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HomeMy WebLinkAbout1829DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35.06 -1 -6 BOX 16 A% :1 MIS A �. . . A16 .. .� l ' r ' } IR 01829 a WELL COMPLETION REPORT 3/71 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report it to be. completed by well driller and submitted to County Health. Department together with laboratory report. of _ "'4hAlysit dfwater °safnple indicating water 15 "df satisfactory bacterlaCquaTify'before certificate °of construction compliance Is Issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME J evelopment Corp. ADDRESS 10 Galloway Hts. , Warwick NY 10990 LOCATION OF WELL (No. 6 Street) (Town) l (Lot Number) Lot #9,/ pple Hill Sub., Patterson, NY PROPOSED USE50F WELL BUSINESS STIC ❑ESTABLISHMENT ❑ FARM ❑ TEST WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ OTHER DRILLING EQUIPMENT © ROTARY � A COMPRESSED CABLE IR PERCUSSION ❑ PERCUSSION ❑ OTHER CASING DETAILS LENGTH (lest) 4} 1 t DIAMETER( Inches) 6 tt WEIGHT PER FOOT 19 lb s ©THREADED ❑ WELDED O X YES ❑ NO WAS CASING YES TJUTED? NO YIELD TEST HOURS G.P.M. ❑ BAILED 9 PUMPED ❑ COMPRESSED AIR 6 20 YIELD (G.P.M.) 20 WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Speclfy 151 �DURING IELD T EST (feet) 2451 Depth of Completed Well in feet below land surface: 265t SCREEN MAKE LENGTH OPEN TO AQUIFER (lest) DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (inches): GRAVEL SIZE (Inches) FROM (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distance#, to at least two permanent landmarka. FEET to FEET 0 26 Drilling in overburden clap and boulders .: _ ....... . .. ... r . Hit rock at 26 _ Drilling in rock, set ..casin rout-edQ_ _ _ . 41 265 IDrillingin rock granitee If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL 5 D� F OF ERT WELL DRILLER (Signal i 1 / 01 Apple Hill Development Corp. 69 Owner or Purchaser of Building Section fJ , & P ) velopment - _ �,. a. >, .4 Building Constructed by Block Old Route 22 Location - Street Patterson Municipality Lot Apple HIll Subdivision Name Single Family Home 9 Building Type Subdv. Lot # GUARANTEE OF SEPARATE SEWAGE 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 success- ors, 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 initial use of 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 occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determin- ,.::.:.:.ai:t:ioxi of:..ths .D r..ec:to.r .of-. t1�e,. D yi_ ion_.. of.�_Eriv_�.:xonin.ent.al- lie a: . h : S:ery Ci !P.�.,•v_,.. of the Putnam County Department .of Health as to whether or not the fail- ure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this 1 d - ly 19 86 Signature of NEB yon Title President . g't Apple Hill Development Corp. '_. r cc tu „�� w Corporation Name if Corp. 2 ��--' 10 Galloway Heights, Warwick, NY 10990 0 601b Address THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Division of Environmental Health Services, Putnam County Department of Health :. BS REWSTER: =LA�ORAT�RBE - Box 224 - BREWSTER, N.Y. (914) 225 -2072 SAMPLE NO. SOURCE: COLLECTED: BY: - WATER ANALYSIS REPORT - 6215 J &PHomes Apple Hill #9 Brewster Faucet - Well July 2, 1986 P. F. Beal & Sons, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 0 per 100 ml. This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. July 7, 1986 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL VOLM SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS 4. 1 ;'FIELD ..INSPECTION REPORT /A,✓ G,-�- /��CJ !�5 Z• 4-11, % ,.,_V__<_ (Name of OwnerY (Street Location) INITIAL SITE INSPECTION YES NO 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 ............................ D. H. 1 Lot _ D. H. 2 Lot Depth to G. W. Depth to G. W. Depth to rock Depth to rock Soil Descri tia 0 ft. 3 ft. 6 ft. 9 ft. 0 ft. 3 ft. 6 ft. 9 ft. Soil UKEM: _ FINAL SITE INSPECTION INSP.BY: House SSDS located per approved plan..... ...... Length of trench measured -� Width of trench average Slope of tile line and trench acceptable......... Roan allowed for expansion trenches .............. Over 100 ft. fran watercourse .................... Natural soil not stripped or SDS area unnecessarly graded.......... ... ......... 10 fti maintained fran property line and 20 ft. fran house... ... . .................. ... Distance well to SSDS (ft.) .................. .. Number of bedrooms checks.— ..... o .............. Stones, brush, stumps, rubble,•etc., greater than 15 ft. fran nearest trench ................ 15 ft. of peripheral soil horizontally from trench..... ......................o... ..... Boxes properly set .... ............... ........ Could surface runoff from driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE A DATE: INSP. BY: D. H. -Deep Hole G.W.- Groundwater D. H. 3 Lot Depth to G. W. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. 00M Soil d� lo r APPENDIX B SHORT ENVIRONMENTAL ASSESSMENT FORM (a) In order to answer the questions in this short EAF is is assumed that the . preparer will use' currently available information concerning the project and the . likely impacts' of the action. It is not expected that additional studies, research or other investigations will be undertaken. _ (b) If any question has been answered Yes the project may be significant and a' completed Environmental Assessment'Form is necessary.. (c) If all_questions have been answered No it is likely that this project is. not significant. (d) Environmental Assessment j 1. Will project result in a large physical change to the project site or physically alter more than 10 acres of land? Yes ✓ No 2.• Will there be a major change to any unique or unusual land-form found on the site? ... . Yes (/ No 3•: Will project alter or have a large effect on an existing body of water? ... Yes _� No 4. Will project have a potentially large impact on groundwater quality? ... Yes V No 59 Will project significantly effect drainage flow - on adjacent sites? _. ... Yes- (/ No' - •6. Will project affect any threatened or endangered plant or animal species? . . . . . . . . . . . Yes (/ No 7• Will project result.in a major adverse effect on air quality? Yes 1/ No .8. Will project have a major effect on visual char- acter of the community or scenic views or vistas known--to- be. • important- to the community? Yes- - t-- No .9. Will project adversely impact any site or struct -' ure of historic, pre- historic, or paleontological importance or any site designated as a critical environmental area by a local agency? Yes No 10. Will project have a major effect on existing or 1 future recreational opportunities? . .. . Yes No 11. Will project result in major traffic problems or .. cause a ira jor effect to existing .h � k , - a transp o1 . _.. i .a�t systers? . . . . . . .� '7oi!ne 9:p Yes -"No. 12. Will project regularly cause objectionable odors, _ noise, glare, vibration,.or electrical disturE- _ ,r ance as.a result of the project's operation ?.: Yes l% No: - _ 13• Will pro 'eqt have any im act on �� tv:�o J Y P public��.-�r`�. ; 1 �T. -` safety? .= .:': Yes jL No • w�ta, _ 14. Will project .ffect the existing community by directly causing a growth in permanent popula- tion of more than 5 percent over a one -year period or have a major negative effect on the - character of the community or neighborhood ?. .. -Yes 11� No - 15. Is there public controversy concerning the project ? - Yes L/ No PREPAREP.' S SIGNATURE: TIM E: REPRESENTING: J Jp eyPLoyra�. k Co DATE: 7 - X.1 R 5- 9/1/78 . I ' i'ntnam County Department, of 9.eal --VA ' Division of Environmental Health Serviee* proved 4s no a for . _o p le Rules and Regulations of the \ am ounty He h epartwn - -- - -_ 24 _ TOPSML /ss;YveLeellril� Ri ! ;Cm7p WELL — SCOO Dev- 540 M O ' � / i'�rSffT10JG 1 � � -•• EOF WE��,Y C-6 *1 CoSftA8-- ., I Kv /�►'r td94� I ? P�'t'1!E OV4 , PUTNo®►1e1( Co. Q•i' .�C. R=27 U `'� L , d Q 202 #;Y4.4 - c..7Mt.°4'1KG aj,,MjMSpR tt® AU-40V N.a► A' VA���CA� i Mli _ OUT Co93.p L!'c. M(>. �s►Ps$, I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .,.f. �C.OUNTY.OFFICE BUILDING-, CARMEL,..N DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILi k. Owner A Ute- h, LL Assoc tj 6h Address_ p L d R6 y e 2. � Located at (Street6dOlcat6 Shr,� L-4ke _Sec. Block �} .Lot e,.4 nearest cross s ree Municipality. & kf.ek San. Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS 9Li 1 �-ss 32.',91, - 3 : 2.G -3o z./ �� �2 % SAI-iE AS ABo1/E- 1 2 F g1 3 t JJ „`a _ 5 a ,4 J'�' ` j y y s..n...... 4Sf `,v b d a d Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. oe Number 9 CLOCK TIME PERCOLATION PERCOLATION Run Eiapse Depth to VaEer Waller ve'1 _ No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in ! Min. /in drop Inches Inches Inches 30 30 2: -- 3 3:0; 3:3-;t 30 ;4.:?_ 2- 3 1 3 0 9Li 1 �-ss 32.',91, - 3 : 2.G -3o z./ �� �2 % SAI-iE AS ABo1/E- 1 2 F g1 3 t JJ „`a _ 5 a ,4 J'�' ` j y y s..n...... 4Sf `,v b d a d Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES s DEPTH:..... HOLE '-NO-.' 9_ HOLE NO: U . w e . _.._ _,t .. HOLE NO. G.L. ?o _sca) L 6.�, 12" 54 h d gj Log". 18" 5, Lt ` G r-a,.e L 2411 3011 Lid 36" 't 42" 48" 5411 6o" 66" 7211 7811 84" INDICATE LEVEL AT WHICH., GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO. WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS P/L4DE `BY "y _ .._ ._ c� s �,.... �,:. _�-P; i++ a:r. Date; -ter DESIGN' _. Soil Rate Used _32 Min/I "Drop: S.D. Usable Area Provided po 0 No. of Bedrooms ,3 Septic Tank Capacity /,606 Gals Type C_dh , Absorption Area Provided By pp L.F. x24" T3 '— . renc . X. name -1 oA h LeA 1= _ signature G 9 Address j p . SEA THIS SPACE FOR USE BY I3EALT�t ?1 I1,? ?`1�RTME -,NT ONLY: ARo' 056O�P� FESS Soil Rake Approved Sq. -1i /Cal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH Permit Div # - �'� Division of Environmental Health Services, Carmel, N 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM ` •- ' Town o► illage Located at C �''^m Tax .Map Block Lot :,.'.Subdivision I�s➢fl:��+,►l69tiYC' ; �... _ - ..� —Q _.,..�_.,a._.._.- r.._, -� d7 Lot' #'S'�' 'Reaewal• (] " Revision , /o G�ow�y /-its Owner /Address I e_ 14 i'L _ ASSOC , W Date Of Previous Approval Building Type i111 !�s J P Few.: L, c Lot Area tC I)y10 .S 4 �- 2. Fill section only ❑ Number of Bedrooms Design Flow G /P /D 4 O O P.C. H. D. Notification Required Separate Sewerage System to consist of 1006 Gal. Septic Tank and S: b 0 'L- ic A hs T.—em a ih To be constructed by __N pCfh1�113e Address Rd AI L42inQa0.ie Water Supply: Public Supply From Private Supply to be drilled by Address 4 PliEha.,, Alit Brews Eel- N Y 1,0_ o ! Other Requirements 1 represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regu a ions o e Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be 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 place 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- ance of the approval of the Certificate of. Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed in accordance with the standards, rules and regu a- T�'rns oof the Putnam County Department of Health. o Date 7 ` 7"Z - D Signed P.E. ✓ R.A. Address License No. 10S e d S APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when sidere necessary by the Co ner of Health. Any change or alteration of construction requires a new permit. Approved for disposal of dome is ita sewage, and /or rivate wat r supply only. �. Date ���� B y Title Rev. 9 -81 ' PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Servlow, Carmel, N. Y. 10512 Permit P - CERTIFICATE OF CONSTRUCTION - COMPLIANCE FOR- SEWAGE DISPOSAL SYSTEM p - T~%r�C.,0/V •. - - -- �'t�"�' /t��$LO��*'► LAI��"- ._ .. ._ . Located at % � C r QL'� Tax Map-- Block i Owner LL / Formerly /� H Tax Map Lot # Subd. Lot # s P G R A C I rN I Address , f Separate Sewerage System b��u��ilt��b/ry�� q )) rY� % !�i Consisting of 1ycs, 0 Gal. Septic Tank and IZ9 L c GPL•LEy_G Other requirements Water Supply: Building Type Public Supply From _ Private Supply Dried By Address Has Erosion Control Been Completed? No, of Bedrooms Date Permit Issued' I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the of which are attached), and in accordance with the standards, rules and regulations, in accordance with the filed plan, and Putnam County Department Of Health. Date 7— / Certified by Address �o /� L 4- © U L mmplet copies the the M Any person occupying premises served by the above system(s) shall promptly take such action as may be necesstry t Lure the conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as on as a pu i available and the approval of the private water supply shall become null and void when a public water supply becomes Ovalle SC subject to modification or change when, in the Judgment of the Commissioner of Health, such revocation, modification or ch Date�'� -� -� B Title Rev. 9 -B1 i i. i i I I. 12'5 PT PRO%i%—P D _ s' /FOOTING 1„ P 4 4d I s 1 I Lb7 X:•.g4. -jo R =225.00 L =9.?8' 6 79 . �= 2'21'44' t G96.4�j- INV- IN Cv94.0 i IN (093.51 OUT Go93.0'. t i tl r Sim (4)-014C G WAY eL. AL %- S�OIzS :Ape �I�C�t�w1 Y GALLEYS TC� BE 1Z O.G. _LOT c3 APPLE HILL. D El�E LQ PM tiT ?A- rMRSOM, PUTNA." co., N.Y. �l.C3VA'i'IQA/ C,ALU!L,(- ad PRac.4%m Sag="aws JO6AN LE"MA.9,p.r. Gop4,6LAL -r'MG EwGlmsem 10 GALLOW A:( %-ke %G VA-r.5 WAI,RW %GK . tee-.,. _. �4 THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM - la '20 20 w WAS CONSTRUCTED AS INDICA ON THIS P AN AND THAT THE _ _ _ _ — — — — -Lit! SYSTEM WAS INSPECTED BY ME BEFORE„ IT WAS COVERED JI OVER. THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE WITH ALL`STANDARD RULES _24 Z.2 0 i N . AND REGULATIONS OF THE -70 PUTNAM COUNTY DEPARTMENT OF HEALTH'S` SFV�iC - � C 1D*►'T7011 - V � � � � ► titG'fr+ It-16 I I \ I- '• '911jTRIPx!'rlau SOX �=-r I . l000 GALLOU 4atGC�fiou it I _ SEPTIC TAM1� 6Eb _ 'SCAL.a : 1". 20' V f I ocAT►OIJ DETAIL - 2 4'bt3ilb- ►NV�euf ��9 � � m I � t Department of Health R1225.06 L=% Putnam Coun y o, 2'2 Division of Environmental Health Services yts�� T3vI�T �. Approved as noted for conformance with applicable Rtjles and Regulations of the Putnam County Health Department. w 0 _11 0 _A DA P 7 :T -RG. 1'44' Iq ry _ Q . coo 4�96 o I �' iw fog8.5 REV ISCfl i -10 -61. a I SOIL- L.OG Cr- 8" -TOPSOIL W - 2 4M SAMTYY LOAM W /31 LT d G12AVeL 2d =$4' CLAY ,LOAM W /31LT d G RAV EL PEFiC0LATi014 'RATE 80MII4. f IV4c" 38oii• x 200 GPt) - v00 GP APPLICA.T%OW RATE = .le6POfF [' 1000/•Co ° 1000 FT' REQ•o. t000FT' /8F'r= 125FT REQ'0 125 FT ?i=OV►lplep LOT 9 AiReAt S IG54 PxrrT__ *0" , pUTn1AM U JO.MN L9MMAN,P -E• C0N3LILTING E104GIN18CSR 10 GALLOWAY 1.11EIGHTIS W" i%w1CK 1 N.Y. �SC1>t.LE:I " =84� �AT�: 5- 20-6f. N.V. L1C- MO. OS40iSB THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM ` •2ozo w i 24222' WAS CONSTRUCTED AS INDICA - `�K�LIMj ON THIS PLAN AND THAT THE SYSTEM WAS INSPECTED BY - M ME `BEFORE IT WAS COVERED OVER. THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE WITH ALL STANDARD RULES _ �- AND REGULATIONS OF THE 470 PUTNAM COUNTY DEPARTMENT OF HEALTH. 40' � f+m• 1 .. p. \• „4 - it y '� D►STR�PStJ�'ioN r�oX 1000 GAU,0M SEPT�G TAN1� L0,CATIQ%I DETAIL Putnam County Department of Health ft-225.06 L Division of Environmental Health Services BV I L:T- z+• Approved as noted.for conformance with applicable _Rules and Regulations of the Putnam County Health Department. 13- te ce'e &90&Ae INV. 1w O WA to 8.5 Ou't V�80 R�vrsec � -10 -6v is v' r. 'S01L I.00�_ d- ft" -TOPSOIL x'-24" SAwl Y LOAM W / -ZILT & G R.sveL_ 24 =84' CLAY ;LOAM W /51LT G RA.V EL PERCOL_AT1014 iZATE. 50 MIN. /IN GEd R 3 SoR- x Z00 GPD = GOO UPD APPLICATION RATP- = .(o6P1D/F ?0 GOO/.& ° 1000 PT` wee V. F I OOO F'i'/ 6FT o 125 FT SXSQ Io f, 125 FT F'1CO41-P2C LOT g �P�w ... A A" �' AlZeAc S I G5 nc SV'S-T @M . 4 PATTER5ov4, .PUTNAM C`- JOHN LgHMAP1,P.E COM3uLT1NC, EMGINaL=R 10 GALLOWAY b1E1G1. -M wA.c wICbe 1 N Y 5C&A-E:1~ =3d DATE: $- 20-8(0 N.Y. LIC.1.10. 05lofis3 i i - �_ 3 PCIG ia,NK' � / '� � � S • GDS T (o9eJlbr ` � j' � ►tJVjeU�tn949 i � I ce'e &90&Ae INV. 1w O WA to 8.5 Ou't V�80 R�vrsec � -10 -6v is v' r. 'S01L I.00�_ d- ft" -TOPSOIL x'-24" SAwl Y LOAM W / -ZILT & G R.sveL_ 24 =84' CLAY ;LOAM W /51LT G RA.V EL PERCOL_AT1014 iZATE. 50 MIN. /IN GEd R 3 SoR- x Z00 GPD = GOO UPD APPLICATION RATP- = .(o6P1D/F ?0 GOO/.& ° 1000 PT` wee V. F I OOO F'i'/ 6FT o 125 FT SXSQ Io f, 125 FT F'1CO41-P2C LOT g �P�w ... A A" �' AlZeAc S I G5 nc SV'S-T @M . 4 PATTER5ov4, .PUTNAM C`- JOHN LgHMAP1,P.E COM3uLT1NC, EMGINaL=R 10 GALLOWAY b1E1G1. -M wA.c wICbe 1 N Y 5C&A-E:1~ =3d DATE: $- 20-8(0 N.Y. LIC.1.10. 05lofis3 i i