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HomeMy WebLinkAbout1522DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -4 -18 BOX 14 01522 I or oo- I no . A. md ; Is 01522 m . 1 e u 1Ure)Izn e�� aL ,1:u l ling. Mur �,ul ily:.. e . .. Idir,d Coniitzructed by Section • tivn - S Free t Block e. a ldirg . I`.YPe Lot, C1)ARANTY OF. SEPARATE SI-vIAGE SYSTEM I represent that I am wholly' and COMOletely• responsible for. the 'lccation;' kmanship, material, construction:.and .draina e of the sewage .disposal s_vs,.tem vino the above described proper i; and that it has been :constructed as sho...n on approved plan or approved amendment thereto, and..in sccord:mnce with the standar _s. as. and reo lations of . the Putnam County D`partmient of Health, and hereby .Cruaranty L-be •o:�iner, his successors,. heirs or assicns., to place in g c o d oP_- ratiT•c*,r.,cond? tio:i part or said system constructed „bV.me -,Which fails to. operate. 'for a period of t:•:o rs irnmiediately follc ;ino the: date of initial' use of: the sew e disposal. s %step, or .irepzirs made . by rye to such system, .except t here the .failure to operate, properly . '.iat1JtU -UV lire willful Ul' lrE'k':L1'^{C111 t11:i l►f. IJle ou%.;UPcaii� vl �+t: L11i14i1.b Na ..pia. —..p The undersi -ned further "• acrees to accept as conclus_;Vt the det'ermin::tion :. _the - I)i2ector of the•...Division_o_i__Env z,oTm—n. al }Icalth. Services_ off. t.,e_ Patn�_:r. irtr -ent of Ifealth as to whether.'"or "'not the •failure. of t;7e syste,i� to operate a =as C! by the coil" iu1 or ne ligcnt :act of .the. occupant ,the building utilizing ie0 Lem �d" this day of..` 19 Signaiizre Title • (ii. corporation, give name and aui�zes: ZE (3) COPIES ARE REOUiP D 11IT1I .TIIREE (3) :COPIES OF FINAL PLANS.- BErORE CERTIFICATE :OMPLETIO\ I -JILL BE ISSUED. - MNITOR TS RF.OUIT"ri D TO. FILL NOTICE OF DATE..OF "T'IRS1' USE OF SYSTEM. -------------------------------- --------------------- - - -- -- ----------------------- - . .11 . WELL COMPLETION .REPORT 3/51 0 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This.,Eep ,M:is t ®sbe:gomplgted;•by.,well:_dr tL-r and submitted--to.-County.- Health'.�DepartmentLtogether� with =laboratory - report -of V 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 LOCATION OF WELL (No. 8 Street) a Rd (Town) Patterson N.Y (Lot Number) PROPOSED USE OF WELL ® DOMESTIC F1 SUPP Y BUSINESS ❑ ESTABLISHMENT ❑ INDUSTRIAL ❑ FARM F-1 CONDITIONING ❑ TEST WELL ❑ (speHEfy) DRILLING EQUIPMENT ® ROTARY ® A R PERCUSSION ❑ PERCUSSION OTHER ❑ if ) CASING DETAILS LENGTH (feet) 20 DIAMETER( inches) (� WEICT§PEQ F�T �f e 4 'j EJ THREADED ❑ WELDED DRIVE SHOE YES ❑ NO CASING Qj ED MYES L7D NO YIELD TEST ❑ BAILED HOURS ❑ PUMPED ® COMPRESSED AIR 8RS .P.M. YIELD (G.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) 18 DURING YIELD TEST [feet) 350 Depth of Completed Well in feet below Land surface: 37 SCREEN MAKE _ LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (Inches): GRAVEL SIZE (inches) FROM (loot) 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 3 Lo & sand 3 374 d granite rock If yield was tested at difFerent depths during drilling, list below FEET GALLONS PER MINUTE 100 200 1 275 3 374 5 DATE WELL COMPLETED 1 '" DATE OF REPORT - o WELL DRILLER (Signature) 1.../ l . 4 BREWSTER LABORATORIES Box 24 SAMPLE No. 3180 SOURCE: Raymond St Martin - faucet - well supply Bullet Hole Road Patterson., N.Y. COLLECTED: BY: Frank Carroll Well Drilling., Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. May 89 1974 0 per 100 ml. Roy B c it P. E. 5 D fteao r { J !0.j ;'! ( [, r �! { ti pp I fy s i. t . !4 c J� i r� r:, +,n i.? �..•� " �i' ,u+: a'. ,.1 . i 1. �t � �• � 2 is R fi; "i �"�; ';i ' �F i { � • In r , APPROVED r Z. L,P J JAN 161974' "UTN�AM�iOUNJ4 ..�1�FHEALTH 8Y % /.,i+!�% ....................... DIVISION OF i ! - `k'lPnNMENTAI HEALTH SERVfM ,b 1,7.. xx� V ero - �• -�..1` `y. .fib } il , � u � rte+• c= 4 r Y u I t "� �i` r �'.+ '.., �� ;�.,• t^�,- °w`.,�.i} _ ".4:..1..x"' �¢4�+tw.wef.7. W,i.... ... o i � � i� _ ��_,�,i�+�tl'�.fati Ad.3a +„w..� s ;°#��"r�i.....xFw.�.�•M§�.w :.,....�,': k , �i��R! � �•, �. i +. �"Y � *�:�'-, z��F,�i3. {� i o � z"..: R�.. �a �'': u: � , ! K w+�m.vnwpa io.+m_am++ea ..�e.<ewwi 't_';'1'lS«'i+,'%1 -T. .. 'a.r4.st{'I (.h•.%�'.idr ;.F• �a. ++ s,Y'i.r `�'a`u•.Y'rS`i•3. +^''.'w =� MnreW�M: +... ,ri•h�.._- wperrp ��• "` .rz• �t r �'`'- S - � ., .< �``'`" `x'�'j wi =,t �'_ 4 .��e' ^k„�" E� . � .,,.. � � - - - - '" .. _. - Es,. -t'• _.,_._. j a f q PUTNA ' Division of x CONSTRUCTION'' PERMIT FOR SEWAGE` E Subdivision 1 ' Owner ' Buildihy TYPe Number of Bedrooms I - Separate Sewerage system,,,to cohsitt of To be constructed. by 3 Water Supply ?ubllc Supply From t d Private Supply to,'be drill µ Address . 3 _ T t , Other Requirements i r ;I represent'that I -am •wholly and- coinplete�y fresponsit i atiove describetl `,will be constructed -as shown °,on the al County Department of4 ,Health and that on comple COUNTY aDEPARTMENIT OF HEALTH' = vironmental` Health- ,,Services` Caine% N Y 10512 ' 4 t Y 4 ' �OSAL `SYSTEM Towa� ow ygp s, 3.. Address Total .Habitable Space l Square Feot ' Gal Septic Tank r �o lineal feet X ` .-. width trench L by � r t cc { { ;2y5 7 � PUTNAM COUNTY. DEPARTMENT CF HEgL •TH DIVISION .OF ENVIRON'VMT.TAL .HEALTH_ SERVICES COUNTY OFFICE BUILDING, CARMEL, N. ..Y. 10512 r DESIGN DATA'SHEET- SEPARATE SEWAGE DISPOSAL.SYSTEM FILE NO. " Owner R,41%yoAip S; ,. 4L1ffD,1y Address UL,L - 1,(o4 12,C A D Located at (Street ), Sec. Block Lot (Indicate neares cross street) — Municipality 1,914 T %/ZSaiy Watershed Al , SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS 5. t 1 3 W� 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. Hold .Number' CLOCK TIME PERCOLATION PERCOLATION Run No. Start -Stop apse. Time Min. Depth to Water From Ground Surface Start Stop. Inches Inches Wate. Levei in Inches Drop in Inches Soil Rate Min. /in drop 1 CAS X19 4� /3 Gk — 152 , 73 2 ..30 . 3/ �' /3r .? i� •S; 31 /e 5. t 1 3 W� 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. TEST PIT DATA REQUIRED `TO BE SUL3MITTED WITH APPLICATION. DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. -�.L� HOLE NO. HOLE N0. G.L. 6++ q 24" V /� i�( 2 N /�/ 5AA10 �e -1'2wA-4 48" 5411 • 60►, 6�" 84" :INDICATE LEVEL AT WHICH GROUND WATER :IS ENCOUNTERED - INDICATE- -:LEVEL—TO -WHICH WATER LEVEL. RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date DESIGN Soil Rate Used :,r Min/1 "Drop: S.D. Usable Area Provided No. of :Bedrooms 3 Septic Tank Capacity 90Q Gels. Type Absorption Area Provided By f (a L.F.x24" b"— e width trench. Ottier Name, Signature Address SEAL THIS .SPACE FOR. USE'. BY HEALTH DEPARTP T, T. 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