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HomeMy WebLinkAbout3156DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 72. -1 -12 BOX 26 r I ' Ji r tr T..-! l_r �� 03156 COUNTY DEPARTMENT OF HEALTH ENGINEER 'MUST PROVIDE Orvis�on of•Environment� /= Hate /th`,'Sennoet, Geniis% N ':Y `10512:- `PERMIT # IF CERTIFICATE `OF..CONSTRUCTION;- COMPLIANCE: FOR. SEWAGE MOOSAL _SYSTEM ° ° iiftltdli" LdJt - kdCi r;c1S n�1r Located .at Tax .Map GBlock o E 75 r . S . Sell man 12,, owner g. / Formerly Mauro Tax Map Lot q.: Z.o salad. Lot r 5 Separate Sewera9e'System built by Wm Pf :inter Add►essWOOd St.. ,Put. Val NY. 10579 100Q 411LF. :of Leachi -n4 Fields Consisting of Oal. Septic, Tank and ' other, idouUements Water, Supply: PubUc SuPPIy From xxx Norman Anderson... ivate SuPPIy Grilled B Address Ra rtPr Ri -t*t , Pia to gm .VA I 1 ay, NY 10579 BuildIrig Type One Family. Re.side'nce ` No, of liedrooms Date Permit Issiled 11/12/82 Has Erosion Control Been - Completedt Has garbage e :.. ... g .grinder been installed? ..'. I I certify that the _- syetem(s): as listed seiving: the .above_,premises - were constructed essentially as shown on the plans of the completed, work ( copies of which are attached), and in aacordance:with the standards,. rules'and'regulations, in acc once with the fil: 'plan, and. the permit issued by the i Putnam, County Depar£ment.Of health ..:.- -Date Certified by P E. R A Muscoo.t No RFD' x -'48 Maho ac NY 105.1 11056 Address GYcenSo No -Any :person occupying premises served by the above systemjsp shall pro Mjwd a sue. a I n,",may be necessary to secure f corredloii, of* any- unsanitary conditions resulting from such usage• "Approval of'.the, 'separate' sew a rn she become "null. and volii as soon as i,publie sinitary'sewer becomes available and the approval of the,.private %atersu_pply, shall- become n I :w n P is Wa ter supply becomes available. Such approvals are subj ect to motli icatt n .or ehsnye: when,' in the judgment of the C issione H h eh rev Ion, .m Hiption or change Is necessary. Date BY Tjtle Rev. 6/85 -- - _ n Yorktown Medical Laboratory, Inc.. LAB # 321 Kear Street Yorktown Heights, N. Y. 10598 Collection Station Used: Director: Albert H. Padovani M. T. (ASCP) Mt. Kisco New City — — r DR. S. SELIGMAN INDIAN LAKE ROAD EAST PUTNAM VALLEY, NY 10579 L6 2'8 - 6 613 Date Taken: 5/3/86 (11:30 P.M.) Date Received: 5 1 P..M.) Date Reported: /86 Collected By: DR. SELIGMAN Referred By: CROSSROADS PHARMACY Sample Source: LABORATORY REPORT ON BACTERIOLOGICAL.QUALITY OF WATER GENERAL BACTERIA .Standard Plate Count per 100 ml A5 (Agar plate @ 35 °C) MEMBRANE FILTRATION TECHNIQUE (MFT) /Total Col'iform per 100 ml Fecal Coliform_per 100 ml Fecal Streptococcus per 100 ml MOST PROBABLE NUMBER TECHNIQUE (MPN) -_ 'I:ptl_ rn1. 3fC� 'm.'.......M ?IJ'T-n[aX''??:'T ZO.n_..ml Padovani, M.T. (ASCP), _ Fecal Coliform: MPN Index per 100 ml OTHER ANALYSES THESE RESULTS INDICATE THAT THE WATER SAMPL (WAS) ) WAS NOT) (NOT APPLICABLE) OF A SATISFACTORY SANITARY QUALITY ACCORDING HE NEW YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. LEGEND RDS = Recommend Disinfect- ing Water Source < = less than TNTC = Too Numerous Too Count Albert H. Padovani, M.T. (ASCP), Director LEGEND RDS = Recommend Disinfect- ing Water Source < = less than TNTC = Too Numerous Too Count • � � �� � � -��1 � ��II_ -� � _.t.o �Qp�.a.�i. NT'^s�V..jr.� :P 1.r4.,.4 ^�.'.(Ir'a �..t R-4 p -v!•�� .{p i��+re• -u T�..•t�rl+�w+. i��..vv DATE VVA R D;LOCATION IEW98TED BY, S.�.SeGtC DATE TIME OF SPECIMEN: �i Z1(RtY - M.D.. M.R.k :LINIC/1lDX. ! ( ".0 Gill L19 E Ari WEU. �T ICS I NAME 9vTN%ih -V ADMISSION NUMBER. LAB N MEDICARE i YE*--,',-.;, p )A TS CqMPLET D. TE IkN 9 X01 NO a= TEST QUESTED RESULTS =U JQ G o.L -1.FO2 of - 37 ° S � _ n -D . . F EG a o Ll. Forms D W. IE- Da ,:. o a 'J . ►i ���1�h'P..[.ak?t -. os.•.•...- J..:-- 'it... •.......,..;..�.w.-._:;. :�.:5- ::..�..•:.:r ��....T "- 1.:.- ...<:...Y: ;r, -. :i.,.. -� � _... ....... C7'.. ..� . . wner or Purchaser of Building Municipality Pfister Building Constructed by Indian Lake Rdad East Location - Street One Family Residence Building Type 75 Section 1 Block 2.12` 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- vi.ce•s cif the _. Putnam County Department_ _o.f.. Heal th. as to whether or not the _ failiz'ro -of -trie system to bperate was caused "`oy -the willful' or negligent act of the occupant of the building utilizing the system. Dated this day of _3 YSignature,,e,1 C Title . If corporation, give name and address) - - - - - - - - - - - - - - - - - - - - Wood St.-, Put.- Val. , NY 10579 - 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 li 8z PUTNAM COUNTY DEPARTMENT OF HEALTH Permit 0 Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Tt.1'►l�l �3li�i, "E�j /- (-a;'� -' - - -t •ti:r Town _ . 4 "Located °at_% f1 i)g1`. `Li`-1. " /�'2c zwr___ */� ir�r��( -�., - .+.a. Tax Map Subdivision -POW 14A Z9 N E/ % i 15:5— 3 i �. A sum. Lot M c 6 Renewal _ ❑ Revision _ ❑ Owner /Address PZ S -J �c-I V: AON l 667 EUG 7 a,�n�lo � Date Of Previous Approval Building Type (f) SAM' 2�5 • Lot Area 9, X04- A 1 -5 Pill section only ❑ Number of Bedrooms Design Flow G /P /D P.C. H..�D. Notification Required 71Z FA/ C,1/1_=.5 Separate Sewerage System Tto* consist of i �, /Q Gal. Septic Tank and 4-0os it �! �!/ G r -Q," ` I DE 1 1 FA/ To be constructed by `� C) w f? t-4 T) Address Q^ AN o pu 5 ^'oLL-Alw 212.1, PUT NyA11A Water Supply: Public Supply From / v-� a� VAL.LG- Private Supply to be drilled by 1goe-M A N NQEJ _5S- Z)1J Address Other Requirements I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal s stem above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regulations o e u nam 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 thedate 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 aeons of the Putnam County Department of Health, Date N k L yb2 Signed ( � P.E. R.A. Address 0-1 t -V 9*'- � `+�/ L A u � � � � hf•Y � � �4 � License No. APPROVED FOR CONSTRUCTION: This approval expires one year from the date iss un s construction of the building has been undertaken and is revocable for cause or may be amended or modified when consid necessary the ommiss ri of Health. Any change or alteration of construction requires a low per t. App soyv for disposal of domestic nits sews a /or vale ly only. ./ Date " By Title - Rev. 9 -81 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 'Date 11 OCT, I96 1Z Re: Property of �T�Ftili� +��- I�M14N Located at JNP11ON LAke 2.0AV E✓AS -r, TM - "5-1- 2-Is Section Block Lot Gentlemen: This letter is to authorize :J 6 E L. C 2E�N a e a duly licensed professional engineer or registered architect -* (Indicate) to apply for a Construction Permit for a 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 vv,,,, -q: Liu„ wlLn Li,i.ti maLi ev al1Li to. supervise ine construe ciurl of said system or systems in conformity with the provisions of Article 14S or 147, Education Law,. the Public Health Law, and the Putnam County Sani- tary Code. Ro •• \g��RENCE GRFF � ti Q p G� F• nt signed: N P.E., R.A., # II043(a Jowel reen rg - Architect Mu oot North RFD�2 Box 488 Mahopoc, NY 10541 °)I 4 - (v'L 8 - Gil Telephone Very truly yours, w x Signed Owner o operty 66 7 Cu G B Y 2_D, Address N��u y��Qk IIZ�r .Telephone Nov - 81982 pUTNTAM COUN'7Y DEPT. OF HEALe 1, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .. ,,,3. .� �J6iVkY �l��t+Tj1_f``ffff 1J11VU, F(iAl�1� L �� �Y- �e -1U�1 -•:`• -�� DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE N0. Owner • S •J GELL,6kAN Address % PZU68y RD. BKLy�yT1 /2 30 / /V7)cAfq I-AKQ TM- 75 -/ -Ida Located at (Street ��oAD E Sec. Block Lot indicate neares .cross street) Municipality N z� P m V Cie atershed 1Juz)5d ice! VAS, -L -' SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse 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 0) T# *� -1 845 - 9,1l� � f 6 i6/ ��3 -/0 -1 Ito- -la4'46 :�t /6 /0) 3 1-V/ 3 1 2 3 4 NOV -81982 5 putNAM CUfTV DEPT. OF HEALTH 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 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES •Ll'J1111 ilV� 1 r T.t. � -..,.. t1'.lilu 'i \,J �. -`i t'^' •.��- _, �'rl"�• +.t- ..�. G.L. P s<: :2 _ IO ��1�1L 12" 18" 2411 30 36" 42" 48" 54" 60" 66" 7211 7811 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO (WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED ���� NirllX'. 8i >) `tip G DESIGN Soil Rate Used 9 -10 Min/1 "Drop: S.D. Usable Area 'Provided No. of Bedrooms Septic Tank Capacity / © ©® Gals. Type ��. S uC Absorption Area Provided By eo L.F.x24" ( width trench. Other name joei vreenoerg - mmmreai Musgoot North RFDSox 488 Address Mahopoe, NY 10541 bignature SE THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq.. Ft /Gal. Checked by r Date t: