HomeMy WebLinkAbout2440DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
50.20 -1 -44
BOX 21
7
i !;
h'i .,
r �
' „�' �, }r , ,,
F
02440
Sa`.
\\ 10 ENGINEER' MUST,
Y DEPARTMENT OF 'HEALTH
PUTNAM COUNT PROVIDE
Dlvision:of Environmantil Haahh. wrincas, Carne% N'Y 10512 PERMIT,
CERTIFICA E, F. CONSTRUCTION. COMPLIANCE FOKI`.SEWAGE. DISPOSAL.SYST.EM wT'N. AhT, /�f�LL6'y
Town or village
LOCated at�V Tax .MaP i Block
Owner ���! • .. I / Fornierly . /'� /��EI� - /:• Tax Map Lott W 90 _ /_.. Subd Lo t N
Separate Sewerage System built`.by �QE4�TOCCi�/ .fO�l/ Address�� LmG `l ,.✓�V
Consisting of V000 Gal.' Septic Tank and
Other requirements '/ �• O �� LL -
Water .Supply: ?Public 'Supply From " t
private. Supply 'Drilled 'BY A d le A% AAJ ,G 0 s
Address s /[7/1Ic 0G --
® :...,
Building' Type �c�• mid 0R,4 wze
Has Eroilon Control Been Completed?
Of. Bedrooms bite Permit: Issued.
Has garbage.grinder, been installed?. N �'
a�•3 8�'
I certify that the syatem(s).as listed serving the above premises were constructed e'ssentially,as shown on the plans of the completed work ( copies
of which are attached)., and in. accordance. with' the etandards,.'iules and regulations �in accordance with 'the,filed' plan, and the parmit issued-by the
Putnam County DepartmenE'Of Health.'
Date O z�a Certified by ' P.E. R A
Addreu X06 >' , SCI /G✓/q /. Afd� cJ/J�L[e� .Dig f S.Icense,No.
Any person occupying promises served `by'the above.system(s) shall promptly Aake such action is$ may be necesuiy to 'secure the Corraction 'of any unsanitary j
conditions resulting from -such usage. ,Approval of the:. separate sewerage systmn shall become. null- and void•as aeon as a public sanitary se wer becomes
available and the approval of the private water supply shal).becomenull and.wokt when a public water, supply becomes available: Sueh `'approvals, are f
subject to modification. or Change when,. in She judgment of .the Commissi\oner ,of Mealth' such .revocation, modlfiutton of change is necessary.
Date B® y ., Title
Rev: 6/85
August 1. 1990
To Whom It May Concern:
On July 4, 1990, John Bertocchi and myself uncovered the
first :function boy: located. on our property, at
23 Far Reach Trail. Putnam Valley. NY 10519. We discovered
the boy: was one inch off level causing the first field to
leech. We then Leveled the boy: and tested for prop_ er seater
flow.
As of July 31. 1990 the system is no longer in a state of
failure.
,0,/ / - � �/� - ,
Michael Fi n5eri
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIERW -ES
VISION OF -ENVIRONMENTAL .REACT
Z zz� ,�,
Owner dr Purchaser of Building
Building Constructed by
Location - Street
4,1,07_,fw� "A-le
Municipality
Building Type
�4 .
Section Block Lot
P jw "Y expe iq
Subdivision Name //r9P0 y ;1AAza
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
'- Certati,cate...of.. Construction - Compliance" -- far - %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 occupant of the building utilizing
the system.
The undersigned further agrees to accept as conclusive the determination of
the Director of the Division of Environinental 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 of the building utilizing
the system.
Dated this day of �° 19
General Contracpdr WWner).4 Signature
Corporation Name (if Corp:)
Address
Signature v-
Title 6) C C L
Corporation Name (if Corp.)
rev. 9/85
mk
At Se
Address
•�
`.,
WELL l:ULLrLZ11UA ALrUAt
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
la
WELL LOCATION
ET ADD 5: LAGAI IfY TAX GRlO NUMBER:
WELL OWNER
ME: _ . Ab
J
❑ PUBLIC
USE OF WELL
1- primary
2 - secondary
RESIDENTIAL C&BLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABAQONE6.
❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify)
O INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT S — gpm. /N0. PEOPLE SERVED ---' —" / EST. OF DAILY USAGE) ab gal.
REASON FOR
DRILLING
fg NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑TEST /OBSERVATION
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH ft.
STATIC WATER LEVEL /ft.
DATE MEASURED
DRILLING
EQUIPMENT
J, ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION O OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING. .9 OPEN HOLE IN BEDROCK ❑ OTHER
CASING
TOTAL LENGTH _ ft-
MATERIALS: ; STEEL ❑ PLASTIC ❑ OTHER
LEN GTH.BELOW.GRADE ft.
JOINTS: ❑ WELDED ;@JHREADED ❑ OTHER
DETAILS
DIAMETER in.
SEAL: ❑ CEMENT GROUT 0 BENTO NIT E BATHER
WEIGHT PER FOOT ___ Z ,�_ lb./ft.
DRIVE SHOE:AYES ONO LINER: 0YES,)ff4N0
SCREEN
DETAILS
DIAMETER (in)
'SLOT SIZE
LENGTH
(it)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
O YES ONO
'HOURS
SECOND`
-
_
GRAVEL PACK
❑ YES
❑ NO
GRAVEL
SIZE:
DIAMETER
OF PACK in.
TOP
DEPTH ft.
BOTTOM
DEPTH It.
WELL YIELD TEST It detailed pumping
METHOD: O PUMPED 1 tests weredone is in-
COMPRESSED AIR , formation attached?
O BAILED ❑ OTHER i ❑YES ONO
WELL LOG It more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
rWtr,,
Well
D�a'
deter
FORMATION DESCRIPTION
CODE,
ft.
ft_
WELL DEPTH
ft.
DURATION
hr, min.
DRAWOOWN
ft,
YIELD
gFm-
Surface
WATER O CLEAR TEMP.
QUALITY ❑ CLOUDY HARDNESS
O COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? ❑ YES O NO
STORAGE TANK: TYPE
. CAPACITY GAL
PUMP IRFORMATIOPd
TYPE CAPACITY
MAKER DEPTH
MODEL VOLTAGE HP
WELL DRILLER NAME _ ► 0
d'%'►'�+ --,
ADD �Y �r SIGRATURE
7-
N,-
bA6UWNTfffDEPAARTrMWM
.,PUTNAM Prr, OF MEALTH Zill' I.,` 'Pmvlde Permft Ill
Cainid, N-Y.
�.;,on CERTIFICATE OF COMPUANCJ9
.Peamft •N
,
N ON PERMIT FORIEWAGEDISIP-16SAL-1 ST
Gt
OWN
- 1—t-A
snbtilvb>ton Name gyx &0,1 —1 I I
�l B16A
I
11.i"id ci Y
.0
x-_
'00r,
d'PreAoU:6, Approval L
ZIP
000 .7
.... .....
mjA_
Y. Woth
Nomber bit Wheliim Is complie
Of FUw G PCW
-AdAi�"
by Z CP -9,19 tA�
Water Y. 11111fle S
or:' * Sm DrEW by 741 -
00
:a
I A0 �, S/pov-0,
Other R09.11ke-W911 /7
7
('represent that I wholly-jaind cornoleteiy'reiponiiblie - for,the design ,4
above' descri6ed,w"i 66,conitr, aed -as shown on tiiiipproVaid amend me
'eunty bepar'tmen�i:. of *
Health, I" nd . that on _ con* pl�t op:h],
of
be submitted to the Department and S'Writter quarantee,w!1j
"ke,fi
plact in good; op*atinj cqndltlqn . any pii" of said diio6iil
anee of the approval of the edr6ficite of Cpiristrkictidn, Compliance
w6l"be,likafed'ars' Witii,alibrbved Plan and"i6at raid well will be
County ':Depart -i 6i "'6--1
th
L
777777
Address
-,.APPROVED FOR_CONSTRUCTION :_Thli S6Pr6vil4x'Pire w rV I
revocable Jor'�C�ause, or ni_&Y�Ibe4rnended 76; modifiaii vvhe nsid red n
i,. Zrequ-rei i-rili Approved for disposal of 0 sans
-pp ov M
w U�4
P
1/87 Date BY
sewage disposal g
Y: , , L Y"
ori . lame-vvith,the standikis; rule I s and regulations of - the system
lon'Complian ell' iitlsfa�Ctoiy to'ths- commissioner of 'Health will
.�c . " % . - builder, , I I r , .
Viui4el;36%,helrs or- assigns that said bu lids will
_..ira,py the
rlod. -bf-,two (2) years Immediately following thedato of the In
u-
n , W 'y !. � - -I I- I I '� . drilied,wi lidescibd ,above
. L
0 with -trie-stinairdi,:rules;�and ra97sTro—psof."r Putn!
tv 3,
P.�E.'- R.A
Canso No'
j*hl"s- construction .'.6f! the _builCinq has been undertaken and Is,
gjfsioner t"i or aiierifilin of construction
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATION TO CONSTRUCTyA WATER WELL
PCHD.PERMIT
,I, M
WELL LOCATION
Street Address
.r AM
Town Village City Tax
A0-'4e_'A1 /G
Grid Number
- S- .
WELL OWNER
Name
Mai] ing Address
�A - ".
Xrivate
OPublic
USE OF WELL
1 - primary
2 - secondary
,ERESIDENTIAL
O BUSINESS
O INDUSTRIAL
0PUBLIC SUPPLY OAIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION
O INSTITUTIONAL O STAND -BY
Cl OABANDONED
O OTHER (specify
AMOUNT OF USE
YIELD SOUGHT__,.r gpm /# PEOPLE SERVED e,0' OF
DAILY USAGE 00 gal
REASON FOR
DRILLING
EW SUPPLY . OPROVIDE ADDITIONAL SUPPLY
OREPLACE EXISTING SUPPLY ®DEEPEN EXISTING WELL
OTEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
L V Azigw
�JSCr
WELL TYPE
RILLED
®DRIVEN
ODUG ®GRAVEL OOTHER
IS WELL SITE SUBJECT TO FLOODING? YES _ NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: �y� �T AIN V deck-
ZA% gd, 02y X' / Lot No. .20
WATER WELL CONTRACTOR:
Name Wd
e„yOOJE'.v
Address:
IS PUBLIC WATER SUPPLY
AVAILABLE
TO SITE:
YES NO
NAME OF PUBLIC WATER SUPPLY:
TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
O ON REAR OF THIS APPLICATION S PARAT SHEET
A; I'D
(date) (signatur
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 s.hall:
1. Pump the well until the water is clear.
2. Disinfect the well in accordance with the requirements
County Health Department attached to this permit.
3. Submit a Well Completion Report on a form pro ided by
Health Depart ent. U61
Date of Issue: 10 7,22 19
Permit Issu .
Date of Expiration: 19
Permit is Non- Transferrab a White r H.
Yellow co °
2/87
PY°
Pink Copy:
Orange copy:
of the Putnam
the Putnam County
n f c a"
° File
Building Inspector
Owner
Well Driller
PUI'NAM OC7UNTY DEPARZMEZ� OF HEALTH
'DIVISION OF ENVIROtHaTIAL:HFALTH SERVICES
-- DESIGN DATA:_SRE13T7, aU SUFACE. SEWAGE DISPOSAL SYSTiM FILE NO.
Owner ,•�� Address .�Ye .�, �a.re...... /....:..,.
Located _ -at (Street)27-/,,!57_
X�i4a f� TEL Sec. - dock S Lot 9,
(indicate nearest-cross street)
• CT2�iL_ of . T/ir�. ...
Municipality ,v ,� Watershed ^/ 4
SOIL PERCOLATION TEST DATA REQUIRED BE SUBMITTED WITH APPLICATIONS
Date of Pre-Soaking p.. - Date of Percolation Test
HOLE
NUMBER CLOC'f. C TIME PERCC=ION PEROOLATION
Run Elapse Depth to Water From Water Level
No. Time Ground Surface In Inches Soil Rate
Start -Stop .Min. Start Stop Drop In Min /In Drop
Inches Inches Inches
,Z=
2 .S,• /J - !: ooh, �/ /,3r1x� -,��,+
-
3 - G '��3irlre„' off/ ii
4
5.
2
4
5
1
2
3 ..
4
5
N=S: 1. Tests to be repeated at same depth until approximately equal soil rates
are obtained at each percolation test hole. All data to be sukmitte3
for review. "tr
2. Depth measurements to be made fran top of hole.
TEST PIT DATA REQUIRED TO BE SULt LiTTID Wl''Ei APPLICATION
DESCRIPTION OF SOB IS ENCOUNERED IN TEST HOLES, ,
DEP'T'H HOLE NO. HOLE NO. Z HOLE NO. 13
3'
�r
14'
INDICATE' LEVEL 'AT `WHICH mOC1tim'ATER IS ENCOUNTERED 7---
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED 4&7 gf&, ag
DEEP HOLE OBSERVATIONS MADE BY: `
�'J' • �7L%��r; .. /"O� DATE:
DESIGN
Soil Rate Used Min /1" Drop: S.D. Usable Area Provided 8000
No. of Bedroans Septic Tank Capacity 4000 gals. Type
Absorption Area Provided By BOO L.F. x 24" width.trench
Name Aod�i --4 O ,�3Signature
Address tIMI S �e SEAL
THIS SPACE FOR USE BY HEALTH DEPARTME :<'T ONLY:
Soil.Rate Approved sq.ft /gal. Cbecked by Date
i
FMIAL SITE INSP=-ICN Dated �'
SZREWT 1LiCkTfON '` ate_ P&4, L, CWNF -R /G rc1 � ��
PERMIT a ✓��(�'- (� 24 p OR SuEDIVISICN IDT
Z SN?GE ;pIS . PL
a.� SDS area located as per approved plans
b. Fill section - Date of placement
2:1 barrier. IGM TN= AVG.DPTE
c. Natural soil not striaoed
d. Stone, brush, etc., creater than 15' from SDS area.
e. 100 ft. fran water co wet-Lancs.
II. SaZa DISPOSPZ SYSTR4
a. Septic tank size 1100 1,250
b. Septic tank ins- = - ever -
c. 10' mnimuu free foundation
d. No 90° bends, cleanout within 10 ft. of 45" bend
e. DISTRIBUTION BCX
1. All out? ets at sacra elevatlon - water tested
2. Protected below frost
3. Minim= 2 ft. oricinall soil between box and t
f. JANCTICN BOX - provez-1v set
g.F^�r-�-F�
1. Length reared - .� 0 V I,a ^_c`n instal-1 e3
2. Distance to wat_rCJLsa
3. Installed ed ac_;,rding to plan
4. Distance center to center
5. Slone of tZencz acceptable 1/16 - 1/32 "/foot.
6. 10 fit from urcoe tJ line - 20 f a=t - four -da crs
7. Death of t_e*lch < 30 inches fran surface
8. Roan al? arced for e-man.5ion, 50%
9. Size of gravel 3/4 - li" diamne =_r
10. Deoth of crrvel in trench 12" mi n;mn„
111 . - Pine ends capped
h. _ OR DOSE SYSmv -s
.._...1. Size of pcnnn c:a_nibeaz .. _ ..
-2: tTv�r -�1cw taruc
3. Alarm, vis-j=-? /audio
4. Punm easily accessible mranhole to cede
5. First bcx ba fled
6. Cycle witnessed by Ere=- th Derz_runeT:t
IV. ECU—c7
a. House located per aboreved plans.
b. Number of beiroars
V. Wr f
a.We_1- . located as re--, a =roved plans
b. Distance from SDS area m��,red f°') i ft.
c. Casing 18" above grade.
d. Surface drainage around well acceptable.
VI. OVERALL WCPMGIC=-J:p .
a. Boxes properly arcutzed
b. Ail pipes Fat -dal -1 y ba6=Filled
c. AU pipes flus'z with inside of box
d. Badkfil1 material contains stones < 4" in diameter
e. Curtain drain installed according to plan
f. Cart-ain drain out =all protected & dir. to ex st.wate_rc
g. Footinq drains discharge away fran SDS area
h. Surface water orot_ -c- ion adequate
i. ..osion crn`o provided on sloees are-ter than 15 %.
o,-r)C
P,TTNPM COUNTY DE"iP.FTM.ENT OF HEALTH - DIVISION OF ENVIRObZfEr S, HEALTH SERVICES
.FIELD ZvsPECizc N :.;REP01RT,.
1,0V INSP. BY:
of Cwner) (Street Location
INITIAL SITE iNSP_..CTION I YES NO cr-M MELNM
Wetlands cn /or proximate to property.
Prcce_*-ty lines or corners found ...................
Can estLm ---t-- house location .........................
Will drivewav need cat. .. .......................... I
MIst trees be- r�raved - note these ................ I
reep holes representative of entire SDS are.......
Pnditicra deep holes needed ...................... I
Sufficient SDS area available considering driveway I
cut, house location, separation dista_nc`= =,etc...
Aajaca ^.t weds /=_optics ............................ JJ
nr to nrnres-na we-11 location for dri lli rc..... k' 1
D. H. 1 Lot -
Death to G'. W.
Depth to rcck �! _
Coll Ee-- crinti
0 ft- -
D. H. 2 Lot
Denth to G_W.
Depth to rcpt Q l
0 ft.
3 ft. 3 ft.
6 ft. 6 ft.
9,ft. oG0- . 9 ft.
3
L
j
SaL Descrizticn
D.F. - Gaep Tole
G.W.-t:rcunawate_- D.H. 3 Lot.
Dente to G.W.
Depth to rcck _ D
0 ft.
3 ft_
6 ft-
9 ft.
Soil reEcri:,tica
11 SOou
DATE:
FL'4AL SITE LvSPE TION INSP.BY:
YES
NO
COI-TS
Ecuse S---DS located per approved plan .............
Length of trench me—asured
Width of trench average
Slope of tile line and trench acceptable.........
Roan allowed for expansion trenches ..............
Over 100 ft. fran waterscurse ....................
Natural soil not stripped or SDS area
unnecessarly graded ............................
10 ft. maintained fran property line and
20 ft. fran house ...............................
Distance well to SSDS (ft.) ......................
Number of bedroans chec- As ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. fran nearest trench ................
15 f t. of periphe_►-a.1 soil horizontally
frantrench ..... ...............................
Boxesproperly set....... ......................
Could surface runoff from driveday, road_,'
ground surface, etc., c�iannel nes_r SDS area....
Does lot drainage appear OK•,iri area of SDS::..... _
FINAL GRADNG OF Sj=- ACC-..P'Ln.PM.'
I
I
I
I .
k
COMPONENT
OF HOUSE
A
B
C
D
5,�5 7 e- r ;.✓k
�,7aAle 1-11-0Al
,BvxEs
.3'
83
.�
(070'
G
ZZ
.
V7
j
/o
9
D, oc 7
6 3. , .
7'
9'
9s
8o
G
97
Z
l /5� '
/oa •
� v � ': � �.