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HomeMy WebLinkAbout1858DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35.06 -1 -46 BOX 17 - 48 - ' !11;1 L, y Ir F. .L r 16 C PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 7_; -1-5; DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. C�A�-r�t GA�y -moo `Z:ou $Ca c. Owner ¢+ Address rAN _:.Located at ( Street °o �;, L Sec . -7o Block a Lot 1 �Indicate neares cross street Goo -TdU ��UE� .. Municipality - O© j c� � r � -rte ca�oN Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS --Role— Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to a er Water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches L 1 3: co 5 za 21-4 zc7 ?s -3 2 3•. z s S: Q-6 �'3 ?a Z3 3 91 IE3 z 3 14- Z4- 3 4 5 1 3 CLARK PLACE e • V• VV /. VVV MARGPAC NEW YORK 10541 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. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED 1­N TEST HOLES DEPTH Jd TY.7 r Q�� -T HOLE HOLE NO. G. L. _r10i�CD% %.1 A, v j iii VZA\) S L-'l C—_ t_ AN L_ e> k � Ac Y L.,0 AXA, p42►1 6� Z j C 4811 LL, 5 4 .60" 6611 7211 7811 '8411 '-".'INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED vte.�czzv, kx LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED -TESTS MADE BY7-::,Q\--\, S'oil Rate Used s-roic bt-rVl "Drop : S. D. Usable Area Provided oc>(L-) it No. of Bedrooms —Septic Tank Capacity 11, Z (0 (D Gals. Type Absorption Area Provided By __-gG L.F.x24" 3b" width trench.. AVC, OF Other Name g"vzN� Signature W. Address SULLIVAN • THIEDE S 9 k ar*� G210.5° -- dpll V 1 1 15r-6 6 Ro DEPARTMENT ONLY ':-THIS SPA 39 .51&ALTH Soil Rate Apprqved Sq. Ft/Gal. Checked Date 6 A 12". 0011 1811 2411 3011 361t _r10i�CD% %.1 A, v j iii VZA\) S L-'l C—_ t_ AN L_ e> k � Ac Y L.,0 AXA, p42►1 6� Z j C 4811 LL, 5 4 .60" 6611 7211 7811 '8411 '-".'INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED vte.�czzv, kx LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED -TESTS MADE BY7-::,Q\--\, S'oil Rate Used s-roic bt-rVl "Drop : S. D. Usable Area Provided oc>(L-) it No. of Bedrooms —Septic Tank Capacity 11, Z (0 (D Gals. Type Absorption Area Provided By __-gG L.F.x24" 3b" width trench.. AVC, OF Other Name g"vzN� Signature W. Address SULLIVAN • THIEDE S 9 k ar*� G210.5° -- dpll V 1 1 15r-6 6 Ro DEPARTMENT ONLY ':-THIS SPA 39 .51&ALTH Soil Rate Apprqved Sq. Ft/Gal. Checked Date ` / w / . � � ^ APPROVE[ -f J—— |` MAR 141972 OF PROPOSED 1\ WAGE DISPOSAL SYSTEM t SEPARATE SE TOWN OF SOIL PERCOLATION RATE ... ......... 4i�. MIN/IN GALLON SEPTIC TANK. DEEP TEST CONSULTING ENGINEERS ESTABLISH sLEV^now OF HOUSE TO PROVIDE DRAINAGE orLOWEST nxmvc rn SEPTIC TANK AND FIELDS AREA ocso*cu FOR.SEWAGE on,o,^ SYSTEM 10 ncw^/m vwo/srvxom.^LL CONSTRUCTION TO Fowpnow TO s,m, AND LOCAL STANDARDS AND REGULATIONS ' ` / w / . � � ^ APPROVE[ -f J—— |` MAR 141972 OF PROPOSED 1\ WAGE DISPOSAL SYSTEM t SEPARATE SE TOWN OF SOIL PERCOLATION RATE ... ......... 4i�. MIN/IN GALLON SEPTIC TANK. DEEP TEST CONSULTING ENGINEERS { rX� vXI, j �'T\ >/ /C U �.-:5 nr`' - / � - ' / - � a i %��,'� U F �t?.�`°.5/?� /i ✓l MEr7!'oh /5 ��,✓ � � :'I _fir L U'�U�` � f •,f r � , i ��' + <• T,S'J! /rJ,yo �/ ° 7U $ /.E! �i/° 2 L c�T f.�� /� nn) rx /,ST / / ✓�: _� % s`_L' _ AS- CONSTRUCTED W. Th' /EOE GE ,(/y5 L /c /(/n ,23BO� SEPARATE SEWAGE DISPOSAL SYSTEM ro3'� ��= PR0�/ED GAers��`�ver Jo �v %000yvs p'v f�_OT GG✓c7nJ S % ie "`�If �`�i� L 9L�E3�'E /(/�. l�2 % ✓� i �, -p < =•mss:" '` Gnw OCT241 7 _� R .: TOWN OF ��rTE�so COUNTY. NEW.YORK PUTNAM COUNT,. u HEALTH i- ..E-.- ��\ \�,.�, „� % :.f DATE /O -2 7Z SCALE.a3 Jhbw/✓ JOB NO. /2�0 N OF '•�^ / SULLIVAN THIEDE GALLON SEPTIC TANK ENVIRONMENTAL HEALTH SOVICiP CONSULTING ENGINEERS LF X 32 ABS. TRENCH ' CLARK PLACE pANOPAG NEW YORK PUTNAM COUNTY DEPARTMENT OF -HEALTH Division of, Environmental Health Services, Carmel, N. K: 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL .SYSTEM �� N fir; t ='AT-T �� C5 Q u _ Town or Village Ap 1 Ax M A 1� Block Located at %'S- P L -T A X Subdivision �cl�>���KZi� Lot J Owner. > ��( 3 U w1 ID 00 L+.9 v Address Building Type r--A -fit SZESip, L'ot'Area r�Sea!,ja< Number of Bedrooms V_- en, C�>l•%,S Total Habitable Space_�ra a. Square Feet; Separate Sewerage System to consist of C7-' Q Gal. Septic Tank ZSG lineal feet X 3� �+ w�dthtrench. To be constructed by ��� W nxk 9 A 1 i Address #r is water Supply: Public Supply From Private Supply to be drilled by Q ka k L) v ti Address ' G AV Other Requirements �c �sF `_N ��: W. <VG-f 1� E G:s�rJ� ®� ► I represent that I am wholly and completely responsible for the design and location of above described will be constructed as shown on the approved amendment there County Department of Health, and that on completion thereof a "Certifi �c be. submitted to the Departmeht, and a written guarantee will be furnisiml place in good operating condition any part of said sewage disposal s ert�F► ance of the approval of the Certificate of Construction Compliance fed will be located as shown on the approved plan and that said well will be i a d i County Department of Health. Date NAA VtGi -i 10, %9`72" Signed i,�vVl���tl�q�ri�ess c�� APPROVED FOR CONSTRUCTIONt Ghirs a p'�o4ai expires ore yeea revocable for cause or inay be amended or modified when considered requires a new permit. �Approved for disposal of domestic sanitaf Date �% �! °� ?_� By system(s); 1) that the separate sewage disposal'sysLr;, with the standards, rules an regulations o ' e u non " ffi npliance" satisfactory io.the Commissioner of Healthi ' rs, heirs or assigns by the builder, that said builder. o (2) years immediately following thedate of°the. L> y irs thereto; 2) that the drilled well described al.' th standards, rules and regulat n of the ,!Put E _ Z/� f L 'R A:: License No. Z `� struction of the building has been undertaken of Health. Any change or alteration of 6 itr supply only. Title PUTNAM COUNTY "DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM SON Town or Village , Located at Li9/ =tr �i+%i� //iJl*� C�i/2 %�J 7�n�1/�1`r 7tj Z Block Owner Separate Sewerage System built by �y �' [- ii= /A// Consisting of Y400 Gal. Septic Tank rG'Z(t0 Other requirements ✓G ���7�� /C�iQ./� G.7�f41 /B•aG Water Supply: Public Supply From — Private Supply Drilled By Lot /(s? Job Address ._�'1i(Jl2�f bUti3A AA /u'a�"7r`� `! lineal Feet X width trench Address 2-4 Building Type �/��iLfT //9L No, of Bedrooms es: Iss a bU �. r Has Erosion Control Been Completed? 9r. '.:- a:".r CP Z 1I1 I certify that the system(s), as listed serving the above premises were constructed essentially as shown{ a s Ofa she Q9 Ye2 ork (copies of which are attached), and in accordance with the standards, rules and regulations, plans fl , an the permit is t my Department of Health. " Date — G'O -- % �-- Certified by A� Address �(�!i y1�// ' —iJi ry l�I �(,l,'f,% ---�.. License No._ 'f5&0T..►^ � Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are sublect to modification or change when, in the judgment of the Commissioner of Health, such revocation, modRication or change is necessary. Date � � T 1� BY Box 224 - BREWSTER, N.Y. WINTER ANALYSIS REPORT SAMPLE NO. 280. SOURCE: Garth Widd,0ils rew8 ear, . Ni Y. COLLECTED: Frank Carroll l l B%: 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. c October 14, .1972 oy Bickwit P. E. Director i-2- WELL COMPLETION REPORT 3/71 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK ;,< -This reports- aa•be- ooMpldted.bti- well - driller•- and�subrriitted'to County Health Department together -With- labbratbry- 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 NAME ;tk • ADDRESS I wa m LOCATION OF WELL C]r (No. 6 Street) @ V e. (Town) L OT 13 (Lot Number) PROPOSED USE OF WELL © DOMESTIC ❑ SUPPLY BUSINESS ❑ ESTABLISHMENT ❑ INDUSTRIAL ❑ FARM ❑ TEST WELL ❑ CONDITION r {. _ OTHER INGS (Specify) DRILLING EQUIPMENT ICI ROTARY COMPRESSED ® AIR PERCUSSION CABLE ❑ PERCUSSION OTHER ❑ (Specify) CASING DETAILS LENGTH (feet) DIAMETER(Inches) WEIGHT PER FOOT I THREADED ❑ WELDED IVESHOE YES ❑ NO YES NO YIELD TEST ❑ BAILED HOURS ❑ PUMPED COMPRESSED AIR I '? G.P.M. YIELD (G.P.M.) jo`Z WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) �O DURING YIELD TEST (feet) 3 a. Depth of Completed Well in feet below Land surface: 1{ 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 least two permanent landmarks. FEET to FEET 6rI�Ii) 1 i V hrr O W�e'1e l0 e If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED DATE OF REPORT WELL DRILLER (Signature) Owner or Purchaser of Building Schoonmaker Homes Inc. Building Constructed by ,Lake Spring Drive Location --Street Building Type t i Municip ali y TAX' "'V40 770 _ r Lake Spring Meadows sae:tn 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 building utilizing the system. Dated this 23rd day of Segt 19_L2 Signature W &: COOPER c. Title If corporation, give name and 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