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HomeMy WebLinkAbout0182DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 4.10 -1 -22 BOX 3 m6 00182 v. 3 86 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services; Carmel, N.Y. 10512' �(�•, Engineer Mast Provid - P.C.H D. Permit N,=e - - 0 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Located Owner /applicant Name; 1 A P- w 6-01 �- 1,0 9 Formerly �J Melling Address �_)00_r H ll L2 i y-� 0� iz A 1 L 1, '17-12 zip '1 Town o e Tax Map . Block .`. Lot Subdivision Name4(� TJ i �% • Subdv. Lot N Date Permit Issued 4-2 -01, Separate Sewerage System built by M ei& LAe., So rA V_M LT I (! Address �X r G .6A z M L r N Ll Consisting of OOH Gallon Septic Tank and & o .L AE; ` or_p i o L( T P om 014 Water Supply: Public Supply From Address or: V Private Supply Drilled b4jt? AE?4P_SrA0 Address 12TH GfkTZ iii . N'1 Building Type l 1�-, �Xr i /fit L He Erosion Control Been Completed? 7-1 / Number of Bedrooms Has Garbage Grinder Bee tailed? 0 Other Requirements 1A i I certify that the systems) as listed serving the above premises were Zct cted ease�tially as shown on the ns o e completed work.( copies of which are attached), and in accordance with the standards, rules and tions, inVaccordance with th file la nd the permit ssued by the Putnam County Departme/n3t, Of Health. —T% P.E. Date { Certified Dy /J R.A. . Address r A V-I License No. `�60 "Any person occupying premises served by the above systern(s) shall promptly- take.such act ion.as may. be, necessary to secure-the correction of any unsanitary 'conditions resulting from such. usage. Approval of the separate s ge ewera system- .shall become null and. void as soon as a �pubt'.: sanitary sewer becomes available and the approval of the private water supply shall become'nuU and void when a public, Water supply becomes available. Such approvals are subject to odification or change when, in the judgment of the Commissioner o"ealth, such revocation, modification or change Is necessary, gate It le 0. P(IINAM COLUN DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES MAQIo Owner or Purchaser of Building 1Ac G1 -A-!�-sO o Building Constructed by 15000 QJA�E� �+ILI� 2Gl�� Location - Street r W t,A D F VAT -f e-iP-Q t,1 Municipality � jIVr::-- NTI A l� Building Type Section 2 � Block Lot &T—;, I L-L,a 50IDV1 s 1J Subdivision Name 08 Subdivision 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 imnediately.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 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 utilizing the system. Dated this day of 19 Signature ` & Title General Contractor (Own - Signature Corporation Name (if Corp.) FUN - rev. 9/85 mk 5 Corporation Name (if Co .) D 96 .�lb 6414-'01til Address C COQ, y .e WELL I;Ur1rLC:11U1V rtLrUml DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only / �01 WELL LOCATION STREET ADDRESS: WNIVI TAX GRID NUM8ER: Sot JTry vAKE�e /� pD P9Ti•ERso n/ WELL OWNER ADDRESS: To AY. G,���LD So, tJAKE� N/� RD le!q PERSON Jg PRIVATE O PUBLIC USE OF WELL 1- primary 2 - secondary 9 RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED ' O BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify) ° : ., . ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED ,,. J , 7 _/ EST. OF DAILY USAGE i�6 gal.. REASON FOR . DRILLING NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH $O ft. STATIC WATER LEVEL - 3 ft. DATE MEASURED DRILLING EQUIPMENT O ROTARY ;9 COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT O CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED ❑ OPEN END CASING. OPEN HOLE IN BEDROCK ❑ OTHER ,: ``. " "; : CASING DETAILS TOTAL LENGTH_ fL MATERIALS: 19 STEEL O PLASTIC O OTHER LENGTH.BELOW GRADE CZ ft. JOINTS: O WELDED MTHREADED O OTHER DIAMETER in. SEAL: X51 CEMENT GROUT O BENTONITE OOTHER WEIGHT PER FOOT lb-/ft. I DRIVE SHOE.-J4 YES O =0UNER: AYES ONO SCREEN DETAILS DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST . O YES-, O NO. HOURS _.:_.._..: SECOND GRAVEL PACK O YES O NO GRAVEL DIAMETER I SIZE: OF PACK in. TOP DEPTH ft. BOTTOM DEPTH WELL YIELD TEST If detailed pumping METHOD: O PUMPED tests were done is in- COMPRESSED AIR r formation attached? O BAELEO O OTHER 0 YES O NO WELL LOG It more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE water 8ear- Ing Well Dia- In FORMATION DESCRIPTION COO S• ft. IL , WELL OEM It. DURATION hr. min. ORAWOOWN ft. YIELD gpm. Surla,e CQ Q �1CL�ltJ 8O 7-07-4- ��, .� a. � 47. 1, af — G � w WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? O YES ONO .ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAME �1- DAJE i �y Wu,Zd.CcC'U�4a(Dv. AC / 6 A RES� a-, SIGf Yorktown Medical Laboratory, Inc. 321 Kear Street Yorktown Heights, N. Y. 10598 (914) 245 -3203 Director: Albcrt H. Padovani M. T. (ASCP) F GRILLO, MARIA SOUTH QUAKER HILL RD. Patterson, NY. 12563 L J LABORATORY REPORT ON THE QUALITY OF WATER INORGANIC NON- METALS (mg /L) Acidity Alkalinity Chloride Detergents, MBAS Hardness, Total Nitrogen, Ammonia Nitrogen, Nitrate Phosphate, Total _ Sulfate _ Sulfide Sulfite METALS (mg /L) Copper Iron Lead Manganese Mercury Sodium Zinc MISCELLANEOUS pH (units) _ Color (units) _ Odor (TON) Turbidity (NTU) I, LAB # _ 8/2/88 10; ?Oam Date Taken: Time: Date Rc'd: � — Time: =P — Date Reported: `1988 Collected By:.*Grillo Referred By:_ Sample Location: Garage Phone # 878--6616 Phone # — I Sample Type:. Repeat Test? (check one) MICROBIOLOGICAL (CFU /100mL) GENERAL BACTERIA 4 Standard Plate Count 2-o o . (CFU /1.OmL) MEMBRANE FILTRATION TECHNIQUE Total Coliform Fecal Coliform Fecal Streptococcus MOST PROBABLE NUMBER TECHNIQUE Total Coliform Index Fecal Coliform Index KEY FOR TERMINOLOGY CFU = Colony..Forming Units N/A = Not Applicable LT = Less Than ( <) GT = Greater Than (>) TNTC= Too Numerous To Count CON = Confluent ( =TNTC) NR = Pion- reactive REMARKS /COMMENTS (For Lab Use) Potable Non- notable _ STP INF _ STP EFF Other: SamDl e Stars . (check each) Outgo injz HNO3 _ HC1 H2SO4 _ .NaOH ZnOAc Na2S203 Other: Incoming LE h °C GT i< °C pH LE 2 pH GE 9 pH GE 12 Other. FLAP #10323 THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS ) (WASN'T) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO TH YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DIDN'T) (N /A MEET THE SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STAT DR NKING WATER CODES, FQR �TeE RAMETERS TESTED, AT T.HE TIME OF COLLECTION. 2 /86(Rvsd7 /87)RWE Albert H. Padovani, M.T. (ASCP), Director Building Type � L Lot A. Fill Section Only Depth Volume Number of Bedrodme Design: Flow G P D PCHD NotlHcation is Required When Fill le completed ` Sepente Sewerage System to consist of Gallon Septic Tank and To be constructed.6y Address Water .Sappl)':_ :t-pabllc Supply From Address / on ✓ prlvdte Supply DrWed by _Address �. t�l" I 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 asshown on the approved amendment there to and, in accordance with the standards, rules and regulations o e u nam 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'guaiarifee.Will be furnished the Owner, his successors, heirs or assigns by the builder, that said builder -will piece in good operating condition,' any :part 'of said sewage "disp'osal- system during the period of two (2) years immediately following the date of the issu• i ante .of. the approval of the Certificate' of Constructwn,.,Gompliance of the original system oi,any repairs thereto; 2) that the drilled. well described above f will be located as shown on the approved plan and that.sa�d, well will be_inst .in accordance with. the stand rds,�i les nd regu alts . of the Putnam j County Depart ...'ant f.Health:' - ' r F Data signed P.E. R.A. s�_ Y� Lt!,� s� r Atldress� 12 -fIK% I� - license No '1�i' _ .. J G `APPROVED FOR'CONSTRUCTION• This year!if r9M the' a ass d 'un�_l ss co struction of.the building has been undertaken and is �• revocable for cause Qr may be amended or modified when cons i erect necessary e, o mi loner of Health. Any changev or alteratio of construction % Rev requires a w per r proved for' disposal of d est is n to d .sewage, r iv to a er' p -ly. 3 'V1 r ✓) f 1/87. Oates_ 8Y Title DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT WELL LOCATION Street Address LIr Town /v a 91 y Tax 62 Grid Number 11 WELL OWNER Name Mailing Address OPrivate O Public . 3SE OF WELL - primary 2 - secondary r [/ RESIDENTIAL O BUSINESS ® INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY ❑ ABANDONED ❑ OTHER (specify, AMOUNT OF USE YIELD SOUGHT gpm /# PFOPLE SERVED -�__/EST. OF DAILY USAGE �YOd gal REASON FOR DRILLING UNEW SUPPLY ❑REPLACE EXISTING SUPPLY OPROVIDE ADDITIONAL SUPPLY ❑DEEPEN EXISTING WELL ❑TEST /OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE DRILLED ®DRIVEN ❑DUG ®GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES _X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot N ._'� WATER WELL CONTRACTOR: Name T 6j.0 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES >t NO NAME OF PUBLIC WATER SUPPLY: Lj '9Mr'_' TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: �A +� LOCATION KETCH & SOURCES ,OF CONTAMINATION PROVIDED ® ON REAR OF THIS APPLICATION ® ON SEPARAT Ej 3 (djteY signature) IV 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 W ll,Completion Report n a form r vided by the Putnam County Health De art e t. jai (l Date of Issue: 19 V r GL Date of Expiration: 19 P rmit Issuing fficial Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner 2 87 Orange copy: Well Driller Owner MARIA G R I L L O Address SOU iN Q UA C K E R HILL R D PATT E RSoN N.y. Located at (Street) _�QU YN Q UA C K E R HILL '. R p, Co Block 2- Lot 3 (indicate nearest cross street) Municipality PA TIER s o N Watershed C R07-OA/ SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Bate of Pre- Soaking /0- 9 - BS' Date of Percolation. Test A> - 9 - 8S' HOLE . NUMBER CLOCg ZnE PERCOLATION PERCOLATION Run Blapse Depth to Water Fran -Water Level No. Time Ground Surface In Inches Soil Rate tart -Stop Min. Start Stop Drop In Min/In Drop LOT% Inches Inches Inches NoZE:5 �,. Tests to be repeated' at same depth until approximately eVa1 soil rates are obtained .at each. percolation test hole. All data to' be submittmd for review. 2. Depth measurements to be. made fran top of hole. �) 2 3: so - ZZ '3g,.�:.:::.:.;;;::: . S _ ,: 4 3 oea -7 2 4 �_ LLJli.i NoZE:5 �,. Tests to be repeated' at same depth until approximately eVa1 soil rates are obtained .at each. percolation test hole. All data to' be submittmd for review. 2. Depth measurements to be. made fran top of hole. -L" IZuZSLIU.L,Xl' .0 MCI �kl,l (Al'ION DEM: MON OF SOILS E.NCOUNT= IN .Ti-..e HOLES ~" DEPTH HOLE NO. I HOLE NO. HOLE NO. 2; LOAM 3' 4:, 41 Z Other Nam---- 'RA0DOI, PN W. LAyREN.7 A. sSOc., P.C. Signat Address . 73 r- 41RFIrLO DR yr SEAT, � 4C %mil ;4c Z < �`'i PATTER SV n1 , N.Y. ..10 p No. 045 $, THIS SPACE FOR USE BY HEALTH DEPARTMEM ONLY: Soil Rate Approved sq.ft /gal. Checked by Date v i II� I i 61 10 14' Y�; = INDIC`ATE�EVF� • AT- WfilC�i`.. GROUNI7�r�ATIIt :1S..Fi�I00UNZ'FE2ED• �' _ ;IV1�L�I/�•:.1 � �s ' �1.- `- ..�. � ?��;�nt�: IIJI�ICCAC 'TE LEVEL TO WHICH WATER LEM `RISES AFTER . BEING -Mrb Ur1'I'EE2ED� `•' . r. V! ?� '~ • tv DEEP -HOLE - OBSERVATIONS MADE BY: JQAA %DoL P// DESIGN ' 'Soil Rate Used 31- Min/1" Drop: S . Usable. Area Provided 000 ` ^t r' No. of Bedroans 3 Septic Tank Capacity _/000 gals. Type O G. Absorption Area Provided By ©D L.F. x 24" width trench Other Nam---- 'RA0DOI, PN W. LAyREN.7 A. sSOc., P.C. Signat Address . 73 r- 41RFIrLO DR yr SEAT, � 4C %mil ;4c Z < �`'i PATTER SV n1 , N.Y. ..10 p No. 045 $, THIS SPACE FOR USE BY HEALTH DEPARTMEM ONLY: Soil Rate Approved sq.ft /gal. Checked by Date v i II� I i APPENDIX B �C C PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS (Name of Owner) REVIEW SHEET - CONSTRUCTION PERMIT (Street Location) DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth DATE BY: RWXEWED 3B s/s SUBDIVISION Perc (3) Fill cd House P1 s - Two sets Well permit; PWS letter Variance Request GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan — (north arrow) Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pmnp pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes (grinder notes) Design Data: perc and deep results Two-Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If PmVed Pit & D Box Shown & Detailed House - No. of Bedroans Wells & SSDS's w /in 200 ft. of Proposed Systems Property Metes & Bounds . 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,Top of fill 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains - Curtain, Leader, Footing 351to catch basin,stormdrain,piped watercourse 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' from Foundation; 50' to well 15' Well to PL I t 12' I I rl I j I I I I I I 100 MIN �41 4 I Ir7 1 G° j 11 I 1 II o_ 9'ePTIG� ?� (r.�- Jl�ParJG� -Miu. 0 1 I 1 I \ I I V^NK F.F. �L rLG.O' ; J I �PfL'i N. \\ 1\ II 11e -t Z I �OF Iq I 1 I IQ \ 9N\ 1 \ \ 1 I 1 I I I I I I � I II G i 11 II I I q I - Z J 51 ?740`` -I t D�rLHG.4♦ LD. N � 10W �. Pur.us SITE. jvv s / SITE LOCATION PL. scALt 1° s 2d00� (A�Ti;f ON TA,/'/, MA MaP G C'�I -dGl� 2 55 DS DE SIGN DAT DESIQ N_-FLCW zEC-•If, EN'TtAL '3 'c r NI F5 �? !'dd C F'C�' CvO� SIL 6:A(r= us•r_[ .31.45 1•1, ir•:.i t.. AE>50RL31 "IGtI� -I Kr. NG'rt TEST PIT_DE�SCPPTk HOLE. I : p' p" n' &" -jof-,ol L d' 6'_ -7; d" LOAM w riri GJIL�j 4- GL/. L+oe J fZ rrar �rzAae ° r'KOP. �PoT G�Ar