HomeMy WebLinkAbout2843DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
62.10 -1 -33
BOX 24
02843
'f r,
..,�,,
-.
,�
X
WX 11
02843
PUTNAM COUN`T'Y DEPARTMENT OF HEALTH
DIVISION OF ENVIRON rAL HEALTH SERVICES
A116W 5a44 /- -
Owner or Purchaser of Building
Building Constructed by
Location - Street
14 V X/
Municipality -�
Building Type
Section Block Lot
Subdivision Name
Subdivision Lot #
GUARAN= 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 describer) 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
` Cezt,if:icate c,f - Ccristructicn Co_znpliance °'. for the 4spusai s1-cte^, 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 day of 19 Signature
Title
General Contractor (Owner) - Signature
Corporation Name (if Corp.)
Address
rev. 9/85
mk
Address
PUTNAM COURIY DEPARIME[dr OF HMIII
nj T!3,
*T��'�1 !1F
i crrRr�� +l�Ty��FJ, x.R nq�_. V.+�rtnn, _
i.......�.y...'.:•.: .as%.�..... -.. :•y....;.ee.- .:m- ...a;+..o�•: w.: e.c�niK...ww_
5e
000., Or Purchaser of Building
BYEIA q Constructed by
Municipality
1411, 4 /d
Section Block Lot'
Subdivision. Name
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
y 1 f.i � /� oz ny,
4a +�iitJ l'� Jy V .GJ \��. • G+.� r�
repairs made by me to such system, except where.the failure to operate properly is
cpused by the willful or .negligent act of the occupant of the building utilizing
the` s. 'stem,
The undersigned further agrees to accept as conclusive the determination of
-the Director of the Division of. EnvironsreMta1 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 sy
-Dated this A� day of 4 19 5?0 Signature
General Contractor (owner) - Signature
Address
rev' 9/85
Title e Poll IV, (iL
Corporation Name (if Corp.)
Address
` LAB # 3,Z. Z y
Yorktown Medical Laboratory, Inc.
Date Taken: /� -137- 190 Time: ,
321 Kear Street Date Re d & - ,Ip -" Time: U
Yorktown Heights, N. Y. 10598 Date Reported
(gt�r nG ooh -�—
_ .. _.._.. - --� .� s .....�: �...., .._::..•_ p.:.,: ..._.._ -- - �, �-�,3 �� � �� --rte '�v�✓�' % �� 'r . U;`.,
Director. Albert H. Padovani M. T. (ASCP) PO/Client �#
T Referred By:
lfo�elh -71w -r Sampling .Site :
'00 Phone (71,?)
L J
REPORT ON THE QUALITY OF WATER
INORGANICS (mg /L) MICROBIOLOGICAL U 100mL
_ Alkalinity
_ Chloride
_ Copper
_ Detergents, -MBAS
Hardness, Calcium
Hardness, Total
Iron
Lead
Manganese
_ Mercury
_ Nitrogen, Ammonia
_ Nitrogen, Nitrate
_ Nitrogen, Nitrite
Phosphate, Total
Silver
_ Sodium -
Sulfate
Sulfite
Zinc
_ Standard Plate Count
(CFU /1 mL)
Membrane Filtration Method
Total Coliform < I
Fecal Coliform
_ Fecal Streptococcus.
Most Probable Number Method
Total Coliform
Fecal Coliform
Fecal Streptococcus
Fi`P�anPl�iiG���;? i 2\
Total Coliform P A
PHYSICAL/MIS7ELLANEOUS KEY FOR TERMINOLOGY
pH (S.U.)
Color (Units)
Conductance (ohms /c)
— Odor (TON)
_ Turbidity (NTU)
CFU = Colony Forming Units
IT =
�
= Less Than
GT =
>
= Greater Than
NA =
Not
Applicable
SA =
See
Attached
TNTC
= Too Numerous To Count
REMARKS COMMENTS For Lab Use
(For Lab Use)
SAMPLE TYPE:
(Check One)
s/ Potable
_ Non - potable
OUTGOING:
(Check Each)
HNO
—_ HC13
— HO$04
NaOH
ZnOAc
Na2S203
Other:
INCOMING:
(Check Each)
THESE RESULTS INDICATE THAT THE WATER SAMPLE WAS (WAS NOT) (NA) OF A
SATISFACTORY SANITARY QUALITY ACCORDING TO TH h1W YORK STATE PUBLIC DRINKING
WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE COLLECTION.
THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DID NOT) (NA) MEET THE
SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEVI YORK STATE C DRINK-
ING WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE COLLECTION.
Padov_�. P) 7/87 (Rvsd1 /90) RWE
Padova i, )irector
GT
4 /LE 200C
_
GT
200C
�pHLE2
pH
GE 12
—
Other:
THESE RESULTS INDICATE THAT THE WATER SAMPLE WAS (WAS NOT) (NA) OF A
SATISFACTORY SANITARY QUALITY ACCORDING TO TH h1W YORK STATE PUBLIC DRINKING
WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE COLLECTION.
THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DID NOT) (NA) MEET THE
SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEVI YORK STATE C DRINK-
ING WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE COLLECTION.
Padov_�. P) 7/87 (Rvsd1 /90) RWE
Padova i, )irector
_t A.r�OII. /'�A.,lT,T TTTrIwT n ,Vrnnnm
�'�- ✓Jl� WP,LL l,Vl'1tL!.11VLV itt.r Vitt
►� DEPARTMENT OF HEALTH
* , r Division Of Environmental Health Services
PYTTl��(.'" 0' U1V�1 :`Y£'U�i'�kl'"1�`rTI'`tUr' H�t��'i'i.z�..... :- -�•'-
Office Use Only
>j�'_�.;;.�.�•.{�,:
WELL LOCATION
STREET ADDRESS: TOWNIVILLAUICHY GRID NUMBER:
WELL OWNER
NAME ADDRESS: �7-/9C ,<S0/k /
APE 3 �
IVATE
PUBLIC
USE OF WELL
1- primary
2 - secondary
IrRESIDENTIAL O PUBLIC SUPPLY • O AIR/COND./HEAT PUMP d ABANDONED
❑ BUSINESS ❑ FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE IOd gal.
REASON FOR
DRILLING
'NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION
O REPLACE EXISTING SUPPLY. ❑ DEEPEN EXISTING WELL
DEPTH DATA
yyELi. DEPTH ��� ft.
STATIC WATER LEVEL ft.
DATE MEASURED � a2 20
DRILLING
EQUIPMENT
O ROTARY COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED O OPEN END CASING, a'OPEN HOLE IN BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL LENGTH ft .
MATERIALS: WSTEEL ❑ PLASTIC ❑ OTHER
LENGTH.BELOW GRADE Jq ft
JOINTS: O WELDED IRTHREADED ❑ OTHERR
DIAMETER in.
SEAL: OCEMENT GROUT ❑ BENTONITE ❑OTHER
WEIGHT
PER FOOT (b. /ft-
DRIVE SHOE.'WES ❑ NO
I LINER: DYES )RNO
SCREEN
DIAMETER (in)
SLOT SIZE
LENGTH
(ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
DETAILS
.
FIRST
❑ YES ONO
HOURS
SECOND
- - - '
GRAVEL
SIZE
[GRAVEL PACK
❑YES
O NO
DIAMETER
OF PACK - in.
TOP
DEPTH f .
BOTTOM
DEPTH It.
WELL YIELD Tf_ST If detailed pumping
METHOD: O PUMPED 1 tests were done is in-
ACOMPRESSED AIR , formation attached?
O BAILED ❑ OTHER :OYES ❑ NO
y�IFLL LOG �f more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
Water
Bear-
ing
Welt
Dia-
meter
In
FORMATION DESCRIPTION
CODE
it.
ft
WELL DEPTH
it.
DURATION
hr, min.
DRAWOOWN
It.
YIELD
9Fm
Lana Surface
A
ZA A). C-le14
�o
�.�rr�Esro�vE
/a
WATE)i ❑ CLEAR TEMP.
QUALITY .0 CLOUDY HARDNESS
O COLORED ANALYZED? OYES ❑ NO
ANALYSIS ATTACHED? ❑ YES ONO
STORAGE TANK: TYPE
CAPACITY GAL.
PUMP INFORMATION
TYPE
MAKER
MODEL
CAPACITY
DEPTH
VOLTAGE HP�
WELL DRILLER NAME /80 yb /1,,? rg-S1AAJ WELL eG. --rAIC - OA E
0— U
ADDRESS /(_bnn` - 5- RCV7E 5Z SIGt
L N�
. m*""' S' -" '
- "'"+.r,^T�'-- R":'?��' '-a; .'°,T
� :.; /( f ?• � F f',i Y `i :t f t , { „z, � S § *� [£' '; `�i rr• �'� , *e�..?... `�; \ aP ��` � ,7 15 a, n �Svk a� sxk�s�,r'�1�'S'%f.r ray„
COUNfY DEPARTMENT OF t
` , Dlvlabn a[ EavhronmenW Health Servkes AN" elN Y 10511 Engineer to Provide Permit M:.` s a
`yl; to +r 3 a r On CERTIPICA F C011IPLIANCE e + s' N�
�� TBUCf[ON PERMPI' FOR SEWAGE DISPOSAL SYSTEM_ � �. � °, 'Permit .�M c � :uQ K� ti
10, iO
$abdivWon Name Cnhd •Lot iY d
ti
Ta: MaPt BlockLot
Owoer /AppUcant Name
Remw ❑ Rovita •ion ❑
• -Date ot, Pieviods Approval ?.
7 Vt/�
1KaWe8 Addreed - Town:
Bonding Type ..'Gc5 .'mil G'GU Ldt Area G d a l 3 �� 4
FID Sectlon OoIY Depth yoMme }
Nnmbei of Bedrooms Design Flow G P D :'. PCHD NoH_ 8catlon fe Repaired When_Fill le eotnpleted _
Separate Sew erne, SY.tom to conaled oI t7 G V Gallon Sepek Tack and
comihdeted
To: be
. : , •:' Address
x
{ S Y
Water SapPb Ptd>I!c Supply From ^ -Ad&6& ;
or7 v- Prlvato,SuPpb' Del➢od by e.ta e i
Other_Reaalremonta
I represent thaC l: sm wholly and eoinpletel`y responsible`tor the tlesign and roeat�on of the,_ proposeA systems) 1) j,hat the, se paiste� ,Sewaga.z'0isposal,riystem
n s., !_ to and �n, accord �A" - anda[ds rutes.an regu a. ions o a u nam
above'tlekribed will be constructed as shown on the approvritlamendmeht there
Count De ea ""
y, partment Of ,iHeeRh and that on eompletwn thereof a CecLficate of Construct h;; pna factory to 4he 'Comm HSatth'will
be wtimittetl to the `'Department 'and a written guarantee wUl be to noshed the owner ipns by the builder ••that said builder Will
p1aN in good opertating;conddion any pail of sent fewsge tlisDOSa1 sYStem during tb' ri
.P-- ,
ante of thee. a '� °*? � *- �� >- t...�-� _ p• � . ;Y �,k stliately- following thetlatq of ths�isw
pproval of Me Certdicate .qf Construction Compliance' of the oriquial,S to an [s to, ) that Ahe,drilWd;,well described above
will be
loutad es shown'On the appoved' plan and that sa�tl well'w�ll be installed m actor nc -" th and e% s and'r
COUnt equ anions of the Putnam
y',DepartTBDt OfSHealthY R m C a_x
..t M 1
c 21
�v Atldress Liense No
APPROVED YFOR CONSTRUCTION Ts approval expires two yews from the pate ssue iA +q` he bwlding has been undertaken and is
►evtlea,0le for ;cause or may be amendetljor:moddied when con ;idfi►edw necessary by the Cotri ` :/►n'y chaliye or altelitionof construt:Yion
requires a new . ermit prtiv`etl for disposal of tlomestie sander sewage end /W ►wale. ly
fed.
/87. Oats
Title `
NO. 577-90-19
,.0 DEPARTMENT OF HEALTH
k. COMPLAINT OR SERVICE REQUEST RIECORj
TOWN PUTNAM VALLEY DATE July 16, 1990 REFERRED Td�
TAKEN BY Jim Luke TELEPHONE CALL X IN PERSON LETTER
CONFIDENTIAL
REQUEST FROM Susan Glass
TELEPHONE 526-2585
ADDRESS 174 West Shore Drive, Putnam Valley
ENVIRONMENTAL HEALTH: Home Sewage Rodents Refuse. Public Water Food Service
Migrant Camp Other
COMPLAINT OR REQUESTNear Lake Oscawana, neighbor's new construction is causing
run--+.off onto her property. Ponding muddy water in yard and muddy rivers
run into Lake Oscawana.
ACTION TAKEN BY
DATE
FINDINGS-
-/Z t&trIf-
C,; jr4t)"
7-1 S
X�7
FOLLOW UP INSPECTION (s)
DATE FINDINGS
DATE FINDINGS
?ROBLEM ABATED
)ATE PERSON NOTIFIED
C
ESTIMATED TOTAL MAN HOURS SPENT,===========._
Q Q
a
wP. �
:�nr ww.w..a.- .v.••..�.w r� .e.: � -mvy . -w «.,ar�':r:- e:.++�w, -..,:v •:n >.,, -.n __ �. c� yew -_ . anr�. w.%.: � ,•...�+r�.- .m..�e.�s.- ...c -� >.s .r ..s•.a .- - :e -.>„ :i-_ vim..
8,,z. Gl.iii iam fledgez
PutX.ic HeaX th Sun- �talLian
D iv-iz. ion 0�1 Cnv"i2onmenia e
Pu.tnak County Dgpan.tmen.t .
110 O-ed 8.te 6 Cenite2
Ca,zme_Q, New yolk .90592
Deal NIL. _ Kedges:
Chaaiez 9 Suzanne 9.9a.,6
974 ble ,3.t Shone DIZ.Lve
Lake 0.3cawana
P ut�iMm. Va�.tey N.Y. 90579
585
lit
"- O,cto e v 13,
Rea.Uh SzAv.icez
o/ )Uaith
Ue 2eaiiy appAeciaite you2 conce ?n -in coming to .inz/aect .the
z i.tua.'- ion conce2n.ing my ne-ighFo2' z wa_te2 i2AO91em.
A,6 I am -w2-i:t=ing :th.izl on Sa.tu)iday, it .ii 2a.in ing and again
the catch Aaz.in -ih ove z ;elow-ing and .the wai-e2 _i s 2unn.ing on -to
my P2ope2.ty.
In about a month, we w.iiX to clozing oun houze Ioz the w.intea,
gnd._cQm.iag ou<t _on -2r� �s�o2ad- i.ca.o2y - In v e.ew }L� ��;, _.�Ze?e 1,6 -
-- -
___.._._.. �y__ ze. �" e° jz�iorie" -izu»z�e�r. "'arzcC`°"cici�d2e%h '�i.rz "yoz�`c: 7i"7= 4rI"l5 "0�" �'zicee�;'•":
Fiuzh.ing, New yoak 99367 (798) 463 -4292, in caze you haue.to teach
me.
Ne .thank you again /02 agi the time, 1,1LoukXe and cage you took to
he_ p 2emedy the z i.tua.t-ion.
s.inpce2eiy you2Z, f
Chaz.2e s & Suzanne 5.ed
o- e.
Cha ties S.2uss
69 -400 950 St/zee.t
hushing. N.Y. 99367 -9298
aanua2y 9, 9999
Mz. W iii iam fledges
Puti-i.c fleaith San.i-.taAian
110 Oid Rlz 6 Ceiz.teA
CaAmep, New Yoltk 90592
Deal 0/t. fledges:
On Decem9ez 24, 9990 we went to buz countny house at 974 blest.
Shone Dlt-ive, Lake Oscawana, Putnam Vaiiey to check the house and
ou.tzide paopzAty.
We wou-9d like to .inlo4m you that thesz was s.tagnan.t wa.te2 (quite
a io.t) on oun side oye the /ence. It seems ghat the .t2ench my
ne.ighlo2, Oz. Sat oi, dug on his side o� the fence .is going uph.ii -I
.whew the t ig zockz aae ioca.ted, and .the2e;eoa_e .i.t 2eve1Lses the ;'fl-iow
onto my /220pe/tty.
We aeaiize .that you -jfeit- llz. Sago�t has .compl -ied with the necessa2y
2egaia.tionz to pzevent wa.telt �&Lom spiiiing to out pzopen.ty. howevea,
we lerzi that .th.is ma.t.te2 should .fie kzougA;t to youit atlznt.ion in case
any /a/zthe2 /22o gems should occu2.
7h.is .aeltves as a 2eco2d /02 youit Oiiez.
� 11 _I w.i, h you and youit )eam.iiy a happy and heaithy�New Y'ea2t`
s.inceteiy gouts,
C
Cha/t.2es gia*
Sim r rV Cate
_o _
_ -
-__ -
�r s SIGI
. O
R Su;rDI'T-
1 1 _
rE a— ea lr••r. �,
Li ,I - Date of placz1--rlt
2 :1 barrier w'�'I� tiG-r
c_ Piatur-' sci? nct s�icc
d_ S`.^re, br-y = e c_ , cret_r t,_zul 15' frCCii Si1c
e_ ! �� f �_ f =C , Mct =' c: =r= a /:vct_� cIi� _ .
II _ 5 DI Sr C E ? L c; can
G.
-,o 00
..= �tic
_ b. S=QL? C t-rr_i: i -c =- i 1 =T1 L
C_ 1o, IIL_1?T uml = =.1 LCLT r�`CII
d_ irc a00 =rf_�r C_�rCL� Gi? = r1'_I? 10 f7-. cf 4- Land
e- E- S I-QT -U-- —ICN: B1:X
1 Ctl e_ ate. same e_evat_cn - w `e— L°-=
mot_ mac•; f_
All
"uZ L -- cr;c Coil be :-- bcc ct.4 t'_=nchec
Ivr? n_
se=
-
C- T��
Dist =rc . C. -_r ll_'C C_:t =r
ql _cam c= ac--=t✓bl l /l' 10 1_ -► _ - 20 r __
=cns
SEE-
S. Rc= _cr es--e-n-s i cr_, 50
9. size c c- -;ell 3/4 _ 1 ^11 di a:: ___r
lu Ct -_1✓7- C= c'Vel in tzenc 2 12" TII?liitn*ii
11. P i re a d°
mwq
�I
...-
.�. _} Size cf c-_:u
2. Cye=0 , _-, y
�- P=D ccc`5=ib! ° Tc3'Ecis to cr e I I
by E °-= t :l DECc'
esti*�at = __cq �� c:�e
•DCU�� � CC.. -'' L_r G��- %ZCti ' p1G�i� ' I - 1 I
-- c L = r C.T_ "..rcve Pans
1= 1 1CG= __ c_ — --or I
arc:t C Wall cccc==. e-
`-s f Lsh with iIL_de cf hcx
ccnt=? ns St.CP_e5 < d" in
accord-i-nc to elan ( I
' -- C _t 1 1 prCtZ! �=!' & d; 'tJ �`OiS�_Lvci�'"C :L�e
C= C.2 a'_"ce ai4av t=Qi[ SDS area
FMIAr,rSi?Eu�15`tL =CN rate
l� 3 S �'� a CR SurDr71 SIC?V LCP- � �6 '1177 W7
S ire DISPCE-AL AREA
a_ Sis area 1c=== _� c5 2!-=,- cr-Jroved -c arts -
I
I
I
b Date of place—n—ent.
2:1 LG w 1 N iG_DPT-'H
I
]r'- -: - . cf < 30 ices c r-_Cc I
I
c_ matur=al scii nct st*icc=
I
I I
c_ £`one, bra=: , etc-, are_t_r tl n 15 f -Cm 5%S
1U _ D erth af C ave _ In t= nc 12" ri'.' nizm n I
V.
e_ 100 f `, f=an at_ ccur ==_, /l e - lar_cs. I
I I
EE-;r= DISFCE L EYC=t �
a. senti c tz- s_Z= - 1,000 1, 2. O
ual
,mGnho1_ to crate'I I
' L
1.. G.- 4 t — = i I=aZ 1=v-=! (
I I
C. 117' icm n.Lr :: -t - ---a
D ° ric +c` i' in aco
C._ :'C f] J= c_._._. r C ':Ctii= 4+_- ..r1___ 14 L __ CL
e- li 15 �.! - =tJ-PT(':y Mi --
A! C . E_E'TGt3CI1 'FCL= =-
C.
r.7. E.CCI
c= l/ S - 1 /32
1 - 20 -
]r'- -: - . cf < 30 ices c r-_Cc I
I I 0404 W_�
5. Rrcn
C Size C_" C_ reel 314
1U _ D erth af C ave _ In t= nc 12" ri'.' nizm n I
V.
Pig
i
Woo rS
ual
,mGnho1_ to crate'I I
I I �1 j'•�' -°�"•r
- F i ;-_ =_lam= I I
I
6. by L° -1
L''_S`_'"ice fr Si5 area m= s'urea
e. Ti'ci_C -! GTti_Cc'= CrC_' e
u^
rCLc 1CC? �� rer a�n'rcve^ 'Plans.
C= -Ln'ci 18" atcve c-a^ I
I I y
r.7. E.CCI
C-
V.
I I
i
_
1Cc=_ -zE as Lam'' a_�r:-ve- plans
b_
L''_S`_'"ice fr Si5 area m= s'urea
C_
C= -Ln'ci 18" atcve c-a^ I
I I y
V-1- _ cVr ,I=i WDR_KtA-S _ I
b.
ILL Fires � = a! 1 v bcc� 11 3 I
I _ I
- C.
? 1 �iCe= f 1•�' wi tz inside of bcx
l T.T.
;1 1 sat = -ice c ^r�.i-�= stc're= < a,• in c_�..___ I
I I —
e.
Cinta i n c. ain ins t_.11 er acccrdinc to pia.n
f .
C _r=te i n drain c -t= -1 er ^t =rt=^ & ci r _ to e`ri5- SvcL�' -CCU =�
-
C.
"Ct' L1C C = = ...c C_' "-tea ce away f _:an SDS a? e = I
I I —
_
aCe_7L'. -� Le
E �c. cicCcs cz_= r ? �
v1 rNESSED r?yr %`DEL VF k
PUTINAM C OUN'i'Y DEPARZMENT CF HEALTH
DIVISION OF ENVIRCNMERML HEALTH SERVICES
DESIGN DATA SHEET- SUBSUFAC.E SFWAGE DISPOSAL SYSTEM FILE NO.
Owner -A ' o _ Address 6�3' 7 .)R.
Located at (Street) P�� LSE Sec. Block Lot
(indicate nearest cross street) -
Municipality. Watershed
�•ri�i�f• �;, i•�i���iM{i�i+ya.�+�ntiv���%i��; �� _�s 'f�l: w �a�� .�M�: : • • : rr •..
Date of Pre - Soaking
Date of Percolation Test
Lo.-.;l m• •a • • �- •• • - �- •• •
Run
Elapse
Depth to Water Frcm
Water.Level
No.
Time
Ground Surface
In Inches.
Soil Rate
Start-Stop-Min.
Start Stop
..Drop In
Min/In Drop
Inches Inches
Inches
HOLE #1- 1
124A
o�
z 3°
4
5
2
3
4
5
10t6#5 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 suimi.tted
for review.
2. Depth measurements to be made fran top of hole.
PUM M COUNTY DERARUMU OF HEALTH - DIVISICN OF ENVIRODMMM HEALTH SERVICES
ZMDnIDUAL WATER SUPPLY & SUBSi7RFAa SZ'QM - - DISrPCSAL SYS'T'EMS
_REVIEW.. S''I'.. -. C0NST.RT=I0N PERMIT
DATE R...�P- ';vr'�:
✓moo �J t� �-� BY: 6 W
Mmue of C w-ne_r) (Street Location)
CC��rs
YES
NO f
I
I�
i
i I
I�f
i
I
f.
I
AA
I
J n.t)A
f
LF trench provided _3� y
Jas Para le! to conCours
�100% ems.
I
I
I
I
1
jI
5: Z
I�
I
FILL SYSTEF�41S
clavbarr'
10 ft
fil notes I
n a saec.
dents causes
100 yr" flood elev.
T-.
200 ft.. reservoir, etc. e4�
i��
150 ft. trigall /9a11.
�[r�5
DCCUM=
Per,.ut Application
Corporate Resolution
Plans - Three sets
Engineers P.uthorizaticn
Design Data Sneet'(DCS)
Deep Hole Log
Consis'Le -nt Perc Res-,f-1
Perc Sole Depth
s/s
SJBDIVISICN
Perc
(3) Fill
cd
Howe Plan - Two sets
Well , ' � Pe_rmi t; F;vS letter
Variance Reouest
CAS
Legal Subdivision
Subdivision Aporoval Cneckt�
a- acprcval SSDS Ad- Lots Check-ea
Welland (Tcw-n /DEC Ps=i t R & D)
Data Cn DDS Plans & Perri t Sa:ie
REQUIRED DETATr.S CN PL2NNS
Se-rage System Plan - (nort-i a _- w)
SC.rge System Hydraulic Prof"il - Gravity Flc
Fill Profile & Dimensions - Volume
D or J Box;Trencn /C-allery; PL-urp pit details
Septic Tank - Size, Detail
Well Detail, Service Line if Over
Construction Notes (gr ncer rte)
Two -Foot Contours Existing & Proposed
Driveway & Slopes Cyst
Footin /Gutter,Curtain Drams (disc:harge OK)
Perc & Deep Holes Located
Represe- ntative of primary and e- x- -ansion
Expansion Area; shown; gravity flcw,suff. size
If Pumoei Pit & D Box Shcwn & Detailed
House No. of Bedroans
Wells & SSDS's w /in 200 ft. of Proposed Systs
Prope_*-ty Metes & Bounds
House Setback Necessary (Tight lot)
House Suer - 1 /4 " /ft. 4 "0; Type pipe
No Bends; Max. Bends 45° w /cieanout
SEP,WMCN DISTA=L SPE:CLF!ED ON PLAN
Fields
10' to P.L., DriveTaav, ,Large Trees,Tcp of f
20' to Foundation Walls
100' to Well; .2001 in D.L.O.D, 150' pits
100' to Stream, Watercourse, Iake (inc. e
15' to Drains - Curtain, L,=der, Footing .
35'to catch basin, stormdrain,Aited V- tercou
10' to Water Line (pits -201)
50' inte-rnittent drainace course
Sent; c Tanks
10' fran Foundation; 50' to we-11
15' Well to PL 9
•' /• •• JNTY DEPARnff= • HEALTH
DIVISION • ENVIRONMENTAL HEALTH SEMCES
DESIGN DATA SHEET-SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner 4144� _,Address Jlle
Located at (Street) Sec. Block ¢ Lot
(indicate nearest cross street)
Municipality/' w
W-60m
Watershed
Date of Pre-Soaking 9
Date of Percolation Test
HOLE
NUMBER C= TIME
PERCOLATION
PERCOLATION
Run Elapse Depth to
Water Fran
Water Level
No. Time Ground
Surface
In Inches
Soil Rate
Star• -Stop Min. Start
stop
Drop In
Min/In Drop
Inches
Inches
Inches
—3
5
2--
3 ?2,& , 3a 7 -3
_7 >"?,
5
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 node fran top of hole.
rev. 9/85
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO.
HOLE NO. HOLE NO..
G.L.
1'
2'
31
OAY le-
4'
5'
6'
7'
8'
9'
10'
11'
12'
13'
14'
��.', - T.T�TrA_T..lT1/y
iLr1J1lL']1J."+ J.JL:/V hT YYLr.1.4i1 ViIVVLrLJYrICi1i.:YL\
1:J''••, ii:�JVlr ll'Y4ii :-.. .. .r • -1%�- _... v- .
INDICATE LEVEL TO WHICH WATER LEVEL
RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY:
U/ /l f�Gi'I% -- DATE: _
DESIGN - - --
Soil Rate Used /C% Min /1" Drop: S.D. Usable Area Provided C7 dam
No. of Bedrooms j Septic Tank Capacity /d a U gals. Typejs0�
Absorption Area Provided By. 6U . L.F. x 24" width trench
Other
lita':+ju i
t /
i
j4, 7
I
� f
Flo
lita':+ju i
t /
i
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER'- CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATION TO CONSTRUCT A WATER WELL Cj
PCHD PERMIT
WELL LOCATION
Street Ad res To%1V lage Cit�y Tax
�7� �rG r-i v�q Ya % 7
Grid Number
—4—J4
WELL OWNER
Name jj Ma lin Address
/> ar„G
rivate
13 Public
USE OF WELL
1 - primary
2- secondary
E11RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP
0 BUSINESS O FARM O TEST /OBSERVATION
O INDUSTRIAL U INSTITUTIONAL O STAND -BY
O ABANDONED
O OTHER (specify
O
AMOUNT OF USE
YIELD SOUGHT_ gpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE ,e/;,c-C/ gal
REASON FOR
.DRILLING
N5EW SUPPLY OPROVIDE ADDITIONAL SUPPLY
OREPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL
❑TEST OBSERVATION
DETAILED
REASON FOR
DRILLING
WELL TYPE
LjjDRILLED
DRIVEN ODUG
O
GRAVEL
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES ✓ NO.
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: v
Lot No.
WATER WELL CONTRACTOR: Name Ales" / ow Address: IV
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
REAR OF THIS APPLICATION []ON SEPARATE SHEET
( ate) si 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 s.hall:
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. .
Date of Issue:
19
Date of Expiration: 19
Permit is Non - Transferrable
2/87
Permit Issuing Official
White copy: H. D. File
Yellow copy: Building Inspector
Pink Copy: Owner
Crane rnnv: WP11 nri11Pr
DOUITY
A
17:
'14
k
4�
32' 3
4 cr,
3F 3
49 47
zz
4"
P,
1%
2 f
4 'lle, -Z j: 0,3
/Pli- 044/
Rutnam County S.Deparment of tioa.Lu
Jc-, �e-
41VIDI of 'Envirmfuental Health Bervi
7-. 7 Si
proved as notedfor confoirsnee with
approved
W11cable VtOea nncl Pagula-tions of th
,vatnm County Health Degntment•
Itte=tOW4 -Vg-.
A 0