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HomeMy WebLinkAbout1488DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34.3 -29 BOX 14 .. o I --s ll:l 1 N 11 I ri or ki I I or I IN :� IN ri ` ti . .. NE mit .. PUTNAM COUNTY DEPARTMENT OF HEALTH . Rev . 3/ 86 Division of Environmental Health Seivices' Carmel, N.Y. 10512 ji 1 Engineer Mast Provide P.C.H.D. Permit N ' . P? CERTIFICATE CONSTRijCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM pa 1-,f E_r Gnn Town or Village Located at Ph I 7.1 a t Hn 1 P R ci a d Tai Map 7-1 Btock -3 Lot 26 diCk- Owner /applicant Name Sa 1 Rriit -C13 I im- ' 1. Formerly . $card I Ck Subdivision NamelHn Subdy. Lot k 2_ Mailing Address 55 Mill Plain Rd.. 21 -3 zip 06811 Date Permit Issued DanbLry., CT 0681 Separate Sewerage System built by R R <o �3rCrxV ��3iC� �li� Addteos Wa � IP]-on 14311 $dam X,4hopac , NY Consisting of 10 0 . Gallon Septic Tank and 3411 ' I,1 ° — Ti!QQtaf Ah erptlen -Tx-en-c h Water Supply:. Public Supply From Address or: x Private Supply .Drilled by M1 L L. Address Building Type R ia S i d e n Gp Has Erosion Control Been Completed?_ e Number of Bedrooms 3 Has Garbage Grinder Been Installed? — No Other Requirements 2 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 whi'ch.are attached), and in accordance with the staandards,.rules and regulations, in accord e_ w1 th. the filed- plan, and the permit issued by the Putnam County Depar event of Health. AS Certi led On -AS— 1 ap G 's' P.E. X R.A. Date CartifleC b Address P O Box .7 4 Brewster r TTY 1 0 5 (l 9 License NO. 'i01 Any person occupying premises served by the above systems) . shall promptly. take such action as may be necessary to secure the correction of any unsanitary conditions resulting :from such usage. Approval of the separate sewerays system shall become null and void as soon as a pub": sanitary sewer becomes ilable, and the approval of the private water supply shall become null'and�. void when a public water supply becomes available. Such approvals are -b)ect to modification or change when, iinnn the judgment of the Commisajonpr of Health such revocation, modification or change Is necessary, c � By „�✓f<<rl Title IE DIVISION OF ENVIRONMENTAL HEALTH SERVICES . Owner or Purchaser of Building Section Block Lot" SAL ✓� Building Constructed by 0 20IJ-4-rA044 X061) IC� Location - Street Subdivision Name '®A/ a Muni ipality Subdivision Lbt # • Building Type GUARAR.TEE 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 "Certfica-te -of-- Construction Compliance" for the sewage disposal system,.- or-any.. repairs made by. me'_to _sucki "cyst&, . 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 AVIO day of 4& l9fVT Signature Title Ge#&al Contractor (owner)-- Signa ure Corporation ,Name (if Corp.) Z) > �f rev. 9/85 mk Corporation Name (if Corp.) Address • I UrrIL't Uat UALI WELL,.COMPLETION REPORT-, DEPARTMENT OF HEALTH "Division Of Environmental Health Services P,ffffk M t6UNTY DEPARTMENT OF HEALTH SIREET ADDRESS: IOWNIVILLAGEICI[Y fAX GRIO NUr-WER: Burdick Woods, Patterson NY WELL LOCATION • WELL. OWNER NAME: ADDRESS: Sal Bruccuuleri,- __55 Mill Plain Rd. Unit 21-3, Danbury, Co0,EUBLIC 0 PEIVATE USE OF WELL 1 - primary 2 - secondary ubb-1-1 13 RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP. ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ jNDUSTRIAL ❑ INSTITUTIONAL - 0 STAND-BY ❑ AMOUNT OF'USE YIELD SOUGHT 5 gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE --2-50 gal. REASON FOR .DRILLING b NEW SUPPLY = ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑ gEPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 800 ft. STATIC WATER LEVEL 86 ft. Fs -ft DATE MEASURED 7/�Q/8.6) DRILLING EQUIPMENT ❑ ROTARY 29 COMPRESSED AIR PERCUSSION 1:1 DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. Q OPEN HOLE IN BEDROCK ❑ OTHER CASING TOTAL LENGTH 30 - ft. MATERIALS: EISTEEL ❑ PLASTIC ❑ OTHEI'll LENGTH.BELOW GRADE 29 - ft. JOINTS: In WELDED ❑ THREADED ❑ OTHER DETAILS DIAMETER 15; - in. SEAL: ❑ CEMENT GROUT ❑ BENTONITE ❑ OTHER WEIGHT PER FOOT 19. Ib./ft. I DRIVE SHOE: (DYES ONO I LINER: OYES ONO SCREEN DETAILS - DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? 1111T -YES 0. CINO SECOND­ . HOURS GRAVEL PACK" ❑ YES ❑ No GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH - It. WELL YIELD TEST It detailed pumping METHOD: ❑ PUMPED tests were done is in- • COMPRESSED AIR formation attached? ❑ SAiLED ClOTHER 0 YES 0 NO If more detailed formation descriptions or sieve analyses WELL LOG are available. please attach. DEPTH FROM SURFACE Water pear- mg well Oia- me er FORMATION DESCRIFTH011 C30E it. ft WELL DEPTH It. DURATION hr. min. DRAY /DOWN It. YIELD gpm. Land Surac& 4 silt & Cobbles 4 20 Fractured Bedrock 800 6' 500 10 800 Hard Granite WATER X] CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS 0 COLORED ANALYZED? MYES ONO ANALYSIS ATTACHED? OYES 0 NO STORAGE . TANK : TYPE CAPACITY GAL. WELL DRILLER NAME KILL DRILLING, INC. 1'�e14/86 ADDRESS Putnam Ave. Brewster,. NY.' __ RnharF M_ Mill. PUMP INFORMATION TYPE CAPACITY MAKER DEPTH MODEL VOLTAGE HP Yorktown Medical Laboratory, Inc. 321 Kear Street Yorktown Hcights, N. Y. 10598 _ .. (914).245.3203 Director: Albert H. Padovani M. T. (ASCP) LAB N t 1 ,, z ,t:.`• s Collection Station Used: Carmel Peekskill Date Taken: Date Received: Date Reported: Collected By: Referred By: _ Sample Source: LABORATORY REPORT ON BACTERIOLOGICAL QUALITY OF WATER GENERAL BACTERIA II. Standard Plate Count per 1.0 ml l� (Agar plate @ 35 °C) MEMBRANE FILTRATION TECHNIQUE (MFT) Total Coliform ner 100 ml Fecal .Coliform ner _100 ml Fecal Streptococcus per 100 ml MOST PROBABLE NUMBER TECHNIQUE (MPN) Total-Coliform: MPN Index ner 100 ml - - Fecal Coliform: MPN Index per 100 ml OTHER ANALYSES THESE RESULTS INDICATE THAT THE WATER SAMPLE. di;;) (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. Albert H. Padovani, M.T. (ASCP), Director LEGEND RDS - Recommend Disinfect- ing Water Source < = less than TNTC = Too Numerous Too Count Subdivision �U� 1G� �+1-� Sabd. rot a Renewal _❑ Revision _❑ S S s n a.c.. 'F�- sa ► �.► 'tzs�.. owner /Address SAL :151Z0 CC— ULEIF- i �3�.I�l�..Civ�K -� � Q-T Ofc>£31O Date Of Previous Approval Building' Type � S (�� N GC Lot Area 46 34y � V Fill Section Only' 0 Number of Bedrooms . - Design Flow G /P /D ��� P.C. H. 1). Notification Required Separate Sewerage System to consist of „E?P? d - Gal. Septic Tank and �� T. LE�� l (-� �� r t EL- To be constructed by ­T=, => Address Water Supply: Public Supply From Private Supply to be 'drilled by _Tp - l 'Z �� l t�l Gib Address k- :i V' t i Other Requirements �`�'„ je` Q t Ts F I I, represent that I am wholly and completely. responsible for th0jdes)gn; and location of the 'proposed system(s)': 1) that the, separate sewage disposal system above described will be constructed as shown on the approved amendment thereto and -in accordance with the standards, rules an 'regu a ion ;;o . a u nam County Department of Health, and that on completion thereof a ” Cert)ficate;�,of jConstruction 'Compliance" satisfactory to the Commissioner of Health will ,,a be submitted to the Department, and 'a written'.guarantee. will . be furnished . the owner,,his successors, heirs or assigns by the builder, that said, builder will Place in good operating ,condition any part. Of'saici sewage dIsposat system during the period of two (2) years immediately following thedate of the issu- ance of the approval 'of the Certificate of. Construction Compliance of the original system'or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well willtre, installed In accordance with t andards, ru s and regulations of the Putnam County Department of Health. Date MFigC1 /S . l 2'18 1�2 Signed P. E. R.A. c Address. • 27 S. • S© License No. 5 Iv 1 APPROVEMF R NSTRUCTION: This approval expires .o a yea rom t e .date issued unle construction of the building has been undertaken and is revocable f, r use r a be amended or modified when 'co ) re neces` r by the Commis ner of Health. Any change or alteration f construction requires a pe t Approved for disposal of.domest) ry sew or pr _ ater s ly. Rate ey Title 7, Rev. 6/85 - - - ' ✓�' P:UrNAM,COUNTY DEPARTMENr OF HEALTH - DIVISION OF ENVIRONMENM HEALTH SERVICES INDIVIDUAL WATER SUPPLY REVIEW .: cl & SUBSURFACE SEVMGE DISPOSAL SYSTEMS CONSTRUCTI N PERMIT DATE - B tion) DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization" Design Data Sheet (DDS) - Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter -Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J.Box;Trench /Gallery; Pimp pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area;shown;gravity flow,suff. size If Pumped Pit & D Box Sham & Detailed House - No. of Bedrecros Wells & SSDS's w /in 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 SHEET - (,Name- Owner) COMME�]TS (8t5reet YES_J NO IX- 3 t/ 1X - - - ✓ -- - - . Fields 10' to P.L., Driveway, Large Trees 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' frm Foundation 50' to Well Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same M,/'-15' ! _ /j A . r r..&41 A,A), k� Lo Lc� wqr1`A. ad�es u- T e-L-I Ae Mock Lot 5 cross street) Municipal voviw x, it ��Tbwv ­Watershed,­_ 0 TX 'REQUIRED TO BE SUBMITTED WITH APPLICATIONS fi­7 'CLOCK VIM PERCOLATION PERCOLATION aps 1)ep -cn to water 'Va-U—er Level Ot Time Ground Surface in Inches Soil Rate st.4rt.Stbp..,: Min Start Stop Drop in Min./in drop nches Inches Inches 14 4. 4e law AIC-A �kv 2: V07 :1, t C5 ­1 ......... s:.. .,rat66 ara.obtained VeStS to be'repeated at same at each percolation a depth until test holo. approximatel All data to e I equal soil submiHed L4,6 fi­7 Ot �kv ­1 ......... s:.. .,rat66 ara.obtained VeStS to be'repeated at same at each percolation a depth until test holo. approximatel All data to e I equal soil submiHed ­2) Depth measurements 1;o be made from top of hole. DES�O OTt' - S07 x;`1 ENCOUNTERED IN TEST I30LES. 7. `'!IPTH HALE .`NO oZ TTOZ►E NO . _ : °... HOLE NO .F� rt f { /.\ 't 11 Y M� y...:...�� ..•1 .n..s.6 __ ll x,.1,4 ./1 +� \ ........ ,`: � � � ..... •r.w••.••�• - . 18" S 1�:. taw�f�:_...� ,11,E l p,M„ 24" ra c. A 3pii... 42 rc . �s .��. S��r� . �.`r l �.1 l c��a �J•`rK (pn � ... , � w• N mss' ..w., !!' V" x+41d-. 5�+ �� _ f- D O ti U.• 0 nMICA•TE.. -L VEL AT W�IIGH GROUN WATER IS EIVCOUNTER!�D 1I TNDIOATE LEM, TQ 'W'E�TG -1 WA:T R IWEL RISES AK ER B13TNG LNCDaOttiNTER� /�.� ---- TESTS' :MADE BY te _ _._ .S..D.._Usaale_Area._Prov3.dod_ Sol 1. c 'rank Ca city No. of Bedrooms' • �•,' Absorption Area P"" ro�do�1 BSf' ;` L.F. " " $1t18�L .. ""_ , ,� a :<� P ii;: t„ �+ 3j'P\�•h/�'� �'+•� �. Igna ur`o Address THIS SPACE FOR USE ,BY IlEALIJ? . l;EMARV ENT ONLY: •,r� `�y';. Soil Rate Approved„ „Sq. Fi: /Qal. Checked by 1 f l : •,-. t . _ .-x, ,t}.• ko::^y.. ..::e."✓tY.Yzl. j�•:. •'!4Y .:�.ii°..}< •t..x� t ',�yC.r�,. .;,.•_ _ .,fi., r.; r -•may.' - .3t�v*ir:.._.as,i... _ n'�,:o'+:. r :F....�,... '_�k •,,�S y.- +,�•:'�r,.• r,.►.9 �ak+Ft::iv' • '_i.:r� . °w. +v:ji.:i•:.: • . i.#.o.. ; «:- r•°.n;r:z•.;__�,'• • yc.. -_ _ - •s� -�i PUTNAM COUNTY DEPAiYTMENr OF HEALTH - DIVISION OF ENVIRONME M1. HEALTH SERVICES INDIVIDUAL WATM SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS _ _.. FIEt� Tr]SPECTION REPOR T. _ DATE: INSP. BY: (Name of Owner) (Street Location) �G INITIAL SITE INSPECTION YES NO COMMENTS Wetlands on /or proximate to property................. Property lines or corners found... _ Can estimate house location .. .i .:................:.: 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 ................. ......... ArrPSS t•n- mmnosed well location for drilling. - - - - D. H. 1 Lot - D. H. 2 Lot Depth to G.W. Depth to G.W. Depth to rock Depth to rock Soil Desc: 0 ft. 3 ft.' 6 ft. 9 ft.,' 12 ft Soil Description 0 ft.'. 3 ft. 6 ft. 91t., ' 12. ft. D.H. - Deep Hole G.W.- Groundwater D.H. 3 Lot Depth to G.W. .Depth to rock 0 ft. Soil Description FINAL SITE INSPECTION INSP.BY: 1, YES NO MMMENTS House SSDS located per approved plan ...........:. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Roan allowed for expansion trenches ........:..... Over100 ft_ fran watercourse .................... Natural soil not stripped or SDS area unnecessarlygraded ............................ 10 ft. maintained fran property line and 20 ft. fran house.. ...... Distance well to SSDS (ft.) ....... i(.�1?:.:....... Number of bedroans checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench ................ 15 ft. of peripheral soil horizontally frantrench ..... ................:.............. Boxesproperly set ............................... Could surface runoff fran driveway, roads,.. ground surface, etc., channel near SDS area.... Does lot drainage. appear OK in area of SDS. :...: /FINAL CU ADNG_ OF _SITE.ACCEPrARrE_:._. :- .._- - - - -_- ,il I��Uz�• _.., V_..= I �. Kol HOUSE F-11 Cl ' ITANK D [�_- E DI 5T 5px B SCHROU E . ©E DISTANCES Ftygm. To .. DtsC&ct:cie Prom :Tt B C , B. p: A D S 5 A E k A P $4'` } w ` M W. 144' - 138' - 1 -30' F1. G 7. N 10, 20, 43' 45' 46' 45' . p i AbtorptS'on :C-! fn- gpecrtign, `t I ` 2 Fi'Rasnrom,en,Ga i •(� the: degign sta 3'.z, :. g'hei. a,r;na &;a s iI 4 Dur Ilq 'tion., r f�