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Home My WebLink About0194DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 4.14 -1 -12 BOX 3 III a ml so so 0 F ' �� T 1 ' ti ra JOB I no s ` 00003 PUTNAM COUNTY DEPARTMENT OF HEALTH Rev. 3186, Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Mnat Provide' _+ P.C.H.D 'Perm_ It N CERTIFICATE OF CONSTBQCTION 'COMPLIANCE /FORy�SfEWAGE DISPOSAL, SYSTEM Located at ® L% A- K ER K % Q (� I C A-t7 G'sJCJ �2q') =Town or Village Tax Map Block ' � Lot Owner /applicant Name Al14411 1 2401A Formerly Su bdivision Name �+ Spbdv. Lot H !� S Y T zip_ �Vlaillng Address ermit Issued Separate Sewerage; System built by A4 Vi 19401 A Address Consisting of " % � J�� Gallon Septic Tank and D / s 7. 13 O X' '' C✓:; r 71 ow 4J ��, F• /LF Water Sapplys Pdligc SdpP�y From Address or: Private Supply Drilled by Address Banding Type // �� Has Erosion Control Been Completed?- Nmnber of Bedrooms - . Has "Garbage Grinder Been Installed? N Other Reguiremente h certify that the system(s) as-listed serving the above premises were construct sentially ae on the plans of the 'completed' work (copies of which are attached), and in accordance wiEh the.dtandards, rules and reguluc a in accordan the filed plan, and the permit',issued by the.' Putnam Count Department .of Health. Oats Cartifled,b -Y �j �''' P,E. R.A. Address ` ` L'�l� 0 .P �. •?l ! Licen;s No. v+ �a a' Any person occupying promises served by'the above systems) shall promptly take'sueh action a y be necessary to Skl the eorra_ction of any unsanitary conditions 'resultirig ` from.such usage.- usage'. the separate sawerage- system shairiieeorne- nullind "void as -soon -as-a - pub:= aniUry'pwer becomes. available and the approval of the private water supply shall become null and voltl when a public water supply becomes available. Such opprovals are subject to dificatiors or Change when, 'in ,the Judgment of the,commissionot 6f Health such revocation, modiffeatlon or 'enange 9s naeesairy. Date g / - a BREWSTER LABORATORIES Box 224 - BREWSTER, N.Y. (914) 225 -2072 - WATER ANALYSIS REPORT - SAMPLE NO. 7116 SOURCE: Micheal DiPaola Playland Court Patterson, NY COLLECTED: October 18 1988 BY: Mill Drilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method new well 0 per 100 ml. This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. October 20 1988 Roy Bi kwit P.E. D ector ,mac fy e * ` w WELL CUMYLETIUN 1eErUN:1 DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only STREET ADDRESS: WN /YIL / IfY TAX GRID NUMBER: Playland Court Alpine-Acres, Patterson, New York WELL LOCATION WELL OWNER NAME: ADDRESS: Michael DiPaola, 11 Sybil Street White Plains, NY 10604 PRIVATE ❑ PUBLIC -USE OF WELL 1 - primary 2 - secondary 30 RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑,ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT 10 gpm.JNO. PEOPLE SERVED 3 _t05 / EST. OF DAILY USAGE 400 gal. REASON FOR DRILLING ,I NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 425 ft. STATIC WATER LEVEL 45 ft. DATE MEASURED 10/18/88 DRILLING EQUIPMENT ❑ ROTARY ki COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. >0 OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH j75 ft. MATERIALS: 0STEEL ❑ PLASTIC ❑ OTHER CASING DETAILS LENGTH.BELOW GRADE 174 ft. JOINTS: ❑ WELDED ARTHREADED ❑ OTHER DIAMETER ti in. SEAL:)& CEMENT GROUT ❑ BENTONITE ❑OTHER WEIGHT PER FOOT 19 1b. /ft. DRIVE SHOE: EkYES ❑ NO I LINER: OYES ❑ NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (f t) DEVELOPED? FIRST O YES ONO SECOND HOURS GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE; DIAMETER T!nTOOEFTH OF PACK P ft. BOTTOM DEPTH ft. WELL YIELD TEST If detailed pumping METHOD: O PUMPED i tests were done is in- 61 COMPRESSED AIR , formation attached? O BAILED ❑ OTHER ; ❑ YES ❑ NO If more detailed formation descriptions or sieve analyses 'WELL LOG are available. please attach. DEPTH FROM SURFACE Water Bear- ing well Oia- Meter FORMATION DESCRIPTION COOE. ft. ft. WELL DEPTH ft. DURATION hr. min. DRAWOOWN ft. YIELD 9Fm Land Surface 150 Grey hardpan 150 160 Soft weathered bedrock 300 1 30 300 3 160 425 Mediun to-hard white & grey ledge 400 2 - 400 4 425 6 - 350 50 WATER XX CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? MR! YES O NO ANALYSIS ATTACHED ?,-a YES O NO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAME MTT,T, DR= r INC. yO/?4/88 ADDRESS Putnam Avenue P'r Brewster, NY res PUTNAM COLUEY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Mr. 4- /',1rs. /'i- - j)JP OIL Owner or Purchaser of Building Building Constructed by -P IL,� Location - treet Municipality !' r r �- Building Type Section Block Lot &Ocvk&y- Subdivision Name 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 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 Environirental 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 (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk Corporation Name (if Corp.) Address PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Commissioner of Health - FIELD ACTIVITY REPORT - Sheet of INSPECTION NAME �l� Z42-, Orig. Routine No. Street Tavn TM No. MAILING ADDRESS P.O. Box Post Office Zip Code TELEPHONE PERSON IN CHARGE OR INTERVIEWED Name and Title DATE �v TYPE FACILITY TIME ARRIVED TIME LEFT �- -... FINDINGS: Orig. Complain Orig. Request Compliance Complaint Camp Final Group Illness Construction Reinspection Field, Sampling Only Field Conference Other Explain INSPECTOR: Signature and Title PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. SIGNATURE: 6/86 TITLE: TELEPHONE: �� PUTNAM COUNTY DEPARTMENT OF HEALTH Rev. 3/86 Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer to Provide Permit N n_ on CERTIFICATE OF COMPLIANCE, �(' CONSTRUCTION PERMIT FOR Sn E DISPOSAL SYSTEM / Permit N /J Coasted at (�/+KFie kit, f �L C'C`1 v/t U hFTTt�2Jo wd or Village Subdivision Name J Z �/� Alabd. Lot # Tax Map Block Lot & Owner /Applicant Name /s'/tf 404 /"t /� . Renewal— ❑ Revision ❑ Date of Previous Approval Mailing Address L Town Zip 4.)1hr 04AVAI AJ Building Type F-g 4M l- Lot Area ° Fill Section Only Depth Volume < P Number of Bedrooms � fi)U Design Flow G /P /D PCHD Notification is Required When Fill is completed Separate Sewerage System to consist of JTa .Gallon Septic Tank and �� I A1W To be constructed by Address Water Supply; —' Ptibllc Supply Fro Address F 67 or. Private Supply Dri ed / — Address Other Requirements 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 Healthwill be submitted to the Department, and a written guarantee will be furnished the r, his successors, heirs or assigns by the builder, that said builder will place in good, operating condition any part of said sewage disposal systeE5ntandarcls, (2) years Immediately following the date of the Is su- ance of the approval of the Certificate of Construction Compliance of tairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installstandards, rules and regu aeons of the Putnam County apartment of Health. ✓/ Date a s'sf f� Signed 7'► P.E. _ R.A. — Address 7- t V� ` 1 � Li nfe No Y-53247 ' APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued Vn less construction of the building has been undertaken and is revocable for cause or may be amended or modified when considered. necessary by the Commissioner of Health. Any change or alteration of construction requires a new permit. Approved for disposal of domestic sanitary sewage,'a c /-rr private water supply only. Date C J g�✓ ` YSW PUTNA M COUNTY DEPARTMENT OFHEALTH Rev. 3/86 i 1 Division of Environmental Health Services. Carmel, N.Y. 1051? Engineer to Provide Permit 1i on CERTIFICATE OF COMPLIANCE_ l CONSTRUCTION PERMIT FOGE DISPOSAL SYSTEM Permit III i¢icEr1 /�i /7t P+T [ i—r2sC .y Located at 1 l 1 ihJ7 C C L! tl }� Town or Village Subdivision Name 0 U 4-, t` f- Qi i) S c= C? %`- 1rSubd. Lot II / Tax Map Block rot i2 . $ kI n s' . 44/ 010 t:, 4 Renewal_ ❑ Revision °f ❑ Owner /Applicant Name /t't' Mailing Al F. _ Date of Previous Approval P Building Type I `lz ifw G Lot Area Fill Section Only Depth Volume d L•Z Number of Bedrooms foci, 2 Design Flow G /P /D PCHD Notification is Required When FIB Is completed Separate Sewerage System to consist of Gallon Septic Tank and To be constructed by Address Water SaPP1Y: Pdbllcj. upply From or: Private Supply Drilled by _Address Other Requirements 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 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 pliance" satisfactory to the Commissioner of Health will be submitted to the Department, and a written guarantee will be furnished the o his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system dur' g th period of two (2 years immediately following thedate of the issu- ance of the approval' of the Certificate of Construction Compliance of the orig stem or any ro s 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 rdance with t andards, rules and regu a- Tons of ttte Putnam Count epartment of Health, t� Date e1J'/@*f7� Signed r'( Gs a �. P.E. _ R.A. _ Address �" �+ `." E <r: "A" `�YY Av T'01/111' -'VJ . : t License No APPROVED FOR CONSTRUCTION: This approval expires one year from th date 'sued u s construction of the building has been undertaken and is revocable for cause or may be amended or modified when considered neces y b e Com issioner of Health. Any change or alteration of construction requires a new per t. Ap 0 is for disposal of domestic sanitary se id priv t p o y. Date ///7 f� l!� / / / % /�] /� L 6V T:f la // PLUMM COUNTY DEPARTMERr OF DIVISION OF.ENVIRONMENTAL HEALTH SERVIC a. DESIGN DATA J,SHEET- SUBSUFACE S&QAGE DISPOSAL SYSTEM FILE NO. /l Owner z t f�l i(s a-of �i� [tee¢ Address � y �i- lL ��c. 4 0 4�1 C- Located at (Street) Sec. Block Lot (indicate nearest cross street) Municipality SOIL PERCOLATION TEST DATA RBQI Date of Pre- Soaking Watershed. t TO BE SUBMITTED WITH AP: Date of Percolation Test NUMBER CL= TIME PERCOLATION /' PERCOLATION Run Elapse Depth to Water From Water, vel No. Time Ground Surface InInches Soil Rate Start -Stop Min. Start Stop ,prop In Min /In Drop Inches Inches / Inches 1 2 3 � 4 5 1 � 2 4 5 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until appracimately equal soil rates are obtained at each percolation test hole. All data to* be submitted for review. 2. Depth measurements to be made fran top. of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE DESCRIPTION OF SOILS EN APPLICATION DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. t 4 V1 2' 3' l t 4' / 5 (� PYI 6' V" 7' 8' 91 10' 11' 12' - wf C 13' > 14' x CL INDICATE LEVEL �fi WHICH GROUNDRATER IS ENCOUNTERED ltJ .2 INDICATE LEVEL TO WHICH DATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used 61- V15-Min/1" Drop: S.D. Usable Area Provided No. of Bedrooms 4' Septic Tank Capacity 12!5'0 gals. Type J%& Uls 77 Absorption Area Provided By e0d L.F. x 24" width trench Other � 7 l� Name cw c- it f� ° L ' Signature Address �-3 C-� ij �'y� a ti,.. ��C +,�-� SEAL P THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date I aul- �� I- ( i FUT'NAM COUN'T'Y DEPARUMU OF HEALTH - DIVISION OF ENVnnZ924TAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS 01 P0a_1Pk_-" (Name of Owner) IWO- REVIEW SHEET - CONSTRUCTION PERMIT (� DATE REVI7M: V BY: � ? 0 - (Street Locatio UN=S mit Application's porate Resolution �. ns - Three sets ineers Authorization ign Data Sheet (DDS)�� eep Hole Log onsistent Perc Results (3) COD 0" Perc Hole then se Plans - Two sets PWS - Letter iance Request UIRED DETAILS ON PLANS age System Plan age System Hydraulic Profile - Gravity Flow 1 Profile & Dimensions.- Volume r J Box;Trench /Gallery; Pump pit details tic Tank - Size, Detail 1 Detail, Service Line if over struction Notes ign Data -Foot Contours Existing & Proposed veway & Slopes Cut ting /Gutter Curtain Drains c & Deep Holes Located epresentative of Sewage & Expansion Area ansion Area;shown;gravity flow,suff. size f Pumped Pit & D Box Shown & Detailed se - No. of Bedrooms is & SSDS's w /in 200 ft. of Property Located perty Metes & Bounds se Setback Necessary (Tight lot) se Sewer - 1 /4" /ft. 4 "0; Type pipe o Bends; Max. Bends 450 w /cleanout ARATION DISTANCES SPECIFIED ON PLAN lds 0' to P.L., ivew , Large Trees 0' to Foundation Walls 00' to Well; 200' in D.L.O.D, 150' pits 00' to Stream, Watercourse, Lake (inc. expan) 5' to Drains- Curtain,Storm,Leader,Footing 5' to Catch Basin 0' to Water Line (pits -201) tic Tanks 0' from Foundation 0' to Well Well to PL E RAL al Subdivision division Approval Checked approval SSDS Adj. Lots Checked land (Town /DEC Permit R & D) a On DDS Plans & Permit Same PUITM COUNTY DEPARTMENT OF DIVISION.'OF ENVIRCNMENIA L. '1 EMR •1� DESIGN DATA SHEET- SUBSUFACE SFWAGE DISPOSAL SYSTEM FILE NO. Owner Ac ¢ At 14 4l ` ,04�, l A Address PLltz/400Ae Located at (Street) r'' - ; ` Sec:: 1 ' Block Lot (indicate nearest cross ;,street) L Municipality A % j &-z set a) , 0 • " Watershed % SOIL, PERCOLATION TEST DATA RDQUIIW TO, BE SUBNII� WITFI" APPLICATIONS Date of Pre - Soaking �� 6fr Date f percolation Test Z/7, HOLE NUMBER CLOCK TIME PERCOLATION PIItCDLATION Run No. Elapse Time Start -Stop Min. Depth to Water Fran Ground Surface Start Stop Inches Inches Water Level In Inches Drop In Inches Soil Rate Min /In Drop 1 z 2 ii 62 - 30 2 Il:: 64 it 2¢ -30 �¢ 253�� 4 1 5 v 1 ft a 11; 13 z¢ l 3/q 2 i l:i J %z' y0- 30 3 % 4 y 5 3. 4 5 r 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. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION INDICATE LEVEL AT WHICH GROUNDWATER 1$_ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN � Soil Rate Used 3 /._,��r Min /1" Drop: S.D. Usable Area Provided 7� /�fSD/v No. of Bedrooms- Septic,Tank Capacity rgals. Type C-7 5 h Absorption Area Provided By 8017 " L:F, x 24" -width trench Other Name G A- 6-Al-C- J 1149X0, ��. Signature Address T?'htT Al P&&I V SEAL 4VW7 7-e VAINArs Alt-v- /Ox THIS SPACE FOR USE BY HEALTH DEPARZMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. 7 , HOLE NO. HOLE NO. G.L. H0 2' ; iayrz- �iG I- Z 3' 41 5' 6' r 7' 81 -- - 9' °`.. s, 10' : co r; J r 11' - r ' 12' ' 13' 14' -a INDICATE LEVEL AT WHICH GROUNDWATER 1$_ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN � Soil Rate Used 3 /._,��r Min /1" Drop: S.D. Usable Area Provided 7� /�fSD/v No. of Bedrooms- Septic,Tank Capacity rgals. Type C-7 5 h Absorption Area Provided By 8017 " L:F, x 24" -width trench Other Name G A- 6-Al-C- J 1149X0, ��. Signature Address T?'htT Al P&&I V SEAL 4VW7 7-e VAINArs Alt-v- /Ox THIS SPACE FOR USE BY HEALTH DEPARZMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date d — r W15 /5 TO CEA'T //=Y THAT ALE SfAVALf L W51'R /7GTE0 A5 /ND/CATFD ON TN /S #f- 5 Y 3 7eM WA 5 /NSYEZ iFD 6 Y M E 4JN eR rD D4Ls/?, T//E 5 YSTCM WAS CON CCORDA-A/CF ONt/'N A-14 57ANDAN40 A C 'T.+f PU I N A-M 4 O41VW Y DEPARTMEA/ l YE NEW YORK' 5 TA Tf O4FPAXr/lffN,' OF Q T, J Bntnam County DePartment of lfe&.LXL jivision of Environmental Health gervios, tp;roved as noted for oonformanoe with gplioable Rules and Regulations of th* _County gemith / Department* TITLE: A5 i5a/i T PROJECT: to PA T T FQ9 aW, CLIENT: MA *1WR S EUGENE J. M VCONSULTING SITE AN 8 (HATTERTON PM-A Nll No: m" Ix: (NICKED N e ✓. M •.,i 61 %,AO