mastropietro, 223 Katonah Ave.,. Katonah, N.Y. 10536 (Name and Address) Treasurer: _ Lynne Diano, 223 Katonah Ave., Katonah, N.Y. 10536 (Name and Address) and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. At Sworn to before me this % day Signed: of 19v� Notary Public .LIONEL WEINSTEIN Notary Public, Stato of.New YbrR No. 60.4199150 QUa ified in Waritcha':ter County ftnunissiotr Cxvires tfarch 30. t9 8184 Title: Vice President Corporate Seal o PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMiN`1'AL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. t 1051 �v I)E31GN DATA SHE!- SEPARATE SE,'WAGE DISPOSAL SYSTEM ` w=TAZ NO.- ()WnerCaCkdW&Lj_ Addresszz-�s v_ ro u Located at '(Street )�� ( Sec'. ( _av k� Lot ( ca a nearest cross s ree Mwilcipality 1�'A'C'i� _ Watershed SOIL Pbf=ATION TEST LDATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS ITc,7 u NwIl k.1. CLOCK TIME. PERCOLATION PERCOLATION ^ituii a Depth to Water water ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start. Stop Drop in Min. /in drop Inches Inches Inches N 1:o3- 4:". 4 1 rr 4 Nuton : 1) Tests to be repeated at same depth until approximately equal soil vaLea ave obtained Rt each percolation test hole. All data to be submitted for roviF-u. ►•1ith measurements to he nvide from top of hole. DEPTE G.L. 6" 12" TEST PIT DATA REQUIRM TO BE SUBMIVI'M WITH APPLICATION DESCRIP`I'ION OF SOILS ENCOUNTERED IN TEST HOLES HOLM: NO.- HOLE NO. HOLE NO. r � A 24" 36" 42" 48" \ - 60 �n 1 N1)1 CATE; L1s'VE:L AT WHICH GROUND WATER IS ENCOUNTERED 1 N1)1 CATE: LEVEL TO WHICH WATER UV EL RISES AFTER BEING ENCOUNTERED '1'1 Sl'S MAD1i BY jt' w o1.. Date eC 3oi1 hate Used S' MirVl "Drop:. S.D. Usable Area Provided S 00 ® 16,F, No. of Bedrooms .35. Septic Tank Capacity, 10 ®®. Gal; � _Type. eb Absorption Ar rov dl d By F. X24 Xrench. !A 2P Z_A"7C Signatur u' Add re a a Z� Fr4r �i '! �_ rp ; : :. '.: 'r `' = ► N 0 -04 a �, T1113 SPACE .1�OR USE BY HEALTH DEPARTMENT ONLY: a��UFtS:iIV�� `•. 3011 Efate Approved Sq. Ft /Gal. Checked by P C IV F Sip 2 C i35 PUTNAM •pUNTY _ DEPT. OF HEALTH Date DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (91,4) 225 -3641 06 :a APPLICATION TO CONSTRUCT A WADER WEIL /q/J PCHD PERMIT # WELL LOCATION Street Address LL 11ILL R0. ZAG, Village CIf y ;: =} Tax Grid Number WELL OWNER Name rr,L1iJALL UILL Mailing C . Address ZZ3 LIA `� rlwA 11& WrPrivate ❑ Public E OF WELL /- primary 2.- secondary L`T RESIDENTIAL O BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY 0 AIR�QEnND /HEST PUMP O FARM ❑ TEST /OBSERVATION O INSTITUTIONAL O STAND -BY 0 ABANDONED ❑ OTHER (specify O AMOUNT OF USE YIELD SOUGHT �� gpm /# PEOPLE SERVED-3-5- /EST. OF DAILY USAGES Cj jSal REASON FOR DRILLING ErNEW SUPPLY []REPLACE EXISTING SUPPLY O PROVIDE ADDITIONAL SUPPLY ❑DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING 1J1 t WELL TYPE DRILLED DRIVEN ODUG ®GRAVE.L ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Gorg c.. i�fC�C,C Lot No. Z.'i WATER WELL CONTRACTOR: Name-16 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: Lilk TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: Qh�- LOCATION SKETCH & SOURCES OF CONTAMINATION PROVI a ON REAR OF THIS APPLICATION 0 SE E H (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 thirty (30) days of the completion of water well construction, the applicant s.hall: Date Date 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements County Health Department attached to this permit. 3. Submit a W 1 Completion Report on a form pro ded y Health De rtmen . of Issue: 19 mi Issu, of Expiration: 19 Permit is Non - Transferrable 2/87 of the Putnam to ng utticia .te copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner Orange copy: Well Driller F REVIEW SHEET - CONSTRUCTION PERMIT DATE REVIEWED: (Name'of Owner) CamMENTS (Street Location) YES NO I DOCUMENTS A °`Permit Application tte—Corporate Resolution Plans - Three sets IF trench provided required 60 ft. m Parellel a Engineers Authorization Design Data Sheet (DDS) SUBDIVISION Deep Hole Log Perc jl Consistent Perc Results (3) Fill Perc Hole Depth cd - 1 House Plans w Two sets Well` permit; PWS letter -7 — Variance Request GENERAL Legal Subdivision r Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flora Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump'pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data: perc and deep results Two -Foot Contours Existing & Proposed F Driveway & Slopes Cut Footing /Gatter,Curtain Drains (discharge OK) fr Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If Pumped Pit & D Box Shown & Detailed House - No. of Bedroans Wells &-SSDS's w /in 200 ft. of Proposed Systems Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe f No Bends; Max. Bends 45° w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields ' 10' to P.L.., Driveway, Large Trees,Top of fil' 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan 15' to Drains - Curtain, Leader, Footing 351to catch basin,stormdrain,piped watercours.' 10' to Water Line (pits -201) - 50' intermittent drainage course Septic Tanks 10' from Foundation; 50' to well 15' Well to PL Other Requirements I certify that thesystem(s) as listed serving the above premises;w of which are attached), and in accordance with the standards, rules Putnam County Department'` Of Health. " Date ` r v� ' Certified Address I essentially as shown on the plans of the completed work ( copies in accordance with tha,4Tr94 plan, the rmit issued by the P.E. R.A. ` I%A, License No. 45721 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 . sewerage system shall become null and void as soon at a pubr: sanitary tower becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment 'of the Commifstbner of .Health, su ny modification or change Is necessary. Date. % l� ey Ia• PUTNAM COUNTY DEPAFaKRU OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Katonah rloaf Congtrijotion Co_. Inc. 15 6 Owner or�Purchaser of Building Section Block Lot Katonah Chose Construction Co. Inc. Building Constructed by off Cornwall Hill Rd. Location - Street Patterson Municipality Residence Building Type Cornwall Ridge Subdivision Name 17 Subdivision Lot # • GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM WE represent that au6 wholly and completely responsible for the location, workmanship,. material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by JW 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 disposal system, or any repairs made by M5 to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environmental Health Services of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this c day o ' 193 7alWoAtraL ctot/(Owner - ��pISignature Corporation Name (if Corp.) Signat Title A. Corporation NaJ& (if Corp. , kess Address rev. 9/85 mk II. IV. V. VI. APPENDIX C FINAL SITE INSPECTION _ Date SEWAGE DISPOSAL AREA a. SDS area located as a roved lans l ✓n�� Ins ted oN owNER „by G �T # TM # OR SUBDIVISION LOT e. 100 ft. from water course /wetlands. YEc NO SEWAGE DISPOSAL SYSTEM a. Septic tank size - 1,000 1,250 b. Septic tank installed level c. 10' minimum from foundation II. IV. V. VI. COMM�VTS SEWAGE DISPOSAL AREA a. SDS area located as a roved lans b. Fill section - Date of placement 2:1 barrier- LGTH WIDTH AVG.DPTH c. Natural soil not stripped d. Stone, brush, etc., greater than 15' fran SDS area. e. 100 ft. from water course /wetlands. SEWAGE DISPOSAL SYSTEM a. Septic tank size - 1,000 1,250 b. Septic tank installed level c. 10' minimum from foundation d. No 90° bends, cleanout within 10 ft. of 45° bend e. DISTRIBUTION BOX 1. All outlets at same elevation - water tested 2. Protected below frost 3. Minimum 2 ft. original soil between box and trenches f. JUNCTION BOX - properly set g. TRENCHES /J 1. Length required U Length install 2. Distance to watercourse measured. ft. -- 3. Installed according to plan 4. Distance center to center (� 5. Slope of trench acceptable 1/16 - 1/32 ” /foot. 6. 10 feet from property line - 20 feet - foundations 7. Depth of trench < 30 inches fran surface 8. Roan allowed for expansion, 50% 9. Size of gravel 3/4-- 1P diameter 10. Depth of gravel in trench 12" minimum 11. Pipee ends capped h. PUMP OR DOSE SYSTEMS 1. Size of pump chamber 2. Overflow tank 3. Alain, visual /audio j 4. Pum p easily accessibl= -,anhole to- grade j 5. First box baffled 6. Cycle witnessed by He----,-Li Department estimated flora per cycle HOUSE a. House lccatad per approve clans. b. Number or `.-edrocros WALL a. Well located as per a=: ,=_Ad plans A4 , b. Distance fran SDS area measured ft. c. Casing 18" above qrade. d. Surface drainage around well acceptable. OVERALL WORKMT,SHIP a. Boxes properiv grouted b. All pipes partially backZ i lled c. All pipes flush with inside of-box d. Backfill material contains stones < 4" in diameter e. Curtain drain installed according to plan -- j f. Curtain drain outfall protected & dir.to exi st. watercourse g. Footing drains discharge.away fran SDS area h. Surface water rotection adequate i. Errosion controi provided on slopes greater than 15 %. ` r i Lo, ;✓ Wt;LL l.;OMPLELIOv REFORi Office Use Only J DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH WELL LQCATION STREET ADDRESS: WN /vt / IIY TAX GRID NUMBER: 27 Somerset .set Dri 15. 6.29 NAME: ADDRESS: 223 Katonah Avenue p pgIVATE WELL OWNER Katonah Close Const. Co. Inc. Katonah, N. . 10536 ❑, PUBLIC_ _. USE OF WELL f) RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED 1 - primary b BUSINESS D. FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) 2 - secondary ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /NG. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR EW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION DRILLING ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA ` WELL DEPTH 71 ft. STATIC WATER LEVEL ' � ft. DATE MEASURED DRILLING • ROTARY 016OMPRESSED AIR PERCUSSION ❑ DUG EQUIPMENT ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED O OPEN END CASING. O'OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH_ ft_ MATERIALS: TEEL ❑ PLASTIC ❑ OTHER CASING LENGTH.BELOW GRADE -ft- JOINTS: p WELDED i�THREADED ❑ OTHER —DIAMETER z - in. SEAL: ❑ CEMENT GROUT BENTONITE ❑ OTHER DETAILS WEIGHT PER FOOT ` ` Ib. /ft. DRIVE SHOE:AYES ❑ NO UNEA: p YES [ d0 DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (It) DEVELOPED? SCREEN DETAILS FIRST O YES ONO .... - SECOND HOURS GRAVEL PACK ❑ YES GRAVEL J //' DIAMETER TOP BOTTOM ❑ NO SIZE I OF PACK in. DEPTH ft. DEPTH It. WELL YIELD TEST If detailed pumping If more detailed formation descriptions or sieve analyses ELL LOG are available, please attach. METyDO: ❑PUMPED 1 tests were done is in- t DEPTH FROM Water Well OMPRESSED AIR , formation attached? ❑ YES ❑ NO SURFACE Bear- i�9 DIa- neter FORMATION DESCRIPTION p0E_ O BAILED ❑OTHER It. 1t. WELL DEPTH DURATION DRAWOOWN YIELD Surface '6i a✓(% B(;��%1;�` S7YN+� L04v`Y% It. hr, min. ft. gFm. _ WATER ® LEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? OYES ONO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE CAPACITY WELL DRILLER NAME a - : -.> i ,Lt -' GATE ..d MAKER DEPTH ADDRESS SIGlifXTURE MODEL VOLTAGE HP i�i?5��''S '' i Lo, ;✓ WrP PH'r JSNED STONE Gf 'AVE::L 4 .a s t v 1 f AGH 3 > TWO SIDE t3E K1•IOG K>; D .60!5�v-r ( G s 4Q',5' } WELL' l 9 i � I I t I I J T� -1.t5 1s �o cir�-C1FY -�'t�A->' TE-�E SEW�.GE vt- sptp�AL SYs- tEr-�t _ .. WAS C—PQ6T'y_UC—r6,:> 4Z 4z.,!S` A Of 141 �`.. > s(d. .o' Q3 4o,s' .410 13R.5'n ` 67 AA (03.0 B I 5fo e� 88 131.5 45 40.0' F3Z . si4:o' Eiji. 1Z.5` 47 95.0 3� 40.5 , D 1 t 3Z0 T� -1.t5 1s �o cir�-C1FY -�'t�A->' TE-�E SEW�.GE vt- sptp�AL SYs- tEr-�t _ .. WAS C—PQ6T'y_UC—r6,:>