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HomeMy WebLinkAbout2527DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51.19 -1 -4 BOX 22 02527 'i 1 "6 ;'' ' W: - 'I lQirll J11 ,, I 16 WINE r I INN I �TIN All '. 02527 'CPO PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Servicos, Carmel, N. Y. 10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE. DISPOSAL SYSTEM :PUTNAM_ilA L & Y ^ .. - - ,... .. ... .. .. ^Town � ......... _ _ .....,.__. _. Located at - h iTs k I t+L JZQ Tax Map 19-4- & 17 Block Owner oa Y >ZO &Tr A Lot Job Separate Sewerage System built by ANT44QN !' i Z6 Vi VA Address snou-T -Nzoow_ RD > Y PEskl..Lc. iVY, Consisting of _4060 Gal. Septic Tank and A 0 4 F= OP C t W J DE (F-�%% •}�� S7 Other requirements Water Supply: _ Public Supply From — Private Supply Drilled By /��i �AAd,,��d11r'�,e��ss L -� Building Type MYF..1A A. �J QEj 4 +- Has Erosion Control Been Completed? 7" Y No. of Bedrooms Date Permit Issued-4 - /'- go I certify that the system(s) 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, plans filed, and the pern)# issued by the Putnam County Department of Health. Date / l�� Certified by P,E).j rR.A Address us Q LVi • %. License No. S+ 0J 6 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 sewerage system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Commissioner of Health, such revo tion, modification or change is necessary. Date By _.... Title \\O ? PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYS�'EMj� �,t>>�% t Ll a4�� Located at Va rV 1 4 r= /% ` W- s^° F M �f rr�� �i. �" � Subdivision ,'] F • 1) L UE a sr�A W A N49 A QS—`rr , Owner AN-71 )8e &Z-6 FE T Building Type ��(Yl 1i � J' Lot Area44 i 6 Number of Bedrooms _ Design Flow � � 'S? V Separate Sewerage System to consist of Gal. Septic Tank To be constructed by '07' S ALA5 0—TE °Cj � ��y7 Town or Village Tax Map 0 / #',62 1-7 ' Block Lot *. R67 Job j� Address f-1!r J It 13 Rein � 1z 2 1 ' rr- A :n S e-/ 4 4- , N.Y. J 041-& l�s Total Habitable Space I A ne-) Square Feet and �C 0 L--,F. Or ° ty/P15 Address Water Supply: Public Supply From CO- Private Supply to be drilled by a C �' � Ei •" Address Other Requirements -,71 C cI aTQi i Q'126 W 1 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 or-Me-7-urn—am 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 period of two (2) years immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the original 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 installed in accordance With the standards, rules and regula i�`ons of the Putnam County Depa ment Of Health, 3m sI) Date / Signed P.E. R.A. Address `°� License No APPROVED FOR CONSTRUCTION: This approval expires one year the date issued unless construe ion of the building has been undertaken and is revocable for cause or may be amended or modified when consifinviknecessary by the Commissioner of h. ny change or alteration of construction requires a new pe, nit. pprove disposal of domestic anitar Cge. o to water s piy �^+i r� s d '� r /�'✓/ m YORK IYIALLAV GRAIU. \, VWED Y 4 � ... `* T ,�,�w, .` .:1 ,. ,... x�'k� Ot P.0 99 321, 6KiMi. Street L fox .CATIONS D 321'•KEAR 8T YORKTOWIV HEIGHTS N Y�"?�10598 -245- 203 Yorktown Hei lifs�: 1059 ',PEEKSKI'LL ❑ 201 BUTTONWOOD AVE N Y 10566 7378777 E l ❑ 496 MAIN ST MT KISCO N Y 110549 666�3335r, 245 3203 a = f ❑ 3H .AVE M 7a 0 8 933 ,,,,,:: y= ,. ; ;• RESULTS OF EXAMINATION DAT,E COLLECTED , N OF WATER �zt� OWNER ss �ti ' rs tI sa <<w t a�a ,,,�, r'.L �-�' ` -. r: ,:�rR, a. ".•, '� k`sYr' DATE-RE ;'EIVW z k _�,'s'�r';. ,-, i*"r -.. :Y.r,, s %2• 4 9 -j'� - `3;ia^ 'N f$ �7 4 ��yy XX ✓m �t Jr�R � �.{ �.. � h �i " ._� ��,. Y � 3 Z� f{' I......J.'2a l v dPG� ^.:. •A 3ti }�,t� T¢�1`i' � v 4'y.�: )�S�l, (f :`�33+;L. 1 •` • CITY, VIL+ALAGE, TOWN 6 /OR NAMP- OF SUPPLY d� r r✓ - \l f, c � t R rITT Tir .` i .�.. ,vl C'H4�v' . M t2?.�1...i P�Y{`a,it 2 Q M i F N s � a c• PERML (Age plate;count,ct 35 C)' COLIFOAM GROUP(Most probe lefNo 100rn1)l v pprri� ry,BA yG'I'AERIA ....;;++ y Yf + n �.. .Y�. ,,.+N..L k #1 R �ID.�yE�TERGENTS mg L NITRATES (qs N) m L IRON TO?,GTAL ing L i-.*dxi t... .. ij .. tt 1 F r .i * 4 7rY t �rtY 'g2w h try+• .f AMMONIA,-FREE.(as N) mg/L Y pH CHORIDES (mgJL)'' , all :< t �. _� .•" 1 , ..,v, w ,. c kvs�+._ `S.:R =n,rns.d e `` COLLECTED BY a J. PROETTA iesultslridlcatethat These the water was YES of a'satisfactory sanitary quality when the sample was G 1 }collected PER a CR OS SR OARS PHARMACY INC . r ..:. /J l3 ` r •. ewe ._ / .':= t a /% ;;,. m PUTNAM COUNTY DEPARTMENT QF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ;.COUNTY. OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGY DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner w E_ j j Address —M 6 UT. 1,6e'akIGL„/ )G Located at (S 'reet OV1 �C. Sec � �ck Loth Inaca -e neares cross street Municj:pali:tg.! '' atershed a.� SOIL PERCOLATION TEST DATA REQUI TO BE SUBMITTED WITH,APPLICATIONS Role Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Water Level. No...:;:......: Time From Ground Surface in Inches Soil Rate Start- '2'1-top - Min. Start Stop Drop in Min. /in drop Inches Inches Inches Notes: l) Tests to be repeated at same rates are obtained at each percolation for review.. 2) D. -pth measurements to be made depth until approximately equal soil test hole. All data to be submitted from top of hole. TEST PIT DATA REQUIRED TO- BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED.�N TEST HOLES, DEPTH HOLE. NO. HOLE NO.—' HOLE NO tvame Signat e F �� °• 0 056 O ._ Ofi NE(J THIS SPACE -FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by D4�te_ f,. TOWN' :OF. PUTT 1 " VALLEY WELL DRILLERS `LEG ' AND REPORT MPL�T IW ELL ON I�EP4 This report is to be completed by well driller and submitted to ,�_dg,. department, together with laboratory report of analysis of water sample,i_ndicating water is of satisfactory bacterial quality. i j L Well Location/ i t'!L '!LL'- Tax Map Street - Sec. B1. Lot Well Owner)gAU o usT• /"�oe�%� /�"a � /�Ai� �' 1� Fee, kS�-,, 11 A,1�. lo.$) j IName Mailing Address City or Town ' Tel. # Well Driller Name Mailing dress City or Town - f CASING GN DETAILS YIELD TEST WATER LEVEL SCREEN.DETAILS i,ength ' Ft. Bailed Measure from land surface �,� or Purrtped Hsse' "Static: Ft. Make: • in en Bailed Slot Diameter: � Inches Yield: .1�tGPM 'lor Pumped FtJ Length Ft.Size Kind: f�� !� Diameter In. TOTAL DEePTH OF WELL ;C� F4et _ / -,- - DELI; LOG Depth from Give descript -Lon f%f.fnrmations penetrated, such Ground Surface as: peat:, sift, sand, gravel, clay, hardpan, shale, sandstone, granite, etc. Include_ size. -of .__:.. _..._ -gravel .- g (diam ......_�etPr) and -sand ( ine, medium, coarse) , color of material, structure, (LAose, packed, cemented, soft, hard). For example: O ft. to 27 ft. fine, packed, yellow sand; 27 ft. to 134 ft. dray granite Feet to Feet Formation Desc.rintinn c r� .late Well Completed w -'V1Z jt � Date of Report Well Driller Signature BZS 1 -7'7 Owner or Purchaser o Building Municipa ity _RN 744 ®N'e P ETTq Building Constructed by GVP t-mg r gi- . Location - Street ®ABC- lzdm . Building' Type G�2 4- 6, 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 :rude 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 !Hhvironmental.Health Ser- vices of the Putnam County Department.. of He.al.th_.a.s:..t.o..whether or not the fai��� e o�- t «e- s stem to --o e-rate ac rate b the'rai'llful` or he gent'-- act of the occupant of the building utilizing the syste .----) Dated this. day of N 19 81 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 PUTNAMrCOUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date ,4110! Re: Property of Located at Se ion o r_6' ` -Block Lots] Gentlemen: This letter is to authorize Aut_ a duly licensed professional engineer or registered architec t*__ (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 4. :vA111C1't_tUJJ wi irl i_ili5 ma L Lejv and to. supervise Uie. cunstruc Ciun of Said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- _. -tart' . -Cade 'C ER E O q RC C? �F2 a, 0 �� 01 Very truly yours, Signe d Owner of perty 0. Q- Countersigne AtT, o� tto% �O S#�OU t E2D W -Ook, . i NE Address �°-V P.E., R.A., # ! � �i NYC /06 -t6 M US 01 Q "Jb Telephorfe Address ., A:iM Telephone i-.: :7 7 '2 ax 0 P ��,,I&LL - 0Sf Z061"S,oe-9 �A t�SE SSEWAGE D tTSAT- SYSTEM NOTES: This s re septic system was. installed u: the supervision of the architect and in accordant with the approved plan and the rules and regulat of the•Putnar,-, County Health Department. 2. All work wa$ inspected prior to being bac*. 3 N trucks maq1),�qery._-bui.1di- Cava arth w,;es allowed in the sewage dispos area:" rea Construction of 'the system wZt- in accor, with,the ' se plans; any revisions,thereto and the rules. and reoulations of the permit issue ng Gove Agency. DESI* MCMI E a 5 r- 6 iaV use -1,000 gallon precast concrete- tank :4�0,s in-stalled. 16,20 min/'in., 0".7 gLil/s. f. aj daily. flow .200 gal'lon per bedroom -200x3 bedrooms = 600/0.7 gallon/s,f: -,2 857 s.f. of -leaching 'Area requiwed., b. 'SM 'I.T. of V wide e tile fiellds '4r:. installed.. A" SUFLT Lorw!&PKI. 41' 4, 44"751'047" .7 N :5 4:6 45,'a, Mo F Tr is 0 e VLI ,� 4 0 114 C111 q AVP- L7�v 7 EMS T—Vt P. 46 MILT LAYD.U.T. C' " M IT TT I L06,AT'a,'--',MAF Putnam County Department of Health Division of Environmental Health Servlaaa Approved as n;tcd for coreormanoo with applicable Vu'-,co and Regulations of the Putnau Cou;t,91:0alth Department,, Zlgna &- Title patik JOEL LAWRENCE GREENBERG ARCHITECT - TOWN PLANNER. RR # 8 MUSCOOT'NORTH MAHOPAC, NEW YORK 10541 (914) 628-6613 PROJECT, : NE:N\1 0Q" MR I. A 740, 14Y. L--1T A. . Tr".A'rA 4" V op I L06,AT'a,'--',MAF Putnam County Department of Health Division of Environmental Health Servlaaa Approved as n;tcd for coreormanoo with applicable Vu'-,co and Regulations of the Putnau Cou;t,91:0alth Department,, Zlgna &- Title patik JOEL LAWRENCE GREENBERG ARCHITECT - TOWN PLANNER. RR # 8 MUSCOOT'NORTH MAHOPAC, NEW YORK 10541 (914) 628-6613 PROJECT, : NE:N\1 0Q" MR I. A 740, 14Y. 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