Loading...
HomeMy WebLinkAbout1548DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34.-4 -47 BOX 14 'I r ; r # }, 01548 7. 77 Rev '3 86 PL?TNAMGOI Divislon'of Environm S� DEPARTMENTOFHEALTH Health Servicex, Carmel" N.Y 10512 Engineer Mast Provide :8 7 x T`:� P C:H D Pe_imlt N CE . CATS QF CONSTRUCT[ON,COMPLIANCE FOR SEWAGE DISPOSAL,SYSTEM T m _. ......a.., =. Patter �o Town or Bullet Hole Road Tax_ Map 39 Block 2 Lot ' 1 1 28 Key Realt Cor Stonehedge t $ ' Owner /applicant Name Y -— Formerly Snbdivislon Name Stt.`or 111 n Address 93 .rlPneida�re,T ra;<I�e�� —�T3�, �P 10512 Date Permit Issued- /87 Separate Sewerage System built by Key Realty -Corp. Address 93 Glenel der Ayea Carmel NY 1 051 2 Consisting of �� Gallon Septic Tank and 430' x 24" w ,x 18'1 d D 'l atara l c fj Water Supply: Public Snpply.From "- Address or. X Private Supply Drilledby_30 -yd— xteA -J-aa Well gees -Rte. 52, .take Carmel 'NY 10512 `� . Building Type Modular Has•Eoslon Control Beea Been requi , As' red` Number of Bedrooms .Three Has Garbage Grinder Been Installed? NO Other Requirements None .. I- certify that the'system(s) as,.listed seiNUnq.,the above premises were constructed essentially as shown on the plans of the completed work.( copies of which are attached), and_in accordance with the- standaids, 'rules 'and requ ationa; in accordance'wit he filed plan, and the permit issued by the i11 Putnam county Department'df Health.- oats, 16 May 1987• Certified by �.' .. P.E. Y ' R.A. RD 9 Farr ,,S ,r t, 'Carmel`, NY 16512 29206 Address License No. Any person occupying premises served by: tha;above system(s) shill promptly take such action as may be necessary to secure the correction of any unsanitary conditJons resulting from such usage Approval of the separate sewerage system shall become null and void as soon as a pub('_ sanitary sewer becomes _,__ available and the approval of, the private.water`suppiy shalilikdrie null antf'.Nokl when`s public "water supply" become$ available. Such approvals are i subject to mod tieation or change when, in this' Judgment of the - Commi "ssloner 'of Health*, such revocation ' Ificetkln or change Is necessary, Date y T It Is i MAKER .. DEpH{ AotipESS si :w, MODEL - VOLTAGE Vgu Ompt �T ON RFPORiT Office Usa ~Onlq bEPAk"&NT OIr RtAtbt y bivigion Of EnvitOhffieztal Health 96rvices W Y O PUTNAt! COUNTY .$E1�AfiMENT f�F .HEALTH WELL LOCATION STREET ADDRESS: LLA NUMse . . ,(� PA TTRS OA/ 3• � _,:......NA. WELL ME: ... , ADDRESS: E ET y eF4L? PUBLIC T s..... USE OF WELL 1st RESIDENTIAL O PU80t SUPPLY 0 AIA /CONb. /HEAT PUMP O AE ANriON 'b ,.Y 1 primary O. BUSINESS - 0 PARM O TEST108SERVATION d OTHER (specify) 2 - sscondRry :.. O INDUSTRIAL b INSTITUT16NAL O STAND -BY MOUNT OF USE _. YIELD SOUGHT 5 goifi /NO. PEOtSLE SERVED : -.. S . ,J EST: OF GAILY USAGE.Q: jai REASON FOR .NEW SUPPLY 0 PROVIDE ADDITIONAL SUPPLY -'O TEST /OBSERVATION DRILLING CI.REpLACE EXISfiING ".SUPPL* 17 D.EEPEN'l XISTING WELL, DEPTH OATA , 3 ` .5" 4 .WEE.. DEPTH : -. .- � . . ft. 8�'ATiO 1NATEFI LEVEL ...::3 to.:r tt: DATE MIASOEt? DRILLING . O ROTARY COMPRESSED AIR PERCUSSION 0 DUG EQUIPMENT 'O 'WELL r6l Nf 0 CAM PERCUSSION d OTHER (sdeclfyj; WALL TYPE d SCREENED Cj OPEN EIVOASiN ''OPEN HOLE IN BEDROCK O OTI4m TOTAL LENGTH: t MATERIALS: Y G� PLASTIC . O OTHER CASING v, ...�. ..:: _.. LENGTH.B�LO.W 6R ►DE :; s - �� fG: -STEEL JOINTS` b WEI0b �81'�IREAOED �! O'tEIEII DETAILS DIAMETER __....:..... _.. _. �..; _MY.. in; SEAL ENT GROUT O BEiV'tONi1`E O OTHER WEIGHT PEA FOOT, ib lit: DRIVE SHOE:—RYES ONO LINER OYES 00,. DIAMETER Iirtl 'SLOT 511E LENGTH (it) !t7EPTH TO SCR" (tt) IiE1iELOPEOi DETAILS- FIRST SECOND _ :.. ..: _ ....... HOURS GRAVEL PACK YES GRAVEL 61AMETER TOP BOt-rOM 0 No SIZE:. OF PACK " �; Ui, OEP1'H ft: OEPT}i N WELL YIELD TEST I If detailed Ufnping � t more detailed ormation descri tidns or sieve Analyses ELL LOG aFe available, please �nach, p Y METHOD: O PUMPED 18I COMPRESSED AIR I tests were done is In ,formation attached? DEPTp FROM SuItFACE _ witfr eu�- Well 04- ft1RMAnON tiE5U31PTibN CCtltl. b BAILED O OTHER i O YES ONO t{ -. .......: _ inq meter hi , - WELL DEPTH DURATION DRAWOOWN YIELD ft, hr. ruin. h. gFm: 707,4 A. d - WATER O CLEAR TEMP: _. _. . _.... :. QUALITY O CLOUDY HARDNESS d COLORED ANALYZED? O YES b NO _ . . .......:.... ANALYSIS ATTAtHED7 b YES b Nb 5`TftAGE tAltk : TYk E ._,-,,.,,.,. PUMP INFORMATION TYPE CAOACiTY WELL GRILLER NAME pA MAKER .. DEpH{ AotipESS si :w, MODEL - VOLTAGE Yorktown Medical Laboratory, Inc. = ..::..32L Kcar Street -— . Yorktown Heights, N. Y. 10598 (914) 245 -3203 Director: Albert H. Padovani M. T. (ASCP) L L% i �� J LAB # Collect io.n_Stati -om Used: Carmel 4 Peekskill _ Mt. Kisco _ New City _ Date Taken: �I Date Received: C Date Reported: Collected By: Referred, By: Samp So rc e : LABORATORY REPORT ON BACTERIOLOGICAL QUALITY OF WATER GENERAL BACTERIA Standard Plate Count per 1.0 ml (Agar plate @ 35 °C) MEMBRANE FILTRATION TECHNIQUE ( r•,FT ) //,, Total Coliform uer 100 ml V Fecal Coliform ner.100 ml Fecal Streptococcus ner.100'm1 MOST PROBABLE NUMBFR TECFINIAUF ( VP "7 ) t�PAL..Index'-•r.e•r'_I00 -ml`- �.._......__..�.__._w - _..__...•.. Fecal Coliform: VPN Index per 100 ml OTHER ANALYSES THESE RESULTS INDICATE THAT THE WATER SAMPLE AS (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. Albert H. Padovani, M.T. (ASCP), Director LEGEND RDS = Recommend Disinfect- ing Water Source < = less than TNTC = Too Numerous Too Count PUTNAM COUVfY DEPAR'Ii M OF HEALTH DIVISIC0 OF EWIROM'AL HEALTH SERVICES Key Realty Corp. 39 2 11.28 y, Owner or Purchaser of Building Section Block Lot Key Realty Corp. Building Constructed by Bullet Hole Road Location — Street Patterson Municipality Modular Building Type Stonehedgg Estates Subdivision Name 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 shcwn on - - -the approved plan or .approved . amendment- thereto, and _ in accordance with the st,),ndards, 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 to..Qperate_: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 bu' ding utilizing the system. _ /) /7 _ / a' KAM V, A, - - ore rev. 9/85 mk _6b -ATIRCATEVECO IM CL ersq at jZ MR it WAP US WPM Oy ate sewage.:6iws'�6 system a6 in th the andarc a ion C_ 44`611AKil.616n;,;�iisi er, ea Da License No ROVED-FOR CONSTRUCTION'-— ThR�aijYp_F6vjiI jex�j�4 fi,,r, ijjUod UL�j�jj, C Ing hai been , :undertaken and is date ~ . � • PUTNAM COUNTY DEPAKIMENr OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS _...._,... _ .._ ._.. b ..- < - -,. PEGTION" REPORT ��i �/� -�o� /'ice /�• ��i �G' (Name of Owner) (Street Location)67l,;" INITIAL SITE INSPECTION I 'fES- 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 ............................. ts< D.H. 1 Lot Depth to G.W. Depth to rock Soil DATE: INSP. BY: COMMENTS N D.H. - Deep Hole G.W.- Groundwater D.H. 2 Lot ----- - D.H. 3 Lot Depth to G. W. Depth to G. W. Depth to rock �—�- Dep to rock Soil Descri 0 ft. ft. - - - -- _ 3 ft. �� .�� l / ft.- i • /%Llc 6 ft. /1/0 12i�%%� -� 7` /X 6 f t. 9 ft. /`'° iii�� /�� 9 ft. X12... ft, 12 ft. j' % ft. ft. n 6 f1 . lelo A 9 ft. DATE: 4 11APUl FINAL SITE INSPECTION INSP.BY: YES NO COMMENTS House SSDS located per approved plan .... .. Length of trench measured '4'Z cl Width of trench average C Z 57 .7to7l Slope of tile line and trench acceptable. ......... V4 Roam allowed for expansion trenches .............. Over 100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded.......... .............. 10 ft. maintained from property line and / 20 ft. fran house.. . ............... Distance well to SSDS(ft.) .................JX.. t Number of bedrooms checks ........................ Stones, brush, stumps, rubble, etc., greater / than 15 ft. from nearest trench ................ 15 ft. of peripheral soil horizontally from trench ..... ............................... / !/ Boxes properly set.. .... ........ ........ 14,3 -1D e, remoua 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.. APPENDIX B AUN'T'Y DEPART OF HEALTH - DIVISION OF ENVIRONMRIM HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT _. ... - - -_ .. ....- .. DATE _ - :REV- IEWED -: -_ ..z aner) (Street Location) COMMENTS YESI NO DOCUMENTS Permit Application Corporate Resolution 5- .e- 1W , 4 J,,e ,�j, / Plans - Three sets S Engineers Authorization _ �, s 4"1 -Des�ign�ta Sheet ( DDS) SUBDIVISION Deep Hole I cg-- _...`_- -, -- . Consistent Perc Results �(3) Fill Perc Hole Depth cd . Z 3U �✓- SV -d 'n �Ji `cat !Zi Q 77 F LF- trench provided required 60 ft. max. Parellel to contours ... 0L (- - L House Plans - Two sets Well permit; PWS letter Variance Request GENERAL Legal Subdivision )Subdivision Approval Checked Ex- approvsl SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same' REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic. Profile - Gravity Flow Fill.Profile.& Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank.- Size, Detail Well Detail,'Service Line if over Construction Notes .Design Data: perc and deep results . ZWo-Foot Contours Existing-.&-Proposed. �. Driveway & Slopes Cut Footing /Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion _ Expansion Area; shown; gravity flow, suf f . size If Pumped Pit & D Box Shawn & Detailed ouse - No. of Bedrooms is & SSDS's w /in 200 ft. of Proposed System -Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe . No Bends; Max. Bends 45° w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN 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 35'to catch basin,stormdrain,piped watercour. .10' to.Water Line (pits -201) 5011intermittent drainage course Septic Tanks 10' from Foundation; 50' to well 15' Well to PL L91 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 Bullet Hole Road Town /Village City Tax T. P tter Grid Number WELL OWNER Name Key Realty Corp. Address dPrivate 13 Public USE OF WELL 1 - primary 2 - secondary ®:RESIDENTIAL ❑PUBLIC SUPPLY (]AIR /COND /HEAT PUMP O BUSINESS 0 FARM O TEST /OBSERVATION ❑ INDUSTRIAL O INSTITUTIONAL O STAND -BY 0ABANDONED ❑ OTHER (specify 13 AMOUNT OF USE YIELD SOUGHTFive gpm/# PEOPLE SERVED qiX /EST. OF DAILY USAGE 300 +gal REASON FOR DRILLING NEW SUPPLY ❑REPLACE EXISTING SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ODEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING Priyal"P RARi dPn[`P WELL TYPE DRILLED DRIVEN ODUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES 8 NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Stonehedge EAtatAC Lot No. $ WATER WELL CONTRACTOR: Name Be ,,d q,tpn.an Well-Q, Inc Address:. Rte. 52, Lake Carmel, NY 7/107 n IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY'FROM NEAREST 'WATER'MAIN - - 0ver'4-2' mile LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED (See Dwg. No 1 [job no. S.0.2377] Q ON REAR OF THIS APPLICATION [30N SEPARATE SHEET By John H. Prentiss,P.E 24 November 199886 (date) U CsignatureT PERMIT 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 provided by the Putnam County Health Department. Date of Issue: 19-- -� Date of Expiration:,y- "-r-5' 19 � '� Permit-Issuing Official' Permit is Non - Transferrable 8/86 s PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE, -BUILDING, CARMEL;- 'N.`Y - -;-` 1051 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner kewwrAddress Located at ( Street -�- (( (�d : Sec .T Block Z Lot ( 1. 1-6 # �n ica nearest cross s ree Municipality_ s 00 Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS 3 [iAg r 4 1 iy8 2` Plj- Notes: 1) Tests to be repeated at same %wi'i 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 from top of hole. o e Number CLOCK,TIME PERCOLATION PERCOLATION Elapse No. Time Start -Stop Min. Depth to Water' From Ground Surface Start Stop Inches Inches Water er ve in Inches Soil Rate ;Drop in Min. /in drop Inches 11.100 fig LS fo 3 [iAg r 4 1 iy8 2` Plj- Notes: 1) Tests to be repeated at same %wi'i 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 from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH = .HOLE G.L. o Say I�o_w, e 12" 1811:- 24.11 30" 3611 42 48" 5" 60". _i. . 66 ca( ers � Jeroc - . 72.11 84,E e ero�, INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERH TESTS MADE BY _ AJCu� /M.B.�w,i.�ef'_ a Soil Rate Used loo Min/l "Drop: S. D,. Usable Area Provided 'pob f No. of Bedrooms Septic Tank Capacity iOOU. Gals. _ R 0 GIV Absorption Area Prov _ded By + L. F. x2�+" . ,/ - of %UAR �6 nc p N. PR B r SOS Name Signature ' JOHN H. PRENTISS, P.E. Address RD0 FAIR ST 814 -878 -6170 SEA GAM-6. NEW YORK 10512 THIS SPACE FOR USE BY HEALTH DEPARWENT ONLY: orTHE ST Soil Rate Approved Sq. Ft /Gal. Checked by Date f C10. n, N 0� Y V, ,G.9rEe9L G�- orro.c+ ¢29r2g0 f; rucnam County lleparrmenL of ti8altL )ivision'of Environmental Health Ssrviose approved as noted for conformance with Nk .Pplidable Hules and Regulations of the lutn*� County Health Department., 'i rina Ft +rn A• .1 a to /_ 1 1 7 i i "A 5 - P!j ILI L.D Al-A.- Structure located from survey by surveyor note d•belows Well lototed by: Surveyors survey.— Well drillers report Engineers me sure ments-C1_— Tank, boxes, pits, galleries 8 laterals located by:Contractori" Engtnea; f H e a;th dc•{it t' Field inspection by: Health dept IDl dat e::_y Engineer .i,v rr This is to certi.fy shat the' disposal system vas1ponst,r4t,,' NOTES: indicated on this plan an4'.'i` 'W` system a s i.nspecteib by; >* :''qe`*g' c. was covered over. The sye, constructed in accordance i standard rules and regulst:Lviib,ti the P.C.H.D. 6 the N,.Y. bIMENSION•S A B. — r -r� / N n A E •_ °�s42 =�2 B - E •1OQy _ °s A - 6 •1�� O�_B - G LO �p - A K °.i.- -�- --B K - - - - -- -- • 1 ! i' ' fjS A ITA Y TEM DL51 -"AS" ' CO CATION Street: Town:_f% +T1 County:�^"(��� _Stots:_� +f SUBDIVISION'. Z- Ma p:— Block,. _ _ — _ —_ _ LOT Ns.��•2_ Budder: — y Surve Drown: r Do-to: CAI e:.l I D Job NIf '' JOHN H/ PR EN -TISS PE'. r Y CONSULTING ENGINEER_ J �I i J t: V) o Jt Al / of �oAD 7 � Y V, ,G.9rEe9L G�- orro.c+ ¢29r2g0 f; rucnam County lleparrmenL of ti8altL )ivision'of Environmental Health Ssrviose approved as noted for conformance with Nk .Pplidable Hules and Regulations of the lutn*� County Health Department., 'i rina Ft +rn A• .1 a to /_ 1 1 7 i i "A 5 - P!j ILI L.D Al-A.- Structure located from survey by surveyor note d•belows Well lototed by: Surveyors survey.— Well drillers report Engineers me sure ments-C1_— Tank, boxes, pits, galleries 8 laterals located by:Contractori" Engtnea; f H e a;th dc•{it t' Field inspection by: Health dept IDl dat e::_y Engineer .i,v rr This is to certi.fy shat the' disposal system vas1ponst,r4t,,' NOTES: indicated on this plan an4'.'i` 'W` system a s i.nspecteib by; >* :''qe`*g' c. was covered over. The sye, constructed in accordance i standard rules and regulst:Lviib,ti the P.C.H.D. 6 the N,.Y. bIMENSION•S A B. — r -r� / N n A E •_ °�s42 =�2 B - E •1OQy _ °s A - 6 •1�� O�_B - G LO �p - A K °.i.- -�- --B K - - - - -- -- • 1 ! i' ' fjS A ITA Y TEM DL51 -"AS" ' CO CATION Street: Town:_f% +T1 County:�^"(��� _Stots:_� +f SUBDIVISION'. Z- Ma p:— Block,. _ _ — _ —_ _ LOT Ns.��•2_ Budder: — y Surve Drown: r Do-to: CAI e:.l I D Job NIf '' JOHN H/ PR EN -TISS PE'. r Y CONSULTING ENGINEER_ J �I i J t: