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Home My WebLink About0904DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.39 -1 -13 BOX 10 . ;. F 2A , I � , h - r of i 11.1 PUTNAM COUNTY DEPARTMENT OF HEALTH ENGINEER MUST PROVIDE Division of Environmental Haslth Services, Carmel, N. Y. 10612 PERMIT # f2-51-96 CERTIFICATE OF .CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM 1 1 6 Town or Village Located at �� Ott • ' ` Tax Map Block Owner L • • ,\ �a�►o / Formerly Tax Map Lot x Subd. Lot i Separate Sewerage ConslstSystem built by Gal. Septic Tan and e-�� Ad d� � c� Other requirements Water Supply: Public Supply From t •� Private Supply Orill By j Address Pt k,- � �- Building Type nu dry No, of Bedrooms -3 Date Permit Issued a llT Has Erosion Control Been Completed? la Has garbage grinder been installed? Me I certify that the system(s) as listed 'serving the above premises were constructed essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the atandards, rules and regulations in acco dance with the filed plan; and the permit issued by the Putnam County Department Of Health. /1 Date f Certified by /A�1,+' ' _ _ I P.E. �f�s R.A. Address Z am • - do- r . License No. ¢3 / 5� Any person occupying premises served by the above system(s) shall.promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a public unitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Commissioner of Healt4. such revocation, modification or change is necessary. Date Rev. 6/85 orktown Medical Laboratory, Inc. 321 Kear Street Yorkto*R,Heights, N. Y. 10598 (914) 245 -3203 Director: Albert H.- Padovahi M. T. (ASCP) T G,ut( R& �.PA-77 C e-S 0Yl,. -1 T LAB N _ CA. 00-3192 Collection Station.-Used: Carmel & Peekskill _ Mt. Kisco „� New City _ Date Taken: a2.� Date Received: i C, Date Reported: U Collected By: Referred By: Sample Source: J, LABORATORY REPORT ON BACTERIOLOGICAL QUALITY OF WATER GENERAL BACTERIA Standard Plate Count per 1.0 ml (Agar plate @ 35 °C) MEMBRANE FILTRATION TECHNIQUE (MFT) Total Coliform Der 100 ml Q Fecal Coliform Der 100 ml _ Fecal Streptococcus per 100 ml MOST PROBABLE NUMBER TECHNIQUE (MPN) Total Coliform: Fecal Coliform: OTHER ANALYSES MPN Index per 100 ml MPN Index per 100 ml - THESE RESULTS INDICATE THAT THE WATER SAMPLE. Lam') (WAS NOT) (NOT APPLICABLE) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO THE NEW YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Albert H. Padovani, M.T. (ASCP), Director LEGEND RDS = Recommend Disinfect- ing Water. Source < = less than TNTC = Too Numerous Too Count WELL COMPLETION REPORT Office Use Only DEPARTMENT OF HEALTH _ Division -Of- Environmental= Health - -Sery -ices. - - -- - - -- PUTNAM COUNTY DEPARTMENT OF HEALTH WELL TYPE O SCREENED ❑ OPEN END CASING. .OPEN HOLE IN BEDROCK O OTHER CASING DETAILS SCREEN TOTAL LENGTH 30 fL MATERIALS: STEEL O PLASTIC O OTHER LENGTH.BELOW GRADE 29 tL JOINTS: O WELDED ,RrHREADED O OTHER DIAMETER 6 in. SEAL: 2rCEMENT GROUT O BENTONITE 0 OTHER WEIGHT PER FOOT 19 1b./ft DRIVESHOE�(ES ONO LINER:OYES -ONO DIAMETER (in) 'SLOT SIZE I LENGTH (11) DEPTH TO SCREEN (ft) DEVELOPED? DETAILS.- :._ FIRST - SECOND - _ - - - O YES ❑ NO-. HOURS GRAVEL PACK STREET AOURESS. TOWN /VILLACE /CITY TAX GRID NUMBER'. WELL LOCATION Quebec Road Patterson. New York WELL OWNER NAME: Louis Milano ADDRESS: Rocco Drive, Brewster, NY PRIVATE O PUBLIC USE OF WELL RESIOENTIAL O PUBLIC SUPPLY O AIR /COND. /HEAT PUMP O ABANDONED 1- primary O BUSINESS O FARM ❑ TEST /OBSERVATION O OTHER (specify) 2 - secondary ❑ INDUSTRIAL O INSTITUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED 4 / EST. OF DAILY USAGE 400 gal REASON FOR JINEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST / OBSERVATION DRILLING O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 525 ft. STATIC WATER LEVEL 20 ft. DATE MEASURED 10/14/86 DRILLING ❑ ROTARY XCOMPRESSEO AIR PERCUSSION ❑ DUG EQUIPMENT O WELL POINT O CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED ❑ OPEN END CASING. .OPEN HOLE IN BEDROCK O OTHER CASING DETAILS SCREEN TOTAL LENGTH 30 fL MATERIALS: STEEL O PLASTIC O OTHER LENGTH.BELOW GRADE 29 tL JOINTS: O WELDED ,RrHREADED O OTHER DIAMETER 6 in. SEAL: 2rCEMENT GROUT O BENTONITE 0 OTHER WEIGHT PER FOOT 19 1b./ft DRIVESHOE�(ES ONO LINER:OYES -ONO DIAMETER (in) 'SLOT SIZE I LENGTH (11) DEPTH TO SCREEN (ft) DEVELOPED? DETAILS.- :._ FIRST - SECOND - _ - - - O YES ❑ NO-. HOURS GRAVEL PACK ❑ YES GRAVEL ❑ NO SIZE: . WELL YIELD TEST If detailed pumping M¢H00: ❑ PUMPED I" i tests were done is in- A COMPRESSED AIR ; formation attached? ❑ BAILED ❑ OTHER ; ❑ YES O NO WELL DEPTH DURATION DRAWOOWN YIELD It. hr. min. ft. 9Pm. 475 2 - 30 385 4 525 6 400 _ 5�_ WATER IM CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS ❑ COLORED ANALYZED? )IrfES ❑ NO ANALYSIS ATTACHED ?RYES ❑ NO PUMP WFORMATION TYPE CAPACITY 7 MAKER Goulds DOH 300' MODEL 7EHO7412 VOLTAGE 230 HP 3/4 IDIAMETER I -ft. I BOTTOM OF PACK In. DEPTH . . DEPTH It. WELL LOG It more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROhi Water Well SURFACE gar_ Oia- FORMATION OESCRIFnoN coot it. (t, ing Ineter 1 201 5251 1 1 Hard grey & black granite STORAGE TANK: TYPE diaphragm CAPACITY 62 GAL. 19 WELL DRILLER NAME MIIZ DRIII IN .. ADDRESS Putnam Aven A Brewster, NY 10509 M. X11, President Owner or Purchaser of Building Building Constructed by '4 f 1) A) (ZI - Location - S ree P,Atvg Municipality REP C, t a.l At-&c Ef!! 4V;R;n J4Cf'1:'fA t q I Building Type 't{ �q Section - -- t---- ______._._ Block Lot Subdivision ame 4)30 -'flay Subdv. Lot # j 3/?0/5 5 '87 AM 10 AID :06 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 regulations 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- - =- a_t4on of--the- Director .of- the Division'.o.f Exivir .onmental_"_HealthServices 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 19_JM Signatures Title ROGER MAYFs Corpora��E�a -- orp. _ P0.UGHQHAr,_ N_ �n 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIMNMSNTAL HEALTH SERVICES /0,W Y&WO Owner or Purchaser of Building Section Block Building Constructed by T1 YaL / )?OA D Location - Street 'Plf 96r,0-50A] Municipality A�06N&!g Building Type I Lot lArH /Y '4p 6)- 41WW MK Subdivision Nazzme Subdivision Lot # GUARAN= OF SUBSURFACE SEMGE 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 systcin; except "where" tiie failw�e " "to- operate- properiy 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 J-4- day of P�I� 19_2L Signature A"O Title General Con a or (Owner) - Signature Corporation Name (if Corp.) Corporation Name (if Corp.) Address Address rev. 9/85 mk PUTNAM COUNTY DEPARTMENT OF HEALTH Re 18 6 Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer to Provide Permit N y'% on CERTIFICATE OF COMPLIANCE �[Permit H ACV- t CONSTRU ON PERMIT FOR SEWAGE DISPOSAL SYSTEM Located at 1 v"0 a� 1J� W 4�� Rk - __ -__ i .a�*a or Village Subdivision Name 1?1k w. sad. Lot N413d" T w Map Block 1 Lot 1 Renewal_ O - Revislon O Lou wner /Applicant Name t k4 KA &,A-r1 (� Date of Previous pproval (` Mailing Address 0(to Town ki5 09- Zip Building Type a�w Lot Area AR /dA-'a' FB Section Only Depth Volume Number of Bedrooms 3 Design Flow G /P /D _ ka� PCHD Notification is Required When Fill is completed - sep—do Sewerage System to consist of yy GaROn Septic Tank and Z's To be constructed by °tO �� Address Water Supply: Public Supply From_ on Private Supply Drilled by Other Requirements It -n tike V%arzy . represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that they 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 of e Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill 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 duri period of two (2) years immediately following thedate of the issu- ance of the approval of the Certificate of Construction Compliance of the final sy em 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 install in ccor c with a stan s, rules and regu aT ns of t a Putnam County. De artment f Health. , Date i Signed P.E. R.A. — Address ` License No 437U APPROVED FOR CONSTRUCTION% This approval expires one year from the date issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction requires a new permit. Approved for disposal of domestic sanitary siawage, and /or private water supply only. Date m PUMAM COUNTY DEPARTM U OF HEALTH - DIVISION OF ERVIROMMmm RKAr SERVICES INDIVIDUAL HATER SUPPLY SUBSURFACE SEWAGE DISPC5AL SYSTEMS FIELD INSPECTION REPORT . • • .. ' =- DATE:. INSP. - -BY: - -- - - - (Name of Owner) (Street Location ) INITIAL SITE INSPECTION YES NO ..CONS Wetlands on /or proximate to property................. Property lines or • corners found...''...'....... Can estimate house location...;.: ..................� WilldrivL-aay need cut ........ .................... Must trees be re -roved - note these.................. Deep holes representative of entire SDS area...... Additional deep holes needed ...................... Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacent wells/ septics ............................ Access to nrorosed well location for drilling.... _ D.H. 1 Lot Depth to G.W. Depth to rock Soil Description 0 ft. 3 ft. 6 ft. Y - L 12 ft. FINAL SITE INSPECTION D.H. 2 Lot Depth to G.W. Depth to rock 0 ft. Jolt 17e -crl q DATE: _ 4 INSP.BY: ,1s D.H. - Deep Bole G.W.- Groundwater D.H. 3 Lot Depth to G.W. Depth to rock 0 ft. YES I NO House SSDS located per approved plan ...........:. I &� Length of trench measured �� c4 b, Width of trench average Slope of tile line and trench acceptable........ - r r/ Roan aJlcwed for expansion trenches ............... Over 100 ft. fran watercourse ................... . Natural soil not stripped or SDS area unnecessarlygraded............................. Soil Description f .. ' pplmM CIM= DEPAMMaU OF HEALTH - DIVISION Of E MMM?ML Eli7L S SERVICES • INDIVIDUAL NATER SUPPLY & SUBSCgU= DISPOSAL SYSTEMS � P OQ23SIRUCTTON PERMIT SF RESrzEw - - - REVD: (Name of owner) (Str eet Location) CCNEM- YES NO DOCL14ENM � . ---- ��- Permit Application Mr r Corporate Resolution Plans - Three - sets Engineers Authorization- _ Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole - Other House Plans - Two sets PwS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System. Plan Sewage System Hydraulic Profile - Gravity Flaw Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Puma pit details _ Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes ._Design Data itao -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located -Representative . of Sewage & Expansion. Arc- , Expansion..Ar_ea.;sh ;gr-avity floE.= =11f -:- size - -- -. _ -. -_...- TP _... . If Pumped Pit & D Box Sham & Detailed House - No. of Bedrooms P Wells & SSDS's w /in 200 ft. of Property Looted Property Metes & Bounds -House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 110; Type pipe No Bends; Max. Bends 45° w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O_D, 150' pits 100' to Stream, Watercourse, iake (inc. e_xpan). 15' to Drains - Curtain, Storm, Leader, Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fran Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked o f .Ex- approval. SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same ii r• •• � �• • •�� is •�- : y• rsi DIVISION OF ENVIPaNERM LETS SERVICES d DESIGN DATA SU GUFACE SEWAGE - DISPOSAL SYSTEM Owner l : s % 1 a. w o Address Located at (Street) ZIA 1� _ '� e�;� �d� Sec. iR Block 1 Lot 7 (indicate nearest cross street) Municipality Poe c s eti• Watershed • • on V a• k• •: ra. • v • l• •• a• • -, 1 2 y m Li n, ell �: • Date of Pre - Soaking 17S6 S gb Date of Pervolation Test �86 SAM 30 13 *34 1 A A HOLE NOMBER CLOCK TIME PERCOLATION PFRCMATION 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 Indies Inches -Z `z3 �� ? 2 3.3 2'f )9 % - 2 •3q �Z q 30 13 *34 1 A A Y !A vl.,y V• k• I 1 1 y 10 Y41 v: r• •' 1 G.L. 1' 2' 3' 4' 5' 6' 7' 8' 9' 10' 11' 12' 13' 14' " INDICMM LEVEL AT WHICH GROUNMMER IS ENOOiJNTERID INDICATE REVEL M WHICH WATER LEVEL RISES ATMR BEING FNOOUNMMM DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used _ ........ Min/1 "-- Drcp:- r . _ ...- S.D.. Vkble Area Provided._.... _. -No. of Eedroans septic•Tank Capacity gals. Type Absorption Area. Provided. By.... _._. .._...._....,.I,.F....x..24" .width trench ..... ___. _...._ _.._.... Other• . ._._ ........_.. _... _ . Name °Signature Address .. Z`IZ �" N!a i•. � .7� - ...�..,.,....._. - - ........ _. * �� . . F� ... �`. .. .. •:: 'tra�...d.� : �.r, .:..l.. trrj ti,.!•.:..>t/ �.':.aJh:�C. ..`tti .'� ,�,.(:�..- �h C .. .. .�.fV� :I�r;,� .. , THIS SPACE FUR USE BY ' BMMR- ';DMAR:ft,Nr.•ONLY: fftnFE w Soil Rate •:tj.•y Approved 3• ..... � Uytrt`he . '. r; H wil •: •�� r,r is v •ty r: -t�• DESIGN DATA SHEET-SUBSUFACE SBIAGE DISPOSAL SYSTEM -- - - FILE N0. Owner l-oy Zk s tAlt 1 #--"o Address �c(O P(� - �5R E E JJ5•i Located at (Street) �l"a,�or �� ` \? `, Z 50`iSec. 19 Block I Lot 1 (indicate nearest V5 W L%tieet) Municipality �c 5CA, Watershed SOIL PERCOLATION TEST DATA RDQUIRED TO BE SLmmr TED WITH .APPLICATIONS 2 - 26.4 ?,� 2� 3 Date of Pre- Soaking 15 � Date of Percolation Test 5 Z 2 Zl o HOLE � 0. Z 3 27 0 77 NUOM CLOCK TIME PERCOLATION T1 3 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 3 Inches Inches Inch 4..., - -,. .•',f •� }. �j+- _ ',J';:y :• .� . .. -.x•m: .: +.� ":.- ....•ww,.. . YI a: IN .: :•-.4�>r_ia_:_W.S.:Y..,,vx:.t �K.... _...._![..lt_..M...J -. , - .r .5.. "�•-" . '�::�" = . ,:ram _ ... - _...._.. .. 2 - 26.4 ?,� 2� 3 1 4 5 Z 2 Zl o ! 3 � 0. Z 3 27 0 77 z 4. 2�� 24 T1 3 1_0 5. .�° j zi .77 3 4..., - -,. .•',f •� }. �j+- _ ',J';:y :• .� . .. -.x•m: .: +.� ":.- ....•ww,.. . YI a: IN .: :•-.4�>r_ia_:_W.S.:Y..,,vx:.t �K.... _...._![..lt_..M...J -. , - .r .5.. "�•-" . '�::�" = . ,:ram _ ... - _...._.. .. _ _ - . ;,: ' j .bs repeated at same--depth until-approoamately equal soil rates . • at are ` a a d`." per c6lati each too �.be 'sui�mitt�d �, .. o� _,test�io].e,�.�; r .: ,M.,aaatas 2•`� -Depth reoeu s to be made, fray trop 881 rr rov_ 9/85 1-10-14 G.L. 1' 2' v. M' •' •' • ' • • ••' I Y�1' �I 1 Y� : 11 r: THI fttm m County Department of He"u +ivision of Eavironmental Health Serrrioe<1: ..pproved aB, noted for conformance with .)PlioaDle Rules and Regulations of the 'gtnam County Health Department. �lsmttara 8 Tit1A s 02 �o N g� m• .g ,o°oo, / - ® existing / Existing 6 [/ Rlaidenee to ^y' y j ,is N 30, O \O SqN BO,Qv 41-1. L ,o � so, I% 0 0 I� iW1ir a f r( [APO `O "This is to certify constructed as b system was ins; ed over. The "s, with all the rules ty Deportment c 51�1� pf NEW COCK j. c�stF� ',o. 437 'bb ,.14101 Fp PROFESS�fl�� SEPARATION [ 1 2 ffA 33' 4 B 21' #5' 131 Plan based by on survey by as -e p ri LOUI, TOWN OF PAT PUTNAM COUI PA 19 -I -1 �/v Ir ® edsHnq �o �P ."This is to certify that the sewage disposal system was constructed as indicated on this plan, and that the system was inspected by me before it was cover- ed over. The "system was constructed in accordance with all the rules and regulations of the Putnam Courr ty Department of Health. pF DIEN e �lP 410• 437 ��cs AFC PROFESS%O�� Frederick A. Zenz 292 Main St. Nelsonville, N.Y. 10616 -nrn • --mn O p m SEPARATION DISTANCES IN FEET ; ON z I Plan based by on survey by R. H. BERGENDORFF AS -BUILT SEPTIC PLAN prepared for LOUIS MILANO I TOWN OF PATTERSON SCALE: 1"=4d PUTNAM COUNTY, N.Y. MARCH 15,1987 PA 19 -1 -1 I 2 3 4 5 6 7 8 9 10 " e U, 36, 2Q 246 I Plan based by on survey by R. H. BERGENDORFF AS -BUILT SEPTIC PLAN prepared for LOUIS MILANO I TOWN OF PATTERSON SCALE: 1"=4d PUTNAM COUNTY, N.Y. MARCH 15,1987 PA 19 -1 -1