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HomeMy WebLinkAbout2526DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51.19 -1 -3 BOX 22 I,yti 4' NIP %, ON IN-iori L . rj- i� 'N �IN r ON I 1 .J 02526 PUTNAM COUNTY DEPARTMAT OF HEALTH 3 Division. of Environmental Health Services, Carmel, N. Y. 10512 bL `110ERTIFICATE OF CONS1RUCTI0N COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM ? UTWAM L/40.0EY Town of %WNW Located at � ����'�� ��� Tax Map J ' - Block Owner G r „'' �� &&,Q C K L• I5- Z Tax Map Lot # -m Subd. # (J • ,t,'�LwJ� 1 1 Separate Sewerage System built by JQ "w kA LW Address Wu u i t � Poi4D u• GTbI`CJmViL.L Consisting of /b� 6 Gal. Septic Tank and 'Coo L F or r-i F-4,,DS �. Other requirements Water Supply: Public Supply From Private Supply Drilled By 1B O Y D W r-- L L- CO. /N G . /) Address rL C L-e- � L „ 015_/2 Building P Type ,L ` T = No, of Bedrooms Date Permit Issued Has Erosion Coptrol Been Completed? Z certify that the system(p) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulations, in accordance with the filed plan, and the permit issued by the Putnam County Department Of Health. _ �] Date i© /� � n�Cartified by P. E. R.A u X21 ,* g P i o tl off_ License No. Any person occupying premises served by the above system(s) shall prompt"ke 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 n as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water wppl ones available. Such approvals are subject to modification or change when, in the Judgment of the Commissigyar -W Health, such revocation/; or change Is necessary. -0 W am "Aff -. VV C'. PUTNAM COUNTY DEPARTMENT OF HEALTH VD visic±n of 5nvironmental Health - Services, -Carmel, elf. •Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM ?LrTNAM VALLEY Located at W M ITI= ILL jZ_ y Tax Map 19 -4- Town Block Subdivision 0S o-A Lu ki-n A C� S Lot Job 81-M.3 Owner ` r=S_i N Q CKt.E lL Address 1&4 COP-1 L A 64 D T ST Building Type Z>NE FA tZE5. Lot Area o, 65 i AC. 14ANAN - N� Number of Bedrooms 3 Design Flow 6409 CZ92 Total Habitable Space 114¢ Square Feet Separate Sewerage System to . consist of/s 10 Q O Gal. Septic Tank and -50 o L r- 01= F/ E L D 5 ' - 2 - 0 t � kV 1 D E To be constructed by JTr'�/ E KASTU IG Address E-E k-5 KI LL H OLLOLJ - t -QUO• G Water Supply: Public Supply From /� pu- rNAg/�,. i/Aug / /Y y� WPrivate Supply to be drilled by �/�• ryiv'� t� //�� VA LC A Address - 13A R-C'r'P, S 1 . PUTN A VALC r- y 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 perio of two (2) years )m ediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the origi al systemot any repairs theret • ) that the drilled well described above will be located as shown on the approved plan and that said well will be inst in a with the standards les and regulates oof the Putnam County Department of Health. Date ///:z V 1 Signed P.E. R.A - / Address Ji� f=- R� - Q G % Lice se No. APPROVED FOR CONSTRUCTION: This approval expires one year Worn the date issued unless co ruction of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Cor n of Health. Any change or alteration of construction requires a new permit. Approved for disposal of domesti i !y sewage, and /or priv to .1 r supply only. i GTSF rEL4 o G &Q- _ _ _ ... 7t;�VW4 Or- c�-I�M A ►d� ABC Gwria-r-or txrc astir °of - -Buil'dzng 1�unicipality BuS� 9Nt- ��i.o�,t<1 -r-p.. ng onstruM -d by Location - Street Building Type Tip 2c)44 wg 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 prop.erly 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- vices of the Putnam County Department of Health as to whether or not the failure of. the system to operate was caused b y the. willful...or...n.A�i.ierit`. - -- • - act bf 'the'obcupant of the building utilizing the syste L Dated this /Y day of L %� 19& Signature ,.., 'V — SI�NA iu If aorporati=, give name and address) THREE (3) COP -LES 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 Erwironmental Health Services, Putnam County Department, of Health YORKTOWN MEDICAL LABORATORY INC. P.O. Box 99 321 We8rVhe*t LOCATIONS: . oc9) 321 xeAnuT,voRKTOwm *E|GHT�N.v.,059V 24�32uJ �U[�om�A�NB�>« N.Y. 1M��� �w Yorktown Heights,. ~~°°° � OoV1 BUTTONWOOD Avs,pssKoouL,m��1usa6 737-8777 ' ���� ` O��|m��K|S�m�.1O��� - E/#nwf\VE (���-An mEL^N.��11o5 78-91:' LAB # 2282 r DATE RECEIVED: 10/11/82 M. STEPHEN MOCKLER DATEREPORTED: 41-- 112- SAMPLESOURCE: TAP: BASEMENT RFD.#3, WHITEHILL ROAD --PUTuAM VALLEY, NY .10579 REFERRED BY: L_ � COttEC�OD� By. OCKLER, LABORATORY REPORT . mg/L []ACIDITY / -------^------'--- O��uw|wu� --'^-------.-----------._ u ALKALINITY ------- '^ [] Amrwmw� ..--.---_---.----.---- �� �� � ---. uwe�oTsn//�ror��/m� —'..^^�^ ....... ................ []ARSENIC .___-..______—,_______..,___.. []BOo.s DAY .................................................. []BARIUM .... ............................................................... [] CARBON moxxos.FREE —.------�--... []u/mwur* —.--_---..-'-.--__' " �---.--.---.. []cx�onms --.._.-----_..---.-.. Ouonom ........................................... �..----.-----. []CHLORINE ................................. []CADMIUM —.--.----.---..--.-------- [] coo ............................................................. []CALCIUM —_—.-------------------' []COLOR ....................................................... O CHROMIUM hml.-.---..—.—..-'-..-------.. []cvA os m/ ..................... ---------.. [] c*nmw/mwmov^vaxmo ................................................... OosTsnssmr Ammw/c .................................... oonAcT —.—.-_-------.-----^—.._--. [7FLUORIDE ----.---.—.--__-....—. Ouoppsn ---.----.--.--_.—.------.--. 1:1 HARDNESS ' � ' ---------'-------' �� ooLo —.---,.--__.___...__________. []mpwcouponmcouwr/1uunm ..................... []IRON —.--.-------.. . ��»m�`couponmcouwr/1ounw v�--.--_. [] LEAD .------------'.--------'--- [] CONFIRMATORY TEST ................................... OuTmuM —.—.---`-------,-----.--.,— [] NITROGEN, AMMO N-/A .................................. [] wxGmsu|mw ............................................................... [] w/Tnos�w^�us�ox*�_�� ...................... �''�' �- � � — .. .. . .' . .-' ..... [] NITROGEN, NITRATE —.—..--------. O msncunv ---.--~---.-^-.---.^.''.—.----- ] NITROGEN, onsAm/o --.— L] m/onsL ............. .......................................................... [] moon ....................................................... [] PALLADIUM ----^'-'-_—.-_---_--^—.—.~—` O OIL &GREASE ----------.-..---.. 0 P*orAuoum --.-.—.----_—.----.--------. Un* .......................................................... [] nxom/mw ------.—..--_.—.'^—.—`. ................................ UPHENOL ...................................................... - []SELENIUM ........................................................... p*osp*Ars <u,mv> ...................................... [] m/uoom ............................................. O p*oSpxArs (condensed) .................................... [] u/Lvsn ---.-.--.--..----......----.—.—'--_ ETp*oupHATs (,umU ...... ................................ [] SODIUM .--.—.----.---.---.---------.. U SOLIDS, SETTLEABLE, mVL .......................... []TIN _.------__--.._.---__-----..—.--.. [] SOLIDS, SUSPENDED .................................. [] mmo .............................................. O SOLIDS, D/uuocvso -------.—^-- '' O ' ' '''--� --'--^—'---'' [] SOLIDS, TOTAL ------.---.----. [] .-----.-------_.--..--.________. [] noumS. VOLATILE ...................................... 0 REMARKS: ..................................................................... [] SPECIFIC CONDUCTANCE .............................. [] -------------.----------.—.----. � OSULFATE .................................................. [] []uuLp/dE ....... --------.------- [] --.---^--.------.--~------._—._.. � O suLp/rs ....... ..—.--.—.----_—.--- [] ---.----------'_—_—_.______..__.. � []SURFACTANTS —_—.----.-----.—.. O OTuna/o/TY .......... [] .............. --__—____.____._____ � THESE RESULTS INDICATE THAT THE WATER W ` OF A SATISFACTORY SANITARY QUALITY WHEN ' THE SAMPLE WAS COLLECTED. THESE RESULTS INDICATE THAT �� �� DA MEET T� 0TIS CH�(� QUALITY OF NEW YORK STATE ADMINISTRATIVE DOLES & REGULATIONS, FOR THE PARAMETERS TESTED. ALBERT H. PAD8VAJI M^I (ASCP) , DIRECTOR: ' WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF. HEALTH 3/71 Division of Environmental Health Services e 4 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 of satisfactory bacterial quality before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME Stephen Mockler ADDRESS 164 Cortland Street Buchanan, NY LOCATION OF WELL DOMESTIC ❑ SUPPLY i9hite .Hill Rd.. ❑ ESTABLISHMENT ❑ INDUSTRIAL Lake Oscwana, Putilam ❑ FARM ❑ CONDITIONING (lot Number) Va U TEST WELL ❑ (OspeaifRy) PROPOSED USE OF WELL DRILLING EQUIPMENT ❑ ROTARY COMPRESSED ❑; AIR PERCUSSION CABLE < ] PERCUSSION i El ((SSpe ify) CASING DETAILS LENGTH (feet) 82 DIAMETER (inches) 6 WEIGHT PER FOOT Z9 j � THREADED ❑ WELDED S O �I %YES ❑ NO CASING YES NO YIELD TEST ( ❑ BAILED HOURS ❑ PUMPED COMPRESSED AIR G.P.M. YIELD (O.P.M.) 15 WATER LEVEL IAEA$URE FROM feet) LAND SURFACE ft) DURIN feet) G YIELD TEST i tiY Total drawdon Depth of Completed Well in feat below Land surface: 205 SCREEN MAKE LTH OPEN TO AQUIFER (feet) DETAILS BLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (Inches): GR VEL S ZE (Inches) (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent lanpmarks. FEET to FEEL R E'er, E I D. AUG . 3 1992 PUTNAM COUNTY -1 4E HEAI,TH ! t; If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED July 284 1982 imaprE OF REPORT WELL DRILLER (Signature) i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - Date 20 NOV. 19$1 Re: Property of ST PNJ=i i MOGKL L-fZ- Located at W N iTE- H ILL 2 iJ (T)-'Z9 - 4 - 9 Section Block Lot Subdivision of CAS C,,q W ANA A QZES Subdv. Lot # Filed Map # 367A A Date JAN. Gentlemen: This letter is to authorize a duly licensed professional engineer or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to sere ". \the above noted property in accordance with the standards, rules or 'ations as promulagated by the Commissioner of the Putnam County i Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in confor.mity.. with, the - pnovi"si'cn-s -of t:rtie1e i 5' or' 147, Education Lai ublic Health Law, and the Putnam County Sani- (EaED 4,RC� WR � ENCE 47 0 ..... o -A tary Code. Countersigne 4Z P.E., R.A., # 1/0 �- , SOY 4-69, M05UOT R Address 6S8-6613 . S8 -6 13. Telephone Very truly yours, Signed 4&er AP . roperty 16 C1A2TLAf4 5-t, Ad ress Town Telephone RECEIVED E C 11981 PU E NAM COUNTY DEPT. OF HEALTH \VAG LA :.. :. S Wd1GE DiSFMPA- "" 3 s 'expire" §e,'RS • syst''dm will be . installed under the super visio i' of. the, architect: ':an4, in accor4rice with the apprgvea elan and.the;rules.and reguiations of the Enitnam Coi ni_y Health Depat.t ent., 2. All work to, De inspected prios.'to tieing 'backfille€1 3. No trucks, machinery, 'building Maters - .S niar: ex:_ cavatea earth shall be allo"j.,in the s¢irage dis{SOSa9y :.:. - .. ._ _ arezi Cc•nstructroia crft}ze systeiR ws LO b irc accord ^ - ante with. these plans; any revisions - thereto rules and regulations of the'permit.issueing Gosernme.ntal Agency.. . AES GN CFI�ERIA :..3 bedz.6 "iivuse 1, ,000 gallon precast• concrete. . sepia c tatnk reguire -dc 2'.' Soil: 7`1 -30 irtisz:;:in:. a. Daily 'flow, 200 - gallon per bedroom 20Ox3 =500GPD' v� N 4$9 i �00 J = 0 - �__........... _. __ .._ .. _. _ , _....o..... .. .... _. _.. _ _r o ; • . • 11Jj i � � I v r— rODy O z ' eacrST \VAG LA :.. :. S Wd1GE DiSFMPA- "" 3 s 'expire" §e,'RS • syst''dm will be . installed under the super visio i' of. the, architect: ':an4, in accor4rice with the apprgvea elan and.the;rules.and reguiations of the Enitnam Coi ni_y Health Depat.t ent., 2. All work to, De inspected prios.'to tieing 'backfille€1 3. No trucks, machinery, 'building Maters - .S niar: ex:_ cavatea earth shall be allo"j.,in the s¢irage dis{SOSa9y :.:. - .. ._ _ arezi Cc•nstructroia crft}ze systeiR ws LO b irc accord ^ - ante with. these plans; any revisions - thereto rules and regulations of the'permit.issueing Gosernme.ntal Agency.. . AES GN CFI�ERIA :..3 bedz.6 "iivuse 1, ,000 gallon precast• concrete. . sepia c tatnk reguire -dc 2'.' Soil: 7`1 -30 irtisz:;:in:. a. Daily 'flow, 200 - gallon per bedroom 20Ox3 =500GPD' LAKE - yS(IGATvAkAy 4 WKI iw - N ITF. yR o W'BLL � ILL County Department of Health ---Divl--sleon-of-EnvirormentaI Health Serviaes A _,I- rot .- conformance with pl -appliZoabrulef7,N and legulations of the Putn Oun H lth epar gnature & T le, C— Date 1 20 N� 4—'T-;"M-+A TOP- � i :T r—, � A L--L P--O A V;,' raj T L A-r,4v 07 6 A, p Y. µPUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING,.:: GARI!7EL; 105,1-2-.,--: ... DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner STEP{ Uj MDC L-C&Q- Address /64 C�OZT�/ar�DT ST, f Located at (;Street )GU I E/( /LL P_ TP 2q°4'8 T ec. Block Lot In ica e.near%es cross street) Munic�ipality� .T . Tit= �` .A 41L Watershed WA60t4 �1 y� � SOIL PERCOLATION TEST DATA REQUIRED TO BE.SUBMITTED WITH APPLICATIONS 0-1e 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 Inches Inches Inches l 1 2= 0:) - /�v 3 �3- /6 /9 3 63 2 ;2 / :o4 - -Z'07 63 (I l� 3 0/3 2-:08 - 3;i/ 3 c), - 3 6 3/3 21 C� y v --�4 a , CIE E�iC �...y B J T�- Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. for review. All data to be submitted 2) Depth measurements to be made from top of hole. DEPTH G.L. 6" 12" 18" 24'1 30" 36" 42" 48" 54" 60" 66" 7211 78„ 84" TEST PIT DATA REQUIRED TO-BE SUBMITTED WITH APPiLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO . - DTH HOLE No. T HOLE NO. 3 P7-P - .T��Sc�1L Y SAuL> CLAY Cf 5AND C-L1p I y g 5,4 /VV INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED NONE INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED ?VIA TESTS MADE BY J �� �Q�,�Q G Date 161,21181 DESIGN. t Soil Rate Used'/ = UMin/1 "Drop: S. b." Usable Area. Provided. S No. of Bedrooms Septic Tank Capacity dio pe .5-T 014 ye" Absorption Area Provided By., L.F.x24' .er - - - -- -- -- - - - -- � Name Joel Greenberg - Architect igna Musc of North RFD �1, Box 488 ( I Address:'. Mahopoc, NY 10541 � 1 6 THIS SPACE FOR USE BY HEALTH DEPAMENT ONLY: of NE`1� Soil Rate Approved_ - Sq. Ft /Gal. Checked by - Date 0