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Home My WebLink About0392DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -3 -29 BOX 5 00201 Form y- se Putnam Cqu.n Of ~ � � ' | � \ / ! � - | ` PrC En A E BREWSTER LABORATORIES Box 224 - BREWSTER, N.Y. (914) 855 -1930. - WATER ANALYSIS REPORT - SAMPLE NO. 8542 SOURCE: Crompond Contracting Corp. Cornwall Hill`.Road Low„ Patterson, COLLECTED: 4/l/93 BY: P.F. Beal & Sons BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method TEST WELL This result indicates the source of the sample was of satisfactory sanitary .quality when the sample was collected. 4/5/93 1 1 4 'l 0 per 100 ml. l � I 0 per 100 ml. 0Q'®G. T.TC+T T k�nX DT VMTnM DVnnnM W 04 WL1LL li Vi "lt LPr11VL`I LIr'Ev"L DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTN C TNTY DEPARTMENT OF HEALTH , Office Use Only WELL LOCATION STREET AOURESS: WNW IL t y TAX GRID NUMBER: Cornwall Estates Patterson NY Lot #8. WELL OWNER NAME: ADDRESS: Jose ��i Crompond Contracting Corp.,Box 451,Cromp.on '�� 17 O PRIVATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary :K1 RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED O BUSINESS ❑ FARM ❑ TEST /OBSERVATION .O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm.INO. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING .[]REPLACE EXISTING SUPPLY [].TEST /OBSERVATION ❑ADDITIONAL SUPPLY ®NEW SUPPLY (NEW DWELLING) ❑ DEEPEN EXISTING WELL DEPTH DATA ' WELL DEPTH 195 ft. STATIC WATER LEVEL ��ft. DATE MEASURED 1/z6/93 DRILLING EQUIPMENT ® ROTARY ® COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT O CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED O OPEN END CASING IJ OPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH _mil fit. I MATERIALS: ® STEEL 0 PLASTIC ❑ OTHER CASING DETAILS LENGTH BELOW GRADE_ ft. JOINTS: p WELDED ®THREADED O OTHER DIAMETER �_ in. SEAL: ® CEMENT GROUT O BENTONITE OOTHER WEIGHT PER FOOT 19 Ib: /ft. I DRIVE SHOE ES YES O NO LINER: OYES 13 NO SCREEN DETAILS DIAMETER (in) SLOT SIZE LENGTH (it) DEPTH TO SCREEN (ft) DEVELOPED? FIRST ❑ YES ONO HOURS ' SECOND GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK _ Tn. TOP DEPTH ft. BOTTOM DEPTH ft. WELL YIELD TEST It detailed pumping METHOD: O PUMPED t tests were done is in- t 129 COMPRESSED AIR , formation attached?' O BAILED O OTHER ❑ YES O NO WELL LOG if more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear- Ing Well Dia- meter In FORMATION DESCRIPTION paE }t. ft. WELL DEPTH ft. DURATION hr. min. DRAWOOWN ft. YIELD . gpm. LaAa ce 10 Drilling in overburden clay 8c boul rs Hit r ck at 101 195 6 120 30 10 31 Dr'l1 ng in rock, set casing, grouted. 1 195_Dril.'.ing in rock granite. WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? ❑ YES O NO ANALYSIS ATTACHED? ❑ YES O NO STORAGE TANK: TYPE Wel lXtrol 250 CAPACITY 44 GAS. WELL DRILLER NAME P . F . Beal & Son nc DAT ADDRESS 4 Putnam Ave. SIGt7ATU Brewster, NY 10509 PUMP INFORMATION TYPE submersible CAPACITY 79 MAKEA Gould DEPTH 14o, MODEL 7EHO5412 VOLTAGE2-20—HP -.12-_ J/ ov a alffift TM y(/(/di'G Lot Ares NE"W of Heiswe DnAp Plow G P D f7� S@Pww Sbwt> W Sydm is emadvt d 1 Gold. Seple Tflet d U 14 be Wstar Stl l*: -PtiYe SRO* Frea- an Seg>♦b Dd9sd by pd�eaa Odpw 1 represent that 1 am wholly, and ,completety.iefpon*e'for the design and location .of above deacrieed will be constructed as shown on the aP pro vad amendment therm to angS t,oullty Depaftlrient .of Meelth. and that on compN4km thereof a?'Certificate .of Col be submitted to the Department, and a,written guarantee witl'be 'furnilif the-owl o piece in good operating condition any Part of aid sewage disposal system dur, ants) of the approval of the "a7ertifkata "of Construction Com Mpliepce of torigi I will be located asfhoavn on the Iapproved plan and that said well will'be" Installed" i ` County Depart of NMith: Signed Address " y APPROVED FOR CONSTRUCTION: This ,appror " expires two years from. the dote if revocable for cause or may be amended or modified when considered necessary :by the the 0v. �t Wes a new permit. , Approva0 for disposal of domestk "sitditary sew " 1 °c�f 10/88 Data T_ sy Pm s-edee Oil LJ PC® Nddimlion -is Depilb Vabo e r'-filititid04 to the Commissioner of ke-enhwill irs.oi a igns y,the. builds►, that said builder will yews l tely following thedate of the ifau- s t rsv t tfie drilled well deeaibW -bow nda►A iu J�ad tep— a' IMS o. of/ the Putnam r P.E.✓ R.A. License No d a4. 1 7 Lion ,of' the building has been undertaken and if lliie. Any change or alteration of Construction DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster,.New.York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL . /1*1Q_ -Z S -' PCHD PERMIT # WELL LOCATION Street Address Village City Tax Grid Number WELL OWNER N e Malling Address rivate 0 Public USE OF WELL 1 - primary 2 - secondary 07RESIDENTIAL O BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP ❑ ABANDONED ❑ FARM 0 TEST /OBSERVATION ❑ OTHER (specify b INSTITUTIONAL ❑ STAND -BY O AMOUNT OF USE YIELD SOUGHT 1 gpm /# PEOPLE SERVED_ /EST. ❑ REPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION RNEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL OF DAILY USAGE 2-00' gal GI ADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE ,DRILLED ODRIVEN ODUG OGRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES 4,-'NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME; OF 5UbDLV151UN: Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: //�/ // //�J• Yr ' ^ °'` ''1 S5 1�' a 9, LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED y, QON SEPARATE SHEET`'> :fl 1 L ! Y (date) (signature).: PERMIT TO CONSTRUCT A WATER WELL ° %5." - vim:•..,,. 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 otherwise contaminate surface or groundwater. t-- -ite of Issue: /Z 19 Ytof Expiration 19 Permit Issuing cial 31L is Non - Transferrable White copy: HD File Pink copy: Owner Yellow copy: Bldg. Insp. Orange copy: Well Driller PC -1 PUT NAM C O UN TY D E PARTMENT O F HEALTH _ APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of App 1 i cant : �- �vy1-i ��1 ( G �7 /0' <1'i�,� ( vim• 2. Name of Project: CUf c'/ 3. Location T /V /C: 4. Project Engineer: �(� ,� %' //lid /�� 5. Address: a License Number: %al3 U Phone: 6. Tvoe of Project: _ Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 7., Is this project subject to State Environmental Quality Review (SEQR)? Tvoe Status (Check One) Type I.. Exempt Type Ii. Unlisted_ 8. Is a Draft Environmental Impact Statement (9EIS) required? .............'� Has DEIS been completed and found acceptable by. Lead Agency? ........... 10. Name of Lead Agency 1. Is this project in an.area under the control of local planning, zoning, or other officials, ordinances? ......... ............................... yPi 2. If so, have plans been submitted to such authorities? .................. r 3. Has preliminary approval been granted by such authorities ?. Date Granted: 4. Type of Sewage Disposal System Discharge...... Surface'Water .-if Ground Waters .5. If surface water discharge, what is the stream class designation ?........ 6. Waters index number.(surface) ........... ............................... �. 7. Is project located near a public water supply system? .................. 4v B. If yes, name of water supply Distance to water supply .9. Is project site near a public sewage collection or disposal system ?..... �D :0. Name of sewage system, Distance to sewage system 1" Date observed: 23. Name of Health Inspector: 4. Project design flow (gallons per day) ............... koo ............... 4 2. 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. 4/9/. 26. Has SPDES Application been submitted to local DEC Office? ............... 27. Is any portion of this project located ithin a designated Town or State A�,U wetland ? ................................ ................. _ L 28. Wetland ID Number ............................ ..................... ". 29. Is Wetland Permit required? ............................ t% .. Has application been made to Town or Local DEC Office? -- 30. Does project require a DEC Stream Disturbance Permit ?� 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, !/ landfilling, sludge application or industrial activity? YES or NO 32. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or NO DESCRIBE: 44, 33. Is there a local master plan or file with the Town or Village? ........... Y/�/ _ 14. Are community water, sewer facilities planned to be developed within 15 years ?c� 5. Are any sewage disposal areas in excess of 15% slope? ........................ 36. Tax Map ID Number ............................ ........................ 31. Approved Plans are to be returned to: ................ Applicant Engineer If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. Failure to comply with this :Jrovision may be grounds for the rejection of any submission. . I hereby affirm, under penalty of perjury, that information provided on this form is. -true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Hisdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: :'- .`.'�AILING ADDRESS: d� (•�'�'�0 ��' /�G�� r f r PUI'NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Owner or Purchaser of Building Riii'Irlina rnngt-nirt- d by �1 Building Type I Section Block Lot Subdivision Name Subdivision Lot # GUARAWEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, wor)ananship, 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 Environmental 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. ,, Dated this day of 4 f Signature /, Corporation Name (if Corp.) .r. - rev. 9/85 mk Co7poration Name (if Corp.) A�dr � ('l ' y�; '� ? Ali 1) j BREWSTER LABORATORIES Box 224 - BREWSTER, N.Y.. (914) 855 -1930 - WATER ANALYSIS REPORT - SAMPLE NO. 8542 SOURCE:. Crompond Contracting Corp. Cornwall .Hill Road Lot #8 Patterson,,N.X. COLLECTED: 4/l/93 BY: 11. 17. Rent I & Batts, BACTERIOLOGICAL EXAMINATION_ Coliform Count, MF Method TEST WELL This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. 4/5/93 1 Thomas Meye 6' Director 0 per 100 ml. � oo�E�cP A R 15 n q b m -1$bx CtYP� (9/ yCL-EAM-Mr j :a1 1 C7AL. SEPTIC • V��1 -� �- 1HCN PIN SET 0 .:..' TANK t B o � o .3 sR F}ous6 \ a c {tl f litON PIN SET ! ! PLAN I TTAL Lf REQUIRED 3.100 �ROJIDEA 300 rutnrm County Bepa ent of Health Div ion b P.hvi 3 IIealth 3ervie, IfPpi�oved as noted for conformance min applicable Vulos and Regulations of the Outnam.CO_fy health Department.. `tan!atulre �e� Tttl.w � ,�•„ 11 12 -,This is to cer-,ify that the sewage_ disposal system was constructed as indicated on this plan and that the system was inspected by me before it was covered over. The System was constructed in accordance with all standard rules and regulations of the Putnam County Department of Health and the New York State Department of Health." - --, ' CRONPOND CO^ITRAGT�Ny CORP. p--VON ROAO I'1 p.er , 3 7A. r.0 401 Z3 pArrE� soh/ runs: I' AS nu a r� Pt-AIN lB Y3 s6, r/C TANK ' 1 as 56 CL6AX/0Wr 2 '71 91 Tuwe-rlom Box/ 3 122 /36 - 4 /25 1yO z 5 132 /y�6 3 6 /38 /SI 5 7 /'f3 157 9 153 /78 FAID7TACA(C- t 10 /%fl /97 ENO TRENCH 11 12 -,This is to cer-,ify that the sewage_ disposal system was constructed as indicated on this plan and that the system was inspected by me before it was covered over. The System was constructed in accordance with all standard rules and regulations of the Putnam County Department of Health and the New York State Department of Health." - --, ' CRONPOND CO^ITRAGT�Ny CORP. p--VON ROAO I'1 p.er , 3 7A. r.0 401 Z3 pArrE� soh/ runs: I' AS nu a r� Pt-AIN lB Y3 S - 4J r►/' � `• � \ \ � `� P�` e`er ... � ' S � • Y'rt�yJ' � x'�i � Lod •�. /AQ d, V'/a / . f i^ f l y �� f �. \ u �- �.�f•S� •rte, 1- r 7. CL 1 / � fit p'i -�_ ....� .�', \ -74•+ � \ �. 1.. � .. ' �Jklo F• F� w � ,