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HomeMy WebLinkAbout2173DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 30.18 -1 -12 BOX 19 02173 16 L 6 IrJ 02173 PUTNAM_ :COUNTY DEPARTMENT OF:,HEALTH division :of Environmental Health Services, GarmelF N Y .10512 Putnam. Valley (T) •.,.G�� - is C 'CONST:RUCT;I(:i1(' f. ©!'Jia'L IAF3CE ,FDFi SEA °JAf�E-DISPf �AL,,SYSTCl41 -Town or village' hake: Shore Road Map- 655 — Located at Section Block John Hasper - -— Owner Lot ,F Job •" Separate Sewerage System built bye J; ohn Hasper Address hke e V all 1200 L 'Consist�ng° of Gal Septd'c_ Tank : lineal Feet : X k? P� t� • '' idth trench 4. �, x _ 4; � Do ' 0n1 Other requirements AlestC ,.USB, y ' 'Water,. SuPPIy:. Public. Supply' From s '' • ' �4 iCl Ia1 a - - X Private supply Droned ey Ptiekey D�31i_ers;- out Brook Road Eeekskll NY PUTNA Address -ri i. Ras eta 'Ranch. 4 Building Type tNb of BedroonlSG bate, �Mi1H�4glild $ Has Erosion: Control ,Been Completetl�," ieS �� `�•�. EIYS d • S. Rpy • f - I certify that the systems) as ,listed serving the above premises were constructed essentially °as "shown n the `` h Is �NIi�1copies of whi '• are "attached) and••in accordance °with the standards, =rules and regulafions plans filed;and the permit issued ttte ou �artment• of Health. s.� - r •�- ' .� ' "February 10 1879 /f : •, ° , x- Date fled by 1 R.A. erU E E.: 1, I�Torthridge Road kskill •10 . : 02.846 Address � ,' - - en9e �o Any,`person. occupying premises:.served by the above systems) shall promptly take such action as may be'nect o•�ction of any unsanitary ik- "cond�t:ions .resultingj{from such usage•' 'Approval of the: separat`ei'sewerage system. hal1,' come n 11 and `vo "" d• 3 t is sanitary sewer becomes available. and the approval of the private water supply ,,shall become null voidr•when ` -a; public supply -be %@So ailable. Such approvals 'are. subject ,to, modification or hange when; in the judgment of .the Com )ss� n 'of Health, suc rev cation, modification' or change is necessary. 7 e y ti kV� -1+�•- -a, - ,Dat - - Title _ B : - �'. � ..:-J :• c �. ,....:..`s. ... ,._:: .n:. -,. r. r� `. .. _...... • -. ........ S.. .. . rw,.. ,c .. • -. � J }. i;._ __ _.l _,. ..4 ..:.. G_. f+. �. 'r. .. ..RESUI.,TS'OF EXAM INATIOk O'F WATER � DATE OLLECTED OWN ER DATE TC3CJ -�,� • RECEIVED. CITY, VILLAGE; O /OR N QF AUPPLY DATE REPORTED , SAMPLI G POINT' BACTERLlt PEQ( ML Apra plate count at 95 C). CO:IF'ORM CROUP (Moat a 4 •.. . P liable No lQQncih) -Ppm DETERGENTS.- poiiri NITRATES (as N) - pp cn 1R0 ,�d�:.������ Ilk - r ..- 1 2 1971 PUTNAM. COUNTY 'These reAUlts kndicato that.. the. wilier was of d satisfactbuy sanitary quality when the ".sample was coI"V T. ,OF HEALTH ' A. H. PADOVANI, M. T. (A CP) pp 9 el _ "PUTNAM COUNTY DEPART114ENT ,OF IiEALTH y Div.'ision of Enw�onmen`fal Health Services, Carmel /V Y 10512 ;gym vial P4ERMI �F;OR ,SEWAGE .DISPOSAL SYSTEM Y or' village L`- ocated at ' ®fie ���f- t�� Sectionr"'�J 8 Block _. Subdivision of del . -.a <, ice" ,, �. - .:� ...'- ,�- � � �..• s� ,,�. � - �© -�" Owner a�0�14'.'J•'�8�8P a Address Q!, 63rd Street fi building ,Type �; _ Lot Area-®kl��:,. I.Y._ 11234 Number of Bedrooms - Total Habitable Space Square Feet f �.2E Fx`t 3610 Separate-;Sewerage System to consist of n .,Gal SepUc..Tank lineal feet -.'X width trench _ _ 0 s _ y` FtuE1� dal ®>�tiai # 20 rTl o(43 To be .constructed b - Address 4� Water supply:Public SuPPIY From y Prrvate Supply 'A.6 'be drilled by< Lek ® ®11 i?�i11effi t;,p�. ®ut Hrk Rd PeeId1T,, I�•Y. Address . Other Requj ments d ffifB lfSeB ®fil104� _1e11::W p4'o*04 X11 6];i to � i ced i� 3i 17:�ti ®„ 416M.66" short .d big. `T ®ciw miVjz mm ®f +Dj_ it0 rd. L represent that I am wholly and ;completely respohsible for the design ar above described vr.ill be 166hstrueted as's"liown on the.approved�amendmen County gepartment of Health, and that on completion thereof a Cer1 tie submitted to the Department and a, written guarantee. will be fur place m <good iiperatmg, conditio "n" any `,part 'it said sewage disposal ' ante of the approval of the Certificate of Constructi6nmpIiance will be located as:shocwn o "n the approved plan and that said well will 6-1 , in County Department of £Health di, Date �� 17x5 S�gneq. - yHddress APPROVED FOR. CONST,RUCTION 'This,approval expires -cone yearfr ` d erevocable -,for cause or:may be amended or`modifiedwhen co -ni •'requires new ;permit' Approved for, ;disposal. of;domesYlc Sa harks Date Off'BYr - icaUon of'the proposed systems) ul),'A '' h � eaewage disposal. system ere toiand m accordance with•the st` aeons o„ "t e- putn am' ate of Construction Compliance' ®_' i Nissioner of'Healthwill ed the-�oviner his successors 'heirs s, r.thaf said builder will :m duruig the period of tw.o:(�'yq r gethedate of the issu- tie origirial systerri or eny re'pjr eto; a dr _ ll.desc►ibed above led m accordance• with the sda s, r ul s® .of the Putnam' .. i_ ® c o O &Pi g R.A. � p se V the, date „issued unless construction® e• I r. been.undertaken anu.•is ®11 0f � }11181► _,> Ir`y by tFje Commsswner'bf Hea'Ith a11y��Ihi�gE�ir:.alteratiomof construction . g nd /o iv to water supply only. e� 1 WELL ��'IYfPL'ETION'R' PORT <:� ..,.- <t.. �.:. ,r..:.w.___ ;,: PUTNAMG COUNTY, -DEPARTMENT DF' -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 . r DATE WELL CUMFURIJ DATE OF REPORT ,I WELL ORILLER (Signature) . ;i ! '' • ! 1 l i i � l JI t t��l � }. j ! J f1 t NAME ADDRESS OWNER .�.•, .. ..,' !� 1� fi f' � '� ` ...1� � !! �! � L:' i (No. 6 Street) (Town) (Lot Number) LOCATION OF WELL � •� f .... ( y� ', ^, � t ...j'A..1 ;.. _!_LL•J, !'Ili �, t z• ,r1 (' i iUC• %'' i% .R_ /U BUSINESS ❑ � ❑• 0 PROPOSED L�j DOMESTIC E TABLI_ S-H,M.EN. T TEST WELL USE OF WELL I ❑ PUBLIC AIR ❑ ❑ CONDITIONING OTHER ❑ (Specify) SUPPLY INDUSTRIAL DItiLLING j`� COMPRESSED � a CABLE OTHER ECUIPhAENT ROTARY L_J AIR PERCUSSION PERCUSSION (Specify) CASING DETAILS LENGTH (feel) DIAMETER(Inchas) WEIGHT PER FOOTS , THREADED ❑WELDED .,DRIVE SHOE © YES ❑NO S C�ASIN YES 0 NO 1IL'LD E] ❑ ® COMPRESSED AIR HOURS G.P.A. �i YIELD (G.P.M.) TEST BAILED PUMPED VIA MEASURE MEASURE FROM LAND SURFACE — STATIC(Speclly leaf) DURING YIELD TEST fleet) Depth of Completed Well LEVEL y1 i I in feet below land surface: MAKE LENGTH OPEN TO AQUIFER (leaf) SC�cEN DETAILS N SLOT SIZE t. DIAMETER (Inchest �� _ IF GRAVEL Diameter of well including PACKED: gravel pack GRAVEL SIZE (Inches) FROM (feet) TO (leaf) DEPTH FRG.M LAND SURFACE] FORMATION DESCRIPTION Sketch exact location of Well with distances, f0 of least two permanent landmarks. — FEET to FEET '— t Ll ' .l �'� �•� '~J (.- APR 3, 179 -- — PUTNA , CUUiv "i Y pEP_T OF, HEALTJ: r; If yield was tested at different depths during drilling, list below — FEET GALLONS PER MINUTE •t r DATE WELL CUMFURIJ DATE OF REPORT ,I WELL ORILLER (Signature) . ;i ! '' • ! 1 l i i � l JI t t��l � }. j ! J f1 t ki 'k C Owner or Purchaser of Building Munici allty Gi.v .�'/� /1rY /•mot• �Zo <y Building Constructed by Section ,1A /� �k,9r.' .� v �,.. .� . / 1/C y /J. Location - Stre t Block 4. 0ei6,00 ra -� o Building Type Lot GUARANTY OF SEPARATE SEWAGE SYSTENF*W� I represent that I am wholly and completely resporisi tile. ChbjNTthe location, workmanship, material, construction and drair_age 6EEf '"E e 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 Environmential 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�f Signature A 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 y 14 Iq <._i� I Prop:_­rty linct., or corners found ­ . . . . . . . Can estimat-, hoi.,,-,;r_-, location Vill. drivoi.,,ay need cut Mlu­,t trees be remove=d -note the: e t .[s deep liolc rep-esentative of entire. SDS area 1,6dil ional dacy). 1-ioles needod Sufficient SDS area availabl� .'considc*.�rii . driveway cut-, house location, separation distances etc. DER 110IT, P-ArILIA Mpth: I-later el-Mration: Rlock elevation:. Soils descri Teti on: FINAL SITE PISPECTION InsD. bv - House located where shown on approved plan.. f �. SDS located"where approved V Slop -- •of tile, lir_6 and trench Zlcceptabie'. oom allowed for expansion trenches J. i-latercourse Over 50 r't - from swaiiii) V tural soil not stripped or SDS area lmecessariiy graded 10 _.T�t ''L 0 naint8.i`-��d' ',m­pr_6p­Iine nand 20 ft. from LIOUse . . . . . . . Separation of trench from house., well etc. follow'-s plan.. Number of bedroct-is checks Stcnes, brush., stunps, nibble, 'etc. greater than 15 ft. from .near.-st trench 15 FL. of peripheral soil horizontally from• . .trench 0 06040"0-600* 0 1 junction boxes properly set .*oUld surface run off from driveway.. roads, ground surface, etc. channel near LIDS area. . . - - - .4 0 0 4 0 '0 * )0.­s l6t drainage az)rcar 0.11'.. in area of SDS 'UMU GRADING OF SITE ACCEPTABLE I M j A_ 7 REVIEU CHECK SHIN DOMENTS' House plans O.K. Design data sheet Peres presoaked? DUn. 30' perc.test depth ConA. results for 3 runs D. Hole log O.K. Corporate Affidavit for other than individual Authorization for.eiigin'-eer Letter from Water Supply if applicable If variance requested-such noted on plans & apps.l. 'eets Std.1 Remarks es i No I DETAILS if charge is proposed, Existing contours shown if new contours) Slopes for driveway cuts, etc. shown Water service line location Footing..drain, etc. location, Top slope., bottom - slope of fill Percolation tests and deep test pit location I Septic tank size and conformance to std. 3 B.R. house minimum House' setback shown I t'-,P_`Lb1-,t o n D J.s -"t,F, PIM-1 . J'r3S tj I LIJ -U: ' E--U * 0LiU-W!'1"_"' Add Watt�v W' ILL11 50 Plan and profile SDS� All other wells and SDS closer 2001 shown or'reference -m.ade - - (metes and bounds-clearly shown, SEPARATION DISTANCES SPECIFIED ON PIA N' 101 to P. L. 201 to Foundation walls LOO' to Nearest well 50' to stream., march, lake, etc. 15' to Curtain drain 101 to water line (pi—t`s--20' T__ 15' to storm drain 101 to large trees 101 f, rom foundation to septic to 5 to pipe from leader drain & .expansion)i i' Y PUTNAM COUNTY DEPARTMENT OF HEALTH ,:....... ... ...... _..�:� _ -. _ . _ _.._, �DIVIS�ICIN..: OF�� ENVTR ©NI r�'- N�' A�- ;•,I,{R.Ai;I` }.¢,.,SE�Rt7ICE.S� - ,... . - >.,,: ,. -.x , -_ _ -...M .., .� ,,.:., I Date_ June 9, 1975 Re: Property of John J. Hasper .Located at Lake Shore Drive, Roaring Brook, Putnam- Valley Section Map 655 Block Lot A Gentlemen: This letter is to authorize John S. Romeo . a duly licensed professional engineer x or registered.architect (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 promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in L VJIIIL- : LiVll w.L Lfl ULLS ma L Lei• alai to. supervise the construction of said system or systems in conformity with the provisions of Article 145 or __..........._.147.,._ Edug4tion --� _L.ZW,,. - the ..P<abIiO'. HeaIth..Iaw,..and _the._ Putraai� :C�u at} ►: Scala...: .. . tary Code. Very truly yours, Signed Countersigned: ell-11-7- Aaaress P .E ., W.MM # 027$46 l Northridge Road °•' ° 000" ®• " Telephone Address Peekskill, N.Y. 10566 737 -1056 9 y 6 ° • ° Telephone ° °m9�F NE�� ,• • O• PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY•'OF' FILE -�=BUILBINU:;:::CAEMEL DESIGN DATA-SHEET= SEPARATE SEWAGE DISPOSAL SYSTEM' FILE N0.' Owner. .. -ohn, S. Hasp2r Address 2040 E 63rd.,street, Brooklyn, N.Y. 11234 Located at ( Street) Lake Shore Rd. See. Map 655Block - Lot A Indicate neares cross streeET Municipality. ?imam Valley (T) Watershed Feekskill SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run apse Depth to Water Water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches (1) 1 12 06 12 :38 2 21.0 . 24,0 3.0 o.67 2 12 :40 12:4 6 18.0 21.0 .3.0 2.00 3 4 5 - (2) 1' "1200 '12 :53 3 20.5 2305 3:0 1100 .3 �. 4 5 3 4 5 Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE N0. _. l HOLE -NO. -2 ,: 12" sandy. gravelly to rgra ®, r alk T8" : ' • souse 'lard® r��ks 2411 - 3011 3611 42" 48" 5411 60" 66" 7211 78" 84" loam HOLE NO. 3 sandy gravelly loam sandy gravelly loam s Mergraud rec F .. ed roc soma largo rocks INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED None INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY John S o Rome® Date_ .,aril 12 197 DESIGN ,w. Soil "Rate -iisec� M n%l r'brop: S : D. Usable Area 'Provided 5 00 .SF..$ No. of Bedrooms 3 desigx Tank Capacity 1200 Gals. Type MsoWy Absorption Area Pro ded By 200 L.F.x24" 3b" k width trench. Other Name n S. Romeo Signature_ Address 1 ftrtbridge Road SEAL ® ., N.Y. 10566 TNTR RPA(!R. RnR TTRR RV 'PRATM9 nPPARTPARNT nNTY! Soil q C; uti Mena, Tr? v6P7y h -7 7' 4 .� I1 ILI w r �, LQ 0 N a 5 17'— 30" W 6n -lo pp L Z 11A 1 74 a.�F MEMP Ulvinmx"TAL. "Me aw"elp SEPTIC SYSTEM FOR DESIGNED & SUPERVISED By A- BEDROOM HOUSE • SOILS RATE 44 r-�i A ' S -ROMANELLI-AMICO t. ROMEO t tz V GAL. TANK VAL L CONSULTING ENGINEERS TOWN OF Pur-Af"l Pu-r"A" Otl�) R... COUNT+'_ I NORTHRIDGE ROAD I L. F. 36" TRENCHES NEW YORK PEEKSKILL, N. Y. ORPGINAL=APart_ (3, i9 SCALE I" is FINAL (`7s N.Y. S. LIC. NO. 02, 6 I ii I . �• � __. .. ; f J t :`� t' 1 i .i i �� � '� 'a , - - , . , . . - - - " &, 7 � , .I. � - I 4 0 ;I I , � , :.9 , .1 , !j ; ,r, I , , , . � ;4 ; II ;I ;f I _7 ­lk� 1 �: � ­_ ­:_�; ��;L_�. � -4;" , " , ­- - � -7, r . 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