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HomeMy WebLinkAbout2553DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51.19 -1 -40 BOX 22 I Mrs �' �' �' ; ; I,yti . ; L I F . � soI 1� - I 16 Nee ' Nee 02553 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM PUTNAM V &LEY . 'J Town or Village ._ ... Tax 1'iaB Block Locatetl at Ft aG I i AA % lk n j t Tax Map Lot + @�1� ate/► subd. # e Owner ie • . i �i� �`��F� 1( Address""�1L�M� fa s� Separate Sewerage System built by (�-AA � ' z, � �/�@ � (o � I Iii mil. F`% Cr- '�4f� W. Consisting of Gal. Septic Tank and��� Other requirements Water Supply: — J= 'Public Supply From f✓ ,, 45i ` Private Su61Y Dr Ile�Sy Address �A No. of Bedrooms Data Permit IssuedjL Building Type Has Erosion Control Seen Completed? syat ('s) as listed sery ing the above premises were constructed essentially as shown on the plans of the completed work ( copies I certify that the and in accordance with the standards, rules and regulations, in accordance with the filed plan, and the permit issued by the of which are attache-A), Putnam County Department Of Health. ^ Vd Certified by Date P� 2 � X ? Address P.E.JL.— R.A. License No,_a< I I Any person ocfupYin9 premises served by the above systems) shall promptly take such action as may be necessary to secure the correction of any unsanitary coy person 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 supPlmobdiico�on orlChange is necessary,Vals are subject to modification or change when, in the judgment of the Comr�ts one of Health, such re o r� _ By Date �) PUTNAM COUNTY DEPARTMENT OF HEALTH w (� 6 - g G� Division of Environmental Health Services,__Carmel _N,_ Y., 10512 ... CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM �� y 7 Located at ��v �_J d rj VVr� -L1 1 i /1 "C h/d Town or iliage Tax Map Block Subdivision /� Lot 7, Owner — `` r^ 4 / 1 G n a r) ��o � Job i � � q �� Address • +� Building Type —A' a, it t'- A Lot Area 00 Number of Bedrooms `-3 Design Flow 6 0 ® !l IBC Total Habitable Space' Square Feet Separate Sewerage ;System to consist of I ©o a Gal. Septic Tank and _ 36 1 n " �/5-C70 l` I . �ZS i� n TP uu f ` To be constructed by -cv+� Address Water Supply: __ Public Supply From —� Private Supply to be drilled by Ai/) l ersot/i Address Other Requirements `Q A i/ !: ti of e d I represent that 1 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 an regu a ions o e Putnam 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 thedate 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 regale i— o ns of the Putnam County Department of Health. Date - 9 el T z /!.� Signed ' , t ' �L.s£.� P.E. � R.A. Address �0 � License No. 5,C) APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued u ass conduction of the building has been undertaken and is revocable for cause or may be amended or modified when consi ed necessary by the Co sinner of Health. Any change or alteration of construction requires a new permit ApprQ(ved for disposal of domesti san a sew or priv p y onil Date— ✓ By 0 �. Title f :1 A10 Owner o ser of Building Bu— ilding Constructe by .A 4,S(L(_cu-_ rD Lon - Sti4eet 2A-NCA- Building Type PuMA-M (1) 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 :Wade 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- 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 19k-4 Signature If co oration, 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. D'AQUINO and DONAHUE &ONSULTING ENGINEERS Relaltb y x x 9_ 44 Au p Pige4lth Department,., pR� TM-51v- 5L-7- 0-- -7, 4, I at tt1A vw " ,4 ATgo►� A 5 LLE�CIK, Aye i AS— f�-z>U tLi— 3 g2 R ANGN I AA U 11,-r 5"t"A N CESS t . DR►vE wAy � Z '' -� :- G ✓' 4; io Ila wA75C W. wa 1z1 i -5/4 LCC. K $ L vat 1000 c- rALLou PRE- CAsr coNC,� Se P -r I C 'iA.IJ K 46 r % z 9,9 3865'^ ({y p -) 5, 86 NySG�e Pole z J4 i 70 747 -- ---- -e i =- ---- -6 10 - -- ----'4 IZ R0 US6 WC LL- S�u,Ac,ta /� ►?ate i is fi: t4l ?lk Co f. Abs. Tient,� :r`'w v,NCENr F'fP, . �.� ✓� c.. � � r, OdK �.°� , � PC r r _ D e ACLGi- 'le c"ao% it re {ere nee o °n 9 ae 0-1 laul k 641"Ces skovin "Ovc WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Neelth 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.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'.Y OWNER NAME ✓ ADDRESS LOCATION OF WELL (No Street) (Towh) (Lot Number) PROPOSED USE OF WELL C/7 �j BUSINESS CJi DOMESTIC CJ ESTABLISHMENT ❑ FARM ❑ TEST WELL CI SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ OPeEfy) DRILLING EQUIPMENT �I A COMPRESSED CABLE THER R PERCUSSION 1:1 P PERCUSSION ❑ ROTARY (specify) -- CASING DETAILS LENGTH (toot) �C DIAMETER ( Inches) WEIGHT PER FOOT / ® THREADED ❑ WELDED O YES ❑ NO C`�TIiIA YES lJ )5'F NO YIELD TEST (�j HOURS GPM. ❑ BAILED ❑, PUMPED COMPRESSED AIR 7f . YIELD WATER LEVEL MEASURE FROM LAND SURFACE —STATIC ecifyteet) DURING YIELD TEST l leaf) Depth oftompleted Well in feet below land sivrfacec SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE DIAMETER (Inches) IF,GRAVEL. PACKED: ; _.Diameter of well including gravol pack.(Inchss): GRAVEL SIZE (Inches) FROM (feet) '. TO (feet) DEPTH FROM LAND SURiFACE FORMATION DESCRIPTION Sketch .exact location of well with distances, to at feast two permanent landmarks. FEET to FEET 34) If yield was tested at. different depths during drilling, list below FEEIr GALLONS PER MINUTE DATE. WELL MPIE' _D DATE OF REPORT . WELL DRILL ignature) .. 'ORKTOWN MEDICAL LABORATORY INC. LocaT)o P,0', Box 99 311 Kear Street LOCATIONS: • ❑ 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245.3203 Yorktown Heights, N.Y. 10548 ❑ 201 BUTTONWOOD AVE., PEEKSKILL. N.Y. 10566 737.8717 •. �;•...::• ...._ : -;. ,:__ •: ;495 ,_MT -3335 - y jP549 666 .. KISCO, N: 245'310 T STONELEIGH AVE. (NEAR HOSPITALI, CARMEL,�N:Y, 1(�Si2'278 9J.' LAB # _ DATE TAKEN: - o °� DATE RECEIVED: I _ CJ/`G� /�,y p GATE REPORTED: �.� c�i h' I(NW C J C C� SAMPLE SOURCE: S lVec< 161 vd I REFERRED BY( ' L. ��' " `G vl ��� ?/ J COLLECTED BY: Y LABORATORY REPORTe AS CGS mg /L� "I "fat ❑ ACIDITY .................. ............................... ❑ ALUMINUM ................................ ............................... ',A❑ ALKALINITY :.1. ❑ ANTIMONY CTERIA. TOTAL /mL...I . ........................ ❑ ARSENIC .................................... ............................... ❑ BOO. 5 DAY. ..................... ❑ BARIUM ....................................... ............................... :. ❑ BROMIDE .. ............................... ❑ BERYtLIUM ................................ ............................... ❑ CARBON DIOXIDE. FREE .............................. ! ❑ BISMUTH .................................... ............................... ❑ CHLORIDE ................... ..............................: ❑ BORON ....................... ,................................................ ❑ CHLORINE ................... ............................... ❑ CADMIUM .................................. ............................... OCOO ........................... ............................... ❑ CALCIUM .................................... ............................... ❑ COLOR ................................................ ..... O CHROMIUM (tot.) ........................ ..... ............................... ❑ CYANIDE ................... .......................... :.... ❑ CHROMIUM_ '(hexavalent) .................... ............................... '❑ DETERGENT, ANIONIC ... ............................... ❑ COBALT .................................... ............................... ❑ FLUORIDE :........... t ...... ............................... ❑ COPPER .................................... ............................... OHARDNESS ................... ............................... • ❑ COLD ........................................ ............................... ❑ MPN COLIFORM COUNT/ 100 ml ..V ............. ❑ IRON ........................................ ............................... :,.,�F.F.�T_. COLIFORM COUNT/ 100 ml ❑ LEAD - FIRMATORY TEST ...................... .... .......................•. L1 L! THIUM .............................. ...... _ ❑ NITROGEN. AMMONIA ............. ......... .i.... ' ' ❑ MAGNESIUM ................. ............................... ........... ❑ NITROGEN. KJEL.DAHL ... ............................... ❑ MANGANESE ................................. ............................... ❑ NITROGEN. NITRATE ... ...........................:... O MERCURY .................................... ............................... ❑ NITROGEN. ORGANIC ... ............................... ❑ NICKEL ........................................ ............................... ❑ ODOR ....................... ............................... ❑ PALLADIUM ................................ ............................... ❑ OIL & GREASE ............... ............................... O POTASSIUM ............. ................................................... ❑ PH ........................... ............................... ❑ RHODIUM ..................................... ............................... ❑ PHENOL ...................................................... O SELENIUM .......................... ............................... , ..... ❑ PHOSPHATE(ortho) ....... ............................... ❑ SILICON .:.................................. ............................... ❑ PHOSPHATE (condensed) .............................. ❑ SILVER ........................................ ............................... ❑ PHOSPHATE (total) ... ............................... ❑ SODIUM ........................... ........ ............................ ❑ SOLIDS. SETTLEABLE, ml /L ❑ TIN ............................................ ............................... ❑ SOLIDS. SUSPENDED .................................. ' ❑ ZINC ................... ............................... ..................... ❑ SOLIDS. DISSOLVED ... ..................:.... ....... , ❑ . ....... ................................ ............................... ❑ SOLIDS. TOTAL ........... ............................... .............. ... ......................... ............................... ❑ SOLIDS,VOLATILE ....... ............................... REMARK• ............................ :.. ..................... ........................... ............................... ❑ SPECIFIC CONDUCTANCE • .... ❑ SULFATE ................... ............................... ` ❑ ..............................:..................... ............................... ❑• SULFIDE ............................................ ❑ .................................................... ............................... ❑ SULFITE .... ......................... ❑ .. ............................... .............. ............................... ' ❑ SURFACTANTS • ........ ............................... ❑ .................................................... ............................. ... ❑.TURBIDIT`. ............... ...... .I........................ ❑ .............. ........ ............................ ... _._ _ ....... THESE RESULTS .INDICATE THAT-THE .WATER WAS OF A SATISFACTORY SANITARY QUALITY WHEN THE 'SAMPLE WAS COLLECTED. THESE RESULTS INDICATE THAT THE WATER,DID MEET THE SATISFACTORY CHEMICAL QUALITY OF NE8 YORK STATE ADMINISTRATIVE RULES & REGULATIONS, D1�IX C JATER STANDARDS y(PART 72) FOR THE PARAMETERS TESTED. A��ppnsTl (�/1' rLA.m I D'AQUINO and DONAHUE CONSULTING ENGINEERS 914 -526 -2039 1J Site • Sanitary • Environmental - October 26, 1983 Putnam County Dept. of Health County Office Building RE: Property of Fischman Carmel, New York Watson Way & Sillick Blvd. Attn: Mr. Robert Tutoni Putnam Valley (T) Dear Mr. Tutoni: Enclosed herewith please find: 1. Application for a construction permit. 2:. Letter of authorization. 3. One design data sheet. 4 Four sets of construction plans. El. One survey of property. E;. Two sets of general house plan. 7. Location map. Your prompt attention to the above submission will be appreciated. JVD /1d ENcl. Very truly yours, John V. D'Aquino, P.E. RECEIVED OCT 311983 PUTNAM COUNTY DEPT, OF HEALTH RD 0 2 Box 89 Putnam Valley, NewYork 10579 tiv PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date 10 - Re: Property of A. a sch mom Located at Wxkoy9 Way A Se 19 ez, �— B I dA • (T ) c1-id awk Va f (u �. 54" Block Z Lot r7.4: 6 Subdivision of AI/A Subdv, Lot # Filed Map # Date Gentlemen: This letter is to authorize �� a�9 V. .V o; 6to � a duly licensed professional engineer s/ 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 connection with this matter and to supervise the construction of said .... -- system dr syst'e1�rs"in" conformity with : 145 - proviszons of Articl.e - _ - - - -. 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned: N P.E. , aftu , # J�®4-02' Very truly yours, S i gn e d Owner of Property ZIL 5-0 r= l� 3 Address Z BSc 1-7 Address \/ Town �Z � � Telephone Telephone RECEVED N OV 31993 PUTNAM COUNTY DEPT. OF HEALTH PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF .ErMROTTMENTAL HEALTH SERVICES COUNTY OFFICE FJILDING, CARMEL, N. Y. 10512 DESIGAT DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner A# F(-,i<-4 icy Address 455 �5. j��-s s,,4. XZ,�10021 -T Located at (Street i�iaQ 5cay. '�� - Sec.. 3'46- Block Lot '7 , Indicate neares cross s: reet Municipality f "1,hl 1i1' Watershed /i'Z s, SAIL PERCOLATION' TEST DATA REaU= TO BE SUBMITTED WITH APPLICATIONS: 'Numbe.r 'CLOCK TIME 'PERCOLATION PERCOLATION . k..apse. No. 'Time Start-Stop J✓i A"'t Depth o Water Water ve From Ground Surface in Inches Soil Rate Start Stop Drop in Min. /in drop .Inches Inches Inches 3 ell 4 is 6-77 2- 5. 2 OCT 4 11983 5 1 DEPT, OF HEALTH 2 Notes: 1) Tests 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. Z fi 'r cI C e.P ho k-- pr-e 5e- ai «g 51_4,".- y/a Imo! ' ,'^ � •,''. \�:4; �''•'. ' e 1 '.uG 0:1.••.'1\ ��: a ; �C C�4�• Q � :• t� �. O may' r4• f,, • •{• L•r.;\o• �?+..l \.••' i i v 1c,cov, a .aJ ®�� t Je a �� f t i ,f .�?; G�O of -�- 1 4+ ,f/.'i�^ f,�.. )- .71� •r`• >/ ;n'f i��l.'(a t �• ^ >''': J 011 eZ •. n„Q �q .ice ?� }r�,�il r{y�y��� G:; �• r��• .>' .' 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