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HomeMy WebLinkAbout1744DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -4 -83 BOX 16 rm ti - ' ', r L ` . L •} r r. 01744 L . L is r F. r % �' L_ 01744 PUTNAM °DMW6n of Eavb Owner /applicant Name Milling AddeeasT OUNTY DEPARTMENT OF HEALTH " imentil'.Healtb Seivlcer, Canimid, NY 10512 Erigfneer -r P-A& p , P.C:H.D' Permft N Water $apply: Publk'Sapply From Address ,t //�� tt' on itte Supply DrWed by Address 4 pii �Q . e AJ yre Y BandIng dy-, J ..` ), —Lot—size �1 �,3 `%/ —if 4s Erosion Cr)nI-rn1 Roan rinn= l.Ptpq i Number of Bedrooms Hue Garbage Grinder.Been InataliedT Other Requirements I certify that the system(s).as listed seiviny the above,preaises were cone - cted..essentially as shown. the'plana of the completed wrk C copies of which'are attached)', and in accordence.with the standards; rules and re ations,'in accordance with f ed plan, and.the permit issued by the issued County oe��pffartmeennt --Of eealth. Date -` . d�7" / ` Cartit by `P.c RA. , Address G2M UL License No.',, �2 Any person occupying prernises,s•rvad . by the above sys' pm(q shall?p►omptly tai• such actlogas may be neceasary to secure the correction of any.unsanRory . conditions resulting from such - usage.. Approval of thi s parite iiweraya_systain �inall become nuit and vowat mood as a .pubti. sanitary sewer becomes avaliable and the approval of the private- water supOlY = shall b•coma nuq: -and. void whin, a 'public' water supply becomes. wailabla. Such approvals arse wbiect t modifieitf n or Ma •when, ;in the- judgment of tM' Cotri Is on 1td.-such revoeatbn, ntodNIcetkfn Is�nocasaary.. 3/89 Dito ik �_ � B T IM. _�. _ w WELL COMPLETION REPORT DEPARTMENT OF HEALTH PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only p+ lo , 7 WELL LOCATION STREET ADURESS: 75WwViLLAr,11CIIY TAX GRID NUMBER: ei hts Patterson, NY Lot #1 Andrea Lane, Steinbeck Heights,* WELL OWNER NAME. ADDRESS: Spinnaker Companies c/oClay Fowler,Box 3287,Stamford,C ❑ PBIVATE O PUBLIC USE OF WELL 1 - primary 2 - secondary f3 RESIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND. /NEAT PUMP ❑ ABANDONED O BUSINESS r1 FARM O TEST /OBSERVATION O OTHER (specify) 0 INDUSTRIAL 0 'NSTITUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD SOUGHT _ gpm. /N0. PEOPLE SERVED I EST. OF DAILY USAGE gal. REASON FOR DRILLING []REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY [ONEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH G0 ft. STATIC WATER LEVEL ._ t10 . ft. ' DATE MEASURED DRILLING EQUIPMENT f3 ROTARY ® COMPRESSED AIR PERCUSSION O DUG ❑ WELL POINT ❑ CABLE PERCUSSION O OTHER; (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING ® OPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH ____30 n MATERIALS: '® STEEL O PLASTIC O OTHER LENGTH BELOW GRADE JOINTS: O WELDED [2t THREADED O OTHER _ DIAMETER 6 in. SEAL: 10 CEMENT GROUT O BENTONITE OOTHER WEIGHT _ PER FOOT ___ 19--lb./ft. I DRIVE SHOE ® YES ❑ NO I LINER:OYES ONO SCREEN DETAILS OIAMETER (in) SLCi SIZE _ LENGTH (It) DEPTH TO SCREEN (it) DEVELOPED? FIRST O YES ONO SECONO _ _ HOURS .�.._._. GRAVEL PACK O YES O NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM I OEM IL WELL YIELD TEST If detailed pumping METHOD: O.PUMPED 1 tests were done is fn- I 0 COMPRESSED AIR , ! ormation attached? O BAILED O OTHER ❑ YES O NO WA ELL: LOG II more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE wafer Pear- Well oia- neler FORMATION DESCRIPTION con It. it. WELL DEPTH It. DURATION hr. min. ORAWOOWN It. YIELD gpm. Sunice Dr .11ing in overburden clay & boul er Hiq r ck at 5 6o5 6 20 5 30 Dr ll ng in rock, set casing, grout ed. O 60 Dr li n in rock ranite. 7/10 H rdrfracked,Well. WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS _ O COLORED ANALYZED? O YES ONO ANALYSIS ATTACHED? OYES ONO STORAGE TANK: TYPE Well Xt:t of 251 CAPACITY 62 GAIT. PUMP INFORMATION TYPE r»hm R r a i h A l CAPACITY Map Gould DEPTH 540' MODEL 5ES10412 VOLTAGE230HP 1 WELL ORILLER NAME P.F. Beal & Sons I c. DATE ADDRESS 4 Putnam Ave, SIGNATURE Brewster, NY 10509 3/89 U t y 9s4�!lF':aBQRATO€3 Sox 224 - BREWSTER, N.Y. (914) 855 -1930 -- WATER ANALYSIS REPORT SAMPLE NO. 8422 TEST 14ELL SOURCE: Steinbeck Estate Lot #1 Brewster, N.Y. COLLECTED: 4/15/94 BY: P.F. Beale Sons BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method p per 100 ml. This resulil !ndical ?s the source of the sample was of satisfactory sanitary quality when the sample was collected. 4/18/94 J Thomas Meyer Director Q PUITAM COUN'L'Y DEPART OF HEALTH DIVISION OF ENVIR0NLMENTAL REALTH SERVICES Owner or Purchaser of Buildi_n v �r,•e�- t' � �, (� Building Constructed by AJ Location - Street -3 Section Block Lot (_G� �oj P/ c,� Subdivision Name- Municipality j Subdivision Lot Building Type GUARANTEE OF SUBSURFACE SEM.GE 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 conditiQn 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 systgri, except wfRrd_ th&' fa lure b opetate-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 detenn ration 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 o TP was caused by the willful or negligent act of the occupant of t�Q the system. Dated this f `I day of , 19 V. General Contractor (,�+�*"*�ner) - Signature 4""L, Corporation Name (if Corp.) C'lrzr_tq L,) 6-� . CT 6, ,o 6 rev. 9/85 mk Si Title .S., Lkr� '344z,•,`���l��r(r r3 Corporation Name (if Corp.) Mdress n �I 4)_OTp I DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 w ~ APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION Street Address Town Villag City Tax Grid Number -P SOA) WELL OWNER Name )C-� Mailing Address - % rivate 0 67 iA-Zal?�X O Public SSE OF WELL �j primary 2 - secondary RESIDENTIAL ® BUSINESS ®INDUSTRIAL O PUBLIC SUPPLY O FARM O INSTITUTIONAL Q AIR /COND /HEAT PUMP O ABANDONED O TEST /OBSERVATION .O OTHER (specify, O STAND -BY ® AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE p SERVED • S /EST. OF DAILY USAGE O "gal REASON FOR. DRILLING O REPLACE EXISTING SUPPLY O TEST/ OBSERVATION 12 ADDITIONAL SUPPLY ®' NEW SUPPLY NEW DWELLING ) ® DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN ®DUG []GRAVEL ®OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: OA) / S Lot No. a WATER WELL CONTRACTOR: Name Address : dot) -IA))j'yj /00b_ , ;ji=9CIi;�L IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ✓ NO NAME OF PUBLIC WATER SUPPLY: IJA TOWN /VIL /CITY - DISTANCE TO.ruzo *',RTY Vnom NEAREST 'WATER MAIN: LOCATION SKETC SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET 2_"j'1�_A_ � j , /'�_j ( -gg-4, (date) (Sig ture) 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 thirt }c (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 provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well dri ' se g operations be contained on this property and in such manner as not to degrade or o er contaminate surface or groundwater. Date of Issue• 19 Date of Expiration 19 3 it Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller n A.PP,_Zzix 3 P -^i CCUI\'Iy CE %'_- .fH2\T OF F_-- A=,f - Dr%I SICN CF � i-cOl� ti"'a r• �?,T:i SE V-1, = E!ZITti , -D[_ -.L PAT=S SUPPLY & c Lwe ti AC S-�� � D_Sr.�, SC ,S Pre -1969 Nei2hbor notificat LF t_reoch orovlded �p rni= -:: � d f t . rL:c. -- _? 1 _l to 100% e-��. FILL SYS!•�S -- . clayba-rriar 10 ft. fill noes new SY'. deo`n cauces 100 vr. =loci elev. 200 r "-. resez vo i r, etc. 100 rz. SY: (" (Strs`t ?k_X_�t_!Cn) YES DLO 1�'l G� :Ts Pe=nit Aolic.aticn cz)rpo! -ate Resolution ./ Plans - Three sets I ` uthcri zS.t_cZ I� resign C=tr She-et- (DS) Deep Sole Lcg I Cor_s_stenu ? rC Results I Il Perc Hole Death S/S CN (3) Fib' Cd House Plans - Two sets t `-1ut; WS lcttc: Variance �.��;ues _ =__ UAr, Legal S;bdiv -s i on Subdivision A-poroval C' eck_z D�- aoorc,al SSDS Adi . Lots Checked e -_ an (T-_,,,, _/DEC (T-_,,,/0EC Pe_-mi L R & D) Data On DDS Plans & .. a_ni i t Saria R.QuZR= D=- zk � r ON PLI S S a age System Plain - (nort:-i a- row ) Se _=3e Jy5t°^l =id- rateic P =JFi? -- --f- -r _ 11 JP_oMe &t Di ,tarsi cns D or .J Box; Tre, ch/C`llery; -?--, q pit =1=11S Seotic Tank - Size, LLv_1 - Well DC: ?!, C °_rv_ce Line ].f over i"_rat °) _ .. .Dasi ir?'C ar. Caep r=s,. s 1 va-F oot Co _1toi.'..rS Ex _ `i :^a & Pr opos, Driver :ay & S1ov.S Vii. Footin_/Gatter,(D rtG_n Drains (disc_- _e C_ {) P`rc & D eo ' c'_es Located — Representativ�?of primary and e Derision Araa; show-i; gravity f1aw, suf=. Size If PL-ed Pit. & D Box Shcw-n & Detailed House - No. of Beirocrs Walls & SSDS's w /ln 200 f=. or Proocs=,3 : ysters P_ _oerty '.etas & Bo�:^.s - HJ' S` t.:rC't 'Necessary ( yit lot) House Ser er 1/4"/ft. C "0; Typpe P} -i- No Bends; IMay. Bends 43' iti /Cl ,=_nollL c =anRATION DIS= - N-CI.S SPECUF=1 ON PLIDLN Fields 10' to P.L., Driv& ay, Large Trees,T= of fill 201 to roun�....ation [•; =? is 100' to Dell; 200' in D.L.O.D, 1301 pitS 100' to St =_ , Ka }e_co�sa, Lake (__ : :c. exza,i) 15' to Vr_i_ ^.S,L�'t:._-:, :rode_, Foozfnq 1 JJ F l..V Gish i 10' to Water Linz (nits -20' ) 501 inn--- - ittent drat -_-. e course Sentic Tanks 101 fran Foc- ndatlon; 501 to Well 15' Well to Pr � Putnam County Department of Health Division of Environmental Sanitation AFFIDAVIT _ CORPORATE OWNEf� A�#L;ZCAIT:I.i� FOR PERMIT• APPLICATION SUBMITTED- TO _ PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health - In the matter of application for ' I, _ _D A V 1 Q _ Gt b C60 L_ i'JY (- represent. that.I am an offi er or employee of the corporation and am.. authorized TD to act for. _ �Pt2 M_ _ A7�5 (name of corporation) having offices at _ .-t tz . (fp siMPSLN IRDAp_ _�?D, 5o�c .�70 ` A 1z._91_Fz U _AJ -. - _� D.S� Z . _ _ _ _ _ _ _Whose officers -are President C(oc�tO c-- ---- .____ -- (Name 6. Address)'- - Vice - President �OLL"-'� o'er - a0L6_-aCa'& Q (Namq and Address) - L Secretary _ 0� Cc 0 C__ .D (Name and Address) _ .....__ __- - -.�.. __....__..._ -._.._ (Name and Address) - ---- --- --- - -- and that I =award w�.11 be individually responsible €o r, any or all actp of the corporation with respect to the approval eques_ted and all .sub- t sequent acts relating thereto. r. Sworn to before me thisn day Signe Of QQ -� �� � � 19 Title -r- L4, Notary Public' EDWARD J. CRFscrtJTA Notary Public, Scat" o. (." i YorJFy� QLaIlft�gi in Putnam Ccur,;Y [JjJ�/ 76rmreS Novembbr 30, 15,. / . . Corporate Seal P UTNAM :C OUNTY D E PARTMEN T O F H EAL TH APPLICATION FOR APPROVAL OF PLANS 1. Name and Address of Applicant: `� r?IA ?" 4 2. Name of Project: PteD��Sp SS CAS. 4. Project Engineer: OA2g;l I)Q . N t G FOR A WASTEWATER DISPOSAL SYSTEM TD M.�2K�T 1✓S-T �C'f C S i`i5o>C 3l d (21520 3.._- Location T/V /C: "CA --V-- e KS0 i4 9_._•`? 5. Address: 1DR . License Number: 5& 114 Phone: _[_Ga 6. Type of Project: ; Private /Residential Food _Service ..- .Commercial , Apartments Institutional Mobile Home Park Office Building, Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEQR)? Tvve Status (Check One) Type I.. Exempt Type II. Unlisted_ 8.-Is a Draft Environmental Impact Statement (DEIS) required? ............. 9. Has DEIS been completed and found acceptable by Lead Agency? ........... K A 10. Name of Lead Agency � Y i 11. Is this project in an urea under the control' of A ocaii planning, zoning, or other officials, ordinances? ......... ............................... 1-Ao 1 12. If so, have plans been submitted to such authorities? ................../�c 13. Has preliminary approval been granted by such authorities ? — Date Granted: "— 14. Type of Sewage Disposal_ System Discharge...... i Surface Water _Ground Waters 15. If surface water discharge, what is the stream class designation ?........ N ;16. Waters index number (surface) ........... ............................... 17. Is project located near a public water supply system? .................. N b �18. If yes, name of water supply r-� 4 Distance to water supply I X19. Is project site near a public sewage collection or disposal system ?..... K 120. Name of sewage system NA Distance to sewage system "21. Date observed: 1�5 23. Name of Health Inspector: M. i24. Project design flow (gallons per day) ...... ............................... 1'0'0 PU _. - ENV 25."is State Pollutant biscMarget,Elrn�igtion System (SPDES) Permit required ?.. 6 26. Has SPDES Applica{; 'on'b"666 subm�.tto to local DEC Office? 41 27. Is any portion of this project located within a designated Town or State wetland? .................................. ............................... N d 28. Wetland ID Number ..... .......... ...... ............................... EGA 29. Is Wetland Permit required?•.o ............. ............................... t r7 Has application been made to Town or Local DEC Office? ................. (�(_ 30. Does project require a DEC Stream Disturbance Permit? ................... N d 31. Is or was project site used for agricultural activity involving application of pesticide$_ to orchards or other crops, solid or hazardous waste disposal;`' landfilling, sludge application or industrial activity? .........YES or NO N 32. Is project located within 1;000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or NO �_�D DESCRIBE: 33. Is there a local master plan or file with the Town or Village? ........... 34. Are community water, sewer facilities planned to be developed within 15 years? N 0 °35. A`re any sewage - disposal `areas in excess oi" i5X scope? ........................ �� G 36. Tax Map ID Number ....................... ............................... 37. Approved Plans are to be returned to: ................ Applicant _( Engineer If the application is signed by a person other than the applicant shown in Item.1, the. application must be -accompanied by-a Letter_ of Authorization. Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the Pena 1 Law. SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: pr* PU11MM COUt= DEPARn4EtU OF i. DIVISION -OF, ENVIRONMERML FDMLTH -SERVICES. DESIGN DATA SLMT- SUBSUFACE SEWAGE DISPOSAL SYSM FILE NO. ' Owner fpm 7-2) . mR)eK-j:�T X57; Address 1`1 0 . 20X '15%�,6,eek)s -f�� Located at (Street) flea, 7Z7 Ak77 sec-.° Block 02_ lot -9 ( indicate nearest cross street)' Municipality 70W A) 0r- 4417Y 4S0, Watershed 01-47T01 • • • �• �• e' ra. i • We • 0• •• �• 11 1 • i r�i 9,1 • • �. • Date of Pre- Soaking Date of Percolation Test 'HOLE $ . NL]mm cr= TIME PERCOLATION PERCOLATION Run Elapse Depth to Water .From Water Level No. Time Ground Surface In Inches .Soil Rate .. Statt Stop Min: Start Stop Drop In Min/In Drop Inches Inches Inches 2 00 T3 I:of -.1, 3-7 :3& 4 .. .. 5 / p 'r. 2�� 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until apprcmizately equal soil rates are obtained at each percolation test hole. All data to be submitthd for review. 2. Depth measurements to be made -fran top of hole. DEPTH HOLE N0. G. L. 1' 2' 3' .4T 5' 6' . 71 8' 9' 10' 111 12' 13' • a M• ■• m to) • • O' •O DI. 3• Y3► a . • ML%, HOLE M. d� HOLE NJ. i lYT INDICATE LEVEL AT wHICH GROUND;Q= IS ENOOUN'1R miu& I VM TO WHICH WATER LEVEL RISES AFTER BEING E 40MNTERED ; � + . iceBY: DATE: DEEP �_HQL• E OBSERVATIONS MADE t >� DESIGN SoilR4�te Used 1,21 ?J0 Min/1" Drop: ,(pp S.D. Usable Area Provided No. 6f Zedroam Septic Tank Capacity [ rFr LIJ • �- gals • Type Absorption Area Provided By ' L.F. x 24" width trench Other 71 DeT--P 0- J)�2779 10 7212',4 USE BY HEALTH DEPARIlIENT•ONLY: Soil, Rate Approved sq.f t,% . Checked by Date Name ..L,&/2rA) Address P 'I i��l E7 %� T /� [ 'l� L� SERI+ ri T + \/OFFSfz'03" J f. USE BY HEALTH DEPARIlIENT•ONLY: Soil, Rate Approved sq.f t,% . Checked by Date s VI• b 1 M [%1�1�✓ 1 Of�1 G H��7 (1N 1�. ) �a A 2 _ �fi X5.5 �t.0 8 01 bl�.D 8).0 to '15.0 X3.0 11 X1(0.0 x'1.0 12 �l�i.D '12.0 1� 103.0 `11.0 l� 1Dt��0 52.0 15 1 D 'l.O 8�.5 18 -JP •0 X13.5 20 82.0 103,0 21 ell 0 tol.0 , 0 4 L i i n N6,9 °56 "04'j!� l� 13.49 i 3I 0 m r 4�.wIF-u.