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HomeMy WebLinkAbout3249DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 71-1 -41.11 BOX 26 03249 17%. r Ir W ., Lr , ` , JAI 03249 .ev. 3/86 �H PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Mast Provide � t 1 �3, -- I -� � I P.C.H.D. Permit k_ .s &F j;ICVnSAT: SV,,TPM Located at r� �r a Owner /applicant Na/mme, ,L � L� � �cd Formerly Matling Address , `� 1 G ��` Zip. /Vy Town or ege - } Tax Map -7-9 – VW Block �Lot .4 J NI-G"'6ds >y! Subdivision Name tlbdv. Lot # Date Permit burned Separate Sewerage System built by �h `� L n t� r j Address Consisting of ' Galion Septic Tank and ' Water Supply: Public Supply From Address or: ` Prlvste Supply Drilled by h� -4u� Address 1/5. re J ZY Building Type r Has Erosion Control Been Completed? Number of Bedrooms Has Garbage Grinder Been Installed? �CJ Other Requirements I certify that the system(s) as listed serving the above premises were constructed ass Y+ she plans of the completed work ( copies of which are attached), end in accordance with the standards, rules and regulations, rk d iled plan, and the permit issued by the Putnam Count De artment Of Health. N Date Z C tilled by P.E. R.A. Address / I " > '' License No. —C Any person occupying premises served by th "bove system(s) shall promptly take such actkin•es -niay De ;n6e66tiry`to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage sly all become null -ano void as soon as a pubt'n sanitary sower becomes available and the approval of the private water supply shall become null an ld >4hen a publk'wif i supply becomes available. Such approvals are subject to 9dli %Se'at o or change when. In the Judgment of the Co m Health, oe�tion, modification or change is necessary. Date t7m /� r (vj�2` By Tit to /10/k �J 1!UMM COUIf)19f DII:A)e!lOM W ERAIM DleYlwdia�aalaaotlal BuM loeelan. Cmmal.11.1!. lf6lt /a PaN@ V M* peslt! :ldll .G/ --�' Vow Lai / Tex Yap 7-3 11aek J Jet RottpwaL O lfa+fiaa p Dais of Prow Anweval is.. me raw GPD 6 V Soluble 9wwaM $Ysi m to snow dl rV UGaM Sa*do Talk --a � .� 5 To b,ea�atmaW b —' Atllhom wow 111111111111%n l dMb 919* maw s odw 1 rapaaat'.taat 1 am wholly a w completely rsee, sWN for the design and location of the Proposed system(q: 1) that the M ate saw disposal stem above described wan be constructed as shown on the approved amendment there to and in accordance with the standards, rut regu ns o INS County Department of "UK% and that on eomilletton.t1woof s °Cortificete of petlon Compliance° satisfactory to the Commissioner of Health will be submltm to ton DeportmaM, and a written gueraht" will be turn la >teaCCaeaers, heirs or asigns by the builder. that aid builder will blues in Prod -operating condition, any pert of mid sawW disposal sy ttSr Asi Owkid.�of two (2) yews Immediately follosekag tlwdate of the law "a of the appreaal of tie CertNkato of Construction Compliance of j of systdni ar regain tharetol 2) that the drNNd well 4 a abed sieve MAN be Natty se siaorrw on the approved plan and that Yid WON will be In 1 Ire aceorAanoe, sae ru ad dN Putnam Calatg nnsa N "=NIL ` r ° i 911111110 t1� .I7 /L s P.E./_ R�.416 — A Q�/ ��� r Lkena No % �i� APPROVED FOR CONSTRUCTION: is approval eapirM two years Iroih.tlae to issued unlp's struction of the building has been undertaken and is rentable /a or of may a a or modified when considered Aces pry by the CommiAl of Il/aitR Any chahg. Or aKeratNn of construction resiolm a new permit. Approved for dlsome of domestic sanitary saweft and/or KlJoate,water 'supply only. ... inn 0d% rZ f lmpz By DEPARTMENT-OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 x .. '�dNST�tUCT >A-WAT, R'- ;�;.,-.,. 'AL�"YI;rC�i'rY01� �'TO TER WBL'L � � �• Dann DFAMTM 4 WELL LOCATION St eet Address elrF- ;ter! e- Town illage Cit Tax G % Grid Number _f �-- � WELL OWNER Nam �'' M itL ng lGi� .s Address f `/' ` /y— rivate 2Public USE OF WELL 1 - primary 2- secondary . RESIDENTIAL ❑ PUBLIC SUPPLY Q AIR /COND /HEAT PUMP/ 4BUSINESS O FARM O TEST /OBSERVATION 0 INDUSTRIAL O INSTITUTIONAL O STAND -BY D ABANDONED O OTHER (specify Q AMOUNT OF USE YIELD SOUGHT c� gpm /# D REPLACE EXISTING SUPPLY NEW SUPPLY NEW DWELLING PEOPLE SERVED -4- /EST. OF DAILY USAGE '!� 'eGaSal ❑ TEST/ OBSERVATION Q ADDITIONAL SUPPLY 1 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE MDRILLED DRIVEN []DUG 0 GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: ci Q / Lot No. / WATER WELL CONTRACTOR: Name Af.0 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _L_NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY ate- - LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED 'QON SEPARATE SHEET (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. 2. 3. Pump.the well until the water is clear. Disinfect the well in accordance with the Department attached to this permit. requirements of the,Putnam County Health 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 otherwise cgntaminate surface or groundwater. Date of Issue:/ �e i9 199 Date of Expiration 19.'_ Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller � �-i-• � �� �� CND 1 � c `--" �i% /��- Ca ta . - (! _..�� �"',-:- _ r,•;., - ._.._ .�.; -Z� }'- "'' "'��'.,_ : „ESN Nu je D Inc_ h. - fill t �� --Gy=j - �� R 15 C_ ;,j[ 1�- :-1 -z=1 _a :ALT___ -mac_ cf c= I C_ D -, two ca_ _ 17 — i /jL =CG =- 20 f _ I ®I I i I I I ✓ I - 50% I C. • ever j_ =-nCin - -- Es `�' c•� tea.- cHS = r =L= !CG === C =T c_ I_ r C- c= 1 EDS �.: = =C� c_ =_ -•__ �• =t_ = k�. ACC= =�-= =' =- C_ , �i `cc �_I•c:i F%? �Z 6e of GC ]`CL < A' in C -"T_: C_ — i. ' - i 2.n_ G�L c_r= � I 1:Z% _ f f — 0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES :;4 Date f!`/.f Re: Property of Located 'at Cle, (T) /Section Block Lot -0/- Subdivision of /,tV/C Subdv. Lot # Filed Map # Date Gentlemen: This letter is to authorize 7"""", 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. Countersigned: P.E. I Telephone Very truly yours, Signed Owner of Property Address PC. 4a C Town C// � - 9-a 6 - (0>1'- " g Telephone I% DEPARTMENT OF HEALTH Division Of Environmental Health Services CERTIFICATE OF APPROVAL OF REALTY SUBDIVISION PLANS July-27, 1989 TO: Michaels Way ;Corp. c/o Philip 'Ke,ating, . Jr. Old Albany Post Road Garrison, NY 10.524 This certificate is issued under the provisions of the Public Health Law in connection with the approval of plans on July . 2 7 , 1989 for your realty subdivision known as Michaels Way Corp. . The following data was furnished in connection with the submission of the plans.. Location Cherry Lane (T) Putnam Valley.TM #59 -1 -5 Acres (approx.) 37.0 No. of lots 3 Size (approx.) 2.0 to 29.0 ac Owner intends to build on some lots & sell others without buildings Topography moderate slopes Depth to.Ground Water greater than 7 ft. When April 1989 Soil generally sandy loam to 84 inches Gradin Cut of fill).. N/A Drainage "" 'Natural overland flow Water Supply Individual overland flow Sewage Disposal Individual subsurface sewage disposal system Approval of this subdivision is granted on condition: 1. That the proposed facilities for water supply and sewage disposal are installed in conformity with said plans and notes. 2. Each purchaser of a lot is furnished with a copy of the approved plan on file with the Putnam County Department of Health,' Division of Environmental Health Services. L,4L BY: is ae . Bud in ki, P. E... cc: F. Sullivan Sr. Public Heal Engineer File NYSDH FORM GEEN 154 (REV. 3/85) PUn" COMM DEPARTMENT OP BEALTH DIVISION CP ENVIRCROMM BEMM SIItVICES r DESIGN 69fi9XW= SIIWk= DISPOSAL SYS''i'EM ME IAA. Address _ L Located at (street) /�'�'� Sec. Block Lot t9.aci cats.Pft.r est cr I street) r. Municipality d� Q /r-', Watershed SOIL pIIbOQLA3ZON TFST DATA TO BE Sa&4r = Wrrff APPLICmIONS Date of Pte - Soaking � e7 Ce Date of Percolation Test BOLE Nmm aDC K TDM PER= A=CN PF3 LATION Run _ F.Lapse 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 � 1 7 71 1 .mays -4/5-7 4 /--1- 7-5-4,- W � 2, - mss- �f L /,�,�.✓ — i. Ste- . tom, _ Gfi �,i.I S._ _.. i _ .. w i 4 5 1 2 3 4 5 1. Tests to be repeated at same depth until apprraocimtely equal soil rates are obtained.at each percolation test hale. All data to'be subdtted for review. 2. Depth ueasureaent% to be made from top of hale. rev. 9/85 3W I lip 110 DA10 10 141, SIM PPMOZ-900WKI HOLE NO, HOLE NO. HOLE NO. G.L. 20 31 41 51 61 71 81 go 10, 121 131 .14' INDICATE LEVEL AT WHICH INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING EN000NTERED DEEP HOLE OBSERVATIONS MAW BY: DATE: DESIGN Soil Rate Used Min,/]." Drop: ' S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity gals. Type Absorption Area provided Bye L.F. x 24" width ..bench Other Name 4-71-1 Ie //; Address ?-,c7 1-7% THIS SP= FOR USE BY ONLY: Signature Soil Rate Approved sq. ft,/gal. OF Nely Date ` APPLIC7kTION FOR PUBLIC ACCESS TO RECORDS TO. iLCODS "'PLC =:S' U_ �y CL: =� d JOSEPH L_ PELOSO, JR., PUBLIC Name f A :ency . I`IF OR". u:TIOIJ OFFICER Address I HE?_:.PY APPLY TO INSPECT THE FOLLOt:_NG PZCORD: • �m�l AavtY 3JI Mailinc Add_es= A_ PROVED . — • DE:•i_ i7 4-65 -�5 Da , e 1053 ,. -.. FO? AGF:iCY L ==. ONLY . Record of w z_c l tzis acezcy is Level Clsstodian cG ^_not be fa mac. • c Q 1S CC �21AE by t'--- p:GenCV Date _c :at. u.e NOTICE_ Y^rU F —W—z A R_G _T TO A?P5= L A D- ,7N;A_T, N TO THE . PUTN:_•1 Name Business Acc=.ess i^i_1 MUST FULL`! : XPL?I`I HIS F�.ASCh S FGR SUC'r. D- ` I = =`, IN Sv= ITI'.`iC SyV-v I HER= SY S I ca`tu_ e % Da to l _ b YML Environmental RESULT UNITS "`''" } `" SITE LAB NUMBER S.U. Services PHOSPHOROUS AMMONIA mg/L mg/L _ HNO3 _ pH LT 2 CALCIUM DATE /TIME TAKEN 2-5-92 10AM <20 >4C CHLORIDE Kpar::ceetY ;t� ^,- F°il�t{ 1�1 ✓_1 �z_ s . i„�,�•rEi� i�sE`R�`%° � �= e� —�`2" .l y' jt�1�1 i, � — ELAP #10323 �914) 245 -2800 ZnOAc 12 1992 Lue SULFIDE FEB. mg/L umhos /cm DATE REPORTED SULFITE COPPER mg/L Robert Scott 20 Cherry In Putnam Valley NY 10579 COLD BY I Same NOTES X RESULTS OF ANALYTE RESULT UNITS ..,.. SITE ALKALINITY S.U. mg/L PHOSPHOROUS AMMONIA mg/L mg/L _ HNO3 _ pH LT 2 CALCIUM — Nonpotable mg/L pH GT 9 <20 >4C CHLORIDE HCl n-g/L _ >20C _ STAT! COLOR ZnOAc Units Lue SULFIDE CONDUCTIVITY mg/L umhos /cm SULFITE COPPER mg/L n-g/L TURBIDITY CORROSIVITY NTU LSI _ ree chlorine FLUORIDE mg/L mg/L HARDNESS n-g/L IRON mg/L LEAD mg/L SPC. MANGANESE per 1.0 mL n-g/L TOTAL COLIFORM MERCURY per 100 mL mg/L FECAL COLIFORM NITRATE per 100 mL mg/L E. COLI NITRITE per 100 mL mg/L FECAL STREP. ODOR per 100. mL TON SAMPLING Kitchen tap ` SITE S.U. PHOSPHOROUS For Lab Use Only mg/L Potable _ HNO3 _ pH LT 2 — <4C — Nonpotable — NaOH _ pH GT 9 <20 >4C HCl Na2SO3 _ >20C _ STAT! _ _ H2SO4 ZnOAc Lue SULFIDE M MPN P/A mg/L X RESULTS OF ANALYTE RESULT UNITS ` pH S.U. PHOSPHOROUS mg/L SILVER mg/L SODIUM n-g/L SULFATE n-g /L SULFIDE mg/L SULFITE mg/L TURBIDITY NTU ree chlorine 0,1 mg/L SPC. per 1.0 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 WAS] [WAS NOT]. [NA] of a satisfactory sanitary quality according to the New York State Sanitary Co de,. for the p ram rs tested, at the time of sample collection. These results indicate that iva sample [WAS] [WAS NOT] A] a satisfactory chemical quality according to the New York State Sanit ry Cq e, for the parameters tested, at t e tim of sample collection. NA = Not Applicable N = Not Present (Negative) SUBMITTED BY: P = Present (Positive) SA = See Attachment(s) ' = Also done because Total Coliform was present Albert H. Padovani, M.T. (ASCP) TNTC = Too Numerous To Count Director > = GT = Greater Than < = LT = Less Than Wr,LL UVr1rLP,11V1'4 rX1r%Jr%-1 a. DEPARTMENT OF HEALTH ��1­6 f-- - &RV i r yfririi�h: nal - Rb ic f PUTNAM COUNTY DEPARTMENT OF HEALTH office Use Only WELL LOCATION STREET ADDRESS: TAX GRID NUMBER: (2_ Vf�, lrjjte LI-41 A.Z. WELL OWNER NAME ADDRESS: I/ I �1114111_ Y,_,-er � " � KHBIVATE 0 PUBLIC USE OF WELL I - primary 2 - secondary - _ZL 6- ESIDENTIAL ❑ PUBLIC SUPPLY—J ❑ AIR/COND./HEAT PUMP ❑ ABADONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) 0 INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY ❑ AMOUNT OF USE YIELD SOUGHT gpm./ NO. PEOPLE SERVED _/ EST. OF DAILY USAGE — gal. REASON FOR DRILLING V E]REPLACE EXISTING SUPPLY ❑TEST/OBSERVATION ❑ADDITIONAL SUPPLY ffrfw SUPPLY (NEW DWELLING) E]DEEPEN EXISTINQ WELL DEPTH DATA WELL DEPTHS ft. I STATIC WATER LEVEL o ft. DATE MEASURED DRILLING EQUIPMENT NOTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED P,15'PEN END CASING ❑ OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH J ft. MATERIALS: 'STEEL ❑ PLASTIC ❑ OTHER LENGTH BELOW GRADE 3 V- -5� ft. JOINTS: 0 WELDED CHITREADED ❑ OTHER DIAMETER in. SEAL: ❑ CEMENT GROUT ❑ BENTONITE &UHER WEIGHT PER FOOT lb./ft. I DRIVE SHOE: ❑ YES 3-N6 1 LINER: ❑ YES @-NO SCREEN __ET,A,flLS DIAMETER (in) SLOT SIZE LENGTH (It) DEPTH TO SCREEN (it) DEVELOPED? FIRST_ SECOND-­1 I I HOURS GRAVEL PACK 11 YES 0 NO GRAVEL SIZE: DIAMETER OF PACK in. I TOP DEPTH ft. BOTTOM DEPTH — It. WELL YIELD TEST If detailed pumping , METHOD: 0 PUMPED 1 tests were done is in- %,COMPRESSED AIR formation attached? 0 BAILED El OTHER ❑ YES 0 NO If more detailed formation descriptions or sieve analyses VELL LOG are available, please attach. DEPTH FROM SURFACE water Bear- ing Well Oia- mete In FORMATION DESCRIPTION CODE WELL OEM It. DURATION hr. min. DRAWDOWN It. YIELD Lan d Surlace S C_ ri, 52 WATER 0 CLEAR TEMP. QUALITY El CLOUDY HARDNESS 0 COLORED ANALYZED? OYES 0 NO ANALYSIS ATTACHED? 0 YES 0 NO I STORAGE TANK: TYPE CAPACITY GAT, PUMP INFORMATION TYPE C CS �// CAPACITY MAKER- Gr".Al DEPTH MODEL VOLTAGE — HP WELL DRILL P NAME DATE 0-0 'k du*,�, - - 1 3 L' V" L ADDRESS � SlGhATURE d Aox &0 PUTNAM COLUl'Y DEPARTMENT OF HEALTH �... �a>. snc- _.,=...- ,- .�.- f�__.•�... -��.e. Y.,•. a•. -.,L .:••� -.9 �...,. fiSI rN • w ,:.:.O. aN�MT �:.;. e: t- - • �a:._.. -..:: i• v- i ° ia...w__ . .... � r Owner or Purchaser of Building Building Constructed by Ii /A Y�7 Location - gtreet Municipality /. d- Building Type Section Block Lot Subdivision Name Subdivision Lot # GUARAN'T'EE 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 ir1C?3?.'COfi10lialic e". f3?" i' �- .�v'%aZ7P.�i:�LX?c_�,! ri 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 Environinental 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 3-Q.AJ y o - --19._ 2 Signature - S Corporation Name (i�Corp.) Address rev. 9/85 mk Corporation Name (if Corp.) Address ry;.�