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HomeMy WebLinkAbout0566DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -1 -30 BOX 7 00566 - L ,�, IN Tw i I .; ` , 00566 -T—� pa'cee C O R P O R A T E D 'Itit ASSURANCE OF OUALITY Neckles Builders, Inc.. 47 W. Old Farm Road Hopewell Junction, NY 12533 SAMPLING LOCATION: PACE Sample Number: Date Collected: Date Received: Client Sample ID: Parameter INORGANIC ANALYSIS INDIVIDUAL PARAMETERS TOTAL COLIFORM MPN REPORT OF Q,I• TORY ANALYSIS May 05, 1992 PACE Project Number: 820430509 Outside Faucet Lot 26. Hampshire Ct., Patterson, NY Units Col . /100ml 95 0018736 04/30/92 04/30/92 NECKLES- LOT 26 MDL HAMPSHIRE DATE ANALYZED ND 04/30/92 These results indicate that the water WAS of a satisfactory sanitary quality when the sample was collected. MDL Method Detection Limit NO Not detected at or above the MDL. These data have been reviewed and are approved for release. Sin(),A0'\rl G Sharon K. Brakeman Manager, Inorganic Chemistry t I Charlotte, North Carolina An Equal Opportunity Employer Robinson lane, RD 6 Offices Serving: Minneapolis, Minnesota Wappingers Falls, NY 1290 Tampa, Florida Asheville, North Carolina TEL: 914.227.2811 Iowa City, Iowa New York, New York FAX: 914.227.6134 San Francisco, California Pittsburgh, Pennsylvania Kansas City, Missouri Denver, Colorado Los Angeles, California 1 Atf—U... a_On } OC� �ja v ;n. �. WILL UUrirLLiiULV cccrurci DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET ADDRESS: TOWNIVItC1177CITY TAX GRIO NUMBER: WELL OWNER NAME: ADDRESS: Alec,kle, - PRIVATE ❑ PUBLIC fE OF WELL primary 2 - secondary RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED _22-25 / EST_ OF DAILY USAGE gal. REASON FOR DRILLINGTEW [:]REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY SUPPLY (NEW DWELLING) [--]DEEPEN EXISTING DEPTH DATA WELL DEPTH 116 - ft. 'WELL STATIC WATER LEVEL eft. DATE MEASURED 1 �`� DRILLING EQUIPMENT ❑ ROTARY Of COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE 0 SCREENED ❑ OPEN END CASING OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH zf I _ ft MATERIALS: 06 STEEL ❑ PLASTIC ❑ OTHER CASING DETAILS LENGTH BELOW GRADE ft. JOINTS: ❑ WELDED THREADED ❑ THER DIAMETER in. SEAL: O CEMENT GROUT ❑ BENTONITE (6TH R WEIGHT PER FOOT lb./ft. f DRIVE SHOE 9YES ❑ NO I LINER: n YES dkin SCREEN DIAMETER (in) SIZE LENG ft) DEPTH TO SCREEN (ft) DEVELOPED? D TAILS FIRST ❑ YES ❑ NO HOURS ONO GRAVEL PACK O YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. TOP 0EPTHf ft. BOTTOM DEPTH It. WELL YIELD TEST if detailed pumping I MEjH00: O PUMPED i tests were done is in- /COMPRESSED AIR . , formation attached? ❑ BAILED O OTHER ; ❑YES ` ❑ NO WELL LOG )f more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear- inq Well Dia' Ineter FORMATION DESCRIPTION coot ft. ft WELL DEPTH It. DURATION hr, min. DRAWOOWN ft, YIELD gPm- Surface S WATER CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ❑ NO ANALYSIS ATTACHED? O YES O NO / STORAGE TANK: TYPE CAPACITY ") ..GAT,. PUMP INFORIPTION TYPE MAKER MODEL DEPTH V VOLTAG, HP WELL DRILLER NAME OAT ADRT M. HYATT & SONS, 06RE Well Drilling Rte. 311 R.R. 2 Box 171A .J /dy t 9 O PC.iiMMM COQN7 Y D IjFt`INiEt7I Or ka nZ7i Owner or F.Ux t-�aser s: - Building section Block Lot X25 Building Constructed by Lc,mmtion - Street 5U' Daivision Name Mur,icipality - - - Subd4visitm Lot - - - -- building 1 G[Jr,RZLN �`.�:b, OF SUB-SURFACE SF_ -MGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the lo(mtion, wor) -iship, material, constxuctiQn and drainage of the sewage disposal system 5er-ging the above described property, and that it hau been constructed as shwa on the approved plan or approved amendment t[iereto, and in accordance with the st,an -lards, xules and regulations of the Putnam County Depa_~trent of Health, and ,here' % guarfixtee to the ol�mer, his &u ssors, heirs or assigns, to place In good opera -ting condition any part of said system, constru�rted by me which fails to i c:<. a period of two years izmedi.ately following the date of approval of the 14Cei`1:_ .'ic:.ate of Construction Compliance" for the sewage disposal system, or any repairs nude by me to such systems except where the failure to operate properly is caused by the willful or negligent act of the occupant.of the building utilizing the systt:�m. '� ttv u ersigned further agrees to accept as conclus -ve the c?ete=ination of the Di =rL b.,.` of the Oi,vi.sion of Bnvironi,,,_�,ntal Huth Services of the Putnam County Departmeiit 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 U e system. Dated t his clay of 19 CUL i5 1V U1 if Corp.) Address rev. mk Signature' Title CX,za Address 1�_ Corp.) 7 _ �/l � � �G i i� i I-1,1\5- DOILf bIMrN5ICN GNAKT N° A � I — 2t l q 10q 1" 913 - 5 1 121' O' I I I 5 -G" I O8 `- - „ 9 l2S ,,, I13 --7 10 13q O" l ILD' - 3, 12 I�F5' O" 131 -" Igo lo I " 1-7 I O8' TH l S t 5 TO Gt✓t�T l� `( - TH,g -T SYSTEM INAS �NSTI�UGT THIS t°t�AN ,a.N t7 T4-IAT THE OVE THt✓ SYSTt✓M NA,5 AGCOt�D�.NGE WITH ALL .a.Nc� t'�[✓GUt_ -/'.T IONS OI% '1 NE,4L.TH �EE°A<22SM1✓NT , ST�T� NE,�,L�TI -t DEt°Ar� rr<oM " SUt��l�`S OF l°CeO� I�� ! , �r�>✓PAt�Et� �Ot� N� Pr�Et°Ar�t:D � 1�UNt�IE:'i . IE ,. 7. q � .a 1Qi11Yl00DMYTDWART INtOlBRACI71 - 6m DIaY�d1 wYoa�at W Baal taa.l�+a�. Casa1.I1 T low aw(�CAIS ~TawW Pi�lt . r Liiiai at l.�/ Tv ar. i liiiddM lira to l Z� y a.et h 30 /O ) ._ . oMr��P�iert ra. � �a�, � / 4 �r ,� � s %�l(L!/S. %1�i�w...:.t O Z..w.. ❑ r,,,s �`,�.. 1,111 ���� �Q► -�", 'J� Ala// - ZIw `� O G . `m .;:: .I:�.S` ?3 d Date Subd vasioBn li4ikoved 5 -�S �J�2 ^ Fee "Enclosed amn ,,,r !++rs -u .0 I -Vt Ana C3 q 04 l+t! Saallar 0a>b Da s yir Isar al � ' D�rp PMw G P D OG PCB Nd 'Iiw la4iM lY`w P� b ei �Nlai.'' j =aanira. la'ti.rl.e ai ' a DO 11aik o 'L. t • Dalai Otte n ,l�a�a`aaraab �s � r• T riMasanttthat 1 ini :who11Y afaa ooinoMtoty ntapenateN i0f tM daaiOn ane location of.�tM piopoasd sYra�lsl {} 1)' that tlii ` ' � at �Ai aai_ F om'" Novo bsr i0ad wIH ties eonat►uefa0 at Mown on tiw aat»ows awwNWimnt tlNri to anel M acewanp;wlth tM ataeiaa►e; rules a :rqu S Y OMKtnawt N MyRlti aM tMt on COi101�tiiw,�tr;v a i +'Cootifieato ' of tooksOuetion Conwlai�e !'Ytiflictory CamnhYoMr of Ml� aft will M':wiw�Ntw _q JIM ,OgNtiMM„ a~ a rinNtM' aWrnMM wN1,0a fwaith�A tM:Pw" tmi Ais.Mcc s. Mlmcii iMlons -tai the 64"k. that taY oiiNMr "trill tea U 't10M ;Na►afM'pArNMw,Mw ant of =aaM ssMpp' olNfaotal syfa�if0 ewln�;.tM oMisO of'twe.(t) ysan Mlatoty 1oltodrlf+ -tMMto elitfN larr. awq M tM: aaMawl of tM'`CertNtcat� Of Coiaitfuctbn Canppin o1 tM a IMI p ifs t t 2 ttyt tMA NIN ww ooswtltM','ai«a wM -N loa fr a.tAairn M tM aaMeoM' Nan aM'that sa1A woM will Uo Mate in Accamanao "wit hi tta Ms, rN of. tM At�utnnn ': COY 0~Mtniawt N IlaawR " > _ . �r �Ieama New ' 4 Y` AMIIOVEO fow CCNiT11tJCTlON: TIaU yMeril sno& s, two yarn f tfN .I unlga cpaathuetbn' of t �iaMl/ lys OMn u�iOMtakMl aM i; tarOpaM fOS .aaYM e1 1f1ay M •naaur.e< mO�Mla/ wMn eeetielorW y tM ml eMnN or aKatatbn of C01Nt[Yttlell 10, mw fo► Qaraaal W �ewnalk tMNa► nA /or ly r ' n pp Y�t+ r i n. :..- ,...- .... «•:.:. .,.., ;,....u:- .,w,.+..r.,,... ,. .,...,.., .. ,.� .. , z..a _. <.; eN.. :.: sire. :....� �. .... .v._a : -x ..> s. -x . sr. .: xx `+ rP�" :fin. >'��'` Yu * t� a:.�i`5 nhir.,lv�,i.,a �-�.'� 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 fla -�/ WELL LOCATION IS WELL SITE SUBJECT TO FLOODING? YES Z,--"NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot WATER WELL CONTRACTOR: Name 71 B D Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _LZ NO NAME OF PUBLIC WATER SUPPLY: _ N /A TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED)i 9'0'N SEPARATE SHEET of - -- '1/ _ t \,/ - L' j I (date) rsignatuie 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 thirt3c (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 Department attached to this permit. 3. Submit a Well Completion Report on a form requirements of the Putnam County Health provided by the Putnam County Health Department. During all well drilling operations, the applicant sh any and all water or waste products from such well dr property and in such a mann r as not to de rade or of Date of Issue: / ® 19 Date of Expiration Q 19 r take appropriate action to assure that ing o erat' ns be contained on this ifis/ on minate /sgXVice/or groundwater. it-Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller Street Adc res - h� To Tax Numb3 WELL OWNER yName W4 ,A e(, ' ling Ad r _ei 1/Vt O% ss rivate r eljvdl jet, OPublic. SE OF WELL 1 - primary 2 - secondary SIDENTIAL ` 15 BUSINESS ® INDUSTRIAL PUBLIC SUPPLY ® FARM ❑ INSTITUTIONAL ❑ AIR /COND /HEAT PUMP O ABANDONED ❑ TEST /OBSERVATION 0 OTHER (specify Q STAND -BY O AMOUNT OF USE / YIELD SOUGHT � gpm /# PEOPLE SERVED 3, /EST. OF DAILY USAGE&&() gal ❑ REPLACE EXISTING SUPPLY E3 TEST/ 13. ADDITIONAL SUPPLY SUPPLY NEW DWELLING ❑ DEEPEN E ISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED ®DRIVEN ®DUG ®GRAVEL. OOTHER IS WELL SITE SUBJECT TO FLOODING? YES Z,--"NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot WATER WELL CONTRACTOR: Name 71 B D Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _LZ NO NAME OF PUBLIC WATER SUPPLY: _ N /A TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED)i 9'0'N SEPARATE SHEET of - -- '1/ _ t \,/ - L' j I (date) rsignatuie 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 thirt3c (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 Department attached to this permit. 3. Submit a Well Completion Report on a form requirements of the Putnam County Health provided by the Putnam County Health Department. During all well drilling operations, the applicant sh any and all water or waste products from such well dr property and in such a mann r as not to de rade or of Date of Issue: / ® 19 Date of Expiration Q 19 r take appropriate action to assure that ing o erat' ns be contained on this ifis/ on minate /sgXVice/or groundwater. it-Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller A •• a• • - is • . y T. / 2 3 .00 4 5 1 . 2 3 4 5 .6 22 2 3' 2 2 5�.oZ - 5 : 08 3 6-JO 4 5 No'I'FS: 1. Tests to be repeated' at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to'be suh�nitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 3' 4' 5' 6' 7' $1 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS EN00UNTERED INDICATE LEVEL TO WHICH EATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used IZ Min/1" Drop: S.D. Usable Area Provided 500o 5.f:-. No. of Bedroms Septic Tank Capacity. J od gals. Type COAL Absorption Area Provided By 36() L.F. x 24" width trench Other L AV REAV T E WG INREiNG Name ASSOCIATES P. c. Signature Address 73 FA I R F /E[ P P R i v E SEAL PA TTER SoAl A1,6vu,' yoRr I z &3 2�F No.5s12fi O THIS SPACE FOR USE BY HEALTH DEPART4'Nr ONLY: FESS�OK Soil Rate Approved sq.ft /gal. Checked by - Date fJ W AV-12 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS EN00UNTERED INDICATE LEVEL TO WHICH EATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used IZ Min/1" Drop: S.D. Usable Area Provided 500o 5.f:-. No. of Bedroms Septic Tank Capacity. J od gals. Type COAL Absorption Area Provided By 36() L.F. x 24" width trench Other L AV REAV T E WG INREiNG Name ASSOCIATES P. c. Signature Address 73 FA I R F /E[ P P R i v E SEAL PA TTER SoAl A1,6vu,' yoRr I z &3 2�F No.5s12fi O THIS SPACE FOR USE BY HEALTH DEPART4'Nr ONLY: FESS�OK Soil Rate Approved sq.ft /gal. Checked by - Date Putnam County Department of Health Division of Environmental Sanitation a AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT. APPLICATION SUBMITTED- TO .PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health - In the matter of application for ' -- -- ... - - - -- — — — — . — — — — — — - - - — _ — --. — — — . _ . pepresent. that .I am an officer or employee of the corporation and am_ authorized' to act for. _ —EGlej 17 tit Ic`%v�rt itiC — _ _ - - — p ... — (name of corporation). _ . having offices at _ �� _We _ — — — — — — _ _ (" e_1`'_6 1 ( .� %Z _ ` _ _ _ _Whose officers'-are President — ln�_ol�' -F,�2 (Name and Tddress)_. • Vice - President _ �A s� %� cl�S. W © _ _'o�_-•�4 _ 1�v _ ?�i� - '(Name and Address) 'L L'�-�" J Secretary N 6 jc. Le—s (Name and Address)— _ Treasurer .(Name .and Address) ' and that I=am -and will be individually responsible.fon. any or all aptp of. the- corporation with respect to. the approval reo estgd and -all .sub - sequeit acts relating - thereto. Sworn: to before me this �n day ,�',�,,, D ' Y Signed C G %��� , _llgy� r 19 y Title o f ._ .3� ` t9e'' ... — o ary PUbli �nr�i� J•• Z�i(iS. �985 0� '• ' No +a i- 10u b f �'G 54n +� 11' New lork C;hral��� in i ss Ocan I�� C�aYnrni55ian.1!�L�Jirc��� g- -� -q3, - •. Corporate Seal 1:1 (1' 1 1! 1 Rri V► U Ill 1_j Vi Ir J �1 ) ff V l.1 L' Ell ► -I Ill '?, i'1� o L3 �'i Itf 1,1 u� Lei R U fV rFri C u I -1 E r Ia Irl . 1- C1 r' u I- L t l' (u 1' I [)1 V J Il I11 o, III Ll 1,1 f': r•I V) •• I �I 1!1 11 11 1.1 .IJ (I) Lit 0 11 1.)1 j '-1 •• I UI (11 .11 U) 1-1 .IJ LI r -I II? Lj n. PI Ill [' 111 •I': • p .LI lr) A 1-! Ip Ut U u v ( 1 ij 0 ► -1 ►%1 I11 10.1 u! 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