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HomeMy WebLinkAbout1653DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34.13 -1 -73 BOX 15 y'L J. .: ., ,. J61 � L'-0--'77 ��r �i J 1 1 01653 t `t AM', CO Divtsronrvof Environri OF 4�$�9El �L N �AAI!°4IAN E — / Located =at • �� /l �' ` � J�° � �d 4 Owner plc �asse s 8 i Separate Sewerage System built by , Consisting of �� Gal ptic k Se Tan n/C /bh ^� - 'Other` requirements ". Water SupPIY Public Supply From 'By- Pr ate'SuPp1Y;Drilled .BY - Address Bwiduig= Type . aL�rrP a,i Has Erosion Control Been Completed r' re l e' s asli3ted ser "vin" the atiove remises w -:. I certrfy+ that the syst mO . ,9 2 -, P_ •;,�, -.: attached) `and in accordance with the standards 'rules andtrey f r % 1. Date .c. ,.:. .� c k . Adddress Any;; per son occupying premises served by the lab ove system(s);,. conditions resulting from such` usage riAppro`val,Yof the sepal available and the approval of the private; water supply sfialf be. sub)ect totimodification =or change when; Fm athe judgment of t Dated .y 1 77 Y ' DEPARTMENT OF HEALTH � M 1l Health Services, Carm% N Y ` 10512 �k � y ';,� t a.EW�4a! POSAfY$TEM �"r4'3?s2 •� a "' � `- � s ' � ,y Town'orV�lla9e� �II- Section Block Lot Joti�`IO 1 G ��� lineal Feet X width trench O � No =of Bedrooms Date Permit Issued �T�� onstructed essentially as'shownon the plans of the completed work (copies of which are . ms, plans fiI and the {permit issued by r the Putnam ° County :Department of_Health.. fled ` • P E R Ay License Noy u� promptly take4such action as may, be' necessary to secure the correction of ,any 'unsanitary sewerage system.shall become null and void as soon as a 'public', sanitary,sewer becomes : null Viand void when a ?public water 'supply becomes available, Such •approvals are Comni�ssionerof Health such revolat�on modif:iwtioh,or change 4 necessary -' -99 321,KearStr et:,_ DATE COLLECTED �RESULTS OF EXAMINATJON OF WATER OWNER DATE RECEIVED ,SAMPLING POINT:, WELL­� LOT I­ -BULILETHOLE RD PATTERSON N.Y. LESS THAN 2.2 rmWA.lT.m(ASCP)' � ^ '| ------------- -- -`` - ^ ' � ' . | ~ ' | WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING CARMEL, NEW YORK 4 .et itwd�!-.7i_cou Pty._-,HealtK -DeRaa-mew _Vgejl­_,er-,w_ith:Jahjn; ratory_--.rqpt W 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 NAME ADDRESS OWNER McGlasson Builders Carmel N.Y. LOCATION (No. & Street) (Town) (Lot Number) OF WELL Bullet Hole Rd. Patterson N.Y. Lot #1 BUSINESS PROPOSED R DOMESTIC ESTABLISHMENT FARM TEST WELL USE OF WEILL PUBLIC AIR OTHER 11 SUPPLY INDUSTRIAL CONDITIONING (Specify) DRILLING COMPRESSED CABLE OTHER EQUIPMENT F1 ROTARY A AIR PERCUSSION PERCUSSION (Specify) CASING LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT DRIVE SHOE WAS CA—SING GROUTED? DETAILS 45 7 26 THREADED [:]WELDED ii YES F1 NO 0 YES NO YIELD HOURS G.P.M. YIELD (G.P.M.) TEST BAILED PUMPED COMPRESSED AIR 1 2 25 25 WATER MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST ffeet) Depth of Completed Well LEVEL 2 total drawdown in feet below.,L.and surface: 200 SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE DIAMETER (inches) IF GRAVEL Diameter of well including IGRAVEL SIZ ' E (inches) FROM (feet) TO (feet) PACKED: 4ravel pack (inches): DEPTH FROM LAND SURFACE Sketch exact location of well with distances, to at least FORMATION DESCRIPTION two permanent landmarks. FEET to FEET 0 35 sand and bankrun 35 200 ledge well is connected to well next door If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL )Royd A . Oezlan W611 60., 1 R. COMPLETED DATE OF REPORT WELL DRI LLE�' (jignature) 52 3 A1,4 �c AZ3 7/2OZ7 I g -2 ?'044 4- e� Jr - z Owner or Purcs'iaser cif building' Building Constructed.by Location - Street . �rgir,E Building Type Kinicipality ,. 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 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 initial use of the sewage disposal system, or any repairs made by me to such system, except where the failure to operate,'px•operly is caused by the willf-al or negligent act of the occupant of the building utilizing 'the) cvctam 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 _ c ause_n..by thewillful or., neg:!, gjent„ act of the occupant of the but ding >> t i.?_izing fine system.. Dated this .,? day of J 19a Signa Title (ir corporation give name and address) AV_5V:aQ'- ,12 --- - - - - -- -----=-------------------------------------------- - - 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 PUTNAM COUNTY DEPARTMENT OF HEALTH _. - - - - . DIVISION.. 0�' F,�]VI�tONMENTAL.,HEALTH. SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512._ DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM. FILE NO. Owner �� sson 9,0;AdPMxkddress ,w Ile I` b &o a 1&h9 V4 5410. Located at (Street.' �,;,� $�, Sec. Bock- Lot .� nearest cross s.ree Municipality,pa . s ®„ Watershedo SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH;APPLICATIONS Role Number CLOCK TIME PERCOLATION PERCOLATION apse 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 1 2 Zg . /o ?0 6 .f 3 /03 4 5 you 4 \ 5 .. Notes: 1)' , Te'�ts to be repeated at same rates are obtained. at each percolation for review. , . 2)' Depth- measurements to be made depth until approximately equal soil test hole. All data to be submitted from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH 'HOLE NO.- HOLE N0. HOLE NO. G.L. 6,.. . 12" 18" 24" 301 361 " �+2 48" 54"1 60" 66" 78« .. . 8411 INDICATE LAT OG OUND WATER IS ENCOUNTERED �✓ h/�e.� .�'so�►ti INDICATE LEVEL TO CH WATER LEVEL RISES AFTER BEING ENCOUNTERED V Av/va/ 01►d11% TESTS MADE BY Pere . �. Soil Rate Used / DESIGN Mi Vl "Drop: S.D. Usable Area Provided ��i�► No. '.of Bedrooms 7� Septic Tank Capacity /f0® Gals. Type /_ Absorption Area Provided By y3 %. L.F. x24 b ✓ width trench. Iii' // Se,�� a r�•�n___ �a�io_� .� �i _�_m/J��. e/�� Other _. - - -- - -_� pFtS�iu�r Address R. D: 6, Box 953 EA annpl t4pi r Yod 100 ytiJ�r* H. PR�y� /sue �tF THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: � G Y Soil Rate Approved Sq. Ft /Gal. Checked by 2g2a6 0p TNf $t :PU$NAM COUNTY DEPARTMENT OF HEALTH 4 Diiiisron` °of Enwronmenra/ Health_ Services, ;Carmel ,N Y .10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Patterson, i Town or Vrllage LocacaSo. I I; I, P I ��Cr i R(1 Twl n Acres Sub'd subdwision Lot ( VJob S01048 i owner McG l assort Bull >ders Inc _ Address 93 vG l ene i da °Avenue y a ` A New�3York'° (0512 B ildm9'TYPe Frame Lot Area I 000 Carme( , y Number_, of Bedrooms Three £ _ Y Total Habitable Space I25D� Dn lit 'Flquare;Feet Separate. Sewerage System to consist of` tr 1 000 Y Gal .Septw Tank p.. - 480 lineal feet X 36: -:I nch • -width drench " =To be constructed' by r ? ' Address IV Water suppiY PubIic'Su poly ,_IF: m ro ' k,k Private' "Supply `.to be dialled by Address otherRegwrements F °1 I i Section 128' f` L x 45`t Wx Deep e her i 0. I represent that l - -.am wholly and :completely responsible for the des�9n and IocaUon of the ,proposed- systems) 1) that the .separate sewage, disposal system - 1 above described w,ll be constructed as shown on the approved amendment there to and ur`accordance with the standards; rules an regu a ions o ..A he Putnam County,;_Deparfinent of ;Health, °and thit'on con pip. ion thereof a,!`Cert�f�cete of "Construction Compliance' =.aat�sfactory -to the Commissioner "of Health will be..submitted to' the ,Department; and 'a ?wntten' guarantee wUlbe furnisfied the'.owner .his successors heirs or assigns by.the builder thaYrsaid builder will place: in "goodoperatmg condition any, part- 'of, said sewage disposal system •during the -perwd of two (2j..years.inimediately; following the date of, the issu= 1 ance.'of the approval of.`the Certificate of . Construction •Compliahce of tthe original system or, any repaiisdhereto; 2) that,thedrilled vrell.destribed3above _twill tie: located as shouvn on the approved plan and thatrsaid' well will be installed m; accordance with; -the startilards, rules and; iegula ions of ahe Putnam , i County Department Of Health t r.. ,17 8/73 P.E. X. RzA Date _ - S.i9n h Address License,No. 29206 �, ed { RrD 6 B 35 , APPROVED FOR CONSTRUCTION ..This approval expires one year from the date issued construction of the bull "ding has been undertaken ;and is ;revocable- for cause toe-May be amended or= modified when considered necessary by `the mm�ss�on r of Health Any change or alterat ion -of construction regwres a new permit ..A proved for disposal of domestic `r s age qr rrvate r. supply only : _ � k o-} `. Date '.,. � ` -. ' � •r "BY Y F r t �-"-�. 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