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HomeMy WebLinkAbout3219DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73. -1 -4 BOX 26 No ��. . Is is � �_, ; , f � rp '' 03219 Water Supply: Public Supply From Private Supply to be drilled by A niM L Address _ Other Requirements I } O 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 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 th S�ri anal syste or ny repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be instaile in c rdan e t the standards, rules and regula i —ns of the Putnam County Department of Health. Date / ! S Signed �^ r I P.E. R.A. Address /T' .5' /Z E:N i !y Gate-° j� J� 7 �J 83 License No. APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless sgistruction of the building has been undertaken and is revocable for cause or may be amdnded or modified when considered necessaj�Y by the Commissil er of. Health. Any change or alteration of constructs n requires a new permit. APprovedjArdisposal of domestic sar i 11`Vewj[ b, apdLawfrivate v/a Date r' BY •�� -s/ Title PUTNAM COUNTY DEPARTMENT OF HEALTH .-;On ' of t nl im. nmeni?i Heap SErI �t:�c; !,firmer, N, : Y . l X53 .. _e _ CERTIFICATE'.OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM -h. 16A, \�A i_-%:zr' i Town or Villa e Located at_ v t'° D C Owner Tax Map — Block Lot Job— Separate Sewerage System built ,by y1 D�Address Consisting of Gal. Septic Tank and legit, f r r' Mi y m " Other requirements Water Supply: Public Supply From Private Supply Drilled By Address r^ _ Building Type ���� ��", �A ( No, of Bedrooms Date Permit Issued '".. Has Erosion Control Been Completed? ._ r.:! t " - ;;; "•: ///'� tJl A. rdi'ti I certify that the system(s) as listed serving the above premises were constructed essenti a p�Wn on the pg, - pf'the completed work (copies of which are attached), and in accordance with the standards, rules and regulations, plans filed, aI th - erf lit b7� he Putnam County Department of Health. � 11.11 �i�f�t � . Date Certified by Address Any person occupying premises served by the above system(s) shall promptly take suc conditions resulting from such usage. Approval of the separate sewerage system Z. available and the approval of the private water supply shall become null and void when subject to modification or change when, in the judgment of the Commissioner of Health, Date . J i— / By P.E. 2 R.A. License No. L ( E�120-"Z secure the correction of any unsanitary on as a public sanitary sewer becomes -.becomes available. Such approvals are modification or change is necessary. Title rujjNAM UUUN'I'Y DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM VA il.>E Located at �L� �+> trl/LC.( -j1 CC� illa Section Block Subdivision 1- -i�,���G%+}dN 6- - 'y LStt� - Owner Address Building Type Lot Area Q CIl Number of Bedrooms a " N n_ Total Habitable Space Square Feet Separate Sewerage System to consist of I © Gal. Septic Tank 1% lineal feet X ii � � width trench To be constructed by F J--rl L Address 7 ,' AJL' 15'00-) Water Supply: Public Supply From Private Supply to be drilled by A niM L Address _ Other Requirements I } O 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 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 th S�ri anal syste or ny repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be instaile in c rdan e t the standards, rules and regula i —ns of the Putnam County Department of Health. Date / ! S Signed �^ r I P.E. R.A. Address /T' .5' /Z E:N i !y Gate-° j� J� 7 �J 83 License No. APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless sgistruction of the building has been undertaken and is revocable for cause or may be amdnded or modified when considered necessaj�Y by the Commissil er of. Health. Any change or alteration of constructs n requires a new permit. APprovedjArdisposal of domestic sar i 11`Vewj[ b, apdLawfrivate v/a Date r' BY •�� -s/ Title PUTNAM COUNTY DEPARTMENT OF HEALTH .-;On ' of t nl im. nmeni?i Heap SErI �t:�c; !,firmer, N, : Y . l X53 .. _e _ CERTIFICATE'.OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM -h. 16A, \�A i_-%:zr' i Town or Villa e Located at_ v t'° D C Owner Tax Map — Block Lot Job— Separate Sewerage System built ,by y1 D�Address Consisting of Gal. Septic Tank and legit, f r r' Mi y m " Other requirements Water Supply: Public Supply From Private Supply Drilled By Address r^ _ Building Type ���� ��", �A ( No, of Bedrooms Date Permit Issued '".. Has Erosion Control Been Completed? ._ r.:! t " - ;;; "•: ///'� tJl A. rdi'ti I certify that the system(s) as listed serving the above premises were constructed essenti a p�Wn on the pg, - pf'the completed work (copies of which are attached), and in accordance with the standards, rules and regulations, plans filed, aI th - erf lit b7� he Putnam County Department of Health. � 11.11 �i�f�t � . Date Certified by Address Any person occupying premises served by the above system(s) shall promptly take suc conditions resulting from such usage. Approval of the separate sewerage system Z. available and the approval of the private water supply shall become null and void when subject to modification or change when, in the judgment of the Commissioner of Health, Date . J i— / By P.E. 2 R.A. License No. L ( E�120-"Z secure the correction of any unsanitary on as a public sanitary sewer becomes -.becomes available. Such approvals are modification or change is necessary. Title a A' PEEKSKILL MEDICAL LABORATORY 1879 Crompond Rd.' Barclay Plaza Bldg. A, Apt. 1 Peekskill, New York 10566 PE 7-8777 DATE COLLECTED RESULTS OF EXAMINATION OF WATER OWNER DATE RECEIVED CITY. VILLAGE, TOWN & /OR NAME OF SUPPLY DATE REPORTED otd &AMPLING POINT 3ACTP -RI A PER ML. (Agar plate count at 35 Q. COLIFORM GROUP (Most probable N6. /100m1.) Lts -N TOTAL - ppm )ETERGENTS - ppm NITRATES (as N) - ppm IRON, TOTAL - ppm. 'LOUH10E (F) - mg. /1. A 'hese results indicate that the water was of a satisfactory sanitary quality when the sample was collected. A. H PADOVA?,11, T. (ASCt ) Owner or Purchaser of Buildin Municipality ILA) C -4 A 1 t d Pis Bui ding onstrucLEd by Section Location - Street Block Building Type Lot { wl GUARANTY OF SEPARATE SEWAGE- SYSTEM is represent that WtafCwholly 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 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 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- vices of the Putnam County Department of Health as to whether or no the failure of the system to operate was caused by the willful or negli act of the occupant of the building utilizin Dated this day o 19� Signature i Title If corporation, give name and address) 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 A."". 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 WO ®����0`', Address il�y111�11�rN��1�.` Located at (Street Sec. Block Lot �Indicate cross street) Municipality �" (, Watershed � ILSILILL 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 1 � o •.1'L 10,14 17 � b '7.� 4- 2..1�•,lg 10•.31 �Z. -� ZZ Z. 31011.31. 1045 14- z„t t. Ar 7 4 X0'.4, 11 19 21 Z ( . Coo 5 .24 Z3 Z. to 3 V VC w. Z7 IZ ►1 19 ZL (. 5 like 14 1 '2.: SS 3 •.00 S ?.� � 1 I �' 2 3'.00 3'• 1Z.. 11, 'ZI Vs Z !o 3 5 Notes: 1) TO'Sts to be repeated at same depth until approximately equal soil _ �.. rates are c�t,t j_ned. as ?a cr. pArCC?1a? a.ox?. est�..hnl.e,.:. -_o.:. ...data _ t o_.. a s„ ,rt,i tta'i : ..., .:. -. for review. ' __ _ .- : - ... _ 2) Depth measurements to be made from top of hole. DEPTH G.L. 6" 12" 18" 24" 30" 361 `F " 2" 48" 5411 60" 66" TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE N0. T, HOLE NO. HOLE NO. °Cow" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED Q %PJC' INDICATE LEVEL TO WHICH WATER LEVEL. RISES AFTER BEING ENCOUNTEREDI� TESTS MADE BY T. tI g ,4,4 f,%C -. S. C�-�ti Date DESIGN Soil Rate Used (o. Min/1 "Drop: S.D. Usable Area Provided No. of Bedrooms 4" Septic Tank Capacity 0IA® Gals. Type Absorption Area Prov By' AQ L.F.x24" �j' width trench. i jDer ure Address SEAL THIS SPACE FOR USE BY HEAUrH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by Date ,I 't D tat ; 1 }ilii CH .. e.: a.a • -;`,_ 7, W. 3 y. IQ [`j� t j; �' �:e �r ''..', g6G- ,..6th', ^, �l �;;. � � � s \ �5H µ P�.f ''•m S."h',t, �hl � }", _ .. .. a M' Cp . MBA J y r APPROVE ��' D a n HOR. 1 OCT j5J__ - � P 1{7 .big'-- —.._ ""� < f ��,,� �—•� !nu :.�.8� i5�1,�'LL1.FiG_ %., •=:; Nt'� -.,J�, t`raJ �. + os: "aEw�o�. .�-oivrioa iov, ,�±�� l [2zio Yv4 .J�4 EEC T�ltP� kENfAI HfAIT� r- I o ;= ' trV �- /,�5 Al" �. �y K N, t SEWERAGE 015�+0$A SYSTEM G(�E rJ i __ NAfwE aTAN'`{ 00' k U1l D S 6• NURC„N „ ,SC✓a� .J 6 .: + y , . No a2��'. W ^ E TR E 7 5 E � o�n_ c E s�O�HOFESSA9Np�4 TOWN P3 t1 t`fAM Y GdlitiTY I'L77NAE NE'N YORK L07 NO; i BL04►� 7A MAP hfu' Nth. 1'RUCscS$ MACHMERY, 811da_DING Mh'F RIAL$ .NE `,6X'GAVaL1'T I:!• EARTFI,'.SHA't {CSE At_Lc)WED ( 7,ME SEWAGE WSPQ5AL', AREA CCNSiRU.CTION 6F' -Tkt s 'STEM IS r ^v HE 1 NA, C6(A6ANCE .VVt 1 H T±iESEc',Pt "A NS: AM,Y' .REV,IS,IONS, THERE & AMD' THfi. > ' pP yn st.Rr,(: rtodteiAic,.r A „„,jt q tON7RAC f AGENCY „ R Q AN 9 +ua *vcu, "ry a�vG, qtr r> cc en+!t �2EGULATICNS OF THE PEf?MfT:'I,9SUiN(S (}OVFRMMEN7Ai A5. 9�T•.pt AN: 1i1 r4•,aY,' 1: f iK F fS t J 1 [ , Y +j !i ,P 0. 0 Z., 4 etv P r4,�, 1. 0 7 V-!> Y. I L J Al 5 Ali Y -" IT Appl-R li N0;'1 J j yTn 1. C, H EAiTJ DIVISION OF MVIRONMEMU REU&MMM n— 01240 =>W M I Cl� .7 Appl-R TOWN PU7NlK_)AUXr, OUNTY i y LOT 1,10. BLOCK T4 SUBCIVF�fON A51.7.a_ CONTRACTOR - -_ N, J� IMER n` N0;'1 J yTn 1. C, H EAiTJ DIVISION OF MVIRONMEMU REU&MMM n— 01240 =>W M I Cl� 0"' SE',VERAGE DISPOSAL NAME `ZTRECT TOWN PU7NlK_)AUXr, OUNTY i y LOT 1,10. BLOCK T4 SUBCIVF�fON A51.7.a_ CONTRACTOR - -_ N, J� IMER n`