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HomeMy WebLinkAbout4625DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.09 -1 -13 BOX 35 iLicr is r r �. . t };& - UL 04625 PUTNAM COUNTY DEPARTMENT OF HEALTH Permit x C" Division of Environmental Health Services, Carmel, N. Y. 10512 zSONS?'RI11g, ! t - .°E9�P.1!•I�T FOR = SE6MA�E © €S °OSA! . SyETE!!$ :. a�., , .;;. ����_. - ..,.. F' • o ... . {rte — - / n /� _ own or Ilage f Located at _! s��w�''����is�� Tax Map r G t-/ ock 2—. rot �!, Subdivision Subd. Lot # @� Owner /Address qq A Building Type �3:�i�ti�li�it� Lot Area Number of Bedrooms 115 Design Flow G /P /D 600'.; 6 1 o Separate Sewerage System to consist of Gal. Septic Tank To be constructed by Water Supply: Public Supply From _. / Private Supply to be drilled by Address Other Requirements k Renewal _ [] Revision _EJ Date Of Previous Approval Fill section Only ❑ P.C. H. D.. Notification Required A and "" t zqq I k saN � ( ez `A t-�'T �( Address tanx- I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage dis oral system above described will be constructed as shown on the approved amendment there to and in. accordance with the standards, rules an regu a ons o e Putham 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 re irs thereto; that the drilled well described above will be located as shown on the approved plan and that said well will be installed in accor a with th standards, r s and u a� ations of the Putnam County Departm ti t of ealth. Date � Signed P,E. d -'R.A. Address , +? License No. 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 considers necessary by the Com ssion of Health. Any change or alteration of construction requires a e permit. Approved for disposal of domestic tar Sawa, an r priv a wate supply only. n Date ( t - — By a Title Rev. 9 -81 O _+ PUTNAM -- �l COUNTY DEP RTMENT OF `J ENGINEER N Division of Env' �EALTH EER MUST fronmenta/ H"I h Serlaoas, Carmel, N. Y. PROVIDE CERTIFICA 0 CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM 10512 PERM I T:J1ktk A. —� Located at ; Town or Village Owner T ('�I =k:: ,j Tax Map IL 1 /� / Formerly - , f-7 n- � Block C. Separate Sewerage System built by A Tax Map Wt p v �? _subs. tot N S�v Address L J u Consisting of Gal. Septic Tank and � Cr Other requirements rI i Water Supply; � Public Supply From —L Private Supply Drilled By Address Building Type 171 Z> � q Has Erosion Control Been Completedt No, Of Bedrooms Date Permit issued_L�uG Has garbage grinder been installed? I certify that the systems) as listed serving the above premises were constructed essentially as shown on the plane oP the c If which are attached), and in accordance with the standards, rules end regulations, in accordance with Putnam County Department Of Health, the filed plan, and th�leted work (copies ('� n permit issued by the Date � � fIl'f3� 'd�l� Certified by Address Any person PYing premises served by the above System(s) shall promptly take such action as ma conditions resulting from such usage. Approval of the available and the approval of the separate sewerage system shall became null be necessary of subject to modification or change When, the July shall become null and void when a g_ _ + lutlemenr ns •.� ..__ _ . Public water �...�,.. r P. E. R.A. License No. the correction of any unsanitary I Public sanitary sewer a ate..— - 2002 yat WbLL UUrLrLL11UA rLruml Office Use Only DEPARTMENT OF HEALTH Division of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH S 7k-10�VESS: IVI Ty TAX GRID NUMBER: WELL LOCATION WELL OWNER NAPPR ADDRESS:- _7$1UBLIC BIVATE USE OF WELL 1- primary 2 - secondary )KRESIDENTIAL 0 PUBLIC SUPPLY 0 AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST/OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY ❑ AMOUNT OF USE YIELD SOUGHT g'pm.INO.. PEOPLE SERVED EST. OF DAILY USAGE 5/0 L7 gal. REASON FOR DRILLING EW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST/OBSERVATION 0 REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH g 1-ft.1 STATIC WATER LEVEL `fir ft. FOATE MEASURED DRILLING EQUIPMENT X-ROTARY ❑ COMPRESSED AIR PERCUSSION 0 DUG ❑ WELL POINT 0 CABLE PERCUSSION 0 OTHER (specify): WELL TYPE ❑ SCREENED 0 OPEN END.CASING. XOPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH 3e , ft MATERIALS:' -g-STEEL 0 PLASTIC ❑ OTHER LENGTH .BELOW GRADE Z JOINTS: OWELDED )ZLTHREADED OOTHER DIAMETER in. SEAL: 0 CEMENT GROUT ❑ BENTONITE InTHER .WEIGHT PER FOOT lb./ft. DRIVE SHO YES ❑ NO I LINER: 0 YES ,*O SCREEN DETAILS DIAMETER (in) SLOT SIZE LENGTH (it) DEPTH TO SCREEN (1-0 DEVELOPED? 0 YES ONO HOURS SECOND -G-RA-VEL-PA-C-Kj Q YES 149AVEL SIZE OF PACK in. DEPTH —ft. HOTT OEM It. WELL YIELD TEST If detailed pumping -'W 1700: 0 PUMPED tests were done is in- C HOMPRESSED AIR formation attached? 0 BAILED 0 OTHER 0 YES '0 NO LOG ELL 11 more detailed formation descriptions or sieve analyses are available. please attach. DEPTH FROM SURFACE Water Bear- ing Well Oia- meter In FORMATION DESCRIPTION COLE, IL WELL DEPTH It. DURATION hr. min. DRAWDOWN ft. YIELD gpm. Land Surface af i ii WATER ❑ CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? 0 YES 0 NO STORAGE TANK: TYPE y CAPACITY A GA h. 'PUMP INFORMATION TYPE CAPACITY MAKER 71- DEPTH MODEL VOLTAGE — HP WELL DRILLER NAME 0AT?E,/ ADORES 4 _-.91 Building Constructed by Location -'Street Building Type 1Kdlmg, . i Section Block J 9 .1/ Lot GUARANTY OF SEPARATE SEWAGE-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 guaranty to the owner, his succes- sors, 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 systemm, except where the failure to operate properly is caused by the willful or negligent act of the occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the de- termination of the Director of the Division of Environmental Health Ser- vices of the Putnam County Department of Health as to whether or not the failure . pf, the. system }to.. operate Taas._.c.aus.e,d._ -by, the .willful or, negligent, __a.e cf- t-he°- occupant of° the bu°ildir�g utrlizin °the "s rs`tem.�` _ ` Dated this day of Signatu Title {' So If corpolration, give name and address) r9Le,,- � '------------------------------- 4_�' -`.�, - THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE- CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE, OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health DAVID D. BRUEN C,ounty..Executive. ' :,.%di �`%!_'.: �'c .�.i•"W r:v.QY-�a•= �:�'r•':e��.:.�: �.y. .'d.'��,.s = =.,. ."si -:�w =� DEPARTMENT OF HEALTH Division Of Environmental Health Services May 22, 1986 Mrs'.Kay Hanlon Route 3, Box 116 Finnerty Road Putnam Valley, New York 10579 Dear Mrs. Hanlon: SIMMUNYJ.• S 4Deputy Commissioner Re: Putnam Acres, Inc. SDS PCHD Construction Permit Putnam Valley 20 -82 Finnerty Road (T) P.V. Tax Map 120 -2 -1.2 Field inspection of the above referenced site on M.ay 19, 1986 and review of approved.Health Department plans dated August 18, 1982, indicate the proposed well location approximately 250 feet southwest of Finnerty Road,still meets with this Department's approval. This location is apparently in a New York State controlled wetland (ML -6) and would accordingly require a Department of Environmental Conserva- tion Permit. The al ternat.e..we.l 1 1 ocat-i on .�sh•o.wn -o-n• _ti ev•i.s.ed.,:Ip.l an-.d4t�-d� —' : • .� r-- 7 t J a•n,uarji`�i'J-6 '•1`9tZ —ii" `he west °•p roper`ty corner and field staked,is not acceptable,as the necessary separations between the sewage disposal system and well cannot be maintained when consideration is given to the 50% expansion area required. Additionaly, well placement here would result in additional encroachment on the wetland to expansion trench distance. Any future trench expansion must be in the front of the lot. Upon receipt of a copy of the Department of Environmental Conservation Permit to drill a well and a new construction permit application signed by the designing engineer, the Health Department Construction Permit renewal will be issued. Very truly yours, . ::�Zes S. Hodg`ens JSH:pt Asst. Public Health Engineer cc: Tom Daly, P.E. Bob Baxter, L.S. Mike Priano, PV CAC Marvin O'Dell, PV, Building Inspector Joe Steeley, New York State DEC, New Paltz,NY TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 PUTNAM COUNTY HEALTH DEPARDENT W - - DIVI.SONp::QF'. EN`�T'Rxv"EIDr .....L, r _.. �._._._ .:,ar• :. ;ea,° .t ;- 3C . =c..e . - _ •,L _ . =i ce- . JoYin'Mo Simmons, M. D. Deputy Ccmmnissioner of Health - FIELD ACTIVITY REPORT - Sheet of INSPECTION NAME w+ _ ,/" �_�� �S Orig. Routine / Orig. COmplain ADDRESS �� i �r �> �N ��%� y��� , _ Orig. Request No. Street Town TH No o Cmipl iance -' Cmplaint Cc mp ,,MAILING ADDRESS 1 Final P.0. Box Post Office Zip Code Group Illness Construction TELEPHONE w _ Reinspection PERSON `IN CHARGE Field, Sampling Only OR INTERVIEWED Field Conference Name and Title _ Other DATE.5 ff TYPE FACILITY TIME` TIME LEFT Explain INSPE i'OR: TELEPHONE: Signature and Title PERSON IN'`'CHARGE OR INIERVIBM.- I acknowledge this Field Activity Report. SIGNATURE: 6/86.:k TITLE: lc� IL's- -p A-r �4 A. 71 ---------------- 77 ......... ..... . ... � ter. Y� — `�, — - - _U:_"U � !/" �'� --G'� �Z.��� � ^G��J)�'�,, • PUTNAM COUNTY DEPART M. T OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 6 26 Date ®! e) Re , Property of�� Located at���. Section Block Lot C; entlemen This letter is to authorize T. zMichael .Daly, 13 E a duly licensed professional engineeror registered architect ( Indicate) to apply fo.r a Construction Permit fora separate sewerage system;. to serve the above noted property in accordance with the standards, rules or re, ulations as promulgated 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 zn conformity_ • with-:t 4)4o�ti r � f - Article .... ... aVP •T" 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code, Countersigne I P E. R -A 9 #_4840 Bo-,<,-243, She n o : g c (Seal) Ad ress NoYo, 10.587' 2487022 Telephone Vet Sih elephone <<w AUG RECEOVED N) I CK 1-'7 �,����,;,) 52g -5 4� 1 ?' 1982 PUTNAM COUMV17 DEPT. OF I PUTNAM COUNTY HEALTH DEPARTMENT Ali DIVISION OF ENV I,RONMENTAL H.:AL''Ih} ,ERVTCE`S "' John M. Simmons, M.D. Deputy Commissioner'of Health - FIELD ACTIVITY REPORT - Sheet of Other. DATE TYPE FACILITY yc-s 11) F A) L TIME ARRIVED �i° : ¢ TIME LEFT; 3 [,� Explain FINDINGS: Eli �1� - 1 ! A I 1 I I I]- 11 r-- 11 INSPECTOR: Signature and T1fQle ?ERSON IN CHARGE OR INTERVIEWED: acknowledge receipt of a, copy of this SIGNATURE: 'ield Activity Report .................. TITLE: 185 ^ice F � - TELEPHONE: A <-� INSPECTION NAME L -0 /14 Orig. Routine Orig. Complain ADDRESS Orig. Request No. Street Municipality (T) (V)(C) Compliance. Complaint Comp MAILING ADDRESS R J. lo)( i t& not31541 'i €1:>' pt f Final P.O. Box Post Office Zip Code Group Illness � -7 -7 7 _ _ Construction TELEPHONE t Reinspection PERSON IN CHARGE .r- Field, Sampling Only OR INTERVIEWED �Y C�1�^ Field Conference Name and Title Other. DATE TYPE FACILITY yc-s 11) F A) L TIME ARRIVED �i° : ¢ TIME LEFT; 3 [,� Explain FINDINGS: Eli �1� - 1 ! A I 1 I I I]- 11 r-- 11 INSPECTOR: Signature and T1fQle ?ERSON IN CHARGE OR INTERVIEWED: acknowledge receipt of a, copy of this SIGNATURE: 'ield Activity Report .................. TITLE: 185 ^ice F � - TELEPHONE: A <-� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512' DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner T�� Addresst�-„ Located at (Street V-NQagMj d Sec. Block Lot n Ica -e n6arest cross street) Municipality Watershedjep,(�. SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME to PERCOLATION PERCOLATION Run Eiapse pbc th to Water Water .,evel No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches M 2 r� ►'L \L Zo z l2 l 3 0 i 5 n 14- 14- z_ 1 0 - l0 10 1_0 ..,. _ - 2, 3 20 12- 13 -1 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 made from top of hole. f TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES _. .. • « ._ .. w.ta1 .'t'. w i 5... - ^> ,4'^ .- t o - _T . .. w t . �- .. M .... ♦ .1r �'R4; -, ^ •,A ..r • .n . DEPTH HOLE NO. �_ ~HOLE NO. HOLE NO.. G.L. j I�D7azotL. 6" a� 12" w t 18" A� 24" 3011 y 3611 y 42" 4811 ►r 54 60" �r 66" 72,; , 7811 - 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED (a 1VCO1UNTE TESTS MADE BY �_�„ Date e> 1 �� DESIGN Soil Rate Used tG :bDin;/l "Drop: S.D. Usable Area Provided 000-C 6 No. -of Bedrooms �Septic Tank Capacity. Leo Gals. Type Absorption Area `Prdvid6t - By L.F. x24" �' jb�"— width trench. Other _ THIS SPACE FOR -USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq.'A /Gal: _:Checked•by Date Jj- .,.. 4 OGA-rtC) ki -C, A � � Scf���aK - I t2 - 1 42' �_ S57'1 5.1 _ 1. - U 8,. 5 9 -b" 4" -b - - ra � -b' 'AV - - 4v- , aA � — A :f IFIM Z,_ � A of N7. 04Q �Xi�aadilo"t . —C_ V V.t_��tc� 5i �sp�•�5 �_ 4v- , aA � A � A A-15 Ou,L -r G -1 --M �i�*�.n "izns►C� .t i. C. t o C STS -q 1 °•1 . �t1 f f. 1 rutnam Q ty Depart ent of Healta 'n— oi'Envixonrua.ta Health Servio @p Approved as noted for conformance with applicable Pules.and ReTalatioris of the,I' Putnam County Health Department'., r.