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HomeMy WebLinkAbout0334DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -33 BOX 4 00143 .. NJ- f� 4 T �6 T man 00143 r,•: �..- -— .°"" s-?+�r, ;.•ac�� -rz r�^:.�.E.� rzr•: 'k. Rev 3 86 PUTNAM COUNTY DEPARTMENT OF HEALTH x Division of Envh oumental Health Servlcex, Carmel, N.Y 10512 s Provide Engineer Mast de mi P C H D Pert q CEWMCA (OF. CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Towne) Located at Tai Map 1 d_>'Blgck Lot Owner /applicant Name i Formerly Subdivision Name Suli dv Lot M P Date- Permit leaned MalIInJ; Aadre.® a ,' ..O ok � 'ZZ zi 17 �✓'�a 3 '� o ►l ,Z 3 r�� Separate, Sewersge System built by � K t �� Address Lj Consisting of ..� Dd Gallon Septic Tank and i Water Supply: N lic Supply From Address or: Pd. ate Supply Drilled by Address Building Type . � �t� 93%, tr LA--- :His Erosion Control Been Completed? Number. of Bedrooms Has-.Garbage Grinder'Been Installed? Other Requirements 1 Z , I certify that the systems) as- listed serving. the above premises were constructed essentially'as shown, on: the plan the completed, work ( copies of which are attached] „an 'in accordance with the standarda,'rules and'requla na: Yn.a oidanc with, the it 1 the permit iesuedby the Putnam County De),. tment Health Date Certifled.by P.E.�Ft.A. ' Address Ignse No. Any person occupying premises served.by, the above systems) $Ball promptly take such action as may be'necessary to so re: the correction, of any unsanitary conditions. resulting. from such usage: App, she .the'separste seweragesystem,ihall become hull and vold.aa. as a_pub(': sanitary sewer becomes availetile' and the approval of the'private:wateY supply shall tiecOme null mq..,vole -when a; oublie water wpD1Y becomes available. Such approvals are subject to modification or change when,' in the 'Judgment of the Commissioner of'liealth, such revocation, modification or change is necessary, Data A� Gym �'� — lTitle DISrCSAr• ARE ss area l.r'— _= 0-5 per b_ f:11 Ems. mac: -Dam oz F er F�1tr sl_ =`L�l c.-rte " = M LC ;plc. -pTE L. 1 _ C_ Lac ='1t =� sc1_ c.- = t�s-� ' fm-a-, u area e _ - 17. DISPOSAL S =fit 1,000 b- =mot -c t =r C. °J III_il'�r iC_�L ` 1 iCLT CIi 4 Z `t3:I ln __ cf CC o t LG ' - -1 — I I rl' I i P -ctr_ - L:��� L- I I i 13/fcc- C-Z /32 10 20 i DES `"1 E. < `Q lncHe- s= :L E_ Rcc� mac; =cr ex=. �icr_r Su= ize c:=- C=7aviial 314 I- l r -s - C -�i " i t_ Lu 1 c I I 1 b_ Pi Lc = S_ J c Pam- CR LOS � ( I - Size of r= c-= t'' I �T! cN tarok I ^ 11 Vl to PA f _ - E _ O"C! e W ' _= _C_ i .. CL'i - � �_ c CcT ITT. EC c- ^iTC_ I C. _ _ �_nc �A" L? _ C E :.l b. ALI L as C — "_11-r ha C. ? -' viCcs f_Lshl With 3'+S:Ce cL L,--x t _�? ccr_*ZS s�cnes < a" in --- accora. ^c to ' --I-�I _= --- �__ ^? Sl C_� COL= _ ? Crctn� = =� & C_T - _- -� I h_ cCC✓- L' =�' -_ _ �U�!�:.�. iJ..�� .��.. ��� t��.1-�e -per° -- � n ���3! �n %��y�- ��..4� ,� ��....��jv� el`A�On �y W tij O WELL UV1'1YLL11%JA ATrvAl DEPARTMENT .OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET ADDRESS: C r-os- 5 d, WNIYIL 1 1 Y j4-j- TAX GRIO NUM8ER: PC' F n WELL OWNER NAME: �, -+c— ADDRESS: .. �3 z z 1:> - t– Scd�,, �,�1 - O PUBLICE USE OF WELL 1 - primary 2 - secondary RiESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP ❑ ABANDONED O BUSINESS ❑ FARM ❑ TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE � gal. REASON FOR DRILLING VNEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA ' pp, WELL DEPTH ! KJ- ft. STATIC WATER LEVEL ft.1 DATE MEASURED 9 DRILLING EQUIPMENT ❑ ROTARY COMPRESSED AIR PERCUSSION ❑ DUG O WELL POINT ❑ CABLE PERCUSSION O OTHER (specify): WELL TYPE O SCREENED ❑ OPEN END CASING. OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH ft- MATERIALS: STEEL O PLASTIC O OTHER CASING DETAILS LENGTH.BELOW GRADE.ft. JOINTS: O WELDED THREADED ❑ OTHER DIAMETER — in. SEAL: ❑ CEMENT GROUT eBENTONITE OOTHER WEIGHT PER FOOT �� 1b./ft. DRIVE SHOE.2f YES O NO LINER: 6YES ❑ NO SCREEN TAILS DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (f t) DEVELOPED? FIRST' /O YE ONO HOUR SECOND GRAVE O YES ONO GRAVEL SIZE: OtAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH It. WELL YIELD TEST If detailed pumping METHOD: O PUMPED ; tests were done is in- L�J COMPRESSED AIR , formation attached? ❑ BAILED O OTHER ; O YES ONO WELL LOU If more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear- ing Well Dia- meter FORMATION OESCRIP•TION cooe, ft. It WELL DEPTH ft. DURATION hr, min. DRAWOOWN It, YIELD gpm, Land t5 � er A)hi� •C A,M off• WATER CLEAR TEMP. QUALITY O CLOUDY HARDNESS ❑ COLORED. ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAME DATE LBERT M. HYATT &,-SONS, INC. ADDRESS SIGfIATURE Well Drilling.: ,r. Rte. 311 R.R. 2; `° 1l x 171A TTERSON NRV "y',.' K 12.563 Yorktown, Me' dical Laboratory, Inc. 321 Kear Street Yorktown Heights, N. Y. 10598 (914) 245 -2800 Director: Albert H. Padovari b,. T. (�,SCP) T_ —T PETER 01HARA P . 0. BOX 282 PATTER$ON,NY. 12563 L J ........ i LAB # Date Taken.: 9/27/89 Time: 9;50am Date Rc'd: 7%2%8 Time: �` Date Reported: bhF. 1989 Collected By: ara Referred By: Sample Location: 1 c en ap Of.Hara Subdivision; Lot Phone # - Phone # Sample Type: Repeat Test? (check each) LABORATORY REPORT ON THE QUALITY OF WATER INORGANIC NON- METALS mg /LT- MICROBIOLOGICAL CFU /100mL Acidity Alkalinity _ Chloride Detergents, MBAS Hardness, Total Nitrogen, Ammonia Nitrogen, Nitrate Phosphate, Total Sulfate _ Sulfide Sulfite METALS (mg /L) Copper Iron _~ Lead Manganese Mercury Sodium Zinc 'MISCELLANEOUS PH (units) Color (units) Odor (TON) _ Turbidity (NTU) GENERAL BACTERIA Standard Plate Count T (CFU /1.OmL) MEMBRANE FILTRATION TECHNIQUE Total Coliform Fecal Coliform Fecal Streptococcus MOST PROBABLE NUMBER TECHNIQUE Total Coliform Index Fecal Coliform Index KEY FOR TERMINOLOGY CFU = i Colony Forming Units CON = Confluent (q.v. TNTC) LT = < = Less Than GT = > = Greater Than N/A = Not Applicable S/A = See Attached TNTC= Too Numerous To Count REMARKS /COMMENTS.(For Lab Use) vL Potable Non- potable _._. STP INF _ STP EFF _ Other: Sample Status: (check each) Outgoing HNO3 _ HCl _ H2SO4 _ NaOH ZnOAc — Na2S203 r Other: Incoming LE 4 °C GT 4 °C _ PH LE 2 PH GE 9 _ pH GE 12 Other: ELAP No. 10323 THESE RESULTS INDICATE THAT THE WATER'SAMPLE (Was) (Wasn't) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO TH ORK STATE PUBLIC DRINKING WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE CO, TION. THESE RESULTS INDICATE THAT THE WATER SAMPLE (Did) (Didn't) (N /A . MEET THE SATISFACTORY CHEMI L QUA TY.STANDARDS OF THE NEW YORK PUBLI DRI ING WATER CODES, FOR THE P AM ER /ESTED , AT THE TIME OF SAMPLE COLLEC 2186(Rvsd7 /87)RWE Ir. ert H. Padovani, M.T. ( CP), Director PUTNAM COUITrY DEPAR'EVMT OF HEALTH DIVISION OF ENVIROMUMAL HEALTH SERVICES Owner or Purchaser of Building 0 H Building Constructed by Location - Street .Ll Municipality Bui dl ni g Type Seetiort - Block. Lot Subdivision Name Subdivision Lot # GUARAR= 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 Environirnntal 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. Dated this _ day of 19� Si 9 nature `J-;:KL O .. Title General Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 -nk Corporation Name (if Corp.) Address Wsttei Sapp!) ' pdbNc S'aw, , pkpsn or:.:. Pelvate $apply 1)rllled by i Ems r 1 A to Ovate w_ P IYL o >ry. Title' and is 'uct too DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # 49 WELL LOCATION Street Address Town/Village/City Tax Grid Number WELL OWNER Name Mailing Address I�I PO f�l�rivate Public USE OF WELL 1 --primary 2- secondary CI Rg'SIDENTIAL O BUSINESS O INDUSTRIAL ❑ PUBLIC SUPPLY ❑AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY ABANDONED ❑ OTHER (specify O AMOUNT OF USE YIELD SOUGHT �gpm /# PEOPLE SERVED /EST. OF DAILY USAGE REASON FOR DRILLING GWW SUPPLY ❑PROVIDE ADDITIONAL SUPPLY OREPLACE XISTIN SUPPLY O DEEPEN EXISTING WELL OTEST /OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE QC eILLED DDRIVEN ODUG GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES C___1�0 IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No'. WATER WELL CONTRACTOR: Name. --F;; -Et a -D - Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES LSO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY 'DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION �AT'SEP G (date) (signature M3al7U00 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 s.hall: 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. Date of Issue: zZ--�,a 41 19 - --� Date of Expiration: 19 � Permit Issuing f cia Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner 2/ 87 Oranap conv: W011 nrillpr r• •iTi �WAN a D,• iDI • lompmuc,,Ire e• • i� r i �- «�,, DESIGN DATA SHEETSUBSUFA,C/E SEWAGE DISPOSAL SYSTEM FILE NO. Owner AddressT kk Located at (Street) Ceoc �7 se 10 Block 3 Lot — (indicate nearest cross street) Municipality e'p,J Watershed SOIL PERCD=ON TEST DATA RDQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking 1 1 i 7 �g Date of Percolation Test HOLE NUMBM CLOCK TIME b i�cA} ti ( PEROOLAMON PERCOLATION Run Elapse Depth to Water From Water Level No. Tine Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 10— 2 ,o - so o 1 3 a() 1z3 7 2 (O 4 5 � 1 2 © ZZ 10 Z 3 0- C� �D 1�? 2U a, lo m NOTES: 1. Tests to be repeated are obtained at each for review. 2. Depth measurements tc rev. 9/85 at same depth until appraocimately equal soil rates percolation test hole. All data to'be submitted'. be made fran top of hole. .ter.." TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOU UERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 2' it 3' jr 4' 6' 7' r� 8' 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED CD � INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP- HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity -(O0C) gals. Type Absorption Area Provided By �'�5' L.F. x 24" width trench; x 0 ..Other Name Signature r v Address SEAL P �� THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date 1/0 CD El (D FCD\�N4� Ea 34 Q caw 4 0 � ID u P4 0 d ID gl 0( a A U (D 4- �Ad �9 I p. �r 9 \�34— CD El (D FCD\�N4� Ea 34 Q caw 4 0 � ID u P4 0 d ID gl 0( a A U (D 4- �Ad �9 I p.