Loading...
HomeMy WebLinkAbout1535DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -4 -31 BOX 14 01535 me m 6V J ' . . , . ' rL r 01535 < - - - -- /PUTNAM COUNTY DEPARTMENT OF HEALTH- ; RV. 3,! 86 r ` '' ^ e of Environmental Health Services, Carmel, N.Y. 10512 Engineer Mast Provide � p " . P.C.H D , Permit N CERTIFICATE OF CONS UCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM_ .Patter S•o n Town or Village meted at Bullet H of e Road~ Tax Map 7 3. Brock 6 Loc Owner /applicant Name Little Associates Formerly Rayesen _ Subdivision Naml Subdv. ' t H Mailing Address 5 Kelley Ridge Road yip 10512 Date Permit Issued Carmel,- New'York sepamtesew8ri*e'Systembullt-by North County Const Co Adds Carmel, NY 10512 Consisting of l O O O. Gallon Septic Tank and 5 0 0. L F of Tile Field s Water Supply' Public Supply From Address or; x Private supply Drilled by Mill Drilling Address Putnam Ave . , Brews ter i NY Building Type Ranch Has Erosion Control Been Completed? N/A Number of Bedrooms - 3 Has Garbage Grinder Been Installed? N o Other Requirements .31 Fill Require d 600 C.Y. I certify that the systems) as listed serving the above,premises were construe ssentially a s on the p ns of the completed work ( copies of which are attached),/ and in accordance with the standards, rules and regula in ace d e th i d rmit issued by the Putnam County Department Of Health. Date 1,0/22 86 Certified by P.E. X _ R.A. Add res or Baldwin & Cornelius , :P . C . ,Brewster, N.Y. License No. _q 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 pubt'o unitary tower becomes avellabla 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 o1 the Commissioner of Health,.such revocation, modification or change is necessary. 5_ �. ��(/ C/ l � � y 'rte Tit le � T Date �,, .�— 7 E WELL,.GOMPLETION REPORT- DEPA.RTMENT, OF HEALTH Division Of Environmental Health Services PUTNAM tOUNTY DEPARTMENT OF HEALTH STREET A DURESS: low. I ILLAGEICI[Y IAX GRIO NUMBER: Burdick Woods Patterson, New YOrk j4ot'3 WELL LOCATION WELL OWNER NAME. c/o' L&0?26F-.Holf elder T.K. Services, Inc. .5 Kelly Ridge Rd., Carmel, NY. PRIVATE PUBLIC USE OF WELL 1- primary 2.- secondary 0 RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ... ❑ TEST/OBSERVATION, ❑ OTHER (specify) 0 INDUSTRIAL ❑ INSTITUTIONAL - ❑ STAND-BY ❑ AMOUNT OF'USE YIELD SOUGHT -5 gpm./NO. PEOPLE SERVED 4 /-EST. OF DAILY USAGE 450 gal. REASON FOR DRILLING 'NEW SUPPLY = 0 PROVIDE ADDITIONAL SUPPLY ❑ TEST/OBSERVATION .❑ aEPLAGE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 6 25 — ft. I STATIC WATER LEVEL 19 it. DATE MEASURED 7/25/$6 DRILLING EQUIPMENT ❑ ROTARY 4'COMPRESSED AIR PERCUSSION. ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION 0 OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. <OPEN HOLE IN BEDROCK ❑ OTHER CASING TOTAL LENGTH 25 ft. MATERIALS: O'STEEL ❑ PLASTIC ❑ OTHER LENGTH.BELOW GRADE 24 ft. JOINTS: ❑ WELDED ;9-jHREADED ❑ OTHER DETAILS DIAMETER 6 in. SEAL:,M'CEMENT GROUT ❑ BENTONITE OOTHER WEIGHT 'PER FOOT 9 lb./ft. DRIVE SHOE• WES ❑ NO I LINER: OYES ONO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH.(It) DEPTH TO SCREEN (it) DEVELOPED? FIRST HOURS GRAVEL PACK" 1 ❑ YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK In. I TOP DEPTH ft. BOTTOM DEPTH - 11. WELL YIELD TEST I It detailed pumping METHOD: 0 PUMPED tests were done" is in- ,09COMPRESSED AIR formation attached? 0 BAILED OQTHER 0. YES ❑ NO It more detailed formation descriptions or sieve analyses WELL LOG are available. please attach. DEPTH FROM SURFACE 'a"' Bear. ing Well Dia* Ineler In FORMAnON DESCRIPTION COOE it. ft. WELL DEPTH ft. DURATION hr. min. DRAWOOWN YIELD 99m. Land Surlace 8 Clay & boulders R 625 Hard granite 625 6 500 7 WATER X�CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS ❑ COLORED ANALYZED? AES ONO ANALYSIS ATTACHED? J%rES 0 NO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE CAPACITY MAKER DEPTH MODEL VOLTAGE ' HP WELL DRILLER NAME MILL' DRILLING, INC - 6 8 6 ADDRESS SIGHAI ruRE • Putnam Ave., -Brewster, NY.10509. Robert M. mill, ires Yorktown Medical Laboratory, .Inc. 321 Kear Street Yorktown Heights, N. Y. 10598 ._._(914) 245 -3203 _ Director: Albert H. Padovani M. T. (ASCP) LAB Collection Station Used: Carmel Peekskill _ Ait':` Kis o Neer fCi -ty Date Taken: Date Received: ;i fa Date Reported• Collected By:. !- Referred By: Sample Source: ZKY LABORATORY REPORT ON BACTERIOLOGICAL QUALITY OF WATER GENERAL BACTERIA Standard Plate Count per 1.0 ml (Agar plate @ 35 °C) MEMBRANE FILTRATION TECHNIQUE.(MFT) Total Coliform ner 100 ml L Fecal Coliform ner 100 ml Fecal Streptococcus per 100 ml. MOST PROBABLE NUMBER TECHNIQUE (MPN) Total-Coli-form: MPN Index ner 100 ml Fecal Coliform: OTHER ANALYSES MPN- Index per 100 ml THESE RESULTS INDICATE THAT THE WATER SAMPLE. A) (WAS NOT) (NOT APPLICABLE) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO THE NEW YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. ,�XXA-l1 � �- �- �C�.e�l ems► �'3'),�° Albert H. Padovani, M.T. (ASCP), Director LEGEND RDS Recommend Disinfect- ing Water Source < = less than TNTC = Too Numerous Too Count O PUT'NAM COLUTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Owner or Purchaser of Building Section Block Lot Building Constructed by / d a et' 91/C �a¢ Location - Street Subdivision Name Municipality Subdivision Lot # ,&ed &C'A Building Type 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 - "Certificate of- Construction Compliance" for the sewage disposal system, or any repairs made by me to such system, except - where the failure'bo 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. /1 / A Dated this 9 day of OCT, 199& eral Contr cto (Owner) - Signature O A16 rI SSOCI�¢ /Corporation Name (if Corp.) ,p Address rev. 9/85 mk Signature Title JNJ12-rd 4- i) vor/,[I ,w Corporation.Name (if Corp.) �alrA.l y Address •�] ClJi11�191r1 I.VVt�lli :ucrt�nai�iri�i va aaa.�a.aia ON CERT IC-47 E -OF 'COMP 3A'NCE�! Diws�on of Enwronmental%Health- Services Carmel N :Y 10512 PERMIT CONSTRUCTION -PERMIT. FOR SEWAGE. DISPOSAL •SYSTEM '. A.TI'EP�S07V _ .Town or -. illage be*.submitted' t place . in good' ance of the,'ap Willi bedocatedzi County O/epi rti Date standards, rules and regu a_ ionso a utnam Satisfactory to the Commifsioner -of Healthwill dor assigns by the builder, that.said. builder will years immediately following- th'idate, of the issu'- r 'thereto; 2) that the 'drilledw'ill; described .above iyard ► es an regu a ons- . of the Putnam, License No ion ;of the building has been undertaken and slth... Any change or_ alteration of constructs.j requires a new permit Approved for disposal of -dome is sa dry' -sews ._an /or -pr vats w r iupply `only.;.__, Oate�L_. gy Title rinq PUrNAM COUNTY DEPART OF HEALTH - DIVISION OF ENMONMMAT, RFATrm' SERVICES INDIVIDUAL VUMM SUPPLY SUBSURFACE SEIVkGE DISPOSAL sysm4s FIELD INSPECtIOWREPORT DATE: -INSP. BY; (Name of Owner) (Street Location) INITIAL SITE INSPECTION YES NO CCMKDM Wetlands cn/or proximate to property ... : ............ property lines. or corners found... Can estimate house location...'.:'.. Will driveway need cut ............................ Must trees be re!mved - note these.. *** ............ Deep holes, representative of entire SDS area ...... . Additional deep holes needed...... .. I ........... Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacentwells/septics ............................. Access to urcuosed well location for drillinq ..... ole D.H. - Deep 1, G.W.-Groundwater D.H. 1 Lot D.H. 2 Lot D.H. 3 loot Depth to G.W. Depth to G.W. Depth to G.W. Depth to rock Depth to rock Depth to rock Soil Description 0 ft. 3 ft. 6 ft. 9 ft.,' 12 ft. 0 ft. bo3a uescri Soil 0 ft. FINAL SITE INSPECTION INSP.BY: YES NO camMEMS House SSDS located per approved plan.. � ....... Length of trench measured _ Width of trench average C. Slope of tile line and trench acceptable ......... Roan allowed for expansion trenches... ...... Over 100 ft. fran watercourse.......... .... .. Natural soil not stripped or SDS area unnecessarlygraded...... ... ... ............. 10 ft. maintained fran property line and 20 ft. fran house.. Distance well to SSDS (ft.) ...... .0 U ......... Number of bedroans checks ........................ stones, brush, stumps, rubble, etc., greater than 15 ft. fran nearest trench, 15 ft. of peripheral soil horizon frantrench ....................................... Boxes properly set ............................... 7 Could surface runoff from driveway, .,roads,. ground surface, etc., chainnel"near SDS area.......: Does lot drainage. appear OK -in area,' of :SDS.....:. P-MAT. r-PIMMr. OF STTF A(rF.PTARTR_ * ................. L_­I' Z ( I DIV15ION Or ENVIRONMENTAL jiriALTii SERVICES CQUN1'Y OFFICE BUILDING. CARMEL;. N. Y. 10512_ _ DE510II DATA .SIIWV- SEPAIIATE_ SEWAGE DISPOSAL_.SYSTEM . _ _ _ VILE. NO. 7599 _ _ ......�. Uwiier- Van:dra-ve,- or Address 15 Ta ur 1 Taney cha=,qqL,' NY 1051L� Located at (Street Sec. 73 Block h Lot 1 �Ilidica�"Veross itreeEj' Mmiicipality Patterson Watershed croton Bulb PERCOLATION TEST DATA MQUIIIED TO BE SUMMED WI'1'II APPLICATIUNS 5 � - 2 3 iJoten: 1) 'Pests to be repeated at same depth uptil a roxlmately egml soll rates are obtained at each percolation test hole. All data to be submitted -for review. 2) Depth measuremeitts to be nude from top of hole. LOT +134 aokp ck wooPS 6uBP1V1S(a►.L ]tile Number 3 CLOCK TIME PERCOLATION PERCOLATION — liruii IJo. Start -Stop Elapse Time Min. 155pEli to Water From Ground Start Inches -. Surace Stop Riches a water Level i.n It cI►es Drop rn Inches Soil hate M1.n./iu drop 1 146:76 30 min 23 25.75 2.75 10.90 2 17-4,q 31 min 2-3 25.50 2 50 12.40 _ 3 49 -80 31-mia 23 25.50 2.50 12.4Q 4 ' 1 5 - 2 148-78 30 min '28 29.25 1.25 24.00. 219_51 32 min 28 29.25 1.25 25.60_ _ 352-8-3 31 min 29 29.25 1-2-9 94 -An 5 � - 2 3 iJoten: 1) 'Pests to be repeated at same depth uptil a roxlmately egml soll rates are obtained at each percolation test hole. All data to be submitted -for review. 2) Depth measuremeitts to be nude from top of hole. 41 I r? 5 , -�_ f :E T SPIT DATA REQUIRED TO BF' $t,'I ,'T;ITTF.D i:ITti APPLICf�TIOII DESCRTPTIO ?d OF SOILS 00TYP ' FED II, TEST HOLES DEPTH HOLE.,:__n0;. _:. 3A ::,:. HOLE .h0,. ...:3B _._ _ . T . HOLE NO._ . 3C.... . G. L. 611. ?5— 12" rp(i -hrnwn 18" mix 2411 clams Gilt i0" sand 36" 42" 4811 5411 6011 66" 7211 78'1 rock 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL ' TO- - WHICH WATER LEVEL RISES AFTER BEING ENCOUNTER3-1/t/ ED TESTS MADE - -BY -� o fH w -; G86P LE - Date.:.. " I's S . DESIGN Soil Rate Used 25 Mir4/1 "Drop: S.D. Usable Area Provided 5000 No. of Bedrooms Septic Tank Capacity Gals. Type Absorption Area Prov ded By �nn_L.F.x24 "_'bj — width trenc OF till. Qther 00 R IU�c,,,v Name ` Ratdwin � Pr bignature- -6on ro y, ` Q ; Address RD 6, Rte. 22 SEA Brewster, NY 10509 = m THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by, SEAL . +� : W 1980 32 !� �FESS1011P�'� Date P7S. DIST. PTS. DIST. :A -1 41.2 B -1 24.3' rA -2 51.4' B -2 44.2' A -3 47.6' B -3 45.6' A -4 43.5' B -4 47.2' A -5 40.5' B -5 49.6' .•A -6 35.6' B -6 54.2' A -7 32.5' B -7 59.6' A -8 82.4' B-8 81 .0' A -9 80.2' B -9 81.3' A -10 77.4` B -10 82.2' A -11 74.5' B -11 83.1' A -12 72.5' B -12 81.7' A -13 70..5' B-13 89.1' A -14 69.3' B -14 89.1 8 -15 43.2' 4 -15 51.7' 8-16 44.5. 14- 16 49.2' 8 -17 45.9' 4 -17 '46.8' 8 -18 47.5' 4 -18 44.6' -8 -19 49.8' 4 -19 43.2' 8 -20 52.4' 4 -20 42.6' THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WAS CONSTRUCTED AS INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS INSPECTED UNDER MY SUPERVISION BEFORE IT WAS COVERED OVER. THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE WITH ALL STANDARD RULES AND REGULATIONS OF THE PUTNAM COUNTY DEPARTMENT OF HEA AND THE NE14 YORK/' PART NT OF HEALTH. / C. C' SA IL Co 980 fW YO � Putnam County Department of Health -- Division of Environmental Health Serviced Approved as noted for conformance with applicable Rules and Regulations of the Putnam County Health Department. Signature & Tide- e o nr_aTtnN CHART PTS. DIST. PTS. DIST. A-1 417 B -1 24.3' A -2 51.4' B -2 44.2' A -3 47.6' B -3 45.6' A -4 43.5' B -4 47.2' A -5 40.5' B -5 49.6' A -6 35.6' B -6 54.2' A -7 32.5' B -7 59.6' A -8 82.4' B -8 81.0' A -9 80.2' B -9 81.3' A -10 77.4' B -10 82.2' A -1 t 74.5' B -11 83.1' A -12 72.5' B -12 81.7' A -13 70.5' B -13 89. ' A -14 69.3' B -14 89.1 8-15 43.2' 4 -15 51.7' 8 -1 6 44.5' 14- 16 49.2' 8 -17 45.9' 4 -17 46.8' 8 -18 47.5' 4 -18 44.6' 8 -19 49.8' P 4 -19 43.2' 8 -20 52.4' 4 -20 42.6' BALDWIN & CORNELIUS, P.C. CONSULTING ENGINEERS -LAND SURVEYORS WELL O HOUSE B A 1 7 6543 � j r 1 f 2 j 1 1 1 i1211jI P I I I I 14 II 8 111 l o I I I I I 1 V III llll 20a 9; / ii i1 5 18 t 17 N0� � Fp 6� S.D.S. PLAN SCALE 1 " =50' BURDICK WOODS LOT 3 SHOW acre 9129/86 S.S.D.S.'AS BUILT' �n9,.e �SZZz