Loading...
HomeMy WebLinkAbout1516DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -4 -8 BOX 14 01516 } 4' ` I IN 01516 t� � :r yr r Orvisron of:lm COUNTY DEPARTMENT OF HEALTH / ronmenra/ Health Services, Carm %`M. Y- :'10512 ICE FORSEWAGE :DISPOSAL "SYSTEM' /`}2 -j"� Owner or-purchaser or.Building Buis 3ng onstrECTSy et /o LASE Location - Street To /t Building Type . AZ W ti� un c pa ity 'section - �fl z 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 reguLtions of the Putnam. County Department of Health, and hereby guarant y to t e owner, his succes- sors, heirs or assigns,.to place in good operating condition any part-of said system constructed by me.ikLhich 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• - Dlre:ctor 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 willfA or ne 11 n act of the occupant of the building: ;utilizing the syst Dated this /Q day of &I 19g'4- Signature Title corporation, give name and addr.e.ss) . 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. - - - r - - - - - - - - - - - - - - - - - -. - - - - - - - - - - - - - Division of Environmental Health Services, Putnam County Department of Heald 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 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 Richaard Rapp ADDRESS Drewville Rd. , Brewster NY LOCATION OF WELL (No. 8 Street) (Town) (Lot Number) Ice Pond Rd. Brewster NY PROPOSED USE OF WELL BUSINESS D DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING El (Specify) if ) DRILLING EQUIPMENT © ❑ COMPRESSED ❑ CABLE ❑ OTHER ROTARY X AIR, PERCUSSION PERCUSSION (Specify) CASING DETAILS LENGTH (feet) 30 t DIAMETER(lnches) 6 tt WEIGHT PER FOOT 1 g lb S . ❑ THREADED El WELDED DRI E SHOE DYES ❑ NO S C-A5ING 50 YES NO YIELD TEST HOURS G.P.M. ❑ BAILED ❑ PUMPED ❑ COMPRESSED AIR 6 5 YIELD (G.P.M.) 5 WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) 201 DURING YIELD TEST fleet) Depth of Completed Well in feet below Land surface: 4651 SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (feet) SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well includingGRAVEL gravel pack (Inches): 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 O 3 Drilling in overburden clay and boulders l Hit rock at 3 feet 3 30 Drilling in rock,set Casing, grouted- If yield was tested at different depths buring drilling, list below FEET i GALLONS PER MINUTE } DATE WELL COMPLETED 8/20/84 DAT O PORT u=' 1171+�4 ;� WELL DRILLER (Signature) I PUTNAP�H CO�)NTY ` ®EPART1ddENT OF �iE�1LTI� Permit « . Division:. of Environmental Healih'Services, Carme/ N _..V 10512 - `CONSTRUCTION PERMIT FOR .SEWAGE DISPOSAL SYSTERA ,.ccgf' �f �1 Town or village Located' at 3 �' Tax 'MaP Sow alock Lot E v. ,Subdivision }``. subd Lot # Renewal 0 Revision. �' F Owner /Address /* �� � -- y i e.,Of Previous Approval Building Type J Lot, Area = ',6iPi�11 section .Only ❑ Number of'Bedroofns ' � Design Plow c /P Separate Seweiage "System to�c°o'n %sist of Gal Septic Tank :'and To be constructed - Address Water Supply Public Supply From _Piivate Supply •to be drilled by— Address n Other Requirements A z I represent .that I `am wholly and completely responsible for the tles�en and location of. the proposed systems) _3)�:_ttiat the soparate. sewage dispotial system 1 above described-will be constructed:as "show_ n on theapproyed °amendment thereto and; in accordance with the standartls rules an -_regu a �onso ; e . u narn ,County. Department of Health, and.that on completion thereof a Cerrtificate `oi .,Construct ion,Compliance sitisfactory'to; the Commissioderof. HealthwiW ` '- '- the builder, that,,said buiide ►, wilt. be submitted 1:6 .the Department and -a written guarantee ,will De furnlsheq :the owner; his` successors; heirs or •'asslgns'by. , , I place in good operating condition any, part of said, sewage,. disposal system during,;the period of 'two (2) years "immediately followlny the date of the issu ance- of approval of the Certificate of: Construction Compliance`'ot the- -original.,system-or any repairs theieto 2) that the:d illed well described above will be, locate vas shownon the approved plan and that said welt. will be Installed in accordance. with the standsrds,'yrules and .reyu aTFions of the ,- Putnam': County Department of Health g t• Date 4� gnetl P E R A F ' APPROVED FOR CONSTRUCTION: This 5pproval; expires one yea► from the date Issued unless construction of, the building has been undertaken and, .is. revocable for cause or Tay amentled or, modified =when co sidered- necessary „by fhe,C Issioner of- :Health. = Any Change` atterotion oi'conitruction'. .requires a.ne ermit A oved; i osal of dourest it sewa a 'and /or pr va ` w P Date 10EL, Rev. 19 -91 ' P TTDIAM COUNTY DEPARTMET OF HEALTH DIVISION OF ENVIRONP�ENTAL lnn LTH SERVICES COUNTY OFFICE BUILDING, CAR1.2L, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL YSTEM FILE NO. Fee 1, eeW7 Owner ddress ,�7 6 dR4Z ! -4EK A&,0,e /s Yet FECRO , Located at ( Street Lf_ N P64 jr<.b�imj rvec . Block Lot �Indica.e nearest cross street) Municipality 70w,v 6.,C .�ra+�Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS hole 4 Number CLOCK TI14E PERCOLATION PERCOLATION Run Elapse Depth to Water a er ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start. Stop Drop in Min. /in drop Inches Inches Inches / 1 9.4s' /0.0 t o _4 6 *0 3 f " _�? or ?e 2 /0, 10 3 5 e.Sa. L 1 2 9 3 4 5 Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. App data to be submitted for review. 2) Depth measurements to be made from top of hole. '1ES2 riT DATA REQUIRED TO BE SUBMITTED idITH APPLICATION DESCRIPTION OF' SOILS (ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. ''HOLE NO. HOLE NO. 611 12" csoi L 18" ---5'CI --In - 24" 3011 3611 ,. 4211 4$'1 ►� 5411 t� 6011 1 , 66" 72" , 78 << 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER RISES AFTER BEING ENCOUNTERED TESTS MADE BY e, M/1 /40& �EL Lr.01Y Date Ib !-1 J/ , I V f Z Soil Rate Used /o MirVl "Drop: DESIGN - S. D. Usable Area Provided dOo No. of Bedrooms Septic Tank Capacity D,r d Gals. Type A e,9.ro ve Absorption Area Provide By 333L.F..x24" — width trench. Vv 0. 1'. Other Name �`�.•� Address�7? /LF.,�. �-�,F� �� � �Z W /�� n e i. V•�., t:':• v ,•ter. THIS SPACE FOR USE BY HEALTH DEPARTPENT ONLY: �'•,��,o�'�' ?nNP�,.,��� OPEW Soil Rate Approved Sq. Ft /Gal . Checked by Date. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SZPARATE SEWAGE DISPOSAL ;YSTEM FILE NO. ol4ee, qa0 ®/ ` Cre a f, > P"Z7 ` Ow ner )Lugga L. ?,oP// J e Addres s .Q7 6 Ojz C` A".f � Located at (Street M.-TIcate PAAoa el,6lmElaec. Block Lot nearest cross street) Municipality 7 wN O F 4.rzeASowWatershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run apse Depth to Water a er ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 2e .31 h 1 A yin 2 10I 124 ! D,3.2 I- i= 5 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. DEPTH G:L-. 6" 12" 18" 24" 30" 36" 42" 48" 54 60" 66" 72" 78" TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES ° HOLE NO. % HOLE NO. HOLE NO. 0• Po to to 1I oa ,e 84" as INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WINCH WATER RISES AFTER BEING ENCOUNTERED TESTS MADE BY �, /� /L� ®i% �1�� �/_�. Date `, j DESIGN Soil Rate Used /® Mi l'lDrop: S.D. Usable Area Provided 00' No. of Bedrooms 3 Septic Tank Capacity h9rd Gals. Type A -f f rvase%1 Absorption Area Prov ded By 33aL.F.x24" width trench. Other THIS SPACE FOR USE BY HEALTH DEPART14ENT ONLY: Soil Rate Approved Sq. Ft /Gal. A/ A 0.400 Checked by " "" Date l/