Loading...
HomeMy WebLinkAbout0718DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23.12 -1 -43 I " I mill, ,. I me 1 ,. Is -. is IN tj 11, ,` , '� 111 ,,, r i i r r 00718 Rev. 3186 OF PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N:Y 10512, Mast Provide P.C.H.D. Permit ;# - -- e —= FOR SEWAGE Located at POWr9--_waOR J R.O& ' Owner /applicant Name .yRwlo�n G�eNsP.onl Formerly I, is Mailing Address P c. Fox 330 _Zip tosto Town or Village Tax Map . l S Block cS Los 4 Subdivision Name Sabdv. Lot # 5 R�oi6C Date Petmit.lssued 40 14-98 �RIARG�.IPF MAPlOR w1Y Separate Sewerage System built by 6-VAJANI-0^01 tau i ltexs Address P o Box 5&o aQLI ANtca.a FP rr1AWok Consisting of tZ°S� Gallon Septic Tank and AW L_F .ABSCRPTioni "T4Lq1i!;biCA Water Supply: Public Supply From Address or: vats Supply Drilled by f F. BerA%-_ of Sod' —& Irlc. Address fm, Box ft l lslea, WY Building Type Res 1 ot:nic E Has Erosion Control Been Completed? yh Number of Bedrooms 9 Has Garbage Grinder Been Installed? IJ 0 Other Requirements 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 a filed plan, and the permit issued by the Putnam County Department Of Health. Date ©G� `� Certified by � P.E. �_ R.A. Address - +�'`�`�1^� I S �� 9;2- C";ftMeLw NY License No. 2600® Any person occupying premises served by the above system(s) 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 pub;% sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becofnea available. Such approvals are subject to modification or change when, /ink the Judgment of the Commissioner of Health, such revocation, modification or change Is necessar /y` Date- - �/ /5_1 �?� �� Title �JJ PUTNAM COUN'T'Y DEPARTMENT OF HEALTH -� a DIVISION OF ENVIROiZ AL HEALTH SERVICES Owner or Purchaser of Building Section Block Lot Building Constructed by rq } -s c Location - StrddE Munici ity -^�-- C Wt- C,-a Building Type' ' — I I � T--q/4- We Vt'(f woxk S ivis on Name Subdivision Lot # �- GUARANIEE 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 accept as conclusive the determination of the Director of the Division of E.nvironiwntal 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 Corporation Name (if Corp..) 0o r; C-,/ -� �;r Address rev. 9/85 `� mk Corporation Name (if Corp.) Address r'J J BREWSTER LABORATORIES Box 224 - BREWSTER, N.Y. (914) 225 -2072 - WATER ANALYSIS REPORT - SAMPLE NO. 710 0 SOURCE: Greenspan Lot 5 Flintlock Ridge Patterson, NY COLLECTED: October 4 1988 . BY: P.F.Beal & Sons, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. October 9 1988 LS Roy @ kwit .E. rector 0 per 100 ml. a �' [V O WELL lJVV1YLb"11UV MZrVAI DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET ADDRESS: WN /VI 1 1!Y TAX GRID NUMBER: r �- Flintlock Ridge, Patterson,NY Lot #5 WELL OWNER NAME: ADDRESS: Arnold arcliff Manor NY ❑ PBIVATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary I3 RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND.IHEAT PUMP ❑ ABANDONED. ❑ BUSINESS ❑ FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING A3 NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST / OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA ` WELL DEPTH 445 ft. I STATIC WATER LEVEL ft. DATE MEASURED 8/26/88 DRILLING EQUIPMENT 91 ROTARY 10 COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. FLI OPEN HOLE IN BEDROCK ❑ OTHER CASING TOTAL LENGTH ft. MATERIALS: CXSTEEL ❑ PLASTIC ❑ OTHER LENGTH .BELOW GRADE 41 ft. JOINTS: ❑ WELDED IM THREADED ❑ OTHER DETAILS DIAMETER 6 in. SEAL: I@ CEMENT GROUT ❑ BENTONITE ❑ OTHER WEIGHT PER FOOT 1 A lb./ft. DRIVE SHOE ID YES =NO LINER: ❑ YES IO NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST O YES ONO HOURS SECOND GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH It. WELL YIELD TEST If detailed pumping METHOD: ❑ PUMPED 1 tests were done is in- E) COMPRESSED AIR , formation attached? ❑ BAILED ❑ OTHER ; ❑ YES O NO IELL It more detailed p formation descriptions or sieve analyses LOG are available. lease attach. DEPTH FROM SURFACE Water Bear- 1n9 Well O'a- neter FORMATION DESCRIPTION raoE. It. ft. WELL DEPTH It. DURATION hr. min. DRAWOOWN It. YIELD gpm. Surface 1 rilling in overburden clay & bld s . 445' 6 425' 15 151 42 DriAling in rock,set casing,grout d. 2 in rock granite. WATER ❑ CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? O YES ONO ANALYSIS ATTACHED? ❑ YES O NO H I I STORAGE TANK: TYPE WX 250 CAPACITY 44 GAL. PUMP INFORMATION TYPE submersible CAPACITY 5 g MAKER Gould DEPTH 00' MODEL 5ES07'412 VOLTAGE.�cIP�4 WELL DRILLER NAME AT P.F. Beal & Sons,I I11/88 ADDRESS PO Box B 51011TURE Brewster,NY 101, 50 Z4 II. IV. V. VI. FINAL SITE INSPECTION Date Inspected by ;CATION m CW14ER TM # OR SUBDIVISION LOT # YES NO CprqMENTs S - DISPOSAL AREA a_ SuS area located as approved plans b. Fill section - Date of placement 2:1 barrieY. LGTH WIDTH AVG.DPTH c. Natural soil not stripped d_ Stone, brush, etc_, eater than 15' fran SDS area. e. 100 ft. fran water course /wetlands. ' S'r� =-E DISPOSAL SYSTEM a. Septic tank size 1, 1,250 b. Septic tank ins evel c. 10' minimum fran foundation d. No 90° bends, cleanout within 10 ft. 'of 45° bend e_ DISTRIBUTION FAX 1. All outlets at same elevation - water tested 2. Protester betca frost 3. Minimum 2 ft. original soil between box and trenches f. JUNCTION BOX = rope' -1v set I g. Zak 1. Lenath recui red - Iznath installed UJ 2. Distance to water-ccurse measured _ ft. 3. Installer according to plan- 4. Distance ctnte-r to center 5. Slone of trench acceptable 1/16 - 1/32 " /foot. 6. 10 feet fran Prcpe_►-ty line - 20 feet - foundations I I 7. Depth of trench < 30 inches frcmn. surface I I 8. Roan allcNed for e-xpansicn, 50% I I 9. Size of gravel 3/4 - 1 " diameter i 10. Depth of aravel in trench 12" minimum 11. Pipe ends t .' med h. PUMD OR DOSE SYSTEMS 1. Size of Lmm cha*nber 2. Overflow tank 3. Alan, vis-ual /audio 4. Puma easilv accessible manhole to grade 5. First box baffled 6. Cycle witnessed by He-alth Depc�rlt estimated flow r cycle HOUSE a. Hcuse located per approved plans. I I b. ham' sirs of bedrooms WELL a. Well located as per approved plans b_ Distance fran SDS area measured ft. c. Casing 18" above ade. d. Sumacs drainage around well acceptable. i OVER.?1, WORMASHIP a. Bcxes properly arcuted b. Ali pipes partially bar-kfilled c. All pipes flush with inside of box d. Eo- akfill material contains stones < 4' in diameter e. C=`tain drain installed according to plan f: C: _*tain drain cutfall protected & dir.to enist.wate-ccurs g. Fcotinq drains discharge away fran SDS area h. Surface water rotection adecruate i. E_csion control provided on slopes greater than 15 %. r ,PUTNAM COIINTY DEPARTMENT OF HEALTH Divb>ton of Envhanmeufal Health Services. Carmel, N.Y 10512 Engineer to Provide Permilt N . CONSTR N PERMIT FOR SEWAGE DISPOSAL SYSTEM Located at �u/DE►z (= ir7�n/ 7�cP+7 on CERTIFICATE OF LIANCE Permit: q - Town or Village Sabdivlslon Name FL.t AJ1 tpeK Tu Map_! S Blod� r"� Lot �— Owner /Applant Name .A ie.w1� t.�17 Gi�/S PA n% Renewal-0 - Revision lon ❑ Date of Previous Approval Mailing Address f d 13223, 3 0 Town J50alAer-L -1 FF P, h Ole zip l05 (.O Banding Type �i�cS 1 �g,�lCt= Lot .Area � � �C- Fm Section Only Depth Zr i Volttme i� c Number of Bedrooms Design Flow G P D BDO PCHD Notiff"don is Required When Fill is completed Separate sewerage-System to comdgt ofXZ_,S_0G J9n Septic Tenn and, HBO E:.. F 1S, 350 rxPT /OAJ --7ZeWc14 To be constructed by-7-11 a A Address water Supply. Public Supply From Addre or: Private Supply Drilled by _72- B€ AMT I ss Address Other Requirements I represent that 1461 wholly and completely responsible for the design and location of the proposed system(s) l 1) that the separate sewage disposal system above descr.Wed will be Constructed as shown on the approved amendment there to and in accordance with the standards, rules an regulations 07 e u urn County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" Satisfactory to the Commissioner of Hea1Mwi11 be Submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition, Any: part of "said sewage disposal system during the period of two (2) years Immediately following the date of the issu- ance of the. approval of the .Certificate.: of Construction Compliance of the original system or any repairs thereto 2) that the drilled. well described above will be located as shown on the approved plan and that said well will be installed in accordance with th andards, WAS and regu a ons of the Putnam 'County Department of Health. P.E. Date /�C) Signed R.A. Address F�11j J! t s S CIA. License No APPROVED FOR CONSTRUCTION:TMS approval expires two years from ,tlie date issued unless construction.of the building has been undertaken and is revocable for cause or may be amended.or modified when.consideredneeessary by the Commissioner of Health. Any change or alteration of construction requires a w permit. Approved for disposal of domestic sanitary sewage, and /o rive ater supply only. Rev. 1/87 Date Title " d' «; APPEOIX B PU'TNA,"! CCURTY DEP=1RU OF HEALTH - DIVISICN OF EM-IRCNMENTAL HEALTH S"^aVIC_"S INT)17j-=UAL WATER SUPPLY & SUBSURFACE SZQA=- DISPCSU SYSTEMS ciEae of Cwre- R=ni S= - CONSTRUCTION PERMIT DATE RL �v� � _ BY: (Street Lccaticn) YF. S NO DCCjN,= Pe it it Application Corporate Resoluticn Plans - Three sets i x I I EngLrieers Authorizaticn �X I I Design Data Sheet (DOS) I I I Deep Role L g o< I I Ccnsistant Per: Res-,:I _zs - - Pe_rc Hole Depth L- =sncn prov_G z ) re—quiz I X 60 ft. max. Pa_e_l_l to contours I SCI F= SYSTEAS 4_ clavcarrier f�. fi7,1: ot= j Cec e.-Ucesyz_� 100"I. fl c e,ev. 200 ft. rese- rvoi -, 150 ft. tricall /gza1 s/s SuEDIVISIC: P_rc (3) Fill T CA &_ 7.15->n S - T.. o sets pex -mit; F;qz-: 1e�_er -Variance Reauest t-RPL Lc-_-al SabClivi sign Subdilrisicn A -ccroval Cae ked Lc -a_ _rcval SSDS 11 Lots C =' "sue We' and (TCw -n /DEC P- = =,i = R & DI Da. Cn DCS Plans & Permit Sama REQU= DETA , r c CN PL` NS Se a e SvstzR Plan (corm mm� P_ofle - Cray F_ iCns - 4o_-- le-ry; PI -= Pit cetc-11 s Septic '18n;'C - Size, De 31l Wel1 Detail, S =mice Line if cve_ Censt-ruCticn Notes (grinder rats) — Les.gn Data: pe-c and deep resw_.. Twc-Foot Contours Existing & Prccoser Drivegav & Slopes Cut Footin /Gutter,Cti: rt=in Drains (discharge M, Pere & Deep Holes Lccated Representative of prim.:_ry and e pansicn _ Expansicn , Area; shcwn; gravity flc-w, ssf f. s iz e „I= Pamed Pit & D Box & DeT_iled House - No, of Eedr Wells & SSOS's w /in 2 t. of r cpesed Svst Prcce_rty rtes & Bounds House Setback Necessary (Tight let) House Seger - 1 /4 " /ft. 4 "0; Tyne pipe No Bends; Max. Bends 45" w /cleanout SEPAMION DISTANCES SPECIFIED CN PLTNi Fields 10' to P.L., Driveway, Large T_E- _s,Tcp cf 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, LE�ka (inc. ex 15' to Drains - curtain, Leader, Footing 35'to cat(fi bGsin,stor arain,oic-::d ,rtEr= 10' to Water Line (pits -20') 50' intermittent drainage ccurse Seotic Tanks 10' fran Foundation; 50' to well 15' well to PL 9 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 # WELL LOCATION Street Address Po WDC►allo�rJ Town/Village/City Tax Grid Number oAp 1�'',c.TT�l25 on/ S - S WELL OWNER Name Mailing Address Private oc. c;leet=_ s ten! P-0- F5* oA 0 Public USE OF WELL 1 - primary 2- secondary V,RESIDENTIAL ' 0 BUSINESS O INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT mid gpm /# PEOPLE SERVED�r_ /EST. OF DAILY USAGE grav gal REASON FOR DRILLING IaNEW SUPPLY O PROVIDE ADDITIONAL SUPPLY OREPLACE EXISTING SUPPLY ODEEPEN EXISTING WELL O TEST OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE DRILLED []DRIVEN ®DUG GRAVEL El OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: ��- W-rt,ocr- t DCWEs Lot No. g WATER WELL CONTRACTOR: Name --7;;- L7er7 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES. � NO NAME OF PUBLIC WATER SUPPLY: 1-i Xs TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED- �,5`�' ON REAR OF THIS APPLICATION ON S P RATE `e (date) �,(�ig a ure PERMIT �,,.. TO CONSTRUCT A WATER WELE. 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 Dep rtment. Date of Issue: Date of Expirati 19� ermit ssu ffic n: Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector 2/87 Pink Copy: Owner Orange copy: Well Driller pUn M C OUNN . DEPARM4 NP . CP HEALTH DIVISICtN OF ENVIPLEMERML HEALTH SERVICES DESIGN DATA SHEI r SUHSUFAr~E SEWAGE 'DISPOSAL SYSTEM' FILE NJ. Owner A+z00Lb Ge_.QeAJSP,dtil Address FabK 350 f?-,e %Aeca.-Irr Located at (Street) $em, I's_ Block. s lot (indicate nearest cross street)' Municipality _ f,21,TesJ •Watershed' �eo7aj 5OIL'PERC0=CN.TEST DATA,RDW= TO SE SUBMITIED WITS APPLICATIONS Date of Pre- SQaking S. Date of Percolation Test 3 s e8 . i HOLE L' NUMBER CTACK TIME PERCOLATION PERC OLAT1W . . Run Elapse Depth to Water • -ram Water Level No. ''Time Ground Surface . In Inc bes Soil Rate Start-Stop Min.. 'Start Strip ' Drop In Min/In Drop Inches Inches inches • 1 -5:00- 18 18 21 29 3 2 q: ,B - q 39 z i 2 I Z9 3 7:59 Io:o3 Z9 ZI Zq 3 8 ' 8 51O.2i 3• �' l9'1S 9'3Co 2.1 to 2q 3Co -16 oo z� 20 Z2;... r - 3 jo DO lo -29 z9 20 Z3 3 8 4 io•zg �0 48 'Z9 20 Z3 3 8 5 2 ' Tests to be repeated' at same depth until •apprcodmately equal soil rates are 'obtained each percolation test hole, All data to' be • wu13nittpd .at for revie4. TEST PIT DATA RDOUIRE.'D TO BE SUBMI= WI']S APPLICATION DEPTH. HOLE -NO.' 1 HOLE NO..' HO NO. ••• r• G.L. ... .. • of�oi� 3 F25 jjj 4' 5' 6; 7' 81 ` 9' ' 10' 11' • 12•' 13' INDICATE LEVEL AT WHICH GTtO MXU'M IS ENOOUNTMW 1J otil E INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING F.NO(]NTWL D DEEP' HOLE OBSERVATIONS MADE BY S o s F>e- F► L ` i`t �.� DAM: DESIGN Soil Rate Used 8 Min/I" Drop; S.D.. Usable Area .Provided, scaoorA No. of Bedroans q Septic Tank .Capacity iaso gals. Type r-As wey Absorption Area Provided By qBo L.F. x 24" width trend; Other 2 z �•��'. o. B ��� C s�9, c�• YDS i �;': it., Name AssoCIA -765, P. C. Signature Address �O rm, SZ SEAL n ✓� THIS SPACE FOR USE BY- HEALTH •DEPARIIKENI ONLY: Soil Rate . Approved sq. f t/gaa,... Checked by f-