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HomeMy WebLinkAbout4668DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.15 -2 -19 BOX 35 I r INC', ror i� I. "� I L r 6 IN IN 0 IN 1�••i t } 4 = r ,PUTNAM COUNTY DEPARTMENT OF''HEALTH _'. D ���• x Diwsfon of Enviconmenta/ Hea %th Services, Carmel, N ;Y' '1Q512 rr > T V P t 11 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM own of u nam, a ey own. or Bone WoodDrlve off Wood Street .123 I Located.'at _ Section Bloclo us °Construction Co. 3`= �j Owner Lot Job r _ K. Y. 33 Tan us, Construction Co., l Lake Road, :Maho,pac, Separate Sewerage System built.by g „ Address } 1200 40Q :3b inch Consisting of Gal, Septic;Tank lineal Feet.,X width trench Other requirements' Water Supply Public 5upply From r Private Supply Drilled .'By ,* � r � Address r "` • i Buiiding Type No of Bedrooms - Date Permit Issued .Has Erosion Control Been Completed T10 xi i certify ;that the system(s) as listed serym9.the above premises were constructed essentially ass -ihown on the plans of'the completed work (copies of which are , u attached) and in accorCance withahe?standards':rules and regulations plans filed 'and'the °permit, issued 'by the 7 Putnam.; County Department oY Health. E December 16, 1970 j I Date Cert,fied by 'P 12 • - R.A. . . ... Add dense e's's &., iBehr "'�12_ G,len'ea da Ay CarmeT,�IY . o 984 ' Any person occupying premises served:by the above systems) sh 1,1,promptly take such action as may be necessary,to secure;thd correction of any unsanitary t +F ;.contliytions' result ng from+ such usage Approval,yof the separate`seweraye systemsshall become null and void as•soon as ,a,0'ubllc. sanitary _ sewer becomes �`, : available, and tl g approval of the private water °supply shall become nulF)and void °when a ;public water supply becomes available 1 Such approvals are %.subiect..to modiiicatwn'or change when;_ in the judgment ofFthe.Com� issi er of Health, suc revocation modification or change; is necessary: x� ( Date "- ` r gy ?. a V, Title t s, i 7 wgoteh-.J!:fLor CoZLnty Dopi ..rt.a1aznt G., inc ith, ..,:... - - .. D ".'•.� 6��.,.'?Id L•:. '�4.. 1'T� "�s�1".�.Q�41Li - o ✓.��.i:?ir'f:��".1�aG�ii.,�. � _ � . , This report is to be comp?ctcd by =2-1 driller and aut- "Ittcd to Health Dcpartmiant, togc14hzr with laboratory report of anna27 --is of aota: ozmplc indicaw :; to v'.' is of aatia$actory bacterial qua ;, before certificato of construction co:? iimncw .kct3, 'o be 9x acco3vac' , lcWal.1 construction : 0 - L Fa Sr,-.62' °RU� ° c R iIEG e0 LZIN UA MIMM" Sil":Pf n :ACATYONt PIU°Vi I IPxU",71i S .C:'.iC> BLOCK L ,n/MX /4, Lob, D Dn, C/e �•���c'S� %�.� //� ` If �. � � - a Street Addrei;d City •, ad Tom J,ongt.hs Foot 91 ;4p /e. Ally S,.3r..e V Addrozz . e (meaouro from land ° Hours £Statist .�a� xowra a Foot a PFD :toe / 9 �Mhen B&S ca ° °Slot %3 P,:m.ztera c, InghocLYie),d -. 10 G ,,P,,14,vOr Pumwd Foot- Lonr,,+.h Ft QSize• V. r-d s �� / 9 ° ° Dieter 'TA ° T(RAL DMI H OF t,..IeL • _ -. .-,..♦ � - ..f:,: - ~1- .. .�. W rr, .. -c .ter... tee_. .. -C• r v :r!' -'l] '4..! Depth Fr Givo description of formations p©nfotratcd, ouch czs prat, silt, sand., grevoig Ground Surfaeo ° clay, hardpan, chale, radstonc, graaito, eta. incll4o oizo of gravel (diameter) 9 and cand (fine, medium, coamo), color of material, otructure (Looze, packed, 9 cemented, soft, hard). For <xmploa 0 fto to 27 ft. fine, packod, yellow sand; 9 27i, tO4 Ftn faVI'g131jtf3n ° Q e ° 6C JC- a ItIto e , .. � o Ft, ° o B k ,tO 'Yoe e m� Date Wall Was Completed , ZY %/- Data of Report Edell Driller Signaturo ALL PIT AND PUMP EQUI* :' : °';: ; D tad LS 4 `�:Y —En x�u` l�h'i'�: = `Zriec .::.= .- . - Pit with-4 -inahY G�avicy D:wi�3 to G-- do Pit with 4 -inch Gravity Drain to Baset-mt r Pitless Adapter -- Casing lino 12 Lnclhico above grado �. Other: Describe R :cps °riake Type Capacity G.,P.MQ ha -tor age Tank:. Type Capacity Gall. (42 Gal. Min.) DIAGRAM SHOWING LOCATION OF VIELI, ON PcZr''"QS�S Indicate location of house, well a.d sewage disposal system witia distances. Also indicate direction.of slopes, and I direction with distances to,all wells and sewage disposal systems within 250 foot. • i I • 1 I cee4ify that the individual water supply indicated above was installed as per the ales and regulations of Bulletin SD.62 of the Westchester County Department of Health.. cu. ' ..ia. -._.. .. "'tit: o. :"e -:..�- 'tee.._: ;� C�.: _'�$. i:' '.z"`^'.;.a..._ .•r. - ?: :fas ..�a - �. � .c -w �, .:.a�. -!r� .. tr..,.._� =';: L:'T' R� o < Owner or Purchaser of Building Municipality rov Building Constructed by Section Location - Street Block �R a if e& .. Building Type 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 Departm -ent 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 - he,.Dj.recto_r.of the Division of F vy.roz?men�al Health, Ser- vioes -'of, thu-- -'Pacnam Cothty: Department of Health as ". tb 'whether or no the 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 �_ day of 19 Z�L Signature. Titl e,/ If corporation, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OP COMPTETION 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 yu,3p'. NOTE•: TI.1 /5 IS Tq CE12T /FY TLJA,T THE - SEWAGE. DISPOSAL: 5YS•TEM WAS' C:O%VSTRUCTED AS IN0164TE'D ON TW /S LAN 3 AND THAT THE SYSr of .PVAS* INSPECT D' BY ME BEFORE /T 4-00 Z OT #.3 WAS' .COV6'QF_D`OVER: 741- 9YSTElVI LA`S COIVSTRtJQSTED' 1N- :A.'000R'DANGE W1TN ,ALL T61E RULES fiN`D RECULATONS `THE -PUTNAAf; COUNTY DEPARTMENT 'OF 14EALT14 i •� o ? 4'BOXfS EkCEP..TIONS TO T/.4F- ABOVE,IFANY, NOTED 8 LOYV: n%ONE `P /:TGN FROi}il -BOXES .TO E.MDa CAF .1715 FAG TA y ,a xz ✓ ,y' � � Y � t i it R 3 i � � 'l ?� <f .lty i.` - iY - . '��Y 4 a r -n'. � .[)I.r �.t lfrYLONN. 1 ! r s - ti �.�. s _ .. ` - ! 1 .. Ss° {�•, - rr1- 1.1�1C >.♦ •5 s ?`I /? / /4/T� s ; VA t 4 O .SE`W�1Ca£ OYI,$AQAL. �.$TE119. w� 4Qi.%i'I'�QN`�` •i T S J -' � r ..;,. _ •.�, :, y �,;.�. ,,. �: ,� sc ; :BFPT /C "TANxfN` ,f3.D.N,.I�E. 1/�/O.O.D.. _L�S•T � �: ::, - � , ,� p .,�- � .,59,5 - -. 24,• � - / / - ::vassia+��.++.�+. � l 3 �. laQ s.Z_ 4w.. _� - :� 's^f'. ..r :er •!f- `L'r^ -� .!. 1 ... .. t. t .n ��.. t3 :ro. f. •`- ....� -... a tt„ 7•rf• �` a "} - - �;� •'PUT/Vi�lM • "G uNY -Y N.Y. 3� {'` fib" 4.'WN ._O'FhPf uTNIh4LLE 4 , a eENO. x DEC %4,1970 03 .B.Srf -' ri s -0 11 ; jt r � - l�nF 3 2 �S � . _• • UL 1;S um �7 e IT P. ffi- 7?r t _ E 0 '•Of IHpNMENTy FAITH_SERVICES i21 _.. -i .: �d�_ .. #�, £... [.f _. .x _.t. ... _ .. .. , •� {.i'�- - ' �1• g� is r `2 4 a: UTNAM COUNTY DEPARTMENT OF HEALTH Division of -Environmental Health Services; Carmel, N. Y., 10512. CONSTRUCTION PERMIT FOR :SEWAGE DISPOSAL SYSTEM Town of PutnamValley - . -. Town or village " Located at` "B'�'1i'ie Wood .:Lrive off• Ti�ood,' StreB .. - Section Block � Subdivision Bonie Wood Estates Lot 3. iob X-;-408 3Tan us'Construction Co. One Lake Road, a pac Owner g Address Ranch 1 acre(43 56 SF) N. Y. 10 Building Type Lot Area � Number of Bedrooms 4 Total )Habitable Space Square Feet Separate Sewerage System to consist of 1250 Gal. Septic Tank 400 lineal feet X 3 width trench To be constructed by Tangus Construction Address One Lake Road, Mahopac3, N. Y. Water Supply: Public. Supply From X Private Supply to be drilled by Address Other Requirements Torlisch Bros Armonk, N. Y. 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 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 system 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 accordance with the standards, rules and regu aeons of the 'Putnam County Department of Health. Date October 28, 1970 Signed P,E. R.A. Addres�urgess & Behr -128 Gleneida Ave, Carmel, NTIcense No. 9 45 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 consider necessary by the Commissioner of Health. Any change or alteration of construction requires ew rmit. Approved for disposal of domestics ry sewag and ivate er supply only. Date �� /9zQ By Title . - 11, . . ;�-';--------l.�:--- --------i-----.-'-- , .- - - --l-' -.- '� -...� '11---*,tv;."�A�a'-� _�J�-'.�%� "j�'�.;�r-.:'-'-'75'1�"" W_' , -11, 4LNI�SVR -*-;m----la0L�F---------Tl .-, -1. I - - . . . - - I ,. 71 - - - I - 1. . . � �$i{3'4: li�tl'J-'ALR; A .: tv, ';A�-'..', a* 0. , i'--'--�7'.�5.+�.- - . " " - '�r' '�'.��. -'���:. 'I .Td�&-'-qt'p'g- ,,-,,. .,f-"T-,:l t �!. ,'. � . ,, - - A " - -, . . '�N.l 1� , "'.' " , . " ' - �7� . � " -�,,-�,,-.�-.,.',,�,����,�,�*�,*.:., - . 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