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HomeMy WebLinkAbout4440DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.14 -1 -13 BOX 34 1. , T T 1 L 1; I■ r Ar a OWN SIT MAI PEP DAT PRO Pro (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal from licensed professional engineer or registered architect. Proposal approvej;;�,4' Inspector's Signature & Proposal Disapproved proposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed components tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, re agent of owner ggree'to.the above conditions. r . . SIGNATURE -' _%z TITLE IMS: V&te (PO~D); YeUcw Mmn HI); Pink (APpliomt) DATE 11-1v1—$73 1y1 — $73 V ,, 1 :1 5 i PHONE :aj o� �' - 3 3 L/ SITE IDMTION r r(t/ l ► a `f ie l%, f vt (401 r% 11-e u Tw / 12 L/ • > 3 MAILING ADDRESS PERSON INTERVIEWED PW Complaint # Name'& Relationship (i..e, owner,tenant, etc.) DATE / TYPE FACILITY PROPOSED osTuJZR S ,z �'i4o S t u PHA Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location. and of sane type as original. sewage disposal system. Different location may require submittal of proposal from licensed professional engineer or -- registered architect. Proposal apprcvedv� Proposal Disapproved Inspector °s Signature & T' r000sal approved with the following conditions: 1. Procurement of'any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map, number. c. Location of installed carponents tied to two fixed points d. System description (e.g., 1250 gal. concrete septic tank, drywells surrounded by one foot + gravel). e. Installer's name and number. Date (e.g. house corners). three precast 6' diem. x 61 deep 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, r reportad age o er agree to the above conditions. SIGNATURE TITLE DATE cpim: %lite (PLID) f YeUc w (fin HI); Pink Ck#iamt) -2380 TEL. (914) 528 9269. 9523 KASTI-JK-- & SONS9 INC* General Contracting R.F.D. I • ADAMS CORNERS • BOX 55 • PUTNAM VALLEY, NY 10579 ...................................... ................................... 19 ...... .................................................................... .............. ................................... ................................ . 7 ........... .............................................. .................................... ........................................................................... .. .. ...................................................... .............................................................. * ................................................................. Titil q /05 55 DA .4 <,M: EW�,Atlx- Musil UN II(MY'DE �0 PROVIDE P ,�.�,4 ........... . D kii6 R`;�,of V", '4 T� A� ON COM '(JWtt4GE- oQISPOSAL-.�g YW-_bliiiil'� 74�,, 7: CERTIFI,CATE_.,'OF CONSTRUCT-1 PLI, Located a Tax Map I ":Bloc 7 J Formerly Tax MiLp Lot # Lot Owner— /Al A 3 Separate Svweeage System. bullit by Address Consisting of" Gal. , Saptic�,Tonk' a Other requirements Water Supply: public Supply From P at '410001. ii-v e',SUpply Drilled By �_L Building Type No. of -Bedroomi-, Date Permit Issued !M l ed Has Erosion Control Been' om eN " de0b6dn'zlhsU :Has' I certify thatthe system (s) as listed -serv'i n ­remises were cofis L C n - �s. -shonm 6 ."a plans of the completed,work copies 'g,rt!r ppoye'lp of,which are attached) and in accor�lance, with. the -.a - standards rules and,feWgy a filed plan, and the permit issued by the Putnam County Department O� nealth" -MAR, P. E. R.A. Date 6'41 4 by q 'License No I�Oall,P,Kompt Y� c, �ni !ATMpto h t1a as_M Any perso :�.tklll Iiii to ,,611i the correction .of any unsanitary conditions royal separate t, era Id.as soon as a -public; sanitary sewer. becomes ,!rqval.:p he separe.Te sew K� u uih-' i iiii:6 44aliabk S approvals are ii d.ripill an T�, � rn ppy . Mell available and the approi�al ol'the,private watei,iu0bly,shall IN.- subject to modification ge-*-- .when iiii the of the .'odification or change is neceimioy. ii h or. chin.' - Commissioner , "din m Date BY TRIG Rev. 6/85 &,--- '�ifN /��v � r �A�N ifl��r� /�,S // Z Owner or Purchaser o Building �� Section • =- =,��, w =° ^°,r'{i I ciL'�A�[�.q�•, �y IOQ iV4 l 7 0W ^�..�.'. M �� Y^.rf• - J » i;'74-:. w : >'� iiy. of ^ -. T• uil ing Constructed by Block C'r•N �/ �i�'NL % 1 vii yr Ui�G�C7/ Location - Street fJTu,+07 (�i4GGC y Municipality 0006 FAAA2E� AIASVWOKy r- 00,A197464i Building Type Lot G f Y,!! 6 eie 6- Subdivision Name /3 Subdv. Lot # GiARANTEE 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- -- of .the D- irectoT- -of-- -the Division- of Environmental Health Services- of the Putnam County Department of Health as to whether or not the fail- ure of the system to operate was caused by the willful egli en� ct p;w", of the occupant of the building utilizing the system. Dated this /� day of v«- 19 Signatures, Title Corporation Name if c�xp . I -S 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 WELL COMPLETION REPORT RUTNAM COUNTY .:pEPARTMENT OF MEALT14 ant . . �:. r • -' Oivbion of An ronnw1lal Nealeh 1341►t/itIRE . �, COUNTY OFFICE SLIILOING - CARMEN, NEW YORK. r. . "T is "feporf'is Ct1 Fib Eotnpleted fiy.'weit i!¢r nii SUbereittesl YOrCouritF;; ~ tle; Dslpsrtrtgent .-to"thar_yvlt* &W,&tory report of :.•t analysis of water::sarriple indicating water is of satisfactory bacterial quality before cectlficate of oonstruction eompoance' is, 'inued:.. M REPORT.'MUST BE SUBMITTED WITHIN. 30, DAYS OF WELL COMPLETION NA �- ADDRESS OWNER LOCATION - :. f StieoU own ', fiatfgretaerl OF WILL (� E4DOMESTIC BUSINESS 0' � �. PROPOSED ESTABLISHMENT FARM TEST WEIR USE OF WEU 0 1:1 a ONDITIONING 0, SUPP Y INDUSTRIAL (OEb•cifT) . ORILlINO COMPRESSED CABLE " OTHER' D a a.lEpod:yl EOWDMENT ROTARY AIR PERCUSSION PERCUSSION CAEIHO `LENGTH (feel) ' . DIAAIETER(Inches) WEIGHT P92 FOOT , . YES TES DETAILS Ile 'f G / THREADED WELDED NO.' .:_. . -. D _. HOURS . G.F'.M .. �. ® TIELD-/ P.M.j TEST .... RAILED . PUMPED. . COMPRESSED AIR'. ! �O WAIER MEASURE FROM LAND SURFACE= STATIC(SAsclly leaf) DURING_ YIELD TEST IIFFt) Oeplh b .Cortlplebd Well o LEVEL In feet below. lend wrtacel MAKE:. ul�Ttt OPEN TO.AQUIFER OW) SCREEN EL SIZE DIAMETER (IncAos) IF GRAVEL ObmtiNr of well incWdtnB, �f1 O (�4 DETAILS PACKEDr o►ovol pock (IneAUI: % DLFTN lEpM LAND SURFACE ll With 611111101111011. ft) of NMr Sketch erleof a Weil -- DESCRIPTION five panl>1Ma tIRntOftRM a rb . FEET to of IT r Ii • If yield was tested at difforoni depth during drilljng, list below FEET GALLONS PER MINUTE ' DATE .NEIL COM IETEQ GATE OF REPORT WEL ER lSlBrut tt�� Yorktown .Medical. Laboratory, liC• LOCATIONS-.". 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245 -3203 321 Kear Street 43LOl BUTTONWOOD AVE., PEEKSKILL. N.Y. 10566 737$777 Yorktown Heights, N. Y. 10598 ❑ 495 MAIN ST., MT. KISCO, N.Y. 10549 6663335 (914) 245 -3203 ❑ STONELEIGH AVE. PEAR HOSPITALI, ARMEL, N. Y. 10512 .278 -9330 Director: Albert H. Padovani M. T. (ASCP) j �� �OJ DATE TAKEN: yw.. +.. - v +„nn _ a. �ec ,ate . . ^.:t�C1'r:' P ziF; C:.,a':sn'�.. --;r •..<�'`, - F ':.� ¢. i t, -. - ASE- RCCEIV�D"�" DATE REPORTED: �Z2 ,t V / �J SAMPLE SOURCE Lab �� ' / D 7 ��i'� REFERRED BY: L OLfh Gam✓ ��r /�-� � �!/•�1• Collector : 251- 068 �I i LABORATORY REPORT -- ' ❑ ACIDITY .....•• ..................... ............................... ❑ ALUMINUM .................................................. .. .. .............. P= ..............:_ ....................... ❑ANTIMONY , .............,. ........... ............................... ❑ ALKALINITY i . BACTERIA, TOTAL /mL ...,...... . ................... ❑ ARSENIC .................................... ............................... • BOD, 5 DAY ............................ ....................0.......... ❑ BARIUM ....................................... ....6................:......... • BROMIDE ............................ ............................... ❑ BERYLLIUM ........... ..................... . ............................... ❑ CARBON DIOXIDE, FREE ....: ... ............................... ❑ BiS:IUTH ............, .......................... 0......................... ❑ CHLORIDE ............................ ............................... ❑ BORON ........................ : ...... . .............. ......................... ❑ CHLORINE ............................ ............................... ❑ CADMIUM ............. , ......... .......... , ............................... .. ❑ COD .....................:.............. ...........0................... ❑ CALCIUM .................................... ............................... ❑ COLOR (units) ................. ............................... ❑ CHROMIUM (tot.) ........................... , .... 6.......................... ❑ CYANIDE ............................ ............................... ❑ CHROMIUM (hexavalent) ...... ,.,, ............................. , .......... . ❑ DETERGENT, ANIONIC ............ ............................... ❑ COBALT .................................... ............................... OFLUORIDE ............................ ........................6...... ❑ COPPER .................................... ............................... ❑ HARDNESS ........................:... ............6.................. ❑ COLD ......................................... ...............,............... ❑ MPN COLIFORM COUNT/ 100 ml ............ ❑ IRON .................................... ..... ............................... FIFT COLIFORM COUNT/ 100 ml ..........0 ............. ❑ LEAD ...........................:............ ............................... ............0....... ❑ CONFIRMATORY TEST ............ ............................... ❑ LITHIUM ...................... .................... /1 ❑ NITROGEN, AMMONIA ............ ............................... ❑ MAGNESIUM ................................ .........6...0................. //J 9/ ❑ NITROGEN, KJELDAHL ............ ........................0...0.. ❑ MANGANESE ................................ ...0..............0............ ❑ NITROGEN, NITRATE ............ ............................... ❑ MERCURY ..................................... ............................... ❑ ' NITROGEN, ORGAN. IC. ............ ............................... ❑ NICKEL .............: RUOGDCIR 1 .......................... ............................... O.Pi,LLADIJiV! �. .. _.. , <, '... ❑ OIL & GREASE ........................ ............................... ❑ POTASSIUM ................................ ............................... ❑ PH ( units) ...................... ............................... ❑ 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 (uhmo S / cm) ............... ❑ .......................................... , ................. 6...................... ❑ SULFATE ............................................................. T NT C = Too .Numerous To Count ❑ SULFIDE ............................ ............................... < ❑ SULFITE = less than (below detectable limits) " " " " " " " " " " " " " " " " " " " " " " " " " " " "" R S = Recommend Sterilization o f S o u r c e ❑ SURFACTANTS ..................... ............................... FSBT = Filtered Sample Before Testing ❑ TURBIDITY ( NTU) ............... ............................... THESE RESULTS INDICATE THAT THE WATER WAS p OF A SATISFACTORY SANITARY QUALITY WHEN THE SAMPLE WAS COLLECTED. THESE RESULTS INDICATE THAT THE WATER DID MEET THE SATISFACTORY CHEM- ICAL QUALITY OF THE NEW YORK STATE ADMINISTRATIVE RULES & REGULATIONS, INK NG WA TANDARDS (PART 72) FOR THE PARAMETERS TESTED H S PLE AS COLL T N/A = not applicable Albert H. Padovani M.T. IASCPI, Director R W F, 8 5 ' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL.HEALTH SERVICES COUNTY OFFICE 'BUILDING; " CARMEL,­ N. ' Y. T051� DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Address .,Located at .(Street C".410 G- cxra:C Se/c. /% Blpck Lot - iQa, nearesT, s s -, sTree�TT, Municipality. /l? - >"9" Q Watershed SOIL PERCOLATION TEST DATA QUIRED TO BE SUBMITTED WITH "APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth U-77a-f—er a er ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min'. /in drop Inches Inches Inches 0v i 4 1 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. 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. t TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH (HOLE NO. 0 } HOLE NO. �- HOLE NO.� 3 G.L. rev 12" 18 '' 2411 30" 36" 42'1 48" 5411 60" 66" 7211 78" 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED 71 RY -49 ;T -O. WiaR%H.`W&T} R. LF 1 1` CIS 1T1�i°['E � C TESTS MADE BY ' . ���) i yeOW Date -- /- - DESIGN Soil Rate Used. // Min/l "Drop: S. D. Usable Area Provided No. of Bedrooms Septic Tank Capacityi(� a6" Gals. Type Q` �/ Absorption Area Provided.By - .F.x24" width trench. OF...NFpl Other Address THIS SPACE FOR USE BY Soil Rate Approved 0 pea"��i a.�'�O• 248�Ys DEPARTMENT ONLY: �, �'•o,,,m�•` Sq. Ft /Gal . Checked by APR 16 1884 PUTNAM COUNTY DEPT. OF HEALTH, Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL.HEALTH SERVICES Date y Re: Property of /z Located at o (T) Section %/ Block Lot i Subdivision of Subdv. Lot # J3 Filed Map # Date Gentlemen: This letter is to authorize �_el�r' /.�'�/ a duly licensed professional engineer 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 sys-ae i or systems in conformity w_ tfi"f pro`vis`- ions-of Article 145V' or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. OF 1VEa, %-% ' ~ C Countersigned: P.E., , # Y% �� Qs09RRRS0Rlw� Address Telephone 0 oY a A Very truly y s, Signed Owner of Property Address / V T wn L//4/ 'Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIELD INSPECTION REPORT ... i^ •• ^i _'?"''t. '. -, .. �`-M: 'A - J.J.._� _ r.- t� ,- ._r ..._ ... .,.-.. - .. _ i R 9.; .. ia'.._. ..- ,�,I,i"�.r.,J __ _b+'f. _ +' _ INSP. BY: (Name of Owner) (,Street Location) INITIAL SITE INSPECTION YES NO COMMENTS Wetlands on /or proximate to property .............. Property lines or corners found ................... Can estimate house location ..................:.... Willdriveway 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. D. H. - Deep Hole G.W.- Groundwater D.H: 2 Lot D.H. 3 Lot Depth to G. W. Depth to G. W. Depth to rock Depth to rock Soil Description Soil Description 0 ft. 0 ft. 3 ft. I I - 3 ft. 6 ft. 1 1 6 ft. 9 ft.. 1 1 9 ft. 12 ft.l 1.2 ft. sic. -._.. ..•s+ s. ���.�... -v, _,, ...o .�.. �•. s.- ..yy. _._- �.Ytt•' �.p ,..moo- � �- .— �,_.+� DATE: 1 Z-5-.-) - - FINAL SITE INSPECTION INSP.BY: YES NO CAS House SSDS located per approved plan ............. Length of trench measured 3 jU-�- Width of trench average Slope of the line and trench acceptable....,..... �. - Roan allowed for expansion trenches .............. ' l'�c c_•c.c_ F57 Over 100 ft. fran watercourse .................... Natural soil not stripped or SDS area unnecessarly graded.......... .............. lb 10 ft. maintained from property line and 20 ft. from house .............................. Distance well to SSDS (ft.) ...................... -- Number of,bedroans checks........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. fran nearest trench.. ........... 15 ft. of peripheral soil horizontally fran trench ..... ............................... .. ..... ........... Boxes properly set .. .� Could surface runoff fran driveway, roads, , ground surface, etc., charm e&r--S S area.... Does lot drainage in ea of SDS....... FINAL GRADNG OF SI ..... LJ JOSEPH F. SULLIVAN, P.E. -2972 FERNUREST-11DRIVE YORKTOWN HEIGHTS, N. Y. 10598 (914) 962-4248 Putnam County Health Departriient R6ite-.52. Carmel N.Y. - 10512 Attention Mr. Jay Hodges D 7. -December 9. 1985 Re: W011 r lookti-pp Fieperty qf- An ton Tantola.s Cindy Lane Town of Putnam Valley Seotion 119 Block -TAt 13 '`,'Dear' Mr. Hodges,, Enclosed .please find a, plan -indicating the relocation.. of the proposed well for Mr,, Tant.olas,propert Cindy. y on Lane in the town of Putnam Valley* From.a field inspedti.on Sher w, 4r* -n.e- surromdin se go. dispepal.--syste o., dill adv6raely affoet theta proposed well# e/e Mr. Ant in TantAles, Very truly yours Joseph F. Sullivan P.F. M I { 2 . f 4 70 J J fi - �.nx.. «....- .r.. »-.... .._...mow - •._ -_..., _4 l ! t y . - .. _� ' vy .: amu +.t+m- ..�... �. ra» .r+. � «� ,.. -,.•�•, A+�.i -+..r .•..w. .i �.w. ..A_...�_,..�......� -_.. �.. � _ _ _— +,r- .arr..�..�+•4'- t r ` { S { 1 .x r�•"s J- t 3 0 .,,�, � . , /- ...,,; � \ ; `„�.f.,`•°'� ter,., "~'-•- .s_ -. .e— .yy. _,��.. �.V.�. -.... �....- ..�.a...._r.w, ._.` .._ �. L.pP.c+r J•'�t �`.� *b � .. .e.. � p 1 .sw• -� .c ®.�.ts:l,..c'�"..� '�.. ars...� .. °`,�""';?'.�.:•�..,_. __'�. '� ter`.'- "•ahT,�' 'c�+z .,'��::� 6'.Z::" -n. `tS"3� '��...a�..�""t�it;'� ;;�'a��.a. _a�..y=.Jx� .MO. r_. ..,xxs '� -.�`: t, st, tl -e sewage disposal system was c.onst.ruated tad an this vlen and that the system was tnspeated. tP'y 'no was eovPred ,ver. T'a system was constructed in t,�c erdami.