Loading...
HomeMy WebLinkAbout3883DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.16 -1 -5 BOX 30 M PUTNAM COUNTY. DEPARTMENT OF HEALTH Division of Envlronmentat Health Services, Carmel, Nit. 10512, -- Engineer Mt;st P.C:H D Permk fi tl� 5 �Vd _ . CE CATE OF .CONSTRUGfIONXONT ANCE FOR SEWAGE DISPOSAL SYSTEM � �rt1 . G$:j U.i�l. � t -_7�6 � - / Towg or VIDag Located at d ) 141 ' I �� /00J j� Tax Map �t� /' Block' —Lot 1� Owner/appilcarit e�V:dN_ lvlm raf a, *,4 Formerly , Nleik Subdivision.Nani _ N+ �� Subdv.•LOtN� Maftg Address ` tyl 8 (A i�}� I h1Aot a ikt u Zlp �%'S � Date Permit Issued Separate Sewerage System built by 1 e,-A n �) ( . � t� R!- R- -�. JI Address . - ..� . Q a. G 7 . ( NYft 1� �, V &neistirig of �DOV Gallon- Septic Tank and X i_U��ii s�'d" ' f dam' i/ifi'���e Water Supply: Public Supply From Address - -- _ or: Private Supply Drilled by A&W,—aA-fdiy 4KkI1 &A-VAddress Building Type �1'�st0� i 1r "A: 4�1 Has Eroelon Contiol Been Completed? A k; Number of Bedrooms r Has :Garbage Grinder Been Installed? Other Requirements ///"v r I.certify that the system(s) as listed serving the'.above premises were constructed essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rulesj d regulations,. "in.accordance with the filed plan, and the permit•issued by the Putnam County Department Of Health. _/ Date ~'96� Certified by % /�� P.E. I/ R.A. A�t�1' Address , 6 ' ,46.4 ^ Vi l v� � lelljv�' ///'r%. e//3 License No. Is 6 f"t1J 1 ltl v Any person occupying premises served by the above systems) shall promptly take such action as may be necessary to Secure the correction of. any unsanitary conditions resulting from such usage. Approval of the _sepa ► ate; sewerage_ system shall become null and void as soon as a pub:': 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 or change when, In the juud'gment of the Commissioner of`Mealth, such evocat�nmou�110n� hange Is ne,creslsa'ryy..,�is '�" Title.../°. _// PU NAM COLUEY DEPARTMENT OF HMIH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - >,.o.- ... - <•._ .t:. T: -s -. �^,. ,- .T-- + -.c.. '..qe .. r...._. _., _.. >'�.L .._o- _y_.,..'... �.:.. :r-.�r... r. �r -.•s- ..n1....�%��-.� r .. . -,: �rTe_.y ..,. :..�• ,r .. .�. _.r. >i: =. <a- ..r o - s Owner pPr Purchas. er of Building Building Constructed by ,eo,y cos WPI,4 PuAjApw tX�i1gu �/ Location - Str"eet Municipality �1 2 B F6C Fs t d m �AIU41 Building Type Section Block Lot Subdivision Name Subdivision Lot # GUARANPI'EE 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,.. ., . repairs made by icie to such - system, except `where the -' failure tb "- opetate ` 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 19e Gener 1 ntractor (Owner) - Signature Signature Title Corporation Name (if Corp.) lip )Y.���j�'`-_ CC��1ti� ,L-t '. 1�lr-� 1 l�Ll ?�iZ jPIfus� , ! Corporation Name (if Corp.) f 4y Address Address Address l' 1• rev. 9/85 irk TFICATl`E OF : CONSTRUCTION COMPLIANCE ,fore - a,_C ieate of.-Occupancy. for. a dwelling is issued by the local Building Inspector, a Certif icate of Construction =C6mp11 riC&- for '-th -e•- s2bsurf a�:c disposal system must first be issued by this Department. The Department must be notified before the system is backfilled in .order that an inspection of the completed system can be made. Open work inspections may be omitted only at the discretion of the Director or his designated representative. In order for the Department to issue a Certification of Construction Ccmpliance, the following must be submitted: 1. Certificate of Construction Compliance. 2. Three (3) copies of a two (2) year Guarantee, signed by the installer, general.ccntractor, and /or the owner. 3. If the water supply is from a drilled Drell: a. Satisfactory results of a bacteriological analysis of the water, pe.rformed.by a State Health Department approved laboratory. b. A Well Log signed by the well driller, including the results of at least a six -hour pump test. 4. Three (3) sets of "as- built" plans, signed and sealed, etc., showing house location with respect to property lines, the actual layout of the sSDS and water supply facilities as they have been installed. The distances necessary to locate the septic tank, distribution boxes, junction boxes, and ends of the trenches from two fixed points, preferably the corners of the building must. be provided. ThesE: plans ...must include a legend, which reads as follows:. "This is to certify that _ ` tne: sewage disposal system - hies- :constnlcted . as , indi.cat!g d; pny ,this plan and that the system was inspected by me before it .was covered "over.' • Aie " `-7 system was constructed in accordance with all standard rules and regulations of the Putnam County Department of Health and the Ned York State DepartrrPent of Health." "As- built plans must also include a title box, giving the information required. on the original design drawings. Minimum size of "as- built" plans should be 81" by 11 ". 5. A Certified Check or Bank Money Order in the amount of $25.00 payable to the Putnam County Department of Health. After the Certificate of Construction Compliance is issued by the Department, a copy should be brought to the Town Building Inspector so that he may process the Certificate of Occupancy. tv -i2 -66 3 S en PU}hdLw. IOUnt �n�iroo►e..tn.( Ne4�t1.:5erv��s 4LtMe1, Ai �asia A 'orktown Medical Laboratory, Inc. LAD 321 Kear Street - Yorktown. HeiShts,N.V.059s Collection .Station Used: J / 914 24 - C ar mel :Peekskill !/ - ...9 �C,. 5;320 ::........_ _ _ - _- .. 1i Yy� v gb�/�y��C ...T -•e. :_�^^r. a�109 r m rrypi... F'.re. -tii.. v:' .p 4.e.1..... e.- •Yam...•rTs.• �.T: /S 0...�. F9� ;�• • ~t~•� •�M _yY.�.•w:' Director: Albert H. Padomen AIL Z (ASCF) `1 Date Taken: /0 h44 Date Received: sp Date Reported: /a /1, L OTT / C,in/v y collected By: �J��CytL4(_ '. Referred By: �c,/hcz�.,� Gti �/ �y •� Sample Source: lor3 ; J 62- LABORATORY REPORT ON BACTERIOLOGICAL QUALITY OF WATER GENERAL BACTERIA V/Standard Plate Count per 1.0.•ml (Agar plate @ 35 0C) MEMBRANE FILTRATION TECHNIQUE (MFT) Total Coliform per 100 ml.. Fecal Coliform ner 100 ml Fecal Streptoe.occus per 100 ml Y! S^ POORABLE NUMBER TECHNIQUE -(MPN) Total Coliform, MPX Index -i;er 100'ml'. _ Petal Coliform: OTHER.ANALYSES MPN Index per 10b ml THESE RESULTS INDICATE THAT THE WATER SAMPL WAS NOT) (NOT APPLICABLE) OF A SATISFACTORY SANITARY QUALITY ACCORDIN EW YORK STATE DRINKING. WA ER STANDARDS, FOR THE PARAMETERS TESTED, OF. COLLECTION. LEGEND Albert H. Padovani, M.T. ASCP), D12'ector RDS ® Recommend Disinfect- ing Water Source . o less than TNTC i. r If yield .wos tested of clifforent depths during drilling, list below FEET GALLONS PER MINUTE """ I" ' • DATE OF REPORT C WELL COMPLETION REPORT _ - PUTNAM COUNTY ,DEPARTMENT AF HEALTF 3nf. . nvirontnatltol Hwlth. Se►rieeR.. Division E . COUNTY OFFICE BUILOING -. CARMEN, NEW Y04a This report is to be completed by welfV tier and submitted to County Health Oepertme, to"ther with .laboratory sport of :. anal.ysls of "dater sample indicating water is of satisfactory bacterial quality- before cettiflcate of construction compliance,is i:susd _.,. H~ 1 .REPORT MUST BE SUBMITTED, WITHIN 30 DAYS OF WELL COMPLETION. OWNER LOCATION OF (N0. t -roe trn) fto/ Nyltbor) WELL . !� �O BUSINESS '' ❑ r' /ROPOSED PS.DOMESTIC ESTABLISH FARM TEST WEII' USE OF , WEIt PUBLIC (� ❑ ❑ g NDITIONtNG..,. OTHER SUPPLY. INDUSTRIAL .0 OEIIIING. - ❑ COMPRESSED CABLE ❑ ❑ EQUIPMENT ROTARY AIR PERCUSSION PERCUSSION ;, „ (OEpo W) CASINO bra LENGTH (t) ., .. OIAMETER(IncApsl WEIGHTIER i00T - THREADED ❑ NO C%1TtiT : YES too . DETAILt YIELD HOURS " G ► CI ❑ IR AIR WNW (0 ► Y.) " TEST BAILED PUMPED COMPRESSED �/ ..: - ,.•. �..: V �- WATER . MEASURE FROM LAND':SURFACE' STAT /C(Sps cily to DU RING YIELD TEST (1401)' Depth Of C N*04#0d Well, LEVEL �7 In feet below hand Rui"? ` MAKE . LENGTH 'OPEN TO AQUIFER (aai ^i SCREEN, DETAILS SLOT 'SIZE DIAMETER (Inches) IF GRAVEL 61. or af`wdl including C 1 Hof) 111001) PACKED: growl pack (Inchos)? DEFTM FROM LAND SURFACE FORMATION' DESCRIPTION. ... _ SA atCA aJlaC) io"a r1 Ot a�dt with out *""I 10 of 10"! .. two permanent IffRdwl!Ma' ' IEfT is /EET 1 ri i. r If yield .wos tested of clifforent depths during drilling, list below FEET GALLONS PER MINUTE """ I" ' • DATE OF REPORT C 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. - Deep Hole G.W.- Groundwater D.H. 1 Lot D.H. 2 Lot D.H. 3 -Lot Depth to G. W. Depth to G. W. Depth to G.W. Depth to rock Depth to rock Depth to rock Soil Descr 0 ft. 3 ft. 6 ft. 9 ft. 12 ft.� Soil Descri 0 ft. 3 ft. 6 ft. 9 ft. .�.._ . . __. 12 ft. LHl"r;: _ FINAL SITE INSPECTION INSP.BY: House SSDS located per approved plan.. .......... Length of trench measured So * j Width of trench average "> Slope of tile line and trench acceptable........: Rocco 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..... .......0 ................ Distance well to SSDS (ft.) ...................... Number of bedrooms checks......... ....... ..... Stones, brush, stumps, rubble, etc.,greater than 15 ft. from nearest trench.... .......... 15 ft. of peripheral soil horizontally from trench ..... ............................... Boxes properly set.. .......................... Could surface runoff from driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE.. YES NOI Ci'S M 5011 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. YES NOI Ci'S M PUTNAM COUNTY DEPARTMENT OF HEALTH 1 j2�? Vi 3186 Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer to;Proyide Permit I(� b on CERTIFICATE OF COMPLIAN (xv/ CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Permit / !J�'! L4,) J . �� r ✓�'. Town or.. ago —mac- -- _ •_. � —�- -.. ...�.,.... � . , 1 .:.. -�• . ..._ : -,.b.: .:.�.. Subdivision. Name l t� Subd.. Lot N 2 Tax Map PV /ArW Block I Lot _ Renewal-0 Rovlslon Owner /Applicant Name 1144542-5I 1. Date of Previous Approval Mailing Address —8 +� �� /�'.' /`� '�'`l^�-' Town ZIP Building' Type 3 812 RS n ic'h Lot Area r • 1 9 A Flli Section Only Depth Volume Number of Bedrooms Design Flow G /P/D 6 © d PCHD Notification is Required When Fill is completed Separate Sewerage System to consist of 1 CJG® Gallon Septic Tank and 3ot-FA 24' Wi do . A65s -- iit-i 1GA To be constructed by M• . �i`tKtra� �eCCA t' cC / / i Address >�ra {riezwt Va /t /�4' a ��y Water SaPP13': Public Supply From Address j + f or: � Private Supply Drilled by AV1d S� K// Address �ca �%, Sf� q =4" Pun'4", i/4 ��t?�1. A/• Y! /O6'%W Other Requirements Dr: ll:✓i� . ;» I represent that I 'am wholly and completely rest' esponsible for the design and location of the proposed system(s); i) that the separate sewage disposal' system above described will be constructed as shown on the approved amendment there. to and in accordance with the standards, rules and regu a ions of e . Putnam County Department of Health,. an.d that on completion thereof a "Certificate of'Construction Compliance" satisfactory to the,Cdhimissioner of Health will be. submitted to the .Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage ' disposal. system during the per iodof two (2) years immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto;•2) that the;drilled well described above will be .located as shown on the approved plan and that said well will De installedoin-acDcoertlan�ce /with the standards, irru, and �regu a ons of the Putnam. County Department of Health. [N' Date �.4 —�� jj Q_ /Siigned . ] , // rye/ P.E. �,c R.A. p —/( Address 66 Q-0-9Z t -- f Blvd. 10,04nd. 4, �/• O?434; License No 56CJC/S� e.Ql%S APPROVED FOR C NSTRUCTION: This approval expires one year from th ate issue unless construction of the b tiding has been undertaket, and is revocable for cause r may a amended or modified wnenconsidered es by the stoner of H th An hangs or alteration of construction requires a mra By r d for disposal of domestic considered ,and /or t p o Y. Date Title ��]/� SS IS-J 5116 G� �G 1,110 1� 0 ov DAVID D. BZEN �l ,s/ �+ JOHN SIMMONS, M.O. County Executive ��1i YO� �V Deputy- Commissioner DEPARTMENT. OF HEALTH a Division f Environmental Health Services May 9, 1986 f Charles Weth, P.E. 666Roosevelt Boulevard ��C[ 0 land, New Jersey 07436 Re: SSDS Dear Mr. Weth: Tax Map B1. 1, Lot 9 (T) Putnam Valley Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been competed. Comments are offered as follows: A hydraulic profile is not provided V_' A well detail is not provided 3. J -Box., trench and septic tank details are incomplete or unsatisfactory as_ follows: Box 2 nch 12 eptic tank 6 11. Numbers relate to the attached sheet which is part of the Department's Guide to Submission Requirements." What is open joint pipe. Usual materials for tile fields is 4" perforated PVC pipe. Standard construction notes are not provided. Deep hole locations are not shown on the plans. Footing and gutter drain discharges are not shown. The house sewer slope at 1/4" /ft, minimum is not shown. The type of pipe and size of the sewer line is not shown. The slope of the pipe from the septic tank to the boxes must be a minimum 1/8" per foot. 10. J -Boxes on the plan should be labeled. What is the purpose and type of box 25 feet from the house? TWO. COUNTY CENTER — CARMEL, N.Y. 10512 (914) 225 -3641 Charles Weth, P.E. May 9, 1986 Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. J K:.pt r very t 1 J �n Kar 11 Jr. P.E. D Vr'ector, Environmental Health Services Pr C-G�r�1+ �Iv� Two Car- rn.e-1, my I d$-1 Z R 4.r-��,� „UP,1 5196 PU P�A� �EALt" 11 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF.ENVIRONMENTAL HEALTH SERVICES Date 14AI 61 CXo . -• . -- - . . . /•. e i' Re: Property of Located at OTccRWA; a, Lga�c �atnci Df /•Ve. (T) fOj4pWM_ Vg //Cj� Section 113 Block % Lot .02 Subdivision of Subdve Lot # Filed Map # `i•r./& 8 -2 Date Gentlemen: This letter is to authorize Gaol r° IBS 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'Count,y 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 14 ' , 'a`"titoifi °-Eaw, the Public Health Law, and the Putnam County Sani- tart' f•.Co'd?e %`j PI3 I II A aq. 1;,OWITY Very truly yours, DLrj s . OF f gEAl.TH Signe Countersigned: S Owner of Property G P.E., R.A., # 56So!; Address �(o Roo Sce V r- VC(- Address on'k 14n d) AI J: ® 743C (Zor) 33 i- 39 S c/. Telephone Town Telephone z 86 Z "lu t plc PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS _.; _ ... Rr�rET. SHEET CQNSTRUy PERM _ _ ... -TION T . ^ . �.- � ®� T' 05;e, . � j� f� w DATE REVIEWED t BY: (Name of Owner) ( Street Location) DOCUMENTS- Pet Application < Ae Corporate Resolution Plans Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footin .�rveu rtain Drains Perc & Located Repres of Sewage & Expansion Area i1,�pa_nsion Area; shown; gravity- fl low, suff , -size If Pumped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Se (Tight lot) House Sewe - 1 /4 " /ft 4 "0; Type pipe No Bends; ds 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake Unc. expan) 15' to Drains- irtain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fran Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same PJTNAM CWNTY DEPARUMU OF DIVISION. OF TNVIRONbENTAL HEALTHSERVICES . ;. - DESIGN _DATA SHEET- SUBSUFACE . SEWAGE DISPOSAL SYSTEM ; ,, FILE ICU, owner l�lr, J%:.5. 1V'C1'to1aS 9Z/04' Address �lP ��tn fir,' ✓� Located at (Street) Og ccL vja P N, k- Sec. /13 Block / Lot 9 (indicate nearest cross street) Municipality Fu¢ hef rn ve::;� Watershed /_a k e Pze: �s k t' l Date of Pre- Soaking Date of percolation Test 5- 2 -$� HOLE CLOCK �. do TIME ` PERCOLATION PERCOLATION Run 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 ✓ 4 s K. cr Jr t 9 3 S• ��t�n 1 !' t J' 5 en' , ?l 1'17 4 5 Ho[..e +L! U t3 �...wra. ..- ���ww+ �..... .-.- -. .. ..Yr- ...W -. s.+ r. ar.. 'w",�w .. ..�. .. �. wu.K Sm -�.. .).r. ...�. � �.�..... .. /).+��wj tea. � +�.. .•r�r. .ter •�'`�(.. .^, ._�- �•i u�.. ...r.. � ...�. 2. i /�t/) ! Fe ~{ ! J! , J' G• ! yd��'i)l+rl �14�1 3 �u "�^C a i G/ l 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. All data to. be submitted for review. 2• Depth measurements to be made fran top of hole. rev. 9/85 Ac"-A, OF DEPTH HOLE NO. / G.L. tcOt 1 °�, 6 29 1 4' e? Loot 51, P 6' All fi k&lq 7't /+, 8' 9' 10° 11° 12' 13' 0 WITH APPLICATION IN TEST HOLE NO. HOLE NO. 14' AT'- WHIQI "GROUNI7&gM `IS' - ENCOUNTEM- t' � > "', r e a c;- +ice F_e-. C INDICATE LEVEL TO WHICH DATER LEVEL RISES AFTER BEING ENCOUNTERED �rec, t rcn cove+' -1 jn 71r dozp o i DEEP HOLE OBSERVATIONS MADE BY: �'1 q r° 1 c . S � ° I� , PE. DATE: a ', DESIGN Soil Rate Used Drop: S.D. Usable Area Provided�� No. of Bedroans Septic Tank Capacity 1, 0 0 C5 gals. Type G'o n e . Absorption Area Provided By 43 C) L.F. x 24" width trench Other . Name ��,- I m s /- 4, -A Signature C� s Address =eDs < y C l4 a N C, SEAL c 074 3, THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date y3 cr I. �tl �� ter_ 3� OAT- log L-� ,iiA fins §t..A I -r,.- .- -/ ----L.l