HomeMy WebLinkAbout1678DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
35. -3 -15
BOX 15
l' . :3
, e; -,., z.�J _aid s f.Y ,�, ,v °3'.E.yf ,3' •'c a$y�
r }PUTNAM COUNTY DEPARTMENT'OF "HEALTH
Rep 3/86T fi r F r+
Division of Environmental HesIt61Serytces, ;Coimel,N X 10512 y
Eb eer Mast Provide
4x� ' �' °r �` P a D Peiuta �5 iP r71 15 87
% '�.: ^ i -.y.t I r. _' .,� •�:+.�� _.. � J. r, l f, x s l C _. t
CERTIFICATE O O STRUCTIONCOMPLiANCE FOR SEWAGE DISPOSAL SYSTEM~ k� Patterson _
�' '1 i 1 o.-,�r e �+.r+ s:r„r f 7• > ro. Tana OUT }I�i6ge �._...�.......... .
71
Roads � Ta :�lvlap 3 w - �sloc� r iA�
an Pu lades Ssibdivtsloi �Subav Let q 2
Owner /appllcmtNam`e +� , Formerly 1 n Name
Mawn Address's P 0 t +Box 683 Ztp 10591 Date Permit Igsaed : ~12/28/87
4 � �
i Ta+rTt�m)n, NPia York
Separate�Sewerdge System builtFby '- Addr`ess y
"�a Coneletbtg of ` Gallon Septic T"k and
1250 583 5 L F
r ,
SWa�er
S ° 1� t� P0116 Sapply'From Address
y �; or ` X` PrivateSapply Dialed by Address
t �` ' Has Eiosion Control Been CompletedY
;snuaing Type Sinale Family Yes
Nmnberof Bedroo1 me (t Has Garbage Gunder Been tnstalledY yQ�f
Other Regalrementsl'y r t q t p r µ a + Vr + y� y on the plena _of Etie completed. work ( copies
,
I certif that there atem(s) ae listed servin the above remises were constructed essentiall as,'shown
;of whictiare attached) and in accordance with 'the standards rules and iequl ions in acco ce with the filled lan and the permit issued by the
Putnam Cotmty, Depart�sent
NIIIIS .OatO "( 7x�`6�88r -� C ° ' b`F, 5 7Cmtifletlnby a , � J "' �, { j� P.E. ^ '' R.A.
Y t Address _ _' ROLJtEi' 22 �— BTP nIgtP.r' ,INPIA Ynrk 1 fJ' 9 Llcensa No
43791
Any person occupYiR9�D !emises¢servedJby'rthe above systems) shalhp►omptly� take such action as may be neeeswry to awn the cornetion of any unsanitary
conditions resulting from~ wchsusage ,,i ApprovaF -'of the aeparaterseweragsr system ,Hell +become nulF and void ss soon as a,_pubt' sanitary ewer becomes
available and the approval of the' private water suDP1Y shall'•,become� null and yoW ,wh'en a puplic ^water supply' bew + itvallabN 'Such approvals are
subject AdJnjddlf �fciatlon or ehanye when in.;the' judgment( of t(he Commissioner of Nplth ueh revoeati modifi 'ea tlon or change Is necessary.
Title ,
II.
IV.
V.
FINAL SITE INSPECTION • _ - s ••
IAspeCted
AAA
r
1
.
S1r +iAC DISPSAL"'ARFA .4. _ - =_ -.... _ .. -. _ ..- _......... ..
C�
a. SDS area located as per a roved plans
b. Fill section - Date of placement
2:1 barrier. IGM WIDTH AVG.DPTH
c. Natural soil not stripped
d. Stone, brush, etc., Eeater than 15' from SDS area.
e. 100 ft. from water course /wetlands.
SEN=- DISPOSAL SYSTEM
a. Septic tank size - 1,000 (1,25
b. Seatic tank installed level
c. 10' minimum from foundation
d. No 900 buds, cleanout within 10 ft. of 45° 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. MEN= i
1. Deangth required - Lenccth_ installed S"
2. Distance to watercourse measured_ ft.
3. Installed according to plan
4. Distance center to center
.5. Sloce of trench accentable.1 /16 - 1/32 "/foot.
6. 10 feet fran property. line - 20 feet - foundations
7. Depth of trench < 30 inches fran surface
8. Roan allowed for e. ion, 50%
9. Size of gravel 3/4 - 1 ' diameter ,
10. Depth of gravel in trench 12" min,nnim
11. Pi ends capped
h. PUMP OR DOSE SYSTEMS
-1. Size of..p=M chamber
2. Overflcw tank
3. Alarm, visual /audio
4. Pump easily accessible Ole to grade-
S. First box baffled
6. Cycle witnessed by ESgth Departnent
estimated flow cle
HOUSE '
a. House located per approved plans.
b. Nmter of bedroans
WELL
a. Well located as approved plans
b. Distance fran SDS area measured ft.
c. Casio 18" above grade.
d. Surface drainage around well acceptable.
OVML T T. WORKMAS'rIIP
a. Boxes properly grouted
b: All pipes partially backfilled
c. All pipes flush with inside of box
d. Backfill material contains stones < 4" in diameter
e. C=tain drain installed according to plan
f. C.irtain drain outfall protected & dir.to exist.watercours
9. Fcotin dra._ns dischar a away from SDS area
h. Surface water rotection adequate
i. E^_-osion contro provided on slopes greater than.15 %.
1
APPENDIX I
PUTNAM COUNTY DEPARTMENr OF HEALTH
DIVISION OF MIRWOUAL HEALTH SERVICES
Owner or Purchaser of Building
.'sZo-
Building Constructed by
Locatioh - Street
Municipality
t_k C L '67
Building
� 1 2- 8)
Section Block Lot
Tax Map Number
RO Z Cc & 7 O p4b &, e, tk,
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- pr6pertyr 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 hmiediately following the date of approval of the
"Certificate of Construction 'Compliance" for the sewage disposal system, or any
to: where the failure to operate properly is
renairs. made by M to. q:..qyqtem,, except
caused.by the willful or negligent a . ct of'the occupant of 'the building utilizing
the system.
The undersigned further agrees to accept as conclusive the determination of
..-&f_the_ 'vision of Environmental Health Services of the Putnam County
J_
Department of eal whether or not the failure of the system to operate was
caused by the llful or n igent act of the occupant of the building utilizing
the system. n
ted this day of a 19 Signature
Title `
A-1
(owner) -
07d; ? .
Corporation Nam (it Corp.)
/V
Address
rev. 9/85
mk
LTD,
Corporation Name (if Coip.)
AddYess._._
16
DEPARTMENT OF HEALTH
D vision --of-Efivironmental- Health Services
TWO COUNTY CENTER - CARMEL, N..Y. 10512 (914) 225-3641
APPLTCA'.V16 'Iii 'C;UNSTRUC'T A` WATER WELL'
PCHD PERMIT #
WELL LOCATION
Street Address
Big E lm-Road
Town Vf(ED 8 GX&t�,x Tax
Patterson ,.
Grid Number
71 =2,-8'
WELL OWNER
.Name"
Juan P'u jadas,
Mailing
P.O. Box
Address
683; Tarrytown, . NY 10591
C(Private
OPublic
USE' OF. WELL
1,.- primary
2 -secondary
® RESIDENTIAL
D BUSINESS
O.INDUSTRIAL
0.PVB.LIC SUPPLY D AIR /COND /HEAT PUMP
O FARM D TEST /OBSERVATION
MINSTITUTIONAL O STAND -BY
D ABANDONED
O OTHER (specify
O
AMOUNT OF USE
YIELD SOUGHT 5 9W#
PEOPLE SERVED 4 -5 /EST: OF DAILY USAGE 800 gal
REASON FOR
DRILLING
QNEW SUPPLY ..
0 REPLACE EXISTING SUPPLY
D PROVIDE ADDITIONAL'SUPPLY
❑ DEEPEN EXISTING WELL
COTEST OBSERVATION
DETAILED
REASON FOR
DRILLING
Pri
well or singI6
family residence
WELL TYPE'
- DRILLED
DRIVEN
ODUG
[]GRAVEL
C]
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES X NO
.IF WELL IS LOCATED IN A'REALTY SUBDIVISION, NAME OF SUBDIVISION:
Rnhert A* • Mnran' Lot No. 2
WATER WELL CONTRACTOR: Name To be determined Address:
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: ' - --
LOCATION SKETCH &'S'OURCES OF CONTAMINATION PROVIDED
DON REAR OF THIS APPLICATION ®ON EPARATE SST 'See SSDS Plan
(date) (signature)
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
County Health Department attached to this
3. Submit a.Well Completion Report on a form
Health Depar me t..
Date of Issue: 19
Date of Expiration: 2 19
White copy:
Permit is Non - Transferrable Yellow copy:
2/87 Pink Copy:
Orange copy:
requirements of the Putnam
permit.
p v'ded by he Putnam County
ermit ssuing fici
H. D. File
Building Inspector
Owner
Well Driller
PUTNAM COUNTY DEPAKIl� OF HE
APPENDIX B
TH - DIVISION OF ENVIRONMENTAL
& SUBSURFACE SEWAGE DISPOSAL S.
HEALTH SERVICES
- CONSTRI�.T�b1V 'PERNiIT � /
DATE 1ZE<IIEW l
'� LJ
BY: �--
(Name of Owner) (Street Location)
COMMENTS YES NO DOCUMENTS
Permit Application
Corporate Resolution
Plans - Three sets s/s
LF trench provided -1
required q if 13
60 ft. max . _
Parellel to tours
-I
FILL SYSTEMS
cla barrier
10 ft.
fill notes
new spec.
depth gauges
100 vr. flooa elev.
e L461- ayu +.L /14"i1 e
r eet ( SUBDIVISION
g Perc �6 =�erc Resul s (3) Fill
pth cd r--�
House Plan - Two sets
Wel l permit; PWS letter
Variance Request
GENERAL
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Town /DEC Permit R & D)
Data On DDS Plans & Permit Same
RDQUIRED DETAIIS 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
7.
Construction Notes (grinder - -rate)
;. -lesigri F�atao�perc an deep results
Two -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,suff. size
If Pined Pit & D Box Shown & Detailed
House - No. of Bedrooms
Wells & SSDS's w /in 200 ft. of Proposed Systems
-- Property Metes & Bounds
House Setback Necessary (Tight lot)
House -Sower - 1 /4 " /ft. 4 "0; Type pipe
No Bends; Max. Bends 450 w /cleanout
SEPARA 1M DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees,Top of fill
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake Unc. expan)
15' to Drains - Certain, Leader, Footing
351to catch basin,stornr3rain,piped watercourse
10' to Water Line (pits -201)
50' intermittent drainage course
Septic Tanks
10' from Foundation; 50' to well
15' Well to PL 9
I
�' e
7-/
V X - '---
Ap
nr A-r i
P �.
A.0
q
BIG ELM 1zoA�
approved as noted for conformance with
applicable Vules and Regulations of the
Putnam County Health Department..
A- L
6+. 0'
'
Ri anaturP
A. Tit P
p
P
LcoGATI.oq
c.0aRT
A -G
13.o
g - F
Led•O'
A-P
�S.o'
P�-C7
2�•�'
A -t:
A -Q
87.0'
4°I.o�
A- F
2--3.0,
8- 1
A -G
21.0'
6--3
A -N
ZI.
4.0'
A- 1
2'5
b - l-
2-'1. e
A - J
27.s'
M
o'
A- K
5o. 0'
B- H
Z 3• �E,�
A- L
6+. 0'
A- M
A- N
++o'
52
A -Q
87.0'
?2_p
f� - r
tpCo. J'
SCALE: AS SH[71.JW
DATE: 7 - I - 8$
JOB NO. 7 7 Z I I
-a.,I wI/l I