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HomeMy WebLinkAbout1495DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -3 -35 BOX 14 01495 I ' IS II11ti ; f x' Is '- I Ir IN IN No IS I me, I r1 ON I r �, . y L - ` I ti �- .r - 01495 .y ti�C'`�tlI T.TVT T f'nxMT 1VMyA" nvnnnm Y �, •e w 0 YY JJLL VVLJi LLJi iVLY aWa VLtl DEPARTMENT. OF HEALTH Diysion Of Environmental Health_ Services=,,.:­. PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET ADDRESS: WN /VI ! 1 Y TAX GRID NUMBER: �' 6 1 7 3 _ WELL OWNER NAME. �_ ADDRESS: - PRIVATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary m RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS - ❑ FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT ___� gpm. /N0. PEOPLE SERVED _________/ EST. OF DAILY USAGE -rte gal. REASON FOR DRILLING NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST / OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTHT ft. STATIC WATER LEVEL ° / ft. DATE MEASURED DRILLING EQUIPMENT ❑ ROTARY COMPRESSED AIR ,PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. dOPEN HOLE IN BEDROCK O OTHER OETA CASING TOTAL LENGTH ft- MATERIALS: IffSTEEL ❑ PLASTIC O OTHER LENGTH.BELOW GRADE tL JOINTS: 0 WELDED THREADED. . p. THER. DIAMETER r in. SEAL: ❑ CEMENT GROUT ❑ BENTONITE 0TH WEIGHT PER FOOT 1-6 _ Ib. /ft. DRIVE SHOE YES O NO I LINER:0YES eNO SCREE DETAILS __ DIAMETER (in) SLOT SIZE LENGTH (it) DEPTH TO SCREEN (it) DEVELOPED? FIRST YES ONO 5 N0 H0 RS GRAVEL PACK ❑ E ❑ tJ GRA SIZE DIAMETER OF PACK - in. OP DEPTH tL BO OM DEPTH It. WELL YIELD TEST It detailed pumping ME,�H00: ❑ PUMPED t tests were done is in- t COMPRESSED AIR ,formation attached?. ❑ BAILED ❑OTHER ❑YES ONO WELL LOG It more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROh1 SURFACE Water Bear- i„y Welt D�a- mete In FORMATION DESCRIPTION cooE, (t. it. WELL DEPTH ft. DURATION hr. min, DRAWOOWN it. YIELD 9Rm. land Surtace r. 9 �; WATER WCLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? OYES ON ANALYSIS ATTACHED? ❑ YES O NO STORAGE TANK: TYPE CA56 CAPACITY _ ,k WELIaq$ W'W%Mtt SG ,*Ono, Inc. DATE s pooaE XIPII 1141 ing SIGi*TURE lk- 311 r�.. . 2��oX 171A may+ sttprsun,7e n; rk 125E+3 PUMP INFORMATION TYPE s CAPACITY MAKER `� DEPTH MODEL VOLTAGE HP PUTNAM COUN'T'Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES er or Purch er of Anilding Section Block Lot Building Constructed by tion - Street Muni- c-iipality i--1 T Building Type R� &_i� I 144ZZIO L I Subdivision Name S Subdivision Lot # GUARANTEE 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 Environinental 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 ofL 19 General Contractor (Owner) - Signature Corporation Name (if Corp.) %r. - rev. 9/85 mk Corporation Name (if Corp.) Address YML ENVIRONMENTAL SERVICES - - ^ 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 93.008220 CLIENT #: 2205 STAT PHOC PAGE 1 WALLACE, DOUGLAS DATE/TIME TAKEN: 10/12/93 13:00 RFD 9 FAIR STREET DATE/TIME REC'D: 10/12/93 15:b5 CARMEL, NY 10512 REPORT DATE: 10/13/93 PHONE: (914)-878-9548 ' SAMPLING SITE: CAROLYN WAY KITCHEN TAP SAMPLE TYPE..: POTABLE : PATTERSON, NY PRESERVATIVES: NONE COL'D BY: DOUGLAS WALLACE TEMPERATURE..: { 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL — RANGE 10/13/93 MF T. COLIFORM ABSENT /100 ML ABSENT COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDING �O THE NEW YORK STATE ~ AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. SUBMITTED BY:______________________________ Albert H. Padovani, M.T.(ASCP) Director LLAP# 10323 deco' Yl :.po® op�atitlS 1Bloe1 anw, pr4','of 'ol® s5walla'Also eec0, Of HM' opproerol of 4100 CcrtNlrst ®,of, Cormfuctioe Compl r10J't o roeYto®,ss tleomvw ow It that inld Voll;w wto AYfItY O6�ftOpt907t ®f- 'lOSreltl0. .;. � -, 'Aross tPPROVED F!OR COPdSTR%kT,%6 i Thio MWOVal',oupboa tmio y t11®.9W'CBV Or'.lneY =. LimC7e o► mo9i4i�8 arlian eon Ot;ba for diMOCMI Of� doR10tf REV... 1n/88 ®ot® FAY DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 "APPLICATION T0- "CONSTRUCT ` A" WATEW-WELh" PCHD PERMIT #'�r� WELL LOCATION //`,Street Adldres(s� Village City Tax Grid Number ia WELL OWNER e - Name i in Address -T- d, rivate E3 Public USE . OF WELL 1 - primary 2- secondary RESIDENTIAL D PUBLIC SUPPLY 0 BUSINESS O FARM 0 INDUSTRIAL O INSTITUTIONAL O AIR /COND /HEAT PUMP O TEST /OBSERVATION O STAND -BY 0 ABANDONED O OTHER (specify, O 'AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED_& /EST. OF DAILY USAGE al ® REPLACE EXISTING SUPPLY O TEST /OBSERVATION GL ADDITIONAL SUPPLY W SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED 13 DRIVEN aDUG ❑ GRAVEL Q OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL A LOCATED IN KALTY SUBDIVISION, NAME OF SUBDIVISION: c� ! C1C y Lot No. WATER WELL CONTRACTOR: Name Address: C_..,o� IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY -DISTANCE -TO. PROPERTY FROM NEAREST WATER MAIN: �w LOCATION SKETCH CES OF CONTAMINATION PROVIDED 'UPN SEPARATE SHEET ' 141- (dat ) (signatu 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 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. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well dril ng operations be contained on this property and in such a manner as not to degrade or o erw se contaminate surface or groundwater. Date of Issue: i 19 Z �: �? Date of Expiration % 19 P rmit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 T APPLICATION TO' CONSTRUCT -A WATER WELL ur Un Dri DMTT a WELL LOCATION Street Address Town Village City Tax Grid Number Name Ma ling Address 3� 'private WELL OWNER All 1 O Z--- O Public USE OF WELL ACUSIDENTIAL 0 PUBLIC SUPPLY O AIR /CO /HEAT PUMP 0 ABANDONED 1 - primary O BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify 2- secondary 0 INDUSTRIAL U INSTITUTIONAL O STAND -BY p AMOUNT OF USE YIELD SOUGHT , ,AT gpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE gal REASON FOR O REPLACE EXISTING SUPPLY O TEST/ OBSERVATION Q ADDITIONAL SUPPLY DRILLING EW SUPPLY NEW DWELLINGY DWELLING O DEEPEN EXISTING WELL DETAILED REASON FOR tJ DRILLING WELL TYPE de DRILLED DRIVEN O DUG []GRAVEL 0OTHER IS WELL SITE SUBJECT TO FLOODING? YES. 2 NO IF WELL IS LOCATED IN A REALTY SVBDIVISION, NAME OF SUBDIVISION: ��fl t C.bG• G..t�- �D P.�'�i� Lot No ,.,z' - grog WATER WELL CONTRACTOR: Name - COQ k4,p ylt d i l phS Address: --�Z,1"no/ Al'a0 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 SKETCH SOURCES OF CONTAMINATION SEPARATE SHEET PERMIT TO CONS 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 thirti* (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 provided by the Putnam County Health Department. During all well drilling operations, the applicant any and all water or waste products from such well property and in such manner as not to degrade o Date of Issue: j C% , 19 "Lv Date of Expiration 19� shall take appropriate action to assure that n dri operations be contained on this r o e contaminate surface or groundwater. ermit Issuing—Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller e PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION_ OF _ENVIRO-NMEN.TAL. HEALTH .. SERVICES.. _•,,;.. •, ,. • - M- - - ;_.__ __ Date 7-- -2-.6 --- pd Re: Property of L.AO9 D f Located at ��. (T) Section Block 3 Lot Subdivision of Subdv. Lot # 1-57 Filed Map # Date�l2 Gentlemen: This letter is to authorize BX tAQ,D l ,Vd a duly licensed professional engineer or registered architect (Indic te) 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 matter and to supervise the construc system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Cod Counters P. E. , R.. )d Address ' Telephone kc-1 /0PL-- Town ' A 6 Telephone •• JNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET-SUBSUFACE SEWAGE DISPOSAL SYSTEM FTTF NO. Owner 9L4%U1aG.6WM Y Address Located at (Street)o.,,L�11,1 Sec. Block Lot (indicatef nearest Tr—oss street) Municipality Watershed efro7MP4 SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITMD WITH APPLICATIONS Date of Pre-Soaking 7-:L6 Date of Percolation Test ROLE NUMBER CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to'-Water From Water Level No. Time Ground Surface. In Inches Soil Rate Start-Stop Min. StaLft Stop Drop In bji� -Drop ....... ' Inches w6-twB 3 2 3 H 2-7 4 5 ilas- ngo 6- 11/Lo- it V9 �.S'r b 2 3 5 3 -1 L4 Z_ - 411,03- 11-2-10 -7 ;?_3 -11--y I - 5) 2-;1v - to zy zr - I & N=: 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 fran top of hole. rev. 9/85 INDICATE LEVEL TO WHICH DATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY:- —I �,. �an.�, �X�� DATE: L� d DESIGN - Soil .Rate Used 8 ---10 Min /1" Drop: S.D. Usable Area Provided �o eOt No. of Bedroans 4 Septic Tank Capacity SS Absorption Area Provided By 1-�-T L.F. x 24" width tren h� =p�� J- C� Q, z -. Other t-) Signate Name � o53*Aaa Address ©• �oyC �j SEAL SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE N0: - __.. __ .. - . - HOLE "N0: H LE Imo`. G.L. 2' 3' o` bti-� tti w ►J �T �9 G'G �trJ�i_ 4' s -11, LJ 40 T 5' r v'e 7' L.1 r, j+-T- 81 IMa -b�eN� P 1"we 9' o E A)o 11' 12' 13' INDICATE LEVEL AT WHICH GROUNDKATER IS ENCOUNTERED o+-� INDICATE LEVEL TO WHICH DATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY:- —I �,. �an.�, �X�� DATE: L� d DESIGN - Soil .Rate Used 8 ---10 Min /1" Drop: S.D. Usable Area Provided �o eOt No. of Bedroans 4 Septic Tank Capacity SS Absorption Area Provided By 1-�-T L.F. x 24" width tren h� =p�� J- C� Q, z -. Other t-) Signate Name � o53*Aaa Address ©• �oyC �j SEAL SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date pp z v1 0 _j (a 0 Ld 0 (n cp U_ Putnam Goilf1t,,ViDepartment jivislon of Envijr nmental Health ealth gw+vioet approved as notilfor confor=1106 With .pplicable Vuled ',,r.d rie.—pilations of tide th Depaxtmer. I-CAZA71-1 0 VEY A -T- = 231 ! % - T— I'S 'a IS, -27 1 98' A: 1S6' A 0. T 4 \ �`t- �� FE , LOT 6 1m a BURDICK GLEN NORTH LOT 5 PREPARED FOO. DONALD AND AUDREY ZADES AREA CAROLYN WAY PATTERSON, NEW YORK 63,662 Sq. Ft. / 1.461- Acres SCALE: 1" =40' OCTOBER 5, 1993 by '6. I I ____ ' ' _.�- I I b, ;01 - — 0 ja'!:� F LEGEND 0 k-F COVERED I. ii DECK GUARDRAIL D E08 ELECTRIC BOX 41' C\1 c6 ul DRAINAGE MANHOLE S 4500.00" W 150.05 E[38 R-325.0� ry to 1 hereby certi Th:t8th a a0rvey one r ubetantially corrects that the title lines And CAROLY N Lines of actual possession are the some, that the S IS TO CERTIFY THAT THIS SURVEY DAVID: L. RYAN bull ng are located ay.shi"neand • not encroach -------- BASER ON A FIELD SURVEY COMPLETED r u rapt title, W4 over . Pon the at . , tj , -or building. lineis OCTOBER 12 1993 AND THAT,THIS.MAP that there are no vlolRtl%.--%n -f t,rlAg rdinonceii - --- I 'Jan ' , r r 11 • I t WAS C0,0P'LETEU Op2� TOBER 21. 1993 reastr h ho u i d r-rut� �onp �lth refeitnocp t: 0ool - S t, p of n-kid L 111*1'r7gP, And that there !-nfn:.e:sv%'111L npirwh nti Iff-31.ting this 6 — N.Y.S. LAND SUC/EYORS property r careful ph kal Ir.-Pec'.1on of the LIC. #47537 41