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HomeMy WebLinkAbout3567DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74. -1 -52 BOX 28 1 ti ; rr 1 Is rl 1 .� f{ ' .` J - - ILLI 03567 . {3 PUTNAM COUNTY DEPARTMENT i OF HEALTH I Division of Environmental Health Services; Carmel, N. Y.. 10512 j�uin/.aM ;44LL -j ,...,...CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR. SEWAGE - DISPOSAL SYSTEM. o.F / �! .�,r,•�-: o :rte : �.�.r+e. .�...•++er..�:v..- a�..�..:.r -, ..v.►.•:.. -.•s: - 'a:vr.-�r �:- "..(',.,�. %L�. :%�NYft''tl°'.i� ill. °y� ..M.►:�..6�,w:�.,. ,o kVOt,70 �i QED% Tax Map J°� - — Block 3 Located at _ Owner /e <:FoAzzy' -/E 4— Lot / In Job Separate Sewerage System built by ".%,(*/,/ 61-1-645:R. r Address (/,S 0,4 Consisting of � -Oal. Septic Tank and �+-ANC y� Other requirements J� 's � /N oel'd 1541V10 G/Q�i �%EL .7. d ee - Water Supply: Public Supply From — �rivate Supply Drilled By Address a' - Building Type / '0��T /� Has Erosion Control Been Completed? I certify that the system(s) as listed serving the above premises were cons attached), and in accordance with the standards, rules and regulations, Date -/ 12-1-1-17 Address �- Certif Any person occupying premises served by the above system($) shall conditions resulting from such usage. Approval of the separate se available and the approval of the private water supply shall become n subject to modification or change when, In the judgment of the Co Date r By— JWN No, of Bedrooms —5 Date Permit Issued n on the plans of the completed work (copies of which are k*,Issussf by thg!�butnam County Department of Health. 1 P.E. R.A. r License No. 2 1� as ay necessary to secure the correction of any unsanitary ne I d void as as a public sanitary sewer becomes Ib c or suppl comes available. Such approvals• are ovation, e- is.necessary. Title RiKI -OWN- M-lCAC ABORATORY INC. Yorktown Heights, N.Y. 10598 P.O. Box 99 321 Kear Street RESULTS OF EXAMINATION OF WATER :1TY, VILLAGE, TOWN 6 /OR N 3ACTERIA PER Iv1L (Agar )ETERGENTS - Mg kMVIO N A. r EF AME OF SUPPLY STREErP MAHOPAC N.Y. 1C count at 35 C). COLIFORM, GROUP (Ma M. RATES (as N) -jag I, --S N 0 mg hese results indicate that the water was YES DATE 1 1 1 AL - lag -a:'9 I•L.. � r - ppm 245 -3203 of a satisiacto it' ) " "'" .. �i'Y, "' 'Ji�ty3 whe t e sample was collected. t 1 •: n I Y DEPT. OF HEALTH A. H. PADOVPINI, M, T. (ASCP) '.r. 'F a PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 { CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM -.. '•.L •B�Ets?.:a,at; ' US rivL`iF Ar ��' . :� :. ,;,,:. -v.. y�v _ _ _ _ _ ::.rt -: w �% �e j tcr2f ..fit✓ E`It % illrEJ'���� Subdivision _T Owner Town or V5 lage i Lot f/° Job Address Building Type Lot Area 3z III Number of Bedrooms 3- Design Flow p Total Habitable Space ' K- �.f /�� g Sq'uacre Feet Separate Sewerage System to consist of / s,^ �` Gal. Septic Tank and _tf'. !�c�' / °� To be constructed by • ° 9L�ryr��� Address Water Supply: Public Supply From . �rivate Supply to be Other Requirements led by I represent that I am wholly and completely responsible for above described will be constructed as shown on the appro County Department of Health, and that on completio be submitted to the Department, and a written guar place in good operating condition any part of said ance of the approval of the Certificate of Cons n or will be located as shown on the approved plan and that i ell County Department of Health. Date :y"" Address _2t' &- APPROVED FOR CONSTRUCTION; This approval expires o revocable for cause or may be amended or modified when consid e requires a new permit. Approved for disposal of domestic nit y Date A® By n q '. J j kproposed system(s); 1) that the separate sewage disposal system ccordance with the standards, rules an regu a ons o e u nam ction Compliance" satisfactory to the Commissioner of Health will his successors, heirs or assigns by the builder, that said builder will period;of two (2) years immediately following the date of the issu tem or any repairs thereto; 2) that the drilled well described above nce with the standards, rules and regu aTrons of the Putnam P. E. ±--w.OR.A. { X License No. 7 - ' a issud4 unless construction of the building has been undertaken and is, the Com ner of Health. Any change or alteration of construction or ►iv e w upply only. - Title J 7 1. 02 PUTNAM COUNTY DEPARTMENT OF HEALTH_ �,l... .. _. .._. vision: of nvir •Di E onmen 'H ' th -.S� .zea= frrsP'• '�: �0"'7�` -. CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM 7-5t„v 04" PurlYAm V144i ey \ Town or Village Located ' at Woo 9 - 6—i -ee' r r� 9 Tax Map �+ Z Block 73 Subdivision Le// i f)2:c a 12i �, �� Lot O °1�1Z JobC Owner- `Tc- R Go a0 iAdruz Address 3558 , �an�S S`I . J1�i2u73ytiK IV. 7. IQ Building Type 120-51 D c 1gri (A` Lot Area Number of Bedrooms Design Flow Total Habitable Space �f :C" Square Feet Separate Sewerage System to consist of �n Gal. Septic Tank and 4Z 1 L!r"! 7i O 24°r %jZCr(Cfl + To be constructed by Water Supply: / Public Supply From Private Supply to be drilled by Address PUT-NA Other Requirements - K ijIV - ()F - I represent that I am wholly and completely respon above described will be constructed as shown on the County Department of Health, and that on com be submitted to the Department, and a writt place in good operating condition any part ance of the approval of the Certificate of will be located as shown on the approved plan County Department of Health. Date JuLy .2z. 19�Z Address 0 APPROVED FOR CONSTRUCTION: This app; revocable for cause or may be amended or modifie requires a new permit. Approved for disposal of Address location of the proposed system(s); 1) that the separate sewage disposal system ,hereand in accordance with the standards, rules an regu a ons o e u nam to Construction Compliance" satisfactory to the Commissioner of Healthwill 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= nal system or any repairs thereto; 2) that the drilled well described above ccordance WM thedards, rules and regula�Tons pf the Putnam P. E. R.A. License No. 32 7 Z 0 " date issued unless construction of the building has been undertaken and is b the Co mission of Health. Any change or alteration of construction d/o + tow sup . ^ ' - - - WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH pivision .of -•- Environmental, Health Sarvices r 6 COUNTY OFFICE BUILDING - CARMEL,,NEW YORK This ikport fs to be completed by will driller and su!•'.:4ted to County Health De)wtment together with laboratory report of analysis of..water sample indicating yiater is of satisfact_or;r bacterial quality before certificate of construction compliance is issued. REPORT MUST BE SUWAITTED WITHIN 30 DAYS OF V ELL COMPLETION T DEPTH FCOM IANI SURFACE Sketch exact location of well with distances, to at least � 4. __ FORMATION DESCRIPTION two permanent landmarks. _1.. -- - - -...- WE If yield was tested of different depths during drilling, list below FEET r GALLONS PER MINUTE 18771 li WELL DRILLEn (Signature) NAME ADDRESS OWNER / 6 r •• y (No. 6 Street) (Town) (Lot Number) LOCATION OF WELL . or NE D D PROPOSED DOMESTIC ESTABLISHMENT FARM- TEST WELL USE OF WELL CONDITIONING OTHER ) SUPPLY INDUSTRIAL DRILLING �j D COMPRESSED ❑ CABLE a OTHER EQUIPMENT l�il ROTARY AIR PERCUSSION PERCUSSION (Specify) CASING LENGTH (feet) I DIAMETER(inches) WEIGHT PER FOOT [I DR VE SHO DYES ❑ NO WAS A NG G >0 ? Mz YES ❑ NO DETAILS THREADED. WELDED HOURS G.PJA. YIELD (O.P.M.) YIELD BAILED PUMPED COMPRESSED AIR TEST MEASURE FROM LAND SURFACE— STATIC(SpeCity feet) DURING YIELD TEST (leett DcA of Comple'od Well WATER LEVEL in feet below Land surface: MAKE LENGTH OPEN TO AQUIFER (feet) SCREEN DETAILS SLOT SIZE DIAMETER (inches) 1F GRAVEL Diameter of well including GRAVEL SIZE (inches) FROM (feet) 10 (feet) PACKED: gravel pock (inches): DEPTH FCOM IANI SURFACE Sketch exact location of well with distances, to at least � 4. __ FORMATION DESCRIPTION two permanent landmarks. _1.. -- - - -...- WE If yield was tested of different depths during drilling, list below FEET r GALLONS PER MINUTE 18771 li WELL DRILLEn (Signature) S weer "or' u-rch&ser or uild ng Municipality gu- f n-iw__Ons true tEd by ~ ooa�i on —Stree B oc WuMdlng Type of 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 b®ax, 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- sorp, 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 util.iz-44:ig 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 negligent act of the occupant of the building utilizing the cyst Tbd iris -,' f __ii � 19 1-81 Title corporation, give name rV�t and address) - - . - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - T A THREE (3) COPIES ARE RE4UIRED WITH THREE (3) COPIES OF-FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS RERE�qjHZD TO FILE QT; CE 2F DATE OF F RST USE OF SYSTEM. . - - - - - - - - - - - - - - - - - - -• - - - - - - - - - - - - - - - - Division of Environmental Health Services, Putnam County Department of H6 910L In PUTNAM COUNTY f)f PART,*,fFNT Cr Ifl?Aull DTVT.STn%, Cr. P %. VTRO%';•1F\TAr, 11FALTlf SFRVECF.S Date J u 'Y 'Z "Z I `i rz (7 — 1 Re:. Property o (6, aLo "N ,cF-R Located at WooA $–,Z ezr r of Vql Le 4eeti-gh— Block `� Lot. Gentlemen: This letter is to authorize STANLEY J. UNDER'_ 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 connection with this matter and to supervise the construction of said . - system or systems in conformity with the provisions.of Article 14S or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned: P.E., n Zl Vic) AM ss DVA 4109 AMA %V" M. V. 10501 Telephone Very trul y urs, Signed Owner of Property Address / ®S ®' lephone i") . 'FIL-L, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES �f />A1 "'COUNTY" `OFFrICE BUILDING; "C�i N1EL,` N . Y: ,10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner ��- Address 0, a� T�� Located at (Street Adicate � �.-�_ . fv Block Lot P/o 4 -1 nearest cross street) Municipality 4 r ILUAJ, Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to WAEer 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 1 17-/), % / rl1- c'l tip •� °Z - 5 2 4 Notes: 1) Tuts 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. 2 4 " 5 Notes: 1) Tuts 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. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. • __ "' G.L. 6►' 12" 18" 2411 30'► 36 42" 48" 54 it 601 66" 721 781 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date DESIGN :.. - _ _.�_. •Soil- ••Rate-. °TIj.�SCd_.. '�iil�1��17t''UrJ: � , ° -�S:Do� Usable'Area "Provided .�` . °... . ° �- ._.:..._ No. of Bedrooms Septic Tank Capacity Gals. Absorption Area Prov By L.F.x24 Address D Type width trench. Other THIS SPACE FOR USE BY HEALTH DEPAR E "+ Soil Rate Approved Sq. Ft /G c "by Date 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 a Eg- rop_ , Auk 0,4V- IJ� f 0568 .# x H,*P- Located at (Street 4dicate �dn? fo"d Block Lot P%v L� nearest cross street) Municipality:Eo�%/,*j D� i` U't'JjAbaLp k,"j Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Elapse Depth to a er Water ve No. Start -Stop Time Min. From Ground Surface in Inches Start Stop Drop in Inches Inches Inches Soil Rate Min. /in drop P) 17 2 =¢�-- �'�' 17 154- I 4_ 1 -1 - ,1.7_� JI -d --�— 2�/, /0 -4 , 3.2 J3 24.3 34' /. f of 2= 4 5 2 Notes: 1) TeAts to be repeated dt -same deptn until app roximatel,y,lec�ual 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: . TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION r n Tr c r T r m �O._.1�, , '� ��?C.f)._INT,I�Ri�D Tn <_ . T_ F�_L,:.:HQI,FS xEp 406!6 1 DEPTH HOLE NO. , PP HOLE NO. HOLE NO. G.L. aPS iU pS o�G To oiL l��Sc�it 6 i ti 1211 F 0A ill 1811 2411 4 3011 3611 i 4211 � 4811 a 51� 1 if a 6`0 6611 721f 1 �% 781f m W 8411 TNDTQATE : LEVEL AT WHICH GROUND WATER, IS E'.V_ C OUN T ERED .INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED7,j :TESTS MADE BY _ - Z Date 6­10-77 DESIGN D1 Soil Rate Used de, Min,/111Drop: S.D. Usable Area Provided eT No. of Bedrooms Sept c Tank Capacity j 8�?> Gals. Type %"r�c� L�+�c. Absorption Area Provided By �'L.F.x2411 a�3 width trench. RTI �o .AND Other Name "' na ure > , \kAddress A Y, 10501 �, L THIS SPACE FOR USE BY HEALTH DARTP Soil Rate Approved Sq