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HomeMy WebLinkAbout3419DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.17 -1 -26 BOX 27 03419 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Subdivision Owner Building Type Number of Bedrooms To be constrn Water Supply: Lot Area r 0 4,1% of " consist of v v Gal. Septic Tank i- ,L�d r. lic Supply be drilled by / 41 C: '70 WAJ X Al Town or T— Lot Job Address O�� 0 in:;, Total Habitable Space 0 �� y�� — Square Feet lineal feet X ' width trench Address `r L AI-V X1 jl�drV Other Requirements I represent that 1 am oily nd hd! lately responsible Ad the proposed system(s); 1) that the separate sewage disposal system above described will a con uct ho wn on the app sL a accordance with the standards, rules an regulations o e u nam County Departmen of H Ith, d that on completi a to + ruction Compliance" satisfactory to the Commissioner of Healthwill be submitted to t e 'Dep m - , and a written gu i the 'his successors, heirs or assigns by the builder, that said builder will place in good op rating ion any part of said e q uri period of two (2) years immediately following the date of the issu- ance of the appr val; th Certificate of Constru - rig 1, stem or any repairs thereto; 2) that the drilled well described above will be located as sh O e approved plan and that ell in ance with the standard rules and regu a ons of the 'Putnam' County Department ofd it . �-. L - /" Date As► P.E. t R.A. Address� License No.Ta -- APPRO/r.cause CTION: This approval expires one y e •date issued unless construction of the building has been undertaken and is revocabl b6\amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction requires pmit, pproved -for disposal of domestic sanitary sewage, a / r p at w er supply only. Date By Title PUTNAM COUNTY DEPARTMENT OF HEALTH `Division 'of_ „Environmental ; Health - Services;?..Carmel; : N. ---Y ^,- 1051.2, ---° ^ .yrr. _. .7 _ � _ -_- u ^ _ _ ... n3tr -.. ro. _• w. _ , _1 .- ar _- ..�y2....w -. •..c'r . .n =`��.. �.. '�'Y- + *:¢ar••�r.+. _. .^..r•e.a�v:.. e-�... •++- :4'.•� ...'C�weY -•a •. �,^ - . .. ... .. ._ . _.�. .-. <. - .. • -. - :..... _.... .. ..,-o. .^ •. _ ... —r. rte^ .a-. ... CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM 'IL-,W &j 0 6141 Town or Village a Located, at I ' 1 Tax Map� Block / gwrier �' ' i !- Lot b �i Separate Sewerage System built '6y� S , � 560; `t- � L / Address �`�i /�?� 'L'j A L� JV% 'M Consisting of 1066 Gal. Septic Tank and C! D L t t"�T' Other requirements Water Supply: Public Supply From Private Supply Drilled By' ''�// Address � -� i l�--i LL, N i Building Type Has Erosion Control Been Completed? I certify that the system(s) as listed serving the above attached), and in accordance with the standards, ru Date Address ms Date Permit Issued Is shown on the plans o the completed work (copies of which are i p�e)rmit , IpNed by )” Putnam County Department of, Health. P.E. R ^A- �- License No. 32 Z 2 Any person occupying premises served by the above system(s)'',� Mine r�such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate em shall become null and void 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 Commissioner of Health, such r vocation, modification or change Is necessary, Date �/� �� By Title �� 'ORKTOWN MEDICAL LABORATORY INC. - - P.O.., Box 99 321 Mar Street LOCATIONS: :121 KI-Al I ST., Yom- )WN Itr.IGII rS, N.Y. Io5gtr 2.15.3203. Yor�1own Heights, N.Y. 10598 LJ 201 UUTTONWOOD AVC., PCEKSKILL, N.Y. 105GG 737.8777 (1 495 MAIN 'ST.. MT. KISCO. N.Y, 105.19 666.3335 245 -3203 I S.T.ONELGIGII AVE. INCAfI IIOSrIT, \U, CAItA1EL, N. Y. 10512 27R•9 -- - .. LAB # 0974 DATE TAKEN: 6/14/82 (10:1 ) r DATE RECEIVED: 6f /1/4/82 10: 5 DATE IIGPORTED: G ! for ELLEN QUICK SAMPLESOURCE:• TAP: KITCHEN 183 LUIGI ROAD REFERRED oY:' CROSSROADS PHARMACY PUTNAM VALLEY, NY.10579 COLLECTED BY MR: QUICK LABORATORY REPORT .:_ nig /L ❑ ACIDITY ............................ ............................... . LI ALUMINUM ................... .. ........ ............ ..... ........ ❑ ALKALINITY ........................................................ ... CI ANTIMONY ....... ....... BACTERIA, TOTAL /mL .............. ....................:. L.I -Nf1SENIC .................................... ............................... ❑ 000.5 DAY ........................... ............................... CI !IARIUM ...... ....... . 0 BROMIDE ..... .... .... ....... CI !JERYLLIUM ..... ........................................................ . ❑ CARBON DIOXIDE, FREE . ........ ............................... CI 111SMUTH ........................................................... ........... ❑ CHLORIDE ......... :.................................................. L"_I IIORON ........................................ ............................... ❑ CHLORINE ............................................................ CI CADMIUM .................................... ............................... ❑ COD ...................... ..... .... L'1 CALCIUM , ❑ COLOR ................................ ............................... CI ( :I:IROMIUM (tot.) ...... ..............,................ .................. ...D CYANIDE ............................ ..............I................ CI C19ROMIUM (hexavalent) .................... ............................... ❑' DETERGENT, ANIONif� ......:..... ............................... Cl COOALT .................................... ............................... ❑ FLUORIDE ............ ` ......... U COPPER ......... DHARDNESS .......................... ...................... CI GOLD .................... ....... ...... ............................... ❑ MPN COLIFORM COUNT/ 100 ml ............................... CI IRON . .......................... ........ ...................... :. OWT COLIFORM1 COUNT / 100 ml ..6 ............... n- I -r_AD. ' ...................... ............................... ❑. CONFIRMATORY TEST ............ ...............:............... 0 I.IT111UM .................................... ................ ................ ❑ NITROGEN, AMMONIA ............................................ CI MAGNESIUM ............:................... ............................... ❑,NITROGEN,.KJELDAHL ... ........ CI MANGANESE .................... ..... .. ...................... ........ -... ❑NITROGEN. NITRATE ..... ..................... .....: ... f=I :vrEP1CURY ................... :.....:.:.i .r.a,. ..v.... ..... «.:... ... O NITROGEN, ORGANIC .......... ............................... CI. NICKEL .... ............................... ....... ..................... ❑ ODOR ;.:........................................................ 0 PALLADIUM OOIL 6 GREASE .........:.............. 0 POTASSIUM ................................ ............................... ❑ PH .................................... ....:......... ........:.....:..: ❑ 11110DIUM ..............:........... ............................... OPHENOL ............................................................... CI SELENIUM .................. ....:.......................... ❑ PHOSPHATE (ortho) ................. ............................... C3 .;ILICON .................................. ............................... ❑ PHOSPHATE (condensed) ............ ............................... CI ..ILVER ............... ......................... ....................:.......... ❑ PHOSPHATE (total) ................... .......................... CI 30DIUM ........... ............................... . ...................... ❑ SOLIDS. SETTLEABLE, ml /L .... ............................... CI rIN :. ❑ SOLIDS. SUSPENDED .............................................. Cl /.INC ................... � ......: n OSOLIDS, DISSOLVED ............. ............................... C) ........................... s:;r+ �......................: ❑ SOLIDS. TOTAL ................... .................... n .. .............................................. ............... ;. +.......... ❑ SOLIDS, VOLATILE ...... �..�. Gi ll wAnKSt ;.....1....... :dukl,:21-1�Q ............................ OSPECIFIC CONDUCTANCE .......................................... 0 .......... ......... ups...... ❑ SULFATE ............................ . ...... ........ . � 1b❑ SULFIDE ........................ ... ....................... VNTY............. ...... OSULFITE .............. ... ............................... ...... ............. � ....... DSURFACTANTS' ................................................ Cl ................ ............................... DTURBIDIT . ...................... THESE RESULTS INDICATE THAT THE WATER WASU14 OF A SATISFACTORY SANITARY QUALITY 1411EN THE SWPLE WAS COLLECTED. THESE. RESULTS INDICATE THAT T11E WATER DI(. _. MEET THE SATISFACTORY CIII•IICAL QUALITY OF NEW YORK STATE AWINISTRATIVE RULES &. REGUI WT.ONS,, DRINKING wA m ST, \NDARDS (PART 72) ALBERT 11. PADOVAN I N, T (ASCP) , DIRECTOR:- r WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71- Division of Environmental Health Services COI�MTY OFFICE BUItDIN<,'= AFtAEC,'Nfw - YORK ' This report is to be completed by well driller and submitted to County Health Department together with laboratory report of analysis of water 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 NAME ADDRESS OWNER ) C I —� T' "! (No. 6 tr et) (Town) (Lot Number) LOCATION OF WELL AAE IC l7 �i BUSINESS ❑ ❑ ❑ TEST WELL PROPOSED 11U DOMESTIC ESTABLISHMENT FARM USE OF WELL ❑ ❑ ❑ CONDITIONING ❑ OTHER ) SUPPLY INDUSTRIAL DRILLING ❑ COMPRESSED ❑ CABLE OTHER ❑ EQUIPMENT I'D AIR PERCUSSION PERCUSSION (Specify) CASING LENGTH (feet) DIAMETER(Inches) WEIGHT PER FOOT ❑ WELDED RI SHOE j ❑ YES ONO 5 CASI G QOUT�D7 I� YES LJ NO DETAILS % THREADED YEL ❑ HOURS ❑ C G.P.M. YIELD (G.P.M.) ✓ TIEST BAILED PUMPED COMPRESSED AIR 7 WATER MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST (feet) Depth of Completed Well LEVEL in feet below land surface: 0­6 MAKE LENGTH OPEN TO AQUIFER (teet) SCREEN DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL Diameter of well including GRAVEL SIZE (Inches) FROM (feet) TO (feet) PACKED: gravel pack (Inches): DEPTH FROM LAND SURFACE FORMATION DESCRIPTION / Sketch exact location of well with distances, to at least' ., two permanent landmarks. FEET to FEET C7 % Sv D R C D 2d G CeMeLerlew V 982 JACOUNTY DLL EALTH If yield was tested. at different depths during drilling, list below FEET GALLONS PER MINUTE wet` i,, l G fD DATE WELL COMPLETED DATE OF REPORT WELL DRILLER (Signature) /� ..•. �' "r �. iL' ,_ :: :.. i- :�.:"1C -i.�_ .. _r .$. ._.'-�___ '.� •�.. .. �''�yr'i,:..-. : ..r ,..: •:�•�: =i:'-� i...r .� � � i i. ^ lac. - -� - � . � A LG. Owner oar :urc if aser or. Building nici.pality Building Gonstr cted by d-1 /W Location - Street Block EfG' i Pic 1 Bull ing Type Lot 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 cons- tructed 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 de- termination of the Director of the Division of Environmental Health Ser- zr_ace:s_-of� Yi. �P.:�tnam. oi�nty.DCp .artment;.:o:f_,:Health�as.sto: Y. failure of the system to operate was caused by -the willful or neglige t act of the occupant of the building utilizing the syste . Dated this a5' day of 19Z Signature ss _ — Title �, � -Tec -- If corporation, give name zr and address) � s %� S _ c:�/�C =_ / les %/ LG i l.,��� _ �TrI.�/ �Z l�'%� t /Z/// - ::.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. RECEIVED JUN 2 81982 PUTNAM COUNTY DEPT,, OF HEALTH k3 R T, NAM Crl"� '11' WTRJ� AMNT Cr ITArMl I V11 J!;"'. "N-T.A. N-+1 PAT., T1 V -SFPk1'f'C',S' D T�Vj�. Date 40 Z7Z'I—' - 'J Re Propert y o d,/ D L't Located a*tzul*.6 4A-),.V' 0 � Z�4 C�f �n 7Z Block Aot .10 Gentlemen: This letter is to authorize i"duly licensed professional engineer J/ or registered architect (Indicate) to apply for a Construction Permit for a separate sewage system; to serve the above noted propertyin accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County -Department of Health and to sign all necessary paper's on my behalf it connection with this matter and. to supervise the construction- of said system or systems in conformity with the provisions of Article. 14S or Z 1.3. L,�t -the Public Hezil'h tai�_ and the Putnam County Sani- on T V� I L IP tary Code. CounS.c6rsigned: 0 Very truly yours, Signed_4 Owner of - Property Address 272-o Address OT 216,37 ..501 24 Telephone a. !' Ar property 'lines or corners round Can esti..rr:t:: house hoc:ation '. ViD. drivci•:ay need- cut — - Mu.ci_b trees b�_-, rer.;oved -note these Is deep hole rcprosenta t- ive of entire SDS area Add.i t i.onal doen i�olcs ne,cdcd. _4Z Stit f.i.cient DS area available considerin driveway cut, houso location, separation . distances, etc. Doptth : g r ldater elevation: � I'llocli, elevation: / p •. Soils descri Dtion: •�� j Date : . FIRAL SITE INSITCTIOD1 Insn. by: House located %.:here shoim on approved plan SM locat ..d �, _....re a.ppr o . ,d .. _. Slope 'of ti 1.e li r_e and' ' —acceptable ccep ±able; -. '.; • ' Moor, allowed for exrpai ision trenches Over 50 ft. from svat>ip. aterc ours e Natural. soil_ not - .s-tri aped, or SDS area ' - tnnsi�l,� bra did~ . ' . = =, ; - -;- :� �;;.�• �. - 10 lft;... maintai�_ebd from prop.line and 20 ft. from 1-Louse . . . _ Separation of trench from house, Drell etc follows plan . Number of bedroei:is checks 1 Stcnes, brush, stumps, • rubble, etc. greater - -' t ba.n 15 ft. from . near° st trench _ - 15F l; of peripheral soil horizontally from -� .trench .. Junction boxzs properly set Could surface run off from driveway, roads, ground surface, etc . cha nne'l noar SDS � area . .... - . , , •. . alas 1bt draina�;° anrear O.K. in area of " >DS KRU GRADING OF SITE ACCEPTABLE, R T Ew CHECK SHL�r�T Meets Std.( Remarks Yes 1 No House plans O.K. Design data sheet i Peres presoaked? i_ i Min. 30" pert test depth i Const. results for 3 runs D. Hole log O.K. Corporate.Affidavit for other than individual Authorization for engineer I Letter from Water Supply if applicable i If variance requested -such noted on plans & apps.: I DETAILS �ishfo*wchnag erw e is proposed,) Existing contours shown contours) (/ Slopes.'for driveway cuts, etc. shown i Water service line location Footing drain, etc. location I Top slope, bottom slope of fill Percolation tests and deep test pit location i Septic tank size and conformance to std. 3 B.R. house inin_imum I Howse setback . shov-n.. j )s G i All. •Wc 6er Wl Ui" 11 Do l U. bf U_U 011UW11 i Plan and profile SW -All other wells and.,S�S closer 2�0 j .M9hoW-- A- or...ref0rOnce made­,;- Property boundaries (metes and bounds - clearly shown.l � + SEPARATION DISTANCES SPECIFIED ON PIA 10' to P. L. .20' to Foundation walls 1001 to Nearest well 50' to stream,. march, lake, etc. incl.i 15' to Curtain drain 10' to water line (pits -20' 15' to storm drain 10' to large trees 10' from foundation to septic tank 5' to pipe from leader drain:& foozing M . COUNTY DEPARTMENT., — _�+t �. — ._ � .. — .�� ...c :r. rJ,'.i� it •.DVS+: DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET� -- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. r� Owner &4 L 6� 1'!- a j c e'C Address k R gA4C 10 /i a Al., , Located at (Street Ul6! '19el ✓e� • Block % Lot / % ica e nearest ; ross street) Municipality t54N r�'iN Water shed �lS'`GL .SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Elapse Depth to Water WaEer_ZFve1 No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 3 & j L 7 . i._.._..�. _ �� 1 � o� �f" l / -• off„_ .. 5 1 E� 2 .3 4 Notes: 1�) Te'�ts to be repeated at` same`'deptrn 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. I TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION. r: OI, -SOILS ?BlICOUN -EREB- =INS Tt--H ....�,. DEPTH HOLE NO.- HOLE-NO. %�a- . HOLE NO. G.L. 6" 12" 18" _ -y 2 It 3011 ti 36" 42" 48" 54'I 60" 66" 7211 78"' _ ::. I1�D�CATE ..I.i. AZ`WHTCH:.GRUUNDaWATER ISM_E1 C.OITTERF4 INDICATE LEVEL TO WHICH WATER DEL RISES AFTER BEING ENCOUNTERED '.PESTS MADE BY � 5= mgr r,�` ®� � Date 7j_ DESIGN Soil Rate Used__,Zo Min/1 "Drop: S.D. Usable Area Provided — No. of Bedrooms 3 Septic Tank capacity,/4000 Gals. Type -e Absorption Area Provided By L.F.x24" 5b" width. trench. STANLEY 1. LANDER oth n -� Address THIS SPACE FOR USE BY HEALTH DE Soil Rate Approved Sq. by. Date d soz 4 36" 42" 48" 54'I 60" 66" 7211 78"' _ ::. I1�D�CATE ..I.i. AZ`WHTCH:.GRUUNDaWATER ISM_E1 C.OITTERF4 INDICATE LEVEL TO WHICH WATER DEL RISES AFTER BEING ENCOUNTERED '.PESTS MADE BY � 5= mgr r,�` ®� � Date 7j_ DESIGN Soil Rate Used__,Zo Min/1 "Drop: S.D. Usable Area Provided — No. of Bedrooms 3 Septic Tank capacity,/4000 Gals. Type -e Absorption Area Provided By L.F.x24" 5b" width. trench. STANLEY 1. LANDER oth n -� Address THIS SPACE FOR USE BY HEALTH DE Soil Rate Approved Sq. by. Date ti Putnam County Department of Health Division of Environmental Health Services Approved as noted for conformance with t I allie n tons of the 110, Count ealth Department. Signature Ti le Date togs Wa wmdef a in' *S 08 vo to al SMM ed 6g hft" It = tMed LT ri N S013 *a IWAVA k WMAW, VO Wft 4 to MA Ik"It 0