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.