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HomeMy WebLinkAbout1510DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -4 -2 BOX 14 01510 Is r 1 `fir J L 6 ,.. ,L r. 01510 PUTNAM ' COUNTY DEPARTMENT 'OF HEALTH" ENGINEER 'MUST PROVIDE Division , of Environments/ Hesli► .'Sevroea;' Carrie% N Y :10612 ' '16 _-8 8 PERMIT- # . . CERTIFICATE O CONSTRUCTION COMPLIANCE FOR - SEWAGE DISPOSAL SYSTEM_ Patterson,., Town or village Located at Ice Pond Road. Tax 'Map 79L. block' 2; Owner Thomas Bisogno / Formerly Tax Map Lot q 6. 1 Subd 7 Lot '# 2 Separate Sewerage System built by Cerlich Const: Co. Inc Address Peadeahe1 Hill` Rd 131_12W-Iter Consisting of 1000 pal. Sept1c Tank and 336 if a'bs trench 2'wide by '7' o c Other requirements 2'-0'r R.O.B. fill over entire SSDS .area Water Supply: Public Supply From X Private Supply Drilled By Mill Drilling Inc. 44, Address rug- 'racxau nvc oicwMt.ci ivi i Building Ty4esidential. No. Of Bedroom: Date Permit Issued 3 Has Erosion Control Been Completed? Backf.11led Has garbage grinder been installed? NO I certify that the system(s) as listed serving the above premises were coristructed essentially as shown on the plans of the completeid,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. FOR K.EAN5 COPP - �� Date 9-2'5- 90i�lG;NEE �Nl T P.E.�R .A. fJRPOiRATION XOUNT I lI 0, Q ` g License No. �° (914)) Any person occupying premises served by the above syttem(s) shall' promptly take such action as-may-Yie necessary- Wsecum the correction of any unsanitary conditions resulting from such usage. Approvai of the separate sewerage 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 d void when a public water. supply ,becomes available. Such approvals are sub)eclr to mo ification or change when, in the Judgment of the C sio of Health, such tion, modification of Change Is necessary, Date `' `' By ! Title Rev. 6/85 �I ®�J A1RT1T T1 TA1T TTTIATIM W Y tlV1'2t LL 11 V" lxl.,r VA1 DEPARTMENT OF HEALTH Division Of Environmental Health Services - PUTNAM COUNTY DEPARTMENT OF -HEALTH. Office Use Only — AV f� WELL LOCATION SiREiiT ADDRESS: TOwN/VILLACLICIFY TAX G 10 NUMB : Ice Pond Road Brewster, NY , WELL OWNER NAME: ADDRESS: Thomas B i sogno Ice Pond Rd., Brewster, NY 81VATE p PUBLIC USE OF WELL 1 - primary 2 - secondary �RESIOENTIAL ❑ PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP ❑ ABANDONED BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT 5 3 -5 gpm:lNO. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING (]REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY X W SUPPLY (NEV DWELLING) ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 400 ft. STATIC WATER LEVEL 125 ft. DATE MEASURED 12/ 14/89 DRILLING EQUIPMENT ❑ ROTARY COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION. ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING POPEN HOLE IN BEDROCK ❑ OTHER CASING TOTAL LENGTH 3Di ft. MATERIALS: U STEEL ❑ PLASTIC ❑ OTHER LENGTH BELOW GRADE ?q ft. JOINTS: ❑WELDED THREADED ❑OTHER DETAILS DIAMETER 6 in. SEAL: XXCEMENT GROUT ❑ BENTONITE ❑ OTHER WEIGHT PER FOOT lb./ft. DRIVE SHOEM YES ❑ NO I LINER: ❑ YES ❑ NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST O YES ❑ NO SECOND _ -- GRAVEL PACK 00 NOS GRAVEL SIZE: DIAMETER TOP OF PACK in. DEPTH ft. BOTTOM DEPTH It. WELL YIELD TEST If detailed pumping METHOD: ❑ PUMPED tests were done is in- 1 COMPRESSED AIR ,formation attached? O BAILED ❑ OTHER ; ❑ YES ❑ NO , WELL LOG if more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE ling Water Bear- Well Oia- meter In FORMATION DESCRIPTION CHIDE ft. WELL DEPTH It. DURATION hr. min. DRAWDOWN ft. YIELD gpm. surface 0 silly 2 41 Clay & cobbles.. 260 - hard re ,white and 360 1 45 400 6 - 300 60+ WATER CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS ❑ COLORED ANALYZED? )6 YES ❑ NO ANALYSIS ATTACHED? )(I YES ❑ NO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE S&Ersible CAPACITY 10 MAKER (j(�4 DEPTH_ MODEL �� VOLTAGE 23Q HP WELL DRILLER NAME MILL DRILL- I' MNCC. ADDRESS Putnam .Avenue s Brewster, NY pp 1L� 27��9 I *11,(z ulrwnt J/ V./ BREWSTER LABORATORIES Box 224 - BREWSTER, R.V. (99 4) 279 -4945 ® WATER ANALYSIS REPORT SAMPLE NO. 7 5 9 5 NEW WELL SOURCE: Tom Bisogna Ice Pond Rd.. ' South East, N.Y. 10509 Y, COLLECTED:. 12-18-89 .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. 12 -20 -89 PUTNAM COUN'T'Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES.. . _ -- Thomas Bisogno 79 2 6.1 Owner or Purchaser of Building Section Block Lot Solid Construction Building Constructed .by ... ,,... :.. Ice Pond Road Location- Street Patterson Putnam Municipality "`", Residential Building Type Ice Pond Subdivision Name 2 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 -- --0Cert:i icate- of Conatruction Compliance" ._.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 "Environmental 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 '� �� day of S' 19 1?0 neral Contractor (Owner) - Si nature 5r), e- - ( /--) Cep -r ✓ ✓� �' c�� >G�crrJ Corporation Name (if Corp.) Address rev. 9/85 mk Signature -`-� -` —, - Title' Corporation Name (if Corp.) Address 15 'Ve4 J /VI ./ Lv - ;4::, ;c T. `c•r 1 C ?DM D _ Z _ ca CvLJl'1 LET area h _ En - rata cf p � a_ =:z- ,lt ;�iC C_ Zc ='?� i Sc.I._ nC Sr t7-1 T-,' D CS?- _ ! ' :.ter -+l-.: __.-. '• --T- -� C _ 3 I C w- -- 1'J i All _ F -mot =� = =- =: f_c�_ _ L _ _ _ _ :. • - -- _ -- I _- C__C__ j=-- i it -- ^r r- = ^c �: 5U� � . RCS �_ ,� - E_ - - r ? Lac = c_ c_=' ii-! t:-=n 12,E - -_L �- CR LCS' S,c^ c 5- z_ c_ er /a_=_= _ to crace �r _ tcN L� - -- 1_ 3S i WaLL c -' I a_ Ckf In I/ I i P I [, E I' I V I I •' I I i I i I I I 4 i I I I ri R!o C �n rig I ' PUTNAM COUNTY DEPARTMENT OF HEALTH Divlslori of Environmental Health Setvlce`s, Carmel N:Y 10511 En bleel•to Provide' Penmit N .' „I . on CA OF COMP ' CON UCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM permit M- _ = t�taayA Psi S d. J i LoLsfod at d - T wn or Pillage - �c� cis 1? ' ` •.�� 'L' Subdivision Nome, Sabd: Lot IR Tax Mip4_Block Lot Renewal'_ ❑ Revle_lon ❑ > Owue_r /Applicant Name Date of Previods Approval •MaWng Address 1�3 Q �=. Town_'-' own Zip Banding Type IPff Si0jtjL>CZ Lot Area s l� � "'1 dC ° Fill Section Only Depth Volume _ Number of Bedrooms Design Flow G P. D - � 'PCHD. Notification Is Required WhennF�W Is completedd parsto rage System to consist of GalloUS optk Tank and 0 a(;. Ulu 11 11M. To be constructed bY-'�E it fi .. ` Addreei Li%�� Water Supply: Pnlfllc Supply From Q Address'. - _��: Id, or: _Private Supply Drilled by' a , Fi �_- Address ��- �,(I�[rcE.s -lstr Other Reouiremente , "'�\t � , i7 a iii 1.{�' V�i2 -660A I represent that l am wholly and completely. responsible for the design'end'location of the proposed `sys1tem(s);. i) .that the separate sewage disposal system above described . wilfbe constructed as shown on the approvedernendment . there to:and in accordance with the standards, rules.an :regu a ions o e T u nam County Department of Health, and that on completiori-thereof a "Certificate' oL Construction Compliance" satisfactory to the Commissioner ofHealth,wilL 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 said sewage .disposal system_tlyring the periotl of -two (2) years immediately followingjhedate of the iisu= ante of the approval of the Certificate of 'Construction Compliance of the oiy'inal system or any r ereto; 2) that the drifiel ovelLdescribed above OFT, W ill be located as shown on the approved plan and thatsaidwell willbe- installed' in. accordance with the standards. rules -an 'Pins, of the Putnam County Department of Health. - - KEAN COPFE a - Date' /f) "'�: �% Signed - R. = Address Lix SERA 17'j LJ 0 A M. R 0 APPROVED FOR CONSTRUCTION: -this approval expires two years from the date is ss constr.uction of the building has been undertaken. and �. revocable for cause or may be amended or modified when considered necessary_b Commissioner of'Heelth. 'Any change .or alteratiory of construction r ` requires a new permit. Approved .for disposal of domestic rotary - wage, b ' foi private• ter p Only. ` //1 Rev. . - 1/87 ' Date '��� 9y /.� Title 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 Street Address P00 C7 Town/Village/City Tax Grid Number IrIOA P PAi're ZSOS J S%4- Z l®i &.2 WELL OWNER. ail Address %M eWe >O NO 14F PbPJO IFOACP e O Public USE OF WELL 1 - primary 2 - secondary RESIDENTIAL ® BUSINESS ® INDUSTRIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION L7 INSTITUTIONAL ❑ STAND -BY O ABANDONED O OTHER (specify AMOUNT OF USE YIELD SOUGHT gpm /# PFOPLE SERVED _ /EST. OF DAILY USAGE 600 gal REASON FOR DRILLING 0 NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY OREPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED. REASON FOR DRILLING rolz WELL TYPE rn L^jDRILLED ®DRIVEN ®DUG ®GRAVEL ®OTHER IS WELL SITE SUBJECT TO FLOODING? YES _NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: )C.V Lot No. WATER WELL CONTRACTOR: Name RF. Address: 8J2ZV1'57*M . IV.Y. IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: A. TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: M(LES LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ®ON REAR OF THIS APPLICATION (date) .TE ature) FOR _Vi PERMIT A PROFESSIONAL CORPORATION 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 y t Putna o n y Health Departure t. Date of Issue: 19 Date of Expiration: 19 rmit ssuing f icia Permit is Non- Transferrable White Copy: H.D. File Yellow copy: Building Inspector 2/87 Pink Copy: Owner Oranae coov: Well Driller It n, :i . • DIRT• W, • f /• mfr! ! DI' ' 'J6 ID! J • V • k: f • DI !' i; IDI V• :IDS` Y: 'tD1• aD� ! Is 91KIF-AVRIMNIM21 • f MUMM f : vi' WgwiRm uret • • i. • YD (Name of Owner) CHI'S LF trench provided "4 rewired 60 ft. max. Parellel to �. -RE�TLEW SHEET -_ cbNS PF.F2M?TP:, DATEJOED-... (Scree YES - Location) DOC@ETPS Permit Application corporate Resolution Plans - Three sets s/s Engineers Authorization Design Data Sheet (DDS) SUBDIVISION Deep Hole Log Pe_Tc Consistent Perc Results (3) Fill �- Perc Hole Depth cd House Plans — Two sets Well pe-rmit; P9vS letter ariance Request Le-aal Subdivision Subxivision Approval Checked Ex- approval SSDS Adj . Lots Checked Wet'-and (Tcwn/DEC Penuit R & D) Data On DDS Plans & Pewit Same REQUIRED DE.T. = ON PLANS Sewage System Plan - (north arrow/ Sewage System Hydraulic Pr .Gravity Ficw Fill Profile & Diuriensions Vol e D or J Box;Trench /Gallery; ils 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 Footina/Gutter,Curtain Drains (discharge CK) 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 w/' 200 ft. of Proposed System Property Metes & unds House Setback N (Tight lot) House Seder - / " /ft. 4' 0; T_ _ pipe No Bends; cleanout SEPARATION DIS IED ON PL?V 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. expa 15' to Drains - Curtain, Leader, Footing 351to catch basin, stormdrain, piped watercour 10' to Water Line (pits -20') 50' irate= dttent drainage course Septic Tanks 10' fran Foundation; 50' to w-l.l 15' Well to PL DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Tro 13- ijo y . . Address _�z 3 EVAD Located at (Street) � �4n to n:. 2r') ,&D Sec. .r Block Lot (indicate nearest cross`-street) Municipality PA7TF R&C5 j Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking jp - % '� Date of Percolation Test huLb � 4 i ,T NUMBER CL= 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 1 �' 4214 -ZA /A -Z 1 3 9 2 q-a- 5,48 <2 4 I�' °' /f?,6 5 1 ?ice 9 37 V) -- /c 2i ) a °zJ `3 5 G� 1 ['� � 4 �2 5 _ l NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to'be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION ~ DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES -: DEPTH_ "H01:8­"% HOLE::NE) .:. _.. _.__ ... -HOLE G.L. 1' Z01 _ 3' 4' . 5' 6' 7' 8' 9' 10' u i_ 13' 14' - - INDICATE LEVEL, AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: � DATE: DESIGN Soil` Rate Used Min /1" Drop: S.D. Usable Area Provided, % ©C� No. of Bedrooms G _ Septic Tank Capacity /,00c) gals . Type Q Y Absorption Area Provided By; L.F. x 24" width: trench 1 - Other NaO �� 1 L. 6- -1- AdJ&) Signatur Address % id-6 �4i� S FOR KEANE C::�PPGt_MA _ Ye THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date 11 A i y J ! A" 4• 1 t :� J �kfy M is T � 'irk 4 R}} } l A x , t i._ �.. <.• t 4. .. f. t Qlvv Flow it". 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