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Home My WebLink About1983DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.31 -2 -8 BOX 18 01983 OP S', -0 Bedroom Ue Date ' Date r - ~ ' QSAIL an or Beiiri� 46 1 ' m NO A copies 1pem�t Issued by the are - ' ' — Yorktown Heights N.' Y. te Rq.d: ba ' R 9 14S4203 at e Rep*6rtdd:' Vridor-AlbifftH. JDI��Ovanlk T. (AS&) r Collected By. . 7� B , HOMETOWN-MODULAR s e L oca tion -.15 QUOGUE RD.- k :�Rd,..: Norfolk PATTERSON, NY. 1256? a e,son, T.- Phope I. Phone # L _j Repeat Test ? LABORATORY REPORT ON THE BACTERIOLOGICAL qUALJ-TY:-� OF, -,WATER GENERAL BACTERIA - X Standard Plate -Count.(CFU/1.OmL) (Agar Plate 8 35 °C) MEMBRANE FILTRATION TECHNIQUE (MFT) X Total Coliform (CFU/lOOmL) Fecal Coliform (CFU/iOOmL) Fecal Streptococcus (CFU/100mt) MOST PROBABLE NUMBER TECHNIQUE (MPN) Total Coli-form: MPN -Index (per lOOmL.) Fecal Coliform: MPN Index (per 106.*mL) OTHER ANALYSES REMARKS (For,LaboratorX Use) Time U b N88 Sample Type.- (check one) X Potable Non-potable STP INF STP EFF Other: Sample Status: (check each) Outgoing Na2S203 Incoming X LE 40c GT 4 °C KEY FOR TERMINOLOGY RDS Recommend Disinfec- tion of Source TNTC=,Too Numerous To Count CON = Confluent (=TNTC) LE = Less Than or Equal to 54 'dc v Medical Laboratory Ala GT =.Greater Than "i M- �'Uf k i ii street z .1 "K F" U Yorktown Heights N.' Y. te Rq.d: ba ' R 9 14S4203 at e Rep*6rtdd:' Vridor-AlbifftH. JDI��Ovanlk T. (AS&) r Collected By. . 7� B , HOMETOWN-MODULAR s e L oca tion -.15 QUOGUE RD.- k :�Rd,..: Norfolk PATTERSON, NY. 1256? a e,son, T.- Phope I. Phone # L _j Repeat Test ? LABORATORY REPORT ON THE BACTERIOLOGICAL qUALJ-TY:-� OF, -,WATER GENERAL BACTERIA - X Standard Plate -Count.(CFU/1.OmL) (Agar Plate 8 35 °C) MEMBRANE FILTRATION TECHNIQUE (MFT) X Total Coliform (CFU/lOOmL) Fecal Coliform (CFU/iOOmL) Fecal Streptococcus (CFU/100mt) MOST PROBABLE NUMBER TECHNIQUE (MPN) Total Coli-form: MPN -Index (per lOOmL.) Fecal Coliform: MPN Index (per 106.*mL) OTHER ANALYSES REMARKS (For,LaboratorX Use) Time U b N88 Sample Type.- (check one) X Potable Non-potable STP INF STP EFF Other: Sample Status: (check each) Outgoing Na2S203 Incoming X LE 40c GT 4 °C KEY FOR TERMINOLOGY RDS Recommend Disinfec- tion of Source TNTC=,Too Numerous To Count CON = Confluent (=TNTC) LE = Less Than or Equal to GT =.Greater Than N/A Not Applicable THESE RESULTS INDICATE THAT THE WATER SAMPLE kfWASY (WASN'T) NIA) OF A SATfSFACT6RY SANITARY QUALITY ACCORDING, TO THE NLW YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS SVESTED9 AT THE TIME OF COLLECTION. For -Lab Use Only: H/C_to Albert H. Pado v a ni M.T. -(,AS CP) :IDirector 9 -k, PUTNAM COUNTY DEPARTI'M OF - HEALTH DIVISION OF, ENVIROi�AL HEALTH SERVICES 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 succbssors,.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 repairs made'by. me to such system, except 'whe-re the-- failure - -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 utilizing the system. Dated this o i day of 3 19 F F( Signat ur n 1. V % S e Title General Contractor (Owner) - Signature �-3 /m� u✓7 /r119 1 Xn C Corporation Name (if Corp.) /Z l S Q LAO l u e lzd R yF Address rev. 9/85 mk C'O�L &c►��Oni Corporation Name (i Corp.) (I10 r n/ts�� Addtess C�9 r9 eZ .l sA 2_01, A WC.LL UUr1rLG11UV rizrual 4 .e DEPARTMENT OF HEALTH v_:Env1- ronmental_ Healtls:.Serv1ce _&_.::� ,`W Y o4 PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only - WELL LOCATION STREET PRESS: TOWN/91 TAX GRID NUMSUR: Norfolk Rd.., Brewster, NY -WELL OWNER NAME: ADDRESS:, iometown Modulars', 15 Quogue Rd. ,Patterson.,N,y D.Breslin . 0 PRIVATE 0 PUBLIC USE OF WELL ` 1 = primary 2 - secondary f9 RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT. PUMP .O ABANDONED ❑ BUSINESS 0 FARM ❑ TEST /OBSERVATION ❑OTHER (specify) 0 INOUSTRIAL ❑ INSTITUTIONAL 0 STAND -BY' 0 MOUNT, OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED /EST. OF DAILY USAGE gal. REASON FOR DRILLING 91 NEW SUPPLY 0 PROVIDE ADOITIOiNAL SUPPLY ❑ TEST /OBSERVATION 0 REPLACE EXISTING SUPPLY. .: ❑ DEEPEN EXISTING WELL DEPTN DATA WELL DEPTH. z45 ft. STATIC WATER.LEVEL 30 ft. DATE MEASURED 1/6/88 DRILLING EQUIPMENT M ROTARY W COMPRESSED AIR PERCUSSION ❑ DUG 0 WELL POINT ❑ CABLE PERCUSSION 0 OTHER (specify): WELL TYPE 0 SCREENED 0 OPEN END CASING. EX OPEN HOLE IN BEDROCK 0 OTHER TOTAL LENGTH 22 fL' MATERIALS: (31 STEEL D PLASTIC 0 OTHER CASING LENGTH.BELOW GRADE 2l ft. JOINTS: 0 WELDED t3THREAOED '0 OTHER BE DIAMETER ti in. SEAL: 10 CEMENT GROUT ❑ BENTONITE ❑ OTHER WEIGHTIER FOOT - 9 Ib. /ft. DRIVE SHOE DYES 0 NO ' LINER: 0 YES 2ND SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPEDI FIRST OYES URS ❑ NO SECOND - -..: ..._ .. .:.. ... GRAVEL PACK ° YES O NO GRAVEL SIZE: DIAMETER OF PACK in: TOP DEPTH fL BOTTOM DEPTH It. WELL YIELD TEST ; if detailed pumping METHOD: O PUMPED . tests were done is in- � COMPRESSED AIR , formation attached? O BAILED O OTHER ; ❑YES ❑ NO n WELL LOG If more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear- ing weft Oia- In mate FORMATION DESCRIPTION cooE. ft. ft. WELL DEPTH 1t. DURATION hr. min. DRAWOOWN It. YIELD gpm. Surface 10 Drill ing in . overburden clay & bldr H.it r ock at 10' 245 6 225 6 10 22 Drilling in rock,set casing,groute . 22 245 D ill1ing in rock granite. [WATER O CLEAR TEMP. .QUALITY 0 CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO p STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAME P.F. Beal & Sons , ric . DATE 22 88 ADDRESS PO Box B SIGs AE BrewFt;er, NY 10509 .- ... »...C.,.�.N.,. r.w. ., .r .. ...: ..r .. . ..,...- -...qt <,r "n..r,•NV .•m4. :. ....L,4r( - a..';i.i' `'` -' y° "f'S'�`^7!t'.'y+u^/p�nl ?L +T., 9,.�nyx t};.t -.��y ..a�? - -�; < +} ,'y faJ ,f +r!". ,. \" PU4m COUN'f/Y'OEPARTMM OF HEALTH �\ Division of Eovlronmontal Health Servlooe. Carmel. N.Y. 1051? Engineer to Provide Permit M l on CERTIFICATE OF CO CONSTRVVVUCTION PE`Y FOR SEWAGE DISPOSAL SYSTEM Permit -10-61111111 at T ca Subdivision Name Subd. Lot N .� Ta: }Map Block Lot .. ..��',. Owner/ ,„ Renewal_ ❑ Revision ❑ Appllcaat Name ,/ Date of Previous Approval MaWng Address &2 M,040'100, 1 % Town rz- !°nabl ZiPT'L 2�F7— Building Type IL AJ�� >�Ii Lot Area • "l F �` ± FW Section Only Depth volume Number of Bedrooms Design Flow G P D • . GvDd PCHD Notification Is Required When FIB Is completed Separate Sewerage System to consist of �yD Gallon Septic Took and 12D i/F �i2I fJ%� �i i�� To he constructed b9'%% Address Water Supply. Public Supply Ftom Address ortPdvate Supply. Drilled by--- Address Other Requirements — press represent that I am wholly and completely responsible for the design and location of the proposed system(s); l) 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 u nom 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 thadate of the lssu- onte 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 ins ed in accordance wit the Stan rds, ley regulations of the Putnam County Department of Health. Date 2�. $7 sign, P.E.- R.A. I Address License No APPROVED FOR CONSTRUCTION:This approval expires two years from the date issued unless construction of the building Ms been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or •iteration of construction requires *par t. ADD, for disposal of domUtic sanitary sewage, annr private water supply only. /187 Date Title .,. ..- ...:,. ,... n.m.:.. .. ..mr: v..n, ..... .,. ... ... �.. .:.. �. �. .., .. ...`. ..: r.;�Y: •:i i,iA. .. .. .. . 'vY � t 1:,. �4 WW Y3 !. - DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT. # A6 WELL LOCATION Street Address D Town �� vrZI il F,�y Tax Grid Number 3 0 — WELL OWNER Name Mailin Address C]Pri-Vate O Public USE OF' WELL - primary 2- secondary r G RESIDENTIAL O BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O FARM 0 INSTITUTIONAL Q AIR /COND /HEAT PUMP O'TEST /OBSERVATION O STAND -BY O ABANDONED O OTHER (specify O AMOUNT. OF USE YIELD SOUGHT r-57 gpm /# PEOPLE SERVED.'> -�% /EST. OF DAILY USAGE gal REASON FOR DRILLING NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING I:::: > WELL TYPE EIDRILLED 0 DUG ®GRVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL 1 S LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name '�.]�, Address: / IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:, LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED []ON REAR OF THIS APPLICATION 9ON �PAI;UkTE S ET (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 thirty (30) days of the completion of water well construction, the applicant s.hall: 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.. Date of Issue: 19- Date of Expi on: 19 ermlt ssuing �fc�ia Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner 2/87 (lranrrA mnv• WAI I nri 1 i ew AjaM COUNTY DEPARTMENT OF HEALTH DIVISION OF -r (Ndme -bf- owner) r./ CC'S WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT - DATE REVIEWED BY (Street Locatioii) - YES NO DOCUMENTS ° Permit Application C:brporate Resolution - Plans - Three sets s /s. Engineers Authorization - Design Data Sneet.(DDS) SUVIVISION Deep Hole Log Per Consistent Perc Results (3) Fill Perc Hole Depth cd . E LF trench provided jL;_1 required �Z- 60 ft. max. Parellel to contours Plans - Two sets permit; PWS once Request 77 letter GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked yC_ Wetland (Town /DEC Permit R & D) 1A( Data On DDS Plans & Permit Same REQUIRED DFIAI S ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flow Fill Pr 'e & Dimensions - Volume D o ,Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data: perc and deep results Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter ,Curtain- Drai.ns'(discharge GK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area; shown; gravity flcw,suff. size If Pumped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells &.SSDS's w /in 200- Proposed Systems Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 110; Tie pipe No Bends; Max. Bends 450 w /c__nout -_ =:BRA TIGN DISTANCES SPECIFIE✓ `I PAN gilds 10' to = Driveway, Large _ :_ ees , Top of f il: 20' Lc _ . _-_ __-ion Walls 100' to 1; 200' in D.L.C. D , -1, 50 pits 100' tc Watercourse, '�e (inc. expan' 15' Lc .__.______ in, Lerch_, Footing 351tc c tc cas in, stormdrain,piped watercourse 10' to Wa Line (pits -20') 50' inter ttent drainage course Septic Tanks 10' fran Foundation; 50' to well 15' Well to PL }� 9 10 DIVISION OF ENVIRCNMERML'HEALTH SERVICES DESIGN DATA sHEEr-sumumc.E s&qAGE DISPOSAL SYSTEM FILE NO. -. -. ° �Owner ��_�`�'''� address .j�cfilOr.�i:�� rl~TT�pt�..=�`_j2G�°�.,_r. I Located at (Street) LAM Block--# 2 Lottjjf4 (inacate nearest cross street) Municipality Watershed SOIL PERCO=CN TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS 6-7 ZIP - Dateof Pre--Soaking Date of 'Piqoolation Test ROLE M74BER.- C1= TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fraa 'Water Level No. Tim Ground Surface. In Inches Soil Rate Start S Min.. Start stop Drop In Min/ln Drop tip Inches Inches Inches 4 5 - - - p*--.16 ;-1 67.:91 - 2 �W114WOM&� 12- 2. 5, NOMS: Tss,. epeate be rd at same depth until apprckimately k —..; et- to I - soil rates are obtainediAt each percolation test hole. All data to'be submitted or 1 - R- pas 54, t� g'p ts to be made .from top of hole. qremen rev. 9/85 t TEST PIT DATA REQUIRED TO BE SUBMITTED WITS APPLICATION DESCRIPTION OF SOILS -ENCOUNTERED IN TEST HOLES., 'DEPTS. HOLE, HOLE NO HOLE M. r_ T. 21 31 i4l !61 7 :8 .91 10, N) 12' '13' -14 AV 'INDICATE* LEVEL AT WHICH IS EN00UNTERED g� INDICATE LEVEL TO WHICH WATER LEVEL, RISES M%TM..BEIN,G ENODUNTERED JA, DEEP HOLE OBSERVATIONS MADE BY: (ZA a DATE: DESIGN Soil 'Rate Used 6:zl Min/Vf Drop: S.D. Usable Area Provided No. of Bedroarts Septic Tank Capacity,. gals. Type 4PkL�5_1. Absorption Area Provided By I IV' L.P. x *"width trench Other THIS SPACE EDR USE BY HEALTH DEPAFMMU'ONLY: E&I"Ir IM 44- Soil Rate Approved sq.ft/gal. Checked by . .1 Date iy �IxI sfIN6,� 107.72' UU It,% Olo q Cil %DISPOSAL �`ly1>;M H l ,5, PLA N AN -fH AT 13�P0 c2E if NAy iON�Tt?.UGT�D IN R-U l.E s f�N t7 R.�GU LA ZTMENT O'F H�AV'(�-t ADt2.a�NN>% �r>Pt✓eMA I�SS, Ptz>%PA2E� �Y OIZ y i Rl _ 3 ..Koo. r ,nr AS -DUI Vr t�IM1iN614N GHAl2.'f E 2 35.0' 5%. 0' 0.0 419.0' ' X5.0` 40.x' .. 31.0' ' �XtsTIN.G 3V� I f7r-, 0 0v�� „m TAN G� O -b 5 G Pj 6 is E - Ac-2 .r ' . �1'.1;L.301o.0 ��• ^ IV GRApGD Co2AVeLe O vr �? ' N b GRl:15H>%D �T01;1� 'lD0 o• > > _',� . � �' � 300