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HomeMy WebLinkAbout3545DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74. -1 -20 BOX 28 IN I J t `�. 1� ` �I 03545 1 `A 1NSTRUCTION. PEI eted at f livision it - log Type —lam L �r of Bedrooms _ 1 instructed by I rePrei above c County be subn Place in ance of Will be to County 1: Date PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 MIT FOR SEWAGE I .. /p-r 3 Lot Area - /- 274� Ik' to consist of %•Z ° "' y �-- Gal. Septic Tank Public Supply From Private Supply to be drilled by Address �L KsJ' gt t I am wholly and completely responsible for d will be constructed as shown on the approvf tment of Health, and that on completion tt to the Department, and a written guarant operating condition any part of said sew pproval of the Certificate of Construction gas shown on the approved plan and that said rent of Health. a APPROVED F revocable for requires a nee. �Date�� Y WN Q F- ��f MHO ,4s -GE%�✓ own or Ilage T`' - --- "" Block L42 Lot Job Address ! /Ri 4PJ 016X ' 4ZS/4:�/4 L. Total Habitable Space 0"eli - Square Feet 1136 I'll lineal feet X °,j��d width trench Address C,��r`a+r' proposed system(s); 1) that the separate sewage disposal system ordance with the standards, rules an ragu a r__ ns o e Putnam ion Compliance" satisfactory to the Commissioner of Healthwill successors, heirs or assigns by the builder, that said builder will lod of two (2) years immediately following the date of the issu. or any. repairs th veto; 2) that the drilled well described above with Ale stands, rules and regu aeons f the Putnam ��� P.E. R.A. Addre ° License No. �, c� CONSTRUCTION: This - approval expires one year a issued unles onstru tion of the building has been underiaken� and is i or may be amended or modified when considere�sary by the ommis oner of ealth. Any change or alteration of .construction rmit. Approved for disposal of domestic sanitary ag , and a y_on)y;,__y `—// / IL By I , f Title r i i ` �T OF HEALTH .. . PUTNAM COUNTY :DEPAItTMEI- _........ _ .. _ t. , ( Division of Environmental Health Services, Carme% N. Y. 10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM 7—OPW Def /"Uj.✓�� i Town or Village tI/ �� Block �� Located at Owner All / .4/�i �T a� e `�' Lot Job Separate Sewerage System built by � XC/*& nwc .fie Address >�EE -et'.� 4 Consisting of 10a Gal. Septic Tank r 6 lineal Feet X �4 width trench Other requirements Water Supply: Public Supply From Private Supply Drilled By Building Type - • —i "" "�' Has Erosion Control Been Completed? I certify that the system(s). as listed servin attached), and in accordance with the st �r Date 41- Gt " Af -IV No. of Bedrooms— Date Permit Issued essentia �y' as shown on the plans f the completed work (copies of which are filed, a he permit i ued by a Putnam County Department of Health. P.E. R.A. — R • ,I,&/,l , J OS License No.3 �v� Any person occupying premises served by the Esrh I mptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval ewerage system shall become null and void as soon as a public sanitary sewer becomes available 'and the approval of the private water supply s come null and void when a public water s PY,d!.cf01ca1teJora s vailable. Such approvals are subject to modification or change when, in the Judgment of the Commissio f Health, uch revoc on, or chang e is necessary. 7 Title Hato / BY c PEEKSKILL MEDICAL LABORATORY 1579 Crompond Rd. Barclay Plaza Bldg. A, Apt. 1 Peekskill, New York 10566 DATE COLLECTED RESULTS OF EXAMINATION OF WATER _ OWNER DATE RECEIVED -ITY, VILLAGE, TqVjN & /OR NAML OF SUPPLY DATE REPORTED jx ochr&'Cll ��- jAMPLING POINT PE 7-8777 a f 3ACTERIA PER ML. (Agar plate count at 350 Q. COLIF RM G.R.�OLUP� (Most probable N6., /l00m1.) HARDNESS, TOTAL - ppm )ETERGENTS - ppm NITRATES (as N) - ppm IRON, TOTAL - pPm, LOURIDE (F) - mg. /1. I hese results indicate that the water was, YI`S of a satisfactory sanitary quality when the sample was colle GOP A. H. PADOVANI, M. T. (ASCP) a ; i (iC� /GG //iiyl EJ TAUA 2 i(C r7� Owner or Purchaser of building nicipality o - s.:+ ii' �/c% �,<'..'o.- r.:�:::�.�i..��.ci�Y':4 Vii•. ,ro�i:i'7•,r: '�: y :;,:.; :.�_ �,..- .,.....:%.: "': �....::. 2' a-• r. e---...+ a.:..« ...a�S' «:r:::ai.�:•..��.i•..:�, «K.::,•y'. '�ij:�.. :r•c -%•-. �..� ..Building. Constructed by /fix Location - Street es _/2 1,V714-4- T Building Type Block 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 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 initial use of the sewage disposal system, or any repairs made by me to such system, except where the failure to operate properly iS .nAii.Pri by tho tui_ll.fii.l.... nr_nocrli.cre n+. ant nf. i-11c_ nnniina.nf-. of i-1in 1-hni.l rlinrr iii-; l i vinr . t..r - - - The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environmental Health Services of the -Putnam County De•p:artment of. Health •as..to •whetheror . not the- •fai:lu.re ,of. the . system -,to. operate- was. cati'sod by -the' 4ill::fi:il- or­negligerit act of the occupant "of the building utilizing the system. Dated this •-� �/� day of /r l L 19 Signature -Title :r (if corporation, give name and address THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE I OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE Or -FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This re on is tn,b�gcgm lgted;byr ye4, drglgj.-a go:ysubmitted;,to- County!Health ® eparErs�ea i:togett�eraaiith:laboratbr i r�brt bf� w=l analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED' WITHIN 30 DAYS OF WELL COMPLETION OWNER NAM �� ADDRESS LOCATION OF WELL I (No. a Street) (Town) (Lot Number) v �v �% -^ PROPOSED USE OF 1AfE66 BUSINdS DOMESTIC [] ESTABLISHMENT ❑ FARM ❑ TEST WELL ❑ OTHER iff ) SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify) DRILLING EQUIPMENT COMPRESSED � PERCUSSION � OTHER D ROTARY AIR PERCUSSION if ) CASINf3 DETAILS LENGTH (lest) DIAMETER (inches) WEIGHT PER FOOT THREADED ❑ WELDED S 0 YES ❑ NO G YES NO YIELD TEST HOURS G.P.M. ❑ BAILED ❑ PUMPED © COMPRESSED AIR - - / I YIELD (G.P.M.) %4 WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST lest) j Depth of Completed Well in feet below Land surface: 2, S SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (inches): GRAVEL SIZE (inches), FROM (lest) TO (lest) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET f 70 � n If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL CO 2() E DATE OF REPORT W RILLErgnat� PUTNAM COUNTY DEPARTMENT OF HEALTH s,. .. 'DIVISION' 0 ENVrRt7NMENTAL HEALTH YSERVICES Y `✓ Date 00r- 6 I�P 7--91- Re:* Property of�c ivati�r�K� Located at ,_9,,., Of- RrAt,�I- 641,4,64 'iA,,_1-1A,,0 o Block r Lot Gentlemen: This letter is to authorize STAL �° ���°� 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: Vil11Cl: L1Vi1 w.L girl LlUb Ma L Let• a;iii to. supervise ine construction of said system or systems in conformity with the provisions of Article 145 or 1 7; "M uz;at.1-on. T L'acv; "t1fe' Public - *Health° Law," and" the 'Putham­County " "Shnf tary Code. k l� r .� Go'bnte signed . Very truly yours, Signed Owner of Property 949 . ALCXSWILY-, Address P.E., ZA, # .31 -72�- ess evr Z I ML .1. LAS OX 267 Telephone . u. 73 �7 .3& telephone PUTNAM COITiITY DEPARTMENT OF HEALTH DIVISION OF ENVIRONPJENTAL HEALTH SERVICES " COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE.SEWAGE DISPOSAL SYSTEM FILE NO. " Owner kvlLL/AMJ_1�u� -���� Address 7(, fj'�n�r��- �.� 04Ks / eex- -sue /LG Located at (Street q AAx FfyP seael/ kooso . 62- Block 4!�_ lo Lot g 10,-d / Al ;y ; Indicate nearest cross.s reet j � � L � [J�• 2� ! �r �•� Municipality /opiN of I? ,+����i f��4cGt: y Watershed ` I�.SK /L� �7� L� °s� � e� F�GC- SOIL ' PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS oe Number CLOCK TIFF PERCOLATION PERCOLATION apse Depth to Water Water ve, No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 91"27 2 -3-1 ' /5'- r 4' 5 �. 1 3 4 5 V Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to be submitted for review. 2). Depth measurements to be made from top of hole. 2 10,-d / Al ;y ; `i! C� j � � L � [J�• 2� ! �r �•� 4' 5 �. 1 3 4 5 V Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to be submitted for review. 2). Depth measurements to be made from top of hole. r TEST PIT DATA REQUIRLD TO BE SUL,MITTr'M WITH APPLICATION DESCRIPTION OF SOILS E,11COUnTl RED IN TEST HOLES DEPTH HOLE NO HOLE NO. HOLE NO.1'J , G.L. c_ 611 - `f. 18" �r 3011 dl 36" u 4211 p 4811 5 11 a !f i .660:1, .. .1+ -•1.. r.•.A +r•., a...u. . .. _. _.♦ - a 7211 C �a 8411 i INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES.AFTER BEING ENCOUNTERED TESTS MADE BY Date - -- j DESIGN r Soil Rate Used�� Min/l "Drop: S. D. Usable Area Provided-S/emr _.— No. of Bedrooms Septic Tank Capacity /2 cis Gals. Type�r. Absorption Area Provided By - E-04 L. F.x2411 �11— width trench. Other STANLEY J.' LN® , Name ��X �c�- ure . Address AMAWAI K N V i nrgmi 9 71 _wmn iT THIS SPACE FOR USE BY HEALTH Soi1•Rate Approved . Sq. A. . ?� Date � 4 ' t i:. APR 2 8 197.E i RUTN D DN , � Age r ? DIR OR, DIVISION E N� OVIRONMENTAL HEALTH SJ I ,• � t 'r�n< gas eonstn ftb m this pan and that c�as taspect?"I by me Were ii cpet Thy systuil vlas Go cdauce tdlaa a!l the 1 ruIE (E, N yY q { idivi of the [%1r q (feel' Y. T t,. N �J3'C'3f'ltJR.�f fL%pS Y Y ^ I ! i SS� Y n � 4 ' t i:. APR 2 8 197.E RUTN D DN , � r ? DIR OR, DIVISION E N� OVIRONMENTAL HEALTH SJ I ,• � � � m certlro .that 'r�n< gas eonstn ftb m this pan and that c�as taspect?"I by me Were ii cpet Thy systuil vlas Go cdauce tdlaa a!l the 1 ruIE (E, N idivi of the [%1r q (feel' T ;T17e /off .shfl vn erean /,j ,4 �J3'C'3f'ltJR.�f fL%pS � 4 ' t i:. F^ras AN�; ll l A: - � F^ras AN�; ll l A: