Loading...
HomeMy WebLinkAbout0576DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -1 -40 BOX 7 00576 �� : T yea 016 r ., 1 V �. � ,- i �.: Ll Ve #p Lr 00576 - - - PUTNAM COUNTY.DEPARTMENT OF HEALTH Rev. 3 Dlvision.of Emv_iroumm�tal Healtb"Services, Carntel, N.Y 10512 „. Engineer Mast provide 3 —$Z CERTIFICATE OF, TRUCTION COMPLIANCE FOR SEWAGE DISPOSA]AYSTEM ice, .T. T iZSo :% Totvu Located at Co iZV W +%LL Hit-(, i2 D ... 'T'E 1 (c; 4 Tax Map Bloc Lot Z u CoRNWAti -t. 414L �?RA,wHt -L P21Df,6 'r Owner /applicamt Name �'� � &rM% ' -. 1'1`► G , Formerly Sabdlvisloii Name � � 5 Subdv. Lot NJ Melling Address Z.Z 3 i< A j'o ►.y />, Ave- Zip 1 O� 3 �c Date Permit Issued Separate Sewerage System built by A, Fc S E P r 1C_ Sys r f; Fr)-- ) N G • Address' ►PI o , ?Y2k ) 4 / t L2o��5 �i�16 i� /.�]+ i'o )'3 Consisting of f � ' O Gallon Septic Tank and 4 O D L , I'. A S So J3 rJty ti T f2 � M C. H Water Supply: Public Supply From p Address or•. Private Supply Drilled by. ,3T� t`tl� tiy�' Address 9® eVc.KSwRoc. lzp. ToM.KiJLY taV&, Jvy Buildhig Type IZrge5 t D6N'T 1 L. Hue Eroelon Control'Been CompletedY Number of Bedrooms Has Garbage Gripder Been InstauedY O Other Requirements I certify that the systems) as listed serving the above premises were constructed essentially as shown on t�la the completed work ( copies of which are attached), and in accordance with the standards, rules and regu ations, in accordance with the d the permit issued by the Putnam County Department Of.Health. - - Date Certified by ... P.E. X R.A. 4 w Add►eAddress 1 CUV ZS6 Ice se No. Any. person occupying premises served by, the,SbOve,system(s) shall`, promptly take such action as may be necessary to,securs the correction 'of any unsanitary conditions' resuiting' from such usage. Approval.of the separate awe ►'ago system shall *come null and void as soon as a pubs!_ unitary sewer 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 r change when', in the Judgment, of .thhee Commiisi6gor of Health, such revocation, modification or change Is necessary. oat Title n WELL COMPLETION REPORT Office Use Only —� DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH STREET AOORESS: _-rOWNIVILLAG1101Y TAX GRID NUMBER: 0 j, 6 �8 ) WELL LOCATION ® ,e iftL ko NAME: ADDRESS: BIVATE WELL OWNER , . /�J'7iS Zz3 j�•✓�- yat,,,a� .�� it., Q PUBLIC USE OF WELL ESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP p ABANDONED 1 - primary ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) 2 - secondary ❑ INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY p MOUNT OF USE YIELD" SOUGHT gpm. /N0. PEOPLE SERVED �� / EST. OF DAILY USAGE ' gaf. REASON FOR &<EW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST / OBSERVATION DRILLING ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 60 ft. STATIC WATER LEVEL _Zs�k ft. DATE MEASURED IX-1,0 DRILLING OTARY PRESSED AIR PERCUSSION ❑ DUG EQUIPMENT ❑ WELL POINT 0. CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED, ❑ OPEN END CASING. OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH CASING LENGTH.BELOW GRADE DETAILS DIAMETER WEIGHT PER FOOT DIAMETER (in) SCREEN DETAILS FIRST SECOND / GRAVEL PACK 1 ❑ YES GRAVEL O NO SIZE: WELL YIELD TEST MEWO: ❑ PUMPED OMPRESSED AIR O BAILED ❑ OTHER WELL DEPTH DURATION ft. I hr. min. 7" If detailed pumping tests Were done is in- formation attached ?. ❑ YES ONO DRAWDOWN YIELD ft, gCm. WATER ErCLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? ❑ YES ❑ NO ANALYSIS ATTACHED? O YES ❑ NO PUMP INFORMATION TYPE 55t6" CAPACITY MAKER 624)"_2S' DEPTH "o VOLTAGE ZZO HP ft- MATERIALS: M-fTEEL ft. JOINTS: ❑ WELDED in. SEAL: ❑ CEMENT GROUT 7 Ib. /ft. I DRIVE SHOE S ❑ N SLOT 512E LENGTH (ft) DEPTH TO SCREE D PLASTIC 0 OTHER BREADED ❑ OTHER NTONITE ❑ OTHER 0 LINER: O YES ❑ NO N (f t) DEVELOPED? ❑ YES O NO HOURS DIAMETER 70P BOTTO61 OF PACK in. DEPTH ft. I DEPTH _ It more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. DEPTH FROM Water Well SURFACE Bear- Dia' FORMATION DESCRIPTION ft. It. in9 In* Land i. � �����if✓�� �:l�jr dE-6C% Surface It. G70E fj r k STORAGE TANK: TYPE_V7P-07_- CAPACITY GAL. WELL DRILLER NAME ' F�� g° C4C ,,, �S -AW4_% OAr �y f.� �xk -Z 4o / %/ � / ADDRESS SIGT ".des tea$ , f• fj r k COUNTY OF WESTCFIESTER E-11 Rev,86 DEPARTMENT OF. LABORATORIES- AND RESEARCH S VALHALLA NEW YORK 10595-, = dg BACTEFi'IAL EX,44INATIO4 OF pRINKING:AND TREE WAxER , ,4 #� Lab �Io W ­ o ' LaD No;ENT Date Colld> -E ` ���' Time - } Time Set w Time Submitted Tests (Circle) SPp �Cofifo '�f - C oliform•Membrane Fecal, Other � t ^• { / t Agency Coli'd for - p Coll d from Neme �_ rr r' 3!f } + i Roll r Addf @Sa a ri ai l�lt7:r' }y:ifT /.e� ``£ ' (si nq;l ICq, To. v,n/N�lt� _ 12jpC�3ICweIVV .I 'fit f Ideniihcation o1 Source _ _- - Sampling Point within Premises 4 L, ';f c1 - Retrigerated� 'Chlonnated� Ves9 No a Flee mg /I Toral mg /I -pH - RE §UL7S'OF EXAMINATION' OF` WATER 3 MPN /100 ml-, ' Standaid Plate Count �4 'Bacteria -per ml (48 hr ) C-pliforn Group Membranb Method /100 ml. Number Posihve Tulles Toial Coliform Fecal_Coliform Other These results indicete aainple was wea riot) of ~ Reported by Date satisfactory sanitary quality wham a sample was 3 n ^ i 3 IV. V. VI. APPENDIX C FINAL SITE INSPECTION Date / InspkEed CWNER - �-S; 7 9M # OR . SUBDIVISION IOT 4 y.- - C CMMEDiTS SEWAGE DISPOSAL AREA a. SDS area located as per approved plans x b. Fill section - Date of placement 2:1 barrier- LGTH WIC7I'H AVG.DPTH c. Natural soil not stripped d. Stone, brush, etc., greater than 15' fran SDS area. e. 100 ft. from water course /wetlands. SEVaGE DISPOSAL SYSTEM a. Septic tank size - 1,000 :1,250 b. Septic tank installed level c. 10' minimum from foundation d. No 90° bends, cleanout within 10 ft. of 45° bend e. DISTRIBUTION BOX 1. All outlets at same elevation - water tested .2. Protected below frost 3. Minimum 2 ft. original soil between box and trenches f. JUNCTION BOX - properly set g. MKS 1. Length required - I.,--n : installed-:�� ' 2. Distance to watercourse measured: ft. 3. Installed according to plan 4. Distance center to center 5. Slope of trench acceptable 1/16 - 1/32 " /foot. 6. 10 feat from property line - 20 feet - foundations , 7. Depth of trench < 30 inches from surface 8. Roan allowed for expansion , 50% 9. Size of gravel 3/4 - 11" diameter 10. Depth of gravel in trench 12" minimum 11. Pi' ends capped" 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 flow per cycle HOUSE a. House located per approved plans. b. Number of bedrooms -< c- WELL a. Well located as per approved plans b. Distance from SDS area measured c, ft. Sfi c. Casing 18" above grade. y d. Surface drainage around well acceptable. OVERALL WORKMASHIP a. Boxes ro 1 outed b. All pipes partially backfilled c. All pipes flush with inside of box d. Backf ill material contains stones < 4" in diameter e. Curtain drain installed according to plan f. Curtain drain outfall protected & dir.to exist. watercourse g. Footing drains discharge_away fran SDS area h. Surface water protection adequate - i. Errosion control provided on slopes greater than 15 %. ' 77� S 7 7 � n- {' tk P,UTNAM COUNTY DEPARTMENT OF HEALTH Dlvision'of EnvireumenUl Health Seirylces Ct emel N Y.105 Engineer O provide Permit tY oa CERTIFiC TE' F COMP CE PWGtMg type • r ��••�•_j�,•• Lot Area .� • •• • `– rw section UNy I L' Depth Volamo' Number Of Bedrooms Design Flow G P D �%� ` PCHD NotlOcatiouas Required When FM le rnmpletod , Separate Sewerage System to rnnset of ?- Gallon Septic Tank To be constrtiMed by'' 7- .,C�',r%'�%i /i{%.D Address . i Wat6r.S4,013 `` PaBilc:Supply From Address onPrlvate Supply DrOled by /� % � Address Other Renuiremeats ' 1 iepresent.�that 1 am wholly and completely respon sib 16 for the design and loutiOniof: the proposed systems) 1) that the% separate sewage disposal system above described will be constructed as shown'on the approved amendment there ao and -in accordance with the standards ,rules an- regu # ions o e u nam County Department oP..Heakfi ; -'antl that on completidA thereof a .Certificate -.,of ConttiuctiontCompliance satisfactory tome Commissioner of Hea_lihwill be submitted -to the`, Department; and 'a: wntten.guarantea, -" be furnishetl.,the owner, h�ssuceessors;'AeHSor issigns by the Duildor, that-said,.builder- Will puce n good operating'eondition any?part of said sewage ,tlispossl'system dunng,the.period'of two(2).yearsimmetlutelyiollowi4q itedate of tfie issu- ance of the.apDroval o "i, the Certificate =,ot Cdnstruct�on Compliance_ of he or�gmal ystem or .any :repairs thereto;2) that the.drillad; wall tlescritrod above will De located ai shoavn on the approved plan and that said well wJl be ins a etl in accordance with the it der rules antl ,requ aaTf'ons of the Putnam County Department of Health c a' Date,:: /, Signed R.A. Address ;. APPROVED FOR CONSTRUCTION This aDprovai expires tw.o yeas 'from t date slued unless. construction ;of `the building has "been undertaken and is reyocaDle' /or,`cau .or, mq amended or = modified, whencoris�dare neces `?Dy Y om iss' i of eatth.: Any ' change or. alteration of construction reQuires a new ermrt proved for disposal* of domestic' saint ry ge and a 87 Data BY Tula�V E:�1 ti Cif 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 #j P-3-3 � WELL LOCATION Street Address ?t:�i�/fiQ� Tow Villlp�age� //City / Tax Grid Number /•��v �/ WELL OWNER Name Mailing Address 7 Private zsr�l�•� 0 Public USE OF WELL primary 2 - secondary aRESIDENTIAL ® BUSINESS O INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify O INSTITUTIONAL O STAND -BY El AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED :3- ,_5_ /EST. OF DAILY USAGE gal REASON FOR DRILLING KNEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION ❑REPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING .S ��✓��C�= WELL TYPE DRILLED 1 344 DRIVEN ODUG ®GRAVEL El OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 4 /!/.lJG7 Lot No. 1112 WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE :. YES A( NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:�� LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED O ON REAR OF THIS APPLICATION SEPA TE HEET (date) ( gnature 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 pro id d th Putn o n Health Depa ent. i Date of Issue: 19 mit I'ss ng ffi cial Date of Expiration 19 Permit is Non - Transferrable to copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner 287 orange copv: Well Driller LF trench provided required 60 ft. max. P^ el. to House Plans - Two sets Well permit; PWS letter Variance Request GENERAL Legal Subdivision Subdivision Approval Checked. Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DEPAIIS 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, i 'Yell Detail, Serv.ic i e i over nstruction Notes Design Data: perc d results Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If Pumped 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 45° w /cleanout i SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L.., Driveway, Large Trees,Top of file 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,piped watercours 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' from Foundation; 50' to well 15' Well to PL d ` REVIEN SHEET - CONSTRUCTION PERMIT }" y DATE BY: R4VIEWED (Name of Owner) Ica .NTS (Stree Location) YESJ-A I YES, - Dods Lo _ Permit Application Corporate Resolution Plans - Three sets s/s ✓ Engineers Authorization Design Data Sheet (DDS) SUBDIVISION Deep Hole Log Perc g: Consistent Perc Results (3) Fill Perc Hole Depth cd LF trench provided required 60 ft. max. P^ el. to House Plans - Two sets Well permit; PWS letter Variance Request GENERAL Legal Subdivision Subdivision Approval Checked. Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DEPAIIS 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, i 'Yell Detail, Serv.ic i e i over nstruction Notes Design Data: perc d results Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If Pumped 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 45° w /cleanout i SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L.., Driveway, Large Trees,Top of file 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,piped watercours 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' from Foundation; 50' to well 15' Well to PL d PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services AFFIDAVIT - CORPORATE OWNER APPLICATION FUR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health In the matter of application for: CEIVED Cornwall Hill Estates, Inc. I, Kenneth Emerson '87 APP 22 P 2 :17 represent that I am an officer or employee of the corporation and am authorized to act for Cornwall Hill Estates. Inc. (Name of Corporation) having offices at 223 Katonah Avenue Katonah, N.Y. 10536 Whose officers are: President: Edward H. Emerson, 223 Katonah Ave., Katonah, N.Y. 10536 (Name and Address) Vice - President: Kenneth Emerson & Martin Diano, 223 Katonah Ave., Katonah,N.Y. (Name and Address) Secretary: Janet G. Mastropietro, 223 Katonah Ave., Katonah, N.Y. 10536 (Name and Address) Treasurer: Lynne Diano, 223 Katonah Ave., Katonah, N.Y. 10536 (Name and Address) and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. /j y Sworn to before me this % day Signed: /u• of 1 19 V Title: Notary Public .LIONEL V,1EINSTEIN Votary Public, State of New YDW No. 60. 4199160 Qualified In Westcliwter CODA. , UbrAniss�h- Expires Morc:h 30,19 8/84 'Vice President Cornorate Sea I'U`'NAM COUN`!'Y DLPARTMENT OF ]U?AU`rIi i1i V l:il UiV Ui , i;1V VIR01w,16111'AL HL.AiA'H SMiVICES COUNTY OFFICE BUILDING, CARKEL, N. Y. 10512 DE31ON DATA SHWI'- SEPARATE SEWAGE DISPOSAL SYSTEM PILE NO. AQSO , }�1.1�. -tO'S8 u�rtie.r �-O �, Addresa�{�j C'�i.�'t'(AA. , �, 'Z �Located at (Street �'` �.� Sec . ('� B1 oc k Lot�earest cross areet:7 MwLicipality j"T�(Z Watershed �Q�"n�� SOIL PERCOLATION ` EZT DATA REQUIRED TO BE SUBMITTEb WITH APPLICATIONS IIuT� Nwnl -r CLOCK TIM13 PERCOLATION PERCOLATION WWI Nu. -Start -Stop kUapse Time Min. Depth to Water From Ground Start Inches Surface Stop Inches Water Level in Inches Drop in Inches Soil Rate Min. /in drop 50 ::_.. 2 1 4 5 . t -0 ' .1 L•. NULun: 1) 'rests to be repeated at same depth until approximately equal soil rites.are obtained at each percolation test hole.. All data to be submitted for -niv 1"•w . ' % .I )th meas.urement:3 to he made; from top of hol e . UL•'P`1'H 6 TEST PIT DATA REQUIRM TO BE SUBMI'711M WITH APPLICATION i)E6Grurl'.1uN Of" SOiL; IN Th;61' BOLLS HOLE NO. �_ ROLE NO.� HOLE NO. G. L. 61' 7TQ eaQt� 12" 18" 2411 ) It 36" 4 211 i� �of 'I-A 11 ll..•r 11 vlt 1 N1)1 CATER; LEVEL AT WHICH GROUND WATER IS .ENCOUNTERED . I ND IC A`PE�E LEVI ;L TO WHICH WATER LEVEL 'RISES. AFTE13 BEING ENCOUNTERED TESTS . NE )W BY R. to Date_ •:. L DMIGN Soil 'Rate Used MirVi "Drop: S.D. Usable Area Provided S°oa® �.F. No, of- Bedrooms ii Septic Tank Capacity 9 ® ® o` Gerl�; N►1- �e Absorption Area rov d� By g o L.F.x24" -` `c t1- rencT1.1 Nanx� ,v gna u e z Address Zx> t �E SI�I! N. U 04 %b. THIS 'SPACE FOR USE: BYMAUM DEPARTMENT ONLY: ® boll Bate Approved Sq. Ft /Cal. Checked by bate R ECC,. 6 I ED PUTN DEPT A F �-OUNTY HEALTH 4 F7c- -7 -,�>U,77--1 . A ce, - As E5U I L,-r 1--, 50, r7 Spa A5-I-,5UII -'( t�IMENhION� GNA12`( Nell A P> 1 22.5" G7.5' 2 35.0' Goo' 5 X9.5' X3.5' 7 62.0' 35.d 8 GO.0' 3 82.0' IOS.O' 10 90.0' 105.0' I I 92.0' 101.5' 12 94.0' 90.5' 13 O1S.Q' 9G.0' IA G V 16 co 1.5 " 90.0' I.. A5 SUII,T i iNl� I� TD GG2TI�( THAI THE �GN/AG(i I%1�1�0� 5�l5TEM WAy INDIGA'itid ON 'fHly t7t,AN AND -(HAT <HC,- INSpE 0',( M5 13Et/o2t: l'( WAS GOV5�IZOW O\I>i1Z . THE s W,q� GON�TiZUGTI:D tN A6609- t7ANGE WKH AV STANDAtZD RULES ANA THE r,V-fNA M GO U IJ'CY P VWA RTM E NT O F H C-,A vrH A N t NSW YOIZV- OF HV--A,(H. NOTE' HOUSt✓ �OG/�'ftON '�P�KEN Ft20M "BUR P20PERL1'{ " OF LO'( I � P12>it�Al2En X012 KATOr G�06E t�ATI:D I - �- 8�, pt2>ipA121:D 01Y 1?,UNN A��OGtATES, IP�Nt� S��zJEYDt2S .