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HomeMy WebLinkAbout4517DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85. -1 -15 BOX 34 04517 .. !6 6 loll III me I i L �' �'i - .. NN' ' ' ` '� UL I .:. 4L I 04517 , PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM 7,_ © v �4LG� _ own or, Village +' - .. - •-r'"c.= ,a.';,.L 1,; r: rs•,... _ .cru�o a• ►i,° ":r- ;?<..2. - _ - - c _.c' ^' boc. ...,..'_ �'.. r rLocated at �T�PN�a� "/ liiff YL�i�/ i% Tax Map / 2 Z Block Owner ya, &!w7- his / Lot �`� Jobs Separate Sewerage System built by �UlLD G6 Address /t'%i�f'.a "�� A/- ' y' Consisting of - /Q-V / —Gal. Septic Tank and �i ;-3 /�' A!' f 7°- q r _0A4r14 Other requirements Water Supply: � UbliC Stinnly Frnm Private S Address Building Type /+ ZAL Has Erosion Control Been Completed? No. of Bedrooms -:�' Date Permit Issued I certify that the system(s) as listed serving t I lb p�f�mise ucted essential) as shown on the plans of the completed work (copies of which are attached), and in accordance with the st r�•°. ans filed, an he permit issued by the Putnam County Department of Health. Date •� 3- / �' "a ur n- ^y t, tifi P.E. y R.A. A rbss License No, / Any person occupying premises served bAk e bar syi�i`(s) s ro tly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. A f Ate age system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private wa 11 and void when a public water supply becomes available. Such approvals are subject to modification or change when, in tE f ommi r f Health, such r cation, modification or change Is necessary. Date By Title I' PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION.. PERK Located at°T'�A Subdivision Rus-TIC. V T FOR-SEWAGE DISPOSAL- SYSTEM Owner T`_—W_7r-1c 1 7- 1 sM M1 Building Type Lot /Area 4 51 Number of Bedrooms Design Flow to Separate Sewerage System to consist of �! Gal. Septic Tank To be constructed by 270S-"-4_ Water Supply: Public Supply From Private Supply to be drilled by Address Other Requirements I represent that I am wholly and completely responsible for the above described will be constructed as shown on the approved al County Department of Health, and that on completion there, be submitted to the Department, and a written guarantee place in good operating condition any part of said sewage ance of the approval of the Certificate of Construction C will be located as shown on the approved plan and that said we County Department ooff Health. Date Address L.,R ` APPROVED FOR CONSTRUCTION: This approval expires one year revocable for cause or may be amended or modified when conside requires a new remit. A provedf2disposal of domestic s,Aitar Date 900 By by the Town or Village 12 Tax Map Block Lot 2r Job AddreSS411 f3p.0ox 1)_�, Total Habitable Space ]- TV3 Square Feet -� and � 4 � ' /�'" Address ®/L[. At 40 'sed system(s); 1) that the separate sewage disposal system nce'with the standards, rules and regulations o e u nam Compliance" satisfactory to the Commissioner of Healthwill ,cessors, heirs or assigns by the builder, that said builder will of two (2) years immediately following the date of the issu- any repairs veto; 2) that the drilled well described above lNthe ards, rules and regulaions oof the Putnam P.E. R.A. '. License No.. 3 nless construction of the building has been undertaken and is lissioner of Health. Any change or alteration of construction ,wgler supply only. CP�~, Title JP4/. B. _ -. _ . ,r'ec:.. z, „syr- „_,.,b., aa*-.. o -. :, � t,•<e6 r.e...,.. ., ..x _'” •t --..r _ • - 3- a .. ., ar *e D• a Y:ORKTOWN MEDICAL- LABORATO•RY'INC. P 0: Box 99 321 Kear Street Yorktown Heights, N Y.10598 245 -3203 m _.._ m _..._ _... w...._ _ .,. , ;91139 DATE COLLECTED .RESULTS OF, EXAM INATION OF VATER OWNER VE DATE RECEIVED B & V BIIILDING (IORPo. ITY; VILI AGE,.'TOWN &/.OR.NAM8; OF`SUPPLY • . - DATE REPORTED 188 IINION AVPa PEEKS IffLL NoYo 1o56d. 1/9/78 ?'AMPLING�POINT - • . •. TTB7TT 1_�-•TRTBI.IBT�A9R TTAT T. L7Sl,. � BfT 4' BACTERIA` °PER ML- (Ag'ar•plafe' count: at,- 35 -,C). COLIFORM.GROUP (Moshprobable;No. /100,m1:) HARDNESS, TOTAL -ppm DETERGENTS. - ppm NITRATES (as N) - ppm IRON, TOTAL - ppm, =LOURIDE (F) - mg./l. These results ndicafethat the water was YW of a satisfactory sanitary qutility wheri. the, sample was collected. lit 6- j 6 -AkJ A-A-A A. H. P.ADOVANI, M. T. (Af CP) ( Y.F�ei,7�yx '�j %i. nt b,�L,.w lytl s a 1 :ff Y f"< �t4 to �a as f t :� .. } f JpEi r t r�'a `•�i ��' �,g e� b i 1f � ' � �' } � -r t ?X WELL COMPLETION REPORT PUTNAM COUNTY-.DEPARTMENT---OF HEALTH I 3/71' °a <: - » •; , �j vision "of E641ronMe"n4l Health Services'' COUNTY OFFICE BUILDING - CARMEL, NEW YORK +; This report is to 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. f REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAM - ADDRESS LOCATION OF WELL PROPOSED USE OF WELL ) _ (Nb. d Street) Z (Town) (Lot Number) (� j BUSINESS DOMESTIC ESTABLISHMENT 0 FARM LJ TEST WELL I jj I `__I SUPP Y El INDUSTRIAL �J CONDITIONING ((SSpe iy ) DRILLING EQUIPMENT IX Y COMPRESSED (�j CABLE OTHER L =� ROTARY L�J AIR PERCUSSION L�l PERCUSSION (Specify) LENGTH (leaf) DIAMETERtanches) W[1UPHT PER FOOT �» LIVE SHOE WA ACING Z E�513- // I ® THREADED ❑ WELDED YES ❑ NO YES NO CASING DETAILS YIELD. TEST HOURS G.P.M. BAILED PUMPED COMPRESSED AIR YIELD (G.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST [feet) l Depth of Completed Well in feet below Land surface: / J SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (Inches): GRAVEL SIZE (inches) FROM (lest) TO (lest) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. ''FEET'; to FEET I i 4-GC_� If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL CO PLET D Y DATE OF REPORT WELL DRI R (Signs ) n�� Isis wn ®r or Purchaser of�Bua.lding n onstructEd by ,A, 7{ Location —Street U11aing hype -7 401,J117 14666,. Municipa ity ..,_ r:'.•- c ,�... �� - ...,;,� ,. a ,fig;^ . . 4X 2 Block Lot GUARANTY OF SEPARATE UWAGE 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 hareby 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 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 bua.7,din ubl�s�ig :te.__.ss.t.em• _. -t- °. Dated this day of 1 ,44' 197 3ignature B✓12�iL��// a Title /62- corporation, give name and address, )) . THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL 'BE ,I SSUF!b. GUARANTOR IS RERUIREP TO FIDE NOT C, AF DATE OF FIRST USE OF SYSTEM. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - m r Division of Environmental Health Services, Putnarn County Department of Health T", p Rx R t 4. f, X., 4 Dated at ...... . . . . . . • -1 4t. Thi ldttfir.,� o rl Z*6 'l. .a 83I y j a -.4 * td TO d y I .... ..... . . I- f -onetru suet �.O It ft t..o. 416P Wa above hot 6 f pp e rt 'u c ' ;On 4 r*, I ,o a-'as p n. i. .; llb - Cho t' 6f or,t` "ti ti d'' ,_ga ,.e y u,_ ne qtqo�r ,pore R! 8, ma er an ..p,!jjN 44� f lj�w ri 41 th thl t d t, 't, 010 e3�etem b3' 8. ro *� N ­ Fu lfft,` .the Fub 'the l 0 y t.'Odm* PUTNAM COUNTY DEPARTMENT OF HEALTH :t7,_ 7, -7, DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner A F Address4 If P3P-,0;Vy_ '91 Vea- )�,O�J469S, Aj y,, Located at (Street JZ­7 Block Lot te neares cross street) Municipality"-J—D y,4 Aj 0 r- Pol-V 14 LCU Watershed &E(C5 /jLL SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Eiapse Depth to Water Water Level No. Time From Ground Surface in Inches Soil Rate Start-Stop Min. Start Stop Drop in Min./in drop Inches Inches Inches -1 LP 5-43 10 171 :8 2.3 2 25',k O,JZ JO e? q :3 3_3 3 :9_s6 7;'y 3-7 2 3 -3 — 5 q- 4 5 Notes: 1) Te,qts to be repeated at same depth until a �oximatel rates are obtained at each percolation test hole. Affdata to equal submitted for review. 2) Depth measurements to be made from top of hole. f ' b TEST. PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATI.ON,. . UESCR��P7tiI°OiG Gig' �SO %L-Ss i.�COJ1V'T'ERED-' IN�TES1'-- �I(�:f;ES - , .. DEPTH HOLE NO. /�Z_ HOLE NO. HOLE NO. �E G.L. 10F',3 ,0IG i��iS��C� 6" 18" v 2411 h 3011 361f 42" Oft 5411 60" 66" 7211 8411 :�T�rDICATE LE1r'IL.AT ?r1HI.0 T UROUND <Wt�T R _:IS- EIV.COUIVTTERED ... INDICATE LEVEL TO WHICH WA T LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date 91 DESIGN i Soil Rate Used —Min/1 "Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity. Gals. Type C/ , Absorption Area Pro ded Byy L.F.x24" F 5b -width trench. STANTV J. LAN DER �� T . 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