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HomeMy WebLinkAbout3131DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 63. -4 -20 BOX 25 03131 17 1 1 10 L's, J III , 1 In ■ j,■ , I , 03131 PUTNAM COUNTY DEPARTIIM NT OP HEALTH Y ReV 3/ 86 Division of EnvWhmentsil HealthSeivtceo; Carmel, N Y 10512 t EuglaeerMast Provide P essay GE. DISP SA ci'STF /�G Gj Locates at .4 ✓ Town or.VlUage ./ c Ta:'Map d3 BlockLot Formerly Sdbdlvislon Dig o/ .� Sabdy Lot N "Owner /applicant Namep— Name ,y� Mauin6 Addteas: �3T S44, l " / °/' "'� �P /U t/ Di .16, ed .. Separate Sewerage System ballt by A Address . d �. 33' Consisting'of / U Gallon Septic Tank at►d' Water Sapplys Pdblic Sap ply From Address / ors Private Sapply DrWed by!_�_,, Address __ en� 10c: Bnllding Type ', "� �S C �7 G'�° Has Erosion C it I' Been Completed? Namber, ofBedrooms - Has Garbage Grinder Heen Installed? �� Other Requirements ���, tO �/' G Ah I I certify that'the systems) ;as listed serving the above;pr ses were constructed tTal % wn:.on the plans of,the. completed, work ( copies 4. of which are'attach'ed)l,'and iri accorddnce:witfi the standards rules and isolations cF th the filed plan; and the permit issued by the PutnemCounty Depnrtm nt Of Health Date ►tiflett / License No. -s Address Any person occupying' premises 'served by th above systems) shall promptly take wslsa saiy to secure the'co►rectlon of any unsanitary conditions,resulting fiom such .usage •.Approval: of the feparate sewerage system shall � w� void a59001 ,46 a, pubs : sanitary, /ewer becomes available and tha.approvsLOf the• rivate' water "supply shall.beeome•null and.vokt when a supply b�coma�vallable. Such' approvals subject to nodifk:etlon or change'when, in ttie ludgrisent of the'Commislt , ch revocatkin; modification or chanp. is, ��necessary. LOCATION WELL OWNER USE OF WELL 9 - primary 2 - secondary WELL COMPLETION REPORT Office Use Only _.. DEPARTMENT OF HEALTH a. Division Of Environmental Health Services PUTNAM, COUNTY DEPARTMENT OF HEALTH 3, — STREET AOUHE`S_S. 111WRIVILLA!,1107 TAX MO NUMSER: NAME: AODAESS: r% ! `a l�` &f SIVATE ❑ PUBLIC ,j; , , l�,!h4' ?v �' r s i , 9'RESiDENTIAL ❑ PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP ❑ ABANDON 40 ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm.1NO. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR ®REPLACE EXISTING SUPPLY ®TEST /OBSERVATION ❑ADDITIONAL SUPPLY DRILLING ONEW SUPPLY (NEW DWELLING) ❑DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH � � I _ ft. I STATIC WATER LEVEL ft. I DATE MEASURED DRILLING VROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG EQUIPMENT ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE 1 ❑ SCREENED 0'6EN END CASING 0 OPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH CASING LENGTH BELOW GRADE DETAILS DIAMETER WEiGHT PER FOOT [— SCREEN DIAMETER (in) FIF.3T �f = SECOND - GRAVEL PACK O YES GRAVEL ❑ NO SIZE WELL YIELD TEST METHOD: ❑ PUMPED Q ,6MPRESSED A;R ❑ BAILED ❑ OTHER WELL DEEM DURATION It. hr. min. It detailed pumping i tests +ivere done is in- formation attached? ❑ YES 0 NO DRAY1OOWN YIELD. It. gpm. WATER O CLEAR. TEMP. QUALITY ❑ CLOUDY .HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO PUMP INFORMATION TYPE S "^e t'r s CAPACITY MAKER G LU DEPTH" _. MODEL VOLTAGE 111 1 HP. L4- I fL MATERIALS: MISTEEL ❑ PLASTIC O OTHER S n_ JOINTS: WELDED 0- THREADED 0 OTHER in. SEAL: CEMENT GROUT O BENTONITE O OTHER. Ib./It I DRIVE SHOE ❑ YES 0 LINER: CJYES 014b SLOT SIZE LENGTH (It) DEPTH TO SCREEN (ft) DEVELOPED? HOURS OF PACDIAMETER in. ITOP DEPTH ft. L OEE�'T}tM ft. �IFLL LOG if more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM water W-I! SURFACE Bar- o" FORMATION DESCRIPTION 00E meter tt. Ei ' "9 in Land 5urtace O V t{ r< r d� .t/ S' .4 S L i ' s STORAGE TANK: TYPE CAPACITY 0 WELL DRILLER NAME ADDRESS J j •4LK, MGFrtMK GAL. PIUrNAM COUNTY DEPARD= OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH_ SERVICES .rr vWmr.FrrH •K a ;� w. . ._ .•.•.'•h".�nrw�3d.�r _ _. ! .r .�cf'. �r .. -..y: Fs- �.s.�'�LYm./�oaru.:0a;e.n.o wa l�.��m. F�.��.¢M+ +, J�hrM awrwf ^..: �::. •- :..s/ �. r- y.ni.. Owner or Purchaser of Building Section Block Lot fj Building Constructed by jq %l �d Location - Street Municipality Building Type Subdivision Name Subdivision Lot # 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 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 irmediately following the date of approval of the °�erti icd C C : ConstLrUCt Or- CGiiip .?ianceI+ for _Fhe SewagC�CiiS�L.�. HStt�"lj '.Or p3%j7' r - 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 Environmental. Health Services of the Putnam County Department of Health as to whether or not•t.he failure of the system to operate was caused by the willful or negligent act of the occupant of I he building utilizi the system. Dated this day of D ` 19 ±,7 Signature • Title d' General Contra or (Own ) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk Corporation N (if Corp.) Address ` ' ~ YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 105'1/8 (914) 245-2800 LAB #: 32.312329 CLIENT #: 3433 NON STATPROC PAGE 1 SPACCARELLI, CONST. CO DATE/TIME TAKEN: 06/12/94 14:30 P.O, BOX 747 DATE/TIME REC'D: 05/12/94 15:10 BALDWIN PLACE, NY 10505 REPORT DATE: 05/16/94 PHONE: (914)-621-2003 SAMPLING SITE: RICHARD DR. KITCHEN TAP SAMPLE TYPE..: POTABLE : PRESERVATIVES: NONE COL/D BY: MICHAEL SPACCARELLI TEMPERATURE..: { 4C NOTES...: COLIFORM METH: MF ~~~~~~~~~~~~~~~~~"~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE 05/12/94 MF T. COLIFORM ABSENT /100 ML ABSENT COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER (Q "WAS NUT) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. SUBMITTED BY:____ ________ - Albert H. Padovani, M.T.(ASCP) Director ELAP# 10323 \_ -� PUTNAM COUNTY, DEPARTMENT OF HEALTH 'Divistoa of Environmental Health Services Carmel NcY 1051? Engineer to Provide. Permit If 'oa CERTIFICATE-OF COMPLIANCE q CO UCTION PERMIT FOR SEWAGE DLSPOSAL SYSTEM Permit iY Q /�'vy �J Locats_d st l C% G�� 17! 1� _ ,Town' or `,..�{ S CMG ti,� -t�'P f^'•^wT.✓�ti- -.iT'1 `4 ^a:_ Qru ra1n +•vn*�i �-Si i 9-W.0 o �_ `s..� d. ff. 's � Sabdlvlsioa Name Sabd. Lot lY ° Ta= Map Block ' Loth y3 Owner /Applicant Renewal ❑ Revtsloa ❑ Date of Provioaa'Ap rover iiW4, Addiees Bulldhig Type, Lot Area FW Sectloa, OdY Depth Number'of Bedrooms : Deai ti Flow G P D d G r, PCHD Notiticatlod ls:Regol —When FW Is'co plated 8 Separate Seweiage System to consist of % a S �Ga11on Septic Tank. ands Wig t �.G to•be con' etracted:b'y AddeeBe Water Sappli. c Supply From Address orr Pdvste Supply _ ed.by - Address: Othei Reriakremeate " / y, /`r✓f i'. I represent that I am•whoily arid' completely responsible foi'the design and location of the S�yyss (s) 1) _that the. arite .sewage'disposel�'system ' above described wilt be.conitrucled as shown on theapproved amendment there -to and'in' tyda a M h andards rules an regu a :ons o e u nam County Oapartment,.of Heelfh, and that do completion'thereof s Cert�frcate,''oi Co -cA�t QQeOdsteljl�ncea© ishctory to;the Commissioner Of Health will qp be. submitted to the Oepirfinent, and'a wnften guarantee will be lurnrshed the o er 14it ys,�Qt, Rrlir- ssiyns by tho builder, that said builder will place in good operating condition any part of said ,sewage disposal system duri th i d of iwo�ayears mediately.following thed{te of the issu• ante of the, approval ;of thecCert�ficate, of Co nitiuct�on'Complrance rot the pr'1 or repei��.t•Oeret 2) then the drilled well ,described above wilf,be located as shown on the approved ,plan and that said well wr11 be stalled In co' a 't stir( les a d regu a� o� n�f the Putnam County Oepir, ment of'Health:` g,, Date' /,� . -' Sr4ned` r" (l. .. P.E. R.A. Address_ .2. 9 T a li .: License Nc R. - � e AP.P-ROVED FOR CONSTRUCTION This approva(expuesvivo years =from the to A_ s tits a 1buiiding has been undertaken and Is revocable.for Cause or.m y be .. ended or modified when considered ecessar y the io0a ofd ny change or,dlteration of requires a .new ermit Ap oy foi disposal 64 domestic samta and /or p n Rev: 401 , ` 1/67 Date BY .,.,.... Titlo r . • �,u �t 4114 • :1 k: •' • �• •; �� :� Y: -rJ+• 41�. -Owner) COMMENTS FILL SYS clayba 10 ft. fill r nerd s depth 100 vr. provided required 60 ft. max. Parellel to BY: V I �- (Street Location) La YES I NO DOC 24MUS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) s/s Deep Hole Log Consistent Perc Results (3) Perc Hole Depth SUBDIVISION Perc j r Fill ca House Plans - Two sets Well --permit; PWS letter Variance Request GRID Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked 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 Fill Profile & Dimensions - Volune D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes. (grinder notes) ,I?esign: DataK --) =ee- € 9Wp- -resUlt5 - �aa- FootContours Existing & Proposecl�"��4',��- -_ 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 PmVed 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 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 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. ern) 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 DEPARTMENT OF HEALTH ' Division of Environmental Health Services f, TWO COUNTY CENTER - CARMEL; N.Y. 10512 (914) 225 -3641 -. - APPLICATION TO CONSTRUCT A WATER WELL PUTT- PEliml "'1 Street Address Town Village City Tax Grid Number ,(,0f- BELL LOCATION re WEL1 OWNER Name j 070 E cG Address j��� €-' c A JJ 4 /%P afrivate ❑ Public USE�OF WELL ffRESIDENTIAL ❑PUBLIC SUPPLY ❑AIR /COND /HEAT PUMP ❑ABANDONED. 1 - I'imary ❑ BUSINESS 0 FARM 0 TEST /OBSERVATION ❑ OTHER (specify 2 - 6condary ❑ INDUSTRIAL O INSTITUTIONAL O STAND -BY O OF USE RILING TILED EON FOR . 1ILLING YIELD SOUGHT gpm /# PEOPLE SERVED .4 /EST. OF DAILY USAGE ,:�'PQ✓' gal 01Ew- SUPPLY O PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION O REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL WELTYPE l DRILLED DRIVEN DUG ®GRAVEL OTHER f ` IS.WL SITE SUBJECT TO FLOODING? YES il" NO IF W` IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 1 �C�as✓c�s'G!!G j`�S Lot No. fr � 11-7m F, WATE�ELL CONTRACTOR: Name A • Jf� v,-,' Address : s IS P7IC WATER SUPPLY AVAILABLE TO SITE: YES ENO NAMEIPUBLIC WATER SUPPLY: TOWN /VIL /CITY I... .. -. DIS TO PROPERTY FROM NEAREST WATER MAIN: SKETCH & SOURCES OF CONTAMINATION PROVIDED . ❑ ON REAR OF THIS APPLICATION []ON SEPARATE SHEET 27 a 14 02 0z 0 (s nat PERMIT TO CONSTRUCT A WATER WELL �is permit to construct one water well as set forth above is granted under the rovisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and rovided that within thirty (30) days of the completion of water well construction, e applicant shall: 1. Pump'the well until the water is clear. i 2. Disinfect the well in accordance with the re q irements of the Putnam County Health Department attached to this per it. 3. Submit a Well C mpletion Report on a form pr v'd by the Putnam unty Health Departm t. It of Issue: 19 UV (te of Expiration. 19 Permit ls§ffing Offs Irmit is Non - Transferrable i . B6 jjj UAJ-i) v" - DIVISION OF E2qV11U4*RfAL 11EU11i .SERVICES DESIGN DATA SHEET-SUBSUFACE SSIAGE DISPOSAL SYSTEM ME NO. *2 Cwner e117 0 e, fd Located at (Street) Sec. 3 '01 Block LoO` (indicate nearest cross street) 1pf4 A70, Watershed Municipality SOIL PERCOLATION' TEST DATA MQUIRED TO BE SUBMITTED WM APPLICATIONS Date of Pre -Soaking �/ Date of Percolation Test HOLE REBER CIkX:K PERC0=0N PERCOLATION Run Elapse Depth to Water Fran Rbter Level No. Time Ground Surface In Inches Soil Rate Start-Stop Min. Start Stop Drop In Min/in Drop Inches Inches Inches r-12 3-3 -rl -3 3 .233 � 3 %� -3 3-09- 3 3> 4 5 1,33-S-3 �'7 2el? ) 2- -3 4 5 2 3 4 5 MOTES: 1. Tests to be repeated at same depth until apprcDcimately equal soil rates are obtained at each percolation test hole. All data to'be suhmitttd for review. 20 Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA RNQUIPFI) 'JU IT.', SUI-MI'VITI-) W1111 APPLICATION DESCRIPTION OF SOILS ENO"ITHM IN 'PEST HOLES DEPTH HOLE NO. -HOLE NO. HOLE NO. 21 3' 1 41 51 61 71 81 go 10, 121 131 141. TTMR:� _YIFWU- AT•.,WPIX -,-.-GR0rj,',TJNATER I"'. EIN-COUff—EED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used Min/lit Drop: S.D. Usable Area Provided V No. of Bedroans Septic Tank Capacity gals. Type Absorption Area Provided By L.F. x 24" width trench Other e- 6, L4,r 0i Name 9 e Address 2- IF-4� 6;e-e' 5 /Z__ ep,�_ THIS S ACE FOR USE BY HEALTH DEPARreM ONLY: c$ t Soil Rate Approved sq.ft/gal. Checked by Date s TM. a � o FM sash e G* vabtme Humbai at 39heig®s . ]Flow G P D d dQ. @C® Modaeadon m Ragaigind Wbm M Is sag wfAo sawmw SYSUM , 90 omaafa!B ®d 6's E g AwA 3 7.s � � CI Wad Sop*Ei+® Area© 1 ►epresent':that I am wholiy and compietbly rm>ponsibla for the deign and location o0 thO . proposed sy tom(s); 1) that the sopa►ate lass di sal s stem above 40c fjbed will be constructed as shown on the ippr" ime County. Ooipertmenit 01:'►leaah. and that on eoinpletk►n'rtliereof: be submitted to{ the. Department and ,,a. written,sua►antee will Own in peed .opNntinp.eo f0ltbn any part of :_p10 aawapa dig aurae Of .the apptarel of, the.;Certifliate OT , Cogstrudion ;Comps wft0 tko oototee as aAOenN'on the approiieb Alin And that sakt,woil wl County ®ap`artment /of g,Health. 090 �� /� ��7r7- :' , Sig Addrb ` APPROVED FOR CONSTRUCTION YnYB approval a><pirss'tsrp yi revocabto for cause or: 1naY t►a. aura* .or modified when co a rapuires a new permit roved'for'di"sal °ofdom n 10/88 . ®y tdirlant there to and in accordance with the standards, rules and ►pY lls O m i "Certificate of :Construction Compliance" satisfactory to th Commiglonw of Maalthwill ".furnished the seiner, ?iii SucOaYortr _hoili or auign$ by the builder. that said bulkier will posal systaim during the parie�„O 8)'. yeas Immediately folloiwhip titedate of tho isau- a lee Of -a AO o►ginal.aysteg0i` therotos 2) that ths.drilled well described 860vp II 4 Instil aeoorda „ iSp E rules and /puTaiUns oof th0 Putnam ned P.E. R.A. a[s from the date issu un uct .the building has been undertaken and Is ed n sp1.y Oy the Om- 1t0 or Reny change or alteration of Construction iy and /or nrate'+iYBt� �QTRIO -5sN t w n` IE DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 May 10, 1994 Frank Sullivan 2972 Ferncrest Drive Yorktown Heights, W 10598 Re: Spaccarelli Construction Dogwood Acres Lot #6 Richard Drive (T) Putnam Valley Dear Mr. Sullivan: Fl- -JOHN•."RELL Jr., P.E. M.S._ cJ .. .... ^I A field-inspection of the above- captioned lot was conducted by the writer on May 4, 1994. Comments are as follows: 1. 2. 3. 4. 5. 6. 7. The septic system was installed without a trench permit. Sieve analysis of the inplace fill indicates 24% of the fill material passes a 200 sieve and 17% passes a 100 sieve. Current codes states that fill suitable for sewage absorption should contain no more than 5% and preferably ho more than 2% fines by weight and no more than 10% by weight, of. ..ihe:.fil:i �matie;r�i�� ::,I;►r�.����i_.pa�Y_ �_�iG� si�ve,�_..r_ ._:..,_: _..:_....... -- - r._:__..._-- ____. °.__.__. Fill does not extend 10' horizontally past the edge of the trench and then slope 3:1 to grade. Clay barrier has not been installed. Absorption trenches are 2.5 -3 feet deep in areas. Current codes state that the maximum earth backfill is 1 foot. Three junction boxes have been installed incorrectly, i.e., the inlet is at a lower elevation than the outlet to the next box. The lid to the last junction box must be replaced. If you have any questions, please contact me at your convenience. Ver truly yours, N'n' Robert Morris Public Health Engineer RM /j P o | _____ v . ______________==____ w� more than -------------------'--------� .gwauwvv"— �'� - ^ -- 576 and ,'~ 2�°.~«�^h_'r~a �dm� pno� o ��a�S�P= y^ u dd pgsS �U _ - l[T. by WO cf�xo -' - ' --�--'-- ------- -- -- C -.as. --�-- '--' ---- - - gLCAA" SAD �' `' E� 1 z �-lcZ - Dom; � cr F? mac= = " -`_- T._, �c %G_ r � --.: C-R SZ7=D: etc- Ll [)-. c - ,000 i _- �.ut ticn- 'I Ij 7 1 bar RIZ- -C lo f:- cr ti e. catle= at r �t` 2 M-- c z 20 C. 10 -ZO C Ic:l f os C C-=77 C2 TF EC -v to er- 2D S--v Car Ve'a ED= 2-raa C--ace- czci M(=. waLi -CF C-- ZU- B-Z- r 1-7- d7 cf -C to air -Czc to f crzt t & c r.-I arc-- aWa, SDS S.. C AIL x A.,, I-kA-1 1WA4,4- -�tvsjc 1% I p ol? it 1 131 ......... 14e r _ __ _ DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 __.. ..�. e►YiL1l:t�Tll�1� `tJ l�T tlUCT :i�H1L'ilZ PCHD PERMIT WELL LOCATION Areet / Addres Town /V llage .0 /ity Tax Grid Number wAvolyq WELL OWNER Names ,¢ M{a� i ddress. /� /� ® �3����� v7 �L��/ Private �. Public USE OF WELL 1 - primary 2 - secondary RESIDENTIAL ® PUBLIC SUPPLY O AIR /COND /HEAT PUMP ® BUSINESS O FARM O TEST /OBSERVATION ® INDUSTRIAL 0 INSTITUTIONAL O STAND -BY ® ABANDONED O OTHER (specify AMOUNT OF USE YIELD SOUGHT _. gpm /# ® REPLACE EXISTING SUPPLY §tNEW SUPPLY NEW DWELLING PEOPLE SERVED /EST. OF DAILY USAGE Zire nal ® TEST /OBSERVATION 12- ADDITIONAL SUPPLY ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING FELL TYPE 14DRILLED ®DRIVEN ®DUG ®GRAVEL. ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES P" NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Da.-we-do" �Gr� Lot No. 06 STATER WELL CONTRACTOR: Name IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: Address: YES A-- NO 61-- "P' K, NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY rtc L _- rR0X-N- ST 'WA -tER-. 1AI> LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET /Q da e) (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 thirt,• (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 drilling operations be contained on this property and in such a manner as not to degrade or o wise contamin a surface or groundwater. '7 Date of Issue: = 19 Ik 1 4 -- a Date of Expiration ,j/ ®G 19 /' Permit Issuing Officiaf 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 -... ..I - -.1 r , T014-,f Q TM - r -IM I�c D a t e �-Z Re: Property of Located at (T Section o/-3 Bl ock Lot Subdivision of q-_W Subdv. Lot # Filed Map # Date Gentlemen: ��'� This letter is to authorize 41 a duly licensed professional engineer registered architect (Indic`a-t-e�— 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 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, e. Countersigned: Telephone S i gn e d caner oT -Pftperty Address C1\ e� V) 'A a I/ Town x Telephone DESIGN DATA SHEET- SUBSUFACE SFWAGE,_DISPOSAL.,.SYSTFM. _.FILE NO. .,w ..- �,r.:.. �..... :.. •."f .._ �-. .•- .q.�. -s•.: -.e -- : -.- /'�`� ,� :a:'.a ,:..... "�•,-- :a�.v.- .,�.,.._:. :.:... n.va -:,.. ..::.._:.�. >.:"'-= i'3w�.:: a.a —.•. air r -.::_, .i.:;. Owner • %/ s '� ' r _I ft eo re- %ji Address J 1 �i �a ,� // g�•d Located at '(Street), A7 o,61, a it a Sec. Block Lot (indicate nearest cross street) — fa Municipality �� l�li Watershed / Date of Date of Percolation Test /Z6/ /� ,Fd HOLE NL7 BM a= TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In,Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 2 3 4 5 3 4 5 1 2 v� 31'4 Uj uU Z C c � rev. 9/85 1. Tests to be repeated are obtained at each for review. 2. Depth measurements to at same depth until approximately equal soil rates percolation test hole. All data to' be sihnitted be made fran top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES . - -... - - `17�t''in _ .,_,. - ... s.r� -! a ,-.�r �.:,_ . a- - �•:��:� _� .��,u '�Yi7LE�7�iv e ":: �� v:.�:; n , e ::L:� :. . �.��;'; 4. G.L. 3' 4' 7' s' 9' 10' 11' 12' 13' y. .... ..r.�rn. - ?"•G — !.•��2 .ur-r � o— a a +s _ .. .+_ ...'1•T-Au�wr•K..rV.vi.r�'n 01 INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: 0( a 11))r-1W DATE : 'Ma llffl - DESIGN - Soil Rate Used Min /1" Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity , 0el6L gals. Type "&-�i Absorption Area Provided By S Other 2;1, %f e /—�5 L.F. x 24" width trench ,A;rl Name �G! /�� %�l%l /� Signature Address �� ,� �r G1��. SEAL t THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: 4 A�� Soil Rate Approved sq.ft /gal. Checked by Date