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HomeMy WebLinkAbout0446DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13.07 -1 -11 BOX 6 Lim 00255 V . F#' Fr 1.?!Lq r �+ 1 } i 1 .. 1 00255 R v: 3186 PUTNAM COUNTY DEPARTMENT OF HEALTH . Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Must Provide .P P.C.H.D. Permit N -- FOR SEWAGE DISPOSAL Located at P't.,ta R C> Ax> Owner /applicant Name Jd.MES QvSS t Formerly Mailing Address 3°J �-�La t.161E3ZFoR D Ke by Zip 10'31 O QtsTT BIZS 0 tJ Town sr- Allege Tax Map 1 Block w7 _ Lot of Subdivision NameC-*-6SS9 -'0 6ubdv. Lot # Date Permit Issued' 4. 13 • 9`7 SR_%A- tCL.i pp 1MAt aOP- R og31 Address 3q �'� � TtA gQt,e t;ec�.t Pt= M&0— Consisting of t�C Gallon Septic Tank and 400 L.P. A-Zt o Q2 PTt O IJ •'T)ee lJCH Water Supply: Public Supply From Address or x Private Supply Drilled by P. F' goAL- 0 So4S Address PO Bo k B,. BiZeSVJs q t I.IY Building Type RF,r�►�t --lJGZ Has Erosion Control Been Completed?—�ES Number of Bedrooms '4 Has Garbage Grinder Been Installed? ° Other Requirements I certify that 'the system(s) as listed serving the above premises were constructed essentially as shown on the Alans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulations, in accordance with the fvod plan, and the permit issued by the Putnam Cn SQrtment (*,Health. Oats Certified by P.E. x R.A. Address A3S0CtA ES iZT 5 ` License No. 2totf0� Any person occupying premises served by the above systems) shall promptly take such action as may be 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 pub! % - sanitary sower 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 Conlmissioriertuf Healtl ch revocation, modification or change Is necessary. By __ _ Title _ -_ I APPa1DIX C OR SUEOPTTiSICN Wr � / ' a_ SLS area lccr1- as b. Fl s2cticn - Dat=_ 2 : l tarrie :. LGrc = TN-_iTYMNo u P_VG _ DFrIr? z c_ i,sfiy, -rte so; nct striLCE d_ Sui:2� Z`L- il E`C_ cr" =tD1" ticll 15' _ Si�S era=_ e. 100 tat. t- f=Ctr wet=' CCL?r�c /'v"ctl c^ . �. S_cLic t:--n2< S­­ - 1,000 1,250 b. t— =k i sal' __'� 1_•74 C. 10' II`il?IEZs -rL i =�?R fC'_rr;z wt r!i ri 10 f z. Ci CS- berE e- D1S. R - .:LZIGLN EC!X 1. P? ll cLt1= s at e el e=rGticn - wa = =r test = -H 2. Prot=r= be=.cw f_cst 3. I1i 1iT .Lu 2 T_- CriC_T =I soil t=�riee bcX a ^G t=__C �5 f. J-L7N, • ICN EOX - crc=_1-v pet c Le_ctt ias t=2. 2. Distac= �o wit= :�=- 3. I-i_t =l ± ac =r: nc to plan C Dis`nC°_ can_ta-_ to can-L?- J 5. Sloe cf tancll acceot able 1/16 - 1/32 6. 10 feet f_=. crc_ertv line - 20 t =an_ch < 30 2=sG1c5 fiC�i surface 8. Rccm alicwa fcr e.K'...ansicn_, 50% 9. Size of craval 3/4,- 1 ;" Game= r 10. cen t h Oi c-m Z in trench 12" jam; n i riotii L. Pict ends cncer h. P�32- CR LOSE SrSTEYIS 1. Size of r.L"i7 ch:-_mher 2. ow tank 3- Plarml, yil sua /a"_i o d P' ,w easil v ac =_sill e rral -- of e to CraCe 5- First bcx ta= =lam 6. cvcle w1 `r'es_=.'- ; tv E�`l trl EECc_? men-It est1_rrcted f low car CJCI e rT. FOUEE a. EcLe lc=.ta r acorcv pla_rls . b. Nom. cEr c= V. TV= a. W-e l 1CC?t a5 rez cCC_ roved D_1_ns b. Di stance frcm EDS arm. Meas-� f t_ c. C___ng 18" a=v_ c-a -- Q- sur face crcu- d WZl cCC °C�DZz _ 4 I . C -, i a?AlL W13 Ma S =� a. ECX°s rCCcr 1 v C ' -"CLIP b. All vi=es bac filled c- All pises f L_, 'w_i'"l inside of tc_ c. Eack=-ill rrater•ial ccr_t =ins stone < V 'n E. C? ��' -_'Zl �?-a- rl Z'c -=l l cr' accord nc DI rl f _ C'ar t_ in Crain & Ci:.to C. FCCt? nC Crc ?_ -S C__ °i=:r C? GthGy f =CT SLS ar= h. su= -ace wcC�T C=C.r=f =1c^ aGezl''_ � = i_ Errcsicn C'nt_-C.1 Crcv_C'_-'V'' cn slcces C:`t`r' 3. 1;gmes J-j a e Owner or Purchaser of. wilding wilding Constructed by Location - Street Rihicipal.ity S f-� Ai Ld a 0 w �� I Building 1 -1 9 Section Block Lot e,C o rS'�o d.- cis Subdivision Name, Subdivision Lot # GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent .that I am wholly and completely -responsible for. the location, workmanship, material, construction and drainagg 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'.prop.erly'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 Envirori rental` 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 S_er�-, 19 Signature.. r Title eral Contractor,.,(Owner) - Signature Corporation.Name (if Corp.) 3i 110h6�� -�, - Address - — - rev. 9/85 mk Corporation Name .(if.Corp.) Address �r «rc �J�' ix����,r, n1•� ��lsiv BREWSTER LABORATORIES Box 224 - BREWSTER, N.Y. (914) 225 -2072 - WATER ANALYSIS REPORT,' - SAMPLE NO. 6x66 SOURCE: James Rossi Patterson. Hose Bibb - ''dell COLLECTED: !august 11, 1987 BY: P. F. Peal &. >ons, .Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF. Method 0 per 100 ml. . This .result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. .August 15, 1987 Roy ickwit P.E. . / Director .. ....,v - -..- >, -, -f, r n ;,vv ...... _. :: ''.r -!vr. a. _._ r -: �, .°'Px :eYYX��Tnir Tri ---• _ _ . - - . PUTNAM COUNTY DEPARTMENT OF HEALTH 86 eer to Provide Permit p 3/ 1 _ Division of Environmental Health Services. Carmel, N.Y 1051? E>� on CERTIFICATE OF COMPLIANCE' CONSTRUCTION PE FOR'SE DISPOSAL SYSTEM ' Permit `.'N s Patterson Located at_ 'Pan Road . Patterson Town -or vine . Crossroads ,Rossi g 1,_ 7 g Subdivision Name Subd. Lot # Tax Map Block Let, Jose h James Rossi Renewal_0 Revision ❑ Owner /AppUcaat Name . p Date of Previoas Appioval• Briarcliff Manor 10510.. Mawng Aaaresa 39, Hungerford Road Town zip 40484.+/- SF Bun.ding Type 11 Fami.hv RAS _ Lot Area 1111 Section Only Depth ` Volume Number of Bedrooms! Design Flow G /P /D 800 PCHD Notification Is Required When Fill is completed, 125 '400 LF of 2' wide trench Separate Sewerage'Syetem: to consist of ,1250 Septic Tank and To be constracted,by to be determined Addross water Supply: Publfe. SapPIY From ' Address or: X Private Supply Drilled by. t0 be de t, ----Address other'Regtirements 2' :ROB, fill `-(ave)'. (380 CYO represent that i am wholly and completely -responsibie'for the design and location of the proposed sysfom(s),; 1) 'that the separate sewage disposal 'system above described will be, constructed'as shown'on the,approved amenciment there to and. in accordance with the standards, rules an , .regu a wns o eHealth .. Putnam County' Department of. ^Health, and'that on completion thereof a "Certdicaie •.of Constru'ct' ion Compliance" satisfactory to the Commissioner;of will be subrriitted 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 thedatebf 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 showh on the approved plan and that said well will be installed in accordance with the stand S. rules and regu a iTf one s of the Putnam County Department of Health, Date Signed' " P.E. X R.A. -- Cashin Associates:, C. Rt arl�el NY 10512 26008' Address T�i� _ License No APPROVED FOR CONSTRUCTION: This approval expires'isae year- om thO date •issifecl .unless construe n of the building has been undertaken and is revocable for ca a or may be_amend r modified when cohsidere" etas byte' mmiSSiO r,.Of, Ith. Any Change alteration O} COnftIUCLiOn reouires a ew ermi A rovetl sposal of domestic sanit r .se e, and/ at r 4p -only. Date By Title — (Nam of Owner) REVIEW SHEET - CONSTRUCTION PERMIT DATE REVIEWED: BY: (Street Location) DOCUMENTS ''ON�1E'N'PS YES ENO I r IF trench provided `,. �fi ` V. required 60 ft, max.'" Parellel to contours' ..�" r� ✓ as A:F ffN i i a Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth .Q' l(_ t 7, r s/s SUBDIVISION Perc (3) Fill ?,,/ cd House Plansr ` Two sets Well,-,,---' permit; PWS letter Variance Request Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Tcwm /DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump'pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data: perc and deep results Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter,Cartain Drains (discharge Ox) Perc &Deep Holes Located Representative of primary and expansion Expansion Area; she wn; gravity flow, suff . size If Pmped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells &. SSDS's w /in 200 ft. of Proposed Systems Property Metes & Bounds House Setback Necessary (Tight lot) 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,Top of fil' 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits ! 100' to Stream, Watercourse, Lake (inc, expan 15' to Drains - Curtain, Leader, Footing 351to catch basin,stormdrain, iped waterccurs:. 10' to Water Line (pits -201) 50' intermittent drainacre course Septic Tanks 10' from Foundation; 50' to well 15' Well to PL 0 jr I+ 1 + DEPARTMENT OF HEALTH 4 Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL �% PCHD PERMIT #&O s WELL LOCATION Street Address Pon Road Town/Village/City Tax Grid Number Patterson 1 -7-9 WELL OWNER Name Address Joseph & James Rossi- 39 Hungerford Road Briarcliff Manor APrivate O Public USE OF-WELL 1 - primary 2 - secondary . )R: RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP ❑ BUSINESS O FARM ❑ TEST /OBSERVATION 0 INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY O ABANDONED ❑ OTHER (specify O AMOUNT OF USE YIELD SOUGHT min 5 gpm /# PEOPLE SERVED 1 Fam. /EST. OF DAILY USAGE__&aD___gal REASON FOR DRILLING NEW SUPPLY ❑REPLACE EXISTING []PROVIDE ADDITIONAL SUPPLY O TEST/ OBSERVATION SUPPLY ❑DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING New Residential Supply WELL TYPE ®DRILLED DRIVEN E]DUG GRAVEL []OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Crossroads Lot No. WATER WELL CONTRACTOR: Name to be determined IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: NAME OF PUBLIC WATER SUPPLY: N/A Address: YES X NO TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: Greater than 1 BONA LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED c,US j• CgSyfFF� ❑ON REAR OF THIS APPLICATION• ©0 4ARl�� (date) s g __ *e)) F PERMIT �F r °: ,5 ^ ^. f: 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 rartmej 1 CoIt etion Report on a form provi ed. the Putna County -Heal th a Date of Issue: 'J 19 Date of Expiration: 19 Permit Issuing 0 fici Permit is Non - Transferrable Y+ DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner -:�C-os&(�l� « - s'ames, Rossi Address 3q HttrLQef -brd Pc( Qrtc:rcllo Located at ( Street) �'a„L R o c,-d Sec. I Block -7 Lot 2_ (indicate nearest cross street) Municipality L =�So.1 Watershed Cro to 41- SOIL PERODI,ATION TEST DATA RDQ[T.L M TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking gpr•t j Z Date of Percolation Test 0,,or d 3 '?7 1Z 22 2S HOLE 5I° -L-1 - 2 NUMBER Cl= TIME PERCOLATION iZ 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 , ?-'s4 - 1: 0 9 1 12'10. -12=12 1Z 22 2S 3 5I° -L-1 - 2 12;23 -12 -'35 iZ 22 C 3 rZ= 37- 125 z 4 , ?-'s4 - 1: 0 9 2 S 5 1t(0 -- 1-' 25 15- 22 2c4 .3 1 12.'/5-- 11,2-7 r Z 25- Z g 3 2 I,Z- 'k6 -Q-4 3 IS '24 2-7 3 S 311:44- I. 0>� i'� 2+ 27 3 4 1'O3 -- 1:Z1 rg Z4 y2 2,71 -3 6 5I° -L-1 - I.qO tf? 2 �2. 27 Z 7 C 1 2 6 --2 mto 111n 3 4 5 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 TEST PIT DATA RDQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. if 2' 3' 4' 5' 6' 7' 8' 9' 10' 11' 12' 13' 14' owl WER-55M on. 139 0-0 pic •' INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER.BEING ENCOUNTERED Per.- res F —) OBSERVATIONS MADE BY: T�> DATE: -- DESIGN - Soil Rate Used Min /1" Drop: S.D. Usable Area Provided 5—coo-6 No. of Bedrooms Septic Tank Capacity I;.S0 gals. Type wry Absorption Area Provided By Opp L.F. x 24" width trench �JS`;�Nr� O Other 2 R O D fill � n J e') -- r,�` Name Ls k „v�, Signature T� �- "• • `® `� Address 2 S- 2 SEAL o a t F /hk C"-f (A r THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date !4 AAA it W 14" .� Wyl'- fi N'O OWN ANAlmys ....0 vQW-Owl-An A e �Z ........... --------- doxy Yt W, S. ;ks,�, A -5--Ma 0 r Von, J Sy .......... OW "WO Moto "W". ly SYS A"A W Aj of VA, Ow Ar