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Home My WebLink About0531DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 22.12 -1 -3.1 BOX 7 -2 - 16. . ko. 1, 16 �� i %r. 00531 16. . ko. 16 �� i 00531 PDTNAM COUNTY DEPARTMENT OF HEALTH DtvWm of gavhqueaestel BeeM'Servaces, Carmel, N.Y. 10512 Pngb,eer Moat Piovtdo P.C:H.D. Peimlt Y-,— CA OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Ph Tr C?i2S0/� Town or Located at L ',i-&)/ -ro eJ L/ %Liam Tar Map — Bloc!( vjB12 'Let applicant Na GC b Ts luS/i�+% i�c G C: Sibdivlatn weed fame.. LV ;.1m.Gt)ii1 mama Aaa�.a ` e '73 a c,qe— zip iZS'3l Subdv. Lot 46 Fee Enclosed iff Amount ;� Zfo Date. Permit issued.. 2r;:�Z) Sepm to Sewerage System baUt by n , n a - xddrees - ,• •. - - Cunsilift f / "L a Gallon 'Septic Tank and <'A "L X�" ii B,u4�zs f ilP .•�Rle �1r'tI✓G1i fly Water Sapplys Public Supply From Address Aq ortPelvate SnPPIY Dr10ed by 1(•C• CL Addressi/ rYl��tc+i, /7 tZu?�( BalldhgType %C' ct�1 Ir4[��/ Lot -Size 04f .4c Has Erosion rantreil RPPn Cn,nPl Pt-Pd? _ Number of Bedrooms % Hue Garbage Grinder Been LtstaDed! Other Retp>iremnents niiT ar `i i �' Yt. r)ls r I certify that the system(s). as listed serving the above.premisea were constructed essentially.as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regal do in,accordanc� a fil plan, and the permit iasged by the putnae Count pare nt of Health. - !j°!/ Date - Cwtifled by P.E. R.A. Addre • ' �l �l7 ss License No. . Any person occupying piemises ilervea,by the itiove system(g sha0,prom0)y take such action as may be necessary to secure the correction of any unsanitary conditions resulting Iron such •utige;, Approval of the separate , systems shall became null and volt as soon as a pubt, unitary. sewer becomes available and the approval Of the private water supply shall pewme nul and_. void when a lic water supply becomes available. Such approvals are_ subject to modification or when, in tM Judgment of the _Co i of ,aid► rerocatbn, modHkatbn or change b INeessa►Y• o ,�89 a. TRIG TK V L `--� BY .3 J A WELL COMPLETION REPORT' Office Use DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH WELL LOCATION STREET AOURESS: ,uw41nLLAU91t:n T TAX GRIO NUMPER: Ludingtonville Road, Patterson, NY (Filed Map 2405 - 4/27/89) WELL OWNER ADDRESS: Gordon & Susan Greene, 70 0 Neill Plaza, Yonkers, New.York ❑ PUBLIC USE OF WELL XX RESIDENTIAL ❑ PUBLIC SUPPLY 0 AIR/COND./HEAT PUMP ❑ ABANDONED 1 - primary O BUSINESS ❑ FARM O TEST /OBSERVATION ❑ OTHER (specify) 2 - secondary ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY . ❑ AMOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED 3 5 / EST. OF DAILY USAGE gal. REASON FOR .[]REPLACE EXISTING SUPPLY ® TEST /OBSERVATION []ADDITIONAL SUPPLY DRILLING )ONEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA ` wELL DEPTH 320 ft. STATIC WATER LEVEL 50 ft. DATE MEASURED 12/27/89. DRILLING O ROTARY X® COMPRESSED AIR PERCUSSION. ❑ DUG EQUIPMENT ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED O OPEN END CASING )a OPEN HOLE IN BEDROCK ❑ OTHER WATER XXCLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? i:YES ONO ANALYSIS ATTACHED? JkYES O NO PUMP INFORMATION TYPE submersible CAPACITY 5 MAKER 191IN'DECIS_ DEPTHZ80 — MOOEL 7 E H 0 7 412 VOLTAGE 2 3 0 HP 3/4 128513201 1 lWhite granite. STORAGE TANK: TYPE Diaphragm CAPACITY 62 GAL. —1 WELL DRILLER NAME ...MILL DRILLI NC, ADDRESS Putnam Avenue Sf Brewster, NY °175/90 side TOTAL LENGTH 182 ft. MATERIALS: XXSTEEL O PLASTIC O OTHER CASING LENGTH BELOW GRADE 1:B1 ft. JOINTS: ❑ WELDED IKDCTHREADED ❑ OTHER DETAILS DIAMETER in. SEAL:Xq CEMENT GROUT O BENTONITE OOTHER WEIGHT PER FOOT I_ Ib./ft. I DRIVE SHOE: KWES ❑ NO LINER: O YES ONO SCREEN DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? DETAILS FIRST o YES ONO SECOND HOURS GRAVEL PACK O YES GRAVEL DIAMETER TOP BOTTOM O NO SIZE: OF PACK in. DEPTH ft. DEPTH It. WELL YIELD TEST ' If detailed pumping P P 9 �IELL LOG -If more detailed formation descriptions or sieve analyses , are available. please attach. METHOD: O PUMPED tests were done is in- ® COMPRESSED AIR formation attached? DEPTH FROM SURFACE Water well Dia- , O BAILED O OTHER ; ❑ YES O NO ft. ft. Pear. ing Deter FORMATION DESCRIPTION CODE WELL DEPTH DURATION DRAWOOWN YIELD Lurlace ft. hr. min. ft. 90m. 0 60 Hardpan & cobbles. 250 1 30 250 1 60 74 ISand & gravel. 320 6 - 280 5 74 98 Silt, sand & grave w/cobbles. 8 170 Soft brown weathered bedrock _1717L 914r, Pink & white zranite. WATER XXCLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? i:YES ONO ANALYSIS ATTACHED? JkYES O NO PUMP INFORMATION TYPE submersible CAPACITY 5 MAKER 191IN'DECIS_ DEPTHZ80 — MOOEL 7 E H 0 7 412 VOLTAGE 2 3 0 HP 3/4 128513201 1 lWhite granite. STORAGE TANK: TYPE Diaphragm CAPACITY 62 GAL. —1 WELL DRILLER NAME ...MILL DRILLI NC, ADDRESS Putnam Avenue Sf Brewster, NY °175/90 side d l di BREWSTER LABORATORIES Box 224 - BREWSTER, N.Y. (914) 279 -4945 - WATER ANALYSIS REPORT - SAMPLE NO. 7600 NEW WELL SOURCE: Allen Moorehouse Builders Ludingtonville Rd. Patterson, N.Y. COLLECTED: 12-27-89 BY: MillDrilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. 12 -29 -89 0 per 100 ml. PUTNAM COLUEY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Owner or Purchaser of Building Building Constructed by Location - Street Municipality Building Type /3 Z- A / Section Block Lot Subdivision Name Subdivision Lot # GUARAFP= OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and. completely responsible for the location, worknanship, 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 '1 19 90 General Contractor (Owner) - Sig ti—ire- Corporation Name (if Corp.) Address rev. 9/85 mk Signature a Title �ie CS Z73 CIA.) i' &War- yozv. Corporation Name (if Corp.) A d Alm &e6WrZ7-4 . Address wo V. Vi. Fr]z,r, Sir'_ L�ISr�� rN r,n� r- - --- - -- - - - -- �� c...c��rS 10. Deco-! c-f c-_ve? in torch 12,; a_ SJS as per accoroLed olans I ( I b. fi i.l se-Licr, - Date of plac�nt . I I . v= :�1 /a^o p1: �, 2:1 ba?^r 7.cy . yyTi •y L>_�JC . D : ^- E = P=r) e= -. , ac::ssS ih1 l rra le Z-0 CLcC° I C_ TTCLZIL =� 5Cl_ nCL St=?L:-=,;; I �I d_ S�^ne, brLL e c_ , CrEarer thlan 1_J t f_an I I es timat_= c-a C� cv c l e I e. 100 ft: f= c,i%Gte- ccnr- se /I++e --t and- -- ECUEZ G_ ECLSe 1CC? =�- Lam'" cCorc4 fa plans. I '%'-- DISFGS ?!, SYS `tit f c-L C =. as rer cCCrcve— D! ans b. D; =;arc= f-= EDE c^ -r- =^ T•5'=C'L Taa 10 -rf `. C.• iC Qoo -C- e= .`:cut with-4n, ZO 2.L. Ci Cc� Lc =c e_ 1 Al l CiiT 7 G_ G� �_l= E %G _Cn - 'Ha L -er c. '- 2. Disi= -c=- - wa = T ---=se mr- easulr. I. Di Strap- -c s . Le'_'ith c- �_ =- < 30 L_c_es a size C-' 314 — l,tt Imo - 10. Deco-! c-f c-_ve? in torch 12,; Y,. Fate OR LCS= SYS 1 Size CZ= C_�,.. I ( I 2. Cr'v erfl C-9 t__tt I I . v= :�1 /a^o p1: �, E = P=r) e= -. , ac::ssS ih1 l rra le Z-0 CLcC° I 5. First hy---ti 6. Cvc1e Eeca tu` ^_ I I I es timat_= c-a C� cv c l e I ECUEZ G_ ECLSe 1CC? =�- Lam'" cCorc4 fa plans. I f c-L C =. as rer cCCrcve— D! ans b. D; =;arc= f-= EDE c^ -r- =^ T•5'=C'L Taa 10 -rf `. c_ C:t= inc 18" a,=C e C --- a^ e b. C. P' � PiCes *_'_U•C•; w? = ins-ice ar cc_l t ccnt ? ns s tcnes < a" in ci `*r.;✓}= e. C"-tai ri d=am; n instal-led accordinc to Fi n f. C- -rt^in Qr`_ n catf=l l L'L''cte! �.e & C1r.to emi5- -wa —ccur5e F•,ct? nC disc'iarce away from S,5 a =ec I = -ace wa Crctac _ -CII adecru te cn slcces cr ==t =' �u I� ,114%0 PUTNAM[ COUNTY DEPARTMENT OF HEALTH J + Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer to Provide Permit # on CERTIFICATE F O CO LIANCE CONS ON PERMIT FOR SEWAGE DISPOSAL SYSTEM Permit ,M Locited sf Town or •.Village ubd. Lot Ill Tax Map t Block r�'O Lot •o /" z0. t Renewal_ ❑ Revision p :reed llcant Name •S�f- =' � Date of Previous Approvah q ;o Mill Address yh f ; Town�G4.)ZL i ..i �f+' �7 Zia Building Type Lot Area Fill SeMion Only Depth —Volume Number of Bedrooms Design Flow G P D PCHD NotiBcstion is Required *ben Fip Is completed •. Separate Sewerage System to consist of d7z i Gallon Septic Tank dad To be consbul by LA / � ' , r'�l�+'� as ; Address rt1 d/ei ?r.l .f/ Ali D ✓I G Water.SuPP1J : Pdblk, Supply From Address or: Privnnsi Supply Drilled by .�--Address _ Other rodent that 1 am Ilya d complate l re onsiDle r t esign any d location of th�re�prOpo system( s); 1) ttibttl he separate s'ew g is ` � Other Reonirements +✓ �`�� —t' posal system above described- will be constructed'is shown 6n' the approved•amendment there to :end in accordance with the standards, rulesand regulations of e Putnam County Department of. Health, and that"on completion.thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Health Will. be submitted to the Department, .and '6 written guarantee will be furnished the owner, his successors, heirs or assignsby the builder, that said builder vi ll place in good operating condition any part of iild .sewage ' disposal system during the;per,iod of. two (2) years Immediately following the 'date of the ism - ance of the approval of the' Certificate .of 'Constiuciiom:.Compliaoco bt•the original system or.any repairs thereto; 2) that the.drilled well described above will De'located as shown-orl approved plan and that said well_ will bd'installed `i ac rdance with the - standards rules and regu aTrons f Putnam County Department pf Health. Date �✓ s S Signed - j r' ?Q �� P£R A J y Address APPROVED FOR CONSTRUCTION: This approval expires two y s from the date sued unless construction oft a building has been undertaken and is revocable for cause or may be amended or; modified when consid ed,.rl � ry b_y a CommISM er H th. Any change. or alteration of construction , Rg requires a n permit. Approve r sposil of domestic ry, age, r a e u only. Jill 1/87 Data BY' Title 6L DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY...CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL (j�G� U('NT) UF.RMTR+ 4 � �— fD /'4 WELL LOCATION Street Address Town/Village/City Tax Grid Number WELL OWNER Name 0f S r ,4-r/ Address MTrivate ,4AI .f ❑ Public USE OF WELL 1 _ primary 2 - secondary WkESIDENTIAL ❑ BUSINESS ❑ INDUSTRIAL ❑ PUBLIC SUPPLY ❑ FARM CIINSTITUTIONAL ❑ AIR /COND /HEAT PUMP ❑ ABANDONED ❑ TEST /OBSERVATION ❑ OTHER (specify ❑ STAND -BY ❑ AMOUNT OF USE YIELD SOUGHT 5_�'gpm /# PEOPLE SERVED :�i_ /EST. OF DAILY USAGE v4 gall REASON FOR DRILLING MNEW SUPPLY O REPLACE EXISTING SUPPLY ❑PROVIDE ADDITIONAL SUPPLY ❑TEST /OBSERVATION ❑ DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING f; &1?1.9 Y WELL TYPE ®DRILLED DRIVEN ®DUG ®GRAVEL ® 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 P, NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED F []ON REAR OF THIS APPLICATION DION SE E SHEE (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 pro ded b the Dutnam Count Health Department. Date of Issue: 9 Date of Expiration: 19 P6rmit Issuing OffiEi al Permit is Non - Transferrable 0 ioc ° VA-� I CE?-,-t=:-=Tr CF EE:— Dri!S!CJ' GF EEAL-1-H -- 7-L aWA- D =z < - S�,S= c 57 of NO ncn r zv r inns. C::NEIF =,-ICN BY: PI - ----------- AL- criz-=t-icm (-�C 7 1) !-CC -Z:rZ,7a- ChE7=-Zl:a:i c . �= LC &V- D cr z we'll EE r -m -1 if c— v r a E ces-cm DatE: Per= & Drivenvay S I C C C-It C== Eol== ar s;cr = =-, 4 Pi t & D B c x C -, 4 Z & DE t IT .0- cf. EeIr-c-c-ms (= *n. = Is W// 2 0. 0 ft- C- P procart7 & EC,-,-e Nlecassa2:77 (TICht lct! SEEVEZ A"o; No B-- Ear-Es 4.50 C�l F; z T--= 2 0 t to Fc- =-r-z= t Wa i0o, tz Well; in- D.L-C.D., 150' P.:-= L=-ka Fccti;:9 10 to Ida =r L.-A. ne i =_ -? 0 Ttr Wail zl- actes d=th caucas 7, 1` vr. )&Lc- ./. JA ra E%r7;cz-, em=- TFI A LAI J I C::NEIF =,-ICN BY: PI - ----------- AL- criz-=t-icm (-�C 7 1) !-CC -Z:rZ,7a- ChE7=-Zl:a:i c . �= LC &V- D cr z we'll EE r -m -1 if c— v r a E ces-cm DatE: Per= & Drivenvay S I C C C-It C== Eol== ar s;cr = =-, 4 Pi t & D B c x C -, 4 Z & DE t IT .0- cf. EeIr-c-c-ms (= *n. = Is W// 2 0. 0 ft- C- P procart7 & EC,-,-e Nlecassa2:77 (TICht lct! SEEVEZ A"o; No B-- Ear-Es 4.50 C�l F; z T--= 2 0 t to Fc- =-r-z= t Wa i0o, tz Well; in- D.L-C.D., 150' P.:-= L=-ka Fccti;:9 10 to Ida =r L.-A. ne i =_ -? 0 Ttr Wail DIVISION OF ENVIRUMMAL HEALTH SERVICES DF,SIGN DATA S=-SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. 1,11,r Owner Address -1'/ 1-12. , Located at (Street). Sec. /3 Block 7— Lot (indicate nearest cross street) Municipality Watershed Date of Pre-Soaking Date of Percolation Test Wl��114,p 301 2 ZZ: .1 HOLE NUMBER Cl= ME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Leve). No. Time Ground Surface In Inches Soil Rate Start-stop Min. Start Stop Drop In Min/In Drop Inches Inches Inches 3,r) 2 3 iZ 5 3 2 3 L��Pxk 301 2 ZZ: .1 3 4 5 3 2 3 �e--Oj 301 4 5 I)=: 1. Tests to be repeated are obtainedat each for review. 2. Depth measurements to rev. 9/85 at same depth until approximately equal soil rates percolation test hole. All data to' be submitted be made fran top of hole. DEPTH G.L. !4-/ 21 31 41 51 61 71 81 91 10, ill 121 13' 14' TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. (q, f—,) HOLE NO. 77 �3 HOLE NO. u -7 INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL M WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED • DEEP HOLE OBSERVATIONS MADE BY: 111V-,L,iki 2 � 1 C/Z-- DATE: DESIGN Soil Rate Used 3.0 Min/l"• Drop: S.D. Usable Area Provided J,�ev,i"r No. of Bedrooms Septic Tank Capacity n gals. Type '27 Absorption AreaS,P,'r'qvided By L.F. x 24" width trench Other bdrktp,11-17o, Name Address Zx- /,L), Y" THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Signature SEAL Af Soil Rate Approved sq.ft/gal. Checked by 4- •0. 04-410 �"V PROF Date ro A LIO NZ % 1 � � � Z R �� i� o tA � � Nll � l � � : a i 1 AR � � ° 'll I � i � � �l� � � � � off. ill � � w ob �� i A ca 6'.014adv 41,dry I 1#19 IS TO CMTI-FY THAT THE .SEWAGE DISPOSAL SYSTEM I.-.rD ON THIS pLAN AND THAT' jNA--S COiNSTRUCTED AS TH,E SyST71 7;,Y 118 BEFORE IT WAS COVER- -T AC f"ANCE M) OVET, WITH A-,r:-:- LATIONS -L F4- or , -, 4 & J,., ?//' , A . -AlreoAoj 29 99 =o- 3 9f 9.C. 7 I 1#19 IS TO CMTI-FY THAT THE .SEWAGE DISPOSAL SYSTEM I.-.rD ON THIS pLAN AND THAT' jNA--S COiNSTRUCTED AS TH,E SyST71 7;,Y 118 BEFORE IT WAS COVER- -T AC f"ANCE M) OVET, WITH A-,r:-:- LATIONS -L F4- or , -, 4 & J,., ?//' , A