The URL can be used to link to this page

Home My WebLink About2725DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 61. -2 -46 BOX 23 a or is iF :NN ` t@A I E•� I L I IN 6 Is I fj� 02725 Lbcated at C � Tax Map 6 Town or .Village Block ? { Job e Separate 5ewerage'`System' built by 4 sss Addre Consisting of —Ga1. Septic Tank and public" Su I From ... Water :SuPPIy �: PP Y '�prrvate Supply Driletl' 8y /� �i i- sr7 � � /•f" CJ.��/ r'��'Q � Address .G*Y { Building Type � �� Nor: of Bedrooms `" Gate Pe mit Issued Has Erosion Control Been Completed? Y` r 4 I certify re constructed essentially as shown o, the plans of the completed work ,(coples of which are r9 attached), antl in= accortlance with- the'st5ndards �rulestiand.regulat�ons plans •filed, and the permit issued by'` the .Putnam:COUnty,'Departnient,of :Health. r , 0 7'R A • . i jo r� Address ! . 'IN t ( /' License No� 44ny person occupying premises served by the above, systems) shall promptly take such action as maybe necessb�y to secure the.correction of .any unsanitary conditions 'resulting from such usage 'Approval, _of the separate sewerage system shall become nult:antl void, as soon as a ;public,sahitary sewer ,becomes available .and the approval 6f -the watersupply shall' become n 'C.'void.wf en a public .water supply becomes available Such approvals `are subject Ito, moditication,or change:_when,, in the judgment of the,ky mmi io er OT-Health uch reJ modificption•or change is necessary �. 7"k aj Date ^ BY Title i - t en ;J u y a ,� f2xv\O x»:. PLJTNAr "� Division of::E Lbcated at C � Tax Map 6 Town or .Village Block ? { Job e Separate 5ewerage'`System' built by 4 sss Addre Consisting of —Ga1. Septic Tank and public" Su I From ... Water :SuPPIy �: PP Y '�prrvate Supply Driletl' 8y /� �i i- sr7 � � /•f" CJ.��/ r'��'Q � Address .G*Y { Building Type � �� Nor: of Bedrooms `" Gate Pe mit Issued Has Erosion Control Been Completed? Y` r 4 I certify re constructed essentially as shown o, the plans of the completed work ,(coples of which are r9 attached), antl in= accortlance with- the'st5ndards �rulestiand.regulat�ons plans •filed, and the permit issued by'` the .Putnam:COUnty,'Departnient,of :Health. r , 0 7'R A • . i jo r� Address ! . 'IN t ( /' License No� 44ny person occupying premises served by the above, systems) shall promptly take such action as maybe necessb�y to secure the.correction of .any unsanitary conditions 'resulting from such usage 'Approval, _of the separate sewerage system shall become nult:antl void, as soon as a ;public,sahitary sewer ,becomes available .and the approval 6f -the watersupply shall' become n 'C.'void.wf en a public .water supply becomes available Such approvals `are subject Ito, moditication,or change:_when,, in the judgment of the,ky mmi io er OT-Health uch reJ modificption•or change is necessary �. 7"k aj Date ^ BY Title i - t en WELL 'CO MAPEET1 0* REPORT PUTNAM COUNTY-DEPARTMENT QF-HEALTH _ 3/71 Diylsio6 64 Environmental Health Services COUNTY OFFICE BUILDING CARMEL, NEW YORK This "'-,"be .completed b*1well:driller. and 'subMitted to County Health Department together with laboratory report of - analysis S r is of satisfactory eria quality Health certificate of constructiomcompliliince is issued. _r. 461ple indicating water tiifqct6ry_baqt" .1 ality REPORT MUST. BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION, ADDRESS OWNER . . LOCATION OF WELL (N A Streeal (Town) (Lot Number) PROPOSED o�f DOMESTIC I AB , LISHAENT ❑ FARM TEST,WELL USE OF WELL E]..PUBILIC AIR OTHER- DINDUSTRIAL ETCONDITIONING ❑ (Spe) SUPPLY DRILLING_ COMPRESSED CABLE. OTHER-: '.ROTAR 'PERCUSSION EQUIPMENT. AWTER -USSION (Soecify) HREADE LPLVE; SHOE ES L_j NO CASING YES I DETAILS HOURS G.P.A. YIELD (G.P.M.) YIELD F] 9-COMPRESSED TEST BAILED PUMPED, AIR TER MEASURE FROM. LAND SURFACE -�-'STATIC (Specify feet) DURING YIELD TEST.,ffeet) Depth of Comple led Well ,WA ,AEVEL in feet below -Lamij -i64aci: MAKE LENGTH OPEN TO AQUIFER (feet) SCREEN DETAILS SLOT SIZE DIAMETER (Inches) 'EL GRAVEL Diameter. of well GRAVEL SIZE (inches) FROM (test). TO. gravel, p6ck (inches): ' DEPTH FROM LAND SURFACE FORMATION DESCRIPTION ....$katoh exact 4ocation of well with d $I ne6i, to 8140 ast two permanenUlandMarks.. FEET to, FEET CA If tested different depths during drilling, list below yield'was at ,FEET GALLONS PER MINUTE PATE WELL QOMPLPED I DATE OF REPORT DRIL Sia t u re) '(S �r ORKTOWN MEDICAL LABORATORY INC. K St of LOCATIONS: P.U. Boz 33 321 ear re 1. , • 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245.3103 ' Yorktown Heights, N.Y. 10598 ❑ 201 BUTTONWOOD AVE.. PEEKSKILL, N.Y. 1056G 737.8777 t.. , ....<....a.. �,r2 'a 2 ;..,....._.. ._ .. 0495 N. ST., MT._KISCO. N .Y. 105,49 666-3335, STONELEtGH AVE. INEAR HOSPITALI; CARMEL;'N;'Y;'105'11 "278 933('° LAB # 2101 DATETAKEN' 2/22/8 10) r —) DATE RECEIVED2 23 NOON DATE REPORTED: 2/25/8.4 SAMPLE sOURCE: KITCHEN TAP BEA DONNAN BELL HOLLOW ROAD ;.�...., PUT..NAM.. VALLEY, NY L. 526 -2337 10579.1- LABORATORY REPORT mg /L ❑ ACIDITY .................. ................................ ❑ ALKALINITY BACTERIA, TOTAL /mL ................. 7---o ❑ 800, 5 DAY .................... ...................... ......... OBROMIDE ................... ............................... ❑ CARBON DIOXIDE, FREE .............................. OCHLORIDE ................... ............. ................... ❑ CHLORINE ................. ❑ COD ....................:...... ............................... ❑ COLOR ....................... ............................... ❑ CYANIDE ................... ............................... ❑ DETERGENT, ANIONIC .......... ❑ FLUORIDE .................................................... OHARDNESS ................... .............. .................. ❑ MPN COLIFORM COUNT/ 100 ml .......p..,............. )EFT COLIFORM COUNT/ 100 ml ..0 ............ CONF.!RMATORY TEST ....:.. ❑ NITROGEN, AMMONIA ... ............................... O NITROGEN. KJELDAHL ... ............................... ❑ NITROGEN, NITRATE ... ............................... ❑ NITROGEN, ORGANIC ...............: ..............1... ❑ ODOR . ....................... ............................�.. ❑ OIL & GREASE ............... ............................... . ❑ PH ........................... ............................... ❑ PHENOL ....................... ............................... ❑ PHOSPHATE (o(tho) ....................................... ❑ PHOSPHATE (condensed) .................................. ❑ PHOSPHATE (total) ...................................... ❑ SOLIDS, SETTLEABLE. mt /L.. .......................... . ❑ SOLIDS, SUSPENDED .............................. ❑ SOLIDS, DISSOLVED ..................... :............ O SOLIDS, TOTAL ........... ............................... O SOLIDS, VOLATILE .............................. I....... O SPECIFIC CONDUCTANCE .............................. ❑ SULFATE ................... ............................... ❑ SULFITE .................... ............................... ❑ SULFITE .................... ............................... ❑ SURFACTANTS ............ ............................... ❑• TURBIDIT .. ................ ............................... REFERRED BY: CROSSROADS PHARMACY COLLECTED BY: R nnn>XA .0 ❑ ALUMINUM ............................... ............................... ❑ ANTIMONY ................................ ............................... ❑ ARSENIC .................................... ............................... ❑ BARIUM ....................................... ............................... ❑ BERYLLIUM ................................ ............................... ❑ BISMUTH ............. ....................... ............................... O BORON ................... ................ ................... ............................... ❑ CADMIUM .................................... ............................... ❑ CALCIUM .................................... ............................... ❑ CHROMIUM'Itot.) ............ ................. .............................. ❑ CHROMIUM (hexavalent) .................... ............................... ❑ COBALT .................................... ............................... ❑ COPPER .................................. ............................... ❑ GOLD ........................................ ............................... ❑ IRON ........................................ ............................... ❑ LEAD ........................................ ............................... ❑.LITHIUM �..... . ._. N.: ............. "........._. .... .., . ❑ MAGESIU...� _ . ....... M ................. ............ .. OMANGANESE ................................ ............................... OMERCURY .............:......:............... ............................... ONICKEL ........................................ ............................... OPALLADIUM ................................ ............................... ❑ POTASSIUM ................................ ............................... ❑ RHODIUM .................................... ............................... OSELENIUM .................................... ............................... OSILICON .................................... ............................... ❑ SILVER ......................................... .............................. OSODIUM ........................................ ............................... 0 TIN. ............................................ ............................... ❑ ZINC ............................................ ............................... O..... ............................... ......... . ............................... ❑ .................................................... ............................... ❑ REMARKS: ............................................. ....................... O.................................................... ............................... ❑ .................................................... ............................... ❑ .................................................... ............................... ❑ .. .............................:. ............... ............................... ❑ ........................... ....................... ............................... ❑ .............. ............................................. ... ... _ ....... THESE RESULTS INDICATE THAT THE WATER WAS OF A SATISFACTORY SANITARY QUALITY WHEN THE SAMPLE WAS COLLECTED, THESE RESULTS INDICATE THAT THE WATER DI MEET TILE SATISFACTORY CHEMICAL QUALITY NEW YORK STATE ADMINISTRATIVE RULES & REGULATIONS, DRINKING 14ATER STAND S (PART 72) FOR-- THE PARAMETERS-TESTED. �Q, ��L OF C.0 :f /crr% . -Ipvrn .0 /! ,23 Owner or Purc a r of Building, Section Location - Street Lot 0_ Municipality Subdivision Name 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- ation of the Director of the Division of Environmental Health Services Hof, tbe.-Put.nam.. County ,L 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 Z day of ace— 4 19U Signature r-g� Title Cpl A-))gb , Corporation Name if corps 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 ,fr 1UTN! ►M 0 fi Drvisron of Envir� `C6N9TRUC7rION PERMIT FOR "SEWAGE" 06 r a <LOCrte rt ! :[/ .Pr B`� 1: -1 `►i.� i Subdivision f., Owner /Address J 9 � n � CJ Building Type r 1� 5 Lot Area —W. 1— i t' .tA lv ' G t4 Vl > Numbec,of rBedrooms � Deaiyn. Plov Separate Sewerage System to consist of % C? C y T' by f 1 � Water Supply Public : Supply From w Private; St (pply .to be drilled by,,: i t Y., :Address. t rt /• ` oti t,Other Requirements �= l � � • .r �•� '�,` L � ' # `I represent that , -am wholly And completely responsible for,i `:be�submitted'ao the•;Department; -and a': writ ten;'guarantee wil place -in .good'.operating -condition any part :of saitl -s- ay" pge'.dl Z pnce of ,the approval of ,the Certificate* of Construction Corn' will be located as,shown on the approved plan. and that said well w County Department of Health -Date G!I Y - 7 / rAddress �` �/+ 'APPROVED FOWCONST,RUCTION Thli approval expires one revocable; for cause or may be $mentled or'.mod�fi 4 when, ►equves'. °a new ermitpp for tlisposal of dourest sat s � s Date 4 ey z DEPARTMENfT� OF HEAL d H 't Permit Health Serwces .�Ca� melt .N`� Y 10512 t .- >TEM t �> - � r �� 7 � rr7 �! fie' /�• "i' gown or lage i a' a -. • C Z � �' -_�l� ' alo Y m•' rat - � ! � >t U Renewal m R Revision � 4e 3 S j •ff. 7 u.T S'4 f � 1 7 Date Of Previous Approval ' i x 4 Fil'1 sec tion`Only - r P C 'H D Notification Required L'" .al Septic Tank and �� '? Atldiess � - t° � - f r '• t '✓ f. Y t ' Y i c t �t 7tif t 1 �.•Y x -. end I location of then proposed systems) 1) ,that the .separate sewage disposal system mt there to 'a- nd in accordance with the standards' rules.an iegu a ons o e . u nam v irtificafe of Construction Compliance satisfactory to the "Commissioner of" Heglfhwill umished the owner hisauccessors;,tieirs:or : assignsby the builder.' that said builder will system during ` tha. - riod oLtw (0th °pp�! pdiately.fol low Ing thedate of the lssu pr i of the or{g nalLLsystem'or,an y� s f15er ho)° tiVat the,drilled.well described above Installed in accordance `regulatTons of the Putnam ni rim •• " a.' E. � R.A. ' �i'�` ..t 3 „ i"'i b� '�'`� '� ,yi.M'• t "R' r di Y9.�, d.icet se No fromthe date issued oon rutsro h by'ild7 nh •has •been undertaken and`.:IS" ecessary, by the: C missyo in ofsljlealtfi'.` Any Tha$# S alterafbn of construction sewag man or`'pr ate w ^ ply eo y sJ o;: o° T �" t u iY � s ®'4pa79sOYAl Y�' *lO � '.`• D S -... �� 1 t 1� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of z 0' H e e7 n. Gt.X57 Located at��' /�cl Section `� Block _ Lot ,eF• Gentlemen,: This letter is to authorize a duly licensed professional engineer � 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 V Villlt lQ 1.1.V11 w a. Ln Ltii5 ma is Lev anii to. supervise the curisrrucciurl 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 Sani- tary Code. ~j Very truly yours, Signe d Q G � Owner � Property Countersigned: Address P.E., R.A o, TT Telephone Address / RECEIVED Telephone JUN 101983 PUTN.AM COUNTY DEPT, OF HEALTH I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFF'IGE BUILD C1VG; CA1L; N : Y . 10512' DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. OwnerR;:,r: JGr�-i Address Located at (Street) /f��`'' �� Sec. -73 Block - Lot (Indicate neares cross street) Municipality �`ll?�,G'ol !' VIII& Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse 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 19 l zi 3 4 392,2- 5 1 2 5 Notes: < 1)' T&4- s to -be repeated at same depth until approximatelyy equal soil rate6.,are obt4tn'ed at each percolation test hole. All data to be submitted for review. 2) .Depth measurements to be made from top of hole. ..D�r1�tI G.L. 6" 12" 18" 24" 30" TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HUB ti O e riC1L� ° iV U . HOLE NO.* lap d. �, INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE__LEVEL TO WHICH WATER I-EVEL RISES AFTER BEING E?\ICOtrn?TFR_Fn ifST,•CT nrtA 1,Y'.. D -�i � _.... "� •� L c 5 f ; r i tL. iS a•YU�L' gate �/ f '� :: DESIGN Soil Rate Used '' Mirvi. Drop: S.D. Usable Area Provided p c7 C/ 3 1 No. of Bedrooms 3 Septic Tank Capacity Gals.- Type e Absorption Area Provided By 2s -C' L.F.x24" width trenc Na- me 6iRnature °. Address ��. THIS SPACE FOR USE BY Soil Rate Approved Sq. Ft /Gal. 0 p a 0 � Q ONLY: �d`�e� °' 2''69'1 °mfg'"* • do ° °o0o ooaoo 1��yo o6O ��Dl�F�u� i �i4��oaa�a Checked by' Date JUNE 1 01983 PUTNA4q COUNTY DEpr. ®F ,EALTH i � �( ": rt:`:'_- �. -'r _ _ _ -. - - � .. ".+ e.a n�v -a- -. s.,:t, .._. ....a.n•• -.," u-.. so: �`r�. raa. �'....r .. .. ,.� z,. 1 1 1AM ±N1 „��j�na -5 �, - * •. .'- t v � .C. •t�f 4tr t �'ir J� � � iGF�F /''� ,,�i �J�+ ] ' 4 ] t, - d�f��'r�' �. 'CT✓�t'i4�f'BisF �Yi1f,� ./� s � u �• 3a qza >E,•., � ;..;, r Waryr� YtY�.r i wb "4 a .u` .w"N� 0. i 4 v 1 � 1 } N ?' t r � { - • t � � C.T !�O* 92 i • � - � � ,�1 „ter -� - �'. ��' �-�� ...�.. �... '. _ - -_ .: , ... �. ..-� - ��*• -s n.. +..r. _ .. .......1'LL'tT18iL lrount '138 lleallb - .. ,•� _ r" a Division oY Enviroim ntal Hea th Servioeq roved as rcted for cor_ores9, ,ce with pl -cable a.�eD��laiions oY the Cosmty seal Ys artment:. is w 77 Io rte.- ;«•�^^ f �,}J� 'r(G� �j / ,,,..^�^ /' �i � ,..,.... —,.�� L � ' . ' �GI T!`i. ,%r j.��.� ,,,� s t;,,. r 't� !r,�+� . 7�y �►'� 1 + 1 CP /3. J7 • - .. �fESS10��.� � ,� /J /'. �ef �J� j iYCA� .�a,�e!w