Loading...
HomeMy WebLinkAbout0024DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 1 -1 -27 BOX 1 00024 �r. Y. - IN ' f I i � 00024 �r. Y. Street /`7,00# "E y /� ` /L �� TMx Cons z ruct i on /f.- Mai 1 ing Address 364 /3 Town !__ Description of Addition C' /I 04 Number of exist ;ng bedrooms 3 proposed numoer of '--grooms A] Square Footage of ex.sting house a 1 o U B] Sauars Footage of =- ocosed Add' --cn v v % increase in f'ccr area ( A d-%1-d_c oy 9' X ..-C y-y-3 93 1]; . lq Please subm- - th? s form arc :ne fol lowing c M '' ! NA;f C -v N- F=-%: C -PNE/A ROAD, ?FENSTE=�, yY . -_509, Phcne ? CC wi t_n - ^e fc "Cw` nC :n= ra- T- THE PPCF Sc1 ADnTT :C�,\: GPEA.E? THAI. ' = C, .. Cr!E�.,rC � c r 3 , C . 0 2. :ketch o- ex-_-irg f "c. o';ar.s (a' . r� :rg area ^c- :sir_ Nan- prof�_�'cna� draw- .. Ske -cih o- proposed i icc— aian. "on prc--=cz�ona� draN'. _ Copy of survey _ncN'r.c i arc se e- 7cca _ion , -_ `ne :=z7 c- y!-,,- knc,,gieCGe, InCl .de C -__ or ?nsza7 c^ if -.nc.. r. Ar;' contact W':. , ia:� Hedees cmr Fobert IF THE ADD: T :CN WILL F=SSuL- ?N AN ADD T = -NAL ° =DROC-�M 60 C-11-ek CHECK.fc! S .C. CC c. Sketch of existing f._=. plans (2':. =ving area - :tc Lc :, Non - professional Craw;r:c 3. Sketch of proposed feer plan. .von professional drawing It for the Sewage D-sposal System prepared by a Professional E ^g= ^eer meeting present code r =quirements, ma.i be required. OFFICE USE Comments and /cr conditions Approved by: ' TITLE c7 Date. cc: BI (T) addition Apoi ICA70N - ADDr_'r.y - r =cS:DENT :A_ GNU, Name:, et) J C) A ��� Phcne 9 &'75' _ 7� Sl p year 'of Cr? g? na': Street /`7,00# "E y /� ` /L �� TMx Cons z ruct i on /f.- Mai 1 ing Address 364 /3 Town !__ Description of Addition C' /I 04 Number of exist ;ng bedrooms 3 proposed numoer of '--grooms A] Square Footage of ex.sting house a 1 o U B] Sauars Footage of =- ocosed Add' --cn v v % increase in f'ccr area ( A d-%1-d_c oy 9' X ..-C y-y-3 93 1]; . lq Please subm- - th? s form arc :ne fol lowing c M '' ! NA;f C -v N- F=-%: C -PNE/A ROAD, ?FENSTE=�, yY . -_509, Phcne ? CC wi t_n - ^e fc "Cw` nC :n= ra- T- THE PPCF Sc1 ADnTT :C�,\: GPEA.E? THAI. ' = C, .. Cr!E�.,rC � c r 3 , C . 0 2. :ketch o- ex-_-irg f "c. o';ar.s (a' . r� :rg area ^c- :sir_ Nan- prof�_�'cna� draw- .. Ske -cih o- proposed i icc— aian. "on prc--=cz�ona� draN'. _ Copy of survey _ncN'r.c i arc se e- 7cca _ion , -_ `ne :=z7 c- y!-,,- knc,,gieCGe, InCl .de C -__ or ?nsza7 c^ if -.nc.. r. Ar;' contact W':. , ia:� Hedees cmr Fobert IF THE ADD: T :CN WILL F=SSuL- ?N AN ADD T = -NAL ° =DROC-�M 60 C-11-ek CHECK.fc! S .C. CC c. Sketch of existing f._=. plans (2':. =ving area - :tc Lc :, Non - professional Craw;r:c 3. Sketch of proposed feer plan. .von professional drawing It for the Sewage D-sposal System prepared by a Professional E ^g= ^eer meeting present code r =quirements, ma.i be required. OFFICE USE Comments and /cr conditions Approved by: ' TITLE c7 Date. cc: BI (T) addition ld)$9,d!:578* 514. Z(.O' ot Z4.,. 40 " !OS Lo" v'7- = OZ'- 10 " 1.a TO '362489e IT ALP LL ............... ...... ....... P6000 pep Kk;?.WJ POLUTT 3M euc -rc>w-iw os= (D a .� 0 'Z c Ito rl PUTf -iAM COUNTY DEPARTMENT OF HEALTH } Rev. 31 S l� Division of Environmental Health Servlces, Carmel, N.Y. 1051i _. /) Engineer Must Provide 5 10 86 P.C:H.D Permit N == . CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Patterson Town or Village Located at Mooney 'Hill Rd./Rt. 2 9 2 Tau Map . 1 Block 1. tAt 12 J V Construction ..)Q&I y.. Hill Es�I tiiq�iy 2 Owner /applicant Name Formerly Sabdivis v, Mailing Address Harmony Rd.- Zip Date Permit Issued Patterson, 'NY Separate Sewerage.System built by Roger Mayes Address Poughquag Consisting of 1 7 V U 0 Gallon Septic Tank and 48 L F of T i l e Fields R5 Peet Water, Supply: Public Supply From Address or: x Private Supply Drill ed by Hyatt Address Patterson Building Type Colonial Has Erosion Control Been Completed? N/A Number of Bedrooms 3 Has Garbage Grinder Been Installed? No Other Requirements 1' Fill Required I certify that the system(s) as listed serving the above premises were construe essentially as hown on thpplans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regal io s, in acc rda e ith ie 'fled plan, and the permit issued by the Putnam County Department Of Health. IOU n P.E. X R.A. Date 7�8�86 Certified by Address Baldwin & Corne.lius P . C ..Rt . 22 Brews tErkN se No. 38329 Any person occupying premises served by the above system(s), shall promptly take such action as may be nwAsury 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 pub:': unitary sower becomes available and the approval of the private water supply shall become null and void, when a public water supply becomes available. Such approvals are subject to modification or change when, in 'the judgment of the Commissione:L of Mealth, s p revocation modification or change Is necessary.. Date %� & C, / • ` / By ' Title �— WELL COMPLETION REPORT 3/W-1 PUTNAM COUNTY DEPARTMENT OF HEALTH . Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report is to be completed by well driller and submitted to County Health Department together with laboratory report of analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME ADDRESS LOCATION OF WELL (No. & Street) (Town) (Lot Number) k1w Q. rpeak#��� PROPOSED USE OF WELL (� BUSINESS LKJ DOMESTIC ESTABLISHMENT ❑ FARM ❑ TEST WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ OTHER ) DRILLING EQUIPMENT ❑ ROTARY COMPRESSED CABLE OTHER AIR PERCUSSION ❑ PERCUSSION ❑ (Specify) CASING DETAILS LENGTH (feet) oZ DIAMETER (inches) WEIGHT PER FOOT ( L! 1 THREADED El WELDED RI SHOE )YES ❑ NO W CASSIHG EDT n YES NO YIELD TEST HOURS P.M. ❑ BAILED ❑ PUMPED COMPRESSED AIR G. YIELD (O.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE— STATIC feet) DURING YIELD TEST [feet) 6O Depth of Completed Well in feet below Land surface: 200 SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (Inches): GRAVEL SIZE (Inches) FROM (test) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET 0 /0 10 boo 4 If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED DATE F REP RT �® 2 WELL DRILLER (Signature) i (orktown Medical Laboratory, Ina ` 321 Kear Street s Yorktown Heights, N. Y. 10595 (911x215 -320; Director: Albert H. Padovm m T. (ASC P) Lop J LAB / 33VJ Collection Station Used: Carmel Peekskill _ Mt. Kin _ Nev City Date Taken: Date Received: , Date Reported: Collected By: J, ,r .Referred By: Sample Source: ,2 LABORATORY REPORT ON BACTERIOLOGICAL QUALITY OF WATER GENERAL BACTERIA Standard Plate Count per 1.0 ml (Agar plate @ 35 °C) YEMBRA ?1E FILTRATION TECHNIQUE (MFT) Total Coliform Der 100 ml_ Fecal Col i form ner 100 ril Fecal Streptococcus per 100 ml _.__...5..-- PRO??ABLE- t;UMBEP.�TECHNIQB-E--(.MPN) - - - -_= - -`�' Total Coliform: MPN Index ner 100 ml Fecal Coliform: OTHER ANALYSES MPN Index per 100 ml THESE RESULTS INDICATE THAT THE WATER.SAMPLE,'d� (WAS NOT) (NOT APPLICABLE) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO THE NEW YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Albert H. Padovani, M.T. ASCP), Director LEGEND RDS Recommend Disinfect- ing Water Source < less than TNTC Too Numerous Too Count PUTNAM COUMY DEPARTMENT OF HEALTH DIVISION OF ENVIROM,=AL HEALTH SERVICES Owner or Purchaser of Building Buildings Constn.,rt—A I- , J.V. Construction, Inc. Harmony Road i Patterson, NY 12563 Municipality Building Type I d Section Block Lot .. - .. vision 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 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 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 he system. Dated this day of r 19 neral Contractor ( er) - Signature Corps J: V. Construction, Inc. - - - Harmony Road Patterson, NY 12563 Nddr rev. 9/85 nk ROGER MAYES CONST. CO., INC. CorporatiM0 Bancorp.) jpOUGH, UAGb N, Y.. 12-570 ess 3 6� 3' ENGINEER -TO PROVIDE - PERMIT # PUTN.AM.COUNTY DEPARTMENT OF HEALTH ON CERT FICATE OF' COMPLIANCE, Division of Environmental Health Services, Carmel, N. Y. , 10512 PERMIT -. ISTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM fERSaO Town or village, I _ Locatetl at ���N #/L�. ,`� Tax Map" � 9alock / Lo't /Z Subdivision ./%add /Vey %fiLL .T .4 ?CS S.W. Lot # Renewal _❑ Revision ❑ owner /Address yy' Cd/U�- /Ci,I� _Date Of Previous Approval CY74.01Wi4 r ..2+ L� Fill Section" Only . Building Type Lot.Area y ❑ Number of -Bedrooms ¢ Design Flow G /P /D QOd 6? ID P.C. H. D. Notification Required Separate Sewerage System to consist of Gal. Septic Tank and . �� �' F= 7-16 G' T /E[PS To be constructed by �t7CiP/»dNfC� Address Water Supply: Public Supply From _X Private Supply to be drilled by Address �� ^ Other Requirements fir�,06��7ATEG� / �/u l- L'-!� /!L£%!� C y • Fret 1 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 constr.ucted'-.as shown on the approved amendment thereto and in accordance with the standards, rules and regulations o _e;. Putnam County Department of Health, and that on completion. thereof a ''Certificate of Construction Compliance" satisfactory to the Commission_er'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 the date of the issu- ance- of the approval of the Certificate of Construction Compliance of the on 'nal system or any epairs_ thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed accordance it t it ds, rules and regu a ; ons of the. Putnam County Department o Health Date ` Signed P.E.X R.A. Address - N License .No, v ' APPROVE lot This approval ez 'res on fi a iss e s st ction of t buildin as been undert antl is revocable us or y be amended or modified whe i. y. e C f Health. Any change n ction requires a new rmit: Approved for disposal 'of tlo�mf .e sancta v sews a lm only. y ?. Date ®x _ Title -11- ._ PUTNAM COUN'T'Y DEPARIlKM OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FZ:EL,D INSPECTION REPORT DATE: JY �o a ` n d' INSP. BY: . (Name of ) ( Street Locag on ) INITIAL SITE INSPECTION YES NO COMMENTS 7. Wetlands on /or proximate-to property .. . - Property lines or- corners found.: ". ...:. :: Can estimate house location ......................: Willdriveway need cut ............................ Must trees be removed - note these................. 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 Descri 0 ft. 3 ft. 6 ft. 9 ft. 12 ft D.H. 2 Lot Depth to G.W. Depth to rock Soil Descri titio_� 0 ft I nI e — f ds T- /ivi­t-5' 3 ft. 6 ft. 9 ft. 12 ft. D.H. - Deep Hole G.W.- Groundwater D.H. 3 Lot Depth to G.W. Depth to rock a) 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. �_ Soil Description . ?F DATE: FINAL SITE INSPECTION INSP.BY: j YES CCMMENTS House SSDS located per approved plan.... Length . of trench measured.. b Width of trench average 1 �_ Slope of tile line and trench acceptable......... o G Roam allowed for expansion trenches .............. Over 100 ft. fran watercourse .................... Natural soil not stripped or SDS area unnecessarlygraded.............................. 10 ft. maintained fran property line and 20 ft. fran house .............................. Distance well to SSDS (ft.) ...................... Number of bedrooms checks ......................... Voe Stones, brush, stumps, rubble, etc:, greater than 15 ft. fran nearest trench........... ..... 15 ft. of peripheral soil horizontally frantrench....... .......................... Boxesproperly set............................... 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.. c� �i I'V11'ull•l %JVVllll Ju i1►1►114U1►i Va. luUw"AAA ' DIV1510N Or ENVI]IONMENTAL JEALT1I SERVICES COUNTY OFFICE BUILDING, CA11fEL; N. Y. 10512 DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE 1J0. OutieliGera d VanCoughnett Address Harmony Rd. Patterson, NY Located at (Street Mooney ill Rd Sec. 1 Block , 1 Lot 1-1-1-idi-Cii-Ee tieareal� cross, a re6UT 1,1WLIcipality. Town of Patterson Watershed Croton 12 801L PERCOLATION TEST DATA 1tEQUIIiED TO BE SUBMITTED WITH ArTLICATIO113 3 17 - 47 30 21 3 1/16 9.8 min /in Il 2 1 17 - 47 30 21 22 12min /in 2 48 - 18 30 21 .22 12 min /in 3 19 - 49 30 21 2 3/8 12.6min /in 5 2 C- Jo �1VA�IVA 5 110t-en: 1) 'Pests to be repeated at same depth until approximately eyirt.l sol� Untes are obtained at each pereplation test hole. All data to be submltte .1or review. 2) Depth measuremetits to be nude from top or hole. LOT #2 ](ole Ilumber CLOCK TIME PEACOLATION PERCOLATION HU11 apse 156p Eh to WaUer Water Level 110. Time From Ground Surface In It Ales 801.1 (late Start -Stop Mill. Start Stop Drop n Mitt. /in drop Iliches IllC11e8 11101es 1 15 - 45 30 21 3 10min /in 2 46 - 16 30 21 3 10min /in 3 17 - 47 30 21 3 1/16 9.8 min /in Il 2 1 17 - 47 30 21 22 12min /in 2 48 - 18 30 21 .22 12 min /in 3 19 - 49 30 21 2 3/8 12.6min /in 5 2 C- Jo �1VA�IVA 5 110t-en: 1) 'Pests to be repeated at same depth until approximately eyirt.l sol� Untes are obtained at each pereplation test hole. All data to be submltte .1or review. 2) Depth measuremetits to be nude from top or hole. i; � aO• G.L. 1' 2' 3' 4' 5' 6' 7' ©' 1 TEST PIT DATA REQUIRED TO BE ...- ...iw..�.... - • —rte __rr — — HOLE N0. L VT ,� ! • •I sSAIVTy 40A A) 1 ;UBMIT9.TED WITH APPLICATION VT.TTT0nmT% T&I TLtiT Tl/,%T LIQ HOLE NO. 10' 12' PUTNAM CO"TY .wr l 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: TOHN E,8cgi a DATE: 6 130ZL DESIGN • Soil Rate Used / 3 . . ; Min/1" •' Drop: S. D. Usable Area Provided Sy 0 D s, No. of Bedroams Septic Tank Capacity /aao gals.. Type Absorption Area Provided By ' Soo L.F. x 24" width trench Other / Flt 2F'purhEO o CORN,c, °., �, OF Name lr/,�Lf� C/�'6T% '' Signat • e cot X11 � Address )0(0 2� �Z' SEAM W 41 0FESS1G1WP THIS SPACE FOR USE BY HEALTH DEPARrIIMENr ONLY: Soil Rate Approved sq.ft/gal.' Checked by Date 4 ' L- OT N °. 3 �4�2 S IS G F S� LOT Imo° z Z.27CP 6C. It icy .17 :y 7' . 8& \ \ \ \ 5\ cv IRON) I NJ O 1000 6�6L- D I IzT 9.70' O ru77° os sc N 7C9. OZ 10 20 N/r i �n - 7t). 00 ' iL.1o' c_ONSTR -000T lo►J _MONY R-D. 'Ai5�) - LT . rutnam Uounty.Department ox ae&4 vision of Environmental Health Serv: proved as noted for conformance Wit] Plicable Rules and Regulations of t] tnam County Health Department... tore & T M 00N EY LOT- l SZ . poTTER Doti NF W I ". r--;,O' on1 r.. 4Lie'_ 1-CD,198Cp 7C�Z03 JOB M1Q__ w .N _I OP l A I 5z. CO, 2 C9 4 I. C9, CvI.7' 47 4' 4 CDC 8' S3. Lj. 5 71. 3' S0). S" CP 7Cv. 2 7 3(El 4' S4. o' g 44. 7 ' 58. 7" 03.1 10 1 CPS . 4' 75.1 I z 72.7' 71.2' 13 82 . 48. 4' Iq 84. z' C)O.Cj rutnam Uounty.Department ox ae&4 vision of Environmental Health Serv: proved as noted for conformance Wit] Plicable Rules and Regulations of t] tnam County Health Department... tore & T M 00N EY LOT- l SZ . poTTER Doti NF W I ". r--;,O' on1 r.. 4Lie'_ 1-CD,198Cp 7C�Z03 JOB M1Q__ w .N _I OP l