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HomeMy WebLinkAbout0315DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -13 BOX 4 .. d ;. Z' �� Z ..3 -.- r 1� I , i' �r i i 121 UL I 00124 1't! r r~ r ! . i' PUTNAM COUNTY HEALTH DEPARTMERr DIVISION OF ENVIRONMENIAL HEALTH SERVICES �q - 21Sr15�5- OWNER'S NAME ��. 6/, _ PHONE �S SITE LOCATION ,-3 MAILING ADDRESS PERSON INTERVIEWED t '�+ fi1 c' �i ��� PCHD Complaint # & Relationship (i.e, owner tenant, etc.) DATE TYPE FACILITY PROPOSED INS PHONE REGISTRATION # Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal fram licensed professional engineer or registered architect. Proposal approved ,,,,� Proposal Disapproved Inspector's Signature & Title to Proposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed canponents tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' deep drywalls surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, or reported ag of agree to the above conditions. SIGNATURE TITLE MIS:. %Abe (PC:D): YeUcw (Tam ED; Pink (Afpl.icant) DATE -2 3 T lo: rZ, X x 7� jr 5 jaze,'2e` 46.33 5 _0 AS BUILT" A JT A Structure iric3te,j tram survey by surveyor noted Well fccated by: Surveyors survey.— Weli drillers report JI- Engineers masurements-0— — Tor. k, rrxes, Pita 90110ria s 5 laterals located Ly: ContfOciar: A8 Engineer: HeOlth d2pt: Field inspection by Health dopto Engineer 1 -3 1 0 that 11, Sc.aage t as NOTES: :rd chat th'! 1Crcl Lt Tit, s.-st.c!r -was a 1.1, i'MS of N. .'-. I.H. 0 1 A E N SION A E5 iL — A C =_� -1 _ _ _ _ - — A A E A F E3 F A -7 1-- 7 0 H 8 j E jr 5 jaze,'2e` 46.33 5 _0 AS BUILT" A JT A Structure iric3te,j tram survey by surveyor noted Well fccated by: Surveyors survey.— Weli drillers report JI- Engineers masurements-0— — Tor. k, rrxes, Pita 90110ria s 5 laterals located Ly: ContfOciar: A8 Engineer: HeOlth d2pt: Field inspection by Health dopto Engineer 1 -3 1 0 that 11, Sc.aage t as NOTES: :rd chat th'! 1Crcl Lt Tit, s.-st.c!r -was a 1.1, i'MS of N. .'-. I.H. _P4jTA : RY SYSTEM DESIGN AS BUILT" Is OWNER LOCATION Street: -5, 7— _ cStole: Tow -oy . _ Sj3 DI%I S ION' P j! Block-. LOT B U il der surveyor: -Z - _z:1 ------ Job 7 Drawn , 7 -1 c 1 —rCkg. J N H P P F M T I S S dab. I 0 1 A E N SION A E5 iL — A C =_� -1 _ _ _ _ - — A A E A F E3 F A -7 1-- 7 A H H 8 j E _P4jTA : RY SYSTEM DESIGN AS BUILT" Is OWNER LOCATION Street: -5, 7— _ cStole: Tow -oy . _ Sj3 DI%I S ION' P j! Block-. LOT B U il der surveyor: -Z - _z:1 ------ Job 7 Drawn , 7 -1 c 1 —rCkg. J N H P P F M T I S S dab. I Yorktown Medical Laboratory, Inc. 321 Kear Street Yorktown Heights, N. Y. 10598 (914) 245 -2800 Director: Albert H. Padovani M. T. (ASCP) r 1 JOHN PRENTISS,P.E. RD9, FAIR STREET CARMEL,NY. 10512 L _j LAB # 93. 0029'30 1_ 40C Date Taken: 5/10/90 Time: 7;45am Date Reld: Time:17TU—am Date Reported : t 4 1990 Collected By* w 7 $uc ainan PO /Client # Other: Referred By: Sampling Site: Kitchen Tap Wm Buchanan:Rte 3- Patterson.Ay.12557 REPORT ON THE QUALITY OF WATER Phone ( 914 ) 878 -6339 INORGANICS (mg /L) MICROBIOLOGICAL 100mL _ Alkalinity Chloride _ Copper — Detergents, MBAS Hardness, Calcium Hardness, Total Iron _ Lead _ Manganese _ Mercury _ Nitrogen, Ammonia _ Nitrogen, Nitrate _ Nitrogen, Nitrite _ Phosphate, Total _ Silver _ Sodium _ Sulfate _ Sulfide _ Sulfite Zinc Standard Plate Count (CFU /1 mL) Membrane Filtration Method Total Coliform Fecal Coliform Fecal Streptococcus Most Probable Number Method Total Coliform Fecal Coliform _ Fecal Streptococcus Presence /Absense (PA) Total Coliform P A PHYSICAL/MISCELLANEOUS KEY FOR TERMINOLOGY pH (S.U.) CFU Color (Units) IT Conductance (ohms /c) GT Odor (TON) NA Turbidity (NTU) SA TNTC Colony Forming Units < = Less Than = Greater Than Not Applicable See Attached ' Too Numerous To Count REMARKS COMMENTS For Lab Use (For Lab Use) SAMPLE TYPE: (Check One) Potable _ Non - potable OUTGOING: (Check Each) HNO —_ HC13 _ H2SO4. _ NaOH ZnOAc Na2S203 Other: INCOMING: (Check Each) LE 40C GT 4 /LE 200C _ GT 200C _ �pHLE2 _ pH GE 12. Other: THESE RESULTS INDICATE THAT THE WATER SAMPLE WAS)- (WAS NOT) (NA) OF A . SATISFACTORY SANITARY QUALITY ACCORDING TO TH YORK STATE PUBLIC DRINKING WATER CODES., FOR THE PARAMETERS TESTED, AT THE ME OF SAMPLE CO. CT N. THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DID NOT) (NA) MEET THE SATISFACTORY CHEMICAL QUALITY TANDARDS OF THE NEW YORK STATE UB C DRINK- ING WATER CODES, FOR TH P TERS TESTED, AT THE TIME OF SAM COLLECQTION. x 7 /87(Rvsd1 /90)RWE Albert H. Padovani, .T. A , Director WELL COMPLETION REPORT. 3/71 a' PUTNAM COUNTY:bEPARTMENT OF HEALTH 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 30 DAYS OF WELL COMPLETION AME dd r,r L OWNER � a 11 6 �c � A n ADDRESS p l Q y �ry p � 1 VV f / t � 1 •'1'es I" l CfS-3 LOCATION OF WELL (No. 6 Street) (Town) V (Lot Number) 8 [ TM10 -1 -15.2 ) PROPOSED USE OF WELL BUSINESS ` DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING El OPeif ) DRILLING EQUIPMENT ❑ ROTARY COMPRESSED CABLE OTHER AIR PERCUSSION ❑ PERCUSSION ❑ (Specify) CASING DETAILS LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT ! THREADED El WELDED D I E S O YES ❑ NO A 4 ,C D YES NO YIELD TEST ❑ BAILED ❑ PUMPED HOURS G.P.A. COMPRESSED AIR ��.� YIELD (G.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE — STATIC(Specifyfeet) L) DURING YIELD TEST fleet) � % Depth of Completed Well `^] in feet below Land surface: 6 l' SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE `, DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (Inches): GRAVEL SIZE (inches) FROM (feet) TO (lee,) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET 3 If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE 100 Pro yl- DATE WEl COMPLETED .s ATE OF REPORT 0 eff WELL DRILLER (Signature) _4� FA sn -g;s �t,es Lvk ,I" PUTNAM COUNTY DEPAR'I.MERr OF IIEALTH DIVISION OF ENVIRONM=AL HEALTH SERVICES William Buchanan Owner or Purchaser of Building Owner Building Constructed by Route 311 Location - Street T. Patterson 10 1 15.2 Section Block Lot Subdivision Name Municipality Subdivision Lot # Modular Building Type 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 utilizipg 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 caused by the willful or negligent act of the occupant of the building the system. Dated this 11 day of May 1990 Signature 1,4, A ' Title Genera Contractor Owner) - Signature Corporation Name (if Corp.) Corporation Name (if Corp.) RR1 Box 129, Holmes, N.Y. 12531 Address rev. 9/85 t RR1 Box 129, Hdlr4tes, N.Y 12531 PA&ess Fir, SZI'r �ISPLL?'Ir�1 Cate T. ICI cm )ER C 4 Iii . ECL al - CR =,=Dri_Slal LOT ir I - NC S u r DISi -r.�r� ARE: I 1z= C� e C- ` = -r %, ar --- =^ fin i c 1/ 1 '' - i /32 "/_cct.. c_ EDE aree. lc: =- == as r a=roved DIcP -S C 10 L =- =- Cr ^r c�-i 1-:-.= - 20 T— - tc:um =__C S I ✓ 1 I .%� ��/� b_ fill �ca 1. - Date of placErr =fit & Rcczt � i -oaf `cr es- ansi. r , 50 ° ! 2.1 tarries,- . _ ... rte r ?VG D C_ ZTat=. --' SCil nct S =- irc,=,_...• I I d_ 5`_^.re, br s =, etc _ , cr= =t =r L-�an 15' fran SLS zr�_ 1 I e_ 110 f t_ fl:-cr. -water ccLr= c_i - E= c'Li1I irat__al ccrt =ias stcnes < 4" in ci`-raT- I II _ S 5�= DISPCSAL Sf= P--mm- ea-S-10 aC== cc_ ]nls im-n- ci°_ to � I I F•r�� tc, a. sent-TLC t om;: s. =s 1 ,0 1,2 0 t _ S r-`Ce Wct— CLCL= ' =3C�1 cCE_Tl=_3Le I i. os =C. c_-�:c! Crc� cs_ Crn s' cces C_ ==L='" t r ^_ 151 �E^.�e Ice _ CST arcrCC� p1�_s _ r I -I� I C. 1'7' II ilrl.L i-m G_ ►�: QO o tci °Q C_=� ^_CL L W1 _rl' ^ 10 f-:-. cf a;" I I' e_ r STTP T =�-i' N; i 1]1 l C __a_ c` S`T:= EI °_=Tc Ci1 - We ==r . Prat =� == icy f;cst I I 1 -` CrC= l b;= _cc bcx area ==--e!5 ? ' 2 f _ N=ICN E.a; -' CrcCErl y set i I C. Iii . ECL 2 DiEtanc=- tZ wa --e r s e " L^==^ i 1 Ec: ter^ ^C i.0 r L En D1 C`nC_- C___ =r LC C_ -L °r I �•�tt'� I 1z= C� e C- ` = -r %, ar --- =^ fin i c 1/ 1 '' - i /32 "/_cct.. C 10 L =- =- Cr ^r c�-i 1-:-.= - 20 T— - tc:um =__C S I ✓ 1 I .%� ��/� C _ Linc 1�" & Rcczt � i -oaf `cr es- ansi. r , 50 ° ! I . a_ 10. C�Cr'! C= C-.ave in t_e_�c1 12" m-, n. Tn-i1 I .. b_ L Pir e e_,-= c=r=y R32 CR i�E EYE- 1. Size of C•_.u.. cL_ I 1 2 Gti�r=� c� tank I c_ E= c'Li1I irat__al ccrt =ias stcnes < 4" in ci`-raT- I e_ P--mm- ea-S-10 aC== cc_ ]nls im-n- ci°_ to � f. F•r�� tc, I i:`CL =_nC CSc_'S C_SC_ ^.a ce away f -rcm 52-S area t _ S r-`Ce Wct— CLCL= ' =3C�1 cCE_Tl=_3Le I i. os =C. c_-�:c! Crc� cs_ Crn s' cces C_ ==L='" t r ^_ 151 �E^.�e Ice _ CST arcrCC� p1�_s _ r I -I� I Iii . ECL 4 Ir '-cE Z�T' GT_ rCtc^ i�? enc LD G � =r' c= L a Ti.e -a urn `cra�e_ C _ Linc 1�" C. =C° C, a :L• ^ ^� Sties � c ' a_ ErYes rrcc� - =i c:ct_t .. b_ A.1-11 pi=,eS t'• ='- c! 1 �T tcC.� T 1 1 I - C. ?�� vi=es f- l•_�, w i `Z inside or tc. I c_ E= c'Li1I irat__al ccrt =ias stcnes < 4" in ci`-raT- I e_ „-`ain dra- : ? ^s ? 1� acccrdi_ ^_c to Llan C ' f. C_Ttain dr` Cwt =a11 �rctect= & c_ -.to Evi =t_c��_�Tccur =� C_ i:`CL =_nC CSc_'S C_SC_ ^.a ce away f -rcm 52-S area t _ S r-`Ce Wct— CLCL= ' =3C�1 cCE_Tl=_3Le I i. os =C. c_-�:c! Crc� cs_ Crn s' cces C_ ==L='" t r ^_ 151 . \ > Dhmm ate BsaEtl BareleM. cam" y. fiND Bubtutspsadft Paatsiit i U ►ssss�st� ;. 'r P54 88 _ ..T-i.-,-PattefsbnI. -- Route 31:1 10 240vmm 14 filled, get f TIM.- e� William Buchanan °S Beae�.a1 a Sever . 0 2 46 8 Dece'st A�aaval 8 ' $�t7f MmMkm Raj Box--j Yom Holmes. N 1'2531 eats Subdi isiori Approved Fee.Enclosed ❑ Am�„nr y t Framer %et. Armor 1 5 8 8 A('Y P dry Ssxfio..0� �tpl Waite Q�1■atiae ofiwa�a�L %.. u.v Ptaw G P D 0:0D Ia Whew M s omAlaa 4 1000 rte, .,.a .1 tank' to be: used as' um lt" w /vl s.ga.r Sy 1ao r'aa ¢ e[ rooft 'P P P . P sib 1 e Tema crud le alatin and .104,fL F of `.tri= gallerie WfiMr ��l�t [ti9e Sti1�y II+tw . Adtlll�se X Odker �.q�trNaaaa� °'`R 0 B 'F. 1 1 Section 2 2 8 0 s f t I,iepresent'.that 1 ani.whONy arld COTpNtely "IespOnsible f01. the ration and location 'of ;M proporsd syitam(s)1' 1 )',.that the sapaiata seew' disposal stem abgtN descrNlad Will be Constructed as shown on the approved.an endment,thwn to and in accorAanco' With the standard% rules a /egu ns O Coltoty OopartmahY of FWKIy snd'thot bn Completion thereof a I Cert!f to • of Construction Compliance'• setistectory to, tM' Cominipioha d/;Nealthwtll M °wbmtttsd to•t/la'0,cps"malt, -'and "a`written,.yua+rsMee wNi t1e'furnifhid the owncr his sucaesaars, h6rsor,.assiyns'by, the builder. "'said•bWNNr will place in good oprratbq' condition any pert 'of ";raid; s wye dNwosal pgetnn during : the perloi of tvro.(2) vows bnwusiatoly "follorrilp tMdate of'tlle isati= of" at the'agprevel "Of the O r* ato of Construatlotl .Compliance of the original systeri;or.any;repaNS Hereto, 2) that the drilled well described a6ow WW be located M Nto1Mn oA the app/011ed pNh and" that Maid wall still IN Mstallod aCOerdanOa wNA the 4tandaMf, rules and rmgu ns -. Ot the : PYtnim C - Cotnity Departmeera of hlaaltii.' "' { o a 31 ; Janu 'ry 1990' si.naa pe _X_ it A. rnRD9— Fair" :Street rmela�n` <. .... -License Wo APPROVEO'FOR COPISTRUCTION This approval oupi►as two years fr M date' issued uniass'construdionr of the buildhq has been undNt "and is revocable for cause ormsy be;afnendeA'or matifiad.whon'oonsidered neoaasa y by'�t1 a Corm' ssiow- of- Heattfi Ring chs�go'O► aNYratiah :Of eofnt uctbn f nouiret a 7"" pa►mit Approve® Ior diapOSal of moslk sanitary sewage andjor private crater supply only. 1 AO-/A8 Dee. ; l� . �j'- -r /- // • rmm axmyDEPAFMMU OF HEALTH DIVISION OF ENV1RCNMRM%L HEAIM SEWICES DESIGN DATA SHEET-SUBSUFACE SEMM DISPOSAL SYSTEM FILE NO. Owner Willi-am 9Ue-hdmzft'dj% Address Located at (Street). 14 4 Sec.' hA-0 Block i.: Lot IEZ (indicate nearest cross street) Municipaiity emL-L-e"*V% Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMrrnD WTrH APPLICATIONS Date of Pre-Soaking Qrldmb— -'-Vate of Percaation Test 4-h-j- Is a HOLE NUMM C= TIME PERC0=CN PERCOLATION I:hm 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 1.63 t (0 D 4- 2. 4 10 F3 lofs 5 2 4 (1 148 K 4 *Yf 5 L 1. Tests to be repeated: at. saia&;'depth until approximately equal soil rates are obtained at-,ea;:h*,per-coi7aG;;; test hole. All data to' be M*mitttd for review. 2. Depth measuremeni*s'�'*be made from top of hole. rnv.. DEPTH HOLE NO. HM NO. 2 HOLE NO. G.L. if 40A ;4 21 I&A Locim 31 4 41-- Ll 73r -,� ", 5go. 'A -t I I -5414 Ub *1 M A 51 Lilme 6 Leb—emA rseK ,. 1 L &41 rook 71 81 91 10, 12' 13' 141 INDICATE LEVEL AT WHICH GROLUMTER IS ENC10UNTERED INDICATE ImM TO WHICH WATEP. LEVEL RISES AFTER.BEING MMUNTERED 06 V%& DEEP HOLE OBSERVATIONS MADE BY:'. If.F.r. DATE: 4 I. DESIGN Soil Rate Used Min/1"'Drop: G S.D. Usable Area Provided o 00 + I d d 0 No. of Bedrooms Septic Tank Capacity loopgals. Type_Hdgana Absorption Area Provided By U==C, dt q, 1=WjR*F*jWj2h 1, � A Other IZ-6-8 r-.-Ij Seals 1ID - 'emb 1i j 0 04, Nam JOHN R. PRENTISS, P.1i". R FAIR ST 914-- Address CAD9 RMEL. NEW YORK 878 1056110 12 t THIS SPACE Fq# Q�FA,BX, HEALTH DEPAMWM MLYIZ�'`k.,.s'w�' Soil Rate Approved sq. f t,/gal. Checked by Date A APPENDIX B PUrNAM COUNTY DERART' 'T OF HEALTH - DIVISION OF a VIROIZMENM�L HEALTH Sr'RV?=S INDIVIDT-AL, WATER SUPPLY & SUBSURFACE SEVQAGE DISPOSAL SYST11 -0 REVI i - CONSTRUCTION P-E= / DATE REVD % A & (�-d��- !l BY: (Ngk of Owner) (Street Lxation ) COMMENTS YES 0 Pre -1969 Neioibor notification LF trench provided required 60 ft. max. Parallel to contours 100% exp. FILL SYSIDS cla barrier 10 ft. fill notes new spec. depth gauges 100 yr. flood elev. 200 ft. reservoir, etc. 150 ft, trigall /gall. DOCUMENTS Pernit Application — Corporate Resolution Plans - Three sets s/s Engineers Authorization Design Data Sheet (DDS) SLB%:�!SION Deep Hole Log Perc Consistent Perc Results (3) Fit Perc Hole Death ed House Plans - Two sets Well pernit; F:tiS letter Variance Request Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Pemtit Same REQUIRED D"TA= ON PLANS . Sewage System Plan - (north arrow) Sewage Sys teen Hydraulic Profile - Gra. °ity F1cw Fill Profile & Dimensions - Volute D or J Box; Trench /Gallery; Pump pit moils Septic Tani{ - Size, Detail Well Detail, Service Line if over Construction Notes (grinder rate) Design Data: Perc and deep results Two -Foot Contours Existing &Proposes Driveway & Slopes Cut Footin /Gutter,Curtain Drains (disch—arge OK) Perc & Deep Holes Located Representative of primary and expans-ion Expansion Area; shown; gravity flow,suff. size If Puttiped Pit & D Box Shoran & Detailed House - No. of Bedrocros ' Wells & SSDS's w /in 200 ft. of Propos-3 Systers- Property Metes & Bounds House Setback Neces _ (Tight lot) House Sever ft. "0; Type pier No Bends; as 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLrN Fields —`1\ 10' to P.L., Driveway, Large Tree Top of fill 20' to Foundation ' 100' to Well; 0' in D.L. .D, ^0' pits 100' to Stream, a se, e (Mc. expan) 15' to Drains- 0artain, Leader, Footing 35 'to catch basin, storrrc3rain,piped watercourse 10' to Water Line (pits -20') 50' intermittent drainage course Septic Tanks 10' fran Foundation; 50' to well 15' Well to PL PUTNAM COMM DEPARTMENT OF BEALTH DIVISION OF.ENVIRCMWTAL i • E- •E. DESIGN DATA. SHEET- SUBSUFACE.SEWAGE. DISPOSAL SYSTEM FILE NO. Owner __ -yi►!f i�r,n �.�yernarn Address �-��.� t 1 �,`S• 0..2�-�G ,A Located at (Street) . R4v ( g 4 Sec.1l to Block _! Lot (indicate nearest cross street) Municipaiity Watershed„ SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking Date of Percolation Test 411-LZS S HOLE 10 o 4- 24- Z NUMBER CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time, Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 1 183 10 o 4- 24- Z / 2 6 3 toff lno 6 � 4 10 53 10F0 Z 1 131:fi 13-14 ' f 2 13A 13a 13 3 1 l 2 4 5 4.. .` 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 fran top of hole. rev. 9/85 R TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. 2 HOLE NO. G. L. t9 d ec' SeM a ';x Sly w►e'.. ear 2 ReA Lo cxm 14v it L do' 'e, 41 4s" Lt •►+mss r e eG $and 51 Y 6 Le��e rvede a re cK 7' Le-Qye rocie 8' 9' 10' 11' , 12' 13' 14' 4. INDICATE LEVEL AT WHICH GROUNDMTE . IS ENCOUNTERED N m hta INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS :MADE BY: I +, F.T. DATE: ¢ I -Z. a8 DESIGN Soil Rate Used Min /1" Drop: S.D'. Usable Area Provided 5-006+ No. of Bedrooms Septic Tank Capacity (00p gals. Type Absorption Area Provided By 196 Tr- f d I lerier �S Other 2 -® -B F;lI -je uteri : 34 "110,..6 gl _�cFSSin^ N �'f0 yv" i Name '�? g JOHN H. PRENTISS,'P.E.' RD9 FAIR ST 914- 878 -6170 IT Address ceuWCi - uru vnue IAR12 "My 0 `c, THIS SPACE FOR USE BY HEALTH DEPARP Soil Rate Approved sq.ft /gal. Checked by Date / LOPERMrr PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services. Carmel, N.Y. 10511 Engineer to Provide Permit # on CERTIFICATE OF CO LiANCE /�CONSTRU FOR SEWAGE DISPOSAL SYSTEM Permit B 88 �° T. Patterson Located at u t 311 Town or village Subdivision Name Subd. Lot A Tax Map 10 Block 1 Lot 15.2 Owner /App Renewal— O Revislon 0 Job #S . 0. 2468 llcantName William Buchanan Date of Previous Approval Malling Address 26 Fowler Avenue Town Carmel, NY ZIP 10512 Bd(,gog Type Frame Lot Area 1.588 Ac. FID Seedon only LX—j Depth 3 -0 volume 350 C. r. Number of Bedrooms Three Design Flow G P D 600 PCHD Notification Is Required When Fill is completed Separate Sewerage System to consist of 1000 Gallon Septic Tank and To be constructed by ? Address Water SOPPh': Pdbllc Supply From Address- ors X Private Supply Drilled by ? — Address Other Requirements R -O- R F 11 '; t i nn • 3150 s= ft. 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 and regulations of e Putnam 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 data of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be Instal s in accordance with the standards, rules and regu Ions of the Putnam County Department of Health. - Date 20 July 1988 Signed i P.E. X R.A. Address— RD9-Fair St. , C 1 NY 105'f2 License No 29206 APPROVED FOR CONSTRUCTION: This approval expires two years from the pate issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration Of construction requires ,a new ipermit. Approved for disposal of domestic sanitary s�ewag/e, /annd private water supply only. Date - y e ri BY �-" `I —�—� —1 Title FUMM COOIfI'Y DWAItl1!M OF MUM b �tvvido Ftltvlt / Dlsltlro e[)Da.ttasMSSedsi >liaallb Sinlleaa. Caul. N.Y.1�S1? a NTH OF C0119 IJANCB r P""t B P54 -88 C >>oeer WIN UWAM DIPOW T. Patterson fat Route 311 Or v� LW. W r Tu Map 10 1110611 1 15.2 ROMWEL_0 >9 QS.O. 2468 Ow�adA��llaa�tila�i William Buchanan Dab of Ftevku Approval 111a�Adiaw RRl Box 129 Town Holmes. N.Y. zip 12531 patc Subdivision Anuroved Fee Enclosed ❑ Amrnsnt wit Typ Frame lot Ate 1.588 Ar-rp- FFffISOdkMO* LIJ Dept 3'- Q!b4�-m253 Cu. Yds. proms_ Two Design Flow G P D 400 PCB;1D Ndlsatlan Wbee FIB b awpM/ed SstlaabM Strwae S7Mtro M anode[ d 1000 alas, Sop* Teak ad To ba by 9 Address; 9 Wfder Satan pdwb So ly' Ftnsis Address on x —h Avails, Sepoki DOW by � aAd " 9 Olbay R n R Fill S p n t i on 9 2 R f) a= ft 1 rapraant ".that 1 am wholly and completely responsible for the assign and location of the proposed systam(s); 1) that tha separate disposal as m above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a regu Mn o County Department of MaKh, and that On completion.thwaof a "Cartifk8ta of Construction Compllantw" satisfactory to the Commissioner of Hea thwill M submitted to the Department, and a written guarantee will be furnished the owner, his succesors, hairs or assigns by the buihler. that said builder will plate in good Operating condition any part Of Sid sewage disposal system during the period of two (2) years knmedistely following tlNdata of the issu- ahoo of the approval of the Certifkate of Construction Compliance of the Original system or any repairs thereto[ 2) that the drilled well described above wo be located as shown on the approved plan and that old well will be Installed in accordance with t standards, rules and regUO elms of the Putnam County Department of "sank. fate 27 July 1989 Signed S � f P.E. X RA.- Addrass RD9-Fair St. , Carm N.Y. 10512 License No 29206 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of tM building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by tM Commissioner of H"Kh. Any change or alteration of construction requires a/�s�aw permit. Approved for disposal of domestic unitary sawige, and /or or water supply only. DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 5.0.2468) APPLICATION TO CONSTRUCT A WATER WELL (Job�� � �/�} PCHn PRRMTT !i/' iS 5'C WELL LOCATION Street Address Rte. 311 Town Village City Tax Grid Number T. Patterson 10 -1 =15.2 WELL OWNER Name William Buchanan Mailing Address 26A Fowler Ave., Carmel, NY 10512. COPrivate ❑ Public USE. OF WELL 1 - primary 2 - secondary D RESIDENTIAL (3 BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP ❑ FARM 1 ❑ TEST /OBSERVATION M INSTITUTIONAL ❑ STAND -BY D ABANDONED ❑ OTHER (specify AMOUNT OF USE YIELD SOUGHT Five gpm /# PEOPLE SERVED 6 /EST. OF DAILY USAGE 400 gal REASON FOR DRILLING CINEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑REPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL []TEST /OBSERVATION DETAILED REASON FOR DRILLING Residential Supply WELL TYPE DRILLED ®DRIVEN ®DUG ®GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name 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: Over one.mile LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED(See dwg. 1, Job #S.0.2468 BY John H. Prentiss, ON REAR OF THIS APPLICATION ® ON SE ARATE SH P.E.) 20 July 1988 (date) (signature) 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. `Kz� Date of Issue 19 Date of Expiration: 19 erg it Issuing Official Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector 2/87 Pink Copy: Owner Orange copy: Well Driller rya � ,. /14 `/Vj dry © (>✓oR� r' (.rj Q) S\� I 0 T . t i �U t'lc(1 t7 i" I%ox vII-fj'a P-�'P� N Iau M P ' L o0o G,AL pi lei ,�'. 'cI hG - '(l• I--, K. I 1 !1 "�1 36'oAr - tt 2, °�O Yo S.a /h/roTAGL�yJ �u -i t °Pt W O I ' � J 51 aze'22''G 46 ••33 ' (t, cAlz t-n.ELj-4— �O V l/ � 1 N 1p S0 °16- 'E 74 l2�' FAS �3 C 1� . r4 -r-T-, rZS o 1-4)-- ?y %we county peparcmenc ui nil /� d YO of Env ronmen � '6 U �?LBiO f noted for oonform»oe tai as APP ve�as ea `and SeBulati0ns od ipPlloabls nut Ps rtmenst.• Qut� county 8 g 4.e a 7�Rnahlrw JL•T1 . structure located from survey by surveyor noted beloa®_ -- _ Veil located by'. Surveyors survey.- - rt®'-tf- -- - -- Well drillers report -- _ - — -- -- -- Engineers mesuronientsD-- - -- - - rank, boxes, p14s,gollerias d laterals located by:Contractor: Engineer: I� Healthd'a.pt: Field inspection by: Health depto dot o:-4— Z9 Engineer ® dato: = —Z This is to certify 0,41: the: Ne%`ag disposal system was constructed a NOTES: indicated on this plan and that t system was inspected by me befOrQ was covered over. The system was constructed in accordance witli-al standard rittes and regulations of ' the P.C.H.D. 6 the N.r.S.D.H. - D I ME Q�pitssroagi t N SION S ti��dH• PRE, R- E= 3 i - -k B_ E k A -F =�� �i B - -p °. 2sZ°6 a� F =- �l%Y_ -_ oaf ' r /' �-Z7� me stnttOt A- °- - - - - -- B - d ` - -- - - - -- A - tt `. - =_ - - - - ®- of - - - - -- SANITARY SYSLEM DESIGN .A$ QUITn OWNER: _ _ t //_�7Li%?�N/�! ,-- LOCATION Street.: LZ�LlZ"��a1-Z °_ Town:A7 -2 ,I �Ui °_Cotinfy: _ _ - stote:�(. � SUBDIV SIGN' Block•. _ Surve y or: D raw n:.£) „0 (S• 40t0:rJ Jg S call e: L� JOHN H PR EN_ PISS PE. CONSULTING ENQINZER RD 9, FAWS -j'j CARMEL NY 10312 - -MKI 878- 6470..- t �i QOM I I cq c4�.c .�► ...} 4 o � fi i S ,u ,