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HomeMy WebLinkAbout2620DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 52. -3 -7.4 BOX 22 02620 lu 49 1 in IL , z� 6 i',. ML No 02620 �1 t 01a dm otnmd m Boles a SWWIDM CUMML Y 115tr to hug W Push / w CM OF � Pmm POLY UWAM DEPOUL s� Put. / �z Laehwd lgi�fYea Iig�b C� `� " Lai / Tae map 5,2 Oak 3 W O..gdA�ie..t r.`.'"lb��/�� VV � L�- I/sh'I ��R�btiF'i'" � g1....rt ❑ O..I.Ie. o Dub of Plovions rg■�s Adiaga 8 � 1� l bG� >J Tow■ �TKWA YAU � I flS 19 fl.. *n Q,i1,A4v4a4nn O.nnrnvari'5 13190 FM02119-S5 Fee Enclosed Amn.rnt ' f cars lj'4NC4.�_-- U' W Ana 5. 015q ` — M S.ew. 0* Deptb v k m 18 llmbw d •odnli�g Daatga Flow G P D PCHD N.-0i -- s Is Oasimbod WMa FM Is co alblad s aye amwm of n..M s.F41e Taalt F1 Lt- To In magYaelad b `(_D � 1 LfaGPMIP�� —AM. Wild.r a..bz > Sw* Fuca Address .et fit. Sap* Ddw by Dl; ► •�" 0I1101, Begahg�aan I loprMNtt that i am wholly and completely responsible for the design and location of the proposed system(al: 1) that the esparate sswage difpOYl system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rule an reed County Department of MesRh, and that on eotnpletion.thereof a "Certificate of Construction Comp#iance" satisfactory to the Commissioner of Nesahwill be submated to the Dols aftme t. and a written gwarentes will be furnished the owner. his sucoa erf, heirs or assigns by the builder, that sled builder will glace in pod .opwatMg condition. arty pert of old sawsp d(soosal system dur per of s Immediately follow" thodate of the NMI- an" of tin approval at tho Certificate of Construction Compliance of the I a repairs t 12) that the drilled will descrand aiow wow be located as shoran am /tar agorov d plan air that said well will M dh he ads, rules and rgia ns off( the Putnam Dole Department of "Nall. P.E. aG` R.A. - �' 15 , I193 gi'ne° 6 2,Z 1. nla. led Co74116 APPROVED FOR CONSTRUCTION: This approval OWN$ two years ham the data issued unless construction of the building has been undertaken and Is IOaable for cause or may bar amended or mod" ad won considered "unary by the Commissioner of MesRh. Any change or alteration of comtructlon rguYes a Mw Permit. Approved for disposal of domatk sanaaWom age, and private water supply only. ,s / ✓mac' !t itle ��✓ pUTpU M COUNTY DEPASTNMT0F HZALTH —. -- !' / Magi Ptwvide � 2,. "' 3 P.C.H.D. Peemlt / r V ( CATS OF CONSTBIICI'ION COMPLIANCE FOB SEWAGE DISPOSAL SYSTEM Town or V ®Ilge GG0 1 � Tar M 52. , - / Block 3 it A1 ! 1 Otruer /applicant Name rdl.� P(S�i�.1T, Forme sabdlvls Natsyv (C✓� k k �� GGoP _y�, Subdv. Lot # Q' Fee Enclosed Amount Date Permit Issued Sep.nta Sewerage System buftt by A ^adnM c d I r� Gapoa Septic Tank and '�' Water Sapplys Pabllc Supply Feo d�`drow an _ VPdvaW supply Drilled by �l �8,� �sjf-� O N L SIAddnes �® �x (oS � JkM, Lot Size C70 OS�� 'Has Erosion Contra) Boon rnm„iPt-Pd? �e�s Nmtber d Bellim a Hag Garbage Gebtder Been bleWledi Otbiw Bequhementa I certify that the systes(s) as listed serving the above premises were constructed a Lally as shown the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regale o accordance wi the filed plan, air the permit issued by the Putnam county rat Of Health. �° P.E. RA. Date �2T 11-3 � tort ;fled bra ?�.S (o � 2 O (8��' ' I Addre t.IeenM No. Any person occupying promises served by the above systems) shall promptly tale such action as may be necessary W. Mats. the correction of afly unsanRary conditions resulting from such u5990. Approval of the separate sewerage system shall become null and void as soon as a pub(:: sanitary Mower becomes . ausbis and the aooroval of the private water supply shall beeoma 11 rid void when s Ik water supply baalmes available. Such approvals ere _. - _ ..__ �kMM& N rletaYVV. .1 �,At_fhx arc WELL L;urirLziiuN mzrumi DEPARTMENT OF HEALTH --Healrfi-ServicFOs: PUTNAM COUNTY DEPARTMENT OF HEALTH office Use Only WELL LOCATION STREET ADDRESS: TOWNIVILLACLICHY TAX GPjO NUMBER: C pad o _'?e WELL OWNER �h NAME: ADDRESS: yn �)icGj -,*-c �j V " OBIVATE 0 PUBLIC USE OF WELL 1 - primary 2 - secondary GI/RESIDE?k]AL 0 PUBLIC SUPPLY ❑ AIR/COAD-IHEAT PUMP 0 A8ANDONEd 0 BUSINESS ❑ FARM 0 TEST /OBSERVATION 0 OTHER (specify) ❑ INDUSTRIAL 0 INSTITUTIONAL ❑ STAND-BY 0 AMOUNT OF USE YIELD SOUGHT gpm./NO. PEOPLE SERVED _/ EST. OF DAILY USAGE - gal. REASON FOR DRILLING ❑REPLACE EXISTING SUPPLY ❑TEST/OBSEliVATION ❑ADDITIONAL SUPPLY OEW SUPPLY (NEW DWELLING) ODEEPEN EXISTING WELL DEPTH DATA CQ -5-0 WELL DEPTH _fL1 STATIC WATER LEVEL ° L_Oft] DATE MEASURED Z DRILLING EQUIPMENT 0 ROTARY 0 COMPRESSED AIR PERCUSSION ❑ DUG DWELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE 0 SCREENED OPEN END CASING 0 OPEN HOLE IN BEDROCK 0 OTHER CASING DETAILS TOTAL LENGTH ft MATERIALS: CkSTEEL 0 PLASTIC 0 OTHER LENGTH BELOW GRADE JL-:L tL JOINTS: ❑ WELDED MTHREADED 0 OTHER DIAMETER in. SEAL: [,jaMENT GROUT ❑ BENTONITE 0 OTHER 7 WEIGHT PER FOOT Ib./It. I DRIVE SHOE. 0 YES 0*0 1 LINER: ED YES Q NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE. LENGTH (it) DEPTH TO SCREEN (it) DEVELOPED? FIRST 0 YES ONO HOURS SECONO.. GRAVEL PACK 0 15 0 NO GRAVEL SIZE DIAMETER OF PACK In. I I TOP OEM ft. BOTTOM DEPTH - IL WELL YIELD TEST If detailed pumping MIFTHOO: C3 PUMPED i tests were done is in- CP6MPRESS1O AIR • formation attached? 0 BAILED 0 OTHER 0 YES 0 NO 11 more detailed formation descriptions or sieve analyses WELL LOG, are available, lease attach. DEPTH FROM suRFAa w.,! ,e! le m� l meter FQA!4A=N DESCRIPTION WELL DEPTH ft. DURATION hr. min. DRAWWAfN It. YIELD nd S Laurface OvAt WATER 0 CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED7 0 YES o No ANALYSIS ATTACHED? 0 YES 0 NO STORAGE TANK: TYPE CAPACITY GAIL. PUMP INFORMATION TYPE �� L-11 JZ­ PZ �4_ CAPACITY OEM c), MODEL VOLTAGE J11, -HP -:L WELL DRILLS NAME OATF y3 /j � VA C,,, X I Af1nRr1tj4 00. ca&&^- I , 4 4, 1/6, Ito 'A� �1�. a YML ENVIRONMENTAL SERVICES 321 K a.r Street Yorktown Ht ithts, N.Y. 1059= ( 914) 245-2800 :-Albert H. Padovani, Director _ LAP #: 32.308061 CLIENT #: 2424 NON STAT PROC PAGE 1 COLASANTI, WILLIAM DATE /TIME TAKEN: 11/13/93 09:00 114 WIC:COPEE RU DATE/TIME RECD: 11/16/9:3 16:50 PUTNAM VALLEY, NY 10579 REPORT DATE: 11/2/93 PHONE: (914)-528-0473 . SAMPLING SITE: SAME AS ABOVE KITCHEN TAP SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE COLD BY: WILLIAM COLA ^ANTI- TEMPERATURE..: < 4C. NOTES...: COL I FORM METH: MF DATE FLAO PROCEDURE RESULT ALT NC iRMAL — RANGE 11/22/93 MF T. C� il_ I F ORM ABSENT /100 ML ABSENT COMMENT =; BACT THESE RESULTS INDICATE THAT . THE WATER (WA'= , ( WAS NOT) i �F A SATISFACTORY SANITARY QUALITY ACCORDING TO THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. 2 SUBMITTED BY: ----------------------- ------- Albert H. Padovani, M.T.(ASCP) Di rector- TWT ELAN# 10323 PUTNAM COUNTY DEPART OF HEALTH SION-- (DF: :+�tllRd TAL;,:.H .. ... Fi FEt�IICES Owner or Purchaser of Building Building Constructed by Location - Street / Municipality Building Type Section Block Lot Subdivision Name 4 Subdivision Lot # GUAR NI'EE OF SUBSURFACE SEWAGE DISPOSAL SYSM 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 iamediately following the date of approval of the b "Certificate_:bf ' C -oars - ;:ruction. Co.,npli ancae" for --the.:sewage_ 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 day of �Q C 19 93 Signature f Ct • (2a4!,t 0-4 C-L • l�-t ua._cu� 0�.(, Title General Contractor (Owner) - Signature Corporation Name (if Corp.) Corporation Name (if Corp.) ess Address rev. 9/85 mk T4S = __I_V Lc =c J . � T '�i � L• Vim} %��. " `_ = j�- ,�'('��'_� C- '0- r-- u"1 C= C = -i E! i-1 L ==C"' 12 E'c Cam_ C EZ - CJ L- `_ =r C_ L= '.....=- c_ j1 =_1 1 CCU =- c= t= F- 7- =rCVe=. DIEMS _ i _tea =_T:C= __ a == C_ Es =kfill Ti.. = =_- =1 c =nt *'L SC._:__n_ES < 4" t_•n E_ 6=--L a L1 E=;- acc- �,_^_C Liz "'L'E'I f. .. =3= C: � C:c� = l iL'LCL��=1' be C_= _ �rJ E'�� -�.c __ ...L•. _ C. t.ct -Inc C =c C_ =C_^ -S *C_ away L -rc a SE'S h- =C? wcz C. S? C` —c l i Ste.? ca - Date c/f- �p-iac -- -e ` C- SCil , E. LSO f t- 1. eiG C.'L == �:vC t Grp - I ( ! �/ /✓ - �`.c L=•=_ s- z_ - 1,000 ? .250 . Lam_ L:C_:L�_ —G C_ C. ;C Cho C—;c, C__ Cut 1(] T-4 - fz -� �• 1 J.— L rel b % CE C. ��C L:r C 1��1 I 7. El GCc C= _ C_"3 GCC= ^? ° 1/1' 32 B/-CvC_ I r 29 C- '0- r-- u"1 C= C = -i E! i-1 L ==C"' 12 E'c Cam_ C EZ - CJ L- `_ =r C_ L= '.....=- c_ j1 =_1 1 CCU =- c= t= F- 7- =rCVe=. DIEMS _ i _tea =_T:C= __ a == C_ Es =kfill Ti.. = =_- =1 c =nt *'L SC._:__n_ES < 4" t_•n E_ 6=--L a L1 E=;- acc- �,_^_C Liz "'L'E'I f. .. =3= C: � C:c� = l iL'LCL��=1' be C_= _ �rJ E'�� -�.c __ ...L•. _ C. t.ct -Inc C =c C_ =C_^ -S *C_ away L -rc a SE'S h- =C? wcz C. S? C` —c l i I I r DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 :.:., APPLICATION' T0''CONSTRUC`tr'A`�nl PCHD PERMIT WELL LOCATION St; i e d WC� To�n Villa C, i� F,Tax Grid Number WELL OWNER Name Mailing Address / rivate vilu'lA'j Ccq- f a , F�*141f A 10519 O Public USE OF WELL 1 - primary 2- secondary RESIDENTIAL X— RESIDENTIAL 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP ❑ ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify O INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE ROC Sal REASON FOR DRILLING O REPLACE EXISTING SUPPLY O TEST/ OBSERVATION 13. ADDITIONAL SUPPLY NEW SUPPLY NEW DWELLING D DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN E]DUG OGRAVEL C1 OTHER IS WELL SITE SUBJECT TO FLOODING? YES I No F WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION Lot WATER WELL CONTRACTOR: Name - rp "g� "P" - Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES __)�_NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY .......DISTANCE TO. TROPERTY ... FROM .._ TE /.CREST .: WATER... NfAIN.: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED r PON SEPARATE SHEET (date) (signa ure) 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 othe�se contaminate surface or groundwater. Date of Issue: Date of Expiration 197-5-" Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller loe t IRMUff •I 9 kneeve 12 v :cv. IY: :1}' a- DESIGN BATA SHEET - SUBSUFAC..E SEWAGE DISPOSAL SYSTER' Fn .z No.. Owner Address 44 I,1 ez -k Ls,..iTgxk- A, e-L,,- Located at (Street) 1vJ e-cc >FEE. Zo Sec. 19 Block �II Lot • I (indicate nearest cross street).: t s��til. t "•.,- 'mod Municipality �r-�/� r'i �.�t_� E Y Watershed _ N u r2e, t„ -`r■ ■ ' 7%'.�■ •' Yom. t Y 9■ ■• 59 • ■P ■ -S Date of :Pre*Soaking Date of Percolation Test --5,/2.1 /85 HOLE REBM CL= TIME PEROQ=0N PERCOLATION Run -- . Elapse - Depth to Water From Water 'Level 311zc -1 , No. Time Ground Surface In Inches Soil Rate Start -Stop Fain. Start Stop Drop In Min/Ion Drop 2Y2 ;'2• Inches Inches. Inches • 21� -bs�i' 4ilila - I i�L 2� 2 (.. 2-� 3..:. 8-1 2 f a56:, -11 311zc -1 , 22 314 . 1 Ott : -122,C> 2.z ,24 5 j2zo- 22 �Zq/ 2Y2 ;'2• NOTES: 1. Tests to�'bie,'repeated at, same depth until approximately equal soil rates are .obtained ;.at each percolation test We. All data to' be suimitted for 'review:` 2. Depth'.measurmerifs,,to ;be' made fran tbp of hale. rev. 9%85 u -TEST PIT li'TO BE SUEMrMD W"-M- ARPT.M DEPM HOLE NO. 1 HOLE NO. 2 HOLE NO. -T 21 3 .41 51 4W 6 7.1 81 91 10, 121 13' 14' INDICATE LEVEL AT WHICH GRO(NDWAM IS M=MMED %, INPICATE IMEL TO WHICH -NATER.IZVEL RISES AFIM BEING ENOOMMUM DEEP HoLF. oBsmATioNs mAr)F, BY: DATE:- 1/2 �7�_-j DESIGN Soil Rate.Used it -!r MirVT' Drop: S.D. Usable Area Provided .7. No. of Bedroans Septic Tank ,Capacity ',gals. T -e ''L± - y, _ yp Absorption Area Provided By L. F. x 24" width trench Other Q. Name Si -bare gna Address SEAL los/2 nh CAR T VL THIS SPACE FOR USE BY HEALTH DFPARZqERr ONLY: Soil Rate Approved sq. ft/qal.' ChPL-kPA )nv j N_ J . . . . . . . . . . . . Jel, . Put nam County Department 'of'Health Division 7 Approved. a. noted for conformance -'. with shL 41A 7 , C,ules'and L am Health' Department J. V., 'p lb ... ........ Jel, Put nam County Department 'of'Health Division 7 Approved. a. noted for conformance -'. with I app b'l 1,guiitionb.,oi the G! C,ules'and L am Health' Department ... ........ 11.1 .�, s Zr 4.p x 7 4,.;i .� d wr v P �,y ' r a v , g5 e t e L �a v t ',_ KI'' t .n $. d. zz} n I.I j „a,1 I `a a, t '. ,N - . t'` 'r ' v c ! Y R 4 t I 4Y 2 a e 5 e�` , t i 4 -'" k e 7t t ; r s t r f. k A t ? 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't a, 't ,i1, 1 ,v. p'.. t ,..�� .. , r ti., l.Y �,b. 0 lJt =l_l_ � 3 M PWL�La.t �1C� g 1COD 6&U-Cr 1cTa+K 7 2 $ / L Juf vnc�j Ip we 67 io 'Jl t-F CrvP� t i i . • [3 r l j, t f 1'. i ifI 1 J ' is f k County Health Departm t sha(I the system; The syste shatt been Inspected by the En Ineer Department: 7. Minimum weW yedd of 5 gpm I r gpm must be reported to th B. The sewage system design s o' Installation of a garbage g ndc the .approval of the Putn Cc 9. The contractor must not y de Installation: of any porti of i 0 FILL ,�loT C 1. RUB fill must be tabilized by of at leas. 6 m the and inclu be achieved by chanical coop density of;th undisturbed and ©. the P tnamk aunty Health Doper 2. ®®®®�� relative ;dry periods to mini 3. Run of nk fill shall be suit unsuit lei material end shell ®N in th natural soil after the ®®®.NEM 4. The impervious fill, clay barr se age absorption capacity. 5. F 11 suitable for sewage absor ®I t i i . • [3 r l j, t f 1'. i ifI 1 J ' is f k F e• t a of r t i� i -0' 2' -9. ,I I County Health Departm t sha(I the system; The syste shatt been Inspected by the En Ineer Department: 7. Minimum weW yedd of 5 gpm I r gpm must be reported to th B. The sewage system design s o' Installation of a garbage g ndc the .approval of the Putn Cc 9. The contractor must not y de Installation: of any porti of i FILL ,�loT C 1. RUB fill must be tabilized by of at leas. 6 m the and inclu be achieved by chanical coop density of;th undisturbed and performed in the undisturbed u the P tnamk aunty Health Doper 2. Site modif cation activities i relative ;dry periods to mini 3. Run of nk fill shall be suit unsuit lei material end shell in th natural soil after the shal perform final percolatio 4. The impervious fill, clay barr se age absorption capacity. 5. F 11 suitable for sewage absor re than 2% fines by weight. d no more than SOX by weight b F e• t a of r t i� i -0' 2' -9. ,I I