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HomeMy WebLinkAbout2943DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. 1 rm www.scanyourdocs.com 631- 589 -8100 62.17 -1 -8 BOX 25 02943 PUTNAM COUNTY DEPARTMENT OF HEALTH . Division of Environmental Health Services, Carm�e— ly�N.. Y. 10512 % COIWJSTRUCTION PERMIT FOR SEWAGE DISPOSAL Sl` S r �M ' 1 o Wa�1 c �= ^�+-twtANk V/kLLE `I Town or Village �Locatod -at _ - -- --_— 4� Block i3LdFV 1l.' . i c Subdivision 050AU A I-JLLTOP E5`ATE LcT �g, 13 -IL w:L Lot 2, Job Owner Jot-(" 14, '5 iM(Tt-1 Address Lo" i 7P. PJTMAt A 0-\L-Lr —. q r Building Type QC-5i0iE0TJA1_ Lot Area 2- 7,0cc. 6 APPP=)C Number of Bedrooms Tai E 1E" Total Habitable Space �'��` I� Square Feet Separate Sewerage System to consist of (/�-,� C' Gal. Septic Tank lineal feet X �� width trench To be constructed by ® � 'Ai C Address •� Water Supply: Public Supply From Private Supply to be by Address %Es�C Stf /mod Other Requirements i?0H. 6j(2 %IGL t=i�i I represent that I am wholly and completely responsib above described will be constructed as shown on the a County Department of Health, and that on co n be. submitted to the Department, and a written place in good operating condition any Part of ante of the approval of the Certificate of Cons i will be located as shown on the approved plan and t t Count De artment of Health • y s S A.PP1`csic cta Cu "'(Os I�v� GLAVEtr M of the proposed system(s); 1) that the separate sewage disposal system nd in accordance with the standards, rules an regulations o e Putnam onstruction Compllance" satisfactory to the Commissioner of Health will d ner, his successors, he or assigns by the builder, that said builder will n (jQ the period of two (2) years immediately following the date of the issu- e igi I system or. an,?� repairs thereto; 2)'that the drilled well described above )' a ordance witly,'the standards, rules and regu a ions of the Putnam Y P L � - �CKGi° P.E. ✓ R.A. Date sn ($igned - li�� `t I c �'c� i3 2 -700 Address License No, APPROVED FOR CONSTRUCTION: This approval expires he date issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction requires a new permit. Approved for disposal of domestic sanitary sewage, and /or private water supply only. ,�- -- Date �?�"i)�� �. By "`" Title — PUTNAM COUNTY DEPARTMENT OF -HEALTH �• E Division of Environmental Health Services, Carmel, N. Y. 10512 CERTIFICATE OF, CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM o+ V ~�bf/ f f TNMq sjLE.,1-�% Town or Village Located at V ail // rLL � t1 s�tton 48 Block g Owner %_//o �� Lot © Job Separate Sewerage System built by o rV� 4'0�% "' ' Address _ rN1& sl Consisting of %Q P Gal. Septic Tanlj lineal Feet X �-' (' width trench kOther requirements O D 1,k) Water Supply:' Public Supply From _ i - Private Supply Drilled By { Address I U AJAA'I VALUAFr / 1 / Building Type � %��'�(�.,(��� No, of Bedrooms. Date Permit Issued Has Erosion Control Been Completed? I certify that the system(s), as listed serving th e' isas o ucted essentially as shown on the plans of the completed work (copies of which are attached), and in accordance with the stan and r ns filed, rid the permit 'sued "the Putnam County Department of Health, Date �:' t Y P,E. R.A. Ad a} ? [. r Ei�7J1 License No. Z.C> Any person occupying premises served by e a s 11 om ly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. A the sepa we a system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private wa fiallB {{��@ and void when a public water supply becomes available. Such approvals are subJect to modification or change when, in d$}fief pHe mmissioner of Health, such revocation, modification or change Is necessary.' — Peekskill, New York 10566 T PEEKSKILL MEDICAL LABORATORY 1579 Crompond Rd. Barclay Plaza Bldg. ,A, Apt. 1 37564 PE 7 -8777 ese results indicate that the water was yes of a satisfactory sanitary quality when the sample was collected. I/! A. H. PADOVANI, M. T. (ASCP) DATE COLLECTED RESULTS OF EXAMINATION OF WATER 8/6i73 WER DATE RECEIVED Mildred Smith 8/6/73 TY, VILLAGE, TOWN &/OR NAML OF SUPPLY DATE REPORTED Sunset Dill Rd. ,Putnam Valle 8/8/73 LMPLING POINT %CTERIA PER ML. (Agar plate count at 35 C). COLIFORM GROUP (Most probable N6. /100ml.) HAR ES S, TOTAL - ppm 6 less than 202 :TERGENTS - ppm NITRATES (as N) - ppm IRON, TOTAL - ppm .OURIDE (F) - mg. /1. ese results indicate that the water was yes of a satisfactory sanitary quality when the sample was collected. I/! A. H. PADOVANI, M. T. (ASCP) TOWN OF PUTNAM VALLEY WLLL DRILLE4RS LOG AND REPORT WELL LOCATION street section b oc o r WELL OWNER u name address city or town WELL DRILL" r� GU �-3 �a! z �'�'� �! .. � C!L %,' name address city or town o J CASINU DETAIES I TEM, A E SCREEN DETAILS Lengh: 3 feet Bailed.. or Pumped74H kFeasure from . Static ft surface 'Make: Diameter: ` Inches Yield: /O GPM a rePumede ft Len th Ft ize Kind: Diameter In. TOTAL DEPTH OF WELL c;,L30 ° Feet Depth From 'Give description of formation penetrated, such as: peat, Ground Surface 'silt, sand, gravel, clay, hardpan, shale, sandstone, granite, etc. Include size of gravel(diameter'and sand (fine, medium, course), color of material, structure _ ._..(Loos.e.,- _packed, cemented, soft, .hard). (Ex. Oft,..to -.2.i .ft., fine packed, ellow sand 22 ft to 1 4 ft graX granite) Feet o 7eet Formation Description etc h exact location-of well to at least two permenarit Landmarks. Date Well Completed 3�7 173 Date of Report Well. Driller signature D,an�er of building v ' Building Constructed by 4" Location - Street • .� ,� �. - G.a � �;,I�j1 /ate � f G . . .. Municipality e Building Type Block 2. 9 Lot GUARANTY OF SEPARATE SLIVAGE 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 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, 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 occupant of the building utilizing th ?. cvci-om J The undersigned further agrees to accept as conclusive the determination of the Director. of the Division of Environmental Health Services 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 occupants of the �)ilding tilizing the -system:_ Dated this day of �u 19_x_3 Signature Titlel f (if corpora tion, grV name 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:Servic.esl Putnam County Department of Health All PUTNAM COUNTY DEPARTMENT- OF..HEALTH DIVISION OF.ENVIRONMENTAL HEALTH SERVICES Date fQ -- / 8 -- 7;z- Re: Property ofo Located at 15V,17 6 e f // i� i?d . ✓,� i% y Section c s C ,j Lv.�WR .[ c Tc�' Block Lot 3 1 3 14 /S'� /t 1E s 'r-n rc 5 7 -4x� qR •46, !3LcCCie 9 1GYS 2..�. � /G Gentlemen: This letter is to authorize STANLEY J. LANDER a duly licensed professional engineer or registered architect (Indicate) 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 Depar t1iienl� vi 'rica,itii, and to sign all riecessary 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 147, r •Education Law, the Public. Health. Law, and- the Putnam =_Qoun tary Code. Counter gned: s P. E . , • � # Z-` 2--o ' �A L �, ENDER (Seal ) Very truly yours, Signed ner of Property .4 < V. %I- s J ,Z8 -6-6 '/3 e ep one WELL CO;Vif'LETION rEIP02i PUTNAM COUNTY DEPARTMENT OF HE1;11_11. 3/71 r Division of Environmental Health Services COUNTY OF =FICE BUILDING CAf1A1EL, NEW YpfiK This report is to be completed by we!I driller and submitted to County Health Department together with laboratory report of analyvis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. ;T...iViUST: ?L' SUCifti..... ED lidITHIN 30 DAYS OF WELL -6h CEYLON ..,.�.7 I OWNER LOCATION OF WELL NA JE ADDRESS , � / fj(No. 6 �Street) (Town) (Lot Number) PROPOSED USE OF WELL �( j BUSINESS r� C DOMESTIC Cl ESTABLISHMENT ❑ FARM ❑ TEST.WEl4 PUBLIC AIR OTHER ' ❑ SUPPLY 1:1 INDUSTRIAL ❑ CONDITIONING ❑ (Specify) ° �.. DRILUNG 'EQUIPMENT COMPRESSED ❑CABLE n OTHER ROTARY AIR PERCUSSION PERCUSSION E l (Specify) CASING DETAILS LEiJGTH ( feet) 3-1— DIAMETEP(incheS) `WEIGHT PEP. FOOT �`'j DRIVE SHOE, THREADED,, I MELDED EI YES ❑ NO WAS CASING G� OUTED? ® YES —� NO YIELD TEST. HOURS G.P.M. ❑ BAILED ❑ PUMPED L�COMPRFSSED AIR ,.0 YIELD (G.P.M.) !d hlAt'ER LEVEL MEASURE FROM LAND SURFACE —STATI (pecUy feot)T �* DURING YIELD TEST fleet)-' • , j _ _ , Depth of Completed Well � ?� � in feet below Land surface: J — SCREEN MAKE LENGTH OPEN TO AQUIrER (feet) DETAILS SLOT SIZE DIAMETER (inches) IF GRAVEL PACKED: Diametei of well including gravel pock (Indhes):. GRAVEL SIZE (inches) FROM (feet) TO (loot) L DEPTHJ.k0N LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET fro- — -FEET I U I 1 _ If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL CJlOM%%PLEE�TED DATE OF REPQRT WE RILL ;�. (SJi/gnature) _ ..... ..__.PUTNAM - COUNTY. DEPARTMENT-. OF HEALTH ... DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N.-Y. 10512 DESIGN DATA SH V EET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. '/ Owner 30,1A$4 1 14: 5Mt74 Address Lo,Gi _2D �` +'C6�1At.� ALLE-1 74 / ;9,q `j Located at (Street uuc- sT t (LL �aAD s=. .461 Block Lot 2 �, <!F lo Indicate r coss street) Municipality 'A) OP" O TIJAM VALL EI Watershed opal' SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION apse Depth to Water a er ve No: Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 2 I; S3 Z:4 zz i14 8 Ve t "/P, 15. 4 tl `,'3Z (VOL �G X4 2- 2 l I /5 Is, 3 iZ;3`3 ►��3 3o fS� r%S 1 j 7/$ ���` 5 1 - 2 3 4 r� Notes: 1) Tegts 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. Address jiggglAIA1 tf fj_y_ THIS SPACE FOR USE BY HEALTH DE PART GQ- Soil Rate Approved Sq. Ft/Cat z�� d by Date TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF IN --TEST HOLES' DEPTH HOLE NO . P1 HOLE NO. HOLE NO. WCLE G.L. —T; P 611 1211 01-AY* hit V elq (41 Aft �D, JU b Jq Y 1811 If 2411 30" . P 1. 3b 4211 4811 5411 6011 6611 7211 78" 8 8411 -INDICATE LE1,`EL AT -W1qCH GROUND- WATER --IS —ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED '.*TESTS MADE BY --5, L A A.14) E,E Dat e ® enm&f e ' 72- DESIGN Soil Rate Used 7- min/l "Drop: S.D. Usable Area Provided S0-" No. of Bedrooms Septic Tank Capacity Gal Type /01,9-5,0A W/ t7 0 Absorption Area Provided By �'F x2411 36" width trenc _Y1 STANLEY J. LANDER Oth n 1 -0- Address jiggglAIA1 tf fj_y_ THIS SPACE FOR USE BY HEALTH DE PART GQ- Soil Rate Approved Sq. 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