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631- 589 -8100
34. -3 -33
BOX 14
No r
. ,.
I�yti L �J 1 �I L I me
F. �� �I�
IN
j . ' . '.
1
2 rm 1 01. k
01493
Consisting of 1 Z 5� er" l-- 7 - '— � b ��,77! e ion Septic Tank grid o
Watgr.Sppplyf Public Supply From Address
or. Private Supply Drilled by Address
Building Typed Has Erosion Control Been Completed ?. S
Number of Bedrooms' �• -' Has Garbage Grinder Been In
:Other Requirements
I certify that the syetem(s) as listed serving.,the above premises'Ward constru entially as the plane of the completed work (copies 1. of which:are,attached),, -&nd in, accordance with,the'standards, rules�and.,req do in 'dc rd w the'f d plan, and the permit issued by the
Putnam Cqunty Department Of Health
Pate Csriiflad b P.E.A.
Address ,: License No cc
Any person occupying premises served by, the atiove'system(s) shalt romptly tak6 h action as envy tie necessary to secure thecoiractlOn of any, unsanitary
conditions resulting, from such _usage Approval. of the', ,separate sswerige, ytam shall become null: and volq• as soon as a pub.': aanitery .qwM becomes
available and the approval of the p►iv`ate'water,supply, shall become null end void when a `public water supply becomes available. Such 'approvals are
subject to modifif Iccaa /tion or change .when in .the'Ju`dgmenf, of the Commkil(i at_of -hl!al such revocatbri;..motlifleatbn or. change Is; meetsar
Oats �yV � TIt '
-s
YML ENVIRONMENTAL SERVICES
;521 Kear Street
Yorktown HeiAhts, N.Y. 10595
(914) 245 -2800
Albert H. Padovani, Director
LAB #: 93.008253 CLIENT #: 2205 NON STAT PROC PAGE 1
WALLACE, DOUGLAS DATE /TIME TAKEN: 10/22/93 02:30
RFD 9 FAIR STREET DATE /TIME RECD: 10/22/93 09:00
CARMEL, NY 10512 REPORT DATE: 10/25/93
PHONE: (914) -878 -9548
SAMPLING SITE: CAROLYN WAY KITCHEN TAP SAMPLE TYPE..: POTABLE
: PATTERSON, NY PRESERVATIVES: NONE
COLD BY: DOUGLAS. WALLACE TEMPERATURE.. < 4C
NOTE...: COLIFORM METH: MF
NNtiNNrJ�NNNNNIJNIJ rJN J iJ rJ--------- ---- --------- NNNNNNNIJN-------
IJ J �JNNNrJN ♦J
DATE FLAG PROCEDURE RESULT NORMAL — RANGE
10/25/93 MF T. COLIFORM ABSENT /100 ML ABSENT"
COMMENTS:
BAC:T THESE RESULTS INDICATE THAT THE WATER WAS , (WAS NOT) OF A
SATISFACTORY SANITARY QUALITY ACCORDINj O THE NEW YORK STATE
AND EPA FEDERAL DRINKING WATER STANDARD'S, FOR THE PARAMETERS
TESTED, AT THE TIME OF COLLECTION.
40e��7
SUBMITTED BY:------------------------------
Albert H. Padovani, M.T.(ASCP)
Director
FLAP# 10323
PUTNAM COUNTY DEPARTMENT OF HEALTH
IyISIOi�1..OF _ Ol .
Owner orrPurchaser of Building
Building Constructed by
Location - Street
Municipality
Building Type
Section Block Lot
Subdivision Name
7/ G
Subdivision Lot #
GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYST ML
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 sham 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 build i g utilizing
the system.
Dated this day of 19 Signature
Title
General Contractor (Owner) - Signature
Corporation Name (if Corp.)
Corporation Name (if Corp.)
Address
Address
rev. 9/85
mk
�'t_Oir DVD/1DT
(� .e
4* �*
6V W O
WLLL UUr1rj'z1LV" LXj,rvn.L
DEPARTMENT OF HEALTH
vision-..OE- Environmental_.Hea1t.IT..$.e v_i.- cgs._.._.___
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
STREET ADURESS: 7OWNIVItLAQVC11y TAX GRID NUMBER:
LC4 In 0 V
WELL LOCATION
WELL OWNER
NAME: ADDRESS:
:
q C, C' s r rr S, r e e ! L'r�rrmp 6137a
pgIVATE
O PUBLIC
USE OF WELL
1 - primary
2 - secondary
RE DENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED
❑ BUSINESS O FARM ❑ TEST /OBSERVATION O OTHER (specify)
0 INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY O
MOUNT OF USE
YIELD SOUGHT � gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE _60 gal.
REASON FOR
DRILLING
NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST / OBSERVATION
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
` WELL DEPTH ft.
STATIC WATER LEVEL 19 ft.
DATE MEASURED
DRILLING
EQUIPMENT
Q ROTARY COMPRESSED AIR PERCUSSION O DUG
❑ WELL POINT O CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
O SCREENED ❑ OPEN END CASING. OPEN HOLE IN BEDROCK O OTHER
TOTAL LENGTH ft
MATERIALS: STEEL O PLASTIC O OTHER
CASING
DETAILS
LENGTH.BELOW GRADE 31 ft.
JOINTS: O WELDED WTHREADED OTHER
DIAMETER in.
SEAL: O CEME GROUT O BENTONITE OTHER
WEIGHT PER FOOT Ib. /ft.
DRIVE SHOE: YES ONO
L1NER:OYES NO
DIA (in)
'SLOTS
LENGTH.(ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
SCR N
S -
AST
S ONO _
HOU
SECOND
GRAVEL PACK
O YES
❑ NO
GRAVEL
SIZE:
DIAMETER
OF PACK in.
TOP
DEPTH -ft.
804 ht
DEPTH ft.
WELL YIELD TEST if detailed pumping
t
M�7H00: O PUMPED i tests were done is in-
COMPRESSED AIR , formation attached?
0 BAILED 0 OTHER ; O YES O NO
It more detailed formation descriptions or sieve analyses
WELL LOG are available, please attach.
DEPTH FROM
SURFACE
water
Bear-
ing
Well
Oia'
In
FORMATION DESCRIPTION
caoE,
ft.
it.
WELL DEPTH
it.
DURATION
hr. min.
DRAWOOWN
ft.
YIELD
gpm.
Surface
°
9655'
V
s•
WATER irCLEAR TEMP.
QUALITY 0 CLOUDY HARDNESS
O COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? 0 YES 0 NO
1
STORAGE TANK : TYPE
CAPACITY GAL. CI
PUMP INFORMATION
TYPES^�-k- CAPACITY
�r�d
MAKER i`�`_,_ �+�� DEPTH .a
MODEL Cd y� VOLTAGECT~rtv HP
WELL DRILLER NAME GATE
ALBERT M. H l Drilling & SONS, INC.
ADDRESS -Well Drillinn, SIGtOfiIRE ,
Rte. 311 R.R. 2 Box 171A
SON; NEW YOPK 12563
ea .ws/e�mea to f1a® OrS�orga 8 nRr1;'o ryvi @4i gaovawtao rmill -be, urnio" 4P�a t
i4Ce, N;jOB® oMet_Ngg o�ion,9ng:j�gPl OP.;ata th0i
®nq. Of tfart - e�ovsl ®P: t1aB CcmtNiss4o' oP Constyac4lon 1co" ianee oB 't Or nal; sya@i
w(N tlO IOCato! es slow on @Iq`t poon� �0en pn�
tmi mi9 -vao11 will N ins@ acco
COUMy pe8orteant oR.14®014Po.
A04�70GS u�♦ /.�' V T
A PROVED FOPt COPdSYPdlJCR10W Phis nptmonol ettpbt�4`.tarp 1/ s' °PVOan tl�e on istiiad;
venoepble Por cak! of inay bo opnar4mm or modwic9 arncm con he con
OCCil G" OfF1O696C son
my wo ®�vq: vaara rowv - C7voaaaama v anv rxawem .
Pt:a m
L COnSO Pd0 -
mAnuetio 04 thm,tiui�ingAna_bcon uli0ertatten a!ia.is
r" 04 ,"W.i4N ' Reny cMngG or: altpatlon of coentruction
Title �'f
PUMAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENML HEALTH SERVICES
_ . DESIGN .DA-TA- -SHEET- SUBSi)FAC',E--SEWAGE
Owner (a L6.&CE Address �T.
Located at (Street) ►JV Sec. % Block Lot /•�
(indicate nearest cross street)
Municipality C%SO Watershed Orly
Date -of Pre- Soaking
Date of Percolation Test
HOLE
NUMBER CLOCK TIME
PERCOLATION
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
1
3
'5
1
2
3
4.
5
NOTES:. 1. Tests to be repeated
are obtained.at each
for review.
2. Depth measurements to
rev. 9/85
at same depth until approximately equal soil rates
percolation test hole. All data to'be submitted
be made from top of hole.
G.L.
21
3'
41
51
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
HOLE NO. HOLE NO. HOLE N0.
i�
61
71
81
go
10, C-1 r-, NOW I
120 L)
13'
14'
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 Septic Tank Capacity gals. Type
Absorption Area Provided By. 5'00 L.F. x 24" width . trench
Other 0 >,5v wlr_—
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved sq.ft/gal. Checked by Date
r
C--UN TY L ` a = .'T OF cr. T - DIVISICN- CF
�► %? i= i_� r NL ?T SuFp y & c- E- -�r�' �- �" =- -S
(=ate-= of owner) -
C== ��il'� � NO LAC'`
I F — a.plic =ticn
f I I D� =_cn Cat_ s�_ =_- ( CS )
( I D =_ ac_e
PLC Rea-
Cole
_- enc*i
�,iC
no � c
C `'1 CcI C=_e
1 =0 tip- f =cam � =•r.
15 J
cr._,L _ _ I -
s,'s
C.
=1 E. �' `- Two - --
Tom_ 7 c,_d_ J_ca
S •r' c a
R & J)
Sewage
I S�.va•�� C_ `� ='-2 = ail =._`i �C- "'��`_ -�tr` _
I D cr j
I Wall
I
7C�Ca�S�`�C}7C���, -�?Cn
C..a (C_'_ZCS�
QeeC 1CC�• -
Y�YV &
I Dr= ;sri-_v, & S1cceS Cat
pcotinc I -
p_rc & Dee!:) lot=s - _ L:�)
I Represa:, . wive cr p: - -- — --
z-�1 -_T
j- Bcx Shcwm & Da_ i 1
FCL.- Cr Be
yp;s & SSOS's whin 200 =-. c= _CCS.'�r- S_5
nc` C
fiQtSe a er _
�T � N
Fi -
`7 r�
10' to P.L. , Dri VEWa-.1, L =*-cam r-=-, TC_ cf
20' to Fct= nc=_ticn lvai 7 s _
100' to well. 200' in D- L.O.D, 1=0' pi
' 100 t-0 S tre .1, �L (i r.c. e- -
C' tC _C,,
r,
3= 1 tc •, -
�..
10' to W=-t =T Line
50- int=.: ; = -_nt ter=• =.e c__ - -_
se= l C 1crlics
DEPARTMENT OF HEALTH
Division of Environmental Health Services
110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310
APPLICATION "TO' COrTSTRUCT A WATER WELL �! % C�°
PCHD PERMIT # / (� �L �`
WELL LOCATION
Street Address
Town/Village/City Tax
Grid Number
WELL OWNER
N
Ze
�$6.b.
ilin
Ad rasa
j®
rivate
® Public
USE OF WELL
1 - primary
2 - secondary
� -RRESIDENTIAL
® BUSINESS
® INDUSTRIAL
13 PUBLIC SUPPLY OAIR /COND /HEAT PUMP
O FARM O.TEST /OBSERVATI.ON
U INSTITUTIONAL O STAND -BY
®ABANDONED
O OTHER (specify
AMOUNT OF USE
YIELD SOUGHT 5- gpm /#
CI REPLACE EXISTING SUPPLY
EW SUPPLY NEW DWEL I G
PEOPLE SERVED <9 /EST. OF DAILY USAGE_�al
O TEST/ OBSERVATION G ADDITIONAL SUPPLY
® DEEPEN EXI.STING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
aG i E FE C-
WELL TYPE
OD'RILLED
®DRIVEN
ODUG []GRAVEL
0OTHER
IS WELL SITE SUBJECT TO FLOODING? YES X _NO
IF WELL IS LOCATED IN A REPtLTY SUBDIVISION, NAME OF SUBDIVISION:
'3Q RE) I Gam. M_N 92 E—rk� Lot No. �
WATER WELL CONTRACTOR: Name 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.:
LOCATION SKEjVON SOURCES OF CONTAMINATION
SEPARATE SHEET
(date)
PROVIDED
(signature)
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 providjA :,by the Putnam County Health Department.
During all well drilling operations,, the applicant s1aIl� take appropriate action to assure that
any,and all water or waste products from such well dril ng operations be contained on this
?roperty and in such a man er as not to degrade or o erw se contaminate surface or groundwater.
r
ilte of Issue: 19
'e of Expiration Z _19 2— Permit'Issuing Official
lit is Non - Transferrable White copy: HD File Pink copy: Owner
Yellow copy: Bldg. Insp. Orange copy: Well Driller
1'A
s
Putnam County 13'epariweni u rioalih
)ivision of Environmental n-1; a 6afth;
N 0<J55'13' W N 51'41'32' W
'.PprOVed as noted for conformance wit:. "• 9.34' 1aaD"
Ppllcable Rules and Regulation of tL d N 31'22'41' w
27.61' \
utnam County alth Department. N 7638.45' W
29.77' .1
I
W
N 6631'14' W
A tt].e /fir
n
�� 23.00-1-.,
0-11-?3'30r W `�.
N 4648'40" W
32.98' ` LOT 3
N 60'38'54' W \ \; 61.568 SQ. FT. - 1.41
31.44'
N 8720'51" W
15.86'
68.2'±
60.6'±
" R - 50.00'
I 12`ACCMP L - 106.30'
STORY PAVED <DRI7(€ " �� \
DECK
I �
TF - -NUk �_c y Ili 11 R 25.00' \
S� >\�wc;Y••�:1_� 1 \, L - 18.07'
of �LMNG SPADE
BAK ._. -
N ER '�$ OVERHANG I —COVERED'='�� R - 225.0b' /
PORCH 108.6'± L 65.97'
hl > > v \
68.5'± �Z ,
S 14'05'33' E
23.38'
S 3r29'43' E '// 266.89' h
S 5wOO,O(r W rl LDT 2 E 10 i
6.00 n�' �T
MAP r ti
LOT 3 f 1hi 0 p
PATTERSON, NEW
R - 225.00'
L - 11.39'
N/F
snEBUNG
1 �
L pNT�NF� /rN L
Y e ebyy certify to
?h thfe- wrvey.an
ar wDetantlally o
11`
:.of aCtual p9a
0 11d1rqe are lecat
sr and' upon this 'a
at there ars nos
Ostrtettene or eth
eferenee is the If
there are no easeel:
proporty,frox-i car
oboe. ether than th
B U R D I U K G LE N N O A H s, THIS IS TO CERTIFY THAT THIS SURVEY
PREPARED FOR, v F '5310 IS BASED ON A FIELD SURVEY COMPLETED
O :'�d:Y �) .' ON MARCH 16. 1990 A. THAT THIS MAP
ARTHUR AND JADE WtJ
WAS =COO 76' '�°
YORK 61,568 SQ. FT. / 1.413 ACRES
� N.Y.S. LAND SURVEY C. 847
1" =40 1 MARCH 16
� ? , 1990 O 537
ig'N- Fp,00. b8
c'
:i
and .
rule: and re•ulatlons hrlth
tlen ,of .eafd -lldlnte, ab the
o!',i;ercro :a.._ me a(l�o.WTR to
uY phyilcal Inepdetl�o of, the
oke" and ds�oted.hareen. _
DAVID L.iRYAN
r'
—e v nir
m� nrwia
I'
a.a m oe.eshavr nai
!I
I S'
t•
;t
i'
G—iz =40
,—�7i
1la'
N 4648'40" W
32.98' ` LOT 3
N 60'38'54' W \ \; 61.568 SQ. FT. - 1.41
31.44'
N 8720'51" W
15.86'
68.2'±
60.6'±
" R - 50.00'
I 12`ACCMP L - 106.30'
STORY PAVED <DRI7(€ " �� \
DECK
I �
TF - -NUk �_c y Ili 11 R 25.00' \
S� >\�wc;Y••�:1_� 1 \, L - 18.07'
of �LMNG SPADE
BAK ._. -
N ER '�$ OVERHANG I —COVERED'='�� R - 225.0b' /
PORCH 108.6'± L 65.97'
hl > > v \
68.5'± �Z ,
S 14'05'33' E
23.38'
S 3r29'43' E '// 266.89' h
S 5wOO,O(r W rl LDT 2 E 10 i
6.00 n�' �T
MAP r ti
LOT 3 f 1hi 0 p
PATTERSON, NEW
R - 225.00'
L - 11.39'
N/F
snEBUNG
1 �
L pNT�NF� /rN L
Y e ebyy certify to
?h thfe- wrvey.an
ar wDetantlally o
11`
:.of aCtual p9a
0 11d1rqe are lecat
sr and' upon this 'a
at there ars nos
Ostrtettene or eth
eferenee is the If
there are no easeel:
proporty,frox-i car
oboe. ether than th
B U R D I U K G LE N N O A H s, THIS IS TO CERTIFY THAT THIS SURVEY
PREPARED FOR, v F '5310 IS BASED ON A FIELD SURVEY COMPLETED
O :'�d:Y �) .' ON MARCH 16. 1990 A. THAT THIS MAP
ARTHUR AND JADE WtJ
WAS =COO 76' '�°
YORK 61,568 SQ. FT. / 1.413 ACRES
� N.Y.S. LAND SURVEY C. 847
1" =40 1 MARCH 16
� ? , 1990 O 537
ig'N- Fp,00. b8
c'
:i
and .
rule: and re•ulatlons hrlth
tlen ,of .eafd -lldlnte, ab the
o!',i;ercro :a.._ me a(l�o.WTR to
uY phyilcal Inepdetl�o of, the
oke" and ds�oted.hareen. _
DAVID L.iRYAN
r'
—e v nir
m� nrwia
I'
a.a m oe.eshavr nai
!I
I S'
t•
;t
i'