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HomeMy WebLinkAbout1108DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.55 -1 -7 BOX 11 rum ": 1 t �; IN in IN � } - �' I i' �` T IIN IN. 01108 1 r r 1 MUNvL iL �k �xOx „. .-u+ �`� ,� •`k CO .TY ;DEPARTMENT F'-HEA�LT11 e� _ 1> • - . ;. ;Divi�JOn of Environmental Health Services Carm N Y� 0512 , s CERTIFFCATE OF CONSTR'UCTtQtV CONIPLIAN'CE, F,O,R tSEWAGEDISPOSA 'L,.Si!STEMllIOTCJ`, ' r �'�r -�' �; t , :Town or�u111a s a Located ;at Section �� lock Owner Lot,-., O ii 7. e _ Job` Separate'Sewerage System built, `by Address i r.? Consisting of Gal; Septic Tank /v lineal Feett X e�V width trench .. .. 4 -i. Other requirements Water:Supply. Pubhc,'SuPPIy''Fro n 1.:. Private ;SuPPIy_ Drille ^ By dd ress~ s B uildingType No of Bedrooms'' 'Date Permit Issued HasE" rosion Control Bee Complete 7 _ N ,�tllltlllJ,J '� r : }i j; � `���. '� • :i; `Y y iii ,.;. ` ': u. • - I certify ,that the systems) as listetl serving the above prem4ses were constructed ✓plans of he completed work'(copies "of which -are .4. ttaced); and . in -accordance with the standards rules and = regulations plans fi Pie pe ^rmi�A Putnam. County `Department,oi Health.'. 'Data ` Certified b Add f fis f r r , e ressr � license Any person occupying piemises servetl by the above systems) shall "✓promptly tIk�.;u "ion ar, f e Q�ce. nary to secure the correction. of any unsanitary - conditions resulting from such :usage: Appro3al" of the °separate sewerage�..systema ip�``````�il void as.soon as 'a.,public sanitary sewer becomes . available .and the approval of, the:private water supply shall become null and void wh�Nq'" 1iJater supply1 becomes; ,available. Such' a prove ls,Care ; subject to mo ' 'cation or change {whe - "inzthe judgment of th :, C,Qmrniss�oner rot Ith suc1h revocation, modification or change,; is necessary, i h li Date Title. f4_ _ ��._�� _ _._ _•<.s , _� _ _.._.�.�_ l _ ,__,., , . t. _._ _ _ _ _ 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. and submittedto 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 ADDRESS yH-• LOCATION OF WELL 6 Street (Town) (Lot Number) e "' t b° S 0 ri PROPOSED USE OF WELL BUSINESS DOMEST C ❑ ESTABLISHMENT ❑FARM ❑TEST WELL SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (spHEB ❑ ) DRILLING EQUIPMENT 1.4y COMPRESSED, CABLE ROTARY ❑..A R PERCUSSION ❑ PERCUSSION ❑ (S(Specify) CASING DETAILS LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT % 7 THREADED ❑ WELDED Lztm 0 ❑ NO Li SIN YES NO YIELD TEST ❑ BAILED ❑ PUMPED HOURS G.P.M. COMPRESSED AIR YIELD (G.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) �— P;7 C b DURING YIELD TEST fleet) G Depth of Completed Well in feet below Land surface: 6 SCREEN MAKE LENGTH OPEN TO Ap FER (feet)' DETAILS SLOT SIZE DIAMETER (inches) PACKED: gravel pack (inches): EL SIZE (Inches) FROM (toot) TO ( lest) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET I If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE �j TE W LL COMPLETED DATE OF REPOR �i WELL DRILLER (Signature) tir® d: BREWSTER LABORATORIES Box 224 - BREWSTER, N. Y. WATER ANALYSIS 'REPORT SAMPLE NO. .3255' SOURCE: Emma Spaulding - faucet - well supply Troy Place COLLECTED: August 11, 1974 BY: Edward Savoy BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 0 per 100 m1. Total Count, MF method 32 per ml, Detergent 0 ppm Nitrate Nitrogen 105 " Ammonium Nitrogen 0 Chloride 45 Iron 0 Hardness 8 gpg ph 701 This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. August 17, 1974 I �,:n� % or 1Lrchase., of build:i.lib �yyM.rYj "J •d.�t?.dFfL� i'�•.yJ`y'.J � __-Zdf�i%;i _ -. uilcling Constru "ted by 61'oTl �"C' location - Street - 3uilding Type I .......... - .............. Mu>>acS.�,�,l:i ly . Section Block Lot GUARANTY OP SEPARATE S0,7AGE SYSTEM I represent that I am wholly and completely responsible for the location, iorkmanship, material, construction and .drainage of the sewage disposal system , >erving the above described property, and that it has been 'constructed as sho,,m on :he approved plan or approved amendment thereto, and in accordance with. the standards ,ales and regulations of the Putnam County. Department of Health, and hereby guaranty :o the owner, his successors., heirs.or assigns, to place in good op�r�:tino condition my part of said system constructed by me cahich fails to operate for a period of .t:o ,ears immediately following the date of initial use of the sewage disposal system, or Lny.repairs made. by me. to such system, except cohere the failure to operate properly ('au: (_-6 .ijv 'llle wil.i iul Ul' 71E'j 1 L�tii i ac. L iii ehe Oli:i.ij.,nii a. vi L.,,i; ,.U.� 1...11 , • The undersigned further agrees to accept as conclusive the determination if the Director . of the Division of Environmental Health Services of the Putnam County )apartment, o-f Htalth° as--to-whether -or not the failure. of- the- system. to. operate was ,aused by the willful or negligent act of the occupant of the building utilizing the system. >ated this_ day o 1 Signature Title corporation, give nand addres.l 'HREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS' BEI'ORE CERTIFICATE )F COMPLETION WILL BE ISSUED. ;UAizA\' '.TOR IS RF.OUIP.I,D TO. FILE NOTICE OF DATE OF FIRST USE OF-SYSTEM. _______-- _...._..- __..______.._-- -_ - - -- -- ---- --- - - - - -- --------- ------ _- - -_ - -- )ivision of Environmental Health Services, Putnam. County Department of Health 1\ t r _��'D PUTNAWCOUNTY " Division of E nvirofiMenMl HA tttGGG AUCTONd","PEAMIT. -FOR. SEWAGE ,DISPOSAL .�-SYSYE at -, ovo e n, �,:Sub6lvlsio Area_ rF3uilding. Type .' fi Lot M 4er of Beorqo.T,s, x .Separate sewer age System to consist of %SO -6, constructed - -,�I-To.,b .,,by 7' Water upoly.,. From',' If -Oiivatii �Supply . to be -drilled't Acldirdss'- -Other -ReqUir6merits! L 4 v., vrdpreseni- at I -am,�.woolly, and completely �responsible for the'design - above, I deschbed -Wil 1,6e constructed as shown'on'the approved j + County, Department Hof AHo liii-`,incitfik'�o I t i tie n, corn r p e ion the Cl -submitted to-the.Depai ment;, an a vViitten'gbarantee „place in good,.operat;ng -,sk,d.,t wage d tion,,any.'part,�of", I .,. f i' , _t" ' of the approval . o he 'Cer iWic'ate oftiConstr6itlon co d- r,. �Ws e.. ocated. is: Sh Ci&V h',o h I he:ap prove plain and ,that _.'said ';We -1-Co6riti,� bepartrin' ent', o"if" 11'4alih.41 - Address " o� APPROVE CTI ON: j Ci FO'k �66NST lilb appr f or, cause - or � '16e'�amended '' "inod J-6ay. - 'or. 646iiei new perf'rr`k�.� 'Approved - i6i. disposal ri '.`iA - a] El y '*6 fUrni ;pRsa �1� g sy I iaincb- '91 ili'b6-Inst �.P,-A,RTM,EN'T,,-',IjF,*,.,'iik�kLT,I4 'PS,&-vicis, CqnWel, N. K-'_166 12 67 P Town or Vinage. 7 Section e6t on Block. xr Lot Job Address 6. —1r. Total Habitable 'AIC 6 Squl re'Feet ., S )ilc-i eg Tank'* _Wlclth 'trench , oca tio - ri 6f ..-t he. proposed system(s);-I) -that.,the separate sewage disposal system j i ib'ii3',to;,arid ,'-Ih'ac6drdance with e,�s an iard. �61"es= 1-utnarn th "t d 's.,r. an regulations of , the cate`. _6 Construction , omp ancel.,"saitlif6ctori t6*ihe.Cc;mthiisioner of Healthwill fied the !owner ,his !sucjdessorsi.h'e'lrs,qr,,4ssigns,py�thp builder, that sild'b411der will em �urlrig 6 � 9 � . qL, ., the:.porkid iif' two ,(2) `Y`eari Imrhedla t ely,folk?'wing thaidate of the ,. , ; . ' ' Issu t�e.orlgna I sy it e m qrany,repaI s ihereto; 2). that thedrillid well above,,; '6 rules an,�rec.,, 0 utnam 1� Z_d i7u-I4rq_nsVqf icth P Licen ie No ''the daY i ss66/unless constru dt ion of the':bijMlrij`Kiibe6 undertaken an Commis er U Wth._ArwchanO or alteration . of construction priva supply Only.' Title a' 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 AddressS Located at ( Street Sec. Block Lot 4dicate neares cross s ree Municipality, , 1'?- 17 - T.�'SQ AL/ Watershed Ax y.G SOIL PERCOLATION TEST DATA REQUIRED T.O BE SUBMITTED WITH APPLICATIONS 2 3 3 4 W, Notes: 1) Te'gts to 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. Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse No. Time Start - .Stop Min. Deptti to Water From Ground Start Inches Surface Stop Inches Water v-e in Inches Drop in Inches Soil Rate Min. /in drop 2 �: o /�5 /t.? /� 3 /� 33 -'16 5 J 4/4L / �¢ 11.3 2 3 3 4 W, Notes: 1) Te'gts to 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. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF' SOILS ENCOUNTERED IN TEST HOLES" DEPTH HOLE NO. :` HOLE NO. HOLE NO. - G.L. 6" 12" 18" 2411 3011 3611 42 48" 5411 60" 66" 7211 78'► 8411 ..INDICATE. LEVEL .AT WHICH- GROUND WATER IS ENCOUNTERED X/��✓ - -- - INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY G.A /A Date DESIGN Soil Rate Used / / /e5 Mi Vl "Drop: S.D. Usable Area Provided No. of Bedrooms' Septic Tank Capacity Gals. Type Absorption Area Pro ded By %s-�z L.F. x24" 36" width trench. Other Name Signature Address SEAS THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: P� 6411 Soil Rate Approved Sq. Ft /Cal. Checked by Ptt�FeftEQE�L` ��y Ante o �T' EtLS y 1' `{_4' 75 T \lo ISO Gallor.l 5 �-i(: jA4 R AUG 2 F j '!"''��tV �•tiX��N� "`( iYY OE HEALTH i"' gq DIVISION OF ENVARINUM l4ow" Smog f O F U L - oQG� E A 5Na. L LA PATT fv uT i.. R t L :• tip" � t rri�''? � l _ � : !�i �' � _ ,f �' -- - - _ - - - -' '� '` ' � - . O r /�% "'�. i. 't...._- � / fJr j �! �� � J/' ! 'V � W � —7 _ .. � i _ _ _ _ _ --. �s �•a'i"�'1 � � y'/ r j 2.`6/'/,��4.tr -:`• ..fs J" /LG"�. �1 /i4i �L.../,7 { .L. 1 \ rt F j lam✓ oT •7F .ft1 f t - - ' Z 771c F44D c � /SJ�.f l jQ BtS,%,t��%•?=Z/t'�.!} 4tfL7 hfi'D.G'Grr"`L' 6`I"" j F - ' APPROVEG 44 �72 MAR 15 A ` NULTH Sam= to ENVI - r'