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HomeMy WebLinkAbout1708DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -4 -29 BOX 15 6r Ir LL I T �' 4- JL sir 01708 4/ YT��O�I.. Ar �T�- - 1T TTTIATT >, WbLL i UUrirL8ziiUly AzrUL% Office Use Only ' �C ,y DEPARTMENT OF HEALTH Division �Of_ Enviionm&ifil° Health 'Services' ' ' - �� �j0 PUTNAM COUNTY DEPARTMENT OF HEALTH STREET ADDRESS: WNW IL I TAX GAIO NUMBER: WELL LOCATION Steinbeck Estates., Farm -to- Market Rd., Patterson, NY Lot 26 WELL OWNER NAME: ADDRESS: Monroe Heights Development Corporation, PO Box 970, Carmel, NY BIVATE p pUBLIC USE OF WELL WRESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /NEAT PUMP ❑ ABANDONED 1- primary O BUSINESS ❑ FARM O TEST /OBSERVATION O OTHER (specify) 2 - secondary ❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED 3 to 5 / EST. OF DAILY USAGE gal. REASON FOR XVEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY D TEST/ OBSERVATION DRILLING ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 900 ft. STATIC WATER LEVEL �ft. DATE MEASURED 2/10/89 DRILLING 0 ROTARY XR COMPRESSED AIR PERCUSSION ❑ DUG EQUIPMENT '0 WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED ❑ OPEN END CASING U OPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH 40 ft . MATERIALS: XR STEEL ❑ PLASTIC 0 OTHER CASING LENGTH.BELOW GRADE 39 ft. JOINTS: O WELDED IRTHREADED O OTHER DETAILS DIAMETER 6 in. SEALX@ CEMENT GROUT O BENTONITE OOTHER WEIGHT PER FOOT 19 1b. /ft DRIVE SHOE-ft-YES 0 NO LINER: DYES O NO SCREEN DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? .... ... - ❑YES ❑ rt; - . _: DETAILS SECOND HOURS GRAVEL PACK ❑ YES GRAVEL DIAMETER TOP BOTTOM ❑ NO SIZE: OF PACK in. DEPTH ft DEPTH it. WELL YIELD TEST pumping If detailed It more detailed formation descriptions or sieve analyses u1ELL LOG are available, please attach. METHOD: ❑ PUMPED i tests were done is in- formation DEPTH FROM SURFACE water Well ,OMPRESSEDAIR , attached? BAILED 11 OTHER i O YES ❑ NO Bear- I ^9 Dia' neter FORMATION, DESCRIPTION cooe. ft' it WELL DEPTH DURATION ORAWOOWN YIELD suitace 20 Hardpan & cobbles a ft. hr. min. 1t. gpm. 235 Hard grey qranite. 265 2 30 265. 235 410 Weathered bedrock. 400 3 15 400 5 410 685 Medium to hard black, white 515 4 20 515 5 and gre granite. 600 5 30 600 5 AAq Qnn Medium to and r & 00: 7 - 700 WATER #CLEAR TEMP. QUAUTY '❑ CLOUDY HARDNESS ❑ COLORED ANALYZED? 20YES. 'ONO A4LYSIS ATTACHED ?XXIES O NO . STORAGE TANK: TYPE Diaphragm ,PUTiNAM COUN CAPACITY 82 GAL. C ' PT: OF HEAL, PUMP INFORMATION TYPE .��Sihl a CAPACITY 5 WELL DRILLER NAME MILL DR INC. DIE /10/89 MAKER Goulds D� 700 7EM5412 230 ADDRESS Putnam Avenue r R ' MODEL VOLTAGE HP Brewster, NY .1051 President V � PRLFWSTER LABORATORIES. . Box 224 - BREWSTER, N.Y. .(914) 279 -4945 - WATER ANALYSIS REPORT - SAMPLE NO. 725.6 WELL 1ot26 SOURCE : Steinbeck Estates Indian Hill Rd. Patterson, N.Y. 12563 COLLECTED: 2-10-89 BY: Mill Drilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. 2 -11 -89 A `4i 'IqQ n�P �' 0 per 100 ml. ,. .._�._.., .ate. ...y,... ..._. .....,. -, ..__�..:,,....__.�,...... FUTNAM COUITfY DEPMM IT OF I1�ALIii D.MSIO -N OF ENViRON1,0ML K 5II VICES O.enex or Qurch/a�ser of B ilaing Balding Coastructdd by Location a Street U0 Municipa.l.ity SIaw, f��� Building 41hx Section Block 1/)t 14AL AtA- •Subdivision tune Subdivision Lot f 3: represent that i am wholly and completely responsible for the location, workmanship,_- material, construction and drainage of the sewage disposal system s a is�y e tI .. I P t_v,. wd that it bas bem c=truete3 as shown on the approved plain or approved amendment thereto, and in accordance with the standardsr rules and regulations of the Putnam County Dot of dealthr and .hereby guarantee to the ownerr his suocessorsr heirs or assignsr to place in good operating condition any part of said system: constructed by me Vbich tails to operate for a period of two years i=ediately following the aate of approval of 'the "Certificate of Construction Compliance" for the sewage dzsp=1 tysten, or any repairs made by me -to such systemr except waere the failure to operate properly is caused by the willful or negligent act of the o=pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the deterniination of the Director of the Division of F.nvira*ental Health Services of the Putnam County Department of Health as to whether or not the failure of U* system to cperate was caused by the Willful or negligent act of the occupant o the building utilizing the system. i Dated is � �' , day of Alb V 19 �-O Signature Q Title f /} al. Ca actoz (Owner) ° ignature Fr. 7YN O V 1 r,�ogati amine c if Co Corporation same (if Co 01 ®®�� .PUTNAh �ciJ%J 47��02� 4���- �Y l ®`y WEPT. QF F ''� Address 7 q )0 FrIF1� Sl''i .31 Iaszecna by �� :L �.� _ �� ;: cR sU��rr�zc�i rrrr = N� Cr area as car a roved DZ_n s Dz t�e of piec-rit r _ -� AI C.� =_ � I 2:1 icy � . ? nct `, 15' f-cm SDS ar- _ cc_ _ cic-Er =-�; y�� ri•ef , brs= etc- . ir0 L- f =V. eat - cCL DIS- is 1.000 b. s_mLi C t " ; �� ri 45 �TL G_ :, d�° b2r c� C�� =_^CLL 4l . 1. _rl 10 i =. CL 1 I e. T sari el EVE jiri n =i,� i 2 =- C 2C_ I I f. _ uL1iT_`TC�I E�v "L'rCry >1�T �_- - T- D�T�`r1cZl.S__'�..-- ..-.._ Di ceazar L-0 1/32 y C= �__ _ G Tr„:_ i c C I �- 20 f=='- — C. 1.Q _ I _- -I-- -I �. Rccn =cr ex=a sicr_, 50% rj cf C- ; e— i Siz- of C == ' rra-.n;I01° to Clcrc ,.. ~- E . Cbcla' by E_= tz LE . ' - i r,:er c, cse - Iii _ EC�E c_ _ E =Lc ZcC =_1- L`'- Z crcG� Plans- C-- C_ C= _nc 1.8„ c:. C-7a Gals'- VT- OVERi. I b_ 1 ICcS C� �? � j V b✓C.� i 1 1 �.� I� ( - c_ 1�' Vices f-!---.L GiZt_Z - -s- of bC_ti I �� i Z'. =rte. ccr_�ns stcr_es < 4 in a -= I---- I---I� iy- ecccrrinc to FI.a� f L'rCt�`''�= sc C??• -_to C_T-=�n crc-_ cuL `l I I I _ GjVGV t =Cm S,5 area I ✓ h- S deli -I'" i _ -c =_cn c. --, crc y _c__ C:r - i � 1 C�4 C),P jzk_mrr,WA-t_ DEPARTMENT OF HEALTH Division of Environmental Health Services 11'0 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # p WELL LOCATION Street Address Irfbt I A11,L Town Tax Grid Number )2-0, 'f --t 1. .O WELL OWNER Name. -4 Mailing Address 20 /Z,ouT , 'Z rivate A) . lo,-o o Public USE -OF WELL - primary 2.- secondary ; Z DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y.. 10512 ('914) 225-3641 App FrnwIvIom T'O"CURISTIMM- --WA PCHD PERMIT # IS WELL SITE SUBJECT TO FLOODING? YES NO WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. ER WELL CONTRACTOR: Name_ Vk' 164_A~ Address: .,P�,T:&'PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _NO OF PUBLIC WATER SUPPLY: N/A- TOWN/VIL/CITY R ­DISTAN_C_E FROM PROPERTY ­ -TO P 61 M NEAREST- WATER MAIN:' LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED SIMET []ON REAR OF THIS APPLICATION 7L SEPARAZ WAS at Ki ) r, -7 J10b -7- (ate (si atuie) 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. Submit a Well C pletion Report 0 form prDvided.. t Putnam Coun y 3. Va Report permit. r vide4d t Putnam Coun y I n g YAff cl a Health Depart Date of Issue: m tr 19 t r rml mit ssu ng fflCldl Expiration: 19 Date of te copy: H. D. File Permit is Non-Transferrable Yellow copy: Building Inspector Pink Copy. Owner 2/87 Orange copy: Well Driller Street Address Town) ; 111;iel 134 Tax Grid Number 'WELL LOCATION EA" AttY�-f 120" FW&tSa 90 7-- 2 A4 tJ /V Name M Ailing 'I-7o ;Address WELL OWNER - & c rg A/ mz cmmm Co L v, CA -ezm� tv� i05' L_ OPublic E OF WELL XRESIDENTIAL 0 PUBLIC SUPPLY E3 BUSINESS 0 FARM (3AIR/COND/HEAT PUMP 0ABANDONED TEST/OBSERVATION 0 OTHER (specify' primary, , secondary 13, INDUSTRIAL. OINSTITUTIONAL -BY ❑ STAND. C3 AMOUNT OF USE - YIELD SOUGHT 510 gpm/# PEOPLE SERVE D /EST. OF DAILY USAGE ev gal FOR NNEW SUPPLY OPROVIDE ADDITIONAL SUPPLY C3TEST/OBSERVATION ,,REASON TLLING OREPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL ,­-4`?DETAILED ul;pw PT6 I D_ I 111.�.REASON FOR 'DRILLING WELL TYPE DRILLED DRI VEN. 13' ODUG [3GRAVEL C] OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. ER WELL CONTRACTOR: Name_ Vk' 164_A~ Address: .,P�,T:&'PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _NO OF PUBLIC WATER SUPPLY: N/A- TOWN/VIL/CITY R ­DISTAN_C_E FROM PROPERTY ­ -TO P 61 M NEAREST- WATER MAIN:' LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED SIMET []ON REAR OF THIS APPLICATION 7L SEPARAZ WAS at Ki ) r, -7 J10b -7- (ate (si atuie) 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. Submit a Well C pletion Report 0 form prDvided.. t Putnam Coun y 3. Va Report permit. r vide4d t Putnam Coun y I n g YAff cl a Health Depart Date of Issue: m tr 19 t r rml mit ssu ng fflCldl Expiration: 19 Date of te copy: H. D. File Permit is Non-Transferrable Yellow copy: Building Inspector Pink Copy. Owner 2/87 Orange copy: Well Driller 5 v A CCUNrv_ DEP.ARIM= OF MALT INDMT=UAL W-AM SUPPLY & "A dvI (fRiime of Cwmar) APP-r- MIX . B - DIVISION OF ENVIRCNMENTAL HEALTH SF.Rvias RE=,q S= COMM== PER= 'RE= WED . BY: C C P-1. Af YES I NO P I ( OVI VVL (41 It L A L-2 trench provided r�_=qui red 60 ft. xax. Parallel contours 100% e_xn. CAAM, F= S-ZSIP-S cl C-11 , 'v- ie-- f 1 10 f t. 0 fill n n es es n nei s C! _or q dentin 1 aces 100 f o ood elev. f 200 ft. re e -7,1012:, etc. Li 50 ft. tri 11/gall. DCCMOM - - 'Permit Application Corporate Resolution* Plans Three sits Encin rs A-ut-horizaticn Design Data Sheet ME) Deep Hole Log Consistent Perc Res-,f_its Perc Hole Depth ' Perc (3) F 4'. 11 QI_ ca T L House Plans - Two setS Well Fermat; Pvrz Variance Reauest GCE_ _ L Legal Subdivision 7 Su'"i-Asion Approval Oier_"ked SEMS Ad-:. Lcts Checked Wetland (Tcw-n/DEC Ps=_it R & D) Data Cn DDS Plans & Penmit Sjra RE(:Tj= DETALTITUS CN PL2NIS tievac-e System Plan - (north arrcw) CZFaaca Sys tan Hv(f--aLL1- ic R-r-Of Gravity Fl-c,, Fi 11 Profile & Dimens --cns " Vol D or J Eox;Trendh/GaII=_ry; pit delMils Septic Tank - Size, De+--=-,l Well Detail, Service L-L.-.e if over Ccnstr-u&Ucn. Notes (grinder rate) Design Dat.a: 1perc and deep res-112-Its tw&Foot Contours Existing & Prcccsed Driveway &'.Slopes cat Footina/Gatter,Cur-',-ain Drains CK) Perc & Deep Holes Located Representative of primary and ecpansicn -E=ansion Area; shown; gravity flag, suff. size IJ-'-: P=ped Pit & D Box Shawn & Detailed House - Vo. of Bedroans Wells & SSCS's w/in..200 f-;L--. of Proposed Syst*a7 Pr.aperby Metes * & Bounds House Setback Necessary (Tight lot) House Seder - 1/4"/ft. 4"0; Z,�e pipe No Bends; Marc. Fends 45" w/cleanout SEMMON DISTANCES SPECIFIED CIN PLAN Fields 10' to P. L. , Driveway, Large Trees, Too of f 20' to Foundation Walls 100' to Well; 2001 in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. ex--ca 151 to Drains - Cumin, Leader, Footing 35'to =tch basin,s-t-or: =ain,ciced watercour 10' to Water Line (pits-201) 50, inte=nittent drairace course Septic Tanks 10' fran,Foundaticn; 50' to well 151 Well to PL 9 a Putnam County Department of Health Division .of'Environmental Sanitation. AFFIDAVIT CORPORATE OWNER APPLICATION FOR PERMIT. APPLICATION SUBMITTED TO - - PUTNAM COUNTY :HEALTH DEPARTMENT. The Commissioner of Health - In'the matter of application-for Am oe -if T CIC-4.0 V-r: -ORPA-WV IL� r9 J 1.�� •�_i� C hoc= ��l _ ,� _ �, ,_ o represent that I am an officer or employee of the corporation and arm authoriied�= • to act. gOr &d ROC- z 1 � �tTs_ Z� (%�Gt> ��1Y &0.' L 7� — _ • (name of corporation) having offices atQl�f Whose- officers -are PresidentQS ClOCC-.� an _ Name d XZress) Vice- President �}� (� 1 C o Ct� e- -7 � - - _ (Name and Address) Secretary l _ GLo GG0 I- sfvl7/ (Name and Address) Treasurer (Name. and Address). `� — _ _ _ and that I am and will be individually responsible for any or all, acts of the corporation with respect to the approval r quested and all -sub- sequent acts relating- tlieretoo' Sworn to before me this /;� day Signed _ _ Of 1987 Title l _ otary Public _ ANNE B. COhRIDkN Aly Con�•N„ �� QU Corporate. Seal A ' • ,, -PUTMm OOU[1i'Y•..DEPAB'IIE.,CF HEALTH,,..... 4y DIVISION':OF HEALTH •SEtZVTCFS , DESIGN t (U► O N tZO lz H t Cz N T Owner tf�t df��nc17 .., Co+� �; Address =o.. �o1Gr Gj 1l N ,4(LM To M t�2 t~.�7 C2olt� Located -at --(Street) ~ _ C►n��my�� �.a Seca:...... ' Block 2 Lot Z f (indicate nearest cross street)r ...._:....,.:�.:. fir. ,__....:......_ ". ..:.•:,e ....�..+.. J Municipality "Tbw �► .. p (�7T b watershed GlZO7o M. SOIL Pgt00LATI0N TEST DATA REOLMED ,M BE SUBMITrID WziB APPLICATIONS Date of Pre-Soaking I a . �'y aZ s Date of Percolation. Test i o 1 SOLE �.NC�lBERv._:._..C�ACR T.fI�.,...: .` ..... ::. .,,.: • PEEtaQLAiTON - . -- ....PEROOLATION ' ' • Run t Elapse, Depth. -to Water :.Fran Water Level . AIo: Tune " `Ground Surface = in' Inches :: Soil Rate ;: -Y 'Start- Min. Start Stop Drop In Min/In Drop..; - :Indies ? • 1 � 2 1 , 3 .__� :tip _. - ....:��. . _ ..... .. �::. .. ,.... � :. .2 3 _ .................. I o .5 ...... 1. ,.......},..._.. - ..... �:... ....... _ .. ............. _ ........, � .. . 2 . 24>: 3 12'2 1 1Z. TI 130 24 1 2 3 NOTES: 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 from top of hole. rev. 9/85 14° INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED O/A INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING EN�70UNTERID l�l DEEP SOLE.OBSERVATIONS MADE BY: bATE: DESIGN Soil hate Used U -15 MirVim Drop: ().780 S.D. Usable Area Provided . No. of Bedroans 4" Septic Tank Capacity - 12 !�_U gals. Type SO N G Absorption Area Provided By 00 L.F. x .24" width trench. Other Name (.A-y►2WT E-Q6UJF- 6Ki1J4. kssec. ec, Signature A aevl hU rc .a Address '� 3 1� (121 =1 rr t�l7 C� 21 V4 SEAL- No. 56124 ��vV pra-77 t2s0 ^ �NLj ©EESS THIS SPACE FOR USE BY HEALTH DEPARDEIT ONLY: Soil Irate Approved sq.ft,/gal. Checked by Date 11 GIZ055 SECTION GLEAN FILL SALT HAY OR UNTREATED 6UII.DwG PAPER `q'0 PERFORATED PIPE (CvG.) 51 -of'o - Y92'lF7• i o o o rIN15HE0 GRADE CLEAN FILL LAYeK OF SALT HAY OR UNTREATED 151.0&. PAPER -1'4 PERFORATED PIPE (f'v.c) 5LOPe Y32'IFT. q' Ih' GRUsHED STONE OR WASHED GRAVEL ,CAP eND OF EACH LATERAL LONGITUDINAL SECTION DO NOT INSTALL TREN61­le5 M WET S011--, 51DE1S, AND EoTTOM OF TRENCH PRIOR CINC GRAVEL. ENDS OF ALL DISTKJBUTORS BE CAPPED. NOT TO 5CAI.E I I I 3,5'DIA. INLE75 PINI500 GRADE rKCMOVA mle_ GOveK NOTES: P. VC. ONLY THE INLEt, FROM PUMP OUtLET AND TWO SI GNAMBE(:0- OUTLETS t0 BE KW N-- A 0 I --I.0' 3;.o' 2 580� 70:0' 3 G3.0 -11.0' 4 fo0.5 72.0' 5 74.0' 74.0' Co 19.5. 7G.5' • N44'29'SA"E - 2�+.3isii' �/ 8 84 0' 110: 5' -f;v1?veY aF -P1zoPerRTY f:►err.IAK�D.- 6Y 112.5' 10 94.0' 114.0' II 9,1 a' 11-7 12 101.0' 111.0' 13 10!5.0 1 11 "1.0' 14 e7.0' • 30.y' 15 (o2.d 34.0' IS 1-1.0 I`1 84.h 4 I i `- INt71EiATG��;ON;TNIg'PLAN'AIiID TYFA'G•TNFi ;e �� l� I 9Y°.�7Pr,M WAh tN*.yPGIiTCiD`OY N1Pi:OP.POI�Fi N06.49'19 ?E - 13.28'/' � IT WAaJ`GOV,�IZG�'oVei>* 7itL' g`f9T2M WAq �a• ,'�: j GON�'7W1lr7Lp,IN,A4601Z,121 iL�. WItH ALl. V. AF'J 4Z 12V',".•! IRP.YiUt�ATION9OF.TNP N2940'03`E 27.10' • PVTNANI COUNTY I?f:Ps�iRTNte:hrf•OP= N>✓ACtN -'' Gti�'� ANO THE NEIN YOIJK-b'Wfl'. f96PARIMe,NT • N44'29'SA"E - 2�+.3isii' �/ a WEU4;NOUhE GQGATION TAK'LN PROM -f;v1?veY aF -P1zoPerRTY f:►err.IAK�D.- 6Y ( . 'fE�'r �EI¢•GENOOI�i'� GOLLlNS� L.S. �• DA-(t✓D 11-2 -q0• � �� (6sG�` •.'s �' i' N55'07'20;'E - 59:215' N75'12,1I "r- - 69.1 —�— t• ,- w0 y \ \ 1 \ Q i F 1 a 1 I 1 , 1 1 1 1\ 1\ � 1 � 11 � 11 — '- 1 1 FFF r /y�'rwutlo5 \�yh3.5S 7 i 104 A p f1 Ir �t 1 t• i' %t :I I: 4 , X'1,P 17 G 4 !O .O G3 � 129 !sAl. r0� �