Loading...
HomeMy WebLinkAbout2831DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.10 -1 -5 BOX 24 .. ` i- ; ! or Is I • . Lr■ i . I• ■' . I . I lk 02831 PUTNA'vI COUNTY DEPARTMENT � y OF HEALTH \ Division of Environmental Health Services, Carmel, N. Y. 10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE'FOR SEWAGE DISPOSAL SYSTEM WA+ 0. =AV,—VA IV P4'4 4P Y Town or Village y Owner 944nA4,L -"fOF-= °trF, /z- Tax Map Lot #%o subd. # Separate Sewerage System built by�L �°'����� / _ Address /1��f9PE1 E �' �• G ��° "T Ei�f Cf! Consisting ofS Gal. Septic Tank and 4' s •�' Other requiremgnts Water Supply: Eublic Supply From Private Supply Drilled By ,CV��'./y%�/�✓ N /���� %S�a %.� Address ,/ Ld` ✓Jlil4/°il �` ALL /T_,!V �1 Building Types ✓�l� /��%!�� No, of Bedrooms- Date Permit Issued Has Erosion Control Been (;ompleted? I certify that the system(s) as listed serving th' of which are attached), and in accordance with Putnam County Department Of Health. Date o" � Address Any person occupying premises served by the tparatq conditions resulting from such usage. Approv available and the approval of the private water s subJect to modification or change when, in the Date : By constructed essentially as shown on the plans of the completed work ( copies Vegulatioys,, in accordance with the filed plan, and the permit issued by the P.E. y R.A. LdSo� License No. 2 such action as may be necessary to secure the correction of any unsanitary i shall become null and void as soon as a public sanitary sewer becomes when a public water su omes available. Such approvals are of Health, suMrevoca on, mods cation or change is necessary. Title Owner or Purchaser of Building A 4N04Zz, 1-6.4- - Building Constructed by Location - Street Buil ing Type Municipality ' Block Lot n 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 system. The undersigned further agrees to accept as conclusive the de- termination of the Director of the Division of Environmental Health Ser- v cas of the Putnam County --Depart ont 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 19P Signature AACMC u) Q,.Q& Title -�e.F" corporation, give name `11 s / 4� 4e,4 and address) i 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 •1 e YORKT'OWN MEDICAL LAB.ORATORY.INC. P.0 Boxy 99. 321 Kear Stree# LocATroNS ` _ Yorktown Heights, N Y. 10598 ❑ 321 KEAR ST YORKTOWN HEIGHTS N Y: 10598 ,245 - 3203'.- ❑ 261 BUTTONWOOD AVE ;, PEEKSKILL; N.Y. 10566 737 -8777 .-- +yg cars MA; IV'v IJ:iT.7 l.J4Y'3JJJ ..:: #11564 .,: STONELEIGH;AVE. (NEAR.,HOSPITAL), CARMEL, N `Y:10512 278 9330 DATE COLLECTED RESULTS OF EXAMINATION OF WATER 7/44/8O: (4PM) OWNER DATE RECEIVED RANDELL - MOELL-;ER _. >.. CITY, VILLAGE, TOWN VOR NAME OF SUPPLY DATE'R£PORTED RD, 2.t ;BOX 59 OA , . ;PUTNAM VALLEY.,.. NY SAMPLING POINT TAP', (KITCHEN). BACTERIA PER,ML., (Agar plate count of 35 C). COLIFORM GROUP (Most .probable N6. /100ml..) ., RD TOTAL - ppm 3 6 /MF:T DETERGENTS - mg /4 NITRATES,(as N) - . mg /L IRON;'. TOTAL - mg /L AMMONIA, FREE (as _N) -mg /L' pH =`' CHORIDES = (mg /L) These results indicate that the .water was YES of a satisfactory sanitary quality when the sample was collected. COLLECTED By: R.' MOELLER qj A. H. PADOVANI, M. T. (ASCP) •1 e W5Kk'PQV:,49T1QN 09-PQ. T P"TNAM COUr4TY DEPARTMENT QV-jJiRA�T" Olvis.1on of Envirimmental, Health Services COUNTY OFFIC9 BUILDING CAIWEL, NEW YQRK Thh roport 14 m Pti t, pomplet by Wall driller and stibrnIttwo to Coonty Health Department tojqiher with oil@ jV; ,jo coi pqpar qunipla'in icoting Ohtdirlio of ialisfi6tory bacterial quality before certificate of construction pa REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETIO pw!jgp /A i hA ADDRES�), -t Li4a LOCATION 4 OU441) xympoo, E]; U. F INPUS RIAL T AIR CONDITIONINQ OTHER MULLING EQUIPMENT 0 RPTAOY COMPRESSED AIR PERCLISSIO14 CABLE VERCUmol,4 OTHER Opocify) CASINO LgNpaq (lopl) g TER pl" jWgiptil' PER fool W, THREADED R WELDED In y':9. No YE YTT "'D EIDA)140 d HOURS COMPRESSED D FUMP90 0, .,ESSED AIR G.P.Al (Q.P,g� %VATC-A Ggykh ME6�49 Ego,% 4N §0fAC9-5T6TlC(SP?4!lr (got) VURINQk YIELD TEST fleet) Depth of Complateif Well In foot 44qlow Land surfaces od. MAKI WJ9TH (??kN TO AqVjf9 40► &17# pl"gTgq if GRAVEL, PA P1 - 9(inator of well Including gravel pork (inches): IK?TH F20M LANQ SURFACE R*ATIPN DESCRIPTION} Sketch exact location of wall with 0jetwes, to al 49;4t two potmQnqnt 14ndM4 . fka, fICT to FEET A If ylold was lasted at clifforom doptho during drilling, list below FEET GALLONS PER MINUTE 419 vvell, 9F4 (Signaturc) •OF f)19PQf1 n. PUTNAM COUNTY DEPARTMENT 'OF HEALTH Dn(sfon of>v'Environmenral Healfh Sewrces Camel -`N. Y , ;1,0512 CONSTRUCTION. PERMIT FOR SEWAGE DISPOSAL SYSTEM. TNd, 11Adt[.Ey v I f P Town or e Subdivision Lot _ r'..Job (- �/ owner �/D LL d Address�ACifiC�NE� J]' BacNs7�r ar IS/ Y Building Type L Lot Area°ye X069' ftCiE'ES•- , Number ,of bedrooms "'Totair lllabifable'Space As/p—, Square Feet a - .`" Separate .Sewerage System, to consist of .'�% Gal Septic Tank ®� lineal feet X width trench T -/> 'To be constructed by ` f� B� / 'Address `eUAP V+ Water Supply; _ • Publ�c.,,SUPply From _ Privafe SuPPIy -fo be, drilled, by Ve �6 — Q Address L (�Ti1fAM Ste— :other .egwrements�dg ,rI�N �L 6Lt d �� f : ° NCrr� o,L i vcof °49s�v vh! 'C14 Ac'_ P ST GAT T1 :Tom; ? � vs•pFR r vc if T}Z I represent -that I am wholly and completely responsible for the-66 - si§'n and location of iproposed.'system(s);' 1) that' the separate sewage disposal system -_. above described will be constructed as shown 'on the.approved amedment there to .and ;iri accordance' with the " standards, rules and regulations o the u nam County Department -_of Health;-,and that- thereofa "Certificate of Construction Compliance'! satisfactory to the Commissioner of Health will '.be submitted to'. the, Department; ,and a;;written guararitee wi11 tie.,furnislied the owner his successors he�rS 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 (2j yeais'im "mediately following the,date of the issu- ante of the approval, of the .Certificate of .Construction Compliance of�_the rig-inal-system or ^any.repairs thereto; 2). that the'd`rilled well-described above will be located as shown on the approved plan and that said well:wilI be instal( in accordance with the , dards, rules and regulations of the Putnam County Department of. Health =.Date ` � hgne P.E. y R.A. - Address - _ ���' L License No. 32 72 O. _ — .APPROVE•O FO,R .CONSTRUCTI'ON This, approval, expires one year,. roniAhe ate issued unless construction of the building liar been undertaken and is ''. reVocabie',for .cause or may be amended or�'modified;wlien considered necessary:by •the. Co issioner`:of Health Any..-change - or�:alteratiori,of. construction requires anew permit . Approved for disposal of',domest'ic saint se age, and r;pr' a water supply only Date �T/ �i° BY Title - a PUTNAM COUNTY' DEPT' RT1TF'V T OF I-rL;ALTH a _1 Well_ 1-4,,41vo Ales 47,..1 �^ DTVIS1Q -N . .0 E'11T (ANN i Date /- 2 7;E Re: Property of ,�0:41Vz>,4z1- . Located at W'4�5r L)Riye Block_ Gentlemen This letter is to authorize �TA � �° LANDER -`& a duly licensed professional engineer or registered architect (Indicate) to apply fora Construction Permit for a separate sewerage -. system; to serve the above noted property in.accordar_ce 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 supervise the construction of said sy tait or sy c 'uGms in coil or�ni ' y with the provisions of Article 145 o-r 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. i` J Co tersigned S a9� q� (Seal) z 6s s BOX 2 -7 Vl.050.],_- 245 -2645 —513­15 1-16n 3 Very trul,. yours, Signed Ow - er of Property Address _71Y 37 ,- Telephone p PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION. OF EN)ZIRONMENTAL -HEAL THa SERVICES.., .. _. ,_...• _ _ .0 u^_.c. v..,. �c .__.m_ - .r�_.m «..w r� ^.�r.-r_s�s-,a_--""'"�'i ;.^-rr.• --�, _ `- -.. .. .._, r.r. �.__. ... ... __..m �rra...e..e... ..s..naar_�..ave: -... �- -.�..n: � �-'�.. w .,.:',ac._�,,.,: .�v COUNTY.OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. OwnereAN014zi_ Gera Address �� �237 �7At44g:'441 -> Sr. 6vcw,4,yA&, IVX U Located at (Street Block Lot indicate neares cross street Municipality. ©F' /urAraM Watershed ScAui..Ig.g/� SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION apse 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 2 10 "Is, io-42 17 174 y 3 4 r t? _l yo w 10,7_2 1:71 - - -- C 2 t4L 3 4 3 /x:31 /O'S-v 4 5 2 3 5 Notes: 1) Teyts to be repeated at same depth until approximately 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 DEPTH HOLE NO. P1 HOLE NO. P HOLE NO. �cr i4etf_s 112$3 PS -O TC 611 Jz4ov 1 04 ,gNov LoA, 1211 ti 1811 2411 if 3011 b1 u 3611 4211 4811 54 If 6011 6611 7211 7811 8411 "i 6% -<An it 11 — /,e-,o ce 4c: <. INDICATE I= AT WHICH GROUND WATER IS ENCOUNTERED &/,o )111A 77; /Z- INDICATE LEVEL TO WBSI W4TER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY DE. S rs Soil Rate Used 7 Min/11'Drop: S.D. Usable Area Provided At– No. of Bedrooms septic Tank capacity, ZO-" Gals. Type fl-ec-�-d .,),V-C, B.�� width trench-. Absorption Area Pr L.F.x24" 5b" * I— Other IE-S,Ts --ro ar- MAPF, li4 Fj LLr 5-011- IRATE PJOSr f3r-- '-J5e_-y-R(L ThAj LE Y - J. LAM' or t2 biRnature Address c2,417 04u4WA1_X A(Y, THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved —Sq. Ft/Gal. Checked by Date .. — WAS-0 �jv ... x. -. y - p o , Mn t x ny 1 � it r ; � a ]. &e. �f „e -• Sf �'-s ,° � F y, .. v o s r x srz g iJ s �s w a fi ^rz1 logo - 2e• v z�� ` _ .,mac T `,, ,r � • ; rx... ;^ i fin ;tom t'�}r'i ��iyt'!►� �s ;� � �y '4r i "�i , y. y G _ - -AU IM IMFof Quit( � 3 �M E ie } a r Awn! X qQx 1. �y,. •. _ f - .�r�"� �'� �'.' , ..~ f.F"v+',t' zvk A.- Mason = T f ; r. - d � r 1 , ,i ,.1y,' �� A ✓✓ r� WIN fp, Low 3, ii -1