Loading...
HomeMy WebLinkAbout3743DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.19 -2 -8 BOX 29 NEI ls Lo t 4 1_6 i � ' tip' I 19 0 19 or m UL 03743 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 .^mac ri�l i� 'i_ON ..TC:::c: id& 1rdCT" PCHD PERMIT # WELL LOCATION Street Address To IS WELL SITE SUBJECT TO FLOODING? YES ENO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name &.&)egsoo Address : �r�i6 / ,¢��/ .! �IJLo�7 W. IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES 4-'NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED WON SEPARATE; SHEET ` A 9 (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. 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 otherw a contaminate surface or groundwater. Date of Issue: / 19q Zkl_ Al ._ Date of Expiration 1 �19gra Permit Issuing-Official Permit is Non- Transferrab e White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller /Village /C ty Tax Grid Number WELL-OWNER Name C► G0 Mailing IV -,z -3 9 ddress z Az ew Wrivate O Public US WELL 1 - primar 2- secondary "RESIDENTIAL 0 BUSINESS 13 INDUSTRIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION U INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify, O AMOUNT OF USE YIELD SOUGHT pm /# O REPLACE EXISTING SUPPLY NEW SUPPLY (NEW DWELLING) PEOPLE SERVED /EST. OF DAILY USAGE ®p al [3 TEST/ OBSERVATION D: ADDITIONAL SUPPLY QDEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REAS6N. FOR DRILLING � - �t i exre WELL TYPE DRILLED �DRIUEN ODUG GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES ENO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name &.&)egsoo Address : �r�i6 / ,¢��/ .! �IJLo�7 W. IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES 4-'NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED WON SEPARATE; SHEET ` A 9 (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. 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 otherw a contaminate surface or groundwater. Date of Issue: / 19q Zkl_ Al ._ Date of Expiration 1 �19gra Permit Issuing-Official Permit is Non- Transferrab e White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller 't BS OPP" INI ifk&to of Construction Compliance' Utisfactory to the Cornmi"na!,Of,HdetthWill eifhN,,the owner hif'seicosasoif, Irohf a s i2ils by the blailds► that "id.bmlldw will ystdin during tho pariod of two.(2) ymsrs igninodi®toly folk/a ierp tha'dste o4 tIN NM- 10 is Oripirel sYStwn. or any repairs thor�to; 2) Q4at th® diillod well dsoitfse0 ettove it id danoa witA t �a' r bs and, repo aii%ns of the. Putnam License NO im 4P�o date ;issued un S .construction of the .building has bean undertaken and is 0gt�ay.` by. :COmmisslonor 'of keaitrc, Any chon®o or, elteratbon of Construction Waage, an piivate .urtor supply only. A Tim X DERWTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 CAT r0bt'- .'rCi'-CUitiSt'RiiCT; A.. > ATEit =w"EI;L' -_,:,.- PCHD PERMIT # WELL LOCATION Stree Address Town Vill ge City Tax Grid Number pFr- C)'00 WELL OWNER Name 44j* taxre Mailing Address r DC-Re, ZOO 46.8rw4©d- rivate D Public US L - pr�:ary 2- J RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL . ❑ PUBLIC SUPPLY 0 AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY ❑ ABANDONED ❑ OTHER (specify, O AMOUNT OF USE YIELD SOUGHT _'gpm /# PEOPLE SERVED /EST. OF DAILY USAGE 6009al ❑ REPLACE EXISTING SUPPLY 0 TEST/ OBSERVATION Gl ADDITIONAL SUPPLY NEW SUP LY NEW DWELLING 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING A&reli _r0 1- Etc) WELL TYPE ®DRILLED DRIVEN ODUG GRAVEL C] OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Naive Al /) aen.6` d 440- Address: 61 muff— Ji,. .6y' -A640i E, W.141 IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES V NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY nIST . T__' ° 1UEAItL?S'"= w'ATE MAIN .. _. A�TCE .� n LOCATION SKETCH SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET `- S�z 4J' (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. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the the Putnam County Health 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 contaminate surface or groundwater. Date of Issue: Z`:_� �"- 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 ..7„ .•,.- ,�.�,.ro -.� _;'°, r'a- -s'^r r a, -+.-q v-° w--r rx r y-°. -"fix z,;..: tt- v2a�,. .,�,.,"'""�„g",..s. �, "}, rzr, ITS N / T CON91RUCIROW PEMW 9011 UWAG3 DEROS AL 97SM . y l?�f- .- .,.,.. ..,, .•--: �7(3�41) --- ..>. -t c-.. - v.._ -,- -r '.6`•;m.�Qq • :�. ✓ -... ..�.:. 11,68:••r -Y �r .:. � �. ,,. sp�.'.:i.+,:'.... .-. Date of >ia m i Wefts Ad&= -Bile .0. T. Sl�%,PeRd/ /Lass* natii Subdivision Approved Fee Enclosed Amrntnt t A��/� ,,*X0K! rL, lag 'Ann — p 0I vat. A)tai�bcss oi'1 F5atr G 8 D_ l 1V Bo W H+i9 W WW- Ate, ' . at ''. f `n t iii✓ msia ,�' t�7� c�' /Qr�r,*s a" Odw �O 4-4- X16, 44),61-f- WIC �f>` C'_ o—car-f oc/ 10=l c.L 1 ropresenC Chet 1 am,mvholly, and completely retponsiblo is the design and location of the proposed iystem(s): 1) that the sapbrato sswage'.di ml systom . above describod will a constructed a3?fhorun on the approved avnendmont thera to and in'accoraance faith the tondards,'rules a regulations o. . ham County Depart me .04 , R�. and that , Pn eomplotion thoroof a','fCortificbto. of ,Construction Complbnto" satisfactory to the. Commissioner o9.MOolthvn111 be submitted W iho Dope!21hit . anl, a mrittan guartantoo- %fill bo furnished tho ocarnor, his succmws hobs or assbgna, by tho builder'. that said builder trill pbco Cn good' .piomatiM condition, any part. of said as %±ago disposal syotmni.duiing, thio paned of. two (2) Vows bnntcidiatoly 4otlowiPeg @hO date of the isou- since Of the apt fOaal. 04 the Cortifictate 09 ConstvuctiOn Complinnco of the orlginel, system or, any iopabs tharoto- 3) that the drillod troll ®ossal®a® above . ,. . WHI be loeeto9 os dietGrw on the ipprovod, plan and that. fa id troll will'bo Installed in ccordanco avith undo s, rulss and r®@u _ ns 04 Ono. Putnam Cowin @y owl.t 09 mc6tth. t Date /$z� Signed AOddross Lrd9etl �:'C�/ License No w+ _ 'AFPROVEO FOR. CONSTRUCTION: This approval pupirps t" yosrs from.tho data issuod nless construction of the building has boon undertatcon and is revocable for causo 0r vneY be amm' dod or inodifiid aihwm:eonsideied n6cas�i'y by the Commissioner of Health. Any Change or alteration of construction Mquiros a iWw permit. Approvo0 to dGissppo'sal oP omestie sanitaiy seer g a o► private prat ly only. 88 pat® �— sue! P�� / Tvevr, �' r APPENDIX C F 1 NAL SITE INSPECTION DATE inspected STREET LOCH 1 ,� PERMIT # � # OR SUBDIVISION LOT # I. SENAC£ DISPOSAL AREA a. SOS-area located as per approved b. Fill section - date of placement 2:1 barrier LGT H C. Natural soli not sti d. Stone,brush,etc.,gr+ e. 100 ft. from water 11 SEMIACE DISPOSAL SYSTEM a. Septic tank size - b. Septic tank install c. 10' minimum fram fox d. DISTRIBUTION BOX a. 1. All outlets at s< b. 2. Protected below 1 c. 3. Minimum 2 ft. or- 0 e. JUNCTION BOX - properly :cet f. TRENCHES 1. Length required - Lea 2. Distance to watercour:;e measured 3. Installed according to plan 4. Slope of trench accept:ab 1 e 1/16 - 1/: 5. 10 feet fram property line - 20 feet 6. Depth of trench < 30 inches fran surf 7. Room allowed for expansion. 100`% 8. Size of gravel 3/4 - 13" diameter clf math of grave .ice }reP ench 12" �ainimalr 10. Pipe ends capped g. PUMP OR DOSE SYSTEMS 1. Size of pump chamber 2. Overflow tank 3. Alarm, visual /audio 4. Pump easily accessible manhole to gr� 5. First box baffled 6. Cycle witnessed by Health Department 1 1 . HOUSE a. House located pe b. Number of bedroo V. WELL a. Well located as b. Distance from SD c. Casing 18" above d. Surface drainage ' . OVERALL WORK I,ANSH I P a. Boxes properly gi b. All pipes partia c. All pipes flush i d. BackfilI materia e. Curtain drain im f. Curtain drain oul g. Footing drains d h. Surface water pr< i. Erosion control m YES NO COMMENTS PUTNPM COUNTY DEPARTMERr OF HEALTH DIVISION OF EWIRONMENrAL HEALTH SERVICES �Ul•' • _ .. .. �. 4^. .Y' � '.f r .- a�...G --f3s �.-� - TI�9�iV�^ -.3 �5'r. 'up: +��, y - Owner or Purchaser of Buildi g G,11/I' 7 �'2%fClC.Fe� Building Constructed by Location - Street Section Block Lot Subdivision Name J2 Municipality Subdivision Lot i# Building Type GUARANTEE OF SUBSURFACE SEDGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for t`ne 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 cwner, 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 . "CertifEJ * t-6 of-- Construction 'Compliance far_ the sazacTe d-i.sposal 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 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 u u izing the system. „X ///,/ It/ Dated this �-': day of 0C,7 19 'CIS Signature Title L- General Contr or (Owner) - Signature Corporation Name (if Corp.) l n v .r C� I J S 1 � Address rev. 9/85 mk �L j IZAL Corporation Name (if Corp.) Address $'77J�.�ttJiLx e- 4V / ZS? 7-- � ' 321 Kear Street Yorktown Heights, N.Y. 10598 - (914) 245-2800 Alh t H Parinvani or-. - �=`=���=�����'�����s�������'�����=� . [V1ATERHORSF DATE/TIME TAKEN.' 10/04/95 14:05 P.O. BOX 402 DATE/TIME REC-D: 10/04/95 15:00 ' STORMVILLE, NY 12582 T DATE: 10/05/95 PHONE: (914)-628-0971 ' SAMP'ING SITE: LOT #10 B1]JE JAY LANE MAHOPAC SAMPLE TYPE..: POTABLE ' PRESERVATIVES: N |E C,01--'D BY.' MICHAEL SPACCARELLI ' '� TEMPERATURE..., 4C ' NOTFS�..: ` .IFORM METH: MF DATE FLAG PROCEDURE ' RESULT NORMAL - RANGE 10/05/95 MF T. C0'IFORM ABSENT /100 ML ABSENT ` COMMENTS: BACT THESF RESULTS INDICATE T� T THE WATER( ,(WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACC THE NEW YORK STATE AND EPA FEDERA|' DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. ' SUBMITT�D BY:___-����-__-_______-_.____-____ A]hert H. Padovani, M.T.(ASCP) [)i :.-.'t reor � ELAP# 10323 ` WbLL UUL"1YLL11V1v AFPEvni a I)EPARTMENT OF HEALTH ... - r;.V }z -z �n of:.Nr a Health Sery .ces. j� PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only - STREET ADDRESS: '�.. NILLAU41GUY TAX GRID NUMBER: WELL LOCATION' WELL OWNER NAME: AOOR ,� PRIVATE ❑PUBLIC USE OF WELL 1 - primary 2 - secondary RESIDE IAL ❑ PUBLIC SUPPLY ❑ AIR /CONO. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL `❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT _ gpm. /N0. PEOPLE SERVED EST. OF DAILY USAGE i gal. REASON FOR DRILLING NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST / OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH ft. STATIC WATER LEVEL O DATE MEASURED G �� DRILLING EQUIPMENT ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG O WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED ❑ OPEN END CASING. OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH ', ft. MATERIALS: aSTEEL ❑ PLASTIC ❑ OTHER LENGTH .BELOW GRADE ft. JOINTS: ❑ WELDED )<THREADED ❑ OTHER DIAMETER 01 in. SEAL: ❑ CEMENT GROUT ❑ BENTONITE ❑OTHER WEIGHT PER FOOT Ib.lft. DRIVE SHOF-AYES 0 NO LINER: ❑ YES ;AO SCREEN DTAII:., DIAMETER (in) 'SLOT SIZE LENGTH (it) DEPTH TO SCREEN (ft) DEVELOPED? FIRST __ YES H(JUAS - SECOND GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH It. pumping WELL YIELD. TEST If detailed um ing METHOD: ❑ PUMPED 1 tests Were done is in- COMPRESSED AIR r formation attached? ❑ BAILED ❑OTHER ; ❑YES ❑ NO 1�I�LL LOG It more detailed formation descriptions or sieve analyses are available, lease attach. DEPTH FROM SURFACE Water pear- i�9 Well Dia- meter in FORMATION DESCRIPTION cooe. ft. ft WELL DEPTH ft. DURATION hr. min. DRAWOOWN 1t. YIELD gpm. Surface Q �► B' ©' 360' �,. % l� WATER XCLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS ❑ COLORED ANALYZED? ❑ YES ❑ NO ANALYSIS ATTACHED? ❑ YES ❑ NO STORAGE TANK: TYPE CAPACITY d GAL. PUMP FOR ATION TYPE CAPACITY _ '� MAKER DEPTH - f t MODEL O' VOLTAGE a& WELL DRILLER NAME GATE lam.✓ �� AOORESS� ✓ 4 SIGRXTURE PUTNAM COUNTY DEPARTMENT OF HBALTH Dlvislon of lslvhmemental Health Sorvbz4 CWW, N.Y. 10512 Iblast lsovta�m ,{j y P.C.H.D. Permk t) i '':�r : ::;:�. ;.... a dCATI; rii�2�iivi .�rc:�i'-:taiwl."-rl.Glat;'lt IFS' l�. aS) �E�P�d� °�'a"9II5SA�-�:�s�r�'.P�a•: ; ,;:..: •..:.-_ ..:'. _ _. � :.�e� ', Town or Village ' at _ T" Map Block W Owner /applicant Name �t d1/#l�T�/fd�fi� �� 1/� 4A�oiinerly �d •i Subdivision Name M Address Subdv. Lot # Fee Enclosed w Amount Date Permit Issued��g- SeparateSewerneSyste-b.Mby l r?.�fl� s9Gst%+ I Addaees L,�• -�� L •70,&qhd'id Consisting of ���`�% Gallon Sepdc Tank and :V0 CA k ?=t" Weil��rMORP7161 e> ` Water Supply: Pubilc Supply From Address art g'� jPtivate supply Drmed by ' AW e,1ll IA-1 ku 13 O� jg= Lot Size 04 4c- Has Erosion Conrrnl Rppn. cnrn 1 Atixd 9 Number of Bedrooms Ise Garbage Grinder Been Installed? tither Reauirements I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work,( copies of which are attached), and in accordance with the standards, rules and tons, in accordance m fil plan, and the permit issued by the Putnam County Dap rtment Of alth. A� r Oate 7t Certified by Address z Licen6e No. Z-PY Z Any person occupying promises served by the above system(s) shall promptly take such action as may be neosssssiy 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 pubt': sanitary sower becomes available and the approval of the private water supply shall become null and void when a public water supply I , , roes. avallabis. Such approvals are subject to modificaMon or Mange when, in the judgment of the Commisdoner o4 Health lion, modlfloatl or change Is necasaary: 3/89 By -- --'`�1 Title FORMAT NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT Date July 18, 1994 Re: Department of Health Review of Proposed Seaaae-Disposal System, for property: Name: Dolores Eyster Address: of f Wood Street Town: Putnam valley Tax 65-2-13 Old Dear 74.19-2-8 New Please 'be.-.Adv.ised that an a-ppl cation:- - for- -a Construction- P)rm i relative. to the'cohstruction of a sewage system and/or well proposed for 'the the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call Mr. Hedges or Mr. Morris of the Health Department at '278-6130. Very truly yours, By Title RECEIVED BY: r%, ',idress: Tax P"lap:__ J'K; c1j 2 lk, 'N TT 1-� -�I, . . . . . . . . . . 7777777, A • 2T" AX, t Fee -Tri'd: 'of iyiite 47, T "am" it bddiiiiiiiig�- GAVID 4 X n. Dig6d-bi !Ppa Will' T'z taaattli. ' A*,toot--#n �44 wIN Oo bcatee es ialeM111 on floe iOprovatl plan and that teW well wUl a installed in atcoMsna w8h,�tM fi f.OYnty Dspb NN mt".vc, tnis . *4Iuued fu rsgofros anew permit t' Ap/p�roved for disposal of tlomestk w a ®s' one /or " i s `wiita Su Rev. v n. Livae will Ilaw Ion of `the bu�l6inq has Oeen ion and ill undertaken %W OF a.. TiM DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 +:. er .. h.• -. .. ve.^ .a. - .s - e —^1: -F 4: it ��. 4Y 1. [. - KT ___ �.•. a^. .w. • -s^:....a. e. v _ ...< ••-ytT} APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION Street Addre�s°�s _,�� To Village /CcIt�y`./ Tax Grid Number WELL OWNER Name �VS`.^'r'/L Mailing Address jWrivate ��� -4E7� �D • O Public USE OF WELL 14 - prima - secondary RESIDENTIAL O BUSINESS 0 INDUSTIRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify b INSTITUTIONAL O STAND -BY 0 AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED_B _ /EST. OF DAILY USAGE_kg?p Xal O REPLACE EXISTING SUPPLY O TEST /OBSERVATION 12 ADDITIONAL SUPPLY 'NEW SUPPLY (NEW DWELLING) 13 DEEPEN .EXISTING .WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING : - 45 L.L. WELL TYPE DRILLED ODRIVEN ODUG aGRAVEL ❑ OTHER IS WELL SITE SUBJECT'TO FLOODING? YES � NO . IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No.. WATER WELL CONTRACTOR: Name :Z- V Ads xi Address IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES C,,�NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST'WATERR MAIN: _ LOCATION SKETCH SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET a (date) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one: water well as set forth above is granted u e �o s of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provi �. Z dt'in thirty (30) days of the completion of water well construction, the applicant 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam Cg�ntydlisj%th Department attached to this permit. �� ` 3. Submit a Well Completion Report on a form provided by the Putnam CbVAITY•4 lth 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 drill operations be contained on this property and in such a manner as not to degrade or of wi contain to surface or groundwater. Date of Issue: ? ��� 19 q f Date of Expiration 19 f Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller PUTNAM COUNTY DEI'AR'TMEN'T OF HEALTH Permit # D� Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM g�/ jam)/ (1 fIrA J 1 village - :cat�s'at sri;-1tzfA�3 c' >' _ _�— - ..TeX- oti4a13' Subdivision e' Subd. Lot N Renewal Revision Owner /Address s' JJ .b�gdfa Date Of Previous Approval GHQ/ [ F Building Type � -- ��/nqf �'� Lot Area / In Fill Section Only ❑ Number of Bedrooms +� Design Flow G /P /D 60 n P.C. H. D. Notification Required Separate Sewerage System to consist of ` �0� Gal. Septic Tank and 3;- S•G�X92S4`.tt >8Ca' BSO/2P%/asJ '�'rQ�,t!('AW -$ To be constructed by 4'"6✓�� `' �� Address Water Supply: Public Supply From — Private Supply to be drilled by Address �i na / Other Requirements EID,..f RAKE) DoEt WELL W/ C -L-ephQ Faw— 1 represent that I 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 and regulations of e Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Health will 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 in accordance with the standards, rules and regulations ons of the Putnam County Department of Health. Date �•a Signed r A P. E. 2!!� R.A. Address Jf —ff /-/q APPROVED FOR CONSTRUCTION: This approval expires one year from the date is revocable for cause or may be amended or modified when considered ne scary by the requires a tpe pe mit. Apor e r disposal of domestic a wage, nd or Date ry By Rev.-9 -81 License No. V?�7- unless construction of the building has been undertaken and is rrog*ner of Health. Any change or Aftftation of construction Title Henry Wirtz Box 301, HD Wood Street, '.Plahopac, NY, 10541 October 2, 1985. Raymond S. ones, President, Du; J nam County Department of health, Two,, . Uounty Center., Carmel, IiY, 10512. Dear Mr. Jones: I was advised that there would be a meeting of the Board of • :ealth held on September 23rd. I assume that my request for a variance on my property on --would be re-considered. Recently, delivered to Mr. Sager a copy of a sketch show- ing the exact position of the well on the Rank property across the street. 6n _T_ It is now over a- week since the meeting, and I have0eard from the Board. Please adv-; - se as to the present disposition of the Board on this matter. Yours very truly, CC: Karell rl Sagpr, Henry Wirtz FIELD C]I1.CK 1AST. l Date Insp . by : INITIAL SITE JP-I3PECTI01' sT C R 7S � Ycs . No Comments ,Property lines or corners found . . . . . . Gan estimate, house location . . . . . . . . Will'. driveway need cut . 9 0 Must trees be removed =hote these .Is deep hole representative of C-ntire SDS area Additional. deep holes needed. . . . . . . Sufficient SDS' SDS' area available considering driveway cut, house location, separation . distances etc. DEEP HOLE DATA Depth: 3:•- Water elevation: - -- Rock elevation: t)OK U%3 e-J Soils d.esca u .i-) t ion: _SAL_ - Date. FINAL SI7' i INSPEEC`i'IO Insp . by: �. ) Hoes-_ located where 'shown on approved plan SDS located where approved . . . . . . . . . :Iength of trench measured Width of trench average - - -- - Slope of the line and trench.acceptable , Room allowed for expansion trenches . . . . . Over .50 ft. :i'rom.:szaamt�,ti:aiercour•s.e. TS .. . .-. __ _.. ...-. -_ -l�atiir�il 'soil P-6, .stripped cr 5115 area _........._._..,� -,-.- _. iu•u-iecessarily graded . . 10 Pb. maintained from prop.line and 20 ft. from house . . . . . . . . . Separation of trench froi'D house, iiell _ --etc. - follows -plan - - -- - - - - -- -- - -- - — Awliber of bedrooms checks . . . . . . . . . . . Stones, brush,,' stwnps, rubble, etc. greater than 15 ft. from nearest trench . . . . 15 Pt. of peripheral soil horizontally from - Jiulct,ion boxes properly set _ Could surface rim off from driveway, roads, ground surface; etc.. channel near SDS area. . . . . . . . . . . Does lot dra."u' ige appear O.K. in area of SDS - FINU GRADING OF SITE ACCEPTABLE - n 0 Plan and profile LIMS l.. C....... ! ..... ......... . All other wells aria SDS closer 200' ! shosm or reference rladz - _ Y ._ _� =Plc �idaries - I;�e E;s" and b6unds- clearl shown REALTY SvUDIVISfcl\V QETLAO I ;SEPARATION DISTANCES SPE CIFIED ON PLAN .10' to P.L. 201/to Foundation wall. s 'fOO to Nearest well 100` to stream, march, lake, etc. incl:expa.nsion 15' to Curtain drain i0' to . lMeets Std .1 Remarks 15' cs ho ' DOOLUC- 1TS OCAT -Y to 1ar`,e trees Design data sheet_ ✓ Peres presoaked? I !,in. 30" pert test depth �- Const. results for 3 runs , -ice i ✓ D. Hole log O.K. to TI�_) ✓ Corporate Affidavit for othep than individual �� ! Authorization for engineer ✓ I IPtter from dater Supply if applicable ALL i If variance ' request*Eld -such noted on plans & apps. C '.3 -75 .✓ D;-ITAIIZ ' Rhow f change - is proposed, ) hown Existing contours s new'contours) Slopes for driveway cuts, etc. ' shown TL-ter service line location i Footing drain, etc. location # Top slope, bottom slope of fill /VX •! I percolation.tests at)d deep test pit location Seotic tank size and conformance to std. ! 3 B.R. housa rlinirum_ House setback shown c1R I 1 Distribution box ftg. below frost All water within 50 :ft . of..PL shown -• - ✓ Plan and profile LIMS l.. C....... ! ..... ......... . All other wells aria SDS closer 200' ! shosm or reference rladz - _ Y ._ _� =Plc �idaries - I;�e E;s" and b6unds- clearl shown REALTY SvUDIVISfcl\V QETLAO I ;SEPARATION DISTANCES SPE CIFIED ON PLAN .10' to P.L. 201/to Foundation wall. s 'fOO to Nearest well 100` to stream, march, lake, etc. incl:expa.nsion 15' to Curtain drain i0' to water line (pits -LO 15' to storm drain �0' ' to 1ar`,e trees 0' fro11l ]'01111(lation tc soptic tank 5' to Pipe 1'i °oIn leader dvgin & ,1,00U1I1c; 25 To G}Tc 4 P a S i iv _ JO(:, LZ : LL Ft 1-L(', D LCC nCD � G�1}h) 1'alIl Ixr� •rte . f :✓ /Y J- I znYE PUTNP,M COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES :. COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE N0.° Owner .4��/Gn/.., CYs�er Address - 3 9.7 ��DLocl �o; /ak/< —?-0 Located. at (Street) 0 rr lW000 S'� Sec. -Block Lot 43 (TrE Ica e neares cross street) Municipality. Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run No. 'Start- Stop. Elapse Time Min. Depth to Water From Ground Start Inches Water level Surface in Inches Stop Drop in Inches Inches Soil Rate .: Min. /in drop l �o�s Z:S7 2 z .. 2� i7 2 L : �'1 3: 2 30 2y Z 7 3 -q: L7 3, sT 3o z 4 3: s'7 '{: 2;% 3o zy z Z 7 3 3: z6z ZL 12, o 4 y•io �0 3o Zy Z6', Z% 1 Z. o. y- Notes: 1) Tuts to be repeated at same depth until approximatelyy 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. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION - - -- DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES-- : --. -_- - 3611 4.211 .2" 48" 5411 6olt 66" 72.11 78« 84 INDICATE LEVEL AT -WHICH GROUND WATER IS ENCOUNTERED CH WATER -T L R -SES- :AFTE.R - BFING -� EN�O0UNT'�'�� TESTS MADE BY �!�IL&I 0 'e. Date 2,7- S" DESIGN Soil Rate Used /.S'Min/l "Drop: S.D. Usable Area Provided Joao -s`y No. of Bedrooms _3 Septic Tank Capacity /006Gals. Type ealu)a Absorption Area Provided By 37S'L.F.x2411 i � width trench. Other Name Slgna ure r ,o Address leer OII' S L .e THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal . Checked b��`O p:``�2 �''�'w Date • �s- Bu /LT //i�rr-NSiow15 Z. //Z /L' 2 44. 66 37' m � 3oi gy O 7. 71 SS' Af7-C OG,°' • �, J al � �I aI M 0 S ) -`- T SITS IS TO CERTIFY THAT THE SEW&E DISPOSAL SYSTEM D /,PT p,1,[iEw,�Y WAS-OOHSTRL'C_� AS -,-7- ..,�._.": C ?1,T. IIS PLAN AND THAT �v IT WAS COVER-i ' "' --D IN ACORDANCE ED OVER T " . :.., s WITH ALL TR := . :.. .. _ :,.. LA3I0:7S OF THE PUTNAN 3/s y6' ',COUNTY DEPARTIL Ni OF H dLTH. i putmm Count& Depertmvnt Of Health ,),.vision Of Environmental Health Servloer / yzEyfzea P Y yr approved as notsd for eg lationes ofithe //V /LL /Are Z6 -64- / C applioahle Rules end Regulations �i�tna® County He �? . l0' e, Title �,, /11,4,q V,4 C, N.Y. l+ pJcR Z74 . .09 SfA JAIr 40°; OMAIAc S bA SCAL E: /-= 40, A.- 0 N .3. T.v,F/�R,FgsOE</r✓. EAT, EDFoRS. EK-. vcFO' crf3zsgLFi .E.wsf`,ExP,v�rsrcw.9.P.EA ¢. La�/rP9roRTI- usrA <c 71 AA14 4 c4s-mlo. To ex7t-mb TOWN 1pe1rw.,qv ov"-, y ry A&MIXI-I I-MA17y, h--wmew 0 Z9A,,,- SV f OW4 'AR116.2—Prz- - AeA, AllrA, OF NEW Pte eV 0 ID� ca 4, 23 41 01 4, 0 TWO Cd 4) 1 0 G 0 It 0 0 ,at' 0 Io O Z, UI �x 47O.w. ,, v SOWAO;Ier ex,pzle A4W `11-A,-Q ;,--,, AW40.9-1,4.-C- -Cpw Yle. 7j- Yjz -A-, A4, ✓az& C-4-rw6 rw IF axojv.✓� Lj*,- 4 Q .4-Pl?7&A),fe- Weretr A,'17A or- ZVC., ;y. Zt 3a-lWSr44—O0- -rAf c 0,11�s.7�,e4jc 7_,V Al . --S7, 2' SirL.9r.EJ.v7if.E. RoLl IeV R4 :Xacy -472,4 cr of New 042io NfEsslolk 7N 0 ID� ca 4, 23 41 01 4, 0 TWO Cd 4) 1 0 G 0 It 0 0 ,at' 0 Io O Z, UI �x 47O.w. ,, v SOWAO;Ier ex,pzle A4W `11-A,-Q ;,--,, AW40.9-1,4.-C- -Cpw Yle. 7j- Yjz -A-, A4, ✓az& C-4-rw6 rw IF axojv.✓� Lj*,- 4 Q .4-Pl?7&A),fe- Weretr A,'17A or- ZVC., ;y. Zt 3a-lWSr44—O0- -rAf c 0,11�s.7�,e4jc 7_,V Al . --S7, 2' SirL.9r.EJ.v7if.E. RoLl IeV R4 :Xacy -472,4 cr of New 042io NfEsslolk ASSEAL TIC / ,1 I I I I I _ I r _;�• I i ING INLET 1 �- i RBOLTS - I I O OUTLET 4 -0,• 5, -0° CONCRETE SEPTIC TANK 3 SLABS POURED IN PLACE + I 1 ARE DESIGNED TO SUPPORT A MIN. LOAD OF 300 P.SF. I 'J PLAN CASING 20 FT. MIN ' i I LOCAT70N STAKE I o I LENGTH UNDER ANY CONDITIONS. REMOVABLE MANHOLE, REMOVABLE MANHOLE, 20" MIN. OPENING /A3 BA RSy 6 ` OL. 36" MAX. ¢I I I + 20 _ MIN, _ OPENING -- — 7 4 �� SOLID PIPE WITH TIGHT JOINTS, GRADED I/B " /FT. MIN. I I USE CLAY PUDDLE CORE CAST IRON PIPE, WITH Y ASPHALTIC SEAL TIGHT JOINTS INVERT OF INLET BETWEEN CASING AND I g ABOVE INVERT n I I DRIL L HOLE. V41 Fl-. MIN. SLOPE INLET i I I OF OUTLET. I I L — ! routo Lfv£L� � DurL ET --• rT SLY 10 ROUX I I I CAULKED JOINT CAULKED JOINT CASING, I j I �.i BAFFLES MAY B£. _ 1 ' SANITARY TEE +/1 MIN GROUT 10' MIN. IN ROCK USED 1NS'EAD I �"� iSEAL -yl I SANITARY TEE OF SANITARY TE°S t„I THICKNESS i ~ i a i I 1 W I` CEMENT PARGING ?I r � O ON INSIDE j 6" MIN. WALL 7H /CXNE55 FOR POURED IN PLACE SANITARY SEAL i` / ON WELL CAP I, CONCRETE SCREEN VENT ' ►•' - 1 T is PEA GRAVEL OR e '�•� ` - + : WELDED SLEEVE S ECTION CLEAN SAND 4 L'' • MIN. ,P TYPE COUPLING 1000 GAL. CONCRE7E SEPTIC TANK _. � FROM PUMP• SEPTIC DETAILS To PLMP —® prepared for WELL CASING — I rBUHING \\ OF NEIV j, tSS1 r ..•t1 F. 2. T prepared by }' - I�,,L�� S`CTION \JILLIU1 F. ZEILER Professional Engineer & Land Surveyor. OF Concord Road - Mahopac -New York 10541 t'= ' (914).628-4764 ..J rT I � ., (] �Y r E L L i ESSIDN'� j 2 C-F3 t r 't r' I - (d -Z �rEOTC�T/LL- G /C•T� �'iili.0 /C Sui =-u :_:_CE Sc. G'_ D :- rOS__. S!Si_ ?S w�_LL o- �: A'; Basic Required Notes : j• c 1. All trees within 10 feet of the proposed* SSDS- shall be removed. 2. SSDS to be inspected by the design engineer /architect and the Putnam County Health MrN• Department after construction and prior- to backiill. -• - 3. No trucks, machinery, building materials, nor excavated earth shall: be allowed in the sewage disposal area. Construction of SSDS to be in accordance with these plans, any �: •' }• ' =` .'�� �'6' Yrr(.: revisions thereto, and tae rules and regulations of the permit issuing governmental �--- •:..:._ , i agency. r I_, •1• Minimum yield of 5 id. Yields l than 5 m vill be immediately mum we gpm s require less an gp , r , p Yc H' -SX_9 OR caul Nro P(P_, G....c; •t a',tnN' a reported to, the Putnam County Department of Health. GRRDF� (�i6'�, S-DNE r %16•_ ! /jz /� •6G� xlM, -n=• The sewage system design shorn hereon does not provide for install -tion of a oarbame grinder. Such installation requires the aoproval of the Putnam County Department of Health _0770/`/ PP,OPILE GROUND T + — • w :rca•_RaeX Notes Required When ROB Fill Pr000sed; t. _ 1. 30B fi11 must be stabil -zed by al:owing the ROB fill to settle natu - ally for a period _ ai at least 6 months and include at least one freeze-thav cycle or .till stabilaticn m: D(Sr%SAL -I FENCH DEir,IL ( INSTALL: ON CctVf = =,) be achieved by mechanical compaction in approximately six inch lift:i to the approxima-. density of the undisturbed underlying granular soil. The results of; density tests performed in the undisturbed underlying soil and in the fill pad ar ;r, to be submitted i • — i., the Putnam County Health Department if mechanical compaction is to :ae utilized. �. 2. Eite 'mod 4 Yi cation activities involving placement of fill are to be conducted during - relatively dry periods to minimize soil smearing and excessive soil�aompaction. - 3. Run of bank fill shall be suitable for sewage absorption, be free of fines or other 1 F unsuitable material and shall have an in -place percolation rate at .east equal to that I in the natural soil after the required stabilization period. The engineer /architect on. shall perform final percolation tests in the 1411 after stabilizati _ i� n 9. The impervious fill, clay barrier, shall be a dense clayey soil vitf�'little or no L A(C �_1_ U BOA — sewage absorption capacity. ; r- -` --__ I.` p 5. Fill suitable for sewage absorption should contain no more than 51 a y and preferably no -- — __ D`'ItiIL more than 2X fines by weight. Fines are clay and silt particles that pass a 200 sieve and no more than 10% by weight, of the fill material should pass a 100 sieve. net cve� T SEPTIC DETAILS I - - -- Cover prepared for : Dret3-r -- by I ?_ofzss'_cr_ai _e_ a ?arnc. Su=-:eyc= Conc= . cac , . a }/ `