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HomeMy WebLinkAbout2617DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 52. -3 -7.1 BOX 22 11 INNS AN 1 11 Sol � � � % �. , 6 rl I 02617 PUTNAM COUNTY DEPARTMENT OF HEALTH ..':_D_IVIS_IaNT- -OF- 1--EINVIRONMENTAL HEALTH Date Re: Property of Located at (T) Section Block Lot Subdivision of hJILCOPEE C51 A UT Subdv.-Lot # Filed Map # .2111% E Date T PP ' i Gentlemen: This letter is to authorize FCZAM�— 5_IL_LIjAtJ a duly licensed professional engineer — or registered architect (IndicateT 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 bi) al 4 A-'n -0o* Oct :and to. supervi.se -t1he -'c_onS'tr-uct'I-bn ---,t, f-- 'a-=.o system or systems in conformity with the provisions of Artic.IeE'2145---6k­_- CZ fl-I NJ 147, Education Law, the Public Health Law, and the Putnam Cou* 'A y SLI C.) tary Code. Countersig4ed: OF NE-ij, F Telephone Very truly yours, Signed C5rkner of Property Address I A Town ,7,3q- Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH DIVIS ON -OF ENVIROirAL HEALTH SERVICES Owner or Purchaser of Building 09 Building Constructed by Location - Stre9t Municipality Building Type Section Subdivision Named Subdivision Lot # GUARAN17EE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM V Block Lot 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 o rate ._for a, period two years immediately following tthe date of approval of the _ �- . "Certificate of Construction Compliance" for the sewage disposal' systan,` 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 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 of the building utilizing the system. Dated this :2 G day of 19 q ( Signature Title��C Gen Contractor (Owner) - Signature Corporation Wame / (if Corp.) Corporation Name (if Corp.)�a G.GzucGi Addr s '161 y /4 S �/ Address rev. 9/85 mk ti YML Environmental Services �Yorktdwn:.Heights,, NY, 1059.8.. ELAP #10323 (914) 245 -2800 d'2— COL'D BY NOTES _ X RESULTS OF ANALYTE RESULT UNITS /potable ALKALINITY pH LT 2 rrg/L Nonpotable , _ NaOH _ AMMONIA � V <20 >4C mg/L HCl _ Na2SO3 CALCIUM STAT! mg/L Z Ac CHLORIDE 6 rrg/L COLOR Units CONDUCTIVITY umhos /cm COPPER mg/L CORROSIVITY LSI. DETERGENTS y mg/L. FLUORIDE rrg/L HARDNESS mg/L 1IRON mg/L LEAD rrg/L MANGANESE rrg/L MERCURY rrg%L. per'100 mL NITRATE FECAL COLIFORM rrg/L per 100 mL NITRITE E. COLI mg/L per 100 mL ODOR FECAL STREP. TON per 100 mL SAMPLING SITE �9 plrAl, 'j d�G �� /✓ y �b��� X For Lab Use Only /potable HNO3 _ pH LT 2 <4C Nonpotable , _ NaOH _ pH GT 9 � V <20 >4C mg/L HCl _ Na2SO3 >20C STAT! _ H2SO4 Z Ac KNOW 6 MF MPN P/A X RESULTS OF ANALYTE RESULT UNITS pH S.U. PHOSPHOROUS mg/L SILVER mg/L SODIUM mg/L SULFATE mg/L SULFIDE mg/L SULFITE mg/L TURBIDITY NTU ZINC SPC per 1.O mL TOTAL COLIFORM per'100 mL FECAL COLIFORM per 100 mL E. COLI per 100 mL FECAL STREP. per 100 mL These results indicate that the water sample tram AS] [WAS NOT] [NA] of a satisfactory sanitary quality according to the New York State Sanitary Code, for the ers tested, at the time of sample collection. These results 'indicate that th wa er sa le [WAS] [WAS NOT] oe�ti f a satisfactory chemical quality according to the New York State Sanitar Code, for tl parameters tested, at of sample c ollection. SUBMITTED BY: Albert . Padovani, M.T. (ASCP) Director NA = Not Applicable N = Not Present (Negative) P = Present (Positive) SA = See Attachment(s) Also done because Total Coliform was present TNTC = Too Numerous To Count > = CT = Greater Than < = LT = Less Than ELc= =L =_:i Cc_c Ev � fir, -� i _ . zt Cg �-L � D - 5r.:Z. r Ate_, = b_ fill Dam at placE•�rit 2.1 b�Tri =Y . LG— w " =-' ?tiG_LPT_ c_ ra Jr i sci_ r_c s t�, I-^- C_ .C•`..._.r°, br s E =C_ , C=_% =T- t�tII 1.51 f_an EDE LE=_ E_ 100 ft- f =c.., Hc=_ cC gL�= i Lrrs - a_ Ee-:-t.,Lc tank =_Z-2(- 1,000 I. 50 G_ !'7 ` Si'L• Z�Tit -it —__1 - C.L'T —= �Cr go' C_♦_ CLi_ W- =^ t n 10 - _ C_ E� : E E! .Tc _C:7 - kc =_ j�- - - -�_-- p -cam =� �Cw f =-sue I I I j42- -i- L =- Cr-C--ELI elm Sh Fcct C. i0 y___ -_ L- --c Lr 1 -- - 20 T=� E Fcci a! ir-we -Cr er. - -s -Cr, 50S- see C. C= :aL 3/4 _ C— i c- ]--i tzEmc h 12" !I pi? 2- �' _! C-w sir le Lr F� T5 b =,C E. Orcl w_- -___ -= bti E =i :- ES I— TTc L =- , cw car cY C! e r. . Ft Lam= Es C- Cs- r"c 13" 4 C= 'z:u.t: L, _ 1_? 'Tc� C_ A_i vices flush wi t� 1^.5_Ge Cf h < 4" III G? =TCT_ e_ C�� La-4 n ��; _ ��?? � acCCrcl ^c to Cl a-11 I to E'i5t_CrcL:az- l'= h_ CCl S! CtcS C =_�='" t- -^ i -� _ ( I I , _-------- DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 ~� APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # �V- 9 -40 WELL LOCATION Street Address LJ� Town/Village/Cit y Tax Grid Number Q "tk-M WELL OWNER Name " Mailing Address )21Private &?_ co i t-A Ave. PtEK6 LL i . IcbG(oCo13 Public USE OF WELL 1 - primary 2- secondary V RESIDENTIAL D BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP O ABANDONED O FARM Q TEST /OBSERVATION O OTHER (specify, O INSTITUTIONAL O STAND -BY Q AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED 1 Mm, /EST. OF DAILY USAGEl�j 0al REASON FOR DRILLING 0 REPLACE EXISTING SUPPLY 0 TEST/ OBSERVATION GlADDITIONAL SUPPLY NEW SUPPLY NEW DWELLING L] DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED _ DRIVEN E]DUG GRAVEL O OTHER IS WELL SITE SUBJECT TO FLOODING? YES 1/ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Wjz4oPM Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _�NO NAME OF PUBLIC WATER SUPPLY: �•l�A TOWN /VIL /CITY t-11A o �DTST -TO- PROPERTY' FRM4 NEAREST WATER MAIN r s.. LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET -6� (date) ' 7 PERMIT TO CONSTRUCT A WA 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 form provided by the Putnam County Health Department. During all well drilling operations, the applicant any and all water or waste products from such well property and in such a manner as not to degrade or Date of Issue: ` 19� Date of Expiration 19 shall take appropriate action to assure that drilling operations be contained on this otherwise contaminate surface or groundwater. ?ermit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE'SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL Prue PRRMTM WELL LOCATION Street Address Town/Village/City Tax Gri Number WELL OWNER Name Mailing Address rivate 1, .-e-C P_ 4Dl \ /^L_ AL_per I`1Y. OPublic USE OF WELL 1 - primary 2 - secondary KRESIDENTIAL b BUSINESS ® INDUSTRIAL ®PUBLIC SUPPLY QAIR /COND /HEAT PUMP ®ABANDONED O FARM. O.TEST /OBSERVATION O OTHER (specify O INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT S gpm /# PEOPLE SERVED I R' M./EST. OF DAILY USAGE5f gal E3 REPLACE EXISTING SUPPLY O TEST /OBSERVATION CS ADDITIONAL SUPPLY ZfNEW SUPPLY NEW DWELLING M DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DEN ®DUG O.GRAVEL OTHER, IS WELL SITE SUBJECT TO FLOODING? YES NO IF' WELL IS LOCATED IN A REALTY. SUBDIVISION, NAME OF SUBDIVISION: 7Ir Lot No. WATER WELL CONTRACTOR: Name 'ro e'E 'ETC— _fZr*ll tE.G> Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: t /A TOWN /VIL /CITY I-JZA DISTiANNa- TO i'ROP8RTY'_ P909 NEARE9T_F1AT9R "H IAT LOCATION SKETC SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET ao, (date) (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 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 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 manner as not to degrade or otheKwise contaminate surface or groundwater. Date of Issue: Date of Expiration 19���-- Permit Issuing Official - Permit is Non - Transferrable White copy: HD File Pink cd y Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller _0�57n� PUIMM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEPI GE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT (Name of Owner) DATE G C�'Ao ,� BY: (S treet i ) DOCCMS CLJ GG Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth s/s SUBDIVISION Perc (3) Fill ,f cd HQu� Plans - Two sets permit; PWS letter Variance Request 024 -ERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland ( Town /DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Swage System Plan - ( north arrow) Swage System Hydraulic Profile - Gravity Flcw Fill Profile & Dimensions - Volwme D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction - Nlot-s ` f gr te -inr -rate) 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 DgDansion Area;shown;gravity flow,suff. size If Puq:)ed Pit & D Box Shaun & Detailed House - No. of Bedrooms wells & SSDS's w /in 200 ft. of Proposed Systens Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout 3EPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees,Top of fill 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains - Curtain, Leader, - Footing 35'to catch basin,stormdrain,piped watercourse 10' to Water Line (pits -201) 50' intermittent drainage course 3eotic Tanks 10' fran Foundation; 50' to well .5' Well to PL 9 'P=M COUNTY DEPAF64W OF aM19 DIVISION OF ENVIRCNMENIAL HEALTH SERVICES DESIGN DATA SHEET'- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. 4D Gou�M �. Owner 1�/G- ScoKK� _ - -� i _ ., Address Located at (Street) Vjie_c.r>FC---E `Zp Sec. 19 Block I Lot I4P.1422 (indicate nearest cross street) E5C?� .. s,e�p.A Le-,-r- i Municipality �i_rF ti 1,4 t� �/�L�E `( Watershed N v r SOIL PERCOLATION •= DATA REQunup TO BE SUB IITrED WITH APPLICATIONS Date of Pre- Soaking 5 2? � _ Date of Percolation Test Sf211g -1 HOLE NUA BER CI= TIME PERCOLATION PERWLATION .. 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 lEA(�) _Nq 24 3 GCS7 -y5I 'Z� 2 24 drf3► -Qt�-� . '2.4 24 5 2 9 r 7 39� -R-3(, 21 2cv 2 7 4 G-56,- 1C.) 1 21. 2v 2 3 7 3. 4 .5 - i NOTES: 1. Tests to be repeated* at same depth until approximately equal soil rates are obtained.at each percolation test hale. All data to*be subnitted for review. 2. Depth measurements to be made from top of hale. DESIGN Soil Rate Used P-5 - i C Min/1" Drop: S.D. Usable Area Provided SCE c:- No. of Bedrooms Septic Tank Capacity /moo gals. Typel'" Absorption Area Provided By 33 L.F. x 24" width trench �sroN Other IM Name ���I� r. lSd L�.��"�S tom- L , Signature Address izT. SEAL, yr. - 40 . �OF Ncv�' THIS SPACE FOR USE BY HEALTH DEPARDMW ONLY: Soil Rate AnnrmmA /--'1 1.4- _ 9 1 TEST PIT DATA REQUIRED - TO BE SUBMITTED WITH APPLICATION DESCRIPTION RIPTION OF SOILS . ENCOUNTWM_ :IN _TEST ;HOLES, : , •_ ..: ,_ . . DEPTH. HOLE -NO. I HOLE NO. Z HOLE NO. -G.L. 2' 3' C,;Iy a� 4' Lcy� ► �,s�h� m ,61 _. W r� p m c� rm 71 . C- m 81 C/) 9' . .10' _ 11' 12' 13' 14' INDICATE LEVEL' AT WHICH GROUNMATER IS ENC7JURMW r . INDICATE LEVEE, TO WHICH WATER LEVEL RISES AFTER BE G IIJOOUNTE M %2, DEEP HOLE -OBSERVATIONS MADE BY: SzJZ DATE:" DESIGN Soil Rate Used P-5 - i C Min/1" Drop: S.D. Usable Area Provided SCE c:- No. of Bedrooms Septic Tank Capacity /moo gals. Typel'" Absorption Area Provided By 33 L.F. x 24" width trench �sroN Other IM Name ���I� r. lSd L�.��"�S tom- L , Signature Address izT. SEAL, yr. - 40 . �OF Ncv�' THIS SPACE FOR USE BY HEALTH DEPARDMW ONLY: Soil Rate AnnrmmA /--'1 1.4- _ 9 1 !'" )74017_ 3 /RA PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N.Y. 10512® Engineer Must Provide P.C.H.D. Permit k - -- yy %cG' . e e- 05-1 Subdivision N c Subdv. Lot # Separate Sewerage System built by 441IU490ef Consisting of Jae O Gallon n 3 i zP:� Water Supply: Public Supply From Address or: Private Supply Drilled by ��� � Building Typo ✓ � -� � Hue Erosion Control Been Completed? Number of Bedrooms Has Garbage Grinder Been Installed? Other Reuulrements I certify that the system(s) as listed serving the above premises of which are attached), and in accordance with the standards, rul Putnam County Depar en Of Health. Date ec ati Address as shown on the plans of the completed work ( copies nce frith the fjled plan, and the permit issued by the P.E. R.A. License No.����� Any person occupying premises served by the ova systems) shall promptly _ta,s Erich action as y be necessary to secure the correction of any unsanitary conditions resulting from such usage. Ap oval of the separate sewerage-System� shall- become hull and void as soon as a pub V: sanitary sewer becomes available and the approval of the private water supply shall become null and void' whein a public water supply becomes available. Such approvals are subject to m9dification or change when, in the judgment of the Commissioner of Health, su ovation, modification or change Is necesse�ry. Date B �~ Tits o r lQ�fgAll COMlf!! D>@A i1rt�'QIP OV EMU 8 V BkOndVadimmanniallWhOwde &CWMILX-T.10 0 wYe..lialeealtl n � M Swats DERGI , s>tMI111 .� V.IiccoPF� RoPto . otllaad�p�Ikd.elfao. �Nll G�oTO 2 as OF D Find # FV _ 9 -Cf Q Tama w VWhW Tu Ift 19 wil t ):mwwd if flaialt p Dab d Previews Approval 1q0 limltK i l l zip o Fee Enclosed [3 Amnnn,t N.Nft TA I MMILY cei Mau 4, 231 Ad- p® S"W O* LJ Dptp vabm 14 1 d Mioama 3 .DWV now G P D Pct Modenthe `Remind wb. Fa b a mpisbd tpmw $* NW Is aamUt er.�OG�O loots, Sarnia YMk ••w �j L,F o r 2 � b•c I I� P�SoPPJ'It71� '��rlC�t -1 U b:easiwMabd ip�c� AS r-IE C) MRJ6— WOO SEPNIP FaMa Sop* Adieux ere Mow Stippb Ot�ad IV ) 0EQ Adiasao Ohm gogtiammn 1 rap►essnt "that 1 am wholly and Compeeteq rsfponsbe for the design and location of the proposed systemts): 1) that the septraft for dI sal system above deseriN will be Wnstrueted as shown on the approved amendment than to and In accordance with the standadf, fUlai-8511 rues -8511 reed t, wA*y Department of Health, and that on eompNfkM.thereof a "Certificate of Construction Compliance" mtistedory to the Commesioer of Haelthwill be Sd m%RM to ten OMartnewd. and a written %wroatse will be furnished this owner. his successors, heirs of assigns by the builder. that mid buNder will pteoa is qsW .dparatbr/ coal in. any W1 of mw owns dkpdsal system durl" the pwiod of two (2) yaws bmedi My fobwklp the date of the her anoa of the aPill l of the CdrtNkate of Constweion Compliance of the origkel system or any rgwlrs tltehttoi ll) that the drNktO well descrIM a6— tam be IeCatwl as O Mrs on the appreved plan MIA that mid WON will be Installed In a cored" with the standard rules and ree—M rs--of of the Putnam CMarlty / at IUaltli Signed P.E. k' R.A. A S=i &-- =A ,f� (-�. License No 5036 APPROV[D FOR CONSTRUCTION, The appoval expires two yews from the date Issued unless Construction of the building has been undertaken and if sovocfbe for gym or may be WAWAed or modified when Considered neeesmry by the Commissioner of Health. Any Menge or alteration of construction lw1uNN�a now permit. A rroved for ddkypoml of doneAk Unitary "MOM • private water Supply only. Title- Rey%.. 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