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HomeMy WebLinkAbout2574DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 52. -2 -15 BOX 22 02574 �' I me 61 Wo k r IL r- I I ' 02574 .-T--- �,," .. �.�. -.-... ,. „ %I �.. K - s_,j.'_'-.max P'�^.,✓',�a+- .- •- -'y" -'+<fg�,� 7?- .�,.�„_,,. ' ENGINEER MUST 1, PUTNAM COUNTY DEPARTMENT O., HEALTH p.,ROV I D.E D�wsion of Environments/ HWth Servroes,t4Cah "i N Y 405t2 MfI ` #v T CERTIFICATE W CONSTRUCTION COMPLIAN CE FOR SEWAGE :;DISPOSAL SYSTEM' `Village: Located at t!i44.9 .,/ Tax Owner - !t 1 .���i / Foimeily Tax Map Lot ii. separate Sewerage System' built' by yj u Address J Con 0 sisting''of �00Gal. Septic Tank and 7 = L Other 're-, cluirements Water SuPP1Y:` Public supply From Private. Supply Drilled 8Y" .» r ✓S o-= Address Building Type No, of Bedrooms Date -parmlt- Issued Has Erosion Control Been Completed? ` ' Has garbage grinder been installed? I certify that the system (a) as listed serving the above premises were constructed essential lens of'the completed work ( copies of which are attached) , and in accordance with;the standards, rules and re latione, in, ac '^ -�f qu e�ev�i,i)I';t�� plan, and the permit issued by the Putnam County Departiment of Healtfi.. Date . 47 srtified ! av 2yG Address Lteenss No. Any person occupying Premises served by th bove system(s): shall promptly take such actb ieeasar to: the.' he correction of my uns•nitary conditions resulting from' such usage:. Approval ot'the separate sewerage system shall pe 4a :v q a. pq " t, , lanitary sewer becomes available and the approval of the private water supply sha11-become a void wh on, a ub e'YIS1p{>/,° adbtliis avattabla.: Such ,approvals are subject to' modification or change when, im the 'Judgment or t Com It n4 .of Health such (kation or clianga k necessary. 1 � ., .ybd3tidsP.�C .'.' ' Date y'.. Titre, C.iG�i .� Rev. 6/85 II. LV. W JI. ;;CATION APPENDIX C L' FINAL SITE INSPE ON Date ZO �_� Ins ed , y TM # OR SUBDIVISION] LOT # 10 s NO CCMMENTS 920DISPOSAL ARFA a. SDS area located as per approved plans -� b. Fill section - Date of placement 2:1 barrier. LGT-E WID`i'H AVG.DPTH c. Natural soil not stripped f; d. Stone, brush, etc., greater than 15' fran SDS area_ !` e. 100 ft.. from water c se wetlands. ,p SEWAGE DISPOSAL SYS a. Septic tank siz - 1,000 1,250 \ b. Septic tar_k instsk1jed 1 vel c. 10' minimmi fran foundation d. No 900 bends, clearout within 10 ft. of 45° bend DS e. DISTRIBUTION BOX 1. All outlets at same elevation - water tested. �� 2. Protected below frost i - 3. Minimum 2 ft. original soil between box and tre_*iches -- f. JUNCTION BOX = roperl set g. 'TRENCHES 1: reqgth uired Length - Len installe& -U 1 _ 2. Distance to watercourse measured _ ft. Ob W a, _ 3. Installed according to plan ? 4. Distance center to center 5. Slope of trench acceptable 1/16 - 1/32 " /foot. 6. 10 feet free prcoerty line - 20 feet : foundations 7. Depth of trench < 30 inches fran surface 8. Room allowed for expansion, 50% -61 n 9. Size of gravel 3/4 - 11" diameter 10_ Depth of gravel in trench 12" minimum c- 11: Pipe ends capped h. PUMP OR DOSE . SYSTE`^!S 1. -.Sze of mp chamber.. - - 2. Overflow tank - 3. Alarm, visual /audio �- 4. Purn-o easily accessible manhole to grade i 5. First box baffled -- 6. Cycle witnessed by Health Department est.imated flow per cycle HOUSE ' a. House :Located per approved plans. b. Number of bedroans WELaL E Well hxated as per approved plans b. Distance fran SDS area measured p ft. c. Casing 18" above grade. d. Surface drainage around well acceptable. OVERALL WOIRF�.S'riIP a . Boxes ]pro 1 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 g. Foo intint drains discharge away fran SDS area h. Surface water protection adequate i. Erosion control provided on slopes greater than 15 %_ 10 s Yorktown Medical Laboratory, Inc. LAB a ":f. , 321 Kear Street Date Taken:' Yorktown Heights, N. Y. 10598 Date Rc' d .,•e p o:r.t Director: Albert H. Padovani M. T. (ASCP) Collected By : Referred By: L'2i'ss� rte-��� Sample Location: _ l/2 /Dew QSCV � 19�1 Phone N Phone � L / Repeat Test? — LABORATORY REPORT ON THE BACTERIOLOGICAL QUALITY OF WATER GENERAL BACTERIA Standard Plate Count (CFU /1.OmL) 27— (Agar Plate @ 35 °C) MEMBRANE FILTRATION TECHNIQUE (MFT)_ /Total Coliform (CFU /100mL) Feca.l.Coliform (CFU /100mL) _ Fecal Streptococcus (CFU /100mL)' MOST PROBABLE NUMBER TECHNIQUE (MPN) — Total Coliform: MPN.Index (per 10.OmL) - - Fecal- Coliform: MPIi •Index (per 100mL)- _ - OTHER ANALYSES REMARKS (For Laboratory Use) THESE RESULTS INDICATE THAT THE WATER SAMPLE I SATISFACTORY SANITARY QUALITY ACCORDING TO THE' WATER STANDARDS, FOR THE PARAMETERS TESTED, AT / x / / /Ft Albert H. Padovani', M.T. 4 12 /85(Rvsdt7 /8T)RWE ASCP ), Director 'Time: Time: G Sample Type: .(check one) _ ✓Potable . _ Non - potable _ STP INF STP EFF — Other:,. Sample Status: (check each) Outgoing ._ Na2S203 Incoming E k °C GT k °C — Other: KEY FOR TERMINOLOGY. RDS = Recommend Disinfec- tion of Source TNTC= Too Numerous To Count CON = Confluent ( =TNTC) LT =. Less Than (<) GT = Greater Than (>) N/A = Not Applicable Lit: : Lena than or equal to (WASN'T) (N /A) OF A YORK STATE DRINKING TIME OF COLLECTION. For Lab Use Only: _ H/C to LAB OFFICE HOURS (Main Lab):. 9AM -5PM, Mon. -Fri. - 9AM -NOON, Sat. Vvj.:IJI.Ll vats DEPARTMENT OF HEALTH Division Of Enviro n.mental.Health.,Services. PUTNAM COUNTY DEPARTMENT OF HEALTH Use Only aE COi) Ar%XAnTr.rrilr^" D'V nnm Vvj.:IJI.Ll vats DEPARTMENT OF HEALTH Division Of Enviro n.mental.Health.,Services. PUTNAM COUNTY DEPARTMENT OF HEALTH Use Only 5i -T AOURESS. TOWN/VILLACI T, GRIO NUMBER WELL LOCATHN WELL OWNE1. HAM ADDRESS: IXT PBIVATE r❑ *$UBLIC. USE OF WELI 1- primary 2 - secondary gRESIDENTIAL ❑ PUBLIC SUPPLY 0 AIR /COND. /HEAT PUMP 0 'ABANDONED ❑ BUSINESS INESS 0 FARM ❑ TEST/065ERVATION 0 OTHER (specify) ❑ INDUSTRIAL 0 INSTITUTIONAL ❑ 'STAND-BY ❑ AMOUNT OF WE YIELD SOUGHT gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE REASON FOR DRILLING NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION O. REPLACE EXISTI N G SUPPLY 0 DEEPEN EXISTING,WELL DEPTH DATA WELL DEPTH 0200 —ft. FSTATIC WATER LEVEL FDATE MEASURED DRILLING EQUIPMENT JE� AOTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER. (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. OPEN HOLE,IN BEDROCK ❑ OTHER ;CASING -DETAILS TOTAL LENGTH �/ it MATERIALS: 2 STEEL ❑ PLASTIC. 0 OTHER LENGTH.BELOW GRADE --/I k JOINTS: Q WELDED .THREADED 0 OTHER. DIAMETER Af .1 in. SEAL: ❑ . CEMENT GROUT. 0 BENTONITE IRDTHER WEIGHT PER FOOT I lb./ft. DRIVE SHOEA&YE LINER: 0YES)QN0 SCREE DETAILS .,SECOND.- DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH To SCREEN (it) DEVELOPED? FIRST 0 YES_ Ja#0 HOURS GRAVEL PACK , ❑ YES 040 GRAVEL SIZE. DIAMETER OF PACK in. TOP DEPTH —ft. BOTTOM DEPTH It. WELL YIELD TEST If detailed pumpi' ng METHOD: ❑ PUMPED tests were done is fig- formation attached? ❑ COMPRESSED AIR tac ed? '0 YES ❑ BAILED ❑ OTHER [3 NO Ti more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. DEPTH FROM SURFACV�i watel Bear' 'ng well Dia- meter In FORMATION DESCRIPTION ft. T_1L ft. WELL DEPTH It. - DURATION hr. min. DRAWOOWN ft. YIELD 1.2nd surface goo I gQ0 , 4q:2k Z99 '0­ V IWATE9 0 CLEAR TEMP.. QUALITY UTY LO UALITY 0 CLOUDY RkADNESS' 0 OLD COLORED,.: ANALYZED?'- ❑ YES ONO IS H ANALYSIS ATTACHE -YES ONd T?. 0 STORAGE TANK: TYPE CAPACITY GAL. . PUMP TION PUMP INFOHMATION P IN OR M TYPE MAKER MODEL ::.CAPACITY DEPTH L VOLT .,GE HP WELLLORILL NAME ADO, if z PUTNAM COUT91 Y DEPARTMENT OF HEALTH :D SI iii.. _ OF. OAT #�AT� -- - ,ER - Owner or Purchaser of Building it Building Constructed by Location - Street Municipality Building Type 3s- Z 7 Section Block Lot S vision Name 17 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 fora period of two years imnediately following the date of approval of the - "'Certificate of Construction--Compliance" for- the -sewage disposa , 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. I 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 i:his day of 19 Signature General Contras or ( er) - Signature rev. 9,85 mk Title Corporation Name (if Corp.) Address ti riu 7� IJF igP riOwl k�lel H. -O. Notific i .to ;consist of ✓!i ®o Gal septic Tank. and, Address P bloc SuPPIy Erom y Private. Supply to be drilled by Date Rev. 6y 5 a • 0' zaoj ADZ ktj •' •; ' I N ; IY I Fl W.0,1413!10 013;. DESIGN DATA SHEET- SUBSUFACE SS AGE DISPOSAL SYSTEM FILE N0. ..:Owner i� G.a� � / ✓PiY. - Address :X-V ,-I- Located at (Street). Sec. J Block 2 Lot T (indicate nearest cross street) ,. Municipality' / �, /�!�'r� ,c Watershed SOIL PERCOLATION TEST DATA REQunm TO BE SUBMIT= WITH APPLICATIONS Date of Pre- Soaking �Z ,F- Date of Percolation Test- .. . HOLE NL14BER (1= TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches .2 7 7-V 3 % 2-° 2 3 a -zv 3��rf >.. Z32 3° Zv 1-3 3 '1a 5 4 5 ,. 1 .. 2 Oi 5 yc„ 11r. NOTES: 1. Tests to be repeated'at same depth until'apprcximately equal soil rates are obtained at each percolation test hole. All data to'be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES 7' 8' 9' 10' 11' 12' 13' 14' >. INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING. ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY T �o9J/ / yeow DATE: 2 TOf' S� DESICGi Soil Rate Used A7 Min /1" Drop: S.D. Usable Area Provided' No. of Bedrooms —3 Septic Tank Capacity /Ori C/ gals. Type Absorption Area Provided By L.F. x 24" width trench Other` EW Nanie 14 Address 7i/7%>- ve, v 4". THIS S FOR USE BY HEALTH DEPT Soil Rate Approved SEAL 0 app't +oeo0o° N. .00 ONLY-. sq.ft /gal. Checked by _ Date t $UTNAH COUNTY DEPARTMENP OF HEALTH - DIVISION OF ENVIRaMMM HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEV,GE DISPOSAL SYSTEMS $FRTTFW SpF m - (Name of Owner) COMMENTS ...__. .._..........__. _: .. ____ ...._ __71 - _ Eel PERMIT BY: Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Ed Design Data Sheet (DDS) Deep Hole Log ya d rwq_ VW 3 y Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter -Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow .Fill Profile & Dimensions.- Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area; shown.;_gravity flow, suf f . size If =-PLC °Pit-&-D Box-Shown & - Detailed . House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundat' s 100' to Well 200' i D.L.O.D, 150' pits 100' to Str a ercourse, Lake (inc. expan) 15' to Drains- irtain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fran Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked 'Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same PUT NADI COUNTY D.EpAR TjjZNT HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY; ignatureaTitue mate p IV clrt (6.,erjo jc) 3 -- I- JF�447 4/ e- tl 20 l-I /1/v /7 -Y*�5 A/ , Z,4.. z 1986 JOSEPH F. SULLIVAN, P.E. cond-utting,F).91A.t 2972 FERNCREST DRIVE YORKTOWN HEIGHTS, N. Y. 10598 (914) 962-4248 2 / f -, 14V PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services AFFIDAVIT — CORPORATE,.OWNER•�APPLICATION FOR.PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health In the matter of application for: rA i I� 'FO Rs7, E (D, K. ✓� represent that I am an officer or employee -of the corporation and am authorized to act for t* ? Veoel0pcA& 3GvC (Name of Corporation) having offices at ,p S �io� ) 91 1 0,)4V„Pi(j' 4 0,6 J Whose officers are: President: �3ie'OiiCt� (�.7. �2-`i NpR.� �(Z,9i5 a01L �cl°1 !a cKVXLQ6�$ fZe� �A1N8-*I i ,V r-¢f N.� (Name and Address) n /0579 Vice — President: l_.lor�la "Dz- \fAj,bAA Go,,' 19y✓� yu iq �R.d `�. ">va,� llort�i�,� � �, (Name and Address) Secretary: `$t)2YS 7b7_`fyuAftt1 (ZbS Y3 oz[ 15°� ur9 -vr - - .(Name and Address) t Treasurer: GI��� �ZitiwDu� 1(ZDb` (you 15�� C✓tau' 8 R1 `1�'�4�"�r�xi �1�r�teY A? J05 7e1 (Name and Address) and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Sworn to before me thisC:;;&77-/ day 192C tary Pull is PATRICIA ANN UNGER Notary Public, State of New York No. 4806887 Qualified n westchester county Peres March 30, 1986 Signed: J--- -U 0 Title: �� +�,�� L ✓d-.a� ICJ . ate Seal j 1 Yk f r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Located at 0-5 COT ryGl1po67 (T)% d Section 5 Block Lot 7 Subdivision of Subdv. Lot # % fled Map # Date 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 - -.Qr :sys - c tems - -.im onformity •-wi-th-the" provisioris� o� °A`rt cle 145' or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, r Gr „ Signed 1rJ` Ownee of Prop y Countersi 4 c*k t9- P . E . 1R 06 C�,u c (� '' Address -r� Address " y S Telephone Rai-z" �*411�d Lc)(577 Town Telephone 4 q 'LIr z" 1 (� f f '44-1 0i S0' C4 99 .3.0 w-3 4,4A 1 rc 99 .3.0 w-3 4,4A 1