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HomeMy WebLinkAbout0318DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -17 BOX 4 00127 ir � . 9 . � 1 . 00127 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Town/Village: Tax Grid # Map Block Lot(s) Well Owner: Name: / Address: Use of Well: 1- primary 2- secondary AL Residential Public Supply Air cond/heat puifip Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length ft. Length below grade ft. Diameter �in. Weight per foot lb /ft. Materials: Steel _ Plastic ,--Other Joints: Welded Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: X.- Yes No Liner: Yes No Screen Details Diameter (in). Slot Size' Length(ft) Depth to Screen (ft) Developed? First Yes—No Hours Second Well Yield Test _ Bailed _ Pumped Compressed Air Hours Yield &tgpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface _ 'N) Q.7 r.- If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 3� Pump Type jkf &0 m ",,��apacity 10 Depth f op Fr Model 10 GS CS Voltage 230 HP Yz, Tank Type XX � RCS- Volume 6_ -RL fQ3 Date Well Completed ax /- Putnam County Certification No. Date of R ort Well l5riper 'gnature) NOTE: Exact location of well with distances to at least two permanent landmarks to be provide a separate sheet/plan. Well Driller's Name Address: l /v� Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 -i7 5 'RENEWAL / �- I0"7 PUTNAM COUNTY DEPARTMENT OF HEALTH /PER`�rrr- r Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Located at Route 311° Subdivision Owner Peter 01,Hara Building Type H f 9 h Ranch Lot Area 75,731 s Q, f Number of Bedrooms 3 Design Flow 600. 9 p d Separate Sewerage System to consist of 900 Gal. Septic Tank. To be constructed by to be determined Water Supply: Public Supply From Other Requirements Patterson Town or Village Tax Map - 1 n Block 2 Lot 3 ^1 3 r 1 Job Address Route 311 Patterson Total Habitable Space i Square Feet and —430 l.f. x 24" tile fields Address X Private Supply to be drilled by to be determined Address 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 o the 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 tluring t e periotl of two (2) years immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the o ' 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 install accordance the sta ards, rules and regulations of the Putnam County Department of Health. Date 8 / 7 / 8 1 Signe P.E.X R.A. Address Route 52, Carmel, N.Y. 0512 License No. 043880 APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless ruction of the building has been undertaken and is revocable for cause or may be amended or modified when considered essary by the ommiss' of Health. Any change or alteration of construction requires a new permitt. Approved for disposal of domestic sa s ag riv or su ply Date ®,!� &1 By Title a a i RENEWAL PUTNAM COUNTY DEPARTMENT OF HEALTH v (� Division of Environmental Health Services, Carmel, N. Y. 10512 - ' Patterson � ?/ 9 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM 7 ~ Town or Village Located Route 311_ Tax Map I) 0 Block l Subdivision , Tax Ma pp #W l 3. 1 subd. 9 Owner Peter 0' Hara Address Route 311 Building Type Hi-Ranch Area 69,165 sq• ft. Patterson, N.Y. ,,Number of Pedrooms Design Flow n8-10 Min.. rate a Separate Sewera System to consist of ._.._9_011 - - -- Gal. Septic Tank To be constructed by ___ _to..._b.e_ d et-ej-ai n e ( Water Supply. Public Supply From Private Supply to be drilled by Total Habitable Space Square Feet and 3 6 0 ft. 2' trench / (' ) ( X )leaching pits � 111 �R1�fr �Iil Other Requirements . Dryl-:T. Ord 'RGl_'1C31.nu I represegt that 1 am wholly pnd 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 attachments hereto and in accordance with the standards, rules and regulations of the Putnam clounty Department Of. Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commission- er of Health will be submitted to the.Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the build- er, that said puildIr. pill 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 issuance of the approval of the Certificate of Constru tion Compliance of the original system or any repairs thereto; 2) . that the dril)� wail described above will be located as shown on the appro an and,that sa' ell will be installed in accordance with the stan- dards, rules and�r9gulationa of the'Putnam County Department Of Health. Date 6/29/79 X Signed P.E. R.A. Route 52, Carmel, N.Y. 10512 043880 Address License No. APPROVED FOR CONSTRUCTION: This approval expires one year from the date 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 Com ioner of Health. Any change or alteration of construction requires a '"w pgrm`it. Approved for disposal of domestic S46,Nta /;a:9e nd or � ater supply only. g e 0 ) kAR4 ACM PSOju FII LD CHEICI: LIST Date: •Insp.by: INITIAL SI`hE INSPECTIOTIT Yes . No Comments Property ].fines or corners found . . . . . . . .... Can estimate house location Will driveway ntsed cut � Must trees be removed -note these Is deep hole representative of entire SDS area Additional deep holes needed.. . Sufficient SDS area available considering driveway cut, house location, separation distances, etc . . . . . DEEP HOLE DATA Depth.: - Water elevation: — Rock elevation:` Soils-description: 6A &16cn Date: . FILTU SITE INSPECTION Ins p. 'by: House located where shown on approved plan -... -_ SDS located where approved . . . . . . . .. __._. Length of trench measured Width of trench average Slope of the -line and trench acceptable ... __. Room allowed for extension trenches Over 50 ft . from swamp, watercourse Natural soil not stripped or SDS area unnecessarily graded . . . . . _ 10 Ft. maintained from prop.line. and. 20 f t . From house . . . .. Separation of trench from house, well etc. follows plan . . . . . . . _. Nimiber of bedrooms checks . . . . . . . . . Stories, brush, stumps, rubble; etc. greater than 15 ft. from nearest trench . . . . . . 15 Ft. of peripheral soil horizontally from trench... . . . . . . . . . .. Junction boxes properly set Could surface run off from driveway, roads, .ground surface, etc. channel near SDS area. . . . . - Does lot. drainage rarr.�car O.K. in area of SDS FINAL GRADING OF SITE ACCEPTABLE IR M=w cr>I•;cx stn,rT j OD R ('u'00 IMoets Std. Yes ' NO R�ul1 iii DOOM, t�1TS / House plans O.K. Da-sign data sheet Peres presoaked? Kin. 30" perc test depth Remarks' emark s ' Condt. results for 3 runs D. Hole log O.K. .Corporate Affidavit f'or other than individual t Authorization for engineer- Letter from Water Supply if applicable If variance requested -such noted on plans & apps.: r D TAILS 9 - if change is proposed,) Existing contours shown kshow new contours) Slopes for driveway cuts, -etc. shown erQ!1jZ � ILater service line location zn ' Footing drain, etc. location Top slope, bottom slope of fill v .PLLL Percolation tests and deep test pit location i Septic tank size and conformance to std. j 3 B. R. house minimum House setback shown I f Distribution box ftg. below frost All water within 50 ft. of'PL shown ! Plan and profile SDS .. . ( ....... ....... ... . All other wells and SDS closer 200' 'shown or reference made ' Prope.rt� ,b,oundaries (metes and bounds - clearly shores ?PARATION DISTANCES SPECIFIED ON PLAN 1' to P. L. ' to Fovhdation wells ' to Nearest well ' to stream, march, lake, etc. incl ' to Curtain drain ' to water line (pits -201 ' to storm drain ''to large trees ' froi�i foundation to septic tank ' to pipe from leader drain & .1'oa1 li% .expansion) i ;; c rain __._.Peter O'Hara Lota_ :?'lZ;.._ to `'. r_ .. Y rES T , ciu'Ll. >r_: c _.._ ._,._ _ George A. H a u g h n e Y 4 a1:)f'Yl �=ci pr'o__ >essicnial eI:C1ineer Tw rc,giste.red ari_itite, l to irip lly fca- a Const:ruc icn. L for a Sepa -,.- tLc: 'c'wagF b3 se ; ti Ul noted pro -i—p -e ty in accoraanc=e ri t'? 'Che 5: ta-j lords , Y•:.iies: r- Iu-'oroul.agat d by the C(YiiTrJL-ssJ,oner of the ridtn.i:F. Co-Linty Di-�pr3Ttinent of H to icln all necessary ry Nat)ers on my }`•c?hali in coi:n1 - -ction -with tIiis Tnati ', L of sai_cw ,ysteiii or y Route 52 C -armeI ; N.Y. 10512 °'' (914) 225 -9353 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. Located at (Street Sec. Block 6dicate neares cross s ree Lot -3 Municipality 'p,j Watershed ►�j.p� SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole ° Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water a er ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop . Drop in Min. /in drop Inches Inches Inches 72-4 E> 240 Z1 I 2 7),.Z4 - 3 t 3Z. e> 3 3-'!L -- -7 2JZP 710 - 5 1 2 M Y 5 - 1 2 3 5 Notes: 1) Tests to be repeated at same depth until approximatelyy 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" 2411 30" 36" 42" 48" 54 60" 66" 7211 78" 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY T. �/, Date DESIGN Soil Rate Used• -io blwi "Drop: S.D. Usable Area Provided ScsC�v�—� No. of Bedrooms j Septic Tank Capacity qoo Gals. Type Absorption Area Proed By_3! U L.F.x24" width trenc . Other DiaL„c �c-z� A•�t� signature `\```fit , .` ��'•i Address 'Vc 3 ., SEA P THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft/Gal. 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