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HomeMy WebLinkAbout2441DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 50.20 -1 -49 BOX 21 lirm Iy'L �. & - INN .1 11111 , 6636 III T :1 ., V. W, t 6 Otp IN r E.,..,: V SN { .. , ` . 02441 >a :; �> � ,.: —. -. PUTNAM COUNTYn DEPARTMENT, OF HEALTH ' 4Y t Division of Environmental Hea /th , 1, 2, ,e ` Located at it SNiy 'R� a °�tfCd�Vion Qf�'�' .4 Owner, f3uildin9 - TYPe1f��Q%/ �AL�/{�� Lot Area � Number of Bedrooms - ' t Separate Sewerage• System_ . tto% consist of �..TO.•be ,constiuctetl?by Water Supply Public Supply .From -rrvate Supply, to be drilled by: -- n Address 1 y3 Other Requirements ■ ' I represent that. I am wholly anJd 'completely "r n °above.described will be constiucted.as sF' ved a County Department of Health, and that t1 be submitted to the Department -'and a.. g n place �n °good operating conddion: any2f sa 8 ance ot'•the approval'of„ tie :Certificate' C nstr `fir will be located as :shown on the.approved pi n ' d the *q-. County Department of Health ?Ia I Date °� fP�C N "" �• 'Address APPROVED FOR:,CONST`RUCTION This a,pp'rovafe ?, revocable for.,, use or;may<be amended "or modified when cons requires;ja ge permit Approved for disposal p, domestic Date By - M r �fiDC:f ( yo 1 h.• Block g� Lot Job Address ' �LJj.'C� S'T '. P/r<7'6���� s ` Total'Habitable Space Square' Feet I Gal Septic Tnk lineal feet'X width trench; ... F - .4441 Sfg Ioca,tUOn of;`the ",proposed -system(s); i) that the separate sewage' disposal system ere to and to accordance with the sfandards, rules an regulations o • e Putnam ;. to of !Construction Compliance satisfactory to the•Commissioner•of'Healthwill pe; f d the owner his'succe'ssors heirs o "rt assigns by the'tiuilder, that said builder will ..�., _- sal; during`xhe period of. two (2)"years immediately following the date of the issu- i ce 'f.: a origin _system or'any repairs"t.heIr ; 2) `triat the drilled well .described above e i a d to a rdance;u "it.-., th stenda rules and regula i— o� ns. of the Putnam •. ' P.E. R.A. License 14 O.'2 feaC the date issued ,unless constructs of the - building has been undertaken and is e ssary by t Any change or alteration of construction sewage, a n ter `s y onl tYS ]•f �i •. .. Title .�. -.fit•, ....'�F t C......s�..�� ' _', _+.�'... ,_aii�._..w.....� 1..a.C.. -w. —• .•— '-- -.- _..— .t...x.a.0 PUTNAM..COUNTY DEPARTNM- .T'-:OF .:HEALTH - DIVISION OF ENVIRONM TTAL' HEALTH SERVICES Date Re.:.. Property of ,�; r ha �� �. ��1 °✓� � � Located at r Ii e c � iA � NOL- U a lly N. Block Lot, Gentlemen: /. This letter is to authorize a duly licensed: professional engineer L.,,,//or registered architect ..(Indicate) to apply for a Construction Permit for a separate sewerage system ;. to serve the above noted .property Jr_: accordanc.e with the standards, rules or regulations as promulgated 'by the Commissioner of the Putnan County Department of Health, and.to. sign all necessary papers on my behalf in c -onnect10- n --i,:, his-- mattar.:and o' -sup '-� to. su er-vi is the_conr_uc:t:i:an _ of..s'aid - - system or systems in conformity.with the provisior_s.of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, • Signed Owner of P per Countersigned* Address. ephone 17 ( Seal) Address m r c, o Telephone ^A TEST PIT DATA REQUIRED , TO.' BE SUBMITTED WITH APPLICATION - - .ue. .�.. x.r.i. a...v.��.. s.s..n.v. _ DESCRIPTION_ OF- .SOILS ENCOUNTERED -IN _TEST._HOLE.S,. ......_.____... �..i.....x. .... •.... n.. ._. .. _ n.... 3 :4.:s oea.np "fit.. • �. .w ...a .. .c w�� .. DEPTH HOLE N0. �� : °' ..' >HOLE NO.. !� HOLE N0. D-ef Lf G. L. 611 12'r ... SAdP R 18 241? 3.011 36rr 42rt 4817 5 4" 6 Orr 66rr 7211 7811 8471 h N 7 At r INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED 0 INDICATE LEVEL TO WHICH. WAT R. L_ E L RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date- DESIGN Q/ Soil Rate Used.. ��.... ,., Min/1 p rt Drop S.. Usable.: Area Provided .Jx-ry No. of Bedrooms Septic Tank Capacity Gals. Type/�'�e Z/ 6.wc• Absorption Area Provided By ,S2-9!;, o� L. F.x241r 361r t�/width- trench /Other Name STANLEY I LA Address BOX 267 � s� a. n � n a A s [A 1 •/ PUTNAM COUNTY DEPARTMENT OF Soil Rate Approved .Sq. Ft. /Ga ecked.by Date 04- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION,OF ENVIRONMENTAL HEALTH�'SERVICES. DESIGN./�ATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owne;V X,1cam ,4�2,6 6 LkVe%, /I Address -3 4uTC. h! �l •VTR �S�a- Y- T4X/"W- Located at (Street) 111,5 . Z !' kS,4cff Block Lot _ (Indicate nearest cross street) r-,4wo�'Uj. Municipality 11 yTiv.Qs d4Lt� Watershed 16z& SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATION Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Water Level No. Timer -. From Ground Surface in Inches Soil Rate Start Stop Min. Start Stop Drop in Min/in.drop Inches Inches Inches 1 2 f 3,� jo: of 17,01 .4 5 2 g-'31 5 1 _ .2 3 4 5 Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are ob- .. tained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be madei�from'top of hole. M �\�� f ��{I�Vnaa� I In , TI, -M IMAM IN!19409" Dane :Approved q11bd jmrL9IVj3 777 IF OFCONImv4m.III'I.,� # w ,.Enclosed 0, 7.,- Rafts Too-: RLSIoL(�r(.4z Volume "Mail" —Dodo PMw G IV' LY-19 jCA i "I 6L2LL-Awim sop* s 4161111" Of TOW A 64Y W1116W /YI S, soinc.thavo ocn-Wholi raiqonsibloo,Wt d"4 abovfr rdiiieribod will'" 'C"OnStr-octoo as-~n, on 04460— 7, ' k4 mith. ind thk an canplation tl f m*iad, io,t" Q iegaft t and quoramteeq wiu b4 of 4 'disk AA& Ilyz wail UkA,ted4sishawr-of . I the so thav' said ,wall will t» Mstallae; area Ir ofonami�t Oats he do t rivoCapN for FOP.�COtA,STRUC-TIO#4:Th!�000".Ml.!t3tp two cause y" "se 'oi J 6odlf wd*6A -- Co 911 now 'permiti,' -49ow'Cood for -:dlsbM­ I of domastk sonhtary awaM. snd/of� ►.7v 'tits 'o, to the-l�oonfnimi� Of Healthwill btla'a C~4 satifficiory ki . s heirs or assigns by the builder, that said bulklervill 110wins thislato of the IMW .,f :drilled well desalbod aboie.." Ou IM, Want PA.' License W- Z zo a unNfs ­rI r "W.Of- the building has been undertake and.is _ aN water ripply on L 'Title COUNTY OF WE$TCHESTER Y NYS FLAP #10108: gEPARTM ENT. OF LABORATORIESAND RESEARCH E11 Rev w • ' "`, `, ., - LA, NEW YORK 10545 BACTERIAL'' EXAMINATION ,OFDRINKING:ANIEATEDiWATERS, / Lab.No. W z Bottle No.. of `� nt T 4b Rl s do2 Time Set � Time Submitted Tes'ts(circle) SR Col)form P /A, Conform MP ,Fecal, Other' 't Coll tl By Agency Coll' d For -y CoIPd From (Name) )' ' ' e; o ..:` `First � .. P# � ✓�, Address ) (City Town Vlllagej (Zip Code) (County) Identification of Source' Sam tin PotwithP i 1. z 11 Refrlg ®rated . ~ r Chlorinated? Yes No Free mg/l, Total mg /l }_ pH RESULTS DF EXAMINAI tON QF W4TER P /4%100 ml F MPN /100 ml 3btal Coldorm 4To -. fal Coliforrn E. Col 4. F Fecal Coliform Standard Plate Count Other t Bacteria Per ml (48 Hr) r. These results tntlicate sample (was, was not) of. Y Reported by " Date: satisfactory quality when sar�tple was collected - Ann Mare Bury Stanley Lander Box "L" Amawalk, New York 10501. JOHN KARELL Jr.. P.E.. M.S. Public Health Director Re: Application: Langer Street: The Far Reach Town: Putnam Valley Fee Due: $200.00 CERTIFIED CHECK OR i MONEY ORDER Dear Mr. Lander: This department -is in receipt of the above referenced project. A review of your application will not be made until this, office receives the required fee. V y tr ly yours, John Karell Jr., P.E. Public Health Director By :s iKfine 1 n i tine John Intermedi l/Clerk JK: CJ v Encl. Your clients check in the amount of $200.00 a Owner or Pur4haser of Building unicipality G �/c. Building Constructed by S =sn ­P Location'- Street Block N"E'SiLliFr' 7744. - 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 :rude 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 willfu or negligent act of the occupant of the building utilizing the system Dated this day of 19 ?f Signature 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 NORMAN ANDERSON INC. WELL DRILLING R.D. 3 Barger St. Box 244 PUTNAM VALLEY, N. Y. 10579 914 LA 8.8698 MR. RICHARD LANGER off CANOPUS HOLLOW ROAD, TRAIL OF MAPLES (FAR REACH) PUTNAM VALLEY, N. Y. • 1,3579 TERMS DATE 3 &43ER 13., 197� 17) NUMBER • .3 0 10 0 a C) D 0 0 -:J 0 -D D .0. • 1.10 PLFASE DETACH AND MIZT.MN WIT. YOUR REMITTANCE DATE CHARGES AND CREDITS BALANCE BALANCE FORWARD 3051 221 casing 5 gallons per minute 6/22/7L $ 1874.1 Received on account 4/29/75 $200. ff 11 it ' 9/2/75 500. 5/15/77 300. ----------- $11jo. - Balance due $ ---774.1 0!J #0 0 0 0 ON 0 '- 3E) 00Q-0 10 - 0710:0 10:1110. woo -060 NORMAN ANDERSON INC. PAY LAST AMOUNT IN TH IS COLUMN WELL DRILLING Za"CY&W 9 i .. -.s .v..yr.r.• ,. . , ..,. _a. f. �. .._ _ %aw a_ <: =... ;•.- :>,a...s �:- -r -OT o . �c.. -.. ,...s �.,.._ .. f� .:.. .. a. ,.a .,.. _ u. ..,.. .. u. _.. �.,,c .. ,._.. .._ ..o., .c. Owner or urc aser of Building Municipality wcm�leJ LAS, tlt Building Constructed by A-,, / ''Eat Loc �v �atiofi - Street Block Ae5ia ?I&L 41-� 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- termination of the Director of the Division of Environmental Health Ser- -- vic- es--of the- :- Ru!-t -nam. Go- u.nty- .D-- partmt t- - -o -f- deal- t-h-- as -.to- wh- e-ther .or •not- -tha _ .- failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the syste na re Dated this % day of 2 19 � 1' Sig to ,,��. -- C • Title 71 If corporation, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMK ETION 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 AA l� G•4niCw,' OI�J,tf c° iv4,sr qtL Owner or Purchaser of Building I�unicipali'ty -c"R D Y4,V r e ft Building Constructed by Locatidn - Street Building Type ( 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- - vicar of the• - Putnam- County ° °Department "of HealtYi'. as" to "vliethe'r' or ndt" 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 2 19 ?2- Signature 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. 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