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HomeMy WebLinkAbout3762DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.19 -2 -36 BOX 29 03762 "6 MILE I IN me e ell 6-2 ME IN j .1--rg 03762 I certify that the,system(sj, as Isted,serv,ng above premises were constructed essentially as shown on'the plans of completed work (cop�es,of whwh.are attached),' and in accordance with the stand,rds rules and.regulations plans filed and th p'_rmit slue t utnam County D.epartmert of Health '•. Date �/' /�•`�/ 7J � y .. TT Certified b u� P.E. R .A. ° Addres /J L License NoZr Any person occupying p emses servetlrbyrth, above systems) shall 'promptly take suc ctwn as maybe necessary to secure the correction of .a unsanitary conditions resulting' from'suchlusage Appiova( of the separate` "3ewerag'` ms- II become nult:'and_vo d as soon_as a public sanitary sewer becomes ._ available and the approval of 'the .'prrvate "wa1er,supplyshall becorrie and void- W ; a public water es available. Such, approvals are subject t' modificat, n or `change when ,n the judgment of Commissi Health, su rev tion,: modrficatw , or change is necessary. • 4 / t ! e r a COUNTY DEPARTMENT OF HEALTH 47 ,1'UTNAM y DiVis,on of Envionmerita lth Serliices Earmel N Y , —D!' j#j faEe?�i EL E� S. N- STR�3:a�T-er-+ A!-,;_6-F:, r i? ' FAVAVAas POSA L. S` -ST —FAl.. T own or Vill ge'y i �w Located at_ Section Block T� - ' ^i 1, A�L.syK� Lot '.Owner - Job. !g nn l p built. by Address _ Amp' VA e-, V. %T Separate Sewerage System _ _ _ 1 �L ©� 'Gal Feet 3 width = -. Consist,ng ofF ;Septic Tank lineal X trench Otli "er requ!rements Water Supply Public Supply J..rc m , ] x �ES�LtiJS VNL1M 1T1$tp �Uai%A� •.= Private SupPly,.'Dnlled By " 'Address � Building Types t`rLE No. of Bedrooms Date Permit Issued ` Has Erosion Control Been Completed��5' I certify that the,system(sj, as Isted,serv,ng above premises were constructed essentially as shown on'the plans of completed work (cop�es,of whwh.are attached),' and in accordance with the stand,rds rules and.regulations plans filed and th p'_rmit slue t utnam County D.epartmert of Health '•. Date �/' /�•`�/ 7J � y .. TT Certified b u� P.E. R .A. ° Addres /J L License NoZr Any person occupying p emses servetlrbyrth, above systems) shall 'promptly take suc ctwn as maybe necessary to secure the correction of .a unsanitary conditions resulting' from'suchlusage Appiova( of the separate` "3ewerag'` ms- II become nult:'and_vo d as soon_as a public sanitary sewer becomes ._ available and the approval of 'the .'prrvate "wa1er,supplyshall becorrie and void- W ; a public water es available. Such, approvals are subject t' modificat, n or `change when ,n the judgment of Commissi Health, su rev tion,: modrficatw , or change is necessary. • 4 / t ! e r a BACTI RIA'PER ML. (Agar plate 66tint.at.35, C)', 8 COL'IFORM ..GROUP- .(MosUprobable No.. TOOmI.) LESS THAN 202 ,', ARDNESS;J TAL =:ppm ;± DETERGENTS - "ppin NITRATES (as N) - ppm IRON ;'TOTAL - ppra Westchester County Department of Health Division of Environmental Sanitation Ol�d�?I✓�TK$NEPao�`� . �:� _. �... -...� �.� .. .� �•.. ��. r .. •�,�. This report is to be completed by well driller and submitted to Health Department, together with laboratory re- port of analysis of water sample indicating water is of satisfactory bacterial quality, before certificate of construction compliance is issued. Well Construction to be in accordance with Bulletin SD -62 "RULES £3 REGULATIONS RELATING TO INDIVIDUAL WATER SUPPLIES" LOCATION: MUNICIPALITY Mahop c SECTION BLOCK LOT WELL OWNER: Quiet Stream Homes, 236 Millington Road. Peekskill, New Yorl� Ou Name Street Address City and Town WELL DRILLER: Designs UnZimited_ 104 West Mountain Road;_gidgef , CT 68? Name Street Address City and Town CASTING DETAILS YIELD TEST WATER LEVEL SCREEN DETAILS w Hardpan Railed measure From land surface) Soft— broken Zedge Length: 90 Feet or Granite Ft to Ft. -AX-Pumped 7 Hours Static: 17 Feet Make: None Ft. to When Bailed o Diameter: 6 Inches Yield: 30 G.P.M. or Pumped 185 'Feet Length Ft. Size Kind: - 17# Ft. to Diameter In. TOTAL DEPTH OF WELL — 235 FEET 91W1!_a r !r. or llrcha:.cz� oL' built in.- Akinica. {,,il ity C by See tion •��� �tivn Street Block Aii',g I�YjJC' Lot . GUARANTY or sr,mP,ATE S17- ?AGE SYSTEM e I represent that I am wholly and coi.pletely responsible for the location; . hianship, material, :construction and . drainage of the se;-.,age' disposal sys fiern ij)- the above described Property, and that it has b, en CGnotructcc: as sh�::n o:i approved plan or approved ari.nnd-ment thereto, and in GCc0rc:.nce with the standa- s and regulations of the Putnam County Depar t!:ier•t of Heal t-h, and hereby c u ar -r ':)c'' oc�ner, ills SLICCE'SSOYS, i1e1r5 Or ZSS1on5, to place in oeoci op`rutlIia Co:sC: )art of sai.I .system' constructed by me c.,hich fails to oae.rate for a period o �. immix li0t`ly follc:,in- the date of initial ,use of the sec,-age disposal s;',. , �epaiz,s . Made b.J me_ to such system, except cohere: the failure to operate p9- L1JE't/ _JJ �' l,lE Sy1111ul US' 1'. L'k'l t t,l i di: i lJl 111L Ut i ii PUJJ (- v1 L cc: ..u. .�.: �a.b u? • e_. The undersigned further agrees to-'accept as conclusive the dc� Director of the Division of Environr, ental Health rv.a.ces of .r.;ent of I calih cas — t'. nether or not the _ fs.i!_ur- Gi he syStemn , t by the_ c:- il]-ful or hegIJoei,i -L act of the occupant of the build this lay •f �' c :.-v 19 7_S Signature Tale �'':. (if corpora`... . 3) COPIES ARE hECUZRED WITH THREE (3) COPIES OF LETIO\ WILL DE ISSUEll. IRIS RT"0UI:I;rD i0. F.TLr \OTTCE Or. MATE Oi I'fi`. ----------------- _ --- ------- --- �--- .: - ---_.. of Envirojimental }Iealth Services, .P�tttla�,: r A k=r5 above described,will be constructed a:sz.thowrilgri the approved amendment t here to and in accordance with the County Department �df° Heialfh, and 'that 'on completion thereof &""C'ert&.`cAe""4 - Qnstrqction'6-ornp'li6nce! be submitted to the Department, and a Written guarantee will -bje furnished the owner, his"SuccessorS.r h.ei 'place in good operating; condition- any part :.of. said sewage disposal. system during ' the period - 'of two (2). A' ' - ' - _�5r!gi_nal'.iystem-_' ' ante `'oi'-the the'kbrt'ifi`6A'te.'of' -onsirudtiah't mON tor an will be located is shown on the approved plan and 'that ,said :well will be installed i n accordance `with the stan Health .6)(intg Depart t f H al �m n, -_I , e Date Sig6bd -,-''Ad r6ss y A I PPRQYED FO'R CONSTRUCTION ' :-' t h ii'appr6va I.,d'x p ire -to d , ate .issue be amended gry by -the Cc .revocable, for cause or may, madified_�wheryfqhsjqe!e'd- �yibquiiev-a fiew, Approved 4'__ -,dispqs_al,of,.qc�*itic_- 1-4r-y-' .:S e,, pri (iY1 Date' —Tr, L9 l,'q, By -k. ­gatisfadtoVy to the Cornmissibriier of'HealthWill rs or, assigns bV the builder, that said.b6ilder Will years immediately following the'date of the issu- 4" - d iheretd;'2) - that, i the drille, • well'd.escribec[L aboVe . dards, r6les: anio"'reg-Ma-TI-ons Putnam.i of the P.E. RR A. -_LAcbnse No. A/ ion of. the 'bu - Ming ha-ibeen. undertaken and is of Health change or 'alterdtion of construction ?T'itle PUTNAM cnUNTY DPPART`FM,;T OF HFArMf . DIVTSTnN OF I; \VTR0V-F\TA1, HEALTH SPRVTCES Date i %1171 �4 Re: Property of 00 G C, 5 -T rz, k., M ji-© "C-s Located at Section Gentlemen: Block Lot S This letter is to authorize V11Yng —vI Gr a 'duly licensed professional engineer k"' 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 systems in conformity with the provisions of article 145 or 147, Education Law, the Public Health Law, and the Putnam ,County Sani- .: s, _. - .tary Code... Very truly yours, Signed Owner of. Property Countersigned: 3C 1% /4lAJhi'o' P0, ,/' �c"dd5 ![ &t. Address P.E., R:A., 4 3 -6,, �'GyL1, ti Telephone Address Telephone &,�C, r - - r 3 J � y C. `o .t PUTNAM COUiiTY- DEPARTi INT OF HEALTH �'a'r•:', • COUNTY OFFICE BUILDIPiG, CARNLL; N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Qv,, F.•r rzep►w% Address tiU_iA t- T_0Q 'Z® 4�C,V-salu_ Located at (.Street Lune» z-tn.�7 Sec. Block Lot 6dicate nearest cross street) Municipality ��z��� �,'(�:�L,� Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS oe Number CLOCK TIt-:E PERCOLATION - PERCOLATION Run Elapse, iep to Va er Water Levei No.. Time From Ground Surface in Inches Soil:Rate Start -Stop Min. Start Stop Drop.in Min. /in drop Inches Inches Inches. i1 1 �0 8 -q'a3 2� I�'' - �C(Vz. 3 g 5 l - . 2 3 - - 5 Notes:. l) Tests to be repeated at same depth until an proximately 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. i� 59 (Gb 19 5 - • 2 . 2 q : 10 Z 1 'S& 3 10..22 - 1 !2 30 5 l - . 2 3 - - 5 Notes:. l) Tests to be repeated at same depth until an proximately 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. i� SST PIT DATA REQUIRED TO BE SUDIMITTED WITH APPLICATION DESCRIPTION OF SOILS. �•;; ifo' -r x 4-t• a K � Y t �, e- i Y _ - } - itz �,.� t �"' .1} ° - ew: s:: in•.+ �- u.- �- aaz �,- �sx— �a- a- :�xnv- mbv.�•w...� -. - - - r _ :.:cs^rrsc= iv.- ".�iF± - -• .. - s r • - � - yay�. — � yr ,." *� . �. � � ,. � •-� `: : S4L .. _ - � ... Y _ Olt VIA A Fr 4 Sit 4 -s. L_ '4 432�� i ... � _� .. •.. off- - *A X a — _�: � � � _...�•-- --'-sz =mss n� h' Y -: VV �S `r�•� F` /iJoa1'or forrnerJc� ' O xt S /o° 11 =moo `vV 270- o' s�" r3a SA. srw `I NZ �• fl n A u J ,,o ti P <6 270. 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