Loading...
HomeMy WebLinkAbout0582DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -1 -46 BOX 7 INN 'IT�. '.� u� IN i■ ��-i .� . 1 . ■ I. I !T f f 4� J 11 :� aUwu - . Located ac C.otzuwALL. H ),.L i21� �.� 1 c�4 Ta='MaP c oi{1Ji7�/>~l.i. i} ►4L. CaUJ4WArt— ...:RIT�Cct Owner /appllcant Name �'�7T Tom* t 0' ` Formerly Sabdivldlon Name iAT S Sabdv: Lot k Melling Address 2 Z3 K'A'ro' AH Ave ; Zip Date Permit Issued Separate Sewerage System, buflt by Sl A ` F L-3 T t, c. 5�'�5_, i n l G . Address �a BoX f 4 i �'t2r��S R 1 "�rC it : NT 10� i3 Consisting of i Zoo Gallon Septic Tank and 4S O L c F, %485c52'R�" lulu �iZ�i IJ C l f Water Supply: Public Supply From Address or: X Private Supply Drilled by s y� j �'�'^� I Ll c Address 98 Sv Gi�ir3� 32� RD . ; b t n K i w� :. �o y iS'; /41/ Building Type ' A,(_ Has Erosion Control,Been Completed? A W j?RfzkLX55 . Number of Bedrooms 4 Has Garbage Grinder Been Installed? JJ O Other Requirements I certify that the system(s) as listed serving the above premises were construct essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulat a, in accordance with the ile lan, and the permit issued by the Putnam County Department Of Health. i �' ,a 'Certified by P.E. R.A. Date � . 18 j Address R l License No. - .^t Any person occupying premises served by the above systems) shall- promptly take such action as may be necespry to secure the correction of any; unsanitary conditions resulting from such usage. Approval of the separate :seweraga system shall become null and void as soon as a pubt% unitary gwer tNComei available and the approval of .the private water suppiY dial!- become null 'and void when a public water supply becomes available. Such approvals are suti)act to modification or change when, in the judgment of the Commissionarof Health, such revocation, modification or change is necessaiy. Date ��6�c —'� Si /. 5O 9y - N w I Cn►. a .e WhLL UUr1r1,L11UN rlrvni DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only STREET ADDRESS: WNIvII I Y TAx GRIO NUMBER: � ,,�+ � , /,� P1j77: xq 4 . WELL LOCATION WELL OWNER NAME: ADDRESS:VATE /� � Zz, 3 -dke O sk,"40 - ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary ESIDENTIAL ❑ PUBLIC SUPPLY O. AIR /COND. /HEAT PUMP ❑_ABANDONED O BUSINESS O FARM 0 TEST/ OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE fro gal. REASON FOR DRILLING EW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH ��� / ft. STATIC WAFER LEVEL 166 ft. DATE MEASURED DRILLING EQUIPMENT iOTARY OMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED ❑ OPEN END CASING. ga'0EN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH �� fL MATERIALS: �TEEL O. PLASTIC O OTHER LENGTH.BELOW GRADE ft. JOINTS: O WELDED (THREADED ❑ OTHER DIAMETER — in. SEAL: O CEMENT GROUT lZBENTONITE ❑OTHER WEIGHT PER FOOT .— 1b./ft. -1 .DRIVE SHOEWYES ❑ NO LINER: ❑ YES ❑ NO DIAM ER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? SCREEN DETAILS FIRST 1A O YES O NO SECOND HOURS GRAVEL PACK O YES ❑ NO GRAVEL SIZE. �/� DIAMETER OF PACK in. TOP DEPTH tt. BOTTOM DEPTH It. WELL YIELD TEST It detailed pumping METFjAO: O PUMPED 1 tests were done is in- % @rCCOMPRESSED AIR r formation attached? O BAILED ❑ OTHER ; ❑ YES ❑ . NO WELL LUG It more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear- in9 wen D'a' neter FORMATION DESCRIPTION CODE. ft. It. WELL DEPTH It. DURATION hr, min. DRAWOOWN It. YIELD, 9M Land Surface 400 14 3 WATER 6<1AR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? O YES O NO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY 5� GAL. PUMP INFORMATION TYPE (5V16 CAPACITY, MAKEA � � DEPTH MODEL? VOLTAGEZZ HP 0AOOR ESs L DRILLER NAME slcr , . COUNTY OF WESTCHEBTER DEPARTMENT OF LABORATORIES AND RESEARCH j E 11 Rev 86 VALH k< ALLA NEW YORK 10595, F BACTERIAL EXAMINATION OF DRINKING ANO TREATED WATERS `'..Lab No.W it t'a "y -Bottle No z Lab No ENT �� t Date 6011 'd Ime f r k, f y Time Set ' �TimeSubmltted; .Tests (Circle). SPC, ohform MPN Coliform Membrane Fecal, Other 1 'Coll li by Agency COII d for r „mfr'r.A 9 + tjT. i Gdlt d from; Name � ; � ✓� m ' �f J� IFi 1 Address 1�1 r� ��i 2 # �° .. �� Rd. F ICM o .. 4 f f q .IZlo ceMl�- / ICs ty) Idant+ficat+on of Sourcefeia� j1 K ¢ .Sampl+rtg Point wdhn Premises!' +�+'t Raingerated�y :- thloriaeted? as 0 No o.Free ti`" mg /I Total ' mg /F pH RE §UCtSOF EXAMINATION,OF WATER ` MPN /t00:m1 Standard Plate Count Bacteria per ml.,'(48 hr ) -Coliform Group. Membrane-Method /100 ml £ Number Posltrve Tubes Total Conform Fecal Coliform '- `.• Other< These results indicate sample (was was not) of Reported by Date satisfactory sanitary quality when the sample was x: collected �� t }%^ 1 ml PurNAM cowry DEPARTKE tqr of DIVISION OF MrIMN24EMAI. Katonah Closp ranstrnctinn Cn. T_nc. 15 6 F2 Owner or Purchaser of Building Section Block Lot Katonah Close Construction Co. �1 Building Constructed by �U lJ(i1iFi iC('C�� off Cornwall. _Hill Rd. Location - Street Patterson Municipality Residence Building Type Cornwall Ridge Subdivision Name Subdivision Lot # GUARAb!)?EE 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 descri bed. property, and that it has:been con structed.as shoran 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 pe 'ri od. of . two: - years immediately following . the. date . o f approval , of the "Certificate o Construction Compliance "' for th`e 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 liilding utilizing 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 operate was caused by the willful or negligent act of the occupant of the bu' ding util' ng the system. , V Dated this j % day of IJOV, 1997 Signatur _-% /'X f/ / <Z­4 Title .4 "o v Construction Inc. 223 Katona.h Ave., Katonah, N.Y. 10536 rev. 9/85 mk :ess "i-'z -c. on Name vi f(�C/orp. r II. is IV. V. VI. APPENDIX C FINAL SITE INSPECTION C i OWNER 9M # OR. SUBDIVISION LC T # Date ///.? / �. Inspected by r YF-C NC CCMEWS SEWAGE DISPOSAL AREA a. SDS area located as per approved plans b. Fill section - Date of placement 2:1 barrier. LGTH WIDM AVG.DPTH c. Natural soil not stripped>( d. St- ne, brush, etc., qreater than 15' fran SDS area. e. 100 ft. fran water course /wetlands. S9QGE DISPOSAL SYSTEM a. Septic tank size - 1,000 1,250 b. Septic tank installed level c. 10' minimum fran foundation X d. No 900 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. TRENCHES 1. Length required - ��� L-e-rigth installed 2. Distance to watercourse measured: ft. 3. Installed according to plan 4. Distance center to center (o 5. Slope of trench acceptable 1/16 - 1/32 " /foot. 6. 10 feet 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 - 1j" diameter 10. Depth of gravel in trench 12" minimum f- 11. Pi' ends capped h. PUMP OR DOSE SYSTEMS 1. Size of puffp chamber 2. Overflow tank 3. Alann, visual /audio 4. Pum easily accessible manhole to grade 5. First box baffled 6. Cycle witnessed b "Health Department estimated flow per cycle HOUSE a. House located per approved plans. b. Number of bedrooms WELL a. Well located as approved plans X b. Distance from SDS area measured ft. .'T r v y c. Casing 18" above grade. d. Surface drainage around well acceptable. OVERALL WORKMASHIP a. Boxes properly grouted b. All pipes partially backfilled c. All pipes flush with inside of box d. Packfill material contains stones < 4" in diameter ,x e. Curtain drain installed according to lam f. Curtain drain outfall protected & dir.to exist.watercours g. Footing drains discharge away from SDS area VIT h. Surface water Protectio n adequate i. Errosion EEn—trol provided on slopes greater than 15 %. im V" PUTNAM COUNTY "TMNT9F HEALTH M iierto Provide ' W Permit Y qq 1 .` sonorvionn ft . (`V.RTMCATE OF tONOt"MCP akovq aescritiea..rm peconstructed-as snow n qn,lhq appro�yeq ar?jr!qmqnx inerp• to 'ano tn,,!iccor�da.nce wnwine. County' -,Department arid that on completion tl�ioieofa ',*.Certificate of, �Construction,comPiiirica,-` satisfactory to the Commissioner of. Healthwill es . sors I he . iirs o r�asiigns by th . -tiullderi that' sai6diliuilder W�ill - will �tiifurn ii&dd iheb��nai`his:�`Saic a I 6,ji i6briiitted'ib 'tAe-.Oepa!Jmqnt, and wr,iltan. quAra in good'.•iipelrating -condition -iny.,part zof said, sewage disposO,systern during the period bi two, (i)�,yeirs immediately following th'edate.of the issu- ance approval rqfl� a r any - y -�­ :will d ' 'fied above ance 'OVthe* a 1h - �&A'tifiiAte`­_of bonstr­ �i Tipil'i4qce.,of, the original. system or, repairs , there o; 2) that the drilhAd escri p with the stand ds!�)jeSr_ind.�,,ej__= w approved lar�4 'd th dai ce Pu a ions-, of the Putnam ill De ' located shoi�worviha7a 'r6 n at said iW611* I I accordance I . 11 0 ­ I , ''. I- -, , , 'i . . w b t County Department of Health Signed P.E. Date. L License No Address-7 Co l7 APPROVED , '�F6R.66NST'RUCTION:Ttiis:-app'rbvil-ekoirest�Av Years rom-'the' Oat Alisued, unless- construction 01 .the building has been 6ndertAken' and Is or 'of c nstr or. y he,,CoT is n I Any aitera revocable ff u?"r may-tio'a'!nended qi� rh6dified when con nec, chang tion 0 uction a domestic air e� v at y* only . , requires t . , prolved for disposal of i�m P Rev.. 1/87 Dat r"t -7, BY Title 10 F 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 #11391 WELL LOCATION Street Address Town/village City Tax Grid Number WELL OWNER Name lC ILL Mailing Address 1,_1L' . , Z,'3 OlFrivate O Public USE OF WELL 1 - primary 2- secondary RESIDENTIAL O BUSINESS . O INDUSTRIAL O PUBLIC SUPPLY O FARM O INSTITUTIONAL O AIR /COND /HEAT PUMP O ABANDONED O TEST /OBSERVATION O OTHER (specify, O STAND -BY O AMOUNT OF USE YIELD SOUGHT 57 gpm /# PEOPLE SERVED /EST. OF DAILY USAGES© ©gal REASON FOR DRILLING FREN SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION OREPLACE EXISTING SUPPLY 0DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING 1�LGw (Z�S j O WELL TYPE DRILLED DRIVEN ODUG O GRAVEL O OTHER IS WELL SITE SUBJECT TO FLOODING? YES ---'NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: e4P�lWAL (_. 1Z,iDGG ES-rl�-_6S Lot No. WATER WELL CONTRACTOR: Name -io Bc_ 'OEM 1MGn Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES '-"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 ON S P E SH T -7-61-8-7 (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 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 pe it. 3. Submit a Wel Completion Report on a form pro ide 'by t e P t a o nt Health Depa -r ment. Date of Issue: 19 Date of Expiration: 19 a it ssuing ffic a Permit is Non - Transferrable �-� copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner 2/87 Orancre copy: Well Driller . •.a+�r11 • h i• r �1• • 'i� 1�1 • :1 • : r •' • �i r' • ! IH+ Y• :1 : al` r Ir a r• r• al- • • . « a n e� r • •. • a REVIEW SHEET — CONSTRUCTION PERMIT Lk DATE MEWED: BY: �P nation) DOCUMENTS f Permit Application Corporate Resolution Plans - Three sets s/s Engineers Authorization Design Data Sheet (DDS) SUBDD Deep Hole Log Perc Consistent Perc Results _ (3) Fill Perc Hole Depth �d _ 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 DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit detail Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes (grinder notes) Design Data: perc and deep results Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gut*ter,Curtain Drains (discharge OK Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shawn;gravity flow,suff. siz If Pm ped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's Win 200 ft. of Proposed Sys Property Metes & Bounds . House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 "0; Type pipe No Bends; Max. Bends 45" w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Drive=way, Large Trees,Top of 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. e 15' to Drains - Curtain, Leader, Footing 351to catch basin,storrrdrain, iped waterc 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' ram Foundation; 50' to well 15' Well to PL PUTNAM COUNTY.DEPARTMENT OF HEALTH Division of.Environmental Health Services AFFIDAVIT - CORPORATE OWNER APPLICATION: FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health In the matter of application for: Cornwall Hill Estates, Inc. I, Kenneth Emerson represent that .I am an officer or employee of the corporation. and am authorized to act for Cornwall Hill Estates, . Inc . LIONEL WEINSTEIN Notary Public, Sato of. New YaM No. 604199160 Qudfied In Westchwier Countf. Ob mm[ssiofr Expires h1brNf 30, . t ? 8/84 - - -•:i t� '.:•.; f 1.: 'sr a s y:, ��as ..� � .�3 i7�t��YH e(t. ,�:�*ti �. �+ s -�k -w; Y?,;'fa, �C` y%t:,, 1LE °1GN -DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. (n+rid t'CCg.11nlLll.. L-1TES 1�.1 C. Address ZZ31Cl�To�lA\A Located of (Street KoA Sec. 15 Block C Lot2.1 hndleate neareat cross a ree Mwricipality Pxa1 ey,%Qr,1,, Watershed CjZA-M� 3011 PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Tfu7 i� Nwul :r• CLOCK TIMI� PERCOLATION PERCOLATION —Burr Elapse D-e-pEh to.WaEer water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop. Min. Start Stop Drop in Min. /in drop Inches Inches Inctres 4 Z 2 3'J57 -: �s �S 3 �► t o _ Noton : 1) r•iutes ur•o Tests to be' repeated at samo depth until 'test nrri,r-oximatelyy .equal soil .obtained at each percolation hole. All data to be submitted 1•or r v.i.i -w . . . -nth ' ioasuremerrtei ,tor ;trvicic `!'rom top of hale. . El TEST PlT DATA H1 UIRED TO BE SUBMl`I ". M WITI{ APPL'I'CATION DESCRIPTION OF SOILS ENCOUNTERED IN `PEST HOLES DEPTH HOLE NO. �_ HOLE. NO. HOLE NO. 1211 m -:.a – \o 18 °1 . • 2410 t1 42" . 48" . (,011 " 78. 11 • INDICATE LEVEL AT WHICH GROUND WATER IS I NCOUNTERLM INDICATE 1.E:VEL 1110 WHICH WATER LEVEL RISES AFTER DING ENCOUNTER Ti 31'3 MADIi BY _.. �, lA9 . L . Date Soil Rate Used 10 MliVl "Drop: S`. D. Usable Area Provided 4'• a IL.� No. ui' .13 --droc ms q Septic Tank Calvicity 1250 Gal Is pe AOuurpl:ion Area rov 6-6 . By <l50 L.F. x24 1pcenc 1. j y ry p jo Na�iiei [. 51griatur Adds -e scs -7 � ��f-;� .�,rFL� •-S� iV6- SI�:A);,!' ;. ,•ir..;...t�F � � '.•'+,:.'i. fps '11113 SPACE FOR USE BY HEAL'T'H DEPARTMENT ONLY: a`wFtJ51V�e :loll Rate Approved Sq. F't /Chl. Checked by Date \\� \ 30' N (T O y2v I ,o e i ", vJI "!00" 2 -0915 o0' i c So YAK 7 V AS QUILT E7CA -E. 1" As r l3�lv-r 1�lMENSION GHA2T A S G 1 15.0' 10.0' 10 60.5' lOJ.S' 3 60.5' 75.5' 12 81.5` 52.0' G 0 .o' G 83.0' tio.0' 15 107.0' 7- 7 I . S' 1 11.0' 16 113. D' 00.0' 17 bh N m 4 N N