Loading...
HomeMy WebLinkAbout2400DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 42. -3 -21 BOX 21 02400 1 ru t Ilm. .111 7,'r �,titi T Lr ..�. ,, N ly , 16 M. K . IL il. Lt , 02400 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~^---------'-'------,=��"� '-~-^~~~�-^------''-----'--- _ ~ '- --~--------'--\ � ------------------'-'--�--'--'----'''' a 44 CA Ova go t4 44� ' ----' evmv ----_-,-_'`---'-----'__ _-- -_' - -_-_-__--_' -' - .- - | ` � 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 4-1 c N r zve cs- Ufa nrt5 jfG �uarc?//7 ZI . tip E. 6 •.