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HomeMy WebLinkAbout2703DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 61. -2 -12 BOX 23 02703 I a Ill 117 ra 17-2 * A. 0 sill V IN IN me T - ,� 16 f IN i 6 Ems , 02703 OWNER'S NAME PUTNAM COUNTY HEALTH DEPARTMENT DIVISICN OF ENVIRONMENTAL HEALTH SERVICES PROP06AL FC)R SEAAGE DISPOfiAL SYSTEM REPAIR /3e'fanc yr l 2 �' PHCNE 9i R P'- sb qS SITE LOCATION ,:9V .Sr (W A4 D U S awla..) Z• MAILING ADDRESS �o S er�arnP��. /- {� /lv� 2 PERSON 6 U/,i C/? PC HD Complaint i Name & Relationship (i.e, owner,tenant, etc.) DATE . -7�TYPE FACILITY PROPOSED IlSTALLER L ea K ar Jj cl � V w _011 -c T • PHC NE REGISTRATION # Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal from licensed professional engineer or registered architect. -- JPk.5+ -J 300 0- Ud s D�- 6a^ r U A Loo 1.,4f/4- rr4nrc. k n � cL ptoLK vi Proposal appr J w/ Inspector's ture & tle W0601F� MA tmr,n al approved with the following conditions: 1. Procurement of any Town permit, if apple blca e. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed components tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' deep drywells surrounded by one foot + gravel) . e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, o eported agent of owner agree to the above conditions. SIGI�TURE TITLE V wti e fZ_ DATE c /O O i : TO& Wiibe (MD); Yellow (Twn ED; Pink (AFp I(mnt) - �"�`��, •. ������4 . Pages r Pa 0 LEO ARDI & SON CONSTRUCTION, INC. 6 CAROLYN DRIVE o CORTLANDT MANOR, NY 10667 (914 736-90-110 : I LIC. # WC- 3112 —H90 m LIC. # PC -560 • s - - - 3 PROPOSAA L SUBMITTED TO 4. PHONE DATE STREET t f JOB NAME CITY STATE and ZIP ODE ^ JOB LOCATION v J i ARCHITECT DATE OF PLANS JOB PHONE F y � We hereby. submit specifications and estimates for: � d' f _ZA) ol go�ld� FT-i � ?(lZc� F aCUJ"r�T l I tl 6 e ) w1 SF.t;� i �f•"� J O LANDSCAPING RESTORATION, OTHER THAN GRADING DISTURBED r AREAS. !S INCLUDED UNLESS SEC!FICALLY STATED.' � - r ry prapgf hereby to furnish material and labor = complete in accordance with above specifications, for the sum of: . M 2 { W "Payment 6 be made as follows: dollars $ 1 A FINANCE CHARGE OF t'(y% PER MONTH WILL BE ADDED TO ALL UNPAID BALANCES. CUSTOMER IS RESPONSIBLE FOR ANY ANC�,ALL COLLECTION FEES. ALL DISPUTES ARE TO BE SETTLED THROUGH BINDING ARBITRATION Atl matenali'is guaranteed to be as specified. All work to be completed in a workmanlike manneraccording to standard practices. Any alteration or deviation from above specifications Authorized " Si nature Involving extra costs will be executed only upon written orders, and will become. an extra g charge over and above the estimate. All agreements contingent upon strikes; accidents or delay§ beyond. our control. Owner to carry fire, tomado and other necessary insurance. Note: This proposal may be .•Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. —The above prices, specifications and eoriditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. I Date Of Acceptance: Signature j 5 PUTNAM COUNTY DEPARTMENT OF HEALTH Y Division of Environmental Harlth Services, Calm% N Y. 1061 2 . Permit CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Putnam Valley Town or Village � Located at • n cs- 1-I'Di'loi Owner Abraham Rosten Formerly Tax Map Lot a 6.2 snbd. Lot r Separate Sewerage System built by Charles Maddicks Address`929 Commerce St., Yorktown Htso, N.Y. Consisting of, 11000 Gal. Septic Tank and 72 Ft, of 4 x 4. Concrete Galleries Other requirements Water Supplye Public Supply From X Private Supply Drilled By N Anderson Address Barger Street, Putnam Valley, New York Building Type Single Family Residence No. of Bedrooms 3 Date Permit Issued 12f 6 ,184 Has Erosion Control Been Completed? i certify that the system(e) 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, in accordance with the filed plan, and the permit issued by the Putnam County Department Of Health. /% Date ,--" 4U6— 8 5- Address P.E. X R.A. go 26008 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 nd v kt who a publ west pply becomes available. Such approvals are subject to modification or change when, In the Judgment of the C mm slo of Health, su revocot n, modification or cha a.Qpcessary. Date �` ✓ �+ By Rev. 9.81 (®rkt®wn Medical Laboratory, Inc. LOCATIONS: 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245 -3103 1 321 Keaf Street 201 BUTTONWOOD AVE.. PEEKSKILL, N.Y. 10566 737$777 Yorktown Heights, N. Y. 10598 ❑ 495 MAIN ST., MT. KISCO, N.Y. 10549 666 -3335 (914) 245 -3203 ❑ STONELEIGH AVE. (NEAR HOSPITAL), CARMEL, N. Y. 10512 278 -9330 Director: Albert H. Padovani M. T. (ASCP) rDATE RECEIVED: —B c IJ-- s, 1k) J-g D D 0 cA� S DATE REPORTED: SAMPLES OURCE: �� Lab N Ir REFERRED L J Collector e me oGei�S f LABORATORY REPORT mg /L ❑ ACIDITY ............................ ............................... ❑ ALUMINUM ................................ ............................... ❑ ALKALINITY i P= ............... A= ....................... ❑ ANTIMONY ..............._................. ............................... 9 BACTERIA, TOTAL/mL ........ ... ./ / .......................... ❑ ARSENIC, .................................... ............................... • BOD, 5 DAY ............................ ............................... ❑ BARIUM ....................................... ............................... • BROMIDE ............................ ............................... ❑ BERYLLIUM ................................ ............................... • CARBON DIOXIDE, FREE ........ .........................:..... ❑ BISMUTH .................................... ............................... • CHLORIDE ............................................................ ❑ BORON ........................................ ............................... ❑ CHLORINE ............................ ............................... ❑ CADMIUM .................................... ............................... ❑ COD .................................... ............................... ❑ CALCIUM ..................................... ............................... ❑ COLOR (units) ................. ............................... ❑ CHROMIUM (tot.) ............................ ............................... ❑ CYANIDE ............... ......... ❑ CHROMIUM (hexavalent) ❑ DETERGENT, ANIONIC' ............ ............................... ❑ COBALT .................................... ............................... .❑ FLUORIDE ...:........................ ............................... ❑ COPPER .................................... ............................... ❑ HARDNESS ............................ ............................... ❑ COLD ........................................ ............................... ❑ MPN COLIFORM COUNT/ 100 ml ............................... ❑ IRON gM T COLIFORM COUNT/ 100m.1 ..........Q ............... ❑ LEAD ........................................ ............................... ❑ CONFIRMATORY TEST ........... . .:............................. ❑ LITHIUM .................................... ............................... ❑ NITROGEN, AMMONIA ............ ............................... ❑ MAGNESIUM ................................ ............................... ❑ NITROGEN, KJELDAHL. ............ ............................... ❑ MANGANESE ................................ ............................... ❑ NITROGEN, NITRATE .:......... ............................... ❑ MERCURY ..................................... ............................... ❑ NITROGEN, ORGANIC. ............... ❑ NICKEL .................. .... ........................ .............................. - - ...... '0'' -ODOR -� uti 'i:3' -. _ _.� ❑- PALLADIUM ............. . ... ........................:...... ❑ OIL & GREASE ........................ ............................... ❑ POTASSIUM ................................ ............................... ❑ pH (Units) ...................... ...........................:... ❑ RHODIUM .................................... ............................... . ❑ PHENOL ................................ ............................... ❑ SELENIUM .................................... ............................... ❑ PHOSPHATE (ortho) ................................................ ❑ SILICON .................................... ............................... ❑ PHOSPHATE (condensed) ............ ............................... ❑ SILVER ........................................ ............................... ❑ PHOSPHATE (total) ................ ............................... ❑ SODIUM ........................................ ............................... ❑ SOLIDS. SETTLEABLE, ml /L . ................................... ❑ TIN ..................... ............................... ................... ❑ SOLIDS, SUSPENDED ............. ............................... ❑ ZINC ............................................ ............................... ❑ SOLIDS, DISSOLVED .....:....... ............................... ❑ .................................................... ............................... ❑ SOLIDS. TOTAL .................. .........................:..... ❑ .................................................... ............................... ❑ SOLIDS. VOLATILE ................. ............................... 11 REMARKS: .................................................................... ❑ SPECIFIC CONDUCTANCE ( uhmo s / cm) ............... ❑ .................................................... ............................... ❑ SULFATE ...............:............. ............................... ❑ .................................................... ............................... ❑ SULFIDE ............................................................ ❑ .................... ............................. ............................... ❑ SULFITE ............................. ............................... ❑ .................................................... ............................... ❑ SURFACTANTS .................................................... ❑ .................................................... ............................... ❑ TURBIDITY ( NTU) ................ ............................... ❑ ....... ..............................: .............. ............................... THESE RESULTS INDICATE THAT THE WATER WAS C14a OF A SATISFACTORY SANITARY QUALITY WHEN THE SAMPLE WAS COLLECTED. THESE RESULTS INDICATE THAT THE WATER DI MEET THE SATISFACTORY CHEM- ICAL QUALITY OF THE NEW YORK STATE ADMINISTRATIVE RULES & REGULATIONS9 DRINKING WATER STANDARDS (PART T2) FOR THE PARAMETERS TESTED WHEN THE SAMPLE WAS CO CTED. N/A = not applicable r l- Albert H. Padovani M.T. (ASCP), irector WELL OMPLETION REPORT . PUTNAM COUNTY DEPARTMENT OF HEATH 3/71. - +. Divlaion of Environmental 'Health Services COUNTY. OFFICE BUILDING - CARMEL, NEW YORK s. report is to be completed by well driller and submitted to County Health Department together with laboratory report of . a I.ysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED` WITHIN 30 16XVS Oi E'LL`i 1`f LE ]f NAME ADDRESS OW R l0 N (No. a Street) (own) / (Lot Number) ' BUSINESS LL OF tj PRO ED ®DOM IC ESTABLISHMENT FARM TEST WELL use F PUBLIC W ❑. SUPPLY El INDUSTRIAL CONDITIONING (specify). Del G COMPRESSED a CABLE . OTHER EO I ENT ROTARY AIR PERCUSSION PERCUSSION (Specify) C ji LENGTH ((0et) DIAMETER( Inches) W IGHT PER FOOT C'ASiR . DELS.. .y J f u / THREADED' ❑ WELDED YES. NO YES NO ' ( HOURS G.P.M: - YIELD (G.P.M.) T D BAILED.. , PUMPED �` COMPRESSED AIR MEASURE FROM LAND. SURFACE- STATIC(Speclf feet) DURING YIELD TEST lee( W R y i. ) Depth okomplated Well L in feat below Land surface: O`er d MAKE LENGTH OPEN TO AOUIfER fe0tj s N \. D ILS SLOT SIZE " DIAMETER (IncAea)_ , GRAVEL SIZE (Inches)• ROM 1001) TO (feet)' IF GRAVEL : Diameter of.,well including PACKED: grave( pack. (Inches). DEPTH F M LAND SURFACE fA� dlltencN, f0 of /Hat 1 to, FEET' ••.FORMATION, DESCRIPTION Sketch'0xact locatlon of well wl Iwo pe�mment. landmarlp. If yield was fasted of different d�pfhs during drilling, list below FEET GALLONS PER MINUTE'.....:. :( DATE Ell COMP ETE DATE OF ,REPORT.., DR)l Sig lure) :, :. Owner or 'Purchaser of Building Section Building�Construct.ed by Block Location - Street Lot Ae- T �-s ,A. -1 4\1,[,e �-i Municipalit J Subdivision Name f FA M4 L, �, Building Type Subdve 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- ors, 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 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- at- -c;n. of the Directa..r. cif t- a �iivisign •.cf . Environmental. Hea- h 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 /!54-day of t4AAU< SignatureX Title„�� p Corporation Name if corpo) 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 k'PUTNAM COUNTYF DEPARTMENTa OF HEALTH, Divisipn •of EnwconmenielwHealth Services Carmel N' Y 10512, = - - CONSTRUCTION ,PERMIT' FOR SEWAGE DISPOSAL SYSTEM ti . pt1TNAM VALLEY Town or ,, Villag e Map t. - suva oc a� N /�A CPU 51 83) cf* - Subdivision + `. ,�''' s , +Renewal Revision x_`j] t r `t - r . 4 Owner /Address D ateOf f l 10 Y I2 83 v I Farnial ;Residence "' 2� <4 w Building "Type y LotsArea �t x` Fillt section Only ❑ F y 60 f � s= 1 Number of Bedrooms' 3 Dea=gn Blow G /P /D O s a Np P C H; -D NotrrifiCatiOn Requ=red Y x•. L 1 4 �,. `>3'$'1 ,..:F X':" , +'sh }�` {^• 4�.? „� y. �'� 2 P ., 1 .N cq 'ii,.. C ).•4 -jj 000 4 r 84 ^ L F Ga "I 11 es. i Separate ;Sewerage System to consist of Gal Septic Tank., antl + r i TO be:- constructed by TO`be determined i Address I l� s ;Water "Supply Public Supply F..rom zr t q a� a ?' X Prwate Supply to be dr�lletl by TO 'be determ i ned;fi r Address. x1 Other Requirements $ 'z l_represent that Pram wholly and completely responsibleforfhedesign' and location of .,the; proposed •system(s), 1) that,.the sep`arste sewage disposaLsysteni'• z .. bbove;Cescribed,`will be constructed =as shown on the`approveq amendment - here: to and in accordance with the standards ,rules an• >regu „a ..ons o e u nam l.County,'Department of. "'.Health,;and that?on complet�on,ihereof a Certrf�cale of Constiuctdon Compli5nce saflsfacfory'do the - Cominisslone'r of Healthwill be iubmitte- to the Depart- ment,, ,and a wrdten "guarantee will be. urn the owner his uccessors; heirs or•assigni`by the builder, that said builder will c 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 Ceitificate,`df ,ConstrucUOn, Compliance of athe'onginal'•system ' o► any repairs•thereto 2)` that, the,drIW4'welCdescribed. above ' .'will .be located as shown on the approved plan and tnat said well will be installed �n accordance 'with theatandSrds rules' and: regula�ons. f he Putnam County, Department of Health { y i w Date `fZ; t r Signed..i.��(.'C.� •=� ' - = P E _ R A. Cash l n Associates, tP C 37 -Fa i ryrrSt� ; CarmeAl , N Y n { Adbress + License No 26008 J APPROVED FOR CONSTRUCTLON Th is . approval expnes. one yeaiaromhthe date issued runl nstru'c on,.of the_building.h'a been undertaken and is, revocable' for cause or may be amended ormodified:;when co s� ed "' ce s ry, by. the Co issaner of Health Any change-or, alteration of,copstruction � Wrequireis,a new :perms ';',Appro d for disposal of,'dome ti sam a y sewage„ and or.priv to iwa" Esuppl only s t tY fi,'�k 1 - "^�•A . sti - ' -' •• � r Title .Rev. 9-8 PUTNAM COUNTY DEPARTMENT OF HEALTH . DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ . nnZmrTy nFFICE BUILDING r_.ARMEL --N. Y_ :10512 - -- _ DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO'. Owner ' AeRAi+Am �ST�� Address _....... a Located at ( Street)CA Qjc)Pj_% o-,L4c3w' `Sec. b 7 Block f Lot (indicate neares cross street) Municipality T'NA M �� V Watershed_ "C :l t : �� ho 6. LLC.�W . SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED..WITH APPLICATIONS r ` Hole Number CLOCK TIME PERCOLATION PERCOLATION:; -� Run Eiapse Depth Eo a er Water Level No. Time From Ground Surface.in Inches; s61l-Rate Start -Stop Min. Start 'Stop Drop.in Min: /in drop... Inches.. Inches Inches.. 30II -1150 -39 l3 . 4 21 _ Polp ^_ / -/,S— �ti �� . IRATE 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. Name ) . -c.& .:i p5 .: i.gna ure TEST PIT DATA REQUIRED TO BE SUBMITTED APPLICATTON ,WITH DESCRIPTION OF SOILS ��NCOUNTERED 'IN :TEST, HOES':: DEPTH HOLE NO HOLE. NO. G. L. THIS 6" ©', t.- .1 Sq. Ft Gal : CYie "eked 18" 30" M I)K 36.. t • 48" M!i 6011 —SAM fi�>l • 66" 7211 Mix .rr. 78��.. .. } 84''+ ti• 1 t INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED. INDICATE• LEVEL' T0' WHICH WATER LEVEL RISES AFTER BEING'ENCOfiJNTERED TESTS MADE BY . CTi4"T- Date /I Soil Rate Used /1�/ Mir/l "Drop. DESIGN, S.D'. Usavle. Area. No. Bedrooms ..3 Septic Tank Capacity /Dc?o Gals 1�fY .of' ,Type AYisorption Area Prov e By�_L:F.x24 " -� width` re��h :. 'other GAI t cs E. Name ) . -c.& .:i p5 .: i.gna ure Address 3i4 R .SEAL THIS SPACE h'OR: USE` BY HEALTH DEPARTMENT-ONLY'-.- So `1 Rat e Approved Sq. Ft Gal : CYie "eked t • ,� �� PUTIeTAM CQ; IZITTY. . DEPARTMENT -OF HEALTH Y,:Permit q 1z111_J1_-Y3 Division of_'Environmental, Health: Services, Cacme% fl!'Y. 'f0512 y JJ�� CONSTRUCTION PERMIT.- FOR SEWAGE - DISPOSAL SYSTEM tjTm =+. Ve4 Town or village '— a• t ,i1. C tP' Subdivision Own p er /Address A1 H:+ -/K�'1 ti 4ti_ �r Building •TYPe 'NuMber o' Bedrdonls Design Flow G /P /D Separate Sewerage System- to.conslst of . To be 'constructed i WA or Supply Public Supply From i �P,rivate•'SuPPIy to be drip f 'Address' i Other itequirements I;reprosent that I am wholly, and completely .responsible for the tlesgn`and location of the prop_ s*:ksystem(sj; l) that -.the separate sewage; disposal system above described will be constructed as shown on the approved"amentlrnent there :toyand ,in:accordante with the standards, rules an regu a ons;o e u nom C(( County' Department of. FteaKh, and that on completion thereof a - Certificate_ of Construction`ComDliance" satisfactoryao the llommissioner of. Healthwitf ba submitted 'to the Department; and a.:wiitten?gu6rantee -will befurnished'the-'owne'r his - successors, heirs or assiyns,by the builder. that sold builder will ll place an good operating- conbition any'.' rt of.said- sewage dIspdkai l�system:rduring •the pe'rfod of two years Immediately following thedate.of the lssu ancW; of the approval of :the'Cartificate _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 installedin aeeordanee with the stantlartls; rules and regu aTiTons of the .Putnam County Department of Health;," r Date Sgned P E. R.Ai f _, Address l z License�No� APPROVED FOR CONSTRUCTION This approval expires one yeaarfrom the'date iuued nless construction. of the building has been undertaken and is i revocable for cause or may'3ie amendeid or =modified when considered neeessary by •the' mrh sioner`- -f'Health. Any- change oi` anon of construction requires a new permit ',A proved, for d�dposal of dom c: sa i ry: a '_a` /or ` rivate wpply only. M1 Date " BY t -Title !, .r subd ".Lot NI Renewal A Q, Revision _Q. /p Previofie ApprovalC c1-y r � Only ❑ kree = Fill Section P d.,�H. D Notification Required :. • _ Gal. Septic. an aniJ J q r.. 4- Address by 7 I' PUTNAM COUNTY DEPAMM OF HEALTH 1.r � >t...:.ac!a�. �.- :ame�r, �_. re��...i• —_ _ '.D T.Y - .n�.l.n0.: � a:. 7r' .v9:am:'%�.,�a4..'M'�....v r :... �'TT,�W'�5..�.:r•.�Y.':T�.Y+, DIVISION OF ^ENVIRONMENTAL HEALTH SERVICES Date: July 30, 1983 Re: Property of Abraham Rosten Located at Town of Putnam Valley Section Tax Map 57 Block 1 Lot 6.1 Gentlemen: This letter is to authorize Cashin Associates, P.C. a duly licensed professional engineer, to apply for a Construction Permit for a separate sewerage system; to serve the above noted property in ac- cordance 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 connection with this matter and to super- vise 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 Cashin Associates, P.C. 37 Fair Street Carmel, New .York 10512 (914)-225-80.$8 '.` Very truly s , Signed' /41.) of Propef ty 1929 Commerce Street Yorktown Heights, N.Y. 10598 Address (914) 962 -4550 Te ep ne 12ECE11�ED AUG. 11 1983 PO'fN&A DEPT. OF l ,12 ,. . Very truly s , Signed' /41.) of Propef ty 1929 Commerce Street Yorktown Heights, N.Y. 10598 Address (914) 962 -4550 Te ep ne 12ECE11�ED AUG. 11 1983 PO'fN&A DEPT. OF l ` Subdiv,iiloon - Awner F� x: BUT NAB Division. of EA �arYh Servjces, Carmel, N. Y 1'05.12 L "{_ Town or Village _ ax.WaP 5.'.� Lot i Job. �L 6 I`.. Address Address "Other .Requirements' ^. represent 1 am wholly and compltely responsible for the design above described 'will be, constructed as'shown on "the approve, amendrn County :Department of,_ klealth,.,anil that on cornpietion.thereot a '.'C 'be'submitted to.: the `Department;,and a writiten,guarantee.will be .1 place in good operating, cond�Uon: any part of said sewage des_ ance of the approval of the Certificate of Construction Complranc wUl be located as- shomvn on the approved plan and that saidwell wiltbe County Department of Health Date 7 = C Signed! _Address-_, APPROVED FOR-CONSTRUCTION This approval' expires,one year revocable for cause or may be, amended or;modi led 'when e r require a ew permit Approved for disposal of. • do estic san�t ry Date � By ' 0 f nd location of the proposed systems) `1) thaf "the separate sewage disposal systlR► it there to and ' in' accordance: with 'tfie�standaids, rules an regulations 3 e u nam tificate 'of. Construction Compliance :satisfactory to the Commissione(of-Health.will '! rmshed the owner,. his successors, heirs'or assigns by.the builder,'that said builder will system during _the period of, tw_ o (2) years immediately.;follow,ing the date of the issu- of the. original system or any repairsthereto; 2) that the'.drlled'•well described above _ ... istalled accordance wdh. t standards rules and regula ion9 of the ..Putnam OV /R.A. '- (i�Li•� —i. . y}tii. 1License No om the date: issued unless construction of the building has been undertaken and is { ces b. the - C " missioner.of Health. Any change ^or' alteration of construction ! s age, ,,v e` ater supply only j � Title �. • � PutnaFn County Department of Health " Division of Environmental Sanitation AFFIDAVIT - CORPORATE OWNER APPLICATION _.. ...............� - - PUTNAM COUNTY HEALTH DEPARTMENT. • T0: Commissioner of Health - In the matter of application for _A -- - -- 0�' — - — — — — — — 11 represent that I am an officery or employee of the corporation and am authorized to act for _ `_'1 _ _ ' _/ _169147,V �_� — (name of corporation) having offices at AC�_)s Gc/ _ t/rC — — — — — _ Whose officers are President _ �L F." -, t?d 0 —�E; 7� e- d .l f l — L/�/, G Le: (Name. and Address) �9l�� Vice - President _ _ _ _ _ _ _ ,p (Name a Address) Secretary �C7 'A� (Ny d Address) Ile Treasurer iflfl �TG/j/ ' _ (Name and..Addr..es and that I am and will be individually responsible for any or all acts of the corporation with respect to the approval requested and all sub- sequent acts relating thereto. Sworn to before me this day Signed �l'YLc of 197q Q/%? ,44:A7 �T Notary Public ABRAHAM ROSTEN NOTARY PUBLIC, State of New York No. 60.3370075 Qualified in Westchester County Commission Expires March 30, 19/ 0 Title Leo ---------- 4,,s.,' Corporate Seal PUTNAM COUNTY DEPARTMENT OF HEALTH �DIVISIOs0�_IV� IFtni1AI ;°i�E`�iLi•rianAT'"- := -�:�_, Ai Date ®°~ Res Property of, P 5, Located at -A IF-9 Section - Block Lot ' Gentlemen: ' This letter is to authorize c��dG�'� ° Jr ° �- duly licensed professional engineer or registered architect (Indicate) : �o apply for a Construction Permit for a separate sewerage system; to a' 1 :sgrve the above noted property in accordance with the standards, rules :9-7 regulations as promulgated by the Commissioner of the Putnam County `Deoartment of Health, and to sign all necessary papers on my behalf in ection with this matter and to supervise the construction of said. .system or systems in conformity with the provisions of Article 145 or 1 � ` -":A 7D Education Law, the Public Health Law, and the Putnam County Sani- .' �ar-y Code. Very truly yours, Signed CQ� FE a Owne o roper y e < F `* May l�Q"unteraigne v Address M m� �. g� A U- 198 Telep on® �A R. IdIIsLT) CTTI,CI: LIST Date: Lf 1617� IV I INITIAL SITE INSPECTION Property ].fines or corners found.. . . . . . Can estinrate house location . . . . . . Will drivcriay ne-ed -cut . . . . . . . . . . . . Must trees be removed -note these ...... . . . Is deep hole representative of entire SDS area Additional deep holes needed. . . . . Sufficient SDS area available considering driveway cut,house location, separation . distances, etc. DEEP HOLE DATA Depth: Water elevation: Rock elevation: ' � � ` Soils description: ? Date: FI1\AL SITE INSPECTION Insp . by . House located where shown on approved plan SDS .located where approved . . . . . . . . . . Length of trench measured, Width of trench average Slope of tile -line and trench acceptable . Room allowed for extension trenches.. . Over .50 ft. from.. si.:amp, watercourse -rr a1 -s1 iot striped or SUS area unnecessarily graded 10 Ft. maintained from prop. line and. 20 f t . from house . . . . .. Separation of trench from house, well etc. follows plan -. . Number of bedrooms checks . . - Stories, brush, sturms, rubble; etc . greater than 15 ft from nearest trench 15 Ft. of peripheral soil horizontally from trench . . . . . . . . . . . Junction boxes properly set. Could surface run off from driveway, roads, ground surface, etc. channel near SDS , area. . . . . ... . . . . . . . _ Does lot drainage arr.�ear O.K. in area of SDS FINAL GRADING OF SITE ACCEPTABLE IYes No I Comments ./ .- 0 � d/-, r Me-nott 2 k, s std.! Remarks - 1Jo o House plans "0. K. ✓ . Do 'sign data sheet Peres presoaked? Nun. 30" perc test depth Const. r --suits for 3 runs I D, Hole log 0. K. _ i Corporate Affidavit for. othen than individual AutYioizaton for eriginee_r Intter from Water Supply if applicable If variance requested -such noted on plans & apps. DETAILS. I i f change is propos- d,� ` Existing contours shown show new contours) Slopes for driveway cuts, etc. shown I Water service line location Footing drain, etc. location V1, I Top slope, bottom slope of fill i Percolation tests and deep test pit location Septic tank size and conformance to std. 3 B.R. house minimum I House setback shown I m ±1' .r Di bO,_ f'L- ,, el o -,r f_rost..____ All Seater wiTnln "U I L . -of FL snUVrtl j i ej d, r Plan and profile SDS All other-wells axad SDS closer 200' shorn or reference made Property boundaries (metes and bounds- clearly shown I T 1 _ _ SEPARATION DISTANCES SPECIFIED ON PLAN _ 10' to P.L. 20' to Foundation walls i 00' to Nearest well 50' to stream, march, lake, etc. incl.expansion 15' to Curtain drain ! I 10' to water line (pits -20' ) i I 15' to storm drain ! 10' to large trees ! 10' from foundation to septic tank i 5' to pipe from leader drain & foo ti.ri r in e _ C k '0 V� Ala o G� 1 6 s Ff 17 P.DS 5'Y� J t t -IN Jfflo .. - -�. . «. ._ r ... .. � :: P -.: , -�..�. r -. .! i :•.• - ,..,. -..�: .,,. - r•, ^. ,., >,.� i / � /+� j y " "" i7 h.�� q� > `.?'.:ii� ::y�''•`� :�: -�'� l���ti�Y_: 4 586 56 w j J, I/ Ir 25' '585 4584 510000 FEET 4583 PIRION . 0 w PUT111�►M COUNTY P I'PARTMEIVT of HEALTH • ,�` �. DIVISION. OP EVVIRON }' HTAI, IRMT T]I 'SERVIC `•�ST!r:..OFF — : A i� T. �P��d.��';, .. i. i 1 ..1 iY o' �qy ♦� ; .. i .. ;��X r:.. <.:- 1 _.,< .�.v f, e -,— . T: sy.:_ , �Y Y_`a;':+G CLZ >.�>'�Ck'+k TT!T�+ �►/� +v.��( , . ' . �• k,�r::: g ;� PTA SHM- UPARAT9 SMMGE4 DISPO +. SYSTEM mg no F�4j4TTrc2CAddress W,,S 6t street Sec. -5:7 Mock ��n • .. .. aa.�� �ear�s` � os� � rep .. ..r. , . ,. ... ... � . e7rshed _ cli— LL SOIL • OIATION TEST RaTA BMUIRM TO BE SUMITTED UI'TN ' CLOCK TIME PERCQLATION LA Y film VOW th to Water a t .,01' 46,Y101 ego' ;. �.ma ►cm Gro=d Surface in Inehei S�v Mart- S� ®�a .1.' r�� q Stark s� o� -Drop in, :... l ;5.4.0 vj� f '•Inchosi Inchon C� t t .,. J 6.1 1,° Z/ (6 S �•i�i �,�`� Y'. ' '> S��9F•AWS P�R. 1 Imli 1''� P:� 9G ®� P9 I } Po S}}" s6^.4Qmh .11 1. Unto, e K'r"� QZ g Taato bo xatc� at say �4�h' �aa�. a ...I: O1cecaa a�: a ®ti ned �t O�Oh ��u°CQ1 � qp t40t hQj @p 4 1' 4 r• .. .. 'p ran Ira Yewl6 .• - .. :W.. Di3p .4 ne�sureAenta to be wmdQ to pf Q 1 DEPTH 1211 18if 24 3011 3611 4211 4811 5411 6o 11 6611 7211 78n 8411 TEST P'FT J.),'Vi'A D 1011 PT 07! Oi-, lc.�)01111111 EL- J. 01 �N,N�E 1,1 , �,.,T IMLIFS HOI;L?, NO. HOLE 11 JO. Hoij? NO. L, — I — I I %.Ie V-),J �-1 INDICATE LEVEL AT V=11 GROUED WATER IS ENCOUNTERT-7-) INDICATE, =L TO Wfll �i WA-;2-R MVEL RISES AFTER P2'.1L'NTG ENCOUNTEFr' TESTS MADE, BY -:J W, Date Rate Used J Mi l"Drop: S.D. Usable Area Provided c3 No. of Bedrooms Septic Tank Capacity ETC Gals. Type AX/- 'bil Absorption. Area-TF6-vided By L.F.x2411 - h trench. e r Name je. 6 ",ANIIIIA Signature Address SEA C4 T1, MIS SPACE FOR USE BY hEALTH DEPARTMENT ONLY: 38998 OF N F* Soil Rate Approved Sq. Pt/Cal. Checked by Date 4