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HomeMy WebLinkAbout0914DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.39 -1 -51 BOX 10 Lj1• p Ll No r �, ,- �' M; ;� r J - No �i X , �, No u, 961'o ., f die r� lloo -� to Lj1• r -`1 PUTNAM COUNTY DEPARTMENT OF HEALTH Rev. 3186 Division of Environmental Health Services, Carmel, N.Y. 10512 4 = Engineer Must Provide P� N t\ P.0 H D. Permi 1 Located at 141- -1 V U kJ I A� *.—n /u. p Owner /applicant Name � �-Z Formerly Mailing Address LI Uo to IA. -To �/�YI�IJ Zip � Z !o ff Separate Sewerage System; built by NEB-- 1�ETL�A11G' Consisting of Gallon Septic Tank and Town or V e Ta: Block Lot Subdivision NaniFLO Subdv. Lot N 46:112- gorPg Date Permit issued Water Supply: Public Supply From Address ors Private Supply Drilled by F-> oD . Address Building Type Erosion Control Been Completed? Number of Bedrooms Has Garbage Grinder Been installed? Other Regaitemegts I certify that the system(s) as Iisted serving the above premises were constructed essentially ass on the plans of the completed work (.copies of which are attached), and in accordance with the standards, rules and 'regulations, in ac ordance i the led plan, and the permit issued by the Putnam county'Department aaO..P Health. Date l vim_ 7 k Certified b P.E. R.A. - Address © Y= License No. Any person occupying premises served by the above.system(s) shall. promptly _take such action as may necessary t secure the correction of any - unsanitary conditions resulting from .well usage. Approval of the separate sewerage system shell become null and void as soon as a pubt`_ unitary. mwer:-becom" available and the approval of the private water iu_pply shalt become null 'and void. when a public water supply becomes available. 'Such approvals are subject .ttomodification or change when, in the - judgment of the Commissioner of Health, such revocation, modification or change Is nec""ry. Oats / B� _ Title 71 orktown Medical Laboratory, Inc LAB 321 Kcar Strect - -- Yorktown Hcights.N.Y.10598 Collection Station Used: (914xM-203 Carmel Peekskill - - .._.__._ Director': Albert H. Move ru A t(AXP) __.._._ ..Nt. Kiac New C.i.ty_._. _...... -- G �� /' Date Taken: Date Received: � u•� ��� Date Reported: �: d-C Collected By: �c 1' -� _ S 7 / 17 Referred By: Sample Source: 7v¢� L J LABORATORY REPORT ON BACTERIOLOGICAL 6Yt QUALITY OF WATER GENERAL BACTERIA Standard Plate Count per 1.0 .m1 S� (Agar plate @ 35 0C) MEMBRANE FILTRATION tECHNI.QUE (MFT) Total Coliform per 100 ml '.Fecal Coliform per 100 ml _ Fecal Streptococcus per 100 ml PaOBABLE NUMBER TECHNIQUF. -(MPN..) .Total Coliform: MPN Index ner 100 ml Fecal Coliform: MPN Index per 100 ml OTHER ANALYSES THESE RESULTS INDICATE THAT THE WATER SAMPLE,. WAS (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 m Recommend Disinfect- ing Water Source < - less than TNTC - Too Numerous Too Count WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEA' �~" T Division of Envlron,ne It I Health Services COUNTY OFFICE BUILDING • CARMEL, NEW Yc 'MIS report It—to comp et well driller a submitted to County Health Department together with laboratory report of _ _ analysis of water. Sample indicating water is of satisfactory-bacterial quality-before certificate of oonstrudtivn doK once is Issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION Ow"" NAME Tom & Nanette Coulter ADDRESS Blueberry Dr. Brewster, N.Y. 10509 LOCATION OFwELL o. A Sir"t) own (Lob amber Livonia Drive Patterson PROPOSED USE OF WELL DOMESTIC ❑ ESTABIL13MMEW ❑ FARM D TEST WILL PUBLIC ❑ INDUSTRIAL ❑ CONDITIONING ❑ �fy) DRILLING BOU MENT AI �� ❑ ROTARY D AIR PERCUSSION ❑ PER USSION ❑ (Specify) CASINO DETAILS LENGTH (hat) 42 DIAMETER no 6 19 ® THREADED D WELDED ES ID NO UAY15 NO TEST ❑ BAILED ❑ PUMPED ® COMPRESSED AIR HOUR G.P 6- S YIELD 6(..M.) WATER tiVEl MEASURE FROM LAND SURFACE— STATIC(Specity tact) 38 DURING YIELD TEST float) 405 Depth of Completed Wall In feet below Land surfacer 405 mum DETAILS LENGTH OPEN TO AQUIFER (ra TAME lie IF GRAVEL PACKEOr Diameter of wall Including grovel pack ( Inch")- (Iowa • toot) DEPnt PaOM LAND i11RFACE FORMATION DESCRIPTION Sketch exact location of well wlnr dletaneee, to W hat two permanent landmarks. FEET to FEET 0 25 Sand & gravel Boyd Artesian Well Co., Inca Rt. 52 Carmel, N Y. 10512 25 405 Gneiss &, , quartz • If yield was tested at dMerent depth* during drilling, list below FEET GALLONS PER MINUTE.. DATE WELL COMPLETED 3- 20- 86 A EPORT [WELL DRILLER (Signature) pUTNAM COUN`T'Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 4- Ma rn o eA,--, i i) +e--ir S- owner or Purchaser of Building Section Block Lot De(Uue 146) mec Building Constructed by 3 5 L r Location - Street Subdivision Name CtrsdY-) GCS LY Municipality Subdivision Lot # SCI �t- LJe�( -Building Type GUARANTEE 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 "t-epairs made._ by_ iiie. to.-such-system, except where_ the. failure to operate__properl� _ 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 day of 619 94. Signature Title General Contractor (Owner) - Signature Corporation Name (if Corp.) 3 S Address rev. 9/85 mk Corporation Name (if Corp.) A Adr ress h W l, -1 Is �ro (4) '�vZnq,, 0 Lov AD' 4-o�o - 4vc, s 019 - 4 00,F Putnam County Department of Health Avision of Environmental Health Bervioeb %pproved as noted for conformanoe wit applioable Mass and Regulations of Puts Cq=ty Health Department.. rte CON-1,R[!CI'R1) AS INI i';) CIN *11 fiS PL. C-: A: D -i 13., f 9111' SYSTEM WA'.,> f!) 11Y MF 14:i ORF 1 1* COVITR) 1-WER. THE SYSTEM WAS COINSTRUCITI-) IN A0 ORI,ANCE NVII H ALL THE RULI.,'-' AND RU-,U-1,ATI0,N1i OF THE F-11'NAM COUNTY I)EPARTMENT Of.; 11EALT14. �Foy 1 "6ea k-\,6w- "mom Ah 17m: U-)V 'Q !)2 Lw P-r @ -A, x4 7:1 24-3' V1 br 5x 1 43- —row �1 OT- J, < �Foy w. a PUTNAM COUNTY ;DEPARTMENT OF HEALTH ' .: ENGINEER TO PROVIDE PERMIT # ON CERT•FIC 0 C LIANCE, i Dirvrson of _Emvronmenial Healih= Services Carmel N Y 10512 PERMIT _ ;CONSTR. ION PERMIT FOR SEWAGE. DISPOSAL SYSTEM nwn, or Villace Located at" �/ �9Tax Map ✓ alock iG iot SUbdiVfSiOn' �•,t� •'�+�,` J/"��`�_� �L SUbd ,,Lot XFRenewal Q Revision Q Owner /Address 1`r�2 . �.+�.�C)1.. ^p11% � /ms's to of Previous Approval Builtling T.ype� !.�V'�! i LLi Lot Area o 0 Fill section only ❑ - - rof P.C. ification.Re aired'• Numbe Bedrooms �.Deaign Flow G /P /Dr�l - Fi. D�Njo/E, ^qT� /� separate Sewerage. - System to consist of IZ giii Septic Tank and <��(t.] rf �`Tyx�t To be constructed by TZ Address Water' Supply:.. Public- Supply •From tl Private Supply to be drilled by ( Address .. 'Other 'RegUire nent5 . . I represent that 1 am wholly and completely . responsible for "the design and location of the proposed systems) `:1) "that :the separate. - sewage disposal system above described will be constructed is shown on the'approved amendment thereto grid in accordance with thestandards,.rules an raga a ions o e _vu nsm County Department of " "Health, and that on_ completion thereof a "'Certif:lcate of Construction Compliance'- satisfactory to the Commissioner of 'Healthwill be submitted to the Department, and a ;written guarantee will be`;furnishetl` the owner his successors, heirs or assigns 'by the builder, that said builder will :place in good, operating ;condition =any 'part of saiq sewage disposal system during the period of ;wo.(2) ye6rs iminedibt y,following.thetlate,of the issu- ance, of -the approval of Lhe Certificate of,. Construction Gompllance of theSoriginal: system or any repairs thereto, 2j.'t ` t the d Iled well described above ,wi11 be . located -is showri,on file approved' plan ind.thaf�said'weil will'beanstalled;•in" accordance with he st ndards, le a` ,r a ons:' of ,the Putnam County Department of Wealth. bate .• f0 I JO�.' Signed P E.L R.A. Address � icense !No U � 14PPROVED FOR CONSTRUCTION This,a'pproJal expires one year -from the- date-415 ued u structioil of-the builrling has been .undertaken and is revocabie.for' cause or may Ze amended or modiiled when idered-necessary. by` ;he' Co issione► Wealth. -Any change or alteration of construction requires a new per it. A roved _for disposal of dome Ic sa tar -se wag , antl /or''priv te,,water' ply .only. , Date: Title 1. 9 PUTNAM COUN'T'Y DEPARDIEW OF HEALTH - DIVISION OF ENVIRONMENTAL . HEALTH SERVICES INDIVIDUAL inII= SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS KaD INSPECTION REPORT (Name of Owner) ( treet Location) INITIAL SITE INSPECTION YES NO Wetlands on /or proximate to property ........°..... Property lines or corners found ................... can estimate house location ....................... Will driveway need cut ............................ Must trees be removed - 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 ............................ D. H. 1 Lot Depth to G.W. Depth to rock Soil De 0 ft. 3 ft. r A 6 ft. 9 f . 12 ft D. H. 2 Lot Depth to G.W. Depth to rock Soil De 0 ft.' 3 ft. 6 ft. 9 ft. In f� DATE: INSP. BY: D.H. - Deep Hole G.W.- Groundwater D. H. 3 Lot Depth to G.W. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. 12 fL.. I A DATE: FINAL SITE INSPECTION INSP.BY: YES NO COMMENTS House SSDS located per approved plan ...........:. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Roan allowed for expansion trenches .............. Over 100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly, graded .......... . ........ ........ 10 ft. maintained fran property line and 20 ft. from house .............................. Distance well to SSDS (ft.) ...................... Number of bedroans checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench.. ........... 15 ft. of peripheral soil horizontally fran trench ..... ............................... Boxes properly set... � .. ............. ......... Could surface runoff fran driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE.. .. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner gg,4, ji�� Addre s s�r'_,5L,, j I Located at ( Street L�� �/� a p. ��ee. C� Block fo Lot 1 �' �' n 'ica e nearest cross street) Municipality. Watershed�{tLr'� SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION - PERCOLATION RIM .lapse p h7o water water ,eve . No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in ..Min. /in drop Inches Inches Inches 5 Notes: 1 Tests to be repeated at same depth until apppproximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. 30 !r 4 2 3 0 ' t5 Vs 4 0 - t�5_ 21 s" 2 5. C) - L 05, ZV 27 3. 1 2 ,3 4 5 Notes: 1 Tests to be repeated at same depth until apppproximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION SOILS. ENCOUNTERED IN._TFST :HOLES_.____. DEPTH HOLE NO. HOLE NO. ^2i HOLE NO. G.L. 611 �� d P 1811 1/ .2411 i 3011 3611 42111 . v. . 4811 66 7211 841H �f � ICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED 1 b \4iZt=-KZ- Trm-r.ry� n T� rfnT_ :. m Lf'[1"rnTr . mTL] T' T�rnT T7) 0 1_ . A r T1T�A . BL�TTT(', T.r�TmL�D�T�'� 11VL.EGATE- I V1JL Q "YV111011 WAYE J..ILJ' VEL RIVl'J13 Ill' ll'J11 L.L�11V �.1 ENCCV1v1J.:111.L'JL TESTS MADE BY T6 Date �'j� r S� DESIGN Soil Rate Used G -7 DftrVlT'Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity. Gals. Ty Absorption Area Provided By L.F.x241' width rent . Other. lvame Address SEAL THIS SPACEOR USi1 T�F D q� EPARTMENT ONLY: Soil R�'TAppr� Sq. Ft /Cal. Checked by Date ZY PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEAUni bmv.1Lt.3 WIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTR4S e"uf �1 J REVIEW SHEET - CONSTRUCTION PERMIT. �� DATE REVIEWED: '�� BY: _ DCC'[E3ENTS - Permit Application _ 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 If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile -,Gravity Flow Fill Profile & Dimensions - Volume v D or J Box Detail Septic Tank - Size, Detail Well Detail, Service Line if PPS Trench /Gallery Pump Pit Two-Foot Contours Existing & Proposed Slopes for Driveway Cuts Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area; shown; gravity flow If Pm pea Pit & D Box Shown & Detailed House - No. -- of Bedrocros Wells & SSDS's w /ln- ZOH- ft.-- of,- Proper y- Located - - --- ,Property Metes & Bounds House Setback Necessary House Sewer - 1 /4" /ft. 4110; 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, Lake (inc. expan) 15' to Drains- Curtain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' from Foundation X50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same