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HomeMy WebLinkAbout2162DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 30. -2 -58 BOX 19 Firm .. �. 1 ,'a ■ I, 02162 r 3 4 t� �.r �0 ."•r_. k. p� t ty }T".r' bt y'1 ��,, �',. ?� /t a r. t it�a" _ a �'�'?,a'3 a � t '�t��•n r � t a t� �F:.��•ry.0 + a 4 -� i. c$^��r � u!K-Y �'i e"i.a •i,3;' :xe rtit r�. ry td � ,t2` ° vl :;: � i.�} � t..,y 2 -.. � ` r F �at•.cv3,:: +'�'.+, k.,y ti � � F t� .;' �'., � ' .... t r s PUTNAM COUNTY DEP�ARiTMENT`�OF HEALTH i Division of Environmental'' Heauul��th Services; Carm% 3 r �t '.tv. ..'A^f .'.E. .t y °•r. 5 t �.. 7 FY x..`k { *h'S Yr e'�'"�4R'}!h. "' t4x tF%�Sr /. ax M •• GEi3 i�1f.9CAE COI�STEiEi� -3QR9 -�(�iv�Pi i74NCF= FOF SEWG� "DISPOSAL SYSTEM_ ,.. ,�UW ALG 3 z r own or VSllage / � r : f :. � - F �. � v � t 2 r '' °•�'a i"v a µ�k , yS �,.,,y a `< - '� t a x i Located at � ` � " •� � � ''�" n Section � • Block i ' � Lot.= �•'+I ob 58perate Sewerage System built by J AAAress : t Y Cohsisting�of � Q Gal'` "Septic Tank �a' °° i Nneal tFeat y +" width ^trench t '• ate .r n *4��r t ,t e. f - � •y :t .' > .y i �, r r r� k r vdt d ( 4 ,y.� +• ; \. f 'r Water SuPPIyUblic Ply.*;; F ;tom ° h° ,° ` $ Private Supply_, DrilICU sy y y � y. w}p+ ,J •� + r �•, t rK s ;F- ate, :\ f Building Type ' z �� * No of Bedrooms Date Permit Issued f `2• , 6/ i - � x r; r :. - yeses Erosion Control Been Completed? o f x h .• ,i} yrj hi s'"� yT y 1- t i � iC t } � r a �C *T {r,��'-�,yrt Vt". •.',•N ✓u A,G. .. 4r,rxc R"' ?, °•�� ' 1g� cart ify „t hat. the,system_ (,$) as h5te8 serving the ' abovepremisesawerelcon"structed essentially ai'shown_,o,n, he -plans of thj3 completed;work.(copias:of' which' are',, { attached); and 'in accordance with, the "standartls -rules aid %regulations plans filed :and the,peimit °issued'by?: t utnam:` "County• Department:pf Health.. L s it t ff i .:} a F �C�t7 rt a � ,, a., °F z. �e t •.� t1 a r n•'•aS v ,:, ,� .�, t �, ` `:s t !r E N.4 � ~X Address * '• c 1. � t x '. r/, License No Any person occupying Premises s`e "rvetl b the above syste Y . _ (s) shall5promptly take such ac` loh as may,'be necessary t cure the correction •of;e'ny unsanitary condifrons resulting from;. such usage ilpproval' ofltheyseparate° sewerage3ystemsshallbecomernull ,.and`voidasso nas a public sahita►y sewer. becomes. x ,,. availabiw'and the= °approvaltof the.p►aivate water supply shal.IrbGecome`null�a'nd void when a ;public water supply becomes available Such; approv8ls are ubJectton,modificahon : or change when`,;Sn the' judgment of xthe'Commiss2oner ; o Health, }such [e`vocatio ' modif;ication o►_change'is necessary v e 6a -.., �r fi/ x. •n * - * t/ 2 K ` }`rx i ;tl { �•' v �� � x i >.:s .. I �- ' " .r..,.�.. -. �..r +�`x"'tFtY -. -' "..'c' ^"" : ",-"'' "^r`�' -y . ` •Y r,- ,C . BAGTIr 'I PER,ML (Agar plate ..mcount at 359 -COMFORWGROOP (Mogt'p66b a b 16 , l�-Y i qQ 1)HARDN TOTAL ppm -N- DETERGENTS,l --p M, RATE -la Y k T All DICAL.'LABORATORY lkt of K t Y..brkt6 H F�7�7 - fi, gift., ar- 7 I f AT F.:; r BAGTIr 'I PER,ML (Agar plate ..mcount at 359 -COMFORWGROOP (Mogt'p66b a b 16 , l�-Y i qQ 1)HARDN TOTAL ppm DETERGENTS,l --p M, RATE 1'uL•l.; CGP;IpI•c� tOtJ TiEF'�Jhi �' PUTNANI COUNTY DEPARTMENT OF HEA;_I'F 3/7I Division of Environmental Health Services COUNTY OFFICE 13UILDI14G - CARMEL, NEW Y6,-,K This report is to be completed by well driller and submitted to County Health Department together with laboratory report of analysis of Ivater sample indicating water is.of satisfacto y bacterial quality before certificate of construction compliance is issued, _ f? C11i��MUST>- >i3E••SUBMIT7ED- ,.+!VFTHli11:3© t3AY3-;iOF�VVE—LL"tON1PLET10�1�' OWNEII 1 AM, � •ADUP.ES$ ,..�...,�. ...� LOCATION o. Street) (Town) (Lot Number) -' - -- %i (N�`A OF 1WELL .rte.. St - - -cam BUSINESS n ;PP.OPOSED �'j(� h DOMESTIC `� ESTABLISHMENT LJ FARM TEST WELL USE OF' ! WELL PUBLIC r� a AIR ❑ OTHER J SUPPLY (—) INDUSTRIAL . CONDITIONING (Specify) r DRitLING COMPRESSED CABLE OTHER EQUI ^ri�iENT LI ROTARY l AIR PERCUSSION PERCUSSION (Specify) L— ENGTH T IAMETER(!nc/;es) WEICH/ T PER fOCT I DRIVE SHOE WAS SIN ? DETAILS THREADED [7j WELDED FKYES 1:1 NO U YES C/S T LJ 110 YIELD HOURS G.P.M. YIELD (G.P.N.) i TEST, BAILED L� PUMPED /L—i COMPRESSED AIR 1 "7 �• �. WATER MEASURE FROM LAND SURFACE- STATIC (Speclly Well /eat) DURING YIELD TEST fleal) /�L— Depth of Completed . LEVEL � _ in feet below land surface: 3,),o M,,KE LENGTH OPEN TO AQUIFER (!eet; SCREEN _ _ DETAILS IT SIZE DIAMiTER (Inches) [L Diameter of well including GRAVEL SIZE (inches) FROM (feet) TO (1601) IP GRD.V PACKED: gravel pack (Inches): DEPTH FROM LAND SUFFACE Sketch exact locatlon of weil with distance:, to at least FORMATION DESCRIPTION Iwo permanent landmarks. FEET to FEET _ . . . ....................... I .................... . . . . . . � If yield wotesied at different depths during drilling, list below FED GALLONS PER MINUTE DATE K'EL_L• Cot.;p DATE OF REPORT 1VELL'_D ILLER (SigA5,1uia) buliaing uonstruc•tea oy Au /) P- //I Location �- Street Building Type Municipality 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 Tears immediately following the .date of initial use of the sewage disposal system, or any repairs made by me to such s -Nrstem, 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 t system. Dated this day of 19`23 Signa re Titl S' f c rporatlon, i name a d - - - - - - - - - - - - - - - - - - - = - - - - - - - - - - - - - THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTITICATE OF COMPLETION WILL BE ISSUED. GUARAI -TOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health w4c� - vq� - A P u o 1,�A L Y, I A& ko ft:) r I j 1914 ni. A PO - Q 2 Ire OT %Ra q3 HEALIH-, TMAr (,o SY... 4wv MIAL HEALTH L U� m � 6 4 t a I � ;. ��•„ Division ofsEnvii alter Servi3es Carmel N �Y° 105,12 y. CONSTRUCTI N PIRMIT .FOR SEWAGE_ DISPOSAL SYSTEM., z_ t g "Located : at oick _ Town Subdivision 1 oY Job i X111 '1'3t '... Owner Address ejCr ' .Bwlding'TYpe Lot Area - C:-�.' . r - .t1tii - y _ ',Num ber..;of. - Bedrooms .. .. ... :: .. ... .., ; : :. -• :. ,._ .. - Habitable Space 54uare Feet Total - Q c�sn n Separate Sewerage System tro _consist of Gal Septic Tank V :w lineal feet X width •trench To be constructed byre Address _ �t1 ` CC�C..�''•.yLy Water Supply =/ Public Supply From •Pnvafe 'BuP.pIY.''fo be dolled by„ Address; `.i Other.:Re9uirements Y L represent that I'am wholly and completely respon ;able for the design and IocaUom of the proposed system(s)' 1) that, the• separate .`sewa a dis osal =system g p y aboveAescnbed, will be :constructed as shown on the' approved, amendment there to and.in accordance with the stain , dacds °rules'an regula on o e < -:.0 nam County ,Department of.;:Health„ a`ntl that on completion.the`re'f a Certificate of Construction Compliance satisfactory to the Comm ssioner.,of; 0 t PUTNAM COUNTY DEPARTMENT OF B ALTH • DIVIS -I0-N- 10 OF- ENVIROAT M—ENTAL�,HEALTH•,SERVICES•;--•- 1 COUNTY OFFICE BUILDING, CARMEL, N. 10512 . ; I., DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner ''�' L Address C0C>QPI' Dr Aetiv Li,64PL Located at ( Street 0 V( ', �� Sec. . ;� Block Lot P0 i � nearest' cross street) Municipality, �✓ Watershed C, r, SOIL PERCOLATION TEST DATA RE UIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION apse Depth to Water a er ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches i (rod 2 3 so ti •7) 1!2 I � l V1 511 ' 4-3 if, 00 I.3 i5 Notes: 1) Tuts to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. DEPTH G.L. 611 12" 18" 24" . 30" 36" 42" 48'► 54" 60" 66" 7211 78" 84" INDICATE INDICATE 'PESTS MAE A a TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. : '^ HOLE NO, COUNTERED Date i Ct.. DESIGN Soil Rate Used —I (kn/1 1IDrop: S.D. Usable Area Provided. c-- t No. of. Bedrooms Septic. Tank Capacity 4,00 Gals. Type S Absorption Area Pro d By :2L L. F. x24 trenc . Address krr THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: U' Soil Rate Approved Sq. Ft /Cal. Checked by - '� Date .. t.`- r'r r+ S'� f'i r t•vt; t ,Y� -r IT r 't`ts iT aJlr; �.,,.. .. . '•d�,:....� - -, ._:_..�.,�.�:x- r..�,_ _.�..,:. ! # I =1 �-- - -..� -LL .,rte.- ,•.,..�;_ _ , A y , t � yet �+ �i tw. 4 ' 1 1,• ( 4 1 t; 1 7 1 a�.+s•i7 Pr:r.oi k .' JI k III r s^ pj i L; LIFT c� �¢4' tt t4x,r y 5 ��.��jf !j i m I t � 1 rj , �� �, `' ....t. a . �;`►3-�Ry� t4 r; rN .� t � 0:5 I 4. a• TWO QWWT S , ` 1 � , t ,�yy 3 � r :t f I ! r ` d J ► ® � � , t` , &G1 , ' �� tf K 'll ai,90 % 4b• �i>1°+t 116 � , 's t o d 70 t �• , • V ' T4 ka 7 k w } =r I 1 • I flr1 v 3' 1 t'� i - •t, ' P, Yar' 1 t l its., - 0201 / t ,: 1�A \V I . 4 �Tw� -�! � -�� �� � \\+n• _ 1 Alit.;• 7 S. A S L .. ..:- .,I s--c4IL-t 81' -'t- o of i •i. MANHOLE COVE *tj"" PLAN S54 A(ppYJ j 1JUNCTiON BOX ralN.lz °le' r. •+4J L1 1 LEV.L l� I. P� _ ry 1 � - _ .. •r SANITARY TEE" I SECTION TYPICAL.. CONIC� PRL CkS'f; CUNC. 'E ;a� 5s.iotiV' F SEPTIC' TANK ao 40 - 4o� _ 0� ^ P 30 ao_. - - -.. GRLt LEVEL r "ARTH SbACKFILL JUINT fg:: •COVE!? r rj PU GF-P IL. , _ 'ts".{�T.1 L., l ,� i !g' " -SU' SLUG. F•APER AL1.1' ? OR HAY L r°n• ,yip' r i' mom- TAh1 YL \ tn,, _ A o PFR Fi,ti nY?'r, '�"5• M J, _ - – tl • - -___- -� o ®.�'� IN ( C Str`�Y ` i • C1J' - " - 124 'MIN CLEAN GRAVEL OR :, u1 - - e, o.._�+--_. --►i CHOS HEt) :TONE ov>ao S'.KI AI_E r` Y ABSORPTION TRENCH 37 w NOTES: J Z �" c,' j� Qi SYSTEM TO BE CONSTRUCTED IN ACCORDANCE WITH `THE RULES AND RE.GULATIONS CFZ,THE - .PU+�'NAHI, COUNTY'OERARTMENT OF }1EALT.H. 1 Imo' a SYSTEM $HALL'N'OT' BE BACKFI LED UNTIL. INSPECTED BY 0ESIGN ENG.INEER,. AND THE LOCAL, HEALTH DEPARTMENT IF R.EOUIRI 0. eP' cy I SN'ST :M .TU tiiiN51 .T 01' A- Oo GALLON SEPTIC TANK AND C F /IfCFPER FOOT. TRF'NCH WITH, AV..MAXIMUM N 49c 39 4° •'510 DISPOSAL..S`%STErd GRADES REFERENt'FO TO .FINISHED FIRST- FLOOR 5o' -o5k - 3o,gA` , ELEVATION NATION . UNL.ESS OTHERWISE NOTED. as S: S. D. SYSTEM FUR.R0bLRT_ 14 -K ��'�APPROVEp - - REVIStUNB- HOWARD A. KELLY, JEt. .. -S - p,9ps --f'N� Nu.. DATE BY - S ASSOCIATES R�� CAk L NEW YO . � �.. APR24 1973: x` i' `� 1 ..� - TAX MAP N0. S BLICNO I LQT NCI. PL o m TOWN OF PU"(NA/v\- VAL.L.:Y . _ FUTHO COUNTY DEPT OF HEAI! MCI.,lol U INVIRONIIIEHTAt nALTH $ERVIB . e, 3 a Zj MAV. -.t 5 .•a��ok NC B Trut9A m AopA