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HomeMy WebLinkAbout2468DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51. -1 -34 BOX 21 , _ iA% 1 ,� ar , ' I1 J I 1 ., �, Am , PUTNAM COUNTY DEPARTMENT OF HEALTH Division_of Environmental Health Sef ces, `Carmel, N. Y. 10512 . i s CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE-DISPOSAL SYSTEM Town or • ... -.., ..,.,.,. .. ._. _. .�.. Villa Located at A Tax Map �,� Block Owner Z20 Lot ©r� Job Separa' Other requirements Water Supply: Building Type Has Erosion Cc Public Supply From - X Private Supply Drilled By I certify that the system(s) as listed serving the above premises were constructed essentia shown on the plans of the completed work (copies of which are attached), and In accordance with v st the standards, rules and regulations, plans filed, the permit issu by he Putnam County Department of Health. Date �y� z Z/ ! T Certified b P. E. R.A. Address 2,9 License No.f: Tai 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 sewera tem shall b ome null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become nu j and oid whe a blic wat ! ply becomes available. Such approvals are subject to modif;7; or change when, in the Judgment of the Q i oner o ev i motlification or change is necessary. Date + 2 it I� 1 /1 6r 14qap a ,6f ' r V 4 dJpn o n ie&lM'r Ali ivW . PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, 'N Y. 10512 ,CONSTRUCTION. PERMIT FOR SEWAGE DISPOSAL SYSTEM Z__ �j/J(�� /% nor I e il.Lo6tnA at /� z oLLow oi`J /J /� 1 Block $ubdiviston ©' v ` ' Lot !0,(�JG Job Owner' > a�t L Addresses • G Building Type G' C Lot Ara J Number of Bedrooms G � Total Ha able Space 2 Square Feet .JCS d lineal feet X v� width trench Separate Sewerage System to consist of G 1. Septic Tank To 'be constructed by e__111 "`-� �J�2D� Address Water Supply: Public Supply From �p Private Supply to be drilled by 'w JeVg��� Address Other Requirements ti,ttt i),111 . nn N I represent that 1 am wholly and completely responsible for the design and location of t\`pptldNte� , 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to ands Thor ftV#J- rich (WVpndards, rules an regulations o e u nam County Department of Health, and that on completion thereof a "Certificate of �nu Comsic�`{s�(sfactory to the Commissioner of Health will be submitted to the Department, and a written guarantee will be furnished the & r��'s s ors0 *i $Xassigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system durOD b` er, o 43, X2a4Immediately following the date of the Issu- ance of the approval of the Certificate of Construction Compliance of the on stem pe i1Wet9to; 2)'that the drilled well described above will, be located as shown on the approved p n and that said well will be Installed ce' anc sta A, rules and regulations of the 'Putnam County D part ent of Health, t'`O Date /07 Signed ' `� P.E. R.A. T_r 2 S1 O d Address llll License No. APPROVED FOR CONSTRUCTION: Thi approval expires one year from the date issued unless construc n of the building has been undertaken and Is revocable for .cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration 'of construction requires ne permit. Approved for disposal of domestic nitary sew and/or private water supply only. . N Date BY Title YORKTOWN MEDICAL LABORATORY INC. Yorktown Heights, N.V. X10598. P.O. Cott 99' 321 K�ar Street. 245 -3203 LAB # 1248 DATE COLLECTED RESULTS OF EXAMINATION OF WATER OWNER DATE RECEIVED MR, JACK McLEAN 2/27/76 CITY, VILLAGE, TOWN VOR NAMI; OF SUPPLY.'.'- DATE REPORTED BELL 3/1/76 ,9AMPLING POINT may BACTERIA PER ML. (Agar plate count at '350 C). .3 COLIFORM. GROUP (Most probable N6, /100m1.) LESS THAN 2e2 ARDNESS, TOTAL - ppm DETERGENTS-ppm NITRATES (as N).- ppm IRON, TOTAL - ppm. FLOURIDE (F) - mg. /1. These results "indicate that the water was YES of a satisfactory sanitary quality when the sample was collected. PER: MOHEGAN LAKELAND PHARMACY D.G. H. RADOVANI, M. T. (ASCP) V y... TOW."'T OF; -PUTNAh' VAL1,EYr- _._.. F...�;.,�_ .�....., U LL DRILLERS LOG AND REPORT WELL LOCATION street section block lot rdELL OWNER name address city or gown WELL DRILLiiR6'Xt44 '� name address city or town_ Ul '' L�:rlgr�: feet V L_. air ete:_ . 1: Inches Kind: Bailed Measure 'rom 1 d surface or �3 Pumped _H Stati.; eft Make: When Bailed Yield: L5G . PM r Pum e ft Length,„ Diameter_ G '07_21M :OEl'TH OF WELL Feet Slot lit..c ze Mlie�te :Nrom 'Give description of forma-,,ion penetrated, such as: Ground Surface 'silt, sand, gravel, clay, hardpan, shale, sandstone, ranite, etc. Include siz� of gravel(diameter and wand ��� Mine, medium, course), color of material, structure (Loose, packed, cemented, soft, hard).(Ex. Oft,to 27 ft. . ­.i fine ac.kea_ _ e.11,ow asar.:d. '.:2 ft:.t.b.134 _:ft Feet �.� Formation Description Ski tch exact location of well to 4"7 at ,least two permenant Landma.r -s ig Q 7 Date ':dell. Completed A'!ORCI 1�%�Date of Report 'T Well. Driller signature 61wner or Purchaser o uilding �G� /'vRv 6r ' Building Constructed by 4r:_-& o a Ul, , /`/ ,.� /�� . Location - St eet ( N' FRMf li Building Type a , t /A 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. D.irect.or of the Division of Environmental Health- .Ser- ' - vicar` of- the "D'`atriam Courit�Departmen`t of " Health'as' to "whether or"fiot' °tie ""-' " ' failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system.- A Dated this day of , 19' Signatur Titl 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 �)D f PUTNAM COUNTY_ DEPARTMENT OF HEALTH Gentlemen: :DhVI'SION OF ENVIRONMENTAL "HEAI;THM 'SER 'VI'CS. "°' Date July 1, 1974 Re: Property of John and Maria Mc Lean Located at Bell Hollow Road, Putnam Valley, N`: Y Section Block Lot This letter is to authorize George Haughney a duly licensed professional engineer x 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 vuIL}CL L1u1} wliri 6ils +ttclUev allu to. supervise the construcriuri of said system.or systems in conformity with the provisions of Article 145 or Edhic�aa:_,aw -;- •tie piiblQ Health Law," end the--Pu-hnam- San'c= eounty- tary Code. Very truly yours, Signed \iyiii419S ?} } }s Owner of PropOnty, Countersi�3:e' ./Address P.E., R.A;, V cl R = e "Z � �z �_y e147 3 Te ephone AMress /X ESS1 f o'+ ++++ a i � t tt ►t�� s-- Telephone --tom 7 x r f ti Y /one y 4 H11V3H VIN3VINUSr " 'O 141 /G°/ A,41- 4�1444—,AISIOA& e �, ld01SIAi U ' _ � "• '' G'' e..�" �'/c%CC��°� !?fit ��'�°�: OF r a > Gam_ y M } • �s �x i ,c - r, FUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner 2az_4z,2 Address t at (Street f fl Block _Lot d eg�, � / 0 Z Bl X , Lot /0, - �Ondicate nears t cross -s-Freet) Municipality SOIL PERCOLATION TEST DATA RE Watershed D TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Mm_ Eiapse Depth to Water ''. at t-ep,, Level,,, No.. Time From Ground Surface in In ., che s' Soil Rate Start-Stop Min. Start Stop Drop in Min./in drop Inches Inches " Inc1le"s" 3/,i2 -1 /0 — - 4/"/Z- /,I:? , /y, I /V4 /0 5 xy 4 * 2 — 3 4 5 Notes: 1) Td is to be repeated at same depth until a roxim4tel� equal soil rates are obtained at each percolation test hole. Affdata to e submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED 14ITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO." HOLE NO. ... ..... .. 611 1211 1811 2411 3011 36-11 4211 4811 5411 6011 6611 72 t 7811 a-,-& INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED. /./OA., R �-, INDICATE LEVEL TOWHIgH WAT -LEVEL, RISES' G,, ,AFTER BEING TESTS MADE BY A7 Date -.DE IGN Soil Rate `Used`, -T� Dr lj Usabl6r- P ,:, \ No. of Bedrooms Septic ank Capacity 00-0 Gals. Absorption Area rovided 0 L.F.x2411 3b" n+ bignature Address 1-wnrP SEAL !Z PE ()4 L 071"" THIS SPACE FOR USE BY HEALTH DEPARTPTNT ONLY: Soil Rate Approved Sq. Ft/Gal. 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