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HomeMy WebLinkAbout1446DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -2 -34 BOX 13 ri 01446 y... '...•— 7k Y"ie 77_77,_ .,E.s.; �_ f�Re v. 3/86 PUTNAM COUNTY DEPARTMENT OF HEALTH b Division of Euvhroumental Health Services, Carmel, N.Y. 10512 Q Engineer Must Provide �c .. wcc Lq! CERTIFICATE OF OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL) SYSTEM �4�e/^So`-► `1.`9l/ / ?G l/Y l f/ e G�� 23^Sovl /V.� .T. Viptdga Located at e:. Map . Block Lot Owner /applicant. Name, Formerly Subdivision Name ` ` S% Subdv. Lot'# 30 Mailing Address P :Date Permit �sned I/— / 2 QG1 '71�f P S/2 ^/ If Separate Sewerage System built by . S, A F S h G SAS - Peru 1i c Address - -ro �. ^ 4.j. Consletin9 of Z D 4 Gallon Septic Tank and - / Water Sapplys Public Supply From Address or: Private Supply Drilled by ii ( �' } h ; 4-12 . � Sn.'Wdress 3 / ( )0/12-, oX j7 / f} t f rsp. l Building TypeM�od ��'i- Z S' r� �pldn��; �Hsul Eroelon Conh»l Been Completed? \ '{ Number of Bedrooms Has Garbage Grinder'Beeri Installed! Other Requirements I certify that the system(s) as listed serving the above premises were c of which are attached), and in accordance with the standards, rules and Putnam" County.Diapartment Of Health. . oste / '7 b Certified bye essentially as shown on the plans of the completed work ( copies in.accordan a with the filed plan, and the permit issued by the ,e4— P.E.4 R.A. Atldress� JS ye-itr "5 .. pf. ^, SVI �C P'% Kb,YI fZ7i'/ kvh,5 'V y Lleense NO. �0 Any person occupying premises served by ,the above systems) shall promptly take such action, as May necessary to secure the correction of any unsanitary conditions resulting from. such usage. • Approval of,: the "separste'- sewerage . system shall become null'and'void as soon as a pub(': sanitary sewer becomes availaee and the approval of the private water iupply shall become null okt wean a. public. water supply becomes .available. Such approvals are subject to modification or change -when, in the judgment- of•the Co lisi er of'Mes14b,`su revocation, modification o► change is necessary. Data � By Title A lu a .. 4 WELL COMPLETIUN KhrUi:cr DEPARTMENT OF HEALTH D vis -ic n Of-Environmental Heal>tIn .Services PUTTIAM COUNTY DEPARTMENT OF HEALTH Office Use Only. " STREET ADDRESS: wNrw� J 1 Y TAX GRIO NUMBER: WELL LOCATION WELL OWNER NAME: ADDRESS: Cv %.� ,'cam; �Soc� PRIVATE p PUBLIC, USE OF WELL 1 - primary 2 - secondary YRESIDENTIA'- ❑ PL&IC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS D FARM D TEST /OBSERVATION D OTHER (specify) 'Cl INDUSTRIAL D INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. 1N0. PEOPLE SERVED / EST. OF DAILY USAGE j�Q_0 gal. REASON FOR ORILLING KNEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑. TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WEL�bEPTH . '�� ft. STATIC WATER LEVEL ft. DATE MEASURED 61 2� DRILLING EQUIPMENT ❑ ROTARY COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. 90eOPEN HOLE IN BEDROCK D OTHER TOTAL LENGTH ft. MATERIALS: IYSTEEL ❑ PLASTIC D OTHER CASING DETAILS LENGTH.BELOW GRADE � ft. JOINTS: D WELDED THREADED ❑OTHER DIAMETER — in. SEAL: D CEMENT GROUT VBENTONITE ❑ OTHER WEIGHT PER DOT ___L 7 1b. /ft. DRIVE SHOE YES D NO LINER: 0 YES NO SCREEN DIAMETER (in) 'SLOT SIZE LENGTH (it) DEPTH TO SCREEN (ft) DEVELOPED? FIRST ❑ YES ONO DETAILS SECOND HOURS GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE; DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH tt. WELL YIELD TEST ; If detailed pumping yipo0: ❑ PUMPED t tests were done is in- Rf COMPRESSED AIR ; formation attached? ❑ BAILED ❑ OTHER i ❑ YES ❑ NO It more detailed formation descriptions or sieve. analyses WELL LOG are available, please attach ". DEPTH FROM SURFACE Water Bear- ing Well Dia- offer FORMATION DESCRIPTION Calif. tt. ft WELL DEPTH it. DURATION hr, min. OR tt.' YIELD 9Cm. surface ' -a c 1" baa E rs S G ) e Od cS 6 �rC) JUC) c: < WATER CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS _ ❑ COLORED ANALYZED? ❑ YES ONO ANALYSIS ATTACHED? ❑ YES ❑ NO STORAGE TANK: TYPE CAPACITY GAL. PUMP WFORMATION TYPE CAPACITY MAKER DEP MODEL VOLTAGE HP WELL DRILLER NAME DATE ALBERT M. HYATT & SONS, INC. a� ADDRESS Well Drilling SIGRATURE Rte. 311 R. R. 2 Box 171A_ PAT'YERSON; NEW YORK 12563 u BREWSTER LABORATORIES - Box 224 - BREWSTER, N.Y. (914) 279 -4945 - WATER ANALYSIS REPORT SAMPLE No. 7581 SOURCE: Foley Development Corp. Windsor Oaks Lot# 30 Fair St. Carmel, N.Y., COLLECTED: 11-28-89 BY: P.F. Beal & Sons 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. 11 -31 -89 RECEIVED DE C 2 0 1989 -mam'VAL CC=- OEI�mal Michael and Maryann Brosnan 30 Lcr- Colonial Ridge'Associates Highview Drive 7=t- = - S"=Ser_ Paaterson,, New York Mrm-i r-+ ----A I jt.y Modular Two Story Colonial Smild:L= Tuma Rosewynd Pond snjr .v=i= Sam 30 54 who —,1,7 and C=- °LET -7 rzs- cr =za-tion and of :he sawac-e that:. it as --howm. ca- serv=q the above desc---Z p=Pt-7, IL a amemdment- the_etc, amd is ac=rdanca w-. t FL thf-. and. sta-mim-rds, =-Ies a=d. reaga�-atienrls of the Put--22m- C==t:Y Dq= f to S=d hi" s=2s5= r he=s' Or as- Sz 9= cuezat.ina- c-:ntii-�-4=3 any car-t ce said systam cmis-tr=-t bV me vzl= 1-ni. z =e--ta- f= y 1 =qi=q the afte z*_ =22 of the t:'-'e sewage c= any" =A- - v zz= Tz5=1, the =ear; r.° t ct cc- -- -t C:ff e r- as mslly-a =2 co-=, T he the : -- , - , pur-p-m- co=ty e as J wme-- 41,- -tte t= C ---=t? WZ'S G':-5 ad bv zte -.-i' —I'=L. C-- aea —14,,nr ac- ----,e caild of tze cc==a J, the syst;:n- Datza this day oi--N (� OL.� =y N, .1C._ as �) 2.5�. , , Ob I L 31"Zf mk U u LJ W Bair TyPe f :. I �L Lot Area m ;J FIIhSeedon X� Only" . Deptb • Volnmti Number of Bedtooms ` 1 " Design Flow G P D C) PCHD N_ odficadon is Required Wiliest Fill le completed Separate Seweeage:Syetem to osnsist of 1i GaDon Tsn L ll� �pe To do co iiii i ted by e l Addeetle Water' SalpPb': PD'bllc Supply From Address` ' or. _ • tPrlvate Supply Deified by • 7,' I� Addieee Otber- Requirements I repiesent that 1 am wholly and completely responsible for the defi9n antl location of, the proposed 'iyStem(S). 1) that the separate, sewage disposal system aDOVe tlascribeC will be Constructed as shown on;the approved amendment there to and in accordance with the standards, rules an resu a• ions o e u Ham County Department of Health,;and that.pn completion the eof a 6ikificate of Constiuotion Compliance satisfactory .to the Commissioner.of Mealthwill be submitted -to the'Department; and ;a written'yuarantee'will be.4urnish ' tha owner, hissuccessors, heirs or assisn• by the Duittler. that :gitl builder will place in good, operating condition any part oR: safd sewage'dispo'sal. system. during the period of two (2►,_ ears Imrnerllately following tfieAata Ot;the issu- ance' of the :approval of the.�6kiffcate'.of do'nitruction .Compliance of `the original system. or.any,re it neret 2) that the drilled well tlesciibed above will be loutedjs shoavn.on the approved, plan and`that said well wilhbe inst � i cc `rtlance iM t d artl ►ulss and regu a of the Putnam Co YHty DAe ►t1lmsnt Of- Mealth - Pate f1r0�4�; =�. 7 / �,.. -{�.� 5i9n°d V License No APPROVED FOR CONSTRUCTIOW T his approval; ex ires•twib Y rs ^fro he `date 'Ass d unless constructs of the building has been undertaken and is P revocable for cause or, may be aiiiendetl _or modiiied when consi redo sary,by- th._ • . mmissio I 'Any change or alteration of construction requires a e permit App for di3posal�Of domerilc- t sewage, and/ t ly 87 Date BY Title' W �Q�►Si � Go' 0 � WA'f�v . JT�t� Jys ��-- . tAA �.g . VRQf !Ak �gu,S y" 6ACK o TANX a S;fo�Ac�� y'• RAv S — - r v p/ e n tv 2' CHLOrwo�•✓ A �ISCHA*�Q. wlcRo�K 1 � L ` '3aef rw Key A S #1 N�ScNwAl L �.fB..f�'.~ �6" ..EIt•: B PuTNAm CCUNTY DEPARnMM OF HEALTH DIVISIM GF R4VIRCNMENML :E Y: SERVicES INDIVIDUAL WAY01• SUPPLY & SUBSURFACE `f . /• !S DISPOSAL SYSIM (Name of Owner) COM14ENTS LF trench provided required 60 ft. max. Parellel tr. FILL SY TEMS clavt4rrier 10 ft. f i1V notes nea saec. depth gauges 100 vr. flood elev. O :1�1 i• • i'� • • �1' DATE REEiTIEMiF..D BY: / (Street iOS NO Location) TT DOC94EMS �- Permit Application Corporate Resolution Plans - Three sets s/s Engineers Authorization Design Data Sheet (DDS) S'JHDIVISION Deep Hole Log Pe_.rc 2c�- Consistent Perc Results (3) Fill Perc Hole Depth cd House Plans - Two sets Well ------permit; P S letter Variance Request ('F NFRAT Lecai Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Pennit R & D) Data On DDS Plans & Pennit Same REQUIRED DETAT_LS, ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flow 0-epultic Profile & Dimensions - Volume J Box;Trench /Gallery; Pm1p Pit details Tank - Size, Detail Well Detail, Service Line if over Construction Notes (grinder notes) Design Data: perc and deep results Two-Foot Contours Existing & Proposes Driveway & Slopes Cut Footing/Gutter,Curtain Drains (discharge oK >`.I Perc & Deen Holes Located Representative. of primary and expansion 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 Proposed Systems Property Metes & Bounds . House Setback Necessary (Tight lot) House Seger - 1 /4 " /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /clearout SEP.WMCN DISTANCES SPECIFIED ON P:.AN Fields 10' to P.L., Driveway, Large Trees,Top of fil 20' to Foundation Walls 100' to Well;. 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. e pan 15' to Drains - Curtain, Leader, Footing 35'to catch basin, stormdrain, piped waterco_urs LI 1, F i % _ `l; ' l' 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10�Foundation; 50' to well 15' Well to PL n PUTNAM COUNTY DEPARTMENT OF HEALTH DiviAcin -of"EnVironmental --He-ilth A)FFIDAVIT - CORPORATE OWNER APPLICATION 17OR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health In the matter of applic'ation for: represent that I am an officer or employee of the corporation and am authorized to act for (Name of Corporation) having offices at 4,kj 7" e­ Whose officers are: Ntj President: k,*,CL,0 -7 (Name and Address) Vice - President: (Name and Address)' Secretary: (Name and Address) Treasurer: (Name and Address) and that I am and will be individually responsible for any and all acts of the corporation with respe,:t to the approval requested and all subsequent acts relating thereto. I'll Sworn to before me this day Signed: of / lqt� Title: C Iv- Notary Public woof ork k �Ik 8/84 Corporate Seal PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPA�IRA-T,E SEWAGE DISPOSAL SYSTEM -�7 FILE NO. Owner(�b\tAi .;k; '/ � -_ Address 4 \��vn � Ct.r �r►a��� 1� t )� 4 Located at (Street ALjLjja,, ,Block Lot 14 IndIcate nearest cross ss ree j Municipality is Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION - PERCOLATION. Run E`iaap e DeptE to Aa er water eve . No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start .Stop Drop in Min. /in drop Inches Inches Inches. Cz 3 Ae-) C Z 1 C) 5 1 2 3 5 l -. tj . I ! i 'L 1 Notes: 1) Tests 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. TEST PIT DATI, REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIP`1'ION. OF SOTIA`j• - i�NOUN�I'RF.D:, IN. TEST�.:HOLES F ^ _ DEPTH HOLE NO. f HOLE NO. HOLE NO. G.L. 6" 12 "� �A _ 18 24" �l 30" it 3611 42" ti 48" 54rr 6011.. 66" 72rr � _ 78" ei 841 LEVEL.AT WIEFCH GROUND WATER IS ENCOUNTERED INDICATE- -LEVEL- -TO WfP:CH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY<77>- _ � �• Date c3 C \ "Drop: IGN Soil Rate Used ZL-� 1�in/1 Drop: S. D. Usable Area Provided C) O �- Y� No. of Bedrooms - Septic Tank Capacity l Gals. Type Absorption Area Prov:�ded By (�C�ZL. F. x24" s� jG width enc . o� Name . ✓!r1 e.�o.�. .�, Y. Signature o Address SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved_ Sq. Ft /Cal. Checked by DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION treet Address Town/Village/City Tax Grid Number WELL OWNER Name Mai - ng Address '7 G Q7 Private O Public USE OF' WELL 1 - primary 2- secondary 0-RESIDENTIAL O PUBLIC SUPPLY O BUSINESS 0. FARM 13 INDUSTRIAL O INSTITUTIONAL ❑ AIR /COND /HEAT PUMP ❑ TEST /OBSERVATION O STAND -BY O ABANDONED ❑ OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE !Odgal REASON FOR DRILLING SUPPLY ❑PROVIDE ADDITIONAL SUPPLY OREPLACE EXISTING SUPPLY ODEEPEN EXISTING WELL OTEST /OBSERVATION DETAILED REASON FOR DRILLING c� WELL TYPE D.BRILLED DRIVEN DUG D GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES ENO 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 C -fi% NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: c LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION [C�01� TES ET (date) (s i e _ 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 Health Department attached to this permi 3. Submit a Well Completion Report on a form .pro e y e Putn o ty Health Department. Date of Issue: ,-- �-� Date of Expiration. 19 rmit I suing ffi i Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner 2/87 Orange copy: Well Driller NO DISTRIBUTION 1250 GAL. SEP77C TANK N 9.3833" E /50.00 HIGH VIEW DRI VE I TERALS AT AVERAGE 7H OF 54 =3" THIS IS TO CERT /FY 77•JAT 7HE SEWAGE DISPOSAL SYSTEM WAS MEASURED BY ME ON DEC. 14, 1989 AND APPEARS TO BED C01VS7RUCTED IN ACCORDANCE W 17H ALL STANDARD RULES AND REGULA77O1VS OF 771E PCHD 8 NYSDM DESIGN INFORMA77O1V FROM FILED MAP) 4 BEDROOM HOUSE PERC RATE - 24 MIN, //NCH LA7E AL LENGTH - 667 LF GENERAL NO TES OI ALL SURVEY 1NFORMA77ON TAKEN FROM SURVEY PREPARED BY ROBERT M BERGENDORFF, L. S, BREWS TER, N Y. O AS- BUILT "MEASUREMENTS 7AKENI2114189' BY S7E'VEN ✓ HYM4,% P.E. LATERAL ENDS LOCA7E 0 BY LOCA77NG ✓UNCTION BOXES FROM O REAR HOUSE CORNERS AND THEN SMKING EACH LATERAL AND MEASURING LENGrh Y CQk�QL POINT N792928 "W 20.00 PT. "A "'' :: PT.-B" _ S 10 3O32_W _ — DRAINAGE 150.02 DISTRIBUTION BOX EASEMENT 50' -0" N1O 3032 "E 61-0 ", 56' -0" b b LOT AREA 60' -0" ® 442O0SS.F. N N 9.3833" E /50.00 HIGH VIEW DRI VE I TERALS AT AVERAGE 7H OF 54 =3" THIS IS TO CERT /FY 77•JAT 7HE SEWAGE DISPOSAL SYSTEM WAS MEASURED BY ME ON DEC. 14, 1989 AND APPEARS TO BED C01VS7RUCTED IN ACCORDANCE W 17H ALL STANDARD RULES AND REGULA77O1VS OF 771E PCHD 8 NYSDM DESIGN INFORMA77O1V FROM FILED MAP) 4 BEDROOM HOUSE PERC RATE - 24 MIN, //NCH LA7E AL LENGTH - 667 LF GENERAL NO TES OI ALL SURVEY 1NFORMA77ON TAKEN FROM SURVEY PREPARED BY ROBERT M BERGENDORFF, L. S, BREWS TER, N Y. O AS- BUILT "MEASUREMENTS 7AKENI2114189' BY S7E'VEN ✓ HYM4,% P.E. LATERAL ENDS LOCA7E 0 BY LOCA77NG ✓UNCTION BOXES FROM O REAR HOUSE CORNERS AND THEN SMKING EACH LATERAL AND MEASURING LENGrh Y avision of Environmental Health Servic.' .pproved as noted for conformance with 1pplicable Rules and Regulations of the 'u County Health Department. .if. 30 to . 11anaturp A• T14! O .1+ a F ILED MAP 0 2/94, F ILED 12/2/86 CQk�QL POINT STRUCTURE PT. "A "'' :: PT.-B" SEPTIC TANK 33' -8" 49' -0" DISTRIBUTION BOX 41' -6` 50' -0" JUNCTION BOX 1 61-0 ", 56' -0" JUNCTION BOX 2 67' -9 "-• 60' -0" JUNCTION BOX 3 74' -6'..; 64' -4" JUNCTION BOX 4 81'-6" 68' -3" JUNCTION BOX 5 88' -5' 72' -8' JUNCTION BOX 6 95' -3'. 77' -6" avision of Environmental Health Servic.' .pproved as noted for conformance with 1pplicable Rules and Regulations of the 'u County Health Department. .if. 30 to . 11anaturp A• T14! O .1+ a F ILED MAP 0 2/94, F ILED 12/2/86 l\fY p w r N n Z► 5 IO° 30''32" W �.02 1 EASEMEIJT N 79. ZA.00 N 10. 30 3Z" E H I, 2ZO S.F.' .94to AL t. r__T- 'Z STRY ItS7Ry sfzAr+E I F� I� to T . I 7 9 ®W1ry.c. 5 d T.l q* 3$ 33" 5 —0.. 1 50.0 NIGH VIEW Di21VE 9 r N 3� r N N O -5URvEy OF Ppeopez -7y FZEPATtED FOtZ. COL.OI JIAL. RIDc2s Q560CIATE5 , IQC.. LDT Q0. 30 AS '5HOWti ON FAIR, STREET 5UBD'VI -5IO►.! FILED MAP# 2CH FILED I2 -Z -$fo TOWN OF PATTERSOoJ PuTtiIAM CO. 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