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HomeMy WebLinkAbout1533DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -4 -29 BOX 14 Ll LE 01533 m o l PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES -P OPOSAL FOR-SEWAGE TREATMENT-SYSTEM-REPAIR".. • id Internal Use Only PERMIT # - l Repair Permit issued in last 5 years ❑of in Watershed Repair within Boyd's Corners, W. Branch or Croton Falls Res. El Delegated l�X Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION .�1�� CQu �Y T -�'� TOWN �[T-r� r�0/�A :, C' 71 . OWNER'S NAME] {'isHONE # - �7�' MENEM MAILING ADDRESS A r$p 63 APPLICANT zk m 104 S U `tare �\D�-- Name & Relationship (' e., owner, tenant, contractor) DATE a5 FACILITY TYPE a PCHD COMPLAINT # PROPOSED INSTALLER j�e.5 i v�IS , +�� PHONE # ADDRESS q (F 1 k, ,pt a REGISTRATION /LICENSE # H 3 Ve,- ,v;,, of S J O-7 L(. A_ Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature and extent of the repair. " - (; the septic -insta er, agree to co p with the conditions of*thi/s�permit'fdi the septic system repair SIGNATURE ,TITLE DATE (installer) Proposal approved with the following conditions: , 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. No completed work is to be backfilled until authorization to do so has been obtained from the Department. INTERNAL USE ONLY P osal A Yrno P d posal Denied El ,06� `7 .. In ector s ionature & Title A-4111W Date Expiration Date is in compliance with applicable codes` Yes ©___� No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 Mcated at Bullet, Hole Rd. &Clifton Court Tape 73 Bak rot 1 Terrence McBreell Fotsnerl Subdivision NameBurdlCk Subdv Lo # ti!8 f! Owner /appHcant!Nsme y. 35 -,26 212 Street zip natereri>aanedWoo °ds Mamg..nddreea 2148 u Baysde; NY, 11361 Separate sewer, e. syate ®, bunt by Edward. McGoorty Ad a 58: N. Main St , .Brewster, NY .10509 Consisting of Gallon Septic Tank and 333 -LF Tile Fields Water Supply: Publlli Supply from Address or. X Private Supply Drllled.by M, l l Tlr, 9 l i!ng Address: Brewster 10509. Bullding Type . Colonial Hall- Erosion Control Becu Completed? „ NA Number of:Bedrooms 3 Has:'Garbage Grinder Been kstagedY NO OtberRe *M, ents Av: 2' fill required, I certify that the system(s) as listed serving the above premiaes-iwere. construc s ntially.a own q& ' e plans of the completed work (.`;copies of which are attached), ..and in accordance with the standards, rules. and re' i s ac o wi led. plan, and the, -p issued by the Putnam County r nt Of H 1' - Date U... Cer Ifietl by P A. Addiesf . (l .^ �....: License No Any person occupying oremisits served byzthe bbove systems) shall promptly..tik. such action as mayb® necessary to securo the correction 'of any -un anitery conditions resulting from such usage.' . Approval of the .separate sewerage system. shall become null and, void.as soon as a pub"-- senitary, sewer becomes available and ths'approval of- .the.piivate water supply shall become_null Lind voia when a public water -.supply becomes avallabk+.` Such approvals are subject to.modifieation or change when `i'inj /the, )udom ®nt of the Commissionei�ot Health,'syc revocation, modifieetlon or change IS necessary, Tt41a Date If .�!• —�7 i . BREWSTER LABORATORIES Box 224 - BREWSTER, N.Y. (914) 225-2072 WATER ANALYSIS REPORT SAMPLE NO. 6129 SOURCE Terry McBreen Well Burdick Woods Bullet. Hole R.d. Patterson, NY COLLECTED: April 1986 BY: Mill Drfllingg Inc. BACTERIOLOGICAL EXAMINATION Cofiform 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. �. � ky VED NOV 2 4 lqqg BALD01 & 0XININUiS, April 20, 1986 F.T*T-j ofIT, _1yV.Wj PUTNAM COUNTY DEPARTMENT OF HEALTH .._ DIVISaON OF�EWIRONMEhfi' 'L ==IifA Zvi= S t Y'.... -�.. zn .....- _ .. -,... .w.o ...w. .+.+.. .:oa. -mow... - Terence McBreen Owner or Purchaser of Building Terence McBreen Building Constructed by Bullet Hole Road Location - Street Patterson Municipality Colonial _ Building Type 73 6 1 Section Block Lot Tax Map Number Burdick Woods Subdivision Name Lot #8 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 inmediately..following ._the .date -of' approval of the . "Certificate =of:._ Construction- :'Compliancev' -f or•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 17 day of Aug. 19 87 Signature Title ,,-!:Z=ZZ A!:Z� General Contractor Owner) --m-Silbature Corporation Name (if Corp.) Corporation Name (if Corp.) Address Address rev. 9/85 16 mk I/10111H11 NI k►I�e1to Mies at ItrelUb.yRl wit r1 COUNTY orFlce DUILE)MG • CAnMC-L, NEW 'rtais- ►epori it to bc'eompleted by well driller and submitted to County - Health Department together with laboratory report •naly:iS of water Sara.;Ic indicating water tS of sati.fzctory bacterial 1au51tty before eeruficaie of eon:trumion compliance is issu FRE-PORT MI LIST BE SU111MITTED WITHIN- 30 DAYS OF %`JELL CO.MPLETIOu cw mi. lc TERYY MC BREEN ( 35 -26 212st Street. Bayside, NY 11361 IOCAtIt)N f/to, d SuOeIJ (lo.e/ µad t..r•rw.•l or WLU Burdick Noods Patterson, .Alew York ® SUSINESS ' ❑ ❑ KOPOSED DOMESTIC .o LSTALLISKMENT .. .. IFAXA1 . TEST vau ust Of iil LLL n hi[)USTCl/II �j Alt D oSP— S /rLT L,J LJ O DI L11HG i �'� cownsSED j'°j CABU Q OTHER ioUl►F.:[tlT _J ROTARY AIR /:RCL'SSION LJ PERCUSSION Eso. earl• CA31Hv . LLI%GIn (i.eli . jwg1WMl rLR 1001 ❑ ju�AVE 55MO?(� �5 �a C��v�w u DFTAiIS 5 0 FA-kLILItoonchoral 6 19 THREADED WELDED, 'r J TES L_J ht0 U 1'E5 NO T1FtD MOURS D 6 20 YIELD (G.P.M4 . 20 • TEST LAILED PUM►ED coIA,RFSSFD AIR t A.1 ER /ALASURL F&Cwm LnND SUaFACL— SIAIIC(Soec.l,letl/ DUkItiG YIELD ILSI/ lCaQ Depth of Compieled Wetl LEYLL 1'0 20`� In feet below Land avrio:e: 305 MA:f L:VGTK O►LV Ird AG:iIF; fCRTTI! DITL.IS SIGs S:w: 01AxLtLR pncnea) IF GRAVEL Dion+etee of %well inelvding GRAVEL Si:L (/neneai /AOPA 410111 10 v*00 PACKM prov*1 pock (Invto ` IIT /t; K ta•:� "A A:L1 rin a F[ET . - ; FORMATION ve.scu nioN 0 161 Sand,.gravel & 166se ledge 16 38 Broken ledge rock : U'5 ( Haru granite Y 11 ylold -vo tralyd of o.n•.eno d.rine dvr:nd d.ill:na, Lot b.Lo.w fill GAtLOtu 11fR MINUIE 200 2 305 20 I%VLLL DRILL 110 '�T 4 SAO /CA Bract $0eattaft et well -1fA 9I311ACta. to at 11aat two permanent lanimaraa. x <r ` PUTNAM � Drvrsron of E, CONSTRUCT PERIyl1T, ,FO'R, SEWAGE ,DI; Located ate -��� ' 4 c^ � Subdivision ¢' 1�atcic'a °DtSr Sv�p1y`I� Owner /Address ��7�C'✓Z VIfT COLON %,FI L Building Type Lot; Number of Bedrooms resign Flow c /P /D Separate Sewerage:Systemao consiit of `iDoo T.o be constructed, by '7� � �IETG'Rrll Wbter Supply } Pubiic Supply From Phvate Supply tobe drilled Address y other Requirements A116! OG G /t,C I representahat 1 am wholry and completely responsible atiove described will be constructed as shownson, the app County Department of Health; and that` on'completio max_. be subm�4fed to the Department and a written guar`! place �n good operating cond"t�onr any part of said s ance of the approval of the Ceitif�cate of Construcfi will be located as shown on the approved piari; "and t1iaU!si jrj County Department of Health Address � ` APPROVED FOR'CONSTRUCTION, ,This approval ez reyo_atile'tor cause'or may ;be amended or modified w`tn require 8 roved ;for disposal of doi Date BY � F year from the date issued construction o_i the building has been undertaken and ere�d necessary .by the C mi "siion r of ? Health `'Any change or oration of constructio hit�y sewage nd /or pi va r s Title >AL` SYSTEflfl0}1rER S� 'i� Tax Ma'p clock RI �``� 5 /DF,,, y� ����_ j��%i Date Of- Previous Approval Fill Section Only ❑ 8'- G P C H;, D., Notification Required ee/,( gal Septic Tank and X33 F �rL n - Address , � F year from the date issued construction o_i the building has been undertaken and ere�d necessary .by the C mi "siion r of ? Health `'Any change or oration of constructio hit�y sewage nd /or pi va r s Title PUTNAM COUNTY ,DEPARTMENT OF HEAUM - DIV161UN Ur rNV1KUNMr;ui71.0 Mr:HLi= oracvii-w INDIVIDUAL VU= SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT. DATE EWED: BY: COI44ENTS I, NO DOCUiMTTS 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 Detail Septic Tank - Size, Detail Well Detail, Service Line if P.VS Trench /Gallery Pump Pit Two-Foot Contours Existing & Proposed Slopes for Driveway Cuts Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion .Area; shown; gravity flow ,If Pumped Pit & D Box Shown & Detailed ;. 2---House - No. of Bedroans Wei3s 5� SSD51s / -in- 200- fit. of Property Located.'.. Property Metes & Bounds F House Setback Necessary House Sewer - 1 /4 " /ft. 4 '0; Type pipe No Bends; Max. Bends 45° w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN 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,Stoym,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fran Foundation 50' to Well 15' 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 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEin M DISPOSAL SYSTEMS FIF.hD INSPECTION - REPORT 7 DATE: INSP. BY: gam of Owner) treet Location) INITIAL SITE INSPECTION 0. CFI'S Wetlands on /or proximate to property .............. Property lines or corners found ................... Can estimate house location ....................... Will driveway 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 ............................ D. H. 1 Lot Depth to G. W. Depth to rock Soil 0 ft. 3 ft. 6 ft. 9 ft. 12, ft.1 ' - D. H. 2 Lot Depth to G. W. Depth to rock NO Soil Descri tia 0 ft. 3 ft. j � � 6 ft. I�7P 9 ft. 12 ft.- -.I..- D. H. - Deep Hole G.W.- Groundwater D. H. 3 Lot Depth to G. W. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. boil Descri DATE: FINAL SITE INSPECTION INSP.BY: YES NO CHI'S 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 .............. Over 100 ft. fran watercourse .................... Natural soil not stripped or SDS area unnecessarly graded............ ... ........ 10 ft. maintained fran property line and 20 ft. from house.... ........................ Distance well to SSDS (ft.) ...................... Number of bedrooms checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. fran nearest trench.. ........... 15 ft. of peripheral soil horizontally fran trench ..... ............................... Boxes properly set.. . .... ........... ........ Could surface runoff fran driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE.. rn�aREEN SEAS PU'T'NAM COUN`T'Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUN`T'Y OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEE'T'- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Henry & Blanche Burdick Addressc /o Heelan Realty, Root Ave, Brewster, N.Y. Located at (Street Bullet Hole Road Sec.73 Block 6 Lot 1 11ndicate neares cross street) Mwii.cipality. Patterson Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Pole NU111hel, 8 CLOCK TIME PERCOLA'T'ION PERCOIATION .-' I UlI Elapse Mpth to Water Water Level IJo. 'I'ime From Ground Surface in Ii clies Un Soil Rate Start -Stop Min. Start Stop Drop Min. /iii drop Inches Inches Inches 1 22 -3.7 15 min 24 27.25 3.25 4.61 2 38 -62 24 min 24 28.50 4.50 5.33 3 02 -33 31 min 24 28.25 4.25 7.20 11 34 -67 33 min 24 28.00 4.00 8.25 Is 5- 08 -39 , 31 min 24 28.25 4.25 7.20 1 -22 -60 38 min 24 28.25 4.25 9.00 2 0 -_7_ 24 _ _.: .. 28.D.d..�.- 4.A(1 -- ..._ .- _ 3 37 -67 30 min. '24 27.50 3.50 8.57 4 1 r,, r of COIJ yFq Ilotea: 1) 'Pests to be repeated at same depth until agroximately equal soil rates are obtained at each percolation test hole. Al data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA RE D 'TO PP SL'l,i•:ITTED WITH APPL•ICI'►TIOIi DESCRIPTIOI7 OP' SOILS �:�i;�`,GU1di'r�RED II' "t'>.3T HOLES /T11 HO NO.. 8A 'HOLE 1�.0. 8B HOLE NO. 8C G.L. 6" TS TS TS 12" clay /loam clay /loam 18" clay w/ 24 ". 1 sand J 3611 stones 42" water water 48 5411 60" 66" water rock 7211 7g11 ' rock 84" . I1DICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED, -UZM MADE 'BY .._ _ 73 i, Date A 1,4s DESIGN Soil Rate Used ^Mi:rvi "Drop: S.D. Usable Area Provided —,5000 5.F. 14o. of Bedrooms .3 Septic Tank Capacity /000 s. Type M.Oa VA Absorption Area Provided By 4W L. F.x24" r` AI - It,,width r%ait� Cr2a uM A L Address ,og 70- EAL -n ! 705'6 THIS SPACE FOR USE BY HEALTH DEPARTMENT 014LY: Soil Rate Approved Sq. Ft /Cal. Checked by Date P. rrhh � V OP COU, PLOT PLAN S.CALE:1 " =.50' . BALDWIN & CORNELIUS, P.C. CONSULTING ENGINEERS-LAND SURVEYORS ~ FREEPORT, NEW YORK OWN E R: TI TQTf)NTQ 3: .t A -1 30.5' B -1 22.2' A -2 29.6' B -2 40.6' A -3 34.1' B -3 46.3' A -4 38.9' B -4 52.1' A -5 44.1' B -5 58.0' A -6 49.3' B -6 64.0' A -7 54.5' B -7 69.6' A -8 46.5' 8-8 75.0' A -9 48.5' B -9 75.8' A -10 55.0' B -10 80.8' A -11 61.0' B -11 85.2' A -12 67.7' B -12 91.7' A -13 76.0' B -13 99.5° C -14 42.2' D -14 63.0' BALDWIN & CORNELIUS, P.C. CONSULTING ENGINEERS-LAND SURVEYORS ~ FREEPORT, NEW YORK OWN E R: TI TQTf)NTQ 3: .t -WELL �. do r t Gam' //--IRON F ! 1 x 1 1 —1000 GAL. MASONARY \\ TANK \ / i i \ i O___`_ - - -- - -_ UNCTION BOXES(6) ; r S. S, D.-5 - - - - - -- / 4 11 . AREA 7 i� r-UN 1 3 TILE FIELD' TE CA r OF ppvEMENT { ED G E � r 1 t t Putnam County lieps )ivision of Environmen / Ipproved as noted for \pplicable Hules and R.