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Home My WebLink About2542DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51.19 -1 -25 BOX 22 I ME ! 7-- oil .y.- . ;m f L � Lm I r jer ' , i !� ' 02542 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, carmel, N. Y. 10512 CERTIFICATE OF.CONSTRUCTION_CQMPLIANCE FOR, SEWAGE DISPOSAL 'SYSTEM �4)VO . 71,, 2 41' �} ? yr �7 I;�J /i Town or Village - Located at C.��:�Yi//1'ry i� %� / �rl -%-° �s✓ `4- i�f � /�.�1 ill _ e T 19*-sa► t YX to s�ti� ' ��Y `-/-. Block 2. Owner E�ii�Cf i / 5 Lot % Job Separate Sewerage System built by ./ /`��t8" Address Consisting of Gal. Septic Tank line I E�et X Ci +� ry » /' yy �� widtAh trench I Other requirements �E�s7+r /"n+ao�i "t'•L!/ /mil �3- �$ . }�31t'�b71at!. :J�t_'p�.'_% ,; < xJ �7i�srr.d ii /E 7�tN G )A it Water Supply: Public Supply From Private Supply Drilled BY Address Building Type /^ N /.lea `�° T �i o. of Bedrooms Date Permit Issued - Has Erosion Control Been Completed? I certify that the system(s) as listed serving the sex ed essential) as'shown on the plans of the mpleted work (copies of which. are attached), and in accordance with the Stan nd r ul s filed, an the permit issuetl b the, tnam County Department of Health. Date � .tw ied ,�. _ q P.E. R.A. Add i ¢ L -lam r F% License No.= Any person occupying premises served by t ab St s aT�p mp take such action as may be necessary to secure the correction of any unsanitary'.!.:'. conditions resulting from such usage. App I se r system shall become null and void as soon as a public sanitary sewer becomes,' available and the approval of the private wate void when a public wa ply becomes available. Such approvals are subject to modification or change when, in th t�� h missione of Health, such evocation, modification or change is necessary. IA i Date y Title i •L t _ - -7- Il PUTNAM COUNTY DEPARTMENT OF HEALTH } Division of Environmental Health Services, Carmel, N. Y.:10512 :. N PERMIT FOR SEWAGE DISPOSAL SYSTEM r4' /r i, 1441L-11� CAA 1WJ CAA � �� .n ,/. � I' L L145 C i4 Y A Town or Village i Located at /a l- y'1iC,e �Se ' i1.9 ,40 4i� ec✓ Z% c �eZ 2 r 19� Lot Block i Job Subdivision �, ,/ �7 � ,/% Address 9a J` �' %7 /_� A/ h Y�' GL: Y. 1 Owner p be submitted to the Department, and a writt Building Type!� Building Lot Area se , Number of Bedrooms will be located as shown on the approved plan a A Total Habitable Space C3 ,� P: Square. Feet -i C? . L9 Separate Sewerage System to consist off G'I... Septic Tank lineal feet X ' width trench To be constructed by ,rte T� %� ' °f� Address J Water Supply: / /Public Supply From ��` Private Supply to b drilled by Address ~"� / —2im Other Requirements 1 represent that I am wholly and completely respons' o! above described will be constructed as shown on th County Department of Health, and that on co be submitted to the Department, and a writt place in good operating condition any part o se ante of the approval of the Certificate of C str tion will be located as shown on the approved plan a t sai County gpartment of Health. Date ; Ir. Address ` ti` _ , & APPROVED FOR CONSTRUCTION: This approval ex the d, revocable for cause or may be amended modified when co Xae brequi res a ne permit. Appr ed for disposal of domestic san" ar sear J. /%) ',)t / r .f of the proposed system(s); 1) that the separate sewage disposal system ;s and in accordance with the standards, rules a nalrle—quTat ions of e Putnam Construction Compliance" satisfactory to the Commissioner of Health-will. i'owner, his successors, heirs or assigns by the builder, that said builder will ' Iing.4 period of two (2) years Immediately following thedate of the;issu (ri I the system or any repairs thereto; 2) that the drilled well described above f��//adcordance witla,Jhe stpAda'rds, rules and regula ons of the Putnalti 1 License No. 2-7 Xa unless co ucb of the building has been undertaken and is missio of lth. Any change or alteration of cons uction PP only. / WELL DR name address city or town ASING DETAILS YIEL D TE 9T V ATE EV S REEK D TADS Bailed (Measure from 1 And surfaces Lengh: / feet or ., Pumpeci & . Static ,_„_ft Make: Diameter: Inches Yield: �PM When Bailed r Pum ed ft __ Leh-ti - � ?t' lot ize Kind: Diameter :Cn. 'JTAL DEPTH OF WELL �f� Feet ^.Depth From 'Give description.of formation penetrated, such ass: peat, Ground Surface `'silti;'sarid, gravel, clay; hardpan, shale, - sandstone, ranite, etc. Include size of gravel(diameter and sand fine, medium, course), color oft material, structure (Loose, packed, cemented, soft, hard) . (Ex. Oft. to 27 ft. -fine acked -.. ellow, sand 2 ft to 1 4 ft ra granite Eeet'to eet orm tion Descri tion Ske ch exact location of well to jv at least two ermenant Landmarks Date Well Completed ' /� 7 i�... Datle 'of Report Well Driller _.- 'signature PEEKSKILL MEDICAL LABORATORY 1879 Crompond Rd'. Barclay Plaza Bldg. A, Apt. 1 ".' Peekskill, New York 10566 DATE COLLECTED ' RESULTS OF EXAMINATION OF WATER . , T OWNER DATE RECEIVED r-1 r CITY, VILLAGE, TOWN VOR NAME OF SUPPLY DATE REPORTED SAMPLING POI :1. PE 7-6777 I . { These results indicate that the water Was y(°ej of a satisfactory sanitary quality when the sample was eoiie A. H. PADOVANI, M. T. (ASCP) 4 1 �C/ gJs•�i�J e /�i' Owner or Purchaser of building .Building Constructed by " f"11 �4, Location - Street ! f �U7i11112 % Municipality Block Building .Type Lot GUARANTY OF SEPARATE SE[VAGE 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 successors, h'eirs..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 iG• (-aticnrl by t}ha wi_1.1fiil nr nperli-crennt- ant of t-hc nnni,nnni- of t},n hnil_riinrr ilt-i117incr The undersigned further agrees to accept as conclusive the determination of the Diz,ector of the Division of Environmental Health Services of the Putnam County Department of Health as to whether or not the failure of the..system.to operate was caused by =the =will`-or neigt ct of thoccant =of tti�- bidigh g u-t:ing - the system_ Dated this J,! day of 19 Signature T� Title (if corporation, give name and address _2 A s_zK)4� 5 iss �zl:: 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 PUTNAM COUNTY. DEPARTNtEN'' OF. HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES_.- Date •� ,� / 701" Re: Property of .��,v �Ct1 ° Located at 015ch41xlyly 10 VSrx1t1'-Y'Y- 4 Ikeles /4/c crif Block Lot ,d . Gentlemen: ®f-- ' This letter is to authorize �T a duly licensed professional engineer, jam! or registered architect .(Indicate) to apply for a Construction Permit fora 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 nece$sary papers on my behalf in 14 Vi111C1_ L!W1 N11.L1! Lili-1 11tdL .ta.` .cMU LQ. Sl. pei —vi6p the constluction Ol Sdia system or systems in conformity with the provisions of Article 145 or 1.47, Education Law, the Public Health Law, and the Putnam County Sani tary Code. u n t e r s i Ve d y� P.E.., ,F Address S'L 'T�( Jo LAND OX 267 Telephone Very truly. •ours, Signed -V.L _' 1 PUTNAM COUNTY DEPARTMENT Or HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA-SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner,_5_-).5AN A946etZ- Address X/;g ,� ��HF� Located at ( Street kf, 05CAl.�AVA / 0., 0 �e . �'� Block Lot (Indicate nearest cross street) Municipality _ . � � ® �T.L'' Watershed �A�� Q C f 4J:¢a; i SOIL PERCOLATION TEST DATA REQUIRED TO-BE SUBMITTED WITH APPLICATIONS Hold Number CLOCK TI14E PERCOLATION PERCOLATION Run Elapse Depth 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 5. 3 12 17X 5 2 3 4 Notes: 1) Tests to be repeated at same depth until approximately equ,- al 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. 0 TEST PIT DATA REQUIRED TO BE SUBMITTIM WITH APPLICATION DESCRIPTION OF SOILS i NCCUNTFRF..D IN 'i'I?5T HODS DEPTH HOLE NO.. HOLE NO. P''i HOLE. NO.- Aez;� G.L. 6„ �. 12" 18ir h ,� 24" N 30', , 36" 42't' 6 c 48" 54" , 60" . 66" 7211 y 84,E INDICATE LEVEL AT VBICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date -�- �= '- Soil Rate DESIGN Used Min�/l "Drop: S.D. Usable Area q Provided S,4zr . ' No. of Bedrooms Septic Tank Capacity o-6 Gals. Type &e�r Absorption Area Provided Sy L.F.x24" width trench. STA14LEY J. LANDER Other - ame e Address K N. Y. 1050= THIS SPACE FOR USE BY HEALTH DE P T 5 Soil Rate Np -I2�� Approved Sq. Pt .p� CY�c ed by Dot e 0 .,, Y W.+ -c ,t^-.r �,. 7,+9 .�, {" q ,..,.�.- ..,,- .•`„r,. ^^.,,^r'•'.;`w.•e.».` —.^ <:; .. 1y r Y 6:,1 y p x"',,�+, p K } �, y�,r.:•T,n�vt�'ih � t{,� + r :, .� � J e >,. rpm s '" d + ka not <.�r us ¢�, ''s� s r. r ✓t r ° :,I t 'ran &:• 'a r Jm. xaw.q; s c.�ayt xv ,. VOW :y e ,r, a Idr ex" tF x a MAO��+�� <� •'o �, e `� s e �+`� > � �, a B - x r Y t ' y y, i SIR= ,*� 4—1 D %,' 97p- p Ta3 "d tr 4 - b r.y :,�,,., t �, �, h' �° + Yytvk' •. 4 7 d ) ` ,FWtI 0. t M. + :? 1 / N Owk a �dv AN, IVI r:.,T ' L'• �� + ` ` S J' -fie � .r k�r �i . ty4 � r '. ¢ y :�'' 4 � 1 -r 'f i,(�; �. . r I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM , FILE NO.._____ Owner��Spn� �fiCf Address /F'!rJ`��G',� ✓;, ?r� ��c ;71 IL Located at (Street LJIV, _ Block Lot Ica e neares cross's Fee Municipality W'V er,c A ,�*r) Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS 3 12�l 3 Notes: 1) Tuts to be repeated at same depth until approximatelyy 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. Hole Number CLOCK TIME PERCOLATION PERCOLATION RM Elapse Depth to a er a er ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inc[h�es _ Inches 3 12�l 3 Notes: 1) Tuts to be repeated at same depth until approximatelyy 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. INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED �6; INDICATE LEVEL TO WHICH WATE13 LEVEL RISES AFTER BEING ENCOUNTERED 4� f TESTS MADE BY Date 1/= DESIGN Soil Rate Used-10 Min/111Drop: S.D. Usable Area, Provided J'/ No.-of Bedrooms -.._5 Septic Tank Capacity Gals. Type''%'�'� Absorption Area Prided By L.F.x24" jb idth trench. _ Other STANLEY 1_ I ANWO - -- ��/ _ -- _ saRR(3RAa� _ — _ — - - Address ag it w" v .2,f-r. DUX _ 745.9645 THIS SPACE FOR USE BY HEALTH DE Soil Rate Approved Sq. Ft /Gal. �7C/,.� Date TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. 2 HOLE NO. G.L. /� U `�+ -'.y': 611 1211 31 q �1 1811 .1 2411 0 °1 w 3011 3611 x+211 ti x+811 4X2� ��i / %�j��.j'�� 54 C'f II i 6011 k 6611 7211 7$11 `r INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED �6; INDICATE LEVEL TO WHICH WATE13 LEVEL RISES AFTER BEING ENCOUNTERED 4� f TESTS MADE BY Date 1/= DESIGN Soil Rate Used-10 Min/111Drop: S.D. Usable Area, Provided J'/ No.-of Bedrooms -.._5 Septic Tank Capacity Gals. Type''%'�'� Absorption Area Prided By L.F.x24" jb idth trench. _ Other STANLEY 1_ I ANWO - -- ��/ _ -- _ saRR(3RAa� _ — _ — - - Address ag it w" v .2,f-r. DUX _ 745.9645 THIS SPACE FOR USE BY HEALTH DE Soil Rate Approved Sq. Ft /Gal. �7C/,.� Date