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ENU I NEER MUST
�f� l PUTNAM COUNTY DEPARTMENT OF HEALTH PROVIDE PV,_ S394
j� vision of Environmental Health Services, Carmel, N. Y. 10512 11 PERMIT! #
CERTIFICATE OF'CO ST UC N COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM LIFIE%I V cL�lIQ(�
Town or Village
Located at • La^Skr l i + 6''" 0 vq 12wof Tax Map 1 j� Block 11
Owner • 1�5 ve /��ytLo / Formerly T x Map Lot k F Sub d. Lot I
�v�irLO� fie. 2.&0 WS r, aJ y 1 Osbq
Separate Sewerage System built by � / i Address ' —/ IN
Consisting of Q �I. Septic Tank and �`� on �s EJdS (( )
Other requirements
d �� G r�lrti i
Water Supply: Public Supply From ir��ta n �At ►/
1✓ Private Supply Drilled By
Address
Building Type J11-2. 2aj Fxz No, of Bedrooms Date Permit Issued
4125 IJ b
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. i
A a
Date `J " 84, ! Certified b a " -� P.E. R.A.
Address '"- Y� " y j License No. h V Z V
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 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 modifications or change when, in the judgment of the Commissioner of He�a�lt such revocation, modification or change Is necessary.
Date .� `t' Itr� gy,�- < "I�11 i.l x mot- fi Title 1 t
Rev. 6/85
PUTNAM COUNTY DEPt ! iT OF HEALTH Permit a
Division of Environmental Health Services, Carmel, N. Y. 10512
CONSTRUCTION PERMIT FOR 'SEWAGE DISPOSAL SYSTEMZ��i'ICif -Yj I/�'/ %� f°
j �/ �t Town or ,liege ///° 7 r�
Located at ! (L��/" �i/C %1 �/ /4-0 //a w pC''"� a G./ J /G� Block lee >> / ✓�( �
Tax Map
Subdivision f�� if/ ""o Subbdf. Lot 0 1
Owner /Address " ` cc �' 13e, .1 • Nf����
Building Type Jib %� ` / Lot Area
Number of Bedrooms Design Flow GjP /D
Separate Sewerage System to consist o ye f / d7'�n Gal. Septic Tank
i
To be constructed by
Water Supply: Public Supply From
Private Supply to be drilled by
Address /
Other Requirements / � ' ! Ole f5 / yel P/%
Renewal 0 Revision _ 0
Date Of Previous pp al
Fill Section only ❑
P.C. n. D. Notification Requiredr
and -2 50 GF
Address - c
I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) tha
above described will be constructed as shown on the approved amendment there to and in accordance with the standard
County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfac
be submitted to the Department, and,;a written guarantee will be furnished the owner, his successors, heirs or assi
Place in good operating condition any part of said sewage disposal system during the period of two (2) years im
ante of the approval of the Certificate 'of Construction Compliance of the original system or any repairs thereto;
Will be located as shown on the approvedII plan and that said well will be installed in accordance with the standards, rCounty Department of Health. Date SignA , -.
Address R r v i If , Vf_ , 1 KI!Lf. V :F2�
APPROVED FOR CONSTRUCTION: Thi approval expires one ► from the date iss less construction of the Dui
revocable for cause or may be amentled,or odified when sidere ecessary by t Commis 'over of Health. Any cha
requires a n w permit. Approved r di posal of dome c nit ►y s a e, and/ o private er y_.onty. --
n ,e�
Date By li -Title
Rev. 9 -81
of
and is
uct ion
J r f l�!iLli�T REWRT . PUTNAM COUNTY dEPAA** OF 'pQl�l�r
1CN y '
" Division of Envlr6h0s0t@I 'ldcellh $1ThY tl
COUNTY OFFICE BUILOING ,- CAF -tMo6. i11EW Y60 .
:Thle..report is to'be completed by well driller and submitted to County Health. Department together with IfiboratOfy report,of.
L
analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliOnce is itulu
Rf?ORT MUST BE SUBMITTEG'r WITHIN 30 GAYS OF WELL COAAPLETION
I,'.: r•:. 6l1�M ` .NAMEAD�DRESS :•....
; . George S t oyo I Box 3 `3.5 , L'a l'k Dr:i vc. Nu triam 'Vcl le
� T_..• t i)eksR i 11 Aict i 1 uw I?d , , I iaii n% �" of umber)
�, iIQCATION ,
Q� 1Ndll •_ _•.•` - -_ TNo 8- Srreoll r I I (l'1 a I n V;.071 ].1 o y NY . •_..
BUSINESS
r pp,pg @p ® DOA0ESTIC ESTABLISHMENT I_..� FARM 0 TEST WELL
a 'b Ow
i tl_811, >' � .a,_
C] Spe l SUPPLY ;r,. IND 'USTRIP L CONDITIONING I if )
COMPRESSED CABLE OTHER
p ((��jj
11iQ1KRAR11Nt ROTARY ® AIR PERCUSSION I_.._..I PERCUSSION (Spoclfy)
6 ) LENGTH (foef) DIAMETER (Inches) WEIGHT PER FOOT
AfiAtd DRIYE
I
8qT t , c THREADED I WELDED x YES NO X Y� ''i Nd ,
2j �(itt 11> .11�ti,l
G.P.A. M
I OURS .....
- rlll0
A 4BfT BAILED {jt !,PUMPED I'I COMPRESSFD AIR
10 1;0
R ' '-� • —t _
MEASURE IRt OM _ - L-AND i SURF ACE—SYATICISpecity toot II LL
DURI- NG YIEIO TEST JfeaJ _ D� epth of C— ornplated Weil
I fast low land 3 wrfaa
t ,
MAKE
PEN TO AQUIFER (lost)
4 OETAILf SIOT SIZE D
w, IAMETER (Inches) RAVEL SIZE (Inches) Nsf O fNt/ .
i �r�IF GRAVEL ( Diameter of well including
PACKED: n 11p gravel pack (Incheel:
iRpM UNe, 74RFAC! Sketch exact location of well wlfg d4iincsC IO F,r leAhf '
'FORMATION DESCRIPTION two permanent landmarks.
i 'tj T i;1g` FEET
Drilling ,irt overbur,d011
rr.:0 5 c;1_Fly anal irf7T Fzs
:.
IHit u
t' c "Icy. ' 3 I. `i
'ri_...Oocic -i�t .... -..... � ,
21 e a s 'in (y• i f;t' ou E'•
-
P'
t d -if yield was fesf.dot diAfe►ent d.pr6!,during drilling, list below
u d7t' FEET OAIIDNS PER MINUTE
4
i
l ,
E L COMFIFTED' } � ••i
DATE OF REPORT WELL. ORIL.L.EN (Signaturtt) I r i ,•r�' 4` �[rr
/85 11/25/86
I � ,
Yorktown • Medical Laboratory, Inc. LAB a YK'a 025597
321 Kcar Street
Yorktown Heights, N. Y. 10598 Collection Station Used:
(914) 243 -3203 Carmel — Peekskill
Mt. Kisco New City _
Director: Albert H. Padovani M. T. (ASCP) —'
Date Taken: 7i�`i
�O,E? G /J C; 2,17 i - Date Received:
c_ nJ
// Date Reported:
Ac- C t��c.)L -�.0 t� -1, Collected By:
Pi�7/J��l�i V��'�� �� `% Referred By: mn< - �L.,\— r= n(t-L7 -o
�/ / _j Sample Source:
LABORATORY REPORT ON BACTERIOLOGICAL QUALITY OF WATER
GENERAL BACTERIA
2-Standard'
Plate Count per 1.0 ml
t
(Agar.plate @ 35 °C)
MEMBRANE FILTRATION TECHNIQUE (MFT)
Total Coliform per 100 ml {
Fecal Coliform per 100 ml
Fecal'Streptococcus per 100 ml
MOST PROBABLE NUMBER TECHNIQUE" -(MPN)
Total Coliform: MPN Index per 100 ml
® Fecal Coliform: MPN Index per 100 ml
OTHER ANALYSES
r
THESE RESULTS INDICATE THAT THE WATER SAMPLE. ((WAS)� (WAS NOT) (NOT APPLICABLE
OF A SATISFACTORY SANITARY QUALITY ACCORDING TO TH3)NEW YORK STATE DRINKING
WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION°
Vkk,
Pt8&_1kj
- 61, �)
Albert H. Padovani, M.T.
ASCP),
Director
LEGEND
RDS Recommend Disinfect -
ing Water Source
< v less than
TNTC = Too Numerous Too
Count -
t
Aw LIE
O
O
O
, r
...... . . . ....
l;ep,&, I, tm, e n -t of 11 alth
Division of En , Vircnmental. Healthkerrices.-
A$ SOILT-
Approved -.s noted--fnr�, conformance with
applicable Ru'-,--:� a#' Regulations of the
t
department.
Putnam County Healt it 1
A R- 2')
I
rb
& Titg Date—Re
FDATE
� r�e�ds
Abl
Rc
4A
19�acd dim f
eo E40(
P a a A4 45 /-11, C. 140 L. 4w 0 VV � 014 D
rrorE
7G c 'e'r f %gy f-ha f -1-be S�e VVa _� � &/
Z
7'hO� A`1C
Al �y
.1tM9M Wa�5 CZ175�,laCAZd /%7 aCCO,-dOI�Ce 0// 9 rlO'OM rUlg5!
rr MVU/Of/oV75' LI'7a �kC =U�njj7o-77 COLJn fY Aoeiw�, 04,
P foie N. Y, :5,4,7 fie Ogparfn?er774 070 kaall�h,
' PUTNAM COUNTY DEPARTMENT-, F HEALTH
q
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
r yK
Re: Property of
Located y �' iii ,*l;,V,.i ,•
(T)PWM(@MV611aq Section /49 Block Lot
Subdivision o
i
. • • j 2 Filed Map # Date
Gentlemen:
e
This letter is to authorize ZO ¢n M. 41'-799'7
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
I.
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 He41th Law, and the Putnam County Sani-
tary Code.
Nei
S yyq�so�® Very truly yours,
Signed
Countersigned: } ��
P.Ee , R. A.
Address
Telephone
Town
C2 ef-
Telephone
t}
i�
'1
1
1
REVIM-1 CIII -.CK Slfrr>T
IM66ts
f r1EI D cTTrrr, mar.
Remarks• - '
DOrMC -11TS
MHP Ld;HTION �, -
jr'ouse plans 0. K.
D--sign data sheet -\
Peres presoaked?
Kin., 30" pere test depth -
Cont. results for 3,runs
D. Hole log O.K.
Corporate Affidavit for other than individual 1
Authorization for eng neer j
Letter from Water Supply if apD icaD e j
If variance requested -such noted on plans &apps.
j T kf N '' EXVa SON ae
'•16AIHTfiRE E '-"L OIJ PEA
DETAILS
.FiLL ,>EpTH RREIa' sHc�. N� CYj `!,�'TC 1,PWN ro aH rpw,nED !
Existjng contours shoym (shox new. contours -)- -
Slopes for driveway cuts, etc. shown
Peter service line location \
Footing drain, etc. location\ 1 1
Top slope, bottom slope of fi 1 1 1
Percolation tests and deep test pit location 1 ;
Septic tank size and conformance to std. 1
3 i3 R. house minimum
i I
F.ouse setback shown
Distribution box ft�1 . below frost\ �
All water within ;t. of. FL shown
aIEt-L-CASING 12" U)ZOVE- GP'ADC - ' \
Plan and profile SDS
All other wells and NDS closer 200' 1
shown or reference made__ ' !
Property boundaries (metes and bounds= clearly shown
LEGAL Sc: gDIV ,S.IO ^� \ j .
Gi6TL4Nl� -Mb S --
:SEPARATION DISTANCES SPECIFIED ON PUN
I10' to P.L. ,�
' ,20'1 to Foundation t�ralls
i0o to Nearest well
'00' to stream, march, lake, etc. incl:expansion
15' to Curtain drain
�0' to water line (pits -20
5' to storm drain
10''to lane trees
10' from foundation to septic tank
15 to pilk from leader d,nin Fi,.l'ooLing k1raill.
25 ro -cArztk ESASIN
15' WELL TD
�G' �EfYIC. TAn',K TG wE+
.--n
Late: fE• -!C7_
Insp.by:
L
INITIAL SPIT IrISYECTIOTI — ��'`AY r ^Yes
No
Comments
,Property lines or corners found . . . . . . .
Can est-iwate house location . . . . . . . .
Will driveway need cut . . . . . . . .
Must trees be removed -hote these
Is deep hole representative of entire SIB Brea
Additional deep holes needed. . . . .
Sufficient SIB area available considering
driveway cut, house location, separation .
distances, etc. . . . . . . . . .
DEEP HOLE DATA
Depth:
Water elevation:.
Rock elevation:
Soils d.escr•:iDti on:
_
_
_--
to : - 1 `-f.0
FINAL SITE Uqi PECTION Ins p. by: J,
House located where 'shot:'n on approved plan
SDS located where approved
:Length of tronch measured Z
Width of trench average
Slope of tile line and trench.acccptable
Room allowed for expansion trenches . . . . ..
Over' °ft. from swamp, watercourse
hatural soil not - stripped or SAS area
ttnriecessarily graded
10 It. maintained from prop.line and
20 £t. from house
SeW. ation of trench from house, well
etc - follows plan : _ .:. - -
Nwilber of bedrooms checks .. ..
Stories, Uillich, - stumps, rubble, etc'. greater
than 15 ft. from nearest trench .
15 P't. of peripheral soil horizontally from
trench . . .
Jiuiction boxes properly set
Cotil.d surface run off from driveway, roads,
ground surface, etc. channel near SDS
area . . . . . . . . . . . .;®
Dies lot drnir>aT;e antar 0.1t.._ -n- area -.of. SDS
_
✓
_
✓,
-
- -' _-
�.
�
�,3 J
I'INAL GPJIDIRTG OF SI "11; ACCEPT11I3T� `��
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIROiZ=AL HEALTH SERVICES
Owner or Purchaser of Building
Building Construct by
Location - Street
Municipality (`
Building Type
i 2- 22--Z—
Section Block Lot
)� -
Subdivision Name
/7
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
"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.
Dated this /7 day of 19 �
D'o 0
General Contractor (Owner) - Signature
Corporation Name (if Corp.)
La -I(R0.k CI- -QnW'; dj
Address
rev. 9/85
mk
Signature
Title
inn
c9�
Corporation Name (if Corp.)
ij-� S d
Addres
'IA 43
pack.
NO
t *� /
CALCULATIONS A DESIGN DATA
14, /::cla ' 41;v 1 15ircy"Al.
Lo i !B'.
A-41 ;k4
CM
— V m
0q. scr,
/v -1
ADIS lb '7 C e
cc, ve r
14-10
124=
3
o
.-jeyl
CM
— V m
0q. scr,
/v -1
ADIS lb '7 C e
Ab cer t) ' 10 /7
Pig Id5
AW
rr' T:i
-
M
pmov."clea
0A /ipso
cc, ve r
14-10
124=
3
a
.-jeyl
C,177 YY45
CCMZ�raC1Ca
vv..
,05-
o=
-94
Nl-
Ab cer t) ' 10 /7
Pig Id5
AW
rr' T:i
-
M
pmov."clea
0A /ipso
AZI Cl. "I, I- -')
(=er /* oey J'-Ija _�ho
.-jeyl
C,177 YY45
CCMZ�raC1Ca
vv..
,05-
o=
AZI Cl. "I, I- -')
DAVID D. BRUEN
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
November 25, 1985
John Swanson, P.E.
RFD #4, Geymer Drive.
Mahopac, New York 10541
Dear Mr.-Swanson:
c�
JOHN SIMMONS, M.D.
Deputy Commissioner
Re: Stoya SDS Construction Compliance ti
Certificate ;
Peekskill Hollow Road, Putnam
Valley, N.Y. Tax Map 18 -2 -17.2
Permit PV 33 -84
Reference is made to your letter.dated November 23, 1985
relative to the above captioned property.
Review of departmental files indicates that the Department's
document.entitled "Program Review and Policies, Subsurface Sewage
Disposal and water Supply Facilities for Single Family Residences"
was mailed to you on October 8, 1985 from our-master engineer's
list. A second copy is hereby enclosed.for your information.
As indicated in Mr. Hodgen's letter dated November 21, 1985,
page 4 of this document lists six (6) items required. These
items are not new as they have been required by the Department
for years.
Item 4 requires "as- built" plans showing the house location,
etc. This information may be provided by the engineer or a
licensed land surveyor, however . the information must be
provided, based upon accurate field measurements and include the
house location and size,bedroom Count, the property lines, sewage
system components and driveway location.
. Upon receipt of the required materials, this application will
be.considered further for approval. If you have any questions,
please call the writer at Ext. 241.
ko' tr X your ,
Ka eVY; 4r., P.E.
JK :pt i.rector, Environmenta1..Realth Services
cc :Mr. Stoya
Mr. M. O'Dell,
Building Insp. (T)PV
JH
File
Enclosure
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225-3641
' --
'-----------�----'----r~^---------'-'------,=��"� '-~-^~~~�-^------''-----'---
_
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----_-,-_'`---'-----'__ _-- -_' - -_-_-__--_' -' - .- -
| `
� A
I
DAVID D. BRUEN
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
November 21, 1985
Mr. John Swanson, P.E.
RFD # 4, Geymer Drive
Mahopac, New York 10541
JOHN SIMMONS. M.D.
Deputy Commissioner
Re: Stoya SDS Construction Compliance Certificate
Peekskill Hollow Road, PV TM 18 -2 -17.2
Permit PV 33 -84
Dear Mr. Swanson:
This Department is in receipt of the as -built sketch for the
above referenced permit dated October 12, 1985.
This submission is not in accordance with Departmental requirements
and your attention is directed to the SSDS Submission Requirements sent
to you October 8, 1985, page 4 entitled: Certificate of Constuction
Compliance.
In addition to the six items detailed on that page, it is
necessary to submit a survey of the property accurately locating the
house.
Until such time as these seven items are submitted, this
Department can not issue a Certificate of Construction Compliance.
Enclosed for your use is the sketch, in triplicate which was submitted
October 22,1985.
If I can be ofi any assistance, you may contact me at
Extension 242..
Very truly yours,
dmv�'rl
James S. Hodgens
Assistant Environmental Health Engineer
JSH /jp
cc: Mr. Stoya; without enclosures
File
JSH
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
i
°PUTNAM COUNTY DEPARTMENT OF* HE�T-H
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY;OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE'NO."
Owner M. Address pk 1�4'. C9P�'J ✓Q/!Q�°.
Located at (Street! //� ec C.
/ Block Z Lot /7, a
7Tn ica e neares cross s ree Lat3
Municipality #0& j" j/Q //4M , </yWatershed OVAW7
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number
CLOCK TIME
PERCOLATION
PERCOLATION
Run
..No.
apse
Time
Start-Stop, '.Min.
Depth to Water
From Ground Surface
Start Stop
Inches Inches
Water Level
in Inches
Drop in
Inches
Soil Rate
Min. /in drop
1
� -'4 6* 66 /V
6
3
2.0� 2�'�de ��
/�
14
3
5
4
J
4
2,.
2
3
5
444.r/.,
Notes:
rates
1) Tests to be repeated at same
are obtained at each percolation
depth until
test hole.
approximately
All data to
equal soil
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. f HOLE NO. HOLE NO.
G.L.
6
12 "_..
21f
18,
24
30"
3611
42"
4811
5411
6011
6611
.l2"
7811
8 It
4
Cr
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WAT LEVEL RISES-AFTER BEING ENCOUNT
TESTS MADE BY, 40=61*1 Date n.V4f(0-.&
DESIGN
Soil Rate Used Mir/1 Drop: S.D. Usable;-Area
/ o�c> 5 P.
No. of Bedrooms Septic Tank Capacity
Absorption Area Provi ded By .L.F.x24"
Fame S351gna
Address X'M 7 Ow
THIS S
SPACE FOR USE B
BY HEALTH DEPARTMENT O
ONLY:
Soil R
Rate Approved S
Sq. Ft /Gal. C
Checkedby-
0
.. Date.
4
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