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HomeMy WebLinkAbout4520DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85. -1 -20 BOX 34 04520 PUTNAM COUNTY DEPARTMENT OF HEALT'' h~ Division of Environmental Health Services, Carme% N.' -Y. 1x512 CONSTRUCTION PERMIT' FOR 'SEWAGE DISPOSAL SYSTEM /" dMwp� �'7`�✓AM GG 3 Town or vaiage Aep - is :�(k n2 :r• .,6:ncAtky r x, -�2-S� `tom- s / Subdivision J P, if , ��� $� 7d IX E� Lot Cam' l .1. Job vft /i�i� �r�sg61 (%�%f'f� Owner Address 7!" /i1yOPf��. X Building Type a Lot Ared -&13 2 �fc oP Number of Bedrooms f Total Habitable Spacei U Square Feet Separate Sewerage System to consi of / 2_'S� Gal. Septic Tank 334- lineal feet X 4�4 width trench To be constructed by Gp s/+dCa �- ✓ h I'�" Address fjlAy4r' A `��1 Water. Supply: Public Supply From IT Private Supply to be drilled by y Address / A4L4 Other Requirements I represent that I am wholly and completely r above described will be constructed as shown , County Department of Health, and that on be submitted to the Departmeht, and a w place in good operating condition any pa ance of the .approval of Rhe Certificate o will be located as shown on the approved pi County Department of Health. Date Address APPROVED FOR CONSTRUCTION: This appr xl revocable for cause or may be amended or modifi requires a new permit. Approved for disposal of don Dater By « ;TY location of the proposed system(s); 1) that the 1Q05e ge- 'dispo al system here to and in accordance with the standards, rule an reg .i., e u Hasa to of Construction Compliance" satisfactory tiDD 6o issioner of Health will the on his successors, heirs or assigns by the builder, that said builder will during the period of two (2) years immediately following thedate of the issu- origi I system or any repairs thereto; 2) that the drilled well described above in ccordance with the standards, les and regula ons of the Putnam t% P.E. R.A. License No. -1 G Zz i th date issued unless construction of the building has been undertaken and is ;sa y the Com issioner of Health. Any change or alteration of construction ge, iv water supply only. Titles, 5 5. -1— �) PUTNAM COUNTY DEPARTMENT OF HEALTIf Division of Environmental Health Services, Carmel, N. Y. 10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM ✓pg�jy' t ��_� Town or Village . 'Cocafed at ) �ss Tax flap &dl Block Owner Y"' ,C:.7 L9iL /�iflf6 �r7?,�7 Tax Map Lot # �'!� Subd. # Separate Sewerage System built by '- �-- / V' Address -&Ci1 ✓ E /I/i/ Consisting of ��� © 4 �r <' ,u Dal. Septic Tank and T lAl' T �• C� y 7 'Ivc,; Other requirgments Water Supply: Public Supply From � Private Supply Drilled By _ Al- Address -- / b'/ I'VR -1 IZ/4- /V Building Type -/ �/ �/�L. No. of Bedrooms_ Date Permit Issued Has Erosion Control Been Completed? I certify that the system(s) as listed serving of which are attached), and in accordance with Putnam County Aepartment Of Health. Date /2-//— Address Any petson occupying premises served by the Ja conditions resulting from such usage. Appro available and the approval of the private water si subject to modification or change when, in the essentially as shown on the plans of the completed work ( copies -in accordance with the fled plan, and the permit issued by the Y CL b ' P.E. /R.A. License No.- %T_ ly t e such action as may be necessary to secure the correction of any unsanitary rate em shall become null and void as soon as a public sanitary sewer becomes o ID old when a public water supply b0t9hes available. Such approvals are i .0 on r Ith, su h revocation, ication or change Is necessary. BY Title 4s J Q rv�C R J RK� 9 IN M DICA�.. :� r�TG �` � �. PO Box 99 321'Kear Street LOCATIONS ' o 3 321 KEAR ST YORKTOWN HEIGHTS N Y 10598.245 320 p Yorktown Heights,`�N 1059$ ❑ 201•BUTTONWOob AVE PEEKSKILL N Y 10566 7378777 M " - :445 3203 ❑ 495 MAIN ST., MT. KISCO-N Y 10549 666 -3335 - S ❑'STONElE1GH AVE (NEAR HOSPITAL) CARMEL,.N Y 10512 278 9330 DA TE COL CT RESULTS OF EXAMINATION' OF WATER' " 1'° 5E s `DATE RECEIVED .: ITY, VILLAGE, TOWN _6 /OR':NAME'OF SUPPLY ;,' :: DATE REPORTED ROUTE 6N RAHOPAC,: NY 4MPNIING4POINT WELL LQT '�kf6 1.1' BARGER STREET;:; PUTNAM VALLEX NY z ACT 3 IA3PER ML (Agar plate count at 35 C) �. COLIFOAM`GO/ ost piobable No /100in1) R T AL ppm ETERGENTS. --mg /L : NITRATES {ps N) mg/L IRON, TOTAL 4MONIA FREE;(as N) rrigiL pH CHORIDES (mg %L) r ese results tridlcate Qhat the water -W68 s; of 'a sat'isfactory•'samtaiy .quaLty: whenlhii sample was col'ect,0* -, . v A H P,ADOVAN! M, T {ASCP) j, .{ I'IJ;TJ� CJTf:C1C l,'C aT . f. bate: W. U IIJITa11 L SITE INSPECT TC'f fires � Ido Comm i.^ c, r� Property lines or corners found . . . . . . . . Can estimate houso Uior. .. Will driveway need c,-:t . , ... /, s trees n nnn Is deep hole i'epresen _ve of entire SD 3 area 1 t il,'l fah, 1"�;/•� Sufficient STS ar::a a :-G_J'_ab7_e considering drivev,a;; cut, house l oca ion, separation , distances, etc. .. .' .. ... - -.. DEEP I�OLI; DTI? Depth Mater elevat:LOn: e -1 .Rock e1eN7a.tic1,' : Soils 3ec�CrlT)t gin: hate: .rIP,4L SITE Ti?SPECTTG': Ins-n. by: House located vh.ere sl7c:: °.: on approved flan -,, �- - SDS lo;,at.,d j•:}���e a�,1�..,�s Length, r-- 4'idth f trench 2cer� _a any. tr-encii acyc,epteble ." Slope 0f til))e ((�'1,ir_pe ,{Roo:, C llo,,. Cad for li:��j.:.�...�:C. -1..1 yt_ enc ha i.! • • • r • 0 el j. 5, Q ,. f L.• t.fA. -o,, . s u:.a•M Natural soil not st?'i -_ = �yor SDS area �__. umieceszari ly graded- 10 E•c . mair_ twined f ro:� -i:',-op. line and 20 ft . from house Se�xtlOn Of ere 1C 1 by USe, 1e11 etc. folio ?Ts plan . . . . . . . . . . ... Nu:!) r of bedrooz„s c}.:�!':s . . ' . . . . . . . . St on' .s, brush, ., t,,:,.,Ds; _ .'�'�le, etc. greater t }L.n 15 ft.. from new _��; t. tree cn — - - - 15 1� 1, . of pe ripheral soy.' nori- zontally Trom trench. . . . . . . . • . . • . r . • • Junction bozos prol;Yrly set COLild - tlrface I':lil OI"C I I= l dl':L�'C'�J�'?.�j', roads, rour!d sui'i ac e., etc. s.',nnnel near SDS .• . 11TOLI Doos lot drain.lr-o O.K. S_n orea of ST) F INTAL MfiDTIvTG OIL ; P-P -E � CCElPaTO L ?s' �•, Vii;.; ► �i � cz - -- .. _ :73. - s._r ";°"<c _ ....• -� SiL. .. _ r ^_. __.. - _. -'- r. —•• - •` ° "s,.:.!'.>`. .. --i _iv"y' f._'s . "`. _ 'ti^.. °_, s.. — - - -• s -.� �, ,r .- . It ' I: n. t 30 pe-rc test dcjAh I _ I Ccne�t .r::sults for 3 r. ur.ts I D. liole lo.; O.K. , I I Ccr•rorate Aff:ici.,a`i:i.t for 01'-ii�:;r Autliorizati.on for eT1p_i.t1::r , 141 Letter frc;m Water SUTm ii ' -rn.! - ca.Ie if vari.arce rogtieste d -� a on plans 6, apps. L TA IL5 if chanve is Frcpcsed, ) x'is -i_n- contours shown show now contours) Slop --s for - dr -; v :%•ray cuts, etc snovn I-,ater service line location r Tootima drain, etc. location i t lop slope., bott';oLn slope of Till 44 1 i Fe�rcolati_on tc sts end deeu test pit location ; { Septic tank s17e and conformance -o td. 3 B.R. house mdnimmm I House C, Ue --back shown ! ) moo: ° - - - -- - 1 ; -A-L-L vater w1Lni.' 111. -or r:L, zsho1•r!I Pltn and arc fi le SDS All other wells ,.and. oser P00' shown -or 3-ef2l=ence i�adE _ Prolxrty boundaries (tttetes a.n d bounds- clearly shots _ 1 CPARATI0N) DISTANCES SPECIFIED C?d P LUT .0' to P.L. '0' to Found�...ion walIs i :0' to W. -a.r. ost well �O' to st.reat.i) march. _L ire, etc .__�incl . expa.nsion) j 5' to Ct_irtalrz drain _WA, I , 0' to water line (pits-WI-) i I 5' to storm drain I 0' to lazy, c .troes —j 0' from foundation to C'oot_ic tank 5 to pipe from, leador dla.i n w f'oot;,.r% urr�l.n . r ' F a Tj . F r F. � •, .. ;' t . F _ C x� "�j 4 -W., `,= a`t �i�,.�`a }}t ,`, y�try�'"�•.' _ � •LX ay '... �:.' e, �'"_ . r�Id �. i, v;r: � ,�X � ',� ftia .<r• � •��" .i �. �'��.� ��r�,'� �c'r ,{Jr �♦ ;., T� wz��a +� X 3.. c t fi. Fp{ .Sky 3T pate", - K _ P �° r � i 4 SA �I iLi Ci V W lid it 2AGi 4 1, . . ` . � Tr 5 • : t ESL- � i ��w t� � , d �����i�`Q✓ RI� {i��YJ Y3J ON, F 1 3 8u1yoersed��ior�Y e} p C y - t , ©:ii7�nrudt 1Vi d + �i s,� i� ifSx jr b64e :na a pra�r�r :y t in �.cr t rdanae 7 . q�X�s qlkp� � •�} X�. rk ,�jtY •� y�r� ('►•Q lip )y�!'FR ,y�.ASy '�C^���: X u+� /7'd�b ���j� r .i�X / {�� ����fr`,�• �f7Y, 4.i7leL b� +a�tman ' f �r /�. y g y� ,p /y �y �g r� �y ,�1��q ,f}F, r/yy� -fit T• y S� � i'r'f ,(•�rY -.. C Vu3i1� ©M \i hid r 6 ®r abd �IiJ y r ,t i ti•�i n 'r�.(y�{`yX��, p�,,{},, C '/{1.� }fit' �-_-{� '£�]r�.....r •..: +, a. ti..' s�• }}jam f i I or �"OUtt x oon R i. V 'S� o i 47 -EtUti$44g $0 �1t g• ii61:Tl �sf A h e kfe Y — y .t wj � .. '• ', .. J � t Vii''.' v 1� t �a'. X st u�i ary L�• • I � .��yy}}yy��yy i a�`' fit �yi r :r r—y- rL�Jidi'Y:r r • t t� J 1 fjv�ari� r �i�$! �gQfE�i/p 2720* , } , r 4 P�iir•+lP� LT+i'b � tyfi �4 " t too x� + � y -. '; •$ - 1 . • , -A /� � i� r£...' {S• �.: t y^ti M �t i .• `'tlt C '`�1(�+ �'' r -,, 0 tyr 6�(, r (: ...: r ry0r 272 .y ,... "'• ryr 4''sR,'; p�Sif7K5. i e r - low �.�F NON '►p�� � k N : Putnam County Department of Health Division of Environmental Sanitation AFFIDAVIT � CORPORATE -CIINE ON_ FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT. TO: Commissioner of Health In the matter of application for "'4 4, 61.,oceP 7,-4;K 044b/ 2��AlTrZ ff T that I am an er or employee of the corporatioA and am authorized to act for 15 *o (npm of. c por., tion haying offices at AV, of 7 _Yfhpse officers gre President/&,D,q jc(z A 1_4 11 t m '9 iniT Tddress) Vice-President _., 6 L A14) ­ 7 -" fJ Wd F (Name, an Address) dreFS) Secretair too, 6.41 V 7in -C( gamjtei dres's ZL 0 Wd e nd U A er s -b� (N Cam ess and that I am and will be individually responsible for any or all acts of the corporation with respect to the approval requested and All sub_ sequent acts relating thereto Sworn to before me this -4,3dav Signed— of aj, Title 4J_ NotAry Pa lic CATHY W.-flTEHOUSE Notary PuNic, State of Mew York Qffd. Westchester County #4636912 Commission expires March 30, 191yd Putnam County of Health Division of.Enviropme.ntal Sanitation AFFIDAVIT CORPORATE OWNER APPLICATION V iz FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health , In the matter of application for ��Vljnc ( z f3r �� (A A) vii,, j) V Ef E_ '4 - — — — — — — — - rpprefeqnt. that I am an officer oremployee of the corporation and am authorized to act far A_ I A) 6. '(n_a`me7o_f 0 or-p'jrjTt7j-07;) �gylng offices at R<>L) (2Ar-- AJ 6 P�J, REP- -7- Hi�- Whose Qfficerp #re President/ "'_,0Ri�_A,617W0 .4�� ,rte Vice - President Y*061_ t4l z_'0 ��z Wo uv-r- tol� ��17 P" (Ramp a7hd7A7d_d7reasT iI Secretary. (N�me and Address) I Tregeur 4 � Address and tW 1 am and will be individually responsible for any Or all #otp* of the corporation with respect to the approval requested and all ,dub -. secjuent acts relating thereto. worn to before -me this 5f day of V-C/4 Nbotor'y''Riblic BARBARA A. LANDER Notary Public, State. of New York No. 60-2242860 Q ' pallfied in Westchester County Cornmissign Expires March 30, 19-79 Signed Title Irk PQMPI0..97I014 REPOFIT PNTNAM COUNTY KPARTraANT Of 3/7� -- Olvltiprt of Environmental Health ORryipgi r COUNTY OFFICE; E ►UILDING - CAI3=4, PlEW YpR This topPl; to tit be completed by vvgil driller and submitted to County Health Department topether yvith 1#0raoa fA _ of �` :,� #gn 1�u I4 of e!Vat��semple indiaating,^nreter.41 afsetitsf;ictc�er,f a�t�rir 1= :IrSl;�y,=� fore cE tiSiCa n P'aii?p�ipRG® �� IR @FfpQr REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION �4'AM� D` D GE3zw , Law Or$ e& L7G50, INp. $ 1. Tosxn ((of.NNc3Aof D ['(l0PR5Cp vJa Bil Via$ { FARA El TEST N94 =t AO NS QUSI K NESS T ESTA41S." MENT LJ PUBLIC - AIR OTHER �SUPpEI( INDUSTRIAL L� CONDITIONINQ El ($,pacify) CrIIDbQ COMPRESSED n VR PTAPY AIR PERCUSSION L- CABLE OTHER 1 PERCUSSION (5pocify) CASING CgTAi6a L !<ypy" (lpflt) DIAMETER(inches) YJ WEIGI{T f00T ED 1J ® THREADED WELDED .TES E SHOE jI L_) NQ 09 MVTKP?' " ika Tool {�'� �[�( HOURS G.P.M, ❑ RAI►.�p 1 l PU14PEO 0 COMPRESSED AIR YIELD (Q.P,gf,/ t'JATEp I69A ;1)114 FRDlri 1AND SURFACE —STATIC (Specify featJ DURINQ YIELD TEST left) Depth of Completed Woll In.fpet below Land ;Yrfpcot el&z) UE[!ts -�fl Mf�K6 LENSITI! QPIR To e!Auins ((getl p "vTQll� 54AT 31 DIAMETER (In4ht?a). IF GRAVEL PACaEDr Diameter of well includlnP grovel pock (Inchoa): GRAYgt:. ;E (W. qq. fRQti1(("l,) P (199V P .-PTH FRpkt LAND SURFACE fPRMATION DESCRIPTION Sketch exact location of wall with dlatangw, to at (0P41 two pormangnt lanom;fts. FEET to FEET .._. -. .. .. — .. .. a.... .... e.£; -.may. - 77 c ...., ... - _.. If yield was tested at diffcront depths during drilling, lief below FEET' GALLONS PER MINUTE P011 E" 09PLET99 DATE QfF RIEPORT M/E_LL DRILL (SIgnat a) 11 Owner. r Purchaser o�ilding Municipality Building Constructed by t---1A P Location - Street Building Type Block 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 Putnam, .Coun- ty..Deoartment - of. Health_ as to- whether,--or-not. - -- f`ail`ure of the "system to operate was caused �by the+ willful or negligent act of the occupant of the building utilizing the system. i� Dated this // day of %sec 19- Signature - Title U! C£ SS' (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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner, V fc,Di,tf_ Address ov E � o c /V- rr Tx qp Located at (Street iRGe2 agv. %22- Block Z Lot %/ 4&dicate eared st cross street) Municipality /©WV © t✓ ,yg LC���Watershed� /�� /IjGG 1bcC ©t� SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION. Run apse Depth to--Va-fe—r Water ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches of KZ 19� 26 5 / 2 3 4 5 Notes: 1) Tuts to be repeated at same depth until approximately 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. Address THIS SPACE FOR USE BY HEALTH DEPARTMENT ON�r� Soil Rate Approved Sq. Ft /Gal. Checked by Date TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION a DESCRIPTION OF °SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO.". "`' P/ HOLE NO. y HOLE NO. " . G arL w, . ;�. ::SF?%G l 7 .✓�f��(.�.1 . ;_.c� %L . rr. 611 u y 1211 1811 y 2411 h 7 3011 p a( 3611 . 4211 T y 4811 y 5 11 6011 1q 66'1 7211 y 78 f 1 84 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED o�/Z- INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING. ENCOUNTERED TESTS MADE BY ,.s: L,q�✓p�� Date Z- 23- _ 86 11 Rate Used 3iMin/1 t11rop: ' S.D. Usable Area Provided~ No. of BedroomsSeptic Tank Ca Gals. e TrC Absorption Area Prov ded P B_L.F. dtb ' width,trenc . d _ _ Other Address THIS SPACE FOR USE BY HEALTH DEPARTMENT ON�r� Soil Rate Approved Sq. Ft /Gal. Checked by Date 1 (f: 4 '( 1.1 ' 3' y 6963 1.43AC.CAL f'( 9 1" �P.63AC. �3j22 T� a ,:. 4 38 AC.CAL.- _ f�. 20, _o 21010 ,. . AC . CAS . LF+ �0.31A e 1.40 AC. N m i /�/ �gfs CAL 1CAL. 0 19' ' 2 Q, ,(i7 12 i .03AC.CAL. . N zsa.s0 1. QC 2 6' \ \` f� 1:3? AC 2.04 r.. CAL. �� °� 16� =.93 726.70 74e.00 o 08 1.0 A (1�CC��, �� 8 7 °O b 2.03 2 eo 244.63 1\ 1� a 1 t -_" s. 1 .. 0/ 346 -14 f . V - f• �fi 5 c 82& .� �, ,� �° m an6g 7, 75.AC 0 J 0 I.O AC. 4, b P A .20r . go9 4 I (2,.� s I S n 19. N 1.016 AC 2 2' 250.6p tnS• �° 3 1.0 A. 1009/�C 1 035.ACr e 114 AC. o� _ 6 qa 7.2' 6. Sp ,�, 673AC. 4:. i g . `1.1 73 AC ' 1so:oo: ISO 00 t �^=-� rn t* - Ki+�� ''^fI 144.'5 _ J( N 0 14 / DRIVE o rn .. N 3 p3� , +, j, c} ,�.• OU2 -N, / S� 159.95 IS5.0O L7p. I ^I. W 1.75 A(,. 3,00 ; 3 3, t ry / 6yz STEP.HEN Is 2 / 4 �� 70 9 , j. C 23.6 1 AC N 1 107 A C 1 2 g " N A y � � /T 2 I OA C 3AC 1 0� 6 046AG '.145.00 159.27. ^_ z7,12� • - .. o n� iS uu X001 d1 6.2T I 1s _ (� 249.37 5 1 I L,. $ v 42: a b ( - Z r 4 (. ;:.3.09 AC.CA. • 6.2 hP�!� '.8.T84AC. CAI ,._. (o .9 C VALLEY 1 - // :. 536.70" • UrT N AM :. �. \. f o 1170 5 PJ T NAM _ scrt �• 1 TOWNS- �16.O���°OF. ,YORKTOW N a --, _SCH :.: COUNTY is NESTER. IF 1 j,... LEGEND :. - 2 ON t . - BLO�Cn K a NUMBER SCHOOL DISTRICT' LINE S STATE LINE F PARCEL NUMBER DISTRICT NO.I E FIR E DISTRICT. L IN E AL SCHOO4 L DISTRICTiNFORMATI PROPERTY. LINE' n 7nh3HFR 1� I'V ' :i � 4l x' -af> lot v i CD Y