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HomeMy WebLinkAbout3238DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73. -1 -25 BOX 26 03238 .. .. .. r r m r w ,,; . .. r� IL 03238 :. ,<,� � •r it �_�r :\1- V 11\("1111 ',%;WVl\ 1 1 iJ Ll,'_A1�.i 1�iL1\ 1 :,Vl sa 1LAL1 ils t �+ t ? t 1. •4' 5 ;. Division of Enwronmenfa/ Heahh Services CaFmel N. Y�'f0512 �' f 11 . CONSTRUCTION PERMIT F_OR SEWAGE ,DISPOSAL SYSTEM ' P��-� '�'A`` pN� � K � '' I :� ,,y -r z' - -?--'-r s $ tTOwn or V iIl�9e a o sc�c v� . '� ` 5ec:�'on r x Dlock v 'Subdivisions e a x p� ' LOS- t x ,1 'atiF �J Obi -� t MM`` . 11 Owner ddress l t� ' A x r -r.•.+ Fta t. f ^; �. ���� ors.. r'-" ut .- y Bwlding Type - Area � ^ + Q.. r Vie` Y Numbervof Bedrooms 1 " Total Habitable Space Square Feet,' Separate Sewerage System' cohsist of Gal Septic Tank 2� Uneal feet X -I width trench 11 To be constructed by I Address ' �1Nater Supply Publ�cf Supply From 4 k 'Private Su to be drilled by. " 11 }, t }° zAdtlre tQ 1p r �IL Other Requirements �` —�" �4 4 l x vl 1 represent that I''am wholly and completely responsible for the design antl location of the propot! systems) :1) that;;,the separate "sewageedisposal.�syst"e ., -above described will be constructed as st of .6n the•,`approved amendment there to and' in accordance with the standards rules an -'regu -a. ions o , .-the - u. nam county - Department of +Health, a_ nd thafon completion thereof a,,Certificate of'Construction P.grpleance satisfactory' to the Commissioner of- Healthwill a a 'be submitted to the Department ' and a '',wMten guarantee will be furniehetl the owner .his is ` --'-- --j heirs or assigns by the "builder Ghat said' builder `will ::3 plaee,inT good {operatuiy- condit�gn any, partsot said sewage dispohsal system ring; the period of tw'o (2):years immediately ^following thetlate °of the issu ance,of';the appi..oval of the Certificate of ConstructionzCompl. , of fti u a t '- = ,., g , ystem_or y r`epays thereto 2) that the: drilled ".well desuibed above .;,will be located'"ihown on the approved plan and that saitl1' l w.11 b -_ a in `, ' dance` he standards rules and, regula i nsz of ;the Putnam - 11 County D partment of Health 9 i "D 't" t Signed y 3� P E R A �; IQ, Address I'a ° ce se No c. t .., t .� 1 u - rN z R+ .~ti'�r�'� na if .{ I - ' 'S_1 .;{ dAPPROVEED,FOR CONSTRUCTION , This, approval expires one year from fhe datissued unless construction of the�buildmg• has been undertakeri�a�d is � m- evowble for cause or may be amended of odified when cdnsi red ecessary by` the Co '' bf Health An'y °,`change: or alteration of;eonstruetion p `-.' +.¢ s- .E .-3 r F h - a n �� j t 4 regwres a new ermit A proved for i ;posal of domestic Ftar sew or: supply tonly 4. r M - Date �= BY Ev Tale I., •. -,: i 1. :;k`" c s e rY.. w ', g r 4 y ,e, ,a t aK 4i." �. ,+a-4 z. x rs rat w w } 711.1 r 'Q�' '.'�` ,�? w C v. r' .,w, :iw 't v ? t sea.. L.. G d E ; s3�, �^: �. '' �, m, y - r k r- "h > 4' - / .i'� -sr" e�5 $w+ y,, Y ^�.. -+�,� a n"a kB . :s`'w? E^,,;, -+i`W .,..r., r'r<,.�.� r J U,.,,,,,�y.74Fnz, �, -7 4 .rr ''t :.n. . 4. 'Ll �� �,�' t � � 1'UTNAM4 COUNTY DEPARTMENT. OF HEAL'+THt, � � f r b 2 �, A BI s - .�, t h 1' t 1� 1 t Division of tnwronmenral Health aerncrs t;aeI, " 7 R 512 y v-a .,ice .'` yx`-�. Jy`' -0 7��`z 4 p.� -, - �- 1 CERTIFICATE:OF _C.ONS'TRUCTION,COMPLIANCE FORSEWAGE DISPOSAL SYSTEM �zjY-y�li4M `%fiLL.>E_. i � ^ r- Town or aVlllage 1. Located at //� �' - IxLI_ bA.o Soation 5 x �� r � Al.l.W a�jfl� ��a , 4:' � 41Z- -- 1 Job Owner r a s Lot e . , R w 4 Se arat ." "er, rage System built .by � ��' . Sv.Sr,C- Addf ess 5 �-M S 7' �`�Wa �('��° -11 e'e,:: P.� .. x'} `'t Wµ: `'.. -i, s" y r 4 �.z...o- '°^.' 't -�±,, ,-,• `jk. �` t .afi. ,` �,,., "l+, ,,-, `x }�3 as "� (i:..r s^`k,sY' i .,. "�' _'`'" ,;,� . s ;� f V 's k f': t { m�rj,50��x lineal Feet X ■ 'hsr., width trench 1. Consisting of Gal Septic Tank x y '4^ 1St Other requirements +i. F r•, 'z fi s `t'`, '�^-ax !. �$,� +.+ c N* '� .3 a, zr sz r r e 11 ` Water SuPPIY 2 YPubltc SuPPIY From ' � ,7 $ 1 c w y P 1 1 xs /1 x za �f r F f t - 1� Private :SuPPIY Dulled BY I �IOtiM ANA �-6N P f"e R41�i 7�� ei t' L' F�. t Adtlress. w t rr-�-�� ?'NA l Building TY. ; rr�-aM � ry --3'1, �il3 i'_E : lLCS t 1��N CE NO of B s- .E T �E ate Permit Issued 1. R� � ` _�. i a r `box �P,� M yp K 1 t F a t 11as�Erosion �Contrxol Been Comgleted�� � '� ' , F+qr^" c k ,a r [ � :. - °zA, 7 �'u'' """v'"�f} m �' f » ea t `�.. w• -,Y4� ,t � , Y s ♦� v�PR .; -. y : +r s n. '.:,I ,r : Fad, ... 'A . t ,1 k t~ k- i� ,�. i t�. a e .air ` zz 1 �' -: i c L':' 1. 3 ,�/ ,� -.... .,u; i- .,rn s+', : v ructed s I 4 t'` of the. completed work(cop�es.of which "are i , F.,1- certify that the system(t) as listed serving';the above prem� ;es were.const Y t attachetl), and m accordance with the standards rules and regulations plans an by? he, Putnam County Department of Health 'Date !J' C 1 (�Jc i' -/ r` t �Cert feed by 11. r t: { z T P E F R.A. '— n, Addr "ess Z `'C +License No 2 �t 21 S 3 r z SFQ ��� z ' An - er`sn ' %cu ing premises served by the above system,(5) shall promptly takes , f'i86f ecessary to secure the correction of `any unsan¢ary; 1 Y P PY - .. m ,resulttn .• from Such •usage �z Approvals = of the separate ,sewerage' system,Sha antl void as soon as a public sanitary "' sewer, becomes "y 11-1 } conditions 9 .., • • .�,.., ' roval'ofzthe rrvateawater supply shall become null and voidwhen apubUc watersupply becomes available �ISuch "approvals; ?are :a- � 11 available and the, app P . r, 4 '' , =subject to modrfiwt�on or clian er when in the udgmerit of the. Coin fc alth such revocation , anon - change Is necessary 11 1 - .'k ";.w 5"r g 3' l t r- a' j 't' -n^ nr' z r k. ,.' <I - .ei u 1 i,� z =. ri,^ i r a 11 - , a r _ t- L ;s (� _° -- 1-1 _. A Y :. _Date t _ -,_ z _ .�LL z +. � �_,_� _ f 11 �,ItL WELL COMPLETION REPORT 3171 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 final sis outer sample indj sting vKg±tgr is:gt� sa ;i�f ctory ba serial_quality befcr? certificate of construction- compliance is issl:ed. f REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NA / , ADDRESS LOCATION OF WELL OZ4ez (No. 6 Street) -- (Town) (Lot Number) / / 7. PROPOSED USE OF WELL j� LJ DOMESTIC 1:1 SUPP Y El ESTABLISHMENT El INDUSTRIAL ❑ FARM ❑ CONDITIONING ❑ TEST WELL. (Specify) DRILLING EQUIPMENT 11 ROTARY COMPRESSED ©A R PERCUSSION CABLE El P PERCUSSION ❑ (SpeHER cify) CASING DETAILS LENGTH (test) cs� DIAMETER finches) r r WEIGHT PER -FOOT �-.�� E THREADED El WELDED O YES ❑ NO YES H NO YIELD TEST ❑ BAILED ❑ PUMPED 9 COMPRESSED AIR HOURS 7/- G.P.M. J ,S YIELD (11,P.M.) S WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST (feet) Depth of Completed Well in feet below Land surface: SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (toot) 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 If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL C MPLIT7E ✓? �Tf DATE OF REPORT WELL DRILLER (Signature r / L K .:.aci t z, y^4 .e+ :.. s r te_ :-n . , --.y z.. -n,.. ' : i; -� .t- .v .. .sa vicew . e* ...a.:: a.._cr •'= s:.ie_ ;:; „A�-= s:i� -ic i s c ;� — :- � , a ._ _ .. Owner Fur c aser o B 11din Municipality ilding ConstructE by Section 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 systen, 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 not the failure of the system to operate was caused by the willful or neglige act of the occupant of t uilding utilizing the sys em.� 7 , Dated this day of 19 /-r Signature Title I corpo t on, give.name an 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 Y a =' PUTNAM COUNTY DEPAO RTMENT OF HEALTH DIVISION OF ENVIRONMF TAL HEAL ti SERVICES _ N Date 1V OV - Re. Property of�t������ — d5���� Located at Section Block Lot Gentlemen: This letter is to authorize a duly licensed professional engineer L✓ 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 ana to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 1.47, Education Law, the .Public health Law, and the Putnam County Sani- f:ar�y Code. Very truly y f � — • r • :; o , r, l Rp Telephone _ Y Owner • A R � LOU reper± Address ..Telephone �A v / LOCQM ON MAP AUGUST 13, 1973 m:5LUy" b:q Li V' o peas o 0 10 J' 0 r r t� ii ZO 12 21 / ZZ � 14 �D / MAP OF ®`D CHUM /BIRCH HILLS SUBDIVISION TOWN OF PUTNAM VALLEY PUTNAM COUNTY NEW YORK x �Y 1: 1 °� t i t i.. N � i', ! � '�3 � � �� � . {� �