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HomeMy WebLinkAbout0394DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -3 -31 BOX 5 00203 7�7 =7 gk :77 PUTNAM: COUNTY DEPARTMOM 'Y� 10512 Dhislona ;661s W,46211111, i'N., h TF ih T 1Ylast Provide ;a ?=4 .4 M Permit CMMCAn OF CONSTRUCTION COMPLIANCE FOit'.SE*AGE,DLSPOSA-L SYSTEM" .'X Tow Lot Forimerl' A C 11., S- U 6v A—L, V., Fee Encib U. _ Permit fso 74- Ve- SepwaW Seweinge System 'bullt by---� - --Addrm' Gallo. Septic. Tank d C� of. I a rai 12 C Water SuPply3 Public Supply From Address re'lAO. e, on, Private Supply D'r!PeOl bby -Address X Building Type Lcit• Size .":Z­,2-3j.k,, Hag' ErOSioii CnntrM NumW of Bedro6uis Has Garbage Gdader Been Instelled? Other Requirements — I certify that the'ayiteis(s) �as iis6�'servinq the akiove..preldses were : constructed essentially &a shown, th 'lava of the completed 'work copies - . - - ` - ' ' ... 1, .. 1 n of which are at6ic or;d"cii.with'the. standards, rul with the f �Tp n, the permit issued by the heil),­inh es:and:r"afi�ons, in accor "Pence *n ea t bipart�6i 6i i" h Putnam County H Date Nt I" by A di re AL License No.- Any person accupy I Ing, promises -si�jed by the . -a-lbi.- stw�js) Sh.j.1 �0* Itly. take such action" as May be necessary I to "cure the correction of any unannary . .1 vp sy 'Irp cond tlons.resuiinj: from AP064il� of ''t-he,spParaO 0*000 sys!en�)O��P, beconve 6611 and void as soon as a PubQ: 4anitary'sSwer beconim such" usage... , , .. . , - .1. . , I . -aval:bl* 'and. theapIxo;481-1 Of;� t!��'�Prb�a i4!vb�0e,.nuI!,:Ond void,rwhien pubIk water supply becornes 'Such sWovals we subject to r6WIfIcatio"'Or chan"'whih, U thejiidpment 6f,tiWicolminismoner. of Nealt Gh nirocatiori, Moilficailon or change Is necessary. 7-5 ;`771 Dot THIs 3/89 1 1. I %. ti -,. 4. PUINAM COUNYIY DEPARTMENT OF REALM DIVISION OF ENVIR0M7TAL fMLTH SERVICES Owner or Purchaser of Building GDtl -p � Building Constructed by Location - Street Municipality Building Type Section Block Lot 2C.,�. Subdivision Name CQ Subdivision Lot GUARANTEE OF SUBSURFACE SE�MGE DISPOSAL SYS'T'EM I represent that I am wholly and completely responsible for the location, workmahship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has -been constructed as sham on the .approved plan.,or .approved amendment .thereto,, .and zn accordance .wit.h ..the standards,. iules and regulations 6f the Putinam Couiity.Depari�nent 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 detenuination •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 Z�' day of F �� 19� eral c r (O7 - tore �f1 W cI•I CAS � C I , Corporation tame (if Corp.) Al Address rev. 9/8S Mk Signature Title toi O at.ian Nano U9 COrp. ) �.5 /tic P d iIN IN 1 ANALYSIS Total Coliform THIS SAMPLE AS RE THE REOUIRE IENT� RESULT T - METHOD Absent COLILER' ..:, F-IVED AT PftnABORATORY:� MET --`�: OF NEW kOR T�A DRINKINGWATER`� C . W D rr l� {,�l S?' J D , l �9 Q 0 O above described Willi be constructed 41 shown one County pipartntaht , of 01611 lth. and that oh Car Ice subniltted to tM;Oepntnrerot ` an0 i .writto plsci in qoOd'.operati4' COrWltion any, part. Of ce No of the app►oiraI of the CertifkA7,of Coy wxl be boated as sfioO avn n the approved plan and County owrtoilo t of Health.; Date ipNtion.thereof "Certdic t* of Coos? giliranteo will be furnished the;ownll YW; swiaoe dispOmi,.skem, during .tl Rruction- Cornpiience, of the _ ri that tild wNtwil M Installd nOLi f ed APPROVED FOR, CONSTRUCTION: This approval �sipMis two ywrs iron► the date iisi revocable for cause or- may be. anaiwW or modified wMn eonsidend neeityiy- by-tM -.! requires a new permit pproved for "difpo /ai of domest IC' unit iy sewage and /o 0/88 proposed stem 40rdance with the statedards, rules and regumix tons or the ction Compliance" sstIjfWory'to the Coinsniaioner of MealthwBl a%- I' his sucossMs or, assigns by the bulldfi . tlist'eab builder will period of two,(2) years IminWlaNly following the data Of the 1pu- tim, o► any r'epeirs thereto; 2) that the drilled weil,de'1WI red 960 nce 'with the ftandaro ru S. and reeu„ ns _ ,Of, thi Putnam 4 -ALI- License No unless construction of tht 1uiktiny ,has bola .urogertakM• and N In Missioner -of MNRh. Any. Change or alteration of Construction rate -water supply only. DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL y PCHD PERMIT WELL LOCATION Street Address o Village City Tax Grid Number go Name Mailing Address C4'[' Private WELL OWNER Au-, 5�, / - tl��wr �- nn OPublic E OF WELL SIDENTIAL ❑ PUBLIC SUPPLY 0 AIR /COND /HEAT O /OBSERVATION PUMP O ABANDONED 0 OTHER (specify 1 - primary BUSINESS FARM O TEST - secondary 0 INDUSTRIAL U INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm/ # 0 REPLACE EXISTING SUPPLY PEOPLE SERVED /EST. ❑ TEST/ OBSERVATION OF DAILY USAGE d e) gal 12. ADDITIONAL SUPPLY REASON FOR DRILLING AEEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE C&RILLED ODRIVEN EIDUG GRAVEL Q OTHER 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 !/ NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY f DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: ,/� // LOCATION SKETCH SOURCES OF CONTAMINATION PROVIDED QN SEPARATE SHEET 2--1 -`3 3 1 , ... , /, J.V (date) igna ure) 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 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 man;neF as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: 19_� 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 PUTNAM COUNTX DEPARTMENT O>�' HEAi.TH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAIL'SYSTEM 1. Name and Address of Applicant: 00 301 2. Name of Project: �r��� %�05��/ SS�S 3:•_• Location T\ /C: a. �,- `i I j 4. Project Engineer: �����7` ����• �s��. ,1��.. 5. Address: 73 }'g�r� Gl�.c License Number: 5 C�(Z Phone:2�JC`�C� 1 6. Type of Project: _1T,*`� 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)? Type Status (Check One) Type I.. Exempt Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS)" required? ......,1!!.��.:. 9. Has DEIS been completed and found acceptable by. Lead Agency? 10.' Name of Lead Agency 11. Is this project in an area under the control of -local* planning, zoning, or other offic0a1s, ordinances? ........ ............................... u 12. . If so, have plans been.submitted to such, authorities ?........ 13. Has preliminary approval been granted by such authorities? Date Granted:_Ab- 14. Type.of Sewage Disposal_ System Discharge...... I, Surface Water Ground Waters 15. If surface water discharge, what is the stream class designation ?........ t�� L ;6. Waters index number (surface) ........... ............................... 17. Is project located near a- public_ water supply system? .................. '8. If yes, name of water supply �(% /� Distance to water supply :9. Is project site near a public sewage collection or disposal system ?..... /(//O _ :0. Name of sewage system /V/ - g y Distance to sewage system r :1. Date observed: (2'�(i� 23. Name of Health Inspector: AL Qve) --) 4r /1- 4. Project design flow (gallons per day) ...... ............................... 0 ♦ t / 1' / 2 . 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. J 26. Has SPDES Application been submitted to local DEC Office? 27. Is any portion of this project located within a designated Town or State / Wetland ?.......... .. 28. Wetland ID Number ....................................................... 29. -Is Wetland Permit required? .............................................. . 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 �c7 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: ' 33. Is there a local master plan or file with the 34.: Are community water, sewer facilities planned 35. Are any sewage disposal areas in excess of 15.1 36. Tax Map ID Number ........................... 37. Approved Plans are to 'be returned to: ....... /vy Town or Vi l l age? ...........% to be developed within 15 years? oslope? ........................... t 3, 3 3 I ......... • 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 Drovision 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 know7edge and belief. False state.,,ents made herein are punishable as a Class A Hisdameanor pursuant to Section 210.45 of the renal La N. >IGNATURES & OFFICIAL TITLES: ':AILING ADDRESS: P02 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: property of %4 v, ,S�`-cv�-► �o / ,r G Located atY -��`+ G� (T) Section 13. Block 3 Lot 3 Snbdi.vi.sion of Subdv. Lot �e Filed Map # a-j 17 A Date 5� -z� Gentlemen: 11..' 7 This letter is to authorize c� N W� c r a duly licensed professional engineer or registers ". 'architect (Iridit;ato to apply fur a Construction Permit for a se tem; to serve': the above noted property in accordance with 'ihe :! stzi.nda rds,.: rules or regulations a.s promulagated. by tile. Cominissibner' .of.,,'tYie`:,F?utnam County. Department of Health, and to sign all necessary papers-`on.my behalf. in connection iri.th this matter and to supervise the construction of said. system or systems in conformity with the provisions : of -Article 145 or. 147, Education Law, the Public Health Law, and the-Pu.tnam.County Sani- tary Code. 4F NEB L CO r Countersig P.E., R.A., No. 56124 pROFESSIONP Very truly our , J Signed - Owner of Property �V Address 0 �O c1b, Address Telephone • q1� ., 2- 7��1.,10 8 Town Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH Rev. 3!/86. Division of Environmental Health Se 6loes. Carmel; N.Y:10512 Engineer to:Peovtde Permit Il on CERTIFICATE OF COMPLIANCE CONSTRUCTION PE FO S AGE.DISPOSAL SYSTEM Permit: aY Located at —–L r" °�' ""° pp Town or Village Subdivision Name C'oAl "1� it i� cabd. Lot N Tax Map I� Block rat t�Lj�/��t/f��t:. /Y/ >Ir'�f %ii� /G-' �I��• Renewal-0 Rovielon ❑' Owner /Applicant Name > _ Date of Previous Approval Wn d Mag Address Z � �/� � AV Town /��0t/3� a /DAY 71p_if%�jW Building. Type�S�i%�%� a Z> 32C. Lot Area Fill Section Only Depth Volttme Number of Bedrooms Design Flow G /P /D f ' 1 PCH,Dry.� - catti, "egalred When Fill is completed Separate Sewerage System to consist of /UO Gallon Septic Tank an iA3 6� To be constructed by Address Water Suppy': Public Supply Frobi .Address K �� P� or:� Private Supply Drilled by •% — zl z Address - _ . � • fir- Other Reremeats - ?C7 gol v I represent that 1 am_ wholly and completely responsible for the design and location of .the proposed system(s)o 1)_jthltt the separate sewage disposal system above described will be constructed as shown on, the approved - amendment there to .and in accordance witfii�he standards, rulesancl regu at ions o e .0 nam County Department of Health, and.that on completion, thereof a - Certificate' -of construction ,ComoiIince" satisfactory to -the Commissioner of Healthwill be submitted to the Department, ,and a written guarantee will be .furnished'the owner, his successora,.heirs oi, assigns by the builder, that said builder will place in good operating condition any part, of said sewage disposal',-syste'm during the, period of two `(2) years,immediately following thedate of the issu- ance of the approval of the Certificate -of Construction Compliance of the original system or any repairs o:2) that the drilled well described above will be located as shown on the approved plan. and that said well wil a insta -in cofdanca with• a st Aar , rules d r u a_ ons of the Putnam County Department of Health. Date L/ �'r �. Signetl, �cT. P.E. R.A. Address es ' '. u��JJbb. • / hl7 /Ld- 0' A V / 2�(7 J Licgnse No— APPROVED FOR CONSTRUCTION:. This approval expires eieyear from the Cate_ ed un s construction of the building has been undertaken and is revocable for use or may be amended or modified when considered, ii ` y e Com nei o -.FI 1 ny change or alteration of co atruct iOn requires a n per • , Ap" rov r' disposal of domestic'sanitary.sewa /or priva r n �i Date BY Title ro. DEPARTMENT OF HEALTH Division of Environmental'Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION Street Address Town /Village City Tax Grid Number N L L ILA 1117 �C ii T��,�25 WELL .OWNER Name Address c;,t2,vwA6c ltg4 rS1 3 I /oIr A14 Private Public USE OF WELL primary 2 - secondary [4 RESIDENTIAL ❑ BUSINESS ❑ INDUSTRIAL, ❑ PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O FARM ❑ TEST /OBSERVATION O INSTITUTIONAL ❑ STAND -BY ❑ ABANDONED 0 OTHER (specify] O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE CVu gal REASON FOR DRILLING ,ANEW SUPPLY ❑PROVIDE ADDITIONAL SUPPLY ❑TEST /OBSERVATION ❑REPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE JaDRILLED DRIVEN E]DUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISI1: i.1% G / T/� Lot _rC3. �A WATER WELL CONTRACTOR: Name 7'Addre i .._ rn IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO -v NAME OF PUBLIC WATER SUPPLY: /j/ /,d TLWN /VIL /~CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED []ON REAR OF THIS APPLICATION N SEPARATE SHEET 7 & 7 '-� (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 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 We 1 Completion Report on a form provided y the Putn m County . Health De a m t. Date of Issue: 19 Date of Expiration: 19 UrmYt IssbffffffitYal Permit is Non- Transferrable r t • "��� " REVIEW �Xj {.. SHEET - CONSTRUCTION PERMIT DATE REVIEWED: BY:-� -y- 7.; (Name 'of Owner) (Street YES NO 1 IF trench provided `A required ° € 60 ft* . max: ParelZel to contours" -- =x _... :.. 'z i I/ I I Location) DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth House Plans - Two sets Well permit; PWS Variance Request GENERAL Legal Subdivision s/s SUBDIVISION Perc " (3) Fill cd letter Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump'pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data: perc and deep results. Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion _ Expansion Area;shown;gravity flow,suff, size If Pupped Pit & D Box Shown.& Detailed House - No. of Bedrooms Wells &.SSDS's w /in 200 ft, of Proposed Systems Property Metes & Bounds House Setback Necessary (Tight lot) House.Sewer - 1 /4 " /ft. 4 "0; Type pipe No Bends; Max, Bends 45° w /cleanout SEPARATION DISTANCES SPDCIFIED ON PLAN Fields 10' to P.L.., Driveway, large Trees,Top of fil` 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake Unc. expan 15' to Drains -- Curtain, Leader, Footing 351to catch basin,stormdrain,piped watercours 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' fran Foundation; 50' to well 15' Well to PL 0 PUTNAM COUNTY DEPARTMENT OF HEALTH DT.VISI%T OF ENVIRONMENTAL HEALTH SERVICES Date . U+r•, Re: Property , of Co Rai vyHLL "ILL Located at __oR1.jWAGL- N %LL IZaA�n lZ4,v' "C� = 4 (T) -?AT-rF- Section IS —Block--a (o ` Lot Z. _.. Subdivision of COTZ W ALL_ iZIDGC w Subdv. Lot # Filed'Map # Date Gentlemen: This letter is to authorize Randolph W. Laurent a duly licensed professional engineer X or registered architect (Indicate) to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education L+ i tary Code. (,: � blic Health Law, and the Putnam County Sani- Y S�1 w Very truly yob urs,, r � Signed..�i✓!.d Owner of Property � FtJS�i mow, sa P.E. , R.A. , # 7 -3, R A11;f1ELr> 'DRIVE Address 2 14 Z7gi� W 0 8 Telephone 223 Katonah Avenue Address Katonah, N.Y. 10536 Town 914• -232 -7171 Telephone I . PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services AFFIDAVIT — CORPORATE OWNER•APPLICATION FOR PERMIT.APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT tT�fr TO: Commissioner of Health n c.: In the matter of application for:, ri I, KENNETH EMERSON represent that I am an officer or employee of the corporation and am authorized to act for Cornwall Hill Estates, Inc. (Name of Corporation) having offices at 223 Katonah Avenue, Katonah; N.Y._ 10536 Whose officers are: President: Edward H. Emerson, III, 223 Katonah Av., Katonah, N.Y.10536 (Name.and Address). . Martin Diano, 223 Katonah Av.,'�katonah, N.Y. .10536 Vice - President: Kenneth Emerson, 22� Katonah Av., Katonah: N.Y. 10536 (Name and Address) Secretary: Janet C. Mastropi,gtro,. 223 Katonah Av., Katonah, N.Y. 105.36 (Name and Address) Treasurer• . Lynne Diano, 223 Katonah Av., Katonah, N.Y. 10536, (Name and Address) and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Sworn to before me this IX , day of 19__�/c Notary Public LIONEL: WEINSTEIN Rotsry Public, Stnte of New Ybt* No. 60. 4199160 QUalified in Westcht „c), Court. Criuzu�s?on Gpiras ri:src:� s0, �1 �� '4 Signed: / Title: ✓1C E. PAN r s P E. At T corporate'Seal 11 d PUTNAM•COUNTY DEPARTMENT OF HCALTH DIVISIC; OF FJ'; 6EHVit: COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 LES1GN DATA'SHE'T- SEPARATE.SEWAGE DISPOSAL SYSTEM FILE N0: UwrrerG� /1.vv ✓�jic j /icc, s %Jlt1. / /r/G. Addre$s ?Z 1�;,9j'��iflf��liE f(,Q"WAY iY)Y, iJ f Co CpQ,►.Lw� -. «� Q.iO. Located at (Street __� �C�.7r, �1,6Q Sec. 15- -Block Lot 'ZA �Tn-dIca nearest cross s ree Mw,icipality. ?h=ez -- iz� Watershed_ CQ0T03&( SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS U 0 " 4 2 Numbor CLOCK TIME PERCOLATION PERCOLATION i Elapse Npth to Water WaEer IZvel. No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 4 33 Notres: 1) 'Pests to be repeated at same depth until a roximately equal soil rotes aro obtained at each percolation test hole. All data to be submitted for rev i (-),, . . , kith moasurementa to he mode from top of hnl(:. . " 4 Notres: 1) 'Pests to be repeated at same depth until a roximately equal soil rotes aro obtained at each percolation test hole. All data to be submitted for rev i (-),, . . , kith moasurementa to he mode from top of hnl(:. . 2 rn 4 Notres: 1) 'Pests to be repeated at same depth until a roximately equal soil rotes aro obtained at each percolation test hole. All data to be submitted for rev i (-),, . . , kith moasurementa to he mode from top of hnl(:. . 2 Notres: 1) 'Pests to be repeated at same depth until a roximately equal soil rotes aro obtained at each percolation test hole. All data to be submitted for rev i (-),, . . , kith moasurementa to he mode from top of hnl(:. . DEPTH G.L. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIFTION Or' SOIZ:; - ENC0Ul TERED IN TEST HOLES HOLE NO.7i7—j MOLE NO. HOLE NO. 6" o \\ ' 12" ,y_YL G vQlvs � 18" _ 24" 30 36" jy Tt-a.Ge of L ©aM 42" 48" 5411 11 60" 6601 Wit } INhI(:ATF:.L1;V1•'I, AT WHICH CROUIID WATIsR IS ENCOUNTER - 1 NI I (;A'I'D: LEVEL '1'0 WHICH WA`PLR LE'VE'L RISES ARVE13 BEING ENCOUNT =o Th;ftSJOLDR, I3Y R. W Date 8!�' IMIGN Soil 'hate Used _7MirVi "Drop: • S.D. Usable Area Provided ' 5 oo.o .F. No. - P.I3udmoms 3 Septic .Tank Capacity I oo Gals.,, � pe Abs orpLion Area rovfde -a By oo L. F. x24" �!.r ernc i�sukj bt18 Imp Address .= TI{13 SPACE FOR USE BY REALTH ,DEPARTMENT ONLY: Soil Bate Approved Sq. F't /(.;ca.1. Checked by Date Ec , SEP 2 i985 pur, DEPT; :4F "OUAf_ �FAt rH Bliffidipa im I1', ot Area �' 2 1�3G I7p Section peb 'i Deptb Yobioe ' Nl= bee. et p Plow G. P D — O%, P(� NotlSOtbn'la Required Wbm M Is cimWta'd swwau Semmes S"im /�.owrl�t d. - ('eBa� Soptle T!ek call — /9tJ `pj67 �5 To be ;a�e4�t1ed.47 (� Addeau Wafer Se!!4f= Pt811ey Pew Addrsea oei ✓ Petiite Seppb lkl9ad -b7 1 represent`.that 1 air 'wholly aid eompNtaly nsponsibla fM tha Aesgn and location of the prop" 'systim(a)i .I) that .the's•parsis saw di ml s stem . . above described mill be constructed as shown on the approved amendment there to anO in accordance with the standards, rules a regulations o_ County Oepartriiwit 'Of MMRh, .arid that on completion thereof; "Certificate of Construction Commiance" satisfactory to the Commisiloii•t of *H"Ithwill be,albrnitt d to the Departniint � and. a written guarantee will, lie, the owner, his tucasao►s, Mkt or, assigns by tha bulMe►, that siid'buiMer will Wee ' M_ good eperatMM cindlibn 7ny part of to "Wage dispoW system during iM, period of two (2) yews Immediately ?o1lowlnN the daq Of the Ipu- ance of, the appro ial of UN.Cii6ficati of Construction_'CoiriplMnce ,of't a original system or any r irs thereto; 2) that the drilled well do a" above well a Iocato0 as shown on the;approwd 69i" n nsl'that iakl well will tie Ins I in accordanei:,with t it' rd rules Vnd 'rpu ons of the putMm county Depntnaat'ot MMhth: Date P.E. Ft:A. 1 =� Agdr•d�j �x? ue.ns• iVo APPROVED,FOR CONSTRUCTION. This ap' proval oxpMes two ywrs from'the der issued luniess' onstructlon of the building .has been undertaken and is revocable for, cause'or -nay tea arri ed'oi ihodified whoii considored neceiYry bj'.6 CommiW6ngj 'of, Health. Any change or alteration of construction MRuires a sw W it Approved for dispoial of domestic sanitary swage and resat water w ly only. Y 108$ Date .0 %�B +uN s �'� x 0 3 �1, a ��Cn, * ,�, DEPARTMENT OF HEALTH w l uva' '" C WP LL L,Vr1rLL11V1V nr,rUA1 �� 4� Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only Z31 WELL LOCATION STREET AOUAESS: TOWNIMMACLIERY TAX GRID NUMBER: Cornwall_ Hill Patterson, NY Lot #6 WELL OWNER NAME: ADDRESS: Cornwall Home Builders, 155 E.MainSt. ,Brewster,NY ❑ PBIVATE O PUBLIC USE OF WELL 1- primary 2 - secondary -19cRESIOENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED O BUSINESS O FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) O INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. 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 605' ft. STATIC WATER LEVEL --4o ft. DATE MEASURED 11/15/9-3 DRILLING EQUIPMENT -aROTARY ® COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED ❑ OPEN END CASING &OPEN HOLE IN BEDROCK ❑ OTHER CASING TOTAL LENGTH 31 ft. MATERIALS: ® STEEL O PLASTIC O OTHER LENGTH BELOW GRADE ft. JOINTS: ❑ WELDED ® THREADED ❑ OTHER DETAILS DIAMETER 6 in. SEAL: M CEMENT GROUT ❑ BENTONITE OOTHER WEIGHT PER FOOT lb./ft. DRIVE SHOE ® YES ❑ NO I LINER: DYES ® NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (It) DEPTH TO SCREEN (IQ DEVELOPED? FIRST O YES ONO HOURS SECOND GRAVEL PACK O YES O NO GRAVEL SIZE: DIAMETER OF PACK In. TOP DEPTH tL BOTTOM DEPTH It. WELL YIELD TEST If detailed pumping METHOD: O PUMPED i tests were done is in- ULCOMPRESSED AIR , `formation attached? O BAILED O OTHER ; O YES ONO liil ELL LOG if more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE water Bear- in9 Wen Dia- mete FORMATION DESCRIPTION woe It. ft WELL DEPTH It. DURATION hr. min. ORAWOOWN ft. YIELD gpm. s�;tace 7 )ri Llijg in overburden clay & boulders Hit ro k at 71 605 6 585 5 T 31 ri li g in rock, set casing, grout d. 1 6o5 bri 1i a in rock granite. 1 H drofracked Well. WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY GAIT. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP DATE WELL DRILLER NAME P. F. Beal & Son Inc 1 4 ADDRESS 4 Putnam Ave. 5IGNA Brewster, NY 10509 R13 S0Rip o� 3-0 L� loLF 7R �l�G N ARF /a DLO) 4JK�n � i.0 co (41 317'E PL A N 36n65 = /, /. 30/