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Home My WebLink About0826DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 24. -2 -62.3 BOX 9 ,Iry 1 11 IN IN, 1' IN , T ly � 6 ' ti - , , , � ' ' - ■ ,11 hNLL I. IN Consisting of � Gallon Septic-Tank -and Address Water Supply: Public Supply From 'kA ,,`` or: t/ Private SaPP�Y`Drllled by -t��!�! ��T"G''Addrese�r p �J": -> —*�YY rri►yHae.Erosion Control Been CompletedY Building Type �i'! Number of Bedrooms ' Has Garbage Grinder;Been Installed? ,Other Regaiiemente •2 certify that the'system,(s).as listed serving the above premises were'consiructed essentially as.sAown nth 'plane .of the completed work ( copies of which are attached), and in accordance with the'afandarda, rules,an9 re ations in :accordance with he 1 plan, and the,petmit issued by the Putnam county. Department of Health P.E. R.A. Date _Q Certifled by O Llcenla No. ✓ Address Any person occupying premises served by •the above systems) shall promptly toke•such action,os,may be necessary to.securs the correction of any unsanitary conditions resulting from such usage. .,Approval of the separate seweragesystemshall become hull and void.&$ soon as a pub(;- sanitary sower, becomes i available and the approval of the ,private. water supply shall become null antl :void when a public water : supply becomes available. ' Such approvls are ` sublect to�mo of change when, in the:fudgment of the Commtisionar.of Neal such rbvoestlon� modlfleittioh or change If necessary /dtftea_tlon Date a� By Title + I+ IIIn, nlnAl• nlMl+ nl• AIMIMInrinAlnAIMIMInnlnwl +Al•/11•nlnn!•/.InAPnnlnnn 1' • +Innl•nIn'nf!.w1n �n+lnnLn: +Inn0.w +[nninPln.nln nA1nn]r, +Pnnln A.nnr� +�..wlnnfnntnw•nanA;. n.nn, A ' +1 :+ n( n 0 1, PUIrN M COME( DEPP.R r1 /"T OF HEAL11i DIVISION OF ENVTRON.►�7LAL REALTH SERVICES Omer or Purchas& of .Building Building Constructed by Location - Street IVY Municipality Building Type Section. Block Lot ��it� S•1J4ti Subdivision fi 3' Subdivision Lot GURRPI= OF SUBSURFACE SFSE-�.GE DISPOSAL SYSTEM I.-represent that I am wholly and completely responsible for the location, wor)c�anship, 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. amendnent.. thereto, and 'in 'accordAnce. •with "thd" : standards; 'rules and regulations of the Putnam County Department of Health,: and hereby guarantee to the omer, 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 rrede by me to such system; except taheze the failure to operate properly is caused: by the willful or negligent act of the cccvpant.of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environrental 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. 60 . 19 `I� Signature Title General Contractor Mwner) - Signature Corporation tame (if Corp.) .Address rev. 9/85 mk Corporation tea (if Co� Pxllress TARLTON ENVIRONMENTAL lLABORATORI S9 RNC. CT Cert: PH -0404 3 A Division of Northeast Laboratories, Inc. DANBURY: P.O. BOX 2328 - 22 KENOSIA AVENUE - DANBURY, CT 06813 -2328 LAW BERLIN: 129 MILL STREET - BERLIN, CT 06037 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: MILL DRILLING; INC. PUTNAM AVENUE BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: TEST PERFORMED. BACTERIAL: Total Coliform (Bacteria) CHEMISTRY: Chlorine Residual ml = milliliter mg/L = milligrams per Liter DATE SAMPLE COLLECTED: 9/7/94 - TIME COLLECTED: 11:30 A.M. COLLECTED BY: ROB DATE RECEIVED @ LAB: 9/7/94 DATE(S) TESTED: 9/7/94 TESTED BY: TEL REPORT DATE: 9/9/94 N.Y. STATE CERT. NO. 11471 MILL,EAST BRANCH RD., PATTERSON, N.Y. TOP OF WELL WELL NONE RESULT: ABSENT * mg/L RESULTS BASED ON SAMPLES SUBMITTED /COLLECTED: RECOMMENDED LE MIT ABSENT 9/7/94 SAMPLE, AS TESTED ABOVE: M or DOT POTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) *BACTERIA SAMPLE COLLECTED IN A SODIUM TRIO SULFATE BOTTLE. CT: DANBURY AREA (203) 748 -7903 - FAX (203) 748 -0652 - CT: NEW BRITAIN /HARTFORD AREA (203) 828 -9787 - FAX (203) 829 -1050 TOLL FREE WITHIN CT: 800 -826 -0105 0 OUTSIDE CT: 800 - 654 -1230 COGS WELL COMPLETION REPORT Office Use Only * * DEPARTMENT OF HEALTH - - Division Of Environmental Health -Services PUTNAM COUNTY DEPARTMENT OF HEALTH — �p STREET ADDRESS: TAx GRID NUMBER: WELL LOCATION FAST $FINCH ROAb Ptt7IF.1 WNW NY WELL OWNER NAME: ADDRESS: WMLD E. MILL . E.. &aNCH RD.) PATd WN? NY PRIVATE ❑ PUBLIC USE OF WELL --& RESIDENTIAL ❑ PUBLIC SUPPLY O AIR/COND./HEAT PUMP O ABANDONED 1 - primary ❑ BUSINESS ❑ FARM O TEST /OBSERVATION ❑ OTHER (specify) 2 - secondary ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY O MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED 24 / EST. OF DAILY USAGE gal. REASON FOR []REPLACE EXISTING SUPPLY []TEST /OBSERVATION []ADDITIONAL SUPPLY DRILLING fnNEW SUPPLY (NEW DWELLING) ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 445 ft. STATIC WATER LEVEL 5 AT E MEASURED 8119194 DRILLING O ROTARY XI�F COMPRESSED AIR PERCUSSION O DUG EQUIPMENT O WELL POINT O CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED O OPEN END CASING NO OPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH 35 _ ft. MATERIALS: xaSTEEL O PLASTIC 0 OTHER CASING LENGTH BELOW GRADE 344 ft. JOINTS: ❑ WELDED xfkTHREAOED ❑ OTHER DETAILS DIAMETER 6 in. SEAL:,&CEMENT GROUT O BENTONITE OOTHER WEIGHT PER FOOT l9 Ib. /it. I DRIVE SHOE O YES ❑ NO LINER: O YES ONO DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (It) DEVELOPED? SCREEN DETAILS FIRST OYES ONO SECOND HOURS GRAVEL PACK O YES GRAVEL DIAMETER TOP BOTTOM ❑ NO SIZE: OF PACK in. DEPTH ft. DEPTH K. WELL YIELD TEST If detailed pumping WELL LOG it more detailed formation descriptions or sieve analyses are available. please attach. METHOD: O PUMPED tests were done is in- DEPTH FROM �y tt Well OCOMPRESSED AIR , ! ormation attached? SURFACE Bea�tr- Di" FORMATION DESCRIPTION toe O BAILED ❑ OTHER ; ❑ YES O NO it. ft. 1n9 Imeter WELL DEPTH DURATION ORAWOOWN YIELD Lunace 23 Hard an & loose retch ' ft. 300. hr. min. l 30 ft. 300 9Fm- 2 23 4.46 Hard black grey gran? e 400 2 30 900 3 445 6 — 350 17 WATER CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? i&YES ONO ANALYSIS ATTACHED? o& YES O NO STORAGE TANK: TYPE PUMP INFORMATION CAPACITY GATE TYPE : = ' '. ~^ " CAPACITY WELL DRILLER NAME MTI.I, bRZL1 Z TE ? MAKER DEPTH ADDRESS Putnam Avenue SIGs MODEL VOLTAGE HP brewster, NY be I ' [i APPENDIX C STREET LOCATION PERMIT # FINAL SITE INSPECTION TM # OR SUBDIVISION LOT # 1. SEIMAGE D I SPOSAL AREA a. SDS area located as per approved plans_ b. Fill section - date of placement 2:1 barrier LGTH WIDTF c. Natural soil not stripped d. Stone,brush,etc.,greater than 15' fran e. 100 ft. from water oour 11 SEWAGE DISPOSAL gST —01 a. Septic tank siz 1 b. Septic tank i level c. 10' minimum fFan foundation d. DISTRIBUTION BOX 1. All outlets at same elevation - wate 2. Protected below frost 3. Minimum 2 ft. original soil between e. .JUNC.'T I ON BOX - properly set f. TRENCHES 1. Length required - Le 2. 'Distance to watercourse measured 3. Installed according to plan 4. Slope of trench acceptable 1/16 - 17 5. 10 feet fran property line - 20 feet 6. Depth of trench < 30 inches from sur- 7. Roan allowed for expansion, 100% 8. Size of gravel 3/4 - 13" diameter clo 9. Depth of gravel in trench 12" minimur --10, Pipe ends capped - - - g. PUMP OR DOSE SYSTEMS 1. Size of pump chamber 2. Overflow tank 3. Alarm, visual /audio 4. Pimp easily accessible manhole to gr� 5. First box baffled 6. Cycle witnessed by Health Department estimated flow per cycle 11. HOUSE a. House located per approved plans b. Number of bedroans V. WELL a. Well located as per approved plans b. Distance from SOS area measured c. Casing 18" above grade d. Surface drainage around well acceptabl '. OVERALL WORKMANSHIP a. Boxes properly -grouted b. All pipes partially backfilled c. All pipes flush with inside of box d. Backfill material contains stones < 4" e. Curtain drain installed according to p f. Curtain drain outfall protected & dir g. Footing drains discharge away from SDS h. Surface water protection adequate i. Erosion control provided DATE: Inspected by: YES I NO I COItIENTS ft. 2 "foot - foundations _ or !Qll�IAla[ COIII?tY DZPAXMM OF DEAL rs DNlili� st1a1 Hetlfm Senbxie. � N.Y 1�SU.� '�� to Fwi w CZMZ ATZ OF Op W,19S SEWAGE DIPOSAL SYSIM Fish _.-Jr, Ofrer '�F�r>BvC 'f.'OUTL�'�„ �i5fi F✓olJ4lrt Fl� p Stilt - I ripron,W WA am wholly, and dmpNtely ►aspons;ble fir the design and "tion of the proposed system(s);'1) that the202!r ate sew dis YI stem above described will constructed as snoMln on thi approveo ameodrneni tfler r to and in accordance with this standards, rules an rpu a ns o e m County. '.apartmefit of 141016 anii that On completion' thaeOf,a'r- d"ficste of Construction Compliance" satisfactory to the Commissioner.of Mealthwill be. submitted to the Departmint, and a writtM.ouaiantN wiii.be'furnlihed the ownei,'M tuccsssors;' 1rsorIass »na by the builder, that.sald buikter will place in. good operatiiM taidKlon any pert •o/ •said lew ge dispoiaf system durkiq th foal of two. 1 yoMS Immediately following ttNAate of'the lam. and of ter u00roval , of the Certifkate of -COnslitietion Compliance ;of the original eT or any i Ire thereto; Y) that the drilleel wail'diacrtbeel above wilt e• located is show" on the approve plea and that-iaid,well vrill be Installed i q with 't standards, rules and rpu ons of the Putnam County Depe ment o tfea¢f1. Oat, 3�-1 SigmO P.E. _ R,A..S� LAS�tnO ;i FKfE+Ey2 Address" License No APPROVEO FOR CONSTRUCTION This approval expires two years, frointhe date! issued unless construction of the building ,has been undertaken and is revocable for cause or may be amaiAed (or inodifled when considered neeasary. by ter, Commissioner of Health. Any'chenge Or alteration of construction Muir*$ a' w permit. ,Approved for .dispowl of domestic sanitary ate water supply only.. Rev. It 10/88 ate f Its* y 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 #f��/ WELL LOCATION Street Address Town Villa City Tax Grid Number �u W C� � ,��r�,e Z4 - a- G"z WELL OWNER Name Mailing Address r� Private -pet - i -f" Milk. e�- &k��C,N � IA'l°!� '� J'Lr>6 3 O ublic USE OF WELL 1 - primary 2- secondary RESIDENTIAL OPUBLIC SUPPLY (3AIR /COND /HEAT PUMP 0ABANDONED C) BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify 0 INDUSTRIAL O INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHA114 5; gpm /# PEOPLE SERVEDI F`4M /EST. OF DAILY USAGE_a�4C) gal 13 REPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION 13-ADDITIONAL SUPPLY NEW SUPPLY NEW DWELLING)- 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED O DRIVEN EIDUG O GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES _ NO IF WELL IS LOCATED IN A R&ALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name eno Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES __X_NO NAME OF PUBLIC WATER SUPPLY: �``� TOWN /VIL /CITY - DISTANCE-TO- PROPERTY -FROM -- NEAREST -WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION _ %_ /_ . ❑ ON SEPARATE SHEET 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 thirt3• (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 contaminat 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 O O O` �I • vl . i t .l y i; EX /ST. kiEll 4 l v' 5 t s EX /ST. RESIDENCE ' A r B /000 CAL 4 "0 .S'EPT /C .TANK /sOR. �S j , .... N 0 - "J. "ZO " "/w �, ud f-7 do gRxNcH 45 - Bu /L T p /MIENS /ON CNART� /NFTI N, A B 44.0 2 25.0 38.5 3 24.5 40.5 4 .275 375 5 420 .6' 45.0 92.5 7 48.5 94.0 d 5-7.0 96.0 .9 56.5 96.5 /0 780 32 0 79.0 355 /2 62.5 41.0 /3 65.0 45.5 14 ! 68.0 50.5