The URL can be used to link to this page

Home My WebLink About2467DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51. -1 -33 BOX 21 02467 I= ~PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE-DISPOSAL SYSTEM . •ITT`' .(� E Located at- N Q�iL' y� %QQ/�,O /, / o n or Village Subdivision =C- �/`� Ot /�j/ / ✓�/'� -rL��f /� Lot �i �Q� Job Owner— �-/ W/`fKLe/_�/�/S/�LIFLL f ` Address Building Type of Area Number of Bedrooms �♦♦ a Total Habitable Space Square Feet Separate Sewerage System to consist of / 6 o Q N g y Gal. Septic Tank �-+ �� lineal feet X �� width trench To be constructed by Ito Address Water Supply: ��fj Public Supply From L_ Private Supply to be drilled by -4 �� G'��,� �,y� /✓ Address Other Requirements I represent that I 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 a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will -be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system durin the period of two (2) years immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the system or 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 Install rules and regu a ons of the Putnam County Department of Health, 40 ' T sign 9 P.E. R,A. 1 Address _ �L ez License Nn A,Y -,N nNSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken, and is ,be amended or modified when considered necessary by the Commissioner of Health. Any change or alteraton i of,.coiistruc�floon ti 1 '�s ved for disposal of domestic s9nitary Sawag nd /or p ivate water supply only. DETERGENTS mg NITRATES (as N) - mg/L IRON, TOTAL - mg L. r . TIMONIA, , r EE as N g /L These results indicate that the water was YES of a satisfactory sanitary quality when the sample was collected. PER c REDS BUILDERS � NORTH Q1AM LANE ;t ;;. �. •�i _ 1 �'' ` ;''� ME PPM9 N.Y. 12538 ��A. H. PADOVANI, M. T: (ASCP) By Title l@ y s I, �, • i YORKTOWN MEDICAL LABORATORY INC. P.O. Box 99 321 Kear Street Yorktown Heights, N.Y. 10598 � '.x#9262 245 -3203 DATE COLLECTED' RESULTS OF EXAMINATION OF WATER OWNER DATE RECEIVED CITY-,. TOWN & OR NAME OF SUPPLY DATE REPORTED' li B$LL BOW* RU. PUl ^ z SAMPLING POINT ! BACTERIA PER ML. (Agar plate count at 350 C). COLIFORM GROUP (Most probable No. /100m1,) RDNESS, TOTAL - ppm t IPBS tha, , DETERGENTS mg NITRATES (as N) - mg/L IRON, TOTAL - mg L. r . TIMONIA, , r EE as N g /L These results indicate that the water was YES of a satisfactory sanitary quality when the sample was collected. PER c REDS BUILDERS � NORTH Q1AM LANE ;t ;;. �. •�i _ 1 �'' ` ;''� ME PPM9 N.Y. 12538 ��A. H. PADOVANI, M. T: (ASCP) __`yr(•r�a�'�' f kJessaoau s! a6ue4o Jo uollea!Mpow 'uol neJ 4ons '431eaH ! Jau wwo0 a4l ;o luaw6pn( a43 u! 'ua4m e6ue43 Jo uo!le3! ;!Pow of loB(gns We slenoJdde 4onS 'elgellene sewooaq kldd JOIeM allgnd a u04M P!on pue linu Owooeq Ile4s klddns JOIeM elenlJd 044 to IenoJdde e4l pue elgellene sewooeq James k.1el!ues ollqnd a se uoos se Plon pue llnu ewooeq lleys welsks e6eJames eleJedOs e41 ;o IeAOJddV •96esn flans woJ; 6ull!nseJ suolllpuoa kJelluesun kue ;o uo!loaJJoo 94l eJnaes of kJesseoau eq kew se uo!loe yons wlel klldwoJd lletis (s)welsks anoge 941 kq PanJas saslweJd 6u!kdn000 uosJed kuV •oN esuaoll _. ,..,.......,..._�:,:. s. -.- �., .......... _ssaJPPV- • _ _ _. V•a•3•d r kq Pal ;!3Je0 eleQ r4 '41leaH ;o ;uawlJedea kluno w Ind a kq -onssl d a43 pue 'pal!; sueld 'suollein6eJ pue selnJ 'sp.lepuels a4l 43!m aouepaoaae u! pue '(13943e4le aJe 4o14m ;o se!doo) )IJom pa�eld a 3 ;o sueld,944 uo mo4s se klle!luesse palanJlsuoo eJam ses!wOJd anoge a4l 6U!AJOS pals!! se (s)walsks e41 le43 k ;!lJeo I Epaleldwo0 uaeg IaJluoO UOlsOJ3 sell penssl 31w.4ed Oleo sWOOJPe9 ;O 'ON edkl 6ulpl!ne t S^ t ssojppV ,� k9 PelllJo klddnS OlenlJd woJ3 klddnS ollqnd :klddnS JaleM St42� /} sluaweJ!nbeJ Ja430 _ duel a!loBS 'IeOooC,+'7,` ;o 6ullslsuo0 ssaJppV '�0� \ �-� kq II!nq walsks e6eaames aleJedaS .y M 1 1 JBUMO le peleool Mlow a6ell!A Jo UMOI _``"► J 0 W31SAS IVSOdSId 39VM3S UOA 33NV11dWO3 NOIAofkasNO3 :10 31V31:1111:133 y4`^- Zt50t it 'N 'law�e0 saa/n�aS,, y4 /ea/./ /eluaWiJ0J1AU3 Jo Uo/s /n /Q I[ 1'1V3H 90 1N3N11AVd3O A1KnOJ WYNIflld[ PUT NAM (COUNTY DEPARTMENT OF HEALTH" ;fr° Division of Environmental Health Services, Carmel, N. Y. ' 1051. f CONSTRUCTION PERMIT FOR SEWAGE DISPOSAI..SVSTEM l— uTN�' =�! r Villa � • C.��S Town or Villagep Located at '- b!=L_L_ �,Y1 ( g19Ck F.O�r �S G c I Subdivision p l- �nJD +�<+ t� Lot `r•- Job 1 Add' ss t``Q cg) lGEq25 IZ- Building Type �E� �-- Lot Area Q- / ^' N Number of Bedrooms Design Flow 2.D Total Habitable space e)JC , / — Square Feet Separate Sewerage System to consist of Zd d Gal. Septic Tank and SC9 0 (^ I A) l 2 ,41( Tg! To be constructed by L & f A )S T'. Address' [. (� (— Water Supply: - Public Supply From �/ Private Supply to be drilled by Address Other Requirements I represent that I 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 and regulations o e . u nam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system during the eriod of two (2) years immedi e y following the date of the issu- ance of the approval of the C tificate of Construction Compliance of the original s or y repairs I. ereto; 2 a the led well described above will be located as sh n on the -proved plan and that said well will be installed in a r n the sta ards, a d r a ' ns of the Putnam County Departme of H It . Date � Signed P.E R. A. Address Li a No. APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the build has been undertaken and revocable for cause or may be amended or modified when considered necessary by the Comut sioner of Health. Any change or alteration of construct, requires a ne /pwq permit. Approv^ed� / for disposal of domestic tart' eowae an r priv pply only. 64 Date y � / By _ `r Q�7Zwa�TA�L�� \,000 1 l • .9,Yr' Box 5� �`'I' %� -• , -� •8, '�TA' �FV�GT��f'� �� A', -1,. l 0 3 t: 8 - 'X t�, 1='F'� G- G71��- . j�ti�t't\ • Tags 7ry ' �If�f9DJ,A:i �''(4{>•�ri ��r,,,,((h��j �onarj'TGju<T�Ta �� -T s • oN`Ta�t��Lar� �T►tA.T T�la _, o '=a .. p ra 1).. , �:��.a•_ L./a�b gq`►Gteo 'E� "C ►� ,F�j t> wows: L , V4A4 601JI&r �uGCcm''j,.. {�GCoRQw:iZc (�TK Ax IDNL OF �"it1� ?�i:T+.lAr�''�o �',E'- T'T'•'o� t•1�rc-T-a • • r l TL At-s- G' G ALA _O .. L1 s o Fig- E-Ti jre'' • EJL�.I. x'10 ;- 1.G�.l�.'. C)D Ate- - /. _ .. .. • ' �OviN ,OF �iailif.M `IAi._L.�'R, Y� •'(a .APP (EVE. . °, �.0 yam,, - . - FE81 •c�OK' Z.Ai 3�. ... - ., • . ,. :uTNA �Sf- .•�O'F�c.:.K I`:% '� . - , . CryI310N Ofi • "'• • s�nliaoNMFJ+TD4 NFN:TN'BE®fll&� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF 9MRaNMENTAL HEALTH SERVICES - -C4UY- - OFFICE-_BU.ILDING;- .CARbELti ;..N:-- Y:. - - -- ..10512'.: y =4 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Qwner 4 L Address Located at (Street Lo /,> 2 Block; c , ,:: t /O. n ica e nearest cross s ree Municipality�z&W I ,�[L G�� Watershed 6 l SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Water Level No. Time ,,. From Ground Surface in'Inches Soil Rate Start -Stop Min. Start,`,. - ' : , Stop,' Drop in Min. /in drop Indies Inches Inches 2 3r G� / �` �� l✓ J C-L . 5 Notes: 1) Tests 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 SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. 4 HOLE NO. G.L. 6" 12" 24 Son -~ � �,�°.:� ��_�•.� ��`�`��_ `�4 . 3611 42" 48" 54 if D 60" 6 it 727' 78' "; A 84 tt INDICATE LEVEL AT WHICH GROUNDWATER IS- .,ENCOUNTERED 14d�5 A INDICATE LEVEL TO W.[;ICx&R LEVEL RISES AFTER BEING•ENCOUNTERED TESTS MADE BY 7' Date - DESIGN Usable Area Provided:- ., �00tu1,, ��• THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: "OiIIIVO► Soil Rate Approved Sq. Ft /Gal. Checked by Date PUTNAM COUNTY DEPARTMENT OF IiJ�ALTH DIVISION. OF ENWRONP42TITAL WLTH SERVICES .,.,. ... >,- ..��.:A.�_, _. '- COUNZ 'Y._.OFFTC�,..F�U,[LDI1`IG; �.CARM1�h; =� ;N .ir.. ��a�12� >� ..,. n � �,., - ... 4:..,,,.. _. ,•.I DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM. FILE NO. Owner' Address c) r (IA AA4--P-S1 ;'• Located at (Street S sue' Ty ica near cross s euj Municipality ��,-�-,��,,ti Watershed �. ,�� d S CA w �v� SOIL PERCOLATION `PEST DATA REQUIRED TO BE ST BMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION 2 5 0 ~� �. Zz- Notes: 1) Tests to be repeated at same depth until aP.pr.oxima.tely equal soil rates are obtained at each percolation test hole. A11 data to be submitted for review. .2) Depth moa.surements to be made from top of hole. Run No.' Start -Stop Elapse Time Min. Depth. to tI.Ater Water• Levei From Ground Surface in Inches. Soil Start Stop Drop in Min. /in Inches Inches Inches Rate drop / 2 19- 20 24 - z3- -1 % 9 - Z 3. D, - /'0 /D Z �' - d ZJ - 24 2 5 0 ~� �. Zz- Notes: 1) Tests to be repeated at same depth until aP.pr.oxima.tely equal soil rates are obtained at each percolation test hole. A11 data to be submitted for review. .2) Depth moa.surements to be made from top of hole. DESIG Soil date° Used Min/l "Drop: S.D. Usable Area Provided DUd - --. N6.'-'of Bedrooms, Septic Tank Capacity Gals. T Absorption Area Provided By L.F.x24" wid Ype th trenc . h/ Addressy 0 ure SEAL v .. 1 1wclev o1: i'tix crJ =��c . of Bu:i lcc Lri�; L4U uc;u.. _U y . Q, Sze ...L.ocaton .Street � Bixilding Type • a, ,n :_.::_` i°iuih1C31),Ll i.t;y Lot GU!►t?PMY OP SEPARATE S_:'IW AGE SYSTEM I represent; that I am wholly and completely responsible foi- the .' location, Wor'_�ansh.L material, cons truct:7_'on and dra:l.na: e cf the .3e-Yi . .' _ _..-- di.sposal system serving the above .desc_ ihed proucrty, , and that it has, boen constructed as sroi:n on the approved plan or approved amend:lient tEicre`t.o, :.and in accordance with the standards, rules and- regulations of the PutnIn'lu County Department:, of Health, and hereby guaranty to the owner, his succes- sors, hairs or assigns, to place in good operating condition any. part of said syste:i constructed bar ?r,e rrhich•f.'ail_s to operate for a period of two years i, - n media tel_y follo-:i1, the date of initial use of tl.e sewage disTacs_tl system, or any repairs made by . me to such system, except i.Jrhere the fai,lura to operate Drop; rly i s c�iused by the w-1 l.lful or negligent act of - the occur pant of the building utilizing the system. �y�t: uriiici sigr�ea �urtiiar aFr•ees to Accept as conclusive the do- termination of she Director of the; Division of vironmcn-,;al Health Ser- vices of the Putnam County, Departr:cnt of Health as to whether or not the failure of the syster to operate ,as causod by the willful or negligent act of the occupant of the building utilizing the syste, Dhfid.. thi's' ...- aay of 1 �19 Signature ' �c % •� ` - '�.....__ I_ •Ti t•I e (li c,orpora i;ion, give I1A!4e and 2:dd -ess ) ALCAR CV -4 UIU WTV114 !Nc. P._EEKSf IL! '�J. Y. THREE (3) COPIES ARE REQUIRED WITH, T 11 iR.BE, (3) COPIES OF FIPiAL. PLANS BEFORE CERT.L ICATE OIL' CO1.1p'ETION 14ILL BE ISSUED . GUAI;!ANTOR IS REQUIRED TO FILE NOTICE OF ll9TT OF FIRS"' USE OF SY'STE?M Division of Environmental Health Serviecs, Putnam County Department. of. Eicaltiz WELL COMPLETION REPORT 3/71 PUTNAM COUNTY DEPARTMENT OF HEALTH 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. o-, Satisfactory_bartesfal,Owlity�b fore;64riifi'Cate of'cohsti5 tion`compliance is issued. N J FREPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER &JAME ADDRESS LOCATION OF WELL Aiz (No. 6 Street) (Town) (Lot Number) PROPOSED USE OF 1AfEL6 L DOMESTIC SUPPLY BUSINESS Cl ESTABLISHMENT INDUSTRIAL E] FARM CONDITIONING El TEST WELL El ((SSpe iffy) DRILLING EQUIPMENT ROTARY COMPRESSED AIR PERCUSSION CABLE PERCUSSION OTHER p(Specify) CASING DETAILS LENGTH ( feet) Q DIAMETER (inches) �� WEIGHT PER FOOT 7 ( J L THREADED El WELDED E SHOE YES [I NO CASING G YES T NO YIELD TEST ❑ BAILED HOURS PUMPED COMPRESSED AIR G.P.M. YIELD (O.P.M.) WATER LEVEL MEASURE' FROM LAND SURFACE —STATIC (Specif feet) y . DURING YIELD TEST fleet) i Depth of Completed Well v2 � O in feet below land surface: SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS 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. FEET to FEET If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL OMP TED DATE OF REPORT W RILLER i ature) PUTNAM COUN`.rY DEPARTMf-,'NT O ' 1fr,ALT1t DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date_ Re . Property of `..' Located at L7yS -&e eT:mn �J ( .1 Gentlemen; Lot This let is to authorize T. YJCP,A,EL DALY p,E„ -a duly licensed professional engineer X nor 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 ;onnection with this matter and to supervise the construction of said ;system or systems in conformity with the provisions of Article 145 or 147, Education Law; the Public 1lealth Law, and the Putnam County Sani-- Lary Code. ,untcr s ign GCG .E., R.A., T 43468 _ !;o.0 243 Shenoroek �ioyo A& r e s s 914 24.8 7494 :lephone Very trul yours- e Oe:� Signed Telephone 04/