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HomeMy WebLinkAbout2710DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 61. -2 -20 BOX 23 02710 _,_...._ '. PUTNAM COUNTY DEPARTMENT OF'.HEALTH; Division, of Environmental Health Sewces; "Gaimel .N Y.. 10512 ..: . �I�G T7,-- C i f;rAl4'm!�1I ^T I C.,-4 !,'; 6-m P "t!f r ran STu1w T;*. P, nnr"0 I niie�T�' _ � + •tr r . , Towri or' V ii ne O. V sue" /- Block. Located at Owner',I Lot % ., joh v cr� ac.....� , Separate Sewerage System built ,by Atldreis . 1,12 n69�1 Consisting: of .I�GaI Septic .Tank,. liheal Feet. X� width trench Other requirements A0VAle - - Water Supply: Public Supply From Private Supply. Drilled By -4 4 e"'sr i 4VC-4. 1A16 1A. ' SP.rcau �- f O s:�.GG./ �✓ Address Building Type F LrS A��! � „ No of;',Bedrooms Date' PermitAssued Has Erosion 'Control Been Completed? syy*ea,areey I certify that the systems) as listetl_ serving the above premises were constructed .essential) as shove, �t�th441t ns,,4, l� ompleted work (copies of which are attached), and in accordance with the standards; rules and reguWtons .plans fil the p �rt9�t� Jhs•� n County Department of Health. Date � � : 1.7, If/ Cert�fied..by P.E. R.A. eF k ti Address• License No.' .e- . .,e Mari. Any person occupying premises,served by the above systems) shall promptly take such actioh -4 ay bgpecessa Ito sec�ire; the correction of any unsanitary to sewerage system shall becorrge IPend'wdi &�5ooqs?a public sanitary sewer becomes available and the approval ,of the . private Water supply ,shall bec � • I, ,,e� $ ,- conditions resulting from such ?usage. ''Approval of the separa p ome nuil. void when •a. put►li�o�wa �wppgiF "ec� es' available. Such approvals are subjeci to .modification or change when, in the Judgment of the Commissioner; of Health .such °rby' rc214i�tj{ V110i�tion or change is necessary. Date BY Title _�• ° s ' PEEKSKILL MEDICAL LABORATORY 1879 Crompond Rd. Barclay Plaza Bldg. A, Apt. 1 PF -PeeksiJ111, New 170.Z I DATE COLLECTED RESULTS OF EXAMINATION OF WATER 12/7/73 OWNER DATE RECEIVED Patrick Hurlev 12/7/i3 CITY, VILLAGE, TOWN'VOR NAMP- OF SUPPLY DATE.-REPORTED 449 A Cahopus Hollow 8d, Putnam Valle 12/10/73 SAMPLING POINT BACTERIA PER ML. (Agar plate count at 35 C). 6 COLIFORM GROUP (Most probable No. /looml.) e S, TOTAL -ppm DETERGENTS - ppm NITRATES (as N) - ppm IRON, TOTAL - ppm FLOURIDE (F) - mg. /1. These results indicate that the water was YeS of a satisfactory sanitary quality when the sample was collected. A. DDVANI, M T. (ASCPYv- WELL 'COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE. BUILDING - CARMEL', NEW YORK ° "" -• - ; "r�i�`i pr7ii � i a=Y csnj i£' L' i3y � fi C�i ii rviru�'Sir O- r- lf'Yaci''L`O C6r until' °11mi'iilll .ihioaTY9i�nCi -bl a2i5sf 'Mtfil�aiiU�aiSryYfl�7ifl'i 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 NAME ADDRESS OWNER PA) TR 1 r.lr YLI IIQ L E 4 1 R F D -4' 2 P U"1'/IAA4 ,/.A'LLIC �1 LOCATION OF WELL BUSINESS PROPOSED DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL USE OF WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING OTHER DRILLING COMPRSED (S(Specify) ER ❑ ❑ EQUIPMENT N ROTARY AIR PERCUSSION P RBCUSSION LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT SURFACE ULVE S O FEET to G CASING U ❑ IV ❑NO OYES DETAILS f� THREADED WELDED YES NO YIELD HOURS G.P.M. ❑ BAILED ❑ PUMPED � COMPRESSED AIR YIELD (G.P.M.) TEST 5 WATER MEASURE FROM LAND SURFACE—STATIC (Specify feet) DURING YIELD TEST feet) Depth of Completed Well LEVEL )dry. 1� 1 in feet below land surface: M SCREEN DETAILS SLOT SIZE DEPTH FROM LAND SURFACE FEET to FEETx. U _. .._._.. ,..._..__, IF GRAVEL Diameter of well including PACKED: gravel pack (Inches): FORMATION DESCRIPTION Sketch exact location. of well with distances, to at least two permanent landmarks. 2 17 r Q A A/ 1 l r U Al ri L If yield was tested at different depths during drilling, list below FEET I GALLONS PER MINUTE J a7 DATE WELL fl '�"�� t R� �vF 3*� ri..��`•m �2h *y • -`'lty �. 'r �.. ,' S r � S � � V �': N 1 � 7yy7 h � , � w y Z N of K. lS + i i ' kr� k „ -.r, - f a: ST �-g C 1P Al 11 OF REPORT WELL DRILLER (Signature) it 0 Owner or Purchaser ui.lding Municipality �3 Building Construct y Section Locati n - Street Block Building Type 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- v,ic:es _of . the- .Putnam, C:ourty::P.:.Qp rtm^n <t o.f:- ?iea,lth a,s..to whether or• :nx t _t`?.e 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 46t��, 19 J.' Signature .sG___rre ��e/STz9t 4Es� Title If corporation, give 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 MELD CfIE L.3T Date.:__ -ley t VI Insp . by : _ 1NTTT_A7, SI'Z'E Ir;SPECT:ION IYes No _ Comment:. P1 )perty lines or corners found . . , .._ . L/ r3a., estimate house location ... Separation of trench from house, . well etc. follows plan . . . . ..0 , 0 , Nun.ber of bedrooms checks ~--- Vi.;.l driveway need. cut A:zsi;: trees be removed-note, these tr!.n 15. ft . from near e st trench .. . 15 Ft. of peripheral soil horizontally from trench ... : . Junction boxes prope_,ly set. Gould surface run off from driveway, roads., ground surface, etc.. ctiannel near SDS . . Ts deep hole representative of entire SD5 area Addit -i .cnal deep holes needed. . • .. 7 FINAL GRADING OF SITE ACCEPTABLE ' _ _ -•- SuffiCient SDS area available considering dYivektay cut, house location, separation . -di_stances, etc. ... _ DEEP HOLE DATA Depth: Water elevation: Rock elevation: Soils description: Date: iii -73 , FINAL SITE IITSP�CTION Tnsp. oy:n douse -located where shown on approval plan. : , JJ 4lidthL of tre:nch average Sl ope `cf tale line and trench acceptable Room :a11:ot:-ea for ex�aans�_on trenches. Over."_99. ft._ from . swamp, :ratercourse. . lid t l lr 1 5 lJ1'! rti U-G :; t 1`. pp ; d or - v7.1�7 &.r e . unnecessarily graded . . . . . . . . 10 Ft. rraintained from prop.line and 20 ft. from house .... ... ,. . . L/ Separation of trench from house, . well etc. follows plan . . . . ..0 , 0 , Nun.ber of bedrooms checks Stones, brush, stumps, rubble,' etc. greater tr!.n 15. ft . from near e st trench .. . 15 Ft. of peripheral soil horizontally from trench ... : . Junction boxes prope_,ly set. Gould surface run off from driveway, roads., ground surface, etc.. ctiannel near SDS . . area : Does l:ot drainer e an ear O.K. in 'area of SDS . 7 FINAL GRADING OF SITE ACCEPTABLE ' ran I Y ' wPUTNAM s; Dwision 'f En CONSTRU( 'yLocated at `as',i� ✓ � . eG r�• Subdivision �� y� - '^ Owner.- Lot Area'_ ,Number -:''of Bedrooms ,Sepirate.� werage;System to consist of °A r t' S a/th Services Carmel, -N Y.' M t Address Total Habitable Sl e' Square Feet J .� )al feet X ` ^w,dth trench ./ To be cortstructeii by Address Water SuPPIy Public SuPPIy From p;oo �, `„ .. r 1 .Private 'Supply to be drilled by Adtlress� �' ; :Other ,Requ,remehts k I' represent that I am wholly and copletelyrespons,ble foi m above described wilt be constructed as shown on the epprov County 'Department of ,Health,: ±and that 'on complAid'h-t be submitted tor, he Department,. and a ;written:..guarant place in -,good operating -conditiod any part of said sew 'ance of Ahe approval of ,;the Cert,ficate of Construction: ,� `will be located asahown, on the approved plan and that said; County Department o Health v Date.,. f # APPROVE13 FOR CONSTRUCTION This approval expir revocable''for cause or may be amended or;modifled when requires 'a new permit Approved for disposal of dome: 'Date By, s .� ffI ie�year from they date 4ssued . °s° o ste ideretl necesear"y by the Comiri`r�ipt�gt° offo6ded samtay sewa a d /or pr ate wSt�'IC(J�i��gl�fJN <<r r u i ri r .t^iLt 1) that' the, separate ,sewage',disposalz § yste`m x an- ar sj,-ru es and regua ,onso ;, e-:. Putnpm &- jfactory to,the Com, missioner of Healthw,ll or sPy ns by the builder,, that said, builder will :l X057 rped lately :folio wing the date of- the'issu g- (T -t hat the drilled 'well Aescribed above I. ifd{5,,i°.rules and 'yegu a_�ons of 4 the ,Putnam 9 ° 'i .� i License No Lo8�y�Fi@`bwldIng has be emundertaken'arfd is' ^' chang8. or alteration o construction Tdle O .+6 +`w hrrT :.•r«sv.s�+: !'f.:u..:r: :- '�>was+r.i..:�w �.��:5.�w }- :'- a+.x_�+. - -. .�rvrtv_.stnu-�...�r •a:r��•/r �._- u-.��. - .*i + -.�nqr ..rf- •.ut:�e.w nas :'tvu ;:.ti �r�:�r.•�'f esrvn�. <v �rnu +rsi�iw�+aw~uw•L•m'e•1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date aE "-;I) Re: Property of ;Q/,( / C Located at aed 1:Pef 4�'Z'l R a Section ?,-3 Block .3 Lot Gentlemen: {{ This letter is to authorize 961-0 ✓ W i ✓R a duly licensed professional engineer or registered architect (IndicaYe-T- 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 Healt11, 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 145 or 147,� Education law, the Public Health Law, and+ the Putnam�County Sari - - � tary Code. Countersigned: '�� {ITf P.E., R.4gj,131 #Nfdv� °'., Z- oe. (Seal) Add MIB a ° yo o v e Very truly yours, Signed - Owner o Propeerty Address- '2 /'-p —,lp o �9# — � oel PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTI`SERVICS COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner/ oxjrA��� 44de, V Address Z13 / J Located at ( Street c�-r�v �s -Sec . �3 Block ,.3 Lot Inndi'6a e nearest cross street) Municipality SOIL PERCOLATION TEST DATA Watershed ��4 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 /o. %y24 30 Al /3 .3 OCR 4 5 31/' I_ 12, ©�' ?-v 12, 3 4. 5 1 2 3 5 Notes: 1) Te,gts to be repeated at same depth until apppproximately 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. v TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION -D.FSCRIPTION,.OT,-.SOTLS _7oNCO11NTFMED_ IN__TEST_H,0LF,,)---- ' DEPTH HOLE NO. HOLE NO. 2 - HOLE NO. S G.L. Of 12 w 18" 2411 3011 3611 V 42" 2 4811 5411 6011 6611' 7211 18ti 8411 • ol -INDICATE IEVEL AT WHICH GROUND W-kTER.IS...FN��OITN.TER-P�'D'.,..---,.-- 416 'rPESTS MADE bate' DESIGN Soil Rate Used lel Min/1"Drop: S.D. Usable ,Area Provided No. of Bedrooms Septic Tank Capacity DU Gals. Type /4 ,0,s Provided Absorption Area By_2_ZZ_L.F.x24" .5b" width trench. Other yvrrrlurr u� Tame d c, va vi Sig re i Address 44- THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: j/0. 24615 . Soil Rate Approved Sq.,Ft/Cal. Checked Date PUTNAIiY COUNTY. DEPARTMENT :OF 'IiEAI,g`I� . i Division of Envi�onmenta/ Heal[h Services Carme/ N Y: 10512' ,CONSTRUCTION PERMIT. FdRI. SEWAGE; _DISPOSAL SYSTEM �. r>� /V . _ ipI ,� ,�;y�Pr�f--w' .., Parr- ,�:.,.•„�s•-:�- �;��� Section Block ..� • k na- Lot,' :Job ..Owner %"� =' � � ' Address .. Bwldmg TYPe ���o d �� -e � 6+ Lot Area /� i�•.GW:: -Number ?of Bedrooms Total Habitable Space �3- Square Feet Separate ;Sewerage System, to consist of `� n Gal Septic Tank -� lineal feet X width trench To be constructed by Address water Supply Public Supply From Prrvate,Supply wto be drilled by ` Address -Other Requirements I Irepresent that 7 am wholly and completely responsible for the design and location of the proposed . system(s)' ll ®dtid �� �sdrate sewage is system . above described wil•I be_constructea :as shown on the approved amendment there to'and in accordance with the'sj89� rd} rUi n Cl gula ions o t e Putnam County` `Department ofr Healtn,.. and that'on completion•tfiereof a ,Certificate of Construction Compliarice4b°s���ety ;fop>heJCoixmissioner of 'HealthwUl sz be submit o .the De art -and i ,written r t` �I f r. r t p_ gua an ee w I bet. urn�shed the owner hissuccessors,-hors� . M b "g44iAd4�-that.said'builde Will `a:place m?good operatmg',condition` any part of said sewage disposal system during the period of "tw,o (�;j year� mmediately oRowing. the -date of the issu= ance of ;the approval of,the Certificate of Construction., Compharice of the origjrial system or any:,rep 5: the Mto; �p;�4liat the; y}`,�led', ell, described above ' will be located as.shown on the approved plan and that sajd well wdl be installed �n accords e,•with the; deF�s essa.�,., r.egUt ti— '-on�1 of�;;fhe Putnam ` County Department of Health Yt 111 a Yr „ :E � R A Ib qp • . Address APPROVED FOR CONSTRUCTION Thls.approvaP expires one yeaj from the date issued - unless co�rucU ; .,, "e o e sa s° been undertaken and is u �J+ e�ie revocable for.ceuse or, may be amended ormodrfied :when consi dered,necessary by -the Commissioner of Health. {A ysr f a(ge•`or alteration of construction _requires a' new permit. ApproVed for disposal of':domestic sanitary sewage, and1or private w supp niy. r Date / �/ gy�rLr� Title] i �( v, i "• P N r ,,,.; : = 3 b A q/ � s r� 7y rr' . Cl e� � s ^ o a, : c in .- t \ .t OR/5 3q PALO 0 33" '/ i• _ � �v� /:�-, vim/ .BGX ; • APPROVED Ab 6LL� DEC 19 1973 PUTNAM CODUII OEVL OF HEALTH TgX/rl,�%�it/!�b.'Ja JrLOC.t'i(/ - ° -3 s"O%r ✓! - °// ONE -OMECIOR• DIVISION OF AS CONSTRUCTED , ENVIRONMENTAL HEALTH SERVISS SEPARATE SEWAGE DISPOSAL:yYSTEAE `ws� +•�.,.,,�•.. .C?c.T•�' /C.CO. �';�"OSyLEEi <�% riU.�'c.LEY' TOWN OF �lTi ✓%�/'7 )/fa�GEY�i �lJTi1/ =�7� COLIWiY• NEW. YORK "�!'• R', DATE /c - -7-jr SCALE �S,s,,:�y�,� JO�3 NO. :J'- <" SULLIVAN - THIEDE: CONSULTING . ENGINEEf 4 CLARK PLACE HA'T]FAG A1FW YORK :t i� i� i� I --4"75 N � V �t �J /�N p - 4J QI OJ K t41 y ' lj N—; t { • �— "9�i/Oo�jS 1 1 GALLON SEPTIC TANK LF % 36 ABS. TRENCH ,"��/ y �i I i .- t \ .t OR/5 3q PALO 0 33" '/ i• _ � �v� /:�-, vim/ .BGX ; • APPROVED Ab 6LL� DEC 19 1973 PUTNAM CODUII OEVL OF HEALTH TgX/rl,�%�it/!�b.'Ja JrLOC.t'i(/ - ° -3 s"O%r ✓! - °// ONE -OMECIOR• DIVISION OF AS CONSTRUCTED , ENVIRONMENTAL HEALTH SERVISS SEPARATE SEWAGE DISPOSAL:yYSTEAE `ws� +•�.,.,,�•.. .C?c.T•�' /C.CO. �';�"OSyLEEi <�% riU.�'c.LEY' TOWN OF �lTi ✓%�/'7 )/fa�GEY�i �lJTi1/ =�7� COLIWiY• NEW. YORK "�!'• R', DATE /c - -7-jr SCALE �S,s,,:�y�,� JO�3 NO. :J'- <" SULLIVAN - THIEDE: CONSULTING . ENGINEEf 4 CLARK PLACE HA'T]FAG A1FW YORK :t i� i� i� I