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HomeMy WebLinkAbout2285DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.09 -1 -1 BOX 20 I ■' , �` i J 02285 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 `�60NSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM J I� /� N� L1... E Town or Villdge � Located at Section Block � X a 0"V KAP 1�-O I�(4I N� IL�IDf� �/'t K. IC Lot ( Job Subdivision �i , q r' d� "� /( Owner 1 c- AQ � 6`1 It.dr-L- Address -a � A* 1 L iK 34 ® // CQ.� Building TYPe i ` irS I ` Lot Area O O A M A L L e t 1 0 5 J. �/. . Number of Bedr oms 5L Total Habitable Space X-0 C> % Square Feet- Separate Sewerage System to consist of 0 Gal. Septic Tank ,a �T lineal feet X W i' width trench,: To be constructed by S�c�bi' 1 CZII (��ia�G-� Ad�ress 1Z D1, 9 �X �LLE ��,y1EL, Nl� Water Supply: Public'SUpply From i--" r i= Private Supply to be drilled by E A L Address r� (�� (,�n't ,� �► /� A Dells, Other Requirements 11 -PEt✓ o B, , 6 IL A y �_ ^� L L* 3 06 ® ' v 1.=- ( d �%- eI�. S ' t I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal' system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations of e Putnam. i County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwiil' I be 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- issii- ance of the approval 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 Inst4WV in accortlan with W0 standards, rules and regulations of the Putnam County DepartmenYoof Hea h. Date °�/ -oZ7 � Sign d ` P. E. R.A. K% ✓ ✓ C v� t Address ALA � , o2 e w License No. Imo( APPROVED FOR CONSTRUCTION: This approval expires one year from the date issuel unless construction of the uilding has been undertaken 'arid isF revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of constructio'n.. requires .a ew permit.. Approved disposal of domestics itary sewa and /n ivate water supply only. ........... Date 9 BY Title eZ4 it .C.CL�✓rit�LAi r PUTNAM COUNTY DEPARTMENT OF. HEALTH Division'of 'Environmental'-Hea / th Services,- Carmel; N. Y. 10512f� / CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM / �T !�/fLLEy !-�)' Tow(y V.11ag /L[-' �'/}D1ZE /z�r�%J C a/ ri o o Section Block Located at sy�� n A n Owner F�.4 A) V_ !�'f /Gj%L L f< Lot Y 47 Job t s FIZ 4 � II6 GiGG oGG r �D /, eax ,340, ®V7 -A)4 ��Ey, u Separate Sewerage System built by -- Address .rte* �• Consisting of 69 Gal. Septic Tank lineal / q/ lineal AFeet XX '�% T! / w�dthd trench` Other requirements ©ef f/ l r (.�/YL �L�GIG. ` IF,4e r i / �7 - 6 ��� 7� - "'(' � 4.: Water Supply: Public Supply From E ,i'0 7 - Private SuPPIY Drilled By D +2WE5'1� �c1 W/ U_ Address f / Building Type 7 / No of Bedlµa(ns pate Permit Issued ,.. ° Has Erosion Control Been Completed? I certify that the system(s), as listed serving the above premises were constructed es tiall as show q�ll' he la s bfhe completed work (copied `of which are attached), and i cc tlance with the standards, rules and regulations, plans f' ed nd t e per 1ss the•j Putnam County Department o Health 1 7 i 4 , Date Certified by P E R A' Address License No T Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of'any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a public sanitary sewer becomes _< available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such aopr'ovals are subject to modification or change when, in the judgment of the Commissioner of Health, such revocation, modification or change is necessary: ; /�l2 ev // - Title BACTT RIA`PER ML..(Agar plate count at'95. C). 8 COLIFORM.GROUP (Mostrprobable No; /TOOmI.) Less than 2,2.. ES ;, OTAL -ppm "DETERGENTS - -ppm NITRATES (aW N). -: ppm. IRON, TOTAL -. PPM 7, dis Jam. r C 0 n-- 5 zc ye= r -�7 7 7*: 07 ID a nt Z) z fie S V S o c p n e bu-i-la'l S7S 73 e o A) is 17. T n -1 G U lv,islon 0- ','^-,%_"v xn WELL COMPLETION REPORT 3/71 s•! PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK Trias,eport -is to- beompieiei; -fiy welt ` dr'rhler -and submitted to-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 OWNER NAME Fr@Lnk GrO7 !. 1 and Son ADDRESS Lkke Shore Dr. Putwgri V&T 7 e A? Y LOCATION OF WELL (No. & Street) (Town) (Lot Number Lake, Dr. Putna -1 � .� �; N.Y. See. e ` 7AX AromO ® , ®% 1 PROPOSED USE OF WELL BUSINESS ESTABLISHMENT ❑ ❑TEST WELL Q DOMESTIC ❑ FARM ❑ SUPPLY El INDUSTRIAL E-1 CONDITIONING ❑ OPeERI DRILLING EQUIPMENT 1:1 ROTARY- COMPRESSED ❑ CABLE ❑ OTHER AIR PERCUSSION PERCUSSION (Specify) CASING DETAILS - LENGTH (feet) 261 DIAMETER(inches) 7 #t1. WEIGHT PER FOOT P6 1 � THREADED ❑ WELDED DRIVE SHOE ❑ ES ❑ NO WAS CASING G OUTED? [� ES FI NO YIELD TEST HOURS G.P.M. ❑ BAILED ❑ PUMPED Ei COMPRESSED AIR 2 YIELD (G.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify fee=DURING 7 t 6 LD TEST (feet) .- drTa�ae� Depth of Completed Well in feet below Land surface: ?30 SCREEN MAKE _ LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (Inches): GRAVEL SIZE (inches) FROM (feet) TO (feet) DEPTH FROM LAND SURFACE FOR DESCRIPTION Sketch exact location of well with distances, to at least two Permanent landmarks. FEET to FEET 0 10 Boulders G- �--47 10 15 Soft -Brovn reek If yield was tested' at different depths during drilling, list.,below FEET GALLONS PER MINUTE _ -L - -f BOYD ARTESIAN WELL C DATE ^WELL COMPLETED — I_`.J /71.: !2 DATE OF REPORT 1..0/1 �`T WELL DRILLER (SignaturQ) �jy��'/ /� //���� ROUTE 52 r/P`FCr� .!?�� '1 .�JY"v rAniWT. NV PUT?dA COL?i �'% •J�? _ -1—T- ._, E - ; r T - 1. V DI�IISIO't 0-7 �='- ' CES . D2 t a��? ►�'. Re: Property of F (Z A L L. I Located at icc 54orLe. R AD IQW06% ST, T Section Sloe- ®Pt 0 96. Lot 4 2.1 , PUT" .AA-At VA LLEtY Cen tlewar_: -. This letter is to' au t'_or_� = � f� �� E AQFFA4 a .duiy i_censeo )lnofess_on_- en_ - or u a':101 for a v'cnJ •.,Lc -0,,. ?v-: --, --D:' G sew' Z' S e .. e !. e r - = 3 7 -Ju _ _ o serve the v':7 iJi �_''_'otef yroppe „t__ tae Star-daris. .•,� �'� or rem-- Iatlons as oro�__,i� ,a�. Co __e ?UL_— De-oar'lmenV of .LeGi -to S :IJ .. .C.�L•I T'L �-V y n -v7 _ t:, t.�.� 7,. _._ •„ ve�, Jun -:~' Je - L _.. �.�.. ..,:..f'. v� on Ci_ -.. .. .. J r -1 system. or syst !.s i n confo_'�- v� �.f �.~_. 147! Education Law,. the Public Heal`h T and the Patna Count- San-4- .tare Code. crSe roy 09 PAP 9 i $E rz is u: dress IL jp �- �..� . Teleoncne dd� r I LbWI N ROAD YORKTOWN HEIGHTS, N. Y; r a o �;• `Riif�SSlOth� _,•T nr ... D j � ? T S , C-`' DESIG` DAT_ 2� SEF.APRA E DIS_ ,SAL S`:S :` ` FILE \70. M A Iz c. X31 Q 1. 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Y,� baili-- -� PliT�vaLi CG��TY DE?�. 1L,;,T '0r hLLTri PliT�vaLi CG��TY DE?�. 1L,;,T '0r hLLTri PU N A' I C 0 Y D E T LN 1 0 F Dlvislro�' O*Z - Dc S I GN SH, E E SE, Ft RA FILE, NO C', n e r F124AI Addrmz FA(� Yde ?VTAMAI , 4,4 0 ro Loci t-�f /L) 571-125 Sec 3� _ B102' &le D- LO-' .__ nd i C a�m S C,:) I ity -1,-.'at-'2rshe 00 S I" 3,t cOj p D r. r -1 T C F T-9 1 T p7n --n 071 LJ 1, CT T -I-, ED ;T T 2 PPT T(2TTr)\' ;L e E 1 NO Start E:-,. (D -D P7 r.7 T T 1+ 3 (70 l Z t U© Y� 4 os 'e J t 0 It -2 r. e oe -M L, CL Sam �3 n so, Fir ol- -Z., S a t e 0C!'0 0 0- 0 ro 'Tr C S at 1� L-- L S C,:) Droo. in 00 S I" 3,t S 3 pfl /0 P7 r.7 T T 1+ e S -L-.,:3 os 'e J t 0 It -2 r. e oe -M L, CL Sam �3 n so, Fir ol- -Z., a d a t e 0C!'0 0 0- -2 S '!-%,D 'Tr C S SO-4-1 IlFt-- - L-- L S C,:) Droo. in 00 S I" 3,t S 3 pfl /0 ��� 11 y �Z3� `_�_ �� z.�,�= /! _ •_ Z!k /0 ! 3� 28 Z3 f �z� No-Les: 1+ e S -L-.,:3 os 'e J t 0 It -2 r. e oe -M L, CL Sam �3 n so, Fir ol- -Z., a d a t e 0C!'0 0 0- -2 S '!-%,D I d 2 a to Oje- --re S No-Les: e S -L-.,:3 os 'e J t 0 It -2 r. e oe -M L, CL Sam �3 n so, Fir ol- -Z., a d a t e 0C!'0 0 0- -2 S '!-%,D I d 2 a to Oje- --re TEST PIT D A T A RE 0 U I . 1 'Dp D --0 3-613NITTE"D T H At L r ICATION D E S C R T P T I ON7 0- ;.0- 'S ^ 7 N TE R E D --T'T HOLES DEPTH HOLE HO. / HOL-:' NO HOLE NO. E G.L. IT Xe ejos 6?r 121- 18 tt 24" 30"- (T t+ 36" 42' 49 54" Of- C-)j 66" 78 8 4! i N D I C A T E L L :AT 1. 1 CIL GROUND %'_A TE, R IS ENCOUNTIEPIOL� FDIC DICA T;:' TO I IE�,:,:L RT BrT� IS EN C OU'NT TE FR. E D A SEE S FTER Y I., Da-1--e TESTS M-A E B Date 9 7a- S o i I R a .-2 :'se Dr 0 p - S. D. L's I c A r e F 0 NCEP---- L Gal s. O. o 2.d o -SE? Q t -'C Tan lk Ab -1, r e a, Pr L.F.x2L", 36" widt'n trench. Othc,,., "n; e S i t a r e Address ENEA Ila I � dL E AU ANT, P. E P U T A .1 COUNTY DEPT..%%-* nEALTH Q- r+- /r_ -1 BAUDWIN ROAD YORKTOWN HEI(IHTB, R. nn +-n > T16.wT. JT, -PtPE (1141U- SLOPC '/,4"/FT-) Pr=v-F&-1,&,TEV PI PC CMAX. 'LOVE lh -"/FO L r-- !R 0 r's c &A 0 C. e- M A. X., & 0 cl tA I L 6 rt,4v C- L fILL r-- Q C- rA N3 u �wf S v W D E'o i?�" AA S U . I 1 -0- X 0 s K T: ID IP�l + 400 L Lo �j 0 50 0 u m'PT'e- TA", 1Y 0 PRC PO lizn i / � . P L A f-,l '14 6 A L T � C. PMOVED th, j 4 v v=YLT, 10' NAY U6 g19 &7 EUGENIECW~, P. IS. fjj��4`AMGOUTIUY DEPT. Of HEALTH gy . ....... P. E all BALDWIN ROAD DIRECTOR, ­D'IVISION OF YORKTOWN HEIGHTS, N; ENVIRONMENTAL HEALTH SERVICES �J- ct.—� ±. J"T"' fs"r—s Fll T 1,1 1& AA vsLL OG.4= T A W. A&A L T 47.7 V- 2'Z r7 5 F\I/A,-- Z C> I S I' C, SA L A W C: \'/ATJ!,rL SUPPLY F-Aa'L'Tlc- ;r o $Z, - F W- -4. W W- , CA* w- 0 L L. I F7-0*1 box 34-C) 5t rr�,3 io c s SMj & V ➢F- � -ij o 13 4 F5 p- 6, Ct A "ILL 4" fi '14 6 A L T � C. PMOVED th, j 4 v v=YLT, 10' NAY U6 g19 &7 EUGENIECW~, P. IS. fjj��4`AMGOUTIUY DEPT. Of HEALTH gy . ....... P. E all BALDWIN ROAD DIRECTOR, ­D'IVISION OF YORKTOWN HEIGHTS, N; ENVIRONMENTAL HEALTH SERVICES �J- ct.—� ±. J"T"' fs"r—s Fll T 1,1 1& AA vsLL OG.4= T A W. A&A L T 47.7 V- 2'Z r7 5 F\I/A,-- Z C> I S I' C, SA L A W C: \'/ATJ!,rL SUPPLY F-Aa'L'Tlc- ;r o $Z, - F W- -4. W W- , CA* w- 0 L L. I F7-0*1 box 34-C)