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HomeMy WebLinkAbout2348DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.14 -1 -5 BOX 20 oi P6 . i W • ',` Il 6. �. ` Consisting pf _ Q GaL 'Sep Other requirements­. Water Supply, :Public ;Supply From Type .Ha`s Erosion Control ' Bei in t, 1,0512 PEEKSKILL MEDICAL LABORATORY 1879 Crompond Rd. Barclay Plaza Bldg. A, Apt. 1 Peekskill, .New P :York 10566 E 7- 8777.. DATE COLLECTED RESULTS OF EXAMINATION OF WATER 10- ' 7� OWNER DATE RECEIVED /0 CITY, /VILLAGE, TOWN VOR NAME OF SUPPLY DATE REPORTED MCC /0 i%Cli /U'd�'�y SAMPLING POINT BACTERIA•P R ML. (Agar plate count at 35 C). COLIFORM GROUP (Most probable N6.. /100ml.) CSS '�iG.n �•a D ESS, TOTAL. - ppm . DETERGENTS.- ppm - NITRATES (as N) - ppm IRON, TOTAL - ppm, FLOURIDE (F) - mg. /1. k'-Y. G�GOeYDtS These results indicate that the water was yCs of a satisfactory sanitary quality when the sample was collected. 0 ADO A , M. T. (AS ) ' wf Owner or r Municipality - Purchaser o Building---' Building ConstructE by Cry r-e. Location - Street j e,7 / y / . Building Type /Y,dzO13 Sdction 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 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. the system -to operate--was caused by the- willful-or negligent act of the occupant of the building utilizing the.system. Dated this day of.�'. 19 � Si g nature r i VALCAR CONST;;U; Iii;; s, INC. Title 20 WOO If c Mjapj.*jb5 jgi ve name and address) 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 WELL COMPLETION REPORT. PUTNAM COUNTY DEPARTMENT OF N.EALTH 3171. Division of Environmental Health Services COUNTY OFFICE. BUILDING CAJ9MEL, NEW YORK This report is to be completed by well driller and submitted.to County Health Department together with laboratory report.of '' ° °afi2fysaso t}ra'ie� sis pie it iea €ii�g waiervisa; ;airstactory bacterial quailty'5efcre•' certificate 'of "construcuori'corflpliaitc&ls - issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OOWNER .DDRESjS .. T !V c I _ No. 6 SUeet) (Town) (Lo Number) LOCATION OF WELL . BUSINESS FI EJ C) PROPOSED U J DOMESTIC ESTABLISHMENT FARM TEST WELL USE OF.' WELL PUBLIC SUPPLY l O INDUSTRIAL (�� El OTpHER l_I CONDITIONI14G ecify) DRILLING D ROTARY COMPRESSED � AIR PERCUSSION CABLE EI OTHER E] '(Specify) EQUIPMENT PERCUSSION CASING LENGTH (feet) .DIAMETER( Inches) WEIGHT PER FOOT - DRIVE' SHOE I I IAI A. NG P�CIrID 1 7 29 THREADED OWELUED I Ci7 YES J NO OYES Li NO 20 YIELD D L HOURS G.P.A. YIELD (G.P.M.) 15 TEST BAILED PUMPED COMPRESSED AIR 2 15 WATER MEASURE FROM LAND SURFACE— STATIC(Sp'eclly feet) DURING YIELD TEST !feet) Depth of Completed Well LEVEL 20 �otaldrawdown in feet below land surface: 2001 MAKE LENGTH OPEN TO AQUIFER fleet) SCREEN _ DETAILS SLOT SIZE DIAMETER (Inches). IF GRAVEL Diameter of well including GRAVEL SIZE (Inches) FROM (tool) TO (feet) PACKED: gravel pack (inches): DEPTH FROM LAND SUIkFACEI FORMATION DESCRIPTION Sketch exact location of well with distances, tout least, two_ permanenf' landmarks: 0 ledge • 1 A --- k If yield was tested of different depths during drilling, list below Q �\ FEET GALLONS PER MINUTE 'NF . , h i '4z �I �yt1�S risk VCS DATE YESk COMPLETED DAT9'07 REPORT W 1, DR LL R (Sign ;t ) R. Q,*lttl$��! r' z- ,^--^ -- - °��°'^--: ^ter•- v,-•^F- --r- .r, -+'}— .•'^^' :--„3r s PUTNAM COUNTY 1 + � Dr�rsron of Enwronmenfal f - CONSTRUCTION. PE;RMIT,,F.OR SEWAGE :,DISPOSAL,SYST _ l � ., Located at g1� Subdrvisign 0 Owner" �J�i TB BIYI G=® Building Typed /,��/S/ ���L- Lot Area` Number of Bedrooms' Separate Sewerage System pto consist c �O© tGal Tq7 be constructed by r ,y Water Supply Public Supply From _ ti Pr Vate:5upply o be drilled by .- Address' / z Other Requirements � h i d of I, represent that f am whollyfand completely responsible for the desrign am above descri bed will be constructed assliown on the,approJed amendment ':County Department of :Fiealtif, and that on completion thereof a Cerf .. . r . be submitted .to :the "Depart merit, and al. :vq.1 . en ,guarantee will be; -fun place yn'' good ,operatmg`condtion any :part of said sewage disposal s arise =of the. approval ofthe Cer,'fifieate',of Construet�on^ ComplCanee e r t will Abe located a ;'shown on the approved plan and that said well will County`Departme� of Health Date //fir! " ! Signed' a � APPROVED FOR CONSTRUCTION Thai approval expires one year frc '.revocabie for,cause or may be amended or- modified when conslderetl'nec cequlres;a new permd Approved�yfor digposal of''d`omestie sa nary se .rte a c a, PARTMENTOF HEALTHY ._ lth Services` Carmel: -N Y 10517 w Town or ° V J Id4e R F Elo k h � 7- Lot Job Add ►ass? -_, r Total Habitable Space /S00 Square •Feet - eptic Tank width trench • Address •- r r� ,/ W; ,lee canon of''the proposetl;�system(s),1)- that ,the- separate,sewage. disposal system ere to and m accordance with the - standards rules an .raga a ions -o .' e . _u nam, ate ofrConstruction .COmpliance'`satisfactory toahe- Commissioner of Healthwill, tom., r ;ed the owner hissuc6isors heir'soi assigns by'tlie_builder,.that said "builder will. e'm during the period of two (2)'year +grp¢ly_follow`rig thed "ate of, the •issu- the original sstem- a,ny repairs tmloe �t�jz).�q dr�lled:,well "described above led in-accor d an e; wit - he st "'or_. jr la ions of the .,Putnam e�0 °5 oOO °,► > r j •� o �v� oe ¢ t>' �.S J� :. 4 diµ p ' .o L • � L � �•• the date''issued unless conYtr al(i 4 (ding h2 Ll en undertaken and W icy by Attie Commissioner of e'alth A change o'r ratwn of:.constcuction :- and /orr, - private" water �m -`supp '- ;�s:PiCPA t 0�`� Gjji i.1I 1:1 1 l ! a ..._ h�`•'`.LS3.�•S_....r..........a ___.. -4_ S e IV I..�vu.s; ;c.e, .r,:.....:.+x.,.,a.::•.u', +. �v_ ....n.u::.�._r. .a _�,.re+..�., wco •. R _ . ,M. . �. �. , i.a .... ... /.. ..r sr.+. .!c.a .s..o.n ...w.sV./* ...r.ai r .� .n .+ar..ru R r..... ... Gentlemen: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date /973 t Re: Property of &57.erol -0 AUEC- % Located at Section Block Lot O �. This letter is to authorize a duly licensed professional engineer (Indicate to apply for a Construction Permit for a or registered architect rate sewerage system; to 11 serve the above noted property in accordance with the standards, rules or regulations as promulgated by the Commissioner of the Putnam County (•f 1'1e r.. J- XI TT l 11_ 1 ! tj 't Lcya,rtmeint vi llei].L Uil, and to sign all necessary papers On my behalf In connection with this matter and to supervise the construction of said - .system or systems in conformity with the provisions of _.A tic.le.._145�- or..... _�...•..._. _._ .- 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, n f/ a -'C Signed , tnL223j'n -Owner of Property Countersigned:� 1 66 T � ° ress P.E. , ( Seal) Teiephone AdcIress' /yi�.yov�9c .c/y cos¢ e -cs777 '. Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH D 91ON'- OF-- ENVIRONMENTAI iEEALTH`b'SERVICES. �:..- .._-...._. ::- ._:::.:..,_...- ,..::_:�: -a COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Address 667 F el AC�5'; IV,, yC, Located at ( Street 4y,_=. Sec . z913 Block (U-3 Lot indicate nearest cross street) Municipality 47 X1,,VAv 611966csy Watershed L9 Z SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 1 Z; 3o 3.'00 30 1z0 15 3 io 2 3,100 Y "So 30 4 5 2 3; d Z 3113Z 3o z o z 3 3 is 3 3:32 4:02 30 20 Z3 3 /0 OL (1 ,j L 5 Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED. -TO BE SUBMITTED WITH APPLICATION _ .DESCRIPTION. OF. SOILS: ENCOUNTERED -IN,. TES_''-- IJQIaF�.S '. .. �.ua.¢•n.• v-a.SC:.: .. .n'::'M+ •t: K.. ... !rs^^/01.•.— ned�• - DEPTH HOLE NO. O HOLE NO. HOLE NO. � G. L. 6" 12"` 18" 24" 3011 36" 42" 48" 5411 6o" 66" �t 72 - 78" 84" . . ay e691y INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED --.INDICATE I'L- TO WHICH WATER 'LEVEL RISES AFTER' BEING ENCOUNTERED TESTS MADE BY Date 3 - 22 -.73 DESIGN. Soil Rate Used- Z2—Min/1 "Drop: S.D. Usable Area Provided ,gDoo No. of Bedrooms 3 = Septic Tank Capacity 700 Gals. Type !t/Ifso u e Absorption Area Provided By l77 L.F.x24" 36 width trench Address SEAL AJ� B -e777 THIS SPACE FOR USE BY HEALTH DEPARTP '1 T ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by Date I , O n\ 01\ GRAVEL OApJ, J, hJ 4 ' GOT OG.i -c/ T- \o -B.6 T/E /A/ D /ME.V.3 /ON3 SEPARATE SEWAGE DISPOSAL"SYSTEM OF NEW"" \P _•i�A�WS +�Oy�; f' �2ov� sr,.eE�r t,: . ,ass R-4•Blo =O" B•- 4•(00 =0" 9100 - GALLON SEPTIC TANK 177 LF X LABS. TRENCH 900 {�yL, SEPT /c TAN.C: , �,91y9 /c // -fOUSE y — ;, i •C "T /BHT `°� � f ,� „J '� 0 3 q Ju v5x • 1 =2Q" AP S O) )VIC71C) e� j Ns� ° -MAIR 197 WT HFALTb . OY , plep omslonhOF 1 � JE!�iS/F. - SU.'- G /{/fJ•c/ d. E. �S L /G.Ns'� -1cS�S " •I 9 i �° ysTE,.� co UFO ei✓r 7-0 aUT�vA /+-7 CO. ,OE,oT. OF /7�E.'9G T� ,�v L E.5 .9i ✓> ,2EC�.�UGriTiO�v,S 1: t x � E i� 'y u C' \ ./Un/GT/O.v 9oX- Rl SEPARATE SEWAGE DISPOSAL"SYSTEM OF NEW"" \P _•i�A�WS +�Oy�; f' �2ov� sr,.eE�r t,: . ,ass o A� � +s "b - TOWN Of COUNTY. NEW.YORK .0, !✓l/�.'? / ✓° / .�a'T /O�c/ :O" . ,c(o?-..i /g 235 7.9X/�h9.0N -' 4/3 BLGY� :�J` -' 03 le rnucrourrcn c•GOTi` ✓° OZ .. Rl SEPARATE SEWAGE DISPOSAL"SYSTEM OF NEW"" \P _•i�A�WS +�Oy�; f' �2ov� sr,.eE�r t,: . ,ass o A� � +s "b - TOWN Of COUNTY. NEW.YORK g� DATE �— ,3' %SCALE,9S.S /�f,�✓.v JO NO. 7a ^Z/ ss�o yo. 24895,•`0,* SULLIVAN - THIEDE11. R �FSSIOPI�;,•`" __ - -- - -_- CONSULTING 'ENGINEEIS a s'. `t 2 t