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HomeMy WebLinkAbout1569DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34.-5-2 BOX 15 01569 1 e N - i e me 1 -` ` ' LL iL ., �� i' I I I r mi I� I' J2 01569 PUTNAM COUNTY DEPARTMENT OF HEALTH Rev. 31 6 Division of Environmental Health 'Serviceb,'Carmel,'N.Y.10512 r - Engineer Must Provide P.C.HX. Permit N - CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE - DISPOSAL SYSTEM I ��`C -� Vz 451Dt`1 •�-- p 2 Town, or'V e 2 Located at bdLusk 4 1��0/�►D ' Tai Map. 7�' Block '1 Lot RP�Ai.ID ScMM� ewy/�,w b Owner /appllcadt Name Forme'r'ly S ' Subdivision Name V Subdv. Lot N 2 Mailing Address3 � R r� Zip Date Permit Issued Separate Sewerage System built by goLAND. S1,8M 1 PT Address _ Consisting of � ® Gallon Septic Tank add �t7 L� Water Sdpplyl Pabllc Supply From'-- Address or: --x Private Supply_ I)rWed.by Address .g., /. Building Type J Has Erosion Control Been CompleWd.? i �5 Number of Bedrooms Hue Garbage Grluder'Been Installed? Other Requirements ✓ r .I certify that a system(s) as listed serving the above premises were of which Bra a [ ched),'and in accordance with the standards, rules see Putnam.Coun rtment Of H Ith..` Date Certifled by Add.CASHIkA AQ;444 �" "on the plans, f the completed work '( copies the filed , and the permit issued by the P.E. R.A. Or IW 6; gouT* 2y ue�$�4fr&&re Any person occupying, premises served by. the above systems) shall:prOmpi ly take such action as may be necessary to secure the correction of any, unsanitary conditions resulting from . such usage. Approval of 'the 'ssparAG' 4iwerage system shall become null and void as soon as a pubs;: sanitary sewer becomes avallatile and the ipproval of the private water supply shall become null and void when a public 'water supply becomes available. Such approvals are sub)ect to dfflutfon' or change when, in. •the )udpment of 'the Commis i�naes -o f- Health, such: revocation, modification or change Is necessary. Date /� Title @3 PUTNAM COUNTY DEPARTMM OF HEALTH _ DIVISION OF - ENVIRONMFMA'L = HEALTR :SERVICES = fZ m r) sc-Am i bT Owner or Purchaser of Building OWNS Building Constructed by BULLET DOLE. ROAD Location - Street PATIf�-K 5 0t� Municipality ,51N6 E VAM)LY RE512E!kE� Building Type 34-5 -2- Section Block Lot � - DU PICK 1--RM Subdivision Name 2 Subdivision Lot # GUARAFP= 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 " " eattfficate . of-Construction-Compliance" -for `the' sewatje - disposal -syste . or any repairs made by we 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 of the buildin 4 tilizing the system. Dated this a- 9 day of V� -1 . 19 9 Signature -7' Title 2 '21 G- General Con act r (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk i" Corporation Name (if Corp.) Address WF �; COMPL '1�� n• -< •�.. r.iiviv.r�tti DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF REALTH office Use Only WELL LOCATION STREET AOOAESS: - 1 TAZ C'qw yuUw8 . Bullet Hole Road, Patterson Lot 2 WELL OWNER HAMS AOORESS: Heelan .Realty & Development, Route 6, Brewster, NY 0 PRIVATE O PUBLIC USE OF WELL 1 - primary 2 - secondary ® RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /CONO. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION - ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY 0 MOUNT OF USE YIELD SOUGHT 5 gpm. /NO. PEOPLE SERVED 3 300 /EST. OF GAILY USAGE gal. REASON FOR DRILLING ® NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TESTIOBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 4 25 it STATIC WATER LEVEL -3 5 1t. DATE MEASURED 6/19/87 DRILLING EQUIPMENT ❑ ROTARY IN COMPRESSED AIR PERCUSSION ❑ DUG O WELL POINT O CABLE PERCUSSION ❑ OTHER (spec.ify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. ® OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS - TOTAL LENGTH 9- — ft MATERIALS: p STEEL ❑ PLASTIC ❑ OTHER LENGTH .BELOW GRADE 8 9 fL JOINTS: .0 WELDED ❑ THREADED ❑ OTHER DIAMETER 6 in. SEAL: Ill CEMENT GROUT ❑ BENTONITE ❑ OTHER WEIGHT PEA -FOOT- - - 19 Ib. /ft I DRIVE SHOE- CRYES ONO I. LINER:OYES ONO SCREEN DIAMETER (in) SLOT SIZE LENGTH (ft), DEPTH TO SCREEN (it) DEVELOPED? DETAILS FIRST O YES 0 8 HOURS SECOND GRAVEL PACK O YES O NO GRAVEL SIZE_' DIAMETER OF PACX kL TOP DEPTH tt. BO'Tmht DEPTH ft. WELL YIELD TEST If det�jled pumping METHOO: ❑ PUMPED tests were done is in- • COMPRESSED AIR , formation attached? • BAILED O OTHER ❑ YES O NO 1fELL LOG t more detailed formation descriptions or sieve analyses are available. please attach. DEPTH FROM SURFACE Watcr Bar. i Wdl o,a. inr FORMATION otcRnon oo¢ WELL DEPTH IL DURATION hr. min. OHAWOOWN ft. YIELD 9Fm. Surface 80 no 10 Grey hardpan & mbbles 80 425 yes 6 meaum to hadr grey grar ite 425 6 - 350 40. ATEA O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? O YES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE Diaphragm CAPACITY 62 GAL. 16 PUMP INFORMATION TYPE S ii hhm r S i LIAKFR Goulds h 1 P CAPACITY I_ nctmt 250' WELL DRALU NAME 1'm`I' ID -� .N16/87 .. Acct - -- - YML Environmental LAB NUMBER 193-006421 ?: S e iv 1 C e S DATE /TIME TAKEN ; p y'321 °Keay Street,'Yoiktown Heigtits;'NY'10598 914 ATfi'TIME RC'D ' 06 =03 -92 71-': 35 pm FLAP #10323 ) 245 -2800 DATE REPORTED JUN. 'Bath Tub Tap: 2 Bullet Hole COL'D BY Ronald 11, Schmidt (914) 878 -4642 NOTES —� RESULTS OF WATER.TESTING X ANALYTE RESULT UNITS <4C _ Nonpotable ALKALINITY <20 >4C mg/L _ HCI .Na2SO3 >20C 1AMMONIA _ _ H2SO4 _ ZnOAc mg/L MF ' MPN ARSENIC rrg/L CHLORIDE.. mg/L COLOR Units CONDUCTIVITY umhos /crn COPPER'G/L NTU DETERGENTS mg/L . FLUORIDE mg/L HARDNESS mg/L IRON mg/L LEAD mg/L MANGANESE mg/L MERCURY mg/L NITRATE mg/L NITRITE mg/L ODOR TON pH S. U. SAMPLING [Patterson, New York 12563 SITE. RESULTS OF WATER TESTING For Lab Use Only ANALYTE Potable _. HNO3 _ pH LT 2 _ <4C _ Nonpotable _ NaOH _ pH GT 9 <20 >4C mg/L _ HCI .Na2SO3 >20C STAT! _ _ H2SO4 _ ZnOAc mg/L' MF ' MPN P/A RESULTS OF WATER TESTING X ANALYTE RESULT UNITS V' PHOSPHOROUS. mg/L SILVER mg/L' SODIUM mg/L SULFATE n-g/L SULFIDE mg/L SULFITE mg/L TURBIDITY NTU ZINC mg/L SPC per 1.0 mL TOTAL COLIFORM per 100 mL FECAL COLIFORM per 100 mL E. COLI per 100 mL FECAL STREP. per 100 mL These results indicate that the water sample U�A [WAS N OT] [NA] of a satisfactory sanitary quality according to the New York State Sanitary Code, for the is tested, at the time of sample collection. These results indicate that . e w er ample [WAS] [WAS NOT] 9�til a satisfactory chemical quality according to the New York State Sani ary e, r the parameters tested, at t of sam ple collection. NA = Not Applicable N = Not Present (Negative) SUBMITTED BY. P'= Present (Positive) SA = See Attachment(s) ' = Also done because Total Coliform was present Albert H. Padovani, M.T. (ASCP) TNTC = Too Numerous To Count Director > = GT = Greater Than < = LT = Less Than ®` wP-T- 7- Al DR �O FeQy Enclo3o(1 ;o ;n r n caod locatiaw oe twa lo?o®Oefd agsstmn( i`ai t@imt tM SIR at®'e�w di n flan , s 4 tAN7J® @O a i QiCin6nm® W 6-iii6'Wnl"� ;'.il' a _ �a�lf n/ "O Ira •�e:ta @tsata -o4 'COwi@eYt@tow ComOtN9W¢d•: settee .52M to the cOmmkf : of the tlwdu io aurn tuo ,nee t; assigns nv OM builder. SM said - build.. will, , i0eoi �aYeow dw - tWe ' qa) yeaoe bwwoga®eayi fO1tOwNrabadab.of.tM heY� 1 i�aaaa oitM: u 1 - ' � a� .` astwwat ®: aia�i`eleo ww@.e.wal saaiad f�io.e 8 M mdW tRe 4t 6ed� vialao �R6i ! u s eM ` hNmain i :'I kT ��� �� RD •6�.... R UTE 22,�Sk�{rS'i�,i: w� � -744 =6 tvs o® @WO @U@©,�,i unem ions@vedlon OQ t6o ieNiidbq Rae toed undatakin 4" ie _ice Of wg`WDrl"ga a eetavatron ot.00rntnietbn; iavq aeeA /ar ®v�eae ©-ar�atm sa��� ain@s� .,, <! PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of R0UAt 1p Sow i I?T Located at $ULG�-r AOLE, ROW (T) PATTERSotJ Section 5' Block Cj Lot 2, Subdivision of 6UI2WK F*(ZMS Subdv. Lot # 2 Filed Map \\ Q # 215) DatecJLA -L4 8.0 Gentlemen: This letter is to authorize 6ASRIN �SSC.LIAT � PG a duly licensed professional engineer x or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education tary Code. Countersignelk P.E., R. A., # e Public Health Law, and the Putnam County Sani- OF NEIV o67Qaw/, _�OFES610t1t��, RD r, RouTE 22 Address Very truly yours, Signed r i� Owner of Property Address / ,< 3 1sd�k o 4- °'Town UEWSTF?, , r4Y IoSoq J7 —A 3 6 Telephone l�-- 27F ZSoD Telephone I is DESIGN DATA M E r-S MUFACE SEWAGE DISPOSAL SYSTEM FILE NO. owner RoI -�'o ScOM Ivr Address �3 W Z40 , �t`fG . tJ`� Located at (Street) 5u LAT AP� Sec. :-T Block -✓ Lot (indicate nearest cross street) Municipality P &T I �n ( Watershed • • ' x k • •: Y • • V ' p• 1• �• • 1 �• .. • Date of Pre - Soaking Mows( 31 -`j 2 Date of Percolation Test AMll, I , 12 HOLE 3 155 ' 225 3� M A N• 2•q-" NUMM CLOCK TIME Aj �Z 7 PERCOLATION 4 225 - 255 '*3:0 MN 24n PERCOLATION Run No. Elapse Time Depth to Water From Grround Surface Water Level In Inches Soil Rate Start-Stop Min. Start Stop Drop In Min/In Drop Inches Inches Inches 112:`%- 1.26 ao mw '24 24 ►12 „ r1, 1/Z 12 MIN��r� r 3 2 1. - 2:00 'ac MW , 24" 25V z I'/12" LLD mim /Irl 3 2'ao - 2= 3� MIN . 2�'' u . 'L5 1 -�;o H iM /1 >J 4 2: ?6 - 3 --0 � MIN. o 24' _L 21 � 1.i 30 t4IW1IH4 ✓`� 5 2 1.2o - I . SO ?0 M lit 29•'• 3 155 ' 225 3� M A N• 2•q-" (� 2" Aj �Z 7 M l N/ 1 t A 4 225 - 255 '*3:0 MN 24n 0 4" 8 MIN/(N 5 NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to* be snhaitted for review. 2. Depth measurements to be made from top of hole. TEST PIT DATA.RDQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOUS ENCOUNTERED IN TEST HOLES DEPTH ..,:.HOLE -NO. �.. .HOLE N0. .° HOLE. -;NO. G.L. 1 a T��iL 2' 3' La°&m 4' 51 G6 f -) 61 SILsT 7' E3 TQ0 W%T 9' 10' 11! 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used 5!�? Min /1" Drop: S.D. Usable Area Provided (OCOC' 15f= No. of Bedrooms Septic Tank Capacity loo gals. Type Absorption Area Provided By 5r,70 L.F. x 24" width trench Other Name A- s-c o c c pct —C- PC.. Signature 9 r � � 1�t. Address 12 � G (fin;,. Z`Z- SEAL _ t� L 0614 pf)(lCrec THIS SPACE FOR USE BY HEALTH DEPARTME T ONLY: Soil Rate Approved sq.ft /gal. Checked by Date . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner k'I� -A < g v ker AvE nJ Located at ( Street "oLc --J�h See. Block Lot 8.A 4dicate nearest cross s.ree Municipality — A-rri��� SOIL PERCOLATION TEST Watershed DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Bole Number CLOCK TIME PERCOLATION .4 ., , _ . IS— 4> ',�� PERCOLATION Run apse , No. Time Start -Stop Min. Depth to Water From Ground Surface Start Stop Inches Inches Wat er Levei in Inches Drop in - Inches Soil Rate Min. /in drop FL- 1 PRE 506k- 2 30 IS.S l.' 3 0 3 1: 11-91-7 3o N zS 1S.0 r`�S At 0) 9 - 1 ° ! Cl i 7 3Q 19.9.E 1 EY o7.5 �+o 5 W',11�- !Q;IYi 3rd 1$.15 Ko d7`, 1 , 13. 2 PR E 54A K ° 2 4 ����(tY�l jl' ter, t� i t �a•.,. Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole: A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. i t .4 ., , _ . IS— 4> ',�� tQ >' tt z� -7s 9 U 2 4 ����(tY�l jl' ter, t� i t �a•.,. Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole: A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. i t TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES xaEPTH HGLE 7NO- Z -� I : - _ -HOLE NO. �- Z:._.::. HOLE , NO. _ - - G. L. Rn�le�c�c.��91 611 r i' I Lott \ I.—Pit 1.s" 24" 30" 36" 4211 48(( 54 ".. 60" . 1 ��in_ L+LiCttM C, r ACA, CA ,+ Mai I wul �- P' l e_ 1 SG1 K rt tr`I Tt, I A() n: S +�r c, 1,, Lo,,V�\ _ (IL LQ ei _ 66" . 72 r — . M " rt 0;, �8. 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO.WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date 18 �B � moil Rate Used_J 60 Min/1 11 Drop: c S,. D. Usable Area Provided do o r i No. of Bedrooms Septic Tank Capacity ZSC) Gals. Absorption Area Provid By oG L.F. x24" c . _ r r %, i �► Cam.' - ? i t° Pam Address—T, M' ►t 5 f R THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal. Cheeked,by. Date PUl'NAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SENkGE DISPOSAL SYSTEMS (Nhme of Owner) REVIEW. SHEET - CONSTRUCTION. PERMIT.. _ ._ ...... DA BY: (Street Location) DOCUMENTS 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;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area;shown;gravity flow,suff. size If Pumped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 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- Cllrtain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' from 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 COUNTY - - _, - - PUTNAII� DEPARTNMM OPHEALTH Re Vs 3/86 Divislon of Ent+ironmeii Health Services. Carmel N t4o511 Ettglneec to provide Peemlt q . on'CERMCATE'OF COMPLIANCE _ �.. Per®It . q rL�eT ,CONSTRUC17101 PERMIT FOR WAGE DISPOSAL SYSTEIYI Located 'at Town' or • Vwage .. y Sabdivlsiou'Name ,� y c'•il� Subd, Lot q _ Tai Rap Block Lot Renewal O Revision ❑ Ovmer /Appllcanf- Name - S E>;tA t'Qtu �ea�eul� Nity. owe. _Cp Date of Previous Approval �- (S ©N rK rr e n a Md11nB Address +� R �'�� �. � me 'CQ ®.`' -Town Zip 1 .uko , iiSGloj —T_ suual;og�e '��g t� a a etz Lot .' '� fl ► `� frill Sectldn oil y Depth Volume Numbau of Bedrooms Design Flow. G /p /1D PCHD IVotificatlon Is Requhed When FIB is completed ' Septiiste Sewerage System to consist of —Gallon Septic Tank, en 100 k-15 to be contracted by - Addres® Water SapplJ " Pablle.Sapply From Address: oes Private Supply DrWed by — Address 7. Other Reguiremeuts ' 1 represent that-T,, am- Wholly and completely responsible for the.desrgnand location of the "proposed systems) 1),that the .separate;sewago disposal system' above: tlescrrbed.Wrll'be2on'stiucted as shown'I -,e approve. amendment there to and rn accordance With the sta' ntlartlS. rules an regu a ions o e; u nam County ,Department of ; Health,' and.that on complatron thereof a Cert,frcate, of Construction complra�ce" satisfactory to'the Commissioner of Health will . be sutimrtted to- the ;D,epartment,'and a written guarantee will be furnished fhe owner 'his successors, heirs or assigns by the builder, that said'builder *will w_ place :inr good',operatrng.. congrtion any tpart of said sewage Grsposali.,system during the.:perrod' of two' (2j years immediately following the date of the assu- ance'of, the approval: of. the .Certificate.:of ..Construction Complrance;:of the original system pans thereto, 2) tbat•the'drilled well described Above will be- located as shown on the approved plan and that card w'elQwrll be installed n cords ce With" o 'standards rules and iegu Mons of the " Putnam County; Depa /rtment[� of, Health t Date : ' G.�ZQI �6 Signed . P.E R A. Address 'License No - „ APPROVED f0. CONST UCTION This 'approval'expue ;'one year`fro the to issued' unless eonstruction of the building has been undertaken and is revocable for ca or,m' a amended or modrfietl. when considered nec sar by the Co rssroner of Ft it Any: change -or alteration of construction requires a .riew• perm roJed for disposal Of'•tlomeStic sandary s and /Or pr' t0 SU p ` ply. . . Date. / By Title MI. u.- Y RICHARD 1. Q.OLDSANC Notary Public, State of New No..6573920 Qualified in Putnam Cty. No Term'Exp ir I es . . h' 0 V Corporate Seal r Id v4bl< i,2 I 664' /� �'�a. '12 '7(, 10 31 -b-7,,z 4302- 49' %2 5,::, �2'��