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HomeMy WebLinkAbout1416DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 33. -2 -38 BOX 13 R ' ;, � r ;+�.. i 01416 \C� Owner /applicant Name Melling Address -/-1 Fee Enclosed PUTNAM COUNTY DEPARTMENT OF HEALTH ti' Divbton of Envbmmentd Be" Services, Carmel, N.Y. 10512 Gt zngwwmustpmvw P Zo — �1 P.C.H.D. Permit M F CONSTRUCTION COMPLIANCE FOR' SEWAGE DISPOSAL SYSTEM _. __.....- Tai PBlede —L —Let 5 . /� Cal Z 1 iY•w l d L-&rT oLr Formerly Subdivision Name — !ff-�' maj � �Sici�E a94 Subdv. Lot # 3� 1 Amount / Date Permit Issued. Separate Sewerage System built by l Vt11e4 1-1d I e y r . — T aa-I . Cemkftg of I Gallon Septic Tank end � N J Water Supplye Public Supply From Address p /�, ore — — Private Supply Drilled by Address e 3I I . Q�C /71 A Tl tq "SO p /UY 1 �3 Bugdbsg Type rr?Li� Lot Size off. IVtdci Has Erosion rnntrnl Rppn rnm ted? /J4i✓'S Number of Bedroome A Has Garbage Grinder Been metalled? -.n Otber Requirements I certify that the systm ) as lLalled sewing the above premises were constructed essentially as shown on th an$ of the completed Work ( copies of which are attached), and in accordance with the standards, rules r ations in accordance wi th it plan, and th 'permit issued by the Putnam County Department of Health. Date ' ' , r^ (' Ce1rtifled V1 P.E. X RA. Address rQ1 fT I Q IC7 aJI I �P �,�y t � `' ' � aS �� License NO. �� � Any parson occupying premises saved by the above systems) shall promptly take such action as may be necessary to secure the Correction of any unsanitasy conditions resulting from such usage. Approval of the separate sewerage stem shall become null and void as soon as a pubito sanitary sewer beoomws avallble and the approval of the private water supply;shall become null when a public water supply becomes available. Such approvals we sub)ect to mods lotion o change when• in the Judgment of the CO m of Ith, such revocation. modification or change Is 3/$9 Date v - By- Tnle u .c WELL COMPLETION REPORT fiEpAItTMENT Of HEAL`!.0 i m£al Health: Seizices Divisioti Of E' PUTNAM COUNTY DEPARTMENT OF HEALTH 1 Off ice Use only STREET ADDRESS: Nl p # TAX GRID NUAtRER: _ 5t:.... _ Cara NAME: ADDRESS: / Normo.h I tf P9IVATE lVar f r ❑ Puel_Ic WELL LOCATION WELL OWNER USE OF "WELL 1- primary 2 - secondary RESIDENTIAL O PUBLIC SUPPL O AIR /COND. /HEAT PUMP O ABANDONED 0 BUSINESS 0 FARM 0 TEST /OBSERVATION 0 OTHER (specify) ❑INDUSTRIAL 0 INSTITUTIONAL O STAND =BY O MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY. USAGE 6 gal. REASON FOR DRILLING K. NEW SUPPLY, 0 PROVIDE ADDITIONAL SUPPLY 0 TEST / OBScRVATION O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH - Q _I' 5�AtiG �IIATER LEVEL J fi DATE MEASURED. / F7 DRILLING EQUIPMENT 0 ROTARY 9COMME88ED AIR PERCUSSION O DUG 0 WELL POINT . 0 CABLE PERCUSSION O OTHER (specify): WELL TYPE 0 SCREENED O OPEN END CASING edPEN HOLE IN gEDROCK 0 OTHER ' "TOTAL LENGTH__ = ---W tt- MATERIALS: STEEL 0 PLASTIC O OTHER CASING DETAILS LENGTH.BELOW.GRADE . , : :�.ft:. JOINTS : C� WELDED, THREADED O OTHER DIAMETER in.. SEAL b CEMENT GROUT BENTONITE CI OTHER WEIGHT PEH E00�', :.t.. _ :...: .._�� Ib, /it:. DIAMEThf1(litj dth SloTS1E L � . DRIVE SHOE YES 0NO LINER:OYES NO ,. (ftj f)EPTH TO SCREEN (IfI„ DEVELOPED? _ _ .SCREEN - DETAILS ._ FIRST � _, ...; _ YES 0 N H Rs._.— _ _ - GRAVEL PACK [] YES d NO GRAVEL SI7t«• DIAM dE PACK � 1n TOP . DEPTH tt. BO hl OEPtH . It. WELL YIELD TEST If detailed pumping VCHOMPRESSED 00: O PUMPED I tests were done is In AIR ;; formation attached? ' b YE5 '" b O BAILED .O OTHEA ,. :.. " "rr 11 more detailed forih tion descriptions Or sieve analyses WCL�L117 . are available, please attach. . DEPTH FROM PRFACrc 1. Water eear Ilhl well Dja' • I�ater :. FORMATION DESCRIPTION t00E. It (t WELL DEPTH It. DURATION hr. min. DRAWOOWN It YIELD 90m•,, S`and .ac. e urf A ©Q AA �S. WATER KaEAA TEMP: QUALITY ❑ CLOUDY HARDNESS O COLORED ANALY20? OYES i7N0 ANALYSIS ATTACHED ?. O_YES O NO .. ;, - STORAGEAi`1IC i TYPE CAPACrY _ .. GAL. PUMP (NFOAMAtION TYPE MAKER MODEL CAPACITY y DEfrtH , VOLTAGE HP V WELL dRIILER NAME OAtE �/ A1,13tRVM94 HYATT & SONS,' INO. ADDRESS yi/6 .Drilling., 3lGtiititlpE RED:' 311: R.R. 2 866.. TTERSON, NEW YORK 12563 YO LABO C;Ek. Ek r. ME SATWAOI I XV Alb6l i2/85 as r-l:ym LU LCCATION .7 V. vi. APPENDIx c INSPECTION Date /L 11 Ins y Y # r -Z, T M # OR Sl�ilvv�S,5:3m LOT 4 YF-c NCI SE-WAGE DISPOSAL AREA a. SDS area located as per approved plans b. Fill section - Date of placemnt 2:1 barrier. LGTH WEM AVG.DPrH C. Natural soil not stripped _ '�-Ec-ne, d.' brush, etc., greater than 15' fran SDS area. e. 100 ft. fran water course/wetlands. SFXAGE DISPOSAL SYSTEM a. Septic tank size - 1,000 1,250. b. Septic tank installed level c. 101 ndnimun fran foundation d. No goo bends, cleanout within 10 ft. of 45* bend 4� e. DISTRIBUTION BOX 1. All outlets at same elevation - water tested J 2. Protected below frost I 3. Minimuu 2 ft. original soil between box and trenches I f. JUNCHON BOX - properly set : g. ME,)= 4�1- (12 S- 0 1. Leength required 7�L-) 06' length installed,_ 6 2. Distance to watercourse measured'. 3. Installed according to plan 4. Distance center to center 5. Slope of trench acceptable 1/16 - 1/32 "/foot. 6. 10 feet frcin property line - 20 feet - foundations 7. Depth of trench < 30 inches fran surface 8. Rom allowed for expansion, 50% 9. Size of gravel 3/4 - 1�" di-ameter 10. Depth of gravel in trench 12 " minimm ll.- Pipe e-nds capped fT3!P OR DOSE SYSTEMS 1. Size of puTp chamber 2. Ove--flcv, tank 3 3 . Alarm, visual/audio 4. PLmp easily accessible manhole to grad-e 5. First box baffled 0... Cycle witnessed by Health Department estiimted flow per cycle rT ..Ou--e located per- avTDrcve,-; plans. N=nher of Ledr-ccms Weil lccateki as -.er plans IVA b. Distance fran SIDS a.�aa measured C. Casing 18" above gra'de. d. Surface drairzce arcund well acceDtz-�- OVERALL WOPY%MASHIP a. Boxes properiv -arcutEc: b . A-11 pipes partia-111-7 HIled c. All pipes flush wi-. m inside of box d. Bar-kfill material contains stones < 4" in diameter e. Curtain drain installed according to plan f. Curtain drain out-frail protected & dir.to e-xist.watercour g. Footing drains discharge away frcm SDS area- h. Surface water protection adeauate i. sion control on slopes qr ater than 15%. John M. Simmons, M.D. PUTNAM OOUNTY IiFALTH.. DEPAR�iFNT_.�_._.- _ DIVISION OF ENVIRONMENTAL HEALTH SERVICES Deputy Canmissioner of Health - FIELD ACTIVITY REPORT - Sheet ( of 1 INSPECTION NAME /; (� S /i/ [ - Q % � w Orig. Routine F _ Orig. Canplain S rze e L- ADDRES/� s � Orig. Request No. Street Town TM No. Compliance Ca plaint Camp MAILING ADDRESS Final P.O. Box Post Office Zip Code Group Illness Construction TELEPHONE PERSON IN CHARGE OR INTERVIEWED Name and Title DATE V TIME ARRIVED TYPE FACILITY TIME LEFT Reinspection Field, Sampling Only Field Conference Other Explain INSPECTOR: Signature and Ti PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. SIGNATURE: 6/86 TITLE: TELEPHONE: _ m. A.•,,. rnvsaa ,4PPq uaruw represent that 1 arr wholly above described will be;consl place in .good operating condition any': pail a n e rice the approval of the Cert,f �cat; of, will be located' as s o>rvn;on the approved plan County Depart men • o�f9 H Ith "Date . . 17" t D � G., ��y a� � o• isi a for the design and location of the propo system(s) 1) „that the I approved amendment there to and in accordance with the standards rule )let ion theieof a 'Certificate of Construction Compliance". satisfactory, t guarantee •will be furnished-the owner; w his cCesSOrs, heirs or, assigns by aid 'sew5ye disposal system.during the period of two (2) years immediat ruction Compliance of the o igmal;syste or .a repairs thereto 2) 1:1 hat said.well wilfbelnst - n the stand ifs; rule's Signed " Address- APPROVED FOR ONSTR CTlON: This approval expires,`eia: year, from the date " ued unle nstr cti f t b i revocaD le for taus or, ma be amend or, modified when co nsidered: necessar by . e Commt e f t y c a requires a new m /y�. A�'broved for .Cisposal oUdomestic sanitary sews or private - t D IY Date BY Title separate:se ge disposal system san regu a Ions o e u nam o; the Commissioner,`ot Heatth'will, the build r that said builder. will ely toll n9 the Gat® of'the'issu- t the. it welt described above of the Putnam �� E - R.A. ice nse� Iding has been undertaken and is nge or alteration of,cons Yuc t Ion l _` A G ���`; r� ^,J _ __ _ — __ — _ _� �• sent+ Ira, a n , J- cer,, a :7';Jc'v-e o'I ?re C'D' "i' "aii'an tar"d',aM =:it}IOTized to act ..for Ly Ces j�'1 n� ^ „!tjli'L,�_ 1,.��.` �?t _�'.! ,. ✓ �� _ _ ._ _ _�rt�ikl5e E -'Cers arc C� ru C.�j�•t,rd�tiiry "r�. f /i °iiGr�Ji/t Aj e and aF'd, '>":= I an an 4 a1 y :eS =" cl?'Ie for any or all acts rE? tr}t peC, i;:2 et.'•�;'c1'ad 7�:�7wIJQec: i,-ed an r:01 dsub- t at 4 } .5 a .1' J'.:1;� t . s _ 't... ` Z *Ns i� t.4eo: e ran %�11s !Q j) S; �.___ - ..car_ ..�b��c LINDA R. BURP E Notary PubliC, State of N"Y No.4808377 . Qualified in Westchester Count+ commission Expires g1tgg, CC,rp -, - c : e F, eP, 1 DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPIrICATION ;TO -- CONSTRUCT - A-WATER WELL... PCHD PERMIT # �_. WELL LOCATION Street Address Name v► Town /Village City Tax �%�• �i\i Address �j a .� ?Low /�� Grid Num er r '� e DPublic 0 Public WELL OWNER USE OF WELL 1 - primary 2 - secondary CKESIDENTIAL ❑ BUSINESS ❑ INDUSTRIAL 0 PUBLIC SUPPLY 0 AIR /COND /HEAT PUMP 0 FARM D TEST /OBSERVATION O INSTITUTIONAL 0 STAND -BY O ABANDONED D OTHER (specify ❑ AMOUNT OF USE REASON FOR DRILLING YIELD SOUGHT �� gpm /# PEOPLE SERVED (o /EST. OF MEW SUPPLY ❑PROVIDE ADDITIONAL SUPPLY ❑REPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL DAILY USAGE gal (3-TEST/OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE KRILLED ®DRIVEN EIDUG ®GRAVE L OTHER IS WELL SITE SUBJECT TO FLOODING? YES LINO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name - Address: .IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY...F$OM_NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION TE HEET (date) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct 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 Hea th Department attached to this 3. Submit a We 1 Completion Report on a form Health Depa tment. Date of Issue: 19 Date of Expiration: 19 Permit is Non - Transferrable 8/86 _ eu 67 nFpAFt TMELv -T OF HEALTfi - DIVISION CF FNVI_RCi�" 3'T �L fiFALTH SERVICES LV-A SUrPLi & SUBSURFACE "Jli.aJ — REVIEd Sr___ - CON TIRUCI'ION "PENT :. DATE REv ^ �vFD : �•—� Y BY: 3 (Name of Owner) ( S ccm-NE INTS I = I � I 1 � I � I - I I I LF trench provided I requir 60 ft. Max- � p(-,ra=l le to c ntours i i re nation) DOCUM-a- US Permit Applic--tzon Corporate Resolution Plans - Three sets Fnaine rs Authorization sign Data Sheet (DCS) Deep Hole Log Consistent Perc Re_a, ,- Perc Hole Depth s/s SiBEDiJ I SIC?v Perc 6 (3) Fill -Z, rL -- cd U h- se Plans - 'tao sets W�l letter L 4ariance Request 147 C L 4 Legal Subdivision Subdivision tmprcv-1 Ciecked Ex- accrcval SSDS paj . Lots C'leC.ked Wetland (Town /DEC Pe-mm i t R & D) Data On DDS Plans & Pest Sa-re RF'., U= DELa T ON PI -PNS Swage System Plan - (north arrow) Se=wage Syst.an Eyara „I is Profile - Gravi tY Flc,a Fill Profile & DLrensions - VoiL"r� D or J Fo;X;Trencz /G:.11ery; PLrT pit deter is Septic Tank - Size, Detail Well Detail, Sarvice Line if over Cons ruction Notes Design Data: perc and dee-o res.�?ts . Two -Foot Contours F ;fisting.& Proposed Driveway & Sloces Cut Footing /Gutter,Curt =in Drains (discha.rge CK) Perc & Deep Holes Lccatea Representative of prino --y and EYtcnSIOn Expansion Area; shc; --n; gravi ty flow, sufr . size If Rte' d Pit & D Box Shcw: & Detailed House - No. of Bedrocttis Wells & SSDS's w /in 200 ft. of Proposed Syst`n .Property rtes & Pounds House Setback Necessary (Tight lot) � pipe _ House Sewer - 1/4"/ft. d„ O; T' 'o Bends; IAa.x. Bends 45° w /cleanout Sip SON DISTANR=-S SPEr-IFI D ON PIS 'A-N r ( D Fields 10 to P . L. Dr;veraay, lame Trees r Top of f i C �ti 20' to Founda� 6-w 11s 100' to Well; 200' n D.L.O.D, 150' pits 100' to Stream, atercourse, Lake (Inc. e.a 15' to Drains - Curtain, Ll— der Footing 35'to match basin, stc=ar- ain,ni Ped watercour 10' to Water Line (pits -20') 50' intemaittent drainage course Septic Tanks 10' from Foundation; 50' to will 15' Well to PL I 1/{%@ I I F'� -Ltw,� f I , ',K'�� n PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY• OFFICY BUILDING. '.CARMEL, - N.- Y. 10512° DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM �p FILE NO. Owner `- .���< <C ,c�c_ ��, G Address Located at (Street) 4.19 .-74;, Block Al Lot 2„ j d 2— indicate neares cross s ree j Municipalit Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATIONtK PERCOLATION Run Elapse Depth to Water Water Tevel .No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. - Start Stop Drop in Min. /in drop Inches Inches Inches t �le 13(g �,Z 4 3 4 �5 1 2, 4 Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. AY data to be submitted for review. 2) Depth measurements to be made from top of hole. DLPTH G.L. 6" 12" 18" 24" 301 36" 42" 48" 54" 60" 66" 72" 78" TEST PIT DATA REQUIRED TO -BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE " NO'.' I - - - HOLE NO." HOLE NO . 'Tim l�� l t•- _ C94420 �,o 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL-TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS_ MADE BY `T" ire -� - _.. _ _._. _.......... =- Date... DE IGN Soil Rate Used Z1-50Min/l "Drop: S.D. Usable Area Provided wi � c3 q No. of Bedrooms aj _Septic Tank Capacity I OCO Gals • ,�� Absorption Area Provided By � L-. F. x24" 36 , C4 13 C o���� j bi�na ure SEAL`S Address THIS SPACE FOR USE BY HEALTH DEPARTP9ENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by Date 1 jjpp ), ' A _Z;_W 6- 6ow =Q W w 0-THAT - - f_- W; AN W sit ion �37 .r a R IONIC 1�� coo .......... 4T AM a 4 _5r 02y - 1255 121= ......... T, to y PO N 1 W IF" at v Ira -0700; A IS off LAW,: . . . . . . . . . . . I ARK PIT, nm G VMS Ass Pate Inn Kos T, off, litt!3;0 wal. I oil MAR wh Q nm �z 01 VS Eton -lit too