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HomeMy WebLinkAbout2034DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.40 -1 -52 BOX 18 i AO ■ A : J ' �,.■ , / • I �L r I • I i I . �} ` IN in 02034 6 1v 1si_qn::I( "'Copik fergrinh Tw" -2, COh 'S S',"Lakes: ore r-� `4 Located at S Louis " 10,0W donsi sfi r g.,of Septic Other- requirervierits,. i Water Stipp!y*.;_4,,i�,� ii Fro M X-_ ;Private di Building .Type One Family j a -vW ANGE. F0 40e.nsb ii 'Is Fqs 0 n _E i Cpntr�OV Completed? ., ­. IS wares n!�ilng t-he, above . ', R7T, Ata'6edLjr., "a .jn ;accordance ��hF��@:staficar c� .rules n r u lat J, ,:D!te, Aug, e40 , 73r 7 r7 Ala& T pyr pqr;qn .0040-Y,109 premises )ei,*84, `os, 't haaDQYYA9T (A-AM-, I cbhdIti6hs.*qidItihg 106m"s ,UC06-A` "pa if . a4aliable'laii8* t % ";e ! JII vbacon Vy MY ' M nA -,subject� 1'6-,h6diflc4tioj pr :cA pge��ken, jnrA. npIjqog' t of tfi Date �`,_,_ 6` Y � � �`'��` BY. DEPARTMENT: OF HEALTH yealih $Orvi;Osfj --ar N,-- L-JOS �C -Moll ­ Y." .12' EVYAGZ i0i'SIM on.,- _P LSAV: SY S TE M PbLt .,6.r, s , Tqwn.or Aidge Rd • Section '2,t pt): -rfiel d oCo �Jjijd aL!Feet,,xw, A— width' trench ­ I ­�­ -, 7 7 ? : �, . -3.4s( Wg, "-A- e�,r -pits. t 1.6 t - _e ft. 7, J7 WR 4y of D6c;-. z -.1972 rutted essentially as WoCk 4 Job Address Hammond D shown dpieii-6 f,-,which are`� wn,on� plans -0y n e Pxn ;? ;Department ' orf"Hea Ith. by :�Tu V . p. : ­-Do ek ,t-Rfr` loster Nr'e* .1, 0 IM :7045., X qJn,..i4b mptly take i a h H - , ly nsani t iiage:`system'shall become ary , -401 void sl r!t;Qsqwer- -becomes II 'arid qn, water; S46h,"approyals 'Are ne h; e M Ion— change ji Ae'6isary. WELL COMPLETION REPORT `' 0PUTNAM 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"- submiited'�'tti County Health Department together with laboratory 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 SCREEN DETAILS DEPTH FROM LAND FEET to FEET 0 75 75 90 90 Mo - - - - IF GRAVEL Diameter of well including PACKED: gravel pack (Inches): FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. Hardpan and boulders. Weathered ledge, `ve(l, Hard gray granite, (, If yield was tested at different FEET 200 220 245 M b t�ri V JTl - ing drilling, list below GALLONS PER MINUTE , ;r 12 �ot1d 3 25 1)9 r 0 r L P-,�, j V e DATt wtLL _UmrLC1C DATE OF REPORT WELL DRILLER (Signature) '' 4/20/73 x'/27/73 �,� Pr .s i de nt MTT.T. T1RTT.T.TAT(1 TATO NAME ADDRESS OWNER Edward Anct I Route 22, Patterson, New York LOCATION (No. & Street) (Town) (Lot Number) OF WELL Shore Drive, Patterson, New York ( 'Lake BUSINESS ❑ ❑ ❑ PROPOSED U DOMESTIC ESTABLISHMENT FARM TEST WELL USE OF WELL 1:1 El E] ❑ OPHEfyi SUPPLY INDUSTRIAL CONDITIONING DRILLING El COMPRESSED CABLE ❑ EQUIPMENT ROTARY AIR PERCUSSION ❑ PERCUSSION ((Specify) CASING LENGTH (teat) DIAMETERpnches) WEIGHT PER FOOT ©THREADED ❑ O MYES El CASING X DETAILS 95 6 17 WELDED NO YES NO YIELD ❑ BAILED HOURS F] PUMPED � COMPRESSED AIR 4 G.P.M. 25 YIELD (O.P.M ,) -25 TEST WATER MEASURE FROM LAND SURFACE —STATIC (Specityfeet) 20 DURING YIELD TEST jteet) 260 Depth of Completed.Well LEVEL in feet below Land surface: 260 MAKE LENGTH OPEN TO AQUIFER ( feet) SCREEN DETAILS DEPTH FROM LAND FEET to FEET 0 75 75 90 90 Mo - - - - IF GRAVEL Diameter of well including PACKED: gravel pack (Inches): FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. Hardpan and boulders. Weathered ledge, `ve(l, Hard gray granite, (, If yield was tested at different FEET 200 220 245 M b t�ri V JTl - ing drilling, list below GALLONS PER MINUTE , ;r 12 �ot1d 3 25 1)9 r 0 r L P-,�, j V e DATt wtLL _UmrLC1C DATE OF REPORT WELL DRILLER (Signature) '' 4/20/73 x'/27/73 �,� Pr .s i de nt MTT.T. T1RTT.T.TAT(1 TATO BREWSTER LABORATORIES E6 224 - BR--' , TER; WATER ANALYSIS REPORT or SAMPLE NO. 2�0�,1� l SOURCE: Ed'um rd A ap o�4 heto ve l 'l Pu�nar�a$Lctte Road. �. coLLEGTED: Ap. rl t- 20 2973 BY: r Z t Drilling* jpwi - BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 2 per 100 ml. This result indicates the source of the famplt was of satisfactory sanitary quality when thl tamplt was collected. April ?14 19 73 Roy Bickwit P. E. olrtdor c i'J 8 buiiai.ng uonsvruct6a by LUOMMO e Location - Street one V=1 n. Building;Type 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 sewag1 . 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.disposa1 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 P.' tnam 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 day of. At 19 Signature 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 t .q i i lz �'�'(• ,P.� ea `i _ __ _� _I.. 12 (0 ! ZD -0 cis t q.. 010 A-Z.T k000 G- :L E " cu SETiC T�31� .� rn. ©X67N .o+)p I m o MI � •�+ o v � sv +� C) w a) ar v1 rn Cdv+) tv� ED lx� - ta U 44 O 0+-) U) Q1 O' U U cfS td Ui $ v 4 .�+ F! cd tD -P td •C 'SG.A to FF- APPROVED ,,' A y qtr s o �a s,w yo rz 973 c Uv V. t;�{ZI �.'� t o _• pF HEALjM fin. �� �UTN ot 00, 6L 0 S C cL _ RE R DIVISION OF' /� (, '2'o ' ell .7 � tNVIRONMENTAI HEIILiIi' a6 70 r. FIELD CHECK -.LIST 04- .v e Date: INITIAL SITE INSPECTION 6s I N I Comments Property lines or corners found . . Can estimate house location Will driveway need cut . .. .. . . . . . .. Must..-trees be removed-note these . . . Is deep hole representative of entire SDS area Additional,deep holes needed. . l .. l �. driveway cut,.house location,separation . distances, etc. . . . . . . . . . . . . . . DEEP HOLE DATA Depth- Water elevation: Rock elevation: Soils description: Date: - 7 . -;i. 73 FIML SITE INSPECTION- Ins p. by: House located where shown on approved plan .. v v SM l o,7- t e Zrliare. a,nr,rove.d. .. lxC116 611 Of l,t'C!llal ffie& &Lcr.ed Width of trench average Slope of file line and trench acceptable Room allowed for expansion. `trenches . Over :50 ft. from swamp,watercourse Natural soil not.stripped aP SDS area unnecessarily graded . .. . than 15 ft. from nearest trench .. . . . 15 Ft. of peripheral soil horizontally from - trench . - -- Ji- action boxes properly set Could .surface run off from driveway, .roads, ground surface, etc. channel near SDS 2rea. . . . . . . . Does lot drainage e a ear. 0. K, in area of SDS MAA.L GRADING OF SITE ACCEPTABLE '¢ A 0. a . PUTNAM CO pcvisfon` o- Enwroi �Q*NSTAUC. ao ,PE :RMl ;FOf;b«Yr& {Al iG DISPQS/ rocTated'. at Coy. ,%S L kes o_re�:Dr. '�& Subdivision - Owner - Edward Ante_ t Res Frame Bwldmg Type • _ _ � Lot Area dNumber 'of Bedrooms~ _,. _ Separate-.Sewerage_System to consist of 1 000 To be `constructed by = `L()}$ water Supplyo- Pubiic Supply From _Prrvate,:Supply Ito be drilled byy,_ Address { - ?c other Requirements - - 'J represen''t that 1 am wholly and completely responsible'for ; th above described will be. constructed as sh'ow.n on theiapproVed:a County;; bepartrrient of-!_Heaith, aand.that'on com'pletion-iheu tie submitted Ito ;the ~Department -, and, a :wntten- guarantee ;y place ur gooil.o.peratmg conditioFjany part,of� said sewage, anee . of ;the ,approval of 'ihe' Certifieatia:. of Con'strtuctrpn ,Cg will;-'6e as shown,on the approved plan and that said we( k v4 rY DEPARTMENT `OF HEALTH ita/ AWth Services Carmel SYSTEM " Patterson :'( Putnam , LakE:'� _ r - Town .or- Village,A . ildbnsbueV -- Rd9,Bbt�an Block 2 Address RI'' D #3 ( Rt . 222 } v416.;ns . -f ,Patte rson . ,N . Y.. . ' - Total#iab�table`Spa'c``e 230 ~Square Feet 3Ga1 Septic Tank �— - (J line31 ,feet 'X . width trench,x 3D3 ; Brev�ster;N. Y..10509 " ic Address rgh and Location of the proposed system(s); 1) that'the separate ,sew,�i, d,ispbwl,,iystem dmenYthere to :and; rn:accordance'with:fihe standards:,rules : an :requiations:o '- t emPu nam'z County 'Department of ;Health: 11/22/72 . : Date 5�9ned '- Address 2`73 Closter �Do;ck Roa APPROVA5D FOR CONSTRUCT40N This approval,exp�res *one yea'~ from tlie�_ ~.evocable for cause or maybe amehdetl or;modifi`.ed'when,considered` necessary -b requrres•,a new permit Approved for disposal of domestic SaRitacy sewage a Date BY - r - nrs. SU fCF-5 0 s �lgelrs'Or assigns 'Dy InO'DUllaer,'LnaL salal: Dunagr wm e period of two (2) years irlimediatety- ;to116 ving�thedate of th8 issur yitem ;or any ;repairs thereto 2j'that,tFie drilled ;well describeq,above lancer with t sfandartls, ,r -ies and' :regulations of "fhe 'Putnam _ f P:E R A X... loster.$ N.J. 0762 License No. 7045 x ed� unless construction of they burldrp9'.thas been undertaken and iii t omm'_isswnerg'of Health Any`.'_changeor *alteration of construction rivate: afar supply only i . _.._ PUTNAM: COU`VTY-, DEPARTMENT- OF - HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. OwnerJC s�/�e ONE .. Address f /V- S,. A41tC St*2E /_2- Located at (Street,US Pln Sec Block Lot indicate nearest cross street) Municipality pef-r �0.5 d (4 Watershed SOIL PERCOLATION TEST DATA.REQUIRED TO BE:SUBMITTED WITH APPLICATIONS Hole .. Number CLOCK TIME PERCOLATION PERCOLATION Run apse Depth to Water Water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches - .2 3 32.3:V2 /0 2� 02 e /Z- 6 7.0 Z A k 3 t 4 3 2j /o /J? 2 a 5 17 If - 3 Notes: 1) Te'gts to-be repeated at same depth until approximatelyy equal soil rates are obtained at each percolation test hole. All data to be. submitted ffor review. 2) Depth measurements to be made from top of hole. IRED..TO BE .SUBMITTED -14 -I -H -AJ-- OAS - DEPTH HOLE NO. C- _. HOLE NO. Z HOLE NO. G.L. . 0,1 /C'0A 12" SCUP ij - .5eMEetA. y -7 Jdur �'cC�c� $�4NU -3d � F�:�tA"Y Y� - 30�� �� " '; 36" - - . 3. `� „ . T/t!+CE Loe4, -ui 6011 66" . 7? It • 7g If 8411 /rOAIC r ..INDICATE LEVEL-AT'WB[CH- GROUND' WATER- IS -ENCOUNTERED ''V INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED ..TESTS• MADE. B _Guy IV 4�0 2'0AA/0 Date r>C— C x/97? Lr„J 1 V1V _' Soil Rate Used? —JO Db-rvl "Drop:, S.D. Usable Area Provided Vo. ,of Bedrooms Septic Tank Capacity. /000 Gals.. Type: pje -C-+S.T.CAjC. . Absorption Area Provided By L.F.x24'I width trench.' Lr -nctf /04 pty-s L Fa- i1j jj 4 P1 rS em A4 ,tit / 7y s ©. ,r r. A) LL ,a..z iS,a Address A73 CLaS7`ee Eck SEAL �; v moo. _ 000s T 2 ^t- ✓ D 76 2 Y THIS SPACE FOR USE BY HEALTH DEPART PRENT ONLY: ti 7 0 A. Soil Rate Approved Sq. Ft /Cal . Checked by r °F THE 51f'j e r ` A rz 1N1 T /S RAO Nov. MIA. 5 L07 . . . . . . -FIC -rA� w-: Lt_ . . . . . . . . . . FOLh� I �.J O51 1 0. jg 4.,o' 7 T . . . . . . + 42 . . . . . . . . . . . . I 40T --oO T L7 J,:, -14AA too } C AIL fi -Mots F- -77 T F- M­ Ow N,