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HomeMy WebLinkAbout3885DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.16 -1 -8 BOX 30 .m I . I I 1 !!%7% 'VE III 1 '. r '. `�. jj '1 J .�1 'L. �6 . Y. Z T or 1 �. PTWI � r a -'.� � � �PUTN•AM' ,COUNTY DEPARTMENT °qOF `HEA'LTH < _s' � d Orvisron. of_ Enviionmenfa! Healih. Services, Carmel, - = _ Putnam Yall ~ CERTIFICATE OF, C011�STRU0TION; C.OMPLIANCE_FOR- SEWRGE DISPOSAL SYSTEM Y i i!-W. age — v < Town or Niit j `- Uppland Drive Located at YJFaik Map 2 K Block . James Formes , �5 Owner �.w 4i Lot ti Job Separate Sewerage Systerii built <by James Forbes Address ' -. Upp AM nz?1Ve -J li nam `Va11eT 100.0 X33 LF 24" Trench z Consisting of Gal ,Septic Tank An d ti r � r s _ Other requirements ,k 1Voner �x a �� a water Supply Public Supply From f x FrivatelaSuPP1Y Drilled�BY{ SO PY'j a x' Ander n Well nrlll Bger_ Address Street, Putnam valet' 105 i 1VY '7 9 °2 stor frame L Y - Building Type y k No of Bedrooms Date Has Erosion Control Been: Completed z rv_ s ' I'certity That ,the.system(s):as listed'serving the above premises were constructed essentially of shown nth -o t {eop�es:gi which are attached) 'and in,'•accordanc� wdh the standards rules and reguWtdons plans pled and the permit issued •tisQB+��< `untrtment,of Health Date December 2,. 1980 Certified byY _ - L X DA 4 Address l Northrld a 'R ad, PeekSklll' N. p�i N a 027846 Any person occupykng prergises� served by the above,system( ;) shall promptly,.:take such action'&s may be necesl + �Q�on of any'unsanitary conditionr` result iag from -.such u$age Approval `of the separate sewerage system shall become null.and �voitl d OR�a p� ; sanitary,'sewer tiecomes _. a_viilable -and "the approval 'of the' private water supply shall become null and .void when a public•!water Supply l6RiKaaWli�ble.'- ; Sueli approvals, are:.. subject�to', modification or clh�ange?wh,n �A the judgment of the Commissioner of Health such revo on modification or change is necessary Date YORKTOWN MEDICAL, LABORATORY INC. P.O. Box 99 321 Kear -Street - WCATIONS: ❑ 321 KEAR ST., YORK TOWN HEIGHTS -N.Y;110598 245-3203 Yorktown Heights, . N.Y. 10598 7 77? -- x201 .BUTTONWOOD -245-3203 ❑ 495 MAIN ST. MT.. Ki SCO N.Y... 10549.16.66-313 51 18509 El STONELEIGH AVE. (NEAR HOSPITAL), CAR EL, N. Y. 10512 278 -9330 # :- DATE COLLECTED b" RESULTS OF EXAMINATION OF WATER 3 2 Z3: OWNER DATE7ff EMI��;D JAMES FORBES 12/17/80 2: 30 P..M,.-:.).. CITY, VILLAGE, TOWN 6 /OR NAME OF SUPPLY DATE-REPORTED -- T%i-1+TTT.' . VITTMATT T! I TA 'r T TTT AT[r r% rrl a 7)... BACTERIA PER ML.- (Agar plate count at 350C)..COLIFORM GROUP (Most probable Mo-./100ml.) QZMFT --URDNESS-.TOTA,L -pprp- DETERGENTS - mg/L NITRATES (as N) - mg/L IRON,TOTAL -. mg/L AMMONIA, FREE (as N)-mg/L., pH= CHORIDES - (mg/L) COLLECTED BY: J. FORBES These results indicate that the water was YES of a satisfactory sanitary quality when the sample was collected. PER: CROSS ROADS PHARMACY A. H. PADOVANI, M. T. (ASCP) us I I Owner or Purchaser.of Building Municipa_fity James Forbes Building Constructed by Uppland Drive Location - Street Map 1255. Section dk 2 story frame 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-regulation s of the Putnam County Department of Health, and.hereby guaranty to the owner, his.succes- sors, heirs or assigns, to.placei 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 furth * er agrees to accept as conclusive the de- termination of the Director of the. Division of Environmental Health Ser- vicos. -of-. the_-Putnam. -County-Depart-ment.- of. Health-as. to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this 22 day of Dec 19 80 Signature Title If corporation, give name and 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 WRA COM49TIQPI 9g!"ORT P4$TNAM COUNTY DEPAIRTMENT Off, �;940,T" . W79 010slon of Envlrpnmontal Health Serviaa® COUNTY OFFIGI OU14PINQ CAHMEL., NEW Y9 EbI6 . Thia sport. Ia N - Fomplote l_by we04 drillar_�n��ybmii e� :to Caunt}r_kloaltt pepactmsnt�4og tt ®c vitti�4�4 c tot C ®Ii:frBiA$ n- -;;: ; "`r', -�n � Sly 'y� tflf' sfip1� Int�icafifig'itia ePTa"af actor'y bacterial quality before certificate of construction complipric uf4 REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION. TO ADDRESS PIp tts9 1� Rn aR NEOCATIO� SUSIN! SS NA1pct ol>as� STIt FARM WOT W€ i IlStB 4.. PiIOLtC: • (^� (''j AIR OTHER i WF� UPF[y 4-J I"PLISTR1AL l_-1 CONDITIONINO (�poxify) pgI�INO ��-'-' _ COMPRESSED CABLE ('''� OTHER EOIdIPfAEhl� El &OTAO � AIR PERCUSSION Q RERCUS51OW Q (Spocify) CAGU40 tW9111 (190) D14*.&T R(Inches) j4 � � j J ❑ C Yg$ O TjRQADE W9iDED YES YIELD ('�j . ('� HOURS G.P.M. YIgLD(Q.f X4,1 TEST EI RAiI €1) El 4'HMPE0 fa COMPRESSED AIR WATER (y }FA$t)R.� EE O/d l¢flQ SURFACE- STgFIC(SPa4Uy too DURING YIELD TE&i Ifect1 Depth of Complolad Well .aLyn In foot l ..low Land surfgcor L9"gTH QFgN To 495iff((gvfj •. GCPL'E� t)EYAIi StQT 17,E DIAIXETER (fn4hga) IF GRAVEI, P 1 motttr of yvoll includin4 riRA�Eti �Z (fn.�hgg1 Fr.0e1((pvtl T4 (tgpiJ PACr.ED, grovel pack (lnchoe): pfPTH FROM tt.NO SURFACE Sketch execs location of Hgll wlth QfatarrCea, to of fgnyf FEET to FELT MRMATIOM RE$CRIFTIOttI (WD Permangnt landmarks, • - .. ... -. is If yield was tested of diEoront dopths during drilling, list bolow FEET GALLONS PER MINUTE ; iTy' , �- = '���e'^.- �•rt_' -r- i + s sue° x T°'^,'�^.. `°may ,°s .°'r �—'- --� -�" "- -•e-- - s NAM COUNTY ADEPARTMENT OFD HEALTH; C." r " :Division of .Environmental "Health . Sewices Carmel N - Q 512 CONSTRUCTIONA! IT FOR SEWAGE EDISPOSAL SYSTEM' _ ,(T`) T r n or ,Ilage aeat�sL:..... �PA� a]r�C�. �.Z'.�.Y.^, � .� .� ..f � � � . ; f-. � r•;- •,;, :�„ j, �. BROOKDALE HEIGHTS x Si ubdivision ' Lot Job i Jamies Forbes PO Box 82 °'Monroe,< <NY Owner - Address ` r_ Building Type 2 story frame rLo6ota 2 2 +Acres ..[ of ! A 0,. als =da Number of Bedrooms 'Design Flow g y Total 'Habitable Spacev'2128 Square Feet. x Separate-,Sewera"e 5 stem'to consist of �1i000 w 9 y Gal Se tie Tank 333 T;F ,• P r' and Hof 2�'! - trench F =Z Construction ty 0 on To 'be constructed , by -- - red Road '1'�OWn` Oaf u Address C Ort landt °j ` i P,e6kskall,� NY Water Supply. Public Supply From x = Anderson.Well drillers -` � Private Supply to :be dulled by - Barger Street, Putnam Vale NY Address y r Domestic Use Only Other Requirements N f ?: ht - rA32cv.`r� •�� y y+ t yT ' i.'� .,�•••••`••�•�,, �,.~aF �.F_., I represent that 1 am, wholly and completelyz►espons�ble for the design and Iocjti6n of the proposed system s)`' R t 31B:= sewage -idis osaL- system above described wili be constructed a - i' I on the a i i p M y pproved amendmeht thereto and Sri: accordance w'th th A " �u'fions o r e u�m Ii County !Department; of Health and -that on completion thereof a 'Certificate of Constructwrt Compliancy to .' r%isioner of Healthwill ` be submdted to the be rtri e t an r ' a pa. , .., ., d a w !tten guarantee,w,il1 be furnished the owner his uccessors; 14i s�r h ,that said bWider• will' place m good operating corddron :any part `of said ' sewage _disposal`ysysterii''Auring afieFper�od %of: two,( 3ti 9 e foil g' he date of, the Issu- } _ �.. area of, the' approval of She` Certrflcate of ", 'onstiuction Compiiance'of ,'the ongtnal system'ok" any`repai ret dr I iaell described -above s -will, be located as. shown on the approved plah`antl that saitl well will be_ingalled in accordance with the 1R a s, Sr ul ; =of, the; Putnam., -` County Department of Health • e ^� Da e . March 31,` a1980y �� • ,� '° _ °` _ Aad.es °� 11 Northrdcge �Ro a Peksk1= 11, . •�E 02 8?�6 pg�4e 3 APPROVED FOR CONSTRUCTION ' This a •` •° p"proval expires one year from the date �ss'ued u ass coast coon o *gyp 'has been undertaken and ;is `revocable for :cause or may be amended or mod�fjedw.hen cons; d n' essary -by the`Com Isiiioner Health.::-A.ny,C ange of alteration of.,construction requires a new mrt ppr d for dlspOSa1 of domestic_ nit y wage / ;vat jj y ` I Date By Tale I T PUTNAM COUNT TY DEPARTMI+N T OF HEALTH 0 : :E-!.u'�TrVTRE)NivMTAI;�,A,4;-T4 - SENT - 5 r, Date March 31, 1980 Re: Property of James Forbes Located at UPpland Drive Putnam Valley Section Map 1255 Block Lot 4 Gentlemen: This letter is to authorize John S. Romeo a duly licensed professional engineer x or registered architect (Indicate) to apply fo.r a Construction Permit for a separate sewerage system; to serve.the above noted property, in accordance with the standards, rules or regulations as promulgated 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 s s ear o,r--systeirfs -in cbilz"ormit w th -tife provisions of Article l� or '° •_ -._ 5 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, Signed �tne of Property: Countersigned: N - Address P.E., XXX9.X, # 027846 00000000— /o /D'1dzt- 1y 1 Northridge Road ©0 ° ��.E�g ® °� ®° Telephone (Seal) fF�� o � S. Ro ° Add Peekskill,' New York 10566 7� y 1-5-0 4 O C p 0 A 737 = 1056 0 d ® a Telephone © ! 27.80 ©00000 Notes: 1) T Ats 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. PUTNAM COUNTY DEPARTMENT OF.HEALT& DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY : OFFICE BUILDING, . CARMEL, N. Y. 10512 DESIGN.j)ATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM. _FILE NO..- _ James Forbes Owner r. Address. PO Box 682 Monroe, N 'Uppland-- Located at (Street Drive , Map - .1255B1ock Sec. 'Lot ca e..:neares cross. street) ;. Putnam'Valley Municipality;...,,. ,,. Watershed Peekskill, NY m _ ...........SOIL PERCOLATION TEST .DATA .MUIRED TO BE - SUBMITTED. WITH,,APPLICATIONS o e Number CLOCK.._TIME PERCOLATION.. - ":'.PERCOLATION apse Dept o water water 7,eve Time From Ground Surface in Inches -.. . _- ..Soil. Rate Start - Stop'` Min. Start Stop Drop in Min. /in drop Inches Inches ..Inches 10:37 ' 22.5.0 23.50 .1-0.0 5.00 10.41 10:47 6. 22.50 23-..50 l , 00 6. 0.0 .. 10 50 ,1'0::56: 6 22.50 23.50 .1 00 .6.00 • _ .•. '.'t _ .. .. .. (2�::1.. 10:; :10:.42 7 18.75 -19.75 1. oo :... 7, 00 2 10:45:0.5` 9 - i8.` -75 19:75" b +,. 10 :59k ii: 08`` 9 18.75 19.75 1-1 oo. :._ goo: 5 1. - r Notes: 1) T Ats 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. Frame - -John 'S . ` Romeo. Signature NA14-9 1-11 e 1 Northridge. SEAL 0 �' Address .... g peakskiLl N.Y_ 1.0566 0 21846 °® A. �u o THIS SPACE FOR USE' BY" °HEALTH DEPARTfMT ONLY: °0000°° 1 S611 Rate Approved Sq.- Ft /Cal. Checked by Date TEST PIT DATA REQUIRED TO- BE SUBMITTED WITH APPLICATION ' DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. 1 HOLE NO_. 2 HOLE .. Z..z �rG.L. Topsoil - -:..a z' .r-•.' - w- ..,+- yyi�- f.}.. J,. ... Topsoil .'�f :�.f.�e =Pv�V.. ._'.. .: ... ��': .y -T _ Topsoil 6" 7" Topsoil 8" Topsoil 9" To. psoil 12" san g ravell Y sand yg ravell y loam . sandy gravell y loam 18" . .loam ._,.. ....,. ..., ..F: ..... ...., some silt„ loam - Frame - -John 'S . ` Romeo. Signature NA14-9 1-11 e 1 Northridge. SEAL 0 �' Address .... g peakskiLl N.Y_ 1.0566 0 21846 °® A. �u o THIS SPACE FOR USE' BY" °HEALTH DEPARTfMT ONLY: °0000°° 1 S611 Rate Approved Sq.- Ft /Cal. Checked by Date PUTNAM COUNTY DEPARTMENT. Division of Environmental Health Services . Garmel 'N Y 1'0512 CONSTRUCTION PERMIT FOR. SEWAGE DISPOSAL SYSTEM. J TIJAA/� r LLC_:Y Tow Z� n or 'Village ,` , �p.� Located at `.' PPLAf,.1 1 V E -6 alien 16 alock a Subdrvis�on �+V $4 �A OF �'l � % ' Lot �� dob � lDOt2 q LE ' . � � �.G ►JS J TO A.M. �iA��U r Owner Address �. r Buildm9'TypeEiDE1J1 Lot Area` i •+©e� x IAC. i4� -�^-+ j Number • of Bedrooms r Total Habitable Space square- Feet 3�a '``� Separate_i5ewerage,5ystem to consist ,of Gal Septic Tank - Lnealfeet X width 'trench' .Water Supply Other RequirementsZ ' x i w I represent tha ,(e rn_ whol above - described .will be,__ :County Department of 'il be submitted J6 the Dep ,place^ in. good - :operating_;; ance'bf ahe approval of will be- located;as;shawri`oi County Department of Hi { F APPROVED FOR C6' revocable for cause or maj regwret new permd` z' Y C Address Prrvate'Supwy Ito be dr. d by _ -s OA Add ass y and!*corn pi, �SpO sign and location of: the; proposed - s9,Aem(s) 1) thaC the separate sewage. disposal system l istructed_as< jp" m_ ent;there;,t; ^and in accordance with the st`indards,�rules"andI regulations o ' the u nam. feaIth, .an I i ertif sate 'of 'Construction Cor»pliance .aaUsfacfory to the Corimmissioner -of Health` ill. artment� ? to Mee,, furnished the'ownei,, his successors heirs. or a55igns {by the- builiie ►; that said builder, will's ' ond,tion ' rt ti - , ge d I system during t e. period' of,two (2),years immediately following the,datesof.the:issu- he Cert' c`$t ofkricl� ©t) m i of ,tfie ongina system or 5ny repa�is ".ffiereto. 2) that the drilled: well described - above the app ved Ian tria4 s��cyt", kit Il ti installed in ac" ordance wdti, t e stand ds rules and regulation "s of the Putnam alth) �ra a� �•^^a j., a 1`7 ,Si9,, �. s:F .,,•• r e a P E R A F IMAV7 _ RUCTION This ne year from the date iss ess construction of the. builtl�ng has been undertaken and is ' f be amended- or�modrfie en considered necessary by the Commissioner_of�,Health AnyRchangeror;alterat�on of construction approved for disposal of, domestic san�t ry�se ag and /or prwate water supply o y w : I ..mss .,ems BY ti - - -- _ - - PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date o"I .XI(.. % Z Re : . Property of�,j� Located at UP12- L'4;yy Block c? % Lot 0/ Gentlemen: This letter is to authorize ��; STANLEY L LMDER a duly licensed professional engineer or registered architect (IndicaTe-T- to apply for a Construction Permit for a separate sewerage system; to serve the above noted property in accordance with the,standards, rules or regulations as promulgated by the Commissioner of the Putnam County Department of ncza,itli, aind to sign all necurssary 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 i4+ Education Law, the Public Health Law, and the Putnam CountySani- tary Code. P.E. . , t , # � -7 a STANLEY I (S �Q/X 2671, Very truly 'I ours, /cnu'�e �c'a2cPvru1 l�' C Signed — Owner of Property ,;r -3 Mress Z 4- 6 e ep one d� u - - -- _ - - PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date o"I .XI(.. % Z Re : . Property of�,j� Located at UP12- L'4;yy Block c? % Lot 0/ Gentlemen: This letter is to authorize ��; STANLEY L LMDER a duly licensed professional engineer or registered architect (IndicaTe-T- to apply for a Construction Permit for a separate sewerage system; to serve the above noted property in accordance with the,standards, rules or regulations as promulgated by the Commissioner of the Putnam County Department of ncza,itli, aind to sign all necurssary 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 i4+ Education Law, the Public Health Law, and the Putnam CountySani- tary Code. P.E. . , t , # � -7 a STANLEY I (S �Q/X 2671, Very truly 'I ours, /cnu'�e �c'a2cPvru1 l�' C Signed — Owner of Property ,;r -3 Mress Z 4- 6 e ep one d� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION T)F�ENUTR-6NNt�L I;ntEMd s COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner $:Roo K D ALC- GAPOaps . J OC Address O P PLAJAD 'PiZl VE •TAX MAP t Located at ( Street )UPPLUID 1. 9w. 117 Block O l Lot (Indicate neares cross stre-eTT Municipality. __P0 -rfJ AM 1%Au ey Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole 3 Y6 Number CLOCK TIME 1(0 4 PERCOLATION �/4- PERCOLATION Run Elapse Depth to Water Water Level /%,Ott, No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches , Zo 53/4 £3,0 2 x:19 9 i Slo �1 s' /t- i S alb 3l8 l 1. o 39:S) to:1-7 30 Ile 3 Y6 2'T t1 �: sa �g 1(0 4 �� jl� �/4- 3 /%,Ott, f Z� 1 2 3 4 5 Notes: 1) Te'gts 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. Address THIS SPACE FOR USE BY HEALTH DI Soil Rate Approved Sq. by Date TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION _T DEPTH HOLE NO. HOLE NO. HOLE NO -_PC-6:' a0LC_ G. L. 611 1211 FEND PA1Y_r,1a6 15AAJ 0 CL-Al fA I Y-TV12f- (ft-A-1 MI ATV i2c- 1811 24" 3011 36ft '42't tir 48'f 5411 n" 60 11 Leoae '2o c 14- 66" w. 7211 78t' 84" tl I1\,DICATE I.=L AT WHICH GROUND WATER IS ENCOUNTERED. f4o W.A T ie 1�� -.INDICATE - LEVEL Td WHICH WATER 'LEVEL RISES -AFTER'BEING ENCOUNTERED, .TESTS MADE BY L A0 01E dZ Date DESIGN, Soil Rate Used MirVl"Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity 1 a5iW Gals. Type M ASo &3 P_'l Absorption Area Provided By ,208 L.F.x24",Z1.jjt 5611 width trenc Other _qTAN1 rV I lainn Address THIS SPACE FOR USE BY HEALTH DI Soil Rate Approved Sq. by Date t e py -.,- . p.. r : -, . 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