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HomeMy WebLinkAbout2223DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.05 -1 -15 BOX 19 02223 him J AR F ' � �'�,, 'r ', ' 'V f i I I.' , �,'- Ir . I I - I. 02223 r w � .,fit � � 7�a, e '� l a��a 34 � s -� a� h Y 1'�iad 5 d� fi � . t •T � 4n- ,A PUTNAM 'COUNTY DEPARTMENT OF HEALTH ' i Divis /on. of Environmental Health Services Carmel N Y 10512 ' '.'CERTIF•ICATE OF CONSTRJCTION WmFLIANt-- Ft,R 3EVVAGE DISPOSAL SYSTEAA x Town or Village: -.Ldcated' at owner., �iG s.. -FyG' .f Lot Jobe 1 - Separate Seerage System .'built built by t Address= �-�' w Cons�Stmg ofd `Gal !Septic Tank Iirteal F�9et.'X��a 'I width, trench, ± otFi'er revuirements'' 41' 1 :1 -Water Supply. P bIICSuppiy.From j 1 t Private Supply Drilled By a Address PU i°`i iV�{1.��•7 !y 7 n 3 ' Building:-Ty. Type Permit�,lssued sHas Erosion Control Been Completed y 5 x4 v s h# I srcertif that the s stems assisted serviri' the above remises,vr ` s i ds` on the plans of th'e completed .w rk (copies, of which are y. Y O 9 P. attached] and in accordance with the standards, •rules and reg lb s, , he -.iss d by a Putnam County ,Department of .Health ', } Date" y 'F , Ufi y tt x, P E 1' R A. ;Admi4• ^h�c',°°i�'ki+,;^'.. i dress fS S� ,License•NO Z�''a Any persom occupying premises served by the above systems) shall p fl��ul c a as may be necessary�to; secure the correction any uhsanitary contlitions resulting; from such. usage' i. Approval of the separate_ sewe ecome null and,," I' as soon : as'a - public sanitary sewer beco`me`s I, ,, • .:. . available; and ttie .approJal of `aiie private water, supply'shelF become null and v hen a ::publi '. ply becomes available. "Such ;approvals are _ w subject.ao modI icatiod.or.`ch`ange when, °In the; judgment of -the Commission 'o't Health, su revocat n 'modification & cRenge'is,necessar`. Date BY: A Title n 1LYUrTC1I7 ESE COUNTY DEPARTMENT ®P HEALTH 11 H II..ABORA A ®R ]l r_ 22 MARKET STREET POUGHKF.EPSIE, NEW YORK BACTERIOLOGICAL EXAMINATION OF WATER 23 SU LTS OF ZISA3,91NATION Agar plate count, 24 hours at 37° C. 8.2 ..... .. .............. per milliliter. Most Probable Number of Bacteria of the Coliform Group [ �. 2. 2.. ................................................. ............................... per 100 m1. Remarks: Te bacterlold -eld .examination of the sample of water shows the absence of bacteria of the coliform group and therefore the absence of pollution of animal or human origin and therefore of satisfactory sanitary quality when sample was collected. HD -72 cT 9 Laboratory Director m :IWELL DRTtLZZRS LOG- YM REPORT Well In C oulaty's Q a Name of. ace ity, '.:Vi11ag6,._.or.X' own , T_ ss Owner Depth "of wa 'bjteter'I­­r--''Yield Was we 11 di sin fe�dted?, fti inl gpM yes ,or no W 0 seal Amt. of casing above e gr,,ound,. _,B6 -Ii in ft packer, *cement, grout -'*he depth of Draw a diagr'8A­-ih7thei "spid-i" And sh­ow :J c, .-.sing, the w-11 s,,-.al,', -kind and thickness of forma; ions enetr.at ed,, .'water Ibbarin formations, diameter of drill hdles with dotted lines 'and 'casing s) with solid, :W REYIz.:XS ELL DIA� '; ; r All FORYIaT I ONS: PEIT-- ITILI 'Ry e of well, ,Diameter, in. Depth Find, thiplffi ..ess an in ft., if "wa, t r­ bearing : ' & Ming mitl'aod g� r Grade:_ .as W '' well'dyhbbited? -PUMPING- T-11'1"TS'' 25 #3 Details. #1 §12 gtatic�'aater. 50 'v bralow c-�xade . pumping rate_ in gpm ... ... .... 75 Pumping level in ft.' below .:.rade Duration:. of. 100 test in hrs. '4' . ........ WAT�M, 200 IP.-i-L'DN a 6-k—ef-Ch of the property bn the back of this sheet.locatiog TZHE 'W: LL IJ-D S.-MAGE DtSP08AL-SYS-.I.P!-S Ulear . t/. Cloudy —'Purb-id- Recommended depth of pump in well, feet b,,;low ;.--,-rade W,,LLS IN.bMTID & GRiNEL: Sand "Eff' sizo. mm Until, 466 f size Len,gth�,..o� screen Diam. ;screen S* I . X, - C "U OFII,!�E IT Drilling. start,:d/, _Z Well Driller J Si; na ;;mplet-.,.=d re Owner or Purc a�o` Building Building Constructs by Location Street Building Type Municipality V Zactd;en t,4AP . 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 Cl 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 -- t -he - �yste: -to -operate was caused by the willful or ne igent act of the occupant of the building utilizing the syste Dated this /© day of kelL, 19__L�_ Signature ME 9 Title _S1C- x' If con ;off o and adclre s )'�' 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 r i P,UTNAM COUNTY " D,iwsion ;Of Env /�onmfr Yf CONSTRUCTION ,PERMIT FOR SEWAGE -DISPOSAL: SYS1 Subdw.ision iieLV`t>l /sc' ` •�fe�?Od�l ;Z.9� a h Sewices Iarmel 7V Y 105 M' T�lv�t✓ of OtcMle. Lot 8 Town or viliage Block Job BWldmg.Type %E- S//JE/t�� //�4 Address c�fs O Lot Area . / .r2o�/e* Lyiti Number of Bedrooms 'T��� =� Total Habitable Space `Feet' A e `$8 Sewerage System of, D y. ,,��, ' �� Gal Septic Tank �� ' feet'. `3 width''tr.ench' p arat8. consist lineal X - 1 To be constructed by Water Supply Supply From t `by �� =�'_1 Private Sul?PI to be tlrilled r�si�C �• Address Other •Requirements �' :d ®�vL ;_ ; . t . /r�i -1 I represent that I am who and•,com letel r ns� d location ,of the partite sewage disposal system y p y pro posed'system(s) 1) that the se• --- „above described, will be constructed a's-shown J&1 there ti and in' accordance with lia standartls; rules an regu a ions o--'T'-e P M nam County.'Department of - =Health,.and ?that ate; of'COnstruct on Corripl!ance'! satisfactory to the .'Commissioner of Health_will be submitted to the'Department; and',aCgq$ralYt'ab in ed the.owner his successors heirs or ass�gns,by the buiider; that said tiuiltler will -! f �6e),¢dg the ' place good operating: condit(on.'any, ance :of, the approval;,of the Certificate sa osa m tluring ,period of two (2)years imrnediately`.following thedate•of the issu- f n ;tr d-)i. rice' a original tern or any. repairs thereto q2) that,the.tJ►illed well described, above ` wlll.be; iocated as shown,on the approved.' .County _? d th t sd(d vi(elF be i sta d{ in 'arc ance with'the stand s 'rules and regu al ons "of `:the; ;'Putnam Departure of Health r %nt "Date P E R A. Addr ess 1' � Icense No. 3z.7zo,,. %D 5 L i- APPROVED FOR CONSTRUCTIbN ,T.his ; appro r from the dateaissued unless construction of the building has been. undertaken and is revocable for .cause or may be amended,or modified who ider'd necessary by, the Com " "missioner'of Health °"Any changq,or alteration of. construction regwres, a new permit: ;App ,ved or; disposal :. of domestic 58n' s'ew a and /or Nate water•,supply only., Date BY Title' �/'• ; :.-, . .-, s . V C F r. r`+� x. .,�. rU y.. .1 rn .t -..<r ..yy .J +1. `Q �j�j' -... o+ f r-p.,yp .11 t Sd.',ZS. V a7. �.t7j r,ll: .i�W1 Y �'+', 'J " a'+ + •� _ :u , a . _ r r i i - v - - y � . i d ° .. , "�'i7, z a r 7 +fie ,,t -_' 1 , ,Y,x sk j' „,c .1 Q. . -,., t; -. . � o, tea �: �J , 1 p -x. s r i r - Y .,tom t.. - -=- -"'^r' 5 -f e i . _ 1 � _ _ , �t r i � `Gi L is i a oSr i 0 , t, ; T Y ,.- .�1 4I - �" y 1 • �--,�, - - r - .(.�"' j �}, / �y jJ �y.�y $�, �y t �4,.{�j j N' - 2 b y, / �,5 /} {'� �. - ' `a? t'w .. 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".tf;,?, .,.lti .4'x'- sir d';'. ``;�'w,: • C . - PUTN'.AM COUNTY DL DA -l"EN T OF � = =.L1H ' a.L:tNF�,T -?��CES ._�... - S� _ r ..._- ._........_ . _. DESIGN DATA SHELT = SEPAR:ATE SE., AG£ DISPC AL SYSTL.- FILE NO Owner . Address Located at (Street). Block _ Lot' (Indicate nearest cross s tree �) 1 — 3 Notes. • 1) Tests to be repeated-at sa'•r;e, depth a ,tit approxi -_tel� equal soil rates are ob- tained at each percolation- test hole. All data to be submitted for review. 2) Depth measu.rem.ents to be made frog top of hole. hfunic ipali L T�riv ®r' 4v��W . �°�GGLr`�J' �';atershed �°S", /C� Gi .Jtj � . Jo,� SOIL PE RCC. LATI0N TEST DATA. REOUIRED TO B£;;SLE ?:I ~T£D (dITH APPLICATION Hole ' i rber CLOCK TIME PERC.0 ATI0N PERC0LATIO\ Run Elaose Dept to f;a Ler S ater Level No. Time Frot:: Ground Sur ace in Inches Soil Rate Start Stop Min- Start Stop Drop in `fin /in . drop Inches Inc;1es Inches . 3 -1 i-,V .17 1i1. 2 -r�iq �6 4 S -- �'� -3 1 — 3 Notes. • 1) Tests to be repeated-at sa'•r;e, depth a ,tit approxi -_tel� equal soil rates are ob- tained at each percolation- test hole. All data to be submitted for review. 2) Depth measu.rem.ents to be made frog top of hole. r4714:�' .SV /c 2V 30 36" 42' 48" S 4't 6 07T ./ J/ i 4 VA VA 72" 78'T // 8 Wr .INDICATE LF,. TL. AT _Ml-11CH GROUND WATER I`S ENCOUNTERED IN?JICATE LEVEL TO WTHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED T£ S7 S 'M-lA DE B ;' Date 1 �/ Soil_ Rate Used Min /1`, Drop S.D..Usable Area Pro-, ided oao No.. of Sedroo- s Septic Tank. Cap ac _ �y Gals. Z�pe �l/lsr.�.9s��. Absorption.Area. Provided By 177 L.F.x '� q ` t":idth trench. Other. Name Address a 2; 7 A PUTNAM COUNTY DEPART'M7'NT OF HEALTH r °0 a �o ti Amp OW, AMMERry 497 AoVzo�G A IV Ponywo e®oory m. • � S CAGE s / rr s -¢Q � r�/►ysic�/ �ou�ds tyhele Shaw^- . r IIFe Terence _.,... ,�oori�7 17 �iaok,Cake .: _ ... Survey Co�� /ems 3 - /6 - 71 M'ap ec,mp lelea, 9 - 17- 71 eyo r No. I-Ud¢ w Tic /'�% GZ. s/ 86 H Max u- P►a � �33J 46 Nlontiine�iL�' _ fOUn cy 1 / Land ,su,rveyoe-- ° Survey Co�� /ems 3 - /6 - 71 M'ap ec,mp lelea, 9 - 17- 71 eyo r No. I-Ud¢ w Tic /'�% GZ. s/ 86 H Max u- P►a � �33J 46 Nlontiine�iL�' _ fOUn cy 1 / Land ,su,rveyoe-- ` Ur FYI r NMI zl All ZP PUT DivisioN RONMENTAL 'HEALTH ENVTONMEqTAL It