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HomeMy WebLinkAbout4667DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.15 -2 -17 BOX 35 1 �N is -1 r r T 17-- Vs. I ' �� �l �, , .,I ls F Iss 04667 Division :b Environn CY DEPARTMENT OF .HEALTH �l Hea /ih 11 n Came% N Y 10512 .�Eii ► eE� i fo Sa'�i. Y51 E�`� i utnW`_VttZleg _ Town or 'Village W604. Street' 123: 1 Located at Sect w n Block � f Rbert ;Conkln �' 3 & 12 wrier r t Lot n o Job i Separate sewerage system built, byk� -A :C n4 ::r tCii�1 inrn E Address t Buekshol7 "o[w Rd. `Mahonac, " N. Y 1 rc�-+. nv.,.. ,.Prt,.p.,- :.rr�.n.re- +.,.A:+ -X w.,.'�.. ,-- +m�"._^ ."'.^.'.:"- '- a•'�"'-•-_� ""•r° _x�^ -^^ � ;err U n ^� O- ""�-,. ,Y �.,,,_, ,,; .�--�0 y �C({�— Consisting :'of ' Gal Septic Tank . `' _ ,lineal Feet X S it widthtrerich r Other requirements Curtain Drain installed above septic field `area `Water su, i' F Publ�c.SupPly From " �n R Private SupP.ly Drilled^ BY 4@r84jAol� Ilrr��l i j M er Address's Street Pgtnam Valley. N `Y uilding Type R @iii RS�h No of Bedrooms Date PgrpflD4s8u� T'' c. K O 0. .. Has Erosion Control Been Completed? Y o �FFe o z 'll rt _ O s. RO '- (:certify that:the system'(s) as.Iisted serving the above premises were constructed essentially as:shown.'on the pbi f edFriD caples of, which are 1 attached) and 'in accordance .w,ith the standards :rules and regulations plans fled, and the permit `issued ;ifyc, 1P a nty' i a tment of Health: e� err e' r,, ryDate flTC�1 z�i,. 7 r) t Certif�ed�by° �� -mo o R 'A Address .Y r+ -Any person occupying premises served!by the m , above systes) shall,promptly` conditions resulting from such '.usage • Approval of the. separate; Fwerage -s ;available and the approval of _the private water' supply shall become null and. r' :... ...-. G R - subject'.to modification_,or Change when in the judgmeht of the Commissi Date t„ WK 0 such action as may be necessa9�p,fff�e�'q���ge errtlon of -any unsanitary shall become.riult and .Void as•:3op� u ieianitary sewer becomes I when -'a. public' water., s,uppl becoRe4AAflable. ' ,Such approvals are i �i Health su rrevocati on ^or change is necessary., iiloft 0900 ILS I c;,• �.� ..� . . .•. ... ...�.;;y. .,� _.. ..�, ye .:,an.. `.' t.. .-.e, .. .... .. , :mss' a�..v .- •• •m•v ..... •• " .. ,e I J z z O O] PUTNAM C t CY DEPARTMENT OF .HEALTH �l Hea /ih 11 n Came% N Y 10512 .�Eii ► eE� i fo Sa'�i. Y51 E�`� i utnW`_VttZleg _ Town or 'Village W604. Street' 123: 1 Located at Sect w n Block � f Rbert ;Conkln �' 3 & 12 wrier r t Lot n o Job i Separate sewerage system built, byk� -A :C n4 ::r tCii�1 inrn E Address t Buekshol7 "o[w Rd. `Mahonac, " N. Y 1 rc�-+. nv.,.. ,.Prt,.p.,- :.rr�.n.re- +.,.A:+ -X w.,.'�.. ,-- +m�"._^ ."'.^.'.:"- '- a•'�"'-•-_� ""•r° _x�^ -^^ � ;err U n ^� O- ""�-,. ,Y �.,,,_, ,,; .�--�0 y �C({�— Consisting :'of ' Gal Septic Tank . `' _ ,lineal Feet X S it widthtrerich r Other requirements Curtain Drain installed above septic field `area `Water su, i' F Publ�c.SupPly From " �n R Private SupP.ly Drilled^ BY 4@r84jAol� Ilrr��l i j M er Address's Street Pgtnam Valley. N `Y uilding Type R @iii RS�h No of Bedrooms Date PgrpflD4s8u� T'' c. K O 0. .. Has Erosion Control Been Completed? Y o �FFe o z 'll rt _ O s. RO '- (:certify that:the system'(s) as.Iisted serving the above premises were constructed essentially as:shown.'on the pbi f edFriD caples of, which are 1 attached) and 'in accordance .w,ith the standards :rules and regulations plans fled, and the permit `issued ;ifyc, 1P a nty' i a tment of Health: e� err e' r,, ryDate flTC�1 z�i,. 7 r) t Certif�ed�by° �� -mo o R 'A Address .Y r+ -Any person occupying premises served!by the m , above systes) shall,promptly` conditions resulting from such '.usage • Approval of the. separate; Fwerage -s ;available and the approval of _the private water' supply shall become null and. r' :... ...-. G R - subject'.to modification_,or Change when in the judgmeht of the Commissi Date t„ WK 0 such action as may be necessa9�p,fff�e�'q���ge errtlon of -any unsanitary shall become.riult and .Void as•:3op� u ieianitary sewer becomes I when -'a. public' water., s,uppl becoRe4AAflable. ' ,Such approvals are i �i Health su rrevocati on ^or change is necessary., iiloft 0900 ILS I c;,• �.� ..� . . .•. ... ...�.;;y. .,� _.. ..�, ye .:,an.. `.' t.. .-.e, .. .... .. , :mss' a�..v .- •• •m•v ..... •• " .. ,e I PEEKSKILL MEDICAL .LABORATORY 1579. Crompond Rd. Barclay P1aza.'Bldg.' A, Apt. 1' . dSW 10566 k?F 7 -8777 . DATE COLLECTED RESULTS OF EXAMINATION OF WATER )13— OWN R DATE ` ECEIVED: CITY$ VILLAGE; TOWN & /OR N Ir OF SUPPLY DATE REPORTED bhod, reef. ocu. Ku/cu ,SAMPLING POINT BACTERIA PER ML. (Agar plate count at 350C). COLIF RM GROUP (Most' probable No, /100m1.) L -ppm DETERGENTS - ppm NITRATES (as N) --ppm IRON,. TOTAL - ppm FLOURIDE (F) - mg. /1. These results indicate that the water was Ves of a satisfactory sanitary quality when the sample was collected. y j A. DOVANI, M. T. (ASCP) *h Q! 4 Robert Conklin RAIMM Valley Owmer or Purchaser of building Municipality 'u.woc.'.ecµ.';;y :"ev•:ts7, `.'4.4 a >K �'e�=- .- �^�\e�oRr .> - �.-n'�'c«'. ..: 41.' 2<'.. c...'• i��' ?+ ti.'--""....:: L'. w+`•' L';,':;',": w%• f^: �S' aa4: :'it•�;:�;•;',�'';:'c::;:;v:• -i r7 .,y,:a:." rV.'xt:,u .::ii:ire.: n }. �h Building Constructed y Section wow street ^' Location' - Street Block Building 3_` 7pe & 12 Lot GUARANTY OF SEPARATE S0#AGE 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 thelstandard.s, rules and regulations of the Putnam County Department of Health, and hereby'' guaranty to the owner, his successors, 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 thn 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 _ c ausod by the•willful., o-r� )iej_,jigent_ :act .oaf .the or_cup:art. of the building: uti:lizir -g the-. a system. `. Dated this 5 _ day .of OeUbW 19 73 Signature �.vL -, /t.Q�J•� Title / 6-'e'L C 0 /7 S f= C a-, 10' (if orpo ation, give name and address) -------------------------------------------- - - - - -- - - - -- - - -- - -- &I -------- - - - - -- THREE 2) 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 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK Thir�s�to baatnle�eal4�1.J, ler�m, �g4A: Gaia4.' �ortt: iegetr�aiiFbtitdf�tb7y:t0porto� ` �-� 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 NAME -%lYt/ ADDRESS LOCATION OF WELL / (No. 8 Street) (Town) Lot Number) PROPOSED USE OF WELL © DOMESTIC F] SUPPLY BUSINESS ❑ ESTABLISHMENT El INDUSTRIAL ❑ FARM ❑ CONDITIONING ❑ TEST WELL ❑ ((SSpe ifRy) DRILLING EQUIPMENT ❑ ROTARY COMPRESSED D AIR PERCUSSION CABLE ❑ PERCUSSION OTHER ❑ (Specify) CASING DETAILS LENGTH (feet) S ' DIAMETER (inches) f WEIGHT PER FOOT J a THREADED ❑ WELDED �• SHOE LJ YES ❑ NO C'ASIA YES NO YIELD TEST ❑ BAILED HOURS ❑ PUMPED COMPRESSED AIR G.P.M. 7 YIELD (G.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify teetJ DURING YIELD TEST [feet) Depth of Completed Well in feet below Land surface: 02 O SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (feet)' SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (inches):,, GRAVEL SIZE (Inches) FROM (leer) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION . Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WEl COMPL TED IL LDATEOFREPORT IWELLRILLER D gnature) l .. aj TNAM-CO Division of-EiMr6n :CONSTRUCTION ., P OS EWA�M,Vls . PERMIT_ TOR ;'S Local d at J ­,:.,SubdIvisIon ,5 own�riL.�L Re6�� Coikin' Ranch F'SIS Ed YA,­!Bullding T Lot Area -Number of a e rooms B 'Separate Seweragej,Syst6m. to ',consist of 'b oiIUa . Contractive To be constructed Y ­- H S, up-ply; Public. Supply From X� Privat;?, Su b Supply ��,�be, drilled:- Y ess SOtit 7. Requirements V­�' A repiesint thatA ii-h wholly and cornpletely responsible for the ,pb described -will be c6fist�,udteo.s.showii':cinlih6'app-rLo,,��" County' Department of�Heathi "a-6ilthaCn_CM completion there " be, submitted, to 6e.'bepirtinehti ',aithd a *,written' gbarant", said place' in good opqratini ,condition any ,part of sa - sewage ance: of,Ahe' approval of.,the Certificate of:"-CC)nstruaioW.C6, 6 Dc atid is sffownbii the aa ;that , sald`*,�l e14 wbve7dpla_� andih' 1 'County. De partment of Health Date Ame .6, 9 I'M % APPROVED FOR CONSTRUCTION .-' 'This .'-approval hr. , es.,,on 1'­-'­,_revocabIe for cause or may be aO*ae'd:or' modified -W-fie"ii.-d6n 'p'e-rmit."-",*, Approved for' disposal .7 of doMmestic /0 Date' 7 7; LINTY ."DEPARTMENT'Of HEALTH i7dital-N&i1th S*Wces, Carmel, !V. , Y. .10 9 1'2 Ile (T) 'Va Pdtiiam i own or Village iV: r 7. 'S. n L 3"AA-2­- t Job Fake ad zV: South: Addres�i, RO 'T 4�1�1i� 7: Total Habitable _�jpace Feet GalSeptic Width trench an I'1neaI:: feet X 3611 orn Address Ift'18 Biielqihoij& Rd N.Y. Well 1�111,iwi 0566_ IRA a�q?� ti e, p! s); that Mpglr*%�A '�e l­`n'*A 4"_ proposed iystem( tai system T-9n, pnpd�_l LL ­ I I - - . - I _ �e d mendme'i there to' ; ul e, Putnam stanclarcls#Fi nstruc ion Tf., ert'If Icua f cbi6i5i ance saes AC, of Health will I rr-'. � Ile 1the',owner,­ his .succe!"ri,' heirSL6�_.iStig e. Id builder will dISPOS&IL in tj of the issu- �,sy _ am during :th6,. riod of two'(2),year.sin Pe,.L original L'system ' or any*re . pa , Ir . s,ihereta2 that I e I *scribed above �willlbe installed co"r, with thi'st'a"n-clardt. s -an s tie 'Putriarn P • R.A. *794 6LL 27 A e -yea LWELM r froml 6 date; is_ su, e d .unj ?T , e3 s 15, k�h . j4 4 b, , f SAM undertaken and Is idered necessary by :the Cqmm!ss i oner,6i Health 4P V on of construction n ary sewage, d a e"water supply only Title, :a•;� �..5.: PLTINAM -COO Ru.ii3 L•ERARTIU, Ir "'_011VTMA rF--, DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date June 6A 1973 Re: Property of Robert Conklin Located at Mood Street Section 123 Block 1 Lot 3 & 12 Gentlemen: This letter is to authorize John S. Romeo a duly licensed professional engineer x or registered architect (Indical-el- 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 LGpar tlllellt Vf Heal L 1, and to sign all necessary 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 .FC�iaca ion: Law, t-Fi€' P- ,wbsi -c He �'rr. w,,:. nd -_try= Put ie i� t�'�nt S r v- tary Code. Countersigned: P.E., R.A., h 27846 1 Northridge Rnad (Seal) AcTdr —es 8 Peekskill. N.Y,, 10566 0004Dam, PE 7 —.1056 ���� Eta° �A Telephone rd'd 27846 Ao� °eF VO�� s o� 0000000 Very truly yours, Signed' � ' .Owner of Property Soo Lake Blvd Mahopac N,Y, Address 628 — 8979 Telephone f ... REVIEW Cuff' °T ��T Meets Std. Remarks >iG, • Ye s No .ti:.•'ir /- �..T.rn. ..�{" .vv x .f- i cn,• c .-.... .vx . _"aay..n '. .k ar .�.._.. ''.' y da � e- :L.:.^i Ea Ve S:4S.: DOV Ul`1L' l 1 .J -.,y' -'�^ „n,s••� ran ? ,,,' .:�'S',".:, cy3� _�.;:;.�i%•.ei "1: 2 a House plans.O.K. if Design data sheet I I Peres. presoaked? Min..30" perc test depth Const. results for 3 runs I D. Hole log O.K. Corporate Affidavit for.other than individual ! I Authorization for engineer Letter.fr.om Water Supply if applicable If variance requested -such noted.on plans &•apps; � i DETAILS if change is proposed,) Existing contours shown j show new contours) . Slopes for driveway cuts, etc. shown Water service line location Footing drain, etc. location Top slope, bottom slope of fill i ! Percolation tests and deep test pit location Septic tank size and conformance to std. 3 B.R. house minimum i FTouse setback shown i T-14_4­11.. ... ,..• . box, .1 + U 1.6.1 11 .{Jo t,g.._b,G .ow....i.r.oaJ..... -All water. within 50 ft. -of PL s.shown Plan and profile SDS... ..All -- othe.r- wells and •SDS- closer ,2(20' ° shown or re is erence' made ` ..... Property boundaries (metes and bounds - clearly shown ' i SEPARATION DISTANCES SPECIFIED ON PLAN 10' to P.L. 20' to Foundation walls I ' 100' to Nearest well I 50' to stream, march, lake; etc. incl.expanslon Y t 15' to.Curtain drain I 10' to water line (pits -20' ) .15' to storm drain 101 to large trees ! i 10' from foundation to septic tank I 5' to pipe from leader drain & footing drain � I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION 'OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING-, CARMEL, N. Y. 10512 DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. • Owner } "Robe rt Conklin Addre's South Lake Blvd YM6Iaa,, N. Y • 12 Wood Street`` -'8&C'.T,123 3 Located at (:hre6� Block �_n dicate neares t cross street) :C1 Municipality. Putnam Valley (T) tershed 'Peekskill SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS 4 5 ­5 .... '19075- 2 5:5i. `6:22 30 22:75 `25.25 • "200 12:00 �3 4 .. . tj 5 2 3. Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Eiapse Depth to Water WaUe_r_EFve1 No. Time From Ground Surface in Inches Soil Rate Start-Stop Min. Start S top Drop in Min./,in drop Inches ' Inches Inches U 5:10 5:35 25 20,25 23.25 3,00 8.33 2 5:35 6:05 30 23,25 26.26 5,00 10.00 4 5 ­5 .... '19075- 2 5:5i. `6:22 30 22:75 `25.25 • "200 12:00 �3 4 .. . tj 5 0� Notes: 1) Tests 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'ma&-,Prom top of hole. 2 3. 4 0� Notes: 1) Tests 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'ma&-,Prom top of hole. A TEST PIT DATA REQUIRED TO BE SUBMITTED WITH.APPLICATION _.. .��..., �' I�ESCRIYT- IO�V" • OI'° SJTLS''` i�IyTC `OI�1��!Ei�,F"t�rTN��?'CEST H�Tit�-S°' _ .-� ":: ,. � ::_.. ... - ... > .�_p:. DEPTH HOLE NO. 1 HOLE NO. 2 HOLE N0. 3 G.L. Topsoil Topsoil Topsoil 6" 12" .1211 Topsoil 12°1 Topsoil 18" = sandy. loam raith sandy loam with 2 11 trgoe clay & some trace clay and 30„ some stoh6s some stones 36" 4211 4811 . 54 if 6011 6611 7211 781' 8411 1401 .Topsoil sandy lom with trace claw and some stone's T�ICATE: ?VLL.T "u�rB CH:.I�,ROUNL; W1�mD?Y IS FNCO,LNTEED noY�e a y INDICATE LEVEL TO WHICH WATER IsEVEL RISES AFTER BEING ENCOUNTERED ®0 ° Re1ow TESTS MADE BY Date June..69 1973 Jobm S . Rnme o Il #15 � �� p: DESIGN. Soil Mi 1 Rate Used Dro S. D. Usable Area Provided 5000 SF + No. of Bedrooms 3 Septic Tank Capacity 900 Gals. Type e9 off. Absorption Area Primed By 240 L. F <x2�+" _yid -, r{q� .. ' 'M .,. i Name John S. Romeo Signature 1. N rthrid a Road $ SEA Address • ��t��f�� � o peeksid-119 N.Y. M66 o' THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: o%�� Soil Rate Approved Sq. Ft /Gal. Checked by Date DESIGNED & .SUPERVISED BY ROMEO.- ROMANELLI -AMIGO CONSULTING ENGINEERS 1 NORTHRIDGE ROAD .�}PEEKSKILL. N. Y. N.Y.S. LIC. NO. .Z.' r C0 .1.1 E TAI ZA.l 4. I Isop J I.. a� 4 �.w is • ��NiN. EtiCt�� • 3 -BEDROOM HOUSE SOILS RATE -= - ,' o �. go 9 ^GAL. TANK k - a `{? L. F. 36" TRENCHES •_ �i�ie� Nit! tOr� ..' fj ORIGINAL g 73 1' t':FINAL = OGr. it 1 973 . �1 Tyy-• — d. e� f= 2 C IM1 Y� "1 FrNA%- L crq -r1 3m's AI- 2I' 131- 141 Ai. ts,G' @L. a2.' =. A3c 39. S' 8-3 3q.S' A4= JI' 534= 34 AS= z2.5' P 5= z9.5' A G- ' OV � A e:7G' . lPp BE q, A Aq z 74' B9- -12 S At•.» �$' g�os P7r Wc. 31 9?S' p HEAD' ttL DIVISION OFD HEALiN SER'�`�' NMfiEflAl �G SEPTIC SYSTEM -t FOR. i )F0.84 IV- 7- CO,vr_,L Afy� TOWN OF Pu-rN A M VAL Z Ey PUTN A Mj COljNTY , w, !� NEW YORK SCALE 1 = 4{3' ' IM1 Y�