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Home My WebLink About0207DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 4.15 -1 -9 BOX 3 00016 JL lot, i0 IS Sir JL ILL'S 00016 qj PUTNAM COUNTY DEPARTMENT OF .HEALT ENGINE-ER "MUST �I PROV Division of Environmental Health Services, Carmel, N. Y 10512 `. LDE. : �j PERMIT #, 14-8 CER IFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM [1TL�c�N ��J ' �i �p}�1 (� cc Town or Village Located at bt ✓9/' 'n.�� ?�f/�tl/ Tax Map .Dwner /.LU99W W�,71' 6L_ 1A / Formerly Tax Map Lot N t1c l • .:A/Subd -Lot Separate Sewerage System built by PAW/ IANb6-J,.IIAS Address 1312C44 . 41'/ k1:1) o ;. PA -4 ?601J Consisting of J.00O Gal. Septic Tank and -t Other requirements til R.0.5, RVIi i!.n� PIS . 6aKTAIA 0 A 24 .. Water Supply: Public Supply From Private Supply Drilled By MAUI! DAILUKIA N2, Address Lp Building Type 9,0510ef l PAL No, of Bedrooms Date Permit Iswsd Has Erosion Control Been completed? Has garbage grinder been installed? 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, in accordance with the filed n, and the permit issued by the Putnam County Department Of Health. Date $1 Certified by RE. >/ R.A. Address .1. +0,.1 i .. ense No. Any person occupying premises served by the above system(s), shall promptly take such action as maybe 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 unitary 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. Date Zz g5✓?..2� ! Title Rev. 6/85 :h /. AC�IJ .T,T TTT A17 i1TT AT... W r+LL t,vrir LL" j .L..&7 ..a:c VL%L Office Use Only DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH WELL LOCATION STREET ADDRESS: WHr 1 TAX GRID NUM8Erk Birch ' Hill Rd Lot 2 ' WELL OWNER NAME. ADDRESS: Charles Lichtigman,370E.76th St. NewYork 10021 O PBIVATE ❑PUBLIC USE OF WELL 19 RESIDENTIAL O PUBLIC SUPPLY O AIR /CONO. /HEAT PUMP ❑ ABANDONED 1 - primary 2 - secondary O BUSINESS ❑ FARM O TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY O MOUNT OF USE YIELD SOUGHT 5 gpm. /NO. PEOPLE SERVED _/ EST. OF DAILY USAGE gal. REASON FOR FLI NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION DRILLING O REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 345 ft. STATIC WATER LEVEL 172 TftDATE MEASURED 2/7/75 DRILLING IS ROTARY O COMPRESSED AIR PERCUSSION ❑ DUG EQUIPMENT O WELL POINT O CABLE PERCUSSION O OTHER (specify): WELL TYPE ❑ SCREENED O OPEN END CASING. ® OPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH 13 5 _ ft_ MATERIALS: 0 STEEL O PLASTIC ❑ OTHER LENGTH.BELOW GRADE 34 ft JOINTS: O WELDED ® THREADED ❑ OTHER CASING DIAMETER 6 in. SEAL: O CEMENT GROUT ❑ BENTONITE ❑ OTHER DETAILS WEIGHT PER FOOT 19 lb./ft I DRIVE SHOE FIYES ❑NO LINER :®YES 0 N SCREEN DIAMETER (in) 'SLOT SIZE LENGTH (it) DEPTH TO SCREEN (it) DEVELOPED? DETAILS FIRST o YES ONO SECOND HOURS GRAVEL PACK ❑ YES O NO GRAVEL DIAMETER SIZE OF PACK tn. TOP DEPTH -ft. BoTTom DEPTH IL WELL YIELD TEST t If detailed pumping METHOD: CtPUMPEO 1 tests were done is in- • COMPRESSED AIR , formation attached? • BAILED ❑ OTHER ; Cl YES O NO WELL LOG If more detailed Lta ch. descri are available. pleaase se attach. or sieve analyses DEPTH FROM SURFACE water Bear. ing well D'a- meter FORMATION DESCRIPTION cooe, tt. tt WELL DEPTH It. DURATION hr. min. ORAWOOWN ft. YIELD gpm. Surface a it rock at 115 345 6 325 6 in rock set casin rout d 13 345 ri ling in rock granite. WATER O CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY G L. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP wELLORIL.LERNAME P.F. Beal & Sons n DA /12/87 ADDRESS PO Box B S►GtrATU Btewster,NY 10509 i ' ELLIS A. TARLTON LABORATORY DIVISION OF ELLIS A. TARLTON, ENGINEERS, INC. CHEMICAL 34 PLEASANT STREET DANBURY, CONN. 06810 WATER -WASTEWATER PHYSICAL METHODOLOGY BIOLOGICAL P. 0. Box 246 203 - 748 - 7903 APHA - WQO - ASTM REPORT OF BACTERIOLOGICAL AND CHEMICAL EXAMINATION OF WATER NAME AND —7 SOURCE OF SAMPLE ADDRESS OF Mill Drilling Co. I PERSON TO Water Supply, Andretta RECEIVE Putnam Ave Birch Hill Road REPORT Patterson, N.Y. Brewster, T.1 -Y_ 10501 DATE OF COLLECTION March 21, 1985 DATA COLLECTED BY Mill Drilling Hydrogen ion COLOR TURBIDITY ODOR CORROSION INDEX DISSOLVED SOLIDS Concentration LANGELIER (pH) RYZNAR NTU Mg /L Alkalinity as CaGO3 Fluoride (F) Bicarbonate Nitrite Mg /L Mg /L Mg /L Alkalinity as CaCO3 Chlorine Residual NITROGEN CONSTITUENTS Nitrate Mg /L Carbonate Mg /L Mg /L AS Total Hardness NITROGEN (N) as CaCO3 Ammonia Mg /L Mg /L Mg /L Albuminoid Mg /L Iron as Fe Mg /L Mg /L Chlorides as CL Mg /L Manganese as Mn Mg /L Mg /L Detergent os MBAS Mg /L Sulfate as 304 Mg /L Mg /L The arithmetic mean of all standard samples examined per month using the membrane filter technique shall not exceed MEMBRANE FILTER TEST one colony per 100ml. Coliform colonies per standard sample shall not exceed 3/50m1, 4/100ml, 7/200m1, or 13/500ml Coliform Colonies/100M]. in: (a) Two consecutive samples; (b) More than one standard sample when less than 20 are examined per month; or (c) 0 More than five per cent of the samples when 20 or more are examined per month. ® 1. The results of the analysis of this sample are satisfactory and meet requirements for a potable water. 2. The results of the analysis of this sample satisfactory for a potable water but certain of the chemical or physical constituents are high. These are as follows: F] 3. This sample is not satisfactory since it does not meet the bacterial requirements for potable water. The presence of organisms of the coliform group in a sample of potable water is undersirable and, while not necessarily Indicating the presence of any disease - producing organisms, does Indicate that such contamination might survive to the same extent. The presence of organisms of the coliform group may also indicate that the treatment was not adequate at the time the sample was collected. El4. This sample is unsatisfactory as a potable water because certain chemical or physical constituents are above. acceptable limits. These are as follows: COMMENTS �.. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISIOiV.OF ENVIRONMENTAL HEALTH SERVICES Owner or Purchaser of Building Building Constructed by - SxAt L - Location - .Street i�%l' X14 # L Municipality %TL- 4S,91V IBS'63 Building Type S %NG-G.e h ivy �L i N G- �i P.D. 7 -V Section Block Lot Subdivision Name Subdivision Lot # GUARAN= 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. �1� A Dated this y day of CC l3 19 7 Signature 4 J Title General Contractor (Owner) - Signature Corporation Name (if Corp.) MC9 RILL kuXb Address . N 7 7F, /-,s U,v , /UY rev. 9/85 mk Corporation Name (if Corp.) Address F TNAM COUNTY, RTMENT HEALTH _4 -.DEPA -F vision .-En wronms6t4i Hea -40512": i lih ;,§�iviees,_-CjM41,,:N.Y. J"1,15 CONSTRUCTION PERMIT-- W SE AG SY E%DISPOSAL STtM' Town o► Village 7� ax --mai:i 0 Lc; -T Lot Lot h. Su'O'dIvisig' Ss�_rs,' Sum Renews Revision % Approval 5roval - 'Owner /Address 0jr Previous �D.te 3 -77q, C', " 5-S- Buljding'Ty pe _T 1 7 'Number -of Bedrooms. P. C'., H. .D. Noti ication iie�fired f rl Design' F16W,GZT/D Separate �Sewerage Syste'- o conps 't, of Tank and k,i To: be constructed-.by Address Vater Supply: 'Public Supply From,- �a,,, Supply ,to- be dnlletl by V �rAddress L co her --Re4uifeiiierits 07 14V _70 -At location . .*of s�par P6 I represent- that I am wholly and completely'.reso.onsible for the design and proposed systefn-(s);. I) that the" ate, sewage dis' sall'system m -and-regu lat ion's e u nam above diiisc-ribed will be constructed -as sh8Wn ippifoved a eniinen there to and in accordance with-the-st;ndards, rules County- ,:Department -, - ' of Health ".,a rd that on -ii'm,piet ion t i if icate of Co-nstrUctibn,Compliance "-satisfactory -to.'the'Commissioner " 6e-submittec to `the Cepar t men . and al written guaiintee Will-Ve�I urn ished the owner hls success ors,' ers,oi.issignibytKi-builder" pace An good operating :condition`' any part of sa la se wage''disposa sy er_:aii4`6, he period years - immediately tollow'i the g t-' 2) at7th 11 described . ance,o oval' of dion orn-0iian,ce" ci the original, y oil ilIpprov hai said well will & i 'stalled iin actor e an r e a r I f t will be located 'asihbiwn,on 6 ' e 6 an With, th c ed plan and t rd ions p1iinty `p'epartment of. -Heaith' C4 'A>04 L - 'ie =016Z rl::;— OE ic_�enie No , . Wa7 T _r, of 'a! 'a0p DVil,.expir es,6nii, f fro rn'the date'Assued. �unle construction tie' oilalniil,ti e.In`,1unc1eVi !APPROVED,FOW�4tO -I' YPA �Io - ca6w'for- cause ."Change rei 1 ' amended ` " � _-i- '. issued _of,,_ 1 — h' coil6nitru6tio".' mo ii A� - `p� 6 p. ed or-mpoi ied when jo a of dcim!sto!V,�ify iiiwig new I'm It —Ap-girove ov, isposal requires ;a' !#n e Date BY :P 1577 12- 9-81 j PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF.ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO Owner,D2a3 (AQCXVA) b&-rrAAddress Z 1750X �r97'C,�'.,N 1 Q Located at ( Street �%� `ji, ", 46- Sec. Block Lot street) Municipalit Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS o e Number CLOCK TIME PERCOLATION PERCOLATION apse Deptti 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 3LQ'44- I1 ,2? 4 5 2 3 10`.48 - l 4 1 2 3 4 5 Notes: 1) N'z�ts 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. HOLE NO. HOLE NO. G.L. 6" 12" 18" 24" 30.11 36.. 42" 48" qT7 Vj 5411 60" C L' 66" 7211. 78,11 84" jIINNDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY '%/J'J1> Date DESIGN Soil Rate Used4�-(C?Min/1 �� Drop: S.D. Usable Area P U No. of Bedrooms 15 Septic Tank Capacity lCX3 Gal ��'�� P fi p` ,q Absorption Area Provided By�'�L. F. x24 . E�j' �i. tre3a Name r[ c -F 610THTUr e Address Z SEAL �J•� CG£S��j� �b THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date C C ti.I 7 r 533 -55' oo•."1 541' 19: ZIV,%a 528=39=40 "%a 78.93' 69.18' 92.54' Bl2CH HILL P-OA-D ..F!w- 5 V 2\/E.Y o f P 2oPE FZ.-1" Y t Pu.EPA2En Fotz AIV'[�RE�/�.CAROLYA! AN�RETfA LOT AS SHOt.1h_t OtJ u FIIJAL PLAT OF ESATES FILER HAP 10 15ISA FILE:1> 6 -b -8'4 'T04J'1..1 OF PATTE2�.�0>`! PuTti.JA►►� Go,rvY• �` pCALC I"= IOCS Qov. . 1,-{. 1985 Er> To C;�A-1 sue,", ; - LOA/�•I. 1GA'flO�l�i ILJDIG,41ElO .NE2E[xl:Sltr:dlG`� -tllaf- 1}N�i `..It1AFs F�£f3S.vFr� IL1 /S('[�epd�E 1C.ffTN '7►� Jr- CCOE- CP PIZACI- —F— COQ L.AJ,La ScJt Vri A XNII D x1�lE`loes, 4AID G iGjc.!CTTOI.Ih Sguj- P5jw C*JL.Y FEZe,oQ F<r- v1Fk141 Tilt: ll p ,41,.=0 'Ia IW- M TC E CICMF=rii.P( Ak(C> L ej- UI I - ,qc* {, L ie5 Fle :l.'cEri!f1Fi<_.�t'tc �, AWE I_ICS7' :E2dr% -£ -ra' AZ:�� AL . i1,lSTT T OI K Oe �l.aEl:1T OV..l1�le_.BS. - NO: �000 >B Q0. 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