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Home My WebLink About0611DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -2 -18 BOX 7 L� .1 rig �tiIN �- IN .1 . , 00611 , SAM C�G ,� . �/. v '10 WELL COMPLETION REPvni DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only s WELL LOCATION STREET ADDRESS: izWRIVITEXU mil Y TAX GRio NUMBER: a acs IQ s !� WELL OWNER NAME: ADORES : eNt Yt'I I, l+a P d �✓. X vh e Q� �%, Div �r c. g- PRIVATE ❑ PUBLIC USE OF WELL 1- primary 2 - secondary RESIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND. /HEAT PUMP O ABANOONE ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) O INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY 0 MOUNT OF USE � YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING QREPLACE EXISTING SUPPLY ®TEST /OBSERVATION [ADDITIONAL SUPPLY D*EW SUPPLY (NEV DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH ft. STATIC WATER LEVEL. - ft. DATE MEASURED DRILLING EQUIPMENT P40TARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT O CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED Q OPEN END CASING O OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH 0- f ft. MATERIALS: PSTEEL O PLASTIC O OTHER LENGTH BELOW GRADE S ft. JOINTS: O WELDED QTHREADED ❑ OTHER DIAMETER b in. SEAL: O CEMENT GROUT ❑ BENTONITE C3.6THER WEIGHT PER FOOT lb./ft. DRIVE SHOE. ❑ YES (_10 LINER: OYES ®NO SCREEN DIAMETER (in) SL07 SIZE LENGTH (it) DEPTH TO SCREEN (ft) DEVELOPED? DETAILS FIRST ❑ YES ONO HOURS SECOND GRAVEL PACK 0 NoS GRAVEL DIAMETER SIZE: OF PACK in. I TOP DEPTH ft. BOTTOM DEPTH It. WELL YIELD TEST It detailed pumping METHOD: ❑ PUMPED tests were done is in- � g.COMPRESSED AIR , formation attached? BAILED ❑ OTHER ❑ YES 0 NO �I�LL LOG it more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear- ing Well Dia' meter FORMATION DESCRIPTION coat ft It WELL DEPTH ft. DURATION hr. min. DRAWDOWN It. YIELD gpm. Land y s,w ' G (e t WATER ❑ CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS ❑ COLORED ANALYZED? ❑ YES 0 NO ANALYSIS ATTACHED? ❑ YES ❑ NO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HPO_ WELL DRILLP NAME DATE AO ESS A iGrlATURE I 1 L ' �� 1111 e v PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ! l ro er or Purchq& of Building 0 to A" a V- Building Constructed by - Street Milnicipality ,---A e- f - •(.f k( 1� 1 Building Type -)�:3 3- 69 Section Block Lot S on Name Subdivision Lot # GUARANTEE 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 Environinental 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 JQ 19-u neral Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 Mk Signature /) OL4 4- Title G(% Corporation Name (if Corp. ez Ac1dress M. YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovani, Director f/J LAB #: 93.007914 CLIENT #: 1733 NON STAT PROC PAGE 1 -------------------------- ------ NNNNN N NNNN ---- --N-- ---NNN ----- -- -- -- - - PALMIERO, MICHAEL & DO DATE /TIME TAKEN: 07/26/93.08:00 42 WIXON POND RD DATE /TIME RECD: 07/26/93 09:13 MAHOPAC, NY 10541 REPORT DATE: •07/27/93 PHONE: (914) -628 -4497 SAMPLING SITE: MCMANUR RD OUTSIDE TAP SAMPLE TYPE..: POTABLE '4- PATTERSON, NY PRESERVATIVES: NONE COLD BY: DONNA PALMIERO TEMPERATURE..a < 4C NOTES...: COLIFORM METH:.MF ----- NNNNNN- ~~ -Y ------------ N----- IMIHI- NNNN NNN---- NNN•INNNNNNNNNNNNNNNNNNNNNMNN DATE FLAG PROCEDURE RESULT NORMAL — RANGE 07/27/93 MF T. COLIFORM ABSENT /100 ML ABSENT COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER (WAS (WAS NOT) OF A SATISFACTORY SANITARY DUALITY ACCORDING 0 THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. SUBMITTED BY:----- - - - - - -- --------------- -- Albert H. Padovani, M.T.(ASCP) Director ELAP# 10323 v V • � v / -• „ .� LlVrelVD Y1 GDVDVDDIVDDY II I'ilDl.ltllVrlNe W[DlOI 1 \:1', 1VJli - �"e— on CERTIFICATE OF COMPLIANCE - ? 1V {t C UCTION PERMIT FOR SEWAGE DISPOSAL ; SYSTEM Permit N c;ultzs Located at . Town' or' Village n � apSabdivlsio Ln To Block Lot _ O R enewe - Revisio n ❑ wner /Applicant Name ki l-W& J A &4,? 1 of to .'Date Previous Approval MiMng Address /”- e �U !] �� O« /U - Town th Zip C saucing . Type /7% G :. Lot Area' FID Section Only Depth r Volnnie Number of Bedrooms ' Design Flow G /P /D _ PCHD Notiflmidon Is Required When FIB is.compieted '— a 99 /f Separate Sewerage System to consist of��Gsllon Septic Tank an U "' "'C To be constructed bY. Add<ess Water Sappl . Mile Supply From . Address or- Private Supply Drilled by s.tdress 1 .Other 13egaliements 't atcl am wholly Anil, completely responsible !or thedesign� and location -of• -the proposed system(s),'1)`that the�separatesewage 'disposalsyitem' t ab.Ve'described will be constructed as,shown on'the approved amendment there to and in accordance `witil the standards; rules an IegU_a,iOrlsO - e° u nam County' .Department of;; Health • and that on completion thereof a Ce tiLWte ,.of'Co'nstruction�Compliarice' satisfactory tO the COTmissioner;of Healthw�ll ..,t: i be ••,submitte he d 4o t g': Department, and a wilt ;a r, _ee;w�ll be, furnished „tfie ownei, his dllccessors, hefi oi,assigns,by the builtler, that said. builder will ”- place. in good operating condition any,part of'saiit sewage,dosposa_systerricAuring the period,;of tw,o,(2)' ears'i 46 stely following the date of the'issux } ante' of the approval of, the 'Certificate of,Construciibn Compironce;;yof tlie'or anal system or y epai "the o; )that the drilled welLdeseribed above a will, belocafed as shown' on the approved plan and that�5aid well will be inst 14d"' _ accord a w'- a •sf no ds, 'r I andreg ons of ' {the Putnam - i r _ County. Dep • art 4 nt ,b Flealth'' Date 5i9ned P E R A 1 .'. - �' ; Aess ... , ,.. 1.,.. r, Lic. No's = {�� CGr ' APPROVED FOR CONSTRUCTION:' This:approval;'expues one year frorn the date issued unloss co truction of the building has been undertaken and ii revocable for` c8use.or.may be amended or'modified` when considerednecessary:'by the'Commissioner.of. Health:; Any change or alteration. of construction - requiies a new permit. proveE for disposal of �domestic.saniiar sewage, an r _'vale wa - supply only;.. - t b �l /�G /'mss Datef� /ter .� /• `� / 7�eY .'a�'rGT —, Tftie i4-' - -_. F :,. : � r �'+�L - f., - ; ^ �'_ d .� "`Z" � _'�': t - :.4-- r- 7 " -.rr- z -z ^7 +^.a•� -rR - { � x T 9� •( :+ PUTNAM COUNTY DEPARTMENT OF HEALTH w a 7 REV 3/86 Division of Envhnnmental health Servloes Caemel. N Y.1051? Engineee vide Permlt N .- on CERTIFICATE OF C011 _ ANCEE CONSTRUCTION PERMIT F'A' SEWAGE DISPOSAL SYSTEI4Y n{ %� Peltmit fir `� n : Located et ' own , Vlllage r Saixllvielon Name /¢ /F bd. Lot N -Tax Map T Bbek r Lot Renewal, Revlsbn p ; Owner /Applicant Name -� Diite of Previou�spApp�roval Mailing Add.no /J f�1C_ /� 'Town ! ®L B-� yip r y7� e�! «Pi��, �lOz IDSSL� 9 Building Type -- lot Area FID Section Only -J Deptli� Volttmo PCHD Notifl&don is R en Fall b irom leted Number of Bedrooms Design Flow G/P/D P Separate Sewerage Syetgm to'conleist 'of �[QQILIIen septic Tank aud� — /0 �: t n Te be ro�tro�a by - 'Aaareae 1: Rt Water,SapPl) Public $apply Flrom Addreee ' - 4y r `-fig orsFrivate Supply Drilled by sddrosa) Other :Requirements' a ' represen that „I am wholly and completely rospons�ble for the design and locat,on of the proposed systems) 1) hat the separate .sewage,disposal,;system above'dascribeD:will be con ;tructe0 asrshown on the approved amendment theretto and in! accordance wRh.the stantlards ruleSan regu a ons o e u nam County Department of ^Heakh ,did that on completion thereof a Ceit f�cata of Construction - ComDhance, sat�sfaetory to £he Comm�sslono ► %ofdHealthwsll :- be'sutimitted; o the - DepartmenC; and a :wntten: guarantee -will be furnished the owner his wccesso►s heirs or assigns by the builder, that ssig bwider .will place, in goodYoperatsng _,,,con dition any part of, said sewagesdssposal system .During the per�otl of two year'siminediately following the date of the isw ance,..ot the a royal of the CertGticate -of Construction Complwnce of the', y�naLsystem;or any ro ri to• 2 thatahe drilled well desGsbed above DP wUl be'locatedas shown:•on the approved plan and that sand well wall be ins 1 accor ce the sta- arr es and °.r -ons of t Putnam County rtme 'Of 'H i Date s -n sg [gyp e Address' s License No iJ APPROVED FOR CONSTR VCTION This'approvexpires one year from the;tlat6 issued Un18sSCOnSirUCtiOn of ,the bu Jding hes`been undertaken and �S revocable tor:csuse ormay be amended oim'od�fiedwhen eoosidered necessarysby the Commissioner of HealthAny;change or akerat on of`constru -lion - ,Arequtros a new permstADProveO for d�rs7posal bf Gomesticsandarysewage and /o r_iva afar wDDly only s F Date.�r/ r / 7 / /'� IBY°� ilia -- — — —_ --- e t c ENGINEER "TO PROVIDE PERMIT ®i PUTNAM COUNTY DEPARTMENT OF HEALTH o,N_.CERT FICATE - F COMPLIANCE \ \ ,' Drvrsion of .Environmental Health services, Carmel Af Y 10512 PERMIT .# CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM 7, /V Town., or village Tax Map _ .may •,,, r - , Located'at a+ / lock tvt 1 PA at $ubd.:`LOt .� Renewal .' Revision Subdivision " . ®:, Owner /Address' - ." - - .APP Date Of Previous royal 8ullding Type Lot Area- Fill section only ❑ Number of Bedrooms Design Flow G /F /D F C H. D Notification Required Separate sewerage System to consist of :Gai.-Septic.Tank and ✓� - To'' be :constructed by Address. y.., Water Supply Public Supply From m Private Supply- to be drilled by _ Address, - •• Other' Requirements (.represent that I am wholly and completely; responsible for the design and location of ,the proposed, system(s):' 1) that the separate - sewage-' - disposal, system % above described will be constructed. as shown on the approved amendment thereto and in accordance with the standards, rules an regu a Ions o e u nam County, Department of „'Health, and that on completlonrthereota "Certificate .of COnstruction.ComPliance satisfactory to the :Commissioner of, Health will - . be;submitted. to the Department, `and a: written guarantee will be.furnished'the'owner,•'his successors, heirsor assigns`tiy the builder, tlit "said builder will place in: good .operating ycondition any part of said 'sewage `.disposal system during t ie period of two (2) years immediately following the date of the issu- Vance of •the aa`pproval,of- ,:the'Certificate bf-" structi - Compliance of he original system or any repairs thereto ;2),tkit ihe'drilletl well described above will be located as shown on the approved planand that sold well oll be ins it in accords ce wfft�a nIs, , rules and regula —f oni =of the utnam CountyDepa ment o Health , bate -Sign r PP%E�% R A Address License r, $Fl APPROVED FOWCONSTRUCTION Tt`i ap roval expires o ye ,from the "'date Issued u less construction `of the building ;has been undertaken and' is revocable. for cause or maybe amended .or modified when'con id' d-, cessary by the Co - ss ner of ealfh_ Anv change or er n of construction requires' a new' permi Appr ed' -tor disposal of ;domestic', nit cy sewage, 'nd /or pri to w ` ly only. Data —..., By le _ Tit Rev.. .6/85 0 -s. II. IV. V. VI. r_e rrivu.L," t-. FINAL SITE INSP =ION Date �'� in ed by -!ON C/ Il(,/�Iil�f.C� s Y �Yl CWNER�� ,► IM a OR SUBDIVISICN LOT 73-3-6 - ► ► YES N NO C CCMNF �S .0w -- DISPOSAL, AREA a. SUS area located as r approved plans b. Fill section - Date of placeTient 2:1 barrier - I= WIDTH AVG.DPTH c_ Natural soil not strinned d_ Stone, brush, etc., greater than 15' fran SDS area e. 100 ft. fran water course /wetlands. v v Sr�U'=-- DISPOSAL, SYSTEM _ — - a. Septic tank size 1,00 1,250 b. Sentic tank instal ed level c. 10' minimum fran foundation d. No 90' .bends, cle :rout within 10 ft. of 45' b--rd I I � e. D I.STRLBUTICN EOX ( ( j j 0. s � ,�- 2. Protected below frost I I A AM - b o K 3. Minimum 2 ft. ericrin� soil between box and trenches f. JU ION BOX prc�ly set g. U114 � , 1. Length r= _^_aired - y Length ins talled'y '/'� I I A)h 3. Installed according to plan j j J- 4. Distance center to cante_-r 5. Sloce of t=ench acceptable 1 /1'0 - 1/32 " /foot. I I L L 6. 10 feet fran urccerty line - 20 feet - four_dati cns 7. Depth of trench < 30 inches fran surface 8. Roan allcxed for excansion, 50% I I 9. Size of gravel 3/4 - 1�" diameter 10. Depth of gravel in trench 12" minimum I 111. Pire ends carped h. PL%T OR DOSE SYSTEMS I 1. Size of um chaanbeY 2. Overflaa tank 3. Alarm, vi sal /audio I I 4. Pump easily accessible manhole to redo' 5. First box baffled 6. Cycle witnessed by Health Der�nent estimated flow r cycle GE Ia. Equse located � approved plans. cc j0$ L-Q b. Iri.-nber of bedrarns WaL Ia. Well located as r approved plans b. Distance fran SDS area measured j d D ft. c. Casing 18" above grade. i d. Surface drainage around well acceptable. I I I OVER.M -L WORKM.AS= a. Boxes roperly grouted b. All i ipes - r Lie? 1 backf illed I I c. pipes flush with inside of box I d. Backfill material contains stones < 4" in diameter e_ C�.rcain drain installed according to plan f. C•:rtain drain cut-:all protected & dir.to exist.watercour g. Footin drains discharge away from SDS area h. Sarface watt protection adecuate i_ =osion conLol provided on slores greater than 15%. III, F5111111 i� t' i iii 0 uck�l ad SS D5 /Y2e t AW c� /D� G � adaPzc+° ��- `��z �,co y„or9n 'Y .'rte ENGINEER TO PROVIDE PERMIT # PUTNAM COUNTY DEPARTMENT OF HEALTH ON CERTLFICATE OF COMPLIANCE. Div J ision of Environmental Health Services, Carmel, N. Y. 10512 PERMIT 9 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM �dpf, own/or-el—age Located at Tax Map 5 Block �) Wt Subdivision Subd. Wt q Renewal :[I Revision ^❑ l . owner /Addresses d /{/f Date'Ot Previous Approval Building TypeJl ' O E Lot Area Pill Section only ❑ P.C. :A0 fication Requiro Number of Bedrooms Design Plow c /P /D � Separate Sewerage System to consist of Gal. Septic Tank and o /s r I I ! �a•+' To be constructed by Address Water Supply: �..` Public Supply From `Private Supply to be drilled by max. Address Other Requirements 1 represent that 1 alit wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations ol the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Hoalthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following the date-of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be ins 11 in accorda ce with It tanda ds, rules and regu a 9onS' of the Putnam County Depar3ment., Of Health. --- / Date -9-1-Z 2A!25 P.E. R.A. or Add►essa e ' • '� License APPROVED FOR CONSTRUCTION: This ap roval expires o e y from the date issued u less construction of the. building has been undertaken and is revocable for cause or may be amended or modified when conrideied necessary by the Co�% of ls4igner of_Health..._ -Any change or,altifition of construction requires a new permi ApDro ad for disposal, of domestic nitarylsewage, and /or privbte wafer supply only. j .Date ! �) °'"® ...+ .�f.�_...;L J -� 1 �•C n� 1 Title BY __._ �`.... Rev. 6/85 .....::....:..,�.,.,�.,..... _, .. .., Win. '. .. ... .:,., .. '... lt_i ♦ .. W C: LIJ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property of Located at W (T) Section —7"-3 Block j Lot Subdivision of ff-W(!A2 /[J ZKF"' � �yj j -6!S2 (-- Subdv. Lot # Filed Map # a2d Date Gentlemen: This letter is to authorize /�!/�, / 6, lz6ky49? :2K / J 6 a duly licensed professional engineer or registered architect (Indicate to apply for a Construction Permit for a. separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, Signed. Countersigned: caner of P erty Address a Address /04 '1�/Wc Town 11 ::' Telephone 6�ECEIVED' OCT o 11985 PUTNAM COUNTY DEPT. OF HEALTH GUT 60 f. . b PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM Owner Locat Munic FILE NO. c. 1,17 Block Lot ssree Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole I I Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to a er Water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop P / Inches Inches Inches 2 / 1 / s 13 Z2, 4,�> �-- 3 e00 3 Ott 5 J/' 6 /2, 1.9 Ad 2 l '°4 jZ4'/2 3 77 1 2 4 9,&`1%. &Me w amow PUTNAM COUNTY DEPT, OF HEALTH Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED.TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS �,TICOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE N0. Z� HOLE NO. G.L. 6" 12" 18" 24" 30" 36" 42" 48" 54" 60" 66" ti o® It 0 c� 721 78" !9 a Z L 84" t>.1a�Ye�6e �E1C� t1,G Zt� ` del ' INDICATE LEVEL AT WHICH OUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date C� DESIGN Soil Rate Used ` 0 Min/l'.'Drop: S.D. Usable Area Provided No. of Bedrooms--5 Tank Capacity Gals. Absorption Area Provided Bye L. F. x24" �j'b'�— tY� c.— Address THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: SEAL ' pROFESSm OA Soil Rate Approved Sq. Ft /Gal. Checked by Late a T uj IL Op ,Lj aObWlz A,'. CL uj IL 6 six,r- _— 4 4,A4 � ZZ-- , n r4 0 0 �- �-- " '4 w 11ali Z I 1, :z T Op 6 six,r- _— 4 4,A4 � ZZ-- , n r4 0 0 �- �-- " '4 w 11ali Z I 1, :z T