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HomeMy WebLinkAbout2455DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51. -1 -18 BOX 21 I rm ' � IA% I .0 ; � . .� T I. I oil �' ,� mile r, WE ` , 02455 PUTNAM COUNTY DEPARTMENT OF HEALTH Division,'of Environmental Health services, Carmel, N. Y. 10512 CERTIFICATE.. OF CONSTRUCTI,.ON ;COMPLIANCE. FOR SEWAGE DISPOSAL SYSTEM _ V_ TV L.L� Located at LL OW W R-6 it d- Q Owner i�K - J ff R� F- /C-, 1 frC L fi /J � IL —. Separate Sewerage System built by �7Qj co1z (7. Ir � b Consisting of Gal. Septic Tank _ Qi✓ Other requirements Water Supply: Section Lot Town or Village Block Z Job Address - 1 io Z2F* 14 j! 7 7 j 4 v YK�/�) I lineal Feet .X - width trench; ' Public Supply From ', Private Supply Drilled By ,PJ<f l _Qavotio,6 i .r� Address; _ ,P9 . V y, G�% 4. /G.Ci ®(... �VRYt r �j 4� I�L.L. Building Type - hit No, of Bedrooms` Date Permit Issued Has Erosion Control Been Completed? I certify that the system(s). as listed serving the above premises were constructed a sentially as own o e tans of the completed work (copies of which are ' attached), and in accordance With the standards, rules and regulations, plan d t ,�+ri /�r /1 p rmit i d y th Putnam County Department of Health.. Date � 1 9.12 1, 7 Certified b e P.E. R.A. v. Address r'. License No. Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any. unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a available and the approval of the private water supply shall become null and void when a public sanitary •sewer;;'becomes subject to modification or change when, in the judgment of the Commissioner of Health, such revocation, modification orlchange`is neces'sapy,vals are Date i4V li7 l f /3 BY �L� +� �Gi' /,SOi1L71J4JY7 T It le PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental. Health services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM II ��/ r'Town or village Located at BELL BELL 14,O -ILO L) IZ04 Section Block Lot /'fJ1t �+p� Al /�1��)G/ 1r �,r 1ev J�obailf� fY Subdivisiil -✓i Address �o(vt✓ 'T " Owner v 1 Building Type - Lot Area Number of Bedrooms ©� Separate Sewerage System to consist of �t /Gal. Septic Tank To be constructed by Water Supply: Public Supply From Private Supply to be drilled by Total Habitable Space y Square Feet lineal feet X width trench, 4O U Address ob- r Address - r" Other Requirements t b 1 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 regulations ions o e u, nam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance!'-. satisfactory to tiie Commissioner of Healthw.ill be submitted to the Department, and a written guarantee will be furni hed the owner, his successors, heirs or;5ssigns;by the builder, that said builder will place in good operating condition any part of said sewage disposal sy em during th p d of two (2) years immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance he final sy em o an ,r firs' thereto; 2) `that the drilled. well described .above will be located as shown on the approved plan and that said well will b nst Iled I a o da ce w he slander ,rules and regu a ons of the Putnam County Department of Health. V _�� Signed Date P. E. R.Pi .!.. License No. Address APPROVED FOR CONSTRUCTION: This approval expires one year from the by the�CommissionernofrHealth .ofAny change 1gor alteration undertaken and, construction revocable for cause or may be amended or modified when considered necessary by 1 requires a ew permit. Approved for disposal of domestics sanitary sew e, and /or private water supply only. ' /� ,�j / i "� t Title G J e? Peekskill, New York 10566 RESULTS OF EXAMINATION OF WATER 1 I OWNER DATE.REUEIYED Jeff Spielberger 11 2 1 73 CITY, VILLAGE, TOWN VOR NAME OF SUPPLY DATE-REPORTED. Bell Hollow Rd. .Putnam Valle 11/4-3/73 SAMPLING POINT BACTERIA PER ML. (Agar plate count at 350C). 7 COLIFORM GROUP (Most probable '/1-00-ml.) less than 202 TAL - ppm DETERGENTS - ppm NITRATES (as N) - ppm IRON, TOTAL - pprw FLOURIDE (F) - mg. /1. These results indicate that the water was Yes of a satisfactory sanitary quality when the sample was col le A. He PADOVANI, M. T. (ASCP) Z. .41, ,A) STC." OF L T, P- T,17-7z S-- TC :z Da. Re: P rope -n-;-77 o =_ He r— !:MELep-p-Gi;;r2. Located at RELL OOLLOW 120,40 4l U4 -LLB", , Sm ct. lon B]. o c k Lot Gen 1 *e -42 Vv 0 ID fo S C C Z. 7 n' 7D 3 0 :z D a r- C 0 S J. o 3 4' 0 r s "!.- �i' J_ 2, 3 3, ., --; - - S - - - - - I - :_, -"" -: 1. -1 y *.�: I --1 t :- - - - - - - �--- _c_e --7.- 147 -- f: o n L -a - _• i -1 �" p n.0 CO--=-,- tary Code. very ",uly yours, C o "m t-ers i cmelzi R.A., e i ep ac n e See. I, A L A 5 on 16 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. Owner M2 �eF-E ?1RZ jln' Address. �UO WE:l PU2 AVE—, PYC .Located at (Street 8F_;_LL gca w (2P', Sec. Block Lot Indigate me_a7 tLF ,:::�i Muni cipality� G, Watershed SOIL PERCOLATION TEST'DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Elapse pth to Water Vater E5—vei No. Time From Ground Surface in Inches Soil Rate Start-Stop 'Min. Start Stop Drop in Min. /in drop .Inches Inches Inches l . r2. � � � � q i 2� %a . 2 0 1 °� �-�— �,� f � oil 2 4 Notes: 1) Tests to be repeated at same depth until a roximately equal soil rates are ,b ' . obtained,at each percolation test hole All data to submitted for review. 2) Depth measurements to be made from top of hole. 0 1 2 4 Notes: 1) Tests to be repeated at same depth until a roximately equal soil rates are ,b ' . obtained,at each percolation test hole All data to submitted for review. 2) Depth measurements to be made from top of hole. 0 1 + a t. r "[ t lU - t x. -. t s 3. 1 1. �, �.a s ,, �:x t , h v, w . ,q.. ., , :. t.. _ F .. . 3, R p r .a - f " r TEST .PIT DATA REQT7IRED"TO BE SUBMITTID WITHa,APPLICATION 3 >',� DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES J. 'DEPTH HOLE NO HOLE NO HOLE NO - ll� t , ,,�,�,.,. , ,,�, . ,,­�!:, . – 1. "I- I I _ ..3- I G: L < TsuQ� ;_ � z . r �/� 11 ; h v d.. �, }.� ;�,'s' ,r h p,� .a~ {y I 1- + S'# �ia.x,,»,v v ° x " 5 r ,,c: �( ,41 ( G , — . a ,b =» iC.'Lf' aY t 11' r F k l$ fr r h , 2�F II ! r >I o t r " �w ` y { �'., `z r `� y 3611 x� x �. ,. L, i ,vi i i [I , � - I _. _ � �_! � ', �, � ­ " ,­__,__� _­1 - Y ; , X � �A ` E 1� �." ;, e , �� , J y cp r o yw t` �� , a 5 '11 ti4 ,:r li I. '� '�, 3 , f 4 y 60 11 r of 1- I 66•' u1JiV I Ew as +- i r y ? yv - �.Y sz a � �, r .,,,.�x'' "" + �' N,'� t i c 6 �" _ �� - s 3 r" y �' "i a �7?,� s 78" '' t : 7 y ji Q� .�� t x - .j i V�;. gd� a r. x ° t-� > a x s� L a ...�. u;. p ,�; - c INDICATE LEVEL -AT WHICH GRQITND WATER ISM ENCOUNTERED INDICATE LE'UEL ° "TO WHICH WATER LEVEL :RISES AFTER BEING ENCOUNTERED L a . � TESTS MADE BY ` . L a Date - - 11 .1 r F 'DESIGN v x x 4 Soil Rate Used S� ®_a Mir , -'Drop � ��� � S.D. Usablhe .Area r Provided I5j. � �� Zr _ n .:-r� t... xf s tu'� x` ,cy '� n („° „` w .- s "`�` c �' 9 + t s=, 1:ts s,. k i FFFY No of Bedrooms Septic Tank::Capa city 114) Gal's : Type �� 1�, s, "* II` — �Absorption Area Provided ByL. F a �/ w dth trencY%. 4 �� . A - 91 h r — j Name C,9 fL _P i'gna ure r f ',,, t 1'g` xn7.> zti -,� •� y' s '":} s _x ^i r x,. d t� + � "�` /..' �� , % ! 5 y f Y �o i "�� �� Acldre s sEf > 4 Y �< SEAL f 4 1 l 'A �� r. I THIS SPACE - FOR ;FUSE. BY HEALTH DEPARTMENT ONLY' „ ; j 4 J t♦ fi $® d6oS + ` ` 4 r- � i� of rt t:�r 1 T} '� r. III Soil Rate. -Approved � j . Sq,. , I IQ l ;�d 'C,he�cke�'d�'b.y ° j`. ., °" *14.11 ,,, 9 .9 „, ”. Y l I - $" �, L _ r 1, . L. i ,,T ' 3 I'� `3` : v f j `� _ - i `It4 T Owner or -Purchaser of Bui ding Municipality (f0) (f0)5jr cofzpl D b LLOCO IZD Building Constructed by Section / � cuA 19Y,51 DFE ,aU� . s. JV SAC 4 � Location - Street f7_-F_!51 Pr-'CF_ 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 :Wade 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- viers o._t.Ye_ �.t- r�:_C�u�t.y Department .c�f_._Hdalth ^ -a.s . to._whet.her_- or_na.- •h.e.. -.._ failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the sys em. i e• Dated this 0-/2- day of 19jL Signature Title SRC l ' C��Cesti 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 r "I "J r 1, i ;� �► / 5P►C/141-:211_1 C _Ap,�r <fo/ZO Building Constructed by r4 '51VAVr'PPK- AVE s, �Y�� Vi'(- Location ­Street Building Type Municipality Section 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- visas- of - -- the Putnam- Coun-ty Departm- bnt• -of �He�alth-••a . •to whether o -r= not the - failure of the system to operate was ca.used.by the willful or negligent act of the occupant of the building utilizing the system. Dated this of 19 Signature Title -� 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 LGGT- AITT7IdI20RT- Iwe1=t7ELF_-Ht)1 LALI-i ' 2 r1h lrfk�-A-n.i A3 I I e I/ t.V O /* .. kiame or viace Ulty, V111age or.-To — % wn Ra UZIS4V_-r,,f2` P-Oz' j: Addres s F 9 P 4110+ -Depth of wolI.._-ja_DiaIteter Vra S we disinfected? f t. in ; gym -y-c-9 br no , plmt.. of casing- above 'ground 9. -Below..;:round /6 -1.1 seal C-411-516.1 in pe7er r, cement 7 -Q4:e� Draw a diagram in the space provided below and shun I J :he depth of c si;argr, the w-,-Il. s...-al, kind and thickness of f9rma,'"Pi.oris en-atrated, water ions, diamet bearinj3 forma ions, er of drill holes with dotted lines and w,;,-th solid lined. dBILL 1 RNMuNS IIE'r ULLT,J "D mind, thiclimess a�nd ype of well-7 Dia.,.ieter, i3i, Depth IT in ft. if wat.----r bearing rilling G 're, 9 Grade Was well. -dyna.miteTT._AI_I____I_7­, I - .25 TS PUM'11,7G T"'I'3 tails- ��-2 . It A,; n­ - - -- .11 *-=.. I— 1�_ � D 1. Btati c aster levei, in ft, .5 b6low - _ Eade Pumpirig­ rate rl (5 100-­­1 . .................... 250 J'OTA, IR a ri.etcia oc the -property ie 'ouch of tbis, sheet locatiog D.Ti-;PC)6AL sys., ...LAO in gpm Ik TLTj) —jj I F:, - i f(� Va. = f n Ift,.,.. below_, r:ada� :MU -7 7171 t-;st in ear Clo y. .::urbid I L'ecom-C.ended depth of -pump w,,...11, feet b:--low- -.,-rade__J IN Y " EIT .Length of s7rc.--en I)iam,, of sci- * een Type of screen q.11k x COHL.j�,j 1�0: Drilling. start.:d/ G.--m-plet dA.-I.Ize- Well Driller' Si -natu:., e