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HomeMy WebLinkAbout1509DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -4 -1 BOX 14 01509 PUTNAM COUNTY DEPARUYr OF HEALTH _ _.._. 'DIWSION OF ENVIRONMENTAL HEALTHSERVICES' _ ..... -_._ Owner or Purchaser of Building Building Constructed by Location - Street Municipality Building Type (l ` 2- O Section Block Subdivision Name 13. Subdivision Lot # GUARAN= OF SUBSURFACE SEWAGE DISPOSAL SYSTEM Lot 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- ComplIande" for the sewage disposal system, or' -any` repairs made by me to such 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 / 1 q day of 7G16" 19 90 Signature 0444.1�� a_14� Title General Contrac or (Owner) - ignature Corporation / Name (if Corp.) rC' t1 S/,�_'Znm /"5�e d12 / Address rev. 9/85 mk ��i� CousT �c Corporation Name �f Corp.) ze - Al- Address "BREWSTER Box 224 - BREWSTER, N.Y. (914) 279-4945 WATER ANALYSIS REPORT SAMPLE NO. 7302 NEW WELL: SOURCE: Glenn Bi * sogno Ice Pond Rd. Brewster, N.Y. 10509 COLLECTED: 4-1-89 BY: Mill Drilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 0 per 100 mi. This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. 4-5-89 I'hdmas Meyer Director II. IV. V. vi. a INSPECTION FINAL SITE Date /�-p / r _• •/ G' Cl• �° �/ ✓ir',�,"� !� • 71� (may- . 1 ?l I-M-# -OR SZMDIVISICN LOT. 1 ES Nd 9FMAGE DISPOSAL AREA a. SDS area located as r approved plans o I 0 aQ� b. Fill section - Date of placement 2:1 barrier . 1GTH e 0& WIDTH DVO AVG.DPTH C. Natural soil not stripped d_ Stone, brush, etc., greater than 15' frem SDS area_ e. 100 ft. from water course /wetlands. SrrUvP=- DISIOSP.L SYS a. Septic tank size 1,00 1,250 b. Septic tank installed level c. 10' minimimi fran foundation d. No 90° bends, cleanout within 10 ft. of 45° bend e. DISTRIBUTION EOX 1. All outlets at same elevation - water tested 2. Protected below frost 3. Minimum 2 ft. original soil betwee.� box and trenche f. JUNCTION EOX = rocerly set g. 'I'?.IINKIi`F_S _ 1. Lenath re u-;xed - S Length installed TI _. AA 0 2. Distance to watercourse measured. ft. — 3. Ins Called according to plan .�� 4. Distance c`*ite_r to center no . 5. Sloce of trench acceptable 1/16 - 1/32 " /ioot. 6. 10 feet. from prcpe_rty line - 20 feet - foundations 7. Depth of trench < 30 inches fran sarface 8. Roau allowed for exrension, 50% 9. Size of gravel 3/4 - 1 " diameter 10. Depth of gravel in trench 12" minimum 11. Pire. ends card h. PLC OR DOSE ,SYSTEMIS ... 1. Size of pLmm chamber 1. .. . o_ ._... _ - _. -, 2. Overflow tank 3. Alain, visual /audio 4. Pump easily accessible manhole to grade 5. First box baffled 6. Cycle witnessed by Health Department estimated flow r cycle HOUSE . a. Hcuse located per abnrcved plans. I --f . t b- Number of bedrooms 3 4V= a. Well located as per approved plans r b. Distance from SDS area measured i p,s ft. � c. Casing 18" above grade. d. Surface drainage around well acceptable.. OV RAIL WORKMIASHIP a. Bcxes properly grouted b. All pipes partially backfilled c. All pipes flush with inside of box d. Backfill material contains stones < 4" in diameter e. Curtain drain installed according to plan f. C:rtain drain cutfall protected & dir.to exist.watercour g. Fcotinq drains discharge away from SDS area h. Surface water rotection adeauate i. E_- =osicn contro rovided cn slopes greater than 15 %. 1 PU TNAM COUNrY DEPAFRM41M. OF HEALTH DIVISION OF HEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Address VD Located at ( Street) 1 pm ra o 9--,z) • Sec. -'°I q Block I .. Lot L. •Z ( indicate nearest cross street) Municipality E„ y_ rd Watershed rA _e SOIL, PERCOLATION TEST DATA REQUIRED TO BE SUBMIZTEII WITH APPLICATIONS Date of Pre- Soaking to - vs - %'l Date of Percolation Test t c� - HOLE NaMBER C= TLME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 2 ?_4 7-1 3 �� 311 :oS -11: 41 24- 2-1 4tk-4.- 1z,.\S ?:)tom 74 2 "1 3 tz 5 5 7.4.. 21o!S4- d'''ate ",r„ ?_ "I 311'.oq -t 9 4 5 7.4.. 21o!S4- d'''ate ",r„ ?_ "I 5 NOTES: 1. Tuts to be repeated'at same depth -until apprcaimately equal soil rates are obtained at each percolation test hole. All data to'be suYmitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 DEPTH G.L.. 1' 2' 3' 4' TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. 7 HOLE NO. a CL �n n1 1 t. 4 M CAA !- N 1 C. f-,o L...6? A. m 5' 6' ° 7' 8' 9W 10' 11' 12' 13' 14' CZ.cc y— I.a INDICATE LEVEL AT WHICH GROU[JI = IS ENC C)UNTERED ►�1 / F; INDICATE LEVEL To WHICH. WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY :k a A,,a � DATE: /a — •� DESIGN Soil Rate Used - VB Min /1" Drop: S.D. Usable Area Provided -17. No. of Bedrooms P-�, Septic Tank Capacity \ gals. Type ,a.ot tz't Absorption Area Provided By -L.F. x �4" width trench Other ' 7 S gnatur Address 1 \ n ry v\ '� `'� E C a r; AN ,.a a'C L1 •a ea `� %� FdO E�SfC�r,AL �:v,,; -� RA'TION1 THIS SPACE FOR USE BY HEALTH DEPARTMFNI' ONLY: Soil Rate Approved sq.ft /gal. Checked by Date PUTNAM CC= DEPARTHENr OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ftsiquDAT-A SHEET7--UBSUFACE S&qAGE DISPOSAL SYSTEM FIDE D Owner -o Address Located at ( Street) . \ --- -,-- Pe-, \ Ci 9-• o - Sec. 9 Block -i- Lot t, -7- ( indicate nearest cross street). '� -, P... L,, -A t--s en , 7} Municipality - \)a-\ I 1L. IV• t, r-1 Watershed to V , C- Date of Pre-Soaking I o 1, Is :nnfw- • am Date of Percolation Test 1 c) - - $S'l HOLE NUMBM C1= TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start-Stop Min. Start Stop Drop In Min/In Drop Inches Inches Inches 2 2x o 7-4 2-4- 24- 7-1 5 2 4 t 4 5 2x o 7-4 31 t'. oe\ I k ",'I k 2 4 t 4 5 NOTES: 1. 2. rev. 9/85 Tests to be repeated are cbtainedat each for review. Depth measurements tc at same depth until approximately equal Soil rates percolation test hole. All data to'be sub-mitbed be made frCm top of bole. 2w . S4 i\'•'bo 7-4 41V 1\ NOTES: 1. 2. rev. 9/85 Tests to be repeated are cbtainedat each for review. Depth measurements tc at same depth until approximately equal Soil rates percolation test hole. All data to'be sub-mitbed be made frCm top of bole. TEST PIT DATA RBQU= TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOMIERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. I- HOLE NO. G.L. .21 31 t- A--r CA 41 5' .61 71 81 go 10, 12' 13' 14' INDICATE LEVEL AT WHICH GROUNUKATER IS ENCOUNTERED t,,-k INDICATE LEVEL TO WHICH, WATER LEVEL RISES AFTER'-BEING ENCOUNTERED VN /A DEEP HOLE OBSERVATIONS MADE BY:kF DATE: DESIGN Soil Rate Used I teB Min/1" Drop: S.D. Usable Area Provided -17. No. of Bedroms b Septic Tank Capacity gals. Type tjAe=em-% \z-f Absorption Area Provided By - �n c5o L. F. x 24" width trench Other Name Etr�,t) ►e ra 2 P P Sig Address V\ SPAT. p'C A PriO-F-ESSIONAL COIRPORATTOR A THIS SPACE FOR USE BY HEALTH DEPARTMEW ONLY: Soil Rate Approved sq.ft/gal. Checked by Date DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES kmgmtgma-mg uolpo�Q 31, bed-cf psa'�(.=E_A dEpth af liquIL- 41 miniinn taice width to IEEE) qmning - minfinm\M diuem�_-n. d. Baffle i3c � 20% of -1iquid t- -1 -311 level !e,-4,, 1:F=10,,, &v b-22"). 9. If 1L--:..th G.T. 9 feet - use 2 cc Lo. Mh-Amx, tank capdty 1" gO cJW4 :,-=dmm:134 cO bcbm;161 11. AsEtn7-itic anting Ex reinfamad 12. Inlet `24/baf fie I Rl - 13. OJI&- is" 14 Irilik 15. Valet - asst 16. pipe s1cpe 3/8" per 17- QuIkr--J jousts for sanitary Sarlitar !,.Imp P I Z4 7-Ij u to z a in �V . • WIL EEIAM 1. •• of msuxj 18" above grm-B. 2. •• •f asirg 21 abcxe EPL cr aterbght_ 3 btnim� 201 aming cf ste4 vzr6i I=.' Cr 4. 101 mini= grout into rock. 5. Oitlet 41 belcw O.G. inin. 6. ': r saals 7. Grard •o• s• aqy f • ran - • UE • I sigiglom, I above 1i 1. Overfill bo allcw fcr settLirxg: 4"--6" natuml son bddill. 3. Unt r=d boilding pap--. 4. to 1111 clean 9mvel cr stcre. YA hffi parfcmted pipe. .6. Pipe invert 6" cff boftaTL Wa 2411 wide trench. 7. 1811: 8. Depth a5agmte. RNA 9. SEpamticn frcm MCS arm 151 min. 1. kflf-*- imert n- n. 2" abase atlet in%;erL 2. All o.�J-,ets at sire elemtim. 3. OiLU-_a 1!, to 5" abase tank bottom. 4- minimm 1211 bo3ding dIcEn sand cr pm gravel. 5. MLEt_- Ulf Clp-. 6. Mmdmin 12-, air. 7. Paaxnue cox-_r for 8- Sm1al pipe joiR (aqiBltic cr alml.). 9• MCPe cutlets at 1/8 kVft. (1%) 10. 'First W 5 W Mr,Mppe IA6 in./ft. to 02 in. (0.5% to 0.25%), 3/4" to Jill mmtna stcre •� e• qmmal a L-••t 99Et:e erl dimeaggr�teu-&rlatao. ��C" minfinni, 12" mmd= earth bx:kfiU. Q,)Of-IU to allcw fcr settling, mrWrm fron trench •ottrm ■• uater-5ft.920a oW. Tmin.frcm trend, b:Atm to jqow,-jaB gmd-- Wacingardn.610.C. (24"trErrh). ctEd latEml en5s mzt be pLuggEd. min. 101 b -trenich'. clash 3r'cto�rrYOC3c +;2''rr Dater 1:9,3951ROM IRL 111 m �RZIFXMW 1. Pcbzjmte cmx-x pnp line ing cr s1cpe autme Imp- to pmp pit. 2. 0jerELcw capacity,me dayod-jer aomptble armngmmit. 3. Rup an-s�_� p:ocf bcx oat_� dimimr. 4. DoEe 75% pipe w1uTe. 5. Alann - ayiihl - Ndsible. 6. Ttn ft. man. pmp pit to faPhtim. 7. Fifty ft. min. pmp pit to w-U. 8. R9 ec-t wc& =p th NEC. 9. Q)erk xal:ve,gate xalw, mim. 10. RaffiM D-bcx,cr J-••• - 1st bcv- 11, Rj•zulk infmmtim -cpemting leuels pit- -gpm vs. bEed jXg, %,� ozves. V ll 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 IACATION Street Address e- M Pe t:b lzft.Lo Town/Village/City Tax 9.4wT T as o.1. jb%.% Z Grid Number L dz.-r G-1- WELL OWNER ame Mailing Address av�1/ tze� leol Pamo 4jeb.T tA:Y. %as rivate DPublic USE OF WELL Q- primary 2 - secondary EMESIDENTIAL 0 BUSINESS 0 INDUSTRIAL 0 PUBLIC SUPPLY 0 AIR /COND /HEAT PUMP O FARM 0 TEST /OBSERVATION b 1NSTITUTIONAL O STAND -BY 0 ABANDONED O OTHER (specify, AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE, gal REASON FOR DRILLING WNIEW SUPPLY. OPROVIDE ADDITIONAL 'SUPPLY 0 REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL 0 TEST /OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE 03'DRILLED DRIVEN ®DUG O GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES [�C@ IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:1 e.6; P,�,Ac) Lot No. t3,-,p, L,=,-v WATER WELL CONTRACTOR: Name Q.P. 6eAv. Address: gQ�.,�err tee, aAY IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES No NAME OF PUBLIC WATER SUPPLY: DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: Mit-ra.-5 TOWN /VIL /CITY LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED []ON REAR OF THIS APPLICATION ON SE S EET (date) Ni E ca _.-pj r,;q,� (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 Health Department attached to this permit. 3. Submit a Well Completion Report on a form pro ided by t Putnam Count Health Departm nt. Date of Issue: ?t-7 4-f- Date of Expiration: 19 ermit Issuing Official Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector 2/87 Pink Copy: Owner Orange copy: Well Driller APPENDIX B PUTNAK COUNTY DEP-ARTMMr OF :1 • k: DIVISICK OF EN r: SERVICES IMIVIDUAL MMR SUPPLY & SUBSEPONCE SFAMM DISPOSAL SYSYa 1 s d */y (Name of Owner) ['tY4+1rn_FNrS ■ :101 •• Y• we 580 Q1 • • 01'J �• Y (Street Location) / w US NO DOC EM (� Pezm.it Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth House Plans - Two Well t permit; Variance Request REVIEWM: 1 Z d -- Perc �ill i�� cd C rNF:RAT - Leal Subdivision5� Subdivision Approval Checked z T Ex- approval SSDS Adj. Lots Checked Wet and (Town/DEC Pe --nit R & D) Data On DDS Plans & Permit Some REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sedage System Hydraulic Profile - Gravity Flcw Fill Profile & Dirriensions - Volume D or J Box;Trench /Gallery; Pup 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 triveway & Slopes Cut Footin /Gutter, Curtain Drains (discharge CK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area; shown; gravity flow,suff. size If Pumped Pit & D Box Shown & Detailed House No. of Bedroans Wells & SSDS's w/i 200 ft. of Propose. Systen Property Metes ands . House Setback (Tight lot) House Seder - 1/ . 4 "0; Type pipe No Bends; . Ben 450 w /cleanout SEPARATION DI SPECIFIED ON PION Fields 10' to P.L., Driveway, Large Trees,Top of fi: 20' to Foundation walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. E:�i 15' to Drains - Curtain, Leader, Footing 351to catch basin, storazrain,piped watercour! 10' to Water Line (pits -20') 50' intennitte_*it drainage course . _­� -,- -- .. ---,-7q� Z�::7�­ - ­ -1 , ­ �­ -­ ��, ­:k`­�,',�--�­. 7 -_7 77. --.7-�7-7-7,'. 7-7- -­=, ­ ow-� % -10, " - _k� ,zl lis-AT I " e -1 "Q-'�lp'%t _CW,­­�---_,� - , �, i�.. . .I f .- , 77 ,__ ,81,411 *­.t ,, 'v­ Q qN 0 v vfer _!­', - .. , �65&4 - - I y "W� " ,­.. "pl- 4�,­ :2- -14 " "w">, - - �,�,,,'.:_ zlk_,, _ - -, .1, ,,�.,,�al-,,t�-. ., , , - v - � " , '' I - - ;, --�4-;�-'4'-'-'--"-',,-�.�,",-,,,�,�.-�,� ,,,�,­� -,,.,. ", � , ,;­.*,?,f.'T� - I N_ , � - . . ` 11 , 4, -.n�.­�­ -&� ­ - , � � 1,� � �� - - . 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