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HomeMy WebLinkAbout2226DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.05 -1 -21 BOX 19 I his I F , l -.. , ,F , 1` ,� mr 02226 er "'P -;,,'DivW6hjdf% -4- v Ulf N F I PAT-9-_7;.QF',,CQM RUCTION jd(�M 1A, CE QK xv _$Y T 0, -.06. oi Village e� Located.. 't�d at S c 'Separate: SeWerage System.:built —by., Ad&eSs :` Consisting of 00 I Gal. SePtic-,Tarik (I'neal Feet- '..width tr Other rdil-6ir* 0o ;,W Water Supply:: Publfr Supply From S u PPI D will ri`st Building, A dI!flAV Type 141 f R Y. Has Erosion Control Been Compliiteil?, TNAM',COUNTY. F HEALTH ceqify, that .,th I e.systern( . s)'", . li,itedl'sbr4kig the. b­_ constructed eiss6ntidll ..as" own 11 AT-6IetdWWork,( 14 of which are 189VP - hq .�".p!,e,pr�T.ises�were con -witfilf6'it'inclards, rules,and"JeS14" atta'ched) "And In act`ordande�' requ n,w PU 4 eIii im6nt of Health. 7ZA,, 57 Date' P. E. R.A. Address, ses:served'by the above -system(s),, e r to je Zorre'c_tiq`!_1�:qif-, -any unsanitary Any person occupying prerpi babe " :c6nd1148ni�-'risLiftilng' t rom, such usage A p of SvS ff 2AUQF "P6blic,sariltaiv sewer becomes , available and the ap, p rVV. aCof'ihi,-Jrivate TO 106 UbJ6 0 oa if i ca t ion )r I 'fjldgmenV`of suc 0 oats , 7*: By approvals are mv cqan 'o'r,chahge Is*nece'ssary. 'T It le el weer or Purchaser o l* Budlding Mun ci p al ity -,u r ng ` • Construo,t6d by Rection -'--- Location - 3tr—ea ' o Block u n-g 'Type 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 eonst'r4eted 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 repai rs made. by me to 8ucki 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 dp, 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 oaoupant of the building utillaing.the system. 'this�'�_'day o1' - -19 wSigna.ture .. _..._..._..._ Title corporation, give name and address), THREE (3) COPIES ARE REQUIRED WITH THR.JaE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETIGN WILL BE ISSUED. GUARANT9R S R4qUjRgP TO EILE NOTTC9 2f W9 QF FIRST USE OF SY�. - - - - - - - - - - - - - - - - - - - - - - - - - - - - Division of Environmental Health Services, Putnam County Department of Health. TOWN OF PUTNAM VALLEY WELL DRILLERS MG ANb. REPORT _ .. _ ... .. ...... ... . xT.s •.. - . -tee-. x. __ .ate ..¢bw ..i! -. a < ♦ r,o•P -Vry � - WELL COMPLETION ' REPORT This report is to be completed by well driller and submitted to Bldg° department, together with 'laboratory report of analysis of water sample 'indicating water is of satisfactory bacterial quality. Well Location ��� �%%� /D�r,� /3/�/�//� ��� 7 c"Y Tax Map Street Sec. B1. Lot Vle.;.1 Owner.8/r,8292, q� Alovr ��/9 N. I'* Name Mailing Address I City-..6r ToWn Tel. #A2 V` = V)a� Well Driller�LS�� Name MailizZf Address. City orTown CASING, DETAILS YIELD TEST WATER LEVEL SCREEN DETAILS Length Ft. Bailed Measure from or and surface) Pumped Hrs.�Statics Ft. Makes �J ( When Bailed _ Slot Diameter: Inches Yield: GPM or Pum ed Ft (Len: th ' ;':'" Ft e- Size shale, sandstone, granite, etc. Include size of gravel (diameter) and sand (fine, medium' � ° Kind ° � { � � D eter Date Well Completed %���•�� Date of Report Well Driller Signature BZS 1 -77 Qt Ij TOTAL. DEPTH OF v r; WELL Feet'',j��� . �, 3 I WELL LOG t'UiNA'sV; COUNTY Depth from Give description of formations penet ,r s` ' Ground Surface asi peat, sil:t9 sand, gravel, clay, hardpan, shale, sandstone, granite, etc. Include size of gravel (diameter) and sand (fine, medium' color of material, structure, (L^ose, packed, cemented, soft, hard,).. For example: 0 ft. to 27 ft. fine, packed, yellow sand; 27 ft. to Date Well Completed %���•�� Date of Report Well Driller Signature BZS 1 -77 Er 3. -00 Zoo c) GALLON SEPTIC TANK LF X-ABS. TRENCH Ci - 17 13 2 3 /0009 a r7 J1 .,4 7 -3: Z R 12 91, 1/0 !3 0 731 4 wy 7j 2, 4 I 170 23 -511717,9 1-3,10 2 AS CONSTRUCTED SEPARATE SEWAGE DISPOSAL SYSTEM TOWN OF o 4 COUNTY. hEW.YORK DATE I SCALEq5 _.:CWW.,j JOB NO.7 /r .5V P_ F4- FE-SULLIVAIN - VMOIIIIE� CONSULTING ENGINEERS NEW YOR A I 3(5' 7L ithA APPR.............. , �l I OF 4 ..JUN .17 OF sp 4 I 170 23 -511717,9 1-3,10 2 AS CONSTRUCTED SEPARATE SEWAGE DISPOSAL SYSTEM TOWN OF o 4 COUNTY. hEW.YORK DATE I SCALEq5 _.:CWW.,j JOB NO.7 /r .5V P_ F4- FE-SULLIVAIN - VMOIIIIE� CONSULTING ENGINEERS NEW YOR A I le PUTNAM COUNTY DEPARTMIEI�1'I OF ;r�LTH , Dwis!on, bf En-*6o rno f, Hea %th- Services, r ol, : r 'Y ,1iQ -P2, CONSTRUCTION B,EiRMIT 'FOR_S_f;WAGE_'DISPOSAL SYSTEM: _ Town or village s S4bdivision �i✓ > owner /1 7 3 Bu�Itling Type Lot Number ,of "Bedrooms Separate `'Sewerage System toy consists of r R a To be, constructed by - 'Water 5ply 'up Publlc, Supply From t- . y F S �. ,, IR !Cat., pply to be idr.illed'by Other ';Requirements I represent that I;:am wtf6lly and completely responsibietfor the design and above described ^wall1be constructed as showh on the approved amendment' Gounty, geparYment of 'Health;`,and it•hat on completron tiliereof1a 'Certil tie submitted to the Department and a tten {guarantee well beAfurn place yin, ;good o,peratmg conddio'i any part ,of' ,sad sewage disposal sy anee of ;the approval of „=the 1Cert ficate -of �Constructlon iComplianie zo; County Depart eht xo_f, iHeaith APPROVED FOR''- CONSTRUCTION Thls.approgal� expires o revocable for -cause or ,may be arriende. or iinodlfiedm0en c_o "_n- requires a new, permit . i Approved for 'disposal _of- ,domesY'ic Date. -�� BY z Sect,ior �� Brock 2-- t, Sys Lot L - Job _ —�. !Address °_ _ J% lam. 1Lz t -,Y A, lx Total Habitable Space �-�- O - 7square Feet Sep �c Tiank� -� lineal feet?X� — ,kwidth trench . , 3 Y J Address F a � n ion It the :proposed systerji (s); 1) that; the separate. sewage disposal system te�,of Co.nstrucfonYC�Qn1�A�dYy tisfactgry,to the,Commi ;sionerof Healt`hwill eC the towner his:. cefor3�4idliC signs by the'bulld'er,, itliat said builder will, '% rb� media'teVV ,fo.11ow:in g, thCclate of dhe :issu- ;inaduring h_,pif@ �:$,-,� r- �_Y 9 hec ,p !npj sys�6�ry .. _ i r abo.Ve �,��jr� reto. )that the drilled. well descriibed. ed to accordce d r a, , l , r and regulations of t;he Putnarn B:E RA.' o. he date issue8i,lEis st e. building, has been ,undertaken and is fyyby t _ ; , i�Qw�ybr y, change; `or ,alteration of nstruction je a or 'pri' t atQ� L y R - ltle