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HomeMy WebLinkAbout2186DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 30.18 -1-45 BOX 19 02186 ON 4 1. No , r .04 l J� �� L� .a 111 02186 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10312 Permit a PV 39 -81 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Putnam Valley Town or Village cated L Lo at ake` Shore-- Road Ease• Tax i�aP : g ::.. Blcak 3 e owner William Barrett / Formerly Tax Map Lot N 36 subs. Lot s 352 Separate Sewerage System built by Howard Gragert Address Oscawana Lake Rd., Put Puti Val ey Consisting of 1000 Gal. Septic Tank and . ( 4 8 1X6 1 Precast Conc. Leaching Pits Other requirements Water Supply Public Supply From X Private Supply Drpletl ey Nor; -_ Address Barger Street, Putnam V Building Type One Family Residence rson Has Erosion Control Been Completed? ley, NY 10579 No. of Bedrooms 3 Date Permit Issued 12/29/81 I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the of which are attached), and in accordance with the standards, rules.,and regulations, in accorlance with the fi Putnam County Department_ Of Health. Date 5/30/83 Address >Certffied'by .Joel Greenbe .... �..... 11n .r__ A of the completed work ( copies n, and the permit issued by the R.A. X License No. 111056 "1VeW,xeVCn'.. Any person occupying premises served by the above system(g) •shall . promptly' ake such action as may n sear to secure the eorrectl of any unsanitary conditions resulting from such usage. Approval of the-'sepa ►ate, sewer$ge system shall become' null n void s soon as a public unitary sewer becomes available and the approval of the private water supply shall become null'and'vold when a public wat y becomes avallable. Such approvals are subject to modification or change when, In the Judgment oi'the,Comm oner of Health, such rev Ion, modHleatlon or change Is necessary. BY` Title Date � Rev. 9 -81 -3 FK_ PUTNAM COUNTY DEPARTMENT OF HEALTH A/ - c�. Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Located at Lr A Ka S w O R.)~ P_17 1` 14 ST' Subdivision JZQAI2-Jh14 c>0 k LA ka Owner LddL.L I AM, 6ARz?_Zz1 ' Building Type ©N E R=AM • sc.Sis r7e Lot' Area zOo 6-7 % F Number of Bedrooms Design Flow Separate Sewerage System to consist of 1000 Gal. Septic Tank To be constructed by �uT Ann VA[.LEY Town Q / Tax Map Q- 3 "3 7 Block Lot Job 81-179 Address 61! L A" Sit Q?_ F_ RD W 6S'#° PUrrl tAM LIALLEY T N 10579 Total Habitable S /pacep 1500 Square Feet and VV IN (�C b , lr i i1rJ7 '� Qw i • �. �Q�'FI L7MJl06 Address V N M VA LL F- V . MV Water Supply: Public Supply From REE Private Supply to be drilled by �nnQrp���� Address - �/^01� � �T� P / l,q m V&L ey. N /. Other Requirements 21 A &Ak_ 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 system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regu a 0ns o the Pu ffin am County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the original syste 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 be installed In accordan a with the standards, rules and regu aaTrons of the Putnam County Department of Health. Date 7 PEC1. 1981 Signed P.E. R.A. Address i License No, APPROVED FOR CONSTRUCTION: This approval expires one year f the da issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Comny)s loner of Health. Any change or alteration of construction requires a new permit. Approved for disposal of domestic �ar %y sewage, a or private ater supply-only;—- Date J ` �' ri -flu. 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Box 99 ...,.. 201 Buttonwood Avcnuc r 321 Kcar Strcct (Corner of 202, across from Hospital) Yorktown Hcights, N.Y. 10598 Peekskill, N.Y. 10566 (914) 245.3203 (914) 737 -8777 r W i,L k 495 � `�Ston cigh Avcnuc " (Across from Lloyds) (Corner of Drcwvillc Road) Mount Kisco, N.Y. 10549 Carmd, I4.Y.'10512 (914) 666 -3335 (914) 278.9330 LABORATORY REPORT mg /L ❑ ACIDITY ............................ ............................... ❑ ALKALINITY ............................. BACTERIA, TOTAL /mL ...... .. ............................... ❑ BOD, 5 DAY ............................ ............................... ❑ BROMIDE ............................ .....r......................... ❑ CARBON DIOXIDE, FREE ........ ............................... ❑ CHLORIDE ............................. ............................... ❑ CHLORINE ............................ ............................... ❑ COD .................................... ............................... ❑ COLOR ................................ ............................... ❑ CYANIDE ............... ............................... ❑ DETFR0':,4'''. ANIONIC ..... ............... ❑ FLUORIDE ............................ ............................... ❑ HARDNESS ............................ ............................... MPN COLIFORM COUNT/ 100 ml .......Q ..................... M,?h-,rrEC-A•L--ST. - 1EP COUN -T/ 100-ml .0 ......................... ❑ CONFIRMATORY TEST ........................................... ❑ NITROGEN, AMMONIA ............................................ ❑ NITROGEN, KJELDAHL ............ ............................... ❑ NITROGEN, NITRATE ............ ............................... ❑ NITROGEN, ORGANIC ............ ............................... ❑ ODOR ................................ ............................... ❑ OIL & GREASE ........................ ............................... '❑ pH .................................... ............................... ❑ PHENOL ................................ ............................... ❑ PHOSPHATE (ortho) ................ ............................... ❑ PHOSPHATE (condensed) ............ ............................... ❑ PHOSPHATE (total) ............................................... ❑ SOLIDS, SETTLEABLE, ml /L .... ............................... ❑ SOLIDS, SUSPENDED .............................. ❑ SOLIDS, DISSOLVED ............. ............................... ❑ SOLIDS, TOTAL .................... ............................... ❑ 50LICIS, VOLATILE ................. ❑ SPECIFIC CONDUCTANCE ......... ............................... ❑ SULFATE ............................. ............................... ❑ SULFIDE ............................................................ ❑ SULFITE ............................. ............................... SWR:FAGTANTS ..................... ............................... ❑ _TURBIDITY ....................................................... DATE TAKEN: �+ -1.2 d C 3 DATE RECEIVED: �,-,Z DATE REPORTED: y —/r, / _ ?3— SAMPLE SOURCE: REFERRED BY: H H a a ❑ ALUMINUM ............................... ............................... ❑ ANTIMONY ................................ ..........................:.... ❑ ARSENIC ...................... H ❑ BARIUM .. .................................:... ..I....................I....... z ❑ BERYLLIUM ................................ ............................... to ❑ BISMUTH ................................ ............................... W ❑ BORON ........................................ ............................... a ❑ CADMIUM ................................... ............................... cA ❑ CALCIUM .................................... ............................... 4 ❑ CHROMIUM (tot.) ............................ ............................... w ❑ CHROMIU(v. , :.:xavala::) ..................... ............................... O ❑ COBALT ............................................................ ........ ❑ COPPER .. ......................................... :..................... ❑ GOLD ❑ IRON ......... ............................ -Z-LEAD- .......:_......,..... ..........,.... .......,.......... �._.. ❑ LITHIUM .................................... ............................... 3 ❑ MAGNESIUM ................................ ............................... a ❑ MANGANESE ............. ............................... EWE ❑ MERCURY .... . ............................ ............................... 3 ❑ NICKEL .................:...................... ............................... ❑ PALLADIUM ................................ ............................... W ❑ POTASSIUM ................................ ............................... H U ❑ RHODIUM .................................... ............................... H W ❑ SELENIUM .................................... ............................... a ❑ SILICON .................................... ............................... H O ❑ SILVER ........................................ ............................... G] ❑ SODIYM ......................................... ............................... to ❑ TIN ............................. ............................... ........... U 3 ❑ ZINC ............................... W ❑ ........ ........................................ ....................I.......... H a ❑ REMARKS ...................................... ............................... u) H N ❑ ............................................. ........ ....I.......................... to W ❑ ............................ .................... ............................... ❑ ......} . ...... ............................... .....................4......... W E-4 ❑ .................................................... ............................... to Z ❑ .......................................... ............................... ....... x x ❑ ............. ................................... ............................... F' 3 r J!, TOWN OF. PUTNAM VALLEY W E -L DRILL --REPOPT - L ERS WELL COMPLETION REPORT This.report is to be completed by well driller and submitted t* Bldg, Departmentq together with laboratory report of analysis of water sample indicatin' 9 water is of satisfactory bacterial quality. Well Location 6' Tax Map Street Seco Bl, Lot Well Owner ame Well Driller UA Ole �ss City or -5. Ci y or own CASING DETAILS YIELD TEST WATER LEVAL SCREEN DETAILS Bailed -(.Measure from land surface) Length �1 Ft, or X _Pumped Hks, Staticoo Ft, Make; When Bailed Slot Diameterd Inches 'Yield-./y,tGPM or Pumped FU Length Ft. Size Kind: Diameter In, J.V.L/U.; Vrrin Vr VVV_LJ' .tft4eLL_r V= WELL LOG Depth from Give description of formatioms penetrated, such Ground Surface .ass_. Peat., silt, sand, gravels clayv hardpang she'l-e,i---s•andstorte-s,- .-gr.,an,L-te-, - etc-e,-----I.n --lu - e­slze. 0 gravel (diameter) and sand (fines medium, coarse), color of material, structured (Loose, packed, cement, soft, hard), For example* 0 ft"to 27 ft, fine, packed, yellow sand; 27 ft. to ,DAte, Well Completed /to y Date of Report r Well Drille r > Signature BZS 1-77 In c -. .. ..1 .M�r-.. n . r. <tt � .....�.. ..+- a: ..y • �sv .. u . - ..: -.ri .'•Yr . a. n ..... - .. ,. V. ».Aw.. .n_....qt ..r.. . �. i .. .. <a .. �.�•. ..1 a ... William Barrett Town of Putnam Valle Owner or urc astir of Building Municipa ity William Barrett Building ConstructE by Lake Shore Rd. East. Location - Street TM 3 -36 Section Block One Famil Residence Sub Lot #352 Building .Type Lot GUARANTY.OF.SEPARATE SEWAGE-SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction a.ld drainage of the sewage disposal system serving the above described property, and that it has been constructed a ' s 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 guaranty to the owner, his succes- sors, 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 initial use of 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 occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the de- termination of the Director of the Division of Environmental Health Ser- f : t. 3t _.u-ic�s_ of.= the. Putnam_.- County-u - «o ah_as to_ whe- ther_ ro.r..not- -the failure of the system to operate was caused by the ,willful or negligent act of the occupant of the building utilizing the sys em. Dated this 20th day of Mai 19 83 Signature Title f corpo atio give name a addre ) - - - - - - - - - - - - - - THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health PUTNAM COUNTY DEPARTMENT OF HEALTH DTV'ISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CALL; ,_� e_ .,Y: �...... 1.0. 12... -.. . DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. ��) 611 GRACE SdiORZ Owner WILLI M &PUP_ _ 7T Address P4j 7 -NAM VALLEY � IVY il7�79_ TM -6-?, -.s lock Lot Located at (Street Sec. 6dicate nearest cross s ree Municipality)Z�LL Watershedd/��QctiD/VF�. SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED .WITH APPLICATIONS Hole 3 9;C7�l. Number. CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Wate r water ve No. Time From Ground Surfabe in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches. Inches Inches 10 -#'Z 1 8'1-7.5 - 8: 26 J-I /6 4//3 V 3 9;C7�l. -#'Z 1 8'1-7.5 - 8: 26 J-I /6 4//3 V 5 1 2 RECEIVE 3 , 4 COUNTY 5 DEPT. OF HEALTH Notes: 1) Tuts to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. 3 /01 5 1 2 RECEIVE 3 , 4 COUNTY 5 DEPT. OF HEALTH Notes: 1) Tuts to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. t �.�� �j C 6sik1 PUTNAM COUNTY DEPARTMENT OF HEALTH �Q DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL q / please print or type PCHQ Pe�rrlliti ''.:r,k ,? Well Location Street Address: TownNillage: Tax Map # 370 Lake Shore Road, Putnam Valley Map 30.18 Block -1 Lot(s) -45 Well Owner: Name: Address. Attn: Bob Chestnut, 72 0akridge Phone M RJ Chestnut Const. Drive, Putnam Valley, NY 10579 45- 667 -0504 Use of Well: X Residential _Public Supply Air /cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring - _Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield Sought 5 -10 gpm # People Served Est. of Daily usage gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drillin X New Supply (new dwelling) Deepen Existing Well Detailed Reason Low yielding well serves existing house for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes _ No Is well located in a realty subdivision? ........................................... ............................... Yes _ No Name of subdivision Lot No. Water Well Contractor: P. F. Beal & -Sons, Inc. Address: 4 Putnam Ave., Brewster, NY 109M Is Public Water Supply available on site? ....................................... ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/ 1 Date: 6/13/07 .- Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Puth m County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within"(hirty�`�, (30) days of the completion of water well construction, the applicant or their designated representative shall: the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam Counfr Health Deoartment. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department:::;; take appropriate action to assure that any and all water and waste products from such well drilling operationsti� contained on this property and in such a manner as not to degrade or otherwise contaminate surface or grourk&ater� 0 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue Permit Issuing Official: Date of Expiration Title: Permit is Non - Transferable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller a Form WP -97 Rev. 3/06 II" [ ! •�.1 ((1) [ \ ! '1 !1) l i" •� l'Z I ®! ! \ I (1> I ! ! i •� AM ! JDffVIi5ff (DH ®IF IENWROMM ENTAIL HEALTH S EIi VRC ES APPLR CAS ION TO ABANDON A WATER WELL please print or type PCHD PERMIT # i PERMffT This permit, to abandon one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code, Subpart 5 -2 of Part 5 of the New York State Sanitary Code and/or Part 75 of 10 NYCRR and provided that: Within 30 days of the completion of the abandonment of the water well, the applicant shall submit to the Department a certified statement that the information delineated on the application for this permit has been completed. Date of Issue Permit Issuing Official Title White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 Street Address: TownNillage Tax Grid # Wen ILocatn ® m 370 Lake Shore Road Putnam Valley Map 30.lflock -1 Lot(s) -45 Wen Owme>r: Name: Address: RJ Chestnut Construction 72 Oakridge_Drive, Putnam Valley, NY 10579 dYelm Type: X Drilled . Driven Dug Gravel Other Depth Ds tsa I.Well Depth ft Static Water Level ft Date Measured Use of Wen: X Residential _ Public Supply Air /Cond/Heat Pump Abandoned I- primary Business Farm. Test/Observation Other (specify) 2- secomdalry Industrial Institutional Standby Watiteir Wen Name: Address: (C ® ®tt>r�etY ®Il°< P. F. Beal & Sons,- Inc., 4 Putnam Avenue, Brewster, NY 10509 Reaso® IF ®>r Low yielding well - new house being built AltD�m�lo ®mme ®�a Dese> pflom of Work To Be ]Performed: We will remove pipe, pump & electrical components from the well and then fill well from botttom to top with concrete. 1 Fri . Y_ Date: 7/2/07 Applicant Signature: F1:.. : �•' f f� -� hilip Beal i PERMffT This permit, to abandon one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code, Subpart 5 -2 of Part 5 of the New York State Sanitary Code and/or Part 75 of 10 NYCRR and provided that: Within 30 days of the completion of the abandonment of the water well, the applicant shall submit to the Department a certified statement that the information delineated on the application for this permit has been completed. 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