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HomeMy WebLinkAbout0200DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 4.15 -1 -2 BOX 3 �i� PUTNAM COUNTY DEPARTMENT OF HEALTH Permit tC Division of Environmental Health Services, Carmel, N. Y. 10512 )INSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Town or Viiiag e Located at AAKEZ Q5s Y�tF Subdivision t YUjky-F-e- 4O-:F_ F76;-IS subd. Lot # Building Type I1,�Tf`- Lot Area �P' L Number of Bedrooms Design Flow G /P /D .�P�,�&, � Separate Sewerage System to consist of 1 Gal. Septic Tank To be constructed by �© 'g J>ETEZN► 1Ngjfl Tax Map Block Lot Renewal _ ❑ Revision _0 Date Of Previous Approval Fill Section Only ❑_ P.C. H. D. Notification Required .�r�� (� and &W ILf OF Zw 1 /'-cl'�r W'—;e, Address Water Supply: Public Supply From � _ Private Supply to be drilled by ' • � Address) Other Requirements IOAS FILL D9FZ+-> C—L 4 , AJ IN ( - 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 an 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 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 original system or any repairs hereto; 2) t t the drilled well described above will be located as shown on the approved plan and that said well will be installed in accordance ith the st ards, ru d regula i —Pons of the Putnam County Department of Health.. Date ®�✓� / /, ` ` Signed P. E. R.A. Address l� �-- APPROVED FOR CONSTRUCTION: This approval ex revocable for cause or may be amended or modified wR requires a npw permove for disposal of don Date ` By Rev. 9 -81 �1 t�°� ° — nse No. from the date issued unless struction of the building has been undertaken and is ftSessary by the Corn ' loner f Health. Any change o ration of construction swage an or priva w su -•- ( Title PUTNAM COUNTY DEPARTMENT OF HEALTH ENGINEER MUST Division of Environmental Health Services, Carmel, N. Y. 10512 PROVIDE_ -- _ PERMIT #.l� RUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM �R-IeERSCUV Located at��C�Uaker tI•.vC.,lpe i�r� ye.. Owner_ w "`�11r M -) - r.`Q� / FoQQrme__rly Separate Sewerage System built b, 4 Consisting of DOES® Gal. Septic Tank and Cc x) Li lv• I Other requirements Town or Village Tax Map Block Q Tax Map Lot # �_ Subd. Lot # C� Address 4 A Water Supply: / Public Supply From �kL Private Supply Drilled By t -°/t ` 4�y ,Address Building Type RF-si en±;* 1 No. of Bedrooms Date Permit Issued Has Erosion Control Been Completed? Has garbage grinder been installed? V.,V I certify that the system(s) as listed servin of which are attached), and in accordance wit Putnam County Department Of Health. Date Address ,f the completed work ( copies i, and the permit issued by the P.E. ` RR.A. License No. 41A-466 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 wat ecomes available. Such approvals are subject to modification or change when, in the judgment of the Co ssionor of Health, such ovation, modification or change Is cessary. Date By Title _ .. A .....: . op A i3 SEP7/C TANK ,35 0.. /7 j. -LOT O," BOX 72'- O' -55 ..6. i AREA, /:652 ACR£S c/UNC. BOX / 89 O" /00'- O" 77'- p:. /06,-0, '8/ -' WELL /000 GAL. /.•1A SnN Y 5-0-77j 7Aqkl. Cugi9 /M D;.60J6 l3)\\ gE ,�, USROpM - E �. c rutnam younty Department of HeuLa ..a on at savironumtsl Health BUTLO" . . am ee noted. for ooniosmaaoe With. Sv'.:_ a ? i Ppliaable sad Eegulations Wi tlw eertm e SEPT /C SYSTEM �.�SO DUTCH MES //V N i C �cQG/ /F'ED /NS:ALLEe7: _ A c Y /000 GAL. MASONRY SEPT /C TANK ° " T PT. 1985 yi oOp i,N. FT. '24 ' TR61JCN'. Fv �G QxPabe. a° O 1' 2' R.O.E. FILL -SOP Cl/h'TA /N --FA//" T. M /C' a Ess �t ; f a : Al sox, Y r n 't. 'C k a: S K PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL �S�STEM �F %ILE NO. Owner T ' E C Address 1! /iV&Z)A � /V' Located at (Street vi4--09 ?,,Q,-,,57 l• Sec. Block Lot Indicate neares cross street) Municipality Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH.APPLICATIONS Z4 III a7 5 1 2 3 4 5 Notes.: 1) Tuts 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. Hole Number CLOCK TIME PERCOLATION PERCOLATION apse Depth to Water Water Level No. 'Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches l f d UAC - /0 34 218-x- Z4 III a7 5 1 2 3 4 5 Notes.: 1) Tuts 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. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. 1 HOLE NO. HOLE NO. G.L. 'C, Z 611 12" 18" 241'' .► 30" Zo 1 361" �W L `t 211 48" 5411 60" 66" 7211 178 it 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED�� TESTS MADE BY `Tfll� Date .. DESIGN Soil Rate Used,?J --46Min/1 " Drop: S.D. Usable Area No. of BedroomsSeptic Tank Capacity I �� X.+;:e. Ga /.� p ` , Absorption Area Provided ByL._ F. x24�b�`— ; :�} wdt%'tre�Zic_ t SILL Name Signature , Address SEAL <IS THIS SPACE FOR USE BY HEALTH DEPARTPENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date tl=6 OF IAI;7LL. T _. 'WELL COMPLETION REPORT t� PUTNAM COUNTY DEPARTMENT OF HEALTH W71 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 36 DAYS OF WELL COMPLETION OWNER NAME --Dutcher Homes Inc. ADDRESS PO Box 73 . Patterson , NY LOCATION OF WELL (No. 6 Street) (Town) (Lot Number) Alpine Village Brewster U _ PROPOSED USE OF WILL DOMESTIC ❑ ESTABLISHMENT ❑ ❑TEST WELL C 07 FARM a OTHER SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify) DRILLING EQUIPMENT X COMPRESSED CABLE OTHER ❑ ROTARY AIR PERCUSSION ❑ PERCUSSION ❑- (Specify).. CASINO DETAILS LENGTH (feet) 12 5 DIAMETER (inches) 6 WEIGHT PER FOOT 19 l THREADED ❑WELDED X YES NO YES NO YIELD TEST HOURS G.P.M. ❑ BAILED ❑ PUMPED ® COMPRESSED AIR YIELD (G.P.M.) 12 WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) 60 DURING YIELD TEST (test) :JD.pth Total DrawdowrL of Completed Well feet below land surfaces 255 SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (feel) SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (Inches): GRAVEL SIZE (Inches) FROM (feel) TO (I"1) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at lust two permanent landmarks. FEET to FEET 0 95 hard pan boulders x :. 95 105 hard, soft rock J. 105 139 mica brown 139 140 water seam, blk, brown, red m 140 180 same 180 255 blk mica, white quartz. If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE 139 2 -3 225 3 -4 255 12 DATE WELL COMPLETED 1 2 -26 -84 ° T �� ->POR ELL DRILLER (Signat 1 ti Yormown meaicai Laooratory, mc. LUt,N11UNb: ❑ 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245 -3203 321 Kear Street ❑ 201 BUTTONWOOD AVE., PEEKSKILL, N.Y. 10566 737 -8777 Yorktown Heights, N. Y. 10598 ❑ 495 MAIN ST., MT. KISCO. N.Y. 10549 666 -3335 (914) 245 -3203 ❑ STONELEIGH AVE. (NEAR HOSPITAL), CARMEL, N. Y. 10512 278.9330 Director: Albert H. Padovani M. T. (ASCP) � GATE TAKEN: r —) DATE RECEIVED: K rJ� GATE REPORTED: SAMPLE SOURCE: a a 1.11 IC Lab N EE99 SS ' REFERRED BY: (/ J Collector: L LABORATORY REPORT ,//' mg /L , ❑ ACIDITY ............................ ................:.............. C1 ALUMINUM ................................ ............................... ❑ ALKALINITY ; P= ................ A= ....................... ❑ ANTIMONY ................................ ............................... _EPBACTERIA, TOTAL /mL ................ , .. ❑ ARSENIC t BOD, 5 DAY ............................ ............................... ❑ BARIUM ............................ ........... ............................... ❑ BROMIDE ............................ ............................... ❑ BERYLLIUM ............................................................... ❑ CARBON DIOXIDE, FREE ........ ............................... ❑ BISMUTH ............. ....................... ............................... ❑ CHLORIDE ............................ .......................:....... ❑ BORON .................... ❑ CHLORINE ............................ ............................... ❑ CADMIUM ........ ............................... ❑ COD .................................... ............................... ❑ CALCIUM ... .......... ........................ ............................... ❑ COLOR ( units ) ................. ............................... ❑ CHROMIUM (tot.) ............................ ............................... [).CYANIDE ❑CHROMIUM (hexavalent) ❑ DETERGENT, ANIONIC ............ ............................... ❑ COBALT ..................... ❑ FLUORIDE ............................ ............................... ❑ COPPER .................................... ................:.............. ❑ HARDNESS ............................ ............................... ❑ COLD ........................................ ............................... ❑ MPN COLIFORM COUNT/ 100m1 �'�j ❑IRON ........................................ ............................... ¢01r 1' COLIFORM COUNT/ 100 ml lJ ............. ❑ LEAD ............... a....................................................... /❑ CONFIRMATORY TEST ............ ..........................::.:. ❑ LITHIUM ........................... ............................... ❑ NITROGEN, AMMONIA ............. ............................... ❑ MAGNESIUM ............. ............................... ❑ NITROGEN, KJELDAHL ............ ............................... ❑ MANGANESE ................................ ............................... ❑ NITROGEN, NITRATE ............ ............................... ❑ MERCURY ...............:.................... ............................... ❑ NITROGEN, ORGANIC ............................................ . ❑ NICKEL ........................................ ............................... ❑ ODOR (u71 its ❑ PALLADIUM ................................ ............................... ❑ OIL. & GREASE ........................ ............................... ❑ .POTASSIUM ................................ ............................... ❑ PH l // UIl l t S ) ..................................................... ❑ RHODIUM ❑ PHENOL ................................. ........... .................. ❑SELENIUM .................................... ............................... ❑ PHOSPHATE (ortho) ................ ............................... ❑ SILICON .................................... ............................... ❑ PHOSPHATE (condensed) ............ ............................... ❑ SILVER ........................................ ............................... ❑ PHOSPHATE (total) ................................. ............. ❑ SODIUM ................... ................. ............................... ❑ SOLIDS. SETTLEABLE, ml /L .... ............................... ❑ TIN .......................... :................................................. ❑ SOLIDS. SUSPENDED ............. ............................... ❑ ZINC ............................................ ............................... ❑ SOLIDS, DISSOLVED ............. ............................... ❑ .................................................... ............................... ❑ SOLIDS, TOTAL ..................... ............................... ❑ ....... ............................... ..... ............................... , ❑ SOLIDS, VOLATILE ................. ............................... ❑ REMARKS:..................................... ............................... ❑ SPECIFIC CONDUCTANCE (uhmo s / c m) ............... ❑ ........................................,........... ............................... ❑ SULFATE :.................. ............................... ❑ .................................................... ............................... ❑ SULFIDE ............................. ............................... ❑ .................................................... ............................... ❑ SULFITE ............................. ............................... ❑ .................................................... ............................... ❑ SURFACTANTS .................................................... ❑ .......... ............................... .... ....... ............................... ❑ TURBIDITY ( NTU) ............... ............................... ❑ .................................................... ............................... THESE RESULTS INDICATE THAT THE WATER WAS 112,0oOF A SATISFACTORY SANITARY QUALITY WHEN THE SAMPLE WAS COLLECTED. THESE RESULTS INDICATE THAT THE WATER DID MEET THE SATISFACTORY CHEM- ICAL QUALITY OF THE NEW YORK STATE ADMINISTRATIVE RULES & REGULATIONS, DRINKING WATER STANDARDS (PART 72) FOR THE PARAMETERS TESTED WHEN THE WAS COLLECTED. rSAMPLE N/A = not applicable _dA, Albert H. Padovani M.T. (ASCP), Director ^,-C , "Owner or Purchaser of Building Sv3� t- Bu-- l- d -in -g— Constructed by Q e -a RI Gam- 2)r 1 V�r Location - Street Municipality Section Block Lot Subdivision Name Q V .4 «L2 ,?)DGZ Building Type Subdv. Lot # p� a l GUARANTEE OF SEPARATE SEWAGE 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 success- ors, 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 initial use of 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 occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determin- ation of the Director of the Division of Environmental Health Services of the Putnam County Department.of Health as to whether or not the fail- ure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this .S` day of Ste" J 19 a.5� Signature CZ Title Corporation Name if corp.) 0? � 91 ecW --3 IPi977Z " Address THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health r- CONC MG O S2 •• 5' CONC. MON., HYDRANT ,•i UTILITIES -l.' PLAY LA I ;COUR1 I I