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HomeMy WebLinkAbout1863DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35.06 -1 -56 BOX 17 01863 ro . t, , 01863 --• ­ 4 a a L1JrrAKFXI iV'I'`OF HEALTH 1=I4U 1 lvttK . MUST Division of Environmental Health Services, Ormel, N. y 10512 PROVIDE PERMIT #- CERTIFIC rEOF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Located at Town or Village V I,11 'Z Owner A� M i ��. .Cl/_ ♦*� ►p/ Formerly .,� Q S� Tax Ma L9 Block 4 -,• . _- �`+n+�- _ . - tom;#,.-- �:�„� -as'�° -- �s;bd: rqt:;.� °. ...., �„__.� ,,._ �. Tax "M ,• -., •. °'° Si+pei�ii£e "5eweiage sysiem bufe by ' P ra o t n¢ Address 0 LLA.Gt►��ol e I A) J Consisting of -L-0-OLD—Gal. bQGal. Septic Tank Other requirements Water Supply: � /Public Supply From _ _1G Private Supply Drilled BY —Pi Address Building Type sil.- I.A�j - S Has Erosion Control Been Completed? Yf s No, of Bedrooms-3--Date Permit Issued Has garbage grinder been installed? ^/ .0 I certify that the system(s) as listed serving the above premises were constructed essentially as shown onLthe'plans`of' the completeii work ( copies of which are attached), and in accordance with the standards, rules and regulations, in accordance with the filed pian; v WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report is to be completed by well driller and submitted to County Health Department together with laboratory report of - 2f!'31ySSSOf �ygt?r;gp +�lQ. � iratil]¢;Lgi ter:is:'vf tatiSfactory.bacterial Quality before certificate-of construction complianc.3 is issuad'- =_ REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME J &P Development Corp. 110 ADDRESS Galloway Hts, Warwick, NY. 10990 LOCATION OF WELL (No. & Street) (Town) (Lot Number) AppleHill Sub., Apple Hill Rd. Patterson,NY #1/ PROPOSED USE OF WELL © DOMESTIC F] ESTABLISHMENT El FARM ❑ TEST WELL eg — 4 - (0 ER ❑ SUPP Y El INDUSTRIAL ❑ CONDITIONING ❑ (s(specify) DRILLING EQUIPMENT COMPRESSED CABLE THER ® ROTARY ❑ AIR PERCUSSION 1:1 P PERCUSSION El ((SSpe ify) CASING DETAILS LENGTH (toot) 30 DIAMETER (inches) 6 WEIGHT PER FOOT 19 bl s . a THREADED ❑ WELDED E SHOE 1" IYES ❑NO EYE, �7C$iiT GROUTED? ) LJ NO YIELD TEST X HOURS G.P.M. ❑ BAILED PUMPED ❑ COMPRESSED AIR 6 fO YIELD (G.P.M.) 10 WATER LEVEL MEASURE FROM LAND SURFACE—STATIC (Specify feet) 301 DURING YIELD TEST l feet) Well in feet below Lantd surface. 3401 SCREEN MAKE LENGTH OPEN TO AQUIFER (feet)" DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (Inches):. „ GRAVEL SIZE (Inches) FROM (feet) TO (feet) DEPTM FROM LAND SURFACE FORMATION DESCRIPTION . Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET 0 2 Drilling in over ur en clay and boulders Hit.rock at 2 feet 2 30 Drilling in rock,set casing, routed. O 340 Drilling in rock granite. If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED 7Z22 /85 DATE OF REPORT 9/25/85 WELL DRILLER (Signs , ZL=2z ,Apple Hill Development Corp. Owner or Purchaser of Building 69 Section J. & P. Development 4 Old Route 22 Location - Street Patterson Municipality 6.4' Lot Apple Hill /J. Monasch Subdivision Name Single Family Home 1 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 - ors,,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 Putiiaat-- County-- Department -- of--- Henalth--as... t-o whether ,or- not- -the ure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this 28 day of September 19 85 Signature C Title Secretary Apple Hill Development Corp. Corporation Name if Corp. S EP 2 6 1985 10 Galloway Heights, Warwirk_N_Y. 1099 pU7- -P.JA A Address - - - - - - - - - - - - - - OF H H�r. - - - - - - - - - - - - - - - - - - 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 Box 224 - BREWSTER, N.Y. (914) 225-2072 ya SAMPLE NO. 5939 SOURCE- J6 & P. Development Corp, Hose Bibb Well #1 Apple Hill Sub. .Brewster COLLECTED: September 190 1985 BY: P. F. Beal & Sons, Inc. 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. September 230 1985 0 MAN W ARR4. 5. N� \ — PERCOLATION 'F :A•T E FT. /- T./ ' + — \� — � \ � y �_ '• � L11�1.�T'.�'i"R'ENCN C'V I�EjD• 3'i5 •_ -� r ` 4* \ ♦ \ � � Ica J=O t division of Eavironmental Health Bervloes Ipproved as noted for conformance with r g \ oo•,� epplic le 1fLlles and Regulations of the ftt uilty Rea 'Department. FE -TOz.o . 's,l��T — '100 ' a & Tit1�1PPLE 1�L _•..�: L.,OQN!1 Pb'-TT evrsoM, Pl3T �- - -- COPS- "�1hlCw C »r ? a C. NO. O'sloCoS� 1 I D Aj o l 1 I I m I " "- y i I I 0001 i �� 11d 1iW v o U ►xZl0 r/ (Iii Ii I/ i! i r�^�' Ln � 1. _- ... I I l o_ ► 11 I I o 4 1 o,w o 0 0 0 0 0 0 .G (rf� C. Coll `l � ° m o 0. ➢ r r � m w �r' -gyp .-0 o� CP rp d Rl 0 P d v PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING,__CARMEL,. N., ,Y.,,.._.- DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Apple mill; Assoc. Owner J, M oy.� s e;L. Addresses Lj , p,+- ;-2. Located at (Street }S Lake- Sec. to Block's) Lot' (, :9 ( di ca e neares cross street) Subdiuvsioti Lo-t�# I Municipality, pa tte,.-5„ Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to WaEer water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches IA 1 /o:yl -/v ;SS 1�1 :X.13/,4 x-43/4 3 2 11'.og - 1 r. 3v 2_) A 2- 3 -- 3 i1 4z- 2:vq .2.�L 4 T ,-,.; L IX"- Acs'. C Lot, Lemi.. w l,gghJ S, LA if G es �L 5 Ili_ 1 1037 -1/ %07 30 -7 Y2. 3U�4 2 3/ 3 1 A.' IT 7 /3 4_' 1 2 3 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 -- ^PICOUNTEPED IN TEST. HOLES DEPTH 'HO3� : N-,0,, HOLE NO-. HOLE 'NO-.'. G. L. Tob So: L '01 30" 36" 4x211 � 48" 54" 60" 66" 72" 78" 84" jj INDICATE LEVEL AT WMCH- GROUNDWATER IS ENCOUNTERED - _...- ..INDICATE LEVEL TO WHICH WATER LEVEL RISES_AFTER BEING - ENCOUNTERED TESTS - PIA-DE - -BY.. Ise, - - :.�.._... y Date. - DESIGN Soil Rate Used 1 Min/l "Drop: S.D.-Usable Area Provided 3',0od No. of Bedrooms 3 Septic Tank Capacity I,UaO NE 'Ype Cohcre,6c Absorption .Area ,Provided By 32S L.F.x24" x �E trench CO �� ;.. y er Y Name J� t,. 1 �.I,.rh c r. i�na u Address i o a�gj t. olaz9 zS,s �,�•• �, , 9 0 THIS SPACE FOR USE BY IMALTH DEPARTP/MT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by Date 4 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS -- ^PICOUNTEPED IN TEST. HOLES DEPTH 'HO3� : N-,0,, HOLE NO-. HOLE 'NO-.'. G. L. Tob So: L '01 30" 36" 4x211 � 48" 54" 60" 66" 72" 78" 84" jj INDICATE LEVEL AT WMCH- GROUNDWATER IS ENCOUNTERED - _...- ..INDICATE LEVEL TO WHICH WATER LEVEL RISES_AFTER BEING - ENCOUNTERED TESTS - PIA-DE - -BY.. Ise, - - :.�.._... y Date. - DESIGN Soil Rate Used 1 Min/l "Drop: S.D.-Usable Area Provided 3',0od No. of Bedrooms 3 Septic Tank Capacity I,UaO NE 'Ype Cohcre,6c Absorption .Area ,Provided By 32S L.F.x24" x �E trench CO �� ;.. y er Y Name J� t,. 1 �.I,.rh c r. i�na u Address i o a�gj t. olaz9 zS,s �,�•• �, , 9 0 THIS SPACE FOR USE BY IMALTH DEPARTP/MT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by Date