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HomeMy WebLinkAbout1172DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.62 -1 -12 BOX 12 01172 A 174. t L� kc a 'V Ll . i lip . 1, ,6 01172 ►� W WnLL UUr1r.Un11Vn ATIrv1-t DEPARTMENT OF HEALTH .. Division Of Environmental Health ,Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only ' "' 4 ' °'- WELL LOCATION STREET ADDRESS: wN /VIL ! 1 Y TAX GRID NUMBER: Addison Road, Putnam.Lake, Patterson,. New York WELL OWNER NAME: AOORESS: BERTRUM Construction Co., 100 Fairfield Drive, Brewster, NY 10509 PRIVATE PUBLIC USE OF .ki-L 1 - primary 2 - secondary [A RESIDENTIAL . ❑ PUBLIC SUPPLY ❑'AIR /CONO. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS, ❑ FARM ❑'TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ 'STAN D -BY ❑ MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED_/ EST. OF DAILY USAGE 100 gal. REASON FOR DRILLING Q NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 945 ft. STATIC WATER LEVEL i_ft. DATE MEASURED ii DRILLING EQUIPMENT ❑ ROTARY 61 COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE- ❑ SCREENED ❑ OPEN END CASING. 12 OPEN HOLE IN BEDROCK ❑ OTHER CASING TOTAL LENGTH. 38 ft MATERIALS: El STEEL ❑ PLASTIC ❑ OTHER LENGTH.BELOW GRADE 37 ft. JOINTS: O WELDED Il THREADED ❑ OTHER DETAILS DIAMETER 6 in. SEAL: rD CEMENT. GROUT ❑ BENTONITE ❑OTHER WEIGHT PER FOOT 19 lb./ft. I DRIVE SHOE: BYES ❑ NO LINER: OYES ❑ NO SCREEN DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? DETAILS FIRST .- OYES ONO. HOURS SECOND `GRAVEL PACK ❑YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH ' It. WELL YIELD TEST If detailed um inIFLL p p 9 METHOD: O PUMPED tests were done is in- ❑ COMPRESSED AIR , formation attached? O BAILED O OTHER ; 0 YES ❑ NO It more detailed formation descriptions or sieve analyses LOG are available, please attach. DEPTH FROM SURFACE water 8ear- ing well Dia- peter FORMATION DESCRIPTION CODE• ft. tt. WELL DEPTH DURATION h min. ORAWOOWN YIELD g Land 24 C & boulders 24 28 Soft brown weathered bedrock 2 2 45 6 6 - 200 0 5 5 28 245 Hard. e. & bl"ack_qranite i WATER 9) CLEAR TEMP. QUALITY O CLOUDY HARDNESS ❑ COLORED ANALYZED? BYES O NO ANALYSIS ATTACHED? YES: O NO STORAGE TANK: :TYPE CAPACITY GAL. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAME E MILL DRILL , INC. /1/.86 ADDRESS Putnam Ave. SIG Brewster,, NY 10.509 0 0 r a Mill :13 en --5 7- +,,. .4 % 7 Z­��.,,,,:,� WX CUKTAN KAO S p 3w f.2 ry F0114T 4 Y f 7 000AAL. C, 1000'GAL, MA60tl<Y 9,ff IC, TANK T? vl�!,r; j ex '5' Q9;W WfZTA.14- DkA W . . ..... i6t, a' eV.5. r A t , `' f� i - 100 0 &AL, - MAC -04r, � I C, TA < cow cu r"TA 1W C) ZA I t4 rutn":q0UntY Departme6t or lisa.LT.L tivision-6f�Eavironm6nte, h I 6b Sery ' 1 Health A IE9J I LT 5WTr, e,.Y -oproved ..pplici conformance with. ----- fo r, -------- ------ We Rules and *Regulations og the,.. I ky "ot-m-70—untY R4 th.Departmant. C-4 &HTH MW OF RffNAM L,. Q ADpisot. SYSTEM WAS TE4? TOW4 OF MT $00, -CERT.II:Y THAT TI-IF: SENW.AGE DISPOSAL. THIS is TO 'YHAT THE ED ON i)41S PLAN AND.. MIPWA 'CO. NY CONTRU&MID AS INDICAT . . . . _ j WAS COVERED OVER.- WAS INSPECTED Br1!qRE IT ely - OF NE SYSTEM WITH ALL SYSTEM WAS CONSTRUCTED IV ACCORDANCE W T MOO THE COUNTY ,AND REGULATIONS F THE. PUTNAM C ULATIONS THE RULES 0 O DEPARTMENT OF HEALTH. SOX 24*, MAY F'ESSIO ae� d Tai,% ..A ZW� PUTNAM COUNTY DEPARTMENT OF HEALTH ENG:- I,NEER MUST' PROVIDE Divisron of Environments/ H®a %th Svl loss, QMW, N.Y. Y, 10512': PERMIT. # v '� iUCTION COMPLIANCE FOR.SEWME DISPOSAL- .SY,STEM I � ` Town or V Illage located at ^v''•_ •�• _� Tax Map ' Block Ownei �Q'`�✓,./ iw 1 / Formerly I Taz Map Lot k l l0 - Subd.. LOt N Sewerage .AA 4 � -W / i Address T� v _TF Separate Sewee System built by' ! ,, . _., Consisting of .L Gal. ,Septic Tank and I 44-n Other requir , ements b ` ' izT DR.A Water Supply; Publir!Supply From Private, Supply. Drllled.By Y nl ►Y., Builtltng Type �� +✓,��lV No, of Bedrooins Date Permit hued a'. Has Erosion- Control Bean ' Completed? - Has garbage, grinder been installed ?. a 1 certify that the syetero(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 standards, rules and regulations, in accordance with the filed pl and the permit issued by the Putnam County Department•Of Health Date l HU7 ` Certified by P.E.• —R.A. X 54-K n1 ,Y; Address License No. Any person occupying premises served by the above systems) shall promptly sake such action as maybe necessary to secure the correction of any unsanitary ,conditions resulting from such .usage. Approval of the - separate sewerage 1, shall- become nultand void as soon as a public.sanitary sewer becomes available and fhe approval' of the private water supply shall become null ind'void'when 'a public :water, supply becomes available. Such 'approvals are subject,.to modification or change when, In the judgment: of thwC' ommissiorer of Health', such ievocation, modification or change is necessary. Date `7 4i / BY' Title Rev. VAS a3 Q PUTNAM COUYYfY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Owner or Purchaser of Building Building Constructed by Location - Street Municipality 15 � �24-, � �- W 1—/A Building Type . 5";- J r' �,- `v Section Block Lot Subdivision Name Subdivision Lot # GUARW= 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 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 19,r.;' Signature ? Title dW — (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk Corporation Name (if Corp.) /00 Ai1, �Clkle ,�1, PA=ess r a BREWSTER LABORATORIES -- _ _ ..... ........- - -_.._ _ _, .......! Box 224 - BREWSTER, N.Y. (914) 225 -2072 WATER ANALYSIS REPORT — SAMPLE NO. 6408• SOURCE: Bertrum Construction Co. Addisdn Road Putnam Lake Patterson, NY COLLECTED: Nove1Llber 299 1986 BY: Mill. Drilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method well 0 per 100 ml. This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. December 3-, 1986 Roy ickwit P.E. Director ENGINEER TO PROVIDE PERMIT # P. VT A �� ��`������ ��'�� ��%1II.�� ON CERTIFICATE OF,.COMPLIANC , Division of Envi ronmenial Healeh'zSeivices Carmel At ';.V 905.Y2 ,PERMIT cogs �u ..eon ��� �o`� s�w�,c� Dospos 'AL sys ��+ ®A- TF�ZS©N %� �. T e - .,_.lC/ / r.-•= - c7 aloaA ow village . , 8�- . LO,.at6d at Tax MaP J Subdivision w�1 Subd. Lot ll. Renewal Re isiop. '.Owner /Address ' 1� - - �Date Of. Previous, Approval - _ Building •Type Lot Area i Fi11i Section Ort1y o 0 J Number,of Bedrooms Design Flow G /P /D " DO P C. .111 f D �Njotification Required / a 1 �/ Separate Sewerage` System '•to con -sisrt of Gal Septic Tank and, ° e 4 J N �T OF T 6J` I- Ar S To be constructed by a� Address water Suooly Public .Supply From _ Private Supply to. be dialed ddress Other Requirements - � � � � � �--• d "� . (,represent that f am wholly and completely�responsib,le for -the design and location `oi'the proposed system(s)'1) that the separate sewage disposal system above described- wiili.be'constructed as showri;on the'approved:amendment there?to and in accordance with the standards, rules and regu•a Ions o e Putnam 4 County' D®partmenf of; Health; and that.on completion dhereof a 'CerUficate of Construction Compliance satisfactory to the Commissioner of Healthddill be' submitted "to -ahe- Department; and a,,wiitten guaia "ntee w,U =be furnished'llie owner fiii'successors heks or, assigns by the builder .that;'said builder' will piece in good operating condition any -:part of mid,- sewage disposal systern.during'.the period of two (2) years'l diately•follow.ing the data of the issu- ance of: the approval of .the Certificate of ConstructionCompliance of th'- i.ginal syste'- aIr any r 'irs,t.h o; that the Or well described above. will be'.located ii ill on the approved plan and that "said well wail be- install wrath t an r s, r ea }and rsgu,aons `oi 'the Putnam County.- Department of Health y 1 t j� Date Signed - P E R.A. Addrett .. I! �® s�J7�t1 Y. v. License No APPROVED F CONSTR,UCTION'c This approval expires one y Y` ►om the :da issued unless construction ,'of the:buildmg has been , undetaken an is z revocable for us r maybe amended o► modified; when consid ed n• essary',b he `Cominiss'io er .of Health. Any change'or. alteration af►co structdi•on requires %a t A. pproved for disposal of domestic ar' sewage, d r' r w ter wpply only. ,I► Date gy / Title f, Rev. .6 /85 n Lei l<7Z PUTNAM COUNTY, DEPAF 40T OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIELD INSPECTION REPORT DATE:' �?aRrQ- INSP. BY: (Name of Owner (Street Location) INITIAL SITE INSPECTION I YES I NO [ _ COMMENM 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 Descri tion 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. D.H. 2 Lot Depth to G.W. i Depth to rock Soil Descriptia 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. 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 ft. Soil DATE: A0 - 1 FINAL SITE INSPECTION INSP.BY: JA YES NO COMMENTS House SSDS located per approved lan.. ..........' Length of trench measured Width of trench average ' Slope of tile line and trench acceptable.........' Room allowed for expansion trenches ............. Over 100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded ............................ 10 ft. maintained from property line and 20 ft. from house... ........................ Distance well to SSDS (ft.) ......... .......... Number of bedrooms checks.. .........-Z).......... Stones, brush, stumps, rubble, etc., greater than 15 ft. frcm nearest trench ................' 15 ft. of peripheral soil horizontally frantrench..... ........................... ' Boxes properly set . ...........Y ........ .......... Could surface runoff from driveway, roads, ground surface, etc., channel near SDS area...., Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE.. ..... ... i trom .the --- -d-esh 0 ° - JOHM KARELL JR., P.E. Director Of Environmental Health Services n� P I• 4-4 n DAVID D. BRUEN` County Executive i DEPARTMENT OF' HEALTH Division Of Environmental Health Services . March 17, 1986 Mr. Michael T. Daly, P. E. Box 243 Shenorock, NY 10587 RE: Bertrum SSDS (T) Patterson Dear Mr. Daly AHN' sIMMONs, M.D. Deputy Commissioner A Note /18 should not state that construction of the system can begin after fill has settled. Please note a second application must be made to this office and approved prior to SSDS construction. 14. The basic required'notes and notes for fill sections as presented'in the informational packet on SSDS Submissions from this Department dated October 8, 1985 should be provided on the plan.. ✓5. The D -box should be a minimum of 20 feet from the foundation. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. MJB:mk cc: JK file Ver, , , rul -your Michael J. Bu zins'- Public Health Engineer f /1 /m -6 TWO. COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 This Department has received and reviewed the revised engineering plans for the above referenced proposal and we offer the following comments for your consideration. /. Two (2) set of house plans are required to complete your application 12. Note' #'7 depth specifies a fill of 2 feet although the plans show a 3 foot fill section. Please clarify this inconsistency. A Note /18 should not state that construction of the system can begin after fill has settled. Please note a second application must be made to this office and approved prior to SSDS construction. 14. The basic required'notes and notes for fill sections as presented'in the informational packet on SSDS Submissions from this Department dated October 8, 1985 should be provided on the plan.. ✓5. The D -box should be a minimum of 20 feet from the foundation. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. MJB:mk cc: JK file Ver, , , rul -your Michael J. Bu zins'- Public Health Engineer f /1 /m -6 TWO. COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 11 DAVID D. BRUEN -- - — _ County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services January 16, 1986 Mr. Thomas Daly,'P.E. Box 243 Shenorock, New York.10587 Re: Bertrum Addison Drive Putnam Lake (T) Patterson JOHN SIMMONS. M.D. Deputy Commissioner Dear Tom; The enclosed is returned to you for revisions as noted. Z lVu s, Robert J. ni Division of Environmental Health RJT:pt Services cc : JK RJT Enc. TWO COUNTY CENTER — CARMEL, N.Y. 10512 (914) 225 -3641 . PUTNAM COUN'T'Y DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS 1 i of Owner) CCMME Ca" he &J"* 9. REVIEW SHEET - CONSTRUCTION PERMIT DATE 0�,� - - -- -BY: (Street Location) YF 1..N0 DOCUMENTS Permit Application Corporate.Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Dee p.Hole Log Consistent Perc Results (3) o.� 30" Perc Hole Other House Plans - Two sets 4 If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS V' Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow ®/" Fill, Profile & Dimensions - Volume 31 c✓ D or J Box;Trench /Gallery; Pump pit details Vol Septic Tank - Size, Detail Well Detail, Service Line if over Cons. I truction Notes Design Data - Two -Foot Contours Existing & Proposed &-ol Driveway & Slopes Cut vol Footing /Gutter Curtain Drains %000. Perc & Deep Holes Located 7---;;;- Representative of Sewage & Expansion Area d•-, Expansion Area;shown;gravity flow,suff. size _ If Pumped Pit & D Box Shown & Detailed House-- No. of Bedrooms Wells & SSDS's Win 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe, No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN / N.S 7 91 CC A•'CC pt L 1 S=RO Fields njM C V 10' to P.L., Driveway, Large Trees osi vti , t,ia /& 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 50' to Well WO �" ► G.— 151, Well to PL GENERAL AN r Legal Subdivision Subdivision Approval Checked ,� 19 Eft= approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same 61- 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 �E� 7 —i�UN� Addre s s Located at ( Street zoj50/V Z)Rl�Sec.: Block 3 Lot 61 9, "C'110 Indicate nearest cross s ree Municipality. A'7Tt&SQA1 Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS i Hole Number CLOCK TIME ' PERCOLATION X, -46 PERCOLATION Run Elapse i)eptrn to water water Level CD No. Time From Ground Surface in Inches' Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches' Inches i 1 0 - D (7 - C) .3 ! o 2 t7 r (%. is 3 O 4 o �..-�. 5 CD \ 2 t ( 3 3C.l) t S> t- _ :.... 2...o :_ z 2 4 D t� 5 O' «, t7 1 3 1( t r \ 2 t ( 3 3C.l) t S> t- DI 1TAI R AA r"n� gnaw -v DENT. OF HEALTH 5 Notes: 1) T(i�ts to be repeated at same depth until approximately 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. : 2 DI 1TAI R AA r"n� gnaw -v DENT. OF HEALTH 5 Notes: 1) T(i�ts to be repeated at same depth until approximately 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 .. _._ - - . _ DESCRIPTION OF SOILS ENCOUN�1'ERED--IN--TEST- -HOLES DEPTH HOLE NO.--/ HOLE NO. Z HOLE NO. 1811 Ij 2411 3011 3611 4211 lei 48ft 5'+ it rr 60" tr. �t 66" If I I 7 8411 � .INDICATE LEVEL AT , WHI CH... GROUND _WATER IS . ENCOUNTERED 5 . INDICATE LEVEL TO WHICH WATER.LEVEL RISES AFTER*BEING ENCOUNTE TESTS MADE BY Date DESIGN Soil Rate Used— LCMin/l "Drop: S.D. Usable Area Provided_ . No. of Bedrooms Septic Tank Capacity /000 Gals. Absorption Area Provided By/4 L.FI er.`� Name "T r C.hf /1 EL L Y , -- Signature ,'` Address 0 0 � a� SEAL O BOG �0�- -7 I� I `�.r�. �1.. �A. " o, THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by Date ' I All N1 i - DAVID D. BRUEN County Executive -j o DEPARTMENT OF HEALTH Division Of Environmental Health Services January 16, 1986 Mr. Thomas Daly, P.E. Box 243 Shenorock, New York 10587 i Re: Bertrum Addison Drive Putnam Lake (T) Patterson JOHN SIMMONS, M.D. Deputy Commissioner Dear Tom; The enclosed is returned to youi. for revisions as noted. ly Y s' -- Robert J. ni Division of Environmental Health RJT:pt Services c c : JX RJT _. E.nc. TWO. COUNTY CENTER — CARMEL, ' N.Y. 10512 (914) 225 -3641 ��l'clr+ . _. - ..;xf. � � .sany .,,r.. :. .a .7.-c: r _ ,r- --r:,. _, -�c•., ::;; r.. Y - .}Y:z•'_. r "s�.F �•' �,.�,� �,�, sy. 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'Ovholf DR V ..'Vablemolyt S1 MATE IM.Tyk, 0,71Y Cwlss from the original of flus survey marked. Arith an original of fte OWN Certifications firreon signify lho� this survey was prepared /# accordance K/ h he T TTERL /an surve ..41 yor s. inked seal or hls-emPassed seal shall be considered to Lv existhig Code of Practice for Land Surreys, adopted by me hbw. York Sigfe Assoo:' valld• lrd/* copies. of Professional Land Surveyors.' Said carl/fievf/vok shall"ran an/p,- to thwpoisoo t whom The survey Is prepared, and on his twhaff to 'Ar title camphay, governmental /or PU TNA M' COUNTY agency and landing inslifulion 115tea, hemon, anal to /,*o� in- ROBERT E. BAXTER a ASSOC. glws of.th. �*noliog Ir SlAft"Zon. cerliftefians are not 'transfarable a ad'diflan'b'14ISfitalioni ortasabz 0 E 'ond surv'ey';Ors'� and planngirs seqAwnl owners. NEW;�k a Box P98 R. D. �, Box 277-c. 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