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Home My WebLink About2448DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51. -1 -8 BOX 21 1 rm Ir J - ■ - , jj- I ` EL Separa a Sewerage y m To be constructed by Address Water Supply: Public Supply From Private Supply to be drilled by Other. Requirements I represent that I am wholly and completely responsible for the design and location of the proposed above described will be constructed as shown on the approved amendment there to and in accordant County Department of Health, and that on completion thereof a "Certificate of Constructio be, submitted to the Department, and a written guarantee will be furnished the owner, his, place in good operating condition any part of said sewage disposal system during the p-0 -A pe ante of the approval of the Certificate of Construction Compliance of the original syste�bod"an will be located as shown on the approved plan and that said well will be installed in accordsaH it•� County Departmeirit of Heal h. 7? Date Signed U Address v �D APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued + s °i revocable for .cause or may be amended or modified when considered necessary by the Co • ,dYp requires a new permit. Approved for disposal of domestic sa age, r pri Ate 14A Date By system(s)'- 1) that the selparate sewage disposal system iptiglailthijfjAndards, rulesain regj a ons o e u nam ?lip nce'SrssttVactor.y`fo the Commissioner of Healthwill �I;s,°taegls ora41 his.by the builleT,that said builder will two (PC as44}tr9ediately foI too/ hng the date of the issu- e repairs §rato�'. tr}_that the clriled well described above ds *.r 5. d reg u d+c)ns of the Putnam ^�' r • r P.E. R.A. G of License tic)_ 4 $nsGl'ucft Ion � >Atre buildiirog tsasb ,een undertaken and is C ed'f Heaalth. Any Chang® or �10uction S upply Title PUTNAM COUNTY DEPARTMENT OF HEALTH cl 1J z. PUTNAM COUNTY DEPARTMENT OF HEALTH R7 Division of Environmental Health Services, Carmel, N. Y. 10512 STRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM a Hy e CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM U A'ra7 y V illMe_ Section -22-, �;PQ fi � � y Town or B IOCk C–. •. Located at /✓ �, / / 7 _ Section 4. I ? la ec)+J S i^Ei_- rt'oc� Subdivision .... / oa rr Lot Job ��' Owner Ql y Addre Total Habitable Space Budding Type Lot Area z �C6'[° 6 ei �� width trench J ®� Number of Bedrooms . Total Habitable Space Square Feet i Z90 t S ste to consist of a �(> Gal Septic Tank lineal feet X 'G width trench Separa a Sewerage y m To be constructed by Address Water Supply: Public Supply From Private Supply to be drilled by Other. Requirements I represent that I am wholly and completely responsible for the design and location of the proposed above described will be constructed as shown on the approved amendment there to and in accordant County Department of Health, and that on completion thereof a "Certificate of Constructio be, submitted to the Department, and a written guarantee will be furnished the owner, his, place in good operating condition any part of said sewage disposal system during the p-0 -A pe ante of the approval of the Certificate of Construction Compliance of the original syste�bod"an will be located as shown on the approved plan and that said well will be installed in accordsaH it•� County Departmeirit of Heal h. 7? Date Signed U Address v �D APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued + s °i revocable for .cause or may be amended or modified when considered necessary by the Co • ,dYp requires a new permit. Approved for disposal of domestic sa age, r pri Ate 14A Date By system(s)'- 1) that the selparate sewage disposal system iptiglailthijfjAndards, rulesain regj a ons o e u nam ?lip nce'SrssttVactor.y`fo the Commissioner of Healthwill �I;s,°taegls ora41 his.by the builleT,that said builder will two (PC as44}tr9ediately foI too/ hng the date of the issu- e repairs §rato�'. tr}_that the clriled well described above ds *.r 5. d reg u d+c)ns of the Putnam ^�' r • r P.E. R.A. G of License tic)_ 4 $nsGl'ucft Ion � >Atre buildiirog tsasb ,een undertaken and is C ed'f Heaalth. Any Chang® or �10uction S upply Title I represent that I am wholly and completely responsible for the design and location of the proposeje)yf;gr8(s); 1) that the separatee%wage disposal system above described will be constructed as shown on the approved amendment there to and in accorgar, jI h gj)gi tardards, rules an' reaguh ions o t e u nam County Department of Health, and that on completion thereof a "Certificate of ConstruclibVlp� 9lljrlc s,*Ujaetory to th,e C -omn'ossioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, 4tise9ugoe� Re oP��ejgns by the= bu Tilde. that said builder will place in good operating condition any part of said sewage disposal system during thlperio o��f�}wo_�2j`, �iEtrfpiepiately follmwhgthedate of the issu- ance of the approval of the Certificate of Construction Compliance of the original sir *err►, any repairs if f�to;�� th @t the derilld well described above will be located as shown on the approved plan and that said well will be installed in acc Oan- it h stanc!22 �I.rlas a d r -egu Ba urns of the Putnam County Department of Health. ,�-� ° , y b Date X L) Ca J'S s Ci "7 r7 Signed �• , P:.E• v R.A. Address O � rte. o Liceutse Na - i s-A APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued °tyn °eaiowty ofsel� the building ha, s We:n undertaken and is revocable for cause or may be amended or modified when consitl necessary by the Comm °ij �i,�5�14)i� N� Any change or altea lion of construction requires a new permit. Approved for disposal of domestic ary sew ar�i rivater at'eilttgdpO Only. Date% 7o Bra '—�� / .'�y/I:(�l -Zt/ Title PUTNAM COUNTY DEPARTMENT OF HEALTH cl 1J FKI( Division of Environmental Health Services, Carmel, N. Y. 70512 R7 STRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM a Hy Town or V illa;e ?ited at EEL- L kC>t -L-G W R O kl> Section -22-, Blmck 4idivision Lot - Z Job .Nner O etc i~T la ec)+J S i^Ei_- rt'oc� Address ct ti V Q C 14 ez oa rr )uilding Type lit = SIC -1 Cam. Lot Area A H iF prtL.C7 i Number of Bedrooms Total Habitable Space _� + Square Feet lieASook -j I/Separate Sewerage System to consist of 9 Gt5 Gal. Septic Tank _+ lineal feet X �� width trench To be constructed. by Address ' Water Supply: Public Supply From Private Supply to be drilled by Address 2 �b J2 a Other Requirements O H' I represent that I am wholly and completely responsible for the design and location of the proposeje)yf;gr8(s); 1) that the separatee%wage disposal system above described will be constructed as shown on the approved amendment there to and in accorgar, jI h gj)gi tardards, rules an' reaguh ions o t e u nam County Department of Health, and that on completion thereof a "Certificate of ConstruclibVlp� 9lljrlc s,*Ujaetory to th,e C -omn'ossioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, 4tise9ugoe� Re oP��ejgns by the= bu Tilde. that said builder will place in good operating condition any part of said sewage disposal system during thlperio o��f�}wo_�2j`, �iEtrfpiepiately follmwhgthedate of the issu- ance of the approval of the Certificate of Construction Compliance of the original sir *err►, any repairs if f�to;�� th @t the derilld well described above will be located as shown on the approved plan and that said well will be installed in acc Oan- it h stanc!22 �I.rlas a d r -egu Ba urns of the Putnam County Department of Health. ,�-� ° , y b Date X L) Ca J'S s Ci "7 r7 Signed �• , P:.E• v R.A. Address O � rte. o Liceutse Na - i s-A APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued °tyn °eaiowty ofsel� the building ha, s We:n undertaken and is revocable for cause or may be amended or modified when consitl necessary by the Comm °ij �i,�5�14)i� N� Any change or altea lion of construction requires a new permit. Approved for disposal of domestic ary sew ar�i rivater at'eilttgdpO Only. Date% 7o Bra '—�� / .'�y/I:(�l -Zt/ Title 1r Pv'II'NAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM ow 0 aP- A"11- VA-LLGY Town or Village n Located at "h jlu Section Block Subdivision .0 C— Lot I o Job Owner Address 115 9 i! S Q Fyi; YQV01 a 09, , lo-1 10 Building Type P-Gs1 QIS—nA'j" l P�4- Lot Areay' ( � Number of. Bedrooms Total "Habitable Space Square: Feet Separate Sewerage System to consist of OZO¢a Gal. Septic Tank, lineal feet X width trench To be constructed by Address`_ ", 1 Water Supply: Public Supply From Private Supply to be drilled by Address Other Requirements 12 : Q . C� dG' -�11� �`* L�.(. �.lJ.•l i Q� r'b O i 4- G-C? t� L��f'� ��1:GG I represent that I am wholly and completely responsible for the design and.location of the proposed system(s); 1) thitst'I� se�{°a�i$Re� ('sewage disposal 'system above described will be constructed as shown on the approved amendment there to and in accordance with the standossk *ufesZit�Y�gu) to o e u nam County Department of Health, and that on cgrnpletion thereof a "Certificate of Construction Compliance" sajiVaR8jykW£ tie Cp' t ' 6ner of Health will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs,ov asgigfls(t�l�th�i��ed�r;%th^a said builder will place in good operating condition any part of said sewage disposal 'system during the period of two (2) y�rs imr�diately,foll k6��(� th date of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs Oigreti2 °'2) l�hit'tfie'dridedawgl4described above will be located as shown on the approved plan and that said well will be installed in .accorda ce h Ards* :4Lles �artd�regu la ions o the Putnam County Departme t of Heal m ;� "•� •' ° it x Date Signed _ ti R. A Address APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of fhe'ba d�jSh -,peen undertaken and is revocable for .cause or may be amended or modified when considered neces ry by the Commission ealth. AnyaEAafl9g.eor ; fetteration of construction requires a new permit. Approved for disposal of domestic age, nd/ private �nly. Date Al ^ � �� By !X !Y°""° Title 7- _ 9y 6` � .• v ,o � ,•cam II ,� i = - { r•'" �.00' to % %,i ` ;I a iI N II{ i I k • � o i 6_ IPu7N nenLFH BY_.. IVISION OF ENVIRONMENTAL HEALTH SERVICES TO 7-0 it�DTE,"- /�PTu� SL(/r7L,i° /s ,�ELoc�TEO CID 1,5:f it PLf lv; FUt_�TL /EL �tUT '�Lf7t/ / /(/�vc�i /U.t 1 <.� /�� d .E Gs ��U /Lf ✓ E �� ;, _ `,�� - - -- /.V,jT`JGGf�T /O,'✓ ,F.TE�;''" /C .Y•TES�1. Nair I �.,�I= jor?aNTr�,zo,nAj • y >gos ,� oriE -�.M1L Hr. -'T'4 SOIL PERCOLATION RATE ...... .....lO..... MIN/IN I> D/-.1 LON SEPTIC TANKa, DEEP TEST .. .VO LE'�GE .eOC.0 e"200LF X_1-15-ABS. TRENCH J 1 41 ESTABLISH ELEVATION OF HOUSE TO PROVIDE DRAINAGE OF LOWEST FIXTURE TO SEPTIC TANK AND FIELDS ...... AREA RESERVED FOR SEWAGE DISPOSAL SYSTEM TO REMAIN UNDISTURBED.ALL CONSTRUCTION TO CONFORM TO STATE AND LOCAL STANDARDS AND REGULATIQNS ......... ✓u.✓crIO. <l cox 9-7 y'.;,,^,r7��.,•til= Gh+c_4Jn:f `J' OVLI� 1= i._O \J 2 LV I b - 0 PROPOSED SEPARATE SEWAGE DISPOSAL SYSTEM BEL L /-/oL L O 1<'- TOWN OF GU Tit/ �n7 1 ✓�JGLEY F�Ci TiVfiH1 COUNTY. NEW.YORK DATE _17-31 -7ZI SCALE As ss2wi.✓ JOB NO. SULLIVAN - THIEDE CONSULTING ENGINEERS CLARK PLACE NAIWAC. EtY YORK 4 6_ IPu7N nenLFH BY_.. IVISION OF ENVIRONMENTAL HEALTH SERVICES TO 7-0 it�DTE,"- /�PTu� SL(/r7L,i° /s ,�ELoc�TEO CID 1,5:f it PLf lv; FUt_�TL /EL �tUT '�Lf7t/ / /(/�vc�i /U.t 1 <.� /�� d .E Gs ��U /Lf ✓ E �� ;, _ `,�� - - -- /.V,jT`JGGf�T /O,'✓ ,F.TE�;''" /C .Y•TES�1. Nair I �.,�I= jor?aNTr�,zo,nAj • y >gos ,� oriE -�.M1L Hr. -'T'4 SOIL PERCOLATION RATE ...... .....lO..... MIN/IN I> D/-.1 LON SEPTIC TANKa, DEEP TEST .. .VO LE'�GE .eOC.0 e"200LF X_1-15-ABS. TRENCH J 1 41 ESTABLISH ELEVATION OF HOUSE TO PROVIDE DRAINAGE OF LOWEST FIXTURE TO SEPTIC TANK AND FIELDS ...... AREA RESERVED FOR SEWAGE DISPOSAL SYSTEM TO REMAIN UNDISTURBED.ALL CONSTRUCTION TO CONFORM TO STATE AND LOCAL STANDARDS AND REGULATIQNS ......... ✓u.✓crIO. <l cox 9-7 y'.;,,^,r7��.,•til= Gh+c_4Jn:f `J' OVLI� 1= i._O \J 2 LV I b - 0 PROPOSED SEPARATE SEWAGE DISPOSAL SYSTEM BEL L /-/oL L O 1<'- TOWN OF GU Tit/ �n7 1 ✓�JGLEY F�Ci TiVfiH1 COUNTY. NEW.YORK DATE _17-31 -7ZI SCALE As ss2wi.✓ JOB NO. SULLIVAN - THIEDE CONSULTING ENGINEERS CLARK PLACE NAIWAC. EtY YORK '3G 41 � xPslv.3/ of✓ JuvcT /av Box 0 /ZOO ��7 /G TiG'N.(C p 4 L� moo O A� -o �y BELG /yvLGOx/ .�Os9,!' GALLON SEPTIC TANK - 007 LF X- jEABS. TRENCH 64, o v► �i �1 Ali ALL - /" �G O• I APPROVED DEC281973 t l @YN�CO. TV DEPT. OF HEAL11B NOT ��.er of ,q ..SaBO /Y /B /O /J DIRECTOR, DIVISION OFN�AXmfiPN° ZZ BLOC•CrV -° 2 LoT/ve 4 t ENVIRONMENTAL HEALTH BL?dM - AS CONSTRUCTED SEPARATE SEWAGE DISPOSAL SYSTEM JGn9,y'� �ELC f- /OGGO.K/ X0.9® p�°s�P�FPa'�c:s • # w /z•; �' - TOWN OF 'Tit/f�fWJ ALGE>/ w• i✓T,i(fi9,r!/I COUNTY. NEW. YORK 21y DATE /2 /Q %3..SCALE � ;,;,,V' JOB NO. SULLIVAN - THIEDE CONSULTING ENGINEERS • �. CLARK PLACE WMW?AC, NEW YORK PEEKSKILL MEDICAL LABORATORY 1879 Crompond Rd. Barclay Plaza Bldg. A, Apt. 1 Peekskill, New York 10566 RESULTS OF EXAMINATION OF WATER I 12/4/73 OWNER DATE RECEIVED Potral 12/4/73 .CITY, VILLAGE, TOWN VOR NAML OF SUPPLY DATE REPORTED Bell Hollow Road, Putnam Valli_ 12/6/73 :SAMPLING POINT 40019 PE 7.8777 EACTtRIA PER ML. (Agar plate count at 350C). COLIFORM GROUP (Most probable No. looml.) less than 2.2 HARDNESS, TOTAL -ppm DETERGENTS-ppm NITRATES (as N) - ppm IRON, TOTAL - ppm, FLOURIDE (F) - mg. /l. These results indicate that the water was YeS of d satisfactory sanitary quality when the sample was collected. A W A. H. PADOVANI, M. T. (ASCP) PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM f- j7N,r,�yy� J�/3L.GL�Y Town or Village Located at GL /�dG�°� ®/�� .6eetien ZZ Block Owner iGl�it /�e1'��. Lot 5 1 - Job Separate Sewerage System built by e /�i4,T'uf� .Sr��v ✓ Aec Address / 44:— Consisting of % ®0 Gal. Septic Tank lineal Feet X j� width trench Other requirements /�O� IAI /044�G �1�+'%�Xr!i -� —� /tilt.' d /`%Z�`:� �/✓-5� /�C -G� =J� Water Supply: Public Supply From JL Private Supply Drilled By ©�'%A% �/�f�J.�'SC3sU�li�'% SCi/►1 Address 'a 4�&s�v /t-✓• Building Type ,f " �� y�1�/��% -- No, of Bedrooms Date Permit Issued Nac Frnclnn r`nntrnl Rann rn— lntnel7 ' O I certify that the system(s), as listed serving the above premises were constructed essentially as,° attached), and in accordance with the standards, rules and regulations, plans filed, and top ' Date, `, G AP 1Q7-4 Certified by A G� °r Address �rLf =%�-�• Any person occupying premises served by the above system(s) shall promptly take such atr' *.gs conditions resulting from such usage. Approval of the separate sewerage system shall 14- 1 available and the approval of the private water supply shall become null and void when as "4i subject to modification or change when, in the Judgment of the Commissioner of Health, 412 yt,tlltlltlr grDl m, on pLafi of.Athe completed work (copies of which are W dY. a °Putngm County Department of Health. be APA14kO P.E. R.A. ` License No. y4o,3ecure the correction of any unsanitary gWbn as a public sanitary sewer. becomes '1iiecomes available. •:such 'appr`ovals, are iodification or change is necessary. i NMI Owner or Purckaser of Building Municipality budding nstru tea oy Location - Street u�9i Ps.a a A Oaf Building Type Bey Block 41 Lot GUARANTY OF SEPARATE SEWAGE SYSTEM I represent that I an 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- 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 sMtemk . r_1 ', Dated this day of 19 Signature�� Title If corporation, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPjETION 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 ti Owner or Purchaser of Building 4 Building Constructed by Location _ Street Building Type Municipality Vin 07- -e~n 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_2j Signature Title � :•,y,� -�'� �� "``",, (If corporation, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPjETION 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 n L PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date / Z Re: Property of t G r-r� Located-at �c c_ \-{� c_� ��-� �-'O o'- Section Block Lot Gentlemen: This letter is to authorize a duly licensed professional engineer V"' or registered architect (Indicat� 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 T1...... yt...........1- 2� Health, i ly 1 � J all '� Department of 17Ct7lth, and o sign all neueasary 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 Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. FF% P all Countersigned: OF P.E., R.A., # SE ress Mr• 1. I Z' G o' 248 '35 ,•° ��+ Very truly yours,v Signed k l,,,J -'U, Owner of Proper y q VZ E NACSS tJ -6 ea ►A e�r= e 1'z e- %10 E'Zw; , to 8 t 6 Add ress. ACi t *e) ,ate �lTelep one PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date i 4 7 C Re :. Property of -�: eoacv__ \-\C7USi <ECpZe-, Located at 86L� ke�toti �c,AC. Purl -��,M \t i.Le7 rz, .11 . Section Block Lot Gentlemen: This letter is to authorize a duly licensed professional engineer J 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 in conformity with the provisions of Article 14.5 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. �'� 11j99YY EQ� oun ersine °� P.E., ,: #� a e a -` =( Seal) A�I�TPlIE6E r'v P•. °oo ►'l!° \r t\ s CLARK PLACE. MANOPAC, NM YORK, i os q i 9 l 4- - �� 2 9_ - r -7.7 -7 Telephone Very truly yours, Signed caner of per y Address �t l 4- 2 a— Z mot 9 5 Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTRI SERVICES DESIGN :,DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner 1,�a��T �.ous ��e Ptcz Address c�v�c;�oa.o PuT,� cam v t�Ll E�' , V-z" Located at (Street) G,,,,�,p, ,k6�� -Ct.; e�nb Sec. Block Lot _ Indicate nearest cross street) Municipality VkLL" Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATION 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 3`33 3:45 1 2 3:A5 o 3 4- 1 33:%7 4:oq 1z i'Z zv 3 d- 4 5 z 2 3: SZ 4:.%g Z 3 4 5 1 PE�cc,LA % z�-tS SULLIVAN- THIEDE - 2 l---RARK P..R 3 HIAHOPAC, NEW YORK) -- 4 SyhTE -� -70 (�e1 C 7 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. r 4 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. Owner Address SC-o-) AVG Y, Located at (Street BE .H LLDL go&o Sec. Block Lot Indicate nearest cross street Municipality ,tpAV*V U A -LLg�j Watershed =s Ppa, SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Water ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min.., Start Stop Drop in Min. /in drop Inches Inches Inches 2 l2 7 +c��1 i2 11 11 1-1 20 � zo 3 U 3 -I 5 U l *s4 s:s2 18 2 3 -4:10 4 5 i i P t '`a' �.... s. -• `a..,�. .o f,.�. -'Y Z. # �3 ., G r u `A $'.Z �. a - v 5 Dotes: 1) Tests 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. 4 -4 -I 5 U l *s4 s:s2 18 2 3 -4:10 4 5 i i P t '`a' �.... s. -• `a..,�. .o f,.�. -'Y Z. # �3 ., G r u `A $'.Z �. a - v 5 Dotes: 1) Tests 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. DEPTH G. L. 611 12" 18" 2`I'" 30" 36" 42" TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION ` DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. � HOLE NO. UD HOLE NO. DAP N� (fi ('0C,o N 0 "1 A-T&C 5 VI 6 ft 7811 v .` 84" INDICATE LEVEL AT WHICH GROUND WATER.IS ENCOUNTERED -- 2-' —�'" INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUN'T'ERED TESTS MADE BY Su (-Liu Aw,�) - TAic-oG Date DESIGN Soil Rate Used a Min/1 "Drop: S.D. Usable Area Provided So c> No. of Bedrooms 4 Septic Tank Capacity 120 o Gals. Type M ik3oN I_ Absorption Area Provided By 2o® Lp F.x2411 — r/ .ea Width trench. "9g' r of NEC✓,he] ss ® A, W %Tb9- -to p�v�%d:��e Name o s Signature f SEAL' : ° Address � � )3o K � P 9 IL Cr �2 D p °9p pOp90 °° THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: i Soil Rate Approved Sq. Ft /Gal. Checked by Date WELL COMPLETION REPORT 3/71 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report is to be completed by well driller 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 ME ADDRESS OWNER 0A i9 LOCATION 3 Street) (Town) (lot Number) OF WELL NESS Q ❑ ❑TEST PROPOSED DOMESTIC ESTABLISHMENT FARM WELL USE OF WELL 1:1 SUPP LIC Y ❑ INDUSTRIAL ❑ AIR ❑ OTHER CONDITIONING (Specify) DRILLING I �� .{�+ CABLE E 11 ROTARY Izi AIR PERCUSSION ❑ ❑ ,EQUIPMENT ((SSpeciify) PERCUSSION CASING LENGTH ( feet) DIAMETER (inches) WEIGHT PER FOOT ® ❑ IVE SHOE_. M MES DETAILS '?o THREADED WELDED YES NO NO YIELD HOURS G.P.M. ❑ BAILED ❑ M YIELD (G.P.M.) TEST PUMPED COMPRESSED AIR WATER MEASURE FROM LAND SURFACE —STATIC (Speclly feet) DURING YIELD TEST (feet) Depth of Completed Well LEVEL in feet below Land surface: 17 Q MAKE LENGTH OPEN TO AQUIFER (feet)' SCREEN DETAILS SLOT SIZE DIAMETER (Inches) EIFGIAVEL Diameter of well including GRAVEL SIZE (inches) FROM (feet) TO feet) : gravel pack (inches): . DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at feast two permanent landmarks. FEET to FEET M 4 , If yield was tested at different depths during drilling, list below�� ir.. FEET GALLONS PER MINUTE DATE WELL C METED DATE OF REPORT 1WELL—QPILLER(�i tu e)