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HomeMy WebLinkAbout3717DOCUMENT CONVERSION SERVICES PROVIDED BY IMAl0.']j'ING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.17 -1 -74 BOX 29 IN f, No I sm .�� �� J T IN L No IN "'{ I I I, �' 03717 < x." 4M 'COUNTY DEPARTMENT OF HEALTH. EnJironmenta /> Health : Servtoes, Carmel, N -.Y 10512 eermlt 4 LIANCE .FOR `SEiNACIE DISPOSAL�SYSTEM i own Viile We Block r / 1 r SUbd ly ! Tax Map ,LOt' N v Lot k ,j...,E47- - !��N: , Addr�eiJS�i ank and, ,`.� � ° €� ,i °.L 1 i�'fti: i°Y /!. •.f . .CaiP,�- :.1i�';�,.L ����iD. �.�6aa:.' I��,a Private Supply Drillletl By, Addr S, , Building. Type Nas Erosion Control Been Completed? I certify that the syste(s) ae.l'isted sere of which are attached) and ia- accordance ^r Putnam County Department of Health Date Address Any peKion occupying premises se►ved,by the ":conditions resulting from': such usage AP, available and the `approv6Fof the $hvite *ate! subject to modification or change when' t �� C-*.'� H. N Certif)edDy- PEy t R.A. f .'' Licenso No ' +4sy m(3) shall piomptly+tske such action as may be neceasa►y t. o secure the correction of any unssnitary t the separate sewerage system shall become null end void q "s soon as a publie sanitary ssvver;;beeomes ply sha(I become null and ,void "whey a public+ water •supply, becornw 'aviigble. Such .approvals ,are idgment of the,Commi Warier, ;of M it such revocation; mod0l"tion or change is'necesniy. Date .' �.:O�C� 7 Y Title � par 2. y Rev 9-Si' s• �.�' ". .i 7q x ,[ t �ivi�rc►n t. '.CERTIFICATE' °OF CONSTRUCTION 1;3 T ', •` Located at Owner' .�F,+ 'Separate Sewerage System^ built by� Consisting of,0a1 =Sep Other j requirements 1Nater Supply � Publfc� Supply From' < x." 4M 'COUNTY DEPARTMENT OF HEALTH. EnJironmenta /> Health : Servtoes, Carmel, N -.Y 10512 eermlt 4 LIANCE .FOR `SEiNACIE DISPOSAL�SYSTEM i own Viile We Block r / 1 r SUbd ly ! Tax Map ,LOt' N v Lot k ,j...,E47- - !��N: , Addr�eiJS�i ank and, ,`.� � ° €� ,i °.L 1 i�'fti: i°Y /!. •.f . .CaiP,�- :.1i�';�,.L ����iD. �.�6aa:.' I��,a Private Supply Drillletl By, Addr S, , Building. Type Nas Erosion Control Been Completed? I certify that the syste(s) ae.l'isted sere of which are attached) and ia- accordance ^r Putnam County Department of Health Date Address Any peKion occupying premises se►ved,by the ":conditions resulting from': such usage AP, available and the `approv6Fof the $hvite *ate! subject to modification or change when' t �� C-*.'� H. N Certif)edDy- PEy t R.A. f .'' Licenso No ' +4sy m(3) shall piomptly+tske such action as may be neceasa►y t. o secure the correction of any unssnitary t the separate sewerage system shall become null end void q "s soon as a publie sanitary ssvver;;beeomes ply sha(I become null and ,void "whey a public+ water •supply, becornw 'aviigble. Such .approvals ,are idgment of the,Commi Warier, ;of M it such revocation; mod0l"tion or change is'necesniy. Date .' �.:O�C� 7 Y Title � par 2. y Rev 9-Si' s• �.�' ". � � �� _, � • 4 � �• .. gt�'I ��Y��itr Sllypt'Fi; t� ;l'. , -. �...,., _..; -.. - ... Il:I h, ,l(ryXilf WELL COt P,LETION. 5 REPORT' PUTNAM .COUNTY DEPARTMENT OF HEALTH ( - Division of Erivironrnentel Health Sarvresr, 1. COUNTY. OFFICE BUILDING - CARMEL, NEW YORK .' } This report is to be completed by welrl 'Iier and submitted to County Health Department together With laboratory report of analy iis:�f �vaCer sam lP,indlcepng water �s ofaatisfaotdry hactenal-quality;_b fare certif i rate of construction campliance is issued., . REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION. NAM ADDRESS .; t OWNER LOCATION (N is 'Strssl) % (Town)' (lot NumDef) '! 9f WELL BUSINESS - ❑ ❑ ❑' PROPOSED, DOMESTIC .. ESTABLISHMENT FARM TEST WELL USE OF WEII Q ❑ INDUSTRIAL ❑ CONDITIONING El. i SUPPLY (SPA y). DRILLINq COMPRESSED CABLE OTHER ❑ SPe i y) ®BOTANY ❑ ❑ ..CASINO..,.,,,_ LENGTH.(Jaet) DIAMETER(/ hes) / �l WEIGHT PER FOOT ® ❑WELDED NO CASING YES NO DETAILS THREADED . YES - YIELD �. j HOU ❑ ❑PUMPED I YIELD (O:P:Y TEST . ` aAtLED COMPRESSED AIR L WATER MEASURE FROM LAND SURFACE— STATIC(Spocfty.fsel) DURING :TIEW TEST fleet) " ' Depth of. Completed Well t yy in feet below. Lend surfoa: l7LQQ . MAKE . ' LENGTH OPEN TO AQUIFER (leer) SCRREN ...,. DETAILS SLOT SIZE DIAMETER (inches) IF GRAVEL Diameter of well including. RAVEL SIZE Q na _ ) BOA► (NarJ "TO (roetj 'PACKED: pidvel pock( (inches):' ` DEPTH FROM LAND SURFAC[ rORMATION'DESCRIPTION Sketch.axact location of well with dafances,'to at least two permanent landmarks..; FEET" to FEET - i i • If yidd' was tested at different depths during drilling, list below FEET CATIONS PER MINUTE DATE. IVEllLO TED. PALE OF REPORT WELL GRILLER 9 a s)' �. ; Owner or Purchase r of Building Section . Building Construe ed by - -•'r.. ,.... : --' Bloc`k._. .. .... : � .... . . 1 p Ord Location V - StIreet Sd Lot Municiballity ^{ ' Subdivision Name L3 Building Type` °' Subdv. Lot # GIiARANTEE 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- .:.a.tion of the.Director.of.the Division.of Environmental, Health Services of ttie Putriam"C'6unty Dispart"merit of Health as to' °wlietrier "o "r "'not "tfie' °fail - "" ure 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 Signatur - �✓ Title I /? Q4 U_ .i LL l v Co poration Name TIT cor . 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 J Yorktown Medical .Laboratory, Inc. LOCATIONS: ❑ 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245.3203 321 KCar Street W-201 BUTTONWOOD AVE.. PEEKSKILL, N.Y. 10566 737.8777 Yorktown Heights, N. Y. 10598 ❑ 495 MAIN ST., MT. KISCO. N.Y. 10549 666 -3335 (914) 245 -3203 ❑ STONELEIGH AVE. (NEARI HOSPITAL). CARMEL N Y 10512 278.9330 ni .Alhert -H Padovaha r e (Arectn. DATE TAKE_ : y 2 , (- DATE RECEIVED: SAMPLE SOURCE Lab /1 REFERRED BY: j J Collector: 264- 9 75 ZABORATORY REPORT mg /L ❑ ACIDITY ........ ...... _ ............... .......... :. ❑ALUMINUM .......... ............................... ................ .... .... .... ❑ ALKALINITY i P= ........... .. .A= ....................... ❑ ANTIMONY ............. ACTERIA, TOTAL /mL �. ........................... Q ARSENIC ...........................:... ........:...................... UeOD, 5 DAY ............................................................ ❑ BARIUM ..:.............. ............................... ..... . ❑ BROMIDE ............................ ..........................,. :.. ❑BERYLLIUM .....:.......................... .....:......................... ❑ CARBON DIOXIDE, FREE ........ ............................... ❑ BISMUTH ............................:....... .....:.........:............... ❑ CHLORIDE ........................................................... Q BORON .................................... ............................... ❑ CHLORINE ................................................... ... ❑ CADMIUM .................. _ ............. ............................... ❑ COD ................................ ............................... . ❑ CALCIUM ......... ........................... ................................................ ❑ COLOR (units)..* .... ..... ❑CHROMIUM (tot.) ............................ ........ ................. ...... ❑ CYANIDE ............................ ............................... ❑ CHROMIUM (hexavalent) ...... ............................................... ❑ DETERGENT, ANIONIC ............ ............................... ❑ COBALT .....:. ...:........................... ❑ FLUORIDE ............................. ............................... ❑ COPPER .............................:...... ............................... ❑ HARDNESS ............................ ............................... ❑ COLD ........................................ ............................... ��❑��MPN COLI FORM COUNT/ 100 ml ...0 ........................ ❑ IRON ........................................ ......................... ....... 32',(I `''COLI FORM COUNT/ 100ml ............. ❑ LEAD ....... ............................... ............:.................. ❑ CONFIRMATORY TEST ......... ... ............................... ❑ LITHIUM ...... .. ............................... .. .... ❑ NITROGEN, AMMONIA ........... ............................... 11 MAGNESIUM ................................ ..............:....:........... [],.NITROGEN, KJELDAHL .................................... ..... ❑ MANGANESE ............................................................... ❑ NITROGEN, NITRATE .........:.. ............................... ❑ MERCURY ❑ NITROGEN, ORGANIC ........................:...... ❑ NICKEL _ ................ ......:... ❑ ODOR u n i t s ) ................ ............................... ❑ PALLA191UM .................................... ....................:.:..:..... . ❑ OIL &GREASE ........................ ..................:............ ❑ POTASSIUM ................................ ............................... ❑ pH ( 1121 i t S) ...................... ............................... ❑ RHODIUM .................................... ............. ................... ❑ PHENOL ................................ ............................... ❑ SELENIUM .................................... ............. ................... ❑ PHOSPHATE (ortho) ................ ............................... ❑ SILICON .................................... ............................... ❑ PHOSPHATE (condensed) .. ❑ SILVER .............. .......... ......,........................ .......................... ............................... ❑ PHOSPHATE (total) ............. ❑ SODIUM .............................. ........................................ ............................... ❑ SOLIDS, SETTLEABLE, ml /L .... ............................... ❑ TIN ............................................ ............................... ❑ SOLIDS, SUSPENDED ............. ............................... ❑ ZINC ...:........................................ ............................... ❑ SOLIDS, DISSOLVED ................... ❑ ............................... ................... ............................... .... .. ❑ SOLIDS. TOTAL ..................................................... ❑ .....................................:.............. ...............:............... ❑ SOLIDS, VOLATILE .................... ❑ REMARKS:..................................... .......:....................... ❑ SPECIFIC CONDUCTANCE (U11IDo S / cm) ............... ❑ .................................................... ............................... ❑ SULFATE ....... ............................... ............ El OSULFIDE ......... ............................... ............. ❑ ......:....................: ❑ SULFITE ............................................................ ❑ .................................................... ............................... ❑ SURFACTANTS ............................................... ❑ ...... ............................... ❑ TURBIDITY (NTU ). ............... ............................... O ........... ............................... ............................... THESE RESULTS INDICATE THAT THE WATER WAS J OF A SATISFACTORY SANITARY QUALITY WHEN THE SAMPLE WAS COLLECTED. THESE RESULTS INDICATE THAT THE WATER DID MEET THE SATISFACTORY CHEM- ICA QUALITY OF THE NEW YORK STATE ADMINISTRATIVE RULES & REGULATIONS, D ING. WATER ANDARDS (PART 72) FOR THE PARAMETERS TESTED W H S PL W S C ELECTED. �. N/A = not applicable 111 oate APPROVED, I P111"M CJTEC'KK Ij,5T. P &&01 rDA)f1 1000, fm Pjamw Zn�p.b.Y... INI.TTAL SITE, Ii �Y1?CTIO?' _ Ycs NO Comments ,Propert.y lines or corn:•r3 found Can cstiinatc hour; location . . .. . Ifill drivcway need cut • . • • - . Yiust trees be removed -note these . . ... . . Is deep hole representative of entire SDS area __ P - Additional deep holes needed. . . . . . Sufficient SDS area available considering driveway cut, house location, separation _. � distances, etc. DEEP HOLE, DATA k. Da h: ldater elevation: � . Vf VN Rock elevation: ivy; Soils descr.i,,)tion: cr. -Y1,s� L� — Date . : by: F NAL S-TTE I',, P,1 -CTTr 1iSp• - - House located vhera shot.n on approved plan '• . SDS Located whei'3 approved Irrgth of i;rcnch mcasur-OCA, Z•Lid to of trench aver! c e Slope of tile, line and trench. acceptable ✓ . Room - allow-dd for.. exransion trenches Over. 50 ..fi;. from swamp wa .ercourse "_ . .e ,..:.... .o: _..... •�.. ;.._ . �...... _.. ,- _. Vatural soil not . stripped or SDS. area inuiecessarily graded ... . . . __ 10 It. maintained from prop.line and 20 ft. from house Sep*-- ration of trench fro ;i house, well _ etc. - follows' plan . - ..- - -; - - -- - . � --e- . -� � � -- : -: - _�-. _-Per - - - v Number. of bedroo-.r,s checks . . . . .z . Stones, brush.,' stumps, rabble, etc. greater than 15 ft. from nearest trench . . . . . . ,✓' 15 Ft. of peripheral soil horizontally fron trench . .. . . . . . . . . . . . . f Junction boxes properly set Could surf. acc run off from driveway, roads, • ground surface, etc. chamael near SDS ✓ area . . . . -- Does l.ot dr. airnEte armor), 0. K. in area of SDS FINAL GRADING OF SITE ACCEPTABLE f �� 1,41 l � -- 75 ---- ---ate' 2. L. � 5 X �1lrC C r �FfZ.EDRtKS�rJ - CNGfz :_.._ REVIEW CIT:CK SIQ;T j (Moots Std . f Remarks • nAtIT TT,mnrme I House plans 0. K. Drrasign data sheet Peres presoaked? Kin., 30" perc test depth Cont.-results for.3 runs D. Hole log 0. K. Corporate Affidavit for oth o than indivs Authorization for engineer Letter from Water Supply .if applicable If variance requested -such noted on plans DETA I IPS , if change is proposed,) Existing contours shown show new - contours) Slopes for driveway cuts:, etc. shown Rater service line location Footing drain, etc*. loca lion Top slope, bottom slope of fill Percolation tests and deep test pit location Setitic tank size and conformance to std. 3 B.R. house minimum House setback shown Distribution box ftg. below frost All water within ft. of PL shown -r Plan and profile -SDS -, : All other wells and SDS closer 200' 'shown or reference made Property boundaries (metes and bounds- clearly s SEPARATION DISTANCES SPECIFIED ON PLAN 10' to P. L. ?0" t o Foundation walls _ )0' to Nearest well 50' to stream, march, lake, etc. L5' to Curtain drain !0' to water lira; (pits -201) .5' to storm drain (?' ' to lar,o trccs 10' Vrolil i'011ndation to septic tan: .1)' to pipe from leader d. rain &. 1'd L.0 ADZ_ h`► I �" ScoPp- .expansion i .ne, aralrl ! C) CA-Y_4_ I< P_ . I I IA A 7. j . aD; 00 10� _/O/ /J , PUTNAM COUNTY DEPARTMENT OF HEALtH Located at (T) Section � P Block W Lot ` N Subdivision of 11 NO. UIL� V-OOK._- ;;Z�7 o IZ Subdve Lot # O Filed Map # 160 Date G( 46: Gentlemen: This letter is to author ize17�Z1 a duly licensed professional engineer �or registered architect (Indicate to apply fora 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' n' conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned: P.E. , R.A. , # Ve,, Ly,n Address A, G 1-1. o -4 I Telephone Very truly yours, Signed O2 ,t.t:bA u-&99 10'4 a tit Gin22 Owner of-Property Address d Town C Y2 -- 7,4/1 Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES °- -- ° _- -- COUNTY = OFFICE- BUILDING; CARNiEL, . N. "Y'. -1-0512--"-" DESIGN DATA SHEET- SEPARjkTE SEWAGE DISPOSAL SYSTEM FILE N0. Owner ZA y'l ja til wl 4 Address Ao ( . y 1. F7 . Located at (Street Sec. Block to Lot -Z--- n icate ne est cross street Municipality OLD S Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole 5 Number CLOCK TIME PERCOLATION PERCOLATION Run apse Depth to Wa er Water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop 5 Inches Inches Inches Z 2 3a 17 %- l % %z 1 2 3 4 5 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. 5 1 3 i 5 1 2 3 4 5 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 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE N0. HOLE NO. G.L. D 611 12" 1$" 24" - 36.. i 42" 48" 54 60'► 66" 72.. 78'► 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED :...:. ..INDICATE. LEVEL :_TO YJgCH ATE :LEVEL: RISES AFTER BEING ,ENCOUNTERED TESTS t�1ADE 'BY _ _ D .. 5� Date- Soil Rate Used 0— / -s kn/l "Drop: S.D. Usable Area Provided 6 E c gn5ie- No. of Bedrooms _Septic Tank Capacity 0 Gals. Type Gr�� Absorption Area Provided By3;L. F. x24 rent . �.. Name L lgna ure s Address KS L �)e a LvD SEAL z nzal THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: �J�Q s 0 5 00": Soil Rate Approved Sq. Ft /Gal. Checked b SS10 ��, � ion 9 L - L,�1,► =0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUN`T'Y` OFFICE BU7Lb G, CARMEL 1f...T. - ". -.105120. DESIGN /DATA SHEET- SEPAR4TE SEWAGE DISPOSAL SYSTEM FILE NO. Owner LAM 4 tJ Q Ar Address Located at (Street iZl�, Sec. (otp Block (o Lot 2.- Indicate-nearest cross street) Municipality IC Ot4 f} .� i4A Y LLE-Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS 5 - 1 2 3 5 Notes: .1) Tests to be repeated at same depth until approximatelyy 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. Hole Number CLOCK TIME PERCOLATION PERCOLATION Run No'. Start -Stop apse Time, Min. Depth to Water From Ground Start Inches Surface Stop Inches water ve in Inches Drop in Inches 'Soil Rate Min. /in drop ' � 1 3c) 2o 2 y !�- 2�� 3 3c) 4 .17 5 - 1 2 3 5 Notes: .1) Tests to be repeated at same depth until approximatelyy 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. BAR!iER ° SEE INStT• I f I R I " SHORE -� '} 9, e�o �� +.+LANE 1 2. ` 2.2 3.2 6 3. I 4N' fso oFIE L0STONE ® ROAD I Ar J ¢ a 1.2sa AC. - I AC - ..> I� �\ SAC. V I I C3 , 2 .. I I I I 3 A 2 4C. C. ti • as O ° 3.2 I I IAC I' I 5 O �q If 11.234 AC. 1003 AC. n�j ° I 3.3 .: p = I I ml t e IAC Soo CROSS 2 I I (a 1002 AC. n . 1.002 AC. 1.002 AC. I I W f O J 2 1.002 AC uj I ao I 3 0! 1002 AG I 4 A5 0-' 1 U-T- (-AYD!3r At --iL tllz�- f- 10 u 'A PIO A b 4 F1 TO Tu- A-S r-v-rl -Y Til.— 41' N 4 PINIHAM, C00,4T't OF IiE-�qq 4 , L -7 T Z F F-c--T --.--1000 4 L. TAN4 TI 37- T 4 FlE-rj '>7lLj, RO4 GF cIL-" 2 FL.. 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