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Home My WebLink About3582DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.09 -1 -3 BOX 28 03582 CrI+L L 03582 --� "'t-'e... ' rr } p— ,�-`e ---Q e Jk>r-+-'+- ---. -1.. -.,- _^^• --F --��c - -- //� ' . r � 7 ~�� t •� � icJ ,` � �'r, � � ,1�.�� `�::'��.+�.� r�YG�[�"(��' r :w+-, n^�- --'w Si 1 ' { .'Y PUTNkM COUNTY ®EPART1itENT :OF I�EALTH p Perm Dcyision.:of - Envirogmental,,Hbilth Services 'Carmel',N. Y} 1,0512 : a' 1 _ i. CONSTRUCTION PEAMIT_FOR S�WAGE:`DISPOSAL SYSTEM '' LJ Town or illage / `i• Located at e[--� ; t` Tax :Map `� Z Block Lot ,! Subdivision Subd Lot a Renewal2 Revision (] a A fl ➢ } 1 �+ Date,Of Previous Approval Building Type`r � VviJ .�t r LOt Area +Y idl'.-section,only ❑ Number of Bedrooms Design Flow G /P /D �.�� P C. x D Notification Required ., Separate.Sewerage', System ,:to' consist of Gal - Septic Tank and - t` -• To :be constructed 6y Address Water Supply: Public Supply ,From, Private' Supply -; to be dulled by Address Other Requirements.. .I ,represent that,i.am wholly "and :completely responiible for "the deiign and location of, the proposed °system(s); 1) - that the •separate sewage 'diiposal system C abo4e described will be constructed as shown'on the approved amendment "there tdand in accordance with the standards; rules an regu a, ions o e' . u nam County Department' of ' Health, .arid that on cortipletion thereof a -- Certificate :of: Construction Compliance "lsatisiacfory to the bommiisloner of Health Will': be submitted. to'the Department; and a- ,written guarantee wiU De' furnished the owner ,his. .successors heirs or, assigni- by`,the builder; that said builder.will , place , in,good operating, condition. any"part 'of' said:'sewage 'disposal system during' the period' of two (j' j' years immediately :followingthedate of ,the issu•,. ;ante' of'the,,approval of, =the Certificate:of Construction ;Compliance ofrthe original system br any. repairs thereto; hat the drilled, well described above '.will" be located as shown.on he approved plan` and that -said well Will be installed cord ance ith'th .`standar s,, le and uu a�ionb - of ,the ;Putnam County Oepar. e t of 11 al a l/ 'Date "Signed P.E. R.A.' Address License No APPROVED FOR 'C . -This approval expires one'year from'the date`,ssued`u" ess 'construction of; he;bwlding' has, been undertaken grid is '-revocable for cause or may be amen ed.or modified when;conside're sa'ry the Com i sione'r of Health., Any change or alteration %of construction.. iequires a ne perr�t Ap d for disposal of domestic sa aiy a_ge and /or pnv wateply only Date By, Title Rev. 9 PUTNAM 'COUNTY DEPARTMENT -.OF HEALTH:s� DIVISION'OF'- ENVIRONMENTAL�HEALTH SERVICES " :. _ ......... ... :._.__._____ -_. COUNTY OFFICE BUILDING;"- CARMEL, N. Y. -10512 DESIGN DATA SHEET- SEVARATE SEWAGE DISPOSAL SYSTEM,",- FILE' - CVO.'' _... _. �.. _ z:..:::::::__..._ w:.. 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. ?) Depth measurements to be made.from top of hole. �r ,3 � :Y__.Qt: �� ,�.. • _.:_. _w.:� .�___..._._�..._. _.�. �� -= ._� ._.... �� _ :.___:._._�__ .ice ' � �j,✓ _ � �' �.y i 1 rr'w�L` t� \�-a i ! r �-� � ,j. �..;�•.;��:..i,�Z.l %; _.._ 2 5..... o, 3 JUN PU) NAM COUN ; Y DEPT. OF 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. ?) Depth measurements to be made.from top of hole. A_ ' 7.. PU.TNAM CgUN'Y'Y DEPqkTMENT' OF :HEALTH permit &Xk Divrsfon.:of Environmental Health Sewices Cacmef N: Y. - 40512 ; CONSTRU N :PERMIT :FOR SEWAGE .DISPOSAL SYSTEM'` ✓ d p ." Locate' at "/ i /mot �'t%� :'c"' �✓✓ 61� clock .� ag tot Tax Map or III Z :'Subdivision 'Sulid...Lot'N Renewal _(] .Revision _� /y •yt✓`.t'TtK/') / -•';1� Owner /Mdress Date .Of Previous Appioval Building Type i !/. CiP7/` ef _ . Lot Area ✓ Fill section only El Number of Bedrooms _ Design Flow G /P /D D .Notification Requited Separate Sewerage System to . consist of , C/' C1 Gal.. Septic Tank and 2$ /a 1/ ;Je -. . T 0- `tie- Constructed by' Address ,.Water Supply: P blic Suppi ''From P Prwate Supply. to be :drilled.,by Address l fl� / Z�� /e✓ . ..��`� Other': Requirements 1 represent that,l am-whollyL and. completely responsible for the desigr* OF IONS. f,0! 0 proposed ;system(i)l''1) ,that. the, separate `sewage, disposal system above .described will be constructed "as °shown on the appro "ved imend;►,y��`F� it tagr to,`it�tl f�j� t'ordance with the standards, ruts; and-regulations o a Puma m County Department 'of Health,' and that on eompletion thereof, �C%e of!Ai5il(�Ctwi t on Compliance "•_satisfactory • to.the Commissioner of Healthwilt' be`submitfed to_ahe Department; and a'writfen' guarantee wiN�be <sa�i ished the o �'ed hi�gwccedsors, heirs or assigns by the'builder;,that• said builder will place in good operating condition any ;part of -said sewage giipo, A ystern, du !in �rhetper%d;of two (2).years immediately following the date of the issu- arice of the approval `of fhe' Certificate of Construction= Cor#Ipliafl a ofy the original system r. any repairs thereto. 2) that the drilled well described above will. be located as shown on the approved plan and that said wel4wiil'be installed m bcco ce irithlthe standards rules rand .regu ads of. the Putnam ..County Oepartme t of Health. s , Date R.A. 'Andress APPROVED FOR CONSTRUCTION;- T S a pproval a Tres one year iro 1 revocable for cause or'may . be amends or modified wh n ' nsidered nece3s8 ,;Yequires a new p mit. Approved or disposal .of do SZI Mary sewal .'Date r By ..\ . ' 'Rev. 9 -81 ..� ? -License No, le ;date nless•,construction' of the building has been undertaken and Is y b`' he'`C m issioner of:'Health .'._Any,cha alteration of construction s, s�A{er =prt ate water supply "only.* ` Title PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property of r-,1 r1 Date 31,11 .5S Located at An / 9 -4 :.1 kIr-e.-% (T) I i Jj a C- t, Section Block Lot Subdivision of Subdve Lot # Filed Map # Gentlemen: Date This letter is to authorize a duly licensed professional engineer I' or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated 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 provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, �G��✓ y Signed 5 °'' a, °yam t 0 ' er of Property Countersigned: �� r �4 a r • " 30 Id llt(LIOU PaEe , Address Address I Telephone own Telephone 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 llo..3 e -1 ey Address i Located at (Street Sec. Block Lot 6dicate neares cross street) Municipality Watershed, SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole-- Number CLOCK TIME PERCOLATION PERCOLATION Run- apse e v No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop.in Min. /in drop' Inches Inches Inches C-1 0 4 5 1 2 3 5 Notes: 1) Tuts 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. F TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS.ENCOUNTERED�IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 61' 1211 1811 24". 3011 3611. 42" . 4811 5411 6011 66'1 7211 7811 8411 INDICATE LEVEL AT WHICH GROUND WATER.IS ENCOUNTERED.�> INDICATE LEVEL TO WHICH WATE EL RISES AFTER BEING ENCOUNTERED TESTS MADE BY c.3 ; 7 r ) ; V°C'd?/I Date /� DESIGN Soil Rate Used_ZLMir,/l "Drop: S.D. Usable Area Provided No. of.Bedrooms - Septic Tank Capacity !r'67 Cl Gals. Type e-- � Absorption Area Prided By. c�� L. F.2' width trench. Other_? Address THIS SPACE FOR USE BY 4 Soil Rate Approved LgnaLUre ONLY: Checked by Date DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES VIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIELD INSPECTION REPORT (Name of Owner) (Street Location) INITIAL SITE INSPECTION YES, NO Wetlands on /or proximate to property .............. Property lines or corners found ................... Can estimate house location ....................... Will driveway need cut ............................ Must trees be removed - note these................. Deep holes representative of entire SDS area...... Additional deep holes needed...... ... ...... Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacent wells/ septics ............................ D.H. 1 Lot Depth to G.W. Depth to rock Soil De 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. D.H. 2 Lot Depth to G.W. Depth to rock Soil Descri tio: 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. DATE: . INSP. BY: COMMENTS D.H. - Deep Hole G.W. - Groundwater D.H. 3 Lot Depth to G.W. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. soli Descri DATE: -ro FINAL SITE INSPECTION INSP.BY: `� YES NO COMMENTS House SSDS located per approved plan.:: :........ (� L. Length of trench measured P50 L Width of trench average Slope of tile line and trench acceptable......... Room allowed for expansion trenches .............. Over 100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded.......... ................ 10 ft. maintained from property line and 20 ft. from house .............................. Distance well to SSDS (ft.) ...................... Number of bedrooms checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. frcan nearest trench ................ 1 (JC7 15 ft. of peripheral soil horizontally from trench ..... ............................... Boxes properly set... � .. .. ................... Could surface runoff frcandriveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS........ c p iN; Ater,;- Rc0 F„cJ(4 �,� �J FINAL GRADNG OF SITE ACCEPTABLE.. ... c n ,� _ . ,� ` ,f`�0 1 \ PUTNAM COUNTY DEPARTMENT OF HEALTH R ENGINEER MUST P OVIDE b Division of Environmental. Health Services, Carmel, N. Y. 10512 # 2. =� PERMIT CERTIFICATE CONSTRUCTION COMPLIANCE, FOR SEWAGE; DISPOSAL SYSTEM /dr+./�l�%iyJ l! c► /% Town or Village Located -.amt — j err Tax Map Block Owners! `r _`.1 • ' fs �� / Formerly Tax Map Lot N Jy Subd. Lot N. Separate Sewerage System built by. Address Consisting of dam% Gal. Septic Tank and I Q O /2 �—� Other requirements 7' Water Supply: Building Type Public Supply From _ Private Supply Drilled Has Erosion Control Been Completed? of eBedroomis '' v Date Permit Issued Has garbage grinder been installed? r� 3 I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plane of the completed work ( copies of which are attached), and in accordance with the standards; rules and regulations, in accordance with the filed plan, and the permit issued by the Putnam County Department Of Health. " Date Certified by P. E. R. A. OSeP • Ullivan 2 4 Address t2,972 GEM License No. Q Any person occupying premises served by the above system(s) shall promptly fuss? tS�f� ?VIIRItj681gi1U> ➢,t11I1/e�pto secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon'ss a public unitary 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 �'orrchange when, In the judgment of the Commissioner of Health, c revocation, modification or change Is necessary. Date e!� By ` Title —APd Rev: 6/85 PUENAM COUYfY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Z X Owner or Purchaser of Building Section Block Lot J% Building Constructed by '0004 Location Street / Ile 44zqi2�2 P "P Municipality Building Type Subdivision Name Q— Subdivision Lot # GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL 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 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 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 occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environinental 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 �� 19 Signature Title General Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk I W-m-, Corporation Name (if Corp.) Ad ess — t rP�4 jP _ ... ... r..:, ... ,.: ... sdkmr.. rr {)) ?w� n '�' r.tf ,.. b rJ � '+•. 0? � „� f � Ji • i 1 5i`a{ f .I I f } iri y�t� . ., � ,1 j i WEIR REPORT.zf' ,Y Pu �i �►i... i .y *� } +' DIVIR {OA Of :' AV Ti 1 IR fdt +9 { COUNTY 'OFFICE YUILDING IAI1yN1N, YO This report is to be completed by welm. ;Iler and submitted to Couhty Heailth Oepartrhint'tap�ther wi>Ett 11rPlon,4 anal sit of water sample indicating water is of satisfactor bacterial uality.before artlfieatle of oonstruetipll.. Y P 9 Y Q �'r• � � i' �+ � , � i�� REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF' WELL COMPLETI l ;� � . a , a t OWNER LOCATION /NO.• ♦ U / oR r� t . ?i ��[�} + " ^ile • . OF WELL r, SUSINESS TIC ESTA�I ISNMlNT V.. ❑.T[sT I ,L 0'¢,1 5 ,,�yj' } t hFd !, �.1 .:�r PRO ►OSEO. - ®. MES � I ❑ PUBIC . Ulf OF' {' Qp 1 AR ❑ (Sli " uxr , e��ki:,cl`t °'fit i"5 ❑ SUPPLY ❑ IND�S /RIAI C.,NDtT10NIN0 . ORIllINO COMPRESSED CASLE OiHIR' RQUI ►MINT ® NOTARY AIR PERCUSSION PERCUSSION ❑ IEMtl1 �'!a t`�'ti,c %�aaW, i tia� llNOTM (Inr) OIAMEiER /IneMal WEIGNT PER.f00 r WfINO i! ® THREADED ❑WELDED E+ETAIIS : 'p10 4 ` HOURS O.►J11. �J !� 1 , A YIELD tJ_° TEST', a MIIED ❑PUMPED K COMMRESSED AIR 4 i� s. WAT[R MEASURE FROM LAND SURFACE= STATICISOONIY looU DURIND TIEID TEST floor) a' M R• LEVEL % f•�t!' ow,MAKE r 0[TAltf Sl 112E DIAMETlR (Ineha) FPAOCKI MVEI DiamNer of woll Ineludln0. s5' . DP G ravel pack /inchoo a►TN noM t.NO suaAee sketch •Riot --r FORMATION DESCRIPTION fwo O�MNM�r ; fait a 'Fitt A �• I i r�P �{ •7�1 , q' ... t ' _..S�tJ'�•�F L 1� }A � (i ''k {, 14k }V�"1 yl ki } r r Nbty ; {t 1 yS tr}}ak ,t tl > + P. If rio10 wok te1Nd. of diAahnl d�plh� durM/ drilli J list btalovv V t J�+ r a r FEET QALLONS:PER MINUTEti; �' { w v ` l �,�� o} � y1 ".g" J*, , . L � _. 5r,4i ih � ., ;�6 h:.N �+•�„ L `roh{t j r;r 1i�8 1jr�� , � .:.f � i Je�4 ,_ r � ' �,i,.; \t. < #:5� t + �i ., , ti7 J j Jt viY �� dJt a ♦ G !� a v � ;� ..4 - J ct � .. , t � �l ' a 1,r � Sn,4 .:i�'1 ..5 P1 ,•t OATO EO .E Sian kGATE �El771 � G /q, VT� .. ,. r ir.F..n.. _0 °�,.:�_ti�...�' a:.. l.... .Lsr• s5 ,bw t.. r r ,.� :• ! Yorktown Medical Laboratory, Inc. 321 Kear Street Yorktown Heights, N. Y. 10598 (914) 245;,3203 Director: Albert H. Padovavia M. T. (ASCP) r- -8 Gs 4 ¶ LAB Collection Station Used: 'Carmel _ Peekskill Mt. Kisco _ New City Date Taken: J�' 3 —�� 2rll Date Received: 3 144 Date Reported: Collected By: ,j, 1 AJ-SA t1_Q. Referred By: Sample Source:l�� S% LABORATORY REPORT ON BACTERIOLOGICAL QUALITY OF WATER i GENERAL BACTERIA V Standard Plate Count per 100 ml 1 (Agar plate @ 35 0C) MEMBRANE FILTRATION TECHNIQUE (MFT) V"T'otal Coliform tier 100 ml Fecal Coliform ner 100 ml Fecal Streptococcus per 100 ml MOST PROBABLE NUMBER TECHNIQUE (MPN) Total Coliform: 14PN Index ner 100 ml Fecal Coliform: MPN Index per 100 ml OTHER ANALYSES THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS) (WAS NOT) (NOT APPLICABLE) OF A SATISFACTORY SANITARY QUALITY ACCORDING E NEW YORK STATE.DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Albert H. Padovani. M.T. (ASCP), Director LEGEND RDS = Recommend Disinfect - ing Water Source < = less than TNTC = Too Numerous Too Count