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HomeMy WebLinkAbout1443DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -2 -30 BOX 13 01443 a- 6 f ,.0 E .� 01443 7 7 PUTNAM COUNTY DEPARTMENT OF HEALTH RQV. 31,q6: Division of to ektal Healt1h Services, C"eli ]N.Y 10512 E'&OrM t Piovid .0 e _-66'�-89 P.C.H.D. Permit Locat, 7EM T.; P&.t,t -son.-. _pT Town ,oi-Vll1a­i` Village Tax MAP 7 7 Block 1 Lot 19 Owrier/appitcant Name -Ed'wa!7d -M6Glasson Formerly Subdivision Namie Subdv., Let # Melling Address. High -View Drive, Patterson, NY Zip 12563 Date Pennit Issued '.5/19/89 Repair sepsretesew * 9 _'0ysibM,bu11 Consisting of Address—Saine. as above Gallon Septic Tank and 200 lin.ft.,of 2' wide trenches Water Sqpilly:.. 7- fthil.c., Supply From Address .. ors 2r[Vite,Supply Drilled by .'exi s t ing . --Address Bau dins. Type . Ex j in g fitle s Ao u ar ous e Erosion Control Bekironolete As required Number of- Bedrooms Two Has Garbage GrinderBeen Installed? No e Other *q on 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' attache"d)',,,:anid.'in accordance' wi:th the siandirds- rules and ri4ulations, in accordance kith the'file.d plan, and the permit issued by the Putnam County bjpa�i nt'Of Health" Date 5 June 1589, Certified by 2V P.E. X R.A; :t a- t/ 105 1'2 Address RbSI-Fair d 1 1 N.Y. License No. 29206 t A . ny person occupyjng'piemlses served by the above system(s) shall. promptly,., sk. such action as May be'necesury, to secure the correction of any unsanitary conditions resulting from such usage. 'Apprpval of• the'separate, sewerage system -Shali become null and void as soon as a pub(': unitary sower becomes available and the approval'of the private . water supply , ishall beciorrid-nUll and void when a public water supply kacornes available. Such approvals are dg IN such—revocation, modification o sublect to modification. or change when, In Mont of tho'Commissioner of salt r change Is necessary. oat Title Py Y % V a N: *V eet t0 ititmw COUNTY '0F HEALTH "�',?Y, TiOn om MPLNCE- 161MCATE"OkPo U F 77 T", PfINSTRUMON PERMIT SEWAGE 7 W HIgh vi 7T - Town or 'jjU pifi6e Tgfx lkfi� dek, 40"! 0 Bloch n - lie& of Pevione Approval " Ad, High t - 9 ' ns;.". View r ADrive T,0 d,i" o er Date A cio§, d �Ppr.ove Fee Eh S' g.,a o. Lot Area _xS 'a Ap Bullft 9 Tyile FiU;S"n Depth 4 0`0 , , r . : z FCMN6 Sli. Nousswir o 6;�i'Gl D Is!Regnired Rhen Fill le completed 58 Sowo- YOM 10 Ching of To be oone�aoted by Owner -A P'Ob ddiin Wilei'su x, or Sign and -,System(s);' 1) 'Saw fsgiosil� system I i!�!e for:16 , J�jCa�tio� 04 the ptoposed" "v the. a, Ztiod', 66 ,!n accor a I r�( U .159,77 above aiscriiiiis,'w-iii be io;ni66 �4 qi " o a��d­ d :e'with the standards, rules m _On'Ahe ip0ro4Gd1!ATj!r',' T�T' !Td"t a Putna 6mPIl'n"',"'sist1ifact*dry: to" the: COni alcir" ��Cj!!ific� 6 ,Construction p f 'P!!'�EPTP a f:' County' Department I.". -6:.the M . apartment-ana �.s, %Wiittin;.Otiaiint66,-Wilf,.b67�!urnish�14' the, successors, heirs"or, assigns: 16� y thekiqfl Is er"*11 be _si�binitfiid,t 9wher. Is P ce in good ppi the 6d 0 two (2) years irnihad4teli-follow' �t 0i"i6s' issu- ance of well !"de i above the:,ppproval of Ftno Certificate of ConstrucGOn Compliance of tha:originaf system of any ropairs thereto; 2) thaftfi ®itlrilled will be- )owted_as shown on the approved Aan%and that ' said well ni a I in c or once wi t h the 4n ards . rules and . .:,regu a s i oi` ` i" Ouinam County OeDartment of 171-Ith . ounty 19 8 - 9 oats May �P.E �z_ Y ;"7 f05,12'., S ddi - ' - - r -1.1 , - . .. 29206" A re License No APPROVED FOR CONSTRUCTION is ij;pro4ar' lie. oate . issuid'uniiiss'construction r of, the building has been undertikeri,aind is I I I - -- "'.. : " ad 1-11-6 .1th I I." , , revocable fo'r"cause ",'or may Wvlimah i"W&lf I n'corIsI!�T'!! C ealth'. or lor In 'wpe considered y, e;, o rmffl'usi6nir ��oi`k 'Any.''change or alterailon'iif construction ... .... . .. requires a'new''Oermit. A sqosal:o domestic sanitary , me dLq;_vrs Rev. .pprov, t t supply only. !a 1/87 bate it is PUTNAM COUN'T'Y DEPARTIMENr OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES a .I.OVJr Edward McGlasson 77 > 19 Owner or Purchaser of Building Section Black Lot Owner Building Constructed by High View Drive Location - Street T. Patterson Municipality Modular Building Type Subdivision Name Subdivision Lot # . GUARANME OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the locatign, workmanship, material, construction and drainage of the sewage dispgsgl, § §tM serving the above described property, and that it has kieen constructed as shpwn 0 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 .r-epai-rs..made by-me -to_ such- system;• except where-the - failure --to oper -ate roperl ,-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 Putiia- ` co' n y Department of Health as to whether or not the failure of the n .to operate caused by the willful or negligent act of the. occupant 7,7*� di g* utilizing the system. /v/.. Dated this 5 day of June 1989 Signature General Contractor (Owner) - Signature Corporation Name (if Corp.1 Address " I. rev. 9/85 Title Q W V e-f-7,�-, Corporation Name (it Corp.) jjigb View Drive" Patterson NY 1.2.'6 ess 12563 PUTNAM COUNTY DEPARTMENT OF HEALTH .: ..' .. DIVISION "'OF "Ei3VIRONMENTAL HEALTH °SERVICES Date 13 March 1989 Re • Property of Dolores & Edward McGlasson Located at High View Drive (T) Patterson Section 77 Block 1 Lot 19 Subdivision of Subdv. Lot # Filed Map # Date Gentlemen: This letter is to authorize John H. Prentiss a duly licensed professional engineer X or registered architect' (Indicate to.apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the'Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in - connection -with this rrrabter and- to 'supervise the - construction of: said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the - Putnam County SeIRI= to Address jN" R, PIRTISS. P.E. 00 FA R IT 514 - 878 -617() CMM. late TORK 10512 Telephone Very truly % .x G Owner of.Property High View Drive Address Patterson, NY 12563 Town 914 - 225 -1242 Telephone /• •• �1w1w b oD • 0' • •' t• 7 10-50 V 0; 13,3114 54• •off. S&gAGE- DISPOSAL_. SYSTM ...r - E .E. -IAA. - - -- -- C caner fix' vca� Address Located at (Street) - Lj . ( Ile.+ 2-c1 Sec.. Block _� Lot (andicate nearest cross street) Municipaiity (- ` ' �� 1J Watershed Cm-1—zf)0- SOIL PERCOLATION TEST DATA RBQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre - Soaking g Date of Percolation Test y► '` HOLE NUMBER CLACK TIME P 1COLATION 5 /v /,3 •- to 16 PERCOLATION Run Elapse Depth to Water Fran Water Level No. Tine Ground Surface In.Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches.. Inches`. Inches 1 1� � ►n� � � �'b 9`� � .� 2 )003 - /C) F7 4 23 4 /010 5 /v /,3 •- to 16 _ ........ l josc, -- 10 3 31037 -10'11 �/ 9e 4 516f/S" /U��� 1 2 .4 NOTES: 1. Tests to be repeated at;sam'�.depth until approximately equal soil rates are obtained at- :each- petcolation test hole. All data to* be sukmittbd 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 _....._ DFPTH...,.- :HOLE. G. L. n `,� t i S 2° 3° 4° 5° 6° 7° 8� 9° 10° 11° C ►ACT- I (D -riD 1-� l '3 0 U -. 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED 9.1 INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED - 7 Ca L) DEEP HOLE OBSERVATIONS MADE BY:� rr� Ir= �- ' �' DATE: Ao DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided 15& oo, -t- No. of Bedrooms Septic Tank Capacity j 6CX, _gals. Type �► � �? y Absorption Area Prcvided By - .F. x 24" width trench Dc io qt , C, Other y s CC tCks — s�ti ;v Name JOHN N._PR;:NTISS, P.E. CARMEL. NE'd YORK 10512 Address No, 29 20�O �,�a, ca SPACE FOR USE BY HEALTH DEPAR2MU ONLY:' Soil Rate Approved sq.ft /gal. Checked by Date wLlJL UUr1rLL11VN r%Lrual DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET AD RESS: WNW I TAX GRIO NUMSE&- P19 77 7 eo WELL OWNER NAME. • ADDRESS: �� A FMS �L,/,e /L„�_ pSIVATE /lil GL -ASSO Al 84btf5 G�2t�7V h� /L� D2. N /�S� O PUBLIC USE OF WELL 1- primary 2 - secondary Ak RESIDENTIAL '❑ PUBLIC SUPPLY O AIR %COND. /HEAT PUMP O ABANDONED ❑ BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY O MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED �_/ EST. OF DAILY USAGE gal. REASON FOR DRILLING ;(NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH ft. I STATIC. WATER LEVEL _= ft. I DATE MEASURED /D DRILLING EQUIPMENT O ROTARY 19 COMPRESSED AIR PERCUSSION O DUG O WELL POINT ❑ CABLE PERCUSSION 0 OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING, OOPEN HOLE IN BEDROCK O OTHER CASING DETAILS. TOTAL LENGTH 31 ft. MATERIALS: WSTEEL O PLASTIC O OTHER LENGTH.BELOW GRADE 3O % JOINTS: 0WELDED, ($THREADED C]OTHER DIAMETER in. SEAL: MEMENT GROUT O BENTONITE OOTHER WEIGHT PER FOOT Ib. /ft. DRIVE SHOE C kfES O NO I LINER :OYES PO SCREEN BE-TAILS DIAMETER (In) . SLOT SIZE LENGTH (Iq DEPTH TO SCREEN (ft) DMOM FIRST _...... _ _ am oao - HOURS SECOND GRAVEL PACK O YES - O NO GRAVEL DIAMETER SIZE OF PACK __._, In. TOP DEPTH fL BOTTOM DEPTH - R WELL YIELD TES? ht detailed pumping METHOD: O PUMPED tests were done is in- MPRESSEO AIR r formation attached? O BAILED O OTHER O -YES O NO WELL LOG it more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear. ing Well Dia• meter FORMATION DESCRIPr10N COOS. n, 1L WELL OEM R. DURATION hr. min. ORAWDOWN h. YIELD gGm. SuAice �J p 0 D O ,L O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO NALYSIS ATTACHED? O YES O NO FMAKER O CLEAR TEMP. STORAGE TANK: TYPE CAPACITY GAL. NFORMATION CAPACITY DEPTH VOLTAGE HP, WE DRILLER NAME 6 /7 16 I.Q `A A �, pATE S / " 7 Oct' O� Qj I jiy /0 �� _ .._....._ .. P 71.11-44M-COUNTY HEALTH-- DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Cm missioner of Health —FIELD ACTIVITY REPORT - Sheet of INSPECTION NAME j � . �c" (�,Q� p'y\ Orig. Routine _ Orig. Canplain ADDRESS Orig. Request No. St eet(" Town IM No. Cmpliance. Canplaint Carp MAILING ADDRESS Final P.O. Box Post Office Zip Code' _ Group Illness Construction TELEPHONE PERSON IN CHARGE OR INTERVIEWED Name and Title DATE TYPE FACILITY TIME ARRIVED C� o FINDINGS: � i INSPECTOR: Signature and Title PERSON IN. CHARGE OR INTERVIEWED: I acknowledge this Field.Acts y Report. SIGNATURE: 6/86 TITLE: Reinspection — Field, Sampling Only Field Conference Other TELEPHONE: Explain 2.1 bare - eLr . I -�( I c_ P'anur -? s�i_ nct s`i=� r_ I t�.an 15' fraTt FDIAL SI'Z'E LISrFCZ'_ry Da��_ a_ S` :r_e , try= , e _c _ , cr_t =r Cs 1: G�/l✓� e: 100 ft_ f_a WE zer CrN7`Ilr'Z lit.' Oyl X(.( a /V Lq _ 1.000 1,2 50 `! 1 z 'U' p C 5 rrSIC:I Lrlr / 1 Cr _- C. !'� t IIli Il? TIiL -l1 =� 7 -CLLr == tiCri _ C c r./. d_ _l. �. Q ° rr c - �_�^.cL� Wl�'L' n 10 f �_ GT [i_ L...i O �G: --. i c- S---- DISIP: rJ P?F? I -4— ` e. L L- i L' r- .PTC'i MX _ t a S JS Z'-r- �.0 �� _�_ as r GT-i�%roved DIGT�� = Tatic . -_ We =ar ( _ _ b . f-? 1 s i cn - Dat =_ of piacnt (� I I ��7G Ci C_ t!'L-C 2.1 bare - eLr . I -�( I c_ P'anur -? s�i_ nct s`i=� r_ I t�.an 15' fraTt a_ S` :r_e , try= , e _c _ , cr_t =r e: 100 ft_ f_a WE zer I • ;�r= DISL-CSAL crc t-��nl _ 1.000 1,2 50 b. S r;ti c taric _- C. !'� t IIli Il? TIiL -l1 =� 7 -CLLr == tiCri _ C c r./. d_ _l. �. Q ° rr c - �_�^.cL� Wl�'L' n 10 f �_ GT [i_ L...i O �G: --. i c- I e. L L- i L' r- .PTC'i MX _ t 1 I = Tatic . -_ We =ar ( _ en tcx `_ -cces Svl! �^ =vc `T-G I i _ = Cr1CL -1 _ I I C_ t!'L-C tri 1c L Dist= ^_c =rc Wz ^ —T -rte_- rr ==_'�= _ ft_ Tmst- ` ir.ca c= ` = I I C. 10 1_ -� _ =-Tu GrC. _-v c 20 t = - I -- I < L-1c1� 0 - • ; . Lac -� c. `__ = - I ,fi' ( IkAluo 5 Rcca cr .►2P C Si Z G CT C� = -% C-_ S. r.�-rth C1 C -atJe— t� -u�..Z h_.ro• CR LOSE .STCdc I Size OL L= G:c:sc I I - P"-�• iD e=__ • + c____ -_�__ It'�G 01_ r- a t0 tcx 'c --_=� E _ C�TCi e to b _ b. area rr =Stir c_ C_-:nC 18" a"-,c C -ZaCE c- - `;...__`C° G_r= - _ GT.:L••: Wes! GCC = =:. =�^lc v._ cv_, c_ L.^Ye9 p,rcr_erIv C- -cUceO c_ ?_� pices f_ »��. wi.t_-1 L"� =_ce az: bc� ir. =t_ -e? ccr_ *n stcnes < 4• is e- C„--i; n c_�? _n i '_ acccrc.i rla to via _n ccL =1? crctec-t= & c? r. to c. i`ct'nC G' -c_'S atgav f-an EDS area -�\ h_ S dace Wat�� G_ct ..ca ade at- -i c,l SiC-Cas CC _ter t - Gie -rret_ _Wa 1_ %_ Rev. 3 8.6 PU17 s rLack , edit..Off Hi; Owner /applicant Name Hij Mailing Address - M COUNTY DEPARIM svhonmental Health Servi i View. Bit.' M/M-Edward Mcolass View'Di ve,, Patte Separate Sewerage System bnut by ' „Owner A dress consisting of 1000 Gallon Septic Tank.. and :C4� 8 x 6. :leaching Bits Water Supply: Public Supply From A In or. X Frigate Supply Drilled by Boyd Artesian wellAddreis Rte. 52 i Carmel N.Y. 10512 Frame Building Type Hae Erosion Control Been.Completed? As required - Number of Bedrooms Three Has {gage Grinder Been Installed? No Other Requirements None I certify that the syetam(s) is 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 Department OP, Health. " Date. _ 12 May . 1989 certified by P.e._X R.A. Address :1119 -Fair St. , Carm N.Y. 10512 License No. 29206 Any person' occupying premises served by the above Systems) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from' such usage. Approvsl of the separate sewerage system shall become null and void as soon as a pub is unitary tower becomes available, and the approval of the private water - supply shall become,null and void when a public water Supply becomes available. Such approvals are subject 'to inmodification or chaannge when, in the judgment of the 6ommissioner�pf- 'HH�e'i� ® such - revvocajtionn..m!o'dification or Change Is necessary. 'Date Q fY —( By � a%% TIt to 0 1". PUTNAM COUM RKLARMERr OF REALM Imffs-lao OF HEALTH SERVICES Edward McGlasson Owner or purcb, ser of Building , 7L Owner Building Constructed by High View Drive Location - Street 76 1 5 Section Block Lot Subdivision Nc-pp Patterson Municipality. Subdivision Lot # Frame --------------- Building Type G04FA-WEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM. I represent that I am wholly and I completely responsible for the loqition, - 1. workmanship, m.. aI teri;al , I construction and diainage of the 'sewage disposal skis .trl serving the a bove d escribed property, and that it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules it �j regulations of the Putnam County Department of Health, and P'. hereby guarantee to the owner, his successprs, heirs or assigns, to place in'go6d operating condition any part of said system constructed by me which fails to operate . for aperiol of two . years immediately following the date of approval of the "Certificate-of-Construction.,Compliance" for the seiage disposal system, or any properly is t. such s stem,: except- where .-the fai-lure" to-operate repairs ma :P- me . 6 y 1" ' 1 or negligent act Qf the occupant of Pd building qt+. iziPg .caused by the willful the system. The undersigned further agrees to accept as conclusive the determinatign pf the Director of f ' Division Environinental Health Services of the Pu nam _hE: D .1 n o ' ' to operate Vp� as to whether & not the fa"ilure of the system Department of Health negligent t caused by the willful or i 9 ent act of the occupant of of t.. ng' utilizing . 9 .. the system. Dated this 12 day of May 1989 c,enpral Contractor (Ow .ner) - Signature Corp. �ration Name Co Hi hg view Drive Patterson N.Y. 12563 Addr�5s_ Z tv. 9/85 . Stqnatqre 7 Title co, :)ration 19ame (if Co. P-1 Hi hhview Drive-, PatRbeSkLs L1�qYN­Y 1256 VF'e� SS a' PUTNAM COUNTY DEPARTMENT OF HEALTH Divlsio'n`of Environments 'l Health Services Carmel ,N': Y 10512 . .. .. , i CONSTRUCTION PERMIT FQF S6 E.-DISPOSAL SY$TEM Patter on Town or Village Located at Off H� ah View Dr, t Ti. Map # 76 Block subdivision High UI eW CrreS Tex: map Lot N 4snbd # ` owner MGM Edward MCC1 cZSc'nn . Ada ►ass Gl PqE] da AjIE Cargll -, NY :.. Building -Type Frame got �A�re/►a x,1;1[ 1 AC�"es Number 'of Bedrooms Thr _- Design Flow. � 1/1ItU -�u=- Total. Habitable Space 1 00 Square Feet Separate Sewerage System to , is of ._ _— _4UlW— Gal Septic Tank ,and 333 ft 2, ,trench /.(` ) (`' X )leaching pits To be•:confitructed bX __— Owner.-- __._ - -- Address water. SuppiY - -- Public Supply From Private SuPP1Y to be drilled : by ' Address Other Requirements ROB Fill Sectsonx `3800- Sq Ft (282 Cu' Ydc FI represent that I am wholly and�'oompletely responsible for the, design and location of. the proposed system(s)a' 1). that .the separate sewage.disposal system above described will be, constructed as'sfiown on ,the approved.attachaients hereto ,arid in accordance with the standards rules and regulations of the putnam.epunty Department Of .Health, and'.that on:oompletion thereof a "Certificate_of Construction,Compliance ".'satisfactory to the;Commission- er of Health will be subipitted'to the Department, and - ca.wiitten guarantee•wiil'be furnished the owner;' his successors,' heirs or assigns by the build er, that.sa. Builder „will place'an good operating condition any part of'said sewage disposal system'during. the period of two (2) years,,irt®ediitely foil owing the date of tkie.isstiance of the . apprdval -of the Certificate of Cdnstruction'Compliante ; of.the original system,or any r spa ira,theretoj 2) - that the dril)ed "wall deaoribed-above`will' be icc' ed'as showman the approved plan . and that said wel will be installed in accordance with the stag dards, rules and regulations of the Putriam•County Departiaent'Of- Health. �. Date . 2 1 `Noy .•' 78 Signed` E ` i . P. R.A'. Address_ RD Q` Fair License No, io2o6 APPROVED CONSTRUCTION: This approval expves, one year; from the date. ,,issued (finless construction of the building has been undertaken and is revocatile for cayse or may be' amended or'modifietl when:considered•necessay by atria Com loner -of Health. Any change or alteration of construction , ..• requires a •neW permit. Approved for disposal of:- domesticsani a age priv w.at r- onl Date /:� — 42 Z8 L BY.. Title Q1 PUTNAM COUNTY D NPARTMENT OIL' DIV:[STON. OF ENVIRONMENTAI, JR7!ALTJj',9ERvICRS . ' »coul m. FFICE BU31DING CARN[FI,, Xa; ��-- -. I 105, 12 i. SIPMT- SgpApa4T SL'tJAG9 DISPOS AA = F ...' 0 Omit, E ga Addreee oC�' ied 8°V (S x®e�l� ���-� p„� A. ��y��.y. � :gym Mock _ � . - yp6 St.• .. r nearest d osa ,•� x8•ddBbA.A4J.�L.d. **yy'' ®®o D9 Y•at r® (ray SOIL: TEST DATA REQUIRED TO BE SUBMIT.TED WITH ..- ber PERCOLATION y... . m .x app ! v� er a ,fix+ ve o® Mme Gm around Suit° ae In InBhee• s°•"tgQe�9p .r.A 1 ;i a%$afl°i p Drop f Iraeh®8 IncJa ®s. r; a • ' ' , L-7 .. - ..ti T,, ' repeater! at same de W until ox$ E�I " u: r-Ba g1� obtaixod r4t eaoh percgl§tlp n toot p � &t!i W for review 0 4�= oepo nioaeuramen o Q b® mod® top . 1p �a ; 1 • Lev +:!d.ti- !6.e.a '...::1.�••Y- ....... ,. .. r .. :'7'': 1' TEST PIT M'M APPL-I-CA'J'JON 01•1 ITOLIF:3 DEPTH HOLE NO. J HOLE'1VO. Jfou? NO. 611 1211 18 5'4V 2411 3011 6 36„ 4211 4811 5411 6011 66" 7211 7811 84 INDICATE I= AT Vh-LTICH GROM'D MATER IS EF4CCV1,-JTE1J-,C---') Nesp-e INDICATE =L TO WHICH WATER L�'VEL RISES AFTER PE-ING EWC0UNTERED /hoop #/tke 14Lh = TESTS MADE BYQt�(fi ,PU:-IJ.Ael AR AM -e,d-Le . soil 1� . a e li-S i�bro,p,-: S.D. Usable Area Provided Mead "0 f' No. of Bedrooms 77.,,-g! septic Tank Capacity. /00,0 Absorption•Area Gals. Type Lk to -Provided By— L.V.x24 -_p- width Trench. Other Address R.D. 9, Fair Street Carmel. NY 10512 -k THIS SPACE FOR USE BY h-EAMT1 DEPAR"I'ME,111T Soil Rate Approved Sq. Pt/Gal. 4 173 Date _v .t �, ��'W �j04 WELL COMYLb'11UN 1c -Lruml DEPARTMENT OF HEALTH - -- Environnental :Healrh. Service- PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only - STREET ADDRESS: WN�YtI I TAX GRIO NUM8ER: Iq % G-ir� i %. �� Z121 V'E WELL LOCATION WELL OWNER NAME: ADDRESS: j�r� �[� F c G_AS ,56 AI S ,� 7av i� v ', i` pBIVATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary ,<RESIDENTIAI- ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL 0, STAND -BY ❑ MOUNT OF USE YIELD SOUGHT zy gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal gal. REASON FOR DRILLING ;NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY 0. DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH S--00 ft. STATIC WATER LEVEL — �(,�ft. DATE MEASURED ` DRILLING EQUIPMENT ❑ ROTARY 1 COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION O OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. P<OPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH " L ft. MATERIALS: j(STEEL O PLASTIC O OTHER LENGTH.BELOW GRADE 3'0 fL JOINTS: 0WELDED (THREADED OOTHEq DIAMETER in. SEAL: =EMENT GROUT O BENTONITE POTHER WEIGHT PER FOOT 1b./ft. DRIVE SHOE: "LO NO LINER: ❑ YES gNO SCREEN _.:.- 1ETA+L- S - - - -- DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (it) DEVELOPED? FIRST - - OYES ONO HOURS - - -- -- -- - - -- SECOND GRAVEL PACK ❑ YES ❑ NO GRNIEL SIZE; . DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH h. WELL YIELD TEST ; If detailed pumping ' P METHOD: ❑ PUMPED 1 tests were done is in- OMPRESSED AIR ,formation attached? ❑ BAILED ❑ OTHER ; ❑ YE 3 O NO It more detailed formation descriptions or sieve analyses l�1FLL LOG are available, lease attach. DEPTH FROM SURFACE Water Bear. in9 Weli Dia- meter FORMATION DESCRIPTION DoE. It it. WELL DEPTH tt. DURATION hr. min. DRAWDOWII ft. YIELD g&m- Land Surface Surface , t-/ & WATEfi ❑ CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS _ ❑ COLORED ANALYZED? ❑ YES O NO ANALYSIS ATTACHED? ❑ YES 0 NO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE CAPACITY MAKER DEPTH MODEL VOLTAGE HP-,% WE L DRILLER NAME'_ jI �1� �— CJT OATEN/ �� S SIGs E I jl� -- ---- ---- �-r�-�r-�^�r����'����r��.`'�= / , ` --__-_----'------�---------- y�p----' --------'- _ ........ ___�___�___'-_--__ � ---------�-��p'---------- -----`---'- -- _--__'- -_--_ i I-:: I I We,LA, 3v' i i Li P 4�R�N,2� 1501 It) I At x 60 A 4!'4 U t7 rte; r� � 424 0 10, 2" SCHEDULE Tank inside length Tank insidaiwicith (_jquid I*v4 I_ 'ca Rac _e2jpO__Gal Id �i,lr�y�d Illso Al idth- L e a e h ea N'bo s A FAIL Xsectio -Gal__-- Go( qFt/Day q4 . d. 3 F -,_long wide r2 nvieioa "I"U"" A;OunTY Deparrmenz .0 fteft4r at Environmental Health Service, Oproved as noted for conformaam with &PPlicable "Rule, and Regulatio PutnamC no ar the ant. ?-?Lj P P TEST FOLES A F'r--RC _,OLAT1,_'N 1,4) IOIJ "I; ru'.4 �f7EST 1,-U1 • 7 Y%ITE. _NOTES 4t;tallat„m I. to 1'. 1 ­u "ed arc to 1), 11. is ppi to 11c I l- Iuv for app, 'a T' Ife l'i in, 1, of , J" "a ­1 ti, ;W!e: F, 9egu L, i,ms of the lo., /i I ge ::ompvl­t .:. 'J" I y I i'• n-d d„ Ile, .1" obi. 'm s o'�' t awl Itw req'J''d -.11 •" test 1, ! a, 13 to tm OIW,,iWtl by file LN N I T A! Ow I'l F Q 1-17-�,"i--ifz,,-5,>,,\,.i/�,V-r,7 LOCATIONS`Ie­t,• Trimi; Suhdivision__ MCIp: : 0 Surveyor; h. b, _.T It _01 J 0 I N H. PR E N 1 :5 4z ENGH 0 Al 0 ">V P P TEST FOLES A F'r--RC _,OLAT1,_'N 1,4) IOIJ "I; ru'.4 �f7EST 1,-U1 • 7 Y%ITE. _NOTES 4t;tallat„m I. to 1'. 1 ­u "ed arc to 1), 11. is ppi to 11c I l- Iuv for app, 'a T' Ife l'i in, 1, of , J" "a ­1 ti, ;W!e: F, 9egu L, i,ms of the lo., /i I ge ::ompvl­t .:. 'J" I y I i'• n-d d„ Ile, .1" obi. 'm s o'�' t awl Itw req'J''d -.11 •" test 1, ! a, 13 to tm OIW,,iWtl by file LN N I T A! Ow I'l F Q 1-17-�,"i--ifz,,-5,>,,\,.i/�,V-r,7 LOCATIONS`Ie­t,• Trimi; Suhdivision__ MCIp: : 0 Surveyor; h. b, _.T It _01 J 0 I N H. PR E N 1 :5 4z ENGH 4� © I Gl~ Gol �C �GfP -� Structure lo;co�d from -survey by surveyor noted belowo-, _ _ _ Well located b'y: Surveyors survey.— �, ❑_— _ - Well drillers report -- -Q^_ Englneere mesrirements -11- Tank, banes, prh, galleries d laterals located by:Controctor: Engsaw3. He0lth ftpt: 1 Field "inspection by_: Health dept171 dote: En g u nesr Ku d a t e aU1�� -rlpr! w °x 7hle Is tr, CertICV that the s 'ge! disposal system was cnnetructed ae MOTS: indirared on Ch:s plan sad that. Cho vystom was i118-peeLec] by nu be'fo re i was Covered oval -. The -nYStaas w apt II' Piro, c ui.uwu t:ouuty �'ueya`rtiwent Oz nerut.. vision of F$tvironmeritel Health Service, proved as noted for conformance with - -s pllcable Hulee-'and Hegulatio6 of the ,L tnam— ,County Health:�Department. F�l LA v O . cbnatvUe ted In nccOrdanee with all. standard rides and rugulallons of the P-C.II.D. 6 the N.Y.B.D.H. 1 ME NSION 5 A _ B r-n• u �! A J s'- B - =- - - - --- . A K -B - K ° - - - --- -- 1 vwg rt P�YA.KQ_/v1c� � �✓4:::7,!,L�/ 4 �=,b dpo LOCATION Street: lc�l1 ��� ��gC PoKn:)) �i1Z� NCounty:�� tati 5-- Black.. 1 _ _ LOT NI —/_,,9 — -- Builder._ �cC� Surveyor: ^42 JN� �:E�1S.L% lrown':IJ,r7 oote:Gr —Z -B Scale: N11 Q a� JOHN H iPR.ENT'I.SS PE g' CONSUL INd ENGINEER