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HomeMy WebLinkAbout0381DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13.33.2 BOX 5 00190 ev '86 Y101t, STEM ErRM L4 ROSS q Mal watii t" UcdOdesi rutyt I IV dan sutWactlow Mary available M --hall liec6iifi- Do 74 y ` ~ o PUINAM COLUEY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Ll3L�LT f S s .l !Z , owner or Purchaser of Building Building Constructed by Location - Street �/�TTLS"Cz4v>J Municipality. =r-,S ( bG,�j T1A.L- Building Type 7 IS' Section Block Lot 2�sursDivis��,� or e- or Subdivision Name Subdivision Lot # GUARARrM OF SUBSURFACE SEDGE 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 a9cept 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 buildi utilizing the system. Dated this Z day of / � C - 19 90 Geneiil b6fitrac or (Owner) - Signature Corporation Name (if Corp.) rev. 9/85 mk Signature Title Corporation Name (if Corp.) Address ' el`A COQ. �f4r Y� WELL UVV1rLh"11ULV rLLrUlcl DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET ADDRESS: WN /YI / 1 Y TAX GRID NUMBER: Cross Rd. Patterson, N.Y. 12563 WELL OWNER NAME: ADDRESS. Albert & Janet Rossi Cross. Rd. Patterson N.Y. 12563 PBIVATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary IN RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED D BUSINESS O FARM ❑ TEST /OBSERVATION Q OTHER (specify) ❑ INDUSTRIAL 0 INSTITUTIONAL D STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING N.NEW SUPPLY D PROVIDE ADDITIONAL SUPPLY D TEST /OBSERVATION D REPLACE EXISTING SUPPLY D DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 305. ft. STATIC WATER LEVEL 20 ft. DATE MEASURED 4/18/90 DRILLING EQUIPMENT D ROTARY 0 COMPRESSED AIR PERCUSSION ❑ DUG O WELL POINT ❑ CABLE PERCUSSION D OTHER (specify): WELL TYPE O SCREENED D OPEN END CASING. C OPEN HOLE IN BEDROCK D OTHER CASING DETAILS TOTAL LENGTH 40 ft- MATERIALS: D STEEL D PLASTIC D OTHcR LENGTH.BELOW GRADE ft. JOINTS: OWELDED CRTHREADED ❑OTHER DIAMETER 6 in. SEAL: ® CEMENT GROUT D BENTONITE 0OTHER WEIGHT PER FOOT 17 lb./ft. I DRIVE SHOE OYES D NO LINER: D YES C3tN0 SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST None O YES ONO HOURS SECOND None GRAVEL PACK ❑ YES tYNO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH It. WELL YIELD TEST If detailed pumping1ELL METHOD: O PUMPED 1 tests were done is in- COMPRESSED AIR , formation attached? ❑ BAILED ❑ OTHER ; ❑ YES D NO LOG If more detailed formation descriptions or sieve analyses are available. please attach. DEPTH FRoM SURFACE water Bear- ing Well Oia- meter FORMATION DESCRIPTION race. ft. ft WELL DEPTH it. DURATION hr. min. DRAWOOWN ft. YIELD gFm Surface 3 N 8 Soil 3 40 N 8 Limestone 305 6 N/A 50+ 40 305 Y 6 Limestone WATER 11CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? ® YES ONO ANALYSIS ATTACHED? CRYES ONO 8 0 AS STORAGE TANK: TYPE CAPACITY 80 GAL. 63 PUMP INFORMATION TYPE Submersible CAPACITY 7 MAKER F &W DEPTH 285 MODEL 4FO5AO5301VOLTAGE 230HP WELL DRILLER NAME Wragg Bros. DATE 4/18/90 ADDRESS 44 Miry Brook Rd slGfffnRE / Danbury,Ct. 06810 �� ELLIS A. TARLTON LABORATORY DIVISION OF ELLIS A. TARLTON, ENGINEERS, INC. CHEMICAL 34 PLEASANT STREET DANBURY, CONN. 06813 -2328 WATER - WASTEWATER PHYSICAL METHODOLOGY BIOLOGICAL P.O. BOX 2328 203- 748 -7903 APHA - EPA - ASTM REPORT OF BACTERIOLOGICAL AND CHEMICAL EXAMINATION OF WATER NAME AND. FWragg Bros. TURBIDITY SOURCE OF SAMPLE 6DSS OF A RE DISSOLVED SOLIDS. Concentration Water Su 1 pp y r Rossi Res.. PERSON TO RECEIVE 44 Miry Brook Road Cross Road REPORT (pM) Patterson, NY Danbury, CT .06810 I L_. DATE OF COLLECTION Dec. 6, 1990 DATA COLLECTED BY Wragg Bros. Hydrogen Ion COLOR TURBIDITY ODOR CORROSION INDEX DISSOLVED SOLIDS. Concentration LANGELIER (pM) RYZNAR NTU Mg /L Alkalinity as CaCO3 Fluoride (F) Bicarbonate Nitrite Mg/l. Mg/l. Mg /L NITROGEN Alkalinity as CaCO3 Chlorine Residual CONSTITUENTS Nitrate Mg /L Carbonate Mg /L .00 Mg /i AS NITROGEN (N) Total Hardness as CaCO3 Conductivity Ammonia Mg /L Mg/l. Micromohos /cm Mg /L Iron as Fe Mg /L Mg /L Chlorides os CL Mg /L Manganese as Mn Mg /L Mg /L Detergent os MBA$ Mg /L Sulfate as SO4 Mg/l. Mg /L The arithmetic mean of all standard samples examined per month using the membrane filter technique shall not exceed MEMBRANE FILTER TEST one colony per 100ml. Coliform colonies per standard sample shall not exceed 3/50ml, 4 /100m1, 7/200m1, or 13/500ml Coliform Colonles /100ML in: (a) Two consecutive samples: (b) More than one standard sample when less than 20 are examined pe! month: or (c) More than five per cent of the samples when 20 or more are' examined per month. 0 AT THE TIME THE SAMPLEVAS SUBMITTED: © 1. The results of the analysis of this sample were satisfactory and met requirements for a potable water. 2 °' '1 he resuds rif the anetysis or this s'arriple were satistifctory for a pofable water but certain of the chemical or physical constituents were high. These are as follows: F13. This sample was not satisfactory since it did not meet the bacterial requirements for potable water. The presence of organisms of the coliform group in a sample of potable water is undersirable and, while not necessarily Indicating the presence of any disease - producing organisms, does indicate that such contamination might survive to the same extent. The presence of organisms of the coliform group may also indicate that the treatment was not adequate at the time the sample was collected. El4. This sample was unsatisfactory as a potable water because certain chemical or physical constituents were above acceptable limits. These are as follows: COMMENTS The bacterial analysis showed no organisms of the coliform group at the time the sample was collected which indicated the water potable. Certified................................................... .. Frig, ci�r*� Ll`' -rJ1 rAg , d i Z . CNN ER •C T: TGN . fm ff pR Sur.Dry 52C_'i iffy' . DISPOSAL AFE: c_ SS area Irr -t-1+ as per acoroyea D_ ? sue. ic:z - Dam of piac�-It T -t- 1 sci_ r_ct irr C_ C_=e, bnLs =. e-c. , Cr_� e_ loo f f =C::. Etas C: L =e ar, a. fi =oc `�-,� s=�= - 1,000 1.2`i7 - - C. IIL:1' iT 1-1 C. Wa te. Pr •cV = Cwt C. UG•NCHEC 1. L_rc` -, r1-- - Dist =rC °_ _cza E. Rccn ai1c: - fcr ex--a ms-CI-1, Sc7` 1 D^C•`':CC= C ==-,7cZ L'1 t= ez-C1 12" V'. • 1 1 p; r"C Ems= C = ° =^ 11. 1 Size of L_: G. C e__! crV L__`: JA _='- mac--= -�b1 mh = rracle to CraEe fi. C'rcl e w_ —_ -= by Ee=lz L`e=mot �t?rtet_= �c� Ccr c�cc.e W. S —a Ice rer a =rcvEd cL V. I - C. casci Wall ac:CSCta!2 - -e- — a_ l��cas rrcc�_�% c=cLt C. A' ' Diz:es f_1 i W =-_'i inslde OL �Ct f � C_ H 1 1 IG=` 1= 1 C 21- Lls s L-C ll r=s < d � l -_n c- - �=— & C_ t =C:t� i cr.= ic_a cIl S GtcS C_ —�=Y L t/ Caney. o.o.Kw;.�e `er, Pate �� ' 5 IwrOCabN Iol;fiYN M maY'Oa it�Mrld nomwes a now Permit: APOrosaO " 0/88 Dint ti a N itrom fha dab issued uni coesh io of the Ouiginy .has;."n uiWl"Iten and is �anwry;0y tM';COmmialoner of FINRd.` Any change or alteration Of construction � a priwb water wpoN only. ` . m 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 j�? C>^ PCHD PERMIT #/ - J '/ 0 WELL LOCATION Street Address Town V+"age efty- Tax Grid Number WELL OWNER Name Mailing Address jWrivate O Public USE OF WELL 1 - primary - secondary RESIDENTIAL D BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify p . AMOUNT OF USE YIELD SOUGHT S gpm /# O REPLACE EXISTING SUPPLY NEW SUPPLY NEW DWELLING PEOPLE SERVED /EST. OF DAILY USAGE _1gal 13-TEST/OBSERVATION CIADDITIONAL SUPPLY O DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING 7-0 .cyy0/r-- WELL TYPE DRILLED ODRIVEN DDUG GRAVEL .Q OTHER IS WELL SITE SUBJECT TO FLOODING? YES _ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: G.2 o5s.yp&D s I S5UG -DI V IS J of— LET' Lot No. � WATER WELL CONTRACTOR: Name-1�0 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE:. YES i(NO NAME OF PUBLIC WATER SUPPLY: °TOWN /VIL /CITY DISTANCE TO PROPERTY FROM LOCATION SKETC%H,& SOUR ON SEP. 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 thirty (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 of ise contaminate surface or groundwater. Date of Issue: % 19 L 60 Date of Expiration 19- ermit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller APPENDEC 3 �,- PUMZ_4 C LY?^% D`.-- 'as: =A_T-:r OF f -A_T'_: - DrT-rSlaM CF L SERVICES ?t�'_= ,i_-,� WE—i Su�a�Z & S:Jr.SU - zr^ (•vGr:ta vC.vT:`r) I I I' P�• -zi= Aplic =ccn tam Beso ", nt =ca . Pi ans - m-re'e sets �,•_ i. ee Lv: C, C.- a s a.,1 Per.. aol-3 rN„ _ ' fY i� � I •�/C��G7.1Vrr �LiC�L. _ 0 r f S x w 1 1. • - ^-rs cl jr til" I L� - -,- -i cszC ` s w - J1 N�Ir Z „ _ x L C1 r L r t. an .vcC ol - - -- ,r L ZZ cra t.ur, 1 i F.�? F_or_�e" & DT _ ^__ ,. D cr J B^x;'_'_ _ - . c= st-_ -t? cn Not~` I I I re--: -an D✓t=. �erc a�:crce =_o rs-• - . t...1. -5 1 I Dr_ .a,av & S? o_ es C t I." I Fcotinq L7i ^.c _• r _ ! Per &Dip 1 (:sue CK) . . I BeJr= _Sa ^_r Live Of pr_i' and _r - --,c- ?Civili : a7,T t_7 i'_c'H S-== slZe _;? t notes pit & D Bcx S',Icq l _ J I Ecu-Se Of Bar jam. We S & S� ^uS t s Gil /ia 200 L L. GL R_" .CC sys iz- P= _�� :etas & Bctr*:c?. cue Set^�ck Neca_ -sar (Tlczt lco EeLezr - 1/4" t Q. yr.: CCC e! _ i. I .. ! �TQ / A no; r;_ e o i -le - -- D Sr 10, v �' P. r Dr14�c7, Zar_3 T.= — ,TC.. CL L x n 20' tc rot:nc_�.i ,- ��J fL reservoir; r 1 I �w t° U • Ut . to We? 1, 20 u D L.0 D, �0 ` pl mod{ E l0U r S� 'y 0 _ t r _ �. U- �' Dr- -- T trzc -1 to kL r Ur -L3, Lr15 Zr - -�.o F ; 10 at } .t e _ t -Iri^e - -e 2i 0 ^ ) to Va r: q. 57 ia� L.L.—.L.' ` c S`- _ ' c manks 10. L_:i ^ -Un ry , . PUD M COUNTY . DEPART CP MUTH. .�' :.. DIVISION OF ENVIRaMEMML liEAMM BE MC ES , DESIGN DATA SHEE1`- SUB8UFACE SEWAGE 'DISPOSAL SYS'1EH' FILE W. Owner Addresszo Located at (Street) t rss F26 .. Sec. Block ' -1 Lot �S • (indicate nearest cross street) • Lc-r ,tee I municipaiity �,��-r so,./ -Watershed. C TO,1/. ' SOiL PE, R A'IZ N TEST DATA •RDQU = TO BE WITH APPLIC MUMS Date of Yee- Sgaking I 1 Iz 88 • Date of Pe 6olation Test I I I.8 • �� HOLE qu4BER Ci= TIME PEf2C(IL,Jmctl FEfttXJLlYl'IC4J .. Run •• Elapse Depth to Water, FYcm mater Level No. ''Time . Ground Surface In Incbe9 Soil Rate Start-Stop Min.. ' Start St6p Drop In MWJn Drop a Inches Inches Indies 1 2::C)5- 2 :35 -Sa z.3 2 vas- 3 :oa so 'zq Z77- 3 3:05 -• 3 3� • 30 •2q 2'"i '�z 3/ 9 1. V. 0-7'- 2'3'7 3o Z 3' /z '2 Z' 37 is: 0-9 3ci rr/ .4 ' ,5 2 4 ' TES: ' 1. Tests to be repeated at same depth until..approximatel.y equal soil rates are'obtained ,at each percolation test bole.. All data to' be.subnitUd for review. 2. Depth nexsurenents to be made from tcp of hale. pE,PTLi. G.L. 3' , 4' 5' 6' PIT DATA HOLE -No. I Ta7, B.E SUE94ITM) W= hPPL1CZTIGN IS ENCOUNIEEIF.0 IN U r LKff S HOLE DO. • 2 BC LE NO. 10' 11' yC ' �z•. INDICATE IZ= AT WHICH GROUNM TER IS a4OXNTk'RED tj b t, et INDICATELVEL TO WHICH WATER LEVEL RISE$ AFTER BEING ENaX NIMM rJ /4 '�L DEEP' HOLE OBSERVATIONS MADE , BY: r cg r--i DATE: J I. 18 68 . DESIGN Soil Rate Used =D Min/1" Drop; S. D.. usable Area -Provided No. of Bedrooms 3 Septic Tank .Capacity too cD gals. Type ►�gorJ��- .'Absorption Area Provided By 33 L.F. x 24" width trench Other -•`,- •;,, , a �>J T Signature Name �^ u .. c�,b• E �. C_ . Address SEAL THIS SPACE FOR USE BY' • HEWIH •DEPAR24WX QNLY: Soil Rate-Approved sq.ft/gal.. , Checker3 by Date S A CMG 4 � ¢� JOHN KARELL Jr.,'P.E.. M.S. . 80 Public Health Director DEPARTMENT OF . HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 November 5, 1990 Mr. Howard Kelly Cashin Associates, P. C. Route 52 Carmel, Iev York 10512 6RD.t,4Ajt9 tN VUW- LEh16tH o>F PM FIEt_ - - tpjloNi .P� tE- ,FIEJ E�EJ. ?� 6cQn, Pt�,'Svrzn,; oEPih Wi�nE tlF?TN iErGi ser K \ \ \ �3Ad.•L?L2�� Nt3c° .. \ - �FryLE j�Pll� � f`a""'"'io ,tpvGU:ItiIG � �Fp.. 2.253 P�-T� I `�, �/I f `�- ✓I _ _ yr: qq5 f 9814.3 Sf:s v .6f.� AAA �C,�, \ i v Z W U OC n d� V IL INI z z ?R6A= 2.253 AG} 0 2 grOR'I SNUp INC& Fit,KtA FRM' A J� a A- -- r+elc/=9 N35S c n���6�i1 ♦ ` Putnam County Department of Health Lvision of Environmental Health Services Approved as noted for conformanoo with app ^le I:L`188 ana vogulaLlone of Luu P Co. 2Lealth Depart ent. ature & Title Date q ,6� � I 00 1 � U I e CONC. EtAc. Q ` j V.i a.� 1 ' 1v �1 111/ 6R�LK SfDNE u) �l MASoIJ WAu ml1 N/F KEMP ' � 1 TA5LE OF MEA.SUREMP.FJTS mom I Z S 4 1 5 1 & 1 '7 16 -I 1110 1 11 141.3 1'55.15'1515'1 S4 41.5 W 170,1311.5 1 40 11.0,1 93' 5 1 19' 1 ?dd I 3a5 131 1455 1 98 1 5`3 146 IM 65 144 \ THIg IS TO CERTIF'( THAI' T1{p. SEWAGE O%sv,.SAt- W �� S -15TEM WAS C0114T1XTEa_ AS %Ob%C,&-}Ea ON T:6 QLAJ.) IN ANC THAT THE S(STEM WAS W-A- EcTEp' BY cA.,A%Q D/ ASSOLIAiE.a. •P.C., gaFORE IT WAS COV£REp CVP -P-. THE /J S- Mre--A WAS CC"ST1tUCTeJ> 10 WITH ALL- PI-01 G STAI.NUiLD Fc AMt> 2EGL1LAT101.15' OF THE 'SoITTUAM CaUti?Yf b6FAK'CMFJ. r OF HEALTH GrJD "1'L{E NEW YO¢K srn,-tv-- VE F T IN 4zT of Hec Lrti. . SSDS AS- 5UILT FREPf>REO FOR ALBERT . L.1 ROSSI kJF . i,e.rv�T I��cSI SCALE I 5&