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Home My WebLink About0781DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 24. -1 -90 BOX 9 Ll Ir L� ` mi I. T 00781 a � c / F 1 aSepasrste�;Sewerage Syetem'ballt by^• � `+' ` y ur ConeleHug of Ga11on,Septir Tank and, ` Water Supply: " ' PabHc Sappl`y'From Address x .. ><, #Y 1 7 g c:. t y Address /3� �) Q 4iSOt. Cs or Av$ate Supply DrWed b r e +- gyu;� fYt pe . �) t Has Eoslon Control Beon ComplotedY_� Namberof Bedrooms' i Hie Gsrbage Grinder Been IneteQedY �`�0� Other Regalremente �..;, �x + 1` .._tj y) n I certify that the syateln(s) as- lYeted4serving the alwve premises wereeconat cted essentially ae shown on; the plans of the completed work.,(�popies of whieh`'are attached} and in accordance with the standards rules and re ations in accardance' with Pi' d an, and the permit..iseujd:by the Putnam County Department•�Of Health t, , t ,+:r i , � t !, ,�.� 'Date iffed DY° P E: Rik �t 4 Licence No ; Any person occupYinq premises sp ved byahe abovdiystem(s) shail:p`romptly; "ty ak w'et aetbn ai moray 6e'negtYry to sec, the torreetlon of any unsanitary conditions reiultl'nq from such .usage Approval of tW!separate seweralas system shall become null and vofd;as soon as a puDt; -.-,un tary,;gwer becomes available' and the`appnivai of the,: private ,waterisuDPlyrshellrbecome alt tang ,voldt when a ,puDlk wataq supply,Dacoma ,avallabie. Such approvals are suD)eet .to mo8ifieatlon or ehange� when in the Judgment `of theiCd�nmTssloner of ' Ith such revocation, modlfla:aflon or change Is nicaaae►� F� Dated!/ / ,r j8Y Title jYn N'i?135`y i _ _` ry t.. mj„x. r .r. PUTNAM COUNTY 1)EPARTMENTdOFaHEALTH ; �. < ;K , 'I ' k " 3 t 'Division of& vlionmenau Heakh`Ser Ices, Camel, N Y 10512 + s kl- ' T, r F } �r+En g ear Pe it Provide C N , �P A t T fJ �\$U LF. & C ATE OF CONSTRUCTION,COMPLIANCE F.,OR SEWAGE DISPOSAL'SYSTEM; a74ErI.O4 . 1, ti �� a �' �, e i A.; r f t � r iA..! , rtt. •,� > 4 =Tewn �O[1..lU8ge1 t. � Q ' i xt GI/ ✓: I/t ti + Ta: Msp� r� ` Block , 3 r Lot i o W� ` ;,Owner /applicant Name F,ormedy _ bdivisloa Nnme N Sa v Lot,p it- MaWng Addrelie �p Da ta3 Permit lsened 4� 9 �' - a � c / F 1 aSepasrste�;Sewerage Syetem'ballt by^• � `+' ` y ur ConeleHug of Ga11on,Septir Tank and, ` Water Supply: " ' PabHc Sappl`y'From Address x .. ><, #Y 1 7 g c:. t y Address /3� �) Q 4iSOt. Cs or Av$ate Supply DrWed b r e +- gyu;� fYt pe . �) t Has Eoslon Control Beon ComplotedY_� Namberof Bedrooms' i Hie Gsrbage Grinder Been IneteQedY �`�0� Other Regalremente �..;, �x + 1` .._tj y) n I certify that the syateln(s) as- lYeted4serving the alwve premises wereeconat cted essentially ae shown on; the plans of the completed work.,(�popies of whieh`'are attached} and in accordance with the standards rules and re ations in accardance' with Pi' d an, and the permit..iseujd:by the Putnam County Department•�Of Health t, , t ,+:r i , � t !, ,�.� 'Date iffed DY° P E: Rik �t 4 Licence No ; Any person occupYinq premises sp ved byahe abovdiystem(s) shail:p`romptly; "ty ak w'et aetbn ai moray 6e'negtYry to sec, the torreetlon of any unsanitary conditions reiultl'nq from such .usage Approval of tW!separate seweralas system shall become null and vofd;as soon as a puDt; -.-,un tary,;gwer becomes available' and the`appnivai of the,: private ,waterisuDPlyrshellrbecome alt tang ,voldt when a ,puDlk wataq supply,Dacoma ,avallabie. Such approvals are suD)eet .to mo8ifieatlon or ehange� when in the Judgment `of theiCd�nmTssloner of ' Ith such revocation, modlfla:aflon or change Is nicaaae►� F� Dated!/ / ,r j8Y Title WELL COMPLETION REPORT DEPARTMENT OF HEALTH Division Of Environmental Health Services. PUTNAM COUNTY DEPARTMENT OF HEALTH LR� Office Use WELL TYPE STREET ADDRESS: IMNrnLLA69/a1Y TAX GRID NUMBER: WELL LOCATION CASING DETAILS 0 .� - WELL OWNER NAM ADDRESS: JOINTS: O WELDED 19THFIEADED PRIVATE 0 PUBLIC USE OF WELL RESIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND. /HEAT PUMP O ABANDONED 1- primary ❑ BUSINESS ❑ FARM O TEST /OBSERVATION O OTHER (specify) 2 - secondary O INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY O MOUNT OF USE YIELD SOUGHT _67— gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE j�0_0 gal., REASON FOR [] PLACE EXISTING SUPPLY ❑TEST /OBSERVATION []ADDITIONAL SUPPLY DRILLING NEW SUPPLY (NEW DWELLING) ❑ DEEPEN EXISTING WELL S ONO DEPTH DATA WELL DEPTH ft. STATIC WATER LEVEL ft. I DATE MEASURED DRILLING O ROTARY UtCOMPRESSED AIR PERCUSSION 0 DUG .EQUIPMENT 0 WELL•FOINT O CABLE PERCUSSION 0 OTHER (specify): WELL TYPE O SCREENED O OPEN END CASING [J OPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH a3_ fL oe MATERIALS: STEEL O PLASTIC ❑ OTHER LENGTH BELOW GRADE ft. JOINTS: O WELDED 19THFIEADED O OTHER DIAMETER in. SEAL: O CEMENJ GROUT O BENTONITE OXN WEIGHT PER. FOOT lb.'/ft. DRIVE SHOE YES ONO hr. min. LINER: G YES O SCR. N DETAINS gpm. DIAMETER (in) Oia- SLOT SIZ LENGTH (ft DEPTH TO SCREEN (ft) DEVELOPED? FIAS7 it. ft. In ES O NO HOU S ONO Land Surface GRAVEL PAhj O YES O NO TOP 1 I G IEL SIZE: WELL YIELD TEST ; It detailed pumping METHOD: O PUMPED i tests were done is in- , VCOMPRESSED AIR ; formation attached? O BAILED ❑ OTHER ; ❑ YES ❑ NO WELL DEPTH I DURATION DRAWOOWN YIELD it. hr. min. It. gpm. WATER IN CLEAR TEMP. QUALITY ❑CLOUDY HARDNESS O COLORED ANALYZED? O YES ONO ANALYSIS ATTACHED? O YES O NO PUMP INFORMATION TYPE CAPACITY MAKER DEPTH MODEL VOLTAGE HP STORAGE TANK: TYPE CAPACITY GAL. WELL DRILLER NAME DATE . HYATT & SONS, I. AD ART M uRE % !� NC Well Drilling R #e. 311 R. R. 2 Box 1712 DIAMETER TOP 1 I BOTT ht OF PACK in. DEPTH y ft- I DE -- It. WALL LOG if more detailed formation descriptions or sieve analyse`3`-' `- are available, please attach. DEPTH FROM Wat er Well SURFACE Bear. ing Oia- FORMATION DESCRIPTION t`a poE' it. ft. In Land Surface `? 7 -- STORAGE TANK: TYPE CAPACITY GAL. WELL DRILLER NAME DATE . HYATT & SONS, I. AD ART M uRE % !� NC Well Drilling R #e. 311 R. R. 2 Box 1712 n 7. PUrNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF RWIRORM L HEALTH - SERVICES Owner or Purchaser of Building Building Constructed by CGV y%� Location _ Str <' Municipality X"641 d6h )L J Building Type :24 r I -- qQ Section Block Lot /- c' —�q -.-2— 1 Subdivision Name 7 Subd.ivision.Lot # GUAM= OF SUBSURFACE SEPMM DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location.,_: r):' workmanship, material, construction and drainage of the sewage disposal system.. serving the above described property, and that it has -been constructed as shad on the approved plan or approved amendment thereto, and in accordance wit l: the f 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 fae to! operate for a period of two years i=ediately following the date of approval o4*_ - they "Certifica 'te of Construction- Compliance" for the sewage disposal systan, &P ady> - repairs made by me to such systgn, except where the failure to operate properly is caused by the willful or negligent act of the occupant.of the building utilizing the system. i:tt The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environirental 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 '26e day of Q�� 19 Z- �os5 Alan, ov., /V.a, 4 ,ally GeneraA. Con actor (Owner) - Signature Corporation Name (if Corp.) Address Al- \11 rev. 9/85 mk Signature Title pit Corporation Name (if Corp.) Address YML Environmental Services -:z '321 Kear .Street, Yorktown Heights, NY 10598 ELAP #10323 (914).245-2800 Ross Alan 25 Byram Lake Road Armonk, New York 10504.. COL'D.BY Ross Alan (914) 279 -5180, NOTES Will Pick up: @ CA RESULTS OF WATER TESTING X ANALYTE RESULT UNITS.? OCT. 6 ALKALINITY mg/L -Well Tank: Lot # 7. SAMPLING SITE: (Big' Elm Suhdiv.) . Courtney La. Patterson, New York .12563 AMMONIA Potable _ HNO3 _ pH LT 2 _ <4C mg/L HCI Na2SO3 ._ >20C, _ STAT! 142SO4 _ ZnOAc ARSENIC mg/L CHLORIDE mg/L . COLOR Units - CONDUCTIVITY umhos /an COPPER mg/L DETERGENTS mg/L FLUORIDE mg/L HARDNESS mg/L IRON mg/L LEAD mg/L - MANGANESE n-g/L MERCURY mg/L NITRATE mg/L per 100 mL NITRITE FECAL COLIFORM mg/L per 100 mL ODOR E. COLI TON per 100 mL pH FECAL STREP. S.U. per 100 mL LAB NUMBER C93.006'941 DATE /TIME TAKEN .8 45am RESULTS OF WATER TESTING DATE /TIME RC'D 10/22/92 9 :40am RESULT DATE REPORTED OCT. 6 PHOSPHOROUS mg/L -Well Tank: Lot # 7. SAMPLING SITE: (Big' Elm Suhdiv.) . Courtney La. Patterson, New York .12563 For. Lab Use Only Potable _ HNO3 _ pH LT 2 _ <4C _ Nonpotable _ NaOH _ pH GT 9; <20 >4C HCI Na2SO3 ._ >20C, _ STAT! 142SO4 _ ZnOAc SODIUM RESULTS OF WATER TESTING x1 ANALYTE RESULT UNITS PHOSPHOROUS mg/L SILVER mg/L SODIUM mg/L SULFATE . mg/L SULFIDE. mg/L SULFITE rrg/L TURBIDITY NTU ZINC mg/L r�. r,a - SPC per 1.0 mL TOTAL COLIFORM per 100 mL FECAL COLIFORM per 100 mL E. COLI per 100 mL FECAL STREP. per 100 mL Z These result s indicate that the water sampl [WAS NOT] [NA], of a satisfactory sanitary quality according to the New York State Sanitary Code, for the rs tested, at th time of sample collection. These results indicate that the wat s ple [WAS] [WAS NOT] [NA] f'a satisfactory chemical quality according to the New York State Sani odq f9f the parameters tested, at e ti e of sample collection. NA = Not Applicable N = Not Present (Negative) SUBMITTED BY: P = Present (Positive) SA = See Attachment(s) ' = Also done because Total Coliform was present Albert H. Padovani, M.T. (ASCP) TNTC = Too Numerous To Count -Director > = GT = Greater Than < = LT = Less Than c: 1, OF DdWb AV S, owww9m am on di ft'ttkrS"l 'Nit' ma Of ' | rw jon RM ` ' DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 4310 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT' #. 7 WELL LOCATION Stre t Address T wn illage City Tax Grid Number WELL OWNER N� e Mailing Ad res i rblice SE OF WELL 1 - primary - secondary RESIDENTIAL BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIRR/COND /HEAT PUMP O FARM O TEST /OBSERVATION d INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT T gpm/ # PEOPLE SERVED_ /EST . OF DAILY USAGE &0 ' gal O REPLACE EXISTING SUPPLY O TEST /OBSERVATION 13 ADDITIONAL SUPPLY , EW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL TREASON FOR 1 DRILLING 'DETAILED REASON FOR DRILLING it WELL'TYPE I OaILLED DDRIVEN DUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES 1,--'NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: E' j!a Lot No. 7 MATER WELL CONTRACTOR: Name % (3 D Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES 1,--'NO NAME OF PUBLIC WATER SUPPLY: ;/ 11A TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVID [QN SEPARATE SHEET -( ate) ignature) 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 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 Department attached to this permit. 3.' Submit a Well Completion Report on a form requirements of the Putnam County Health 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 s a manner as not to degrade or otherwisjcontaminate surface or groundwater. Date of Issue• 19_ 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 n .APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: 2. Name. of Project: ►tea`' 3. Locatior(3/V /C: / o 4. Project Engineer: �vv!l "( r S. Address: 73�r1tT:ri4I, Q Li Phone.7%Cd� 6—, of`. Pro ect: i Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty_ Subdivision Other (specify) 7. Is this project. subject to.State Environmental.euality Review (SEAR)? Type Status (Chck One):.:.:. Type. I.. Exempt. , Type II. Unlisted !/ 8. Is a Draft Environmental Impact Statement (DEIS) required :.....: 4' 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 othere offic als' ,:;ordinances? .. . :. . .... 4; P 12. If so, have pl`ans.been. submitted to such.althorities? Q 13. Has preliminary approval been granted by such authorities��T Date 14. ;Type of Sewage Disposal. System Discharge. Surface> Water . ^l'r Ground .Waters' 15. If surface water discharge, what is the stream class designation ?........` 16. Waters index number T.:(sur face):. .................... ....... ... .. 17. Is project located near a public water supply ,,system? 18. If. es Di stance, to...uate7 .supply - y name of water supply 19. Is project site near a public sewage collection or- disposal system ?....: /V iJ 20. Name of sewage,system Distance; to.sewage..system:" 21. Date observed: 23. Name of Health Inspector:- nspector !4. Project design flow (gallons per day) ..... �GQ 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. 26. Has SPDES Application been submitted to local.DEC Office. ?....... 27. Is any portion of this project located,",.Within, a designated Town or State wetland? .... ....................................... O ...: ...:... 28. Wetland ID Number . ... 29. -Is Wetland Permit required ?' ..........:... . :........... ................. :. Has application been made to Town or Local DEC Office? 4..:...:............. 30...Does. project require a DEC Stream Disturbance 'Permit? ................... 31. Is or was :project';site'used`for agricultural activity involving application of pesticide$ to orchards or other- crops,''solid or hazardous waste disposal landfilling,•sludge application or industrial activity? ......:. YES or NO..<'r 32. Is project.. located-within, 1 000'feet'of_-exi'stence,of. abandoned „landfill, hazardous waste site,-salt stockpile;; landfill,, sludge. disposal. , site or any other potential.`,known-'source of contamination ?,'...:;.:....: :..YES or NO AX DESCRIBE 33.; Is there a local.' master. plan.or fi W with -the Town or Village? ........... 34. Are community water,'sewer facilities planned to'be.deve .loped within 15 years. -35. Are any ; - -sews 'e .disposal 'areas: in excess 'of 15% slope? ..:=::.........;:. ".. 'r 6. Tax Map ID•Number ........... ................................. .:... ....::.�.��.,qd. 37. Approved,Plans are to be returned,to:.::........... .:,.Applicant Eng -i' eer. If the application.is signed. by, a. person other.1than the .appl.icant shown,.-in Item .1,'. the. application must be. accompanied. by -a Letter. of Authorization:.. Failure to comply, with thils provision :may,be'.,grounds, for, the rejection. of any submission ;. I hereby affirm, under penalty of per'jury,. than information provided on- this form is 'true to the best of my knawledge and be ief. False statements made herein --are punishable .as a Class A- Hisdemeanor- pursuant ..to Section- 210.45 of the Penal Law. . SIGNATURES.& OFFICIAL TITLES: NAILING ADDRESS: ( FAG �- `��__"r•_ C cz CD C_ -_- � rC:�._ I ( i LCL: --= Cam..._. � r iv�::_ Lam:. __ C- =`_-- •-•' =1 " -__: TO t= lnor t;; r =� i L�fl. -1 _ -'._ -- loo ca- 3z "/Y I I I I- -_ -__� =_ . P''�;�M CCUNZ'Y DEPAF OF HEAI,Tf �'� ; DIVR A OF ENVIRCNMENM HEALTH SFRVIL.._ S. DESIGN DATA SHEET- S(MUFACE SEWAGE DISPOSAL SYSTEK FILE Imo. Owner A G q'^/. - _.. Address 2 S B�IIP4 hl Z4AZ ,&9 n/ /� /1 ,�y. jo so ¢ oc0 foAD � Q Located . at (Street) /V.,..2.7- Sec. B1* lock - LotZ- (indicate nearest cross street) [Municipality Watershed CRo To /V SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMI= WITH APPLICATIONS Date of Pre- Soaking g p/ Date of Percolation Test g b7 S 9 HOLE NUMBER QACR TIME . ........ . PER001AT'ICAJ _......PERCOLATION Run Elapse Depth -to Water Frcm Water Level 2¢' No. Time .. Ground Surface _.. In Inches Soil Rate Start-Stop Min. Start Stop" Drop In Min/In Drop Inches Inches Inches. P 2 / %33 - l: S l ;'/8 2¢' Z7' -7 4 5 F3 ;59 -2:19 ,2a P TEST PIT DATA- RDQLTL' DESCRIB.'. N BE .SUBMITTED .WITH A.P.PLICATION DEPTH HOLE NO. HOLE NO. pj HOLE NO. G.L. 3' 4' C o �9 :. C'R� VAC 6� 8' �(/� �rO C .. v h/6 fro C ft v fr. g 10' 12' 13': 14' INDICATE LEVEL AT WHICH GROUNDRATER IS ENCOUNTERED ./Va INDICATE • LEVEE, . TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: rc /jC o C fr - DATE: -71,? DESIGN ... Soil Rate Used - % Min/1" Drop: S.D. Usable Area Provided ,SU 0 U No. of Bedroans - Septic Tank Capacity 2 Sd gals. Type C o H C• Absorption Area Provided By L.F. x 24" width trench NEW Y Other wMiQ Name /Lly1)W,, 7-,cr_ e/l /h� E�J / ✓(; �%Soc_, P C �ignatur ' �\U'l Address 7-3 SEAL � , 4 5j �.9TT,Ei?sd�✓ ��y �2 SG3 \�RUFE5510N�6/ THIS SPACE FOR USE BY HEALTH DEPART ONLY: Soil Rate Approved ..sq.ft/gal.. Checked by Date DISPOSAL. CA-fEp ON THIS INSPECTED PY :NT OF HEALTH /KENT OF HEALTH kKC--I-1 rKOM i NG LOT 41 -7 .2 PIKZPA�"o :O-L'ws, L. S. A5 13u.vr IF CHAI;2,T A 5 28. 6 2 39.5 9.0.0. 52.5 I <o.5. 5 50. d o 7 GD. 0 25.0 8 74-0 .513 0 t5 10 55.0 Is 9.Z .O -7 l3 4J- 0 E5 I'4 15.4 o &o. X00.0: 8 rp.. 0