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HomeMy WebLinkAbout2469DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51. -1 -35 BOX 21 1 rm "' I % , i 1 02469 r PUTNAM COUNTY DEPARTMENT OF HEALTH Division of ,Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM y A1 ✓�/�,I i�T• ,;. ,rj���C,Ci 1:ro Town or. VHloge r ,l_ocptes}.:dt�ci. 1. _ (raw' 11 a. l�. 9 f f SifiSi'�Eh' �" Block I Subdivision L� r �� d .+U i K� J - ' �L/�/•7 J �% L�r .y r � Lot U • �'. Jo/b^ Owner '- Address.f ' !� �' "ctiAa °S: E r +• G' Building Type Lot Area �� _ i 7 Number of Bedrooms Total Habitable Space �✓� �`' ���� ti' 'Square Feet Separate Sewerage System to consist of �% a -sp Gal. Septi Ta 4-2- Z lineal feet X width trench / To be constructed by "' jr'rf 6^� �' 1 N: L �'� y�! �,' �' y Ad ss G ', a Ad U42S e�r.�' Water Supply: Public Supply From r --j--�Prlvate. Supply to be drilled by -A { r h Address .Other Requirements `�U�` �r3 E C^J u-° Gi° win..._.a -_ %L�U 1 represent that 1 am wholly and completely responsible for above described will be constructed as shown on the approv County Department of Health, and that on completion be submitted to the Department, and a written guaran place in good operating condition any part of said se ance of the approval of the Certificate of Constructio will be located as shown on the approved plan and that sal County Department of Health. rposed sypterij(s); 1) that the separate sewage disposal system danc w h a standards, rules and regu a ons o e Putnam m mpliance" satisfactory to the Commissioner of Healthwill successors, heirs or assigns by the builder, that said builder will lod of two (2) years Immediately following the date of the issu- or any repairs thereto; 2) 'that the drilled well described above with the standards, rules 'and regu aaffons of the Putnam Date �VO�d,3 P. E. ..- R A;... Addresses t74' + • ��� License fVO: APPROVED FOR CONSTRUCTION: This approval expires one year from the date 4ued unless ruction of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissi ne► of Health. Any 'change or alteration of construction requires a new permit. Approved for disposal of domestic san ar ew ge, a ate n)x.aonly. 2 -- 4 �' Date By Title Other requirements Water Supply: Building Type Public Sc__'" Private S Address r— I A-- L. wTTq*e..gf Bedrooms J Date Permit Issued Has Erosion Control Been Completed? I certify that the system(s) as listed serving the above pri attached), and in accordance with the standards, rules Date 6 ' 17 % %, Address Any person occupying premises served by the above syste conditions resulting from such usage. Approval of the Nb.c available and the approval of the private water supply sh subject to modification or change when, in the judgment of the shown on the plans o)the completed work (copies of which are permit issueA by a Putnam County Department of Health. P. E. R.A. License No. -3 Z-7 -2') tv4f action as may be necessary to secure the correction of any unsanitary all become null and v a as a public sanitary sewer becomes when a public water pply beco es available. Such approvals are pf f0ealth, Such rjKoca or), mods fication or change is necessary. ; DEPARTMENT QF ,HEALTH:',. 1 Division of Environmental Health Services, Carmel, N. Y.: 10512 PoTai��a� 'VhLt.EY' CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Ioy4A.' a� Town or Village Located at n 5 s•'L 40('t"0W F- AE) -s Tax Map .2 3 Block 4- Owner �P—,4 a 1> Di Om p—n e" Lot �'�' "Z Job Separate Sewerage System built by KF -V► .AU4"Tl1.)G Address L LICE- Consisting of 12 Gal. Septic Tank and '240 ig . Er 3 u" La E. A,� r 14 Other requirements Water Supply: Building Type Public Sc__'" Private S Address r— I A-- L. wTTq*e..gf Bedrooms J Date Permit Issued Has Erosion Control Been Completed? I certify that the system(s) as listed serving the above pri attached), and in accordance with the standards, rules Date 6 ' 17 % %, Address Any person occupying premises served by the above syste conditions resulting from such usage. Approval of the Nb.c available and the approval of the private water supply sh subject to modification or change when, in the judgment of the shown on the plans o)the completed work (copies of which are permit issueA by a Putnam County Department of Health. P. E. R.A. License No. -3 Z-7 -2') tv4f action as may be necessary to secure the correction of any unsanitary all become null and v a as a public sanitary sewer becomes when a public water pply beco es available. Such approvals are pf f0ealth, Such rjKoca or), mods fication or change is necessary. PEEKSKILL MEDICAL LABORATORY 1579 Crompond Rd. Barclay Plaza Bldg. A, Apt. 1 Peekskill, New York 10566 RESULTS OF EXAMINATION OF DATER DATE COLLECTED 3_av ->4 DWNER DATE RECEIVED CITY, VILLAGE, TOWN & /OR NAME OF SUPPLY DATE REPORTED // //a/0 a) AM - �w Z Aut . PE 7 -8777' 3ACTERIA PER ML. (Agar plate count at 350C). j COLIFORM GROUP (Most probable N6. /100m1.) less Mao x - a- HARDNESS, TOTAL -ppm )ETERGENTS - ppm NITRATES (as N) - ppm IRON, TOTAL - ppm, 'LOURIDE (F) - mg. /1- 'hese results indicate that the water vas of a satisfactory sanitary quality when the sample was collected. 7 /eJ a Owner or Purchaser of Building Municipality J Qs?A-eQ — -23 Building Constructed by 9*04-A=--r4K MAP Location'- Street Block &j_0AA1 t*e— 2,- 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- _vi.c.es:.of. the .Putnam .County. Department of Health has.- 'to,'.whether. or. .not . -the• • -• ailtire"of thb­system to operate was caused by the willful or negligent act of the occupant of the building utilizing the sys m. Dated this day of 19 Signature 0 Title�c%� . 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 0 ( � ,0_ i �gP,6 Owner' or Purchaser o Building 6 ,gv Building Constructed by An Location - Street �S'l��i�%i'i•�l t Building Type F� 4t=- �c✓i .�G� .0 Municipality _ a 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 operat *ing 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 .c.onc-lus ..ve ..- the - de- -- t�errrii�nation -of--the'Di-re-ct' r -o-f 'the Divisi "6n of�Environmental' "Healtfi `Ser vices of the Putnam County Department of Health as to whether or 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 6 Signature T Title, y If c rporat on, g ve nbA7 and address) PE_� E�e_ �;, i� Lj IQ537 ------------ 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 i� 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 oi•viratgr sarrtple �djgajingyir�i,9r_L5;af Saiisfactory..bac *erial.quaUty ;before certificate -of construcfion coovapliarsrre is issued: REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER AME ADDRESS LOCATION OF WELL (No. 8 S et) (Town) (Lot Number) PROPOSED USE OF WELL BUSINESS © DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ OTHER DRILLING EQUIPMENT COMPRESSED CABLE ❑ ROTARY � AIR PERCUSSION ❑ PERCUSSION ❑ OTHER (Specify) CASING DETAILS LENGTH (reef) I t DIAMETER (inches) r r WEwHT PER FOOT ,� � THREADED El WELDED O YES ❑ NO G YES NO YIELD TEST HOURS G.P.M. ❑ BAILED ❑ PUMPED COMPRESSED AIR 1 YIELD (G.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST [feet) Depth of Completed Well in feet below Land surface: SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (loot) SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (Inches): GRAVEL SIZE (Inches) FROM (feet) TO (loot) 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 WEL COMP TED( PATE OF REPORT WELL DR I ER (SIg re) I Full working drawings available; see page 112. Rustic (comfort PLAN 0065JC4—jerkiii-bead roof, leaded glass windows and rustic materials such as wood shingles and stone masonry give a cottage charm to this house's exterior. The interior plan is designed to - grow with the family via a second floor which can be left unfinished until needed. On the first floor,' the living room is directly acc _ssible from the flagstone-floored foyer. While passing through its entrance -arch, one finds old- world influence galore in the form of a beam- laced cathedral ceiling, a pair of s.tory-and-a- 5 3'- 5" x 12' vanity a; desk C. FP F=7- GARAGE half windows, a bank of windows with diamond.•, panes above a window seat, a log-burning fire- place, French door access to a porch and a. bal cony with balustered rail. The kitchen and dl16-:, ing room are open-planned with the possibility��­, of being finished as a 9 kitchen-family room. The'. , two bedrooms on this floor share a common' bath while the upstairs bath is compartmented for multiple service. The- first floor has 1,208 sq. ft. excluding garage and porch while the second floor has 549. I 10' -4'x 12' I C. C. W. T BATH 16-- up laundry �Ct balcony C. Giving room beW lace "Place C. master' BEDROOM balcony alcon!,�, 14'. 16-3 0, above 1 G ROOM i6l`01 BEDROOM I .LIVING 19'x 13'-4" 12'x 12' window seat. second floor plan 'PORCH 4 . a a a first floor Ian Irst floor plan N TODAY'S. HOMES 66* PU T.NAM COUNTY DEPARTMENT OF HEALTH AL HEALTH. SERVICES- DIVISION OF ENVIRONMENTAL Date X- Property of 01-Rjo De Located at A. 17 SeQ-tilan Block Lot /0,2 Gentlemen: WDER This letter is to authorize a duly licensed professional engineer or registered architect .(Indicate) to apply for a Construct-Ion 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 C� W_LLJ1 L11-Lo 111dLLL'V diki LO bUE)L11'V18e Llit. 0715 *LX'UQ' •1U11 OT Sa IQ stem or systerns in conforinity with the provisions of Article 145 or Sy I F; 2 147 Education Law, the Public Health Law, and the Putnam County .._�ani - - '7' ­'ta.'r'y Code. Very truly yours Signed Owner of Property Countersigned: Address / a Telephone' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES . COU1V�'YOFFICE „'EiUILDIPIG, CA`FiNIEL, 1�`: °'Y'. '1D�Y2 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.. Owner 6�PA_gn 491 0460 Address Q.v 3` h / .i,,Z), T -AA41� Located at (Street Fu. �u �� e7q• 5�. J3 Block ¢ Lot �indlcate nearest cross s roe ity r�Muni eipal Watershed r c,F�,s LiS•fc„� -SOIL PERCOLATION. TEST DATA.REJUIRED TO BE SUBMITTED WITH APPLICATIONS 11601-el . . Number CLOCK TIME PERCOLATION PERCOLATION Run Eiapse —TFp7h to Water Water ve No.-. Time From Ground Surface in Inches Soil Rate' Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 210; 4 --- A-44- 3 /g 15 5 2 4 � ' 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. 2 o U If-37 g?e 9_3. 210; 4 --- A-44- 3 /g 15 5 2 4 � ' 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. ME 0 5411 - ..6O1t -'r 66'1 � TEST PIT DATA REQUIRED TO BE, SUBMITTEED WITH APPLICATION DESCRIPTION OF SOILS ENCCUVTTERED IN TEST HOLES DEPTH HOLE No.. �!?� HOLE NO." 3 ' 1 HOLE NO. G.L. 0%4-. 6 s xi �r. 6 ,vra c,9� x >t' o A!� 6�t /`)c-u t 1211 1811 u g , 2411 4 3011 4 3611 42" ME 0 5411 - ..6O1t -'r 66'1 7211 �— 8411 rµ INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER I,>EVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY &46e w ei2'_ Date DESIGN Soil Rate Used /s Nlin/l "Drop: S.D. Usable Area . Provided d.)''b _ No. of Bedrooms J? Septic , Tank Capacity. � o Gals. Type Absorption Area Provided By_L.F.x24" ate`„ width trench. ' �' Ot er IM EY r 9 Name igna ure .._`, ♦G=am r BOX, Z07 Address o u THIS SPACE FOR USE BY HEALTH DEPART. Soil Rate Approved Sq. Ft/ ?, u � yN 61 7211 �— 8411 rµ INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER I,>EVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY &46e w ei2'_ Date DESIGN Soil Rate Used /s Nlin/l "Drop: S.D. Usable Area . Provided d.)''b _ No. of Bedrooms J? Septic , Tank Capacity. � o Gals. Type Absorption Area Provided By_L.F.x24" ate`„ width trench. ' �' Ot er IM EY r 9 Name igna ure .._`, ♦G=am r BOX, Z07 Address o u THIS SPACE FOR USE BY HEALTH DEPART. Soil Rate Approved Sq. Ft/ ?, u —7s avI MENTAI MEAL Jo>tti: ��s2G ri� Lfl{ �siaw „J ,= fsrBaa eryridn+Qw�+'a$. to e, i • _ I ., i t � e .A• . • 7P -? 95 3' IA" .. 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