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HomeMy WebLinkAbout0870DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25. -1 -54 BOX 10 y<... - rF .^y- -•+^ -� .Rev. 3186 , � - PUTNAM COUNTY DEPARTMENT OF�HEAL1'H ••• Divislon of Environmental Health Services; Carmel, Y. 10512 Engineer AQgst Provid® CERTIFICA OF- CONSTRUCTION COMPLIANCE FOR SEWAGE - DISPOSAL SYSTEM Located at Tax. 7 TBlackr v— Lot T '1q Owner/applicant Name ` K Formerly Subdivision Nam _ nbdy. Lot N� Mailing Addre -- Zip OJ lm Da t. Permit .Issued D Separate Sewerage System built b Address oo o i4 ConelstJng' ot: Ga11ou Septic Tank and Water Supply: X Public Sapply From Address �- or: Private Supply Drilled by Addressss�� – _Has'Eroslon Bding Type Control Been CompletedYf Number of Bedrooms Has. Garbage Grinder Been Installed? Other Requirements I certify that ttie.syetem(s). as listed serving the above premises were co ctad essentially as shown on ,*e plans of the completed work (copies of which are attached)., and in,accord'"ce kith 'the standards, rules an eg 1 Iona, in accord a it t filed 'plan, and the permit.issued by the Putnam Coun ty Department, Of health. Date l2^':. 'i4 P. Cer4tisiitl by ��pp a tq �.j �/_R7.A. Address . SiDY 1r�+► �NANS q T y _ I-IT � .� `�Llcanse No. L 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 seperate sewerage system shall become null and void, as soon as a pub( ;z unitary, sower becomes avaliable and the approval of the private water supply, shall�tiecome' nu11 end void when. a public water supply becomes available. Such approvals are subject to modificati� r Chang? when, in the judgment of the Commissioner Ith, such revocation, modification or Change Is necessary. < Date / // . j am 6Y Title R C 0 APP -MMIY B PUTNj1-M"COUNTY DEPARTmEW OF HEALTH - DIVISICN OF ENQV RODZ F'►MU HEALTH SERVICES INDIVIDUAL RD= SUPPLY & SUBSURFACE SE -,AGE DISPMAL SYSTEMS CU�C ,of�r G %rne of Owner) CaRMOMS 151-� LF trench provided — reauired �0 ft. max. a � lel to ex-a. _ FILL SYST-T-Y-S cl vta.rrie 10 t. f1A notes —new 9se-c. deotZ aau -.1 / 91-M ilk M REVIEW SH= - CONSTRUCTION PERMIT contours I REVI�`�vc�D: � — __LPL•. • s/s -7 ISICN (3) House Plans - Two sets well pens Variance Request Legal Subdivision Supdivr_sion A -coroval Cti sed Et- appr�r�l SAS Adi. Lots Ciecter Wet-' and (Tcw-n/DEC Pe -r-ll t R & D) o �� Data On DDS Plans & Per,-nit S =-ra REQUR DFA CN PIANS � 919 PL .4� S Sewage System Plan - (nort -h arrow) 'Sodace -Sy_s: ga_,7Varaulic PP o ile Gravi _y Flcw Pr�file.�& D?in�nrons;= :�= Voltira � ,�- J Eax,Tr .*�c C- allery, t'ariUn pi deter -D' IS . epric TanIC - S1ze, Detail Well Detail, Service Line if over Construction Notes (grinder rate) Design Data: perc and deep results--.— Two -Foot Contours Existing & Procose3 Driveway & Slopes Cut Footing /Gattex-,CuriWin Drains (disczarge OTC) Perc & Deep Holes Located Representative of primary and exr.Gnsion Expansion Asia; shown; gravity flow, stiff . size If PmVed Pit. & D Box Shown & Det ilea House - No. of Bearoans wells & SSDS's w /in 200 ft. of Proposed System Prcae-- ty IM —etes & Bounds House Setback Necessary (Tight lot) House Server - 1/4 '/ft. 4 "0; Type 'pine No Bends; Max. Bends 45° w /cleanout SEP.Mk ION DISTANCES SPBC—TFIED ON PIMN Fields 10' to P.L., Drive=way, Large Tre s,Ton of fil 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Strom, Watercourse, lake (inc. expar: 15' to Drains --C rtain, Leader, Footing. 351to match basin, stoandrain, pire3 watercours 10' to Water Line (pits -201) 50' intermittent drainage course_ Septic Tanks 10' fran Foundation; 50' to well 15' Well to PL 9 DAB ��,-% coil /F'��i�• BY: �R-- (jam eet LCC3:icn) YES i NO DOCr'S Gi' . Peynit A olication Corocra te� Resolution Plans - Three sets I Engine °rs Author-,zaticn Design Data Sheet (DCS) I I Deep Hole Log !� C �. � s onslseflt Perc Results %�-- -t--'- J P_rc Hole Depth REVI�`�vc�D: � — __LPL•. • s/s -7 ISICN (3) House Plans - Two sets well pens Variance Request Legal Subdivision Supdivr_sion A -coroval Cti sed Et- appr�r�l SAS Adi. Lots Ciecter Wet-' and (Tcw-n/DEC Pe -r-ll t R & D) o �� Data On DDS Plans & Per,-nit S =-ra REQUR DFA CN PIANS � 919 PL .4� S Sewage System Plan - (nort -h arrow) 'Sodace -Sy_s: ga_,7Varaulic PP o ile Gravi _y Flcw Pr�file.�& D?in�nrons;= :�= Voltira � ,�- J Eax,Tr .*�c C- allery, t'ariUn pi deter -D' IS . epric TanIC - S1ze, Detail Well Detail, Service Line if over Construction Notes (grinder rate) Design Data: perc and deep results--.— Two -Foot Contours Existing & Procose3 Driveway & Slopes Cut Footing /Gattex-,CuriWin Drains (disczarge OTC) Perc & Deep Holes Located Representative of primary and exr.Gnsion Expansion Asia; shown; gravity flow, stiff . size If PmVed Pit. & D Box Shown & Det ilea House - No. of Bearoans wells & SSDS's w /in 200 ft. of Proposed System Prcae-- ty IM —etes & Bounds House Setback Necessary (Tight lot) House Server - 1/4 '/ft. 4 "0; Type 'pine No Bends; Max. Bends 45° w /cleanout SEP.Mk ION DISTANCES SPBC—TFIED ON PIMN Fields 10' to P.L., Drive=way, Large Tre s,Ton of fil 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Strom, Watercourse, lake (inc. expar: 15' to Drains --C rtain, Leader, Footing. 351to match basin, stoandrain, pire3 watercours 10' to Water Line (pits -201) 50' intermittent drainage course_ Septic Tanks 10' fran Foundation; 50' to well 15' Well to PL 9 • _�,..�.. u +.+..r A- ^ate+ -j* _. Unicorn Industries -LTD - • (4 - OW-1.6-Z Cr Same Danand Lane/ h i l lg d Pat=�on • 1� r Family r �^ Quail Ridge„ w +".rd r a: Z� .L � is �:Cr�� � �.s �. Gv «�� e��.• -` i���C.:w.�i w'i^}:.� Jr..a= A6%% w�i�i+.M+.-i:a .. + o %.S ���� r + ,ems . wc�.C� �'r,• the .~?Gvwa GrC� vSG�. � .r-. rp..taa ..+.....ham .-. w i�.w..0 arc-, C�.`�� w v« •f 2:.. wv� it has A. �..r.^.5�.. -r -- .v.�a� C.. S2,�- .'^- ^• -a•+ �7 �• G+Y 2� �� �.Sr'P.� 'r�++p���:. �. �:a2r ° =C � c.^.G =.7. w`.:� _ .^.1 P �/..• i - . 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C� ♦♦-� r •�.A Sw.7t�_ iT 4\.Y M►11 C! T. �; a Controller C _ -e- CC aC Ga...1. :ti'a.:a (ice Co ) Unicorn Industries, LTD. 7 Corporate :Drive e's�.ti �S • Peekskill, NY 10566 Zga T' CRCttl"i EC=� Sart ?cz - Dam cf p -C—=nent L.1 E_ loo f `_ f =L.. He ccurSc�:vc =' �`_" _ 1 2.50 • c -- C_ go _ sC lop I � I� 1 F O 1 I I-- L — % - -__ _" C= < 3d C= _ c ^� U. ` L C.-V E. CrC? w- ___ =_- e-C `l iG l.._- __cN car c c--e r,.7 . E _ C V. I -• I cc: =_ =�� I I :alb_' vi _ ci L L WL - �_ I _ cf t^ C^ritains stcne -c < LC L'! � -M _. C:: _! 1 & C_= C. °C,_c rC° cC�cV I I-- L — % county tGftW0aw4 Of iith, -aW® tlwt.on cwlitlon,toieireof b'.C®r4iPirist ®_ o/ Coiiructkool Coenplionsa'.4s4isfodory : to_;411© Comrllisetow®r of MOOHhtailA be oubmat� to tM• ®eierQwotlrt ,afl0 a anRtQn'o1larantia..61ti. bo.furhmmd tllo oiwnar'. his i6cco2k7%;,t olrs4r assgns by tho bultda. tha4, "amid buildfr'vill iilss0 in t➢wd .opaa ptimj condition, any W of lilt wwat l ®{ 1 ayr�®m- 'durwq the pria8,0f @ate 189 y�irilinwom9iat®li folkiwing thodate of tole im* anW; Of'4hY `Alpt>f0�tol Of lho:C®rtNkato, of ConfQrua Lion C.onlplligice of Bliio orlgiiial systom: any 1`411111917i 0667lto: 8l that'th®.Wili6d aroll fiiWl Olfoafo fmt11 b9,COeat� Ai8 L4nQtpn:OW'.th® isQaW onA thmt`oeiw'a»II will ba Ins4tillei -in c+eeord®Wco rnitP st ref, `vuba gild r6guys na ; of A916 fttWtirw County $�ned OD.E: O.A. AFMOVFD, FOR COPfS TRUCYION:This t�s•,4ran the.. dato issuod unless conitructlon of the building .has bean undertaken and is revowbeo for. cameo W.:n18y ba.a .OV rriodi96e7a tv cont{�er®d wex q!y',by tha Cpn Mlssionor 04 HWlth. Any cnango of 01ta7ation of constvuetion Ve' fagYiroB a now 0armit.. A�9Qb@8 for, oli�OraF ;04 ®off1os11e @911{terY•��ie., . �t�allow 00117 QNV Z 0 1 Z10,44Z 100 QA VA M P W.'1!2 4; 116*1 -'A Z00 Ll DESIGN DATA- SHEET-SUBSUFACE SB9AGE DISPOSAL SYSTEM .-FILE NO. Owner Id L-rzMdress -77 d Located at (Street) z, Z-4,. Sec /cf Block a3 Lot (indicate nearest cross street) Municipality Watershed A)- C. SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre-Soaking Date of Percolation Test HOLE NUMBER CLOCK TIME PERCOLATION PERCOLATION Ran 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 1 2 3 4 5 —,,v x-eea'-w k>,-, 2 3 4 5 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 submitted for review. 2. Depth measurements to be made from top of hole. rev. 9/85 1. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUN'T'ERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 1' 2' 3' /' --- 5' 7' s' 9' 10' 11' 12' 13' 14° - INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DESIGN Soil Rate Used " ? Min /1" Drop: S.D. Usable Area Provided Sd� No. of Bedrooms Septic Tank Capacity /Z`� D gals. Type 6h-c. Absorption Area Provided By L.F. x 24" width trench Other of -Z- 8. Name e� lL. �/ �7'� 2 Signature_ ..� Address Z' 1%� G�;� L!/�0 "� SEAL S�Q PN R. p y r�,p THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: 31 Soil Rate Approved sq. f t /gal . Checked by FO p ° 05 ^;., ,. .. pUrNM CJOUNIT DEPARTMENT OF BEALZH DIVISION OF MrMMRZML HEALTS SERVICES DETACNCp 7ZE31aMA,�T'l.tii_ ),,acc FAM%Ly � - DESIGN DATA S= SUBSUFAC,E SEWAGE- -DISPOSAL SYSTEM FILE NO:-- - _Owner LEnE2MAt J 4- HoRC H Address °J (o M�II.L STR[�T (SV �T'E D� t _f3REWS"�-� . �v 10 09 - "AY 1 L_A w i> D 2) YE A W D Located at (Street) P r?_ i M•sToNc 1-F u_L_ RoAP Sec. 18 kock 3 lot Z (indicate nearest cross street) Mun.icipal4ty TA T T-E M-s .x-� Watershed C 2 o MO 1J _ SOIL' PERCO=CJN TEST , DATA REOU32M TO HE SuBKr D WITS APPLSCATIONS Date of Pry- Soaking 1 z s/ 8 (o Date of Percolation Test Loft �3 NL�"CL OC'K TIME PEROmATION PERbOLT�TION . Run Elapse Depth to -Water Fraa Water Level No. Tirm Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In!. Min/In Drop Inches Inches Inches Z'.q H 1 Z z 4- Z. 7 3 • 4. 3 3'.03 3:1.(o i3 ZA Z7. -3 4r� 5 r ; Z- 2 z'.$) _ 3'.o Z 11 Z 4• Z7 3 .3,7 3 3':03 - 3'.I5 1Z Z4 Z7 3 40 q 5 NOTES: 1. Tests to be repeated',at same depth until .apprcximately equal soil rates are . cbtained .at each. - percolation test hole. AU data to' be subaitU d for review. 2. Depth reasureaents .to be made frcm top of hole. DEPTH G.L:t 2i 3' 4' 5' 6' < 7' ,. . TEST PIT DATA RDOUIRED TO BE SUBMITiED.WITH APPLICATION 4. DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. 1 HOLE NO. ? HOLE NO. H � i Ra C K •�, ram �L_ ' i. S�NQV �.QAV�Y.Lv 7 81: 9' 10, 11' 2 ' . 13! 141 . INDICATE LEVEL AT WiiICH GROUNUZ= IS ENOOUNTERED ei` INDICATE LEVEL TO WHICH WATER LE.'VkL .. RISES ' AFTER BEING ENCOUNTERED �yo DEEP. HOLE OBSERVATIONS MADE BY: M.• suo'ai "ILI -1Z, 3 • -C LAZY- DATE: 12) I DESIGN Soil Rate Used 16-7 Min/1" Drop: S.D. Usable Area Provided ` 000 S •r. No. of Bedrooms • 3 Septic Tank Capacity 1 0 o o • . gals. Type Absorption Area Provided By 300'1 L.F. x. 24" width = trench Other Z• r=CE? F 1 c_ -- _ a Name ►�A►.1�o L_j�l� tJ� . LAt3RaL)T, P.C. Signature Address f21 14 C SEAL el Z z t THIS SPACE FOR USE BY FMALTH DEPARM\, 'Nr ONLY.- Soil Rate Approved sq.ft/gal. Checked by Date TO: u PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT Commissioner of Health In the matter of application for: 4uail Ridge Subdivision Lot AI Permit for Sewage Disposal System I, Brian R. Dyer represent that I am an officer or employee of the corporation and am authorized to act- for Unicorn Industries, LTD. (Name of Corporation) having offices at 7 Corporate Drive ' Peekskill, NY Whose officers are: President: Paul F. Guillaro Millwood Rd., Chappaqua, NY (Name and Address) Vice - President: Brian R. Dyer 12 Gedney Way, White Plains, NY (Name and Address) Secretary: Treasurer: (Name and Address) Name and Address) and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Sworn to before me this day Signed: of W'# V0 1989 -G � ,G�Lrm- Notary ublic MARJORIE DiCAPRIO Notary Public, State of New York No. 4851814 Qualified in Putnam County Commission Expires February 18, 1 1u 8/84 Title: Vice - President iI Corporate Seal "This is to certify that the s=_dage dispo= -al syste!n was constructed as indicated on this plan and that the system was inspected by me before it was covered over. The system was constructed in accordance with all standard rules and' regulations of the Putnam County Department of Health and the Nea York State Leg-.rta ant of Health-" i IN57 -A4 ,O-D 40o t_F ��v /,eF.D 300 LF N. 22 °001c. I z5o y swat. seavc re. Q1 4-k4% is P ro 6 ♦ 9 6 7 ,r4.�' r W ►TiR� N►14 -- ,. Q DRIVEUgy • i Ses1: -6 Is_�pol � LOT 13 AREA = 0.490AC. ` `PtEpF NEW y�q P. C C A t AuSg LO eAvaN GSM SuRd�Y Qy dua►✓�r 1 17 S ;o Z 30 55 D-eoi� 3 26 35 iF 43 girl ' 7 o , i 8 5 58 too (n4 io 67 64 u 73 75 IZ 7Sr ifU tULila:u LU'1n Ly Ut%L1a1'Lpii;..i is JS llbi�.l Lt. ivISigz' 72IVirOI1U/mntal Health Services APyrnved as nnz �lr conPormanco w h aulAicab:to E',�,o , _;;Motions Putnam un . , : of the ra i-� ''e,�zrtmcnt. via i — t i >/A�-130 1 1 -r PI A I `� � -Ds qA —D f PSI �L� I /1 -Z6 -90