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HomeMy WebLinkAbout1866DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35.06 -1 -59 BOX 17 L d. 0 „ 'T �AM `� . -� L' IKJJ ILO , � u DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICAT- TON- -;T-G-:; CONSTRUCT' -A: WATER. - WE'LL, PCHD PERMIT WELL LOCATION Street Address P ILL, Town /Village City Tax s� , T) Grid Number a 60y) sk WELL OWNER Name NDA Address r-Da rivate 0 Public USE OF WELL 1 - primary 2 - secondary RESIDENTIAL BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP O FARM ❑ TEST /OBSERVATION O INSTITUTIONAL ❑ STAND -BY ❑ ABANDONED ❑ OTHER'(specify O AMOUNT OF USE YIELD SOUGHT 5 gpm /# � SERVED /EST. OF DAILY USAGE (000 gal REASON FOR DRILLING WEW SUPPLY ❑PROVIDE ADDITIONAL SUPPLY ❑REPLACE EXISTING SUPPLY 0DEEPEN EXISTING WELL OTEST /OBSERVATION DETAILED REASON FOR DRILLING 1&1126\1 40 5Cde, yk-,VV WELL TYPE DRILLED ODRIVEN ODUG ®GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES ✓ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: J. MOWASCh APPLrx J41LL Lot No. WATER WELL CONTRACTOR: Name IV ae� mtincd Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES v--'NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY _ ""DISTANCE` TO' PROPERfiY �FROM� NEAREST WATER MAIN -: -�� �� - � -• -�� .__ _ _ _ ^. _. _. � .. .. _ _.__ w__�_._ :;__.__._..._ _ -�.- LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION 9DN SEPA _SHEE (d e) ( 1gnature) 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 thirty (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 pr vi ed biv the Put County Health Depa tment. r - Date of Issue: �' 19 Date of Expiration: 19 Peomit Issuing 0 fi�ia`1 Permit is Non - Transferrable R /RA r O W WELL UU1°1rLL11UA ArAruAl Office Use Only � DEPARTMENT OF HEALTH ` Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH STREET ADDRESS: WN /VII / IIY TAX GRID NUMBER: I WELL LOCATION Apple Hill Sub- Division Patterson, NY I WELL OWNER. NAME: ADDRESS: Andrew Platania p PUBLICS USE OF WELL 1,- primary 2 - secondary iaRESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT 5 gpm. /NO. PEOPLE SERVED 3 / EST. OF DAILY USAGE 350 gal. REASON FOR DRILLING aNEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 400 ft. STATIC WATER LEVEL 35 ft. DATE MEASURED 10/19/87 DRILLING EQUIPMENT ❑ ROTARY 92 COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED O OPEN END CASING. QcOPEN HOLE IN BEDROCK ❑ OTHER CASING TOTAL LENGTH." • 31 k MATERIALS: STEEL ❑ PLASTIC O OTHER LENGTH.BELOW GRADE -1 n fL JOINTS: ❑ WELDED A3J THREADED ❑ OTHER DETAILS DIAMETER 6 in. SEAL: (CEMENT GROUT ❑ BENTONITE ❑OTHER WEIGHT PER FOOT ].51— lb./ft. I DRIVE SHOE AYES ONO LINER: OYES ❑ NO SCREEN :DETAILS -. _ - DIAMETER (in) SL07 SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST OYES ONO SECOND GRAVEL PACK O YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft- BOTTOM DEPTH It. WELL YIELD TEST If detailed pumping METHOD: O PUMPED i tests were done is in- O COMPRESSED AIR ,formation attached? O BAILED O OTHER ; ❑YES ❑ NO W�L� LOG 1f more detailed formation descriptions or sieve analyses are available. please attach. DEPTH FROM SURFACE water Bear- icy Well 0'a- In meler FORMATION DESCRIPTION conE ft. ft. WELL DEPTH ft. DURATION hr. min. DRAWOOwN ft, YIELD gt m_ . Surface 10 no 6 Sandy clay & gravel 400 Black white & pink granite 350 2 15 350 3 -1/3 400 6 10 300 WATER -a CLEAR TEMP: QUALITY O CLOUDY HARDNESS O COLORED ANALYZED ?XXO YES ONO ANALYSIS ATTACHED ?�& YES O NO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAME MILL DRILLING, 1 30/ ADDRESS Putnam Ave. StGT Brewster, NY M. Mi , e 1 t t BREWSTER LABORATORIES Box 224 - BREWSTER;•.:WY (994) 225 -2072 - WATER ANALYSIS REPORT - SAMPLE NO. 6763 SOURCE: Andrew Platania Apple Hill Patterson, NY COLLECTED: October . 19, 1987 BY: Mill Drilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method well 0 per 100 ml. This result indicates the source of the sample was of satisfactory sanitary quality when the sample . was collected. October 24, 1987 Roy Bickwit P.E. i Director A --I' e7; r o B BLz 'Aa a.'ijnS ? ni 8 - p al i tv by -ilock i T a t (-' OF SFPARA.7.E S_FWAG _7 T. rc,-,rc. seniu- 'u-11-iat I am wholly and coripletel:.- ater` 1, constl-uc.".".'_on and c_ _seas a the above desc-;­2bed prope-i'tv, con,, r t a as d p-1s.n or ap­.Q'01.-C.cl. -r. 7-ccordanc- � _ U-1-1 t-,ne an d a 1-° d s County e no a r t m� r e,,, and hereby guaranty to sors:,. h-irs ol- in good operating c f 38.4 d I s I � - -I _L L stem v Tne wh ch-fails to oT:)era.te IL�l C'. C'."2. d of two years ir.,Lnediate'_1'.-.- J. n c, the date of initial use o disposal system, or any re- ca' r,,.; made by me to such system, excep 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 de- termination of the Director of the Division of Environmental Health Ser- vices 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. U —Da. d- this - da-yL--b-f Title If corporation, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPj_.,ETION 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 APPENDIX B pU1,NAM COUNTY DEPAR�IT OF HEALTH - DIVISION OF ENVIROL�AL HEALTH SERVI INDIVIDUAL WATER SUPPLY & SUBSURFACE SEDGE DISPOSAL SYSTEMS (Name of Owner) CAS LF 0 required Q x 60 ft. ma. Parellel to notes REVLW— SHEET. - .CONSTRUCTION,:-PERMI. DATE /! BY : � (Street Location) NO DOCUMENTS Pennit Application Corporate Resolution Co TZ Plans - Three sets s/s r---� i Engineers Authorization Design Data Sheet (DDS) SUBDIVISION Deep Hole Log Consistent Perc Results (3) 7il Perc Hole Depth 3 ✓ House Plans - Two sets Well --- permit; PWS letter Variance Request GENERAL �p p Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked ( ItGr Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flow s Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes (grinder notes) Design _ Data: perc..and- deep results Two-Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If Pumped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Proposed Systems Property Metes & Bounds . House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max. Bends 45° w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN / Fields G 10' to P.L., Driveway, Large Trees,Top of fill 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, Leader, Footing 351to catch basin,stormdrain,piped watercourse 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' fran Foundation; 50' to well 15' Well to PL M PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF RTMOMMI, HMM SERVICES APPENDIX I DESIGN° DA-A °SHEET= SUBSUFACE SEWAGE DISPOSAL SYSTEi : - - 'FILE 10.'' Owner tend mW P ` 1(� iL�- Address W Qua r Lo n G 13Cd1 D6 NY 10 �bl Located at (Street) I�flO�� �'j�� (�C�a�► Sec_ bq Block _ Lot 40 1. d' �u bcl (indicate nearest cross street) mo P�) Municipality Pr,(�• +eg)on (T) Watershed N , Y Date of Pre-Soaking (o �j���7 Date of Percolation Test G f j is HOLE NCmBm c= TIME PERCOLATION PEROOLATION Run Elapse Depth to Water Frcm Water Level No. Tine Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min/In Drop Inches Inches Inches 120- l Z' 2 a.o A�? C� 2 ) Z'� . 12= 15 190 3 4 his' 1 ! .20 5 2 3 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to* be suhmitted for review. 2. Depth measurements to be-made fran top of hole. V.- O /Q r, DEPTH 1' 2' 3' 4' 5' 6' 7' 8' 9.' 10' 11' 12' 13' 14' TEST PIT DATA REQUIRED TO BE SUBMITrED WITH APPIAICATION DESCRIPTION OF SOILS ENCOUNT= IN TEST HOLES INDICATE LP'VEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED My- e- 22:8LA N lSiCn DEEP HOLE OBSERVATIONS MADE BY: 5Ce. SUbA I� kSk • - IE; DATE: DESIGN Soil Rate Used .20 Min/1" Drop: S.D. Usable Area Provided No. of Bedrocros Septic Tank Capacity gals.- Type Absorption Area Provided By L.F. x 24" width trench Other b-070 c�G n�tc�-� arD vt de Name D?Cir)I e-4 J -D Signature Address &- cdte/in0gc, P-jo d SEAL Wfl �r -Forte -e d ry 7�-P/,F oi? THIS SPACE FOR USE BY HEALTH DEPARD1ENr ONLY: defiy4 � o f,Qd en S y Ga�� ✓ ��i�1�1 .. ���'f� �,✓ � off,► �P �{ .� �n� �'�, Soil Rate Approved sq.ft /gal. Checked by Date _ F—TNfL SITE L3SPECTIGN Date l Ins_ecc- by `y z U4 n OR SLEDIV S_cu LOT Cam- ... . - - •- g. SDS area 1Ccated as far a- c-crovc..`' c? Dirac a-i c°_ can -ter to center b. Fill secticn - Date of place—rent 2-:1 Lc-i i W=Y AVG. DF rF. 1 I I I 6. c., %tl1-= l sail nct st - i>✓c d M --mc`r of bedre= I I c.. Stcn e, brash, etc. , create-r t-r--ri 15' f -L[C Si,S area. V. W= 8. e. 100 f _. f--an wa`e-r c-ur �er l a -� c I kl 9. S��GE DISrG` L SYSTDI 10 112H) E. c -Z-alnk size - CO-02 I I I✓ °__t =: Cf c =avell In trench 12" mLT_uLu L. tank li.-. a-- =- iell I I I C C3 v c. f_a-, iclirr rt._cn I I I G. I`G go 0 Cc=.C�C, Cl_CL'i `v_`^�i_r, 1t� tom. C= e. DL'! —, 'ICN F A 1. P i , Cu L1e---=- GL same e- evaticr &- =ac_ d.minage around well accec'trble. - L. ._o%.eT °_C LcLCri LLCSL I I I I - v Z. vjUiX _CN OX - urcce-rl v Lc 2. to :. c? Dirac a-i c°_ can -ter to center 5 . (-Cc Cf r!:G1 GC ^` J ^ Ul°_ I/ 7 - l./--2 " / =c Gt. I I I 6. 10 = f -�-i7 urccer=y 1-.re - 20 - -- - fc - II:dt1C. ^:° M --mc`r of bedre= V. W= 8. P,c. al1c Ed for e-xcans =cn, a. 9. S e Cf crac2l 3/4 - 1 ;" di e = =r I riI I - 10. I✓ °__t =: Cf c =avell In trench 12" mLT_uLu u I 11. P i -De e-r-a -C c cc I I I J v - �- h. FILM C? EC-SE S YS�S I . _......_._..____ l:. i.-., .o..- Gr.- FL'iCJ•'G'1ciI'iLc?;_ `•- _ _ - -- - I- :I_. d. &- =ac_ d.minage around well accec'trble. - 3. 4 P! G.TL, v� s /Guano I F. o essily accessible manrcie to a =aYe I I I 5. First tex baffled I I _ 6. Clcl e w,_-L-es_e'a by Lez— to Deca-r "merit I I b. P11 pices martially backfilled e_ ti ,atw flag F cacle 1 I I Fl. HOUSE a. Ecuse located 2t-,, cDC_ rGyed plans. I I I b. M --mc`r of bedre= V. W= - a. Well lccz-tea as Ff�r acoroved plans b. Distance frc n SDS area >teasur f t. u I c. Casir_c 18" above grade. d. &- =ac_ d.minage around well accec'trble. I �) V1.OVERA L WGF.�� P a. Ecxes rccerly grout ed ix I I b. P11 pices martially backfilled c. All CiCes flush with, inside of bcx ICI d. P:--ckf -i 1 material ccntai ns stores < a" in diamete -r ( I - e. C=tz- ) drain installed accord rc to plan f. C-L r=.F i n cara ; -, cuLall Prot ;= -te & di —to exist Wazercolsrs2 I C. FCOLl "G drains da scCna -qe aGvny fran EDS area ( I I - h. SL=--Face water protecticn adecL :e _i- i. Er =cs?cn control prcviced Gn slcs ar?- -tar tin 15 %. I� ( �--- r Z ' -y i r ~ PUTNAM COUNTY DEPARTMENT OF HEALTH Rev. 3./86 Division of Environmental Health Services, Carmel, N.Y. 10512 vide Engineer Mast Pro P.C.H.D. Permit # �G'\ OF, CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM _. or V TAX 'Map �y Block Lot y Located at / 4 Ay /G Ir f i f It J1re w P4G Tun d A Formerly Subdivision Name Sabdv. Lot N Owner /applicant Name p r/ ZI Date Permit lssaed Mailing Address Separate Sewerage System built Consisting of / U b !J Gallon Septic Tank and G e.t Water Supply: Public Supply From Address ,i ---- Private Sa 1 Drilled by d VC�LI/ �v� /� /.,vAddress or:� pp y � 10— f Building Type rr�` ih, / r� /r f Has Erosion Control Been Completed? 7 I i �� Number of Bedrooms J Hue Garbage Grinder Been Installed? Other Requirements 1 I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plane of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulat ns, in accordance with the filed plan, and the permit issued by the Putnam County Department 0 H 1 / Ce►tifietl Dy Date Pe 1 P.E. R.A. `i �vt n e.4 / N f1 t eG �1 rc J5 t 1 ' r4 &A 4 L !><� / License No. Address t � Any person occupying premises served by the above systems) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from web usage. Approval of the separate sewerage stem shall become null and void as soon as a pub('= sanitary sewer becomes available and the approval of the private water suDP1Y shall Decome null a v id when a public water supply becomes availablo. Such approvals are subject to mo ifieat on or change when, in the judgment of the Co Ii er A, such revoeatlOn, modlfleatlon o► change Is MCeesa[ Date BY 'VL, PUTNAM COUNTY DEPARTMENT OF HEALTH Permit t �'- Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTI PERMIT— FOWSEWAGE'"DISPOSAL SYSTEM O / Town or village Located at r j� a (� Tax Map &q Block 4— l.ot Subdivision MORASW —A ^Qr < 14 1U- subd• i,ot I Owner/Address . ` V(7"+�f's 4 A `�Y 14 19 Building Type FRAME PL IT)- L Area 54 i Number of Bedrooms Design Flow G /p /D Separate Sewerage System to consist of Gal. To be constructed by d v Water Supply: Public Supply From , Private Supply to be drilled by Address Other Requirements Renewal _ ❑ Revision _ El Date Of Previous Approval Fill Section only ❑ P.C. H. D. Notification Required Tank and 430 if x 2 1„ Wide- - Address 1 represent that I am wholly and completely responsible for tIf,, design and local of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approvetl mendment there to nd in accordance with the standards, rules and regulations of e Putnam County Department of Health, and that on completion t 'r reof a "Certificate of Nin.M ruction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guaran ye will be furnished the or, his successors, heirs or assigns by the builder, that said builder will Place in good operating condition any part of said age disposal system duperiod of two (2) years immediately following the date of the issu- ance of the approval of the Certificate of. Construe n Compliance of the original sy5gem or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that, id well will be installed in ac rdan with t e standards, rules and regu aeons of the Putnam County Department of Health. Date Y� / j� Signetl 0 R.A. Address F, to 54 License No. V�� APPROVED FOR CONSTRUCTION: This approval expires one year from a date issued unless con Yction of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of lth. Any change or alteration of construction requires a new permit. Approved for disfposal of domestic sanitary sewage, and /or private water supply ply. Date By Title F Rev. 9 -81 I 4 1 �� r _W.� �,'+ t ^,d � :. a•�ks {�"'��`t'� ., 3 '+�• t' R r '' ; a' —x} � 5'� 5 . x _ .n � t• i f r- a ,. t �,� � r.' '* � � .� rrw L3 -t a r rs o �. rY } 1 'I Cn • ", ,. 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