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Home My WebLink About0202DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 4.15 -1 -4 BOX 3 'N '. 1 61 Lj T r �1 I 00011 r n- •'r'+�,.^._.^_ y'^- ..,.- -z-"—. �•y-_. �.,.,... .. - •..r.•,Fmr- may.• „p....5.d. -* ')- ,rq Rev 3/86 PUTNAM COUNTY DEPARTMENT OF HEALTH A�t r DWIslon of Environmental Health Servicea,'Carmel, N.Y. 16512' En glneer Mast Provide t PXX D Penult TIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM. or VWage Located : Tax MeP lock 2 Owner Y II t Name Formerly Sabdlylsion ame Subdv. Lot p 7 MaWng ee Zip 1 �-"�7 Date Permit Issued A Separate Sewerage System bath bY—s. � Y O Address S t -iJi11 ia111S ! i C,C> 1T , Consisting f S� . �8 Gallon Septic Tank and J MRVh L f I p ,. Water. Sapp, ys Pabllc Supply From Address '• ors Priva' Supply Drilled by IdC1 Addre 1 C% Z. a Eallding.Type � IIae Erosion Control Eeea Completed? Number of Bedrooms Has Garbage Grinder Been Installed? Other $egalremente, a• g / I certify that the syetem(a) as listed servinq the above preauses were constructed essentially as s_' on the an of the completed work( copies of which are attached); Arid in accordance with the standards, rules and regulations, in ce.w th the ed an,'and the permit issued by the Putnamy1�+tyDepartment of He t Date "IV OV w. Certifi P.E. r' R.A. Address can, No. Any person oeeupyin9 premises served by the above•'tystem(s) shall ipso ake'sueh,aetbn as may be.tiatassa►y to atun.tha eorreetion of any unsanitary eonditions. resulting from•sueh usage. , Approval oc the, sspants, enys sy tern shall beeoma, null and 'void syfoon as a.pubt% senitary'.ss**.baopmes avallable and the'•appr6il,oI tne';private wsterr supply shall-bscorvi 11- n akl. when -a' ublk vwter :suPVly b4ebines i'vallibW Such app► orals are subject to modl Itetfo or ehanpe when, in- the. Judgment, of th oner h such revocstlon; 'modlflutlon or change If^4F-4 /m1 [5J Date J 9 Title � 0 BREWSTER LABORATORIES Box 224 - BREWSTER, N.Y. (914) 279 -4945 - WATER ANALYSIS REPORT - y SAMPLE NO. 7 6.7 6 TEST WELL SOURCE: Joe Verga Alpine Acres Patterson, N.Y. 12563 COLLECTED: 4- 2 5- 9 0 BY: Havilland Plumbing & Heating BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 0 per 100 ml. This result indicates the source of the sample was of satisfactory sanitary quality when. the sample was collected. E 4 -28 -90 0a -k. �e I�r Y�4 WnLL UurirLGl LUM LInrvA L DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET ADDRESS: 76WNIVILLAC&ICITY TAX GRIO NUMBER: 47— WELL OWNER NAME: / ADDRESS: r, -� D a 0 �� 5 PSiVATE USE OF WELL 1 - primary 2 - secondary 5rRESIDENTIAL ❑ PUBLIC ffUPPLY O AIR/ COND.] HEA T-PUW ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE 6-06 � gal. REASON FOR DRILLING NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH . �Q 5— ft. STATIC WATER LEVEL ,, ' ft. DATE MEASURED —�� DRILLING EQUIPMENT O ROTARY COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. 'I5;KPEN HOLE IN BEDROCK ❑ OTHER CASI NG DETAILS TOTAL LENGTH ft. MATERIALS: 1RSTEEL O PLASTIC ❑ OTHER E LENGTH.BELOW GRAD ft. JOINTS: O WELDED THREADED ❑ OTHER DIAMETER in. SEAL: EMENT GROUT O BENTONITE OOTHER WEIGHT PER FOOT 1b./ft. I DRIVE SHOE: ;YES ONO LINER: O YES 0 SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (it) DEPTH TO SCREEN (it). DEVELOPED? FIRST ❑ YES O NO SECOND ,HOURS GRAVEL PACK ❑YES ❑ NO GRAVEL SIZE DIAMETER OF PACK in. TOP �` DEPTH ft. `BOTTOM DEPTH It. WELL YIELD TEST It detailed pumping METHOD: 0 PUMPED 1 tests were done is in- COMPRESSED AIR , formation attached? O BAILED ❑ OTHER ; ❑ YES ❑ NO 1P1ELL LOG It more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Sear- ing Well Oia- meter FORMATION DESCRIPTION cooe ft fL WELL DEPTH It. DURATION hr. min. DRAWOOWN ft. YIELD 9Frn Land SuAace Ho WATER O CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS . O COLORED ANALYZED? O YES ❑ NO ANALYSIS ATTACHED? O YES ONO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAM OAT -y�— ��C.ef- e�.cc�r, .C�..P '.mac_ . �_��_ A0 /OOR�EESS �LfLC 4 i r�/ 5(G>l3tTt)RE L�Li'ji�'i � 111 • , /OSI ell PUTNAM COLWY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES owner or Purchaser of Building G I E., \ Bu±Xing Constructed by Location - Street r Block Lot 7,��7 IN -4k US nil 1 .. . - - 7 Municipality Subdivision Lot # �-�s:jl f S-� a / Building Type GUARAWEEE 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 he building utilizing the system. e Dated this .� day of C, 19 a Signat e �i , �.� i, i� i ' L Title Gen al Cor ctor,(Own ) - Signature Corporation Name (if Corp.) IV L� QV <-�-ns r R . Address -N,q rev. 9/85 mk C� a ion Name (if Corp.) Address CNZ z r7 - - _ . z. rc•'j z="c ZC�' - '_`--' c5 < <LDrOL Er.` D ;=Tic Dc� OL picra�*lt 2.1 15 f_GS LC r_ 1/257 is _ G. { t ILL_ �? �TiL'� ` L —f-c C. °� Cr i -J J t =� C. r�N �r.� - D_ -- _CCU. C'" ►mow 1 the — 20 fE -- L • ;. i i- Cr Er-= o1c_Cr.r 5u` E. Roca z._/_•.— � - Pao- CR c nc- _ • Pis --L/ �__�! /c:�. =i n � - � I I i =r c_ EE rz�ar c r==r _ f C _ V2: _ C� C _ 1.i pices f_t•�- _j�wi`-I cz 1=cx d .. In c =cT= I ccr_ —Z= stcr_e� - r _ c to plan Cyr= _'1 - c i ^ _t=1! =_ acccrto T RC C -G _ -[ .L- - -G_�� GTVr1/ 1_`.CI C72S __ 7. ' 1?UTNAM COUNTY DEPARTMENT OF.HEALTH . a e V . 3%86 Divislon of Environmental Health Services Carmel N Y ;10512 Engineer to Provide permit N on CERTIFICATE OF COMPLIANCE9��' _ r :> Permit N CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM fed at l C K ��IIG owu or Village t a: _ . t `Sabdivteton Name Q ��{ � ✓"r/t ' Sabd. Lot q � Tax Map `` � Block Lot i Renewal_ 0 Revision p }0wner /AppHeant Name iCl ' Date a Approval at •• � / Ms1Wng Address�'(04 W LI ITii . I`[�4t IJS. Town _z�_f IV.`9 Zip t U4 1U L c , Building Type �tloraK'iTi AL. Lot Area . ° F111 .0 Building Depth Volume Number of Bedtoome Design Flow G /P /D Lcb o PCHD Noti9catlon Is Requl> ed When Flll is completed, Separate Sewerage System" to corselet o1 Gall. n Septic Twit au d To be rnaetriioted by Address _.. Water Supply; Pabltc Sappiy From Address. on '� Private Supply. Drilled by o t�'Addrese Other Requirements 22 +Ei•.1 (..L 90Gi' C `G� ,� ��t�tw�blr�) 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 1. above_ described will be constructed is shown on the approved amendment there,,to and in accordance.with' the standards. rules and regu a ions of - the. " Putnam County Department -of., Health, and that on completion ihereofa "Certificate of Construction Compliance" satisfactory to the Commissionei 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).yearsimmediately -.fol wing- thedate -of the , issu - ' ance of the ap6eovil of.. the, Certificate,of. Cons tiuct ion Cpmplisnce'of -the original system or any repairs t eto'; 2) thaCt d ill well described above will be located as shown'on the'approvetl plan and'that said well will be instilled - in--.accord'nce ,with i stand s,' rules to s 'of the:; Putnam County Depa lint. oft�koaalth: ` Date A � 0 —mt- V 10 Signed _ P.E. P.E— R.A. Address _ _ _ _ _ _Liven - NO�L`L r . APPROVED FOR CONSTRUCTION. This approval expires one year from the date issued uriless� construction, f -the building has been undertaken and is revocable for Cause or may be amended or modified when considered necessary. by the .Commissioner of- Healt Any change or alterations of construction reduires as new permit. Approved for' disposal' of domestic sanitary sOwag rivate water, supply only. Date - ///�U . �/ a� ' 8V /2"`i /�� Title _ .. r S DEPARTMENT OF HEALTH t Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMTT A A9AX WELL LOCATION Street Address Town/Village/City Tax Grid Number -7, 1 WELL OWNER Name Address eOrivate O Public USE OF WELL 1 - primary 2 - secondary RESIDENTIAL ❑ PUBLIC SUPPLY (J AIR /COND /HEAT PUMP ❑ BUSINESS 0 FARM p TEST /OBSERVATION ❑ INDUSTRIAL O INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify p AMOUNT OF USE YIELD SOUGHT 1!5r gpm /# PEOPLE SERVED __ /EST. OF DAILY USAG gal REASON FOR DRILLING W1qEW SUPPLY OREPLACE EXISTING SUPPLY O PROVIDE ADDITIONAL SUPPLY ❑DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE nDRILLED ®DRIVEN E]DUG GRAVEL 11 OTHER IS WELL SITE SUBJECT TO FLOODING? YES L I-_'NO I WELL 1S LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name F) ,, Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ),-'NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED O ON REAR OF THIS APPLICATION VO E E (date) sfQnature 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 Well Completion Report on a form provided by the Putnam County Health Department. g Date of Issue: ,%'/e!/ S 19 �- Date of Expiratio 19 ermit Issuing icial Permit is Non - Transferrable 8/86 r.__......�__.�._ ... -. ,: �.., s.:..,.: �,.. x_.:,;..:_..::...,.._ a. �.... m.-.. .a...o-,�.:....W..� :.,.�:...�, =- �.-- �..._.i,.•,::;:..�. -. a: �.`.: u.. e:..;. �: s::::. a:.. �,�s:.«�:.�,:._;::v:.:cd,.,..o ...may.:......— �......,,..r,..:. - -.... ....,..� _,.,.V.._. � u n r• r• �+. .. r• • M ti� r• ee � -•. • �a (Namd of Own ) -- /�HATE (Street tion) DOC[IMERES Permit Application Corporate Resolution Plans - Three sets Engineers Authorization' Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & f m 71 Cu Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area;showngravity flow,suff. ! size If Pumped Pit & D Box Shown & Detailed House - No. of Bedroans Wells & SSDS's Win 200 ft. of Property Located 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 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,Stoan,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' from Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING .CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM 1. FILE NO. owner, `l.t6,-V,�a �C� A Address .�- Located At ( Street ��--� � � 'SeA Block -Z. Lot 6ndicate nearest cross streety Municipality. A Watershed ��p�U1`�C7�!�, %- SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS . Number CLOCK TIME PERCOLATION > PERCOLATION Run Elapse 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 1 )0' 2 16 !L � ?,) j-7 1 1�� 31�L a 5� 4 5"- 4 W 5 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. DEPTH G.L. �� cr 12" 18" 2411 3011 3611 42" li Q11 5411 60" TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOIL ENCOUNTERED IN TEST HOLES HOLE NO. j HOLE NO. HOLE NO. �j �r r! �I r� 66" 7211 !! E 7811 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY 3) Date DESIGN Soil Rate Use ,CWrVl "Drop: S.D. Usable Area Provi • v -g pc) NJ No. of Bedrooms Septic Tank Ca Gals. ` o� P Parity � �� Absorption Area Prodded By L.F.x24" � '�GrJ.T�.i' 1 LI- � �3c�4 G`G l �, �` •�7 �-P� ��s,..� `ot rw�'��.�,. - � � � ,. LIM Address THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. SEAL nw7.- her Checked by Date I A E Y ER. H AU 1-4 f- UN-I4 L . 7- rn rn e)o -S: Putnam County Department of Health Division Of Environmental Health Serv4s Approved as noted for conformance e Rules and Regulations of t:j COunaalth Depart Za ate i gnature Title --I, 5111.i, T q%,'u Al &0 -4T -ry ,7y 510, DF Lui f I A E Y ER. H AU 1-4 f- UN-I4 L . 7- rn rn e)o -S: Putnam County Department of Health Division Of Environmental Health Serv4s Approved as noted for conformance e Rules and Regulations of t:j COunaalth Depart Za ate i gnature Title i s � Title a P i ." yl * 3 3 Own- Ali F }y: fi T. J .. 1' k r.: MW KKKIMA qL ow w Not 3 � F , xd a d z. IMAMr S1 � zoo 10 > i y Q. K� f f } J 6 ti a PT EI i y S v J w 1 ' 5 , a F� _ji A f. 4 } T WAM I, €1 » w too 011 AMY ki sit t G F M, ma 3, k is OW M s „ws?} Rudd, ku ) t fy 1 ton! 57, jj` g AR Y �yG t 1 7 j t Y ; 1 F '-�FS� . xc }yAJ= 1' k r.: MW KKKIMA qL ow w Not 3 � F , xd a d z. IMAMr S1 � zoo 10 > i y Q. K� f f } J 6 ti a PT EI i y S v J w 1 ' 5 , a F� _ji A f. 4 } T WAM I, €1 » w too 011 AMY ki