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HomeMy WebLinkAbout2458DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51. -1 -22 BOX 21 I FIN ir N% his } �,A PUTNAM COUNTY DEPARTMENT OF HEALTH ` Division of Environmental Health Services, Carmel, N. Y. 10512 / Putnam Valle T ..... .CERTLFICATE...OF_.CONSTRUCTION COMPLIANCE FOR SEWAGE. DISPOSAL SYSTEM.... _._.._ . Y � J Town or Village ^ Bell Hollow Road 23 4 Located at Section Block Owner Gary Gamache Lot 1 Job Separate Sewerage System built by Tony Cesarini Address Old Peekskill Hollow Road P.V. Consisting of 1200 Gal. Septic Tank 337 lineal Feet X 3611 width trench Other requirements Domestic Use Only Water Supply: Public Supply From X Anderson Well Drillers Private Supply Drilled By Barger Street Putnam Valley, N.Y. Address Raised Ranch . &00°41 • No, of Bedrooms q��g q�o ermit Issued Building Type �� �`NN�p Has Erosion Control Been Completed? Yes ® ® ' 4f � I certify that the system(s), as listed serving the above premises were constructed essentially n h of g,Ccknpleted work (copies of which are attached), and in accordance with the standards, rules and regulations, plans filed, an the it is a P*nsrn County Department of Health. October 15, 1977 • A p,E. X R.A. Date Certified by 1 Northridge Road &kski l . 278$ 6 e° License No. 027846 Address nn[ �u(��� Any person occupying premises served by the above system(s) shall promptly take such action as ing b� Us`s�ryRo secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become nu I rftlN>,Pi 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 sup becomes available. Such approvals are subject to modification or change when, in the judgment of the Co toner Health, such revocati modification or change is necessary, Date Title PUTNAM COUNTY DEPARTMENT OF HEALTH V E� ;} Division of En vironmental.Health Services, Carmel, N. Y. 10512 •DNSTRUGTl0U_PERIIAIT_FOR SEWAGE bISPOSAL •SYSTEM Tpa�C Town or i lags cated at � LG �{vGGo�.✓ e� -�Jt�O - 9ectisti z 3 Block �% 4- .�/ 4/Lot —k'4 0L l,3 Job �: .; ubdivision • s .Owner 777,46 ZfgKEs ritLG . Address 377 %(/EST�f 5?�!� 1�.C- TGff6}51E�lGy Building Type iDE�n� Lot Area f lr Number of Bedrooms Total Habitable Space d U T Square Feet Separate Sewerage System to consist of TO C' Gal. Septic Tank 23 lineal feet X 3Cd width trench To be constructed by U ytw Address Water Supply: / Public.Supply From ` Private Supply to be drilled by �i Q k 00 W tA ) r Address Other Requirements t71�1 Ai /�l� EG�►J tN:)y C: A.: Fv v_'Tti a ca>c>iL. VE plB�E= �'C'E� GUQ �.p•t!J O2/�1 !��1 IJ`jT1�L L 6� I represent that I am wholly and completely responsible for the design and location, of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the staagdtjFli ,� ditpC regulations o e Putnam County Department of Health, and that on completion thereof a "Certificate of Construction ComOiance'\���ac ry�%i�F1e,Commissioner of Health will be submitted to the Departmeht, and a written guarantee will be furnished the owner, his successors, iir ass 'lsy, h dilder, that said builder will place in good operating condition any part of said sewage disposal system during the period of two�o) yak§ iMrfl ely.• � ing the date of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or any rOaOrs4t `eto; 2)'tha%* ril&d' well described above will be. located as shown on the approved plan and that said well will be Installed in accordan w he ul a ns of .the Putnam County Depart ure t of ealth. /I - z Date Signed • •P,E. R.A. Address P -NA -A. OP AG IEK 7 e2e br- , i r9- 4 ;F APPROVED FOR CONSTRUCTION:. This approval expires one year from the date issued unless constru1 #•bf.ttle•bviN. '�7�s been undertaken and Is revocable for cause or may be amended or modified when consid n "essab Comm i ner of H6111, iFfss° ��>�gtElcbr alteration of construction requires a n w ermit. Approved for disposal of domestic n' r se ivat ater supply onr�ftit „el,��� Date By xi, //J Title +� i .. Scated at � k bdivirlon 77- ilding Type x���' ��L'h LOt Area irn ber of Bedrooms = M r parate Sewerage System to copsist 120 of + � r be 'constructed rter; Supply Public _Supply From Private Supply'` Address x her Requirements ' 3present that I am wholly and.completel ive.descnbed`wilI be constructed as sho_y unty Department of- Health, ;and than cond 9 z- 4 . ED FOR CONSTRUCTI for cause or maybe am 11-1 e r _ I. responsible for'the design, on'the approved amendm4 n completion thereof a ,6 nt,gn guarantee will'tie f t of said sewage disposal Construction3-:Compliancl i and that said well wilt be ", 4, v a s .. ..:.�:.,.. 5.. _ rn �ervrces c,arme/ N Y 10512 r Town or Village.' Section ' '_ �` r- '.•Block Lot J ob Br N Y 10662 W Total it Space 15'Qt� `Q Square Feet c pt c Tank 320 Imeal feet X 36it w width tren ' ch i Address X15 he tt�u� Rod h r "h =Lake >Peekslsi119;..:IVY �t�1 ia71' millers „ 7 , p i- tnai�'Uallag9 .- proposedysystemO ®� ' e Sewage :d isposal_.system re to and m accordance with h h 0 0 11 tioqs o,. ; t e % .0 n7 to of Construction Compliance A r issionec,of Hea'IE'fi Will d the'ovrner, +hi'successors; her' b it rkhat said builder will r during the period of two (2 im Ilo ng tl�edate cq the -issu ie original system or any repai to; 4 rill d'aisell,;described. above d in,raccordance with the stag r ulat •of :,;the r Putnam t �EI o ssued unle s construction of .thb ���lSg has been undertaken 'and is Y Y° issi r• of,Health Any change; -or alteration of ;construction ,a or pr ate r .supply,,only - t a - Titl a CTERIA PER ML. (Agar plate'caurit _ 35 -C). C'OL- I °f.`RM.GROUP.- (!Rost.- F:obable rlo. /ICO n1:)- ARD NESS TO TAt .- pp--r-- :. TERGENTS - pPm NITRA TES (as N) - pprri IRON, .TOTAL` 'ppm PEEKSKILL MEDICAL LABORATORY ,_..••. ,. 1879 Crompotid Rd. Barc liy Plazii' Bldg Peekskill, 'New • York -: 0566 PE 7:8777' t DATE 'COL LECTED RESULTS OF EXAMINATION OF WATER L ' NER DATE RECEIVED " !'Y,' '.VILLAGE, TOWN 6 /OR NAME OF SUPPLY',,' DATE REPORTED .., .1..� �4-:�.'l, r APLING' POINT CTERIA PER ML. (Agar plate'caurit _ 35 -C). C'OL- I °f.`RM.GROUP.- (!Rost.- F:obable rlo. /ICO n1:)- ARD NESS TO TAt .- pp--r-- :. TERGENTS - pPm NITRA TES (as N) - pprri IRON, .TOTAL` 'ppm ;•, it -. = � -,'{ . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICESi COUNTY OFFICE BUILDING,• CARMEL, N. Y. 10512 DESIGN DATA.SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM Owner Gary Gamaehe Address FILE NO. 1915 Hunt Avenue Bronx9 N.Y. 10462. Located at (Street) Bell Hollow Road Sec. 23. Block 4 Lot 1 (Indicate nearer cross street) Municipality. Putnam Vall ®y (T) Watershed ?eokskill SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole 2 Number CLOCK TIME PERCOLATION PERCOLATION Run apse Depth to,Water Water ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches (1) 1 4:32 4:59 27 16,5 19.5 3.00 9.00 2 5:04 5:34 30 16,25 19.25 3.00 10.00 3 5:38 6 :08 30 16,25 19.00 2.75 10.91 4 5 C2) l 408 5:06 28 17.25 20025 3.00. 9.33 2 5.:12 5:42 30 1700 20,5.0.:.. ' 3.00..._ 10,00 _ .._. 3.. 5 :45 6 :15 30 17.00 20,00 3.00 10.00 4 1 2 3 4 5 Notes: 1) Tuts 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. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION` DESCRIPTION OF SOILS,ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. 1 HOLE NO. 2 HOLE NO. 3 6" saz0y,, boney &oam sandy,, bony loam shady bonny loam 1211 some silt some silt some silt 1811, 24" 3011 3611 42" 4811 54 60" 66" 7 78•' INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED None INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY John S. Romeo Date May 49, 1976 .. `- - -4 _- _ - • - -• . __ -1115 Soil Rate Used Mir l "Drop: . S.D< (Usable Area Provide, �5000 SF + 00 rae . 0 0 —t run.. o�_ No. of Bedrooms 4 SQptic Tan��Capacityl,�: 1200 Gals, o psc" Absorption Area Provided By 320 L.F.x241' - 36 x ®. o ° y Name Johta S Romeo Signature .� Address 1 Northridge Road ee s SEAL A �� 278x6 P° N.Y. 000' of His ���� • s° THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. R /Gal. Checked by Date _........�- `71 -140- P(3TNAiI COUti TY DLi .?l:L�T OF. 'r_= : =.LTH • DIVISIJWi__07 E�7IR�Cirti :aL`HFA;'iE{�'R'VC ✓.S.k:- -as. DESIGV .DA,TA SCl%ET - SEPA_aTE, SE;_aGE DIS'J J�aL SYSTL:I FILE NO Gagner �iVO oG 77fs G.vle .Tiln- Address 7� k/�sr`c/ 57 AvE } .Al -TAx Located at (Street). 9EGC, I %Uoco ;Po, -SEE Block o4 Lot.., of (Indicate nearest cross stree L) hlunicipalit 1.1atershed C',givv�ovs C�2u&�.� SOIL PERC-OLyTION TEST DATA RE0UIRED TO BE SL'E'iI "ID -TI TL PPLIC TIO-NT . Hole 1\' urber CLOCK TIM PERCOLATION' PEP.COLATIOv Run Elapse Dept:: to U:ater (iater Level No. Time Fro.:, Ground Sur---e in Inches Soil Rate Start Stop Min. Start Stop Drop in Min/in.drop Inches Inches Inches . Q i /o, Zo Z-:3 ; /Z 2 to 3. /lr' ¢Z !Z; !B 3(v . •zv • . 2 z 3 <z 4 5 . 1 /0'3- /0.'// 3CP To Z 3 3 . iZ • . �. 2 /�•' // ®4•' �7 Flo �° 23 3 i2 3(o 2� 2�•. 3 iZ 2 3 5 .. Notes 1) Tests . to be repeated at same depth L ^:tll approxi - =- e- 1 r equal soil rates are ob- tained each percolation -es-, hole. All data to be submitted for review. 2) Depth ,a.t meas,-,.re-irents to be. -made from top of hole. 6r� 12'- 18. w /es i- Ay 241 . 3 0" 3fi" 42" 481' 54" 6 0" 78'' 84" INDICATE" LE, TEL AT S,MICH GROUND WATER IS. E \COU\"TERED INDICATE LEVEL TO WHICH MATER LEIFEL RISES AFTER BEING ENCOUNTERED" TESTS MLA DE BY iv4io- 7�icnvF co ��'ytt►��- Date ..lo-Z& i-^� 1j or' �t �� 7'C ^'�l Area '1 Soil Rates s� /Z ,ir /1• Dro-O S.D. _ �e _1_ "_� da 000 z'ro�=i�_d S No. "of Bedrooms .S Septic Tank CapECi ty 900 Gals. Type 10A5ow/2y Ansor "lion area Provided By 23/ L. F.x2- - �6. "�ci`k�ib ' Ocher - . V Uor� v E2 D�o�� ES�S -c0 gE " NW.� � — °E A , ab�° of t�q�ncn. ; C>Z A,% N :tS 1 At 1 big I Name bs IV Sim ature o o Address.. SULLIVAN - THIEDE SEAT* b ^ z CLARK PLACE.. O..Box 308 MAHOPAU, NEW YORK 111541 PU TNaL%I COUNTY DE PARTL 9:,N T OF HE LTFI Soil" Pate" Aoproved Sa. rt./'Gal Checked b% °'bb6bbN ° Date OWNE SITE MAIL PERSI LWUI= Q i o, CL .iV11C711 -LV %L.C, UW11CL, L=XUJV -, eW. 1 . DATE TYPE FACILITY PROPOSED INSTALLM S4A/ 401' . jg 1/1 PHONE Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original.sewage disposal system. Different location may require submittal of proposal from licensed professional engineer or registered architect. Proposal approved __,21 r Proposal Disapproved Z2 Datd 'roposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submisgion of as built repair sketch in duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed canponents tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diem. x 6' deep drywells surrounded by one foot + gravel). It e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, s gamer or reported gent of owner agree to the above conditions. 3IGI�+iTURE TITLE MM: V&te (PAD); YeUcw (fin HE); Pink Lbgija nt) DATE /6 �A/ _TOWN_ OF P _ _ U_TNAM VALLEY W.:..LT, y?JRILT.,rRS : f:. AND REPORT WELL COMPLETION REPORT This repr:rt is to be completed by well driller and submitted to Bldg. department, together with laboratory report of analysis of water sample indicating water is of satisfactory bacterial quality. Well Locati Tax Map Well Owne Well Drillexi2 Name Street Mailing Address Mailin�ress Sec. Bl. Lot City or Town Tel. # City or Town CASING DETAILS ! YIELD TES WATER LEVEL. I SCREEN DETAILS Bailcd , : (P:ca�,��re from and surface Length Ft . or Puinl�ed Ii.rs. Statics Ft. Makes a ,� When Bailed Slot Diameter-.O/ Inches lYield: S GPM or Pumped Ft,, Length Ft.Size Kindsq s Diameter In. TOTAL DEPTH OF WELL J? �' F eC, C WT?LL LOG Depth from Give description mf formations penetrated, such Ground Surface ass neat, sand, gravel, clay, hardpan, shale;arclstone _ :gr'ai�ite.; etc; Inc3ude ..size gravel (diameter) and sand (fine, medium, coarse), color of material, structure, (Loose, packed, cemented, soft, hard). For examples 0 ft. to 27 .ft. finc, pac:ced, yellow sari; 27 ft.. to 134 ft. g_-ay grans ±e. Feet to Feel Formation Desc:::iRtion Date Well Completed_�� Date of Report Well Driller ' � •- Signature BZS 1 -77 Gary Gemache Putnam Valley (T) Owner or urc aser of ul ing Municipality, u ng o struot -a by Section. Bell Hollow Road Location - Street B16ok Raised Ranch 1 u ng 'Type Lot _ GUARANTY OF SEPARATE SEWAGE SYSTE14 I represent that I am wholly and completely responsible for the location, wort nanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has beean 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 guaranty to the owner, his succes- sors, 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 initial use of 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 occu- pant of the building utilizing the system. The undersigned farther agrees to accept as conclusive the de- termination of the Director of the Division of Environmental Health Ser- vices of. the Putnam. County..: Department of Health as .to whether or 'not the failure o.f .the.1yotem to operate was :.caused.by :the willful or negligent. act o.f the ooQupant of the buatlding� utilising the sy.ste :... Dat'ed "t'iis °12" ciay of VOct 19 ~ '7 Signature' .._= Title2/_aa ir eprporation, give name and address) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - r .. THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS RE UIR D TO FILM QT C , RATS 0 F FFST USE OF SYSTEM. - - - - - - - - - - - - - - - - - - - - - - - - - - - - Division of Environmental Health Services, Putnam County Department of Health PUTNAM COUNTY DEPARTNIt:W' OF 1ILALT11 DIVISION OF FNWRONMIMAL HEALT}[ SERVICES. Date a Property of 4e Fe P y%'� a. •' Located at Section Block Lots Gentlemen: 7 This letter is to authorize John •S; Romeo a duly licensed professional engineer x or registered architect (Indicate) to apply fora Construction Permit for 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 4- -Ort'fipf- l• i rin w•1 17h 1-his mw41-17H•r- "TNi. i -n R11ryP1'`li FP rhLn r?nnci-r1.lr+ ri nn nt caSri system or systems in conformity with the provisions of Article 145 or, 147, Education Law,. the Public Health.Law, and the Putnam County Sani- �ary Code. Very truly yours, Signed hew�. Own of Property Countersigned: i �.' ,;4 Address 4?/� 1 Northridge Road . Tel phone ddress ..'.000�o,opoo Peekskill No;Y 1056E �° I E�►�' r ° °o' 737 a 1056. o. Telephone R. �. 0 2z ; f REVIEW CHECK S - T Meets Std.*' Remarks es i No DOCUME -kS House plans 0. K. Design data sheet Peres presoaked? i Min., 30" perc test depth Cont. results for 3 runs t I D. Hole log 0. K. Corporate Affidavit for other than individual Authorization for engineer I I Letter from Mater Supply if applicable i If variance requested -such noted on plans &apps.° DETAILS if charge is proposed, Existing contours shown ( A. new contours) r--- -- Slopes"for driveway cuts, etc. shown Water service line location Footing.drain, etc. location I i Top slope, bottom slope of fill i Percolation tests and deep test pit location I Septic tank size and conformance to std. 3. B. R. house .minimum F. . House setback shown � U iiiiLl'J l +l.it..!.l +!1. Li.1.1. WaLE:t' vil-61iiii. 50 11�e U1. jj aL1VW11 j + =- -_- ..Plan and. profile SDS .. �..�_ .__�._ ..'_:..h.:: j i ....... (:...... .:._.... A11 other wells anct ADS closer 200' shown or reference made rf Property boundaries (metes and bounds- clearly shown i SEPARATION DISTANCES SPECIFIED ON PLAN 10' to P.L. i 20' to Foundation walls 100' to Nearest well '50' to stream, march, lake, etc . incl .expansion 15' to Curtain drain i 10' to water lire (pits -20' ) I 15' to storm drain V IM 10' to large trees 10' from foundation to septic tank A 5 t pipe from leader drain & footing drain .0 00 11-alp. by: 'b 0 U-11111AL F)PTT", Y(.'.,4 No Commoiitci .P..r(), or. ty -;'L j; 1,10 3.--.Ckr-,C: o rnr-,r.3, Xburnd- .,an estj.Twat-� hou,;c location . 0 0 0 a 0 0 0 0 rlill drivowtV nzecd cut . o o . . . o 14w;t trees b-- re moved -note thl-130 C? . 0 0 0 0 .0 Is (Icep hole r0p,,E.—"ent-ative of entire ST)S area I,Oditio.nal do--T) iiolcs n'codod. *. a . 0 a a 0 0 0 ;01'1.J.cieiit SM area available* consideril1r, driveway cut, house . location.Scparation 0 0 dista]jr-CS., etc o 0 0 .0 a 0 0 a 0 0 6. 0 0 .0. )IP BOLE IlArIP11 �Pth: Nater elevation: }lock elevation: Soils on -�4 *'Is descri--oj Date, 'IRAL SITE, PISPECTION Insp. by: buse located where shown on approved plan C., L, 0. 4 a .,..a -a 0 M lo rt'ed'vhere approved a 0 lope of tile, ine'and' trench table . . . oom all o,,,,ed, for expansion trenches . VC-3? 50 ft. frcm si•;arn), %.,,,atercourse . a 0 0 a atural soil not stri-=6d or SDS area unnecessarily graded o ..o. from pro_ ..1in- and 0 0 a a 0 0 0 o .-Taration of trench from house., well etc. follows plan 0 0 0 0 0. 0 a 0 umber of bedrooms checks 0 *0 0 0 0 0 a 0 6 tcnQs, brush., stumps, rubble., etc. greater -- than 15 ft. from nearest: trench -3 PL. of --- -ohoral soil hori-o "*a-"y from trench e o 9 0 0*'Q .' 0 a 0 a 0 0 0 0 0 0 a 0 0 inct1on boxes properly set )Uld surface run off from drivewav, roads, ground surface., etc . charanel no-ar SDS area 0 a 0..0-0 0 0. 0 0 .0 •a 0 0 a a 0. 16t drainac-- at)rcn- r 0.1' in area of SDS 1114L GRADING OF SITE, ACCEPTA=- a O PUTi�ArI COU?iT DEP- �T!.,E- OF LT DIVISTOa Or y`J �; - Rv. ?�•`_;TL - - 1T. a. S E_P•_VIC ES Date Re : Property of �wn . oF�77fE L., c Located at Moz-49kv ; eo Sazttem z3 Block 64- Lot o l Gentlemen: E F, k-� This letter is to authorize �"vGGiviy,v' -.rEfr �� a .duly licensed p_ = '^.re3S10?'3� or _'a7l s�Ie e ?rC_ ^_? teCt ( Indira -e) to apply for a Ccrstructior ��r; _= .or a sepa ==ae _e:;e.^ s--s,ten; to serve the abgve ncta i �rooe »;'J a,,cord- 7 C e _ h �'e standards; rules or reulwtior:s as promul_a ted b-r Co „ =­iss Ion er o_ tre Putnam County ,L r Departm nt^ o” _ eal -' , and to si =1_. .1 ,ne�essar- pYoe. ys o, mfr behalf In-. con_necti on Frith t._i s r-a*tter ar_d to gL;n'r se . `_:e construction o: said. syste^i or systems .n confor:�i ty `r- t h th- DMv:..io_ s of :_rti 1•a' 1L5 or 1lt7, Education. La:r, the Public Heal th La:r, Ord the Putnam County Sari- ,tary Code. Very tnu19. moo, rs A- S ;;ad' f WF-� -A Qr;'r Oi = = operl �7 c TEg_ P•t�e Cotinters igned:. Addr =Ss rli P .E., R.A. ), �Fo�';ANCIS �•,��', !�® 9 elephone �� • ( Seal' ) ;fie:. • Telephone