HomeMy WebLinkAbout4530DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
85.05 -1 -8
BOX 34
. . In
rM
, �.I. y.
Ir
.
' i' ' I
L .
F ro
04530
-- •- 7�`^'.,».,.,,..w v^.9. ' yr•n• v -';4 x 'S'...° 'r:` a '• r- i+' r -- -. {��-- ,9— f- �q--- �y-- -,
S'3l PEUTNAM COUNTY DEPARTMENT 01 HEALTH
- t.... a.' V
'. Division of° Enwronmental :Hea /ih' Services Carme% N Y 105'12
CERTIFICATE OF CONSTRUCTION ;COMPLIANCE FOR.: SEWAGE.DISPOSALSYSTEIVI A
.Located at ���/ �ae Section ~Blocr�f��
0:68
ownerIY Tpbit Q SGb TT Lot Job �" I I �0�-
.�Oliy 1•c4►A� �` o•t +�J iNTAL tc. «f
Separate Sewerage System built by' Addre M016;rgil-lo Ak
01 .O i P1 of�t'7!" Z V O1� +2T width _trench
Consisting ofQQ_Gal SepU_c Tank n li a Fe
Other requirements atjZ �FACII�V< YtT C� �'S 4 EJ�f'�GT1 wig; I�.J►
Water SuPPIY: . Public .Supply -F,rom
Private SuPPIY Drilled' By N• Am 64421 So
F
Address ,
� l
'Building Type
1'"�S;t'coo G No.* of Bedrooms.' QR� pe Fiij2 ued
Has Erosion Control Been Completed•` �� k�'• v0 FCC- FF.p
�.ysT�M
I cer ify that the system(s). as listed serving the above premises were constructed:es tially as'sh he com I work (copies of "ic'h' are
attached), and in accordance-with-the sia idards rules and reguiations,- plans ,`and the r, ued' _ a ty :Departmentrof Heaath
:� Z.7 T7
Date Certified .b
y P E ^f!!t
Address HE S �� License No.
Any person occupying premises served by the above. system(s) shall promptly take such action as may t e,ne cure the correction of an .�unsenitary
conditions resulting from such usage. Approval.,of• the - separate sewerage system shall become null:and void,as soon'as a'oublic. sanitary sewer becomes
available and the approval of the. private water supply, shalF 'become null an void v hen a public water" ly' becomes available. Such 'approvals'• -are
subject to modification or :change when, 'in the judgment of the.:Co issio r of Health such rev tion,. modification or change is necessary.
Date v - 2 By Title —�
�.�,. -e. .- -^ r may... "._..,.- .~�. .� .-- ......, ... -... ._.v. -ro ... ,.. �. .. `. �.i. + �- -. e• � t ._.... ..«. ,... —...., ., �. .. -.._. .- +..._. ,� ._ .. .r
/ JG 0 rT
h� T�
• _
Own�� Or PUY'CnasC ' O 3Uildi 1'TUn_Ci�21 =�
A) CCM
Bu! 1d'ino Cor stuc Una . Cy. Section .
Location;-...Street Black..
107 . � .i: �► ....
Building. Type Lot
S' s'_�:
rI r °fir °seat t:Yl i a^. ;'nol17T a'nd. CO^ ^�: �e�_ -- »esoons_�i s i5. tie
location, /" •TOr1, a_ SJ^_'� +ra-1- i a! - � true i-/ an' 7 .�J; �� -� n � � .ja_ e
1 _ 1 J :JV L, J .,O- SV_..L.. J_O t.L -� -.L _ V- :JLJ�. JV•
d�_SJ7Jai / Jfi �_ JL��' __ ��n� aJ� i� �J�.: _:��u _ _'�v _' �i
t!O_y'� 1'r• ^ , �]'S'• ?/'10 -__ o� 'i ap •"�ro '�(1 1 ��'l r -1 r � i/� � _vY1"_`__ J L'/1 y-v
• l''. G S__V .~` './_. .J 'J...1 �- O wJl J _ JV
and in ccord nce -one standards.,:, rules and
sons.,, - -.'s o`' ass -- � 7Jo r� aC� --- :--oc 3—pe.- - :C _O
S?- O'J�Ts' .ons_r�_.tc vu c •:�_l -� J.J �- J -� -0_i -r _o +. J..`'
years __� e 1' ?- -� , `�.l� ___ 1v �-. _ :J�'O- J. e J� • J?-
.sys tC7."_� o .r wnT re v•a r _,_:, e by .=e C,Q A-, c' J J.in �__�.va :! .•ine re M,
to Ooe= a e -a_ opev�7 -r cased o 'Ja O_ n.��� _yent ac - f J _e o.2 c --L -
J
_�'•^ -_ ...•Pa*�:�. Oi..:U i ^v U.:J:?'� 4�.r1.� -Y.a �,.L :! _ Z -a .' ✓.. '�S �Yw:+_a,.'..•
lha^ ..U:,'/de_rs `:ne -d f .1r'J .ne- a,7-ee.s Lo acceV J . as -onc • si -ve. he de-
te.nmina'.on of he J �vV Vy OP JL��i �D _-r�J�O O- -- �._�nv i�� �- Ja� =1 �J_ \�ih
��• /� �1 J
ViCaS. OL .e. Phi Vil.'•-- Co i..l��J`/ JeJi_rtmeT o�^ ew- _. --s to ��i ' Jy or n`J Y^-.�i
failure of the system. LO operate as Caused Jy J'�8 iiillfu Or n eViig °n`�
act of t'':2 oCCUDant Of t1ae building n U iiiz, ro �i_° S v °f_.
Da tv.d. : _s daJ .�s� �lo] s; � tore vin
._
iit1�
(l CO _Ora J - -i 'e -
.
p ^
r - - r - - - _ - r -. - � - � r - - �
TEE 3 C0' ±= S :?EET�r' ;;` ,;� '4=- �.3) r, n F,
C / �. ��.'✓ L.._ r C�,J P i ES OF li li.� ?L..1..J 'J LLy1V `J
CERTIFICATE OF COt�LETIO'r ';JILL EE.I•SS� r,D..
CrUr a 1'I '�O -S R7QTJiRED TO F7, _ y YoM TCJ 3 1" D .T E 'v " FIRST V V� J J 'Jr'
D1V1SlOn of nvirominntal Health Sere ceSJ ;P L:tT13:ri CO'•Lr!�y ii °n2= 'tMc":t Oi e
WELL COMPLETION REPORT
3/71
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services
COUNTY OFFICE BUILDING"- CARMEL, NEW YORK
This_report..is _ to be. completed by.Well driller. and submitted .to- Eounty.Health- Depart t together with laboratory reportaf--
analysis of water -sample - indicating wafer`is of'satis "factory ac erlal quality b'efo"re certificate of construction compliance is sued
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION I
OWNER
C�
. I
LOCATION
OF WELL
Rim J
4cv,.yr�+��
(No &. Street)
5��
,,/ (Town)
!/
(Lot Number)
Ab
PROPOSED
USE OF
WELL
DOMESTIC
❑ SUPPLY
❑ E TABL SHMENT
❑ INDUSTRIAL
El FARM
❑ CONDITIONING
❑ TEST WELL
❑ (specify)
DRILLING
EQUIPMENT
❑ ROTARY
�A R PERCUSSION
❑ PERCUSSION
❑ (Specify)
CASINO
DETAILS
LENGTH (root)
a
DIAMETER (inches)
& fe
WEjuHT PER FOOT
z THREADED E] WELDED
O
YES ❑ NO
G �j T
YES LJ NO
YIELD
TEST
❑ BAILED
_jjr HOURS
❑ PUMPED /LJ COMPRESSED AIR ��
G.P.M.
�' �/
YIELD (G.P.M.)
� y_-
WATER
LEVEL
MEASURE FROM LAND SURFACE — STATIC(Speclfyleet)
DURING YIELD TEST (feet) .
Depfh of Completed Wall r
in feet below land surface:OQ
SCREEN
MAKE
LENGTH OPEN TO AQUIFER (feet)
DETAILS
SLOT SIZE
DIAMETER (inches)
IF GRAVEL
PACKED:
Diameter of well including
gravol pack (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
._--
lJQ
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL C
/12
P�L/ET (
0 V
DATE OF REPORT
IWELLD (Signet )
uG
E g-,
Darold 9 eampAell, _7r
PROFESSIONAL' ENGINEER^ - - - -
LAND SURVEYOR
PHONE CENTRAL 8.3555
P. 0. Box 288, CHAPPAQUA, NEW YORK °40514
SUBDIVISION DE GN o LAND PLA+mG o ROADS o SANITARY AND STORM SEWERS o WATER SUPPLY AND SEWAGE DISPOSAL
t a
PUTNAM COUNTY DEPARTMENT F HEALTH
DIV. OF ENVIRONMENTAL ALTH SERVICES
COUNTY OFFICE BUILDI G
CARMEL p -NEW YORK 512 -- - -. .
ST 30, 9976
RE: PROPERTY OF ANTONIA SCOTT
SUBSURFACE SEPTIC DISPOSAL SYS.
LOT 97, THE DRING FARM
TOWN OF PUTNAM VALLEY
GENTLEMEN:
IN MAKIN® A FINAL INSPECTION OF THE SYSTEM INSTALLED ON THIS
PROPERTY IN ORDER TO PREPARE THE CERTIFICATION OF CONSTRUCTION
COMPLIANCE I HAVE FOUND ON RIWGUST 27TH:
1. BROKEN BELL ON 4 INCH C. Io PIPE PLAN CALLED FOR 6" PIPE)
LEADING FROM FOUNDATION TO SEPTIC TANKo
20 FIELDS COVERED WITH 2 TO 3 FEET.OF UNCLA680FOED MATERIAL
CONSAINING LARGE STONES WITH INDICATIONS OF THE OPERATION OF
�? HEAVY EQUIPMENT OVER :THE _FIELD AREAe
3'0- "' TKAczs OF BROKEN DRAG N TILE AND TRACES OF TRENCH GRAVEL IN
AND ADJACENT TO THE FIELD AREAe
4. ExCAVATION WORK ADJAOENT TO THE FOUNDATION WITH MATERIAL PLACED
ON THE ENDS OF THE FIELD AREAo
AT THIS TIME PTO MY FINDINGS 100 NOT FEEL THAT THE - SEPTIC
CONTRACTOR, RICHARD'S CONSTRUCTION, CAN TAKE ANY RESPONSIBILITY
FOR THE SYSTEM HE INSTALLED, NOR WILL I PREPARE THE NORMAL
CERT080CATION FOR THE SYSTEM CONSTRUCTED ON THIS SITEo
S ELY YOURS,
ARIL o CAM B o
cc: JOHN JOSEPH RICHARDS
:f - :k; Y s k. .:; ••.i. <' -• ,..... _ ,r r:4"` d•.5.�t, +fit w'•V(J.s " gin r�F�^t.PjF*: t.� •..,n°,y4 - gyp1,J,. *'.�'$'- zA a
,.?�,;, . •.; .. t ., -„ - � � r t 1 y N k��T £r Jam}. '3 -.�
y�l» -- . . - ,.., . 5 .8:.. t� s •rv..�... ,rs s t..x ... .a- ai'<+s -l: � _ : nqr. ,o.L .'�.�*s- ���Ga';an'?x.'':'`s,J. ^• r+'.�F:
-
j -t ,. .; - i -r.t '^� �xt``'"t }. ",a v. (,.z'.�� aritf y >E� h .r .a•tcz'�R',q'.,;. t.,s( l� {i:r " �iR' 2 ,,. 1�y i� y'� 4
... 4 �, ;• +r,•{ :+6 •. F. 7+• ;7 �t- t�,_.,� i ;{ •4.u;;� .tf� °•t - nft71�".,
c - t : tr t r. r.� tom. it L j! h t . l wv • i< "CiG<; �' •tY.a„ a
•,; _ .t'- .st { nF,•?5. - s. tiFf f ?f'. {' -7- 2'x-tn i J` Tc t rat}; ,�' ,�}'` t }t p.--�t f fvl-• 4'k�
jT' %�J /J• t7 -n ":� r�`tx ;�;r3 P +li �s. 4.:,�.• - 4,{at'r.?rJ'. 3'� '':i firx -t ;�r{ a s s`� .J'�'
J T 77 r i'' ' "t f �y � � wk ie t j �' t � 3` {i.J . 'fit+ 5a r`' a•,a t .� a 6rt : a� u �••`�4�}t#,e�
- � . — •--�'' .L— �� —. - -- � / �/'S GC�I�'r � �� � =t` -!� ie'+.. _: fi 7 i � { ? 4 .� �,^4 -� } -fF i s ^t P }.{ yt+., � y.a,�}k, •, �'
•-- —. `- f c 7�, � :£t s`'c� fk xl •S ty3 �iF �.
= Sq tici
RO V EE
JUN1!01977
•_� � � 1 '�` _..-._ -. 60 - .3U• fr Pn,. ^r� (fiar. . „ „ -qT EtL GFinw[tl
q °�,r r e1¢1 tNJC lLiBtlr amm
supervisedconstrurtion of the sewage., : disposal
ri s stem on this:'site aoe conforrgation to Depart s,
Ftye t,e rules and regulations, � o4Q ,cPMae EN�4
Harold F Cempbel
SEWAGE `SYSTE: ;
Owner':
Il p
y� r
well
Town, -le
. Subdivisions -� ufr�7_,-lJf a2 -- - -. Lv _7 _
>> ;:
FZ-OQ&:VcC ,20,4d T6x Map. dc�ne :-o er~ r-�i�• �•c�/ c��st. -, c c� Scale _l" - --
HAROLD F.. ,CAMPBELL JR IVIL ENGINEER A SURVEYOR- CHAP PAQUA, .N EW YORK
A
•{ ti
! k; i, j z F 1PUTNAM 'COUNTY r DEPARI MENT OF HEALTH
z .m
Divisront of Envr�onmental Hea %th Services, Carmel; N Y Z {0512
GONST,RUCTION 'PERMIT FOR SEWAGE ':DISPOSAL SYSTEM ^ PUTNAM- VALLEY '
l +f, _ ` Town or, V�lla9e -,'
Lac3tali .Fat?ORe:RC �R�'JE _ — S�ctiun -J06 P`i G'�o K r 2
t 7
Subdivision
'
Owner, -� ANTONI A SCOTT,,.T :EABT 237TH STREET Address ANEW YORKi .NEaI YORK i EuF66
Building Type RE81 DENCE i • 001 ACRE$ _ A
Lot Area
Number of Bedrooms F � rR Total Habitable Space Square Feet !
ry Gal Septic Tank
-:Separate Sewerage "'System to cotlsist of `_ nn n lineal feeY'X wb.a. width •trench;
° -To" be constructed by C08TA AND 'FERRET RA '`) NC' " ' Address ,NEw RQGHELLE� niEVY —Y-0Qk
Water aSupPly PUbIiC SuPPIy From
XX :private SUpply to be drilled by> P• F•` REAL AND $ONB� (NC
Other Requvements j
I represent that I am wholly and completely responsible forahe design and location of the pioposed 3yste $�s�7i�liYe rate .sewage disposal system.
above described will be constructed, as shown on the approved amendment there to and in accordance'w,it Q; gula ions ,o :. ,, e u nam a.
County Department of `.Health, and that ton completion'thereof a- "Certificate of Construct -ion Comp" ' ,s1ti _i // missioner of Health will
be submitted ao; the Department and a written guarantee will be furnished the owner his:'success Aor s by��fi, )f er, ;that said buildenwill
; c 1.
place rn. ;good" operat,ng. condition any._ part .of- 'said - rsewage Disposal system pure g the_: y' s i e feiy� Ilo 'ng thedafe of the issu
fl 'ante of the approval of•_•the Certificate if Construction ;Compliance of tt a on nal syi4 d ' _well Qescribed above
will be iocated'as'sharvn , on the approved plan and that said well will 6e ins accord n u a ns of ,Ahhe Putnarim.'.
i. r County .Department of Heatth iJJ
Date rJULY i �Q {� Signed 2 PE u Iy(i
's
z ea
t . Address No
APPROVED FOR�CONST;RUCTION This approval expiires one year from the date issued ;unless con. V, Fd►Fj ng }�bl� has been undertaken and is.'
;revocable ".for cause or'm'ay tie amended or modified when considered necessary ,by the Cominissroner_ of Hea ge or alteration of` construction 1.11
iequrres 'a new permit Approved for disposal of domestic san ary sewage d /or Hate ater supply only
i zV
a
Date (�' ra ` BY
1 Q -
r
a >
h,
3Y- r.,;y- i'..,,,,..,,•a•r _ .� n �"az ��{r. .S':�.d�i :'Z
PUTN:4t�I COU�iTY DEPT PTPOT OF ALTH
DIVISION OF �1I IROid_1 ' TAL :E1LTH SERVICES ES
-Re: Property of
Located. atC/
Section Block ro t',
Gentlemen:
This letter is tb..autho=e.
a duly licensed professional engi:�e.ar _ ___ __________t
(Ind.
to apply for a Construction Perim for a se arate s awe rage s7stem;.t0
serve the above noted property ir_ accordance .•r_ t 'r_ the standards, rules
or regulations as pro::ulgated by the Co?. issioner of the Putnam County
Depar- .tment...of Health,..; and to, sign, all necessa »y._ ?pe.rs on my behalf -in
connection with this matter and to supervise tie construction_ of said
system or systems in conformity sit'_! the provisions of Article 145 or
147, Education Law, the Public Health La.., and the Putnam County Sani-
tary Code.
f OS)
pryq�
F cAM Very truly yours,
Signed
` Y i Cr
ddi^ s s
aFT
P . E . STPSE OF . 4C)
Telephone
d A�t-4 s ti Seal )
Address
.�
Telephone
: c _ PUTNAM COUNTY DEPARTMENT OF "HEALTH
DIVISION ;'OF ENVIRONMENTAL HEALTH: SERVICES
t t " - i 6^✓x tl J. .. � tYFy ^i i . _ . +` .r :, - - ! . __ �O^.? ♦.l .. •� - _Jiy �•.� ; _"�Ar. . , zv.
DESIGN :'DATA SHEET - ;SEPARATE SEWAGE DISPOSAL SYSTEM FILE NQ.:
54 tas-r Z37 S-r26c�
Owner . A1J`r01U (A GOTT Address . >`fc w /oar. i�l, ��� 104 �o+ �o
Located at (Street)Q ✓�. Sec. 8% Block : 3 . '•
1.[:12F V tom=.
Lot
(Indicate.nearest cross street) .
,
MunicipalityJ'r�J A rh :� Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO.BE SUBMITTED WTTH:APPLICATION
Hole
' Number CLOCK. TTME 'PERCOLATION <
PERCOLATION
Run._ Elapse :-,, 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•.:
2.
2 saa�.
�Z
17S'.
3►''
3 s
30 s
3
5, o
sZ,
�I
3 5�'S.
4
(M
•
07.
2 s.
3Z
ZS
_
3 6 ih
16 5
2
�•'�
m.
4
.
5 V
ED
..
►�.
1
3.
4.
5
-
Notes-.;
1) Tests to be repeated at same .depth until approximately -equal soil
rates ar•e ob-
tained at each percolation test hple. All•data to be. submitted for
review.:
2) Depth measurements to be in_ade' from top of hole.
'
PUTNAM .COUNTY DEPARTMENT_ OF: HEAUTH
DIVISION OF, ENVIRONMENTAL HEALTHI SERjftCES
DESIGN DATA'
SHEET -. SEPARATE SEWAGE'DISPOSAL SYSTEM - FILE NO.:
!Owner
Address
' `.Located' at` (Street) Sec : Block
-Lot -
(Indic.ate.nearest.cross- street) –�—
U
Municipality
.. _ Watershed.;
SOIL'
PERCOLATION TEST -.DATA'REQUI RED `TO BE::SUBMITTED WITH'APPLICATION,-
Hole
Number.
CLOCK TIME PERCOLATION ='
PERCOLATION
Run
Elapse: .:--Depth -to Water ; .Water,: Level
Time: From: Ground Surface in Inches
Soil Rate
..
Start., Stop.: MZn. Start.:. Stop Drop.: in .:.0
Min /ln; drop
Inches Inches �: Inches
..
3.
4.
l
2
3
- --
_ 5
_
4
5
Notes
1) Tests
�.:;
to be repeated at same depth until approximately equal soil
rates-.are ob-
tained
at each,percolation teat hole. All-data to be submitted for review:::'
2).Depth
measurements to be made, from top of hole.
TEST PIT DATIL REQUIRED.-TO HE 4U.BMITTED: WITH. APPLSCATIC�1
.,,WITH.
DESCRIMON OF '.SOILS ENCOUNTERED
LE �O�01N0; F .LOT A� -
►=
_
„ - '
G.L. -
C�rd�ss G��s G' o
;.
--rap
�c P
,
6 " 5C)l C.:
`Tc�� .
18" SO
AJOY
48p:
bop
66a:
-
Y
.. .� . -. ...e .
v, t
INDICATE AT GROUND WATER IS ENCOUNTERED
.LEVEL .1rJEiICH
INDICATE LEVEL TO WHICH._:Tr�ATER LEVEL RISES AFTER . SEING ENCOUNTERID
K
t
- TESTS MADE EYi.�!' cil DATE
.. 1
SIGN
Soil Rate Used�_Min/l , Drops , : S.D. Usable Area Provided
No. of Becli�ooms+ Septic Tank Capacity I. �. Gals. Mssonry�
Absorption Area Provided, %r Z L.F.x 36 "_width trench.. Othar
Name -� A2G�.►� -- Ar�►�G tt if1. si�nat
Address. R �'a '� SFA,T.
- 4-hOq-P"6 0 �d
Health Department
Soil Rate Approved �Sq. Ft. /Gal. Checked by Date
Four
w
Y f O _ \ Sri 1r�Y J f„3
Ot
evt Mir, -�'4✓� -
yoin :v / r • •! 4� 7`Q:ri j �': y C .F y = 3 y .: 1
TOV
- ` � fr � : �. .� • '�: �•' i Nam 14;,i .]V >�h���Z�hr,. i.
"'�4 "Q 3G' t!'�:/,�C' i -- � 42:,;x' , - � /S NZ� #_ t?` ,• \• ` .t� �_,.x
: M
t. xn� . e loss �n e Y,..,' ern r rz red
QZ
. 'i� A !�V � l -i% � taK�,.,�i•7�77�J _C�1.SJU�%ry�fLl�'S �.s-n3 l "} ��r
• � � .. ' � �1\4, ,/'. `! ti t. i '•^�•�.� ��:�a�}•rlQf ".(.�� i� <<J .a�`1`.}S a y
y
° consfruetian;af'PP�e. sewa ,
r :✓ d P Ov as }tea
fiis.'slre for GQnfa roalsuit Pcs D W, ;• :
ts or! regulavopS:; .
e
C u
viLF
{i Pry: Ae-
1, y, �s
,
' 03; t wv1E$x�
_ y,s
,. .� ": s'-; .:,, .: .•;!;. .; : •.' ,._ �''� 4Q,•+ -. 1. ^— _T_ -b }s •F'`a s. � .egg;
_ii.,:"H'
}'' -..� �7 I 'i' "•C.:/ f' -C .: ' IG•./
V
i..
G tY1P " r!✓ fr.e> ir/� '� /� t .Isa:j4�,1`. Y
i
_ ewe. "..
GOL : '. ". d � e I'M I. CAS �� �� � E � �