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HomeMy WebLinkAbout0888DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.38 -1 -16 BOX 10 �L 1 ` LIP-.. ' f PERMTT #P 8 80 PUTNAM .COUNTY DEPARTMENT OF HEALTH. S01919 ?` Division of Environmental "He+a/th Serwces, Ce�me% N. 'Y' 1051? �'.. _, CERTfFiCAT�..0F. C-QNSTR.UCT!9N" ^WLIANCE FOP.. SUNIAGE..DISPOSAL_SiiSTEiVi rdtterson :.-' :. Town'or "Viilage' " Located o f Utica & Uni ce Rd's Tax Map 51 Block 'vG Owner G#16 &Steven HoTax ard Tax Map Lot # .4 s,�d #:4244 -52 Incl . Separate Sewerage System built by S.A.F. Septic System -Inc. Address P.0. Box 141, Cross River -'NY 10518:. 100.0 . 336 -�A L.F. x 24" Width Trench Consisting of Gal. Septic Tank and Other requirements Effluent Rump.w /Audible- Visi -ble- Alarm``= Visible Alarm In Gal Rump Pit water Supply: Public Supply From ' 47 'Am 00 X Private Supply Drilled By Boyd Artesian Well Drillers Address Rte 52, Carmel , NY 10512 Modular hree 9/3%80 Building Type No. of Be Bdrooms. Date Permit Issued Has Erosion Control Been Completed? Yes I certify that the systems) as listed.,serving.the above premises were constructed essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulations, in accordance with the filed plan, and the permit issued by the Putnam County Department Of Health. . Date 8 J uly 1981 Certified by P.E. X R.A. Address R.D. 9 , 'Fatr St rmel NY 10 2 License No 29206 Any person occupying premises seared by the above systems) shall promYy take such action as may be.necessaryto 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 antl void when a public water supply as available. Such approvals are subject to� modification oror change when, in the Judgment of the CornoAsSIUM of Health, such revocation tion or change is necessary. Date t BY Title WELL COMPLETION REPORT 3/71 PUTNAM COUNTY DEPARTMENT OF. HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report is to be completed by well driller and submitted 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 B` SUBMITTED WITHIN ^s0 DAIF3 OF WELL COMPLETION OWNER NAME Ste hen Howard ADDRESS 4.7 Overland Rd*. Patterson, NY LOCATION OF WELL (No. & Street) (Town) Ven:Lee & Palisades Patterson 41t o4 f —� N ppq 45d e PROPOSED USE OF WELL BUSINESS FX DOMESTIC El ESTABLISHMENT ❑ FARM ❑TEST WELL ❑ SUPPLY El INDUSTRIAL ❑ CONDITIONING ❑ O(specify) DRILLING EQUIPMENT COMPRESSED CABLE ROTARY ❑ DAR PERCUSSION ❑ PERCUSSION ❑ (S(Specify) CASING DETAILS LENGTH (fast)1 DIAMETER (inches) 6. WEIGHT PER FOOT 19 ® THREADED ❑ WELDED I PBLVE SHOE YES ❑ NO (j L_ n YES LJ NO YIELD TEST ... HOURS G.P.M. ❑ BAILED ❑ PUMPED COMPRESSED AIR 15 YIELD 1 `J� WATER LEVEL MEASURE FROM LAND .SURFACE —STATIC (Specify feet) 35 URING YIE D TEST (feet �otal bawdown Depth of Completed Well P p 200 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 distances, to at least two permanent landmarks. FEET to FEET 0 8 overburden PIlTL.Ii9 CDlINTY DEPARTMENT OF HEAL, COUNTY OFFICE BUILDING CARMEL, NEW YORK 10512 15UL 10 1981 _ 7 8 200 ledge If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE a DATE WE CO PLETED �30�81- DA p ORT �eE/1�� WELL DRILLER (Signature) fr7 - /c ' 4-11 6 YORKTOWN MEDICAL LABORATORY INC. C��16siB 1'I�8876 P.O. Box'99 321 Kear Street LOCATIONS: - -- 1 _321 KEAR.ST., YORKTOWN HEIGHTS, N.Y 10598 245-3203 Yorktown Heights, N-. . 1OJ9� ❑ 201 BUTTONWOOD AVE., PEEKSKJLL, N.Y. 10566.737 -8777- 245 "3203 El 495 MAIN ST., MT. KISCO, N.Y. 10549 666.3335 [P STONELEIGH AVE. (NEAR HOSPITAL), CARMEL, N. Y. 10512 278 -9330 DATE COLLECTED RESULTS OF EXAMINATION OF WATER 6/30/81 OWNER DATE RECEIVED Steve Howard 6/30/81 CITY, VILLAGE, TOWN 6 /OR NAME OF SUPPLY DATE REPORTED Venice Rd,, Patterson, New York 712/81 kitchen tan @ above address 'BACTERIA PER ML.. (Agar plate count at 35 C). 5 ML COLIFORM GROUP ( ) 0 MFT ; TOTAL - ppm DETERGENTS - mg /L NITRATES (as N) - mg/L F IRON, TOTAL - mg /L AMMONIA, FREE (as N) -mg /L pH= CHORIDES - (mg /L) These results indicate that the water was YES of a satisfactory sanitary quality when the sample was collected. A. H. PADOVANI, M. T. ( CP) en 6 Gayle & Steven Howard Patterson Owner or Purchaser of Building Municipa ity Building Constructed by Utica & Venice Rds. Location ® Street Tax Map 51 Section 3 Block Modular 4 Building Type Lot Putnam Lake Subd., Lots 4244 -52 Incl. GUARANTY OF SEPARATE SEWAGE-SYSTEM represent that Udaffewholly 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 P.19ce in good operating condition any part of said system constructed by V6 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 10C to such system, except'where the failure to operate properly is..caused by the willful or negligent act of the occu- ant of the buil®in� utilizing the system. The undersigns further agrees o accep 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 negligen act of the occupant of the building utilizing the syste r Dated this 2 day of June 19' Signatu Title f corporation, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP,ETION 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 PUTNAM COUNTY DEPARTMENT OF REALTY COUNTY OFFICE BUILDING CARMEL; NEW YORK 10512 JUL in 1981' -Gayle & Steven Howard' Patterson Owner or Purchaser of Building Municipality Building Constructed by Utica & Venice Rds. Location - Street Tax Map 51 Section 3 Block Modular 4 Buil2ling Type Lot Putnam Lake SM., Lots 4244 -52 Incl. 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 :Wade 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 e the Putnam County Department of Hea_ lt1i as to whether or not the-_ _ failure of the system -b- o operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this day of June 19 81 Signature Title Owner 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 PUTNAM COUNTY DEPARTMENT OF UEAITH,� COUNTY OFFICE BUILDING CARMEL, NEW YORK 10512, JUL 10 1981 {.".. , P�JTI�TAM C ®LINTY, DE�ART1bIEleTT •OF HEALTH,,. >, Division of Environmental Health -Services; Caimel N -Y 10512 ,a, x CONSTRUCTION PERM1 ,FOR'_ "SLWAGE.D.ISP.,OSAL 4Y `EM P "atterSQ11_ { Town_gr village �._ Utica & Venice Rds� - - _._._ 51 . -- - 3 Located -at Tax Map Block" S�btliv(slon Putnam. _Lake -Lots ;'4244 =52 In;c] Ftl ed Map 1`4�a 4 Job> S01919 owner G6 6.1-'St" , 66 HOWard Address 3A Suhnv ya] 1�R M6du]ar 20500'j]- New Mi16rd.; CT -06776, Building. Type_ Lot ;Area., Number of Bedrooms Three "Design Flow 6OO Ga]: Total Habitable .Space 1.944 square" Feet 1.000 333 L F. x 24l' Width Trench Separate - Sewerage: SYSter -i to. consist" of Gal.- Septic Tank and To be constructed .by Address Water. SuPPlyi - Public - Supply. From Private $uPPIY to be drilled by ' 1.�1- Address.` Other Requirements None - I represent that am wholly and completely - responsible for. the design-and kication:W the proposed,.systeni(s); -1) that the separate .:.sewage:,,disposal. system �- above described_ Will be'conitructed'asshown - on :the approved amendment there to and in'a`ccordance' with the standards, rules an regu, ations:o County Department of Health, and that on. completion thereof a Certificate of'COnstruction; Compliance "'satisfactory to the commis ;ionerof,Healthwill be_ submitted to ;the Department ,:a",:, nd a written guarantee will be furnished -the owner, his successors, heirs or- assigns by the builder, that said buiider.will ,Place in`good operating condition any.part'of saidJsewage disposal, system" during the period of two (2) years'immedi5tely following the date of the issu -` ghee of the approval of the Certificate of,.C'onstruction Compliance,_'of thebriginal, system or,any repairs thereto,•2)`that the "drilled'welLdescrWed above wilibe located as shoavn on the approved plan -and that•said,well will be "installed (ri ",accordance• with the •itaridirdi, rules and regula i�of the" :Putnam County Department of Health 19' August 1980 pate; Signed P E. � R:A. X R,D 9, �a1r,.St - 1 NY`.]0512 . 29206` Address license No. APPROVED FbR'CONSTRUCTION ;This approval expires one year fro he date issued unless c sfruction of. the building has been. undertaken and is rev for. cause.or may "bae amended or modified when consid ed necessaryz.by the Commissio ' of Health. 'Any change or alteration of construction requires a new rmit pr ed ^for tlispospl of domestic da ag rivate " Date By - Title u ia s � Votes: 1) T Ats to be repeated at same depth until approximatel �y equal soil rages are o'otained 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 TEST HOLES j Address R.D. 9j- campl. My: 10512 Fair THIS SPACE FOR USE BY HEALTH DEPARVENT ONL �`� Soil Rate Approved Scf. . k /Cal . Cheo �fT tAjEO Date�____�__ m ''Vo 0 'S ITT oo 3 4 47'7(' -444(o. 4z44� 'o Pn- ,,PoO'5 8 40 ln3w 4�Ta� T .11 r/l IZOAC� JUN 2-1981 v 70 41JO L. PE,2TY OF - Vtk--RAJ;�-R.D POO-` e?T F-. P Eki 4. -,GA**srjE, 140WA12C> H 44-425Z L OT e71VTW MAP Or PUT Q A&A LAVE. MAP i0. 149-E riLlEt> 3-20-31 TOW OF. RATTE,4-� U PUTUAAA Ca, U.%( ,KAL.. 1" 30'fU-SXM-r0q',!TY DEPARTMENT gp"WaFQ 16,19-90 UOVEM e&Q S. r9ec "COUNTY OFFICE BUILDING k1weuac-2 CARMEL, NEW YORK 1051P AFIZIL- t&. 0 .11 opl -I 01 /a0 ltL 1Cafs °r LC AU A64,C--MC -M�7-#J A.Wr> -Tm =".rip AUIC , Ancomb. 64 -n� waw 4Dw-l-=ft A6sdy-lpmou ap - . li, 4 .1 , VftM%t0UP0- LALZ 51-)W8&s - SAtb CEMPC PMOLK amm sox-L euu, cuO io- -rie PeesoLL roe w;t*4 -rgs WtVM 6 PeET-AeEb AdUb OU WS BBW-F --FO IM6 ZDpis -Tnl.F- lC&*4PAUA Atlb LEUNM l0tttruTIOU W61-Bb FIQ1Ii i. - US' , ; M , _Sv.B6E@uew cwue&.. Ott . 11111N., - / 01 l P'. UKai smeEr 'R Va jADjj Pipe MA 4241 z-co,-V 2R '1243 4242 PIPS musib ITT oo 3 4 47'7(' -444(o. 4z44� 'o Pn- ,,PoO'5 8 40 ln3w 4�Ta� T .11 r/l IZOAC� JUN 2-1981 v 70 41JO L. PE,2TY OF - Vtk--RAJ;�-R.D POO-` e?T F-. P Eki 4. -,GA**srjE, 140WA12C> H 44-425Z L OT e71VTW MAP Or PUT Q A&A LAVE. MAP i0. 149-E riLlEt> 3-20-31 TOW OF. RATTE,4-� U PUTUAAA Ca, U.%( ,KAL.. 1" 30'fU-SXM-r0q',!TY DEPARTMENT gp"WaFQ 16,19-90 UOVEM e&Q S. r9ec "COUNTY OFFICE BUILDING k1weuac-2 CARMEL, NEW YORK 1051P AFIZIL- t&. 0 .11 opl -I 01 /a0 ltL 1Cafs °r LC AU A64,C--MC -M�7-#J A.Wr> -Tm =".rip AUIC , Ancomb. 64 -n� waw 4Dw-l-=ft A6sdy-lpmou ap - . li, 4 .1 , VftM%t0UP0- LALZ 51-)W8&s - SAtb CEMPC PMOLK amm sox-L euu, cuO io- -rie PeesoLL roe w;t*4 -rgs WtVM 6 PeET-AeEb AdUb OU WS BBW-F --FO IM6 ZDpis -Tnl.F- lC&*4PAUA Atlb LEUNM l0tttruTIOU W61-Bb FIQ1Ii i. - US' , ; M , _Sv.B6E@uew cwue&.. Ott . 11111N., - / 01 l P'. UKai smeEr tructure located from survey b -y, surveyor note d below- ell located by: Surveyorb survey— Weis drillers report - Engineers mesurement's..13- Tar, k, boxes, P14a,gollenes a'lateials located by:Contractor. E ng t:neer: Healthdapt: Field Inlpsctlen by: Health dept ® dot e:' N0TES::4) Toko 'LaCexo(s -336 Lo. X 2 F "wide x Z4 '..Dm G "WeEe!- G«a.d' e p Control Pon I 44W Dose = 33G�X 7f %'X p, sfrrnl /rf. ='IG3.BGe1,= 21,1 f4 1 D I'ME g_NLS10N_k,- A - C A E,. °-- 4Z'- -- 9 - E A. - 6 =- A M ` - -�} - - -B - H �: Z�• - - - -- A _ L 68'� _ A _ : _ _ AM= COUNTY DEPARTMENT OF h COUNTY OFFICE BUILDING CARMEL, NEW YORK 1051. m LOCATION St eet:^ cg. S-, J_State: TOM n: 7A +,6Pr"_t2 - _County:..,-.. &E? n.tn ,_ .hLy,_ - - SUBDIVISl0N: LOT Ns. ' surveyor Rte{p✓_ - ptgwn Soo Ie:• q A J Q. H N H '. P. R- E N T h S S' P L "'CONSULTING'- `'ENGINEER' RD R, F,4,, -k >'T,, CAR•MEL NY 10912 --- (9141878 -6170. 1 T � ' +w • � / I � � � , � , dot oral: q� r , 3 t ' . Y ` Qa0pfi8810N,K, F Putnam County Department of Healtb;: > :,'Digleon o3 `Envirgninental Health 6ervioes ca °• ;,, t, �p � ,, <, J' lF��.' f•. .i«. z f _:Yt .� aa'n��ted cont'ormanoe � ,.�;�;•., „y, r ;� ,,Approved t • "a able Yiu • tnaln oun`t'.Hea d• Y k�;,DeqpaFtment. � ('� tructure located from survey b -y, surveyor note d below- ell located by: Surveyorb survey— Weis drillers report - Engineers mesurement's..13- Tar, k, boxes, P14a,gollenes a'lateials located by:Contractor. E ng t:neer: Healthdapt: Field Inlpsctlen by: Health dept ® dot e:' N0TES::4) Toko 'LaCexo(s -336 Lo. X 2 F "wide x Z4 '..Dm G "WeEe!- G«a.d' e p Control Pon I 44W Dose = 33G�X 7f %'X p, sfrrnl /rf. ='IG3.BGe1,= 21,1 f4 1 D I'ME g_NLS10N_k,- A - C A E,. °-- 4Z'- -- 9 - E A. - 6 =- A M ` - -�} - - -B - H �: Z�• - - - -- A _ L 68'� _ A _ : _ _ AM= COUNTY DEPARTMENT OF h COUNTY OFFICE BUILDING CARMEL, NEW YORK 1051. m LOCATION St eet:^ cg. S-, J_State: TOM n: 7A +,6Pr"_t2 - _County:..,-.. &E? n.tn ,_ .hLy,_ - - SUBDIVISl0N: LOT Ns. ' surveyor Rte{p✓_ - ptgwn Soo Ie:• q A J Q. H N H '. P. R- E N T h S S' P L "'CONSULTING'- `'ENGINEER' RD R, F,4,, -k >'T,, CAR•MEL NY 10912 --- (9141878 -6170.