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HomeMy WebLinkAbout1892DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.09 -1 -9 BOX 17 01892 y. N16 t Ir7 It L 9� , 01892 k,: '�' ,. '' n.:." .5 "•+r :', t5'7 ::e" s #y3'� ,p. Rev 3 8 PUTNAM COUNTY DEPARTMENT OFrHEALTH x I)ivielon of Environmental Health Services, Carmel,�N Y. 10512 v ' Engineer Must Pro`vlde _ g 6 > P C H D Permit q t � " CERTIFICA Y TE OF CONSTRUCTION COMPLLMiCE FOR SEWAGE DISPOSAL SYSTEM � S oer •• .:.... ".� e� :y t �' - �i.-• a Y .,� .r, Q TOWn 9E- �GII61ge � .. , located °'at j Qr Q►Q "4� Ta: Map l72 =Block Lot Owner Yapplipint Name6 � h C` `fir Formerly Subdivision Neme s Snbdv; Lot iI MaWng Address I fO' �P / 'Z S G 3 Date Eermit Iesned Z 86 s.. :. :. �, 1t Separate Sewerage, System,ballt by enerc lFx t-ava` /oho »- la,<oK tHC Address D Box 77 P�4- �cno�, 'Lf� /ZP'6 3 Coneistin of 1 d dO Ga11on:Septic Tank and Cs 7. rg Water Supplp PnbUc SnpPly'From a Address " "or: private Snpply Drilled by ©y Address n 1 Bnlldln ° �I ` B 5 e h7 (CL Erosion Control Beea Completed! / h ' r'e 5 5 ; B TyPe Nnmber of Bedrooms `Hue Garbage Grinder,Been Installed! Other Requlremente •I certify that the systeui,(e) as'iisted serving. the above "preauses.,were construct�d.,easentia11y4as -shown on `the plans of the completed worlc.� ".('copies of which`are; attached), and in "accordance.witA the standards rules and regq tiona in,.accordance; with the iled "plan and the permit issued by the "Putnam do ty•De rtment Of Health.. R Date :4788 ortif{ed by P E" R.A. r, �YI}�Q ✓S h l.S 3. StoIZ4 Address Lieen_ M No Any person occupying' premises served by.the above systemis)v shall promptly,.take wcA action as may be,nscesYry to acu ,s the correction , of any unsanitary conditions resultln9 _from such :usrge �Qpproval .o the= separate ssvverape.system shall b#comb null•a`nd voW as soon as- a pubt`- sanitary pw�r becomes a4al le' tila; and tKe approwP of, -the ;private water supply�s, become null and --voW" when a pUbllc water wpply beeomef. available. S6A. h appigvals are subject to modificit{ori:;or change when, ,in the .iudgment of the &Mmissioner of Health weh revocation 'modlfkcation or change ti'neeessary.. G Date • � ' Dr• r i Title �� purNAM COUNTY DEPARTmEar.OF HEALIH DIVISION. OF ENVIMNMENTAL HEALTH:<SERVICES N Owner or Purchaser of Building. Section Block Lot.`: r Building Constructed by 7Z Location - Street Municipality Building Type Subdivision Name. Subdivision Lot # GUARARM 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. shcwn 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 systemr. _except where the failure to operate properly. is caused by the•-wil fui or negligent -act of the occupant of the -- bu,ildi.ng ,utilizing- - the.system. The undersigned further agrees to accept as.conclusive the detezmination 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 of, the occupant o e build' utilizing the system. Dated this 9:r_2� day of 19 Signature Title Contractor (Owner) Signature rev. 9/85 mk s _14C W Y� WELL UUMYLbTLUN xLrvnt DEPARTMENT OF HEALTH -Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET AOORESS: TAX GRIO WMEk: R,,,E,� ,QoRD PA7rR -nSoN WELL OWNER NAME. . ,eT ADDRESS: SNLcR Lt.J00 D Ho/n 5 0l 0AW4 A16- Jt/. arPSIVATE O PUBLIC USE OF WELL 1- primary 2 - secondary XRESIDENTIAL O PUBLIC SUPPLY O AIR /COND. /HEAT PUMP O ABANDONED O BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify O INDUSTRIAL . O. INSTITUTIONAL O STAND -BY O MOUNT OF USE YIELD SOUGHT �' gpm. /NO. PEOPLIE SERVED ­6_'l EST OF GAILY USAGE sj4..Q Col. REASON FOR DRILLING IS(NEW'SUPPLY O PROVIDE ADDITIONAL SUPPLY .O TEST /OBSERVATION O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA WEL-,. DEPTH 6 d ,TiL IsTAncWATER LEVEL fL DATE MEASURED DRILLING EQUIPMENT O ROTARY OCOMPRESSED AIR PERCUSSION O DUG O WELL POINT O CABLE PERCUSSION O OTHER (specifyi: WELL TYPE O SCREENED ❑ OPEN END CASING 19 OPEN HOLE IN BEDROCK O OTHER -CASING DETAILS TOTAL LENGTH fL MATERIALS: A STEEL O PLASTIC O OTHER LENGTH .BELOW GRADE n JOINTS: O -WELDED' ITTHREADED O OTHER. DIAMETER in. SEAL: iiCEMENTGROUT O BENTONITE OOTHER WEIGHT PER FOOT Ib. /iL DRIVE SHOE: p(YES ONO UNER:OYES. RFIO SCREEN DETAILS DIAMETER (in) SLOT SIZE LENMN (It) - DEPTH TO SCREEN (it) OEIIELOp M F OM ONO , • GRAVEL PACK O YES O NO GRAVEL DIAMETER TOP SIZE: OF PACK In. DEPTH .;—AIL s01TDlut DEPTH .,..,...r. It WELL YIELD TEST If detailed pumping METHOM. O PUMPED i tests were done is in- ACOMPROSED AM , formation attached ?. O SAILED' O OTHER ; O YES C3 NO WELL LOG It more detailed formation descriptions or sieve analyses are available. please attach. oEPTN FROM SURFACE w,t,r & ,r, inq wen 018, Mitt t A?>D!1 DESCRIPTION WELL DEPTH K DURATION hr. min. ORAWDOWN tL YIELD ppm. Sand Ue IO �'Qi4t:.77J2E'D �-� D Wit' 02/ S t.EdG -E ro 77I 4. 3o Sf//�T -- o 9, q�d�li ✓G is+4rfL oCt Xon/F /A/ 0- " 4R � 7� 5 So r zoo je 5-12 5rr3 So�TZo.vE cJ NvQivciS ,$L6Wv 41A WATa O CLEAR TEMP. QUALITY O CLOUDY, HARDNESS O COLORED ANALYZED?. O YES O NO ANALYSIS ATTACHED? O YES ONO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELL DRUM HAW 5� Q�2.fc d.C,cz�.:� -C.Q.e eo J � AoollESs C�cLJvrn1,Q %L /0 { G CA . 006276 d, Yorl� own Medical Laboratory, Inc: fyM x, �z c.�� ��t�y` f2 a u i% 321 Kcar Street Y n Date Tak 2' 8 Yorktown Hei hcs, N. Y 10598 en . Time: in �. 8 P14j 2443 =s26.- Date.. „Rc! d Date Reporteds U 5 Directors A16ert H. Padovani M. T. (ASCP) Coll,ect.ed By: herwood omea r Referred By SHERWOOD HOMES INC. 'f Semple Location. a e'r ._,a, aVer, River Rd, RD #2, BOX 9-� Patterson NY, Phope # b55 - 5t-500 PAWLING, NY...125,04 'Phone # Sample Type: L Repeat Test ?_ _ (check one) LABORATORY REPORT ON THE BACTERIOLOGICAL QUALITY OF WATER_ GENERAL BACTERIA x Standard Plate, Count.(CFU /1.OmL) (Agar Plate @ 35 °C) MEMBRANE FILTRATION TECHNIQUE (MFT) x Total Coliform (CFU /100mL) Fecal Coliform (CFU /100mL) Fecal Streptococcus (CFU /lOOmL) MOST PROBABLE NUMBER TECHNIQUE (MPN) Total Coliform: MPN -Index (per 100mL) Fecal Coliform: MPN Index (per 100mL) OTHER ANALYSES, REMARKS (For:Laboratory Use) I Potable _ Non- potable STP INF STP EFF Other: Sample Status: (check each) Outgoing _ Na2S203 Incoming LE 4 °C GT 4 °C KEY FOR TERMINOLOGY RDS = Recommend Disinfec- tion of Source TNTC= Too Numerous To Count. CON = Confluent ( =TNTC) LE = Less Than or Equal to GT = Greater Than N/A = Not Applicable THESE RESULTS INDICATE THAT THE WATER SAMPLE {WAS) (WASN'T) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO TH NRW ORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT E TIME OF COLLECTION. For Lab Use Only _ H/C to . . /x/ �ry Ii. IV. V. Vi. is �640 FINAL SITE INSPBCTION Date J_ Inspected try ;CATION IZ J r 0047 OWNER TM # OR SUBDIVISION LOT 1( MMMENTS MGM DISPOSAL AREA a. SDS area located as per a proved plans k--T b. Fill section - Date of placement 2:1 barrier- IGTH WIDTH AVG.PP--TH\- C. Natural soil•not stripped d. Stone, brush, etc.., greater than 151 from SDS area. e * . 100 ft. from water course/wetlands. SEWAGE DISPOSAL SYSTEM a. Septic tank sizes, 000 1,250 ' 49 b. Septic tank installmd-le-vel OP c. 101 minimum, from foundation d*. No 90* bends, cleanout within 10 ft. of 450 bend e. DISTRIBUTION BOX 1. All outlets at same elevation - water tested —— F 0 2. Protected below frost 7 3. Minimum 2 ft. original soil between box and trenches ---'-- 4g!fd' ig 'Ale f. JUNCTION BOX --properly set g. TRENCHES i. Length required - !��Zq /-j*agLh installed 2. Distance to watercourse ineasured- ft. 3. Installed according to plan 4. Distance center to center 5. Slope of trench acceptable 1/16 - 1/32 "/foot: 4-- 1P. Z4111 6. 10 feet from property line - 20 feet - foundations A 7. Depth of trench < 30 inches from surface 8. Roan allowed for expansion, 50% f a 41-f 9. Size of gravel 3/4 - 1P diameter 10. Depth of gravel in trench 12 minimum 11.* Pipe ends capped h. PUMP OR DOSE SYSTEMS ..- l.- Size - -of:. ._ chamber.- - --------- --- 2. Overflow tank 3. Alarm, visual/audio 47 4. Pump easily accessible manhole to grade- 5. First box baffled 6. Cycle witnessed by Health Department ORW-0, estimated flow per cycle HOUSE . a. House located approved plans. b. Number of bedrooms WELL T. —Well located as per approved plans ip 7-o Z o b. Distance from SDS area measured afj I ft. 0 C. Casinq 18" above grade. d. Surface drainage around well acceptable. OVERALL WORKMASHIP a. Boxes ro perly grouted v/ b. All pipes partially backf illed C. All pipes flush with inside of box d.' Backfill material contains stones < 4" in diameter - A e. Curtain drain installed according to plan f. Curtain drain outfall protected & dir.to exist.watercourse /x- g. T661ting drains discharge away from SDS area v h. Surface water protection adequate i. Errosion control provided on slopes greater than 15%- 1( ATI" N owl) - V L�w, 1) 0 1) 6) VA 00 XPU Kej W DATA I VW, Gmklo VA m: I DA to 4; mgjoitgA "241- A -N3 -DESIGN- -DAT-A-SHEEM-SUBSUFACR. S914M DISPOSAL.. SYSTIM FILE Owner T(;) Address P\,jye., RoJ R PD 't-,3 Located at (Street) X i y f- o 9. Sec. Block j Lot (indicate nearest cross street) Municipality s L, 7 Watershed C )-a ic, 1A SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMI= WITH APPLICATIONS I 2,,' 15- . of Pre-Soaking Date of Percolation Test LDate CJ/ Cz 3, HOLE NU1BER CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate start-stop min. Start* stop Drop In Min/In Drop Inches Inches Inches* 17-103 2 3 12-: 1-4-- !Z: Z3 9 2Lt 27 3 3,0 — 4 11: S7 12 !.os- 2.7 2 1 2-il 2,,' 15- 3 3, 4 5 2 3 5:� , M=: l-I,Tests 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 fran top of hole. rev. 9/85 TEST PIT. DATA REQUIRED TO BE SUBMITTED WITH APPLICATION OF IN TEST 2' 3' 4' 5' 7' 8' 9' 10' 11' 12' 13' sue` y w C�� �t.e; Llvrr''Ci iOY' Lie 71-'6 . //y� fir', �,; W'i" 14' --- . - - - -_ INDICATE,LEVEL =AT- ;WHICH_ GROUNDRATER .IS_ ENCOUNTERED. -, . _.._.- -/l/��.,:; __._.�:.:.: _ ..... :...... .._. INDICATE LEVEL TO WHICH DATER LEVEL RISES AFTER BEING ENOOUNTERED DEED HOLE OBSERVATIONS MADE BY : ��� �v , Al « �f J�_ DATE: 4 14 DESIGN Soil Rate Used (D --7 Min /1" Drop: S.D. Usable Area Provided ,J No. of Bedrooms 2 Septic Tank Capacity l o a 0 gals. Type Ca i�ra r� Absorption Area Provided By Other �' Y--4' G aliv.►-i1t.-c L.F. x " 24 " h /width trench, /, + 8 %Y. r4EJc) � Name . 90, il1, Ali cicl r 4 r Signature Address i 3 I Pri v 2, SEAL S-4 3 THIS SPACE FOR USE BY HEALTH DEPAR21ENr ONLY: Soil Rate Approved sq.ft /gal. Checked by _ U&N u► \� No. 56114 Date ,.. PUMAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS ;...:. SP ON-RE1 DATE: �-- INSP. BY: 7 ( ' o er) (Street Location) INITIAL SITE INSPECTION YES NO COMMENTS Wetlands on /or proximate to property .............. Property lines or corners found ................... Can- estimate house location ........................ Will driveway need cut ............................ Must trees 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/ septics ............................ D.H. 1 Lot Depth to G.W. Depth to rock Soil Description 0 ft. 3 ft. 6 ft.'" d' 9 ft. 12 ft.. D.H. - Deep Hole G :W. -Groundwater D.H. 2 Lot D.H. 3 Lot Depth to G.W. Depth to G.W. Depth to rock Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. 12., ft. Soil Description Soil Descr 0 ft. 3 ft. 6 ft. ;9 ft. - -2 -ft.. DATE: FINAL SITE INSPECTION INSP.BY: YES NO COMMENTS House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Roan allowed for expansion trenches .............. Over 100 ft. from watercourse........ ......... Natural soil not stripped or SDS area � unnecessarly graded...... ... - � .... ....... 10 ft. maintained fran property line and 20 ft. from house... ........................ Distance well to SSDS (ft.) ...................... Number of bedrooms checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench.. ........... 15 ft. of peripheral soil horizontally fran trench ..... ............................... Boxes properly set ............................... Could surface runoff fran driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... �� FINAL G ADNG OF SITE ACCEPTABLE.. 4' x A' . PROvit TW y .15 t0 GFit2t`,t.iY AT Tip vEiNl�l�E _v.ts = G S?05t111� : aY trM WAS G01�1SifZUL'(G17.Ac�a iN'D1- T [� ' ST! ' GA'iE>7 ON T�+iS PL.. AN FlN c?•:Tt�AS °ktYriM w�S::iNyPGfn.f ME iT wars T. o'.`;TO �� • Gl�V�~Za✓D iTLG�iZ : '�l-tF �h:�F'6M sN�s G,7hi:-