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HomeMy WebLinkAbout1631DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34.13 -1 -25 BOX 15 01631 ;. IL ; yr ;, �r �. . �. Li 16 OL Lis I Ill r : . , .0. . a-4 I ■ . 01631 �i� attached) ani in 'accordance WIMilie sfindards U "il_,.ie Date i? kny i_ person o( served conditions resulting from. SUC Approval of the �% available and Ahe'appro4al of the,'prlVate water supply hall b Date By4 :i R1 MNMMNFVjBP11d1M .e s , fl 44 akAI I verage system shall - i'lbeedffie,,nUll 'and,vold jJIj, and void when a ,R.4MC !water sup u h .free oca n, riioOV,of'Health. to s!�cure•e correction of any unsanitary soon, as,' a,.pUblic sanitary sewer becomes �aqomes available. Such approvals are dIf1,Mt16 -pr, change Is necessary. 6� Title A 0�- _0 , DEPARTMENT .OF HEALTH- PUT I NAM COUNTY Ca el, N. Y. 10512' Division d Environmental 41th- 'Se' es r1fic" rm E IC 60ZJ&6'N ST R U'CT 10 N OOMPL O *'JFOR SEWAGE QISPO SA,LSYST M 7, Town or V ': Located at 41e4 I§Iodk -'0 Lot J01%, 406 t"641 47' Address J. Separate , Sewerage System bu)It by Cle-Aegg-J, Al, /41:5-Z) . Consi& beef -,x sting t-�.4 width, trench C" Other requirements ��� - Mater '.'SupO1y::Public , Private S�up xq r I I I B y 'g-00®RWO A, aBuilding I�a Date -Type PRE /V . Has Erosion :.Control Been -complete-. 1, certify that the '.,s-yitiirh(s)'ai,liitddcoeVini,,thd"iboiii'pi�e- iiels` (I A ChOW6 4 f Which are �i� attached) ani in 'accordance WIMilie sfindards U "il_,.ie Date i? kny i_ person o( served conditions resulting from. SUC Approval of the �% available and Ahe'appro4al of the,'prlVate water supply hall b Date By4 :i R1 MNMMNFVjBP11d1M .e s , fl 44 akAI I verage system shall - i'lbeedffie,,nUll 'and,vold jJIj, and void when a ,R.4MC !water sup u h .free oca n, riioOV,of'Health. to s!�cure•e correction of any unsanitary soon, as,' a,.pUblic sanitary sewer becomes �aqomes available. Such approvals are dIf1,Mt16 -pr, change Is necessary. 6� Title Q�2 op 0'0:­ . - SZ049 &r(99 -sw4arf. --A ding Constructed by • Loc on - Street Block Building Type 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 saiad 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 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 Director of the Division of Environmental Health Ser- vices.of the Putnam_County.D_epartment of sed Health as to whether or not the erate' was P failure `of�the' s stem tb -o " cau 't� tYie willful or -ne 1i erit� Y . act of the occupant of the building utilizing the system. Dated this day of 19 Signatu l Title (If corporation, give name and address)�,� o - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 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 431r71 ELL COMPLETION REPORT t` z PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING CARMEL, NEW YORK This report Is to be compl'f ad y well —diiller and submitt@176o Comity Healiii Depa�tmerit iogetl e�- with "falio�atory 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 McGlasson Builde s, Inca 21 Avery Road,Carmel,New York, (No. 6 Street) (Town) (Lot Number) LOCATION OF WELL 22 Hi -View Drive Patterson New York. Lot # 22 ❑ ❑ ❑ PROPOSED DOMESTIC ESTABLISHMENT FARM TEST WELL USE OF WELL ❑ ❑ ❑AIR CONDITIONING El OTHER (Specify) SUPPLY INDUSTRIAL DRILLING © COMPRSED ❑ ❑ CABLE (S(Specify) ER EQUIPMENT ROTARY AIR PERCUSSION PERCUSSION CASING LENGTH (feet) DIAMETER(lnches) WEIGHT PER FOOT ❑WELDED S O YES NO CASING YES LJ D? NO DETAILS jF2 1 61t THREADED HOURS G.P.M. YIELD (G.P.M.) YIELD ❑ ❑ TEST BAILED PUMPED COMPRESSED AIR 6: HtD.pth lO lOo WATER MEASURE FROM LAND SURFACE-STATIC (Specify feet) DURING YIELD TEST fleet) of Completed Well LEVEL 181 18 1 ' feet below Land surface: 95'.. MAKE ILENGTH OPEN TO AQUIFER (feel) SCREEN DETAILS DEPTH FROM LAND SURFACE FEET to FEET 0' 42' 21 1 rrl nr_1 IF GRAVEL Diameter of well including ' " - --- _. -' _ PACKED: gravel pack (Inches): FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE 651 4 8o' 7 95' 10 �VA -c t w D IF � E uAIc Wes► UMrICI[V DATE O RE ORT WELL DRILLER (Signature) � i���a. �za %a. 1141, m. ti d - - -- �REWISTER LABORATORIES Box 224 - BRMTER, N. Y. WATER ANALYSIS REPORT SAMPLE PTO. SOURCE: Rld rd Rt&Gi as-904 faueet H too COLLECTED: ' 19 ;* BY: Aid ddKe-Glas.04 BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method This result indicates the . source of the sample was of satisfactory sanitary quality when the sample was collected. App° i 8 2? 1972, Q Per 100 ml. AC(C_�" Boy Bickwit P. E. Director T _ PUTNAM COUNTY DEPARTMENT OF HEALTH y p /vfsfon , Envfronm of entl Heali'hF Services Carmel ;N Y 10512..: CONSTRUCTION PERMIT FOR :SEWAGE DISPOSALiSYSTEM, o,r-f � wn or irmoge - �h�L�� Located at BIOC, SubdiVi ;ion Job - Owner F `Gd S5'e p� p C/ !P� i Address Building TYPe t_ot ,AYea ' .T a Number ..of Bedrooms /P ° Tofal Habitable ASpace Square' ;Feet x M. Separate: Sew,er'age System to cotlsist 'oi �d B o Gal Septic Tank , �7 lineal feet X — —_ width trench c. To be constructed by Q��/y P t Address Vf s• ublic .Supply iv Water Supply P: t Y d y •" , r - J ar r Z 9< v y y I�, i ., A L Prate Supply, to be drilled by ' F A a Address , ' ­Other 'Requirements � it represent that .I' ampwholly +and completely +responsib lefor'thedesign and location of the.,proposed ystem(s); 1) that the. sepa rate : sewage disposal system, ;above described .will be',eonstructed as. :shown on •the approved amendment there to and in accordance with the,standards, rules an regu a ons o e u nam County',iDepartment of,; Health, :and that on completion jthereof,A "Certificate ofAConstruction Compliance -': satisfactory'to the Commissioner of Health will be' submdted #o the .Department arid. a written'jgu _p pWppq, „Nis,e"cessors heirslor' assigns by th'e builder, that said builder will pp ace. in, good operating `condition_ any part of !said sewage d�s`p_ "osal iysfdm iduring the peiiod•of iwo`(2) years immediately following thedate of the 'Will Dance of',,the approval of the Certificate.rof Consfructwn?Compliance of -the orkigrtial system or.any' repairsahereto 2) that the. drilled well „described above if will be located as shoWn;on the approved plan and that said well wyllMbe' installed in ',accordance with the standards rules and regula.i— f`ons' of tAe Putnam Cdunty'Department of Health zDate 5 'P E. � RA. Address lw r 0 ice nse No. ��+�.• .. Y,4, .„q..�. d y, _ •r 1 requires a n 4 ar. r .:Date 91 5 +• a A I,, A < .. dt CONSTRUCTION. ?This approval expires one�year from'the date, issuedrii nstruction of`the building has. - ;been undertaken and'tis or may -a en ed'or modified when considered nec` scary by.,,the Co issioner of Health ?Any change or aiteratio-P of,,construction rm /it Approved for disposal of domestic w e aid /or pr ate at ,.supply only t � gy _ Title JI r PUTNA�1 COiJ`TY DE? =?TNT NAT OF HE =.LTH DIVISION OF ENv��'IRCN:N'` _AL HEALTH SE?G10ES DESIGN DATA SHEET - SEPARATE SE:•::AGE D I S 0SAL SYSTE`f FILE NO.. .. • .... oi�:ner ��� %������' Address �< �/'• Located-at (Street). //� _ �:: Lot,l� : (Indic ate. nearest c rb ss street) Ar nie ip "ality . ��jf ®fig _ tdatershed SOIL PE'RCOLAT'ION. TEST DATA REOULRED TO BE SL'"nNiITTED WITH APPLICATION Hole Number. CLOCK TIME PERC0LATIONT PERCOLATION. Run Eiaose Dep �.. to Later " Wv ttbr bevel No.. Time From Ground Surface in ",Inc'�es Soil Rate Start 'Stop LLin. Start Stop T 'Dr`a` "o ` fifin/in :•dro.p . Inches Inches:. Inc, ie s lot 2 3. Yt }Fhfs'.W�� 4 • S dA / ®'' l ® ; lot Yt }Fhfs'.W�� Tyf x l Notes :. 1) 'Vests to. �e °•reputed' at sa<<e depth u: til. approx; tel equal soil rates are ob -- tained ea d.h percolation test hole. all data to be submitted for review. ,at' 2) Depth measu.re.Ten'ts to be :'made from top of hole. T ff R.8D DESCRIPTION OF SOILS E 0 U.NT E R.—E D IN 'EST HOLES HOLE iz�b TO DEPTH­ HOLE 'TO ,,.,,..HOLE ZA 6ft tt 66-7 12" 78" tt n- /5o(3 (?43. A" A 7% I L\-'D I C A TE LF�TL C H GRbUND 'HA TEE R IS EN C OUN TERRE e6ciQ -I\ G INDICATE LEVEEL. TO WHI Cl T E R LIEVE L RIB.' EE -:3 AFTER. Br-..L._ EL TESTS BLADE. B Date, 0 7? Soil. Rate U s min/l D 7-r op S.D. U s ea P-L ov I a�l No. of -.Bedroo:--q Septic T a 7.1-1 - C p I t y Gals Ty.pe__,-�VARnQ1> Absorption r'lrea Provided By L.. F. x 2 3061r''d t+.,idtrl trel-,Cri. Other 0:01 John N..Prentlss- P.E.--!C.E.C. Name Sic--atu Address. R* 0 6, B 353 EAL a M-Y IUM PU TNAM COUNTY DEPARTHENT I OF HFa.TTH Soil Rate Approved . Sq. F4L--./.Gal. tp 0. r ►I E S Nit Checked b, : Date 414, ' t 30 OAt IO.p�t �,m4 32 tt �rx i ..•i'�� �•x �Z_. 0�01� 4•. Sot: }jj ;.tl?g.S / I UC�TION \J,p_ 0 d 4-C I S_oi�?S� e: All. 1 , ✓ t 1 '� -• i c7 ° � �'�1' �1 iV '�1� -r,.! �1�,.Yxr '� .; 5 1 / i�✓,1 v.�� .. ` N�,