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HomeMy WebLinkAbout3279DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73. -2 -2 BOX 26 03279 L RLome �� J6 , A T - 4.. .. 16 r'r. f - iull - �r; . , 03279 •CERTIFICATE% G Located at 'Owner' , separate, Sewerage,'! Consist other. Water suppiy :Build* `TYPe r Has Erosion Co tro r I certify that tFie`.sy! attached;)', nd :fin ac °Date Any person occupyi conditions resulting +available and the;ap - subject ;to mods- ica t-. Date cessary.to, secure the; correction.. of any unsanitary void-as.soon as.,a_puti6cianiiary . sewer-becomes upply becomes available Such approvals_ are m modification or change ,is necessary LL I .—& - - I 1J s Flat • �M— b S 1 S a §,�. a 'fir t r.. r .•vy � �'�, - °mot •�,t !!l �..�„"„ �, ,: 5'i+ s x M f !7 wir r i us:•r i 5 is :v .ILrcliaF,ez, of guild :1.11 _.:.•.y- - .:.. ._._,,._ .+.. ,r.. ...�- - 'i3cww::., .... a. ::...<.."....�a:�aesue.•..�.... .s.b..¢.;: o. -=. aa.mw::m4.. ».....�:a:..r:,::: -- _- ,�.+e._�...wa:w::d�!:�. uisuilding Constructed by Section I \j t Location - Street Bloc -k e A W 13uildin ; Type Lot GUARANTY OF SEPARATE SL71EDGE SYSTEM I represent, that I am wholly 4 and completely responsible for .the lccation, .1orkmanship, material, construction and ,drainage of the sec•:aje disposal system. servi»o the above, described property, and :.that ;it. has been constructed as shown the approved plan or approved amendment thereto, and, in accordance with:the standard; rules and red lations of the Putnam County Department of Health, and hereby guaranty'. t6 -the owner, his successors, heirs or assigns; 'to place in good opera:'ting condition,' any part of said system constructed by me Which fails to operate for .a period of tiro years =immediately -following the date of initial use of the sewage I disposal system, of any . repairs made _ by me . to such. system, except where the failure_ to, operate properly , Lti .C'nUSE'U .L�' Lr1e. LV1111U1 UL' llNk;1 L�t71 L ac L , lJl 'll1l:. OUL:UPrAil L. tit Litt; 1.ILL -L-L n.lib r�.G 1: cm : The undersigned further agrees 'to_-'accept'as. conclusive the determination of the Director of the Division of Environmental. Health Services of the Yutnain CounL> Department of Ile alth as to whether or not the failure of the system to operate tti�as :_I:aus.ed- _ hy.:ishe:.c;�:.i.:�_- ftil.__or: nealioenj__:,aci._of ,the..occupant of- the--building u-til .zir:g; tlie': >ystem..°' Dated this d of 1V Q •19 Si nature'L°' �.... Y e . Title e; (if corporation, give name and addre, f1lREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES..OF FINAL PLANS" BE10RZE CERTIFI_CATi 1F COMPLETION WILL BE ISSUED. 1ARANTOR' TS RF.OUIRED TO. FILE NOTICE OF DATE or.TiRST USE OF .SYSTE,I. ---- ---- --- --------------- - - - --- - -_ -- - --- -------- ..__:.-------------------------------- ►ision of Environmental Ilalth - Services, Putnam. County Department of, Health WELL�COMPLET16N REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of ,Environmental Health Sorvices COUNTY OFFICE BUILDING - CARMEL_, NEW YORK This repoit.is to be completed by weil. driller and smbI - ratted to County Health Department together with IaboratorV!eport.of . ' arroysls oc`wate� sa�itie`ir�dicating vvo2er is or satisfactory bacteriai qua'liiy before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION I NA p� .�— Cws/ � � e- -C C C3 r2J� ADDRESOWNER LOCATION OF WELL % (No. 6 Street) (To ) / (Lot Number) �\ C� �C /� ® �U �A /J7 PROPOSED USE OF WELL BUSINESS L'J DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑TEST WELL 11 SUPP Y E] INDUSTRIAL ❑ CONDITIONING ❑ OTHER ) DRILLING EQUIPMENT rsD�j ❑. ROTARY lam) COMPRESSED CABLE OTHER AIR PERCUSSION ❑ PERCUSSION ❑ (Specify) CASING DETAILS LENGTH (feet) DIAMETER (inches) WEIGHT HT PER FOOT ,'7 L THREADED ❑ WELDED ORIV MOE�j YES . ONO — WAS CASING RR Ui ❑.YES !::I -No YIELD TEST HOURS G.P.M. . ❑ BAILED ❑ PUMPED ® COMPRESSED AIR RS ��� YIELD (G.P.M.) WATER LEVEL MEASURE FRAM LAND SURFACE— STATIC (Specify /eetJ ±� DURING. YIELD TEST fleet) / ��!� Depth of Completed Well in feet below Land surface: 2'.475- SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS 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. . CGI lJ ILGI )� 9 oc co M Aj e 0 �d If yield was tested at different depths during drilling, list-below GALLONS PER MINUTE %FEET DATE W,JCI 4PMPLE /TED DATF� OF J(EpO�T WELL DRILLER (Signature) i Qom. 4a , PEEKSKILL MEDICAL LABORATORY 1879 Crompond Rd. Barclay Plaza Bldg. A, Apt. 1 - Peekskikl _ a...m. -New .York 10566 _ �..,: _- nj -7-827.7 . -` 4c-. r-..` c... aaww�.. ca.�..:.1;�:iac:`m...a .:.w.-..i.�, w..- e,-a�^.:vrs++.+w�. .rw..+..� -.. :. -,wry. - f:.:-�.:z.�a�.c.:..W _e.ti»+ ,:,nica� shot •-1. �1:%•c- ten+'+..- :+.v.s.w.v�.l r:.� DATE COLLECTED RESULTS OF EXAMINATION OF WATER 10/15/74 OWNER DATE RECEIVED Val Pete Construction Corp., 10 Grandview Avenue Ardsle 10/16/74 CITY, VILLAGE, TOWN VOR NAME OF SUPPLY DATE REPORTED Lot 7, Block 7, TM # 62 1 10/18/74 SAMPLING POINT Well 'BACTIrRIA PER ML. (Agar plate count at 350C). .8 COLIFORM GROUP (Most probable N6, /100ml.) less than 2.2 HARDNESS, TOTAL - ppm DETERGENTS - ppm NITRATES (as N) - ppm IRON, TOTAL - ppm. FLOURIDE (F) - mg. /1. These results indicate that the water was Yes of a satisfactory sanitary quality when the sample was collected. H'PAboVANI, M. T. (ASCP) f PUTNAM COUNTY DEPARTMENT F IEALTH Drvfsion of Enwronmenta/ Hea /th Services Caimel N Y 10512 ' G ®NSTR CTION !T F>�� SEWf�S;E [)JSPes -SYSTEM .- s - ....W x ;.i`own o'riVil(d9 -Locate d: at n Section ��-` r ;Block 'Subdivision Loth Owner _ y Address Building Type ¢ "Lot Area i ANumber ofgedrooms Total Habitable Space (BOO Square`F'eet eparate iSewerage System to cohsist of Gal Sep w Tank ��—© G7 lineal feet 'X width trench , o o be constructed by r Address { Water Supply Public Supply From 'Private SuPPIY to be drilletl by • at Address Other' Regwrements � � .1 represent that 1 am wholly and, completely responsible for the design and location of, the proposed, system(s); 1) that; the separate sewage disposal system _above described _wiil be constructed as shown on the approved amendment there to`and m accordance,with the standards; rules an regula_ ons o e u, nam , County Department, Hof ;Health, 'and that on completion thereof a "Certificate of Construction Compliance satisfactory to the Commissioner of Health.w 11 be submitted to =the Department; and a� written gguaranfee will be; furnisheii the owner his successors heir's, "or assigns bythe ?builder °.that sa d.builder,'will ` ,place ,m; good .operating., Conddion any .,part of saitl sewage disposal system during the period of Ywo (2)',years immediately:,following thedate,of the issuw ance of4'.the approval of :_the Ce`rtrficate ofj'Constzruction Compliance of the original system or any repairs thereto 2) that the: drilled` well dascribed °above, will�be located es shoe non the approved plan and that said well4wi11 tie installetl in ` `ordanca ;with t6Atandar rules and regu a ions of the Putnam ` County Department Of Health z ` ' ,� / •Date Signed x tg Address,- Li rise No J :APPROVED FOR CONSTRUCTLON This approval ex ire "s`one year from the date.'issued unless construction f the; bwiding has been untlertaken and fs revocable, for .cause or may be amended oGmodified when considered_ necessary by'the Comniiss;on "" r of Health ny change .or alteratum of construction iegwres a new permd Approved for disposal of domestic Mary sewa a an or private water 'supply only Date Title _ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION -OF ENVIRONMENTAL. HEALTH SERVICES . COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM c FILE N0. S"IS)O- %!I3 Owner � ,Address C. a C-Tyl ` Located at (Street) Sec ( Block '7 At indicate neVps cross street) Municipality Watershed CC6 44-M ATION TEST DATA RE*JIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Elapse Depth to Water Water ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches. Inches n 1 q` Id' tI.- .._.. 2 1o. I1 3 6 � 5 Zti 5 Notes: 1) Tuts 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. .,.,..- a_ -•-� `. s' ._ .... ,; _ _ _ _: :.., � -.;.: ....___ - . mow•« - - - ;.•LS,?K:•.. -:.Q -' _ . __ _ TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE, NO. I HOLE NO. HOLE NO. G.L. b ;P ' 6" 12" 18" 2411 .J 3011 36" 42" 48" 5411 6011 66" 7211 78" 84'1 INDICATE L AT WHICH GROUND WATER IS E COUNTERED INDICATE LEVEL TO WHICH XTER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY S Date DESIGN Soil Rate Used -to Min/1 "Drop: S.D. Usable Area Provided No. of-Bedrooms Septic Tank Capacity 1430 0 Gals. Typeg Absorption Area Provided By a,v L. F. x24" jbT' —r --; = `width E—rench. c ,a. re,, ame . Address 59- e (c THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH - s DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property c Located at Section — Block. '� Lod .11 -i Gentlemen; This letter is to authorize cu r-- a duly licensed professional engineer ­-,�or registered architect (Indica ems'—` to apply'for'a Construction Permit for a separate sewerage system; to serve the above noted property in accordance with the standards, rules or regulations as promulgated by the Commissioner of the Putnam County Depart -went of nua.L uii, aiiu to Sign all llec;e.-3sa.ry papers on my behalf in connection with this matter and to supervise the construction of said system -.or systems inconformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yo s, Signed k Date gp c.-T- °13 Countersigne P.E. .� o U- Telepfton_e tepnone. MELD CFMCK LIST Date.: [a rm by; rasp INITIAL SIZE INSPECTION Yes � No Comments Property lines or .corners found . . . . . Can estimate house location , Will driveway need cut Must trees be removed -note these . . . . . Is deep hole representative of entire SDS area Additional deep holes needed. . : . Sufficient SDS area available considering driveway cut,house location ,separation ... . distances, etc. . . . . . . DEEP HOLE DATA Depth:. Water elevation: -- Rock elevations -� _ Soils description: ,ggm , l h ,ame orn Date: FINAL SITE INSPECTION Insp. by: House located where shown on approved plan. S )S:' 1 oca.t,ed zrhere approved Width. of trench averagevµ Slope of the line and trench acceptable Room allowed for expansion. trenches Over 50 ft. from swamp,,vat erc ours e .. , Natural soil riot -stripped or Svc =area unnecessarily graded 10 Ft. maintained from prop ,line and 20 ft . from house . . , Separation of trench from house, well etc. follows plan . Number of bedrooms checks . . . . . . Stones, brush, stumps, rubble, etc e greater than 15. ft. from nearest trench 15 Ft. of peripheral soil horizontally from trench. . . . . . . . . . . ... . . . . •Junction boxes prope °ly set Gould surface run of'f' from driveway, roads, ground surface, etc. channel near SDS area. . . . . < . .. Does lot drainage appear 0. K. in. area of SDS. FINAL GRADING OF SITE ACCEPTAME 1� -w -7 RBYIE'W CHECK SHEiqT .y1 Drlue Meets Std. Remarks ' S � No k - DO.CUTT_N.TS House plans O.K. ✓ Design data sh --et Peres presoaked? ]!dn. 3Y pert test depth Conk. results for 3 runs _ - -_ I ✓ I _ D. Hole log 0. K. ! ✓ i Corpoi,ate Affidavit for other than individual i A. ! _ Authorization for engineer Letter. from Water Supply if applicable !►� I I If variance requested -such noted on plans & apps. ,y, i9. DETAILS if change is .proposed,) � Existing contours shown Rhow new contours) Slopes for driveway cuts., etc. shown. ✓ ! Water service line location ! ' Footing..drain, etc. location I Top slope, bottom slope of fill i HA Percolation tests and deep test pit location ✓ i' Septic tank size and conformance to std.�j- 3 .:R.R. house mirLim:Lim ! ✓ House.'- setback shown ✓� G � i � . N �. ice.. t'l Vv ; •:'i:� �. !� LL till wa- UE'A' ................ ... Plan and profile SDS _ All other wells and SDS closer 200' I !, .shown or' reference- made Property boundaries (metes and bounds- clearly shoe— SEPARATION DISTANCES SPECIFIED ON PIA lot to P.L. 20' to Foundation walls -00' to Nearest well 50' to stream, march, lake, etc. 15' to Curtain drain i ✓ I 1 .expansion 10' to water line (pits -20' ) + ✓ ! — 15' to storm drain 10' to large trees 10' from foundation to septic tank I ! 5' to pipe from leader drain & fooLZng rain 5- y 1 J $ . �, .� lF " - ' -.-mow .....) r 1 ' - 1 ` 4 1 , , I I , .1 � 11 , - I - * , .i . 1, . . I I -,� � rl � fi E ,� 11 7 �.' �j .1 I �, „. t tiT s , a _ r ' , ".!,r -�; [ I 1 � . 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