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HomeMy WebLinkAbout1845DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35.06 -1 -31 BOX 17 7 . 1� 1� 1�i NIL ' IN f . �- ,� 01845 x CHANGE ;OF �aOinINERSHIP . RMIrl' PS u ISStTE PUTrNAM - COUNTY DEPARTMENT, O v Drvisron of EnwronMdht.V (Neal h 5ervrces, e^,arme CER I,F,ICI E, CF CONSTRUCTW GQ �4M� F6R SEW 'E , 6iSP L � Meadow Rid e Ro section Located ,at orrester Bu Owner - Lot;F Separate ,Seerage System bwlt by ` B 1 ti Address w P C conc z Corsistin of 1000 ` i 315 f t g . Gal ;'Septic :Tank lineal F Other requnements - r r,,.-. Suopiy Public SuPPIYt From y j 'Private °:Supply ,Drilled �By �� :Address = t - :Bwlding VType Re S1 "dente. > o No; of Bedrooms as Erosion Control Been H Completetl� r ti I' certify that the system(s), as Iisted'servmg t_he above premises were constructed essenti y,, �ti 1 Attached). and_..in accordance with ,the`standards',rules and regulations ,piaris' filed; a bier 4 Date , ` June : - 2 , -19 7 2 Certified by _ Address 2 =- Any person occupying premises served by the above systems) shalL'promptl "_ ke such conditions resulting fr. m such.,,usage Approval`: of theiseparate sewerage system shall b , available and ,the a pp pproval. of the.;piivafe water su ly'shall become null and void: when a pu subject; to modification -.or change; when _,in the judgmei of they,Commissioner of :Health tsucl Dat l 747;22L By IV wNAP!IE__,QFN TfiEODORE UkST HEALTH - �N= �TENd. 'S 6, s ° Town or Village ' f Block a e prinq ea ows r _ 18 V, r Job t Brewster � -New York �- " - - 1 txX ` 4 width trench bate-rmitlssuad D 7q ei- 49 ;. e "pl f t completed work ,(.copies of which';,are. _` d y t e fna C unty Department of Health r - ��� 6 secure the correcf do or any unsanitary SBg:�i) '' s soon'as a public sanitary ewer becomes, P.0-1y; ; becomes available Such "approvals revocaUOn;umodrficaUon or 'change :`is necessary c WELL COMPLETION REPORT PUTNAM COUNTY Dl:PARTMPENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK _" __ .... _ ....._: IJ+ is�epo� .is:xo::hew�orxspleied.,�y..:a/ 811.: drill e�= ax�cl:: subm4tted�c�:. Gount�r:: H. e�lil�. Qepari_ r! iel�t: xngeitlerT�nl�th.:, laba�tory .7aporL-�.f.;; ;_.r:��..- _., 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 BOYD. ARTIES IAN "WELL RFD 3 DATE WELL CO PLETED DATE F EPORT WELL I LER (Signature) fjUUM 02 3 Z2 f CO, i' NAME A ADDRESS OWNER o. & Street) ( (Town) ( (Lot Number) LOCATION o _164 OF WELL S Sk _ BUSINESS ❑ T PROPOSED D DOMESTIC ❑ ❑ ESTABLISHMENT ❑ ❑ FARM ❑ TEST WELL USE OF WELL ❑ ❑ S ❑ I ❑ CONDITIONING O OTHER SUPP Y ❑ INDUSTRIAL ❑ ) DRILLING ( (7,-.0 OMPRESSED C CABLE O OTHER EQUIPMENT ❑ ❑ ROTARY U U AIR PERCUSSION ❑ ❑ PERCUSSION ❑ (Specify) CASING L LENGTH ( feet) D DIAMETER (inches) W WEIGHT PER FOOT � �� D DRIVE SHOE W WAS CASING O TED? DETAILS L LvSTHREADED ❑ ES ❑ YES NO YIELD ( ❑ BAILED E (�/' HOURS G G.P.M. Y YIELD (G.P.M.) TEST ❑ WATER f MEASURE FROM LAND SURFACE —STATIC (Specifyfeet) D DURING YIELD TEST Depth of Completed Well LEVEL i in feet below Land surface: �S- MAKE L LENGTH OPEN TO.AQUIFER (feet) SCREEN DETAILS S SLOT SIZE D DIAMETER (Inches) G IF GRAVEL D Diameter of well including GRAVEL SIZE (Inches) F FROM (teat) T TO (feet) PACKED: g gravel pack (Inches): DEPTH FROM LAND SURFACE S FORMATION DESCRIPTION t Sketch exact location of well with distances, to at least FEET to FEET F i C� If yield was tested at different depths during drilling, list below FEET G GALLONS PER MINUTE 4 �1 / / 4 41/v'- f CO, i' BREWSTER -LABORATORIES Box 224 - BREWSTER, N. Y. WATER ANALYSIS REPORT SAMPLE NO. 2700 SOURCE: Forr.e&ter Builders, Inc. RFD #2 Patterson, N.Y, Lakespring Meadows: Development. COLLECTED: June 5, 1972 Lot ,-¢ -`18 BY: William Bush: 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. .tune 7, 1972 a! Roy Bickwit P. E. Director R unicipality 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 succes- sors, 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 de- termination of the Director of the Division of Environmental Health Ser- vices 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 b 'lding utilizing the system. Dated this day of 192 7- signature Title If corporation, give name and addre ) -- - - - - - - - - - - - - - - - - - - - - ; THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS EFORE 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 .v Q T epaz pa iq 4, � 6 14� �a lLocated at � �� $� �� ., .`�����a�: $ec•tlon Block-'. 7 ie- Sabdivlsi.Dn .emu dot Sob 'Y Z- 0 �yi f MGM` #sfh 'ter fY dBQ°�.� �aL' tu��K 1 �i Ir k`��i [9�" C► DOE 'L�C2 S c Total Fab tablo Space Ifs< y' *f€�.ad ,. -- ee ear; IT v z _ i'3gJu "0 a�`g y3I i;Q �1�3 t�$'�' �x.t:•f�. L .. � _ - z B� , e�x>� `- a - ,..d,-.'- -•,.:- s�•Y..s-.3�.--ram- _-=- -..- ,�..x, �_,kn �.c - �_:. -. ...� - -� <-w. ..�'r 7 - �c� li v'b4�I� an d Oo'qx.. s tp1 .�e >_�:- Y-r. .,4.,c• r - w.., -'a <-sa. u r hp propro -, ee . *�' }G 4 S / a J ;,..-it!Z�:Fi 1x - p` -�� 1 �. a.f�•.k e��'� r i�t- �' .I .. - . a'Qr�st ct d "� hoWn Gl'I < t -. za 3 ' _. �x-ieni vmt wb i 'c .p n in.. c(? ` I ^GCi �.i � Cfi a :atian .0-t- the . ?utrim Count° : D )&i�tmsxtt _' eF 2 y M can' c -6ftocs etio theraoP a -Yce ' � et I f (°-bib tkle .Coxmi.3sidfieY° "di f 3e&7- th All be arcak .hits --to ?� 9 _Vr ,Q:x� ugr t wee ? ^ �°u xr bu rs or a s t ma .k� io b l.d s d b i1d:e rrl 1. �' ondi, on -an -art. e�,f said a� z�ge ip<isal { ) e °s ind eE g °t� .a a = the date- o1' Lhe' © z 'ac "te Of r'Ais true t ,un O'dapIJ ante 0A" and' 1pov.:nre the e o� ? ,teat tl i d��l 16d �1jj� I A � pp 3 . alb`6ordaAge $! i th tIz e Cs bate le 3 pro btSd -� t tli is s'�xt tl, t {J J t�'C +. � :� 4.. G' Xl 1 h YY , , ' , -54 Y n •5 uX9le_, ;� t, ruG lb X1 of . i�,ltd .a:;t 'Win- t ha C�IrAQ "isL 'Gib'tjt�3fi fi + r , `he i. ;_J:� ss o �e� � ' � l i 7, c m�e .ox� - t �3 ,- rn z tr '> p TAT yx g� • f S t{� ♦y yjy nn,}(, ^ �d� ♦ .tai r ; .j.l i iK .,fq f.+yt.l n �f GVi'.S J,L�L dR �-•0 1t ♦�:A. b.X ��r '.i l k Da` P R OF WESTCHESTER -DEPARTMENT OF HEALTH Division of Enviroinental station "STET =.., SEPX'RAT E' 'SMGE ::SYSM- :_z_,.r. <,� "_�.ti._ ,beer i Weo00i?f Fu e.-S7 Address SAY —eAQ. 1 &ffl& Located At (Street Sk !. N ��E d20 1d ®V Sec. H'Tock Lot ] (Indicate nearest cross street MuniciPal3 tY �% �� © l�) Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTEY WITH APPLICATION Role. Number CLOCK TDR- PERCOIATION PERCOWICK m No. Time From Ground Surface in Inches Soil Rate Start Stop Min. Start Stops Drop in Min /in.&op Inches Inches Inches; IL9-,Zr ACV 5 Notes.- 1) Tests to be repeated at same depth until apprMimately equal soil rates auwe obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made frm top of hole . TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICA:n- CK DESCRIPTION OF SOILS ENCOUNTERED_ IN TEST HOLES ?' "DEPTH" G.L. 6" l2" � - 4-.Q M A INDICATE LEVEL AT iRUCH GROUND WATER. IS ENCOUNTERED 4T 97F 6 F INDICATE LEVEL TO WHICH WATER LEVEL RISES. AFTER BEING ENCOUNTERS TESTS MADE BY J3 f � � � ASS S 0 & / L LM DATE DATE - D� i iz . � DE GN Soil Rate used /& - ,_p Min/I" Drop s n.0 usable Area Provided ti ° "rge No. of Bedrooms Septic Tank Capacityj&p Gals Absorption Area Provided By Y L.F.x guE� Other ..Name BIBM ASSOCIAIF —S s'919 CONSULTING ENGINEERS _. Address: 1310139 bl v _ Westchester County Health Department Soil Rate Approved Sq. Ft. /Galo Checked by Da S.D© 27.6 (Rev. 5- 24-66) (Febrnaxy 189 1969) I h!;,I'T ' 121, T3 < - -rA IJ w- 27 -�3 -q d? APPROVED JUN 131972 PUTNAM COUNTY 1) PT OF HEALTH ENVIRONMENTAL HEALTH SERVIQU .13113130 ASSOCIATES CONSULTING ENGINEERS GOLDENS BRIDGE, N. Y. TH AS B= �SEWAGE Dl� -10 . SEWAGE DISPOS bl-Itti - ... ........... .... ........ ULU-A.. ... .......... LV I _ !,o FIELDS REQUIRED= 30:> FT* "-(- IN-WIDE (RE;.--,i FIELDS INSTALLED= 31� FT, '3(,:, IN. WIDE TRFENCH SYSTEM INSTALLED BY: DATE.'-9Tw-.c SCALE 1 -2(r