HomeMy WebLinkAbout0663DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
23.10 -1 -9
BOX 8
•
r• T `
00663
,_.
Trl
Rev. 3186 PUTNAM COUNTY DEPARTMENT OF HEALTH
Divislon.of Environmental Health Services, Caimel, NY 10512
EnglneerMust Provide PI-86.
p C:H D Permit #
CERTIFICATE'OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL;SYSTEM T,. .Patterson
•
..Town or Village
Located at Deacon :Smith Hi 111, Road Tax Map 72 B1k 2 Let 3.2
BUM ,(c/o D. Fish) F.rackman.
Owner /applicant Name ' Formerly 'Subdivision Name Subdv. Lot # " "B"
Mawng Address 14 Jemni6r Lane Zlp 1 n53n Date Permit Issued
3' Jan.','
an.' 86
Harsdale, NY'•
Separate Sewerage System bullt by G.r e g Ma c a l u s o Address ' M i 1 l town' Roads Ho 1 m im.Cz, NY 19531
MOO Consisting of Gallon Septic Tank and 50.0 . f t ._x 24 "' deep: laterals
Water Supply: Public Supply From � Address
or: — Pt Private Supply Drlll � b `F f � ?%Yl Address
Building Type Modular Has Erosion Control Been Completed? Ac required
Number of Bedrooms Three Has Garbage Grindei -B en installed? No
Other Requirements None
I'certify that the systemis) as listed serving the above.premtisesrwere,� onstr4ccted essentially as shown on the plans of the completed work,'( copies
of which are attached), and in accordance with the standairds,�$ulee an11i.6i�la one, in accordance vith:the filed plan, and the permit issued by the;
Putnam County Department Of Health
Date 25 SPptPmber 1986' . Certified. e'y M. 0.9. P.E. X R.A.
Address RD 9 —Fair License No. 99966 .
Any person occupying. premises served by'the above . systems) shall promptly take ukh'action all may be neeesury 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 pubt;: sanitary sewer becomes
available and the approval of the: private watei supply shall become nutl and void when -a public water supply becomes; available.. Such. approvals are
subject to modification or change when;: in the, judgment of the�Co�mmi�ssioner of Health such revocation, '/�mo%dificati�on or change Is necessary.
Oats��.� Title /J
.-
..Y.. ri. .• � � — — •�R Jay J.:��'i1�"Sl+ii�.>FK "`n r .: • • . r w � }•r1
REPO U�i:iU u�E unif ' q
-- -' -'
WELL-COMPLETION G RT-
I ' DEPARTMENT OF HEALTH _
Division Of Environmental Health Services — -
PUTNAM GO•UNT.Y DEPARTMENT OF HEALTH
- r-
STREET AOURESS:
10WN /V1LLAGE 1CI1Y fAX GRIO NU148ER:
WELL LOCATION
Deacon. Smith
Hill Rd. Patterson
WELL OWNER
NAME: ADDRESS:
B.C. F .M. Partnership 14 Jennifer Ln. Hartsdale, N.Y. 10530
0 P61VATEEL
❑ PUELIC
USE OF WELL
II RESIDENTIAL
❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
1 - primary
❑ BUSINESS
❑ FARM ❑ TESTIOBSERVATION ❑ OTHER (specify)
2 - secondary
1NSTRIAL
p OU
❑ INSTITUTIONAL ' ❑ STAND -BY ❑
AMOUNT OF USE
YIELD SOUGHT 5
gpm. /N0. PEOPLE SERVED 5 / EST. OF DAILY USAGE 500 cal
REASON FOR
91 NEW SUPPLY
= ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATIO�•1
DRILLING
❑ aEPLACE.EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
W'1L DEPTH 455
w1 ii
ft
STATIC WATER LEVEL 38 ft
DATE MEASURED 7 -24 -86
- r-
EQUIPMENT
❑ ROTARY R) COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING.? OPEN HOLE IN BEDROCK ❑ OTHER
TOTAL LENGTH 63 ft-
MATERIALS: 0 STEEL ❑ PLASTIC ❑ OTHEIR
CASING
LENGTH.BELOW GRADE 62 ft.
JOINTS: ❑ WELDED 91 THREADED ❑ OTHER
DETAILS
plAfti4ETER 6 in
SEAL: ID CEMENT GROUT ❑ BENTONITE ❑ OTHER
w,
WEIGHT PER FOOT 19 Ib_Ift.
DRIVE SHOE DYES ❑ NO
LINER: DYES 6 NO
DIAMETER (in)
-SLOT SIZE
LENGTH (it)
DEPTH TO SCREEN (ft)
DEVELDP;D?
SCREEN
DETAILS
FIRST
OYES ❑tio
SECONO
HOURS
GRAVEL PACK
❑ YES
O NO
GRAVEL
SIZE:
DIAMETER
OF PACK in.
TOP
DEPTH ft.
f30i110M
DEP -Tli ft.
It detailed pumping
WELL YIELD TEST 'IFLL
METHOD: ❑ PUMPED 1 tests were done is in-
X) COMPRESSED AIR ,formation attached?
❑ BAILED 0 OTHER i ❑ YES ❑ NO
LOG It more detailed formation descriptions or sieve analyses
are available. please attach.
DEPTH FROrd
SURFACE
ft. ft.
water
Bear-
i�g
Wail
Dia-
meter
FOWAATION DESCRIPTION
c:aE
WELL DEPTH
ft.
455.
DURATION
hr. min. '
DRAWOOWN
ft.
YIELD
gF
Surface
:T, Q
O
_
S
'"
6hr
455
0 4'
S3
WATER ❑ CLEAR TEMP.
QUALITY O CLOUDY HARDNESS
❑ COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? O YES 0 N
I
t
1
STORAGE .TANK: .TYPE
CAPACITY ' • ' •• GAL.
PUMP INFORMATION
TYPE CAPACITY
MAKER DEPTH
MODEL VOLTAGE HP
WELL DRILLER NAME j3. [ L)Q _ OATESy�/
ADDRESS 424 s SIG1 (�
CaAlw �•`�i21 I0V/
- r-
'orktown Medical Laboratory, Inc.
321 Kear Street .
Yorktown Heights, N. Y. 10598
(911x245-3203
Director: Alberi H. Padowni AG T. (ASCP)
LAB 11 -i 0027T"2
X27$'2
Collection Station Used:
Carmel Peekskill' _
mt.. Kisco _ Nev City _
Date Taken: 7 (11_ In
r I Date Received:
Date Reported:
Collected By: i
' �S-6 � Referred By: 6.
L Sample Source:.
LABORATORY REPORT ON BACTERIOLOGICAL QUALITY OF WATER_
GENERAL BACTERIA
_ Standard Plate Count per 1.0 ml
(Agar plate @ 35 °C)
MEMBRANE FILTRATION TECHNIQUE WT.)
Total Coliform per 100• ml .
Fecal Coliform ner 100 ml
Fecal Streptococcus per 100 'ml
PROBABLE NU!!BFR TECHNIQUF..•(MPN)
Total Coliform: MPN'Index per 100 ml
_ Fecal Coliform: MPN index per 100 ml
s�
THESE RESULTS INDICATE THAT THE WATER SAMPLE. (WAS. NOT) (NOT APPLICABLE)
OF A SATISFACTORY SANITARY QUALITY ACCORDING TO THE NEW YORK STATE DRINKING .
WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION.
di-V A y C rh
Albert H. Padovani, M.T. ASCP), Director
LEGEND
RDS • Recommend Disinfect-
ing Water Source
< - less than
TNTC a Too Numerous Too
Count
�% PUTNAM COUNTY DEPARTMENT OF HEALTHr ENGINEER T° aROVinE PE
Jp? �I # ON CERTI,FICA 0 _ IA , NGE,,,
c f7 %Vlslon of:Enwronmenbf Hea/ih Services, Cerinel, °N.'.Y 10512 PERMIT'. �. `•
CONSTR TI,ON PERMIT FOR SEWAGE DISPOSAL SYSTEM T 'Patterson
own or i1age
l
1
Located ac Deacon Smith Hill Road Tax nnaD 72 block
SuDdivi ;ion 1�
Deacon, Slnith:'Woods (file 2'083�1a.:mt w "B" Renewal. _[] Revision _[]
rimer /Addieae
BCFM (C %0 D: Fish) , 14 Jennifer Lane, Hartsda �e o rev o�as �rcval I
8uildin9''Tipa
modular Lot Area 2.461± -acres Fill Section Only C]'.
_. .
`: .thre.Waign.Flow G/P/D.. �Qn . P.C. N. D. Notification Require
Number of Bedrooms
Separates sewerage •System to 'consist of 10
nfl: Gal, septic Tank and'n(�! Y err is 21 deer "laterals
To be' constructed by
Address i
Water. SupD.ly: Public Supply 'From
Private Supply'.to ,bo ,drilled %bY
Address
Other Reaui►emo is C 0 Manhole -In Tank Effluent Line (cover of comtnon fill over. line)
z.
I represent that I em wholly and completely responsible for the design ,and Ideation of the proposed witem(s); 1) that the separate "sewa'ge dis oral system
abo"ve'-descr� bed :will be.constructed as shown on :lhe approved amendment there, to and in accordance with the standards, rules and regulations
o e u ham
County - 0epartinent of Health, and that on completion thereof s 'Certificate .of ,Construction Compliance' satistactoiyto fire Commissioner Of Health% i l
be submtted ;to,,dhe Department, -and'a written guarantee .,will b4 furnished -the owns►, his successors, heirs'or assigris by the builder, that said builder will
place m `good' operating' condition :any .part of -said se `wage disposal system during the per.f. of awe (2) years Immediately ;tollowing the date ,of the issu-
ance of,sthe approval of the Certificate of Construction Compil nce of, the original system or any repairs hereto; 2) flist the tlr. Iled, well esc►ibed above
will' beaoeated`ai shown on the approved "plan and1hat seed well wiil be Installed. In 6ccordOcei •with` fha standards, rules and regu aTilon;' of 'the .Putnam
County -De - irtment of "•Health. 711,
Data
December'•: 2- .1985 ' P.E:_x -:R.A:
A jress RD '9. -Fair `'St e'. y .1 License No, 29-0- .
APPROVED FOR CONSTRUCTION This',approval . expires one year;fromthe date iisued unless construction of the building has been undertaken and is
revocable for.caUse or may be emended .or'modified'when con retl: ecessary by tAe m ss or "of Health. Any change or alteration of .construction
►equires,a new per t Ap ove for disposal of - domestic san ar sewage; and /or. - rivate r. supply 'only. --
Date"' By
Title"'
IRev 6/85
0
-e.
_... • ...:.::...;.r, =ir.«. w.i:<s:iznT. :"'atl+'+'^••':•' r i.-- '�y'ir: *- -L^^!._........, �.. r
PUI'NAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY /SUBSURFACE SEWAGE DISPOSAL SYSTEMS.
FM TNSPECTION RF.PnRT % �
G DATE:
INSP. BY:
(Name of Owner) (Street Location)
INITIAL SITE INSPECTION YES I NOI COMMENTS
Wetlands on /or proximate to property ..............
Property lines or corners found ...................
Canestimate house location ........................
Will driveway need cut ............................
Must trees be removed - note these..................
Deep holes representative of entire SDS area......
Additional deep holes needed ......................
Sufficient SDS area available considering driveway
cut, house location, separation distances,etc...
Adjacent wells/ septics ............................
ArrP--;s to nronosed well location for drilling.....
D. H. 1 Lot D. H. 2 Lot
Depth to G.W. Depth to G.W.
Depth to rock Depth to rock
Soil Descri
0 ft.
3 ft.
6 ft.
9 ft.
12 ft.
0
ft.
3
ft.
6
ft.
9
ft.
12
ft.
Soil Description
DATE: _
FINAL SITE INSPECTION' INSP.BY:
House SSDS located per approved p .............
Length of trench measured ZL-
Width of trench average 2 Y
Slope of tile line and trench acceptable.........
Room allowed for expansion trenches ..............
Over 100 ft. from watercourse ...................
Natural soil not stripped or SDS area
unnecessarly graded..............................
10 ft. maintained from property line and
20 ft. fran house............ ... ..........
Distance well to SSDS (ft.) ...,l G. ::.. 't ..........
Number of bedrooms checks ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. from nearest trench ................
15 ft. of peripheral soil horizontally
from trench ..... ...............................
Boxes properly set ...............................
Could surface runoff from driveway, roads,
ground surface, etc., channel near SDS area...:
Does lot drainage appear OK in area of SDS.......
PTNAT. =AnMr. nF STTF ACY''.F.PTART:R_ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ '
D.H. - Deep Hole
G.W.- Groundwater
D.H. 3 Lot
Depth to G.W.
Depth to rock
Soil Descri
0 ft.
3 ft.
6 ft.
9 ft.
12 ft.
YES NO COMMENTS
K SC2 Lib 5
,Ala i' a
fir' .f Gov
P[TnM . COUNTY DEPARM'OU..OF HEALTH
• DIVISION OF ENVIRONMENTAL HEALTH SERVICE'S
DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner B � *CM (A " er) Address _ &WAM 5k hk 14;11 Jew.
Located at (Street) Sec. 72 Block 2 Lot 3•Z
(indicate nearest cross street)
Municipality �4'rsoti Watershed Coz76p4•,
Date of Pre- Soaking
Date of Percolation Test
,Yw W5
HOLE :
NUMBER CL= TIME PERC OI ATIUN
- . - PERCOLATION
Run Elapse Depth to Water Frcm
Water Level
No. Time Ground Surface
In Inches Soil Rate
Start -Stop Min. Start Stop
..Drop In Min/In Drop
Inches Inches
Inches
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 from top of hole.
rev. 9/85
• _ ?•. (
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION .,
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. HOLE NO. .7 / HOLE NO.
G.L.
2'
3'
4'
5'
6'
41
71.
8'
9'
10'
11'
12'
13'
14'
A
Al
INDICATE LEVEL AT WHICH GROUNUMTER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: J, DATE: B
DESIGN
Soil Rate Used Min /1" Drop: S.D.: Usable Area Provided d CIO �
No. of Bedrooms %� Septic Tank Capacity 000 gals. Type �Jb
Absorption Area Provided By OQ.' L.F. x 24" width trench
Other C C® » _ F a- e `-i Ole
oeq ..
C't
Name
q� x.s a
Address JOHH H. PREHTISS P_E_ ! •i�,"'�
RM FAIR ST 914- 878 -6170
CARREL, NEW YORK 10612' 29�0b��'
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved sq.ft /gal. Checked by Date
PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION of ENVIRONMENIAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
M
REVIEW SHEET - CONSTRUCTION PERMIT.
DATE REVIEWED:
BY:
r_- _
COMMENTS NO I DOC'U MTS
Permit Application _
-Corporate Resolution
.Plans - Three sets
Engineers Authorization
'Design Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results (3)
30" Perc Hole
Other
,,House Plans - Two sets
If PWS - Letter
Variance Request
REQUIRED DETAILS ON PLANS
Sewage System Plan
Sewage System Hydraulic Profile - Gravity Flow
Fill Profile & Dimensions - Volume
D or J Box Detail
ptic Tank - Size, Detail
Well Detail, Service P.TntS
Trench /Gallery
Pump Pit
Two-Foot Contours Existing & Proposed
�.� lopes for Driveway Cuts
Footing /Gutter Curtain Drains
__.Perc & Deep Holes Located
Representative of Sewage & Expansion Area
Expansion Area; shown; gravity flow
If PumVea'Pit & D Box Shown & Detailed
1-.House - No. of Bedroans
Wells & SSDS's w /in 200 ft. of Property Located
Property Metes & Bounds
i House Setback Necessary
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
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- •Cbrtain,Storm,Leader,Footing
25' to Catch Basin
10' to Water Line (pits -201)
Septic Tanks
10' from Foundation
50' to Well
5' Well to PL
GENERAL
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Town /DEC Permit R & D)
Data On DDS Plans & Permit Same
"
-in. ui . -nilronmentalyHealth.Servica- .
c•,.ad as noted for,aonformance eith
:l cable 1ules.and Regulatlons'oS US
putnam County Health Department-
AS B
tructure locoleid.tr0T survey: "b• y.'surve:yor "noted:'below:_
Well located: by 'Surveyors survey _ ._
Well drillers report r_ A _ `___
Engrnsers mdeu emerits�_
Tank, boxes, pits; galleries 8r laterals;FOCated by'6Dntroctor::
Engtasers
H e o lth &pt:
Field Inspectlon tiy: ..Health. dept do t s:�
Enganser ® dote
This is io certify that the sewage _
disposal system was 'constructed . as
NOTES: indicated on this ^plan and that the
'View 124 Grp '4,6 • _ aystem was Inspected by me' before' it
was coverbd .over.. The system was
fQ %a•►R•��el'!,/, constructed in'accordance with a -11
standard rules -and re'
A4 of
" �� the P.C.R.D: 6 the N.Y.S. D.
b
I'M .EA, SION S
A _ g �_. �Z'. py v
A - E 4_ _4�r 49 B - E
A - F, :._ ry(oT B - F v . �1 �— G>Ti- r MI
r y. ,
A - d a B' JQ _ --
A - K =�Lf/ g8 K. rO�� --
�� tl■
o- 1�
�� LA
Alo, PDX
�-o' L- G-b • -J'YR "
0
Iv' of rIGi.U� �>
O
6GO
5 y�o (000 C,pL• ���
Cork •
.�. �G � e�-� DvJ� l� L I IJ G►
PCII I c Ili- I o1 � LC- _ -�;oY_ Z-
t �
ub J-I(l -T"W c1—✓� �'�
PRp*ESSION4,
c � A