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Home My WebLink About1643DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34.13 -1 -55 BOX 15 01643 ,1 CC IN a is lot 0 IN IN IN 1p 01643 NAM CPUNTY DEPARTMENT OF HEALTH h ReV 3/86., _ Divieionrof Environmeatal'Health Services, Carmel, N.Y:10512 c x r . EagLueet Mast Provide "! t :� P C.H D Permitq CERTIFICATE F C._ STRUCTIONz'comPL ANCE FOR SEWAGE DISPOSAL SYSTEM Town or Vlllage - Located sit` J`Gt' rid Tax MaP 7 7 •`Block I.ot Owner /appll�nt; Name •tJ� aL i 4 � Formerly T / ` Sabdlvision Name +� �� Sabdv. Lot # `q y� L � :1. �G G zip i riL ..r Malltng Address. P Date Permit 3 .ir, Separate Sewerage; System" 6aJit by Address C 3� Coneisdug of JT (3}}L►.d� Gabon' Septic Tank and Water Sapplp" '' Pablic Sdpply From Address l or Private'Sappl} DrWed 6y Address .f lR%S % . i Baildin �a�".�?F� ss? Has Eroeton Control Been Completed ?J Nouaber of Betlieoms Has Garbage Grinder Been Installed? =D Older ltequiremegte -I;, ertify that jthe s- si e6(s) •as- listed #ei ifiq the iibove "premises .here constructed, essentially as shown on .the plans of the completed work-,j cop ies' of whi c h are attached) and in'" accordance -'wish -the •standards rules"a regulations, in accordarice.with the•filed plan, and the permit issu d'-by' the Putnam County Department Of Nealtfi. Date : lI E R.A. s Address �N /g'f�Je� /,S(�/lfY L{tsnse N0 yjlAl% Any person occupying premises served —6- y tneF above systam(i), shall promptly take such'actfonas may neeessety to secure tM correction of any unsanitary conditions resulting from, -such us , Appioval of the,ssparate seweragssystsm shdll;bewnis' null and Vold as�soon es ",a Pubt.': gnitary sews+- .becomet - " available end the approval:,of the privafe vyater sup'piy shall' become null and void wAen' a puRlk,_vr'a ter supply :bicomis'evallabli. Such_, approvals are sutiJect tto moQiftcetlon or change when;, in the Judgrna'nt . of the CommisAoner;' th, 'such' ►evocation; modification o► change Is. necassa ►y; %� �i•'�/`� Oats /° Title K. Soft 2241 - BREWSTER, N.Y. (9941) 225 -2072 SAMPLE NO. 6373 SOURCE: Widmer faucet - well Fair St. -. Bullet Hole Rd. Carmel, NY COLLECTED: November 5, 1986 BY: PoFoBeal & 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. November 7, 1986 Roy Bickwit P. E. Director 0 per 100 ml. e. COI. .� "ry �yy WLLL UUr1rLL11U1N A-Lrvni DEPARTMENT OF HEALTH Div -is ion.. Of._Enviranmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only i WELL LOCATION STREET ADDRESS: WNlvil ! I Y TAX GRIO NUMBER: Bullet Hole Rd. , Patterson NY WELL OWNER NAME: ADDRESS: Jerald Widmer, RFD #69 Bullet Hole Rd., Carme. ,NY 10512 ❑ PBIVATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary 11 RESIDENTIAL ❑ PUBLIC SUPPLY O AIR/COND./HEAT PUMP O ABANDONED ❑ BUSINESS ' O FARM O TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ . MOUNT OF USE YIELD SOUGHT � .gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING ANEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 46o ft. STATIC WATER LEVEL .30 ftj DATE MEASURED 8/8/86 DRILLING EQUIPMENT :91 ROTARY ® COMPRESSED AIR PERCUSSION ❑ DUG O WELL POINT ❑ CABLE PERCUSSION D OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. ID OPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH 21 ft. MATERIALS: ® STEEL ❑ PLASTIC O OTHER CASING DETAILS LENGTH.BELOW GRADE 20 ft: JOINTS: O WELDED ® THREADED ❑ OTHER DIAMETER _— 6 in. SEAL: CEMENT GROUT O BENTONITE OOTHER WEIGHT PER FOOT t fib. /ft. DRIVE SHOE: ® YES ONO I UNER: O YES (RIND SCREEN -..DET AILS . _ _... I . DIAMETER (in) 'SLOT SIZE LENGTH (It) DEPTH TO SCREEN (ft) DEVELOPED? FIRST ❑ YES o No �� HOURS SECOND ._, ...... _. _ _.. _ _. __... _. _ __... , . GRAVEL PACK O YES ❑ NO GRAVEL SIZE . DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM OEM It. If detailed Um in WELL YIELD TEST p p g METHOD: %(PUMPED tests were done is in- • COMPRESSED AIR , formation attached? • BAILED O OTHER ❑ YES ❑ NO It more detailed formation descriptions or sieve analyses 1�IFLL LOG are available, please attach. DEPTH FROM SURFACE water pear- ing Well Oia- meter FORMATION DESCRIPTION CODE. It. It WELL OEM It. DURATION hr. min. DRAWOOWN It. YIELD gpm. Surface 1 Drilling in overburden clay & bl rs it rock at 1 foot 460' 6 440 50 1 21 rilling in rock ,-set casing,grout d. 21 460 ililing in rock granite. O CLEAR TEMP. O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO NALYSIS ATTACHED? O YES ONO STORAGE TANK : TYPE Well Xtrol - WX 251 CAPACITY 62. G . ,1 .2 NFORMATION Submersible CAPACITY, Gould DEPTH 280 [MAKER Fqn ,511�._VOLTAGE22DHP1,�2 WELL DRILLER NAME P.F. Beal & Sons, n 0 TE11/14/8 ADDRESS PO Box B SIGM URE Brewster, NY 10509 !/ v PUTNAM COUN'N DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Owner or Purchaser of Building t1411 '2_1__ Building Constructed by Location - Street 7 7_,E S, Municipality Building Type 77 / / Section Block Lot Subdivision Name 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 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 imanediately 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 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 detezmination 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. A/ /) A Dated this 1,3— day of ,x1611, 19 Signature Title nexal Contractor (Owner) - Signature Corporation Name (if Corp.) Address G �i %' /✓lam G� ; '.. ;f e X4R rev. 9/85 mk 7Z- Corp.) Addrdss R9 /V/ .rrb�4 i � ." t�3 PUTNAM COUNTY ''DEPARTMENT ®F HEALTH xENGINEER TO PROVIDEPERMIT # ` ,; ON CENT FICA OF COMPLIANCE ,., a' Division of Environmental. Hea /th:; Services Carmel N ` Y 10512 n CONSTRUCTJON PERMIT FOR SEWAGE DISPOSAL SYSTEM.' "iP7rL'3DA1 `f 4t a ; Town' or Riage t �LO4aLetlidt'L :' Lot q Renewal Revision. ./ Subdivision t ra •• _0 Owbei /Address, -' 1�k�ate`bf Previous ApPrl. Building.Type "�I' �1%��L Lot Areant, GP't%� -7 AL Fill section'`only ❑ Number of Bedrooms �3 Design Flow G /P /D' 600 P C H. D Notification Required ` Separate. Seweragei System to consist of OO O �! l Gal Septic Tank antl %,� x LJI�i /lTjOit/ '�1� To, be .constructed' by i �fJ�cs�,J :. Address s+t:��iy� T�� ,, ✓•' Water Supply ! . Public Supply Fiom �T� .- Ai' r„ND �y P,rrvate Supply .to be drilled by A) Address f Other .Requirements �, 2 ' /C / O +�r N! �, f I represent that I am wholly,and completely; responsible for the design and location of '.the proposed system(s),, 1) that the separate sewage disposal stem above described: will be- constructed as shown °on the:approved'amendmeht there to ani tin- accordance.with` the stanCards,,rules an regulations o. e' Putnam 'County . Department of .Health; and that on completion thereof a Certificate, of, Construction Compli5nce satisfactory. o the Commissioner of Healthwill be'submitted,4o the Department, and a, written guarantee will be furnished' the ovine► his successors, hel" dr atsrgns;by.the btuh der that said builder will • place in good operating condition ,any part of said sewage disposal• system during'atie period of two (2),years immediately following thedate of the issu- ance .of•.the approval of the Certificate of- [Construction Compliance`of the oiiginal,system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan'and;,that said well will'b' instalIed' An �acc'ordance with.-the 'standards, rules :and regu a� o� o f 'ithe Putnam County Department of .Health Date " X7..8 Signed i.:` L P.E. R.A. Address f Z i' License No ..7 APPROVED FOR CONSTRUCTION This approval expires one yearfrom' the date issue u s construction of the building has been undertaken and is revocable for cause or may be amended or'rriodrNed when considered necessary by the Gom issi ner, of Flealth.' Any change iteration of construction v . -i' _ requires °a new permit. Approved .for osal of dom is a y`se` e; an or piiv to t y Date eY Title Rev. .6/85 . GO _NA) �4 2 g 4WNA, , V 'HE' 'DE -ATNENT L DIVISION (?F ENVIRONMENTAL' f`-,'COUNTY- A"t-TARA" -PAL HEATH �1SERVICES oaf Health PIELD�ACTIVITYREPORT }Sheet of 0 0 iii,. Routine . - Comp = lain,, - p equest _,._Ofif,:� R Complaint "'Comp-li Final 'n - Z -eq ion, Min, 4m -:ng Only _5 J 11, 0 th 6 Or, 134 J� �4 S, LIEFT,�!� Explain X d�n 15 4-w es. !�V Tt f7 M�t . , § inx X541 iltb J tLEP r .34 Signature Z7 I El r ?I -A ipt .of a copy f 77' 1, 1 YIV�," MI . .� .uvu.�viwrau �rair.R aurri,i��unrev„ri ar.�rtx� L,.Larv►xss., �s.�irca� f I .DATE : INSP. 'BY: (Name of Owner) (Street Location) �-44- INITIAL SITE INSPECTION I YES I NO I CU44E 'S Wetlands on/or proximate to property .............. Property lines or corners found ................... Can estimate house location ........................ Will driveway need cut.: Mutrees .......................... Must ees 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 / septic . ........................... AccPas' to nronnsecl wP- 1, location for drillina_ D. H. 1' Lot Depth to G. W. Depth to rock Soil Description 0 ft. 3 ft. 6 ft. 9 ft. D. H. 2 Lot Depth to G.W. Depth to rock Soil Descrivtia 0 ft. 3 ft. 6 ft. 9 ft. D.H. - Deep Hole G.W. - Groundwater D.H. 3 Lot Depth to G. W. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. Soil Descrir)tion DATE. FINAL SITE INSPECTION INSP.BY: YES NO House SSDS located per approved plan ............. I,ength'of trench measured - Width of trench average, Slope of tile line and trench acceptable........., Room allowed for expansion trenches .............. Over 100 ft. from watercourse .................... �- Natural soil not stripped or SDS area unnecessarly graded ............................ %c- C 100 ft. f maintained from property line and 2 t. from house .............................. Distance well to SSDS (ft.) ...................... Number'of bedrooms checks ........................ Stones, brush, stumps, rubble, etc., greater 15 ft. from nearest trench ................ LS ft. of peripheral soil horizontally fran', trench ..................... 0.............. ` C± Boxes properly set ............................... 3ould surface runoff from driveway, roads, ground :surface, etc., channel near SDS ' area.... Does of drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE .................. DEPARTMENT OF HEALTH " Division Of Environmental Health Services August 6, 1986 Mr. Pravin C. Jain 1065 Spillway Road Shrub Oak, New York 10588 Re: Proposed SSDS Widmer Bullet Hole Road (P) TM 77-1-12 Dear Mr.Jain: . Review of plans and other supporting documents submitted at this time relative to the above-captioned project has been completed. Comments are offered as follows:; The revised plans submitted show the previously approved SSDS area has been abandoned and a new area is'proposed due to ledge conditions. The per-colationt-ests-are -to be�witnessed by a representative-of-this- in the revised SSDS area. r- JOHN SIMMONS, M.D. Deputy Commissioner Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM/jp Yours very truly, Robert Morris Environmental Health Technician TWO. COUNTY CENTER CARMEL, N.Y. 10512 (914) 225-3641 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. �7 Owner P6-7-6-P , Address S�S' ,isbKb jibes` ,oc3? 28 {sccS /U Located at (Street cA J,0 Sec.Block / Lot / Z indicate neares cross s r e Municipality. P,*7r 2XdA) Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Water Level No. Time From.Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop . Drop in Min. /in drop Inches Inches Inches if- 2y -8s 1 ` //: Zl //'3/ /o �� 'z % 3 3,3 3 11,':M /z'OP io , 'L? 4/220? /Z- z.? 19 4.3 5 S� 2031• z: ry z2. Ito 3 1%'� l% / 7 i 5 2 0 ccr11 P 3 S E P 3 0 1985 5 PUTNAM BOUNTY Notes: 1) Tests to be repeated at same depth until aroximately equal soil rates are obtained at each percolation test hole. A11 pp 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 ::. :.. DESCRIPT- ION..OE- SO.ILS:.,EN.COUN`I'ERED IN..:TEST ..HOLES DEPTH HOLE NO. / HOLE N0. 2 HOLE NO. G.L. o 6" 12" _ 18" 2411 30" 36" 42" 4811 60" 66" 72." 7811 84" .INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED "TIVDICATE' "LEtTEI; -TO CH WATER' ' ' -RISES `AFTER -BEING ENCOUNTERED -- . . TESTS MADE BY �� /GL'%' Date _Z_ DEIN Soil Rate Usedd / - /$°Mi Vl "Drop: S. D. Usable Area Provided gVVV No. of Bedrooms J Septic Tank Capacity /® N ®o of E God` Absorption Area Pry Byff 1§-' L.F.x24" nc . ®- 2 %� t� �r. i- /S'O CY -0 ,L -moo fj2ia/K' �%1 �J. ,i �v r 6 Address e474 -LV 'ate THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by ��. 042% Date .._ o DAVID D. BRUEN County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services August 12, 1986 Pravin C. Jain 1065 Spillway Rd. Shrub Oak, New York 10588 Re: Proposed SSDS Widmer Bullet Hole Road (P) TM 77 -1 -12 Dear Mr. Jain: Review of plans and other supporting documents submitted at this time relative to the above- captioned project has been completed. Comments are offered as follows: 1"""' JOHN SIMMONS, M.D. Deputy Commissioner 1) The relocation of the proposed SSDS has been approved on the basis of additional deep holes and percolation tests. 2 -)- -The proposed SSDS is to 'be designed based on a - percolation rate of - - 18.5 i h-c- F as recorded by Vincent "I He ii and a 'representative -� of this Department on August 8, 1986. 3) Please refer to the guidelines on SSDS submissions dated October 5, 1985 and revised November 8, 1986 and revise plans accordingly. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM/jP Yo 'fiery truly, Robert Morris Environmental Health Technician TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 i r. a IN $Y ooW \ O a^,*Vwlf H Z a Aa�atn 0 0 P �40 oQ la A480Tt7� �2r�,to ? TdTr- �pn 4� aoI- o I