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HomeMy WebLinkAbout1328DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.77 -1 -10 BOX 12 1 rm I. ti INS I I Is � s�. . J ' I IN Ir r iA& 01328 a y ' J tAO `��,� PUTNAM _CO> t _ DIJisionyt of�Enwronr► Lw `h 4 -iGE RTI,ICAT�., E3F'- CQ7�i�T.RUCTl01� LOi'ilIPL1ANCE +Located at Owner Ni chol aws D Dagnone', � PA Wi l kd i1ne1 4 $Separate Sewerage�System built ;by g ne Corsisting of '' 1.00OGaI. Septic Tank Other requi►gments uiel 1 86' From `Saner -� ­E x pans'iion' Area 'B'ack of House' r Water Supply t Public Supply From i e " ix X Private Su I Al ber PP Y Drilled BYE ' '-� Building nType 'Eramert , .,F 1 , None �cT 33Has Erosion Control a Been ed Complet? t * s a A Sj. r sf; certify that thesysfem "(sj asxlisted serving' the above pr mises,we 7 ;attached] andwm:�accortlance with thestehdards rules�artd regu 6�,7�72 J a Yt r � L � -- Any'ape son occupying; premises "served,by',thepbove.system(s) s a subject_ Tool fio ation :or change when,. in the judgment iS'fy � Mt+S�A � ',"1yx � •q 5 � � � 3. -1 r � '� '61 DEFPARTMtEN4 OF HEALTH yealth Seivics, Carmel, N Y 10512 EiINA�f D > >,ISPOS'A,�, sv_s�le�r - F�atterson " "` s 4 r Town or `Village •z Sec 1 Block h h,ob'S0500 ~ of xtYn 11 v wste;rNew '1Lork r 296 I��eal Feet X 4 f. 36 i ncli ' Wldth ,t ►arch Two °�6'� x;8' Jxh�6,4 Deep Seepa4,erPi,ts 7i'i'r- Y t rF , a4 � ..,,pi t=- -F"•�i 7/15/71: Z- of' eooms� Three, Date Permit Issued' tT'r``'�. -L er ^ °„,''�u at } �5 }ryt �1 ��1'Y :,y, r�Vr�vx `>y",.5,t •� z I truct`ed esserifially as showri on theyp y 11c the' coinpleteq work (copies of wh'I6'are plans f�iledqand, the permit; slue byr theG„f?utnam'C;ounty �Department.of Heelth. n. T '., =sr$ 1 by .. e1�­:New� York c10512x. 2906 .I L" icen � se No tmptly takefsuch actron as mayvbe +necessary to secure the corroct(on of any unsanitary era9e systemshall become nulhand void as soon as a ;public ,sanitary _sewer' tie' comes II an'd void when a 'public -water 'supply tbecOmes:avallable Such - ;approvals ,are ! mmsssioner ot� Health,ksuch rev�ocation;'modificatioh or change: Is necessary: . r 9 0 �+Xr,s, era^ c .'t }A,w X ✓ �'�4. . �r�.} -- : '„"y}$' { a e fi _ - _ �° .,- _ YOR 0,1[VIV MED {I'CAjL L!A'BOR {ATOuRY {IIVC ' 19638p t PO ;B ;99 3 +21 Kean St'reef 3 Yorktown Helgtiits; N Y 1059$ k�y� �3 >4 415 32 4 � .�. ±_a,. �.+. ..- +..._„_.. . ,.._..._.x.�+• _ a_ _fi�7'C� y.� .:tee- k.s._ �._ u COLLECT ED: £ RESULT +S OF EXAMtiNAT10,N OF WAS ER �..; z' ��._sptir u RECEIVED t, 'OWNER NICE, DAG�T011TE HI�CHCOCS HILL ROAD I, CITY;, VISL;L AGE, TOWN t & %ORwNAME iOFsSUPP�LY r�,Ra DATE R�EPORTED�Y . + s ;MMOPAC t �fiAMP.,LING POINT l- r R' x w x c z a E A C)T 8RI A.'•P ER ML. Agaz?plate:.�count "35° C)` ( ,�COL�^IF�ORM'GftOUP` +(�Mostr pr °`bgble N °, /100m1,�)A' HARDNESS;; TOTAL r ppm�, '� `+ (+1'3 ,at -Te ) �JGX 3 { J�. R..: 3i;. e�F '��,y Py'ar� YRPi�k£.y ) +5H 4y ft,{ ¢ •'� .L_P p .L i" 111 9 p� S� r DETERGENTS ppm IV) ppm ` IRON, TOTAL ppm s ar a s t J° S #' } �� �.TS p ?rl� c` Y� a a M s� „ G%{ E• >n F. tF 3 x... <I v i i ^e.. 1 L'OURIDE °(,F) 'e^27 ) x'U ....rrsc.��JJ,�;�."115, yy� ,.�: }�T�,Ea', A > 4.> fi" jF3 3a.�.irSd�4 _� e,: S.Z'i,$..4f. xk. Eve f:: �N✓. '�.hia .,{u�.„. V«sa'. 5.+& xY`LrM -,... .,.4 -. ✓.R �. �i'S? 9 L 1 Owner or Purchaser of Building Municipality M S&-,(F Building Constructed by Location - Street Building Type Section Block 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 :Wade 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- vie-e-s --•of- the--- P- a�tnam- C,ounty.= ,Department of Head th 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 syste . Dated this 2 z. day of 4<5 19 V Signature � ,/ Title //�7"T��Pso •� ✓lac w `dRlj If corporation, 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 � a WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK — This report4is to'be completed -by -well driller and submitted to County Health Department together viiith Iabo�a4ory 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 ti ADDRESS LOCATION .OF WELL (o. Stree " (Town) (Lot Number) PROPOSED USE OF WELL /DOMESTIC SUPPLY BUSINESS ❑ ESTABLISHMENT ❑ INDUSTRIAL ell ❑ FARM ❑ CONDITIONING ❑TEST WELL ❑ OTHER DRILLING EQUIPMENT v,. ROTARY COMPRESSED ❑ AIR PERCUSSION CABLE ❑ PERCUSSION r_1 (S(Specify) CASING DETAILS LENGTH (feet) a DIAMETER(friches) �� IWEIGHT PER FOOT j� THREADED ❑WELDED O YES ❑ NO t CT YES NO YIELD TEST ❑ BAILED HOURS ❑ PUMPED V-j% COMPRESSED AIR G.P.M. YIELD (O.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) 0 DURING YIELD TEST [feet) ' 0 Depth of Completed Well in feet below Land surface: �40 ';„)' 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 V C1 G s vi If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED DATE OF REPORT WELL DRILLER (Signature) C I , I - - - , - - ­.- - 11 *11: -,�. 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I � ;��13- . 0 . .. . ­ I .-- PUTNAM COUNTY 'DEPARTMENT OF; HALTH p of nroe/ Hah S 1051Diwso m a a a :CONSTRUCTION PERMIT FOR �SEWAGE, DISPOSAL SYSTEM" /4°Stl M /� f r Town or• Village Located at fyJ Uo7i��2 r Section Block . ;Subdivision �'u'�S,gn�l�° Lot " Job i(/i ci,af D Owner S /�(�`�� —oil p Address �! • �• -�,�. / �� / /% Building "TYPe + -, ✓ Lof jArea � D 1 n�ie ,Number :of Bedrooms 'row" Total Habitable Space {dam �nF >� fTT__ /_Square Feet. Separate Sewerage System to consist of. „i Q(a Gal Septic Tank lineal feet: X width trench To be constructed by Address .Water" Supply ; Public. supply From ' — Private.tupply to be drilled by _ t �p Address Ot her 'Ftequirem '�� � 7 1 represent that•I,am wholly and 'completely responsible fo[lthe design and ,location of the proposed . system(s), 1) that 'S lie separate sewage, disposal system •above described' will be constructetl as shown'on the approved amendment'.there to and in accoidance'w,ith;tlie standards, rules an regu a ions o e u nam ;county ;Department. of .Health and that on co mpletion, thereof a !Certificate of,` Construction :Compliance" satisfactory to the Commissioner of Health will :be submitied..to. the. Department; 'antl' a written; guarantee will be °furnished the owner .his successors heirs(orassigns by the builder, that said builder will .. .. - piace 'in good 'operating, condition• any: part of.:5aI sew age.d�sposal system during the.;peried:of•two,(2).years Immediately following thedate of the issu- ance of the approval of: the Certificate of Construction'=Compiiance of ..the,origina6system or, any repairs ttiereto;.2) that the drilled well described above, will be located as shownon the approved plan and That said well will tie installed in accordance with the standards rules and regula —cons of the: Putnam County De arX rent of He Ith..? =` Date - T %�� /". SI P % R f� A. F.E � A . Address r License No. P fb APPROVED FOR CONSTRUCTION. 'This_ approval expires one year from the date `issued - unless: construction of the building has been undertaken and 9s revocable for cau_ ;e or may b'e?amended'or motlified whenconsidered necessary by',fhe. Commissioner of Health Any change or alteration of construction requires f new ' ermit; ,Approved- for ' disposal of domestic se ltary sewage d /or 4"p' vat water= supply'only. -T Date BY ti .. C?�!Q".t'`. ��. ... n. � - - - - � ..:- �' i� i.,�I •�7'a,�� S as , .. �� bc b 4. rn t; ' ���ie� /a1Er'eoir���i '�u{� "i + � ( � i•�, rL � r ' Zoo . i ( n7 1�'t ' I t t _ I PUTNAM COUNTY DE?zRT<<CE T OF L T H DIVISION' OF E \VLRO \ ir'\:T_aL HEALTH SE?LIICES ,- DESIGV DATA SHEET SEPARATE. SE..AGE DIS ?DSaL SYSTE'•: FILE NO Ocaner `G d� �� Address Located at (Street). _ Sec . !� (Indicate nearest cross street)— ®. Municipality �„ sm Hatershed . SOIL; PERCOLATION TEST DATA REOUIRED TO BE SL'E: =TED .PITH APPLICATIO \T Hole ' N-umber. CLOCK TIM PERCOLATION' PEP,COi, -ITIC` Run Elaose Dept'- to Pater Slat er Level No. Time Fro r; Ground Sur, _c'c,., in `Inc'hes Soil Rate Start Stop Alin . Start Stop Drop in L11in%in . drop Inches Inc: e� '� I-nces o ® Y a. 2. 4 5 2 ®� ® ®�� _ EL q. G i6 3 4 .. 5 Notes: 1) Tests .-to be. rdpeated'..at same depth until apProx m.ayely equal soil rates are ob- tained at ,eAch iper_colation test hole. all data to be submitted for review. 2) Depth measLr.ree�i'ts to.'be made from top of hole. PUTNAM COUNTY DZEPARTL%9,7NT OF HEALTH Soil Rate Ap',rowed Sq. Ft"./Gal. Checked. �-v Date TEST PIT DATA RE OU I RE D -0 PE S'LjTj',!ITTED r-:1 T.-H A P P L I C A T 10 N' T DESCRIPTION 0F `BOLLS El T E RE D TEST HOLES DEPTH -,, HOLE '.HOL-T \0 lio 4- 611 vm 12C -7 p. r* 3­0 3.6' .42 48" 5 4' :A­ c, 6. 0.',, 66?f -72 78 8 4' A A j., fg VE L' AT MICK GROUN7D 11-11ATER IS ENCOLINTE, INDICATE LEI R.7tD a. NQC� :INDICATE 1EVE1, TO 'v.7 H I :CH ti_-, �t:k'LE E: VEL \13 OUNT TE RE D F T E R-. E"It EN, R I S -*-'S A �B TESTS *LLADE. 3, & ;D ate pLW Soil. Rate Usea' min/1" p T I S.D. S D. S e Area Provided No. o' Bed--?lo J. 0 S Septic Tank C a p c i._}{ fOo 0 Gals. Ty'p,e /16sm, c� Absorption rire,a Provid d BY32C—L. F.x2'_`, 36 t h trench.. John Prentiss, P.E._C,,E,.,C. Name Sic 111 rp P.D. 6, 0 353 Address. canw. MaY. IV.-)12 ..EAL PUTNAM COUNTY DZEPARTL%9,7NT OF HEALTH Soil Rate Ap',rowed Sq. Ft"./Gal. Checked. �-v Date Putnam County Dept. of Health County Bldg. Carmel; New York 10512 Att: Mr. James J. De Vito Re: Property. of Nicholas D. Dagnone.,: Hazel .::D,ri.ve T. Patterson (Putnam Lake) - Map "B". (Dwg. S0 4 500 of John H. Prentiss, P.E..) ,Gentlemen: I am aware that the well location is only 75.ft.-jih5{�g�do �00 A-5 from the sanitary system shown on the drawing and accept such location. Very truly yours PC Nicholas D..,Dagnone,..., .. Hitchcock HII. .Road - Mahopac, N.Y. 10541 JOHN H. PRENTISS, P. E. CONSULTING. ENGINEER ROUTE CARMEL, N.Y. ' (914) TRINITY 8-6170 June 14, 1971 Putnam County Dept. of Health County Bldg. Carmel, New York 10512 Att: Mr. J. De Vito Re: Property.of Nicholas D. Dagnone, Hazel Drive T. Patterson (Putnam Lake) - Map "B" Our drawing SO #500 Gentlemen: Enclosed is owner's letter re own well separation. Our calculations indicate available sanitary dis posal area of 3100 t ft. sq. without expansion area on North. The owner's letter and this note should satisfy.the conditions for approval. yVer ruly yours,. o n H. Prentiss, P.E. SHP /pr cc; N. Dagnone