HomeMy WebLinkAbout0197DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
4.14 -1 -15
BOX 3
1111•
i
or
r
.,
.
rY
A ,
1111•
PUTNAM , COUNTY DlffPARTM' E"NTOR,. HEALTH E N GI 'N E E R :MUST:
Division of Environmental Health *vices, CerMel, N. Y 10512 PROV,I DE _ '
PERMIT: # P84 -87
CERTIFI TE OF CONSTRUCTION, COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM
Town or Villager
Located at P 1 a y l a n d Court (SoUSC-41L-ve' FXT'" -P---L 5 Block 91
atherine Turturo '
OwneW i' l 1 i a m M a h 1 m e i s t e r/ Formerly y Tax. trap I,ot ' n :14 Subd.. rota 1 LG
Separate sewerage system built, by Birch Hi11 Contractors InQ%ddress RR 4 pox 73 PattPrsnh= NY
1250 900 1.f. 2411 wide trench
Consisting of Gal. .Septic Tank and
Other requirements
Water Supply: Public Supply From
X Private Supply Drilled By B o y d Artesian W e, 11 -s
Address RD 5 Route 52 Carmel, NY 10512
Building TyPe Frame No, of Bedrooms 3� Date Permit Issued 2/110/88
Has Erosion Control Been Completed? Yes Has garbage grinder been installed? No
.I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies
,of which are attached), and in accordance with the standards, rules and regulations n accordance with the filed plan, and the permit issued by the
Putnam County Department Of Health.
Date 8/22/88 Certified. by P.E. X R.A.
AddressSCo.tt- Koknris 'Assoc., RD .RtP 171 Rr.PiAl&Jj&iallo. 59346
Any person occupying premises served by the above,system(s) shall promptly take such action as may be necessary 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 public sanitary sewer 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 Commissioner of Health, such revocation, modification or change is necessary.
-. /cry... .. ._- .. - ._.. �-�. .. ... .
Date / � By [tie :f ==
a
Rev. 6/85 - — - -
y
A� C0l.
Y
WELL UUr1rLt;'11UA tMrUicl
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT , OF HEALTH
Office Use Only
WN /Vll 11(Y TAX GRIO NUM8E '
STREET ADDRESS: q
v/Rk /K AD&E E S l . CAI-P"',IE t/llz/ 6-2E P'Ig7-TEx0N,5 o /c/.
WELL LOCATION
WELL OWNER
NAME: ADDRESS:. ,a�jFo7 /4 /L,SI
VI JuIAM MA/-!�/nE�si�� 1�o.,QdX�i N• Y. S—p
p pgIVATE
❑ PUBLIC
USE OF WELL
1 - primary
2 - secondary
IWRESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
❑ BUSINESS' ❑ FARM 0 TEST /OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGES gal.
REASON FOR
DRILLING
KNEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST / OBSERVATION
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELT DEPTH 605 ft.
STATIC WATER LEVEL �'300ft,
DATE MEASURED
DRILLING
EQUIPMENT
❑ ROTARY COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING. WOPEN HOLE IN BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL LENGTH ft.
MATERIALS: STEEL ❑ PLASTIC O OTHER
LENGTH.BELOW GRADE &,3 ft.
JOINTS: ❑ WELDED THREADED ❑ OTHER
DIAMETER -- in.
SEAL- IICEMENT GROUT ❑ BENTONITE ❑ OTHER
WEIGHT PER FOOT q,�ZP. 1b./ft.
I DRIVE SHOE RYES ❑ NO
I LINER: ❑YES aNO
SCREEN
DETAILS
DIAMETER (in)
SLOT SIZE
LENGTH
(ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
❑ YES O NO
HOURS
SECOND
GRAVEL PACK
❑ YES
❑ NO
GRAVEL
SIZE:
DIAMETER
OF PACK in.
TOP
DEPTH ft.
BOTTOM
DEPTH It.
WELL YIELD TEST If detailed pumping
I
METHOD: O PUMPED i tests were done is in-
)COMPRESSED AJR , formation attached?
0 BAILED ❑ OTHER D YES O NO
WELL LOG if more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
Water
Bear-
Ing
Well
Dia-
peter
FORMATION DESCRIPTION
C00E.
tt.
fl
WELL DEPTH
it.
DURATION
hr. min.
DRAWOOWN .
It.
YIELD
9Cm.
Land
Surface
U
C'�A L' A./ G-.E!
C��i.11/1ro�✓
�? O X1300
WATE8 O CLEAR TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? O YES O NO
STORAGE TANK: TYPE
CAPACITY GAL.
PUMP INFORMATION
TYPE
MAKER
MODEL
CAPACITY
DEPTH
VOLTAGE HP
WELL DRILLER NAME 1666 ��.
/l C9 t t. J✓ — v
ADDRESS SlGfrklURE C
Y
PUTNAM COUNri'Y DEPA UME NT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
J t 11 Ari
A, 6. 1N% /J
f A ToV gRjAj,6 'Tc,,e T6 R6
Owner or Purchaser of Building
AVIS
Building Constructed by
C�yNk�� Tin 6-F - ORIVF
Lobation -.Street
fPA 7 I-F_ R5aAJ
Municipality
ONE Z 1AJC-
Building Type
q l LI
Section Block Lot
g L/n kE2 ? G-E 47sT,4 r Es
Subdivision Name
/Y
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 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.
Id - � /. 4 61
61� -a'
IN
Corporation Name (if Corp.)
Dated this day of ,f6- 19� Signature
A mot
2 i Ls i'/ ��c _ Title
-^�—
General Contractor (Owner) - Signature
Corporation Name (if Corp.)
Address
rev. 9/85
mk
9&j !la x 73
Address / AZ
FENAL Si��z LySr�Ci`'C�i Cat_ .
b. L7Cia
r1:9 (l✓n 1 %? CSvTl -U l
•'
Tr
esti*rat� = �N C-r c;�e
`r%I
T
a_ ED' arC� 1(- !r':'f EC ��r GT- .mrt'1veZ i r)1Gns
�
I
Date cr placament
��
I
I
2:1 ba-rr� LG "�T tiv l ANC _ DPiTH
Icy = c`r accrcver plans_ r
b_ _
`�Ec= Lli=� I
C_ r'a scii nct sicced
r
d_ Sl=cre, br-yh, en-c areatar t arl 1 .5' f' cur in! Si1S arm
I
1�
l
I
i lccat_ as c`r arnrcved plans I
e_ ,icy ccur =e/ e ands
I _ SF,L 1 D=:CE i • `S!, - 1
b. D
Di_=ta_nce f_--, Si,S a=te. rr- s',==
_ C
_��c an.k. z- - 1,000 1, 2 -G
s_
-
c_ ..e
. b_ S -Ztic tark i- -ct-1 i
--
C_ C
C- na 13" a].. s e c °ac
c. G rrirtom. " -t- ,,,-=_t cn I /1
d_ NO 900 herf- =- C'_ = =ut wi_n? 10 z= or a_�° bend I `'
d —= _ce ar --c Wei ac. =--t _ ^ ^le_
1 P1 l CLT=__ c_ - i =- 7c'- -C -
2 . halc' y ZZ -Cs `
4 Ik T'_?iL"i 2 -- Cr C" =" coil be =vc =T'
`{.. -mac_
1. V;.- •,C'I'ICN E�_" - -r
II
c _ B
On
•
� Distanca i__, wa ^L c_ rid = -. :.ra ' 1 L.
Lo^v�c_Z -
D? s t=nc= C_ -_ :o Cant
�. Si Cr,c c= ac` emt_cle 1: 15 - 1/32
E O 20 rr - rCLr -? COQ I I/I
0 r1 L=✓ C� 3 in -=c=
S. Roan a! C'.;e:z f
O S -ze CL C val 3/A - -I-z-"
lG. D`ntZ c= cnva in trench 12",
1 ' pi re em,-4- Gnn I
'
h. P� ^? CR DCS, crc- �S
ccn a ns s `Cnes < `" lrl Q' alr:Et=�- (
( Ji
1 Size C= c_-� Gam- Cer
e- 0
0--t- in * = i i ^ c t : i i ..; aC ^-te it
r.. r C t0 D1
I i
2_ C -ar_lc w -_-��
3. Ala -ter,
f
a PiznD ecs - _`+ cc= =s=;m1 xz-- C! t0 Crace
Firs hcx C = - =! �- I
ri.
V.
4i_
f _ C . to 4 n dr`_ cu a? 1 protect & c._r _ to Ems.
C_sC^_^rCe awa f =an SDS
h_ c =.c= w -- -�c-_t =r�,c, acE^ to I J--
%: 1 _ ,� =: SiCi1 CC: =�•.:: � C- �..L�� CEC C',rl S�GC.2S C.� - . =L ^ -r t'. ^_ � �'3
nl !.L/9 0
b. L7Cia
esti*rat� = �N C-r c;�e
fiCLSI -
I I
I
a_ `
Icy = c`r accrcver plans_ r
b_ _
`�Ec= Lli=� I
r
�a-�`ri i
i lccat_ as c`r arnrcved plans I
I L 1
b. D
Di_=ta_nce f_--, Si,S a=te. rr- s',==
C_ C
C- na 13" a].. s e c °ac
d —= _ce ar --c Wei ac. =--t _ ^ ^le_
c _ B
Beres
b.
C _ P
P? pices f , -1 wi `_ in_ =_ce C`- b=
ccn a ns s `Cnes < `" lrl Q' alr:Et=�- (
( Ji
e- 0
0--t- in * = i i ^ c t : i i ..; aC ^-te it
r.. r C t0 D1
%: 1 _ ,� =: SiCi1 CC: =�•.:: � C- �..L�� CEC C',rl S�GC.2S C.� - . =L ^ -r t'. ^_ � �'3
nl !.L/9 0
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 � � , t� � �� -- �t �✓ � � ,� d '" Orig. Routine
ADDRESS
MAILING ADDRESS
P.O. Box Post Office Zip Code
TELEPHONE
Orig. Complain
Orig. Request
Compliance
Complaint Cam
_ Final
Group Illness
Construction
Reinspection
PERSON IN CHARGE Field, Sampling Only
OR INTERVIEWED Field Conference
Name and Title
Other
DATE TYPE FACILITY
TIME ARRIVED TIME LEFT Explain
'FINDINGS:
jb
n
INSPECMR:
Sidifa -tune and
PERSON IN CHARGE OR INTERVIEWED:
I acknowledge this Field Activity Report. SIGNATURE:
—'5/86 TITLE:
TELEPHONE:
-.� DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATION TO CONSTRUCT A WATER WELL 1-2
PCHD PERMIT #
WELL LOCATION
Street Address
Sunset Dr' Extension
Town /Village /City Tax
Grid Number
WELL OWNER
Name Mailing
W i 11 i am Mah1meister et al
Address
P.O.
(RPrivate
O Public
USE OF WELL
1 primary
- secondary
Ei RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP
0 BUSINESS O FARM Q TEST /OBSERVATION
0 INDUSTRIAL O INSTITUTIONAL O STAND -BY
❑ ABANDONED
❑ OTHER (specify
O
AMOUNT OF USE
YIELD SOUGHT 5 gpm /#
PEOPLE SERVED _ /EST . OF DAILY USAGE � gal
REASON FOR
DRILLING
MEW SUPPLY
O REPLACE EXISTING SUPPLY
❑PROVIDE ADDITIONAL SUPPLY
O DEEPEN EXISTING WELL
OTEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
New Residence
WELL TYPE
LfjDRILLED
DRIVEN
E]DUG
GRAVEL
❑
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES X NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION) NAME OF SUBDIVISION: Quake r Ridge E state s
Lot No. 14
WATER WELL CONTRACTOR: Name To be d e t e rm i n e(i Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: N/A
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
O ON REAR OF THIS APPLICATION ® ON SEf , T S EET
7/17/87
(date)
iJ
s ature)
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 s.hall:
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.
Date of Issue: 19 ��suin
Date of Expira ion: 19� ermit Isg f icial
Permit is Non - Transferrable White copy: H. D. File
'ld'
Yellow Copy. Btu ing Inspector
2/87 Pink Copy: Owner
Orange copy: Well Driller
_..x wuM1'Y DEPARTMMT OF HEALTH - DIVISION OF ENVIRONMENTAL
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSALS
REVIEW SHEET - CONSTRUCTION
(Name of Owner)
DATE REVIEWED:
BY:��L'
(Street Location)
YES NO DOCUMENTS
Permit Application
Corporate Resolution
Plans - Three sets ""s /s
Engineers Authorization
Design Data Sheet (DDS) / SUBDn
Deep Hole Log �%t U Perc _
Consistent Perc Results (3) 7�Fill
Perc Hole Depth cd _
House Plans - Two sets
Well / permit; PWS letter
Variance Request
GENERAL
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Tcwn/DEC Permit R & D)
Data On DDS Plans & Permit Same
REQUIRED DETAILS ON PLANS
Sewage System Plan - (north arrow)
Sewage System Hydraulic - Gravity
Fill Profile & Dimensi s
D or J Box;Trench /Gallery; Pump pit detail:
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 Dr ins ,(discharge OK;
Perc & Deep Holes Located
Representative of primary and expansion
Expansion Area;shown;gravity flow,suff. size
If Pam Pit & D Box Shown & Detailed
House - No. of Bedroom
Wells & SSDS's Win 200 ft. of Proposed Syst
Property Metes & Bounds
House Setback ry (Tight lot)
House Sewer - 1 /4 "/f 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
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 1-01 pits
100' to Strom, 'watercourse, Lake (inc. ei
15' to Drains-Curtain, Leader, Footing
351to catch basin,stormdrain,pi wate..rcc
10' to Water Line (pits -201)
50' intermittent drainacre course
Septic Tanks
10' fran Foundation; 50' to well
15' Well to PL
• I la
MWAM
.
WRM
•
.M_
provided
required[,
. �
a'�
ter►
�_�_
of -
RnMM COURN DE PAR'IMENr OF HEALTH
" DIVISION OF ENVIRONMERIAL HEALTH SERVICES
DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO.
OwnerWilliam MahlmeisLer Address p.0. Box 501 ,_Bedford Hi 11 s NY 10507
Located at ( Street) Sunset Drive Extension Sec. 5 Block 9 IOt 14
(indicate nearest cross street)
Municipality Patterson Watershed
Date of Pre- Soaking S 1 Date of Percolation Test
HOLE
30
NL14B R CLOCK TIME
PERCOLATION
PERCOLATION
Run Elapse
Depth to Water From
Water Level
No. Time
Ground Surface
In Inches
Soil Rate
Start -Stop Min.
Start Stop
Drop In
Min /In Drop
Inches Inches
Inches
2
11.2, j 4"
C-3 :5�p
//'
14
3
:�o- 1'. se
o
4
30
5 .4
CI
2
I 'Ab - l :')o
C-3 :5�p
°°
14
3
:�o- 1'. se
o
3
f 8
s
o lj
4
`.5b- x:20
;y
i
14
1
2
3
5 Y
NCn'ES: ests to be repeated at same.depth_until approximately equal soil rates
,
are obtainedat each percolation test hole. All data to'be suhmittl0d
:� f for review.
2. Depth reasurements to be made fran tap of hole.
rev. 9/85
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS EZKXXR M IN TEST HOLE'S
DEPTH HOLE NO. HOLE NO. HOLE NO.
G.L.
1'
2'
3'
4'
5'
6'
7'
8'
9'
10'
11'
12'
13'
14'
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: DATE:
DESIGN
Soil Rate Used Min /1" Drop: S.D. Usable Area Provided
No. of Bedroa its �� Septic Tank Capacity gals. Type 50NLLf
Absorption Area Provided By '9 00 L.F. x 24" width trench
Other _
• Peder Scott
��ur nCwY
Name W. Signature
tip W.
t Scott- Kokoris Associates
MdresS S 1 1 h SEAL
1 @
t
cc
r i v to
m
W Uj
North Salem, NY 10560
,
THIS SPACE FOR USE BY HEALTH DEPARZMENT ONLY:
9�FfSSi4 �'�
Soil Rate Approved sq.ft /gal. Checked by
Date
i
N.
'� �
a. r
. �
..
";ti- .
}
i
`..
. �,�
..
+'