Loading...
HomeMy WebLinkAbout3802DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.12 -1 -2 BOX 30 17-2 ' . , -' -`' , 16 1 ` �' L L I `.T � . I Tp 16 f m* S.� . I '.� T 03802 z j PUTNAM COUNTY . DEPARTMENT ;OF HEALTH Division of Environments/ Health Services, . Carm% N Y 10512 MICA TE OF CONSTRUCTION COMPLIANCE .FQR SEWAGE 618 SAL�_SYST �: i 1 at Village `# Tow Tax Map � L021' L— Block o4. a Sewerage System built by —I lob 0 Address i>! OA0 Consisting of. .Roo —�-- -Gal. Septic Tank and — / J'j FTC 14 r9E_AJQ4 Other requirements uPPly: Public Supply From Private Supply Supply Drilled By Address `�JI✓/✓. III Type .` edrooms ` Date Permit Issued son Control Been Completetl? _ that the system(s) as listed serving the. above pr'" and in accordance with the stanilerds, rule n - e9� s.shown on the pi ns of the completed work (copies -of which are a perm issued the Putnam County Department of Health. Address ®1 r P.E. R.A. ; )n occupying. premises servetl by the above system I� C; r lO� se t_ can resulting from such usa e q ` No AWw I 9 pproval .of the. separ Z° ch action as may be necessary to secure'the correction of, any unsanitary and the approva6 of,•the m;sha1I become null and,-Ill id as soon as a public sbnitary''sewer becomes private •water:,supply -shall become n modification or change when, in the judgment of the:Co mis vneid -when Healthp,such rev omes avai able. Su tlon; ch approv Is; bec, I a are ication or change �s �lecessarv: 1,d L ?! _ By-.- a �s�SC.MK4 S3 a'X .3 �� --�• BEAU Z ol ii T QF y DEPAR N y X057 zTy THE Carmel N i4LL. t t pUTNAM CO °Health: S Ices ery ;z ental p ,Ila9e of Envlronm e� TOw" Division Mme, a Ma'; a c IOCk s; OR SEVW .lop" - -,� + 'UCTI L Lot L, AL p ddress d re Feet ate at 54ua A4 ad,vision w,dth trench 3 L: s) 4 LOt Area Total Hab,tab le SPace vner r . lineal feet; r T anK Ab �ddin9' TYPE 0.� Gal Septic v a lumber of Bedrooms t separ wer`a9e' System to consist of a Address _` ate Se r r constructed bY'' prom �` �_ Public SuPp1Y atepply*_ / to be. drilled by I, Su W .. A/ Private SuPPIy <' all Sewa a `d�sPOe i S� nam 6 � 9 s _ the P t Tess ° S hat regu at,ons ° ealthw�ll Add / T O d SYstem(1 rub and ner of H • , Y" �E N _ "7 of the PfOp the standards the COmm'SSl °' ilder will a w,th% Sat�sfactorY to that Said bu. cots' t din:accorda Compliance ns +bY the budder the date of the issu Other Requirem r�spottsil °�strucLon r assi9 above IetelY , , hers o n1ed�atelY follow m9 escr�bed am. COMP ner h,s Successors,.- 2) years'•�r" the drilled well d Putnam il whollY.aucted as_Shown:on the. h• er,od! of two ( that ulatl� the resent:fhat 1 COMP r the P a,rs thereto 2) 1 reP will be coast_ and that on , J m or any reP, rules and re9 above described Health, a written; I_,gystem th the .5 dards EountY Oepartrn the pePartm and hart of :; wag ant any P ct n ,C d be submitted t °. colnd�twn f Con in good operatm9 file Cert�f�cate o plate roval O - , roved Plan a" ance of the app the aPP n n on.. e located as showf Health /CS ned ll b Men.• , art_ / bu Id,n95has been u" ofr construct o" rrountY DeP O` of the a or alterat,on _less construcUOn. A "y..chang . 2 e o • 0 issued f Health date �- issioner only pate Address ,res by the Co ply Thin approval n r r to Tale ` ONSTRUCTION r i'nod�f�ad'when'cons� n s W �Yr OVED FQR'C a be amended o Osal of domestic APPR use or, m Y r..:disP x'evocable for W- . �t ppr w �eW.P.d� BY re4oires :a : t. YORKTOWN MEDICAL LABORATORY INC. Yorktown Heights, N.Y..10598 P.O.-Box 99 321 Kear Street 7. 245- 3203. #989 DATE COLLECTED RESULTS OF EXAMINATION OF WATER 10/6/78 WNER DATE RECEIVED Litzrodt Edgar 10/6/78 ;ITY, VILLAGE, TOWN VOR NAME OF SUPPLY DATE REPORT D Oseawana Lake Rd. Put Valley N.Y. 10/978 +AMPLING POINT New Well 3ACTERIA PER ML. (Agar plate count at '35 C). COLIFORM. GROUP (Most probable No. /100m1.) OnnFL� HARDNESS, TOTAL.- ppm DETERGENTS - „ mg NITRATES (as N) - Mg /L " IRON, TOTAL - Mg /L HMMUNIa t C-xzz tas N w mg/L These results indicate that the water was yes of a satisfactory sanitary quality when the sample was collected. d. A. H. PA A , . T. (ASC ) j .. SMELL COMPLETION REPORT 3/71 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. Tepprt_eV 2f iater sarlpl indirav' "V #ater�is- ef.satis5"tr�ry oacterial yuaiitV66fofe certificate of'construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME EDGAR LITZRODT ADDRESS OSKAWANA RD. PUTNAM VALLEY LOCATION OF WELL (No. & Street) (Town) (Lot Number) OSKAWANA RD. PUTNAM VALLEY PROPOSED USE OF WELL BUSINESS I Al DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL PUBLIC AIR OTHER ❑ SUPPLY ❑ INDUSTRIAL❑ CONDITIONING ❑ (Specify) DRILLING EQUIPMENT ❑ r-,5;1 ❑ OTHER ROTARY A R PERCUSSION PERCUSSION (Specify) CASING DETAILS LENGTH (feet) 211 DIAMETER(Inches) 6tt WEIGHT PER FOOT 17# E� THREADED El WELDED DRIVE SHOE YES ONO WAS CASING U E 7 YES NO YIELD TEST HOURS G.P.M. ❑ BAILED ❑ PUMPED COMPRESSED AIR 6 70 YIELD (G.P.M.) 70 WATER LEVEL MEASURE FROM LAND SURFACE — STATIC(Spec /7y eet) 101 D feet) URING YIELD TEST i 1051 Depth of Completed Well in feet below land surface. 105, SCREEN MAKE NONE LENGTH OPEN TO AQUIFER .(feet) NONE DETAILS SLOT SIZE NONE DIAMETER (Inches) NONE IF GRAVEL PACKED: Diameter of well including gravel pack (Inches): GRAVEL SIZE (inches) NONE FROM (feet) NONE TO (feet) NONE DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET 0 5 GRAVEL. WELL IS EXPOSED 18" ABOVE GRADE: OCT 1, 0 0197 PU1 N IA,"VI COUN.T.Y PEPS QE �gim 5 21 DARK GREY GRANITE. DARK GREY . GRANITE.__ If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE' DATE WELL COMPLETED 9/22/78 DATE OF REPORT 9/27/78 WELL DRILLER (Signature) ..� Owner or Purchaser of Building Municipality Building Constructed by Location - Street Block I��'1 O�i✓�i92 _ C,1� -,� 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- sons, 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 :Wade 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 Ser- ..vices of.., the Futnam County- Department- o=f:- Health as_ ton° „T�rhether. ,o_r.:not:',the_.: ` failure of the`systemrto­operate was caused by the willful or negligent act of the occupant of the building utilizing the system�.r Dated this day of a ' C 1970 Signature C,14- - T i t l e ve 4-P r- 1-, 0: If corpo ation, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP ±TETION 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 REVIEW CHECK SHEET ' (Meets Std. Remarks' . IYes 1 No TT House plans O.K. Y Design data sheet Peres presoaked? Min. 30" perc test depth 'Const. results for 3 runs j D. Hole log O.K. Corporate Affidavit for other than individual Authorization for engineer Letter from Water Supply if applicable of-- If variance requested -such noted.on plans & apps.: DETAILS = if change is proposed,) Existing contours shown show new contours) Slopes for driveway cuts, etc. shown Xater service line location Footing drain, etc. location Top slope, bottom slope of fill a Percolation tests and.deep test pit location Septic tank size and conformance to std. 3 B.R. house minimum E i House setback shown ( I Distribution box ftg. below frost All water within 50 ft. of PL shown �. Plan and profile SDS All. other wells and SDS closer .2QQ! or= refereno& made­` - -. Property boundaries (metes and bounds- clearly shown SEPARATION DISTANCES SPECIFIED ON PLAN 10' to P.L. 201*to Foundation walls 100' to Nearest well 50' to stream, march., lake, etc. 15' to Curtain drain 10' to water line (pits -20' 15' to storm drain 101'to large trees 0' from foundation to septic to 5' to pipe from leader drain &. .expansion N •'r. 1' fh i�T n f(1('1 1r1.T;•PL .Property :Lines or corners found Gall estimate e house location Will drivoi•;ay need cut . . . . . . . . . ... . MUSt trees be removed -note these Is deep hole rep »esentative of entire SDS area M..d_i_tio.nal. aeen holes needed. . . SuJ."ficient SDS. area available consider1n dri-veway cut, house location, separation . , . distances, etc. DEET ROLE L' . PA D;,pth •'later elevation: Rock elevation: n� Sails descrinti on: Da te: FII'v?AL SITE IPISPECTION Insn. by: Irisp.by: House located where shown on approved plan S:i�.� located "where approved ... .. , . , ... 1.1'i i•!t-h art' •1 -v..r �h .+__.. r.. .. .. .. .. .. .. _ / + 1 Slo�:e of tile :lino and' trench Ecceptable'.: Roos, allowed for expansion trenches e , e , e Crve,r 50 ft. from swatlm,tiratercourse Natural soil not stripped or . SD3 area e o e a 10 Pt. maintained from prop . line and 20 ft. from house . , e , . , , , , Separation of trench from house, well etc. follo -Is plan' . . . • . e . e . e _ Nwiiber of bedrooms-checks e . . Stcnes, brush, . stumps, rubble, etc. greater than 15 ft. from nearest trench . . . e e ?. 5 FL , of peripheral soil horizontally from trench o e . . . 'Junction boxes properly set Could surface run off from driveway, roads, ground surface, etc. channel near SDS area . 1. . . . Was lot drainap,e annear O.I.. in area of SDS FIRA_I, GRADING OF SITE ACCEPTABLE A A, A rum OT my; g TE P MAT'- v 62, j4 tat R Gloria rodt L oil Roadj Putnam IM: 113 04 L6 6' L STA ''thil4 IT, dt t­ e t i s U b z t- flu. tor' 'h, ­,prof!w ...... k:�tt eir ot n tz do:' �ot­!Aba abav- not,ed ' pr. p . ps +V1-: PtX t M 0 C 4' n e "At of and- ­tb.:' J9, Im eba th E! I 7777:: the 6T s 6on 'o-Tmitly P obd 0. O-At%l . jj� 6h I�xv h1le i>'u+;61"-"I' .4d y' YYQ si awtLng k ROad � Valleyf � 16. resb '14J IT f/r � f U L1 11 1 5 �4 F p owl PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - - COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. OwnerAJA L 1T'ZPop -r Address 0Sca.u.�A, x V=6 g.04,n (% L.c �J 4x HV Located at ( Street �k s�4 Lij/ i� maD . j 13 Block (j�Lot n'ica e near s cross ss reet Municipality 2av�LN ? " C•Ct(4 Watershed lKS10i'L L4 au IL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION apse Depth to Water a e— ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 1 C/ •�'Jj �� �� / �� Y'�!J !� Y /�'� 2 g JT ,3 © 22 4- 5 e 1 m u 5 1 2 3 4 5 Notes: 1) Tuts 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 SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE N0..&,6.,o0 /7�,cjg- 61f 14 1211 61,ki 18" 2411 30" 36ff 42't 11 48" 54 if 6011 66" 7211 ro 7811 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH W TER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date 7 ;? Soil Rate Used r4/1"Drop: S. D. Usable Area Provided 7 1 No. of Bedrooms Septic T,7,nk Capacity _Z0-0-v_. Gals. Type Absorption Area �Provided By_;17-� _L. F. x24 __.�yidth trench. Address THIS SPACE FOR USE BY HEALTH DE Soil Rate Approved Sq. iii L Date