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Home My WebLink About3204DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 72.19 -1 -19 BOX 26 03204 IN 19 I mile 1 1 ��`i■, J �" ,, , :ON, , �VlLb �� ., �t f ' a IN 0 '� i ,' ,NJ s , A _ I 1 �, , 03204 ` °CERTIF;IG/ ., L'oeated at `bwner V W RI Separate SeM v '';Water 3upp1Y `; - Public' Supply From � * � _ hs w. < Private Supply D►01ed BY, " a Type 3 ,�c Building �AlV1!l..Y - Ia�St DING No ,of Bedrooms - Date Permit Iswed '3 9 F .. 4 .. Has Erosion Contiol Been'' Completetlt a +� .� �` r�, A I certify that the ystem(s)Yas listed serving the above premises were constructed °eeaentially as shown on ,t he plane of the 6*01'ilbid work i( copves of which,are attached) Y.an les and re ulations, in` accordance "viii -, a file 'elan .and the ed by ;the q permit issu putnam County Department Of Health a c a 4 e 1 � Date s F Certifietl by B ' P,E, kA --� a _ p Address U %. �q R R, ii N lV , 7, ��Jr�.Y Licefite No O �,% 1� % I Any, person occupying, premise; served by the above`system(s) shall piomptly; take sueh'action as may beneeessary to sswis the corredlon of any unsanitary; w 9e.•sY ' ... contlition3 resulting from' weh usage Approval "ot the separate sewers stem (hall becomq null and void is soon as= a public gnitary sewer becomes, available ,and the ;epprovefsot the +;private water - „supply` shall void wheh a public ai wpply.peCome; avallatiN Such approvals ere' sublect to modification or, =cAanga; when ''in the`)udgmentTo the Com Issfor of Health we rev lion ri�otlifleation or cAenge Is necessary 4�c\otft'8'ttt7tt�aw M. ,mN C. giAwc® Owner or Purchaser of Building 17 Section Building Constructed by Block 6FAM: SAWK 130A P. 11 Location - Street Lot PVT-NAM VA LL8Y Municipality Subdivision Name .51NG-LE FAMILY ?K951®ENCr:F Building Type Subdv. Lot #� GUARANTEE 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 guarantee to the owner,.. his success- ors, heirs or.ass'igns, 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 were 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 determin- ation of the Director of the Division of Environmental Health,Servi`ces o-f -- .the - ..Putnam Count:: - �Deportmert_ of Heal.th..as-_:to whether. or - ro.t.* he tail- ' ure of the system to operate was caused by tiie.' wiilful" or negligent" act of the occupant of the building utilizing the system. Dated this /day of 19� Signature Title V IV VP.`R'" Corporation Name if core.) Address. - 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 WELL`; OMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH �Yt Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL NEW YORK ` is report is to be completed by well driller and submitted to County Health Department together with laboratory report of \. \ a , lysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. - n.- ,-..s. ,..0 w . -.r - _Iw T� .�.7y- ..+J'.i .Lr' �.? � � :.e �!i� E:..i�:.r �i�. �7; - Tr'•.��y�_�� ©L'� *P ��In�_.'= r ,.ir +� I OWP411 ` NAME ,` ADDRESS (No. 6 Street) (Town) .,. (Lo f Number) �.. COCA N OF Ll Ve ` BUSINESS \ RDOMESTIC ❑ ❑ ❑ PRO ED ESTABLISHMENT FARM TEST L USE F.. yWp PUBLIC AIR OTHER ❑ ❑ ❑ ❑ SUPPLY INDUSTRIAL CONDITIONING (Specify) D G COMPRESSED CABLE . R ❑ OP. ❑ ❑ IP` EQU ENT ROTARY A PERCUSSION PERCUSSION ify ) CA G LENGTH (feet) r DIAMETER(IncheS) WEIGHT PER FOOT © ❑ ❑ CASING '?— DET, t5 4 THREADED WELDED / YES NO L� YES NO HOURS G.P.M. =..z COMPRESSED AIR ,j ❑ BAIIED ❑ YIELD (G. P.M.) - - -T . - _.. PUMPlD _ . ` W R MEASURE FROM LAND SURFACE -STATIC (Specify feet) DURING YIELD TEST l leap Depth of 'Compteted Well i ..: l in feet below Land surface: rtr `T MAKE LENGTH OPEN TO AQUIFER /sell SC N D I'S SLOT SIZE DIAMETER (Inches) IF GRAVEL Diameter of well including GRAVEI SIZE (Inches) FROM (Net) TO (fist) PACKED: ' gravel pack (Inchea).-- _ DEPTH fj&M LAND SURFACE .... FORMATION DESCRIPTION -.. _ Sketch exact location of well with distances, to at least ' two permanent landmarks. F4 to FEET _ ,j 9 \ If yield was 'tesled at different depths during drilling, list below FEET GALLONS PER MINUTE DATE MPl TED PATE OF REPORT WELL D ER (Sign e) iff, Jr A YORKTOWN MEDICAL LABORATORY INC. P.O. Box 99 321 Kear Street LOCATIONS: . � 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245.3203 Yorktown Heights, N.Y. 1O59H ❑ 201 BUTTONWOOD AVE:, PEEKSKILL, N.Y. 10566 737.8777 ❑ 495 MAINS T KIS.CO, N.Y. 10549. 666-3335 - LJ SYVNEL'IEiGii AVt. ( NE7iFiNub r'1i jk'i,'CA'kfiiGi`E�; LAB # 13 923 am DATE TAKEN: I _ _ am F —� DATE RECEIVED: _ Jackie Gianico 528-7735 DATE REPORTED: SAMPLE SOURCE: t_-11 lap Sprout Brook Rd Putnam Vally L J LABORATORY REPORT mg /L ❑ ACIDITY ............................ ............................... ❑ ALKALINITY ... ... .. JO BACTERIA, TOTAL /mL ............ .............................. OSOD. 5 DAY ............................ ............................... ❑ BROMIDE ............................ ............................... ❑ CARBON DIOXIDE, FREE ........ ............................... ❑ CHLORIDE ............................. ............................... ❑ CHLORINE ............................ ............................... ❑ COD ..................................... ............................... ❑ COLOR ................................ ............................... ❑ CYANIDE ...........................: ............:.................. ❑ DETERGENT, ANIONIC ............. ......................•........ ❑ FLUORInF ............................ ............................... ❑ HARDNESS ............................ .......................... >.... ❑ MPN COLIFORM COUNT/ 100 ml ............................... j 0 MFT COLIFORM COUNT/ 100 ml 4 ................... ❑ CONFIRMATORY TEST ............ ............................... O-NITROGEN ;..A;d,Fd,0NI ... .. . ...:....................... ❑ NITROGEN, KJELDAHL ........................................... ❑ NITROGEN, NITRATE ............ .............. .................. ❑ NITROGEN, ORGANIC .:.......... ............................... ❑ ODOR ...... :........................................................ ❑ OIL & GREASE ........................ ...................:........... ❑ PH ................ ........ .. ❑ PHENOL ........... :................................................... ❑ PHOSPHATE (ortho) ................ ............................... ❑ PHOSPHATE (condensed) ............ ............................... ❑ PHOSPHATE (total) ................ ............................... ❑ SOLIDS, SETTLEABLE, ml /L .... ............................... ❑ SOLIDS. SUSPENDED ............. ............................... ❑ SOLIDS, DISSOLVED ............. ........:................:..... ❑ SOLIDS. TOTAL ..................... ............................... .❑ SOLIDS. VOLATILE ................. ............................... ❑ SPECIFIC CONDUCTANCE ......... ............................... ❑ SULFATE ............................. ............................... ❑ SULFIDE ............................. ............................... ❑ SULFITE ............................. ............................... ❑ SURFACTANTS ❑ TURBIDITY ......................... ............................... REFERRED BY: CY OSS2"nadS..1511a)^maGy COLLECTED BY :Jackie Gianico ❑ ALUMINUM ................................ ............................... ❑ ANTIMONY ................................ ............................... CARSENIC .................................... ............................... ❑ BARIUM .........................:............. ............................... ❑ BERYLLIUM ............................................................... ❑ BISMUTH .................................... ............................... ❑ BORON ........................................ ............................... C3CADMIUM ....................:....:.......... ............................... ❑ CALCIUM .................................... ............................... ❑ CHROMIUM (tot.) ..........................:. ............................... ❑ CHROMIUM (hexavalent) .................... ............................... ❑ COBALT .................................... ............................... ❑ COPPER .................................... ............................... ❑ GOLD ....... ............................... ............................... ❑ IRON .........................:.............. ............................... ❑ LEAD ........................................ ............................... ❑ LITHIUM ..................................... ............................... -❑ MAGNESIUM-- ..........:. ❑ MANGANESE ................................ ............................... ❑ MERCURY ............................................................ 6....... ❑.NICKEL ........................................ ................................ ❑ PALLADIUM ................................ ............................... ❑ POTASSIUM ................................ ............................... ❑ RHODIUM .................................... ............................... ❑ SELENIUM .................................... ............................... ❑ SILICON .................................... ............................... ❑ SILVER ........................................ ............................... ❑ SODIUM ........................................ ............................... ❑ TIN ..................... .......... ..... ............................... ❑ ZINC ............................................ ............................... ❑ ................................................. ............................... O .......................... ................................. ❑ REMARKS:..................................... ............................... ❑ .................................................... ............................... ❑ .............................. ................... ............................... ❑ ............................... ........ ............................... .... o............... ................................. ............................... ❑ .................................................... ............................... ❑ .................................................... ............................... THESE RESULTS INDICATE THAT TIIF WATER WAS OF A SATISFACTORY SANITARY QUALITY WHE14 THE SAMPLE WAS COLLECTED; . THESE RESULTS INDICATE THAT THE WATER DID MEET THE SATISFACTORY CHEMICAL QUALITY OI' �py� Y�R STATE ADMINISTRATIVE RULES & REGULATIONS, DRINKING WATER STAPiD S (PART 72). _I:OR AAMETERS TESTED ALBERT H. PADOVANT M.T. (ASrP) nTRFrTnR I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES rs:::-= ::iu.:. r,�+.a :-i.c T "�-. er 40-...... .:nc,A:aa..r- :siw'�si:.�e..x... ':i•Ss �.�a•:i.�c-.'- �m� :::4�. "� "r:.v, =-- w.u�•rr +`L e' :��.it i.":e- .;:n:w <a.s+w+.� r' '�:r rives.: " - .�.�'a Date cz)--T Re: Property of .�p�,� �� 0•atl1 tc O ' Located at f�v$ off. 2® 4' o nQmb (T) :4n Z4. Section j- Block Q Lot JJ Subdivision of MAP 14 OF CONTj 41 atu7-,:41 01-446a Sub dv. Lot # Filed Map #_.,,,7 — Z_ Date /V 4-Y _Z /j Gentlemen: This letter is to authorize P't; IMF- 25T-�ac+�,��, a duly licensed professional engineer p� or registered architect (Indicate .to apply fora 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 system or systems in conformity with the provisions of Article 145 or 147, Education Law, uBV th Law, and the Putnam County Sani- tary Code. MAR 12 1984 Very truly yours, PUT'NAM COUNTY DEPT. OF HEALTH Signed 4 A d• •� er o Property Countersigne--- � P.E. , R.A. , #0 4 - 7 S) 167 . Address Q4 Y, �� .. c� �o n � � Address 11 Town IV `/ILj- - -23�- 4. -24-- 2) &4 Telephone Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING rARMEL, _ .. R ... _ _ DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner JOHN cjANIca Address :3Oq r, TFJ AVE.. PELHA11(I , iV.Y. I0603 77 Located at (Street)15pR 7 ica 8 See. Block per, Lot (Street)=7 e nearest cross streeTT Municipality pilrMM VALLIFY Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole 13 - 4 27 3 Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Va er water LFvel 24-. No. Time From Ground 'Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 13:02 - 24 z-7 3 3, 3 23,12 _ 3 2z. io Zd Z-7 ' ,.S-3 33 ZZ - x,.32_ 10 4 13 - 4 27 3 $-�3 33; 31 -,3',4A- �..13 24-. TZ 3 4. -33 1 -err pF MEd jvrY - — -s 5 Notes: 1) Tests 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 r DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES D-kplri — tiVi "iVv. � a... U- -iii E''�c G.L. 6" n(? 12" _ 18 " 2411 30" 3611 422" 48" 5411 60" 66" 72' 7811 _ 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO-WHICH WATER LEVEL PLTZES AFTER BEING ENCOUNTERED YlC%YLQ-- - -- =TS, INYk E BY � - '" DESIGN Soil Rate Used ©- S Min/1 "Drop: S.D. Usable Area Provided 0 (D Q � No. of Bedrooms Septic Tank Capacity, 1 000 Gals. Type �id O P ;kT Absorption Area Pro d By. �Sc�L.F.x24" —` 3�"— width trench. Other � Name PA'fTi Mr KARMkrK SMITH - PF_ igna u-re tCEUT ,jv�a Address SEAL GAR 1ST bNT_N. Y. iaS2-4 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date SITE LOCATION OWNER'S NAME MAILING ADDRESS PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES :°J OFFICIAL USE ONLY e PHONE PERSON INTERVIEWED 4f-0 PCHD Complaint # ame & Relationship (i.e., owner, tenant, etc. DATE TYPE FACILITY PROPOSED INSTALLER �� PHONE_ ADDRESS ��/l.l! REGISTRATION# Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system .Different location may require submittal of proposal from licensed professional engineer or registered architect. 611e4P .,EZ)L !l `7 S OaZL4'x:5 I, as owner, or reported agent of owner agree to the conditions stated on this form. SIGNATURE";: -� y .. _ _ -TITLE._,.. DATE �. Proposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name b. Site Street Name, Town and Tax Map number. <` C. Location of installed components tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6 diam. X 6 deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Proposal approved Inspector's Signature & Title D COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML - I GENITVA ROAD BREWSTER, NEW YORK 10509 Pioue: 1- 845 =278 -6130 Fax: 1- 845 -278 -7921 F.A-X C OVER SHEET FAX NUMBER TRANSMPI`TED TO: To: Of: From:. Z/� COIZffiNTS- D v 0CE� «NOT COUNTING COVER SHEET. IF YOU DO NOT RECEIVE ALL PAGES, PLEASE TELEPHONE US IMMEDIATELY AT 845- 278 -6130 N PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES ^ss.!L .,_ -.,,.. r:tii'?' >',...s,..►�. +'+'> `n'.',r..... -w OFFICIAL USE ONLY - s- v SITE LOCATION 7,2 .5 /1-- I T M# r-7- Z ` � �''` _/7 OWNER'S NAME /17 va&,,, 3"° .o.L PHONE 5"2 MAILING ADDRESS �0 7 v �•auf �3 �� /� L _ �ceaG da ` /.�,. PERSON INTERVIEWED PCHD Complaint #. ame KKelationSlUp (ix,., owner, tenant, etc. DATE TYPE FACILITY PROPOSED INSTALLER PHONE ADDRESS REGISTRATION# /Z,.v A4- Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system .Different location may require submittal of proposal from licensed professional engineer or registered architect. � 1 �� O / fir✓ 3 � �'-O fi G � � � Ct��.+..Y G+ ' +� c�3 `l�T�'•► I, as owner, or reported agent of owner fig to conditions on orm. SIGNATURE f � �d.� �S'!�� <�._..�... .. _• - 'TITLEry�' Gt�/P�2 -�~.. _..-- ATE `�`�,� c�Z _Proposal Qpmved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name b. Site Street Name, Town and Tax Map number. C. Location of installed components tied to two fixed points (e.g.,house comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Proposal approved �.y Inspector's Signature & Title DATE COPIES: White (PCHD); Yellow (Town Bn; Pink (applicant) PC -RP 99ML 02:44p BUILDING DEPT 9145268806 Q, ON tlo!l 11"llYT t V 140 A FL U t "V Ou. P•2 A'Zi Ne, Iq N ENN"� _4 4W 4 'ry MAY-P7-PROP THI 1 01:31 TEL:845-27e-7921 NAME:PHTNAM CnHMTY DFPAPTMPNT np p- 2 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES .- '1 QDQK+ T 2QR-4e s.��A I:€ al; i?YS E L. F.L'_AAR? OFFICIAL USE ONLY SITE LOCATION �i 7� S /-��u� %3�f� �- L TM# OWNER'S NAME 6 .0t PHONE 5-2 ell MAILING ADDRESS PERSON INTERVIEWED 11;7..0 . u , Si PCHD Complaint #, ame arKelatiOnSWP I.., owner, tenant, etc. DATE /.Z 3 /Cl� TYPE FACILITY PROPOSED INSTALLER 3—j__�SZ2 PHONE ADDRESS REGISTRATION# Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system .Different location may require submittal of proposal from licensed professional engineer or registered architect. 40 e I, as owner, or reported agent of owner g= to the conditions stated on this form. _ SIGNATUREV.� J vG _ "....TITLE ' DATE Proposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name b. Site Street Name, Town and Tax Map number. C. Location of installed components tied to two fixed points (e.g.,house comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6 diam. X 6 deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Proposal approved_ Inspector's Signature & Title DATE COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML May 23 02 02:44p BUILDING DEPT 9145268806 "9A . . . .... -Vt. y s ... ........... F,-- -Ap 7-4 V TC 10 Eli 4W %) 4 - Mei.'M MAY T 01:31 TEL:.8&45-278*-79'21 NAME:PHTNom rn INTY nr:pnr)Tmckrr ';;c- p.2 h 1 T t - 1000��''GAL 5�F LE vista, iq WIT A p �. '�v t L L : 11 4 a r q I i M }15 y ! l S MUM ''� E r L �.x 'nt. •($ ' I z} ( rep y W1 S t VV >7 r i B, 4k` T- 4 5 F., ,JB3 zMr k.k h qQ MUN Y a t r,' too J nr"} 5 Woo K}rte A j! + r low y 1 R A t 11 '3 y k Jy r �. •t > y I R, E'j !!0'. X1.5} z Rolls awl, R I s sux s TWO �.r 6 9. OIL c , HOlJSE low AN t S h 1 T t - 1000��''GAL 5�F LE vista, iq WIT A p �. '�v t L L : 11 4 a r q I i M }15 y ! l S MUM ''� E r L �.x 'nt. •($ ' I z} ( rep y W1 S t VV >7 r i B, 4k` T- 4 5 F., ,JB3 zMr k.k h qQ MUN Y a t r,' too J nr"} 5 Woo K}rte A j! + r low y 1 R A t 11 '3 y k Jy r �. •t > y I R, E'j !!0'. X1.5} z Rolls awl, R I s sux s TWO �.r 6 9.