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HomeMy WebLinkAbout1711DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -432 BOX 15 ly �, �. ` : ism 0 01711 —�,,7- 7­7 7777 . PUTNAM.COUINTY DE PARTME-NT OF HEALTH Rev. DiviiionofEri6mmentidgeiawgi-,dg,Carm61, N.Y . 10512- Engineer P;C..H.b.Termll:# 12A tUCTION; COMPLIANCE, FOR SEWAGE DISPOSAL SYSTEM TLI ZIP Separate SO.P. In by Qinslsiln. of Gallon Septic Tank and g Date Permit Issued IV. Lot # Water Supply: Puync Supply From Address P) �AeAA M& A) Y 0 GO or.' V_/ Prh'** So ply Drilled by P ;4e leted? Building Type 65117eA)74#L,- _'Hris Erosion Control Been Conip A)O Number Has Garbige Grinder Been Installed? Aedr.o6ms Other Requirements renets I certify that - &'system(s);dslisted serving the above premises were constructed essentially asshowh on the plans of the completed,work copies of certify attached),' and �in accokdancia with the standards, rules and rego ; a he* led plan, and the permit issued by the ions, in ac rdance with. Putnam County Depar_bn nrMealth. �j 7—j /I E. . R.A.— Date Certified by P. �A-/ P712 _�Icsnse No. Address Any person occupylrigI premlses,served by the abo . ve system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary cdnditip�ns'rsiulting from such usage, Approval of the isperati sewera.0'systern Sh I all become null and void as soon as a pub;': sanitary sewer becomes aviliablo and the ap6ro'vai o'f."the priv . a . to - 'v I �a­ter supply shall bec6me'null and void when a public -water supply becomes available. Such approvals are ► of Health, such revocation, modification or change Is necessary. subject t dification or c6angi when, :. in the" judgment of the COMMISSIOMi Oat y M PUTNAM COUNrN DEPARTMENT OF HEALTH IO ' .0 - E� S > Owner or Purchaser of Building Section Block Lot 4flf44— � 1urvl % CAW ✓1 Building Constructed by 23 ' 0; r+- M�c� Location - Street /� 2 C w I -c't -. ; Municipality lops i den f i -9 Building Type _crc, /3 c C_ HI CC- Subdivision Name Z- 3 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 immediately following the - date of approval of the "Certificate of " Construction` -C6!hplidi. ce`r for `"tYie "sewage a sposal sy� en;" ors 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 Director of the Division of Environmental Health Services o Department of Health as to whether or not the failure of the caused by the willful or negligent act of the occupant of -the the system. . Dated this day of 44ee- 19 /Z GerWxal Contradtor (Owner) - Signature Corporation Name (if Corp.) the determination of f the Putnam County system to operate was building utilizing Signature Title L 1 I N 9, P-r,, y, c-` l� kc'- J'vi- Address ' rev. 9/85 mk , / C,00rporation Name (if Corp.) Address _ A I I 1 L._ .. >...- ..,�....� ...rx ..., m. �. -�.a —w ..�w.. r- ., -...,. a.. .- ., .......,_., c�,o,.o.,.cw..en .a. >..., T, .,� ............. ,...-- ....... «. .... -v-, BREWSTER LABORATORIES Box 224 - BREWSTER, N.Y. (914) 279 -4945 i i WATER ANALYSIS REPORT SAMPLE' NO. 7410 HOSE BIBB WELL SOURCE: R. Sutherland Lot 23.Steinbeck Hill Brewster, N.Y. 10509 COLLECTED: 6-26-89 !BY: P.F. Beal & Sons BACTERIOLOGICAL EXAMINATION Colifo'rm Count, MF Method 0 per 100 ml. i i i This result indicates the source of the sample was •i of satisfactory sanitary quality when the sample was collected. ,1 I i i 6 -28 -89 t ' T as Meyer Director i b p 1. a i?►�oIJ 1TT TTT/lAT TTTAI'1T WhLL LJU1T1rLz11VV Mzrual DEPARTMENT OF HEALTH �;Asion �Of- �Envir-onment<al .Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only 4 ©-� - 6 / - WELL LOCATION STREET ADDRESS: WNw1l 1 Y TAx GRIO NUMBER: Steinbeck Hill Brewster,NY Lot #23 WELL OWNER NAME: ADDRESS: Robert Sutherland, Farm to Market Rd., Brewster;NY p pgivATE ❑ PUBLIC °USE OF WELL 1 - primary 2 - secondary ® RESIDENTIAL ❑PUBLIC SUPPLY ❑AIR /COND. /HEAT PUMP O ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING Q NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 14o ft. STATIC WATER LEVEL 30 ft. DATE MEASURED .12/10/88 DRILLING EQUIPMENT IS ROTARY �] COMPRESSED AIR PERCUSSION ❑DUG ❑ WELL POINT 0 CABLE PERCUSSION ❑ OTHER (specify): . WELL TYPE ❑ SCREENED ❑ OPEN END CASING IN OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH 22— ft. MATERIALS: 10 STEEL ❑ PLASTIC ❑ OTHER LENGTH .BELOW GRADE 21 ft. JOINTS: ❑ WELDED (3THREADED ❑ OTHER DIAMETER 6 in. SEAL: (3CEMENT GROUT ❑ BENTONITE ❑ OTHER WEIGHT PER FOOT 19 Ib. /ft. DRIVE SHOE: E] YES ❑ NO LINER: ❑ YES iD NO SCREEN DETALLS' DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (it) DEVELOPED? FIRST_ SECOND HDURS GRAVEL PACK 11 YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH It. WELL YIELD TEST I If detailed pumping METH00: O PUMPED 1 tests were done is in- 0 COMPRESSED AIR , formation attached? 0 BAILED ❑ OTHER i ❑ YES ❑ NO WELL LOG 1f more detailed formation descriptions or sieve analyses are available. please attach. DEPTH FROM SURFACE wager Bear. ing well Dia- In FORMA710N DESCRIPTION G7oE, ft. tt. 1NELLDEPTH ft. DURATION hr. min. DRAWOOWN ft. YIELD 9PM- Surface 8 Erilling in overburden clay & bldr5. Pit at- 14o' 6 120 20 8 22 it ing in rock,se.t casing,groute . 22 ' 1 ing in rock granite. .140 WATER ❑ CLEAR TEMP. a;QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES 0 NO STORAGE TANK: TYPE Well Xtrol 302 CAPACITY 86 GAL. PUMP INFORMATION submersible 10 g TYPE CAPACITY MAKER Go i 1 d DEPTH . 100 i MODEL10EJ05412 VOLTAGE 30 HP =Z WELL DRILLER NAME P. F. Beal & Sons,I �E/ /89 ADDRESS PO Box B SIGfDZE Brewster,NY 10509 a.Y — t �/ , :., . s— i ,— ."�'..: ,c ^'+s-- e^u••r �^--- �—r xe� i�'"." r �-""'� � _... -.. k- - ---i --- --r•«— -�-- r— •r'---- .•.— .- 7.-, -. PUTNAIVI.COUNTY DEPARiii r" ' OF HEALTH U DlvlWon of Eavtronmentoi Hoaltti Servkes Cume1 N.Y 1051? ; E eer. to Provide Permit M i t . ( con CERTIFICATE OF COMPLIANCE .. '' ". . • , ' 1, • .; ..•Perm! CONSTRU ON PERMIT.FOB- SEWAGE DISMPOSAL SYSTEM t q -g g • + � 'f - i � 'Town er-= i4Hago _ SabilltiWon NMine t rTi� il/+ �C �.U. -Sabel Lot q 2 3 h Ta: Mop Block 2 Lot L �DD IV Renewal ❑ Revision ❑ Owuei /Appuaiot Name i Date.of Previotis Approval MaWng Addreea �! 41 T.0 G N�'�.l ; • �'H ZIp :. BdWing Type Oi Lot Area.' D, Fill Seetlon only De . V,olame • p 0 PCHD Notification is Required When M is completed Number of Bedrooms "r Design Flow G P D 2 _ Sepaeate Sewerilge system to constrt ot�GaOon Septic Tanl� and_ �� � � l�r✓a °'a-� ��� ���. , To be oonsteucted byt' FJ�.•.. ��fiiii�- ilA'IIV% ' Address Water SuPPb: Psi bUc; Supply From Address _ ' on _ . Pelvste Supply DetSed by .Address ' Otber. tteuitlremeute Crepiesent` that I am wholly and completely ►esponiible for'the tles�gn and location of;ths proposed `system(s) ;' 1) that the separate` sewage .disposal system above described will be,construcfed as shown' onahe approved amendment there to and in accordance with the standards,.rulesand regulations.of the Putnam County Department, of, HeaKn,; and that on completion thereof a '. Certii;cate, of .Construction Compliance satisfactory to the Commissioner of Healthwill be' submitted to the Department and a w►�tten "guarantee,,will be furnished the owner, his successors, .heirs or assigns by the builder, that said builder Will place in good operatmq conddion any part of aitl sewage tliaposal system• du►mg :tne peiipq.of two (2f years immediately followirg.theIdate of 'the issu- ance o} the ,approval _ of theCertif�utetot Construction `Complmnce of t s'ori inal, system or an 're g y pairs'thereto 2) ,th�t.thedrillad_well.pesc�ibed above will be louted'as sh&Wn ii;the approved plan and that said well w l be,inst I ' n' acc_or8ance with�he, st and" ds,` as a repu a Tons• of .the Putnam County.0epartmenC ot:Hsalth.' / /� aa t✓ Oab1 . � . ���•TlV 1 ». .. Signed /,,_ c i Addrett�,Vr'� f �� ?� License Nom I Z•� APPROVED FOR CONSTRUC TION This approval expues two years :from t date - ;sued unless eonsiruction Hof the building has been .undertaken and Is revocable for cause or,may be amentled "or modified when consider d nece the Commissioner of. Health. Any change alteration construction ruires a. newfpermi Ap ofor disposal of domestic sun ai e, / p v ter supply, only. e'er. / _-CT t/: rt' -37 Date Title �� By �� t CCUNT`' _ DEPAHEA :Nr OF HEALTH - DIVISICN OF EST RMI'v-MUAL WATER SUPPLY & SJBS'JRFP_C SZQk(C",c. (Name of Cwne -r) REV W SI�r - CONSM-=ION PE'RMTT t YES I�NO I DCCr��rrS Permit Application Co rate Re= 111+_1 ' c rrr5 11,11 1 I t I I I I i I I I L trench provides r _ui= w 60 ft. Parallel ours 100% ex.. I h I I C1 ay rier 10 f- rill 0 e ne-' Ceo" caauges I I. 100 flood elev. I I 200 ft.''! resew ir, etc. 150 ft. trigal?(gall. s I I HEALTE SERVICES DATE R.5'J � -, cv :7110 1� BY: C.(4- �3 rpo _o on Plans - Three s`ts Engineers Aithorizaticn Design Data Sheet (DDS) SUBDIVISIC�', Deep Hole Lcg Perc �' 9, Consistent Perc Resits (3) Fill -` Perc Hole Deptn c-; r -- Hcuse Plans - T•wo sets Well --" Fe.-nit; F;ac letter `�� variance ee ues �r-L Lea? Subdivision Subailvision Approval O ecc E:t- ac_•rcval SSDS Pd- Lots C.';e^';ad Wetland (Tcw -r/DEC Pe nit R & D) Data Cn DDS Plans & Permit Sal RE:QTj= DET<` TT c CN PTA-;S Se:va -ue Svstem Plan - (nort:-i a_.Cw) Sean- Svsten Hvdraulic Fill Profile & Dimensicns D or J Box;Trencn /Call_ry; .pF�q, pit details Septic Tank - Size, Der -1 Well Detail, Service Line if' cc-r Crnstructicn Notes (grinder rate) Cesign Data: perc and deep rasul.s. Two- -Foot Contours Existing & P_c_resea Drivemay & Slopes Cut Footi n /Latter, Cur -ain Drains (disdiarge CK ) Perc & Deep Holes Loci t Representative or pr; inary and e_r,.ansicn tension Area; shcw-n; gravity flew, suff size If Purred Pit & D Box Shc-N-n & Detailed House - No. of Bedroans Wells & SSDS's w /in 200 ft. of Proposed Systr Property Metes & Bounds House Setback Necessary (Tight lot) House Suer - 1 /4 " /ft. 4 "0; T_ce pipe No Bends;. Max. Bends 45' w /cieanout SEPA=ON DISTANCES SPECIFIED CN PLAN Fields 10' to P.L., Drive�Nay, Large T_ees,TCD of f_ 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Strum, Watercourse, Lake (inc. eT 15' to Drains-Curtain, Footing 35'to cm-tcz basin, storndrain,cice3 waterccur 10' to Water Line (pits -201) 50' into= i.ttent drainage ccurse Sentic T.nks 10' fran Foundation; 50' to w-el-1 15' Well to PL 9 variance ee ues �r-L Lea? Subdivision Subailvision Approval O ecc E:t- ac_•rcval SSDS Pd- Lots C.';e^';ad Wetland (Tcw -r/DEC Pe nit R & D) Data Cn DDS Plans & Permit Sal RE:QTj= DET<` TT c CN PTA-;S Se:va -ue Svstem Plan - (nort:-i a_.Cw) Sean- Svsten Hvdraulic Fill Profile & Dimensicns D or J Box;Trencn /Call_ry; .pF�q, pit details Septic Tank - Size, Der -1 Well Detail, Service Line if' cc-r Crnstructicn Notes (grinder rate) Cesign Data: perc and deep rasul.s. Two- -Foot Contours Existing & P_c_resea Drivemay & Slopes Cut Footi n /Latter, Cur -ain Drains (disdiarge CK ) Perc & Deep Holes Loci t Representative or pr; inary and e_r,.ansicn tension Area; shcw-n; gravity flew, suff size If Purred Pit & D Box Shc-N-n & Detailed House - No. of Bedroans Wells & SSDS's w /in 200 ft. of Proposed Systr Property Metes & Bounds House Setback Necessary (Tight lot) House Suer - 1 /4 " /ft. 4 "0; T_ce pipe No Bends;. Max. Bends 45' w /cieanout SEPA=ON DISTANCES SPECIFIED CN PLAN Fields 10' to P.L., Drive�Nay, Large T_ees,TCD of f_ 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Strum, Watercourse, Lake (inc. eT 15' to Drains-Curtain, Footing 35'to cm-tcz basin, storndrain,cice3 waterccur 10' to Water Line (pits -201) 50' into= i.ttent drainage ccurse Sentic T.nks 10' fran Foundation; 50' to w-el-1 15' Well to PL 9 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 X WELL LOCATION Street Address Town V'6#t -y Tax IZa QR- -(- r*.25on1 Al Grid Number - 2- I&, I WELL OWNER Name Mailing Address pi o. bap. q70 AlPrivate MQNfurz- grme FITS' wwrAfW1 Co. urep C *,c: N I,OS 12 O Public USE OF WELL 0 - primary 2- secondary RESIDENTIAL ❑ BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION d INSTITUTIONAL Q STAND -BY 0 ABANDONED ❑ OTHER (specify O AMOUNT OF USE YIELD SOUGHT 4j, o gpm /# PEOPLE SERVED /EST. OF DAILY USAGE gal REASON FOR DRILLING NNEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL O TEST OBSERVATION DETAILED) REASON FOR DRILLING C.l� WELL TYPE IM DRILLED DRIVEN ODUG ®GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES _N0 IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: w21MJV15WL FIJCL Lot No. 2 WATER WELL CONTRACTOR: Name ID M M- 6K.N41 Vrr b Address:, IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _ NO NAME OF PUBLIC WATER SUPPLY: Wit TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: . LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION ON SEPA E EET /a- tr, -5,-o (date) (s nature) PERMIT TO CONSTRUCT A WATER WELL This permit Ao 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 He 1th.Department attached to this 3. Submit a ell Completion Report on a form Health D p rtment. Date of Issue: 19 L�_ Date of Expiration: 19 Permit is Non- Transferrable 2/87 requirements of the Putnam per it. pr vided y t a C ,e mit Issui ng fficia White copy: Yellow copy: Pink Copy: Orange copy: H. D. File Building Inspector Owner Well Driller Putnam County Department of Health Division.of,Environmental Sanitation. AFFIDAVITµ- ._CORPORATE OWNER. APPLICATION FOR PERMIT. APPLICATION SUBMITTED TO PUTNAM COUNTY }[EALTH DEPARTMENT ! :� Tb: Commissioner of Health In the matter of application for ` represent that I am an officer or employee of the corporation and arft authorised; d to act for OA)ROC�.j �i✓ %� (name of corporation) _ having offices at y-9y1t :.L 2z- 4— 32 L04 Whose- officers -are President �k C1QC_1C0J___rq-nJ%1 _ �rE���.57Ck. j `tame and address) Vice- President �� (J 1 � C ( C&-9L 4vt _ o 7 / -SST (Name and Address� ) Secretary _Z?q!J lt? (Name and Address) (Name• and Address) _ _ m 7__ and that I am anp will be individually responsible for any or all, acts of the corporation with -respect to the approval r quested and all -sub- sequeiit acts relating - thereto. Scorn to before me this / day Signed of 1987 Title otary Public ANNE B. COhRIDAN BMtsor M WYWk conni,ew„ Enwifto . 19e� nn6a�a pew a o .� Corporate Seal PUMM CaJ= DEPARTMENT OF HEALTH TEME fC r-P -DIS -SYST POSAL TH.. m o OMA- HEA6Rr.� 11-70 .Owner- tqW"- Om u- I-: -rb tj Located --at -A:Street,-)- 2 lot 2-6•1 (indicate nearest cross street), -r .......... 011.1" ftmicipaiity w fJl Watershed C4z-O--CO 'J SOIL PERCOLATION TEST DATA REOUMM M ME SUBMITZED WM,APPLICATICNS ...... . . ...... ..Date of Pre - Soaking 10 Date of Percolation Te st .......... ... ROLE NEMM CMCK, TIME PERCOLATION FM i Elapse Depth to Water From Water Level Time Ground Surface In -Inches . ...... No. -Soil Rate Start Stop shin. start Stop :11::Ircp In K-UV'ln Drop. .*23' Inches chesLo-" kLjr& 0O t3o .: � _-1-11- 2 3 1 t 3 10'04- '10';'31' 4 to 5. 0 10 'Z 2 0. VMS: 1. Tests to be repeated: at same depth until approximately equal soil rates are - obtained at each percolation test hole. All data to* be submittbd for review. 2. Depth + reasureri-ants to be made fran top of hole. rev. 9/85 �► �� �' DID k6 No. of Bedroans _ Septic Tank Capacity gals, Type GIN c- Absorption Area Provided By ° L.F. x 24" widtib_trea e� Y� Other ��, �y N I CH Name - - �Y' 7 L � I t) �r -%,muJ = A-,-Sec— . �� Si nature.. - Gi l�� g v !✓ -�." �'� N o. 56124 Address 7 3 i-� 1 �b i s yr- SEAL • ti FESSIW�" .12,5&3 THIS SPACE FOR USE BY HEALTH DEPARTMENr ONLY: Soil Rate Approved sq. ft /gal, Checked by Date � v �-i1LL �,pp.1'� DU I LI;T ?IZO V9. V4e,L,L, THIS TO THt5, 0-1GJroe7A EW NA5 C;ON9-f KUOT.Et� A� lNt2(0^Tr,5? ON TN15 rL,^tl ANp Wpm IN WITH ALL �TAN5,ArW rULIIi9 /41\Nv Kc-GO LIAI TION� as; TH � PVTNAM COUNT-f .2 u L-2 r-,,,2 r.51 I�T-f ",12, \- f-�