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Home My WebLink About4365DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -2 -16 BOX 33 04365 COUNTY DEPARTMENT OF HEALTH �} Q� Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Town of pTown or uV 9sge i^1 1 Nnl -l• _. _. Tax map 2_14 -1- -2 _.Block Subdivision ..._.._.... .. -:. wt c. s •. •° ., :-r. r. : —' • _ � '..y. .:..'d• ^.� .�,�. � .4...y. -� _ •:..p.a.. 0 _ ._•.R - + -. � .. .» �� 'Y� . •- .• Van dP V-Perdcink� Lot Job Owner Lirn►+c� Vnn dP Veerdonk Address Peekskill Hollow Road . Building Typ@1 i amt 1v rPRiriPnr`A Lot Area 4 acres Putnam Valley. NPw Vnrk 10579 Number of Bedrooms —3— Design Flow 600 GPD Total Habitable Space 1 500 Square Feet Separate Sewerage System to consist of 1,000 Gal. Septic Tank and i To be constructed by Own r Address Water Supply: Public Supply From * Private Supply to be drilled by Nnrman AndPrann Address Barger Street Putnam Valley, New York 10579 Other Requirements I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) 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 an regu a ions o e u nam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his succes s, heirs or ass ig s by the builder, that said builder will place in good operating condition any part of said sewage disposal system du ing the period o wo (2) years im ediately following thedate of the issu- ance of the approval of the Certificate of Construction Compliance of the on • I s st y repairs theret , ) that the drilled well described above will be located as shown on the approved plan and that said well will be ins n^_ in ac/t�o /roannce w h the standards, I and r /�j, latigons of the Putnam County Department of Health. � ,yJ N hn . :I n I/ln . Date 6142/83 Signed Address %1%l'oy 1•LUJt Vy APPROVED FOR CONSTRUCTION: This approval expires one year revocable for cause or may be amended or modified when considered requires a new permit. Approved for disposal of domestic sanitarl 1 ;.`Date [ ~ By P,E. R.A. a C N.Y- 0541 License 0,11056 the d t .1; unless constryyy tion of the building h s been undertaken and Is ary by the Commissioner Health, Any change or alteration of construction ige, and/ p ivate waterer ply only.. �- �i- a3'�''� -` _ Title F = PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental lth Services, Carmel, N. Y. 10512 permit a 41TE: OF coNSTRUC'i- IONr,COMPL4At4CE FOR, SEWAGE- - 1 Located at ' Owner Formerly Separate Sewerage System built by Consisting al qal. Sept c Tank and Other requirements Water Supply: Public Supply From _ t� Private Supply grilled By )SAL• - tY$TEMA.- " Town or Village Tax MaP Block r - Tax Map Lot a i cubd. Lot a Address / A") 73 Building Type No, of Bedrooms Date Date Permit Issued Has Erosion Control een Como etedf 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, rules and regulations, in accordance with the filed plan, d the permit issued by the Putnam County Department Of Health. Date o Certified by R,A. Address LI No. Any person OCCipying premises served by the above system(s) shall promptly take such action as may be neA2ury to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null an o 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 wat ply becomes available. Such approvals are subject to modification or change when, In the judgment of the CornT of Health, such r Ion, modification or change Is necessary. Date (0 By Title .PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION -OF -- ENVIRONMENTAL HEALTH SERVICES ••e, c —r i • Y• ... �. na µ..b. J..0 _ ...+"1 ^' ". .v. n ...; , DatE� �94•�..� Re: Property of Located at (T) j1q. Subdivision of Block Lott • 1► �' Subdv. Lot # 1 Filed Map ,# l Date Gentlemen: This letter is to authorize a duly licensed professional engineer �r 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. o.r .sy,stems. in- co�fgrmjt -y...with•-t-h-e_�ovisiohs _ .. .<.........z ..� 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, Signed Countersi n, P.E. , R.A. , #r� . Addr e . s Telephone Owner o f Pr n 6 _ . Address Town j Telephone . j b5'I9 °YORKTOWN- MEDICAL LABORATORY INC. P.0.. Bo'x' 99 321 Kear Street LOCATIONS: N.Y. Yorktown Heights, 059 -t 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245.3203 ❑ 201 BUTTONWOOD AVE., PEEKSKILL,_N.Y. 10566 737 -8777 245 -3203 ❑ 495 MAIN ST., MT. KISCO, N.Y. 10549 666 -3335 _ry• __ __ .� ._ _ .�_ -�,_ �..•.,::.�-- SI NELE�G}�.AV.E. N €kR.1i _ ;. L�R,�;MEL �:Y..10512.2 8 <9330' LAB 12 %2 DATE TAKEN: R/m F. DATE RECEIVED: B. Sande ®eePdOY1IS DATE REPORTED: SAMPLE SOURCE: Siu L I LABORATORY REPORT mg /L REFERRED BY: 1100 %s Coady COLLECTED BY: Bo Vandeveerdonk ❑ ACIDITY ❑ ALUMINUM ..... ..............................: .................. ............................... ........................... ❑ ALKALINITY ....... .............:................. ❑ ANTIMONY ....................... ..... ............................... P BACTERIA, TOTAL /mL ........ .. ❑. ARSENIC .................................... ............................... BOD, 5 DAY ................... ............................... ❑ BARIUM ....................................... ..............0.... :........... ❑ BROMIDE .............. ❑ BERYLLIUM ....................4.... ❑ CARBON DIOXIDE, FREE ❑ BISMUTH ... ............................... ❑ CHLORIDE ................... ............................... ❑ BORON ........................................ ............................... ❑ CHLORINE ................... ............................... ❑ CADMIUM .................................... ............................... ❑ COD ........................... ............................... ❑ CALCIUM .................................... ............................... ❑ COLOR .............................. ......:................. ❑ CHROMIUM.( tot.) ............................ .......................0....... ❑ CYANIDE ................... ............................... ❑ CHROMIUM (hexavalent) .................... ............................... ❑ DETERGENT, ANIONIC ... ............................... ❑ COBALT .................................... ............................... ❑ FLUORIDE ................... ............................... ❑ COPPER .................................... ............................... ❑ HARDNESS ................... .............. .................. ❑ GOLD ........................................ ............................... MFT COLIFORM COUNT/ 100 ml ...................... ❑ IRON ........................................ ............................... 11 MPN COLIFORM COUNT/ 100 ml ❑ CONFIRMATORY TEST ... ............................... ❑ LITHIUM .................,.................. ............................... ❑ NITROGEN, AMMONIA ... ............................... ❑ MAGNESIUM ................................ ............................... ❑ NfTRGGEN KJELDAHL a❑. fk141NGADIESE' ..► - ._. �.:_ .. �_ ... —n_ ._.� _ -..A: .•:ud• --.��' .a- .�6- 'c'9'. �•i �, .... .e.. ....... ......,.H.. «.......- .v1v.,..:ea e. 3t la:..f,Ty?I.`.... - _ ❑ NITROGEN, NITRATE . ............................... ❑MERCURY .................:................ ...................:........... ❑ NITROGEN, ORGANIC ... ............................... ❑ NICKEL ................:....................... ............................... ❑ ODOR -.1 ................................................... ❑ PALLADIUM ........... :............................................. :..... ❑ OIL & GREASE ............... ............................... ❑ POTASSIUM ................................ ............................... ❑ pH ........................... ............................... ❑ RHODIUM .................................... ............................... ❑ PHENOL ....................... .0............................. ❑ SELENIUM ..................:................. ............................... ❑ PHOSPHATE (ortho) ......... ❑ SILICON ❑ PHOSPHATE (condensed) ... ............................... ❑ SILVER ........................................ ............................... ❑ PHOSPHATE (total) ..... ............................... ❑ SODIUM ............................... .... ........0...................... ❑ SOLIDS, SETTLEABLE, ml /L .......................... ❑ TIN ... ............................... ...... ........................... ❑ SOLIDS, SUSPENDED ........ ... ........... ❑ ZINC ............. ............................... ........................... .... .... .... .... ❑ SOLIDS, DISSOLVED ... ..........:.................... ❑ .............................. :.................................................... ❑ SOLIDS, TOTAL ..... ........... .........0. ... ❑ .................................................... ............................... ❑ SOLIDS, VOLATILE ....... ............................... ❑ REMARKS: ......... .......: ......................... 0......................... ❑ SPECIFIC CONDUCTANCE .......0 ...................... ❑ .................................................... ........ ........................ ❑ SULFATE . ............................... ❑ ............................................:....... ............................... ❑ SULFIDE .................... ............................... . ❑ .................................................... ............................... ❑ SULFITE .................... ............................... ❑ .................................:.........:........ ............................... ❑ SURFACTANTS ............ ....... :....,.................. ❑ ....................................:.:............. :...............:.............. ❑ TURBIDIT :' .......... ..................... ..... ❑ ............. ................. _... - - _ ....... THESE RESULTS INDICATE THAT THE WATER WAS OF A SATISFACTORY SANITARY QUALITY WHEN THE SAMPLE WAS COLLECTED, THESE RESULTS INDICATE THAT THE WATER DI _ MEET THE SATISFACTORY CHEMICAL QUALITY OF NEW YORK STATE ADMINISTRATIVE RULES & REGULATIONS DRINKING WATER ST NDARDS (PART 72) FOR THE PARAMETERS TESTED. -- ALBERT H. PADOVANI M, T (ASCP) , DIRECTOR: �-�✓� c ��'��'��L TOWN Or PUTNAMI VALLE14' LOG JLND REPORT WELL °'RILU.-.. WELL COMPLETION REPORT 0. Td-:!fubrfii-t od .�_Ug.._department, together with laboratory report of analysis of Vjaler S.Wriple indicating water is of satisfactory bacterial quality. "!n1l. Location' Tax: Map .Street;, Sec- B I. Lot Name Mailing Address. City or Town' Tel. # 1 1.2 -,e-, Name CASING DETAILS.' Ft. eter Ir i.nd: ing(#ddress City or Town YIELD TEST WATER LEVEL' SCREEN DETAILS —Bailed (Measure from and surface) or LX—c; Pumped Hrs. Sta: Ft. Make; When Bailed - Slot Yield: -1/.IGPM or Pum ed Ft 4, Length Ft. S:iz Diametbr In. TOTAL DEPTH OF WELL 3-n-0 Feet WELL LOG,. .Depth from Give description ^f formations penetrated, such Ground Surface as; peat, silt, sand, gravel, clay, hardpan, shale, sandstone, granite tc.. Include size ol gravel, (diameter) an.d, san dl,T(fine P., �'meodium r-of_ seF� pa�ked*- m ati--ri -structure,, (t�o* cemented, soft, hard). For example; Oft. to 27 ft. fine, packed, yellow sand; 27 ft. to 134 ft.; gra-Laranite Frr(:t to Feet Formation Descrintion D"IQ WQ11 Completed 7 Date of Report Well Driller >. Signature 1-77 Owner or Purchaser of Building =uc6' ect . by LodYlion - Str Munic ipali$y Drt� Building Type Section - - Blocku - - / 7- /• Lot 9 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- ation of the Director of the Division of Environmental _Heghh. 5� 4q— c.QS, of = the °Pufcna'm -Ca gent -y -"D-epar"tme it -5f' Heal as to whether or not the fail- ure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. II ll Dated this 4? day of 19 94- Signature. �t.uc�, oLVy�e e � Title Corporation Name if corp.) 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES. Date Re: Property of BgjjCB VAN DE VEEgpONZ.., Located at --Peek§kill- Holl . bWR`6ad.`-'Putnam alL ev- N.Y T.M. 119-2-14.1.2 Block Lot Gentlemen: This letter is to author12P TC)PT?• 0VPrNTnVVn a duly licensed professional engineer or registered architect (Indicate). to apply for a Construction -Permit for a sep*arate sewage system; to serve the above noted property in accordance with the standards, rules or regulations as proffulagated by the Commissioner of the. Putnam Coun ty Department of Health, and to sign all necessary papers on my behalf in VVIIMCLAUP W.L.L1 LJUS Ilia L L.eL aixi' to. supervise i e conat ju cc j 1 01 882.01 System or 'systems -n confbr mity with 'the provisions of Article 145 or "� Eduoation Law, the. Public Health Law, and the Putnam County 'Cbuntersig R.A. Muscoot No -..:"Mahopac.. New York 10541 :628-6613 ephone A. Very truly yours, �b ed -Owner. of Property. Peekskill. Hollow Road',,.,.. Plit-nnm Vial Iicvv New York 10579 Addresg'' -526-3620, Telephone:...,.. , hqjjp:._, ......... ........ . ........... -out illy -H DING DER 'GARM�L 'Y N, zw PUTMM . COUNTY' DEPARTMENT OF HEALTH :.DIVISION OF ENVIRONMENTAL HEALTH SERVICES 0QUN- f'Y•�OFVICE _ TEDING, AMEL' ''N: Y: 10512` DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner F. cure VandP 'Ve _rc3nnk Address pPPkGki 1 1 Hal 1 nw Road, PLtnam Val-ley, N.Y, T.M.119 -2- 14.1.2 Located at (Street. )PPPkAkill T4nllngip. Block Lot_ 1 n lca e neares cross street) Municipality Town of.Putnam Valley Watershed Hudson River SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS .. .Hole ......._ _.. 16 17 1 8/1 = 8 Number CLOCK TIME PERCOLATION 8,/1 PERCOLATION _...., ... Elapse Depth . o.. a er a er ve No. Time From Ground Surface in Inches Soil Rate. Start -Stop Min. Start Stop Drop in 'Min. /in drop R� Inches Inches Inches _.. -8r #1 16:02 -6:10 8 16 17 1 8/1 = 8 -4 6:35 -6:43 8 17 18 1 .8/1 26!11_6 A R 16 17 1 8/1 = 8' 3 6:20-6:28 8 16 17 1 8/1 = 8 4 6: 29 -6: 37 8 1 6 17 1 8,/1 = 8 5 42 16:08 -6:16 8' 17 18 1 8/1 = 8: R� .17 $ •- . _.i..._....:._. g/l _.. -8r 3 6:2-6=6: 34 8 17 18 l 8/1 = 8 _ 1 -4 6:35 -6:43 8 17 18 1 .8/1 = 8.1 2 CA INTY -OFFICE �I ll DING 4 CARMEL, NEW YORK 10512 JUN 24 1981 Notes: 1) Te'yts 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 from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITHDAPPLICATION DESCRIPTION OF : SOILS _ENCOUNTERED IN TEST -HOMS _ DEPTH HOLE NO. 1 & 2 HOLE:NO:.z.. A HOLE NO. 4 .c • - a :.y_ _ . a i ; .: �,, ....;1,. � a `'r' _ - ' q..; _ _.a.: nr .a ', s i, _' , � .r. . _.... .. .• ti G.L. - Toj Soil T66 Scii 1 Ton Soil 6" 5and•and small 4and and czrnnll sand and smell 12" stones and clay 18'► 2411 stones and clay n stones and clay n n 3Q'.' 42" 48" 54. „ 60 66" it 72'► 781 It .91 '10811 It INDICATE LEVEL AT WHICH GROUNDWATER IS,ENCOUNTERED 9 90 INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED 81011 �' y... Joel Greenberg r,'/ f 81 DESIGN TESTS MADE BY Date Soil Rate Used 8 -10 Min/1 "Drop:. S.D. Usable Area Provided 5000 S'.F, No. of `Bedrooms 3 Septic Tank Capacity 1,000 Gals. Type precast .:conc. Absorption Area Provided By L.F.x24" 5b h.trenc.. ED 5 8 ° 0 " x 6 ° 0'! dee song each n bas 7�, ENCE Name joe 1 Greenbercl Signature ,P F z ° Address RR #8 , M oo North SEA � o THIS.:SPACE FOR-USE BY HEALTH DEPARTMENT ONLY: 1105 o OP NE Soil Rate Approved Sq. Ft /Cal. Check d y B to W.— A 7 a 4, 0, 0, Z. ,7/0 Peekskill Ho low Rood or- soo f1ted-mop no, 1771. A, l4pbo, 6'0 0 S. Ir CUR7AI" 0RA L OCA TIONS w 6ZTo v6 p 2 /Z ITO .3 4 ' PO C' 3& 43 /8 30 5.9 -T'q 7, vision. of Enviromental 1104 4412Z 71' a® rote *3 PalatiQn§, Of the C D E- OUTAY II - artment.. ! I C) A., 1 64 1,�-51 31 lk gal-- a�tarQ & t. a note AS BC/ /LT SE141TIC -SYS71.1w 0649Toel.l�v OF NeV L,!-A Cl'/IN G 8.4-S !IKIS tAlciLi D--&RA. VIVY 0 8 D/A. X Gig DEEP "O/C WA-'l P- HOLLOW ROAD TOWN OF FU-I'NAI-7 VALL PUTIVAM L30X 24.3 A c SCAZ-,F-: H. , T. S. po Z. :7 00 -o"oaa, ea, ol-111 0 co "'' 4--' - -'- 9x6,6,' 1�00' ne on Ic % % 50'rigbf a/ I Peekskill No /low Road see filed mop /)a. i771. load A 0' 1011, i"r cqn T A -?o "F�p I-OCA71ONS 7 DopertgoAt Of U4bglt;b ivisjon of Enviropmertal Health Uvvigft OP noted nor e9n4-'3 rM4nqe ed as with 0able rt�les 4"a �;ecul'atlpua pf the 0 E- County V- artment...., A 1,.4 Igmatu" & 47 AS 43UIL7 SE IC -S Y-S 7�flq tqucE* DEBRA V1.4" Z"7-. yzmqi)omt� tAlckj 13 5 - L4-A CHIN G -PASik,1-5 DIA, X 6' OCEP T. li'OLLOW ROAD TOVIN OF PUTNAM VA 4-L E .4. 11C/7/VAM VALLEY /I/. V. of s�sl000' "-0. Liox 2,40 .5�%' 1111A /'/ /—Is DATE'' 5el'T 6 190-a