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HomeMy WebLinkAbout0839DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www. sca nyo u rd ocs. co m 631- 589 -8100 25. -1 -8 BOX 9 11: • -.� k l ��. .,. �� - ell �-Q • , 11: • ri 29 -83 PUTNAM COUNTY ,MPARTMENT -OF HEALTH` v th,S17Wces, Cacm% N Y 10612 ee=mie OIV/Sl0I1 of Environmental lie! ) CERTIFICATE OF CONSTRUCTION COMPLIANCE 'FOR SEWAGE DISPOSAL SYSTEM d Town or Village ,Located /a�t� - �-yiG�- �,�7.. .Tax,Map •Block . W� Fox�erly Taz'Map Lot # �O Subd Lot p '� 1 r e: D 1 S�l�% ` 'rare Separate Sewerage SYstem built by .y� /'�" if L �-� G ddress /000 . 2 t, Consl ;ling of Oal.; Septic Tank a , Other requirements; P- Water Sti Y.- . ° Public Supply ,From Prfvatq SuDPIy- Drilled''By Address i /Z 1A3 i.. Building Type No, of Bedrooms Date Permit ,Issued �.t Has Erosion Control even 'CompletedE " I.certify. that the syetem(s) as listed 'serving the above premises were,conatructed essentially as shown on the,plins of the completed work '( copies 'f which are. attached)', and in accordance with the atandards,'rul as- and ragula£iona, in dccor3ance with the filed plan, and the°permit'ieeued • by the Yirtnam County. Department Of Hsaith Date Dr ��,�!!�i Certiftetl Dy, P.EA _1 ' 7 Address T L7�.f'.:/ o Llanse NO Ariy :person occupying Premises served by. the above systems) shall promptly take such action as maybe necessary to (stun the correctlpn of any; unsanitary conditions resulting.. rom'such usage. ;iApproval of 1Q. epirate., Drap" t&ry,iewer becomoll tem shall ti me nu ll' void aoon availaiiie and the approval of• the Drivate,water'supply shall becomvoid,when a:public e► ply becomei avallabN. Such approvals. are . subject tp modification or.•change,when, in tAe judgment oithe r.;of Health, wch evocatl , modlflution .or ehangs.ii fyDate `a -v BY ' TItN 1 .Rev'. 941 i -s. 'Llko ACKES 3811,L.F 49SORP7101Y WAIN! Soo/ 2S-1 INDIVIDYAL SEWAGE SY5TL As -.EUILT" W. DAPICE H A VILA Alb D PATFf RSojy (T) TO MA? 13 -BLOCk 1 LOT to PkAUL 3 - 41.0 kCR�S Service Division n Of EjvironB1:Mtal Health SBTViP -for Conformance with -f the oprovo 0- en Putnam WELL TIR turp, q7 J�AVPANP DRIvi SCALE 0 4t) x m FgA.MK D. ANhioNzlk-rA P•F-• eoe e • Y _ +.v.. �. •.. v... r..r•..r• .....�..•. yam. _ r COUNTY OF.FICC BUILDING • CAAMEL. NEW YORK Yhkt` report is to be completed by well driller and submitted ¢o County Health Department together with laboratory report of analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED 'WITHIN 30 DAYS OF WELL COMPLETION NAME A<rDRESs owl +cR ROBERT DAPICE lC1CAT10N IND. iT StreefJ (Town) (lot Number) of wlu :Iiaviland. Drive Patterson, New. York - BUSINESS fl;OPOS[D DOMESTIC O ESTABLISHMENT O FARM ❑ TEST WILL. LIST of WILL lJ SUFF Y 11 INDUSTUAL EI CONDITIONING• (Sp *fR) Y . DRIUiNG (—j Q COMPRESSFD CABLE OTHER ECUIPME,NT LJ. R.OTARY X AIR PERCUSSION ;_J PERCUSSION (Specify). lENG1N (;eef/ DIAMETER (inc PER FOOT 4'rivE 5HO, ? WAS LA iNG �a U�FD� —� ctrii 30 6 I 19 ® THREADED R WELDED ��YLS L_J NO YES L_.I NO YIELD: rl MOURS O. ►.M. YIELD (G.P.M.) TEST. 0 LA;LED PUMPED ® COMPRESSED AIR 4 20 20 MEASVRF FROM LAND SURFACE— STATIC(Specily feel) DURING TiELD TEST fleet) WATER � � ,. Depth of Completed Well 685 UVtL 12 685 , in feet below Land surface: SCREEN DkT/.Ili SLOT SI DEPTH PEOM LAND 57tfAQI iffT to FEE_ T LENGTH OPEN TO AQUIFER (feet} R (IsJ GRAVEL SIZE (inches) FROM (leet) TO (tail) IF GRAVEL Diornetar of well incl DIAMfti n_M uding I PACKED: gravel pock' (Inches). FORMATION DESCRIPTION Sketch exact Ioeetion of well with distanees. to at least two pafmanent lanomarks. 0 8 Packed' Clav & Boulders 8 15 Fractured Bedrock 15 685 Med. -Hard Grey & Black. lf.Tiold w•et tested of difletenf deprhs dt.ti,,e dtillinq. lilt below . iITT GAL(ONS FER MINIITI f 480 2 685 20 r.a 1r ll l •, ,r n; I., AI V (`f •11Lr'01tI 1A 1.L UrIILLl.14 (Stgnalatrsl 1/12/ 1/13/63 5DS v POSED �WELL1 N.0 WE'LL- t 0 3 AVFI.AN.D DP,%V EF Zvi D Owner or Purchaser of Building Building Constructed by #A1111-Aw" Location - Street Municipality Building Type Section Block Lot Subdivision Name 3 Subdv. Lot # GUARANTEE OF SEPARATE SEWAGE 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 regu.lations.of the Putnam County Department of Health, and hereby guarantee to the owner, his success- ors, 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 initial use of 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 occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determin- at ori" of - "the' Director" b'f-the Division of Environment-a-1 Health Services of the Putnam County Department of Health as to whether or not the fail- ure 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 (OCT., _19 Signature / Title-- Corporation Name if Corp. Address -- - - - - - - - - - - - - - - - - - THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Division of Environmental Health Services, Putnam County Department of Health MI • v.•-.v• ... r. ..•....•..u•.•v . •u...,•• emu• - ru- t` } COUNTY OFFICC BUILDING - CARMEL, NEW YORK 1100 report is to be completed by well driller and submitted to County Health Department together with laboratory report of analysis of wateb sample - indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION NAME ADDRESS OWNER ROBERT DAPICE LOCATION (ND. a Street) (Town) (lot Number) of WILL Haviland Drive Patterson, New York - PCOFV: f.D ! n lJ ROTARY a DOMESTIC D BUSINESS ESTAB',ISHMENT L_J FARM CJ TEST WELL USr or T�WA$ LA iNC rES DLILMS THREADED WELDED l^J YIELD l:TLL HOURS ® G.P.M. L TEST l_J BAILED PUMPED COMPRESSED AIR 4 El 20 LJ SUPPLY INDUSTNAL CONDITIONING (OSpec£R) DRILLING EQUIPMENT ! n lJ ROTARY a COMPRESSED f CABLE AIR PERCUSSION J PERCUSSION OTHER (Specify). CASIKG LENGTH ( :oat) OIAMEt LR (�ncb csJ WEta,HT PER FOOT 30 6 19 ® C� lr E SHOE{? L&YES ONOf T�WA$ LA iNC rES DLILMS THREADED WELDED l^J YIELD HOURS ® G.P.M. YIELD (G.P.M.) TEST l_J BAILED PUMPED COMPRESSED AIR 4 20 20 NO WATER MEASURE FROM LAND SURFACE— STATIC(Specifylaer) DURING YIELD TEST fleet) :11.- pth of Completed Well LEVEL 12 �68S a feet below Land surface: 685 MAKE LENGTH OPEN TO AQUIFER (feat) SCREEN Dk7A1LS SLOT SIZL DIAM:TFR ( Inches) r IF GRAVEL Diameter of well including g JORAVEL SIZE (inches) FROM (leaf) TO (leaf) I I PACKED: gravel pock (Inches): pEFTH F[OM LAND SUCFACtI _ Sketch erect location of well with distances, to at least FEET to FEET —_j FORMATION DESCRIPiiON two petmanant landmarks. 0 8 Packed Clay & Boulders D 8 15 Fractured Bedrock 15 685 Med. -Hard Grey & Black If yield -pf tttled of diBaient depths du,irt dAlGnq, list bolo - r_ GALtONS PER MINUTL 480 _ _ 2 685 20 r'.. +1 t: ;Il U�•`.ti!:` I L�AII: C•;'• 17i_h�llt7 _r�,:.Ll tatflLLl.It (S�gnnt.nu) 1/ 1.2/83 1/13/63 � POSED DWELL! G vvEL.L_ RED �.a' o f OV q n (98 PUTNAM COUNTY DEPT., OF HEALTH AVrLrjc�ND 2)A \ L=I i BREWSTER LABORATORIES Box 214 - BREWSTER, N. Y. WATER ANALYSIS REPORT SAMPLE NO. 5003 SOURCE: Robert Dapice '-Jell Discharge Havaland Drive Putnam Lake Patterson, 11Y COLLECTED: January 12, 1983 BY: Dill Drilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 0 per 100 ml. This result indicates the source of the sample was of tatisfactery sanitary quality whets the sample was collected. January 14, 1983 C Bickwit P. E. Dlrreer ' RECEiVED- R10 V % 3 1983 PUTNAM COUNTY DEPT, OF HFAI V4 ' PUTNAM COUNTY' DEPARTMENT OF .HEALTH Permit Orvr'sron of Enwronmenral YHealrh Services Carmel N. Y .10512 CONSTRUCTION PERMIT FOR,. SEWAGE DISPOSAL SYSTEMJ}%�iS ©%U / Town or lag d Locate `at Y J L - Q— I'i'G Tax '! S Subdiirision ' S bd , Lot N Renewal Revision �. • W. te of. PreviousA p proval ;Oner %Address _ . 8uilding :Type LOt Area �,`A �C7rU Fill Section Only [3 Number :of Bedrooms ..J Design Flow G /P /D O ®� r P C N D Notification` Requared �� Separate "Sewerage System. to consist ot, ,11100 Gal Septic Tank„ antl tl_'2� <ot IC 1%�� s To be 'constructed by — ISLIOHS� h��/Yi7Jc?h AddressrAn� �� �'f T�/�i% ✓4 Water Supply; >P ublic Supply From ej �. sPrivate .Supply, to be dulled •by �� Address Other Requirements , F t represent that' l' am wholly antl, completely responsible for the design and location of the proposed 'system(s). 1) t at the sepaiate sewage disposal' system above described will be:constructed as shown on the'approved'amendment there to'and in accordance with the staridardr "rulesbn regu a ons o : e u nam - t: ,: •County`.De,partment of ';Wealth, and that on completion'thereof a "@ertificate .of Const►uction Compliance" satisfactory to the :Commissioner of. Healthwill 'be submitted to the Department,' antl, a wntten guarantee will ,be ;furnished th' 'owner, fiis 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. thedate of the issu= ante_ of4he approval of, -'the 'Certificate `of. Const uct,on ;'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 wilVbe'Installad, m accordance :with :.the: standards, -rules and regu a ons ,, of the - `Putnam County Department � f He Ith 'Date /r Signed' E.'A Addressfs'�lN� .li/1%i�`�I_ .�1 ` License No of J APPROVED FOR CONSTRUCTPON. This approval~explres. one ear from the. ate" issued un onstruction: of the building has been .undertaken and if ' _revocable .for cause or may be- amended' or modiiied - when co re " red' necessary by the C. missioner Health: Any .change :or alteration bf .construction new permit Approved for disposal of.domestine wage, d/ r:, a wat pply only. ::Oats BY Title Rev 99 e�— r 9 ii T'T1N.D CHECK. 1AST. Date: Inap.by: INIT.TA.L SITE IMPECTIMN Y03.1 No Comments , Properl-.y line-- or corners round . . . . . . . .. _ Can estimate house location . . . . . Will driveway need cut . . . . . . . .. . . . . - 1 ,1lust trees. be removed -note these . . . ... . . .Is sleep hole representative of entire SDS drea' Additional deep holes needed: . . . . . . Sufficient SDS area available co' siderin6 driveway cut, house location, separation distances, etc. DEEP HOLE DATA DDpth: Water elevation: Rock elevation: Soils d.escr_i,'Dt on: D a te: FINAL SI .!,,] IPdSP ECTIG�j: Ins p. by: -- House located when•.- 'shotm on approved plan SDS located u1 ere approved . / Irrz-th of trench measured %'U Width of trench average -- ._..._ _ Slope of tile line and trench. acceptable . . . Room allowed for expansion tenches . Over 50 ft'. from swamp, watercourse . . Natural soil r_ot. stripped or SDS area unnecessarily graded 10 Ft. maintained * from prop. line and 20 ft . from house ; Separation of trench from house, well --etc..--follows.-plan Number of be'drooms checks . . . ... Stone::,' brush, • Stu,mps, rubble, etc- . greater than 15 ft. from nearest trench 15 Pt. of peripheral soil horizontally from �. -- —" trench. ... . . . . . . . . . . . . . . . �\ Junction boxes properly . set Could surface run off from driveway , roads, ground surface, etc. chaiulel near SDS ... area. . . . . . . . . . . , -�. — . Does :l.ot drainage app-ar 0. K. in area of SDS - FINTAL GRADING OF SITE ACCEPTAME, PUTNAM COUNTY. DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL.HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM. FILLE NO. Owner �� ® /C� f �Oi� �T Address 200 �FV/Iolp 4,7g %�L'� . Lt%/iIle 1!2ari , V Located at (Street V/ Sec. 18 Block _Lot* /Q n lca e nearest cross s ree. 5'V,6. GvT #3 Municipality AAlf )0ti Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Water Level Z2- No. Time From Ground Surface in Inches Soil Rate /3 Start -Stop Min. Start Stop Drop in Min. /in drop Z; 2y /p Inches Inches Inches 5 1 /,' .30 /:f,3 13 2`2 z3 I 13 2 Z;410 zz /0 22- 7-3 l /o 2 2. 51 3 0 3 J 2- 2-7, 4 2'/0 2:.22 /2 ZI ZZ /2 5 Z.: 23 2:35' /Z 2a- I /� 3 .3:01 3:15 11 21 3:2� 1 12- ��. - po 5 3 , 27 Notes: 1) Tests to be repeated at same depth until approximate rates are obtained at each percolation test hole. All data toR = MELD for review. 2) Depth measurements to be made from top of hole. , 0V o 198 PUTNAM COUNTY DEPL OF HEALTH _ _2 y'7 /.s'.. y.Z _. Z2- z3. _..... j 3.2:00 z:13 /3 22- 23 I 13. 4 2._: ,y Z; 2y /p 'L/ z L, /0 5 2 ; 25- 2 %5� 24 2-2- 1 /( i Z;410 2: �o /0 22- 7-3 l /o 2 2. 51 3 0 3 J 2- 2-7, 2_1 ► Z. 3 .3:01 3:15 11 21 3:2� 1 12- ��. - po 5 3 , 27 Notes: 1) Tests to be repeated at same depth until approximate rates are obtained at each percolation test hole. All data toR = MELD for review. 2) Depth measurements to be made from top of hole. , 0V o 198 PUTNAM COUNTY DEPL OF HEALTH TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS.ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE N0. G.L. TO V So IL 6" 12" _ 18" 24" r_oAM 3011 3611 42" 48" 54 60" 66" 7211 788" 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED NOW1, INDICATE LEVEL TO ATER DEL RISES AFTER BEING ENCOUNTERED ALONE -- TESTS MADE BY // / 83 VrAnk LEVEL, Date DESIGN :.......:..:..,.;;..... i Soil Rate Used L z Min/1 " Drop: S.D. Usable Area Provided No. of Bedrooms _Septic Tank Capacity coo Gals �e�� � mere _ Absorption Area Provided By 375 L.F.x24 �� 3b'� o , Address 100 /Pf]'/Z,�G✓�} �f D • SEAL n vrz�� . . ! , ra o THIS SPACE FOR USE BY HEALTH DEPARTP �I T ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date ,x k 0,1 F f t p , # i �r ,r - Jt �' M 'a son r "++4 4 M` � .z ,�,, t a t , ?�..J..� s `➢'""" t � ,. ,r^+.yr.. «.x ... 1 p or h�l Y ➢ r a k wMtr Mr x L— � »� S raw h *wrraS M" j,l r 1 �bd3S ➢ �C r'r t` d'p "1 �' t ¢ Wr. J ,aM« V bn q`^ w R' n. 1Ykk:`hm v4 "? ,..�➢�,.+x+�^;�"f,,,,,` ,.,„ an p.A, d a:1 C 1 1- Y 4 ai. f 'R c't p L r r S�,D i K"A �,% f SCD` A�." ,t ,may, n. 5 Koo Q,2 40 n 72w 4 deT 1, +r t b chA 'hey, R� k.y a ,r l a 'w 4,"Mti "„�;.nr a e ,�, •—wr' a: € ..! RQ' ^ +q..ift }h •'any q A .[5 "D' ''+ r j �' � � ! { w L X 4' 4 h 1 � h� 4� y s.'bY 4r'ir�w ^� r a 9 t 'k t y "�'4» R'+"w'�Ci �E nf➢v"".�+K.* N'+- -� J x t ; I^x• q� .�'� - e r' ; . 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