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HomeMy WebLinkAbout1424DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -2 -10 BOX 13 �' 'his 9 { .J ■1 IN L � I Ir , z�' , . ' IN 11 L9 ' IN ' ' '. IN L Ilk .. I , 01424 Rev. 3/8 PUTNAM COUNTY DEPARTMENT OF HEALTH \j� Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Mast Provide P9-85 P.C.H.D. Permit # — '3 tf, Z —[0 [Job No. S.O.22341 CERTIFICATE OF C STRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM T. Patterson - Town er Vblage " "_ Located at Westgate Terrace' Tag Map 26 Block 1 Lot 23.8 Owner /applicant Name M I M Wm - qrk a" t h Formerly Subdivision Name R f e i f f a tsubdv. Lot # 8 Mailing Address 2295 Village Drive, Brewster Zip NY 10509 Date Permit Issued 4/3/85 Separate Sewerage System built by Owner Address Consisting of 1000 Gallon Septic Tank and 335 x 24" Wide x 1 $" Deen Laterals Water Supply: Public Supply From Address or: X Private Supply Drilled by Boyd Artesian Wellaare c. Rte.52, Lake Carmel, NY 10512 Building Type Frame Has Erosion Control Been Completed? As required Number of Bedrooms Three Has Garbage Grinder Been Inatalled? No Other Requirements None 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 standards, rules and regulations, in accordance with the filed plan, and the permit issued by the Putnam County Department Of Health. Date 12 January 1987 Certified by kl 11 P.E. —R.A. Addross RD 9 - Fair St ee , Carmel, N§ 10512 License No. 29206 , Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of anj unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a pub,': 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 Heal s revo n, modification or change is necessary. Date gy � Title WA PUTNAm COUN`T'Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Lori & William Spaeth 6 ]. 23.8 Owner or Purchaser of Building. Section Block Lot Building Constructed by We Terrace Location — Street Putnam Municipality Frame Building Type (Tara PfPiffar Subdivision Name R Subdivision Lot # 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 repairs made _ by mine to sii6h 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 Environinental 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 7 4:11 day ofJanuary 19 87 Signature Title General Contractor Own - Signature Corporation Name (if Corp.) rev. 9/85 mk Corporation Name (if Corp.) .F. - AM Cpl a 1. ' WELL COMPLETION-REPORT Office Use Only DEPARTMENT OF HEALTH _._....._._ ... sion Of Environmental Health Servicea PUTNAM COUNTY DEPARTMENT OF HEALTH WELL LOCATION WELL OWNER USE OF WELL 1- primary 2 - secondary STREET ADDRESS: TDWN1VlL0GlEjClfT TAW c,RIO NUMBER: . L.1 57- GAri TC- ,e44CE' 4oT eA lez.jE NAME: ADDRESS: �P9�VATE w,4.5P 4 E-rN I�JEST C-47,` Tei A ( �C �� ❑PUBLIC g'RESIOENTIAL 'D PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP p ABANDONED O BUSINESS D FARM O TEST /OBSE,9VATION O OTHER (specify) C] INDUSTRIAL D INSTITUTIONAL ❑ STAND -BY p D MOUNT OF USE REASON FOR DRILLING YIELD SOUGHT ,_,.._,� , gpm. /N0. PEOPL'E SERVED / EST. OF DAILY USAGE S— gal. `` 'NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY 0 TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY D DEEPEN EXISTING WELL DEPTH DATA DRILLING EQUIPMENT WELL DEPTH 30 5 ft.] STATIC WATER LEVEL ft. DATE MEASURED -a9 -mod D ROTARY WCOMPRESSED AIR PERCUSSION ❑ DUG D WELL POINT D CABLE PERCUSSION O OTHER (specify): WELL TYPE ❑SCREENED. D OPEN END CASING. 'OPEN HOLE IN BEDROCK p OTHER CASING DETAILS TOTAL LENGTH L fL MATERIALS: STEEL O PLASTIC . O OTHER LENGTH.BELOW GRADE ft, JOINTS: O WELDED �HREADEO p OTHER DIAMETER 'In. SEAL: EMENT GROUT. O BENTONITE OOTHFA WEIGHT PER FOOT )b. /ft. DRIVE SHOE ES O NO LINER: O YES V0 SCREEN DIAMETER (in) 'SLOT SIZE LENGTH (11) DEPTH TO SCREEN (ft) DEVELOPED? DETAILS FIRST = A . . O SECOND YES 0110 NOUNS GRAVEL PACK °YES GRAVEL DIAMETER O NO SIZE OF PACK TOP BOTTOM --- -_ in. DEPTH .__ K DEPTH WELL YIELD TEST I If detailed pumping METHOD: O PUMPED tests were done is in- 'COMPRESSED AIR formation attached. O BAILED O OTHER ; ❑YES ❑ NO WELL LOG it more detailed formation descriptions Dr sieve analyses are available, please attach. DEPTH FROM Water SURFACE Bear- ft. ft, ing Land a well Dia- . In FORMATION DESCRIPTION �- looe WELL DEPTH DURATION DRAWOOWN YIELD tt. hr. min. ft. gym. aos' WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? O YES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY GAL. WELL DRILL NAME G , DATE AD ESS � � S �C SIGt PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP Yorktown Medical Laboratory, InQ 321 Kear Street Yorktown Heights, N. Y. 10.598 (914x245.3203 •z tor: �! lbert H Padowni AL T. (ASCPI L J LAB / CA;003742 Collection Station Used: Camel Peekskill Mt. Kisco New City._ Date Taken : k 4 10 6 0AM Date Received: :;?.•`/5 Date Reported: Collected By: Referred By: Sample Source C_ A P LABORATORY REPORT ON- BACTERIOLOGICAL QUALITY OF WATER GENERAL BACTERIA 4 Standard Plate Count per 1.0 ml `� y (Agar plate @ 35 °C) YEMBRAITE FILTRATION TECHNIQUE (MFT) Total Coliform per 100 ml 0 Fecal Coliform per 100 ml Fecal Streptococcus per 100 ml `iOST PROBABLE NUMBFR TE.CHNIQUF. (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. .. o Albert H.:­Padovani. M.T. ASCP)o Director LEGEND RD$ a Recommend Disinfect- ing Water Source - - - ---< : less than TNTC a Too Numerous Too Count '4/ •% OF MEAILTH: Permit „'s/ "M of ny q x 105n2. .CONSTR'UCTI'ON PERMIT FOR DISPOSAL. SYSTEM 46n. % -2 A Lc -_at - e'd- 3,t t Te"' iax map .6, giii n. Pfeiffer -c iuibdi4' o o 14t 4 11'eneu ReyisW!­,- _­'. j". S, i� 12- I 0 pSaeth, 2295 Village Dr ,' • Brewistei-'­NY, 10509, Fill` 'Lot '7� A-rea — 3 �Section 'Only T -Nu Bqdfooms -E h tee' C;.H. D­N6t1 Ica_tio � n Re qwre&, Yes%z, Z." ,I. . - setit `G' Tank.` ge a iii�;ara e. Sewerage f 0 0 O�z"� :16,1, -Syiurbi ;iTo be `cdnstruiite cl b d ress *.Water SUPPIY;r, -----Public Supply .From z .Private Supply to be drilled - Address - 7j A Other u'�','RdcI iriim erits 7 I represent that I am wholly an d , comp I e e y responsible for tiie design and .location ihiI 'Proposed systems) , �1) that An Sepa ra t el" sewage dispcial system - rt. e a pprov`e_d� a rKend Mint there to and iri'actbircla �pbqyi�,:described, will be.coristrucitid ii'shqwri on hi ndewith the standards ", iujei- ula ions of the Putnarn Countyi Department of Heajlt h,., and ,t h ' ��t' �rI e ", ­ 66nsir'Zdt GP i Co'm" p ia n'c e saj4jsfictoiy`to the Commissioner of, 'Hea It h w % .be submitted �o he � n 'I'- d "i• " vr.ittei-giaeantee�.WI-li 'I -6Wnir;his 'successO!s `heirs; assigns ty ,ihj ' bdild4i,.thaif­sai­ld builder will ;place .in operating co_ I Ion apy , par CI of 1 sppsa I . systen :during jhi,pe iod of,twb (2) yearn -immediately -followi69 the6ie.:6f the Issu- th �to.'�j is approval - t_ . al of,tKe it6rtifi.Eatb 0 -original system or :of Mpi.oance:.of the r ar�y. repairs thereto; e drilled well described above _10asted as shown oh,1 -ad plari will be with"Ahe -stand I 'd regula�'oni 'of the' will be nsta. standards rules nam DateMarch29 1Q85 J, ig", ' 7 % -Addreis . i ti ceris p, r . . APPROVED FOR CONSTRUCTION Thar- approvapezpues one year , 0 e-,late ' ,A: ss u less fi_cciisE r qct on, or. i ne liuilding; has :bden undertaken and is revocapte or c a e a necessary th6,' omrti ssioner Any cfian alteration of construction requir -a new it A or c ni any e, an6kor pr a - .water supply only. Date'-! 'ritle . . . . . . . . . . . . . . . . . Aev. 4- ------------ ' t+�.- :...-- .- :c.:•��:: °•r .-sa.r. -..; -r„c _ '•;._.; "":!r.` �.'^.. w- �,iiicia�:t...±.+ -.- - .:`�ti+{.r: -' +.. _ _ r,'.1:^".'r ..•^ -' � PUTNAM COUN'T'Y DEPAREMU OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL mum SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIELD INSPECTION REPORT DATE: PS%~Ci-�fXe %L�' /tea SP. BY: (Name of Owner) (Street Location) INITIAL SITE INSPECTION YES NO COMMENTS Wetlands on /or proximate to property .............. Property lines or corners found ................... canestimate house location ........................ Willdriveway 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 .. • -• - -•- Access to.Drocosed well location for drillinq D.H. 1 Lot Depth to G. W. Depth to rock Soil Descripti, 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. D.H. 2 Lot Depth to G. W. Depth to rock Soil Descri tio. 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. DRIZ: _ FINAL SITE INSPECTION INSP.BY: House SSDS located per approved Plan ............. Length of trench measured S C: "-7` Width of trench average 0-7- Slope of tile line and trench acceptable......... Roan allowed for expansion trenches .............. over 100 ft. from watercourse ...............•.... Natural soil not stripped or SDS area unnecessarlygraded..................... 10 ft. maintained from property line and 20 ft. fran house .. • ••••- Distance well to SSDS(ft.).......�1.. .7 •.... Number of bedrooms checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. fran nearest trench ................ 15 ft. of peripheral soil horizontally -- fromtrench ..... ..........................•.... Boxes properly set .........................o.•... Could surface runoff from driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... 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. ©m • i� Soil Description C4 Z.74.12 Q-� a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF:ENVIRONMENTAL HEALTH SERVICES 0901f'lY- .OFFICE.BUILDING, CARME9,, _N: _Y: DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE N0. Owner l�I�i, spa► Addresse�is T�are� go Located at (Street �t aim. %�- lock ' Lot 1n ca near cross . .�,� • 1'yi6 taf Municipality. Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Role Number CLOCK TIME PERCOLATION PERCOLATION Elapse Depth to Water Water Level No. Time From Ground.Surface in Inches Soil Rate Start -Stop Min: Start Stop Drop in Min./in drop Inches Inches Inches 1 2 �iA.Asm# Vii J. /i tiAr /ire" 0% Am _ y, R ►A 3'/M moz zs 5 - Notes: 1) Te'Rts to be repeated at same depth until approximatelyy 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. THIS SPACE FOR USE BY HEALTH DEPARt F;i`y Soil Rake Approved Sq. Ft /Gal. &iecked by OFtHE SlOt Date TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION -OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE N0. = HOLE NO. G.L. 6" 12" 18" :.. 2411. 3011 AM 3 6 it 4211 48 CC'''' 60" 66 72" 78" 8'! INDICATE LEVEL AT WHICH GROUND WATER IS'ENCOUNTERED _TN ,DTCA.T_, . LEVEL ,T0 WJi1CH WATER LEVEL RISES . BEING ENCOUNTERED ��,� TESTS MADE BY , to DESIGN Soil, -Rate Used 46®10 MirVl "Drop:. S.D. Usable-Area Provided ,.,, * e No. of Bedrooms Septic Tank Capacity. jo'po Gals. e Absorption Area Provided -By- L.F.x2�+" nc : y�0 N . P nC&� - 1 ..ure Fame JOHN H. PRENTISS P.E. ,�•�; Address R09 FAIR � Si n�8 CARMEL, NEW YORK 1OS19 THIS SPACE FOR USE BY HEALTH DEPARt F;i`y Soil Rake Approved Sq. Ft /Gal. &iecked by OFtHE SlOt Date i d - a'uufam• t;L"ay vepanc L -WUL t. Ur fit" = U1vision of Environmental Health, Servicee' . SAN TA Y S I) R Approved as noted for conformance with. LOCATION Street: +pplicable Rules and Regulations of the 'utnam County Health Department~„ Town: fsiZ j 1� tote: f . 2�. � SUB DIVJJSIOM: c974, g 4 f Block% _ LOT NQ 2 d Builder: Survey "or: ,Z41-9 c�9,_ fZ: r� T Dravrn:v` /.24.J Date 2j /e Scafe:`aoJf Job N�a•22 , JO RN Fi PR ENTiSS PLE �q } CONSULTING ENGINEER f 1 'I f: �i If �i