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HomeMy WebLinkAbout1882DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.05 -1 -8 BOX 17 L� ., or f,O 1 �< PUTNAM COUNTY- DEPARTMENT OF HEALTH Division of .Envrronmenta% Health Services Carme/ N' Y T,0512' k . CONSTRUCTIQN PERMIT FOR SEWAGE :DISPOSAL SYSTEM 1 �wnLT�?`� e, x. Located, at.�,t �'"' ��n Section Block Subdwision, - �� r 7J Lo Job Owner /��C�! /P r%�S�'S �? !! %��f C J Address Building Type �1 LOt Area Number of Bedrooms hHabitable,SPace �d� Ax -j Square Feet' Separate Sewerage System to consist of ld Gat Septic Tank; E hneat feet X± width trench F t To be constructed, by ;. Address Water Supply Public Supply From Private SuPPIY, to' . be drilled by: Address:. - j ~ Other Requirements . z above d scribediwill be Constructed a shown' on the approved a endni ntthe etto and.. :in accordance with the- t 1) that• the separate sewage_ disposal system P Y P Y P g Proposed sY •, _ .. -, <.. h the standards rules and regu a ions o the Putnam , County Department .of, sHealth, and that on completion thereof a "Certificate: of Construction Compliance satisfactory to the' "Commissioner `of'.Healthwill be submitted. to. the Department antl `a written guarantee ".will be ;furnished "the owner' h�s'successors, he�rs'or assigns;by the `builder, that "said builder will place in ;good`operating;;condition' any part ;of said sewage disposal system during7the; period of two (2) "years immediately following thedate of the issu- ance of the. pproval'of the Certificate of' 'Construction compliance of the original System,or� any repairs thereto 2 }4hat the;tlrilletl weli'described above will be located as'shown.on the approved`Pian ano.that said well will;be instaII66 in ;accordance: with' the - standards ules'.and regula, i— o� ns._ of , the Putnam County, Department of Health �. 3 Data �� Signed; P:E 1000 R A Address License No APPROVED FOR CONSTRUCTION This,- a"pprovalgexpires one yearfrom the date issued unless construction`` "of the building has been und�aken and is revocable for .cause or rnay.'be amenfed or modified: when cons�dered'necessary•;b`y. the Commissioner of Health. Any': change. or, alteration_of construction requiesra 'new - permit. Approved,' for gisposal of domestic sanitary_ sew age;' - and /or.:private ;water. supply only. Date` : BY Title _. J_ WELL COMPLETION REPORT W71 " This-beport is 'to- be-completetf dy well" driller and'su analysis of water sample indicating water is of satisfact REPORT MUST BE SUBMITTI PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW.YORK (ted fo- Courity Health Department together with iabofatory report of bacterial quality before certificate of construction compliance is issued. WITHIN 30 DAYS OF WELL COMPLETION NAME I ADDRESS OWNER. Nickolas Castrovinci ` East Branch Road, Patterson, N.Y, LOCATION (No. ti Street) (Town) (Lot Number) OF WELL East Branch Road Patterson, N.Y. ; k,.- 7 -- '?_0 BUSINESS PROPOSED ® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL USE OF WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ OTHER DRILLING ® COMPRESSED ❑ CABLE El EQUIPMENT El ROTARY AIR PERCUSSION PERCUSSION (Specify) (Specify) CASING LENGTH.(feet) DIAMETER (inches) WEIGHT PER FOOT El RLIVE SHOE ❑ CASING LXJ DETAILS 25 6 1 7 THREADED WELDED YES NO YES NO HOURS G.P.M. YIELD (G.P.M.) YIELD ❑ ❑ PUMPED ® COMPRESSED AIR 2 20 20 TEST BAILED WATER MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST (feet) Depth of Completed Well LEVEL 20 1 300 in feet below Land surface: 3 00 SCREEN DETAILS I DEPTH FROM LAND SURFACE IF GRAVEL Diameter of well including PACKED: gravel pack (Inches): FORMATION DESCRIPTION Sketch exact location of well with distances, to at least FEET to FEET two permanent landmarks. 0 20 Hardpan, 20 300 Hard gray granite, S B v@ If yield was tested at different depths during drilling, list, below FEET GALLONS PER MINUTE 290 20 Sri sT 9?' ,4 Ale DATE WELL COMPLETED F PORT WELL DRILLER (Signature) v 7/26/72 1 �/72 ,President MTLT, DRILL C. BREWSTER LABORATORIES WATER ANALYSIS REPORT SAMPLE No. 2 743 SOURCE: Nickolas Castrouinci - pump discharge - well supply East Branch Road Patterson., N.Y. COLLECTED: July 26., 1972 BY: Nill Drilling., Inc. BACTERIOLOGICAL EXAMINATION . Coliforin Count, MF Method This result indicates the source of the sample was of satisfactory sanitary quality when thi sample was collected. July 29, 1972 0 per 100 nil. 1 f� � Aw/Bickwit P. E. Director P J. UTNt1tti:OUTrT '��� A 'Tti 0r DIVISION OP �Zs; IRO?';' - ;TAL =LTR' S R�TICES Pate Re: Property. of Located at Section Block Lot. Gentlemen: This letter is to author z John H.. Prent1'ss a..duly licensed professional engineer or registered architect (Indicate) to apply for .a Construction Permit -for, a 'se p ara�e .seweram-e system; to serve. the above noted proper`y in accordance ..,i h the standards, rules or regulations as promulgated by t _e (j0MI_i ss10 r of the Putnam County Department of Health, and to sign all necessar; papers on my behalf in connection with this matter and to sucerviTse the construction of said system or systems in conformity ,rith the provisions of Article 1L or 147, Education Law,. the Public Health- Lair, and the Putnam County Sani- tary Code. e Very truly yours-, Si T. ___ - roZ)erty 19I� / r6=a Ye - Countersigned: Kddress'oaq° g;y�y�ESSIOAlq� . E R . A ,o \. PRA "N��'��,2 �© ��� p R &08; . f : t rr a' / l a 35 3 o ( Sep `) Address ; "x C arr i ; a . Y. 10512 No, 2g2Q6 :!�F� s 1� F � °Fr��F Telephone -.... PUT-NAM .DE? =? I:�`:T OF LTH -' '. DIVISION; OF E`VI?O N` A HEALTH SERVICLS. . DESIGN DATA SHEET - S E P ;PLATE SE:,.AGE D I S, SaL S Y S T E L,f FILE NO. Nner f"'�' a��a Address f6frt &wmr-4 Legated at (Street)` �-- Sec ._ Block Lot (Indicate nearest cross street) Municipality, �� ®I ;Tatershed Al SOIL PERCOLATION TEST DATA .RP-OUIRE:) TO BE S.0 TTTED t,:ITH _APPLI.CATION Hole Number CLOCK TIME PERCOLATION PERCOLATIO`\- — Run . Elaose Dep to a ter tea ter Level No. Time From G�cund Sur =ace in Inc':es Soil Rate Start Stop Mein. Start Stop Drop in Min/in.dreo Inches Inches Inches 3 y/ /02 /C 4 5 l 2. 4 t Notes. ' 1) .'Pests to be reheated aL sa�-e depth u::til approx_'­tely ecrial soil rates are ob tained at each percolation test hole. All data to be submitted for review. 2) Depth measu.rements,to be made from top of hole. � 5 F ::P! 'DATA DESCRIPTIOV.OF SOILS E G\T Er' RED 1" `ET HOLES Y . DEPTH HOLE N0• s: .HOLE NT0. HOLE ti0 G.L. 12, 18 2417 3 0:: 4211.''a _ 48" 5 41T o,o. r pp't 8 —� O 4tt.. - ��� - E , ,INDICATE LE EL T ?'.HI GROUND D',T TER I`'YP'L`COL'NTE D "'• ! DIC'TE LEVEL TO WHICH 11%,ATER LEVEL RI-SES AFTER BEING ENCOUNTERED °�) �`� hNs TESTS ti;yDE BY Date Soil Rate '_'s °'_ ��Ii -/7.' D�,�� L, S.D. t's.��i `, _� -r'ca o, ; ,tea � � , No. of 'd_ Septic �, Ca,_ _. _Gals . ?��pe B: oo:- s _D _a Absorption Area Provided By L. F.x2 3.5 vidM tre:ach, Other oa jLoFE Name . John H. Prentl.8s, P.E.- C.E.C. Sio ature @ ' Address. R. 0. 6, B 353 E L Carmelp N.Y. 10512 PUTNAM COUNTY DEPARTiENT Or HEALTH ��� Soil Rate Approved Sq. Ft. /Gal`. Checked blk ��ro9ESt'tEO _ Date M1 r r it ;. -. . �'.�t. �..� ,_Y k .r, h... ,. .� ?` -d ..,, .. .. '' ., _ �. � ... .n ... r. ..ry sr.:. ..." - _... n. r. . -� -, r- .. . •9,�'