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HomeMy WebLinkAbout1555DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -4 -54 BOX 14 01555 I at ssr I . ' I. I Is J ■ 7' . I ' .t. L , . a 16 ■ . ■ ol .. . '. I' . T N ' . . . i IN I 01555 gy PUTNAM COUNTY DEPARTMENT OF �IEALTHr dig _ / Hel9iih Servrcea, Caren% N :Y 10$12 Permit Dryisron of .Enwronmenta I CERTIFICATE OF CONSTRUCTION: COMPLIANCE- FOR SEWAGE DISPOSAL -- ,SYSTEM - w,e .��1 r Village 1 l`ocate8'et . %' `A- aul� -A,ciY .Owner �rn rr!1� (L33 /ir�rlii7►1 % Fozmerly P Lot U` 'Subs Lot q / 1 �14C ( GG Tax Ma _.[, �. Separate:Sewerage:SYstem built DY,�<'CI��% !�lA�'itb Address S.c rUV6+Y�r�Gr ' _ '30 F or - Other i7Li: conmiting of, ©�® (3 al .Septic Tank and Other requirements Water SuPPIY Public Supply From �p.� Reid, ,Private 3upPly _Drilled BY �<r "' "'� Address /� S f Building -TYPE Ilatf) X4-1 ZAL G x< t` Bedrooms Oats Permit Isom :_ N 't r a rS No of COT Iet9d7 " tr } w , Has .Erosion Control Been. s P.;2 r + . M Y Y4. I certify that the system(s) as listed serving the above premises, were constzucted essentially as shown on the plans of the completed work.( copies _ •. of whioh',are, attached) and in accordancewfthtthe atApdarda rules and regulations in accordancp`with'.the filed plan and <the permit issued by'the Putnam County Department :Of a4t, '^ r 3 - t �sr,� Date �l:/r (i 1 �.�� ka s s- t�h.`Certif iEd Dy' P e�'"' t' r f3 i P'E R.A 4 a y ,+•fit ' n'� Atldress License No yS,y.nY Any person occupying prernisss saryed by, the above system(s) shall'proihptly take such action as may be neoassi y td ><6cura the correction of any unsanitary conditions resulting from :weh 'usLge� rApproval.of �the;se'parate sewerage;sjistem shall become null and void as soon.as r;pu6lk sini'tary sewer :becomes Available and-the 'approval ' of ;the private water'supply shall •Decome'riull and- rvoid, when a putilia water - supply,.beeomes awllable ..Such approvals are ' subject to modifieatlon,-or change; wINA *- ri the )udgment�:of the Comnllssioner of :Health; 'such rev- modlfleatlon or :enan� Is >•necessary, K, INK ` r Date y tq 1{ ?, BY �!`• TItN Rev. 9 -8T- t - - i ORKTOW MEDICAL LABORATORY INC. P.O. Box 99 321 Kear Street Yorktown Heights, N.Y. 10598 LOCATIONS: ❑ 321 KEAR ST., YORKTOWN HEIGHTS,, N.Y. 10598 245.3203 ❑ 201 BUTTONWOOD AVE., PEEKS KILL. N.Y. 105613 737-877 7 _ ❑_ 5zMA1 ;N SX;,.MT. KLkgO,, N.Y. 10549 666.3335. _ , �Q STONELEIGH AVE. (NEAR HOSPITAL), CARMEL, N. Y. 10512 278.93: ❑ ACIDITY , ".• ❑ ALKALINITY ..................... .................... -BACTERIA. TOTAL /mL ....... .................... ❑ OD. 5 DAY .................. ............................... OBROMIDE ................... ....:.........I................ ❑ CARBON DIOXIDE, FREE ❑ CHLORIDE .................................................. ❑ CHLORINE ............. .. ............................... ❑ COD ❑ COLOR . ............................... ❑ CYANIDE.. ....... ............................... O DETERGENT, ANIONIC ..................... ❑ FLUORIDE............................................. ....... :.. ❑ HARDNESS ............................ ❑J�1PN'COLIFORM COUNT/ 100 ml ... T COLIFORM COUNT/ 100 ml WT •........... Q CON FIRMATTORV_T. ESA... ............... ,, ............... ❑ NITROGEN, AMMONIA ....................... O NITROGEN, KJELDAHL ... ............................... ❑ NITROGEN, NITRATE ... ............................... ❑ NITROGEN, ORGANIC ... ........................:...... OODOR . ....................... ............................... OOIL & GREASE ............... ............................... ❑ PH . ........................................................... ❑ PHENOL ....................... ............................... ❑ PHOSPHATE (orth0) ....... ............................... . ❑ PHOSPHATE (condensed) .................................... ❑ PHOSPHATE (total) ....... ............................... O SOLIDS, SETTLEABLE; mi /L :. ` O SOLIDS, SUSPENDED ... ..:............................ ❑ SOLIDS. DISSOLVED .. ❑ SOLIDS, TOTAL ........... ............................... OSOLIDS. VOLATILE ........ ............................... ❑ SPECIFIC CONDUCTANCE .............................. ❑ SULFATE ............................... ............. ❑ SULFIDE,',.,,.,. .....:.............. ............................... ❑ SULFITE .................. ............................... ❑ SURFACTANTS i ............ ............................... ❑TURBIDITY THESE' RESULTS INDICATE THAT THE WATER THE SAMPLE WAS COLLECTED. THESE'RESULTS INDICATE THAT THE WATER NE14 -YORK STATE ADMINISTRATIVE RULES & FOR THE PARAMETERS TESTED.. LAB # DATE TAKEN: DATE RECEIVED: — DATE REPORTED: SAMPLE SOURCE: REFERRED BY; COLLECTED B1 : �J�ll1/1�/.1111M r ' ❑ ALUMINUM ................................ ............................... ❑ ANTIMONY ................................ ............................... ❑ ARSENIC ...................:......:......... ............................... ❑ BARIUM ....................................... ............................... ❑ BERYLLIUM ................................ ............................... ❑ BISMUTH .................................... ............................... 0 BORON ........... ............................. ............................... ❑ CADMIUM .................................... ............................... ❑ CALCIUM .................................... ............................... ❑ CHROMIUM (tot.) ............................ ............................... ❑ CHROMIUM (hexavalent) .................... ............................... ❑ COBALT ..................... ............................... _ ........... ❑ COPPER ..................................... ............................... ❑ COLD ........................................ ............................... ❑ IRON ........................... ......... ............................... ❑ LEAD . ........................................ ............................... 0 LITHIUM -- — -- ........................................................ .............. ❑ MAGNESIUM - ❑ MANGANESE ................................ ............................... ❑ MERCURY .................................... ............................... ❑ NICKEL .............. .......:.................. ............................... ❑ PALLADIUM ................................ ............................... ❑ POTASSIUM ................................ ............................... ❑ RHODIUM' .................................... ............................... .❑ SELENIUM .................................... ............................. ... ❑ SILICON ........:........................... ............................... ❑ SILVER ......: ................................ ............................... . 0 SODIUM ....................................... ............................... ❑ TIN ............................................ ............................... ❑ ZINC ............................................ ............................... ❑ ............... ............................... .................... ❑ ............................... ti ............. ❑ REMARKS: ............................................................... ' ❑ .... ............................... .......................................... ❑ ............................. .......... :., ...................................... . ❑ .............................. • ............. .. ❑ . ............................... r::.. ............................. ❑ .............. ............................................ _.. WAS OF A SATISFACTORY SANITARY QUALITY WHEN i. DID MEET THE SATISFACTORY CIIEI•IICAL QUALITY OF REGULATIONS, DRINKTpq WA •R STANDARDS (PART 72) i w Owner or Purchaser of Building Building/ Constructe=d by / Location - tree Building Type Municipality Sdction Black Lot GUARANTY OF SEPARATE S '•IAGE SYSTFI'T I represent that I am wholly and completely responsible for the location, workmanship, material, construction arid drair_a,fze of the sewage disposal system serving the above described property, anti. that it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with. the standards, rules and. regala` ions of the Putnam County Department of Health, and hereby guaranty to the o, er, his succes- sors, heirs or assigns, to place in good operating cond- t.i.o.n any part of said system constructed by me which fails to operate fox- a period of two years immediately following the date of initial use of the sewage disposal system, or any repairs ^ad.e by me to such system, except where tie 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 Putnarz County Department of Health as to whet-her or not the failure of the system tg ogerat- e_wa.s _taus.' d_.by_ the- w xlful or negligent- act- of'­the~ occupant of the building utilizing the w_ ^t3"' Dated this day of 19 Signatur /�xw Title ` corporation, give name and address) Blacktop Maintenance Corp. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - Cgmmerce_Street ,_ Poughkeepsie NY 1260: THREE:. (3) %;OPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF,;CO-MP,ETION WILL BE ISSUED. ,i . . GUARANTOR IS REQUIRED TO FILE NOTICE, OF DATE OF FIRST USE OF SYSTEM. D.vision-'o'-Envirorurental Health Services, Putnan County Depart .Lit of Health Owner or _Purchaser of Building Municipality Building/ Constructed by / Section Location tree/ Block I _ /rz Building Type Lot GUARANTY OF SEPARATE SE ?1lAGE SYSTF11' I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving t'r..e above described property,_ and that it ! 'Ias 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 Heal -.:h, and hereby guarantor to the- owner, his succes- sors, heirs or assigns, to dace in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately followir_g the date of initial use of the sewage disposal system, or any repairs ma.d.e. by me to such system, except where the failure to operate properly is -cau_sed_ 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 . oz'..the .,_sy_st.e.m., t.o.- ap.erate_ was_. ca. used- -�by -- the -•w l ft -il� - -o-r -negligent f i act of the occupant of the building utilizing the system.,' % Dated this 5� day of 19 T-v Signature Title �C�LV5 %'��9 �i� ��4C (It corporation, give name and adess) — — — — - — — — - — - — - — — _ _ — i�� y,��1. %(�c THREE (3) COPIES ARE REQUIRED WITz THREE (3) COPIES OF FINAL PLAi4iS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTGR -�, S REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. - - _ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Division of Environmental Health Services, Putnam County Departu,: : t of Heal''-i N. C:A r7FZ Di.1'AR11,Pir I`f'i' Of'' IIr:�1I,7`; I T; ;I (-,7,T /Ili' ,.. ;r7p d� :17!11, FmAT,TH L'Eti'VTCr S -n cOT.JN 0l F'rcl, DUILDING, CARMEL, T. Y. 10012 DFBIGIN ?):1`1`A '11d,acT- Si.PAIZATE Sm4AGr, DTSPOSAL SYSTEM FILE N0. , r3-5 ✓ i %� 0 K TG U+r-C i I r Addr_ c Located at. (.^streetYdicate 'AMMA4� HPio . P-6 -Sec. 791 Block a� I•ot heaves cross street) ' Municipality Watershed SOIL PERCOLATION TEST r.ATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS -,A e CLOCK TIME PERCOLATION PERCOLATION Tt in Start -Stop apse Time Min. p th to Water From Ground Surface Start Stop Inches Inches Wate r ve in Inches Drop in Inches Soil Rate Min. /in drop `O 3 T i f 9 :35 4 20 3 1[ P- Ioteg:: 1) Tests to be repeated at same depth until approximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted for roview. 2) Depth measurements to bo rale from top of hole. DEPTH 11OLLE 611 12" 1.811 211. 3011 3611 4211 11811 51111 601t 6611 7211 781t ROM --1L)C-(C j HOLE, NO.- No. ska� Y k6,et — M INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE IZVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TEST� VIIADE BY Date DESIGN Soil Rate Used 1P Min/l Drop: S.D. Usable Area Provided S T. No. of Bedrooms, 3 Septic Tank Capacity' /000 Gals. C& Absorption Area ProvIdea By ech. soh . L. F - x24 ;1100 Izo 3 AIL me C41G" -F "631 tjlq . bigna Address "4-&11Afj6' /SEAL THIS SPACE FOR USE BY I(E-411TH DEPARTMENT ONLY: Soil Rate-Approved Sq. Ft/Cal. Checked by -Date O � Q qk Ni W W�a m N o "r N \2 4 � s59 W P crG _ 1.1.1 m i a app ti a a p.q uLo� /n�pp� �/ v 0 ,��L �giw^'6.5cEY I i fy.S -BU /G T �EOT /C OES /G/�' f.eE,�•CEO Fc,e TDti/iV OF X397 -7Z-- /✓-PVTNiAMC�UNTY -N�`/✓ �J uraRCE: /' =.�' 0�•�: �veic /4, /984 ' �EljENO O �JEar /c T,.r 0 0..1r.E'iBr/riaiy 6'ax • 0 jl�aG Putnam County Department of Healtfi Divieion of Environmental•Health Servioue � //a'�S /3 TO CE.CTiFY TH/➢> T.YLC SE�+/A4E p s.�;�3.9G SYSTE /7J lyyJ CoNSTL UC7E� 95 /NOiCA7G�0 G+N TiY /S �9� � y a .'tcd f ^r con ormance with ..1 -rtiona of the Coa;,t;; `a ltii�i:apal�tment.., a ^ t� Pete —4 8 a f,y 2 /B• / 20./ 3 43 Z 95.7 4 427 %20 5 53.5 494 % �5 2 5G•5 �EljENO O �JEar /c T,.r 0 0..1r.E'iBr/riaiy 6'ax • 0 jl�aG Putnam County Department of Healtfi Divieion of Environmental•Health Servioue � //a'�S /3 TO CE.CTiFY TH/➢> T.YLC SE�+/A4E p s.�;�3.9G SYSTE /7J lyyJ CoNSTL UC7E� 95 /NOiCA7G�0 G+N TiY /S �9� � y a .'tcd f ^r con ormance with ..1 -rtiona of the Coa;,t;; `a ltii�i:apal�tment.., a ^ t� Pete —4 8 a f,y