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HomeMy WebLinkAbout0704DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23.12 -1 -29 all ' , IL A 1r r , , � . 00704 yet ,.tt.,, yr..,. x, 5 i � � a ;:.. r t � 5 - � �`� d � �. •t @ a� v ' +„ ; ... } L` s , 1 pt, •! , � i 1 :, ..'. ?W i- 5 � m i� �a 3 .'N9'�°^ ,+�` EJ'a x T y, � ' ,�� 1`�' \ is1 R v 386 ` PUTNAM rCOUNTYDEPARTNIENTtOFHEALTH� Division of Environmental Health Servtceei Carmel, N Y 10512 , z a G Eegtneei most Provide ' �� l�� tL ,y � ,fit , • v�PCHDtPermltM � P �i0 S1 , k i /A\ \' X�; # w ti t +r # •tY r ` 1 - s r,F` r �. t .�•6.. CER TE, OF,CONSTIUCTION,,COMPLIANCE'FOR SEWAGE DISPOSAL SYSTEM.3 ,g'�- �=e✓{iSp1�I a r - :,� , a ti i • i � :Town or Village, •� r O ) �' ov✓DERI- loi2i.l 1A� IS S ,4 Located, at T� MaP M1 Block rt Lot W oa.� G'� Sr Forme "rl Spbdivieloa Name�F�'i r lTtoG< Sabdv Lot k 0{F"Papplicant;Name Y` P O 8ok 380 Zip 1o51CO ermitlseaed5 :L,S 87 MA6611 ddress Date P • .T ..; yF.� +F�IARC�..'t t°F MAJOR �t.lY i . � `:F • r, ,Separate•Sewerage System built by' �-� `� 30 R�`1 t_•Lktz� r -� Addres P O 1 J o x 8 BRIA PF M,arJo(� :� 1250 ABxFZi'`iCtJ '%�x/cs/ Ws, 01_'. Gallon Septic Tank and' S water, Supply: Pdblic Supply Fmm Addreae Private Supply, DrWed by PF ��`� `^fig Address O �rS�, B F'JREM wga., 'lJY T {�s ► p ark�E ` ` Has Eosion Control`Beea Completed? Nm uber -of B m edroos ♦' Has;Garbage Grinder Been InstalledY _Other Regabrementa � � ` r } �, I ceztify that the eyetem(s) ae♦ listed serving the above premises were constructed essentially as shorn on th -plfina of t}ia completed work (,copies a of,phidh are attached),',and in;;accordance with, the standards rules' and regulations in accordant with the iled, plan and.the permit issued by the Putnam C unty Department OfppHedlth 1A C r '' Certiffei! by P E % R.A. Add►eu �`•� �J C�.eatZ �Y-, Lleenso OD 8 Any ,pa�ion, oecuDY1�9 D�enilsesseived by the above tystelp(`s) ihsll promptlyktake iucA actbnit`may be niceawry to stun the correction of any untanitary -condit)ons result nq} iro_m� wch usage ;Approval ,of. <the `separate $sewerage;system,�shall bieoms null }and void as soon as a pub; unitary sewer, *comes avallaDle and the approval of the .private water supply shall, become nult�and;woid when a publk wafei wpply bae0ines ivetlab* Such approvals as act to modiitutton or' change bew�hsen,� i,�`0the�)udgment of the Commfssior(di of ;►teal h �s eh reyoeatbn, �i►odlfleat(on or el►anga If, MCaw Dat4 %� %Z L i5S/ BY ��I Titta This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. 1 -7 -89 PUTNAM COLTUL Y DEPARTMERr OF HEALTH DIVISION OF ENVIRON RENTAL HEALTH SERVICES Q Ins rkAA Ida,' 'C', Owner or Purchaser dj Building 0 0 `- Building Constructed bf PO W L r l Location — Street . Municipality j I r / / rn o �—tM ► 1 �-( 1� J Building Section Block Lot ubdivision Name Subdivision Lot # GUARANI 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'condit:ion any part of said system constructed by me which fails to operate for a period o'U two years immediately following the date of approval of the "Certificate of Construction Compliance" for the savage 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 �y day of J V `l Q 19 / Signature Title l "Conc Ge nerato.7tf er nature Corporation Name (if Corp.) Corpor do if Corp.) ��� f'1 Address, . . eO Z, ;- 0 t-t 0, /7 4A Address . "I r l���II. AI.fTT �••� T/1�T TTT/1TT w Y 0 WALL UUrirLz1.LVV nArviXi DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET ADDRESS: .iir TAX GRIO NUMDER:• Lot #12, Flintlock Ridge, Patterson,NY WELL OWNER NAME: ADDRESS: Arnold Greenspan,PO Box is cliff Mnor NY 10510 p PRIVATE O PUBLIC USE OF WELL . 1 - primary 2 - secondary (3 RESIDENTIAL ❑. PUBLIC SUPPLY ❑.AIR /COND. /HEAT PUMP O ABANDONED O BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL O INSTITUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING U NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 480 ft. STATIC WATER LEVEL 30 ft. DATE MEASURED 11/25/88 DRILLING EQUIPMENT -EI ROTARY ® COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED O OPEN END CASING. ® OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH 31 fL MATERIALS: 9STEEL O PLASTIC ❑ OTHER LENGTH.BELOW GRADE 30 ft- JOINTS: O WELDED EI THREADED O OTHER DIAMETER 6 in. SEAL: ® CEMENT GROUT O BENTONITE ❑OTHER WEIGHT PER FOOT 19 1b./ft., I DRIVE SHOE ® YES O NO I LINER: DYES @ NO SCREEN DETAILS DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST ❑ YES ❑ NO HOURS SECOND GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE DIAMETER OF PACK in. TOP DEPTH tt- BOTTOM DEPTH It. WELL YIELD TEST If detailed pumping METHOD: ❑PUMPED tests were done is in- QrCOMPRESSED AIR formation attached? O BAILED O OTHER ; ❑ YES 0 NO 1ELL LUG .1f more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Dear- ing We11 Ora- Ilneter FORMATION DESCRIPTION qoE, ft. fl WELL DEPTH It. DURATION hr. min. DRAWOOWN It. YIELD gpm. Lan ove rburden- c a b dr it rock at 15' 480 6 460 75 1 1 )rilling in rock-..-,set casing,grouted, 31 480 ri ling in rock granite. WATER ❑ CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? OYES ❑ NO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE We1.lXtrol 250 CAPACITY 44 GAL. PUMP INFORMATION TYPE submersible CAPACITY. MAKER ..Cnulcl DEPTH ?��1! MODEL7EH0 ri 412 VOLTAGE2_3Q HP ._ WELLDRILLEANAME P.F. Beal & Sons,Inc. DATE ADDRESS PO Box B SfOt 9/89 Brewster,NY 10509 ,<-• - v FINAL SL?'� ,•`• Irs�_� ov •'.0 --='• �� . G%1 _ .. C:itq-c %C A4 `B? a L�R SUED- rTISlC�i L„T j �— DI :CSr1LL Por V a.rc CL- ? b. F-4-1 se-c —t ca - Date_ of placa::=--rit 2:--- barrier D-3 -M w �r -r_'. AVG _ Dom: c- r'a =a- scii nct d_ S` me, bra: e cra =ter t`an 1.=,' f_an SuS T e- 100nnft- f :: •wat=- ccur= =_,�wa -. a-r=C. ' 17. SD�� DIS'CL�- F' - -- _ _ I� c. ►c.�"�'C ,- . --1:. = - 1 ,000 -r b. -ce tic tz -r_w i ^c =_ 1 i 1e EL' C. 10 ` miri*.-,L.-:: C_ in. 90° bcr=�� C_ - = ^Ci L w: =r2'_ 10 L_ Cl CEO be e. D! =GjT7,-N f . c. L L. D, °i =.==- 4. DI-Stan-ca c E. 00 1G . C-zm - c= c = V in t L = ; � e_ cc c _- == h. F��-T OR EC-S-';' sirs -- LS 2. C-var-f-LCIq 4. ='?IlD rrz- -S-.c! - tO Cr -Ce flaw Cer C;C- e / I 1 I ' r7. ECUIS7 c. E.cuse b_ N,:-e_T c-f= V. WEI-L c_ aCDrCVC= D1 =nc C. L nC 18" G;_-JC GC-a-Lta^ __ V_. Ci\7 Z iiliPCtii�C- c. F---zas DrCLe=_'i C- C:=I-a b_ t1i D1rcS L� 1'i CcC`:'11 1 crr c_ A -: vices flu w t: in=_ce cf Lcx < 4„ 1P. C'_aT ✓� e_ C' -' R dz- , -L- i i cr, aC = --r" ^_C tO D! = ^. 1=_ (_`•_ - n dr c -f-a 1 Drctect =. f & C_-.tO - C= =i�_^ rce ES4aV r=an EDS a--=—= C___ __! C. �'_C�- cn s ices cz= ,- " t-. ^_ TO4-1 Tw , or ibi PI aF llnk, and—t!—Vv U 'irotistrdi:ted by 0 determined - • Ptttillc Supply : Fiom .;Address r .1 be 'Ott Sioply-DrIDid b rl'O- Date "I of,,Healthwlll his will 'condition any'..•paYL! 0,ft.' said "Oge,,,disp6iil,.iyitervi,,dijriiig the ,period *o11,!" (2► y!arslm!neqiately ho " system *., any repairs ,theFit- d; 2) that ifie:drillec 4ell,dek jibed, above pn the approved plan ' ifid. that ,4WWeWwi be in 4ccordance . with Ids an d. requ Mos% f ., the Putnam Signed- R.A. P.E.� - 260087-:-��'� ut-6: ,52 `pw .��L icihs TIiPC:17.lpN : r o M -date issued -u ss construction of building *asrbeen undertaken and is ay be amended or rWddiiii6:WheKxonsid ► Any Change or altiiration'oi construction Ap roved for ',; disposal,-;o Omest_c'sanq,jry jev!age;.0.nq/qr_-I ate'r. 00, 10 4, %f J- PUTNAM, COUNTY DEPARTNUUiTOFEWALTH,�..�.:,,�, 46v WN t# I MsIono EnArli tal,HeWtfils�,- 105121- Eigli4 r D 'f* do ClaCERTINCATRO CE -..- . . 11 � ;I 3, Pe liwt CONSTRUCTION DISPOSAL SA"Mrs '6 T- 6�dr­ Tat -'Of '.tprsOn-- TJ or Su"AIon F1 4- Name Map Ta: 'Block 'Mbbld Greori§Ddh ;Date� of :F*§vIq"., Approval Am' c/o ;Cash n Associates , P - C -To*. W, kAijiir Ad a R&S d,: Acres Lot Aj". Ful 1 002 Section Oaly Depth VdIumi " Nun6eI, IM M S 00' 16.don Required When FM Is completed `6 .1y M -4 . - - .'7 /1 S I T, TO4-1 Tw , or ibi PI aF llnk, and—t!—Vv U 'irotistrdi:ted by 0 determined - • Ptttillc Supply : Fiom .;Address r .1 be 'Ott Sioply-DrIDid b rl'O- Date "I of,,Healthwlll his will 'condition any'..•paYL! 0,ft.' said "Oge,,,disp6iil,.iyitervi,,dijriiig the ,period *o11,!" (2► y!arslm!neqiately ho " system *., any repairs ,theFit- d; 2) that ifie:drillec 4ell,dek jibed, above pn the approved plan ' ifid. that ,4WWeWwi be in 4ccordance . with Ids an d. requ Mos% f ., the Putnam Signed- R.A. P.E.� - 260087-:-��'� ut-6: ,52 `pw .��L icihs TIiPC:17.lpN : r o M -date issued -u ss construction of building *asrbeen undertaken and is ay be amended or rWddiiii6:WheKxonsid ► Any Change or altiiration'oi construction Ap roved for ',; disposal,-;o Omest_c'sanq,jry jev!age;.0.nq/qr_-I ate'r. 00, 10 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( Q PCHD PERMIT #1 6 O/ .WELL LOCATION Street Address Off of Route 164 Town Village City Tax Town of Patterson TM 1 E; -R1 Grid Number Ic �_ J,nt 4 WELL OWNER Name Arnold Greens an Address c/o Cashin Associates P.C.. Private O Public USE OF WELL 1 - primary 2 - secondary &RESIDENTIAL ❑ BUSINESS ❑ INDUSTRIAL ❑PUBLIC SUPPLY OAIR /COND /HEAT PUMP O FARM ❑ TEST /OBSERVATION O INSTITUTIONAL O STAND -BY [3 ABANDONED ❑ OTHER (specify ❑ AMOUNT OF USE YIELD SOUGHT min 5 gpm /# PEOPLE SERVEDI faro /EST. OF DAILY USAGE 800 gal REASON FOR DRILLING NEW• SUPPLY ❑PROVIDE ADDITIONAL SUPPLY OREPLACE EXISTING .SUPPLY ❑DEEPEN EXISTING WELL ❑TEST OBSERVATION DETAILED REASON FOR DRILLING New residential supply WELL TYPE DRILLED DRIVEN []DUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Flintlock Ridge Lot No. 12 WATER WELL CONTRACTOR: Name To be deter nad Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _)(_NO NAME OF PUBLIC WATER SUPPLY: NSA TOWN /VIL /CITY ..._DISTANCE TO PROPERTY FROM NEAREST.WATER MAIN: Greater.than 1 LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION �? 0 S (date) ; (si PERMIT { 0, % 250 ?; ;11Y TO CONSTRUCT A WATER WE This permit to construct one water well as s,et 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. Date of Issue: 19� Date of Expiration: �7P 19 efft uing ff' Permit is Non - Transferrable 9M �r PVITM COUNTY_ DEPAFrDMV OF BEAI1Tii DMSICN OF HEA= SEtMCES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM'. PILE No I Owner l� r n a l (1 L? ('P 2 n S Q Ct r1 Address . P Ud K "?A C) r t o rS l (I-'f� &I o r N i.oca ted at (Street) p Rt 16 q 'Sec. / Block - Lot 4 (indicate nearest cross street) L6 f 12 municipaiity_ PafterSbn Watershed t;rOf0 SOIL PERC)O=CN TEST DATA RWJDUM TO BE SUBMrr= WITH APPLICATICNS Date of pre - soaking 3 Ntcrc g7 Date of Peroalation Test 24 HOLE . ratPZSFSt CZ�OCSt TIME : PERCOLATION PERODI iCN Run Elapse Depth to Water From. Water Level No. Time- Ground Surface in. Uchea' ' -Soil Rate Start-Stop. Min. Start Stop Drop In- Min/In Drop Inches Inches. Inches 2 1311- 2 -00 30 Zd. Z? ID 4 2 :32- 0 30 24 5 3:0,�- =33 o �2 A 2G 2 1 2-4 2 ► 3� -oS 3v 232 212. /o 3 ,� 2,_O 6 -2 '. -Z6 30 ,23 4 2= 3 7— 3.07 30 2.3 z s 3'b9- 3: 3 30 2_3 1 • 3. 4. 5 Nis: 1. Tests to be repeated at same'depth until apprcx mately. equal soil rates are obtained at each percolation test hale.' All data to'be, submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 DEPTH G. L. 1' 2' 3' . 4' .. 5` 6' 71 8' 9' 10 11' 12' 13' 14' TEST PIT HOLE NO. TO BE Si MMITITD WI79 APPLICATION )ILS IIJ000N'1'ERFD ` IN TEST HOLM HOLE NO.. HOLE No. INDICATE LEVEL AT WHICH GROUNDWATER IS ENMUNTEIRED YnI e 11 CDu r) fer e u INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING EN�UNTF�iFD DEEP HOLE OBSERVATIONS MADE BY: DATE: -- DESIGN Soil Rate Used _ 11 1 Min /1" Drop: S.D. Usable Area Provided 50oo 4z _ i No. of Bedrooms Septic Tank Capacity: 11 5 "0 gals, Type a jt Absorption Area Provided By SOo L.F,- x.24 "..width trench Other Name ssoc r a f c Signature Address M P_ SEAL 1 sJAli) 4i' a t �. THIS - SPACE FUR USE BY HEALTH DEPAR'n -TM ONLY: == Soil Rate Approved sq.fk/gal. 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