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Home My WebLink About2047DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.41 -1 -48 BOX 18 02047 I 4 • J n 1, T , �L IL m. so 1 f 4 . �� . 1' ' '■ 4. ' 2 02047 I certify that the'system(s).as liateCse=ving the above premises were constructed .e ent of which are'attached), and iii accordance with'the standards, rules and iagulati in a Putnam' County:,partme t Of Health.." - Date Certified by Address Zs!�i Any person occupying premises served by the above.system(i conditions resulting from . suc h usage Approval of the sel available and the approval of the-private water supply shall*l sublect to:;niodification or change when, in the judgment, I y as shown.ofr the plans of the completed work'( copies dance with the filed plan, and 'the permit iss�p by the � may b� 'arshall promptly such'i yacu orate seweregejystem shallme.nh soon as eeome null and void when a�public wat or. `supply becom if- tht Commissio of �u . ch; revocetlori, motlifleitl By R.A. License No. re the correction of, any unsanitary a Dub "n sanitary- aver .becomes est4 iallable. Such appiovals are on'or change_ Is necessary. _'Tkle Office Use Only DEPARTMENT OF HEALTH Division PUTNAM COUNTY DEPARTMENT OF HEALTH STREET ADDRESS. TOWN/rILOCTICIlY TAX GRID NUMBER: WELL LOCATION Cameron Rd., Patterson, NY WELL OWNER NAME: ADDRESS: Mario Barone, 7 Pierce Pl.,Mahopac,NY 10541 ❑ P81VATE ❑ PUBLIC USE OF WELL I - primary 2 - secondary XXRESIOENTIAL 0 PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP 0ABANDONED 0 BUSINESS 0 FARM 0 TEST /OBSERVATION 0 OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL 0 STAND-BY ❑ AMOUNT OF USE YIELD SOUGHT gpm./NO. PEOPLE SERVED _/ EST. OF DAILY USAGE gal. REASON FOR DRILLING MCNEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY 0 TEST /OBSERVATION 0 REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELT DEPTH 175 ft. I STATIC WATER LEVEL --20— ft. I DATE MEASURED 2/18/8 DRILLING EQUIPMENT (3 ROTARY 99 COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT 0 CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED 0 OPEN END CASING. 8 OPEN HOLE IN BEDROCK 0 OTHER TOTAL LENGTH 51 ft MATERIALS: 91 STEEL ❑ PLASTIC ❑ OTHER CASING LENGTH.BELOW GRADE _30 ft JOINTS: OWELDED OTHREADED 00-IHER DETAILS DIAMETEU 6 in. SEAL: aCEMENT GROUT ❑ BENTONITE ❑OTHER WEIGHT PER FOOT 19 1b./ft. DRIVE SHOE E)YES ONO I LINER: OYES SNO SCREEN DIAMETER (in) 'SLOT SIZE - LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? -DETAILS- FIRST---- . 0 Yts ONO HOURS SECOND GRAVEL PACK 0 YES 0 NO GRAVEL SIZE: DIAMETER OF PACK in. I TOP DEPTH —ft. BOTTOM DEPTH — ft. WELL YIELD TEST If detailed pumping METHOD: 0 PUMPED i tests were done is in- Q COMPRESSED AIR formation attached? 0 SAILED 0 OTHER ❑ YES' 0 No It more detailed formation descriptions or sieve analyses IWELL LOG are available, please attach. DEPTH FROM SURFACE Bear- ing Well Dia- Meter In FORMATION DESCRIPTION Coe it. I ft. WELL DEPTH it. DURATION hr. min. ORAWOOWN It. YIELD 9prn. Land Drilling in overburdenclay & bl rs. TJj1+ 51 175, 6 155 20 35 51. D illing in rock.set casing,gro-Lte4 $1 175 nyilling in ock granite. f I rWAATEA - 0 CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? 0 YES 0 NO STORAGE TANK: TYPE Well Xtrol, 203 CAPACITY 32 GAL. 1 PUMP INFORMATION TYPE submersible CAPACITY 7 g MAKER Gould — DEPTH 140' MODEL 7EHO5412 VOLTAGE�aH -21 P WELL DRILLER NAME P.F. Beal & Sons Inc . 4 DATE 6 ADDRESS PO BoxB SIGNAME 050 Brewster,NY 1.9 It , BREWSTER, LABORATORIES Box 224 - BREWSTER, N.Y. (914) 225 -2072 - WATER ANALYSIS REPORT - SAMPLE NO. 6981 SOURCE: Mario Barone faucet -well Cameron - Engleside Rd. Putnam Lake, NY COLLECTED: June 7 1988 BY: 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. June 10 1988 l Roy Bi n P.E. D' actor Q PUTNAM COUNTY DEPARTMENT OF HEALIR DIVISION OF ENV[ROAL HFAT,TH- .SktVLGFS.... _.. _. -.. ff" r2l Y9 &a IQ° ti A5 Owner or Purchaser of Building :: �/Iy� Building Constructed by - RO A-D Subdivision Name l V eF LE 5/ OF W4 0,4/ ,,00 -R0 N Location - Street Municipality Building Type Section Block Lot Subdivision Lot # GUARAICPTF.F: 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, _ 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 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 of 19 (Owner) - Signature Corporation Name (if Corp.) - 7Address s" , e -- - rev. 9/85 mk Corporation Name (if Corp.) Arad eseee� �_PUTNAXCOUNTY DEPARTMENT OF ATE OFCOM[PLIANII CONSTRUCTION PERMITYOR WAGE SYSTEM ' naM Depart �nt 7 A lress \X-for Cause Wirt Sy Title Tax A14— Renewal W Pre DP kin or: �,dclress Mi in DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 :�:_..._r_. _...,�...:.._ ......... .. .... ...._ - ._-APPLICATl-6a 7T0r CONSTRUCT�=A `- WATER - WELL .. - _..__. _.... - - -- .__� - XJ_ PCHD PERMIT �� WELL LOCATION Street Address Town/Village/City Tax Grid Number TicJ�✓ /� - 6 - / �� Name Address rivate WELL OWNER �I is ,6e9�di✓L G ®/. c 0 Public USE OF WELL >1BESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP Q ABANDONED 1 - primary ❑ BUSINESS O FARM O TEST /OBSERVATION ❑ OTHER (specify 2 - secondary ® INDUSTRIAL U INSTITUTIONAL O STAND -BY E AMOUNT OF USE YIELD SOUGHT___�� gpm /# PEOPLE SERVED /EST. OF DAILY USAGE G�Ogal REASON FOR EW SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION DRILLING OREPLACE EXISTING SUPPLY .0 DEEPEN EXISTING WELL DETAILED ,R/e�d✓!/ G1G- tSL'"" REASON FOR DRILLING WELL TYPE ED DRIVEN ®DUG ® GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES ><_' NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. 7_r7 — 772! WATER WELL CONTRACTOR: Name .14409W4 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: ��- TOWN /VIL /CITY ' DIST�IIVCE'..T,D_. PROPERTY "FROM "-NEAREST 'WATER -MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED /7 ON REAR OF THIS APPLICATION SEPA TE SHEET Q� (date) ( ignature) 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 provided by the Putnam County Health Department. Date of Issue ,--�// 13 Date of Expiration: 19 ermit Issuing ficial Permit is Non - Transferrable a 8/86 l COUNTY DEPARTMENT OF HEALTH DIVISION Uk' k- NV -u<L* %iravu -u, K� •• .� WATER SUPPLY & REVIEW SHEET - CONSTRUCTION PERMIT (Name of Owner) " .` ( trees- ' COMMENTS YES NO X r� LF trench provided required 60 ft. max. Parellel to contours n Doa' C- .PA 1W go •P _ - - A ? -4 -:5-t wo ss� o Gr. i hl -1 1 I I x I I SYSTEMS DATE REVIEWS • r/e BY: Locat- ion) «.. �....... _ _ _...<� .. -.... -_ DOCUMENTS Permit Application Corporate Resolution Plans - Three sets s/s Engineers Authorization Design Data Sheet (DDS) SUBDIVISION Deep Hole Log Perc_ Consistent Perc Results (3) Fill Perc Hole Depth c3 �i i'( - House Plans - Two sets Well /-� permit; PWS letter Variance Request GENERAL Legal Subdivision Subdivision Approval Checked Ex -ffroval SSDS Adj. Lots Checked et(Town /DEC Permit R & D) DDS Plans & Permit Sarre REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flow Fi 1 o i e & Dimensions - Volume D or , rench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data: pert and deep results Two -Foot Contours Fisting & Proposed Driveway & Slopes Cut Footing /Gutter.,Curtain:- Drains* (discharge OK) q m 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 Bedroans Wells & SSDS's w /in 200 ft. of Proposed Systen Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees,Top of f 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. exp 15' to Drains - Curtain, Leader, Footing 351to catch basin,stormdrain,piped watercou 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' from Foundation; 50' to up-11 15' Well to PL 1 Pun" COLWY DEPAR'Il4W OF HEALTH DIV:QSION'0F'ERvm0NMERML HEALTH SE WICFS Y DESIGN DATA. SHEET.- SU$SUFACE SEWAGE .DISPOSAL .SYSTEM._. .._ _ _ __ ..,FILE ICU. Owner 0....-BA �� Address G� <_ —®-° tort`/ Located at (street) -_� 7?%G.P -aN '. Sec. ,,E Block �� Lot (indicate nearest cross street) Municipality Qi�T/ G� �S��v Watershed / iq�E �yT.✓f�r�y Date of Pre - Soaking ��87 Date of Percolation Test 8��7 HOLE NCO -MM CIS TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate 2 3 •. ,5.. �. 5' 2 3 1. Tests•to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole.. All data to'be sqY tted for review. 2. Depth measurements to be made.fran top of hole. rev. 9/85 ,5.. �. 1. Tests•to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole.. All data to'be sqY tted for review. 2. Depth measurements to be made.fran top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE'SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCAUN'WM IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE N0._ Soil Min /1" Drop: No. of Bedroans Absorption Area Provided By Other DESIGN S.D. Usable Area Provided--'' Tank Capacity ��gals.Type trench Name %%Ei.✓ A /P�!/iELGo �� Signature Address SEAL THIS SPACE FOR USE BY HEALTH DEPARZMPM ONLY: Soil Rate Approved sq.ft /gal. Checked by Date - DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE,IP Owner t0 Address 7 1902k, Located at (Street) Sec. Block Lot !d..?. (indicate nearest cross street) C =.✓ GGG's.��* Municipality T-�-G'",e�Soiy Watershed 1.�4ifG� PyTiy,j2 • ■ • :1• •• •' Yom. • • Y• ' �• ■• �• • 1 Y�II • Date of Pre- Soaking §7/ ,;z 10 A? 7 Date of Percolation Test 4 5 42 fog �� y " 3.3 ,o�• HOLE 5. NUMBER CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level- No. Time Ground Surface ..In Inches. Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 2 /b :e7 - /a: a oZ / n o?I 3 s 4 5 4 42 fog �� y " 3.3 ,o�• 5. 3 /-'CU - 4 / ' 16 ' A' aP r7 i 3r - 4 5. NOTES: 1. Tests to be repeated at same depth until apprcximately'equal soil rates 'are obtained at each- percolation test hole. All data to'be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA RDQUIRED.TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOUS ENOOUNIERED IN TEST HOLES DEPTH HOLE.NO. / HOLE NO. iZ HOLE NO. 3 G.L. 6;4'A"i e. I�s�iri��✓/ Q Name -7-,�Ery 4Z Address ,7 ,EG!/i,; u SF FOR USE BY HEALTH DEPAR74ENT ONLY: Signature SEAL Soil Rate Approved sq.ft /gal. Checked by Date 21 // N dl 3' r b Al 41 N H 5' K !r 61 71 8' rt r r 91 10, it r/ 11' 12' 13' 14' INDICATE LEVEL, AT WHICH' GROUNDWATER IS ENOOUNTERED ) INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENOOUN'''. DEEP HOLE OBSERVATIONS MADE BY:- �,;V C �.✓j� �� 1W�� DATE: 8' 02� DESIGN Soil Rate Used F-10 Min /1" Drop: S. D. Usable Area Provided t No. of Bedrooms 3 Septic Tank Capacity C900 gals. Type Absorption Area Provided By L.F. of Other C.x Py�� iT d✓/ S� Sa f>;y��1�Ti e ��' Name -7-,�Ery 4Z Address ,7 ,EG!/i,; u SF FOR USE BY HEALTH DEPAR74ENT ONLY: Signature SEAL Soil Rate Approved sq.ft /gal. Checked by Date s� 9, 6r`�G .aa ly . PN X� I � Q ,K 300-41 - ;._ P9,0. Xw v� ,i od �a c 14