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HomeMy WebLinkAbout3362DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.06 -1 -5 BOX 27 1 0 ,. .. me i r If o I r ` . ' � 91' , J. ' 03362 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health services, Carmel, N. Y. 10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Town. " Village L Located at 0-C 1 7 Tax Map Block _ r1 0 -7777= wner Tawslilw Lot # Subd. Sepirate sewerage system built by �V"-AhWddress 99-C C,02AA" Consisting of Z'010 Gal. Septic Tank and - it A&P—ILAFF Other requirements Water Supply: — Pub lic SUPPly From --L,-*,P,rivate Supply Drilled 2,�Address . P, Me . ... ... .... 11110of 00011, Lry Do Building Type 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 Putnam County Department of Health. by the' — Date Arlo Certified by P.E.— R.A. Address z, I WAWA Icense No. Stem(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary Approval of the separate sewerage system shall become null and old as soon as a public sanitary sewer becomes conditions resulting from such usage. Any Person Occupying premises served by the above sy available and the approval of the private water Supply shall become null and void when a public wat SU Ply b6COmes available. Such approvals ar Subject to modification or change when, in the Judgment of the Comm e 0 _1WOn f Healthy y o ea th, such rev ca n, modification or change Is necessary. -- /�- g3 Date Title 'PUTNAM COUNTY DEPARTMENT OF HEALTH Division -of Environmental Health Services, Carmel, N. Y. 10512 -PLn- CONSTRUCTION PERMIT FOR.ISEWAGE DISPOSAL SYSTEM Wi_LEFY - - Town or Village Map Block Located at Lot Job Subdivision dQZ L11 /,1 65, Address Owner A49 pe 5 Lot Area 3 Building Tyi 4- Square Total Habitable Space Feet A �1 Number of BedrOOMS3+ 6MVe e 4;g n Flovv'9'00 "Ll X /Z -;2V Separate Sewerage system to consist of OO Gal. Septic Tank and Address OIL To be constructed by Water Supply: Public Supply From Private Supply to be drilled by JAM Address Other Requirements Ab I represent that I am wholly and completely responsible for the design and location of the propo sed system(s); 1) that the separate sewage _dispo Sal SySt6 standards, rules a=nregulations 07 TRe u no above described will be constructed as shown on the approved amendment there to and in accordance with the Stan I of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Health th will County Department ill be furnished the owner. his Successors, heirs or be submitted to the Department, and a written guarantee w assigns by the builder, that said builder immediately following the date of the KSW� of said sewage disposal system during the period of two (2) years place in good operating. condition any part thereto; 2) that the drilled well described above.�- I Construction Compliance of the original system or any repairs ther f the approval of the Certificate of -_ ions of the Putnia ,i\ a will be Installed In accordance with the standard rules and regulat ante s 0 \will I be located as shown on the approved plan and that said we '41-ounty Department of Health P.E. R.A. C Signed -ro A r hA A I, A t 1 11 )A 1-7/ 1. /_/ Q .D FOR CONSTRUCTION: This approval expires one year from the date issued unless ,!)r cause or may be amended or modified When considered necessary by the Commissat _'l ew permit. Approved for disposal of domestic sa(.t>ar sq�age, 140 G vti6g� License -0. d' i's :C TO. building has been undertaken and Health. Any Change or alteration of construction Dr-Inly. e_1 Title ------- _,aq "CIA y "� 16. @.TITAN REPORT 0.fTI�AiU� ¢QUO V PRO� �i� ti�6T�11 3lY9t olviolnn of RoW,vnmontal Hoalttl "Vim COUNTY OFFICE; FIUIL -DINQ - CAFIM64.. N IN This tdpATt i t c4rt�pI%p b�( wflll driller and su4mitte to :I" untX Ii alth'Dtjpaetirieitt 4q` tt e� jyifii lfl print try��q r� if" x • - - " "" "T�It lii f i "r sariiple tridicrattn water is of s tisfactor bacterial quality befgre certificate of construction CpmFt�lQf$ q a V Y . REPORT MUSS' BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION 6OSATIOCI) op Vo$ (Rlp• 4 . t.. (T tTn 1 IEf►+ IVV�Ra+ A?0G'1415P,Ia a£Q Ro"PT Ep4oms.IQM?NT LJ FAR* �' L".J FRET W1 PUNIC (' AIR OTHER AUPPLY INDUSTRIAL, L _i CONDITIONING El iWcifTi OtaILLIPoQ CQ41P6 Igi ( COMPRESSED �-+ RPTAPY Q AIR PERCUSSION Q CATTLE OTHER VERCUSSION (GpodfT) CASINO p4jTAll$ OT" (19po i / 1014041TEAlinchpa) " IWEIQHT PER FOOT / j L' J TFIRrrADER Q bp�p Yes cvo X V4 i YIELD TP41 U "OURS G.P •, RAILED ��! PUMPIPQ COMPRESSED AIR f l f YIE (P-P,04 G 7- WATI;p tL1RAIlAE FROM M►NA SURFACE— STf�TIt:(Specl /rfepU pURIN4 YIELD TEAT last) f Depth of Completed Woll / In fo9f Iglaw Land iturfmi, ,34z o FoIA40 MAN LEPlOT" 9Pt+I T. t�ANLPAE (19v +� 4914174 P14MITOR (tng(tca) .. .. IF GRAVEL PACKEDs Diameter of well in.cluding gravel pack (Inchon): tam E wo (1470"0 Rom ('"f TQ (1990; a....�.' kPH 'Ki AA 4 I♦URPACf FO DESCRIPTION $0(Ch OXON WOW of well P11.4 tllataPGea, To of 19"1 „ twa pormangnt Ignomo?Ao FEET to FEET RECEIVE" PUTNAM COUNTY DEPT. OF HEALTH If yield wan tQmed o! di prom dgpthe during drilling, list bglpw FEET GALLONS PER MINUTE W(EEL t:06'lBAETEhi ` , >.: . _ .... . PAT'4 QF REPORT .... .. ..: •- . .. .. . , ,..:.... .... tUTNAM COUNTY DEPARTMEN`.L' or HEALTH DIVISION Or ENVIRONMENTAL HEALTH SERVICES Date Re: Property of LLK4i1!�9Z?- /Z,YA✓O7— A(f aO Located at 0,S C'4,G1 *1V,,4 L , 1fir ADS i.3G�o LAKE lock Lot e Gentlemen: This letter is to authorize /LC -�Lf �� /L��_ a duly licensed professional engineer v 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 pro- visions of Article 145 or 147, Education Law,.the Public Health Law, and the Putnam County Sanitary Code. FEW;'r�;`7..._ -.,.� . . ---• Very truly.- yours.''.��� No..� f `y Countersigned; J Address' j_ / (P 2-- - V765 Telephone Signed Owner of Prro9,perty Address Telephone 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 , N _ � R� � � NKO Address (30 L, s Located at ( Street • C'AU'114k l �ke DC L� � �L1A,�A *lock Lot_ (indicate neares cross street) Muhicipality & Al,41n E-V Watershed SOIL PERCOLATION,TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME i S PERCOLATION PERCOLATION No. Start -Stop apse Time Min. Depth to Water From Ground Surface Start. Stop Inches Inches Wa er ve in Inches, Drop in Inches Soil Rate Min. /in'drop. 1030 /3 - 4 4 27 3 171 3 -9-3 &6 7/ 3/0� VY l _' Uy /s` v2 8? 7 3 '+ �' 3 31J %0 /i; as 6 3 �; o 5 5 310,1 5-6 i S a .� G3 110,1a7' o, -jl,3 &6 7/ 2V j 36 �' 3 31J %0 /i; as o2v36 3 5 Notes: 1.) Te'Rts 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. /f DEPTH 6" 12" 18" 24" 30" 36" 1 `F2" 4-8" 5411 60" 66" 7211 78" TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION ! \ DESCRIPTION OF SOILS ENCOUNTERED IN TEST DOLES, HOLE NO. �_ HOLE N0, HOLE NO. _ '�� i!f �.:. � �.�.L"- ,- �:../ -3^:_ _ ?t z- ::ay.. � ......rr.`• i r`%c __�: �a:.,:ir- a+°'ra- - .- • .i::.,'r v . - `� �-^ \\'^ 84" V/ INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED NON e INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY `y/L G I)glV A 2C16-C-74 Date 2 7 ES Soil Rete Used '% Min/1''Drop: S +D< .Usable Area Provided @) hU © SF~ No. of Bedrooms&, CXP11 eptic Tank Capacity o,0 Gals. Type eoA)Ce-c� Absorption Area Provided By _y L.F. x24" ) ' dth trench. a� ),-Qther Address ��/,,,,'1l��7 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. PR9rFS�19;�Pti Checked by QJ�Q�' c w; Lax ivr�i�2�'.�yc�aaT lfesr4Jk� _ -. U -Aj**l :� &GW�.•<9i'.- Owner or Purchaser' of Building Municipality Bui ding Constructed by Section Location - Street Block 6--ri 6LZW. 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 r_g years immediately followi 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- �_ vi e_s.. of._the...Pu;ti; i. Co ty,.,:D?pa:xtme t- ,,�� Health: s S . to'..Tnhetheb= o � rii�t .the 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 L3 �'� day of _ 19 _E�Signature 4Z ��2 G Title If corporate , 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 County Department of Health pECENEU. FEB 241983 PUTNAM COUNTY DEPT. OF JiEALTH YORKTOWN MEDICAL LABORATORY INC., P.O. B6x' 99 321 Uar Street Yorktown Heights, N.Y. 10598 l_ 245 °3203 _ r -ZyVJ 0W4evvk®1A1eXazi 4etr 05c.01-vc^r& � ke. Qd , Paf VWA411 vaoei'. I ou L J LOCATIONS:. ❑ 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245.3203 H 201 BUTTONWOOD AVE., PEEKSKILL, N.Y. 10566 737.8777 ❑ 495 MAIN ST., MT. KISCO, N.Y. 10549 666.3335 ❑- STONELEIGH AYE. (NEAR HOSPITAL), CARMEL,;N Y .10512 278.9330 LABORATORY REPORT mg /L ❑ ACIDITY .................. ............................... ❑ ALKALINITY ................ .......................... Mf BACTERIA, TOTAL /mL ... ......................... ❑ 00.5 DAY ................... ............................... ❑ BROMIDE ................... ............................... ❑ CARBON DIOXIDE, FREE .............................. ❑ CHLORIDE ................... ............................... ❑ CHLORINE ................... ............................... ❑ Coo ........................... ............................... ❑ COLOR ....................... ............................... ❑ CYANIDE ................... ............................... ❑ DETERGENT, ANIONIC ... ............................... ❑ FLUORIDE ................... ............................... Q HARDNESS ................... ..............:................ ❑ MPN COLIFORM COUNT/ 100 ml .......j' j 04TT COLIFORM COUNT/ 100 ml .................. �.•.. ............ O CONFIRMATORY TEST ... ............................... ❑ NITROGEN AMMONIA LAB # Sbl DATE TAKEN: _ DATE RECEIVED:: DATE REPORTED: SAMPLE SOURCE:, REFERRED BY: COLLECTED BY: SCIKAt ❑ ALUMINUM .......... ❑ ANTIMONY .......... ❑ ARSENIC ......... ;.... ❑ BARIUM ................. ❑ BERYLLIUM .......... ❑ BISMUTH .............. ❑ BORON .................. ❑ CADMIUM .............. ❑ CALCIUM .............. ❑ CHROMIUM (tot.) ...... ❑ CHROMIUM (heuavalent) ❑ COBALT ............... ❑COPPER ..............I ❑ GOLD ................... ❑ IRON ................... ❑ LEAD ................... ❑ LITHIUM ............... ... ............................... ❑MAGNESIUM ............... ............................... ,,.. N1 RO GEN: K J,4LDAHL :................ ❑ iviANG: NE;> ".........:.....:... .- ...... :.............:......:: ........... ❑ NITROGEN, NITRATE ... ............................... 0-MERCURY .................................... ............................... ❑ NITROGEN. ORGANIC ... ............................... ❑ NICKEL .....................:.................. ............................... ❑ ODOR ....................... ............................... ❑ PALLADIUM .................... ............................... ❑ OIL & GREASE .............. ............................... ❑ POTASS I UM ..... ...........................R.R. VE-D ❑ PH . ........................... ............................... ❑ RHODIUM .................................... ............................... ❑ PHENOL ....................... ............................... ❑ SELENIUM .................................... .......................yyn... .. ❑ PHOSPHATE (ortho) ....................................... ❑ SILICON .......................... ................FE.B..2.4.3983. ❑PHOSPHATE (condensed) ... ............................... ❑ SILVER ........................................ ............................... ❑ PHOSPHATE (total) ....... ............................... ❑ SODIUM NTNAM..WJJ&VT . .......... ............................... ❑ SOLIDS, SETTLEABLE, mi /L .... ❑ TIN ........................................ jW. - HEALT H ❑ SOLIDS, SUSPENDED ... ............................... ❑ ZINC ............................................ ............................... ❑ SOLIDS. DISSOLVED . ............... :.................. ❑ .................................................... ............................... ❑ SOLIDS. TOTAL ...... ...... ............................... ❑ .................................................... ............................... ❑ SOLIDS. VOLATILE ....... ............................... ❑ REMARKS:............ ............................... .................. ❑ SPECIFIC CONDUCTANCE .............................. ❑ ............................................. �❑ SULFATE .................... ............................... ❑ ......... ............................... 145� I * I * * v. \- ......... . ❑ SULFIDE .................... ....:.......................... ❑ .................................................... ............................... ❑ SULFITE .................... ............................... ❑ .................................................... ..................0............ ❑ SURFACTANTS ............ ............................... ❑ .................................................... ....................0.......... ❑ TURBIDIT.. .............. ............................... .......... ............... .........................__. ... .._ _ ....... THESE RESULTS INDICATE THAT THE WATER WAS OF A SATISFACTORY SANITARY QUALITY WHEN THE SAMPLE 14AS COLLECTED, THESE RESULTS INDICATE THAT THE WATER DID MEET THE SATISFACTORY CHEMICAL QUALITY OF NEW YORK STATE ADMINISTRATIVE RULES & FOR THE PARAMETERS TESTED. ALBERT H. PADOVANI M,T (ASCP)., DIREC' ,W NS, IN W TER STANDARD 72) y t. V � \J--,\ , a iyy (A ,539 30 "W 74 -or 'ro ScA L-- J L4 o A., Z) 0 \ VA 4 O"VV 6" 5F/-/ C DE•S /G 7V FOR Q) 4Li�XA1V0EAF'ZKkV07C1-�1yK0. 1_' 11--511ri rA 14 C AT SITUATE 11V 7We rO W/V 0/ plJ71VA M VALZ_Cf� Zj 1--(,I)—I\IAA4 CO(-IIVT)- "5CALC; to 0) 5CAIC, 46 SHOWN OGrO3Fq_z 1977 rd0OA1-01A . 7-0 ,SPEC /F_ ,17-/OV-Z, GQ I IV4 V, Z. V7 AS SFT FO)? 7_J-/ 15'r r <IC- GurN.Infl 11V11_k1AA4 F _-Ell ER, 4,5.50c, A 'ROFeSS 61V14 L e1V0JV6,F,- C ZAAtP SCIRVE Qs 5 D A-IA,110)94C 1.1 N" y 0_5 JWR,9- 4764 'It 7 ----- --- --- 4 ° ` "`N A C. 6" 5F/-/ C DE•S /G 7V FOR 4Li�XA1V0EAF'ZKkV07C1-�1yK0. 1_' 11--511ri rA 14 C AT SITUATE 11V 7We rO W/V 0/ plJ71VA M VALZ_Cf� 1--(,I)—I\IAA4 CO(-IIVT)- "5CALC; V07-E 5 E VA G 3 �15 I IV,5 7A 4 Z A 7-/ 0 IV 5CAIC, 46 SHOWN OGrO3Fq_z 1977 rd0OA1-01A . 7-0 ,SPEC /F_ ,17-/OV-Z, GQ I IV4 V, Z. V7 AS SFT FO)? 7_J-/ 15'r r <IC- GurN.Infl 11V11_k1AA4 F _-Ell ER, 4,5.50c, A 'ROFeSS 61V14 L e1V0JV6,F,- C ZAAtP SCIRVE Qs A-IA,110)94C 1.1 N" y 0_5 JWR,9- 4764 2 4.9- 7- THIS IS TO CE-TIFY THAT T"..,E S77AGE DISPOSAL SYSTEM WAS CONSTR.ur;rD _�T -,(. 7: 7-7113 PL14N A_ND THAT THE SY,,T,,,, n. IT V-!AS COVER- ED OITER 'TED IN ACCORDANCE WITH ALL 7 OF THE PUTNAM -COUNTY DEF1�Rjj;1:'"_"'T OF 11MILTH. tp N QD 14- S . 0 Putnam County Department of Realtn Division of Environmental Health Services ed as j?0-Lc-rj for conformance with ; ppli able "'_'u*j1\.- ::c,-T lation f the CG1_'T,.tA!!L--a1th P-UP ent. Puptri I F N 6 W-> j4 F. Zel yfFO 'p?0FESS10 L) 'e­ D ri uAl C r/ qry 6' G &3' THIS IS TO CE-TIFY THAT T"..,E S77AGE DISPOSAL SYSTEM WAS CONSTR.ur;rD _�T -,(. 7: 7-7113 PL14N A_ND THAT THE SY,,T,,,, n. IT V-!AS COVER- ED OITER 'TED IN ACCORDANCE WITH ALL 7 OF THE PUTNAM -COUNTY DEF1�Rjj;1:'"_"'T OF 11MILTH. tp N QD 14- S . 0 Putnam County Department of Realtn Division of Environmental Health Services ed as j?0-Lc-rj for conformance with ; ppli able "'_'u*j1\.- ::c,-T lation f the CG1_'T,.tA!!L--a1th P-UP ent. Puptri I F N 6 W-> j4 F. Zel yfFO 'p?0FESS10 L) 'e­ D Date, RECEIVED FEB 24*1983' f"qTjiAM COUNTY DEPT. OF HEALTH ri uAl C r/ Date, RECEIVED FEB 24*1983' f"qTjiAM COUNTY DEPT. OF HEALTH '` s,: _'9 7 `E.r s : (+''Y^_ .se's G.. "F5'n r< �• -.•r�. _ __ : 7"ISSFA, 71-71 '1 ` � y ...: ,. _.e ;''1 . � . .. `, - :: �,. {s ,. .r 'as Y„a.4r.� ..�.J �.17• {�54 '�'.�s_ ,�., _.r. c.. .'• ta��l^«... _. :'t ✓�' , r "- a,' '�`;' ''.. , �. '.. ,. .. . .' . -• .3.:.. w:fi :�" 'fit }r -....�' .�. .i,,•': r3'� .5 ein^Ei r�; �e �,s.0�;}�'�- :.i:: . ., ,., .,. -, __.} .' ' -:. :• � 71= .may. 7�. -'ms's 'w ,:fa. f,l a•. :.;`t. E. ' '}. � K �... cS � ....i. � .:Fa j � C _'`�.'' E. � K'i `. e. '4'r .l�'• a� ,l e x. Z s • 'd:. � iN u. fi � B /a?' %4 �ivotr .�ro.''Sc.A,I.�� � l• - c rr . z \ O. oR rA °�5 F O � zoo'.` to — -r- � i} R �.F PLAN —S CA vE BLDG, " i / ?5 7' 7' 7 / orzl G /NAC r7'J (6ROUNA: /3xGAt4OY ABSORP7lo�v.. 0It".SEPrIc7ANC TRENCHES _ liR PIPOF' /LE "T ;/16 •�SP /PT•S G OP.- VE4T, SCALE; NdTE SEbI%EiGE :D /3 /�OSAL /NSTfI L4A7' /ON TO CO?/FORM 7"0 SPECIFICATIONS 9ti 4 .t W d � r f A NE W.y 5� M.F qq; PPoaOSED_ ( \ .. sf0 PgCFE5310NNtV `O� R f o SEprlG OEI$la/ / 8 AJ. PRFf�ARE'O Fo'R ' 4�.EX�in/l.. OF zrWOT.'C%}F1V-6<0 S/M/ATE IN TF/E ti �(p5 MAW OF.PU'TNAM. VA., ZrEpr' IRAN m COu7vr) -; 3 23 APPROV�•� N Eta YORt� � ro 5 �� SCALE; AS sNOWN oG roBER S, /V7 LEGEND sEPT /C T<1N /e OCT 7% D19 E7. SON CT /ON BOX R WYNP{®QQtI E NEAETB iY A N R o