Loading...
HomeMy WebLinkAbout1507DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -3 -49 BOX 14 ,Iry 116 7 - A k 'rj Ill J '� • 16 I f r r �, I '. 6 ILL, LA 01507 a PUTNAM COUNTY DEPARTMENT OF ,HEALTH Division of. Environmental Health Services, Carmel, W. Y. 10512 CERTIFICA OF CONSTRUCTION COMPLIANCE FOR SEWAGE 'DISPOSAL SYSTEM Patterson _ ... Town, 'or Village Located at McManus 'Road Tax yap 73 Hlgck 3 owner Jefferey & Loretta Adler Tax Map Lot # 4 Subd. # Separate Sewerage System built_ by 'George .Howell address Terry Hill Rd. -, .Carmel . NY Consisting of _1,000, Gal.' Septic Tank and 432 L.F. Trenches Other requirements Water Supply: Public Supply From ` X _ Private.Supply Drilled By Mill Drilling Inc. Address Putnam Avenue, Brewster, NY Building Type • Residence No. of Bedrooms 3 Date Permit Issued 5 -15 -87 Has Erosion Control Been Completed? 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 regulati in accordance wit iled plan, and,the permit issued by the Putnam County Department Of Health. - Date December 2, 1987 Certified.b P.E. X R.A. Address Route.6, RD. #9, Bre , NY 10509 License No. 55553 -.1 Any person occupying premises served by.the above system(s) 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 sewerage system shall become, null and void as soon as a public sanitary 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 Commissiner.oi Health, Such rev lion,. modification or change is necessary, / # �1 cy 7 Date Title '- 777 --- Jeffrey & Loretta Adler Owner or. urc ase.r oT Building George D. Howell Building Construct.ea by McManus Road Location - Street. . 3 Dedroom,Residence Building Type Patterson Municipality 73 Section 3 Block _ 4 Lot GUARANTY OF SEPARATE SEWAGE SYSTEM a I represent that 1-am wholly and completely responsible for the,. location, workmariship,: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 guaranty;to the owner, his.succes- sors, 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 initial iis'e of the sewage disposal sy tezn, or ; any repairs .made by me to such system, except where the failure , to operate *properly is -caused by the willful or regligent' act of-the occu- pant.of the.bu lding utilizing the system.. The undersigned further agrees to accept as conclusive . the de- terminati.ori, of the Director of the Division of vironrrienual - Health Ser- vices.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 util,iziizg the system. Dated this _,4�.S day of .�11 19 Signature Title -��-• If corporate . , give name and addres THREE (3) COPIES ARE- REQUIRED ..WITH THREE (3) COPIES. OF FINAL ..PLANS BEFORE CERTIFICATE OF COMP.TTETION WILL BE-:ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST-USE OF .SYSTEM. Division of Environitrental Health Services, Putnam County .Department of :Health .__ . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION - -OF ENVIRONMENTAL HEALTH SERVICES -COUNTY :OFFICE BUILDING�...CARMEL, _ -N. Y� 10512 DESIGN =DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Jar-pp-1--y OrI- op&?T /S. Ao�rEe Address 23 SPRin►s S-r to risco.} NY ►o54 > Located at (Street) gui (_Er HoLr=1ZOAP Sec. 7s Block 3 Lot �{ indica e nearest cross street RECEIVED Municipality Towel Op BiArTEizsop Water she d_,z "I" NY C. w'yG .SOIL PERCOLATION TEST DATA.REQUIRED TO BE SUBMITTED WITH APPLICATIONS ... _ .._. 1 AM 20 P T . l Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Wa er a er ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min.- Start Stop Drop in Min. /in drop Inches Inches Inches 30 24 2z 2- 15.0 2 1: 5G - Z:7- 30 Z4 22y4 3 Z =27- Z =5-7 30 24 22 %q 13 /Q 17.1 Z 1 30 z z Z 15'.0 3 Z= 33- 3'03. ;,p 24 2z I/z- 4 5 M 3 4 5 FaRC -OL MOW TESTS MADE By JAMF-S J • H"W r-_N4'NS&=tact 31Z5-10-7 Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED, TO. BE SUBMITTED WITH APPLICATION - DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOIES DEPTH HOLE NO. I HOLE NO. Z HOLE NO. G.L. 6" Amw, A5 1211 # SI�Ty LOAM sNora 18 To. tmpapy,005 2411 30.. 3611 42" 4$" 54„ 60" 66" 7211 78" 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED Wow& INDICATE­.LEVEL -TO -NCH WATER-LEVEL RISES AFTER BEING ENCOUNTERED' .000a TESTS MADE BY J. BEM 5oLcKg-rT( + Assoc -. Date ? uc,rE: TE5T Pt-r Data. _rAXGW V£-ZQM "15UmeDiCK Guntil, sumplyloslom M<<n PkGpAmb-u f3Y J. zoeramr Foizm=1 � A DESIGN Soil Rate Used 20 Min/1 "Drop: S.D. Usable Area Provided No. of Bedrooms 3 Septic Tank�' Capacity 1�o Gals. Lpe���c T CoNC, Absorption Area Pro ded *_4117- L.F. x24" Address QT �_ D. #k 1 SEAL J, ..,.�• mac, ,o 0555'x. ,• , THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: ��F S10 - N, £S - Soil Rate Approved Sq. Ft /Cal. Checked by _.__ Date 7_7 -,- i —5 .ter;, — — —,— , — -- PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Envbronmental Health Services Carmel N Y.1051? Engineer t q, on CERTIFICATE O PCOMPLIANCE CONSTRUCTION P FOR SEWAGEZISPOSAL SYSTEM Permit Patterson McManus Road _ T own or _v lllage S ' ` Burdick" :G1 en` "`10 73 3. Sabdtylalon Name Subd.•Iof N To Block_" Lot _ Owner /Applicant Name Jeffrey. & Lo'r`ettaAdler Renewal_o Revision ❑ Date of Pievioas Approval } " "Ada 23 Spr.i ng Stre'et Tewn zlp�' 10549 g Mt K sCID Ballding Type ` R P S• 1 d P fl`C e S Ldt Area 1 (1 F R Fill Secdoa Only" Depth Volume i 'i Nmnber of Bedrooms 3 Design Flow G P D 600 , PCHD Notification is Required When FM to completed h Separate Sewerage System to rnnalet of 1D OO Gallon Septic Tank and 432 L F: T re n c h e s ' Owner '. To'be constracted b y _'Addreee Watei SapPb, Pnbllc Sapply Flom 44 : Address r' or: X Private Supply nelued by' Owner _Address other�'Reoulrements �- -, I repiesent that I am wholly anC _completely responsible for the des�9n and location of the proposed systemis), .1) that.Me separate sewage disposal system above Cescribetl, will be constructed as shown on the approved amendment there to,andc in accordance with the,stanpards, rules an regulations o e" Putnam. County Department, of Health, -and that;on completwn 6iroot a Certilwate <,of Conitruction Compliance' satisfactory to the Cominissioner`of Health will . be submitted rfo the :Department; and a wntten.9uarantee will be furnished the owner, h�siuceessors Heir .or assigns by the bwlder; that said budder vOill 11 r t place in good.operatirig condition any pgit o /;.said sewage +tl�sposal.aystem,'durmg the per�otl:of two;(2 ears i mediately following the date of�lhe isw- ante of the bppr_'oVal "of the CertiUcate't;ot, Construction. ;Compliance ,of .t el syste s trier o; 2).thst the drilled welt described above • \_ will be located is shown on the appiovetl plan�arid thaViaid-; well -will berl eol in co ce _. the n i , -ruler _and requ a ions of the "Putnam .. County Department of. Oialtn • [ o V Oats" 4� 1587 Sig ed P.E. ^ R A. 1 R 509 055553 1 �. Address outs "6, RD " #1, ws. r, �i�en :e No APP,.fiOV,E0 FOR- CONSTRUC .TIDN.This'appro4il'expiies- two yea romthe °:dat -i4 4 d unl s.construct_ion -of the building has been undertaken and is - revocable for tau a -or may e�amendetl or:modifietl� when consids .net ry liy the' tommission r;of Ith. Any change or alteration of constiuction requires a newermit p tl for tl3posaf of domestic•.sa ary' aye, a' or t 1/87 .. Date - -. BY - _ Title O/ ADD %t. -� Wl:.LL VVl'1LLrjl.L%JV4 1X.u1 VLXi DEPARTMENT .OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET ADDRESS. McManus Road WNIVII I Y TAX GRIO NUMBER Patterson,. NY BurdzckG7Qods; ?Lot „l0 WELL OWNER NAME: Jeffrey Adler ADDRESS: 25 Spring Street Mt. Xisco, NY Q p81VATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary Q RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST/ OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL - ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT 5 gpm./NO. PEOPLE SERVED 2 / EST. OF DAILY USAGE 200 gal. REASON FOR DRILLING ® NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY ❑ TEST / OBScRVATION ❑ REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 7 6 5 ft. STATIC WATER LEVEL 40=_ ft. DATE MEASURED 7/17/87 DRILLING EQUIPMENT ❑ ROTARY Ca COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. ® OPEN HOLE IN BEDROCK 0 OTHER CASING DETAILS TOTAL LENGTH 32 fL MATERIALS: Q STEEL O PLASTIC ❑ OTHER LENGTH.BELOW GRADE 31 ft. JOINTS: IM WELDED 0 THREADED 0 OTHER DIAMETER 6 in. SEAL: ® CEMENT GROUT ❑ BENTONITE ❑ OTHER WEIGHT PER FOOT 19 1b. /ft. I DRIVE SHOE. ® YES O NO I LINER: O YES ❑ NO SCREEN DETAILS DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST O YES ONO HOURS SECOND _ .. - - -- - ......._.... ...__ .... .... .r... .. - GRAVEL PACK O YES O NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTN fL BOTTOM DEPTH It. WELL YIELD TEST If detailed pumping METHOD: O PUMPED 1 tests were done is in- O COMPRESSED AIR , formation attached? O BAILED O OTHER ❑YES ❑ NO WELL LOG ff more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear- ing We11 D'a- peter FORMATION DESCRIPTION COLE, ft. tt. WELL DEPTH It. DURATION hr. min. DRAWOOWN It. YIELD gGm. Lind 20 no 10 Clay, sitl & loose cobbles 20 .465 yes 6 1 .Hard grey granite 200 1. - 200 :465 525 6 Pink & white granite 500 1 - 500 1 525 610 6 Black nedim to hard .granite 645 1 - 645 1 610 .765 6 Grey &'black granite 765 6 - 600 5 WATER 91 CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? AYES ❑ NO ANALYSIS ATTACHED? 1$ YES ❑ NO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE MAKER ILMODEL CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAME C DATE2 �H7 MZT�L ARILLING, ADDRESS Putnam AVe. S Brewster, NY r si S v BREWSTER LABORATORIES _ .. Box 224 --6At STER, (914) 225 72072 — WATER ANALYSIS REPORT — SAMPLE NO. 6656 SOURCE:. Jeffrey Adler Lot 10 McManus Rd. Well Patterson, NY COLLECTED: August 3, 1987 BY: Mill Drilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 0 per 100 ml. This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. August 7, 1987 IV. V. om 'A T3nMTnTV 1+ 1PT,K17kr SITE INSP A(Alvol 9 P) A) 3 7­­­ 734 .# OR .SUBDIVISION LOT ECTION Date Inspected byL-� OWNER >7A ...Ym C7 NO- DISPOSAL AREA a. SDS area located as a roved lans b. Fill section - Date of placement 2:1 barrier. LGTH WIDTH AVG.DPTH c. Natural soil not striFv� .1y d.' _Stone, brush, etc., greater than 151 fran SDS area. e. 100 ft. fran water course/wetlands. .SEWAGE DISPOSAL SYSTEM a. Septic tank size 1,000, 1,250 b. Septic tank instal ,level c. 101 minimum fran foundation d. No 90" bends, cleanout within 10 ft. of 45' bend e. DISTRIBUTION BOX 1. All outlets at same elevation - water tested 2. Protected below frost 3. Minimum 2 ft. original soil between box and trenches x f. JUNCTION BOX - properly set g. TRENCHES 1. Length required - t-1 2, Length installed --u I/ V 2. Distance to watercourse measured: ft. . ........ . 3. Installed according to plan 4. Distance center to center -2 5. Slope of trench acceptable 1/16 - 1/32 "/foot. 6. 10 feet fran property line - 20 feet - foundations 7. Depth of trench <30 inches from surface 8. Roan allowed for expansion, 50% 9. Size of gravel 3/4 - 1j" diameter 10. Depth of gravel in trench 12" minimum 11. Pi• _)e_ ends capped h.-PUMP OR DOSE SYSTEMS 1. Size of Omp chamber.- 2. Overflow tank 3. Alarm, visual/audio 7 UP 4. Pan p easily accessible manhole to grade 5. First box baffled 6. Cycle witnessed by Health Department estimated flow per Sycle .HOUSE a. House located per approved plans. b. Number of bedrocms WELL a. Well located as per approved plans b. Distance fran SDS area measured /1)0 ft. c. Casing lF above grade. d. Surface drainage around well acceptable. OVERALL WORKMASHIP a. Boxes properly grouted b. All pipes partially backf illed c. All pipes flush with inside of box d. Backfill material contains stones < 4" in diameter 'Curtain e. drain installed according to plan f. Curtain drain outfall protected & dir.to exist.watercourse g. Footing drains discharge away from SDS area h. Surface water 2rotection adequate. X. i. Errosion controi provided on slopes greater than 15%. yr I APPENDIX B � kA&-) PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEMM DISPOSAL SYSTEMS �r (Name of Owner) COMMENTS V LF trench provided Se required 60 ft. max. Parellel to RWIN REVIEW SHEET - CONSTRUCTION PERMIT DATE _ J•(✓-� BY: -Z7 (Street Location) YES NO DOCLNENTS T l Permit Application -----Corporate Resolution Plans - Three sets s s- Engineers Authorization Design Data Sheet (DDS) SUBDIVISION Deep Hole Log Perc b Consistent Perc Results (3) Fill Perc Hole Depth cd House Plans - Two sets Well permit; PWS letter Variance Request GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes (grinder notes) Design Data: perc and deep results Two -Foot Contours -Existing & Proposed • - • - � � • .. Driveway & Slopes Cut Footing /Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If Pumped Pit & D Box Shoran & Detailed t House - No. of Bedroans Wells & SSDS's w /in 200 ft. of Proposed Systems 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 Fields 10' to P.L., Driveway, Large Trees,Top of fill 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, Leader, Footing 351to catch basin,stormdrain,piped watercourse 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' from Foundation; 50' to well 15' Well to PL 4 DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER- CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION. .TO- CONSTRLCT, A WATER. WEL1r,__� .PCHD PERMIT WELL LOCATION Street Address McManus Road Town /Village /City Tax Grid Number 73 -3 -4 WELL OWNER Name Jeffrey Adler Address 23 Spring-St.; Mt. Kisco, NY JOPrivate _ O Public - USE OF WELL} 1 - primary s� ;, .._ 2 - secondary �F♦C F ENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP C :BUS „ESS+, ❑ FARM ❑ TEST /OBSERVATION ❑'INDUSTRIAL 0 INSTITUTIONAL ❑ STAND -BY ❑ ABANDONED ❑ OTHER (specify ❑ AMOUNT OF 13-SE qPR 2YIE�5 ; 0UGHT 5 Min. gpm /# PEOPLE SERVED 4 /EST. OF DAILY USAGE 600 gal REASON FOR DRILLING NEW SUPPLY ❑REPLACE EXISTING ❑ PROVIDE ADDITIONAL SUPPLY SUPPLY ❑DEEPEN EXISTING WELL ❑ TEST /OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE ®DRILLED ODRIVEN DDUG FIGRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Burdick Glen Lot No. 10 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 FROK-NEAREST WATER MAIN. LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED []ON- REAR OF THIS APPLICATION .00 E 0 P E S 1 an ) (date) signs re) PERMIT TO CONSTRUCT A WATER YELL This:permi:t 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 permit. 3. Submit a Well mpletion Report on a form pr vided by a PutnaWCount Health Depart nt. Date of Issue: l 19 Date of Expiration: 19 ermit Is uing Official Permit is Non - Transferrable o roe • 22 a r,. .7- / §i I , 01�t i I2,2 P X7.4 5FpZ /C 7A' lVk ..- 9 7. e2: 2' ,D. Bd ¢ 2 G, l3Dx ' 3 A,-� .6 "5r 'xj�•��.. - - j-Q. (dim- •�.��' 2 � f §i