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HomeMy WebLinkAbout4656DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.13 -1 -47 BOX 35 T 1 ' T ' T JLL 04656 •�— rn•a"�*."-.r^r .-» •/ - ,iF."' ^e m.- -l'^ fin`; 7."_.""F._'. _ xSepa ate Sewerage System-- L1 Private Water Supply Municipality .. .�.. CERTIFICATE OF CONSTRUCTION COMPLIANCE. $; 13- WCDH File No. Lot 7 Job Consisting of �/� V Gal. Masonry, Metal Septic Tank / lineal feet X width trench t�Other requirements ' Water Supply: Public Supply From / J ��J' I� Private Supply Drilled By / —(�� �t��% -'a •Address O r ^ Building Type- t / 4% 6_44 �L44- Number of Bedrooms � Date Permit Issued _.._4 Erosion Control Completed Yf.S r Waived 1 Other Requirements A OF f I certify that the system(s) as listed serving the above premises were'construcled essentially shown on the plans of the computed k ( whl t d In accordance with the standards, rules and regulations, plans filed, and'the permit issued by the Westche ei Cou ty Department of Health. Date _ et7 ' Certified By a Any person occupying premises served by•the above system(s) shall promptly take such action, as may be necessary •to secure the re on- con ion esulting from such usage. Approval.of the separate sewerage system shall become null and void as soon as a public sanitary sewer becomes avail I the ap pri to er supply shall become null and void when a public water supply becomes available. Such approvals are subject to.modification or change when,i if) t of the C on of Health, such revocation, modification, or change is necessary, said modification or change shall be done under the supervision of a licensed Pro chltect. Uth proper nuriatenawd syst e.rrix an he expected to function satisfactorily and are'noG ikely t a 'an Jr )ate William A. Brumfield, Jr., M. D., Commissioner By r S. D. 47.66 Wl ter County. Department of Health 1 ------------ 3� /IOOMI.).'-HA -RDNESS; TOTAL: POm SS. than 133 (s1a) 666 3335 5 . �,-.,Laboratory: 'Moo jtKi'�t6��,`Medical , " - -'t'.- -344-,,E6§f Wih t ree UhT 19 �Y.1,0 4 A -�X-* co,,.N 5 T6 - qTy:criiality-when the ,BACTERIA PER M;7�. (Agar plate untldt35-C).'COI�1F.ORM,GROI:JP:--,(Mdiit,Oi-6bdblle'N6 /IOOMI.).'-HA -RDNESS; TOTAL: POm SS. than I.PETI;RPENT,p*��;p prp IRON, TOTAL pp ' " " 21 J� Th­eik�i results iri'di'dcite"t�h�:rt thC-14,�,�biei,�� qTy:criiality-when the Pera. H. PADOVA] MI M. T, (ASCP) 21 Westchester County Department of Health Division of Environmental Sanitatiou :r= ��:':v�"��.:'a '= •�-�ae :�c`.i: =•q��_;.�,. �.'.. :'G�r,S. -. _.-ra � .,t_._� �.� ..d .... �T S. �w ^'T. ;'8..e. � -we're .� .. +o. .ra •.y.�•�t.. _, .::I This report is to be completed by well driller and submitted to Health Department, together with laboratory report of analysis of water sample indicating water is of satisfactory bacterial quality, before certificate of construction compliance is issued. Well constructicn to be in accordance with Bulletin SD-62 "RULES do MOULATIONS RELATING TO INDIVIDUAL WATER SUPPLIES" LOCATION: MUNICIPALITY SECTION BLOCK LO? W.T. OiiNII+:Rs tt A 1•114 S�i�'�e� S/%�•% ep Me �/,- /j 4 Name s I Bailed '(measure from land surfice) Lengths Feet° or ° ' . j0 ',Pumped 4/a Hours'Statics j,%P Feet' Makes -- t tWhen Bailed - t - Dia tars w Inches'Yield: GpP.�4,'ox Pusataed .;Z %J Feet' Len Ft. esize binds s e l _ -- V - - - -- - — I ° Diameter In. ° TOTAL DEPTH OF WELL 3L' FEET 1:00Ti "t� _ uep-= From vlve..aeacrrgnlarr or xorrations_ peDetrateo., such a©s peat, silt, sasPd, ave - - It -4i; and 9urlaes ° claiy, hardpan, shale, sandstone, granite, etmo Include size of gravel diameter) ' and sand (fine, medium, coarse), color of material, structure (Loose, packed, ' cemented, soft, hard)e For examples 0 ft. to 27 ft. fine, packed, yellow sand; 27 ft. to Im ft. , [!Z granite. to �`l Ft. /]� /�•�i1� � 73 I o`C i Y. to Ft. . Ft.to Ft. ° Ft.to not Date Well Was Completed 711 Date of Report 3� Well Driller 61 Signature DELI. PIT AND PUMP EQUIPA4ERPP DEUXLS ChecEi� Pit with 4-mach Gravity Drain to Basement FitleS6 Adapter Casing Kin 12 inche® above grade Others Describe Pumps Hakafe.0 Type JC110e- -J111* Capacity is/ -/l' GoPo�[o Storage Tanks ` yP& & —mo &.0 -2.4/4 e_ Capacity f2- Gal, (42 Gal, Minn. DIAGRAM SHOWING IMATION OF WUL ON PRMM Indicate location of'house, well and sewage disposal systesi with distances, Also indicate direction of slopesD and direction with distances to all wells and sewage disposal systems within 250 ffeeto I certify that the individual eater suppler indicated above was ins rulps and regulation of Bulletin SDo62 of the Westchester County Depa o ?Y; L �it ._ 1• f II Y it laT'J1Y \11 x"It V t•r S A s '` , rr - „'kt ' �., � Y �; .••, ... ': �,. .,. -c. , .. ._ �,_`! 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'':� -4: a.f to N it( TYC l .w.:LJ .ii £ -t J C pi. wA� •3L X151` 6� }4 Y� zp j u: �.O n i F.iaJt: ;i �i,� c + a.,+..; �'! �. {i t fyr;,.ta.7'`�t, r i• al {'. y, l rJ r!a vC +n i 4 r +. . .. .,. 1 �'�..:+.. �. .Z ,, is i. \:j/4 r+ r i S.a ' G •'"J G.r...'+.. L' C..: ..4`1.':' �= ;r by C:i? ..:' ., i a _,y �Cal� CG LlCt J r' � t t C '+r' b i,•'4 V Z.Y« 1 llj� iliY t , �,. to ,� �;..i. . �. G .l�tS' it i• 1 - .i G 47..0..]. r� M / . , + .. ''l++a i+\�lU.r•,:L:t% t_..\. lTw:j jai ae 4�IA�11aEJ�'Sl a ..ed a.n t, �f) W t r el�.i Si 4\i:V tt E L! ter• /',, ;, C71� ' T 3i r. : `• -t 't•' t .. .. r ro C:Gli CY=i,d t✓`�: :1 •yT, t` . r5i1 �.: ii1+I{� `t5 EY _ :.' Cii 9 G Gy. .i��. is ��tilr� i ` � n LO 'a ✓�i 4is /� t` � •' 4t.:S:�vfA` 1 41 'MG "v .G Jva:AtS►. {, t ti�'tly�t��W,J L i,4 t tr ' .. ' , _.. .. •, . �.'.� :'`�'L. HjuJ :•:. A�b�JMJ �.: Iwi YP�a. ?I.`•', , . tY�f.l aj� ,�����„ �t II :7rrj :i + iV �RE r All 1..�i:]�i::.:1. l . YL : •" l Yp 7y .. �.. : i�ri -7•r [0 f..t 'j ;mil l J:.n �...,....... -.. ..- rte ..��y {t', t +' :y^ ? ;:•i�:,i%/�..r .i.a��•.'�}„',..�A..� - a N,�( tom& a; .,. _.. .. .. .. �.. " --' _ k t s J t .,. t. C yv,•, j r�Rh,r + ' •� i) ..1,r .VfJ C.i l.v 1/4.°Pi T •i<. Y. frrJt St; Putnam County Department ot• Healtb. Division of *Environmental Sanitation AFFIDAVIT CORPORATE (UNIER. APPLTCATTON- FOR PERNIT APPLICATION SIIBMTTT✓P TO TO: Commissioner of Health - In the matter of application for -- - - - - -- -- — - - - - -- represent that I am an officer or employee of the corporation and am authorized to act for— l 5 (V C (name of corporation) having offices at kc Lv--:ems — — — --- — — — — — — — — — — Whose officers are -- — — — — — President L rj R,' — — — — — — — — - �-tl\'!m—e. "a-n-ff Address) Vice-Presid-ent �A — — — — --- -- — — — — — — — -- Air,- (Name and Address) Secretary (N me id ' Address)— — — — — — — — -- — — — — — — — — — — — -- — — - )� Tt (N me ess) Treasurer - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (Name and Address) and that I am and will be individually responsible for any or all acts of the corporation with respect to the approval requested.and.all sub- sequent acts relating thereto. Sworn t�fore me this `Mdlic p v A GAN 1L Notary public, �-2w York No. 60.1369060 Qualified in westc,'iester.courty Commission Expires March 30, 1977 day Signed — — — — — — - — — — — — — Title Corporate Seal ` Address � /f-+' /Va5% _.. _ -_° - 'Other Requirements. r v I represent that I am wholly and completely - responsible for the design and location of the proposed system(s).; 1), the a di po system above described will'be constructed as shown on the approved amd`i ennent there to anid n accordance .wdh the stand ds, Wes of t u nam ``county 'Department, of .Health; and that•owcompletionthereof . a t.Ceriif.icate of �COnstruct on Compliance" sitis tor, to' till i ston ea'Ithwill be submitted,; tc tfie Departm. ent, and a written. guarantee will lie furnished the owner, his' successors, heirs or as thet',b�u'ilder ja ilder will place in good, perating condition any part of said sewage disposal system .during the period of two (2.) year's im i'miUCb f the issu- ance of the approval of the Certificate of Construction Cortipliance of "the original system or:any repairs thereto; L cribed above Will be ' located as shown on the,:approved plan and that said well will „fie installe In ,accordance w,, the ndards,, rules the -Putnam :rCou`nfy 'Depart t f : ealth: Signed P, E, Date- - Address _ t9. )cense ;NO: �'�-• 07 1APPROVED .FOR 'CONSTRUCTIO.N. This approval..expire a year fr the dater ue unless. construction of the building has been undertaken and is ' 'revocable for c use or ma be .amended or modified wh, co sidere' cessary b; tie o Ith Any, change or at' of construction requires a. ne perm' . Approved for disposal:.of me ary sewage, d/; rivate titer p only. Date B” �tl - . I.', .. ,a 'i •• •tea Irt• t,. -I ..y.t .. :. a '. � . � -. I is.r _ ...a.. • -.. 4 . .. .-.'Fq 1F o.r 1. • •41 .. • .. I r . •. .., I I�... w•. ...�v• Y. A-61 " PUTNAM COUNTY DEPARTMENT OF HEALTH P Di.v /slon of ` *Erivironmen al HeaLg� Services, CaKme% N. Y. 10512 ' } . . CONSTRUCTION PERMIT FOR SEWAGE -DISPOSAL _SYSTEIIA //,QL 416, 0 & Town or Village a_.I :u ak.S �Fn�� +� �1 a'5R, Subdivision , "�`�/�" - Lot Job - . ! ,/- �''� �. ;owner Address DdOLL Building Type * V64F_ W11(4_ Lot Area °, .Number of Bedrooms,- - - _, Total Habit�ble Space �y� 10nd Square Feet Separate Sewerage System to' consist of ` i D y GaI Septic Tank lineal feet X width trench p �' /iC. S' `,Address 1� (ee&44 �.. To be constructed by `� ,j •.. Water Supply: Public Supply From F ,NEW Private Sup to, be drilled by,G ` Address � /f-+' /Va5% _.. _ -_° - 'Other Requirements. r v I represent that I am wholly and completely - responsible for the design and location of the proposed system(s).; 1), the a di po system above described will'be constructed as shown on the approved amd`i ennent there to anid n accordance .wdh the stand ds, Wes of t u nam ``county 'Department, of .Health; and that•owcompletionthereof . a t.Ceriif.icate of �COnstruct on Compliance" sitis tor, to' till i ston ea'Ithwill be submitted,; tc tfie Departm. ent, and a written. guarantee will lie furnished the owner, his' successors, heirs or as thet',b�u'ilder ja ilder will place in good, perating condition any part of said sewage disposal system .during the period of two (2.) year's im i'miUCb f the issu- ance of the approval of the Certificate of Construction Cortipliance of "the original system or:any repairs thereto; L cribed above Will be ' located as shown on the,:approved plan and that said well will „fie installe In ,accordance w,, the ndards,, rules the -Putnam :rCou`nfy 'Depart t f : ealth: Signed P, E, Date- - Address _ t9. )cense ;NO: �'�-• 07 1APPROVED .FOR 'CONSTRUCTIO.N. This approval..expire a year fr the dater ue unless. construction of the building has been undertaken and is ' 'revocable for c use or ma be .amended or modified wh, co sidere' cessary b; tie o Ith Any, change or at' of construction requires a. ne perm' . Approved for disposal:.of me ary sewage, d/; rivate titer p only. Date B” �tl - . I.', .. ,a 'i •• •tea Irt• t,. -I ..y.t .. :. a '. � . � -. I is.r _ ...a.. • -.. 4 . .. .-.'Fq 1F o.r 1. • •41 .. • .. I r . •. .., I I�... w•. ...�v• Y. FIELD CHECK LIST Date: `. w h o UN INITIAL SITE INSPECTIONI - Yes . No Comments . 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. DEEP HOLE DATA Depth: Water elevation: o Rock elevation: 6 Soils description: Date: FINAL SITE INSPECTION Ins p. b House located where shown on approved plan SDS located where approved . . . . . . . . Length of trench measured Width of trench average Slope of the line and trench acceptable . . Room allowed for expansion trenches . . : ` ...- _ ..� Over 50 - ft-. -• from _,�amp, , . ,...,z lo ;�y se , ... , -• Natural soil not stripped or SDS area 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, stw,ps, rubble, etc. greater than 15 ft. from nearest trench . . . . . 15 Ft. of peripheral soil horizontally from :trench : • • . O O O O , � Junction boxes properly set Could surface run off from driveway, roads, .ground surface., etc. channel near .SDS .area . . . . . . . . . . . . — Does lot drama e a ear O.K. in area of SDS FINAL GRADING OF SITE ACCEPTABLE IREVIEV CHECKS 1 1 T . •r • Meets Std.( Remarks Yes. No - .�3�t'1C�iit�N�'S --T.. . ,.v:xaµ .. - -��-P: :::.. �i =� :��.�.�: ��: -�:�:: ;� •:. -.:. House plans O.K.- ' Design data sheet i ! Peres presoaked? i + Kin., 30", perc test depth ► i Cont . results for 3' runs I I D. Hole log O.K. Corporate Affidavit for. other than individuia.l I Authorization for engineer t ! Letter from Water.Supply if applicable i N ! If variance requested -such noted on plans &'apps.: i 1_ DEri'AILS if. charge is proposed, ) Existing contours shown show new contours) Slopes for driveway cuts, etc. shown - Water service line location 1 Footing. drain, etc. location I + Top slope,; bottom slope; of .fill ! ! + Percolation tests and.deep test pit location Septic tank size anal conformance to std. 3 B.R. house - minimum I House setback shown j_LIJ�_I..i lJ!1 l�lJ �. J. l �. .1 /C %.I_l7 NT 1J'oz?v _.. .....I i 1111 wa uev w.1.1.Ii:1 is 50 i i, . u- PiJ zihuwli .I Plan and profile SDS �....y :.............. :.......:. �r =iP.�1.1-s -and °DS closer. :.. '. - shown or' reference made Property boundaries (wetes and bounds - clearly showo L_ SEPARATION DISIANCES SPECIFIED ON PLAN 10' to P. L. 20' to Foundation walls .00' to Nearest well 50' to stream, march, lake, etc. (incl.' 15' to Curtain drain 10' to water line (pits -20' 15' to storm drain 10:' to large trees 10' from foundation to septic tank 15 to pipe from leader drain & foo-=C 9 0 0 1 i TO: (We este County Department .of. Heal.th,•: ;.ti;a .'r = vr�ion Htivi�rt5 m%ni �aI e� -des .�.... es rvi Date Greenburgh Field Office 30 Manhattan Avenue White Plains, N. Y. 10603 Mount Kisco Field Office 25 Moore Street Mount Kisco, N. Yo 10549 Gentlemen: This letter is to authorize _5 4 Lt,, Re: Property of buk k L4 T-n C. e-•- Located at VA2 Section Blockllss Lot a duly licensed professional engineer: C____ or registered architect to apply for a Construction Permit for a separate sewerage system; _ private grater 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 Laws and the Westchester, County Sanitary Code.. < Cou ersigned: t r�.t y , �P o f o , R. A. # (Seal) (Address) (Tale 1. � 0 EW Yf OR c.) P R lr ,,M, y� l / LA -4/76 cF�'SF� . 512NG`kk' CIVIL Very truly yours, Signed (L (Owneg-of Property) Ia e'y (1 GA &) M PrS (Address) �(0a -5.?� 7 .(Telephone) I-niL.il VL Ill: illt "11 _- Dxvisi.on_._.o,t' Dilvirorimental Sani L'ation ArrIDAVIT - CORPORATE MINER APPUCATTON . r-OR PERMIT APPLICATION SUBMUTED 7'0 5.:,;U• 1\'. L:A.-1;w.4 ?:L� :�•j•a..:iJ-i� A "�� N1L� 1 TO: Commissioner of Health - In the matter of application for L u_t = "—= '= `` -= - -- — — — — — — represent that I am an officer or employee of the corporation and am authorized to act for Y1_1 - -- — — — — - - - -- r." (name of corporation) having offices at --- () _ (_ L 6' _Q_ Whose officers are President L2`` — - -- _ — — — �Name. and Address)— — — — — Vice - President — —_ — — — (Name and — Address) — — — — — — — — — - — — — Secretary ----- T��� —�'— l ?ti_N — — -- — — — — — — — — — (Name and A— ddress)— Treasurer N© vU _ - -...— Name and Address,)— --- _---- ---. -- " and fhat fam�'and will be individually responsible for any or all acts of the corporation with respect to the approval requested and all sub- sequent acts relating thereto. Sworn to b_efore me Z day f•-., �•,� y Signed off-- 19� Tit 1 e — _��_;'' ry Public EDWARD R. GANLY- .N @tgry Public. State o; 'i •w York No. 60.1369060 ONiified in •Westchester ^ ^u»ty omission Expires March 30, 197, Corporate Seal PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES jr- FF-TCE'EVILDING,' DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner s _72C, Address Located at (Streeter Block Lot -7 indic4te nearest cross street Municipality . _?WFN_k!N 1AALLiEy Watershed. SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION' RIM EJ-apse Depth to Water water EFv_e1_ No. Time From Ground Surface in Inches Soil Rate Start-Stop Min. Start Stop Drop in Min./in drop Inches Inches Inches l 3Z 7 VjQ 22- _? 3'' 2 2-0 3 4 5 3 0 5 26 23 3 2 2Z 2- 3 3 4 5 Notes: 1) Tuts to be repeated until at same depth untl agroximatN equal soil rates are obtained at each percolation test hole. A data to e submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS NCOUNTERED'IN TEST HOLES DEPTH HOLE NO.-. HOLE NO. �_ HOLE NO . �Y7_ �� V L e G. L. EScg Z4 12" ,c� <<st� 1310,)AI G� 18" 24" a —Svc L c 30" 361 42" 48" 54'1 60" 66" 7211 78" 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED PW, INDICATE LEVEL TO WHICH WATER WEL RISES AFTER BEING ENCOUNTERBD TESTS ' MADE BY J 6k L u Pr j o/1E V 10 A4 Date , j./-Jb DESIGN y . � . cl �3 Mi r�/ " S L -sable Area Yrovicie r r tai �c =Jse _� l drop: ":S�DU� 9 No. of Bedrooms Septi Tank Capacity ga0 Gals. Type SS/IW Absorption Area Provided By�L.F.x24" 5b"—i/ width trench. p , 0 w� - J ^ Other l� A ivamc Sal vv/ T��Lt;'/- XU 4 algnature�i® Address UALW�, ,,Io SEAL NEW V- THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by N c c V a . ..1 : S - 1J, .. \ � -.. _.. ice• `— 'EGliD� A — A ' ?., f "- i0� -O•. VFW, -.1; 4t� gppiROVI -S7 ? S y ; 197,6 U \ ,\ ECTOR. OIYISION Q tl,� Mrt t wmaONMENTAL HEALTH CE DI`2.4WW' k(il[ AY3Fr Llefft %�f f� +r; .10 t! d iF� Q g � .1 r n� J_ ... "Aptf 4 r'i r r :ai 4 Ap� w i.t ti?F KL� �T 1 dpi P�1 T r- h - e c . 1 r '' ??/: �� /CXPAfv�'fdN -;RG,> 7i�kc•( 1 ,O�L " f � x . °.Rl%V I G%'Ev � 1 1£ t ' <.c r �r ,/ �± 1�,, ct 't .-+ � < <.. �:r�..y� �-�LV t >✓ t ♦ � :�zA.w Aco'� jJ ," ,<.AIL� ,r,4 ~� '- t-7. rti � �..y_ •d::.ti_. c 1-s.r '• ti� I' *� `'r i i� !''� : +i r t� «^� >-. ;� i .::. F- J� . �.._ � .� S �..: , t-, , , . �s�, .cd., i.� e1 i+' _ . ��,_ t�v ra titr✓ DE*Iu�N DATA . 901. rcNG, 5ff'nG TANK CBO L.P. OF 7RENGHiNG t?C'GUI(i��' • - (r? \l.. -" _. - _.. r a.:r�T.nC f. \/ lPII�NA - DG �' .. toffy ' !:2 „ i' ri mfg • jey 1l1, >q� . r54 sti �A r t� P+§F^,,F(D PLAN.,' 1R . 4i. • { ,.L W i ear r3•i `r l .1• =_ _Y Sq•5 �4�; r .mac•;- `— 'EGliD� A — A ' ?., f "- i0� -O•. VFW, -.1; 4t� gppiROVI -S7 ? S y ; 197,6 U \ ,\ ECTOR. OIYISION Q tl,� Mrt t wmaONMENTAL HEALTH CE DI`2.4WW' k(il[ AY3Fr Llefft %�f f� +r; .10 t! d iF� Q g � .1 r n� J_ ... 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