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23. -1 -53
BOX 7
4' lij
11 :•
11 :•
Rev. 31/86
K, ,
CE CATE OF
Located at
PUTNAM COUNTY. DEPARTMENT OF HEALTH ,4a7
Division of_Eu*.6nmeotal Health Services, Caemel, NX.10512.
Engineer Must Providef Q b
P.C:H.D' Permit,li—
CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM�1.C30' Yom;
i 14 ill 1&14 T Town "or V e �( I
loc Lot
nw
eV e .t ormerI Subdivision 1 �jSulidv. Lai,
p
1-n" of Zip Date Permit Issued / (,
Separate Sewerage System built bj
Consisting of
s . Address' r-42( /'L/
Gallon Septic Tank and
Water Supply: We Supply. From Address
l
or: Private' Supply DrWed b <i L /lic° +�- Address fir% �( /
p ,,
C)
Building Type to_� 4�/ xi' Has Erosion Control Been Completed?
Number of Bedrooms Has Garbage Grinder Been Installed?
Other Requirements
I certify that the system(s) as listed serving the above premises were constructed essentially as shown on th
plans of the completed work ( copies
of which are attached), and in accordance with the standards, rules and ions, w th the
ed an, a the permit issued by the
:accordance
Putnam County Department Of Health.
A
Date go , Certified -by
Addres� 1 I r /
P.E.-R.A.
/� L cense No. "r
Any person occupying premises served by the above system(s) shall .promptly Italia such action as may be neces ry t
secure the correction of any unsanitary
conditions resulting from' such usage, Approval the separate.sewerege system shall become null and vol as
on as a pubs : Unitary sewer becomes
,of,
available and the approval of the private water supply shall become null an old when s public water sup ocomes svallabW Such approvals are
subject to modifiutf n or change when, in the juitgmeint of the Co Is er of Health,, h revocation, modification or change Is necessary.
Date
Title
a SCOi
-�
W �4
WELL l.U1°1YLL11Vn rtzrVnt
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
STREET AODRESS: WN /vl ! 1 Y TAX GRID NUMBER:
�/
WELL LOCATION��
WELL OWNER
NAME: A RE�, C
�JA -A�z'vka e
�Y to' � C It
pgIVATE
❑ PUBLIC
USE OF WELL
1- primary
2 - secondary
ESIDENTIAL ❑ PUBLIC APPLY O AIR /COND. /HEAT PUMP ❑ ABANDONED
❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION O OTHER. (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT gpm. /NO. PEOPLE SERVED /EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
a<EW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING'WELL
DEPTH DATA
' WELL DEPTH /M —_ ft.
STATIC WATER LEVEL - L/_ ft.
DATE MEASURED
DRILLING
EQUIPMENT
❑ ROTARY ❑ CO PRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED. EN END CASING. ❑ OPEN HOLE IN BEDROCK ❑ OTHER
CASING
TOTAL LENGTH tL
MATERIALS: ZWrfEL ❑ PLASTIC ❑ OTHER
LENGTH.BELOW GRADE ft
JOINTS: ❑ WELDED 9 READED ❑ OTHER
DETAILS
DIAMETER 6 'in.
SEAL: ENT GROUT .. ❑ BENTONITE ❑ OTHER,
WEIGHT
PER FOOT 1b. /ft
DRIVE SHOE S ❑ NO LINER: ❑YES
SCREEN
DETAILS
DIAMETER (in)
SLOT SIZE
LENGTH (11)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRS
❑ YES 0 14
HOURS
SE D.
GRAVE, PACK
,.
O ES
❑ NO
RAVEL-
SIZE..
DIAMETER
OF PACK in.
TOP
DEPTH ft.
BOTTOM
DEPTH 1t.
WELL YIELD TEST - If detailed um in
pump P. 9
METHOD: ❑ PUMPED ' 1 tests were done is in-
❑ CO SSED AIR , formation attached?
AILED ❑ OTHER ❑ -YES ❑ NO'
tlV �L L LOG It more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
Water
sear-
ing
Well
Dia-
In
FORMATION DESCRIPTION
CODE.
ft. .,,
: ft.
WELL DEPTH
It.
DURATION _:
hr, min.
DRAWDOWN-
tt. '
YIELD
gpm.
land
Surlace
-
�'
f C
zt
WATER i3EAR TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? P-YfS ONO
ANALYSIS ATTACHED? ONO
S TOR,hGE TANK : TYP �__R . � f
CAPACITY d GAL.
PUMP INFORMATION
TYPE y a CAPACITY
MAKER �'� DEPTH
MODEL- ' VOLTAGI HP
WELL DRILLER NAME //,P,4/ e OATEN
ADDRESS �p 3� SIGti>rCTt1
CA 070A, )eX Z
M
PUTNAM COUNTfY DEPARTMENT OF HEALTH
DIVISION OF ENVIROM-=AL HEALTH SERVICES
GmAWAII Mi
Owner or Purchaser of Building �—
c/ i S go .ti, c. S
Building Constructed by
Y 91- mk,CScf �Ci -j
Location - Street
PR J�e_ 4 S
Municipality
/ '4 �►; // - " of
Building Type
/s 6 a o
Section Block Lot
12/17&�5
Subdivision Name
Subdivision Lot #
GUARA= OF SUBSURFACE SEWAGE DISPOSAL SYSTEM
Li represent thatj,(L aMwholly 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. anproved plan or .approyed.:amendment t e -veto, ,and in accordance with the
_.......__.- standards, rules- -and regulations of -the Putnam County- Department of HE=a tiiy -a:
,hereby guarantee to the -owner, his successors, heirs or assigns, to place in good
operating condition any part of said system constructed by W which fails to
operate for a period of two years unuediat.ely following the date of approval of the
"Certificate og Construction Compliance " .for the sewage disposal system, or any
repairs made by 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 Environin ntal 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 buildknq 6Ulkzjn6
the system.
/°2�A,clay
Title
4P .
k-orp. j
o-qq o N o A
Address �/. /0 *V I
rev. 9/85
mk
Corporation Name of Corp.)
ess
Yorrktown Medical Laboratory, Inc.
321 Kear Street
Yorktown Heights, N. Y. 10598
(914) 245 -2800
Director: Albert H. Padovani M. T. (ASCP)
LAURENT i`'ENGINEERING
.0 /O STANLEY RICHARDS
73 FAIRFIELD DRIVE
PATTERS ON,NY. 12563
L
LABORATORY REPORT ON THE QUALITY OF WATER
3.
LAB # i
Date Taken: 1/16/90 Time: gam
Date Rc'd: Time:
Date Reported: JA o
Collected By: Malanchuk
Referred By:
Sample Location: Well Lot
Hi hview Terrace:Cornwall Hill
Patterson,NY. 12563
Phone #
Phone # I Sample Type:
Repeat Test? _ (check each)
INORGANIC NON- METALS mg /L7 MICROBIOLOGICAL CFU /100mL
_ Acidity
GENERAL BACTERIA
_ Alkalinity
40C
Chloride
Plate Count
_
_ Detergents, MBAS'..
—.Standard
(CFU /1.OmL)
_ Hardness, Total `
GE 12
Nitrogen, Ammonia
MEMBRANE FILTRATION TECHNIQUE
—
_ Nitrogen, Nitrate
.Total
_ Phosphate, Totals
Coliform
Sulfate.
_
Sulfide..
_ Fecal Coliform
_
Sulfite
_
Fecal Streptococcus
METALS (mg /L.
MOST PROBABLE NUMBER TECHN_I_QUE
_ Copper
_ Iron
_ Total Coliform Index-
Lead
_
_ Manganese
_ Fecal Coliform Index
Mercury
Sodium
KEY FOR TERMINOLOGY
_ Zinc
CFU = Colony Forming Units
CON = Confluent (q.v. TNTC) ..
MISCELLANEOUS
LT = <.= Less Than
GT = > = Greater Than
_ pH (units)
N/A = Not Applicable
— Color (units)
S/A = See Attached
Odor (TON)
TNTC= Too Numerous To Count
Turbidity (NTU)
_
REMARKS /COMMENTS (For Lab Use)_
_ Potable
Non- potable
STP INF
STP EFF
_ Other:
Sample Status:
(check each)
Outgoing
_ HNO3
_ HC1 .
H2SO4
NaOH
_ ZnOAc
_ Na2S203
Other:
Incoming
LE
k °C
GT
40C
_ pH
LE 2
_ pH
GE 9
PH
GE 12
Other:
ELAP No. 10323
THESE RESULTS INDICATE THAT THE WATER SAMPLE Was) (Wasn't) (N /A) OF A
SATISFACTORY SANITARY QUALITY ACCORDING TO THE ORK STATE PUBLIC DRINKING
WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE COLL CTION.
THESE RESULTS INDICATE THAT THE WATER SAMPLE (Did) (Didn't) UING MEET THE
SATISFACTORY CHEMIC QUALITY STANDARDS OF THE NEW YORK PUBLIC WATER
CODES, FOR THE PAR ET RS�TESTED, AT THE TIME OF SAMPLE COLLECT
x 2 /86(Rvsd7 /87)RWE
Albert H. Padovani, M.T. (A CP), Director
L
cP suzorrslo! r.= — T "
NKI cc — Y --
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a.��
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ALL
)ices f_,. ='� wit_z i��_ce c= h`=
--
�_
_
yr, == - -- ^ 1 ccr �-JE S- cr.ES < V, in c?
c�- Ctec
`CL RC C -r= S C-- �.G;�° c==-
�'_ -�C° ivGl _r C- Ct1 =_C 1 GCS L' =t a
c- -t ^1 C'v_C =^ C-1 S�CCcs
/ �
� r
/ i
. w,
bis subm
place, in
infie, ;Of
will be It
county I
Oil* It
to the Department, and &.-written guarantee will be
as shown on the appro11e.6 plan -and. thet.said Wall Will Of
maiii'of
rpiened
Add S
LCS
, ' - :
APPROVED FOR CONSTRUCTION. . -- . Th IS iii)Pi6vil"01(iiiiai two
z . -1— ,,
revocable for cause or may be amended or.,modiiied when.consi
requires a now permit. 'Apor lor disposal. of domestics i
Rev. Date By
I
ki's Irl
Ilion Or Me ' PFUP0M9.*YUVM%*I; A) 4"dt — =100-0 M-110 VIOM-1 VY-1-9
a 6 anj)n accor arice with the standards, rules and r"ulal:ons of —TRe—VU—nam
P.-of Ciinstruction. Compliance "-satisfactolri Abithsf COMM Ss;I6n,;jr OJI'Hfalth will
S; the owner, his succewors. heirs Or assigns by thil'buildiii, that sold builder will
6 during the period .of two (2) years Immediately following the data of th*:ISSU-
irorigi . nal the or any i0paiis thereto; 2) that the drilled welliliscribed above
ii in accordance with the std le and regulati on$ of the Putnam
P.Eo R.A.
1A
License No LE
a d I I construction of the building has been underta ken and is
a a 1"Pe
��ijthjrq;Cl junsl,_�is ation of construction
oner of H Ith* ly change or. aiter
16 PF
Title
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATION TO CONSTRUCT A WATER WELL
Prmn PRPMTT $ 10-IO RI 49;
WELL LOCATION
Street Address
7�
own illage City Tax
Grid Number
etiA6Li i (.j�_ 1Z0 •
l
�t
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATION TO CONSTRUCT A WATER WELL
Prmn PRPMTT $ 10-IO RI 49;
WELL LOCATION
Street Address
own illage City Tax
Grid Number
etiA6Li i (.j�_ 1Z0 •
l
WELL OWNER
Name
Mailing
Address
ivate
VJWhL-',- 4ILL EMWES
li-(C
n lto._ �9 tJ,
. O Public
USE OF WELL
erRESIDENTIAL
O PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP
0 ABANDONED
V- primary
® BUSINESS
O FARM
0 TEST /OBSERVATION
O OTHER (specify
2 - secondary
® INDUSTRIAL
O INSTITUTIONAL O STAND -BY
AMOUNT OF USE
YIELD SOUGHT
gpm /#
PEOPLE SERVED4-6 /EST. OF DAILY USAGEIUUc7 gal
REASON FOR
EW SUPPLY
O.PROVIDE ADDITIONAL SUPPLY
O TEST /OBSERVATION
DRILLING
OREPLACE EXISTING SUPPLY
❑DEEPEN EXISTING WELL
DETAILED
REASON FOR
DRILLING
WELL TYPE
ODRILLED
DDRIVEN
®DUG
[]GRAVEL
0OTHER
IS WELL SITE SUBJECT TO FLOODING? YES v�-'NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: <jff
Lot No. `_-SZs
WATER WELL CONTRACTOR: Name- 'ice Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO
NAME OF PUBLIC WATER SUPPLY: Klhl TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN44p�'
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
ON REAR OF THIS APPLICATION ON S PARR SHEE 'A j
1p -6( — 7 S
(date) Tsiinature)
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 p rmit
3. Submit a Well Completion Report on a form p o i d b the P t County
Health Departm nt.
Date of Issue: �7/ 19
Date of Expiration: 19 a mi Issu fficia
White H D copy. . . e F'i 1
Permit is Non - Transferrable Yellow copy. Building Inspector
Pink Copy: Owner
2 / �� nrannc ry runs- Ta..1 l
i
I
PUTNAM COUNTY DEPARTMENT OF RL'ALTH .
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DE31GN DATA 31"T-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Uwtidt�' v_Wat.� Wig GS-y�s �h1C .. Address -Z7__3 ��61.�ICaiJ�.f.
C "z+•iwAt_� 1d 11-i- Zd,
Located at ( Street j —` , ��q See. H1ock �LotZ.,t
( ca e nearest cross s free � 3,
Municipality Watershed
301L PERCOLATION -TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
u
R01-0
N►l1niu.r.
CLOCK
TIME
PERCOLATION
PERCOLATION
�Rwl
kJapse D6pt-Fto Water
Water Levei
No.
Tines
From Ground
Surface
in Inches
Soil Rate
Start -Stop
Min.
Start
Stop
Drop in
ICn. /In drop
Inches
Inches
_2
C'
`1
. .2
4
1
-_ 2 �D �� -101 C) ti s a � a� 311 5 .
4
NuLps: 1) 'retst3 to be repeated at same depth until a proximately equal soil
rates t►re obtained at each perenIntion test hole. All data to be submitted
Tor .rovlov.
' -pth measurements to he mr1r1f' from top of hole.
D TO .3 SU1MI71'sD WITH !N A iYLT CATI0� TEST PIT DATA REQU ltr
DESCRIP'T'ION OF SOII. ► 1ENCOUNTERED IN TFo.;r firi" 3
i)E?fH HOLE NO. ROLE NO. HOLE NO.
G. L.
611
12"
18"
CL?a�lC Y r �o�r --1
24 to
30 of
36"
i
4 211
48"
'1 11
6011
('610
l2
i
I N1)1 CATE: LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
1 NI)1 CATE L.E:Vi -:L TO WHICH WATER LEVEL, RISES AT -rER SING ENCOUNT
'i'Ts.S'T'S MAI)E HY It. W. 1'... Date
DESIGN
Soil Rate Used 7► Min/1 "Drop,, S. D. Usable Area Provided Socoa iL.F
No. of-Bedrooms ' Septic Tank Capacity_ Gals.--.- Type
Absorption Area rov de .By cOo L. F. x24" �, trench.
1�1CC C'�
THIS SPACE FOR USE BY HEAL'T'H DEPARTMENT ONLY: s`` � <�. oa�,u�r�ie
r.. L-
�wvev`�
roil Rate Approved Sq. WWI. Checked by Date
n
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:
Cornwall Hill Estates, Inc.
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.I.
(Name and Address)
Secretary: Janet G. Mastropietro, 223 Katonah Ave., Katonah, N.Y. 10536
(Name and Address)
Treasurer: Lynne Diario, 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 co the approval requested and all subsequent acts relating
thereto.
Sworn to before me this f day Signed:
of 19
Notary Public
LIONEL WEINSTEIN
Notary Public, Stato of New YofR
No. 60.4199160
Quaifled In WQ9tch&::er CO(MI'!
6b+nML%_- 4Eoth• Expires March 30. Z9
8/84
Title: Vice President
Corporate Seal
CLIENT
:GDi� NW,
1�.10.Z1t�.
I t0'
GA►� • 2ESIDENGE �
52
AS- OLAILT
DIMENSION GNA
N°
A
6
Ila 1111,6115
2
30.5
30. D
3
37.5'
30.5"
4
AS- OLAILT
DIMENSION GNA
N°
A
6
2
30.5
30. D
3
37.5'
30.5"
4
•O
4.6 -p,
Q-8.5
73.0"
7
53.0
75.5"
8
57.5"
70-0,
65.0
83.5
10
617.5"
12
Irv. 0 �
53. D
13
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PvtNAM 000 NTY VLf'At?'G?�tPNTOP,t�At:
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