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Home My WebLink About3718DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.17 -1 -75 BOX 29 ru ti� , 1. i�,I I f lu �fi - �� LJ E ` 03718 Owner or Purchaser or Building Building Constructed by 'Location - Street Municipality Building Type (P Section Block Lot rAAa 11 — 61)e,-%ikrooff_ Subdivision Name /4- - 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'peri.od 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 undersigned further agrees to accept as conclusive the determin- -a -ti -,T -6m'--the- --DiY-e;e-t&r -of -- she Di W is -ion - of - -: Ern.,v ranme rntal- .•.HealF¢h-- S,ervi.ce.s ... _ 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 negligent act of the occupant of the building utilizing the system. Dated this 67/ of Signature ✓c �� Title Gam /l� S (J•�'� /�1 Corporation Name if corp.) 10 114d:_ 1,144 10A 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 ' t® Medical P.O. Box 99 321 Kear Street Labdratery5l Inca Yorktown Heights, N.Y. 10598 (914) 245 - 3203. - .... � .:o-.c• •;.a ... .. •� /jam. ..,, .., a _ •-s ......::a ..� ,. � a.. ��. BACTERIOLOGICAL EXAMNAMN OF WATER Bottle, No�_Date Co(I'd._2P ti Time Time Submitted lab,No. W -. Lab No. E:nt. Time Se't .Tests Requested Ird � Refrigerated? - Coll'd. •by. _ __ . , Agency CoII'd:`for- .Coll'd."from; Name�XA-7 -rjr,c 'f a &.a.�j 1St., Rd.) (City, Town, Village) (Zip Code) (County) Telephone °Identification of Sources Number 26 �= (� /�rl S3mpiiii9 Point �,� -�-� 11�c�'' • I MO111A 0 ml. Cdfiform Group ;, FecahColiform Bacteria per ml Membrane Method /100 MI. Tntal Coliform (21 ha 0 Lactose SG8 EC Vol. 24 hm 148 hm 24 hm 48 hm 24 his. 10. m1. 1 ml. 0.1 ml. MI. Sample SPC Bacteria Count MI. Sample Membrane Coliform Count Fecal. Count Completed Test: Pos. ❑ Neg. ❑ Fecal Coliform Sample Reported by: a_ e i'YI 7 These- results. indicate sample (was, was not) of satisfactory sanitary quality when the sample was collected. Date Reported:_ CHEMICAL EXAMINATION (Results in Miiiligrams Per Liter) ❑ Ammonia Free (as N) ❑ Arsenic ❑ MBAS (Detergents) ❑ Nitrites (as N) ❑ Barium ❑ ❑....Nitrates (as N).. _ ❑ Cadmium ❑. _ -.. El ❑ Chromium El ❑ ❑ Copper n (] Sotiluin ❑ Iron ❑ [� Sulfates ❑ Lead ❑ ❑ Oluoridts ❑ Manganese PHYSICAL EXAMINATION ❑Color Units ❑ Turbidity Units F] Odor Units [� Chlorides ❑ Mercury ❑ Hardness, Total (asCaCO,) ❑ Selenium ❑ Alkalinity.(asCaC%) . ❑ Silver ❑ pH ❑ Zinc The 'chemical parameters tested (were, were not) within the limitations of the New York State drinking water standards.. when the sample was collected. -rho results circled represent those In oxcoss of the limitations. a Reported by DATE REPORTED Al. IIE Ii l 1-1. I'AD0VAN1. M.T. (A.. C.P.) - DIRECTOR WEL OMPLETIDN REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL NEW YORK s report is to be completed by well driller and submitted to County Health Department together with laboratory report of lysis of water sample indicating water is of -satisfactory bacterial quality . before certif icate of conit . rUction compliance is issued. � � � . \ —f� ADDRESS LID N CA* Ll (No A Street) (Town) (Lot Number) PRO ED W1 DO MESTIC PUBLIC SUPPLY BUSINESS 0 ESTABLISHMENT — INDUSTRIAL FARM AIR CONDITIONING WELL OTHER (Specify) DR G EQ ENT ROTARY COMPRESSED AIR PERCUSSION CABLE PERCUSSION OTHER (Specify) WEIGHT PER FOO F1 THREiADED El WELDED P VE SHOE ---WAS IL YES NO C' SIN YES El SAILED 'HOURS PUMPED V_.x COMPRESSED AIR G.P.M YIELD MEASURE FROM LAND SURFACE— STATIC (Specitj feef)l DURING YIELD TEST fleet) Depth of Completed Well ILS MAKE SLOT SIZE DIAMETER (inches) IF GRAVEL IF G [PACKED: Diameter of well i.,I.ding gravel pack (inches): LENGTH OPEN TO AQUIF�R�71i (inches) DEPTH M LAND SURfA,cE FORMATION DESCRIPTION Sketch exact location at well with distances, to at least two permanent'landmarks. io' FEET, If yield was tested at different depths during drilling, I ist below FEET GALLONS PER MINUTE � . \ —f� T 'UNAM COUNTY` DEPARTMENT riOFHEALTH' y s `% ` •d�,v`Z� k Devi ;.ion of = Environmental Health' Services; i,arme/ N -Y 105.12 x CONSTRUCTION RERIIAIT FOR SEVIIAGE DISFOSA_L SYSTEM tJN qM A `/;��Q� -I..- k—t.Dry •Y e�.3 o�V7 V: +.a.1. e: -i^s, i:s .•:�Y. Block O ► ` n Lsy�ted�at "Tax MaP z.. r vin Village-_ SUDtlrvision y h'1�3�UO suba Lot q Renewal Revison',_ u �. .Owner /Address ' -•/ .Qti� i 7 Date OfPrevious', Approval 2� '. 1 Building Type Z c T� 1 O�� _ Lot, Area" ? Fill Section A. v Number of Bedrooms Design Flcw G /P /D 2 P N D Notification Requires F v Q . t$ Separate Sewerage `System to consist of G51 Septic Tank • antl To be constructetl' -by 1� � �E 7 Address � Water Supply PuDlit Supply From - k i Private• Supply to;'De drilled by gddress Other Requirements` t represent that f am wholly and cortipietely.rgsponsible for the.-design and location of the proposed sYStem(s) 1). that the, separate sewage disposal .system r §above.descrioed Will be''constructed as shown;an the approved.arrii ent thereto and �n`accortlance with the stangartls rules an ;regula ions of,,- e Putnam County DAepartment of•. Health and that on completion thereof a Certificate , "of Construct1on Compliance 'sat�'sfactory _ h!,-, Commissioner of Healthwill', be wbmitted'•to the Oepprtment . and a 'written guarantee, wjll be. furnished %the ownei his successors; tievs or assigns "by the bulllder tAat, sand buitCer will 1 place in good operating cond¢ron -any part• of said sewage. disposal . system.`Cunng the per�oa of two (2) years immetliafely following the.date of-the issu ante of:the approval oi,fhe Cert�f.icate of•,,( onstruet�on Compliance of'ttie'•o,ng�nal system -p!-a. ny repaus thoreto 2) that the,drilletl well'tlescritled above 'will be located as shown -on the approved planrFind-thit'said well. will be4nst�alt ''n acf�oiCa c with the, standards; rules and regu.a To s "-.of the, Putnam County. Department of Health ti % �� x S rx r /o , r , ,� , Date � R.A. , Adtlress 'License NoO�" ✓� APPROVED FOR CONSTRUCTION: This approve expires one yearfreomthe' date �ssurtl unless e' strucUOn of the building has been:undertaken and is a revocable for cause., or may',be amended or modif,ed when co'nsid"'a eicessary;by the •Corti ioner`of- Health .`Any.cliange 'r of conitrucfion' requires a new 'perms Approved ,for disposal of dome its ' s a e and /or w a_ter w Date BY, ` Title' s, r o. F Rely. 9-81 � '• s y .r �1 D /y/S%o/1 of bivrrohmeilfal Health :Services, Carmel, N Y.,: 10512: ' -z CONSTRUCTIONPERMIT FOR SEWAGE DISPOSAL `,SYSTEM < OCit d . at:- `°'!'.1'.�Li�•, -.elJr �% /.yY ':fir '• . ..'Tax Map' ry�� Block A!! ,,�-. j �a. :.... �/�1 . :. /( .. Subdivision' r " +A/P�O 1 'G+^CaVVRO0.. ^nomsubd. Lot .�•`�'" Renewal _� Revision - ?� ❑ Owner /Address KOLL. %AS .y�IJKERb -� :�Date OfPreviousABProval' Bui`Itlihg Type �y� Lot Art003 Fill section Only`Od' urr-be' Of Bedroo[n5. -- Deaign Flow G /P /D 0O ' P.C. H. ,D. Notification,'Required Separate, Sewerage : +System' to co /nsist of i2oo ! Gal. Septte Tank ` apd ' To be constructed .bY '% S-j Address BUCA Sft01' � i Water 5 uPPIY Public Supply From ✓ ., '1 ,LL1,.1 �tSR Private SuDP1Y•to;,be d►dled`yby Address . eh A Other. Requirements. I represent that I am'wh olly and completely re sponsible ,for the design and location of "the .proposed system(s)";- 1), that' the.separate,;; above tleseriDetl will be constructed as "shown onahe approved amendmentvthe►e :to.and in accordance with :the standard rules awn reg�i County Department - =, of Health and,ahat•on completion thereof,a CeiiificBte of Construction'Compliance satistac or kto'the jZ_., be'submitted to the` Department -and a written guarantee will'be furnished' the owner; his wctessors, :heirs or assigns by;tfle bulldi place ln good operating condition any part .,of saki sewage disposal'systemauring .the period'of two (2) years Inimediately follow an ce of the.;app ► oval of the- Certdicate of `:Construction `Compliance,;of the original system or any repairs thereto; 2) that t1►e d►i11E will;be located as %shCWn on the approved plan•antl that said well will be in I in a cor a ce. wit the 'standards, rules "anq` reguTsf7 County Department -•of Health s v N�f Date 3 ° -... Signed •� t t0. l iaS • " ' Address License N< APPROVED,, FOR CONSTRUCTION This approval expo es one y rom the date issu nles "construction' of the bullding'hast reVOCaDIe fOr cause Or may tie; amended or mod�f,ed when�coniiifeied n essery y the nlmi toner of Health. Any change osr alt requires .a new perrlrLi Appr for disposal o. domestic sew 9e e ,i Date+ BY Title 0 ralav t a 4t i4 1 g s t r 4 z fz a � xa F' agertlispowl `system ialon� of�Hsdlthwill'4. hat raid builder will thedpte of the iswi- • well described abovo �ot�';t e�'Putnam E w �Ar I n unttertaken 'and as _ '_ tbn�ot construction', .: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date p(�3 Re: Property of �0 LL / d- 0 Located at f�� D `Q Nt� �� ( r,s�lrLIirLj bee" e (T) Section Block Lot Subdivision of 6iLEr,LBr2-oog, Subdv. Lot .# Filed Map Date Gentlemen: This letter is to authorize . Nov -T a duly licensed professional engineer t/ 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 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, XSigned Countersigned `��' Own f Property S �' i P. E. , R. A. , # J��S oS Address Addr ss -c W;�-629 -4211 Z Telephone 1 Town ' Telephone RECEIVED JUN 2 P 1os- .3 DEPT. OF F E . FIELD CJ1E'CIC LL•S`r. Date: ' i InI.T_T711.L S:CTE ID1SPrCTJCJ ?: �OC.L I � 1Z Xes" No ust trees be removed -mote these . . .Is deep hole representative of entire SD,)- area_ -- Additional deep holes needed. . . . . _ Sufficient;. SUS area available considering driveWay cut, house location, separation .. . distances, etc. DEEP MOLE EA TA DDp•th : Water elevation.:.. Rock elevation: Soils de scr_i -,)t i on: Date: }¢. FINAL STTE -INSPECTION !Ins p , by: House located where 'sh. otm on approved plan � SDS located where approved . . . . . . . . :Inn�;th of tench measured 3�, -tr) t5 -- - - Widt.h of trench aver -;age Slope of the line and trench.acceptable . . . Room allowed for expansion trenches Over 50 ft : fr -om s►:7amp; l:aLercoui se - __ ......... _ _ .. _ Vat-oral soil not. stripped or SDS area —� =1ecessarily graded . 10 Fb. maintained - from prop .line and 20 ft. frorn house Sepxara.tion of trench from house, well -plan 'RTwnlier of bedrooms checks . . Stones, brush, * stw:ps, rubble, etc,. greater than 15 ft. from nearest trench 15 FL. of peripheral soil horizontally from trench Junction boles properly set _ Could surface rim off froin dr:ivcwoy, roads, • ground surface, etc. channel near SDS area. . . . . . . . . . . . . . . Doers lot dr. a.ii- i f,e app-dar 0. K. in area of SD.-3 -- FINAL GrMING OF SITE ACCEPTABLE �i . v Comnien %s ,Property lines or corners found . . . .. Gan estimate house , location . . . . . . . . Wilf' drivcway need cut N PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUPArf OFFICE BUILDING, - CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner KoLL /65 Address �0_4Kses i t�ELJ —cPK- Located at ( Street v,Cul 'Da Sec . tc(e Block !o Lot 4- nearer . ,cross street) Municipality laws \14LL" Watershed 1 C7 1-4 SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run apse Depth to Water Water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 2 30 Zo 2 Q3 /� 3/4 40 3 20 2 21 4 PEi�c R te- 31,-46- 5 �bL 2 1 3z, 2 2D :�4 4o 2..0 3 21 22- ► 30 �+ F_zcc Effli� 3 _ 4-5" 1 2 3 4 5 Notes: 1) Tests to be repeated at same depth until approximatelyy 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 BF' SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES. DEPTH „HOLE NO.� HOLE NO. HOLE NO. G.L. 'SoI �.- 6" 18" 2411 3011 )36 11 `F2" 48" e 5411 60" 66" ca- 72 78.. 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED VDZCATF: V' -T0,.�q��`�.C, WA�TF�R LEVEL... RISES.:_ AFmrER -BEING =- :..,.?CG.UNTERED::.:::. TESTS MADE BY Ko./ }- i2�'i7�k`t�J Date 8 , Soil Rate Used Min/1 "Drop: S.D. Usable Area Provided No. of Bedrooms � Septic Tank Capacity / Gals QC-ZF E Absorption Area Provided By L.F.x241' t �t ivame KT ;%� J �� iy bignature_ Address (,J�J �J SEAL THIS SPACE FOR USE' BY HEALTH DEPARTMENT ONLY: `��'RUFE� S a Soil Rate Approved Sq. Ft /Cal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CO'�TNTY OFFICE- BUITbING; ' CARMEL, N:. Y. 10512 DESIGN'DATA SHEET- SEFARATE SEWAGE DISPOSAL SYSTEM FILE NO. " Owner Address Located at (S treet �6Lc'>vgWf sec. 6(o Block (o Lot 4- �In icy' -fin eares cross street) Municipality lfl�,�l F� ?j, ' VJ)kyVa t ershed SOIL PERCOLATION TEST TA REQUIRED TO BE SUBMITTED WITH APPLICATIONS I - tz role r ,+xJ ;2g/ A1 j-t- -4 Number CLOCK TIME PERCOLATION PERCOLATION .apse Depth to Water . Water ve No. Time From Ground Surface in Inches Soil Rate Start- Sto... Min. p Start Stop Drop in Min. /in drop p Inches Inches Inches 1 3 i 7 F 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. 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" 24" 3011 - 36" 42.11 - 48" 5411 60" 66 72,. 78'• 8411 INDICATE LEVEL AT MHICH;GROUND WATER IS.ENCOUNTERED INDICATE J TEL: - TO�-W.::CH. I TER LEV-PL _RISES AFTER BEING ENCOUNTERED - TESTS MADE BY Z- t/ -SZZt l .. _.- - - - -_- Soil Rate Used / -i5 MirV1 "Drop: S.D. Usable Area Provided6//??C7 _ /7 4p"' No. of Bedrooms .3 Septic Tank Capacity X00 Gals. Type �e:�►2 -- Absorption Area Prided BY_ .31--C—'L.F.x24 nc . Address ure SEAL THIS SPACE FOR USE .BY HEALTH DEPARTMENT ONLY: � o o -`' Soil Rate Approved Sq. Ft /Gal. Checked by SS6Q►A PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISI0 OF ENVIRONMENTAL HEALTH SERVICES -COUNTY -OFF.ICE° BUILDING;- �- CARMEL; ..N , Y:, '10512 DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner u,i�_ Address Located-at ( Street 4;d;La!_ffa_t-fLV_n#Le F�. , Sec w 6 Block w Lot_; are s cross street) Municipality. Arm Uky Watershed SOIL PERCOLATION TES DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS . Tole - - -- - .. .. . - ., . Number CLOCK TIME PERCOLATION PERCOLATION Elapse- Depth to Water 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 3 - ^ 17 ZC> q . 4 2-1 - .2 . 1/7 Z.0 / C> Notes: 1) Tests to be repeated at same depth until approximatelyy 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 SUL3MITTED WITH.APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH; . HOLE NO. - HOLE NO. ... �, 'HOLE NO. - G.L. 6" 12" 181t _.. 2411 30" 36„ 42" 48" 5411 60" 66" 72" 7.811 8411 INDICATE LEVEL AT WHICH. GROUND WATER IS ENCOUNTERED INDICATE-LEVEL--TO WHICH-WATER LE.VEL:,RISES-AFTER -BEING ENCOUNTERED TESTS MADE BY - - - -- DESIGN, Soil Rate Used Min/l "Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacit y Gals. Absorption Area Prov de By L.F.x2411 j ''— width trench. Other Name Signature Address 'SEAL THIS SPACE FOR USE BY HEALTH DEPARTfENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Late rQuan %iounuy JASPL"WAM"" — avision of zavirommial Health servicot t�, . jurcs: Approved as noted for eonformance with ogble Wes and Regu3.Rti . Ons of the S Ev 4 4 4 W SFALLA I QW14D F(,)RTi P.rJ, TNA M y 2. TREtJC4r.S .2 *4 to R C, a i I RED t E*X PAIQS14.14 L CW&TM l6a .FEET. i P, W *Ir- ri,, LF-p4(5'r04 4 OZ. FF QT 'Fi, TiM 0.0 F. k•4. 14.L rO, DAY:, A-. 4. 4'0'.-FELr cer;.P... ja ).JO WELLS. ',,jtT4'j,'4 100. Pr- c '7 \A,r�*')�, 20 - OF PROP154TY NO SCPT'c -C) �7 BUILDER To 0 F-'SJ;LbjM6t T-0 PRoyitw- ."'FRAqv F"04 ro.�Ys m 3. ALL rR,F-E:5 wii-� INj M-) Ft:c-"- OF .4a6DR?r/04 Agc.� i T-o No. 1080 I NONVI. r4, i95 AS56ILr )t-, Tb CF-19TIFY 7"q4T DWb4RL -SySrEM W" C-WSTR&� A4,* 14ATct- . df4 Ptk--'!� P"P4 A/�m I?t-4T?/Ew-- rE-*+ V4AS ay H a- of ro"', /A-5 Coy Cz9b ov ez - TIc. -Sy 4eA WAs i'TI.4), M A-I 4a,0ZibA,,Xf-, -'rT4 'LL AAn 4Vd6ljj't&fT, Of Hf-N-T,4. 1- 7,11 in . t I Ap. 'W- .0- t r,% . i e, sEFTic, -bE-Si.-(dQ ' PP.E..X> TOv4,14 Of 1PLIJ1,1AM. -A-LLEI ?�TQPIH 4E,14H 402 W ErZT LAK MA ei t4:• S li-1 Of NEW,� �ow 0 0 O b 0 E �SS SSION m WOW IM- sEFTic, -bE-Si.-(dQ ' PP.E..X> TOv4,14 Of 1PLIJ1,1AM. -A-LLEI ?�TQPIH 4E,14H 402 W ErZT LAK MA ei t4:• S li-1 Of NEW,� �ow 0 0 O b 0 E �SS SSION ALP lio I i A - iv:_.� �izLL® f r J1 iv:_.� �izLL® f r