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Home My WebLink About3913DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.20 -1 -12 BOX 30 . .� r ` - i _ Jrl I 03913 ✓: "` `` PUTNAM COUNTY DEPARTMENT OF HEALTH ' Division:'of Environmenia! Health Services, Qrm% N, CERTIFICATE OF..CONSTRUCTION" COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Town or Villaq L�zated at .� ' Y Ca f - Tax -P--& Block 211 Dwner Tax Map Lot # °` d Subd: # "S Separate Sewerage System built 1, ¢ — _�`�W'Zt) 'r - kVA`ddress I'Ch � �� Consisting of G1ai. Septic Tank and Other requirements y c r' Water . Supply: Public Supply From ,wJ' j Private Supply trilled By Aheefb 54/ L0 " l Address y� r � � 1 Building Type � j�C %�' `144t - No, of Bedrooms —2 Date .Permit Issued_ Has Erosion Control Been'ddinpleled? A I t j 1 I certify that the system(s) as, listed. serving the above premises were constructed essentially as shown on the plans of the completed work (copies r of which are attached),'and.in accordance with the standards, rules and regulations, in accordance with the filed plan, and the permit:iesued'by'the Putnam County Department Of Health. s i ]ate Certified by Q E R A Address t_)canss or my person occupying premises served by the above system(s) shall promptly take such action as may be.necesfary to secure the correction of sny unfianitsrY onditions resulting from such usage. Approval of the separate sewerage system shall become nulvoid as soon as "a public sanitary sewerjbeoomes vallable and the approval of the private water supply shall become null and void _.:when, a public w supply becomes available. Such aDgrovals; are- �i ibJect to modification or change when, in the Judgment of the ssio i f .Heal , such =Elt -or c hange Is nece'spry-' r Ste By v Title ` -s TOWN OF PUTNAM VALLEY 1 WELL DRILLERS LOG AND REPORT A. �iiBLL_: �CA�iPd:�E7CION - R1EPCiRa ; "`,; . This repr%rt is to be completed by well dr lher and submitted to . ;-dg. department, tpgether with laboratory report of analysis of water_ sample indicating water is of satisfactory bacterial quality. W211 Location +ib 2 �ZA Tax p S reef Sec. Bl. Lot well Owne� Mailing Address Well Driller cute��r Name Mailing 6O&d3 ty or Town Tel. # o-_1 or Town ' CASING DC7AILS YIELD TEST WATER LEVEL SCREEN DETAILS Bailed Measure from and surface. %ength Ft. or I Pumped Hrso Static: Ft. Make: When Bailed Slot: Diameter: Inches Yield: ,3 GPM or Pum ed Ft Length, Ft.Size Kind: Diameter In. TOTAL DEPTH OF WELL •a o Feet WELL LOG De pt h from Give description ^f formations penetratedg such Ground. Surface as: peat, silt, sand,. gravel, clay, hardpan, _ shale ,-... sandstone, :- granite,...-- _.etc..., - Inglude._ si -ze of _.:: .......:_ -.zs _.�. �.:. �.: �. ��. r _ _ grave: (criame$er- anti" sand ( finne, medium, coarse color of .material, structure, (Leose, packed, cemented, soft, hard). For example: O ft. to ..27 ft, fine, packed,.yellow sand; 27 ft. to `134 ft. gray granite . Feet to Feet Formation Descrintion 'ORaOWN MEDICAL LABORATORY INC. P.O. Box 99 321 Kear Street LOCATIONS: Yorktown Heights, N.Y. 10598 ❑ 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245 -3203 g 201 BUTTONWOOD AVE., PEEKSKILL, N.Y. 10566 737 -8777 : 245 -3203 •:- : -- > ,•❑ 495 MAIN ST., MT. KISCO, N.Y. 10549 666 -3335 •� • "� 1` � -❑ STONELEIGA-AVE. (NEAR -HOSPITAL); CA'RMEL; N: Y•; 105 ?7 2.73 -933Q ° <. LAB # 0 OJ 00 DATE TAKEN: DATE RECEIVED: L/ 174- DATE REPORTED: /2 . a�- SAMPLE SOURCE: -� REFERRED BY: L COLLECTED BY: y�yT�'/fi%.✓ C�� LABORATORY REPORT ❑ ACIDITY ............................ ............................... ❑ ALUMINUM ❑ ALKALINITY ..................... .�f ❑ ANTIMONY ................................ ............................... 91 BACTERIA, TOTAL, ........ D.` ...... ........................... ❑ ARSENIC .................................... ............................... • BOD, 5 DAY.; .... ................... ............................... ❑ BARIUM ....................................... ............................... • BROMIDE ............................................................. ❑ BERYLLIUM ................................ ............................... ❑ CARBON DIOXIDE, FREE ........ ............................... ❑ BISMUTH ........................ ............................... ........ ❑ CHLORIDE ............................. .......................:....... El BORON ........................................ ............................... ❑ CHLORINE ............................ ............................... ❑ CADMIUM .................................... ............................... ❑ COD .................................... ............................... ❑ CALCIUM .................................... ............................... ❑ COLOR ................................ ............................... ❑ CHROMIUM (tot.) ............................ ............................... ❑ CYANIDE ............................ ............................... ❑ CHROMIUM (hexavalent) .................... ............................... ❑ DETERGENT, ANIONIC ............ ............................... ❑ COBALT .................................... ............................... ❑ FLUORIDE ............................ ............................... ❑ COPPER .................................... ............................... ❑ HARDNESS ............................ ............................... 0 GOLD ........................................ ............................... ❑ MPN COLIFORM COUNT/ 100 ml .......................... '�MFT ❑ IRON ........................................ ............................... COLIFORM COUNT/ 100 ml ....................... ❑ LEAD ........................................ ............................... ❑ CONFIRMATORY TEST ............ ............................... ❑ LITHIUM' .................................... ............................... ❑ NITROGEN, AMMONIA .... ❑ MAGNESIUM .... ............................... ❑ NITROGEN, KJELDAHL ........ ❑ MANGANESE- .................... ............................... •...... ••••• ❑ NITROGEN, NITRATE ............ ............................... ❑ MERCURY .................... .. ... .. 11 NITROGEN, ORGANIC ............ ............................... ❑ NICKEL ........................ .:�.................. ❑ ODOR ...... :........................................................ ❑ PALLADIUM ................................. ................................ ❑ OIL & GREASE ......................... :............................. ❑ POTASSIUM ........................404.19. 09172................. ❑ pH .................................... ............................... ❑ RHODIUM .................................... ............................... ❑ PHENOL ................................ ............................... ❑ SELENIUM ......................pd -i t`d -IV, -C.( -" U HI.6-............ ❑ PHOSPHATE (ortho) ................ ............................... ❑ SILICON ...................... Di+T-:•"DrC -HEAL- T1•............ ❑ PHOSPHATE (condensed) ............ ............................... ❑ SILVER ................................. ............................... ❑ PHOSPHATE (total) ................ ............................... ❑ SODIUM ........................................ ............................... ❑ SOLIDS, SETTLEABLE, ml /L .... ............................... ❑ TIN ............................................ ............................... ❑ SOLIDS, SUSPENDED ............. ............................... ❑ ZINC ............................................ ............................... ❑ SOLIDS DISSOLVED ............. ............................... ❑ .................................................... ............................... ❑ SOLIDS, TOTAL ..................... ............................... ❑ ................. ............................... . ............................... ❑ SOLIDS,'VOLATILE ................. ............................... ❑ REMARKS:..................................... ............................... ❑ SPECIFIC CONDUCTANCE ................ :....................... ❑ .................................................... ............................... ❑ SULFATE ............................. ............................... ❑ .................................................... ............................... ❑ SULFIDE ............................. ............................... ❑ .................................................... ........ ........................ ❑ SULFITE ............................. ............................... ❑ .................................................... ............................... ❑ SURFACTANTS ..................... ............................... ❑ .................................................... ............................... ❑ TURBIDITY ......................... ............................... ❑ ................................................. ............................... THESE RESULTS INDICATE THAT THE WATER WAS 6 OF A SATISFACTORY SANITARY QUALITY WHEN THE SAMPLE WAS COLLECTED, THESE RESULTS INDICATE THAT THE WATER DID MEET THE SATISFACTORY CHEMICAL QUALITY OF NEW YORK STATE ADMINISTRATIVE RULES & REGULATI S, RIN7G WATER STANDARD, ART 72). ' `� AI,111,MT 11, PADOVANT M. T• (ASCIII , nTIZEC OR • _7 �' `" Owner or Purchaser of Building Municipality Building onstructed by Section Location - Street Block 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- sors, 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- . .Putnam.- County Department -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 da of '� ' y �-� 19,- �ignature�_��/�L,«uf�l :- ��.�✓� �l��r�� Title Ca 6 r If corporation, give name and address) !� ED - - - - - - - - - - - - - - - - - - - - - - - - - - -C - - - - - THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FI jftV9 BEFORE CERTIFICATE OF COMP.TjETION WILL BE ISSUED. NAM COUNTY GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST -FnrS1"MW Division of Environmental Health Services, Putnam County Department of Health. a b' PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT' FOR SEWAGE DISPOSAL SYSTEM '��d 1'11�%r�'� �L.L -6V f 9 Town p` .•-, � or village -'m :.Tax.jA .. . _, i3lor..k. - — Subdivtsio,� Lot Job � ��% � AA^ ` "� A 22— Owner A/ddress. �9 VA-LL OT Building Type Area �� Number of Bedrooms — Design Fiow Total Habitable Space - Square Feetq Separate Sewerage System to consist of L G/ Gal. Septic Tank To be constructed by Water Supply: Private Supply to be drilled by �►Address � Other Requirements —; r� ✓, 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 t e u nam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Health_will 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 regulations of the Putnam County Department of Health. '/ Date, r'a Signed r!I P,E. ° R.A�.J 'J Address 1 License No 7" / APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless con,�truction of a building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissione f Health. Any change or alteration of construction requires a new permit. Approved for disposal of domestic sa ' ary pwage, and /orrprivate wat suppbL_oaly --- -- _ Date _�� f e Ii r,v By Sy—C-1 Title 9. ?.r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH. SERVICES. Date— cP 7 P Re: Property of / Z CX fi & DEW ZYW J' f L:MI .K 0 Located at 01 LAt)/-�, JAt 1-At5rc= /C41 Section // Block Lot Gentlemen: This letter is to authorize (0,YL.LJ 4M El � C-- a duly licensed professional engineer 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 nece$sary papers on my behalf in VUA1J1CL L..LU11 wi n LiiiS maL Lev ailii to. supervise lne_ curlstrue-ciur! of said system or systems in conformity with the provisions of Article 14S or 147,...Educati.on.. -Law _the -Public. -.Health. Law, _and the..- .Putnam,County. Sani- Jf tary Code. I Countersigned: Very truly yours, ` U' � CMG ' �. ua2'� _ /��'� � Signed r Owner of . i P.E., Rte, # oc ore Address ' J Telephone 6gdrty -� Address �^ Telephone 4& PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. A Owner ky-afid, ef _ k-_0 Addre s.sm/a 5 4 6(,)T>� � 3, V4,WAA,14 � Bec. Lot Located at (Street� ( .1 At / Block -2, indicate nearest cross street) Municipality. `Lrtk",,,j j-n UC4J1Z(-;4 Watershed ION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICA Hole Number CLOCK TIME PERCOLATION PERCOLATION I�Lln Elapse No. Time Start-Stop Min. Depth to Water From Ground Surface Start Stop Inches Inches Wat_e_r_TFve1 in Inches Drop in Inches Soil Rate Min./in drop 6 3 '/Z J .3 03 2 LO!.�y 4 3 10 �J') INBds 13 'd3 Q6 8 7 Cs T go 4 )1, QC 2 3)/;02 b Il 6,3 5 Notes: 1) Tuts to be repeated at same depth until a roximated� equal soil rates are obtained at each percolation test hole. Aly data to e submitted for review. 2) Depth measurements to be made from top of hole. 2 /I V .3 03 4 5 7 Cs T go 6 2 3)/;02 b Il 6,3 5 Notes: 1) Tuts to be repeated at same depth until a roximated� equal soil rates are obtained at each percolation test hole. Aly data to e 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. I HOLE NO. HOLE NO. 6" 12" 1811 /_0 (� — 24" 30 It 3611 42" 48" 5411 60" 66" 72„ 7811 84 ". l.1c? INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL.TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY JL)/L - 16 C-:2!Z Date ,�' - /�- E-6 DESIGN Soil Rate` Used 1� "`� Min,/1 "Drop: S. D. Usable Area Provided 0_& �) No. of Bedrooms _Septic Tank Capacity 182�C) Gals. Type /V , Absorption Area Provided By L.F.x241' width trenc . - � Jl � r � /� v &e / ,4G' Other -� s Name _ It L i /a,-/I F &-R Signature Address X &"1'/ O �C' 0621) V 13 SEA y�P �\PM F. 2F,f THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked PROFESSIO "_ s. to