Loading...
HomeMy WebLinkAbout2457DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51. -1 -21 BOX 21 02457 ' 'I ' 0 all I him a ' � i r '1 ■1 1 I 1 '' 1} y' ,, 16 �' �f . ��� �, mr a , 02457 0 r '' h ru11VAm wuly1 I 11JGrnniL1vLG141 yr nrALIri 1 0" ,• v Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM !p ti town or G�/rllage Located at; /��� Nt ✓ "', z' 4L "-r' Tax Map r /� Block Subdivision �C /� f s C " %i �� =% , ���`� Lot /- rs y Job S 4 C it h V s 3�� Owner � f Adtlress Y Building Type oL,) �:.. %..� l� Lot Area �li'.�/ a �h tiLY.r�' • `/ i Number of Bedrooms Design Flow rag e, 6, Total Habitable Space �� '¢ Square Feet. Separate Sewerage System to consist of ,l�I r� Gal. Septic Tank and To be constructed by �� / �YT / 4 -- Address i'r�, • ` e t / Water Supply: Public Supply From y Private Supply to be drilled by Address Other Requirements`�'j� 1 represent that 1 am wholly and completely responsible for the design and location of 041';prop above described will be constructed as shown on the approved amendment there to and in` ctl` County Department of Health, and that on completion thereof a "Certificate of Construc OjI be submitted to the Department, and a written guarantee will be furnished the owner, s su place in good operating condition any part of said sewage disposal system during the ion ance of the approval of the Certificate of Construction Compliance of the original sy'em m will be located as shown on the approved plan and that said well will be Installed in accorda`rt with County Department of Health. Date Signed � a Address 2 Z.7-- �e/.%7L "'*%'�'r ✓ / _ / d® APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless revocable for cause or may be amended or modified when consider ecessa y by the ommissio requires a ne_w ermit. �Arov�f� di sposal of domestic san tary ew e, an iva e w Date By U em °rs ,,�at the separate sewage disposal system :t bhe,A an ti rules and regulations of e Putnam Iom ``���sst� AtkeM to the Commissioner of Health will s, hei s'db'assign4ty the builder,-that said builder will oe year�s;LSim drately following thedate of the issu- ep`'j_ s here j� t at the drilled well described above �stan@ rds,` a les and r ulaMons of the Putnam €! A eg P.E. R.A. License No. fe the building has been undertaken and is Any change or alteration of onstruction — Title Ir Separate, Sewerage System—Private Water Supply r Municipality CERTIFICATE OF. CONS RUCTIION.,C /OMPLIANCE / 'WCDH File No, _ocated at ^� ' L ®Jt✓S+' ©� 6/t J Section " Block Jwner Lot �• >C� Job Separate Sewerage System built by �✓ ����g Consisting of Other requirementsL'd Masonry, Mirada @Aptic Tank 3E? 4 24 feet width trench Water Supply: Public Supply From �gmber Private Suppty Drilled By AddreBuilding Type of Bedrooms �, Date Permit Issued Erosion Control Completed Other Requirements Waived I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the coma with the standards rules and regulations, plans filed, and the permit issued by the Westchester C unty Dep tment ofJWlth. Date V !�° Certified By 6 b� Ahy person ccupying prerdFses served by the above system(s) shall promptly take such action as may be necessary -to sedpre such usag . Approval of the separate sewerage system shall become null and void as soon as a public sanitary sewer becriirjo; become null and void when a public water supply becomes available. Such approvals are subject to modification or changeI revocation, modification or change is necessary, said modification or change shall be done under the supervision of a IPcen With proper ntrrintenance these systems can he expected to function satWiictori1)Qnd are not � Date 1 `- ©� \ \. S. D. 47.66 4� County Department of Health 0 ,`ta�wtt�oorrnr�y�� woQs (Qie9;'df4wNr Iere attechad), and in accordance � 0 9 ¢. a °o 4Y/ t ;'31 .1 � �n act 'p- � J � e `� l4 ;orr o ,. f ny u ' _ i r kconditions resulting from able?'p•pd''th� �"��1pprov3l of th�privete water supply shell in t�t�llutiQmePt of'Be Commissioner of Health, such Iraf ssle'ri'sl'£naineer co*r,GRegistered Architect. n /A/ JAN 2 21980 M I 1 1 t E M ( ORKTOWN MEDICAL LABORATORY., INC. ;'P.O. Box 99 321 Kear Street u LOCATIONS: N Heights, . 11 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245 -3203 �ob�toW1 N.Y. 10598 ❑ 201 BUTTONWOOD AVE., PEEKSKILL, N.Y. 10566 737 -8777 245 -3203 ❑ 495 MAIN ST., MT. KISCO, N.Y. 10549.666 -3335 3 j ❑ STONELEIGH AVE. (NEAR HOSPITAL), CARMEL, N. Y. 10512 278 -9330 DATE COLLECTED RESULTS OF EXAMINATION OF MATER OWNER DATE RECEIVED CITY, VILLAGE, TOWN VOR NAME OF SUPPLY DATE REPORTED SAMPLING POINT BACTERIA PER ML. (Agar plate cot 157 DETERGENTS - mg /L AMMONIA, FREE (as N) -mg /L a These results indicate that the water S r TOWN OF PUTNAM VALLEY 2 WELL DRILLERS LOG AND REPORT IJAN WELL COMPLETION REPORT This report is to be completed by well driller and submitted to Bldg. department, together with laboratory report of analysis of water sample indicating water is of satisfactory bacterial quality. Well Location Tax Map Street Sec. BI.- Lot Well Owner T( n �. l jro- i �rn.a I 34- 10, g3yd S� A.) , .� Name Mailing Address City or Tows ;k ijo, !��''! -336? Drilling in rock -set casing-grouted Tel. Well Driller P.F. Beal & Sons, Inc. 4 Putnam Ave., Brewster,NY Name Mailing Address City or Town CASING DETAILS YIELD TEST WATER LEVEL SCREEN DETAILS Bailed Measure from land surface Length 71 Ft. or 6 XPumped Hrs. Static: 15 Ft. Make: When Bailed Slot Diameter: 6 Inches Yield: 40 GPM or Pum ed Ftl Len th Ft.Size Heavy Duty Kind: �pa.„i PAR S +AP.� 'Diameter In. TOTAL DEPTH OF WELL 160' Feet WELL LOG Depth from Give description mf formation$ penetrated, such Ground Surface -as: .peat,, silt, sand, gravel., clay, hardpan, ___..�. __... _...... ...._..._ _._ . - . -_: -shale i..- sandst- one.,...gran,.te, -• •etc -.- - Include gravel (diameter) and sand (fine, medium, coarse), color of material, structure, (Lose, packed, cemented, soft, hard). For example: 0 ft. to. 27 ft.,fine, packed, yellow sand; 27 ft. to 134 ft. arav granite __ Feet to Feet Formation Descril2tion 0 to 60 Drilling in overburden clay & boulders Hit rock at 60 feet 6Q to 71 Drilling in rock -set casing-grouted 71'to 160 Drilling in rock schist Date Well Completed 11/20/79 Date of Re rt 7 1 BZS 1 -77 Well Driller Signature JAN 151980 J7, V.,_ -...1- ... -.- Gentlemen: PUTNAM COUNTY DEPARTMENT OF HEALTH DIV YSION OF ENVIRONMENTAL HEAUH SERVICES Date -311217 Re: Property of J4.1 6 � � lTr,'l�/ -� %'� -� y, V 4.1� A Located at�� �� /7110 -'Z/ Section 23 Block Lot 1.6 This letter is to authorize__ : y-,p, ce %l �+ ✓a-s/i 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 a:�aliiC� LlJdt w.L #-ri LIUS nia a Let• anti to. supervise -Lhe construc ciun of said system or systems in conformity with the provisions of Article 145 or ' ..l.tj,7;_ Edu-c-6-fi on - Lwvj- the Public - Health Law, and -the- Putnam"County- Sani- tary Code Countersigned: 1C eE o9 >, 1'r Address Telephone ,�q tga;, •r tlr.. a .. r�anr,c. seo;3s ti Very truly yours, �d•C?/Y'.�� Signed Owner of ",Property '35 Address w ' 0 Telephone PUTNAM COUNTY P 2ART T Oil' HEALTH DIVISIDN.OF ENVIRONMENTAL 1I.MTH'SERVICE9 ' 40i1 - -- `OFF1CL°-B�iir�DT7�rG N.. 10� � P w.... }er g �;� L? TA °�T -3 PAFiA E SEi,IAG1a ISPR , �? ST �d P Lo& v : A4� ? �t (Street �c'' �. Sec. �_3 Block 7L $ cate Wept) ... ,.. ? �° 6Jatershed SOIL •C OIATION TEST PATA ARE UIRM TO BE, SUBMITTED rose - I iJ t PERCOLATION LOO MME � . . . apse Ptn.to 4a er -. FJ�o ' 1�7 ►a�n ound Su ce in lneho6 . :' So., re I.- .. Colt -Stay f r, p Start Stogy°o� in: ; ,: t `Inchos Inch9ss,• Inch©b:'. . X23. 2r • i ' ,, -- 1Ap'1 q AV/''� 9. s ,1�1 Y��.r>a.�.s4e I�m�..imlPOi^ � : 1' Efate s . ) ..Rasta to be repeated at cams depth' untU m o • r a �ta � , u� ± f ra a m?a obtalned At each ercQl tion t® Node, Aj 6 'VD .a n 2), DOPO nioasurementm to be , maclo o f We p i j ;: +• ; V Owner o Purc as r o .Building Municipality Building Constructed by Section J 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 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- .vice.s_.o ._ the- Pu.t =ri m- -taut Department of I�ealth -as -to- whether 0�' riot 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 g6tday of LZO 19-L 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 .gib r ..._„ ,..:,. •�:...r.:t u,a"c g a h Y �-c� w S Z cs N 4 0 --) t c l w G S {{ -!. ,.:.,. _:,:'� "16.0_... R7►6 t_a_�..._.. `.� y,fl ...._.� -S a ,,,, ;' a.y: >:. ...,.,. r to { U f �•.. 8 - 14O�LAPJ� -4\f 0,t, ?,,,.��. i.._N 47S'i+�Ot{ Uq`�i K� 27;11'�d.}� ' F }p ����'.fF�'� -��+ •,.�b�r 7YcrAt,. t.1.. „'s�Y7.M.'Slj,•Vy�;bdb0'3� ( t r ct.t�' 1t ri 1 { +0 not 1. 1 'L'' 18'1.1 . �-~ --_.�i _ � ,� Est � �• r;b r } , 3A(), , IA if i # f SA, D t jt fA. .: `� . i i '. 1 • y. s 1