Loading...
HomeMy WebLinkAbout1537DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -4 -33 BOX 14 01537 .. me rrmim . �Qm-i ly 01537 APPENDIX I PUTNAM COUN'T'Y DEPARTMENT OF HEALTH . DIVISION OF ENVIRONMENTAL HEALTH SERVICES 9jch8gD t Joba I YIq�IOk)E 73. 6 5 Owner or Purchaser of Building Section Block Lot DN S 73 Building Constructed by Tax Map Number 64,6t Burdick Woods Subdivision Location - Street Subdivision Name i�A1RS� , �j �( 1663 Lot #1 Municipalitppy_ Subdivision Lot # J�RIS�.P 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 m—e ­to ' sddh' 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 d�-l� 19'_V Signatureb� ope� , m - Title eral Co tractor (Owner) - Signature. Corporation Name (if Corp.) Address ,F I ..,. .Ore.- / rev. 9/85 16 mk WELL COMPLETION REPORT. DEPARTMENT OF HEALTH _.Division— Of..Environmental Health.Services PUTNAM COUNTY.DEPARTMENT OF HEALTH Office Use Only MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED 4 7 EST. OF DAILY USAGE 350 gal. REASON FOR aNEW SUPPLY ❑ .PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION DRILLING O REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL DEPTH DATA . WELL DEPTH. 300 ft. STATIC WATER LEVEL 30 ft: DATE MEASURED 919187 DRILLING ❑ ROTARY ECOMPRESSED.AIR PERCUSSION ❑ DUG EQUIPMENT ❑ WELL POINT ❑ CABLE PERCUSSION O OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. ®OPEN HOLE IN BEDROCK O OTHER STREET ADDRESS: TOWN/VILLAGIICIIY TAX GRID NUMBER: NELL LOCATION Bullet Hole Road Patterson, New York 40 ft. NAME: DETAILS ADDRES S: �flIVATE WELL OWNER Richard Viglione lA Ib. /ft. ❑ PUBLIC USE OF WELL QRESIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND.IHEAT PUMP. ❑ ABANDONED 1 = primary O BUSINESS O FARM O TEST /OBSERVATION ❑ OTHER (specify) 2 - secondary ❑ INDUSTRIAL O INSTITUTIONAL O STAND -BY O MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED 4 7 EST. OF DAILY USAGE 350 gal. REASON FOR aNEW SUPPLY ❑ .PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION DRILLING O REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL DEPTH DATA . WELL DEPTH. 300 ft. STATIC WATER LEVEL 30 ft: DATE MEASURED 919187 DRILLING ❑ ROTARY ECOMPRESSED.AIR PERCUSSION ❑ DUG EQUIPMENT ❑ WELL POINT ❑ CABLE PERCUSSION O OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. ®OPEN HOLE IN BEDROCK O OTHER WATER 09LEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? )MES ONO ANALYSIS ATTACHED? MMES O NO PUMP INFORMATION TYPE CAPACITY MAKER DEPTH MODEL VOLTAGE HP STORAGE TANK: TYPE CAPACITY GAL. WELL DRILLER NAME MILL DRILAN01, INC..' ADDRESS Putnam Ave. Brewster. NY DATE to TOTAL LENGTH -4 i ft. MATERIALS: BSTEEL ❑ PLASTIC ❑ OTHER CASING LENGTH.BELOW GRADE 40 ft. JOINTS: ❑ WELDED EMHREADED ❑ OTHER DETAILS DIAMETER 6. in. SEAL: UOEMENT GROUT O BENTONITE OOTHER WEIGHT PER FOOT lA Ib. /ft. DRIVE SHOE: 94ES ONO LINER_ ❑YES ❑ NO DIAMETER (in) SLOT SIZE LENGTH (Iq DEPTH TO SCREEN, (11) DEVELOPED? SCREEN DETAILS FIRST o YES ONO SECOND HOURS GRAVEL PACK O YES GRAVEL DIAMETER TOP BOTTOM O NO SIZE OF PACK in. DEPTH ft. DEPTH It. WELL YIELD TEST It detailed pumping P. P 9 WELL LOG If more detailed formation descriptions or sieve analyses are available, please attach. METHOD: O PUMPED i tests were done is in- formation attached? DEPTH FROM SURFACE Water Weil DIa- O COMPRESSED AIR , YES ONO Bear- 1n9 "ter FORMATION DESCRIPTION CODE, O BAILED O OTHER tt, it WELL DEPTH DURATION DRAWOOWN YIELD Surface 3 no.. 6 Soft. silt, clay & loose ledg It. hr. min. It. gpm. 200 2 30 200 3h e i m to hard grey & white-9ran 300 6 15 .250 20 WATER 09LEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? )MES ONO ANALYSIS ATTACHED? MMES O NO PUMP INFORMATION TYPE CAPACITY MAKER DEPTH MODEL VOLTAGE HP STORAGE TANK: TYPE CAPACITY GAL. WELL DRILLER NAME MILL DRILAN01, INC..' ADDRESS Putnam Ave. Brewster. NY DATE to Box 224 - BREWSTER, N.V. (994) 225 -2072 WATER ANALYSIS REPORT well This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. October 3, 1987 oy Bickwh P.E. Director 0 per 100 mi. :7 .a IV. V. Vi. APPENDIX C FINAL SITE INSPECTION -Ole GWNER TH OR.SUBDIVISION U)T 4 Date Inspec4ed gEWAGE DISPOSAL AREA a. SDS area located as per epproved plans b. Fill section - Date of placEmnt- 2*.--1 barrier. LGTH WIDTH AVG. DMye:,�::%P c. Natural soil not stripped d. 'Stone, brush, etc., greater than 15' from SDS area. e. 100 ft. frm water course/wetlands. Or SEkaGE DISPOSAL SYSTEM a. Septic tank siz5=, OG-,,? 1,250 b. tic tank ins evel c. 101 minimun frcm foundation d. No 900 bends, cleanout within 10 ft. of 453 bend e. DISTRIBUTION BOX 1. All outlets at same elevation - water tested 2. Protected below frost 3. Minimum 2 ft. original soil between box and trenches f. JUNCTION BOX - properly set g. TRENCHES 1. Length required -7S,- 7 Sr installedZ�/e 2. Distance to watercourse measured* 3. installed according to plan 4. Distance center to center 5. Slope of trench acc2atable 1/16 - 1/32 -/foot. 6. 10 feet from property line - 20 feet - foundations 0 7. Depth of trench < 30 inches from surface 8. Roan allowed for Sion, 50% 9. Size of gravel 3/4 - 11" diameter 10. Depth of gravel in trench 12" ndnimun 11. Pi' -- ends capped h.. PUMP. OR_ DOSE - SYSTEMS 1. Size . of pump chamber ti 2. Overflow tank 3. Alarm, visual/audio 4. Pump easily accessible manhole to grade 5. First box baffled 6. Cycle witnessed by Health De ent estimated flow per cycle HOUSE a. House located per Lipproved plans. b. Number of bedrocms WELL a. Well located as per approved plans b. Distance f ran SDS area measured ft. C. Casln�glV above grade. d. Surface drainage around well acceptable. OVERALL WORKMASHIP a. Boxes properly Eouted ' b. All pipes partially backf illed C. All pipes flush with inside of box 4— d. 'BEckf ill material contains stones < 4" in diameter e. Curtain drain installed according to plan f. Curtain drain outfall protected & dir.to exist.watercours g. Footing drains discharge away fran SDS area h. Surface water protection adequate i. -Erosion control provided on slopes greater than 15%. 4TEST PIT DATA REQUIRED.TO ME 'SUBMITTED VITN APPLICATIOI1 DESCRIPTION OP' SOILS II' TEST 11OLC DEPTH - 119Li _.- IJO....- ..._A __ _._.- ..„UOiAE hD.._ B..'- _ 1101A...140..._.._ .0 G.L. 6.. • Topsoil Top oil Tops it 12" San y 1131 Loam Sandy Loam Sandy Loam 2.1111 w /rocks 2' -3' 0 N stones 4" -1' 0 ,O" 3611 Flock Q 30" 11211 111311 Roc 45" 51l,i Rock @ 48" 6ci" 66" 72" I hUICATC ILL AT I•liIICH GROUND WATER IS ENCOUNTERED N/A INDICATE LEVEL TO W1LICII WATER LEVEL RISES AFTER BEING ENCOUNTERED N/A TESTS I•IADPS• - -gy- John E b e r l e Date_ 4'1-31 1 8 6 DESIGN Soil Rate Used 1.3 Min/1 "Drop: S.D. Usable Area Provided 3500 SF Ito. of Bedroom3 3 Septic Tank Capacity. Gals. 7)rpe Masonry Absorption Area Provided By 375 L.P.x2411 X '— width Erench. & CORN F'' +.,,, O r� 3.5 Fill Required A% ....... I lame - " ;- v Addre.ss w Z r- , L :.., {. s = 1980 MIS SPACE FOR USE BY I1=r1i DEPARTMENT ONLY'r. ••.• itlf,, ,gir1Yj� SSICNf \' Boil Rate Approved. Sq. Ft /Gal. Checi- "'\\ Date -6 ' TEST PIT DATA REQUIRED TO PE DESCRIPTION OP' SOILS ,?1111COUP 11ITH APPL•ICATIO11 11 TEST HODS DEPTH D ^HOLE�NO 11OLE NO. G. L. 6)` • Top oil 1211 113" S81ndy - 211" Loam X011 w /stones 3611 112" 11811 Rock ® 42" 51111 6o" 66" 72" 71311 INDICATE LEVEL AT WIIICII GROUND WATER IS ENCOUNTERED I1.IDICATE LEVEL TO WHICIi WATER LEVEL RISES AFTER BEING ENCOUNTERED Date DESIGN Soil Rate Used �Min/l "Drop: - S.D. Usable Area Provided 3500 SF No. of Bedrooms 3 � Septic Tank Capacity 0 CA3.q��-,,,,,,,_ Type Masonry Absorption Area rov a By375' L.F.x2411 X ,,'Cr��`cCORN— �Afi��, ti renc �4aRA l c3' her 3.5 Fill Re uire 1a me gna &a-eeAA1&z1aS A/C A, Address 1CML 1980 NEWY,, OP . T11I3 SPACE FOR USE BY HEALTIi DEPARTMENT ONLY: essicN Soil Raise Approved Sq. Ft/Gal. Checkod by Date UIVISIUH OF LIIYIIiUNMLIITAL 1_ML'1'11 SERVICES CUUII''Y OFFICE 13UILD111U, CAItMLL;: H. Y. 10512 LESIUU VA'1'A Sl U -S 1MAIUIJE SL'WAUE ]DISPOSAL SYSTEM VIM IIU. UN1io1 SKY VIEW MEADOWS :DEV .'CORP.Address c/o HEELAN REALTY CORP. Located at (Street BULLET HOLE RD. Sec- 73_ Mock $ .Let i WRcate nearer, arose c reaq fluidelpality, PATTERSON Watershed CROTON SUlb 111101DIA'1'101I TEST DATA REQUIRM) '1'0 1313, SUBMIT= WITH A11'L1CA'1'1U113 llul.e 11unil,e1• CLUCK TIMB, MWI '11111fe iitalt -stop I11u. 111311 OIAT10H WPUII U WaLet181.6i; Level From Urowid'. Surface 1.11 11 0,811 Start Stu I)rol) JLi1 Inches I1Mile� luclfen I'EIICUTATIU11 Bull WILD I,I111. /iu droll P1 1 1017 1047 '30 21 24 3.0 10 _ 2 1047 1117 30' 21 24 3.0 10 - 3 1117 1147 30 21 24 3.0 10 Il P2 1 .1018 1048 30 '21 23.25 2.25 13.3 2 1018 1118 30 •21 23.25 2.25 13.3 1118 1148 30 21 23.25 2.25 13.3 r , 3 - II • f' 110M, 1) 11'este to be repeated at sams depth uift-il n > ITA11"ately egiu0.1 V0 • rt1 es are obtailfed at each peraplptioll test 110180 All data to be submltte . •!'or rev -10W. 2) Wptll measurements to be made from top of hole. PUTNAM COUNTY DEPARnmu OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEnT SHEET - CONSTRUCTION PERMIT UAT OoLr_ BY- j�11 Name of Owner) (Street Location) COMMENTS YES NO DOCUMIIUS 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 PWS - Letter iriance Request 7QUIRED DETAILS ON PLANS -wage System Plan -wage System Hydraulic Profile - Gravity Flow .11 Profile & Dimensions - Volume or J Box;Trench /Gallery; Pump pit details :ptic Tank - Size, Detail 11 Detail, Service Line if over )nstruction Notes :sign Data io -Foot Contours Existing & Proposed �iveway & Slopes Cut )oting /Gutter Curtain Drains arc & Deep Holes Located Representative of Sewage & Expansion Area Tension Area;shown;gravity flow;suff. size, If..Pumped_Pit & D Box-- Shawn__ &_ Mailed - - -- - - -- )use - No. of Bedrooms 11s & SSDS's w /in 200 ft. of Property Located -operty Metes & Bounds )use Setback Necessary (Tight lot) )use Sewer - 1 /4 " /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout 1PARATION DISTANCES SPECIFIED ON PLAN .elds 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,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) !ptic Tanks 10' from Foundation 50' to Well i' Well to PL ZERAL .gal Subdivision bdi.vision Approval Checked approval SSDS Adj. Lots Checked �tland (Town/DEC Permit R & D) Lta On DDS Plans & Permit Same i l 3 f TA 5 � X ' GRAVEL DRIVE y A 3 BEDROOM DWELLING^ / W ! P 0 M M m L 1 n K � M � � B i io J H � C F 0 E � , 1000 GAL. SEPTIC TANK M a DISTRIBUTION BOX (TYP.) M _ U M T ro S R rMn 0 DISTAN E: C' :RT POINTS C D E F G H I K L M N 0 P Q R '4utnam County Department of health S VTv1sion of Environmental Health Services T' Approved as noted for conformance with 0 applicable �'7ules and regulations of the Putnam County healt Department.: v Y 3URDIOK WOODS. UBDIVISIONi LOT 1 A 59.0 61.5 61 ..5 59.5 58.0 56.5 56.0 56.5 30.0 26.5 25.0 24.0 23.5 26:5 95.0 93.0 92.0 90.5 90.5 89.0 B 43.5 41.5 56.5 60.0 63.5 68.0. 72.0 77.0 41.0 46.0 52.5 58.0 63.5 69.0 " 83.0 85.0 87.0 90.0 93.5 96.0 SCALE: As SNoWN DATE: i i /Z-/87 JOB NO. 7(,,?-0!6