Loading...
HomeMy WebLinkAbout3564DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74. -1 -49 BOX 28 03564 i ; A 1 ■�� 1 03564 6 . ��✓ PUTNAM COUNTY DEP RTMENT> OF 'HEALTH (,. Division .of Environmental Health :Services Carmel N. Y. 10512, LkRT�F;II`ATE 'Q1 11 STRUC QN COMPL AN . E EOr� Putnam <.Yallet m t rl l r V"AI.�Ew 71�R0S�,1,.� ^Y�'T�111L `�.,�, �+ � „ J Town or, Village Wood Street " 62'+ 3 Located ;at — Section -Block Mr. &Mrs'• Richard" ;Galbraith 2 ,Owner- Lot = Job SAF Septic Systems ` Katonah; N;. Y. separate Sewerage System built by. - Address 1200 J� 1'- Cons�sting of Gak Septic :tank T�0 lineal Feet X 2rm width 'trench Doinestc Us "e On1 Other requirements - Water - Supply: - Public Supply From ' ­x Pr��ate supply Drilled. By. _Anderson.^ We] 1 drillers., .Putnam -Valley ( Barger St) Address New . York L �I, Building Type 2 story ,fraAle �No, of Bedrooms T Date Permit'Issued " x ••t•• Has Erosion Control Been Completed? Ye `S t. �.• u•� `I ?f °certify.:that the system(s), as listed serving the above, premises were constructed essentially as shown plans •!w aeted work :(copies of which are attached), and in accordance. with ' the standards, rules'and - regulations plans Bled;' and the per�li I'; ounty Department of Health. Sept 10, 1.983 -ate Certified by c _• o. �, P E: X R.A. r -1 Northrid `e R Peeksk 1A, fix ' 6' =a • x�d27846 Adtlress license No Any person occupying premises served by the "above systems) shall 'p take such action asTbaj,/�Ij� _ cur%ihe correction of any unsanitary contl•itions resulting from such. visage. Approval of theseparate - sewerage ;system, shall become. neu 3•�P idA ,as' a public sanitary sewer becomes ;:available and the approval of the' ,private water supply shall become null `and void: when a public, waterpplyr'bewcol'hes available. Such, approvals are subject to modificationcor' change when, m the judgment of the C missioner of, Health(,Docalf&M'-,m6dificatlon- or ch ange .is necessary. 3 Date By z Title r ••��1qq10 `` PUTNAM COUNTY DEPARTMENT OF Division -of Enm;ronmenfa/ Health Seryiies, Carmef N Y 1051,2 . aCONSTRUCTLON PERMIT .FOR SLINA!3 DISPOSAL SYSTEM Putnam Valley '.(T) Town or.:. Village Located' at Wood Street J, Taz'IVlap 6J2 • 91k 3 i Subdivision None r Lot ] Job c t owner Ri'char'd': Call b?'a th Address ' W 2 story frame, 1.1xAcres New °Y rk 10579 Buliding:Type Lot Area 4 8 0,0 gal's /day ` 210 Q Number of Bedrooms' -esign Flow '' Total Habitable Space Square Feet Seoarate' Sewers.. < - Sustain tb 2onsist of '`Gal_'Sentic.Tanki and< ,.?�? 5 LF ',of -, 2.:_,.; Trench, - .. , v V. Water Supply Public SuPPIy From X arson e 1 r--T1ers ' Private Supply t 0:6 6 diiiled by••' n addre5: Barger Street Putnam j Valley, N.Y. Other Requirements Minimum of .100 ft' ,away from4dr� nag ®Antch h:represent that I am wholly and completely responsible for the desjjgyid location of the propo egl(s)R °ire. separate sewage. disposal system above described, will be.constr`ucted as shown on the approved amendment there to and .in acco./da Ias an regulations o e u nam County, be of °' Health, and that on compiefron thereof a Certrficate of^ Constructy, I' .•c sa is- tb the• ommissioner of He"alihwill be submitted to the Department "„ and a' written =.guarantee will be:,;furnished- the.:owner , tNS: ssor assi y�the builder, that said,buiider will ng' the'I r f tw m edrately following ;the date of •the issu ance of : he�approyal' of thetl,Certificat o Construction eCompliansce of the original Syst ny . eto at the drilled well1described above opera g rt g p y `w,ill be_ located as shown on:the approyed plan and.thA said well will be installed in accordarigp• wit i th r" I a ®d. regula, ons� of °,the Putnam, County Q 4. ,epa!i m6ni of Health April 28, 198.0. sq M�; X: Date Signed'' 1 t?,E. R.A. 1 Northridge�Roa eeksk l Address License.No..0.2�8`+6 APPROVED FOR CONSTRUCTION: This, approval p' ex Tres one_ year from the date issued -un i­­ ' nstruction of the ,building ha5'been undertaken and Is ►.`vocable for .cause or may be amended -or mod ified, „when consi re essary._by. -the issued ass er -of Health, Linn' °construction requires 'a new ermit rgpproved` for disposal of domestic nitar s ag r iv a only q Date - .. . Mr. & Mrs. Richard Galbraith 62 Owner,,or Purchaser of Building Section Richard Galbraith 3 v- ` uYding"C"ons'ructe'd 15y ock - Wood Street 4.12 Location - Street Putnam Valley Municipality 2 story frame Building Type Lot Subdivision Name 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 determin- - ati,on, of. -the _Direct•o -r- .of-.:the:..Division -:of >.Envir.onmental:.Health Servia.es of the Putnam Count De artment of Health as to whether�or�nothe faif - ure of the system to operate was caused by the wi f egli ent act of the occupant of. the building utilizing the sys e . Dated this 28 day of July 19 83 Signature RECEIVEDTitle OCT 13 1983 Corporation Name if corp. R '0 1ITY Address L.Th 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 1 TOWN OF PUTNAM VALLEY WELL DRILLERS LOG AND REPORT r, .Lw.a.••.n rwa -, +f s:•: n.`. .Y.:- :. -.r w':'��rX n1 :i.- -.:.. T'' #': :. h. I+ i+ .0• IP^ ..w+M1• .r-t r`V�T P. a.a. .r.b It i \.• WELL COMPLETION REPORT This report is to be completed by well driller and submitted to ,�.Ldg. department, together with laboratory report of analysis of water sample indicating water is of satisfactory bacterial quality. Well Location (CwZ i$i -0�0 -3 Tax Map Street Sec. Bla Lot Well Owner Well DrillertZ Name Mailing Address City or, Town Tel. #6z el, z I Ct Mailing CASING DETAILS YIELD TEST WATER LEVEL I SCREEN DETAILS Length y Ft, Bailed or f X Pumped Hrq 1 Measure= from J.and !Statics Ft. surface Makes 19AIAna %iikroai DEPT. OF HEALTH Diameters t Inches Yields 2-S GPM When Bailed or Pumped Ft Slot Length FteSize Kinds i Diameter In. TOTAL DEPTH OF WELL %�� f .Feet WELL LOG Depth from Give description of formations penetrated, such Ground Surface ass peat, silt, sand, gravel, clay, hardpan, Sha1Q., : gad -oho gs s;it'e, eta~ Inclt!de .s ue di'.:. _- gravel (diameter) and sand (fine, medium, coarse), color of material, structure, (LAose, packed, cemented, soft, hard). For examples 0 ft. to 27 ft. fine, packed, yellow sand; 27 ft. to 134 ft. gray granite Feet to Feet Formation Descrirtion SF 9 OCT 13 1983 19AIAna %iikroai DEPT. OF HEALTH Date Well Completed S / Date of Report Well Driller Signature BZS 1 -77 0 YORKTOWN MEDICAL LABORATORY INC. P.0. Box 0 321 Kear Street LOCATIONS: I'� XjCl 321 KEAR ST., YORKTnWN HEIGHTS, N.Y. 10598 245.3203 Yu�l�Mi1iILIW1141, 11.1. lulilf ► 1,1;11iii'luv'fi I'll AVI.,l-lII it I.I!.,.l1'iiJ; ;� :111 ;;; �45-320� - . I IAU11MlAINt:I MI In'•ti • "� - „=,•• ".,�., >.•. "` •,�.,' - „' � ••_ ” :, '° '� J STONELEIGi; "A•VE "(N[AR F1CyS�ITs'i`�,`G`•A`RfVi�L, N. �••.= 1O�S�2�278'2 3:130' LAB # HV 0177 DATE TAKEN: 1- DATE RECEIVED: 2 9 82 3 P.M. ) PAT GALBRAITH DATE REPORTED: //— CA- SAMPLE SOURCE: TAP: KITCHEN RD4, BOX 196, WOOD STREET MAHOPAC, NEW YORK 10541 L _I (526 -2199) LABORATORY REPORT mg /L REFERRED BY: COLLECTED BY' p _ [rAj.RRA TTN ❑ ACIDITY .................. ............................... ❑ ALUMINUM ................................ ............................... ❑ ALKALINITY ............................ • 9BACTERIA, TOTAL/mL ............ . ................ El ANTIMONY ................................ I-] ARSENIC .................................... ............................... ............................... ❑ BOD, 5 DAY ................... ............................... ❑ BARIUM ,...................................... ............................... ❑ BROMIDE ................... ..............................• ❑ BERYLLIUM ................................ ............................... ❑ CARBON DIOXIDE, FREE .............................. ❑ BISMUTH .................................... ............................... ❑ CHLORIDE ................... ............................... ❑ BORON ........................................ ............................... ❑ CHLORINE ................... ............................... ❑ CADMIUM .................................... ............................... ❑ COD ........................... ............................... ❑ CALCIUM ............................... ............................... ❑ COLOR ....................... ............................... ❑ CHROMIUM (tot.1 ............................ ............................... ❑ CYANIDE . ................... ............................... '.: ❑ CHROMIUM (hexavalent) ..................... ............................... ❑ DETERGENT, ANIONIC .... ..........................::: - 11 COBALT .................................... ............................... ❑ FLUORIDE .................................................. ❑ COPPER .................................... ............................... ❑ HARDNESS ................... ............................... ❑ GOLD ........................................ ............................... ❑ MPN COLI FORM COUNT/ 100 ml ...................... ❑ IRON ... .. .. ............................. MFT COLIFORM COUNT/ 100 ml ' ❑ CONFIRMATORY TEST ... ....:.......................... C1 LITHIUM .................,.................. ............................... ❑ NITROGEN, AMMONIA ... ............................... ❑ MAGNESIUM ................................. .................. _..,. CJ..N17fiOGE- N,.KJLb AlIL °: ........ .....T..........-........R .. -.� L��- Mr, 3M1IG %kNESE = :..................... -...:.... ....�.. .r,. ❑ NITROGEN. NITRATE ... ............................... ❑ MERCURY .................................... ............................... ❑ NITROGEN, ORGANIC ... ............................... ❑ NICKEL ........................................ ............................... -. 13 ODOR ❑ PALLADIUM ................................ ............................... ❑ OIL & GREASE ............... ............................... ❑ POTASSIUM ................................ ............................... ❑ PH ........................... ............................... ❑ RHODIUM ............................ ❑ PHENOL .. .......... ❑ SELENIUM ............................. .J . . . ®.... ❑ PHOSPHATE ( ortho) ............................... ❑ SILICON .......:.... .... ....................... ❑ PHOSPHATE (condensed) ... ................:.............. ❑ SILVER ......... ............................... ❑ PHOSPHATE (total) , ............................... ❑ SODIUM ...................................... ��^^T-1-31993.• ................................. ❑ SOLIDS, SETTLEABLE, ml /L ....:................... ❑ ❑ TIN .................... ............................... .COull yI... SOLIDS, SUSPENDED .................. ................ ... ............................... ❑ ZINC ........................................ P.UT!�AM IiEAL'TH "' CSF ................ ❑ SOLIDS, DISSOLVED .................. ❑ ................. ............................... pEPT. ................. ❑ SOLIDS, TOTAL ........... ............................... ❑ ......... ............................... ........ ............................... ❑ SOLIDS, VOLATILE ....... ............................... ❑ REMARKS:..................................... ............................... ❑ SPECIFIC CONDUCTANCE .............................. ❑ ....:................:...............'............... ............................... ❑ SULFATE .................... ............................... ❑ ..........................................:......... ............................... ❑ SULFIDE .................... ............................... ❑ .................................................. ............................... ❑.SULFITE .................... ............................... ❑ .................................................... ............................... ❑ SURFACTANTS ............ ............:.................. ❑ ................................................,.... ............................... ❑ TURBIDITY ... .................................. I.......... ❑ .............. - - - -- THESE RESULTS INDICATE THAT THE WATER WASOF A SATISFACTORY SANITARY QUALITY WHEN THE SAMPLE WAS COLLECTED, THESE RESULTS INDICATE THAT THE WATER DID ._ MEET THE SATISFACTORY CHEMICAL QUALITY OF NEW YORK STATE ADMINISTRATIVE RULES & REGULATIONS, DRINKING WATER STANDARDS (PART 72) f ALBERT H. PADOVANI M,T (ASCP), DIRECTOR: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES , COUNTY..OFFICE BUILDING, . CARMEL, N. Y. 10512 . DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL.SYSTEM FILE NO. Owner Richard .Galbraith. Address Shamrock ,Drive. Putnam • V8.110'y, 1 N.Y. -1057 9 62 Lot- Indicate., :. .12 Located at';. Street Wood Strad Sec.l ock 3 neares - ;gross . s ree . Municipality Putnam Va11eY,..::.. y,. Watershed Lake Secor+ .. SOIL`.PERCOLATION'.TEST DATA .REQUIRED TO TAE ST�BMITTED WITH:APPLICATIONS `-` r Number ...:....... C OCK-.._TIME . PERGtI AT16N .. °' _ . PERCOLATION, .Run .:, ... Elapse No. ... ... . . �" "` ;Time Depth o Water' . ; From. Ground .Surfs ,66:In' a. er ve Inches. -, -- "Soil Rate Start Stop ;Min. F. Start Stop ''' "Drop in . , in. /in drop ...._.: m..-...: ...__ ....... ......:......:..... .:.. Inches .. Inches.. Inches 2a,,' 6.: .29.25 30.025 .1.00 :. .......'y,.. ,6: 00 29.25 30'.25 1.00.. '., °: 00,; 11.2 11:4 9 7 3.:.... Y .:.... �....:......:......_..: ,. 29.25 .30.,25 1..00 7. o0 5 : ..: ...::.... . .... .... 28.75. 29.75 1. oo::.. .5 .'0.0 . 2 lls'34� it: i - :2$:75 29:75 1..010 +... 3 11: 6 11.:5*3' 7 28 Y 75 . 29-75 1: oo ..: :.1..,.. 7.00.' ' 2' may' .t ✓.Yr `.f ., >s Notes: ..1). T Ats' to. be repeated at same depth until approximatel y 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*. ;� TEST PIT DATA REQUIRED TO-BE SUBMITTED WITH APPLICATION. j DESCRIPTION OF SOILS ENCOUNTERED IN,TEST HOLES. DEPTH HOLE NO. 1 HOLE NO HQ 0 3 • r...0. r... o ., . - ., �_,..r. - -�.. G.L. Topsoil Topsoil Topsoil Topsoil ..brown snady'gravlly 42" 1. ^ I# -r 0 Name John � R6Me6 Signature 1 Northridge. Road Address-. . o ° a SEAL ee s , . ° a C ° 27846 0 o THIS SPACE FOR ,USE BY HEALTH DEPARTMENT ONLY: ��° 00000000 0 °o , Soil Rate Approved Sq.- Ft /Cal. Checked by Date PUTNAM COUNTY DEPARTMIlVT OF HEALTH DIVISION OF ENVIkNMENTAL HEALTH SERVICES Date April'18, 1980 Re: Property of Richard Gailbraith Located at Wood Street9•Putnam Valley' Section 62 , Block 3 Lot 4'12 Gentlemen: This letter is to authorize John S. Romeo a duly licensed professional engineer X or registered architect (Indicate) 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 Department of Health, and 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.-p ro�ris gins ©f Art cley =l : 0,11'" "147; Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned: 3.E., AUW� #. 027846 Very 1 s Signed' • Owner of Property ✓` Address 1 Northridge Road Address Peekskill, N.Y. 10566 ..737 - 1056 Telephone ,*991A 000 h0 Telephone Mo W� °. MFa • pa's • O a � i�f • s �, ?)ga6 • pf HER � ;.� i; Z pis' r� i •. r� F ��< T t � �t i 1 '. .i �.� +�. f ; �1 �J y•. �; �• s i :;