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HomeMy WebLinkAbout3217DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73. -1 -2 BOX 26 1 rm 10. so I is 0111 Owl , , Lr ly is r 0 rill Is r Is M. 61 v 03217 -i —'11 a. i _,k,�rt � �✓ r Y y � f y Z � � fi t.. _ - ..,�. ---� r �� �VINAM COIIIiilY DEPA_ Nl OF �ALTB . • D k �eDI. d _ 601116 h Sn N.Y OS � Co NS1lIICifO , I" "WA(iB 102MOS" SYSTEM. r ._'i' J 1 � - .I'.. �.. -may ..Y- • - - -•• _. ... .. i y s+ -.I... as-n ey haeed at 4 ice'% l� . r �i /'7 [1 c1 d' owa u , Sttbdlvide� Nttoe` d d !YJ /� �, Let f Tax Map %3.'/ / lo. 2 ALIPIPI Nnsp _7 Date of Approvtl y . Maw Adb000 X Town Date Subdivision AAproved Fee no ose Amn„nt O O CG ,iyw L,t FMtI s«aoe oar Dew v Naat+ber of Hedmem 3 DWV Flow P D e l �U PCHD; NotlBistioo V geuubed VYtieb' FIO b completed S"Ons" Sfworw Systems to o•ati d se GO= Sepde Tick asid 13 1-3. To' be;eanNncted by Add ren watetr Sttppb: Sappy Ptias - Add[ae ott �PAvaoe S77 br DelUed by l%J. '00 / /�1.1 Otber 1�ba>hemeats I represent that 1 am wholly and: eompNtety rasponsi0la tp tM design, and lion the proposed systsm(s) .1) that the separate 'sewage. dispOYl t stem above d•acribed will be constructed shown;gn the approveo amendment thereao n ' nee witliaha standard rules regu of o ,. • nam s. County Do of ss•illtli, and that on'completk►frthereof a'.•CMflkat o r plliWW' satisfactory to the Coinmissioner of Mealthwill be submitted to 'the Doper mmt and',a_ written guarantee will bs `furnis6id s;' MNS of assigns by the builds►, that Old buikW will Were• ,in goo0.opaating conditbn any ,part of, said saws", dfspoYl Watt 61B tt) years Immediately following thMgito of the issu- ance of 'tM" approval of thi`.Cortdic to of Construction;Compliance o/: t ' sYitsin' Ira tt�eto- Z) that the drille0 wat described abaft wql M loeatad as Yiowh gn.tM app►or•0 Plan and that said will wi1PM'Institl io vv limards; .rules and reguToni of trio Putnam County'D i► maM of ""Ittr. OL Data 4natl " P.E. #' R.A. /S Addrssi /J License No APPROVED FOR.CONSTRUCTION,This approval expires two ywr .fr h struction .o the euiId .has been undertaken and is revocable for ca or sy be amended or mortified when consider' n -. b ,. r of ;HiaRh. Any chinas or. atan of construction r•Ouinf a mi proved tor: disposal Of domestic saMt ►y ap, /or_. a `ly only. Rev. 1088 Data L er Title V/ PUTNAM COUNTY DEPARTMENT OF HEALTH ,..r � ... ,_, .i. - •�... _;eC.- Rte' +moo v � .z� .: •w.. �M �,,1: _ � n►1�m-rL�� -�..� 2.a ��:.. -y.... �« w... �_ _ ... CERTIFICATE OF CONSTRUCTION CCOMPLIA /NCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at /3.Y4-41 Town or Villagew Owner /Applicant Name gellw/J Tax Map ,%Block Lot A Formerly Mailing Address Subdivision Name No » /10 /41'0 1-5aa' '%36 a�sC.. vyP0 a Date Construction Permit Issued by PCHD i93 Subd. Lot # 2— ,/1a►7, % ;der � Zip Separate Sewerage System built by �! j? ���" A'.vv Address Consisting of ° ° Gallon Septic Tank and /�� �D� l +� %�i e e-,.7 t7 ,t" -,7 '► t vs' ��. ¢-,ter. r � Other Requirements: r 0: �, /3 . �•^a ��l �% Water Su®oly: Public Supply From _ or: ✓ Private Supply Drilled by At' 14W 0�- -se-z7 Address A 14 Address _ -- .. _ .. Biutding i ype _ % %L�i Has crosion control '[;Geri i uYiil)iCtCi ? - - Number of Bedrooms 3 Has garbage grinder been installed? /6/a O I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: �J � Certified °F P.E. R.A. w�� �k `� �i Professional) 2 % 7Z J. Address ,� � /%� arm _ � . . ✓'� - - -- Any perso occupying premises se z , ti ystem(s) shall promptly take such action as may be necessary to secure the correction of any uns t�cs� s resulting from such usage. Approval of the separate sewage treatment system shall become null and Vol as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, mod' anon or c his, ecessary. By Title: Date; �� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Desi Profe sional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE Ti ATMEN`Y"SYSTIN . ? :. •. 2— Owner or Purchaser of Building Tax Map Block Lot I� Building Constructed by / Ch N roll Location - Street Building Type TownNillage Subdivision Name Subdivision Lot # 21 I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that. is 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 for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment 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 Public Health Director 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. :3 lay / Year Si Dated: Month � 1 Y � Signature: General Contractor (Owner) - Signature ,00c�*l 0 r^evp A `rJ o Corporation Name (if corporation) Address: e en State H �� ` /L' Zip / Title: O W17 e,,,- Corporation Name (if corporation) Address: /� el /5- r -A 3 G State Gds �o ��� 0" L Zip Y // 7 'Form GS -97 11AR 15 6 ii:4,i F P 0 N Y11L o w PAGE 81 YML %JRRNaENJAi,, �RVICES Yorktown Heights, N.Y. 1054e - w . P ...�I - .�� -yYS._ �. asy�.�c:.. -.__.a .v �:9!S6 A•n�vs.+4 "'r..�P�a..Yl�. � � -.. .. �• - .. _. .. .a���A'.Gty. v_-.n.•r. -fir >Y r Wr.'w�..�. -�f.e �.. �a i+� .+is �..1.rr w.-+� abovahl, D it'ectc��'; LAB #i 8'7.:3054C15 CLIENT #: 2670 ADORNCi'. RALPH BOX 486 FUTNAM VALLEY . NY '1057Y MON STAT PROC PAGE 1 DATE /TIME T AKEU : o3 / i 1 /98 11 a opp. DATE /TIDE F%EC ` D : 08 / 11 /cF8 1 F: 50A REPORT DATE: 0811-*19/95 PE-i!=tNE : '. 914 )-526-3005 Z^ �_,.: Jrr,4},j ;w,.,.. - +. 1'1! !.1' L:4: P . p'!'1TASLE. SA !,;PL I NC T.E : 'r cais CfVRI -;k y n' : j' 'Y _ PRESERVA f i VES : 13'r', ,TUNE ADOFiN',.a' TEMPERATURE...., ti 4C NOTES. ..., KITCHEN TAP COL IFORM MELETH: MF .�Nwen'vti�—r—•vr•v —.V- --------- --- tY ----/ ---- ---- +r rv.r.+•�.�ti+�w NNM Mf •+•�/Nw.W .r ry rr'r pNNN pIf't4NN !%,A-r7 FLAG PROCEDURE R ES UL T NORMAL - RANGE METHOD . . PUTNAM CNTY PROFILE 1)3/11/99 LEAD (IMS) <1 ppt) 0 -15 opb IE'345 43 /ii /48 NITRATE NITROr O.EL MG /L 0 - 10 9134 rib /11/ ?B. NITRITE NITR ©G 54.41 -MG /L N/A 9146 tj3 /1 1. /99 IR13N (Fe) d0.06f) MS/- 0-0.3 Mg /1 203.7 U3 / 1 1 /ge MANGANESE (Mn) Q . £)�r,B MG /L 0-0,2 mg / 1 5437 03/11./'i8 SODIUM (Na) 9.71 MS /L N/A 1,3/11/98 pH 6.7 UNITS 615 -B.5 9045 OS/111/98 HARDNESS . TOTA:.• 134 MG /L N/A 05il 1 /98 ALKALINITY (AS 1EE MG /L N/A + ?c : 1 1/92 TURBIDITY (TUR <1 NTU 0 -5 NTU 03i11 /9e COPPER (Cu) <0.05 M6 /L 0--1.4 mg /1 2037 ;:,r7Mf �NT3 Fix TO 526 -344'i COMMENTS Prb /Cu LEAD i,:mits for public schools are set at 15 opb. EPA Lead & Copper Rule for Public Systems requires that no more than It % of their distribution. points have. a LEAD valtAe of more a >i_•,n IS ppb and a COPPER value of , 1.8 mig /L. .else water treatment must be undertaken to reduce the waters corrosive pa ten t.;aI. a Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. Na No :imits for Sodium are proscribed. Suggested guidelines skate that. for people on a sodiLtm restricted diet,the water Should Won�:ain no m:;-e than 20 mg /L 1if Sodium. For those or! a moderately restricteA di t. a matsiMum of 270 mgiL of Sodium is su99s=t-e SUBMITTED BY. .P.lber' !?. Padl�vani. M.T. (ASCP) D i r ec t:c r` ELAP# 102E,9 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: - - dLjr Town/Village- LL /I ^� Tax Grid # Map% `/Block Lot(s) Well Owner: N Address: d�no. Use of Well: 1- primary 2- secondary esidential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing ><Open hole in bedrock Other Casing Details Total length `ft. Length below grade % IF,". Diameter in. Weight per foot alb /ft. Materials: -zt Steel _ Plastic _ Other Joints: _ Welded cThreaded _ Other Seal: .L Cement grout _ Bentonite Other Drive shoe: >c Yes _ No I Liner: Yes x No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _Pumped Compressed Air Hour Yield '5- gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet Well ]Log If more detailed information descriptions or are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface o-r�r�'�✓ If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type i s Capacity S Depth s Model :�iT /0 - z �- Voltage 230 t/ HP 1 47- - Tank Type k4We- / olume /7­6 � S "o Date Well Completed Putnam County Certification No. Date of Report Wel tiller (signature) 11 NOTE: lrxact location of well Wltn aistances to at least two permanent/ranamarxs to be proviaea on a separate sneevplan. Well Driller's Name �-Z, Address: // ;&� '.. el Signature: Date: 3 �l d' % -- White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller > 0 .1�2 Form WC -97 ^' YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 ;245���0�—. Albert H. Padovani, Director LAB #: 87.305835 CLIENT #: 2670 NON STAT PROC . PAGE I ADORNO, RALPH DATE/TIME TAKEN: 02/16/98 12:30p � BOX 436 DATE/TIME REC'D: {) ,16/98 12:30P P|'Tm�! i v4LLEY, NY 1059 REPORT [)ATF, 2/19/98 �HOHE: (914)-5r'_* 6�3C0� 6��p' Tw6 STTE:~CHURCH_RD. PUTNAM �ALLEY : COL'D BY: JUNEAbORNO NOTES...: "ITCHEN TAP ' DATE FLAG PROCEDURE N.Y. , .: PUlA8LE PRESERVATIVES:, NONE TEMPERATURE.".. < 4t COLIFORM��METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT ' NORMAL - GE METHOD 02/16/98 MF T. C LI||R` ABSENT /100 ML ABSENT ` 1008 COMMENTS: BACT THESE _RESULTS INDICATE THAT THE WATER (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDINHE NEW YORK STATE AND EPA .FEDERAL .DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED,:AT THE TIME OF COLLECTION. ` _ MITTED BY: Director ELAP# 10322 r:" �:.: r. �r :.v.•= :.i.6sfr�:�o-::c�`A...:w. a+- z >.�.;a„���:,%i:�::�:_,�`f...�; . . DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Gentlemen: BRUCE R. FOLEY, R.S Acting Public Health Director Re: IR, WOVI&A Residenc / ZqT orf (�urch d Tax Ma 3 (`� P 7, Town u k According to records maintained by the Town, the above noted dwelling IS NOT in compliance with ToNvn code and the total number of bedrooms on record is-J Zz T_• This information has been obtained from: CERTIFICATE OF OCCUPANCY: ,tea i ASSESSORS RECORD: OTHER f a>^ s Building pector BRUCE . R: FOLEY; R S. M ~Acting Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 August 26, 1996 Mr. Frank Sullivan 2972 Ferncrest Rd. Yorktown Hts., NY 10598 Re: Proposed SSDS: Adorno Church Road . (T) Putnam Valley Dear Mr. Sullivan: Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: " The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." I. All separation distances are to be measured from the toe of the slope. ,/2. Location map is to be shown on all SSDS plans. r► 3. Footing and gutter discharge has not been shown on the plan. pl. Pump pit has not been fully dimensioned, e.g., wall dimensions, profile view etc. ?.slat =z,m Jv the exnansion.a a ✓6. The maximum allowable slope in the SSDS area is 20 %.' I%7. Expansion trenches are to be shown, dashed lines are acceptable. } G.�, 11 . ,, r IVI:> WO .S A I P" V , Upon receipt of a submission, revised to reflect the above, this application will be considered further. ,truly yours,}. Robert Morris, P. E. Public Health Engineer RNVjP J F SULLIVAN P. E. 962 424e "POT14 E'OUKTf-Vg1FAffTM9NT OF HEALTH DIVI XON,OF ENVIRONMENTAL HEALTH SERVICES Date Re; Property of t - Located at I/ P. 01 Section 2�_/_Block Lot Subdivision of- Subdv. Lot Filed Map # 236 Date A60 Y 19p? Gentlemen: This letter is to authorize & a duly licensed professional. engineer ✓ or r e g (Indicate) to apply for a Construe tion Permit for a separate serve the above noted property in accordance with istered architect sewage system, to the standards, rules or regulations as pr omulagated by the Commissioner of t -he -Putnam --County_ Department of Health, aknd to sign all necessary papers'on my behalf in connection with this 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. -117 Countersig SOP NEW P.E.1 ME M�" A & Very truly yours, Signed Owner of Property -4P71( 4 31 dress / I Address es Town Telephone Telephone m r• •• C z 0 we 0 DI V11 •4i 1D • 11) VA 161 %, Z"Wkyj I VkG I Mv. M, r4h:63101.41A " YDESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner z4d 11-4'E% / �,V U Address %�� h? Jr'g %/' /►' Located at ( Street) ha o C Sec. 73. l Block / Lot 2 (indicate nearest cross street) Municipality /�� m /� Watershed • • • �1• •• F,W*Qmm INN V.-V • S• /• 1 • *-1Z I 13 V 4 *p W.V9 • • Date of Pre- Soaking /° /7 / Date of Percolation Test Z�Zlz � G HOLE NUMBER CIS TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Mina Start Stop Drop In Min/In Drop Inches Inches Inches 3 33a fir% �z- 4 5 NOTES: 1. Tests to be repeated at same depth until approximately 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. rav- 9 /A1; TEST PIT DATA REQUIRED TO BE Isla � WITH APPLICATION IN TEST HOLES .- ..,:.� ......,�;;'��'r'�'r�:_..,... = °Hn'��':'r�3.:�::.::.�►s�:� �r� �H��'�F�.�,�: #.�.���r.�- _ _ - �.: >� =- �J•�'k- I��ia�::_- _ _:4Y:.�• -r�K ;� - ;,_ G.L. ✓O i�l d / 1° 2' 3' 4' 5' 6' 7' 8' 9' 10' 11' 12' 13' .INDICATE LEVEL AT WHICH GROUNDWATER I5 �ENOOUNTERED. e -. _ . ._.__ ..._..� ..._ _.,_....__.._.....,_ INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: - DESIGN - - Soil Rate Used ly Min /1" Drop: S.D. Usable Area Provided Ov U No. of Bedrooms Septic Tank Capacity gals. Type Absorption Area Provided By / S .J' /J L.F. x 24" width trench . Other y� �i /F /� =I-f2C� Name �i // `V; A 1 Z'c, Address ,�/ X 7 2-- THIS SPACE FOR USE BY HEALTH Soil Rate Approved " iff _.. TTIIT TR11T11 sq.ft /gal. Checked by Date PC -1 PUT NAM COUNTY D E PART M E NT OF H EA EY H ... •._. ... ,,w r_ -..m, ..- .:,.L. _. .,� .. ;.- ._, .; .; . _. -:__ c' :. ���.. -., :. .. ... •..•_., :_M.a:•-s _.. , �- ::..Y:.�rs �.'ti•. ": �,.- _,•:::. �: --:- :.,- �•.. -:.r :r`•cy. ^..a .- �..•ar.�.R APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: r'x'! v /V 9x 2. Name of Project: 3. Location T /V /C: 4. Project Engineer: ��i1i %/d l% 5. Address: License Number: Z44 Phone: Z yPYVr 6. Type of Project: � rivate /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building .Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEAR)? A/O Type Status (Check One) Type I.. Exempt Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. Al*lO 9. Has DEIS been completed and found acceptable by Lead Agency? 10. Name of Lead Agency �V/� T�:thi.g..��r. CL;:'j:;?_'M� ?rca nries.i' - Y�e n! 0t;)_)Cal. �.%�nn!:�g;: or other officials, ordinances? ......... ............................... 12. If so, have plans been submitted to such authorities? .................. 13. Has preliminary approval been granted by such authorities? Date Granted: % 14. Type of Sewage Disposal System Discharge...... Surface Water V-'Ground Waters 15. If surface water discharge, what is the stream class designation ?........ 16. Waters index number (surface) ........... ............................... WZ2�1- 17. Is project located near a public water supply system? .................. 18. If yes, name of water supply Distance to water supply 19. Is project site near a public sewage collection or disposal system ?..... �a 20. Name of sewage system Distance to sewage system 21. Date test holes observed: 22. Name of Health Inspector: 23. Project design flow (gallons per day) ....... ............................... 11/93 2. 24. Is State Pollutant Discharge Elimination.System ( SPDES) Permit required ?.. Ala 25. Has SPDES Application been submitted to local DEC Office? ............... 26. Is any portion of this project located within a designated Town or State wetland? .................................. ............................... A10 27. Wetland ID Number ........ ................. ............................... 28. Is Wetland Permit required? ............................................. Has application been made to Town or Local DEC Office? .................. 29. Does project require a DEC Stream Disturbance Permit? ................... A/�O 30. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ........ YES or NO 410 31. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or NO DESCRIBE: Al�l 32. Is there a local master plan or file with the Town or Village? ........... ? 33. Are community water, sewer facilities planned to be developed within 15 years? 34._. Are, any. sewage -disposal areas. i-n. excess_ of__l5% slope? ..... , ..._ .... ,_ .. i 35. Tax Map ID Number ................... .... ..i. y ........................ 36. Approved Plans are to be returned to: ................ Applicant Engineer If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: 7 -�� Z'�'; t-zf MAILING ADDRESS: V, i � � / T��GY /