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HomeMy WebLinkAbout2398DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 42. -3 -18 BOX 21 `I- r Ii + , yFrL t 16 r 02398 A' I PUTNAM COUNTY DEPARTMENT OF HEALTH iI DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner W�OLAA Address E Located at ( Street ,Sec . ` Block 2 Lot J'7 [ 1 Ydicate nearestcross s rqe Municipality Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION ,PERCOLATION Elapse p o a ear a er ve - No. Time From Ground Surface in Inches Soil Rate Start -Stop . Min. Start Stop Drop in Min. /in drop Inches Inches Inches ; _J 1 lo; ©s- ,1e, j1 ' 1 ,r" 26a 3 104-2 12 wit 7S 4 Z4 7S 1 2 . ... ..� 1, 5 I Notes: 1) Tests to'be repeated at same depth until approximatelyy equal soil rates are obtained at each-, percolation test hole. All data to be subrrittd for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SURMTTTED WITH APPL.TCATION DESCRIPTION OF SOTU, ENCOUNTERED IN TEST HODS DEPTH HOLE NO. I HOLE NO. HOLE NO.-- G. L. 611 1211 1811 2411 2011 COW 6)1 4211 48 514 60" 66 7" 8411 INDICATE LEVEL AT WHICH GROtJ1\1D WAT�R IS E1,1CO-UN'TEIRED INDICATE IZVEL TO WHICH WATER !Fj'E--L-, RISES AFTER BEING PNQOUNTEREM TESTS MIADE BY Date Soil Rdt-` No. of B Absbrpti 1 \Q 111C% Address .Min/I. 'I-.DYrop: S.D. Usable Area Provided Soil Rate Approved —Sq. Ft/Cal. Checked by Date i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property o Located at (T� j ection Block Lot 17— Subdivision of��}� Subdv. Lot # Filed Map ## Date �1 } Gentlemen: This letter is to authorize a duly licensed professional engineer or registered architect (Indicate to apply for a Construction Permit for a. separate sewage system, to serve the above..noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Count'irs, . e Telephone Very truly yours, Signed _ __ U of —Proper Address' y Town Telephone t HFALTf DEPART KIM, :.'DIVISION, OF# `IIVVIROIIEIVTAL .'HLTH ; SERVICES John M. Shrinons, - M.D. t, 5 ,1 ."-Deputy Camds§Wier ,of Health -' FIELD.'ACTIVITY' ;REPORT Sheet - _ -=k-of " INSP�GTION _ ,,A F - Orig. Routine Orig. Cc maairi' ADD�tESSS �'�S`- Or g. Request No Street ° A °, :'Town `No. Canplfiance CmVlaint. Capp MAILING ADDRESS, - ' Final. .PO.. Boot = : ;Post Off ice - Zip Code. Group Illness Construction-. TELEPHWE , f Reinspection PERSON IN CHARGE, Y ,Field, Sampling Only OR. INTERVIEWED u(Z T" •Field Conference . Other DATE g TYPE FACILITY o� 3 °TIME ARRIVED TIME LEETr �5 Explain FINDINGS; i_ -. 'rte •r. `' h .... .. , - ;p.,,• •° , Ivtntston of tnvsronmental I1001t11 50(VIC0 11 CAtJPdTI' Oi°FICC (3U1L01rdG • CARMEL. NEW YO' Pepon is to be completed by well driller and submitted to County •T•4calth Department together with laboratory report of on alys%of water sample indicating'water is of satisfactory baeterW g6511ty'before eertlficii a of construction eomplianee•is issued. RE-PORT 'MUST TIE SUCMITTED V)ITFfIN 30 DAYS OF WELL COMPLETIOU �• NraM[ ADDaESS ; MCI IAODULaY, BY Jr..S IG, i T: >� :; Tax 7�s 3 fl ho;lac i; .. 10541 P o LOCATION (roa. a auaaf) GTo�nJ fag? adr�o(tr) ®p.�aLd PeekSk311 H6110W '?'3„ Ptytr_ m Va11ey.a t1Y � ® ® @LS ®PAYE® DOMESTIC FSTA &IISHMENT FARM JEEST WELL ® SUPPLY 0 INdDUSTCIAL CONDITIONING SPHE O iDRILItPdC j� ROTARY r__1 COMPRESSED � CABLE a OTHER TANtPN.EPdT LL.JJ AIR PERCUSSION PERCUSSION (Sootily). CftSING lthGlM (toot) 20 DIAMEITRIrnahU31 `< WOLP"I PER FOOL 1 Q jU'",L " hot WAS CA ,N t 17HO :,.�ETAfIS THREADED WELDED;'` DYES YES NO :: JIFLD "OURS � E% G.P�a. 3 rl[LD (G.P.M.) 10 JEST BAILED PUMPED (:� COMPRESSED AIR _ L WATER MEASUR[ ►ROM LAND SURFACE— STATIC(SOOUlrloel) DURING TIEID TEST 1cal) ! DaAtlt of earrsple +ad Well SFXEb �I_ '' v . 525 In feat below Land surface: MAKE !:*40TH OPE*4 TO AQUIFER I :t - l3CRFFPI I . DETAILS SLGT 5:6: + DIAMETER ( inchos) If C:RAVEL Diameter of wall including GRAVEL SIZE (inches) FROM (►0011. TO poor) I PACKED: grovel pock (in: hot): I Ftic FROM la► :D 5'Jrlsat FORMATION DESCRI7TION $1t0ICh (tract location 01 woa anti otstances. to at Idea? two porn anont lonamarm FEET 0o FEET ; 1 6 525 F1,4rd %rev el. 3-ou"�:i . -c� j ° If Yiold was testrd of dino.ons depths dvrina drill:nq, list bolo<r PIII GALLONS rER MINUTE 420 5525 t✓k.�l.,- ICA �,,�I�,j�z ! <b.G��JsjtS u I D�,T�21� 6 lyRT IWI:.LL DRILL01 (:;IOn,wta) MILL DRILLINGa INCo ,' Yorktown Medical Laboratory, Ina 321 Kear Street Yorktown Heights, N. Y. 10598 (914) 245 -3203 Director: Albert H. Padovani A9. T. (ASCP) Is- LAB p Collection Station Used: Cannel _ Peekskill _ Mt. Kisco New City Date Taken: Date Received: Date Reported: `J /J Collected By: �7 / '3 Referred By: G' y Sample Source: 4d2&X &)1_9 -���� LABORATORY REPORT ON BACTERIOLOGICAL QUALITY OF WATER GENERAL BACTERIA Standard Plate Count per 1.0 ml (Agar plate @ 35 °C) MEMBRANE FILTRATION TECH ?;IQUE 0 -IFT) .Total Coliform ner 100 ml Fecal Coliform ner 100 ml Fecal Streptococcus per 100 ml " - PROBABLE NUF•!RFR TEC}i2%IQIJF Total Coliform: . MP'; Index per 100 ml — Fecal Coliform: MP:; Index per 100 ml C-_ `FU A.NALvcrc THESE RESULTS INDICATE THfiT THE WATER SAMPLE (WAS) (WAS NOT) (NOT APPLICABLE) 07 A SATISFACTORY SANITARY QUALITY ACCORDING 0 T NEW YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Albert H. Padovani, M.T. (ASCP), Director LEGEND RDS = Recommend Disinfect- ing Water Source < = less than TNTC = Too Numerous Too Count e 1 1 1 PUI'NAM COLMY DEPARTMENT OF HEALTH �1 DIVISION OF ENVIRONMENTAL' HEALTH SERVICES Owner or Purchaser'of Building Section Block Lot Building Constructed by t1ocation - Street - Subdivision Name l) Municipality Subdivision Lot # Building Type GUARANTM 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 iunmediately'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 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 Environinental ' 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. E is day of General Contractor (Own ) - Signature N Signature 7 Title � y \ aLCA yz\ •\ Corporation Name '(if Corp.) O ff, "7 <s M 4!) oc AdcIress rev. 9/85 mk Corporation Name (if rp.) o (Z�QK i 83 V-Y\ i�440 P ess w � 1iV/ ►t1`` I CONSTRUCTION PERMIT FO Located at Subdivision PUTNAM COUNTY DEPARTMENT OF HEALTH Permit 0 - Division of Environmental Health Services, Carmel, N. Y. 10512 SEWAGE DISPOSAL SYSTEM — ��C.�_,�� Town or Village J ",rr r—�►- r't�y _ Tax Map lte- -2 Block Lot 17, i i Subd. Lot N I I Renewal _ ❑ Revision _ ❑ owner /Address =>�t Building Type Lot Area s10_ Number of Bedrooms_ Design Flow GVi/P /DLL l� ,� Separate Sewerage System to consist of Gal. Septic T nk To be constructed by Water Supply: Public Supply From / Private Supply to be drilled by Address Other Requirements I r°� �-' 1:71 L Date Of Previous Approval Fill Section only ❑_ P.C. H. D. Notification Required and L4� C)r_ Address 1 represent that I am wholly and completely responsible for the desig nd location of t"R�y posed lystem(s); 1) that the separate sewage disposal system above described will be constructed is shown on the approved amendmpnt there to an m d-ordance with the standards, rules and regulations o e u nam County Department of Health, and that on completion thereof a rtificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owne his successors, heirs or ssigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system during a period of two (2) rs mmediately following thedate of the issu- ance of the approval of the Certificate of Construction Compliance of the origi syste or any r pair the r to; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed in cor a e with e n r s, rules and ►egu a ons of the Putnam Count epartment of Health. A Oat `' Signed P.E.�L R.A. Address License No. 4e,*Ua APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued u s construction of the building has been undertaken and is revocable for cause or may be amended or modified when co si tl �nesary by the, Co i ioner of Health. Any change or alteration of construction requires a new permit. ftppro d f disposal of domesti sanita a or ',p ' ater supply only. Date �LL_/ By Title Rev. 9 -81 G� CERTI i PUTNAM COUNTY DEPARTMENT OF HEALTH ENGINEER MUST PROVIDE Division of Environmental Health Services, Carmel, N. Y. 10512 PERMIT # XE_OF CONSTRUCTION COMPLIANCE FOR Qt.ITN �ptl.� ] Town or Village IP'Located at An,�y;�ry' 4 ✓tNY /V Tax Map Ito Block 2, OwnerAAUDLI"S Eli a / /�Fporm�erlyy�+� �[ P Tax Map Lot N 9l Subd. Lot N Separate Sewerage System built by .w�nl� pAddress�� Consisting of looD� G, al. Septic Tank and �i0o VF Other requirements Water Supply: // Public Supply From Private Supply Drilled By Address Oat . Building Type I No. of Bedrooms4 v Date Permit Issued Has Erosion Control Been 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 t —� C , Certified by a. .� `1'� — = P.E. R.A. � r Address r tense No. d ,,/& 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 public unitary sewer becom 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 Covvynf over of Health, such revocation, modification or change Is necessary. Date J 0 !► BY�� ! Title r i=� 1000 GAL MA50OKY 5�ic, TMr, # Y: 1140 LF OF w,1--c-ALLOY. " I't2.0.�• FlLi. - �.�.' 05rA"D. - 1600 COAL MMNi2Y SWnC, TArirc �A* - 16,0 L F. OF TRi - coA t-wY I' iC CJt9i OSA Y $ "i F.m Wt1S Kx i � AND THAT `t!l9 t - �i'WAS #N��!'!: "'C 1.0 151 d) i +l # UiU s As ce'VER `J (i`GR. -i:I �}tili_`[ •i,'. CTil) t+..[.()RLANC.is \O1 "Cli l'' itli3.: V .!'tii� ' ;I C,( L %l:vP. t'�; "11 ?!. .i;i "I "iVl CU L3 ' sx z?.,'.r. As 5 U I LT 5 f is bYSTM �t M - - - —f -F02 - MOLM05 &Y DPI CG4 TM # 16 -27 17),2 , LOT #I - "FM , 4y th s rvic- TOwa OF FUT11AM VAWPC anoe with PUTWAAA CO., Wf.. one of the at. F T. M1GH � �x ?sF3