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HomeMy WebLinkAbout0766DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 24. -1 -60 BOX 9 �7- .., J NJ . 16 _ -� 00766 Rev. 1/87 CONSTRU ON PERMIT FOR SEW. Lec Aoute 164- " I . PUTNAM COUNTY DEPARTN Division of Environmental Hedth SO Tm,u or ru!lg. - YellinrKh-U'ds.en.. 1 5 -,-..,2 '.,,l 6'. 2 Subdiv Won Name S66d. Let N Tax Barabra Potvin & Mich4el Fast Revislon-0 Oinuri/ApplIesuit,Name Date of Previous Approval NY , -10509 MallungAddress.. 49 Hudson rewster,, n rive T Own 7' ZIP Date Subdivision Approved Fee Enclosed :' Amount Log Home 15 Acres+ Building Type Lot Aria All sec tion i0inly Do # P Volume " Three 600. ICHD Notification is Reqo� When FW Iscompleted Number of Bedrooms— Design Fl 6 P D 1250- 480 L.F. Tile fields Se Sewerage, System to 6onjUt of Gallon Septic Tank and Patrick - 11 - I� 'Hill :R6a -NY trick Typda vy Brewster, .05,09 To be construdeti -by Address Water Supply. Mlic-tupply,From Addlrese k , F F. Beal &I diviss P B6x-B, Brewste r, NY 1009, or Supply Drilled by . Other Requirements I represent that I am wholly and'c6nnpIeteIy respqnsiple'ior the design and location of the proposed systern(.00) that'the separate disposal system o and iccordance with wage P8_8 above described will be constructed.&$ shown o I n the approved am I andment there t h the standards, rules and regu61-5n, .7 Putnam County Depi►tinint of Health, anti that on completion thereof a "CertH'ice"to ''of-Constructl6n 'Compliance" satisfactory to the Commissioner, of Healtlivvill be submitted t6 the,61pa'dMinii'. and 'a .written j6aiintii will.be Nrrilshed_thi owner; his ,.s9ccessorshilers,or as46s by the builder. that said builder Will place in 'good opeiating eonditio'n any part o4 -laid' sawage�-dl*spossi systeni 'during . the p6rl6d of-two (2') y"isimmidiately following ifie"ti of the Issu- 4 ihi,ori inal system or-any're that the drilled well described above ante of the approval of the Certificate of 'Construction Compliance, a. 9, Pi repairs t heiito; 2) t will 60 located as shown'on the'approved'plan and that . . said well will" . the standards, rules and reg7ursTro—nsof the Putnam be Installe(L' n accordance with County Department of Health...;` Date P.E. R.A. ..:7' pr Address RD9'-Fair Cak.jW)"N.Y. 10512 License No- 29206 CONSTRUCTION: This approval eipires,tw6 APPROVED FOR Vaari:.f r6m the! date -issued unless construction''of the building has been undertaken and Is , ro4ocible for cause 1. se or. may be ame I nd ad or,m6dified.wheh considered necessary by the Commissioner .of Health. Any change or alteration of construction requires a t Apir'dvecl -for cii.pojjtj:of 6ornestic sanitary sewage,"Snd�&, povpliavifler iy only • epw permit. -z DEPARTMENT OF HEALTH Division.of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL O h PCHD PERMIT # /- /� WELL LOCATION Street Add ess XG&MM11 G�� age City Tax Grid Number �. Z WELL OWNER Name �L.7 Mailing Ad ress S 2. SWrivate 0 Public USE OF WELL 1 - primary 2- secondary )3�R—E SIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY 0 FARM 0 INSTITUTIONAL 0 AIR /COND /HEAT PUMP .0 TEST /OBSERVATION 0 STAND -B O AB ANDONED 0 OTHER (specify 0 AMOUNT OF USE A�Y YIELD SOUGHT�gpm /# PEOPLE SERVED tU /EST. OF DAILY USAGE 6',005tal 0 REPLACE EXISTING SUPPLY 0 TEST/ OBSERVATION 13 ADDITIONAL SUPPLY NEW SUPPLY NEW DWELLING O DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR •DRILLING WELL TYPE DRILLED DRIVEN ODUG GRAVEL. O OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WEAL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: \/ r�( 110 ), cv 0a &—v Lot No. WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _k-'NO NAME OF PUBLIC WATER SUPPLY: DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVI D ,fgM—SEPARATE SHEET (date) s PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted Linder 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 Putn County Health De rtment. Date of Issue: `r 19 01 C/ Permit IssuinT is Date of Expiration: 19 Permit is Non - Transferrable Mite copy: H.D. File Yellow copy: Building Inspector Rev. 10/88 Pink Copy: Owner Orange copy: Well Driller IM1M!M;Mlwftwflw AlMIM1nA1nfIMIMInAInAIMInA1Ml! AInAIn Al nA1Ml lAln Ai MiMinAlMiw AiMIMIMIMI -All AIM: nA1M IM IMI MIMIMIAAIMUfIMIMIMInAIM1An1 ^Aln nlAnlMlMlnn w, 6 •4 1 1 I 1 b=,-o =,E.7T CF DI71ISiCj CF Lu�?-iJC��L %ir'rr? cuP°LZ & �u�i F ��' Sr:'u��'- DIE?- ZL E_ —Mc Rc'v v S--_- - CANS %ciirTCN P'I: -IT" (Z3s._^ e of Lcc:tica) . c� ^,�,T I YES I NO 1 CCC'�'�= ,e 0-,7 -e Fe --mi t A=Iic- ticn C.r-_cr3t- Resci t2.ca Puns - Tnr e °_ ss4_= E:ncineer AL't_1C_—_* C1 T'eSiCII Ccrr SQ�� ('C� � CJ�c acid Lcc '. Ccas Psrc aci= C'-c`1 i Ecusa Two vc= icr -c -,Ra mses t ca--- Cif lJL _..... (^,I :C_;�LLcJ DTI j C-N V- F & E -cL_-c TG.�� well CCTV_! L_ C`. c_ NLctes De sicn rerc ar-d de c _ Drveaatr & Slcces Cat r_c /G DL :`= =r,C,r _._ ii-iS - Fcati Perc & Ceeo Ecles L: c Recrasa t✓tive cf If Furor Pit -& D Ecx ffcus� - Ira. cf Ee^r;!^ -wells & S: LS's W/z 20.0 ft. c= r` c-r-c- Prccert-�j :•motes & EcU_d. Ecuse Set�c'c Necssza r (Tic t 1ct) Ecuse Serer - 1, /4" /f=. 4 "0; T_:= Pi e x. Eer No Bemcdss; W/ SE;A=IC-N D i S-'r, tiCL S= =C CN Fie' ^..s 10' to P.L_, Dri-ve c-v, L — == T= =`,TC_ c� _ 20' to FcLnc =.tica KEE 1=_ 100, to well; 200' i^ D. r., ^.D, 1.00' to Stream, j�ct ='_�Li " =cj - = {� (ir1C. E:,_ 15' to F ct -r1C 10.1 to at_r Line S_ct C %nti=. ICI I - =... E-rcT--- I - F---i° 10 f --- - 4-1 cs t_n cauce- tip—, r ff Fe --mi t A=Iic- ticn C.r-_cr3t- Resci t2.ca Puns - Tnr e °_ ss4_= E:ncineer AL't_1C_—_* C1 T'eSiCII Ccrr SQ�� ('C� � CJ�c acid Lcc '. Ccas Psrc aci= C'-c`1 i Ecusa Two vc= icr -c -,Ra mses t ca--- Cif lJL _..... (^,I :C_;�LLcJ DTI j C-N V- F & E -cL_-c TG.�� well CCTV_! L_ C`. c_ NLctes De sicn rerc ar-d de c _ Drveaatr & Slcces Cat r_c /G DL :`= =r,C,r _._ ii-iS - Fcati Perc & Ceeo Ecles L: c Recrasa t✓tive cf If Furor Pit -& D Ecx ffcus� - Ira. cf Ee^r;!^ -wells & S: LS's W/z 20.0 ft. c= r` c-r-c- Prccert-�j :•motes & EcU_d. Ecuse Set�c'c Necssza r (Tic t 1ct) Ecuse Serer - 1, /4" /f=. 4 "0; T_:= Pi e x. Eer No Bemcdss; W/ SE;A=IC-N D i S-'r, tiCL S= =C CN Fie' ^..s 10' to P.L_, Dri-ve c-v, L — == T= =`,TC_ c� _ 20' to FcLnc =.tica KEE 1=_ 100, to well; 200' i^ D. r., ^.D, 1.00' to Stream, j�ct ='_�Li " =cj - = {� (ir1C. E:,_ 15' to F ct -r1C 10.1 to at_r Line S_ct C %nti=. 0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Qr�;-T-v r �4. Located at (T) b' i i� j�� Section • / Block Lot 2--- Subdivision of '��[ �:� (j Subdv. Lot # Filed Map ## Date Gentlemen: This letter is to authorize �� : IA O 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. Cot signed: P.E. , R.A. , # PRE�,rs�� /�F F� 3 G 2 - � o 29206 Address ANN N. PRWISS, P.E. R09 FAIR ST 914- 878 -6170 ORIEL. NEW PORK 1051 Telephone Very truly yours, Signed �iw ®&aet'd- Owner of Property Lik ►- ) VCso,, (p r, Address ibrews.�er N�( ) ysoq Town _ a -7--Y- 3 Telephone P PUTNAM COUNTY DEPARIlH M OF HEALTH DIVISION OF ENVIRCNMRqML HEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner OT1[ i N F A ST Address i y Located at (Street) Sec. 1,� Block Z Lot /g"• L (indicate nearest cross street) Municipality 1T� ��I- Watershed C r--0- o / SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking Ll- (, - S cl Date of Percolation Test 4 - b Vic} 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 2 P-oF1 1? 10 /O 4 5 zUS -16-1 1 `f 2 3co 6 al L� % 3 alb 7-z-'5 10 iL -z- 3 I 4 61 3 3 3 L4 I I X 3 5 33y I-/ I1 ;-v -. Z 1 2 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 subaitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 r TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. -44-- 1 HOLE NO. HOLE NO. G.L. c9 ►`c�c >T r-� i c-(? r. A I -) I c S 2' 5' IQ rPN U`Q.I 7' jf r4 w G a 9 00 Lite. Pacte- Noy �cr,r,F° lf,c.C_ , 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: \ q , v� u e rL DATE: DESIGN Soil Rate Used )6 =ZU Min /1" Drop: S.D. Usable Area Provided S y0G t No. of Bedrooms -3 Septic Tank Capacity U gals. Type -�,o w a`I Absorption Area Provided By t0 L.F. x 24" width trench cy )-9 Re Other �— �aQEESSION� Name dumm H. RENTISS, P.E. RD9 FAIR ST 914- 878 -6170 Address CARMFI, NEW VAgIf 10512 GF�si NO 29pb THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by •'" Date `riX.�1a 1-� ht o f.l JET J uIjc-�; pox I�Ai%�l� � G �; , a c , r • 01 O W c� D. GaP Arl.� o CA, Oq s, I -WU ply Q q2 O ojQ' r� 1 I � / 12%q rite�Dottom of french on grade oft -4 %per to i from settling or b 1 dosing Conks - earth to be tamped tightly around distribution box DUAL DISTRISUTIOld 4'j2( solid pipes i from sepnic.tun OVERFLOW SYSTEM WH rZ fiy dalhlf : ! °t �4'Az4 1 ' •;i - q -X24 Xgf ¢•o" 4',cz41 . Sri fti1��G. or13" 0&0 of '5�4d COP' Pitt I PA 4,14A-V451- J yT IOt" e�41.rf7a4reA/•r p�e•('�cL� LlN hGP rIG T41J15`T »� ., IF w,o; 12%q rite�Dottom of french on grade oft -4 %per to i from settling or b 1 dosing Conks - earth to be tamped tightly around distribution box DUAL DISTRISUTIOld 4'j2( solid pipes i from sepnic.tun OVERFLOW SYSTEM ,3� 7 _At, 0 I � to Z O n W M 0 z Hof 10 1 � I6 13' S 1 ,3 .. _ • � Ito tcf� �' ` ,� /a i ti3 foo.Yo�U s 0 31 �... +a1 N 55 .. 4 Al M t; a✓��� lY • � a O Z °J GAP A-Ul L/ 0�2 vi .- i i N 13 ', N� N