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HomeMy WebLinkAbout3289DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73. -2 -13 BOX 26 03289 -7;-J-77 N. PUTNAM COUNTY DEPARTMENT OFHEALTH.. 318 Division of Environmental Htadth Seivices, Carmel N.Y . 165 12. Engineer Must Provide 2e PJC.&D.�Permit , :_ 7. CERTIFIC!A2F CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM erg To V! Located at VV ia,-Map . t.�z Bl" owner/ Form SibdIvIskn:Nem6 Subdv. Lot *.# Mailing Address. _7Ap Date Permit issued /V. V Separate Sewers ,go System built by Address Consisting of --..Gallon Septic Tank and Water Supply: Public Supply From Address or: Private Supply Drilled by Address Building type Has Er oslon Control Been Completed?— - Number of Bedrooms Has Garbage Grinder Been Installed? AX I certify that the system(s) . listed serving the above premises were c as shown on the plans of the completed work ( copies 0. and the permit issued by the of which are attached), ano.i7accordan6a with the standards, rules eg nee w the I d plan, Putn am county bo' tment OP Health. Date. Corti "d Address A Lies se No. Any person occupying premises saved by. the a., ova system(s) shall prompt be necessary to secure the correction of any unsanitary ova system( ;) conditions resulting from such usage. Approval of the separate sewerage 11 and void AS Soon as a Pub(-. sanitary sower becomes available and the approval of the private water supply shall become null and 14611 water supply beeomes ovallfible. Such approvals are subject to modification or change when, In the judgment 614he Comrrilsiao"'rr, ch revocation, modification or change Is necessary. Date 4ee �j T 9'0 Title e, PUTNAM.COLUN DEPARTMENT OF HEALTH .._ _..:; ulv:��iu�y .ur . r�vv�.tc�nvr�vttu, I1CiiliJ;t1 �.C;ttYlC..� Owner or Purchaser of Building Section Block Lot Building. Constructed %by. Location - Street Municipality Building Type 1:::5C/ q!�._2G Subdivision Name Subdivision Lot # GUARATP= OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, wor)ananship, 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 successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fail: to operate for a period of two years immediately following the date of approval of the - - - -e f cue :bran triiP i ao :Coinpliance!L: for_,th sp :.. y t ;►r ;,or _ny- ; 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 Director of the Division of Environmental Health Services 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. Dated this / day of c v/ 19 ��' Signature 11 v ' Title General Contractor (Owner) - Signature Corporation NanA (if Corp.) F rrM- rev. 9/85 irk Corporation Name (if Corp.) Address LAB # fnr3�� 7z ( 1061 20 9 Yorktown Medical Laboratory, Inc. - - - - -- Date Taken: Time: 2 • �o �� 321 Kear Street Date Rc' d : o Time Yorktown Heights, N. Y. 10595 Date Reported • 990 >., r,- .. ,.0 ::,= :.e`•;: +sz+% -�• :.cso....: 'Rr i�.i:�. I�`- Director: Albert Albert H. Padovani M. T. (ASCP) PO /Client Referred By: r Sampling Site :. GZ74,L,,,cs�✓ !"o 2- Q U E 2-1. /Li Lid / '.✓r�i✓F- /ate- �rdy�yr�ia Phone L REPORT ON THE QUALITY OF WATER INORGANICS m L MICROBIOLOGICAL C /100m.L —' Alkalinity Standard Plate Count — Chloride _ (CFU /1 mL) Copper — ` Detergents, MBAS Membrane Filtration Method — Hardness, Calcium L — Hardness, Total Total Coliform Iron —.Lead Fecal Coliform — Manganese _ Fecal Streptococcus Mercury — — Nitrogen, Ammonia Most Probable Number Method Nitrogen, Nitrate. _ — Nitrogen, Nitrite _ Total Coliform _ Phosphate, Total Fecal Coliform. .Silver — Sodium — Fecal Streptococcus _ Sulfate — Sulfite - _ Zinc Total Coliform P A PHYSICAL MISCELLANEOUS BEY FOR TERMINOLOGY pH (S.U.) CFU Color (Units) LT Conductance (uhms /c) GT Odor (TON) NA Turbidity (NTU) SA TNTC Colony Forming Units < = Less Than = Greater Than Not Applicable See Attached Too Numerous To Count REMARKS COMMENTS For Lab Use (For Lab.Use) SAMPLE TYPE: (Check One) potable _ Non - potable OUTGOING: (Check Each) — HNO 3 ._. H0504 NaOH — ZnOAc _ Na2S203 Other: INCOMING: (Check Each) _ GT 4 7/LE�200C GT 200C _ pH LE 2 — pH GE 12 Other: THESE RESULTS INDICATE THAT THE WATER SAMPLE WAS)j (WAS NOT) (NA) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO TH YORK STATE PUBLIC DRINKING WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE COLLECTION. THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DID NOT) (NA) MEET THE SATISFACTORY CHEMICA %�L Y STANDARDS OF THE NEW YORK STATE DRINK- ING WATER CODES FOR F�QP TERS TESTED AT THE TIME OF SAMPLE COLLECTION. 7 /87(Rvsd1 /90)RWE e- rt-H.— Padovani, M.T. "�ASCP), liirector 7 "�4 6`��.. , .' 7, Emvkiommeu 6dthlssr;�'�;— 0 CERMCATEOFICONPI L SYSTM P, mm loll P, sIdwhiallim Mine UY - Renewal : 0"WAppuc t Name 7 Date or Prevtons Approved 'Dppth%L% Vottlme 7. D ]PC= Nofficidon IiLR4*UhT4 "eM Fill J eoptpleted Sept site Setv®eage System to ooaelet of '&,Qou- Sepik -Tank mind 0 be oensteacted by "" Address 7 Wateir Supply, Simply gym Address or. upp Y Address I reoresent tfiliV 1 that the,sepi6rati,,I ,:afn �o de above Aeisiciibid' s` tio wn on , theIppproved , smendment theie.to and i r a e nklruiiii anTregulations of the Putnam be wbmitted ao the ,Department;, antl a written ;guarantee will be >u) place -in gbod operatingi once OfL'69-4liprowil of.,the Certificate -oJ. Construction Compliance' �Wlll be 16cat" t J' i6girovid _" County Departmen Flealt Date Atldress ".5 '61j'fdi cause L or 6 aod " or MOqiji may ",.vvhppj considered nee r iSp- ic' sanitary; ', requireV!fW permit.. pP!O, —'O si i Rev. 1/87 Date By al o. of -.tro :Putnal" J�l icense No 910P ate - a et a b6ilding ha*s been undertakiin.'and is Any change or alteration of construction /0 on Title d=, o n A COV Wr.LL UVr1rLG1LV14 Azrvlll y DEPARTMENT OF HEALTH. ,,P , vis_irtn .Q1_- _E??yxnmental PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use, Only v�O (� 2 (/ — �' S WELL LOCATION STREET ADDRESS: 15WRIVIEDMILICIly, TAX GRID NUMBER: PEEKSKILL HOLLOW RAOD PUTNAM VALLEY / / WELL OWNER NAME: ADDRESS: PRIVATE ADO CONSTRUCTION COMP. PUDDING STROARING BROOK PUTNAM VALLEY NY ( p PUBLIC USE .OF WELL 1 - primary 2 - secondary ❑ RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS O FARM ❑ TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL O INSTITUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING []REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY ®NEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 32A ft. I STATIC WATER LEVEL LD..__.. ft. DATE MEASURED 15/21/89 DRILLING EQUIPMENT El ROTARY O COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT O CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED (2 OPEN END CASING ❑ OPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH tL MATERIALS: q STEEL ❑ PLASTIC p OTHER LENGTH BELOW GRADE 83 - ft. JOINTS: O WELDED )t AHREADED 0 OTHER DIAMETER E>-- in. SEAL: O CEMENT GROUT O BENTONITE, EXOTHER WEIGHT PER FOOT Ib. /ft. I DRIVE SHOE: ❑ YES JaNO I LINER: 0 YESAD NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (it) DEPTH TO SCREEN (it) DEVELOPED? FIRST o YES ONO :SECOND GRAVEL PACK O YES ❑ NO GRAVEL SIZE DIAMETER OF PACK in. Top DEPTH ft. BOTTOM DEPTH ft. WELL YIELD TEST If detailed pumping t p p 9 METHOD: ❑ PUMPED tests were done is in- IN COMPRESSED AIR , formation attached? O BAILED ❑ OTHER ❑ YES O NO WELL LOG' if more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE water Bear- 1n9 Well Oia- Meter FORMATION DESCRIPTION CaaE ft. ft. WELL DEPTH It. DURATION hr. min. DRAWOOWN It. YIELD 9pm. Surrface 4 6 Ir Overburden n Limpqtonp 320 6+ 10 WATER O CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? OYES ❑ NO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY GAk. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAME NORMAN ANDERSON INC ° E 18/90 ADDRESS 152 BARGER ST SiGfIMRE PUTNAM VALLEY, NY 10579 J/ 87 V DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 ` °,PPZICA`iION "TOE- C'ONS'I`RUCT­A'_WATER' "WELL PCHD PERMIT # WELL LOCATION Streye� Ad re s pT9wn V,illl �e,/�Cp*t Tax Grid Number WELL OWNER am `Ma ing Addres �x %2� . �%� 04rrivate O Public USE OF WELL 1 - primary 2 - secondary W16SIDENTIAL O BUSINESS ' O INDUSTRIAL ❑ PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL ❑ STAND -BY O ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm/ # PEOPLE SERVED t/ /EST. OF DAILY USAGE �G'y gal REASON FOR DRILLING UnEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑REPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE WRILLED DRIVEN ODUG ®GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES J-"NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: / 0 r7/`i" i Bea No. % WATER WELL CONTRACTOR: Name Bea Address : A" IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES A---'NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DIS'PANCE TO LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION []ON SEPARATE EET PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health D partment attached to this per it. 3. Submit a Well ompletion Repor o a form pro I ide by th t a o n Health Departm nt. Date of Issue: 19 Date of Expiration: 2 19 a mit Issuing Official Permit is Non - Transferrable Whi te copy: H.D. File Yellow copy: Building Inspector 2/87 Pink Copy: Owner Orange copy: Well Driller APPENDIX B PL'MAM COUNTY DEP.ARMA= OF HEALTH - DIVISICN OF ENVI:RCMMM HEALTH SEMTICES MITEDUAL WATER SUPPLY & SJBS ER(M-2 DISPCSAL SYSTEMS I " REZY9 Sr= -.CONS=-=ION PERMIT.-- ATE RE 7EI ..ay_ "'K.+Y 'r'm ff.'s....r. , r, - ..a. 'q �'.... :: r� :11 Y.Y. _ .'! ='�fA r. '.4 YSl •yy0..: �. v D18-me of Cwne_r) (St:.eet Lec..tica) fix- ni C 1 FI'S YES (. -NO I mcmiam ✓' Perrot Application �p Corporate Resoluticn Plan - Three sets Engineers P_uthorizattcn Design Data Sheet (DOS) S ED1VISIC�i I I I Deep Hole Log - _ I Consistent Perc Res i _S (3) Fill / ( Pe_rc Hole Depth cif_ I House Plans - Two sets W ZZU ell I We pe-m .it; F;is I IM Variance Reaues t T Le al Suhdi.vis icn P All A I I I Sa=d .ri Sion Approval C:aeck d &c-approval SEDS P -d-1 . Lots Che^k &_ I I I Wet? and (Tcwr./DEC Perm t R& D) Da Cn DOS Plans & Permit S,--m L' trend',_ provided I ,- I REQTj= DEl. = CN P=NS r= ui d 3-7 r t z,Y I Se age Sys t -m P 1 an - ('or tZ arrow) 60 ft. S�.rcz System Hydratil i c P_of_l_ - Gravity F l ;:,f Parallel toours Fill Profile & Dimensicns - Vc11_ -.e 100% ems. I - `I D or J Eox;Trand -i /Ca' 1_ry; _P?=p pit de+:.ils .�-I -- Septic Tank - Size, Der -il Well! Derail, Service Lire if Ccnst. -ucticn Notes (grinder rate) Design -Data peke _and* e = +rte - Y Two -Foot Contours Existing & P_or -csed I / Drive%mmy & Slopes C.2t r'I Foctin /Gstter,0ur�,ain Drains (discharge M) Perc & Deep Holes LccatiRd Fr .r, SYStEMS I I Representative or pri rnary aid e - ansicn clay' Her I ficce-ansion Area;shcw-n; gravity flew,suff...size 10 ft. I f Pit & D Box Shen & Detailed fill n tee I I House - No. of Bedroams ne v s I Webs & SSDS' s w /in 200 ft_ of Procosed Systa- ceotR Vuges I Proper ty Met?s &Boards I House Setback Necessary (Tight lot) House Saner - 1 /4 " /ft. 4 "0; T_?-�:e pipe 100 vr. flood elev. I I No Beads; Marc. Bends 45° w /cieanout SEP?=0N DISTANCES SPECIFIED CN PAN Fields / 10' to P.L. , Dri vegay, Large T_-s sjop of L' 20' to Foundation Walls 200 ft. reservoir, etc: Li 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stre..am, Watercourse, Lake (inc. eK 150 ft. trigall /call. 15' to Drains- j_- ur'La-in, Lice_, Footing 351to catch basin, storadmin,ci23 Ovate -rccuz �j 10' to water Line (pits-201) 50' inte_*mittent draimae course Septic Tanks . 10' from Foundaticn; 50' to ua:l of 15' well to PL 9 FINP.L SIME INISP=-ICN Date 1iC �zns -tom y STREET LCATION C7N% � � Cp+...� F�TT a /Oel 2 G - II I.V. V. vi. 2M a OR SJBDIVISION LOT v NOC�'5 -. a. SDS area located as per approved plans b. Fi section - Date of placement 11 2:1 barrier_ LGTH WIDTH AVG_DPTH c. Natural soil not striuDed d. Stone, brush, etc_, greater than 15' from SDS area- i I e_ 100 ft. fran water course /wetlands. . SFWPZ-c DISPOSP.L SYST-R-4 a. Septic tank size - 1,000 ,250 b. Senti.c tank iris' —? led level I c. 10' minimuru from. foundation I d. No 900 bends, c?e?*]out within 10 ft_ of 45° bend I I e. DISTRIBUTION BOX 1. All outleT-s at sa-ae elevation - water test-----3 ( I 2. Protects belcw frest 3. Minimum-2 ft. orici ra1 soi I bet - ee_*i box and trenches I f. JUNCTION FAX - vron--rly set I • �d� war g- TRENCHES _h install Lzn re^uired - �� e i 2. Distance to watercourse neasured 3. Installed a=- rdi nq_ to plan . ♦ 4. Distance center to c°nte_r I I 5. Slone of trench accept=able 1/16 - 1/32 " /fcot. 6. 10 f--et fran nrcne* ty line - 20 feet - four- ,Aaticrs I I I 7. Depthl of tzeuricz < 30 inches fran surface ( I 8. Roan allcv-ed for e-cLarsion, 50% i 9. Size of gravel 3/4 - 1i" diameter 10- Den th of gravel Lrl trench 12" L. • Pi-De ends caDcadd h- _ -raN2 oR DOSE SYSTEY-s 1 Size ofu�_.� 2. Overflow tank 3. Ala-rm, vi sur— /audio I r 4. Pump easily accessible iranhole to aide 1 A I I 5. First bcx baf -l.ed 6. Cvcle wi tnessead by He= --II th Deze- anent I I I esti hated flow per cycle ,HOUSE a. House located r arrorove3 plans. Io,` b. Number of bedzoans Z .-4 1 a- ive_i1 located as per a=rovAfalr-'SyAt 41 b. Distance fran SDS area :measured 1--.1 1 c. Casing 18" above grade. d. Surface drainage around well acceptable. OV RAIL WORKMA-"nIP a_ Boxes properly Qrcuted b. AU Pines partially bac-c-filled I c. PL l pines flush with inside of box ( • d. Bac-kfill material contains stones < 4" in diameter e. Curtain drain installed according to plan f. Oir',_ain dm in outfall prote=-ted & dir. to exist- watercourse 1 J g. Footing drai=ns discharge away fran SDS area I h_ Surface water vrot-e--tion adequate / i. Errosion-EEnzi-81 provided on slopes greater than 15$- i PUTNAM COURrY DEPARTMENT OF HEALTH DIVISION OF MMMENTAL HEALTH SERVICES DESIGN DATA SHEET-SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner -,lip Address Z_ wn Located at (Street) Sec. y Block (indicate nearest cross street) municipaiity, )-'000' // Watershed SOIL PERCOLATION TEST DATA RBOUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre-Soaking Date of Percolation Test HOLE NUCER CI= TIME PERCOLATION PERCOLATION Ran Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start-Stop Min. Start stop Drop In Min/In Drop Inches Inches Inches .2 _3c2 2— 3/ / "/',ate -3,v 12- 12- 4 5 4 5 .1 '� F, f w 3 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 fo r review. 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH API OF SOIIS IN TEST HOLES b _ DEPTH. HOLE NO. HOLE NO. HOLE NO. n:..�r6 'sr:-. - <.. -. �..�..y.;.a:.. — -w •�.r >`., �4 . _: F .c .� U -.a v�+ .'SY' v^� sn+.- w- .q�_xs+.teo +� - _. —� _ . -� _ _ .., .._ ... .. ....tea .�. .. G.L. ... 1' 2' 3' 4' 5' 6' 7' 8' 9' 10' 11' 12' 13' — i r 14' INDICATE LEVEL AT j%MICH+ GROUNDWATER IS ENODUNTERED ~� /b' s'� �� _ _ �._ ,_.�. _ � . - - - -_ • ;� . INDICATE ISVE% TO WHICH WATER LEVEL RISES AFTER BEING ENMUNTERED DEEP HOLE OBSERVATIONS MADE BY: / �/ �% �� DATE: DESIGN Soil Rate Used %Z ��'Miii %1 "'Drop,: S.D. Usable Area Provided No. of Bedroams Septic Tank Capacity %SZ.i gals. Type���l�/ Absorption Area Provided By ®'C� L'.F. x 24" width trench Other (✓ I`� �`'`� �v �4� — Name T,'-5 //'i� �mL Signature Address��� THIS SPACE rOR USE BY HEALTH DEPAR ONLY: Essio Soil Rate Approved sq.ft /gal. Checked by Date Village ", �i j "m Located at Peeksk,l7 Hollow Road Q- Tax, Map 6'Z� T Block I`I a "" `. r,,, o,,,ner Randal LaBarbera a / Formerly Tax Map Lot q 16= S4e Lotazy ! f c ,n 1nrla1Pj Separate Sewerage System built by Frebar COI1St COr Addres�le' AVe11Uea NCO e N Y 10540 t r w Consisting 01. 1ui1SL_.Oal Septic Tank and' �" T, X' r 1a 1 [1P trench rk Other, requirements UiA 1 N DI�At N ' w, <j 4 Water Supply Public Supply From t' a ' A " :Supply Drilled By ArirlPrcnn Nnrinan .I= f " : Address' Barer =St PUtnam Valley Building .Type 1 Fain resldenCe No i of leedroorn 3 Date Permit hued: Has Erosion Control Been Completed? 'Y S `•i certify that�;the systems) as.liated serving the a1>ovepremises; were conatructefl essentially as-shown on the plans of the completed work (copies of-4h ch are atthched), and in accordance with the standards rules and. {regulations in accordance with the filed`,'plan and the 'permit issued )iy,'the S .PutsapjbG my Depar ealth y b x 2 r _ :Oats U Certified P E R A _ ., by t � t Address CasYiul Associates,` P C. 37 Fair CarmelN Y�,�,,a N, 26008 v n Any person occupying premises served bythe above system(ts) shall promptly _take aueh action as may be necessary to acun tM corredion.of any unsaMtary ;congitions resulting-, from such usage Approval of the separate = sewerage,aystem :shall become n fi- hd vold as soon as a public pnitiiy aw r pscomea available and',the °approV51 of the,;prlvate: water supply shall become' ndvoid when a pub supDiY petOmea available. Such approvals are i "• aub)eet'fo modification o► chs``nge: when, in the judgment "of tne' Om oner of: Health, ` ch rev t ,: ri►odiflut'lon or.ehange li;;nseeamary . r-► / Date Rev -9 81 C" RANDAL 62- P., . Owner or Purchaser of Building Section Building Constructed by Block Location - Street Municipality Lot 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 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 deter,min- ati_-on� -:off the Uirecfo -r� of the .Division. _ -of Environmental Health-Services! 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 negligen act of the occupant of the building utilizing the system. }' J � Dated this S day of lVoo 19,14 . Signature :. - Title pit ,eS FREOAR CONSTRUCTION CORP. C o rppC@ 6bXnCDTNAPLEt i/Et;orp. ) Lliti GOLN®AL16- N, Y. 90540 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 YUKAI Uff[I.MtUIUAL LADUIIAIVI11 Illu- P.O. Box 99 321 Kear street LOCATIONS: Yorktown Heights; N.Y. 10598 ❑ 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245.3203 g 201 BUTTONWOOD AVE., PEEKSKILL. N.Y. 10566 737.8777 245.3203 ❑ 495 MAIN ST., MT. KISCO, N.Y. 10549 666.3335 ❑ STON.ELEIGH AVE, (NEAR HOSPITAL), CARMEL, N. Y. 10512 278.9: - LAB # 3l.S DATE TAKEN. _3171-4 5? My\ DATE RECEIVED: b-:!,\- IXJ 1.11S DATE REPORTED: SAMPLE SO RCE: REPERRED BY, COLLECTED BY: LABORATORY REPORT mg /L ❑ ACIDITY .................. ............................... ❑' ALUMINUM ................:............... ............................... ❑ ALKALINITY ................. ❑ ANTIMONY ................................ ............................... BACTERIA, TOTAL /mL ...V3 ......................... 1 ❑ ARSENIC r :......................... O00. 5 DAY ..................... ............................... ❑ BARIUM ..................................:.... ............................... ❑ BROMIDE ........................................... I....... ❑ BERYt,L1UM ................................ ............................... ❑ CARBON DIOXIDE. FREE .............................. ❑ BISMUTH ............. ................... ............................... ❑ CkLORIDE ................... ...........................:..: ❑ BORON ....:................................... ............................... ❑ CHLORINE .................................................. ❑ CADMIUM ................................... ............................... DCOD ........................... ............................... ❑ CALCIUM ................................... ............................... ❑ COLOR ..... ............................... ..... ❑ CHROMIUM Itod ...................................................... ,..:. ❑ CYANIDE ................... ............................... ❑ CHROMIUM'(hexavalent) .................... ............................... '❑ DETERGENT. ANIONIC ................... ❑ COBALT ❑ FLUORIDE : ........... i ...... ............................... ❑ COPPER .................................... ............................... OHARDNESS ............:...... ..............:................ O GOLD ........................................ ............................... ,MPN COLIFORM COUNT/ 100 ml .......... ❑ IRON ........................................ ............................... r1iTCOLIFORM COUNT/ 100 ml ............ ❑ LEAD ............................................................ ............... ........... ............................... ...... N❑ ONFIRMATORY TEST ...... ❑ LITHIUM ........ ................. .. ............................... • Q NITROGEN, AMMON* .. ...i. ❑ MAGNESIUM ❑ NITROGEN, KJELDAHL ... ............................... O MANGANESE ..........................:..... ............................... ❑ NITROGEN, NITRATE ... ............................... ❑ MERCURY .................................... ............................... ❑ NITROGEN, ORGANIC ... ............................... ❑ NICKEL ........................................ ............................... ❑ DOOR ....................... ............................... ❑ PALLADIUM ................................ ............................... ❑ OIL & GREASE ............... ............................... D POTASSIUM ............................................................... OPH ........................... ............................... ❑ RHODIUM '..................................... ............................... ❑ PHENOL ....................... ............................... O SELENIUM ............................................................ ..... ' ❑ PHOSPHATE (ortho) ....... ............................... ❑ SILICON .................................... ............................... ❑ PHOSPHATE (condensed). ............................. ❑ SILVER ..................... ............................... ............... ❑ PHOSPHATE (total) ... ........................ :...... I ❑ SODIUM .......::..... ............................... ...................... ❑ SOLIDS. SETTLEABLE, mi /L ... ❑ TIN .............................. ........... ............................... OSOLIDS. SUSPENDED ................................... ❑ ZINC ....................... ............................... ................. ❑ SOLIDS. DISSOLVED ... ............................... ❑ ................ ................................ ............................... ❑ SOLIDS. TOTAL ........... ............................... ❑ .......... .................................... ............................... OSOLIDS, VOLATILE ....... ............................... O REMARKS:..................................... ............................... OSPECIFIC CONDUCTANCE ❑ .................................................... ................... .I......:.... ❑ SULFATE .................. ............I.................. : ❑ ..............................:..................... ............................... O-SULFITE .................................................... ❑ .................................................... ............................... ❑ SULFITE .:....................... .............................:. ❑ .................................................... ............................... ❑ SURFACTANTS ........ ............................... ❑ ............................. ..:.....:.......... ............................... O. TURBIDIT .. ....................... ......................... O • � ............................ _ .......:.......__. _7" THESE RESULTS INDICATE THAT'THE WATER WAS OF A SATISFACTORY SANITARY QUALITY WHEN THE 'SAMPLE WAS COLLECTED, THESE RESULTS INDICATE THAT THE WATER DID MEET THE SA ISFACTORY CHEMICAL QUALITY OF NEW YORK STATE ADMINISTRATIVE RULES & RECU TIONS, DEATN C WATER STANDAR ART 72) FOR THE PARAMETERS TESTED. ALBERT H. PADOVANI M,T (ASCP), DIRECTOR. PUINAM COUNTY DEPARTMENT OF HEALTH ' DIVISION' UFO EiVIROITTAL HEALTH SERVICES Date: Re: Property of. QA w P&L_ LA SAP-Be-P-A Located at Section Block Lot i Gentlemen-, This letter is to authorize a duly licensed professional engineer, to apply for a.Construction Permit . for a separate sewerage system; to serve th�_abave noted property in ac- cordance with the standards, rules or regulations as promulgated 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 super- vise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, HZ --he -Putnam -County Sanitary Code. a r Very truly urs Countersigned: Signed Owner 'of Property Cashin Associates, P.C. 37 Fair Street . . CarmE (914) SEAL P%_,ECEPRVE� L9'ANc2 P2 1.4 P-u 8 CA K_ 0 110 S e Address' 1983 9)4 -528- &,ss2- Telephone , t�QANA DEPT. OF HEALTH Insp.by• _ . _...._.._ :. INITTA.L SITE IH3P :CTT.O ?' � � Yes NO Commcnt:s ,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 SD3 area Additional deep holes needed.' - -� . Sufficient SDS area available considering driveway cut, house location,separation distances, etc. DEEP MOLE DATA Dap -h Water elevation: Rock elevation: Soils de-scr:i Dtion: Date: FINAL S.T-Tr DIET RECTIGN: Insp. by: House located uhere shot:rn on approved plan • . SDS locatbcu where approved Iength of tr Inch m: a. s ared Width of trench average Slope of tile line and tre. acceptable - -- - - Room allowed for expansion trenches . . . . fit... from-- st:Tali]D;1 °.'a1;E'?'GOU?:�.. Natural soil not .strip -ed or SDS area iuu1ecessarily graded ... 10 FL. maintained ..from prop-line and � - ' `- 20 ft. from house ; Separation of trench froi;i house, well --etc. --follows plan - - - -... —. - - - - -- - - - -- -- 'Itumber of bedrooms chocks . . . .. . . . ... Stones, brush, " stumps, rubble, etc-. greater thall 15 ft. from nearest trench 15 PL. of peripheral .soil horizontally from. / trench ... ... Junction boxes prop -rly set Could surface run off from driveway, roads, -ground. surface., etc. channel near SDS area. . . . . . . . . . . . . . . . Dcs lot dra.in-riLc �l.t�l oar 0. K. in area of SDS -- FINAL GRADING OF SITE ACCEPT1113L1; A4 l `� o4 227 PL PUTNAM COUNTY DEPARTMENT OF HEALTH o DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARIVIEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Tc rg:PA _ LA 5Av_Byr_A AddressrLEAAox_ 22- . JHRLJB ®Ak, 10599 c o �wACs Located at (Street 1"EEKSKft:� RAT z , .�`�'n. Sec.Tm Block i 1 Lot H : 44 - (2 ( (indicate neares cross street) Municipality �UT►J A m j LL_E y Watershed 44wDS0 at _�_• SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS . Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Eiapse Depth to a er Water eve - No. Time From'Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 1 1i�18- 11 :41 Z3 Mir). (g 2 11`44 r- 12:Oaj ccm. n. 18 ` Z(" alf. 3 tV,05-1z' 40 3\ cnrn. 21 10/i 1 1 �. 2 ' 1� 5 DEPT.. OF HIu�'�LT II Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. (i tzo tr-44 -2-A- or) ln. 4 2 H : 44 - (2 ( 3 m� n • . W` 1 �. 2 ' 1� 5 DEPT.. OF HIu�'�LT II Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. iZ,15..-!I. 4G 4 12'•41 -V2A 38 -711 1 �. 2 ' 1� 5 DEPT.. OF HIu�'�LT II Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 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 DESCRIP`1ION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE N0. 12" 18" 24„ 3011 ` 36it 42" i — 48" 5411. � 60" '� 3 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED -•- INDICATE LEVEL TOYHI CH WATER LEVEL RISES AFTER BEING ENCOUN ^1 D .TESTS MADE BY ,% 6C1 � Date az. S� lVRate Usedjl -l5z Miri/1 : *llrop: "" - S'.-D. 'Usable Area -Provided L6Qa© No, of Bedrooms 3 Septic Tank Capacity . j ovo Gals. Type ,e H Absorption Area Provided By�L.F.x24" width tr�?.. .Utne�r_�� C6UftTAi1J 3.)RA zQLiIZED }��R►wi�7EJL -O.� 5595`. `ONAL Name s ; N s s oc-; Tss , C. , Signature Address 3r7 EAiZ- 5=rP.E SEAL - C..4 2WiEL N Evy 0-IZIt THIS .SPACE FOR USE BY HEALTH DEPARTPE -NT ONLY: s'�r Soil Rate Approved Sq. Ft/Gal.... Checked by of THE '�a to