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HomeMy WebLinkAbout1685DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -3 -24 BOX 15 01685 rn PL IN I r re � � � �� I J � �� ■ ■I,; I f, I l 1 .` - h�. L -7 � � L f f I IN . IN III r �� 01685 PUTNAM COUNTY :Rev::3 6 ` Division ofEnvlronmentaI CERIM TE OF CONSTRUCTION COMPLIANCE I Located B i e _ E lin -Rriad EPARTME ealthSer,&9 IR SEWAGE NT OYE EALTH Carmel, .Y 10$12 Engineer Muet Provide P<9 .84 C P .H D Pe®it N — C 2 DISPOSAL SYSTEM T,: Patterson Tzwm or Village Tax Map 7 1 Block_ 2 Lot 3.2 Owner /applicant Name John MOrlarty Formerly Gladys .Birkman Sabdivisio'n Name B Sabdv. Lot q irkman 2 Mailing Address ` Rte 6 B 2;' ew s t e r NY ztp 10.512 Date Permit Issaed 512/86 Separate Sewerage System`46ailt Winer Address _ Above 1000: 500' x 24 w. x 18"­. D. laterals Consisting of Gallon Septic Tank and Water `Sapply: Pnbllc Sapply From Address or X pdvateSupply:Drlll edby Albert .Hyatt & Sor}d�e Rte. 31:1, Patterson, NY 12563 Baudin Frame'. yl Eioston:Control Been Completed? As. required. Nambei of Bedrooms " Three gas Garbage Grinder. Been Installed? No Other Requirements 12 R 0 -B F •11 Section x 3200 sq.� f (120 ° -:CL Yds -i-) I certify that the syetea(s) as aisied`aerdinq, the above premises were constructed essentially as shown on the plans of the completed work ( copies of which are at and in.;accordance :.with the standards, rules and - .regulations, in accordance with .the filed plan, and the permit issued by the .Putnaua COunty Department,- - Health - Date 28 Apr i1:,j'�987, :; _ Certdied bY: P.E. X_R.A. RD 9 Fair'Stre Carmel, NY 10512 29206 Address License . Lice No Any, person occupying premises served by the above systerri(s) shall promptly take :such action as may be necessary to. secure the correction .of any unsanitary conditions resulting from;` such usage., Approval' of the • separate sewerage systom; shall become null and void as soon as a "pub.': unitary rower becomes available aril .the,appioval of i ie,private water •supply shall become(nult and'void when a public water supply becomes available. Such approvals are subjects 6 modification or change "on, in the judgment' of in 'a -bomp MIS slbnar of It such revo tlon, modificatl9an or change Is necessary. Date,l a, f z aU\ T T f1/ %AnT "M r^AT 7)'L *n f/J YY� .t YY L'aLL VVlla LLJ1 iVL aW DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH - Office Use Only WELL LOCATION WELL OWNER STREET AOO ESS: WN /VI ! 11 W'61110 NUMBER: rc NAME. ADDRESS: PRIVATE /�%r �++I -t ❑ PueLlc USE 0 -F WELL 1 - primary 2 - secondary RESIDENTIAL ❑ PtIRLICIfiPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT �.z—. gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE 600 gal. REASON FOR DRILLING VNEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY 0 TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 3 0 ft. lowi etc STATIC WATER La _ ft. q 1 DATE MEASURED 4 DRILLING EQUIPMENT ❑ ROTARY V1COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING (OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH ft MATERIALS: STEEL ❑ PLASTIC L7 OTHER CASING LENGTH.BELOW GRADE fL JOINTS: ❑ WELDED a2rTHREADED ❑ OTHER DETAILS DIAMETER �— in. SEAL: ❑ CEMENT GROUT BENTONITE ❑OTHER WEIGHT PER FOOT 1_ Ib.. /ft. DRIVE SHOE 9TYES ONO LINER: OYES 9NO SCREE! DETAILS DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST O YES, O NO - GRAVEL PACK O YES O NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH.. ft. BOTTOM DEPTH it. WELL YIELD TEST If detailed pumping t MVH00: O PUMPED 1 tests were done is in- ff COMPRESSED AIR , formation attached? O BAILED O OTHER ; ❑ YES ❑ NO WELL LOG It more detailed formation descriptions or sieve analyses are available. please attach. DEPTH FROM SURFACE ling Water gear- well Dia- neter FORMATION DESCRIPTION coos, tt. ft. WELL DEPTH ft. DURATION hr. min. DRAWOOWN ft, YIELD 9Pm. Surface I—r> szvid 4 E .30o 6 it 00 , fWATE� O CLEA R TEMP. ' O CLOUDY HARDNESS O COLORED ANALYZED? O YES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY GAL. WELL DRILLER NAME HG� DATE i't c�Gr/t 5 ADDRESS SiWTURE ••/�,�� �f /r // �/ !ya�'0�.✓ PULP INFORMATION TYPE CAPACITY MAKER DEPTH VOLTAGE HP Of LAB CA.004147. Yorktown Medical Laboratory, Inc. - - , 321 Kear Street Collection Stat -ion. Used: Yorktown Heights, N. Y. 10598 Carmel. Peekskill Mt Kis .... _. _ '(9F14)'24 5 =3203. .._.:........� _. .,..,.. _ _._ .. Director: Albert H. Padovani M. T. (ASCP) . D ate .Taken : Date Received: -1-S T_ t T�/ Date Reported: 1/. Collected By: !L fI G �� Referred By: Sample Source: URA&yi 7AP L 6C ew S� n �l ius 0� LABORATORY REPORT-ON BACTERIOLOGICAL QUALITY OF WATER GENERAL BACTERIA Standard Plate -Count per 1.0 ml (Agar plate @ 35 °C) MEMBRANE FILTRATION TECHNIQUE (MFT) Total Coliform per 100 ml V Fecal Coliform ner 100 ml Fecal Streptococcus per 100. m1 MOST PROBABLE NUMBER TECHNIQUE (MPN) Total Coliform: MPN Index ner-100 m1. `Fecal° 'Coliform: '"- -- F!PN� index "per4100Ym1 OTHER ANALYSES THESE RESULTS INDICATE THAT THE WATER SAMPLE WAS ('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. LEGEND Albert H. Padovani., M,.T. (ASCP), Director RDS = Recommend Disinfect- ing Water Source < = less than TNTC = Too Numerous Too Count •l PUTNAM COUNTY DEPARTMENr OF HEALTH DIVISION OF ENVIROIZ=AL HEALTH SERVICES John Moriarty 71,2 Owner or Purchaser of Building Section Block Lot Building Constructed by Big Elm Road Location - Street Brewster Municipality Frame Building Type Rirkman Subdivision. Name 2_ Subdivision Lot # GUARAWEE 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 - me--to- such.-System, except -where .the fai. lure. to . operate...pr.operly -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 o£ the occupant of the building utilizing the system. Dated this 28 day of April 19_-.&7 - P0, Z Gen al Contrac or (Owner) - Skjasture Corporation Name (if Corp.) Address rev. 9/85 mk Corporation Name (if Corp.) Rte. 6, Brewster, NY 10512 Address IV. V. VI, APPENDIX C FINAL SITE INSPECTION Date f � i ( Ins ed by LION •' OWNER IM # OR SUBDIVISION LOT COMMIIvTS SEWAGE DISPOSAL AREA a. SDS area located as per approved Tans b. Fill section - Date of placement _ 2:1 barrier. LGTH fib' WIDTH S p AVG.DPTH c.. Natural soil not stri de Stone, brush, etc., greater than 15' from DS S area. , e. 100 ft. from water course /wetlands. SEWAGE DISPOSAL SYSTEM a. Septic tank size '00 1,250 b. Septic tank instal evel c. 101 minimum fran foundation d. No 90° bends, cleanout within 10 ft. of 450 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 7 .. f, JUNCTION BOX - properly set s ba TRENCHES g. 1. Length required - Len installed �c- 2. Distance to watercourse measured: ft. 3. Installed according to plan 4. Distance center to center 5. Slope of trench acceptable 1/16 - 1/32 " /foot, A- 6. 10 feet fran property line - 20 feet - foundations Jc- 7. Depth of trench < 30 inches from surface � 8. Room allowed for expansion, 50% 7. 9. Size of gravel 3/4 -.11" diameter .10. De th of gravel in trench 12" minimum 11. Pike ends �ed _ k _....._... - - -_.. M r Y h. PUMP OR DOSE- SYSTFMS� 1. Size of pump chamber .- 2. Overflow tank 3. Alarm, visual /audio �- 4. Pump easily accessible manhole to grade 5. First box baffled 6. Cycle witnessed b y Health Department estimated flaw per cycle HOUSE - a. House located per approved plans. 2 + ►-�S CC �� b. Number of bedrooms - t l WIIL a. Well located as per approved plans zs C�J � e� b. Distance from SDS area measured cz ` ft. c. Casin 18" above grade. d. Surface drainage around well acceptable. S eC OVERALL WOPI MASHIP 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. Curtain drain installed accordip2 to plan f. Curtain drain outfall protected & dir.to exist.wate 'Course 9. Footing drains discharge awa fron SDS area h. Surface water pLotection adequate i. rosion control provided on slopes reater than 15 %. � be' 'submitted to the Department and '&" written guarantee w I place.:: in good operating' con ddion any per of said ,sewage'G ance,of' the approvals of the Certiiicate "of Construction Com, will 6e located'ai sh4iWn on the approved plan antl that said WSJ l %0 County `Department of Health? Date April 22,..'1986 5. Adesress{: .RD ,9� FaiynS : APPROVED FQR CONSTRUCTION . This:approvsl expnes onr requires a new permit, proved ror - disposal or ioome is I Date�� ey fished the owner; his wccessors,`heirs or assigns 6y the Duildat, that, said builder'vvill stem during the period of two (2) years immediately following the date of•,the,.issu- f+the original system o► iffy repairs thereto; 2) that the drilled will described above. ailed in accordance with the, ndards,' rules anQ regu a !ons f. the Putnam o':• P.E. ' - x R.A. _— License No 299�h n t 'ldate sue u ess.. ton ruction• - the budding has been undertaken and Is s y` m Toner f.;Ftealt Any. Chang' or, alteration, of construction e r P i ate e Title d. LO PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES -'.. T';� T,,-� T2T. T -'T :n.nr,T. .i�V.: .'1 .. .. 1.�51G r. _ ..,_. �.i.l CO�.1 0� 1c� �JiLD1 G;' -CA-17 rili, DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Ja k h Ho n a r-L v Address c Located at (Street) r7�d Q . 12- �ree Bloc k Lot 2, In ica e neares cross s ci-lAAJS giriSmah S' ,tbdy 4sl-*2 Municipality. Watershed (frA_b&„ SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Role Number CLOCK TIME PERCOLATION PERCOLATION RM apse Depth to Water Water ve No. Time From Ground Surface in Inches,.. Soil Rate Start -Stop Min. Start Stop Drop in - Min. /in drop Inches Inches Inches 1(100 1133 2 rzL► 312-7) 1833 72 Z� 4 (3 33 1445' 2 11105: 12- 3 I Z23 (319— 57 y4- 27 2 4 FEB 2 8 PU T N AM HEALTH Notes: 1) Te'�ts to be repeated at same depth 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 'NO. " �._.....: ..:N , - .:- ,.1....-.. _.a..:. HOLE NO. �� .... ._ ... _. � _ __.. _: _. -. . _...... �.u; HOLE N0. G.L. 6" TP90;f 12" KGs _ 18" 5a V412 2411 30 It 361 .421t 8 54+" •� eZ Fik b 60" 66" D it smwyl L.® 72".. 78 ". 84" 3o „. INDICATE._L qq . L XJTnf GROUND WATER IS ENCOUNTERED See made INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER -BEING ENCOUNTERED _ TESTS -MADE­ ;j. �:�? Date°t: L1JIJ1UlY Soil Rate Used jr 0Min,/l "Drop. S. D. Usable Area Provided ' No of Bedrooms re-a Sep tic ppp���.,q Tank Capacity. O 0l) Gals. Type cl Sc;4�y Absorption Area Provided By�L.F.x24+ V ... width trench. A[ F Other QRO4 PR .�ci Name p� [ . ig E- �a Y e' C ST. ^+ y _�V Address n -ii, y j� THIS S SPACE FOR USE B BY HEALTH DEPARTMENT O ONLY: � Ok -rl � J:f Health al ilealth Servic- Of 2nV!ronm3r-t rovoa as noted for Conformnee with _:,licablo VULLes and Regulations of the t.itnam County jje. th Department. r Structure located from survey by surveyor noted belo wN Well located by: Surveyors survey•— Well drillers report Engineers mesurernents❑— Tank, DGAeS, pits, galleries 8 loteFols io-ccile4 by:Contr 4itnr: Engineer: ❑ Fidia inspection by: Health depi do? a Engineer date —j556 NOTES: J '-1. '21 ." fk"'- it. DI ME N SION i A A C 41 Z" —t/7r A 3 Q A J,'5T j 6 F 4 L A 6 G A H A K 77t:— J0 SANITARY SYSTEM DESIGN OWNER: LOCATION STrecl:-- Z:; Town Zt5,D'�J County: .7- K . V t e SUBOMSION Mop: Hjz,cl • ;+ LOT N° f: Ouilclet: zz - S b N' 4— N T IS P F R 06 it _ 4 A •� ; . PUTNAM COUNTY HEALTH DEPAR7MENF cK - A a DIVISION OF ENtiIRONMENTAL'HEALTf3 #SERVICES John 'M: Simnorris, M.D.' •Deputy Canmssioner'of Heatth� -FIELD ACTIVITYREPORT5heet' f L INSPBCTION VAE Orig . Routine Orig. Complain ADDRESS -. A.i�i,./�oai f�I�$°'� ° r % %-'�' -.� Orig., Request Ng. Street-- Town 'IlK 'No. Canpliance Gamplaint Cane MAILING ADDRESS Final -P:O. °'Beat- .. ` . °Post. Office :zZip Code Group Illness Construction TEIEPHONE` . Reins pectin n _ PERSON JWCHARGR << Field, Sampling Only OR INTERVIEWED !��^%��? Y "s '' /f^�,�'•� -r./, Field Conference - air��t. Other `DATEI %O 'TYPE. FACILITY TIl� ,ARRIVED TIME Explain FIDIDINGS ` Gds r ✓ iG. /- %L G:'._ .. 1/J!� ^ . _ / 40 .�/' `51 oe- ;/er— cif •or..�. s w ' J _ r ✓ �. C 4r �A / o ez w � - INSPDC't�OR• TELEPHONE: . Z- - Signature 'and Ti - , k y��pp��+ry���� Aq 1 nD r `PJJLY7Vi`Iv' IN ,q ARGFi OR ;I ack*1 ': 0 °this -:7 eld. Activity.. Report: SIGNATtk2E: 6/86 t. TITLE