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HomeMy WebLinkAbout3713DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.17 -1 -53 BOX 29 03713 �. X876 , :: a a 6r 1610, :. , }: r - :. 03713 PUTNAM . COUNTY DEPARTMENT OF HEALTH �! - �\� Division of Environments/ Haolth Services, [:arm% N. Y. 10512 Permit # PVy CERTIF CATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM PU TW A 0,n (%LL r=y Town or Willage tl� a� ' y Owner �" M iJzf,4 0 /%Formerly Tax Map Lot # r�Subd. Lot #y� Separate Sewerage System built by UJA + N L° ° C o f! r -- V_ Address A uR' �✓' A N T' R d #� �3• E R_ 21 A65 y k I LL Consisting of `"' � pal. Septic Tank and 's ® L.� s " IENQ.4s ES 7- -- Other requirements Water Supply: Public Supply From Private Supply Drilled By • V E -2- ' p . o n Address Ul % ..:.�JTs . N ` V LL / `rd v n Building Type JEQM e � s No, of Bedrooms Onto Permit Issued Has Erosion Control Been Completed? I certify that the system(s) as listed serving the above premises were constructed essentially a shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulations, in accord with the filed plan, and the permit issued by the Putnam County Department Of Health Date b/04 �� " r�' �a' Certified DY P.E. R. A. Address n ` 'License No.'-.;.-. 0. Any person occupying prem(ses served by the abovei syftelr�(sttiashali prompt ake such Ction as may be necessary tom ure the correction of any unsanitary conditions resulting from such .usage 'Approval,of the separate #6iiv rsge`'system,sh ll become null and void as soon as a * public `sanitary sewer becomes available and the approval of thg private water supply shell become" ll qnd' void when a public water supply becomes aviilabN. Such approvals are subject to modification or change, where, in tho ju_dginent "Iof. the om itAlioner of Neal , ch r cation, modification` or char ynecessary. Date® ` BY Titb Rev. 9 -81 ,r jT ° Owner or Purchaser of Building James Murphy Building Construct6d by Platnam Valley Municipality 68 PL, I Section Barger Street 3 Location - Street Block One-Family House 15 Building Type 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 i:nrnediately following the data. 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 undersigned further agrees to accept as conclusive the de- termination of the Director of the Division of Environmental Health Sar- vices of the Putnam County Department of Health as to whether or not the _ .fa.i.lu,e. o. . t4e.. sy.ste -m _to- op.e.r. gte. was -- ca.us.ed -by the willful- o•r- negligent act of the occupant of the building utilizing the system. � wner's Dated this day of 19 Signature Contractor , . Si�n�tur pk o a •e, let 41 - <<i THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COTN1P_,ETION WILL BE ISSUED. GUARAITTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of.Heal e WELL COMPLETION REPORT 3171 1 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING -. CARMEL, NEW YORK This report is to be completed by well driller and submitted to County Health Department together with laboratory 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 E ADDR ESS /�_ y 'rrA LOCATION OF WELL (No. d reef) (Town) (lot Number) PROPOSED. USE OF WELL DOMESTI ❑ SUPPLY E:] ESTABLISHMENT INDUSTRIAL ❑ FARM ❑ CONDITIONING ❑TES Ell ❑ OP:ERI DRILLING EQUIPMENT CASING DETAILS ® ROTARY LENGTH (/ et) COMPRESSED D AIR PERCUSSION DIAMETER (inches) WEIGHT PER FOOT 1 / � CABLE ❑ PERCUSSION j� I /'t` THREADED ❑ WELDED ❑ OTHER (Specify) SHO CA>`If� ?— YES ❑ NO YES NO — YIELD TEST ❑ BAILED Gn.. HOURS ❑ PUMPED COMPRESSED AIR G.P.M. �^ YIELD (G.P.M.) �✓ WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST (feet) Depth of Completed Well s /� f in feet below Land surface. SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE �. w ..:.— ...._.. .._ DIAMETER (inches) ... :... �... IF GRAVEL PAC Diameter of well including _grovel pack (inches):_.... GRAVEL SIZE (Inches) FROM (feet) ... TO (1801) r . _ . DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact two permanent location of well with distances, to at /seat landmarks. FEET to FEET ( t If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELY COMP LETED DATE OF REPORT WELL Q_Rkt_LER (Signatur r YORKTOWN MEDICAL LABORATORY INC. ` � P.O. Box 99.321 Kear Street LocaT(oNS: ^ t 3321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245.3203 Yorktown Heights, N.Y. 10598 ❑ 201 BUTTONWOOD'AVE., PEEKSKILL, N.Y. 10566 737.8777 245 °3203 ❑ 495 MAIN ST.. MT. KISCO, N.Y. 10549 666.3335 ❑ STONELEIGH AVE. )NEAR HOSPITAL), CARMEL. N. Y. 10512 278•! LAB # Y 14 ! S"7 ►r DATE TAKEN: �- -� DATE RECEIVED:— �7 —�_� DATE REPORTED: SAMPLE SOURCE: > > aEFEaaeo BY: 4 _- COLLECTED BY: C/ /0 ������� LABORATORY REPORT / mg /L . ❑ ACIDITY ............................ ...........y...^................... ❑ ALUMINUM ..................:............. ............................... ❑ ALKALINITY ................................ .al................. ❑ ANTIMONY .............. ............................... BACTERIA, TOTAL /mL ..............: 0 ARSENIC ........ ..... . ❑ 800. 5 DAY ............................ ............................... 0 BARIUM ....................................... ............................... ❑ BROMIDE ............................ ............................... ❑ BERYLLIUM .................... ............................... ❑ CARBON DIOXIDE, FREE ........ ............................... ❑ BISMUTH ........................ ............................... ❑ CHLORIDE ............................. ............................... ❑ BORON ........................................ ............................... 0: C -HLOAI.NE, .... ... .. _ _ 0 CADMIUM ... - ❑ -COD ............................. .. .. ......... ....................:..:.:�..: ❑CALCIUM ............... .............:....:.:..:....... ..................... ❑ COLOR ................................ ............................... ❑ CHROMIUM (tot.) ..................... 0 CYANIDE ............................ ............................... 0 CHROMIUM (hexavalent) ......:............. ............................... ❑ DETERGENT, ANIONIC ............. ......................•........ 0 COBALT .................................... ............................... 0 FLLIORInF ............................ ............................... 0 COPPER .................................... ............................... ❑ HARDNESS ............................ ............................... ❑ COLD ......................................:. ............................... ❑ MPN COLIFORM COUNT/ 100 ml ............................... ❑ IRON ......................... �MFT COLIFORM COUNT/ 100 ml ........0 ................ 0 LEAD ❑ CONFIRMATORY TEST ............ ............................... ❑ LITHIUM ................. ............................... 0 NITROGEN, AMMONIA ............ ............................... ❑ MAGNESIUM .................... : ..................................... ....... ❑ NITROGEN, KJELDAHL ....................... .................... ❑ MANGANESE ................................ ............................... 0 NITROGEN, NITRATE ............ ............................... 0 MERCURY .................................... .......................:....... ❑ NITROGEN, ORGANIC ........... ............................... ❑.NICKEL .... ............................... . ............................... ❑ ODOR ................................ ............................... ❑ PALLADIUM ............................................................... ❑ OIL & GREASE ........................................... :........... ❑ POTASSIUM ................................ ............................... ❑ PH .................................... ............................... ❑ RHODIUM ....................... ..... ............................... ❑ PHENOL ............................................................... ❑ SELENIUM .................................... ................0.............. ❑ PHOSPHATE (ortho) ................ ............................... 0 SILICON .................................... ............................... ❑ PHOSPHATE (condensed) ............ ............................... ❑ SILVER ........................................ ...........................a... 0 PHOSPHATE (total) ................ ............................... ❑ SODIUM ........................................ .............0................. ❑ SOLIDS, SETTLEABLE, ml /L ........................ ❑ TIN ............................................ ............................... ❑ SOLIDS, SUSPENDED ............. ............................... ❑ ZINC .................. .......................... ............................... 0 SOLIDS. DISSOLVED ........................ :..... ❑ .......................... ......................:. ............................... 0 SOLIDS, TOTAL ..................... ............................... ❑ ...... ............................... ....... ......................... .. .0 SOLIDS, VOLATILE ................. ............................... ❑ REMARKS:..................................... ............................... ❑ SPECIFIC CONDUCTANCE ......... ............................... 0 .................................................... ............................... ❑ SULFATE ............................. ............................... ❑ ............... ................................ ........0...................... ❑ SULFIDE ............................. ............................... ❑ .................................................... ..................::........... ❑ SULFITE ............................. ............................... ❑ ................... ............................... ❑ SURFACTANTS ❑ _TURBIDITY . :, ..,... ?. ❑ .. _ .................................... r .. THESE RESULTS INDICATE THAT THE WATER WAS ��F A SATISFACTORY SANITARY QUALITY WHEN THE SAMPLE WAS COLLECTED; THESE RESULTS INDICATE THAT THE WATER DID MEET THE SATISFACTO CHEMICAL QUALITY 01' �y� YORK STATS ADMINISTRATIVE RULES &REGULATIONS, DRINKING W T TAPiDARDS (PART 72). FOR PARAMETERS TESTED ALBERT H, PADOVANI M. T, (ASCP) . DIRECTOR.; � I BARGE!R STREW o F ••A5 Putnam County Dep tMent nfili 'r,,ision of Environmental Health Servioae I ° -40 QDL .coved as noted for co=iormanoe with ME I 141 0 ou . 0u Old, Ids -vll _L% 12�41Ilyl -Or 11 IdV Co 11%011 ��du 1 ?►- 11�bu $ Ovu �IQu q 91 ►•d' 1141 St91 22 x'011 If G / +�i'0� ito° 2� 930" w C- • � • "+ bO I Ids -vll _L% 12�41Ilyl -Or 11 IdV 14, VIII �• �� III 21 �f!ou St91 22 x'011 X19' G / +�i'0� �lol •Q' 2� qI!o° 1f!or Zl'! �-pu t�l•QN s e Fules and P._ ulations of the o IV L am County a th Department.: 'tena#vra '` JOEL LAWRENCE 'GREENSERG nAta NEW µo _ pMN, N, UK ARCHITECT -TOWN PLANNER 86plC.R...ST. - 'PuTN.dMVAC.C�x. }�,1._ MU8COgT NORTH RFDi2,gox 4,i8 �a r e • oc. T. 1994 Yahopac. Now Yofk 10641 I0 141 624 - 6613 R PUTN 17 h. of 66NSTAUCTIJON PERMIT:4 T -WSE AGE- C 4 .Rcata ;ai_ St I itidivisl p o4ndr/A dd re JFU Number '&f-Bedrooms, Design Separate Sewerage _,System, -t'?­ consist ' F> I­ I z E To be constructed by Accress Water - Supply -" PUblie'supply Private Q Supply ,-to4be`.,araig j _A N4 6 Cher Requirements . , ' 1 S I represent t, at'l `system(s);,' that the 'separate .sewage 4isp6sal, system h -am wholly.�nq completely :responsible for arid 16�atioh of prqpoia� 6 4pp'- a-!nen men here 0 and in accorg ibb4e described' will be,c6ristructeq as sh'own"66 4h roved d t't i y .t�el, Putnam XTregulation Cornmi iSlonei,_df County.' ` Department of - Health, -and -that dn.cqrnpjlet ion, th�er`eof 4,'t-Cer�t ifj"tq-,'cd Construction Ii i`ifa&o�yi(�th�6 4Zqmp iapce.,,� wl;. _. . " j, � subfinitt6d to"the,* Depirtment, 'and 'a -viittih guarantee -wilrb ­ i' ' 'iii `iii��iisors,'.hel ' _-,assijns-by the�,�u__ilder,-ttfat i : ,be be = furnished owner; !, rs py 4!!de!. thai OV, ill placa_jp. good operating -',ci said _ , z '. _64�6,,6 6%W Ag N—ii' 6" "I""sterri,duritig-06,pe )61, _j2j �6ars-imirkidiitely'fiiil j -ihida ondition any part of sewage.' 9�� �Iy -1 1 _rk 0 issu= arice or any, repa i!� _�Uth above - dh �ii�W:.Cdiiipliancelof.rthi:6ii�it�i'i�stir��"'-- ij�'4jrato;l).ih ii-*iiiid' welfcl i of. Ihe,�aop ' r6val of the 64WIlifikate.,blf- 'd itei� - - �,!$P . 1 ­1 - " I �. 'd * shown' 06,approved-Oiah and fha)fsaig well will be inisfalteii—ii accordance' 'with-, the standard '�regul ---Of will be locate as or� 0 s.- rules :Sin' 9ons- County ,Department of Healthi Date / Q L P . 44 Address �✓ i - Licanse No - APPROVED FOR - � 'C'O, NSTRUCTION;This a6piova I expir-es on-e,ydair from the. 1 of ihi-7buildings i as, a ejn ;n i s :revbcable ior-cause.or may be amended dr- modified when. consIdered'necessary- b y th i s oner h ng# construction of rr tp s, -a A W Wr * S CAS" n � ,pry PON on IYW * -, Oate BY A'1yc 7 g 1 , Its, ,V }f�+d ® t�UttpR� I 'g'4 Y d - � ®C� a 9 y 4( a � ry pCV�T fi ,Environmental. Health: Services Carrel COfiiSY13UCYlOiU P,ERMIY FOR SEWAGE DISPOSAL SYSYEji� lw ��a+4.dG. AJ 4 a zi L' *OGated ASS �/r ��e t a Tax Map Hlock rot Subdivision 1 `lr }$ a _ Subd .Lot q a.:.:.� a> Renewal a ❑ Revision z❑ ' Date Of Previous A royal Owner /Address pp '� ltl n 9.' y E/t� d"/Y LC'i�.3 >.�', w"'Oo A�i -V Fill Section Onl ❑ ` +, -�'y q t Number `of Bedrooms Design Flow �G /P /D P C Nt D Notification Required Separate ,Sewerage System to consistr of d Gal Septic Tank andu ` t To be constructetl by Address Water Supply Public Supply From 'Private Supply t0 be tlrilletl by r: /1 Address. .Other Requirements r A i4 1 represent that t'am wholly and 'completely`respon3ible for" "the design's nd location of jthe proposed sysfem(s) 1j that the separate ,sewage_ dis above. described wilCbe constructegass shown on the­`5ppro'vep. amendment thereto antl;in accordance w�th.the stariGards rules an , regu a ions o County Department of ;Heeith antl that on completron thereof as Certificate" of Construction'.Compliance satisfactory `to theommissionar,;;i be submitted to,'the Department "and a written guarantee'.will� De furnished: the ow'rier his successors, heirs or'asslgns!by the builder, that sak place in .good operaLng3. "condd!on any part of said'sewage` disposal system: during; the period of two;(2) years immediately tollowmg thedat ante of' approval of ,the Certificate :of'. Construction Compliance o4 ,flie,`original ' ty'item or any r®palrs thereto 2)rthat the'drille4fweU;Ce7 will be'located as o' !1 On;the approved plan and that said well wilLbe,instaIled ". m accordance with the:: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date IA A Re: Property of Located at (T)G �- Section Block Lot Subdivision of Subdv. Lot ## Gentlemen: Filed Map # Date This letter is to author i ze_,�O. r= 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 construction of said - system -or- - -sys-tems in conformity- Frith 'the provisions of Article 14'5 - or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, Signed '''vV Owner Pr Countersigned: / � ` P.E. , R.A. , # 111 y0 `�c�t��t }� Address a7Zl ,�y�..�,�r l Ff /�.AI 021 Town 76 2 �- 8'= Telephone perty. Joel Greenberg- Architect Muscoot No. /RFD N2 /h 488 Mahopac, NY 10541 j Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Pro er of Located at .13AP-a e v— SIT'eia"T' ThA., 6 f? PG= - 5 -� Section Block Lot Gentlemen: This letter is to authorize JOL-L' 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 CU1j1,eV Liw, wl eil 6118 ova c i ev aad . to. supervise ine construc ciun of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. �EREO qRc ov �,. Countersigned: O NV(d P .E ., R.A ., # Joel Greenberg = Arcliifect -- -` Mu oot North Address RFD12 BoX488 ;.. m.hopac, NY 10541 914 Telephone Very truly/ Ours, Signed Owner of Property 61 -Fr-_Z4Z IS PLACE • Address Telephone. 4. �. ` J PUTNAM COUNTY DEPARTMENT OF HEALTH DI=VISION - - -OF ENVIRONMENTAL HEALTH SERVICES = .........).COUNTY., OFFICE BUILDING, CARMEL, N Y. 10512 a . DESIGN DATA' SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner FZ�G C.t �? e( COST Address 60 ER—Rd M nQ6 Located at (Street) `"T. Se . Block Lot ; ;,......:.; ..:., .. :; ca` e_ nea es cross street) .. Munici.pa.lity_..t tv. ,4 Watershed SOIL. PERCOLATION TEST DATA REQUII&D TO BE SUBMITTED WITH,APPLICATIONS oe Number CLOCK, TIME PERCOLATION PERCOLATION —`dun apse Depth to Water Vater ve No ..:,.:,:.:.._...,_`.:.:_..:_::- Time From Ground Surface - in Inches ­Soil Rate Start -Stop Min. Start Stop Drop -in. Min. /in drop Inches Inches .Inches. 5 .. 2.._'2i l 2.;; 5 DrPT. Notes:' lj Tdsts to be repeated at same depth until ap roximatelgy equal soil rates are obtained at each percolation test hole. All data to be'submitted for review. 2j Depth measurements to be made from top of hole. DEPT G.L. 611 1211 . TEST PIT DATA REQUIRED TO-BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES H HOLE NO. HOLE NO. DZ �- HOLE NO 1, L �D - � 5 ©`L _ i 1811 .. ...... ..:... 241r . ,...... . 36" 7211 7811 84" INDICATE ID, IEL AT WHICH GROUND WATER IS ENCOUNTERED -- t`4 0 N C- INDICATE I.E VE TO WHICH WATER IZVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY oLg 2 .A ._� - _.___ - _..... .. �. .... ..... Date-2pl—n—tt. / DESIGN Soil: Rate Used.16-2t) Min/1 "Drop: S. D. Usable Area provided Joao !Sf= No. of :Bedrooms Septic' Tank Capacity 1006 S D e' Absorption Area Provided By_____L-F-x2411 t rench. Joel Greenberg - Architect- _. ltiame Mu oot North igna Ur -"' R02 Box 488 Address Mahopoo, NY 10541 S i} THIS SPACE I{'OR USE BX" HEALTH DEPARTP �� T ONLY: °F NS`j� Soil" Rate Approved Sq. Ft /Gal. Check6d" by —;' - -" bate