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HomeMy WebLinkAbout0328DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 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 G_ .c•._^!i° �'_"L: E_ , C= - = - ='- L7L^ f =Cliff EDE Lr 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 C- EIZX i Al l c,--. e_ - at- EcZ= E! c' 2-t- - a t=G C. =sm Cant= yL , C= c 10 f�- =— C'C"G LJ 1 - - 20 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 `/__ C_ yi `es f_t� h W'? `-1 1 'S_C` cf I= I G 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 �Ff3 IONP r i 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' �Je/C -Y U46 PM7--R3kZEE> I" Accce -nc) � VJM4 'I}IE_ � �/EY K A \-/IOLATlo7.J cF sE c:Tic* * -7zr 9 EXI5T7► -C CGOE- CF PeA= -LE Coe ZAP C, "(oi!y SMTE_ EO'L T O�-J LAW. &W 714E LlE)d -(O2L� 511GrE F 4iilcoL- AL Snm-x='L)PEr, fFAiJ`/ I V- 6WO 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 O►.J NIF, 5EJJALF -TO 7WF- -F LE. COAkPW -r/ AiJO L>✓L�I►1ca _ mAP ce eoPe,s BEAZ - )4E mPOFSo�,ED SEAL 109'rMt -, r O►J uSr+=n HEOEa -I. C-EOnG'ICA -ric* XX Ae tJcsr CC 714E S4Je\AE740e k.� APPE r veA, F ro AC:DMOr 4AL IQSTTT'vriokJ,17 oZ NEetE07J. 64-�SE4v� pkJ4.leeS. TERRY RF RfaFNrY'RCC' �n �.<