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HomeMy WebLinkAbout2241DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.06 -1 -18 BOX 19 I ro a, --ram rM r. ti l i E axt 02241 -T O- 48 WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK -- .,.;;- :.;,:.;�Thig rgpp�t.;j�,to,_be �ompleted:by „wel) drillQr..anSi, submitted to County.Health Department together with laboratory report of analysis of water sample Indicating water is of satisfactory bacterial quality before c�e. �. r+ty i pf., icat«o:N+4i lidc, oi! mpliance lsdskuedsr o %yuREPORTlUlU8TBESUBMI }TIED /�WITHIN30?DAYS O rjWE�LCbMPLETO . �zI #; TN►t�J� A}P :4C�F�r' 2oAr�t\LjG7� .1 ..sQ& ,a LA-C O' 3'S m 'H5 "' „`r .h• 'EaN# S E� LOT ' NAME AD/DRREE OWNER ��/ V • f/�NL V ;\ (NO. Street) . Town ) (Lot Number) OF LOCATIONS �I� ( wlu' t�AkE �N'�'ee cAo v c =rb ►a of `T- *-a A ty v �.L_E 4 d * ' BUSINESS PROPO D DOMESTIC ESTABLISHMENT FARM TEST WELL USE OFz WELL PUBLIC AIR OTHER SUPPLY INDUSTRIAL CONDITIONING (Specify) COMPRESSED CABLE r DRILd EQUIPMENT ROTARY. A R PERCUSSION PERCUSSION OTHER ) CASING LENGTH (fe9 DIAMETER(Inches) WEIGHT PER FOOT E SHOE t7CWN ` 19 DE i ll5 , .,5 / !f J '� THREADED ❑WELDED YES D NO YES NO TEST BAILED PUMPED �I�I' COMPRESSED AIR HOURS G.P.M. YIELD (O.P.M.) Vii. WATER MEASURE FROM LAND SURFACE- STATIC(Speclfy feet) DURING YIELD TEST (feet) Depth of Completed Well LEVEL in feet below Land surface: .r n MAKE LENGTH OPEN TO AQUIFER n ° ^T DEFTH -FROM LAND SURFACE :FEET -to -FEET 4' s� DIAMETER (Inches) IF GRAVEL Diameter of well including GRAVEL SIZE (Inches) FROM (feet) TO (feet) PACKED: gravel pack (Inches): FORMATION. DESCRIPTION Sketch exact location of well with distances, to at least -two permanent landmarks.... _..., .. I If yield was tested at different depths during drilling; list below FEET GALLONS PER MINUTE i' t dCy .4�r'. �: '��aJ, 2�y��•Y -���� hti rl� ��,�4: 4 �r Y{�}4 �y.. v� .cea � s7s. - ��i �dK �}$.+,,r�,@ ¢� �� ��'L'4.. �.������ �« � ;�l �1r`. -S4F•, p� i r��'.ti�d�} ?14�_', DATE WELL COMPLETED DATE' F REP RT WELL DRILLER (Slgnatu } r 1. P 70, 511 ` ..,..>.. _. _+c,••,.�.e�- :.__..... .,_.e -. _. ,. _.,".•:v . - -.y-a ._......: .:� .mot �. ...... .n. .. .. _.:..... .. �..• .n- iJ.� -.. : � 1 .., .� ... Owner o.r Purchaser of Building Municipality Building, Constructed by TAI L r.t. u �a ®w,w Location - Street Building- Type 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 06unty 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 ' 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. " Tie -d d.ers gried 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 the system. 0 K Dated this 2a"D day of 0L.y 19 -71 Signature_ �Li1t..DE� Title 0Q.3 ��� sEwl�G� SySTEri If co porattion, give name and address) TAI��� 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. a Division of Environmental Health Services, Putnam County Department of Health PUTNAM COUNTY DEPARTMENT OF HEALTH e Sewerage. system` Municipality CONSTRUCTION PERMIT AV Located at•'--\V.E b +rt�c— ���;.,. �'ee'.'o_r; Block Subdivision'` ` `'L; _ -� ��': r, . Lot Job Owner r=;� , :: K. ,- ti: ,; Address L C y. Lot Area Building Type t� �_: - ..\r.- :.,1.�; -.` No. of Bedrooms -a- Total Habitable Space � , : c. -, ti- sq.ft,. Separate Sewerage. System to consist of ;,-:, ,-...Gal. Septic Tank - - - -- -lineal feet width trench -- L s��,.�� \ F�� i n7�;_�: To be constructed by Address Water Supply Public Supply from Private Supply to be drilled by Address ='t : \. ` L.:.1. h ' 4= _ . .. l-• lam. '� •. G .� i =:. - _ ,o-.:� -. �_ t C: l ... C_ J �.: �', Other Requirements I represent that I am wholly and completely responsible for the design and location_ ..Qfhe..p.rQp.os.ed_.sy_st.em(s )•s- -1)! -tha t '-the separate sewa e "dis= posal s_ sy tem above described will be constructed as shown on'the approved plan or approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County tepartment of Health, and that on completion thereof a "Certificate of Construction Compliance" satis.- f; factory to the Commissioner of Health willbe submitted to the Department,_ and a written guarantee will be'furnished the owner, his successors, heirs or assigns by the builder; that said builder will place.in good operating condition any part of said sewage disposal system during the period of two (2) years immediately.following the date of the assurance of the approval F of the Certificate of Construction Compliance of the original system or any repairs thereto;,2) that the drilled well.described above will be' located as. shown on the approved plan and that said well will be installed €! in accordance with the standards, rules'and, regulations of the Putnam County Department -of Health. Date Signed t t, APPROVED FOR CONSTRUCTION: This approval expires one year from the date a� issued unless construction of the building has been undertaken and is re- ki vocable.for cause or.may be amended.or modified when'.considered necessary by the Commissioner of Health. Any change or alteration of construction requires a new permit. Approved -for disposal: of domestic sanitary sewage. Date •tY 7 a PUTNAM COUNTY DEPARTMFN.T OF HEALTH ..:....., .....�., � __;,_.- _..__.. ::: -, �...DIVI' SIGN- ..�F ",��i�RON�lAL HEAD' rH .- .:SEPV•IC�ES...:,�.- .- ::: -.:; ::_: ....�,.,._. �...........r, Date JUDY 30, ��t-tp Re: . Property of Located at L Ajr. T=- Sx�t?G i�P_iy� ­7Atx an 1-4p P-:. Block 3 Lot T�ktRe I-NPtP CAF Gentlemen: 'KDC--3 32,3 This letter is to authorize 'E, a duly licensed professional engineer ✓ or registered architect (Indicate) to apply for a Construction Permit for a separate sewerage system; to serve the above noted property in accordance with the standards, rules or regulations as promulgated by the Commissioner of the - Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system -or" "systems 'irri conformity with the `provisions, of Article 147 or 14 7, Education Law, the Public Health Law, and the Putnam County Sani- tary Code . "1 r OF New .0 "�4*0 0ANCI °'° oop' e • ° ER ss ° °� Very truly yours, • ° G ° ° ° Signed ice, t Owner of Property / ° Countersigne Address y, d,s s.•`• w JeiSEPH IF P.E., ., CS Telephone .111 1MANJHJEDE ( Seal ) Address CLARK PLACE �-o . you 308 MAHOPAC, NEW YORK i o 5.41 - G Ze 87 '7 Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH ±SERVICES I .. >... , ..,,. r•:. . - - .. , ......,,_....,_,. :....�._...:... :,.. _ .., .. ...._ ...- , �. ...... ,.........�. G.. -_ .,, . _. ................ ,. ..:. � ...., ..,,.., _.,.,.• }err... DESIGN,:6ATA SHEET - SEPARATE SEWAGE DISPOSAL ,SYSTEM FILE NO. Owner FQ K GVZ,r-- L_ Address k -Ak6 S "ot-,C- P�tv6,p�z�A,_k c,AL-UF-y Y� t~PKer St-to (z E pV_- IVE i Located at (Stree r��o� ST,� A - Block `3 Lot (Indicate nearest cross street) Municipality_--y -ow, 01F Pv- IZAh UAL" Watershed `2�ROC�k Lhk;� ` T-K % V<v' A. P o o K;e t- o•-r- jl�m . 3S'3 ° SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATION Hole Number CLOCK TIME. PERCOLATION PERCOLATION Run Elapse Depth to Water Water Level No. Tinto:-'. From Ground Surface in Inches Soil Rate Start Stop Min. Start Stop Drop in Min/in.drop Inches Inches Inches 1 a:s`E3 9 =It0 lz 8 4 3 4-, 2 9; tD, -2Z +Z 38 41 3 4- 3 3g, 4 1 4 5 2 9:il z3 4- 3 ck :..z'3 1 Z 4 5 0 1 TGS� 3 -.Ac>E $y - — — 2 JoIn .7 t32 :�S►c a FoR — 3 aULLIVAN-THIEDE 4 CLARK PLACE P, o, gc > 3 0 I��41 5 Notes: 1)'Tests to be repeated at same depth until approximately equal soil rates are ob- tained at each percolation test hole. All data 'to be submitted for-review. 2)..Depth measurements to be made from top of hole. 0 TEST PIT DATA REQUIRED ' -`O , BE SUBMITTED: WITH APPLICATION 42 ►r 48 rr 5 4'r — 7uQTE ItoLE..i 60rt AV'L 6.611 �Vt o 7211 8 Orr INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED �' � �reV INDICATE LEVEL TO WHICH. WATER LEVEL RISES G ENCOUNTERED TESTS MADE BY -�oH� 1: \`�cZVSko -F�- ��L� Date Cum ��,, a�x stag f toa4-1 . Soil Rate Used `�- 'Min/1" Drop: S.D. Usable. Area Provided, ®po No. of Bedrooms 3 Septic Tank Capacity 9 o co Gals. �" "TYgg L�So (sy ,, Absorption Area Provided By L.F.x24rr �_36rr widPr�fC yob, ®her. '3)- sRc_Nt+�G So6EP1t F�Avc15 S�LL1/A���P,�� �r pp a Name ��s, L c �� s.� a� zy 8 Signature o Address . SULLIVAN- TRIEDE SEAL CLARE PLACE 3a 8 4� 0. 24895 0 °° 5Z\ y{0 MAHOPAC NEW YORK � o a 4 � � ��„E �,g - �, � 8- �9°7A'.4°e °.. PUTNAM COUNTY DEPARTMENT OF HEALTH h 4 Soil Rate Approved Sq. Ft. /Gal. Checked b Dated C 16 �-D PrvV --I-- 8 cow 3�- ©'' OP G k_-X\rr_L_ \L- L, � I �" TePSaIL, GC t,uzC_� -'.DESCRIPTION OF SOILS ENCOUNTERED.- 'IN... TEST HOLE'S_ -7 --'_'S0- 7 i' DEPTH HOLE NO. ° NO.. z HOLE NO. G.L. J! j .. .. � \-t t9. ►-1 :� S' 'r1 V La i� S I ij v` ,r-a v �j . I1( 6rr _ -COPSo�t .. rcp �o�t oPSaa1_ 1.21t GL '3 A ivy C7," 1811 L m AM 1♦ cb i t-% Lz> A rut `- 241t 3Orr 42 ►r 48 rr 5 4'r — 7uQTE ItoLE..i 60rt AV'L 6.611 �Vt o 7211 8 Orr INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED �' � �reV INDICATE LEVEL TO WHICH. WATER LEVEL RISES G ENCOUNTERED TESTS MADE BY -�oH� 1: \`�cZVSko -F�- ��L� Date Cum ��,, a�x stag f toa4-1 . Soil Rate Used `�- 'Min/1" Drop: S.D. Usable. Area Provided, ®po No. of Bedrooms 3 Septic Tank Capacity 9 o co Gals. �" "TYgg L�So (sy ,, Absorption Area Provided By L.F.x24rr �_36rr widPr�fC yob, ®her. '3)- sRc_Nt+�G So6EP1t F�Avc15 S�LL1/A���P,�� �r pp a Name ��s, L c �� s.� a� zy 8 Signature o Address . SULLIVAN- TRIEDE SEAL CLARE PLACE 3a 8 4� 0. 24895 0 °° 5Z\ y{0 MAHOPAC NEW YORK � o a 4 � � ��„E �,g - �, � 8- �9°7A'.4°e °.. PUTNAM COUNTY DEPARTMENT OF HEALTH h 4 Soil Rate Approved Sq. Ft. /Gal. Checked b Dated C 16 �-D PrvV --I-- 8 cow 3�- ©'' OP G k_-X\rr_L_ \L- L, � I �" TePSaIL, GC t,uzC_� �fv PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM 'Z- o� v ©� p�•Tt�n,t,� y Al.t -E .. >:; • ....� •_ . ..� . - .- r -:;... ,. ,- ,..... ...:�o.n�._. _ .. ., . _ .. �...A.�...., . _._, ...,_, ..,.,._ ,_., T.owm.oa. Villa9e;. -�. _. P Located at AC9 MA ta o 3+e�¢o � Block Owner V�-NNMV, mALL_I Lot 6 Job Separate Sewerage System built by C 0. Y eF3D Addr s *9 L.EACiV% %MQ-R PiT$ 01,% . x T t 'c =P, i�E PTtI Consisting of 900 Gal. Septic Tank Other requirements I -0", a +®.$. CV itkVP__ y-al-r t. cbVr'9t %iC 1.%3 PL Ac: E Water Supply: Public Supply From �` _ Private Supply Drilled By W At�i?H�S ®BJ �Au� i.SB� -�- ��tLlfjllC'r , Address _ _iAwQey 'STmefri T.. VALLEY Building Type F z 1JE A Pq I L.y l2ES►�DE9JcE No, of Bedrooms Date Permit Issued �— Has Erosion Control Been Completed? _�f1Y yE'i IIl�fnnfri!gi� I certify that the system(s) as listed serving the above premises were constructed attached), and in accordance with the. standards, rules and regulations, plans I Date V L Y 2 1C1 -i t 9 ° 7 Certified b pi~� S-ca� g:liLDt�1�_�0 Address c i PLACE ° Any person occupying premises served by the above systems) shall promptly fa4,sl conditions resulting from such usage. Approval of the separate sewerage sy;;�A available and the approval of the private water supply shall become null and voidr,y subject to modification or change when, in the Judgment of the Comm ssioner o Date Cx By Or NEW � X0000 -_ a plans of We completed work (copies of which are t Putnagyyq unty Department of Health. `EP/�1�� �vL.%.wA� // sn i ,L R.A. z° o, ox,3o8 o - .°_�� AHOENS' License No. Z4-Aq S' ,V �2 cessary to secure the correction of any unsanitary LI R void as soon as a public sanitary sewer becomes water supply becomes available. Such approvals are 1• evocat�ion, modification or change Llsecessary. 9 Title! ®t- Pv , i, Ark VA LA-e-f —rAK fwAt' NOS 8 'BL C1Cr_ TAx N °` 6 YORKTOWN MEDICAL LABORATORY INC. ~ - Yorktown Heights, N.Y. 10598 F 0.••B 'k 99 321 Kea'r Street OWNER CITY, VIL RESULTS OF EXAMINATION OF WATER TIIT W-zSZ7. DUMATAM ITATTT'V 'DnADTIM', 4DnnV T ATrr DATE Tt�1iZi7 P% AP dfr 1zoAp�� G $�aobK _..976 245 -3203 BACTERIA PER ( gar plate count at 350'C). COLIFORM GROUP (Most- probable No. /l00m1:) HARDNESS, TOTAL - ppm DETERGE TS - ppm NITRA as - ppm IRON, TOTAL - ppm r L.vuniur, it - mg./i. These results indicate that the water was Yes of a satisfactory sanitary qudiity when the sample was collected. L)• -TO -Q 8 tra3a'^� ~_t . � _ _. ` _,�,Y �_ � l ..�. _ .- ...... _- R .J_�.�- u+.. -i �Ytr•+,.�ir +- _- �.�.riM .r ...� �kv* a�'�nr'. .__ � .-. � ��' �Cf jj Own, nQ"�' � �� j S'�� '. � -, t j 1' *, ;,rE z �' F''� � } r r � '(2 � � y s r _•. � � 1< E,ry ,. t 4 r,,,,� y� I t '� �'S ,r v u''r + a, �r r ',,, .��r; f �'i MTV F; 1 n " . - ` a •i N.. 4 r! gyp" ! J "y -0 k s^ �rr sr�. 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(f Aw t Mh 7 ts, i I 4aS c Ego y k t ` - °'�•l °4u' °'.`q f 3 'b vz J. }:+Lon ItsJ r :> •` TOWN OF �UTNA/� -f t/i9.C.GEY a <; `` Pur/vAM COUNTY, NEW-YORK :-�;� ,• r`; DATE 7- 27 -7/ SCALE JOB NO. 70 -09 4 SULLIVAN - THIEDE 0fE551UN�; CONSULTING ENGINEERS n.., nip• ` ,�OiSS.Ei.,pu � L TiON B X /^•a /O'1! / "s.20'/✓ ,. t 0 f \ i2o9.� /i✓G B.Pn o/C \i N ' � \ t�°9G.Y /N6 rirs y✓/ 6' GFFEC r /✓C' O/ 7'EFF6c r. ✓c ocyPr'i' r � 6 ' EFFEC> ✓E O /.9HETE'P 5p V •' ,- /' r \ 7' °/'FEGTi ✓E LaEPTN P i 1 \ � ' p.FOI'vE0 s \ / Fit / e 6.p \ � � � a /GiNG T /°/,/ BO.Y' — .7 - - "• 11 .k !� -s,\ \ �::u�r� �t,��"f� --- - - - -yo � /,•' =�` �� � a\ / /�,: � '`__/'%(` ` \�� -- _ a 9` r GHr• PIPE \ � �_ — 9 \ °� F7 / F"9M /LY f/ousE \ _ _ 9'° ci+sr /.e v.✓ PIPE - -� 3 BEO.POOMS APIP50VE it q ,\ ' a 1` _ li�� 91 �lm ! — m PUTN NTY I \ �..�� DIVISIMO), �l"< DIRECTOR. 64 ' GiwccL UMRONMENTAI MMM < .. / � � S rs >�.�' C'J�./FO.rMS ro .>'.c .c fir/ -ACS < ✓su.� - 1 '-�B' v.�'r'rG � /�r.✓�9� Fo��rr OEP9�ryE�✓r o� NEfI.0 r.l� '9L � d / ✓ /SiiJN O/= EN r' /TC. /MG:/✓T /ln.C. /S'E�A.G TH SE.0 ✓ /cES' ✓a5 Py E NHC /s 5u<, L / ✓i4/✓ P E. AS CONSTRUCTED 9P�,POx O :✓ GL.VOE 'iO`/'TE 3 .✓L:S. /c. Ho,• ,2fB9S SEPARATE SEWAGE DISPOSAL SYSTEM -'� I -- —_ I "��' .C/�KE s//a.eE P.E? ///E L aT �✓o. 9B3 — . -- �-- , _" - I — I — -- -- � - _ -900 G<iDL. SEPr G T.V�✓.0 � •,`P�t•1UY'�'v: ••Y.N pn� .� O� /POi9� /N�s BQOO.0 .G /i7<E�E 7".5'/i20 M P :> •` TOWN OF �UTNA/� -f t/i9.C.GEY a <; `` Pur/vAM COUNTY, NEW-YORK :-�;� ,• r`; DATE 7- 27 -7/ SCALE JOB NO. 70 -09 4 SULLIVAN - THIEDE 0fE551UN�; CONSULTING ENGINEERS n.., nip• ` ,�OiSS.Ei.,pu � L TiON B X /^•a /O'1! / "s.20'/✓ ,. t ` d4 ABSO.�BrioN /°.� ✓io6L7 sy.• j ' 900 GALLON SEPTIC TANK C3> LF x =.ABS. TRENCH Yk t�°9G.Y /N6 rirs y✓/ 6' GFFEC r /✓C' O/ 7'EFF6c r. ✓c ocyPr'i' r :> •` TOWN OF �UTNA/� -f t/i9.C.GEY a <; `` Pur/vAM COUNTY, NEW-YORK :-�;� ,• r`; DATE 7- 27 -7/ SCALE JOB NO. 70 -09 4 SULLIVAN - THIEDE 0fE551UN�; CONSULTING ENGINEERS n.., nip• ` \ . ` �'^ ) � ESTABLISH ELEVATION OF HOUSE TO PROVIDE DRAINAGE OF LOWEST FIXTURE TO SEPTIC TANK AND FIELDS ......... AREA RiSER-VED FOR SEWAGE DISPOSAL SYSTEM TO REMAIN UNDISTURBED.ALL CONSTRUCTION TO CONFORM TO STATE AND LOCAL STANDARDS AND REGULATIONS ......... F. 4 /-_' - --' ---_ _-.- APPROVE D AUG06 1970 'q "FALTH PROPOSED SEPARATE SEWAGE DISPOSAL SYSTEM � TOWN OF 47 SOIL PERCOLATION RATE .......... MIN/IN SULLIVAN - THIEDE —GALLON SEPTIC TANK DEEP TEST CONSULTING - ENGINEERS _LF X—ABS. TRENCH Clark Place MahaoaL New York . .