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HomeMy WebLinkAbout2964DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.17 -2 -4 BOX 25 I I I kN W. k, %,. 1 , ■r 02964 PUTNAM COUNTY DEPARTMENT OF HEALTH Dhklon of Environmental Health Servleetl, Carmel, N.Y. 10512 PMkP�de b.v- -39 -84 t CAT .OF_CONSI'RUCIWON COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM -- _. P. _ UTNA•M•_�_,T.� y�,- yM1'^' _ WEST SHORE DRIVE .y�.__. - - Ter: 4� Town orVllhlge of map Bh►ck_ 3 W 1 _ 2 Owner /sipplkwnt NameGARY ,FFFNF.R Formerly Sublihislon Name Mai bg A WEST SHORE DR _ r PUT - VAT.T N_ V _ 1 0 S 7 9 Subdv. Lot # 2 Fee Enclosed 0 Amount ° 100-00 Date Permit Issued 7/24/84 Separate Sewerage System built by HOWARD GAGERT Address OSCAWANA *LAKE ROAD Condsdng of 10 0 0 Gauon Sepdc Tak .cad 41c; Tx PUTNAM VALLEY, N.Y. 10579 OF LEACHING TRENCHES Water Supply: Public Supply From Address on * Pdvate Supply DdDed by NORMAN ANDFRSONAddvn1 52 BARGER ST. PUTNAM VALI Y Tu Bulldi,gType( 1 ) FAM RF.S _Lot Size 1_267 ACRVas Erosion rnntrnl Raen rnmj3lPt- Pri ?VTPq Number of Bedrooms 3 Has Garbage Gdnder Been InstallodY NQc�. Other Requirements I certify that the system(s) as listed serving the -above premises were constructed assent lly shorn on the ans of t he completed work ( copies of which are attached), and in accordance with the standards, rules a regu ions, n ac e i the fi pl a and the permit issued by the Putnam County Department of Health. Date 11/9/90 Gasified by P.E. R.A. Address Ian" No. 1 1 0 5 6 Any person occupying pnmla$ saved by the above systems) shall prom ly to such 964on as may be necessary to sewn the correction of any unsanitary conditions resulting from such usage. Approval of the Separate Sewerage em shall become null and void as soon as a pubt;:' unitary "ww becomes avalbble and the approval of the private water supply. shall become null and void when a public water supply becomes awllable, Such approvals are subject to modification or change when, in the judgment of the�CommisslonR�of Hes , revocation. modification or change Is necessary. By 3/89 I� PUTNAM COUNTY DEPARTMENT OF HEALTH Permit Division of Environmental Health Services, Carmel, N. Y. 10612 COiU'TRUCTION' PERMIT FOR SLWAGE 0lSP6SA_L SYSTEM .__:_. , • . `_ �_� � . • �. • _ _ LL.���, ow •ew Located at yr�\,� / r 02- Tax Map Block '7 — Sykyjylsion dt I (.L—rof 1MP, ,D l Srr. Subd. tot a Building Type dimly) Lot Area it 12(ei rR� Number of Bedrooms N Design Flow C /P /D ©t! Separate Sewerage System to /consist of 10 ®0 Gal., Septic Tank Y To be constructed by � /j T _5F LE C/ -rE J Water Supply: Other Requirements Public Supply From Private S Address Renewal _ 'Date Of Previous Approval Fill Section only [I Revision P.C. H. D. Notification Required y� ��/ } and 4-ZO LP rQ. F LEAC4iW nE Address 1 represent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage dis osel system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and r te a one o e 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 the builder, that mid builder will place in good operating condition any part of said sewage disposal system during the period of two (2) years Immediately following thedate of the Issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed in accordance with the standards, rules and ragu a'� aTro oof the' Putnam County Department of Health. Date L 4 / c: M.4 Signed ��1(,li�i0O �j P.E. �e R.A. 1 Address .V ` P✓ N• ` /to �4 Icense No. �, J APPROVED FOR CONSTRUCTION: This approval expires one year fro t date issued unless construction of the building has been undertaken and Is revocable for cause or may be amended or modified when considered neces y by th mmissioner of Health. Any change or alteration of construction requires ane%w permit. Approved for disposal of domest ary 5 wage, and/ r pri ate water supply only. Oates By Titles -� Rev. 9 -81 A `7 bU I L7r., L io r-4crso t;;.j x;,. Z z H14 4 TOP ROAD -A- Pole 22' CD cc N-,0 jr us Lu Z 92 Anch ozo or Ui o 0 4 32'x" 44' w Ir Ui 49' m at :4 & 44' 54' ' .4 Lu -7 55, 100 UJ I % Ck Ix Well 0) 2' Lu lc, &51 96 -im 0 uju 91 d.. ' OW V., 'aa as 12 55' -Zq VL 14- 4")' 39.' \ m -- - 15 1 45 ' 144 16 142' 141�' 4b ructiam t;oulmy DeparmenT 02 ....4, IL 11 G\_Q 11v1sion of Envirpnmpnt I Health Serftbe, tpprovcd ace notod :or conformanco with ED tpplicabln ifuli3 and !at ions of W fhe Z. 16 3 1'30-W. 4Utn&m County Realth Donart-,:ent. Stone & "'.72 w T). > AS E50 1 LT 1 -5 go 6A L -S't- -reI,A LA VOLIT THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM-WAS CONSTRUCTED AS INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS INSPECTED BY-,ME- BEFORE -IT WAS COVERED OVER THE SYSTEM -WAS CONSTRUCTED IN ACCORDANCE- WnH ALL STANDARD -RTJLES AND REGULATION OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND THE NEW YORK SATE DEPARTMENT OF HEALTH. 4 NIR. & MRS. GARY Gy Fr t4 C (Z- Owner or Purchaser of Building 49 Section Building Constructed by Block WEST SHORE DRIVE Location - Street TOWN OF PUTNAM VALLEY Municipality ONE FAMILY RESIDENCE Building Type 1.2 Lot HILLTOP IMPRO'VPMRNT DTRTRTrT Subdivision Name 2 Subdv. Lot # GUARANTEE OF SEPARATE SEWAGE 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 success- ors, 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 further agrees to accept as conclusive the determin- :_.a.ta thP_IIir.Yc'ti�r:: ©.f:. the_ Xd'vi.si.on..of..:Eni&z..ro imental_H.eal_th of the Putnam County Department of Health as to whether or not the fail- ure 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 19 $ !SSignature Title (4 GC Corporation Name if Corp. OSC_AWAN31 T.AKR Rn AddresspUTNAM VALLEY, N.Y. 10579 THREE:(3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health LAB # _r 2 . r_>c 6561 �.(orktown Medical Laboratory Inc. y - Date Taken: f -/ c -arc- Time: /I),. 321 Kear Street Date Rc' d : i�- - �� - --�� c Time: Yorktown Heights, N. Y. 10598 Date Reported: X1990 L245_-2Baq;_.:.::�r�- .�:z._._. - - -- Director: Albert H. Padovani Mq T. (ASCP) PO /Client }` Referred Sampling Site: A-, 7�,4_r-71 L REPORT ON THE QUALITY OF WATER Phone (2// INORGANICS (mg /L) MICROBIOLOGICAL 100mL Alkalinity _ Chloride CODDer _ Detergents, MBAS _ Hardness, Calcium Hardness, Total _ Iron _ Lead Manganese _ Mercury Nitrogen, Ammonia _ Nitrogen, Nitrate Nitrogen, Nitrite Phosphate, Total Silver Sodium Sulfate _ Standard Plate Count ( CFU /1' mL) Membrane Filtration Method "Total Coliform i Fecal Coliform _ Fecal Streptococcus Most Probable Number Method Total Coliform Fecal Coliform _ Fecal Streptococcus Sulfa:de- .__. Sulfite Zinc Total Coliform. P A PHYSICAL MISCELLANEOUS KEY FOR TERMINOLOGY _. pH (S.U. ) Color (Units) _ Conductance (ohms /c) Odor (TON) Turbidity (NTU) CFU = Colony Forming Units LT = < = Less Than GT = > = Greater Than NA = Not Applicable SA = See Attached TNTC = Too Numerous To Count REMARKS COMMENT For Lab _ se (For Lab Use) - SAMPLE TYPE: (Check One) Potable Non - potable OUTGOING: (Check-Each) HNO HC13 — H2SO4 NaOH ZnOAc — Na2S203 Other: INCOMING: (Check Each) _ ... LE 40C. GT 200C _ pH LE 2 pH GE 12 _ Other: NYS FLAP #10323 THESE RESULTS INDICATE THAT THE WATER SAMPLE &AS)Y (WAS NOT) (NA) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO iii/ YORK STATE PUBLIC DRINKING WATER CODES, FOR THE PARAMETERS TESTED, AT THE DIME OF SAMPLE COLLECTION. THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DID NOT) kNA ) .! MEET THE SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STATE 11 DRINK- ING WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE COLLECTION. ` . / �!��� �i�� -� j j 7/87 (Rvsd1 /90)RWE Albert H. Padovani, M. A , hector /. 5%: in-id S. Dcq,;,, CIO WELL ljU1V1rLtiaL1JN ra!r%JA-1 DEPARTMENT OF HEALTH ajvisi&vw PUTNAM COUNTY DEPARTMENT OF HEALTH office Use Only WELL LOCATION STREET ADDRESS: TOWN/VICLACL1111Y TAX GRIO NUMBER: 4 We S�ofe _104A a 4%_ t1t, /70 WELL OWNER NAME: C West ADDRESS: _efr r 41e 0-f BIVATE 0 PUBLIC USE OF WELL 1 -primary 2 - secondary its ESIDENTIAL 0 PUBLIC SUPPLY 0 AIR/COND./HEAT PUMP 0 ABANDONED ❑ BUSINESS ❑ FARM 0 TEST/OBSERVATION 0 OTHER (specify) C1 INDUSTRIAL 0 INSTITUTIONAL ❑ STAND-BY ❑ AMOUNT OF USE YIELD SOUGHT gpm./NO. PEOPLE SERVED _/ EST. OF DAILY USAGE — gal. REASON FOR DRILLING .[:]REPLACE EXISTING SUPPLY ❑TEST/OBSERVA.TION .[]ADDITIONAL SUPPLY [NEW SUPPLY (NEW DWELLING) E]DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH r:) ft. I STATIC WATER LEVEL oZ _0 ft. D MEASURED -f-/G A-IL DRILLING EQUIPMENT WOTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE 0 SCREENED P4PEN END CASING ❑ OPEN HOLE IN BEDROCK 0 OTHER CASING DETAILS TOTAL LENGTH 1/6 ft. MATERIALS: Q,STEEL 0 PLASTIC 0 OTHER LENGTH BELOW GRADE —*, 5 —ft. JOINTS: 0 WELDED E3-TKEADED 0 OTHER DIAMETER 10 _ in. SEAL: 0 CEMENT GROUT 0 BENTONITE lErOTHER WEIGHT PER FOOT — 1b./ft. DRIVE SHOE. 0 YES 0446-- 1 LINER: 0 YES LINO SCREEN DETAILS - DIAMETER (in) 'SLOT SIZE LENGTH (it) DEPTH TO SCREEN (ft) DEVELOPED? FIRST 0 - YES 0 NO HOURS SEC. ONU GRAVEL PACK 0 YES ❑ NO GRAVEL SIZE DIAMETER OF PACK in. ED&H ft. BOTTOM OEM It. WELL YIELD TEST -'If detailed pumping I METHOD: ❑ PUMPED 1 tests were done is in- PtOMPRESSED AIR formation attached? 0 BAILED ❑ OTHER ❑ YES 0 NO It more detailed formation descriptions or sieve analyses VELL LOG are available, please attach. DEPTH FROM SURFACE ""' Pear. ing Well Oia I meter In FORMATION DESCRIPTION coce ft. WELL DEPTH It. DURATION hr. min. DRAWOOWN It. YIELD 912m. Land SurlaclePlf 3 WATER 0 CLEAR TEMP, QUALITY 0 CLOUDY HARDNESS ❑ COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? 0 YES 0 NO STORAGE TANK: TYPE CAPACITY i1LS GAI.. PUMP INFORMATION TYPE lft%�&IClOic CAPACITY MAKE DEPTH MODEL VOLTAGEjk_ HP !L-4= WELL DRILLER NAME DATE ACORESe Arw&-A TWIGNTuRE ?0461%r PJW&LV1%. Ab iA ()S, 9 "-I* PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY 'OFFICi'BUILDING; CARMEL, "1V.Y. 10512` ' " �. �... _.' `. ...r.0 s .•n �, DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. OwnerraARY r'1::!rMEe__1 Address VLjTt4AtA VALLF �%�_yl IL��S29 iN�ST` 5 40ex- Located at ( Street � 1 y*_-- Sec. 49 Block 3 Lot lo 'Z 4dicate neares cross,s ree Municipality O N Or fuTmAMW atershed jAP.=_50b,4 4UtzQ_, SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number. CLOCK TIME PERCOLATION PERCOLATION Elapse Depth to Wat er Water Level No'. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches ?0�d0 %�� 39,0q- gl,37 to 5 1 2 3 5 6 . 30h.5 - * 1")tes: 1) Tests to be repeated at same depth until approximatelyy 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 H Tiftt No. HOLE NO. G.L. I II, T40 P t I- 611 �3A ND 4 Ny 1211 181'' 2411 3011 3611 4211 48" 5411 6011 66 72" 78" 8411 INDICATE LEVEL AT .WHICH GROUND WATER IS ENCOUNTERED INDICAT E LEVEL , T. 1 WJUCH�WA' ; gR LEVE L, RISE S . A FTER.,BEING E NC OUNTR _..INDICATE: Z ff g 'gZ 7 DESIGN Soil Rate Used Mi n/l Dr o p: S.D. Usable Area Provided _60010 /Sv= No. of Bedrooms Septic Tank Capa C Absorption Area —Provided By_A,eo L.F.x24 Name 6ig ress Joel Greenberg-Architect nature Muscoot No./RFD #2/8x 488 .0 Mahopac, NY 10541 Add S THIS "SPACE FOR USE BY HEALTH DEPARTMENT ONLY: °F N E Soil Rate Approved —Sq. Ft,/Gal. Checked by Date 30', VE"'m JUL 17 1984 PU 9"N A W1 `_'im'U N'71'Y DEPT. OF HEAL H