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BOX 7
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1.6 � � � rL
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,I{ 164
00594
- -�.�_ y_
ev. 386 PUTNAM COUNTY•DEPARTMENT OF HEALTH
Divia)on of Environmental Health Services, Cannel, 'N.Y. 10512
s :w.
.. Eoglneer, Must Provide
' P.C.H D 'Permit li
p-
Z4-r66
CER, ATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM ta4 F wso,Al
Town or Village
Located at cOR- WWALL.. WILL - Qo.4i7. Tai MaP Block b Lot Z
Oweer /applicant =Name:. Formerly COTrNvJ/1L1. Sabdivislon.Name �o1?NWALLSabdv, Lot q Z
MaWng Addreae.'IS- J AKF 4 LF.4p. ??iD cAQMFl NAY zip /OS17. Date Permit Isaaed
Separ�te.Sewer�ge system_ ballt by �1l•FAG 40�.ISTGt10►J' Address ' AF3ovF
Coaslsting of Gallon Septic Tank and �13oT1'Ory� 8-0
lolU[� SF�`TioNS o� .co�cizFTF ''TEE ` ��FS'.: S��ou,w6y ;�3Y l'-o" µill,✓ 3/4" M'�1�. 6��t�/1�1; '..
Water Supply= . Pubil SappI From Address
or Privafe Snpp1Y ;DrlOed by Address _ V.411F4� , JV, y
B �ESt� i.IGF Has Erosion Control ;Been CompletedY --
�g _
Number of.Bedrooma Here Gasbags Grinder Been.InstalledY '
)Jo
Other Requirements 3 =. �+ O, Fj '. F'Lt L D- F� , X T.y
:4
I certify that the system(s) as listed serving the above'premises.were-constructed essentia shown on the h�o a£F� � }eieAd�werk`( copied ,
of which are attached) -,,and inaccordance with the standards, rules and regulations, i rdance .f a plp�}i,gnj� th�(�Y ,�w,�ast
Putnam County Deplartmpen�t Of Health.' 4t �`l�"'L "•"'`a ��
Date OZ•Z�f•00 CertifiedDY �.d�1F1. 4C4 0, MA 1,.J y� P.E. Ri/t
Address 1) 3 SMITH A4iJOK MT KISW - )J•Y i License No P
Any person oecupyino premise3 served by the above system(s) spoil promptly take such action as ntay,be.necessary.to secure the corraetion:of any _unsanitary;
conditions .resulting from such usage. Approval of the separate sewerage. system shall become null and void as soon as a pubt'. sanitary ewer °bscomea' .
available and the approval of the "private: water,supp.ly shall become null and void when a 'public water supply becomes available. Such approvals ais
subject to modification change when. 'inn the )udyment.`of the'Commifsidner of Health, such re4ocotion, Modification of 'change Is necss�iaryy.�
Date
0
. aM COQ.
"/yam
a, .e
. it *
W Y O4
WLLL l,Vl'1rLi.11VLV cNr,rv�t
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
/
�j
WELL LOCATION
Si EET ADDRESS. TAX GAIO NUMBER:
WELL OWNER
NAME: ( ADDRESS:
PRIVATE
❑ PUBLIC
USE OF WELL
1 - primary
2 - secondary
PRESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ _ABANDONED
0 BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE _X!P_ gal.
REASON FOR
DRILLING
19-NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH , ft.
STATIC WATER LEVEL 94 eft.
DATE MEASURED
DRILLING
EQUIPMENT
$LROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING. I& OPEN HOLE IN BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL LENGTH ft.
MATERIALS: OSTEEL ❑ PLASTIC ❑ OTHER
LENGTH.BELOW GRADE �� ft.
JOINTS: ❑ WELDED ,'THREADED 0 OTHER
DIAMETER 6' in.
SEAL: ❑ CEMENT GROUT ❑ BENTONITE THER
WEIGHT
PER FOOT /6' lb./.ft..
DRIVE SHOE).YES ❑ NO
I LINER: ❑ YES 0
SCREEN
DETAILS
DIAMETER (in)
'SLOT SIZE
LENGTH (it)
DEPTH TO SCREEN (it)
DEVELOPED?
FIRST
❑ YES ONO
HOURS
SECOND
.GRAVEL PACK
❑ YES
❑ NO
GRAVEL
SIZE:
DIAMETER
OF PACK in.
TOP
DEPTH ft.
BOTTOM
DEPTH It.
WELL YIELD TEST ; If detailed pumping
METHOD: O PUMPED tests were done is in-
COMPRESSED AIR r formation attached?
O BAILED ❑ OTHER ; ❑ YES O NO
It more detailed formation descriptions or sieve analyses
WELL LOG are available, please attach.
DEPTH FROM
SURFACE
water
Bear-
Ing
Welt
O'a-
(meter
FORMATION DESCRIPTION
cooe
it.
it
WELL DEPTH
It.
DURATION
hr, min.
DRAWOOWN
ft.
YIELD
gpm.
Surface
d
b
a
'
D
WATER ❑ CLEAR TEMP.
QUALITY ❑ CLOUDY HARDNESS
O COLORED ANALYZED? OYES ❑ NO
ANALYSIS ATTACHED? O YES O NO
STORAGE TANK: TYPE Tn4_e1" �1�40
CAPACITY 1 ® GAL %
PUMP IMFQMATION
TYPE CAPA CITY®
c
LLMA:EB DEPTH qo
VOLTAGE 3__0H HP r Y
WE BULB 3 N E 4� ATE
A
77, - -
I /a , g, 7 wo, -
Yorktown Medical Laboratory, Inc.
321 Kear Street
Yorktown Heights, N. Y. 10598
(914) 245 -3203
Director: Albert X. Padovani M. T. (ASCP)
j- RICHARD MORGANTE
.CORNWALL HILL RD
PATTERSON, NY. 12563 .
L -�
LAB N
CA. 006320
Date Taken: P-/9/88 Time: 6;?Oam
Date Re'd: 27�8g Time: :?5am
Date Reported:
Collected By: mOrgan e
Referred By:
Sample Location 1 c en Tap
Sid t � +21. A I o
Phone H
Phone N Sample Type:
Repeat Test ?_ _ 1(check one)
LABORATORY REPORT ON THE BACTERIOLOGICAL-QUALITY OF WATER_
GENERAL BACTERIA
X Standard Plate Count (CFU /1.OmL)
(Agar Plate @ 35 °C)
MEMBRANE FILTRATION TECHNIQUE (MFT)
X Total Coliform (CFU /100mL)
Fecal Coliform (CFU /100mL)
Fecal Streptococcus (CFU /100mL)
MOST PROBABLE NUMBER TECHNIQUE (MPN)
Total Coliform: MPN Index (per.l00mL)
Fecal Coliform: MPN Index (per 100mL)
OTHER ANALYSES
REMARKS (For Laboratory Use)_
2Z_
X Potable
_ Non - potable
STP INF
_ STP EFF
Other:
Sample Status:
(check each.)
Outgoing
Na2S203
Incoming
X LE 4 °C
GT 40c
KEY FOR TERMINOLOGY
RDS = Recommend Disinfec-
tion of Source
TNTC= Too Numerous To Count
CON = Confluent ( =TNTC)
LE = Less Than.or Equal to
GT = Greater Than -
N/A = Not Applicable
THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS) (WASN'T) (N /A) OF A
SATISFACTORY SANITARY QUALITY ACCORDING TO TH YORK STATE DRINKING
WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION.
me I -
Albert H. Padovani, M.T. ASCP , Director,
For Lab Use Only:
._ H/C to
`F
PUTNAM COU fY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONM=AL HEALTH SERVICES
V "
-LL-
Owner Purcha—sar f of Building
Building Constructed by
/A IW U)A! -1411 1po
Location - Street
ATF ���*
Municipality
,5-wtiG-Le FAA4 -
Building Type.
Is 4 2-1
Section Block Lot
Subdivision Name
1
Subdivision Lot #
GUARAN= OF SUBSURFACE SEWAGE DISPOSAL SYSTEM
I represent that I am 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 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 disposal 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 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 _/_ day of 19:515
/Qj 44az
General Contract (Owner) - Signature
Cry �r 1,41L
Corporation Name (if Corp.)
4#e 19
wr: -
rev. 9/85
mk
Signature (F,6
Title Via, 0RIF5
a7 il -�4�a �a�ST ANC,
Corporation Name (if Corp.)
!Miess
II.
IV.
V.
VT.
APPENDIX C
FINAL SITE INSPECT
( Op-V wgi,,- /-// LL- IC64 Q
TM # OR.SUBDIVISION LOT
ION Date J,
il
In t by �L W
OWNER CogN;n1/}u
ri
AC- ( -'- 2 1 L,®; 2
r-
cos
gEVvAGE DISPOSAL AREA
a. SDS area located as a roved Tans
%'(
b. Fill section - Date of placement
2:1 barrier- LGTH WIDTH AVG.DPTH
c. Natural soil not strippedX
d. Stone, brush, etc., greater than 15' fran SDS area.
e. 100 ft. from water course /wetlands.
d b
SEWAGE DISPOSAL SYSTEM
a. Septic tank size 1,000 1,250
b. Septic tank instal evel
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
X
f. JUNCTION BOX - propez1v set
g. TRENCHES
1. Length reauired - Length installed
Sr a,,9c K
2. Distance to watercourse measured: ft.
S .�r
3. Installed accordin to plan
I S 5
4. Distance center to center ('
plc c -�
5. Slope of trench acceptable 1/16 - 1/32 " /foot,
AA,,O ,qwa
6. -10 feet fran property line - 20 feet - foundations
7. Depth of trench < 30 inches fran surface
S�
8. Roan allowed for expansion, 50%
9. Size of gravel 3/4 - 1 " diameter
�{
10. Depth of gravel in trench 12" nininu n
11. P#e ends capped
h. PUMP OR DOSE SYSTEMS
1. Size of punm chamber
2. Overflow tank
3. Alarm, visual /audio
4. PLunp easily accessible manhole to grade
5. First box baffled
6. Cycle witnessed by Health Departnent
estimated flow per cycle
_
HOUSE '
a. House located per approved plans.
b. Niunber of bedroans
WELL
a. Well located as per approved plans
b. Distance fran SDS area measured 0 ft.
c. Casing 18" above 2rade.
d. Surface drainage around well acceptable.
}C
OVERALL 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 & dir.to exist.watercours
g. Footing drains dischar e away from SDS area
o7 ,2NST4 1, d ---
h. Surface water 2rotection ad to
i. Errosion control provided on slopes greater than 15 %.
__
f . ,.�
,`
�t
`\\ ' Y
a
-s
t ,.
PUTNAM COUNTY DEPARTMENT OF HEALTH
Divlelou of Environmental Health Servlcee Carmel NN., i6512. Engineer to Provide Permit it
t
A TE OF COMPLIANCE'
�l on CERTIFICATE
i
-.
CON U_CrlON PE OR,SEWAGE DISP,OSAI SYSTEM .. Permit . M"
PATTERS 0.
Locatedae ca:RIJWAL4 ,HILL IaoAp .. - or XUlage e
Sabdlylslon Itislme CORtt/wALL HaL Sabd. lot iY, Z Tai, Map Block Lot -2,
Renewal< Revision ❑
Owner7Appucant Name. .GILEA�', toNSTRUCTIO.N
Date of Prevloae Approval
ll N Ad", ►S LAKE, 61LEA�. RcAb Town "cA�eFl zip la
Building Type REST DIENG E Lot Area I At' + [�PCHD cd on Ody Depth 3 aVolume �s it x
Number of Bedrooms '- 3 beslgn Flow G P D, 6'100 `
_NotificationleRequlred When Fill ie :completed •.
Separate Sewerage System to conslet of 1000 Gallon Septic Taak,rana 256 L F: GONG, aTFF <:. .io' ON CENTER _
ze be constructed by :61LFAD GgNST- ..TcUCTIO7J Aad ea GAt*Mrj_ N W Y6*1<:%
.-, ,
Water Sappb PabUc Supply From " Addroes
>A
or :_ Prlvate'Sapply:DrWed by N�FQ�U - Addreee "~ STN' Vd�LLFY t 7�r yi
.
•3 0 "' RuN o� B�4NK "Fill ovB>z SSOS'`Ar�Ea � o -�oyt
Other Renulremeate ,
_
1 represent that I am wholly and completely' responsible for the design and location of •the proposed systern(q; 1)_ that 'the "separate' sewage. disposal system
,
above Cescribed will be -constructed as shown on the approved 'amendment'there to and in accordance with the standards ruler an -regu a, ions 0! e' • u nam,
County Depart men t'Oi Health, and [hat On completion thereof a: "Certifiuta; Of ConstructlOrr Compl lance sal Kfaitory to;the Commissioner `of Health will
'
Da submittetl to :tne Department, ,and a wntten ",guaiante'e .will De furnisried the owner, his wccessoi% heirs or attiyns by the budder,; that said builder will•
place in 'good operating cone_ ition any part of .said sewage: disposal. system,tlur.ing the penod�of two (29 years lmmetlutely followirg the data of the isw-
.;
ante, of the approval •of. the,.Certificate :of Construction Compliance of�'the onyinal- system or any repairs thereto;'.2) that ;t he 4i' 11 describetl�aDOve
—of,:
- -'
will..be located as shovin on the 8pproved "plan antl that said Well will be'.InStalletl. -�n accordance wilts the standards; rules antl,. regu�' fhe f?utriam
County Department of. ;Health . ,s a'f�EAi�iE GOPi'�LPAAi�d:�
1
;Signed,- P �iPs-
-
Atldress 113 SMITi A/bN r KI &GO N ' �r;ood A'TION
-
•
- APPROVED FOR CONSTRUCTION: This'approva),exp,ires two years: from the date issued unless •constrUC%0 a wilding has be undertaken and is
re4ocatNe for cause or may be aTBO08tl Or•mOdified Wh'Bn'COMitle ►ed fleclSfary Dy the COTTissioner "of Health.` Any change'or alteration of.conftrUCtlOn
requires a nAw permit Approved for- disposal Of,diomestic sandarysewage and /or pri water Supply only. -
1Ri7
Date r�
a
-s
.-CONSTRUCTION FOR WAGE DISP SAL SYSTEM -
VFW
Reneiial "On
LL
Appfleant Nam
oproval
eted
Ired "W
AL
Sepik Tag and'—
To be cofistrfictetl -bi
Water A:dd s'
or: Private SupOly�"6"Idl 6
Other Requirements
of -'Health, and:th '6sfaaory to
niy- bipakment at the
ea th.
Date
UNTY
, C=F9
APP,ROYF-i)-.FPF/60N�TRU!CTIO,N: Thi=roval V one . the,- -is* unless construction -of thibuilding, has been, ugdartaken and is
revocable for raiffse or ma,
�spry y C mrnissioner * o Health. Any chah�s or aiteration of construction
Permi
A 'Title
pate
~
d N
OUTNAM COUNTY DEPARTMENT -O
Rev. 3186 Division of Evroume�tl Health rmil� Y.Aos ij eto
Provide Permit q r` CONSTRUCTION PE FOR S GE DISPOSAL SYSTEM Permit I
Located at
4 or :VflIsg
Subdivislon'Name 94/y,/A Sabd Lot # Tax -Ma p 4 Block Lot
Sion Cl-
Renewal' -Revi
Owner/Applicant Name C- p1?1Vv1A 15!rIA ME-5, 1,Ve-
Date of Prevlo- A0proyal
own AA -r,: A o Wd 141. Y.,
dress T6 IVA 9 A VS
, , -- T ZAP
Malting Ad
A-
-7 ? S . J.':
S ul
Building Lot A' im Section Y Depth j th
Number of Bedrooms . — Design Flo�.r,G.,/P/D - PCHD Nouncadon When Fin is completed
Voc)
ge System to Gallon Siptic Tank- A
consist of
Separate Sewera., and
To be constructed by Address
Water Supoir—Pillblic Supply From—
Address
7. 9
:
Othei Re
,quire-entp //V. Al
rrepresent- that I am'wholly a I no completely riipoAsiii)e for the design and location of the pr oposed systerh(s)'; 1) that the separate. wage disposal system
-r"u T.. T
nstrLicted as sh6wnbn the'-approVbd-ameridinan't..t'h'e-'re''to and, in ;accordance with ,the standards, rules and nal.n.
above da.scribed�willbejco,
y to the Comm
County De-6artment of Health,. and that,on. cornpietio:n;thereof a "Certificate, of. Construction Compliance" satisfactor issl6ner of Healtliwill
be .submitted 9 to the Department,,'an d aj wetter guarantee will be furnishedthe owner, his successors, heirs,or'assigns by the builder. that said builder : will
inq thedaiie of the issu-
ance in good operating- condition any, Part of. said seirage!, disposal -systeim'during the period of two (2) years immediately follow
0 1 of the 6ertific� r Con�struction Cornpl* of .'the original system or any repairs . spairs t h . o ) that the'drill 11 de scribed above
ance of the P!0YA te 6�... Well
9 d -I;gj =QL-.
will be, r I dance 9 with ihe,st. d' ds, r lea and re"A of the Putnam
located 'hir iiid"wei(w. I I 6"ins"il'
ed as shown on the approved an "t
County .Department of Health.
Sig P. E. R.A.
Date 7"
f C-V e 0
-d&ess License N
APPROVED FOR CONSTRUCTION. This apprpva .LI;.
ear from the date issued unle I SS construction of the building has ,been undertaken and is
revocable for cause or may be amended or modified when .consldordd ner'*'ssary by the Commissioner- of - Health. Any change or alteration,of construction
..ter
Date oe BY Title
M�St" 49
requires' a now permit o' dis3' I '*f �dO
ov r pose 0 ic sam ary'sewage ly only. +.'
Im
PUTNAM CUJNTY DEPARUENT OF
DIVISION OF P O M Y• L HEALTH SIKurCES
DESIGN DATA SHEET- SUBSUF'ACE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner 6UZA1C--> LoNSTZt*-?/ON Address 1S dAK� 64EAr--, iZoAl>
Located at '(Street) COP-NWALL DILL Sec. I Block Lot ?-A
(indicate nearest cross street)
Municipality SAT ?F •SAN Watershed N• Y
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Date of Pre- Soaking 3. 3) -- S7 Date of Percolation Test -1 • )'97
HOLE
NUMBER
CLOCK 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
3z6
1
2 34q
)$
ZI
3
3-4
4
0
1 3 5z -A J'7 ZS �g ZaS Z.S !o
2.q/7 4`)7 zo.S Z.S iZ
3 47 5�7 30 )g 20. Z.S )Z
4
5
1 boa
2 .4Z-� As z
zd �g 3
3 �18 5)S Z`7
4
�� �Zz
_
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 su)mitted
for review.
2. Depth measurements to be made from top of hole.
rev. 9/85
G. L.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
HOLE NO. HOLE NO. HOLE NO.
AF- PTA \jFt> To P;., cz FILL 13Y
11 COR)JWALL WI L FSTA-r -'S
2'
3'
4'
5'
6'
7'
8'
9'
10!
11'
12'
13'
14'
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: DATE:
DESIGN
Soil Rate Used -1d Min /1" Drop: S.D. Usable Area Provided J4,0" :59-TI.
No. of Bedrooms 3 Septic Tank Capacity gals. Type toNc.
Absorption Area Provided By ZS6 "-rsF rjFFs "� /o v,' �fNTF2
Other 3 ' O R-OPS F1" 01JF L- , r->- �]C
).F2 1='. c&F'I7:>.F2 MbAJJ
Signa
Address 11 5M ►TA Aj.Fwf F'OR
KEANE COPPELMAN
MY
ENGINEER'S, P.C.
A PROFESSIONAL CORPORATION
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved sq.ft /gal. Checked by Date
'`.::� K .'; •�i' r .rtn_, wN - t*��.ith,M1r 'Ym4r -d?�`� y ray Est t v . '�auf s r. ;;,v v .r ;;c +. ,. 3 ,, �. �; ;'
PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMERAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
Clr�f
(Name of Owner)
COMMQJTS
REVIEW SHEET - CONSTRUCT ON PERMIT �(I' -3
� DATE REVIEWED.
-�! BY:
(Street Location)
YES NO DOCUMENTS
Permit Application ►/
Corporate Resolution
Plans - Three sets
f Engineers Authorization 0 /
Design. Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results (3)
/ 30" Perc Hole
Other
3 ✓" House Plans - Two sets
If PWS - Letter
Variance Request
REQUIRED DETAILS ON PLANS
Sewage System Plan
`! Sewage System Hydraulic Profile - Gravity Flow
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
-U,7- Design Data
Two -Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footing /Gutter Curtain Drains
Perc & Deep Holes Located
t/ Representative of Sewage & Expansion Area
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 Property Located
Property Metes & Bounds
House Setback Necessary (Tight lot)
use Sewer - 1 /4" /ft. 4 110; Type pipe
No Bends; Max. Bends 450 w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees
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,Storm,Leader,Footing
25' to Catch Basin
10' to Water Line (pits -201)
Septic Tanks
10' fran Foundation
50' to Well
15' Well to PL
GENERAL
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Town/DEC Permit R & D)
Data On DDS Plans & Permit Same
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 . 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.
Sworn to before me 'this* / day Signed: ax�
of 6�0 a 19
Notary Public
LIONEL VdEINSTEIN
Votary Public, State of NeW.YbIR
Nin wild ?150
Qual3fio;! ih Vt�a�lrhM:er C=i!Y±
abnunissoh- Expiras 1414 ,Ch 30. 19
8/84
Title: Vice : President
Corporate Seal
PUTNAM COUNTY DEPARTMENT OF HEALTH
.. DIVISION OF F.INIRONMEN`fAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CAJVIM, N. Y. 10512
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE N0.
owl MrC- *PmwAd.L 141" tsrh�s. 1 Nc._ Address • ZZ3 KA-TnwHH Avd, K.Al2NA4:
co (LuW�L4-
Located at (Street��„�, (G Sec. 15 Block id Lot?.) ,
ca a nearest cross s ree
t�tw,lc;ipality 'QJj"tT��l Watershed
t
:301L PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
TOI0
Nwi l ie r CLOCK TIME
PERCOLATION
PERCOLATION
Ruts kuapse
Depth to
Water
Water Level
No. Time
From Grvond Surface
in Inches
;:Soil. Rate
Start -Stop Min.
Start
Stop
Drop in
Min. /in drop
Inches
Inches
Inches
a
�o. 6-7
'
s�:i�- Iota I�5
3''
37._.33
a
1.15 -3:30 gl
;2.3:
NUL(sn: 1) Tests to be repeated at same depth until a r•oximately equal soil
raLOS arc obtained at each perenlation test hole. All day & to be submitted
for r iv 1(••,,
• , ' lath measurements to he trade from ton of hol e.
NUL(sn: 1) Tests to be repeated at same depth until a r•oximately equal soil
raLOS arc obtained at each perenlation test hole. All day & to be submitted
for r iv 1(••,,
• , ' lath measurements to he trade from ton of hol e.
TEST PIT DATA INQUIRED TO BE SUL3MITTED WITH APPLICA`t'ION
DESCRIPTION OF SOILS ENCOUNTERFM IN TEST HOLES
DEPTH HOI.E NO. HOLE NO. 'HOLE NO. 3
1211 • C'�04- �o�•� C�ci.,,- \Caw,c
18"
24"
30"
36"
42"
48"
wit
6611.
•r�
.[big
U4 11
ock
I NIA CA`1'h; L1;VEL AT WHICH GROUND WATL''R IS ENCOUNTER M-
M11 I r,A'1'h: LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
'1'h.:3'113 MAI16 BY R .W . L . Date
DMIGN
Soil hate Used 4�_Mii?/1 "Drop: S.D. Usable -Area Provided C,0 0 0 $ .F
No. o1' D,-drooms Septic Tank Capacity loco Gals . Type
Absorption Area Provi-cla By L.F.x24" �'—� d Inc
'� her
24a L.
NA76Z
i r.1
AddresB �� SEALC
.
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
:3011 Xate Approved_
o�
�ia
sk,P2C c
%35
PUTNA
DFpr F Co:1/trr Y
AL iy
�to\
Sq: Ft /Gal. Checked by Date
0
2
DEPARTMENT OF-..HEALTH
Division of-Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATION TO CONSTRUCT A WATER WELL 0 /°
PCHD PERMIT #1 9.
WELL LOCATION
cOStreet Address Town/Village/City Tax Grid Number
RW4LL WILL RcAD >ATTZ-t.-SVN
WELL OWNER
Name Mailing Address I §Private
�ILE4D CONST UC-T1ON 15 LAKE GILJ:AD R>, CARMEL , N-Y, IoSIZ O Public
USE OF WELL
1 - primary
2 - secondary
RESIDENTIAL
®_BUSINESS
® INDUSTRIAL
® PUBLIC SUPPLY. ❑ AIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION
13 INSTITUTIONAL ❑ STAND -BY
® ABANDONED
0 OTHER (specify
AMOUNT OF USE
YIELD SOUGHT
$ gpm /# PEOPLE SERVED b /EST. OF DAILY USAGE 60009 gal
REASON FOR
DRILLING
99NEW SUPPLY []PROVIDE ADDITIONAL SUPPLY
❑REPLACE EXISTING SUPPLY ®DEEPEN EXISTING WELL
® TEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
VjEw WA-rr
SUPP FOP pJEW RESIDENCE
WELL TYPE
®DRILLED
ODRIVEN
®DUG ®GRAVEL
® OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
CORNWALL HILL TESTA ?ES Lot No. 7-
WATER WELL CONTRACTOR: Name AK E RSoN Address: PVTMAM yAL Xy 4-Y,
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO
NAME OF PUBLIC WATER SUPPLY: N. 'A- TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: MILES
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
[]ON REAR OF THIS APPLICATION ® N EPA SHEET
(date) ( gnature)
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
Date of Expiration s, /---49 ��
Permit Issuin " fficia
Permit is Non - Transferrable �� copy: H.D. File
Yellow copy: Building Inspector
2/87 Pink Copy: Owner
Orange copy: Well Driller
APPM DIY B
C� U-I�li'Y DEPART�r OF HEALTH - DIVISION OF ENVIRCiv''��7ZAL Hr'ALTE SERVICES
P
INDIVIDUAL WATER SUPPLY & "UBSMF'AC E SE�-M DISPOSA -L SYSTE 4S
REVIEW Sr--1 - CONSTRUCTION P7—QV-IT
DATE R ET,=YY ED j
BY
(Street Location)
DOCUM.F,N'I`S
Permit Appli cation ��
Corporate Resolution
Plans - Three sets
Engineers Authorizaticn
Design Data Sheet MC-S)
Deep Hole Lcg
Consistent Perc Results
Perc Hole Depth
o -?-rre of Cwiter')
s/s
SU�DiJISIC�i
Perc
(3) Fill_
ca .--
House Plans - Two sets
Well Fe----nit; P4v-S letter
Variance Recues t
-
Le.—al Subdivi sicn
Subdivision Pmoroval Checke✓ -
Ex- approval SSDS bLj . Lots Checked
Wetland (Tawn/DEC Pen-nit. R & D)
Data On DDS Plans & Per-rLit Same
REQUIRE DE' A LS CN PIANS
Swage System Plan - ( north arrow)
Sewage System Hydratfl is Profile - Gravity Flcw
Fill Profile & Dimensions - Volure
D or J Box; Trench /G le_ry; PLmm pit details
Septic Tank - Size, Detail
Well Detail, Service Line if over
Construction Notes
Design Data: perc and deep results .
Two -Foot Contours Fisting.& Proposed
Driveway & Slopes Cut
Footing /Gutter,Curtain Drains (discharge CK)
Perc & Deep Holes Located
Representative of prinexy and ec tension
Expansion Area; s:icwn;gravity flow,suff. size
If Pu iped Pit & D Box Show -n & Deta- ilea
House - No. of Bedrooms
Wells & SSDS's w /in 200 ft. of Proposed System
Property Rtes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4 " /ft. d "O; Type pipe
No Bends; Max. Pads 45" w /cleanout
SEPA.RATIGN DISTAN= SPBCIFIED ON PLAN
Fields
10' to P.L., Driveway, Zarge Trees,Top of fi"
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. expa
15' to Drains - Curtain, Lk,.der, Footing
35'to catch basin, stomrdrain,piped watercour.
101. to Water Line (pits -201) - -
50' intermittent drai.nace course
Septic Tanks
10' fran Foundation; 50' to till
15' Well to PL
Van Geldern Construction Corp..
223 KATONAH AVENUE • KATONAH, NEW YORK 10536 • (914) 232.7171
RECEIVED
ENVIRTINME?1TAN �1� A j 11
Apri 1 1, 1987
'87 ABR °2 All :04
Mr. William Hedges
Putnam County Department of Health
Carmel, New York 10512
Dear Mr. Hedges:
RECEIVED
EN VI R N M FN TA { HE L H
'87 ABR All :02
Re: Cornwall Ridge subdivision
Lot 2 - Cornwall Hill Road
With reference to the above subdivision and lot in Patterson,
fill was placed in the septic area in accordance with P.C.H.D.
approved plans dated 4/23/86 to a depth of 3 feet.
Please refer to plans as submitted by Laurent Engineering
dated 4/18/86, SS -2F.
Sincerely,
Philip van Geldern
VAN GELDERN CONSTRUCTI �fiORP.
Am
enclosure
r •• • �• •�r i� • .1W.1 _r.
DESIGN DATA,SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE N0.
Owner CORAIWI)46 /J 11-6 e-:�r T 11116. Address 2 z 3 I,A7''/✓ /Jl/ A V,0' it / -1 r -)^/,a V- W! l
C O'eivv✓wI -c /,� /� c ,Q,O
Located at ( Street) - R Sec. % ,S Block 62 Lot Z. I
(indicate nearest cross street) �Z 1
Municipality AA %'� fz �t/ Watershed C R v l
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Date of Pre- Soaking 3 ' $ 7 Date of- Percolation Test 3 ' S- 8 7
HOLE
NUMBER CLOCK TIME PERC0=ON
PERCOLATION
Run Elapse Depth to Water Fran
Water Level
No. Time Ground Surface
In Inches Soil Rate
Start -Stop Min. Start Stop
Drop In Min /In Drop
Inches Inches
Inches
3 2 //: o
4
2 /�: Ss"- / /:2 Cv : 3 1 LL/ 27
4
5 -- 11V /-"'/I L . Sg c T/ o,A1
1
2
3
4
NOTESz 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.fram top of hole.
rev. 9/85
4
2 /�: Ss"- / /:2 Cv : 3 1 LL/ 27
4
5 -- 11V /-"'/I L . Sg c T/ o,A1
1
2
3
4
NOTESz 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.fram top of hole.
rev. 9/85
DEPTH
G.L.
.. lr
2'
3'
4'
TEST PIT
MUIRED TO BE SUBMITTED WITH APPLICATION
)N OF SOILS ENCOUNTERED IN TEST HOLES
HOLE NO. HOLE NO. HOLE NO..
5'
6'
71
81
9'
10'
11°
_ .2` _
13'
14'
INDICATE LEVEL AT WHICH GROUNDRATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSER`TATIONS MADE BY: 12AM,00 G ,P/ -1 S
DESIGN
Soil Rate Used Min /1 Drop: S.D. Usable Area Provided
No. of Bedroans 3 Septic Tank Capacity gals. Type
Absorption-Area Provided By L.F. x 24" width trench
Other Z /O L L
L 1
Name /,,AUjLE'IV% 41l1(f,lA/,Eic101A1Cj /�sfy��r?CSignature
Address 7Y 0 R SEAL W
PA
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY s o oJFL
Soil Rate Approved sq.ft /gal. Checked by Date
Li {
•
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X
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