HomeMy WebLinkAbout0852DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
25. -1 -15
BOX 9
ti
i
i.
�.
ly
.
i'6
00852
i.
�.
ly
.
00852
o y }
PUTNA-M `COLD
- Divis ion ;of Environm�
,CERTIFICAT F `,'dONSt vC T[ N4 COMPLIANCE F
t
t { fJ 400
A Located "at
'owner VIV AL'O ;,O C—. i �`L�. • ,
_ p h
•Separate Sewerage System built fby �pi4 QJe
� Consisting of Gal �SepticeTank ,'t
s _v
,
` 'Ott her requirements:- '
Water supply. Public "Supply. From
�Privatet5uPP1Y'Drilled,:By -1
j J �Addre "ss
f Building' TYPe
R
Has Erosion Control Been Completed
I ti
jt certify that the,system(s) as listed serving the above premises wel
(attached] and in accordance' with%t6e standards, rules and regul
-N
• C./ / L r ;
• ,Date
Address
Any poison occupying premises served;by ` t h' t
e above system(s)sF
(conditions resulting ;from' such` usage:'; Flpproval of :the sepaa.
_ 1 E
tavailable and the approvaC of the`. priJate +'watersupply, shall beci
z: -
.,subject to mod ificatlon! or ch5nge when; in the judgrnent of =1
4
t �y
Dated
v.
DEPARTMENT'
S"
'!ealrh Services, Cai
F
SWAGE DISPOSAI
- ✓r v'31 c
S
-' Secti
yq
T �l
Lot
�I.�f;.• 43 �h Addr
�,No of Bedrooms —
rutted essentiallyms!h
plans' filed Wand the pe
'y r
a
byCa.. �x
nptly take -,such action
rage syit -W shall b`ecoi
Band void when a...pt,
rimisswner 'of Health,
Sir- �= ,. �°, r. �•, s. . alb'_.
n
� 5
SYSTEM
T n_- SO
�3 or Village
>n 8 Block f
f r� 10 �1.-• �'' ss :lop; S1 �%- .� �'.SO E
355
Feet X o * 3 = =' ,width trench:';
,
•Date Permit Issued
awn on the`. ``I ns ofsthe`eom pleted:woik o ies ofwHi 6,'are',
^'
mit` •'�B
:issued :,b .the tnamr Cou �t ' De "artmentof`•Health
..n ,Y. n Y P
as may be necessaryto, cure the correction of .any unsanitary
ne null and voitl as,soon as a `public sanitary sewer becomes - •�
blic water supply becomes available:''' •S uch'•,a'pppyals.•are
uch revocation mod rfication or chanje. is" necessary
11
. 1.
0vner. or Poircha.ser of bu .lding
`T •
Building Constructed by
—m s TD m6; 4/ /l
Location,- Street
Building Type
Municipality
Section
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 fle \.%standards,
rules and regulations of the Putnam Comity .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
The undersigned further agrees to'accept as conclusive the determination
of the. Director of the Division of Environmental Health Services. of the ".:Pdtfiam County
Department of Health as to whether or not the failure of the system;to,operafe was
caused by the willful` or negligent:. act of the occupant_ of the_.Uu_ ildi_ng utilizing the.
system.
Dated this S day of 19�?b Signature
Title
(if 4orporation, 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
7—
SALES
MA' T Z. P�&STONf-- ROAD J�� �tc�:. S•j � %0
D ��TIL'
20
TOW
�Ap P�VT 4,'AAA, CO,j
L
CIE
44
goo 04Z
S.Eprl c
rARle
56
ih Z
so
ro PR • OVED't
Ao
A U G 171973
F R'. PUTNAM -CoUtill
HEALTH
.............
Lgou' T>(spos 4L 'Sysu-m
VIRONM
NTA
P,
WER T. 1 2 4•
R
35'
75 0
44'
_� .�4-� T��TA , 00 4 TA,�SV,
Zfi el
V
o
ll -5sto/v
A
ley
llvwT
RAI$
AIA
LLy '3
'00 L &A �LS
P. L
L C
WELL COMPLETION REPORT
3/71
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 anil 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
Ronald Scofield
ADDRESS
Patterson
LOCATION
OF WEU
(No. 6 Street) (Town) (Lot Number)
g imestone Hill .Rd Patterson N.Y.
PROPOSED
USE OF
WELL
BUSINESS
DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
1:1 SUPP Y El INDUSTRIAL ❑ CONDITIONING ❑ (S(Specify)
DRILLING
EQUIPMENT
COMPRESSED CABLE
ROTARY ❑ AIR PERCUSSION El P PERCUSSION ❑ ((SSpe ify)
CASING
DETAILS
LENGTH (feet)
26
DIAMETER (inches)
6
WEIGHT PER FOOT
19 0
® THREADED ❑ WELDED
VESHOE
YES ❑ NO
WAS
CASING
YES
NO
YIELD
TEST
HORS �' G.P.M.
❑ BAILED El PUMPED' COMPRESSED AIR
YIELD (G.P.M.)
WATER
LEVEL
MEASURE FROM LAND SURFACE— STATIC(Spec /fy feet)
26
DURING YIELD TEST (feet)
500.
Depth of Completed Well
in feet below land surface: 600
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
600
Ronk,hard granite.-
a .
weI'rt�.x as, f°F
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL COMPLETED
;ce 3
DATE OF REPORT
7 a/ i 3
WELL DRILLER (Signature)
WATER ANALYSIS REPORT
SAMPLE No. 29 9 7
SOURCE: Ronald Scofield - faucet - well supply
Brimstone Hill Road
Putnam Lake, N.Y.
COLLECTED:
BY:Frank Carroll Well Drilling, Inc.
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
0 per 100 ml.
This result
indicates the
source of
the sample was
of satisfactory sanitary
quality when
the sample
was collected.
July 19, 1973
Roy ickwit P. E.
Director
wn or.y,moge
ldck,
C4"
TTUUYT.-��f
A,
width" trench
jI
ippsai 'SYS
d "buildei` will .'
scribed above ;I
n,,"6 is-
construction' "
AM;
it
Q?v Corti
man
a W
i;93
540 OW My
, Mo.
=- rl\
Sal
All
i�k'*,• _ T1 �� , ,��� ,1 � i.�., • �( .�.1.- I!� � �f� -��„�� „r, '�, '1• 1 . ,, `i ` ��. ���(%,Y r ;5�f �r�•,� '� NaW i \ ,\ •�vavkpptt '}`•�'' `;,
1 �1R
7
4-P
84 -T Sol
- _v'.-
1 Owl �";
--i- D*L Al
'tA
spa --p- MI), i"I�j
IA
.�rz, i ,��„�,� ' fld r• "tli ,..5}��„ M` ..•C "}l tW'� #�F� ' -.i I•� 1, . . i. I : 1 • �.„ ' • '�aW .du. ,� !/�,�'.'a+.. -rc 1 1
910) 17i,
A;
'CI
A 1:
oil 401, 1
ei* W OCR
ig.
M'w
Of
Mg
�tn
MIN,
YA,
. . . . . . . . . .
r
i
.r
'.i
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. S '12- Se- SS O
Owner f d1 ALO r e_o'F jj LD Address 11q to2SE c4tS i Pdul VgAo
Located at (Street gD.sec. if Block Lot (0
� mica e neares cross street)
Municipalityi41 i �fS O 1J Watersheds o
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME
PERCOLATION
PERCOLATION
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
3� a.43
1C;
2 1.7:43 1.14J
6
1 Y111t
6oil
3 P S 1 X S3
�
t�
1�
1
� °� ►
1 '
2
3
4
5
2
3
4
5
Notes: 1) Tegts to be repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole. All data to e submitted
for review.
2) Depth measurements to be made from top of hole.
TEST_PI.T DATA REQUIRED TO BE SUBMITTED.WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST'HOLES
0
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Cal. Chec
3c6c3qjb ,o /r
Date
1-
DEPTH HOLE NO.
HOLE NO.'
HOLE N0.
G.L. �P
611 'so) L,
1211
1 1811
2411
3011
3611
4211.
481.1
5411
6011 G
6611
72"
78" d9
8411 OV
._ .._ :.------° INDICATE -LEVEL AT WHICH
GROUND WATER- IS ENCOUNTERED`"
INDICATE LEVEL TO WHICH
WATER LEVEL RISES AFTER BEING ENCOUNTERED
;:TESTS MADE BY _
'r Lt -r 5 G 4 Date
Soil Rate Used j (- LCMin/l "Drop: DESIGN S.D Usable Area
Provided
No'. of Bedrooms 3
Septic Tank Capacity 900 Gals.
Type
M kS
Absorption Area 'Provided
By SO 11 L.F.x24 36"— �
width.trenc .
o d- 4,0
Other.
C2,
o C cuo �vC _
game VW t,-.� U
Y=RAA;&A i ure E �,
Address 3
n
0
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Cal. Chec
3c6c3qjb ,o /r
Date
1-
VIN
IAMS MIM-WIMMAN3
40 Nolswd4u�
tit ny
'Al"no Kulf)4
twiti
?L6L Z 9AV--
r.
:6A
AQ
'it, wj.�a "Ali
I-A
Vt
15 nwi x V-A V'r, t4IW� Rn -ML
Kf
7
V,
pq
43 004 11 VH 5.
WA
41 ja ;do -7
7� r
vd:� AIN
ijav* rq! Al IPF
ri .49 t�l
2� 4,
:F4i5ZYTq6 NW
5N -j 45
WA Krim; *AfXl
f1h
------ 774.-
to A
44vi L, hs
Or,$ I lIff
P)
ti
ftOhl
NV N
Xtm a A0.
j-r- 7-
-TO