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HomeMy WebLinkAbout1534DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -4 -30 BOX 14 I INNS ., .- INN _ NN . so I,` IL - 4�. I IN t dal ma- IN 01534 - ' PUTNAM COUNTY DEPARTMENT OF HEALTfi Rev 3/86 Dlvirion of•Envlronmental Health Serviced, Carmel, N Y;1O51Z .' Engineer Mart Provide ( 1 F* 'CeH.D. Permit N .. .�- CERFICATE OFCflNSRLj - ON COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM �r 1` — Town or _VWage . Located at W �:✓� oL Tax Map Block Lot Owner /applicant Name :Jt< SL —�a �Formedy_LA Subdivision Name Sabdv.: t li z� i Mailing Address " -:G {�F Q�_ �P Date Permit Ironed 0 �+ T2 Q4Pd'A t Separate Sewerage System hailt by �� Address Consisting of t� . Gallon Septic Tank and Jas �� a - � e— ds" 3 &e6 ; Water Supply: Public SaPP1Y From ' Address ors —Private's Ry Drilled •by Address e Building Type 4 a Erosion Control Been CompletedY I Number of Bedrooms Has Garbage Grinder Install �c Other. Requirements 0 A fZ C f I certify that .the syetem(a) as, listed serving the, above ,promises,vere const eet/e ebtY ��� the plans of the completed work (`copies;" of which :are attached), and in accordance; with the;standa'rda rules -and regul ° c filed.pla� d the permit,'issue'd "'-by the Putnam County Depai nt Of Health. �ret."i�,Ftea� <j�1'Q.t;le./ .+- L� Y ;Pate Certified by PE R.A:�J 7 I /10 r C9,+� Address License No. _Z W. i Any person occupying premises,served by the above iystem(si shall Diomptiy lake s to secure the correction of any unslnitsry ' ;conditions resulting from" such .usage Approval OV,th0 sepsrat0 sewers syste at soon as a pub:'.-_ Unitary sower beeo nlea ravailabio antl th_ approve 'of the: private water ;uDPlY; shall become null an yo who p ly facornaa available. Sueh, approvals ",ere suti)ect1.to motl lutI n r ehange when in, the 'judgment ot.the Commi o Re "it t n ification or change is needs' r' D" BY Title WELL .COMPLETION REPORT '377 t PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK - • -This - report -.is ,to be completed .by -well driller and submitted: to..County_ Heelth Department together.with._laboratory repor -t. of �.. analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME American Diversified ADDRESS Box 381,Brewster, NY Att: Jim Roach LOCATION OFWELL (No. 6 Street) (Town) (Lot Number) Burdick Woods Bullet Hole Rd.. Patterson,NY 4 PROPOSED USE OF WELL BUSINESS DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL ❑ SUPPLY El INDUSTRIAL ❑ CONDITIONING ❑ OTHER DRILLING EQUIPMENT COMPRESSED CABLE PERCUSSION ❑ P CUSSION El (Specify) (S 91 ROTARY ®A R R AS[ DETAILS LENGTH (teat) 3� t DIA ETER(inches) tt WEIGHT PER FOOT 19 lbs . ®THREADED ❑WELDED X YES NO '� UTED? X YES NO YIELD TEST HOURS G.P.M. ❑ BAILED © PUMPED ❑ COMPRESSED AIR 6 5 YIELD (G.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE— STATIC (Specify feet) 10, DURING YIELD TEST fleet) 3451 Depth of Completed Well in feet below land urface: 365! SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (Inches): GRAVEL SIZE (Inches) FROM (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET 0 3 Drilling in overbuf°den clay and boulders. Hit rock at 3 feet 0 Drilling in rock, set casing,grouted. 0 365 Drilling in rock granite If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED 86 DATE OF REPORT 5/30/86 WELL DRILLER (Signatu r - ... .... _�._ .� S - - �.. AEWSYER'� LABORATORIE ... _.. - �..,.__.... _._, _ _.. - Box 224 - BREWSTER, N.Y. (914) 225 -2072 - WATER ANALYSIS REPORT - SAMPLE NO. 6183 SOURCE: American Diversified Faucet - Well Bullet Hole Rd. C arme 1 COLLECTED: June 5, 1986 BY: P. F. Beal & Sons, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. June 9, 1986 0 per 100 ml. T"V-". 51(oww PUTNAM OO[Uf'Y DEPARTMENT OF HEALIH DIVySI 'V.OF.�.F- ,Nt7IR9kk�I'AL_._ HEALTH.- Owner or Purchaser of Building Pe-v%^ L,YOv% ["---24 , z�C Building tonstructed by Location - Street Municipality /Yo PC( Building Type 73 .6 Section Block Lot bi,LkOrC(C Wo 00 5 Subdivision Name Subdivision Lot # GUARANIEE 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 shun 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 -••- ".... "Ger-ti- f- ica- te- -of- Constr- uction 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 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 I the building utilizing the system. - -0 Dated this �- day of 19Y(-., Signature (Owner) - Signature Corporation Name (if Co ) ,ALA a Address rev. 9/85 mk Title // 6 wV6-2 S Corporation Name (if rp.) Address F f t ENGINEER T0•- PR0VIDE PERMITI i PUTNAM COUNTY DEPARTMENT OF HEALTH - T Division .ofaEnwronmental,Hsalth Serwce3 Carmel N ,Y 10512 PERMIT...'.,LF C �G E ,. I LI CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM _ own r illagn L r Located at (1/�0 ®if�¢ -C� '` Tax MaP cn Block rot aw / fr /[ Subdivision Subd. t.ot li '�' Renewal _� Revision �` -Owner /Address � IWl� of Previous Approval •.. d . - ;.•�. •7. WV a, . Fill Section Onl Building TYPE s� Lot AA��rea - �j L - Y � •' Number of Bedrooms, Oesign Flout G /P /i, lL� ©r!! -�?17� P.C. H. O: Notification Required Separate Sewerage System to consist' of /aVA,0 ' Gap Septic Tank antl' k On To be constructed by- ��r`(( Address �n ��OtalfL^ Water Supply: Public Supply From !�- 1 \� 1p1 G e _Private Supply to . be drilled by t�� b W^"�� A j p "� =�j��s r'ba -+mob," Address t" Other Requirements C,A ��G l�1!_i� '�;✓r!- #5�iA1 �1'tt�C1��d1F'FW( f I represent that I am wholly and eo,mpletely responsible for th "e design and location :of the Above described will be constructed as shown.on the approvetl `amendrnent there to and in'ac County Department of Health, 'and that completion thereof a ''Ceititicato of 'Constcu be submitted to the Department, and a written guarantee will be •furnished the ownV place in good operating .cond it!pn any part of said sewage, disposal system- Buriii eVj Ante of the appioval'of.the Certificate of. i:6nstruction,'Compliance of•the brig! i will be located as shown.on the approved plan and that said well will be installed in County Department of : Healtph. '. Date T�� T 7 Signed p Address APPROyED,,FOR CONSTRUCTION This approval ei pies :one yea► irom the .da ' revocable for cause or may 'be amended or modified when considered necessary Dy ' requires a new permit. Approved for disposal of domestic' Date . .. By Rev. -6 /8S - - v led- .sysfem(s) ;: 1) that .the separate..sewage' disposal system ice with`ttie standards, 'rules an {egu•a ions o e Putnam liance" satisfactory to the •Commisifoner of Health will eirs or assigns by the builder, that said builder will `bllr ears immediately following the date of the issu- s jU ereto -'2) that the.drilled -well described above d;, rules and .regu s ions f the Putnam _ P.E. R. A. License No. ti of the building has been undertaken.and is Oa qjn. Any chang8_or._oWation of construction Title COUN'T'Y DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH DATE:.. . INSP. BY: (Name of Owner) (Street Location) INITIAL SITE INSPECTION YES NOI COKMENTS Wetlands on/or proximate to property .............. Property lines or corners found ................... Can estimate house location ....................... 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 ............................ D.H. - Deep Hole G.W.- Groundwater D.H. 1 Lot D.H. 2 Lot D.H. 3 Lot Depth to G.W. Depth to G. W. Depth to G. W. Depth to rock Depth to rock Depth to rock Soil Descri 0 ft. 3 ft. 6 ft. 9 ft. 12. -ft. 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. -MbU 0 ft. 3 ft. 6 ft. 9 ft. __.._ 12 .ft._ Soil Descr f — DATE: / °r as FINAL SITE INSPECTION INSP.BY: % yn- YES NO CAS 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 .............. GUi����. '�= ,�,''� cT �� "J `F ��` �RI Mo's"- Over 100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded ............. .... ........ 10 ft. maintained fran property line and 20 ft. fran house ... . ......................... Distance well to SSDS (ft.) ...................... Ec�� 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 from driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE..... i WE= M=T* CQ�ily 'Y DEpAi i C)Fa' H ;aLL'ti Ui�f:t:�iux'i o l �v i,: nu I nt l Qua-L y 1 r,�Q 'fir�ud Uroot - vili o P1 isia l Nua Yorx l oho l :.:vj.1:w T,idTA 31i= + -SUARATE SEWERAGE A)( FV 1 .iklus�r 7�^I %. *^- 7,7 Ac�riru _. Y :.,. sated &t (:Stzbet) duc �� �c. i3 vt �? 1�t � 1. •�«+•�.��1�p�tY' '. �tliA'ili�tY`5•kit3ii � %� 30IL PUW=,ATI()x TEST UtTA . R.DqUUlLl-Z TO BE SU id:'1 "1 Z WMI A.PPLIC AT-LuN C3I,E C��OG'JC TM4E O1,A'rSUN Depth. to W&tor a tea c�ir Loud , a ° El&pde a j'=Au .Garourad Surf &e,4 ,: In Inchdis , :iO3e , .RLU,% �t 'I`.tttle... ! . .Start ; 3truP , : Drop ,. 3011 hate :t�cca0eir NO Start Stoo min. Inches ixa l:rc nee, Kin/in. dlrog JJ� // J1 j ca. - 2 . ' 'ENfp rA!A C ° Vie) •;ts8= _ . .T` 254 O j Testa t.0 . 'Do rdpo&%.d l at 1same? depth 'Until ,,`� obttais:esd 4iir udcil purcolatiou tent hull. 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