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HomeMy WebLinkAbout3463DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.18 -133 BOX 28 .. .. 'r !�'1 ■ � r . 16 '. -1 f IL ;r r 03463 ��. PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y,1051-2 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM L0r -tN7 °[ _. .!'�!!i!E_ .._�G . i^r _., Id s . Subdivision owner PE• Y IF a= T=L—,D p- Builtling TypeEi 1(7 E' wj �Q(. Lot Area ' ' 1TC-i�� Number of Bedrooms Design Flow 600 � -PA• Separate Sewerage System to consist of 1000 Gal. Septic Tank To be constructed by A- f`- A <, i U V_ r7 4.$ -Q4 C - Water Supply: /�P ublic Supply From --L_�- YrIvate Supply to be drilled by A N Dr-. _,*J Address Other Requirements I represent that 1 am wholly and completely res above described will be constructed as shown on County Department of Health, and that on be; submitted to the Department, and a w place in good operating condition any pa 04 ance of the approval of .the Certificate o will be located as shown on the approved pl .County Departpmen,.t of Health. Date Address APPROVED FOR CONSTRUCTION: This app lrevocable for use or may be amended or modifii't requires a net permit. Approved for disposal of don Date By 1 ow" &UT -61 ft ,4LLE1/ T._wn or 'v. ;leas -i dx Map L: Block Lot� Job Address PLyr.4j .NI VAL LF. • rt •�/ Total Habitable Space 16" 145150 Square Feet and L Isle 2 " e agti Address v•1• !. a , nd location of the proposed system(s); 1) that the separate sewage disposal system there to and in accordance with the standards, rules an regu a ons o e u nam to of Construction Compliance" satisfactory to the Commissioner of Healthwill d the owner, his successors, heirs or assigns by the builder, that said builder will t during the period of two (2) years immediately following the date of the issu- on final system or any repairs thereto; 2) that the drilled well described above in accordance with the standards^les and regula ons 'of the Putnam w --' P. E. R.A. L 0-5,01 License No. 3 2 % 7- 8 the date slue unless construction of the building has been undertaken and is ary-. by the missioner of Health. Any change or alteration of construction ige, nd/ Ovate Title �Q PUTNAM COUNTY DEPARTMENT OF HEALTH �1 Division_ of Environmental Health. Services, Carmel, N..Y._ 10512.. CONSTR&tdTION PERMIT'FOR SEWAGE DISPOSAL SYSTEM 7,owN 0/ Z5�, T,y �•1 YLG�y na Town or Village- Located at ��2��+9�� s Tax Map 72 Block / Subdivision Owner Building Type DES.© Lot Area • d7 �• �� Number of Bedrooms - Design Flow Separate Sewerage System to consist of /47,04 Gal., Septic Tank To be constricted by — - K. - v- 4` ­51 yy -Zy_ c' Water Supply:, Public Supply From A!f Private Supply to be drilled by Address -- toaz�e Other Requirements 1 represent that I am wholly and completely respo above described will be constructed as shown on County Department of Health, and that on be submitted to the Department, and a w place in good operating condition any ance of the approval of the Certificate will be located as shown on the approved per}` d County Department of Health. Date Address APPROVED FO CONSTRUCTION: This a revocable for calf a ormjybe amended or mo requires a new bermi ; I/ roved for disposal o Date /V - Lot A Job Address r4 l IRMO O� v �4 Total Habitable Space ®%'�� �'�� Square Feet and Address ?, XZ4 and location of the proposed system(s); 1) that the separate sewage disposal system ant there to and in accordance with the standards, rules an regu a ons or e u nam ificate of Construction Compliance" satisfactory to the Commissioner of Healthwill .shed the owner, his successors, heirs or assigns by the builder, that said builder will I em during the period of two (2) years immediately following thedate of the Issu- e original system or any repairs thereto; 2) that the drilled well described above d in/Accordance with the standards, rules and regula Ions of the Putnam issued unless P.E. /R.A. License No.-,' � %Z O pstruction of the building has been undertaken and is of Health. Any change or alteration of construction supply only. t Title WELL i;UV1rLtT1UA rMrUici Office Use Only rL ..e DEPARTMENT OF HEALTH -.- ._Division Of Environmental Health Services 11ii PUTNAM COUNTY DEPARTMENT OF HEALTH 5 RE'T AOUAESS: I I �Y TAX GRID NUMBER: WELL LOCATION f florw P7% WELL OWNER AM . ADDRESS' P91VATE 00PUBLIC USE OF WELL 1 - primary 2 - secondary N—RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM _ O TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT �L 9pm. /N0. PEOPLE SERVED =/ EST. OF DAILY USAGE �Od gal. REASON FOR DRILLING NEW SUPPLY 'Cl PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION O REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH °?° ft. STATIC WATER LEVEL ft. DATE MEASURED DRILLING EQUIPMENT 0,80TARY ❑ COMPRESSED AIR PERCUSSION 11 DUG .❑ WELL POINT 0 CABLE PERCUSSION ❑ OTHER .(specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. ,9,OPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH fL MATERIALS: .STEEL ❑ PLASTIC ❑ OTHER CASING DETAILS LENGTH.BELOW GRADE �fL JOINTS: ❑ WELDED THREADED ❑ OTHER DIAMETER " in. SEAL: ❑CEMENT GROUT ❑ BENTONITE BOTHER WEIGHT PER FOOT I Ib. /ft. DRIVE SHOEAWES ❑ NO I LINER: ❑ YES 49NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST O YES ONO GRAVEL PACK O YES ❑ NO GRAVEL SIZE DIAMETER OF PACK in. TOP DEPTH fL BOTTOM DEPTH It. WELL YIELD TEST pumping If. detailed METHOD: O PUMPED i tests were done is in- 0 COMPRESSED AIR , formation attached? O BAILED O OTHER 0 YES O NO WELL LOG If more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Pear- i�g Well Ora' In r FOR6IATION DESCRIPTION woe• ft. ft. OEM WELL OEM It, DURATION hr. min. DRAWDOWN ft. YIELD 9Cm Land i ol WATEA O CLEAR TEMP. QUAUTI O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO )NALYSIS ATTACHED? O, YES O NO STORAGE TANK: TYPE _ CAPACITY GAL. PUf>?11PINFORMATION TYPE MAKER MODEL CAPACITY DEPTH LTAGE HP WELL DRILVR NAME DATE ADORES , -,)7 y,SlGrntTURE APPENDIX I PUTNAM CO UNTY DEPAR TMENT OF HEALTH r?F FtT\.>TRO_N � ...: FAI�T�' ^FRL'�C' . 2%;-ex /'/• o.-- Owner or Purchaser of Building Building Constructed by /�ieA�9� 1• / QslfA /�of�A Location - Street 70w,,v <F P r^'A�- 4 Municipality ,e6s -1 ®E �uT /gL Building Type / 12-1 Son Block Lot Tax Map Number Subdivision Name Subdivision Lot # GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL 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 successors, 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 approval of the S �� �,,x1C .]C6r,,:Y. ar35n7dt7e�ldis - -Sal sy...�it, repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environmental Health Services 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 negligent act of the occupant of the building utilizing the system. /11 Dated this -. 0 day of 0C-T- 19 Signature _4� . Title General Contractor (Owner) - Signature Corporation Name (if Corp.) Corporation Name (if Corp,) Address Address rev. 9/85 16 mk I VA A FINAL SITE INSPECTION Date Inspected by STREET IXATION Am t4tS lFuD OWNER F 4. e PERMIT 4 TM # OR SUBDIVISION Mr # a. SDS area located as per a roved plans YEI-Nd- b. Fill section - Date of placement 2:1 barrier. LGTH WIDTH AVG.DPTH c. Natural soil not stripped d. Stone, brush, etc., greater than 151 fran SDS area. e. 100 ft., fran water course/wetlands. II. SEWAGE DISPOSAL SYSTEM a. Septic tank size 00� 1r250 b. Septic tank instal ev—el c. 101 minimum from foundation d. No 90* bends, cleanout within 10 ft. of 45* bend e. DISTRIBUTION BOX 1. All outlets at same elevation - water tested 2.- Protected below frost 3. Minimum 2 ft. original soil between box and trenches f. JUNCTION BOX - properly set g. TRENCHES 1. Length required - 3,3 Length installed,� 2. Distance to watercourse measured-. ft. 3. Installed according to plan 4. Distance center to center 5. Slope of trench acceptable 1/16 - 1/32 "/foot. 6. 10 feet from property line - 20 feet - foundations 7. Depth of trench < 30 inches fran surface 8. Roan allowed for expansion, 50% 9. Size of gravel 3/4 - 1 " diameter 10. Depth of gravel in trench 12 minimun ll.-Pipe ends capped h. PUMP OR DOSE SYSTEMS 1. Size ow- 3. Alarm, visual/audio 4. Pmp easily accessible manhole to grade 5. First box baffled 6. Cycle witnessed by Health Department estimated flow per cycle V. HOUSE a. House located per approved plans. b. Number of bedrccms, WELL a. Well located-as per ar)r)roved plans b. Distance fran SDS area measured boo ft. c. Casing 18" above grade. d., Surface drainage around well acceptable. I. OVERALL WORKMASHIP a. Boxes properly grouted b. All pipes partially backfilled c. All pipes flush with inside of box d. Backf ill material contains stones < 4" in diameter e. Curtain drain installed according to plan f. Curtain drain outfall, protected & dir.to exist.watercourse g. Footing drains discharge ii�y fran SDS area h. Surface water protection adequate i. Errosibn control provided on slopes greater than 15%. Design & Construction Consultation CT -r NLEY J-J", INDER-F.F A Civil Engineer Mailing Address: Box L, Amawalk, New York 10501 CONNECTICUT OFFICE: WESTCHESTER OFFICE: 22 East Avenue Corner of Mahopac Avenue New Canaan, Conn. 06840 & Watergate Drive 203-972-1192 Somers, New York 914-245-2645 Fe ruary 189 1986 Putnam County Department of Health Division of Environmental Health Services Carmelq New York 10512 Re: Re-Issuance of Permit for Peter Florg Kramers Pond Road Town of Putnam Valley Tax Map Z2, Block 1,,Lot-12-1 Gentlemen: I visited the site in late Januaryq 1986 and found that conditions have not changed since the first permit was issued. Also, Mr. Flor intends to use the same house plans* _tr czif the Permit. ;Very r I uly yoursq SJL.obl Stanley o ander Enco a��.'W1t�Y'+.w�Vl �� _ !^'�U ^Vf��y:'` 1.. `�:,.xy�Tl: ^_ _•Yes.- ..�;�.. _ �-� .. ... �: __� ,R -�_L"� .Tf ... •�� >'i�y_b�. �����.. , , •\ 'L i, 1'i is ai`i �.'J`i n i3 iZ L "t�. 1 'i v i� r �iitr '°C J"r. i3�3� �, L ei 15;`.f1'L �'L ., V'P�t �►L �i'Mr , PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES. w. Aa,te� RE: Property of L o c a t e d a t /C R q /LJ -6 ?S 140, W ,476,4 U (T) !2 S.ecti,on / Block 1-07- /2•1 Subdivision of Subdv. Lot ­# Filed Map # Date Gentlemen:. This letter is. to authorize i5/G V/, a duly licensed professional eng.ineer.to apply for a Construction Permit for the wastewater tteatment L,<­ and /or the water supply systems(s) to serve the above noted property in accordance with the standards, rules or regulations as promulgated by the Commissioner of the Putnam Countq.De par, tment of Health, and to sign all necespary papers on my behalf in connection with''this matter and to supervise Luct,i_on_ of, said sy.s_t.pm,_or. eg;.v_stems,.an .c.omf.o.r.mi!ty ^w_ith. the --- cs- ...s^,.— >..e. .. w. ...- .. ..-. .. �.. ..y'... provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sanitary Code. i untersign P. E _ _ 3272 Very truly yours, Signed: (� 2184 "ielepnune . Owner of Property 1� R A wl-tjou PojV q P o A D Address PU-TrJAM X-I-ucv.v 64 n ., Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH DIVUI O ENVIRONMENTAL HEALTH- SERVICES & � +.: iilt. ° Date Re: Property of j�;� �Lo ice_ Located at jtP pMf-,RfS P,6,jjc> ROAb TOYVhJ ©EP�AJArJ •SCL�t"Z'•.8Y 1° Block Lot 2 f Gentlemen: STAIALEY 1. LANDER This letter is to authorize .. a duly licensed professional engineer 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 l: V1111C1 L1V11 w.,. Ln LlUb iva a Let• and to. supervise the cons truc ciun of said system or systems in conformity with the provisions of Article 145 or tary Code. Countersig d: the _.Public Health Law and the Putnam County Sani- Very truly urs, Signed 4 r� Owner of Property Address P .E ., Ia., # J -L 72-z ss BOX 261 . .. Telephone phone 1> 3.QAC `� 0 0 5 \� 2.26 AC 6.3 6.2 :E6. I I. A C.' T3 3 AC, CAL �\\\�. 52.70AC.CAL aso 2,1 Iol SE E MAP 160 - P /p. 95 5 4 7.12 440 . M 0 440 1 AC. oo . I 7 A 7.14 90.31 10. .6.6 0 -A .6, 7 9.4 7.1 10.725 AC. OOAC ! \ SG o N 7 32 9 A C. 7z. 7,15 9 4.69A P 99AC.CAL 99 At 7. 8 10 0 A C 1.979AC CAL 7.-7 fj 0 2 IAC. 0 1539 6. 9.2. 0 1 1 2-1 1 13.9!5 AC CAL. 2.42 A .2? AC.lN .7.6 AC. 2.2 AC CAL -9, 4 4,01 -3.4 ops R D I AC., .7. 21 74 88 AG. CAL. in AC 7.3 lb 12 141, ZAIUI,?rk* c �wc fig Sae 0 to i 8 19 2. 86 AC 0 2 dIikc. ib 6-1:5 AC. r0- 14.1 /Vo 7 .2 VW .104 AC V" lk 2 2 ACCAL .08 (,.A C. `'2.10 AC �QEFa rj, 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 Address AA ME fz's t'04O QoAp, PU?'Nar r VRGLEy !U� ,/ TAx yAp Located at ( Street ) KPAM'e S OOD Pogp . JVBlock _Lot indicate cross s Fee Municipality— FOPY,,/ of %Ui -Ah ,y 1AU-0e Watershed 110ee SOIL PERCOLATION TEST DATA'REQUIRED TO BE.SUBMITTED WITH APPLICATIONS Hole _ S S 4 -- _ 19¢ Number CLOCK TIME PERCOLATION PERCOLATION Run apse 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 I 1 9 =47 9: 75 ° 6 3 17 -1 i S d r✓ 8 3 ion eo; 1*4 9 1,74- 154- ( 9� 4 l o :1'1 lo" 1 9 l 7 a I fS4 I 9 ­0 5 1 'R43 9- _ _ S S 4 -- _ 19¢ 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. Address THIS SPACE FOR USE BY IM111M] DEPA M Soil Plate Approved Sq. F'- 0. e by Date OP ",01 T IT, Dr im noui. ljol,; nou; 140. 1211 3.811 N to 3611. 4211 48. 54 601, j; rO 6611 7 .72 781• 8 if 4 I11 -DTCATE I-EVE AT 1••'-T-jIC!l Glm�'()Ul"D TS E'!CC--�,7'!T"N`!M 114. J.7,1, `7 4-'j INDICATE L TESTS. MYM E 'VIL,,L TO ll"FJ C j i W,�� TER- �LT T S ?R TL Z' r S A' "Tj- By 1, VTj D E"C" "TER" 4ya C/7— Dat e � D N -tlljjr 6�' SO-F- y No - of Dedrooms-__3 P — Septic Tdilk Ca�acit Ga I s. .Absorptiola Area Provided L-)�'.33-3 I�.F..x2411 36 -width other Ral-no Address THIS SPACE FOR USE BY IM111M] DEPA M Soil Plate Approved Sq. F'- 0. e by Date PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N., Y. 10512 CERTI CATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM �unv,gM Town or Village • _. .. L.uGat�u "a[ i! �. a 3 .. �.ct:n`urr.+'f/'�+�a+A)r^:_f%.• - __ - 'irl: 'cioc: :il: cz`•' � /5 -- =^ __ ��� _ Owner Formerly Tax Nap Lot I / 2' / Subd. Lot 1 ,.s j'uK .So.,is -�HC Q� �J Separate Sewerage System built by AhddressLCE�K��� oLLoN/ic�OpP�n/RM �1LLttS/ti of Consisting of 000 Gal. Septic Tank and -*/^/- Fr. `4 "wl c?e-- /._&tdvFy Other requirements Water Supply: Public Supply From Private Supply Drilled By Addresses Building Type Has Erosion Control Been Completed? J o�1/• No, of Bedrooms `5 Date Permit Issued 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 with the standards, rules and regulations, in accordance with the filed plan, and the permit issued by the Putnam County Departmen Date — Certified by / P.E. s-' R.A. L /� •QWA« ! 0 2d ss License No. onon oceu 1 pre a ystem(s) shall promptly'take such action as may be necessary to secure the correction of any unsanitary !on, result, r Dr the separate sewerage system shall become null and void as soon as a public, sanitary lower becomes and the pro y shall become null and void when a public water supply becomes available. Such approvals are modlfl o �oh�ge subs th dgment of the Commissigner of Health, such revocation, modification or change Is necessary. 18 0744 id a " �f4u�lc nanco labs, Inc. R0BINSON;LANE a n..F.._ . .IIVMf1'I IVG LI':J' \I�L��I��i�'I•._ C _�.._.r �• `,. .. _ _. ,_. _ - -., (914) 221 -2485 (� -' A NAME: j� 2RESS: I� hx z Pei SAMPLING ADDRESS X04211 1__ . - .TOWN TREATMENT: CHLORINATEDO( PPM); SOFTENED ❑; OTHER ❑ SOURCE: DRINKING WATER 'gWASTEWATER EFFLUENT ❑ OTHER COLLECTED BY: ?t-mur n . 4 • FL02, TIME 16', 10 A.M DATE 1 Cfslaa, ❑'APARTMENT COMPLEX PRIVATE RESIDENCE ❑'SCHOOL ❑ SEWAGE TREATMENT PLANT. • 13EACH ❑ RESTAURANT ❑SWIM POOL ❑OTHER - 'TOTAL COLIFORM COUNT M.F.T. PER 100 M.L. ❑ FECAL COLIFORM COUNT M.F.T. PER 100 M.L. ❑ FROZEN DESSERT PLATE COUNT LABORATORY TECHNICIAN ❑ TOTAL COLIFORM COUNT M.P.N, ❑ FECAL COLIFORM-COUNT M.P.N. ❑ AGAR PLATE COUNT PER 100 M.L. PER.100 M.L. PER i M.L. t •t 1 r: Y. VI F c t si Jt i s J is r ...,._ ems...., .... _ .� - ,iR.i•� w: ..._... � �. j', f ` \ � ....�.��t...� - -. 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