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HomeMy WebLinkAbout2980DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.17-3-10 BOX 25 elm IN 1 L �" , L 1 omf eP-r .,6.. ,. ,... .. .. PUTNAM COUNTY; DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CERTIFICATE OF. CONSTRUCTION COMPLIANCE_FO.R. SEWAGE DISPOSAL SYSTEM �U7�/i//91'J'1 ✓/�L�� _ _. � ...,. ..ter.... ,_ -,,.. � •� ..._ ...�. ., _. //,t. ..n- <,- »• =�.�._ „. a .... _...,... _ -.,, �- _ •:;o`.vn.,c. .:iiia�3., .�€:•. " ?a; -.,,.. p tf �G.�/iL�� [/ism %1/t Tfeelie Bloc Located at l /� /��� �TV� l A,, Owner Lot Job 1 Separate Sewerage System built by �� ��4 ✓,�5���-Sbb��L Address 12 7 Consisting of 1-20CP Gal. Septic Tank lineal Feet X yr width trench Other requirements X/OA/0 Water Supply: Public Supply From Private Supply Drilled By wGeaY k% GG.�D.t� /LG /�f�� Z,4z -- : Address .�OVT Bails �/ �/>L�L�i.�i G� /t// Building Type /��ti �� No. of Bedrooms Date Permit Issued Has Erosion Control Been Completed? +1+IJ9197PV i�.j. lJ,,,, I certify that the system(s). as listed serving the above premises were constructed essentially as shown on the Q1anI of ep let ,9Vrk (copies of which are attached), and in accordance with the standards, rules and regulations, plans filed the pe mil d 4 b t� `P� a i►ntty' Department of Health. y Ce7 6 G o w V Date Certified by >ru `• M. R. A. Vol Address License4,`�l0`. Z� 9s Any person occupying premises served by the above system(s) shall promptly take such action as may be n°,`,n?��•4yo {eo�t{���Re o r etion of any unsanitary conditions resulting from such ,usage. Approval of the separate sewerage system shall become null and v, 4 aA pl . a -au c�,tsanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water suppt q =ft&IgbA. Such approvalsgare subject to modification or change when, in the Judgment of the Commissioner of Health, such revocation, mddH}i gp,oi change is nece sary. 1,N, to . . 73 By 4 Title n PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTiON FEFiiiril i 'FGFi` SE'vi AGF-'- UiSPOSAa-C— SYSTEf -A' L S C Building Type Lot Area 04 Number of Bedrooms Separate Sewerage System to consist of /ZOO Gal. Septic Tank �r Town or Village) Section Block4f Lot Job - Address 8 0QQQ=- '0194, u. r U e7.e & �=SOC� Total Habitable Space Square Feet 08 lineal feet X width trench To be constructed by Address Water Supply: Public Supply From Private Supply to be drilled by Address Other. Requirements I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that thee; separate sewage disposal system above.described will be constructed as shown on the approved amendment there to and in accordance with the standards, riiFes and re i rip e Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactorjr�'to th si o s althwill be, submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by t gq 4g8� r will place in good operating condition any part of said sewage disposal system during the period of two (2) years immediat > 10" °Q h@+Issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) `th the ed well de`Uvb�d a°�jove iwill be totaled as shown on the approved plan and that said well will be instaFA jjjn accordance wit a Stan rds, rules a�� r a ortif t L pPtllam County /Department f Health. `z� Date J-4-4 f �-- Signed Address APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the buildi%1F'�I a dgtlertalibp, °and is revocable for .cause or may be amended or modified when considered necessary by a Commissioner of Health. Any change Qr� aif��r� JiQ.gr I Oruction requires a new permit. >`Approved for disposal of domestic s=ary.sewa�ge, al/6) private ater supply only. I /� Z 2� . Date By ✓�+ Title �cQ r , YORKTOWN MEDICAL LABORATORY INC, P_n_ Rny QQ 199 Kpar �Oraal' Yorktown Heights, N.Y.. ,10598 .RESULTS OF EXAMINATION OF WATER CITY, VILLAGE, TOWN &/OR NAMP_ OF SUPPLY DATE REPORTED 169 LINDSEY AVE. BUCHANAN) N.Y. '1.2/6/73 SAMPLING POINT L,TPT.T__T,AKF T)-R- T,A=KF PFEKSKILL. N.Y. 245 -3203 BACTP-RI A PER ML. (Agar plate count at '350 C). COLIFORM. GROUP (Most probable No, /100m1.) LESS THAN 202 HARDNESS, TOTAL - ppm DETERGENTS - ppm NITRATES (as N) -. ppm IRON, TOTAL - ppm. FLOURIDE (F) - mg. /i. These results -indicate that the water was YES of d satisfactory sanitary quality when the s ft le was col ed. A. H. P.ADOVANI, WT. (ASCP) e � A PUTNAM COUNTY DEPARTMENT OF HEALTH r ... • L • �. � H •. . . � ♦ <�..0 �:! _ _ _ �� ........ r•,v. a .._ .. .� .s .A .. . . . . ... •� 0. .. .• DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. ownerJO�EPs5� ,9,rl6c i„i,9 ,Di l�q, ddre s s 8q�,�iOGE �E, .�yfy0w Located at (Street �Be�&/P S¢ Block 00 Lot- Indicate nearest cross street) Municipality y Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION 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 '(J 1 i0o 2-3 3 i3 2 i,2.'oy� /Z:¢3 39 2a 2- 3 i3 314'1(3 /.`ZZ 39 Zo 23 3 i3 5 2 &/ W 1ZX; .-5f 20 3 4 1 s. Notes: 1) Te'�ts 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. DEPTH G.L. 611 12" 1811 2411 3011 36" 4211 4811 54 It 6011 6611 7211 781► 84 If TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION TEK ;4 1E HOLE NO.- 0 3-op S ®ice HOLE NO. 9) ,rO,4'-) 50 / e- T v3pa IS. 1�15-0.00 � '-5FZE2-- Tn I-C-A TE. -TO 11L T.. XM-11 0. - MRIZINT-LNrA T INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEIN TESTS MADE BY 452 6 C- DESIGN Soil, Rate Used Min/l"Drop: S.D. Usable No. of Bedrooms Septic Tank Capacity lZc�o Absorption Area Provided By 308 L.F.x2411 3b". HOLE NO. � ; A -4 13T ENCOUNTERED Date. .5- n -7 Area Provided -50C)C)g Gals. Type IWA5011vle- width Erench. THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft/Cal. Checked by Date PEEKSKILL MEDICAL LABORATORY 1879 Crompond Rd.' Barclay Plaza Bldg. A, Apt. 1 Peekskill, New York 10566 PE 7-8777 3k4567 DATE COLLECTED _ RESULTS OF EXAMINATION OF WATER ,, 26 7 OWNER SS'��1 j ,{{. �,nn����jj,�r, Bldrs. `.. ATE RECEIVED CITY, VILLAGE, TOWN VOR NAME OF SUPPLY DATE REPORTED +AMPLING POINT tACTERIA PER ML. (Agar plate count at 350C). COLIFORM GROUP (Most probable.No. IOOml.) TAL - ppm ETERGENTS - ppm NITRATES (as N) - ppm IRON,- TOTAL -.ppm WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING CARMEL, NEW YORK This report is to be completed by well driller and submitted to County Health Department together with, laboratory report of analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION NAME ADDRESS OWNER (No. & Street) (Lot Nuffiber) LOCATION OF WELL R 6, 14 17 EL4-7_A1A1,1 i//4kAr- BUSINESS ❑ ❑ PROPOSED DOMESTIC ESTABLISHMENT FARM TEST WELL USE OF WELL PUBLIC AIR El ER ❑ OTH(Specify) El SUPP LY INDUSTRIAL ❑ CONDITIONING DRILLING M . COMPRESSED CABLE OTHER Eal. I# ROTARY ❑ 'AIR PERCUSSION ❑ PERCUSSION ❑ (Specify) CASING LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT r;;:;i -URWE-SHOE n WAS CASING nUTED? M DETAILS /5– 1 [:1 WELDED ::-j THREADED YES �01NO j4j YES NO YIELD FIBAILED ❑ ,.,---,HOURS G.P.M. YIELD (G.P.M.) TEST PUMPED 14J COMPRESSED AIR WATER MEASURE FROM LAN D SURFACE – STATIC (Specify feet) DURING YIELD TEST fleet) Depth of Completed Well . LEVEL /V in feet below Land surface. .2 MAKE LENGTH OPEN TO AQUIFER (feet) SCREEN DETAILS SLOT SIZE DIAMETER (inches) GRAVEL SIZE (inches), FROM (feet) TO (feet) IF GRAVEL Diameter of well including . PACKED: g ravel- pack, (Inches): 77 �7 DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of welt with distehC4,; I o -at 4 ist two permanent landmarks. FEET FEET to 7 lo S 6 k 61 A4 -4 . . . . . . . . . . ILI e., t2 D i� tq P", I L) IV 6 Ell` RT, , tt el Y v g 3 %. V- R4 A, ;X ,4 a Rz If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE ks A 4; 1 A4' DATE WELL OMPLEII D DATE OF REPRT WELL DRILLER (Signature) i9l 31 73 1 , r � (OvneW or Pu:rch ser of building Building Constructed by Municipality Location Street Block Building Type. Lot GUARANTY OF SEPARATE SEWAGE S�'�T ^M 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..shovvn on the approved plan or approved amendment thereto, and in accordance with tNe�,stan.dar.ds, 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 tho sys t2m . 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 th.Q._wi.11fu7,...nr_ nPal.iger�t.::act.of, the.occiman.t of. the--b ul.1 ding .uta- li-zing..the•.:._: Dated this 6, day of -t/oY 1979 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 REQUIRE TO FILE NOTICE OF DATE OF ;FIRST USE OF SYSTEM. ----------------------------------------------------------------------------------- Division of Environmental Health Services, Putnam County Department of. Health ' .. �� off'..?° ' ;`— 1. /✓' D - G &���/'� f% - .. .. .. �. � , �. ._ �d err' � , •� .. Owner or Purchaser of Building Municipality �3. R. )3® D Building Constructed by k Loc ion - Street Building Type Section Block D� 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 system. The undersigned further agrees to accept as conclusive the de- termination of the Director of the Division of Environmental Health Ser- •i c4. cf the _ "Litnam. C ^:un -1-y Dep.artrie—nl D."r He&' th a,� to- whether 9or-not the .falftlure of the system to operate was caused by the willful or ne ligent act of the occupant of the building utilizing the system. Dated this Z day of 'Pe -C, 19 ` 13 Sign the- Titl ' f'' � cor orat on, give name an a ss) i - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP.TTETION 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 '... -.. ... 1NI•.0_� ru9r- n�f- v..�s.. . >.s- ... ..r.•... •o n�•�= �.a - ^: -'a...J v�i�w�+v s.. - .,raAnl...f. �. 2 :�.9 •:.14v ..maw... .s,. ...... .K 4"Z.. .., -.a .J w.• PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date /973 Re: Property of ✓OSepyjj��� /;f/r� Located at 7�9�� S¢ Block 04P Lotr Gentlemen: This letter is to authorize_,- O.Sexw /= ,SvGG %vim^/ 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 Deparument of Hea-Ith, 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 Article e 147, Education Law., the Public Health Law, and the Putnam �County ,Sani- tary Code. Co-ante'rsigned: P. E., ., #9S =_GVi 14, ( Seal ) Address M'19 -zg-8777 elepnone Very trul yours, Signed -Owner of Property ycr�`y�r� r/�u�s� �✓� Address sz & --zz99 e ep one u •i I' ,l C , ESTABLISH ELEVATION OF HOUSE TO PROVIDE. DRAINAG- OF LOWEST FIXTURE TO SEPTIC TANK AND FIELDS AREA RESERVED T'OR SEWAGE DISPOSAL SYSTEM TO REMAIN UNDISTURBED.ALL CONSTRUCTION TO CONFORM TO STATE AND LOCAL STANDARDS AND - :REGULATIONS ........... �1u.4 ✓�,�r/�iq�e�i � t 4 o evi J c S i 16 41 1z, Eh` /STG.E:° /r'lhr. +. - i 6 ,.��i' �� �i� LO,� ¢"7Jpi /„^ �_/,JiVt;TJPN PDX• - •, '` �� ' ,�.. fl V _ x /200 C� "G:.3EG7•YG Tf'iN/G _ i e�v � `''G7 /G - � j t° - f7'/Y7E,n/,��"G� %l?fi�.•o OF' C•- .�?�I,© ,�OG7.ar G�cJ?' . ) 1. + � �<qx /.�,r�;v/v�s•�, . sir, . .�o,r. i PROPOSED ' � / jai �F?E;�u,'s•L .,�c/s � . ?s .E'Eb' <6�:d - x t , SEPARATE SEWAGE DISPOSAL SYSTEM ��o ;ov��.�rAO�► l4�" _ a � _ - J����r/a/;9:c /r���.:� -c.�;o f! �.A,�e.'o . +"- .F•3ik,''.i.l%G� /,tf'- . ' - s �♦ � 70 ^ >r•r5.,. 't' -. � . ',,'f S`° �p[4C1g J!� . T� _ - r /S j.9 A dry °:e : TOWN OF,_.�C %TiV�TT F%�Le_ �$ ..i " "1i.7�"rt�/4/s'i �.)tlNTY NEYY YORK.• DATE 5 / -.T SCALE• 3/� u .' 08 NQ. 73�f'f ;mss. y t aqa . - su�rvriiv Ty�e;€�e /9, fzoo i ti.. ( $OIL2PERCQLATIOR, R'AT£.. _.. ,MIN�IN -„ GALLON :SEPTIC TAWK :: �:�.!° r + - s {?IMF .a��tS d GONSUL7ING° ENGItiGERS DEEP TEST. S.. ra aa'a voftlr TREKCM�, .: •S -.- ..�,,,_, •. ; , ,.>�.,t.z«F.�_� y _._...3s.i2..,._.S. i?•• _ t - t...,._... �.�_ .._ .�.. _ __•t.__ -: s_:._,., �; .. - ._ . _._ .... ...,.....,.n.. ^...._..,. _<..c.." ... r"..:... z -- - "":57 -1 / /PD Pt ck 112' 'I'll Z-i J 0 2- ""' `z� F` GALLON SEPTIC TANK XfLABS- TRENCH fi APPROVEL DEC 131973 PUTNAM CoUrgy DEPT. OF W-MIFK 0 OW19FO* DIVISION OF OWRMV(TAL HEALTH SEN63 AS CONSTRUCTED SEPARATE SEWAGE DISPOSAi, %SYSTEM TOWN OF DATE, ARK PLACE CotjYTY. NEW YORK SCALE J68 NO SULLIVAN - THIEDE' CONSULTING ENGINE C'?S