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HomeMy WebLinkAbout0705DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23.12-1-30 ,. . , IMF.. ��. . kc I. r 4' T. I I � ` 4 1 . I 00705 \ ©... EN61'Nl:EFi MUSS PLTY'NAM COUNTX DEPARTMENT•. OF HEALTH PROV I D.E ' Division of Envirowimital HWth Services, "Carmel; N.' Y. 10612 RERMIT; # -5 -87 CERTIFICATE, OF STRUCTION COMPLIANCE .FOR;SEWAGE'.DISPOSAL. SYSTEM • Town or -WNage Located at Tax Map IS Block '!.•;6 Owner -'61R JoLg :D0a✓�4-FAg0 / Formerly � Tax Map Lot s. Subd. Lot s Separate Sewerage System built by AddresiP0• E50-X BAO BRIA4aGLIFF 1.46.6109, 'P\J Consisting of 12-SO - Oai. Septic Tank and �1 g t_• !���f2t� T ION ' r?i'aA%Chi Other requirements Water Supply: Public. Supply From Private Supply Drilled By If F• E50^ SVAJSt IJ'ir- Address P o • BCif t3 8i�1.✓STcla , n/ Y Building Type No, of Bedrooms Date Permit Issued. Has Erosion Control Been Completed? �� Has garbage grinder been installed? 1�0 I certify that the system(s) as listed serving the above'premises were constructed essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulations, in accordance with the filed plan, and the permit issued by the Putnam County Department Of Health. A Date /cTtn( 1.'� 1 Certified by P•E.X R.A. Address 40, LGe 08 Any person occupying premises served by the above systems) shall promptly take such action as may be necessary 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 public sanitary 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 or change when, in the judgment of the Commissioner of Health, such revocation, modification or change Is necessary. Date . Y. / T3 CS �y s Title Rev. '6/85 1. PUTNAM COUbTfY DEPARZMEW OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES �,.to t.-:D pe.n Owner or Purchaser of Building UrM Subdivisi n 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 immediately 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 utilizing the system. The undersigned further agrees to ac.^.ept as conclusive the determination of the Director of the Division of Environinental 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 building utilizing the system. Dated this day of 19�ignature �� ----� Title ,Ga Contractor Towner) - Signature Corporation Name (if .) rev. 9/85 Corporation Name (if Corp.) Address v Section Block Lot Subdivisi n 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 immediately 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 utilizing the system. The undersigned further agrees to ac.^.ept as conclusive the determination of the Director of the Division of Environinental 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 building utilizing the system. Dated this day of 19�ignature �� ----� Title ,Ga Contractor Towner) - Signature Corporation Name (if .) rev. 9/85 Corporation Name (if Corp.) Address v BREWSTER LABORATORIES Box 224 - BREWSTER, N.Y. (914) 225 -2072 - WATER ANALYSIS REPORT - SAMPLE NO. 6627 SOURCE: Arnold Greenspan Lot 11 Flintlock Ridge Patterson, NY COLLECTED: July 15, 1987 . BY:' P.F.Beal & Sons, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method hose bibb -well 0 per 100 ml. This. result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. July 17, 1987 Roy Bickwit P.E. Director " ikc � a. C WELL UUF1rLh"11UN rcPlrVml DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only TAX GRIO NUMBErI: STREET AOURESS: 79WNIVIEUGLIC111" Flintlock Ridge ---Pa-tterson Lot #11 WELL LOCATION WELL OWNER NAME: ADDRESS: Arnold Greenspan, PO Box 330,Briarcliff Manor,NY 10510 ❑ PRIVATE ❑ PUBLIC USE OF -WELL 1 - primary 2 - secondary -] RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING ® NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY' ❑ DEEPEN EXISTING WELL DEPTH DATA WELD DEPTH 425 ft. STATIC WATER LEVEL 35 ft. DATE MEASURED 5/8/87 DRILLING EQUIPMENT (3 ROTARY a COMPRESSED AIR PERCUSSION ❑'DUG ❑ WELL POINT ❑ CABLE PERCUSSION O OTHER (specify): WELL TYPE 1 ❑ SCREENED ❑ OPEN END CASING. ® OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH 21 ft. MATERIALS: ® STEEL ❑ PLASTIC ❑ OTHER CASING LENGTH.BELOW GRADE 20 ft. JOINTS: ❑ WELDED ID THREADED O OTHER DETAILS DIAMETER 6 in. SEAL: AaCEMENT GROUT ❑BENTONITE OOTHER WEIGHT PER FOOT 1,q- lb./ft. DRIVE SHOE: ® YES ❑ NO I LINER: O YES Q NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (It) DEPTH TO SCREEN (ft) DEVELOPED? FIRST O YES ONO SECOND HOURS GRAVEL PACK O YES 0 NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH -ft. BOTTOM DEPTH pump 9 WELL YIELD TEST If detailed um inIELL METHOD: ® PUMPED i tests were done is in- 0 COMPRESSED AIR ;formation attached? O BAILED ❑ OTHER 10 YES 0 NO LOG 'are detailed formation descriptions or sieve analyses are available. please attach. DEPTH FROM SURFACE Water ing Well 81 ter meter DESCRIPTION cane. ft ft WELL DEPTH ft. DURATION hr. min. DRAWOOWN It. YIELD 9Cm. Land Surface overburden clay a b H't r ck at 6 feet 425 6 40 6 21 Diill,Lng in rock set casing.gro uted 21 425 D ill'ng in rock,set casing,grouted WATER O CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O.COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE Well Xtrol M 250 CAPACITY 44 GAL. PUMP INFORMATION submersible i1T TYPE CAPACITY �" L - Gould n DEPTH ��n MAKER .+-0 MODEL5ES07412 VOLTAGE30H /4 WELL DRILLER NAME P.F. Beal & Sons DATE/, I 1 8 PO Box B ADDRESS SIGTiMI E / Brewstar, NY 10509 II. IV. m I. APPENDIX C FINAL SITE INSPECTION Date Inspec ed by LOCATION OWNER ,sIT # �° `IM # OR SUBDIVISION LOT # 7,;V 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 stri ped d. Stone, brush, etc., greater than 15' from SDS area. e. 100 ft. fran water course /wetlands.' SEWAGE 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 450 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 6 g. TRENCHES 1. Length required - Length installed 4 2. Distance to watercourse measure. ft. XA* 1l 3. Installed according to plan 4 4. Distance center to center _/" 5. Slope of trench acceptable 1/16 - 1/32 " /foot. 6. 10 feet from propert y line - 20 feet,- foundat ons 7. Depth of trench < 30 inches from surface 8. Roan allowed for expansion, 50% 9. Size of gravel 3/4 - 1 " diameter 10. Depth of gravel in trench 12" minimum 11. Pipe ends capped h. PUMP OR DOSE SYSTEMS 1. Size of pumm chamber 2. Overflcw tank 3. Alarn, visual /audio 4. Pone easilv accessible manhole to grade 5. First box baffled 6. Cycle witnessed by Health Department d estimated flag per cycle HOUSE a. House lccat apprcve plans. b. N, member of bedi-cans W= a. „ell located as per auor3v -ed plans I'AL I 1 b. �s; :nce fran SDS area measured ft. c. Wising 18" above grade. /v d. Surface drainage around well acceptable. 1 n, , j OVT —RALL VvORKMASHIP a. Boxes properly grouted 1-1 b. A11 pipes partially backfilled Pe i c. All pipes flush with inside of box 1 d. Packfill material contains stones < 4" in diameter e. Curtain drain installed according to plan I I f. Curtain drain outfall protected & dir.to exist.watercours� g. Fcotinq drains discharge away fran SDS area h. Surface water protection adequate -YH i. Errosion control provided on slopes greater than 15 %. suflding Type � �iY% /L� s Lot Area Number, of Bedrooms _Design Flow G /P %D Separate Sewerage System to conilit oE.�GAdii, Septic TiA an T'o be consf; acted by Addreai Water Supply: Pdbllc SaPP1Y:m Address 4f,2 9i: C> Or ::' . - �/ • Private Supply Drilled by - Address Other 1"ufremeuti represent that l am wholly and "completely responsible for the design and locatbon'of the proposed systems) 1) ,that the- separate 'so 'ago`dispoiat system above described wiII be constructed as shown on the approved amendment thereto and in accordance with the standards; rules an •regu a ions o e' Putnam County :Department of Health,' and that on completion tnereot a t-Cert,f�cate. of" Condtruetion Compliance" satisfactory to the Commissionei of Healthwull. M- ,� be. submitted to the Qepartment an 1, written'guarantee . w6l`be furmshgtl.the:owner, his,wccedso►; heirs or assigns by the builder that seid'buiider will place. in good• operating condition any;part of sa!d• sewage disposal system' during the period of two (2) years7mmedistely following the date oTthe issu- ance of the;$pprovaC'of the?Certificate.of Construction Compliance, of the original'system or any.repairs;' eroto; 2) that •the drilled-well described above l will be located as shown op-, the approved plan antl that said well will`.be; installed in accordance wit he "sta ards, rules and regu a Ions of the Putnam County Department of �Hea the - - Date V �� Signed' P.E. R.A. ry ... -, , •: - - Address., ��. . �/'�.�� K: • �/� � icense No APPROVED FOR CONSTRUCTION This approval expires one'year from the,. date issued `unless "construction of the building has been undertaken and is revocable for cause or,may be amended or modi}ietl when "considered neces y b' y in '.Commission'er'of Health. Any change or alteration of "construction requires a new permit. Approved for disposal` of. domestic sanitary sewage, , a ate water s�1 ply only. 4 Or " .-72-7 ./ .� `j7- .. BY�i -C,��� -�•�l�.Cyf'° Title - Date ��� y ti 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 i WELL LOCATION Street Address . Town /fig Tax Grid Numbe Cif � / - r4! >a> 1 s - FsTT6R',55 % IK 16 544t' Z47"8 WELL OWNER Name Address ��cPurivate ' c/� �� blic USE OF WELL 1 - primary 2 - secondary )K. RESIDENTIAL ❑ PUBLIC SUPPLY Q AIR /COND /HEAT PUMP ❑ BUSINESS O FARM O TEST /OBSERVATION- ❑ INDUSTRIAL O INSTITUTIONAL O STAND -BY ❑ ABANDONED O OTHER (specify ❑ AMOUNT OF USE YIELD SOUGHT_^,i/ gpm /# PEOPLE SERVED jq /EST. OF DAILY USAGE gal REASON FOR DRILLING MEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑REPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE 19DRILLED DRIVEN ODUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES X. NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: L 1 i`T -LUf K f Lot No. WATER WELL CONTRACTOR: Name T"y - &--- Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES < NO NAME OF PUBLIC WATER SUPPLY: /t//iQ TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: C���; -'-AA3 LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ®ON REAR OF THIS APPLICATION I!fON 5EPARATE SH (date) (sig e) 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 provided by the Putnam County Health Department. = Date of Issue: '719 Date of Expiration: -02> -7 9 ermit ssuing ci Permit is Non - Transferrable PiTIMM COUNTY DEPARTMENT OF HEALTH DIVISION 0F` . .HEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner 0 5P W Address G10 CA-514/At A� iq—r&S PC, Located at (Street) Rharg /64iGivaxlwuL 1141- ,Qo . sec. /5 Block s Lot !/ (indica nearest cross street) ,pp Municipality I)OATT-E�SD14 4 Watershed C.�7�1T"O/✓ 6 20r SOIL PERCOIATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking Nov 17 96 Date of Percolation Test Noy j RC 2 HOLE NUMBER CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time —Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 202 4 2 ir3 - I'3 A 21 Zit 3 7 3 135- Z;oS 3c, /o 4 2.06- 2!+Z 6 20r 5 2 =a3- 3.19 36 j 24- 3 t2 h . 2 3. ;12Pc Rcl � aA rn6'a 7 -rT 4 5 • 1 �SP t (-- 1 � rvt � ! �' � 2 3 4 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 subnittbd for review. 2. Depth measurements to be made fray top of hole. rev. 9/85 TEST PIT DATA RE DESCRIPTION OF DEPTH HOLE NO. / G.L. 1' 2' 3' 4' 5' 6' 71 , 8' 9' 10' 11' 12' 13' 14' TO BE .SUBMITTED WITH HOLE NO. HOLE NO. INDICATE LEVEL, AT WHICH GROUNDWATER IS ENCOUNTERED 14,119AJ . INDICATE LEVEL, TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED AkWS DEEP HOLE OBSERVATIONS MADE BY: 11--1,17-1, C4 I' RI,0& Aa,b,, /fG. V,P, DATE: /9,00 DESIGN Soil Rate Used Id Min /1" Drop: S.D. Usable Area Provided 60,0,05-r. No. of Bedrooms 4 Septic Tank Capacity 12 64-) gals. Type Absorption Area Provided By 5a a L.F. x 24" width trencif" Other ` J Name ?C- Signature. =: j\ '\ ` t; Address 7.mt 6 5�t CAMEL- SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date ' J VP C ea J' � n 1. _,,r,•�!" � /• {.�: / � T��\ •� �t`v =i`` yam, ✓�.. _ ',`' , tKI Co t �n, 2GO' o :. � I W, fn t"N M4 t 57 t"N M4 t