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HomeMy WebLinkAbout3807DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 83.12 -1 -7 BOX 30 1 16 rIL� .6 I , 6. 1 r 1 03807 PUTNAM COUNTY DEPARTMENT OF HEALTH permit # Pyr3__ x_!81 `,_ y .. b^.; ���.rvEranmpn+l Nlesl Services. Carme% N. Y. 10512.. 501976. .. . Town or Village C ERTIFICATE _OF CONSTRUCTION COMPLIANCE FOR SEWAG E DISPOSAL SYSTEM �. 4 Tax 14aP 114 Block Located at Oscawana Lake Road Tax Map Lot # Pal^` I • l„ba' T°t � 3 owner M/M E . Austin .Rader Formerly Construct "o Address Peaceab-1 a Hi 11 Rd Brewster NY -10509 CerliCft � n Separate Sewerage System ° *1250 340 L.F. x 24" We Trendies Consisting of —Gal. Septic Tank and Other requirements None *Tank sized for ossible be addt`tion water Supply. Public Supply From X M111 Dr111in Co. Inc. Private Supply Drilled BY Brewster, NY 10509 Address 9 / / $1 No. of Bedrooms Thar -- Date Permit Iswed Building Type Frame Has Erosion Control Been Completed? Yes as shown on the plane of the completed work (copies I certify accordance rules and regulations, se accordance with the filed plan, and the permit issued by the that the systems) as listed serving the above premises were constructed essentially of which are attach OP Health with the standards, ' Putnam County Department P.E. R.A. 1 December 1981 Certified by 29206 cor.0 Date R.D. 9, Fair St ee Carmel , 'NY 0512 Livens• No. Address to Secure the stem shall become null and void as soon as •public sanitary Sower o als are arson occuPYin9 promises served by the above fSystem( the sesparat shall sewerage promptly such action as maywa � necessary becomes •variable. to Sucha +DD non arY Any P Approval conditions resulting from such usage. APP shall become null and Vold when a public o modlfication or change is necessary available and the approval of the private water supply of the Commissioner of Health, such rev subject to modification or change when, in the judgment TItI* By Date - - — Rev. 9-81 _ _.__ _:_ - - - - -- -- PUTNAM COUNTY DEPARTMENT .OE..- HEALTH..._ �l Division of Environmental Heaith - Services, Garinel, N.- Y. 10512 v CONSTRUCTION PERMIT FOR S. EWAGE DISPOSAL SYSTEM T. Putnam Valley Os caWana Lake Road 114 Town or Village 4 Located at Tax Map Block Subdivision Walnut. Knolls -File . # 1649 -Lot 3 Lot Part of 1.1 Job S.O. 1976 Owner Mr. & Mrs. E. Austin Rader Address Floradan Lodge, Oscawana Lake Road Building Type Frame Lot Area 4.561 Acres Putnam Valley, NY 10579 Number of Bedrooms Three Design ��/jyy0 600 Total Habitable Space Square Feet Separate Sewerage System to consist of Gal. Septic Tank and 350' x24° wide trenches To be constructed by Water Supply: Public Supply From X Private Supply to be drilled by Address Other Requirements None t V 1 I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations o e u nam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed in accordance with the standards, rules and reg-Maions of the Putnam County Department of Health. o Date 21 August 1961 Signed P,E. X R.A. Address P Q Fair qt,, (:armpl, NY 10512 License No. 29206 APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and is revocable for cause or maybe amended or modified when considered necessary by the Co issioner of Health. Any change or alteration of construction requires a new permit. Approved for disposal of domestic sanitary sewage, and /or ,vat water suooly only. WELL COMPLETION REPORT 3/71 d d' 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. REPhRI: MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME Robenat Contractors, Inc. ADDRESS Oscawana Lake Road, Putnam Valley, NY LOCATION (No. 8 Street) (Town) (Lot Number) OF WELL Oscawana Lake Road, Putnam Valley, New York - F-1 BUSINESS ❑ ❑ PROPOSED DOMESTIC ESTABLISHMENT FARM TEST WELL USE OF WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ ❑ (s(specify) CONDITIONING DRILLING COMPRESSED CABLE ROTARY A R PERCUSSION ❑ El (peiyEQU PMENT PERCUSSION (Specify) CASING LENGTH (feet) DIAMETER(Inches) WEIGHT PER FOOT X 1:1 P.LIjVE SHOE IXIYES E] W CA NG 7 y �NO DETAILS 20 6 17 THREADED WELDED NO YES YIELD TEST HOURS G.P.M. ❑ BAILED ❑ YIELD (G.P.M.) PUMPED COMPRESSED AIR 4 15 15 WATER MEASURE FROM LAND SURFACE— STATIC (Specify feet) DURING YIELD TEST (feet) Depth of Completed Well LEVEL 60 260 in feet below Land surface: 260 MAKE LENGTH OPEN TO AQUIFER (feet) SCREEN DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL Diameter of well including GRAVEL SIZE (Inches) FROM (feet) TO (feet) PACKED: gravel pack (Inches): DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two landmarks. FEET to FEET permanent 0 6 Soft Clay & Boulders SAS 6 260 Hard Grey Granite 1AlE��. N IL -� �E C'E1vED "C If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE �EA� H PVT144- of, . . 4 , DATE WELL COMPLETED DATE OF REPORT WELL DRILLER (Signature) 9/25. 1 10/2/81 N,W TILL DRILLING/Ca, , INC, , RbIJGI`t ifi, IV1111, Ere�s`laenr- ,; WATER ANALYSIS REPORT SAMPLE NO. 4691 SOURCE: Robenat Contractors Well Lake 0scawana Road Putnam Valley, New York COLLECTED: September 25, 1981 BY: Mill Drilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 0 per 100 ml. Thii ritult ixdicater the rource of the raetpli war of talirfactory ..rant quality tvAemi thi sample was collected. ECEIVED DEC 3 1981 PUTNAM COUNTY DEPT. OF HEALTH September 30, 1981 Bickwit P. E. Director Owner orl urc aser of Bui ding Owner.- `Building Constructed by Osdawana Lake Road' Location - Street Putnam Valley Municipality Frame Building Type i f� 114 Section 4 Block' Part of 1.1 Lo t Walnut Knolls Subdivision Name 3 - Filed Map #1649 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 undersigned further agrees to accept as conclusive the determin- - -.-ation -of . -.the. -.Dir.ecto.r:._ of -the- Division - -of :Environmental Health._.Service.s._.._._ of the Putnam County Department of HealtYi as to_i4hetlief` -or riot'"tW -e 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 �� day of /__19-0/ Signature � A Title_ RECEIVEDt:� Corporation Name kif Corp, DEC 3 1981�� -�- Address��1� PUTNAM COUNTY 10509 - - - - - - - - - - - - DEPT. -OF WEALTH - - - - - - - - - - - - - - - - - - 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 EwgenQ' A. Rader 114 Owner or Purchaser of Building Section Owner Building Constructed by Block Osman Lake Road Location - Street Putnam Valley Municipality Frame Building Type Part of 1.1 Lot Walnut Knolls Subdivision Name 3 - Filed Map #1549 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 undersigned further agrees to accept as conclusive the determin- �_ - the -Dirk or ..� . ^C•iSe .riZ�T�I 1l flj� f. Envir.ni uffi_ t ..1.H6altb- "S-ery .ces 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 syste Dated this 1St day of December 19 81 Signature f ,v -2, RECEIVE D Title Own;r Co oration Name if co DEC 3 1981 PUTNAM COUNTY Address V DEPT. OF HEALTH 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES. Da to 9e Re: Property of MZM Located at ©Se ff"ana► Locke Block ¢ Lot /per acs L,1 Gentlemen • "'&447 4-e )k* "-S;„�qr —/�i /� ld#?— L.0_- #,3 This letter is to authorize John H. Prentiss, P.F. a duly licensed professional engineer XX 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 Lv1l1iC4 L1V11 w.L f-rl Ut_L6 ma is i ev anLi to. Supervise ine curistYUC ciur! ox saia system or systems in conformity with the provisions of Article 14S or 147,. _ Education_ Law, the Public Health Law, and the Putnam County Sani- tary Code. rs .E., RW4 F PR fN � s91 yF`9 292 THE STASE R.D. 9, Fair Street Address . Carmel, NY 10512 914 - 878 -6170 Telephone Very truly yours, Signed • Owner of Property Si'dLd�CYHe{ 4eYk� �Ct'� AaILZ. dAM l�d��ev� /V• Address ✓ /off Telephone AUG 2 8 1981 PU NIAAY1 Lti.::.}:`iiMY DEPT. OF HEAL "I'li FUTNAM COUNTY DEPARTMENT OF HEALTH _-DIVISION .OF, ENVIRONMENTAL HEALTH SERVICES' COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE 170. Owner Address OSegAZaA2fit 49Z&R eA iz,W Located at (Street), CA&CC-A Wer- Block Lot, 02� (MMIca . nearest cross str MAI. Watershed . AinidlpaUtY2 --JIF SOIL PtItOLATION TEST DATA .REQUIRED TO BE SUBMITTED WITH.,APPLICATIONS, hole Number ..-.....,CLOCK -TIME PERCOLATION PERCOLATION 'un Elapse Depth to Water water LUveT Time From Ground Surface in Inch&:g Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 2_ K 0Fr5jvEU 1A-U U P 1i DES T. Notes: 1) Te'sts to-be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. Depth . measurements to be made from top of hole. DEPTH G.L. ON j' 12° TEST PIT DATA REQUIRED TO- BE SUBMITTED WITH APPLICATION . DESCRIPTION OF SOILS ENCOUNTERED IN TEST.HOLES. HOLE NO. /. HOLE NO. .HOLE T 1A v._ e '• e� r�,�ddn i 't d era,d A d r, I Ih• E a rdi /on S�F.c' loo A l' i 1 Yt Y ra i j i'. 7"{ r f �g .'t u - G•! N!F C A Z w Q) h Well located by:. Surveyors sur -vey.- Well Arlllers report _ -- Engineers mesurements_13- - Tank, boxes, pits, gallories 9 laterals located by:Contractor: Engtneer. Heaithda,pt: - Field Inspection by: Health dept.® date:- /��� -, Eng•Ineer ID date:- r1!%��!- NOTES: '°!B•A°:�. . /.2/!b ,Tv +1 k' 1- nn!-+v! /eql Fmi Fo��fb ,Brr/iro.., �/Fcslr% / /D'Lafur RECEIV i t /8_ ¢y -_ M COI A C - _ -B C. _ _ _ A - D '`- 3- -- B e of 1te;aTL!i A - E Ui.cisian' ? "y q_' fit_; n ezlth Sorvloau R3 R ".PPrc`: A - F ,qus a:e GIdF) ` R Y �,r7;arP: :ache,,, F B3_ ✓,``. A - 6 Well located by:. Surveyors sur -vey.- Well Arlllers report _ -- Engineers mesurements_13- - Tank, boxes, pits, gallories 9 laterals located by:Contractor: Engtneer. Heaithda,pt: - Field Inspection by: Health dept.® date:- /��� -, Eng•Ineer ID date:- r1!%��!- NOTES: '°!B•A°:�. . /.2/!b ,Tv +1 k' 1- nn!-+v! /eql Fmi Fo��fb ,Brr/iro.., �/Fcslr% / /D'Lafur RECEIV SANITARY SYSTEM DESIGN '-AS QUILT" OWN.ER:__ aLF• rsJ� l: r - __ - - ---- LOCATION Street:_ - Town:_ A�,Loau k,z6�kCounty:, P _ State: - S U B D I V I S I O N :• fi/�/s M a p :llama — Block-. _ �— - - �- - LOT Ng_ f✓i?`j7F` /z Surveyor: %Pl"Z-Per - Drawn: �.N• Date: rr k See le: . -JobN °S� /t JOHN H PRENTISS PE Dwg. CONSULTING .ENGINEER RD 9, F4u�.j 2 ) CARMEL NY 10512 -- (9141 878 -6170. DIMENSIONS DEC 31! /8_ ¢y -_ M COI A C - _ -B C. _ _ _ - DEPT. DEPT. Of Hb A - D '`- 3- -- B D - - A - E - -37- - B E A - F - -�j': - -8 - - - F B3_ A - 6 20 A. - N =- - -� - - --8 SANITARY SYSTEM DESIGN '-AS QUILT" OWN.ER:__ aLF• rsJ� l: r - __ - - ---- LOCATION Street:_ - Town:_ A�,Loau k,z6�kCounty:, P _ State: - S U B D I V I S I O N :• fi/�/s M a p :llama — Block-. _ �— - - �- - LOT Ng_ f✓i?`j7F` /z Surveyor: %Pl"Z-Per - Drawn: �.N• Date: rr k See le: . -JobN °S� /t JOHN H PRENTISS PE Dwg. CONSULTING .ENGINEER RD 9, F4u�.j 2 ) CARMEL NY 10512 -- (9141 878 -6170.