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HomeMy WebLinkAbout2396DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 42. -3 -15 BOX 21 02396 IL 41 m if �R '; T y ?� { l, lij� �� _ 02396 77- 77 7 Division or Enwronme� nta/'. CONSTRUCTION PERMIT` FOR SEWAGE DISPOSAL SYS' Located at— QePkslci 1 1 Fin 11] aBoRak owner Claude; MacQulcrrlon Buildih9 T,Yne .�i T .— t, nceot'Are� p [P Number of Bedrooms - Dg ow $00 �t 1[ �Y Separate- •SewerageSYStem to consist of l 2nn "'' �' �� Gi r� i r To:be constructed bye NOtt sele_ cted ' t t Water Supply Public Supply From ' v, * Private Supply to._be drilledrby Address ^r _'OtheryRequirements $r I represent. that 1 am .wholly; an corlipletely responsible for the design ai ds. a -above desc`ribe'd will be constructed as shown on 6- wapproved'a e'ndrmen 1,j _C.ounty . -,Department of Health', , and,that on completion thereof a -Cer j� be;submttted •to '-the Department ;and +a - wrltten guerantee` awill be fui place m good operating conditIon.'any!part•of said' sewage„ disposal:" a`nce of'the approval of the Certificate of: Construction" Co— mpliance ; s will'be located as shown on.the approved plan -and that said well will"be4in County Department of�Health r- v Dater h�75 -'79 r tii d Signed Address 2 ^µ APPRO,V„ 0 t CONSTRUCTION:- Thts' approval expires' one year + revocabletfOe;�cau3e.or may be•amended o`r, Modified, when considered n requires a newpermit Approved foll- sal of domestic -itai =s Date ` /// ar iJ 9y _oAY, Date .Date . Services Carmel /V Y 10512 w nTown of Putnam Valley } s Town or Villag e V. '12 r s .-�, 7�� • p '•Block _ Job' - Add res� t�Ok L3iK k i 1,11 N Y 'a ri ,ti kTotl Habitable, Space ,BOO Square Feet is Tanks and •'480 LF . pf 7 s O'!� ,�g1j i�e `trenches Address - » o :rc �`• ^JT try .��'�'�'� > � x n °' ,mss} "•^r i., t � 'Mr ton oflthe proposed systems) .lj .that.the separate sewage disposal system to and "in. accordance wAh,the stentlards rules an regu a ons o e ,:. u nanl ; of ConsfrucUon Compliance satisfactory to the Commissioner. of_',Healthwill ale owner his successors''heirs or- assigns;by the builder, ,that said :builder will, :during. the period of two (2) years iriminediafely following .the date of, the issu- o_'ngmalsystem repairs thereto; 2) that the'drilled. well described _above. Sin accordance th they stand ar rules and iegu a�'ons of . the' ,,Putnam P:E R.A f_icense No .1 1 056 ':date Sued unless construction oft building -has. been undertaken-and Is 6y the Commissioner of':Health ? Any change or -alteration of, construction" J" a`hd /or private water supply only v � ARTMENT F HEALTH' ,,'Services, . Carm'% N Y 10512 a',E DISPOSAL—, s BUT 1�'�l� '�� �-t►� �z Q L Town aa!MMi�e . ax ­ T :Block' ' Lot Job 9 l � Address - , 777 T. 'of Bedrooms Permit Issued d =essential)as shown on the plans,of the completed work (copies of`which are ' Y f` andthe, per' t tssueil` by ;'_fhe Putnam County .Department of Health 1 t, Pit F2A ` License No: I ±.9 ;OS r take such actwn as may be necessary to secure the correction of any unsanitary ,system'sha�ll become, null'and void as soon `as a ,public sanitary •sewer becomes I ;void when a public water sup ecomes available Such approvals are n9i of Healthch revocatdifica4ion or, change 1s.necessbry )RKT4OWN MEDICAL LABORATORY INC. P.O.�"Box 99 321 Kear Street Yorktown Heights, N.Y. 10598 245 -3203 LOCATIONS: X7dR 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245 -3203 ❑ 201 BUTTONWOOD AVE., PEEKSKILL, N.Y. 10566 737.8777 11495 MAIN ST., MT. KISCO, N.Y. 10549 666 -3335 _ ❑ STONELEIGH AVE. (NEAR HOSPITAL), CARMEL, N, Y, 10512 278 -9330 • E COLLECTED RESULTS OF EXAMINATION O<` WATER 9/4/LE OWNER DATE RECEIVED HOVEL HOMES INC a 9/4/$1 CITY, VILLAGE, TOWN 6 /OR NAME OF SUPPLY DATE REPORTED SAMPLING POINT - -- WELLs PEEKSKILL HOLLOW ROAD PUTNAM VALLEYP NY BACTERIA PER ML. (Agar plate count at 35 C). COLIFORM GROUP COLIFORM GROUP HARDNESS, TOTAL - ppm MFT 1100m1 MPN /100m1 DETERGENTS - mg /L NITRATES (as N) - mg /L IRON, .TOTAL - mg /L AMMONIA, FREE (as N) -mg /L pH= CHLORIDES - (mg /L) COLLECTED BY.- CLAUDE McQUILLAN 'These results indicate that the water 'was of a satisfactory sanitary quality when the sample was collected. A. H. PADOVANI, M. T. (ASCP)' NEW YORK STATE APPROVED LABORATORY fl: PUTNAM COUNTY DEPARTMZ T OF HEALTH _ ,,, DIVISION OF - ENVIRONMENTAL °HEALTH' SERVICES � Date June 19, 1979 Re: Property of Claude Macguignon Located at Peekskill Hollow Road Section ' Block Lot Gentlemen: This letter is to authorize Noel C,Seenher� a duly licensed professional engineer or registered architect (Indicate) - to apply fo.r a Construction Permit fora separate sewerage system; to serve the above noted property in accordance with the standards, rules or regulations as promulgated 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-dystems' in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. RR '8 MuScoot North . Address _Ma Q Djgw York 10-541 914- 628 -6613 Telephone (Seal) Very tr you s, Signed 7 LQ_,Q-11 Owner of Property Box 4 Lake Peekskill New o 537 iAddress 914 - 528 -2809 Telep one i Owner or PurcFKser of Building r> 1 i1i116 � / C Building Constructed by Location - Street Rv T111,411-1 kl,4 Z_ Municipality action Block Building Type Lot GUARANTY OF SEPARATE SEWAGE-SYSTEM I represent that 2 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,. hi.s.succes sors, heirs or assigns, to place.in good operating condition any part of said system constructed by me which fa.ils.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- terminati.on.- ...of - -- the."- Di.re.ctar of the Division of: r' iv-ironmenral- _He-a1: -thi -.Ser -. vices of the Putnam County Departrrient"of HealtYi' as to whether �oVr. not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the em. iC Dated this 19i( Signature 91 I A C, X Title Ae_,>K ¢ ,L . .f�S kiZ. If corporation, name OCT 8 198 1 and address) --------- 2UIN3 %tAC.O�NILY - - - - -- - - - - - - - - - - - -- DEPT. OF HEALTH 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. r i , WELL COMPL'I fION REPORT'' PUTNAM COUNTY DEPARTMENT OF HEALTH 3/7f • .� 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 COMPiLETlON NAME 47eW ­7ADDRESS, OWNER i LOCATION (No. Street (Tow (Lot Number) OF WELL If BUSINESS ❑ ❑ ❑ PROPOSED DOMESTIC ESTABLISHMENT FARM TEST WELL USE OF WELL ❑ ❑ CONDITIONING ❑ (S(Specify) SUPP Y INDUSTRIAL DRILLING COMPRESSED D ❑ CABLE ❑ O(Specify) ❑ EQUIPMENT ROTARY AIR PERCUSSION PERCUSSION CASING LENGTH (!sel) DIAMETER(! cheat WEIGHT PER FOOT ❑ WVE SHOE ❑NO )W CASING UTED? NO DETAILS 3 ��� THREADED WELDED YES YES YIELD ❑ HOURS G.P.M. © YIELD (G.P.1. TEST BAILED PUMPED COMPRESSED AIR WATER MEASURE FROM LAND SURFACE —STATIC (Speclf) feet) DURING YIELD TEST (feet) Depth of Completed Well f LEVEL in feet below land surface: �O MAKE LENGTH OPEN TO AQUIFER (feet) SCREEN DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL Diameter of well including GRAVEL SIZE (Inches) FROM (lest) 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 �z c RECEIVE...:., OCT ;1987 P°...; s NAM COUNTY i)EPT. OF HEALTH. If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE I DATE WELL COMPL TE DATE OF 'REPORT DRIL �R ( gnature) PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES OFFICIAL USE ONLY /(-- 16 0 —0,5' SITE LOCATION IT3 PERSI�1� L 1 DLL/J�/riA. P�'" TM# OWNER'S NAME A 2-r an LD UG PHONE MAILING ADDRESS IV PI [12SIL . 4+DLLnw 6210 01tiA VAL.L.EY, &O•Y. I DK 99 PERSON INTERVIEWED PCHD Complaint # ame & Relationship (i.e., owner, tenant, etc. DATE TYPE FACILITY PROPOSED INSTALLER M r:`` gU o &j cry &I i PHONE (M)491-0-7,0o ADDRESS 5 MATLE rTST. PeL,6 � kCE -fSie Ej 11 ,9 6y/ REGISTRATION 'g ds ���! -��' Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system .Different location may require submittal of proposal from licensed professional engineer or registered architect. ,Is �r a�,� -0 WI'AK-E C1,06606 Q Co"AesE, PIPES 11LIL('Act- pf:w &r.,Av,61^ liv s7 4LL I, as owner, or reported agent of owner agree to the conditions stated on this form. XAS7 [A SIGNATURE (� ' Y� - TITLE= LLLcV, Per nosal annroved with the fol1 9 a conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: DATE a. Owner's name b. Site Street Name, Town and Tax Map number. C. Location of installed components tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e. Installers' name and number. 3. System repair to bb rformed in accordance with the above proposal and conditions. Proposal approved v pector's Signature & Title COPIES: white (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML DATE M� PUTNAM COUNTY DEPARTMENT OF HEALTH _.._.. .DIVISION. OF ENVIRONMENTAL HEALTH SERVICES. _.. ._ -... ... _ .. r _ �. < °.._..._ ..n •- � --';^: .- "' -- -^-. ._ .°.. .- - -- ... -.. - -.. -_ .. .�-- enro- ,.,... e. .a _. z .cam. .....r •..o. ,�:. r_. .. �. ,.,. s r, COUNTY. OFFICE BUILDING, CARMEL, N.Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner) aside a�Q „tenon Address .Box 4,Lake Pepkakillr N:Y.' .10537 Block Located at.*: Sree Lot .. oss. s ree cae Municipality ...Cs�.ta.. put val Watershed :._SOIL,PERCOLATION TEST. DATA. REQUIRED TO�BE SUBMITTED WITH*,,'APPLICATIONS o e Number ..:.::..... CLOCK..,TIME PERCOLATION .. PERCOLATION Elapse Dbpth to Water Water Lee ve No.. ...::.................::.: ::.`. • Time From. Ground Surface in Inches •• -• Soil Rate Start -Stop ', Min. Start Stop Drop in Min. /in drop Inches Inches Inches #1...1_R:: 00-x$ ::_9a;..:. 24 1-A a .3 .. .....2-4,13 24 16, 19 R 24 16 _ '3' 1} 16. 2.8 0-Fj: 4 24 _,_1�2, 19 3, 2443= , 3R_q,c,_9 , -Q 1) a IA is 1.. 7di 'A •_si Notes*: ..1) T Ats to. be repeated at same rates are obtained -at each percolation for 'review ;• >•..: ; 2) Dapth::measurements, to be made depth until ap roximatelyy equal soil test hole. All data to be submitted from top of hole. TEST PIT DATA REQUIRED TO-BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO.. HOLE NO.. . .2 _ _ HOLE_ NO . 3 -._. .. _ G.L. Tn= Sni 1 Tn= Sni 1 _Tnp Sai 1 A 30�� Sand n ' n 361 4211 I Name Joel erg Signature Address RR #8,; Muscoot North SEAL Mahopac, New York THIS SPACE" FOR -USE' BY" EEALTH DEPARTPENT ONLY: Soil Rate Approved' Sq. Ft /Cal'. Checked by Late_