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HomeMy WebLinkAbout0721DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23.12 -1 -46 00721 i '161. I 1 IN 1 - r 00721 a A\. tNU NEE MUS PUTNAM COUNTY DEPARTMENT`OF•HEALTH :PROVIDE .Division of Environmental Health Services, Carnie/ N. Y. 10512 pERMhT CERTIFICATE OF CONSTRUCTION. COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM ' Town or' Village' Located at Rk Lrls 1(,4 - _ .. Tax Map ..'1rJ Block', -. is. �,.f.. .Y... . Owner "p' ln._•rj C-A Formerly. Tax Map Lot N - Subd. Lot 4 - 4• Separate Sewerage System built by Address P�• Box' SJO f3R1AtaC�i FF. M.01.jo� consisting of t250 Dal. Septic Tank and 450 L . F lo►J TJJC�,i Other requirements 'C)l waw -riOIJ Qo-A Water Supply: Public Supply From Private Supply Drilled 13Y p' F EjEAL. So ►.ISM /tic Address PO P.So�t E-S gizEln/S'T(✓iZ r IJY wsc) -3 Building Type �g'SIDC —�IGC No..of Bedrooms Date Permit Issued 9 29 • 8� Has Erosion Control Beep Completed? �-?. Has garbage grinder been installed? 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. Date I2 j " Address P.E. 'A- R.A. Vo. -46,008 Any person occupying premises served by the above system(s) shiil 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 unitary 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 H necesury, /ii Date ,r v i / 7 -gig —�� �-� Title Rev. 6/85 C1 c'�, -I�j� r* �. W'tij O4 WI'JLL IJVi'1L LLJ11Vi\ i \J.:It Vitt DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only I� b.7 WELL LOCATION STREET ADDRESS: WN /VIL ! 1 T X GRID NUMBER: Flintlock Ridge Patterson,NY Lot #2 WELL OWNER NAME. ADDRESS: Arnold Greenspan, PO Bo 0 riarcliff Manor NY p pgIVATE O PUBLIC USE OF WELL 1 - primary 2 - secondary ® RESIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND. /HEAT PUMP O.ABANOONED O BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) p INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY p MOUNT OF USE YIELD SOUGHT gpm. /N0. 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 WELL DEPTH 345 ft. STATIC WATER LEVEL 30 ft. DATE MEASURED 8/10/8' DRILLING EQUIPMENT EI ROTARY Q COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. a OPEN HOLE. IN BEDROCK ❑ OTHER CASING TOTAL LENGTH 23 ft. MATERIALS: (3 STEEL ❑ PLASTIC O OTHER LENGTH.BELOW GRADE 22 ft. JOINTS: O WELDED 13THREADED ❑OTHER DETAILS DIAMETER 6 in. SEAL: ® CEMENT GROUT O BENTONITE O OTHER WEIGHT PER FOOT 19 1b./ft. DRIVE SHOE DYES ❑ NO I LINER: OYES 9NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST O YES ONO HOURS SECOND GRAVEL PACK O YES O NO GRAVEL SIZE DIAMETER OF PACK in. TOP DEPTH -ft. BOTTOM DEPTH It. WELL YIELD TEST If detailed pumping METHOD: O PUMPED i tests were done is in- C1 COMPRESSED AIR , formation attached? O BAILED O OTHER ; O YES O NO It more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. DEPTH FROM SURFACE Water Bear- ing We11 0ia' In FOR61ATlON DESCRIPTION CODE, ft tL WELL DEPTH It. DURATION hr. min. ORAWOOWN ft. YIELD gpm. Surface 1 D it in in overburden clay & bldr 345 6 325 30 1 2 D it in in rock set casi.ng,groute . granite WATE8 O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE Well Xtrol 250 CAPACITY 44 GAL. WELL DRILLER NAME P.F. Beal & Sons , nc . DAT5 /25/88 ADDRESS PO Box B SIGFTMRE Brewster, NY 10509 a-- PUMP INFORMATION TYPE submersible CAPACITY 7 g • MAKER Gnt-I 1 8 DEPTH _210 MODEL 7EHO5412 VOLTAGi ?�HP1� I 11 P[TTNAM COUN'T'Y DEPARTMENT OF HEALTH DIVISION OF. ENVIRONMENTAL HEALTH SERVICES Ae►,10 Owner or Purchaser of Building Building Constructed by o uTC ICoq Location - Street �p.'TT�.RSo t 1 Municipality ► E t.l CE. Building Type 15 5 q Sectipn• Block Lot Subdivision Name Z Subdivision Lot # GUARANI 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 foll_owing_the,date of approval of the "Certificate of Construction Compliance" for the swage 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 'utilizirig 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'to. operate was caused by 'the willfui or negligent act of the' occupant -of the building u ilizi.ng the system. Dated ' this �T" day of _ 19 8! Signature wrporati.on Name tit uorp. V.. - rev. 9/85 mk- Corporation Name (if Corp.) PUTNAM COUNTY DEPARTMENT OF HEALTH Rev. 3186 `n0 Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer twProvide Permit a n . on CERTIFICATE OF COMPLIANCE CONSTRUCTION PERMIT FOR GE DISPOSAL SYSTEM Permit N Patterson Located at Off of Route 164 Town or village Subdivision Name Flintlock Ridge snbd. Lot # 2 Tax Map 15 Block 5 Lot 4 Owner /Applicant Name _Arnold Greenspan Renewal_ ❑ Revision ❑ Date of Previous Approval Mailing Address PO Box 330 Briercliff Manor Town . zip 10511 Building Type _I Family Res, Lot Area 2. 74 +/ - Acres piffl— sm.gon Only x Depth- 1 /? volume Number of Bedrooms 4 Design Flow G /P /D 800 PCHD Notification Is Required When Fill Is completed Separate Sewerage System to consist of 1250 Gallon Septic Tank and_ 444 LF To be constructed by to be determined Address Water Supply; Public Supply From Address or: x Private Supply Drilled by to be de t . _Address — OtherRequlrements 3 1 /21 ROB fill Distribution Box represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations of the 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 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 there O; 2) that the drilled well'desc►ibed above will be located as shown on the approved plan and that said well will be installed in accordance ith the standard rules and regu a i'ons of the Putnam County Department of Health. Oats :'�'' �� Signetl r P, E. R.A. Address Cashin Assoccil1ates, P.C. Rt. 2 Carmel, NY 10SIAc n :e No 26008 APPROVED FOR CONSTRUCTION: This approval expires"8�i5e0year from the date ' sued less construction of the building-has been undertaken and is revocable for cause or may Pe amended or modified when considered n9cessad by eaCommis 'o r of Health. Any change or alteratieer of construction requires a new rmit. pro d for disposal of domestic sanitar a e, an va a r su ly only. 13 Date A � By Title PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer to Provide Permit N on CERTIFICATE OF COMPLIANCE CON UCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Permit M Located at_RnuTE /log Town so V411age- Subdivision Name FLt 11414 -05JG R► CEe@ Subd. Lot N Z Tax Map l S Block Lot 4 Owner /Applicant Name 2S.Rt�1 O t -ice �p2��1.1�PA T.� Renewal_ ❑ Revision ❑ Date of Previous Approval.3 • 13 • 87 F'o2 Pl�•�- Mailing Address f 0 DA 330 Town $stA ALQ% 11*- MA ;t zip toSll Building Type R1RA De*J5 -F- Lot Area z",4 t �G FW Section Only Depth volume Number of Bedrooms 4L Design Flow G P D 800 PCHD Notification is Required When Fill Is completed Separate Sewerage System to consist of t�C Gall on Septic Tads and 450 t_. V A,26%e t.?TlotJ �%fJGbi To be constructed by T$ Se Address �i�T- E$M11.ttc'.b Address Water Supply; Pgibilc Supply From Address art nPrivate Supply Drilled by -rb 8a D@L A/ddress Other Requirements u ` tSTW B "Ti b nl B oft 3th./ �.0 , B . 1=1 1 represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations of e Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder Will place in good operating condition any part of said sewage disposal system during the period of two (2) years Immediately following thedate of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be Installed in accordance with the standa , rules and reyu aions of the Putnam County Department of He th. Date Signed J Signed P.E._ R.A. Address (294S14114 AAMO. & 2- KC License No 71100$ APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when considered Cecessary by the Commissioner of Health. Any change or alteration of construction requires a new per Approved for disposal of domestic sanitary sewage, and/ pr' to water supply only. 1/81 Date yi ,�'Z / / �� BY / i��Z ✓iC =�'" — �' `— _ Titfe pun" C1WM DEPARM -UM CP EEALTH DIVISION OF RNMNEML MUM SERVICES DFSIGN DATA si.mr- sLwuna SEDGE ' DISPOSAL SYSTER FILE NO. owner Oi -'n Address FO-'Box Wso i2SyuAzc.�-%PF MA,.►oR Located at (Street) / (-A Sec. tS Block 5 ' Lot 4..' (indicate nearest cross street) Municipality i�ATTEtz.So�.t Watershed. Cwo -rorJ O X3104• ) #.'U M fuk. rMv �: �: :?�. �o ;a� �� `�i:��VVYyy .Iy1: • J r: M rLti. Date of Pre- Soaking Date of Percolation Test a I 8`1 HOLE . NU -SSER CLOCK TIME PERCO TICJN PERCO=CN Run Elapse Depth to Water Fran ' Water Level No. Time Ground Surface In, Inches Sail Rate Start= -Stop Min. 'Start Stop Drop In Min/In Drop Inches Inches Inches 1. I I o5 - 11 Zo I� zt z.a 3 5 2 it, '21-11:3c.:b, 15 zl ZA 3 S. 3 II °3'7- 11 : 5' 18. 21 ZA 3 5. NOTES: 1.. Tests to be repeated'at same depth unUl approximately equal soil rates. are obtained at each percolation test. hale. . All data to* be sutmitted for review. 2. Depth measurements to be made from -top of hole} .: rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBFIITTFED WITH APPLICATION DE.'SCRIPTION OF SOILS ENCI)(IIU RED IN TEST HOLES DEPTH. HOLE • NO. HOLE NO...., .. HOM NO. . G.L. .. , . .. . 2' 3' .4 5' 7' tl 17A"i"A ET 8" ., 'o R. 7�t= P 77 ST 9o... 12' .13' 14' INDICATE LEVEL AT WHICH QIOUNTJLn1ATER -IS M=UMEPM tJ �A INDICATE LEVEL TO. WHIC H.' WATER .LEVEL RISES AFTER, BEING IIJUOUNTERE D tii /A DEEP HOLE OBSERVATIONS MADE BY: �A. 1 DATE: DESIGN .Soil Rate Used S- /o MinA" Drop: S. D. Usable Area .Provided 500Q �'.. No. of Bedrooms q Septic Tank Capacity tzso gals. Type Nwso���y Absorption Area Provided By AAS L. F. x 24" width trends ��MAL Other . ► s � Bu-r- 0 8 o x 3 ��i. . o. Q c. a 'ti Name C.�s�t rJ �ssoci A.TES Signature' .:: . SEAL Address � R.OUTB. 52 �' eIX �J y M0-'-260 C'Y'E 7N�� , ARMEt -.a tl 10512 S THIS SPACE FOR USE BY HEALTH DEPAMMW ONLY: Soil Rate' Approved sq,. ft,/gal Checked by Date 1 �' � y �° • l7 Y• ly . ?• M9► DESIGN DATA SHEjjET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE W. Amer _1 ROl(� Gre-to so&C Address 3w Pr(c rd l ci M cLflo r 2.4 Located at (Street) 0 � �oa. (� t Sec. 15 Block Lot '4 (indicate nearest cross street) F1,•1 dyu 1-Of municipaiity PoAr'50 "N Watershed Cr•afor, SOIL PERCOLATICN TEST DATA REOUDM,To BE SUBMI= WTTH APPLSCATICNS 54-:(6-4:43 Date of Pre- Soaking a•z Date of Percolation Test 1,44C 2 2 S4 :: I' HOLE 2 I NU-sm CLOCK TTME PERCOLATIC7N PEROD=CN Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inche$ -Soil Rate Start -Stop Min. Start Stop Drop In Min/In Drop inches Inches Inches 1 .1 2:5-F — is v7 1-2 2 1: Oe •— (,7 19 2 r 24 6 2.4 3 9 3 127- 1. �I 2� 2i4 .24�. 54-:(6-4:43 2 2 S4 :: I' L4 2 I 24 3 g 3;2U 7 2i '24 3 �� 4 3:40 - -4 -IS 27 2( 2.4 3 9 54-:(6-4:43 2 2 S4 :: I' L4 2 I 24 3 g 3;2U 7 2i '24 3 �� 4 3:40 - -4 -IS 27 2( 2.4 3 9 54-:(6-4:43 "z 7 l 2 3 5. NCII'FS: 1. Tests ,to be repeated at same depth until approximately equal soil rates a're {obtained at each percolation test hole. All data to' be submitted for- "``review. 2'." Depth measurements to be made from top of hole. tev. 9/85 9 a. • • �e • �• • ai • 9. •1• • • • •• 7�• y� � • 9. DEPTEi HOLE NO. HOLE N0. HOLE NO. G. L. -fop sot I 1' 21 `� �c�v�i CL5 Ce {1�eC� SuaWiStbn 3' 4 1 cu s 5' 6' 7' 8' 9' 10' 11' 12' 13' 14' INDICATE LEVEL, AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING IIXXXR4TERED �} DEEP HOLE OBSERVATIONS MADE BY:)s��Ivvt. I�Pline ak+ ;Iiit�ti DATE: DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided 5v�� No. of Bedroans A Septic Tank Capacity I a g-0 gals. Type j4a.5o4g Absorption Area Provided By 44+ L.F. x 24" width trench Other 3 �' R O �i I1 del s ld (d u ! 104 3 In x Name Ca S 12 d q Os5coc�q •I e S Signature Address 'f y (�irme. SEAL t o S(2 THIS SPACE FOR USE BY HEALTH DEPAMMEN!' aMY: Tq STptE Soil Rate Approved sq.f t/gal. Checked by -Date DEPARTMENT OF HEALTH ° Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO-CONSTRUCT A WATER WELL j PCHD PERMIT # WELL LOCATION Street Address Off of Route 164 Town/Village/City Tax Grid Numbe Patterson 15 -5 -4 WELL OWNER Name Arnold Greenspan Address PO 330 Briercliff Manor 1private O Public USE OF WELL 1 - primary 2 - secondary j9RESIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP ❑ BUSINESS O FARM p TEST /OBSERVATION ❑ INDUSTRIAL 0 INSTITUTIONAL O STAND -BY 0 ABANDONED 0 OTHER (specify, ❑ AMOUNT OF USE YIELD SOUGHTmin 5 gpm /# PEOPLE SERVED 1 FamjEST. OF DAILY USAGE800 gal REASON FOR DRILLING ZNEW SUPPLY ❑ REPLACE EXISTING ❑PROVIDE ADDITIONAL SUPPLY SUPPLY ❑ DEEPEN EXISTING WELL ❑TEST /OBSERVATION DETAILED REASON FOR DRILLING Public Supply Not Readily Available WELL TYPE ®DRILLED DDRIVEN ®DUG ®GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES _,X_NO IF WELL IS LOCATED IN A REALTY 'SUBDIVISION, NAME OF SUBDIVISION: Flintlock Ridge Lot No. Z- WATER WELL CONTRACTOR: Name to be determined Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: N/A TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: Greater than 1 mile _._...._._�_ LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED []ON REAR OF THIS APPLICATION ( ate SEPP*E.HEEV See plans sig.Aatur 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 Heal h Department attached to this permit. 3. Submit a We 1 Completion Report on a form p vid d by he P t -am C my Health Depa tment. Date of Issue: 1 191q Date of Expiration: 19 r it ssuing ficia Permit is Non - Transferrable 0 APPENDIX B PUTNAM COOr"-Itr DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL -- HEALTH SERVICES DIVIDIIAL VOTER SUPPLY &SUBSURFACE SERAGE TI 4" (Name' of Owner) COMMENTS REVIEW SHEET - CONSTRUCTION PERMIT DA BY: reet Location) YES INO DOCUMEN'T'S Pennit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth LF trench provided _. .0 ft. max. Parellel to contours EWE S ®I /iii i s/s SUBDIVISION Perc (3) Fill cd House Plans - Two sets Well permit; PWS letter Variance Request GENERAL, Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data: perc and deep results . Two-Foot Contours Existing.& Proposed Driveway & Slopes Cut Footing /Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If Pumped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's Win 200 ft, of Proposed System Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 110; Type pipe . No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees,Top of fi' 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expa 15' to Drains - Curtain, Leader, Footing 35'to catch basin,stormdrain,piped watercour. 10'. to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' from Foundation; 50' to well 15''1 !! Well to PL1 0 - � �+ �Z �2� fig.; 5'�` 1��,�q �9 •�`�� :ia5�. �I,oB....1 I� �� �,�,t � '• bL i 6 r}�iM1 ! try ( L-01 � I O Rte I �, — 4 �! I \ \fi lot, /0-7— 1 S's I59Poc TA �! I \ \fi lot, /0-7— 1