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HomeMy WebLinkAbout2395DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 42. -3 -14 BOX 21 r ti� IN I �m . 02395 y, AM ;COUNTY DEPARTMENT, OF. HEALTH_ PUTN h - Dn;�sron: of Environmental Heath Services, Carme %` N Y 10512, ,, :•y t (CERTIFICATE OF CONST:RUCTIOIV" ,COMPLIAiV�CE POR S,�IiWAiri= �[3�SPJSAi.�`r~SSTEM �'.. 5 �" Town or village y `,� �� 5 ° ;/ if //� .,:, / / �1`►Y :i. _ SBCtIO + B Ae n IOCk Located at /^ Job SSeparate Sewerage +System °(built by a I Address ; Consisting of O V f � r line al Feet X rnh Gal.. Septic Tank Otherl requirements Water :Supply Public SuPPIY `Fro } }} Private isupoly Drilled BY a OR �.r1 Addiess } `� uilding TYPe No of Bedrooms +pate Permit Jssued + {V r f a c. Has'Eiosion Control Been Completed ] V* WPI E{t•/ },(, cO ies of wh -Ich, are certify that the system(s),as listed serving theabove,premiseswere constructed essentially as showy o t �G�e cod T epatment.of',HealtV �l e P Y. tacked) and in accordance wit the standards rul"end regulatwns plans f +s and the per u ,q f 4. i`�'::gYG �!✓� %� �k Wnrar.�' E. fRA. r ,d :i '^ 'Address d� a r o < rea' on. of any ,un �`ri remises served b.y,the above. system(s)'shall promptly take such,aetion as may b , ce son occupyl..g�p Hilary sewer is resulting .from such 'usage App ►oval of, tFie separate sewerage system shall:become. null ari WBn S13� e royal of .the 'private water supply shall tie come null' and void when ,a public water lyp vai Sueh appr- and the aP.P.. ange is necessary; modification or changelwhen in the judgment of the Commis>LOn r of Health such revocatlo T,Itle t PUTNAM "COUNTY DEPARTMENT .OF� :HEALTH , al 1Haltsioa1 of Environment h servce , ;a 05112 ;: - ' ( `CONSTRUCT:ION PERMIT :'FORS SEWAGE�DISPOSAL SYSTEM T "TouJN .O.i= `., �j,-�� AM ALC.Ey i TAs7C /..t A.F' Town or V ll lage i .Located "at /PEE K Skl*LL2 "42 L :o W: i� oAp .gam 4� ` s Block 2 °Subdrvison.l t�i�T PART��t3`�VV�1�� '�TJAX �,J Job Owner L'E owl A " C° :co~1I °N IE �- : A ` Bu ilding,Type•• 5E'IELot Areq 5 �R 51 064- 'T"45 Q Number of `Bedrooms E%E� QO'1�� a ` NTrotal Habitable Spece ��5��• ±` Square Feet. Separate Sewerage System to consist of Z ©� Gal Septic Tank 23 6 al feet; X �J ��t'' - width ,trench Ilse 1 o be constructed by b M -An 6 2 €?. a Address` r -A► �- 8 A1�1y_ P [� S�"_� A.17 Water SuPPIY PubIlc:Supply From ctiOTfat� �1:) 1- ��i1��u0.1J, �i.�. v i rr y F- �Prrvate Supply tto� be .drilled b JY� 1�I�1 , r 8i L K �• x s a tik Address °Othar •ReaLi iraments '' �(c -_.` •• .' M F ?= ('represent that I:am wholly an'd''com above described,wIll tie constructed ai County Department :of Health, anc be subrnittecl to the Department; a place n, good 'operating co6difion1) :anc . e of the' approval' of - the Certifi Will be located as shown,on the eppro' County 'Department of Health ;Date C al Addre ely'responsible;f,or the design and,locati n.1of the.3pro' d system(s) 1) that, the. separate sewage ;disposal, system :.� )wn on the . approved amendment -tnere to -.an = = ccordance� with theistwidards;,rules an regulations o e' Putnam st,on completion thereof a' ':Certrflcate Compliance 'satisfactory to the Commissioner of Healthwill a "wntten, guarantee will be furors' nto, l s 'ssors heirs or assigns by tFie builder; that said builder will' ` rt "of `said sewn pa ge disposal sy •r i wo (2) years immediate "ly,following the date of the'issu- of-Construction,•Compliance K, l�l/ epairs` thereto, 2) chat the drilled well described above I plan and That said =well will.be i a I ce �ry -t standard rules an re9ula 1�`ons f the Putnam t:EDE P. e,1 PTO E BL"SlJ? C E R A j y; _ZgOZ r �ice nse.NO, , APPROVED FOR CONSTRUCTION ,This approval expires one- yearyf; n e) d .q ruction of the bwkling has been undertaken. and' is revocable for .cause or may be amen or modified when :considered -nec e; of,,Health Any change or alteration 'of.const tion. ' k.. , . ,. , _ ,..n_ requves.a new permit. Approved for disposal of domestic sani se e s pplq only. „ gate siv Titie p r i VODKTOWN MEDICAL LARORATORY.pNC, >: Q. 4oz' 99 1 Street ,KW Yorktow n He iho . N . 1059 245 -3203 RESULTS OF EXAMINATIOM OF WINTER`'` DATE COLLECTED'- OWNER : DATE RECEIVED _ LENA . C DYNE . __ /5'/ ' 3 i CITY-'VILLAGE, TOWN. & /OR NAMP- OF SUPPLY - "' `DATE- REPORTED PEEKS I Z ,H W.. RD P[TTN UAI;I<EY 4:. N.Y. SAMPLING :POINT :.::. WEI,Z -=::- ..T:AX 1!'LAI? ..'18- BLOCK := �� 2 - ..TAX,: 0T .''1 -: BACTI;RI`A'PER ML (Agoi plate 'count at 350"C). _COLIFORM. GROUP` (Iv1osV'probable. No.; /100ai1:) ARDNES, ., TOTAL ppm ov 7. SS.: T DETERGENTS ppm NITRATES (as'N) -PPM, IRON, TQTALr FLOURIDEAF) - mg;/I:%` .._ � r "These results indicate that the water was -y— of a satisfa'cfory, sanitary quality when the "sa a was colle ed. A H. P.ADOV ANI, M. T. (ASCP)< .i in ml) er CLCC �, TI`IE to,z` PEc ?,C'0[ -ATi0\ tg,. PEP,COL:ITIC\ ' Fug 3 Elapse De P. t{o t;a_er c,;G er Level. _ -.. Tir,:e Fro.:: Grour:4 cur_a•`e .i� Inc'-:es Soil Rate 'io a o Start tcp `iin . Star = Stop Drop in �Iin/in . e_ o� : Inch =_s Int`eS Ir.c: ^.:Rs -- I (. 2 Zo 3 co:,�8 'ta�S6 ►g 4 o4 Io: zz tg zi i �. G 2 2 to,z` lo,a tg,. z� Z4, 3 Z 3 'io a o to : se . 2 !VAN -�T HIEOE i CLARK PLACE • r. u. UUA 3UO MAHOPAC, NEW YORK: < MI Notes. ?) 1'eSts to be reb_ eated at sa depth un-_il aporo(,*- _:-eiv ecu-=l. so_l rates are ob- tained at ec -Chi oe;cola i01 -2St ii01=_. ill d?ta to be submit- ef 'or r2vIe:J. 21, i'ePth , ir.eaSC'.rc,;.2ntS •t0 be -made from .-C)0 of hole. I. I I 43.. 54° 60 SA)Z)T A$ $Litt INDIC. TE L? LL, AT T;�?IC r G2C�li \7 rlaT 1S F�:CGUIY ; i E.(Z � S! ` O J\ i � -D PI aFT _N EINDICaTF L i-J TO tvnICr ;:ATi LF� TL.�TS "ADF SY ,G Qv� � VA>a 'c►��E� Cow 50k , i*�� E ►�G'2SDate �a.-- 05 —'7i Soil '_'.sez D_o :): S. D. T's_��� PeE�A�T No. of i -c- t I Z -Gal S%: Typ= AA-it o Be _ oc -.s_� Sep I Tangy cap_ _�y / ,JAY ADsorp �i o t ci_ ea Provided. By z36 : Lr. F.x2 36" y/ G;1dth trench. Other: 4F Na e cz A� c15 ti\E oE�P :Sim attire tt Ni h' Address. SULLIVAN- TNIEDE . o� CLARK PLACE {9 O: Box 308 q k 4 6 28 5'3G t t PUTN NI C�i":`i'' ��..1'1 OF 'riF1 LT�i FO�'� b a�2 Q .2.3. Soil 'late .`?E?ro•.�ed Sq. Ft. /Gal. Chec'<e 9�FE381oNpti Date = ,0 ty Depart, Division of Environmental . ,.... m UEI.I: CCKP1IONr .. _.. 1.. . , This report is to be cckpleted by well driller and submitted to Health Department# together with laboratory report of ana.Vsis of water sample indicating water is of satisfactory bacterial quality, before certificate of construction compliance is issuedo Well construction to be in accordance with Bulletin Sb-62 "RULES & IOGUTATIOMS RELATING TO INDIVIDUAL'WATER SUPPLIES" LOCATIM: MUNICIPALITI 71tF r__ 11<1 1 _ L RO ct,ASEWION BLOCK. wal i. aim: L F -W b`F L � .�� � � �} /Y1 �-i/� ���'�� / Z,70,cj,,y 7 i ; i s c_' � ✓(G'S�' Name Street Address, City and Tom r" WELL DRILLER: ]j2 f F-N /3 / 4 k p4 So ..M.t 4)C>fi,67t& 0116 /,17 4912 cwt/ 61VA1 �4 rV S � Feet? ° Pq Street Address " City and Ta SLD TES? °. WATER : LEVEL ° .'.: SCBEM led. Yrc® land surYice Houreg3tati6s• /49 Feet Make: DOTAL DEPTH OF MML ..7 FM PJL Q lam_ � J ea Feet Imi th C D amet er _n. °Size e Depth Frey ° Give description of formations penetrated, such :as:-peat,, silt, sand, gravel,'' Ground Surface' ° clay' hardpan, shaleq sandstone, granite,:etc, Include'size of gravel (diamete: ° and sand. (fine, medium, coarse), color of miterial,'etructure "' Be., Loo packed, ° cemented, soft,,hard), For example: 0 ft.'to 27 ft. fine, packed,, yellow sand' 1 ft. to ]t34 . ft, srM -granite, 19 Ft,to N c 4� Ft.to _/� Ft. ° Ptoto ''.c, r V Lte Well Was Completed � � > �. /0 1 �Z Date of Report /%�% " w�%ZJ % l ,5� 1 Well Driller -Ft .to .� P r ° ... Ft, to r Ft•to Ft. + + VAto Ft 2.1 Lte Well Was Completed � � > �. /0 1 �Z Date of Report /%�% " w�%ZJ % l ,5� 1 Well Driller 60q _­, ;AD PUMP EQUIPMM DETAINS M I. Finished Well-.. Check .?i s;wlith 4—inch Gravity Drain to Grade Pit with 4,inch Gravity Drain to Basement t_�Pitlessl Adapter --Casing Ddn,, 12 inches above grade Others Describe Pump: Make Type 'Capacity Storage Tank: Type Z i=X%l Capacity L GaL(42 Gam., Min,' DIAGRAM SHWING LOCATICH OF WU ON PREKISFS Indicatelocation of house., well and sewage disposal system with distances,* Also indicate direction * of slopes., and direction with distanc6s to all wells and .sewage dispos4 systems within 250 feet, 41";i; V i,-40 nil- vlw "51FI t" 4. M E t_'L, 4 ur- k'f-Z �_Z -7- I certify .that the individual water supply indicated above tAw installed as r the rules and regulations of Bulletin SD.62 of the'Vestchester County Departwnt of Healtho Svorn to before me this _ day of 196 Notary Public Westchester County. P��� Mo,ne.Y O i2.�i.• -� Y •�� : F PUTNAM COUNTY DEPARTMENT OF HEALTH ~�� aJAlil i "i wit!';V DIVISION OF ENVIRONMENTAL' HEALTH SERVICES 1 � N10V r 20" "1 APPLICATION T CON$TRU91-A;!NME,R. E please print or type C @l it {7'q Well Location Street Address: Town/Village: Tax Map # 4*Vai Map �' c` Block Lot(s) t Well Owner: Name: Address: Phone #: Use of Well: Residential . J Public Supply Air /cond /heat pump _Irrigation 1- Primary - Business Farm Test/monitoring Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily usage gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drilling New Supply (new dwelling) ~Deepen Existing Well Detailed. Reason 6. [ A./ for Drilling Well Type Drilled Men Gravel Other Is well site subject to flooding? ..................:.................................... ............................... Yes No y Is well located in a realty subdivision ? ..........................:. ............... ............................... _ _ ✓ Yes No Name of subdivision Lot No. Water Well Contractor: ' PJL OL ,. Address: Is Public Water Supply available on site? ....................................... ............................... Yes No4,ee_ Name of Public Water Supply: TownNillage Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. < < $ f Date: Applicant Signature:' I Vey PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear.2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Departmer take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue f k1-1 Gz Permit ssuing Official: Date -of Expiration I/ / ;I&/ /o Title: i IX lo c In Permit is Non- Transferable ! White copy - HD file; Yellow copy - Building Inspector; Pink copy,- Owner; Orange copy - Well driller Form WP -97 Rev. 3/06 Sr .� of ",/1J " cOwner ori urc s Ia` tg u11 prig CQnStructE �`� Fv t < Gam: �lCctrrJ ocat�.o - Strut sick Ec� t ' Building G 3A �XTY CAF `S A,RA E , SEf IAt'xE 'SYaT�� ". ;. I represant thy' g am tsab ir.d_ cc m�'� at,�"l� rtspan.s1ale for tie �bca. 7on,. w0rl6�nsq ma-0;er'i4l , c��zstr,tct�'Q1� .aid �drA, lr_'agn .01 the sewa�e,. d.spc�s'aIyst.m'..s vi above de ti p�set:y, aid that at,.has bra: ` cons t uu'te as sb�omnz t can tie app» �# p •, nro`�rek an n mant thes'etr ; and irr ' � c c o rdain,6 e with the s naar` u e an c • rye :gula ;` fts .ci'f the',, Puu ar .,� ,. nd ,��, � �.> otrn�M ris succ' � ..County 3�..:p9.� ,,a. nt � �ealh�. a�> ✓reby �� ,.x1�y ta• the:> , Sorxs, h iz =s c }r a x ra tc glace load o e a. � a ont t� n any p t 6f a :d l M',u:"r C,011St,��2C C� :G + =a LX 'Z t1 �'` G b•1 � 2tU' ..�'qr ,a pC3"l'C3d ;_.of' tXk 2ilx'1?J. t'I .4w �i? Q'd7 it2: C� a t O 1 tom' Ql: lase €) tl-;e seWa&5 CLi p6sa s. rsstem, or any re ap m4cje buy ; �e ;.to sic n sys tem.. Map where the faIZure tfl' 08i't� rJr+r),� �'j v 5��c.`k+Sr�d 0',I �l2t # `i. L� "' �l$' aTsi3 t 1G1 C}i°1t�' 4U �. . paxrt ox, the building 1t, �?��,irr:W � sys ~°m: it tirr2es_ga0d.lt:rtrer agree t .a cent. as .conc?usivc, the d= ; `.:ter n rJr_ cf, the :?zx�ec to of �, ;.; `Di�r?.sz. v:�.raz tr ri. al health Ser� � ces of th:� Pat palm Q&Wxty D -fapa > _ z of th as to he hat or no:t she.. .. 4' ail ur of _I_. syTate 1 to awerate Wa s c a a� `� a �,Uhe' wil Sul on n g Igeht apt of 'the occ upalt .off' the dizilain� ails zir trle systam.. 4' `` Ida ed.. tYri s /�j day of Jam(. ? 9 �.� Szraure �y _ i z l e �� t;orpc��*s t:z.cn, G V wAm� and` ad ­e 1 8 T T T i}3 } r r 7 tj e= r 7" 1 i ItIJ k ., '. t �C ",. (y i O''IES ARE �J1:r�u, ji�ITH THREE l 3) COP1E5 OF F. NIAL. F�;��NS, B��'t3n� C47E_ ��.I.FI� 'A'I_E OF COTIF.,13t ON WTI L BE ;'!IS SUED ,x i rA�?A I �`OR 1 S i? :''Q Ra wD' TQ., FILE .:NOTICE OF .Dp" E O-P FI,RS`T USE ar SYSTEM.' . -�i vi. s• an. of Envi °pamenta �eait ;h:$ervicqp* putnam. Cloun'ty Depar tment .of ;health .PUT��Pti_ COLS;` `J .DE �="'�. 07 LT DI`IISIO`T 0 ' e'r =- -rte= -TP` TCES Da t e C) eT o g,F- cz 18 9 '7 i ;Re : Proper -y of I--.E �A c, -q ��'. PEEK L NoLk: -C� Located.at -pi,�;'`� °F Pu'T•N3 ki-A '.4At_Ley TAX MAP. TAX B? oci_. 2 Lot i S Gentlear.: This 1 e t i5 r _S. /o aut or 2A,10 «O*e Pl•E, a duly i l ce.: Z ~ :JJ_'� :�� �� _ ittr J or rez* J ez ed (Ira_ca. -, 'CO aJJ±. `I Co„ a VV ~J'n•.Ac o~ ?v~.T_.i _O_ se ca:-: JV _er..J S -+Ve L' ^V JJ iV JJ' L_VJJ�L JJw „d H,j It.-� 1 e or r'zial_ "Lons as V CO- SJ : -:' Dapay�L.. -)v,L � J 1 -o., L �w _ rII nH� ��.•1vH 1r — ^.�1 , •"1 _ t,. J_ _. c J__, ,O J1 __ - CtSS'! J v._ _ �� C e _ COn_ri�vt_` ^n '. _ �':1 -�.:? etc',.' ?., �C S:.�3 -; S° _ _.� ^.^r::S �?.^. C= Sa_d system or Sal J Vam' .S _.� t+Jn �o �'. __ Vv ?_ .+. d_�.� �r��. 1..� .. Jl — J! Sri ? � l'.5 0?' ' 147, Education La ? -:, Vh, B Public He-l.,ti? L�.-, o_^_� :,'_^_e Putnam Co::_ ^ -v j S— tar+y Code Very .truly 70?1.ns, t:e� \: CO -YQIE IS -7 N a C o Ix, t e r s i Q ne ��� 17vt:N . Ad- : = s s P .E.",'• (A t� �, �. , _ •':yam �• �� NEW' SULLIVh - THIEUE to W. T yo Address . P., 0. BOX 308 r, Airucynny R�. -7'? 7 Tel °�r0na Pq0 ..23a �O ' _ ESBI,UNP,.. ESTABLISH ELEVATION OF HOUSE TO PROVIDE DRAINAGE-,oF LOWEST FIXTURE - TO SEPTIC TANK AND FIELDS ...... AREA RESERVED'FOR SEWAGE. DISPOSAL SYSTEM TO REMAIN UNDISTURBED. ALL CONSTRUCTION T0- 'CONFORM TO STATE �r - 4'cvsr /.ro.✓ .p�� _ AND LOCAL STANDARDS AND REGULATIONS ......... \ t 0 ? mb �� h .BE .Pros t � � 1 � .. ✓i�✓<sio�/ Bo.r � - 1 �r PPROVED 'c•°.�_ �c y,.e_ .. __ i ••`/ _. { =3,� � ` I ico e s.".a F� � � � \ i� i'� � � i. � o a�. N ' r 1971 — - ._ 7. - ____ -_ J -_ __ ` Q Q' oFK .retL �Vl HEALTH ........ ... ....... J) i y - - -- D orv{s{ON Of iiz - l 5 5. o .v. - 6 0 �• { i ENVIRONMENTAL HEALTH SERVICES .� I j1•,f- -' 9� PROPOSED Q - . -- __� i_ L-- v— -- �o� I F"eA -.cis r✓- >->' EoE .�-E' - _ . OiC :L T. ✓v, S. -NYC, �✓ .'�3GO:C ,ef G �H j { SEPARATE SEWAGE DISPOSAL SYSTEM ,� Qv I a, � '; /��SL- Jf M��, •t• /°EE.�S�t /G.G HoCGoY✓ :°0.9� . ', -� U� � t �. � / `Nr�Gio M%.\ <�\ i ��✓or Pi�.2T os� A .�dB6yiyiS /di✓� {. 9 0 SY3 >EM SN9L•C �iF<'+�°ih' T �G.C'- P \Q \y\ B 99s 9cC�S - "GI6EB "?92 .P96E' 2A5- o i �yl �� -> y� cowry v���.�r. -��.✓> a.� t_ m1 TOWN Of /�dTit /i➢i✓J ✓•9.CG�Y { c \ />.GOT �.0 ,9i✓ .vE9< Div G/ ✓isi o..� of fir ✓i.G oYYCTE.✓T,p.0 �,..� i#; {9�' -- .yEivt .>� 5e,�✓ c -e-s ^t . "� � i f i�U7/� ✓A/✓I COUNTY. NEW.YORK SCALEE JOB NO. DATE ,vs,✓oTa � /orE• c ".Yr v.PS /P.PE .- v,�P,�._..,Y.. >.n c a.or� i .s "asses rco 1 \� %�ti,_ i /y;� SULLIVAN - THIEDE SOIL PERCOLATION RATE .............. 6 . MIN IN i 200 �� yG1`' V" t �� GALLON SEPTIC TANK: DEEP TEST ,?g6 36'` CONSULTING ENGINEERS -✓o tEVGC .E�c"r Lf X_ABS. CLARK PLACE CANOPAC• NEW YORK. 1 ` d � ;� ,,� ` `ill , � �,� e��•'�' � 2� .� ;- Nj ,APPROVED _ APR3 1973 v T0mv., i ,�; :. fy =' ,.' "-' ti' l". i t .c. ! ✓ °- <5 Z611--,;-/- `� ��. ENVIRONMENTAL HEALTH SE@YIWT 4 /`--'© AS CONSTRUCTED g,1,� /� G A/0,: SEPARATE SEWAGE DISPOSAL SYSTEM t TOWN OF '- '.i^'_,�';`•n.? j;�ta _��= y' COUNTY. NEW YORK .0, 5 '. "J%-. DATE :? -lam- ' SCALE:1,'. _,r+o:< -= JOB NO ?' - ��� GALLON SEPTIC TANK SULLIVAN - THIEDE CONSULTING E NGI N ER S LF X� AE S: TRENCH - CLARK GLACE MANOPAC, NEL7 YORK 4 i '1. .r a .s .I