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HomeMy WebLinkAbout1616DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34.13 -1 -5 BOX 15 01616 -:, = S. V . 3 6 ' PUTNAM COUNTY DEPARTMENT OF HEALTH �i Division of Environmental Health Seviced, Carmel, NY 10512" jy Engineer Must Provide 2 P C.H D PenmitN. [- CE CATS OF CONSTRIICTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM P f �' Q 4, /) R Q � Located at r tZf Tas M[ap 7 , _ Block I Lot v Owner /applicant Name —a—, rA L3 l Q, k Formerly to l . Subdivlslon Name QQ101? Caroubdv. Lot # Malling'Address %b �1C00 @g Rd Zip Date Permit Issued , Separate Sewerage System built by_ Consisting of Water Supply: Public Supply From Address / ../I or: � Private Supply Drilled I" teg Drilled by la Address R U 5 Rt S ' QL ry Y gig Type �.:. F 0'M 1 Its RBS Hae`Erosion Control Been, Completed? S .Number of Bedrooms ..:71 Has Garbage Grinder Been Installed? Other Requirements I certify that the systems) 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 Count Dep fitment Of Health. Date UJ_ 1118" Sod CertifleA by L P.E..l� R.A. Address OGICt 1 .C_ �i/l9 License No. 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 Oub;': sanitary sower becomes available and the approval • of the private water supplyshalf become null and,00ld when a. public water supply becomes available. Such approvals are subject to modification or change when, in. the Judgment of the Commissioner of Hes11h1 fuch_19vocation. modification or change Is necessary, Date , ' " Y 2-1-4 4 e.• / - �..�� Title c, -I .orktowp Medical Laboratory, Inc` LJka ',,CA.Oa���l ; I - 321 Kear Berate �:_— _�- ---- -- Yorktown Heights, N.. If. 10398 Collection Station Used: (914k.21!3203 Carmel Peekskill ® _ Dot,. Ku :Nev City r'-i I v Date Taken: Date Received: u. Date Reported: colledtem By: sA . _256 Referred By: S (� / � Sample Source: I LABORATORY REPORT ON.BACTERI ®LOGICAL QUALITY OF WATER GENERAL BACTERIA, Standard Plate Count per 1.0 ml c� (Agar plate @ 35 °C) MEMBRANE FILTRATION TECHNIRUE (MFT) Total Col i form zer 100 gal C1 Fecal Coliform per 100 ml Fecal Streptococcus per 100 m1 Yl^ z,T.FDORABLE NU!!BFIP TECHNT0UF •(°LPN) _Tot al- Col iform:-...__ MPN. Iad.ex_.p.er.1.0.O.,�l.___ - -_ -- Fecal Colirorm: OTHER ANALYSES VPN Index per 100 ml THESE RESULTS INDICATE THAT THE WATER SAMPLE. ( . VA NAS NOT) (NOT APPLICABLE) OF A-SATISFACTORY SANITARY QUALITY ACCORDING TO THE NEV YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION- A Bert H. Padomani, i9.'T. b�SCB�, Di�ecg ®�t LEGEND ADS © Recommend Disinfect - ing Water Source o leas than THTC m Too Numerous `boo PUTNAM COUW Y DEPARTMENT OF HEALTH DMSI0N-'0E- ENVIRUVIUII . AL HEALTH SLRViCFS Owner or Purchaser of Building Section Block _ Lot Building Constructed by Location - Street Mf e-o"(0 Municipality /-a en .i 1� k.8 SCI C /l L e_ Building Type nAQ r 0 ((' C669. Subdiv ion Name Subdivision Lot #1 GUARANM 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 fora period of two years immediately following the date of approval of the - - "Certificate of -Cons-truction Compliance" f or; tli sewage di "sposal� 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 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 willful or negligent act of the occupant of the building utilizing the system.. Dated this I day of o.,y 19 gZ Signatur Title General Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk WIXIMA ,..- W. 9 RN .. . - .. 1 PUTNAM COUNTY DEPARIMEN'T OF HEALTH A OF ENVIRONMENTAL: HEALTH.:: SERVICES y......F r.. _,g... 6'uAi. lCC Owner.-ok-Purchasdr of Building M. CIOIUnno Building Constructed by Fair Stree_ " Location - Street PCRerion Municipality I �G4M fCP_S Building Type '76 I Pto I Section Block Lot 0n4Ai Carp Subdi 'sion dame Subdivision Lot # GUARANTEE 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 Cer- tificate •of•- Con-str.uct ens 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 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 willful or negligent act of the occupant of the building utilizing the system. _ A Dated this day of 19 Signatur 7 3V low Title Con f rciJo r General Contractor (Owner) - Signature Corporation Name (if Corp.) rev. 9/85 mk Corporation Name (if Corp.) Woodcces GarJeg Q Amen k Actress Rt 6 105 41 II. IV. M VI. Wi {• FINAL SITE INSPECTION Date 7, -�V ' �spee ed �o ;CATION �i� w Sf' ^ ? _ �� OWNER # / irSd ` H # OR SUBDIVISION LOT # 10 CCY�iTS. SEWAGE a. SDS area located as per approved plans b. Fill section - Date of placement 2:1 barrier. LGTH WIDTH AVG.DPTH _ c. Natural soil not stripped d. Stone, brush, etc., greater than 15' fran SDS area. "X e. 100 ft. fran water courae74w4tlands. SEWAGE DISPOSAL SYSTEM a. Septic tank size` 1,000 1,250 b.. Septic tank instal evel c. 10' minimum fran foundation d. No 90° bends, cleanout within 10 ft. of 45° bend J� e. DISTRIBUTION BOX 1. All outlets at same elevation - water tested 2. Protected below frost 3. Minimum 2 ft. original soil between box and trenches f. JUNCTION BOX -` ro 1 set 9. TRENCHES 1. Length required - ��0111 Length installed 5,c—::Vv _ 2. Distance to watercourse measured. ft. 3. Installed according to plan 4. Distance center to center �i X 5. Slope of trench acceptable 1/16 - 1/32 " /foot. 6. 10 feet from property line - 20 feet - foundations 7. Depth of trench < 30 inches from surface 8. Roan- allowed for expansion, 50% 9. Size of gravel 3/4 - 11" diameter 10. Depth of gravel in trench 12" minimum 11: Pipe ends capped h. PUMP OR DOSE SYSTEMS 1. Size. of purrp chamber 3. Alarm, visual /audio 4. Pmp easily accessible manhole to grade 5. First box baffled 6. Cycle witnessed by Health Department estimated flow cle HOUSE a. House located per approved plans. b. Number of bedrooms WELL a. Well located as per approved plans b. Distance fran SDS area measured ft. c. Casing 18" above grade. 1 11 d. Surface drainage around well acceptable. �. OVERALL WORKMASHIP a. Boxes properly grouted b. All pipes partially backfilled c. All pipes flush with inside of box d. Backfill material contains stones < 4" in diameter e. Curtain drain installed according to plan f. Curtain drain outfall protected & dir.to exist.watercours 9. Footing drains discharge away fran SDS area h. Surface water protection adequate i. Errosion control rovided.on slopes greater than 15 %. 10 ���5� �� � . ��,� �/ p .� K..... ,. y.- v..���� /.:... �!'t�r-'l_ � �r� U��s .... -�_ fir' � �'..�.:_:!,...;..�Y.... , I �.. i�j� WELL COMPLETION REPORT 3/71 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING • CARMEL, NEW YORK _ ._._...... This, report is. ;to..be:.completed hy:well.drillec_and- submitted to.County...Health Department. together. with laboratory.. report, of. analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION I OWNER NAME Angioli Corporation ILudingtonville ADDRESS Rd. Holmes, N.Y. 1.25 LOCATION OF WELL (Noy& Street) (Town) (Lot Number) Fair S reet Patterson PROPOSED USE OF WELL NESS ® DOMESTIC ❑ ESTAB ISHMENT ❑ FARM ❑ TEST WELL El SUPPLY F] INDUSTRIAL El CONDITIONING ❑ ((spKEify) EQU PMENT COMPRESSED CABLE ❑ ROTARY ®A R PERCUSSION ❑ PERCUSSION ❑ Specify) CASINO DETAILS LENGTH (feet) 60 DIAMETER(Inches) 6 WEIGHT PER FOOT 19 ® THREADED ❑ WELDED M YES ID NO nes NO YIELD TEST j j HOURS G.P. ❑ BAILED PUMPED LJ COMPRESSED AIR L YIELD (q. rE ) , WATER LEVEL MEASURE FROM LAND SURFACE — STATIC(Speclfy /sett 41 DURING YIELD TEST lest) j total drawdown Depth of Completed Wdl in feet below land surface: 250: .i SCREEN DETAILS • MAKE LENGTH OPEN TO AQUIFER (feet) SLOT SIZE DIAMETER (inches) IF GRAVEL PACKED: Diameter of well including gravel pack (Inches): GRAVEL SIZE (Inches) R M feet TO (loot) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION, Sketch exact location of well with distances, to of least two permanent landmarks. FEET to FEET 0 39 overburden _ Boyd Artesian Well CO., Trim,. • Route 52 39 250 grey & white greiss If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE W�bCOOPLE,T5 U �j �yj DE,1TE CL e%1E RT 1 VV 11 ZZ3S J WELL QRILLER (Signature) ar�yt e P 4l�el N.. _Y.. 10 • "/ / • , v / 31 5. kSP SAL. or., village 7 76 TV IOR dd sil Stj � is sy nAtA Z 2605 Sog n. PUTNAM COT" -'mf DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL BEALTH SERVICES COUNTY - OFFICE BUILDING, CARMEL, N. Y. 10512 -) "?SIGN DATA .SHEZT- SEPARATE SEWAGE DISPOSAL SYSTEM FIDE NO. ;weer A Address 5—/C) i NT Nug.,1wa .NOME, %LMES Located at ( Street FA 12 -ST- Sec. %T(o Block / Lot lnndica-e.neares cross street) ripality_P4T1- ER2,�;�J Watershed SOIL PERCOLAT'I:ON TEST DATA REQUIRED TO BE SUBMITTED..WITH APPLICATIONS CLOCK TIME PERCOLATION PERCOLATION - an Elapse. Depth tb a er a t er Le ve No. Time From Ground Surface ih Inches Soil Rate Start -Stop Min. Start Stop Drop';,in. , : Min. /in drop Inches. Inches Inches; ::_ :• ; �;; 11201 - iz 6- S� �' - 4' :..... 1-7. 2 3lss -• 3 0 7S. 18 . � Z � 3 2.S • 5' 1 ►z,o ^ ,+ 20 23 . - 3 t 8 2)o4 -21 0 _ :20 42-2-6 349 81 2C� 23 3 2 7 -- `5.349 -sib 8( 2.0 23 1 l � i+ �• J•J i'Jotes: 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.. DEPTH 'l.L. X11 .12'1 1811 ..)4" �r 3611 42" j 8 11 T 6011 611 7211 .108 11 84" . INDICATE LEVEL AT. WMCH GROUND WATER IS ENCOUNTERED .INDICATE'LEVEL TO WHICH WATER LEVEL RISES AFTER BEING .ENCOUNTER TESTS MADE BY (�J DESIGN Soil Rate Used2j-3o Min/1 "Drop: S.D. Usable 'Area ..Provided_ o No. of Bedrooms 3. Septic Tank Capacity /jz00 Gal NA 11 a N iZz Absorption Area Provided sy_�C L.F.x24. a �enc TEST PIT M.t-ji REQUIRED TO BE SUBMITTED WI'i­.:' APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES BOLE -NO. HOLE NO. HOLE NO. Address SEAL.` THIS SPACE FOR USE BY IMALTH DEPARTMENT ONLY-' Rate Approved Sq. Ft /Gal. Checked by Date o�. -2. VL cm ca .n'.- •,4? :CtiS , Cu% iS�TiCC?Cir.._...,._._._....... S"�� �et3�C�a�ro��'S. �." • +'l JUNCTION BOX Q i i" '0 `-- ;-- - - - - -- CAST .. . S E ° ter. �M TYPICAL -COn hfi �a R U'v is n t,� + i r fit•' 9:;C rl Y WELL I r i I ` -�`o•. s� k /c 2• ;j i� PERF( M ll 2 4' �... R •�ileCr`OV�� —��' t 1. _ 'j :.. n • :Crh , G W r -A•BSORPI 41' ,. Q « G , A y a,., . ��'' N 0 TE S I. JUNCTION BOX• FO ODD } k I: 2. SEPARATION '01ST., EXis . 15 FT. "MiNIMUM. 3. ALL LARGE TREE ''-�'__ _° f�`t H J�_ ,� r AREA ,'TO .BE REMO -.60 N f, I --- — }, -- tai � i — SYSTEWTO BE ".CONS fig. i, THE RULES"•AND REGU COUNTY DEPARTMEN I. l . ' ggYSTEM- SHALL NOT, E 8T OESIGWENGIN EER`. i ..._ 'M NT I-F•REGUIREO. -�"'" SYSTEM TO.'CONSIST o alit "' —= AND'150/ZFT. ,pF * F1 ....PITCH OF I. /Ii PEf�..,F- -; rr � (.ennty Department of "Heal 'DISPOSAL SYSTEM: GR Fn i C.. 9kvision of Environmental' Health Servioer (" i RST FLOOR E L E.VAT