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HomeMy WebLinkAbout4581DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.06 -1 -14 BOX 34 ���.. 14 F ly n IL o ' k. , - � X. 04581 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT' FOR SEWAGE DISPOSAL SYSTEM ';c>\.w%i Oh- PyT).7l41ti \0A (.Ley Located'. at _aC2.l .y '_ •��9.5 G � Q �c't� . I A L3 e . 6 la Town or Block 2 1 Ac PAcc� ;." _ BI Subdivision MAP I�t>. ��. '- EiL�PJafs•P��lG. Lot 6 Job Owner Address 18`�9 Building TypeOiJr =c FN"t"'t E'er: Lot Area Eail'S1^`L.l.• tApzyi Yc2fj/ lost- Number of Bedrooms Total Habitable Space fi Square Feet Separate Sewerage System to consist of q It7 Gal. Septic Tank lineal feet X .I width trench To be constructed by %JQ A 1 t>*Q';E� 1i IG !f - Address ig iy7 A LIRA 14 y Water Supply: Public-Supply From Private Supply to be drilled by Address TI, yl�cscn, R�AX >j (7A103e:)Sty Gplz0 Other Requirements LD I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) - that the separate sewage disposal system above described will be constructed as shown on the approved amendment there t dance with the standards, rules and regulations o t e u nam County Department of Health, and that on completion thereof a "Certifica C tr I ompliance" satisfactory to the Commissioner of Health will be submitted to the Department, and a written guarantee will be furni 45u sons, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal s ergo wg p �8 o (2) years immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance h i 1 y epairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be d ac ce t standards, rules and regul tions of the Putnam .County Department of Health. r , tV r iii E C� Date V �=� �� , q Signed �- R.A. �Vi..i..�J�►n — _MODE F - 'm Ps Address - �E� $ License No, APPROVED FOR CONSTRUCTION: This approval expires one year fr °dy�je issued�fA{�' struction of th� building has been undertaken and is revocable for cause or may be amended or modified when considered nec r hiP B of Health. Any change or alteration of construction requires a new permit. Approved for disposal of domestic sa itary Sew �' at r supply only. t ( Date 44LIC -� -- BY Title PUTNAM. COUNTY DEPARTMENT ,OF HEALTH- _ Division of Environmental Health Services, Carmel, N. Y. 10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM 'Aqrf', -�19" • Town or Village Located at ®.� %i(%�i 4.✓J.AI� % /w &� Block Z Owner Lot 6 _ Job Separate Sewerage System built. ,bby, ��, Address Consisting of Gal. Septic Tank �Tv lineal Feet X width trench Other requirementsily' Water Supply: Public Supply From Private Supply Drilled By ✓Fi��+%/!J ✓ /J /LfL�j► _pN.S Address . O ® A,)� Building Type L �.P=� �io�/1�?'Z/ No. of Bedrooms �� 0 a NF m)t ued ° Z3 7f Has Erosion Control Been Completed? S ANG �ti, �sf I certify that the system(s) as listed serving the above premises were constructed essentially as sho n o the #wmp ,work (copies of which are attached), and in accordance with the standards, rules and regulations, plans filed he per t i tl It` •' U am Co ty Department of Health. r Date _ A1041 % 0 1972 Certified by - P.E. _ R.A. Address O A ' !tense No. gffe az IUNI` <•� Any person occupying premises served by the above system(s) shall promptly take such action as may ben eeC re the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Commissio er of Health, such r (nodif!cation or change is necessary, , t 4 Date _ �� t a . i.. .� � YORKTOWN MEDICALLABORATORY INC. 2822 Yorktown Heights, N.Y. 10598 P.O. Box 99 321 dear Street 245-3203 DATE COLLECTED RESULTS OF EXAMINATION OF WATER OWNER DATE RECEIVED RICHARD To BURKEs. DRING LANE CITY, VILLAGE, TOWN & /OR NAME OF SUPPLY DATE REPORTED ,SAMPLING POINT PARCEL 22; MAP #1 BACTERIA PER ML. (Agar plate count at 350C). COLIFORM GROUP (Most, probable No. /100ml.) Less than 2.2 HARDNESS, TOTAL - ppm DETERGENTS - ppm NITRATES (as N) -. ppm IRON, TOTAL - ppm FLOURIDE (F) - mg. /1. These results 'indicate that the water was Yes of a satisfactory sanitary quality when the sample was collected. PER: J. BILKA _ ' &/'X� � I A. H. PADOVANI, M. T. (ASCP) W-o. - ski .. Taw .. .. t • Owxi r "eo Ui ddng' ox urc Run] c zpa 1 tg'. Bu rig oris t" d. by Str ate t $] o ck •'mod P GUARANTY OF SEPARATE SEWAGE SYSTE7 t I represent that I axe TA o1 and coi:.ipl etely re'sbcnsi.bl for the 1.00� 20n, - wgr'_manShin, ,m Ater -'a1 j co_nstructlon, and drainaize of the' Sawa e disposal 8yst°e'71 serving th`e .abdva described prbpevty, and that it bias bea:ri , zr ramstrus•ted "ds sroT.ari - -on the approved p -Xan or approved amendnemt, 'the -ret6 ` a- in acco:rclan'ce with the standards:, rules. and regulations df .thB,,Putrazr? Gaunty ,Depart -ment of Health and herbb,' 4tiaranty to the owner, hj' 'sudtoes= says; 4eirs 6.v a.ssi grs a to b" ace in goodvo a ati ng onei ti'an env pert of sa_i'd -sys. g� anst_ tze ed :rh. c:t� fai� s to pay a'• " for a : °pe,riod of 'ti�ro years �m<med, t I fo;.lowirg the date'-.6 'init -.al use of the' sewage 41'.' posal s -t r or "aritr ir; ode° , .,ra s�- te:T e pr bar C' ,. L E3 :l:c b_ t, t0 .S'SkC't2 • _{ce' t- t,.r _ e t�1° °failures' `N to op;erata crape`.l1 s c used' b:y the :� 1IfiFl '�r negligent aet of t�� ,oec "u °- t of, -tie bud °l dinw # i 1 z tr sy s Y _; fihe. 'unde�rsig..ed f,i7 - -t per agrees to acc-nt -as, concl ?xsive ;the: de- ~ t ex h�nstion of the D _J.fiee-tor :o-f the °Div�isio i, of y,;riror_menral T?ea1t��_ r�� �� i usr .s o �'re P -a -pam' Count" Depar'trnen of- Hp.a1 u�r a_ �t'o:: rhL t �n orT riv`tf t?=e t.. ni ure ',ol the, s�'. to, operate was car�s9'd by the willful or negI .� e:ri% act -cf t.he. occup'ar�t -of the b=uilding ir_g Ur.- sirs :te*, ,> %E ted this =_ Signature ' Y Title If co orat ` "on ire n "me and address) T IRE (3) CO -P TES ARE .RE "UIRED, WITH T�Ir,2E (3) COP 1-ES OF FINAL PLAN'S .9EFs0�c CEr`�TIFICATE`.'QF COMT.T_�ETION VILL BF ISSi ,. :. : "WAr��tlNTOAR QUIRED T .FILE i QF DATE ` "FiR�T . TJSE QF ­SYSTEM' ; tivird en.tal: He &lt i. Servi- ce;s,. Pucnam,- Cauza :ty' 3epart+er�t. 01' t i. fW '• WELL COMPLETION REPORT : PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK z ..._ �r �_ This.-report is, o-l2e �Qmp�eted:by -w -11 drilwr :and submitted °to �Cau t�, Ne It I�e;�a tr r� ,tayeth r wit l- 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 Py ti � i NAME ADDRESS OWNER , C 14 L).J fi; t. 1 � // l%V L.- �� �� 1.�� "Z, (No. 8 Street) (Lot Number) LOCATION OF WELL `' i(,Toown) YL� , A M Y�1,L -, .. 1 ^ BUSINESS I ® ❑ PROPOSED DOMESTIC ESTABLISHMENT FARM TEST WELL USE OF WELL CD OPe if SUPPLY INDUSTRIAL CONDITIONING ) DRILLING COMPRESSED ❑ CABLE OTHER EQUIPMENT ROTARY AIR PERCUSSION PERCUSSION (specify) CASING LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT DRIVE SHOE WA CASING OU ED4 DETAILS THREADED ❑WELDED � YES [I NO YES LJ NO YIELD HOURS G.P.M. D Fl � YIELD (G.P.M.)'. TEST BAILED PUMPED COMPRESSED AIR / WATER MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST (teet) Dpth of Completed Well LEVEL feet below Land surface: MAKE LENGTH OPEN TO AQUIFER (feet) SCREEN DETAILS SLOT SIZE DIAMETER (inches) GRAVEL SIZE (inches) FROM (feet) TO (feet) IF GRAVEL Diameter of well including PACKED: gravel pack (Inches): DEPTH FROM LAND SURFACE FORMATION DESCRIPTION So teX�„O(SocaUO%(y0 %*we! W.(tli dfs(a`ride's, A ?B Id8 "'t` " - 2406 rmanen) 1 ndma keT r ; FEET to FEET � f L/ In V / ✓ ! ll i / (,t�{ r ��+i %sx �+'.�` ...iri '�F z+- .�-- "iv`a' �� .�+,Y"�.e$, "^---m .: "" t� S,. �� �~ 0e^ i' s.. + Y4` �^ �,. �qy.' . ^`f�"'+Fc'tf*�".wr�e%r�'ai'y� .� �� ,�3'4 � 3 F-.13 §� L'.�`t? .✓ f" �S'��, 'tom �4" .r'9'K•'� � � �.. �j(�S 'k. "1 k.4 r' lye I�01 3'3 'l� � �a Na `r n= l f iA w_ r e j f -} gg "l x••�fY ^i'S '] 7 Imo, �, '�J ���__ s�•��t '� YP. a a3a G�.,m -Z' y / Hr "/xF�h G .rtY •- g' �l iZ 1 � i' if �y k �)�� � �. � a ��� �- •�'�' �r ; 1 F r . .y" ,�. .q� S'+G x '� +L�'`".L1� -i V ^s' L4yW- ht_"'dd{ fr"•'"AU6tkP- i'!'9�-^ST =A2 y^ 3.. 3'. i .sa i z� -���� * 3 "c N If yield was tested at different depths during drilling, list below I ° Vin, r t , r „F r > FEET GALLONS PER MINUTE '. i� � '^��� <`°i.'a' 9 �' ',5` '�j {�'�i' - 3=�'�'=•"'L'ia= i ''°.'9a.�.ny <f�� ra �.?sI �w DATE WELL COMPLETED DATE OF REPORT WELL RIL R (Sign ure/)) Py ti � i do DP:�RT:T.:QF'.. -�.I THE rr'•'�; ' R...' :.:; ,�.c.::'.�:::'� DIVISION OF ENVIRONMENTAL HEALTu SERVICES Pate r Res Property of arc►►1aki-- -T Located at V t »� ►./�. E.' � ,� trj r- P va.LLr.? 7rA�C : R P r�x Block Z `Lot kA k - N--h0, 1 dam.. GL- C) V::, Gentlemen:. : z This. letter is to authorize iE�,k c e z a, duly.licensed.professional engineer or registered architect .(Indicate) to apply for a_Construct.ion Pernit fora 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 Department of Health, and. to. sign ` all necessary papers on.my.behalf in ti:-.or' W ith- -tT is- =rriat•ter and to supervise• th.e f 'said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- terry. -Code . Very truly your , �kC- VAA(Z,fl Ha AS RKz Signed Owner of Property IW7 1 c A`� , y o GAG Countersigned: Address P.E R.A.., # 08 - ©Z- Address SULLIVAN - THJEOE y CLARK PLACE. MAHOPAC, NEW YORK.,t05 Te lep rnone 4 D q' e_ry0. 2S8/ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION. OF ENVIRONMENTAL HEALTH; SERVICES ESZCN :- JF,T�i= SD EAIfAfiE `SE[nTAGE DTFOSAL SYSTbM. FILE 'NO t 4 ; 77 q,... C: 2 c9 n-i P �j t�� tz� A D Owner P�c%AAir_i.�5 _., its kE Address: IV- L. L_ : ue y aRK tp �6 A? Located at` (Street) bzt►�� �-A� 66.. Bloc Lot 6. (Indicate nearest cross street) Municipality o "�� � P�Y,.�QM Watershed �,A.z i� {� +Yb SOIL PERCOLATION TEST DATA REQUIRED TO'BE SUBMITTED WITH APPLICATION a CIE Hole_ Number CLOCK TIME PERCOLATION :PERCOLATION Run Elapse Depth to Water [dater Level No'.` Tinto' From Ground Surface` in .Inches Soil :Rate Start Stop Min. Start Stop Drop.in Mirx/in.drop Inches Inches Inches: i l g' eys S 3Z z7 zo z� 3 2 4i�: Sy z 7 3 rd =�-Q tZ 6 Z"7 4 5 - Z�1 a ; 07 'S. z 2 8 =`3 `�' =mot z6 t�. Zz. -2:15 q a. : 3. s_ 5q R= z5 z 6 19 zz 5 2 3 , CLARK PEACE MA��OPAC, NEW YORK 10541 .S Notes: 1) . Tests to' be repeated at . same depth until approximately ern.7al soil rates are ob- tained 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 T0 BE SUBMITTED WITH APPLICATION' . DESCRIPTION.,.OF SOILS ENCOUNTERED IN .TEST HOLES .• :.. - ., f ", _.. _ .. ice^,::. ° +'rY ,`. 'tee' � r M, _ - DEPTH HOLE .NO. ,HOLE NO.. Z HOLE N0.3 G.L., T �P�c' t.L roP m�i_ ' T o�Z25:45iL 611 GLAD s w1D -4. c--,L .Ay 12 f1 �. o ►� t, o! i a A 1811 2 411 3 0`i " 3611 Gtzav`P 4211 481,11 5 411 6 011 6 6'1 7211 8 4,T INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED ,_ �E2c� TESTS MADE BY Date G - 2 �1 vEEP�r` G o km S U. L' -T MIGN Soil­ Rate Used jl Min/l" Drop: S. -D.., Usable Area.-Provided 5, vb'40 `k- No of Bedrooms Septic. Tank Capacity_ � ate. Gals. Type ,►�ASat���J .Absorption Area Provided By p L: F.x241t 36Tf width trench. Other �ea1 M d S Name ��.�a�i �..' : r�,ebr�. �CSignature OE �EI� N - THiEDE Address S MANOR, NEW V6fltj-j0j4j PUTNAM COUNTY DEPARTMENT OF HEALTH c�O No.. 2 Soil Rate Approved Sq. Ft_: /Gal. Checked b '°9oF pNp� Date 0 0 0 b uV o- o\ P 11 • �F I` !' II `I " _A I„t �.I '.trr I I I � I 0 11 t� " w \ 4",' `� 4 � • 1 } �t 3v c,; — SOIL PERCOLATION RATE .. 9. MIN/IN DEEP TESr'Tf' q h. 9� Lj! I ESTABLISH ELEVATION OF HOUSE TO'PROVIDE DRAINAGE OF LOWEST FIXTURE TO SEPTIC TANK AND FIELDS ...... AREA RESERVED FOR SEWAGE DISPOSAL SYSTEM TO REMAIN UNDISTURBED.ALL CONSTRUCTION TO CONFORM TO STATE AND LOCAL STANDARDS AND REGULATIONS ........ . kippFQVE�I ��ff A/� %� N JUN23 �•IpgPUTT Y.. ....._...........__. P. E. DIRECTOR, OF ENVIRONMENTAL HEALTH SERVICES I'3 % O PROPOSED SEPARATE SEWAGE DISPOSAL SYSTEM TOWN OF COUNTY, NEW. YORK DATE 6 -2/ -7/ SCAIE.dd.i0 JOB NO. 71 -A9 SULLIVAN - THIEDE 90o GALLON SEPTIC TANK `8810ov CONSULTING ENGINEERS ?4y �6 ABS. TRENCH i CLARK PLACE MA"&AC. NEVI YORK /BO. 00 G Z F7i(/E yDG7 GALLON SEPTIC TANK - 4`ARC-TRENCF6 I • �' � �I � I I I I I I • ti� I I I I 'j •� � f, I � I I k 1' • V ti' v,. F. I � � I 1. ��,e \' .I • I � t t. i�o.o M; 1T �Lf7 </ �/ /✓J �/f /i' % C L c �/B20G� /C p t / VE kill • ii 1372 Ptl I OF HEALTH �; • •} 'J d _ �RNY1BRKk�riTA1. NEM.iH seRVlcES '�Ha,� I � i j` ` -, } S f . �r a AS CONSTRUCTED: SEPARATE SEWAGE DDIISPOSAN SYSTEM pi TOWN OF (UTi I,19,VI Y9LLE %aUTn/a/✓% CdYNTY. NEW YORK DATE SCALE Fly 4Wowv ,JAB NO. 771---4 SULLIVAN - THIE CONSULTING ENGINEERS CLARK PLACE y +LIAWPAC, NEW YOI r' Y