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00578
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PUTNAM COUNTY DEPARTMENT OF:HEALTH
R v. 31 86 Division of Environmental Health Seivices, Carmel, N.Y. 10512
• . `7 Englaeer Mnst Provide.3 $'
P.C.H D Pei rmit N=
CER CATE OF CONSTRUCTION COMPLIANCE,FOR SEWAGE ' DISPOSAL 'SYSTEM �I��T .ER�OI
a,r Town
Located at C�o�)J 1KAt.0 1-} 1t;4 iZ I� . Block
Ci91t1iwALt. )r-ttt_t_ cot;�w LL ° 41LL.
Owner /applicant Name �- s'rA,T64 1 4( Formerly Subdivision Name �1af'T�? Snbdv. Lot p!�
MaWng Address Zip 1 O S 3'b Date Permit`Issued (o I .31 8 7 1► `��i D�
Separate Sewerage System built by A+` F 'SG P Z t G s f S j� l S , I WIC Address P. o ' BoX ' i 4 i = C go" • i21 y6 R
Consisting of J 'Z So Gallon Septic Tank and o o L ` F, Ai$%S �z F3 l I o fv T t2.61J C:1-I
Water supply: Public Supply From Address
or Private Supply Drilled by 8� y�Cw Address
Z C —'S I p N j l A L , Has Erosion Control Been Completed?
11.4 120 CS S J,3)( J,3)( Building Type
Number of Bedrooms Has Garbage Grinder Been Installed?
Other Requirements
I certify that the systems) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies
of which ate attached)—and in accordance with the standards, rules and regulations, in accordance witJ
fi d= plan,.and the permit issued by the
Putnam County De rtm nt Of Health.
i�� B7 Certified by P.E.XR.A.
Date __� .
Address ,t
. A � . d N \ s° License No. S 1D 1 24
Any person occupying premises served by the above systems) 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 as a pubs? . sanitary sewer becomes
available and th6 approval of the private' water supply shall become null an l void when a public water supply becomes available. such approvals are
subject to modification or change when, in the Judgment of the Commissioner of Mea w evocation, modification or change is necessary.
Date
Ot
r' DEPAR
t
:E-11 Rev 8B
f BACTERIAL O
'Lab. No. W
Lab'No.ENT -- -
Time get
Tests (Circle) SF &0iJffo PN
f: L
Coll d by k h1 Ck ii1
{,
Colidfrpm Name"f�tcF!
Addreea
6 S� N01
Identdicauon of Source r5
r. Sampling Pomt wrthm,Prsm ee8
Chlormated4 Yes.,�fi No o Free
i
COUNTY OF- 1NESTCNESTER JJi
ENT OF -A90RATORIES ANflE
D SEARCN
VALHALLA NEW YORK; 10595,
OF ljEtINKING_AND TREAATES
Bottle No
r
n
Date Coll.d -� -- -Inge, -
Time submitted i
oldo A Membrane Fecal 'Other. -
r Agency C61 for - -
Mimi) -' -
x Icay Town Vil (Zip Coal / - ICeinMl "
r F- r+' Refrigereted� t
x "mg /h,TO)el mg
-F° -
aMPN /100 ml y+ s r.,
Standd "r`d Plate Count
Bactenaper =,ml (48hr)
;Number?Roartne Tubss
Fecal Coliform � ���
2 xd
Thess results indicate samph '('
sahafactpr sanitary quality wh i
collected y 3a
Gk �
9
. F
` +L
Method /.100''ml =�
-
Other
a
t
_
rraanoq of E �Reportrted by Date
sample was t
II.
IV.
V.
VI.
APPENDIX C
FINAL SITE INSPECT
ION Date
Inspect
CCY�tENTS '
EWAGE DISPOSAL AREA
a. SDS area located as per approved plans
TM #
OR SUBDIVISION LOT #
ION Date
Inspect
CCY�tENTS '
EWAGE DISPOSAL AREA
a. SDS area located as per approved plans
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.
.1X
e. 100 ft. fran water course /wetlands.
SEWAGE DISPOSAL SYSTEM
a. Septic tank size - 1,000 1,250
b. Septic tank installed level
c. 10' minimum fran foundation
d. No 90° bends, cleanout within 10 ft. of 450 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
1. Length required - -5 'Z Length install
2. Distance to watercourse measured- ft.
--
3. Installed according to plan
X
4. Distance center to center
5. Slope of trench acceptable 1/16 - 1/32 " /foot.
6. 10 feet fran property line - 20 feet - foundations
7. De th.of trench < 30 inches from surface
8. Roan allowed for expansion, 50%
9. Size of gravel 3/4 - 11" diameter
10. Depth of gravel in trench 12" minimum
,
11: Pipe ends capped
h. PUMP OR DOSE SYSTEMS r
1. Size of pump chamber
2. Overflow tank
3. Alarm, visual /audio
4. PLunp easily accessible manhole to grade
5. First box baffled
6. Cycle witnessed by Health Department
estimated flora per cycle
HOUSE
a. House located per approved plans.
b. Number of bedroans
WELL
a. Well located as per approved plans
b. Distance fran SDS area measured ,ZG f ft.
C. Casin 18" above grade.
d. Surface drainage around well acceptable.
OVERAIL WORKMASHIP
a. Boxes properly grouted
b. All pipes partially backfilled
.�
c. All pipes flush with inside of box
d. Backfill material contains stones < 4" in diameter
e. Curtain drain installed according to - plan
f. Curtain drain outfall protected & di.to exist.watercours
g. Footing drains discharge away fran SDS area
h. Surface water protection adequate
i. Errosion control provided on slopes greater than 15 %.
i
�ry� PUTNAM LINTY DEPARTMENT OF HEALTH s c i
Divlalon`of Environmental Health Services Carmel N Y.10517 Engineer to Provide Permit N 1
! � '' 'k , ,. � ° �' - on CERTII7CATE OF CO - CE •
'CON STRUL'!t[ON`PERrAH FOR SEWAGE DISPOSAL' SYSTEM Permit
x
Located at �� L- ' �� C C . �� Wit` ..L �� Town `
Sabdlvlsion Name
Cc1PAlb?v�c c ` piiCiESCAsoba Lut p 1 Tax irrsp'_�J -Bieck �' Lot
Owner /A ilcantName• L- O�l1LL N(C LYlS Renewal =❑ Revision
PP.
+r
Date of'P Previous Approval
MaWng Address Town 1CA- COIF( °�at�` .�� '1. Zip -)�
j
Ballding Type � C ALT( L Lot Area , O � F(Il Section Only Depth Volrsme
Nrsmber of Bodroosne " ` Deign Flow G R D •��� ' PCHD NotiScation Is Required When FW le completed'
Separate Sewerage System to corselet of �Z�� t3aUon Septic Tank and �J�.� �--� F10N Li
,-
To:bo conetrocted by0 �G— �L%111.1C -rte ilddtees '
Water;SuPPIJ Prsbllc Sapply, om Address
or ' Private Supply Dialed by C C�iLM I M a"d7 Address
Othe'r:Renalremente - �?
1 represent thaf C am wholly antl completely ,responsible for the design and IocaLOn o1 the, ,prop'osed systam(s) 1) that,the `separate sewage disposal system,
above rlescnbetl- :,will be construct'ed:as show,n;on the approved amendment there to'and in;accortlance with .ttie itindards, rules an ragu 'at :ens o e' u nam
County. Department of `Health'..entl that on complet'�on thereof a Cart�f�cate of Construction Compliince.' satisfactory,to the Minmissione('of, Health -will
be submitted to. the Department; •and a' wntten guarantee will be furnished the owner ';his sdccessors; heirs or assigns by the builder; that said,' "' will
place, in good •operating condition any pert of aiq sewage ?d�sposal',syrtem dur�nq the;penod :of'two (2) years immediately, following the0ate;of tt4 issu:
ence of the approval 'o.(; the Certificate of Construction Cornphance of th original system or'ahy repaics'•ther o;.2) at;the drilled well described above
r r a
will be located as shown;on the appnoved plan antl that'sa�d well`,wJl be insta �n accordance with t standard rul I lieu a l ns f .the Putnam
COUn ;y Department of Health ., � ' A ^r
•
Address J o ;� '�,_'!
�- License N - - -
f 4 , ,._ , .. - building 'his been undeitaken ind is'
APPROVED FOR CONSTRUCTION This approval expires two years from the Cate issued unless construction of the b
revocable for cause or may be amended or, modified when consoda4d necessary 6y the COmmissiOner Of Health. Any :Change or alterat n Of'COnstru`ctiOn
requires a new, permit Approved for disposal of domestic sanitary sewage a private stet Iipply' nly.
Rev.
1/97 Dal BV :Tits_
1]
PDTNAM COUNTY DEPARTMENT OF HEALTH E eer to Provide Permit q
Rev. , 3/86 :. D lvislon of Environmeatel Health Services Carmel N.Y. 1051?
oti CER F ATE O COMPLIANCE
• _ Permit
CONSTRUCTION PERMIT R SEWAGE DISPOSAL SYSTEM
Located 7 ! ` Tow or ' VWage
Sabdivisioa Name .G `� ? � � / `1 /'' � Sabd. Lot q I Tax Map I Block Lot �=L_
Ca /`/�� ✓�yL. /�i /l e ��r�/ /�s l/�� Renewal_O : Revleloa .p
Owner /Applicant Name
Date of Previous Approval -
MaWng Address Z / 1 �C/ Tt7� Town /r/d �/�.�jH %��7 Zip 149
Building Type /fG Lot Area �'�c Fill Section Only Depth - volume
Oct PCHD Nodficatlon is Required When FIR Is eompleted
Number of Bedrooms Design Flow' G /P /D ° -
/z�So f
Separate Sewerage System, to conslst of Gallon Septic Tank and
To be construeted by. Address
Water Supply. PabBe Supply From Address
or.L_Private °Supply bellied by
h
Other: Requirements , ; tt
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 showntpn the approved amendment there to and ,in accordance with the, standards,.rules.an "regula ions o e. u nam
County,. Department of; Health,:,.and that on complet*on thereof a t'Certificate .of Construction Compliance" satisiactory.to,the Corn missioner,of Healthwill
be submitted -to the Department,,. and a ` "written guarantee will be ,furnished the owner,; his successors, heirs or assigns by.Yhe builder, "that said builder will
place : in good operating condition any part Hof: said 'sewage disposal system during'fhe Per,iod'of two W:years- immediately following thedate of�the issu-
ance. of the approval of ;the Certificate of _Construction :Compliance of the original system or`any,repairs they, 0 2) that the drilled well described above
will be located as shown on theapproved plan and that said well will be ' actor ce with the les and egu a ; of the Putnam
County Department of Health
x
Date -3:--;I> S ignedf,%. - /� /
Address 7 ���� /in P.9.. >df�. /ZS� License .NO
APPROVED F R- CON TRUCTI,ON .This:_approval.expires A� r fr the date i ued un ess c0 LructiOn of the building has been undertaken and is
revocable for use o.r y e amended or modified when consider d'nec ssary, by t O m si er f, Health.- Any Chang Or alteration of construction -
requires, . a p A ed fors disposal of domestic• sane r age, and/ iv te. • a r u n Y•. -
Date ley Title
S
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 Town /Village City Tax Grid Number
e�c'�vv��iG I�JGL I1D � J7T %� y �l,E � �✓(/ /yS ' (.�- 2 � /
WELL OWNER
Name Address
Cc7iZ�ti'ic% lG dJ LG �S7 �S Ji'C�. ZZ3/Y,910JY �J.dV� ,tl >��JIJ/ /�/'
'Private
O Public
USE OF WELL
0- primary
2 - secondary
M RESIDENTIAL
® BUSINESS
® INDUSTRIAL
O PUBLIC SUPPLY O AIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION-
O INSTITUTIONAL O STAND -BY
O ABANDONED
O OTHER (specify
AMOUNT OF USE
YIELD SOUGHT
gpm /46 PEOPLE SERVED 3 -S /EST. OF DAILY USAGE �� gal
REASON FOR
DRILLING
NEW SUPPLY OPROVIDE ADDITIONAL SUPPLY OTEST /OBSERVATION
OREPLACE EXISTING SUPPLY ODEEPEN EXISTING WELL
DETAILED
REASON FOR
DRILLING
f/✓ FS // /vC
WELL TYPE
10DRILLED
DRIVEN ®DUG
OGRAVEL
® OTHER
\
IS WELL SITE SUBJECT TO FLOODING? YES _ NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: G Dlw "Z L
Lot No. Jtf
WATER WELL CONTRACTOR: Name �' jo %� /% Address:
IS PUBLIC WATER SUPPLY AVAILABff�TO SITE: YES �`NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST-WATER MAIN: `
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
®ON REAR OF THIS APPLICATION ON EP TE SH ET
(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 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 th's permit.
3. Submit a Well ompletion Report on a fo r ided by the Pu n m County
Health De p nrt. I
Date of Issue: l 19
Date of Expiration: 19 Permit Issuing fficial
Permit is Non - Transferrable
0 Me
4
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:
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, III,�223 Katonah Av., Katonah, N.Y.10536
(Name and Address). w
Martin Diano, 223 Katonah Av. ,` Katonah, -N.Y. 10536 4
Vice - President: jC,.n ,. Rmersnn, 221 Katonah Av. , Katonah. N.Y. 10536
(Name and Address)
Secretaryt .7nnPt, G. NIastroR etro,:- 223 Katonah Av., Katonah, N.Y. '10536
(Name wand Address) .
Treasurer: Lynne Diano; 223 Katonah' Av. , 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.
Sworn to before me this day
of Y14 19�b
Notary Public
LIONEI: WEINST.EIN
RoWry Public, State of New 'YA
No. 6o- 419cs16o
?QLratlfW in 1Nestclic; 1er Cou ,
Varna 'Watt ExDires Wra, SU, 19
PIP
8/84
Signed:it/Lt'�
Title: VIC F_. Pry r S Z .P F At T
Corporate'.Seal
PUTNAM COUNTY DEPARTMENT`= OF- HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y.
=J . .<
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM F NO.
" Owner (f6Le(/V✓A« 61,14.4 ,4r2, Ale- •Address
Located at IStreet gj Q=. t k4 Sec. Bl ek_�� Lot Z 1; `
( ca a nearebt s ree ;.7
Municipality Pwr -rE SZN L Watershed_ °�j"C��
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
:.:.
hole
Number CLOCK TIME
PERCOLATION
PERCOLATION
Run
Elapse
Depth
to Water
water Iavel.
No.
Time
From Ground Surface
in
Soil.
,�...._ Start -Stop
Min.'
Start
Stop
.Inches
Drop in
Min. in drop ;V
Inches
Inches
Inches
2
37
as
a5
3.,,
�a.33
2.
3 a:30- 3 =10 40. R,
4
Notes: 1) Tests to be repeated at same depth until a roximately equal soil
rates are obtained at each percolation test hole. All data to be submitted
for rovi.ew .
1 •r►th measurements to he made: from top of hole.
.;,• TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOIL;ENCOUN`ERED IN TEST HOLES
DEPTH HOLE N0. MOLE 140. HOLE N0.
G.L.
611
12'1
- 18"
24
N11
- Jett '
42'.'
Soy
+� f
.x211
.78f1 rl
8411 _
INDICATE .LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE: LEVEL TO WHICH WATER LEVEL RISES AFTER BEING..ENCOUNTERED
TESTS. MADE BY
DMIGN
Soil 'Rate Used 1 S Mir;/1 "Drops S.D. Usable Area Provided Soop i&,jti
- No. of Bedrooms Septic Tank Capacity/ `� Ca pe `
Absorption Area rov de by,_6 & L.F.x2411 D�NE�i`� 1�h rent .
,► vJ Llg;� }er
Address c L _0QJ fE SEA
i
I: A1.0 N -two
1 OVji
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY.
Boil Rate Approved Sq: Ft /Cal. Checkod.by Date
W
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120.0
123.5
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131.0
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139.5
146.0
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200.5
168.0
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208.5
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