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HomeMy WebLinkAbout0722DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23.12 -1 -47 00722 r, r I% ` 7 J6 00722 PUTNAM COUNTY DEPARTMENT OF HEALTH. tNP P RO l•VIDE J MUST .' • � - • 1 Division of .Environmental Health:. S",ci "s, Carnei, N ` Y 10612 PERMIT # {�- %Z'-81 CERTIFICATE OF ` NSTRUCTION COMPLIANCE FOR SEWAGE,'DISPOSAL :SYSTEM Pe�=i ei :,r nl • .. Town: 'or 'Village Located at ;?,ou'rw Ilo4 Tax nap IS, Block Ownero& � L•ti 57f2GEl i / Formerly Tax Map Lot # Sub,. Lot N. Separate Sewerage system. built by 92 WC gs� Address' 1�:0 L El-ox ,1 Sao i SRJ. AhC., i s=r= SAocbi4o2 Consisting of IZSD pal. Septic Tank' and 40 Lir Other :requirements Water Supply: Public Supply From Private!�Suppiy'Drilled BY P G BBi4` Son/S� 11.lG. Addresi P-6 12552X I3 eye l.j�T I05oa9 Building Type R�- gi��/C•� No. of Bedrooms 4 Date Permi t Issued Has Erosion Control Been Completed?S 'Has garbage grinder been installed? t�-[//O 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 `� J V g �v i� Certified by PE. R.A. Addre Tics S'Z a L License No. 2 -42208 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 'becomai 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; She Commissloner,, pf Health juc�eatlon,� modification or change Is necessary. Date By Title Rev. 6/85 ,r:.: .•.mr n�T nr.�7►nnm p ►� 6V tij O4 WFaLL %Jvlj.L Ll:y L1VL\ aWa WL%& DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office' Use Only L< — = b WELL LOCATION STREET ADDRESS: 71OWNIVIELAralcill, TAX GRIO NUMBER: Flintlock Ridge Patterson NY Lot #1 WELL OWNER NAME: ADDRESS: Arnold Greenspan,PO Box 330,Briarcliff Manor,NIY 10510 O P8IVATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary ® RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /CONO. /HEAT PUMP O ABANDONED O BUSINESS O FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) O INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED EST. OF DAILY USAGE gal. REASON FOR DRILLING ANEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST / OBSERVATION ❑ REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 3251 ft. STATIC WATER LEVEL 15 ft. DATE MEASURED 8/10/87 DRILLING EQUIPMENT ® ROTARY ® COMPRESSED AIR PERCUSSION O DUG 0. WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED ❑ OPEN END CASING. 19 OPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH i tL MATERIALS: ® STEEL O PLASTIC 0 OTHER LENGTH .BELOW.GRADE 20 fL JOINTS: ❑ WELDED ® THREADED ❑ OTHER DIAMETER 6 in. SEAL: ® CEMENT GROUT O BENTONITE 0OTHER WEIGHT PER FOOT 19 lb: /ft. I DRIVE SHOE ® YES 0NO_j LINER: O YES ®NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (1t) DEPTH TO SCREEN (1t) DEVELOPED? FIRST ❑ YES ❑ NO HOURS SECOND GRAVEL PACK 1 ❑ YES ❑ NO GRAVEL SIZE: DIAMETER, OF PACK in. TOP DEPTH ft. BOTTOM DEPTH It. If detailed um in WELL YIELD TEST p a 9 METHOD: Q PUMPED ; tests were done is in- 0 COMPRESSED AIR formation attached? O BAILED ❑ OTHER '0 YES ❑ NO V11�LL LOG It more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE ling water Bear- Well Oia- octet FORMATION DESCRIPTION WOE. It tL WELL DEPTH It. DURATION hr. min. DRAWOOWN It. YIELD gpm. Land in overburden clay & bldrs . 2 ' 6 315' 21 Dr:llilng in rock set casing,grouted. WATER ❑ CLEAR TEMP. QUALITY O CLOUDY HARDNESS ❑ COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES ❑ NO STORAGE TANK: TYPE Well Xtr.ol 250 CAPACITY 44 GAL. 13.6 030/50 WELLDRILLERNAME P.F. Beal & Son ,Inc DA ADDRESS PO Box B SIGt71f'1t1RE 27 Brewster,NY 10509' � P PUMP INFORMATION TYPE submersible CAPACITY 1._ 9 MAKER Gould OEM 280 MODEL ; F st7 �, L.1 2 VOLTAG.�.Q_ HP1L2.. 0 PUTNAM COUN'T'Y DEPARTMENT OF HEALTH DIVISION OF.ENVIRONMERrAL HEALTH SERVICES A�.ao�� csee:�n/SF3�.tJ 15 5 tL Owner or Purchaser of Building Section. Block Lot Building Constructed by ?, O U-r=- I G-A Location - Street Municipality RES �� E •N cE. Building Type Subdivision Name 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 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 ope'rate-.properly is caused by the willful or negligent act of the occupant of 'the building 'util'izirig 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 w_ as caused by'the willful or negligent act.of the'gccupa the system. Dated this ,!'* day of tion Name (if Corp.) Address rev. 9/85 mk 19 &e Signature Corporation Name (if Corp.). Address "o BREWSTER LABORATORIES Box 224 - BREWSTER, N.Y. (914) 225 -2072. WATER ANALYSIS REPORT SAMPLE NO. 6712 SOURCE: A.Greenspan hose bibb -well Flintlock Ridge Patterson, NY COLLECTED: September 16, 1987 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. September 18, 1987 1 Roy BicWt P.E. Director Lot 1 3 0 per 100 ml. ype Depth Volume Number of Bedrooms Design Floiv G P 1)1�860 IMM'Nodfleation Is ]Requhid When Fill Is completed Gallon Septic To be constructed by. r Tht�. Address as iepresen� that 1:inw, w holig'and compwiely resp-onsiblef or the design and location the proposed sysiem(s); 1) that the.sepirate sewage', system above described will be ionstruilid as shown 06 the a oprbVed amer�dmenilh'ero,to 'arid in &�C'(irdancei with the standards, iules and reg4lat ions of the Putnam t7.ou!qy Department of Health, - am % d thaton completion thereof a I ''Certificate of Construction C.omp liance" satisfactory to the Commissioner of Healthwill be submitted% to the Department, and -a written' 0juir ant - oe will' be'f urriished the owner, his succe 11 ss6irs hei rs or assigns by the builder, that said builder Will 64c6, in goo t, condition any of".said period of tw6 j2)'yaais immediately. followinog'the date of the issu. once of the the Certificate of Conitru&ion.'Complian6i of ilhi'original syste'm or i'my'reipairs th t 2) that the drilled well described above will 60 located as shown on trio approved.'�Iam arid thAt said wilEwIll be instaiie4i On accordance wit,h� Z oiulas and roguTaTlons' of the Putnam County Dipartmint of, f4sait-h. -_' APPROVED FOR C ONSTRUCTION:ThiS approval expi!as two yea�s.frorntha date. it requires a now'permit Approved' for disposal 6C6omest*lc s anitar , y siWage,- and/or undertaken and x unless construction of the building has been misji6nej of Health. Any chahge'or altoiation of construction t:39ater supply only. I• i• �1• ' '11 la •I' : J Y. � •' • a �• • la v •IY• Y: .la• •�a. DESIGN DATA SHE T-93BSUFACE SEWAGE ' DISPOSAL SYSTEM FILE NO. Owner A2►_Lo L-r,> (5�;n'eEEQzpA,J Address F.O. g014 336 MAi-10R Located at (Street) ZoK_x-rv_- IGA ' ' - ', Sec. I5 Block S Lot - .(in _ ;dicate nearest cross street). Municipality Watershed MUZ Date of Pre - Soaking g • 1 "1 • 8'7 Date of Percolation Test 8 16.6T • �ii� j Ec-j � 0�.,,1 . • HOLE NL14BER CLOCK TIME PEROOLATIC N , PERCOLATION Run Elapse Depth to Water From'. Water Level No. 'Time Ground Surface Id Inches Soil* Rate Start-Stop Min. start stop Drop In Min/In Drop. Inches Inches Inches 2 I I O I- l l l(o IS .3 11.1'7 - 11 3Z IS 4 1 1 :5-5 - it ;4$. 15 13 I Co -3 rj 5 II': -49- IZ:09- 15 NOTES: 1. Tiests to be .repeated• at same depth tintlil.apprcxialately.equal soil rates are obtained.at each percolation test hole. All data to'be submitted for review. 2. , Depth measurements to be made''fron top of hole. rev. ' 9/85 2 NOTES: 1. Tiests to be .repeated• at same depth tintlil.apprcxialately.equal soil rates are obtained.at each percolation test hole. All data to'be submitted for review. 2. , Depth measurements to be made''fron top of hole. rev. ' 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITS APPLICATION DESaUPrION OF SOILS FZJW(JNT MM IN TEST ECLES DEPTH. HOLE-NO. HOLE NO. HOLE NO• :G.L. 4' 5' 8' `�[ �1 16 ,�}� S 1�i2 �- Cam, 10' E' 0 f 1 n 11' c4e C Wi4 1 --), 12' 14' ' INDICATE LEVEL AT WHICH GRO(MMTER IS ENOOUNTIItID' N !k INDICATE LEVEL 70 WHICH- WATER - LEVEL RISES AFTER BEING EN YJNTERED DEEP HOLE OBSFAVATIONS MADE BY: �v� DATE: - DESIGN Soil Rate Used _ � . Min/1" Drop: S.D. Usable Area Provided 5c ao ¢b No. of Bedroans• q Septic, Tank, papacity ,zso gels. Type ►�As..�rZV Absorption Area Provided By q o o L. F. x 24" -width trench AL h /y Other 1. C hJ�0�� , j�C . Signatur Address SEAL 9 /�rOFNo .,2600% O rNE THIS SPACE FOR USE BY HEALTH DEPARTMENP ONLY: Soil Rate Approved sq. ft,/gal,.. ,Checked by •. Date sanding Type 1 fam. res . Lot A"a 2.80+ Acres FM Section only X Depth 1 2volume 450 cy Number of Bedrooms .4 Design. Flow. G/Vp 800 PCHD Notification is Requited When Fill Is completed 12SO 400 L. F. Separate Sewerage System to consist of Gallon Septic Tank and To be constr6cted,by— t0 be determined:. Address Water Supply: Public Supply Front Address or: X Pavers 'Supply Drilled by' t0 be der . , Address Other Requirements % i ;l!2 R(li l (4 50 c.TrD S txibultis- n BQX represent that I am wholly antl' completely responsible for the deugnandaocation 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 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 written guarantee will oe 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 describetl above will be located as shown on the approved plan and that said well will be installed in accordance• with the stands ds, rules and regu aT r0nr oof the Putnam County Department of Health. Date �t l{ Signed P•E. R,A._ Address Cashin Associat: es X.':Rt 5 Carmel N.Y. 26008 License No APPROVED FOR CONSTRUCTION: This approval expire Swiyear from the to t d unless construction of the building has been undertaken and is revocable for cause or may be amended cr.modified when considered necessary y Comm' toner of Hsalt An , change or alteration of construction requires a new permit. "Appro disposal of domestic sanitary sewa' d r prix r y Date — By Title ����-�A Y r Z�_. • r •• �• • • W1214 • • . IMAM •' • a •• • - ea at :449A tea. DESIGN DATA SHM- SUBSUFACE SERFAGE DISPOSAL SYSTEM '. FILE NO. owner lnuo!j C'1a rPu=rpGa Address f 0 E'er 33 0 BR.IARU lFr M64,0r2 Located at (Street) 09 Rad& i 6, 4 Sec. a S Block �' - Lot (indicate nearest cross str Ploi,Mxk PLJ(p tof f municipality Po iH P,✓-.se, /i Watershed Cro foo SOIL PERC:OLA CN TEST DATA REOUIRED TO BE SUBMa= WITH APPLICATICNS Date of Pre- Soaking (21 3 96 Date of Percolation Test 1-2 �V b HOLE NUMBER CIACR TIME PERCLI=CN PS =IA'IZCN 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. 1 -'si: S r r z Z 1 24 G 2 g :SS 9: 13 15' s 3�:1 -9: �z. t`a �� 2_4 3 6 4 �:3:s' —�: Ste{• 1 Z i z4'2 3 % 1 10 :35- rU: 44 g 3 2 /lJ' 45;-10 ' 57 11 2 2cj j 3 i0 :S9 1J: i 6 1' ! -- 3 4 11 :17 - /l.' 3 5 il? 21 24 3 G s � 1 2 rl�.�I��l 3 rev. 9/8S Tests, ; to be repeated at same depth until approximately equal soil rates 2 are; obtained at each pereolatim test hole. All data to* be submitted 6. "review. Depth measureTenis to 'be made from top of hole. DEPTH HOLE NO. 1 HOLE NO. HOLE NO. G. L. l — toe 5d, I 2 Qt vWn �atdK 3' i 0S A2r SUhC,�uiScad! Ptci1 ! "7,`� 4' 5' /moor vcvi�5 61 Layer 7' 8' 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED Ela,,e INDICATE LEVEL TO WHICH FZATER LEVEL RISES AFTER BEING ENC7XNTERED DEEP HOLE OBSERVATIONS MADE BY: (� 1 Q .. ����,DLt DAM, DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity gals. Type Absorption Area Provided By width J0 L.F. L.F, x 24" widt trench Other ` + P V R I� Name Cc�����:v,,; .S'Soc,xX�e Signature Address f me- SEAL s b bw g0o� THIS SPACE FOR USE BY HEALTH DEPAR'aAFNr ONLY: E I Soil Rate Approved sq. f t/gal. Checked by Date z 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 Number Patterson 15 -5 -4 WELL OWNER Name Arnold Greenspan Address PO Box 3300 Bri arc.1 i ff Mannr X3Private O Public USE OF WELL 1 - primary 2- secondary IM RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O BUSINESS O FARM O TEST /OBSERVATION 0 INDUSTRIAL b INSTITUTIONAL O STAND -BY ❑ ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT S ,;n gpm /# PEOPLE SERVED /EST. OF DAILY USAGE 800 gal REASON FOR DRILLING SINEW SUPPLY OREPLACE EXISTING OPROVIDE ADDITIONAL SUPPLY SUPPLY ❑DEEPEN EXISTING WELL ❑ TEST /OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN DDUG 13GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES X_NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 10�s� Lot No. 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 DO N E ARATE r I� (date-)/ (signaf u, PERMIT TO CONSTRUCT A WATER WELL plans 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 provi ed b%1-the Putnam County Health Department. Date of Issue: `�--�� 19 a Date of Expiration: 19 7 mit Issui g Offlicial Permit is Non - Transferrable 8/86 APPENDIX B PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES -= INDIVIDUAL DAM SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS �O. (Name of r) CHI'S LF trench provided _ required — 60 ft. max. Park1lel to REVIEW SHEET - CONSTRUCTION PERMIT DAT BY: (S ue t Location) YES I NO DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log EWED: r s/s SUBDIVISION Perc Fill cd Consistent Perc Results (3) Perc Hole Depth 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;shcwn;gravity flow,suff. size If PaTped Pit & D Box Shown & Detailed House - No. of Bedroans Wells & SSDS's w /in 200 ft. of Proposed System Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe . No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees,Top of f i' 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Take (inc. expa 15' to Drains - Curtain, Leader, Footing 35'to catch basin,stormdrain, iped watercour. 10'. to Water Line .(pits -201) . 50' intermittent drainage course Septic Tanks J 10' from Foundation; 50' to w11 151 Well to PL - q f NY5 RT- ! 6 4 fro t i q I r \ SEANh zt1�Ai 50! e��t eoQs{ e. J k52 �' F 'i o X50 Cy , 100 F i ¢ H / Gyo, WcTlA�O�— c 0 qc` Al yea _" 4 c iizN i r. li P I 11, lll� ti 1 ✓ r R i J R 11 a. Y . i t y.:fA / . „, i \ i - �, 4° o c :c � q•i .. r M �� •1 t .. I '� Y1 1 4;1 , \t 1 4 - . rfi •lfs. Y: '.r . t - _. mot. _ f r . '. . : t " 'h ' .' r y c' ✓ r 4 t .i ..ii :. Y;,�L fl `v i f - ! why, } .: , b 4 3 % ;.N S f f y ,. e. ,, f r ., 3 -4Y o f t S �z Y i ;R�r : r I. _ ' t - . . lS.. :� �, �e { jg f. 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