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HomeMy WebLinkAbout0745DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 24. -1 -22 BOX 8 gem I 1'� IS BE emle SO IS SIS IS or ff ,, . , , ,, :� � �!` k-P I! 00745 Rev. 3/86 'I I• Located at = S c 0viaer7applloitnt, Nai MiWpg Address `. PUTNAM COUNTY Divislon of Environmental F HEALTH - aruiel, N.Y 10512 Engineer Mnst Peovlde g 8 P;C. P. Permit q W 'Subdivisions Nnme��Subdv Lot q Date Permit Issued OCT 7; /9B-7 Consisting of �_� Gallon . Septic Tank and G Water Supply: Public Supply From . —. r Address ort 1 /Prlvate Sapply.DdH by Address Building Type Has. Erosion Control Been Completed? Number of Bedroom Has Garbage Grinder Been Installed? Other Requirements I certify that the-system(a) as listed serving the above premises were constructed essentially as shown on the a of ompleted work ( copies i of which are at ched), and in accordance with the standards, rulee and regula acco dance th the e p n, the permit issued by the y rtmen Of alth.. Putnam Count De I Date �� Certified, by P.E. R.A. Address License No. Any poison occupying premises serJed by the above System(s) shall promptly take such action as maybe necessary to cure the correction' of any unsanitary conditions resulting from such usage. Approval of the separate,.seweiags system shall become null and vold.as soon as a pubt% sanitary sewer becomes available and the approval of the private water supply shall become.nuh and void when . a' public ,water supply becomes available. Such approvals are subject to modification or change 'when, in the Judgment of the Commissioriej...oi Health, such revocation, modification or change Is necessary. Date Title G� Yorktown Medical Laboratory, Inc. 321 Kear Street Yorktown Heights, N. Y. 10598 (914) 245 -2800 Director: Albert H. Padovani M. T. (ASCP) T_ CHUNG YU TING PINETREE DRIVE, RD2 KATONAH, NY 10536 L 1 J LABORATORY REPORT ON THE QUALITY OF WATER 32.024735 LAB # Date Taken: 544s1 Time: 1,).30 PT Date Rc'd: 5,- -R4- Time: 1-4-5 _RM Date Reported: .x --ZQ Collected By:. GBUNG V11 TTN('_ Referred By: Sample Location: KTTrggt TAP. RT_ 164,— C.QJJDITRv JITT � T.nT 962 PATTER S.nN., NY Phone # Phone # I Sample Type: Repeat Test? _ (check one) INORGANIC NON- METALS (mg /L) MICROBIOLOGICAL (CFU /100mL) Acidity _ Alkalinity _ Chloride Detergents, MBAS _ Hardness, Total Nitrogen, Ammonia Nitrogen, Nitrate _ Phosphate, Total _ Sulfate Sulfide _ Sulfite METALS (mg /L) Copper _ Iron _.Lead Manganese' _ Mercury _ Sodium _ .Zinc MISCELLANEOUS pH (units) _ Color (units) _ Odor (TON) _ .Turbidity (NTU) GENERAL BACTERIA _ Standard Plate Count (CFU /1.OmL) MEMBRANE FILTRATION TECHNIQUE ✓Total Coliform 41 Fecal Coliform _ Fecal Streptococcus MOST PROBABLE NUMBER TECHNIQUE Total Coliform Index Fecal Coliform Index KEY FOR TERMINOLOGY CFU = Colony Forming Units N/A = Not Applicable LT = Les 's Than ( <) GT = Greater Than (>) TNTC= Too Numerous To Count CON = Confluent ( =TNTC) NR = Non- reactive V,' Potable _ Non - potable _ STP INF _ STP EFF Other: Sample Status: (check each) Outgoing _ HNO3 _ HC1 _ H2SO4 _ NaOH ZnOAc _. Na2S203 . Other: Incoming LE ✓ 4 0 C _ GT 4 °C _ pH LE 2 pH, GE 9 _ _ pH GE 12 _ Other: REMARKS /COMMENTS (For Lab Use) IELAP #10323 THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS) (WASN'T) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING T.0 T YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DIDN'T) (N /A) MEET THE SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STATE DRINKING WATER CODES, FOR THE PARAMETERS.TESTED, AT THE TIME OF COLLECTION. 2 /86(Rvsd7 /87)RWE Albert H. Padovani, M.T. ASCPJ, Director FUZAL SITE�R \ISPE'CrTCiV P 1by. CN�. '• �n f 1 ".4 u nR S� ;FnPlISIC-I LOT s I"M S •i��^ DISPOSAL LPE a- JS area lcrrt as per amroved plans YES NO CCM r y I `/I b. Fill s2cticrr - Date cf placement 2:1 barriez . I= W=H AVG.DP'i'fi c. tTatura.l soil nct s _ irced i ,l- d_ St✓ne, bnL etc_ , ere=.te_r than 15' from SDS ara=_ e. 100 ft_ fram�wate-r, ccurs•e/wetlands. SLr;1=' DISPGSAL SYSTn G. Sentic tar. k s'ze - 1,000 ,2� b. Septic ta_r�,c i,�t =i1 level I _ c. 10' nzi n.Lmi -1 _= fcur_ t_or, G_ No 90' cleancut with—in 10 f =. of a5' hard e. DSTRI UrICN-N MX I 1. All cut' et= at sa_=ne ele =iati cn - watar Ices = I L �l 2. Prcte.�=' e=_ c frc =_t IA_L iL,-mL l 2 -- crial- al soi I he _�ieen be t and i_= ^_c_! L-rcr erl,T S= Z.. C. _1- _jLNK=1 :Z instal Ie S 2. Di t�rics tc watar • purse rrna- s'�=a ft _ Lns= -- ac =rd nc to`ulan Dis .nc_ CE =er to can tar Slcrc cr tre^c.l Gcc =c�.^lA 1 /16 - 1/32 " /foot. 6. 10 f— '= orcrs=_ ; line ^ - 20 t=- - fcLrr --ions 7. DeML -i C < 30 L ^.Gres Fran Surfcca S. Rc= a1!ChE_ =cr ex-a r!sicn, 50 °. Size cf c =ve 3/4 - 1 dia:Tcte_r 10. Dect_R c =vel in t_Ench 12" min 1rzt 1 Plrz ends C_ ed h- .to OR DC-q-= E!Ic , _S 1 Size' of L _--zo C:c�:iCZ 2. Ov erfic- t a:-,K Panm a s_!ti acCeSSiJle rr•ar�ole t0 CiGC° First. 6. Circle w_l._ =°_ed by Ea=_ t.R Dena_ •ufant e5 t? ra- t _! c w C_ �=_- c-r c? e / a_ Ecuse loo=t=r =rcv i platers. b. \;-„ice cf h -oars V_ Wes:_ ancrove plans b. Dist�*�ce fra S- arma measured ft.. c. C rind 18" aLcce crade- C. S, ace dra_ _ - arcCun(G well accentahl° VI. C-VF , :. WC)RJ�Z,Z�c 7 a. rates prcrG_v crcut b. ?' pines bac`f i lled c_ - 2 pines f= with inside of box C. c.a•:kfill rrat =vial ccnt=ins stones < a" in d_4arr.et°.r e_ C- ,-tain c-a i n installed accordi.nc to plan f. C:t ai.n era _ n cut =all protect= & ci r. to evist_�,ra rc: C_ Zcctina C_r a_n-c O;scnarce awav trQR SDS area h. S- _-face watar crctertticn ade-quate 1. OSicn cc = ti.l crow 1Ca_ cn s Lores Crez-tar tL 15%_ es 4 ` owl to a` D AAa� 9L Marc_ Kam.- ...'T• PUTNAM COUNTY DIPA*Tti P OF HEALTH 9 (� ; � Dlvlelogof EnvhroomenW'Health Servbew Ctumel. N.Y; lOSI? .: Eogleeer to Provide Permit N,; i `{:. . " ost CERTIFICATE] COQMPLIAN(C�E ' . Permit "N ` 1 p � �r- - CONSTRU N PER1YW FOR SEWAGE DISPOSAL SYSTEM Located u own or. : vRlge Sobditislon Nadi A f N11 WN ttbd.'Lot M �' Ta: Map /S BlochLot C Renewal_ Q! Bev_ talon ❑ OwnedApplkant Name I t it 1 Y� G 81 Date of •previous Appioval Town � �l°�I : L�IC°�� ZIP 1 soul�fag�as��,i,`�i a� iet Area • I1 St3 sew ti�l Depth Volauio • Number 'd Bedrooms Design, Fiow G P D' [�. PCHD`NoH6cadon is ltegdred when Fill Is completed sepsi ate Sewerage Systliia io eouelat dr ? Gallon septle Tank ena. � r To be ooastucted by Address' Water SUP11131.1 prill Supply From Address or: Private Supply Drilled by` .- Addreu Other Requirements - j f repesent that I am wholly . and completely,►asponsible forahe tles�gnsntl location of -the .proposed, system(s);,,1) that the .separate sewage disposal system above described. wih be constructed:as shown'orrthe approved amendment there'to.and in .accordance with the standards, rules an, regulations o.. • Putnam County Department 'of' Health, and that on completion thereof i "Certif_"ie of .Const ►uetion Compliance" satisfactory to the Commissioner of Healthwill be submitted to. the Department; and a ,written,;quarantee- :,will be-furnished;�the owner; his successori,�heirs or assigns by the builder. that said builder will DIaS! in good operatinf) conditien any quit of said sewage disposal, •fystem tluri the pepodof two 2 ear Immedlatal followirq'the'date of,'tM Isw- hi (,I •Y. Y once of 'the appr " of the Certifiute`of Co nstruction'Complian" of-tho oriii"atiy ;tam °or;any repairs i r to; 2) that the drilled well dsicribed• above W ill be located as shown on the ipproved plan and that said well will be Installed -i cc with a ata ar , ru i and regu a ons . 01 : aM 'Putnam County Department Of Health .% Si Date gn P.E.�R.A. r-- Agtlress D Lfcenie.No`J� C J APPROVED FOR CONSTRUCTION This'approval'ekpkas, two years'; from the date �ssuetl, unless construction o the building has been undertaken and is revocable for cause or may. be amended, or modified when connssideied necessary ,Dy the'Commissionei of Health. Any change or alteration of construction requires a new, permit. Approvedr disposal'of omestk san;tary'sewage, and � ^-. and �to / wa� ter ., supply only. tev. /87 Date BY Title I a PUTNAM COUNTY-DEPARTMENT OF HEALTH • Division of Environmental Health Services. Carmel N.Y 10512 EngCinAeer / Re V . 3 8 \�. to Provide PermC q on CERTIFI TE-OF COMPLIANCE` J(� Permit 'A / V CONSTRUCTION PERMIT EWAGE DISPOSAL SYSTEM Town . or Village Located at Subdivision Nam l Subd. Lot # - T. Map i Block Lot, v Z Renewal_ 0 Revision p Owner /Applicant Name1G1+� A)� 9 tM �n G7� �' •� iZ.P n bate of Previous Approval Mulling Address �T a-2 �� X TownlZ���i?i� —� Zip 10�o 9 Building Type �ij2aEl [UAL- Let Area F ill Section Only Li Depth Volume Number of Bedrooms 4 Design Flow G /P /D ©��p,, , PCHD Notificatliis Required When FM to completed Separate Sewerage System to consist of Gillian Septic Tank and ' l��' `jA t lt�N To be conetraoted by 1 o i�, .�, Address Water Supply. Pdbnc Supply from Address or: I,`— Private Supply Drilled bys Address Other Requirements I represent that,l am wholly and completely responsiblefor�thedesigrtand 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 o e Putnam County Department .:of - Health, .and that on'completion, thereof a "Certificate :of .Construction. Compliance" satisfactory to the Commissioner of Healthwill be submittad to the Department,' and 'a written.'guarEntee 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; or the Certificate of Construction compliance of`tne original system or any repairs thereto; hat e•drilled well described above will'be located as_shown'on the approved -plan and that said wail' will be installed in accords ce with the standards, r le a regu a on$ of the Putnam County Department,of Heeeilth; Date t7 —11 .'I ' Signad P.E.— R.A. Address` icense No APPROVED FOR CONSTRUCTION: This approval expires one year'I revocable for Cause may, be amended or modified when considered n requires a new pe it. A for disposal of, domestic sanitary be ..By .1 he -da issueAunss onstructio n of the building has been undertaken and is nary `b the Cor of Health. y change o► alteration of construction rage, - , d /or. priv ly. �� Title 4 -: PUTNAM COUNTY DEPAR7MENT OF HEALTH - DIVISION OF HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS V ,/ ►1 (Rame of owner) REVIEW SHEET - CONSTRUCTION PERMIT (Street Location) DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log DATE BY: Y�l�v Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Swage 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 Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area;shown;grayity - flow,suff. size If Pumped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Property Located 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 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 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 Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same 61 Rutnam County Department of Health Division of Environmental Sanitation AFFIDAVIT - CORPORATE CUNER APPLICATION . TOR PrINIT APPLICATION '.SLIDNITTED TO PUT9*1 COLINTY HEALTH DEPARTMENT TO: Commissioner of Health - In the matter'of application for r cqnstruction .permit fo— — r separate sewage system— — -- — I� Jerry Weissman, V. Pres.— — _ — — — — — — — — ._ represent that I am an officer or employee of the corporation and .am authorized to act for (name —off`. corporation) having offices at _ Rt. 22, P.O..Box 377 — ---------- — — — — — — --- —... Brewster, N.Y. .10509 Whose officers are - - — — — -- - -- President — Robert Fregosi _ _ _ _ _ _ _ _ (Name —nd Addreess) Jerry Weissman Vice- President _ _ _ _ _ (KZe and Ad dressy — — _ _ _ _ --- — -. — _ Secretary — — — — (Name and Address) Treasurer ! • . - — - (Name and Address) . ,,and that .1 am and will be individually responsible or ny or.all acts of the corporation with respect-to the aparov e and •1 sub- sequent acts relating thereto. Shorn to before me this ILday S' ed of Title Notary Pub li 4, . IS NOW-Y Public -, ht<LCr'_ :'.. iv -'S` ygffq I . -Corporate Seal bivision Of Environmental H Services TWO COUNTY CENTER - CARMEL, N.Y. .10512 (914) 225-3641 APPLICATION TO CONSTRUCT A WATER WELL , P- X/- �/ WELL TYPE I aDRILLED DRIVEN DUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:Cz,�,,�, LOT NO.: WATER WELL CONTRACTOR: ..Name t'3= Address IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ✓ NO NAME-OF PUBLIC -WATER SUPPLY: TOW11 /V /C DISTANCE TO PROPERTY FROM NEAREST WATER -MAIN LOCATION SKETCH & SOURCES OF CONTAMINATION._ R4�-_ (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 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 W 11 Completion Report on a, orm rovided y the Putna County Health D partme ' Date of Issue: 19 P emit Issuing 10 f E, icia1 Permit is Non- Transferrable- 1 STPEEI ADDRESS. IUWNiVILLACE1CITY 1AX ViO NUMBER. WELL LOCATION Gal�►��. «��� r�,;� - -����� _ _ 1 WELL OWNER NAME. • ADDRESS: Q'PSIVATE 1Juc -K i� I ZZ F3e>�c SiGlz `�. O 2UoLIC USE OF WELL ErRESIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND. /HEAT PUMP ❑ ABANDONED 1 - primary C3 BUSINESS ❑ _FARM O TEST /OBSERVATION ❑ OTHER (specify) 2 - secondary ❑ 1NOUSTRIAL ❑ INSTITUTIONAL O STAND -BY ❑ AMOUNT OF USE YIELD SOUGHT 5 gpm. /NO. PEOPLE SERVED -8/ EST. OF DAILY USAGE . (000 gal. REASON FOR 9-,'KNEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION GRILLING O aEPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL WELL TYPE I aDRILLED DRIVEN DUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:Cz,�,,�, LOT NO.: WATER WELL CONTRACTOR: ..Name t'3= Address IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ✓ NO NAME-OF PUBLIC -WATER SUPPLY: TOW11 /V /C DISTANCE TO PROPERTY FROM NEAREST WATER -MAIN LOCATION SKETCH & SOURCES OF CONTAMINATION._ R4�-_ (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 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 W 11 Completion Report on a, orm rovided y the Putna County Health D partme ' Date of Issue: 19 P emit Issuing 10 f E, icia1 Permit is Non- Transferrable- 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner ,[' iGl���, 1)c J 6� Address j�'� 22, Located at (Street R-dicate'nearest t�._ 2�e : Block Lot so Z cro ss street) Municipality. Watersheds_fbe_, __5_L,..,�Y SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME -w--' PERCOLATION 41_fL PERCOLATION RM Elapse Deptft to a er Water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches i 1 0- 2 3� d- ___..._.._ 2 2- �o D ! r - 2 f 2 2 30- 30 30 ;i T 5 1 2 3 4 5 .Votes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT. DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. l HOLE NO. HOLE NO. G.L. 6" ' 12" A _ 18 n l 2411 3011 .36" 42" 48" 60" r �. 66" 72" ? 78" 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED 114DICATE LEVEL TO WHICH WATER LEVEL RISES AFTER---BEING - ENCOUNTERED TESTS MADE BY `T: -p (r �,2c,) Date DESIGN Soil Rate Used l(o ZCMin/l "Drop: S.D. Usable Area Provided <:5) No. of Bedrooms�Septic Tank Capacity. Gals. ° Absorption Area Provided By_f-�L.F.x24" o� Address ure SEAL ��o tiQ 76�% THIS SPACE FOR USE BY HEALTH DEPART14ENT ONLY: Soil Rate Approved Sq. R /Cal. 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