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HomeMy WebLinkAbout2449DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51. -1 -10 BOX 21 02449 i - PUTNAM COUNTY DEPARTMENT OF HEALTH RET . 3/86 Division of Environmental Health Services. Carmel, N.Y. 16512 Engineer to Provide Permit A on CERTIFICATE OF COMPLIANCE CONSTRUCTION PERMIT SEWAGE DISPOSAL SYSTEM Permit • # /� Located at ,! /V// & aF' V/ C/ 4 CC- Subdivision Name Subd. Lot N Town or V Tax Map Block �' Lot Renewal_ ❑ Revision — 0 Owner /Applicant Name ` Date of Previous Approval ' Town Zip Building Type // Lot Area �. ��• Number of Bedrooms Design Flow G /P /D zoo Separate Sewerage System to consist of Zog eGauou,Sepdc Tank To be constructed by 'Address Water Supply: lyablic Supply Fro m Address or:---d`!/Private Supply Drilled by _Address Other Regairemente % ✓�,� �iigl'/Yt.i� �.+�* -J'h.. : 'l'"" represent that am wholly. and completely responsible forjhe� design and.locatio of the .pfo above described will be constructed as shown on the approved amendment there to and in acc County Department of Health, and that on completion thereof a "Certificate of Constr is be submitted' to the Department, and a written guarantee will be furnished the owner, is place in good operating condition any part of said sewage disposal system during th ,pyr' ante of the approval of the Certificate of Construction Compliance of the originals to will be located as shown on the approved plan and that said well will be installed, in actor n County.Depar ment of.Health. Date a/ ^ Signed Address 2 APPROVED FOR CONSTRUCTION: This approval expires J& yea r rom•the dat issued uh revocable for cause or may be amended or modified when considered, cessary by the Comm require a new permit. Approved for disposal of domestic ianit se rivate Date / / / By a Cl the alb to the Commissioner of Health will ns the builder, that said builder will 9 edi ly following thedate of the Issu- Iq'11, the drilled well described above U-_ s d regu a ons of the Putnam )P�.E. R.A. _ License N9' f building has been undertaken and is ny change or a ter lion of construction Li e-101 _ Title (' 13 If 14<71I)OW Rea a A -3 92. 6l A-Im Nis �V te OV I'd v C Fi 1) 30 c Nq 0 z. 0. (NI N . yl- \ P 0. (NI N . in "' t S*a,. � Eyi' �YVV'°" mi �yy b# 1 T�� tp u• sc � `� � Jay/ Cf T`r -'�` � y....ds�.. �t G?kYr fNr'r iYl IN CA rxl i23'µ61 s',ta L- ',r�k.,f.�' ,Ke4pqi my g. >kf �' Y" . r -i' f�i,.y , �a •M' 1, a ,' ON cjp 3. py r� guy E °'� � , . 4,✓ Y�.`�4S'4"1 t� ��.' 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F�C.�fF i7r"�.,i4r'fit:•'i6'yr'' ,F"+. _ r f`c zv il �s/ol e 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 # A-/X& WELL LOCATION Street Address Town /.Village /City Tax Grid Number 3e �, 61 �ad P�. ��, 2" �- a.- iy._12. WELL OWNER Name Address -j" i✓L? 1411 rivate ❑ Public USE OF WELL 1 - primary 2 - secondary mlirw SIDENTIAL ❑ BUSINESS ❑ INDUSTRIAL []PUBLIC SUPPLY O FARM O INSTITUTIONAL ' ❑ AIR /COND /HEAT PUMP ❑ TEST /OBSERVATION ❑ STAND -BY O ABANDONED ❑ OTHER (specify, ❑ AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE�iV & gal REASON FOR DRILLING EW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION OREPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED ®DRIVEN ®DUG ❑GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES / NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name ror?q' �r�► Address: �d��; TTT IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES 14' NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:I;�c s LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION ON SEPARATE SHEET (date) 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 shall: 1. Pump'the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a f:;zng the Putnam County Health Department. Date of Issue: �� 19 Date of Expiration: �y2eL 9� icia Permit is Non - Transferrable 8/86 PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services March 3, 1987 Mr. Joseph F. Sullivan 2972 Ferncrest Drive Yorktown Heights, New York 10598 Re: Proposed SSDS Hernandez Bell Hollow Road Tax Map # 22 -2 -4.32 P.V. ar Mr. Sul l ivan Review of plans and other supporting documents submitted at this time relative to the above captioned project has been completed. Comments are offered as follows: Shortest length of trench appears to be less than 20'. Provide at least 500 linear feet of trench. Curtain drain should not be i stalled in clay barrier; redesign trench layout to provide adequate separation on north property line for clay barrier and 15' from curtain drain to end of trench. Provide oversized pump pit "with one (1) day storage.over high level alarm in lieu of a.separate.overflow.' tank. move well further into property; i.e., at least 15' from property line. Upon receipt of a submission, revised to reflect the above comments, this appl'cation will be considered further. Very truly yours, r 1" Anne M. Bittner Assistant Public Health Engineer AMB/jP JOHN SIMMONS, M.D. Deputy Commissioner 110 OLD ROUTE SIX CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIROIZIENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS 3 L- rX f� P FIELD INSPECTION REPORT (Name of Owner) (Strdet Location) INITIAL SITE INSPECTION YES NO 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 \J cut, house location, separation distances,etc- Adjacent wells /septics............................ Access to proposed well location for drillina..... DATE: INSP. BY: i COMMENTS DATE: D.H. - Deep Hole YES NO COMMENTS House SSDS located per approved plan ............. G.W. - Groundwater D.H. 1 Lot,_ D.H. 2 Lot , D.H. 3 _ Lot Depth to G:W. Depth to G. W. Depth to G. W. Depth to rock Depth to rock Depth to rock Room allowed for expansion trenches .............. Soil Descri tion Soil Description Soil Descri tion 0 ft. 0 ft. 0 ft.' unnecessarly graded.......... . ................ 3 ft. 3 ft. 3 ft. 20 ft. fran house .............................. Distance well to SSDS (ft.) ...................... Number of bedrooms checks ........................ 6 ft. 6 ft. 6 ft. than 15 ft. fran nearest trench ................ 15 ft. of peripheral soil horizontally fran trench...... Boxes properly set ............................... Could surface runoff fran driveway, roads, - 9 ,.ft. 9 ft. 9 ft. ground surface,.etc., channel near SDS area.... Does lot drainage appear OK•,iri area of SDS::..... 12 ft. FINAL GRADNG OF SITE ACCEPTABLE:.. �' 12 ft. 12 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......... Room allowed for expansion trenches .............. Over 100 ft. frcni watercourse .................... 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 bedrooms checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. fran 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•,iri area of SDS::..... FINAL GRADNG OF SITE ACCEPTABLE:.. �' t�rrr�vli.11s is PUTNAM COUNTY DEPARTMENT' OF HEALTH - DIVISION OF HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS YA 1./d 11� "lam (Name of Owner) REVIEW SHEET - CONSTRUCTION PERMIT A j DA � ) BY: (Street Location) DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth House Plans - Two sets Well permit; PWS Variance Request GENERAL Legal Subdivision •mil L s/s SUBDIVISION Perc (3) Fill cd letter Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Tcwn/DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic.Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data: perc and deep.results . Two -Foot Contours Existing.& Proposed Driveway & Slopes Cut Footing /Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If Pu:)ed Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Proposed System Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 110; Type pipe . No Bends; Max. Bends 45° w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees,Top of fi' 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Take (inc. expa 15' to Drains - Curtain, Leader, Footing 35'to catch basin,stormdrain,piped watercour. 10'. to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' from Foundation; 50' to well 15' Well to PL WeI( {N)tihI� ff 1)C'AlT[0 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date er/ 0-r Re: Property of (-Lp��.- 17r�'3t�7'.rl , Located ate /% �,✓�a ;�� /� o C Section 22 Block Lot -4•30 Subdivision of Subdv. Lot ,# — Filed Map #, Gentlemen: Date This letter is to authorize a duly licensed professional engineer or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, 7G t- Y 2i ':?' Telephone Signed . R Town 'S aC�- Telephone •' I• •• 81 zo we • 0I' ' ' I� • DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTER FILE NO. Owner j //�r- at JOIX— Address .3p ?.4 i'�'% 1011e{✓ Located at (Street) e� %/ �i�/ j� liJ Sec. Block (indicate nearest cross street) Municipality ✓ ' %well Watershed SOIL PERCOLATION TEST DATA REQIIRM TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking Date of Percolation Test / Lot 41 -4' HOLE NUMBER CLOCK TIME PERCCULATION 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 4 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated are obtained at each for review. 2. Depth measurements to rev. 9/85 at same depth until approximately equal soil rates percolation test hole. All data to'be submittmd be made from top of hole. DEPTH G.L. 1' 2° 3' 4' 5' 6' 7' 8' 9' 10' 11' 12' 13' 14' TEST PIT DATA RDQUIRED TO BE, SUBMITTED WITH APPLICATION DESCRIPTION.OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. •�',� HOLE NO. V4- fit INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED 7 INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUN'T'ERED DEEP HOLE OBSERVATIONS MADE BY: �// / f DATE: //5; DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided -:0410 No. of Bedroans Septic Tank Capacity gals. Type,_Jvor Absorption Area Provided By L.F. x 24" width trench Other,/ Name SiCJp.a °e.o;o~ N Address '-if 7 z-- )5rr7ct-" &.0 FOR USE BY HEALTH DEPARMAFNr ONLY: Soil Rate Approved sq.ft /gal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL VOTER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIELD INSPECTION REPORT (� P ; �: DATE: G� f / %'��/,+�c'l "J�'�'L✓ INSP. BY: (Name of Owner)( (Street Location). INITIAL SITE INSPEMON 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*renoved - 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 Descrivti, 0 ft. 3 ft. 6 ft. 9 tft. 12 ft. D.H. 2 Lot Depth to G.W. Depth to rock Soil Description 0 ft. 3 ft. 6 ft. 9 'ft. 12 ft. D.H. - Deep Hole G.W. - Groundwater D.H. 3 Lot Depth to G.W. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft' 12 ft. Soil Descr llf11'r;: ' FINAL SITE INSPECTION INSP.BY: YES NO COMMEM 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 fram property line and 20 ft. frcm house.:... Distance well to SSDS (ft.) ...................... Number of bedrocros checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. fran nearest trench.. ........... 15 ft. of peripheral soil horizontally from trench ..... ........:...................... Boxes properly set ............................... Could surface runoff fram driveway, roads, ground surface,.etc., channel near SDS area.... Does lot drainage appear OK'Jh area of SDS::.....:. °INAL GRADNG OF SITE ACCEPTABLE.. .......