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HomeMy WebLinkAbout1178DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.62 -1 -21 BOX 12 All i im we V.-4. 16 P'l }. E , }% 01178 4+ PUTNAM COUNTY( DEPA 1 L Environmente/ Hela /th CERTIFICATE OF ,CONSTR.UCTION COMPLIANCE FOR .SEWAGE ~Located at e7J� t/�'%Z/Z/)fd�eii8 y w Owner Separate Sewerage System built iby J��l'/ �/'22'rd_�/Lrit/ Consisting of o Qa ptic:Tank and Other ►eQu(remerits i� -Water," Supply Public Supply' from Private Sup,Diy. T lled ;ay as., Building Type Has Erosion Control Been iCompletedtr yy i certify that the system(:) a6;liated serving the above premises were ;cons of which are - attached)`;; and in "accordance with;;the standards rules and re Putnam County DeparLaent Of Health �; t )x + }� s • 1 r -�a Y d' 7 " tw '- Date " , � �'�,.LtwCertifietl by .t� Address Any person occupying premises served by the above systems) shall'promgtly to cond(tlons .resuliing' from such, usage.:' Approvah.of 'the 'separate'sewerageay , ;available and the approval of the *private water supply shall become null:and i v subject to, modifi cat lon;.or change when, fn the` - Judgment of the'Commissio ,(� '• � f S X72 � T N Date n r ti r ' { tirti c BY s c S RTME , OF .HEALTH Services, Calm% N Y 10512 Pe i x' 'DISPOSAL SYSTEMi %T/'2�'a`/ Town 'or Village ' �tTaMap r .• /� / `� l Block Tax: Map Lot N S, bd Lot p TBedrooms ._,— Date Permit Issuetls tructed easentially'as shown bo the.plafi of the completed work ( copies j gulationa °i'n';acco=dance_ with the filed plan, and .the;•permit_ issued by the t J� ; elo 'L can" Nod i - ,L Y/C�� . /p ke such . action as may be heLe6Klry t6 secure the correction of any ununitary,' stem4hall'become-eufl and; void as soon'as a�vubllc.sanitary sewrer becomes oid ;whe�,•a• putilic' water 'suppI becomes available. Such ;approvals are ner of Health,. wch rev ion;: modification or change is necessary. !Title a ,I w tipv � ,G! •Y. � ' '` i F. SAMPLE NO. SOURCE: Bon 224 - BIRIEWSTEIR, N.V. (99 4) 225 -2072 6070 Nick Grazioli Patterson COLLECTED: February 17, 1986 BY: P. F. Beal & •Sons, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method Hose Bibb'- 14ell 0 per 100 ml. This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. February 20, 1986 Y ickwit P.E. Director i • 1' .L Owner or Purchaser of Building ,� z.10 L1,4- Building Constru__c�t_ed by C'�q�vM C'021,1152 49 16-1_5517OR' �iz1vr ° l2a6 o Location Street Building Type Municipals y 94 Section i Bloc 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 day of =fer 19JP1C� 'Signature Title j (If corporation, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF PINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF; DATE OF FIRST USE OF SYSTEM. i Division of Environmental Health Services, Putnam County Department of Health 1 � QUELL COMPLETION! REPORT 3/71 PUTNIAM 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 Nicholas,Gra.z_.ioli ADDRESS Box 36, Chappaqua, NY 10514 LOCATION OF WELL (No. & Street) (Town) (Lot Number) Barnard & Lakeport, Patterson, NY PROPOSED USE OF WELL rV1 BUSINESS DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑TEST WELL ❑ SUPPLY El INDUSTRIAL ❑ CONDITIONING ❑ ((SSpeciiy ) DRILLING EQUIPMENT ROTARY � e AIR PERCUSSION ❑ PERCUSSION ❑ (specify) CASING DETAILS LENGTH (feet) 44 DIAMETER (inches) 6 WEIGHT PER FOOT lg ® THREADED ® WELDED DRIVE SHOE 5d YES 0 N CASING YES NO YIELD TEST HOURS G.P.M. ❑ BAILED � PUMPED ❑ COMPRESSED AIR 6 8 YIELD (G.P.M.) 8 WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specifyfeet) overflowing DURING YIELD TEST jfeet) Depth of Completed Well in feet below Land surface: 1/31/86 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 (lee,) 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 20 Drilling in overburden clay and boulders Hit rock at 20 feet 2 0 Drilling in rock,set 281; —casing.grouted, k-rilling in Pock granite. If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WEL 486LETED 1/31 DL7�� F gg'ORT WELL DRILLER (Signature Lam' 1 N 05 °55'/O "W' 95.00' 7702 d 29. a' ;RO 7701. 1 COMrele 610c*l is i 7700 76' 9,9 . 71:z � o 707C 98 Q o E> '05 °55'10 "E 95.00, ' _... t ' 7697 76'96 � j F 1 T r IPA T'd NAM ���JRI'd SY �D /vaion of Environmental �orvsTUar,00� � RMo� ®�� -Located at- +rZ�6,�7,�%z,� f 5 - - Subdigision = OWner Building Type 1. °,L.:� `� /i✓� jLOt Area: N mber -of Bedrooms Design Flow Separate' Sewerage System to consist aof To be constructed by k Y Watei SU'p ter, �� Public Supply From hvate ,Supply 6:b­ drilled w '- Address Other Requirements * Y 3 r l; represent that l am wholly and completely responsible for fhe desig'9�; t. aoove'descnbed will be constructed; as shown on the�approved amendme county Department of `-Health, and. hat'on completion Ahereof a 'Ce be:.submitied to -the--Department'rvantl a- written. guarantee will be `ft place. in good operating ;condition any ;part of said jsewage disposal ante of -. the approval of,`. -the Certif{cate�of Coristructwn Compliance 6. Will be located ass_"n on., the approvetl plan and that said well will be 1 County Department of Health`„ tl r r z Address °� APPROVED FOR CONST:RUCT1O. tiThis approval expires' one year f revocable, for-, cause or may be amended od modified =when tonsidered:n n requires'a new permit Approved for disposal of,domesti ca { y -Date'x BY, J.[r -7 l h Serlrces, rmel lN. Y 705Y2 M Town or i lage 4 Tax _Map f�P :.' Block = k Address r Total Habitable Space Square Feet Septic Tank and %° # - Address :® } .. r, w , location ofiA proposed system(s); 1) that the separate LseWLage- disposal system. .:...... here to and?,in accordanceTwith the standards; rules'an -regulations of e'.Pu nam < j {cafe of Construction Compliance ,satisfactory to tKe'Commissioner of Healthwill` + w, shed the',owner his successors, heirs•or.assigns by the.builder, that said builder will stem during. the period of, two (2) years immediately,foilowing.thed'ate of the issu- 't11e original system_or any, epaus:theret6; 2j that tf e'drhled well descr.iDed above ailed in accordance •with'Ahe standards rules and regulations of. the -Putnam, „. License n the date ;issued- un nstruction of the. building "has; been undertaken +"and is i ;so y by the Co isswne 'of Health Any'change'.or on:oi� construction 4D d /or phv >•e wat itC- ei►tp ---- F' Y SA MIT, FOR TION, PEA ,SEWAGE: DISPO, or village nn Type C' Notification R.enii� 7:tb co S­ Gal. Septic Tank and a:c-cor'd'a'n*F'9':'rpit�'thd-itandards, rules and regulat ons of ',the Putnam �Funeity' tie" Oved:,p Mons-7 ,ij4.,County Department- of- Healtti�., Address License -6ildlhg has'b6en*,,undirtaken and s-: RU 6 T approval :eXp ire r -the 4 is:sued Mass construction of the'b orh -;revocable for� b -anien'ded oi.*,iiiodified when' Cor, i'dere . d loner of Health.' I 'Any OeL, niiiuctlor' cause.pr may eL, necessary by !the o Witera on o co ri Tit v 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. Owne r d6 j <-/_,= Address �.p- Cd/2��✓✓��i0�' s0 /L7 41 ?76 ,�02 Located at ( Street Kaicate J�9i1��.g2D ,0 Sec. Z92- Block Lot neares cross street) Municipalit 7,,y4!-,7 Watershed O W^/ SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION apse Depth to Water Va E er ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 2 IJ7 .2/0 ;2 3 2, /U r 4 5 ? :2- z 4 5 1 2 3 4 5 Notes: 1) Tests 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. Address . 4 SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION Soil DESCRIPTION OF SOUL ENCOUNTERED IN TEST HOLES Sq. Ft /Cal. -NO. G.L.,a 6" 12" 18" r 301 36" 48" 54" 6o" = 1 � �• 541�112 y 7211- ,r 7 8" 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WATER LEV RISES AFTER BEING ENCOUNTERED ..TESTS ..MADE..By...... �� D,S, u!�4jz6y Date � DESIGN' Soil Rate Used MirVl "Drop: S.D. Usable Area Provided Qi No. of Bedrooms: Tank Capacity /66 0 Gals. Type _Septic Absorption Area Prov ded.By width rent Other aC� �.�•�' r " E j��am Signature ure / . Address . 4 SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: i Soil Rate Approved Sq. Ft /Cal. Checked by Date ••`G of NEW `% y : p• 'F . '•N•cQ !. °• 0126:•• b�.� Mu r� :-'ar: r 4 ' r I II I' .. .... .♦.. .. - .� ♦. air.. ....♦. �.... •.' ... .,. ••• .... �. w.. •... .. ..♦ .. •.. •.... ..,.. ...,.. r . 1 ,�4 Q