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HomeMy WebLinkAbout2597DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 52. -2 -43 BOX 22 02597 �: , ;; a1 IN �, r � ' ' � , J4+ �4 , 16 , Y ti 7��,� �• i' IL 02597 �b�� PUTNAM COUNTY DEPARTMENT OF HEALTH LNG' I N E E R "MU S1`. 1�\ PROVIDE Q� Division of Environmental Heeht SWWCOS, Cermgf, N.-' Y. 10512 PERMIT # 1?0- ✓8' 049 CERTIFICATE OF CONSTRUCTIOWCOMPLIANCE, FOR SEWAGE.DISPOSAL,- .SYSTEM Q ;rap,�,'�/,o y: Town a Village- -.:Tax-map 35 ; Block , Owner Iw1GE1.1 &AM,,raf4 /Formerly vm.mp tot Sulxl. L.-t # .. Separate Sewerage System built by V,Wcx,- -r SatGidld Address pO• -iSCRX 6-1 L v4E .Fgr="WtLL- Consisting of 1000. Gal. Septic Tank andj'00 L .4t3SeI�PTIOA/ /'�e6rtCH Other requirements Water Supply= Public Supply From Private SuPPIy Drilled BY . N�'�'LA►.IGWU K Address L3ok 31'S Cii:.o?oh! rALJ.bS fJ�(. Building Type �E'sl DE�.lcec No, of Bedrooms Date Per-mit1 Issued 8 • �4 ��o Has Erosion Control" Been Completed? Yes - Has garbage grinder been installed? O I certify that the systems) 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 I Z Certified say. P.E. k R.A. Address LA'zgAt ASSC CIATE'S RnV 5Z L,pf t-lEL License NO.', Z(oOOB Any person occupying premises served by the above systems) 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 a okl when a public- water supply becomes available. Such approvals are subject to modification or change when, in the Judgment of the C missiorr0r of 'Heaith, such revocation, modification or change is necessary, Date f 1i1 1 1 /v BY f {/c/' 1 �W �3/�lT' l v Title Rev. 6/85 CI. N. F. a. APPENDIX C FINAL SITE INSPECTION Date lInspected Eby tJWP r m T.# ORS DIVISION LOT Q ' NQ CON24ENi'S SEWAGE DISPOSAL AREA ` a. SDS area located as per approved plans b. Fill section - Date of placement 2:1 barrier_ LGTH WIDTH AVG.DPTH c. Natural soil not strinoed d. Stone, brush, etc., greater than 15' fran SDS area. e. 100 ft. fran water course /wetlands. SEWAGE DISPOSAL SYSTEM a. Septic tank size 11000 1,250 b. Septic tar_k install evel c. 10' minim= fran foundation d. No 900 bends, cleanout within 10 ft. of 45° bend I AJ eR' ; e. DISTRIBUTION BOX 1. All outlets at sarne elevation - water tested 2. Protected below frost :. , 3. Minimum 2 ft. original soil between box and trenches f. JUNCTION BOX —properly set g. TRENCHES 1. Length required -80 0 Len install J0 _ 2. Distance to watercourse measured_ ft. 3. Installed' according to plan 4. Distance center to center 5. Slope of trench acceptable 1/16 - 1/32 " /foot. 6. 10 feet from property line - 20 feet - foundations 7. Depth of trench < 30 inches fran surface o 8. Roan allowed for expansion, 50% 9. Size of gravel 3/4 - 11" diameter 10. Depth of gravel in trench 12" minimum 11. Pipe ends canoed' h. PUMP OR DOSE.SYSTEMS I. Size of puap chamber r i 2. Overflow tank 3. Alamu, visual /audio 4. Pmp easily accessible manhole to grade 5. First box baffled 6. Cycle witnessed by Health De t . estimated flow per cycle HOUSE ' a. House located per approved plans. b. Ntnr►ber of bedrecros WELL a. Well located as per approved plans b. Distance from SDS area measured ft. c. Casing 18" above grade. d. Surface drainage around well acceptable. OVERALL WORKMc=P a. Boxes properly grouted b. All i iall bac-kf illed 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. Footing drains discharge away fran SDS area X h. Surface water protection adequate i. MEosion control provided on slopes greater than 15 %. 10 WLL.L uu1"1rLL',iiVN AGrVAl. Q, ►� DEPARTMENT MENT OF HEALTH �.,.. ..:..� 04 PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET AOURESS: WN /VI 1 I Y TAX GRIO NUMBER: Wl CC-0 NJ v!L j WELL OWNER NAME: ADDRESS: A1z,7V Ay-0 Ll (/l L -57 IVATE ❑ PUBLIC USE OF WELL :'primary 2 - secondary 1114ESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND.IHEAT PUMP . ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED �/ EST. OF DAILY USAGE 00 gal. REASON FOR DRILLING (31.4eN SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA ' WELL DEPTH A&F 0 ft. STATIC WATER LEVEL _ Z ft. DATE MEASURED � l DRILLING EQUIPMENT ❑ ROTARY ❑ CO RESSED AIR PERCUSSION) ❑ DUG ❑ WELL POINT UKABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED PEN END CASING. ❑ OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH tL MATERIALS: EL ❑ PLASTIC ❑ OTHER CASING LENGTH.BELOW GRADE ft. JOINTS: . ❑.WELDED EkTI: BEADED ❑ OTHER DETAILS DIAMETER in. SEAL: ENT GROUT ❑ BENTONITE ❑OTHER WEIGHT PER FOOT _Z ::2 lb./ft. DRIVE SHOE S ❑ NO LINER: OYES oxif SCREEN DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (it) DEVELOPED? OYES 0 .NO__:_ HOl1ftS SECOND GRAVEL PACK ❑YES ❑ GR E; Dt OF PACK in. TO DEPTH ft. t DEPTH It. WELL YIELD TEST If detailed pumpingIELL METHOD: ❑ PUMPED t tests were done is in- � O C ESSED AIR , formation attached? AILEO ❑ OTHER i ❑ YES ❑ NO LOG It more detailed formation descriptions or sieve analyses are available. please attach. DEPTH FROM SURFACE water eear- ing Wett Oia- meter FORMATION DESCRIPTION root . it. It. WELL DEPTH It. DURATION hr. min. DRAWOOWN ft. YIELD 99m Sara Surface i �o /()o 61� /00 4 © t WATER jJ16LEAR TEMP. IL QUALITY O CLOUDY HARDNESS O COLORED ANALYZED ES ❑ N0 ANALYSIS ATTACHED? ES ❑ NO STORAGE TANK: TYPE E15 CAPACITY GAL. PUMP INFORMATION TYPE S 1/48 CAPACITY / 0 MAKER 6: n D s _D--E))PTH E 0 MODEL VOITAtsK2 0 HP 461, WELL DRILLER NAME 1�)q DATE r� ADDRESS R o l( 3/ 3 SIGMATt)RE V C (Q a 7-6,41 f-j? ,. (orktow,n Medical. Laboratory, Ins. LAB I Coe. a s o 7,? 321 Kear Street Yorktown Heights. N. Y. 10598 Collection Station Used: (914k.24Sr32.0'.' Carmel Peekskill New City. Director: Albert .N. Padov�t AL T. `ASGf ,ioHN 1)f /3/ dIV TQfob? Date Taken: 6 Date Receive : � 6-d R1b Date Reported- Collected J RI�} R C���i /� J✓a R Referred By: . / v C . L �� _j Sample Source: E , LABORATORY REPORT ON- BACTERIOLOGICAL QUALITY OF WATER GLNERAL BACTERIA Y Standard Plate Count per 1.0 ml V_V (Agar plate @ 35 °C) YEMBRA11E FILTRATION TECHNIQUE (MFT) Total Coliform aer 100 ml Fecal Coliform, per 100. ml Fecal Streptococcus per 100 ml YOST PROBABLE NUMBER TECHNIQUF. (MPN) -- .- -Total - Colifor -m:­- -MPN Index per 100 m1 Fecal Coliform: OTHER ANALYSES M.PN Index per 100 ml i 0 THESE RESULTS INDICATE THAT THE WATER SAMPLE. WAS) (WAS NOT) (NO'T APPLICABLE) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO T E NEW YORK STATE DRINKING. WATER STANDARDS, FOR HE PARAVETERS TESTED,, AT THE TIME OF COLLECTION. CP)o Director LEGEND RDS ® Recommend Disinfect - A ng Water Source < a less than TNTC ® Too Numerous Too r 0% 12 w d PCTT'NAM COUN'T'Y OEPARTMEtTr OF HEALTH DIVlSIOi9 "Ofr'-ENV:ROLNZi &tiTPAL-'HEAL'IH 'SIMVICFS ' ;:. _......_... ....._� ... .__... ., Owner or Purchaser of Building Section Block' Lot Building Constructed by V.1 �c�of'E.� Coy�eT Location - Street 'LIT -ta A_M V IJ�E�i Municipality �'ES11'�EtiICE Building Type %CCca ,PEE Subdivision Name 4 . 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. ooe.rate_forna.- period: of -two -yeax-S..i -am. i J. . �ly..follaa�ing 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 -Environmental 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 day of :I)La C.- - 19� General Contractor ) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk - 4 Corporation Name, (if Corp.) Address PUTNAM COUNTY.DEPARTMENT,OF HEALTH Division of Enviro Health Services. C"el 'i6jlnier to provide Permit # Rev.�, 3186 7 N.Y. 10k2 on a CERTIFICATE OF COMPLIANCE Permit CONSTI FOR SE GE DISPOSAL SYSTEM TOT, QAA VAt, Located at \KACL10 Pec— � Town or Village — - Subdivision Name millid. Lot # •T'a X Map 27 Block Lot 7 ew —Rev1slon_0 'Date of Previous A ppikoval C Mailing Address (6-7 To.(Ak::E CE9!L02-v—iLL, zip let Building Type J%t Area Fffl s-d-i only Depth —Volame Number of Bedrooms— Design Flow G/P/D-6)m!6PtJ PCHD Notification Is Required When FBI Is completed Separate Sewerage System to conalstof J4DWChnSptlTW&and I-') constructed To be by b — ----- Water Supply: Public Supply From Add ss Private Supply Drilled or: by Other Requirements I represent.that I am wholly and Completely responsible for the design and location of the proposed. system($); 1) that the separate sewage disposal system above described will be constructed a . s shown on the . approved ved am ' endment,there to and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by tho'builder, that said builder will place in good operating condition any part of said sewage disposal system during the, period of two (2) years Immediately folloiwinigl the date of the. issu- ance of the approval . of the Certificate, of 'Construction Compliance of the original. system or any repairs thereto; 21 that the drilled well described above will be located as shown on'the approved plan and that said well will be Installed yicordance with . the .standards, s and reg–MIlonsof the Putnam County PaRart t f Health. ea r Signed_ R.A. Date P.E. Address License No, APPROVED FOR CgNSTRUgTION: This approval expires one year 'orn t daite is;u 111`11.ss c s for taus .7n,truction of the building has been undertaken and i �Kr may a ended or modified when considere etas by the of HeaKthny change or alteration of construct* I e Is requires a for disposal of domestic sa/nis age, and /or er I c Date 7 Title By Title M PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date -0 -6 Re: Property of z G" �1-C 1 / ,0 %S 7 Dd f Located at s S (T) (0 Section 57 Block I Lot b 1. Subdivision of W1 (,C0 °T A,r --�— Subdv. Lot # Filed 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 .- sy-stem or--systems -rn eon ormity- zv t%- t- he-- p�ovisioi�s of Art�cle -145 E __._.._...�..:_ 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Cc Countersign (ED R.A., Address ie L) LL- Very truly yours, Signed .1 Owner of Pro Address / u`37 Town I _ 'z O S _ Tel phone Telephone pt7 CLX1N'.CY DEPARMXn7T OF HEALTH - DIVISION Oil E1VIRONKERM HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS OOI�I.S' REVIREVIEW SHEET I'RL7CTION z __ .. PERMIT _ DAT'E- 2�:E:VylEWE� .6V-- BY: , (Name of Owner) (Street Location) CONTgNIS YES DOCL14DM _ Permit Application Corporate Resolution Plans - Three - sets , Engineers Authorization" Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If M - Letter Variance Request REQUIRED DETAILS CN PLANS Sewage System Plan Sewage Systan Hydraulic Profile - Gravity Fla, 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 Fr � g /Gutter Curtain Drains Deep Holes Located esentative of Sewage & Expansion Area Expansion Area;shcwn;gravity flvwsuff: If 'Pumped Pit & D Box Shown & Detailed House - No. of Bedroams Wells & SSDS's w /in 200 ft. of Property !,or--- Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 '0; Type pipe No Bends; Max. Bends 45° w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. e\qpan). 15' to Drains- •Qirtain,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 4 • PUTNAM . JUNTY DEPARTMENT-OF HEALTH ir DIVISION OF ENVIRONMENTAL HEALTH SERVICES hr; COUNTY OFPJ. CE BU'I LDINGs_CA RMEL N . Y xO 12 3c DESIGN: DATA SHEET- SEPARATE SEWAGE DISPOSAL Owner' 1_� QA C-t j jtJ !Address 1 C Located at ( Street Nndlca t1JlCx"_c� E, Sec. t1e/nea`'res cross s ree .Nhlci.pality Li -CY Watershed. , :_�..*�` �N tra► SOIL PERCOLATLON TEST -DATA cJUIRED TO BE 'g CATIONS to! e ;umber, CLOCK TIME Elapse 140'. p Ti me Start -Stop Min.. PERCOLATION``' p o a er- ,...;':;: From 'Ground ,Surface Start Stop Inches. :7nc'hP.q 4'•.., 'k 461,,:' PJotes : 1) Tests 'to be repeated at same de.pth' until .avbro -k rates are obtained At each percolation test hole.,s A for review. 2) Depth measurements to be made from top-off` D18 . Ci5 I 1 � 1 y {k�'M.,r., 5 yU -- 2 sue` , 2• J `;x ,,,`- : _':' •�: IN 4'•.., 'k 461,,:' PJotes : 1) Tests 'to be repeated at same de.pth' until .avbro -k rates are obtained At each percolation test hole.,s A for review. 2) Depth measurements to be made from top-off` D18 . TEST FIT DATA.. QUIRED TO BE SU11MITTF.,D WI,'%ii1 `�"ti +.' JCAii� •, DESK R I PTI ON OP ' SOI1Z'. IJCOUNTERED IN TES DEPTH Hoi�E NO . IIOLLE NO r Y 1 AN Gff . V k� ��Sp i L • 1 � S!'� I�M�� �rK� �' ��a 24 f 6. i 3 rryra� S 421f Z—o 6011 , 66" t , 78f� F,k. 84 INDICATE LEVEL AT WHICH GROUND, WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES 'A BEIN C 'i TESTS `MADE BY; Soil Rate S i'n/ " p: S. Usab m • User 1 Dr o �,;��,�?� � � 5 -•r'c- . N-o. of Bedro:onis ' 3 Septic Tank Capacity % °:Qg ; ;; ;+ A) R Absorp:t�on Area Prqvided By�V'© L. F. x24" Name LS _ 6ignature Ax Address f as�2 THIS SPACE roR USE BY HEALTH DEPARTP�[INT ONLY: Soil Rate Approved Sq. Ft /Cal . Chocked 'by Dote wq 7 J. t� 5 - • pw iii' M' i { 5# J�1rl'M, • x,11. °�i.`{'. , DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 March 10, 1993 Livingston /Barton One Wiccopee Court Putnam Valley, NY 10579 JOHN KARELL Jr., P.E., M.S. Public Health Director. Re: House Renovation Barton /Livingston (T) Putnam Valley To Whom it May Concern: Please be advised that I have reviewed the plans f.or the proposed renovations to the recreation room within the existing house and the plans for the subsurface sewage disposal system. Based upon such review the Department considers the sewage disposal system adequate to serve the property and therefore a permit from the Department is not required. If you have any questions please contact the writer. Very truly yours, //oh n /Ka r e-- 11 1 Jr., P. E Public Health Director JK /jp cc: R. Morris Q -tee c -Z DiViSi6 Ge Diana Livi.ngston Vince Barton One Wicc'6p6e Court Putnam Valley, NY ni:Ar6nrn e va 'Road, '8 ewst -(914) -1 10579 Dear Mr. Barton & Ms. Livingston: Goa . JOHN Ell S --,4 W F HEALTH ' lhtal i;Health Servicei er, New -York. e WYork' 10509 '8-6130 February 22, 1993 Re: Application for Addition Your application is being returned to you or being held by this department for the following reason(s). Fee should be paid by Certified Check or Money Order only. Fee is --nofl.- enclosed or incorrect amount .. -- Fee due is; $100,N- ( ) New Tax Map designation should be provided. . . ( ) Incomplete application. Please provide: T a- (;) p as C-7)---:) ,,,) c- c 6="s -r;. o n � n- 14-12 Pk TWA ta-t l)All1&?-f1 J-h 4 t - pf -0 - 0 � c > 1v-c" (� /4o- � Z? 7e-V, e ./7 ly-li- 9-'3 rft 460' HIGH HALF MALL Ve L H ti ir WoltlTOWE .21 9' 6 now . . . . . . . . . . .......... a. My VOW 0 77 ......... 4 AMN N mm fp tt I R. W n"j!jx. My � it 747 7­,77777 M S �.R 4 An now . . . . . . . . . . .......... a. My VOW 0 77 ......... 4 AMN N mm fp tt I R. W n"j!jx. My � it