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HomeMy WebLinkAbout4121DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.73-2-37 BOX 31 1 r ,. - 'r ,ti , T -� 11 kc r. IN �.r., , �� ,, , - A .. .� -� IN IN III I 04121 - F. PUTNAM :COUNTY DEPARTMENT OF HEALTH Division of .Environinenfal *iialth Services, Carmel -:N Y. ' 10512 _ }.... _ . 7 a / ,:Z.ERTfF1CATE CAF a11C YR.liC1'YOIV C6'MF'LIAi�iCE �rUR SEW G' I�1SPUSAL yY5YENi /z"t,•,Tid4F"/ Town -or. .village, Block Located at. 3�f.�i" C�/L S�6✓ Lot Job .. --r-� :Owner �� l ewerage SYStem built by � Separate se' :. l� Address�ol�tiJ a Consisting cf Ga:l. Septic -Tank qy lineal Feet `.X mS t!. p' width' trench '�c o Other requirements i a �/ v7 Water supptY .. P bltc Supply From •� f o �1' Private SuPPty: rolled BY dress Bwlding Type No of Qedrooms Date Permit�.IsSuetli •` ,. fir. I ,Has Erosion Control Been Completedv i th'e completed work (copies of which are l.certify that the system(s) as Kited serving the aboV attached), and in accordance with the_standarils,' Were o tally as shown on the pi ns of eg'�pla nd the perms issued Y the .Putnam. County Departm of Health. ,},en%t R.A. Date ~' +z � Address License No / Any person occupying premises'served'by the,abov II ,�fh -such action as may be necessary to secure the correction of any unsanitary ' become null and void ai soon as a public sanitary sewer becomes conditions resulting from,such usage*. Approval of,,, available and, *the approval.: of the private water `supply s m shall I' did when _a pu wa supply becomes avallable.' Such approvals are sub)ect to modificat�o :br change when, m the;,)udgmen stoner. of Health' uch revo tion, modificatlori or change is necessary. { � � Title i Date , BY :' , , - PEEKSKILL MEDICAL LABORATORY 1879'Crompond "` -Rd� lvlaple Terrace Bldg::-A f Peekskill, New York _ PE 7 87'_7'7 , y 32Fi67. DATE COLLECTED RESULTS OF EXAMINATION OF 1�lAl'ER 1 12 7.3 OWNER _ DATE RECEIVED! GEORGE QLEN 1 -12 _ 73 CITY, VILLAGE TOWN & /OR NAME OF SUPPLY DATE REPORTED 172 LAKE DRTUE9 LAKE PEEKSffLL9 N °Yo m'3 ?3.. SAMPLING POINT WELL; }:BACTERIA P.ER ML,' (Agar plate count at 35 °) COLIFQRM GROUP s(Most probable No /'I OOmI) RESIDUAL CHLORINE AS RECQRDED A"f SAMPLING POINT '. PQINT-•OF "TREATMENT CHLORIDES` -(CI) 7., NITRATES (as N) mg /I,LL FLOURIDE (E) -Mn( S 3 P r i These results indicate that the water was yes -,of. a s - fi factory sanitary quality when the sample -was collected r A, H PADOVANI, M. T. ,(ASCP} . . 6:: ..9 ..H ...._ ..�sr..,. .. ... ..... e, . ., ax- .r •)a- .. �. ".rCS' , -. � i r..n 0: �6. n ....tsri..o ..-:o .. ...F .. .. rrr^ , >r ". a- •:,y.... .. u (rI-0AC,E r- G1 Z,413Ei 14 QLJC-J Owner or Furchaser of Building Building Constructed by Location - Street Building Type L Y. F. L L - P" rlv;,4of 4AGf Ey Municipality -rA 4.ss,sna i _m ` v_ ! T qo section A M.mr4' S6 � Block 1G7-17�' 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 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 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 tY i.s —IS day of ,/A 19 73 Signature f 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- GUARANT0_ S•;.REQVIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Division of Environmental Health Services, Putnam County Department of Health County Of e 11 at TH,17. lace J7 2own ame of T Ellagp or/� 7 e r AC�,06 A:dd. Diameter Was wo'll-disinfectedY t I ink yes or no of casing above ground :.-round" 'Vdoll seal in _ft_ packer, .ce e. grat a Il 1 diagram in the, space provided below and show " he depth of -".--h-- w--!-' s-al, kind and thickness' of forma ions enetrated, water doted. lines and n diaza-eter- -qf d.r.L.: h.o.. ..s. with t I? s) �,;i t1a solid lined. ir. Y Depth hind, thickness and Type of well in ft. if watz:r bearing drilling iiiitaod Grade Was well dynamited? 25 50 75 100 150 250 PUDTING T__!J.:3:TS Ca Details txl ll 11 ✓ Static - dater...... level, in ft. ?5-61ow •,trade pumping rate i in gpm ±,umping ieve f-t,,.- -bel-ow. .Duration of te;st in hrs. in e -: Clear_ .---Clouay ___Iurbid I ILi ) ii , , 7, ecomiended depth of purap in wall, feet..-b,.'low :-.-r.ad.e W_;�LLS IN 610"ID si_z­ -: ........ MM, Sand,-Eff. 'Sa3k(I,,.eOOef size ILength of,s; croen f U Diam- -----of - screen Type of screen, Screen C)i)enin s x a sketch of the property t,-.­D: back of this sheet locatiog Drilling start.:d C�;mplet­d.. "D AGE. DISPO.SAL S"J' Well Driller Si, ;nature W PUTNAM COUNTY DEPARTMENT- OF HEALTH - r-;' Division of Environmeniai Heaih Services 'Catmei, N. Y: 10512 CONSTRUCTION PERMIT FOR SEWAGE..: DISPOSAL —� Town or ViIlage •,,,,�wyy ,. . f /.i.'r4 �G •t+ .I'• F.F'., �.'fn . ,1�� •'t' ©. . i"J�� r..'.,1 Y Ysl' RLocated.;at -'- - ,� '. _ •9ecEwn Block. Subdivision k'Sti`lL Jul; sc cJ S I -'� Lot Jo /G L .7-77 M Building .Type r /f�� /��' Lot Area' 23, 24 Number of ;Bedrooms Total Habitable Space �Y%L %+ —� Square Feet g Gal Septic Tank �_�7 lineal feet X ' -- — • width trench Separate.: Sewera a System to consist of ^_ ° To be "constructetl by Water Supply Public' Supply . From Private.'Supply 'to be drilled, by;' � A dres U L e Other Requirements 17epresent that I am whollnd 'complete) ons�ble fo e n the roposed ,system (s);' 1) that the separate sewage disposal system above described will be•constructed as shown on the apor n t accordance_ w.ith_the.standards, rules an regulations of --the u nam County Department of`. Healtfi, -antl that on completio ruction Compliance" satisfactory to the Commissioner of Health will be. submitted to.the: Department, and a written -guar �E I f e' th his, •successors, heirs,or. assigns by the builder; that said builder will place, in good operating condition any part of said . Wd ill uri period of two'(2) years immediately following the date of the issu- V•ance;of 'the.appioval of the:Certificate'of Construe n_ omp: i s ter or any, repairs thereto;2)' that the drilled well described above "will be located as shown on the approved plan•and. that 11 w ;a ccor nce: with ]the'-sta dartls, rules and regu a ons of the Putnam County Department of Health pate P.E. R.A. 7 , •.3: y Address , , �yC' License No. 32 „APPRCNED FOR CONSTRUCTION: This approval expires one, date issued unless. ,construction of the building has been 'undertaken and is revocable for cause or may be amended o'r modified when „considered necessary by. the G issioner ,ofi Health..' Any chiinge or alteration of construction requires ,a new'permd :Approved for disposal off domestic sa y wage ail /or ry '.water aupply `only. Date le — i `+ BY. Title "i =: -.. • r,..: ..._ c ..r.,., '�eorge Olsen: c) tM Lake Dr.; lake Peekskill, N. Y. 10587 .. ..:, •.. . , ,.. <.' �. 'l . p .'.:._ .; c,,' .., .. ��.. �. .. ..n• -a :, .. "•.�,.: .;,. ., ,. ' .,i, . .o . ., n. r,.� d' d , .. •. ; tr .o - - - - -- _- - -- . —.- Putnam County Dept. of Health -- Garme-l- ;- New - York------ - - - - -_ -- - -_ - -- —___ _ - - --._ - RE: Lot #'s 167 thru 174 Lake Drive, Lake Peekskill= Putnam County, N.Y. The layout of the sewage system and well are such that only 80 feet can be maintained between well and septic ~ system. I wish to ask for a variance to drill the well ^y' within the minimum distance of 80 feet, I will except full responsibility for possible contamination. Yours truly, I PUTN_A I COUNTY DE?A ?T'T,NT OF : � =.LTK DIVISION, OF ENVIDON CNTaL HEALTH' SzN. S QE61UtV DATA SHEET ' - 6EFA_RATE SE„,:AGE,. DISPOSAL SYSTE - FILE' NO, Owner Address t.,1� Loc at d a. t gel r / �, 7 �— • e t (S�r C),_ k�Y.� - ._ Block t_ Lot, 3. - ., (Indicate nearest cross street) %s Municipality urr' ®����i 1�`w4C%..'watershed SOIL PERCOLATION TEST DATA REQUIRED TO .BE SLE' I ! ED . ITH :APPLIC_ATION Hole . N1u,mber CLOCK TIME PrRCOI�aTIO \' PERCOLATION Rin 'Elaose Debt'-'to t•raLer S, :titer Level No. Time From Ground Sur aCe in Inches Soil Rate Start Stop Min. Start . Stop Drop in Min/in .drop Inches Inches Inches R/1 - -SD J L• V z 3 -!7 4 5 5 1 4 5 Notes: 1) Tests to be repeated at sa ^e depth until approxi -.a _-el,- equal soil rates are ob- tained at each percolation test hole. all data to be submitted for revie=w. t - _ TEST PIT DATA REQUIRED -0 uE SUBMITTED .;ITH APPLICATION i DESCRIPTION OF SOILS OUNTERED I \, TEST HOLES DEPTH HOLE N0 . I ,H_OL= \0 HOLE -N 1J�C G.L. �vJc� J. J' 'S "y��, Psc' {� 12 T, w fi C a 18T t _lam - -�-- -- 24" L 30r: ti �- 36« — 42:: 48 " 54" 00" 6 6'1 7 L;. 78`' • a' 8 4 :r ' INDICATE LEVEL AT WHICH. GROUND WATER IS EtiCOL'NTERLD INDICATE LEVEL TO WHICH WATER LE` EL RISES AFTER BEING ENCOUNTERED TESTS LL•ADE BY f Le.t✓�Is Date , �/:;✓ %�% /7 -- Soil. Ra--e Used �Min/1" Dro? S:.D. Usa le Area Pro: is ed �dary No . of 5edroo s Septic Tank Caps i ty 9, t> Gals. --�— =- Type Absorption Area Provided By L. F 36" �� widtz. trench. Ot;Ler Name STANLEY .J. LAND Address i , a Jaz��s %L T 7 ! PU1'tiA! I T COLNTY. DEPART�Lr�T OF. HEALT Soil Rate Approved Sq. Ft./Gal. Checked bS7 _ Date tif t , wFa'• t - ✓ , r kp , �;,aw ;gB 1973 r ` f iY PT. OF HEAEH G YIS10N EFF . S} C 'WRONMENTAI MULTH VKP rdi 11 pTtcs'!dbd 85 in j systeir 1V t� :over 'sIY ! srsc:acted m�. F r 3ilLE l i u` c 4m_and .legs :. . """'7�'""""�'�4�,S�fl1 ��:PEt'•6w�rty�ept-of� �__._. ...'., �..rA _..•, .,.-., r c c °'OOF .7 i ,y. -THAS Lo,;�,ti1e94 La•r 2 ° ► ? l :; i ASI N CQ Asst =--i� NASQz Ai t r ���� c�s��� -ea.�cx���s�9o`��.s= c�;.,: •P+�- ;�rs�r.�. CFa�:�i�•,�(, 4�t. ,. 5 t� :over 'sIY ! srsc:acted m�. F r 3ilLE l i u` c 4m_and .legs :. . """'7�'""""�'�4�,S�fl1 ��:PEt'•6w�rty�ept-of� �__._. ...'., �..rA _..•, .,.-., r c c °'OOF .7 i ,y. -THAS Lo,;�,ti1e94 La•r 2 ° ► ? l :; i ASI N CQ Asst =--i� NASQz Ai t r ���� c�s��� -ea.�cx���s�9o`��.s= c�;.,: •P+�- ;�rs�r.�. CFa�:�i�•,�(, 4�t. ,.