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HomeMy WebLinkAbout2152DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 30.-2-45 BOX 19 fro Lim 1 I I' IN ' I f T r . �, IN I '. 02152 Y'•"',r e i ,." {, b� .F ..,z.,�. .'F'C.�..... T�..a .. 1 'o. .?i^ >- af`�.- ..+�, -ti: ,o x n t ' [ "<< PUTNAM COUNTY DEPARTMENT =OF: HEALTH Divisron of:Env�ronmenfe/ Health, Services, Caine% N. Y. 10512' CERTIFICATE. :OF_,CONSTRUCT.ION COMPLIANCE 6w,'S' EWAGE .DISPOSAL = _SYSTEM i vv ?f, 7�/!, Town or %V lllage 1 . Located •ate 1 �^'�'i✓ Tax Map .:::.+ Block • / r owner �'l. a"''7 �s m'! fig /f .0 L� / I'V ,`. `. Tae reap. tot IE . , =�r. Subd. i. Separate' Sewerage System; built by �% /� Address o'& —' j l � Consisting, of '� pal. SePtic Tank /an-d � Other. requirements r , Water Supply Public Supply From ;Private supply Drilled, By _ Fqlddras Building -Type d%[� ���i� tZ: No. of Bedrooms Date Permit "Issued i.t? Z Has Erosion Control Been.;Compieted7 I:certif that the s steals) as lieted,aervin the above a °pgnunr�e y; y g premises :were constructe3 essentiall plena of the completed work ( copiee of which are attached) ,.and in accordance with the standards rules and regulations in ac e��31ti e at�.0 plan •and the,permit`iseued by the Putnam 'County -.Department'-Of Health ` oQ O e o" .o:• u o • (Al �p ' pNCi Date /�' �'�' _�/ - i'. e��(: Certified by P,l RA: Address �``V n a° m r o °, Licenss No '• �' G� Any person occupying premise; served by •the above ysfem(s) shalt promptly take such actiorpe y l>A netet tool se the correction of any unsenttary . conditions resulting from . such usage, 'Approval of the separate'seweragesystem'shall becol�q°aiFRRlI,�� sosd'a a'Public sanitary s/wei beCOmes ,available and the appioval of the private water supply shill become null and :'. d when a pubf� ..otdreaYPPNP Sties, available. Such approvals ere ` ,subject to- modification o.r. change when, 9n the" judgment of the�Comml oner f: Health, s6c VbiFgt�� cation or. change Is necessary. anebw,er , Date BY Title r f v 1- YORKTOWN MEDICAL LABORATORY INC. • P.O. Box. 99,* 32-1 'Keay Street LOCATIONS: T EIGHTS, N.Y. 10598 245 ❑ 321 KEAR $ YORKTOIN H. -3203 . Yorktqwn ht$,. Y 10598 �011 BUTTONWOOD AVE., PIEEKSK' I LL, N.Y_1 0566 737.8777 245--3203. .0 495 MAIN ST:, MT. KISCO, N.Y. 101549 666-3335 ❑ STONELEIGH AVE. (NEAR HOSPITAL), CARMEL, N. Y. 10512 278-9330 DATE. COLLECTED -RESULTS OF EXAMINATION. OF WATER 0 OWNER DATE RECEIVED lei di. 40, CITY, VILLAGE,•TOWN VOR NAME OF SUPPLY DATE REPORTE,Q'. Lou SAMPLING POINT BACTERIA PER ML. (Agar plat 'count at 35. C) COLIFORM'GliOUP,'(Mo'st.plobableNo./lOOmi.) HARDNESS,-, TOTAL - ppm DETERGENTS mg /L' NITRATES (as Dj) - 'mg/L IRON, TOTAL;- ng/L AMMONIA, FREE (as N)-mg/L pH= CHO,,RIDES - (mg/L) These results indicate that the water was„ of a, satisfactory sanitary quality when the sample was collected. A., H. PADOVANI, M. T. (ASCP) VjW I �!I &TION. fgEPQE3jT 3/74 KIT NAM NI !FQW4TV PPAIRTW lT 8f. "944«I Division of RovirQnmental Health Pervis" COUNTY OFFIGF B4I1,.01NO - CA1RM§k, P4 YORK This oapprt Ig tq 4 pgrnpletad by wal{ driller and sybmitte� to CQUnty HfjaIth pepartment t9gether with Ii1bfQWn/ tpppTt fag q11a111si§ 9f 4yqtht :lifrrtpip indicating water is of satisfactory bacterial quality before certificate of construction gain Iion¢o ja jgw ", REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION t74Afd� � I LOCATIOU ( rrgPt) a Il�ef +YenOw 9PWITIC !p�lf�PCIBQID EATApItS"M4Nj L_J FEAR I...J 194T 1NI A drsrl �� -�' ('" 1 PUDIC f('�""''ij INDUSTRIAL AIR Q CONDITIQNINQ OT"act Q t.,.l ,SUPPILY L) (f(pacifr) DQILLItdYd COMPRESSED Q AIR PERCUSSION Q CARLE OTHER C41PLf1 SIaTAwDv PERCUSSION L J (SPocify) CASING. 044TH (toot) DIAMETER(Inches) ` WEIG"T PER fQ T LA? TIJR9ADOP Q ►4091) ; n No V44 Elm ®OTAILS a I �� m YIEILQ. ''-� Q MQURs Q ff G.P.A. v1ILp ((l.P'#q Tp" RAID PyMPE41 COMPRESSED AIR �► O �1AT� .9,0�tlttt L=RAM 1ANp SURFACE- STATIC(Sppcll taRU r DURIN4 YIELD TEbT tapU l Depth Completed Wall , BLS in Not hglgw Lond turfacq, /60 M.A46 1.1"W 1 WIN TO YIPRR (140th wtiT,AI�A tidi SI p1AMETFR (Inohea) IF GRAYFL Digmator of wall includino G(tA t E (InQA(Tfl1 (IgM11 foot (fpsip' -""""" PACIMP, grovel pock (Inchoa): PIP* PROM LAMP S{URPAC6 FQRMATION DESCRIPTiQir sketch exact loo9tlon of woll pr(tQ d /atoRR9A,.10 of �pql., ,too pormangnt landmarks. PEST to Feel If yield woo tooted at dif grout cl;ih. during drilling, list bslovj Faff GALLONS PER MINUTE ` 4 P� WIbL O /M44E R �i � 69T .. 9 OF FIFF.AFIT 16YZ%�f 11 z1fly Je /V div, 4, Njter or Purchaser of Building A/ Building Constructed by Location - St et BuildiriJgddType l Municipality .50, 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 �3 day of 19;'x/ Signature -'241 _ '' a r-91 G 1-10 Title c� If corporation, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE 'OY'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 F] ",- 1> b. L ,A;V,4 ,✓ / jf� PLC i i AG z APPROVEL.1 - 3 29'32 DE -S, X? :47. , L6 7 7S P 47 :7.3 cxmw, 5 -f t-c rr" C 0 Irl n I -s o f 200 r lot L-352- ViL 5 AS CONSTRUCTED SEPARATE SEWAGE DISPOSAL SYSTEM k -/Z TOWN OF DATE /I/ /�'>twl,,);��,r?-)COUNTY, NEW YORK ?IY,V I SCALE /, -5 -VvJJOB NO. 79 - Y4 ,3-06 E P 0 SULLIVAN - P E- CONSULTING ENGINEERS �b ' PUTNAM CUUNTY DEPARTMENT QF HEALTH ` Division of Environmental.Healih Seivkes, Car.'mel N.° Y 10512 i CONSTRUCTION PERMIT -,FOR ..SEWAGE DISPOSAL SYSTEM - i.�J 71 a fi w :: Town or Villa. e + { ..n Locatetl at Tax Map 4 Block Subdivision Lot: „r ?' Job Owner oe4 Ad ress v y /p p -Building Ty Lot Area Number•bf Bedrooms ..Design Flow w Total :Habitable Space;_ v- Square Feet She arate:'Sewarage;.System ;to consist of �d © .Gal Septic .Tank andY �' J �' :,.' . .. ,e To: be 'constructed by � n'' Address Y Water SupPly:, Public Supply From r zo Piivate -Supply to, be drilled" by IV fr j.• Addres ; OfhernRequirements, J" a' �'�s'`t i- zri e e'F : -�� r $ `-�,Mx n 4 z- a w a 4+ 1 ,� f r G r .� ,� -,�,. .,i a"d �.,3i. a,S r ^1 "t u� aAil �,lyl N+ � ♦ f B.�l i\ ' ro.:.; �.tq n'°i+ -'t z�.L�i ...,y �, Y.L: e- r•.,er..�. '' '�'� -Y+n= •T?S'' h'_.. a c..-- Y--- "n-��' r.. � � '��a +, -a��, s l ..+. _ � I represent. that -1 am wholly:antl completely:responsiblefor • thetlesignand location -of the proposed s"stem(s). 1) that�the, separate sewage disposal system Y above described will be co'strucfed,as shown on the, approved amendment there.fo and in accordance with.the'sta A a ons:o e u nam County: Department of•- Health-,; and that on completion thereof a ".Cert�f�cate,.of,Construction Compliance sa �•• ��tpp'�Q QQ��Tn�� ssioner of Healthwlll b'e:'subrnitted 'to the Department,' and .a .written guarantee will ,be :furnished the owner hissuccessors, heirs oraBaS�glis i1jA,t bfttlbF; that saitl builder will place in good coperating condition any part. of said -sewag.q isposal.syiieiin during the,periotl of•two:(2) years immediately,!oIldwing thetlate of the issu 'ance of the approval ofAhe :Certificate- of Construction Compliance of the original - ,system or'any; repairs thereto 2), that the drilled:weli` described above I. will be located as shown on.ihe approved plan and that said well will be installed in acco rdance with ahe s Bards, rules and .regulaa ons -79f the eRutnam County Department of F�ealth ( ?: Date P.E. �'R A r Address - License No. �l C/� �/ �� APPROVED FOR CONSTRUCTIQN': This-approval; expires one year1from the_ date issued unless :c^ stroction'of building has been undertaken and is revocable for 'cause or,may be amended or modified when considered;necessary_.by +the. 'Co mmissioner of. Health.-. Any ctiange•or: alteration of construction requires a new permit 'Approved for ..disposal of domestic Bar 'sew d or Iva water supply only bate BY Title - lu F19 cbo J��- 0 7 7 r V-- ) aG --S CEO -,E, I PUTNAM COUNTY DEPT. Or HEALTH -71 71! PIZ P A/ sco /c 15 <�;m APPROVtO. SEP agm Ilium -Z,,,; A * / - Aav -4 7? v, �el 3c F19 cbo J��- 0 7 7 r V-- ) aG --S CEO -,E, I PUTNAM COUNTY DEPT. Or HEALTH -71 71! PIZ P A/ sco /c 15 <�;m APPROVtO. SEP agm Ilium -Z,,,; A * / - Aav -4 7? ATE SEW_ AGE DISPOSAL SYSTEM f-", C4 r7 1AV1 e oq 01'e. kV j Lo '14 r_ <1 11 TOWN,'OF Du COUNTY, NEW YORK DATE :7-'P= ,*00 * JOB No. SCALE,#.j �j�4jv LL IVAN -4t;t� CONSULTING ENGINEERS New York v, �el 3c 43 ATE SEW_ AGE DISPOSAL SYSTEM f-", C4 r7 1AV1 e oq 01'e. kV j Lo '14 r_ <1 11 TOWN,'OF Du COUNTY, NEW YORK DATE :7-'P= ,*00 * JOB No. SCALE,#.j �j�4jv LL IVAN -4t;t� CONSULTING ENGINEERS New York r PUTNAM COUNTY , :. . Division of Environmental CONSTRUCTION PERMIT FOR. SEWAGE.OAPOSAL. SYSI �' 'Located ;at �� � t =1n fA6� r •,,�" t.° � Subdlvision Owner �'G r rNA A Building Type , `—` • 'Lot Area. Number of Bedrooms Design Fiow Separate Sewerage: System, to consist of Ga To be co_ nstructed by t i Water Supply ';Public Supply From .Private Supply to be _drilled by _ Address . tither Requirements (''represent that) am wholly and completely responsible for,the desigr ai 4. above described will be c61nstrueted as shown on thee;app`roved amendhi n County,_ Department of = Health -; and that on completion thereof a Cer $e submitted to the Department; and a written'- guarantee •will be ifui ,place in'good operating,cohdition any:,part_of;,sajd sewage disposal a,n`ce of the approval cf ,the Certificate of Construction Compliance will be located as'shown on the approved, plan and that said well will "be it County Dapartm' t of Healt b. , . Date Signed Address :.. APPRDVED FOR CONSTRUCTION This approval expires one year fr revocable for cause or may ,'be amended or modified when consider s ` e requi `a . new //p►►e��rmit p'Ap ®proved' fgry,disposal, of, domestic s?ilka4ts Date APARTMENT ,OF HEALkTH'' , IlAlh Services, Carmel, N. Y 10512 i Town ror illage sTax .`Map } Block Lot' s, AFL. Z Job Address 777 -7 Total Habitable Space �! Square Feet ; Peptic Tank and Address , } r a ocatton of!ahe proposed system(s),'1) that rthe separate •sewage,disposal'system iere'to'and'in accordance with the'staniiards.r}ules andir egu a ions,.o a :• u nam, } ,9t of Construction Compliance ;satisfactory 04190iisioner•:of.Health.will had theowner, his successors helisdr assign; tll 'bul(qar Uit"said bu ild e w 111 t :em duringahe period of,two (2) years iirt(S IyacUlgWin�� date of ftie issu j the.origtnal system::oi ?any repairs there2f +bb's itfti. gascribed, above 1 Iled in accordance with; the• standards, iuI / regua er -of w, he 'Putnam it ti V the date dssued unless struction ot;' u n h cye. Mt' rtaken' and is ��. ary by Erie Commissio of'Heal th. y?,cilaQe ara of •construct tom fge v +° • P '•• • Title (' ..0".. • PUTNA`S C.rt'::T1' ffI Ar-Tif DTVTSTn� OF —r.. �NTAI, iIF:�LT11 SFRVECrS Re: Property of Located at / ,+ n cp Z= Section Block Lot Gentlemen: This letter is to authorize a"duly licensed professional engineer or, registered architect CD (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 pro.mulagated 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 system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary:Code. Very truly yours, Signed Owner o • Property C fitter ign .''`dye °�; s . F mss. Ad ress P.�l 7i 4 'AHi }C j ll y Z r Telephone Address 4 p se e Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL; N. Y. 10512 DESIGN DATA SHEET-SEPARATE DISPOSAL SYSTEM FILE NO. Owner .gym iSEWAGE M enjpilv�; Tddress e - r) ce 2 q Y� Located at (Street P4XC ; 4, Sec_. Block 1 Lot . indicate nross street) Municipality PO;' 12 rs1_��1 �. Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE.SUBMITTED WITH APPLICATIONS Role Number CLOCK TIME PERCOLATION. PERCOLATION Run apse p o a er a er LFvel No.' Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop . Drop in Min. /in drop Inches Inches Inches 11.3 Z1 1 2 q:I 9 ► d 2, 2A . . 3 Notes: 1) Tuts 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. <j I E TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATI6N DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. THOLE NO.. 2- HOLE N0. —il G.L. ✓ c� � 6" 12" t 18" 24" . 30" 36" 42 ", 48" 60" 66" . a 72" 78" 84" INDICATE LEVEL AT WHICH GROUND WATER IS ,:ENCOUNTERED ,INDICATE LEVEL TO WHICH WATER LEVEL RISE5 AFTER BEING ENCOUNTERED m TESTS MADE BY CfS p �/� a�D Date REL l ll Soil Rate Used O - S'Min/1 "Drop: S.D. Usable Area Provided a l No. of Bedrooms - Septic Tank Capacity / 7 Gals. Type ,- Absorption Area Pro ded By ",0 L. F. x24 b widtq,.tr•.enc .. Name ign ;T Mm f GAS ty b .o Address � e ESL ; X06P7 7V c ° lip CIO THIS SPA CIE FOR USE BY HEALTH DEPART P T ONLY: �'qqA Agroi �esuovno °,•• ." nnaaY ,. Soil Rate Approved Sq. Ft /Gal. Checked by Bate I - r ♦� /^I Z QIJ, 5f O ri f ' r u r U/e O � r 3 ,40 O r t' �r �4 ?c_ L r ao ,G \ 100 . Y, . -JA