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Home My WebLink About1670DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34.17 -1 -19 BOX 15 I SON I I No y I a I� . 14 No N -� . IN , �a �t ; IN, ,.` , r o N No 01 i Fit I II 16 XiI.L. 01670 Located at Owner/i Mailing Address Mme Separate Sewerage System built Cohslsilnj of PUTNAM COUNTY DEPARTMENT OF HEALTH Divisloil, of Environmental Heilihtirviceei9 Carmel, N.Y. 10512 Engineer Must Provide P.C.H.D. Permit # IRIQCTIQN!C, -QMPUANJ&.FqR-SEWAGE DISPOSAL SYSTEM 0— Town or V '11!8) Tax Map -ilock at Lot Formerly Subdivislon'Name Subdv. lot # V C-0 Zip 1-061 Z* Date Permit Issued C4i?dIj e, ly Z4 zj Pr n C) Q Gallon Septic and 2, qI <e)o (nx- Water Supply: Pnhile Supply From Address or: v Private'Sup oly Drled by 4 Addn Ws Building Type - JZ&5 12� 4 ci, Has Eroslon,Coniml Been Completed? t1lo Number of Bedrooms Has Garbage Grinder Been Installed? Other Requirements I certify that the.qystem(s) as listed,,serving the a.boye premises were const d ease ati F'�s shown on the plans of the completed work copies of which are attached), and in accordance with the standards, rules and red aTatiAns; , County 6' tm plan, and the permit issued by the ,pfi enTifHealth. Date - 6 Putnam i Cwtifled DY P.E. L"/ R.A. MAddress License No. 1-5 5ZL-S Any person occupying promises served b y:the above system(s). $hall • promptly take such action as may binecossar y to secure the correction of any unsanitary conditions resulting from, such usage, Approval.of the separat, je, sewerage.•systern shall become nuil.and void as soon as a pubt% unitary sower becomes available and the approval of. the private water supply shall become null and void when a public water supply becomes available. ' Such approvals or 'a Subject to Modification or change, when, i in'the JUftmeirli of tfiG -C60hm issidnir of 148alth, such revocation, modification or change ,Is necessary. Oats 5 Title In M WELL COMPLETION' REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 e. Division of Environmental Heelth Services COUNTY OFFICE BUILDING • CARMEL, NEW YORK This report is to be completed by welft• 1ler and submitted to County Health Department together with laboratory report of analysis of water sample indicating water is of satisfactory bacterial quality,bef ore certificate of construction compliance is issued. REPORT .M — BE - S09MITTE6 WITHIN 30 DAYS OF WELL COMPLETION AME ADDRESS OWNER i LOCATION _ (No. A Serest) (#own) (Lof Numbed OF WELL PROPOSED �1 ROTARY DOMESTIC E] BUSINESS ESTABLISHMENT FARM LENGTH (lest) TEST WELL / USE OF . ❑ LIVE SHPF,—_ X CASING GR DETAILS WEII I SUPPLY YES INDUSTRIAL D CONDITIONING D (spe i r) DRILLING EQUIPMENT �1 ROTARY COMPRE55to AIR PERCUSSION CABLE PERCUSSION (specify) CASINO LENGTH (lest) DIAMETER (inches) �� WEIGHT PER FOOT . ❑ LIVE SHPF,—_ X CASING GR DETAILS /� THREADED WEIDED YES NO YES NO , �� YIELD TEST BAILED HOURS PUMPED COMPRESSED'AIR G.P.M. YIELD (O.P.M.) MEASURE FROM LAND SURFACE— STATIC(specify feel) DURING YIELD TEST (test) WATER Depth of Completed Well LEVEL In feet below Land surface: 91-0 O MAKE - LENGTH OPEN 70.AOUIFER Cheri 4 R 6 U-4 7<9 Owner or Purchaser of Building Section S }, _.. ..:..� _ ]3uildin Gonstructed"�`b "' � b °ac ' --•- •� r.•_. - - =-- 41 Location - Street Lot ngp'50 Municipality Subdivision Name s IF D Building Type Subdv. Lot # GUARANTEE 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 guarantee to the owner, his success- or`s, 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 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 determin- ation of the Director of the Division of Environmental Health .Services. of the Putnam County Department*of Health as to-whether or riot the - fail'= ure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system.. A/ e. Dated this ��_day of 5 19 Signature ' Title ��jeJ &P"I Ali eL XP4, Corporation Name if corp.) Address 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 1. 'TION PERMIT SEWAGE M , 8R( ",, Other :,jReqUireylpp!s alig.veApscritAo will tie,i 4nZe df', "aPProva �C will be ',Ciiat County. '`Department of, , A PP R OVJE b� F 0 R,,-:,,CON' ``revocable for cause orxri cl i`7 ne"krniC squires o4i, -cliij�pilflbf d6 _A HEIV A/ MIM1111 --HEALTHf xx Permit 0 1z -c,,,,�, Town 7or V liage, 'C] Revision revious,. pFr Notification Required � �' d systems) d I hat tW �siparate seWa§e,,dispLo �iaI i s yiteffi awitp thq;stanj#fds, rules and reguliiitions-pf. Ahe_ Putnarr, ,mpliiike�!""satisfactory . I I c Winiss ( to the 0 loner of,Health will issors heirs o► assigns by the builder; that said builder g,th6clkale of the i •repays thereto hat 6i drilled... well described above e. itincards,ru!ps. a_ n i _ ,reg. ulav—�Bf the Putnam . 'JiEense No ton it rotfi�oh of the.buAtling 'aken "and; is Hof Health. Any. change or,- alteration ,:o'U,'- Fonstruc,lon, eT ilia ,M PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION. OF ENVIRONMENTAL HEALTH SERVICES ~- R`COUNTY OFFICE BUILDING, CARMEL, N. Y. _ 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner ?A 6 L-/•4 Address A" 0cGr AV FHB Z--Si . ?,977JEZ T J - VIF o -DZl e.. t Located at ( Street) e Sec. /8. Block 2 Lot / jj di ca es near cross smeet) Municipality, /00r4 4 'a? r-zso rtL Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Dep o Water Water ve No. Time From Ground Surface in Inches Soil Rate :Start-Stop Min. Start` Stop Drop in Min. /in drop Inches Inches Inches 17 3 5;5A 3 � gs o rc, _/D Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. a - 5 l 2 3 5 Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. G. L. 611 1211 181", 2411 3011 3611 4211 4811 5411 60". 6611 7211 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS-ENCOUNTERED IN TEST HOLES • HOLE 1V0. M r M _z 78 84 INDICATE tMt AT WHICH GROUND WATER IS ENCOUNTERED INDICATE..LEVEL T' HIW -WA jER LEVEL RISES-AFTER-BEING ENCOUNTERED. TESTS Y -1 Date I/ IADE Tf. DESIGN Soil Rate UsedS -/0 btxVl"Drop: S.D. Usable Area Provided 6D7, No. of Bedrooms -Septic Tank Capacity /000. Gals. Type Absorption rea ProvTd—ed By_,%6_33.L-F-x24" ......... 36" widtk�Z ;rent TT.— CF Name V.&IJ ft. Signature i _1 Address _ OeG;—, L.Ake,, N—J SEA' - 2 A* THIS SPACE FOR USE BY HEALTH DEPAMENT ONLY: Soil Rate Approved Sq. Ft/Gal. Checked by - .?.::? -ri: :.=s•::q.Ml`:.•r; rt.- xa:i+!} +':_:�. ^.: - �: kr �- .-ir.,�,_T :•:' ic-. a. �r. �_.. +.- ,e�- ir.,.r;.t.+iriec-- :•'�•.: _ ... . PUTNAM COUNTY DEPART OF HEALTH - DIVISION OF HEALTH SERVICES FIELD INSPECTION:. REPORT s DATE. ��✓ G�� -� C��` �-w °1 �'�lo INSP. BY: (Name of Owner ) (Street Location) INITIAL SITE INSPECTION YES NOI COMMENTS Wetlands on /or proximate to property .............. Property lines or corners found ................... Can estimate house location ........................ _ Willdriveway need cut ............................ Must trees be removed - note these................. Dee hole - representative of entire SDS area...... Ad itisnal deep holes needed ................. .... S fficient SDS area available considering driveway cut, house location, separation distances etc... Adjacent wells /septics ................. Access to proposed well location for drilling..... D. H. 1 Lot Depth to G. W. Depth to rock Soil Descri ti 0 ft. 3 ft. D. H. 2 Lot 9/ "��pth to G:W. pth to rock 1 0 ft. ~r 3 ft. 6 ft. 9 ft. \� 12 ft. r 6 ft. 9 .ft. 12 ft. Soil Descrl tlon D.H. - Deep Hole G.W.-- Groundwater D. H. 3 Lot Depth to G.W. Depth to rock 0 ft. 3 ft. 6 f t. 9 ft. 12 ft. Soil Description FINAL SITE INSPECTION INSP.BY: YES NO COBS House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Roan allowed for expansion trenches .............. Over100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded............................. 10 ft. maintained fran property line and 20 ft. fram house .............................. Distance well to SSDS (ft.) ..................e... Number of bedrooms checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. fran nearest trench ................ 15 ft. of peripheral soil horizontally - fran trench ..... ............................... Boxes properly set.,_ ..................... Could surface runoff frcn driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FTTIAT. r,RAT1M OF STTE ACCEPTABLE..... . .... a .. . ;t.3Y-�''- x?" -;•- - rb• ..KAC;✓ }= °�.,"F«a'.:;..•- - ^•w.r ys,v�..,w;sasrer= ;_. '+F•.:..,.ra•"„d.?�'`,;,i7^��' Y - •:.._..y s> .. .. ....- �.`;'...... .._. .. -Z 4. PUTNAM (AUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIELD INSPECTION REPORT DATE:. INSP. BY: ( Name of Owner) (Stfeet Location) INITIAL SITE INSPECTION YES NO Wetlands on /or proximate to property Property lines or corners found ............: Can estimate house location ......................... Will drive<.qay need cut ............................ Must trees be removed - note these................. Deep holes representative of entire SDS area...... Additional deep holes needed ...................... Sufficient SDS area available considering driveway cut, house location, separation distances;etc... Adjacent wells/ septics ............................ Access to T)r000sed well location for drilling..... D.H. 1 Lot Depth to G.W. Depth to rock Soil DescriDtio 0 ft. 3 ft. D.H. 2 Lot Depth to G.W. Depth to rock 0 ft. 3 ft. 6 ft. 6 ft. 12 ft.l I 12 ft. Soil Description FINAL SITE INSPECTION INSP. BY:! House SSDS located per approved plan.. .. . Length of trench measured Width of trench average r� Slope of tile line and trench acceptable....:.... Roan allowed for expansion trenches........ ....... Over 100 ft. fran watercourse............ ...... Natural soil not stripped or SDS area unnecessarly graded..................... . :.... 10 ft. maintained fran property line and 20 ft. fran house.. ........... t Distance well to SSDS. (ft.) .......�1..`�.: Number of bedrooms checks ................ .. Stones, brush, stumps, rubble, etc., great than 15 ft. fran nearest trench.. ........... 15 ft. of peripheral soil horizontally fromtrench....... ........................ Boxes properly set ............................... Could surface runoff fran driveway, roads,. ground surface, etc., channel near SDS area.... Tk�a-q Int. Ara i nnaP annear. OK in area of SDS. - - _ _ _ . CC M ERrS D.H. - Deep Hole G.W.- Groundwater. D.H. 3 Lot Depth to G.W. Depth to rock 5011 Descri 0 ft. 3 ft. .6 ft. - g-ft.. 12 ft. MOMMEME A6u1u131 ��t., PUTNAM COUNTY 1ND- �.v..s � v rqr MENT OF HEALTH - DIVISION OF M"AMONMENM. HEALTH SERVICES %L WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEM . FIELD INSPECTION REPORT DATE: 1"'r INSP. BY: (Name of Omer) (Stfeet Location) INITIAL SITE INSPECTION YES NO CQMMENTS Wetlands on /or proximate to property........:... Property lines or corners found ............. Can estimate house location .......................: Willdriveway need cut ............................ Must trees be removed - note these................. Deep holes representative of entire SDS area...... Additional deep holes needed ...................... Sufficient SDS area available considering driveway cut, house location, separation distances etc... Adjacent wells /septics............................. Access to proposed well location for drilling..... D. H. 1 Lot - Depth to G.W. Depth to rock 0 ft. 3 ft. 6 ft. •. M 12 ft, D. H. 2 Lot Depth to G.W. Depth to rock 0 ft. 3 ft. 6 ft. - - .._..._ 9 ft. I ` 12 ft. Soil Description D.H. - Deep Hole G.W.- Groundwater D. H. 3 Lot Depth to G.W. Depth to rock Soil Description 0 ft. 3 ft. 6 ft. 12 ft DATE: �T., YZ:,S I NO I - C:'N'TS . . FINAL SITE INSPECTION INSP.BY:/ House SSDS located per approved plan.. Length of trench measured Width of trench average , Slope of tile line and trench acceptable....:.... Roan allowed for expansion trenches ........:... >. Over 100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded..................... ...... 10 ft. maintained fran property line and 20 ft. from house.. . ...... ....�: Distance well to SSDS (ft.) .......f! :� : �. Number of bedrooms checks .. . • Stones, brush, stumps, rubble, etc.,great"�- than 15 ft. fran nearest trench................ 15 ft. of peripheral soil horizontally fran trench.................................... Boxesproperly set................................ Could surface runoff fran driveway, roads,. ground surface, etc., channel near SDS area.... n'.-G int. RrainaaP annPar OK in arpa of SDS_ _ - - _ - . v PUTNAM COUNTY DEPARM92 T OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FJMD INSPECTION REPORT h l/i �. DATE: �y' INSP. BY: (Name of Owner) (Street Location) INITIAL SITE INSPECTION YES NO Ca*a2 TS Wetlands on /or proximate to property ........:..... Property lines or corners found................:.. Can estimate house location—, ..................... Will driveway need cut ............................ 4. Must trees be removed - note these............... Deep holes representative of entire SDS area...... Additional deep holes needed ................... Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacent wells/ septics ............................ D.H. 1 Lot Depth to G.W. Depth to rock Soil Description 0 ft. 3 ft. 6 ft. 12 ft. sa-�y D.H. 2 Lot Depth to G.W. Depth to rock Soil Descriptiol 0 ft. `377 14 3 ft. off 6 ft.J' O, ft, _ a,Lc'G/ 12 , D.H. - Deep Hole G.W.- Groundwater. D.H. 3 Lot Depth to G.W. Depth to rock 0 ft. 3 ft. 6 ft. ft... 12 ft. DATE: FINAL SITE INSPECTION INSP. YES NO C'CFTS House SSDS located per approved plan.. . ........ Length of trench measured 3 � Width of trench average Z l Slope of tile line and trench acceptable......... Roan allowed for expansion trenches .............. Over 100 ft. fran watercourse .................... Natural soil not stripped or SDS area unnecessarlygraded............................. 10 ft. maintained fran property line and 20 ft. fran house.. ....... Distance well to SSDS (ft.) .....C1. �.. . Number of bedrooms checks .................... Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench ...............: 15 ft. of peripheral soil horizontally. frantrench....... ............ .............. Boxes properly set ............................... Could surface runoff from driveway, roads,, ground surface, etc., channel.near SDS area.... Does lot drainage. appear OK in area of SDS....... RAMS r=i �■ � r v No , MNE��! V t It Iz ' C�9 / & � � 0/ ' I N ^o r xx _ •�7 � i •. 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