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HomeMy WebLinkAbout3114DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 63. -4 -2 BOX 25 1 ru jai 1 c, ' .` r til ; . ml ; . � rr , " %I' � 03114 u 7, t r,_ y [ p} y PUTNAM 0 - "Ivin of ,Enviro, TY DEPARTMEJ J- Health Services , Located • at Y L Owner ' ' c ri x :Separate'Sewerage System built by Consisting :of��"C a Septic'Tank�� t ,I� Other requirements `�'' � • L Water Supply. Public ,Supply -From Private .SuPPIy 'Drilled 1�v ' �. ddress. (� Build mg Type �+�1" fi No Has Erosion Control Been Completed? I certify'that the'system(5) asiisted serving' the above premises were constructe< attached) and-16 accordance with the standards, jrules end' regulations plans 99 � yt;L YZ C I..:.L Z... x a Date ; Cer4ifietl by Address Any person occupying premises served byAt i above systems) shall promptly conditions resulting from such usage ,� Approval of the.,,separate.`sewerage s available and they approval of 'the private water. supply i iall become null 'arid subject to modification. or change when; in the,:judgment of the•,Commi'ssi ~Date Cn ` ,Town 6 wr+thile�6 J ry m t , Feet XC 1 {Ip width trench �• as ����r� �CVv 'S ep ps of the completed wor.k,(copies.bf which are is by the .;Putna County` •Department of Health,` m License No ®� �" cti as t ry to secure the correction of any unsanitary', i I _ ad as soon as a "public `sanitary sewer becomes :}}' e pply • becomes available , . Such approvals are S .r o lion; motlification o'r change. is'necessary of Bedrooms ; ;Date Parmit Issued *' ep ps of the completed wor.k,(copies.bf which are is by the .;Putna County` •Department of Health,` m License No ®� �" cti as t ry to secure the correction of any unsanitary', i I _ ad as soon as a "public `sanitary sewer becomes :}}' e pply • becomes available , . Such approvals are S .r o lion; motlification o'r change. is'necessary SACTERIA PER ML. (Agar'plcdte count at 35 0:C). COLIFORM _GROUP, jMbst'probable' No'. %100m1.) _RAN „ "; HARDNESS:; TOTAL - ppm DETERGENTS - Ppm . .. NITRATES (as: N) - .`Ppn?.., IRON, TOTAL =ipprn .. , K .... ai-h�c..... ...,r -v .:e•r -., v+ +e_.G�c -a •:fvL•,n •�+r^^. r- n-.... ,..y r-... .. v-II.-wr•. ...ti mm� -n. ...c, ..� -': v..r; m+�e - :.Hy.M +w•... s?;..•... :�v -v'�wn -s r,, G_I�j Owner . or r of Building Municipality Building Constructed by Section Ci Location.- Street Block Building Type Lot y GUARANTY 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 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. tfl�.4'..•,= .:n= .:.'e�'-Si�� •v�^ '•. it` v'r� u.'' -ac-�+ to accept a.~7 conclusive Lf18 •l].G'- 6 termination of the Director of the Division of Environmental Health Ser- vices of the Putnam County Department of Health as to whether or not he failure of the system to operate was caused by the willfu r Egli nt act of the occupant of the building utilizing the syst Dated this day.of 19 7 Z Signatu Title If corporation, give name and address) 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 // WELL COMPLETION REPORT � PU.TNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Slices COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report is to be complete�i�� .we�l.dril.ler_ Grp_ submitt?, ctG�! I?;; L�rshr��Yi? ,tats;t!�e.r;tbic*i� ;=.:ezti!fi -u a ._� _ ...� ...,._.,,. _ sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME ADDRESS LOCATION OF WEL )s (No. & St r t) (Town) (Lot Number) 1d,4-;;F_ • 11 �7t ct7r� f __?7 • /t3 PROPOSED USE OF WELL /U' DOMESTIC D ESTABLISHMENT El FARM TEST WELL 11 SUPPLY D INDUSTRIAL CONDITIONING (S(Specify) DRILLING EQUIP MENT ❑ ROTARY AIR PERCUSSION PERCUSSION OPe if ) CASING DETAILS LENGTH (feet) ©� DIAMETER (Inches) ��� WEIGHT PER FOOT % "7 ® THREADED ❑ WELDED DRIVE SHOE ® YES 0 NO W�jS CMG UTE ? t5j YES NO YIELD TEST HOURS G.P.M. BAILED D PUMPED ' COMPRESSED AIR , F, YIELD (G.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE— STATIC (Specify feet) DURING YIELD TEST (feet) Depth of Completed Well in feet below Land surface: SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (feet) SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (Inches): GRAVEL SIZE (inches) FROM (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL C PLET %�-� rY GATE OF REPORT WELL D ILLER (S' nature) % r �.--� M., E, R, • 41 PUTNAM--,C UNPY,;40EPT OF HEALTH oy. too D1F�f6TQR- DIVISION OF �:j 4, E, 7 All 30 r4 IS\ I 'Nol iN F. 7� kj 'k- X x, 0 UE f z Srs "Y ? �~ rc r, PUTNAM COUNTY DEPARTMENT 'OF HEALTH " * *V. b" Division ,of Environmental Healih JS, rNices Carme% N Y 10512 CONSTRUCTION PERMIT +0R ,SEWAGE DISPOSAL STEM, u -�� uA SIC/ CT.) Tow I lgq el. r -• r �.: LOCated at r•`. i• itkb 2 ,.:W Section `Block .Subdivision _ —� Lot Job t •� L 2Adtlress ' i ' .Building Type One inn (2.c� l_ of Area • 45 oan F.�- Number -of °Bedrooms bitable Space Square. Feet ' Total Ha a �© Separate Sewerage• System .to consist of ` Gal Septic Tank lirieal feet; X �► width trench. To ,be constructed by 016' Qx I' y1•Q.V', w Add ►ess Water Supply Pu61id.SuPP1Y: From r Pnvate Supply to be `drilled,.by G" L .i Address " Other, .Regwrements - 5r�y ,I represent that am wholly and completely responsiblefor,.thedesi §n >and locitU posed syitem(sj 1)rthat`the, separate.sewage.disposal system above - described •will tie-constr,ucted as•shown on the approved amen dment th_' 166 W ce with the standards, rules an regu a ions o e. .0 nam. County' Department ;of:, Healtti;;andahaton completion thereof a ,'Cyertif' tiil(� pliance ",'satisfactory to.the Commissioner,of Health will 'be:asubmitted to. the •Department And' ''a written guarantee will .6eY•fur rs heirsZfiaisigns by•the builder', that: said builder; will place' in good' operating condition any part of „said sewage disposal ste_ 'Uri fp _, of 0 (2).'years immediaiely,•following the date .of the ,issu ance =of the approval ;of:the Certificate':of Consfruction'`COmplianc f o i ri stem ap ny pairsthereto 2) that ahe'drtlled`well` described above:.' will be located as shown on the approved .plan and'fhat said well will,be wit stanifards rules and`.regu a ons of ,the .P,ufnam t .epart ment•.of ;Health ^.. , :,- ^ ..'._ � ." _ - �� � • � Date �•� � �� � t� ``�' r Sign' 4 - >I1 6"w i • � i`E'� � cif 'i y t �_ P E �tYR.A: f;:° Address w �� w APPROVED FOR "CONSTRUCTI;ON :Th_isapp oval expires onebyearufro ® ` yrt � onstruction he bui di ng hae be 1 C1. Q revocable or :cause or':may be amended or modified when corisideed neces 'jt�ha lQj rer: of Health Any change' or alterationnofrconstructon ..,..: 'r ,.a u requires a new permit.; Approved for disposal of domestic sanitar sews a or a water "`supply -,only Date! BY Title m PUTNAM COUNTY DEPARTMENT OF HEALTH El'rTIRCTMENTATa: =Ia T rnu S�rTrFS,...,r.,_. - -- - -I Date 11 Re! Property of Located at W�3 Section Block Lot Gentlemen° This letter is to authorize M. a duly licensed professional engineer. or registered architect (IndicaTe to apply for a Construction Permit for a separate sewerage system; to serve the above'noted property in accordance with the standards, rules i or regulations as promulgated by the Commissioner of the Putnam County Depa.rtli;2ilt Vf l t5tt -L ll.9 llu VU 8.! 1gn all 11CC:�asa.r'y papers OT1 my 'tJehalf In connection with thi.s 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 Health Law, and the Putnam County Sani- tary Code.. Counters P.E., rm. Address' Telephone (Seal) Very truly ours,,* i Signed ; Owner of--,'P perty Address e ep one ''SOIL PEKCOLATI0.,N1 TEST DATA REOuIHD TO .•BE ..SUE:•ij' TED w'I.TH APPLICATION Hole N�mber CLOCK TILME PERCOLATIO`'' PEP,COLATIO\ Run No. Start Elapse Time Stop Min. Deo _:: to From Ground Sur- L' •ace Sart Stop Inches Inches L e r Level in Inches Drop in Inches Soil Rate Min/i�n.drop t 7L UZ z 1 �D Ac A 4 2_9 'I 6t ( � 3 \O s 14 wA8 z �Z 3 (�11 A4 t o(O 2-Z 3 Notes: 1) Tests to bf- repeated at same depth until approxi -..' %elv eaual' soi 1 ' rates are ob- tained at each percolation test hole. all data to be submitted for review. 2) nPnLli mPa5;L2rp a;Pnts to ha macIa frn-i +nn of hnl n - TEST PIT DATA REO_U IRE D' TO 73 SUBLIITTED :,'IT APPLICATION DESCRIPTION OF SOILS ENTERED I': TEST HOLES `:�CL 42` 48 if , S 4'. M I • ,2 78, 84.1 INDICATE LELTL AT 'VN, ICH GROUND WATER IS E`COUNTERED IN'DI'CATE LEVEL TO WHI C' l j,TATER E�%EL RISES AFTER BEING ENCOUNT -1;�-,Z'q D TS Date TES 1 „ DE; B Y: S ,�,. . L16 j Soil RaLe Used k (o-20. Min /1” Drop: _ S.D. UsaKe Area Pro: i `ed 0 No . of Bedroo"s ' Septic Tank Cap ac _tyf �. �� Type e A yo 4� Absorption Area Provided Eye L..F.x?'` " ,��y t nch. Other f Name 10A CLVS Signature Address L• PUTNAL%I COUNTY DEPARTMENT, OF HEALTH Soil Fate, Approved Sq. Ft. /Gal. Checked b:,. Date 6 _ r` n � CI .I J FFi. EL /00.0 t}SSci„oEO L / ✓c ^.: f; tj ,f � . , :,.. � � -•- pro. - - -- -� 4,_�; - - -. -- —� :; i ' � n '� J � � t / G.>;J " o . iC°.:^ '•/ h / O �� �= %!''c:r7 i i , }lt �' s � — � l ,, �) � � �� Fly /✓ _ _ t � - •I � 1. •'�__ _ ..._ .__- -_ — '---�_.__� 90 h '� ✓O ' F, i< .3lv "•t7�S 7:E? ,g00 ",SO.!/TF/ Of C, s� / %/G'.�N'q,� -Y !� f } 1 0 '' f P.�E OF NEw y SEPARATE SEWERAGE '.� SYSTEM i .� OWNER: G' �Jc APPROVED — — i LOCATION: pin a SEC 9 BLKrL0T3 _ y i 1117•!Y 9 CF ?JF No. NO TRUCKS .MACM•TNERY.BU:ILD,ING MATERIALS NOR EXCAVATED EARTH SHALL' BE s 1972 CONTRACTOR: ALLOWED IN-THE-SEWAGE DISPOSAL''' AREA, CONSTRUCTION OF THE`SYSTEM IS — bt TO BE I -N ACCORDANCE WITH THESE PLANS ANY REVISIONS THERETO ((A�ND THE j r+rtnae+ couMn uEVt• oc nu�� RULES AND REGULATIONS OF THE PERMIT. ISSUING GOVERNMENTAL AINCY. i o mrom or ° :� DOLPH ROTFELD ASrOC1ATES �¢JYTN. AS BUILT PLAN: SI2 MAMARONECK AVENUE.WHItk- PLAINS.NY ' Qc ! + 97 i it t a Y' ' C t 8. P rv�a.r :- •iai- ...tk��. ,.c r .�s ..u.- ......v��r -. r. PUTNAti1 COUNTY HEALTH DEPARTMENT (JVISION OF ENVIRONMENTAL HEALTH SERVICES - -- .-�•, =� .: ..,,. >..::.a:.- Internal Use Only ❑ ® Repair Permit issued in last 5 years' ❑ Not in Watershed ' ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated ❑ Repair within 200 ft, of a watercourse or DEC - mapped wetland Joint Review SITE LOCATION V TM # r OWNER'S NAME /� Cl �� PHONE # -� MAILING ADDRESS �3 woc1 S/ APPLICANT J � (� Name & Relationship (i.e., owner, tenant, contractor) DATE /� G / FACILITY TYPE ��`S PCHD COMPLAINT # PROPOSED INSTALLER,.. 'J��ea /' C PHONE # 1 j�fJ� &11V0 ADDRESS r �e . r% REGISTRATION /LICENSE # ! V Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed trenches) NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location and proposed pump systems will require submittal of proposal from licensed professional engineer or registered architect. Pro I, as owner, or reported nt of wne , gre to the conditions stated on this form (pe(�L✓ SIGNATURE TITLE DATE l �� Proposal approved with the following conditions: 1. Procurement of any Town Permit, if applicable. 2. Submission 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 components tied to two fixed points d. System description (e.g., 1250 gal. Concrete septic tank, etc.) e. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and condition Pr osaI Approved Pr posal Denied o In pector's Signature & Title Date COPIES:. White (PCHD); Yellow (Town BI); Pink (Installer), Orange (Applicant) PC -RP 99ML Rev. 8/05 SIHRLITA AMLER, MD, MS, FAAP Commissioner of Health Associate Commissioner of Health May 17, 2007 Evans Septic 162 Barrett Hill Road Mahopac, NY 10`41 Dear Mr. Evans: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE - Director of Environmental Health Re: Repair Permit — DiPasquale 283 Wood St. (T) Putnam Valley, T.M. # 634-2 Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. The following was not submitted with your application: 1. A comple':e sketch showing the following: - House Property lines - All adjacent wells within 200 feet of the repair or a note stating no wells within 200 feet oxist. - The location and type of existing and-.proposed t er�i ii s... _.._.. _'' _ . ...� :: ---_. - 'Y' -2.` 'Tb6pr6posed;secti6n on the permit needs to be filed out in detail, clearly stating what system is existing and what is being proposed for replacement. 3. The lot is in the NYC Watershed and it appears that it is within 200' of a regulated NYSDEC wetland. The application can not be approved by this Department until it is forwarded to the NYCDEP for review and approval. Upon receipt of a submission, revised to reflect the above. comments, this Repair Permit will be considered further. JSP:kly Sincerely, Joseph S. Paravati, Jr. Assistant Public Health Engineer Environmental health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Far (845) 278 -6026 WIC (845) 278 -6678 !Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 Fax:914- 773 -0343 New York City Jun 5 2007 11:20 P.04 c.'t�r� +:ad��.v.-.r_r.:^c,a. -.:. tiro* al. o+!!1'3.�-�:.o'�a�— �.9ar.✓:veN Environmental Protection �O.ti,�E+V7AL PRO��� SUBSURFACE SEWAGE TREATMENT SYSTEM REPAIR DETERMINATION Pursuant to the authority granted under: Article 11 of the New York State Public Health Taw; Rules and Regulations For The Protection From Contamination, Degradation and Pollution Of The New York City Water Supply and Its Sources, 15 RCNY Section 18 -38 (or Chapter 18); and 10 NYCRR Appendix 75 -A Wastewater Treatment Standards - Individual Household Systems. DEP Project# County Repair# r Q it -.. of Site Location: 3 t,),A 1 T.M.# _ 2 / ce Reason for Joint Review: 1/0 TaLCLo� .(A Drainage Basin . 200' of WC/Wetland Repeat Repair in 5 Yrs. Name of Owner: Owner's Address: a �,'� �yv�( S �• Drainage Basin of Project Site: Installer: Kr General Descriptions of Sewage System Repair: S f t kl et,_, (n., 5e. wA- a.r 4114 Dates of Site Inspections and Soils Tests: Approved *In.complete Delegated * *Denied *Required: Soils Tests Repair Sketch WC/Wetlands Wells Other * *Reason DIG a wade by: �r- Engineering Division Date G 1 ,i i V .:x }+/. �y f �:jV, r .? `t I � �,•. PUTn' �DIVISIC : - Sheet of i OF HEALTH Ke FIEL_ "D ACTIVITY REPOi2xT ' �, �k���.L i�i£,.��'3+. HA.� :r:� YC•iC c.� 4, �:��, ..-ns 1^Rq 4 - A�'Yy.:i �'�.'1..w ��G - ��. Lq.tU� CHL'N`i ui'. Lj'1�= � ^�'�a.�.. i.� ?`_Z8•F i�,�.#'t".J Street Town ';State.' :Zip PERrSON wIl, ,CHARGE b= / 7 a }QR SiNTFR (ITFUVF +n; .. "nafe Name and.tle �T,YPE SOF�FA;C•II.ITY ° - ;� f "���'�,�• - - � .� F T NDI NHS '� %04:01 s,^.. k _ _ 3 ..., _; .. jam Signature,. an acknowledge receipt of this report: SIGNATURE; 196„ _Title LeV.'' � ,' �� ` •rte .. _.;, ,Y- :.�..����•�,;;;.."•— ._�'.: -• _ .C.p' - ,� 3• � D . .. .�. •;'� ' tee,' r - `, �'�4 , .. - -: �. -" 1 - �� 1 - _� a i-•��10 .� '••J.. : ..y ''•• 'r ..:�,I .; :. rte' ''I N .f. .. "a '.�� •Ol' p0�4ed� 1' rr ou Ij f" ^ —/7.a /!0% "9 )�I. .YV. •."'/'V ^. ��L� �• 's./h `,.. �'59�'rW �• '�' .t Y,: 'T.O' °,$#•._ i .. 1;� Y�PJy E %v7 ��'.'!'�'w /'�' =. �C7�",�/.r".i�',�•_'�• I' .a��' �` - 'i': .�'T 7r'• \� .. I.y{ •N' ..r•.i 4."'. 4•. l r �G t'1� �' ' r•4 . .r w� i. ',art .te j%O •'r'• s� 3. .TM 1.. •I• a +1 !1 1 A f t; I � g' 4 •l i C. r• "h r , 't r. • `•p:. n. t . u Y �,r s` .s e' w \t: t •s ' 1• t4 .je