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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23.12 -1 -35 I � 1'L 00710 r'7t PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SE ENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at ` own or Village r��77 -1E �`G➢ Owner /Applicant Name�� ")�./.c' CjN� � Tax Map s - Block Lot Formerly ? j(jLo,fig - 6--7/ �� Mailing Address /Q_�. S Subdivision Name Lj m z A ,,4 Subd. Lot # l Date Construction Permit Issued by PCHD cl !� Separate Sewerage System built by �,y�c��,s �o �p�t ��:Q� Address Consisting of 12-50 Gallon Septic Tank and Zip 10 -F l':�' Other Requirements: Water Supply: Public Supply From Address or: Private Supply Drilled by ' pp) & Address. Building Type r��' �i�', Has erosion control been completed? yeS Number of Bedrooms Has garbage grinder been installed? A/O 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 regulal Date: Zdb= %'l' Certified by / Address /I/ l e J/7ri°i�zr� AO County Department of Health. P.E..X R.A. License # -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 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 Public Health Director, such revoc io , modific t'on or change is necessary. By: �� i Title: % (l�GC Gr�/�F�� te: �f l White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Dn (A 5 cc 16-P Owner` r Purchaser of Buil ing Tax Map Block Lot Buildi`'dg Constructed by / TownNillage Pnwele t 9c),^ h L, ri la)�5 Location - Street Subdivision Name 7a. ym 4i M /x, i, l � 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 ,r 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 rsigned 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 Day Year v General C acto (Owner) - Signature /r Corporation Name (if corporation) Address: Pjj q r, f e S' p y e. State ( a Vol 0, 1. 1 V " Zip i 7 Signati Title: Corporation Name (if corporation) Address: State Zip Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 1,.4 / �L WELL COMPLETION REPORT Well Location . Street Address: flyalK U P-1) Town illage: Tax Grid # Map Block Lot(s) Well Owner: Name: Address: am, Use of Well: I- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion V Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock _ Other Casing Details Total length ft. Length below grade ft. Diameter _�in. Weight per foot lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded Threaded —Other Seal: _ Cement grout X Bentonite _ Other Drive shoe: Yes _No Liner:_ Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield Test _Bailed _Pumped _ Compressed Air Hours A Yieldl✓ gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) 16 d6dg6 _ Depth ofcompleted well in feet !�96, Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 1, 1 r If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth Model Voltage HP Tank Type Volume Date Well Complete 7 Putnam County Certification No. �� Date of Report 7/.; G Well Driller (si nature) � NOTI1f E�Act location of well with distances to at least two permanenmanamarxs co oe provlueu u11 a Scpa aiu blir Vi(ui. Well Driller's Name/ _ Address: /9/0' H3/ Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 YML ENVIRONMENTAL SERVICES 321 Kear Street �~ Yorktown Heightso N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 93.904745 - - -�- - - -�-------��--------- CLIENT #: 8641 7 ----------- --- --------------------------- NON STAT PROC PASE 1 m ------ - WALLACE, DOUGLAS DATE/TIME TAKE*: 10/21/99 09:00A P.O. BOX 154 DATE/TIME REC'D: 10/22/99 09:20) M| EGAN LAKE, NY 10547 REPORT DATE: 10/29/99 PHONE: (914)-734-1187 SAMPLING SITE: LOT #12 LITTLE POND HILL ESTATES SAMPLE TYPE..: POTABLE : 17 POWDER HORN ROAD PATTERSON: NY PRESERVATIVES: NONE COL'D BY: SAME TEMPERATURE..: -N/A NOTES...: KIT TAP ow--m—m—m—mm --- ' COLIFORM METH': —m— ---------------����� DATE FLAG PROCEDURE RESULT NORMAL - RANGE ' METHOD PUTNAM CNTY PROFILE 10/22/99 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 10/22/99 LEAD (IMS) 1.1 ppb 0-15 ppb 9101 10/22/99 NITRATE NITROG 0.53 MG/L 0 - 10 9139 10/22/99 NITRITE NITROG <0.01 MG/L N/A 9146 10/22/99 IRON (Fe) <0.060 MG/L 0-0.3 mg/1 2037 10/22/99 MANGANESE (Mn) <0.010 MG/L 0-0.3 mg/l 2037 10/22/99 SODIUM (Na) 19.5 MG/L N/A 10/22/99 pH 6.7 UNITS 6.5-8.5 9043 10/22/99 HARDNESS,TOTAL 80.0 MG/L N/A 10/22/99 ALKALINITY (AS 58.0 MG/L N/A 10/22/99 TURBIDITY (TUR <1 NTU 0-5 NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDINM-AHE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for public schools are set at 15 ppb. EPA Lead & Copper Rule for Public Systems requires that no more than 10% of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg/L, else water treatment must be undertaken to reduce the waters corrosive potential. 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 are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium is suggested. ;1 �'*I- YML ENVIRONMENTAL SERVICES 321 Kear Street- Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 93.904745 CLIENT #: 8641 NON STAT `ROC PAGE 2 WALLACE, DOUGLAS DATE/TIME TAKEN: 10/21/99 09:00A P.O. BOX 154 DATE/TIME REC'D: 10/22/9�� 09:20A MOHEGAN LAKE, NY 10547 REPORT DATE: 10/29/99 PHONE: C. 14>-734-1187 SAMPLING SITE: LOT #12 LITTLE POND HILL ESTATES SAMPLE TYPE..: POTABLE : 17 POWDER HORN ROAD PATTERSON, NY PRESERVATIVES: NONE COL'D BY: SAME TEMPERATURE..: NOTES...: KIT TAP COLIFORM METH: N/A ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ D A T iE* FLAG F'ROC.EDURE RESU'LT NORMAL -- RANGE METHOD pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREOUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TQ METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND WHICH THE WATER HAS BEEN SUBJECTE,, . SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L MODERATELY HARD WATER: 70-1,0 MG/L MG/L = MILL7GRAM PER LITER HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) SUBMITTEl BY: Albert H. Padovani, M.T.(AS CF' ) Director ELAP# 10323 ` on � � ` ` n IV ftte of the Iiiiw tu WIN e,Any' "alteration, occolistrucifte > — I r PUTNAM COUNTY DEPARTMENT OF HEALTH �lei IVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PE # �J D Located at �� T f > Town or Village I - .� �!% C^ % J Subdivision name I d Subd. Lot # Tax MapZ-3,1 `VBlock )_ Lot 3 S� Date Subdivision Approved 3 1 1 d" —01�- % DOS %lAt.t -A-C L--7 / Owner /Applicant Name S - CQA1 7-bl A/ Mailing Address Amount of Fee Enclosed Renewal )k Revision Date of Previous Approval Building Type '- C- Lot Area )�O No. of Bedrooms /— Zip 0 Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage -System tem to consist of l gallon septic tank and 5—o () uF ?fi Q 1 P - Pf c 14-- D Other Requirements: F � 16 V.�® To be constructed by 0 Address Water Supply: Public Supply From Address or: 6Private Supply Drilled by T6 10 Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the eparato sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will 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 treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. / Signed: Address P.E. R.A. / Q J� / . ''License # _ Date 2-2- ,S-3 4-i % APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. raved -for d' charge of domestic sanitary sewage only. Bye -�- Title: ���i Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Profe sional Form CP -97 PUTNAitiI COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH SERVICES a` FINAL SITE INSPECTION Date: 9 / Inspecte y/: : , Street Location 5+e, be /o reS ( 7 aw , fro f n Owner _ ln/ai l (a a /crYdw sc Town !` #.,r s cps L, Permit # — 7 -Q3_ TM # Subdivision Lot # /0- '`L�`,� /e Pomp 1. Sew age System Area CMMENS - - a S:TS area located as pproved plans: ............... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth / �f c. Natural soil not stripped ....... ............................... X ' d. Stone, brush, etc., greater than 15' from STS area.......... ' e. 100' from water course / wetlands ...... ............................... k II. Sewage System /O ell X� a. Septic t size - 1,000 ......... 1, 250 ......... other ............... ,\ b. Septic tank installed level '� V, c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... ............................... f. ren'I� _cTi es 1. Le required _ 50 Length installed oc7 2 Distance to watercourse measuredta ©o Ft....... ___ Installed according t plan ............................. �a 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... Ile 6. Depth of trench <30 inches from surface.................. 1 7. Room allowed for expansion, 100% ......................... X v 8. Size of gravel 3/4 - 1' /z" diameter clean .................... X 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ........................ ............................... g. Pump or Dosed Systems i 1. Size ot pump c am er ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual/ audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. ! 5. First box baffled .......................... ............................... i 6. Cycle witnessed by H.D.estimated flow /cycle........... III House /Ruildin - °-- �- -- �:.:. �--� -- �-7-- �C Se mar k v ¢?I®:►� mouse ocated per approved plans -� b-. �, Number of.bedrooms ..............�f . r� Qm.s.......... -`- IV. Well . a-11 L)p s4A 1.-_j ' q� i'lan `--"a: Well located as per approved plans . ............................... b. Distance from STS area measured / / at ft........... c. Casing 18" above grade .................. ............................... k d. Surface drainage around well acceptable ....................... V. Overall Workmanship X a. ''Boxes properly grouted ................... ............................... b. All pipes partially.: backfilled ............... z ll. ofbuh .......... A ...... _ r,- c _ ,�•� — d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area.......... --a t�h1Surface water protection adequate ............................... 0 5: ,r--i. Erosion control provided=... : ........................................ 9 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. I HOLE NO. HOLE NO. Bel o Py%, r-,,40 k,1 a 7,—/-7, Indicate level at which groundwater is encountered /V0/yc- Indicate level at which mottling is observed A / &N E Indicate level to which water level rises after being encountered /Va// G Deep hole observations made by: Date �i3 — , 4, Design Professional Name: Address: Signature: Design Professional's Seal ADH - �L A 00—/ j{ouSC r 7 ' 1t 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 # WELL LOCATION Street ,.Address o Village City Tax Grid Number .� WELL OWNER Name Mailing Address efrivate O Public E OF WELL 01-fiSIDENTIAL Q PUBLIC SUPPLY O A.IR /COND /HEAT PUMP O ABANDONED d) primary 0 BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify 2 - secondary (].INDUSTRIAL U INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT og" gpm /# 0 REPLACE EXISTING SUPPLY PEOPLE SERVED /EST. OF DAILY USAGE .6600 gal [3 TEST /OBSERVATION 13. ADDITIONAL SUPPLY REASON FOR DRILLING M&W S PLY (NEW DWELLING) O DEEPEN EXISTING WELL REASON FOR DRILLING'" WELL TYPE WRILLED 13DRIVEN RAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES V% NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME ,OF SUBDIVISION: Lot No. :`WATER WELL CONTRACTOR: Names ,.i') Address: IS PUBLIC WATER SUPPLY AVAILABLE 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 �N SEPARATE SHEET 7 (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 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: 1_!!E G 19 IA__� ~- 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 /l/p72 : S S p S �TA-•T� � 6 �T i �ST� GG ED iitJ .. "Z ?�s is, to certify that AS —BUILT /fS 4vwv2oV,M L.e SSu p disaosal- system was constbucted as indicated-on this lan and that the system s6*insoected by me before it was covered over. The MEASUREMENTS - system was constructed in accordance with all standard rules and / fT Dc3L� —/� STA u cap ?ZOO S 5. .. regulations of the Putnam Count De y Partment of aalth an3 the taw York State Dip rtment of .Health." . x-77. 9C pR i�E wt4_�' _ y o M ego � o d NO A B REMARKS '40. IMR[ 1 MMON9 ri (Z;5;0 q. Con C T/C f w. q0 L4 O box 3 p v 1 xc-rr I 1 .T6vx 51 5g e 5 sYo �y (p) Y #3z)A 8 58 °I 1 (p8 96 rl qy 5b 13 �s1 k8 I4 `d3 ( �3 4QC �j Tr4 A-7 3.1 2.._ �A .. J of New y Putnam County DepaYof'H % , OO. ! V p �� Division of Environmental Health Services Approved as noted for conformance with. OW Nt�Z �P <:`�' :5'- aPP o b1e.Rule��yy and Regulations of the f�uC� w - '/ C R� V SE CU u5T co2p o��Tjalth Dep nt. ...: FAA A `� r GR �NleL N`( �OG 6ov/v �awx6Y .. , —corr L-� S�s /9�% I I '40. IMR[ 1 MMON9 °'i r7 b 5 C KOVJ$W�i G4NTG0 mwcr.. f w. y %nE_/���� P,¢�SON�T) x- ►�.+ c✓b JOIRV KARELL JR P.E. eC cush�HAiv /1P aa- r,E,es„r Nr rosb3 p v 1 xc-rr I 1 WELL LOCATION 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 # L,Address (Tox gIVillage/City Tax Grid Number WELL OWLVER Name Mailing Address ,' W'Private O Public 1VE OF WELL - primary 2- secondary OrfMSIDENTIAL O BUSINESS O INDUSTRIAL O PUBLIC SUPPLY O FARM M INSTITUTIONAL O AIR /COND /HEAT PUMP O TEST /OBSERVATION O STAND -BY O ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT o5' gpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE 600 gal 13 REPLACE EXISTING SUPPLY O TEST /OBSERVATION GI ADDITIONAL SUPPLY SEW PLY (NEW DWELLING O DEEPEN EXISTING WELL REASON FOR DRILLING DETAI LED REASON FOR DRILLING WELL TYPE DTRILLED DRIVEN DDUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES � NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WML CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANC TO.PROPERTY FROM NEAREST WATER MAIN: LOCATIQ SKETCH & SOURCES OF CONTAMINATION PROVIDED —__� N SEPARATE SHEET _(d_ at PERMIT TO CONSTRUCT A WATER WELL This peat to construct one water well as set forth above is granted under the provisions of S ubyrt 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thir tt- 4,30) days of the completion of water well construction, the applicant shall: 1. ?imp the well until the water is clear. 2. iisinfect the well in accordance with the requirements of the Putnam County Health apartment attached to this permit. 3. ubmit a Well Completion Report on a form provided by the Putnam County Health Department. During X11 well drilling operations, the applicant shall take appropriate action to assure that any axZiall water or waste products from such well drilling operations be contained on this pro p e -3z,; and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date GIs sue : 19— y ----�� Date- Expiration 19 S Permit Issuing Official Perm -t s Non - Transferrable 3/89 White copy: HD File Pink copy: Owner Yellow co • Bld Ins Oran a co • wail Tnr;ltar FY • g • P.• g PY �i APPENDIX 3 ONMENTAL HEALTH SERVICES PUTNAM COUNTY DEPARTMENT F HEAYLTHSUBSURION SE rrAIGRE DISPOSAL SYSTEMS I�TyIDUAi WA IT REVIEW SHEET for CONSTRUCTION P � / �� IE OF OWNER / i �<, /vim FT LOCA ON TAX MAP # � � / am i DATE Z,..L D MENTS. DISCHARGE (OK) DP HOLES LOCATED PERMIT APPLICgTION DEEP PRIMARY AND EXPANSION PC -1 REiVTATIVE gUFF.SIZE WELL PERMIT YWSL� FR - EA, SHOWN; GRAVITY FLOW, ENGINEERS A�OgIZATION v HO WN & DETAILID DESIGN DATA S=T(DDS) 0 s - No. OF BIDROOMS DEEP HOLE LOG PROPOSID SYSTEM CONSISTENT PERC RESULTS (3 PERC HOLE Dig CORPORATE ItEgpLUTION PLANS THREE SETS HOUSE PLANS - 11;0`SETS VARIANCE REQUEST GEN— ERR L �r & SSDS'S WAIN 200 FT. OF WOUSEMETES & BOUNDS E SETBACK NECESSARY (TIGHT LOT) SEWER -1/4 "�T' 4"0; TYPE PIPE © NO BENDS; MAX BEi1,MS 45 W /CLEANOUT FILL SYSTEMS r �-��.nT�nrrt'Ai -SLOPE 3:1 TO GRADE LEGAL SUBDIVISION EMPROSUBDIVISION AppROV CHECPERC RATE /1 FILE & DD¢NSIONS FILL' REQUIRm :L/ - ff VOLUME INCH CURTAIN DRAIN-RtEQUIRED ESTWES — _ _--- -- EX- APPROVAL, S'DS ADJ- LOTS ( PROVIDID WETLAND (TOW)DEC PER.Nff R & D) `�•" 60 FFMAX T SAMEPARALLID TO CONTOURS DATA ON DDS pANS & PEA PRE- 1969 - IVEj OR NO CATION M 100% EXPANSION PROVIDED Zg A SEPARATION DISTANCES SPECIFIED ON PLAN LEiTERBI/ FIE 100 YR. FLOpD g:EVATiON P.L, D�WAY$ LARGE TREES, TOP OF FILL WIRED DETgP,S ON PLANS p+ FOUNDATION WAILS SEWAGE SYSTBI PLAN - (NO 200' IN D.L.O.D., 150' PITS C EXPAN) SSDS HYDRA OFILE GRAVITY FLOW 0 TO WELL, `WATERCOURSE LAKE (IN D/ J B OX NCFLGALLEY ED ETAILS O sm" SEPTIC TANK -aE, DETAIL TO CATCH BASIN, RMDRAIN, PIPED WATER WELL DETAU�ERVICE LINE IF OVER 10' TO WATER LINE (PITS-20') CONSTRUC'TIp(IYOTES (GRINDER R'°'TE) INTERMITTENT DRAINAGE COURSE RESERVOIR, ETC.m 150 FT. GALLEY SYSTEMS DESIGN DA.TA,.�ERC AND DEEP RESULTS 20 • RES SEPTIC TANKS TWO -FOOT CQITOURS EXISTING & PROPOSl ��/ 10' M FOUNDATION; 50' TO WELL DRIVEWAY & � OPES CUT WELLS FOOTING /GXR/CURTAIN DRAINS 15,IDTO P.L. °G AMENTS - PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Datel}L�'1 I %a Re: Property of pp tnV / ffpjr,_j2lQ1', �fi C EM,- -N 2, 4)14 C�� Located at I Uis 4 'hnft ryes (T) �_f (ao m-r ction 2'3t, 12-Block Lot 3S- Subdivision of Subdv. Lot # Filed Map # �j?j�.j Date=- •4- ��)• -�-- -E k . Y. T. MICHAEL DALY, P.E. Gentlemen: CONSULTING ENGINEER This letter is to authorize P. 0. BOX L43 a duly licensed professional engineer L/ or (Indicate to apply for a Construction Permit for a separate sewage. system, to �• r serve the above noted property in accordance with the st�a7hdards„ rules a or regulations as promulagated by the Commissioner of th,e"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. 0 Very truly yours, • / Signed A Owner of Property ;ountersign� /� /iG /v�l�: . - 'r1 P.E., R.A. , # KCU` ^^ 10 ? ��n_, Address ess r'� T. MICHAEL DALY P.E. {���"� G�.Yo.�,1 �P�C Address CONSULTING ENGINEER Town N. 0. BOX 243 /- ,iKY?! O K, N. Y. 10587 ( I ct lo�� Tel hone telephone s FC-1 PUTNAM C OUN TY D E PARTMENT O F HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: IDO l %rt7 An MAKU ti ,' o k0'5'10 2. Name of Project: Vi Locatio T� V /C: 4. Project Engineer: `j�'��L a�`(.�� 5. Address: T,::1764- Z43 License Number: 4',L46 8 Phone: 6 � . 6. TvDe.of Project: V Private /Residential Food Service Commercial . Apartments Institutional Mobile Home.Perk Office Building Realty Subdiv'is.ion Other (specify }, 7. Is this project subject to State Environmental Quality: Review (SEQR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted ✓ 8. Is a Draft Environmental Impact Statement (DEIS) required? 0 9. Has DEIS been completed and found acceptable by Lead Agency? 0. Name of Lead Agency 1. Is this project in an area under the control of local planning, zoning; or other officials, ordinances? .......... .....:.......................:01 •�j 2. If so, have plans been submitted to such authorities? .................. 3. Has preliminary approval been granted by such authorities? Date Granted:.— 4. Type of Sewage Disposal System Discharge.�Y.P? ��' Surface Water Ground Waters 5. If surface water discharge, what is the stream class designation ?........ 6. Waters index number (surface) ............ ............................... 7. Is project located near a public water supply system? .................. K\ B. If yes, name of water supply Distance to water supply - 9. Is project site near a public sewage collection or disposal system'..... ). Name of sewage system 1. Date observed: Distance to sewage system 23. Name of Health Inspector: 1. Project design flow (gallons per day) .............. �?(�G................. 2. 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.._ _ 26. Has SPDES Application been submitted to local DEC Office? ............... r 27. Is any portion of this project located within a designated Town or State ,+� wetland? .................................. ............................... is 28. Wetland ID Number ..... ............................... ..... ... .. 29. Is Wetland Permit required? .............. ............................... �J Has application been made to Town or Local DEC.Office? .................. yj 30. Does project require a DEC Stream Disturbance Permit? ................... d 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 ,t any other potential known source of contamination? ..............YES or NO DESCRIBE: 33. 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? N 35. Are any sewage disposal areas in excess of 15% slope? ........................ 36. Tax Map ID Number ......................... ............................... 12 37. Approved Plans are to be returned to: Applicant LEngineer 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 pursuan o Section 210.45 of the Penal Law. i% SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: °;: JS( 44----5 • • • � r • i� v i �- tea,. DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Ownerj2L,1 I��xPl�i a�.1 Address �,'2� ?"�iZi�.l� I�alo�Z l� • �C�oS10 Located at (Street)- 'CQ .See:. 2 3 I Z Block - l Lot - 513 (indicate nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking Date of Percolation Test A -1(, --6 6 HOLE NMM CLOCTC 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 k 14! W -442, - Z2 Z4 Z16 71 ( I 1 2 4;4Z- 604 3 6•D4 -6-'ZA 6,4 1 4 y' 5'SL Z4 Z4 Z.b 5 - 14-la-4161- o Z4 Z 1 ::b I o 2 4-6T -15 14 Z Z ZA -Zfo Z- I.1 5 1 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 measurements to be made from top of hole. rev. 9/85 L4 Z i2 5 1 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 measurements to be made from top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. I HOLE NO. HOLE NO. G.L. ArdI L 3' 4' cAP 0 5' 6' 7' 8' 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used I( —j< Min /1" Drop: S.D. Usable Area Provided No. of Bedroans 4- Septic Tank Capacity ice) gals. Type Absorption Area Provided By 4,t5Z3tD _ L.F. x 24" width trench Other 48 ►2 =C�P� '�1Li .0 190 G -c 1 ; Name T. IdICHAFl. DAI,y, P-R. Signature Address CONSULTING ENGINEER SEAL C —�-0: -243 <-,s, SIREN ®ROCK, N. Y. 10587 0. ArO THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # / l Well Location: Street Address: TownNillage Tax Grid # V) S 1 , 96 L0eL= S P6 kv-f #h (T) Map 23,12-Block ( Lot(s) 3;i Well Owner: Name: b 6061 LkA V Adrdress:� ' 1 , Ll"af"I 10P Use of Well: lyic, Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use , Yield Sought _ gpm # People Served Est. of Daily Usage s U Sal. Reason for Replace Existing Supply Test/Observation . Additional Supply Drilling New Supply, (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes �D _ No Name of subdivision ;mil 'ih.e P co P H-11 Lot No. Water Well Contractor: ' 7� 0 Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed ell location & sources of contamination to on separate sheet/plan. Vrovide , �� 17 Signature: Date- Applicant PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and 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 or their designated representative 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. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and 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. APPROVED -FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue Permit Issum Offici Date of Expiration /L'pu Title: Permit is Non-Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUT AM COUNTY DEPARTMENT ENT OY REALTH DIVISION OF ENVIRONMENTAL H-EALT K SERVICES LETTER OF AUTHORIZATION 1b' RE: Property of �DUC L SIN ��ZoyS= O/1%s772Uc770N Located at V137-4 DO L40 tLe-- 5: & -XA) 12e ff'D) TV i2Ar7r:jZSd Tax Map � 23,1.E Block _l Lot 35' �- � � D L. lxj 7' Subdivision of 177- 10dN i� /L Subdivision Lot.'.' �� Filed Map = Date Filed . Gentlemen: This letter is to authorize a duly licensed professional >✓ng�ineer� or P.i =rpse! 1 '" '22t to a.P_ply for the required wastewater treatment and /or later supply permits) to serge the above-noted proper rl accordance 1 i r ? r s e b l ft DL r r 1 . ;.�r the stPraa.d;, ml-.s o. regulations a.. Aron zt..gat,.,. �� t._e Public Hea�u� �Lec.or of the Pt.ma:n County health Department, and to sign all necessary papers op. my behalf i n connection with this I?la%tzr and to supervise the construction of said :wastewater treatment an&or water supply sy-sternis in conformity with the provisions of Article 145 and /or 1`7 of the Education Law, the Public 114-1alth Law, and the Putnam. County Sanitary Code. Very truly v urs, Countersigne*r- Signed: P.E.. R.A,, tr 3 Z7 % ;o sreres Mailine Address L1 US'1 fMA-A) /AW,. '0 P.4T7�-7�.Sv/1/ State %y Zip 14,56 3 Telephone: 9�y �7 f= %r - r011^1 Mailing A (ldress: ADD# State Zip 1OS> Telephone; qlU— �'�� Form. LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIN71SIONTOF' ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SU13SLWACE SENVAGE TREATMENT SYS 1'EN'T Owner. DO U6 tv &C&- Address 9 F*I& 5 C7X0US-f-- COIVS7RUCVON Located a- (Street) 111S TA- DaLoa&S tvp T ax Nf a P 2311l-Block. Lot 3 �-- (indicate nearest cross street) Municipality 6AI r7-). Drainage Basin '-,4,6VF1Z__74UV_r0A1 AJII&71— SOIL PERCOLATION TEST DATA Date of Pre-soakLna Dm of Percolation Test Role' o. Run N'o. Time Start - Stop Ela e1ime Min.) Dtpth to Water 11rom Ground Surface (Inches) Start -Stop Water Level Drop In Inches Percolation Rate Min"Inch 2 A tA J Ito I �I i .I � 4 5 NOTES: 1. Tests to be rineated a: same depth until approxima:ely equal percoiation rases are obtained at each 'ercolatior, test holle. I min f67 1 - 30 minulinch, :5 1 mir, for J l- 60 min,'inch) Afl, data m b-. submitted for review. 2. Depth measwemenn, to be made from top o'Lhole.' Form DD-97 V 7r 4 r r'; I., - N DEPTH G.L. 0.511. 1.0' 1.5' ?.0' 2.5' 4.0' 4.5' .0' 5.5' 6.0' 6.5' 7.0' 7.'S' 8.V' 0.5' 9.0' 9.5' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUI TERED Fq TEST HOLES HOLE N0. ,r i HOLE N0. Indicate level at which groundwater is encountered Indicate level at which mottling is observed IWAlk- Indicate level to which water level rises a °er being encountered —' Deep hole observations made by: 1�-'-t-- Date AM-,.. Design Professional Name: �nhA) x44LZ , Pk. Address: Cu soq F At�j ,20.4 0 y AAVERso / ti �12�s7o3 � *AREQ off , Irk Signature, _J Design Professional's Seal .. -. .. .. .. -- -_ :•„ - _j, - -._ �.� _ .iii -' - !�1.. __ T __ T _ _ APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET for CONSTRUCTION PERMIT STREET LOCATION �.;I�tS't.t -, NAME OF OWNER BY B. HEDGES R.MORRIS OTHER DATE _/� TAX MAP # DOCUMENTS. Y pip ERMIT APPLICATION C -1 ELL PERMIT EEI PWS LETTER AUTHORIZATION Lid DESIGN DATA SHEET(DDS) ® RPORATE. RESOLUTION PLANS .THREE SETS HOUSE PLANS - TWO SETS m VARIANCE REQUEST SUBDIVISION LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED RC RATE FILL REQUIRED DEPTH M CURTAIN DRAIN REQUIRED mSTANDPIPES lH140XP. AREA; SHOWN; GRAVITY FLOW, SUFF. SIZE PUMPED PIT & D BOX SHOWN & DETAILED OUSE - NO. OF BEDROOMS ELLS & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM RO ERTY METES & BOUNDS SE SETBACK NECESSARY (TIGHT LOT) USE SEWER - 1 /4 "/FI. 4 "0; TYPE PIPE m NO BENDS; MAX. BENDS 450 W /CLEANOUT FILL SYSTEMS 10 HORIZONTAL: SLOPE 3:1 TO GRADE SPECS m FILL NOTES m AIL CERTIFICATION NOTE m D PTH GAUGES m L PROFILE & DIMENSIONS m LUME GENERAL IN EXPANSION AREA Eli EX- APPROVAL SSDS ADJ. LOTS �ULAND ( TOWN/DEC PERMIT REQ ?) TRENCH EE DATA ON DDS PLANS & PERMIT SAME m LF TRENCH PROVIDED =60 FT MAX ®PRE- 1969 - NEIGHBOR NOTIFIFICATION m PARALLEL TO CONTOURS ®LETTER BI/ZBA m 100% EXPANSION PROVIDED 100 YR. FLOOD ELEVATION REQUIRED DETAILS ON PLANS WAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE m GRAVITY FLOW CONSTRUCTION NOTE<E))aS NOTE) /DESIGN DATA: PERC A ESULTS *O -FOOT CONTOURS POSED 016VEWAY & SLOPES CUT ,FOOTING /GUTTER/CURTAIN DRAINS tROSION CONTROL; HOUSE,WELL, SSDS EROSION CONTROL NOTE PERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY AND EXPANSION LOCATION MAP 11 Yil 10' TO P.L., DRIVEWAY, LARGE TREES TOP OF FILL 20' TO FOUNDATION WALLS DJ 15' WELL TO P.L 100 TO WELL, 200' IN D.L.O.D., 150' PITS 1100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (PITS -20') 50' INTERMITTENT DRAINAGE COURSE 200 FT. RESERVOIR, ETCH 150 FT. GALLEY SYSTEMS 9Y MIN TO C.D. S= >5 %,20'- 4 %,25'- 3 %,30'- 2%,35' - 1%,100' <1% 0'MIN TO C.D. DISHARGE /100' WITH 182 CONS DAY DIS. SEPTIC TANK m 10' FROM FOUNDATION; 50' TO WELL COMMENTS: PC -1 PUYNAM COUNTY DEPARTMENY OF HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: A) D 2. Name of Project: 1 7 4f 3. Location T /V /C: 4. Project Engineer: ► t�. 'iL'i{ ilk-�� 5. Address: IT d LA-tv &— a-,a (-& �c b & License Number: �v Phone: 7 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)? Type Status Check one) Type I.. Exempt Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. N 9. Has 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, 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 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? .................. L G 18. If yes, name of water supply Distance to water supply 19. Is project site near a public sewage collection or disposal system ?..... 20. Name of sewage system Distance to sewage system 21. Date test holes observed: S -'.k` 22. Name of Health Inspector: / 4?J .�i�G��T-7 . 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? ................... ti o 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? ........................ �v C 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. L , SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: I •• b o1• • Uk ID, 01 Y: DESIGN DATA SHEET SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Ownerpo l � Address Located at (Street) V w, Sec. 'L Block _ I Lot 3 (indicate nearer cross street) Municipality r & p Watershed N Y6 Date of Pre- Soaking Date of Percolation Test HOLE REM C= TIME PEROOLA ON 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 1 2 3 4 Si i,__ SZ/49-P i1-E //JGAvS 5 �/- /,-'/' 4WIY,/ � 3 4 NOTES: 1. Tests to be repeated are obtained at each for review. 2. Depth measurements tc at same depth until approximately equal soil rates percolation test hole. All data to* be submitted be wade.fran top of hole. I 4 V N D a 1 0 10 4: 1 1 1 • -,i I zj 10 (C Irel ' 4) afts w1 JR A Vol ,I Do 11M 0, a W 5zt : DEPTH HOLE'NO. HOLE NO.. HOLE NO. G.L. 21 3' 4' 51 61 71 81 91 10, '11, '12' 13' 14' INDICATE LEVEL AT WHICH GROUNUR= IS ENCOUNTERED WHICH WATER LEVEL RISES AFTER. BEING E31yo, p JA114 INDICATE LEVEL To DEEP HOLE OBSERVATIONS MADE BY: 40 DATE: Drop:- DESIGN S.D. Usable. Area Provided A Z- Soil Rate Used Min/1" No. of Bedrooms Septic Tank Capacity gals Type COAl Absorption Area Provided By 0 L.F. x 24" width trench Other I h'- 94 A C4 LL-- (2,0-6- MS) Db/ THIS SPACE FOR USE BY HEALTH DEPAIMUM ONLY: Soil Rate Approved sq.ft/gal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property of Located at V Date 4< —1"s M (T) WVETS9N, Section) -3. 12- Block Lot 3 / Subdivision of �% � - Aw , /4' /L L- Subdv. Lot # I y Filed Map # Date Gentlemen: This letter is to authorize —j?)A" a duly licensed professional engineer .11 (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. .a ;r Very truly yours, ! Signed Coun / rsi ned Owner of P operty • is »~ Address Address Aly le J 2- 2 �7,33 7 Telephone Town Telephone LOT . 12 01, 1 V -AG / io ol n 1 I M I! 11 . Il n , �1 !.UNj tt,��� • ' � �; , . II 11 I II II 18' 50 OHM j •.•. , ,. •• S .,�kY t� ::: , .. II I II II II PROPOSED. j II II II II REGRAD I N6— G Il It II II II MIK • _ . % _� II II II II 11 • Pt z � ` -� II II 11 II ' II `- II II II II �II 540 O 0 ^:. 11 II II II II . �TaQ / 4. II II II II II LE-AD r z t FO TI O y / II II jll It II 11 Ell 11 til tl 11 =11 II II / II II - II II II II I{ 4 11 ` 11 II I! II PROP. ti0 p V�LL SSDS NITHIN $ Y _. .2 p Iso.00' s k ISTA DOLL 6 1• i PLAN SCALE 1 " _ 2.0' o ` MASONRY Q �1 �.� d► 4" G I SEPTiG TANK PROP, 1 /4 °/FT. YELL LOT 13 a , O PROP. ti0 p V�LL SSDS NITHIN $ Y _. .2 p Iso.00' s k ISTA DOLL 6 1• i PLAN SCALE 1 " _ 2.0' PUTNAM COUNTY DEPARTMENT OF SBAL18 ' DhYw a[ seoW BeaNb Senlexa: Cat�tei. N Y., 1!611 'Enshmecto Pod& PaasE ou CERMCATE OF COMPUANCE NgT";;;=N PERIIQT FOR SEWAGE Nwms r FL E j:)h M n 14 i LL, S.bd cot # ) 2-- Ov.aaiAppala.tmoae obis✓ C S PA-A) Etdl�ts sr ,F„ �'r� r � cat A,�t �. C13 f � Fm s � V .gym / ' vamas -ao r s 3 Nobee at Rad<oome L Dedp Plow G P D POM Notldadoo Is Required Whft FM 1a ampleted saparata st�.ea ee s�ece. a aepalat of - c.mo &9& TV& la 5PO UN Fr. 2_4 `TR ttne tl To be:ooeotreded.by T. ' Adlbeaa water so ply. PI&& Sw* PYos —fthaft Stipob DOW by 'i, — J1d�ew Other p ` . n �I Ll. 2 o6 Y. 3 1 repremnt ".that l am wholly' and completely, responsible for the design and location of the prop&. above described will be constructed as shown on'the'approved amandment there to and In accordar County Department of Health, and that on eon p ionthereof a '•Certificate of Construction i be submitted to the Department, and a written guarontea will be furnished the owner, his suc place in pod operating condition any 'part of said Iowa" dlsposal' system •tlurino 4M period an" of the approval of -the Certificate of Construction' Compliance of_the final Jt m o► will M located as shown on the approved plan and that mid will will be Instal c County Ofapikmaot of Molith. Date �p l 12 1 Man.d — n J i A A I r AP r n crn:D A xe" JliEldactolY to th .Co issioner of M«fthwill hairs �ssgn }:by the ' W that YIA bulldM Will (2) y s UnmllOiattly O ' iq thodate of the Issw eirs.th.ieta Q 'thet t drI well described above lea r -an fpu ns of the Putnam No 0231 S y . 4i :.' P.E. RA. E ter,. No 423 Q APPROVED FOR' CONSTRUCTION: This approval Oxpire;:two years from the AM issued unless construction of'tha• building .has been undertaken and is revocable for cause or may be amended or modified when considered nricessar the Commissioner of Health. Any charge or alteration of construction requires a new permit. Approved, for disposal of domestic sanitary age and / a water supply on Rev. /-- 1��88 Oats �y�:/ Title se 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 # WELL LOCATI ON Street Address " 'Town Village/City Tax Grid Number 1�t5rA CiP : z: U 2112- - 3._� WELL OWNER Name Mailing Address m rivate _ i- S -i= 7 St'3 7 )yC .�5i3 ' ,rl/ C` LI �- C1 l: 'S 10 O Public E OF WELL Q RESIDENTIAL O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O ABANDONED (71--primary O BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify 2- secondary 0 INDUSTRIAL 0 INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT ) gpm /# PEOPLE SERVED /EST. OF DAILY USAGE al O REPLACE EXISTING SUPPLY 0 TEST/ OBSERVATION M ADDITIONAL SUPPLY REASON FOR DRILLING [YNEW SUPPLY NEW DWELLING B DEEPEN EXISTING WELL DETAILED E I. Q ,i l E REASON FOR DRILLING WELL TYPE OD/RILLED DRIVEN EIDUG 0 GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: TrL ET v L i' Lot No. J 2- WATER WELL CONTRACTOR: Name:. Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES L/ NO NAME OF PUBLIC WATER SUPPLY: DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: Cti` i.:'di�fy rr. LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED l- OON SEPARATE SHEET (date) '& (,464'tfiire PERMIT TO CONSTRUCT A WATER 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 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 contami.na ace or groundwater. Date of Issue: S 19 Date of Expiration 19`51'1 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller 6n �? (PA-L- A L" w/ PUTNAM COUNTY DEPARTMENT OF HEALTH GO DIVISION OF ENVIRONMENTAL HEALTH SERVICES - LETTER OF AUTHORIZATION -. -`- - roe o . •';xiii :':'a:..a.. .. .. .1. `.:.:xM S5G'flP:if. a' Located at V15-FA I )L -U914_ Tax Map # . 31 12- Block / Lot 3 .3 4 3J7 Subdivision of 4177nF 27 3, 5, 1 Subdivision Lot # _/ v, i/ ,-L, Filed Map # Date Filed Gentlemen: This letter is to authorize �740h l XAIZeg'a"17L a duly licensed Professional Engineer. X to apply for the required wastewater treatment and/or water supply permit(s) to serve the above- noted.property in accordance -with the standards, rules or regulations as promulgated by the Public Health Director of the'Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam Code. �ARE<< 0 Very truly yours, P.E., R.A., # Mailing Address State /U Zip % O Telephone: qty 4`71-21/ 7 Signed: (Owner of Property) Mailing Address: �ai1-e- '471 State GG `ola l Zi P `o /,2 Telephone: Vf