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HomeMy WebLinkAbout3360DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.06 -1 -3 BOX 27 I '- ' I Alt mo .. 1 ` +r 03360 01 Punm mm HEALTH MMUOU DIVISION OF ENVIRONMENEAL HEALTH SERVICES 225"0310 R REWNGF DISP "�W SY -R PROPOSAL ,F_0 .01— STM__ -WAM ; �`tJ nom, .�1"lZ�f� alt? PHONE �--76-73 OWNER'S w-. SITE I=TION TO MAILING ADDRESS'S n y� ��t IN 1 n 5` q PERSON INTERVIEWED P_ CHD Cimplaint-# Name & Relationship (i.e, pwner,,tenant,, etc.) T�_170, _ . . TYPE FACILMY A40ow DATE PROPOSED INSTMJM PHONE Proposal (include sketch locating all adjacent wlls): NOTE: Repair must be in same location and of same type as original sewage.disposal system. Different location may require submittal. of, proposal fram licensed professional - engineer or registered architect. L i IW( `VWC.4 6 iJ 91 &'d I - /42,' Ate ro R - I; ... I Is X Proposal Disapproved Date Kopp@4 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 6arponents tied to two fixed points (e.g. ,house corners). d. System description (e.g., 1250 gal. concrete septic tank,, three precast 61 diem. x 61 deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be perfonned in accordance with the above proposal and conditions. I, as owner, or re rted agent.of owner agree to the above conditions. SIGNATURE TITLE (fL1 A tX— DATE ZSO OPTS: Ttbite MV; Yellow (UNin HE); Pink (Applia3nt) i Tif O i' t� s N'AM VKl�'_ Owner or Purckinger of Building Municipality Building Constructed by ROAD n sP 0 r CA kVA N) A L AV—& !� 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- .. _mac ce =tie =. ,, fian:Mm .6o nt L� .m;nt of :.Heal --h �o �rr�a Cher -. or --not the- Jam-- 1` failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this '23 day of bcF 19 Signature Title diti"Ie If corp ration, give name and 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 y Departm f Health OCT 2 919 PUTNAM COUNTY, DEEL 06 t _ UM WEkk OMMT10M R�-.NQRT POTNAM COUNTY DEPARTMENT OF. "RA Tkj . W71 Division of Envlrpntnental Neplth Carvlov® ' COUNTY OFFICE BUILDINQ • CARMEL, NEW YQRK This report 14 to 49 FornpitatO - by,woll driller and submittaq to County tjpalSh_Aepar.Pman�togeth©r� t l [ rv.repsarit of ._.: . .� co i{t�rgafierYli'r`s`Eitfactci'r bacferi� quality before cortific�te Df construction ca mpiiARC� REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION P. APDRE55 It z rvcl f ice � a le 04 4 uQ01l lT4slrt (t p1 f> MA01 60CATIO of W99 �.,5 (fir:[ �'% �� � ` . !(' Gf Cl LC WI: $ € T QRAPOSIT� � 4Or�z�Tl� � �;aiA>aEISHMENT. l-.-a FAR�1 � fir- • I15A Op. i PUCLIC AIR . �^-� (''] : OTHER IMRUSTRIA! �i EONDITIONINO ($pmslllr) IaJdlLrlldt;t j''') M COMPRESSED CABLE OTHER i E�lltPfr9 P!$ I .1 R'DTAhY I AIR QERCUSSIOtj Q PERCUSSION Q (SPPcifY) CASINO t$NPJLf (!Q @u DiR1p¢ //i,ER(lnch9gl YkF!9jJT P" FOOT (' �y sTAtl $ THKADER ❑ W91.DED YgS NO YE$ L J Epp YIELD j j ['"j �( y1w ap,oq TF43 t�1 RAIJ,gR t,-J PLIM PRo L4J COMPRESSED AIR �Q 'j I�gEASLILtg FROM 4141), $LIRfACE-- 5T¢;14($PeQllr to DUFINO Y19LD T90T lepfJ tg4i�TER j Depth of Campiatmd Well 6EyLE - lJ S In fegt l}olaw Land surfctcpi. f?AISS LeyGTH Q?&N TO AAuiff.4 (loot) sCitw pETs41 €$ SLKDi 1? PIAtpETER (tn0#0 IF GRAVEI, Diamotpr of wall including GRA�Eti &1Z pr,cttQal Fg4A1 Igo!) TQ fla9ti '� PACYEDt i gravel pack (inches): aFPTH FROM LAP40 SURFACE : Sketch exact location of well with QlafanFaB, to of lgagl FEET to F.E[TRMATION GIESCRII"j)ON 1wa permnnQnt landmarks, i✓� a r7:° v U O ,PL T(9 D,AT9 OF R PORT Wt~Ll, RI LER yam.. UCTION PERMIT FO Located at owner—'- I- Building Type YU'1'PIAM- 1LVUIVJL a La:a AJL"'A'aau. a ,•.. :ar.... ,- r �x : t -- ;mac -s� Division of Environmental Health Services, Carmet, N. Y. 10512 h R SEWAGE DISPOSAL SYSTEM -7virVAI ®/CV �/ %/✓ iii fJLLE�/ . �i Town or ill4e aT r.�U Block Lot© L. g� Job V' �:.�` .ii"i�.�..yr:- „.,�,: -a'=• . , .... _.. ti .. _, �: 17�” t��'-;."J LGf 79: et: :: %d.12Gd ;C:.a/.'�11�/_./11�.7G Lot Area Number of Bedrooms Separate Sewerage System' to consist of Gal. Septic Tank To be constructed bypr� Water Supply: Public Supply From Private Supply to be drilled by Address Other Requirements 1 represent that 1 am wholly and completely responsibl above described will be constructed as shown on the County Department of Health, and that on come be submitted to 'the Department, and a writte' place in good operating condition any part 6f ance of the approval of the Certificate 0f ;. 8" ton will be located as shown on the approved plan'an he said County Department of HeAlth. Date 7f 04 Total Habitable Space '.J tiSquare Feet lineal feet X .,width trench Address ✓� of the proposed system(s); 1) that the separate sewage disposal system and in accordance with the standards, rules and regu a ions of e I Putn4rn Construction Compliance" satisfactory to the Commissioner of Health+11 owner, his successors, heirs or assigns by the builder, that said builder will ng the period of two (2) years immediately following the date of the issu-, 1 a system or any repairs thereto; 2) `that the drilled well described'•,above Icordance with the standardlotules and regu a ions of the 'Putnam n Address 4-1-1' / APPROVED FOR CONSTRUCTION: This approval a `6W;e f he date I, S revocable for cause or may be aniended or modified when ei efsary by the requires a new permit. Appr ved for disposal of domestic se. da►y e, and /or Date 16 °°V By P.E. R.A. License No, !32 z2 �'—,r•— unless construction of the building has been undertaken and is missiggis'r'Jbf Health. Any change or alteration of construction Title PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM 7W V ,0 / ul 41LI I�AL" t a {J/� Town or Village Located at s'C - c /� 0.4 .t.. _ . tixax rfap - g0 ..- Biocii Owner ep 4*f} P / T ' 1 %+ZR.9 P r Tax Map rot # i/L'! �' �= solid. # Separate Sewerage System built by 462 6 6, , k rZ1?02r Address ✓d N Con0sting of ODD Gal. Septic Tank and -307 L (°`i � � Other requirements Water Supply: / /Public Supply From Private Supply Drilled By , ° ° A,4 s' Address Building Type /� `S %1 4- No, of Bedrooms Date Permit Issued Has Erosion Control Been Completed? i certify that the system(s) as listed serving of which are attached), and in accordance with Putnam County gepartment Of Health. Date -" Address Any person occupying premises served by the abov C Mp conditions resulting from such usage. Approval of available and the approval of the private water supply s i subject to modification' or gchange when, in the Judgment ;Date �✓ l%U L By WWAE essentially as shown on the plans of the completed work ( copies , in accordance with the filed plan, and the permit issued by the P. E. R.A. No. 3272-0 We such action as may be necessary to secure the correction of any unsanitary O%tem shall become null and void as soon as a public sanitary sewer becomes void when a public water supply becomes available. Such approvals are )nor of Health, such revocgUO iodification or change Is necessary. Title YORKTOWN MEDICAL LABORATORY INC. 321. Kear- Street - ::.,� C3 321 �.�_ "�od•�4own Eiei h�, N.Y. 1 ®d�0 � � KEAR ST _YORKTOWN HEIGHTS, N.Y. 10598 245 -3203. ❑ 201 BUTTONWOOD AVE., PEEKSKI LL, N.Y. 10566 737 -8777 ��g•J60J ❑ 495 MAIN ST:, MT. KISCO, N.Y..10549 6663335 ❑ STONELEIGH AVE. (NEAR HOSPITAL), CARMEL, N. Y. 10512 278 -9330 DATE COLLECTED RESULTS OF EXAMINATION OF WATER 10/10/80 (8 A.M. OWNER DATE RECEIVED EDGAR LITZRODT 10/10/80 ( 9A.`M.). CITY, VILLAGE, TOWN 6/OR NAME OF SUPPLY DATE REPORTEDr L3% r n. yr. r•4 A.)2 zYs SAMPLING POINT r.. TAT) c'rrp tin T.nrP *Rn? T Aug C)CZ0ATJAN MTA. TYTTmRTAKA NTAT T VIV MTV..ti BACTERIA PER ML. (Agar plate count at 350C). COLIFORM GROUP (Most probable No. /100ml.) HARDNES L - ppm _ I. DETERGENTS - mg /L NITRAT -(as N) - mg /L IRON, TOTAL K mg/1 s, AMMONIA, FREE (as N) -mg /L pH= CHORIDES - (mg /L) COLLECTED BY: E. LITZRODT These results indicate that. the water was YES of a satisfactory sanitary quality when the sample was collected. A. H. PADOVANI, M. T. (ASCP) . i, PbTXAM COUNTY DEPARTMENT OF HEALTH -DIVISION OF ENVIRONMENTAL..HEALT SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner &D6,4R 1147-2,,q4T Address R.03 '47 1144f All, /0,577,;P Located at (Street er &4 4Ke 9-0/1.0 _L Block _Lot 5,0.2_ kindicate nearest cross street) Municipality ZC,& z6w Xzz..S 4/ Water4ed Pe SOIL PERCOLATION TEST DATA 4U6ED TO BE SUBMITTED WITH APPLICATIONS M5 1 e Jd,",Sk lot Number CLOCK TIME PERCOLATION PERCOLATION Run Mapse 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 P/ 1 10;410 /'0: 5 65 k 0 P,3 3 /0 -'53 P:s:j 17Z 4* 2 1,041. Joe'3v 3 Jd,",Sk lot 44 4 5 P,3 3 lo, 5T rn :� 9 �' �i4 j ¢ -n in W &IA" Notes: 1) Te�:,�,ts to be, repeated at same depth until approximatel� equal soil rates are obtained at. each percolation test hole. All data to e 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 INn TEST HOLES DEPTH HOLE NO. HOLE NO. ?2 /' HOLE NO. ¢ ��� � .`°°' .. ..a ps-n ,,,c- .-.•'r ifs: i <^.r'�"'', .;;:�'... ".: ."'- -.c.».z„',v >> -- 611 or l' 12 "i ohm 1'.4", 1811 (� 24" y k X 3011 4 u 3611,�� 4211 4 if y. 5411 60" N 66" g 7211 7811 84 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WI�CI� WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date 7 DL IGN - Soil RAte- Used Min/1.'Drop: ' S.D. Usable Area Provided p-vro° No. of Bedrooms 3 Septic Tank CAMC Gals. Type.- Absorption Area Pr—o ed By L.F. width®— T Other Address Ro, r9 6 THIS SPACE FOR USE BY HEALTH DEPART - _ y4Pr`'�� ®� 1 Soi. Rate Approved Sq.. /Gal. Checked by Date RDV3i4 �0,':TMCF A._! KinoO wt/ ind 6M 9 T d g 3 � O I� zi. 17 sr - Lt ww zi. 17 sr - Lt