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HomeMy WebLinkAbout1528DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -4 -24 BOX 14 01528 , L i Ll- yam 01528 7 iT 1 , ENGINEER �UT4AM`CC UNTY- DEPARTMENT OF HEALTH . 'TROVIDE'. z. Poston otl,�w T m :6it-6m OSA TRUCTION.-coMOUANdt f_60,rstft ---,DISP 'LSYSTEM, CERTIN .0VIDOW �E --Map Loiated at -Tait �Subd.v Block /C' wt # Formerly Tax Map Lot # }separate 5i4varage,9 y stern by _ L E. - Addresf pon 'itti-og of Septic Tank and,' 434Z Other -requirements Z 2, Water Supply: Public Supply From Private I u.pp y D rilled By Address u 0. of Bedrooms Date Permit , IssueO . !.H 'Completed? Has garbage grinder been installed? /VO as �Eroslon �Cdnfroi dean C '4sted . deFry ng' the were constructed essentially as shown',on the pla . na Of the .6ompleted, work 60pi6s that the sksjteiu(6) ap- and a , !6dokrdanda.�with the B; :nalei3 and regi4ations, in accordance, Piled '�by the 6f which�aie`attacoe4), in }Putnam County e �of: Health l A : Date Certifled,b4 P F X. nise N ;09, Addr 4� Lice . r, Any person occupying pr tern(s all pro take, such y be: niecissley to saicure thia,cqr!ectl6n of an unsanitary. I S, s� OT s) su and void -fro . m piior�a I" of "A he' `separate tc shall become null as a public wnitary,�j4Wir%p6ic6mG4,, I - , I 's"OT. '' -_ - I s.,Lgppn I , . - . 6 t 11 Water supply. beco4nin j4iilli6lei Such.­app liavallable'ishel Ihe­�,'aRprP0v t a u �44�i a _kII _iqva s,-.a e , a', ti iui)ject,.to, rii6dijl on.or cha jry th' -itid of ii� sinner Heal c revocaflon, odifl, Ion or change necessary.. (S Title gtWerit i Co Cd, Gate By— L . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Owner or Purchaser of Building d im Builid' g- Constructed by /, Z / le, Location - Street - zakle Municipality Building.Type Section Block Lot Tax Map Number 1&,ea;��e Subdivision Name l0 Subdivision Lot.# GUARAN-rEE OF SUBSURFACE SEWAGE DISPOSAL 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 guarantee to the owner, his successors, 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 approval of the "Certificate of Construction Compliance" for 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 occupant .of , the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environmental Health Services 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 19 General Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk Signature Title Corporation Name (if Corp.) Address ! i | � ' � � � ^ . ; \[ `. ^ , ' F', UL LF_f- i ' / � ---- � ,JE ` � / | ` | / ` � � W 0 � 0 � VA- |H /\("CoxoowUL mI.// ANk |<[CUL0[� YU|NoH CUUW[Y DEP/ 0HD |||L 1- ' U[ |iL0Ll|{ cc ' WOW LOCA Putnam County-DePaltment of Ilealtb I Health services as oted for conformance with es and Regul ' I Lt Date ■ v :la D, 1, 1 li /lJl�'l%IJIlJ( �� IL Y _ - a r / rf u a�. � ` a n - IL Y 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 r��a z alysis:of_yater sample;indicating:WateF t3 9fr.Eatifactpr zatctertal: cdalIrty e4?re: certificate; of _construction.complian s1 = s5�lect; ti REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME John & Patricia Ullrich ADDRESS Yorktown Rd.,Lake.Carmel.,NY 10512 LOCATION OF WELL (No. A Street) (Town) (Lot Number) Bullet Hole Rd., Patterson, NY PROPOSED USE OF WELL jj BUSINESS Lam} DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL El SUPP Y F] INDUSTRIAL ❑ CONDITIONING El (s(specify) ER DRILLING EQUIPMENT COMPRESSED CABLE U ROTARY KJ A R PERCUSSION E] P PERCUSSION ❑ ER CASING DETAILS LENGTH (feet) 0 t DIAMETER (inches) 6 n WEIGHT PER FOOT 19 lbs . a THREADED ❑ WELDED S O X TES ❑ NO �j YES LJ NO YIELD TEST HOURS G.P.M. ❑ BAILED 'J PUMPED ❑ COMPRESSED AIR ( 15 YIELD (G.P.M.) 15 WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) 50-6o, DURING YIELD TEST (feet) Depth of Completed Well in feet below land surface: 2851 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 toast two permanent landmarks. FEET to FEET 0 4 1-ay and boulders - Hit rock at 4 feet 4 30 Drilling in rock,set 30 285 Driliing in rock granite. If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED 12/19/85 DA" F P RT 3 / %l WELL DRILLER (Signature) - 2L, zfz�' r/ ,_ .._ .. „ ..>___. ......._._..... _ - - - BREWSTER=•`L ABORATOREET -� - Box 224 - BREWSTER, N.Y. (914) 225 -2072 - WATER ANALYSIS REPORT - SAMPLE NO. 6107 SOURCE: John Uhrich, Lot 10 Bullet Hole Rd. Patterson, NY COLLECTED: March 27, 1986 BY: P. F. Beal & Sons, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 0 per 100 ml. This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. March 31, 1986 �— 4- s� -r— —— - -�- r - �- x- -- ---- -- — ■ 4 +� _ riALTH ENGINEER TO ,PROVIDE PERMIT if'- dal PUTN AM COUNTY DEPARTMENT OF ~HE �r ON CERTFICAT OF COMPLIANCE, 1 Division of.: Environmental .Heal[h: Services Carmel N. ,Y 10512 PERMIT , CONSTRUCTION PERMIT FOR SWAGE DISPOSAL SYSTEM Patters an.__ •- _ Town or village V Located at B :U 1- e t 'H 01 e 'R 0 a d Tax�Map 73 6iook _ 6 Lot 1 `� Burdick ` W'o o d s S D Su,�d.t N Renewal Revision 10 0 subdivision Owner /Address- John & '. P a t r T C16 ' U'1 1 r 1 C h..- ' Date',Of Previous Approval House 961 A 'Building Type Lot Area: Pill •section only ❑ •1 ,. ; Number of Bedrooms 3 Design Flow G /P /D �+ �0 P C. 'H. D 'Notification 'Required ",Separate sewerageIsystem�'to consist of 0_00 Gal. Septic Tank' and �19 FtELDS To be constructed by Address 1 Water supply Public :SuPPIy From. Private SuPPIy to be drilled by, Adddress ,Other 'Requirements -� /3_1�1�• r �� `f✓� �� . .iI represent that l am wholly' and completely responsible for the design and location of the proposed. system(s).; the .separate, sewage disposal system, above described will be constructed as shown on ,,the-approved amendment thereto and in accordance With standarCS,'iuled : an regu a ions o e' u nam County 'Department of _Health, `and that on corimpldtion,thereof a' "Certificate -` of- Construction Compliance satisfactory to the'Commissioner : of:Healthwill be; submitted •to the Department--and a' written guarantee will be, furnished the owner, his successors, hevs.oipssigns by the. builder, that said builder will Wets in. good. operating con d_tion. any, part of..said, sewage disposal, syti' during the period of two (2) years immediately follovring the date of.tha issu- ante of 'the' approval of the'Certif.icate of :Construction 'Compliance, of the, nal_ system o► any repairs thereto 2)'tliat.the drilled well described above will b'e located asshown on the approved plan antl that said woll will beanstall m ccordsnce ;with <t e,,stan rds ►ules,'and ;regu a ions of tde 'Putnam. I County Department of Health P E Date signed i License TNOU ✓LL- Address ,e�lr M. FCPPROV.ED FOR:CONSTRUCTION T his 'approval'_expnes: one year from the.,tlate issued unless construction. of the Du�ldmg has been undertaken and is eyoeable for cause.or maybe amended or modified',whene sidered net _ss_r .,:by :the Com ioI Iof' Health. Any change ation of. construct ion requires a. new. per APP ►oyod. for ;disposal of dourest mtar = sewage, nd /or rive wa Oate R. Tit .: le UPI KQC* E jJ1,M1*TTED WITH APPLICATION TEST PIT DATA REQUIRED TO B. ST 1, DESCRIPTT Oil OF SOILS T,,"C0TJJ',!TEaRED Ili TEST HOLE-3 DEPTH HOLE- NO.-. HOLE NO. S. HOLE NO. (;_T._ 611, 77S. 12• 1811 JA*PV CdAID 2411 -7.011 3611 4211 4811 L4 04M 5411 6011 SAND 66 7211 ROCK 7811 14, 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO -WHICH WATER-LEVEL RISES AFTER BEING ENCOUNTERED TESTS Date DESIGN Soil Rate Used Min/1"Drop: S.D. Usable Area Provided 50oo 5.9 No. of Bedrooms Septic Tank Capacity 4000 Gals. Type *459wie-Y 4 Absorption Area Provided By xc)_..L-F.x24" to width trench. Address THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: ure Z: sm:� ., =Qn. � 7, L T_13,0 Soil Rate Approved Sq. Ft/Gal. Checked by At rl�% RECE.IVEv- SEP 3 0 1985 PUTNAM coUNTY J)EPT. OF HEALTH h4l LZ 10 1 PUINAM COU1V!'Y DEPAIiIMCNl OF 1iCAL111 DIVISION Or ENVIRONMENTAL 11tALT1I SERVICES COUNTY OFFICE BUILDING, CAIiMEL;..N. Y. 10512 DESIGN DATA S11W1!- 8EPA11ATE SEWAGE DISPOSAL SYSTEM FILE N0. Owner ToNN s PAMem w1rich Address rBUUFT ljotr RA. Located at (Street 0 «4 PEA. oLE Sec. 73 Block (o Lot indicate nearest cross sEreaq MWACIpality. Mfl-eAsa"- Watershed SOIL PEHOOLAT'ION TEST DATA REQUIRED T'0 BE SUBMITTED WITH APPLICATIUHS 7101e Number 10 CLOCK TIME PERCOLATION PERCOLATION Hun Elapse, Depth to Water Water level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 158 -88 30 min 28 32.50 4.50 6.66 228 -60 32 min 28 33.75 3.75 8.50 302 -34 32 min 28 32.00 4.00 8.00 435 -65 30 min 28 31.50 3.50 8.57 1 5 156 -87 31 min 27 28.75 1.75 18.00 227 -61 34 min 27 29.00 2.00 17.00 302 -36 34,min 273 29.00 2.00 17.00 1 r It S E P 3 0 1985 5 PUTNAM COUNTY 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.