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HomeMy WebLinkAbout4664DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.15 -2 -11 BOX 35 rp r 64 ArOI 61. 1 IN 1 , , IN � , �•, ,;�:� ', . � . ol 16 r , - IN If ml IN IN D � PUTNAM COUNTY DEPARTMENT V OF HEALTH .• �, .;�'• �-" Division of ..'Enviionmental % Hcalth Services, Carmel N.'' Y• '10512 CERTIFICATE OF CONSTR JCTION';:CO MPLIANCE FOR ,,SEW�IGE DISPOSAL •SYSTEM I�La1 �1 ZZ �y��• [ 1 '\ - •_ TOWnA�"'�Q8 Located at n'�r` Tax MaP Block/ r Owner /'�ik tt XI��. C9 cSfL Lot / /� �'/) / -Job �3O �. /I/fC�J� I" r P 9 Y Y ss ! pl�IAll !alit �! PUL;l�L1WVl'V L . Separate Sewera e S stem. built b �AGt L�.- ,i'a(L�la !,rte- ` r Addret . I( —rss p �� n Conslstin of l Gal _:Septic Tank and_ �•fdD Lt dC" Z wL� "' iRf5 taf>F N. g ODb i _. Other requirements water Supply Public Supply From Private, Supply Drilled e,y �'., 1\..... Address Bwldmg Type 'FA No. "of Bedrooms'`Q�� Date Pe'r.mit Issued D Has Erosion ContcoF -Been .Completed? r t I certify that the systems) as listed `serving, the above premises were constructed essentially as shown on the plains of the. completed work (copies of which_ are ttached), and in "aaet rdarice with. the sta'ridards rules and regulations ` plahs f and the permit i sued by:.'the': Putnam County 'Department of Health a Date �`�� CerLf�ed by P:E R A . • Address License -Nci- Any person occupying premises served by the above systems) shall promptly: a such ac ion as may be ecessary to secure the correction of. any unsanitary conditions,.resulting from•,;such usage Approval of• the separate sewerage system.$fi'atl become null "and void'as soon as a'public sanitary sewer,become's' ; available and the approyal`of the private water supplyshall:'become null and 'voitl. 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 revo m, ritodificatioh or change Is necessary. Date T BY' Title am .. _ _ _.......... �c _... ... tOer _ .... lAug C�o t i`.- p c.� � �-g or urc assn o Building Municipality ?A1.1t G09,N i -� 1�. 12'3 -1 -� Building Constructs by Section lIYO f 441 LL RD. 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- ice.s...�`� .:she:...Du :t- arr C i :�?t�T�:B`'�partment- bf = 1i-ed1 h as to •whe-ther br_ziot °� ea - :­.:.:� failure of the system to operate was caused by.the willful or negligent act of the occupant of the building utilizing the system. Dated this 24 day of NOV. 1991 Signature—. Title 0WIV15T2- If corporation, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF MTL ETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE 07 FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam Count t of Health t ,� K. GI , DEC 3 1981 PUT. NAM C 0 U NT Dr"P T. 0 F HEAL1 i 171 ' Division of Environmental Health Services COUNTY OFFICE. BUILDING CAFIMEL, NEW YORK This report is �o � cf�mpleted Oy well driller arld' Sub'rpitted tq County Health Department to ;' t 1Nith dapori�tory report of analysis of water sample ind'iCating water is of satisfactory bacterial quality before certificate Of dillf,uction compliance is issued, A,EP gWNORA NAME ... UL GO.NIE:. ,. aooRESS �' INDIAN HILL ROAD,, PUTUAM VALLEY, N.Y LOCATION QF W9,4 ` (NQ• 8 Street) (Town) (Lai Npnt0�rl1' ' PROPOSED r1 46 BUS NESS j�j �X DOMESTIC LJ ESTABLISMMEN.T El FARM LJ TEST WELL nPUBLIC AIR OTHER - q SUPPLY INDUSTRIAL q CONDITIONING 4J op, 0 0 psILLINa rt EquIPM €N.. COMPRESSED �: "I'A$I. RQTARY ' AIR PERCUSSION I_1 PERCUSSION CI 'e lief c" �EIAILri LENf3Jjj (LI et DIA V ER(fnghe$) WgYPT PER FOOT — ❑ TOREADED D WELDED X E YES CI NR X C7+3TR YE$ NQ ' YIELD TES[ HO S G.P.M. n X COMPRESSEi? AI Ca BAILED H PUMPER R P YIFID (Q.P.IW.) 5 y WATER �Yl MEASURE FROM LAND SURFACE- STATIC(Speclfy feet) r DURING YIELD TEST Meet) Depth of Completed Vfell In feet below Land furfgce: 5001 $CRR €N.� MAKE OPEN TO AQUIFER (feet) ' P TAILS SLOT:SIZE pIAMPTER (inches) IP GIIAYEL PACKED: Pig Freter of well igcluding argyel pack (inch&; GRAVEL SIX! (Inches) FROM (fe @t) TO (last) ' Tf'F eTM ANO SURFACI FORMATION DESCRIPTION _ f two permanent, perms otnt luntdma ksW Well with dlsta9nces, to at least E o FEET t } , F . �• '106 ! overburden �.. •,�.. •ro.....w�.... .. ..�,.- ..n..y.- .�..�..•,4,.•� ...... .. - ..... CEIV Q111 DEC 31981 106! .500! bedrQQk granite a' �_. �• .,;y- „..,.Y, ".yam .. _.= --tr+- ..•cam- ,.- .,.-- •.a. >.— •., -... If yield waf tested of dlfferenf depths during drilling, lilt pelow FEET GALLONS PER MINUTE - WELL COMPLETED 3%25/81 DATE OF RERORT'. WEL, DRILL it (Signature) ., I, . • C)WNTV DEPT. OF HEAL” U R �I I y } 'ate -..Y ,..: 1>7 ... .-,� !'''.4ffS a16} .onKU "e 'x,5`26 w'C,3Y LS7`. -, <Sii iy',y��'b y'�"*�,S.X. 5"�j•>�b -h 3?vRj`�Ip„,:�1*kY. kb #YS 1'�ic. 'y-4;� '�r? { U k, - xkf"'x x r�'r r f ` 4 �F -y.r •� '�' p`i•�r'..�. '� ,,,- 2 n a`ta`rttx.f.` ,4§� * ..,�`{i e" x "i . �„ ; t .Rhi' y _' A© �OWNxM2EDICAL 3LABfORA�, :,S , — C 'ti FS s, ,,h 4 z °; x ' ww ^ C I ,4 1 ""• c- `4• .v +,e =a, r k _ r - tr - t.`.S "r r. I � , : LOCATIONS - . t' , r, 1. P.. BoxY99� 3,21 Kear Street s , , }, ,.t n.f v n �. s x.a L: ` y� ,� �, ' ' , a '' rcu . c _ . � QL32fAKEAR ST RKTOWN °HEIGHTS, N Y tOS9$ 24b 3203 -., 11 '�v 44 � : 1� a-_4 o Y® ktawti eit'h s H"Y =1A�9 w=,� r a � zT �v o AVE aEEK�KI:I iv�r- °r�sss srs�, �' ti '°a " a `"" `psi s,. 4 F `� ❑' 495`MA I N ST MT PC I SCO;'N Y 10549 666 3335 } 1. 145 -3203 a } x f O STONELEIGH AVE; (NEAR.HOSPITAL) CARMEL N` Y tObt2 278 =9330 :. ro r _ G � LO —, �._., m?_, .. _,' _.i. �_� yea u3 - - �' .t� J �, tl'�gf °� . 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L -� y r E , Ft d,��!� vt •h-.t ,a *,,(� n „1 �,; aJ.i e *. ..y, lc -' '' },.. -: a `. v. .S 4 _ �': '.."A )}`GT , i -! die - !'hF�R+s� t �, F ri 4. • � 1 '`✓ `. ''t'I t .� Iry �d;,.i A _it -e, -J4Rt� .gy p- .,,,`+. w�„w: +.kaT Smy.,.a'a„ l.!, a' > .� #6„j'. r r ..� .: •,, • ' ._, '�.. � %'=' ..�. -j +. rtLsr, �tv�'�-v�;• ,-, rN �"�L':;, , K%xr"�t 7sy i PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM ?U-Q4 AM VAL(,r. Town or village...,...- Located at Tax 1vfaP Blo Subdivision [3 �A r- Lot Job iso - 1:Z Z2 Owner Avg► Z)�I J & Address INDjAbNItL Rn Building Type 40"S Ffi)A. 5• Lot Area j ACRM SIMUS ( AR., l My /050A Number of Bedrooms 1' —Desl r Flow Total Habitable Space �-�•0nO �.�r �✓ Square Feet Separate Sewerage System wt'o/consist of I da0 Gal. Septic Tank and 4 `Q L 6F "Lr1 tV jVG ma-6 To be constructed by / g / -5VLZC_ 1 zP Address Water Supply: Public Supply From Private Supply to be drilled by OT S F1L� CTS Address 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 sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations of e Putnam 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. I 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 the original syste r 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 accordan with the standards, rules and reg —u-15 ons of the Putnam County Dep rtment of Health. 19^ 40 Date Signed P.E. R.A. !1 Address v Sv0 OT License No. APPROVED FOR CONSTRUCTION: This approval expires one year the d issued un ss construction the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Com ass over of Health. Any change or alteration of construction requires a new permit. Approved for. disposal of domestic ni y wag and/ priva ater,�pply only. th4 r � / Date �-�°) By Title r 'a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OR. ENVIRONMENTAL .HEALTH, SERVICES— :r _q _ " Js•'. +yan.q._'y :: c •-c-n •c.•c._. ,. ..:.c- „�4r.-r3 oia ::�"' -ii°S =•- AS:i• :�.p°'. .' . Date S t-p`r• 29, 19 84> Re: Property of }u 1- 6 Dr4N 1 & Located at INDIAN UJLL;ZOA-j.7 Section TM-ITS-1-9 Block Gentlemen: Lot This letter is to authorize J O &Ll- N S 'SR-C a duly licensed professional engineer or registered architect (Indicate) to apply for a Construction Permit fora separate sewage system; to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in UVAJIM.0 L-LUIS w.L Ln L1115 ma L Ler and to. supervise "Lhe construe C1un of said system or systems in conformity with the provisions of Article 145 or _ 147, Education Law, the Public Health Law, , an_ d the Putnam County Sani- tary Code. / �aED aRc� v\�j��RENCE �RF ��A Z ISM Countersiiane,T: P °E e, R.A °, � "+ RWA6 MUSCooT NOET44 Address ��� ®P�lC M.I+• !864 1 914 • &29 Telephone Very t • • ,` . Property ii - a 9 3 Telephone 1'UTNAM COUNTY DEPARTMENT OF HEALTH DIVISION -OF ENVIRONMENTAL HEALTH SERVICES' .=.s •ct'�.t'- e• C 4t:. .. a \. —' ."°. �.. "'.`v.r_ _ q; l �i�`_iP 7. ..64it.1^Y'v.. ..r eBOf._•: •Ct � •� ` — COUNTY.. OFFICE BUILDING, ` CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE 140. Owner Address - INDIAN RILL RD : , Sldws • OAk, f MIX Located at `(Street )JIVOtAAd HILL 1Z Block Lot . nd3 street) -" ........, �....., �. ..;:;.:.,.,r:.,.:M...;�- ,:_.._ ca�e neares cross Municipality Y11 O �UTN AI AIl. h Watershed UD�Sd rV .::.SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH,APPLICATIONS . Hole Number CLOCK. TIME PERCOLATION PERCOLATION Run apse Dept o 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 T/6 • 3�3 �s 3 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.' _2...:� -, 33/3s1/ 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.' . TEST PIT DATA REQUIRED TO- BE SUBMITTED WITH APPLICATI�OP1 DESCRIPTION OF' SOILS ENCOUNTERED IN TEST HOLES... DEPTH. NO. Q HOLE NO. rL HOLE. NO, , .0, A] THOLE a '►04_4•' � ~� -:. �, i�`, -�.w� s� �N. .�•PO'6 R�:� �G .. �S �..,,. • 0 ®�.: SM CG.L. 6" SAND g C,LA P 5541 4 C LA t 14 Y. 1211..',_.: , ...... •.'.... 9 . INDICATE I=, L AT WHICH GROUND WATER IS ENCOUNTERED 7'0 a INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY JnE� C��Nt3�w Date DESIGN Soil: Rate Used {J /5--Min%1 "Drop: Sa' Usable .Area- Y'rovided Now of, Bedrooms'l Septic `. -Tank Capacit` ®� Gals. pe � (;Dq�C✓ Absorption Area_ Provide By4Z(� L.F.x24" �'� Eb renc'h. • - �.� .FENCE - - -- g .. A _ _ I-A THIS SPACE"FOR USE BY- HEALTH DEPARTMENT ONLY: Soil 'Rate., Approved Sq. Ft /Cal. Checked by \• 01105�� OF NEB 11 D�_ite- I DEPARTMENT OF. HEALTH Division Of Environmental Health Services August 25, 1986 JOHN SIMMONS, M.D. Deputy Commissioner Mr. and Mrs. P. Gornie Indian Hill Road Shrub Oak, NY 10588 'Re: Gornie Sewage Disposal System Dear Mr. and Mrs. Gornie: Indian Hill Road, PV, TM 123 -1 -9 Review of the proposed structural modification for the dwelling at the above referenced site indicates the existing sewage disposal system, which was designed for sewage flows from-a three bedroom structure, will not require modification if the system is,properly functioning presently and the proposed addition results in three bedrooms upstairs and the kitchen, family, living and dining rooms downstairs. JSH:amm cc: File Very_ truly yours, Jam'b2' `S: Nodgen's Assistant Public Health Engineer TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 ., ISM � n •j -f c 1 4' `L 'h. 1_ ",, C 'Ct�R' Rai f7 `•.0 M'- _:{. �, —SAM, \ a ti k .t t't c , i' ° " N '"' a•+rt 7� ` - 1 . C I 4 \ 1 f F A 1 1 Mt# kn ak. �y • y `tE- � - 'a 1- z � 1 '� •R r � r " ", - 0 1 ' '1 t+ �. i .S �i t• -'•}\ .."L `ti' '��. 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