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Home My WebLink About0476DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13.08 -1 -94.1 BOX 6 00285 73 mr 4"1 1 am Ill ILI �' O 1 ' �� I �' ; , � ' , ' ■ ' ;� Ire i ', a, I J 00285 Located at Owner /applicant Name - Mailing Address 60 v OMPLIANCE FOR SEWAGE DISPOSAL SYSTEM P,Nj ' 'Town or. BCD q Village Map -�B1. Lot �� Forme Subdv. Lot. N� ZIP- Date Permit Issued Separate Sewerage System built by Consisting of 12ST Gallon Sepdc Tank and r e, Water Supply: Public Supply From Address or: Private Supply Drilled by 4 r g_ Addre�sps Building Type �. f` Pe9�bli°�►c Q. Has Erosion Control Been Completed? Number of Bedrooms Has Garbage Grinder Been Installed? IUD I car tify that the system(s) as listed serving the above premises were of which are ) , and in accordance with the standards, rules and Putnam County De r ent Of Health. Date Certified �by. Address Zq Z ' Wy e � 2*" constpuctea essen ally as shown on the plans of the completed work ( copies req ations, oAccorgance with th led plan, and the permit issued by the P.E. R A. License No. _ 393 Any person occupying premises served by the above systems) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval, of the separate sewer! stn shall become null and void as soon as a pubt;: sanitary sewer becomes available and the approval of the private water supply shall become nul n vo when a public avatar supply becomes available. Such approvals are subject to modifl tion or change when, In the judgment of the. Co ml WOf a lth h revocation, modification or change Is necessary. Date ST�/ /�� BY• Title" D T ^s _t�� /)�. RTT 1`TTT/1LT T1 T'f', r.p.. ,.r-.. rw_ .. �� —rjj w�LL lrVl'iCL�11V1V nr,rVl�t DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only R- 7 WELL LOCATION STREET ADDRESS: WN /VI 1 Y TAX GRIO NUMBER: South Street Patterson, NY 13 -000 — 1 WELL OWNER NAME: ADDRESS: Robert O'Connor Patterson, NY a PUBLIC USE OF WELL 1 - primary 2 - secondary )q RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND.IHEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED 2 .to. 5 / EST. OF DAILY USAGE gal. REASON FOR DRILLING aNEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA ' WELL DEPTH 330. ft. STATIC WATER LEVEL 15 ft. DATE MEASURED IOf'8/90 DRILLING EQUIPMENT ❑ ROTARY 3M COMPRESSED AIR PERCUSSION 0 _ho Z40 .ft. O WELL POINT 2@ CABLE PERCUSSION 240 to. 330.:ft. WELL TYPE ❑ SCREENED ❑ OPEN END CASING. 4 OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH 3 tL MATERIALS: 51 STEEL ❑ PLASTIC D OTHER CASING DETAILS LENGTH.BELOW GRADE ft JOINTS: ❑ WELDED AD THREADED 0 OTHER DIAMETER in. SEAL:,) CEMENT GROUT ❑ BENTONITE 0OTHER WEIGHT PER FOOT 19 Ib. /ft. DRIVE SHOE] YES ❑ NO LINER: OYES ❑ NO SCREEN DETAILS DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST O YES ONO HOURS SECOND GRAVEL PACK O YES ❑ NO GRAVEL SIZE DIAMETER OF PACK in. TOP. DEPTH ft. BOTTOM DEPTH It. WELL YIELD TES? It detailed pumping METHOD: MUMPED tests were done is in- O COMPRESSED AIR ,formation attached? D BAILED O OTHER ;DYES D NO �IELL LOG It more detailed formation descriptions or sieve analyses are available. please attach. DEPTH FROM SURFACE water Bear- ing well Dia- meter FORMATION DESCRIPTION coof¢, ft fL WELL DEPTH ft. DURATION hr, min. . DRAWOOWN It. YIELD gpm• Surface 50. & gravel. 0 330 MediLm to.hard white limestone. 2t. 2 2t. 0 330 24 - 35 60 WATER )CC CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? )QYES ONO ANALYSIS ATTACHED? YES ONO STORAGE TANK: TYPE Diaphragm CAPACITY . 62 . GAL. 16.5 (1 WELL DRILLER NAME p`i6�22�90 ADDRESS MILL ..DR I LING INC. l Putnam Avenue Brewster, NY Robert M.-Mill -j President PUMP INFORMATION TYPE S ubme rs i b 1 e CAPACITY __, U7— MAKER Goulds DEPTH �(L��((�� MODEL 1 OF.I07 12 VOLTAGE -MHP 3AL A PUTNAM COtUTY DEPARTMENT OF HEALTH DIVISION OF ENVIRO1VUMAL HEALTH SERVICES 7�� -NOEL e, CCNI NO 2 +3.0 (6 - Owner or Purchaser of Building Section Block Lot 0, Building Constructed by S 6 uT # 5 T" Location - Street A4TV � 2 sou /V y Municipality Building Type Subdivision Name Subdivision Lot # GUARANM 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 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 19_U_ General Contractor ► - Signature C`CO,ra62 INS Corporation Name (if Corp.) P D - (I C) V a �-o Address p 9 �f W rev. 9/85 mk Signature Pj,.1 r4 Titled /V 0 2 /Jue- Corporation Name (if Corp.) 06V o29-0 ess� � �. � /V/ I r ELLIS A. TARLTON LABORATORY DIVISION OF ELLIS A. TARLTON, ENGINEERS, INC. c'HEMI!:^Ls 34 PLEASANT STREET DAN BURY, 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 f �1 SOURCE OF SAMPLE ADDRESS OF i Mill Drilling, Inc. I Water Supply, O'Connor Res. PERSON TO RECEIVE Putnam Ave South Street REPORT Patterson, NY Brewster, NY 10509 DATA J DATE OF COLLECTION Oct. 8, 1990 COLLECTED BY Mill Drilling Hydrogen Ion COLOR TURBIDITY ODOR CORROSION INDEX DISSOLVED SOLIDS Concentration LANGELI ER (PM) RYZNAR NTU Mgil Alkalinity as CaCO3 Fluoride (F) Bicarbonate Nitrite Mg /L Mg /L Mg /t Alkalinity as CaCO3 Chlorine Residual NITROGEN CONSTITUENTS Nitrate Mg /L Carbonate Mg /L .00 Mg /l AS NITROGEN (N) Total Hardness Conductivity es CaCO3 Ammonia Mg /L Mg /L Micromohos /cn Mg /L Iron as Fe Mg /L Mg /I Chlorides as CL Mg /L Manganese as Mn Mg /L Mg /I Detergent as MBAS Mg /L Sulfate as SO4 Mg /L Mg /I The arithmetic mean of all standard samples examined per month using the membrane filter technique shall not exceed MEMBRANE FILTER TEST one colony per 100m1. COlilorm colonies per standard sample shall not exceed 3/50m1• 4 /100ml, 7/200mi. or 13/500ml Coliform Colonies /100ML in: (a) Two consecutive samples: (b) More than one standard sample when less than 20 are examined per month: or (c) 0 More than live per cent of the samples when 20 or more are examined per month. AT THE TIME THE SAMPLE WAS SUBMITTED: Ex- 1. The results of the analysis of this sample were satisfactory and met requirements for a potable water. F12. The results of the analysis of this sample were satisfactory for a potable water but certain of the chemical or physical constituents were high. These are as follows El3. 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. D4. 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. Ceml,ed . ........................... ...... ............................................. . . ..................:...... 341 Leek: U— Lot Arm �f D, 0, Oe�0 NSiae of pei }=a DWv Plow G4 D SaNMa'Swamp Sysism to engM d o so= S. a iaak sad b M earr4.egad dy ` 0 CO :�wo It _ lea. WOW SW* Ptho Up* Praiiii . acct � Nyasa Up* by 42 aawwal_ o eare�Me p Doe of Provion Appoval—. Town Zip ?ee Enclosed ❑ . Amn„nt Pm Secdoa Otub " vahme PC®. Nolleadon Is Neaa1se4 When PIO Is oaedeted M R.D.. �iih► �� oaw R. anb 1 represent that 1 am wholly and completely responsible for the design and location, of the proposed system(s); 1) that the separate sew di sal s stem above described will be constructed as shown on the approved amendment there to and in accordance with the standards; rules .. r.gu ns o m County` Department of Health, and that on completion thereof a °Cartificata of Construction Compliance" satisfactory to the Commissioner of Healthwili N submitted to the Deportment; and a written guarantee will be .furnished the owmr,.his succiaors, heirs or assigns by the bulkier, that said builder will frlece Wtood opentin/ condition any part of pld sewage disposal' during a perked of two (2) yeas imriwdiately following the date of the tau- sets of the approval of the Certificate of Construction Complier" 'Cho tea orginal sy Nn o►,,anFt�ndards, s thereto; 2) that the drilled well, described above WOW located as ohm on the approved plan and that sold well will'be stalled in ce wi rules and regZai noT of the Putnam Ceonty n Ow "W l q91 Health. Date '/D /ail!' Signed P.E. —1 R.A. 1c.S'ILic.n.. No 1J3736 Add►ea APPROVED FOR CONSTRUCTION: This approval, expires two tears from the date issued unless construction 'of the building has been undertaken and is revocable for ause at may be amended or modified when con ed neeaary 0y- tea Commissioner of Health. Any change or alteration of construction Mquires a ft. Approved Approved for disposal of dom.A K y age, a /o.' ate water supply only. //nom,/' Rev. One � � l 0y Title A , )r LO /88 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 J / L� WELL LOCATION Strejqt Address Town /Village City Tax Grid Number CA - Pte / � % 5�- 5',1 WELL OWNER Name E�'CowmL a ' 1 ' ng Address AA ivate 1j, Glre ' %I` L NJ3_ I 050q 0 Public USE OF WELL 1 - primary 2- secondary B— RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP D ABANDONED O FARM O TEST /OBSERVATION 0 OTHER (specify M INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT 00ek Sgpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE OU al ❑ AEPLACE EXISTING SUPPLY 0 TEST/ OBSERVATION GIADDITIONAL SUPPLY EfNEW SUPPLY NEW DWELLINGI D DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE RILLED ODRIVEN ®DUG ®GRAVEL ®OTHER IS WELL SITE SUBJECT TO FLOODING? YES '� NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: it utiagelu Lot No. WATER WELL CONTRACTOR: Name C.6 L.4 G Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: iJ�A' TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: P)P- LOCATION SKETCH & URCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET 'Z 10 (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 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 rwise contaminate surface or groundwater. Date of Issue: 19 �� o,yo Date of Expiration 19 Permit Issuing Official Permit is Non - Transfer able White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller 6-,1 APPENDIX B PU'.1-MM COUNTY DEPARL'�3�'T OF HEALTH - DIVISION OF E'WMONMEMML HEALTH SERVICES INDIVIDLA-L WATER SUPPLY & SUBSURFACE Sri. 77 GE DISPOSAL SYSMMS RE'JIEW S'= - CCNSTR=ION PERMIT "�J /Z�:[ / DA'L'E RE'V : BY: (,]ane of Owner) S feet Location) DOCUMEM Permit Application — Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet .(DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth s/s SU�DIL�ISION Perc (3) Fill cd House Plans - Two sets Well permit; PWS letter ariance Request GEN7;RAL, Legal Subdivision Subdivision Approval Checked. Ex- approval SSDS Adj. Lots Checked Wetland (Tam /DEC Per-nit R & D) Data On DDS Plans & Permit Sane REQUIRED DETAILS ON PLANS Sewage System Plan - ( north arraw ) Sewage System Hydraulic Profile - Gra..ity Flcw Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit c_tails Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes (grinder rate) Design Data: Perc and deep results T'wo -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing/Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and e_x ansion Expansion Area; shaorn; gra flow, suf =. size If Pumve3 Pit Box Shawn & - tailed House - No. of Wells & SSDS's w /in 200 ft. of Proposed Systens -Property Metes & Bounds House Setback Necessary (Tight lot) House Sager - 1 /4 " /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPDCIFIED ON PLANN Fields 10' to P.L., Driveway, Large Trees,Top of fill 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (ine.'expan) 15' to Drains - Curtain, Laader, Foot zg 351to catch basin,stornrirain, piped watercourse 10' to Water Line (pits -201) 50' intermittent drainage course. Seotic Tanks 10' from Foundation; 50' to well 15' Well to Pr 9 Neig�ftr P� provided required .0 ft. rrax. ' - 00• e-xp. ®r r � 100_yr. flood elev. 2 f t. reservoir, etc. M � _M _MMM M_&M_ I AV MLal DOCUMEM Permit Application — Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet .(DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth s/s SU�DIL�ISION Perc (3) Fill cd House Plans - Two sets Well permit; PWS letter ariance Request GEN7;RAL, Legal Subdivision Subdivision Approval Checked. Ex- approval SSDS Adj. Lots Checked Wetland (Tam /DEC Per-nit R & D) Data On DDS Plans & Permit Sane REQUIRED DETAILS ON PLANS Sewage System Plan - ( north arraw ) Sewage System Hydraulic Profile - Gra..ity Flcw Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit c_tails Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes (grinder rate) Design Data: Perc and deep results T'wo -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing/Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and e_x ansion Expansion Area; shaorn; gra flow, suf =. size If Pumve3 Pit Box Shawn & - tailed House - No. of Wells & SSDS's w /in 200 ft. of Proposed Systens -Property Metes & Bounds House Setback Necessary (Tight lot) House Sager - 1 /4 " /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPDCIFIED ON PLANN Fields 10' to P.L., Driveway, Large Trees,Top of fill 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (ine.'expan) 15' to Drains - Curtain, Laader, Foot zg 351to catch basin,stornrirain, piped watercourse 10' to Water Line (pits -201) 50' intermittent drainage course. Seotic Tanks 10' from Foundation; 50' to well 15' Well to Pr 9 Purim COUm.. DEPARTHW OF.: HMTH DIVISION.OIr HEALTH SERVICES . f . DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Q �CoOJ�UO1'L . Address koy_j �rt. _, I�j! Iosny Located at (Street) Sec. Block Lot ._L (indicate nearest cross street) F unicipality � _ ��_ --�� - Watershed:_ - - - SOIL PERCOLATION TEST . DATA REQUIM TO BE SURUTTED WrM, APPLICATIQNS `. Date of Pre- Soaking 157 y Date of Percolation Test It. j s. 8 SOLE NLEM a= TIME PERaQLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No.. _Time Ground Surface In Inches ...Soil Rate Start-Stop Min. Start Stop Drop in Min /In Drop Inches. Inches Inches 4 3 20 2;y 2 a 3 6- , 24 z7 3 6.7 5 _- 2 1 y _ 27 43- 3. o 2 Zy zi 3 3 2% 2• 3 . 4 5 NOTESs l': Tests to be repeated at same depth until approxirnately 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 DEPTH G.L. LL �1 j(D 5, J 5R Uj 6 T PIT HOLE W. TO M SUBMITTED W1:111 HOLE NO. Z. I OLES H01:4 NO. 141 1= AT WHICH- GROUNDWATER Is E1iCOUN=UtD nmidLTE LEVEL. To WHIG WATEP., LWM, RISES AFTER BEING ENMUNTERED WJ/k' DEEP HOLE OBSERVATIONS MADE BY: zqq? D=: to D_ ESIGN Soil Rate Used6--°4 'Min/I" Drop: S.D. Uikible- Area Provided No of Bbdrobms tept!:6 TaAk Capacity _gals'. Type Absorption Area Ptovid6a By'_ L.P. x 24 width trench Other, -OF, IV4C;V Name signature Address 77 2 AAL Nis0. 4370 THIS 9PACE. Mk USE BY-,,* EEALTR DEVARTWM-J'.d4LY: Soil ]Rate Approved 1. Checkea,by Date i U 'V P O c0 2 .. A 10 11 N 13 -30 -00 E _ 223.36' 4 5 6 1 1250 AREA: 40,000 srt:; ^Tft. S 19 -29 -20 W 224,58' { 44< N /F PENN CENTRAL RAILROAD 0 O m O O► W' O O- i w Divisi Appr ap' i Sig. It This is to certify that the sewage disposal system was constructed as indicated on this plan and that the system was inspected by me before, it was .cover- ed over. The system was constructed in accordance with all the rules and - regulations of the Putnam Coun- ty Department of HeaIth.p ,�pF NEW YO S�J QO %C K �Fy �L A *0. 43736 RFD PROFESSk��P� l� Frederick A. Zenz 292 Main St. Nelsonville, N.Y. 10516 Pi 5- EPA.:R;ATION.. ;_DISTA - CES - __..IN- _ FEET - _..._. _... a County Department of Health of Environmental health Servioes �d as noted for oonformanoe With .ble Rules and Regulations of tae clam County Health Department. M �o re & Title Da � 7�— lu AS -BUILT SEPTIC PLAN prepared for O'CONNOR RESIDENCE SOUTH ST. . TOWN OF PATTERSON DI ITKIAIuI rnl INTY NY SCALE: 1 " =30' 4/12/91 M B S. L .f�1 r -1 f 1 J 4 3 6 T 8 1 9 10 11 12 13 14 13 16 17 Is 19 A ►oz py Ib8 135 131 /07 98 9 3 86 0 33 93 rob '127 ito 116 11) 113 ios lop yy — c zs a County Department of Health of Environmental health Servioes �d as noted for oonformanoe With .ble Rules and Regulations of tae clam County Health Department. M �o re & Title Da � 7�— lu AS -BUILT SEPTIC PLAN prepared for O'CONNOR RESIDENCE SOUTH ST. . TOWN OF PATTERSON DI ITKIAIuI rnl INTY NY SCALE: 1 " =30' 4/12/91 M B S. L .f�1 r -1