Loading...
HomeMy WebLinkAbout3641DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.13 -1 -19 BOX 29 03641 Address Building Type �a o, of Bedrooms Date Permit issued Has Erosion Control Been Comp1eted ?Ea��g ®�9• 'fr certify that the system(s) as listed serving the above attached), and in accordance With the standartls, rul ,o la f /the as shown on the plans of the completed work (copies of which are permit i Putnam Department 'ss etl b County •De a tment of Health, D ate' 2' 5 ., 7T. j� Address %� .n : License No.z�20 Any person occupying premises served by the above sy (+ rTc' uch action as may be necessary to secure the correction .of any, unsanitary Conditions.resulting from such usage. Approval of'the, a available and the +.. , - e9" shalf.become null and void as soon as a public sanitary'sewer becomes approval of the private water supply shall'b void when a public water supply becomes available. Such approvals -are .ubiect to modification or change when, in the judgment of the: oRimissioner of Health; such re ion, modification or change is. necessary. .. , gate .`::•,,;..;.. Title • -�'`'yYf ;,d 1+0,� =, •� c•rA� ARTMEN PU il\A'1 i1N� F DE ph'Serwces, Carmel, N ; 'Y LO . I _� '� i3 of Environmental,;, � h � ti '� a »x ,� tyi' t. •r- .S �, �IN ®_ Town or -Val �, �"'' n 4.�; �.:.� . , tip r _ 7 - .v FOR SEWAGE DISPOSAL SYSTEM ';..� CON STRUCTION PERMIT cG � LO s Located at G/l `' Cw9illQ- SAS f ' Address Subd,viston� owner ! ` Lot Area SOUare Feet �S% N wid Building; TYpe v:;. , _ - ' neat feet X ench i Total Habitable Sp Number o e drooms p Gal Septic Tank f B t A Separate Sewerag e SYemf to ,consist of. ddress To be constructed by Public Supply From Water SUPPIY ` Private SupPIY to be drilled by c .r+ Ad, r ss � a pow syste(5)tne' se`para Other Requirements I ton of thAM 1) th to sewage dispos 1 u nom ' + u a ",ons o respon a f'. �ance ^wthhe'standards, r' the Comm�sstoner.of Health will lately o and m ,satisfactory that paid budder, Mill 1 rePre�nt that I• am wholly and comp f Construction Compliance _v ed wili; be conetiucted.as shown oh t• 6 � r e ova descr,ib and that on.co t -. f n owner • his successors hearse rs ',immediate IY fo above ❑oweng the date of the issu a vii that the drilled well described above papa ►tment of : Health, �� ste in the •period of County,, a artmerit and' a: wLitt _ IfS ^y repo ' thereto; 2) u a ons of rthe xPutnani {, 6e. Submittedy`to the D Yp �� ( rt h ,, t_ o al system or any lards, rules and.,re9 ood operating condition -any part NYC �P j accordance dh the place in' 9 �� ,veil w�11 all once of *the :approval: :qf the Certdtcate of C roved plan a- t mon the approved P E R will be located as show« ' County Department of Health: >� Sighed License, Date has been undertaken�un on Address change or alteration of const. Add. t e date issued unless Cr of Health of budding F the Commiss UCTION: This.aPproval exPl I only. ...ate � nsidered,necessa� by er -supply- Tom' • ..,. �- 26"1- .�:- - .. YORKTOWN MEDICAL LABORATORY INC. ' F� P., Q. Box 99 321 Oar Street i :Yorktown Heights .N:Y.10598 245 3203 DATE'. COLLECTED ' RESULTS OF EXAMINATION OF" WATER. 2 ER. DATE RECEIVED., JOE MILES 2/3/75 f; VILLAGE, TOWN VOR NAM8:OF SUPPLY DATE- REPORTED BARGER ST o _:PUTNAM .:VALLEY,. ;N..o, , FLING POINT 2 KITCHEN TAP — 'LOT 0—;=. GLOCCOMOR.A,_ ACRES' `TERIA"PER . ML. (Agar'plate count at 35 'C) COLIFORM:GROUP (Most probable No; /100m1) RD: ES , TO AL -.ppm :10 LESS,. THAN: 20 2,: . ER GENTS - ppm NITRATES (as N) = ppm :.IRON,, OTAL ppal )URIDE (F) - mq. /1• ase results- indicpte that the -water was YES of a sat sfactory'saaitary quality when the s8 e. w s c 1 cted. A. H. P:ADOVAN , M. T.'( SCP) �6 c1,r, 017 y PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type pCH� Permit_ ?a3 Well Location Street Address: Town/Village: Tax Map # j ® W Dd ST. . ,V / � PAC te y i 19 I Block PU Map Lot(s) Well Owner: Name: W a-W AM Address: g / +y W il o-q ST 'I. Phone #: MA14ObC Y. rvs�l 5'a t§ 34zI Use of Well: 1 • ./Residential _Public Supply Air /cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring _Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily usage b 00 gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason !M P20V r A'lrk 5dP1JL7jF ! 51' G w ESL /S olyLy for Drilling G ' Qt--FP- . A Ui; AdAl J, ;' � r I�/��'YZ .S 16 ;V671At- "'T) IM E S Well Type V Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes _ No---- Is well located in a realty subdivision? ........................................... ............................... Yes No Name of subdivision Lot No. Water Well Contractor - YOAMArJ AN2 t✓ ns DM Address: /Y2 0/4A'5 L 5'T' Pu7N.4,ot. AL- Is Public Water Supply available on site? ....................................... ............................... Yes _ No Name of Public Water Supply: NO;JC Town/Village Distance to property from nearest water main: N Dry L Proposed well location & sources of contamination to be provided on separate heet/plan. �J. pate: 9- 01 -Applicant Signature: _ _ PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set fortli above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and 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 or their designated representative 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. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. take appropriate action to assure'that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any revision or alteration of the approved plan requires a new permit. Well % to be c onstructed by a water well driller certified by Putnam nty. _I Date of Issue 1 �1 /f a Permit wing Offi al: Date of Expiration Jq f ,41ia Title: fc'V114 Permit is Non - Transfbra White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 N-Alk 2II J �)?" ��', GUN F�uG I-ed W i }P� G\ lYI +Iv; �vr► G� , ®O. Rev. 3106 DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT # AW I I— I C) Well Location: Street Address: TownNillage Tax Grid # Map Block Lot(s) Well Owner: Name: Address: -l� Well Type: Drilled Driven Dug Gravel Other Depth Data: Well Depth J ft Static Water Level ft Date Measured v Use of Well: , l /Residential Public Supply Air /Cond/Heat Pump Abandoned 1- primary Business Farm Test/Observation Other (specify) 2- secondary Industrial Institutional Standby Water Well Contractor: Name: Ma k nh Address: Is-)- r S�- V,,1le / /Vor C. 0 , /c Reason For Abandonment: /P "gyp. Wes. f �✓ S" {��l ` '� "' s j Y Description of Work To Be Performed: f Yv( -d u(�G 4 /0cl f f Pw 1 0 04,Jj, Date: Applicant Signature: This permit, to abandon one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code, Subpart 5 -2 of Part 5 of the New York State Sanitary Code and/or Part 75 of 10 NYCRR and provided that: Within 30 days of the completion of the abandonment of the water well, the applicant shall submit to the Department a certified statement that the information delineated on the application for this permit has been completed. Date of Issue White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LOR'I- A MOLINART,, RN, N18N Associate Commissioner of Health ROBERT J. BONDI County Executive ROBERT4MORRIS. PE Director of Environmental Health DEPARTMENT OF HEALTH DRINKING AND RECREATIONAL WATER Norman Anderson, Inc. 152 Barger Street Putnam Valley, NY 10579 Subject: Proposed Well Sterling 210 Wood St. (T) Carmel September 10, 2010 Dear Mr. Anderson: A field inspection was conducted on the above referenced lot by Vincent Perrin, Public Health Technician. The application to drill a new well is approved with the following stipulations: 1. The well pump and any electrical components are to be removed from the existing well during abandonment. - 2: The well-is-to be constructed with a minimum of 100 feet of casing. - 3. A Well Completion Report (WC -97) shall be submitted no later than 30 days after the well completion by the permittee. Please contact me at (845) 808 -1625 ext.46235 if you have any questions. Sincerely, /V /_- /Z53�_� Vincent Perrin Public Health Technician cc: file 110 OLD ROUTE 6, BUILDING 3 - .CARMEL NX 10512 (845) 225 -5186 FAX (845) 225 -5418 Uri, � f v�- 0 0 OOP ST M h �h �. P)Ilhll)v 7-740 n�s�r.�u'Ttb,✓ �b� � f I + J 5 A PD /Z #,*I )C1 S T + ,✓ a is �u l5 Gs�'0 5"a t ®at GA N -Lernit I "rE GENERAL N O TES.- MMMATICN PC* IMS T i 'TAKM FWDM SUK%OW FWAPW IV i t As= SMqq'"M a1►4.11 �.e OKs a LOT, #q �j r+ I ST gI5.21 y+�� //yy� ��W Na A6q.2' � 25.0' NO / ... •� ` ' mow. ' , -% �. ... �. ��.... �.._.. .... ate.._._'.• _... :� . . r r � r � rr J r , � ! rr r d I r I t � r � ! r d r ! Q3 U 4? !WO a r+Y A /6r s•l N a 1 E..._ . ..._ 09/09/05 spi a a 1 E..._ . ..._ 09/09/05 spi Artesloan -Well ® o 1054 Rte. 52 Carmel, N- ' Y. 10512 r (845 22 - 3196 ABILITY Fax (845) 225 -8420 8"l9/`b OL z 1 �i iF } Owner or Purchaser.oi building Building Constructed by Location - Street �J6 Building Type Municipality Block Lot GUARANTY OF SEPARATE SEWAGE SYSTEM I represent that I am wholly and completely responsible for the- locat-ion, 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 guaranty 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 initial use of the sewage disposal system, 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 i -1,o czfat -am The undersigned further of the Director of the Division of nGpar.tment of Health as to whether caused by the willful or negligent :..�..:gysfiem, agrees to accept as conclusive the determination F,nvironmental Health Services of the Putnam County or not the fail.ur�E of :3.a system. to op-rat Nis act of the occupant of the building utilizing the Dated this day f - ..._._..........�.,.... � � ..._, _ �+ ..... J... "_... _,.. .�_ _.� . __ y� 19,LJ� Signature Title (if corporation, give name and address) THREE, (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL .PLANS BEFORE.. CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS PZFOUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health D_ T OF PUTNAM VALLEY -DRf WELL JDOCATIONy��- st WELL OWNER WELL DRILLER name name section address city or town 17 (J-address city or towne/- WEING DETAILS YIELD TEST VI TER EL SCREEN DETAILS Lengh: feet .13ailed or ... Pumped 7YHre. (Measure rom L Static ft d sur f ace) 'Make: Diameter: Inches Yield: GPM When Bailed :)t,Pum ed' ft lot Length Ft ite Kind: ff Diameter-.._.... In.* ITAL DEPTH OF. WELL �-JFeet Depth From 'Give description of formation pen;trated,.such as: peat, Ground Surface @silt, sand, gravel, clayt.hardpan, shale, sandstone, Fanite, etc. Include size of graVel(diameter and-sand ine, medium, course), color of material, structure (Loose, packed, cemented, soft, hard).(Ex. Oft.to 27 ft- fine, Packed, yellow sand. 27 -ft to 134 -ft. Rrav, Rranite) ee.t'-..-.to-_rn-.et. _!._For-jn tion-DLiscriptiont Sketch exact location of well to SO er )ate dell Completed Date--.of. Report Well Driller signature PUTNAM COUNTY DEPARTMENT OF HEALTH ..... -.,,.° ..,;:..- . d'.,�..,. -.:.. _.:.� ..=- �31V�S•ION�- ^OF' Ei�1VIRONMEIdT�i� ;' "1-IE1�IH "'SERi7Y�E�, : _,- _._...._ .r :,- _ .G . Re: Property c Located at CY -SevrieA Block 4 Lot° Date 7 2 Y,' 4t Gentlemen: This letter is to authorize. STANLEY J. LANDER 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 1:V1111CL L1V11 w.LLfi Lit-is maLLev and to. supervise the constiucciun of said system or systems in conformity with the provisions of Article 145 or 12 t i Qn:.Law,:._the. Public Health= Lira; =' and.. the - Putnam= County -Sani _.....r. tary Code. Coun Very tr yours, Signe Owf&r of Property Address�'Tn�/�P1 �LF.y Af 2 % ST3 //,-j PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY.OFFICE BUILDING CARMEL, N. Y. 10512 DESIGN DATA SHEETj - SEPARATE SEWAGE DISPOSAL SYSTEM f� FILE NO. Owners Address "-c� Located at (Street oc y la Block_Lot- . kindicate nearest cross S ree Municipality Watershed �E.x:rhiGL /GG okr o4yC _ _ � T SOIL PERCOLATION TEST DATA REQUIRED-TO BE SUBMITTED WITH APPLICATIONS 5 r 3 /D• 4 2 3 5 ' Notes: 1) Te'E�ts to be repeated at same depth until apppproximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2). Depth measurements to be made from top of hole. hole Number CLOCK TIME PERCOLATION PERCOLATION Ran No. Start -Stop apse Time Min. Depth to a er From Ground Surface Start Stop Inches Inches water ve in Inches Drop in Inches Soil Rate. Min. /in drop P� 1 �.� -�� 21 10.4-1 _i 2 2 :1, .�© i�Y 12- z 5 r 3 /D• 4 2 3 5 ' Notes: 1) Te'E�ts to be repeated at same depth until apppproximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2). Depth measurements to be made from top of hole. ..x e. .. u a._. r w _.. ...Yn. _ .. c..,..,...... y ,. ,.a..- v ., . .. .,.. :.. ..... r m.. �- .. .r _ ,wa n•b;,.:.,;,y,.,...,'ti.` r..a TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. PI HOLE NO. P Z HOLE 6" 12" 18" 2411 " 14 30" !A � 36•• `. 42 G 48" � 5 it 60" -� 66" -i 7211 78" A I N INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED' L`'j.� ,INDICATE LEVEL TO W�21C I WATER LEVEL RISES AFTER BEING ENCOUN'fiEd TESTS MADE BY �J Lf �� Date -4J 71 S 19n ' � a.5`L� c, 4 � /nr D d6 C� �Xri� j� 11jo o C / -j" DESIGN ® ` Soil Rate Used Min/l "Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity. g'� Gals. Type/ e-c..,�r 6.4/c , Absorption Area Provided By L.F.x24" 5"--- -- -width trench. Address THIS SPACE FOR USE BY HEALTH DE Soil Rate Approved Sq. FC1&Ca r Q Y Late r9,Lc o c ii t0 (7 n D � co m 148.88 O 935.67 V n 348.80 N D -4 co n 0 3*e.at t71 \ g � �• to 118, m z "s L ( 4 III i j I'M syster, was ran re "mid fegi Ida F y ; AN % N i lop` F 8 TICE* _ • f ` f LX 5` r� 5 ps" • t rb 3Y i 1)9, DWISION OF S - ,74NfAI•. HF,AITH SERVWF-. !�' `. 1 ( rC 7'oin,%T ,s�j �OT Y •LZ/FGKQ ' %• C7 . 8 :: ij �DiY/J',ryy- N_SSifIF/19 Q' L.7 �Q .� 14%