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HomeMy WebLinkAbout1270DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.70 -132 & 33 BOX 12 I rs V. mj him J T 01270 PUTNAM COUNTY DEPARTMENT.bF HEALTH l Dlvlalori of Envlronmentel Health Services: Carmel, N{Y 10512 Engineer to provide Peemlt M~ �\ E --d CERTIFICATE OF COMPLIANCE CONSTRUCTION PERMIT FOR SEWAGE`DISPOSAL SYSTEM ��'a , G 321 -1Y a T. Patterson'. u"tedat ''Salisb'urX ''Zurich & Sudli.van Roads or. Village pu '' Town 3 1/12 Putnam Lake Av-L 8&A9 Sabdivlsloo Name Sabd 'Lot q Map Block Lot• 1 r both INc1 Ta: Revision ❑ o ..... 'Awniii /AnnllMnf Narna` MAttYPPTt r.T,f)hYA7C1A .. ,• � i ,. ' Other Iteaulremente' :NONE` I represent ,that l am wholly and'completely responsible; or the design and location of- the proposed s`ystem(s) `3). that he. separate ,sewage disposal.aystem abode descrfbei will be_constructedias shown on the „dpproved amendment thereto an in accordance edre the stantlards,'rules an regu a ions o e u nam , County ,Department of Healthy and that On Completion thereof a - Cert�f� cafe of Construction Compliance satitfactory to the Commissioner of He6ltheill be 'submitted AbAhe Department and b`.wrftton' guarantee'w�ll De turn�shed;tha owner his successors aietrs or'sssigns by the buildei, that said builder' will ; place. in good•operating condition anypaqt of said sewage tlisposal'systoni durmg,the periotl';of two,(2) year {immediately. folloeing thodate of.the issu -. p fr 6t the'tlrilled well, tlescribed' above will 'be located as shown on the,ap roved elan and that said well will be installed in 9 cordanee 'with the Bards rules' "a anoea of the a provdl •of the. Cetdwate -of ConsfrucUOn ;l Om Dance of the' on mil s stem or.an repairs thereto 2 tfi P D. County ;6epartment of; Health " I Tfi ni a Putnam ntl'.regu a O O /';th Date' 2 jt ly, 1987 Signed P E _ R.A. R9 -Fair St'.-.-- 105Aad.eu ' 9206 2 License APPROVED -FOR CONSTRUCTION This 'approval expires two Years Wom the date issued; unless construction d} the'building, has been undertaken and is ' reVOGDIe; /or cause -Or may. De amended 'or _ ' modified when ton idered.necessary' by the':Commissioner of He alt h,'.'Any; Change or alteration. of construcifon requires a new` pe[mitr, ADProJed for disposal' ot. domes sanitary sewage, and/or private' water wpply. only: Rev. 1/87f Date ,i qv, Title ¢! a r; PUTNAM COUNTY DEPARTMENT OF HEALTH -" DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date 2 July 1987 Re: Property of Maureen Lobraico Located at Salisbury, Zurich & Sullivan Roads (T) Patterson Section 67 Subdivision of Putnam Lake Block 3 Lot 1/12 Subdvo Lot #A914 -8 Incl. & Filed Map # Date A937 -41 Incl. Gentlemen: This letter is to authorize John H. Prentiss a duly licensed professional engineer X 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 - caiineetion with- this- ruatter" and ~�G sup'z1 vAise the construe 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. 6'0,��amnte rsigned: : , R.A. , ## a Very truly yours, Signe l Owner of Prop ty Address JOHN 11. PrENTISS. P.E. RD9 FAIR ST 914 -873 -6170 Qi D IEL, NEW MURK 10512 Telephone Barnum Corners Address Brewster, NY 10509 Town 914-279 - Telephone I DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 i APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION Street Address Salii'sbur , Zurch Towci Village.City Tax Grid Number & Sullivan -Rds„ T. Patterson 67 -3 -1/12 WELL OWNER Name Maureen lobraico Mailing . Address Mrivate Barnum Corners, Brewster, NY 10509 0Public USE OF WELL 1 - primary 2 - secondary U RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP 0 ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify, O INSTITUTIONAL O STAND -BY AMOUNT OF USE i YIELD SOUGHT Five gpm /# PEOPLE SERVED Six /EST. OF DAILY USAGE 400 gal REASON FOR DRILLING ONEW SUPPLY OPROVIDE ADDITIONAL SUPPLY OTEST /OBSERVATION OREPLACE EXISTING SUPPLY ODEEPEN EXISTING WELL DETAILED REASON FOR DRILLING 1 j Residential Supply i WELL TYPE ®DRILLED ODRIVEN [:]DUG ®GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED INCA REALTY SUBDIVISION, NAME OF SUBDIVISION: Putnam Lake Lot No.A914- 8&A937 -41 Both Incl. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: Over one mile LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED(See dwg. #l,job #502430 By John H. Prentiss, O ON REAR OF THIS APPLICATION O O S PA T S T P.E.) 2 July 1987 (date) (signat e) PERMIT TO CONSTRUCT A'WATER WELL This permit toconstruct one water well as set forth above is granted under 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 Putnam County. Health Department. Date of Issue:,, 19 Date of Expiration: 19 I Permit is Non- Transferrable 2A7 Permit Issuing fficia White copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner DIVISION OF ENVI110RMML HEALTH E• . E - ._.. ___....._._..__._. _ _.. __ - DF�IGN DATA SHEET= SUBSUFACE Sj bV=� DISPOSAL SYSTEM - - FILE Y�O, Owner � td ��i� "!6Tb �� ;`w -dreSS �grCis�uir� .�d0� , A vas &w _ � �9 ®0- A A 4!x'7@ 40 "M d/. Located at ( Street) a �' ®�m9 �� Sec. 9 F- Block Lot �� (indicate nearest cross street) Municipaiity ��g Watershed My SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking f$ Date of Percolation Test L-q 1 la HOLE N[MBER CI= TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Tithe Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 1 11 lack H131 3 -&7- Rq- 5 K ® 1 14 ZI�4 1 2 2 1 2 3 5 - 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 submitted for review. 2< Depth measurements to be made fran top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DLPTH HOLE ... d .HOLE . N0... G.L. 1° 2' 3' 4! 5' 6' 7' s' 9' 10' 11' 12' , 13' No ; Cec(aerdck p Pa'cic -�— 14' INDICATE LEVEL'AT WHICH GROUNDWATER IS ENCOUNTERED N6ie INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED A%hP DEEP HOLE OBSERVATIONS MADE BY: DATE: 3 LL2 8 DESIGN -- Soil Rate Used Min /1" Drop: S.D. Usable Area Provided 0' f No. of Bedrooms '° ��r Septic Tank Capacity ( Q 0 0 gals. Type q sgh Absorption Area Provided By L.F. x 24" width trench Other nee Nl� i -- _aoFESS Name Signature JOHN N. PRENTISS. P.E. R09 FAIR ST 914 -879 -6170 Address CARMEL NEY YORK 1e512 S �IP,NO. THIS SPACE FOR'USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date - Beechwood Series P.O. 80X. 323. d . BERWIM $ENNSYLV.AN!A 1.8803 0 (717) ?525914 Optional 3/4 Bath With 2 Closets 70K. 018 J - .._.._.. _ . �. BEDROOM 1 %Lf� FAMILY KITCHEN 15' -0'ic 1 1' -3' 0 17' -3'x 1 1' -3' I-J- Action Associates Inc. N Barnum Corners .Brewster, NY 1050g I BEDROOM 2 BEDROOM 3 LIVING ROOM I i' -8du i 1' -3° 8' -d"x 11' -3' 14' -0 °x 11'-3' dn. W . SUGGESTED LOWERi IE VEL opI. door © opt. f.p.d. UTILITY AM O ®gam SINGLE CAR OARAOE Met e'ft U&rdu 0 e( - FAMILY ROOM �ryDOSn 4' /f 'e rollimgv ®� uo DEN /STUDY l-- -------------- --- ---J --------------- Elevations are artist renderings and may vary to actual construction. Floor plans and room sizes are approximate. Appliances shown are optional. Plans, Specifications and Prices are subject to change without notice -EQUAL �3&0 r10 of to obso 11 6e limit of grovel solid p1pos tiding paper )nlet. to Motif rado rl from seplic nk box 12" deep 3 to obsorpm 3/4'stone 6r" MIES:lBoth boxi 7J-F5 ff*—ff box ERF OVERFLOW gravel tone -I 40 }orated of ff firmly supports below ground Ii 2 YnEM T CAL CUR DRAIN CURTAIN Raterpr -Oisfo Mae joint pope Baffles to mewl PL AN S E 4-'ri 0 . � �a t� A I -4/ 7– All 4� 7 A 16AH I �3&0 r10 of 6e