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HomeMy WebLinkAbout4617DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.09 -1 -2 BOX 35 04617 rAgo �I -81 111 ,T ly, T 04617 PUTNAM COUNTY DEPARTMENT OF HEALTH Divided of Envl o amental Hed& Services, Carmel, N.Y. 10512 ,�O Mart Provide / P.C.H.D. Peamlt / KATE OF CONSTRUCTION COMPLIANCE FOR SEWI iE DISPOSAL SYSTEM PUTNAM VALLEY Town or �WLMY Looted at - BARGER STREET Tat: Map 12 0 Block— Lot 1 1 Owaler /appuantNameWILLIAM O'CONNF. LF�dy NJA SubdivtdmNamO'CONNELL F,R��F�CT Ma01og Address 9 7 BARGER ST , PUTNAM VALTW , N Y 10 5 7 9 Subdv. Lot # 4 Fee Enclosed Amount Date Permit Issued 7/ -41/R� Separate So-erne System built by JQHN HnT.T.ANn Address21 -5 CRONIN T.AKF. RnAD Consisting of 1000 Gan �qe Tank aad 412 KATONAH , NEW YORK 10 5 3 6 LF OF LEACHING TRENCHES. Water Supply: Public Supply From Address on * Private SupplyDrilledbyNQRD4AN* AANJ)RRRQW Address RARCPR ST. r PTITNAM VATTFV N.Y. 10579 jElalldingljpe ONE FAM_ RF.S Lot Size 1 _00£i At"R Erosio ygs Number of Bedrooms 3 Has Garbage Grinder Been Installed? 0 Otber Requirements S certify that the eyatem(s) as listed serving the above premises war cone cted aeaent fly a shorn on the p of the completed work (copies of which are attached), and in accordance with the standards, rules regula ions, in ac ce with the fil fan, the permit issued by the Putnam County Department Of Health. Date- 2/15/91 certified by a.E. R.A * Address 2 MUSCOOT R AD RTH A 0 t_ nu No. 11056 Any person occupying premises served by the above systbm(s) shall promPNi wed aetfon as may W necessary to aNeuri tM action Of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system, she become null and void as soon at �i t;: sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes fable. Such approvals are subject to modification or Change When, in the Judgment of the Commissioner at Health s revocation, modification or change Is necessary. Date �2v✓/ /� / / ! / By %'. —'_.� TItM 77 �. A0 3`r1liAR!:C4UNTY "DEPARTMENT! OF HEALTH acr.it x�' Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Located at Barger Street Subdivision �1TIi1 n 1 C'nnnPI 1 Subd. Lot a 4 owner /Address Bx 306 ,Jefferson Valley, NY 10535 Building Type ( 1 ) Fam. Res. Lot Area lAC Putnam Valley 120 °sun it loge 3.13 Tax Map Block Lot Renewal , ❑ Revision _ Date Of Previous Approval Fill Section Only Number of Bedrooms _3—_ Design Flow G /P /D 1600.0 P.C. H. D. Notification Required Separate Sewerage System to consist of 1000 Gal. Septic Tank and 40OLF of Leaching Trenches To be constructed by Owner Address Water Supply: Public Supply From Private Supply to be drilled by Norman Anderson Address Baser Street Putnam Valley,NY 10579 Other Requirements 1 represent that I am wholly and completely responsible for the design and location above described will be constructed as shown on the approved amendment there to County Department of Health, and that on completion thereof a "Certificate o be submitted to the Department, and a written guarantee will be furnished t place in good operating condition any part of said sewage disposal system i ante of the approval of the Certificate of Construction Compliance. of t will be located as shown on the approved plan and that said well will be Install County Department of Health. Date 6/24/85 Signed Address v APPROVED FOR CONSTRUCTION: This approval expires one year from t ati revocable for cause or may be amended or modified when considered necessary by .nn „i,es n new nermit. ADDroved for disposal of domestiasanitafy seNaage,ar`, 1) that the separate •sewage disposal system andards, rules an regu a ens o e Putnam jiltisfactory to the Commissioner of Health will assigns by the builder, that said builder will Wft Immediately following thedate of the issu- hb t ; 2) that the drilled well described above irt ules and regu a ens of the Putnam �. ,y P.E. R.A. License No. 11056 of the ilding has been undertaken and Is 1. Any change or alteration of construction l y. (,I WbLL UUN1YLt 11UV MEXUMI ►� DEPARTMENT OF HEALTH Division" -Of Environmental Health` Selvie's'� F. I� 04 PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only Ts a`�• " _:• -- WELL LOCATION STREET AOORESS: wNi 1 Y TAX GRID NUMBER: er Vq Ile WELL OWNER NAME: ADDRESS: / C PRIVATE PUBLIC USE OF WELL 1- primary 2 - secondary OESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED O BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT 7 gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE gal. .REASON FOR DRILLING []REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY (NEW SUPPLY (NEW DWELLING) ❑DEEPEN. EXISTING WELL DEPTH DATA WELL DEPTH 30&_____ ftj STATIC WATER LEVEL DATE MEASURED 9 9a DRILLING - EQUIPMENT 0- ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED fg,BPEN END CASING ❑ OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH a !�. ft. MATERIALS: U -STEEL O PLASTIC O OTHER LENGTH BELOW GRADE �2,.sft. JOINTS: ❑ WELDED &-THREADED O OTHER DIAMETER in. SEAL: O CEMENT GROUT O BENTONITE EWT+IER WEIGHT PER FOOT 1b./ft. I DRIVE SHOE DYES 0440 1 LINER: DYES QUO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (II) DEPTH TO SCREEN (ft) DEVELOPED? FIRST _ __ ❑YES o-ua^ GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH It. WELL YIELD TEST If detailed pumping METHOD: O PUMPED i tests Were done is in- • COMPRESSED AIR , formation attached? • BAILED O OTHER ; 0 YES O NO WELL LOG )f more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear- Ing well Dia- (meter FORMATION OESCAIPr10N CODE tt. It. WELL DEPTH It. DURATION hr. min. DRAWOOWN It. YIELD gpm. Land 30 �- 0o 2. ❑CLOUDY HARDNESS ❑ COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO [MAKER O CLEAR TEMP. STORAGE TANK: TYPE 2l�- -Trill o� S6 CAPACITY GAS. INFORMATION Se CAPACITY n C., A DEPTH _sL.� VOLTAGE 3k HP !11- WELL DRILLER NAME DATE / 3/ AOORESS �SSIGHXME 1 V 9 " J v Yorktown Medic I Labor tnry Inc I LAB # -23'2. 00 90 321 Kear Street s Date Taken: 1-15 -91 Time: 9 :15AM Date Rc'd: 1-15-91 Yorktown Hei hts lV. 1059 . ae �. f - Dt ,e R.perted 9 - X w JAN. t Time: -Soon Yk ' (914) ,245 -2800 ' ' Collected By: O'Connell Director: Albert H. PadovaniM. T. (ASCP) PO /Client # t/ - 3 7 - S T- Referred By: Sampling Site: c en a Crossroads Pharmacy 97 Barger St, Wtnaz Viy, NY PO Box 161 Putnam Valley, NY 10579 L -1 REPORT ON THE QUALITY OF WATER INORGANICS (mg /L) Alkalinity _ Chloride _ Detergents, PIBAS — Hardness, Calcium — Hardness, Total — Iron — Lead _ Manganese _ Mercury _ Nitrogen, Ammonia — Nitrogen, Nitrate. — Nitrogen, Nitrite — Phosphate, Total Phone ( ) MICROBIOLOGICAL _ Standard Plate Count (CFU /1.0 mL) Coliform & Related Organisms Circle Method MPN P/A Total Coliform Fecal Coliform - Fecal Streptococcus E. Coli — Silver Sodium KEY FOR TERMINOLOGY Less °e.`an. Sulfide GT = > = Greater Than Sulfite NA = Not Applicable _ Zinc SA = See Attachment(s) _ TNTC = Too Numerous To Count PHYSICAL MISCELLANEOUS P = Present (Positive) N = Not Present (Negative) PH (S.U.) = Also done because To- Color (Units) tal Coliform Positive 0 Conductance (uhms /c) _ Odor (TON) REMARKS COMMENTS Lab Use _ Turbidity (NTU) THESE RESULTS INDICATE THAT THE WATER SAMPLE ((' SATISFACTORY.SANITARY QUALITY ACCORDING TO THF4 WATER CODES, FOR THE PARAMETERS,TESTED9 AT THE THESE RESULTS IN SATISFACTORY CHE .ING WATER CODES, THAT THE WATER SAMPLE (DID) UALITY STANDARDS OF THE NEW E PARAMETERS TESTED, AT THE irector (For Lab Use) SAMPLE TYPE: (Check One) �! Potable _ Non- potable OUTGOING: (Check Each) HNO _ HC13 — H2SO4 _ NaOH ZnOAc Na2S203 Other: INCOMING: (Check Each) LE 40C ~ �( GT 4 /LE 200C _ GT 200C — pH LE 2 — pH GE 12 — Other: NYS ELAP #10323 (WAS NOT) (NA) OF A YORK.STATE PUBLIC DRINKING OF SAMPLE CO CTION. (DID NOT) (NA) MEET THE YORK STATE BLIC DRINK - TIME OF SAMP OLLECTION. 7 /87(Rvsd1 /90)RWE, PUTNAM COUNTY DEPARTMENT OF HEALTH _ DIVISION OF ENV RONMENrAL HEALTH SERVICES �.. .•q: ,.r i`f• .. .. ... _..�.,, �• r .,o. '••i;.� 4 —e:a; ... ,�'e . ... :f. ..�: :•.i.1 . ,.i,:y'- � -. -..- _ "':�'v 1. �. r': •,:o Fi il�� ��%� _ - a.'.'�,'i:.�..•.. ;C.i •. Owner or Purchaser of Building Building Type 110 Section Block Lot Subdivision Subdivision Lot # GUARANTEE 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 "C.erti.fi.cate of Construction_. Compliance".-..f for . the .sewage disposal system, pr, Any•„ repairs mane y'm"e` "to suc- Yi " "systF n`, "eXCept whete-•the failure to --operate 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 ahe '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 5] caused by the willFZW- -or negligent act of the occupant° of the building utilizing the system. Dated this 2 ` day of 1 19,51 Signature ., Title G General Co tractor (Own ) - Si gnat Corporation Name (if Corp.) F;7 61p-jz- e� (--'r Add ess rev. 9/85 mk '� � lutd <A tau► 1.? Corporation Name (if Corp.) 2t -� C.Ru'�wJ L.�.lza 12p ICA 5-3L Address 'k. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES `COUN'T'Y OFFICE DESIGN DATA'SHEET- SEPARATE SEWAGE DISPOSAL: SYSTEM FILE NO. Owner Win 0 'Conne11 Address Bx 306,Jefferson Valley.NY 10535 Located at (Street BprQpr St reet Sec. 120 Block_ t 3.13 Indicate negLres • cross• s ree Municipality Putnam Valley' Watershed 'Hud bn Rivet SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION ... ......,, .. - ., V s_ e..e NQ. Time From Ground Surface in Inches Soil Rate 'Start -Stop Min. Start Stop ..Drop in .. Min./in drop: Inches Inches" Inches . PTH #11 '9:45, ; 10: 15 .30 16 ' 19.33 ' 3: 3'3 30/3.33 =9' '2 10:19 10:49' 30 16 19133 3.33• 30f3_33 -9 3 in -s-A i1 -91 An 19 is 3.33 30, 3.33� -33 PTH #21 .9:50 10:20 30 16 19.0 3.00' 3'0%3 =10 - 2 10:21 10:51 30 16 3 •19.0 3,00'­ 30/3 =10 3 10:52 11:•22 • 30 16 19.0 3.00 '36/3=10 Notes: 1) Tests to be repeated at same depth until a roximatelyy•equal'soil rates are obtained at each percolation test hole. All data to be submitted" for review. 2) Depth measurements to be trade from 'top- of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOIL ENCOUNTMD IN TEST HOLES . DE�H :HOLE.. ;N07. ; -� T' #1 HOLE:NOo G.L. Top Soil 611 Sand & Stones 1211 1811 2411 • 3011 u 3611. ,i •• 4211 ... If 11 ... 601' :... 6611 a 211 .. ... • 7811:. . INDICATE I : EIS "AT WMCH GROUND WATER IS ' ENCOUNTERED NOND ,. 3NDI£A - EVEL 1O..bofDICH VATS -� —RISES ^AFTER QEEMG ENCOUNTERED NONE :. 'i-�. oe-i^Lo 'GYeenbercr, _, . ,<,�•-._.=- _•�.�/`AS -; -- .. • -- - Soil Rate Used 4/1Q'Drop: ;. Bobo Usable'Area* Provided 5000SF No a of Bedrooms 3 Septic Tank Capacity l o o o � Absorption Area • xov a By go L.P..x24" �� R • �, bo MM �". Address .. . Soil Hate Approved Sq. Yt/Cal.. Checlod by Date . i 'ty f �t i� r � , •�i - °'•i .z J 1 O 'GoNNE1� VVIL AN1 - ERLyl OR FARM O . O .N0►^r j5p. J� N I I 1 N / � °P I 'J THIS IS TOp.CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WAS CONSTRUCTED AS INDICATED `n ON THIS PLj9 AND THAT THE SYSTEM WAS INSPECTED BY "ME- BEFORE -IT WAS COVERED OVER w THE SYSTEM'ii'AS CONSTRUCTED IN ACCORDANCE WrTH ALL STANDARD-RULES AND REGULATION _ OF THE PUT1dM COUNTY DEPARTMENT OF HEALTH AND THE-NEW YORK STATE DEPARTMENT OF _ HEALTH. CD cc CC W .. Wz M� z< 0 1 � 0 `O r 3 V 47{;1435 4 5191"502 57 °'SS' (s (126.11,11511 67"117!7' 10 42` is84° I t .487 : 12 53° 8�6 13 (01_.191 7 . 15 �3� l0 /p0' Q 9 IG G70j,,49 6' 1 a 633p `' � r8 47.8' P °sc I? 740: 151 ¢i F�38 4,4 I I 14 3.8' N O � lu 1 � 1 J� N I I 1 N / � °P I 'J THIS IS TOp.CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WAS CONSTRUCTED AS INDICATED `n ON THIS PLj9 AND THAT THE SYSTEM WAS INSPECTED BY "ME- BEFORE -IT WAS COVERED OVER w THE SYSTEM'ii'AS CONSTRUCTED IN ACCORDANCE WrTH ALL STANDARD-RULES AND REGULATION _ OF THE PUT1dM COUNTY DEPARTMENT OF HEALTH AND THE-NEW YORK STATE DEPARTMENT OF _ HEALTH. CD cc CC W .. Wz M� z< :i bfi A5...t) J. 7_- �y�SG: 1�- _P��rs L_ - TAM - -- 0 d ruinam County ueparzmenz ui nealw. �ivi�ion of Env iro nta1��13�vS05- F P!_5 15 1-11 - ' approved as noted for Conformance with } applicable Mules and Regulations of the ,ua Count tment.. W Dar 'i.¢n4turw 7F. Ti ter 2 N WJ LU tr SL c� z e LU 3` _ 00 z LU <W s - _j FO -J= o. O a W¢ rz o ,. O y u c "_j i 01ll� IL2 > �I< 0� mJ� C_ P �Q• a i C a. z� Dr- of r" 1 2 3 V 47{;1435 4 5191"502 57 °'SS' (s (126.11,11511 67"117!7' 10 42` is84° I t .487 : 12 53° 8�6 13 (01_.191 7 . 15 �3� �42g IG G70j,,49 6' 17 633p `' SG(( 6 r8 600,:'4° I? 740: 226 :i bfi A5...t) J. 7_- �y�SG: 1�- _P��rs L_ - TAM - -- 0 d ruinam County ueparzmenz ui nealw. �ivi�ion of Env iro nta1��13�vS05- F P!_5 15 1-11 - ' approved as noted for Conformance with } applicable Mules and Regulations of the ,ua Count tment.. W Dar 'i.¢n4turw 7F. Ti ter 2 N WJ LU tr SL c� z e LU 3` _ 00 z LU <W s - _j FO -J= o. O a W¢ rz o ,. O y u c "_j i 01ll� IL2 > �I< 0� mJ� C_ P �Q• a i C a. z� Dr- of r"