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HomeMy WebLinkAbout2769DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62. -1 -34 BOX 23 02769 M L■ , ;, 6 IN 02769 I PUTNAM WILMY�.DEPARTMENT OF- HEALTH Diwsron; ;of EnviMnmenta/ Health Sevices Carmel; N Y.,. ,10512: Lt'ik i- 'rAf -k CAF"GUNSI'iil1C1 "I()N A'O" lAiVCi= FOFi StINAGI •17151'OSAL :S1fS��M .:' _ t'uS-.1,1ANt 1/i41.L. &y.' T or .ill 9 Located at OSCAW- AWA --AatE 3 �~ Block . Section' own v' a e I. Owner W1 I-L t APA . L6 BBEIiS Lot. �• a 1 \► + obb �/ Separate Sewerage System built by ^r�L�IAI$- 4.1U8BG�SN E Address 'DVN�IPJ ` it�e. eaw t�JE�1i� , IUA"GUY Z. Consisting, of'. �'D0O Gal Sepfic Tank E AST I�neal Feet X width trench " Other requirements `:water Supply: ,Public Suppl Fro m, private sui,?Qpl�y�onilea By �k Pi ONE.: AddHrel�ss 7A'y Re k 5 s (D�G� S% N U0�1 Date - •Permit Issued ,Buildm g. Type, N $edroms n -H,as :Erosion Control Been : Completed? 1 certify that the systems) as!listeil serving the above premises were:constructed esse` tally -a s the plans oft ies of -which are attached)�J,!an/dliri accordance with the standards, rules and regulations plans Bled; nd t it is ued ',by the . ,u Coun�1 dfVHealth. ."— Vii'• / � -�` -. DateE' Certified by ' R.A. rt Address .L'eQ,� 1 MD N, /� se { d,68Z Any, person occupying premises served by the above-system(s) shall promptly take such action as maybe necessary Co. of any unsanitary conditions .resulting from, such usage:. ApproVal 'of -the, separate' sewerage system shall become; null and ' id assoon. ,a}i � itary sewer becomes available and the, approval,of. the private watersupply'shall; become null,and void _when a:_pu @lic,wat sup ly becomes'. e. Such approvals are subject W modification 'or "change when, in the= judgment of .th$ Co ` ner of Health - such r.e oca$io modification or, change is necessary. yDate /.:� C/V r BY Title F '09KT0WN MEDICAL LABOATO.ky INC. .- P.O.- Box 19 321 Wr. Street. ,,, LOCArim 0 .321 kEAR ST., Y�ORK,TOWN i�EI,GHTS, N.Y. 10598 245 '-3203 Yorktown HeightsiN.Y. 10598 1:1 -201 buTtONW66P AVE., PEEKSKI . L . L,'N.Y. 10,566 737 -8777 iv.' (r,- bev.;r 5 -ff-496NiAili U) "4'Y 'I 04V b js Q STONELEIGH AVE -(NEAR HOSPITAL) CARMEL, N. Y. 10512 278-9330 DATE COLLECTED RESuLTS-OF EkAM IN AT-ION & WATER sb. .OWN ER DATE. RECEIVED. CITY, VILLAGE, TOWN VOR -NAME OF SUPPLY DATE REPORTED A v 0 a e & S ,,BACTERIA PER ML. (Agar plate count at 350, C). COL I FORM GROUP (Most: probable ,No./ 10 Offil.) 0, X� HARDNESS, TOTAL = POT. ;DETERGENTS'- mg/L NITRATES (as mg/L IRON,'TOTAL - mg/L AMMONIA, FREE (as N)-mg/L pH= CHORIDES - (nng/L) These results indicate that the water was . of .a satisfactory sanitary quality when the sample was collected. A. H. AbOVANI, M. T. (ASCP) M M IPQW4TY WART P14TNA fXA IT 0?'j4§A&TM PIV141pn of anvir9nmental Hoolth fArvk" COUNTY OFFICIR RUILOING - CAIRM. 94 NOW YQAK This ropo Is j4 - q "o plipn;M J@ j@j.M, rWiAp it iJdd1dWW0a 6r is of iq ory bacterial qMRIfty before certificate. of construgfion go REPORT MUST i3E SUBMITTED WITHIN 30 DAYS OF WELL COMPLETIONj MOP Al- LOCAV004 i (No• 4 &fqqt) F (Fog Mir,14194 =44 PUSINESS El EAT4114150mg"T FAR44 TEST WW AIR Ll OTHart INPU$TAIAk CPNPITIQNIN.0 COMPRESSED CARL E OTHER 1-4 RPTA. v AIR PERCUSSION ?IRCUS$ION (Spocify) CAiINQ� 41TER(Inch9s) 44111 WgIGHT PER tQQT El WAS qawmg VIM- m4il : 0 TWA= ►E Wp YFS NO oit VIOLD El HOURS El B COMPRESSED AIR I -7-- G.P.m' 1 T19W 10'rfiq To" A 111#0 RA PUA4PPQ . .0 t WAT40 MCA 449. flOt4 j•ND SUP F CF-STA VC(Spe (00 0 DURING YIELD TEST ftaqt) Do Pth of Completed Wall In f9.9t plow Land ;urfq;qi 31L P;ffM FCOtA tAND 4UPPAj FOOT to FEET r.f 11T?"11117 7" 411111TTWI-r-, IF GRAVEL I Diameter of wall in5luOinp PACKEDt grovel pack (Inchoo): Sketch OXOGt 10GOtiOn Of Well r.11114 411040044, 10 of NMI. FO. RMATIPIN DESCRIPTION, T two pormanqnt 14nomwika, If yield who t Wed W I sliftron, dopthe during drilling, Hot bolpw* F2ff GALLONS PER MINUTE P410 "Im" WN filly I PATE„ QF1 Rr;FORT I W 1-1, DEL11. I-ER (I$ t4 I r /"a"Z2,_]dM ��/' "':5 j, Owner oPurchaser of Building Building Constructed by Location - Street Building Type Municipality Section Block Lot GUARANTY 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 guaranty to the owner, his succes- sors, 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_sy_stem.. The undersigned further agrees to accept as conclusive the de- termination of the Director of the Division of Environmental Health Ser- vices of the Putnam County Department of Health as to whether or not the failure 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 ACS Signature Title If corporation, give name and 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. aeo -------------------- la F FDOT144 DRAW 34' ),z 5T,(. FRAMk ONE FAM. bWELL c I P. C 0 1 STRI sorwo Box' I I , FRom pb�W-77�7�7;4-7?- -TO POWT A-- -9s" s7' TO. POINT -a -4:1-s-, 9 .TO I-Cil.A)T. To pol"T F=;*-tie' 7t 37' To,.PoIMT Hl;..'J�%' 15, -WIZLLL APPRO JA i �� D 14 WO PUTN,iM COUNTY, D EED . 'bF HEALIH :V `PUTNAM COUNTYPARTMENT. OF; HEALTH. �yY.. Division of Environmental Health Services,. Carme% N. Y. 1'0512 Pu-rI.�AM V A L � � \' CONSTRUCTION PERMIT FOR SEWAGE 'DISPOSAL SYSTEM: = _ Town or village Locacea at y iv "vim vEJ �i .:: ' s Gr--�1 >\ ;x. .. �dc'�ion aY +r ;T BIocK . Subdivision��u -1Aa� �UB$S �At1i��1v�L' �AU�N�IN' "r Lot �� Job Owner .&-I Am Lvr668q5 Address �� � MOV�+7101w��IQ1UE Building Type ©NS AWL. �iv8c Lot Area I7, b44, Awze-5 pC't"vtS�f.1L -C, Number of Bedrooms Total Habitable Space I� `o Square Feet Separate. Sewerage System to consist of ''00 Gal Septic Tank - lineal feet X y— width trench To be constructed by 1 1.) I SC. A 1, C H l ASDN Ry - �' IJe.� Address" Oz _ Al.gpNy . PST . Water Supply: Public Supply From Private Supply to be drilled by N�R!/1101.� A ����s ooJ , 11Jc•� 1 ' Address Other Requirements I represent ahat'I am wholly and completely responsible for the design and location of' 'the ,proposed system(s); 1) that the separate sewage disposal system above described will be. constructed as shown on the approved amendment there to and inaccordance with the standards, rules and regulations o e Putnam :County Department of Health, and that.on completion thereof a- " Certificate , wnof Construction Compliance" satisfactory to the Commissioner of Healthwill 'be submitted to the Department, and a written_guaranfee wili.be, urnished the oer,, :his successors, heirs or wi assigns by the builder, that said builder ll ,place ,in good operating condition any, part of said sewage disposal system. during the per.iod.of two (2) years immediately foflowing'thedate of the issu- -ance of the approval, of the Certificate of Construction Compliance of {fhe igina 'ys o y repairs thereto; 2y "that the drilled well described above ikill.'be located as shown on the,approved plan an'd that wd :weII will be mst'alled i ;A n e, ith >, he standards, rules and regulaions oof the Putnam County' artment of Health. D f / 9 k igned Me S : P.E. R.A. Address O 40 �IeOIN.POa% D: i1 C �! ' `. N. / D "�'� License 'NO. 'APPROVED- FOR CONSTRUCTION: This approval expires one year from the dite:`issued unies"s construction of "the building has been undertaken and pis revocable.for•cause or may be amended or modified when consi.dered;mecessary by'i_he Commissioner 'of 'Health. Any -change or 'alteration of construction requires a new• permit. .Approved. for disposal of domesticUn�t_ar..py sewage and /,or private water 'supply only. Date L� ©:'� - t7 ?�. gy t�.1V/'� Title fides' K _ ;iiljt„�..��'• � :�7.�.:. ?�L:i lle r1.: •�.._..._ _ .: .. ,_ ... •. •iV . I i X p 11 r,c,'rc tes ;` U07 Con,-,t. r ru.l't;� fUr 1101:,' 10"), 0 . Y:.: '�.' „�;f.' 1`i J. — LCD•?. �1JA f *0).' T04 I "1C::i'- Lr:�? it _tI1C1:LV:LCil1 a7 -- t`_u.t� }1UT:'ZF,t :!.011 for e11C11)C: °r T'!at,':,,I-, �(-,UtII)•} -- �" v'i r oqu, s 4;ed -s,-1ch noted on -,-ans u, apps.: ' 7 2 con -curs shown r.how, 1 e-Tw contours ) S S for d 1V ?;'ay C etc shown Filater ac-r v., co -inn, 1GC:Lv i_Oil rood, drain, et,c . loc 1:i.01 'lop :.7_o1): -, bo'V.6cLi .3_i.O of rCC.Lati on tests 4vnd deci� teUt, nit, loca-Lion __ _ -�1� i✓ ____ Wit,` Yry Gank S1 /° c`-....t1 d Ot1fUr'ia;cl.IICO l o std. - t� , ) ,.,7a er 1'T_�_ �•Ll l_ �. �V T. 6 • V1 f�1_I �JLiU�' l.t l...._ ___.•_....- _.__.._._.__...__ -._ _... �....._, ._. _.. _.. .i -._... �...._._...... a.__._._ 1 P_LM11...."%i1Ci p:c,o"ilc SD,S .. .. .. ............:.... �...� .. :...� � .__:__S___.:__; __-- .....� .._ . -:... All ot11- wells .fin 5e 2o R1.opai y bow s, and bounds- c:l •�s10,1rr j _I _ t�i - Ap " ®�� a CITC1 r, to P.L. to C. ' t1 "'11l ___.___._._. .1ot.)t ?ihi{.1.C)I1 _l:U ;_(::i : ?l;:i :c, !t;,= �___._.__.. I__..-._.-___J..._--____.'-..__.___. __...___..........__.....___... � l,: .1'llJ•�` 1)J.�:., I,1.'C�'t':i .L�'•Cil.i.:11' Ct ';?,l. ?1 (:: .Lii'r].1.1.1 -- I J s 6 FIELD C11I,CI: L'f.ST Date: _- Imp . by : 1 1 INITIAL SITE TNSPECTION r As No Comments Property lines or corners found . Can estimate house Location ... . . . . . . . . Will driveway n .ed cut . . ♦ . . . . • . . � Must trees be removed-note these Is deep hole representative of entire SDS area Additional deep holes needed• j' Sufficient SDS area available considering driveway cut,, house location, separation . distances, etc. . • .. . - ------- ....__.____ DEEP HOLE DkTA Depth: Water elevation: Rock elevation: Soils descriY)tion: Date. 'FINAL SITE INSPL'CTI Ol; Ins,-2. �by : Eouse located where shozrn on approved plan. SDS located where approved . . . . . . . ♦ Length of trench 111 d u-L.1 of trench average Slope of the line and trench acceptable , Boom allowed for expansion trenches , - Over 50_ f . from swamp, wat.ercow?st ... 1f(A 'stripp;;d 'or -_ SDa . a' oa unnecessarily graded . . . . . . . . . 10 Pt. maintained from prop line and 20 ft. from house . . . . . . . . . . -- Separation of trench from house, well e - -r` etc. follows plan . Number of bedrooms checks • e • e o • o a •o e Stones, . brush, stu,Ips, rubble, etc. greater than 15 ft. from ne-arest.trench . . . . . . 15 Ft. of peripheral soil horizontally from - trench. • a . • • o • e o . e . o ... ♦ e o Junction boxes properly set Could surface run off from dr_iveway, roads, .ground surface, etc. channel near SDS - areaa . ♦ o a f • • • • o o • o . e e . a e_ Dies lot. drainq,?,e anl:;ar O.K. in area of S1�S FINAL CMDING Or SITE ACCEP1'AME, Gentlemen: DEP1?R`'l-"��T'== �1�••�Llir . DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date AuGU sr 2B, 1979 Re: Property of 0 1L.L% a #,L t o g �6-Rs Located at QSO-AWAMA hAW6 /Co ,4O, RUDUAM Section -3 & Block 2 Lot 1. . This letter is to authorize KIC.14M-A% ).C.11.�IC.Af-k t(FL 1L.0 a duly licensed professional engineer C_ or registered architect ( Indicate r— 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 -4----4- i of nedltii, �ii1u to S LCi c111 L1ei u��aT f papers On my behalf In connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 1)] 7 --:E du on Lbw, .Mth- -'u,lic Hp,,q] t b:: r � T,�. , and t e• .Pa+ � :Co"Z ty •Saari- - u_ ��.�..., tary Code. Countersigned: P.E., R.A., # 0461 2- AO' y OZ-0 ROID r Address � ! EbbSL'i,LL. AU. /. 106-4 Fa 9/4- 739 - 49l1 Telephone Very truly you , Signed Owner of Property Address °— Tei ephon� es�.� 99#� f YyvY' J. j 1„ AUG 2.91979 pU l 1'vAivi. uuuly j f, LOZEr, of HEALTH - _ . �UTNAM COTJNT" .- .EEP- AIRTMENT.. 4F HFA.LTH. DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Olt-t -IAN k.0 IMa % Address R7 #2 Hocprn„, b2wu 4ILL, I) -i, los66 Located at ( Street OSC WANA L&fu R"o Sec. 3 �, Block 1 Lot 1 �'Indicate neares cross street) Municipality PUTI,3AN VR1.1.e y Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole a Number CLOCK TIME PERCOLATION PERCOLATION RIM apse p o Water Water ve , No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches i- 1 9'05 9.'21 2- 7S 3 S.3 1 - 2 1.13 9'11 IL 72 30 1- 3 9: 4Z 1-'51 0 5,.-7 1 - 4 io,o3 ►o;z -1 I$ )2 7s, l �...._.. �1 .5. 10;2- 2- 1 lo: 38 11 , 03 ZS 4i So 3 83 Z - 2 I1', 08 II'. 3(� ZS 4) SO 3 Q 13 _2' 3 (1 .2Z 11, SZ 30 3 Io.D 2-^ 4 12 %o1 1232 31 4) -3 (D,3 Z - 5 1z.;40 1 �m 31 4 7 Sa 3 1o,3 3- 1 11.- 1 S i 1, 43 2-8 482- SI 2 3 q, 3 3 - 2 W,S-6 !Z, zb 26 48i SIz 3 9,3 3` 3 12 , Ub 31 0 i 51 i 3 -3-- 4 1,,o9 1:41 32 48 i Sl i 3 10,6 3- 5 11,43 2;(5 32 4S2 SIZ 3 (o,b Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 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 S';ILUV�T;TCy �TiC';r`x1Ty` '"iT'tCniT:?'.•:. ..��. .. DEPTH HOLE NO. HOLE NO. 2 HOLE NO. 3 G.L. 1 U P u'1t 611 1211 1811 MGO , 72) 2 60u SAND 2411 3011 3611 4211 4811 Si4-7- G,/LAU�� TOMS /JARD 0AN_ 11 #1 co, is tic S 'l N'D 5 s;L:r;, GtiaAy &I 6011 6611 7211 7811 8411 T, F S m z M EP , TV iCi NC Serf IVP S i LT, C-- QAi19L, SOME MAtL0 FAN ":Iq" 1oP SU)z G�RAd�z - Sv,,.1 ITv'DiC1.1' LE!rET�_ AT 1rIH CIts CR(TLJ P_ GIA1i i +`�t _ � �� "(�J� ;,;c ,! n�i�iE''�FT) INDICATE "LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTEPED tv07' E7vcavti E7)r_ :TESTS MADE BY' �� IcKa��s �ci�icg� «z�,� Date Aue y57- 2 3, 1979 ' DESIGN Soil Rate Used /S— Min/111Drop: S.D. Usable Area Provided S?ID cD Aso. F-T No. of Bedrooms 3 Septic Tank Capacity / 000 Gals. Type Absorption Area Provided By L.F.x24 —3 '— — width trench. 3 LGACFi {uti R2 6-AC14 Id-o" Di A,, fame 1Ct60L6j5 SC1IJlCA/2j6-L,0 Address DAD 4 /acwjpoA'4 1,2c 7 ,0 ;v, r o sa l gnature THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Other SEAL z` n k0468-1-h FSS IQNp�•` Soil Rate Approved Sq. Ft /Gal. Checked by Date ENRT: 'z,Q_F DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owned; it-LIA0 1-U -1�66-1z5 Address Rb #2 (' (oouj)Aj&j Dkwc. Located at -(Street 0SCAWA,"A LAaie l"o Sec. 3 C Block �- Indicate neares cross street) Municipality PLq7JA" VALLG'"Y, Watershed Lot U SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Hun apse Depth to a er Water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches � 1 4- 2 1 2 3 4 5 1� 2 3 -fkr T 1,vAS 10oT 1 Ill) S+wCe I- uAL -TE->t v 1-jDy R3o►i 0H ( StF- c 5 Notes: 1) TeAts to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 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 DEPTH HOLE NO. G.L. Cn 6" 12" 18 e'Di i b �i a£ S,y A4 S �,c7-, 6 a/w eZ . 24" Santa l•YAnO PAa. 3011 36" 42" 48" 5411 60" 66" 7211 7811 84" �� Y 2- 0 o" HOLE NO. HOLE NO. 1il2L:.. :_G.i'OlT1VD. TnrATE;2 S_:I INDICATE LEVEL TO V. CH WATER LEVEL RISES AFTER BEING ENCOUNTERED IJ07- TESTS MADE BY (y co�,�15 Sc►v�can�tz�a Date Avc.yST DESIGN Soil Rate Used !S Min,/1 "Drop: S.D. Usable Area Provided 5-MO sa, �cr No. of Bedrooms Septic Tank Capacity 000 Gals . Type )D ,2e- �q s Absorption Area —Prod By L.F.x24" b" width .r'e j j� 0th �E OF PoF 3 c G44I0 c, �` i3 =71GN I ©� �%k 1 A. lC Name -Iv4 C-W OL-A s SG e tz Lp Signafurej J Address 01 o (/Z0.-7 1-e._? &1,0 SEAL 8N , THIS SPACE FOR USE BY .HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by Date