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HomeMy WebLinkAbout2814DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.06 -1 -2 BOX 24 1 r7 m ,� , .. .. !'y ~� ��� Lw T '. a. '� r' T I i.L- I T 02814 Rev. V6-1 Located at -' V _ ���///��� Owner /applicant Name4k!l MaWng Address = PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Mast Provide P.C.H.D. Permit.. N COMPLIANCE FOR SEWAGE DISPOSAL-SYSTEM Pr Tax Map Z2--" Block ' [ Lot -A. . 1 Formerly Subdivision Name SabdV. Lot N ZIP + O IZE Date Permit Issued Separate Sewerage System built by 4"Ze WOW" L- ' JW U /'!T S R Address L---/ cf- Consisting of % 2 jrV Gallon Septic Tank and 4 el y .4 -50 "w� /K Water Supply: Public Supply From Address or.-1,f"r Private Supply Drilled by ,9d "% Address �Gr Building Type �� = Hue Erosion Control Been Completed? Number of Bedrooms Hue Garbage Grinder Been Installed? -Al Other Requirements I certify that the system(s) as listed serving the above premises were constructed essentiall - on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulations, in e e filed lan, and the permit issued by the Putnam Cu / f . Date rtified by P.E. R.A. Address / License No. Any person occupying premises served by the bove system($) shall promptly take such a s ure tho correction of any unsanitary Conditions resulting from such usage. Approval of the separate sewerage system shall b I n as a pubt': sanitary sewer becomes available and the appro al of the private water supply shall become null void when a pu comes available. Such approvals are subject to m ficatio o► change when, in the judgment of the Com o r of Nsait bdifleation or change Ism scary. Date BY ��' Title. WELL COMPLETION REPORT Office Use Only DEPARTMENT OF HEALTH L-atr_ __ .. . _ . PUTNAM COUNTY DEPARTMENT OF HEALTH 4� 7 ' 6 STREET ADDRESS: WNJVlLLArL1CIIY TAX GRID NUMBER: WELL LOCATION �sf �'Larare�a rct�e pu+,L W, va[i NAME: ODRESS: WELL OWNER M . ° / -r--39 . l ' I I a r S PRIVATE 0 PUBLIC USE OF WELL OL RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED 1 - primary ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) 2 - secondary ❑ INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT __5-_ gpm. /N0. PEOPLE SERVED .�_/ EST. OF DAILY USAGE ,5-00 gal. .REASON FOR []REPLACE EXISTING SUPPLY ®TEST /OBSERVATION [] ADDITIONAL SUPPLY DRILLING ®NEW SUPPLY (NEW DWELLING) ® DEEPEN EXISTING WELL DEPTH DATA ° WELL DEPTH A6,' ft. I STATIC WATER LEVEL �a ft. DATE MEASURED 7,27 —1 3 DRILLING O ROTARY 19 COMPRESSED AIR PERCUSSION ❑ DUG EQUIPMENT O WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING IR OPEN HOLE IN BEDROCK O OTHER CASING DETAILS SCREEN TOTAL LENGTH — ft- MATERIALS: IN STEEL ❑ PLASTIC 0 OTHER LENGTH BELOW GRADE — ft. JOINTS: ❑ WELDED 10 THREADED ❑ OTHER DIAMETER in. SEAL: ® CEMENT GROUT O BENTONITE 0OTHER WEIGHT PER FOOT A Ib. /ft. I DRIVE SHOE ® YES ❑ NO UNER:OYES ONO DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? PET-AILS I FIRST -.. _ SECO:40 GRAVEL PACK ❑ YES GRAVEL TEMP. O NO SIZE: WELL YIELD TEST ' If detailed pumping METHOD: O PUMPED t tests were done is in- ® COMPRESSED AIR ; formation attached? O BAILED ❑ OTHER :OYES ❑ NO WELL DEPTH DU TION DRAWOOWN YIELD It. r min. ft. gpm. , Qs _.. � ❑ YES I].N4 - I HUUNS I DIAMETER I ft TOP I BOTTOM OF PACK in. DEPTH . DEPTH It. WELL�O F+ "if more detailed formation descriptions or sieve analyses G are available, please attach. DEPTH FROM Water Well SURFACE Bear- Dia- FORMATION DESCRIPTION COOS It. ft. ing meter 1t- STORAGE TANK: TYPE CAPACITY GAL. WELL DRILLER NAME p (^ DATE ADDRESS k b SIG' r'a-4 wvt Q. "1 -11, o'1a S ''3 is L WATER O CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES ONO PUMP INFORMATION TYPE CAPACITY MAKER DEPTH MODEL VOLTAGE HP _.. � ❑ YES I].N4 - I HUUNS I DIAMETER I ft TOP I BOTTOM OF PACK in. DEPTH . DEPTH It. WELL�O F+ "if more detailed formation descriptions or sieve analyses G are available, please attach. DEPTH FROM Water Well SURFACE Bear- Dia- FORMATION DESCRIPTION COOS It. ft. ing meter 1t- STORAGE TANK: TYPE CAPACITY GAL. WELL DRILLER NAME p (^ DATE ADDRESS k b SIG' r'a-4 wvt Q. "1 -11, o'1a S ''3 is L vi PUT!NAM COUNTY DEPAFM41M OF HEALTH DIVISION OF.ENVIROI1ZRMAL HEALTH SERVICES Owner or Purchaser of Building ij Building - Constructed by Location - Street Municipality Building Type Z.;!' P/ Section Block Lot Subdivision Name Subdivision Lot # GUARANPI'EE 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 "C�r+ ,erica -te of Construction Cc npl .arse :! for- Lhe .- .rv:s- e %z ssai syst - repa rs riiade by me to stick 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 --J�— day of / %�j�(,� 19� General Contractor (Owner) - Signature Corporation Nq(he (if Cdrp.) Address rev. 9/85 mk Signature Title ` Corporation Name (if Corp.) � s �/ vTiUp ,, V Viz- i, i/ i ti y, &S 7 YML ENVIRONMENTAL SERVICES a 321 Kear Street Yorktown Heights, N.Y. 10595 ( 914 ) 245=-2300 Albert Ho Padovani, Director z. .. .. .. .... .. LAB #: 320303469 CLIENT #: 1255 NON STAT PROG PACE 1 POZZANGHERA, TONI DATE /TIME TAKEN: 05/17/93 11:45 3 CEDAR LEDGES DATE /TIME RECD: 05/17/93 12:15 PUTNAM VALLEY, NY 10579 REPORT DATE= 05/18/93 PHONE= (914) -526 -4011 SAMPLING SITE: WEST SHORE DR BATHROOM SINK SAMPLE-TYPE..: POTABLE : PUTNAM VALLEY, NY PRESERVATIVES: NONE COLD BY$ TONI POZZANGHERA TEMPERATURE..: < 4C NOTES ... 9 COLIFORM METH: MF --------------------------------------- --------------------------------------- DATE FLAG PROCEDURE RESULT NORMAL - RANGE 05/18/93 MF T. COLIFORM ABSENT /100 ML ABSENT COMMENTS BACT THESE RESULTS INDICATE THAT THE WATEW(WAS� (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDING--M THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION° SUBMITTED BY:_____ _ Albert Ho adovani, M.T.(ASCP) Director ELAP# 10323 ,._. ...,.nom,.. ..,..,- ,'.- amp- m�..- •. -,,.- ....- .aa-.. .... 77. 7. DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER,_CARMEL, N.Y.. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # / fi _ /a X12 WELL LOCATION S;ree Add5eps Town Vi age City Tax Grid Number WELL OWNER N e /� ✓� �i a ' ing Address o��ipr� ef'' �!e Ar 1 A" • Private y!/i% iOlylsar� ire O Public USE OF WELL RESIDENTIAL ® PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O ABANDONED 1 - primary ® BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify, 2 - secondary ® INDUSTRIAL U INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT lS� gpm /# PEOPLE SERVED 4 /EST. OF DAILY USAGE _gal 0 REPLACE EXISTING SUPPLY ® TEST/ OBSERVATION 12. ADDITIONAL SUPPLY REASON FOR DRILLING IZNEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED ®DRIVEN ®DUG ®GRAVED 0 OTHER IS WELL SITE SUBJECT.TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name UrJ 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.- ��r✓. s w _- _ -... _ . _ . . _.. ;. r _ LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED BION SEPARATE SHEET /(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 thirt3c (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. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well dril operations be contained on this property and in suc a anner as not to degrade or of e w e conta inate surface or groundwater. Date of Issue• 19 Date of Expiration (g 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL - HEALTH SERVICES _ -- w -. a _«�, .m .+c�.m �.. .c � - ,_, ca -, r . . � +�. y.s. v:..as ta.o-a .^. ...iv..v.c. •.5 • -maw= w.-.m.- .esa,e. - >...e.:�.�c - -. _ ..• -., .. .-.: .r�.•.xvCa•- r�w•�e.- enw..e rr.. e�i•T: ..vw Date `,9 Re: Property of Located at 1�/ej�� S /'e (T) 14W9&Z Section g:42 °U,�' Block f Lot �- Subdivision of Subdv. Lot # Filed Map # Date Gentlemen: This letter is to authorize `� v��i� �y ��� /� ✓�/ v a duly licensed professional engineer or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with _thi.. - mat,t.er._ and.. o.:�1aperv.i -se ..the system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, Sig --- ?' G te i n er of Prope P.E., # -7 7� - U) I L_ L I bidj,S Al i—, ounJ j� p Address _:F� LCY) L i 1 oG3 own Tel phone tD==7'D'r< 3 s 1 C D::-= Z;Z S'Y_C_'Y_S EZ) & SURSU_RFA M12%fiNTS vlans Tnree S:Sts S/S Data S* P=-c: Ras-lllts (3 F P=rc F01-2 ci Use PC t , , �1 L - ; $. S-,:b.civ-sicn Aooroval CZ'lzeckea *s 2 e ck ai SS )S Adj EONS c: Pre--1969 I I watland D) Neighbor t-cation DDS P :EQT c,_--j �rench zzovided -th S:Ewa:=-2 SYS --- e Sys te:-.1 -;c pr-cile G_7_:_ ft. max. 1r I Fill PrCl f i I & D- =-;-= -C:: �S VO" D cr i r S t= n, cver -7 ...... DE cot- z Oat CK: & =S F= Pig & D Scx Shc4- & DEZ =-, =.-g-ed 10 Ha-_-:se fill notes weiis & SS-L"S'S 200 --Ft. P:'O-Oc-- r1le7w sz�ac. - :--.v --,= ,s Bz)=Es de-th ::,cze _ T -10t) False _Sa�;er NO Be:_as; . Benas 450 100 vr. flocd el ev DTS_j�!�N_ �=-S S=--_'F-=' ON Pll;., Fie2ds 10- to P.L-, 20' to FoUr^ -=ticrl W_=11S ------ to We' 200' in D.L.0-D, 13 00, U 200 f 100' -to st�-== Wa�-2-00-_,rse, rake e•_ 151 -%to 2.50 fz. to DE ni 10, o mater Li. 2 501 irA---,t-Ent (araf-amage co-ar-S-2 5=-Jti nulks 101 well i5, Well 'CO PUTNAM COUNTY DEPARTMENT DIVISION OF I• r M is w HEALTH SEWICES _._.— _:�......I�FSI ^�� A ,�,T'�:.5�3:��'E�: ;���5�•�s�rF �`�'n'.,��F%T °,:L•. >�'-S'i�s. -� ,��.. -�,: .sF'- ����•�,: �,....�.. _- _�.�� -� —__ owner, -i� %� 'a a7loy7���'��l Address v Located at (Street) l ✓� U�� /��'j r-e Sec.6-�'Ud Block % Lot 7- (indicate nearest cross street) Municipality �� �� Watershed SOIL PERCO=ON TEST DATA RBQUIRM TO BE SUBNIITTED WITH APPLICATIONS Date of Pre- Soaking _7,,7,Z- ,7, 2- Date of Percolation Test ��f %� 2- HOLE NUMER CLOCK TIME 2COIATION PERCOLATION Run Elapse Depth to Water Frcm Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 2 4 5 s y T . 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 submitted for review. 2. Depth measurements to be made from top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO, BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE _NO. �_ HOLE NO. HOLE NO.. l; 2'' 01 l/ �id Cir 4' 5' 6' 7' 8' 9' 10' 11' 12' 13' 14' INDICATE LEVEL 'AT 'QiICH GROUNDWATER IS-ENODUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED ` DEEP HOLE OBSERVATIONS MADE BY: DATE: ll�l(a1V Soil Rate Used 41 Min /1" Drop: S.D. Usable Area Provided �4e©U A j No. of Bedrooms Z+ Septic Tank Capacity % gals. Typelva�h Absorption Area Provided By L. F. x 24" width trench Other Name 01 / --') 2-S ) ) , vor b7 Address act 7 y2e'� Soil Rate Approved sq.ft /gal. Checked by Date