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HomeMy WebLinkAbout1123DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.55 -2 -11 BOX 11 rV ., , f I' , ti� - r Lei , IN dl.'6�' 16 4 NIL 6 il I N , 01123 ron ;11� 'D►vis►on +of Enviments)'. Na3 2, s , f....a +.. r MRT1;FICAT,E,:.,_ _ •- CONSTRUCTION CQMRLIANCE ,FO,RNgt ��L "ocated�at�r� =Ri3t1a11d��Rd° &'©ri =ent}rPl7ace `�`-� Owner Jame13 S,Pr1a�ue� , �y-eazmerd /b /�a aJYii �' •f1 Separate Sewerage j5ystre�mp built rby �� r a Conslsting oft5 �iQ9C u pal Septic ,a kya d NOnetK "t, Othei �r ulreme�pl�Se � kPfr P 3d �; h rs 'v y ar 'rGr Water Supplys , Srr�Public Syyupply ,rom + .;+ r � �'�" = +h *P►IVetey Su FpYriplytaD ►111ed+ BY)� 11PIx�11��DriK r bAtld►ess �-� � iFj1 Building TYPe t ' >il0�Cil�llar {���?7�Lk 1 t� gt' x ar Figs Erosion ControtBBesrt Completedt� fA r i , V. Ijcertify that,tthe�s'yatem(s)Y se �liated serving the ^above fp xemiaes of which,'ara attaohed).'� and in accordance with trio ,standards rule! .Putnam County DepartmentjOf Health �','� � az "� Jy'}1t• � � �`� r,, �� "- k '"$`g r n 7 i, ,{ tip + •,a'�ti�,.il Oate , <1 September�198,7 :E l - t, t r �� lty t7✓ � {�`�'Add1,e f y ! i t��'�1T'na >ir'i"si'�S�torieJe + F� Xv,1r..a1sn7 w ,•see "yard} Any person occupying , premises sevetlby therabove�system(s)+ at - ,tonditaoiis resulting�,from such usage�,� ,Approval �o l ith�e�asepa, .- �-rx�• ,-gvallableand theapproval��of therYpr ivate •watertnsupplytshall�become;,tm ! ¢ � ?i. .r c+a >d` t K•t Fr,r �vr- a X�'4t,. $' t,.. 1 srn Y"5 subjec to modification aor� change when t fn�,the Judgment �ot�theAcc . < it �nti +^rf.^� •Tµrr s�- ���•^� 1.'.� ir.�� •p�'�'x - '�,...'xy- .,`"'+ ''"rT y � ..Date �'Z��.�/ �� •' %.��� ��� ,+F ��,,�•�'.! ' �,� ! v a ReV 6/85 + _ t TaXMap ,'sr.�r %r («, a I, j•.Bl'°oc`kt n�F t.' Tani amp rot a' ; 2 3'/ 24 �5 sued' i cs a 6 3;U &�iI S '' incl. x . . 4ddr "eu �'R 5.2''Box� F43 ►1�.�Holnes....NY_jF �1253i •i, it , : .� sP�t 1` zt•�i �: s , �'iti;: r> �i a ?� .tom m� n .F i ��,..� lKS(86 �'+;ry � r �• Date Y( a�mit� I "truedl l 12 86 ,n i installed? s i,shoan oatithe plena of ttieLod mFileted rk (copies :e`withFthe° filed p andi 'the `permi wo issued by the tam shall tie�coome null�and{vo)d a�s',soon`las' a publ)e santtarYtswver;,beeomes i r' bdwAe(i"�a¢^puDlic waters sup�Dly becom�s� avillablp. CSucht approvals are ier offxHea'Ith,'�sucA revoeatlon; motflflcatlon or,cAange,i %,necaf�ary: �q^+r�i`c. >s a b ' i � '+•if'°'"C r!_`: 4 1:' Wo r �•-. r :. � � t 0 C lAQ �%. TT11T T AAw.T,T T1TTAIT T1TT1ATfT WL" LIUr1r1jL1lU1V Rr.rvmi Office Use Only DEPARTMENT OF HEALTH �W Division Of Environmental Health Services .YQ4 PUTNAM. COUNTY DEPARTMENT OF HEALTH STREET ADDRESS: WNIVI 1 TAX GRIO NUMBER- WELLIOCATION Orient Place Patterson WELL OWNER ADDRESS: "`James Sprague Gage Road, Brewster, NY ®PgIVATE 0 PUBLIC USE OF WELL M RESIDENTIAL ❑ PUBLIC SUPPLY . O AIR /COND. /HEAT PUMP O ABANDONED 1 - primary O BUSINESS ❑ FARM- ❑ TEST /OBSERVATION O OTHER (specify) 2 - secondary ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY O MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPL'E SERVED _�/ EST. OF DAILY USAGE 350 gal REASON FOR X3 NEW SUPPLY ❑ PROVIDE ADDITIONAL. SUPPLY ❑ TEST /OBSERVATION DRILLING ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA ' WELL DEPTH 365 ft. .STATIC WATER LEVEL 45 ft. DATE MEASURED, 5/14187 DRILLING ❑ ROTARY 0 COMPRESSED AIR PERCUSSION ❑ DUG EQUIPMENT ❑ WELL POINT O. CABLE PERCUSSION ❑ OTHER (specify); WELL TYPE ❑ SCREENED O OPEN END CASING f7 OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH 30 ft_ MATERIALS: (R STEEL O PLASTIC 0 OTHER LENGTH.BELOW GRADE ' 29 ft. JOINTS: 0 WELDED ® THREADED ❑.OTHER CASING DETAILS DIAMETER Ei_ in. SEAL: R) CEMENT GROUT O BENTONITE ❑OTHER WEIGHT PER FOOT 19. lb./ft. DRIVE SHOE Q YES ❑ NO LINER: DYES O NO SCREEN DIAMETER (in) "SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST ........._ - - :. ... _ _ O YES_..O NO - DETAILS SECOND HOURS GRAVEL PACK ° YES GRAVEL DIAMETER Top BOTTOM O N0. SIZE:. OF PACK in. DEPTH , ft. DEM It. WELL YIELD TEST If detailed pumping 'If more detailed formation descriptions or sieve analyses W EL� LOG are available, please attach. METHOD: O PUMPED tests were done is in- Q • COMPRESSED AIR formation attached? DEPTH FROM SURFACE Water Well , • BAILED O OTHER ;!].YES 0 NO Bear. ing .Meter .Dia' FORMATION DESCRIPTION woe ft. it WELUDEPTH DURATION ORAWOOWN YIELD Surface No 10 Silt a.y. g �'.. ��jS E . It. hr. min. ft. gpm. 365 6" b ck..& . aivte 300 2 30. 300 4+ 365 6 - 300.. 8 r WATEa IN CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? M YES ❑ NO ANALYSIS ATTACHED? K) YES D NO STORAGE TANK: TYPE Dia hr_ acim CAPACITY 62 GAL. 15 PUMP INFORMATION TYPE cal} mr'si } l.e CAPACITY _ 7 WELL DRILLER NAME TE MIDI, DRILLING, 5/18/87 MAKER GOULDS DEPTH 200' ADDRESS Putnam AVe, SIGr • MODEL 7EHO7412 VOLTAGE230 Hp3f 4 Brewster, NY 10509 Mil President s PUi'NAM COUN`T'Y DEPARTM= OF PEALIR DIVISION OF ENVIRONMENTAL REALTH SERVICES JW6O6 7O JAwmeS ?br-d d tkt S- Owner or Purchaser of BuilIJincjJ Section Block Lot OW H evs Building Constructed by i�u-E -14h� 2d: � D��ea -� Prate Location - Street Municipality Mo�uler Building Type PcCE n a r,n �:a IEA Subdivision.Name 6. 10 99 =/ 5- -SHe- I: Subdivision Lot # GUARAN= OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am.wholly and completely responsible for the location;, wor)ananship, material, construction and drainage of the sewage disposal system serving the above described property,..;:arid 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- Iv e� -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 day of 19AL CLAOi �• Gbrinral Contrac r er) - Signature Corporation Name (if Corp.) rev. 9/85 mk . Signature Title O. cc Corporation Name (if Corp.) Address Af3 CA:0045 Yorktown Medical. Laboratory, Inc. _::- -.321 KearStreet. Collect ion-- Station Used- - _ Peekskill Yorktown Heights, N. Y. 10598 Nt. Kisco New-City _ (914) 245 -3203 Director: Albert H Padovani M. T. (ASCP) Date Taken: Date Received: r-� - Date Reported: ��1 Collected By:M)LL ni2)�L�I -� %►� l�L' . Referred. By: AVE Sample Source: tJ�LL L 5. . f- LABORATORY REPORT ON BACTERIOLOGICAL AUALITY OF .WATER. GENE AL BACTERIA _. Standard .Plate Count per 1.0 ml (Agar plate @ 35 °C) NEMBR E FILTRATIO;J TECHNIQUE 04FT) f Total Coliform Der 100 ml Fecal Coliform.ner 100.ni Fecal Streptococcus per .100'm'1. MOST PROBABLE NUMBER TECi1NTOTJF ( *ep "�) Tb "taT.Coliform: MPN, Index r.er 100 ml Fecal Coliform: MPN Index Der 100 ml-`� T i..1 OTHER ANALYSES r' " a THESE RESULTS INDICATE THAT THE WATER SAMPLE OF„A SATISFACTORY SANITARY QUALITY ACCORDING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT -Albert H. Padovani, M.T. (ASCP), Director (WAS) (WAS NOT) (NOT APPLICABLE THV NEW YORK STATE DRINKING TIME OF COLLECTION. LEGEND RDS = Recommend Disinfect - ing Water Source < = less than TNTC = Too Numerous Too Count � II. I V. 1 I. -'A-kIC.L-LULN, ZVI #1 APPE MIX I C SITE INSPECTION Date Inspected by - ------------- TM # OR SUBDIVISICN! LOT 10 NCV OM DISPOSAL AREA .a. SDS area located as per approved plans b.. Fill section - Date of placement 2:1. barrier LGM WIDMI AVG. DPTH -------- .,c. Natural soil not strinued d.. ' Stone, bru-sh, etc., greater than 151 fran SDS area. e. UO, ft.. from water course/wetlands. S9QA.C-E DISPOSAL a. Se p 'c tank size(- 1,000 j 1,250 b. Septic tank inst alled-,-1-6vel c. 10 ' minimm, fran foundation d. No 90' bends, cleanout within 10 ft. of 45* bend e. DISTRIBUTION BOX All outlets at same elevation - water tested 2... Protects below frost 3. Minimum 2 ft. original soil between box and trenches f.. JUNCTION BOX -7 properly, set g. TRENCHES Len installed .1*. length required .1 2. Distance to wat-P -sim measured ft. 3. Installed accordj-nc4 to plan 46 4 -7 4. Distance center to center 5. Slope of trench acceptable 1/16 - 1/32 Is/foot. 4r T 10 feet fran prope---ttv line - 20 feet - foundations .7. Depth of trench < 30 inches fran surface! B. :Roan allowed for exransion, 50% 9-. Size of gravel 3/4 :: 1j" diameter 170. Depth of gravel in trench 12" minimum ll.' Pipe ends canoed h. TNIU OR DOSE. SYSTEY-S 1. Size of pump chamber 2 . Overflow tank. 3. Alarm, visual/audio T Pump easily. accessible. manhole to grade 44A 5'. First box baffled 6. Cycle witnessed by Eealth De estimated flow per cvcle lid MUSE a. House located per approved plans. C'. I kP b. N�smber of bedrooms WELL a. ' Well located as per approvea plans b. Distance fran SDS area measured ft. c. Casing 18" above grade. d. Surface drainage around well accept-able. OVERAIL WORKKkTdIP a. Boxes properly qrouted b. All pipes partially backfilled c. 'All pip2.2 flush with inside of box -AC d. Backfill waterial contains stones < 4" in diameter I e. Curtain drain installed according to plan f Curtain drain outfall protected & dir.to exi:st.,w-ate--cours+--�----J JAL, t, q- Footing drains discharge away fran SDS area Vn t- �O,t h. Surface water protec-tion adequate I i. Errosion control. provided on slopes great -,than 15%. Fos -4:2 10 J 17'x:1 d £- rIZ} -61 A. VLG -IZ I �S 14.4' -oil 10-( Ion oC. ,V O Q G2. >S2_o a.. i PLAc'E Putnam County Department of neattD oivielon of Environmental Health Servioee, `,:1• owed a6 noted for conformance with . f,PBr lationa of the r ryyligable Hulse and B Department., ' County H ?utR�9 2 g'• , 4 � F� P- t m e� M -� - -` "AS BUILT" DATA, Y' =j Structure located from survey by surveyor noted belori Well located by: Surveyors survey._ Well drillers report -- Eng{nooro moeuremonts -O__ _ -- Tank, boxos, pits, gollones 8 laterals located by:Contractora Engu+cars- -- Health dept; Field inspection by: Health clop►❑ dote:._ =hk Engenoor ❑ data This iS to certify that the a9 @dFfIIg�:. disposal system was conetrucG`ed,itg': -: _ NOTCES: indicated on this plan and'.that t'te : system vas insyected by me"beifore Vt ` was covered over. The sys'tEt�li- w9 ® -;_y =# constructed in accordance r bith c��: { standard rules and regulations of''.' the P.C.H.D. 6 the N.Y.S. r. D 1 SAE N SION S A A' C A- D 7 B D ° c?Q 7 - a ° _ _ A - F T Sn,B, F - - A - H. o �3r 07j_B a =_ �oA__ a� O W.lhgvt LOCATION Stroet:��/Z�A /r!/� Tow n:,,L0A1%li- ­501'-' County:-e/) /--1 .Stafo: _ Z ;k. SUBDIVISION: o�B TJS2 Map: .,(Ix,) — 7-- Block:. _ _ LOT Ns 2 Buwl'der :�f/Z/N�� - - -- - - -- y- Survayar: Drawn: �, pq,. Date: /O _31_Pj Scalei /! -3O� J s JOHN H. PR ENTISS tE. �r CONSULTING ENGINEER `�"''"'t'%�°'T`'i'�. 4 y r R+, e✓ t'q 3 x S � , i `^� � ,y^ ` u i;+ p na +i! ' c t t '. t �.�•< v -}r y jt�t �' ° 1e f `��.t � L, ,+�''"t4 �i� t1'+ •� � tkY�� yS titr�y,ak }aTuta F p yfro ��, y ', + +, � `shy ki '` 4 T x.,a•,,,,f{j,,i }, .y x xy - t :., +� PM" COUNTYDEPARTMENT, OF IIEALTH t $ ;r , 3/86 DhAslon of Envlronmontal Health Servloee Carmel N Y 1051? r� tF 'E RT r to:Provlde permit a ' '� /' CEIFICATE OF COMPLIANCE 6 yrlb. do ':_ �'' , '>t a • 4i � Permit a RUCTION` PERMIT .FORSEWAGEiDISPOSALcSYSTEIIK F 1l iX 4,'�• . T Pat`t`erson Rutdand� Drive &Orient`• Place Town or vulage ' t F Putnam Lake 6308, 15 Incl _ 5 ° ; 4" 1 Satbdivielon Namei ;. cubd Lot a Tax Map Block f Renewal ^❑ Revision Q A r 'James` Sprague ;Owner /Applicant 1Vsime , Date of Prevloae'Appreval Gage Road Brewster, NY 10509 ` Ad, :'Ma11)ng dreae . Town Zip ' Modula`r 2 -A1cre "'Ballding? Type Lot Area Fill Section 0 ob :berth �--- 'volume.} °' 4 't P t,Three '6000 "G PCHDNotl0cat1onlaR alredWhenFllllsirnm leted P Namber'of Bedrooms Design Flow /P /D o4 Separate Sewe rag ei System .to cons let o[Q�Q_Gdllon Septic Taoh and 144: Tr i - G a l l e r i e s t _! To be` conatracted by Addtase i Water S 3 ^'Pdbllc Supply From + Address _p J e 9 X a ors? y.lvate SaPP�Y Drilled by, s�dreee ;t fi r , one,, + Otber}Regalremepte � t. .l represent thabl ;am wholly ,anO;completely,riei0ons°til@ fbi the design and location of ;the. proposed systerh(s), 'I).;-,t hat the. -separate ,sewage. tlisposal system above descrrlietl will be constructegas�shown;on the'approved. amendment there toUantl irtaccordanc i with the standards, rules an regq a Ons o e u nam L;. County ?r Department of Heslth gntl that on com'plebon thereof a CerEltFCate .of Construction Compliance:' satisfactory t0 th'e Commissionarbf Health will he ' "f h fr„ cesso►s, heirs or.assigns by the builder that said;bullde►,w I r{ place �ri +ttoodYOperabO9`'conolionaan a w rtofT,aid rSewa eWtlisbosal s lstem,durinW the'period�;of:Cwo: 2 yearsJmmediaiely , follow.hp the data, of the,issu 4r� g ;: s,•.. y part, ;, �,. ,:;,i �y. i,9.,. .z p w > -...: ,: .y , v..t,,._. 9 s•. s -:,. C1 ance'o /` the approval ci lthe CertFticate of: Construction;,COmplianca of the ougmal• system or.any repair therafo; "2),that•the tlrilled well described above •: J, 1 will beaocated as`shownyon the approved plan aril that rsard well W'. rJl be installetl n accordance with'Tthe s'i ` aids :rules and 'regu as ons ;01".-the Putnam i� y: County DepartmentOf Health y a c 1 'ri�.'a4Dat8 -r `3 November T198�6 'rR r c 1..':5rgned,�' { �. P.E X #7 29,296, RD Fair St, tw �9.PL�6 �9 reet i r I`�t 1 i1 ,.•!: •I• "SST i•k `>" . j + Address r d' a. F t, j .fir' i �- License No ...,, �,� ...i.+•,. � f t, :.: � .. ..., _ •. -;.. .�: ;;APPROVED FOR CONSTRUCTION Th+s approval axp+res' one year t ate issu unless ruction of the building has'been undertaken and is i +k Fi: u + s r ((UUw 'k, .. ovrocaple for cause r:may be amentled or' modified when "con idere - -ce`s •fly the mmissionei of'•, oalth.•- Ariy change�or altaration of conttructfon t , k T} •.r).f.J '+S f -' d, , . •1" +Y.:� 1 (+ regwies a new p mil rovetl for deposal of Qomestic saint s ge aritl /or $r' at t y , SDate ° gy Title y m +a Y: E. .Yes k` ,s i� „rkhr. -a, . .;r lOwy F�. -,::c w "� .. xy w... ;y ux ..qn' -x fi •: ° t � H.. : a hM� art ;8' P[TPNAM COUN'T'Y DEPAR'IlMENr OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WNTER SUPPLY & SUBSURFACE SZQGE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT DATE REVIEWED_: J% 6 7_5�1./7ws -.5 17112 i el BY: (Name of Owner) (Street Location) DOCU MEM Permit Application Corporate Resolution. Plans - Three sets.- Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results 30" Perc Hole Other s/s SUBDIVISION Perc -z o (3) Fill — cd s— — ,House Plans - Two sets If PWS - Letter /well appl. Variance Request REQUIRED _DETAILS ON PLANS Sewage System Plan - Sewage System Hydraulic Profile - Gravity Flow Bill Profile & Dimensions - Volume. ZD r J Box;Trench /Gallery; Pump pit details ptic Tank - Size, Detail Well Detail, Service Line if over. Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage-& Expansion Area Expansion Area;shown;gravity flow,suff. size If Pm ped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Property Located 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 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake Unc. expan) 15' to Drains- C�tain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fran Foundation 50' to Well 15' Well to PL GENERAL 1 Subdivision .,,Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same �,IIIIIIIIIIIIIIIIIIIN F c” trench provided j1. _. ired _ .0 f t. max. I %� Val Val ,W:a111111M J LOW - " MR' - MU rnmm DOCU MEM Permit Application Corporate Resolution. Plans - Three sets.- Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results 30" Perc Hole Other s/s SUBDIVISION Perc -z o (3) Fill — cd s— — ,House Plans - Two sets If PWS - Letter /well appl. Variance Request REQUIRED _DETAILS ON PLANS Sewage System Plan - Sewage System Hydraulic Profile - Gravity Flow Bill Profile & Dimensions - Volume. ZD r J Box;Trench /Gallery; Pump pit details ptic Tank - Size, Detail Well Detail, Service Line if over. Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage-& Expansion Area Expansion Area;shown;gravity flow,suff. size If Pm ped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Property Located 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 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake Unc. expan) 15' to Drains- C�tain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fran Foundation 50' to Well 15' Well to PL GENERAL 1 Subdivision .,,Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same DEPARTMENT OF HEALTH Division of Environmental.Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 'APPLICATION TO CONSTRUCT'A_- VATER-WELL - PCHD PERMIT # ° 1 WELL LOCATION Street Address Town/Village/City Tax Grid Number Rutland Road & Orient Place T. Patterson 57 -4 -23 24 WELL OWNER Name James Sprague Address Gage Road, Brewster NY 10509 WPrivate O Public USE OF WELL 1 - primary 2 - secondary (TRESIDENTIAL (3 BUSINESS 0 INDUSTRIAL OPUBLIC SUPPLY OAIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION U INSTITUTIONAL ❑ STAND -BY OABANDONED O OTHER (specify, .O AMOUNT OF USE YIELD. SOUGHT Five gpm /# PEOPLE SERVED 6 /EST. OF DAILY USAGE_325__gal REASON FOR DRILLING NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL O TEST OBSERVATION 'DETAILED REASON FOR DRILLING 3 Bedroom Residence WELL TYPE DRILLED DRIVEN 0DUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? 7YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Putnam Lake Lot No. 6308- 15'Tncr1»sive ;WATER WELL CONTRACTOR: Name P.F. Beal & Sons, Inc. Address:Rte. 6. Brewster- NY 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 PROVIDED(By John H.Pgrelliss, P•$•S.0.2369) ON REAR OF THIS APPLICATION SEPARATE S T 6 November 1986 (date) (sig atu ) <n PERMIT ' nr^ TO CONSTRUCT A WATER WELL C3 Q This permit to construct one water well as set forth abo`�ie is� —qpnted under the provisions of Subpart 5 -2 of Part 5 of the New York Stale Sani,.;t' y Code, and provided that within thirty (30) days of the completio6 -V watdrn well construction, the applicant shall: W .T 1. Pump the well until the water is clear. '> 2. Disinfect the well in accordance with the regU4Tementj of the Putnam County Health Department attached to this per it. 3. Submit a Well Completion Report on a form pr' ided by the Putnam County Health Department. Date of Issue: Maz", ,/:, 19 Date of Expiration:/?/ U/2 19 V /Xrmlsuing ffi is Permit is Non - Transferrable 8/86 � e PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL.HEALTH SERVICES ,"COUNTY OFFICE BUILDING, CARMEL, N Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner. j Address 4�cCNetr , Located at (Street Sec . TH h7- Block Lot l � �3 v¢ J �Tnd'icate neares cross street) � � Letk� Sy�� L& e6 , 3 t 6 Municipality. �q.�p, Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION apse ..Depth-to Water Water ve . No. Time From Ground Surface in Inches. Soil. Rate Start -Stop 'Min. Start Stop Drop in Min. /in drop Inches Inches Inches 2 �O 4 Notes: 1) Tegts to be repeated at same depth until approximatelyy 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. TEST PIT DATA REQUIRED TO BE,SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS IENCOUNTERED IN.TEST HOLES DEPTH HOLE NO. HOLE NO. 2 G.L. 6" 12" " r 24" Soft-# o! 36" 42" .48" 54" 60" 66" 72" 78" INDICATE LEVEL AT WHICH GROUND WATER IS.ENCOUNTERED INDICATE LEVEL TO WHICH _WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BYE"' Date DESIGN. Soil Rate Used 8 -10 Min/.1 "Drop: S.D. Usable Area Provided 33D4' Ik1 No . of Bedrooms Septic Tank Capacity (b b v Gals. Type M u Sa m Absorption Area Provided By. L.F.x24" Z= 'trench. ►T1_ _II r' r Name i.gna ure, JOHN H. PRENTISS. P.E. Address RD9 FAIR ST 914- 878 -6170 f w °� .; {: `• v . THIS SPACE FOR USE BY .HEALTH DEPART14ENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by_ No. 6 29'Q� j�r`3� 0F1HE S to *4 Do"l ' Kam• �i 0�ole Ih(u /�.� Inlet I slpg u VIEW -I [-So afr4und unAOr r+at r •I `z• vc rf-edge �'•r av �znmw .rmr - •o j OLAN;, ,. I mom-• ^.� a•l (( LOW PROFILE GALLERIES e � '.� '� Fy � 1 SE'M , ,• . d 1. .-•j�, IMef .. IBS /rra M y. 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