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HomeMy WebLinkAbout3201DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 72.19 -1 -14 BOX 26 fT� ! Ir y �� T V: �T I ��� 1 . ' k, 03201 TUTNAM .COUNTY DEPARTMENT OF HEALTH. ;Pe:mit.1 Divkion d Environments/ Hea /th Services, :Cann% N Y. 10512 Y CERTIFI TE -OF CONSTRUCTION COMPLIANCE.; F..O.R ;SEWAGE DISPOSAL SYSTEM_ Putnam Ualle`y Town oa Village .: Sprout. Brook Road .-v.a, .•.w�1ZCC'�.Li� _ �.�.•_...� :,.. .-- �,'..- �...�:: - -s= -- �"=_•- .- .�.Tc1F..A1HT' � B1eCY •4...v�.`�.:.. •..w <uu•�u Owner Keith Bobo 1 i a rl. Formerly Tax Man Lot a. 14 subd.. rot a Sheldon G,ar.dner,. Stevenson Ave.;:Peekskill.;NY10566 Separate Sewerage System built 'by Address consisting of 1000 Gal., Septic Tank and.480LF of 21=011 width trench Other requirements Curtain Drain & Frill. Water Supply- Public Supply From, Private Supply Drilied By xxx Norman Anderson Address Rargor, StreitTpuhn,am Val ley, NY "10 E' g Building Type One Family Residence No.` of Bedrooms 3 Date Permit issued 11/30%84 Has Erosion Control Been Completed? I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plan. of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulations,-in accordan with the filed plan, and the permit issued by the Putnam County Department Of'Health.. - - - Date 324486 xx ce►rned_by` PE. R.A. AddressMuscoot No RFD #2 x . $8 M opac NY10541 icons. NO. 11056', Any parson occupying Premises served by the above system(s) shall promptly t ke s ch acti as may be necessary to secure th� correction ,of any unsanitary conditions resulting from such usage .Approval. of the separate sewers ge sy a ,shall come null and void as ioon as. a ubUc sanitary sevrer becomes available and the approval of the private water supPly shall become null and void when • e public water `supply becomes available. ` Such approvals are subject to modification or change when, in the judgment of the Commissioner of Healt such revocation, modification or change is.necessery. Date By Tatty Rev. 9-81 M ©llr1l T ,6060 1,14 Owner or urchaser of Building Section f�rr ,(06041 Building Constructed by Block X/0/ ?0tc7— aiP00-f- /�J Location - Street Lot pt4r419127 11111, <d (l i0.s'7 g Municipality Subdivision Name Building Type 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 accordanc.,e 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 at 'ar :; f,;�the',_ Dire:c.tor:. of the Div.is`lon of- Environmental Health S_ervi.ce.s 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 � 19d%o Signature �? �✓ �- Title T . G &hX&V'alR Corporation Name if Corp.) 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 PUTNAM COUNTY VEPART ENT OF. HEALTH 3/71 Division of EnviconttMdtal Health Servips COUNTY OFFICE BUILDING • CARMEL. NEW YORK• This report.is to be completed by welfl•;Iler andsUbMitied to County Health Department together with laboratory report of .:. l.k:- .•w- :�•i'�-- ,r•::... '+r• a �.Y r'l.. •sees.. �rnfy`sls of wafer is 519 ii�d i 3fin�= ti�h igYo� s Cisiiactory= bat; teriel --gLi;litV�oefose'cortifi atv;acohstruction REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION NA AooRESs OWNER ' LOCATION (No: 6 SuSue ~) (Town) ILof Nunlb9rl OF WELL BUSINESS 4. PROPOSED DOMESTIC 0 ESTABLISHMENT FARM' TEST WELL USE OF PUBLIC AIR WELL SUPPLY INDUSTRIAL El CONDITIONING (030• ER ) DRIkLING COMPRESSED CABLE EQU ►MENT ® ROTARY: DAR PERCUSSION PERCUSSION. D �Sp.ly) LENGTH (/det�-�-- DIAMETER(Inches) WEIGHT PER FOOT t:A� CASINO (� DETAILS a+ ` `„ L 'THREADED ' ❑WELDED ES, NO yes NO . ,). -HOUMS G.P.M. TIRLD - YIELD SAILED, TEST , D PUMPED ' �J COMPRESSED'AIR. .• ��. ,. � _:. WATER MEASURE426M LAND SURFACE- 3TATIC(SDec /1Y 1sv1) DURING YIELD TEST 1bN) pdP of "Compbbd Wall LEVEL In feat below Lend wrfeoR: �Op . MAKE Opt" E 00#0 LENGTH N TO AQUIFER ' •SCREEN ,:: sees � : `,. .. .. .. IF GRAVEL Diameter of well. including, DIAMETER ) /NIJ TO (0091) :: „'DETAILS SLOT SIZE :- (Ineh�s L SIZE ( a) PACKED3 gravel pock (Inches): otrT� 46M i�ND SURFACE Tact row I w(M eletMeN, to at west FORMATION DESCRIPTION Sr9rce • ~FEET to FEET --two permanent la ... . _ sees.. �.. .. � .. �,...... ... - �., sees... ....... � sees. sees sees, .. . If yield was tested at difFiiisnl depths during drilling, list below FEET GALLONS PER MINUTE DATE El CO DIETED GATE' OF REPORT �ELL'O R '(Si9 u // II :: P sees. . .. sees Yorktown Medical Laboratory, Inc. LAB or 321 Kear Street Yorktown Hcights, N. Y. 10598 Collection Station Used: (9 14) 245 _ P 3203 Carmel Peek i3 s ill l�a`c3"ovcni r- ' Date Taken: 3/,/Rr, (1, CHRIS BOBOLIA Date Received;�Z41R; SPROUT BROOK ROAD. Date Reported: 1 /6/R6 PUTNAM VALLEY, NY 10579 Collected By: r- nnRpLIA 739 -8602 Referred By: CROSSROADS PHARMACY L _ Sample Sourc e: KITCHrj TAP! LABORATORY REPORT ON BACTERIOLOGICAL QUALITY OF WATER GENERAL BACTERIA 'V Standard Plate Count per 100 ml. (Agar plate @ 35 °C) MEMBRANE FILTRATION TECHNIQUE (MFT) Total Coliform oer 100 ml. d Fecal Coliform ner 100 ml Fecal Streptococcus per 100 ml MOST PROBABLE NUMBFR TECHNIQUE (MPN) Totn.l,__C_olifor,m: RESULTS INDICATE THAT THE WATER SAMPL ..jg1j. Index per 100 ml Fecal Coliform: MPN.Index AT THE TIME per 100 ml OTHER ANALYSES THESE RESULTS INDICATE THAT THE WATER SAMPL (WAS) AS NOT) (NOT APPLICABLE) OF A SATISFACTORY SANITARY QUALITY ACCORDIN E NEW YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Albert H. Pa ovani. M.T. (ASCP), Director LEGEND RDS = Recommend Disinfect - ing Water Source < = less than TNTC = Too Numerous Too Count ­,PUTWL Oqvfpon, L,qvT _&WT -,"RU ION PERMIT - FOR ,SEWAGE ,DISPQ ou t br� 13r-oo zi9d� o m m� . ubdivision 46n-tin ' al NU : : 6 b ol 1 a '9,,7_18jHE0N,!Xiv uilgng Type cil)�; ,__ F atnLYR A S Lot Area Nbmde'e'ofjB6&06m­ s 3 Design - Flow c /PiD Sepa rat e—'se'werage System­to consist .6'r, h 100 To Owner, �IWater j 's- Vpp I y Z 7 Public Supply , -From ,,,.L zXX �Wafia� Sup-�Iy,td,` �p be" drilled-'bv Bar " S t Curtain e Ordim, -' :aftc that 1. am wholly` -and completely 3esponsible for 1 above -Sh w h- the -,a �- _6 r 6� County Depaitment of ,Health 'fend that on- completion th`i ;diicribed , e'�Jfruct d a�i, 6 - +hjj'r r% 0- Im nental 1.44, 05a % Ll' SYSTXM­­�,7 'Town pr,-rollage.- 4� ap ,T 1wj Lot l4 x455 Renewal' lb: .iteAsion i'b -Of FreVl:?US Approval -7m - Section :Ong T oi, r P C H:I i �,-Notification Required Gal 48 6 -ahrl of .-Libach ncr:= r tk e_nch Zk -7 ;Address Orman r —a IA:txlolti aiue­v 7, Y 1,05_66 A Bank 2� f n design and location_ of the proposed , t sy$efti(s)'_j):'that the separate sewage; disposSl, system' cessors- °'heirs or assigns by: the builtle thatsild -builder wili .any repairs thereto 2) ttibt the:drUled:w'ell described above: ° { ........... V t e.' build hig 'h4,, t been` undertaken and �s Drier' of =Health y c6nge-o I Titie PUTNAM COUNTY DEPARDEW OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL va= SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS ;r FIELD INSPECTION REPORT _. DA J Y..- J• =l..i r:T.:rT u. .. .emu. .� -. -- v?.: rv�_.a.^.- .r:si'.'.T:Y.i -:' "t: �FS'..:�. •-•.. (."Y :J..II -f T. .._ -. .- ... .. �Ot-i A P Rom (Name of Owner) (Street Location) INITIAL SITE INSPECTION YESI NO I COMMENTS Wetlands on /or proximate to property .............. Property lines or corners found ................... can estimate house location ....................... Willdriveway need cut... ....................... Must trees be removed -;note these................. Deep holes representative of entire SDS area...... Additional deep holes needed...... .. ...... Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacent wells /septics ............................ D.H. 1 Lot Depth to G.W. Depth to rock — Soil Descri 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. D.H. 2 Lot Depth to G.W. Depth to rock Soil Descri tia 0 ft. 3 ft. 6-ft. 9 ft. 12 ft. D.H. - Deep Hole G.W.- Groundwater D.H. 3 Lot Depth to G.W. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. Soil -10 DATE: 1 2- S -S� 12 FINAL SITE INSPECTION INSP.BY: YES NO COMMEN'T'S House SSDS located per. approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... ✓ Roan allowed for expansion trenches .............. c-cc. Over 100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded.......... .............. 10 ft. maintained fran property line and 20 ft. fran house... ........................ Distance well to SSDS (ft.) ...................... Number of bedrooms checks ........................ 1- Stones, brush, stumps, rubble, etc., greater. than 15 ft. fran nearest trench.. ....... .. 15 ft. of peripheral soil horizontally fran trench ..... ............................... , 4�T geoL ►� Boxes properly set....... .......... ......... Could surface runoff from driveway, roads, ground surface, etc., channel near SDS area.... INr, I I I Does lot drainage appear OK in area of SDS....... **'*** I I,-� GRADNG OF SITE ACCEPTABLE.. ...... mss, N, �uj r PUTNAM COUNTY- DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES F v= .r�t� -e _.. ra..:,.._ - ....z.__-.e. -:. >x M -.i � ::m +'.- ar's.._s. s. -�. u...w..s �...rr .:.:j ir.''7� ;:+n`•._= ._�+. -•� _.:: rig.;.__.. _ -.. .. .. >.c,:.•w. -fit _ _r- ..... sa.�t.r....:s...:i.;,i:.- :�v,.: ;,->i.:. <..:.r Date 10/29/84 Re: Property of Keith.Bobolia Located at Sprout Brook Road. (T) 77 Section - -- Block 1 Lot 14 Subdivision of Map 14 of Continental Village Subdv. Lot #__ _ 45_____ Filed Map # 372 -T. Date Gentlemen; This letter is to authorize Joel Greenberg a duly licensed professional engineer or registered architect XX (Indicate to apply for 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 _.syst.em or- systems:.: in- conformity -with the. ;provisions of Article 14�_ a:r_ •, 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersign P.E., R.A.,. Very truly yours, Nluscoot North,RFD #2 Bx 488 Address Mahopac,N.Y, 10541 (914) 628 -6613 Telephone igned �;• Owner of Property 978 Pheonix Avenue Address Peekskill.,N.Y. 10566 Town 737 -3333 fiW Telephone f•G/ 291984 ®E�� coujv ry I HEALrp§ P.UTDIAI`l COUNTY DEPARTMENT OF HEALTH DIVISION OF ENV IRONIMENTAL HI ALTI _SERVICES _ . ; COUN'T'Y OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE 140. Owner Keith Bobolia Address 978 Pheonix Ave., Peekskill. N1. Y. 10566 Located at (Street)S rout Brook Rd. Sec. 77 Block 1 Lot 14 ( In ica e.neares cross street) Municipa lit y_Towr _. 6 :Putnam Valley Watershed Hudson .- River..:,:..;. SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH�APPLICATIOTTS .o e Ilumber CLOCK.. TIMR PERCOLATION PERCOLATION Run apse Depth to Water Water Level. No....:.. Time From Ground Surface in Inches Soil Rate Start -Stop Min Start Stop Drop in Min. /in drop Inches Inches Inches PTH #1 .1:. 9:45 _iO:'15 30' .15 17.75 2.75 30/2. 75 =11 2 10:19 10:49. 30 15 17.75 2.75 30/2.75 =11 3 10:53 11:23 30 15 12', 7 75 30/2.-75=11 # 5 _ _PTH #2 ' 1 9:50 10:20 30 16 _ _ ._ .......19. _. 3 30/3= �0 - - -• -_: ;: >: : - 2 10.21 rn C1' 3 .1 ni4 in 3 16-S2 11c.22 30 16 18,75 2.75 30/2 75 =11 5 �A6%,� 3 Apv2 POTIVAM 5 - OF HEALTti Tdotes: 1) Tests to be repeated at same depth until ate roxiw_itelyy equal soil raves are obtained at each percolation test hole. All data to Le submitted for review. 2) Depth measurements to be trade from top of hole. TEST PIT L : _'i? REQUIRED TO- BE SUBMIT= WITH APPLICATION DESCRIPTION OF SOIL: ENCOUNTERED IN TEST HOLES DEPTH HOLE NO DTH #1 HOLE NO. DTH #2: HOLE NO._.._ • .. -L.•' ..•ry'nT..vi h.. ... .Y ... _ . .'�. .. .- .ate_ .. -v r-. ii _ ,F'. �.'�.����C� �.�u. . :.. _I- -- .. 'ft _.r � r.. .. ..- .' - < -.. G.L. Top Soil Top, Soil 6" Clay. Sand Clay, Sand 12" &•'Stories & Stones . n n 3011 , rs V'� n n n n 54 n n �� to 11 60;, . �� II 66'! 72,. it 84" ITMICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED.- 2 -0 ITaiDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED- -.2 -0 TESTS MADE BY Joel Greenberg Date 8/29/84 DESIGY Soil Rate Usedll -l5 -Min/1 "Drop: S.D. Usable Area Provided 5 , 000 SP. 7:, No. of Bedrooms 3 Septic Tank Capacity O Ga e Conc. Absorption Area Pr�ov dream By 480 L.F. x24 2- rent 7' Curtain drain. and 2ft. of Bank run fill \ �PyaR RrFy I ai7e Joel L. Greenberg Signature _ Addres's'Muscoot N8-rtl, RFD #2, Bx 488' SE Mahopac,N:Y. 10541 A THISL ;SPACE FOR.:. USE` BY HEALTH DEPARVMNT ONLY: oLPN E% SoilRate`.Approved Sq. Ft /Cal. Checked by 0 *II -I. -. _Dome . I "I 4�) . . .... Q7 CLS15I,I FILL lufty"nIbm P4pt.-AL me-h� a L IN '3,W1 4 tti(1. -171,, 5 51 . " "41. I Wt� JJ 44 e;, Z,4� Q1 k go 41 E W A G F _ - _ D I F 0 A L.. SYSTE M ' LAY")11,-JT Pact, G N—a 51 . " "41. I Wt� JJ 44 e;, Z,4� Q1 k go 41 E W A G F _ - _ D I F 0 A L.. SYSTE M ' LAY")11,-JT Pact, G