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HomeMy WebLinkAbout1756DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC: www.scanyourdocs.com 631- 589 -8100 35. -4 -95 BOX 16 19 1 or ,n , IN ' - 16 ol 1.6 01756 PUTNAM COUNTY DEPARTMENT OF HEALTH x , Rev: 3186. 'Division of Environmental Health Se'rvicex, Carmel, N.Y 10512 � l 'Mu at Provide CERTIFI -A 0 . ; ONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM / Q tV a o ? 7" Located at Q Ta: MBP_ Block Lot Owner /applicant. Name Formerly_L 'r �al.fti -S i on Nam s bdv,. Lot N Mullins Address . �P 3 ' - Date' Permit ;Issued Separate Sewerage System built ,by. V) �-�/ K fi— Address • Q t �7 Ox "! �: Off► Y Coneleting of - Z, Galion Septlo Tank and Water Supply: Pobuc Supply From Address or Imo, Private Supply DiQled by LL;1 Address ►-r c g� g Has.Eroslon Control Been Completed? dd , Number of Bedrooms '7 Hue•Garbage Geinder'Been InstalledY /�� Other:Regdremente Z certify :that the system(s) as listed serving the above premises were const tad esaentia4y as shove on the plans of the compl4ed'work'( copies of which are attached) and in accordance with the standards rules and reg 1 tiona in accordance. with the file la an the permit issued by the Putnam. County Department ,Of Health Date' Cwtifi by - 3.�-�— P E: R.A. Addreu • icense No�. Any person occupying premises served by the above, systam(s) sha0. promptly take such actlon as may be nee soery to secure the correction of any unsanitary contlitions resulting from such usage Approval Oi the- separate= sew99g.- -.system (hall becorne:nuu and void as soon as a pubt': sinitiry sewer. becomes availat& and the.approval_;of the,pr)vate water supply shall become null and =void ;when a - public - water .supply- beeornes- available. , - Such approvals are suti)eef to modification .or change when 'in the )u.dgmeni..6f the Commissleaer of Health " eh revoeatlori, modifleit(on or'ehinga is necessary. Date / 8Y Tine K. PUTNAM COUtM DEPAF3II4ERT . OF HEAVIE ISIW OF ENVIRONMOUI. I, 1�1FAL' �i SERyCFS- rl ��,�s l .1 �U 4L .. Owner or Purchaser of Building Building Constructed by TO /�''1�► - /�,yT ��� Location - Street Section Block Lot .J-- r- 'e- Al k Subdivision Name Municipality. Subdivision Lot # i� de, L111 LQ.l Building Type GUARA =.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 sham 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.. .....-Certificate. of .Constructiar.: Compliance" for the sewage-disipos-al systeti,._or 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 utilizin the system. Dat a this � day of cl a 19 ?Z L/-q �/ rev. 9/85 mk Title �. I AJ_�4 .:. See ess "I- �Mcn� WEL_ COMeLETIUN KLruAl Office Use Only tae DEPARTMENT OF HEALTH Division Of Environmental Health=-Services P.UTNAK..CO1MY _PYF _ AR71. -._J zqEUA]kT _s TAX GRID HU N STREET ADDRESS: 7OWNIVILLAULIL11Y Mau- 11 --St Well WELL LOCATION Ice Pond View Estates I Farm-to-Market Rd., Patterson, NY�'1471_6 WELL OWNER NAME. Ice Pond View Estates, ADDRESS: c/o Eagle River Bldrs., Po Box 970, Carmel, New York 10512 9k PaIVATE 1 0 PUBLIC USE OF WELL. -30 RESIDENTIAL ❑ PUBLIC SUPPLY ❑. AIR /COND. /HEAT PUMP ❑ ABANDONED 1 - primary ❑ BUSINESS ❑ FARM ❑ TEST/OBSERVATION 0 OTHER (specify) 2 - secondary 0 INDUSTRIAL 0 INSTITUTIONAL ❑ STAND-BY 0 MOUNT OF USE YIELD SOUGHT 5 90m:/NO. PEOPLE SERVED 3 to 5 / EST. OF DAILY USAGE gal. REASON FOR ❑ NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY X3 TESTIOBSERVATION DRILLING ❑ REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 300 —ft. I STATIC WATER LEVEL _il_ ft. DATE MEASURED 1/10/89 DRILLING ❑ ROTARY &k COMPRESSED AIR PERCUSSION ❑ DUG, EQUIPMENT ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. )51 OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH _72_ ft- MATERIALS: x&kSfEEL 0 PLASTIC ❑ OTHER CASING LENGTH.BELOW GRADE 71_ ft. JOINTS: OWELDED JaTHREADED OOTHER DETAILS DIAMETER in. SEAL: :aCEMENT GROUT OBENTONITE-0-OTHER — WEIGHT PER FOOT 19 Ib./ft. I DRIVE SHOES YES ONO LINER: 0 YES ❑ No DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? SCREEN DETAILS FIRST 0 YES ONO SECOND HOURS 64AALi 0A­CK D'Y'S GRAVEL- DIAMETER TOP BOTTOM ❑ NO I SIZE: OF PACK — in. DEPTH IL I DEPTH — It. WELL YIELD TEST If detailed pumping It more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. METHOD: ❑ PUMPED 1 tests were done is in- DEPTH FROM Water well )ftCOMPRESSED AIR formation attached? SURFACE I Sear- 012- FORMATION DESCRIPTION C30E 0 8AILlfD 0 OTHER ❑ YES ❑ NO It. it. ing "ter In WELL DEPTH DURATION DRAWOOWN YIELD Und Surface 12 Sandy gravel & cobbles. It. hr. min. ft. 9pm. 12 20 Grey hardpan. 200 1 30 200 3 20 30 Hardpacked hardpan. 30 60 Soft fractured bedrock. 300 6 15 250 20 60 300 Medium to. hard a anite. WATER WCCLEAR TEMP. QUALITY 0 CLOUDY HARDNESS ❑ COLORED ANALYZED? )MES ONO ANALYSIS ATTACHED? XXYES ❑ NO STORAGE TANK: TYPE CAPACITY GAL. — PUMP IHFORMATIOH TYPE CAPACITY WELL DRIUS NAME MILL DRILL INC. 11 / 8 9 MAKER DEPTH — ADDRESS Putnam Avenue MODEL VOLTAGE — HP Brewster, NY Mre eid 'en t s.4.- ...G BREWSTER .LBi7R�►iil7i�t� Box 224 - BREWSTER, N.Y. (914) 279 -4945 - WATER ANALYSIS REPORT - SAMPLE NO. 7216 WELL SOURCE: Ice PoAd Estates Lot 13 Patterson, N.Y. 12563 COLLECTED: 1-10-89 BY: Mill Drilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. 1 -12 -89 0 per 100 ml. • Thomas FROM 40 i Director Ts lc: as T:,;-r a,-zrc: EC c a !9 C plats -- a - - 2 :1 Vii; �> LC-? ?ry Jrr_ vG _ D? C_ ?Ta_itrl sci_ r_ =t _ - C -^..�° �.TiL =• E =C_ , C=_L =l_ tF-rl a- G_ se--tic a-_ __ -- 1,000 1 �- C_ CL==- 10 w - - 1. F11 1 EG::= 11 L =_- C r =C? =1 cr T 1 'Zr -YC =1 C =i anci -C. c C= = _ C_'� cC' == ^'t = f 7 - IJ3L �� =CGC_ I X z_ C. C=--:: G_ 3/A _ 1-1-11 C= C =-;al ii-- t=ie-± 1' p ae- E= w F7 SZ E. C-u-cl G _ - -__ __- h- T:G c,,C-I-E 1 c_ r ^Lc ?CC=- r=--r a=rcvc= Tuns. V_ h 574:z C_ 18" accz V__ a_ B=YcS rrcce _v c--cut—at I SC`_^_Es- < d.. Inc =:cL_ E_ ri (Era; - i Cc ` 1 i � cG: ^rG� ^_C L.O L' i_`'1 f_ C= am e_� C" -all l,r tee- c_-_tc E-_5�_waL_ i?= =` I I C_ as "`CL'nC C_'=' -� C_' =C^�Ce ctscV - 1_ -ac =_ WEZ= DEPARTMENT OF HEALTH Division of Environmental Health Services OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION Street ddres 'm � . '� � o Vi a City Tax Grid Number � •P/c's o r) o — 5 -- ► 3 WELL OWNER h=--4 M ilin S ddregs, PO (So x 6T&(4-2.Y Private O Public USE OF WELL a)- primary 2- secondary RESIDENTIAL 0 BUSINESS. D INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP [Q FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY O ABANDONED . O OTHER (specify O AMOUNT OF USE YIELD SOUGHT Rpm /# PEOPLE SERVED /EST. OF DAILY USAGE gal REASON FOR DRILLING O REPLACE EXISTING SUPPLY E(NEW SUPPLY N DWELLING D TEST /OBSERVATION GI ADDITIONAL SUPPLY O DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING, Ge- WELL TYPE ODRILLED - DRIVEN []DUG OGRAVEL OOTHER IS WELL.SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION,.NAME OF SUBDIVISION: Lot No. I F WATER WELL CONTRACTOR: Name 4, R Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X- NO NAME'OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY ._._- -.D1STANCE °TO'PROPERTY FROAi NV.REST WATER MkIN: �0- - LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDE MON SEPARATE SHEET (date) 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 thirt3� (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 drill perations be contained on this property and in such amanner as not to degrade or oth wis contaminate surface or groundwater. // Date of Issue• !3 19� Date of Expiration ! 7, 19 3 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller APP—ENDT( 3 aP �y1 CCLT'I'Y %�A_ •` 'T OF I- ALTH - DIV-ISICN OF ENWIRO�ENL'n.L ~S<PLTH SERV?C� r DO—V .�'?_L Gam' = R SUPPLX & SUPSLaFACE .�..�t ?GE DIS?C r_L Svc' S C\%-Laer ZZ ✓�/�V w ' -rte -t/L. BY: az=ITS Pew lti t Application Corporate resolution Plans - '_ .ree sets L :resign Data j'.a t- (DDS) yep Hole Log Consistent Parc Perc Hole Deoth S/S S'v_-=v?SION par` F i1 cd House Plans - 'Iwo sets - Well pe —mut; P %YS l=— Variance reauast Legal Subdivision Subdivision Pooroval Chec:ed E�c-aoorv,---1 SSJS Pdj . Lots Check-ad w-etla,nd (TcF,,•:� ,/DBC Permit IR & D) Data On DDS Plans & Pe_ -mit Sar,,-- R:-:QL�T� DZ.- !=, ON PULNS Sewage Systzn Plan - (north a=rcw) Sewage Syste;i Hydraulic P_ o F i l' F11-1 Profile & D- ::ansi c: s- - Vol:-„ D or J Box;Tre-adn /Caller1 s; ?-V, pit �e�ils T Seotic T Lnk - Size, Wail Detail, Service Line i f over Const...roction Notes (grin--2isr rate) Resign Data: _p rc -and -deep- - esalts 1.: i :Gs=rJ ML, �l i n� tY +�rGp. =s' Dr_ve ay & Slozes Cut Footin Gutt_r,C�r ain Dra' s (disc_: v1) erc & D-zeG 'Holes Located ep�ase :,'r.tive of pr -,.azy and ex^�ns o1 . j L-�.ansi on A--rea; shown; gravity size II ?z med Pit & D Box Sze z & Da _i'__3 Haase - No. of Be roa-s Wells & SSc)S's wlin 200 i t. of Prooc =-5 Syst--lS Prooerty eta & Boun^'_s House Sethac!C _Necessary (Tight lot) Ho: se Sewer - 1 /4 n/t t. 4"0; ype pi_r No 3ai ds; 'l.Ji. 32- ndS 45" w /cleF -IoUt SER_' -_P TION' DIST="N= S_ B2 E = ON Fields 10' to P.L., Drivewav, age Trees,T- -o of fill 20' to roan`= lion �:a11s 100' to Well; 200' in D.L.O.D, 150' pits 100' to Str a F -,I, k'aterCo: •-Se, lake (:,c. ea-an) LG Dr- i -,— :•amain, :r= lei, "oOt: lg- .15"o CrtCn I"•csin,storitia;n,yit;rd 10' to Water Line (pit - -20') 50' in'u?`mi tellt drain-ace c'y -'r'se icGti C Tanks . 10' Fran Fo, :5- ---ion; SO' to loll .J' Well to pr s Putnam County Department of Health Division of Environmental Sanitation 'T T OR—FO— i' OWNER A PPLICA`1`l UN `. ti Y l`l'i�ci V l l - .L 1 E FOR PERMIT• APPLICATION SUBMITTED- TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health - In the matter of application for` ' I, __DAVID _ Ct0C.= Go�� Z( ___• represent. that .I am an offs er or employee of the corporation and am authorised' -W r A K44 �1 cod to act for_ _ _ F-X2M_ _ 172)•_ M A. 21e-a7( IF—S-j"A7ir-- 5. ' (name of corporation) — ! f f having offices at P_-E. 6 SI MPGbAj 120Ap `fin,' 5oX .1'7o 6-A (zNiE, l- N'.`r_ 10.S I12 ,— _ _ _ _ _ _ _Whose officers -are President C�oC_GO c.V��l-- --_ - -- - - - — — — .— _ 'Name an Address) Vice - President ��l/`� _aoLt --a(6T o (Name and Address) - Secrt tary _ — _ _ O� CL GC.D - (Name and Address) Treashrer _ _____' — ,(Name and Address) _ _ and that I =award w�.11 be individually responsible for, any or all apt¢ 1 of. the- corporation with respect to the approval e0ested and•all .sub - sequeit acts relating - thereto. % i. Sworn: to Before me 'this day Signe ._i�Z Of '!'Y'f %�' � 19 Q� Title L(,� P/l� `� _ �' TA " • Ilk Notary Public' EDWARD J. CRESCPNT.A Notary Public, state of New yo, OUGA1140 . in Putnam Coullty 'form November 30, 16•, / . Corpor4te Seal • 1 I I + .. 6 Municipal-ity Pi of Pa7-r Iz►'z J-' Watershed, Gr,-o70 F 3 SOIL, PERCOLATION UMT DATA REQUMM TO BE SUBS WITH APPLICATIONS y . Dane of Pre - Soaking 5 3 . I. b g - - Date of Percolation Test _, .. _,•_ S h I b13- SOLE 141lSER _ "CLACK TIME Run !Elapse Depth to Water From Water Level xo: ................. . Time Ground Surface - In Inches Soil Rate- Start-Stop Min. Start Stop Drop In Min/`In Drop Inches .. _ :..... inches .._ inches :._ ...... ; -ci 2 P,OLC I2 4.. 1 I 2 to :5? - ll'. I- 3 I1:2'j - 12:03 ; 3G .2A- ZS� Z - • 1 2 F 3 y NOTES: 1. Tests to be repeated. at same depth until approximately equal soil rates are cbtained•at each percolation test hole. All data to'be snbmittla for review. ' 2. Depth measurements to be made from top of hole. Y TEST Prl .ATA REQU=,TO BE SUBM h_ .�i APPLICATION DESCRIPTION OF SOUS ENCOUNTERED IN TEST HOLES _ ... DEPTH - Hom NO- I EOT2 .rte-... $ME NO. G.L. 1 .To P.501 L pso 1 L 31 .ii � '; -'.r. tY ;:. its 1.i4.`�. %:; ��'t'1'c' C'•' "Y '�ii :: ?t• ;:•`� % ?' 61 11' 13' 14' INDICATE LEVEL AT WHICH GRAUNDAAM IS ENCOUNTERED N l� INDICATE LEVEL TO WHICH W= LEVEL RISES AFTER BEING II3JOUNTERFD DEEP SOLE OBSERVATIONS MADE BY: LA VL jo-'O-,K P G. D'. o. H.... bAZ'E: 5/1406 DESIGN Soil Rate Used 2I '3 a Min/1" Drop: o f (a0 S.D. Usable Area Provided . No. of Bedroams Septic Tank Capacity- 125U gals. Type ,vG Absorption Area Provided By (a L.F. x '24" width trench Other ' l � •t Name I-AL "T 9MUiAJ6K4z (AJCt �S3 o c PC. Signature 11"'t4T Address 73 rM m F/ 9t-P D rZi v r- SEAL. 'ant Ci2� • �h77�t'L3Ut�1 NY• •I ZS(v3 �• �',�`-- __.._ -- ,,P�� THIS SPACE MR USE BY HEALTH DEPAEMEM ONLY: Soil Rate Approved sq.ft,/gal. Checked by Date vqr--LL- 0 MA►KET KOAD AS - BUILT am P Ro J [ C L EI 1:,A-T DRAY f f.. i -.' ' S .f .'*., k` -., x ., ,. { tj _ - -, £ _ s - 1 ),yam v p^s - -� a 3 •- Y tm r -C 2 w 11 . _ - 4 f 11 � -.' :' - x .' 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