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HomeMy WebLinkAbout3648DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.14 -1 -4 BOX 29 r ' ri 4 L r ,L = .. —`A a i/La- /1A'1Y11I71\ 1 " Vr nZAL1111 �or�C Division of Environmental Health Services, Carmel, N. Y. 10512 Permit n CER TIFICATE •F CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Town or Village Located Gt 1i8L f9:�Q_ • - � -�: -_.. . /Formerly . .. .. ,_: -: �,.. .. -off ..- ..t• -.�• (� � .. -_ • n�+rf.. k Ow� � j Map Lot k . Separate Sewerage System built by Address I Consisting of - ID OQGal. Septic Tank and `✓ {.11 5 pr-(p -,A,, Other requirements _ Water. Supply: Public Supply From Private Supply Drilled By ii•-t- \ -_�' L Address Building Type No, of Bedrooms Date Permit Issued C3 i 51 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 ed plan, and the permit issued by the •• y,` m' Putnam County Department Of Health. r Date i (/ !� �.� Certified by P.E. y R.A. Address License No. CJ Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null a old when a public w supply becomes available. Such approvals are subject to modification Jor .. ehango when, in the judgment of the C missio er of Health, we rre�voc /st /qn, modification or change Is necessary. Date Y ' BY t-'L'{ Title Rev. 9 -81 -Q PUTNAM COUNTY DEPARTMENT OF HEALTH P1/ /ell O Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT. FOR SEWAGE DISPOSAL SYSTEM 'Town our 921aue Tax Block _ Located at Tax Map ,r C..'- Job `!% !Y➢ .r- Lot k Subdivision Address /V1 lFi�l! /` %J o" s✓� a Owner Building Type Lot Area r i �%i �� Square Feet I Number of Bedrooms °� Design Flo.. ,� ' Total Habitable Space 9 4 % r —' / / Separate Sewerage System to consist of Gal. Septic Tank and � / Jra. Add ress To be constructed by �y 1r0 l /0 1 Water Supply: Public Supply From ` 4:. —z-Private Supply to be drilled by Address Other Requirements I represent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage aispvsal above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regulations County Department of Health,, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Hea-Ithwilt be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assign y the builder, that said builder will place in good operating condition any part of said sewage disposal system during the period of two (2) years im ed ately following thedate of.the issu- ance of the approval of the Certificate of Construction Compliance of the original system or a repairs thereto 2) at the drilled well described above } TI will be located as shown on the pproved plan and that said well will be installed j(t�ac Or 'nce wit the stare tls, ule an regu a ions of the Putnam County Department o Health 7<69 Date %C P.E'. R.A. Address) r, Z- ` �( % c License No. APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unles onstr ction of the building has been undertaken and„ is revocable for cause or may be amended or modified when considered is essary by the Comm 164r of Health. Any change or alteration of construction requires a new permit. ARproved for disposal of domestic i r er supply only. Date / ¢ /� <. / By 0 Title -? ^ Su6dwision s Building_ 71r s . Number of,, Bed Separate Sewer To be'_ construe Water upplyr. it Other.?Requiren �� I represent that; above, escribed' County, Departi submi ted' fi place ?in good >j ance of the ap will be located`.a County Departs I , }' ` APPROVED F.0 .,... .•. - �.:,._: -. _.,..�.µ... �, I. �.::,. �.rt. r•.,e u.,. �... hl: r.x Hr." ARS. �:.n�mR..aN'+`.e.WY,(:!?k'11!�f Y'9Mv�i�ftyl,l�pMq,y�,y B Owner or Purchaser of building Section R ..Timothy . -Inc 5_.. Building Constru� cted by Hlock y - - -'`- Shamrock Drive Location - Street N.Y.S.E.& G. Municipality 17 Lot Glocamorra Acres.,: Subdivision Name Raised Ranch 17 Building Type Subdv. Lot # GUARANTEE.,:, 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 guarantee to the owner, hia success- ors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period.o;f 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 thi' failure'` to operate properly -is caused by the willful or negligent act of.;: "the occur a t of th b i ' l di ' t ' i 1 s p n a ung u a +1k t ..ng a •sy em. - The undersigned further agrees to accept as conclusive the.deterdiin- -- - ation: -of the ­Directo-r- of the,. Division. of Environmental Heal_ th Services of the Putnam County Department of Health as to whether or not the fail- ure of the system to operate was caused by the willful or negli-geit act of the occupant of the building utilizing the system. Dated this 24 day. of Nov. 19 82 Signature'".�,.,.,..`E� Title President R rr". R—Timothy Dwyer., .Inc.. Corporation Name i:f corp. P.O. Box 74, Patterson, N.Y. 12563 Address - - - - - - - - - - - - - Qt_. irk-? -, - - - - - - - - - - - - - - - - - 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 e � i ...... --... -�..'. r.> Y%z ':• .:..,..:.: 6,+e.....a.r..r,;. . .' ::�. « .4.. �.. .P -.♦ ..: ....— ..{yyy. .` :..AC':'Y�^ --�. r r... .�.-.. w�... � a �, o- ....r.w J. BREWSTER LABORATORIES Box 234 : BREWSTER, N. Y. WATER ANALYSIS, REPORT SAMPLE No. 4929 SOURCE: Timothy Dwyer, Inc. Well Discharge Shamrock Drive Putn4M VAJ;,ey, NY COLLECTED: October 21, 1982 13Y: Mill Drilling, Inc o BACTERIOLOGICAL EXAMINATION Coliform.Count, MY Method 0 per 100 ml. Tbit retmlt ixditatet the tnrrore ' V the taa pb w7at ej tatitjatwry tasitary 4aa4ty U4111 lbt,.. iaigph . tiiat rdlieud. October 23, 1982 RECENE mom 3 19 82 . o ivmAM COUNTY e y., .- . > -..: ... }... ., ..,n.- ....rra< -a =r ��; .... - -,,. �. e... . -r ,r.r •.._�,....- .......... .... .'� .. .. _d... t- ... .•.t .., .� �. -�:.:� �..r-. -. .. r,...�.^_ a ...- - ... .. BREWSTER LABORATORIES Box 214 - BRMSTER, N. Y. WATER ANALYSIS REPORT SAMPLE NO. 4929 SOURCE: Timothy Dwyer, Inc. Well Discharge Shamrock Drive Putnam Valley, NY COLLECTED: October 21, 1982 BY: Mill Drilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method This renk indimaj the source of the wmph . wds of rdtiifartory fawitdry quality whrr 40 iamplo wai collected 0 per 100 ml. C0r IVA L October 23, 1982 Bickwit P. E. DlfKlef . 5 360 Hard Grev & Black Granite:* If Yield was tasted of different depths during drilling, list below FEET GALLONS PER MINUTE 0 I NA X7 l PUTNAM COUNTY DEPT. OF HEALTH1� 0 DATE WELL COMPLETED )Al'E OF REPO T WELL DRILLER (S19naturo) (�, / 1- ,Q 10/21/82 1.0/26/� � �� Zvi(' %` -�' Ro er 14o ft res UNI °- 3 a 0. WIE:LL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3171 ` : Division of. Environmental Health Services COUNTY OFFICC BUILDING- CARMEL, NEW YORK This report is to be completed by well driller and submitted to County Health Department together with laboratory report of _ - arTalysis of water sample indicating water is of satisfactory bacteiialu21i?y before! certi #icate of, cgnstruc ;ian ct npliA. �r F is issued; .-- REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION NAME ADDRESS. OWNER R, Timothy Dyryer, Inc o 1po.Oo Box 740 Patterson, NY 12563 LOCATION . (No. 8 Street) (Town) : (lot Number) OF WELL Shamrock Drive Putnam valley, Plea York . BUSINESS- ® O PROPOSED . DOMESTIC ESTABLISHMENT FARM TEST V✓ELL USE OF WELL El Cl O(Specify) SUPPLY INDUSTRIAL CONDITIONING DRILLING COMPRESSED CD ROTARY CABLE_ OTHER P ❑. EQUIPMENT AIR PERCUSSION RCUSSION .. (Specify), CASING LENGTH (feet) DIAMETER (inches) WEttsHT PER FOOT. ���� ,�'��jj OkIVE SHOE ox � a WAS A.EN• R UYD7 CA � DETAILS 24 13 THREADED !_) WELDED ! nJ YES ' NO ~ES NO YIELD HOURS G.P.M.. O BAILED ` F] ® YIELD (G.P.M.) TEST PUMPED COMPRESSED AIR 15 15 WATER MEASURE FROM LAND SURFACE —STATIC (Specify leaf) DURING YIELD TEST (loot) +1. pth of Completed Well LEVEL 50 360 feet below land surface: .. 350 MAKE LENGTH OPEN TO AQUIFER (feet) SCREEN. . DETAILS SLOT SIZE - DIAMETER (Inches) IF GRAVEL Diameter of well including GRAVEL SIZE (inches) FROM (feet) TO (leaf) PACKED: gravel pock (inches). DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch erect location of well with distances: to at least FEET to FEET two permanent landmarks. Sand. silt*' 5 360 Hard Grev & Black Granite:* If Yield was tasted of different depths during drilling, list below FEET GALLONS PER MINUTE 0 I NA X7 l PUTNAM COUNTY DEPT. OF HEALTH1� 0 DATE WELL COMPLETED )Al'E OF REPO T WELL DRILLER (S19naturo) (�, / 1- ,Q 10/21/82 1.0/26/� � �� Zvi(' %` -�' Ro er 14o ft res UNI °- 3 a 0. • PUTNAM COUNTY DEPARTM.EN T OF 'HEALTH DIVISION OF -_ _ENVIRON; MENTAL :HEALTH `SERV'TCES" Gentlemen: This letter is to authorize T. =Michael Rely, P.E. a duly licensed professional engineer or,registered architect (Indicate) to apply fo.r a Construction Permit fora separate sewerage system; to serve the above noted property in accordance with the standards, rules or regulations as promulgated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf ink connection with this matter and to supervise. the- construction of -said- sys.tem.or, systems in ,conformity with the provisions of Article 145 or-. 147,. Education.Law,. the Public He'alth.Law, and the Putnam County Sani- tary Code.. Very truly y ups, Signed Owner of Property Countersigned: Address r R p # 48468 Telephone P. 243 ^ e r (Seah) �� Address 1` EIVD N.Y." 10587 OCT 14 1981 248 -7022 PUTNAM COUNTY Telephone DEPT. OF HEALTH • C' x PUTNAII COUii ^�% D RT F? =N 1 T OF 1EAL•TH .. zDIVIS'I,ON OF =jUTRO'i' =;TAL :: =_LTii SFRVICFS Data :Jr roc' a ," 11171 Re; Property of Located at 70�r �o Block - L'at Gentlemen This: letter is to author z - STANLEY J® .LANDER a duly licensed professional engineer or ra, s t e r e d architect (Indicate) v t0 apply _ °O L' a vCT1Jt;"ucti0 °�w__ —Or s;,: a:,a�a Sa 'e"' 3,f8' ", �0 serve the above nomad prop=rte - ccJ=''da ce _til the S andards, _ul S Or re gulations as nro 1 atau b v l_e C �� '^ f the Putn?ai1 Co __ 3S _v__.. Cil C.7l rs i. 'T Depart;lant of iealth, and to sign all recassa= nane- rs e : my behalf n connection with this lnattar and to sucer- isa `:.a COnStruCtlOn of said system' or systems in confor::_t of Article 1L5 or 1L7, Education Law, the Public Healtr La:l, and the Putnam County Sarni - Lary. Coda. QROFESSip��` Very .truly yours, o:,; 0, 9.« '. +�`� -� •d�.� Q �O. 3a7 Oq.'� _ ..• a �� ,. CO ur_`, s_gned: ®� Ad�:ra, . P.E.,:R.A.,.�7 Te1aphone STANLEY I DER (Seal -) Addres 8OX 267 245 -264 PUTNAM COU N, TY DL'? "T' — ]E `T OF _='.LTH •DIVISION OE:. 1V . -ZL\ P0`?•CN:T:aL .HTEA_L-THf '� -L DESIG \T DATA . SnEE:T - SEPARATE SEaaCE DIS=�C-AL SYS= —! FILE NO . Owner "Wicc-� Address C-Az 45729c �-.�-.nurti. yA�cL y Located at (Street) ��ivG� 5._ o .Block 3 Lot _ (Indicate nearest cross s%reet) _ Municipality ,Two :4 rM/ioj v4 i.:c4 :Watershed SOIL PERCOLATION TEST. DATA P,EOUIRED TO BE SUE`'I'_I'ED 7ITH . ?PPLICATIO�' Hole i.rber CLOCK TI`tE PERCOLATION PERCOLATION Run Elapse Dep �.. -o t;ate_ :;titer Level No. Time :: Ground Sur =_ce in Inches Soil Rate Start S t 0 2 "lip. �F+ro S tart Stop Drop in l lin/in . drop Inches Inc=es Inches . 4 5 1.0 2 5. 1 2 3 5 _ Notes. . 'l) Tests to be reoeated at saMe depth u it approti _te1v. earsal soil rates are ob- i tained at .each percolation test hole. all data to be submitted for revie.,. 2) Depth n;ea::,.reiments to be made from top of hole. t d • TEST PIT DATA REQUIRED N- -0 T .SU3 I I T T E D '-:TTH APPLICATIO` DESCRIP T IO�i OF SOILS E': OT D I'. T=ST HOLES DEPTH HOLE NO �'/ .HOLE NO.. -I-7Z HOLE \0'. G.L. %B�.' <So /G = %�i� --5'0 /c At 6" 18r _ 2 4" ..3/7iZ�4 ott/ tSTd�' .J`•"%/tJ.d .5O/L�cc` .STbEL!L -' S�iU9� ° -rt�G� S'T136t/C 3 0" 36«. �r 42'' 4s fr 6 0'i _ ... 6 5" iBT 8 ItiDICATE LF� L AT t ;rIICII GROUND WATER IS. ENCOUNTERED INIOICATE LEVEL TO LJHICH 9%ATE:R ;E� FEL RISES AFTER Bc NG ENCOtJVTERED TESTS U\ DE BY IT7 f11V/- -F J, :. C Date - 31 - 7 Area d 5'00a U i Soil Rate Used i 40 MIr /l. Drop�_ S Usab, e °r o. lu", _ NO. of Beuroo-s Septic. Tank Cap _City ��00 Gals;. Type /���•�rtvJ Absorption Area Provided By 2 ,36 L. F.X � t idth trench. O-Liier' @ �' Name STANL , : i Address U A A rW' 9; 0 PUTNAM COUNTY DEPARTL9NT OF HEALTH Soil Rate Approved Sq. 77L,./"Gal. Checked bar - __ Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL. HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512"'.1 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL'SYSTEM. FILE NO. Owner 4''�]c.�D�..O ,S�IE�t�I. �I�C33&�• Address NAVst.WC.&T- '-Q A014a sw .ale`^ Located at (Street Rdicate U4.0k ock �� Sec. Block Lot nearest cross street) Municipality yv'X0 4-w,, gh" Watershed © SCAmi g,,; X SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number - CLOCK TIME ,. PERCOLATION PERCOLATION No. Start -Stop apse, Time Min. _. Depth to Wa Water —Warmer From Ground Surface Start Stop Inches Inches bevel in Inches Drop-in Inches Soil Rate Min. /in drop t 2,0 .. /p !O �9 2Z 3 ►_. k. 30 17, .19 2Z 3 9 Z......2 ._.. �� 10 2��; .5 . OF 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. TEST PIT DATA REQUIRED „TO BE SUBMITTED WITH - APPLICATION r DESCRIPTION OF, ;.SOII,S..��TSOOUN�i'ERED::'IN` -TEST 'HOLES. D PT.H HOLE.: NO HOLE..NO:.- HO?E NO. Address .. a �t `�' ... SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil RatE`Approved Sq. k /Cal. Checked by. _Date f; p l ' ' RT "4 JF' F'" 15Cr/Z�I\ �Lr' ' ✓' ti x`,4{'4 _ b��� �'y �.� .�4 t a tz.• '^` "+.�;; `_� i$ ldCJ�•}hF�` - r•ti l w3�. MT t 7 .4 , \ 4 ^fF H..y, ` =,i Y 1 IC30�(�A� NMA►tkx°� x. �� .. 1 j� - ✓�� �V: !"t l ,1+� , ee ol P T a ltf h H eSearlath io . C eio ?aofnvicnr ntaHe r 4 ` r , r, manco,with p ro oic _ons of the 1' cJ y �I J Al k, f0i t�f Tit e. pate lgnatllTB. .. - *µi'.1. .. � �` �. I O y' A"1( f(IAh�QdC� TTjc?.t�1G u G ,s� k an G Colal_ o>r C�sct1A*t .VA�.wC`' 4 a, 15 i TU C TT# Ti S$1v ,C F.' 17iSi'05AL SY5TL'D1 %V AS ONTRU( ED AS II4.I�IC,ATEll °ON �'L-iI$ '1?JsAIVj'ANQ THAT - � � + a S] STF NI WAS INSPLC-7 ! I)•:1�Y A1L 7tL,f t�RL [T �Xft1& GOVER6ll �a; TLiG Sl'S'I TM ]4't1S �ONS'M' IjctP.►J IN ACCORDANCE WITI3 'AI THE Pa r :ICULFS •AID i� RTsGIlT ATIDNS OF T'HF..P, T 4AM " COUNTY pi Pt41iLL RECE IVEO ., >dT C}b NEAt,Cii per{; s ' DEC -3 i9 �L" Pit PO 'WAA4 COU T 2 DE OF HEALTi " f � .. ":, _...: , _ ` �� � 'ti•"! ,, r�: -rgr. w . �:. •¢ "'. r 'a+''�vnk. �"� `�+. .{ .,?... '��.t.,.. . � , � .. .. \ .. .... nx ib .. .. .' Z. s, i ':� - P : � _ ,.. 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