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HomeMy WebLinkAbout2454DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51. -1 -17 BOX 21 02454 klo 0 ? F 1 , �, L in I L6 00 66.2 n I 02454 'Y UTNAM' P COUNTY DEPARTMENT i CERTIFICATE OF �iyfsfon OF HE of Environments/ yea /th ` ALTH CONSTRUCTION r Services Carme/ N O_MPLIA `' NC Y X10 E FOR 512 Locate SEWAGE DISPOSq L SY.STEh4 _ 5..�A� ,Owner .- /`i• w SeParate:Seweraga g Town or Village . Section 3 M: Ystem built Lot z K Block T Co Honsisting f ' Job - ^ r Gal , Septic ,Tank, Atldress 3 - ` Other requirements Public $u Y r ., • . y, idth trench " Ch i Private S uPPIY Drilled B ! .Y Address. Z BLit s Building :T �7 k) as Erosion_ Control ^�LL F ' Been" Complefedi of Bedrooms .. u Date Perm certify that it Issued the s , L a Ystem attached) and (5). as fisted servin " { l �n accord With the 9 a the above premises. ' w r .,, r standartls rules and ,'Were constructs Date �� t r d . , _ �, , �e9Ulation5 pla s filetl nd as show }On Yh' r, I ` r, : * x ►m� Issu ns .f the wor k completed P •Cou (copies Of :which are -Cert�f,ed"+by" :: r ` ntY Department of Health:• v }} Address >K .' id "occ4pyiri conditio 8 Premises servetl b ns resultiri - P.E. _RA ; available 9 from y the above system `"�d and ;the usa9e• APOroval of'the (S) -shall promptly take License.No. subject to approval- of the private water su Separate 8e s such action as`rr�a modif, cation or chap PPIy shall sewers System Y be•necessar. "Yto h 9e when m fhe ludgm become null and. void W nd'void as so0 n of any hall:,becoma null a cure the correctio ant of the Cornmissioner hen :a Public water'su public. unsanitary Jate - h of Health such revoiationplY. becomes ;available, ;�ni Sewer becomes I 7 7 tart' motlif� cat Such` a Pr k ton or change is necessary vale 'are " r- ,y t Title�%•P n...F"' Y. +,' ik. -•� _ fit 1 r � l •S k J 4 V t _ •• 1 •, . iii _ � S -. r PUTNAM COUNTY DEPARTMENT OF. o a HEALTH ° Qfvafon 'of Eri "vironm "ants/ HI/th Services ;Carmel ,N Y . ;10512` CQ STRUCT@'O,V; PERMIT FOR: �SE•WAGE" 'DISPOSAL'SYSTE(VI- �J -E• _, , Nld� % fIf p� , Town or. VIII e Located at4`© a, Section "Block Subdivision t .p Z1 h� H y Lot Oners � Job w pp�� pp"�1.1. 1�OLLpUU tZcI�D (a - BUlldln g T e RB I ��111i*'PG *' Addre • ^ v YP —_� rq Lot rea � C2�S k ' Number of, (Bedrooms -- x Total Habitable �6 s- Space Square Feet Separate Sewerage System to consist of "� ®.• M1'�Gal 'Septic Tank } p lineal feet' X To width trench, Address �L4fliplJ'1 l Water $upP1Y Public:SuPPIy .From 'I rxi Y4(�� Ns ! J j Private Supply. to De tlrilletl'by r WT�[.1., LL I I� N Address her Re qu irements ` , : represent that I'am• wholly and completely responsible for�the design and location of�the `+ above,described� wilhbe constructed as shown on the a ?;r proposed• systems) rt) that �h�e, separate: sewage disposal system t l:ounty Department 'of,'; Health,:: and tFia-t onlcomolefiori ;Yna.as..'n'���e... -__:1. ordanc@ wlth ltre Sttandards irules.an raga a ons o pproved amendment there to and in arc vanc8 Of the 8 - •• °aa P N-aa! sysn pproval or >the - Certificate,: of Construction - Com liariCe ,of Will' be located as'show.n on the ?approved plan lrtd 'h+�t ceid, well. will tie ail F 'County Department•of Healthy, -z Date�1 Signed Address APPROVED FOR CONSTRUCTION TI%is app►eval expires one revocable for cause or may be amendedjgr modifiad;rirhen consid tr from.:t nacesssr requires a ew .permit ^� A�pPrrovetl fo %ra {disposal .of domestic sritary` ti'sew c truct�on Compliance satisfactory to the `IComrnissioner of; Healthwill ari, Ts, successors, lheirs'or assigns lby, the builder; that said ,bu'ilder will' he ofr, two( 2) yyears` �mmediatelyfollowing ,thedatesof'the'is Su- to m, or a repairs theill 2) thiflhe drilled well described abov rice.. wi he standards rules and raga a, ons,: of the Putnam, = Y r i i P'E. R.A. Licerise No. led` unless construction Of the budding has ,been undertaken, otnmissioner.of Health Any`change,or alteration of con r rwate: watery supply only PEEKSKILL MEDICAL LABORATORY 1579 Crompond Rd. Barclay Plaza Bldg. A, Apt. 1 'eekskill, New York 10566 398o4 PE 7 -8777 DATE COLLECTED RESULTS OF EXAMINATION OF WATER 11/21/?3 R DATE RECEIVED Stephen Zimmerman 11/21/73 VILLAGE, TOWN & /OR N'AMt OF SUPPLY DATE REPORTED ERIA PER -ML. (Agar plate count at 35 C). COLIFORM GROUP (Most probable No. /100m1.) HAttUNLbb, 'iUTAL -ppm 5 less than 202 RGENTS - ppm NITRATES (as N) ppm IRON, TOTAL - ppm RIDE (F) - `mg. /1. I results indicate that the water was Ye 15 ofd satisfactory sanitary qu ity when the sample. was c cted. _._....:-- _..i0.., H. PADOVANI,. M.. T.- (ASCP). PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTRY OFFICE ' BUILDING, CARMEL, N. Y. 10512 bESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. _Address j�o �! f �2 IV � Located at (Street ` 1.0"Z V g ApSec. Block Lot �Indicate neares rr ss street) 6nicipality PO j BAH UAL,(, F-Y Watershed "....SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS w imber CLOCK TIME Elapse Time Start -Stop Min. _2 _ 3 PERCOLATION Depth to a er a er ve From Ground Surface in Inches Start Stop Drop in Inches Inches Inches PERCOLATION Soil Rate i Min. /in drop r ,. ,.r. - - � Y - )tes,* 1) Tests to be repeated at same depth until approximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted ,J-or review. 2) Depth measurements to be.. made from top of hole. �t 1 I 2 4 I 2� 5 N elol l 20 0-A Zi µµ'7d ,. ,.r. - - � Y - )tes,* 1) Tests to be repeated at same depth until approximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted ,J-or review. 2) Depth measurements to be.. made from top of hole. TEST PIT DATA DESCRIPT DEPTH HOLE NO°.o G. L. 611 1211 1811 2411 3011 4211 4811 5411 60" 66.11, 7211 REQUIRED TO BE SUBMITTED WITH APPLICATION ION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO.- HOLE NO. vj 4 -[ E& - 78 LEVEL AT WHICH GROUND WATERIS ENCOUNTERED.: .-INDICATE LEVEL TO WHICH WATER LEVEL RI AFTER BEING ENCOUNTERED �TESTS MADE BY Date q#�� P r Soil Rate Used Min/lIfDrop: DESIGN S-D. Usable Area Pro'vided '. /570 No. of Bedrooms Septic Tank Ca'pacity Gals. Type L3 C .Absorption Area ProvidedT Y�, 37- nth trenh r ,-A*m Address SEAL ea'4& 16-5& THIS SPACEi.,FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Appro.ved Sq. Ft/Gal. .�Checked by a ol r� Ne, Xir ,. M7 A-A . � P , 0 1' &4 C -11T e a i �j. O :�z �0 pUrk)4H VALLEt Owner or Purchaser of Building Municipality Building Constructed by Section j6!5XA't?Y5i49& Ave Location - Street Block Building Type Lot GUARANTY OF SEPARATE SEWAGE- SYSTEM . I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drag -rage 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-- Direc -t.or- of the Division of Environmental He.alth.:.Ser vices of the Putnam County Department of'- Hearth' 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-IJ Signature . �clm-L- 41 TO ca vv5T. Title .p D 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 F0RLh,TI,.-NS PEILT. IaT•LtT--Z 71, Ter 7), TFE, 17 —Lind s and Ty e o f in ft. A if wator bearing' drilling t-SUF 25 G-ROUA/) 50 0 200 106 G / Ac rA k. a OAK of the Iroperty QT back of this sheet - locatiog DY 6PObAL SY'S. - 1, Z Was well LvU il'amh Place -Y111age A, 4L,J11 14 in V Coupty 0 —Orn of I LTY. il T. F lit IDepth--of L" �11 P. Ot Addless it ameter well disinfeck"NIT"40 �-�Yi --4 L f Q --Was (Y 11 1, — , , - .P.M Of Casing above ground,. 4• Below .',rotuia- 0,011 eal Mel, in ft. ft paa4er, Saw a �:11 diagram in the spaca,rdvided below and"Ahcu V a death wing, the wall s.aij kind and thickness of formusicolls d&,SgAl Itod, My bearing jprv4Qqps, diamotez of drill-hides with dotyA Qnet and F0RLh,TI,.-NS PEILT. IaT•LtT--Z 71, Ter 7), TFE, 17 —Lind s and Ty e o f in ft. A if wator bearing' drilling t-SUF 25 G-ROUA/) 50 0 200 106 G / Ac rA k. a OAK of the Iroperty QT back of this sheet - locatiog DY 6PObAL SY'S. - 1, Z Qngth of is 04m. of screen. Type of Drilling star -t Well Driller Was well NOW 17" a t a r 7 Mel, in ft. 6-2 d Tjj 7 tv, Inst in pecum-eu0no. a OP C A14. wall, AS 01vu -Xadn_1A ... . .... .. 1-77 QUO Eff, S10- Qngth of is 04m. of screen. Type of Drilling star -t Well Driller 3 Owner or Purc user o Bii ding Municipality 151 TF_ 60 P) @LL PP Building Cons ructEd b'v Sec ion aC U �. ocation - 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- vi Dopy. rtrrent -- •of--Hea-1••th-- as -•-t•o --w- hethe-r- o•r -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� Signature Title �K-�� . S� (LP• L � v,T 1 T�c�'o 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 to r l/ , 1�,�✓ -isp . by . o 1NITIAL SIZE IMPEMIOId Yes No Comments, Property lines or. corners found a a a . a Can estimate house location o . a Will driveway need cut . . 0 o a'. a Must trees be Y-ermoved -note these . : Is deep hole representative of entire SDS area Additional deep. holes needed. . . Sufficient SDS area ,available consideri: driveway cut, house location, separation . ,. ;..•d.L Dance s, etc. a O O' O O._ a a a s a a O a a REEF HOLE DATA .. Lepth e Water-elevation: Rock elevation: Soils description: Date: FINAL SITE Il�THECTIO�t Insn. bv: House located where shown on approved plan .. . 8TH l oc?:teri i -!here ap rove-ft a a " 0 4 a L �- Vidth of trench average ` .Slope of the line and trench acceptable �✓ Room al- loved for expansion trenches a . a a a _ over_ 5P--ft... :from swamp, dater.course ✓ ..:Natural soil not stripped or SDS area unnecessarily graded . a : a" o a` o r a a a, a o 10 . Ft a " rrair_tained from prop a line and 20 ft a from house a a a: a a a 0 0 a a a a a a Separation of trench from house .. .,well etc. follows plan a o a a '.a< .0 0 o a o a a a a ,i ✓ Number of bedroo�as checks a a: a. a o a :o a a a a Stones, brush, stumps, eater than 15 fta from nearest tr°ncr a a a a a a 15 Ft. peripheral soil horizontally from '' 22of . trench o o o o o o' o . o o o. 0. o- o, o a a a a a Junction boxes prope_-ly set Could surface run off from driveway, roads, ground surface., etc a chain. el near SDS*, , . area. 0 0 0 0 0 'o •o o a o: o o .o o a . o .a : o o Does 'lot drainage appear ear O.K. . in area of SDS FINAL GRADING OF SITE ACCEPTABLE o 7 C p T-d ' - - D ll 17 T S T 0 T Ole" Da t e ��F > 4 Re: Property cf 060 K FEWA-P, S -- C -t, I" fo n— B3. o c L T j 0 G el n e -D "I z o an a C C) e i VIM, -7L---- Z, 0 7 -7 ZL j T e a a o S z z4 -all- t-he -PUt--- ..r: Cc- 0-11 zL z o an a C C) e 0 L? 7, T F-abbi i c -'H7e, J 1 2-71*1' -all- t-he -PUt--- ..r: Cc- tary Code. C 0 Lm t e r s- n e cl. Very yours 7AJ I& IfIAOIS AM A@A AW.,Ul- S i d AC-ldrass' VIL -341 fT -o nc n Tele (S V .-Y—L