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HomeMy WebLinkAbout2397DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 42.3 -16 BOX 21 I.tiL ' . • Z I .` NMI r' T • ' 02397 3 / PUTNAM COUNTY DEPARTMENT OF HEALTH Division of .Environmental Health Services, Carmel, N. Y. 10512 1 / • ..CERTIfIGATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM- P(,�T1•dA VALL PEY i�+�1 ll i� n _, . /1.. Town i �� CJ' y d L.l f O L:L OW COY . Tax Map a '6• ` l Block Located at pp nn C LALM& '1V A L��G J•ol?N Lot Job Owner �' ENE Address. T �p EeKs K (L' ) /Q Separate Sewerage System built ,by /I I i-011 c 4 )i •� Consisting of % ©'0 Gal. Septic Tank and 1 M Other requirements Water Supply: Public Supply From — Private Supply Drilled By Address �°-� ' r —� / r S% (/L /'� 1% �� No, of Bedrooms Date Permit Issued Building Type �•+ � � -�1 Has Erosion Control Been Completed? 1 certify that the system(s) as listed serving the above premises were constructed essentially as attached), and in ed accordance with the standards, rules and regulations, plan , and the Date / Certified by 47 044,o kd j i c & AA , . Address Any person occupying premises served by the above system(s) shall promptly take conditions resulting from such usage. Approval of the separate sewerage system available and the approval of the private water supply shall become null and void subject 'to modification or change when, en, in the judgment of the Comis r Date By it CONSTRUCTION PERMIT FOR $ Located at on the plans of the completed work (copies of which are issued by the Putnam County Department of Health. P.E. �+R+.A_ 16 PA License No. action as may be necessary to secure the correction of any unsanitary I become null and void as so as a public sanitary sewer becomes n a public water suppl ecomes available. Such approvals are ealth, such revocatio ification or change is necessary. Title NAM COUNTY DEPARTMENT OF HEALTH r1 .of Environmental.-Health Services, Carmel, N.. Y. 10512 %� E DISPOSAL SYSTEM Putnam Val 1 A u Town illage Subdivision %_1auae 1v1acumiCfnOn owner__ Claude MacQuianon Building Type 1 fam RP-g dt'nn(3Lot Area 7. 37n arres Number of Bedrooms 3 Design Flow 600 app Separate Sewerage System to consist of i , nnn Gal. Septic Tank To be constructed by nOt selected Water Supply: Public Supply From * Private Supply to be drilled by nOt nel ACf-P_r1 Address Other Requirements Tax Map 18-2-16 Block Lot Job Address Box 4 Ake ReAkekill, N.Y. 10537 Total Habitable Space 1 y SOO Square Feet and 360 L_F. of 1 .a�l,;ng trenches Address I represent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regu a ons o the Putnam County Department of Health, and that on completion thereof b "Certificate of Construction Compliance" satisfactory to the Commissioner of Health will be submitted to the Department, and a written guarantee will be furnished the owner, his s ccessors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system during the per of two (2) years immediately following the date of the Issu- ance of the approval of the Certificate, of Construction Compliance of the original syste r any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be in6tahed In accoidanc ith the stand�tds, rules and regu 57 o s of the Putnam County Department of Health. Date 11 /101/Rn Signed Address APPROVED FOR CONSTRUCTION: This approval expires one year 4 revocable for cause or may be amended or modified when consiclpred ne requires a ne permit. Approved for disposal of domestic sa a 1 Iron _q_,1 _I o I) Pty IRd� v V IoG fv P.E. R.A. License No. 1 1056 issued unle construction the building has been undertaken and is C the om sion r of Health. Any change or alteration of construction P nr rat wa supply only. Cl WOWN MEDICAL LABORATORY INC. P.O. Bok 99 321 ' Kear Street Yorktown Heights, N.Y. 10598 245 -3203 #4391 RESULTS OP EXAMINATION OF WATER N ER C_LAUDE MACQUIGONE 'Y, VILLAGE, TOWN.6 /OR NAME OF SUPPLY BOX 4 T.AKF. PFFKSK TT.T. - MY :TERIA PER ML.. (Agar plate count at 35' Q. COLIFORM GROUP (Mc � LOCATIONS: 2421 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245 -3203 ❑ 201 BUTTONWOOD AVE., PEEKSKILL, N.Y. 10566 737 -8777. ❑ 495 MAIN ST., MT. KISCO, N.Y. 10549 666 -3335 ❑ STONELEIG'H AVE. (NEAR HOSPITAL), CARMEL, N. Y. 10512 278 -9330 DATE COLLECTED 4 1 81 7s 30. A.M. i DATE RECEIVED 1 4 :81 (8 A.M. ). DATE REPORTED 1 st probable No. /100ml.) HARDNESS, TOTAL - ppm �^ ri 0/ MFT 'ERGENTS = mg /L NITRATES (as N) - mg/L IRON, TOTAL - mg /L ' [ONIA, FREE (as N)-mg/l, PH= 'CHORIDES - (mg /L) COLLECTED BYs >'Co MACQUIGNONE se results indicate that the water was S of a satisfactory sanitary quality when the'sample was collected. -- I A. H. ADOV NI, M. T. (ASCP) P PUTNAM.COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY+ OFFICE�BUILDING, CARMEL,' -N. Y. .10512 DESIGN DATA-SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. - Ownerrl audP mArQiiignnn Address Rnw d T.akP PPC�k�ki 1 1 N-Y_ 10517 T.M -, , Located at (Street e � k; 1 1 Hollow i Pc ock Lot �ndica e nearest cross s ree MunicipalityTown of Putnam Valley. Watershed Hudson River SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS o e ,. Number CLOCK TIME PERCOLATION PERCOLATION •- � apse p o a er a er ve No. Time From Ground Surface in Inches Soil Rate - Start -Stop Min. Start 'Stop Drop in Min. " " /in drop Inches Inches Inches 41 15 :00 -5:24 4 16 1 4/3 =8 25.9.5 -5 -AC) 2A 16 .... 19 3 2d,L3 -R 35:50 -6:14 24 16 19 3 24/3 =8 4 5 #2 19:00- 9:'24 24 16 19 3 24/3 =8 29:25 -9:49, .24 16 19 ... 3 24/3 =8 39:5:0 - 10:14' 24 16 19 3 24/3 =8 X10;15 -10:39 24 = 16 19 3 24/3 =8 2 5 . Notes: 1) T6 is 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 S01IS.ENCOUNTERED IN' TEST HOLES• Deep Hole P,erc Test Perc -Test Dee Inspected DEPTH X 1 �$l�.:_ -z9 G.L. Sand Sand Sand Sand 6" 3011 3 42" 4 8 if 5" 60" 66" 7P. 78 I If INDICATE_LEVEL AT WHICH GROUND WATER IS ENCOUNTERED None INDICATE LEVEL TO WINCH WATER LEVEL RISES AFTER BEING ENCOUNTERED N/A TESTS MADE. BY .Joel ,.Green erg.. _... :... ..Date.6!,jf 7,9&j /8/80 DESIGN_ Soil Rate Used8 -10 Min�/1 "Drop; S.D. Usable Area Provided 5,000 S•F.+ No. of Bedrooms���, Septic Tank Capacity .p q e Absorption Area.:,Provided By a60 L.F. x24 rent THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 ' 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 OWNER NAME e, BCC.�l .yv6 � ADDRESS i LOCATION OF WELL (No. 8 St re t` —) � ��Z� (Town) (Lot Number) j9 /J 'P!' PROPOSED USE OF WELL NESS ® DOMESTIC El E TABLISHMENT ❑ ❑ FARM TEST WELL 11 SUPP Y ❑ INDUSTRIAL ❑ CONDITIONING El OPeif ) DRILLING EQUIPMENT COMPRESSED CABLE E[ ROTARY El R PERCUSSION ❑ PERCUSSION ❑ ((SSpeciify) CASING DETAILS LENGTH (feet) / DIAMETER (inches) G l WEIGHT PER FOOT em's ®" THREADED [:1 WELDED SHOE YES ❑ NO CASING YES O ED? NO YIELD TEST I HOURS G.P.M. ❑ BAILED 11 PUMPED •I-'COMPRESSED AIR YIELD (G.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE — STATIC(Spec /ly feet) DURING YIELD TEST feet) l Depth of Completed Well �ll7v in feet below Land surface: SCREEN DETAILS MAKE. LENGTH OPEN TO AQUIFER (feet) SLOT SIZE DIAMETER (inches) IF GRAVEL PACKED: Diameter of well including gravel pack (inches): GRAVEL SIZE (inches) FROM (feet) To (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. i FEET to FEET i I ( If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL CAMY TED f/ DATE OF REPORT WELL DRILLER Signature �_... ©/W Owner or urc seer of Bui ding 110v,e--'G 4lv;r- Iry c, Bui ding ConstructEd y Municipality Set on Location Street Bloc 42l4 -Cl-�; 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 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- terr1ination of the Director of the Division of Environmental Health Ser- vi.ces of the - Putnam- County Department of..-Health as to whe:the.r -.or -:not, the fa i lure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the s em. Dated this day 'of PI j4 19 Signature 0 Title S1,1-aie5 f 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 JOEL LAWRENCE GREENBERG Architect ® Planning Consultant RR #8 0 MUSC00T NORTH MAHOPAC, NEW YORK 10541 (9 14) 628 -66131 w 628 -2851 T, wra-- Flanner.. -e .. Putnam - -- Valle• 0 TO Ci'PS 2.T l 171, Pl d PE A64 OF ijEAL-M CAZM>= i , ii� 1 � GENTLEMEN: WE ARE SENDING YOU Attached ❑ Under separate cover via the following items: ❑ Shop drawings Prints O Plans' ❑ Samples ❑ Specifications ❑ Copy of letter ❑Change order ❑ nn nn nn��MM wry,�� 5� �n L�FEUTEW 0� �WG�.IU SE� L1 MLA DATE � a/ JOB N0,.6 q �_Ki_ •AT1'ENTtON•^"^ -_ -. r...,.,.. 1.. ...�.,......._..�.+�.- ..:.....� .,.._ _ _v. i.. .. RE: A5 '80 ,L Q., zz u q No N below: Q�+tZ. �flLF V- 0® -15' ❑ COPIES DATE NO. DESCRIPTION f COPY TO SIGNED: If enclosures are not as noted, kindly notify s t once. FORM 240 -3 Available from e i Inc., Groton, Mass. 01450 THESE ARE TRANSMITTED as checked below: f$ For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution - ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FOR BIDS DUE 19 p PRINTS RETURNED AFTER LOAN TO US REMARKS j %N C L CSC 12 FLEA SL F"IiyD fTO a..J I 2ki Z2 COPY TO SIGNED: If enclosures are not as noted, kindly notify s t once. FORM 240 -3 Available from e i Inc., Groton, Mass. 01450 f i Gentlemen: PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL - HEA1JH_SERVICES, Date TTnvAmrr�g 10, 1980 Re: Property of Claude Mac4uianon Located at Peekskill Hollow Road T. M. Section 18 -2 -16 Block Lot This letter is to authorize Jagh Greenberg a duly licensed professional engineer 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 `:61J1J1CC L..LU4J %Y.L Lfl L11.LS ma L Let• anLi to: supervise the cunstY'ucCluf1 of said system or systems in conformity with the provisions of Article 145 or 147, . Eduoation Law.: ,the- .Public Health haw,. and the Putnam .County- -Sani L. C Very truly yours, e Signed Owner of Pr erty P.Ev RA., # 11056 RR #8. Muscoot North. MahoAac , N.Y. _Y. Address Telephone :•. •__ ►. 528 -2809 Telephone