HomeMy WebLinkAbout4675DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
85.15 -2 -29
BOX 35
rN lcvw -i�.
i .T !'' ■' 'I �i
1 I '' L�
`T• �{} I�
�`' I' ' I' �'f •.
R +'' I
r , 6 a. T
UL I
04675
..PU:TNAM 1COUNTM-DEPARTMENT-l" OF HEALTH
Town -or vina e
PrP
Job' NY
wrier
swood
Tan
z Consisting Septic'- tank'.
ir
Address
buildin' 4T
no
iber
Novelm
pate
-Address —
and. the approval I of the'private water_'suppiy-ihall-:"
ilaps;- Wins
;e' bull and
4 re
width trench
License N2
rri'iha`ll�'b`e'co in d. null and void is' soon as' -a public. sanitary sewer becomes
wh I- I becomes vailabl6. Such approvals are
of
r^--°~`~°-�'-^~'---- --~—^--- -- ^-'-------^-------= ^`~~-�'-- ~--^- '``-'—`'— -~----'----''~--~
Cn
..0
BACTERIA PER ML. (Agdc Oate.'coucit at 359,C)-.
COLI.FORM. GROUP ",(Mosh.piobable.N6; /100MI.
' HARDNESS, T TAL ppm
•
DETERGENTS - ppm
NITRATES (as N) _• ppm _ '
IRON,r TOTAL -,opm
m
4MMM"=tMr County Department of Health
Di-ris' nf
LOZ
This report is to be completed by well driller and submitted to Health Departmentp together with
laboratory report of analysis of water 6ample:-indicitifig water in of satisfactory bacterial
qualityp,b6for'd certificate'of'construction c=pli &nce is issued,
Wall construction to be in accordance with Bulletin SD-62
"RULES & REGULATIONS MATING TO INDIVIDUAL WATER SUFMM"
LOCATION: MUNICIFALM
hmi C'WNER:
Rams
WML DRELLERI
SEM CSI BLOCK IM
Street Addrea6
a Wi- 4�7*Xe
sa
City and Town -
4//It-
City and Town
De'pth'From f Give aeacription of formations penetrated, such an: peat, silt., sand,,' gravel.,
Ground Surface t elzyp hardpmv shale, aghdatane, granitep, etc. Include size of gravel (diameters
and sand (fine, medium, coarse)v color of materialp structure (Loocep packedp
camentedp soft, hard), For example: 0 ft. to 27 ft. finep packedp,yellow sand;
27 aa to I& no gray p_ranitee
Ao Ft
Ft.toZ2-.Z Ft,
C
to
Bailbed
t(measure from land
surface)
Leakth,
—
Feet' * or
Hours •
Feet' Make:
"Unto
_LPumped
tWhen Bailed
Islot
t0
'Tic 1d;
G, P, 14 for Pumped --,544�
Feet I Lenifth
Diameter
rOTkL DEPTH OF'W=-3& o FEET
De'pth'From f Give aeacription of formations penetrated, such an: peat, silt., sand,,' gravel.,
Ground Surface t elzyp hardpmv shale, aghdatane, granitep, etc. Include size of gravel (diameters
and sand (fine, medium, coarse)v color of materialp structure (Loocep packedp
camentedp soft, hard), For example: 0 ft. to 27 ft. finep packedp,yellow sand;
27 aa to I& no gray p_ranitee
Ao Ft
Ft.toZ2-.Z Ft,
C
to
Ft.
"Unto
F—t I I
t0
t
ate Well bias .Completed Date of Report
7-
Well Driller
Signature'
' f
'�. e,.,C,!tir c . -G iv:li'. Ga ::.. .�::::1 .p. Cd >1,':i'�c+r iF'cL►V� ~.G ^s'.: ,@f�.;,, G.A--P• ^r•4iy •::arn.'s:a .<rn _ .'.
p•;2r wm s•.!�'V:+'.:s we•�o+iti �". �rj' =�
WELL PIT AND PUMP EQUIPMENT DETAIIZ tFt
Finished Well.- Check pit with le —inch Gravity Drain. to Grade
Pit with 4 —inch Gravity Drain to Basement
I11 Pitless Adapter Casing Minn 12 inches above grade
Others Describe
Pumps Make co Type ..dub Ale jJi f< Capacity l ..��' G,P,M®
Storage ranks Type Capacity Z Gam (42 Galo Rin, )
DIAGRAM SHCWlNG LOCATION OF WELL ON PREMISES
Indicate location of houseq well and
sewage disposal system with distances,
Also indicate direction.og slopes., and
direction with distances to all wells
and sewage disposal systems within 250 feet,
% certify that the individual water supply indicated above was installed as per the
rules and regulations of Bulletin SD.62 of the Westchester County. Department of Health,
Building Constructed by
Location - Street °
% )Q aMC4
Buiding Type
Section
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-
. ta.rm nation of the Director of the. Divi.si.o.n ,o.f_ ,I't vironmenral Health Ser-
. vies. _of`the,-P�tnRm Gotayty"D'ep°ar:tment._o-f- -Her th - a-y- to,•whe the r
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 l/ day of L°. 19 7 S Signatur cl
Title �.
I corporation, give name
and address)
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMP,ETION 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
,
Al u
Owher or Purchaser
of-Building
Municipality
Building Constructed by
Location - Street °
% )Q aMC4
Buiding Type
Section
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-
. ta.rm nation of the Director of the. Divi.si.o.n ,o.f_ ,I't vironmenral Health Ser-
. vies. _of`the,-P�tnRm Gotayty"D'ep°ar:tment._o-f- -Her th - a-y- to,•whe the r
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 l/ day of L°. 19 7 S Signatur cl
Title �.
I corporation, give name
and address)
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMP,ETION 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
.. . . .., � -ra. _ .. -. .. /y ^/ r _ •9 �:."y. F. . x_ .. w, � '. <y,�ii,A.•r�• ..v, r' .-=a .. r -. +�v� ... .�1: �t i� � : n•
11/�u -�i VVV
) er or Purchaser of Building Municipality
3uilding Constructed by. Section
&I /'F, UV tom" �� o> ,
.vocation - Street Block
sui ding Type Lot'
GUARANTY:O.F SEPARATE SEWAGE SYSTEM
I represent that I am wholly and completely responsible for.the
ocation, workmanship, material, construction and drainage of the sewage
isposal .system serving the above described property, and that it has been
onstructed as shown on the approved.plan or approved amendment'thereto,
nd in accordance with the standards, rules and regulations of the Putnam
eunty Department of Health, and hereby guaranty to the owner, his succes
Drs, heirs or assigns, to place in goodvoperatina condition any part of
aid system constructed by me which fails to operate for a period of two
cars immediately following the date of. initial use of the sewage disposal
;stem, or any repairs made by me to such system, except where the failure
operate properly is caused by the willful or negligent act of the occu-
ont of the building utilizing the system.
The undersigned further .agrees to accept as conclusive the de-
.rr? 11-h,e ,n irector of Division of �zviron:�rienta Health Ser-
ces of the Putnam County Department of Health as to whether or not the
lure of the.system to operate was caused .by. the willful or negligent
:t -of the occupant of the building utilizing the system.
�' Jf
.ted this day of Vfze 19 7S Signature �-..
Title /4
II corporation, give name
and address)
i
REE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
RTIFICATE OF COMPj_JETION WILL BE ISSUED.
ARANTOR IS REQUIRED TO FILE NOTICE, OF DATE OF FIRST USE 0_F SYSTEM.
vision of Environmental Health Services, Putnam County Department of Health
Al k;, tl( /Iny_
TFE—er.or Purchaser of Building
3uilding Constructed by..
�.. a•� s'. .ti.y,3: �. c:-�.. .. ? -- r. .-. ie_• —r Jvl, -�'. r.'. :r e•r` --` +�
Municipality
Section
ocation - Street Block
C4
;ui ding Type Lot
GUARANTY OF SEPARATE SEWAGE SYSTEM
I represent that.I.am wholly and completely responsible for the
ocation, workmanship, material, construction and drainage of the sewage
isposal system serving the above described property) and that it has been
onstructed as shown on the approved plan or approved amendment thereto;
ad in accordance with the standards, rules and regulations of the Putnam
Runty Department of Health, and hereby guaranty to the owner, his -succes
>rs, heirs or assigns, to place in good operating condition any part of
3.id system constructed by me which falls to operate for a period of two
,aars. immediately following the date ,of'.initial use of the sewage disposal
,stem, or any repairs trade by me to such system, except where the failure
operate properly is caused by the willful or negligent act of, the occu-
int of the building utilizing the system.
The undersigned further, agrees to. accept..as conelusive._the de-
;saxiia a ..�:f`A M1 irc -tom .o- '.•tip Ui=1�-sio�� ~o� - iv��o�Lr n *, 1'He- 1 i`S .r __�_
.ces of the Putnam County Department of Health as to whether or not the
:ilure of the system to operate was caused by the willful or negligent
:t of the occupant of the building utilizing the system.
ted this day of 2 �°. 19 '7S Signature i
i
� I
Title /)� L__ j
If corporation, give name
and address)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
T1 COPIES 1 1 1 T T T T T1
REE (3) COPIESS ARE REQUIRED WITH THREE (3) COPIES OF .FINAL PLANS BEFORE
RTIFICATE OF CO1^1P-,ETION WILL BE ISSUED.
ARANTO.R IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
vision of Environmental Health Services, Putnam County Department of Health
r t.t
a:' �. jp' • u N T.E TN /S ;1S TO 'CERTIFY WAT THE SELVAGE _OISAOSALr"
SYSTEM. WAS CONSTRUCTED AS - /ND/CAED ON--TH /S PLAN`
r2' ^� WEtt 1 A'ND :THAT THE SYST €M' i!VAS iNS'PECTED BY ME BEFOR . /r
WAS COVE- ,QF-D,OVER�. 14F- SYSTE/V1. 'W'A, 5 CONST!?UCT
I
{{ D /VCE tN1TH ALL THE RULES ANC7 R�GLLAT %bNS';
6 (N. ACCOR A
_ �7a l- �; i OF• TfIE;PUTNAM COUNTY DEPARTMENT OF NEAL7H_ 5
Y EXCEPTIONS TO TNE- A80VE� ArANY NOTED BELOW.
Q�y G t
p�� .'rye � ,'l � s {: 3 'y �•
T.
of 4'F L141$':�
-�� uY[:4i:- tiv��p?F• t F tJ *�! � � , '.1 !
T -.(0.75: �' - $Se ���:`"" }O ,S' lt5C1�'C.7,�4 -0. f:.q � . :�. , .. a. ,, �S t� ,•. \•
. Z 4E �'• boa :
s _ 2 �9a riE ME UREn� €airs .. OF` SEWA- E DJSP ®9.4L. , 3D'�T 119.
Baxrs moo; y �...
13oa�� 'gib
A'
B LoCA7~ %ON �-� -Qi� K Y �t✓•i
✓9LE l PUTN:4/V! .COUNTY'N,Y.,
4 •'' L`L' =�I��. izo pS -4'�i RU`:Nf�. � � .Tjk -'�/ \v 4t'4V ',r Fnl°S +c7$�' °C?� , ° y
4b: Q?3' �Mx 9� J RPR ~ V I-
0
_
sua r
ciw- f
y _ 1, 64.'
a �° . R1A 41 $19 �
ONP PRi,.J.? r'i �o e ssi�o/ �/ne�n9' si Lors!ur✓cyi�9. °Y" o{ FGJe�eido- A✓en ue C'ocme/ '.Y. • �vIRON my NR {TH %ERV
ry
a '
t`
i'
rCOUNr Y 'D 9i �R
f
PU T O
PA T
MEN F HEALTH
TNAM ;� T- G E R
Division ,of ,Environmental Health Services Carmel -'N Y. 10512 •;
CONSTRUCTION PERMIT :FOR :SEWAGE. DISPOSAL SYSTEM, y �'OiN'1 ;of 1?ztnam iTalaoy
�Tor.th side ,rona.e good "Dr a�prc 900 ft froth fOwn or. ulase _
Lu taa`. a* ` + Sectwn BIOCk 1'ar:CE'L 2 :.
Subdivision A Pw17C7d 'Rpl' Ate Lot` Job
'Cans truc lion Corgi. ti 9 BoniE�;ood 'Drive.•
Owner Address
49. Nlaho a cT y: 105
-Hi Ranch 97� :S. Nom. h 9
Building ,Type Lot Area
-Number., of .Bedrooms Total Habitable Space / Square Feet
O S l
�f Separate35ewerage, System to" ':606slit 6f,*
-1:2 �0 Gal Septic Tank���' lineal feet ,X width trench
'.an us JConsaruction .:Corp° Address
To be constructed by Sali1G 'a5 :r`l?Joyer
Water SuPPIy Public Supply From
{ Private 'Supply to be drilled by
rj'OY'1�1SG:�1
N �.c'ho�'i's Road,'. Aj?biO.nk, N. .Y
Address
Other Requirements
I represent that i am wholly and completely responsible for ;the design and location : of the ,proposed systems) 1) that the separate. sewage disposal system
above described :will be constructed as- sliown.on'Lhe approved amendment there
be submitted to-the" Department, and, a w
;place in , 966, d operatingcondition any; pal
arcs of Ahe approval of •the Certificate: of
to and in accordance wlth the st e's, and +regulations,of ,. the ,PPutnam. , f
of�Construction Compliance' =satisfactory to,fhe Commissioner of Healihwill' -1
the ownei, `his successors;•'helrs or,assigns by the builder, That said builder will
during the period of two (2).years Immediately followi ,the date of the issu-
original system or any: repairs thereto; 2) that, the drilled well-described 'above II
r +,,will be ocated as'shown,on the approved plan and that said well'wiilpe Installed in accordance ;with "'the''stan6rd"' r '1' ...d regula rs "of .'tufriam
`County�Department ,of' Health
x°
Date Aunt s 1971 s+ ned P E �= A A
z ;w urg s B e'n r',
�.
Address f ' n License No, l ��`+'�"
APPROVED FO,R CONSTRUCTION: Ttiis approval expires one.yearfrom'the date 1Issued .unless ,.constr.uction -of the building has been un'deit ken and is
`?revocable for a—uWor may be. emended o_r modified when considered necessary by, the Commissioner: of`Health. Any change or alterati n of'coristruction
:.requires a new,:permif •Approved for, isposal of domestic nit5ry sew `e, antl /or riva a water supply, only
Date .4 '�� -� f By. ` Title kC�r( ui
y
- t
PUTNAM COUNTY DEPARTMENT OF HEALTH
v DIVISION OF ENVIRONMENTAL�HEALTH�1.SERVICES.
DESIGN: -DATA SHEET - SEPARATE. SEWAGE DISPOSAL; SYSTEM FILE NO. 45
Owned Ta sCo nstrizc tion CarpaAddress I . BoIio ood. DrIve, ..A'Ta io ac.9 1�To '�?o
1,,*r o r t .11 ti1_de Boni ewood Dr, a�:�ac�ot. 900 . t
Located at (Street) froth T ^good :Strr et -ISec. 1_
_ 22 Block --1 Lot arC 1_. 2.3
Indicate nearest cross street ;�I
( ) Lot 1.1 o_f !-�otaict•�rooa ,- -cafes �
i
�'C)Z;1i O 1�t 1c�C] i!c 11_e. r I :E'T;j. '1rfirk C1_t Jr .
Municipality, y Watershed,
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
-Run Elapse. 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
io:0r 10.23 18 21.1. 2� lli.r.e '
_ !
] �a25...11ot 3 � } t 25 1
2
3 11115 12003. 1_, 2� 1
4
18 F�
-.1...
10.0910023 19
21
21�.
10.
19 r�
2
10' 30 11:07 37
21_x:
2E
? .
19 T`
3 '
1.10 10 11.0 2`? 19
2L1
2
.19
1
--
2
5
Notes:
1) Tests
tained
2) Depth
to be repeated at same depth until approximately equal soil rates are ob� -!
at each percolation test hole. All data to be submitted for•review. ! `
measurements to be made from top of hole.
TEST PIT DATA REQUIRED '20 BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. - E • N0.1: HOL
HOLE NO.
G.L. topsoil 4LI
317 17 .34 11
61
loam Wols',
ho -10 I
18 a•d s t a a.11 stones
241r
3011
3 61
42
48't
5 4'1
6 Olt
661?
72"
7811
8 411
-�
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED 5 f f r-o m -16 o p h o le
INDICATE LEVEL TO WHICH. WATER LEVEL RISES AFTER BEING ENCOUNTEREDsta.ir-q �'i :c ors t0
I J.'r �
TESTS MADE BY Diro-ess F. Behr, P. C. Date/Al,cp i"197)_,_ Sent!
VbbibN
Soil,-Rate Used 16-20 min/1" Drop*: ...S. D-.
• , 000 +
Usable. Provide; d�
No. of Bedrooms Septic Tank Capacity, 1200 Gals. Type a Frocst conc,.
Absorption Area Provided By. 400 L. F.x24tl 361f. X width'trench. Other
Name Roy A.. B-ui.rcr e s s, Signature'
Address B1.1.1 2 P, e s s F B PC C
SE
128 G'lenol_da Ave..,
LU51-
7.
Z A,&
PUTNAM COUNTY DEPARTMENT OF HEALTH
Soil Rate Approved Sq. Ft./Gal. Checked Date
oe+��� j
PUTNAM COUNTY DEPARTMENT OF 14EALTH
Date August 19711.
Re: Property of Tian ,us Co.-cistruc-IL-.ionCorp.
North side ) oniei,,7,00d Dri e, approx. T7 e s t side
,Located at of *'.good Street, To-v.,n of Putnat-ii Valle
Section 123 Block I Lot 23
'
Gentlemen: L T,,,
Two 11 Bonieood s.-'a'es
V A. Buruess
This letter is to .authorize RO
a duly licensed professional engineer
or registered architect
(Indicate)
to apply for a Construction Permit for a 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
I - - I - .- connection -with this matter ana - to-. supervise .-the construction of said -
system or systems in conformity with the provisions of Article 145 or
47,._Ed.i,i.eati,o..q L.aw,,..thje Public Health. Law, and ..the Putnam -- County- $ani-7.,
tary Code.
Very truly ours
Signed
Ij,an,j,' el 0 bIff t PbIqW_ kjorp,
9 50nie%ood Drive
Countersigned: mahow-',C, �T. Y. 10'?.I
Address
P.E., R.A.1 9L`45
)376
.,..oy A. Burn—ss
Address
DI'laorress Beh.r, P. C.
12Y'I._Ieneida. Ave. 114�
Cprmel,, N. Y.
Tel_qphoii
2 2� - 3 -1, 1$
I
Telephone