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HomeMy WebLinkAbout2569DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. vAmscanyourdocs.com 631- 589 -8100 52. -2 -10 BOX 22 "rm me km! . r ,. 16 02569 LtlbaMd eit J .wiA�..e . ' o..ar i ^ "! ^A'�i :l.i �'E ;. ...fi.r N i ..�T^^t_)^�.r±- 3 °r''.�' -•Y� /. �.C.... SwMbs _ . Let Alms 3- .� G. Fm see bal oaf, Va�me Na�ebac d Bedroom � Derai�t Flow G . P D 6' dfs PCHD Node sdeat 4 lee mk" Fli b it a tetl Sop�nil• serw«tl{�LSTfa. ta:o..e�t et 6v_ .GiMm SW& T.a 'l D Q:r . . U b• eeeto0eeteiad "T Address. Addreae WaterSappb:_ Pelbdc,$alpp�y:Ftaea "° - . v a'e" s.p1r. DelW by Aadmm Otbar G'u /i'✓J �rrL n 1 represent .that 1 em wholly and completely responsible for'the desgn'and location of the proposed system(s). p that the separate sewap'di ai stem an- described v►ill be constructed as shown on tM appiow0 amerWmant there+, to and . in accordance wean the standards. rules a regu ens o, m. County .Depertmant of Me+etth,,,and that;on eomplNk 'tnaeof a �Cat�ffcay;,of Construction Com ' satisfactory to the Commissbnw.of Meanhwill be submnt", to iM Department, and a written' quarantee will Wfurnished` the owner his fu "its' s by the builder; treat :se1C 0uilde► Will pMCfr 'in pod o1M►atkt� condition any "art of, tak/ aawaoe dispofH system during the per �A a (nWlebly rollovring tMdtto.Of the iteu- anie.of the; app'¢ral of,.tM Ciro /katr`'o1; Conetructbn� ComplNnea of the+,orginal,tystenf , ) that the Willed well 0aecfibad above wiff ba'sik , as,thown on the apprareA; plan and tMt sek1;wN1 will be InstalNtl; in aeco n - cRa ' "I a and. inqu Ons of the Putnam county' Dpirtimint `of Wane. " —�! • Date 193 SgneO P.E. _O R.A. Addre �� . I✓!i License 'NO Z APPROVED FOR CONSTRUCTION. is approve) expirei two,yewrs .from the data issued building bas been undertaken and is revocable for cJUIN or may be a or modified when considered efsaiy . by 'the Co m1 y change or alteration of construction requires a Mw Omit. Approved for disposel of domestk meiltary a swat 0 . X11 ®✓ 0/88 Oare • Title 1 �C:J I (� �... =_ = CR f" prc : r, L = =1 • _ �J�. 2-a- 1_ GS Gar =1' -! I b -1= Z y„_T rvG -r = -- c- Z'� ===- _� ' = azaa- . 1 iloo ;�� _ � =_•._ -_ mac- _ z - c c_ n" • c- I ra i✓ =�_ -- L I wa _ _ _ i /�� ' /=CCt_ LJ c �_ :;C��•- Vic_.:: "� _�:.= EEC ^_ =C t =-t: _ C C..7 C.- �I I/A _-• 1 �3 C: �\ Y G° — Cie �E cw Car C",rG cc- �F--- _ Cv�,- ' c_ _�._j.- r,. _._ _ c_ , c r- - - E_` C_ L. _ ^.0 C = C_: ''`_c =C° c�•cV t -t=« <-- _Ca= C' S I I I i I I I I I %MM min �I .J �Ir f "✓ I I i � DEPARTMENT OF HEALTH Division of Environmental Health Services I 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 AP,PL.I.CA�:ON:_:.TO_ „CONSTRUCT.. Ai9ATER=.WEbL..- -� - -- �_, PCHD PERMIT # - WELL LOCATION Street Address To Village it Tax Grid Number WELL OWNER Name rr Mailing �6 Address l'/ 0l�” !/7 lY l Private O Public USE OF WELL 1 - primary 2.- secondary XRESIDENTIAL O BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION U INSTITUTIONAL O STAND -BY 0 ABANDONED ❑ OTHER (specify Q AMOUNT OF USE YIELD SOUGHT �' gpm /# 0 REPLACE EXISTING SUPPLY XNEW SUPPLY NEW DWELLING PEOPLE SERVED /EST. OF DAILY USAGE d&OP gg1 ❑ TEST/ OBSERVATION 13. ADDITIONAL SUPPLY D DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN []DUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING ?' YES k' NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 7'B3 �pA %�gpro Lot No. ; WATER WELL CONTRACTOR: Name /Y, Address: 4M 1/y /Z� 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 %� ON SEPARATE SHEET date O� (signature) 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 thirt;- (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 form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a�mann /er as not to degrade or otherwise contami . e'surface or groundwater. Date of Issue: 19 Date of Expiration _192,-71 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET for CONSTRUCT ON PERMIT / NAME OF ER STREET CA ON ...v..... ._. c BY DATE ;TAX MAP OCUMENTS. APPLICATION PWS LETTER ENGINEERS AUTHORIZATION .DESIGN DATA SHEET(DDS) �FEP HOLE LOG CONSISTENT PERC RESULTS (3) RC HOLE DEPTH ,CORPORATE RESOLUTION PLANS THREE SETS HOUSE PLANS - TWO SETS _J_ I ,ARIANCE REQUEST GENERAL LEGAL SUBDIVISION - SUBDIVISION APPROVA,; CHECKED PERC RATE_ z-_;;1 '��J CURTAIN DRAIN REQUIRED~ C�JSTA'VDPIPES AL SSDS ADJ. LOTS WETLAND (TOWN/DEC PERMIT R & D) DATA ON DDS PLANS & PERMIT SAME PRE -1969 - NEIGHBOR NOTIFIFICATION ^ 100 YR.-FLOOD ELEVATION REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE m GRAVITY FLOW m D/ J BOX m TRENCH/GALLEY M P- PIT DETAILS M SEPTIC TANK - SIZE, DETAIL m WELL DETAIL, SERVICE LINE IF OVER M CONSTRUCTION NOTES (GRINDER RATE) M DESIGN DATA: PERC AND DEEP RESULTS CD TWO -FOOT CONTOURS EXISTING & PROPOSED CD DRIVEWAY & SLOPES CUT CD FOOTING /GUTTER /CURTAIN DRAINS COMMENTS- D DISCHARGE (OK) D PERC & DEEP HOLES LOCATED ED REPRESENTATIVE OF PRIMARY AND EXPANSION m EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE D IF PUMPED PIT & D BOX SHOWN & DETAILED �I HOUSE - NO. OF BEDROOMS M WELLS & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM IZ7 PROPERTY METES & BOUNDS CD HOUSE SETBACK NECESSARY (TIGHT LOT) M HOUSE SEWER - 1/4 7FT. 4 "0; TYPE PIPE CD NO BENDS; MAX. BENDS 45 W /CLEANOUT FILL SYSTEMS EDCLAYBARRIER m 10 FT HORIZONTAL: SLOPE 3:1 TO GRADE D FILL SPECS mDEPTH GAUGES = FILL PROFILE & D]NIENSIONS M VOLUME TRENCH CALF TRENCH PROVIDED M60 FT MAX - M PARALLEL TO CONTOURS m100% EXPANSION PROVIDED FIELDS m IT TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL M 20' TO FOUNDATION WALLS` ` - m 100 TO WELL, 200' L 1 D.L.O.D.; 150' PITS M 100 TO STREkM WATERCOURSE LAKE (INC.EXPAN) M 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER M 10' TO WATER LINE (PITS -2(Y) CD 50' INTERMI ITENT DRAINAGE COURSE CD 200 FT. RESERVOIR, ETC.m 150 FT. GALLEY SYSTEMS SEPTIC TANKS ED 10' FROM FOUNDATION; 50' TO WELL WELLS D15' WELLTO P.L u PUTNAN COUNTY DEPARTMKNT OF HEALTH DIVISION OF ZNVIRONMENTAL HEALTH SERVICES Date Rs: ;Property of 0�drVO:!� Located at �vv►ra a I. , . (T),Pg & BOG tioa_f2_ Block 2 Lot /o :subdivision of Subdv. Lot * .3 piled Map .# Date %9�.5 Qentl�ious s This* letter is to authorise ���• '` G /u /f �rG� a duly licensed professional a sneer' or..regisAAre4 architect__ Indicate to apply for a Construction Permit for a separ.ats`sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulalated by the Commissioner of the Putnam County Departmont of Health, &ad to sign all necessary papers on my behalf its 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 Lax, the Public Health Law, and the Putnam County Sani- tary Code .• Countersigned: F.B. I YAO 2!772-- as Telephone Very truly yours, Signed Owner of PropertY l S J64 Address% Town Telephone f' r RLOji z owec D4 Vx,4 i 1D • DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner G /l! S ai-ri Address Located at ( Street) ©3 " �� '�� Sec. Block a Lot 1 b (indicate nearest cross street) Municipality Ae -I-,h a,*1 l/ �i `� Watershed Date of Pre- Soaking Z%2 1 &,,4- Date of Percolation Test HOLE NUMBER CLOCK TIME PERCH ATION 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 1 41492 11,37 -3-1- 2 jAe A rr ` 21J.3,9 /2 Zb 30 ZZ�i 21z- 32 i9 2% 9 3C, 42, 3/9 3o 1 // sO /..,- Zv 3 o 10 Z/ Yz . / .2- ZIP :_.2. 3 /2,5y 6i 1 2 3 4 5 NOTES: 1. 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 from top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENOOUN' MED IN TEST HOLES ,:HOLE --NO:- /.._, __._ . ; HOLE - NO. .. HOLE. Imo..:: G.L. 7v .sa u 2' �Oi1�G»i 3' 4' 5' 6' 7' 8' u INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED '- l DEEP HOLE OBSERVATIONS MADE BY: O !/� ��� DATE: DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided 6d v 6 No. of Bedroams 3 Septic Tank Capacity / y�U gals. Type /V40. Absorption Area Provided By 3 L.F. x 24" width trench Other • . • - eic.�j�w�: fir' ;1.�� '" � � , % THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date o.,P, tr .. OS IT, I t AWL- 4��- I- ti 4L leg,