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HomeMy WebLinkAbout0670DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23.11 -1 -1 BOX 8 00670 1 21 IN IN 16 16 ISO r. .. , 00670 - 'ENGINEER 'MUST; - OUTNAM COUNTY DEPARTMENT iOF HEALTH° / RROVIDE Division .bf Environmental Wee /tjb ,Seitncea, Carnie% N . Y 117bs12 ; RE'RM I CE T rCOF CONSTRUCTION COMPLIANCE F,OR =SEWAGE (DISPOSAL SYSTEM Town or villa ge located at / %c'fti✓V5 Tax •Map �L Block ,t Ie_ SA4,0Y Formerly i iV Tax Map Lot M Owner 3ubd ., LOt Separate Sewerage System built bY' ® La2s Address �j�'iv1 /LL B Consisting of A;1 Gal. Septic Tank and <;f pF o? 34" T/[.O' A /6"S Other requirements Water Supply: Public Supply From Private SuPP1Y Drilled By -40D iP>Er/it�tJGj� �[lt9tiliJrTO Address en Z Building Type % No. of Bedrooms Date Permit Issued Has Erosion Control Been Completed? Has I certify that the system(s) as listed 'serving the above premises were of which are attached), and in.accordance with the standards, rules and Putnam County,Department Of Health. Date _Od- 'a Certified by installed? /x 40 on the plans of the completed work ( copies the filed plan, and the permit issued by the P.E. ZR.A. License No. Any person occupying premises served by the above systerri(sy shall promptly to �fthl �id,Y� s ru�--,hply nary to secure the correction of any unsanitary conditions resulting from, such usage. Approval. of the separate sewerage sysEe taf�i,�rF d as coop as a public unitary sewer becomes available and the approval of the private water supply . shall become null and voi;!• w . .a 9db I becomes available. Such approvals are subject to modification or change when, do the judgment of the Commissioner of Hea revocation, modification or change Is necessary. Date. 2/ // 9�''� ,�� By ��� Title Rev. 6/85 Q1 .t ' BIBBO ASSOCIATES Hardscrabble Road Rt. 22 CROTON. FALLS, NEW YORK 10519 (914) 277.5805 TO A& >6eew L [EUTEa OF MUSEDUML DATE JOB NO. ATTE�NTI/� •��9� • �itrC��r!/1 �9'� 6eS RE: a 5 R4, �ts�✓Si'7�LteT /off 6't7�.,.t�G /,Q.�c2 _ WE ARE SENDING YOU &4alached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION �ts�✓Si'7�LteT /off 6't7�.,.t�G /,Q.�c2 THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ • Resubmit copies for approval • Submit copies for distribution ❑ Return corrected prints ❑ FFO,R/ BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS TC (Tdx'l COPY TO SIGNED: vnnnun�ea� niM C.O. u— men If enclosures are not as noted, kindly notify us at once. 1_7­16 { / ' Owner a r o iii. urc aser or Building b PA( -(1n,1 � U&S mnns .Building Constr ctE by. '32. -Z -*S> M. c rY� 4 Ewa Lop Location - Street. S �\%,r. BuildirZg T e Pr+ i+ eAs Municipality Section Block Lot GUARANTY OF SEPARATE SEWAGE-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 regvlat.ions of the Putnam County Department of Health, and hereby guaranty to the owner, his succes- sors, heirs or.assigns, to place in good operati.ng.condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of initial use of the sewage disposal s'ystem,. or any repairs :Wade by me to such system': except where the failure. to operate properly is caused by the willful or negligent act of the occu- pant of the building utilizing .the system. �.._.... The undersigned further agrees to accept as conclusive the de- termination of the Director of the Division of Environmental Health Ser- vices of the Putnam County Department of Health as to whether or not 'the failure of the system to operate, was caused by the. will or negligent act of the occupant of the building utilizing the s em. Dated this10_�Aay 'of 19,� Signature .Title (If corporation, name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF. DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Healtr A:! II. IV. V. VI. FINAL SITE INSPECTION Date lo% 711 d�- Inspected byj&&a., ;CATION MM,,A o l /U,, Piz , ; OWNER qM $ nR SURDIVISION LOT a - — 2 P 6S `Ol • r vw - NO CCMMENTS SETivAGE DISPOSAL AREA a. SDS area located as a roved plans ' �2'ns eA�°n A kc A-v b. Fill section - Date of placement 2:1 barrier. LGTH WIM AVG.DPTH ret#yvskv1Q\.Ch'ah v c. Natural soil not stripped d. Stone, brush, etc., SEeater than 15' fran SDS area. e. 100 ft. fran water course /wetlands. ' SFWCE DISPOSAL SYSTEM a. Septic tank size - 1,000 1,250• reins P b. Sentic tank installed level ur nrMa� e-- ' c. 10 ` minimum from foundation ins .firm �� d. No 90' bends, cleanout within 10 ft. of 450 bend e. DISTRIBUTION EOX 1. All outlets at same elevation - water tested AiL 2. Protected below frost 3. Minimum 2 ft. on inal soil between box and tre*lches f. JUNCTION BOX --properly set g. T-�S i 1. L-ength reruired - Lencrth installed = 2. Distance to watercourse measure. 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 fran rcpe- line - 20 feet - foundations 7. Depth of trench < 30 inches fran surface � 8. Roan allcwed for epansion, 50% I 9. Size of g ravel 3/4 - 1 " diameter 10. Depth of gravel in trench 12" minimum 11. Pi ends capped h. PUMP OR DOSE SYSTEMS 1. Size of puap chamber 2. Overflcw tank 3. Alarm, visual /audio 4. Pump easily accessible manhole to grade/ 5. First box baffled 6. Cycle wit- nessed by Health De estimated flow per cycle HOUSE " a. House located per approved plans. b. Nmnber of bedroans WELL a. Well located as per approved plans b. Distance fran SDS area measured ft. c. Casing 18" above grade. d. Surface drainage around well acceptable. OVERALL WiORKMASMP a. Boxes properly grouted Al b. AU pipes partially backfilled c. All pipes flush with inside of box d. Bac -Vill material contains stones < 4" in diameter e. Curtain drain installed according to plan f. C=tain drain outfall protected & dir.to exist.watercours g. Tc:R-H�ng drains dischar a awav fran SDS area h. Surface water protection adecruate i. =osion controi provided on slopes greater than 15 %. II.. IV. V. VI. ,CATION e�rrr�vLln �. FINAL SITE INSPECTION Date 3 U Inspec ed by _ OWNER ,. �) � . +i �E � TM # OR SUBDIVISION LOT # v � ` 10 P.r . YES NC COMMENTS SEWAGE DISPOSAL AREA a. SDS area located as per approved plans b. Fill section - Date of placement 2:1 barrier. LGTH WIDTH AVG.DPTH c. Natural soil not stripped d. Stone, brush, etc., greater than 15' fran SDS area. e. 100 ft. from water course /wetlands. SEDGE DISPOSAL SYSTEM a. Septic tank size - 1,000 1,250`C b. Septic tank installed level c. 10' minimum fran 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 -` ro 1 set g • TRENCHES �. 1. Len required - ,,D C6 Length installed \� _ 2. Distance to watercourse measured: ft. 3. Installed according to Flan 4. Distance center to center .`. 5. Slope of trench acceptable 1/16 - 1/32 " /foot. 6. 10 feet from property line - 20 feet - foundations -t 7. Depth of trench < 30 inches fran surface 1; Q: � Q �.e 5 ' e R OuP 8. Roan allowed for expansion, 50% h oz- 9. Size of gravel 3/4 - 1 " diameter e• �;. 10. Depth of gravel in trench 12" minimum 11: Pipe ends capped h. PUMP OR DOSE SYSTEMS 1. Size of pump 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 flaw per cycle HOUSE a. House located per approved plans. b. Number of bedroans WELL a. Well located as per approved plans . b. Distance from SDS area measured / Q ft. c. Casin 18" above grade. d. Surface drainage around well acceptable. OVERALL WOP MA.SHIP a. Boxes properly grouted b. All pipes partially backfilled c. All pipes flush with inside of box d. Backfill material contains stones < 4" in diameter e. Curtain drain installed according to plan f. Curtain drain outfall protected & dir.to exist.watercours g. Footing drains discharge away from SDS area h. Surface water 2rotection adequate i. Errosion control provided on slopes greater than 15 %. v � ` 10 P.r . PUTNAM COUNTY DEPARTMENT_ OF HEALTH ENGINEER TO PROVIDE PERMIT # Q� ON CERT FICA OF ,CO PLIA CEO 1 \ Div�s�on 'of Environmental Health 'Services, "Carmel N. Y 10512 PERMIT CONSTRUCTION: PERMIT FOR SEWAGE DISPOSAL 'SYSTEM Town or vaiage Located at9%�o°yA/0%i�s '"'^"w'd1, — Tax Map ��^ Block Wt Subdivision C1yQ�L i�� �wr'V SUM. Lot N '� Renewal 1 Revision 0 �l�lsa �4,el %� ( /.38',S� ✓�xs/Yi /OJ2� &A '�� /� ��� �Trtnrso.� Owner /Address Date of Previous,Approval Building Type � �d�C%`¢t l�L Lot Area oft • Fill Section only ❑ Number Of Bedrooms Design Flow G /P /D P.C. H.. D. Notification Required Separate Sewerage System to consist of 1.2 ;[ ✓� al. Septic Tank and 3 To be constructed by Address "`�� IVY Water Supply: Public Supply From. Private Supply to be drilled by Address AIQ /7321! %iDra/S7}!iy AAA A0SV9 Other Requirements 1 represent that I am wholly and Completely responsible for the design and location of the ' that the separate sewage disposal, system above described will be'constructed -as shown on the approved amendment there to.and in rds, rules and regu a ons o the u nam County Department of Health, and that on completion thereof a CerUf�cate of Con gi t dYi® tory to the Commissioner of Healthwill be submitted to the Department, and a written' guarantee will be '.furnished the ow c he t0 '�' s by the builder, that said builder will place in good operating condition any ,part of said sewage disposal system during d_o. ( y_ I��@@ diately following thedate of the issu- ance of the approval of the Certificate of Construction Compliance of the origin t QD► n her t6; that the drilled well described above will be located as shown on the approved plan.and, that said well will be installed im;`ac 'de ards to s and regulations oils of the Putnam ^� s County Department Of Health. Date ^• 8 R? Signed - P.E. _ R.A. Z W- terms . Y /9 4127-1-1 Address � f ���Q��iQ- � License No. — APPROvED FOR CONSTRUCTION.. This approval expue3'one year from the date issue n PO the building has been undertaken and is revocable for cause or maybe amended or modified when.considered. necessary by the Co 1`6 r I Any change or alteration of construction requires a new permit. Ap roved. ff`or disposaF of domestic sanitary sev ge, and %or riv t wale y only. Date JO' By— Title Rev.. 6/85 - PUTNAM COUNIY DEPARTMENr OF DIVISION OF r •• E v HEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE SDgAGE DISPOSAL SYSTEM FILE., NO. ,ee 2 waocv.uy Owner 1114 &Z drt Address ,--70 1 a a-1 /O6T? Located at (Street) A114AAC t A Sec. /Z Block / Lot `4j (indicate nearest cross street) .' Municipality A,4TT 71--2 c eT) ,Watershed Date of Pre- Soaking Date of Percolation Test 9� /oL-1 HOLE NCCE R CLOCK 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 2 3°r SU Z / Z� 3 9• .3 3 3 33 T ®Z �9 2y 9 7 4 5 30 Z /O 30,, 2 3 30 /a. 9 3 t3 sus 1/ i8 3o Z / 4 NOTES: 1. Tests'to be repeated at-same depth until apprcximately 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 2 4 NOTES: 1. Tests'to be repeated at-same depth until apprcximately 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 REQUIRED TO BE SUBMITTED WITH APPLICATION OF SOILS IN TEST HOLES INDICATE LEVEL, AT WHICH GROUNDWATER IS EN03UNTERED S INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENOOUNTERED -A b*, DEEP ROLE OBSERVATIONS MADE BY: (%3r313� DATE: DESIGN -Soil Rate Used Min /1" Drop: S.D. Usable Area Provided 5ZW s-r ,N6. of Bedrocros . Septic Tank Capacity /000 gals. Type Absorption Area Provided By 6-O0 L.F. x 24" width trench Other �tssiorua� F�; 1. Bibbo Associates Name Signature ar Engineers-Planners Address Rte'. 22 & Hardscrabble Rd SEAL V-1 Croton Falls, N.Y' 10519 F THE SPACE FOR USE BY HEALTH DEPARTMENT ONLY: moil Rate Approved sq, £t /gala: Checked by Date e PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of 04VI6 B040A) Located at 1gCI1_1*Ju3 r (T) *0-0r76Z5&t,) Section �2 Block / Lot Subdivision of - OU6AC.00K- Ds Subdv. Lot # / Filed Map # o� /`f O/ Date '%- /7- $(p Gentlemen: This letter is to authorize 45VN>° JIC/!%AMlvle -I a duly licensed professional engineer Vle or registered architect (Indicate). to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or. 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, Q o4ESSIONAt fNC/ Signed Countersigned: , Owner of Property w Address N ca G"L i %/•��a3� 1��F� rd Address Town Telephone �4r�r 1 Z? 7 -Sa�)5' Telephone r � Division Ot Environmental Hgolth Services ti TWO COUNTY CENTER - CARMEL, N.Y. .10512 (914) 225 -3641 _ APPLICATION TO CONSTRUCT A WATER WELL WELL TYPE lrJ DRILLED F_� DRIVEN DUG F� GRAVEL ED OTHER IS WELL SITE SUBJECT TO FLOODING? _ YES IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:0yWe[c22t -- A10003 LOT NO.: / 4ATER WELL CONTRACTOR: Name Address :,QM /4, ,4095 � 1 �Wca. �Vi/ i :S PUBLIC WATER SUPPLY AVAILABLE TO SITE: ____M;9N1V1LLAGE1C11Y IAX GRW NUMBER. HELL LOCATION Me MIN %moo A.c�-r �v, I2 84.ae. / 44 r; WELL OWNER NAME. •%�.0 ✓!6 � Jc�� ,�& S�r - nooRESS: Y �G /3e ,- /oj� PsIVAT[ ❑ PUBLIC USE OF WELL O�RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED 1. - primary ❑ BUSINESS ❑ _FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) 2 -secondary ❑ jNDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED ���� / EST. E gal. OF DAILY USAGE REASON FOR 2(NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION DRILLING ❑ EEPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL WELL TYPE lrJ DRILLED F_� DRIVEN DUG F� GRAVEL ED OTHER IS WELL SITE SUBJECT TO FLOODING? _ YES IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:0yWe[c22t -- A10003 LOT NO.: / 4ATER WELL CONTRACTOR: Name Address :,QM /4, ,4095 � 1 �Wca. �Vi/ i :S PUBLIC WATER SUPPLY AVAILABLE TO SITE: ____ YES �NO LAME OF PUBLIC-WATER SUPPLY: ,y1,9 TOWN /V /C ,Nlf )ISTANCE TO PROPERTY FROM NEAREST WATER MAIN > Z W/wr LOCATION SKETCH & SOURCES OF CONTAMINATION (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 shall: 1. Pump the well 2. Disinfect the of the Putnam permit. 3. Submit -a Well the Putnam Col Date of Issue: until the water is clear. well in accordance with the requirements County Health Department attached to this Completion Report on a form provided by anty Health Department. Permit is Non - Transferrable 19 Permit Issuing Official •a.rC +.+aw. �• sM ..++.�.ati+...- +.1.....�. <....... t�.. �...w.a vL .�..�+� ,• y `_ _ pUhZVM COUNTY DEPARn-1ETT OF HEALTH — DIVISION Of ENVIRUMNrAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBbU111*PL-1:, SFWi GE DISPOSAL SYSTEMS... REVIEW S= CONSTRUCTION PERMIT • DATE x��vlEZaED: /�/��` (Street Location) DCCfJi�NIS Permit Application Corporate Resolution Plans - Three-sets Engineers Authorization' Design -Data Sheet (DDS) Deep Hole Lag Consistent Perc Results (3) 30" Perc Hole Other 4--- rtaqrm nf Owner) House Plans - Twn sets If M - Letter Variance Request REQUIRED DETAZIS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flc,4 Fill Piof ile & Dimensions - Volure D or J Box;Trench /Gallery; Puma pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two-Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area 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 Property Locte3 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., Driveway, large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O_D, 150' pits 100' to Stream, Watercourse, Lake (inc. elan). 15' to Drains - Curtain, Storm, Leader, Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' from Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Fps. approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same 4 - -pun�M C OLMY DEPAR1.Mh �...Ln 1~Ur' tsit•u,in 1. Tnlcfi inert min. 2" ab� akJet Inert- 2. AU a lets at sar, e1-uatiaL 1 0+1 Ft- s 1" to 5" abx e tank bottcnL 4. Mini = 12" bs3airx3 c1em ---xxl ar psi 9mmaL. 5. 7rilzt, bye. 6. Mmdmm 12" ax;er. 7. ale, aver f= as . 8. �1aI pine joints ( {ali is Cr is a ). ' 9. SIC e Qtdets at 1/8 - irvft- (1 %) 10. Rv t gam- a--1- rn 1. Slop- 1/1.6 in. /ft. to 1/32 in. (0.5% to 0.250- 2. 3/4" to 11" a&)E l S' c r wB4jSa 9--%k22' 3. 4" minim n latsal (iaieter. 4, . 2" mi.r i ate caper lateral.. 5. 6" minimm mate txrl =r lab---al- 6. u ttreate3 builrlirrj peper cr 2" -af straw cat. ate- 7. 6" min n( 12" mmdmn eBrth backEM. 8. 0 11 to allay fcr sd i g, 411 --Cl- 9. 2'minim= fran bm)d bottan to eater- 5f+-a, de 10. 5'min.fran tr&� bo(ton to igPavias 7 ft- g2de. 11. Tce-rh gracing run.6'O.C.(24 "trzxb). 12. TY=nzbEd 1abe al erls mr-t be plLzjgsl. 13. FM - 2:1 acpes min. 10' bolaxI tree. dq:th:3Pm3x.a;er xa k +;2lnmc.a)er meter kpmmeUe bm5ar. 3. Iatezals BL7 with bottrm 4- TLStit }tints Pies 'bx�. ■ IS1 ■ w ■ - I. • 1 J •- • - CE asing'B" 2. 1 11 •-• •f •-- 9 - (•• • casing ..• - • i cc udxrticht. 3. 1 &pffi cf liplid 41 3. Flinimn d asirxj •. steel cc W=jt�- imm- 4. - • minium twize wZth • axial • 1 1 mffiirmxn gm± into •• _ width. 012-et r • O.G. 11 • ••: . - .- !m • • qr•C• .. - fran uell. • - .•- . rrdxlirrLm 21 ZbOrter dimmsim - ••'11.1 rRVN EEMIES - (84', i 6=51 • • mt-ml soil •-c• 1 Mirifirm r -1•a•1 ••1 .a •a•1 •• 11 to lilt cleen 9m -R1 - • -- go •aa •• d1`3, •5 :1 •1 ••1. 1 •:if •a a• pipe- )3 MAet • r r. • o±lp-t • •- •r 3/811 par wr 1 - � jaintS ■•• smitaV tees- 1. Tnlcfi inert min. 2" ab� akJet Inert- 2. AU a lets at sar, e1-uatiaL 1 0+1 Ft- s 1" to 5" abx e tank bottcnL 4. Mini = 12" bs3airx3 c1em ---xxl ar psi 9mmaL. 5. 7rilzt, bye. 6. Mmdmm 12" ax;er. 7. ale, aver f= as . 8. �1aI pine joints ( {ali is Cr is a ). ' 9. SIC e Qtdets at 1/8 - irvft- (1 %) 10. Rv t gam- a--1- rn 1. Slop- 1/1.6 in. /ft. to 1/32 in. (0.5% to 0.250- 2. 3/4" to 11" a&)E l S' c r wB4jSa 9--%k22' 3. 4" minim n latsal (iaieter. 4, . 2" mi.r i ate caper lateral.. 5. 6" minimm mate txrl =r lab---al- 6. u ttreate3 builrlirrj peper cr 2" -af straw cat. ate- 7. 6" min n( 12" mmdmn eBrth backEM. 8. 0 11 to allay fcr sd i g, 411 --Cl- 9. 2'minim= fran bm)d bottan to eater- 5f+-a, de 10. 5'min.fran tr&� bo(ton to igPavias 7 ft- g2de. 11. Tce-rh gracing run.6'O.C.(24 "trzxb). 12. TY=nzbEd 1abe al erls mr-t be plLzjgsl. 13. FM - 2:1 acpes min. 10' bolaxI tree. dq:th:3Pm3x.a;er xa k +;2lnmc.a)er meter kpmmeUe bm5ar. 3. Iatezals BL7 with bottrm 4- TLStit }tints Pies 'bx�. r- 13113130 ASSOCIATES CONSULTING ENGINEERS & PLANNERS P.O. BOX 403 CROTON FALLS, NEW YORK 10519 C9141 277-5B05 --I TO ZA W—� SUBJECT- -6- DATE..._.. -.9.402 2 s3 dzr Awv-r MAU AA 4.746 I;& &IdNEO FORM OL 87 0 DIST RIBIJ TED BY allILL CORPORATION • I DOS. SCHELTER ROAD • LINCOLNSHIRE, ILLINOIS 60099 -41m, &S-v ^. PUTNAM COUNTY DEPARTMENT OF HEALTH �# DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION CAT ON TO CONSTRUCT A WATER WELL please print or type PCHD Permit # W (0q - O S$ Well Location: Street Address: TownNillage Tax Grid # 260 McManus Road North, Patterson, NY Map23.11 Block -1 Lot(s) -1 Well Owner: Name: Address: Amy & Bruce Goddard 260 McKanus Road North, Patterson, NY 12563 Use of Well: X Residential 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 5+ gpm # People Served Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) X Deepen Existing Well . Detailed Reason Current well is 85' dee;� and keeps running out of water for Drilling Well Type :i Drilled Driven Gravel Other Is well site subject to flooding? .................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Lot No. Water Well Contractor: P. F. Peal & Sons, Inc. Address: 4 Putnam Ave., Brewster, NY 10_509 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: 91/12/05 Applicant Signature: Christopher Beal 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 Director. revision or alteration of the approved plan requires a new permit. Well to be constructed by a water ell filler certified by Putnam County. �. Date of Issue , h Permit Is ' Date of Expiration 17141,04o Title: Permit is Non - Transfer abl White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 -17 --- ------- 'A A r MACADAM m K K r> 1ZW SWAY O. 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