Loading...
HomeMy WebLinkAbout1827DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35.06 -1 -4 BOX 16 ME i ' . ;1 95 r � ` _ �4 ' L09 , r 1 ` I } ' A-9 .. ` 01827 3/86 V/\\` \ Division of Environmental Health Services. Carmel, N.Y. 1051? E�� to Provide PermU ' ` \ on CERTIFICATE OF COMPLIANCE�2 Qr+� �CONSTRUCfiON PERMIT FOR SEW GE DISPOSAL SYSTEM Permit N 'Located at Subdivision Name AI's d L L Saba. Lot # Dwaer /Applicant Name P `f" PPE Dp-- u , C o2 A Vlailln9 Address �7'A LLf X j-3AV NT l I� i T EA_PSo N Town or Village Tar Map Block Loth Renewal_ ❑ Revision ❑ Date of Previous Approval Town Zip jailding Type S � I aot Area( al, _() v9 Fill Section Only Depth Volume 'umber of Bedrooms -� Design Flow G /P /D PCHD Notification Is Required When Fill Is completed �parate Sewerage System to consist of Q 50 Gauq. Septic Tank ana 'Li A) � T � I � / To be constructed by 6i - P�Q4 Cxj Ns Address n b A*/ (Ay 1 .[Y &W I y`J %, rater Supply; Public Supply From Address On Private Supply Drilled by R eA Address 'her Requirements C o -M1 1, i J:!1Q A 1 AJ epresent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system pve described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations of o Putnam unty Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will ce in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following the date of the issu- ':e of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above be located as shown on the approved plan and that said well will be installed in accordance with the standards, rules and regu aTfrons oof the Putnam inty Department of Health, j % P.7­ /Q �( Signed P•E._{,L_ R.A. Address r License No ROVED F R CO STRUCTION: This approval expires one y r fro the date i ued unless construction of the/building has been undertaken and is 07 cable for use o y be amended or modified when consider a scary by t ommiss• r f Ith. Any change or alteration of construction ires a n7MV pp roved for disposal of domestic $a t swage, and/ p a a r only. --i• By Title 9)tYL Rev. 3/86 1 \� PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N.Y. 10512 ��- Engineer Must Provide P -42 -86 P.C.D. Permit q - - -- CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DL' Located SYSTEM 61 Town or Village Tar Map 6.9 Block 4 Lot 6.4 Owner /applicant Name -Apple M 1l Formerly Subdivision Name Anz 1 P H i 1 1Cabdv. Lot # Malllng Address 17 Ri irpr 41-rpet- zip-1-0990 Date Permit Issued 7/14/86 Warwick NY Separate Sewerage System bullt by N. Per-agine - Address RD 1 Wingdale, NY Consisting of 1,250 Galion Septic Tank and 720 1n ft abs. trench Water Supply: Public Supply From Address or: X Private Supply Drilled by P -F - RPa1 Ad tnam Ave. Brewster Bul1dlng Type S n g l P family r a c Has Erosion Control Been Completed? 7 P G Number of Bedrooms 5 Has Garbage Grinder Been Installed? no Other Requirements I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulations, in accordance with the filed plan, and the permit issued by the Putnam County Department Of Health. Date 1-6-88 Certified by— _444A ✓'�� P.E. —R.A. Address 17 Ri yer StrPPt r •ri rk ANY 10990 License No. 05665 Any person occupying premises served by the above system(s) shall promptly take such action a$ may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a pubt'_ sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Commissioner ofHaM It 'su- oca_t�,�fication or change Is necessary. Date 2 BREWSTER 'LABORATORIES Box 224 - BREWSTER, N.Y. (914) 225 -2072 - WATER ANALYSIS REPORT - SAMPLE NO. 6402 SOURCE: J & P Development Apple Hill Brewster, NY COLLECTED: November 28, 1986 BY: P.F.Beal & Sons, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method Lot 11 hose Bibb - well This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. P December 3, 1986 k ! oy Bickwit P.E. Director 0 per 100 ml. PUTNAM COUITEY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Apple Hill Development Corp. Owner or Purchaser of Building J & P Development Building Constructed by Old Route 22 I,ocation - Street Patterson Municipality Single family residence Building Type 69 4 6.4 Section Block Lot Apple Hill Subdivision Name 11 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 "Certificate of Construction Compliance" for the sewage disposal system, or any _. rep irs..made..by..me .to ..such._system, _.except, where., the . failure. - to..op,erate• .proper-- ly.. -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. Dated this 6 day of January 1988 Signature Title .. 96neral Contractor (Owner) - Signature Apple Hill Development Corp. Corporation Name (if Corp.) 17 River Street, Warwick, NY 10990 Address rev. 9/85 mk Corporation Name (if Corp.) JOHN LEHM- ', P.E., P.C. CONSULTING ENGINEER io GALLOWAYHTS. WARWICK, N'.Y. 10990 914- 986-7737 June 23, 1986 Putnam County Health Department Division of Environmental Health Service Carmel, N. Y. 10512 Gentlemen: This is to certify that I am President of Apple Hill Development Corp. and I own one third of the development along with Mr. Peter Goertzel and Mr. Jerome Monasch. I have signed the enclosed forms on behalf of Apple Hill and as President of Apple Hill. Sincerely yours, _ -John Lehman, P. E. —.7 RECEIVED UN 3 L 1986 PUTNAM BOUNTY DEPT. OF HEALTH PM M COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMEZUAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW, SHEET..° CONS�'R1f�CTIQN- ..PERP�iIT ...._.,. DATE REVIEWED BY: MW-o-f Owner) (Street Location) t ® n YES NO I DOC[]MENrS Permit Application ® Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions.- Volume _ L,?. , c 1 ; �p pit Septic Tank n. it Well Detail, Service Line if over Construction Notes sign Data details Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located 9 ft Representative of Sewage & Expansion Area _ Expansion Area; shown; gravity flow, suff e If Pumped Pit & D Box Shown & Detailed House - No. of Bedroans f` a Wells & SSDS's Win 200 ft. of _ a / 1, Property Metes & Bounds s -ize Property Located House Setback Necessary (Tight lot) W r - 1 /4 " /ft. 4 '0; Type pipe x, Bends 45° w /cleanout DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 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,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' from Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - . C OUNTY.:. OFFICE- BUIL-DING9-- GARMEL; - =N-: �Y: -A - -- 10512.__ DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner APPLE Hill Development Address Old Route 22 Located at (Street / CL ,A -Sec. 69 Block. ( Indicate neares t cross street) Municipality Patterson Watershed 4 . Lot 6.4 SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Proposed Lot #11 Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Wa er a er Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 2 t;z: 3n — P.00 3c5 a 4 C5- l D, T c-) Ea` ni C q ri CLA )� Ln,__4m X] /Si T ,-�))Ot L. 5 _- 4 0- 507_C>QSn) � ".- �" C Lny Lo-9 m w L t LT_ Rd=) v r= L 5 N 2 ;l PUTNAM rOUNTY DEPT. OF HEALTI-t Notes: 1) Tests to be repeated at same depth until apppproximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. 5 `' �1 U e ;l PUTNAM rOUNTY DEPT. OF HEALTI-t Notes: 1) Tests to be repeated at same depth until apppproximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. _2 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES :..:. DRPTH : - HOLE NO. ti - - Hr� r,F...nTn ... _ ..<.. `TTOT 'M AM __., _ .. ... . _ . _..... G.L. 611 1211 1811 2411 3011 )3611 4211 4811 5411 _. 6011 6611 7211 7811 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE..LE.VEL..TO.WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED— TESTS -MADE,.•BY - ° °R-.• Demarest & John Lehman Date. Soil Rate Used % � Mi 1 11 Dro DESIGN S.D. Usable Area Provided p: No. of Bedrooms 4 Septic Tank Capacity 1000 Gals. Type concrete Absorption Area Provided By�L.F.x2411 3b" width trench. ,e., Other ri Name John _Lehman, P. C. Signature _ Address 10 Calloway .Heights SEAL Warwick, N. Y. 10990 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: j r; 6i n 1 4 sae Soil Rate Approved Sq. Ft /Ca.l.. Checked by `�F �Q � � to PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNT TOFFICE "'BUILDING, CARMEL, _•N. -10512 "" DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner ASE I LL1)FC E YD r- -/MMre s s OLD L-R- ( o� o� Located at (Street) ! \) C Sec. Block_Lot ( ndlca e nearestcross street) Municipality PAIME RY('Z K) Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS hole Number CLOCK TIME PERCOLATION PERCOLATION Zu�z Elapse 'Depth to Water Water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start_ Stop Drop in Min. /in drop. Inches Inches Inches in 1/).,S -1a :27 3 aaya. a5% a3 /y 2 Q:.�C)-LCb 3C) aaV2 Z2y /a as 033%u i 31Y /7 #A- Fops:!)i L ly - g ar- y LQP ►M c v ,1 L. � 311:5 3 a 32. 15 a' T -- 4 ()_S „Fr)tS01c ',- QR`(2 LRN1 LLn ►rn u-)A- I ��-- t C- r� 5 1..; F-1 3 5 Notes: 1) Tuts to be repeated at same depth until approximatel equal soil rates are obtained at each percolation test hole. AY data to �e submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION - DESCRIPTI.ON_�QF....S. OILS ...uNC.OUNTERED__IN.TEST. HOLES DEPTH HOLE NO. �_ HOLE NO. HOLE NO. G.L.C2��C>I 6" 121' 18" 2411 30" \ 4211 S L= 84" INDICATE °LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED.- INDICATE LEVEL TO WHICH WATER LEVEL RISES' AFTER BEING ENCOUNTE TESTS MADE BY ,17�1�'11)��y�T 3 • LE.Hm f) N Date) �) DESIGN ) Soil Rate Used )-7 MirVl n Drop: S.D. Usable Area .Provided sq r" No. of Bedrooms Septi Tank Capacity Gals. Type' Absorption Area Pro — v ded By�_L. F. x2�+" width erenc Other ure Address S . SEAL �� �� A- Bey\ THIS SPACE FOR USE BY HEALTH DEPART14ENT ONLY: 2 Soil Rate Approved Sq. Ft /Cal. Checked by N�� °• PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services APPENDIX L AFFIDAVIT — CORPORATE OWNER APPLICATION FOR PMKIT "APPLICATION' SUBMITTED` TO PUTNA.`i COUNTY HEALTH DEPARTMENT TO: Commissioner of Health In the matter of application for: Construction Permit for Sewage Disposal System LOt #11 I, John Lehman represent that I am an officer or employee of the corporation and am authorized to act for Apple Hill Development Corp. (Name of Corporation) having offices at 10 Galloway.Heights Warwick, N Y_ 10990 Whose officers are: President: Peter Goertzel, 46 Wall St., West Hurley, NY (Name and Address) . Vice—President: J. Monasch, 60 East 42nd St. NY., N. Y. 10165 (Name and Address) Secretary: John Lehman. 10 n11 nway HP; �, Waiwi Gk' i,. y- 1'0799 (Name and Address). -- -- Treasurer: John Lehman 7., - - -- :- (Name and Address) _ '. "..:' _:. -'. •- '. ",,: and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Sworn to before me this 10 day Signed:? Of July 19E6 Title: See 1 i 1 Dell Wino fond Notary Public 8/84 "my PA06 of NOW York Q No.'s counq 0 eW 04064 in orenW ell 29,10L My C4WMISsion , IMS M rnr.nnra[e Sa_aI y sip= rl4riT_�� .0 R ' {�U.• ` DLt''r S, �'$' 1 �'iL15' w.• — ..q:. :i.il..'!.r.= �•:- .- rlX.: ':✓Yi; .'^i'� .'itiit" •.. —.. •c•.- - ..3'�.lt,'r':�.. .;Y;"? _ . 1'.i --- .__ y!a...._.se�: �'w%i ?,.. _!h.Y.b3,:SY!4t� ?.,+�«.::s. }• .�.�,. , � d :•:,+:n+ek' - - _ _'�. - : - .. r.-. nCYb'i'+..r- -•°.3•.. -;..c i�.wTs? 'tea ^:w .: .. +t...+�'! -.w-- ;fir :.�►° .... w— ...- _ _. . �. • .�., :.. _. ___ .,; ,r•. ... �r'rr•.+v:r••. ,r.: -. .:i. 13i••Y�...r,�!.•��'�y5 - _ � T -:C'Y. ' PUTNAM COUN'T'Y DEPART OF HEALTH - DIVISION OF ENVIROI�IENTAI, HEALTH •SERVICES ' INDIVIDUAL V�TEEZ SUPPLY SUBSURFACE SEt�►.GE DISPOSAL SYSTFT9.S FI= 70SPECiIC7N" dig '° ._�,,.., . .k..._... .., ..... ,._........._ _ // / �J �,L DATE: y *(l �JI tY. -� /�: -INSP. BY: ( of Owner) (S Location) INITIAL SITE INSPECTION YES NO CCMMERrS Wetlands on /or proximate to property......... :.... Property lines or-corners found... Can estimate house location..,.; ................. *. Will driveway need cut ............................ Must trees be removed - note these................. Deep holes representative of entire SDS area...... Additional deep holes needed ...................... Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacent wells /septics ................... ...... Access to nrorosed well location for drillina..... D.H. 1 Lot - Depth to G. W. Depth to rock Soil Descri tia 0 ft. 3 ft.' 6 ft 9 ft 12 f t. D.H. 2 Lot Depth to G. W. Depth to rock 5011 Ltilr;: _ FINAL SITE INSPECTION INSP.BY: House SSDS located per approved plan............. Length of trench measured r- 00 Width of trench average p1 Slope of tile line and trench acceptable......... Roan allcwed for expansion trenches .............. Over 100 ft. fran watercourse .................... Natural soil not stripped or SDS area unnecessarlygraded ............................ 10 ft. maintained from property line and 20 ft. fran� house .............................. Distance well to SSDS (ft.) ...................... Numberof bedrooms checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench................ 15 ft. of peripheral soil horizontally fromtrench ....... ..............:................ Boxesproperly set. ...... ......................... Could surface runoff from driveway,.=oads,.. ground surface, etc., channel near SDS area.... Does lot drainage. appear OK in area'of SDS.....:.': • FINAT, r.RAT)w, np STTF Arrpp'PART F D.H. - Deep Hole G.W.- Groundwater D.H. 3 Lot Depth to G.W. Depth to rock 0 ft. 3 ft. :.'6 ft'.': 12 ft. Soil Description AN CA MR / - IRON ROD rO0N0 PA WD RrTA/N /AG 9p1I.2G WALL .IOM DRIW ffrAINNG WALL ttL /09 w }Ac3 m Im /q.lJ/ / /> IG .lG MIp M./1 -102' J STOW ONE5TORY / 5TONE HOU5E / / a BF IM25 'oI. . / 14 /1 1 /100'' 410,17 y G - l .11 14 iOG l9.N /d� / / G.e4 10 9 0 / 3H 1 J L]. 1 [ A PA r7O / Ip / 102.0 rRNPA 102C >/ J , h 02.13 99X1 / +9. -. MW p2 / > / "a +�iG1 LesPRUa 13 / I3 PLV?fR ] L / / u / 2 �15 12 R[TA/N /NGL / }�9� a. 1! 30 .1/ WALL / 114 IS5 •9n *51.4 X96` 36s7NC vLL / //! CN 9).12 5w / +W� GAPO / ro.cu / 4SIPLTi1CLr.( / / ' / 30%4MLf / }C3. +6 302 CA- 33 ON, 14 m �I.3 PqNrfR / /Q 93. A 72 / >I / / ro $5.04 l„ 9+.99 PLAN7rR / � / zaA,_1_ D_ . J� Q, •� PF 30 Wr LL. UUr1rLr.11U1V r%ZrU1C1 DEPARTMENT OF HEALTH _. Division Of Environmental Health.Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only IWELL LOCATION STREET ADDRESS. WNIVI ! I Y TAX GRIO NUMBER: Apple Hill Sub —Div. Patterson, NY Lot #11 69 -�.�,� j WELL OWNER NAME: ADDRESS: J & P Develo ment Cor a Iowa Hts. Warwick,NY 10990 F001PUBLIC BIVATE USE OF WELL 1 - primary 2 -. secondary 9RESIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND. /HEAT PUMP ❑ ABANDONED O BUSINESS O FARM ❑ TEST/ OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD SOUGHT 5 gpm. 1N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING XXNEW SUPPLY O PROVIDE ADDITIONAL SUPPLY ❑ TEST / OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 280 n ft. STATIC WATER LEVEL 30 ftFDATEMEASURED 10 /16/86 DRILLING EQUIPMENT 91 ROTARY ED COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION 0 OTHER (specify): WELL TYPE O SCREENED ❑ OPEN END CASING. OPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH 41 ft. MATERIALS: M STEEL O PLASTIC O OTHER LENGTH.BELOW GRADE 40 ft. JOINTS: O WELDED ® THREADED O OTHER DIAMETER in. .SEAL: iaCEMENT GROUT 08 . ENTONITE OOTHER WEIGHT PER FOOT 19 lb./ft- DRIVE SHOE ® YES ONO LINER: O YES ®NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (it) DEPTH TO SCREEN (ft) DEVELOPED? FIRST _ _.. O YES -. O NO HOURS SECOND GRAVEL PACK O YES O NO GRAVEL SIZE: DIAMETER OF PACK In. TOP DEPTH ft. BOTTOM DEPi}i lt. WELL YIELD TEST If detailed pumping t METHOO: X?cPUMPED 1 tests were done is in- • COMPRESSED AIR , formation attached? • BAILED ❑ OTHER ❑ YES O NO WELL LOG It more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear- Ing Welt Oia- Deter FORMATION DESCRIPTION CODE. it. it. WELL DEPTH lt. DURATION hr. min. DRAWDOWN ft, YIELD gFm. Lurtace 2 Dr lli in overburden clay & bldrs t 280 6 260 10 2 41 D3111ing in rock,set casing,groute . 41 90 nwilling J_n k granite. WATER ❑ CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE Well Xtrol 203 CAPACITY 32 GAL. 9.9 PUMP INFORMATION TYPE submersible CAPACITY 7 g Gould MAKER DEPTH 2 50' MODEL EHO 5 412 VOLTAGE 2—aOHP Jj__2. WELL DRILLER NAME F.F. beal DA PO Box B 86 AODRESSEIrew s t er , NY 10509 5IGrMWE SAM c�U t - �� PUTNAM .COUNTY DEPARTMENT OF,HEALTIi DIVISION O€ r N VIRONIVIENTAL REA.TLH s— VICES �'ki .Y04 FIELD ACTIVITY - r REPORT = ;<a jv NrF • M A 61, AIII24E l �?l Cr t� Street 'Town State Zip PERSON, IN CHARGE )R TT`TTFRVrFwPln; T �. ` L T)ataj_ _Name and Title TYPE OF FACILITY : FINDINGS:u� -o- .12�.r� ,nom- �e¢�_• A„-: 3 %_? ®E., t_ . c t - • y r TN:SPF.� tl' TFT Signature and' Title` R - PORT.RF.CRUZFhRY: acknowledge receipt-of this report SIGNATURE:: - , "'Title: r- NO EXISTING WELLS OR scprc sYSazws LOCATED WITHIN 200' 206.30' p MN `~ wu EXISTING WELLS OR scpno sYsnEws -T LOCATED vwr*/w cmr q 44A ul Pr ZN EXISTING ftLL NOTE, HOUSE SEWER To BE*. CAST IRON _ ~_ 1/4- / FT. w|w. SLOPE ' WITH NO BENDS LOT 12 .'' ^� ( \ pnopooco SEPTIC ^m \ \ \ _ ^ / pPnpnsED ) scPro AREA �--7--- -^ --` �^~+--'—�-- -----~---�—� ` < / ` LOT 1 ` `` 7 WELL LOT 13 � -------' \scpno Anc� I kz° Sf- ,JS'P-rlC- L-OCbz:TiO" 'PLANA putwal County Department Of RMIO Division of Environmental Health Sgr7'oqe approved as noted for conformance With &pplioable Rules and Regulations of the Ktn" Coun th Department.., QienatnrA to 5,,6TT✓M HN LE' AI",-,AMPE 0 N S L LT US` E �Mj� 10 GALLMVAY MONTS VARVACK9 NEW YORK nasal C Ill. rn' nATF: 10-31-86