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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�. )
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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
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ell 0
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