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HomeMy WebLinkAbout0355DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -62 BOX 5 I No oil nvj "S' !7%. . } L L IlW 00164 �J_ IINI P'Mci FZ fjf' 2D, - f RT �4 T-NAM'," �,-OU TTY.-,a,:4)EP, MMENTM, -,'F4HEA ARX-fa PUT E � N WVW�arwdOA'�'i 41,,;�kW W, mehWPHfiW t x, W7- Nn-&. N SYSTEM Att 0. sf: - Ftt)O-TION--,�-'COMPLIANCE�'�FQR�,'SEWAG.1t,--?,-UigO,"—O' CERTIFICATE 0 i d 77777 0 T M alt, f V Located at 777- vi r, "a General $eparate b U i lt,.�, bY, cJ t` 0 s_s 99. q 000 paI,.q;.,sepu6T Qtsl 46 `4 sliv W WA., -K it 4 g' Z, -S yx� ", � �' :Z� ... , .... . . R Water 'S MY Kiblic '. rm�. d4ate: SUO'Oly -.Drill Av1 b6 "2 ou -e� dw ­jj�' ". . r. - , �,., t , . A � Q Log Building Type 0 Date ,,�permit .-*,',I swid ..j A, §,�'R, N of Eiiki�66 % Nd�`h"` Hat'Erosion ,�i C 511OPWY, Control �;,Been . 4 A q 1[ ceiiiky that t4iq,,sYp,tT 0 sewing y; -,!g 9" P, "P11.0 of which'aie attached), aril in�abcordance 4 �Pikfiaii: Couney'Deparbnent of N. 2 4 3.q - Date C Address 7 n 14 No K, f iak�o#d­b�: the -such'action., �kny: ppridnL 0$:C '?IAL;"­ "�­. . �,q Aake� occupying premises served r rfsctigh',.,.,of:,aihy,,,(insanitary. k�prpTp.� _y. j!�y�p . !jpp�svary t usage , Approval of the ara,feseteragqi ts" IIC*4anItary",t,,Sivve. - _epp!� ;;.ava _q , e,.'apd i i�,suppjy,.4n4i!�,becomp,-,nuii,�anal, 11 h approvals brad sub)ect to, modification for change :when, ;in a t 15 :necessa►y, 41, �N 3 ,t, +C.i4,04FL47i0 R FDF�T , PLITNAM COUNTY DEPARTMENT Qt? �ti?�ltiT" 3171 Dlvhlon of Environmental Haslth Gorvlc".. COUNTY OFFICE: BUIi.DlNQ = CARMEEI„ NEW YQ13(G This report Is tQ b® Completed by Well driller and submitted to County Health Department together with laboratory roport of onglolq of-WO-or eemple indicating water Is of satisfactory bacterial gttality before certificate of construction compli�n p js 'REPORT'MUST BE SUBMITTED WITHIN 30 DAYS L OF WELL COMPLIETIQN / OWNq NAME .. ADDRESS _ mdjr't` at Is r q M CKS h wt p h Ckf (n mat n 94. (gtkl4 NorK T 4 0 i.QCAYIOtd of ' �• NA' $ . IrehtJ (T4rXn (t�PI NNmnot See P90J.i(Jo pf:eht-isstf'.iE. "oPas�fa (d8@ ®9 �yR'� f� ff��11 BUSINESS P,Qto €5Tlc I_.1 ES 44M.ffMI NT I—� FARM l�.:I TEsT wrl� PU6LIC ('^ j AIR OTHER L__I SUPPLN © INPUSTRIAI (~QNDiilOPOlNt3 I ecify) p,�lll(IdQ Etdt!lPtYlERii (� COMPRESSED CABLE . OTHER ROTA" AIR PERCUSSION � PERCUSMON � (Spodfy) CA51PfQ D#TAILS LEN @TH (fRp,U. � P14449TER(lnchea) % O �D. WEIGk(T PER FOOT 19 j� } 44! TkR�ADED ' l_,.J WfLPED S. Q{-- YES lQ NO YRS NQ vlwio TE ;T El HOUP,$ G.P.M, pam a PUMPED 19 COMPRESSED AIR Lp YIg (Q•P.ljf,1 WATER t (:� (AEASUPE FROM t4!gp SURFACE- STATIC(SAeGllyfeatJ 70' DURING YIELD TEST lapt) �; - 10+0 � Pipth of Completed wall In foot k;olow Land wrfgcet 10 4. •SCRREP6 MAKE' . .. ., ^ ^ ^ Norte LENGTH OPEN TO ARt11I`f R (faQtj pETAIb� .: Sl0'd SIT,Ix PIAh1ETER (lnchgs) -+ IF GRAVEL PACKED! piamatRr of well including gravel pack (inches): oAnyEL r2lZE (lr?4hos) FRAM ((eet) TO (feyt) Perm FROM LAND SURFACE FQRMATION DESCRIPTION Sketch exact location of wall with d/amngee, to of fgPat two permanent landmsrka, FEET to FEET 4d rA gob .Set No"�e• 1� -�,ove y , ID Litntes�o _ .. _.. ... If yield was tested at differont dapths during drilling, 110 belpw FEET GALLONS PER MINUTE . MTE Yyf(rl CQt"LkTkN DAT9 Of ; /RCPQljT WlEL,L PRI /.LL'R (Slgnaturol D� /1„� _ . t8 Z Sez4 - tB2 / / n (�Ji >l /" /12-4 J� A. Martha Bryan -gush an Owner or Purchaser of Building Owner, Building Constructed by Cushman Road (A /K /A North Road) Location Street Patterson, Municipality Log Building Type- 10 Section 1 Block 17.11 Lot Subdivision Name Subdv. Lot # GUARANTEE OF SEPARATE SEWAGE SYSTEM I represent that I am wholly and completely responsible for.t.he 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 success- ors, 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 initial use of 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 occu- pant of.the building utilizing the system. - The undersigned further agrees to accept as conclusive the determin- ation of the Director of the Division of Environmental Health Services of the Putnam County Department of Health as to whether or not the fail- ure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system., 1? ,i Dated this 3 day ofNovember 19 82 Signatur Title rporation Name if'corp. N. White Rock Rd., Pawling, N.Y. Address THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health BREWSTER LABORATORIES Box 224'- BRMSTER, N.Y. WATER ANALYSIS REPORT SAMPLE NO. 4950 SOURCE: A. Cushman Hose Bibb - Well Cushman Road 'Patterson, NY COLLECTED: November 6, 1982 BY: Joe -L Plumbing & Heating BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 0 Per 100 ml. � NOV 1 gU- This result ixdicates the source of the saintlt was of satisjoctory saxitary quality whtx thi sample was collected. November 10, 1982 Bickwit P. E. Dlrecter 4: ADO I 1% J. i4N'l Y Y. OF HEA'_ CE Notes:---.-l) t��ts,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.;.'.... Depth measurements, to be made from top of hole. I \ o. e Number CLOCK ':.TIME PERCOLATION TPERCOLATION Run Start- Stop Elapse Time n. Min. Lept o Water Surface -From Ground Surfa Start Stop Inches Inches water n'Inche6 Orop_ in -Inches..::..':..: 7 . Soil Rate Min./in drop - >4 349 4: ADO I 1% J. i4N'l Y Y. OF HEA'_ CE Notes:---.-l) t��ts,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.;.'.... Depth measurements, to be made from top of hole. I \ DEPTH G.L. TEST PIT DATA REQUIRED TO-BE SUBMITTED WITH APPLICATION DESCRIPTION OF.'SOILS ENCOUNTERED IN TEST HOLES.. HOLE. NO. HOLE NO. HOLE NO'. 6" ncS IPA 9 d imme _ ....:...... ............... 1 r o Address fi c: r 1 THIS SPACE FOR­ USE BY "HEALTH DEPARTMmT ONLY: fVo. Soil Rate, ApP'roved . .. ' ...........Sq. Ft/Gal. Checked,() DgLte �' ', ' ; , ;+ .* '.. • ; - " A S .BUILT " D Aw ..: �,,e ructu►e° loeat @A troth:;urvey by surveyor not Deloa(�_ uve;g II loiofed::b•y„ S rvegors`sur ' _ +aei1 are I a ._.- 1 eTa 1�t _ $;n 9`1 n-0, uv,m c. kementadar - -- — — Tolk,•bosea, Rlta, galleries d_IAtvroku= focot� 6y ConfroctQr_ :' y •'' NoutYtrciQpi , • h ' 1eld �eepec,#ion. by: Heq�tA'dep1 �.� piper o 2�19�'82 't . Tro w Ove/ Jan .- Box 5e,6. off A*. L MOTES— u) ���pp4-•r 1`oo�c :loco Cool. �av�c,e e -TO l L.,T64 A.o' x ZCUP- x ,S "-I *� _ {zi 4 . • Boxes 6 D's�i/+vliun Bex /J D„t,,6Ytt,.s' /D :/a�tb'eh �' 41 MEN3l,QNS q•dc.r F t a= F ;32'G a Fit•° I - -- ! H. PRE;4?��c :ern A op- �iE �ocq E o t3ax�s ' t r TIIK `f/ ' Y it c .N bi 4 T... ocATwN strier`ksF,�.e;�R�sp��.,Ce[L� `- �sa - Townrsc� .County u4 Aa;'t' J51� a; LOT. N'$_.P's�E i - _ �I J ;L fi 1•'i iL7eno of health Uai2 tel FiC31'ttl SBZ'p1CCe,- $yrYegAr; .' y.. ,",-•— .—•-•. �'8Z T= yy p, s�£a �f'3q� r z ? a co or¢an9 a .vit�h la to of t a Drewa: k N F'.. Date : 1r9: Mole N4 5.0. 1999 11 `:: LR.S. P F i ., JOHN :1.1 P i4 E'N T . 0 0 Cer.1 �a +:- 4 � 4 F. x of x e xw Ht d X X. X X 4X K gE ------------ ."04 . a TAX Ml !D,t,i' 1. ay I N N i — ., A 'Q� , 05 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT W1_LL #1 Well Location Street Address: 164 Cushman Road Town/Village: Patterson Tax Grid # Map 13 Block 2 Lot(s) 02 Well Owner: 'Name* Address: Amanda Cushman Coley 164.Cushman Road Patterson, NY 12563 Use of Well: 1- primary XXX 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable :percussion Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 91 ft. Length below grade 90 ft. Diameter 6 in. Weight per foot 17 Ib /ft. Materials: Steel Plastic _ Other Joints: Welded 'A, - Threaded Other Seal: Cement grout X Bentonite Other Drive shoe: X Yes _ No Liner _ Yes X No. Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped -X_ Compressed Air Hours __6 Yield 0 gpm Depth 'Data Measure from land surface- static (specify ft) 0 During yield test(ft) 0 Depth of completed well in feet 1040 Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water. Bearing ` Well Diameter(in) Formation Description ft. ft. Lana surface 20' Sand Loam. 20 30 Sand & Gravel 30 .75 Hard 'Pan 75 180 ',, +hite Limestone 180 320 Gee Limestone 320 .1040 White limestone w /seam black & white & mi ca If yield was tested at different depths . during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 400 0 Pump Type Capacity Depth Model Voltage HP Tank Type Volume 800 0 1140 0 Date Well Completed 5/13/03 Putnam County Certification No. 02 Date of Report 5/1:9/03 a sign Nw'E: Exact location of well with distances to at least two permanent. lanarnarlcs to be proviaea on a separate sneevplan. WellDriller'sol Address: 75 Putnam Ave., Brewster, NY Signature: Date: % —5 '� 3 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 tr W PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT WELL #2 Will Location �> Street Address: 164 Cushman Road Town/Village: Patterson Tax Grid # Map 13 Block 2 Lot(s) 62 Well Owner: Name: Address: Amanda Cushman Coley 164 Cushman Road Patterson, NY 12563 Use of Well:_ 1- primary XXXX 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion . ; Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 71 ft. Length below grade 69 ft.. Diameter 6 in. Weight per foot _._17_1b/ft. Materials: _X_ Steel _ Plastic _ Other Joints: Welded X Threaded _ Other Seal: _ Cement grout x Bentonite Other Drive shoe: _�X_ Yes _ No Liner Yes No Screen Details Diameter'(in) Slot Size Length(ft) Depth to Screen (ft) Developed? First_ _ Yes—No Hours Second Well Yield Test Bailed _ Pumped X Compressed Air Hours 6 Yield 18 gpm Depth Data Measure from land surface- static (specify ft) 20 During yield test(ft) 580 Depth of completed well in feet 605 Well Log . If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 10 Brown Sand .10 50 Wet Sand & Gravel 50 130 3 Limestone �,'hi to 130 605' 18 White limestone with soft seam & wa er If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 13 p 3 Pump Type b Capacity 1 _I Depth 500 Model 13GS30412 Voltage 230V HP 3 Tank Type_ Volume 119 300. 3 580 18 605 18 Date Well Completed 5/14/03 Putnam County Certification No. 02 Date of Report 7aP&IIa 6/2'C%03 NOTE: Exact location of well with distances to at least two permanent landmarks to be pr6vfded on a kpirate sheeVplan.'- lli Inc. 75 Putnam Ave., Brewster, NY Well Drill e � Address: Signature: Date: er White copy: HD File; Yellow copy Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 4P . . JMS ENVIRONMENTAL SERVICES, INC. 15oo SUMMER STREET .l STAMFORD, CONNECTICUT o6905 NELAC, CT and NY State Certified Environmental Laboratory At the. time of analysis the sample was acceptable for total coliform N/A = Not Applicable mg /L- milligrams per Liter ND- None Detected S.U.= Standard Unit NTU- Nephelometric Turbidity Unit MCL- Max. Contaminant Level TON- Threshold Odor Number ug /L- micrograms per Liter Signature. State #: PH -0218 Michael Lapman ELAP #: 11715 President Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com Mailing Information: Collector's Information: Name: Mill Drilling Co. Client: Amanda Cushman Coley Name: Russ Address: 75 Putnam Ave Address of site: 164 Cushman Rd City: Brewster City: Patterson State: NY Zip: 10509 State: NY Zip: Telephone: Fax: 845- 279 -5075 Telephone: Sample's Information: Site! : water tank ' Date Collected: 7/2/03 Date "Received: 7/3/03 Preservative: HNO3 Time Collected: 15:30 Time Received: 12:30 Temperature: <4C Lab No.: J034661 Method Date Analyzed ;Test Name Result MCL 7/3/03 15:00 'Total Coliform Absent Absent SMWW 9222B '7/3/03 'Chlorine Free Residual <0.1 . _mg /L N/A SMWW 4500CIG `7/7/03 Color ND 15 Units SMWW 2120 B 7/7/03 Odor ND 3 TONs SMWW 2150 B 7/7/03 Iron. <0.03 mg /L 0.3 mg /L SMWW 31118 7/7/03 Manganese <0.01 mg /L 0.3 mg /L SMWW 3111B 7/7/03 Sodium 14.8 mg /L N/A SMWW 3111 B 7/7/03 Chloride 25.0 mg /L 250 mg /L SMWW 4500 Cl C 7/7/03 Hardness 162 mg /L N/A SMWW 2340 C 7/7/03 Nitrate 1.44 mg %L 10 mg /L SMWW 4500 NO3E 7/7/03 10:00 Nitrite <0.1 mg /L 1.0 mg /L SMWW 4500 NO3E 7/3/03 pH 7.43 S.U. 6.5 -8.5 S.U. SMWW 4500 H B 7/7/03 Sulfate 21.7 mg /L 250 mg /L SMWW 4500 SO4F 7/`7/03 Turbidity 0.40 NTU 5 NTUs SMWW 2130 B 7/7/03 Lead <1.0 ug /L 15 ug /L SMWW 3113 B At the. time of analysis the sample was acceptable for total coliform N/A = Not Applicable mg /L- milligrams per Liter ND- None Detected S.U.= Standard Unit NTU- Nephelometric Turbidity Unit MCL- Max. Contaminant Level TON- Threshold Odor Number ug /L- micrograms per Liter Signature. State #: PH -0218 Michael Lapman ELAP #: 11715 President Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com t t �x s ;•. f � � x4'!r . 3g $ -+y}t �+ � a,- F� � �zi^nir" s 5+3,"i � #�'. xls .x ?z, ,y,�� �-,,� . - z Ar 1!" rs� 1 y i ..�e3 ,t„�f �* 3 P,UTNAM COUNT,Y�HEAL�TH DEPxT � k xz� 1 Oeneva, Mid,` �(& 5) 278 -6130 r , , . �nBrewster, NY 10509 Y` Date � � 3 q Heceived,of f . t V $ ollars;�0 0 0 THANK YOU► ❑ Cash [Check ❑ M 0: ❑:Credit Cartl By - -_ . i 1. ' t l } t l PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # 2q-0 Well Location: Street Address: Town/Village Tax Grid # 168 Cushman Road Patterson Map 13 Block 2 Lot(s) 62 Well Owner: Name: Address: manda Cushman. Coley 168- Cu- s:hma -n- oa-G- P- atte -r -son, 1;Y 12563 Use of Well: X Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm . Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage _gal. Reason for X Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason Ex isting well on adjoing yroyeftX to be sold forDrilling Well Type X Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No X Is well located in a realty subdivision? ......................... ............................... Yes - No X Name of subdivision Lot No. Water Well Contractor: Pail l Drilling, Inc. Address: '75 Putnan AVe. - Br vjs . r- NY Is Public Water Supply available to site? .................................. ............................... Yes No X Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to e p o ' ed o separate sheet/plan. No SDS within 200 P se ell Date: 4/ 3 / 03 Applicant Signature: 4 ' G PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and 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 or their designated representative 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. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and 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. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. A ' y revision or alteration of the approved plan requires a new permit. Well to be constructed by a water , ell ller c ified by Putnam County. Date of Issue -0 ` i Permit Iss ' icial:, Date of Expirati Title: Permit is Non -Trans a rab e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 �1 " n t p• A i� coG vc �P a Sheet or PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLH SERVICES FIELD ACTIVITY REPORT C(ASVlVIA k-0--a Streef Town . State Zip ERSON IN�CHARGE Lo R WT-F V�TF�UUFI�: Na a and Title fiYPE OF FACILITY : j1 Q(�>,j ,3 4r0AA kavif ot c 49- "119 - ZO�� �Y G v S a' fh m �t C. 02/96 .Rau - �y, ' and Title of this report: SIGNATURE:. Title: 2235 m %Z 338 FOR ASSESSMENT PURPOSES ONLY Y NOT TO BE USED FOfl CONYEYANCES� nvuon JAMES W. SEWALL COMPANY 147 CENTER STREET. OLD TOWN. MAI I i I i a15NIm IRIr cwrlaola onnw nmalw+mlm Y'ECIA OlaRlm LI wm onRlm ul 1 Ul 3mf a• .:n. ,e r nla t• wa nammm elsRla as I i ^'° '""^ III I o.� IIj 6 I 1d 45.1 --'- s'rada ac II�.- _..- -- �11 I 1 I f1I I III � I III I I� I I \\ i� „ I WIC mmw� -- =- �- �------=- - - - - -- 338 FOR ASSESSMENT PURPOSES ONLY Y NOT TO BE USED FOfl CONYEYANCES� nvuon JAMES W. SEWALL COMPANY 147 CENTER STREET. OLD TOWN. MAI ncr I• I�IUO SPECIAL DISTRICT INFORMATION !(140. ail• Inlll mlR llm mm uK. -- MILK rltum llm —_ -- mWl U.17 - -- IaONIIR Um a15NIm IRIr cwrlaola onnw nmalw+mlm Y'ECIA OlaRlm LI wm onRlm ul 1 Ul a• .:n. ,e r nla t• wa nammm elsRla as I °tea' ^'° '""^ w.+ 'a/Ww + Lit -i a+'aaaa �+-a wa+a �A n a•na.n avn .l + 338