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HomeMy WebLinkAbout3160DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. �% www.scanyourdocs.com 631- 589 -8100 72. -1 -16 BOX 26 p:1 F. LLP F.T , 03160 J PUTNAM COUNTY D* EPARTMENT -OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Located at r �v LIAN : LA45 L!,7% I� / �5 -r %$ / �TlOivn er�iilege Tax Map - t ! ! Block Subdivision T O w h 14TAl i Lot. #/ Job' ( - Owner IL04M/n1�1LU98i5g -S Address - /MD / 09 k LK. RD• IF; Building Type (1) IYt.C_G�, Lot Area 9, 0IZ.00aE -:5S SU111�M[�/��LjL 1,1 r � Number of Bedrooms Design Flow / 01) Total Habitable Space �"r^�' V " Square Feet Separate Sewerage system � Ito �consist of t ®� � Gal. Septic Tank and l�%') D I DIAM• a!'•d� ���fl P�C%�sr � �I�/Ci To be constructed by 1= Address CRNbPUS 146ILL 12D.. L LEQCN iN6 6 46/,6f5 Water Supply: K Public Supply From c DtlINA M VjqL/ may. Private Supply to be drilled by -f n JTp�yi /. ,/�' / } ` % Address F)AW —G v ST. ,_ ?U7- ?9A4 1 �/•J[.L,C' U . M, . 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 system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules —and regu a ions o e Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of HealthwilI 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 accordant ith the standards, rules and regu a ons of the Putnam County Depar'tJmeent of Health. Date _. /I �"-0 /SI ,t� Signed / U.5ej i NdR �iM P.E. /7� /rR.A. Address g e/ License No. �7 APPROVED FOR CONSTRUCTION: This approval expires one year fisrAthe date issued u; revocable for cause or may be amended or modified when considered necessary by the Comm requires a new permit. Approved for disposal of domestic � sew prprwate Date % o� 7" �► / By --o r istruction of the building has been undertaken and is of Health. Any change or alteration of construction Title PUTNAM COUNTY DEPARTMENT OF HEALTH V. CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM RrwAM, UALLEY Town .eM••Wiileg Located % fatt J1�iYJA4 L� pA''ac Owner "� iLL f &A LU 55rz2, Separate Sewerage System built by r!" Consisting of ! OPID Gal Other requirements Tax Map 75 - /" "20 116 Block ZTax Map Lot # L.. r t ( Subd. # l Water Supply: Public SuPDiY From ®ZM — N � A 6 Y D G 0rsl Private Supply Drilled By Address pLLila C- E J?U riAM VALLEY i N• 7. O/+7 S_ y 0) Building Type fi) . I'i7 s^ -�- -� No, of Bedrooms Date Permit Issued Has Erosion Control Been Completed? I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulations, in accordance with the filed plan, and the permit issued by the Putnam County Department Of Health. Date J0 A.5 Address 12M -n Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public er ply becomes available. Such approvals are subject to modification or Change when, in the judgment of the C9mG' (ajioner of Health, such/revogt4n, modification or change is necessary, n.re 1 0 V— RV ' ��'� "`'% Title d -" 3 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re Property of WILLIAM L a8pEfLS Located at INDIAN LAk-F- 20. j5AST- (T) Section Block Lot Subdivision of -POW 14 47P N L-S- ig7r;S nn Subdv. Lot # f Filed Map # l78 / 0, Date c$ 8J 78 9 A Gentlemen: This letter is to authorize — J0r =t- 6ie--�i5NI35e,4 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 connection with this matter and to supervise the construction of said 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned: /�VkSD q\ �R£N � CE GR�F v Q o s 0.011 og� F op KIcV0 i P.E. , R.A. , # 1%a i1 Very truly yours, Signed Owner of Property to USC.0 oT N o R.T- 4 2 -FD -#S , 130U 468 KECEIVED Address Mx�NaPA�i��. I]EG ? 191 Telephone DEPT. HEALTH INDII0N LAIG.G— TLD Fe95T Address PUTN A M V4L(r Y Town 6,700 Telephone WELL COMPLETIO REPORT 3/71' P PUTNAM COUNTY DEPARTMENT OF HEALTH 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. ,. ST ;BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAQ ADDRESS LOCATION OF WELL (No. & Street) . (Town) (Lot Number) —y� �1 PROPOSED USE OF WELL BUSINESS ® DOMESTIC ❑ ESTABLISHMENT ❑ .FARM ❑TEST WELL 1:1 SUPPLY El INDUSTRIAL ❑AIR El OTHER CONDITIONING (Specify) DRILLING EQUIPMENT COMPRESSED CABLE � ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION ❑ OTHER ) CASING DETAILS LENGTH (feet) / DIAMETE3(inches) (p (� WEIGHT PER FOOT © THREADED El WELDED D O YES LINO R G YES D? LJ NO YIELD TEST 1 HOURS G.P.M. ❑ BAILED ❑ PUMPED COMPRESSED AIR ,� YIELD (G.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify leet) DURING YIELD TEST (feet) Depth of Completed Well in feet below Land surface: 3r,d SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (feet) SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (Inches): GRAVEL SIZE (Inches) FROM (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET � ..q -��r• _...-- ...+1. �..� -r .� - -_�� _.!9'�1 ^��.v..� sue. �....1 _� _... ._ � �� OCT 281982 pUTMQM COUNty DEPT, OF WALTH 16 ' _... .. r 1 .' .. ' ' wr ._... .. _._gyp- If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMP „,�- / ��. D ATE OF.REP.ORT WE RILLER (Sig e) " ` �;- ...taa ;�.. �:. _. _Ar. . Y�•�(�� �� >:�.'v:ya: t ate. � .._wa l< - - nrn' ♦c-. F.�n�. >:• � �- r • dater •i. b1 r� -i�c. �.A'._�: riRt. :v ��^ m:MS� Lim Owner or Purchaser of F• Building Municipality r \-A` 1A)BLLI AAA t Q6J3 r- .5 _TM 7,54-2#/67 Building Constructed by Section INP�AN LAS ma 5AST Location - Street Block Building Type 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- aQ,_of. the....:P —tnam.._- County: Department of He.cl:th,_a:3.- ,o whe :?�_ r: r: not :the _- " "° �'iiizre `o'� °t'�ie "system "o� operate was�'ca`usec��by the illfu3 or negligent+ act..of the occupant of the building utilizing the system. Dated this 27 day of C3 CT` 19812 Signature lie Title �6i fe Ze (If corporation, name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP+.,ETION 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 RECEIVE® OCT 2 81982 PUTNAM COUNTY DEPT. OF HEALTH YORKTOWN MEDICAL LABORATORY INC. P.O. Biz 99 3'21 Kear Street LOCATIONS: Yorktown Heights, N.Y. 10598 ❑ 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245 -3203 g M-201 BUTTONWOOD AVE., PEEKSKILL. N.Y. 10566 737.8711 245'3203 ❑ 495 MAIN ST., MT. KISCO, N.Y. 10549 666.3335 . -. -• - ..(C:n ..� N- ..._..� fir. -=.. � ti .., .: ...�'. -_.. .... ., ..,. ,_.... �. .. -.a .. ..; s -�. :�..c�.•I..�i.:�1.Fv�t.y'i.l f�c ^.I"tn.�.'e _� .��i .. fiU. eF-.,. T-.,. 1.. �. .�r'ii.�:!�.�..t'%�'.f:+. -..... i._;. L.'.':.i' �-7O v._ LAB # S I 1 ,. /7 y `x „/10 / DATE TAKEN: r GATE RECEIVED: �12- DATE REPORTED: f �J•� 1� SAMPLE SOURCE: Ly hh l� REFERRED BY: r COLLECTED BY: fJ . LABORATORY REPORT mg /L ❑ ACIDITY .................. ............................... ❑ ALUMINUM ................................ ............................... ALKALINITY................... O ANTIMONY ................................ ............................... ACTERIA. TOTAL /mL ...... .. ........................ ❑ ARSENIC .................................... ..........:.................... ❑ BOD, 5 DAY ................... ............................... ❑ BARIUM ....................................... ............................... ❑ BROMIDE ................... ............................... ❑ BERYLLIUM ................................ ............................... ❑ CARBON DIOXIDE, FREE .............................. ❑ BISMUTH ..................................... ............................... ❑ CHLORIDE ................... ............................... ❑ BORON ........................................ ............................... ❑ CHLORINE ................... ............................... ❑ CADMIUM .................................... ............................... ❑ COD ............................... ❑ CALCIUM ..................................... ............................... ❑ COLOR ....................... ...........................:... Q CHROMIUM (tot.) ............................ ............................... ❑ CYANIDE ................... ...............0............... ❑ CHROMIUM (hexavalent) .................... ............................... ❑ DETERGENT, ANIONIC ... ............................... ❑ COBALT .................................... ............................... ❑ FLUORIDE ................... ............................... ❑ COPPER. ................................ ............................... ❑ HARDNESS ................................. :................. ❑ COLD ........................................ ............................... ❑ MPN CO Li FORM COUNT/ 100 ml ...................... ❑ IRON ........................................ ............................... 9D MFT COLI FORM COUNT /.100 ml 0 ................ ❑.LEAD ........................................ ............................... ❑ CONFIRMATORY TEST ... ............................... ❑ LITHIUM ..................................... ............................... ❑ , NITROGEN AMMONIA _ _ _ MA NESIIIM .�._...._ `❑' "N�P•i HCiGcN, °KJEL`UAH� - :. :....: ".... .. . °.:::.`;:.... . _....may �- '�CJiVIAN�ANtSE t ..............� ..........'..: ............_. _� ..•.•........- ..o...._. ... _ �. . ONITROGEN, NITRATE ... ............................... ❑ MERCURY .................................... ............................... ❑ NITROGEN, ORGANIC ... ............................... ❑ NICKEL ........................................ ............................... ❑ ODOR. ....................... ............................... ❑ PALLADIUM ................................ ............................... ❑ OIL & GREASE ............... .......................0....... ❑ POTASSIUM ................................ ............................... ❑ PH ..................:........ ............................... ❑ RHODIUM .................................... ............................... ❑ PHENOL ....................... ............................... ❑ SELENIUM ...................................: ............................... OPHOSPHATE (ortho) ....... ............................... 0 SILICON .......... ...................... ............................... ❑ PHOSPHATE (condensed) ... ............................... ❑ SILVER ................................................... :.................... ❑ PHOSPHATE (total) ....... ............................... 0 SODIUM ........................................ ............................... ❑ SOLIDS, SETTLEABLE, ml /L .......................... ❑ TIN. ............................................ ............................... ❑ SOLIDS. SUSPENDED ... ............................... ❑ ZINC ........... ............................... Fp ❑ Rzre SOLIDS. DISSOLVED ... ............................... ❑ ................... ............................... a . m ❑ SOLIDS, TOTAL ............... ❑ ............................ ............................... ........................... .... g� y;.................... ❑ SOLIDS, VOLATILE ....................... I ....... ........ ❑ REMARKS:.......... ............................... ❑ SPECIFIC CONDUCTANCE .............................. O .................................................... ............................... ❑ SULFATE ................... ............................... ❑ .................................................... PUTNA aUjgjV ❑ SULFITE .................... ............................... ❑ ....................... ............................Imm -DF HEALN ❑ SULFITE .................... ............................... ❑ .................................................... ............................... ❑ SURFACTANTS ............ ............................... ❑ .................................................... ...........................:... ❑ TURBIDITY ................ ............................... . ........... ..........,....... ........................_ -..... _._ .......... THESE RESULTS INDICATE THAT THE WATER WAS OF A SATISFACTORY SANITARY QUALITY WHEN THE SAMPLE WAS COLLECTED. THESE RESULTS INDICATE THAT THE WATER DID MEET THE SATISF TORY CHEMICAL QUALITY OF NEW YORK STATE ADMINISTRATIVE RULES & REGULATIONS, DRINKING A ER STANDARDS 71� FOR THE PARAMETERS TESTED. 1 ALBERT H. PADOVANI M. T (ASCP) , DIRECTO ' v�� �x 2� c d' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner 1- Lr�'R Address e ,Lem ur N �% ,Located at (Street 4dicate AI d Lk, ". FA�7 -, Sec. Block Lot CIA. I nearest cross street) Municipality�J�J '0 r �TN.QM �U.E Watershed c�DSaN. v 2, SOIL PERCOLATION TEST DATA REQU RED 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 3 9: 3 9- 9: J9 Notes: 1) T& is 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' S.OILS.. ENCOUNTERED.'IN .TEST 'HOLES _ ?�FPT1 K TTOLET -_N H�?4E n,- G.L. I cl ��01 �- _ Z) 51�1L' _r6P5OIL_, 6" �� Y sAND Ct-AY ..�. �iQNP ec.Ay iv 556ND 12" 18" 2411.... 30 ►' .. . 36.. 42" 66" 7?. It . �t 84" i INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED -. NONE INDICATE LEVEL TO WHICH, WATER LEVEL RISES AFTER BEING ENCOUNTERED - 4A TESTS .MADE RY - rcl,Ga2s�N/l D. IGN .�-� Soil Rate Used( [ Min/1 "Drop: S.D. Usable Area Provided.�56,00 S;i FR 0_ A5_r . No. of Bedrooms' Septic Tank Capacity %tea Gels. Type Absorption Area. Provided By L.F.x24". T idth Erench. g� ENCE oy her Name j Joel Greenberg- Architect ��g a Musc of North RFD f2, Box 488 I Address j Mohopoc, NY 10541 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked '0"04C/ OF NEB T Date