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HomeMy WebLinkAbout2329DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.10 -2 -50 BOX 20 LL 1 J Ik k.-lvs I 16 �' I IL 02329 7" .4 UT 14AM COUNTY -DEFARTMENT Oft. - _HEALTH , Division of Environmental Carmen ,I.V.` Y. 10512 Fir, TE,.-;aF, Y CA cmmsr rr I �:M. mpu.xom q E1VAG:lE�.Q.1SP0eSA.j;, S..,SITIF��M:-.; P. I A Is– Blo,c Located, a... Y.� Owner 7_1 Lot Separate S em bjullt� A J Address .Sysi Consisting of ail Septic Tank lindi It Feet'' width trench -.PfLD5­ A TAL requemen.t s 7_0ther ir Water Supply: P ic ,Supply 'From I Drilled by' to,, Py -P Addrbii T __ ofo `Date – ii rdo i;hs " F4�wli, �i N9 B ,Buildi P9 Hilt.,Erosion' 6ontrol-1§e6n -C6mplot'ed,Z' ,� A, c listed above certify that the .1 syst�m(s)_as I -cln, plans of the complete WOrK (copies -of which are r con r 3,�Vli the ns attached); I acc� ce,-With the. standards r a d u an it: is by --tob Putnam'-,Diportment of Health. P RA.— Date 'Add ti. DSO l 37 d License No ress Any person , occupying premises - the,41?qv!� s uct ic4ssary'�o secure the,;0rFe;tioq, of. any unsanitary as !rjy,�,e.n, -,6ublic,',I!jahjtAFy _ . 5�pw , or becomes ies conditions lrrom,'su*cfi',Usa go .'shall I cl void: as 'soon as sup ly 'bliicoinles -Such' approvals are, water " supply available and the approval ofthe�.private water supply s e al,'public: -available. id When subject t6 modification, or:: change ,�when, 9� -in the Jul f Health m64015 -,c ange, necessary. stoner o" such revocation, , is )on.or r7 Tdle ate— B In 'J 6_,. .., r� it 4,Z& 4V16 ,0er:J" Building Consttucted by Location - Street �9 Building Type 15 _ Block J 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 system, or any repairs :Wade 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- vcas -of the Putnam County .D.epartment,..of...He.alth as to whether or not the failure df the+systet'to operate was caused by the willful'or neglige -t" act of the occupant of the building utilizing the system Dated this! day of _ �% 19%'`' Signatur A. A h . X Titl 6,'C C0,1T;'111f0'T D, If corpTgajtign; ,gam ,,game and address) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP1,ETION 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 0 er or urc aser of Building Municipality r� it 4,Z& 4V16 ,0er:J" Building Consttucted by Location - Street �9 Building Type 15 _ Block J 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 system, or any repairs :Wade 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- vcas -of the Putnam County .D.epartment,..of...He.alth as to whether or not the failure df the+systet'to operate was caused by the willful'or neglige -t" act of the occupant of the building utilizing the system Dated this! day of _ �% 19%'`' Signatur A. A h . X Titl 6,'C C0,1T;'111f0'T D, If corpTgajtign; ,gam ,,game and address) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP1,ETION 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 t A: H PADOYANI, M :T. (AS.0 ) i WF_LL COMPLETION REPORT 3/71 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services. COUNTY OFFICE BUILDING - CARMEL, NEW YORK ,... .. Department ory r 1. ...'kis r�5rt -s c t. fnyncr Eiit th t0 F7 her i ora., -ort . n f_ . 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 ADD j� LOCATION OF WELL. (No. & Street) t � (Town � (Lot Number) •�� "' PROPOSED USE OF WELL BUSINESS �7 DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING (S(Specify) DRILLING EQUIPMENT COMPRESSED CABLE ❑ ROTARY ©A R PERCUSSION ❑ PERCUSSION ❑ OTHER CASING DETAILS LENGTH (lest) .Z 0 t DIAMETER(inches) (( WEIGHT PER FOOT � THREADED ❑ WELDED DRIVE SHOE ®YES ❑ NO W CASING O TED? YES NO YIELD TEST HOURS G.P.M. ❑ BAILED ❑ PUMPED ©' COMPRESSED AIR . YIELD (G.P.M.) p; WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST (feet) Depth of Completed Well �• in feet below Land surface: 11 SCREEN MAKE LENGTH OPEN TO ;AQUIFER (feet) DETAILS SLOT SIZE DIAMETER (inches) IF GRAVEL PACKED: Diameter of well including grav @I pack (inches): GRAVEL SIZE (inches) FROM (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET f If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED / DATE OF REPORT JWEI_ DRILLER (Sig Lure)f I �, U sa� ��' ltd' ✓� J�su s�`.. f 14r. 4:49- aa 2? C ;PUTNAM' COUNTY DEPARTMENT OF HEALTH - = Division of Environmental Health Services;- Carmel, 10512 "CONSTRUCTION -.PERMIT FOR : SEWAGE - DISPOSAL :SYSTEM (/,44 }✓' TAX MA Town or Village ,- P: Subdivision 6.C7 I°� :- �M�4. °.D':,�11� G'l% �(%19�iat�r. 'r��G� J Lot.. 4 Owner yi AJ Add Rl20��al: v" ®ile 7l. Address %� Bwldin9 "TYpe.. R SfD�M di _ A:2 Lot Area' Number of Bedrooms Total Habitable 'Space Square Feet' ii. Separate: Sewerage System to consist of -, ' Gal Septic Tank lineal, feet X ��' width trench To be "constructed by KLi Address Water Supply: Public, Supply From ,..,. :. Private; Supply to be .drilled ' by, Address' J >r A• r'LC >'• /� '' o Other Re4uiremerits' y represent that I am.wholtyand completely responsi location of the. proposed.system(s); 1) that the separate- sewage disposal system above described wtli be con structed'as shown on th pi� re to and in accordance with the standards, rules and regulations o t _ e Putnam County, Department of Health, 'and #hat on co` Ere& of Construction Compliance "satisfactory fo_:the "Commissioner of Healthwill be submitted to the Department, and a. writ f the,owner, his successors,`.heirs or assigns by the builder, that said builder will ' place .in' good operating condition any `part osal': wring @period' of two (2).years immediately following the date of the issu- ance of 'the approval of the 'Certificate of ra' "of. rigin sysferri or any repairs thereto; 2)'that'Me drilled well described above' will be.located as shown on the approved plan d -t at sta ordance- with' -Elie scan ds, rules and regulations of. the Putnam County Department of Health, . Date : P:E: R. R.A. Address License No. APPROVED FOR CONSTRUCTION This a, rov ) o a e date issued unles .con ruction of the building has been underta _,ken and is 51 revocable for .cause or may be.am'ended off = modified w ry by`the Cornmi oner Health. Any change or alteration of onstruction requires a e permit. p d for disposal o'f •domestic s age, . " o privat pp y only. :Date 1 f, BY Title Q! ... F' '^_"`_�+: °'�"'r"•- --T..' "'1 - "' °r;'^- r`- ---T ^_ ...'- 5_`- ..y'°"` '' _'w -�-_ ^- .TV- r-- T....- r - - -..- -^F" • -'T+.S {� PUTNAM COUNTY DEPARTMENT -OF HEALTH` Division of Environments/ Healih Services Carme% N: X406)2', K ' i CONSTRUCTION PERMIT .FOR SEWAGE DISPOSAL SYSTEM"�cpcv.�'�,�uisOr,q �i46�tbJ ToWrV.or V illa9e Is - L �2 /�'y Subdivision D,T B�,f1i/lJ�l. �a,� G�',�vBJ t_ot' Job ' �`ii�t?R!9 _ �% �N�t 1 s • a - TOO 'std v�9I� Owner Address��°" Buildin`9 TYPe ' /r�S f/� Lot Area - �� 3�� �l�Ch' %�%✓ r Number ;of Bedrooms Total Habitable Space ���'� ~` �eDeQ Square Feet(`,; Separate = Sewerage System, to consist of d Gal Septic Tank �� lineal feet :X� width trench To be con5tructef bY, �� Adifress s Water Supply I�ublic Supply Fr m - YPrivate Su plY.t be rill b' Address 7. Other Reguiremeots 1 represent that I am wholly and completely_ r po '}- of the proposed systems) ;� -.1) that the 'separate sewage dispdsal� system above ;described::will_De_COnstructetl as stfow`n -t nt t - d in- accordance. with the standards, rules- an_;regula ions o. a -u -nam County Department :of Health,.`antl that:on.co` n ' e 'cate onstruction Compliance' satisfactory to the Commi3sioner of Health "will .{ be submitted to,the .Department, -and a :writ ante ed a caner - his.successors heirs.or assigns by the;builder,;that said builder will. = "j place in _good .operating 'condition` any part of; id wa d _ em dur g the period of two (2),years immediately following thedate of.the issu ante of -the approval of. the 'Certificate of 'Con n th' �'! al systQ@m or any - repairs thereto, 2)'that the driiled >well, described above.._; will be located as s"h on the approved plan and. t d Ile` in cco adce with the standards lei and regulations of the Putnam ' County Department of Health Ar Date " �` PE •RA Address e'%t O,• _ Licen "se No APPROVED FOR -CONSTRUCTI'ON This'approval expires one year from the date "issued unless construction of the building! has been undertaken 'and is revocable forcauie or may be'amended or modified when considered, li :.the Corrimissioner °•of Health .`Any - change 'or alteration of. construct ion: requves a" ne ermit Approved for disposal ofd domestic itary ewa e, a`nd Nato water supply .only _ ''� Date ' ` ` '- BY Title z FUTN.AM COUNTY DE.. ?- RT_•',NT OF LT, -� �—j�; - -- _ ._ ........_ .... DIVISION OF FViPOQ� _L_�iF ;LTA - C =S - + vv:..•,:,+... w... a. vc_.. e..-- we-. vv-. es. w..,- o... s:....-... nu s.•...r- .oa- e�.^'�- �.'�.T^-t.; •- ..••�c ^- m-- +nc+q +:,wwe " - ... .. .. _ _..n.,....e... ..,... DESIGN DA -A SHELE T - SEPARATE SES::AGE DIS ?0SAL SYSTE FILE N0. Choner zfc Address i�oo�sf •� 5i'_ s o� GSif> �' Located at (Streit). �' !��4ja;� ��/IcZ�r SM5._ Block Lot - (Indicate nearest cross stree �) �--=S _ MuniciPality, %taw O� ��tT ,/% ia�rshed f �= rsar�tt fr7� �� °� SOIL PERCOLaTIO` TEST D?TA .REODIP� D. TO BE SLB:•:IIfTED KITH _APPLICATION . Hole i� zmbar CLCG� TI` E PERCOT�ATIO \' PERCOL -ITIO` Run Elapse Deot'- _o (rater L, -ester Level No. Time From Ground Surface i:: Inches Soil Ra_e Start Stop Min. Start Stop Drop in tin /in.drop Inches Inches Inches 2. 4 5 . _• Z 2 i C .`�� l lla. iZ.. del /z- , cl , 4 1 z 3 . 4 Notes: 'l) Tests to be repzate.d at sa-:e death. u-i t it a pp, roxi atel. equal soil rates are ob- tained a.t e Bch oercolati o test hole . all data to be submitted for rep ie:o . .2) Depth meas ,.rements to be made from top of hole. TEST .PIT DATA REOU IRE D TO E SUBMITTEDi :IT [ APPLICATIO` DESCRIPTION Or SOILS E�:� �- NTERED L_: = ST HOLES DEPfiH HOLE NO. �' °HOLE \0. HOLE NO'. G.L. Tom S/L t.� st;1� 7� sat c 6'f Jr 12" 18 Tt Ss�iv.J icc Lt S✓��i %� -r� er7.�1 1�1���� Gt�3�J . 24" SaydC:" 5l�tft, 30" 36" 42" 43 54" . 6 0" 66" 72:.. 78 ' 84". INDICATE LF.VFL .AT. S.IICH GROU \D W ATER IS ENCOUNTERED? INDICATE LEkTlL TO 'N'HICH G,MTER LEVEL RISES AFTER BET G ENCOUNTERED 'DE TESTS 7j _ \roc �r0 Soil. Rate Us �Iir/1 ' Drop : _ S.P. �'S'Jl n No. of Bed. -oo7.s 3 Septic Tan :, Cap_ci v y �1£�c Gal,s. TYpc <l ?%scr.✓,.il/i✓a/ Absorp:Uion Area Provided By %Z L. F.x2' =' 35" 36 c:idtR trench.. Geer OFE�S/ _ r— --�� r� RN Wi Nam, e STANT&N LANDED .,90.: fi �. � Address WX 267. _ c � L A±�� 1 01971 RAW r. 0645 :. PU1-NAM COUNTY • PUTNAI COUNTY DEPARTL1ENT OF HE LT, Elm Soil Pate Aaproved Sq. rt. /Gai. Checked L- Date f R T �NEN T OF HEALTH PUTNAM' COU-NTY DT P- TT -VT' -111aT I L T'r 1 S":'RVICES =-., Iq -DIVISION OF C) ILT .4A(4 Re: Property of Located at fT A5;' B! o c k ..Lot e : G -lem n n -UL 1 le STANLEY, LA UER' This letter is tb auth 0 _Ize A -7 a duly licensed p r o 'L s s o n a I _31n_ e 2 n or re i stered architect .(Indical -ion Per-; t -for S a -.e system; to to.apply. fo r a C ons -ac t 'anda-ds, rules U pro-o=­17v c 0 _2A c -a the s- serve the above -ot the Put-n-am, 1.0 n'- v or rec-ulations as Tc- m'� 1. S a.'V ed bv of 'i", U Uv am neces-sa-_7 pap-er.3 connection with this matter and to s uc 3 a e construction of said system: or systems in confo-t, M v. t 1-1- p r o 1: 1 S c n s of Article 145 or 14 w 7, Education La, the.Public Hew! tb T a a n al the Patna . Counu ty 3aft- tary. Code Very fours, ours, d S g:r- e ro-DerT; Ow o y Add:--ss ountersi e 0 J. P.E., r Tel ione 11N, Th RI C., ACLCLr6g- L-MILAAA a�_tersi BOX 267 ... 0 A" 0. 32 M50I 245-2645 Telephone ........ ..... . CN . iL ggtl6-vl Ih IL i. jt 141 h. Wff ft Is to terify trial ti'a V,0F,w disposal sysum Ws , musiml ee as in- dicated on this O!"1 20d vat Itre was inspected by me Uqoft it was covre6 over. The Systam VYIS CODSM'..'-d il. - accordance with ^0 •hD ruh ZA. reu.- labous of dlq painam county Dept. 11 T II Lj 11C2/7 4r11,f Orr GO' 'Ie ........... .. .. ... ..... CeIR! CA S.P., 0-1 Soo 1,,,dMG ,1 Nss AII)i the i ti P101 1 --A 7- e�. � Wff ft Is to terify trial ti'a V,0F,w disposal sysum Ws , musiml ee as in- dicated on this O!"1 20d vat Itre was inspected by me Uqoft it was covre6 over. The Systam VYIS CODSM'..'-d il. - accordance with ^0 •hD ruh ZA. reu.- labous of dlq painam county Dept. 11 T II Lj 11C2/7 4r11,f Orr GO' 'Ie ........... .. .. ... ..... CeIR! CA S.P., 0-1 Soo 1,,,dMG ,1 Nss AII)i the i ti P101 r:Ll Q 70 0 N h h 0000 00' 130. �e 5