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Home My WebLink About1700DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -4 -21 BOX 15 01700 NO 1 6 16 IN NJ 140 �- ,; 6 NO IN I NIININ 01700 MIT --77 PUTNA I K CO UN J Division o E& mhebtal He 5 CERTIF7 TE Qf.rQNSTRV.CnON,CO MR E I P ARTNENTOF HEALTH id ib ' f> Sim, R SEWAGE DISPOSAL SYSTEM reAC S i) t.) -i" !-Mcc A-r fAiz,�I Block t Located it— MV, wn:er/dp04cant Naipe b•&>tor►gw r Co. Cry ForIeHy — - SubdlAslid N S V # MaWng Mdress Q .6170 ZIP4lQ Dite Perinit Issued , fp,laq 18 J Cl 7- Separate Swwem by g� . System di Address L4 Consisting . I ,lf —GW16n. Septic Tank and -0 Water Sy� pp I y; 'Pu bie Supply From A ddre" ALCAddress ie A4 ' LI— &I Ul m _U or: Private Private S�Oply PrO�4 I I - Has Erosion Control Bieentouip.Nted? BOd!ng .:! 1: �. L. I "., - .. 1 1. .% ... � L .". '' ..z '. ". , I MS "skie Grinder Bees InstaUed?' 61 1 p ejtt ,Ot.hee.R_e 1q listed :serving the shove as. . wej�e constructed . essentially 11 1 y as L sh ovn on the plans of •th . a 6ompleted'Qork copies ifis - h(s,)I�s C ,of which'ars' il - qystei i�w in�4866rdance'vyfth the standird#:,�r , uler and, irs U)apions;; i I , I 4CCOFdince. with V; and the permit issued by the iat a6hed), 1 9 Putnam County Department of Heiith. P.E. R.A. AAA, '7. Date d by . ense No g, SS Lic , Any p!rsqn occupying premises .L!! iv ed by the -above j,;"je* n($)-shall,,, tp""":h a' c, tlop-as may be n, e-c'Le,r ssary to, secure the co rectiori 6t any unsanitary I,ons resulting frqh-,s4ch usage .AOproVa!,:qf-tq t ihall bijone rtll: jnd void as soon as a unitary' savNer 'becornes approval 6f,,'jpje p!ly�, e id tilk i�iifii supply' available. Such, approvals are avalli6i fnd,the,ji "t null P4, _Yo... 5 et qkt odific,ation or change '" w hsn.�.AnLJM6 �.Wd su ch nivocs c; grneht "of,Zthe Cofnhiliilonier. �df 'Health t ion, m6difi 'tion or change Is'necessary. Date Y TItN e� M WZ1.,1, t0Vr1- i,EjL.LVL9 i..LL vL%l DEPARTMENT OF HEALTH �.Divisi n. Of_Environmental Health Services -__ Y O PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only STREET ADDRESS: WNIVI 1 I Y TAX GRID NUMBER: Steinbeck Estates Farm —to— Market Rd., Brewster WELL LOCATION WELL OWNER NAME: ADDRESS: NY M PBIVATE ❑ PUBLIC USE OF WELL 1- primary 2 - secondary ® RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP 0 ABANDONED ❑ BUSINESS ❑ FARM 0 TEST /OBSERVATION ❑ OTHER (specify) C1 INDUSTRIAL ❑ INSTITUTIONAL' ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING ® -NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 900 ft. I STATIC WATER LEVEL 30 ft. DATE MEASURED 4/20/88. DRILLING EQUIPMENT ❑ ROTARY ® COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION. ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. 12 OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH 71 ft. MATERIALS:. ® STEEL ❑ PLASTIC L7 OTHER LENGTH.BELOW GRADE 70 it JOINTS: ❑ WELDED M THREADED ❑ OTHER DIAMETER 6 in. SEAL: I&CEMENT GROUT ❑ BENTONITE ❑ OTHER WEIGHT PER FOOT 19 1b./ft. I DRIVE SHOE11YES ❑ NO LINER: ❑ YES ❑ NO SCREEN DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? DETAILS FIRST OYES ONO OUR- - SECOND _ . _ .., . - ._ ..> ..:. _ _.. _ . _...., . _ .. - ... GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH It. WELL YIELD TEST pumping If detailed METHOD: ❑ PUMPED 1 tests were done is in- 10 COMPRESSED AIR , formation attached? O BAILED ❑ OTHER i ❑ YES ❑ NO SELL LOG if more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear- in9 Well Dia- meter FORMATION DESCRIPTION GJOE. tt. ft WELL DEPTH It. DURATION hr. min. ORAWOOWN ft. YIELD gFm Land Surface $llt ..Sand avel & boulders 30 300 no 6 Medium to hard .grey granite 400 1 30 400. 1 2 300 560 Medium to hard grey & black granite . 500 2 - 50 3/4 560 685 1 mite black __& j2ink gEanite 700 3 - 600 1 6851.760 9= & vink granite 900 '6 _ te WATER CLEAR TEMP. QUALITY O CLOUDY HARDNESS ❑ COLORED ANALYZED? EYES ❑ NO ANALYSIS ATTACHED? ® YES ❑ NO STORAGE TANK: TYPE Diaphram CAPACITY 82 GAL. 26 PUMP IXFORMATION TYPE �° CAPACITY 5 MAKER Goulds oEPTH 840 MODEL 7E20 VOLTAGE 23OHp 2 WELL DRILLER NAME MML DRILLING, INC. DATE AooRESS Putnam. Avenue s a 4 .26 88 .46V Brewster, NY o ant I represent that I am wholly, and completely responsible for the location, wor)ananship,'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 the Director.of the Division of Environinental Health Department of Health as to whether or not the fail ur caused by the willful or negligent act of the occupant the system. Dat ed this _ day eral actor (Own `1LQroc Tlti OA conclusive the d Services of the e of the system rev. 9/85 mk of 19 r :— Signature Corp.) Pane Signature Title etexmination of Putnam County to operate was Lding utilizing I., ELLIS` A. TARLTON LABORATORY ` DIVISION OF ELLIS A. TARLTON, ENGINEERS, INC. CHEMICAL • 34 PLEASANT STREET DANBURY, CONN. 06813 -2328 WATER -WASTEWATER PHYSICAL METHODOLOGY p BIOLOGICAL P.O. BOX 2328 203 - 748 -7903 APHA - EPA - ASTM k6o' k i —OP BAC:i`�ia OLOGICAL AND-049MI �, Af�AIRIAIi�CS - F WATER NAME AND r ADDRESS OF I Mill Drilling, Inc. PERSON TO RECEIVE Putnam Ave REPORT I Brewster, N.Y. 10509 DATA �1 SOURCE OF SAMPLE Water Supply, Steinbeck Ests. Lot #4 Patterson; N.Y. DATE OF COLLECTION COLLECTED BY July 1, 1988 Mill Driling Hydrogen ion COLOR TURBIDITY ODOR CORROSION INDEX DISSOLVED SOLIDS Concentration LANGELIER (PM) RYZNAR NTU Mg /L Alkalinity as CaCO3 Fluoride (F) Bicarbonate Nitrite Mg /L Mg /L Mg /L NITROGEN Alkalinity as CaCO3 Chlorine Residual CONSTITUENTS Nitrate Mg /L Carbonate Mg /L Mg /L AS Total Hardness as CaCO3� Conductivity NITROGEN (N) Ammonia Mg /L Mg /L Micromohos /cm Mg /L Iron as Fe Mg /L Mg /L Chlorides as CL Mg /L Manganese as Mn Mg /L Mg /L Detergent as MBAS Mg /L Sulfate as SO4 Mg /L Mg /L The arithmetic mean of all standard samples examined per month using the membrane filter technique shall not exceed I MEMBRANE FILTER TEST one- colony. per 100mL - Coliform colonies per standard sample shall not exceed 3/50ml, •4 /100ml. 7/200ml. or 13 /500mi coliform Colonies /t00ML in: (a) Two consecutive samples: (bj More than orie standard sample when less than 20 are examined per month: 'or (c) .0 More than live per cent of the samples when 20 or more are examined per month. AT THE TIME THE SAMPLE WAS SUBMITTED: ❑X 1. The results of the analysis of this sample were satisfactory and met requirements for a potable water. F] 2. The results of the analysis of this sample were satisfactory for a potable water but certain of the chemical or physical constituents were high. These are as follows: E] 3. This sample was not satisfactory since it did not meet the bacterial requirements for potable water. The presence of organisms of the coliform group in a sample of potable water is undersirable and, while not necessarily Indicating the presence of any disease- producing organisms, does indicate that such contamination might survive to the same extent. The presence of organisms of the coliform group may also indicate that the treatment was not adequate at the time the sample was collected. El4. This sample was unsatisfactory as a potable water because certain chemical or physical cor `!cents were above acceptable limits. These are as follows: COMMENTS The bacterial analysis showed no organisms of the coliform group at the time the sample was collected which indicates the eater potable. II. IV. V. eu'rr�v1l1�1 1. INSPECTION FINAL SITE - • it �!1... ,�� r / i �i� OWN rru •: r E• O a li, .e 1 a. SDS area located as approved plans b. Fill section - Date of placement 2:1 barrier. LGTH WIDTH AVG.DPTH c. Natural soil not stripped d. Stone, brush, etc., greater than 15' from SDS area. . e. 100 ft. from water course /wetlands. SEWAGE DISPOSAL SYSTEM a. Septic tank size - 1,000 1,250 b. Septic tank installed level c. 10' minimum from foundation d. No 90° bends, cleanout within 10 ft. of 450 bend e. DISTRIBUTION BOX 1. All outlets at same elevation - water tested 2. Protected below frost 3. Minimum 2 ft. on inal soil between box and trenches f. JUNCTION BOX --properly set g• TRENCHES 1. Length required - Length installed S7) 2. Distance to watercourse measured. ft. 3. Installed according to plan 4. Distance center to center 5. Slope of trench acceptable 1/16 - 1/32 " /foot. 6. 10 feet fran property line - 20 feet - foundations 7. Depth of trench < 30 inches frcm surface 8. Rosin allowed for expansion, 50% 9. Size of gravel 3/4 —11" diameter 10. Depth of gravel in trench 12" minimum 11. Pipe ends capped h. PUMP OR DOSE SYSTEMS 1. Siz _ p _chamber .. _ .._ ^2. Overfl 3. Alarm, vi udi 4. Pump easily ac le manhole to grade 5. First box fled 6. Cycle essed by Health De es ' ted flow per cycle HOUSE ' a. House located per approved plans. b. Number of bedrooms WELL, a. Well located as per approved plans b. Distance from SDS area measured ft. c. Cas.in 18" above grade. d. Surface drainage around well acceptable. OVERALL WORKMA.SHIP a. Boxes properly grouted b. All pipes partially backfilled c. All 2ipes flush with inside of box d. Backf ill material contains stones < 4" in diameter e. Curtain drain installed according to plan f. Curtain drain outfall protected & dir.to exist. watercoursE g. Footing drains discharge awa fran SDS area h. Surface water rotection adequate i. Errosion contro provided on*slopes greater than 15 %. 1 ` ^4 DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 AP PLCAATION' TOt'CONSTR�JCT�A WATERWELL y rw -gp PCHD PERMIT i WELL LOCATION Street Address (Tow'/Village/City Tax Grid Number WELL OWNER Name Mailing Address , p,ry1C C�'Z� rivate 0 Public USE OF WELL �- primary secondary SIDENTIAL 0 BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY (J AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY 0 ABANDONED ❑ OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED 4 -& /EST. OF DAILY USAGE1 (>gal REASON FOR DRILLING EMEW SUPPLY O REPLACE EXISTING SUPPLY. ❑PROVIDE ADDITIONAL SUPPLY 0 DEEPEN EXISTING WELL F3 TEST/ OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE : DRILLED aDRIVEN ❑DUG GRAVEL DOT IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: �(� L Lot No. WATER WELL CONTRACTOR: Name --Toe Address: IS.PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NAME OF PUBLIC WATER SUPPLY: Kj�, TOWN /VIL /CITY nISTANCE TO PROPERTY`AOM lffAAESt WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDEWON ON REAR OF THIS APPLICATION SEP RAT HEE date)' ignature 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 pro i b the Putnajy County Health Depa ment. Date of Issue': `'0 19 _# Date of Expiration: 19 Fermit ssuing cia Permit is Non - Transferrable 2/87 White copy: H.D. File Yellow copy: Building Inspector Pink Dopy: Owner Orange copy: Well Driller I APPENDIX PUJINAM C[ADM DEPARMENr OF :E . t: DIVISION OF MWnXKqNML HEALTH SERVICES INDIVIDMI, VMM SUPPLY & SUBSUMM SEM5M DISPOSAL SYSYE t Owner) LF trench provided W, required 60 ft. max. Parellel to notes new P1 ev. 4-1 -e C� tit S� r BY: (Street Location) YE NO DOC(u+�F.�TrS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization s/s Design Data Sheet (DDS) (3) GERMAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Tcwn/DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Seeaage System Mimensio te �-' ravity Flora Fill Profile & D or J Box;Trench lery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes (grinder notes) gn Data:. perc and deep results.— Tao- i'ocit "ConfodF "�i'sting i�opos Driveway & Slopes Cut Footing/Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If Pumped Pit & D Box ShaHm & Detailed House - No. of Bedroans 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 SEEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, large Trees,Top of fill 20' to Foundation Walls 1001 to Well; 2001 in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains - Curtain, Leader, Footing 351to catch basin,stormdrain,piped watercourse 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' fran Foundation; 50' to well 15' Well to PL 9 SUBDIVISION Deep Hole Log Perc Consistent Perc Results Fill Perc Hole Depth cd House Plans - Two sets Well permit; PWS letter Variance Request (3) GERMAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Tcwn/DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Seeaage System Mimensio te �-' ravity Flora Fill Profile & D or J Box;Trench lery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes (grinder notes) gn Data:. perc and deep results.— Tao- i'ocit "ConfodF "�i'sting i�opos Driveway & Slopes Cut Footing/Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If Pumped Pit & D Box ShaHm & Detailed House - No. of Bedroans 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 SEEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, large Trees,Top of fill 20' to Foundation Walls 1001 to Well; 2001 in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains - Curtain, Leader, Footing 351to catch basin,stormdrain,piped watercourse 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' fran Foundation; 50' to well 15' Well to PL 9 Putnam County Department of Health Division of Environmental Sanitation AFFIDAVIT CORPORATE OWNER APPLICATION FOR PERMIT. APPLICATION SUBMITTED TO PUTN4M COUNTY.11EALTH, DEPARTMENT. Tb: commissioner of Health In the matter of application for 116(6-[FT-5 )6(1C-1_0P1)46V7_ 4,7b represent that I am an officer or employee of the corporation and arft authorlied, to act for 0 (name of having offices at -.5'-2 d4-?.P— OL—f S02 4-Q Whose- officers -are President T?fa-me WnTTddr7e_ss)— — — — Vice - President 0 Ce-0 L til -7 " me—aWn Address) d sdT s — — — — — — — C a7 Secretary �c . C. 0 . ZNA. 7/ . . . G 2 E /J (Name and Address ---------------- ..(Name.and Address) - and that I am and will be individually responsible for any or all,actp of the corpgration wl:th-re . pect to the approval requested and all sub_ se'que"t actd rel' tin' tlierito.' n a 9. Sworn to before � m e this zk6 day Signed 7 — of 19 Title otary'Public I ANNE B. COWDAN My CortNmts�Nn county U) 4-0 . . . ....... Corporate. Seal ::p0rjm,CCQw. JI• ' •III ly OF i y' Y. DIVISION e • ENVMMa v FMALTH SEMMES DESIGN DATA SHEET-SUBSUFACE SFSIAGE DISPOSAL SYSTEM FILE NO. u.1`�t�2c�E T��t�O- '�•'CS.... ._ _ . _._ y.,..,_�r,..__.a_ -. ,_ye......_..�.._. yF. --..,_ ._ ._ _. ._,:.n. Owner 1 ti M�J�IT o. Address P?O. 8�o Vhf m �r-[e, KAY ► ggiz, `z'S.. AQyCT 1190. Located at (stteet) V;n a& I1,4- t6wt.[. rco Sec: 6D Block z LotZTo..I (indicate nearest cross street) Fmicipality Watershed <2tx7- t SOIL PERCOLATION TEST DATA REQUIM TO BE SUBMITTED WITH APPLICATIONS Date of Pre - Soaking 74►'� /8'7 ! Date of Percolation Test HOLE . NOMRER CLOCK TIME PERCOLATION PERCOLATION Run Elapse! Depth to Water From Water Level. No. Time :' Gr' d Surface In Inches Soil Rate t Star Stop Min. �_ Start Stop Drop InMin/in Drop Inches inches inches Z7 3 2 4-3 3z:44- 3.: ,4Q S- z4 Z7 3 5 • 2 A:oc7- A,. z( Z7 3 4 :ZZ -A,.44 754- Z4 27 4 , 5 .. 2 3 4. 5 °+NO'D'S: 1 Tests to be 'repeated at same depth until apprc imately equal soil rates are cbtained.at each percolation test hole. All data to'be:submitttd. - :,.... for review.:.. Depth measurerridnts'to be made fran top of hole. TEST PIT DATA'ELOUIPM TO BE SUM41TTED WIM ARPLIC"T ON, DESCRIPTION • SOILS ENCOUMWM IN YE. T.HOLES 1 21 41 51 17-1 81 10, ill - 121 13' HOLE M. N0*0 14' INDICATE LEVEL AT wFiICH GROUNDWATER IS ENMUNTEPM imicm LEVEL TO wHim WATER I= RISES MMM BEING ENMUn=. DEEP ROLE OBSERVATIONS MADE BY: DATE. DESIGN Soil Rate Used Min/1" Drop: S.D. Usable Area Provided -05(oc>cD No. of Bedroans A Septic Tank Capacity I76-tD gals. Type Absorption Area Provided By 50 L.P. x 24" width trench Soil Rate Approved sq.ft/gal. Checked by Date • � A9 t OUII:? ' ' If 1�1MEN510N Gt -iA121 , rt, co .7 1a6 3 aGO 2°l.5 IG. 1020'. -. 100 -72 0 G: of 0 a1 o I�; �2a' 8ro ', co 0 52 0 20 s %5 6`.; 82 d ' 6 yea 916 21� %35� B96' % h %o G33� 22 %ao �JOy \ \ 1 °J \ \1 \ 1�0;TP. NOUyE �OGAtION TAKEN \mss: PtzOlvl �UQVEY 01%�.p12pG�r?SYI \-2� \ \. M6N120E NEtGHt�i•DEVEc QPMEN? c� . \ \ �\ GO't✓"fD `-t?A1t'.19 FUbVhi 31 "� c'' \\ \ \ p1z7Al2tr7 +�Y G17hhf2hGt0 �\ \ �\ t r C .41 L7 ,s 8 � J\ J 1 \ \\. 1 \ I \ I i \ o la Nq I' 1 I •� I L \ 594 - sp _ p, 1 Is ro ' 1 ( II"» ''�' •' Lei \� I� Pl.A1...1 r - 60 , - p¢.gP>:�'TY LItJE AI.tD - tpplpGQAx�1•l1Cl. ._ _ At1QU S'Y �1 + 148'7 .LS 1-4.d9 t�10. ZZ