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Home My WebLink About0851DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25. -1 -12 BOX 9 4 rl r sm I ML I IL Ills. 16111 %r' 00851 'OUNr, , DEPARTMENT OF HEALTH Divisron of Envdronmentat Wearm Sennroea, (,e�m% N+ Y ,105,12 Pew ,:CERTIFICATE'' OF :CONSTRUCTION, COMPLIANCE FOR °SEWAGE DISPOSAL' SYSTEM /iy'T o Town or Village i' .'LOCated•.at j ��4 y✓ Fs TaxMap /�,.� -.Block / lqw Owner Subd t:ot q Separate Sewerage Systom but ((by !' _ 1SetetL_ . n '��f i� OaISeptiTank and y24, Conslsting'of i ` Other r"uiremen. a Water SuPPIY Public Supply From a * ! 5 k 4 Pr { vate`Supply- ;Drilled ey - ��"'","NS-'�U e r � —l` Address ;Building Typed Lo�,.�•G hlo.. of Bedrooms_ Date Permit Jawed' �^ Z, n r i :Has Erosion Control Been Completed? '.I certify that the apstem(s) bs;'liated serving the above „premises were,;conatructed esaenEially as,ehown on "p,plana.of' the completed work (' c6pies of which are`atEached) ,.;and in accordance with the standards rules and regulations in accordance with the filed, plan, and the permit issued by the `Putneni "- 'County` Department Of Health "y r i �' -'�'•� '`' i Certified bye P,E R A. Address f` %Lf . :.. r: _a Any person oecupying premises servid byr.the above system(!) shalf:promptly take such action as may tie neteatary to peeuro the.eorrectlon' of any' unsanitary conditions = resulting +from such usage ; 'Approval of tIt' separate ssweroge systsm'fhall beeome h611 nd'�void it !Dori as, a public sinitary'sewer• becomes available and the approval of, the. private'`water. supply 4.1 all become n and void when a pubik w supply becomes aval able. ' Such` approvals .are subject^ to modification' or charge when i the Judgment of the, C sio rot, "HSalth,. such r lion, modifiut {on or change Is necesNry,` 9 Date b r Rev 9 -81 J. 5 71 Q WELL COMPLETION. REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environowntel Halth 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 ,t no ADDRESS Q hL' J "7o LOCATION OF. WELL (No. a street) BHA) ims (Torn) - �50n (cot NumOer) 1-9 PROPOSED USE OF WELL MESTIC ❑ SUPPLY BUSINESS E] E ESTABLISHMENT ❑ INDUSTRIAL ❑ FARM AIR CONDITIONING ❑ TlST WILL . (-"-j OTHER LL_J.I (Specih) EOU p MENT D. ROTARY COMPRESSED ❑ AIR PERCUSSION PERCUSSION ❑ (Specify) CASINO DETAILS LENGTH (het) 3 0 DIAMZ11111neh•a) (/Q JWEIGHT'FER MOT / 01 THREADED ❑ WELDED DWI stur— ES NO ES NO YIELD TEST - AILED ❑ PUMPED ❑ COMPRESSED AIR HOURS G.► YIELD (G.P.M.) WATER Ulm MEASURE FROM LAND SURFACE –STATIC (Spdolty f•0,1 DURING YIELD TEST ! 41' 10 Depth of Cam Plow Weil. in feet below land wrfaoss / SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (feet) SLOT 1 IAMET nah•s) IF GRAVEL PACKED: Diamst•r of • including gravel pack (inches): GRA SIZE OM (lost) TO (lent) DE/TN FROM LANG SURFACE FORMATION DESCRIPTION Sketeh exact location two permanent of will with dlstsncN, to of least landmarks. FEET to FEET SO 1 Jb tie .. I t yA ✓�cqN' I 3 4� i -7 AZI C 1 If yield was tested'at different depths during drilling, list below FEET GALLONS R MINUTE 000/ DATE WELL CO PLET / ep G ATE OF REPORT WELL D RILLER (Sisgaturs) Nt y t :PUTNAM COUNTY_ DEPARTMENT OF HEALTH Ff _ �` t• Division of Environmental Healih Serviv� Carmel N: Y '10512 ,a CONSTRUCTION PERMIT. -:FOR' SEWAGE ,.DISPOSAL SYSTEM:: _ Town or village J{ Located -at /`fA4Y /LRNd _ .�� /�%:7�yJ� i`✓i[J� Tax MapQC/�•- Block ' t . Subdivision Lo t_/ Job s ®6Ownel� X-` ` %Z =%Z �,q i '- Bwlding Type �C�C N /lj,l Lot Area Number of Bedrooms Design ,Flow Total; Hab�ta.tile Space Square Feet %L10 �D separate Sewerage System. to consri�st of.:- Gal Septic Tank and T.o be constructed by. /[_AF_' r Address �� /flZS'ON'7 Water. Supply public Supply From r Private: Supply':to be drilled bY. ± `• ;Address`: ^Other Requirements' .' I represent that am wholly and completely, responsible for the design and location of ,ahe proposed system(s):; 1) that the.separate sewage. disposal, system: „ above ,described W'd be' constructed as shown on the.$pproved amenifinerit,th'ere "td and in accordance. with the standards, rules an regu a �ons•o e Putnam -County ;Department of : Health, . and that on completion thereof a' "Certiticbte of Construction Compliance. satisfactory .to. the Commissioner of Healthwill .: b'e submitted to the Department;:and a, "written.,guarantee` -will be: furnished the owner, hi ;:successors, heirs, or assigns by,the bullder, that said.builder will j place' in good operating, condition any 'part of .said sewage disposal ,system during the period of'two'(2),yearslimniediately following thedate ofthe issu- i,' , ance of the•approval. of the `Certificate. of Construction %Compliance of the origiri5l, system:or any repairs thereto; 2) that ,the drilled well described above l� Will be located as shown on'the approved plan and that said well will be installed in accord nce with the standards rules and.regula ons of the Putnam :county, bepartment of:�Health ' a' r k- ..Date ' /7RI• L / Si9ned' P:E.'' -..R A. Addre ss License No. APPROVED FOR'CONS.TRUCTION This approval expires one yearfrom, the date, issued ",unless it of the building has been undertaken and is revocable for cause orm'ay be amendetl or- modifiedwhen co sidered' necessary by the Com s over of Health :Any change or alteration of.construct_lon requires, a new permit Approved fo disposal of4dome c nit r,y a nd /or'. nv water -- ;* c Date By Title r w> Y c- Fzl��i �._._..�._.._ TEST PIT DATA REQUIRED TO BE suumiw& WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED.IN TEST HOLES --- - - DEPTH-- - - - -- HOLE NO.- HOLE NO . _ -- - - . - -- HOLE NO. G. L. 6" K ,D- 1211 M / i✓ /UM 374010f . rs.�J,¢c!- 1811 24" 3011 3611 /! 42" 448" 54 " 60" It 66" r i� 7211 ri r 781 8,4" INDICATE LEVEL AT WINCH GROUND WATER IS ENCOUNTERED D 4i*DWA� A INDICATE LEVEL TO WHICH WA LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE- BY-- C•��46&. . z: -�. _ _ .. ¢_. Dade — DESIGN Soil Rate Used 8 y.MirVl "Drop: S.D. Usable Area Provided /v No. of Bedrooms Septic Tank Capacity Gals.,,,,,,, ,OSo0✓?Y Absorption Area Provided ByL. F. x2�+" r -LI �� o�' "�� rent C, �9,L�osr lYiG r sa.�e ame Cigna ure 2 c s - , : Address 12 - vv f2 SEA# :. w '. fin•'. °• n, A THIS SPACE FOR USE BY .HEALTH DEPARTMNT ONLY: '! s�OrESS,ONP.'�,, Soil Rate Approved Sq. Ft /Cal. Checked by Date EIVr r,,I n Y F' 1884 PUTNA M COUNTY DEPT. OF HEALTH TEST PIT .DATAI,REQUIRED T61 BE SUBMITTED' WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES'.' -DEPTH - - -- 'HOLE- - --NO: 1 - - -- - - HOLE - NO...:. _..__. _._ __— HOLE -NO.-- -- G.L. a 12" iiS 24" 3011 36" 4211 48" 5411 60" 70P "5all- -7op ��Cc . S1�r,� �rDiUM 37v�f ��cc4i�oiu S7oi✓fa' u . It A 66" ► ► �� 72" 7811 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATU LEVEL:RISES AFTER BEING ENCOUNTERED - ..__.... __ TESTS 'ME-.By fL.�e4L ZZMAeL.__..__.. _.__._. -..._ _._._ _ Date T Soil Rate Used 8y MWl "Drop:. DES IG N. S.D. Usable Area Provided 56(:�O 4& JA/ No. of Bedrooms Septic Tank. Capacity.--/606.. Gals. Type A,4SGv✓� Absorption Area ,.Provided . By_��L. F. x24" i!' ��1. " I t ' trench. name signature = '7 4C r Address _ W ,OCAL SEA z:• ��( ;� to • acr k� • � N ti a • v • � • /I r W • THIS SPACE FOR USE BY HEALTH DEPARTPENT ONLY: ,!!'•�0,FESS'ONP00 Soil Rate Approved Sq. Ft /Cal. •Checked.by Late 1' DEPTH G.L. 6 ►� 12" 1811 2411 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE N0. - -- - - - TIME NO. HOLE NO. M SAi,q t e. X / X 37b6ef L'kIFDlof S76YAe I/ 3011 �� p 3611 4211 48" 5411 �f '• 60" '' 6611 ► f n 7211 �f _ r. 7811 8411 / f INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WA� LEVEL RISES AFTER BEING ENCOUNTERED - - - - -- - - -- -TESTS -MADE - BY . C- �1�9e.�....- �� ht DESIGN Soif'AR to :Used 8 y Mtn/1 "Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity Q Gals. Ty Absorption Area Provided By �$� L. F. x24 r .�'' "��{ C/ A/ L D C eeeee.ee. e Name, Signature Address - vV f/L SEAS,! . ►- �,yt THIS SPACE FOR USE BY HEALTH DEPARTMT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Type '•.��oESS 13 SOw/d trench.' F Date TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE 'NO: - - - -MOLE -NO . ' HOLE 'NO-.-- --�- -- G.L. 6" 75P 7�op ,G ,� 5,9e,0 l oAr� 1,< 18" 2411 �� 3O it 361 v �, 42" 48" 5411 60" 66" 7211 r, p 78 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED �D7E TESTS -: Mp.D.BY...L°, ��7a IICH T LEVEL RISES AFTER BEING ENCOUNTERED A INDICATE LEVEL TO,Wj WA �...u.. - -- Soil -Rate Used 8 y Min/1 "Drop: DESIGN S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity Gals. Type Absorption Area Prov ded By L. F. x24" r ��' " " "' 7L o Name igna Address E ei : .. THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. ' Checked by � � A. ,.Fr.w• •• Yo ,!•. ,,,0PESS' ass �9Sow2 trench. .r Late RECEIV p., Ay (; 1984 • PUTNAM �,OUNTY DEPT. OF HEALTH TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH. HO!2--NO-.- HOLE NO`_._ HOLE- -NO. G.L. 611 71-9 -5, 9 / Z M3/9H0 1211 -dim 4'? Z S76k.07 1811 2411 3011 3611 PO 4211 4811 5411. 6011 66" 7211 7811 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED* vv INDICATE LEVEL TO WHICH WATF RISES AFTER BEING ENCOUNTERED �w ,,R LEVEL TESTS -MADE---BY --.Date So'il'hate Used Min/1"Drop: DESIGN S.D. Usable Area Provided No. of Bedrooms Septic Tank CApacity. Z4=.. Gals. ,Type Af,0.10*12-1 Absorption Area Provided By_lt=� F. x24 trench. V. r Name Signature ♦ � * f Address 12";2 t 6g, ca y VS /L SEA ni THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Sdil Rate Approved Sq. Ft/Gal. Checked by Date Sul RECENEU y '984 PUTNAM COUNTY DEPT. OF HEALTH i DEPTH G.L. 6" 12" 18" 24" 3011 3G 422211 11 48" 5411 60" 66" 7211 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS.:ENCOUNTERED IN TEST HOLES HOLE . NO. _ .1 _ _. HOLE-. NO ..`• - HOLE NO. mop c�;,G 1 o,o,-n .'BALL' kIt60) 1g' 57dYOJ n r 7811 ► „ 8411 , INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED �D Z..- INDICATE LEVEL TO WHICH WAT LEVEL RISES AFTER BEING ENCOUNTERED . � TESTS MADE -�Y- � 8 -.. h!- .. __._ _._. _. __- . Date- ..- •..- 9�� I -e -- /W¢-.- DESIGN Soil'Rate Used 8 y Mi iffDrop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacit Q Gals. Absorption Area Provided By �L.F.x24" r -L! `�_ •••`1111e — ;-i 1 V ame igna ure , � e s ; Address �� - _yv A2 SEAS a pe ,osc*2 trenc . r THIS SPACE FOR USE 'BY HEALTH DEPARTMENT. ONLY: ��'••;�fESS�Dy ;.•`, Soil Rate Approved Sq. R /Cal. Checked..by Date r 1 / 1 I L' tV b QL I I• f I I_ I' � / I 1 t 1 'I , , : L : • , -- I� I 1 1 y 1 1 1 �%a$%djl..�fJ•. _. 2/�l rr` ��..�i f,:�,17'.Jr/!*�/"'"'� ! .. ' I 1 ! , � . , f 0 �'