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HomeMy WebLinkAbout0592DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -1 -56 BOX 7 00592 ii Krjr oim6 00592 PUTNAM COUNTY DEPARTNUMOPH S 105121 2 Mlud'-Provme�.� C Gaffon, Septic Twk:and - ,�ojjgjsij" Of 4— W.awlwo: PubDe-Supply F'r= —Aiddre" 4?^&A 1�,Kem j5iz- art Prwaw $. UPOY DMW byEtf_ 0 `: AL 9X X . I . Widmg Tyj, I t (AL,16t Size ath `j e C-., Has Erosi6n Ci4-i-ell d?, OOP 17' Number of Bedrooms 'Garb 890 Grinder Been Installed? Other` Regaliemeats L I certify that the systtim(s) as listed serving the above.premil-es were constructed essentially as shown on the,plans of the completed, work l copies of which are attached), s:nd,,in,aq_co'Fdance with the -standards, rules ands qpuptions,i. accord *i",. and the permit issued by the Putnam Co"ty.liepaii6drit alth. ,7 oats I NO. --- P.E.— R.A. ACdross :Csitifled by A� License 'M unanKary Any - person occupying premises served' ­b* systems) shall promptly take such action as msybe�nacallsary to secure the correction of any conditions resulting from 11 -such' tinge. ^Ppro4al, of the j6parste -sair4rage,systern shall. become null and void 46:90" si i"pubV: military sr~' "M null and id supply1 - , 11"lico . available and the approval of tile p, rjjafs'%vst6r supply chili become wo witil!" a -public water - mas available. Such approvals we subject to modification or, couin •when, in, the A'dignisrit' of the commlili6in or d, f, Wealth such revocation. modificiItIon or change Is no . cessary. Cate :2, By �/89 21 1I1 \ �l i It-0 WLLL LU1virLL11UV rcDrUAI DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET AOURESS: TOWNIVIEDICLIC1119 TAi GRIO NUMBER: Cornwall Hill Patterson, NY Lot #4 WELL OWNER NAME: ADDRESS: Cornwall Home Builders, 155 E,­-Main St., Brewster,NY ❑ PBIVATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary II RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED 0 BUSINESS ❑ FARM ❑ TEST / OBSERVATION ❑ OTHER (specify) 0 INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /NO. 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 60.5 ft. I STATIC WATER LEVEL -.._3o ft. DATE MEASURED 94 DRILLING EQUIPMENT a. ROTARY ® COMPRESSED AIR PERCUSSION ❑ DUG O WELL POINT O CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING ZI OPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH 153 _ tL MATERIALS: ® STEEL O PLASTIC O OTHER LENGTH BELOW GRADE 152 ft. JOINTS: O WELDED f3 THREADED .❑ OTHER DIAMETER 6 in. SEAL: LFCEMENT GROUT O BENTONITE ❑ OTHER WEIGHT PER FOOT 9 1b./ft. I DRIVE SHOE. ® YES ❑ NO LINER: O YES ®NO SCREEN DETAILS DIAMETER (in) -SLOT SIZE LENGTH (11) DEPTH TO SCREEN (ft) DEVELOPED? FIRST O YES ONO HOURS SECOND GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK JTDOEPTH P ft. BOTTOM DEPTH It. WELL YIELD TEST If detailed pumping METHOD: ❑ PUMPED tests were done is in- i � 1QcCOMPRESSED AIR , . ormation attached? BAILED ❑ OTHER :OYES ONO WELL LOG It more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear- mq Well Dia' Inecer FoRh1ATtON DESCRIPTION can ft. tt. WELL DEPTH It. DURATION hr. min. DRAWOOWN It. YIELD gpm. surtia 4 Drilling in overburden clay & bould rs ro k at 411 60 6 585 5 4 53 r57-94 li g in rock, se casing, grout d 15 605 li g in rock granite. Hydrofracturing Procedure WATER O CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY GAT,,. I PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELL DAIUER NAME .17.17.1155.L Ori , C . OAT ADDRESS 4 Putnam Ave . 7/94 Brewster, NY ld'j" J /by \' I I PUI'NAM ODUM DEPARn4EY2 OF HEALIH DIVISION OF ENVIRO,iIQTAL REALTH SERVICES Owner or Purchaser of Building. Building Constructed by ��M���r 'I�12►V� Location - Street Municipality Building Type Section Block Lot Subdivision Name Subdivision Lot #1 GUAR -711 .E OF SUBSURFACE SE PU GE DISPOSAL SYSM 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 Envi.ronin?ntal Health Services of the Putnam County Department of-He ' alth as to whether or not the failure of the system to operate was s caued by the wilful or negligent act of the occupant of the building utilizing _ the system. - Dated this day of/I__76 194 Signature Title , eral r ( - tune Corporation Namd (if Corp.) Corporation Name (if Corp.) l .5 Sv M e5srr ser /fie Address � n . rev. 9/85 mk ANALYSIS DATA SHEET TYPE: PW LOCATION: Lot 4, Devon Rd. REPORT TO: Cornwall Homebuilders Inc. ADDRESS: 155 E. Main St. CITY, STATE, ZIP: Brewster, NY 10509 DATE COLLECTED: 01 -26 -94 TIME COLLECTED: 11:20 COLLECTED BY: Sylvester J. Pecora Jr. REPORT DATE: 01 -31 -94 SAMPLE: 94 -0454 SAMPLE SOURCE: Water tank DATE ANALYSIS RESULT UNITS METHOD ANALYZED Total Coliform Absent COLILERT 01 -26 -94 THIS SAMPLE AS RECEIVED AT THIS LABORATORY MET THE REQUIREMENTS OF NEW YORK STATE DRINKINGWATER STANDARDS. Laboratory Director NEW YORK STATE ELAP CERTIFICATION NUMBER: 11218 618 CLOCK TOWER COMMONS, RTE 22, BREWSTER, NY 10509 / 914 - 278 -7600 / FAX 914- 278 -7754 Lot Acv. N=bw d . .. Deter I%w G P D �� PCED tibd Moa is RegWmd Wben F61 i ea ipww Sepaeobs Sewee e, S 0 to as+" of top" 51109 Teeth God � Z�D 0 To 6-ommkoded.by e Addreae Watss Sam; @oa me S,"Ii,Fe an I/ Pdwn" Suptib DsIBed bt . A&dN= Olive eeta 1 iepiesant "that.) am wholly a'' -' pNtaly nspogsiblofoithe "ilgbandaoeatioil of tM proposed systorn(s)l 1) that the saparate' few.. .di sN f stem above described will bo constructed a's drown on the approved ainentirn m th®►o to and in accordance with the standards,' rules ii rpumpons of nam be fubmllted -to tM Oeperinlenl and a 'wr.i' ptKe 'in fiMq' -'at' condtiloh snji'slart: ahCe of the appmal.of the iwtifkats'of t will be WrAted as, -I- W, 6 on threpproved Pion I County Oaparuf a of I A"Ith. oat® ndd.ea... APPROVED FOR CONSTRUCTION Thii app revoeabso for cause or r w.amondoe oi.mo requires a na mif%�pproved for dispoi Rev. 10/88 ace tNion fhMeof a 'Certifweto -of Constiuction_Compliante' satisfactory.to tM:Cominisslonor of McNlhwill I,yarantim :will bi',sumisn� :;the;ownar his fuco_ es**,,MMs oi'aiiigni- by'the bulidei, that said builder will ifd apwape disposal 'systoin duriiq.tlle,psiioe 04 two (2?)'yeais bnmodiaNlY follawirp tMdete of the iseu- iuction; Complknq 'of., t¢o original, system; or any repair therNO: 2) that the drilled well deseribe0 above let said well will be.lnstVi" in aocordanoo' with the s)badarpt. yt W and. ►in -U-6 oE1Ms of . the Putnam MMZ Eli i IM � 'exp ires two yeah fro'rn.the daidlssued unless construction of fM building has been ulWwtaken and is I whop cDnsidere rieces00ry by-the Commissioner of Heal h. Any change or alteration of construction domestic sanitary sewag% andlpriivmte 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 99 PCHD PERMIT # ' /V /� WELL LOCATION Street Address Town Village City Tax Grid Number. F�,L� fL3. _ I _ WELL OWNER Name p Mailing Address j z)JL Ef ty eq U ¢Private O Public USE OF WELL - primary 2- secondary 13 RESIDENTIAL O BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION b INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (spec ifq O AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED �5 /EST. OF DAILY USAGE _6,:9nn Sal ❑ REPLACE EXISTING SUPPLY ❑ TEST/ OBSERVATION GIADDITIONAL SUPPLY NEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE ®DRILLED ODRIVEN DDUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES 1/ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: �pU�,e�w }2fRF Lot Mo. iJ. WATER WELL CONTRACTOR: Name (J Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES V-/ NO NAME OF PUBLIC WATER SUPPLY: W IA TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ®ON SEPARATE SHEET (date) nature 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 mannX as not to degrade or otherwise cont i surface or groundwater. Date of Issue: 19 Date of Expirati en 1_ Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller rLJililx'♦ �ll�il LLCly lJ11L...�t V4 11Lt11JiL _ _ ... DIVISION OF RFALTH- SERViCFS DESIGN DATA SaEh,T- SUBSUFACE SERI I.GE DLSPOSSAL SYSTEM FILE 'NO. Owne -- P.ddress Zf Located at (Street) 'p0-7 U,:O K) 1� Sec. Block Lot <o (indicate neirest, cross.street) Mvnicigality. �C'rh4 N Watershed �ifzaTo� sorL PE` MLASIC�I TFST DATA RE�rUIl2F7D TO BE suFi'rirrrED w PPPLIC ICNS Date of Pre- Soaking Date of Percolation. Test /fe HOLE NU-4BM P= RCflLA CN PERCOLATION Run Elapse Depth to Water Fran Water Level ' No. Tune Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop _ Drop In Min /In Drop Inches Inches Inches 1 Ind v- _ -. ,1; 1 r2 �1 2 v _ D 3 4 5 • .... 1 �G 2 .2- is 3 j : 2. 4 5 1 • 2 3 4 5 NOTES: 1.' Tests to be repeated' at. same depth until appradmately elLm1: soil rates are' obtained at each percolation test hole... All data to' be sdbmitted . for review. 2., .Depth measure Tents to be made fran top of hole. rev. 9/85. L�LJ.uv......+ tv Lazo ouzx: L11L11 rr1Al1 Mzrj�L. 11VN DESCRII?TION OF SOILS ENCOUZ41ERED IN TEST HOLES DEPTH HOLE NO. i HOLE N0. HOLE NO.. G. L. l' 2' 3' 4' 5' 6' 7; I/ g' 9!- . 10' 13 ... 14' INDICATE LEVEL AT W'diiCH GROUND;rZATER IS E 900UNTERED INDICATE 10-M TO WaICa KATER LEVEL RISES A.F= BEING ENCOUNIE M DEEP HOLE OBSERVATIONS t2 -.DE BY: DATE:. DESIGN Soil Rate Used Min/l" Drop: S.D. Usable Area Provided -5 No. of Bedroans Septic Tank Capacity gals.' Type Absomtiob Area Provided By erV L.F. x 24" width trench Other Nary �c�I�2� W • 'i l,v ��: Signature. Address _T?2 MI � j �D DI �I �!E SEAL TT _ THIS SPACE FOR USE BY 'HEALTH DF.PARTMEN P ONLY: S i b�s-is_r SM04i Fri� oil Rate Approved sq.ft /gal. Checked by AROFESSXO Date pL77CNAM COUNTY DEJPARTMENT OF HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: 2. Name of Project: Location d�V /C: 4. Project Engineer:��f 5. Address: License Number: Phone: _=_610 6. Type of Project: I/ — Private /Residential Food.Service ..•.Commercia•1 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 t/ Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? 9. HaSDEIS been completed and found acceptable by Lead Agency ?:........... 10. Name .of Lead Agency -I'J /A 11. Is this project in an area under the.control of -local planning, zoning, or other officials, ordinances? ......... ............................... Q.7U 12. If so, have plans been..submitted to such author .sties ?....._............... 13. Has preliminary approval been granted by such authorities? N4A- Date Granted: 14. Type -of Sewage Disposal: System Discharge,...... Surface Water ✓ Ground Waters 15. If surface water discharge, what is the stream class designation ?........ i6. Waters index number (surface) ....... ............................... .. 17. Is project located near a public water supply system? .................. ! a 8. If yes, name of water supply Distance to water supply_ ;9. Is project site near a public sewage collection or disposal system ?..... _ ija :0. Name of sewage system %Ac Distance to sewage system 11. Date observed: �$ 23. Name of Health Inspector: 01;�. tLm? ,nN`��� 4. Project design flow (gallons per day) ...... ............................... z4>0 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. D 26. Has SPDES Application been submitted to local DEC Office? ............. ... lAr 27. Is any portion of this project located within a designated Town or State wetland ?......... .................... �b 28. Wetland ID Number .........................../,� 29. Is Wetland Permit- required? .............. ............................... 1J D Has application been made to Town or Local DEC Office? .................. N� 4 30. Does project require a DEC Stream Disturbance Permit? ................... l� D 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 ,J 12 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 Q-0 DESCRIBE: 33. Is there a local master plan or file with the Town or Village? i 34. Are community water, sewer facilities planned to be developed within 15 years? 35. Are any sewage disposal areas in excess of 15% slope? ........................ .0_ 36. Tax Map ID Number .............................. ......... ............ -�- 37. Approved Plans are to'•be returned to: ................ ' 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 provision 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 knowledge and belief. False statements made herein are punishable as a Clas A Misdemeanor pursuant to Section 210.45 of the Pena 1 Law. %/ A SIGNATURES & OFFICIAL TITLES: 4AILING ADDRESS: PU'TNAM COUNTY AEPAATMENT OF HEALTH DIVISION OF LNVIRONMENTAL HEALTH SERVICES Date 5 Re; Props arty LQr'ated at VpN _ fix? (T) �'.�,r,�Ot -� Section 2 Block Lot � Subdivi,ei,on of Corte Wa-I �R14 -e — - Subdv. Trot Filed Map E 7.1 ( Dat, a 5 -2.1 CI Gentlemen: This 1Qtter is to authorize HIIIr� 6C;ICw /S` C'Jel a duly licensed prof®ssional engineer 4./' or registered architect {Indicate to apply for a C6riate'uetion Permit for a, separate sew9,ge system, to serve the above rioted property in accordant® with the atandards, rules or regulations as px•emulatAtad by the Cohimissioner of the Putnam County Department of 14*alth, and to sign all necessary papers. on my behalf in conneati.on vr%th this matter axed to superviag the QOnstructi.on of said bystam or systems in conformity with the provisi.ona of Article 145 or 147, Education Law, the nubtia Health I,aiv, and the Putnam County Sani- tary Codc, r� C6untersigned: P.E., R-A.,, ` Address 4 Y-- Telephone Very tl %AI)'j/Y0%Irq' -�--.- Signed. Owner of Property Addre5n - 0(4�4� AJ V Town Telephone- �X G t�OGK �iSt . eaX ii io i7 T�eN to C br_-1 V0 N �fHAT THE S�WAv� A �AN A-.) ANC -( HAT T H F—� THE 5 -�eTEM VVAS ale OANGE W hTH AL-1. R2 1QEGUL,ATIONS OF 2 3 4 5 G ri�IelQi A v a 125 COAL -LOW SE ►?T 1 G AN K- RPA b Putnam Cow Avision of Ens tpproved a# not applicable Hul( ?utnam Co�unt�y I J AS -WILT VIMNSION GNA12T N� A t3 I (G) I !o .0' (t7) 30.0' lob 0' 3 101 �O.' 1 10.0' q ( 03.0' 1 13.0' 5 I. O(o 0' 1 10.0' ( 23.0' 7 I8�1.O Ig1.0' 8 i 83. •?' 18`1. D !0 ! -N .0' 185.0'. I I 1 -78 0' ►g3.O' MI, I'U! SITES Lc SO TM. #