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HomeMy WebLinkAbout1442DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -2 -29 BOX 13 01442 .. 19', VIE"' ' r -t� IN ' IN di � � IN r !C �,.' �, L 1� t ' ,y ' : N f IN ;�I- r 01442 Malt Address.. a a . Rc it • T- �- n "•1 urmt A u nArT%rry "WD A DTnRFNT. nF UW A•T 9!R zip poi 60 Permit leaned l Separate Sewerage System built by OR 106V A 1 ; 0 JU nk. 4 e-7 z/J Address � �►�l F �T Consisting of Gallon Sep dc Tank and Water Supply: Public Supply FYom ' Address " orr Private Supply Drilled by B F L Address 484 E LJ 3 r, i a6 Baildin %� 0 0 0 F"s� /y7 Hai ioalon Control Been Completed?' 9, Type Number of Bedrooms —+ Has Garb a Grinder Been Installed? Other Requirements I. I certify that the system (a), as.: listed serving the above premases were construct a entiall�eg "nSr� pig, s of icompleted work ( copies of which; are attached), and in aocordarnce with'the standarda, rules and r' ulat n acco th t n, d' a permit issued by the Putnam County Department Of Health. 1 Oats /Q f Ce►tifled by 'R.A. Atldress �, t. No Q `f'O G �d ::. ondittoesisnresultinyi. omewseh usageetl bAPPro a/ off the sespar� e'sawerageiiyst shill ti corns nu' I a dY� rad<+ n l: section, y any unsanitary omen c 9. �3 °a b'.: sanitary wvini becomes avallatile and 'the approval of the' Dri4ate water wDPly shall become.'nult and:, void when a' publk "water - ' `ty�� � alNbla. Such app[ovaU are subject to modification' or change when; In the uIdgment. of the'.Commltsioner- of Halth, n on or. change is necespiy, Title Cate in WELL COMPLETION REPORT office Use Only DEPARTMENT OF HEALTH �Divis ion Of Envirorimeiital•• •Hea2'gh` Serv'"iCes-�'" - " - PTPPNAM COUNTY DEPARTMENT OF HEALTH iTREET ADDRESS: WN1 I TAX GRIO NUMBER: DELL LOCATION Windscr Oaks Carmel NY Lot #1 NAME: % /�%/G� /v��CJ�/� ADDRESS: Joe Mirra O PRIVATE WELL OWNER Crompond Contracting Cor • Box 4 1 Crom and NY O PUBLIC USE`OF WELL ® RESIDENTIAL 0 PUBLIC SUPPLY O AIR /COND. /HEAT PUMP 0 ABANDONED 1 - primary 0 BUSINESS ❑ FARM O TEST /OBSERVATION ❑ OTHER (specify) 2 - secondary O INOUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ ,MOUNT OF USE ti YIELD SOUGHT gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR REPLACE EXISTING SUPPLY ®TEST /OBSERVATION []ADDITIONAL SUPPLY DRILLING ®NE []DEEPEN SUPPLY (NEW DWELLING) DEEPEN EXISTING WELL----, DEPTH DATA WELL DEPTH 560' ft. STATIC WATER LEV i 2 �! it. E MEASURED DRILLING 0 ROTARY ID COMPRESSED AIR PERCUSSIO DUG EQUIPMENT ❑ WELL P0II4T 0 CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED O OPEN END CASING El OPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH — ERIALS: El STEEL ❑ PLASTIC O OTHER CASING LENGTH BELOW GRADE 30 ft. INTS: O WELDED ® THREADED O OTHER DETAILS DIAMETER 6 in. EAL: ® CEMENT GROUT ❑ BENTONITE ❑ OTHER WEIGHT PEA FOOT 19 Ib. /ft. HOE:1isl YES ❑ NO I LINER: OYES ONO DIAMETER (in) 'SLOT SIZE LENGTH (it) DEPTH TO SCREEN (It) DEVELOPED? SCREEN DETAILS FIRST o YES ONO . _ SECOND:._... _ _ ......_..: _ ._.._._._._. HOURS ..._... GRAVEL PACK ❑ YES GRAVEL DIAMETER TOP BOTTOM ❑ NO SIZE: OF PACK in. DEPTH tt. DEPTH ft. WELL YIELD TEST ' If detailed pumping 'WELL LOG It more detailed formation descriptions or sieve analyses are available, please attach. METHOD: ❑ PUMPED 10 COMPRESSED AIR i tests were done is in- , ! ormation attached? DEPTH FROM SURFACF. Water Bear- Well Oia' ❑ BAILED ❑ OTHER - O YES ONO ft It i; meter FORMATION DESCRIPTION poE WELL DEPTH DURATION DRAWDOWN YIELD Surface 15 D ill . ng in overburden clay & boul er It. hr. min. It. gpm. 560''_ 6 500' 5 15 31 �D ill'n in rock set casin grout d. 7- , WATER O CLEAR TEMP. _ QUALITY O CLOUDY HARDNESS _ O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO PUMP INFORMATION TYPE submercihl e- CAPP,CITY r MAKER Gould VEPTH 52Q� MODEL 5ES 10 412 VOLTAG12 30 HP 1 STORAGE TANK: TYPEWellXtrol 2510 CAPACITY 44 GA>s,. _A WELLDRILLEANAME P.F. Beal & Sons c 0/18/93. ADDRESS 4 Putnam Ave. SIGNATURE Brewster, NY 10509 PUTNAM COUNTY DEPARnfflT OF HEALTH :..... _- _ .. _ . _ -.. ........ .. DIVISION.. OF_ ENV!RONM=A—L.- -HEALTH- -SERVICES l 3 `( Z 2-c Owner or Purchases of Building Section Block Lot c a--ni S' 1uilding Construct ed by /Y' i Location - Street Municipality r"t I -' �. Building fi k' Subdivision Name I Subdivision Lot # GUARAN= 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 Environmental 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 G 19 �� / rev. 9/85 mk Signature =� L Title 71�x7� 7 Corporation Name (if Corp.) Address -- - BREWSTER LABORATORIES Box 224 - BREWSTER, N.V. (914) 279 -4945 . SAMPLE NO. 8 705 TEST WELL SOURCE: Grompond Contracting Windsor Oaks Lot #1 Carmel, NY COLLECTED: 10/8/93 BY: P.. F. Beal--&-Sons BACTERIOLOGICAL. EXAMINATION Coliform Count, MF Method 0 per 100 ml. 10/11/93 This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. r-� lu qj 0,)'0 4 0 C C; r W :5 u U > 00 � 0 0 U -H :Z Zr ro o W V) 14 0 u u 4j tn I 8 9 tc) 10 41 -4 W 0 Q) c 'C 00 tn 4 4J ro 44 3: o N n v In `0 n CD D. 121 Im U Z5 Ln 2 j NU- am) Q) LQ 4) Ul C: 4j C: ra 4j Fj Ln —4 Q) 41 LU tl 7 A Sr 43 0 N!, p Qr 0 C� 4� §, @ U. . 1 0- LIJ �j 0 0 a .-I V) f Qt u >1 w ul v, a lu 0 4.1 L4- El y01 N U1 UI 0 4J 4J U) tn Z) 0 'Z �> <D � W. - e9e --------------- co Iq = J -.1 ul tn Z OIL 11 10. %n W r, MnJ W (n 0 X CE) C.Q (Y) Q CC) '40 lu qj 0,)'0 4 0 C C; r W :5 u U > 00 � 0 0 U -H :Z Zr ro o W V) 14 0 u u 4j tn I 8 9 tc) 10 41 -4 W 0 Q) c 'C 00 tn 4 4J ro 44 3: o N n v In `0 n CD D. 121 Im U Z5 Ln 2 j NU- am) Q) LQ 4) Ul C: 4j C: ra 4j Fj Ln —4 Q) 41 LU tl 7 A Sr 43 0 N!, p Qr 0 C� 4� §, @ U. . 1 0- LIJ �j 0 0 a .-I V) f Qt u >1 w ul v, a lu 0 4.1 L4- El y01 N U1 UI 0 4J 4J U) tn Z) 0 'Z �> <D � W. - e9e --------------- co Iq = J -.1 ul tn Z OIL 11 10. %n W r, MnJ _. �z N,, ql,.q �-•s-^sw� -s.- Q� IQII�iAM OODMY DSPA.OF HEALTH V . Dh1uM� •[ l�ti •uea�tal Ham S•evloa•. Caul. N.Y low � 4 i iw ids Friat i ii_-I Y U r—:A w CiH1Ca► 18 O ah ''I liusumON P >r0>t sNWAu DwosAC SYSTEYi stivlsM� TsP Ontaay /A�t'a�t Ntar 1, _ r= x%37/ /F!A//! [ o/! l ylCl lte°°wnl_ ssrid•n Dab of Pmvk= Approval Town ZIP Date. Subdivision Approved Fee Enclosed Afmn„nt Lot Aran ©r / Fm Sectlon 0* V611111100 . , , Nta•b•r a[ Heiown De•ipit Flow G P D Z J90 PCHD Nodbaden b Yegwmd WhM ltasaapistetl .�'� s.�a.a S..«s• S,a. to e..d.t.e' a�° (ie0o. st+plle T.nt Y � L � otaia�eitid Addtaa• Weser St+l4U.: Pills ' Fsota Ad&*= del `✓y.1"A' Stapp DdBed M Other i represent that I am. whoI,ly and cornpiataly responsible for tha dtsipe•and location of the proposed tystem(s)• , atttl,... •parat• Sawa ti air ose1 s stem above despi0•d will be oonstraicted of shown Ma a0proved &mandm•nt then to and in accordance with t �� rpu a an, o, • na county O•paitlrl•nt Of FN•nh, and that on completion thaeot a "Certificate of Construction Compile mniis"ner of ""Ithwill bra wOmlttW ;tO tM ,0.•parttfiint and a writN ee n guarant will be furnished: the owner, his sues s ase that said builder will plat• iA go00 Operetitlg condition any part of Mkl aawage dispesal system during the permM t irnm•di (at the date of the IM. an" of tM approaral• of the, Cirtifieati. of Construction Compliance of tna priginal. system or an Ito,. that d well described a6- w"M M IoeatoA as shurrw on thi• app►arod plan snA thet,sakt well will M InstalNd a risen with .v ti lards;= .ru1., and , of tM Putnam county tiwrt of,'Mianq., , Doti Sinned. ' c e :et E. R.A. aadrest APPROVEOF OR CONSTRUCTION: This approval e,.o ias two years from "a date issued unless co trust , n ry the �Qli hash en undertaken and is niiDo for cause or :' y a am•ndee or modified who eonsidMsiA eKesYsY by .th Commissi0 9%ns4.Q ��' ration of construction requires perm Approw0 for 1iW- o'"I of.doanestle sanitary sewage, / Iva water su Rev. ,� _.� /q�'_ F NE'21 -- - - - - -- 10/88 at. _____� Br - - -- - - - -- - _..- - - -- -- a] DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO-CONSTRUCT A WATER WELL P RMIT WELL..LOCATION StF�et Address Town Village City Tax Grid Numb r /j`7 v P C /% /�P �d WELL OWNER Nam4f Mai] . ng. Ad ress CWflyate D Public USE OF WELL 1 - primary 2 - secondary CWtMIDENTIAL ❑ PUBLIC SUPPLY 0 BUSINESS O FARM Cl INDUSTRIAL d INSTITUTIONAL O AIR /COND /HEAT PUMP O ABANDONED O TEST /OBSERVATION ❑ OTHER (specify, O STAND -BY O AMOUNT OF USE YIELD SOUGHT -f"— gpm /l6 PEOPLE SERVED I/ /EST. OF DAILY USAGE C2 Sal ® RPLACE EXISTING SUPPLY 13 TEST /OBSERVATION 12-ADDITIONAL SUPPLY MIE-W SUPPLY NEW DWELLING) 0 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE ILLED DRIVEN DUG GRAVEL. OTHER IS WELL SITE SUBJECT TO FLOODING? YES _4�E- NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Fp /, _/f'• Lot No. WATER WELL CONTRACTOR: Name tv Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY -,..-,..DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: _.. E 011' LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED OON SEPARATE SHEET ( at d 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 such a man er as not to degrade or otherwise contamin a surface or groundwater. Date of Issue: Date of Expi ion 19 % Permit Issuing Offi ial Permit is Non - Transferrable White copy: HD File Pink o . Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller PURPAM COUNTY DEPARTMENT OF DIVISION OF •• •' ' 1N Y• HEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE SE_W/ M DDISPOSAL SYSTEM FILE NO. Owner �`!/� L Gh7i'o�T�is G Address Located at (Street) Sec. Block Lot / (indicate nearedt cross street) Municipality �l ✓vim+ Watershed SOIL PERCOLATION TEST DATA RD unw TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking 7 y Date of Percolation Test HOLE 2.0 21 NUMBER CI,OC3Z TIME PE RCOLAMON 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 ?•'ad 7. >d 3 49 l 2.0 21 2 2-X 4?'d 0 3,9 3 AW d: 31 30 V 4 5 1 2 3 4 5 1 2 3 4 5 NOTE'S: 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 HOLE . NO. HOLE G.L. 21 31 41 51 61 71 81 91 10, 12' 13' 1V 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 Min 1" Drop: S.D. Usable Area Provided No. of Bedrooms J Septic Tank Capacity IQ9 gals. Absorption Area Provided By CfC/ L.F. x 24" width trench Other Name Signatufo S Address SE4� Y. *fosv THIS SPACE FOR USE, BY HEALTH DEPARTMENT ONLY: of Soil Rate Approved sq.ft/gal. Checked by Date PUrNAM COUN'T'Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONME= HEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE S]� DLISPOSL SYSTEM FILE IAA., Owner &p u� r� �Gf7f�4�Ti Address /e d a "L / 6r� Tom ., �/�1'�� Located at (Street) Sec. Block Lot (indi to nearest cross street) J!A4 / Municipality Watershed �. • ■ • �1' �• �' Yom.. �' Y• ' 8• /• �� � / �� ... �, Date of Pre- Soaking Date of Percolation Test HOLE NUMBER CLOCK TIME PERCOLATIOIJ PERCOLATION Run Elapse Depth to Water Fran 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 4 E 1 2 3 4 5 1 2 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.: G.L. it 2' 3' 4' 5' 6' 7' 8' 9' 10' 11' 12' 13' HOLE 'NO. HOLE NO• _ a Pilo INDICATE LEVEL, TO 1.MCH DATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used � � 1Q Min /1" Drop: S.D. Usable Area Provided ;"C&I No. of Bedrooms 3. Septic Tank Capacity ��� gals. Type oGlC. Absorption Area Provided By i�Y(> L.F. x 24" width trench Other ,y....'17 Name Signature ` ;` 4q "I IL P Address N. Y. � n SEAL THIS SPACE FOR USE BY HEALTH DEPARTMT ONLY:'v..' .Soil Rate Approved sq.ft /gal. Checked by Date