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HomeMy WebLinkAbout1258DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.65 -1 -2 BOX 12 I- -NJ r I xi qr.- L. ' 01258 ' �Y GGGIVV PUTN ,COUNTY DEPt AM ITMFVT 'OF vHEALTH e. I iwsion :of Environmental Health r ices Earmel N Y. ' :10512 G v ' CERTI�I69�TE .O - tONSTR!lCTION C011APL1'A'N E POR'3EYdACI== ''D,ISPOSAL SYSTEM r ilia — '`, �f. e Located at 6: "1 o nco V�gFW 14"', :. rB lock w Section t Owner': 1 Lot C] z�9 Joti S I'Z SSO'l _ t_ Separate Sewera e S stem buiittiby 9 Y Y Address u Consisting 4of �_+ Gal Septic Tank lineal Feet X width trench 9. ° I"Oth&, req.`Uirementsf` v Water supply Publ {c ISuppry From :, t Private�SuPPlyi Drilled ° BY A 1 Address �� s 1 . r Building TypeNo of Bedrooms T ry -' Date Permit $ Issued _Has Erosion Controi Been Completed? Ll ` 4:a I certify thatAhe3ystem(s) as listedaserving the „above premises were constructed'esser Bally as shown,on,,,the..plans of.;tfie.completed work co les of:which are -� .. ..,c P., , .'attached) }anil "in accordance with the' standards; rulestandlregulations Mplans filed ;;an h ermit .issued.`'bY the utnam - COU:'Wo epar,finent of Health., Date ertrfled by^ E. R A•. 4 #1 s w } Adiiress } a : I }cehs No 1 ;Any poison` occupying:wpremise5served by the above systein.(s) shall�prompfly take'such action as may be necessaryto�. ur the correction'of any unsanitary. 'conditions resulting from such - usage. :'Approval of the ,separefe: sewerage systerri shall ;:Deconie null and`void asisoon a a public •sanitary _sewer becomes available and the approval of'the ` privatewater- supply shall become null and void,,Wlien -a 'public ;water supply becomes-� available. Such ,approvals are . u sub)ee .;to modif}caUonu:or, change when, in Ahe: Judgment of thl iCommiisioner -of Health such reyocatioh modification`,or change is necessary. �. tF s y� s- T it le 1 ' I i r y �I � � I I ' o r r � All 27n t��T/ :P a \A % /�,��+:.�� jr4it t �,,i�t s �r%��;�.�� :,' � s s � ; ���' { �bvro� r� 4• ����' t�J �, ®�''�,:1 ;;� S L O40 _j� TL r F P L U 09 P.0 024 SA TV, 2A. q, Ogg" q ..... . . . Oak . . . . n t 1 P..- ' . ...... ...... . . . . Y M A : R .!0.: ti GIs SO ski i ,7777 64. iJ Alto MA: total my ps NJ a YK 0 TOM Ac pz 4­10: Tv CFO !b ;L 1b two, AN . . . . . . . . . . . p. N NSA 3 11 �q Fan still M A : R .!0.: ti GIs SO ski i ,7777 64. iJ Alto MA: total my ps NJ a YK 0 TOM Ac pz 4­10: Tv CFO !b ;L 1b two, AN . . . . . . . . . . . p. N NSA 3 11 �q Fan WELL COMPLETION. REPblT 3/71 r y This ;report is to be completed by well driller and submitted to .analysis of water,. sample indicating- water•as -of satis#actory bscteri REPORT MUST -BE SUBMITTED WITHI PUTNAM COUNTY DEPARTMENT,.,OF HEALTH Division of Environmental Health Services' COUNTY OFFICE BUILDING • CARMEL, NEW YORK ;ourity.Health Department together with laboratory report of • quahty-befor ..e:certificate-of•construction compliance--is-issued.--, " 30' DAYS OF WELL COMPLETION OWNER NAM F„% 1 ADDRESS 1 LOCATION OF WELL (No. B eet). A (Town) (Lot Number) •. PROPOSED USE OF WELL BUSINESS DOMESTIC h ESTABLISHMENT FARM D TEST WELL PUBLIC AIR OTHER INDUSTRIAL CONDITIONING F] (Specify) t ' SUPPLY El' DRILLING ". EQUIPMENT COMPRESSED CABLE a OTHER XCI T ARY ,SIR PERCUSSION PERCUSSION (Specify) CASING DETAILS , LENGTH ( feet) - DIAMETER(Inches) WEIGHT PER FOOT C THREADED ❑WELDED DRI E SHOE 'ES ❑ NO �jS CASi�PfG D? LJ YES NO TEST :BAILED I 'j ! PUMPED !I COMPRESSED AIR HO G.P.M S YIELD (G.P.M.) _^ WATER LEVEL '' MEASURE FROM LAND SURFACE —STATIC (Speclfyfeet) DURING YIELD TEST fleet) �j ,�-- Depth of Completed Well in feet below land surface: O J ., , ' SCREEN MAKE i LENGTH OPEN TO AQUIFER (feet) DETAILS' SLOT SIZE DIAMETER (Inches)' IF GRAVEL PACKED :' Diameter of well including gravels pack (Inches): GRAVEL SIZE (inches)'FROM (feet) TO (foot) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET Dk II ' 1 If yield was tested at different dept'is during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED DATE OF REPORTS (.� WELL DRILLER (Signature) t �llir�l�a r ' REPORV E1tARf WATION OF POTABLE. WATER : APP. COL. TRU COQ 'ODOR (De cription) (Deg. SAMPLE . � ®. `PH =�r � x.20 f %RRis WATER LABORATORY Mab 'I Ave .r DanburP ; Conn. 06810 e 3350 EXTENT OF ANALYSIS OTHER t ❑'PHYSICAL;. ❑ CSMPLETE ❑BACTERIAL • NITRITE (as N) NITRATE (as N) NAME OF.M4TFB..SUPPLY ®% PR -SS JOU TOWN _. DAT REC' DAT TES ED '. COLLECT BY DATE OLLECT D PUBLIC -, SEMI - PUBLIC PRIVATE O IRON, Fe) . ' ALKALINITY (CaCOj BICARBONATE ter /i o ALKALINITY (CaCO,) CARBONATE ' TOTALHARDNESS (CaCOj �•"' `J t J u !*C +r1LM1/�a.rO4�r��p• iN_,•`-"s.``C'*P' ^# k fir L1.W LJP! c* NL• LOGTION AND /OR ADDRESS ,OF SAMPLE COLLECTION POINT Cv NAME AND .ADDRESS OF . ZVIC " P ERSON TO / f ? RECEIVE LAB. /�� I1� /p' - TREATMENT RESIDUAL El NONE 11 CHLORINATE CHLORINE REPORT J ... (TEST) r g I El ❑.. ;OTHER (SPECIFY) . MEMBRANE FILTER TEST "ON SP. .01 ee coed one colony per 100ml. Coliform colonies per standard sample .shall not exceed 4 /100ml. in: (a) two consecu• if lonies COM. TYPE F WATER (At Sample Collection Point) Raw or untreated- ?2. Treated water at ❑ 3. Water from distribution ar . El 4. Water from distribution; ❑ water at source treatment. station (One source only) (Mixture of.2 or more sources) REASON FOR EXAMINATION :t: , COMPLAINTS OF 1. The results of the 'analysis of this sample are satisfactory., and. nieet requirements for a potable water. ❑ COLOR ❑ SEDIMENT. ❑ ❑ IF SUSPECTED OF CAUSING DISEASE GIVE DETAILS are as follows: G a ODOR FOAMING group in a sample of potable water is undesirable and; while::noJ. necessarily indicating the presence of any disease-producing organisms, does indicate that such contamination might survive to the same extent', The presence of organisms of the coliform group -may also indicate that the ❑ TASTE ❑ OTHER ' ur APP. COL. TRU COQ 'ODOR (De cription) (Deg. TURBID `PH =�r IL t NITRITE (as N) NITRATE (as N) AMMONIA (ef N) ALBUMINOID (as N) CHLORIDE (C) O IRON, Fe) . ' ALKALINITY (CaCOj BICARBONATE ter /i o ALKALINITY (CaCO,) CARBONATE ' TOTALHARDNESS (CaCOj �•"' `J t J u MANGANESE (Mn)' FLUORIDE (F) DETERGENT- (ABS), SULPHATE(SO�j` v . The .arithmetic mean of all standard samples examined per month using: _fhe „membrane filter technique. shall not.. ex. MEMBRANE FILTER TEST "ON SP. .01 ee coed one colony per 100ml. Coliform colonies per standard sample .shall not exceed 4 /100ml. in: (a) two consecu• if lonies COM. , W U .. .. five samples; (b) more than one standard sample...when less than 20 are examined per monte; or (c) more than.fice -per m cent of,the samples when 20 or more are examined per month. tk`= 1. The results of the 'analysis of this sample are satisfactory., and. nieet requirements for a potable water. The results of the analysis of this sample, are satisfactory for a'poiable water but certain of the chemical or physical constituents are high. These are as follows: G ❑ 3. This sample is not satisfactory since it does not meet the bacterial- requirements fora potable water' . The presence of organisms of the coliform group in a sample of potable water is undesirable and; while::noJ. necessarily indicating the presence of any disease-producing organisms, does indicate that such contamination might survive to the same extent', The presence of organisms of the coliform group -may also indicate that the U treatment was not adequate at the time the sample was collected.' ; O to ❑4. This sample is unsatisfactory as a potable water because certalh'•'themical or physics( constituents are above acceptable limits. These are as fol- Iows: E-1 The. coliform content for this raw surface water is ❑ 5.., Low= " -'- :❑ 6. Moderate ❑ 7. High F] This sample. -was analyzed for fluoride. The fluoride concentration' was ^ ❑ ,B High ❑ 9. low• ❑ 0. Satisfactory 'i <8 g . o wo J F7 .O 1', Z'u!'C iaGw D L }:Li'. t'.i_I'1__ a' ��l)a.11LC].ILy .00.6 tlon. 1c71<ion�` Stree`It. F , , i , .'� Bu � 1, i n , . Ty e --- �--- -� ---- �'` ---- ---w , � Tt r -, RAT" -�5 ,� , :f -UA, ���r�. 0, SEgip }��.rr, s�:rAr7r, sv�TI,,M: ` a, ' I -epee ,e>>t `th:xt ` i girl t,�h.olly arld cor,i a.etel � rc:s,�o�� sib l.e J'�,r. t!z�' i location -, VIOr�ts^1 .n'�hip, nlatc:rial, conStluc t. it, c^::'c�'��.r "r'.c'. 3 Of �;hG':Setd�lv'ri ;di §- p;osa,l s`Ts-t-In1 s�rv`ir' `:trio. ^��J'OVi' clesc l;'ed t�r.o'perty- and :th,a:t it' has hp' n, l :. constructcd `'2s . sroL•ri1 on the pprov ed plan or. unproved amendlnent t}ie.reto, and :in acc.orczance. :rich 'the standards, rules.. rl.rict: regulat: old;=. of 'the Putlrrl�lll County Dcpar.,nleif�, o'f Hea -lt.i, and: hereb�r �uara ~it;� to• tie otinzer, his succe;; S0I's r :or assisigns., - to place. .iI1 g v �'.ODr ?'c ^.'t'rl Condition •anj' -p rt of 1. said system `cons +.r —d �y r_e.w,hich fF11�i_s to' on�ra,t for' a ;.�cz,.iod ;of .l;l'r:o Y fo'.low- J.r_ the' d.at:e of initial :usc of? t sera. di, csal ::.ystcm, or.-, .y r ;:a rs :nude 1:)y .�1Ie to :�,'rcii systoi�; ;�. cept'x'i,There the .fa- I ura to over u. ,c. a. otiE:� l i s cuL,�ud r�r the , �I.lf.tzl '' :r�,ne ligent •a.c,t of the' 0"' C ciz- pah rOf.thc; buildi'1f,° ;ut'iliz!nrr the syst;m 1.iiL : lucsl':i q.0• �L%CFpt as-..&b r1 1 " "U�'; G L "IZG CiC: tE)'7'r'11I: }1 v'1.0 "n' Cf vrle D ll'� ct „' /�f. T . c t. �] l n 1' ) ,,�� e e o_ z t.: J] .�.�iozl ,a r�vi� o. _� Ie.1 .,al Health Se vices of t11 P►ii:ri �i- r. "CoLU�ty' Dc-,, tlr_�nt -. -di' Itealt: �.as to it lethor -•.or. not t?ie �''E1 ll:llX -e 0 , i:}�t S`ISteI'1 to C:)T) -ra, o was c3.'.i5`:'C3 'C1�' t't`�1C , 4,r; r r, ,, , ac.t, of thc, occupant. of the buildin '-, ut, l z, -1n day or 'Ti fi J100 l 0 -p'bi t_ton, give rlaiin , and a.ddre'.ss;7. TH.I7EE (:j) COPIES !EIiE R;;QUI "ti?'1J WI'i' =I: TiiiiE- ( COPIES 0•F FINAl PLI:NS ,BirM:iL, CErZTI1� ICATE Or C61 -%P IETION WILE, B}� TSSUl`D . Gt1��I {111I`!OIZ LS t;.QtlilZ ?� TO F'�.;iL .AyO LC:, Q,< a�f1J <<t' Pipm. •tJS.?:.0}�'. S1S:aEtt:;`. Division of Enviranetal 'Helth.Servi:cbs Puti r Count of Heal ti , 11 1 1 t f 7 a r x i x�PU AM COUNTYnEPTMENT 'OF HEALTH' k� { p F w r iwsionof�Environmental SHea %ih Services, Carme% }\ a S,CONSTRUCTION iPERMUT FORE WAGE DISPOSAL SYSTEflA_ k -­MMM7 or., r /4 Located . at = ll..E�J i� � •�1.6i z v e.ct P c5i C - y.,Subdivislon - �V1��� �- �'rlc'�•�. � ��� � o7C%�`s. 5 on Block Lot Job WN :Owner Address -± -� CO r Building Type +��a +.� 'Lot Are n7�pCcl R ��.�1�Q.� CO go Al Number,,�of Bedrooms " rc a Square:.FeetTotal Habit ce .. Separate Sewerage System to cnftsist of ��0 Gal .Septic Tank e I �t lin a wfeet X width 'trench ;tTo ibe constructed' y Adtlress a k± 4 n �� Water Supply Public "Supply ;From Privat Supply.,to be ,dulled by f ? " y �' i •Address a M V Vin" /;1 T u .•`,� ,! Other Requirements �t @ �S7r�6i)i� ( ®SAilL P'(��ik ;nl represent that +l amwholiy and completely responsible for the design and location .of the proposed : °system(s) '1);- ,t hat �he rsep5ra,sewa e'dis oral s stem j above described will be constructed as shown �ontheappvvedF ma endment there to `and in accordahce'wdh' the standards rules+an Yegu a ions;o ;County` ^Deparfinent of .Health, +and that on�completion'thereof a ,'Certifleate of:Construction Campliance< satisfactory. torthe•Commissioner < of Health rbe su'dirn tted to' ,the Department, and a °written: guarantee will -be furnished the owner, his successors, hells or a" signs_ by.'the tiuilder, that,'said builder• will' Fe in, ,good operaLmg'condifion any :part of saidysewage' disposal system during the. period of two (2) Years iriiinediately_ following the,date,of'tfie <,. lowing erica of ;.the approval, of� the ,CertiUficate" ofr Construction 'Compliance! of ache original system or any repairs ° there to,- 2j,that athe ,tlri lied ,well des_ cribed` °`above r _.. will be'aocatedtias, shown on the approved plan and Shat said well will be installed in ccordance with 'ahe standar s, rules and'. f u I s rof" :tile• :,P.utnam' CountYDepartmentrof Heal Date LL i/ 5lgnetl P A "ddress _1` ;APPROVED FOR CONSTRUC ?fi;ON Ttiis approval expires one year from,the date. issued: unless. construction of, th'e bulldiri has been un ertaken land -is revocable for cause or m_ay be amentled o►xmodifIed when consitle';Z necessary by the Commissioner of Health.• -QriY change o'r alteratlon'of•construction requires =a new ;;permit ;Approved for`dlsposal jof domestic sanitary 'sewage, and %or private water supply `,only. /F „ Date U Title T r m --.----;---PU-TKAM-COUTILT-Y—.,,DEPARTMMff---OF-'LEUTH-..-:., . DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner 1F P! 'LL CZA Address FAtfF1FL) COtJQ. Located at (Street � A<c-- '&P(Kc D(_. Sec. P4- Block .9 - Lot 7,&1f(,)9 i �'Tndicate nearest cross street) Municipality T)A:l I E-k-s o �1 Watershed C e-,U:l 0 tj SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Elapse Depth*to! Water WateF-EFveT .No. Time From Ground Surface in Inches Soil Rate in. Start Stop Drop in !P Min./in drop Inches Inches Inches 010 9 3/1 2 12% 3A 3 AX-J* 0 1 511 4 12A34 5-121,34 11 �ffl- 2 .4 2 Notes: 1)' Td,Ats to be repeated at same ;deptti until ajpproximatel� equal soil rates are obtained at each percolation test hole. All data to e submitted for review. 2) Dp I pth measurements to be made from top of hole. 4 TEST PIT DATA REQUIRED TO BE SUBMITTED, WITH APPLICA I TIQN '-DE5CP!-PTI-0N*0P- SOILS --E7N(50V&TERkb' IN tifft HOLES.' DEPTH HOLE NO. f HOLE NO. HOLE NO. G. L. 611 121T 1811 2411 3011 3611 42" 4811 5411 6011 66" 7211, 7811 8411 ,.-....INDICATE L-AT1WJ-a,--H---GR0UND WATER IS- ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED .':TESTS MADE BY fZC:j S c-- (4 Date �(o ,u. DESIGN Soil Rate Used_fl-_ Min/l "Drop: S. D. Usable "Pov, d c. t, 0 o 0 . — . t Kk� No. of Bedr(DOMS Septic Tank Capacity C-) 00 A Absorption Area Provided By OL.F.x2411 nch. o Z)CL'j- ek%, --tb cou-0-4- a0, Tame o"r f-t I c.. a- Signature Address 34 !31,e�?LAt- SEA THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft/Cal. Checked by Date 0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH.SERVICES COUNTY OFFICE BUILDING, CARr�--�-Z N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner EL -k-tG 2,A Address Located at (Street LA14e loo - Sec: mac - Block Lot-)? )9 n ica e nearest cross istreet) Municipality �C-}'j jC7i� Watershed IJ SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS r CLOCK TIME TION PERCOLATION man Eiapse Depth to ,Water Warmer ve No.. Time From Ground Surface in Inches Soil Rate Start- Stop', Min. Start Stop Drop in Min. /in drop" Inches Inches Inches 2 1') )LI 1a,�a 3 �a: �4 �a•.''a�, t `� tin i s� 2 5 F4 3 5 ' Notes: 1) Tests to be repeated at same 'depth until approximately 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. i TEST PIT DATA REQUIRED TO BE SnMITTED WITH APPLICATION -DESCRIPTION OF- SOILS- ENCOUNTERED IN-TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G - T.. 12" 1811 2411 3011 361f 4211 4811 5411.... 6011 66.11 7211 78" 8411 INDICATE L -AT. WHICH. GROUND .WATER.. INDICATE. AL TO WHICH WATER LEVEL RISES FTER BEING ENCOUNTERED TESTS MADE BY MaL C Date DESIGN Soil Rate Used jL— t \ Min/l "Drop: S.D. Usable Area Provided No. of Bedrooms .2) Septic Tank Capacity goo Gals!_ Type M A-S Absorption Area Provided By L. F. x24 5b" 26 th trench. r, _ "IV her A. JcC� fir.,.,.. I 1 4 Address `54 61,� THIS SPACE FOR USE BY . HEALTH DEPARTMI T ONLY: STS j 1891913, Soil Rate Approved Sq. Ft/Cal. Checked by Date T ?e 'A, 4 n A�_� A L IROW "s. I TPL my, YF E, :'I-, _VAN (5- TYPVCAL��CONC lw� p! < I & LANK 1 "PEINF O'c c: 13"w, 47 z A Q j— z ....... tUAA; vo ARTP a .,i. t T ' - �.�a.. . T -:115 9, J 0, Em 47. UACX FILL 0 R 14, mm, u OR -MAY it FI, R k PIPE U� CLEM4 *RAVC1. OR "Wi�ORPTIDN TRENCH _t7 44% 1.. '1, ORIJANC WITH j),.Lpt-.LW TPUC - IQ IN ACC 6 H THE RULESANU _7_ 3-1 "A!6. C OU N T-Y -DEPAR TME R-�- Th Vie, AA L, N,(; T BE '6AitKFILi.k.0 .4TII ECT -SY0TrM-.S U 4 lit INSFI: ED 13Y DESIGN '-'EN- FR',LNNDTHLQ CAI HLAI!T" ifl-PARTM U R D 4- f+L I) I ! Vil. INF .'A 'N SEFt),-, TA NW t 0 IE -,'J:A �X, GA LU, t". Ito :-7SY-$T TO -Z _H 4r, )�,r, TRF N Cit' W11 A 14X V U M I TC W —PLTC <-�OF­f,/Arj:: :PEW- f,'90T. 77 9, V4. �'l 77��- CS 7P j..." 4'. q, A. . . . . . . . 2; R: "N' S :PELLI:(� /a VI`V��: Olt, k. 7771 ARD A' L L A I J SS iATES r- �nATL`7 YORK` gF ZIP RPROVEC". 4r 7 T ?e 'A, 4 n A�_� A L IROW "s. I TPL my, YF E, :'I-, _VAN (5- TYPVCAL��CONC lw� p! < I & LANK 1 "PEINF O'c c: 13"w, 47 z A Q j— z ....... tUAA; vo ARTP a .,i. t T ' - �.�a.. . T -:115 9, J 0, Em 47. UACX FILL 0 R 14, mm, u OR -MAY it FI, R k PIPE U� CLEM4 *RAVC1. OR "Wi�ORPTIDN TRENCH _t7 44% 1.. '1, ORIJANC WITH j),.Lpt-.LW TPUC - IQ IN ACC 6 H THE RULESANU _7_ 3-1 "A!6. C OU N T-Y -DEPAR TME R-�- Th Vie, AA L, N,(; T BE '6AitKFILi.k.0 .4TII ECT -SY0TrM-.S U 4 lit INSFI: ED 13Y DESIGN '-'EN- FR',LNNDTHLQ CAI HLAI!T" ifl-PARTM U R D 4- f+L I) I ! Vil. INF .'A 'N SEFt),-, TA NW t 0 IE -,'J:A �X, GA LU, t". Ito :-7SY-$T TO -Z _H 4r, )�,r, TRF N Cit' W11 A 14X V U M I TC W —PLTC <-�OF­f,/Arj:: :PEW- f,'90T. 77 9, V4. �'l 77��- CS 7P j..." 4'. q, A. . . . . . . . 2; R: "N' S :PELLI:(� /a VI`V��: Olt, k. 7771 ARD A' L L A I J SS iATES r- �nATL`7 YORK` gF ZIP RPROVEC". \\ i .\ , i t 1 1 f�