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HomeMy WebLinkAbout2556DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51.19 -1 -43 BOX 22 02556 .— .,_........_.._. - P .. ,,.,. \- ! T , ,�� PUTNAM COUNTY DEPARTMENT OF HEALTH Permit q f/ -! g\ �( i Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM ' 0127 Town or lags LOca"teb Wt T.� ..`.i7t... _ .. - - Tax UiaP�LdY�BZock Lot Subdivision �6 �! O - W_56ubd. Lot q 2+ Renewal _� Revision Owner /Address_;Ll e "' �y Ji"Pod Date Of Previous Approval r�� Building Type —�L! - Lot Area �Y� �`�° Fill Section Only ❑ ' Number of Bedrooms Design Flow G/P /D / ` � U T �d P.C. H. D. Notification Required Separate Sewerage System to consist of &O Gal. Septic Tank and �f1J • , 4 I 0 " 40' To be constructed by Address Water Supply: _, —/ Public Supply From _v Private Supply to be drilled by Address Other Requirements - 1 represent that I am wholly and completely responsible for the design and location of the proposed system ill"0#1athe separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with sta�[tia Ian regulations o e u nam County Department of Health, and that on completion thereof a "Certificate of Construction Comp � � saa ry1 a Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his sucte ei69 �,g,}9 X-Muilder, that said builder will place in good operating condition any part of said sewage disposal system during the period of o /s imPh bgly lowing the date of the isw- ance of the approval of the Certificate of Construction Compliance of the original system or a re the eto; 2) t oheL Iliad well described above will be located as shown on the approved plan and that said well will be installed in accordance wit e n as s erL a Ons of the Putnam County Departmenl: of Health. t 3 a • K Date � i Signed .E. R.A. , w Address � iZ --e-Pf ! //^r "�� • aj - g e No. APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued ules coitljrUc t asQf ;be ui 'has bean undertaken and is revocable for cause or may be amended or modified when considered necessary by the Com stoner o e or alteration of construction requires'a new ermit Approved for disposal of domestic Sant s ge, and /or priv a water supply �rftaa•c¢'''n Date BY L-� Title Rev. 9 -81 PUTNAM COUNTY DEPARTMENT OF HEALTH 1 Division of Environmental Health Services, Carmel, N. Y. 10512 Permit q .._ - CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR _SEWAGE. DISPOSAL SYSTEM ii���� �Iy " Located Alt �L�1`;�, �� pf� s or Owner--oz .^�'"6tO /�/ �. /Formerly Tax Map Town or Village J Block /J Tax Map Lot q 3 2- Subd. Lot q Separate Sewerage System built by ZZ ©y Address Consisting of Gal. Septic Tank and ��p ®yLL Other requirements Water Supply: _ Public Supply From Private Supply Drilled By zK. C<-,9 f�Address /--� `s'A' - / � Building Type No. of Bedrooms Date Permit Issued r >_3 Has Erosion Control Been Completed? I certify hat the a stems) as listed serving the above ll g -ahav^ Y Y g premises were constructed essentially as.shovm =on the plans of the completed work (copies of which are attached), and in accordance with the standards, rules and r ° '' regulations iri accofdanae with thg, filed plan, and the permit issued b the Putnam County Department Of Health. w n',aa ter- Y y�r 4 � V �•;r y � r �VV/ Date v Certifi d by P.E. R.A. Address / s`` °P License No. ey S_ Any person occupying premises served by the ab a systems) shall promptly take such•aotbn at may b eeesssry ty secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become nu If and vo(dissoon as a public sanitary sewer becomes available and the approval of the private water supply shall become null a void when `a. Rutilie' water'.`supply" becomes available. Such approvals are subject to modNlcation or change when, in the judgment of the Com lion of Mss r ;r ,.. It qn 'mod lion or change Is necessary. Z i8 Date By Title Rev. 9 -81 YORKTOWN MEDICAL LABORATORY INC. P.O. Box 99 321 Kear Street LOCATIONS: Yorktown Heights, N.Y. 10598 X 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245 3203 g ❑ 201 BUTTONWOOD AVE., PEEKSKILL, N.Y. 10566 731.8777 245'3203 ❑ 495 MAIN ST., MT. KISCO, N.Y. 10549 666.3335 ❑ STONELEIGHrAVE. (NEAR HOSPITAL), CARMEL, N. Y. 10512 278 - LAB 7f DATE TAKEN' DATE RECEIVED: 27 DATE REPORTED: �9 SPECTRUM BIDS SAMPLE SOURCE: BATHROOM TAP L WATSON WAY R €FEF1FiEDEtY: CROS6ROADS PHARMACY J LABORATORY REPORT mg /L COLLECTED BY: SPECTRUM 739 -3175 ❑ ACIOIT'Y ......................... ............................... ❑ ALUMINUM ................................ ............................... ❑ ALKALINITY ............ ......... ❑ ANTIMONY ............................... ............................... ...... .... . . Kl BACTEFIIA, TOTAL /mL ........... f ............................ ❑ ARSENIC .................................... ............................... ❑ BOO, 5 DAY ................. ....... ............................... ❑ BARIUM ..........0..... _ ................. ............................... ❑ BROMIDE ............................ ❑ BERYLLIUM . ....:.......................... ................................ ............................... ❑ CARBON DIOXIDE, FREE ........ ............................... ❑ BISMUTH...... . ...... . ...... ................................................ ❑ CHLORIDE ........................ :..................................... ❑ BORON .......... :.................................................. .......... a. 'O'GH'LORI'AlE`- ,rr. ..- .......s.. ,_❑ CAOMj,UM ......a.rtes�..__..._.. _ _ ❑ COD ..•. ..................... ......'........................ ...... ❑ CALCIUM ' .................................. ........................ ................ ❑ COLOR ................................ ............................... ❑ CHROMIUM (tot.) ............................ ............................... ❑ CYANIDE ................ :..................... . ................... .. ❑ CHROMIUM (hexavalent) .................... ............................... ❑ DETERGENT, ANIONIC .................... .I.................... ❑ COBALT.......... ...... ................................................. .. ❑ FLUOR10F ❑ COPPER .................................... ............................... ❑ HARDNESS ..................0... ........... ❑ COLD ...................................... ................_.............. ❑ MPN COLIFORM COUNT/ 100 ml ❑ IRON ........................................ ............................... ,WMFT COLIFORM COUNT/ 100 ml ...4, ..................... ❑ LEAD ........................................ ............................... ❑ CONFIRMATORY TEST ............ ............................... ❑ LITHIUM' .............. ............................... ❑ NITROGEN, AMMONIA ....................... ❑ MAGNESIUM ................................ ............................... ❑ NITROGEN, KJELDAHL ............ ........0...................... ❑ MANGANESE ................................ ............................... ❑ NITROGEN, NITRATE ............ ............................... ❑ MERCURY ..... ::........................ ., ........ ................... ........ ❑ NITROGEN, ORGANIC ................... :....................... ❑.NICKEL .............. _ .. ❑ ODOR ................................ ............................... ❑ PALLADIUM ................:....... ..0............................ ❑ OIL & Gil EASE ........................ ............................... ❑ POTASSIUM ...................... ........... ............................... ❑ PH ..................................... ............................... ❑ RHODIUM .................... ................ ............................... ❑ PHENOL ....... ............................... ......................... ❑ SELENIUM ..................................... ............................... ❑ PHOSPHATE (ortho) ................ ............................... ❑ SILICON .................................... ............................... ❑ PHOSPHATE (condensed) ............ ............................... ❑ SILVER ........................................ ............................... ❑ PHOSPHATE (total) ................ ............................... ❑ SODIUM ........................................ ............................... _.•. ❑ SOLIDS. SETTLEABLE. ml /L .... ............................... ❑TIN ............ ........ :...................... ❑ SOLIDS. SUSPENDED ............ ............................... ❑ ZINC ............................................ ............................... ❑ SOLIDS, DISSOLVED ............. ............................... ❑ ...................:................................ ............................... ❑ SOLIDS, TOTAL ..........................0 ❑ ......0.......... ............ ............. 0 ........... �... ❑ SOLIDS. VOLATILE ................. ..:.................. ........... ❑ REMARKS:..................................... ............................... ❑ SPECIFIC CONDUCTANCE ............. ..............0........ ❑ ... ............................... . ...................... 0 .................... ...,.. ❑ SULFATE ............................. ............................... ❑ .................................................... ............................... ❑ SULFIDE: ............................. .......................0....... ❑ .................. .............................. .....................0......... ❑ SULFITE: ...............:............. ............................... ❑ .................................. .............................0. .............. ❑ SURFACTANTS — + ::. ......:................ ❑ TURBIDITY ...................... ............................... ❑ ...............................:.................... ..0............................ THESE RESULTS INDICATE THAT -THF WATER WAS OF A SATISFACTORY SANITARY�QUALITY'WHE11- THE SAMPLE WAS COLLECTED' THESE RESULTS INDICATE THAT THE WATER DID MEET THE SATISFACTORY CIiL'MICAL QUALITY 01' NNS�WW p A STATE ADMINISTRATIVE RULES & REGULATIONS, DRINKING WATER STANDARDS (PART 72). FTOR Y PARAMETERS TESTED _ ATRFRT 'P PAnnV DIRECTOR..' ANT M. T . (ASCPi . _ _._ _..__ •____._ TOWN OF PUTNAM VALLEY WELL DRILLERS LOG AND REPORT WELL COMPLETION REPORT This report is to be completed by well driller and submitted td!: Bldg. Department, together with laboratory report of analysis of water sample indicating water is of satisfactory bacterial quality. Well Location 32- Tax Map Street Sec, Bl. Lot Well Owne Well Drille Name Name Mailing Addre Tel. # ty or Town/ C' 1V 111E LL' i 11-1 V1' YY L' LL a` U V r CC L WELL LOG Depth from Give description of formatioms penetrated, such Ground Surface 'as: Peat, silt, sand, gravel,.clay, hardpan, shale, sandstone, granite, etc. Include size of gravel (diameter) and sand (fine, medium, coarse), color of material, structure, (Loose, packed, cement, soft, hard). For example: 0 ft. to 27 ft. fine, packed, yellow sandy 27 ft. to Date Well Completed // Date of Report Well Driller Signature BZS 1 -77 CASING DETAILS YIELD TEST WATER LEVEL SCREEN DETAILS Length Ft. Bailed • or 7/-- Pumped Hrs. Measure from ..:. Static — Ft.* t land surface, Make: Diameter: h`Incfies �C eld= :..G�:GIi�f' _ When Bailed _.. �,r_.P + edr-- Ft —Length- .,Ft.., Slot Kind: Diameter In. 1V 111E LL' i 11-1 V1' YY L' LL a` U V r CC L WELL LOG Depth from Give description of formatioms penetrated, such Ground Surface 'as: Peat, silt, sand, gravel,.clay, hardpan, shale, sandstone, granite, etc. Include size of gravel (diameter) and sand (fine, medium, coarse), color of material, structure, (Loose, packed, cement, soft, hard). For example: 0 ft. to 27 ft. fine, packed, yellow sandy 27 ft. to Date Well Completed // Date of Report Well Driller Signature BZS 1 -77 .� rY� -5e r'G%l '{s r✓i T� Owner or Purchaser of Building ii Building Constructed by Location - Street Municipality Building Type Section Block Lot Subdivision Name Subdv. Lot # GUARANTEE 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 guarantee to the owner, his success - _..,.___....o_rs..,.T.hea ^s ". ora ass- i:gns; •to p1- ace -. -in good__. op:era•t- ixrg-`c'o'�idrti"ofi any..-pa'rt 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 determin- ation of the Director of the Division of Environmental Health Services of the Putnam County Department of Health as to whether or not the fail- ure 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 J_Yov`e 19-EY Signatur J Title Corporation Name if Corp. 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. ,.Divison'of Environmental Health Services, Putnam County'Department of Health Owner or urchaser of Building Building Constructed by Location - Street X9,1 Municipality f Building Type 3& Section Block Lot Subdivision Name Subdv: Lot # GIIARANTEE 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 guarantee to the owner, his success- . .. . __.Qrs..,... heai._r_s .or_ .s s. - gns•,- .to p1ac.e -in govd-- ap-erati.ng. ctsnz3CY:tiori aiiy 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 determin- ation of the Director of the Division of Environmental Health Services of the Putnam County Department of Health as to whether or not the fail- ure of.the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this (fJ day of _5� 19 Signatur CJ Title Corporation Name if corp.) e7 j Addr e.$ s u �� -------------------------- -�` /-% `� - - -- 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. -iivisiono Environmental Health Services, Putnam County Department of Health -Z% 1K �-.p e -e - i✓ 1 /.7 Owner or Purchaser of Building Building Constructed by Location - Street 3 G iA Section Block 3Z Lot Municipality Subdivision Name Building Type Subdv. Lot # GUARANTEE 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 guarantee to the owner,._,.his_..success _.._.__.'-ohs` hbiY's'or ass "iis "to °� iace -rn.- ood o g e P g tion an y- pa rt o (- - in g con di 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 determin- ation of the Director of the Division of Environmental Health Services of the Putnam County Department of Health as to whether or not the fail- ure 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 Signature Ti.tlel�a Corporation Name if Corp. 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 PUTNAM COUNTY DEPARTMENT OF HEALTH a. DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # J-4z-00 Well Location: Street Address: Town/Villa # V if "IG U ap -� Block Lot(s) Well Owner: Name• A Address: � Z, n w ftlsoV W# yrlyn L% Use of Well: Residential Public Supply Air /Con eat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought —1 0 gpm # People Served _ Est. of Daily Usage 4p6 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling Supply (new dwelling) Deepen Existing Well Detailed Reason Lvat ILAjo Wtti,- w_ for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ..................................... ............................... Yes No Name of subdivision o:..._... - Water`Well C- oritiacfor: ��jte� -Ai' A-/j{' (�i A jy A/ Address: 13_ 61- Is Public Water Supply available to site? . ............................ ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest Ovate main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: AAVA� M 'P Applicant Signature: O�L PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue l0 Permit IssuiJ Official . Date of Expiratiop coq coo Title: Permit- fS: NonnTransfer alDl _ ..._. _.. -_,. � ­ .....:._ ... , . White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY..DEPARTMENT OF:HEA_LTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE.BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SE`/WA�I�ISPOSAL SYSTEM FILE NO. 0`�ner /Y JerG /y�►"i¢z,iAfa� o1 Address /_01rn4rn lea %� �✓y. L , Located at ( Street �T.s�' -� Sec., a7� Block Lot � Wa Indicate nears cross s ree Municipality low c? / /fir Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH. APPLICATIONS o,e Number CLOCK TIME PERCOLATION PERCOLATION i apse 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 7y 2 /vim jP93 l d I /0011 ,/o 4 4 5 5 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. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. / HOLE NO. HOLE NO. --� G.•L.. i 6" 12" 18" I 24" 3011 78 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date Soil Rate Used % Min/1 "Drop: S.D+ Usable Area Provided �b�c No. of Bedrooms -3 Septic Tank Capacity J92:746 Gals. Type G� ��• Absorption Area Pro— v d By L. F. x24" 3b" width trench. 361 42" 48" 5411 60" 66" 7211 Other Name aignaL e• Address 7 THIS SPACE POR USE BY HEAL`T'H DEPARTMENT ONLY: N�le Soil Rate Approved Sq. Ft /Gal. Checked s m Date 11933 artificatiRas hereon are valid for the map and copies f only if said map or copies hear the sed of the sx*zoeyor whose signature appears hereon." TO- WAT3 ON 4rrod14, 0- p 'YOM wt, ICE KITH THE EXISTING-Coog.04M 61' 17' D SURVEYS ADOPTIED,.BY. THE tNEW.%1 OF PROFESSIONAL kMD. SyRV.ObP& ta-3 T zt IMSENG;AOT :AtE 3Z ".MAP kA oak lq t%"!; ;E5*. �Fl ko L F_D:: I THE L& K E -'tt:;;, OWE, PIJTMAM.n:..," A5 MAP--, NO JAW 8 1°J5 5 0 zz M tl 5. 2 AREA.`, l ors she:* run only to thou m under fhe W6 policy No..' iottransfere6le URVEYED & BUNNEY AsSO LAND SURVEY �SBRIIDGE ROAD I ii 'Q,! t 2. . . . . . . dog. 5UF%V 0 N/A HELL � 11EY TO. wN 0E-1-1tt--'---- PUT NAM COO Qa&: JUWF, 1983 2CAL E 0q, a• �a <:� 1, s�s = � %• ty ,� f t 7. n 9S t I M� ✓YY .a r L ' .` s(�i},.�'n i {L 1 �,fi 7ra •r .'.y 1r q U '� } kr • 1hi '4- q\ 1 h Isar art" , I''. t» f _ _ �,"y .ti J Y 1 � i' i t , I k" �_'. '�,(Q} � h'�� �� � tr .�L�,f 4 f < „µJ4 1•q,� tt ��. �J J.. ±t t I r�� f �'+ t �. it � 1j' -�G�*� rC 4 w. `1.. s'T' � t y, r•- Tt� -i3a ! s Y t 145't/�Mr w T YI f. .r � J.� y y ink F•i�a� 1r�h• d Cr ,��16Jry >S'' �vYr "�'�i ��!i>• re � fi}'^iJ.°, •�`i�+t'Tif t h � S.rj rs r t�% M —I c '. � Y •I ' Ir �nj UTr ' J yI rj 1 .• .. crr•� 1 ! 1�' " � t n �� a , u NIT :fir:: , r4 • ... r_