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HomeMy WebLinkAbout0265DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 5. -1 -38 BOX 3 ,N96 rr .. Fes' ,, , T f , 11A % T ■' WL 00074 -: i'z'°"'. ,.; .,,,..,- .r.,.+- ,--- .,.,r -r. r ,.-. -. •..b - "- '°^-a- -°:x--'-,tr^.,•°�.�m_ --- _ T`..'*w- �-r+.-- -r•"' .�^;' -r^ - PUTNAM COUNTY DEPARTMENT OF'IiEALTH Rev. 3186 Dlvislonof Environmental Healt s': rmel,9.1..10512 Eaglneer Mast Provlde. P95 -86 P,.C.H D Permit #—=— -- S/ CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM 'Patterson Town or Village Lecsted st Birch Hill Road Tax clap 7 `Block -'2 Lot 1'. 1 1 Matthew J. Donaldson Former) Subdivision Name Subdv. Lot # Owner /applicant Name Y . Mailing Address Rake 2, BOX 31 Zip_ 12%3 Date Permit Issued 11/12/86 Patterson, Neuu York - Separate- Sewersge System built by PaL I t r del it is Address RgUercm - WEul Ydik 1250 450' tile fields Consisting of Gallon Septic Tank and Water Supply: Public Supply From Address or: X Private Supply Drilled by �att Address �ttarcm Yak. Building Type Has Erosion Control Been Cgnt No ,y�•�,� fr, ,, �� e yr ro Number of Bedrooms 4 Has Garbage Grinder Beef IneialledY ' ^� r., , Other Requirements I certify that the system(s) as listed serving the above premises were canstructed'essentChlly as shO ri`on he pia Hof; ted'work ( copies of which are attached), and in accordance with the standards; rules and ;r 'ulations in "accardanceNwtthe:filed- plan p. permitissued by the Putnam County Department Of Health. 6/25/87 , Date Certified by P E_ R.A. Address RD 6 Route' 22 is n3e No r Any person occupying premises served by the above systems) shall promptly take- su�N?apjj�f�eAaybs news y re tM corsScfion; of any unsanitary conditions resulting from such usage. Approval of the. separate sewerage system shall become null and void as soot►'i�.a Jl l ' tgttt>ary _ Sewer becomes available and the approval of the.:private- water.supply.$hall become null and_,vok!_when ,a ,public_ water, wpply,; MCOri4ls= avallabie: Such atpp ► ovals are subject to modification or change when, in the judgment 'of the Comntissioneitof Health, ch r ocat Ion, modification or change Is necessary.' Date) �'�P �Cr, /! �/ By t A' "�' OIJ TTTl1TT Iy .e ` W 0 Wl_LL l,rVl'1rLL' ltvlV 1�.rVnt DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH office Use Only WELL LOCATION STREET AOURESS: WN /VIL / I Y TAX 10 N MBER: WELL OWNER NAME. ADDRESS: pgIVATE O PUBLIC USE OF WELL 1 = primary 2 - secondary `RESIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND. /HEAT PUMP ❑ ABANDONED O BUSINESS O. FARM O TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY O MOUNT OF USE YIELD SOUGHT L0 gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE _00 gal. REASON FOR DRILLING KNEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION O REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH c2 q0 ft. I STATIC WATER LEVEL -1-6 ft.1 DATE MEASURED r DRILLING EQUIPMENT ❑ ROTARY YCOMPRESSED AIR PERCUSSION O DUG ❑ WELL POINT ❑ CABLE PERCUSSION O OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. OPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH tL MATERIALS: STEEL O PLASTIC O OTHER CASING LENGTH.BELOW GRADE ft. JOINTS. O WELDED &ftHREADED O OTHER DETAILS DIAMETER 7_ in. SEAL: O CEMENT GROUT ❑ BENTONITE EfOTH R WEIGHT PER FOOT 7 - Ib_ /ft. DRIVE SHOE: IKYES ❑ NO• LINER: ❑ YES NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (lt) DEPTH TO SCREEN (ft) DEVELOPED? FIRST ❑ YES ❑ NO' HOURS SECOND GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE DIAMETER OF PACK in. TOP DEPTH fL BOTTOM DEPTH ft. WELL YIELD TEST If detailed pumping MFFH00: O PUMPED t tests were done is in- t COMPRESSED AIR , formation attached? O BAILED ❑ OTHER :DYES ONO WELL LOG tf more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear- ing Well Dia- meter C' ' FORMATION DESCRIPTION COOS, ft. (L WELL DEPTH it. DURATION hr. min. DRAWOOWN ft. a YIELD gFm. Surface 10 i' 4a57 go WATER CLEAR TEMP. 'QUALITY ❑ CLOUDY HARDNESS ❑ COLORED ANALYZED? OYES ❑ NO ANALYSIS ATTACHED? ❑ YES O NO STORAGE TANK: TYPE_i r-(, CAPACITY GAL. /c2® PUMP INFORMATION TYPE 5"MCM. i 61C CAPACITY / 0 V MAKER GM11CJ& ; DEPTH 4 64Fo MODEL °16* VOLTAGE =O HP-4E7 WELL DRILLER NAM DATE ALBERT M.iYATT & SONS, INC. 6 ofd ff ADDRESS Well Drilling 5tcrbtTURE Rte. 311 R.R. 2 Box 171A PATTERSON, NEW YORK 12563 PUi'NAM COUNTY DEPARTMENT OF HEAL11i DIVISION OF ENVIROiZ=AL HEALTH SERVICES Matthew J. and Kimberly Donaldson Owner or Purchaser of Building Fairfield Homes Building Constructed by Stagecoach Road Location - Street Patterson Municipality Single - Family Colonial Building Type ; 7 2 1.1 Section Block Lot 'Patterson Matthew J. Donaldson Subdivision Name 1 Subdivision Lot GUARARM 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 constricted as sham on the approved plan or approved a:-mend,«ent 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 Environinental 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 occupa . of t e buildin till i g the systen. Dated this day of 19)v Signature Title General Contr ctor (Owner) - Signature B A L D W I N & C O R N E L I U S, P. C. Corporation Name (if Corp.) Corporation Name (if .) Address 12-S^C 3 rev. 9/85 ink RD 6, Rt. 22, Brewster, NY Address CHEMICAL PHYSICAL BIOLOGICAL NAME AND ADDRESS OF PERSON TO RECEIVE REPORT ELLIS A. TARLTON LABORATORY DIVISION OF ELLIS A. TARLTON, ENGINEERS, INC. 34 PLEASANT STREET DANBURY, CONN, 06813 -2328 P.O. BOX 2328 203 - 748 -7903 WATER - WASTEWATER METHODOLOGY APHA - EPA - ASTM REPORT OF BACTERIOLOGICAL AND CHEMICAL EXAMINATION OF WATER I Mr. Matthew- Donaldson 1 Lindberg St. Bethel, Ct. 06801 DATA SOURCE OF SAMPLE Water Supply, Donaldson North Birch Hill Road Patterson, N.Y. DATE OF COLLECTION June 22, 19 8 7 COLLECTED BY M. Donaldson Hydrogen ion COLOR TURBIDITY ODOR none CORROSION INDEX DISSOLVED SOLIDS Concentration (PH) 6.8 20 2.9 Taste 1 LANGELIER NTU metallic RYZNAR 115.0 Mg /L Alkalinity as CaCO 3 Fluoride (F) Nitrite . 0 0 0 Mg /L Bicarbonate 32.0 Mg /L .00 Mg /L NITROGEN Alkalinity'as CaCO3 Chlorine Residual CONSTITUENTS Nitrate 13 Mg /L Carbonate 0. 00 AS Mg /l • Mg /L NITROGEN (N) Total Hardness as CaCO3 Conductivity Ammonia .000 Mg /L 88 . 0 Mg /L 195. Micromohos /cm Mg /L Iron as Fe 1. 20 Mg/L' Sodium 11.4 Mg /L Chlorides at CL 38.0 Mg /L Manganese as Mn .09 Mg /L Mg /L Detergent as MBAS 0. Mg/l. Sulfate as 304 14.4 Mg /L Mg /L The arithmetic mean of all standard samples examined per month using the membrane filter (echnique shall not exceed MEMBRANE FILTER TEST one colony per 100ml. Coliform colonies per standard sample shall not exceed 3150m1, 4 /100mt, 7/200ml, or 13/500ml Coliform Colonies /1100ML in: (a) Two consecutive samples; (b) More than one standard sample when less than 20 are examined per month; or (c) More than five per cent of the samples when 20 or more are examined per month. 0 AT THE TIME THE SAMPLE WAS SUBMITTED: EJ1. The results of the analysis of this sample were satisfactory and met requirements for a potable water. ® 2. The results of the analysis of this sample were satisfactory for a potable water but certain of the chemical or physical constituents were high. These are as follows: iron above 0.3 mg /l, manganese above .05 mg /l F] 3. This sample was not satisfactory since it did 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 was unsatisfactory as a potable water because certain chemical or physical constituents were above acceptable limits. These are as follows: COMMENTS Moderately hard, moderately mineralized water with slightly acid reaction. Physical appearance shows ele\,-ated color and turbidity due to the iron and manganese contents. Iron and manganese, in excess of recomme nded:limit,,:.may.cause. staining of fixtures and laundry. In new or unused supplies, they may reduce with.usage. Otherwise, treatment is available to remove them. Sanitary chemical history is excellent; showing no organic contamination by disposal system leachate. Chlorides are above the area isochlor of 20.0 mg /l and may be due to road salt or softener backwash. The rate of corrosion towards iron and copper;is average, -Z- Certified"� G kL h . is TABULATION CHART A -2 22' -0" B-2 B2' ~G. 8 -3. 77' -6. 20' -G" M -4 '71' -6" rA 8.5 6G' -o" 27' 06 6 Go7 ll!!� -7 A -a 3s' -c" D-a 496" 9 40.-014 0 - Cl ,4.4. -6,l 1O F 45'-C" 8 -10 , A- It !> A -12 55' -G" A -13 6o' -r" 13-13 27_0" A -'14 67' -0" 8 14 24' -G' A -15 72'-G" c3 -15 A -G 52' -0� B- G 104 =0' A - H H 34' 0' 7 -D 9t=6" S -E E41 G" A -1 A- B G8 0" T-:[ 55'-x° WELL B 121 ' -0" WELL- 1 13d, 0�, 114.70' a -S 3 -7 2-7 5 34°-57' - / N C—r-%( WEA: 70,404 5F J.Gtr- ACK.F-S wi N-r-T:--t 51.1 N 2 1'- 5r-'- 5 7 2 N G-7. II. IV. vi. APPENDIX C FINAL SITE INSPECTION Date - 2. Inspected by OWNER ` ` 2- _-1 7 NCB COMMENTS SE'TivAGE DISPOSAL AREA a- SDS area located as per approved plans - b. Fill section - Date of placement 2:1 barrier. LGTH WIDTH AVG.DPTH --7/ - c. Natural soil not strinued d. Stone, brush, etc., greater than 15' fran SDS area. e. 100 ft. fran water course /wetlands. SEWAGE DISPOSAL SYSTUA. a. Septic tank size - 1,000 1,250 b. Se tic tank installed level c. 10' minimum fran foundation d. No 900 bends, clew cut within 10 ft. of 450 bend e. DISTRIBUTION BOX 1. All outlets at same elevation - water tested 2. Protected below frost 3. Minimum 2 ft. oriainal soil between box and trenches f. JUNCTION BOX.—promerly set _ ` r TRENCHES g- . 1. Length re^,uire3 - Len installe3 2. Distance to wate_ecourse,measured. ft. 3. Installed according tdv 5la.n 4. Distance center to center 5. Slore of trench acceptable 1/16 - 1/32 " /foot. 1-40 1 6. 10 feet fran rc� -v line - 20 feet - foundations 7. Depth of trench < 30 inches fran surface 8. Roan allowed for erosion, 50% 9. Size of gra vel 3,1 diameter 10. Depth of gravel ir" trench 12" minimum 11. Pipe ends canoed h . PUMP OR DOSE SYSTEMS 1. Size of punip chamber 2. Overflow tank 3. Alarm, visual audio �- 4. Pump easily accessible manhole to grade 5. First box baffled 6. Cycle witnessed by Health Department estimated flay per cycle HOUSE - a. House located per approved 21ans. b. Number of bedrooms WELL . a. Well located as per approved plans i b. Distance from SDS area measured ft. 'Casing c. 18" above grade.' d. Surface draina a around well acceptable. OVERALL WORKMASHIP a. Boxes properly grouted b. All pipes partially backfilled f , C. All pipes flush with inside of box d. Backfill material contains stones < 4" in diameter e. Curtain drain installed according to plan ' f. Curtain drain outfall protected & dir.to exist.watercours --r-- g. Footing drains discharge away fran SDS area h. Surface water rotection adecuate i. rosion control provided on sl qreater than 15 %. _-1 7 BALDWIN & CORNELIUS, P.C. CONSULTING ENGINEERS - LAND SURVEYORS RD 6 - ROUTE 22, BREWSTER, N.Y. 10509 (914) 279 -7115 October 28, 1986 Mr. Michael Budzinski Putnam County Health Department Two County Center Carmel, New York 10512 RE: DONALDSON SSDS. Birch Hill Road Patterson, New York Dear Mr.. Budzinski: Enclosed is revised application and three (3) sets of revised drawings, for the individual SSDS permit for the new lot on Birch Hill Road. Other required materials were already submitted on October 22, 1986. I B./ b Enclosures xc /Matthew J. Donaldson Very truly yours, BALDWIN & CORNELIUS, P.C. Irma Baron, P.E. ©C P T 2 8 i986 UrNA DEpr 4 yoUiV r A(r� _INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEt4S� - -" - REVI W SHEET - CONSTRUCTION PERMIT. DATE fffKD: BY:_ DOC[R4ENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design.Data Sheet (DDS) Deep Hole hog 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 Detail .Septic Tank - Size, Detail Well Detail, Service Line if P.tniS ;_ Trench /Gallery Pump Pit Two-Foot Contours Existing & Proposed Slopes for Driveway Cuts Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area; shown; gravity flow 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 House Sewer - 1 /4 "/ft. 4 "0; Type pipe No Bends; Max. Bends 450 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 Unc. expan) 15' to Drains- Lurtain,Stonn,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' from Foundation 50' to Well 15' Well to PL COAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Pemit R & D) Data On DDS Plans & Permit Same utrAK I MtN I OF HEALTH Division Of Environnverstal-N lgA1th Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 a APPLICATION TO CONSTRUCT A WATER WELL 3 WELL SITE SUBJECT TO FLOODING? _'YES XX NO WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Matthew J. Dona-Tds—on* LOT NO.: ►TER` WELL CONTRACTOR: Name To be determined Address PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES XX NO ME OF PUBLIC•WATER SUPPLY: TOW -N /v /C STANCE TO PROPERTY FROM NEAREST.WATER.MAIN •N/A CATION SKETCH & SOURCES OF CONTAMINATION See SSDS plan; No SSDS within 100' downhill,. - -- 200' uphill /o v 379 (date) (signature) _.. PERM IT 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 2. Disinfect the of the Putnam permit. 3. Submit a Well the Putnam Coi until the water is clear. well in accordance with the requirements County Health Department attached to this Completion Report on a form provided by anty Health Department. Date of Issue: 19 W Permit Issuing Official Permit is Non - Transferrable SMUI A00RESS. tOWNIVILLAGEIC11Y IAX ViO NUMER. ELL LOCATION Birch Hill Road Town of Patterson Map 7 - Block 2 - Lbt 1.1 "JELL OWNER N Matthew J. Donaldson RT. 1aooBox 31,E PATT£RSON, NY 12563 RkP51VAT[ ❑ fUBUC ISE OF WELL 0<11ESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /CONO. /HEAT PUMP ❑ ABANDONED I -.primary ❑ BUSINESS ❑ _FARM ❑ TEST /OBSERVATION 0 OTHER (specify) ? - secondary ❑ INDUSTRIAL O INSTITUTIONAL 11 STAND -BY ❑ IOUNT. OF USE YIELD SOUGHT 5+ gpm. /N0. PEOPLE SERVED Av9.4 / EST. OF DAILY USAGE60C�� gal. SEASON FOR INKNEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION DRILLING 0 REPLACE EXISTING SUPPLY ❑ DEEPEN. EXISTING WELL r�ELI TYPE ® DRILLED DRIVEN DUG � GRAVEL OTHER 3 WELL SITE SUBJECT TO FLOODING? _'YES XX NO WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Matthew J. Dona-Tds—on* LOT NO.: ►TER` WELL CONTRACTOR: Name To be determined Address PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES XX NO ME OF PUBLIC•WATER SUPPLY: TOW -N /v /C STANCE TO PROPERTY FROM NEAREST.WATER.MAIN •N/A CATION SKETCH & SOURCES OF CONTAMINATION See SSDS plan; No SSDS within 100' downhill,. - -- 200' uphill /o v 379 (date) (signature) _.. PERM IT 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 2. Disinfect the of the Putnam permit. 3. Submit a Well the Putnam Coi until the water is clear. well in accordance with the requirements County Health Department attached to this Completion Report on a form provided by anty Health Department. Date of Issue: 19 W Permit Issuing Official Permit is Non - Transferrable