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04653
TI
PUTN,AM JCOUNTY DEPARTMENT � OF HEAiLT'lI
ed 1° DiVISton of .Env/ronmental Health Ser11 /ces, Carme% :N .,Y: 10512`,
>GERTIFICATE' OF CONSTRWCTION COMPLIANCE F,OR SEWAGE DISPOSA, t SYSTEM Riitnam Va 1ley
�` ,. b • "-s f..,r, rr -:'::- + "'•�. .:' z:• o ',F $ ;. '.. TtiH ,yg. E:�Ii ag��,.. c..
Stephen Smith RDrive. sr s T 1188:
Located at Tax ?Map Block'
T &` S R ..13Uil ers 3> 10
Owner
Job
Separate..5ewerage` System built by
S ` yF Septic �5ystejns, InCAddress Elm �St :New Rochelle,° N.Y.
Consisting of 1250 Galr.'Septic Tank and 6i-
4
L F X.
K
Noner
4
Other requirements'�F.�
Water SupPIY
Public SuPPIy ,From
X Torlish
private SuPPIy Drilled BY
Maple Avenue, Armonk;, ,New York
Single Family A.
Burldrng TYPe
of m 4
4 No. Bedroo
Yes t 0R�
P
A June 197.6 .
Has Erosion Control Been
;L.certify that the system(") as listed serving the above prem!ses were constructed essentially as "flow �QQ -pl pie rk (copies of. which are
e attached), -,and in:`accordance wdh'the standards rules and regulations plans -filed nd the permi ,iii b C un Department of Health.
i
October 3, 1977 �f
Date Certr ied by . P,E: X R.A.
�. Valley 'Pond; Road, .Katoriah, • rk1l 51251
Address = 51 nse No.
t
Any person occupying premises seared by;the above system( ;) shallpromptly� take such acUortes maybe n CD' `i�V ` e correction of .any unsanitary
conditions• reid1ting -,from, such •usage ';Approval +of th@ separate TSeweiagesystem shall tieco'me null'and "Voi as :a public sanitary sewer ,becomes
,i
aJailable and the approval of the ,private water_supplY.shall become null _.' ;.void when a public -water supply becomes bvailable, $uch approvals are
Subject to modification dr. change_ when,, in .ttie_': judgmenf of the ,Co m stoner of H t such ievo lion odification or change
_is necessary:
Date s BY x �t� ' _ Title : - i
W,
j
M* #1140
(914',A -'666-3335 - Mount Kisco Medical Laboratory
344 East Main Street
idiourit Kisco, N. Y. j 0549'`
DATE COLLECTED
RESULTS OF EXAMINATION OF WATER
OWNER DATE RECEIVED
Builder
7/12/77
CITY, VILLAGE, TOWN VOR NAMt OF SUPPLY DATE REPORTED
Stephen Smith Road, Putnam Valley, New York 10579 7/14/77
SAMPLING POINT
Lot 10 Kitchen Tap
BACTERIA PER ML. (Agar plate count at 350C).
5
COLIFORM GROUP (Most probable N6. /100ml.)
Less than 2.2
HARDNESS, TOTAL - ppm
-
DETERGENTS - ppm
NITRATES (as N) -.ppm
IRON, TOTAL - ppm
FLOURIDE (F) - mg. /i.
k
These results indicate that the water was Yes of a satisfactory sanitary quality when the sample was collected.
Per: games Torlish
A. H. PADOVANI, M. T. ASCP)
X10 41
_ _ .a
Westchester County Department of Health
Division of Environmental Sanitation
t, 7•.7 Z
W= COMPLETION REPORT
This report is to be completed by well driller and submitted to Health Departmentj, together with
laboratory report of analysis of water sample indicating water is of satisfactory bacterial
quality, before certificate of construction compliance is issued.
Well construction to be in accordance with Bulletin SD-62
•RULES & MICUIATIONS MATING TOINDIVIDUAL WATER SUPPLIES"
LOCATION : .MUNICIPALITY SECTION BLOCK. Ia
WKLT OWNER, 4 i� .80/ ldcje J_ j lexl 4 C /J /
we
Nam Street Address City and Town
WELL DRILLER:
t joeJ
Uft-
Vaalea IkMeaMrO rrom land surfAce)
Len0h3 Feet' or
, jo t x Pmqmd Houra'Static: .7-,-1 Feet' Make:
Diameter: tMen Bailed $s lot
Inches'Tiekd; G.P.M. 12E hm—d Feet tLength n. tsize
Diameter last
TOTAL DEPTH OF WELL 306 FEET
lt,t
rvaF-on- vrom r., uive aescr.,&pzion or'-rormationo -penetrated,, -such--s*j peat' 91
a gavel.,
6 halep. sandstone,, granite,, eta* Include size of gravel (diameter)
and sand (fine, medium, coarse), color of materialj, structure (Loosep packed,,
camntedp soft, hard). For wmmple: O-ft. to 27 ft. finej, 'packed, yellow sand;
27 ft.` to LU ft, gray granite
0. 17 lft. t
ft, tQ Z t
rtfito Ft.'
Ftito
Yt.to Ft.'
Date Well Was Completed Date of Report .7 -7
Well Driller
;1
c
WEJA, PI'S' AND PUMP EQUIPMENT Dh"PAY%a4
-46'- h:Viii itiybR sn °`W, IG
Pit with 4—inch Gravity Drain to Basement
Pitless Adapter — Casing Min. 12 inches above grade
Others Describe
Pampa MakA Z d Oo/o Type Sai mde —S CA' city �; r G. P.M,
SQorzgi` `Dank: `3W &- 4 -11(X �'s �s�'��� Capacity Galo(42 Gal., KinJ
DIAGRAM SHOWING LOCATION OF WFJ1 ON' PRIMSES
_. Indicate, l oeation of - Muss 9:_-well ;and
sewage: disposal system 'with .disteraces,
`4190 indicate direction of',slopesg and
direction erith distances to all wells
.;,and sewage disposal systems within 250 feeto
I certify that the individual water supply indicated above was installed as per the
rulps and regulations of Bulletin SDo62 of the Westchester County. Department of Health.
T:'& S. R. Builders Putnam Valley
Owner or Purchaser'of Building Municipality
••i"a•�iY•v:w :�:: i-.: <: °'y; -_'•:y %- .`rG•�.t.: a• ,'gyp:- �'}.. _:_.••�:- •- n- r.':!!>�. n.m:I3' •a••rn•V?'0 -i.• %w •��^a�� w. •a•..�i::�.'`:G •O1,t;'e ,.•�,.. �'}�': "9'.,�'a'.•,s ..:• -o: ey Vin`,
T. &.S. R. Builders
Building Constructed'By.
Stephen Smith Drive
Location -,Street
Single- Family.
...Building -Type
s
GUARANTY OF.SEPARATE.SEWAGE SYSTEM
•I represent that I.am wholly and completely responsible for the location, workm,.nship,
material, construction and drainage of the sewage disposal system serving the above de's -
cribed property, and that it has been constructed as shown on the approved plan or approved
ame thereto, and in accordance.with the standard:;, rules and regulations of the
'uta m
DdUXOM2MM County Department of Health, and hereby gu«ranty to the owner, his succe,,sors,
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 dato of
completion 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
occupant of the building•atilizing the system.
T�ac ��.ndersigried .further _dgrQes--to .aci:ept •as_ •concZttsive. the- determination -.of-the.., . -- -.� - - -'• •,r
Assistant Commissio urt ao mHealth for Environmental Qua"_ity of .the Division oe'Env- Vi-
-imental
Quality of the x 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. I .
Dated this 3rd day of October 197 7
at Katonah, New York
Place & State
Division of Environmental Quality
1M:kx County Department of Health
Putnam
Form S.D. 50
Signature U-
Title
I:.-' corporation, give name and address
January. 1, 1960 (1977)
'CQUN 'H"'
AM,-
TY''DEPART
MfN
i, Is/ :0 tal Hepim services, uarmei,
r poiron0ein 10512
A -
W
4'410ALM I
CONSTRUCTION RE T. FOR � SEWAGE; OIOQW,
1717.,4, .1
-�7
jo Job
C
ION Town or Village'
SubdMs n u Lot;
"A d A� Q-; S6
dies
bwner . _�
1
Building 'Type .
real
:
-'Number of B Orris e Square Feet
an
ee Width trench
4j)o
g,
be d s 1t • Water `SUpPl4"L_. --:'Pub1i P _to Ft&A
,me I ill
X
10ther-dReolre
gj OF Nfl�
1'represbrit 'Wh completely -r si e, m disposal _
that -1 r� 611 — , _m , - �, �o -f t'�ie�,' d, iyiiein .1 system
_y,.arici,,qo _ , I e .,
kructitdaisho% Vlt, the Putnarn
above described !will be ,constructed 01 with h,
A:", .0
t 11
6_2 , - i ,
Courity$biipaiiW6t 1arlcq'- ,S�ta `0 of Hear_nWi
elrSr S
be submitted 'i'o � 1 k e D" "'i 9"ir-iii�h-ed:;thb'�6WTipr,,-Iiis.'sucpessqrsi,,tf s
Department; a ,Wrgj.en guar4ntqe�,Willj 9. U_ t -builder Will
d --r ti diticiA,arfY paet't6f said . st uring- the-per�ibd&-t of the issu-
1 0 disposal sy em W (2,)�. rg& medi
e, approval Construction .
'of tHe a ro, al of the;'-,Certif6t6 :Yrig
v.
e Iocated as,7sho-w0;9
),:th0,ap 41
iplafi,�
VdIF _W
ill'bdAhstdlle'd n
nty-54paitryleni of H eilth.
Date Signed
APPROVED F A CONSTRUC
revocable for use or ay -be a
requ�r, s-
if,
n e itj','"`A�ppr(
}Date
r,apy 46aiis-t f t _; 2) t we I ribed. above
4 , th 'the �,,",stand s, ule ns of he PuthAm
RAfta
a FIRLD CI-ICCK LIST
Date:
INITIAL SITE
r
Yes
Property lines or corners found . . . . . . .
Can estimate house location . . .. . . . . . . .
Will driveway need cut . .... . . . . . . . .
Must trees be removed -note these . . . .
Is deep hole representative of entire SDS area
Additional deep holes needed. . . . . ..
Sufficient .SDS area available considering
driveway cut,house location, separation .
distances, etc. . . . . . . 0 . . . . . . .
DEEP HOLE DATA
Depth: 7 ,
.Water elevation: O
Rock elevation:
Soils descr_i.otio :
'FINAL SITE INSPECTION Insp, by:
House located where shown on approved plan. .
SDS _located where approved . . . . . . . . ..
Length of trench measured
Width of trenciz average
Slope of tile line and trench acceptable
Room allowed for expansion trenches . . . . .
Over 50 ft: from swamp.,.watercourse
ra .,
=Natur�:io� nOt erlpped
unnecessarily graded . . . . , , , ,
10 Ft. maintained from prop.line and
20 ft from house . . . . . . . . . . .
Separation of trench from house, well
_ etc. follows plan . . . . . . . . . . . .
Number.of bedrooms checks . . . . . . . .
Stones, brush, stumps, rubble, etc. greater
than 15 ft. from nearest trench . . . . . .
15 Ft'. of peripheral soil horizontally from
trench
Junction boxes properly set
Could surface run off from driveway, roads,
ground surface, etc. channel near SDS
area. . . . . . . . . .
Does lot drainage anDear. O.K. in area of SDS
FINAL GRADING OF SITE ACCEPT-ABLE
a
No ( Comments
REVIEW CIIE'CK S ,T
f
Meets Std.
es I No
• nnr-^ _:�'.'+- .°�..l.,x• ,.'�:.^'tc•> .. _ S' Z:S••,- v°P +c.•Tv �'c'F.:N�z%- 77
House plans 0. K. `
Design data sheet I
Peres resoaked? i
AUn.�. 30" perc test depth !
Const. results for 3 runs I
.D. Hole log 0. K.
Corporate Affidavit for.other than individual i _
Authorization for engineer
Letter from Water Supply if applicable i /,
If variance requested -such noted on plans & apps.: N
DETAILS
if chap-ge is proposed,,)
Existing contours shown.kshow new contours)
Slopes for driveway cuts, etc. shown
Water service line location i
Footing.drain, etc. location I
Top slope, bottom slope of fill
Percolation tests and deep test pit location
Septic tank size and conformance to st !
3 B.R. house-minimum f
House setback shown !
1 !� ,.�.' 1 1'! 1J�.IT•..t.l..11 1 1 U.A. II '!g. .I IG.A.ow 1 r3z; U _ ... .. ._ . .._ —_. ....I
x11 wa Lei, w1.'l.idi1. :)V 1 6 a . w. ri, 611VWli
Plan
-�1 -o:Uh6`r Yells "and• ME closer 2U(-5-1-. !!
shown or. reference made I
Property boundaries (metes and bounds- clearly sI
SEPARATION DISTANCES SPECIFIED ON PENN'.
10' to P.L.
20' to Foundation walls
I.00' to Nearest well
50' to.stream, march, la
15' to Curtain drain
10' to water lire (pits-
15' to storm drain
10' to large; trees
10' from foundation.
5' t:o pipe from lc
f
/- I
etc. incl.expansion ;
I Remarks
;.'v'.'.•'r.'c�:• -.. •. -ear c:.� • •
T0: estchester_ County ;Degar.tment - of• ,health._ _ 1_._ .__..
Diviaon''o nvfronmental'Ilealth Services' S bate / r
Greenburgh Field Office
30 Manhattan Avenue
White Plains, N. Y. 10603
Mount Kisco Field Office
25 More Street
Mount Kisco, N. Y. 10549
Gentlemen:
Re: Property of T +S R-
S-tepken Srn�tL. Drive
Located at Put.na -M V 2l� e j thy,
Section' Block1199 Lot
This letter is to authorize SCj -JDT 0 irk v . k,.,\ \ n oa-
a duly licensed professional engineer v or registered architect to apply for a
Construction Permit for a separate sewerage system; private water supply;
to serve the above -noted property in accordance with the standards, rules, or
regulations as promulgated by the Commissioner of the Westchester 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 or systems in conformity with the pro-
visions of Article 145 or 147 of the State Education Law, the Public Health Law, and the
f' Westchester County.. Sanitary, Code.—
(Telephone)
LA -4/76
Very truly yours,
Signed
(Owneig of Property)
R.A. # 5) a2 VO—il -pu f6,a_d . S 0 1 Y� PN �i •� .
(Address)
seal) _35E4�- q 6 a- 59 5 7
(Telephone)
P '
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
tbbT4�_0FkdE Bbi ujiWd, ' &RM.EL, ± N. Y.- 10512
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE N0.
Owner 7_j((oegu/L,iPX! WC • Address YALLFy Z) r, ,c. t ti (� .
Located at ( Street ) 6w/w,S' ec . � ock�Lot 0
inndi.cat e neares cross s ree
Municipality RTAf 11 Watershed'
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
'Number
CLOCK
TIME
PERCOLATION
PERCOLATION
Run
Elapse
Depth to
Water
Water Level
No.
Time
From Ground Surface
in Inches
Soil Rate
Start -Stop
Min.
Start
Stop
Drop in
Min./in drop
Inches
Inches
Inches
D o
2.10 1
Z
3
2'.
Zy
2a
3'
5
3
4
v
5
U 12 Z �,Y /o 20 23 3. 3
3
5'
Notes: 1) Tuts 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.
^y�4-` DESICTN _ _ -
Soil Rate Used Mi ..1 "bro _
r/ p'. S . D. UsaUl'e Area ~Provided "v0 .-
No. of Bedrooms Septic Tank Ca pacit / . Type �v� �f�/ L
�
Absorption Area ovided By_2LW L.F.x24" width trenc .
(lt-.har
1J c_ � d &� Te-(7-,s1/r-- IS
Aame i-Jr, M 0XIM11 6- c.ac 4-0 VV19P rM1re —
���
Address, )A(,( 9-14 PVNn A-,&A i SEAL
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Gal. Checked by
0w, iL
C
TEST PIT DATA REQUIRED TO
BE SUBMITTED WITH APPLICATION ,
DESCRIPTION OF SOILS
ENCOUNTERED IN TEST HOLES
DEPTH
�',
HOLE NO. �_ HOLE NO. Z- HOLE NO. U
r
r
6"
12 a 1ivr r,
12"
L
1811
C&
24"
90 L- S
177)l,=
30"
361
6�tA a Sot LS
42"
S01 LC
48"
6o"
L C
66"
7211
78"
84"
INDICATE
INDICATE
LEVEL AT WHICH GROUND WATER IS ENCOUNTERED d //
LEVEL TO WHICH WATER LEVE�j RISES AFTER BEING ENCOUNTERED
TESTS MADE BY 5A} -y .jj�)Lg- X1
Date_ ,fzzo6
^y�4-` DESICTN _ _ -
Soil Rate Used Mi ..1 "bro _
r/ p'. S . D. UsaUl'e Area ~Provided "v0 .-
No. of Bedrooms Septic Tank Ca pacit / . Type �v� �f�/ L
�
Absorption Area ovided By_2LW L.F.x24" width trenc .
(lt-.har
1J c_ � d &� Te-(7-,s1/r-- IS
Aame i-Jr, M 0XIM11 6- c.ac 4-0 VV19P rM1re —
���
Address, )A(,( 9-14 PVNn A-,&A i SEAL
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Gal. Checked by
0w, iL
C
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SS.D.A. 512
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'"- ---- -- 62.a3. • `.,o- � � `- __ ' .` �
'1251971
/
cNTGI Npq[7N ' �•
.S M/ TH 'y •. DRL•V E LEGENn '
is
OEEF rESTP /T
PEQCOLAT /ON TEST . i /OLE
'PERCOLATION TEST RESULT = 1 "DROP /N MINUTES. .. -20 FT. M(N/MUMFROM 0OkE,5 ANO'F /EGOS. _ - - - F ILL COND /TIONS,
OEEP.TEST FOR ROCK OR WATER = 'MAXIMLiIKf LENGTH OF 51"GLE,FiEL0= 60 FT
?L /EO'RATE= GALS. PELR.S.F, PER PA Y MA /NTA//J A M1AIIA4(JA4 "OA-AL SEPARAT /ON, OF /O_FT OEPTN OF F /LL TO .BF /NS TALL'ED. FT.
V /MUM DESIGN RATE =.300 GALS. PER S.F. C'
-ER DAY. ' � `.' FROM AZI ' PROPER_TY _L/N_ _ES,_'TREES AND WA -T_ ER SERV /CE DATE OF F /LL /NSTALLAT /ON _
=T%C" TANK CAPAC IT)= N-° BEDROOMS X 30b GQ.[�L.S'. =j7r -,o GA'<S L /n/ES.` - - ' - - SEPT /C SYSTEM INSTALLED -! `
AL G /HEAL FT.OF TRENCH =____'G. F. YAK�`'N FROM TABLE WHERE C(/RTAlNDRA /NS ARE.EM-LOYEO THEY MUST BE A 7N FILLED AREAS F /LL MUST Ex TEND -
CAST REV/SEO BULLET /N- S.D.- 22�B:4SE0 ON' PERC. TEST '. MINIMUM D/STA/VCE OF 15' FROM A�SSORPTLON F /EGOS. BE)-OND THE LIA.IITS OF OISPOSA'L.AREA,
V /MvA4: TRENCH OE'PT14=24 TFdBNCq WIDTH : 24''. MA/NTA/A% A M1,VvAf(JA4 D /STANCE OFIOO FT FROM ALL :MA/NT FjL MIN. /3 FT FROM ENDS TREN51OPE
SgRRT /ON F /EGOS TO BE CONSTR(ICTE'p OF''4 "PERFDR%9TE0 BROOIfS, MARSH LANOS•OR OPEN WATER COURSES. ro TOP OF SLOPE: - - -
ER P/PE..OR EQUAL ENCASED YN'CQUSHED STONE .TO - "OVER PR6 .POSED SEPT /C'AREA TO 6E KF'pT FREE OFTRAFF /C
,E: ,WITH 57-A "DARD PRECAST ✓UNC7YON BOXES AT INFLUENT, AND DEBF' /S OUR /NG HOUSE CONSTRUCT /ON ANO INSTAL L ALL CONST.QUCT/O,V TO BE o01✓E.!N
f"ECT EACH BOX ,WITH 4.. SOLD FIBER ? /PE/ CONNECTION _ ADEQUATE ORA/NAGE T'O F'F7EV_ ENT EROSION AFTERSYSTEM
)M`SEpT /C TANK TO FIRST BOX TO-B�"16"SOL /O F/B ER F' /PE /.$•INSTAL 4 E0. ACCORDANG'•';�.,,tN /TH LAST RE Vl�SED
WECT /O•N FROM-TANK TO HOUSE TO BE 4; CAST IRON W1 7-14 BULLETIN SD. -22.
vN/MUM' D/STAArCE OF /O FT. BETWEEN HOUSE ANO.TAMW AA/D
Li !.
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