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HomeMy WebLinkAbout1847DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35.06 -1 -34 BOX 17 1876 Is I . .. . . �T J Jr 16 ' 01847 v .. --CERTIFICATE O Located at "tYN7Tier" PUTNAM COUNTY DEPARTMENT OF HEALTH g / Division of Environmental Health Services, Carmel, N. Y. 10512 COMPLIANCE FOR Ode r% . . ;AL SYSTEM NG'U Town orrVillage Tax map- Block '74) � /i Tax Map Lot # I subd. # Separate Sewerage System built by J I'"'+ j i Olosja J6M Address Consisting of Gal. Septic Tank and 4 W17 T_9QJLIC eW Other requirements Water Supply: � Public Supply From j r� ►� Private Supply Drilled By Address 0 Building Type fbleXAC421 No. of E Has Erosion Control Been Completed? I certify that the system(s) as listed,serving the above premises were of which are attached), and in accordance with the standards, rules and Putnam County Department of Health. Date ' Certified by Address �'� -- I- )1 f 10 RAC y/ a Permit Issued plans of the completed work ( copies Le plan, and the permit issued by the a K P.E. R.A.3z i Fh it License No. Any person occupying premises served by the above system(s) shall P: romptly take such action - s ma 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 vo whet+ a public water supply mes available. Such approvals are subject to modifica ton or ange when, In the judgment of the Commi n o Health, such evocation, Ion or change Is necessary, C Date BY Titl / M COUNTY DEPARTMENT OF HEALTH i �� I PUTNA j� Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM .042M��� - _ Town •br•-Villa9 Located at f Tax Map , !� Block r �,? Subdivision Lot s,+/� Jo1b�%/��s Owner Address Building Type Lot Ar r1 Number of Bedrooms b:? Design 4wr Total Habitable Space �^"L Square Feet Separate Sewerage System to consist of ®�eA Gal. Septic Tank and �¢� L To be constructed by 1 � �t➢R - - Address d dwA F, Water Supply: Public Supply From ,/ �. �L Private Supply to be drilled by Address "� ���� IL TW Other Requirements V . r 1 represent that I am wholly and completely responsible for the design and cat Ste (s)r ) �the arat e sewage disposal system above described will be constructed as shown on the approved amendment ere o an . n actbi -w h th standards, rules an regulations o e u nam County Department of Health, and that on completion thereof a "Certif to of C struct.,, omp ar1b ' satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furni ho he o et,;lSF, sso s, h is or ass' by the builder, that said builder will f t ears t tel following thedate of the issu- place in good operating condition any part of said sewage disposal sy a uriny•SiiSct RY( ,Y Y ante of the approval of the Certificate of Construction Compliance of B+o final. system or an r s theret at the drilled well described above will be located as shown on the approved plan and that said well will, be instal .s�iinn e% t andards, rules and regu a i�T�o s of the Putnam County /Deepart``menit of Health, iyn rte" /® /y P.E. R.A. date F Signed a 1� Address License No. kPPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the/building has been undertaken and is evocable for cause or may be amended or modified when considered necessary by the Co I sioner of Health. Any change or alteration of construction equires a new permit. Approved for disposal of domestic ary d /o sews e, and/or pr' -rT Sv[atter suooly only. �- )ate 13— C-_ `° ,± I BY - ` Title Lei c . ,...�...::0. er or urc' as( Building Municipality .Wm 'Building Constructed by Section Locatio - St eet Block Building Type 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 operr.ate 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. A ,, Dated this day of 19 [ Si nattuu're� lr corporation, gs.v-&- 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 V t '44 31 .,,7y DEPT". OF HEAL i 1 WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3171 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 BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION NAME ADDRESS OWNER Richard Rapp Dr.ewville Rd., Brewster NY 10509 LOCATION (No. & Street) (Town) (Lot Number) OF WELL Meadow Ridge Rd.,Lake Spring Meadows, Brewster, NY BUSINESS ❑ ❑FARM ❑TEST PROPOSED DOMESTIC ESTABLISHMENT WELL USE OF WELL 11 Y El INDUSTRIAL 1:1 CONDITIONING ❑ SUPP (specify) DRILLING COMPRESSED CABLE © ❑ ❑ ❑ (SPe EQUIPMENT ROTARY AIR PERCUSSION PERCUSSION (Specify) CASING LENGTH (teat) DIAMETER (inches) WEIGHT PER FOOT ❑ D E O X ❑ W CASIN —T D — GROUTED? DETAILS 309 61, 19 lbs . I THREADED WELDED YES NO L�J YES NO YIELD HOURS G.P.M. ❑ BAILED PUMPED ❑ COMPRESSED AIR YIELD (G.P.M.) TEST 6 WATER MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST (feet) Depth of Completed Well LEVEL 201 in feet below land surface: 4201 MAKE LENGTH OPEN TO AQUIFER (feet) SCREEN DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL Diameter of well including GRAVEL SIZE (Inches) FROM (toot) TO (feet) PACKED: gravel pack (Inches): DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET Drilling.in overburden- 0 1 clay & boulders Hit rock at.l foot icasIngrouted Drill4mar.in rock set, 1 30 30 420 Drilling in rock granite s [a�JrrR 6yvf yi('LL��.1 e� ®r .% (ji ;tom 5 l y If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE> t�� c` r• /i ] 25.A� DATE WELL COMPLETED 5/4/81 DATE OF REPORT 8126/81 WELL DRILLER (S)gnature) PUTNAM 'COUNTY DEPARTMENT OF HEALTH] _Separate Sewerage System .,� ;dun cipa i.ty . CONSTRUCTION ?FRMIT Located.. Section Block ,.L Subdivision �_' ~.. ,<} ;' L' t - s Job Owner_ .� ?i ;:. � � r, ;Address �-�� � ~Lot Area Building Type 4 No''. of Bedrooms` - Total Habitable Space sq.ft.. . Se],arate Sewerage System to oonsist.of Gal. Septic Tank lineal feet width trench To:be constructed by Address. Water Supply. Public Supply from Private Supply to be.:drilled.by Address Other Requirements I represent that I am wholly and completely.responsible for the design and location.of the proposed system.(s): 1)' 'that the separate sewage dis- oos1 system above described will be constructed as sho�Am.on i e approved plan or approved. amendment thereto and in: accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satis- factory to the Commissioner of Health will be submitted to the Department, . and a written guarantee will be: furnished the owner, his.successors, heirs or assigns by the builder, that said builder -will..place in good operating condition any part of said .3ewage disposal system during.the period of,two (2) years immediately following the date.of the assurance of the approval Of the Certificate' of ConL;truc pion Compliance of the original system or any repairs thereto; 2) that the drilled well described above will be located as shown on.the.:approved. plan and that.sa d well will,be installed in accordance with the standards :, rules and regulations of-the Putney County department of Health. Date - �, ,/ Signed - - -� ._t� �_ �, .. ; .,�• !.. L l % APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been uAdertaken.and is re- vocable for cause or may be amended_or modified when considered necessary .by the Commissioner of Heath. Any change or alteration of construction requires a new permit. Approved for dispo.sal= o ,b t� Westchester County,Department of Health Division of Environmental Sanitation AFFIDAVIT CORPOF-ATE. OWNER APPLICATION- FOR PERMIT REQUIRED BY WESTCHESTER COUNTY SANITARY CODE (Please type or print in ink) TO: Commissioner of Health - In the matter of application for - - . - - - - - I'— — — - CLEE0 ,D0�? G _ t=-1�� — — — — — — — — —a represent CJtZ`� �D that I am authorized to act for the (Name of Corporation) having offices at _ _ _ ST. CHARLES REALTY CORP-_ _ _ _ _ _ _ _ _ DIM 'BLDG. KE THOR!NWOOD, N. Y., whose officers are President (Name & Home Address) # Vice -Pres. —3 e—nv L — — — — - — — — — — — — — (Name & Home Address) Secy. — — — — — — — — — — — (Name..& .Home Addre._ss.) Treas. — — — — — — — — — — — — — — — (Name & Home Address) by Resolution adopted _ _ _19 and that I am and will b individually responsible for any or all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto, Si CHARLES REALTY CORP. DUKE BLDG. Sworn to before me this day Signed T 90D, N. of 19 Title _ _ _ _ _ Notary Public Form S.D. 28 September 30, 1969 R �jfj I H �= �- .r� ►1 ►� r . I �� � it rv��.:�,:::ry �. ro fi � Co 32 ti °� ro ti 5'L- RA / /HOUSE I VD t EAID OW E21 fJGE R _._llL :.. _ .fl_. SYST F16- .N L.F ,ENl7 oEpr. of HEALY4 TREA�tC h� 'TH I` ` ITE I�I,nN �:tcSER �1PG'N � i c,,sffpT Ion THE _: �1ryNER-:._, A _�rIrLT__I.iMENlIlltfSGVTiC'e1G ,yCIO . Fy IL ro� ,°ro syoti xti yti' w�' o A r Co 32 ti °� ro ti 5'L- RA / /HOUSE I VD t EAID OW E21 fJGE R _._llL :.. _ .fl_. SYST F16- .N L.F ,ENl7 oEpr. of HEALY4 TREA�tC h� 'TH I` ` ITE I�I,nN �:tcSER �1PG'N � i c,,sffpT Ion THE _: �1ryNER-:._, A _�rIrLT__I.iMENlIlltfSGVTiC'e1G . - PUTilic4iM GOUNTY 'PART E, T CAP HEALTH DTVISTON. OF ENVIRONMENTAL lr,-AT TJi 'SERVICRS ®€ter oFFxcE Hulx,�xrtc,_ . cAR�I. =� .nr.o �,o�_ PAT' ' SIMT- 39PA•RATE SEWAGB DISPOSAL, SXSTEN Fia ' n0a � Adrec� 0 =0 l C .^ �c vd at . (Stageet S �( L k Bee's B100,�,�;��, : jj 4 c rost crone Watershed 4 .: SOIL . COI.ATION TEST TA MIRED TO BE SUBMITTED WITH Role ® CLOG TIME PERCOIIATION _ LA I apps �P o ,va er ►om Grou nd Surfue' in Inches 89:2 te op I''IA Start atop Drop in,,.; f . Inches InchQ9 IncheW.I. , i 4i ze 4 .7 r •x ♦.jai•.=. F ,`• ` k.. : - *.• f, � • • i � �. ... ,'�J ,yam' . Vat o . s 1 �. Ztast to ➢� prated at eanr de h' a�a3tA�. a ro1� s t I a a , r� s are obtalnec,9 t each ,pgrc l�tio o er Una �® 9� {�� �i,�44BB � Q $� � �a �4i�. w. �1�►• �'' Mpth to be, =do ; frm toXi . pf hol ®a DEPTH G. L. '611 -12'f 1x11 1 24" 3011 36" 4211 1p T,: TEST I.XF1.11 APFJ,'J.(',A'.1'10N "T 1 OLES HOLE, NO.L',P " fi HOLE NO Ja.A� t:L 4811 L VA - -- 54 60" 01F 6611 ms 7211 412 78 $411 INDICATE LEVEL AT UMClf GROUFD WATER IS ENCOU•ITIEM INDICATE LEVEL TO WHICH WATER LEVEL RISES AF'T'ER `�TITG ENCOUNTERE TESTS 14ADE BY _15 Date -So2-1 --Ra-U'e Used., Affh/l TlDr`oj) S-.-D.--UsLib-le Area Provided CCO No. of Bedrooms �0�.Septic Tank Capacit Cal l� Absorption-Area Provided By3o- L.V.x24" D P ure 12 Address SEAL IDS(. u '0. 125 THIS SPACt" FOR USE BY 1]�AUJU ]DEPARTMENT ONLY: Soil R1, a t A`pproypa Sq. Dt/cal. Checked by Date Ll y`- COUNTY 'OF wESTCHESTER'DEPARTNIENT -OF HEALTH -D v%siari�of ` nnirorimerital Sa i3tatiori' �- DESIGN DATA SHEET e SEPARATE SEWAGE SYSTEM FILE NO, Awer;5Z` -CA aLES &L-T" !' Address D L E B 1, Located At (Street) ME P+� Sec. Bl®ck .. Lat Indicate nearest cross. street). Municipality- Z �'fVTT SON Watershed C, SOIL PERCOLATION TEST.DAU REWIRED TO BE,SUBMITTED WITH APPLICATION Hole r "t- t i t 1 Numbert. CLOCK- TIME _ ' PERCOLATION 'PERCOLATION 'Run' 1 2 t 'Elapse 'Depth to Water Water Level' 'No.'. t ' Time !From Ground Surface in Inches 'Soil Rate t t Start Stop t Min. tStart Stop Drop -in rMin /in.drop 1 ' t ' 'Inches Inches ' I t t 1 _____Inches t t t t 1 1 1 t t t t l I t 1.. 1.. t r r 2 t t r 5 t t t t It r t t 1 t 1 1 t I t t T t t 1 r 4 t t t `f'--- r r 1 ._, t 1 1 1 1 t 5 t t t t t t e t t - -- t a t "t- t i t . 1 2 t t t t t t I t 1 t t t t 1 1 1 t t t t t t t t t t 1 1 t t t. .. ... . _ 1 1 t t t t t t t r 5 t t t t t t- t 1 1 t t t t t t t t t 2 1 1 t t t t I t r 4 t e t t - -- t a t t t t t t t t r A r t t t t t t -- t5t t t t t t r t t Notes: r _. 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 ef' hole:` r .x •. , TEST PIT`DATA REQUIRED TO BE SUBMITTED WITH APPLICATION - DESCRIPTION OF _S.OILS ENCOUNTERED IN TEST -ROLES . DEPTH HOLE NO. HOLENO. HOLE.NO, HOLE NO. G.L. f 6" - _ 12" V 30" 36" . d 42" 48" 60!' 661 72! 781 INDICATE,LEVEL.AT WHICH.GROUND WATER JS ENCOUNTERED, INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEII TESTS, MADE BY b (f3 E&a A,-§GqG� DATE OUNTERED 7,0 �1 DESIGN Soil. Rate Used U ' Min /1" Drops S.D. Usable Area Provided ? °?t::t No. of Bedrooms Septic Tank Z-F`- acity 1it7U Gals Absorption Area Provided By .x24" 36'.� ri they_ Name] r �� — t''I�'l Signa Address6' 4LC L� e� j SEAL sF� pROfESStONP�c, Westchester.County Health Department . Soil Rate Approved Sq. Ft, /Galo- S,D. 27.6 (Rev. 5- 24 -66) °' Checked 3 by Dat+�•. , a