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HomeMy WebLinkAbout2693DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 61. -1 -55 BOX 23 02693 �. ,ter, 1 Ir -e • I , a 02693 S.a , 9 £ s 9 7k PUTNAM COUNTY, 'DEPARTMENT ` OhF HEALTH r „j Division of`EnvironmentaF Heal>h Seivices Carmel N YY 10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL'SYSTEM f�� _. .,Town or village cafed at Block . Tax Map � • �� Owner �IlT.N.. GECJl�lA °i21D dot /O. 3 Job :Separate .Sewerage System .built by 0, 6.) . "�° « g� � Address c% � -� Consisting ofZZ� d Qal. Septic Tank, and `�+ TQ rCW,C N Other •reQuirements - \' � ,. .`'^ •.. ,., - Water Supply Public Supply From 'Private Supply Drilled BY A G ddress v IC l� V Till e9? V i4 L �- (�= i✓ Building Type 1- 1 No :of Bedrooms Date Permit Issued ! i 75 , Has Erosion Control Been'Completed� n' v { " ., 1 certify that the systems) as ^fistedserving 4he above premises:were constructed, essentially as shown on the pl ns'of the completed work (copies of which are i % attached , .and �n, accordance wdh the standards rules and [ ulations plans J led an the permit issued a a Putnam County bepartment,of Health ; e9 - 'Cate Certified by R A is s -T eatL J g g 'Address License fVO. -Any person occupying premises served by the above systems) shall promptly take such actan as may be necessary to secure the correction.of any unsanitary �conditioris resulting from such u'sdge: Approval of the separate sewerage system shall become null and void as soon „ar :a ',public sanitary sewer' becomes available "antl the approval of the - 'private water sgpply,sha11,6 ome null grid void when a, public wator:'su ply becomes available. - Such approvals 'are sub)ect to' 'modification -or -. change .when in the ;jutlgment ;.of the_'C i er of Health, such re lion, ification or 'change -is necessary v : Date BYE Title 1E PUTNAM COUN'T'Y DEPARTMENT OF HEALTH , DIVISION OF ENVIRONME,, NTAL 1 ALTH SERVICES sT- COUNTY OFFICE BUILDING, CARMEL, N Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. x'1 `0 1-11 Owner�k�j(L, Olo�2 Address Located at (Street CQf10 ��.,Sec. Block S ,,1 {ot )O, s n 1 cF1 I e neares cross s ree Municipality. V011,1 ^ W -el Watershed_�� SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICA� S=ONS 01 Oe i Number CLOCK TIME PERCOLATION PERQrdATIC apse Depth Eo Water a er Level � No. Time From Ground Surface in Inches So--',! Rate Start -Stop Min. Start Stop Drop in Min./ j:.drep Inches Inches 1 W50 10'.S(, 6 17 { 1 6111. 2 1 If 1q 3 11'01 ll:t2 `� 19 70 II 10 5 11 : Il 11:21 to 716,(7 _ Z 1 X47 9 "P12 5 Notes- 1) Tests to be repeated at same depth 'until an ,roxir:.atelyy ea-,zl soia rates.are obtained at each percolation test hole. All data to be 9--bitlitteifn for review. 2) Depth measurements to be made from top of hole. ,. DEPTH G. L. 1811 21 3011 3611 42" 4811 5411 6011 66" 7211 78ff 8411 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS IN TEST HODS HOLE NO. HOLE NO. HOLE NO. J. V-[!, IM,"CAmE '='L JIJ 'W'HICH GROMND 'WATER IS ENCOU11TEREID L I I — INDICATE IYVEEL TO 14TElCH WATER IE','VE� RIER BEING ENCOUNTERED .9 TESTS MADE BY U dn_ "Ae Date D ESIGN Used 1.0 -Mir Drop: S. D. Usable Area Provided No. of Bedrooms. Septic Tank Capacity o Gals Type_ Absorption Area Provided By Yo- L84D L. F. x24 36;/ width trench.- q Other Address 016 THIS SPACE FOR USE BY BEALTH EEPARTNE-K ONLY: Soil Rate Approved Sq. Ft/Gal. CheckedY Date TOWTi - OF PUTR IM VALLEY W I1L DRILLLRS --LOG: REPORT WELL LOCATION C�iG v s 3 street - section -- lock -- of WELL GWNER Arthur Leonard name V&.,/ :Putnam Valley ress - - city-or--town WELL DRILL'S Anderson Well Drilling Barger. Street Putnam Valley name address city-or-town k6ING ETAI - :YIELD TEST WATER LEVEL. SCREEN DETAILS Bailed Measure" from 1 d surface) - 2.engh: '22 •. feet or -Pumped:: Hr s Status:_ _ ft Maker Di.ameter.:..•.: - -.� Inchesj-t.' -� t iYie1d.: GPM en r =Pum ed �, _ ft : - -Len th°-.-::- ': Ft.tize:_ •lot., - 4 Ki�d'z Diameter._ ..._ :.. In. TAZ. 1 EPTH OF WELL 200 Feet Depth From - Give description of forma:,ion penetrated, such as peat; Ground Surface 'silt, sand,. gravel;-clay, hardpan., shale, sandstone., anite,'. etc. Include size ..of . gravel(di,aieter and sand fine.,:-- medium, course).; .color. -.,of. mater °a1 structure Loo9e`, packed.... .cementedv,. soft; *,hard),.: (Ex. Oft. to' 27 ft.- "_, fine acked =• .ellow- Isai:d, •:27- ft ;to: 134- ft. gray granite' _ locntio- of,�aell -to at least-: two -permenant Landmarks )ate Well Completed Date 'of Report August 17, 197 Well Driller signature Log' QvUARd�9TY OF SEPARATE SEWAGE SYSTM4 a represent that I am. wholly and completely reepoausihle fore the location, caor�cmans�hip, m teriab, cmnatsructiosa' and drsinage of the >$e age diip6sal system .aegving' the. above deem 3 ibed pr ®pert�s and that it has been Constructed as shown on the approved plan �r approved �< a nd�ent thereto,. and ii �tcor�aace pith the sthndardo, males end gcgnlationa of the Wcetchet� ter `Cou$aty Department of �flealth, and hereby gaaarauntgr to the over, his s�ecceesoreo x.13' o assigns,: to' place fn good operating con aitio n any part of laid "It �? a�lnich fans 't® operate f ®r'`a period of too years fdiatly $ ®glowing the date og co@pletion'o f tie sewage di p®sal 'system or any rep rs s e by to seactn ®ysteaa, except k xa tae failure t ®'.operate pr6peily is caused by the willful or neglige�at act o.. the { occ �a+a�t of the building tiatiliairig the systemo ! 4 F' �tne undersigned further agrees to accept ao corpclusiv� the determination of the' Director oil; th�,'Divis low' �# I oe�ireonmen�ta1'­Hts th Segvice' s of the U46tcheater - County. - Department ®f Re lth ass t ®:`whether' or 'not, the ;failure o the aye ten`t0 operate was caused by the willful og �e ligea i act of the dccaepant `qf the building aatiYi ping the eye r , y: oft d t�ei.► day of 19 $i�rnatnar, tV� Title Ce QIf corporation, give name and address) General Contractor / SQ m ®� o ac �oeam ce�amo mom a..........7 ®e oepmmoea_mmmo ee- ---- -m o ----------- oo oe FYI Q 5) �OPiES REQUIRED WITH FIFE ( 5) COPIES OF, FINAL PLANS BEFORE CERTIFICATE OF aaITI®N VIa,�, iss�D o GUARANTOR IS R1 tJIRED TO FILE RoTICE OF DATE OF VZRST �g OF SYSTE&� -------------------------------- m --------- _ s m m _---- m m Di Won ''f Environmental health Services, Westchest (ir County 0epartmant of health 7 70 r® S.D. 50 January 1, 1900 (1973) vwl 7A-? 's .71 b4 %, C 7- o Av 0 A 77' APPROVEP 's AUG2 719 "UT 'o f y Of HEAM ail P- i-A 6Z D ET R, MVISICI. OF - ENTAt HEAI.TH*"kRvlcp ;rqv m, -51 4 34 0 C)FESSI Ao, '7 71 A. < < tv u wn. ;rA J k keinentv .*- 0 i, ac kni.KI Frir tli'kpcinm�anelnea nn�nf-"th' -�rroobsad isystfm(sf- Il 4hit- Ah e. fe oiraie sew qe 66sai 'Syste m will be -t' -a v , ad, plan j n _jj�fhafsa said �aCOUnty _Department of Health S" Address 07 —non^ cm,u o 7-- - ' , tL' , owner, -. - . , - assigns S th'.builder, that said �builder will furnished he owner, hisJucc6is.drij�heirs,br,a igns by ':e. he lisu- !-'d duririg-:the �O ,two (2.) 'years the4pta., 'ji )movin& , the -olriginil'syiiein 9 , r. _ any. r ' !p ' a irs'thereto;'2) ' t L hat. the.dr 1. describ I ed above With the sta % hdairds rules: and - regul- 46�hv&rinitafidd' 'ir-"a'c'c"6-rda"n'c*e' 1 VOT itne.-L.: Putnam Signed Z. F A License one year " from-toe date, �$Up a uniess;*cdn Ar tion of the building h s been undertaken and is o r IM m missi ne �cfianqe. or,alteration of construction ;revocable q _g . -' """L­ -A 'Plles�" :0 g and f"domestic " `0 t p u ad di I Sa a, X g �p gun I Title:� % 7' z -IDEPARMENT H T Z.; T �FUTNAWCOUN Y Y " Oyycvisron of Environment it ',60th Services, CON T RU CTION-KRMIT;* "QE, S SYSTEM . � — i :.ToWW-or-village T 41 -Located -0 r Job i 'Subdivision Lot s £4� A` Ni 0 sS 'Area Lo AR 'Number,' of Bedrooms Total,-Aab!tible Square Feet X 'it ne ail fe X width ',,trench i _Sepaiate Sewerage System f � T?:,be :construct— t N 't Address Water'- Supply : Ou'b i c: S6iiWy'*i ' �j a `e drilled Private -SMpply:: b 7- .' 9�, k keinentv .*- 0 i, ac kni.KI Frir tli'kpcinm�anelnea nn�nf-"th' -�rroobsad isystfm(sf- Il 4hit- Ah e. fe oiraie sew qe 66sai 'Syste m will be -t' -a v , ad, plan j n _jj�fhafsa said �aCOUnty _Department of Health S" Address 07 —non^ cm,u o 7-- - ' , tL' , owner, -. - . , - assigns S th'.builder, that said �builder will furnished he owner, hisJucc6is.drij�heirs,br,a igns by ':e. he lisu- !-'d duririg-:the �O ,two (2.) 'years the4pta., 'ji )movin& , the -olriginil'syiiein 9 , r. _ any. r ' !p ' a irs'thereto;'2) ' t L hat. the.dr 1. describ I ed above With the sta % hdairds rules: and - regul- 46�hv&rinitafidd' 'ir-"a'c'c"6-rda"n'c*e' 1 VOT itne.-L.: Putnam Signed Z. F A License one year " from-toe date, �$Up a uniess;*cdn Ar tion of the building h s been undertaken and is o r IM m missi ne �cfianqe. or,alteration of construction ;revocable q _g . -' """L­ -A 'Plles�" :0 g and f"domestic " `0 t p u ad di I Sa a, X g �p gun I Title:� PUTNAM COUr47Y Di;PARTPJE,,''7T OF Hrl_ L7'II DIVISION OF FNVTROT ?Pfi!,Pj.VAL HF.ALT]T S iRVICES COUN'T'Y OF'F'ICE Bi]TLDICUrz CAI'J! TEST PIT DATA 13EQIJIRFD TO BI-; SI'I''.!:�f "f'T:D iJTT11 AT'J'LI:CA'f'IUIQ DE'3CRTP'.1'TM' OT' 07L:.; F''f': C:L'('`.i`!;I;f;D TfV 1!01JfU,S DEPTH HOLE NO.—) HOLE 11,10. — HOLE N0. G. L. Of 12" 18'1 24" 30" 36" 42" 48" .54 11 60" 66" 7211 7811 84" L- - C� INDICATE LEVEL AT VrIiTCH GROUND INTATER IS ENCOUNTERED INDICATE LEVi 0 L(HICH MATER LEVEL SES AFTER Bi'Ii`IG ET'ICOtTNTERL TESTS MADE BY tt r.,9- c� Nit Date P DESIGN , q` ..... - ,• Soil Rate Used Q, 1�1in/1 "Drop:~ S. D. Usable Area Provided No. of Bedrooms Septic Tank Capacity Gals. Type6�,.S , Absorption Area Provided By 1 , Q L. F.a24" width trench. ,:1 Othe "r Address -M , V . 1 - THIS SPACE FOR USE BY HEAD.PH DEPARTMENT ONLY. Soil Rate Approved_ Sq. Ft /Cal. Chocked by__ 4 . Date PUTNAM COUNTY .DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date • Re: Property of 'b�- Located at I(V Section J-7 Block Lot Gentlemen: This letter is to authorize a duly licensed professional engineer,to apply for a Construction permit for a separate sewerage system; to serve the above noted property in accordance with the standards, rules or regulations as promulgated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in con- -ne-ct-iori-.with'-.t-his.,.ma-tter and- to supervise .--the. construction • 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 Sanitary Code. Countersigned: �jmg= Howard A. Kelly Jr.— -P Ej-. 34 Glene ida Avenue-. Carmel, New York,," 10.-512 < 914-225 8 SEAL Very truly yours, Signed Owner of Property Telephone r w 4'LJTNAMCOj J T :- CONSTRUCTION PERM M7 FOR �' EWAG•E':,_JV POSA Owner u� p��L3 i hsR: r �fJa.�Ob�1NrL! ° Buildmg':Type f Number of Bedrooms sy Separate Sewerage System to consist o -� f A 2® iF , �a rt •`To be constructed Water Supply Public,Supply !From Prrvate``Supply to be dral led 'by.•_ I Address - i Other Requirements '� 6 °� Y.:. Department. and; a'; }.vuniy �nparunnm o� nemu� - �. -_ ^/ a A99ress APPROVED FOR CONSTRUCTION This approval expire "s o'n revocable for cause or may be amended or modified when consi xequires',a ne permit A proved forr isposaal3of domestic s r C >'�Date �•'� � BY M Y „DRP�RTIIPENTOF HEALTH ^ j. V j4se b r. #1 Health Services Carmel, N Y. 10512 1 - Town „or. Village ” Sec 61ock 'Jo to Arui )Op �riAWT4leC� tai �� I v Total ,aabrittable Space Square F.,eet Gal Septic Tank �'� ° lineal Yfeet X 3 width trench { 4 � nand location of the proposed system(s); 1) that the separate sewage disposal system _ Went there to and <m acodance with the standards, rules an regulations o i e' u nem' ertrficatefiof Construction Compliance "satisfactory to the Commissioner of Healthwill' furnished the owner his successgrs, heirs or assigns by the`buildei;,_that said builder will'-' al system during the period of two (2) years immediately- following thedate of .theissu ce of tfie ong�nal system or any repairs thereto 2) that the Mid we described above. e installed m ance wi th the standards rulesand ;'regulations of -the Putnam'° r accord rt n a PE t � F :389aB w License No �� r from the date issued unless construction of the building has been undertaken 'and is scary by the Commi n >of Health Any change `or alteration of;.construction y se a and private wa supply only a r v Titles •r'�� . 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