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HomeMy WebLinkAbout2739DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 61.08 -1 -26 BOX 23 02739 his I `� I Ir 'rj ` 02739 Separate; Sewerage System,_ PnVate ,Water Supply "I'o Pry.T iM 1k* vHj.�r`( Municipality CE•RTIFLCATE OF CONSTRUCTIONCOMPLIANCE <} sG (.. a6 . �.` O " WCDH File No. Located',et L . a R % .•�• °�1 'Qc A- 1-.sr. - Qw' Y.. w'• .(��•i?i fJ' � Block "Section Owner �/�% I� L "7� . of Job Separate Sewerage System built by--.K (` L L. C.® C B NJ— I N C_. Address C 14 04 "k 0:6-"5. ' I' L.L6 W '''R D:° •PU'T V AL :Consisting of 10 6V Gal: anon ,rdwel Septic Tank •0 lineal feet-X, '6 ^width trench Other. reQuirements. ) Water Supply: Public Supply From1 Private Supply Drilled By P U(-- Y Vv ELL ..ywL'�E Ss . 5 PRfiLrr .&S-00.K1 PEE K5X /1.1. _ j Building Type GA t'V 6, In L. FA Nillt.L Number of Bedrooms . Date Permit'Issued f Erosion Control Completed �w t. ti Ed. ",,ad"' j 1 Other Requirements - - I certify that the system(s) as, listed serving the above premises were constructed essential) 1a3�awn on fhe with the standards, rules and regulations, plans filed• and the permit issued by the Westch'a ,er County leper Date Certified Any person occupying premises•served by the above system(s) shall promptly take such actions Aiay� jiei such usage: Approval of the separate sewerage systemahall become null 'and vmd as'soon as a bhc ,; ita become null an void when a public water supply becomes available Such ,approvals are subject t odifie revocation, modification or change is necessary, said modifcation or. change shall be done under the supe With proper nirriotenonce these sycteois can be expected to function satisfactorily and are no Date /.� / ':S WtYrn Jr., M. D:, Commissioner By_ S. D. 47.66 r County Department of Health (copies'of which ere attached), and'in accordance to se{su� he;c rr �ibn.of any unsanitary conditions resulting from c s avai ab end the approval of the private water supply shall ge when,�e judgment of the Commisgioner of Health, such of a licensed Professional Engineer or.Registered Architect. ihrl lq create an unga itary co ppdi��ti��on. © QVAJ V PEEKSKILL, MEDICAL LABORATORY 1879 Crompond Rd. Barclay Plata Bldg. A, Apt.j . Peekskill,: kill, Nework- 1,05,66. PE 7-8777. _ 7, 7' DATE COLLECTED RESULTS OF EXAMINATION OF WATER OWNER DATE RECEIVED CITY, VILLAGE, TOWN VOR NAME OF SUPPLY DATE REPORTED old- �04d- Triqj,/ Ate m 4ALI-61(4� SAMPLING POINT 64 BACTERIA PER ML. (Agar plate count at 35'C). P COLIFORM GROUP (Most probable N6./100ml.) HARDNESS# TOTAL -ppm DETERGENTS - ppm > NITRATES (as N) - ppm IRON, TOTAL - ppm, FLOURIDE (F) - mg./I. These results indicate that the water was of a satisfactory sanitary quality when. the sample was collected: A. 1q. PADOVANI, M. T. (ASCP) TOWN OF PUTNAM VALLEY WELL DRILLERS sw. r.vrs J..L •/us.rn..e WELL DOCATION dk!k!li s�reet section block lot WELL GWNLR LV �TErz.' 564-1, Or l r. �i name address city�-6r town '4 ELL DRILLER u c. %�J y✓�'� ) ii'r �,1/�yc _.j? F l) '3 Pe L lt''S'.(�'1 .name address city or town CAS iVG DETAILS —7—EID TEST WATER LEVEL SCREED DETAILS � Bailed easure from 1 d surface Lez,gh: feet or -y'Pumped6Hr . Static dd ft Make: When Bailed slot Diameter: Inches Y.eld:J, GPM or Pumped ft Length Ft.size _ Kind. F ,L Diameter In.� T r 011: �L DEPT.1i OF WELL 16 Feet From 'Give de,;cription of formation penetrated, such as: peat, Ground Surface 'silt, s :•.end, gravel, clay, hardpan, shale, sandstone, rani.te., etc. Include size of gravel(diameter and sand fine, ijxdium, course), color of material, structure (Loose, packed, cemented, soft, hard).(Ex. Oft,to 27 ft. �•_,_f._ ,,•,_,__, fine, packed ellow sand 27 ft to 134 ft gray .tiramite) L'c�. jJ0 Feet.. r'ormaa on�_:Descri- tion, aketch .exact. location-,- .of-- well:..to,.•, .�._�_Y..._� •_.., _ _. � . _ . _... -- -- at'least two..,. ermeriant�Lasidmar_]�s... _ ...... _ Mh o G- d Date Well Complete -Date of Report Ge,,e /9 'Well. Driller 6,Z a r �.: ', signature —d �().ancr or Wrchascr Of bUildi:lg - }3uildiiIg Constructed by �I.ocation - Street - Building Type ' ).i_ty .`�•.. ^•- �.n.... :.max_ - .' .,. . ._. r.. �: a e Sec L ion ° Block Lot GUARANTY OF SEPARATE SE117AGE SYSTEM I represent. that I am wholly and completely responsible for the location, -workmanship, material, construction and. drainage of the sewage disposal system. servin; 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:guajanty to the owner, his successors, 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, oz any repairs made by me to such system, except where the failure to operate properly lti..4'aljseu'.UV- Gale W1:1 -L1U_L UV J1e�41.1 -UJUL CIUL U1. 01C^ 0 L:UNai1L =.V1 v�i�1 ULLii+1!!g- t�111O1b t!le r. YG i nr!f The undersigned further agrees to .'accept as conclusive -the determination of the Director of the Division of Environmental health Services of the Putnam Count, :`::De "p�lrtment._o.f Uealth.._.as- wto`;whether. or. not tile - .failure of the s stem to operate, was caused by the' willful or negligent act..of. "the occup.ant�`�o�f�t h " uildkb Cr, u- ing the system. Dated this 1 day of -19 SignatureU° Title _ (if corporation, give naiTie and addre: -THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES ' OF FINAL PLANS BEFORE CERTIFI•CATI OF COMPLETION WILL BE ISSUED. GUARANTOR TS RFOUIPZED TO FILE NOTICE OF DATE OF •FIRST USE OF. SYSTE11. -_-- ---------------- ------ -- - - - - -- -------------- --------- - - - --- -- --- - - - - -- Division of Environmental Health Services, Putnam County Department of Health o RTMENT YOF HEALTH PUTNAM COUNTY A ".�, a. E , r yam, +i-. � •.r .. a Divisron ',of nvironments% flth Services Carmel `N. Y 10512 t _ ( } CONSTRUCTION PERMIT `FOR :SEWAGE DISPOSAL' SYST� QT L��W `� Town or. V 411age > Located # at �� /t l 1a ` Sect).on 3' BIOC� Subdivision. — Lot= Job s :Owner �%4L T'�' � ` "��(� 1� Y1n \ i°i�� r ; °` y } ` • Address i p s � Building Type L Lot Arp _ , M Number of Bedrooms u' ` #,able Space , Square ;F,eet # s s 1 s Total Habit k � F Separate Sewers e S it to cotlsist of. 1 ` •� %i e ` lineal feet 'X width' trench f 5 y F al Septic Tank To be ,constructed by. S Address '� C V 1 L` W ;Water Supply Public;SuPply,From4t +.. \k�'+ Private Supply, to be drilled by 4r - Address - so 4d 3 ; r rt e >< sfi= .Other 'Regwrernents � ` •,L. Y,�;A'.V '� -. ^� _ # I represent that l am wholly and'.completely responsible forth design and_locat#on of: the proposed systems) 1) that the separate - sewage disposal system above described, w,ll'be constructed asrshown on the a � a: ^pproVetl endment th "ere to an in a ith the- standards,`rules an negu a ions o e ,; u nam +, m , COunty `,,Department of Health, and that on completion they fra''?CerUflcate of Co tierFG ce - "sattsfactory.10 the Comrriissiorier of Healthwill ;.be. submitted'to the Department and'a'written`'guaranfee ill be, furnished the or assigns by the, builder, that said builder will �' rs place in .good operatiing condition ,any- -part �of.' said ,sewage disposal system d p ioFr,o ' �t ears immediately following'thedate of the issu- ance , of'the approval•'of the Certif,icate':of Coristruct�oh „Compliance of the o in t Fr. ereto; 2) that the:diilled well described above ' "will be located as shown on the approved plan and,that said- wellwJl;be Instal Td ac a the s rules d regula wns of .the Putnam h�F County Deepiartment Of'H881t�/h t to 3 « ;. ?Date "T / �-A'. ± 5 at i ,, a ' # P E. R.A.' A License No ddress APPROVED FQR CONSTRUCTION This •approval '­expire one year from the unless const vCt' of th uild�ng has been undertaken. and,n * �.��� r ion L ^revocable for ;cause or may be- amendedor motlified when consi a nec sary lSy , e,. &.1MI , � `Ith Any change or alteration ,of const requtres.a new, • er mit. Appr ed f disposal of domestic 'Mda s age nl Is r , t ;Tile , r i B • .. 4. :m ',�'PARTI-'21 T. OF. HHEALT.4 PUTNAIII GOTIPNITY..'D: -DIVISION OF, Ei TVII�:ILON=­.NTAI HEALTH SERVICES Lj Re: Property of V*A Located at • l Sectin B ock Lot t Gentlemen: I -14V U0 or, This letter is au" ze .1 ?p:��()7 a duly 'Licensed professional engineer 11 or r-&&Iet 1 (in -licate) to apply for a Co.nstruction De_-mi-'U ;or a separate se,.•rera.:­I system; to ZI serve the - rules 'andards , ---he above- noted D_- =r--,7 Jn accordance w s the 5 ,pith 4-h=� Putnam Coun-Y or r_Lz--u! a'i'"' n.-a! �7,-a`ed by th� Connissioneer Of U U , - u ons* as pro __ L' .1 n U Department of Health, and to s III gn all necessary papers on my behalf in confe'ct'ion wit1- this ire tier and :-to `supervdsa' �h"e on s t r t i 6-n -:6 f 's af. d - system or systems in conformity, wit".-I t-he prcvisions of Article 1L or 147, Education Law, . the Public Health Law, and the Putnam County Sani- tary Code. - " I Countersio-ned, M T Address Telephone Very truly yours, I Signed. -0 w n, �I T Property 04, Address Telephone a ' COUNTY OF i= DEPARTMENT OF 'HEALTH Division oi.' Enviiromaental, Sanitation ..= .,.:...DESIGN• -SEWAGE-,. -: SXSTE -. > s. ... . �- =FIiE overt A L, < Ste% r,.. �- Aadre � ..:5 t� �. C , •...:L � � , s ._._. ; sv Located At (Street S BSok�Lot I L (Indicate nearest,cross street MunicipalityLl- .5? ��° «V+�►rr��AiT rshed ��`.14``'V a C��� Y\. SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATION oe..... Number CIDCK TIME* PERCOLATION PERCOLATION WE 7 Elapse Depth to Whter. Water Level .. No. Time' From Ground .Su -fwe: in Inches . Soil Rate Start Stop. Min: ' ; Start, Stop' Drop in XWin.drop Inches Inches Inches; Name 7.r Address: Cj ) -,rte A- ryN . t Wmty Health Departwnt Soil Rate Approved o Fto /Gralo S.D. 27o6 (Rev. 5 -24-66) (FabraarY 18,9 1969) m ?� t, t, 5 . � r,;r- � •t".. , � ._ _�_ ; � , - -...._ ....,. -.. :...�,..- .:,fir•,,:., ...._ "� _ -- -- —, � .•... 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