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HomeMy WebLinkAbout0669DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23.10 -1 -18 1 rm INN% 11, 0%" 1. 0 .. e-7 ILI I I 1 As 0 1 1 IN me I I 116 IS is T IN rn rl IN 11 IN �, �. �r 0 }� PUTNAM COUNTY.DEPASTMENT OF HEALTH4 Dlvblori of P.tivhonmenW Health Seevlcea, Gemel, N.Y 10512 �� x � 5 ` \� � , � MaatProvlde P 28 89 k p:C H D Pefmlt M tJBTQ+'[CATE.OF LUMON COMPLIANCE FOB SEWAGE DISPOSAL SYSTEM T:. Patterson' ' Town of Vulage 73 — u ' :, Deacon Smith Hill Road Tai M"P • 23 10 � 1 1 Owner /app8eaat Name Gary C . Redlon Foemerly subdivWell Name MaU ft Addre ii Deacon• Smith •Hill Rd. Patters 125'63 Siibdv Lot 4� Fee, Enclosed Ej Amount` $200:80 Date Permit Issued 7/25/89 , Separate Sewerge System ballt by Lawrencb: E. Smith & Son. .. A `East. -Branch Ad.,,;, Patterson, NY 12563 :1000'_ ConalsHng 'of , . . , _ .. Gallon Septic Tank sind �7`5�, a t e r a l s 61 '0. C. Water Sapplys Pubt Sdpph From Add�ss on .. X Private Supply. Ddfled by. Ex i s t i n Addroea . Q RWIdIng Type Frame 'Lot Size. 1.08'48±_ Has Erosion t^nnt•rn1 Rapti Cmm�1ataA9 'As required :Three No Number of Bedioome Hna , e Grinder Been Installed? Other.Bequheatents None I certify that the system(s) as' listed serving the above premises. were constructed assentially.ae shown on the plans of the coapleted'work ( copies of which are attached), and in amordence' with the standards iiiles and` regulat "na in ,accordance with the filed plan; ind the peraiit issued by the Putnam County Department Of Health .�� Date 25 September :1991 Certified br., "�K.c4•- P.E. X R.A. Add.eu ;RD9. =Fair -St .. Ca (/61,, : N. Y: - 10512 Lkri.. NO. 29206: Any ppson Ipccupylnq pnmtaf. spvd by the above systam(q shall,promOtly tak•such adbn at< nlay bi necessary to sawn the correction, of any unsanitary conditions resulting from such <usage. ADproval ;of ;thi soosrata ""s !aoi' m. It beeomn null and vold as soon as a pubt;n unitary eewv become• availobl• and the Ail it of the private`iNat•i'.supPly. shall Dacoiee null A „ vo lien "a pubik a ,'suPWy boon M avallibb. Such ' *Wiavale We i. wWc4 to modif bn o► �l}un�• when, in the Judpm ist of the .Corn IH ith; lush" tion,,Modification or`chango Is ry. wt• d l ey s!j." Title Vd%' 3/89 -CRIER I ^< ad by (I = OR SvE-Dr,71510, Lor-r = I fF= Iry J sc -aa L'== = G_ b_ F=� s,=cz - D�� o= plac =r=.�t C_ _ G t7-all l] f.Ctii SEE c 1n0rf�_ f =c.. Na ==- ccLr:= I G. c_nt, .1000 -50 �- i C- 113, IIL:1'_:TiL -1 =_ "� = L=r== LiCIi _ a �c t 10 _ C. el bc:i ci__ "_ T � - 1=_CK - E� _ C. . ` -i�rJ� ; DT cr -Crf wG Gr` -..__� 1i.�C S - Lns _ _= _ =MT :c �o Cl =Z I I t lI ! �32 �I _CGS - 20 i 7. C. E. RCC:.:Lq Zit -.:E= =Cr Er���'S1Ci.� 500 -lb U_ i _ g Es i Pi I i 1 Siz_ cf c_.� 2. C e_' -_-Lc- =-Y I I I F_ = = =t tcX, c=-= I I I Vic,: Car 1 • _ �, ^�?cE ? C�:�' LC -T' GL�%r`.vr� p�-C I I I G_ V. C_ [= SiI"iC Ic31 cL.^ic C'cC = b- 1_, i :::c5 - C_ �_� �'i=c5 f:'=- ,�D,;i `h i^S_CE Of J=CY C^I: ? -is SLR^ - ^ES < E_ C �—i�l G_�'' i -�c� =� 1 cC:^._ ^C to t `? :1 C_� C:1L= = � � L`r^.L`�-^ & C:- �-' }. - L =C= W. = C'CL1 _C:1 GCE^' = '- Cra2C=C CP_ ` ry ti fib : � °' YML Environmental �`• ..:: Services 321 Kear Street, Yorktown Heights, NY 10598 ELAP #10323 (914) 245-2800 MR. GARY REDLON 306 DEACON SMITH HILL RD. PATTERSON,NY. 12563 • X RESULTS OF ANALYTE RESULT UNITS I g /1791 ; 9aM ALKALINITY,) mg/L AMMONIA 9 1 1 •11 and mg/L DATE REPORTED CALCIUM mg/L CHLORIDE SAMPLING SITE mg/L For Lab Use Only Potable _ HNO3 _ pH LT 2 _ Nonpotable _ NaOH _ pH GT 9 _ _ HCl Na2SO3 _ _ STAT! _ H2SO4 _ ZnOAc COLOR r Ifaas M MPN Units CONDUCTIVITY umhos /an COPPER mg/L DETERGENTS mg/L FLUORIDE mg/L HARDNESS mg/L IRON mg/L LEAD mg/L MANGANESE mg/L MERCURY mg/L NITRATE mg/L NITRITE mg/L ODOR TON pH S.U. LAB NUMBER << 93 005553 X I DATE /TIME TAKEN I g /1791 ; 9aM PHOSPHOROUS mg/L DATE /TIME RC'D 9 1 1 •11 and mg/L DATE REPORTED I SEP. 2 019 mg/L SULFATE SAMPLING SITE Holding Tank For Lab Use Only Potable _ HNO3 _ pH LT 2 _ Nonpotable _ NaOH _ pH GT 9 _ _ HCl Na2SO3 _ _ STAT! _ H2SO4 _ ZnOAc <4C <20 >4C >20C r Ifaas M MPN P/A X RESULTS OF ANALYTE RESULT UNITS p PHOSPHOROUS mg/L SILVER mg/L SODIUM mg/L SULFATE mg/L SULFIDE mg/L SULFITE mg/L TURBIDITY' NTU ZINC mg/L SPC per 1.0 mL TOTAL COLIFORM per 100 mL FECAL COLIFORM per 100 mL E. COLI per 100 mL FECAL STREP. per 100 mL These results indicate that the water sampl [WAS] [WAS NOT] [NA] of a satisfactory sanitary quality according to the New York State Sanitary Code, for the ters tested, at the . time of sample collection. These results indicate that the water le [WAS] [WAS NOT] NA]� a satisfactory chemical quality according to the New York State Sanitary Code, or th p ters tested, at e ti of sample collection. NA = Not Applicable N = Not Present (Negative) SUBMITTED BY: P = Present (Positive) SA = See Attachment(s) ' = Also done because Total Coliform was present Albert H. Padovani, M.T. (ASCP) TNTC = Too Numerous To Count Director > = GT = Greater Than < = LT = Less Than p(.TM M COURN DEPPRIMENr OF IIEALTH DIVISION OF ENVIRO AL HEALTH SERVICES Gary C. Redlon Owner or Purchaser of Building Owner Building Constructed by Deacon Smith Hill Road Location - Street T. Patterson Municipality Frame Building Type (New23.10 -1 -18) (O1d73 -3 -14) Section Block Lot 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 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 inniediately 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 ptilizipg 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 L-� caused by the willful or negligent act of the occupant of the building the system. Dated this day ofQJ V iE 19 General Contractor (Owner) - Signature Signature Title Corporatjon Name (if Corp.) Corporation Name (if Corp.) Deacon Smith Hill Rd., Patterson, ess N.Y. 12563 Address l6 7 rev. 9/85 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES r John M. Simmons, M.D. Deputy Commissioner of Health - FIELD ACTIVITY REPORT - ADDRESS 0,� a� M mil. No. MAILING ADDRESS P.O. Box Post Office Zip Code RQDIADRRWI� PERSON IN CHARGE OR INTERVIEWED r" nn Name and Title DATE TYPE FACILITY TIME ARRIVED 2 . 'o 0 TIME LEFT 3 ©J FINDINGS: Sheet I of I INSPECTION Orig. Routine Orig. Canplain Orig. Request Cmpl iance Canplaint Cam _ Final _ Group Illness Construction Reinspection Field, Sampling Only Field Conference Other Explain INSPECTOR: PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. SIGNATURE: 6/86 TITLE: DTNAM COUNTY DEPARTMENT OF HEALTH P Dlvisfon of P.bvEronmenW Health Services. Carmel. N Y.10512 �Qlneer to Provide Permit N on CE"MCATE OF CO CE - • Pernik.. N CDNSTRUC110 FO$ SEWAGE DISPOSAL SYSTEM Deacon Smith Hill Road A /K /A Do Street T ieri T. Pa_t i'5:0..2495 located at $ Town or Village S"vidon.Niame �. lot Tax Map. 73 Bloch Lot . 1 Orner/ uc.at,main Gary G, Redaon. - Renewal_ 0 Revlslon 0 APP ,. Date df, Pre4m; Appiovlll Ma111ng AddreBe 107 CRYSTAL Road Town Somars, N Y: Zip 10589 Date. Subdivision Approved Fee :Enclosed Amount $150.,00 Frame - Lot Area :1.0548f ,Acres Fill Section:only _ No '.I)eptb Y aallding .Type 24" volume'323 Cu dS . Thre2 600. PCHD Notification Is Regnired When Fill is compieted Nimber of Bedrooms Design Fbw'G' P- D 1000 375''x 24" w. x 24" 'deep laterals Separate Sewerage Syiitem to. oonalatot Gallon Septic Tact and D To be 000ttracted by Brian 01, Connor Cons tr . Co . Add Box 621, Carmel.. N.Y. 10512 Wafer Supply: Supply From A�dd.��eeeess. Bo d Artesian .. ells, Inc'. Rte. 52, Carmel, N.Y. 10512 or: byte S 1 DrWoll by '� _ _Address .,..... ,.... over ..�., .. Other Renolromente ., None ., I.represent that lam wholly ii completely responsible for the design and location of -:the _proposer! system(s); 1) that the separate sewage_disposet system above described will be constructed as shown on the approye0 amenpmontahera.to and in accordance with the standards, rules an —regulations o e Putnam County Department of Health, and,that on completion thereof a :'Certificate: -of Construction Compliance'.'satisfactory to the Commissioner of Healthwill be submitted- to the. Department and: a writien',quaiantes will be furnisher# the owner his'successors, heirs or assigns'by the builder, that said builder Krill place in good oporating'.condition any .part o/, :lard somsye disposal fYitem during the period of, two (2) years immediately following the date of the issu- ance of the 4006val` of the Certificate ;ot Construction Compliance of rho originar'system or any repairs thereto; 2).that the drilled well described above will be located i s snoavn on the appro4ed plan and that said well will be install in, accordance' with a standards,' rules and regu s ions of the Putnam COUntY Oepaitment'ot Health.' Date 17 May 1989 Sgnad P.E. — R.A. Address RD9 -Fair. St Care N Y. 10512 Licen :e Ne 29206 APPROVED, FOR: CONSTRUCTION This approval expires two Years: from the date,.-Issued unless construction of the building has been undertaken and is revocable for Luse Or may be amended or mod if I'" when'considered ' nweslary by' the'Conlnlissioner, Of, 11"Ith.' Any change or alteration of construction r uires a n ': permit. Approved tor, disposal of domest c sanitary fewage,,arrd /oi,prri'i te,.water suppl only. S` j'�1;y ie � 0 -c DIVISION OF ENVIRORMEZL HEALTH SERVICES DESIGN DATA., SHEET- SUBSUFACE S&gASE DISPOSAL' SYSTEM. FILE-NO. Owner c��o�... Address _ ctLCjj 21 -m1-I M& Z!W . Located at (Street) 3 Sec. :73 dock 3 Lot (indicate nearest cross street) Municipality Pa H e r s o -0. watershed Cy t:' ' -*-X,. SOIL PERCOLATION TEST DATA RDQUT.RED TO BE SUBNLC= WITH APPLICATIONS Date of Pre- Soaking MAR • 27-1999- Date of Percolation Test HOLE NUMBER CL,OCR TIME PERCOLATION PERCOLATION. Run Elapse Depth to Water From Water Level No. , Time, Ground Surface In Inches Soil Rate Start-Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 1090 - to %¢ ��i' �� �� � ►► J; 2 /0 /6 - /0� 39 �.t IS 3r# 4 5 1 (MU C_ /02/ _94. 21 2 F1 NOTES: 1. Tests to be`repeated:'at'same depth until appracimately 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 PTT.:pA -A REQUIRED TO BE SUBMITTED WITH OF SOILS pEPTH , ;; , ; �: HOLD NO. • �., G.L. 2P. 3' IF 5 6' i rw► e Sk o -n r. S CL,-n rL. (Z f <s .. 7' 9' 10' 11' HOLE NO. 2, , HOLE NO. �A-1c 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED L1p 4 9 INDICATE LEVEL, TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: p` / -lo g DESIGN Soil Rate Used tl- Min /1" Drop: S.D. Usable Area Provided -5 % 0 No. of Bedroans `( ,-jie C Septic Tank Capacity gals. Type A od Absorption Area Provided By L.F. x 24" width trench Other '2.-0 u r4 of' a 0-,N K FI l 1 ottOFESSIOryq� �. Name Si R09 FAIR ST 914 - 878 =6110 Address CARMEL. NEW YORK 10512 4 2 a� `F�s�ly NO. 292060 9 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: �s Soil Rate Approved sq.ft /gal. Checked by Date MA-� I of CF V . RIZ Z�m L s CF EE� . ..... .. F . — - " P=' -_-;, 1 ,Z7., —,-.-7 -1 _L= - :1 -1, NO i Lcc:2_:aT__S _c L= ,rte — =_C_; Ce:: t c_ =v'. r 60 ft. 10 C. - Aoo Data ca Z & _c D c C Tar-, _=Z"c C-. c CC=—= C == FCC C.: r-771:_-_ Y E-::a E:C=B-n�` C": .:-_anS-cc Fr- & ;nn Z -=e: E;;=_t= W/- C C=CS s & Ec!= (T Aftc; T- Nc, p- _N a- 10 Drive,-;ay, La-rz_:=_ TtaES,T'z_c; 20' to Ic : 100 t. r.�al, '00, 1).L.-c-D, 1- P loo, tc S*.-_=-sam, Ea-ka nc:. 'Dr= 3E'tz 10 to 'R! t a r L i -n E t Z 2 IJ Sol 10' tz 1E, weL! tc b� b PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 1 �� APPLICATION TO CONSTRUCT A WATER WELL -2 • j please print or type y —aq (, Well Location: Stre t��n5!60�p' T ilia Tax Grid # Map 'x.10 Block Lot(s) le Well Owner: N e: Ad s s: Use of Well: XOkesidential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage ..... Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason ` for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No x Is well located in a realty subdivision. Yes No x Name of subdivision Lot No. Water Well Contractor: Address: - Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: Applicant Signature: ,Q.- PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and 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 or their designated representative 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. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED _FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Dire cto . y revision or alteration of the approved plan requires a new permit. Well to be constructed by a wat r wel driller cqhfied by Putnam County. Date of Issue T Permit Iss ' f ici d t! Date of Expiration Title: Permit is Non- Transfrra e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 / -7S i 3' -� `� �( ate 7 # ## - . y £ }` h C li Ir 1 r a i� ,, 0.. -,ay _ �Jc� tr. ,i@ gr v _ r s r 't +.i q _ ' #:,, ,_7 '� - - " iittl �Iilklt 5 f rD4 �. x �y s. ,.,-. a' � ,, .- - i 4Ti�rSD� arka9r se - ,. . z_. � � . .1 iaF i "4ia ors ni9� 'y�tr f th€ 'cG #s t Yz.d is .. .sit :t s': �; ! r _ ! ` . f -- : Pry �" oelrart �teratut� tle.#t t�� . 1. 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