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HomeMy WebLinkAbout0717DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23.12 -1 -42 00717 ' ,. �� IN m 's : T ' IN 1'6 NN } Nis is -111 IN a rill 0 1`11N r :11 00717 °Rev. 3/86 CAOF CERTIFICATE -r•.. h — — hLTH N.Y 10512 " 4 Engineer Mast Provide � r P C:H D. Permit q��� •�� , �� ►L SYSTEM : �C�,r� ✓S ;? Town ok Village: ;/ '4.Y✓d ti/ �j /✓�_ , q Tai Located u 1Kep, Biock Lot .pp ame Sabdv Owner/ llcant Name Former) Sabdivlelon'N IUlailing Ad".. J3 y3 ZIP > os u Date Permit. Issued Separate Sewerage System bullt by 4 ✓� r ✓r 194 A_or7 i Address Consisting of Gallon Septic Tank.and .1 ,l F 2 . Water Supply: .. Public. SU" Iy From Address oi: Private Supply Drilled by PG ° % Address �J/`G » �✓ 0✓ y . E� Bnudi;,g ✓�1� /4.CP" Has _ rosloa Contro ,Completed? Number of Bedrooms %�/ Gazt.4 .G n installedY_ U � �i Otber.Requirewents OF NE I'certify that the systems) as listed serving the above premises were construct ee ',of standards;, lf�AtdOt� s .the plans of the completed work ( copies 'th.' which are attached), .'and in, accordance with., thi rules and regulat s,'' accordance iled plan' and the'.permit issued by the Putnam. County Department Of deal c� %d. C' rifled by Oats � f v .. _ P.E. � R.A. 1; .../ y_ d No Address Licenw Any person occupying prom by th bove: systems) shall promptly take su t conditions •resulting from, such, usage. •, Approval of the separate ;aavverpgs system fh may no o secure the corroction of any unsanitary wZAB ' soon as a pubf;: sanitary sewer becomes available and the approval of the -private "water'supply shall.become,null and volo, who subject to modifiratlon or change when; In the, judgment M the.Cominisslonar of, Neal ai becomes available. . Such approvals are i►Si modification or change Is n cesury. tL Title ti _PUTNn.M COUN`T'Y DEPARIMMr OF IIEALTR DIVISION OF ENVIRONMI -MAL REALTfI SERVICES Owner or PurcIlaser of Building �i Building Constructed by Location - Street RTlicipality Section Block Lot Subdivision Name Z Subdivision Lot # GUARANIEE 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 Environiriental Health Services of the Putnam County _ Department of Health as to i- .he.ther or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building uti- .izing the system. Dated this ;Z-el day of 4T'19 q e/ Signature rev. 9/85 Hilt /— Q4 o /% 6Z -;t - h L CorporaEion Name (if Corp.) Address T G Y a C4- Ir9 7r 1,1 Sp0 r iaLioDc)-G /C-& ly .c WZLL tjVrlrUDi.LV" nc.rVni DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET ADDRESS: TAX GRIO NUMBER: Flintlock Ridge Patterson NY Lot #6 WELL OWNER NAME. ADDRESS: Arnold Gr>ee Q PRIVATE ❑ PUBLIC USE OF WELL 1- primary 2 - secondary 9 RESIDENTIAL O PUBLIC SUPPLY O AIR /COND. /HEAT PUMP O ABANDONED ❑ BUSINESS ❑ FARM O TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY Q MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING IN NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST / OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 365 ft. STATIC WATER LEVEL _30 ft. DATE MEASURED 88 _ DRILLING EQUIPMENT [3 ROTARY a COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION O OTHER (specify): WELL TYPE O SCREENED O OPEN END CASING. -U OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH —f 1 fit MATERIALS: [$ STEEL O PLASTIC O OTHER LENGTH.BELOW GRADE 6o ft JOINTS: ❑ WELDED MTHREADED ❑ OTHER DIAMETER `.6 in. SEAL: aCEMENT GROUT O BENTONITE OOTHER WEIGHT PER FOOT AA Ib. /ft. DRIVE SHOE 91 YES O NO I LINER: ❑ YES 0 NO SCREEN DETAILS DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST O YES ONO HOURS SECOND GRAVEL PACK O YES O NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH fL BOTTOM DEPTH It. WELL YIELD TES? It detailed pumping P P 9 MMOO: l2FPUMPED tests were done is in- OKCOMPRESSEO AIR formation attached? O BAILED O OTHER ❑ YES O NO It more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. DEPTH FROM SURFACE , water Bear- ing Well Dia- meter FORMATION DESCRIPTION G70E, tt. fL WELL DEPTH ft. DURATION fir, min. DRAWOOWN ft• YIELD gpm• Surface 2C Erillinp-in overburden clay & bldrs t ock at 20' 365 6 345 20 20 61 il..ing in rock set casin route . WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE Well Xtrol 250 CAPACITY 44 GAL. PUMP INFORMATION TYPE submersible CAPACITY 7_ __- MAKER ,.r -n-11 ri DEPTH ;�pQ! MODEL 7EH07 412 VOLTAGEZ-3-0-HP3�A WELLDRILLERNAME P.F. Beal & Sons , Inc . DATE 8/31/88 ADDRESS PO Box B SIGMMRE Brewster, NY 10509 '—` BREWSTER LABORATORIES Box 224 - BREWSTER, N.Y. (914) 225 -2072 - WATER ANALYSIS REPORT - SAMPLE NO. 7063 SOURCE: Greenspan Builders Flintlock Ridge Patterson, NY vv�rrv.�v. a'au7 uJ �. GJ 1�VV BY: P.F.Beal & Sons, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method Lot 6 This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. August 30 1988 Roy Bi kwit P.E. actor hose bibb -well 0 per 100 ml. .? n `77N— - '�'^�r- -±: -,-, F-r`° c^a --+F ^� �^.ry- '• rz?^„�^"s 'I Lr t; / �� (b PDTNAM CODNTY DEPARTMENT OF HEALTH I / 3 Diylsbn of Envhbamental Health Servleeo., Caemel, N.Y 10511 ; . Eaghteei to Piovhie Peeotlt M t (on CERTIRCATE OF CQWUANCE CONSTRUCTION FOR SEWAGE DISPOS IRV f,OCitOa It • Own Ott.. ,VlOage Sabdiybba Nsme OG Sabel. Lot N Lot' ' R&Won �' Renewal p Owner /Applkant _ Date of Ptevlone Approval' ' MaWng Address , �/ Town BalldinQ Type Lot Aeea FBI Secdon.Onlr Depth Volume Number of Bedrtioma Design Flow G P D G tl PCHD Notlfi -d Is Regalred When MR le 'mPleted Separate Sewerage System to eenslat of GhOon ttc T an'd / G To.be oonatrgcted by ��'l dh / Address Watec SnPPb i1c Supply From Address or= 0k;iite Sappiy.DrlIlW by' Other - er ReQatremente -• . ` .. " I rebreierit that i am wfio0y and comple(ely responsible for the des�gn'and location of the D ►o (fit. °ty��wy " `that tlie} separate sewage dis oral. s stem above described will be constructed as shown on the approved amendment there to antl in ac w' staa� rules an regu a cons O e.:, u nam "County, Depa►tment',of` Health; antl that'on completion thereof a Certifwate,•,ot Constr i�il'' (RMp� s y.to,the Commisslonei gf'Healtliwlll bs wbmittadao the Department and' a written,quaiantee will be furnished fns owne his s, hairs` - n y,,the.buildii. that laid builder will place in goo dperating eonddion any pG►t of said sewage tlispofal, system- during ,f per f f yea%J "rise "tely, following, thedate of -the isau- ance of the epp►ow,l, Of tM, Certificate, of Coristr`uction Compliance. of the original e p� a is is li 2) t t.th6 drilled weltdescribed above will be louted�as shoWn,on the aPProved: plan ind that said well wilt be installed, m acc` Wi., di, s. `d, regu as ons of the PuWan +r County Department of Health Date Heel- . P.E. i►ddress License No Z APPROVED FOR CONSTRUCTION ppr This,aoval.expues two years from thq date issue s budding' has been' Undertaken and ii revocable for cause or'msy amentled of modified when considered nscessa►,�r :by the Co F ��tt�t`' y Change or alteration .of. construction . requires a ` ew permit" por disposal �o,(fdy}o�mestic sanitary sewage; ;and /or' priva lRev. ,' Date I 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�!' PCHD PERMIT WELL LOCATION Stre t Ad r ss 7e h(1_1 * Town Vil /� ge City Tax Grid Number WELL OWNER Name M r_n dd 'ling Address i �O �O jv�'G�i rivate Public USE OF WELL 1 - primary 2- secondary rBUSINESS SIDENTIAL 0 INDUSTRIAL O PUBLIC SUPPLY O FARM O INSTITUTIONAL ❑ AIR /COND /HEAT PUMP O TEST /OBSERVATION O STAND -BY O ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED . /EST. OF DAILY USAGE ,7od gal REASON FOR DRILLING WNEW SUPPLY O PROVIDE ADDITIONAL SUPPLY OREPLACE EXISTING SUPPLY ODEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE BILLED ODRIVEN ODUG O GRAVEL O OTHER I IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY G DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: ^ LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED .� O ON REAR OF THIS APPLICATION N SEPARATE SHEET (d e) —7-71 _ (si WapreX ®.® 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 Dep rtment. r Date of Issue: 3� ermit Issuing icia Date of Expiration: 19� Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner 2/87 nrancre PL]7NAM CO= DEPARTMENT OF DIVISION OF ENVIRONMENTAL. HEWCH. SEMCES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner �i^�a� ��r''! �o�iv� Address Located at (Street) a' ✓�'Gz '�'� (/% Sec. /S Block Lot _� Al (indicate nearest cross street) , Municipality 4 ,�� ®/i Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking / Date of Percolation Test HOLE NUMBER CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil'Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 3167 /c3k` 3y 4 5 1y y� 3e2- 4 5 1 2 3 4 NOTES: 1. 'Tests to be:,repeated'at same depth until approximately equal soil rates are obtaineffat:,each percolation test hole. All data to'be submitted for '-review., . 2. Depth measurements to be made frm top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION ''- DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. / HOLE NO. HOLE NO. G.L. 1' 2' 4' 5' 7' 8' 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RIS AFTE %R BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: Lm // %%r DATE: ZZ o DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided 2�00 U No. of Bedrooms Septic Tank Capacity. ✓�s� gals. Type C- 0.0/ Absorption Area Provided By 4-:!;V LF. xd 24" width trench Other �E Y Aj Name C50 i Sig Address �9`7x /t'+�i/IC/CS�� /�. S THIS SP FOR USE BY HEALTH Soil Rate Approved 0 1 NT ONLY: � sq.ft /gal. Checked by Date APPENDIX B PUINAM CCURUY DEP=4JaU OF HEALTH - DIVISION OF ENTv-MCDZflM!AL HEALTH SERVICES fk DIDD-TIUML WATER SUPPIT;f & SUBSURFACE SZ- DISPCEA-L SYSTEMS RE"v7=R S= - CONSTRC=ION PERMIT DATE R.;V----.v7EI) BY: Clone of 0nar) (Street Lecaticn) DCaD Pe---ait AnIolicaticn, Corporate Resolution Plans - Three sets S/s L'ngineers Authoriizaticn Design Data Sheet MCS) I S Ceep Hole 1,-c Consistent Perc Results (3) Perc Hole Depth C- __T6 Varianc-- Recuest G --- A L Leca-1 Subdivision Subdivision A-ccrcval Checked Ex-ac-crwal SSO-c Adj. Lots Cher :-,=-- Wat-land (Tcw-n/DEC Ps=ti-- R & D) Data Cn DDS Planes & Fermi S,17,:a REQU= DETA 1=1 S ON PL-: VS C&-e -c Svcz=-,n Plan - (rorth ar--n74) -e F1 Se-race Sys tan E-1-rdrau-1 -ic Pr f Fill Profile & D--irnensl*cns J Box; Trench/Gal lery; R pit d=-,-:J, Septic rra-nk - Size, Gail Well Detail, -cervice Line is cv=--- Czr.structticn Notes (crind-er rate) Design Data: pert and deep res-ult'S Two-Foot Contours Existing & P-rccosed Driveway & Slopes Cut Foo=a/C-atter,0,2r----'Ln Drains (d-ischarge OK) Perc & Deep Holes Loc-atted Represaritative of prLTL=--y and expansicn Expansion A-re--;shcw,-i;zravit-v flcw,suff. sLzc- If Pxnped Pit & D iL Shcwn & House - Vo. of Bearoans Wells & SSMS's Win 200 ft. of Propcsed Syst P-rcperty motes & Bourds House Setback Necessary (Tight lot) House Sever - 1/4"/ft. 4"0; Tyke pipe No Be-ids; Max. Be-rids 45" w/cleanout SEPAMION DISTANCES SPECIFIED CN PUUNI Fields 101 to P.L., Dr-iveway, Large Trees,TC-0 of 201 to Foundation Walls 1001 to Well; 2001 in D.L.O.D, 150' pits 1001 to Stream, Watercourse, Lake (inc. e:,- 15' to Drains-Curtza-L-i, Leader, Footing . 35'to catch ba-sin,stormdrain,niced watercc' 101 to Water Line (pits-201) 50' intenuittent drainage course Sentic — 10' fran Foundation; 501 to w7-11 151 Well to PL 9 CC1V--V-7rS YES I NO la I =,encn pr:v-cec: to ccntour-z II I s A A F= SYSTEMS claVca.rriex 10 ft. fill notes I OV, I new scec.F. decth cauces 100 v--. flood elev. 200 ft. rese--voir, etc. 1:41 150 ft. te- i tr t t ? ,t a ?: t F >o f? tt '6•�, s Ei. t 4. r� L 4. t i . 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