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HomeMy WebLinkAbout4618DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.09 -1 -4 BOX 35 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT rOR SEWAGE DISPOSAL SYSTEM v ► i' 1A tip. \, r1 L_Lc f Town or Village _Located,:at•- ` . ( (c' Ci= Y l J _i' sect bb Subdivision 'Lot Job r' Owner—', L---, oe h` j�1 n iS tv !,i L3 i. j Address P, C; . � 6-X J"t H �'Ft GG? A�, 1w0. ,rE , Building Type J �' °�Gi r��- �'C�^• Lot Area t ACRD Number of Bedrooms Total Habitable Space Square Feet p g y C, Gal. Septic Tank i lineal feet X „ width trench Separate Sewerage System to consist of R J -�•�' r!%�• / !i ��-n� To be constructed by r Z, ",L �/1 t- 0 tit Lit" Address [ C no),-oi /d b' ,� "t 7 %Sd (r CS �(• Water Supply: Public Supply From 1 '� Private Supply to be drilled by 4�JUik.mil'l, Address 6- J/� (2Lti� 'ems , �; T71),11 M /•j Other Requirements I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewageQ above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations 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, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following thedate of the issu- ance of the approval of the Certificate of Construction Compliance of thgoriginal syst m or any repairs thereto; 2)'that the drilled well described above will be located as shown on the approved plan and that said well will be Installed ,in acdbrda e - with standards, rules and regul ons of the Putnam County Department of Health. C, 1 Date _Ain "L / �� / �ti Signed �lr!`6 4�r rR ti P.E. >S R.A. Address c, .r7 �llc?Itifl�c7nJ;� 9U� �L Z(561tcJLf k" :S �E �.i 2 License No. APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and is revocable for .cause or may be amended or modified when considered necessary by the Commi o er of Health. Any change or alteration of construction \., requires a new ermit. . Approved for disposal of domestic =F1 privat er supply only. ;n Date By Title ,, ,l PUT_ NAM COUNTY DEPARTMENT OF HEALTH Division of Environmental. Health Services; Carmel; A ' Y. Q V 1051 -Y - , �I CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM PL),TVA �t a�LL 11 { y`� Town or Village Located at Ft-o me -Wca Or, 1 y fr Section "'i' Block b 1 Owner J u^p +i rtoi A©iL�' a Lot ® `� �Mflr `N'Cl Job ,.A 14 Separate Sewerage System built bby�9 S 1 d-L p i-A i S I c l` Address vv C�0 v s • � H A 1401PAG , P.J • 10!['i Consisting of Gal, Septic Tank Z 4'o lineal Feet X 3 a 0 to width trench Other requirements Water Supply: Public Supply From Private Supply Drilled By Address Building Type d �'Y D wi -J1. ti- No, of Bedrooms Date Permit Issued Has Erosion Control Been Completed? • en. I certify that the system(s), as listed serving the above premises were constructed essentially as own on the plans of the completed work (copies of which are attached), and in accordance with the standards, rules and regulations, plans file and e r YLL� County Department of Health. Date' /�,,Certified by P.E. R.A. Address OL o Ww�� e"o pJ �'iS�YI 4/i J& /rFI• w ��'Le License No.. �'c� 3 Any person .occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure 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 Commissioner of Health, such revocation modification or change is necessary. Date , �' By. Title I "i-A '... _,.p_'�C — a.- :a- .ot.s•c� .. x.. ,. !. -i' .. sT. -�.i .+^i'r:g•.,. �•s+. -a.vY .... —_ _._ _' .. • 7 PEEKSKILL MEDICAL LABORATORY 1879 Crompond Rd. Barclay Plaza Bldg. A, Apt. 1 i Peekskill. New York 10566 PE 7 -8777 I I ACTERIATER ML. (Agar plate count at 350C). COLIFORM GROUP (Most probable No, 100m1.) HARDNESS, L - pp ess Cv.S n. Q, ETERGENTS - ppm NITRATES (as N) ppm IRON, TOTAL ' p i; i - OURIDE (F) - mg. /1. :1 hese results indicate that the water was of a satisfactory sanitary quality when the sample was collected. ` A. H. PADOVANI, M. T. (ASCP) .. -r . .....ice �.c. -�.. .- b .. a :. PUTNAW COUNTY DEPARTMENT ' OF HEA -LTH- DIVISION1OF ENVIRONMENTAL HEALTH SERVICES Gentlemen: Date MkIiI614 � zjj lq Re: Property of ��' f . iz o ►�"= C1 c �c , Located at � Yz� 4�t Section Block Lot I+ This letter is to authorize )K) lQArta1,A; C_-IQ I c.F1z2t E= _QC a duly licensed professional engineer or registered architect (Indicate to apply for a Construction Permit for a 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 f ai, J epartuieit Heiul and to sign all nectb3ary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 1147; -- 2dueat3b *- ,aw - -- the-- Public-Heal h- �.w,,.�and. the °.Putn�m�C:oi�nty . S�ni� tary Code. Countersigned: Very truly yours, Signed ,,,Pwnet of Property Address Telephone c.f:J ,2c:�r�r•��� �1 i.;�,� A, g_1 S / 91 a -_�361 - `9 1 i Omer ol- Purchaser of .L ilding • M. a Building Constructed b �t�2CC��SGI =. •D(Zt � L Location - Street Building Type Municipality Section Block Lot GUARANTY OF SEPARATE SEWAGE SYSTEM I represent that I am wholly and completely responsible fer 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 succe.ssors,: 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 occupant of the building utilizing The undersigned further agrees to accept as conclusive the determination of the. Director of the Division of Environmental Health Services of the Putnam County Department of Health as to whether or not the failure of the system to operate was ­Cause_d-by the .wxl -ful.,or..•negliaent-act�of the - occupant of„ the, vbu ldi g.u�tiliz�,;n _, he system.. w ...... �. � _ ., ,..... Dated this (j day of 0A,,P ,,r 19°76 Signature Title (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 WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3171 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK Thi$ .r.3port, is. to, be :cornpJete b .,well. dgi�!gr. and Subm tted to .Codnty.,Health ,Depa�tmert together, .with, laboratory report -of - ;ti.........._ . 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 OWNER NAM r ADO E,i� `f LOCATION OF WELL V (No. B St r e1) (Town) (Lot Number) i f/ / 1- /o J�-2 I ' PROPOSED USE OF WELL BUSINESS L'J DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL ❑ SUPP Y El INDUSTRIAL ❑ CONDITIONING ❑ OTHER ) DRILLING EQUIPMENT r7l COMPRESSED CABLE R 11 ROTARY l! J AIR PERCUSSION ❑ PERCUSSION ❑ ((Specify) ~ CASING DETAILS LENGTH (feet) 2, f DIAMrO E�ER(Inches) WEIGHT PER FOOT r ® THREADED ❑ WELDED SHOE YES NO E] rul CASING YES NO YIELD TEST HOURS G.P.M. / ❑ BAILED ❑ PUMPED 12 COMPRESSED AIR lv YIELD (O.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST [feet) Depth of Completed Well in feet below Land surface: � SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (feet) SLOT SIZE DIAMETER (Inches) I F GRAVEL LPACKEDs Diameter of well including gravel pack (Inches): GRAVEL SIZE (Inches) FROM (feet) TO (toot) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION _ Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET 13) /.3 ;Z36 If yield was tested at different depths during drilling, list below FEET GALLONS PER'MINUTE DATES DEL COMP ,IETED l �© 6 DATE OF REPORT WELI_Na i LER ( gnature) In PUTNAMiC0UNTY'- 7t3EPARTMER -TI OFV- HEALTH_;�.�'.; DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner �c?�c =��ii d ,Zc%;1,��%� Address `i ;U�c,x �, �'����`�:�+� ��,�z l�,% 1c%5-4? J Located at ( Street DN V 'Sec. Block Lot % -_2> Z Indicate neares cross street) Map i l l e) Municipality cut k5 vl= :11�;a A A� Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION ITun apse 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 Notes: 1) TeAts 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. -_2> Z 3�z 3 2 I 3 5 � I 1 2 I , 3 4 5 Notes: 1) TeAts 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. T 'DRSMIPTI 0 .T�ST­ I* . :TA­16TW6T�,,A LS 1q,N OMMM) IN TEST '0128 DEPTH HOLE NO.- HOLE NO. HOLE NO. G.L. 611 Tc,- Sn,_ 1211 1811 2411 301 I 3i" 3611 4211 4811 5411 60" 6611 721► 7811 8411 -D 'IS-ENCOUNTERED. 1NDICATY 'LEVEL AT 2 WHI-CH GROUN -WATER C, � -:0 INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED Le CUL'ly 1 cz'9 TESTS MADE BY Date ApillL iojq-?C DESIGN Soil Rate Used NurVl "Drop: S.D. Usable Area Provided C No. of Bedrooms Septic Tank Capacity 12- 0771 Gals. Type 1917L--e_A3-F , Absorption Area Provided By_L4.0 L.F.x2411 36 width trench. Other ivame bignaturp Address (%_e &e lei, 0 '4 682 THIS SPACE FOR USE BY HEALTH DEPART' T ONLY: Soil Rate Approved Sq. Ft/Gla Checked by Date APR 2 U *111f10­ -J DEPT. OF HEALTH S� tl d 'l . .• Yea✓'. J c4^ • �v � � � c .� ' 1� ry•... � '4 � � w�i ..�(r.� .W- ,. � �..� Ap�'l : , q :a :. q�-e�u P'.: [;films �Y'1 ',R.'� .� ���q f'I .oY v .. IJ t i�Y.1 ' - 'n '^N•Y^�s••M r �1F�ti � • .ti�i •- I— -- — 50•x3— — — '.� r 3 - --. Y� So',Y3• �' 3o•Yj_ • may cr rI a SEPTIC -TANK a ry t, IG o O 41 o- RANCH TYPE N 4o Or � > e 1 + o O i. - _•- -..... •_ .. < S .. O .S � ;; i • ... • .. ... aY vy. „ rty a .y, +e> v...c ._ ♦YS _.. .S..,r� � � .. a a ,• I I WEU I I I 1. I FLORENCE .DRIVE This is to certify that the sewage disposal system was constructed ^r% ` as indicated on this plan and that the system was inspected by. me C' „ before it was covered , over. The system was constructed in accordance with all the rules and regulations of the Department of Flealth. County of PUTNAM