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HomeMy WebLinkAbout0964DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.41 -1 -31 BOX 10 I, , Is + - - : m ,, 1111 Ej 9 Is low L 16 J' J ' ''T '�T o ' L* ,� 'T, ' Rev.. 3 %86 VV >A ce ..-n _+}...x,.�v- a.xy:x?. rta^+'F+san .^AS ^'s°_*�t7f 'f—x w.'.4?4:4 -:5 �-.4'm�,`Fa "� "•`�S � R 77: . "P^'. �'� �l y'^"� , S `_11 " "'1 y �•i;�.t ., PUTNAM COUNTYDEPAMbikI HEALTH T OF w Division of Enviroomental'Health Seviaxst►; Carmel, N.-Y-10512 - Peer Must Provide �1C1 fl C:H D Permit N r vornnr•�n.ew.���inri�vi•ra rv�r. oZ7rtl ♦— vi.0t• 0AT VW& " .- _�%ATT�o C•r:L ^, Located at L .M4 Q SOAK Taal Z Z . Matp Town or V111— . - -- Bloc �-: Lot p (2 P� . Owner/.PHcant Name LAn -•1N &t5k1ko M Formeily Snbdlvision Name 3['i� -- 3116 Snbdv. Lot #. Maluog Aaareas too :F &F, E LD DMZ. l Vsr:-:F 51> Rte. 1 0 5 oq Daite Permit leaned ` (5- 9 l Separate Sewerage System built by Addressi�i►thL.. RIS 'i4.Buc%S Consisting of t ©oo Gallon Septic Tank. and '72 L • F: Water Supply: .. Public 'Supply' From Address or:_Privaie,Sapply Drilled by cddreae p /9`L�/Y(/a!T �l /�L L , /)R/LL /iV Building Type Rar,5.1��4►T��� Has"Erosion Control Been Completed?—NO 3 cRt✓Ss14N . Him : Number of Bedrooms e Garbage Grinder, Been Installed? Other` Requirements A, I certify that the system(s) as listed,serving'the above premises, were constructed essentially as shown on,the plans of the completed work ( copies of which are attached), and.in accordance with the standards, rules and regulations, in accordance with the filed plan, and the permit issued by the Putnam County gepartm9n, f Of 'Health. Date Can led by Y tt P.E. � ` R.A. Address �/y1 /�/ /Z. License No. Any parson occupying premises served by the -above syitem(s) shall .promptly .take such action as may be necessary to secure the correction of any unsanitary conditions - resulting from such usage. ADproval of the, separate sewerage system shall become null and void as soon as a pub(: unitary sewer becomes available and the approval of the private- i;iater supply shall become null. and;, void when a public. watts supply becomes available. Such approvals are subject to.m'diflution.iir, change when, .in .the judgment of ihea'Commlisloner of Health, such'revoatbn, modification o► change Is Mcassary. Date --� By ��r �� it la PLM AM COUNTY DEPARTMW OF HEALTH ' DIVISION OF MWITRD2 N AL-HEALTH -SERVI Owner or Purchaser of Building Section Block Lot Building Constructed by 4M"IA Location - Street Municipality Building Type A6,rAA,,PI 4-4AT Subdivision Name Subdivision Lot # GUARANTEE 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 Environinental. 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 % 'i day of '% 19 `oz— Signatur Title �eral Contractor (Owner) - Signature 66sF?TU KJ CA) TR"CrtaJ CO, _ Corporation Name (if Corp.) rev. 9/85 rrk Corporation Name (if Corp.) sWnLT Address a LcOi, WELL UUr1rLt 11U1V 1[r rual DEPARTMENT OF HEALTH Division bf -Enviroamental health Services PUTNAM COUNTY DEPARTMENT OF HEALTH office Use Only WELL LOCATION STREET AOORESS: INN/virclGlIcily TAX GRID NUMBER: GARLAND ROAD Putnam Lk„ Patterson, NY _ WELL OWNER NAME. ADDRESS: RTRUM. CONSTRUCTION CO„ - 100 Fairfield Dr,, Brewster, NY PRIVATE PUBLIC USE OF WELL 1 - primary 2- secondary )(A RESIDENTIAL O PUBLIC SUPPLY O AIR /COND. /HEAT PUMP ❑ ABANDONED O BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify) O INDUSTRIAL O INSTITUTIONAL O STAND -BY O MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED 2 - -5/ EST. OF DAILY USAGE gal. REASON FOR DRILLING .[]REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION []ADDITIONAL SUPPLY >TEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH Z60 ft. STATIC WATER LEVEL _L____ ft. DATE MEASURED 5/.1/92 DRILLING EQUIPMENT ❑ ROTARY )Q COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT O CABLE PERCUSSION ❑ OTHER. (specify): WELL TYPE ❑ SCREENED O OPEN END CASING ®(OPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH 52 fit MATERIALS: XI(STEEL ❑ PLASTIC ❑ OTHER LENGTH BELOW GRADE 50 ft. JOINTS: ❑ WELDED ):THREADED O OTHER DIAMETER 6 in. SEAL: )QCEMENT GROUT O BENTONITE ❑OTHER WEIGHT PER FOOT — 9 Ib. /ft. I DRIVE SHOE.)R YES ONO I LINER: 0 YES O NO SCREEN DETAILS -.. DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST ❑ YES ❑NO GRAVEL PACK ❑ YES ❑ NO GRAVEL DIAMETER SIZE_ OF PACK in. TOP BOTTOM DEPTH ft. DEPTH It. WELL YIELD TEST t If detailed um in P P 9 METHOD: O PUMPED 1 tests were done is in- COMPRESSED AIR , formation attached? O BAILED O OTHER :OYES ONO I�IELL LOG it more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE water Bear- ing Well Oia- meter FORMATION DESCRIPTION CODE ft. ft WELL DEPTH It. DURATION hr. min. DRAWOOWN It. YIELD gpm. Lance 35 Silt,, $ , grave clay 9 Soft bedrock 200 2 - 200 3/4 and grey & black granit 400 350. 1 600 400 .1 -.1/2 0 6 - 300 5 (CLEAR TEMP. Y ❑ CLOUDY HARDNESS O COLORED ANALYZED? AYES ❑ NO ANALYSIS ATTACHED? YES O NO [MA STORAGE TANK: TYPE CAPACITY GAL. INFORMATION CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAME 0 ADDRESS MILL DRILLING 11 Putnam Avenue R R SI .3166 01 ELLIS A. TARLTON LABORATORY DIVISION OF ELLIS A. TARLTON, ENGINEERS, INC. CHEMICAL 34 PLEASANT STREET DANBURY, CONN. 06813 -2328 WATER -WASTEWATER PHYSICAL METHODOLOGY BIOLOGICAL P.O. BOX 2328 203- 748 -7903 APHA - EPA - ASTM REPORT OF BACTERIOLOGICAL AND CHEMICAL EXAMINATION OF WATER NAME AND ADDRESS OF PERSON TO RECEIVE REPORT F Mill Drilling, Inc. Putnam Ave L Brewster, NY 10509 DATA SOURCE OF SAMPLE Water Supply, Bertrum's Construction Garland Road Patterson, NY DATE OF COLLECTION May 6, 1992 COLLECTED BY Mill Drilling Hydrogenion Concentration COLOR TURBIDITY ODOR CORROSION INDEX LANGELI ER DISSOLVED SOLIDS (pM) RYZNAR NTU Mg /L Alkalinity as CaCO3 Bicarbonate Fluoride (F) Nitrite Mg /L Mg /L Mg /L NITROGEN CONSTITUENTS AS NITROGEN (N) Nitrate Mg /L Alkalinity as CaCO3 Carbonate Mg /L Chlorine Residual .00 Mg /L Ammonia Mg/l. Total Hardness as CaCO 3 Mg /L Conductivity Micromohos/cm Mg /L Iron as Fe Mg /L Mg /L Chlorides as CL Mg /L Manganese as Mn Mg /L Mg /L Detergent as MBAS Mg /L Sulfate as SO4 Mg /L Mg /L The arithmetic mean of all standard samples. examined per month using the membrane f(Iter technique shall not exceed MEMBRANE FILTER TEST „- -,c!^ ?^0^ .. �C!'!Crn Cc' ^ ^i�_ Et_ndera Ca:°p!e eha!! not C--Cc--C! �!5, -. ., 1CCrf. 7, 200:n% c. 13/ 50^_. ^..! Coliform Colonies /100ML in: (a) Two consecutive samples; (b) More than one standard sample when lei;s than 20 are examined per month: or (c) More than five per cent of the samples when 20 or more are examined per month. 0 AT THE TIME THE SAMPLE WAS SUBMITTED: ® 1. The results of the analysis of this sample were satisfactory and met requirements for a potable water. 2. The results of the analysis of this sample were satisfactory for a potable water but certain of the chemical or physical constituents were high. These are as follows: 0 3. This sample was not satisfactory since it did not meet the bacterial requirements for potable water. The presence of organisms of the coliform group in a sample of potable water is undersirable and, while not necessarily indicating the presence of any disease - producing organisms, does indicate that such contamination might survive to the same extent. The presence of organisms of the coliform group may also Indicate that the treatment was not adequate at the time the sample was collected. D4. This sample was unsatisfactory as a potable water because certain chemical or physical constituents were above acceptable limits. These are as follows: COMMENTS The bacterial analysis showed no organisms of the coliform group at the time the sample was collected which indicated the water potable. L X-- Certified - PUTNAM COUNTY DEPARTMENT OF HEALTH NO.2 8 2 - 8 7 TOWN PATTERSON .._- CUMPLAIN Ox.. SERV CE_REQUEST-RECOR __..._. >_.___ -_ ...---- .•.- _ - - - -- DATE 5/14/87 REFERRED TO TAKEN BY JP TELEPHONE CALL XX IN PERSON LETTER CONFIDENTIAL (H) @ sc 2 7.9 - 6 9 7 6 REQUEST FROM ROBERT BEROK TELEPHONE (W) 278 -9292 ADDRESS 4 FERNDALE ROAD, BREWSTER, NY 10509 (T) Patterson ENVIRONMENTAL HEALTH: Home Sewage Rodents Refuse Public Water Food Service Migrant Camp Other 24 COMPLAINT OR REQUEST PERSON BUILDING BEHIND HIM, FAINT ODOR IN CORNER OF PROPERTY, WATER CASCADING DOES NOT WANT STREAM ENCLOSED._ Directions: Go to monument bear left on Haviland Drive, past new bar. Kermits. 1/8 mile past Kermit, lake close to road, follow rd, on right, off Haviland ACTION TKEN $� ' all around lk, sign Homer Rd, then Gand, trn L on Garland, FINDINGS tremendous piece of property -walk property to back, will see stream, stream has sludge or whatever. ,!D -I t) ' 4� / - & n c- A r i,:3 vv czn Cd t Vert" /-YQr,- W 6 FOLLOW UP TNSPECTION (s) ✓1 �` /�G" DATE FINDINGS DA o!� FINDINGS PROBLEM ABATED / DATE PERSON NOTIFIED -� Gt ESTIMATED TOTAL MAN HOURS SPENT 1711/`1 1 V' NORTH AMERICAN PUTN APA Cou,,rrY LABORp 0M S, NIC. DE 9 ' QF El. A.sLTH REPORT OF BACTERIOLOGICAL Fl L_ C XAt'i1:t +IA"f]:9N OF WATER ; 1 - 1 Report to: Havi•land_ Plumb. _& Heat •_�o_� 1 SAMPLE NO .._DW- 46.Q5 .......... 1 1 Address : _ -Box 50.9x_ Kenwood.__Ra_ . ..- __.___._..._...._..__._.__._ 1 REPORT DATE ................. 1 1 Town. • -- Patterson.,_------ .�i_<�a•t:e: NY ..__ ._�'iF��_.J,..2_S.u__._.._. -.__ 1��:'.lel)11C71"1r.•? ran :27.9.- 897...7.._.__.__....._ �. 1 1 1 Sample �o�•�r-ce- : • John & Maureen._. w .. ._._..._..___..__.._....__..___._.___-_._._-•----•--•--..___.__._...__.--- 1 1 Location: ` _.____-__.__.-.__..__-._..__ -.. _..- __--- .-- __- __.- __-- .- .._.__ -____-•-_____--___.-- .- _•__.- __- .____._-- .--- •__ -• -. 1 1 1 Street address: 1 1 1 1 1 Town: Patterson ....... County: m1mamL_--- -- --- --.. State: - N�L- _-__.-Zi1: QZ568._._..__ 1 i 1 1 Sampled hy: _Haviland _Plumb ^_._$�_- ����t�= `r��i:� 3�1Q/_92___ Time: - a^QQ.-._ 1 I i 1 RESULTS 1 METHOD 1 1 Total r_ol i •c=orm M& Present .___.--- ---•---- ---•-Absent_._.._._'_______.._ 1 ,ate (16) , 909A 1 ; 1 1 I 1 Total co.l i •corm F• PN: Present Absent ............ 1 SM (:ltd) , 90x:3A 1 1 1 1 ' i 1 _N . Col i :..._. _ __... _- ........_.._......._.._f -'rc_ ae•_n.t____..._..._.. _. _- .._.. - - - - -- ���en•...... _.... - ..... ,.... .. _, 1 1 � 1 _ A. - - 7 (' per ` �• LEI ( .1. 6) , '���-�,�i C 1 ! 1 k-cac<:z1 cc;l i •1 or• ��� membr-�nc. r 1 l • t:c..r :.__.____._...____.._..__ no la ".r 1 ��! ml 1 ,.� _ 1 1 i Fecal col . i -Form MPN: __.._______._._ .__.___..__.____..- •-- •-- _ -..._ no per 100 ml 1 SM ('ifs) , 9YBC 1' 1 , 1 Standard Plate Count: .... - ......... __ - no per 1.0 ml 1 SM (16) , .'=�07A 1 1 V -1.. THIS SAMPLE AS RECEIVED A T THIS LAb ]FAfChY MET ___� _ •____ T I D NOT "E _._._____._. THE k EOUIREMENTS OF NEW YCJFiK STATE DRINKING WATER STANDARDS /-- Deborah A. Wilson, Bacteriology Laboratory Director l:Jtte. NEW YORK STATE DEPARTMENT TP ~iENT OF k"1f_- ::AL._TH APPROVED L_.F-1k: ORA-F OR0 E:.LA P ID NO. 11218 618 CLOCK TOWER COMMONS, RTE 22, BREWSTER, NY 10509 / 910 278 0600 / FAX 911297 -0536 PUTNAM COUNTY DEPARTMENT OF HEALTH NO.2 8 2 - 8 7 COMPLAINT OR SERVICE REQUEST RECOR TOWN PATTERSON DATE 5/14/87 _ REFERRED TO TAKEN BY JP TELEPHONE CALL XX IN PERSON LETTER CONFIDENTIAL (H) @ &27.9 -6976 REQUEST FROM ROBERT BEROK TELEPHONE (W) 278-9292 ADDRESS 4 FERNDALE ROAD, BREWSTER, NY 10509 (T) Patterson ENVIRONMENTAL HEALTH: Home Sewage Rodents Refuse Public Water Food Service Migrant Camp Other 24 COMPLAINT OR REQUEST PERSON BUILDING BEHIND HIM FAINT ODOR IN CORNER OF PROPERTY WATER CASCADING, DOES NOT WANT STREAM EN LOSED. Directions Go to monument bear left on Havil a Drive past new bar. Kermits, 1/8 mile past Kermit, lake close to road, follow rd, on right, off Haviland ACTIO hoke r ' all around lk, sign Homer Rd, then GBk�and, trn L on Garland, FINDINGS tremendous piece of property-walk property to batik, will see stream, stream has sludge or whatever. , l VLLVW ur - ` OdO/Y DATE ^r �_ FINDINGS ?ROBLEM ABATED )ATE PERSON NOTIFIED fJ I `4 ESTIMATED TOTAL MAN HOURS SPENT ols8. �` DEPARTMENT OF HEALTH Z Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 - -- APPLICAT- IEN-- TO-- CON?.ST.RU.CT_ A_ WATER WELL_ . - P/ Lest #2 PCHD PERMIT # WELL LOCATION Street Address Garland Road Town/Village/City Tax Grid Number WELL OWNER Name John Bertrwn Address gPrivate O Public USE OF WELL 1 - primary 2 - secondary 10 RESIDENTIAL O BUSINESS ❑ INDUSTRIAL 0PUBLIC SUPPLY QAIR /COND /HEAT PUMP. O FARM ❑ TEST /OBSERVATION O INSTITUTIONAL O STAND -BY 13ABANDONED ❑ OTHER (specify, 13 AMOUNT OF USE YIELD SOUGHT min 5 gpm /# PEOPLE SERVED 1 fam /EST. OF DAILY USAGE 600 gal REASON FOR DRILLING NEW SUPPLY OPROVIDE ADDITIONAL SUPPLY 9REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL OTEST /OBSERVATION DETAILED REASON FOR DRILLING Public Supply not raadily available WELL TYPE XDRILLED DRIVEN ODUG GRAVEL D OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Putnam Lake Lot No. 3116 -3111 WATER WELL CONTRACTOR: Name to be determined Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES No NAME OF PUBLIC WATER SUPPLY: N/A TOWN /VIL /CITY Dl T- fN,C�E- -sO- -DROP- FRTY- .FROM_NEARES.T- WATER- MAIN: -- LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED []ON REAR OF THIS APPLICATION (date). e ee plans 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 - --�' ='- -� �c19 `3' Permit ssui n Of i ci al Date of Expiratiop�� 9 Permit is Non - Transferrable / / R /RF :4WM '� s •< . =t` APPENDIX B PUTNAM COUN'T'Y DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WAM SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS ' x r A P (Name of Owner) COMMENTS LF trench provided. U required T 60 ft. max. Parellel to REVIEW SHEET - CONSTRUCTION PERMIT �C✓ ( - _ ----- .__. BYTF�- -R�"�Ir"WED : -' -� C� •c-� `(Street Location) YES NO DOCUMENTS Permit Application i.. Corporate Resolution Plans - Three sets s/s Engineers Authorization Design Data Sheet (DDS) SUBDIVISION Deep Hole Log Perc Consistent Perc Results (3) Fill Perc Hole Depth cd e Plans - Two sets WELl permit; PWS letter Variance Request GENERAL Legal Subdivision Subdivision Approval Checked' Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same ,MUIRED DETAILS ON PLANS "age System Plan - (north arrow) qewage System Hydraulic Profile - Gravity Flow All Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data: perc..and_ deep results . Driveway & Slopes footing /Gut tain Drain (discharge OK) I?erc & Deep Hole e Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If Pumped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Proposed System Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1/4 " /ft. 4 "0; Type pipe . No Bends; Max. Bends 45° w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees,Top of fi' 20' to Foundation Walls to Well; 200' in D.L.O.D, 150' pits / -` to Stream, :W course, Lake (inc. expa ' to Dra' fain Leader, Footing 35'to catch ba ormdrain, piped watercour 101. to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' from Foundation; 50' to well 15,'1 Well to PL A* �I�j1TlJ� 1 ae Ix G7 J16M PUT T— 12E P �D FIPC nommaka Id Resimbrili Wfiali FM b 66*6wd. Supob ,q,lder."'that laid WIN* -0!;1100, !..Pg ':diipdWk system dWiAg- the 's immediately follow joij,1=11. yew wo be located "'ihowli oii,tlii- plied ' n 4"' 'that. esid.will,iiiii.be . Installed hi I&C I COFIS - PCs with It sts"M rulas ond roguMMrs—of "ille Putnam County Depart, caw E. RA ^ddrefs� 1-1,6686, No unless construction of the building has been undertaken and is revocable for ceU'SS Or may "'affmWided, Or modified' epill"O.00 necessary bi. the COMMISSIOnir Of M0111th. Any chango Or -alteration of construction Data By ~ a s r ` PUTNAM COUNTY DEPARTMENT OF HEALTH t C/p i Rev'. 3z 84 15� Division of Environmental Health Services. Carmel, N X.10512 Engineer to'Provide' Permit R on CERTIFICATE OF COMPLANCE. Permit . N CONSTRU R SEWAGE DISPOSAL SYSTEM Lot #2 er Putt so n r m ed n: �� —I � To__ I or .rpm Subdivision Name RLltnam Lake.' Baud. Lot ll 3116 -3111 Tax Map 22 Block 2. iAt .. /0 12+ p /o' `1' f: Renewal= ❑ Itevisioti p Owner /Applitint Name John . BertrLDTI Date of Previous Approval MalungAddress 100 .Fairfield Drive Town . Brewster, N.Y Zip 10509 Building Type L Fab:_ Res, yet Area 12, 000 SF Fill �Secdon 'On ly Depth Volume Number of Bedrooms 3 Design Flow G /P /D 600 D Notification Is.Retiaired When Fill Is completed Separate Sewerage System to rnaelst of -1000 Gallon Septic Tank sad 24 +24 ±20 T.F of 41 x 4 t Pr1'Cgcr� Cnnrratr-va l� 1 i Pc To be constructed by ` to be determined Address Water SDPP131 Public Supply From Address X to be det. or: Private Supply DrWed ay '. � ddeeee Other Requirements Distribiuf imri Box, : ':. Curtain .Drain represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regulations o e u nam County Department of; Health, anG that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill 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 contlition any part 'of said sewage disposal system during the period of two (2) years immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliarice_.of the oilginal system or'any repairs thereto; 2) that the drilled well described above Will be located as shown ontlie approved: plan and that said well will be installed -in accordance with the sta rds, rules and regu aT r4 ns of the Putnam . County Department of .Health. Date Signed P.E. X R.A. Add, Cashin- Assoc:,, P.C.", Rt.' -52,UArme1j N.Y.10512LIcense No 26008 APPRO VED:FOR CONSTRUCTION This approval - "expire. year from the date issued unless construction of the building has bean undertaken and is revocable for cause or may be amended or' modified when considered necessary by the Commissioner of Health. Any change or alteration of construction requires a new'permit. * Approved for disposal of'domestic samtary:sdwage, and /or ri afar supply only. Dat � /�� —.. Title �'�� PUINM COUN'T'Y DEPARTMEUT OF HEALTH. DIVISION OF ENVIPOMM%L HEALTH DESIGN -DATA--5U -�th�Au DISPOSAL SYSTa4---- Owner Address too Fa,41eld DVI-N-e- Located at ( Street) —GarlafAj R Sec. z Block 2 Lot ?,2-,Z- (indicate nearest cross street) Municipality PCL e r 0 0 Watershed G;- to f) Son PERcc)=oN TEST DATA RBw= To BE suBmi= WITH APPLICATIONS Date of Pre• Soaking i �, 12. 8 C Date of Percolation Test -Z /;31-s;16 HOLE 10.- 3-7 NLVBM CL= TIME PERCOLATION PERCOLATION Run' Elapse Depth to Water Fran Water Level ' No. Ti Ground Surface In Inches Soil Rate Start-Stop Min. start Stop Drop In Min/In Drop Inches Inches Inches 1 q.: S`5-- i: 0-1 -3 2 --7; US-. �2 0 3 10.- 3-7 Iq 2► Z4 3 4 x:-*O- -?:SO I SP -2-1 Z4 3 6 5 10: 17 2- 2ZA 6 0- s 2< A? 2 10.- 3-7 lo:4 Q - -4 21, 1 3 1;,0:6-C) 1 ('09 rg 2i 2A 6 4 11: oy I 1.'q -Z r 3-4 3 5 :1:2S?- 11:116 t F 2.4 N=: 1. 'rA--sts.t6,1�e repeated'at same depth until approximately equal soil rates are o8tained.at each percolation test hole. All data tb*be submitted for review. 2. Depth measurements to be made frcm top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION f` DESCRIPTION OF SOILS EI]COUNTERED IN TEST HOLES DEPTH HOLE -..Nn. ...._.__ .. _ _ ..._.._. _ ... - - HALE -1`0. - - HOLE._:.__ �_. �.,..... _ G. L. 1' 2' 3' 4' 5' 6' 7' 81 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENOOUNTE'RED qbri.t. INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED N(a DEEP HOLE OBSERVATIONS MADE BY: R o O DATE: (0/7/ G DESIGN Soil Rate Used 1 - 7 Min /1" Drop:. S.D.-Usable Area Provided ts-oo s� No. of Bedrocros 3 Septic Tank Capacity 100(9 gals. Type (y2asonr Absorption Area Provided By 24 +2,4f zd L.F. G'X41 precast conc. Go(A" S` AL Other I I J.sf r, Jig.l ia,7 %nx . 6' (rtr l(Lr_2 O%LKL yrs I. ca.� Name SSo cca to Signature G t . O Address Q 1 S Z 0--,^ M e, SEAL mss, ,yo. 2 6008 �4 THIS `SPACE FOR USE BY HEALTH DEPARTMEN3' ONLY: Soil Rate Approved sq.ft /gal. Checked by Date DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER` WELL——-�- PCHD PERMIT # P -31 -81 WELL LOCATION Street Address lZraoc� Town/Village/City Tax Grid Number t-1 - Z_ ro tz. d is WELL OWNER Name Mailing Jo►to 0o F` Address �.� WPrivate O Public USE OF WELL 1 - primary 2- secondary RESIDENTIAL 0 PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O BUSINESS O FARM O TEST /OBSERVATION 0 INDUSTRIAL O INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify, O AMOUNT OF USE YIELD SOUGHT P14 5 $pm /# PEOPLE SERVED /EST. OF DAILY USAGE loo, gal REASON FOR DRILLING 0 REPLACE EXISTING SUPPLY NEW SUPPLY NEW:DWELLING O TEST /OBSERVATION 12-ADDITIONAL SUPPLY © DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING ti.la.l PsID�1.tT"► �l _ SuPP�Y WELL TYPE DRILLED ODRIVEN DDUG GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES iC NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: R-rr� L.,.t x4m Lot No. a% —:3 it Co ( lsrr 2� WATER WELL CONTRACTOR: Name---t;. 'F3a �� t —Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES '-%( NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DIS1AI� ?i.E- _TO- -PROPERTC1-TROM- NEAREST WATER MTAlt.' LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED n ON SEPARATE SHEET (date)` (s ature)` PERMIT TO CONSTRUCT A WATER WE 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: iGy M 19 S;� �-Z.�✓ ""_ �—� "'_ Date of Expiration: 19 emit - issuing ffficia Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector Rev. 10/88 Pink Copy: Owner Orange copy: Well Driller kl r 1 s DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 'APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # P,5/ -sl WELL LOCATION Street Address Town/Village/City Tax Grid Number WELL OWNER Name 4�� Mailing Address loo r- iELO �rivate 11:kZ, C3 Public USE OF WELL 1 - .primary 2 - ,.:secondary XRESIDENTIAL. ® BUSINESS ® INDUSTRIAL O PUBLIC SUPPLY ® FARM b.INSTITUTIONAL Q AIR /COND /HEAT PUMP O ABANDONED O TEST /OBSERVATION 0 OTHER (specify, ❑ STAND -BY O AMOUNT OF USE YIELD SOUGHT rJ' gpm /# PEOPLE SERVED_Frpr!njEST. OF DAILY USAGE6pO gal 0 REPLACE EXISTING SUPPLY ® TEST /OBSERVATION GE ADDITIONAL SUPPLY W SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED ®DRIVEN DUG []GRAVEL 0OTHER IS WELL SITE SUBJECT TO FLOODING? YES tl� NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: P,yn1P tej L.AK -•F Lot No. -6111-,- 3116 La r- Z- � _Mff M WATER WELL CONTRACTOR: Name '�o ►I%Jt7=a�> Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES �O NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: -T-} j `•e�� LE LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED / ON SEPARATE SHEET / date) signature) G 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 thirtg (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 wel illing operations be contained on this EbA."r property and in such manner as not to degrade r of erwise conta inate surface or groundwater. Date of Issue: 19� M&�g Date of Expiration 19� ermit Issuing Official Permit is Non - Transferra le White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller 4 ( ) I WILL HAND DELIVER MYSELF ( ) PLEASE SUBMIT TO THE SPECIFIED DEPARTMENT FOR ME SIGNATURE ' APPLICATION FOR PUBLIC ACCESS TO RECORDS TO: RECORDS ACCESS OFFICER DATE: � T G, Name of Agency JOSEPH L. PELOSO, JR., PUBLIC INFORMATION OFFICER Address I HEREBY APPLY TO INSPECT THE FOLLOWING RECORD: R,�►� �tQ�Urn Con.s7 . i° TS Signature A Date Representing _ ��- - ---./ -� •- �.._.- - -- Mailing Address FOR AGENCY USE ONLY APPROVED 'z DENIED Record of which this agency is Legal Custodian cannot be found. L1 m -cz Record is not maintained by this Agency C n `j Signature Title Date v% NOTICE: YOU HAVE A RIGHT TO APPEAL A DENIAL OF THIS APPLICATION TO THE PUTNAM COUNTY EXECUTIVE. s Name Business Address WHO MUST FULLY EXPLAIN HIS REASONS FOR SUCH DENIAL IN WRITING SEVEN DAYS OF RECEIPT OF AN APPEAL. I HEREBY APPEAL: 1-=�` - -- AS—BUILT MEASUREMENTS NO.- A B REMARKS -7 V7 bco4Q-, 201 jut -IJ lop i�X NO. A C REMARKS 4 771 51' —/4' 70 -7 b -7( - 71 jL -LT& Pox RECORD OWNER: JOHI t5F_FTFIJI� loo FAFFIP-iv 0Y TO WN 0 F: WTEK500 PUTNAM COUNTY, TAX MAP NO. ZZ, B NOTES: 1. THIS IS TO CERTIFY THAT THE-'SE1 WAS CONSTRUCTED AS INDICATED THE SYSTEM. WAS INSPECTED BY I DESIGN, P.C. BEFORE. IT WAS COVI WAS CONSTRUCTED IN ACCORDAN( RULES AND REGULATIONS OF THE. DEPARTMENT OF HEALTW AND THE DEPARTMENT. OF HEALTH. 2. ALL FACILITIES EXISTING, UNLESS 3. TOTAL LENGTH OF FIELDS, REQUIRE TOTAL LENGTH -OF FIELDS PROVIDI euum County Depar Avial P drozuiwA