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631- 589 -8100
13. -2 -27
BOX 4
' I�T ` , ilre
,
_ 1 ��
JLCI ,
00137
Water. Supply: ' Public Supply From' Address
or: Private Supply Drilled by Address AfQ 3 � � �ax � � � � PAT%P.��� y
Banding Type {�S 1�PM�f1 /a'lJ Has Eioslon Control Been Completed?
Number of Bedrooms Has Garbage Grinder Been Installed?
Older Requiremetita_ ` -� � �1 .
I certify that the iyetem(s) as listed serving the above premises were constructed essentially as shown on th ns of the completed work (copies
of which are attached), and -in accordance with the standards, rules and regulation in,accordan with t e pla -and the permit'issued by the
Putnam County'pepar ant f Health:
Oats / certifies,_ I ,p �-e.
Address JI /G.' /`r'a /` �Q t;;{i� 1 r /u S �. Li YS y
ivy 6 O
Liana No.
Any person occupying premises served by the above system(s) shall promptly .takosuch.action as may be naasssryto secure the correction of any unsanitary
conditions resulting from such usage. Approval of the separate sevverage, system shall become null antl vo' ss soon' at a pub!': anita►y, avwi .becomes
'avallabls' and the .approval,of; the private Water supply shali.tieeome null and ?voi hen a public water supply, Meomes.'evaiiabM. Such' approvals are
subject to modification or change when; in the judgment of the commisigi r oi-Nealth, 'revoeatlon, modifiafion or change Is necessary,
Date 992 B TItNI
a
21
I A,,-
, C ,
�� a
-j0
WELL I IJr1rLt 111J V MC rur l
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
WELL LOCATION
STREET AOORESS: TOWN/VILLAGLICHY TAX GRID NUMBER:
WELL OWNER
NAME: ADOR sS: '
PBIVATE
o PUBLIC
USE OF WELL
1 - primary
2 - secondary
RESIDENTIAL ❑ PUBLIC SUPPLY O AIR /CONO. /HEAT PUMP ❑ ABANDONED
❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION O OTHER (specify)
O INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY O
MOUNT OF USE
r
YIELD SOUGHT J gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE &A—) gal.
REASON FOR
DRILLING
Q PLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY
fNEW SUPPLY (NEW DWELLING) D DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH ft.
STATIC WATER LEVEL — 3 - ft.
DATE MEASURED
DRILLING
EQUIPMENT
❑ ROTARY iKcnmPRFSSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED O OPEN END CASING OPEN HOLE IN BEDROCK O OTHER
OC
TOTAL LENGTH ft.
MATERIALS: VSTEEL ❑ PLASTIC ❑ OTHER
CASING
DETAILS
LENGTH BELOW GRADE ft.
JOINTS: ❑ WELDED #THREADED ❑ OTHER
DIAMETER in.
SEAL: ❑ CEMENT GROUT ❑ BENTONITE VOTHER .
WEIGHT PER FOOT -15� Ib_/ft_
I DRIVE SHOE t1YES 0 NO
I LINER: DYES 16N0
SCREEN
DETAILS
DIAMETER (in)
SLOT SIZ
LENGTH (ft)
TH TO SCREEN (ft)
DEVELOPED?
FIRST
❑ YES ❑ NO
HOURS
SECOND
GRAVEL PACK
❑YES
NO
EL
SIZE:
DIAMETER
OF PACK in.
TOP t
DEPTH ft.
TTOM
DE?TH It.
WELL YIELD TEST I If detailed pumping
M¢HOO: ❑ PUMPED t tests were done is in-
t
COMPRESSED AIR , formation attached?
❑ BAILED ❑ OTHER ; ❑ YES O NO
1PIELL LOG ff more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
e r
Wat Bear-
ing
W
Well
meter
FORMATION DESCRIPTION
poE
ft.
ft.
WELL DEPTH
It.
DURATION
hr. min.
DRAWOOWN
ft.
YIELD
gpm.
Surface
7
%7
WATER IVCLEAR TEMP.
QUALITY ❑ CLOUDY HARDNESS
❑ COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? ❑ YES O NO
STORAGE TANK: TYPE
CAPACITY GAL.
PUMP INFORMATION
TYPE
MAKER
MODEL
CAPACITY
DEPTH
VOLTAGE HP
WELL DRILLER NAME DATE j
ALBERT M. MYATT &SONS, INC. O
ADDRESS Well Drilling SlOAMRE
Rte. 311 R.R. 2 Box 171A
TTERSON, NEW YORK 12563
d,.
.-o
PU NAM COUNTY DEPART OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
tl; f 0-W&
Owner or Purchaser of Building
Building Constructed by
Location - Street
Municipality
Building Type
IC) 3 I
Seetiah Block Lot
/0 4/c
0114
Subdivision Name
I
Subdivision Lot #
GUARAb1TEE 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.
f
Dated this day of '3()u6-� 19 Signature
Title
General Contractor (Owner) - Signature
Corporation Name (if Corp.)
Address
rev. 9/85
mk
Corporation Name (if Corp.)
Address a
.a.
A YML Environmental
Services
321 Kear Street, Yorktown Heights, NY 10598
ELAP #10323 (914) 245 -2800
Peter L. O'Hara
P. O. Box 282
Patterson,.New York .12563
COLD BY 1 Peter O'Hara ( 914) 878 -7529
NOTES Will P/U @ CA
RESULTS OF WATER TESTING
X
ANALYTE
RESULT
UNITS
?
ALKALINITY
mg/L
AMMONIA
mg/L
ARSENIC
mg/L
CHLORIDE
mg/L
.COLOR
Units
CONDUCTIVITY
umhos /cm
COPPER
mg/L
DETERGENTS
mg/L
FLUORIDE
mg/L
HARDNESS
mg/L
IRON .
mg/L
LEAD
mg/L
MANGANESE
mg/L
MERCURY
mg/L
.
NITRATE
mg/L
per 100 ML
NITRITE
FECAL COLIFORM
mg/L
per 100 ml,
ODOR
E. COL1
TON
per 100 ml,
pH
FECAL STREP.
S.
per 100 mL
LAB NUMBER 93.006490
DATE /TIME TAKEN /22/92 2 : OOpm
DATE /TIME RC'D /22/92 2:15pm
DATE REPORTED
Kitchen Tap; O Hara Subdiviisi6h
SAMPLING Lot # 7 Patterson, New York
SITE, 12563
For Lab Use Only .
X Potable _ HNO3 pH LT 2 _ <4C
_ Nonpotable _ NaOH _ pH GT 9 �Q <20 >4C
_ HCl _ Na2SO3 , >20C
STAT! H2SO4 _ ZnOAc
CCOLFCI M M1~7IiCi USED
RESULTS OF WATER TESTING
X
ANALYTE
RESULT
UNITS
p
PHOSPHOROUS
mg/L
,SILVER
mg/L
SODIUM
mg/L
SULFATE
mg/L
SULFIDE
mg/L
SULFITE
mg/L
TURBIDITY.
NTU
ZINC
mg/L
SPC
per 1.0 ml,
.
\TOTAL COLIFORM
per 100 ML
FECAL COLIFORM
per 100 ml,
E. COL1
per 100 ml,
FECAL STREP.
per 100 mL
These results indicate that, the water sample WAS] [WAS NOT) [NA] of a satisfactory sanitary quality according to
the New York State Sanitary Code, for the p am ers tested, at th le of sample collection.
These results indicate that ate mple [WAS] [WAS NOT] INA) o a satisfactory chemical quality according to
the New York State Sani ry Co for the parameters tested, at a tim of sample collection.
NA = Not Applicable N = Not Present (Negative)
SUBMITTED BY: P = Present (Positive) SA = See Atta6ment(s)
= Also done because Total Coliform was present
Al ert H. Pa ni, M.T. (ASCP) TNTC = Too Numerous To Count
Director > = CT = Greater Than < = LT = Less Tlian
r7.
4.
FT]Ar. SITE rV ca _c 5
cR Su= —Dr , 5iC24 L T
S DlSrwry 3. E
c_ rS Zc3 lrr_ == as re c--mro E-^_ clans
C- rTa L-- s ?_ r_ct
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E. D0 ft- f-C'. HG- cC'r- -_icr:c -_
- -t- c t 1,000 I, 2S�7
C_ LC COJ Lcr'_=, c--- w--,' thim10 f= Ci C' ccc
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i
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r_m_ �_ < �o -_�_
6- RCen =L.r SU^
h- L- -o CiR DCL ^ S -= ,Cc:
2.
4. F'...-- E_= _v
i 1
ES�?T GL��
1 Or
I
C_ -r =C= Cc
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st--nnes < 4" in
E- C'' i r2
L= _I1 Gam- CCU =1 1 Cr. =L =� � C_ -. trJ E� _Lrc = =rC' L =E
- -_
C:..,' -C=- Cn clCCcS C___ar t--^ _
FOTIIAI[ DEFAnNWr OF MALTS
DIt�WdSa ltl�IwWBMIIrSrnYr.C�eM1.lfY . 1olwvWlwrit /;
aiii CER21FICATE OF CQ
• . �, ,.� ! _ .. .. _ F� :6NA60 D16F!OS+►L SlSi�ii , ; ; • ,
Felt %
_
ti
I/e�1ei at <y�e
Seif�tlileet hTia��1. 10A .Lt f Tasz M�pHbet .1 ems_
,
` O:n.rrA�ie.a tra.. `fit. ..
Dols ❑' ,;fir
Yai AA"n A ED °3- Z Tows Tlp r� �]
JjAt
d v.is o j Me Enclosed W.
N�iae ai w.+.�.. Dwlpl
: Fm Sectet
PCSD N.0NiIb d
nfYe Y RW" FM e Flow G P D Yeae
Y d�pYEsd
Somme - M. . w @MAW G- � r�ti
ael st plle T.
s�
t.
_
WgMr;SttB� -, Firc
on ✓t1.t..e. S job Deadb�:
J °otwr Figi,,.e' �''s`YifiJ'y�'t!e�o.( Ili
A represent that 1 am :wholly and completely reponaible foi tM dasi4n and loeition os „tlla propo a0 systnm(p;,,1} tMt tM aipante Yweie diyi s *,M:, ,.
abova describad will,be constructed as slwwn on.tbevappioVj6 arrlendnlent theri -to amei in accordancq with`tlie standards, rules anb repula Ions or tm Fusnem
OOUMy ,DpartnNnt ',01. sNrRg';and ttaton eom0latioim ;the►eof a "t:arti/icaN' of Construction Compllenp" YEtpieto►y to "the ConimiglorNr.of lfaal)hwill
t e submwad to the O "punt, and' a written wiarantea.wll1 M !Urnishad,the owikar, his fucq"wf.•MNs or :ess i by the k4ilda►, that said buiWer wilt
dace 41'.9006. ,operitW4 .oDndttion anY ;pet o1 said: nwage dii"O I� system during he perba,of two (s) years to y folio rlmil theelate of the Bier .
am" Of the ipore"( 6f-the �Certlfksti of "CokOruetion compliinee of the• orlainal fyrtarn or my :repairs t O; ) that 'the drilled will described above
rYlll M located as sfgNw On tM apOreved plan and that YW well will ba:Insta11e0 in a wits► eta �. hers and -rMU ,ns of tM Putnam
Ce"Y Oape 01.►1Ytthl Cr�c�%Q
cite P R Ate'- '
license No L
APPROVED FOR CONSTRUCTION: Thk{ approval dxpMes two years, from tM dab issued unkitf; Construction of, t buigirq Ma been un0aitaken and is
rerotabN fOr. CauY o► nuy M. arnandea. or ntodllkay w1Yn,eonsk# end nbtea�ry., tM `COmmisgona► 01 kfaaltli ny. thergr or `alteration of construttbn
),., require a new mit.. Approved fir disposal of 4,14,~ e; YeKary a a water supply' only.
tev. /f /
o ' 88 Oat• " _ . 41 . 19 By �- /- �Title
In
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 #1� Z/
WELL LOCATION
Street Address
Town/Village/City Tax Grid Number
WELL OWNER
am
�.
jailing �Address
J
.� j
MWivate
O Public
USE OF WELL
l'- primary
2- secondary,
SIDENTIAL
D BUSINESS
D INDUSTRIAL.
❑ PUBLIC SUPPLY
O FARM
M INSTITUTIONAL
O AIR /COND /HEAT PUMP
O TEST /OBSERVATION
O STAND -BY
O ABANDONED
O OTHER (specify,
O
AMOUNT OF USE
YIELD SOUGHT gpm /# PEOPLE SERVED g /EST. OF DAILY USAGE (oCK) Sal
❑ UPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION Q ADDITIONAL SUPPLY
La'NEW SUPPLY NEW D ELLING D DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
'DRILLING
WELL TYPE
DRILLED
®DRIVEN
ODUG aGRAVEL
0OTHER
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 Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES L-�NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN;
LOCATION SKETCH & OURCES OF CONTAMINATION PROVIDED
ON TE 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
thirt37 (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 otherwise contaminate surface or groundwater.
Date of Issue: C/ 3c.5, 19 Z- ✓�,_ -.... -'
Date of Expiration 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
J
pcn =-m={ g
D n_ ^' rG- � CF Ei±a�:�'; - DiVisiC4 C^
T-.-, � r .rte c' "fir S'A= DIEcrSrL c-_cr�`�c
�.•,
ell
W
CCNSi.C4`TCV PERMIT
YES NO CCC:�frlf
I I PLans -
cal °- Lcc� � DCS i
Ccr�_s
I � I
=_. Maze.
�
I c `-
c�
/
( = - --
r; c=
Ga _anc_ P _
uc Cia uCs P_= Zi =cam- -
_ti
W °' 1 Lc i J S= _-J_C� lri c I_ C-c-
_ra...C_
T *.tip _cc` C r_tcur= {__uric
- ac:
E ca- =nsi Cc 3rd: - f = ^CNL:I � �G'J? _�J __CN r c, - -= . =_c
I p,- � P? �`& D rc:� -cl cwn & LL _il
ECLc - RC. CL
W-el- & Ss:CS' s wl z - 200 c= -cres=" -_
-,rc^ - T' Lc )
E_.,` �� =.mac:{ NcC�s�` r (__c;:� mac.
ECit�C CCVCY — - _• 41T O; No Sass / . L!=. C.
D y-„N Chi P_=
F_ - =
L-= �� =..`' J � - CZ _
20' tz- c
100' tc A 1, 200' in D. -.C.D) 150' pit-
100, to Ste_-
13' to Y/
10' -
z
DIVISION OF ENVIRONMERIAL HEALTH SEMCES
DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner r-NYA Address
Located at (Street) _c : (Q Block Lot ""l
(indicate nearest cross street)
Municipality ' �& 1 Watershed
• DIVO• G C H 2014 : I:UVBYYD11 3011
Date of Pre- Soaking 9 It t K`% Date of Percolation Test
Run Flap
No. Time
Start -Stop Min.
MUD+; -•Sftw olu
ueptn to water k-ran Water Leve
Ground Surface In Inches
Start Stop Drop In
Inches Inches Inches
1:204:1WOMNORT
Soil Rate
Min /In Drop
1 0_ 0 15 6 1 I I d
3 n _ in .�
4
5
1,0 -
3
3
2 2 Q _ 3-o 0
2 3 - 3 D
s
s
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 fran top of hole.
rev. 9/85
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS EN MMERED IN TEST HOLES
DEPTH HOLE NO. HOLE NO. HOLE NO.
G.L.
1' � r�� �� i'fl� �► M �-S� v�
2' �
3' �(
4'
rl
5'
r/
6'
7'
8
9'
10'
11'
12'
13'
14'
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: DATE:
DESIGN
Soil Rate Used -1 - Min /1" Drop: S.D. Usable Area Provided &CW 1Z
No. of Bedrocxns -."— Septic Tank Capacity ` ZSjl gals. Type
Absorption Area Provided By -!500 L.F. x 24" width trench
Other '7 r=-
Name ( -7 M " p , i nature
SEAL 3 ( �. i',,•a �`;: �;�:= �� , `�:r
Address -196k 7Z4--3
v:s
THIS SPACE FOR USE BY HEALTH D
Soil Rate Approved sq.ft /gal. Checked by Date
• IoJ�
T°
LOCA'(IbIJS.
I
1`�
u
36 LF
P� 'w_ . sO" ey
"..COW nth
v9�uu
0 604
LOT I
s
3
. 5 �
g 31 .
• 3
3� p
.
C
FJ
1 r
F.
A 1
p 1 `./20
1
I,, .
THIS IS TO {..... t:.'.' t'.:r':' 'I1 ,` fiF✓ /.C,E DISPOSAL SvSTi;M WAS
CONTAUCTPD A:: it'DICATED ON THIS PLAN AND TIiAT THE,
r., STEM WAS 1C1SF1:CT:iU BY M,17 BEFORE IT W,AS COVERED OVER.
PI 'ill SYS'I W tx. i- d3'17i11C'(w IN ACC O112ANCE WITH ALL
11111 RUl.11S AND REGULATIONS Of THE PUTNAM COUNTY
; ITARTURNT Ok' 11FALTI1,
re,
i ....5.'.::. f..
rUT"M County Department of hes4t ,
:17151 of nwronme Health Servio..
pproved as noted for oonforroanoe d
wlioable Wes and Healatiom of the
'utnam County Health Department.
LOT
�Ys 1
31.1
Ill,
1LI�'11 II+
JVN�.
y� I, H F p
<0�� y
nr
7
,
W
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N
O
3
:Q
Z
N Iq ° 58' 5c%" E
C 58.52
7 � ( Q � p1 .:N9 20 �r °E S�9•sa's
14.'74' 30.Oo
T N <I' L0 X61 N/0 °0907"
j / 4�
�, VNV, ACCESS 6�SFj1/IENT _ _
- -Z — MAC. DRIVE
`J G• ZO' SI" V./ 13(o.2y Sr009'17 r3
S9'2o'sr "w
N.Y.S. Fu]UTE N' 311 12.3q •
SURVEY O PPOPERTY -
BE Nca
LD7 N° I
AS ON
"ALArN05�V SUSDINISION PLAT , LOT NO3. 5,-7,54 1 OF C(HAPC^ SUSpIVISJO1J, 8P -rto I 1
FILB� MAP W. Z5GOA FILLS-C2 5-0-gl
TOWN of PpTTER50N PllTNAM CO. iV Y
SCAt,.�= t "= so, TUNE. 24, ldtdl2
G>%I¢CrPIG� To:
SAMES -F} PA'TRIGIA KILCAWLE`f
F'fOUDENTlPAL HOME MORTGAGE GO., INC. '5
GNIGAGD -T T L1 a INSUI¢ANCE CO.
cE2nPc.& -nc tiJ07 iur> A7E.D WE vFrY 4 - -M-ZAT IO1J ce AoDMo" -1o'
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LAQo 1,Ato CEz:TTt`fc�Cnof * SHALL PUQ o+JLY ALL CE- ZrjFICA- T7o1.l,,5 NEeF Q AOF- \lA4JO r
-ro 7WE FEP170�J CcM V.1WO l ?NE Su l I,,i GELD A1.4o -rPK7 Mme' AIJa mPle5, 714EZEcP ouLY 47 �d l
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64-�SE4v� pkJ4.leeS.
TERRY RF RfaFNrY'RCC' �n �.<