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Home My WebLink About3328DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.05 -2 -2 BOX 27 lolls I r . 1■ I 1% ' N` ' ' '� 6 vil ' r " me 03328 PUTNAM COUNTY DEPARTMENT OF HEALTH ENGINEER MUST \R PROVIDE 6 Division of Environmental Heie/ih Servioet. Carmel, N. Y. 10512 PERMIT # r CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Town or Villa „d✓ ��';_�s Tax MaPJ I block Located at ±'U4 Y^^ '51 - 3 L Tax Hap' Lot H Subdpg. Owner (� " p Separate Sewerage System built by Cj( Address Consisting of -ItL-- -Gal. Septic Tank and /7_ Other requirements Water Supply: ublic Supply From Private Supply Drilled By Add ess �'99i•. � 1� � 1�46w No. of Bedrooms--3- Date Permit Issued Building Type Mli Has Erosion Control Been Completed? Has garbage grinder been installed? , work copies I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed ( of which are attached), and in accordance with the standards, rules and regul one, accordance with the filed plan, and the permit issued by the Putnam County Department Of Health. �• . 6J.1 P.E� R.A. 1.5 �� Certified y Date =6 73 Address License NO. Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become n old when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the ommi o or of Health, sie?hh revocation, .modification or change Is necessary. Title Date , PUTNAM COUNTY DEPARTMENT OF HEALTH ENGINEER TO PROVIDE PERMIT # ON CERTI�FICAT 0 COMPLIA CE. Division of Environmental Health Services, Carmel, N. Y. 10512 PERMIT # 3_ %ONS a t3ii::': 2Ofc ` PclSililii,_ FQF_ 47 GE DISP:Df, f. ;YS EL:... Located at R' Poe - .y Subdivision _ 11� , (� Lobk+o ll7► �• `-. [� subd Lot Owner /Address V . - 1S 4,NV &_ it I&, Building Type &QMCk Lot Area Number of Bedrooms __ Design Flow G /P /D Separate Sewerage System to consist of �00� -1 _ Gal. Septic Tank To be constructed by �_f�QG�g \iM '�O 644— Water Supply: Public Supply From Private Supply to be `drilled by �` f"' r'�`M-1. r'm&v, Address ````Q1,�,,9.w+, i4)J� w Other Requirements 2 A\'7ixkN uU " 60%£S Tax Town or vaiao Map 5t Block 6 Lot 3132 Renewal _ [] Revision _ ❑ Date Of Previous Approval Fill Section Only P.C. H. D. Notification Required`, and Address I represent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regu a ions o the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following thedate of the Issu- ance of the approval of the Certificate of Construction, Compliance of the original system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed i cordance with the standards, rules and regu a —lirni of the Putnam County Department off( Health. Date qk ?� Signed P.E. it R,A. Address 2 - 1 kh-a J` � J - License No. 73736 APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction requires a new permit. Approved for disposal of domestic sanitary sewage, d/or rivat water supply only. Date� By Rev. 6/85 Title A YorM *n Medical Laboratory, Inc. LAB f 321 Kear Street Y% Time: Yorktown Heights, N. Y. 10598 Date Taken - - - .-Date Rc d .- Time • �. n _r c.. _ _ --•:ar tiw �. =;-mod s:; .t... �-'.:;�:'..- :�.,_�:. .� ..... :.;- - .>, :-- ` ,. :-- 77. -- Director: Albert H. Padovani M. T. (ASQ) Collected By : /'y e.: 15 U.rlaz Referred By: C'IZOSS / gob T Ilj_&A 111A1e 7 Sample Location: i 7. �Q L,S;� GLJ d fi� /W7 los-T ` J Phone ff Sl- 46 Y Phone # Sample Type: Repeat Test? _ 1(check'one) LABORATORY REPORT ON THE BACTERIOLOGICAL QUALITY OF WATER GENERAL BACTERIA 9/ Standard. Plate Count (CPU /1.OmL)t_ (Agar Plate @ 35. °C) MEMBRANE. FILTRATION TECHNIQUE (MFT) 3z"*Total'Coliform (CFU /100mL) Fecal Coliform (CFU /100mL) Fecal'Streptococcus.(CFU /100mL) MOST PROBABLE NUMBER TECHNIQUE (MPN) _ Total Coliform: MPN Index (per 100mL) Qk per mi;.I OTHER ANALYSES REMARKS (For Laboratory Use) ✓Potable _ .Non- potable. _ STP INF _ STP EFF. _• Other:. Sample Status: (check each) Outgoing ._ Na2S203 Incoming _ALE k °C GT k °C _ Other: KEY FOR TERMINOLOGY RDS = Recommend Disinfec- tion of Source TNTC =.Too Numerous To Count CON = Confluent ( =TNTC) LT Less Than (< ) GT = Greater Than (> ) N /A.= Not Applicable LE = Less than or equal to THESE RESULTS INDICATE THAT THE WATER SAMPLE UWAS' (WASN'T) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO THE ORK ST ATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. For Lab Use Only: _ H/C to x /./ Albert H. Padovani, M.T. (ASCP), Director e LAB OFFICE HOURS (Main Lab): 9AM -5PM, Mon. -Fri. 12 /85(Rvsd7 /87)RWE 9AM -NOON, Sat. ��,� � WELL COMPLETION REPORT Office Use Only a .,,3.viclan O4 DEPARTMENT OF HEALTH pf Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH WELL LOCATION STREET AOURESS. TAX GRID NUMBER: i tAa. z, 5 4 _6 .- 3i -�Z WELL OWNER ADORES NAME $' c a 0 PUBLICS USE OF WELL 1- primary 2 -secondary 6 RESIDENTIAL 0 PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP. O ABANDONED 0 BUSINESS ❑ FARM ❑ TEST /OBSERVATION O OTHER (specify) 0.. INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY 0 MOUNT OF USE YIELD SOUGHT _ gpm. /N0. PEOPL'E.SERVED / EST. OF DAILY USAGE 600 gal. REASON FOR DRILLING :(NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA ` WELL DEPTH 0 - ft. I -STATIC WATER LEVEL �35,. ft. DATE MEASURED 3 *7 DRILLING EQUIPMENT O ROTARY ad COMPRESSED.AIR PERCUSSION 0 DUG O WELL POINT O CABLE PERCUSSION 0 OTHER (specify): WELL TYPE 0 SCREENED O OPEN END CASING ® / OPEN HOLE IN BEDROCK O OTHER CASING TOTAL,LENGTH tL MATERIALS: OSTEEL 0 PLASTIC 0 OTHER LENGTH .BELOW GRADE O tL JOINTS: . O WELDED THREADED O OTHER DETAILS DIAMETER 2 in. SEAL: CEMENT GROUT O BENTONITE ❑ OTHER WEIGHT PER FOOT ____ Ib. /ft. DRIVE SHOE YES ONO UNER: OYES (—YkO SCREEN r1TA T, ��tiri9LLi DIAMETER (in) SLOT SIZE LENGTH (it) DEPTH TO SCREEN (ft) DEVELOPED? FIRST --°� OYES ONO p- - GRAVEL PACK ❑YES O NO GRAVEL SIZE:. DIAMETER OF PACK In. TOP DEPTH ft. BOTTOM DEPTH ft. WELL YIELD TEST pumping It detailed METHOD:. O PUMPED i tests were done Is in- ! COMPRESSED AIR formation attached? ❑ BAILED ❑ OTHEA ; O YES ONO /ELL LDG It more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE water Bear. ing Well Dia- (meter FORMATION DESCRIPTION CODE. ft. (L - WELL DEPTH tL DURATION hr. min. DRAWOOWN IL YIELD gpm. Surface WATER eCLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE p CAPACITY GAL. A *IPA *E !AWATT & SONS, INC. DATE A00�} SS Well Drilling slGt'dKTURE AT RS R.R. 2 R K 1 56 PAITERSON, NEW YORK 12563 A&r'." PUMP INFORMATION TYPE s "nge.YP%y;6k CAPACITY i.'sl MAKER (21-9 e d rd I DEPTH -26 6 MODEL -%S VOLTAGE aQ HP kz I II. I IV. t +� I VI. . •.91 � r FINAL SITE INSR 0N---'1 Date 6 ' 2 (� " Inspected byVn OWNER J ✓ �G�� NO CCMMENTS 8- 27WAGE DISPOSAL AREA a. SDS area located as per approved plans b. Fill section - Date of placement 2:1 barrier. LGTH WID`T'H AVG.DPTH c. Natural soil not stripped d. Stone, brush, etc., greater than 15' from SDS area. e. 100 ft, fran water course /wetlands. SEWAGE DISPOSAL SYSTEM — a. Septic tank size - 1,000 1,250 b. Septic tank installed 1 c. 10' minimum fran foundation d. No 90° bends, clear -cut within 10 ft. of 45° bend � e. DISTRIBUTION BOX 1. All outlets at same elevation - water tested 2. Protected below frost 3. Minimum 2 ft. oriainal soil between box and trenches f. .JUNCTION BOX = proop—rly set g S 1. Length re *uired - Z� Length installe:3 / Z Z <Irl � b 6 Z 2. Distance to water cours measured ft. 3. Installed according to plan ti 4. Distance centar to center 5. Slope of trench acceptable 1/16 - 1/32 " /foot. I 1 6. 10 feet fran property line - 20 feet - foundations I 7. Depth of trench.< 30 inches from surface 8. Roan allowed for ex=sion; 50% J 9. Size of gravel 3/4 - 11" diameter 10. Depth of gravell in trench 12" minimum 11. Pipe ends ca-med =! �. yQU,��_Cl�;.'.- .`r1CF•„CVC�LT�• r._�.•i,.. �.:_. , •..� - .. _. _ o .. :., .- ........... _ _.,_ __ 1. Size of pump chariber i�..,.r.: 1 ".- °• .., ...,- .. -... ... :•.._ i 2. Overflow tank 3. Alarm, visual /audio 4. Pump easily accessible manhole to grade 5. First box baffled 6. Cycle witnessed by Health Department �'" estimated flcw_per cycle HOUSE ' a. House located per acproved plans. b. Number of bedreams WELL ' a. Well located as per aporoved plans b. Distance fran SDS area measured I ft. c. Casing 18 "above trade. 5 d. Surface drainage around well acceptable. Q OVERALL WORKMASHIP a. Boxes properly outed I��e `I " b. All pipes partially tackfilled c. All pipes flush with inside of box d. Backfill material contains stones < 4" in diameter e. Curtain drain installed according to plan f. Curtain drain outfall protected & dir.to exist-.watercourse g. Footin drains discharge Ly fran SDS area h. Surface water rotection adequate i. rosion control provided on slopes greater than 15 %. �i PUTNAM COUNTY DEPART OF HEALTH - DIVISION OF ENVIRONMENrAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SZOM DISPOSAL SYSTEMS SHEET - CONSTRUCTION.. PERMIT - t�,l BY. (Name of Owner) (S ee tion) DOCLDU2rS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions.- Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes,Cut Footing /Gutter Curtain Drains Perc & Deep Holes - Located. .._... Representative of Sewage & Expansion Area k pans_i.n!1.Area,.srr,,tin.�gr ti *j f195:rsuff...s zee- - -If PL:itgped Pit - -& -- 'liox- 8h& & - Detailed House - No. of Bedroans Wells & SSDS °s w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 201 to Foundation Walls 1001 to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains- Curtain,Storm,Leader,Footing 25' to Catch Basin 101 to Water Line (pits -201) Septic Tanks 101 fran Foundation 501 to Well 15° Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Ex-approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same rJ� 0� 0� 0� 0� 0� 0� M� i mm _I_ u� MWAE r 0M DOCLDU2rS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions.- Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes,Cut Footing /Gutter Curtain Drains Perc & Deep Holes - Located. .._... Representative of Sewage & Expansion Area k pans_i.n!1.Area,.srr,,tin.�gr ti *j f195:rsuff...s zee- - -If PL:itgped Pit - -& -- 'liox- 8h& & - Detailed House - No. of Bedroans Wells & SSDS °s w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 201 to Foundation Walls 1001 to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains- Curtain,Storm,Leader,Footing 25' to Catch Basin 101 to Water Line (pits -201) Septic Tanks 101 fran Foundation 501 to Well 15° Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Ex-approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same PUMAM COUNTY DEPARTMW OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIELD INSPECTION REPORT INSP. BY (Name of Owner) (Street) ovation) INITIAL SITE INSPECTION ? (; i = r" I YES NO CONAUS Wetlands 'on or proximate to property.............. Property lines or corners found ................... Can estimate house location ....................... Will driveway need cut ............................. n/ Must trees be removed.- note these ................ v Deep holes representative of entire SDS area...... Additional deep holes needed..... .. .......... Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacent wells/ septics ............................ D.H. 1 Lot (� �- Depth to G.W. Depth to rock Soil Descr 0 ft. D.H. 2 Lot Depth to G. W. Depth to rock 0 ft. 3 ft. ft. ft. ` " 6 ft. 9 ft. i� 9 ft. 12 ft.� 12, ft. 5oi.i liescri D.H. - Deep Hole G.W. - Groundwater D.H. 3 Lot Depth to G. W. Depth to rock 5oii uescription 0 ft. 3 ft. 6 ft. 9. ft. .. ... 12, ft. DATE: FINAL SITE INSPECTION INSP.BY: YES NO COMMENTS House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of the line and trench acceptable......... Roan allowed for expansion trenches .............. Over 100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded ........... .............. 10 ft. maintained from property line and 20 ft. from house... ......... .................. Distance well to SSDS (ft.) ...................... Number of bedrooms checks... ..................... Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench ................ L5 ft. of peripheral soil horizontally fran trench.... ........................ Boxes properly set .... ...... .......... ........ :ould surface runoff fran driveway, roads, ground surface, etc.., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE.... o .. .. 0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ✓- Date Re: Property of 0 F1 u(ZA Located at iz%,Le_ AJC_ (T) Section 54 Rlock ( Lot 31 -37- Subdivision of Leo\Awk Subdve Lot- # 1'tl -i'IZ Filed Map # 79 C' Date /L /.z 7 Gentlemen: This letter is to auth.orize �- - IzeOz- 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'hecessary papers on my behalf in connection with this matter and to'supervise the construction of said -. ` �system .or syst ems uin`conforinity with th6 provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani tary Code. Very tru y ours, / Signed Countersigned: �L Owner Property ' Q�2 PoEe , RoAm , # q373 G<)n�rti P, It) , Address Address Town i Telephone Telephone PUTNAM COUIUY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES A,10 Owner or Purchaser of Building rn f b,S Building Conrmcted by J at'� Arf I Tev-A+-inn - gi-r- Lh a Municipality fo 0 tuilding.Type t 4 3 Section Block Lot 'o i r-4 Lcrkncc�- Subdivision Name _Z: 14,142 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 "Certificate of Construction Compliance" for the sewage disposal system, or any repairs made by we 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 V the system. Dated this day Of 19�f 7 Signature Pad 77 Title ,Gq6eia1=Guxtrae/tor (Owner) Signature Corporation Name (if Corp.) Corporation Name (if Corp.) /9's, /I 2 Address ,_0 A / ' Address 6/ rev. 9/85 mk el"I'Mm 31MA I Fz I z ra V •IDr Y' W 57 AV ei DESIGN :MAYA SHEET- SUBSUFACE SPME - DLSPOSAL7 S 'STFM-- Owner y .5, RJOnv�te Address 14Az�4 24% A S rA 00_K ��- i tkT- 41N) Located at (Street) A� t _ 10D 01A ' (ZOAO . Sec. 5Y Block .6. Lot3l -3Z . Undtcath nearest cross street) Municipality Watershed r, SOIL PERCOLATION TEST DATA ,REWIRED WIRED TO BE SUBNIITIED WITH APPLICATIONS Date of Pre- Soaking i -L�j Sb Date of Percolation Test 1 2g 17 3 C. - - - HOLE NUMBER CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level 3 No. Time Ground Surface 'In Inches Soil Rate Start-Stop Min. Start Stop Drop In Min/In Drop. Inches Inches inches 2 20.E 2y z� 3 ,1 3 l 27 24.. 2 3 +.l NOTES. 1. Tests. tof •be repeated at same de until ' .. P� P'� �-Y �l CnClIila are obta ed at each "percolation finest aiiale { All data to be submtttod - ! for�.xevi*w. t 2. DepthI easurements to be .made fray top of hole. • rev. 9/85 17 3 C. - - - 2 3 2) 3 24.. 2 3 +.l NOTES. 1. Tests. tof •be repeated at same de until ' .. P� P'� �-Y �l CnClIila are obta ed at each "percolation finest aiiale { All data to be submtttod - ! for�.xevi*w. t 2. DepthI easurements to be .made fray top of hole. • rev. 9/85 TEST PIT DATA EaURM TO BE SMUTTED WITH -DEPTH.. -,HOLE NO. 1 HOLE NO. —.-,.--.-.--.HOLE NO. 21 3B 40 50 69 79 80 99 10, 11 129 13' 14' INDICATE LEVEL AT WHICH GROUNDMMIS ENCOUNTERED INDICATE LEVEL To WMaj WATM LEVEL RISES AFTER BEING ENCOUNTERED DEEP HoLE.oBSERVATIONS MADE BY; DATE: ZS g6 DESIGN Soil Rate Used 14in/1119 Drop:-. Usable Area. Provided .,.-..1-500.0->.:-.�. .�. -No.,. of -Beclrccms 3 .SePtic 1z ..,gals....:, Type Absorption Area, Provided. By L.F._..x,24 " width ...... ivame F) z FvJZ_ Signature L Address SEAL. 77 Ai sz THIS -SPACE -FOR,USE 'BY FaM'DEPARIMENT 1LYo ek4 f sq f Soil Rate Approved ,/gal. (cciced by Date