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HomeMy WebLinkAbout0061DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 3.15 -1 -14 BOX 1 00061 . lir -31 3 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services,.` Carmel, N. Y. 10512Jj'//j CERTIFICATE. OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM r Town ..or 'Village " } _ Located at /L�' Section Block Owner `�� C Lot Job Separate Sewerage System built bye*' —� Consisting of ' Gal., Septic Tank Other requirements Water Supply: Building Type Public Supply From - X Private Supply Drilled By Address li lineal Feet Xf width trench" Has Erosion Control Been Completed? I certify that the system(s), as listed serving the above premises were constructed essenti y as shown on the plans of the completed work (copies of which are attached), and in accordance with the standards, rules and regulations, plans filed d the permit is ued b the Putnam County Department of Health. Date�f /� �` Certified b P. E. R.A. s r� Address ( �" G� License Nod`' Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Commissioner of Health, such rev ion, modification or change is necessary. Date —�� By Title Yorktown Heights, N.Y..10598 YORKTOWN MEDICAL LABORATORY INC. P.O. Box 99 321 Kear Street RESULTS OF EXAMINATION OF WATER [6Pbb LAB # 8116 CATHERINE FARRELL 10/17/75 CITY, VILLAGE, TOWN &/OR NAME OF SUPPLY DATE REPORTED SAPLING COURT. PATTERSON. NEW YORK 10/20/75 ARTF.RTAN WF:T.T 245 -3203 BACTERIA PER ML. (Agar plate count at 351C). 9 COLIFORM. GROUP (Most" probable No. /100m1.) LESS THAN 2.2 HARDNESS, TOTAL - ppm DETERGENTS -ppm NITRATES (as N) - ppm IRON, TOTAL - ppm FLOURIDE (F) - mg. /1. These results indicate that the water was YES of a satisfactory sanitary quality when the sample was collected. f PER: LAKE CARMEL PHARMACY H. PADOVANI, _V. T. (ASCP) .Go �r I. C Owner or Purchaser of Building Building Constructed by Lo at on - treat Bui ding Type Municipality Section Block Lot GUARANTY 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 guaranty to the owner, his succes- 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 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 de- termination of the Director of the Division of Environmental Health Ser- vices of the Putnam 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. Dated this day of 19 Signature,( Title If corporation, give name and 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 PUTNAM COUNTY DEPARTMENT OF HEALTH 3171 u Division, of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report is to be completed by well driller and subniiited to,County 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. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME f�R�E L L ADDRESS Ae," 6 LOCATION OF WELL (No. 6 Street) (Town)) (Lot Number) PROPOSED USE OF WELL BUSINESS ® DOMESTIC D ESTABLISHMENT FARM ABLISHMENT D TE$ Ell• AIR SUPPLY OTHER INDUSTRIAL � CONDITIONING � (Specify) DRILLING EQUIPMENT WI COMPRESSED CABLE ❑ OTHER ROTARY AIR PERCUSSION PERCUSSION (Specify) CASING DETAILS LENGTH (feet) DIAMETER (inches) WEIGHT �j r� PER FOOT / © THREADED ❑ WELDED DRIVE SHOE ❑ YES ® NO wAS CA3TNG �ROjU ? YES L_I NO YIELD TEST BAILED PUMPED HOURS G.P.M. � COMPRESSED AIR 3 %0 YIELD (G.P.M.) /0 WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST five() Depth of Completed Well '300 *' in feet below Land surface: SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of. well including gravel pack (inches): GRAVEL SIZE (inches) FROM (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with dista ces, to et least two permanent landmarks. FEC-7 iv ri:ET ILI HoC4 sr. �5 f • L . If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL 9OMPLETED DAT OF PORT WELL DRILLER (Signature) m 'S. R PUTNAM COUNTY DEPARTMENT OF HEALTH, DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner ���J�2% Address Located at (Street. ' Sec. Block Lot n cafe eares cross street) Municipality1 G!/I.O,D7c Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED ITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Elapse Depth to Water Water Lev e No. Time From Ground Surface in Inches -Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 11 1 - - 2 3 4 5 1 2 3 4 5 Notes: 1) Tests 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. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN "PEST HOLES DEPTH HOLE NO. i HOLE NO. HOLE NO. G.L. 6" 12" 18" 2411 3011 36" 42" 48" 54 if 60" 66" 7211 . 78" 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED /V ©�✓E INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Q. C' Date DESIGN Soil Rate Used /l /5 Min/l "Drop: S.D. Usable Area Provided �d0� No. of Bedrooms Septic Yank Capacity 900 Gals. Type /�- ,�ISOrVi27� Absorption Area Prod By L.F.x24+ 3b width trench. Other Name 6a=oizGE- AAVGNtja -r' 6ignature Address •QouTE 52- SEAL NFri� ��.�``�P��O THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: K'= Soil Rate Approved Sq. R /Gal. Checked by �e n YNI`1'TAL SITE IPISPECT1011 :Property lines or corners found . Can estimate house location . Will driveway reed 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 KOLE DATA Depth: / Water 'elevation: Roc)c elevation: �G `� �/ • Soils description: D e- FINAL SITE INSPECTION Insp. by: House located where shown on approved plan. .. . _SS �l,�r ?.I P.rl. Z.rhr?T�p arrr[1��Pr7 . . . . . . . Width of trench average Slope of tile line and trench acceptable . Room allowed for expansion trenches . . . . . Over �O ft. from swamp, :watercourse . . Nattml soil not stripped or SDS area. uritx ce s sarily graded . . . .. . . . . . . . O F�. traintained . from prop . line and 20 ft. from house . Separation of trench from house, .well etc. follows plan . Nurabe- of bedrooms checks . Stones; brush, stumps, rubble, etc. greater tb- 15 ft. from nearest trench �5 lit. of peripheral soil horizontally from tx- ch .. . JurletLon boxes prope set ICettic surface run off from driveway, roads, grand surface, etc. channel near SDS , Does Lot drainage appear 0. K. in area of SDS_ FBI GRADING OF SITE ACCEPTABLE Date.: Insp. Yes INo Comments REV..LLW GIILOK 61i Meets Std.( Remarks es NO DOCUI,2111TS House plans U.A. Design data sheet Peres presoaked? Min., 30 perc test depth Cont. results for 3 runs D. Hole. log 0. K. Corporate Affidavit for other Authorization.for engineer Letter from Water Supply if a If variance requested -such no- than individual i ✓ I )plicable ed on plans & apps._ .4 if change is proposed,) Existing contours shown show new contours) / Slopes for driveway cuts, etc. shown Water service line location Footing.drain, etc. location I Top slope,,. bottom slope of fill Percolation tests and deep test pit location i -- -i-- -- Septic tank size and conformance to std. _ ! i 3 B.R. house minimrLim i ✓ I o House setback shown _ �2 _=lei;; i•!1•: U i�rJ AL _L" 1Y O. UV_ YYy U1J111 JV 1 V.a V1 ay ►iiv .1 Plan and. profile SDS All other wells and SDS closer 200' I shown or reference made ( /Uo Property boundaries (metes and bounds - clearly showy )i i nvkaU SEPARATION DISZANCES SPECIFIED ON PLAN 10' to P.L: 20' to Foundation galls 100' to Nearest well 50' to stream, march, lake, etc. incl 15t to Curtain drain 10' to water line. (p3.ts -20' .15' to storm drain 101 to large trees 0' From foundation to septic tank 5' to pipe from leader drain & fCo in .expansion w .{ �t