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Home My WebLink About3660DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.14 -1 -23 BOX 29 03660 -1 % ; % � �- i :I !!N7 �zl I ' & r T ,9 $I I ` I T L I L' Ll Ai., I I } r �1 I - 1� 03660 3 PUTN AM f C Division of Ei CONSTRUCTION PERMIT FOR SEWAGE DISPi - ' "'Laeafed`•ai • � Subdivision ox& noma 1AAA.... A1,4-,e n Building Type j7r en - Lot Area Number of Bedrooms .4 Design Flow G /P /D Separate Sewerage System to consist of To be constructed by DEPARTMENT OF HEALTH Permit # Health Services, Carmel, N. Y. j10512 rEM Town or�ge OF Ta Ma, • `� "�"( Block o Loo � v •��i - # 3A •_ Renewal Revision _ Sy t^Y'KD s7 dr✓ % . C" t Gal. Septic Tank Date of Previous Approval Fill Section only ❑ P.C. B. D. Notification Required i /'1G'l•7EYJe'S and - / Lnt � r CrG- , oc Address Water Supply: Public Supply From 1 # /Private Supply to be drilled by Address Other Requirements _ I:n:✓ r'►r�a ar i, I represent that I am wholly and completely responsible for tKesign and location of the proposed system(s); 1) t ,,��e separate sewage disposal system above described will be constructed as shown on the approved {gndment there to and in accordance with the st off�'i r regulations o e Putnam County Department of Health and that on completion them}" a P a "Certificate of Construction Compliance f lac crar °ttl -the � mmissioner of Healthwill be submitted to the Department, and a written guarantee � be furnished the owner. his successors, heirs b °' Rgel' jjlger, that said builder will Place in good operating condition any part of said sewage)posal system during the period of two ) y� e - oJy,fCliovi1ng thedate of the issu- ance of the approval of the Certificate of Construction Coliance of the original system or any re irs, to; 2) that i"'40144 well described above will be located as shown on the approved plan and that said wel(II be installed in accordance with thus ntl Fits, ru "s. end regu,atiors . of the Putnam County Department of Health. ° o Date Ld °4 E. R.A. G� / /,,, �... , Address �� '� x w ° 2 � 3 e• , :> a, ce�t3e "'JV6. 1 tom' APPROVED FOR CONSTRUCTION: 1s a ( 6i' �"�3`\✓ ° a' approval expires oryear from the date issuetl ules onstruo�ne ;F�L �ylikflngr`,'fips� been undertaken and is revocable for cause or may be amended or modified when co ed ecessary by the Comm er Ay a -011-a iteration of construction requires a new permit. Approved for isposal of domesti stl y se or rivau�onTfrinav acava'azf Date w f By Title Rev. 9 -81 -7 %A . PUTNAM COUNTY DEPARTMENT OF HEALTH s Division. of Environmental Health Servioes,. Carme% N. Y. 10512,.. _ -. - ...... CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM % 177 t^ Town or Village Located at .5 / /'I_°`� / —! n 'y /,/C Tax MaP e+ `S' Block Owner - LE-�*r t., s�.{{ l %x .'f.- - Tax Map Lot # .� �' � � Subd. # Separate Sewerage Sy}tsm built by Address" onflitlnp pi's Gal. Septic Tank and Other requirements IJt �� s, i y: ! t > ✓ 41, Jllf Water Supplant t— Public Supply From Private Supply Drilled By ddress Building Type ,..4 ti No. of Bedrooms Date Permit Issued 1t' �-3 Has Erosion Control Seen Completed? I certify that the typtgm(s) as listed serving the above premises were constructed essentia shown on the plans of the completed work ( copies of which are attgghed), and in accordance with the standards, rules and regulations, i n the filed plan, and the permit issued by the Putnam County pepartmsnt Of Health. t,, L n Date / / 5 Certified by -' �(}✓ P,E. � ✓ R.A. Address � •5' "�� License No. Any person occupying premises served by the ab ve systems) shall promptly take su ` on aces secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system sht�� o null and void' on as a public sanitary sewer becomes available and the approval of the private water` supply shall become null and void wh "u v�,$ eeomes available. Such approvals are subject to modification or Mange when, In the judgment of the Commissioner of Heh h rev (fication or change Is necessary. Date T_ By Title Ale, Owner or Purchaser of Building Building Constructed by Location - Street Municipality Building Type Section Block 2�%• Lot Subdivision Name 5A 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, his 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 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 utilizing the system. The . imdearsigned further._.agre.es to.. accept, as conc.lus.ive the determin at'iorri of the- 'Di'recto� "'of -the 'Division of., Env : ironwentaL' - Health 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. negligent act of the occupant of the building utilizing the system.,.' Dated this -TLS —day of 19 �Signatur Title Corporation Name if corp. 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 YORKTOWN MEDICAL LABORATORY INC. P.O. Box 99 321 Kear Street Yorktown Heights, N.Y. 10598 245 -3203.- LOCATIONS: " ❑ 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245 -3203 201 BUTTONWOOD AVE.. PEEKSKILL. N.Y. 10566 737$777 ❑ 495 MAIN ST.'. MT. KISCO. N.Y. 10549 666.3335 ❑ �STONELEIGH.AVE,-,(,YtArl.!iOSPITA-L; C:4lMEL; N-Y.AV512 ?_78,93'.3 -_ LAB Y tic,)& — / DATE TAKEN: /.—' O.0114 77 DATE RECEIVED: �/O J ( / / �� v��- DATE REPORTED: �d / / SAMPLE SOURCE: l/ l/ REFERRED BY: L COLLECTED BY: -V _ ) LABORATORY REPORT mg /L ❑ ACIDITY .................. ............................... ❑ ALUMINUM ................................ ............................... ❑ ALKALINITY ........ O ANTIMONY ........................... ........................... BACTERIA, TOTAL /mL .................................. . ❑ ARSENIC ......................... ............................... ....... • BOO. 5 DAY ................... ............................... ❑ BARIUM ..............:........................ ............................... • BROMIDE ................... ............................... ❑ BERYLLIUM ..:............................. ............................... • CARBON DIOXIDE, FREE ................ ............... ❑ BISMUTH .................................... ............................... • CHLORIDE ................... ............................... ❑ BORON ..... :............................. ..................................... • CHLORINE ................... ............................... ❑ CADMIUM .................................... ............................... ❑ COD ........................... .............. .................. ❑ CALCIUM ..................................... ............................... ❑ COLOR ....................... ............................... ❑ CHROMIUM (tot.) ............................ ............................... / ❑ CYANIDE ................... ............................... ❑ CHROMIUM (hexavalent) .................... ....:.......................... ❑ DETERGENT, ANIONIC . ............................... ❑COBALT .................................... ............................... r� ❑ FLUORIDE ................... ............................... ❑ COPPER .................................... ...................... :........ ❑ HARDNESS ................................. :................ ❑ COLD ........................................ ............................... ❑ MPN COLIFORM COUNT/ 100 ml ...... .�.'f ❑ IRON ........................................ ............................... 1FTCOLIFORM COUNT/ 100 0 ............. ❑LEAD :....................................... .................:............. . ❑ CONFIRMATORY TEST ................................... ❑ LITHIUM .................................... ............................... ❑ NITROGEN; AMMONIA. O.MAGNESIUM, ......... ...........:............. ....,... ❑ NITROGEN .KJELDAHL .. _ . . • -... . - . ... ............................... ❑MANGANESE ................................... .................. :............ - ❑ NITROGEN, NITRATE ...... ❑ MERCURY ...... ............................... ....................... ❑ NITROGEN, ORGANIC ............................... ❑ NICKEL ........................................ ..............I................ ❑ ODOR ....................... ................... ............. Cl PALLADIUM ................................ ............................... 'Cl OIL & GREASE ............... ............................... Cl POTASSIUM ................................ ..............:................ ❑ PH ........................... ............................... ❑RHODIUM .................................... ............................... • PHENOL ....................... ............................... ❑ SELENIUM ............:....................... ............................ .... • PHOSPHATE (ortho) .....:. ............................... ❑ SILICON .................................... ............................... • PHOSPHATE (condensed) ... ............................... ❑ SILVER .................................................... .................... • PHOSPHATE (total) ....... ............................... ❑ SODIUM .........:.............................. ............................... • SOLIDS, SETTLEABLE, ml /L .......... ❑ TIN ............................................ ............................... .............. ❑ SOLIDS, SUSPENDED ... ............................... ❑ ZINC ................:........................... ............................... ❑ SOLIDS, DISSOLVED ..... ❑ ....... ......................................... ............................... ❑ SOLIDS, TOTAL ..... .................................... ❑ .................................................... ............................... ❑ SOLIDS, VOLATILE :...... ............................... ❑ REMARKS:..................................... ............................... ❑ SPECIFIC CONDUCTANCE .............................. ❑ .................................................... ............................... ❑ SULFATE ................... ............................... ❑ ...................:................................ ............................... ❑ SULFIDE .................... ............................... ❑ .................................................... ............................... ❑ SULFITE .................... ............................... ❑ ................................. : ....................................... :.......... ❑ SURFACTANTS .... .... ............................... ❑............... .................................................................... ❑ TURBIDIV. .......... ............................... ... .................. ...... ...............�_:..- ._..�..... THESE. RESULTS INDICATE THAT THE WATER WAS OF A SATISFACTORY SANITARY QUALITY WHEN THE SAMPLE WAS COLLECTED. THESE RESULTS INDICATE THAT THE WATER DID NEET T S.TISFAC R CHEMICAL QUALITY OF NEW YORK STATE ADMINISTRATIVE RULES & REGU RI G W ER ARDS ( 2) FOR THE PARAMETERS TESTED. ALBERT H. PADOVANI M.T (ASCP), DIRECTOR: y: WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF. HEALTH 3171 Division of Environmental Health Ser oes COUNTY OFFICE BUILDING - CARMEL, +W YORK This report is to be completed by well driller and submitted to County Health Department together with laboratory re rt of analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance istued. .... -. ;�_:__ .- - r_ . L; RsI 'aFi ?:::Ml1ST_- 8E..'SUBM ITT ED W!TFI;IN!..30 DAYS- .. :O.F_WE:LL..COMPLETEOIU ._... N ADDRESS OWNER (No. 6 Street) (Lot Num ) LOCATION OF WELL _(Town) © PROPOSED DOMESTIC ESTABLISHMENT FARM TEST WELL USE OF WELL a; OVER k SUPP Y INDUSTRIAL. CONDITIONING . ) DRILLING COMPRESSED CABLE EJ OTHER D EQUIPMENT : ® ROTARY AIR PERCUSSION PERCUSSION (specify) i CASING LENGTH (feel) DIAMETER( Inches) WEIGHT PER FOOT © ❑WELDED S ❑NO AS t'Ti 3TN DETAILS �s� f It THREADED L' =DYES YIELD ( HOURS ❑ G�. G.P.M. YIELD (O.P.M.) -BAILED PUMPED COMPRESSED.. IR WATER. MEASURE FROM LAND SURFACE —STATIC (Specity fear) DURING YIELD TEST Meet) Depth of Completed Well LEVEL in feet below land surface r MAKE LENGTH OPEN TO A '' IfER (leaf) SCREEN DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL Diameter of well including GRAVEL SIZE (Inches) FROM (feel) TO 1 et) PACKED:. gravel pack (Inches):' .._...• DEPTH FROM LAND SURFACE "' FORMATION DESCRIPTION "' Sketch exact location of.well with distances, to at least' two permanent landmarks.. " FEET to FEET 3 .. . .... .. ... If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL OAP TED .. DATE OF REPORT WELL ER (Signal e PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of / �2 / ,,per; Located at Ale •a C/ SA � e_'� (T)lh�rr✓ �' Section ' 5 Block % Lot Subdivision of ems! AV Subdv. Lot # g /-9' Filed Map # Date Gentlemen: 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 connection with this matter and to supervise the c tion of said system or systems -in- conformity with the provisions o/f�TTAr - 5 or 147, Education. Law, the Public Health Law, and the PuVAam,,' ty Sani- p�,N 5 tary Code. Dkpr O Coi,,,,- r }i Very truly yours, ��71Y Countersigned: P.E., R.A., # s Address OF pp L. a �j3Y�i M7: > ti Signed MZ114 � t9 Owr& of Property , Address lm4z VEIC / 0 a Town f/�>- ,� Telephone Telephone RECEIVE OCT PUTNAM C'>t1wry a. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL N. Y. 10512 DESIGN DATA SHEET, --S SEPARATE' SEWAGE DISPOSAL SYSTEM FILE NO. Owner /r %c, icv / /t., Address /'� C $ � /�: /" .:Pvn Located at (Street) �f" iL Sec. Block _Lot 2- (Indicate nearest cross street) Municipality Z,47dn%, Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS o e Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Water Lev e No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches ell- 2 -22J 31 Z 43 Z-3 -� �._ __.....� . 2� 4 5 l 2 3 5 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. - - a 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. d- 6" . 12" 2411 3011 36" 42" 11.8" 54" u 60" 66" 51983 72" DEPT -4A4 CC)UM r Y 78" W 84 ff INDICATE LEVEL AT.WHICH GROUND WATER IS ENCOUNTERED I 1DICA,T=,.. TO Mf H:.WATER L %EL_.:RTS�`.AFTPR BEIPG_ ENC.�INTER _� _. TESTS MADE BY Date " DESIGN. Soil Rate Used_Z7—Min/l "Drop: S.D. Usable Area Provided- No * of Bedrooms ' Septic Tank Capacity 2 6W62 Absorption Area rr�ded Ey��L.F.x24" Q� `w4 Yaltdvth trenc oa_n a' ^her Address THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by OCT F 1,99 P 'TNAM COUNTY • Late 5 q .7 jrc 0 • =,?o 0 Putnam County Department of Real= - ZP-.- Olvision, of Environmental Health Services 4- voted for conformanoe with applioab Mfles end iations of th Pa ty Real p qJanaturp 17-*e j,4 '15 tot "OA ref 41, All. 17 20 0 3,9 7-3 q .7 jrc 0 • =,?o 0 Putnam County Department of Real= - ZP-.- Olvision, of Environmental Health Services 4- voted for conformanoe with applioab Mfles end iations of th Pa ty Real p qJanaturp 17-*e j,4 '15 tot "OA ref 41, All. F 7a/ r. s �11AO-xd u� toyer, i ' p F 7a/ r.