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HomeMy WebLinkAbout2754DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62. -1 -17 BOX 23 J ' NIL I �. 06 02754 '_' L'.'" k' iVry.:'"- r"^* F" .,-•,•sr..°"""x''7'r7s'-a'r';"e n-•-- .�+�.. •--- •---"- i R PUTNAM COUNTY SDEPARTMENT OF HEALTH • Division of Environmental Health r Services, Cerme% N Y, 10512 - J �A�L CEF�irt1FIGw► °fE l�r ".V�V�T�i�,Ci:�' .ii t.E -a � a.3r� °c?'±� � !�'Jd�G CT'!9°OSAI. Sly &TEI41 i'�?AM it nn J 6 1. or Village':- T ocated+ at �5� � `"� 6est+6n Block L owher `` Eo �..f4 i�t/,t -iA l:Eoa l t�'c,. Job-­' . got Separate Sewerage System built by. �: a9L T Address v Consisting of .a` ®d Gal: Septjc, Tank, _ - d d lineal Feet •X t ' 11 j width trench Other regui-rements s � ° � t✓ � 6' ''' C � i�."C'A l f? 'SIR A'1`t� Water Supply:. Pubk 'Supply. From k / �ucjcY y Private Supply. Drilled By ddress A Building Type '� = ` �.t.... of Bedrooms -Date Permit issued' — d i Has Erosion Control Been Completed? •I cgrt:fy;that.theaystem(s) asaisted serving the abov i ; e ` r t III as shown on the,,*,_,, pl s of the completed work (copies of which are - attached), and in accordance with the standards ';r es• no rs filhe permit ued the Putnam County Department of Health ePT 2 1` ? `.'1..\�' � P.E. R.A. i • Date . • Address ' 1' License N0.'`'��® Any person occupying premises: served:by It. he above syst s8�)fN 'Oj a such action as may be necessary to secure the correction of any unsanitary ._. , conditions resulting from such - Visage..,Approvai,•.of thus, stem': shall become null and;void as Soon, as a public sanitary sewer becomes available' and,.the approval of the priv5te water supply all become null ind voi"I' Aen -a 'public water. supply 'becomes, available. Such approvals are subject to modification or change when, in ttie Judgment of tq?elPpmmisswner`. Health, such rev ion, modification or change is necessary. Date. By Title m 1 � y - PEEKSKILL MEDICAL ABORATORY L `' 1879 CTOmpond Rd Maple; Terrace Bldg A I�ekskill New York PE 8777_ Y S "'6 ".,;� 't er" �'�l��' ^"�`la ;_ c -TM - w7J•�' G' }.- �i`�� —� `"ra �: � a . DATE CQLLECTED - { -RESULTS , O,F .EXAM'( NATION `OF WATER 11 11. 72 OWNER _ DATE kECEIVED f SARI WIIAI z 11 11 72 I CITY VILLAGE TOWN & /OR NAME OF SUPPLY DATE REPORTED •SYi1VSETSLLL RD, #2PUT X NAM UAZLEY yg 11 13�72 SAMPLING POINT t WELL h } (BACTERIA-PER,ML. ( Agar -platbb 'ntat35. __ `COL +IFQRM GROUP (IvlostprobableNo %100m1:) RESIDUAL CHLORINE AS RECORDED AT , L .2q. TFiAitT 20'2 SAMPLING POINT POINT OF TREATMENT CHLORIDES NITRATES (as N)mg /1 v 1FLOURIDE (F) mg:, /1 Ji i These results indicate thatthe water was2S of a satisfactory samtaiy,quality.when the sample was collected LH. •PADOVANI M T:. (ASCP) i •' J WELL COMPLETION REPORT 3/71 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK . "N �.. .:.Thin rep rt,,., r�iS:,.G:° .^.•QfT`.'J,Iai�,�1_!+.• ..L�`nll_, LI :4 d »�:h:l;i ;c�1'_t - f.iD'y'n„`,V, i"(Q:1!il,...fiF aLt Rt a?the ^�L,'J• ). iaM,�rn 7r • rtl^ L1 analysis cf 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 Al ADDRESS LOCATION OF WELL (No. & Street) (Town) (Lot Number) l -f-;v/ PROPOSED USE OF WELL BUSINESS 59 DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL 11 SUPP Y ❑ INDUSTRIAL ❑AIR ❑ OTHER CONDITIONING (Specify) DRILLING EQUIPMENT COMPRESSED CABLE ❑ ROTARY Cal AIR PERCUSSION El P PERCUSSION El ((SSpe ify) CASING DETAILS LENGTH (feet) DIAMETER (Inches) WEIGHT PER FOOT `J �I THREADED El WELDED DRIVE S O YES NO )YA CASING YES GROUTED? NO' YIELD EST HOURS ❑ BAILED ❑ PUMPED COMPRESSED AIR R G.P.M. YIELD (G.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIEID TEST [last) Depth of Completed Well /� in feet below Land surface: V U SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (feet) SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (Inches): GRAVEL SIZE (Inches) FROM (leaf) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET lv If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE Af l U )LI o-� c DATE WELL COMPLETED UN 1 y�., DATE OF REPORT T e, A, / I WELL DRILLER (Signature) a o .b w:i . +-a _ Owner or/Purchaser-of hBuilding Municipality Bui. ding Constructed by UN Location - 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 :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 .Putn,..am, C;gr:ty..I).epa..rtment of . Health as t.o. whether- er- -no:t_ tra iau�-o of -tlie 5ysteir� °to ope'r'ate T�ras caused° by" trio willful 'or negligent act of the occupant of the building utilizing the system. Dated this day of Al V 19��— Signature s Title , '/ (If corporation, give name 7 an address) o V- v�.t/!�'? 7 j ��Al - - - 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 ;,1 '� - ^ FUTNAM cOUNTY� 1 , s Division of Enwronri�enta/ f CONSTRUCTION .PERM,lT FOR SEWAGE DISPOSAL SYST- Located at Subdivision. Building Type Kr'Sl�iue �'ICC Lot Area �O Number of Bedrooms CIA Separate Sewerage `System. to connslst; 'f i Gal To be constructetl by �✓O� ` �� � Water Supply Public Supply Fro , � m f �o Private Supply to be drilled by L. Address I represent that 1 am .wholly and completely responsible for the. above described will,be constructed as;shown on the approved a_ ht County bepart -J, .of Health, and ;that on complefion there as art be 'submitted to the Department, and a written guarantee w, a furl Place" in good operating condition any part 'of said sewage I s ante'' of the ,approval of the, Certificate of Construction iCom an 'fit will te located as sFiown on tFie approved plan,and that said well County' Depar`tmeht of Health "Date OG� - � Signed 6 A APPROVED FOR CgNSTRUCTION This approval expires one year,frc revocable for cause;or may t e',amenbed or;modifled when considered net requires a new p' mit ' Approved for disposal of .domestic it si / a s ,D >ate By k A TRTR MENT �OF HEALTHW j h Services; Carrne/ N ` Y.,, 10512 TT y ^- Q %%4 T �rD r tY rce cu T�OWR Or illage i! Block 3 , JOb x A. 'AddCeSS: ec s, Total Habitable i5pece 044 ~ ©a Square Feet. Ric, Tank S ®Ca�L iineal feet K' s 3bi� Width trench' r t � - Addr855 �{✓ /1%/�l•!4f � * f.rl��ig 'r.�� y ' 1r" ' '� �e' .tf , , get �t � �y�tit a,+ w w � -•: ��, ' _ - k F,�' '� tf systern(s) 1),at oat: the separate sewage disposal system s' racc 'with. 'f a standards rules an •regu a eons of e. Putnam z 4-St mplia satfsfactory,;to:the Oommissioner of;Health,will ehi su ssors, heirs or, assigns by the builder„ that said ,butider' will • ` f e p frctwo (2j y4rs,immedWely, following :thedate'of the'issu- st any repairs thereto 2) that the.drtlled: well de ;crtbed above acs ce th a pstandards. rules:'a regu.aVoo` of the' "Putnam'•; ✓p SZ7QQ► r 1 License No at i trc . , e de yissued u less construction of,,,! he building,,has been undertaken` and is t:W the Gommissroner of.'Health `Any .change or* alteration ofrconstructlon ' s ry' d or ovate water supply only:; t L r r ''.fii !@ Y e n v 4 L' a. � ti - MTitle =�► ' /7 r � 1 .,s 'A PUTNAM COUNTY DEPARTMENT OF HEALTH r:jT Tak TL Date zo 1 Lq I Re: Property of Lo J-1 f� L'Lv'j -rot, o P 10 KT). AVK Located at _'S LA,-, L 57 Block -3 Lot P/ an Gentlemen: EY L STAN This letter is to authorize. a duly licensed professional engineer 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 J +7 -P TT-'--1 4- U --A 4--- gin ne-a-sary papqrs I IjtZ;;parI.IIIvIiU L).L 111"CL-L ULIY CLIIU U%j s-L a a-L 0 my, connection with this matter and to supervise.the construction of.said.. system or _:aystems..-in..,conformity with the -orovisions..of..Pirtiol.e..14.5....or...- 147.,, Education•Law, the Public Health Law, and the.Putnam Count y Sani- tary Code. untersig P.E., STANLEY I 'LANDER (Seal Address BOX. 267 Very truly yours, Signed RCLj_(C_" Owner of Property . A C x AddPoss Teieprione PUTNa�1 COU TYI DLL'7?1LL`T OF HE'LTH ...,.._... DTVhSIO� OF _ENKTT OQN E1:1- Tn1t..hEALl ��S.ER:� rES ..._........ �. _... r .- a.,.. .. .. ., .:; DESIGN DATA SHEET - SEPARATE SE,`-AGE DI SEE ? SAL SYSTE •1 FILE NO O�ti�ner Len sFl�e� ' (.✓��1 Address lo.7q c4yvWoyc,� eoV�q (� -tA-x mAAW �� 3 ;• Located at (Street Ar- 04. 11aw ._ 5-7 .Block Lot (Indicate .nearest cross A Tee l-) Municipality `Tow ,o c,c PkTiv,� V .9atershed �p�� GCc� SOIL PERCOLATION TEST DATA REQUIRED TO ' BE SL'E: iI'! ED ,,ITH _a P?LIC_�TION Hole Number CLOCK TIME PERCQL_aTION' PERCOLATION- Ain Elapse; Dept.- to D i ater t;ater Level No. Time Frog:. Ground Surrace in Inches Soil Rage Start Stop LIin . Start Stop. Drop 1 n Min/in . dr.ob Inches Inc; :es Inches . P1 2-1 2 -z 8,0 ._ 3 Z! -Sv 16, 4- 74 l.0 4 P2 1 a' 3s �;�s� J ir�4 Z•� �5.� 3 3� J ?� .. 14 Z'3, �p S V . S .. . 1 ? 77-- 3 4 Notes: 1) Tests to .be repeGted at same depth until aobroxi -_ e1% equal soil rates are ob -. tained at each percolation- test hole. All data to :b_ e submitted for reviecr. 2) Depth measu.rei:.ents to be made from toy of hole �:.. f- S A }"WY :� �'_.c:m- >v...:1•rr....n n- .:rls'n <t.'s :. •-w.- . ^_,asr.. . Rr::KaMOIYS:_.rc >•r+ - -.1 ^' M-a .- .S'A:'.'(.I -A�. �- R:iM.uaT_.caa A rv« :.Ay:n .... I. -- ! r �J9.� _ TEST PIT` DATA REO_UIRED 7_0 ?E SJ3`fITTED :ITH APPLICATIO` DESCRIPTION OF SOILS E`_-nUNT..RED T_`: :'EST HOLES Drew DEPTH. HOLE \T0. P" <H_OL o0. P HOLE N0,1�. G.L. p 6'r 12? = 1:.14 K W Inc lac t-KI f 18:.T 24.. � 30" �� n 36': � 42'` _ R 48"t. S 4't 0 0" :,66,* 2:. 78* 84 INDICATE L;r VELT. j':�:ICrL GROU \D .�?�TER" FS. E \C0T?NTER2 iiv ATcA INDICAT LEVEL TO 6dHICH WA TER LEVEL RIS =S AFTER BEI'"G ENCOUNTERED 'TESTS'&tADE: B;�' SsA� L .S. LAyiotyz Date 10 -23 -71 Soil Rate .' ed � Drop-, Us ^�i _are pro 'ded ��ofl LAC s� �� Ii_, /1' _ S: D. �e G No. of 5edroo7 ,g Septie Tank, Cad,_c?t5 iZero Gals. Type 4s.-w ., Absorption 'rea Provided By rJ-'oa L. F.x2' =' 36" � tr ch: 0 el, Name STANLEY o LANDE Sig acre c v. Address' l Ux Z.6 L AMA B o Y. 105ul `�' �• " ° ° 0.38 ®� PUTNAM COUNTY DEPARTMENT OF HEALTH ®� Soil Rate Approved Sq. 17t. /Gal Checked by �_ Date v ;STAht,C� �I�dM'' ,:; Yd h 4i3 gap 5}SEI m,'W#AUUZICIi`: Ux IJf db� Wffl �6an s33 thzt 43i System —�" ; fyy ,ra;4�,t�Mc A L.t_ `Ovo itre> SySt m': SFAS rss8'►iPt "aft 4it. r�1ss >a rff ` = th fmuat# :Dept. of :. IJ 4� W` %Utz�T DQtkf'C F y ;STAht,C� �I�dM'' ,:; Yd h 4i3 { i�;szCaata: w, to j : IVA , � r Lt^� a'f �`f • i t ; Y, 'ctC;l�►c^ai;cc 4_ u l LL i APPR ru �' � - �-- - • ti+ 3� : s� d„ N0� -0� ,Tc� wt..� o� dvrt.+..ia:c,.�; c a �'Y,`n°�n €�.4ta cv`Cc.�Aoh Cfdc.mI~c„�