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HomeMy WebLinkAbout1727DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -4 -49 BOX 15 1yti J` ' 91 -' � J T 1 I L 11 ' a■ or 01727 PUTNAM COUNTY DEPARTMENT OF HEALTH Rev: 3 "86 Division of Envlronmentpl "Health Seivices, Canmel,:N:Y 10512: Engineer Mast Provide a Y P.0 H D Permit N . Dp CO*?S . �T!0 Tx R SFWAt -E DISPOSAL Y TEM " 'ms o- . r COMP ..ANCE" FO -S_ -SYSTEM _ '` y— -- a pp���', "i�d*n'ur'i e Located at 4. Ta=.MBP Block Lot Owner /applicant Name Sabdlpisjon Name. 1 L 1- S- v. Lot p� MaWng Addreie' 1 �. Date Peimit1sstied Separate Sewergge "System ballt by Mb RD F " LIM -i "c n� Ve L„ eO V--? . Adams . o . .� %d , . �A i21�/� E V Conalsting of 0 Ar Gapon Septic Tank and Water Supply: •: Pubdc Supply From Address or: Priyate"Snpply Drilled by>AILL VP LW 04- S - &Address '601PA -th .4 Vli —_ Building Type ��S I Has Eroslon "Control Been Completed?— Number of Bedrooms q Has, Garbage Grinder Been Installed? Other Regdiremente . 'I certify that the system(s) as listed serving the above premises were constructed essentially as_ehown on th pla" of the c=pleted. work ( copies of which are attached),, and in accordance with the standards, rules and "ieg 1 tions, in ao rdanc ith the' 1 dn, d'the permit issued by the Putnam coimiy"Department Of Health. Date P '��� Certified bY. P.E. R.A. Address Any parson occupying premises served by the above systam(s) shat1 promptly take Such %action as may be necessary to secure the correction of any unsanitary conditions, resultin9"from .such usage. Approval •of the- sepaute,seweraye._systsm hall become null and Vold as soon as. a pub;;: sanitary sewer becomes available and .jhe approval: of the, private water supply shall become null and void• when a public water. supply becomes available. Such approvals are subject�towAmodifieatlon or change/wG,h►an' in the :Judgment of tlie/,Coommm�lss�ioner ot- Maalth. such ►evocation, modification or change Is necessary. Date L� - f-.LL— aY Title =� IE A� cOi, a ` Ei 1 WJuLL U.UrirLPj11ULI t% F rvi.l DEPARTMENT OF HEALTH Division.. Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only . ` - s _ STREET ADDRESS: WN vI I Y TAx GRID NUMBER:.. Steinbeck Estates, Farm -to— Market Rd., Patterson-, NY Lot 16' WELL LOCATION WELL OWNER NAME: ADDRESS: Monroe Heights Development Corp., PO Box 970, .Carmel, NY ®PRIVATE t0 PUBLIC USE OF WELL 1 - primary 2 - secondary 9WESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) O INDUSTRIAL Q INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT 5 gpm. /NO. PEOPLE SERVED 3_j0 5 / EST. OF DAILY USAGE 450 gal. REASON FOR DRILLING &NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION O REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 500 ft. STATIC WATER LEVEL 1 0 ftj DATE MEASURED 8/15/$8 DRILLING EQUIPMENT ❑ ROTARY )0 COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. XR OPEN HOLE IN BEDROCK ❑ OTHER CASING TOTAL LENGTH 71 fit. MATERIALS: AR STEEL ❑ PLASTIC O OTHER LENGTH .BELOW GRADE 70 ft. JOINTS: -O WELDED AR THREADED O OTHER DETAILS DIAMETER 6 in. SEALX91 CEMENT GROUT 0BENTONITE OOTHER WEIGHT PER FOOT 19 lb./ft. DRIVE SHOEARYES ❑ NO LINER: O YES ONO SCREEN DIAMETER (in) .SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? DETAILS ..._ ..FIRST.- ❑YES ONO !':OI:RS SECOND GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. TOP BOTTOM DEPTH ft. DEPTH it WELL YIELD TEST It detailed pumping t METHOD: ❑ PUMPED i tests were done is in- OMPRESSED AIR , formation attached? ❑ BAILED ❑ OTHER :OYES ONO �l�Ll LOG It more detailed formation descriptions or sieve analyses are available. please attach. DEPTH FROM SURFACE Water Bear. ing well Oia- meter FORMATION DESCRIPTION voce ft WELL DEPTH ft. DURATION hr. min. DRAWOOWN It. YIELD 9Cm- Surrlace 60 Hardpan & boulders 60 .450 Medium to hard grey & white granite 420 2 30 420 2 500 6 - 450 5 WATER MR CLEAR TEMP. QUALITY O CLOUDY HARDNESS ❑ COLORED ANALYZED? X® YES ONO ANALYSIS ATTACHED?XQ YES O NO STORAGE TANK: TYPE Diaphragm CAPACITY. 82 GAL. 26 WELL DRILLER NAME MIIL DRILLING, 22/U /I ADDRESS Putnam Ave. SIGi Brewster, NY ' ,i PUMP INFORMATION TYPE submersible CAPACITY 5 MAKER , Gaulds- -- DEPTH 400 MODEL5ESO7412 VOLTAGE 230 HP 3/4 ELLIS A. TARLTON LABORATORY DIVISION OF ELLIS A. TARLTON, ENGINEERS, INC. H PHYSICAL L 34 PLEASANT STREET DANBURY, CONN. 06813 -2328 WATER - WASTEWATER P PHYSICAL METHODOLOGY BIOLOGICAL P.O. BOX 2328 203- 748 -7903 APHA - EPA - ASTM REPORT OF BACTERIOLOGICAL AND.CNEMICAL EXAMINATION OF WATER NAME AND ADDRESS OF PERSON TO RECEIVE REPORT F Mill Drilling, Inc. Putnam Ave 2 I Brewster, N.Y: 10509 I DATA �J 0 SOURCE OF SAMPLE Water Supply, Steinbeck Est. Lot 16 Indian Hill Road Patterson, N.Y. DATE OF COLLECTION Aug. 23, 1988 COLLECTED BY Mill Drilling Hydrogen Ion COLOR TURBIDITY ODOR CORROSION INDEX DISSOLVED SOLIDS Concentration LANGELIER (D „) RY2NAR ' NTU Mg /L Alkalinity as CaCO3 Fluoride (F) Bicarbonate Nitrite Mg /L Mg /L Mg /L Alkalinity as CaCO3 Chlorine Residual NITROGEN CONSTITUENTS Carbonate Nitrate Mg /L Mg /L Mg /t AS NITROGEN (N) Total Hardness Conductivity as CaCO 3 I 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/1 The arithmetic mean of all standard samples examined per month using the membrane filter technique shall not exceed on cclony por• 100m1. Coliform colonies per standard sampl9'shall —not' exceed 3�Soml,. 4 %t00igl,_ 7 /200inL,,,.oL .13 /,�OOr�I, _ _ t.. in: (a) Two consecutive samples; (b) More than one standard sample when less than 20 are examined per month; or (c) I More ^ than five 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. MEMBRANE FILTER TEST Coliform Colonies/ 100ML` _. -.. 0 Lj 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: 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. 4. This sample was unsatisfactory as a potable water because certain chemical or physical constituents 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 water potable. Certified................................................................ ............................... ..... DEPARTMERr OF HEAL111 DIVISION OF ENVIRONMENTAL HEALTH SERVICES o�J�oc A97 &14 7-5 PW51,, Cam. 1_7-D . Owner or Purchaser of Building I,MAV0 �5 %CyEL . Ca • )--rl? Building Constructed by o Location - Street Municipality Building Type Section Block Lot Subdivision Names (0 Subdivision L t GUARANTEE OF SUBSURFACE SEAMGE DISPOSAL SYSTRA 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 :meew�ich �a.�_3.s t.-. o_petate for a per�.od =of =twc, yeexrz jautediately 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 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. / A this )- y day of 19 Signature A i. TO - ... rataon lbuie (if Corp. rev. 9/85 mk M o uic 7Z3 t rr dii — Corporation Name (if Corp.) 1�0.. C�t7ti2��Z ess �e6 Il. IV. V. vi- F�IPL SiTEyL"'IsPECTICN Dates 0 : TICN Cv a 0 GT n nn c--cr 17rrgTf`�1 TrfP gt iU?r' DISP CSA-T, AREA SJS area lc=—ti as 2fr. amroven plans Cr- M- "'FfLS. b. F11 sec—ticn - Data of piacenent . 2:1 barrier . LG H W_MTh P_VC. C. Fatur -I scil nct striure3 I I - I I d_ Stcne, brur , etc. , ere= -tar t-an 15' fran SDS ara_ I � aWELar c ^ur el e` ands. e. 100 ft. frr, SLi':c� —DISPOSAL- SYSTa1A a. S °_.LAC l..G.rk s_ze - 1,000 /2[" b. Sectic tz--r:k -installed d level I c. lo" rnin i _T , mn f_ G^t fcur_ tion I I c_ 90° hcr:ds, cle scut Within la f =. of a bard I I e- CN 1. All cuL' C_- GL_ sLe eleva i cn - WGI.er test -. 2- Prot c` _=�_ belc' fres t 3. Min 2 ^- cricirial scil hEtWeen bcx and trEnc !es I �- f ju-N 'I'ICN KX . l L-anc: -i_'1 A L. Dist ^.0 to Ir =t= L i - ^ " ac--rdi nc to..c d Di ct = nC� C�l _r to Cents -- 5. S_GCc C_ �ercn acz:su� ^le 1/160 - 1�3L " / -CGS. I , 6 10 f=-" = ---Z DrC -eTt; lire - 20 LC—= - fc'ur:r_ '- Crs I / cemt l C= �'a ch < 30 Lr'_C:=S LrGit s=aC° I I I 8 Rccm al cwi_�- =cr e­cr'arsicn, Size cf c =vim 3/4 10. r.,ezptrl cf c-avel in trench 12" mini�r�t 11. Pi re E,ds den=s I h. FDT CR LCS3 SYSTM"IS a. Size oz i En t 2. Cvem -flaw t_n_k 3. A1amn, v =sza jj /cL'^'. -' c I C t:D e =s__�i cCC?551ble n'a r_hole to crade r .I 5• Firs` hcx b = er 6. Cycle wi g e-s_ed bV Flea to Decarc="i Ent i I eS t i TIGtc '! C4T r� =r cvc l e a. Fcuse lc = t= rer acnrcvea Plans.- b. NC<icer Cf he�xlms a_ We l lcc=t_= as rerr ancroved" Plans sr i ft_ b. Dista_r ce f_ SLS are= m_. =a c.. C_s1.nc 18" EL-cye crade I I d_ S=-ace arcurIc well aCC °_DL =L'1° a. S---Yes prczG_v c--cut b. A?' ires ally hac`fiLe3 I C. A*,'. pines with inside of hex cent =ins stones < a" in ai amet_ - e_ C :-.a n dr-- inst-alled accordsnc to plan f- ~_ Lain Cli._'- cuL41l prctact == & d T. to e- vist_watt_- Czur59 c_ F -,ct' na Cr =' " C_'= czarce awav f =cm SDD5 arm. i I — h. c•r =cce wat=r Qratectaicn adec:ate - ? _ —_osicn c_n�c1 prcvi ced cn sloces crZter tan 15%. — pMCe; n..,,gova,vperauny. wnantun any. porgy ..anw m..oyv ante -of the app►oval'of 'the Certificate -,o f Construction Co will. be located(as shdwn:on the approved plan and trial said wel county Department /"of Health" . :. Address APPROVED f.OR CONSTRUCTION Tnifapprov'al exOires tw revocable;forcause or,May be amended,oi mo when con requires, av permit. p roved for disposal of` domestic �v. L rte- 3)87 Dbt® By vill De furnishedCthe owner his wccessori ,heirs or a3signs by "the builds[ ttlatssjid builder will d� g of tw() years irodi lspon system Curin t followingahedate of lie isw- mpliance of the original iystem,oF:I repairs th e to; 2j,that•to®_drilied well d6attiDed_ above 1-will beinsta `a�n accordance with the standa S r s and, regu a_ ions .- ojf�the `Putnam License No o years from the}tlate. �ssuetl unloss construction 07-th e building hasbeen.untlertaken` and is sf red n essary the :Commissioner of 'Health;_, Any .change or alteration of construction rotas` sewage" /or private '' a r st)pply only. Title %�I�t_e/7 DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A sWATER WELL PCHD PERMIT #/ WELL LOCATION Street Address To' Village City Tax Grid Number f/� .��6 V Al 1/ 7— Z45;./ WELL OWNER Name Mailing Address o.• J.( C17v D o 0,74.x/ Cv Lam. C; 12MA52- &K @J?fivate 0 Public USE OF WELL 0 - primary 2 - secondary GYf ESIDENTIAL 0 BUSINESS O INDUSTRIAL ❑ PUBLIC SUPPLY Q.AIR /COND /HEAT PUMP O FARM ❑ TEST /OBSERVATION 0INSTITUTIONAL ❑ STAND -BY 0 ABANDONED 0 OTHER (specify 0 AMOUNT OF USE YIELD SOUGHT S gpm /# PEOPLE SERVEDC/j� /EST. OF DAILY USAGE /dyq gal REASON FOR DRILLING GAEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑REPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL ❑ TEST /OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN - E]DUG 0GRAVEL ❑ OTHER IS WELL SITE SUBJECT TO FLOODING? YES 40'__ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name %�,ES "0 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _1,1NO NAME OF PUBLIC WATER SUPPLY: ItIOA TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: X14, LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION ON SEPARAT SHEE );L-76 (date) ..... %!� 0 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 s.hall: 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 provide y he P nam C unty Health Department. ; Date of Issue: 19� er t ssuing Offidial Date of Expiration: Permit is Non - Transferrable 2/87 19 White copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner 6 d ! ti Putnam County Department of Health Division of Environmental Sanitation = -w"CORPG v�iTE 04 REit "'A - F-6ILt�' ;69—. FOR PERMIT. APPLICATION SUBMITTED TO - PUTNAM ACOUN.TY HEALTH DEPARTMENT. ! ; Tb: Commissioner of Health - In the matter of application for ` — — — — ® represent that I am an officer or employee of the corporation and arti authorized:. to ac t for AoO Yl�iJr (name of corporation) having offices at 'eow_ zv_4-© K-bl Those officers .are President Q Vice- President DA0 1.� _C(o G��rjv_7j . _ (Name and Address) Secretary _� }./ _ G(,o GGO - i¢�!t7/ _ G. _°M � _ /- 1�— (Name and Address) �:- _ Treasurer - -- -- . -r . - -_ ._. ,.~ .__�._•_ -.... . (Name- and Address) _ — Q and that I am and will be individually responsible for any or all ;acts of the corporation with•respect to the approval requested and all -sub- sequent actd relating- theretoo' - Sworn to before me this `/ day Signed of 198' Title otary Public I �5 P E "'C� L Corporate Seal ANNE B. CohRiDkN °6Ma�' � 9N��a1 Ww vrt Wch2i it 4q Ae, ti' a,„ :. tt488-743� APPENDIX B PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SKAGE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT DATE EWED: jC3 BY: (Name of-Owner) (Street Location) / COMNEPTS NO wamwTs Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth s/s SUBDIVISION Perc (3) Fill `---- cd House Plans - Two sets Well permit; PWS letter Variance Request COAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (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 Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over .Canstruction...Notes -;. - (grinder.- rate).:.m_ _ Design Data: Perc and deep results Two -Foot Contours Existing & Proposed 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 Puped 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 Sewer - 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, stormdrain, piped watercourse 10' to Water Line (pits -20') 50' intermittent drainage course Septic Tanks . 10' fran Foundation; 50' to well 15' Well to PL 9 k"r- it- S PL111• •• XJIM DEPARTMENT • BEALTH :RIVISI•N • ENVIROtZMqM HEALTH -S 9A�i -SUBSUFACE-ZEKAGE-DISPOSAL- B -DR-IGN DATA ...I= FILE' . • Owner -DweLo PAn em-r - co. ) L.-CD, Address -f.o. -Box 1-7o•j &kt2A1F-L 105 12 -AaA4 To M AdtX-A,( r-OA.D' Located at (Street) FV6rgqW6jT0tQ 1-10A-D Sec. Sd Block 2 Tot 2&. (indicate nearest cross street)' Municipality TOWtJ OF- P/,TTffWG0fJ Watershed r-o -rO t► SOIL PERCOLATION- -TEST DATA P=MM TO BE.SU&Ml= WITH APPLICATIONS Date of Pre - Soaking -7- 12.1 t5l Date of Percolation Test -7 I'l HOLE A. PERCOLATION PERCOLATION Run Elapse Depth to Water ]From Water Level Time Ground Surfac! No. P, In Inches Soil Rate Start Stop Min. Start stop Drop In Min/In Drop. Inches Inches Inches 1 /w,>3 5' -2-7 2 to.,O+ - to: lo 211 3 2 4 5 2 R `2-77 -3 3 ID',16- -2-4. 7-7 3 CP 4 5 2 3 4 5 e - r 9/85 v 7 1. Tests to be repeated' at same depth until approximately egu;al soil rates are obtained at each percolation test hole. All data to be submitW for review. 2. Depth measurements to be made•-frcm top of hole. TEST PIT DATA REQULRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES ' DEPTH HOLE NO BOLE NO. MOLE NO. G. L. TO (SO 1 L 1° 2°. 3° .4° 5° 6° . 7° 8° 9° 10° 11° 12 °. 13° O i I s 14° INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED �j Z6 INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED I� ...DEEP BOLE OBSERVATIONS MADE BY, DATE-. - -- DESIGN Soil Rate Used b - 7 Min/. °, Drgpe..< S.D. Usable Area Provided No . of Bedroa-ns Septic Tank Capacity 1 2 0 o gals. Type Absorption Area'Provided ;By & -L.P. x 24 °' width trench Other lk Name 4VI�F l -6166_� 433 o-- ; R-C, Signature °AA Address SEA, THIS SPACE FOR USE BY HEALTH DEPARDTM ONLY: Soil Rate Approved sgoft%galo Checked by Date a*AN FILL X UWWA150 ftD&. Mftk 'AP No OF EAGH TRENCH m iluoK JUNCTION i..NOIAN HILL KOAC ONLY tNE INSET. T6 A5 .UILT OlMbNS1O'N 'CHART A A Up. 6. I'11.0, 1.1; =0'< 100-01 % 00- 104.0, Q. 1.