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HomeMy WebLinkAbout4628DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.09 -1 -16 BOX 35 is mal PUTNAM COUNTY DEPARTMENT OF HE_ ALTH D ivision o "'f - Env "ironment®l Health Services, Carme% • N; Y: 10512 i crgUCTION_COIUIP! 1 i. vc / - _ CFRTiFIC�0.T .OF+CON, IA.NICE �Q.R,- SEWAGE,DISPOSA_�S:�STEM �UTfY�M �y�4r� Tow n or village . h- > 1 Located at r' //✓'��/ ! " Section Blocky '�S�/�g` Owner, 'Lot' �-� Job /� 4 //� [� �jj�j ;6�'Ect"7)J;. ' - /i7�- �f7eCl�r�f`..57`L47/�F' /- N.l'k'J�'i // ' separate "Sewerage System built ,by Address �, Consisting.'of �'� Gat'Septbc ;Tank - �7 fineal Feet X width trench t AC"iGi Z C1 Ll /I \ie ?LI /V w Other requirements water Supply 'Public 'Supply. From Private SuPPIY DrUled.lBY fit✓/��Jn% =9ND��'StsrT ,/ -- Address YdiLC /" " NO: of Bedrooms ' �� ^.Date Permit Issued _ r „Building:'Type — — Has - Erosion Control ,Been Completed? / :ev- — .,;I certifyYhat the system(s), as. listed- ser. "ving the above premises were constructed essentially as shown or the plans of ttie`completed,WOrk,(copies of which are I '� attachedj, antl "•in:.accoctlance with; the, stantlards rules and,'regulations, plans filed, ;and the permit issued by' the Putnam. County Department of Health. Date / f 7 Certlfaed by .�✓ P.E. R.A. Address f3%rLp tla.t/ r �ilff/ /C /�fyr l °rvh : / License No._'12.4 C/ r% J. Any person occupying ;premises served by,the above systerri(s) shall promptly take such action as may.be.necessary to secure the correction of any unsanitary w� . •contlitions resulting ,from. such •'usage: , Approval ,of he, •separate,�sewerage system: ;hall become null',and. Void, assoon as a public sanitary sewer becomes available and the approval of the ^pr(vate water supply'shalt:becomeinull and void�vrhen.a ;public °water' supply;,becomes available. Such approvals are subject to modii.catlort :or.. change when, - m the,: Judgment of the'CommiWoner of Health; such rrevocation, modification, or change is necessary. t « Date L" �i `. gy C(J�f— Title /tf t PUTNAM COUNTY DEPARTMENT, OF HEALTH " Division of Envionment�l Health< Services, Carmel N Y :10512 CUNSTRUCTfON - 0ERMIT: -FOR 3EWA "E' DISPOSAL:- SYST�IVI !Ji ��i�7 (✓f���E l /%✓�' J�L9/�� t To Village wn or Located, at Section Block a' Subdivision Lot, Job a e, /9, rim 4..- =Owner_? Address ' Building Type _��/�%�L'/� ... Lot Area Number of.Bedroom; �' Total Habitable Space `;" ©Q Square Feet :, :Separate' Sewerage System to cotlsist of ' �Q Gal Septic Tank ' lineal. feet X width trench To be constructed by e/ E.t'C, C"o'�P' Address <� Gv/t/ Water Supply:, Public Supply From Prrvate Supply to .,be drilled by /9 Address p�/� .,E A �! / . i0/1ls°C' s ' G�/V ieA�/� : �i Q , �. //P/s / '044 45� /4. o�h�yWAI Other Requirements'. - �' . _ Off/ -/oe.��✓. : � _ __ _. _.. ... _ . , —I represent that =loam' Wholly' and completely responsible for the design and locatwn ,of the .proposed system(s); 1) t to sewage disposal syste above described willrbe „constructed as shown on the approved amendment,there to ariil in, accordance with theatan �u ions o e u na County cDepartment .ofr.`Health; and that on completion thereof a;'Certificate 'of° Gonstructton Compliance fadt�ry C stoner of Health be submitted to_the .Department, antl. a written ;guarantee will be furnished the owner;.tiis successors; heir r s'sigirb t said builder' place.. -in good operating condition arty "part of said sewage disposal system during the period of two ('2) r�i�me� � n date of the ance. of .the -approva6 of the Certificate.of Construction',,Compliance of..the original system or•ariy, repair there_ o° th a ri described "will be located as'shown on the approved plan and that said well w�ll:be installed in accordance with the st d�r�s r t f. the County Department of ,Health.., x / .Date o/t✓G 'jam /G L ✓7� Signed v l Address r , License t' APPROVED FOR CONSTRUCTION': This approval expires one year from the date issued unless constructeo ip u'a �sb and revocable for.cause:or may be amended or modified•when consideretl necessary by the Commissioner of Health. ( ation o requires a rjew permit. A proved .for disposal of domestic rotary sews nd or a water supply- only r ey ....Date �'V ` _ r. 4669 , r YORKTOWN MEDICAL LABORATORY INN P.O. Box 99 321. Kear Streets Yorktown Heights, N.Y. 10598. 245 -3203 DATE COLLECTED .RESULTS OF EXAMINATION OF WATER 3 DATE RECEIVED . PV NAM ACRES . 0/0 G RPAN 10/15/23 VILLAGE, TOWN &/OR NAME OF'SUPPLY DATE REPORTED BARGER ST. BOX 262 PUTNAM VALLEY, N.Y. 10/17/73 ING .POINT WELL RIA PER ML. (Agar plate count at 35'C). COLIFORM. GROUP (Most'probable N6. /100m1:) : ES TOTAL -ppm 8 LESS THAN 2a2 .� 3ENTS - ppm NITRATES (as N) - ppm IRON, TOTAL- ppal DE (F) - Ong• /I, sults "indicate that the water was YES of a satisfactory sanitary quality when the sarrgqle was colle ed. A. H. P.ADOVANI, M. fr. _ .. -..Q .� . . _ (ASGP) I i 6 T NA.m ACRES, (NC. Aug u s t D'Amello C ipali ty P-1,Ctir x.•1:1 Milgor Associates_,_ I B Ll 3-: Ed­: L'7; GGHstr. u. c ic, c-, d .by Y6"6 T1, '3 _0 I c/o M L Miller Vaughn Ave. New Rochelle N. Y. 9674- Block W % 3 bedroom ranch. 33 _ST fl—d: 'LF) g- Y y' p­ -c Lot GU A R A_N T Y OP SEPARATE S E1 1 A G E SY S TIE I il coicipletely- respons I reprosent that I am wholl.-7 and i b 1 for tho o c a t i o r.1 i4o ric man ship, material, construct.ion. and drainage, of the scwaFE, bed y spos'.al system serving the above dasc.ri property and that it has been o n s t ru c t e, d as s12-o-vin on the app -oved plan or approved eunenLment- therezo in accol"dance with t'ne standards rules and ren-ulatlons of the Putrial-ri Q 0 1U-1 U Y Dc�-Parlv-ri-,3nt of Health, and 1,71-c-reby guaranty to U th wn e ocr, his suCce_s- or assigns, to place in good operatin.c- condition tion any part of 0 IS 4-0 system constructed by ri-e 11hich f a L U Operate for a period of two Y -"o nc- the date of initial use of `1-in se.wa.-e disnosal -,ars U 4- 94-0,, eXCe )t , rein, r 1 he 0 -t- fall 11 . or any repairs made by m�e to SUC11 SIT r tl 1, f 11 e 0 o p e r a t o rl v i s c a- s e d b,, h - 11. f ul or negligent aic t of the occu-- a n t of the building utilizin& tl.,.e system. the de-' Die -Luridors,"n'-n-ed furth�-ij- aiz:•ees to a�;cept as conclusive `q iron*_nienual lie t IS e 1, - P.Ml.nation c f ILI b c 'D I. I, a c t o r of tho Division. of _r v- J� a s to whether or not the of the P-Lit-na-m County D e p o, r t, o health of tae sy--t-erri to ua,-rate lAras caussd by willful or negI.-i:gent 4 -o-ccu-panl­of th di .c. buil n, -u -t i-I i j n p. t.he syst-m__ • :Dat-d. thi s day. of. 1-9 7-1 S.Ignlatur TO Lit name o corpra"Jon, give naL..L M-U-41trbet Lake -Peekski 11 N. Y. GOPI-ES 01i, p,rNAL PLANS Br!TC)RE THREE (3) COPIES ARE REQUIR"��]` WITH THHEE '(3) `-'CERTILFICATE OF C0i`1P.TET10N 1.11LI, BE ISSUED, TO FILE NOrLnI`_,7,' OF DA.mE OF FIPLSr" US.E' OF SYSTEM OUARAIITOR L 2nvironiriental Health .Services, Putnam County Departilient of .11caltti vision of P v'ELL PUTNAMI COUNTY DEPAHTMENT OF;,,; EALTh 3%71 Division of Environmenta! Health &:fvices ° i r, COUNTY OFFICE BUILDING - CARNIEL, NIEV)'.%ORK This report is to be completed by well driller and s:±brriitt(,d to County Health Department together with laboratory report of analysis of water sarnp;e "indicating water is of satisfactory bacteria,! - duality i efG_re certificat<e,•of eor)struction_rom_pliapce.is issued_. .J +••� -. +0.... :�+L� .�.: _ �' ...� . _;y. . . � . - V �`• �'v^•..r� --aN.^ Q1 ..... > -�. +S]� r a..�.wr....�.woM:.,�4•- �f.. • .., j "M f. � f�•': "� .' �...°Y' . -, M . REPORT MUST BE SU[ifliITTED WITHIN IIN 30 DAYS OF WELL CONIPI ETION OWNER NAME PUTNAM ACRES, IN C° , ADDRESS 78 VAUGHN AVE °9 NEW ROCMELLE_9. Ne - -Y.o - -. LOCATION OF WELL ° jYROPOSEL, USE OF I WELL (No. a Street) (Town) (Lot Number) �• /C.�� %7� BUSINE- U DO)AESTIC ❑ ESTABLISHMENT ❑ FARMS CJ TEST WELL , PUBLIC AIR OTHER i._) SUPPLY . ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify) -- ` TOUIPMENT DRILLING ROTARY AIR COMPRESSE CABLE P RCUSSDION C� PERCUSSION ❑ OTHER ) :.CASING . DETAILS LENGTH (feet) DIAMETER(iachas) G rf Y.'EIGHT PER .`'00T AS S THREADED ❑ WEtDED DRI E SHOE YES ❑ NO jj4VA�5 AEG ROUTED? - L_i YES I NO ^__` YIELD TEST HOURS G.P.M. ❑ BAILED ❑ PUMPED COMPRESSED AIR YIELD (G.P.M.) ' v WATER LEVEL MEASURE FROM LAND SURFACE — STATIC(Saecl /yleet) CURING YiELR TEST.(feet) Depth of Complefed Well / in feet below land surface: 02 oc, SCPECN MAKE LENGTH OPEN TO AQUIFER (leaf) DETAILS SLOT SIZE DIAMETER (inches) IF GRAVEL PACKED: Diameter of well including gravel pack (inches): GRAVEL SIZE (inches) FROM (last). TO (last) ...- DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of wall with distances, 10*01 least two permanent landmarks. FEET to FEET - V- �F� —� -.�v- •�G9. r. � f �. r1• r •r'.n�` s {: • -.�. ... •.+ r .. . .. . � u -�-: �T�r. �� • �.. - .." - fir• ^'�?° "�y��.�.� If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WEII. CO %PLETEy DATE OF REPORT WELL DRILLER (Si9naturo) i 0-7 1-j TC D I Da t- e Z Re rop L o c at. ec a -U /:WV41,C4 w p C) S= Gan til -- r: e- - - Blocle: T , L) 0 -sj is ':3 alll'J :10 T i-� il s a I c I D S S 0 a n f .n c o 0 cn z en '7 0- said of c--:) or V' utrar' Co *.,,n--,, Sc: Law a ll n- tairy .Code.. CO,U -1 e r s j g- n .L'I��v P E -Z'070 J,4W 1,11,44 , -Add-ess /V- Very ",uly yours, //VC, S ca 'V4 , lil'6 La Address of NEW 1, ---' Te -Oncnzz.� . . . . . . . . . . 1 2*()o 10 *41 ENGINEER m PUTNAM COUNTY DEPART= OF HEALTH - DNIS•ION- -OF ' -EN ZR{} MENaLAffir 12ALT- sERV3CES COUNTY OFFICE BUILDING,'CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner 144zi°S' 11VCj Address 1 C Located at ( Street 019P. Sec. Block 5'6%'4 Lot .647 indicate nearesT cross street) Municipality 42w- *,4in 11/i-'--e5P Watershed' ,� i�tS�Ci d- l SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS - Hole Number CLOCK T3ME PERCOLATION PERCOLATION apse Depth to Water water ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 2 `ff.'s / i' i'9 /s� CI' / 2 2- -_;�7 ! j' � 1 ,��' �a' a �C9 �� � A/ 4 5 1 2' 3 5 Notes: 1)- Tents to be repeated at same depth until apppproximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be imade from top . of hole. 0 jr o TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION _ DESCRIPTION OF _ . S OILS ENCOUNTERED ,IN TE -.T -. HOLES,..,_ a _DEPTH HOLE . NO. (i) HOLE NO. HOLE NO . -_Y G.L. eO �'u a __ 6" 1211 r` 18" 2411 69 3011 J/ . le '01 r -h �' 6 1.E it i9 42" 48" 5411. 60" 66" 7211 7811 / c7i4/?9 -4. f 2- ,� e/. J !': INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED .INDICATE LEVEL TO WHICH WATER LEVEL RISES 4FTER BEING ENCOUNTERED TESTS MADE BY Date &v6. z-- 14 DESIGN Soil Rate Used 90 Min/1 "Drop: S.D. Usable Area Provided 543.00 No. of Bedrooms S Septic Tank Capacity ®D Gals. Type Ca 4,,c Absorption Area Provided By 'L.F.x24 w' ,nch Pt�'h Name ip'.ar..�acr� ,�� •. Lana ure n Address pao 7c SEAL L` THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved * &0' Sq. Ft/Gal. Checked by ' 24VY � FnsideE�' Date 'ENO 0R ` . Z� 4 " I (.,ha , -�r y vrr ! n_y, •;- ?,Pr:�: 4 �, t �1° i"t +p+� .a �qwn a ;. v�r 4� i. .h �s:;,�° ' L0 T 3.3 o- o r o t u � � �� r d u I v �,:� !� i' � q,{ -s d �••> .. a4 � � i < ! t 'L f } n r h f s , I � � w Y ORAv� '2` Gl d y s.� 4 y yt ,bt p r 1 £XP.4N5/0N.s 4R£4 LOT 34 '' .� Pr i ` r ! .k w 15 s� Y ! tz W 30 t U 3 '1 :e� � S rl 7' 1�` 1� r, Ir ^4 �' � � � 1 ><�•l � s i wa. �. r 53 3/ fi rj 1 `,t r00 u 3873! - >O g Quo °�° 38. 39 f !i' 0%1 y y V f' �y t `� A� � /sr�N G/ �� ' ,�,�f � s ,� � � ti � t� ,, e � i,rr56 q5 k oc . s i { 1>•1 t! ry i/ s£P TEO d s ep t 0 a ! 1 a , Ara /p 2GG a4 ELL tte r �,, { h F to p f Ij 0. .. p I z ! , k '1 s ° A 4jA 89 V} t � �� s. ` � a t ( '.�'1}i1V�i ��A DE"$t'G�Ai"tf��(.� , i ,Q ` 50if ' •s' 5EQ;�lflp n i s n �A , F 2