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HomeMy WebLinkAbout4308DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -1 -12 BOX 33 Vim ■ ti T 0L•, z rX 6 . I . r' : , , ti y I �,CERTIFI - TErOF` CONSTRUCTION. COMPLIANCE F HEALTH �- N, Y 10512 LL JAGE DISPOSAL SYSTEM %Oyyp� O ��T+`�aM7 '"'.Tt„prl dt'Vihapo• , s� { ?' " 11 t {1{ Located .at Ay� T ax 'Map Block Owner Lot. t °/0 Job Separate'Sewerage System, built by C N© �WC Consisting tof t�On 1 cwntlr Tank and �w � �� �'F'L�! � t ` �° Other requirements Water Supply ;Putihc Supply From �'- Private Supply Drilled 6, Address' / 'u7 v Building Type •- i i Has Erosion .CSAr61�',6 6 Completed? wa F .. r >. I�cert�fy, that the system( ;),as listed serving the abor vie pr y i "attached), and in. accordance w,itthh 't'the standards rule 8�xx' .egui Date:... Z2: , Y C a Any person'occupying premises served t1y ahe above system •.available,antl'the approval.of• <thi N. subject ,to modif.ica;ion or chan ' Date ge: ApDrovalYnof the-sepa Irwate, water Supply shall'.becom ,, when, In the .judgment of the'C Y By- 'S ©A',. 'rt A Bedrooms Date Permit Issued e es :as 'shown on the plans of th mpleted work (coples`oi which are e.pe T ' issue y -the " ." nam :County Department of, Health. P.E. ✓ R.A. �- �✓ ©� License No. Bch'actio'am s aybe necessary to� secure the correct n ion of -any unsanitary 1 em shall become null `and voiil:as soon a public.sanitary�sewer,becomes ntl void when a public wate*Opecrom- � es available. 'Su ch °approvals are of ealth ;s' h revotion' or. change Is necessary. �---- — Title Plff NAM C.UU ' D 'Enr n Division of ' HEALTH �- N, Y 10512 LL JAGE DISPOSAL SYSTEM %Oyyp� O ��T+`�aM7 '"'.Tt„prl dt'Vihapo• , s� { ?' " 11 t {1{ Located .at Ay� T ax 'Map Block Owner Lot. t °/0 Job Separate'Sewerage System, built by C N© �WC Consisting tof t�On 1 cwntlr Tank and �w � �� �'F'L�! � t ` �° Other requirements Water Supply ;Putihc Supply From �'- Private Supply Drilled 6, Address' / 'u7 v Building Type •- i i Has Erosion .CSAr61�',6 6 Completed? wa F .. r >. I�cert�fy, that the system( ;),as listed serving the abor vie pr y i "attached), and in. accordance w,itthh 't'the standards rule 8�xx' .egui Date:... Z2: , Y C a Any person'occupying premises served t1y ahe above system •.available,antl'the approval.of• <thi N. subject ,to modif.ica;ion or chan ' Date ge: ApDrovalYnof the-sepa Irwate, water Supply shall'.becom ,, when, In the .judgment of the'C Y By- 'S ©A',. 'rt A Bedrooms Date Permit Issued e es :as 'shown on the plans of th mpleted work (coples`oi which are e.pe T ' issue y -the " ." nam :County Department of, Health. P.E. ✓ R.A. �- �✓ ©� License No. Bch'actio'am s aybe necessary to� secure the correct n ion of -any unsanitary 1 em shall become null `and voiil:as soon a public.sanitary�sewer,becomes ntl void when a public wate*Opecrom- � es available. 'Su ch °approvals are of ealth ;s' h revotion' or. change Is necessary. �---- — Title �° Other requirements Water Supply ;Putihc Supply From �'- Private Supply Drilled 6, Address' / 'u7 v Building Type •- i i Has Erosion .CSAr61�',6 6 Completed? wa F .. r >. I�cert�fy, that the system( ;),as listed serving the abor vie pr y i "attached), and in. accordance w,itthh 't'the standards rule 8�xx' .egui Date:... Z2: , Y C a Any person'occupying premises served t1y ahe above system •.available,antl'the approval.of• <thi N. subject ,to modif.ica;ion or chan ' Date ge: ApDrovalYnof the-sepa Irwate, water Supply shall'.becom ,, when, In the .judgment of the'C Y By- 'S ©A',. 'rt A Bedrooms Date Permit Issued e es :as 'shown on the plans of th mpleted work (coples`oi which are e.pe T ' issue y -the " ." nam :County Department of, Health. P.E. ✓ R.A. �- �✓ ©� License No. Bch'actio'am s aybe necessary to� secure the correct n ion of -any unsanitary 1 em shall become null `and voiil:as soon a public.sanitary�sewer,becomes ntl void when a public wate*Opecrom- � es available. 'Su ch °approvals are of ealth ;s' h revotion' or. change Is necessary. �---- — Title •.available,antl'the approval.of• <thi N. subject ,to modif.ica;ion or chan ' Date ge: ApDrovalYnof the-sepa Irwate, water Supply shall'.becom ,, when, In the .judgment of the'C Y By- 'S ©A',. 'rt A Bedrooms Date Permit Issued e es :as 'shown on the plans of th mpleted work (coples`oi which are e.pe T ' issue y -the " ." nam :County Department of, Health. P.E. ✓ R.A. �- �✓ ©� License No. Bch'actio'am s aybe necessary to� secure the correct n ion of -any unsanitary 1 em shall become null `and voiil:as soon a public.sanitary�sewer,becomes ntl void when a public wate*Opecrom- � es available. 'Su ch °approvals are of ealth ;s' h revotion' or. change Is necessary. �---- — Title TOW OF FU'.L'N1%h VALLEY _.. -DRILLERS ?AG►" I�EPOR'' WELL LOCATION Peekski] s Hollow Road eat -- section - . WELL OWNER Hanson P90. Box 206 Putnam Valley New York name - address - - city or-town WELL DRILL'+ name address city or town AG7LNG ETAI YIELD TEST WATER EVE SCREEN DETAILS -Bailed Measure- from lzad surface T-enghs 29 feet or -. Pumped:: Hr s. Statit, _ ft Make s i en._ Bailed.. •lot D�_amet ®ra .:.- • Inches j -:: ,Yieldv .� . =.GFM - r'= Pum ed -v:= ft . .: -Len th-:- Ft. ize ._ �Ciud: Diameter- In.[_ TA-L DEPTH OF WELL 305 Feet Depth From Give description of formation penetrated., such as: peat, Ground Surface ® silt, sand,. gravel., -clay., hardpan.,' shale., sandstone, anite, etc. Include size,.of. gravel (diameter and sand fine, -.--medium, course) :color.: -ofe.- material:,-: structure L oose`, packed,..• - cemented, =. soft Ex'. Oft, to 27 ft. :....:o fns: acked 1•'..ellow;.bw:d- :;2 ?� f ;to::1:34 _,f ..,fir _rangy e ,�V o- eet 77 Forma i-on-. ascri tlon- -. Skc :tdh :exact : - location • of-: •taell to at�least:.two permenant Landmarks Date We-!! Completed October 31 Date 'of Report August 199 197 Well Driller _. signature Own r or Purchas er o B �ing Municipality ' 0 Building Constructed by 7A �If/,3p 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 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- :vic.e.s:. of...t.he...Pu!tnam C.o,unty" D.epa-rtment ..of. Health ,as to- whether , -,o.r: not. the-------, ~. failure "of -the system - to•- op`erate' Taas caused' byythe willful 'or iiegfigent �.. act of the occupant of the building utilizing the system. Dated this 1V day of 14V& 19 -714 Signature -k, 7Z le?m--j If corporation, give name /� and address) ��! , Vic, _C _�f?Y ©perLGvc� ! P .4 -c..c_ 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 Aki6i� 0 L -6--t �1 gL) d 0 Owner or Purchaser of Building Municipality 0 Building Constructed by &I f—oc&tidn Street Block .. P e P_ ,j -r i 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 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- unt -Dartment; f -, -Ue , 'th -w h6 vi c e s o f�- the_ Put narL C o, -v-.: D e _al .. __a,�,_tio�.' _IQ ilure o;_f_t1ie­'­sy"­s,t"`e`,m 16--o'perate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this day of 191 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 AJ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _. _... , .._ COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DAT SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner .4�QeiD Se,� Address 9 VS 04V AIAI,,4, A , Located at (Street ✓r -r �e�. Block _Lot 12, indicate nearest s ree Municipality / a R 4t Q/ Watersh ed ed A ",e,4 -V SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse p o a ter a er ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 2 i�. T Z X o9 17 4, �3! _ S -7 3Z/ =/0 // -2 Z 17 4 5 r o r 2 3 4 5 Notes: 1) Teets 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. 54 If 60" w "' . 66'.' 7211 7811 f 8411 %P r m .Q:_ W....... II�TDICATE LEVEL AT- WHICH GROUND ?nATER - IS E1V Q JNT 'INDICATE LEVEL TO WHICH WATE LEVEL RISES AFTER BEING ENCOUNTERED 'PESTS MADE BY �` ��/iJf.�/L.- Date DESIGN Soil Rate Used Min/l "Drop: S.D. Usable Area Provided No. of Bedrooms 3 Septic Tank Capacity Gals. Type �^� C- •�G Absorption Area Provided Bye L. F. x24" width t en-, - - - - - -- n - - - z� - - -7 THIS SPACE FOR USE BY HEALTH DEPARTMEN Soil Rate Approved Sq. Date TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION C+ T r i + .,.DESCRIP_TION OF- SOILS E COUNTERED; -I >'�' T DEPTH HOLE NO. �l HOLE NO. HOLE NO. G.L.��� 6 ►' y _ y 12" f� 18" A �, 24" �� . ` �2l�✓ ��. p `l 30 36" Y 42" `� 48" h a 54 If 60" w "' . 66'.' 7211 7811 f 8411 %P r m .Q:_ W....... II�TDICATE LEVEL AT- WHICH GROUND ?nATER - IS E1V Q JNT 'INDICATE LEVEL TO WHICH WATE LEVEL RISES AFTER BEING ENCOUNTERED 'PESTS MADE BY �` ��/iJf.�/L.- Date DESIGN Soil Rate Used Min/l "Drop: S.D. Usable Area Provided No. of Bedrooms 3 Septic Tank Capacity Gals. Type �^� C- •�G Absorption Area Provided Bye L. F. x24" width t en-, - - - - - -- n - - - z� - - -7 THIS SPACE FOR USE BY HEALTH DEPARTMEN Soil Rate Approved Sq. Date PEEKSKILL MEDICAL LABORATORY 1879 Crompond Rd.'Barclay Plaza Bldg. A, Apt.. 1 Peeskill; w rk, 1:056t� PE 7 =87 ?7. DATE COLLECTED RESULTS OF EXAMINATION OF WATER OWNER DATE 'RECEIVED CITY, VILLAGE, TOWN & /OR NAME OF SUPPLY DATE REPO 1'ED SAMPLING POINT. BACTERIA PER ML. (Agar plate count at 35 C). COLIFORM GROUP (Most probable No. /100m1.) HARDNESS, TOTAL -ppm DETERGENTS - ppm NITRATES (as N).- ppm'r IRON, TOTAL - ppm I.,�� x Act e% "'Subdivision Lot - Building rxna Lot Area A; Number of, Bedrooms Total.H4bitable Space gO V Separate, Sewerage System V consist of G . al. Septic T ank. 116' let X pal fe ` ' To be co�structed by Address ���w. ' wo�, ----~. pvm�svnn� ��m Private Supply to be. drilled by - | ' | Address ` Other Requirements 'County Department of * Wealth an t at place In good. operating 'condit n 'an rtr.� County Depart ant of Health. Pate Address APPR6VED FOR, CONSTRUCTION.. Thii-.6ppr_ revocable for..cause or may be am-einded.6rrh6clifl R requires a n6& piimij. Approved for disposal o jl.. do x ` = I taasuncti'(. boxes wlth'slol #. r oondi't'l M 4 , Abso�PtSon Yields shall. perforated bltuminous impi4 f grade of. 1 6° per foot` in Kee w� +' M of;;unifdrm sfiA S of" stone ,so, that �it m. bottom :of , . the trencFi.. Coy j p minism�4 to 15" maximum. T �� Wf1BlfeVel' shawnson' he plans Dip sal.-fteldt Shal'1 b Sy 6. Fflr rietatls_ of Sept Y" < ° janetioa`:,boa, see County; S i A11 ss °field area tij t,�e in be= removed. Durin�Y constructioc ;t . , 9.; Lea�ie>r and �f,'ooting; draS septic 1'� y 10•.ak1 'rid"' matsr 91?2 Wept before Certifieate,i i, U2d :. ,p y; ll Mex comp3eti on . of at vi•th opsa3l and s.esd ;1 SO-" en t; f ' yrMTYr* $x✓ tart 4, At IS ,✓+3b` )" a +. -r f 9 j �6 �r '1 ' ij r r VL z �i ,{ s L ft '� 1 ` is �'f 1��,•� d t � � ,,yy J ��� wy t , a' u� �r!•r u S ?. t it . tj r r t.r �� ' r'a l 3 +�."'4e. A� 73,{�' 1 a z• f b '�'r+ �1� ` %$�' l• .. . `h•N m, "K., R. n fr,CJ / Y5 # y .�y Lr Y E% _ iir j/j� _ ��I 'W .! �� . a+ 4rl `j & 1 � '? Y Y �}`f� tt ,�� �,�,.%'�•y�..�J�' 7a, + pwiT•AN�GE� F�r`oA G D. alas =.3" a o` ,q LT - _ .. ... � � _ that the se>el '� � fi�� V • . �}�� ` CBS 06fEi�.BS a�4 A'P� l•�t 7 �8A'8litt tW tie Syjbo 4 7.. ills system �2s :rABStructe� io • ! "j c, n� -rut, , c k �4 �. ,rye. z �' • }}/.�{�.���l!jj �t11.8�i � RIiES 8�d TE�1��!{-f � ,. . i�tlL"'.� aSJ � � �. � Hi. :" . � Ac? t: �{ 0. .1 . �..G c1 C �.t=- . • � /�'� � ., � It�rtar �r i�a:_ ''rG• .w1+ .. _ •. a ° � }� �4'i iw! l; Ir! i t� t ', PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date A/c Re: Property of Located at° ys A(©�, 56e_t:i / Block Lot Gentlemen: °� fl p� This letter is to authorize6A��°E� J. �B� ®ER a duly licensed professional engineer �-� or registered architect (IndicaT_&)- 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 Dpaitucn , ic• it aid to sign all nece6sary 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 147, Education "Law, the` Public Health Law, arid_ the Putnam County Sani- tary Code. Very truly yours, Signed l 44.E Owner o Property Ld C tersigne © r s P.E., Rte-:, # 3 2 •2o TAKEY i EANDE -a �- (Seal) e ep one AddreX 267 AlMR e.n 51 nrni FA �y PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL-HEALTH SERVICES... _ . COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN ;440zo A SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner h-14 E Address ,, A07W GL 44,0 �X HAP Located at (Street n ,5' Block Lot 6;•0 , a e neares c oss s Tr-e- _e Municipality-7P yy!.�.� o - U 6 V atershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS., Hole Number CLOCK TIME PERCOLATION PERCOLATION` am Elapse Depth to.Water Water-Level No. Time Start -Stop Min. From Ground.Surface Start Stop Inches Inches in.Inches, Drop in Inches Soil Rate Min. /in drop . lam' 1� l =31 416 j 2 20 3�a7 1�l¢ a?� .: . .�n -Ci . 5 :4�0 I �2 4 ..l 2 Notes: 1) Te'�ts to be repeated at same depth until a roximatelyy equal so rates are obtained at each percolation test hole. All data to be submitt for review. 2) Depth measurements to be made from top of hole. � r , Notes: 1) Te'�ts to be repeated at same depth until a roximatelyy equal so rates are obtained at each percolation test hole. All data to be submitt for review. 2) Depth measurements to be made from top of hole. � r , F14 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE' NO. HOLE NO. HOLE NO. 6" 2 1811 24 '30". 36 4211 4811 _)4 If 60 6611 ti 72" 2 84 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED ,.INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED Y TESTS MADE BY "-A/0 fet Date ig DESIGN .. Soil Rate Used n/l"Drbpt S. D. Usable Area Provided Z•d No,-. of -Bedrooms 'Septic Tank Capacity ?04> Gals. Type Absorption Area Provided Bj_g.31 L.F.x2411 3b width trench. ott1w 'Address THIS SPACE FOR USE BY HEALTH DE Soil Rate Approved Sq. —Date