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HomeMy WebLinkAbout2362DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.14 -1 -41 BOX 20 02362 all .� � J 9 1 F i i ��� �,, - ' '' i i�p 02362 WELL COMPLETION REPORT 3/71 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK hg:�e�or..j3.,tor�e.rr� Itefi�.�!�II,ill�r;apd submtted;toG.ounty Health..DepmeR3: tether .:.t3.18Eicrsio'r-V.:rQpoit--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 r N ADDRESS OWNER LOCATION OF WELL (N 6 Street) Y , own) (Lot Number) 44OX �1 0 /9 frNii�i 121, BUSINESSf ® ❑ 1:1 PROPOSED DOMESTIC E TAB ISHMENT F ARM TEST WELL USE OF WELL 11 SUPP Y a'INDUSTRIAL ❑AIR 1:1 OTHER CONDITIONING, (Specify) DRILLING ❑ © COMPRESSED ❑ CABLE ❑ OTHER ROTARY AIR PERCUSSION EQUIPMENT PERCUSSION (Specify) CASING LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT © El O ILI { CASING DETAILS `// THREADED WELDED YES NO YES LJ NO YIELD HOURS G.P.M. ❑ BAILED ❑ YIELD (G.P.M.) TEST PUMPED COMPRESSED AIR J WATER MEASURE FROM LAND SURFACE— STATIC (Specify feet) DURING YIELD TEST (teat) Depth of Completed Well LEVEL in feet below Land surface: O MAKE LENGTH OPEN TO AQUIFER (feet)' SCREEN DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL Diameter of well including GRAVEL SIZE (Inches) FROM (feet) TO (feet) PACKED: gravel pack (Inches): DEPTH FROM LAND SURFACE . , FORMATION DESCRIPTION. Sketch exact location of well with distances, to at least FEET to FEET two permanent landmarks. 5LopLIZ �o el/` S �GLL Q U h r) I AI S 77, If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WE COMP ETED DATE OF REPORT WEL ILLER atu 7- r r 'Q11tllental Ha4lth sepviRa , 'u n rr County Pepgrtment or I9gl th A 'Q11tllental Ha4lth sepviRa , 'u n rr County Pepgrtment or I9gl th W` r k PUTNAM COUNT Division .''of Environrrienia CERTIF.ICATE':.OFMGORIST-RUGTION COMlPLIAlV E FP SST Located at '.:Owner OB %2 � % ^•` /C l L� %Y %i ,� ' -• �k Separate Sewerage System built by Consisting of.'Gal. Septic Tank Other' requirements :Water Supply:. .Public Supply F,rOm i 3 r x 4 Prate' Supp/l�yD, nlletl y��7 NCB w ).)Address Building Type Has Erosion Control Been Completed 1; ertif ,thaYth s stem's as.l�sted servin the above premise "s were.co C Y e . Y O 9. attached); and ?in 'accordance with, the standards rules and' ?egulatioi t Y y ,Date AcJdress JR` Any person occupying premises served byAhe above systems) shall?l conditions resulting from such.:usage Approval of the separate st ;availible and the approval of .the private water supply shah become subject t modification or change wh n ��n the judgment ofth.. MDate a • � �,, r �t DEPARTMENT, OF 'HEALTH r _ Healfh Services Carmel N Y. 10512 r i SEWAGE DISPOSAL SYSTEM 'a Yown or V illag, - FIVR I� Block t 'n 1� I Job S -7 '_ -` .Aiidiessl 7`J 'i5{IeBV%�.��IG01+�iQ� • �%'(• Y+'T�Lej lineal Feet:X' -! ;width trench 45 y No, of Bedrooms Date' Permit .Issued r4' 4 structetl essentially as 3hown,on the plans of the':completed work:(copies „of which are plans filed, a d the perm issued by': the - Putnam County Department of Health Y, S L�i F ° 1 • S 'P ,E. R A f �r F�- •��� License No o uc�water supply becomes available Such :,.are v canon modification or, change. necessary ` - . YT �t le a l,' Y P ' 1--5-Ay :.r.. ..� :.xr••� 'ee- > -w::a �.w�..'_c. v.+s:uw ..a ,.•.v::..r, w-1w . :ros.. �.ca, m..ox_... .. :;a�•,su. - ,- ++ x. c_y. �sea..r..- r:.- ,x...x.. m .,� � - r.... r_...+ -�a.a. a no,rd.au -.< ,,s:_o" Y � L T h J. t 31.' Zoe 1b( ti 2,4 I -- `` h +rt \L S r Y i.sal' 4 tt3fE� 4� rJ e , r r x �rt1r t t. }Ft f�'��i'7ili }��h��)i �'A�i �.. -.. Wt�.1•.. 4. .. h r ! i. 9.00 Ta. @.�4.1.f �'C:. t,, K zC DIRECTOR, DIVI940N OF � • -' „A~; • NrAl HEAl,7H SERXI - A 1. YI111JAL SIT1 :11" S? P"M'T011 1:9 75 ye.3 Pro �pr. ty. Ij.ncs or corncr.3. found an c��t,.r�i:;: ►io��:.e lox ;a.tion . V ill , drivet �zy need cut —� t4m;t trees be r -moved -note thes- is (1cep hole rdz��;c;senteti.vc o f enure S,Da area ndcl:i -tion ,l do --n hol.cs ncodod. . Yo . Ccimmont,cs 3u1'.f J.cie;nt S area avalle.ble considering drivOei!��.y cunt, /house location. Separation . • . d.� StancCS, etc • e ' • '• • )EIP ROLE, by 1A 1 Dopth Water elevation: o ' Pock elevation: ' Sails c?escri rtion: G h • Date : -- 'IVAL SITE PISPLCTION Insn. by: . 'ouse, located :here shorn on approved plan M loc:ateci•'vh.ere a.pprove d ..... • . _� _. lop ° of tile, li nc ' and trench c.cceptable • -: - ' oom allowed for expansion trenches. • , • • vej� 50 't - frcnl S- %raliil),1ru'tercourse . • ♦ • ♦ - -- `" 3tural soil not stripped or SDS area unnecessarily graded . . . . . . v L .. L�ainta i;� �d fro;;, prop .line and 20 f t : from houase : .. .pa ration of trench from. house, bell etc • folI O-vis plan a . - . imber of. bedroc:::s checks �cnes, brush, stumps, rubble, etc. greater trap 15 ft. . from nearest: treInch i FL of - or ipheral soil horizantal ly Pr o -- trench . • . • • • • • unction boxes properly set auld surface run off from drivewa., , roads, prau nd surf�ice, etc. channel noar SDS . ' area.... - . •. : • yes :tbt dr-aina.re arrcar O.K. in area of SDS IL•'1i./ GRADING OF. SITE ACCEPmBLE ' .. I- . —1 .... d i Ik -'::. �•.J. �• M :.v'.:�Sx-:- .Cf•-;r..:�::#Y -m.a .Ya:. rfm.'.cvn• -e-.0 a. -:+: ✓•.� ?'A..x ir�A.es.»_:.trY...:�s��.. n.(`.:A..'rC7«a: _: s�T ✓�F -- F :_sL_1.- sO�JSa.�.s..y:.������•a ...6*o-+> > �_ r=... x�+. a. ��:- xs ..n- '.z.- •a:�.- aa_r.- �r.�u�c-ai PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Avg UA Re: Property of Located at Section Block WO Q i Lot _//L� . Gentlemen: This .letter is to authorize %vw Sir a duly licensed professional engineer,to apply for a Construction Permit for a separate sewerage system; to serve the above noted i 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 con- nection with this matter and to supervise tYie.constriiction ` of said system or systems in conformity with the provisions of Article 145 ak St - or 147, Education.Law, the Public Health Law, and the Putnam County Sanitary Code. Very truly yours, Signed �o . ^v��a` Owner of Property Countersigned �j Address P.E. # 38998 Howard A. Kelly, ',Jr­, :.�' E:. "` Telephone 34 Gleneida Avenue Carmel, New York 10512 914 -225 -8088 SEAL - PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. S 7s 08 Owner � 6,EW % /i ! LC Y Address z F� Located at (Street uvol.-V C SF Ze_,.. 308,4 Block '— Lot— indicate neares cross street) Municipality. 1-','tJ7-1V,0VAf Ale4 ,0Y Watershed l9jecw< SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION No. Elapse Time Start -Stop' Min. r_�> Depth to Water From Ground Start Inches Surface Stop Inches Wa er Level in Inches Drop in Inches Soil Rate Min. /in drop 1 3A1 3:47 ( /(" 17" 2 31 7 Ill /2 /7 -- - 4 4:'0 C 4,'/-S % 7 ©'' 2 .. 7 5 1 2 3 4 5 1 2 3 4 5 Notes: 1) Te'�ts to be repeated at same depth until approximatelyy equal soil rates are obtained at each percolation test hole. All 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 TEST HOLES ' DEPTH HOLE NO.- HOLE NO HOLE NO. 6" 12" 18" 24 :v A. ��" �t;' 3011 SEAL., 361f P 42" 48 54 if 60" S w a y 72" ` k /+C E�s 78 if CLAY 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY S UAI,,9 /l/ Date 5— jp 7 Z DESIG N . Soil Rate Used 6` % Min/1 "Drop: S.D. Usable Area Provided 00 0 .S,Sr No. of Bedrooms _Septic Tank Capacity POD Gals. Type A S, Absorption Area Provided By 3�a L. F.x2�+ "ice"— width trench. Other 0 S� 5,P 40 0,C F'4UAL Address J7 /cW1,01? 57-, THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: �`• "" ' Soil Rate Approved Sq. Ft /Gal . Checked by gna ure l ; :v A. ��" �t;' %,a! K. SEAL., P THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: �`• "" ' Soil Rate Approved Sq. Ft /Gal . Checked by ike INLET AiF[ Ald _ CuTLET.S CtcAK 5^11D ` oR PEF 6KlIV�L. . T'. -5, Iah .boo Sa( ToN NY- /cL.. ' `1� /'� �� ,5� �� fXP/%d1.� /�A. �4"h'F\`�• f��, i-P.GN'.�O D' i- :30kE5 �J t! 7 ! - /E.X�S"riNG'� i .k,sj,KCa m - P f. aA • _... '' � ' �\ GIs u. �" � _ "l z r "i'�SYS kt,u5j K , ;' PUTNAM COUNTY DEPARTMENT OF HEALTH Kff Division of Environmental Health Services, Came! N: Y 10512 ". {` , �• 1 cv)vsi;rruci;(uly rtr�rvllT FOR SEWAGE DISPOSAL SYSTEM PUT /yf1Nt _ a t Town', or' .Village �. j x /� fj Located at ' ��w G rr� �'c r ;, � 8 r1 (316ck r p�{ 2 N 6 Rr2o is K Subdrvis�on ' Lot I .� � f Job S .. %�O "'Owner fG -O g �' R ez r=' =y` Address 84 2 A M�: G A. /C A V C, �LRNCh► -= '� Building Type Lot Area ..a o,S �4cE�s 2csNx 'Number - of Bedrooms Totail Habitable Spa ce "Squaw eet Q:. !So a t 1 ` Separate Sewerage System. to consist otf� - QV Q ' Gal Sept,c Tank -- lineal feet X width trench ro be constructed by To /3 f % �n�NE� Address { Water. Supply "public Supply From f7 j .,f �� drilled Private Supply to be D a r r f Address. >" e Other Requirements 3 40 o % Q N iIJ EW Solt Tf� i2C, X77- SE 0 N 'I represent that l'am. wholly and. completely responsible for the design and: location`;'of, the proposed system(s) : )-that the separate sewage disposal system ` above de "scrvbed will be: constructed asshov ri on the approved.ari a &ndment itiere to'.and �n accordance with the standards; rules an regulations.o the Putnam y County= .Departriient of Health, and that'on complet,orr,thereof a''Certificate of Constructio_ n Compliance'. satisfactory to the Commissioner of HealtHwil �be submitted. to`,the Department >and, -a' wriften guarantee wUWbe: furnished the owner h! ;• successors h eirs or assigns by "the buJder; that said: bwlder.:will. -place in good ;operating. condition any part' of :said sewage disposal system during -the period of two (2j - yearn immediately following the date of tlie:.issu ante of the, approval 'of the Certificate` of Construction Compliance of the original system or any pairs therefor 2) that' the drilled well described above will be, located'as,'shown on the approved :plan antl that said 'well will be installed accordance - with" stand and. regulatio of" the Putnam County Department of Health i t J ^7 r I °Pat e -ZZ II Z/ S / -s Signed X37 F S� C: rah N.Y, 3644 8 j Address License No APPROVED FOR,CO STRUCTION This'approval expira one" ear from tfie at issued''' n "struct�o'n of the bwltling has been undertaken 'and is 7 cevoca6le ;fo cause o may be'amended or�mod(fietlwhen onsi red necessar by rm Cori' ofjHealth "Ay o of :construction . requires . ew.,p r i pproved for disposal of do' 5amtary sews a d /or pr at f Date ' By Tit n,. PU`1' :Atr COUiI`1Y Di:I'ARTi.1''''I' OF I PIALT11 DTVISIOr1 OIL F;r1VTROP•I7PiTAL 11I_!1LTH SERVICES Of'FICH BUILDIN , CART' ^L, N. Y. 10512 DESIGN DATA S1 =T- SEPARATE SE;•,AGE DISPOSAL SYSTEM FILE NO._'- ® Ownerr _t_:r \L. Address -2.. 'iii �Ce;o�L.� �V..�6pT: •- . Located at (Street �iuS>P%'L ' G� Block — Lot �T=Ic.a -e ,ncares cross street) Municipality . Z•.'ate.rshed O ?-3 SOIL PERCOL- 1TIOi' PEST DATA RIQUIRED TO BE SITEK TTTED WITH APPLICATIOT. . Hole Number CLOCK TTLT PERCOLGTIOIN PERCOLATION Run r�Lapse D-p - �o ,;a i:er �. a -er evel Ito. Time From Gr.ound.Surface in Inches Soil .Rate Start -Stop Bain. Start Stop Drop in lin. /in drop Inches Inches Inches Ncioi:, 1) Tests to be .repeated at sage depth until a royimatel.y equal soil mates are obtained Zt each percolation test hole. Ayy. data to be, submitted or rova.ew. . 2) Eupth measurements to be nude from top of' hole. 2 3 4 2'40 - 252 122 11 2b I Z 5Z:5Z -.off \Z Ncioi:, 1) Tests to be .repeated at sage depth until a royimatel.y equal soil mates are obtained Zt each percolation test hole. Ayy. data to be, submitted or rova.ew. . 2) Eupth measurements to be nude from top of' hole. TEST PIT DATA RF,,QI1IIiT-,D TO RE SU1'.; IT'['. ,D L'].`►'II A PPLTCATION Dh3CRIIT10111 OF' SOILS 'i'j;f;I;D Ifd `i'1?��`I' IIOLP;,3 DEPTII HOLE IVO.. HOLE 1\10. HOLE N0. G.L. . �...:. -,ems ,.. _ _.._ ...- ;.. _ - -- �.:.....�.�.. _ - _ - -< ;.._� .�....:.._ ,_, .....,._.:. �....- .�.. - • _.T ...,, _._ _ - Y _ .... -- 1211 �.�►� 18" ��iC 21111 ` �t ----- 3011 , 361 42" 48" 51+ 60" 66" 72" 78 84 " II\TDIC_4TE LTA: "L AT „'�ZCH. GROuiuD ; �.T' R IS EiiCOUI'J' ERi D INDICATE Li llrs' ';:r_iC11 WATER gZ�',-T RISES ArT�R Br:TiTG ENCOUNTE:',ED TESTS I, =4Dr, BY �.v� Vrar+� r���o� D3te - DESIGN Soil .Rate .Usedlt -1 -T.�. 1. "Drip: S. D: Usabl6° Area Prov dcdK - No. of >✓edroor;s Sept? c Tank Capacity_, ":? Gars "`1 ype � KS, Absorption Area Provided By >_-L. F. x24 �o ` j` F SS' e� trench. 60? rr,, ll%"� . Name _►v_i 1 I Lrna .ure?7w A (,7A Eel Address_�a � � � 1 r } , i Ti THIS SPACE FOR USE EY I.MAL,[H DEPAR IT'NT O,rLY: Soil Rate. Approved Sq: R /Cal Checked try Lhi e ci GGl - � nand * 0