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HomeMy WebLinkAbout0586DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -1 -50 BOX 7 Jr � f . , r.. 16 M �� = . cn AM Cst. a �_, 4� W WLLL UUr1rLP,1 iUN Anrual DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET AOURESS: N /VIl ! I Y TAX GRID NUMBER: _ gf"940, ���, 4,o-r- 90 WELL OWNER NAME: /� Q ADDRESS: tom? R-11� LJ•11 t AYV,0 Pik, 'ice . C 9 e O PBIVATE ❑ PUBLIC OF WELL primary 2- secondary ESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED O BUSINESS O FARM ❑ PEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD SOUGHT _�D gpm. /N0. PEOPLE SERVED __Ya_ / EST. OF DAILY USAGE 9 �2 2 gal. REASON FOR DRILLING WWrW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION D REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH ft. STATIC WATER LEVEL A3 , ft. DATE MEASUREDSet T14 0 DRILLING EQUIPMENT 1 O ROTARY ❑ C9AI"ESSED AIR PERCUSSION 0 DUG O WELL POINT 216ABLE PERCUSSION O OTHER (specify): WELL TYPE ❑ SCREENED PEN END CASING, OVEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH .1 C2=-f- MATERIALS: EEL O PLASTIC ❑ OTHER LENGTH.BELOW GRADE ft. JOINTS: O WELDED 0,KREADED ❑ OTHER DIAMETER in. SEAL: WtfNIENT GROUT O BENTONITE ❑OTHER WEIGHT PER FOOT — I Z lb. /ft. DRIVE SHOE: &YES ONO LINER: O YES GMT SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? I ST ❑ YES ONO _. HOURS SE ONO GRAVEL PACK S ❑ NO GRAVEL SIZE: DIAMETER OF PACK in- TOP DEPTH ft. BOTTOM DEPTH It. WELL YIELD TEST If detailed pumping METHOD: O PUMPED i tests were done is in- t O CO RESSED AIR ,formation attached? ILEO ❑ OTHER ; 0 YES O NO . 1r�%ELL LOG If more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear- in9 Well Dia- meter In FORMATION OESCRIPTlON qOE. tt. is WELL DEPTH it. DURATION hr, min. DRAWOOWN it, YIELD gpm. Land L 4 /14 i2a �c 6 WATER LEAR TEMP. S QUALITY O CLOUDY HARDNESS `—°"' O COLORED ANALYZED? S ONO ANALYSIS ATTACHED? ES ONO STORAGE TANK: TYPE�R�'J -�RS CAPACITY GAL. WELL DRILLER NAME A /yC U DA ADDRESS Q d X 3 I 51W ATURE ` G R 0 Tay PUMP INFORMATION TYPE J� �% Q CAPACITY MAKER DEPTH MODEL - �- VOLTAGe�'-3-0 HP Yorktown Medical Laboratory, Inc. LAB # _ 321 Kcar Screct Yorktown Heights, N. Y. 10598 (914) 245-2800 Director: Albert H. Padovani fit. T. (ASCA) -1 r DENNIS MALANCHUK P.O.BOX 313 CROTON FALLS,NY. 10519 L J Date Taken: 725/90 Time: 1pm Date Rc'd: Time: 7_707m Date Reported: JUL. 31 1990 Collected By: a anc u Referred By: Sam 1'e Location:' wen o Higiview Terrace Patterson,117. Phone it Phone it Sample Type: Repeat Test? _ (check each) LABORATORY REPORT ON THE QUALITY OF WATER INORGANIC NON— METALS _7mg_/TT MICROBIOLOGICAL CFU /lOOmL - Acidity _ Alkalinity _ Chloride Detergents, MBAs _ Hardness, Total _ Nitrogen, Ammonia _ Nitrogen,.Nitrate Phosphate, Total Sulfate Sulfide Sulfite METALS (mg /L) Copper _ Iron _ Lead _ Manganese _ Mercury _ Sodium _ Zinc MISCELLANEOUS pH (units) Color (units) Odor (TON) Turbidity (NTU) GENERAL BACTERIA _ Standard Plate Count (CFU /1.OmL) MEMBRANE FILTRATION TECHNIQUE Total Coliform Fecal Coliform _ Fecal Streptococcus MOST PROBABLE NUMBER TECHNIQUE Total Coliform Index Fecal Coliform Index KEY FOR TERMINOLOGY CFU = Colony Forming Units CON = Confluent (q.v. TNTC) LT = C = Less Than GT = > = Greater Than N/A = Not Applicable S/A = See Attached TNTC= Too Numerous To Count REMARKS /COMMENTS (For Lab Use) y�Potable Non- potable _ STP INF STP EFF Other: Sample Status: (check each) Outgoing _ HNO3 _ HC1 _ H2SO4 NaOH ZnOAc _ Na2S203 Other: Incoming � 'E k °C GT It °C _✓ DH LE 2 _ _ pH GE '9 _ pH GE 12 Other: ELAP No . 10323 THESE RESULTS INDICATE THAT THE WATER SAMPLE (Was) (Wasn't) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO TH EW ORK STATE PUBLIC DRINKING WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE COLLECTION. THESE RESULTS INDICATE THAT THE WATER SAMPLE (Did) (Didn't) (N /A) MEET THE SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK PUBLI RIN NG WATER CODES, FOR THE PARAMETERS,.4STEO, AT THE TIME OF SAMPLE COLLECTION. PUI'NAM COUN`T'Y DEPARTMENT OF HEALTH DIVISION OF ENVIROiZ=AL HEALTH SERVICES COKA0A It 14i ( ( br. o E, /0 elm Owner or Purchaser of Building Au is 140 r�1 f...s Building Constructed by ohmk �Ci I,ocation - Street /s a Section Block Lot 12�j5 GS T S Subdivision Naive Municipality Subdivision Lot # /� /601/.41 Building Type (.c C414RAfTM OF SUBSURFACE SEWAGE DISPOSAL SYSTE24 Li represent thatUL aVCwholly 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 tifeieto, 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 W which fails to operate for a period of two years immediately following the date of. approval of the "Certificate ogConstruction Compliance" for the sewage disposal system, or any repairs made by to such system, except where the failure to operate properly is caused: by the willful or negligent act of the occ q=t,of the building utilizing the system. The undersigned further agrees to accept as conclusive the detenaination of the Director of the Division of Environbental Health Services of the Putnam County Department of Health as to whether or not the failure of the system to operate caused by the willful or negligent act of :the occupant of the buildgg u,� lt'z n the system. Dated this _5 day of 19 Sigma A Z-L4-A- -7_—___ Title (Owner) - Sii nature C441A tdq 1 9; /oo /Y. Corporation Name (if �1Corp.) I , 4c,4_ Address A;. Corporation Name (if Corp.) `t EM FMIAL SITE L•�- rC?'_C�i Cate n °=�- =ed by .i CRIER rzruA/U-1,6-2 1 147) 2,1 OR -ted as per a=rc)ved SLS are - - Date plac t b. F-! sue�." _ r 2. 1 W 1 j �TG C_ P'.rt= ,l sci_ r_ct , Tizc d. S`cne, br-y e c. , cr t_r t :.an 35' f_a1 S a e. 100 ft- f =c. r Star cq ,-rse;k _ C C.. sem is tank 2- 000 x l r b- Ss=tic tz-7-r- -{ C. !'0' I[L'_*1?TrC_?1 C_ i0 a0o be ^.`.- C_e:- -ricut Within 30 f= Gf 4'-5,2 hen E. uIST'll.' ='-Cti BC{ P =ct mac.. f_cs . Z . j t.,s=CN EC = = r-rCCE r s =a C. 20 D_c � c= < 1-0 _c_ == -.=C: fi . Rccn all3c-wea =cr ex-zezns i cn , 50 9. Size Cf cr - el 3/4 - it" c= cna e in trench 12" Ai 1L. Pire CR . EC---z 4 T_'• ea-s-1-17 GC^ s=-: b e l.O cc- fi. Cvc1e W= _ -_�• by c °�� tZ L`e� — :� =-=t FS t i _Ti1ct= _ c'N c� �e - r.. Ec U. e. icL=e 3cc =�- z�r accrcc� p3�� V. i • -- c- 51 =! 3 3 cG=t =- aE rear cr:,rcve—,- plans c_ C?57 a c. ��' �� a...CS f u�h W? `.Z Zns1GA CL Irci 3I era_ - -e? ccrt =iz_= stare_= < a" in + e- C'T tma i rl dam= i _ i ns al i = ecccrdinC to clan FrC'CEct=,,3 & C'_- - tC E C. F-- -ct_nc Cry- C= f - =arce Gwav fI= S2S are h- S :ace WE' Ccctsct C.q cQELTU?L' DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 Z-a-r I �a APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT #-® WELL LOCATION Street Ad res, T e y Tax Grid Number �sG Uri v-z, q WELL OWNER OWNER Name �c,. ti w� l M fling_f Address , / rl / Private �'r 6 a 4(% oy ve /�i �oc�, O.Pi, blic �1E OF WELL - primary 2- secondary .RESIDENTIAL ® BUSINESS O INDUSTRIAL ®.PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O ABANDONED O.FARM O TEST /OBSERVATION 0 OTHER (specify, U INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT = gpm /# PEOPLE SERVED /EST . OF DAILY USAGE_L_ _gal 0 REPLACE EXISTING.SUPPLY ❑ TEST /OBSERVATION 12-ADDITIONAL SUPPLY %NEW SUPPLY NEW Sy ELLING ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR 'DRILLING WELL TYPE DRILLED ®DRIVEN ®DUG C3 GRAVEL 0OTHER IS WELL SITE SUBJECT TO FLOODING? YES N0 IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: (-c Lot No. WATER WELL CONTRACTOR: Name B Q 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: LOCATION SKETCH SOURCES OF CONTAMINATION PROVIDED -:L71 111ON SEPARATE SHEET (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 &hall: 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 provi d by the Putnam County Health Department. Date of Issue: 117,3 19 Date of Expiration: 19�_ rm�t suing Official Permit is Non - Transfer able White copy: H.D. File Yell Buildin Inspector aw copy. g Rev. 10/88 Pink opPy: Owner Orange copy: Well Driller LAURENT ENGINEERING ASSOCIATES, PC. 73 FAIRFIELD DRIVE PATTERSON, NEW YORK 12563 RANDOLPH W. LAURENT, PE. (914) 278.6108 - (FAX) 278 -2658. HARRY W.NICHOLS, JR,, PE. ffl CONSULTING SITE ENGINEERS January 9, 1991 Putnam County Health Department 110 Old Route Six Center Carmel, New York 10512 Att: Mr. Robert Morris Re: As -Built Plan Cornwall Ridge - Lot#40 Patterson, NY Dear Bob: Enclosed are the following: 1. Four (4) prints of Drawing S -40, "As -Built Plan ", Lot #40, dated 1 -9 -91. 2. "Certificate of Construction Compliance for Sewage Disposal System ", dated 1 -9 -91. 3. Three (3) copies of "Guarantee of Subsurface Sewage Disposal System ", dated 10 -5 -90 4. Well Completion and Well Log Report, dated 9- 24 -90. 5. Water Analysis Report. 6. Money Order in the amount of $100.00 payable to Putnam County Health Department. If there are any questions concerning the enclosed, please call. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. dY. i Harry W. Ni ols, Jr., P.E. 89057/map cc: Cornwall Development Corp. FUtna.. ,ounty Department of Health Division of Environmental Sanitation ' Corparate Seal . • �' • •' �' F,0 Y• 'ly ffl' M?. DESIGN DATA SHEEN- SUBSUFACE SEWAGE- DISPOSAL SYSTEM FILE NO. ' owner r LA k,Ct l .%��, l o . �, �M % Cv� Address d ,,�%► -i� )ve• lei ZOCated at (Street) SOt,, , =a _:L �a 1 sec. % Block % lot (indicate nearest cross street)• Municipality s Watershed SOIL PERCOLATION--= DATA R3QUIRID TO BE .sUBmnTEa WITH APPLICATIONS Date of Pre- Soaking Ce Date of Percolation Test .BOLE . N(P4HER Q,OCK TIME PERCOLATION PERCMATION- Run Elapse Depth to Water Yon Water Level No. Time: Ground Surface In Inches -$oil Rate .. Stai`t stop Min. start Shop Drop In Min/In Drop Inches Inches Inches 1 c:4 - ifl:4" 30 ZZ �7_ 3 �G 3 ll;lo - /I rs`t� ?Z Z- 12- .. 5 ; 20 - 11; 0 6 zi P2310 4 5 1 • 2 3 4� 5 NODS: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to•be submitt0d for review. 2. Depth reasurements to be made-frau top of hole. DEPTH G. L. 1' 2' 3' .4' 5' 6 71 8' 9' TEST PIT DATA RDQMM TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOUS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. HOLE NO. 10' 12' 13' INDICATE LEVEL AT WHICH GROUNMAZER IS ENpOUNBMM INDICATE LEVEL TO WHICH WATER LEVEL RISESi AFTER BEING E1]OOUN1!ERED DEEP HOLE OBSERVATIONS MADE j BY: Rg,., jr/ DA7 ::, DESIGN Soil Rate Used Min/1" Drop: S.D. Usable Area Provided 000 S (=', No. of Bedroans '3 Septic Tank Capacity 0 0,0 gals. Type C' ci mac, Absorption Area Provided By 3`7r L.F. x 24" width trench Other Cv L q h /J rG. L �. Signature P NIGH `, -` s i SEAL tu ,A.rx tr Lu THIS SPACE FOR USE BY HEALTH DEPARUMM. ONLY: V P t- Soil Rate Approved sq.ft� gal. Checked by Date DE T HAY D 6VNE Av5L PINlS C�t2AD� AoO E GOVE%F on .a A, "NIG - l % "M(N. !2Ti NG 5E�-GYIO ' -A" �ETAIL 1" La i FI '7 t T 'Yj/ay� GOV V. l�V E=t2f 7fA WAra� Gl.�N�TElJG7E't�� IN fY1G0�ANGC� YVtYMR�iht:i 1 gfANi7A }?C7 lZL1t��h #,E2E{il1L'(tptf'S,pP.'F?M �U"fNANi JG ©UN�Y t?r✓��tzYNtP�t1"OF t��At��M �lN,p TNT N t✓l►V Ypi?�t11 t�Pfl;t2TM?.t1 Z. HiI u � �-r I(�I La. LaGA'flOrlS TAKl =N FI��OM Sl�l le -VE`( Pt�PAI�t7 �`( �INN�Y: `ASSOG, nA�17 g -2 -qo. AS - OU I L�C bIM�NSIOI�t G HAle-T A 53.5 50.5�� ng 0 72.o (05.5" 0' 72 0' X2.0' 84•D� X07.0 o(0.0 X3:5" t) 5.0' 43.0, 32 •D ` (00.0' Alf✓