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HomeMy WebLinkAbout0214DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 4.18 -1 -3 BOX 3 00023 i mill 'ar } ' m 00023 9 .- PLTI'NAM COUNTY DEPARTMENT OF HEALTH S01918 Division of Environmental Health Services, Carmel, N. Y. 10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL .SYSTEM Patterson Town or Village Birch Hi 11 Road Tax Map 83 Block 4 Located at Owner Charles J. & Irene V. Romano 15 Tax Map Lot # Subd. # Separate Sewerage System built,-by Paul Lundellus, Jr. Address Patterson, NY Consisting of 1000 Gal Sept" Ic Tank afdW L.F. x 24" Width Trench Other requirements Curtain Drain 90' x 4' Deep Water Supply: Public Supply From X Private Supply Drilled By Boyd Artesian Well Drillers Address Route: 52, Carmel, NY 10512 Building Type Modular No. of Bedrooms Two Date Permit Issued 9/5/80 Yes to Donna T. Smith Has Erosion Control Been Completed? I certify that the system(s) as listed.serving the above premises were constructed essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulations, in accordance with the filed plan, and the permit issued by the Putnam County Department Of Health. Date 11 Sept. 181 Address R. D. 9 Certified fair q A/1 Carmel, NY 10512 P.E. X R.A. License No. 29206 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water suppI becomes available. Such approvals are subject to modification or ch a when, in the judgment of the C �ssio of Health, such revocat , odification or change is necessary. Pi. Date .� BY Title YORKTOWN MEDICAL LABORATORY INC., c #195 YM�# (o:i 03 P:O. Box 99 321 Kear Street LOCATIONS: Yorktown Heights, N.Y. 1OS98 El 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245 -3203 ❑ 201 BUTTONWOOD AVE .', PEEKSKILL, N.Y. 10566 737.8777 245'3103 ❑ 495 MAIN ST., MT. KISCO, N.Y. 10549 666 -3335 I?5 STONELEIGH AVE. (NEAR HOSPITAL), CARMEL, N. Y, 10512 278 -9330 DATE COLLECTED 'RESULTS OF EXAMINATION OF WATER q/11 /81 13 :00)nrn STAI !'nl n IAIATP7R TANK NAME OF SUPPL 9/11/81:_ , 3 : 59 DATE REPORTED - BACTERIA PER ML. (Agar plate count at 35 C). 9 COLIFORM GROUP MFT 0 /100m1 COLIFORM GROUP MPN /100ml TOTAL - ppm. DETERGENTS : mg /L NITRATES (as N) - mg/L IRON, TOTAL-' mg /L AMMONIA, FREE (as N) -mg /L PH= CHLORIDES - (mg /L) These results indicate that the water was YES of a satisfactory sanitary quality when the sample was collected. A. H. PADOVANI, M. T. (ASCP) NEW YORK STATE APPROVED LABORATORY 0 WELL COMPLETION REPORT 3/71 iI �J r PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report is to be completed by well driller and submitted to County Health Department together with laboratory report of 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 M & H Custom Homes ADDRESS r,1 Deacon Smith Hill Rd, Holmes NY LOCATION OF WELL (No. 8 Street) (Town) (Lot umbe Birch Hill.. Patterson PROPOSED USE OF WELL BUSINESS © DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL if ) ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING El (Specify) DRILLING EQUIPMENT COMPRESSED CABLE ❑ ROTARY AIR PERCUSSION ❑ PERCUSSION ❑ OTHER CASING DETAILS LENGTH (feet) 1,00 DIAMETER(Inches) 6 WEIGHT PER FOOT 1;9 C THREADED ❑ WELDED DRI SHOE © YES El NO W C Nj TED? LJ YES LJ NO YIELD TEST HOURS G.P.M. ❑ BAILED ❑ PUMPED ® COMPRESSED AIR 2 10 YIELD (G.P.M.) 10 WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) 4.51 DURING YIELD TEST (feet) total drawdown Depth of Completed Well in feet below Land surface: 2255 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 (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET 0 15 overburden 15 85 sand & gravel 85 225 ledge If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED 8/2/81 DATE OF REPORT 9/11/81 WELL DRILLER (Signature) - A. Charles J. & Irene V. Romano Owner or Purchaser of Building M & H Custom Homes Building ConstructE by Birch Hill Road Location - Street Modular Building Type Patterson Municipality Tax Map 83 Section 4 Block 15 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 followi.r_g 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- vices of the Putnam 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 s Dated this j /'L day of r�f 19'1 Sig n atur r Title If corporation, give name and address) Birch Hill Rd., Patterson, NY 12563 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 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 Charles J. & Irene V. Romano Owner or Purchaser of Building M & H Custom Homes Building ConstructE by Birch Hill Road Location - Street Modular Building Type Patterson Municipality Tax Map 83 Section 4 Block 15 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- vices of the Putnam 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 f/ day of J ': i 19,x% Signature � � � (. . -�' Title Owner v 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 - .. 1.1 Y41 Vrp rV4V+OV t. vrr ,. cr v.J au oru .r.(•v Vwrvw Ly —_ � — _ _ ?;y. f ell located by; Surveyors survey _ - _ e,lt-drillers repofr ..lp--yL_ _. Enoineers`m_osuremen,r , s-YS,1 Tonk',:boxes, pits -, galleries a 4aferals lo•coted• by,,Controetor. r Engtneerr Health ac.pl: Pield inspection b y Health dP pt® p� ddc0t1 aa:' ; �!1 _ +1_81, Engineer �. +yy{;� r • j}�' - NOTES srl. COAT e 6r + . 1Cjp� I a - fM ;.. '�' , t. -. :: "' _.�iu Vi_l.•Y E♦t'Q•.f S.. _ ._rU "R4.h .rS'/ %4'':D� , s2� e 8+re.r a , 4 •• ^3 _ y IN f i' 5 M+_ it '�' � � �.f alt�Y { i rF}� r i �� " -+ ,t g ^D I fK1 S I OU, o • r' 9 A . 4 'G: a crP iP, t . M A 1 t, ?♦ '•.. a 3a,r. •s .96!4":- y' _ . - .. +'. _. "•r ,• as :,y t y: Leh s -A o'v ir, `,a p �,4. °•_ — g 1'- �+ & T W 5 •s t �'4�S �� F , {�'+ `� }' V —7,691- r : %'� � ' �53t'37.1M'4r•:� A-• - H " 72� g._ _ -.N 77/0 g - J A K _B'- -g - It u A'_ t _ 67'2' - -:8 - L '�+ .b / Pa.k • /oe ` .�^b /a r ? A — N 1 9�. +T t' �„ •4r ^ q. /V.Z /epgiy� ell 'lk9eCan - �zs =...• a.�;i +_NIT A R— zSYST &_ A- DE t N%f L�+in9�Bliy S f�o OWRER:_ Char �4 �. �i{g.�e ✓ "�o oho __ _ — _ LOCAT - Tor4n: Count Sto te N. _ { J SUg01VISION. M0 4x 83 ':Didins Conneej/e— — -- 'Ta • 81 ock LOT N2 1, Builder _.ILd ".far refsory„ . Surveyor: ­1 QtTL .-. -- Putnam County Department of HeiMb -- -- i 'tai A,H:F• e. 9 ,/ gi X30' Nd.1918 �lvision of Environmen Health Servtoep� Q►ow,n Oaf �Sc01e :rr Job r. P, v AP"TOVed ae ot_3 ' °o co,£ormance with ,� „O H ,H , P R E N T' 15 S P E • Dwg, j ble Lulea and Eegulatione of -the --. — CO N S MtT'i N G E N'G I N E ER Putnam o y Hea h Department RD F. `1 , � s r eARKEL' NY 10512 4491Qi 878 -15170. �: • � �;Ll� r. f. Orr• . o� off. Z��. -. ' "COO h "� s EED) <iVtZU'E.�l OF-7 P2C>P>F 07Yr— f G1GA:l F" !"=30' Ax u--, -T .I -7..1520 SEP 1 1 EZTIFIED- T6 -ntE. rte. - V.4-IVZUE-F IE. eAjJ! E-MltLICAT-0047 JQC>ICATED 7-fF� SIGI.LILY - rgM- -U':i 1asM UU Z.�P P�O I-J.1D sutzvel5, e.noPTE-n -T UEkj v s» <t�,occ�noU of > y,IC�lal_ MAID cE2TIqc4nOl.i4 IdLL euxi (O.1Ly '[i IE FE e�t�l Fb2 kli iOA ( R IE Sc.�/EY tS peE.PAOED k �t1 111S eE 94L-P- "ID 7WE'['C C-OVFW-`/ strip LE11CG,IG, (`�TCRJT101.1 LISIEC7 WEEECA 1. CEZnPr4f7O"/, AEF QC5F n IGaysFv X -rb ADC)rnCiIdL. I> fSTI (111 t( L1G, Q2 tool ,Ll2HIV_�, t'_rctlVi7SS, f �A IA tJf} f7�D b1- "Tr.4,6 -,nc .1 ce ACaTf01::1 � 00 OF aJ2�Y t�7 A K�2� � -ruE WEW - OOZV SrarE- r�x ' OQ �A�l. cat 1GE eCaP�tJ11p croL znjuec1i, 1C7A/ -N, t.Ic F S 40u ALL LEOT-Ii2c Knokkl , NEIL 1 AZE \/,UJD 1:0 -n-V? MAP A), f CyPtE=5 - TPE>?.EOP OI-1L( IF AiD M4P O>? CORES- € CAO T} � IA�hEz ,5e L OF - fl-lE. SjONje ce- V11400?E SK -,1-14 R s wt= nt7y "EFMO J. 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 _'lJer,.�, .. ei Adaress �ii�it /�i�i�,[ .. • Located at,'.-. Street. ( `h Block._Lot� at ca . ..... _.. ,.. �,ti . e._ neare— dross. MunicipalityGrfo Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE `SUBMITTED:.WITH'�.APPLICATIONS oe Number._ CLOCK_.:.TIME. PERCOLATION.. PERCOLATION Zun apse Depth to Water Water Levei No.. "Time From. Ground ;Surface in Inches <` -Soil Rate Start -Stop Min. Start Stop' Drop in Min. /in drop ,\ Inches. 'Inches Inches YJAC 11 :std 9 .)4t ' 20 Notes: 1) Te`Ekts t6 be repeated at same depth until approximatelyy 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. �1 I� W am :............... o n ..­' ren iss;.. 1 r Address.. R. D•;.:g�;t.F..��r..st.. :., PREy��scyF� Carmel NY 1 512 s � 3 THIS SPACE "'FOR' -USE'"BX "'HEALTH DEPARTMENT ONLY: " o Soil' Rate .Approved _.: Sq: Ft /Cal . Chec 3 Date , .. of THE Si otl ...... I. State of New York Re: Sanitary Disposal System.- SO1918 County of Putnam Two Bedroom Construction For Miscellaneous Land Records For Parcel Located On: r .. Birch Hill Road In The Town of Patterson Tax Map 83 Block 4 Lot 15 As Owner /Builder of the Sanitary Disposal System proposed for the noted parcel, permission has been granted by the, Putnam County Board. of Health to: . Design and install a disposal system for a'two- bedroom dwelling, instead of a three- bedroom system required by Health Department standards. A cony of this document with the County Clerk's stamp is to be delivered to the Health Department prior to issuance of a Construction Permit; with a copy to the Applicant. (Must be K Signed c.ri no.a� m Notarized) . Printed Name Donna T. Smith Birch Hill Road NpRMA LANE ALL 140tery Public, stet* � Ne.w York Patterson , NY 12563 No. 40-9SWI5 Ouatlfled In Putt C&^ 914- 878 - 6819 Tenn Expires Mar4h30, t,1, . � is l /"� J. -� , c� �� 1 tip.0 r : �► •fit .. r..a . 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