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Home My WebLink About0056DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 3.15 -1 -8 BOX 1 00056 L 96 L 6 4. . kT 116 1 Val m 00056 :. f ... .`" t ;fit �• T,.y, r �STry$' t �� h 7 .) , i V pyL N b• 1- c� {'-.mss r }y� °��j� ». •%._ "Y ♦ 1, ...F' (�/ R.t� h ('.; Nj p Q, I % T7-I +4r --, 4kc L x$11 `riR.R ✓"i ' ;" ��r^rt f c �":: � ., �! �1, ��, f-- ��rr�� "!✓��1!'/1%�. ==•.�. ^ � � � r��., w��...�f„li- +-,//l��vc.Ti•��•" �'�x�;° APPROVED. S ' . OF� e--:!5 JUL2 6 1973 POTNAM COUd CTH Dom& DIVISION Oi • °%.c'.� 'E c i Cif J�;l1C7 4$N Z ti,1E o�3aj :�i, � I 5 - . AL` HEALTH SFRVIri'• i� N�� ,`�� _ ► 1` . t�'t ` :a[.^'it `I!!k#;.,CaY. •.•�.: o�i..i.(`!��ceftRHr�vsai• 5Th':- r< yc•ce�.L;,w.+.Mt:++'Hnx�w <iecw � � .. .. - _ .. Owner or !.--chaser of building Building Constructed by yo.q Tl-Z Si Location - Street Building Type Municipality 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 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 thin evet-am . The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environmental Health Services of the Pu-i:nam County Department of Health as to whether or not 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 193 Signature �- Title (if corporation, give name and address) THREE (3) 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 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION' PERMIT FOR SEWAGE DISPOSAL SYSTEM Located at ✓ 4/�0 R r— 1, / ' Subdivision 0� P1 z 1•'L /0GG /: s � 4 owner ✓`%tR'>�oG / //L /!_10-S?"iFl4 %1_s Building Type �L�7 Lot Area Number of Bedrooms Separate Sewerage System to consist of 27?1 <n Gal. Septic Tank To be constructed by _ Ah T7_1—_ S 04/ �T Town or Village Section Block Lot Job _ Address +�T L Total Habitable Space Square Feet 1 410 lineal feet X 3 width trench Address Water Supply: Public Supply From 1'/Private Supply to be drilled by Address v . Other Requirements �A,� /1 Ll �� , /L� ✓` S fir—' %�G/ilL� I represent that 1 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 the date 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 installe accordance with the standards, rules and regulations of the Putnam County Department o_ f ,Health. Date P,E. 6� R.A. Address ` ' License No. yG APPROVED FOR CONSTRUCTION: This .439. oval expires one year from the date issued unless const ti of the building has been undertaken and is revocable for-cause or may be amended or modified when considered jecessary by the Co issio er of Health. Any change or alteration of construction requires a new permit. Approved for disposal of domestic r p supply only. Date By Title I� YORKTOWN MEDICAL LABORATORY INC. Yorktown Heights, N.Y. 10598 P.O. Box 99 321 Kear Street RESULTS OF EXAMINATION OF WATER CITY, VILLAGE, TOWN & /OR NAME OF SUPPLY ROUTE-9 FISHKILL, N.Y. AP —_— LOT � 'I q4 DATE 2401 245 -3203 BACTERIA PER ML. (Agar plate count at '350 C). 22 COLIFORM. GROUP (most probable No, /100ml.) LESS THAN 202 HARDNESS, TOTAL - ppm DETERGENTS - ppm NITRATES (as N) - ppm IRON, TOTAL - ppm FLOURIDE (F) - mg. /1. 'These results-indicate that the water was YES of a satisfactory sanitary quality when the sa le was col ted. i PER: LAKE CAR EL CHAR 1 n lid tc r A. H. P.ADOVANI, M. IT. (ASCP) 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 v'`%�.ec� 11t)4%116 Address Located at (Street RIOX7 -1/ 677- Sec. Block Lo£' �Indicate neares cross street) Municipality /",17-7,:�,es Olt/ Watershed A -1. - SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Role Number CLOCK TIME PERCOLATION PERCOLATION apse Depth to Water Water Level No. Time From Ground Surface in Inches Soll Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 2 7 11 3 4 5 1 2 3 4 l Notes: 1) Te'gts to be repeated at same depth until apppproximatelyy 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. DEPTH G.L. 611 1211 lglt 2411 �"zz 3011 3611 4211 4 i 5411 6011 6611 7211 7811 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER EL RISES AFTER BEING ENCOUNTERED / 'PESTS MADE BY W. Date DESIGN Soil. Rate Used Min/1 "Drop: S.D. Usable Area Provided No. of Bedrooms 3 Septic Tank Capacity "70' Gals. :Type Absorption Area Pr— ov* By /� L. F.x2�+" j '— width trenc; Name - ,q Y Signature w� ' Address SEAL THIS SPACE FOR USE BY HEALTH DEPARTPZENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by Date TEST PIT DATA REQUIRED TO'BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. HOLE NO. i � -1 e i— "III',,, 111 - -1111: u11-11 11— " .,, :r 1 1. 1 , A 1, 1= 11 . 11h ; — OATH ll/cl -k. 0 5✓6 70 0!= C041,5 7-,IYVC-- 72-�,U 116 /�FiW 1-11Z 11V 474 4c��' q5::i- -De -F— Z:7-771-11 .6 APPROVED 0 F ftQ 1973 a bq P, ss,GtOv till . ...... .... e7' PlIVAM A1 " v"j soh PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR YES NO Internal Use Only ❑ �,//,'�(epail Permit Issued in last 5 years ❑ In Watershed ❑ 1r� Repalr within Boyd's Comers, W. Branch or Croton Falls Res. (�egated ❑ (d Repalr within 200 R of a watercourse or DEC-mapped welland ❑ Joint Review lv o a - S I h 'Sy PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES D * PROPOSAL_ FOR SEWAGE DISPOSAL SYSTEM RF.pALR USE ONLY 47'Doo (y. SITE LOCATION 4/ `i 111drLH Si- N4,, s— e# 3, f 9-- 1 - Ff OWNER'S NAME 4 v Q t r rc Sy PHONE s-- 9 3 MAILING ADDRESS 411Y ,Qo - -W r- 511 PERSON INTERVIEWED /�—flame Le, o PCHD Complaint # e o p wer, enntec DATE 6 TYPE FACILITY 14CJ IJ SIF— PROPOSED INSTALLER 0'4,, )6 ,, f' x cc, va 4.',: HONE tVS- 17799 - yo 3 Ci ! ' ADDRESS b' ifa w k R: d RD. Brw i �L r REGISTRATION# P,ropgsa1(include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system .Different location may require submittal of proposal from licensed professional engineer or registered architect. �NS+-A-tt 3 Tt- -.-ag-s cG- .s ;sk/-4-r --5 c4- if.-z0 14,� k cW� C„Ik ! -S C iC-r Cl7 W, I, I A UJGS 14,p &--kyc I. I, as owner, fdport age f o� er agree to the conditions stated on this form. �� SIGNATURE � � TITLE DATE Pro pQsal_gpvroved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name b. Site Street Name, Town and Tax Map number. C. Location of installed components tied to two fixed points (e.g.,house comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6 deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Proposal approved Inspector's Signature & Title DATE COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML tr y rte`' 25 . 2a .81 AC. 20.5 AC. 23I r mu, ►e•- i!i -t -t p- 24, ggagg 0•i +4�.r ❖.•. ❖. ►•f! SIRE ► ❖. ❖ ❖.•. ;� +f1i` +fif �•1•��1i1i1i1f i;i•� R�►ff••i +iffff•� rififfiff♦ �1�,i1f1i1f1f1f 1• _ �1�,i111.1f1114�1� �1� ►f1+1.1.1.1.1.1� • i� 1� i1� ►1i� f i 1.1• r 1�� f ►ilf�ilf +f iif� y.�►�ffi•�►1.1� •i•0.00piOp• �•�,1•f•1•1.1+1•1•� - = f1��i1f1f1f11�i i1� f� �y•f1f•fff� : +i11ff1f11�i1� �i�:•fff•• ❖ifs �i�:•ifii �1��f1f1f1.1f11 +iii0� f1� +fiiiifi� - • . �i�• �1��i1i1f1i1i1i1f1� - ii ❖ : ❖:• : +: ❖i - - iii ► • :0•' ❖:+i�:•i �•i•iii•� /fif - �� f ❖f +ff +fffl� +ffieieieieei �i�► f��11�i�f�1e1e1�1�1�t�1�1�1�iei eie��l+1�f•fa i+ ifieffii�if •1►i� ►f ie1�1�' ��1�1�1f1a+ ♦•fflffi•ffiifi•fflf♦ ff� fffff♦ f••iififf,►fffff•iiff • l�ifi. iif .❖ oo f o. +. +.�f ❖. +. ❖.•f.•.o+:•W . +, W ! ►o f.1.; 1i.•. 1. ii.•.`.•.1. i.1. 1.i f,.•.1. 1.•.1. 1.1.f. A.i.1 1• f�1e1�4pf��► .i...r1•i1f. fif4.Af.•f....•f+•....•ff.- ❖.1. ❖i•.o•��.f.': ifl./.ii. 1 .�.i..,.,.i.1.1.1.,.•.1.,...... icefi1�1�1�ie1e1�1�1? f_ ♦if♦ ❖. ❖. ❖. ❖. ❖.• f�/ ff.iii•ff.ff.f..,►iif� ---- ------ ...ff..... ❖.. o• f•.. •.�il.�.`!�. ►.�,�.�.��7�1-,,!.• ,► �.�: �.- _ �►�..- . -. -.- - . - : -r.• ...........•n.:' +��ff1f1�+►fiel•1e1 ►i..�...... . ►.' ,..L i. �. � F f1 %!�. !, -. �� ► ' ' - MAP �Ik \ \ \\ ERSON ■■ mss,. "' „ .- rNJ0 Nt th S��S PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR OFFICIAL USE ONLY �) ��^^ �wv� SITE LOCATION Aldr4-1.4 -Sf 'P0,4Qr_S- _ # �• < �-- — OWNER'S NAME %� (> 13 �.l it +, PHONE S �t 3 MAILING ADDRESS (/ PERSON INTERVIEWED A UJ PCHD Complaint # Name & Rela—tionsEip (i.e., owner, tenant, etc. DATE 8,11.5;10,6 -TYPE FACILITY wsr�. PROPOSED INSTALLER 0'k Jo r ��. yc. �' e PHONE rS4/� a7�/- ADDRESS !( RD. BYcj,5,Lc_r REGISTRATION# C ®y ov Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system .Different location may require submittal of proposal from licensed professional engineer or registered architect. _T-IS4 -�tl 3 c4- 1*-zv A .t _e .,_. _1_A_r_ - _P_ L9_.. I, as owner, ported age f o er agree to the conditi ns stated on this form. f-/ SIGNATURE TITLE DATE 7" Proposal annroved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name b. Site Street Name, Town and Tax Map number. C. Location of installed components tied to two fixed points (e.g.,house comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e. Installers' name and number. 3. System repair to be pe oomed in accordance with the above proposal and conditions. Proposal approved Inspector's Signature & Title COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC-RP 99ML s/z 4- DATE 7 m Y3 4 -A or At Z . . . . . . . . . . . ... ...... . 72� PROW/ a!f7 �e 0 OF Nir �TW F 4 J.UL2 S 197 tjc�t4 ly LT fqTNAM COUNly -I) Ay p V U6 4N o T DIVISION AF HEAtT14 R jNVUtGNfMffAL FRVIC sl fz,061D