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HomeMy WebLinkAbout4438DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.14 -1 -11 BOX 34 I I ION I r r I I r or 011 ' I I � rr I so: I df 1 so 11 Is Is ■ • _- .,;_.. -.__.. ._.. _,_.��_ .�- �.— '-- , -i'�iS - .mFS +Tv'�"'.°_'T•.:. r :: �:1 ft s rt + r� � ., � _u N -_ sw..w�•+ -.•. :.. , ,..: ^.:;n x �...: '. .n-a.. m,..o..�: isw'+v `.u.;:- ��c.:_.- v- i•,r.w. .- �+.n...ryc_.a'r..:!.•r+. v...•• .e�.svme�++^" "^'�T.'.°.`^'� -!"' �._���< �h PUTNAM COUNTY DEPARTMENT OF HEALTH /` v Division of Environmental Health SerVicea, Carmel, N. Y. 10512 Permit # " / J CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM S /770117r5p _ Tq-wn or Village o ..•.�c=._. �+:�•a� a.�e..� %> d.d., . Located at l Tax MapT �J ,} Block Owner / Formerly Tax Map Lot # ,�, Subd. Lot # Separate Sewerage System built by e 4 v �' �� O ! Address Consisting of Z OG'e? Gal. Septic Tank and Other requirements Water Supply: Public Supply From Private Supply Drillleedd BY ti // t �✓ / ' Addresse Building Type No. of Bedrooms Date Permit Issued Has Erosion Control Been Completed? tttttt������aaaaaa -gi certify that the system(s) as listed serving the above premises were constructed gl a on the plans of the completed work ( copies of which are attached) , and in accordance with the standards, rules and 4% a o e� the filed plan, and the permit issued by the • • e •' Putnam County Department Of Health. 4�� p °' e 0 . A VW a P.E. R.A. Date / d� Certified by G` I ` o License No.���� Address �: Any person occupying premises served by th bove system(s) shall promptly tak conditions resulting from such usage. Approval of the separate sewerage syste ctt n as ` y be n to secure the correction of any unsanitary 41,11 ng'+ s soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and _ "vdr�.b c $t6Y i ly becomes available. Such approvals are subject to modification or. change when, in the judgment of the C ssione of 1�?SA °r° n, odlflution or c�necuury, W. Date B y Rev. 9 -81 Owne or r c as r o Building- Section 4 r Building Con st.r ted.by Block' Location Street Lot Municipality Subdivi ion Name Building Type 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- " '-..-,:'6t - i:orri':;q� •.t ie-'.. Directoi -of ::the-- Davision.of Environmental- Health - Ser�rice.s 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 system. Dated this e� 2 6 day of �. - 19 ( Signature Title Corporation Name if corp. 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 WELL COMPLETION REPORT. PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environrnental Health Services COUNTY OFFICE BUILDING e CARMEL, NEW YORK This report is1to 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. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION 11 OWNER E ADDRESS LOCATION F 0 WELL (No. Street) (T own) i 1 Number) . PROPOSED.. ' USE OF WELL 0 DOMESTIC ❑ BUSINESS ESTABLISHMENT PUBLIC SUPPLY ❑ INDUSTRIAL 11 FARM AIR ❑ CONDITIONING TEST WELL El/ OTHER (Specify) DRILLING EQUIPMENT 9 ROTARY COMPRESSED ❑ AIR PERCUSSION CABLE PERCUSSION ER F] OTH(spacif A CA SING DETAILS LENGTH (test) DIAMETER (inches) Z A FOOT WEIGHT P; �9THREADED . DWELD E D "4VE SHOE E ONO L?SY S rWgY AS 0 ES UQUTED? 0 NO YIELD EST 1:1 BAILED HOURS ❑ PUMPED COMPRESSED AIR G.P.M., YIELD (Q.P.Mj — WATER LEVEL MEASURE FROM LAND SURFACE STATIC (Specif 7.9ol) DURING YIELD TEST ffeat� Depth of Completed Well I,. feet Wow Land surface Q SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE DIAMETER (inches) IF GRAVEL G PACKED: Diameter of well including gravel pock (inches): GRAVEL SIZE (inches), FROM (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL .CPMPLqTED W, DATE OF REPORT WE LL L E R (Si ture) '�, YORKTOWN MEDICAL LABORATORY INC. LOCATIONS. P.O. Box 99 321 Kear Street 321 KEAR ST., YORKTOWN HEIGHTS, N.Y, 10598 245.3203 Yorktown Heights, N.Y. 10598 ❑ 201 BUTTONWOOD AVE., PEEKSKILL, N.Y: 10566 737.8777 ,z :' �- 95� P.9IelN ST,� PAT, KISCO, N:Y:_i�Q_SA9, 66.3335 ~ _ 25's70J ❑ STONELEIGH AVE. )NEAR HOSPITAL), CARMEL, N, Y 10512 "2)8 9 LAB # . 13 924 DATE TAKEN: pm .per —� DATE RECEIVED: - (- Legeierd.,B 528 -0097 DATE REPORTED: Gyersberg SAMPLE SOURCE: REFERRED BY: L'./LdSS/�.D,e29 S L 'J COLLECTED BY; A I°4 LABORATORY REPORT mg /L ❑ ACIDITY ............................ ............................... ❑ ALUMINUM ................................... ❑ ALKALINITY ....................../........ . ........ :............... ❑ ANTIMONY ................................ ............................... #BACTERIA. TOTAL /mL ......... ?,. b ....................... D ARSENIC .................................... ............................... OSOD, 5 DAY ............................ ............................... D BARIUM .....................:................. ............................... ❑ BROMIDE ............................ ............................... D BERYLLIUM ................................ ............................... ❑ CARBON DIOXIDE, FREE ........ ............................... D BISMUTH .................................... ............................... ❑ CHLORIDE ............................ ............................... ❑ BORON ........................................ ............................... ❑ CHLORINE ....,• ....................... ............................... 0 CADMIUM ....................:............... ............................... „❑ COD ..................................... ............................... D CALCIUM .................................... ............................... ❑ COLOR ................................ ............................... D CHROMIUM (tot.) ............................ ............................... ❑ CYANIDE. ...... D CHROMIUM (hexavelent) ...... ............................... ❑ DETERGENT, ANIONIC ............ ............................... D COBALT .................................... ............................... ❑ FLUGRIDF ............................ ............................... D COPPER .................................... ............................... ❑ HARDNESS ............................ ............................... D GOLD ....... ............................... ............................... ❑ MPN COLIFORM COUNT/ 100 ml ............................... D IRON ......................... ............................... ............... VNFT COLIFORM COUNT/ 100 ml ...d ..................... ❑ LEAD ........................................ ...........................:... p.CONFIRMATORY TEST ............ ............................... D LITHIUM .................................... ............................... t: NITRO- G`f- N -.-AMl`AON`lA• ........................... L] MAGNESIURi ,. D NITROGEN, KJELDAHL ............ ............................... ❑ MANGANESE ................................. ............................... . ❑ NITROGEN, NITRATE ............ ............................... D MERCURY .................................... .......................6....... D NITROGEN, ORGANIC .......... ............................... ❑.NICKEL ........................................ ............................... - DODOR ...... : ........................ : ................ :.............. D PALLADIUM ................................ ............................... ❑ OIL & GREASE ............................................. :........... ❑ POTASSIUM .................. ............................... ❑ PH .................................... ............................... ❑ RHODIUM ....................... ............................... ❑ PHENOL .....................:".......... ............................... ❑ SELENIUM .................................... ............................... ❑ PHOSPHATE (ortho) ................ ............................... ❑ SILICON .................................... ............................... ❑ PHOSPHATE (condensed) ............ ............................... ❑ SILVER ........................................ ............................... ❑ PHOSPHATE (total) ................ ............................... ❑ SODIUM ........................................ ............................... DSOLIDS, SETTLEABLE. ml /L .... ............................... D TIN .............................. ............ ............................... ❑ SOLIDS, SUSPENDED ............. ............................... ❑ ZINC ............................................ ............................... ❑ SOLIDS, DISSOLVED D ..................................................:. ............................... DSOLIDS. TOTAL ..................... ............................... ❑ ................................................... ........................... ,r... .D SOLIDS, VOLATILE ................. ............................... ❑ REMARKS:................ ..................... ............................... ❑ SPECIFIC CONDUCTANCE ......... ............................... D .................................. -................................................ ❑ SULFATE ............................. ............................... ❑ .................................................... ............................... ❑ SULFIDE ............................. ............................... ❑ .................................................... ............................... ❑ SULFITE ............................. ............................... ❑ .................................................... ............................... ❑ SURFACTANTS ..: ......... ::. ::-.. ............................... ❑ . .................................................... ............................... . ❑ TURBIDITY ......................... ............................... ❑ ..................................................... ............................... THESE RESULTS INDICATE THAT THE WATER WAS OF A SATISFACTORY SANITARY QUALITY WHEN THE SAMPLE WAS COLLECTED' NTHHEESE��RRREESSULTS INDICATE THAT THE WATER DID MEET THE SATISFACTORY CHEMICAL QUALITY 01' RYisARAMETEADMINISTRATIVE RULES & REGULATIONS DDRINK�IGpN-G WATER STANDARDS (PART 72), ATRrDT a DAT)n17AWIT M 'r (AQrPN nTRFrTnR:' I I WWI 4e qio3 f d0, NMOK, Sot - ri? VA� vx 7 Pei, '40TA-0; It —ova, ,,:Act ..... ..... in 777 I 14 d 1� r I ffl'o ^V PUTNAM COUNTY DEPARTMENT OF HEALTH Permit +� Division o f Environmental Health Services Carmel N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM - vVl A y" V C11. Town or i lags mcii' :l'=.s•c�e A.:; Subdivision ] 4 -� t� �°y Subd. Lot + ` Renewal d •_��p� +Revision'_❑ owner /Address F• �' �'''Y'" f 1 " i N� C �;wy. �. t�Of Pre ; tour Approval Building Type 5 Lot Area I • ` j- e Pill section only ❑ Number of Bedrooms Design Flow G/P /D E� ®� P.C. H. D. Notification Required i 1 Separate Sewerage System to consist of t% Gal. Septic Tank and �GCi •Y.'t Vilt�bC' }t�'Gy1CI1�S To be constructed by Address Water Supply: Public Supply From Private Supply to be drilled by Address Other Requirements s ''�9 ms's 's y I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposals stem above described will be constructed as shown on the approved amendment there to and In accordance with the standards, rules an regu a ons o the 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, land a written guarantee will be furnished the owner, his successors, heirs or assigns by the,b'�.s�`+��°. •�x�t,W��Ak' Uld builder will place in good operating condition any part of said sewage disposal g ( ) y A '_ '6" VF' system Burin the period of two 2 years immediate,) '� i tf(edYt�i�o� the issu- ance of the approval of the Certificate of. Construction Compliance of the original system or any repairs thereto; 2) that' 1{e aMcdesCiittd above will be located as shown on the approved plan and that said well will be Installed in accordance wi h the standards, rules _a r. a. ddba . of nfh4 �P foam County Department of Health. �—e �N a Date / `� 'R� - 6c�9f` Signed i�i Address M( 2i APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless n ruction of the b has been undertaken avid is revocable for cause or may be amended or modified when considered necessary by the Commissioner Health. Any ch sa , c�n�truetIon requires a new permit. Approved 'for disposal of domestic sanit pge, and r to wa supD !/J Date 17 By O Title �eAaaano �� Rev. 9 -81 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of% Located at !L. ��`�n C!�,v✓) (x �.. �? _ (T) c2 j7 e Section Block -,44 Lot �- Subdivision of �Li�- 1✓�� Y ��j Subdv. Lot # Gentlemen: _ 1. Filed Map # Date This :Letter is to authorize 7J7�,!5 r � to 1 � � va 77 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 necessary papers.on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity witli' `the provis oris" of Article 145 . or 147, Education Law, the Public Health Law, and the Putnam County Sani -. tary Code. VY�6` J Countersigned: P.E.,., # Y CJs N'Etj/AyDa� . �ma . r 3 �y' as PP a t �++ o 0 eo Address 21 G Telephone Very truly yours, �9 Signed— Owned- of p'ropert'y Address Town Telephone �® EL (� ��.V U DEC 151982 ( PUTNAM COUNT PPM OF HEALTH PUTNAM COUNTY DEPARTMENT OF.HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 551NT1' OFEYC 'BUIi;DING; ' CARNIEL' G1V .` _ _ _Q. -r . DESIGN ]aATA SHEET- SEPARATE SEWAGE DISPOSAL--SYSTEM FILE NO. Owner 4.,� Located at ( Street �.� e- Sec-. / Block ,� Lot �- i.ca a Alearest . cross s ree , Municipality. SOIL PE ION TEST DATA Watershed TIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Hun apse Depth to Water Water ` Levei No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches . Inches 33 .3-0 G' Notes: 1) TpE�ts 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. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO.' ' j 'HOLE NO. G.L. 1.211 1811 2411 3011 3611 4211 4811 a,,-7 d" y it INDICATE LEVEL AT WHICH. GROUND WATER IS ENCOUNTERED INDICATE,LEVEL TO WHICH,.WATER I�E<TEL RISES AFTER BEING ENCOUNTERED TESTS P,1ADE- 'BIT :.=.. sc �ex-�i - Date /*%/'- :. DESIGN Soil Rate Used 45 Min/1 "Drop: S. D. Usable Area Provided No. of Bedrooms Septic Tank Capacity G�� Gals. Type�1��� r . Absorption Area Prow de By L. F. x24" width rFi. others, • e�. aan I,sl r uo'ay y p `w name_ oC> W .1. 1 i r/GL -� Signature otl -fit. �aa�:;;3 ;f`,p y, Address 7 F —e r+ C-'r« `) e--, v e- THIS SPA FOR USE . BY HEALTH DEPART ONLY: Ua Soil Rate Approved Sq. Ft /Gal. Checked by Date DEC 15 7982 PUTNAM COUNTY DEPT, 01: N9 A I I,.