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HomeMy WebLinkAbout1454DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -2 -42 BOX 13 r II '� - ■ III . ' J IN . 01454 Lot Sub M le- 0 t go Fee Inc Candsdzkg of Gaff6n:Siptfe Tank and Fr, Waft Supply: PukWSupply Fro" I certify that the system(s) as listed s6rvi"..,thi above premise* were etrue tial ly as sh,?i- on the plans of . the 6ompiet- of which are attached), and in ac66 ce with the -standards; r'ules* and ad, work copies th the f led plan and the perMit issued by the Putnam County I)ipartmeht Of Health. p. Any person 'occupying promises served bj the" e6046 systsirn(s� 5�111 -wompt aiii Su hlactlofi as My be y to secure the correction of any unsanitary lions resultinj fro condl rn such usage.. �Ai)prorl-p 561 -11 Peco4ne null void As sooWas a pubt.-. unitary sewer nm avallible and the..approval 'of the privati water supply.shall.become'n 4 when a public t supply becofflas avallabW Such approvals we t66 judgri.�t: of no.. of 04, in. .'sumill i .=on, niodification or change Is TR BREWSTER LABORATORIES Box 224 - BREWSTER, N.Y. (914)X 855-1.930 ® WATER ANALYSIS REPORT SAMPLE NO. 7884 ` SOURCE: Windsor Oaks Lot # 22 Carmel, N.Y. COLLECTED: BY: P.F. Beal & Sons BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method .S. TEST WELL 0 per 100 ml. This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. 11 -11 -90 _N__ . - _T WZLL t,Vr1r1LZ11.V14 i\L,rVi\1 DEPARTMENT OF HEALTH _ - +'Division Of 'Envir6ninental Health Services ��'W NO PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only - -- WELL LOCATION STREET ADDRESS: TOWNIvitLACTICRY TAX GRID NUMBER: Fair St. Carmel NY Lot #22 WELL OWNER NAME: ' ADDRESS' Windsor Oaks Assoc. ,83 S.Bedford Rd.,Mt.Kisco,NY ❑ PBIVATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary ® RESIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND.IHEAT PUMP D ABANDONED O BUSINESS D FARM ❑ TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING .[]REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY E]NEW SUPPLY (NEW DWELLING) ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 22�' ft, STATIC WATER LEVEL 30 ft. DATE MEASURED 10/3/90 DRILLING EQUIPMENT f9 ROTARY ID COMPRESSED AIR PERCUSSION ❑ DUG O WELL POINT D CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED O OPEN END CASING 13 OPEN HOLE IN BEDROCK O OTHER CASING TOTAL LENGTH 81 —ft. MATERIALS: W STEEL D PLASTIC D OTHER LENGTH BELOW GRADE So ft. JOINTS: O. WELDED .f] THREADED ❑ OTHER DETAILS DIAMETER in. SEAL: W CEMENT GROUT O BENTONITE D OTHER WEIGHT PER FOOT Ib. /ft. DRIVE SHOE: ® YES ❑ NO I LINER: ❑ YES ® NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (it) DEVELOPED? FIRST O YES O NO HOURS SECOND ...... GRAVEL PACK O YES O NO GRAVEL SIZE: DIAMETER OF PACK in. TOP^ DEPTH ft. BOTTOM DEPTH It. WELL YIELD TEST It detailed pumping METHOD: O PUMPED tests were done is in- t CY-COMPRESSED AIR , formation attached? O BAILED O OTHER ; 0 YES O NO 1 FLL LOG if 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 ft. DURATION hr. min. ORAWDOWN ft, YIELD 9pm. Surface 40 Dr ll ' ng in overburden clay & bldrs . r ck at 40' 225 6 205 82 40 8 1 Drilling in rock,set casing grouted. 8 22 it in in -rock granite. WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE, WX 203 CAPACITY 32 GAL. PUMP INFORMATION TYPE submersible CAPACITY 7 a MAKER Gould DEPTH 180, MODEL VOLTAGE yOLTAGE230HP 2— WELL DRILLER NAME P.F. Beal & Sons, nc Olt 1 90 ADDRESS PO Box B 5<Gf E Brewster, NY 10509 J/ ov t. I v Pug DIVISI, APPENDIX I ,M COUNTY DEPARTMEI OF ENVIRONMENTAL Ochs 46� cC.... Owner or..Purchaser of Building Building Constructed'By OF HEALTH .Section Block Lot Tax Map Number. Lbf, L VW( SL. Location - Street Subdivision Name Municipality lr � Buildinj Type Subdivision Lot # GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL. SYSTEM represent that Pam wholly and completely r s i for the , workmanship, material, construction, N b'u��� of the sewage disposal system serving the above described.propertyl 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 constructed` system constructed by A6r 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 utiltizing 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 uti izin theys Dated this, day. of �. 19` Signatur. ;►� i . Eksk Xve. 14,e fres;ow4- Title, j /Genera actor Owner - ,Signature Foley =,eve ment',.Company of Pattetson inc.., Corporation Name if. Corp. gnr partner Corporation Name if Corp. Windsor Oaks Associates 83 South Bedford Road, P. 0. Box 141 Address. Address Mt. Kisco, N. Y. 10549 Cross River., N.Y. 10518 ;_ .. APPENDIX I Y: PUTNAM COUNTY DEPARTMENT OF 'HEALTH DIVISION OF _ ENV. I,RONMENTAT�._ HE_ALTHSERVICES Asa ' Purchaser of Building Section Block Lot KOwns r Buildinq.Constructed By Tax Map Number t — nnrf�/ LCL, � TC�'r r S� S L�-I�c�.i U; L G tlon, Street Subdivision Name. Murilcipality Subdivision Lot # di g Type GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM .represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of t 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, r Al 1' nd 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 constructed ~` system' eons tU(:ted---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 ro er1 is .caused b the willful or negligent act of the occupant. P.: P Y; Y P utilti�zi.ng the system. ,. T,he undersigned further agrees to accept as conclusive the determnation of the Director of the Division of Environmental Health Setv_ices,of the Putnam Count Department of Health as to whether - Y P or. not`; the failure of the system to operate was caused by the will 1 or negligent act of the occupant of the buildin�...uti ring ,h A ys.� 1 Dated ahi % day of 1 Signa ,`-t- iL Exec.Vice -Pres Title Ge er;al Cont wner Signature eve- opment Co . .of . Patterson Inc., general Windsor 0'al s Associates partner SAF Septic Systems Cor oratio`:Name if Corp.) Corporation Name if Corp. 83 S.'-Bedford'Rd. Mt. Kisco, NY 10549 P.O. Box 141 Cross River, NY 10518 Address Address DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 . APPLICATIOr1_.TO •CONS'PRiJCT- pr= WA'I'ER WELL- PCHD- PERMIT # AW41 WELL LOCATION Street Address Town Vil� ge City Tax Grid Number Rli" 5 �Ce 4- -5,4k7dlvi5 /ate, WELL OWNER Name Mailing Address S, r ri) / e D.../ /c. M +. Cisc J4 - �r rivate D Public USE OF WELL C- primary 2- secondary >(f RESIDENTIAL O BUSINESS U INDUSTRIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE gal REASON FOR DRILLING 13 REPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION Q ADDITIONAL SUPPLY EW SUPPLY NEW DWELLING L1 DEEPEN EXI TING WELL DETAI LED REASON FOR DRILLING PI''I V'd V 1• r M W a e / 2 ne P U an WELL TYPE DRILLED DRIVEN E]DUG GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES > NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:fair S +• :: lvdiviSlai Lot. No. o WATER WELL CONTRACTOR: Name F Pw,`i - Address : '13MW 5 r AJJ . f 0501 IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: A A TOWN VIL /CITY ­�q+*PS0kl _.DISTANCE TO PROPERTY FROM NEAREST.•WATER.MAjN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED 5.23_ %0 ON SEPARATE SHEET (date) (sign ure) 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 swell 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 Date of Expiration: 1g ermit ssuing is a Permit is Non - Transferrable White Copy: H D. File . 1 'ldin Rev. 10/88 Yel ow cppy. Btu g Ir Pink Copy: Owner Orange copy: Well Driller K. C�tJA �� �..1�'��' ' r f-=.T? - D y�LT'i Sc=;: = =J 7_ LL i�r SUPPLY & i.BS yC✓ S�- .rt A D_SPCS:- T S Q:S E� 2a 'ST c-= V��- L I Y^ S NO DCk- -- ,. E .:IS Plic =ticn 1_ Corporate Resolution PlaanS - Tire°_ sct5 E7c i ^1cerJ� z'Uthcri Zaz :—. rJ 1 1_ l.J -1eet ) I s gn ,r �.".� (D� 1 - Deed ;?ole L,-)g I ConSiS�ent Perc Res;!'tS I I Perc tole D--cth Pre- not LF trench Dl"OGi Qc'3 --red 60 r= 1.1 I 00% t' T T S JS•,� c1ay�rri_ r 10 fL. fill notes new sD Qe:)th cauc=s 100 vr. -10 �1 av• I I I� 200 rn lt. S _JOir, etc. I House P?zns - 1 °,vo sea Wei PWS Variance Re7,2eSt S/s S- LSICN (3) F.l c3 ct mac_ L�-a1 Saocivision Subdivision Approval C`:ec {_Z E.x-acPrc;val SSDS Adj. To- L-S Checked Ke l and (T,-,.7-/D= C Pew ili y R & D) Da-ta On DDS Plal-?s & _ =_�i t P =Qli1l1 J A 7T ON PL �\S S�haye S1-stam Plan - (north arrow) J Serwage SJSt°'n _7vraui i c ✓."•..��i i _1 _ F PrOLiln &it7i, -nSi D Or j Bcx;TrenCi /C= 1lerY; PL.—,,Lo ADZ _1 SePtiC tGIL' - s { Size, mail Yr! ` 1 L tai , -v l , S� , ce Line .i - over Corstr �cticn Notes (grincar rate) ... - ..- - . .. D -- • °_S.ty_vl•- L'�c: a': '?�rC c:'1Q Qe °b r?S'•i1 _S Con -.- rs psiSti - & PrOL7CS Driveway & Sloo s CLIt rDOt17C/Qat— eY,Oartain Drains (disc^- =' _ -- _ O {) Pe rc & D_eo r;OleS RepreseztaL of Pr---ma=y --id e..a-S_o F— Y—LalsiOn Ay= �'S�i0iv71• pity Ir PL _' r na, sue_. ,-ize _ ed Pit & D B :X S 1ccw -,n & Det i ed House - No. of Bedrocrs We is & SSDS'S wlin 200 r =. Or Prorx_- s t Pro 'rL-y Metes & Sounds °iS .._ -House Set:r =c!t ', °ecessary (Tight lot) House Se'her - 1 /4'V t. 4'10; ly -e pi No Bends; i%x. Bens COQ w /cle.F--IoL_ S_RILRATiON DIST = 'vC;�S S� LL= I� ON PAN Fields 10 L7 L.L. , Drlvewav, T - i eeS �- T , of r; l r 20' to FOUnc =Lion ;•:ails 100' Lo X11; 200' in D.L.O.D, 1501 100' to St-ream, j4ate ca=z= I lake (inc. =l aa) 15' Lo Dr -i^•_- ''-'" �-_ , :roe- l r - 351 to Ctch _ -- 10' to titer Lire (Z)its -20') 50' t `i -o course SeSEC Tanks 10' fran F:)vmdation; 30' to well 15' Well LC ?r o - PUTNAM. COUNTY DEPARTMENT OF HEALTH Division of Environmental. Health Services APPENDIX Z AFFIDAVIT — CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health - In the matter of application for: . 1 nd1U1d(4q [ '55D .S 4OC 0+ 0\,/o. `ZZ �ole4 r represent that I am an officer or employee of the corporation and am authorized to act for Pole T)euelo e44- Co TG44 e; -so,, . (Name of Corporation) having offices at 8 3_: Souk- G,.ec%►'CI _ /�(�G.G( M-�. iSco A `/ lUSys Whose officers are: I President: ��-(U ( 7, Vice — President: SC4N' L4 4e l' Secretary: GN�uef Treasurer: J Y-. and Address A- 93 sow-41 A44-, 41.sco (:Tame hand Address) F0be• (;`Tame. ,and Address) ol�y fir. - ��• k�Sc� �1� � oS� O cr. - - -and Address and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsea t acts-relating thereto. • 1 Scorn to before me this % � � day Signed: of 191 Title: Notary Public MARIA HARDMAN Notary Public, State of Now York No. 4934641 Qualified in Westchester County Commission Expires May 31,19 Lv 8/84 Corporate Seal pUI' m cOUNTY DEPART Ear of HEALTH DIVISION OF ENVERONMENTAL HEALTH SERVICES LOT � 2 DESIGN TA. SHEET- SUBSUFPCE A(X DISPOSAL SYSTEM FILE N0. 1i?y-- peve-10— A, /� I Owner 'PCI '1�'` eS 011.7 �✓7 C Address s5 s Ti:,J gd , '`� F-/S", © /� r y to y q j Located at (Street) A view w S,� . Sec.. Block Lot (indicate nearest cross street) Municipality Pr, +-,e rs D rl l �� Watershed SOIL PERCOLATION TEST DATA RBQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre - Soaking Date of Percolation Test HOLE NUMBER CLOCK TIME PERCOLATION PERCOLATION Run No, Start -Stop Elapse Time Min. Depth to Water Fran Water Level Ground Surface In Inches Start Stop Drop In Inches Inches Inches Soil Rate Min /In Drop 1 2 'Pe r C- "Fe S '1' O Al to ! r1 C''1 3 5 1 2 - 3 4 5 1 2 3 4 5 NOTES: ,l. 2. rev. 9/85 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. Depth measurements to be made fran top of hole. TEST PIT DATA RE1QUIM TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE - NQ, HOLE NO. 491 � J- -- wit G.L. 21 31 41 51 61 71 81 91 10, Per P,90roveof- 12' 131 PSC) Y cod Dem,, A, G) 14' INDICATE LEVEL AT WHICH GROUNDRATER. IS ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: /11 DESIGN Soil Rate Used Min/1" Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity I Do L) gals. Type Absorption Area Provided By bDt7 L.F. x 24" width trench Other Name :54eve-i se t, 4,mign Signatur Address 12S CAO-C,1 5+Kee-14- SEAL Nqlverp)e THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: o Soil Rate Approved sq.ft/gal. 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