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Home My WebLink About4820DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 92. -1 -1 BOX 36 1 1 INS I yti J IIIT gh J6 L ■ I T� � T 1 I' ` I r ' �- I. Ka PURM COUNTY DUMMUM OF INDIVILMAL WKELK 5UL-L-1iX/bUt5bU1UR" --)ZVVMJZ LJ1DrV0tW 011.Urrio FIELD INSPECTION REPORT DATE: :.7. f'�. P. L T� K (Name of Owner) (Street Locatioh) V INITIAL SITE INSPECTION U YES NO Ca4mus, Wet-lands on/or proximate to property .... ...o....o. l Property lines or corners found ......... Can estimate house location ................ Will driveway need cut ............ o ... o .... : ****** o a 6 o o o L;_' Must.trees be removed – note these................. Deep holes representative of entire SDS area.. .o.. Additional deep holes needed... .. ... o Sufficient SDS area available considering driveway cut,, house location, separation distances,etc... Adjacent wells/septics... oo ..... o ** *oo***o****o Access to grgosed well location for drilli D. H. -Deep Hole G.W.- Groundwater D. H. 1 Lot D. H. 2 Lot D. H. 3 Lot Depth to G. W. Depth to G. W. Depth to G.W. Depth to rock Depth to rock /Depth to rock 0 ft. 3 ft. 6 ft. ,.ft. 12 fta Soil Description 0 ft. 3 ft. 6 ft. 9 ft. 12 -ft. 0 ft. �3 ft. 6 ft. 9 ft. 12 ft.: Soil Descr DATE: FINAL SITE INSPECTION INSP.BY: YES NO COMMENTS House SSDS located per approved plan ...... oeo—o Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Roan allowed for expansion trenches .............. Over 100 ft. from watercoursecoo — aso — a — . 0000 Natural soil not stripped or SDS area unnecessarly graded ......................... — 10 ft. maintained from property line and 20 ft. from house... .......... o-o ... o.o.o...o.. Distance well to SSDS (ftJo. — o ............. Number of bedrooms checks000-e—oo 000 — o'ce —oo TUbbld, -etc., St6xi&, - -)5kff§1f, stumps, " - greater than 15 ft. fran nearest trench........ ... 15 ft. of peripheral soil horizontally frantrench ........ o ........... o ... o... oo. Boxes properly set— ....... o—D000g000 — D00000 Could surface runoff from driveway, roads, . ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE-o .... o—o—coo: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date' Re: Property of C_ Located at (T )_I.",717 aj2Z Section Subdivision of Subdv. Lot # Gentlemen: 11� Block 7 Filed Map # Lot Z7 ! Date This letter is to authorize a duly licensed professional engineer registered architect (IndicateT_ 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 i of said sys_ ys oiis- of 147,'Education Law, the Public Health Law, and the Putnam County Sani-, tary.Code. Telephone Very truly yours, Signed Owner of Property 1 � Address Town Telephone PUPNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIROMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEMGE DISPOSAL SYSTEMS III 61m� ' tee• :r�� : :y'' fl ..:... ► i"�+`'6•'r ::.v- err ;�. a._ .:� i'" _ F.. .^C °� .a+: 4`sc. =-.C- �. �wi LL'11Lia ♦ 1 � = J-'z.� = x�"LU`� -.:. {� %I_ .� `f�LD 4�D I PK.i� BY: (Name of Owner) (Street Location) COMMENTS YES NO DOCUMENTS ENTS p kp Permit Application Corporate Resolution VV Plans - Three sets Engineers Authorization b, Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other y House Plans - Two sets If PWS - Letter N R Variance Request REQUIRED DETAILS ON PLANS / Sewage System Plan -� Sewage System Hydraulic Profile - Gravity Flow i 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 l Two -Foot Contours Existing & Proposed / Driveway & Slopes Cut ✓ Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area . ... . .... ..... .. P c 0 Expansion. Area; shown;gravi.ty flow, Buff,.._ size ..... _ -. __ . If Plumped 'Pit &" D - Box"Showff & House - No. of Bedrocros Wells & SSDS's w /in 200 ft. of Property Located Property Metes .& Bounds N� House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max. Bends 45° w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake Unc. expan) 15' to Drains- Curtain,Storn,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' from Foundation 50' 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 i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUYLDING, CARNlEL, N. Y. 10512 - DESIGN DATA SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. /SHEET- / Owner /��d Address /tea ��X ,%��f>'T Located at (Street Se'c . Ile Block )7 Lot indicate nearest cross street) Municipality. Watershed .3_ SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run apse. p o a er a er ve No. Time From Ground Surface in Inches Soil Rate Start -:Stop Min. Start Stop Drop in Min. /in-drop Inches Inches Inches 22_4720 z11 9 / 3 W rz7 i Notes: 1) Tuts to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to �e submitted for review. 2) Depth measurements to be made from top of hole. l . 2 ;. .3_ - i Notes: 1) Tuts to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to �e submitted for review. 2) Depth measurements to be made from top of hole. x. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION y. - � _�•. DESCRIETION'' OF�SOILU= tiETJCOUNZ "ERED- IN�TEST "HOLES _ -_ � .. - . �-�.�,- .;- �,•;.;;;,,�:Y� -. DEPTH HOLE NO. / HOLE_. NO. HOLE NO. G.L. 611 ` 12" 18" 24" 3011 3�I 42'r 48" 7211 78" 84�r `., ..rnTDICATE IVEL.AT 1rJHICH..GROUND,WATER IS ENCOUNTERED i INDICATE LEVEL TO WHICH WA4 R LEVFI� RISES AFTER BEING B�1C�UN'IRED TESTS _MADE BY `�' I) i yaw . Date DESIGN Soil.Rate UsedD :�7 Min/1 "Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity /acw Gals. Type Absorption Area Provided By �L. F. z�2�#'" width trench. Other Address THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checke e �4 Qf Date DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL ; PCHD PERMI &L/07p WELL LOCATION Street Address Town Village City Tax Grid ' ' Number WELL OWNER a Maili g Address I IRA: RESIDENTIAL O PUBLIC: SUPPLY BUSINESS', O FARM 0 INDUSTRIAL U INSTITUTIONAL Private Public [j AIR /COND /HEAT PUMP O 1BANDONED O TEST /OBSERVATION O OTHER (specify O STAND -BY 13 USE4 OF WELL - primary 2 - secondary AMOUNT OF USE YIELD SOUGHT__ � gpm /# PEOPLE SERVED _ /EST. OF DAILY USAGE -gal REPLACE EXISTING SUPPLY. O TEST /OBSERVATION LIADDITIONAL SUPPLY O NEW SUPPLY NEW DWELLING , 13 DEEPEN -EXISTING WELL REASON FOR DRILLING DETAILED ' . REASON FOR •DRILLING tv CC N c yx weji C: �r. 5v 1 - ► cl l N WELL TYPE ®DRILLED DRIVEN ®DUG ®GRAVEL ' OOTHER IS WELL SITE SUBJECT TO FLOODING? YES _X_NO IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name hpMyyM ArAa!r *#e _ Address: RMW IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES Or NO NAME OF PUBLIC.WATER SUPPLY: TOWN /VIL /CITY i -DIS-TANCR TO` PROPERTY. FROM -NEAREST'WATER --MAIN: ~ _. : �� ... LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET. ( ate) (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: I 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.con.tained on this property and in such a manner as not to degrade or otherwise contaminate surface`or groundwater. Date of Issue:�G� g 19 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 PUTNAM VALLEY TOWN HALL MARN PUTNAM. VALLEY, N.Y.,- _-VI"� &D'ELL� Inspector (914) 576 2377 iAp TOWN OF PUTNAM. VALLEY BUILDING, ZONING, AND SANITARY DEPARTMENT November 12, 1991 Department of Environmental Health Department 110 Old Route 6 Carmel, N.Y. 10.512 Re:. Proposed Well TM#PV 920 -1-1 33 Peekskill Hollow Turnpike Gentlemen: Owner: Schroeter The proposed Water Well site as shown on the attached drawing was inspected on 11/8/91 and as could be determined was found to be a minimum of one hundred (100') feet from any reported sub-surface sewage disposal area. Applicants that receive permits shall upon completion of construction, submit to the Town of Putnam Valley (Building Department)a copy of the well drillers Log and �. Water - analys.i.s.. report t • -.-.-,.-befo.i7-e.....sa.id.,,well,-is Put- in service- MA 'Building Inspector MO'D:es enc, IS WELL SITE SUBJECT TO FLOODING? YES N0 IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: n4 . Lot No. WATER WELL CONTRACTOR: Name_howw a ApAervHk1 Address et IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YESNO NAME OF PUBLIC WATER SUPPLY: ---- TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: +mom NgNt, LOCATION SKETCH:: 6 SOURCES OF- CQNT..AMINATZCN. PRt^V DE - �` SEPARATE SHEET /0/10111 " - - n.tl'� huh (date) (signature) PERMIT TO CONSTRUCT A WATER WELL .his permit to construct one water well as set forth above is granted under the provisions if Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within hirty (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. firing all well drilling operations, the applicant shall take appropriate action to assure that iy and all water or waste products from such well drilling operations be contained on this -operty and in such a manner as not to degrade or otherwise contaminate surface or groundwater. tte of Issue: 19 .te of Expiration 19 Permit Issuing Official rmit is Non - Transferrable White copy: HD File Pink copy: Owner 89 Yellow copy: Bldg. Insp. Orange.copy:',Well Driller N � ' C 1i 14 .o z Zk k :�� • /OB id s 'ea. � II �� i 4;C eve ® i Ln v �1 `•A� L=1C appiicant 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: 19 - 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 .! ®� �� ® CCU 9G o �� E7 Putnam County Department of Health - es