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HomeMy WebLinkAbout1720DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -4-42 BOX 15 ,, IL II 1.6 6* 01720 avall%bla and M app►oval of tM private water supply sha6, haoomr Bull hn0 otA vvhM a Puelk ".w supply 6060 iwll�bM. Sueh .�p�ovalt we subliet to mo0if tIon or ehaiip. 'when, in tM luApniwit of `thi COm � +MNlth °. iuCh tlori - modl�k tbn of eMnN n' Meawry. �-1 �1n Data Tit /�{�' . 3/$9 pU�NAM COIJrFL'Y pE�1�RTNiFfi7Y' OF` H�1�I;1'H .. . .. °. ".<:' DIVISION OF ENVIRaNWE TAL HEALTH SERVICES o� Acwner or PurcchasNer of Building Building Constructed by AO M IVL kop� Location Street � � UO� ki anicipality S d uiLf/ f M IL- Building 'zjpe go 9 Section Block Lot E2LkA4.7_0 M&4_Cr1W �y��st/ISlo� Subdivision Name Subdivision Lot # GUARANTEE OF SUBSURFACE SEKhGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, wor)mwship, 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 tor' a pezio3` of two, years 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 building utilizing the system. Dated is day of 19 1� Q Gmaixal Co actor (Nner) - gignature P119III'Ve- wit' b- AS dla4� P 44t4t 6�Z 4 L Corporation (if Co j "6 4 i (,). 9 e&WZTE 2 �Jy toSv� Address rev. 9/85 mk Signature Title Corporate Name (if Co . - - /U-�_ \ J . AIAUO-1, WiLLL UUL11rLL 11UN LCLirual ry .e DEPARTMENT OF HEALTH _, +� M.N piy Sion Of Environmental Health Services :.. - • �.�:: • :vim . .. - - -- ._ _ PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only ., . WELL LOCATION STREET ADDRESS: WNIVI Y TAX GRIO NUMBER: Steinbeck Estates, Farm —to — Market Rd., Brewster Lot 9 WELL OWNER NAME: AOORESS: Nonroe Heights Development Qo ration, PO Box 970, Carmel, NY P IVATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary 19 RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND.IHEAT PUMP O ABANDONED .❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT 5 gpm .'/N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING ANEW SUPPLY .0 PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION O REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 425 ft. STATIC WATER LEVEL 35 ft. DATE MEASURED 5/11/89 DRILLING EQUIPMENT O ROTARY X29 COMPRESSED AIR PERCUSSION O DUG O WELL POINT O CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. x® OPEN HOLE IN BEDROCK ❑ OTHER CASING TOTAL LENGTH 115. fit. MATERIALS: 'XW STEEL O PLASTIC O OTHER LENGTH.BELOW GRADE 113 ft. JOINTS:' ❑ WELDED x® THREADED O OTHER DETAILS DIAMETER ti in. SEAL: XICEMENT GROUT O BENTONITE O OTHER WEIGHT PER FOOT 19 lb./ft. I DRIVE SHOE%® YES, O NO LINER: O YES ONO SCREEN DETAILS _.. DIAMETER (in) SLOT SIZE LENGTH (It) DEPTH TO SCREEN (it) DEVELOPED? FIRST O YES -.❑ NO _ - HOURS. SECCNO" _ . . ............ :.:... : -- . _ GRAVEL PACK OYES O NO GRAVEL SIZE DIAMETER OF PACK in. TOP DEPTH ft. BOTTOAt DEPTH It. WELL YIELD TEST It detailed pumping METHOD: ❑ PUMPED tests were done is in- ME COMPRESSED AIR , formation attached? O BAILED ❑ OTHER ; 0 YES O NO 'WELL LOG It more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE water Bear. ing Well Dia- meter FORMATION DESCRIPTION Coal, ft. IL WELL DEPTH ft. DURATION hr, min. DRAWOOWN It. YIELD 9Fm, Lana surface 101 Hard &boulders 101 425 Medium to hard grey & white granite. 300 1 - 300 1-1/3 400 1 30 400 2 -3/4 425 6 - 340 15 WATE)l XR CLEAR TEMP. QUALITY O CLOUDY HARDNESS ❑ COLORED ANALYZED? 0 YES O NO ANALYSIS ATTACHED?A YES ❑ NO STORAGE TANK: TYPE DiaAhragtr CAPACITY 86 GAL. PUMP INFORMATION subTTtersible 7 TYPE CAPACITY MAKER GO it ds DEPTH _3.40 MODEL 7EH07412 VOLTAGE230 Hp3 /4 WELL DRILLER NAME DATE MILL DRILLING, 2� 89 ADDRESS Putnam Avenue SIG? Brewster, NY ' 11, resi BREWSTER - Li460R1�`� ®RTES ' .. Box 224 - BREWSTER, N.Y. (914) 2794945 SAMPLE NO. 7347 NEW WELL LOT# 9 SOURCE: Steinbeck Estates Indian Hill Rd. Patterson, N.Y. 12563 COLLECTED: 5-11-89 BY: Mill Drilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 0 per 100 ml. This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. 5 -13 -89 m Meyer birector Iasi: ._ by Sip=- LLYCATION . � �Cf /1 0 � � D OWNER P -1-M MTT 2 t OR UEDIVISION O a YES Na Cdn''-�= '`frs amroved plans " - _, _ ,...�..... .._ .. ... . b_ Fill section - Date of plac_�--.nt 2 =1 barrier_ I= W= AVC--DFrH c- Natural soil not striz=ed �( d_ Stone, brush, etc-, are tar than 15' fzcm SLS ax—ea.(-�-r e_ 100 ft_ fran ;vat--- course /wetlands. I I? _ SE - DISPOSAL SYSTEM- a. a. Septic tank size - 1,000 ; 25 � I b. Semtic tank inst =1 1 ed level . I I c. 10' minimm fren fcundation I �(- d_ No 90° Y:encs, clle=nout within 10 f__ of 45° bend I ( I e. D1S=Tj -- !aN BOX 1. A-11 cut—lets at same e? vjstion - watsr tested 2_ Protect"ed belcw f_csz I I 3. Minim= 2 ft- orii c mal soil be =weed bcx and f. SuZvC'I`ION BOX - nroce—rly szt 2_ Langth re�r� - La-!c -��i insr�ll � 2. D? s anca to W'atar -,C JL a f t. 3. Lnsta 1 1 - ac_"roo ng to plan 4 Distance to c--rlta - 5. Slone of t=ench accept=hle 1/16 - 1/32 "/ -foot. 6. 10 feet fran prcoe. -"v line - 20 feet - fcur -bars 7. Demth of trench < 30 inches frees =face B. Rc= 211axed for e- m-m- 'sion, 50% 9. Size of grave? 3/4 - l2" 10. Deoth of gravel im trench 12" 11. • Pioe ends corgi h. _ _ OR DOSE SYS=mS 1. Size of pL3ID 3 _ P -lawn, vi su=1 /aLa ? o 4 Ptmm e=siiv ac=a=sible manhole to crane 5. First bcx G. Cwc_l.e w= `-�_=s— by fi =.=i th r./e� u .Ent I I I estirrate f! cw px—=- cvc-le I I I a. F--t,--e lex--'Ied per a:=rcve3 plans. b. Nunhe - of bedrecm s I V. -^' r. a. W-1 loiter as rA--- arnrcved olars b. Distance nce fresh SDS arm= ms—= sur / t" ft. C_ Casing 18" above crade- d- S=face d_r�r=-Ge around we2l accenta le. VI- � ;�T% WCRKN'--Acn � P • • a- Fixes vrc ly crcute b. ?111 pipes partially baddilled I ---I C. P11 pires flush with inside of bcx I ---j- d. ;Z-ckfill Irzterial contains stones < 4" in diamet=r I �-1- e. 0--fain drain i*Ltztl-ed according to plan f. C` ,ai.n &—r-in out =all orot�-ted & di r . to e'cst_wa t=rCOUrE-4- _ _; --�- -- g- tootznq drat nG d? scnarQe away free SLS area. --I- -1 h- SL*-face water prote^- }ticn ade?uate i _ t__oszon c--nZrOI provide.. -' cn slooes crZt=* than 15% _ 1 I V, " 'JV C (Name of Owner) (Street Location) DOCUMENTS Permit Application Corporate Resolution �s Plans - Thee°- se /s .�P-gi.nen s.- Itbari:zat?Aon- - Design Data Sheet (DDS) SUBDIVISION Deep Hole Log Perc Consistent Perc Results (3) Fill Perc Hole Depth cd House Plans -:Two sets Well ✓permit; PWS letter Variance Request GaERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Weiland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flcw Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes (grinder rate) Design Data: Perc and deep results Two-Foot Contours Existing & Proposed Driveway & Slopes Cut Footina /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 Shown & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Proposed Systems Property Metes & Bounds House Setback Necessary (Tight lot) House Seaer - 1 /4 " /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees,Top of fill 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains - Curtain, Leader, Footing 351to catch basin, storndrain,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 'm�^t* \1 ;vi"�77'S'F ,.17.. g .'• bhsiry A k1 4' '""A" t�,�CF 3 , PUTNAM COUNTY DEPARTNDIT OF HEALTH ,,, Dtvielou of Eovhonmenbtl Hedeh Servloea. Cte®el. N "Y fasts CES17Fi�r Peemk oa. COMPLLIN /fy CATS OF / /f� /� CE Ma-.nu N PEitNIPI`IrOE SEWAGE DLSPOSAL SYSTEM .. _ f/ Peemlt K �AT7',�� ?s a� u ,gRAV, 7d ryA k T L? ewnM ..nl�w� .w� wwwl' www..�.ww �ww�ta tw �. ��t. -.. �� .�� :.��,�-{ X. .e _• r,vuncy ueparcmanc or ngalm Date Z Z Signed' APPROVED FOR' CONSTRUCTI!b' Thls approval expues two:'years from the,gate Issued' unl revocable for cause of may be amorided or modltled when eons�dared necessary ti the Com i requires a' permit. pprov t dis sal of domestic s6nitary sewage d/o nv" a� j Oate ;yp By.- m !It. .1n0 D%!, eras, rtes a reyuuslvns W 119 "0 ru[nam P.E R.A. license No ess',construction, of the building has been undertaken and is sinner of . . .; Health. Any change or alteration of,construetion �atp ly PUrNAM C U ZY DEPARRMU OF HEALTH DIVISION..OF HEALTH -SERVICES ..M CE r1n, TLF -mw Owner y "/V,6 *r r Cc , L TJ Address /�0 A 9 %b C A / ?111 -L . /V j/' / 1-4/?k/ 7-0 I' /11l?h'A-% R,�%_ � ' Located at ( Street) ,C-(2 C, U1.y i LIZ" y, Sec. B6 Block �. Lot Z !o_ (indicate nearest cross street)° Mn cipality /22 (.f.i11- 01 /A 72F-APsy A/ Watershed SOIL PERCOLATION -TEST DATA RBQU3= TO BE.SUBMITTED WrM APPLICATIONS Date of Pre- Soaking L /1 S 7 Date of Percolation Test ii 8 .HOL&- AnPlBER CiACR TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Tune Ground Surface In Inches .$oil t Rates . Star Stop min. Start Stop Drop In Min/In broil . Lo7R. Inches Inches Inches 2 .3'.09 — 3:39 1.. 3 '3'.4,0 q-, �� 3a 2,4 2G 5 4 .. 01 1 24 3 2G,. %.. 2.. 2 3 o I- 3; 3 30 24 5 1 2 3 4 5 NOTE,Se 1© Tests to be repeated' at same depth until approximately equal soil rates are obtained .at each percolation test hole. All data to'be.subnitted for review. 2. Depth measurements to be made -fran top of hole. t. p TEST PIT DATA RDQUIFtID TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENOOUNTERED IN TEST HOLES ' DEPTH HOLE NO. HOLE NO. HOLE N0. G. L. 1' 2' 3' sa.avY . .41 C t34M . 5' 6' 4 8' t 9' Cam'. • • 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENOOUNTERED INDICATE LEVEL TO WHICH WATER LENM RISES AFTER BEING ENODUNTERFD f4 /A ..DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used I& _-Zo Min/1" Drop: S.D. Usable Area Provided' No. of Bedrocros Septic Tank Capacity 12 Sao gals. Type Absorption Area Provided By 506 L.F. x 24" width trench Other Name L .�U�P�/tr% ,�G //VIE //� /� : 95. jj(�SSignature Address 7 A;41-f if -1 . 2 j.�i?j VE SEAL fig., j THIS SPACE FOR USE BY HEALTH DEPAR'IlM ONLY: Soil Rate Approved sq. f t/4al. Checked by Date .t Y Putnam County Department of Health Division of Environmental Sanitation __: _.: ----- ..__...- ._-- •....._... F ��, - .CORPOR�T_ C4JNER: APP11.xC TLON F. FOR PERMIT. APPLICATION SUBMITTED TO - PUTNAM COUNTY }IEALTH DEPARTMENT. ! : The Commissioner of Health - In the matter of application for ` fft l 6 -IfTS .� Lie represent fl _ that I am an officer or employee of the corporation and am authorlied. a to act for . �t��4C_ .1 �` ��voGd•,.��'Y1 7-��� L7� (name of corporation) having offices at ,r1� �,�9 _� .�'►2�� -_ _ �_ �:�0 ,� - _ _ Whose- officers -are � President p S } C lOG C� �f}-x1 �,� ���� 57 6z2 _ (Name ana- Address) Vice - President DA0 j� _C ( o GG,9 t- 114 7 / (Name and Secretary m��t} 1� _ CLO Gc_o �- J-_i t7/ _ G _ /l�_ (Name and Address) . Treasurer -- .- (Name• and Address) _ — P and that I am and will be individually responsible for any or all :acts • oil the corporation with•respect to the approval requested and all•sub- sequent act9 relating _ tliereto m ' - sworn to before me this day Signed of 198 Title otary Public �--� ANNE B. COhRIDAN Mme► P ft-swe r NM yet Wo?I e . RE!1 0 4 i Pew qa-v- k Corporate Seal DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION Street Address Town Village City Tax Grid Number A a % /( T 122, . ,7.$)I✓ Zs P �3D_ Z _ of WELL OWNER Name O� Mailing Address gip., dX4'�a rivate Co., 6TP. c ? ,� Al Public ,SE OF-WELL 1 - primary 2- secondary RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED . O FARM O TEST /OBSERVATION []OTHER (specify, 0 INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT ✓ gpm /# PEOPLE SERVED y ! /EST. OF DAILY USAGE /O 0 gal REASON FOR DRILLING 0 NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST OBSERVATION OREPLACE EXISTING SUPPLY 0DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING =- WELL TYPE DRILLED DRIVEN EIDUG C3GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES y NO IF WELL-IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. GG. NAME OF PUBLIC WATER SUPPLY: IV A TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION 4KON SEP nTE HEE Z Z ( at- e signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a -orm prow de by th Putnam Co my Health Department. (' Date of Issue: 1 19 Date of Expiration: 19 e t Issuing Official Permit is Non - Transferrable White copy; H.D. File Yellow copy: Building Inspector Pink Copy: Owner 2�$% - nrancsP mnv_ WP11 l)ri 11 ar WATER WELL CONTRACTOR: Name Tn J3c /7��?/471/V6% Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: IV A TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION 4KON SEP nTE HEE Z Z ( at- e 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 -orm prow de by th Putnam Co my Health Department. (' Date of Issue: 1 19 Date of Expiration: 19 e t Issuing Official Permit is Non - Transferrable White copy; H.D. File Yellow copy: Building Inspector Pink Copy: Owner 2�$% - nrancsP mnv_ WP11 l)ri 11 ar TION N'TED 'RATED PIPE fOINT 0 5EGTION CAP END OF EACH L ATERAI, 'INCHES IN WET SOIL. OF TKONCH PKIOK OF ALI, DI,5TKI3UTOR-,5 TON TRENCH .E 1T J 3,5 "DIA. INLETS D &KADE —' /EK NOTE5: ONI Y THE INL r-,T, I PUMP i OUTLET AND TWO SIDE AW OK Of OUTLETS TO BE KNOCKED PVC. OUT AS SHOWN. A St:PTIG C. -- I 1 PINISHEO roRADE 5l' REMOVABLE WVE12 �., 2' ALL OUTI.t;16 UET I \qI SAME ELEd OUTFZVV 174 MIN. 5E;CTION 'A-A' A5 - buiLT SGAL,O : I' c cj0' i 0 r In Tmep 1c-,7 TO GEICT1 -< THAT -wo SEWA&e, 17151003AL Si9tGM WA°i GONSTI�UGT7✓t7 A°� IN,010AT00ON TN15 PLAN ANn 01 M6 MfoaKFi IT WAh COVpiKW Od6tle. THt: 9'f9TGM WAS CONSTKUGT`lro IN AC.G01l-1 ^A14 i WITH AL.L STANIOAI'.0 KULG9 ANt2 tCGCPUl,A -QoN9 OF THe, rO-TI AM o6,ut rN t�GrACCTMt%NT OP HPALTH' AN17.THG NPW YOKI� °1CATt: \\1 OGI°AICTMGNT OF N�ALTH•. NOTE'. HOUc;7e ANW? NOLL, I.OGATIO,N' Ti.KEN rIcloNI "SVICVE,( OF D� LuT q r1PArceO I'OF- I%ONAI,0 K • 4 VIAND MUKPH`f , ox-few. & -25 -10, PI<GPARGp 6q TGtlfK`( cou IN5 I°✓6KGtGNt�DI�PP L.�i • A5- 0U1LT ' EJIMP�N910N GI -1/�KT N° A 0 N° A 0 2 40.2' , 40.3' 13 IOG.O' .101.0' I O q 102.'1' 4 01.G' G4. ?' 15 101.0' 104.5' 5 .5q;.2' _GO;y• ID �►8.0, 1D5.�1' �G ~51.`3' 5?.O'� -17. y•q�1.5' �I'10.5� 1 G0.5' S3•'►' IS qq:o' 114.2' 6 G3. G" 50.8' I to 0' II"l.'1' 61 &7.2' 4q.0' to 101.9 121.0' to -11.0, 41.&' 21 101 . B' 124.7' 11 1 75.9 ' 'T 22 I I O t o, I30 O