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HomeMy WebLinkAbout3630DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.13 -1 -6 BOX 29 03630 ■ L I ' i � I t I�- 1 1 Lr 11 11 ir 1 ■ / OLE , , � �.; L sm 03630 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental.Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR .SEWAGE DISPOSAL SYSTEM i' TJu�!�M V !� � rage P�.1ZCn� AX �ARd� - 1_ �t "...Located.: aj,., �--- ......_ --.�. 1 ...��._. -,_�, •.� . - -- - - -- . , _ .. _. , Ao - Sgc�ew �C3 y- Town orB Qi�k9e Subdivision — Lot Job Owner 1 vas `r/iPi.E'T0 a.! Address "SAMC.EIZ Sr '`rA)AM 1!ALL01 Building Type Lot i ` Lot Area Number of Bedrooms Total Habitable'Space �' /6 4xv, Square feet Separate Sewerage System tp consist Of Gal. Septic Tank /-.77 �s lineal feet X width trench 4 S - /" / /1 -k ° -a Address —J G�f h`F1�I �i+'�L1iE.f',..,. To be constructed by Water Supply: Public - Supply From Private Supply to be drilled by 7 Other Requirements I represent that 1 am wholly and comple above described will be constructed as sh County Department of Health, and th be submitted to the Department, and place in good operating condition any ance of the approval of the Certificat4 will be located as shown on the approved County Department of Health. )Of cation of the proposed system(s) 1) that the,,separate sewage ,disposal system re to and in accordance with the standards, rules an regulations o e Putnam a to of Construction Compliance" satisfactory,to the,Commissioner of Healthwill rbe ed the owner, his successors, heirs or assigns by the builder, that'sid builder will rfiosa m during the period of two (2) years immediately,foilowing the date of the issu- Iianc he original system or any repairs thereto; 2) that the drilled well described above III b ed in ccordance with the standards, rules and regula i'ons of the Putnam Date , E, .. w. C ryi %' .o ' P.E. R.A. Address cy ' r License No. 3 APPROVED FOR CONSTRUCTION: This approval expires one year from �e date issued unless construction of the building has been undertaken and is revocable for .cause or may be amended or modified when considered necessary by the Commrssi ner of Health. Any change or alteration of construction requires a new,_AI mit. Approved for disposal of domestic sewage a /or private r supply only. t`� f s� Date j By Title -:;l_- `1UTNAM -COUNTY - DEPARTMEN'I Division of Environmental Health Services, Carmel, N. Y. 10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Town or Village Located at Section Block c;rzp. 1_0Y �, Owner Lot . Job Separate Sewerage System built by'�� —y�"f Address �Ta^u�' / au Consisting of CJ Gal. Septic Tank i Z lineal Feet X �' width trench Other requirements 6 i V C' e F' . C 0 ��� 1 � .D P_ A�h' i t".� Water Supply: Public Supply From – Private Supply Drilled Address i° =A V Building Type E S i C>R t'l-r I A L_ Has Erosion Control Been Completed? I certify that the system(s) as listed serving the above premises attached), and in accordance with the standards, rules and r Date v VEilr1 c% 'Z ; � � �z Address ux Any person occupying premises served by the above system(s) shi conditions resulting from such usage. Approval of the separate available and the approval of the private water supply shall become subject to modification or change when, in the judgment of the /1- -9- 17�i ._� 0 '1 roomsl��l� Date P`I rmit Issued on the Tans of the completed work.(copies of which are issue %by the Putnam County Department of Health. < P.E. '1r R.A. License No.•yz / � 0 (1010% "' ' as may be necessary to secure the correction of any unsanitary ly s i come null and void as soon as a public sanitary sewer becomes v i I a public water su ,ly becomes available. Such approvals are Health,,` such revo Lyon,, modification or change is nneecessap�ray..�— t ..' • -.. -� . ±4. ..i. .M }.Y'w. Y.��S'... t W c: - -. .. .: .....,: .... s . "� �':. -. i. � . :: . � �. _ � qtr. � Rn wP. Y.z:i... 4{:. Yr 1 ... t -. .� . 8482 YORKTOWN MEDICAL LABORATORY INC. P.O.. Box 99 321. Kear Street Yorktown Heights, N.Y. 10598 .245 -3203 DATE COLLECTED RESULT$ OF EXAMINATION OF WATER OWNER DATE RECEIVED TOM STAEUT 1111/72 .CITY,: VILLAGE, TOWN & /OR NAML OF SUPPLY DATE REPORTED GLOCAMORRA ACRES - PUTNAM VALLEYN.Y. ll. 2 SAMPLING POINT I.TF.T.T. BACTERIA PER ML. (Agar, plate count at 350C). COLIFORM GROUP (Most probable No. /100ml.) . HARDNESS, TOTAL -ppm . SS THAN 202 DETERGENTS-ppm NITRATES (as N) -. ppm IRON, TOTAL - ppm FLOURIDE. (F) - mg. /l. These results- indicate t.hat the water wasYES of 'a satisfactory sanitary. quality when the sample was collected. r A. H. PADOVANI, M T. (ASC,P) . SITE PERSON INTr;KV.LtXW PC HD Canplaint # Name &Relationship (i.e, owner, tenant, etc.) DATE TYPE FACILITY L SAM PROPOSED INS r` PHONE —-5_ Proposal (include sketch locating all adjacent wells): 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. rcIW P U►2/eov�.���v Proposal approved Inspector's Sigi rurpl& Title rA _ /%'0z Cf�3a- �'?' yGZa�r� �d✓y Proposal Disapproved .r Proposal 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 canponents tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diem. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, r reported ac ent of owner agree to the above conditions. SIGNATURE TITLE DATE C 2 3 . J;V: VtdtL- MV; Ye1.]cw (7bm HI); Pink Lkgiiamt) �j ' WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 1 Division of Environmental Health Services _ COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report is to be completed by well driller' and submitted -t —66 °iinty'Realfih''D pertiTi�ric tdg tFier vitith Iaborati5ry .report of _. 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 NAME,; -` t, ADDRES c LOCATION OF WELL "yo. 8 Street) (To ) (Lot )Vumber) PROPOSED USE OF WELL BUSINESS DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING F1 (Specify) if) a DRILLING EQUIPMENT COMPRESSED ❑ CABLE El OTHER ROTARY �J AIR PERCUSSION PERCUSSION (Specify) CASING DETAILS LENGTH (feet) DIAMETER (inches) �i WEIGHT PER FOOT / ©THREADED ❑WELDED DRIVE SHOE I YES ❑ NO 5 CASING D YES LJ NO YIELD TEST HOURS G.P.M. ❑ BAILED ❑ PUMPED ®,, COMPRESSED AIR YIELD (li.P.M.) . 7 WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Speclfy feet) DURING YIELD TEST (feet) Depth of Completed Well in feet below Land surface: l 7o 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 (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to :FEET If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL CQ MPL kTED DATE OF REPORT WELL<"ER (Sig0ture) ,? t i r . � .� � d ...t } • • a..... � ..l..... �. - 'J: \ - .. r <.. � . ,r r.. � .... .. � i r . rrt � • _ .r. a .... • . i� _ :. � . - _ w ♦ n. .1 .. +��i:h+1il� Ey AiP-iCiA STAPLG70 Owner or Purchaser of Building __1_H_ M A S `1 ;`A P L E -r a ti Building Constructed by Location - Street Building Type � 0 0 d P '1-Z r0A M \/A L LE� Municipality MA? L Block `f r, L 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 :Wade 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- eutilizing 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 systerm. Dated this day of 19'7 l-,"Signature f ?r tA Title�'� If corporation, 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 Kv r.: s. PINITAX COUNT" ' I3XPAR MI XT of - <� , NTH ; ��` DIVTSION OF � AL. LH SERVICES fiV 1 L F L! Date AL P .. Re a Property of i OM APO G *rO&) a �, • H Located at t3 tp_ma- n� Sr' ?uIrni.�e'�1 1'!ALL _"AA M(*P sin BI ock - Lot s Gentlemen e A r This letter is to authorize �STA:MY Jo. a dul.Y lieen eed professional engineer or reg 3sterd a°hte�ct ( lzzdio:ate ) 41 t o apply for a Construction Per f'vr a separe s ®wad systq scar® the above noted property in accordance with the standard. rubes or regulations as promulgated by the Cissfoaer, of the Ptitnam`Ct�aty µj z A. Department of Health, and to sign all necessary- papers, on Thy be f connection with this mater and to siipervis.e the construction cf: sal A d i` system or systems in conformity with the previsions of Article .145,-Or- 147p Education Law, the Public Health Law9 and the Putnam County 5�n3'« tary code Very truly yours.fl Signed P 0 us Users V16 EI:O #32720 � r 1-27. ' tom- , ry�. ✓ � elep fine , Y(J( rp TA,= . a LAMM .A. rM4>a Bdx w r 1 2 67 V New York 1:.0501 . Tel eiphone' DESIGN ;DATA SHEET _ SEPARATE SE.: Ai,E. DIS= OSaL SYSTE"' FILE NO . amer 1 olk! tTI�PLE -rb:6 Adiress�'F� 3 � c 9- u rk)t*m VALwv�l� Located at (Street) A� C -� `� Y ;_'(p 3 Block Lot:•T b (Indicate nearer c cross s tree �) ;� 9 Municipality �TNAtw VA Ld. y � _ -11atershed S1�:G` ���E� SOIL 'PERCOLATION TEST DATA REQUIRED TO BE SUB'�'T T`, ED WTITH -APPLICATION Hole Number CLOCK TIME PERCOLATION' PERCOLATIOti Run Elapse Dept- to fti'ater t, "ater Level No. Time From Ground Sur `Lac e in Inches Soil Rate Start Stop ,,fin. Start Stop Drop in �1in/in. drop Inches Inc:_es Inches 7-41 4 S 2 � .34 2 i t" % S 1 � ' 2 ,- 3 S Notes: . 1) Tests to be repeated at sa ^e depth until approxi- .=t-e?v equal soil rates are ob- tained at each. percolation test hole. all data to be submitted for revie:a. 71 Tl - - ..? _ --- �- t- - -- -7 - r.- - - y - - - -r , -, . TEST PIT DATA REOU IRE D .-0 BE SUBMITTED r-:! 7H APPLICATION DESCRIPTION OF SOILS E CUNTERED IN 'VEST HOLES DEPTH HOLE NO. .HOL? NO. HOLE NO��'�c G.L. 1i. —7dP-�,o iL, o �iitm. 61r 12:: . -?iacg 01 -AY. .2 4t1 30" .361T 42:: 431r 5 4' 1 -- -- -_ r 6Otr�_ ,1 S" O^ 6 6 i8`r 8 4'1 INDICATE LEVEL AT UTHICH G;ROJ \D WATER IS ENCOUNTERED' INDICATE LF' L TO WHICH WATE LEVEL RISES AFTER BEING ENCOUNTERED TESTS TML -ADE .BY.....:. .. -J"?. Date � -'��s•s7� Soil. Rate. Used 10 fin /1'• Drop - S. D. Us e Are G Pro-: ide"d :Vvv No. of °edroo:-s Septic Ta:i': Cap = city" - Gals. Type IwAS&.eV AbsorptiO.n Area Provided By r 7 7 361: %-l' width trench. Other ®� r f Address. '� >j 4; � AL AMAIN- i Op PUTKA�i COUNTY DEPARTMENT OF HEALTH Soil Pate Approved Sq. Ft. /Gal. Checked b: Date