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HomeMy WebLinkAbout1723DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -4 -45 BOX 15 01723 1 �; .. J; him, �, m . ; . �� . � r . OL +'' IN , . 1? 1 1 .. 01723 14'� T.TWT T rnI "T V rTnK7 tVDr1DT` �' �Ji - -- ---- - - - - -- - -� - -- DEPARTMENT OF HEALTH _Division Of Environmental Health .Services FW r I : Y PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only j -- �y Z5 WELL LOCATION WELL OWNER USE OF WELL 1 - primary 2 - secondary STREET ADDRESS: wNivt I Y TAX GRID NUMBER .; Steinbeck Estates Farm —to- arket Rd., Patterson, NYLot1�2,z ' NAME: Monroe Heights DevelO t Coro. DORESS: PO Box 970, Carrel, N�York PRIVATE RPUBLIC XNRESIOENTIAL ❑ PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP O ABANDONED O BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL 0 STAND -BY ❑ MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED 3 to 5� EST. OF DAILY USAGE 400 gal REASON FOR DRILLING MCNEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 250 ft. STATIC WATER LEVEL 3 __._ ft. DATE MEASURED 10/12/88 DRILLING - EQUIPMENT ❑ ROTARY XW COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT O CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING IN OPEN HOLE IN BEDROCK O OTHER CASING TOTAL LENGTH 95 tL MATERIALS: XIM STEEL ❑ PLASTIC ❑ OTHER LENGTH.BELOW GRADE 94 fL JOINTS: ❑ WELDED JS THREADED ❑ OTHER DETAILS DIAMETER 6 -in. SEAL: OCEMENT GROUT ❑ BENTONITE OOTHER WEIGHT PER FOOT 19 lb./ft. DRIVE SHOEX YES ❑ NO UNER: ❑ YES ❑ NO SCREEN DETAILS DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST YES ONO _O r IiOURS� GRAVEL PACK 11 NO GRAVEL SIZE DIAMETER TOP OF PACK in. DEPTH fL BOTTOM DEPTH It. WELL YIELD TEST It detailed pumping METHOD: O PUMPED I tests were done is in- � 109OMPRESSED AIR , formation attached? BAILED O OTHER '0 YES ❑ NO WELL LOG �f more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear- ing Wel( Dia- meter in FORMA110N DESCRIPTION CODE. n fL WELL DEPTH It. DURATION hr. min. ORAWOOWN ft, YIELD gpm. Surtace Hard an &boulders . 80 250 Medium.-to hard white & grey gra n' 250 6 - 200 70 HEATER xIR CLEAR TEMP. QUALITY O CLOUDY HARDNESS O- COLORED ANALYZED? S11;sfES ONO ANALYSIS ATTACHED?x ®YES ONO STORAGE TANK: TYPE Diaphragm CAPACITY 86 GAL. 23 WELL DRIUER NAME MILL DRIfe G, INC i'f/12/88 ADDRESS Putnam Avenue Brewster, NY t IM 1, e s i ent PUMP INFORMATION TYPE submersiblE;CAPACITY 10 MAKER Goulds DEPTH 200 MODEL 1OEJO7412VOLTAGER30 HP31L te. ovRFILL fOR SETYLEMENT FINI5HE0 GRADE GLEAN FILL N - LAYER OF SALT HAY OR UNTREATED BLOC N F •° - �j'cp PERFORATBD PIPE • w° Z (PVC; SLOPE %32 °;IFT - - -; _ —�q•• I'f2• GRJSN6D STONE 2q^ -4 CR055 SEGTION :LEAN FILL SALT MAYOR UNTKF %ATED BUILDINfs PAPL'R', q'� PEREDRATED PIPE 5'IOPB /.. CAP END OF EACH 'JOINT LATEKAL .n iv LONGITUDINAL. l5ECTI0N .i ;t DO NOT INSTALL T zENC.HES IN WEl SOIL. SIDES AMC) BOTTOM OF TKV'NCH PRIOR \LINCy 6KAVEL. END?; OF ALL DISTRIBUTORS BE CAPPED ICAI, ABSORPTION TRENCH NOT TO SLPyLe. sh Y2 .. -4 KNOCK ✓UT I, 11 I - 3,5•DIA INLETS I i JUNCTION bQx (TYf.) 9 17I4T4 .Onx Yd,70L•10 P.VL. (tYR) rr 7 c rg 2� 1p i7 �q 3o I i to , a� A5 - tuILT t; '•I 1 Y \mac B m V N PL 2 ra \ \ MIN• \� \B \ \ � �y paGq` r, \ { NE SAVE V ra - 2'wALLs „ 2•� PvC _ _ _ GHAMRK OR- q ¢ Pvc N FROM- 5GP11G TANK ; NOTES I %w MQJ THIS 15 TO OMTIPY THAT THE"MWAGE ONLY THE INLET, d15P09AL'9YyTfM WA9 CONr?rRUGTPA ANI9 ONe A`, INDIGATGDORTHIy FLAN AND THAI OUTLET TO 6t- KNOCKED' Tl-1E y197EM WAy IN'iPeGTI:D 9t MD. OUT AS aHOwN . prFO(2. rr WA,, cwrv.EI7OVr-v- IHG f : 5Y9tEM WAy CON4ITR•UGTEO IN A6GOt2 BOX DE7AIL bANGE.WIIH.AGt yTANI2A l2 "LPh - - '','ANI9 ►2?,(if1LA -fIQNy OF'TNF> .1°UTNAM ;,; :000NTY_�PAI2TMENT-OF.;HEALTH -AND i THB "NEW YORK ill Pte, DEF'ARTiv1ENT ' OF HEALTH . ScAVE ` NOTB: H,DU9E UOGATION TAKBN F20N �� "JU..FZVBY::OF PIZOPEf2S.'f; ",:LOT 12, ' i� I't2�PAtZEV F%OI� MONsz-0E HEIGHTy [7BVEL.GO; IYD tiA ?Eb .°(.- 1.9 -610, 'li 191zF.PAIZED' �Y. CONTI?A610? -S, LINE re iFIU15NE0 f�RApE Gt2 -ApPi 'lOU7H. J Q REMOVABL••��E GOVEK cvi •�'"i Aw OU1LE-r5 'IL: ,_Y _'1A SGAI-l:: 1'> 4'O I A 5. -�011l LT LAMP.NyI�N GHAPZT I %w MQJ AOJ . I�OT .y GONG POUTING +s P z z SEC�'ION • A-A� 1L f : BOX DE7AIL .I 'i ' I 2 IG -q" 28 -2' IG GO 10 7G- 1r''3o 161-2" 70' -B" g 25' 3" 22'-G' 1? J5g0` 71-10 31. G7' -5i` .G4' 2' P r. 61 0 59.10 11'-2 32 GI' -lo` �1 =9' � 4'501 -IVY 81' -4' 34 I q' 101' G 7 112' - 10'10-1' -3" 21 72;11' 8G' -7' 35 15 10105=2' :6. 101' -7' IOq' -O' 22 78 q 112' i' 3G 78' -Id IOG=B" q 109' -q' IIG•-5" 20 8`<D" 111'-7• 3�':.94� -q' III' -G' to qc'-0, 108' I1' .24 110='11." 1a6� =o' ::.38 v-1, IIG=4•" 11 q0' -q" 103 7" 25 fa er IOd =9" 311 .115 O' 12o °O' 12 84' 8' 118' -0" 2G lom o" 'f 8' O' .ao 100' °l' 124=8' 513 18�-q' 112'-7" 29 qg=;4" 91' -I" 'hl 107'0" 1610=7" >19• 7 ?.-'i S7'- 3' 28 8G =;10 84= 5` 4 ".TOG HIGH-, I %w MQJ AOJ . I�OT .y GONG POUTING +s P z z SEC�'ION • A-A� 1L f : BOX DE7AIL .I 'i ' I APPROX.. exlgr. i GRAVC Pno7oyP.b P r. 61 0 i' _G90 � 4'501 -IVY Z / P•V.G.E v 20% ! .620 V ♦9 15 �9 i i 0•P.G2P o -G20 ii _- �d Z 2 "m s"gwrp P•V.G. 1A1�/. •!. a b 90H- 0/9 N WOW. 3 } `�YSTCM � I 2 � \ i- \ �J 6110 to G °0 A L G2ri GZO �o a� nlciTl?IRI Pr2oP• well. AOJ . I�OT .y P 4 f : i .I 'i ' I APPROX.. exlgr. i GRAVC 2 � \ i- \ �J 6110 to G °0 A L G2ri GZO �o a� nlciTl?IRI 13AM, . box Db- 5 t0 t1JT TO 6CAt.E 7 A&602P -(10N 107' -3' 21 tQENGN : 0 101' -7" 10'1'- 0' 22 "gU1ZVEY OP PtzOPE2TY LOT 12, q lO3' -q' I1G' S' � ' �� 10 FINISHED GRADE. 100' 11' � OEVEL.GO.LTO t2A- reV-1- 1°1.00, •,'I1 q0' -q" 103'-1" 25 PR•EPAREO VY CONTRAG1OV -l> LINE Q ; 12 04,-0" q0' -0' `0wlE2N A ;? ;LA-roeAI,. REMOVA[3LE DOVER L • ..I � ' i iTy. q2' -'7' 27 101=0' It r AWplJtl �t5 At6,AME 0-LEd. .� 10 AE�l?o(ZPt On f2ENGH GONG „ 4".'(06•HIGH I:w Mili FOO'fir.IG SECTION A —A IPF I.9 � VeKZ. 72'-q' c 35 75-10 UY HE%HLTH 7 112' -10' 107' -3' 21 NOTE' NOUOE LOCA-rION TAY-'rN PPOM : 0 101' -7" 10'1'- 0' 22 "gU1ZVEY OP PtzOPE2TY LOT 12, q lO3' -q' I1G' S' 23 PREPARE[' F019- MON-0E HEIGHTS 10 qC' -0" 100' 11' 24 OEVEL.GO.LTO t2A- reV-1- 1°1.00, •,'I1 q0' -q" 103'-1" 25 PR•EPAREO VY CONTRAG1OV -l> LINE Q ; 12 04,-0" q0' -0' 2G G12ADE 9pUTH. 13 - 79, -q' q2' -'7' 27 101=0' It r 7?.- 11' 07'- O-T y' A t 5Y5TC1"I � I 72'-q' O6' -1' 35 75-10 1092' :58g} ��. 78'- `►" .92 "- I' 9(0 7O' -IO' IOG'0" <.-�" Oq=D" TT- -7' 3l 110' q" IOV-O" 38 qO'- 1 116 I&' 0" 1,90,- 5• 3q q5' O' 120'-0" loo'-O, q0'-O' 40 100*- 3" q94" q C.- I , 41 101=0' 130=7' 06'-10 O-T y' Pt20P •--yam, DJ WT 5Y3fGM Z \ w -J PUrNAM COLUlY DEPARTMENT OF HEALTH - D.V rSION nF ENVIP.nIN --7TA .- .HF7�LL. hy.,.:SWJICES- 47? 0 iii 'p C f 'l NTS REV - C.� • l TD Owner.or Purchaser of Building Building Constructed by O. o� x 97 0 Location Street Municipality 12r 5 D 6-A)T /A71 Building Type 96 / Section Block Lot Subdivision Name l� 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 __ _ _..... , Cert3ficat� of .Gv�:strt :tier -CompZ ancQ" far :he. S �T3g° -d ,oral syStQP, or. anti ...... 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. I k A n "e- 90WRIJINVIFIFIEW Y rev. 9/85 mk jSignature Title 416 U%JG,6 31 Corporation Name (if Corp.) Ass 3. Ala=n, vi s gal /audio 4 Pumo easily accessible manhole to trade, I I I 5 First bcx cafle^ I I I 6. Cycle wit_e_ =sue by Hsalltri Deca-,"me_nt I + I estirrzt - =1cr Der CVC e I I IV. HCUSE, ' a. Ecuse lccatw r---z anurcve;i lams _ b. IvL-ni\--- of 'be~. oam.= - V . lIE r . a. as Per a-c -croved plans b. Distance f,=: SiS area t[:e. -ssred ft_ C. Ca, ing 18" a cve grade. d. S-:race dra I..- cs aroun=d well acceptabie. VT. CVO:= � -, W0RI!AS a_ B=es procer_v c -cut=er b. AL' pines martially illed c. ALI pines f= , with inside of bcx d. Erdkfill m: tV-i a ccnt� i ns stones < 4" in di am�et_r e- Ci "ter in dry i z ins to led according to plan f- .C•,: --twin drai_� oat===h protect= & di r. to exist- wate_rc g. rrotincg drains disczarce awav from SDS are? h_ Sc-r::-:ace wat_r trot= rticn adecua.te 1 _ IE sicn c=61 Drcvld= cn s Lores create tt' n 153 . FINAL SITE L`1SPECTICN Date a-a . Ins�ed b_v .;Q:T: {ON Q Cwt] ER I F ! w A OR SJEDIVISICi�] / , -.. Sr iPr`"^ DISP`'OSAL AREA a. SJS area- lc —t -! as per acnroved plans b. Fill sue, cn - Date of place-ne-rit j 2:1 barrier. LGTii yv= AVG. DPTH I C. mat=,l soil nct stricced I I d. Stcne, bras::, etc. , greater than 15' from SDS are.. _ J e. 100 ft_ from 'Hater course /wet._i_ands. I I Ii. •♦ -E. SLS`LDISrOSAC-, SYSTD- ! I a. S°_ntic tart -, size - 1,000 1,2� b. Sentic tank irsta i led level c. 10' minirm,-Ln "=CIn foundation d. ,No 90° bEnd<, clear-cut within 10 ft. of 45° bend e. DISTIgLL'TICti ,- ; 1. All outlet. at sane elCyaticn - wa tar tea Ed 2. Pretec ye be c•.a fres t 3. Minim= 2 L= ericir -F soil between bcx and trenc -hes f. jUNCTION BOY, -- promly sett-- I I g. zS r 1 Lenc``n 9C)- - 2. Dls Eunc°_ to wa—tercc- rye. irea-siLed 3. Ins- ? 1 c c=rG1nc- mac) plan I 4 Distance center to canter 5. S_cce c= t=ench accent_ble 1 /1 -00 - 1/32 6. 10 f t.r_un prcDert"y line - 20 fit - fcurc�.ticns 7. L!eoth cf �` ^.�z < 30 imcl eS f -an ciL=cce 8. Room alich� f cr e_r...ans i cn, 501 °. Size of c a,�-:I 3/4 - 1 +" diameter 10. Depth of c--,=vel in trench 12" minhrrmn 1 Size of zL-,-o ch- amber 2 . Ccerrlcq taEk I I 3. Ala=n, vi s gal /audio 4 Pumo easily accessible manhole to trade, I I I 5 First bcx cafle^ I I I 6. Cycle wit_e_ =sue by Hsalltri Deca-,"me_nt I + I estirrzt - =1cr Der CVC e I I IV. HCUSE, ' a. Ecuse lccatw r---z anurcve;i lams _ b. IvL-ni\--- of 'be~. oam.= - V . lIE r . a. as Per a-c -croved plans b. Distance f,=: SiS area t[:e. -ssred ft_ C. Ca, ing 18" a cve grade. d. S-:race dra I..- cs aroun=d well acceptabie. VT. CVO:= � -, W0RI!AS a_ B=es procer_v c -cut=er b. AL' pines martially illed c. ALI pines f= , with inside of bcx d. Erdkfill m: tV-i a ccnt� i ns stones < 4" in di am�et_r e- Ci "ter in dry i z ins to led according to plan f- .C•,: --twin drai_� oat===h protect= & di r. to exist- wate_rc g. rrotincg drains disczarce awav from SDS are? h_ Sc-r::-:ace wat_r trot= rticn adecua.te 1 _ IE sicn c=61 Drcvld= cn s Lores create tt' n 153 . PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES JohnM Simmons, M.D; Deputy Commissioner of Health FIELD ACTIVITY REPORT Sheet of INSPECTION _C '�7 IA119 k Orig. Routine- rm�FOrig. Canplain tqlM JQ MAkKE7 9 A f Orig. Request Street Town TH No. Compliance Complaint Cxxnp L'ING­ADDRESS MAI Final P.O. Box Post Office Zip Code Group Illness Construction -;TELEPHONE.- Reinspection P Field, Sampling Only ­l�NIN CHARGE 0 R INTERVIEWED ' Field Conference Name and Title Other TYPE FACILITY 4/ccj Yaol V/ ...T. 'ARRIVED TIME LEFT Explain FINDINGS: y' 7 TELEPHONE: Signature and Title 1;2°PERSOWI.IN CHARGE OR I aekriowledge this Field Activity Report. SIGNATURE: 8 TITLE: TELEPHONE: Putnam County Department of Health Division of Environmental Sanitation. AFFIDAVIT CORPORATE OWNER APPLICATION FOR PERMIT.APPLICATION SUBMITTED TO - PUTNAM ¢OUNTX HEALTH DEPARTMENT. Tb: Commissioner of Health - In the matter of- application for 0�►.1Qo E n _ — _ 9 represent that I.am an officer or employee of the corporation and artr authorized; to act for DA�ROC�. 1 ��f"� � v�GI� �'I��✓rC�;� L7� _ _ ®. (name of corporation) having offices at �Q1�7`� ;� �� v1�,��j ® se 4-Q -�01 6ghose. officers -are President -rv? '6E64e)S > j Name and �d�ress) _ Vice- President /Dhu )� C1 0 C&,9t -4 x-71 (Name and Address) - Secretary _ — G 2 m'0 � _ ,C) (Name and Address) Treasurer (Name- and Address) V 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 act8 relating - thereto. Sworn to before me this �/ day Signed _ of 197 Title L •L,ai'( — _ _ otary Public ANNE B. COhRICAN r� u�4' �r ca"' Iry PELJ RED 1+ 9 �67! ' �q (� 4887 ,43� - �' V a �* # b� Corporate Seal _ Read, ' 31i96 ' t �b . •-- .- -' Located' aE "T = .: Awner %applicant Name McWng Address PUTNAM COUNTY DEPARTMENT OF HEALTH b Divlelon of Environmental Health' Servlcex, Carmel, N.Y Engineer Mast Provide / PsCsH D Permit N — — CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM owa Jr ill"o J Separate Sewerage System built by Consisitlna•of ti® . Ta: Map BI nerly SdbdlvtalouName ZIP—�Q _ Date Permit issued ddrese 7 Gallon Septic, Tank and s # l Water:Sapplys Pdblic Sapply. From Address: p, / -�, _ ors Private Sapply Drilled bIlI L -1MJL L/A i Add.. �yT / l V �i . 1/ /G�6� Building Type 5 m! / /�� L Has Erosion Control Been CompletedY 7 65 Number. •Bedroom s l Has: Garbage Grinder Been InstelledY 7� d Other R,egdiremeiits I certify that the systems) ae,- 1leted serving the above premises were. constructed essentially as ehown'on the ,.pians of the completed work ( copies of, which are•attached), and .in`aocoidance with.the.ataridards,_rules: and regal Lions :in.dccordance'witti fi pia and the permit issued by the Putnam County Department 0 alth. Date IA 1,65, n. Ce►tified by . E �7 P E. fi A Address y V!'i . 5 ... � i License No. Any person occupying D!emises served by •the above systems) shall promptly .take such action as maybe necessary to stun the correction of any unsanitary conditions resulting from cacti usage 'Approval of the uliaote'seweraye system `ihaii become null:and void as soon. as a pubt':'sanitary sewer becomes eveIlabls 'Ad the approval of ttie private water supply shall: become nu and void when a public water supply becomes available. Such approvals are subject to,.modif ication or change when '. -in_ the udome,nt of the Commissioned of Mealth, Such revocation, modifleatlon or change is necessary, Date C oS /{ (1 ey -.�J' - Title m /' T.TVT T rnMDT VTTnNT VVPnVT VV ILI.Li Li office Use Only DEPARTMENT OF HEALTH *A1 Divj, -tal Healtin Service PUTNAM COUNTY DEPARTMENT OF HEALTH gU 01Z '- STREET ADDRESS: N-Y TAX . GRID NUMBER: WELL LOCATION Steinbeck Estates, Farm—to—Market Rd., Patterson, NY WELL OWNER NAME Monroe Heights RESS: PO Box 97 07h )BIVATE ' ,PUBLIC USE OF WELL 1 - primary 2 - secondary t7RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR/COND.IHEAT PUMP 0 ABANDONED 0 BUSINESS ❑ FARM ❑ TEST /OBSERVATION 0 OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ AMOUNT OF USE YIELD SOUGHT —1— gp,m./NO. PEOPLE SERVED 3 to 5 EST. OF DAILY USAGE 400 gal. REASON FOR DRILLING %XNEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST/ OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH — 2 5 0 ft. I STATIC WATER LEVEL � 3% PATE MEASURED 10/12/88 DRILLING EQUIPMENT 0 ROTARY x1W COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. MR OPEN HOLE IN BEDROCK 0 OTHER CASING TOTAL LENGTH. 95 tL MATERIALS: XID STEEL ❑ PLASTIC 0 OTHER LENGTH .BELOW GRADE 94 ft. JOINTS: OWELDED ME THREADED 0 OTHER DETAILS 6 --in. SEAL: INCEMENT GROUT 0 BENTONITE 0 OTHER —DIAMETER WEIGHT PER FOOT 19 1b./ft. DRIVE SHOBO YES ONO I LINER: OYES ONO SCREEN DIAMETER (in) 'SLOT SIZE - --;.— LENGTH (11) DEPTH TO SCREEN (it) DEVELOPED? -FIRST - . :­ .,-. - .❑ YES 7 ONO HOURS--- GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE. DIAMETER OF PACK in. TOP DEPTH ft- BOTTOM DEPTH It. WELL YIELD TEST 1, If detailed pumping METHOD: 0 PUMPED 1 tests were done is in- WICOMPRESSED AIR formation attached? ❑ SAILIff) ❑ OTHER ❑ YES 0 NO It more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. DEPTH FROM SURFACE Water Se:ar. in 9 Well Oia- Mete In FORMATION DESCRIPTION cote WELL DEPTH It. DURATION hr, min. DRAWOOWN ft. YIELD gpm. Land Surface 80 Hard an & boulders. 80 250 Medium to hard white & grey an 250 6 200, 70 WATFIi XJR CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O'COLORED ANALYZED? MES ONO ANALYSIS ATTACHEDZKIM YES 0 NO STORAGE TANK: TYPE Diaphragm CAPACITY 86 GAL. 23 WELL DRILLER NAME MILL DRIL G1 INC ff/12/ 88 G, ADDRESS Putnam Avenue Brewster, NY eUt J kT) .-Mi 1, --esi-'*' t PUMP INFORMATION TYPE — submersibl APACITY 10 MAKER Goulds DEPTH 200 MODEL lOEj07412VOLTAGr2j_0mP3_j_L to I ,y BREWSTER LABORATORIES_ ...., ... _�. .. , -.». _7_t,. .._..a..,.. =Box 224.- (914) 225 -2072 - WATER ANALYSIS REPORT - SAMPLE NO. 7114 SOURCE: Steinbeck Estates Indian Hill Road Patterson, NY COLLECTED: October 13 1988 BY: Mill Drilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method Lot 12 new well 0 per 100 ml. . This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. `October 18 1988 Roy ckwit P.E. irector dounty7l Department be wbmitted _ to'th place �.on,good:<opert ance..:of the approve will b0 locatad as slio County Department' t� APPROVED 'FOR 'C( revocawe�lOr cause a re0uires a w perA Rev. 7 Oate_/ Health -Yantl thaVon complet on thereof a Cert Mcate'''of COrlstfudion. Compliance satisfactory to the Commissioner of Health will raiment antl a'writtemguarantee_ will be furnished the owns► his wccesso►s,'hei►z or assign; by the builder, that :SaiO builder Will condition any part',of ,fatd sewage disposal system during the period of two (2) years immediately following the date ci the issu- the Certificate "of Construction Compliance of the ;original system or;any iepaiisthe►eto 2) that the ,drilled- well,described'abovo n the app►oyedplan and "that seitl won wil6tie9nsta in accortlance, wit Me sta and `rules anti regu a ions of the.. Putnam ealth Si9netl .' . P E.�' / R.A. Address y _ °0� License No RUCTION Thif yapproval,ercpi ► es two years from the do a :issued unless construction `of the building has been, undertaken, and is y be amendotl or motlifietl when'consideretl n essary'° the'Com sio !or of .eel Any change or alteration of construction Ap v_ for disposal of d m6it Ic"Sapita i' sewage % w or p ' only. _-� 8Y ' - Title El DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 "AP91;1*CATI69' "TO -CONSTRUCT A WATER WELL ✓�� PCHD PFRMTT 9 WELL LOCATION Street Address Town Tax (20 VL90 I j Al il$la v Grid Number - 7---4&j WELL OWNER Name 64ruli.., T Mailing Address :lr1w. P a, 13 9 "Te9 G Ss Z WPrivate D Public USE OF WELL ® -'primary 2- secondary e"RESIDENTIAL C BUSINESS 0 INDUSTRIAL 0 PUBLIC SUPPLY 0 FARM O INSTITUTIONAL 0 AIR /COND /HEAT PUMP 0 TEST /OBSERVATION 0 STAND -BY ❑ ABANDONED O OTHER (specify Q AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED 4'-G /EST. OF DAILY USAGE 8 gal REASON FOR DRILLING tkNEW SUPPLY 0 PROVIDE ADDITIONAL SUPPLY ❑REPLACE EXISTING SUPPLY 0DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR .DRILLING WELL TYPE CffDRtLLEb DRIVEN DUG GRAVEL C] OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION Lot No. WATER WELL CONTRACTOR: Name D"OLMwW Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY:, W/A TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: W • LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED. 0 ON REAR OF THIS APPLICATION N SEPARATE S T -�".�� (date) s ature) 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. 2. 3. Date of Date of Permit 2/87 Pump the well until the water is clear. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit Submit a Well Completion Report on a form provi d b he Putnam C u t Health Department. Issue: �'�� 19 Expiration: 7 2 19_ t Issuing Official is Non - Transferrable Zte copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner Ornnrra rvnrxr- rAnd 1 r wi 1 1 ^7- ve &A-� - -�° 'mss V7- -- _� l_� _C��C�� �° � �7�� s is 7-0� _rf�c � _ __ �S ��r _rte _ �-x„�J .o ohs ��o F l 0 CA Y2 t4 ^)f� f 46 LA At 1_ MUM. DEPARTKM OF REALTH. ..PUrNAM -SER VICES, :OF--ENVIRONMEN1AL*-'-- DIVISION HEALTH .-DESTGN DATA*-SHEE-T-M.UVAC9'-SEWAM'-LiISP08AL" SYS= FILE. wis Owner ­ 2� ro _tji �-Ac 1&es S, m Locatecl- -at -- (Street)-, Sec Block- 2 Lot (indicate nearest .cross street), Mmicipality 0 t9, F- E61TIMS0 fJ 'Watershed, Gtl a7o tJ SOIL PERco=cN DATA RBw= To bEsuwn=,w=. APPLICAZZONS -Dite ot Pre-Soaking Date of Percolation Test �jy'" ? o HOLE P&")M=CN h0m ­­­C= T324E, - .. ... ... Ran . j Blapse Depth to Water From Water. Level In -Soil Rate.* No;-,. Time Ground-Surface Inches Start Stop tMin. Start Stop Drop In M,in/Xn Drop. -Inches.,. Inches 11 . , 1.414 14 1 5;7. -;- -2 IAV 30 :-3 -2,A&­­­-3,j-&�-'- 5 2 3 4 5' NMS: l,. 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 a 11° . 12° 13° 14° INDICATE LEVEL AT WHICH GROMMATER IS FNOOUNTMM 04 INDICATE LEVEL TO WHICH 6= LEVEL RISES AFM BEING E[00UNTERED 4v�� DEEP HOLE.OBSERVATIONS MADE BY: bATE: DESIGN Soil Rate Used 14 -30 mini" Drop: 0,&o S.D. Usable Area Provided . Noe of Bedrooms • 4` Septic Tank Capacity 1 Z gals, Type Co AI C, Absorption Area Provided By _ _ L.F. x 24" width trend . Other C,<< Name ��J I A,� ,fit h&oc W, Signature ; Address . '°�$ �:t.� (L i SEAL . .. "' L.0 �. U� C. :1 �l�" tm Sd Ad Ai � 121r6 3 �FO� fdo. 56124 � THIS SPACE FOR USE BY HEALTH DEP•ARTKW ONLY: Soil Rate Approved sq. ft/galo Checked by. Date j� 6l 4 V. APPENDIX B PU INAM CCUNI'Y DEPAR'IlM= OF HUALTH - DIVISICN OF ENVIRONMENTAL HEALTH SERVICES Zbar4 -MUAL WATER SUPPLY & SJBSURFaCE SEWA M DISPCSAL SYSTEMS EZ tr.encn prov_de4 r ui r 60 ft. Parallel 100-3 0 It S. clavi 10 f, fill- 100 y*. 200 f t. 130 ft. REVIF,q S CONSM=ION PET= . -DATE BY: ! s (Strea_t.Lca2ticn) / r YES I NO I DCCaUMITS I PaY-nit An P 1 ic3tion tours tri4ll /call . Corporate Resolution Plans - Three sets Engineers A_uthorizaticn Design Data Sheet (DDS) I I Deep Hole Log I Consistent Perc Re =_;its I Perc Hole Depth i SuEDIV 'SICK Perc "� A (3) cd..ry, I Hcuse Plans - Two sets �^ i Well Fe -snit; P-N-S —_J variance Re;ruest ` Gam_ _I L&m1 Subdivision Sutaivi Sion Acaroval Checked Ex -a_ prcval SSDS Ad . Lots Ch'e�fKemd Weti and (Tcw -n/DEC Permit, R & D) Da -I Cn DOS Plans & Permit Same I REQDMED DEI , c CN PL:LNS Sewage System Plan - (north a=_:.w) I ss%ace Sys-Lan Hvd;aulic Prof__=_ - Gravi v F? Fill Profile & Dimensions - Vol = - ne —( D or J Box;Trench /Gallery; _P =q- pit details Septic Tank - Size, Dermil Wel1 Detail, Ser-Ace Lire if over Ccnstructicn Notes (grinder rte) Design Data: ,terc -and asap r2 =_,.1 -s ..... Two4a t Contours Existing & Prc_resed Drive.imay & Slopes Cut Footi n /Gstter, Curta i n Drains (discharge OK) Perc & Deep Holes Locate Representative or primary aed er..ansicn ,fi�ransicn Area;shcwnn;gravity flaw,ssf=..size I If F.ped Pit & D Box Shcw-n & DeiMiled House - No. of Bedroans Wells & SSDS's w /in 200 ft. of Proposed Syst`- Proce_rty Metes & Bounds House Setback Necessary (Ticnt lot) House Serer - 1 /4 " /ft. 4 "0; Zyce pipe No ids; Max. Bends 450 w /c1G.nout SE M=ON DISTANCES SPECIFIED CN PLAN Fields 10' to P.L., Driveway, Large Ttees, Top of f_ 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Laic-- (inc. ei-a 15' to Drains r'ur t`in, L.—der, Footing 351to mtch hasin,storrrirain ;cicei uraterccur 10' to Water Line (pits -20') 50' inte*nittent drairace course I Sentic Tanks 10' fran Foundation; 50' to we!! �( 15' Well to PL 9 2. All cutlets at Sarre elevatim 3. Outlets 1" to 5" above tank bat tm _ g. AMP PIT DEt4M 4. Mfinfinin 12" taiirYg clean send cr pea gravel. d PIE kbqmte oxer prp, ].ire fre=zuV cr slrp-- 5. Inlet haffle. a utre lire to pnP pit. 6. A'mimm 12 ii (3te. (j � 2. apdty,rne d3y,other able 7. Paromble caer fx aon✓ss. armrQmet. 8. Saled pipe pints (as�l tic cr equal). �j''' Rep rb34=� l0e FYast p orn. 1 � - : '�: Ta$` m.)m wlu Alam - audibl c. 7 ZEN & I 'OEM DDS 6. Ten ft. min. pirp pit to faarhtirn. 1. Sloe 1/16 in. /it:. to 1,/32 in. (0.5% to 0.25%). - 7. Fifty f min. paxp pit to well. 2. 3/4" to 11" cnm3ed store cr washed gravel oft- 8. Flyt. wxk amply with mr- aggrgate. 01, Ci�k tialve,gate valor, 3. 4" minim n late al dianeter. ©[41, 0. Baff ed D -bcx,cr J-1m -1st bcx. 4. 2" minim= ate suer lateral. Idaulic infmaticn 5. 6" minunm ate u tier lateral. gwu-e- t= levels 't. 6. Ulmas E d Wilding <3i ng ors cr 2" at stoma over -9 Im vs. head pmp with azves. aggregate. 7. 6" mini=m, 12" m dam earth b x:Uil1. 8. r� ,-F; 11 to allay A, �-1 i,, All ,f ' a 9. 2'nz nui r m fr m trench both= to dater- 5ft.92 e 10. 5'min.fxan trees bottom to kTWACUs 7 ft.. grad- 11. Trench gacirig:min.61O.C:.(24 "trench). 12. tsd lateral ergs most be plugg>'i. 13. FM - 2:1 slgaes min. 10' beyad tom. dqth-.3j'rrma?en ro:k+;21nmc.a;xr water kpmmsble barer. /V�( 1 .r- PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONME',NTAL HEALTH SERVICES SSDS/WS REV11M SHEET - DETU S ! a. SEPTIC TIM DMUES d< Bpi, `CUt lit 2" below inlet. of �tra318" show .. � ^�• �...�., ...... _ .._ - it .._ ...`.'...�.., ..�.��3, L'LL11.7.11L1U 3 "'� 7"w�. . _.:_.. `. ._...' _.... _ _ _ _: -. - _ ..'� - .. -q-c � }'y�. 2-I v� _ -- - "`':e7...,..,.ac ee��d!V j'1 to Mini=m d�kh cf liquid: 4' 3. I�Snimm 20' cssirrg cf�st c r wroug�it -urn: - Ierjth - mm mm twrir_e widtih to rmaram foot 4. 10' muumm grout into rod,. times width. -5. O-tlet 4' belaw O.G. min. �. Yadi m 12" oar. 6. Sanitary seals i. 'Loccyat�i,m st alo- 7. Gmund graded aAay fin Xll. 7. y� y , y Mrhole - cpming - minima= 20" in .dime. dimensi m e. C LRMM ER ION LMiII.S 3. EaM ede-d 20% cf liquid dgth abme l iqm 1. Oa m±M to al.laa fcr sattling: 4 "-6'1 level (c1=4', b=10 "; d=5',b- ].2 "). 2. 6" -12" natural soil mill.. 9. If length G.T. 9 few - use 2 amen meets. 3. Utmated bAlding fir. .0. Minim= tank capacity 1000 g31/3 bel -roan; 1200 4< P to 11" r1Een gradl cr stcm. gal/4 baclrcm:134 cf /3 bdtm;161 c: /A hdam 5. Min. 4" perfcaate3 pil. 1> Asiixltic aaating for reinEm)ed cm=ete. 6e Pipe irnest 6" aff bothm 2. Inlet tawbafEle 16" below flaw lire. 7. 18" = 24" wide trench. 3. Cutlet tawbaffle 18" balsa ELcw limo 8. Dq:)th mate, i4 Inlet pipe dlrpe i" per foot min. (2%). 9. Scgaration fine SSCS area 15' min. 15. inlet pipe cast i rcn, 4-h-dn.. 16. Cutlet pipe sl.ppe 1/8" Per Rout min. (1 %). f. nRP CR JU= B3( ffiAIIS 17. (bulb pints fcr sanitary tees. 1. boK cover. 2. Cbrracbcr cutlet 1$" abom lateral . cutlet. b. NSIM= BCC DEMnS 3. Iatemis flush with botbmL 1. Inlet invert min. 2" above cutlet invert. 4. Tint pints pipes bass. 2. All cutlets at Sarre elevatim 3. Outlets 1" to 5" above tank bat tm _ g. AMP PIT DEt4M 4. Mfinfinin 12" taiirYg clean send cr pea gravel. d PIE kbqmte oxer prp, ].ire fre=zuV cr slrp-- 5. Inlet haffle. a utre lire to pnP pit. 6. A'mimm 12 ii (3te. (j � 2. apdty,rne d3y,other able 7. Paromble caer fx aon✓ss. armrQmet. 8. Saled pipe pints (as�l tic cr equal). �j''' Rep rb34=� l0e FYast p orn. 1 � - : '�: Ta$` m.)m wlu Alam - audibl c. 7 ZEN & I 'OEM DDS 6. Ten ft. min. pirp pit to faarhtirn. 1. Sloe 1/16 in. /it:. to 1,/32 in. (0.5% to 0.25%). - 7. Fifty f min. paxp pit to well. 2. 3/4" to 11" cnm3ed store cr washed gravel oft- 8. Flyt. wxk amply with mr- aggrgate. 01, Ci�k tialve,gate valor, 3. 4" minim n late al dianeter. ©[41, 0. Baff ed D -bcx,cr J-1m -1st bcx. 4. 2" minim= ate suer lateral. Idaulic infmaticn 5. 6" minunm ate u tier lateral. gwu-e- t= levels 't. 6. Ulmas E d Wilding <3i ng ors cr 2" at stoma over -9 Im vs. head pmp with azves. aggregate. 7. 6" mini=m, 12" m dam earth b x:Uil1. 8. r� ,-F; 11 to allay A, �-1 i,, All ,f ' a 9. 2'nz nui r m fr m trench both= to dater- 5ft.92 e 10. 5'min.fxan trees bottom to kTWACUs 7 ft.. grad- 11. Trench gacirig:min.61O.C:.(24 "trench). 12. tsd lateral ergs most be plugg>'i. 13. FM - 2:1 slgaes min. 10' beyad tom. dqth-.3j'rrma?en ro:k+;21nmc.a;xr water kpmmsble barer. /V�(