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HomeMy WebLinkAbout0550DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -1 -17 BOX 7 00550 .1 Ir I= .0 will ti I ' I r� i .r J. }L L 00550 PUTNAM COUNTY DEPARTMENT OF HEALTH r X4v. 3186 Division of Environmental Health Services, Carmel; N.Y. 10512 Engineer Mast Provide �p \�\ P.C..D. Permit N. RTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM /zrS'o% _ Town or Village. Z Located at O v Ta. Map Bloc &._ Lot Owner /applicant Name "`'r cG c, oU Ii4 Foeme y Subdivision Name C" r �`°� Sabdv: Lot li /'- -.— Mailing Address S W ZI - 10512— Date Permit Issued S —19 —A Separate Sewerage System built by f—et F,, 4 Address Cw ��` `I n f� Consisting of d o b ,� Gallon Septic,Tank and � v � : , c �`/' � z Water Supply: Public Supply From Address or: f/ Private Supply Drilled by 1301" 30-to es.. Gt� dress l lL Banding Type '\ Y rj � ^ Has Erosion Control Been Completed? Number of Bedrooms 3 Has Garbage Grinder Been Installed? A Other Requirements' ! I certify that the systems) as listed serving the above premises were constructed . essentially as shown on the plans of the completed work ( copies of which are attached)' in accordance with the standards, rules and re ationa, in accordance with the file plan, and the permit issued by the Putnam County Department Of Health. Date h ' f Certified by l P.E.-LZR.A. - Address f License No. S Z 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 pubs': unitary sower becomes available and the approval of the private water supply shall become null and- void when a public water Supply becomes available. Such approvals are subject ttto,/modification or change when, inn the judgment of the Commissioner- of Health, $U revocation, modification or change Is necessary. Date i �' C� D / BYE �����Title WELL COMPLETION REPORT DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use STREET ADDRESS: TAX GRIO NUMBER: WELL LOCATION 4:1-;E', 14,41 (2.0Ae /L A41_ Ors /LL AA71%E -P50A/ NAME: 70 ADDRESS: "RIVATE WELL OWNER PH!>L L /LL �P,C• 6'w7'�pe1sF,5 avLLErN,01 O PUBLIC USE OF WELL RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED 1- primary O BUSINESS O FARM ❑ TEST /OBSERVATION O OTHER (specify) 2 - secondary ❑ INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY O MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPL'E SERVED 5 _ / EST. OF DAILY USAGE � gal. REASON FOR t;XNEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST / 08SERVATION DRILLING O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH /i2 ft. STATIC WATER LEVEL j DATE MEASURED -Z DRILLING ❑ ROTARY COMPRESSED AIR PERCUSSION O DUG EQUIPMENT ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED O OPEN END CASING. PC OPEN HOLE IN BEDROCK O OTHER WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO PUMP INFORMATION TYPE CAPACITY MAKER DEPTH MODEL VOLTAGE HP I I I 1 1 Ao" 5-qX'— I I TOTAL LENGTH 1 tL MATERIALS: CK STEEL 17 PLASTIC D OTHER CASING LENGTH.BELOW GRADE it JOINTS: ❑ WELDED WHREADED ❑ OTHER DETAILS DIAMETER in. SEAL: 19CEMENT GROUT O 8ENTONITE POTHER WEIGHT PER FOOT 1b./ft. DRIVE SHOE 9YES ❑ NO I UNER: ❑ YES WO DIAMETER (in) SLOT SIZE LENGTH (11) -DEPTH TO SCREEN (ft) DEVELOPED? SCREEN STORAGE TANK: TYPE.. CAPACITY GAL. WELL DRILLER NAME aatewaa,. OW OJ 1% ADDRESS 44 , .�a2J 51Gr DETAILS FIRST o TES ONO SECOND HOURS ._._ GRAVEL PACK O YES GRAVEL DIAMETER TOP mom ❑ NO SIZE: _ OF PACK ,._._:_.,,.., bL DEPTH ..._;. fL DEPTH WELL YIELD TEST ; It detailed pumping WELL LOG t more detailed formation descriptions or sieve analyses are available. please attach. METHOD: O PUMPED t tests were done is in- t Q(COMPRESSED AIR formation attached? DEPTH FROM SURFACE Water Well Dia- , ❑ BAILED ' O OTHER 1 O YES' O NO It. It. Bear- ing meter FORMATION DESCRIPTION WOE WELL DEPTH DURATION ORAWOOWN YIELD land Surface 3 It. hr. min. It. 9Cm• _ _ , .... . _ WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO PUMP INFORMATION TYPE CAPACITY MAKER DEPTH MODEL VOLTAGE HP I I I 1 1 Ao" 5-qX'— I I STORAGE TANK: TYPE.. CAPACITY GAL. WELL DRILLER NAME aatewaa,. OW OJ 1% ADDRESS 44 , .�a2J 51Gr „ nanco`iabs inc -' B001 5 4* 1 ROBINSON LANE Ft_ D 6 ° lI WAPPINGERSFALLS, N;N 12590 ' • \ a. (914) 221-2485.,: -NAME: - a�� �G spi.9.�/ Gri�4G G� DATE RECEIVED _. .... . ADDRESS-` .12T C/_ 4 f. S °7 0 % AMPLING ADDRESS . ” / L/ Z �/ l TOWN TREATMENT': CHLORINATED'❑( PPM); SOFTENED ❑; OTHER-, SOURCE: DRINKING WATER )KWASTEWATE'R EFFLUENT ❑ OTHER ® COLLECTED BY: C� /�i�S Si.�pn/�e��. _ TIME // O(� _ <_ - DATE ❑APARTNIENTCOMPLEX' PR IVATE:RESIDENCE "" ❑SCHOOL- -. ❑SEWAGETREATM ENT ALANT `. ❑BEACH- ❑RESTAURANT OSV111MPOOL OOTHER T. PER 00 M L. ❑OCOLIFORM COUNTVN ❑70TAL COLIFORM COUNT M.F. PER 100 M L ❑ FECAL.COLIFORM'000NT'M F T z PER 100 M L., ❑ FECAL COLIFORM COUNT M:P.N P.ER 100'M.L. ❑ROZEN DESSERT PLATE COUNT ° ` = ❑AGAR PLATE COUNT RER 1 M t j LABORATORY TECHNICIAN - - DAT REPORT LA AT .I Y'DIRECTOR THESE RESULTS INDICATE THAT THE WATERSAMPLE U • • MEET • • • • • • ' • ' - k :HEALTH DEPT. PUTNAM OOLIMEY DEPAR914W OF HEALTH DIVISION OF ENVIROV1M?M HEALTH SERVICES Owner or Purchaser of Building Section Block Lot Ei-k:Uding-Constructed by /Ice / b! l C"-,.7 r�� /7ri // 4/ I,ocation - Street Municipality Building Type Subdivision Name Subdivision Lot # GUAP -kN 'EE OF SUBSURFACE SEWAGE DISPOSAL 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 guarantee 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 approval of the "Certificate of Construction Compliance" for 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 the system. 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 system to operate was caused by the willful or negligent act of the occupant e bui u jlizing the stem. , Dated this . 2 day of 19 ,-e 7 Signature Title eral Contractor (Owner) - Signature Corporation Name (if Corp ) CI r z / Address rev. 9/85 mk brporation Name (if �Coo/rp. ) �hT ' Address 2 2 S— — 76 dc-(' 4��' Building Type[ �YC4 Lot Area %o T - FlllSecdon Only Voltwie 77 ( Depth Number of Bedrooms ' -Design Flow G P. D J © ,PPCC (H,D Notification is Requir-edd When FIB Is completed Separate Sewerage System" to consist of iS6SGGauoa Septic Tank 'and ��� t %I f ,+��� e)c,6LO�'l / Li To he constructed by 777—R, l � Address Water Sappb:` Pdblle Supply From Address or: f ~Pdvdte Sapply.DrWed by �J Address Other Requirements I represent. that Kam wholly and compieteiy; responsible or! the designpnd location of the proposed system(s); 1) that the _separate sewage disposal, system above described will be' constructed as shownon the approved amendment. there to and in accordance with the standards, rules an regu a ions O o u ram .County Department of Health,' and that on conipletion thereof a�•�Certificate of Construction Complia ice" satisfactory to the Commissioner of- Healthwill be. submitted to the Department, and a wiitfen guarantee will be (urnidlied the owner, his successors, heirs or assigns'by the builder, that saidtiuilder 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 "Corriptiance'of the original system or any repairs th reto; 2) that the drilled well:Aescribed above will be located as shown on the approved plan, anti-fhat said •well will be'in ` ' accor ante with the to a si :rule`s and regu as ii'iIons, OU.-t. ne Putnam County Department of .Health. - `' - - Date T�a�aZ .5�8 Sign P E. R.A. Atltlress- i �J _ _ _ •. License No APPROVED FOR CONSTRUCTION: This'approv_al expires two years from the date issued unless- consVUCtion' of'tfie, building has. been undertaken and is revocable for ,cause, or. -may tie amended Or'motlifietl when Co revocable by the Commissioner of Health. Any change or alteration of construction reouires a new permit: Approved for tlisposal Of tlornestic sanitary sews dr orrvate Waterwpplyonly. ,/. 87 Date- y�l f �if� B- Title J` /?�i" PUTNAM COUNTY. DEPARTMENT OF HEALTH T �REv 3// Dlvlslon.bf Enviremnental Health Services. Carmel, N.Y. 1051? Engineer to Provide Permit q RTIFICATE OF COMPLIAN on CE i?ermlt q ` T L ' ,CONSTRUCTION PE SEWAGE DISPOSAL SYSTEM Ali.- .�a� :► �Co 4 ` Located at Town or Village Subdivision Name4 -JIMM � � -Sdbd. Lot q Taz Map Slocic Lot Owner /Applicant Nime tAiLLLS -11 =5 tkle -_ IVf"g Address Baliding Type Number of Bedrooms a Separate Sewerage, System' to consist of tAt Are Design Flow G /P /D C-An7Q Renewal ❑ Revision ' [� Date of. Previous Approval Town: To be constructed.by °*5 � Addrees' Water SUPPIy: Pablic.Supply From Address . or:. ite Sappiy Drilled by I represent thai�I am wholly and :completely'respon {ible for the design and location 'of the proposed system(s); li ,that the sepaste`'sewage. disposal sysEem above described will be constructed as showW'on.the,a'ppioved amendment; there: to and in accordance with the standards, rules an regu a Ions o e' u nam County Department of Health; and that on completion thereof a "Certificate of'Construction Compliance" satisfactory to the'it mmissionerof,HealthwiII 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 thodate of the:issu- ance of the approval of the Certificate of Construction Compliance, gf.' tie original system or any repairs hereto; 2) that, the drilled well described above will` be located:as. shown on the approved plan and that. said well will be ied in a ccordance . with the sta ards rules a regula�f the Putnam County Oepartmp{ent ofggH /eaalth G�� Si9netl P.E. r!' R.A. Address L tense No APPROVED FO CONST UCTION: This'appioval expirei-.on year f m the -da i sued unless construction of the building has been undertaken and is revocable for w- se or m e amended or modifietl_ when conii red' essary by t e - omm 'Si Health. Any'change or alteration of constr ction requires a newt” oved'for. disposal of,domestic n' ar ewage, and r. iv a w a pply .only. Date Z BY ;: _ Title -s. 16 PUTNAM- C.OUNTY DEPARTMENT. QF 11E LTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUN'T'Y OFFICE BUILDING, CARMEL, N. Y. 10512 DI,SIGN MTA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner��, Nip; _?c_r� l ►.ic'. Address 'ZZZ, ILA�t ,1,� a 6.� 1L?>%1 c7 ,iJr 1� �(. I53Co coC1,1 � �-� �u— Q.O. Located at .(street) T. ��4 Sec. Block Co Lot. 1 Indicate nearest cross s Are (49) Municipality `t'Z'F Watershed C-y-- ,T0t --A SOIL PERCOLATION TEST DATA REQUIRED TO' BE SUBMITTED WITH APPLICATIONS IL . 5 1. 2 1 1 '.a r--2 :2c7 77 2 2; Z( --4 ,Qo "?67 Z'Z '� �. 3 it 7-7 34.0.1 fS. '74 zZ z� 11 Note:]: 1) 'Pests to Le repeatcsd. at. same depth until a roximately equal soil rates ai-e obtained at each percolation test hole. A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. To- .e Number, CIACK TIME PERCOLATION PERCOLATION Hun E16pse Dp-pth Eo Water Water ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 21:A t Z IL . 5 1. 2 1 1 '.a r--2 :2c7 77 2 2; Z( --4 ,Qo "?67 Z'Z '� �. 3 it 7-7 34.0.1 fS. '74 zZ z� 11 Note:]: 1) 'Pests to Le repeatcsd. at. same depth until a roximately equal soil rates ai-e obtained at each percolation test hole. A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. DEPTH TEST PIT DATA REQUIRED `I'0 ..BE SUBMITTED 14ITH APPLICATION DESCRIPTION. OF SOILS .ENCOUNTERED IN TEST HOI2S HOLE NO. HOLE N0. HOLE NO._ 7211 7B" 8 INDICATE: JJ1VEL AT Mil.Cll GROUND WATER 'IS ENCOUNTERED INDICATE LEVEL TO WEICE WATER ld.,.VEL, RISES AFTER BEING ENCOUNTERED TESTS MADE BY —Date DIESIGN S(,)J.l Rate.l.i.sed t7 Min/1"Drop: S.D. Usable Area Provided 5 No. of Bedrooms 3. Septl.c Tank Capacity 1000 Gals. 7�r= Absorption Area- P-ro-VTcle-El By L. P. &I Wth, b mqch. -r- zoo Signa e Address :�p _C� FEZ Sc� N /Lt Y' SEAL 111111S SPACE li'OR USE 13Y HEAiNE.DEPARTMENT ONLY: "ol. I Rate Approved Sq.. F%/Cal. Checked by E C E pY E- S E P 2 c. 1985 1UTNAAA COUNTY DEPT r%r #­, o4l ZA lo Date I PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT ` TO: Commissioner of Health In the matter of application for: Cornwall Hill Estates, Inc. I� Kenneth Emerson represent that I am an officer or employee of the. corporation and am authorized to act for Cornwall Hill Estates, Inc. (Name of Corporation) having offices at 223 Katonah Avenue Katonah, N.Y. 10536 Whose officers are: President: Edward H. Emerson, 223 Katonah Ave., Katonah, N.Y. 10536 (Name and Address) Vice - President: Kenneth Emerson & Martin Diano, 223 Katonah Ave., Katonah,N.Y. (Name and Address) Secretary: Janet G. Mastropietro, 223 Katonah Ave., Katonah, N.Y. 10536 (Name and Address) Treasurer: Lynne Diano, 223 Katonah Ave., Katonah, N.Y. 10536 (Name and Address) and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Sworn to before me this , day Signed: of art 19 V �' Notary Public LIONEL WEINSTEIN Notary Public, State or ideN YorX Rlo. 60-4199160 Qualifled in Wwa tche:t:;r Coun -9 C" nimissioh- Expires l4nich 30. b 8/84 Title: Vice President Corporate Seal P Q r Q Q v 'd 5OUO PVC. =1LE �,5 :448 _ `��`�`----- ------------- - - - -_, ;`�`-_ x4441 _" - '"- - - - - -- --------- - ----------------- — � / r l9j r 470 SDP' i 9 / � r 1 Q 4to5 i , , F.F. CLEV. i 4(op.0 I ]"'Co. � r it IUV. / - _ 454'75 dl t-4" d C.t R 1 @ Z_5 -loov QD.L. SEP'Yt C TAISK 445 A V. / r / / / rjl�l[1�LIYIU, / r p-k F>= ELEV� / / 5EQT1C TAUtG / i Q V� i i / / / / / / 1 \C,,4 1 � �qv SAh��, �amo h' - trPi 3rTE Pf -.A�l veoc Cor-U WALL Aa (LJEX:�EsG To c P�EYACE'O B`. W_ LALIICEUT,C 1� r �J \ r� s' uo rE I. PICOQEr_'T\/ LII_!E At, l� TOPpC3�APN tCAL OATA. 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