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HomeMy WebLinkAbout4660DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.15 -2 -3 BOX 35 �Im..1 I" Kli, - rr 7 T ■I r I �Im..1 ov PUTNA ;/ .. 417, Divisio'ni of CERT I IF . IC T E'OF; CONSTRUCTION .160mot, 8txQet 7" 'NT ­°0F HEALTH ditine/ . N. Y.: 10512 SA Ysti M PUt nain :Vall Valley Town or Village* Tax Kip Xo6t # S R&dhaft Builder -b 11 Owner V*oiderly'. P.O. x Separatir:Sewerage System built by pic:k. gpdmnnd, Address 7. Consisting of 1000 Gal -Septic Tank and 375 I.F. x'21 wide trench Other requirements -Water Supply: public- Supply F r6m Private Supply Drilled By Torlish',&-Sons Maple Avenue; Anw..hk, New Y6rk Address 3 A/20 84. Building Type 1 Fa'm. Residence- No. 'of Be,1066ms Date Permit Is Has Erosion Control Been Completed? I certify that ,t he system(s)•as listed,.serying-the: abo;Vel'premiseis were constructed essentially as.8h6wnLon the q . pleted . wokk'(,'6 plans of the "con, . . opies: c a with the filed plan, and the permit issued by the of which are atiacheid), and in accordance with the standards', rules and ie aiions in a'66rdanc' Putnam County Department Of-Health. Date ��lL 6eit ifled, by P.E. R.A. Cdshifi Associates ,,*PX.' 37, aafr S:t. '.Carmel, N. Y '26008 Address rcenes N a Any person occupying promises served by the above iyst6m(i) shall promptly take. -.such action as.may be necessary to secure the correction o1 any unsanitary conditions resulting from such usage. Approval :of thi "'parate . sew , a me� nu, 11 and veld ss'soori as I a public. unitary' ewer becomes _rage -sy am shall b*co available and the approval of the private water supply shall beco - me null -46id when a, public water supply,becomse; available. . Such: approvals are the chanoi, is 'heciiiii subject to modification or. change when; in the judgment' of Co Mlis, Health,yiuch -rev modification 6i� ry. BY , 11n Date V. -H /ORKTOWN MEDICAL LABORATORY INC. P 0 PIoz 99 171 Kear Street LOCATIONS: 0 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245 3203 Yorktown Heights, N.Y. 10598 ❑ 201 BUTTONWOOD AVE.. PEEKSKILL. N.Y. 10566 737.8777 p C n 495 MAIN ST., MT. KISCO N.Y. 10549 666.3335 ' 1t3... x':, �ti,;; w._:�°0�1:,;��i��_:.�t'ti= '-asK. :•�`,.�c: �o.o...�_. -.. _::ra �_ —LAB # DATE TAKEN: DATE RECEIVED: �•�� �� DATE _REPORTED: VVVaaa 111 «` SAMPLE SOURCE: ��� REFERRED BY: Q �c� J COLLECTED BY: , LABORATORY REPORT mg /L ❑ ACIDITY .................. ............................... ❑ ALUMINUM ❑ ALKALINITY ............ ....................... ❑ ANTIMONY .............. ............................... ............. BACTERIA, TOTAL!., . : ......................... n ❑ ARSENIC ......... ............................... ....................... ❑ BOO. 5 DAY ................... ............................... ❑ BARIUM ....................................... ............................... ❑ BROMIDE ................................. I................ ❑ BERYLLIUM ................................ ............................... ❑ CARBON DIOXIDE. FREE .............................. ❑ BISMUTH ....................... ............................... OCHLORIDE ................... ............................... ❑ BORON ........................................ ............................... ❑ CHLORINE ................... ............................... ❑ CADMIUM .................................... ............................... ❑ COO .:......................... ............................... ❑ CALCIUM .................................... ............................... ❑ COLOR . ....................... ............................... ❑ CHROMIUM (tot.) ............................ ............................... ❑ CYANIDE ................... ..........................:.... ❑ CHROMIUM (hexavalent) ................... ............................... ❑ DETERGENT, ANIONIC ... ............................... ❑ COBALT .......................... .......... ............................... ❑ FLUORIDE ................... ............................... ❑ COPPER .................................... ............................... OHARDNESS ................... ............................... ❑ .COLD ........................................ ............................... ❑ MPN COLIFORM COUNT/ 100 ml ..... .......:..... ❑ IRON ........................... ............................... ............. T COLI FORM COUNT/ 100 ml „ .............. ❑ LEAD ........................................ ...........................:... ❑ CONFIRMATORY TEST .................................. ❑ LITHIUM .................................... ............................... --- �^] �f�t:$ � ^�Pi;�4Pr4d�.4+e??:1 +'�i�.....: its.. e. cp. .v:..a�ra.....�.sro :.p..o...... .. A: Qi 'iAliShcdRA..o.- .:....�..o.r.. ,.. ...... :�s�..;.a.:::r,..m,..- rr- .,�... ,w::.:.:.e..:-,'. - •env ❑ NITROGEN, KJELOAHL ... ............................... ❑ MANGANESE .......................... ...... ............................... ❑ NITROGEN, NITRATE ... ............................... ❑ MERCURY .................................... ...................4........... ❑ NITROGEN, ORGANIC ... ............................... ❑ NICKEL .....................:.................. ............................... ❑ ODOR ....................... ............................... ❑ PALLADIUM .................... ............................... ❑ OIL & GREASE ............... ............................... ❑ POTASSIUM ............................ ❑ pH ........................... ............................... ❑ RHODIUM .................................... ............................... ❑ PHENOL ....................... ............................... ❑ SELENIUM ........... ............................... ......................... ❑ PHOSPHATE (ortho) ....... ............................... ❑ SILICON ........:............... ............................... ❑ PHOSPHATE (condensed) ... ............................... ❑ SILVER ........................................ . :............................. O PHOSPHATE (total) ....... ............................... ❑ SODIUM ................ ❑ SOLIDS. SETTLEABLE. m1 /L .......................... ❑ TIN ............................................ ............................... ❑ SOLIDS. SUSPENDED ... ............................... ❑ ZINC ............................................ ............................... OSOLIDS. DISSOLVED ... ............................... ❑ .................................................... ............................... ❑ SOLIDS: TOTAL ........... ............................... ❑ SOLIDS. VOLATILE ....... ............................ ............. ............ REMARKS:I�•9... it� .i �...\JV.T %A `r.... ...... ❑ SPECIFIC CONDUCTANCE .......................:..... ❑ ......... ....................................... ............................... ❑ SULFATE ................... ............................... ❑ ........................:........................... ............................... ❑ SULFIDE .................... ............................... O .................................................... ............................... ❑ SULFITE .................... ............................... ❑ .. ............................... .............. ..............0................ ❑ SURFACTANTS ........................................... ❑ .................................................... ............................... ❑ TURBIDIT.. ................ ............................... ❑ ....... ................ ............................_.. .._ ......... THESE RESULTS INDICATE THAT THE WATER WAS OF A SATISFACTORY SANITARY QUALITY WHEN THE SAMPLE 1dA3 COLLECTED, THESE RESULTS INDICATE THAT THE WATER NE14 YORK STATE ADMINISTRATIVE RULES & FOR THE PARAMETERS TESTED. DID MEET THE SATISFACTORY REGULATIPV&,l DRINKING JWATj, S CHEMICAL QUALITY. OF ANDARDS (PART,72) AX Owner or Purchaser of Building Section Building Constructed by' Block \10jo3 > IET l 1 Location - Street Lot 7'UTt i.-a- T;AgA ACC10 Municipality Subdivision Name IS AJ F'� Jw,\ Building Type Subdv. Lot # GUARANTEE 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 - o.rs, 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- i - q : -Env 'r e�mentalaLh- Srvices P::t D 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 or negligent act of the occupant of the building utilizing the system. Dated this day of 0-6lr 19 3C3 Signature Title Corporation Name if corp. P-101 c30X Z ILO MtAW 6PAG) M. 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 A- Westchester County Department of Health Division of Ehvironniental-Sanitation WMI COMPLETION REPORT This report is to be completed by well driller and submitted to Health Departments, 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 & MCULATIONS RELATING TO INDIVIDUAL WATER sUPPLIEsm LOCATION: MUNI �AlllfV SECTION 2 3 BLOCK WM-1 OWNERs All ��/n Nam Street Address C ty and Tom L f Ae - C�l WML DRILLER: �f - - Av s,1a1V1( Name Street Address City and Town CAS N6 T =-- T EST WATER UTIL F -Sam MCAIW L 3/ t Bailed f(measure.from land surf Ace) en1th, Feet' or =Pumped ---Hours Itstatict Feet It Make: --I ') TOTAL DEPTH OF WEM' FELT Ground Surface -COidftPtrcW6rf-oiuitionn' penetrated, ';u;h- as: peat, silt, sand, avel, clay# hardpan, shale, sandstonep granite,, ate, Include size of gravel diameter) and sand (fine, medium, coarse),, color of materialp structure (Loosep packed, cemented, soft, hard). For sx4nplst 0 ft. to 27 ft.-finep packedj, yellow sand; t.27 ft. to lU ft_ craw aranif.a. 419 Ft.to /3 r s7nags�Ft.: n.to n-t n.to n. nag n.to nao n. n.to n. Date Well Was Completed Date of Report Well Driller Signature WELL-PIT AND- PUMY -EQUIPMENT WrAll$ Viniuhed Well: Cheek Pit with 4-inch Gravity Drain to Grade Pit with 4-inch Gravity Drain to Basement Pitless Adapter - Casing Kin, 12 inches above grade Other: Describe Pumps p4akQ 'T"e .511LNL8rj' le- Capacity G.P.H, PS Storage Tank-. Ty Capacity � Gal. (42 Gal. Min.) DIAGRSHOWING SHONG LOCATION OF WF U ON PRMSKS Indicate location of housej--well and sewage disposal system with distances, Also indicate direction of slopes; and direction with distances to all wells and sewage disposal systems within.250 foot. I certify that the individual water supply indicated above was installed as per the ruleo and rogulationo of Bulletin SD.62 of the Westchester County Department of Health. ISO M k "f ,l Va 0 lk, A "410. 44 a's Ink 1 Q OWN - "t� UR MIS W As oil 71 jv­ I lot -Xv .11, 'vo y...... ....... 4.1-7777 7, r eve- AN; 0 41. ,f 700, MEMO 4.1-7777 7, r eve- `r� ti �3 1, }l \$ F > _ ;PUTNAM COUNTY~ DEPARTMENT OF `HEALTH Permit w v s „P '�' - �'� ?' Dn isfon of. Enwionmen[al Healih Services Carmel N Y 10512 r CONSTR CTION PERMIT FOR SEWAGE DISPOSAL SYSTEM _ 1 l ev e a Ms at 2 wa c tii�II) ow Or Village B ck tot W�d JLreet�'. lo ."L .. Located at T ° t A ! cCi aiTt� p FSi afiaS s,�a �LOt M C Renewal ❑ x 1 Revisign Subdivisio a s RPriharfi'' >Bi - 1&rs /P 0 :Bow 216 Mal opac �` �. 'Owner /Address Date Of Previous Approval r 1 F�no Res r B611ding Type Lot Area 1.5.4 acres ~ Fill Section Only❑ `k ( `3 �.a "+„a600 l�. k w Y+ih r !3y� . a.,A... 4K+ ci • ..�� Number of Bedrooms Design F10w G /P /D� r ^?:Ci -H D NoE'ification Required {{ t 3 1000: t 3T5t ft °u of 2 fto Mtrench Separate_Seweradd System to consist of Gal Sepfic Tank a`nd h rmiiied �' �To 'Be Dete �' � ` � > To be. constructed by ' ' "s ' Atltlress =Water Supply SUPpiy From { "� �`.. ` "Be BeF Determined'I 1, Private Supply to be drilled by 'b" n utJ'+''cs �y'�, i , �.'Adtl►eSS� ,a. •6,�+�'' S t =u ''.:: h a .'7- 'M1 t � i + _ , i! , 1 kJ' Other Regwrements Civ —" - a .,• -- . a- V I represent that 1 am whol >ly and completely, responsible for the design and +locdtion ofwthe proposed system(s),' 1) t a the' parate sewage disposal sy j ;, above_descnbed{w�ll be. constructed as shown on the?approved amendment there to and in accordance with the'stardards;:rules an regulations o e u nam :-_ -' 9. i"' .'County 'Department of Health,, and'that'on completwn thereof ar'£ertrf�cate of Construction" Compliance satisfactory toahe Commissioner of Health will; I t i< - ".be.submitted'ta the Oepartmeht; and a writteniguarantee, will Deafurnished the owner his, uccessors, heirsor'ass�gns;by the builder,, .that said builder will, place,'in good operating` condition any ;part of said sewage disposal syitem during }the period ofofwo (2) year`s immediately following thedate of the Issu- z '- :ante. of :the, ,approval Of 4he Certificate `of Construction ;t:ompl�ance of the ong�nal (system or any repairs theretop.2) that the drilled well'descrit>ed above j 4,' '.will be located:asshawn on the appro0ed plan andr fiat said well will be installed in accordance 'with the `stan ds ru and -regu aa� TiOnsof . the Putnam' V o ae �a i v ,. �, a 7K .+ rgc Paz? �x }.P"h �� " F a t +j [.� County Department -o Heal�tyh Q; AP E n Oats P E.X R.A. ET 1 : Nay :26008.. Aad ►euhln Associates; P;G, 37'Fair -° ° ° ' °,Lieense No APPROVED. FOR, CONSTRUCTION This approval expires one yea►,from the date issued unless cohstruction' of the building has been .undertaken and is . t revocable for cause or may be amehded or, modified When consideretl necessary' bye the.# lss�oner ,of Health: Any :change .or alteration of construction' ' a iequirea a new cF 3�i ermit Approved for disposal of dourest ni ry se age and /or' rw a water supply only 2, Date p �, By x Title 'Rev. 9 el `£` , s a, •�{ i to Y. .1 . 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES �, ..:s.:` 'a: _ �' 'j ":. -.=y ��!; -,. r. .r _ _, -• !:�`U,. . ..:e .��...f%CC.i :i.:."_..':c eT`' ...�. -f Z41 c: :i%�' -7Zr s`• ^'K^sF i. ;r: ...., Date Re: Property of RE Ot}g RT �c� r L [Jir 2S Located at WOOD S,' � �UTNRm VA-C -L-ey (T) PUTL4,_,rL11 Section 1,23 Block Lot 57 // Subdivision of AKACr icD EZ` r-4T',2f'5 Subdv. Lot # Filed Map # /6P67 Date vlzrj Gentlemen: This letter is to authorize (-'&,S141N 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 :+-s :cs,• mss, ..t .... a.. a-- _. _ _ .�. .— yt ... -....0 system cir sysiems in °conformity' with th6l provisions - o Arfa.cl-e'- f4`5" or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned: P*Eo, ReAo, # 3 7 T--F? 1 R Address Very truly yours, AL EIVGI �\s cq Signed .- y'r'., . + Owner of Property Address p �dti: 2�1j _ . Town L 42,(Y1 CL Telephone Cg1LI) 2.25a2016� Telephone 'CIP4 w REVIEW CfTi:CK SJ T .T IMoets Std . f no,ma.rks es o DOr1Ii'Ti`JTS - Eouse plans 0. K. Dr--sign data sheet Peres presoaked`? Min. 30" pert test depth Const. results for 3 runs D. Hole log 0. K. Corporate Affidavit for othep than individual Authorization for engineer Letter from Water Supply.if atiplicagle If.variance requested -such noted on plans & apps.; T DETAILS , Rhow f ehange*is proposed,) Existing contours shown new-contours) Slopes for driveway cuts, etc. shown Hater service lire location Footing drain, etc. location Top slope, bottom slope of fill Percolation tests and deep test pit location SeDtic tank size and conformance to std. 3 B.R. house minimum House setback shown Distribution box ftg. below frost All water within 50 ft. of PL shown Plan...and .profIl.:e. :SDS _ ....:...:.. .. . kid' ether e rls�anci c Deer 200' shown' orrWYeference made Property boundaries (metes and bounds- clearly sho` 00T (A9'b (C14��j I I i i N i I 'SEPARATION DISTANCES SPECIFIED ON PLAN 10' to P. L. Q ?01* to Foivadation walls a0/ )0' to Nearest well a0 ; 50' to stream, march, lake, etc. incl . expansion L5' to Curtain drain I j S !O' to water line (pits-20') /p� .5' to storm drain ) y tsl .01' to large trees , _/01 :�' rUlll l O1111ilation to septic tank to .5 pipe from leader drain & . fool jig (r'aill !� W t.c(, S rO DE. LOC-A" `T-0 K)OCJH OA) 2! PRO PS_.&7C_S �G w ccs Cv-(f ,L SOD cbM S(W P,(A.P - Q�£� SOY SSE ®t� S�"(CcS 0 2 coo STMA� )� WOOD 9V:. . , FIELD CH E31" 31" 7; r Sir • 6A) Date • - ' ^y� -a 'b`� ...:'t •..•- .'7.t]�.,C+: �`.; -y-1 .. r'.i9^'.�.•'Y �:•a';: �tl . -9 .::v, �•�J =� c-.5.r U�•..... .q:.} vn.�.:;t M••..Z • rG`. � =��p - a.$.`r °.'i?„-- c• -•,K} t IN-I-TTh,L SI'L'T: INSPECTTIO ' Yes No Comments ,Proper.•t•y lines or corners found . . . . . . . .. _ Gan cstima.te house location . . . . . . , . . . Will driveway need cut .. .... . _ . ... . . . . -_ A'!u>t tree 4 be r0moved -note these Is deep of entire SIDS area Additional deep holes needed. . . . . . . . . / Sufficie -nt SD'S area available considering driveway cut, house location, scparation distances, aetc. . . . . . . . o . . . . . DEEP HOLE DATA Dspth . 6 . Zdater elevation: fJ-0-106 Rock elevation: . Soils description: /7•-6 "rPN, 0 L , t� V G D N4" ••(3 C,Ua cN c ©to Date: Fli IAL SITE FNSP;-:,CT (jA Insp • by : Houso located truer- srotrn on approvod plan SDS located where approved • . . . . . I. n ° GI1 Ol trOnch m 4 s u�'l:u nc,•� ___ -- Wdd lh of trench ave aSe Slope of the line and trench. acceptable . . .� _ _ _ ___v_ - I�acm - all:sot�c_d..for- Ayransi on. trenches e . . _, . •6•ver "��; e from s;anp, i�ra;ercoUrse .o . ` o .• •< Natural soil not stripped or. SDS area tuu-iecessarily graded 10 Ft-. maintained from prop . line and 20 ft. from house . . . . . - - _.,� - - � Sep; ration of trench front house, well - -etc. folloris plan - - -- - -- - -- - -- -- -- - - - - -- _ =— ----- - __- - - - - -- - - -..�. 'ntjnber of bedroo ns chocla . . . . . . Si;ones, brush, • stuimps, rubble, etc : greater than 15 ft. from nearest trench . . . ., . . 4. { 7`V/��' lor".MU 15 Ft . of peripheral soil horizontally from trench. ... . . . . . . . . . . . . . 0 .0 . Junction boxes properly set. Could surf. ace run off froii1 driveway, roads, -ground surface, etc. charulel near SDS . areca x r� Lx'C.U!!r- FOP- 1rCX:Drra1,iP, Docs lot drain.,.igo ayrear 0. K. .-M area Of SDS FINTAL MADITNCi OF SITE ACCEPTABLE vD Y '�0.0.•...✓00��� 5 0 Vil t • '�� Vi.O P � V.X. ��i. i f: y' kk 9 o. P�JTi11c4M couivmx n �'PARTMENT OF HEALTH DIVISION. OP ENVIRON ATAI, H17WRli 'SERVICED .. ' 401JiliTx == OFFICE .SipTMING CARM lLi :,N -. a T�; STET -39PA AT SL�dAGF ISPOW4, OXST F'I 10a i ++ 'LL= ,Addre �2 at (S a�et V\,6aD Ste, Be co 12 3 Bloal $ �ln aa. � Meares �moaa a red . . � • -�'. �. �P e maywe i�v ; N I�) • 1/ l� �t Watershed C �o ►�'oy� S011i . MCOLATION TEST TA RE UIRED TO BE SUBMITTED WITH ' A No a �►� � .CLOCK. �� �;RcOLATrO;u ®� Y in arpgq pth to ,va er Ada ;.. ' i. 'g►�m Ground 8 urf4e o� riche att°t -tip .1:.M$iA 3ta stop n '.4. MP An Inch6a Ianfts Inches.:' - -. z. Y(O , 1 1.7 Ul Vt •�.� ��:;: � - .; -2'x•7 J,3 0© ,, �°-° - • - �b• . - :2.3 ,3 i . ,. Inj �� �• .'•111 ,� ' - 1 __.,,,� —"��_� 1, ''•' , • IMQl %� °��t9 �O6k �IQ Y°api:Fil��(� 8�t 8�r� �Q �i +T�B�a� � " �Jt� ' :.• •' .;�.. l BFF .0 � ®kat nod �t each ' ��rcQl�,��o� Dapt4 was,uremento to be, rade ° � too o n DEPTH G. L. A 611 1211 1811 24" , 3011 3611 .42 11 4811 54 fl 6011 6611 7211 mm LIM TEST jxrr WW7TT-17) 1:' .1111 A-1)1'-T,•1'(NA'Y10N IiOLES HO1;C1 NO.— HOLE P;'0. HOLD; NO. INDICATE IME1 AT 1,[HICH GROUED WATER IS ENCOM1TERLD INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER E. "NG ENCOUNTERED TESTS MADE By Date � 2U � . Sdfl 6 t -6 U e" a r- Ts' i j- f Drop: S.D. Usable Area Provided �O�IAL E, No. of Bedrooms Septic Tank CapacitY -IQ-060) Ga Absorption. Area Provided By �7,5-�-L-V.x24" t1 Other Address 37 f}i2 S, SEAL %. E Si THIS SPACE FOR USE BY EEAU11i DEPARTMENT ONLY: Soil Rate : Approved_ Sq. Pt/Gal. Chocked by�_ �04 l �g Ailt4 C, 0 'P 4, Date,