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HomeMy WebLinkAbout2771DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62. -1 -36 BOX 23 1 ru owl's a 1 6 RrL 02771 PUTNAM COUNTY DEPARTMENT OF HEALTH ; ReTq;...:3 /81i Division of Environmental Health Services, Carmel, N.Y. 10512 ; Q, Fglneer Must Provlde P.V. 38 - 8 4 V P c.H D Peimit a �, Viz. - � - 3b• CERTIFiC OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM per__. .. ..... '1'NAI ..._ . 0S- --ZAP. A1_�'A INYh �OP,D �'sw�-ar�ivage � Ta: Map 36 Block�Lot l� 3 I:ocated at 10vvner /applicant Name M, • Formerly aT v(slo 'l�i�ame '_�I� !,1�LTI i v. of a 3 'MaWng Address RD# , � B- -8 7B • Zip -1 G) , 79 Date Permit issued 0 8 4 DAK E RD, PUTNAM VALLEY, .NY Separote Sewerage System baflt by STEVEJJ S'r-kTJ)-)2 -R Address "1.91 MikIN -S-T, _ SHRUB OAK `NY Consisting of i n n n Gallon Septic Tank and' 4 An T F: QV ,'P T T D S- Water Supply: Public Supply From Address or: X Private Supply Drilled byER TCKS()1`J BIRO. S. Address OLD AT 'RANV 0,9T RT) � gi g Type 0 N FAM R . Has'Eroslon Control Been Coin leted. YES. GARRIS N r. NY Number of Bedrooms 3 Has Garbage Grinder Been InstailedY NO Other Requirements I certify that the system(s) as listed serving the above premises.were, %a�tions, d essen_tia y s shown on the p ns of the completed work ( copies of which are attached), and in accordance with the standards, rules and in acc rd with the fil plan, and the permit issued by the Putnam County Department of Health. Oats Cartifis X Address tense No. 11856 Any person occupying prism ises. served by the above system(s) shall prom ti, ke such /iscin s may be neces sary to sscu a correction of any unsanitary conditions' resulting from such usage. Approval of 'the.separate.seweri � stem shae null and void as soon as a publ;: unitary sewer becomes available antl the approval of the private water suDDly shall become null and `voki wh lkt ,w ater supply Weorna avallabh. Such approvals are sub)ect•t /o modification or change when, inn'ihe lutlgment of the COmi,'IsslorlM opOksalth, inch revocation, modification or change Is necesury, 1 Date �D6 J r Wl/LL %j%J. -u LL i.vav lw1 ..,�.� DEPARTMENT OF HEALTH i � �_ ,._ ....-I'i�'�„ �i��_ �� - Eza•I'`�rrt::rt`��t rd�::t1t. S��'vi.c.�G_ ,_ PUTNAM COUNTY DEPARTMENT OF HEALTH -..M. K .. 7 17 STREET AOURESS: TAx GRID 1j'UMI1ER W• �OIJ TRH NAME: ADDRESS: ►� ��L �i c "t ❑ P8IVATE ❑ PUBLIC Wl/LL %j%J. -u LL i.vav lw1 ..,�.� DEPARTMENT OF HEALTH i � �_ ,._ ....-I'i�'�„ �i��_ �� - Eza•I'`�rrt::rt`��t rd�::t1t. S��'vi.c.�G_ ,_ PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only .... G_" <.�'�� _ :tY STREET AOURESS: TAx GRID 1j'UMI1ER WELL LOCATION, WELL OWNER NAME: ADDRESS: ►� ��L �i c "t ❑ P8IVATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS O FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ .AMOUNT OF USE YIELD SOUGHT -5 gpm. /N0: PEOPLE SERVED ���J / EST. OF DAILY USAGE �3 / J gal. REASON FOR DRILLING NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING DEPTH DATA WELL DEPTH o , ft. --W77E,,L,,L STATIC WATER LEVEL _7D__ ft. DATE MEASURED DRILLING EQUIPMENT ❑ ROTARY 91COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING 0 OPEN HOLE IN BEDROCK O OTHER CASING . DETAILS TOTAL LENGTH tL MATERIALS: STEEL O PLASTIC 0 OTHER LENGTH .BELOW GRADE ft. JOINTS: O WELDED BITHREADED O OTHER DIAMETER in. SEAL: CEME ROUT O BENTONITE ❑OTHER WEIGHT PER FOOT 1b./ft. DRIVE SHOE 12111YES O NO 1. LINER: OYES ONO SCREEN DIAMETER (in) "SLOT SIZE LENGTH ft DEPTH TO SCREEN (ft) DEVELOPED? - HOURS SECOND GRAVEL PACK ❑ YES O NO GRAVEL SIZE . DIAMETER OF PACK in. TOP DEPTH tt. BOTTOM DEPTH ft. WELL YIELD TEST If detailed pumping MEIH00: O PUMPED 1 tests were done is in- COMPRESSED AIR , formation attached? O BAILED O OTHER ; ❑ YES O NO ELL LOG If more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE water Bear. in9 well Dia- deter FORMATION DESCRIPTION ace. ft It. WELL DEPTH fLn DURATION hr. min. DRAWOOWN ft. YIELD gCm. 5 itace 1yo WATER ❑ CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO pn_ STORAGE' TANK: TYPE L:(, ) �% � fie dif4ie f CAPACITY �� GAL. 2 WELL DRIVER NAME f K cjv,3 �j�t'S �� DATE ADDRESS � r`f 'r SIGR #TURF C""� j� r� ` 5 �-. b�- . - `4(,�" "'` PUMP INFORMATION TYPE m • CAPACITY n MAKER � O11� L L DEPTH MODEL Lf 11 VOLTAGE 23 0 HP f Yy .S al 'l `f► i .' l j i ii vtti � �: jj c�. Xai�i � t:.+ -�- - .. Z., -- -=-LCD W P O F Owner or Purchaser o Building Muni //cipality Building Constructed by Section Location - Street Block Building Type Lot GUARANTY OF SEPARATE SEWAGE-SYSTEM I represent that I am wholly and completgly responsible for the location, workmanship, material, construction and drainage of tale 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, exceie, where the failure to operate properly is caused by the willful or negligent act of the oc@u- pant of the building utilizing the system. 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 - Ccitlu .ty, Department of Health as 1--n ..hether or not the Iai�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 A/ day of 19�5� Signature //A%i p'r'de4 e, :�' Title_ C ONTQ„"dIZ If corporation, give name and address) - - - - - - - - - - - - - - - - - THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION Mt TLL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE, OF DATE OF FIRST USE OF SYSTEM. G Division of Environmental Health Services, Putnam County Department of Health Yorktown Medical Laboratory, Inc a 321 Kear Street YorNcown Heighcs,.Id. X.10598 (914) 245 -3203 R Director: Albert H. Padovani M. T. (ASCP) 1— L �'1 % L �h''�7 U �y�� ,i.?., /►/�; . /ill —�� LAB # 7 % Date Taken: - 2 epo Time : 11,11,5, '41 Date Reported: Collected By: - %_A- Referred By: _ Sample Location: -z I Phone # Phone # Sample Type: Repeat TestT +(check one) LABORATORY REPORT ON THE BACTERIOLOGICAL QUALITY OF WATER GENERAL BACTERIA ZStandard Plate (Agar Plate Count (CFU /1.OmL) 35 °C) MEMBRANE FILTRATION TECHNIQUE (MFT) F�Total Coliform (CFU /100mL) Fecal Coliform (CFU /100mL) Fecal Streptococcus (CFU /100mL) MOST PROBABLE NUMBER TECHNIQUE (MPN) 02-0 V Total Coliform: MPN Index (per 100mL) _ Fecal Coliform: MPN Index (per loom'O f OTHER ANALYSES REMARKS (For Laboratory Use) Potable _~ Non - potable _ STP INF _ STP EFF Other: Sample Status: (check each) Outgoing, _- Na2S203. Incoming, 4,1 LE k °C _ GT k °C Other: KEY FOR TERMINOLOGY RDS = Recommend Disinfec- tion of Source TNTC= Too Numerous To Count CON = Confluent ( =TNTC) LT = Less Than (<) GT m Greater Than (>) N/A = Not Applicable LE o Less than or equal to THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS) (WASN'T) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO T E NEW YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, A . TIME OF COLLECTION. Albert H. Padovani, M.T. ASCP 12 /85(Rvsd7/87)RWE _ I For Lab Use Only: fl Director �.H /C to LAB OFFICE HOURS (Plain Lab): 9AX- M, Non. -Fri. 9AX -BOON o Set. \*\1 PUTNAM t _ COUNTY DEPARTMENT OF HEALTH Permit, —,3 Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Vu:�t4A VALLI✓y ...•..••'zLocated at ]]l'a g..�%9�F}11�d{�!�� �- �yN�jy^IG,.'C eI'GrCI•J .� ,..,s/��. -�t•.. ..:- ..:rTax --M pe,:e JK! «81ock�.r:.;• ...n,;wt..�e8...vx�. .,.. -... Subdivision L088+� 4, AAA L4U � 1)%% sum. Lot /q :i Renewal _� Revision _[ owner /§Jd L ~ / �; D �t>:e 2""e) �/ �L L Date Of Previous Approval Building Ty Type JT+i1�L •�. t of Area � : Fill Section only ❑ Number of Bedrooms Design Flow G /pP /D �Q P.C. H. D��Notificjation Required ,/ Separate Sewerage System to consist of r 00c'-, 1 Gal. Septic Tank and `� - - L E op _�. EFA "'1 �1 s Fl ig i -U5 To be constructed by � ,A p�Y Address 1AN /0" FU6 IM O L-,1L O W {f1�, A C Water Supply: Public Supply From FLI T-N � �1. V � L E ✓ o Y • ly Private •Supply //to�o be drilled by ne •T�9'11rTL 1<k —s o N /t 1 � /t 1 �% e � '�(� Address ZAES Fi 'I''_.., '�% 1 PEV -r PU -rN Ato sI PA 6.. .EVI N, V- • g0 ;Ln Other Requirements I represent that 1 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 in accordance with the standards, rules and regulations of o Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system during the period of two (2) years Immediately following the date of the Issu- ance of the approval of the Certificate 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 installed in accordance with the standards, rules and regu amens of the Putnam County Department of Health. Date 7! Lit l %� nt 4, Signed P.E. MUS Go©?- A ; I/ �eu� 2 cerise No, APPROVED FOR CONSTRUCTION: This approval expires one year fro the date issued unl cnstruction of the b iltlIng has been undertaken and is revocable for cause or may be amended or modified when considers essary by the Com of He 4hange ation of construction requires a new ermit. Approved r disposal of domestic dry age a r priva upply only. Date By Title Rev. 9 -81 d DIED �� r� e I KITIAL SITE TYISPECTIO?' Yes + No Comments ,Property line or corn:rs found . e o . . e . _ Can cstima.tc house location . e e e . e e Will driveway need cut e e e . Mju �t trees be removed -hote these Is deep hole representative of entire SDS area _ Additional deep holes needed. . e e e e Sufficient SD3 area available considering driveway cut,hou-- location, separation . distances, etc ... e. e e e e e e e e e DEEP TIOLr' DATA D -pth: .Water elevation:. Rock elevation: Soils d.ercr-i:,)t on: �.��;.�' �U � 1`} , Date: PIN AL SITE IN SP ECTIO Insp . by: House located where 'shown on -approved plan SDS located where approved . e e . . . e Inn; PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 1 BU:i:: NO°-OARMEL; ` N : � 0 >� ....._ . .. DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. P—v -,Z, L:2> ox Z87(5 Owner AA. BELANIC+I Address OGr�AwANA LA1kj� P•Z).. FuTNAMVALLr=y ^7-M N, y. 105^701 Located at (Street) OSr AWANA LNKF ? L) Sec . 36 Block Lot I. -3 (Indicate neares cross street) Municipality i O WN OF Pv7NAAn VAUEY Watershed gUOSoN ZI VSe, SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION I,.✓C%w ✓ 1 ✓ PERCOLATION 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 0 r:�� 30 1�© l7.�v 1,% �"�,,� l %/zt 2 3; 5 �, 14-: ,)1 '6 o. � C�, f, 7,-%F I'• M 2 '/1, Ja, - 17, /4 3 4 'Z - 4 : ! ro - ,� ")ST, /, l� fir, /! r� � � �i 14 r Notes: 1) Teats 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. I,.✓C%w ✓ 1 ✓ , / / K/. /•62 LI16 s r 4 0 50 160 17,6'48 Notes: 1) Teats 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. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST.HOLES u FAIR ro., 11 oxT G.L. mud.. =7 0 611 ec L A Y 121' 181f 241' 3011 3611 4211 4 11 8 54 It 6011 6611 72" In 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED -PONE INDICATE LEVEL TO(WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED -NONE Nu DESIGN Soil Rate Used Min/l "Drop: S.D. Usable Area Provided '15 000 ' /6-20 -V MECA-5 T- No. of Bedrooms Septic Tank Capacity /04--50 Gals &J C- PLE �a Absorption Area Provided By O L.F.x24"3b nc .Name ------ bigna•ure QA AM1aA9_,fA Joel Greenberg-Architect Muscoot No./RFD #2/Bx 488. Address— Mahopac, NY 10541 S L A, >Z01 Ao" -0 I I O THIS SPACE FOR USE BY HEALTH DEPARTMI T% ONLY: . Soil Rate Approved Sq. lit/Ca'l. Checked by Date RECEIVE J1 UL 11984 PUT,*NAi'-,A DEPT. " OF PUTNAM COUNTY DEPARTMENT OF HEALTH*. DIVISION OF ENVIRONMENTAL HEALTH SERVICES 1984..... Re:.; Property of Maria Belanich Located at Oscawana Lake Road . (T) Section . . B_ I '' . Lot 1-3 Subdivision of LUSBEO ! M¢LAaGUL N Subdv. Lot # 3 Filed Map # 1701 Date 61101-76) Gentlemen:.. This letter is to authorize Joel Lawrence Greenberg a duly licensed professional engineer or registered architect XX (Indicate to apply fora Construction Permit fora 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 connection.with this-matter and to supervise the construction of said. system or systems-.in. conformity .with. the provisions. of Articlo• .145 - or. 147, Education Law, the Public Health Law, and the Putnam County- Sani- tary Code. terbifhed: P.E., R.A., # D A.% Y 'E GR cy� F � 0 a 011066 O op N5- 8 110 Muscoot North, Box 488 Address Mahopac, New York 10541 914 628 -6613 Telephone Very truly yours, Signed Owner of' RD2, Box 287B Oscawana Lake Road Address ' Putnam Valley Town 914 528 -6945 Telephone �. 10 - THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL _ SYSTEM WAS CONSTRUCTED AS INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS INSPECTED BY ME BEFORE IT.WAS COVERED OVER. THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE WITH ALL STANDARD RULES AND REGULATIONS OF THE PUTNAM.COUNTY i � o DEPARTMENT OF HEALTH AND THE NEW YORK STATE , i, u a DEPARTMENT OF HEALTH.' r N� z v� T'\ 4 R6D r "' / r,.,,��s �P� o m�� @ •� 1p t� �' � 55 5 �o� � f tP• � � .ti � Q w Y i� 1L� r 0 v to :illlll . T4 Oq VE �w ee to f Si. P a wo �o' a0�� 00� O m O�r� 10 D .C- 's a m O .on nm v o . =.r a, o n1 a r Z. m A 9 m Z o On Z :*m Ji o Z0 m N �m rm m aZ �o za) ox zm v,► mm a mo s o • w o � P �a r� Z W '0�0• ° 00_ C _� p 0 Z r� Ddb P 0 4 r F = 0 C W p p 0 m m m ro w�a —gip ro pq m er C m m m S.wm r c`° 4 'f 'Dk7 D ;q b7d b m o ct m � 1V 0 Me m m m 00 G 9ooJ�N P �� = 0 9coJ6�Va f w�a —gip D ;q o � o o s n °py�o DD ulG�d Q' C 0 6` d•