Loading...
HomeMy WebLinkAbout1444DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -2 -32 BOX 13 OWN . ? ,ry l ,� l ruj jr 01444 Rev... 3%8 PUTNAM COUNT] . \ �' Division offs virosimerito] Located aLA Owner /applicant _ - r YWage Ta: MaP _._ Block_Lof ..., ormed y &Ca Snbdlvieion 6! J NOJdR 09K� Name Sabdv. Lot 11% f. 74 .�d�7 -2-- Date Permit Issued % /� P Water Supply Public'Snpply > om Address 'or:„_Private Snpply Drilled by R, Address: Q, �d .)� "8 Qrew p /(/, `! �jjj?Jq Building Type - ���+i't '44 4' / 4 Has Erosion Control Been Completed? ti G r Number of Bedrooms �� Has Garbage Grinder; Been Installed? Other Regulremegte. .I certify, that the systems) as listedsergingthe above premises were constructed.essentially as.shown on the plans of the completed work ( copies of which are attached) qnd in accordance .with '.the atandards'> rules and regulate "` , in accordance` the.filed plan, and the permit issued by the Putnam'Coun .liepa tment Of Health , Date Certified by / P.E. R.A. Address l.lesnse No. T �r+ IF Any person occupying premises served b'y, the above system($) shelf, promptl ake ch.action as may be necessary to secure the correction of any ;unsanitary conditions resulting from such usage. Approval of the separate 'sewera em hall become null d void as soon as a pubt% unitary saWer becomes 'available antl the approval of the 'private water supply shall become nul anAeri. a ,publi supply becomes available. Such approvals are subiect to' 1416iippi cation Achange when, in the, Judgment. of the Co` m n meaaljt®'hJ'� modification Or change Is 0 Date + / By' - / "` Title W .,� C0� y WELL COMPLETION REPORT J� DEPARTM13NT OF HEAL" 7M . ~! Division. ;Of Environmental Health ServicesJ' FW Y0� PUTNAM COUNTY DEPARTMENT OF HEALTH... Office Use Only WELL LOCATION STREET ADDRESS: TDWNIVIELAG11 CI1Y TAX GRID Nur`,sK- Windsor- oaks Carmel NY - Lot #32 WELL OWNER, "All ADDRESS:. ❑ pgIVATE Eugene Philli s Unit5-8 Vista on /Lake,Stoneleigh,Carme PUBLIC USE OF WELL 1 - primary 2- secondary ) RESIDENTIAL 0, PUBLIC SUPPLY O AIR /CONO./HEAT PUMP 0 ABANDONED 0 BUSINESS O FARM O TEST /OBSERVATION 0, OTHER (specify) d INDUSTRIAL O INSTITUTIONAL O STAND -BY . O MOUNT.OF USE .: -- . ,... . YIELD SOUGHT . gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING RErLrit c EXISTING. SUPPLY . ®TEST /OBSERVATION ADDITIONAL SUPPLY ®NEW . SUPPLY '(NEW: DWELLING) []DEEPEN EXISTING WELL DEPTH DATA wEL� DEPTH 445 #t. 60 . STATIC WATER LEVEL ft.' DATE MEASURED 9/12/90 DRILLING EQUIPMENT 91 ROTARY 0-COMPRESSED AIR PERCUSSION 0 DUG O WELL POINT O -CABLE PERCUSSION O OTHER (specify): WELL TYPE Q,%REENED O OPEN END CASING 0 OPEN HOLE IN BEDROCK 0 OTHER CASING DETAILS TOTAL LENG-.i H 41 fL MATERIALS: .. -U.STEEL O PLASTIC .O OTHER LENGTH BELOW GRADE 10 ft. JOINTS: O WELDED ® THREADED O OTHER DIAMETER in. SEAL: (0 CEMENT GROUT O BENTONITE OOTHER WEIGHT PER FOOT - 19 1b./ft. DRIVE SHOEgJ YES. ONO LINER: OYES 19 NO SCREEN IIIAMETER (in).. 'SLOT SIZE .. LENGTH (it) - DEPTH TO SCREEN (it) DEVELOPED? FIRST - .... _ YES. 0 No n_.,,.A.ETAI.LS-...�_ _ .. -. -� .. SEI:ON.O - .- .: z __ .:o HOURS GRAVEL PACK 0 YES O NO GRAVEL: SIZE:. DIAMETER OF PACK in. TOP DEPTH f< BOTTOM DEPTH fl WELL YIELD TEST If detailed pumping METHOD: O PUMPED 1 tests were done is In M COMPRESSED AIR , formation attached. O BAILED � '3 OTHER_ : 0 YES. . :0 NO it more detailed formation descriptions or sieve analyses WELL . LOG are available, please attach. ., oEarli FROM :: SURFACE water ear, in9 well oia- ' meter In FORMATION DESCRIPTION p0E It.. tL WELL DEPTH it. DURATION hr. min. , 01RAWOOWN - IL . YIELD ': '.. 9pm.:::. Land '2 D it ng in DBerburden clay & bldr a 2� 445' 6 425' S' 12.' 41 D it •ng.in rock,set casing,groute . n rock granite. I I FWA O CLEAR TEMP. O CLOUDY HARDNESS._ O COLORED . ANALYZEDT OYES ONO . NALYSIS ATTACHED? O YES O NO ..` STORAGE TANK : TYPE WX 302 CAPAC TY 86 G A NFORMATION . , CAppCITY_Zg, Gould DEIrW 400► woLTAGE.23C ,1 wELLDRILLtANAME p.F Beal: & Sons Inc90. ADDRESS .PO. Box : SIG7EH1041z'.: Brewster:`,NY 10509 Nu i GUARAR= OF SUBSURFACE SEWAGE DISPOSAL SYSTE4 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 "Gerti €i'cate o 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 uilding utilizing the system. Dated this 3 / day of �L 19 Signature i Title Genera ntractor (Owner - Signature 7 .1� "'�r� c ice Corporation Name p(if Corp.) Corporation Name (if Corp.) rd 0 Add7; Address rev. 9/85 mk 12 -13 -90 b • 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..._Cnnstruction. Compliance "... for.. tb e, - -sew- age.. disposal._. systemF. .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 yt^ 1y the system r } j L....i:e..: lYY+>r %.';SA- l.i._h..1 T.. �_ Vin::` -. . ,..<.t.h ...:.. -- .::: - —. -' :; :.:. . { - {..r .. ..v.. .._ . .. ;. re4:1�- .. ?.'_5 �. -, .X. .• ... . .-1 _. .ta.: }li .3.,..... —. S:t u >the system rc Dated this . day of 651f 19 �(� Signature l Title po Genera ntractor (Owner - Signature ration Name (f Co ) Corporation Name (if Corp.) Address . -Y" -- rev. 9/85 - mk rpo i rp. s { ;. ��� e. PITTI'NAM COUNTY : DEPARIMENr OF HEALMH DIVISION OF ENVIRONbIENM. HEALTH.- SM- URGES• ` Owner -Purchaser of Building. Section Block Lot Building Constructed by �© V. jot LocatioA - Street Subdivision Name <Munici ity Subdivision Lot # N Building Type GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTE4 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..._Cnnstruction. Compliance "... for.. tb e, - -sew- age.. disposal._. systemF. .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 yt^ 1y the system r } j L....i:e..: lYY+>r %.';SA- l.i._h..1 T.. �_ Vin::` -. . ,..<.t.h ...:.. -- .::: - —. -' :; :.:. . { - {..r .. ..v.. .._ . .. ;. re4:1�- .. ?.'_5 �. -, .X. .• ... . .-1 _. .ta.: }li .3.,..... —. S:t u >the system rc Dated this . day of 651f 19 �(� Signature l Title po Genera ntractor (Owner - Signature ration Name (f Co ) Corporation Name (if Corp.) Address . -Y" -- rev. 9/85 - mk rpo i rp. s { ;. ��� e. Lir Zaj� 00 ol y alla j, way FJFP F7: UK LOT ^ ' w DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER : CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION -TO CONSTRUCT A -WATER WELL r PCHD PERMIT #A WELL LOCATION Street Address To Villa a City Tax Grid Numb r \11eV9 R�, %�& WELL OWNER Name Mailing Address I4IW P VIS\k X44 VIE- %�� C�Mt -:L 6v51 2- rivate O Public E OF WELL 1 primary - secondary RESIDENTIAL O PUBLIC SUPPLY 0 BUSINESS O FARM 0 INDUSTRIAL 0 INSTITUTIONAL ❑ AIR /COND /HEAT PUMP ❑ TEST /OBSERVATION O STAND -BY O ABANDONED ❑ OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED] /EST. OF DAILY USAGE i7�gal REASON FOR DRILLING N3aXEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED .REASON FOR DRILLING WELL TYPE 121DRILLED DDRIVEN ODUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Wtr, oaso ,, 0AVC, Lot No. WATER WELL CONTRACTOR: Name 10 j3& D0-kz-2A4`1 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST "WATER'MAIN. N I• LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION ON SEP TTY S Cd it e) (signatur 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 provi by the Putnam County Health Dep rtmen�. Date of Issue: r 19 - 1,7 Permit Issuing Official Date of Expiration: 19 %G- Permit is Non-Transfer/able White copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner 2 87 Orange -copy:, Well Driller PU NAM COUTA'F-v DEF�F'Ii MENT OF HEALTH - DIVISION OF ENVI ZONMENI'AL HEALTd SERV_C IM-7V-- Dt_-' -L Y-ATER SUPPLY & ff 7E URFACE S ,,?AGE DISPOSAL SYSTLvs _.... _ ': _ .. CNSTRUttION P�.IT DATE RL1TiT qJ (Nagle of ter) 4tre�et BY' Locatio CAS I YES — DCX:IJ'�7`PS _ Permit Application Corporate Resolution Plans - Three s`ts s/s Engineers Authorization Design Data Sheet (DDS) SUB7 Z ION Deep Hole Log Per` Consistent Perc Results (3) Fili I Perc Hole Depth cd I Pre -1969 Neighbor notification LF trench provided _ required 60 ft. rte. Parel.lel to contours 100% e-xp. FILL SYSTiS clayb crier 10 ft. fill notes _ new spec. depth gau es 100 yr. flood elev. t. reservoir, etc. 150 ft. tr House Plans - Two sets Well pernit; P ;vS letter Variance Request GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Team /DEC Permit R & D) Data On DDS Plans & Permit Sar.r,_ REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gra-ity Flcw Fill Profile & Dirr!ensions - Volume D or J Box;Trench /Gallery; PIMP pit d=-tails Septic Tank - Size, Detail Construction Notes (grinder rate).- Design. Oatac perc and deep results Two -Foot Contours Existing & Propose: Driveway & Slooes Cut Footing/Gutter,Curtain Drains (disc:jarge 01<) Perc & Deep Holes Located . Representative of primary and expansion Expansion Area;shown;gravity flow,suf -: size If Pmped Pit & D Box Shawn & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Proposed Systems Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 "/ft. 4 "0; Type pipe No. Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCFJS SPDCIFIED ON PLP`; Fields 10' to P.L., Driveway, Large Trees,Tcp of fill 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse,) Lake (inc. expan). 15' to Drains- 0artain, Leader, Footing 351to catch basin, storirrsrain,piDed watercourse 10' to Water Line (pits -201) 50' intermittent drainage Course Septic Tanks 10' fran Foundation; 50' to well 15' Well to PL o 72, apt i� ti t '7e, 10 ._ 6a .4f SA 2 ST�wy 1}N Wf 5 tiQ`O b'oa "ti✓ ; o ^z��t s z��- -L -ta to r A S B 0 1 L T SFw,y6F.. L F,41R SIRE ET 1 PA-rT-,E RSVIV x Survey �y Ter'ry 8ern cq 8or ff Coill os 3 a, a g,' 44 (97 - & 2 ,5 YS TE M 11,51NI r—, _F4 S te�uq Putnam County Department of Hea.11"t'i -1, 114 Division Of Environmental Health S�e"i� r"V Z Approved as noted for cOnformana e . - w P�, 1cab;e and Regulation,6 Utn tY Health Denar+mEil; ture t- Ti—t—le wz ..... . . . . . . . c c r �VV ,I' WO S C � S c, S Is lan all cl w,4� frlvt'- 46 hkC Tbd 'SYSlef", wris f� 2,f Jar 1%, /CT 4;� r es 0 'la qb 0 S 6 1" 5 t [am E IN5 ON IT 13 3 C, 0 6aA S (.7 39 73 7 S-0 73 76 79 g3 . Putnam County Department of Hea.11"t'i -1, 114 Division Of Environmental Health S�e"i� r"V Z Approved as noted for cOnformana e . - w P�, 1cab;e and Regulation,6 Utn tY Health Denar+mEil; ture t- Ti—t—le wz ..... . . . . . . . c c r �VV ,I' WO S C � S c, S Is lan all cl w,4� frlvt'- 46 hkC Tbd 'SYSlef", wris f� 2,f Jar 1%, /CT 4;� r es 0 'la qb 0 S 6 1" 5 t [am P,UTNAM COUNTY DEPARTMENT OF HEALTH � � � ��- ,h Dlvlelon of EnvlronmenW;Hev , lt6 Se[vloee Carmel NY 1031? Engtneei to Provlde.Permlt N' '. CEgTIFICATE:OF C CE i CONS TRU PERMIT FOR`SEWAGE,DISPOSAL SYSTEM -= Loa.ted at, or Y Cage 1 SabdivWoa Namel j..�F V/ ryw� Sabd of N�' Ta: ijJ { ill. MapBlock Lot_ Owaer %Appllcanl Name�11V { 1.� ✓ Reaowal ❑ Revle_lon ❑ 4 Mailing Addrose'��a%'�lrC.`e� 7 1..� - Towa Zip IRA i f a x , Bauding Type It /�1�� Loi Area D� FW Section OriIY Depth Volame'>; Number of Bedtooms Deg y sign Flow, G P D PCHD Notfficatlosi 18 Repaired When Flll Is completed Sepairfe Sewerage System to conelst of'Gillon 5eptic Tank iu �-f t T y by To be coae� ac �� ted � �1�% Addeess k Water SaPP13 Pa611c Supply Isom Address �' or: �,�Prlvste;;SapP1Y DrWedhby� �� *� ; c Other Reoaleemente I represent tnft;i_ em wnolly a Ad; :comple[ely . responsiblefor tnetlesign_gnd' location of the: proposetl systems) 1)•'tSat the separate''lsewage �dis•osal s"stem _ above described will be constructed, as shown on the bpproved. amendment there'$o andlnpccordance w,th_the standaitls, rules an_ •.regu a �o s'o r p e u nam County Department of Health;; and that on comptetion ther_eot'a C•erhiicate of Construction Ctimphance' satisfactory tgthe Corrmmissioner,:of Heelthwill ' ` ba ` ;ubmitted,to the Department, and a. written'quarantee';wJl {De.furnshedr the owne`i his successors AeHS Or assigns by the builder, that'said builder,JWi11 { :;. Place -.in 9eotl,.operst�ng.i3condition anyypart of _said sewage "tlaposat" system dur�ny'�thepenotl�of two''(2) years- immetliafely'follownythe0bte ot.the issue._ ,•' ante of the, approval of, the `Certificates of ,Construction :Co-mpliancee of the;o'rig`" .system or any rs irs thsretb; 2),thet the,d[illed. well describeQ abovb will be locatetl'as shc;Wh on the approvetl plan and that said well wJl be7nstalled' =i- cgrtlsnce with to artls rules and' regu,a�OnS 0f.` -,the Putnam County Oep rtme of Health > e t Date Syned Address �e . � License - �t/ •:s No APPROVED FOR CONSTRUCTION I h,s:approval ezpueatwoyears tromthe•dats issued., unless" constiuction':of.the building - has been. undertaken and js revoeableifor `cause or ma_y be ementled or rriod�t�edwhan cons ed ecessary.,by the - issioner "Of'Health :'Any change or alteration• ot- .construction '. requires a ,new 'permit p roved for d,sposal of do ti n Y e age an /or iv' w to wpply" only 87` Data BY Title _ A �G fy WELL COMPLETION REPORT j M$ a. _ - `.....: DEPARTNT . 'OF HFALTH . Divis.fon.Of Environmental Health Services W Y�� PU' ?NAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET ADDRESS: TDWN1ViLLAQL1CIIY TAX GRID NUkISER: Windsor Oaks Carmel NY Lot #32 WELL OWNER . NAME: ADDRESS: ❑PRIVATE 'Eugene Phiili s. Units -8 Vista on�Lake,Stoneleigh,Carme PUBLIC USE OF WELL 1 - primary 2- secondary G RESIDENTIAL O. PUBLIC SUPPLY 0 AIR /COND. /HEAT PUMP O ABANDONED 0.13USINESS 0 FARM O JEST /OBSERVATION O OTHER (specify) 0 INDUSTRIAL G INSTITUTIONAL D STAND -BY. , 0 MOUNT OF USE YIELD SOUGH f gpm.1N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING .[]REPLACE EXISTING. SUPPLY []TEST /OBSERVATIAN. OADDITIONAL SUPPLY ®NEW . SUPFLY (NEW.. DWELLING) . O DEEPEN EXISTING WELL DEPTH DATA WE�� DEPTH 445. ft. STATIC WATER LEVEL 60 ft. BATE MEASURED 9/12/90 DRILLING EQUIPMENT 91 ROTARY ..® °COMPRESSED AIR PERCUSSION `0 DUG O WELL POINT 0 CABLE PERCUSSION O OTHER (specify): WELL TYPE : O,SCREENED 0 OPEN END CASING ® OPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH 41 ft MATERIALS: .STEEL 0 PLASTIC O OTHER LENGTH BELOW GRADE _ t ft. JOINTS: O WELDED (0 THREADED O OTHER DIAMETER A in. SEAL: ®CEMENT GROUT O BENTONITE OOTHER `WEIGHT PER FOOT. - 19. lb./ft I DRIVE SHOE:g) YES 0 NO LINER: O YES I) NO SCREEN DETAILS.._ DIAMETER {in).. SLOT SIZE . LENGTH (ft) DEPTH TO SCREEN (it) . DEVELOPED? FIRST o YES _OiVO. HOURS - SECOND GRAVEL PACK O YES 0 NO GAp..VEL. . ' : .:: SIZE::. DIAMETER OF PACK in. TOP DEPTH. ft. BOTTOM DEPTH tl WELL YIELD TEST If det;liled pumping METHOO: 0 PUMPED i tests'Mere done is In -. :0 COMPRESSED AIR r fo.rma.tion attached O BAILED :`O OTHER : ; ❑ YES 0 NO Il more detailed formation descriptions or sieve analyses WELL LOG are available. please attach. DEPTH FROM suRFACE Water gear. In9 well Dia' (meter FORMATION DESCRIPTION p0E it. fl. WELL DEPTH DURATION ORAWOOWA YIELD •. Land 12 Duill ' ng in DBerburden .clay & bldr a` 2 ... 445 6 425' 5' -- 12. 41 D it -ng.in rock,set.casing,groute . ina n r.o6k ran te.. WATER D CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS:_ O COLORED ANALYZEDT O YES ONO ANALYSIS ATTACHED? O YES O NO .` ` `= STORAGE TANK: .TYPE WX 302 CAPACITY .86 GAL PUMP INFORMATION.:: TYPE anhtrA ra i "mil P CAPACITY'�Pai ..MAKER DEPTH. 400' Gould 7EI310412 23 1 MOD VOLTAGE._'HP WELL DRILLEa NAME P . F:. Beal': & Son's ,Inc '.PO. Box . B:.. �:.., A� 19i'90. AooaESS stcr' ;. Brewsteit -NY' 10509