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HomeMy WebLinkAbout2835DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.10 -1 -16 BOX 24 02835 5 1 16 r r )Idmrrl all 02835 JTNAM COUNTY DEPARTMENT`, OF HEALTH ' � _ � v of Environmenf�l Hea /tn Sert!ices,xQarme% N Y 10512 � � ' , 1 - Town or `Village Located at `TJ Block 'J owner M GG obi. �G °LG � "Lot, li S Addre �E�r.�.�ii�° /GG �r�1�LtJle� �� if/ ✓; Separate Sewerage System built by ss r Consisting of Gal Septic `Tank �Z lineal Feet .X 3roN width trench Other requirements Water Supply- . f r * *Or Public' Supply "From Private. Supply. Dulled BY�UG/CC y Atldress ,� Bwlding'Type , Pdo f Bedrooms =Date Permit Issued a Has Erosion '.Control Been Completed? , o I certify that the system as listed serving the a, ve remi- res�r cte s ntially'as shown on them fans of the completed work (copies-of which are' y �� _ attached) and in accordance with the -it _dartl I s an 3r ulat�o 3; .p en fil and the` rmit issued by th Putn ounty Department of Heatth ? 7 CertifiedLb`= Q P E R A Date _ •iV ,�; „�-- A Address +' Ldcense No �. Any person occupying pemises,served by the above system omptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such `,usage Approval;, of the:;separate sewerage system�shall� become null and void as soon as a pubhc_samtary sewer becomes available arid,tne approval of the ^pnvate; water supply,shallrybecome null entl void when icr. water ,supply becomes available '. Such•''rapproVals are subject -to modification'_or change when;' in the' judgment of he „Commissioner -of Health. such revocation, modification or change.is necessary, jog r. '-a bat. Title ' m 23 "llb Y Zlct. t, R COLLECTED RESULTS - 'AM -NAT lON-' .-'QF��EX JE r J1 t -r tAt t RECEIVED ,'tl�� t,7Z I CITY VILLAGE TOWN & /QR NAME OF SUPPLY ol r DATE REPORTED i Route r2 We;sEt Dra ve, :Putnam Valley, No3Yo 12 , 7 Try ;Shore M -,w IR- SAMPLING 4 - BACTERIA �ddW-66dh 1 Y K OV- EATMENTj CHLORIDES -T /j -�l At. - �.FLOURIDE% ih-g A �nT, A ntw "J6 -� R 8 1�,Aa h &tj --,jA6Utdfy,quqi r D hE , the T-1 I'll I lz f,, 9 -'T VANI `(A'SCP) 23 WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK � .. .++ yr. -. "cC.�•_sf r- ..'.Sn a j � .7..� G. fir'- -'�'• .c�? .f4� • "' i i1S ,..N"Ji• i5 '.0 •:,C ViS:}noa�:S-{Yj vir'i�tiil�i5� r3���Y „JI,i1 �9L't'tt;G`i0 �etLC�Ly' �v: il''d�-j,�.i' ,n'L•�. ��y., iic7 ^'v.,... �a �sP6fi`fli"y ,�. jivtTi 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 l�l i1 • '1 NAME ADDRESS OWNER (No. 8 Street) (Town) (Lot Number) LOCATION OF WELL l 12giviL T/Yrf J4 nik F BUSINESS ❑ ❑ ❑ PROPOSED DOMESTIC ESTABLISHMENT FARM TEST WELL USE OF WELL ❑ ❑ ❑ (s(specify) ❑ SUPPLY INDUSTRIAL CONDITIONING DRILLING ® COMPRESSED ❑ CABLE ❑ ❑ EQUIPMENT ROTARY AIR PERCUSSION PERCUSSION ((Specify) CASING LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT � THREADED ❑ WELDED S O YES � NO YES ONO WA5 DETAILS YIELD ❑ HOURS G.P.M. ❑ ® YIELD (G.P.M.) . TEST BAILED PUMPED COMPRESSED AIR 7 WATER MEASURE FROM LAND SURFACE -STATIC (Specify feet) DURING YIELD TEST (feet) Depth of Completed Well LEVEL 1 '—' in feet below Land surface: �Jr' MAKE LENGTH OPEN TO AQUIFER (feet) SCREEN DETAILS SLOT SIZE DIAMETER (inches) IF GRAVEL Diameter of well including GRAVEL SIZE (Inches) FROM fleet) TO (feet) PACKED: gravel pack (Inches): DEPTH FROM LAND SURFACE FORMATION DESCRIPTION - - Sketch -exact location of welt- with_distances, two permanent landmarks. to at least ) FEET to FEET rRs a�A- J - � Z 3 .x . M 4n 1 - 1 1'1X�'> ✓. /a'�1 y2�7 jjtE .� � A' iii..,..._,.,..._...._... If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE (j a DAT WELL COMPLETED DATE OF REPORT WELL DRILLER (Signature) l�l i1 • '1 .i„2„� f�'(, : 7'_ ='Yr i? f ''fd ...0 'HSt S � ,�r.vR � ,"!:F F^4 N1c'fY'y �^'" li'C-f Z „�!F.xv- 4 .. 3!- t _ /•�W.' S� _.',r "'T t Y A'f`�'H% tin . i [ H - J i4`M7 4: +7' i'. � T'P?f� '•�i •u+ry -S' '" �1 .'v'es�'• � d#':'L ,,�yiC= l�"" Y'!r ,le .�'�:L�f'i"" {r. f' _ tsU,. • .Z '`-`�' • 4 b, � � t d � � -. ii N. ,7 + t t. 4 1 � X t y hk ,y.. '4. ,�, -�>w o Qr Pu s.er o. 1 -d -ng_ Munl c _ pa i'ty z V/ ��d C.� a' ?AX ir�A� �S $ " ' orisrt °c t by Lvc Block t. �. .. r ' GUARANTY OF SEPARATE .SsfAGF - SY.STEt�l I represent that I ai who:lly and cot,.bletel;� responsibly • fart:4the,- .1,-oeation, wa^r�anship, n:st.eri.al, cons.truc_tio.- and dra?.r_age of th :,38, -ge d`ispvSAJ syst rrl sQr,vxng �hc above• descr be;d property,' and that -t .has e c r strut ted ;: s :s�ovin, on the, approved. plan :or approved amendment thereto, and,xn 'acco'.rliah;ce with- the suandard's, rules and regulations o£ th�:.Putnam �.. otait Do -P * of LTaalth, and hereby uarar_t;r to try o neap, his s somas, hezr s v " .ss ins,, to .bola e i.n good• opa at i ng condx +ion any !part o'f sa ,ci "system•.: ores t��uc ted: by, me. :r �_c'�1 fails to cz��rat for .a'.perlod o" tw`o �.rs ian�- cii.ate fo�lo.a -9- 'tre date bf �-nit ial use of tre' sewaaz dispos31 S S; t6T1,. or, c2ntT •,�rE' a'1 'S :ride by :ji?e to .SUC GI Sy' t i i, XCBp i, where tale failure v 4operate. p:"� - >7�y is 'caused by the -IiL ul or negligent act of 'the' occu- ait btzl :ulna util i z ;stem..` Z"he' undersign ad, furt r agrees to ac-cept as,, conclusive the 'de t. - - iftts },o. a 'f'+-he .D,'re� o� h� v_ z�anrr� gal uea�±;.��.. _ of -'� D1V� siOn J� �" LAl:nam"Co my 1J °p -ar , - n,6r,v bl ieaLG_2 3 �� 5di'Ct l¢r` or iTUt • hie 'a -lure. Q ' the s�r`st m to; 'opearatE was cause §d by tt�e willful or ne l' gent R act ~af the 0�cupan of the building util tiirg t� e system. p� Signature �atsd t'h1 s.: _ ,d-ay of �;,� �- 19- Q�. Poiuriva.VNU LPG Title A 5 L • a If corpora t O n, , give. ;n me' and address) } iP, E -(3 i GC P S AR gF riR p WiTh ,i'ziFEE ; ;) COP lES 0•F FI ?dAL P "L'ArJS BcF'QR� O?TIF3CATE "'.4: G0�1P.TIC1� MILL . B`• ISSU i- GLTOR hS RQU.ZR'D= TO FILE k+Q`�'IC OF DATa, vF F'iR:SZ' USA OF' SYE1 F ° i�rv��pn a.fv%ronmenta.l F%l.th Sa- rvices, Puy. :am. County "DQp :artrrie.nt of hea3 th r P " c' iSf FT = 4: CONSTRUCTION PERMIT mvan0ac ls'' K Owner f1izA►J C 1^� . Building; Type Q Number of .Bedrooms Separate Sewerag "e' System to To be constructed by!Z_� 1Nater Supply :Publi r v Prrva :.Addr Other Regwrements • Cc9Va I represent that i am wholly ani above described will be:constru< ­-,County.-'Department. of - -H"ltl -be submitted to the Dep`brtme place in_;goo 1 operating ;condi ;;ranee `of "the'�.a ooroval 'of �' 'the: "iC n­; Fcm»`5t'3 `mTx+�gf.�- i'�^S„'_'R(r //�� 'T.'�°__"5 ;"r 3 'F .J�v °y. °Z•,� �J' A ?q: rfit�L, ' Y3z�'u W44'Qxt k P4-, �.�;«� r` '` 5 F / -`'�}• Y� ?� PUTNAM COUNTY DEPARTMENT ;OF HEALTH DlJision of Environmenta!`Health'SerGlces Carmel 1V Y� 1.0512 FOR SEWAGE 'DISPOSAL SYSTEM To\.•� N O F s F'v-r A M A L�.Ey Town or Village AL y r Address �a �. _ �iia Lot Area I.fl8` Q►GCESu r\� A,.\ �.I:EI �y 1 105 Z9 BED ��R�� Tofal Habitable.,. Space -r° p� + 'Square Feet onsist of q Gal Septic Tank lineal feet, X �t width trench i1 a j u� -• Atldress � is Supply From a „i e ;u' pp;y to be dulled by f�uty�t�Q�� tt� ��` u 3 i ' ,1Ee�•�"�.�oF 'Z` �`i ^ t ©_ir off- ��AVIci•_. C��`.�w% TGiE�`O I completely responsible for;the tlesign and location, of` the prop"I system(Q 1) that- the rseparate sewage disposal system teal as shown on the'approved amendment the e,to n accordance, with thestandards;.rules en _ regu a ions;o `the -- ,u nam . a: "7i ir,arar; rmm�letRlonahereof -a Certif on Comdhance": "satisfactoryito the Commissioner of Healthwill County .:Department of Health T _Date =�P Q \s\.- Z'.� i Q 7 Z' uimff A" Scis d - sign s i4ildress� APPROVED FOR CONSTRUCTION Thivaappprro _6N_, expires one ye_ ) revocable for cause or may be amended or modified when considered_ requires ,a new '`permit Approved for disposal of'domesfic sanitary I IVA ivAZ ter :supply only. - :I iiow Title eri,that . sai d bwider %will -LL ? ing thedate of the"issu ; ed:.wellzdescriDed` "above I., <i ions of `.the Putnam., �PEw _ RA .:! o 23`802x. ` been undertaken and is - eiation //ot construction i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date APVitOL- Z4, 19-1z Re: Property of,�- �,,��c>s �, ,1= l�:�NCiM� r�.✓s�_ Located at �� sr -,���� O�iv� ---- �°� ®%-- VA L L s-y Block .S"° Lot S- Gentlemen: This letter is to authorize rr-r �.� e�� Lea rT�«5„ P•�• a duly licensed professional engineer r/ or registered architect (Indicalej- 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 T ev... tw..... J- F TT._.- 1 17_ 1 _ ,,cpa,r mel-It 0I ncci.L -Lull., and o sign all riecessary 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 1�+7, Education Law'.. the Public Health Law., and the Putnam County�Sani- tary'Code. ell Si Countersigned: F5 ANbc -- E> w. iweEp� • r _ 4 - bp- -Mdress - 7z -4.-s PUTNAM COUNTY DEPARTMENT OF HEALTH r...9 �.- _ mR.V..Y.r.....�..a.r.r ate:',. yy -... �.w+t':.�i �e'M .. _m . N.s-i' ::..NCt+.. -.1. .�, -., .. _..:.•.. �.. . �.. ....• m ter.. e. \sAw aw...s r^..e�i DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE.SEWAGE DISPOSAL SYSTEM FILE NO. FgAvAct—M. -t�• 4 3 Owner +=wA�ya c.%w s 'TR tj se-j Address vA.%_+e.E-YP �-br -_%A9 VvF_G: %JeST =2vtAcMe _m c. MAP ­rAx. Located at (Street ea�ev� Sew .4-15 Block S Lot S 6dicate nearest cross street) MAHOPAC, NEW YORK 10541 -N-4z,,-0 4--,. Cr- Municipality yAL Watershed ®�s cz-AvjR,�. SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS U o-- P ft%'F_T 0;= A e..Kg e�S Hole Number CLOCK TIME PERCOLATION PERCOLATION Run apse Depth to Water W a er ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop rates are Inches Inches Inches 1 1 z. 4- Z: Oa Z► -Z4 ___1" 1-2- 2 'e;156 1 e-4- 7A_ b i 3 4 5 3 4- 3: cad, 4- 4 SULLIVAN • 3HiEDE 2 V A, t c-:. - ° _t z_ A_ (i_ B(ix 31M 3 MAHOPAC, NEW YORK 10541 4 5 Notes: 1) Teets 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 1 1Y 1L1J'1 �11Y/iLL:i/.�'•i°' c,r=_2C. -Tr-_- ,T 'PERK:.. �reST DEPTH HOLE NO. t HOLE NO. -r- G.L. �nAi I�q 6" 12" 18" Prt 2411 LEVEL 3011 bT�.� r ^ <; T FiJC;() "11i� {..[ r2r!:1) 3611 LEVEL 42" .TESTS MADE 48" 5411 60" 66" 721 t)1eF_ 1 acD1�_ HOLE NO. -T`ET i ,Z tv ... 7811 �nAi I�q 8411 Prt _.... : _ . i KATE LEVEL Al 1rT�TICH GRt�ifiVl, bT�.� r ^ <; T FiJC;() "11i� {..[ r2r!:1) INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED .TESTS MADE Date 4 ST DESIGN Soil Rate t)1eF_ 1 acD1�_ HOLE NO. -T`ET i ,Z tv ... 7811 8411 Prt _.... : _ . i KATE LEVEL Al 1rT�TICH GRt�ifiVl, bT�.� r ^ <; T FiJC;() "11i� {..[ r2r!:1) INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED .TESTS MADE Date 4 ST DESIGN Soil Rate Used Min,/l "Drop: S.D. Usable Area Provided •' , C:,Pc:) -t- No. of Bedrooms 3 Septic Tank Capacity 9po Gals. Type Absorption Area Provided By_?__L.F.x24" 36"� width trend Name Address SULLIVAN - SHIM eQ�� ��o9� ��� Ax CL499 PLACE THIS SPAC &MME W# AYX WjbTH DEPARTMENT Soil Rate Approved Sq. Ft /Cal. P9Q -�• 1r Ff88100RL: Date / .5'O /° ° - Ws-1. L 41�.- h S'La SOIL VERCOLATION RATE ........%4 ...... MIN/IN DEEP TEST .. NO GRGPC/A/O LV�7TEF? 2-- C-49 4-- E i c OC AC .4Q T Sl -'011 F j Na rAF TH /u StWA�iC' :J /SOaJAL .SyJTESM �`//f�LC �G'' CON.i :•'�/?;iC ] -Ei CJ /// COn // =Grnr, AniGk %lITN /�1n% Cori Nor./ arP.y r.?]"'M ENT of f+Fr -7 <'rN OG V/S /o ti� o F" L ? -��V /� (/ ^ //(q �'/✓ YNL NC'��LT.4 SE/$ ✓e C ct" 3 Fl /•�' /✓/c/,nrf ;a Jc +F" ? -O oF' /mac/,;/ v,�,t3A / ✓F! lF'�7VEL ✓✓G,4'' aF- 7- 0,1' 30/Z- 7-0 ,tar PL /�CL",O a! /e =• �' /- �b'Sa1'?�'T;'C.!% F7T� t�2 ^�, W N O' `U h 9oc 4 9 o a GALLON SEPTIC TANK Y 23L LF X f TABS. TRENCH i APPROVE— D /.✓o;= MAY 2 1972 pariAM COUNTY DEP1. OF HEILn: e r /fr "NC DJVDIVISIO OF / UIVFROKMENTAL HEATH SE1H'ICE6 ESTABLISH ELEVATION OF HOUSE TO PROVIDE DRAINAGE Cf LOWEST FIXTURE TO SEPTIC TANK AND FIELDS ...... AREA RESERVED FOW SEWAGE DISPOSAL SYSTEM TO REMAIN UNDISTURBED.ALL CONSTRUCTION TO CQNFORM TO STATE AND LOCAL STANDARDS AND REGULATIONS ......... ti �w f "L L / /I/C- 3 Z3 EO,Fi rJCa M 5 .i �. � "C'HST_ /✓2c•.✓ SEINE? 1- /F�i ♦ ^_ SEP TgG 7F�.1�R 1 t TAX /Y/f9P-1.5 BL GIc _I- G G 7- PROPOSED +' SEPARATE SEWAGE DISPOSAL SYSTEM FR �J/Ve /S l3 Ffd 4NC /N 7;9 1VSEY � � t TOWN OF Pz/7 -lv 91:," VAGc'�Y P(/77i1,1" COUNTY. NEW.YORK L DATE SCALE AS VaT.EO JOii NO. %2-!7-.3 SULLIVAN - TNIEDE;: CONSULTING ENGINEEF18 CLARK PLACE MIiWPAC. VIEW YORK, r� o' f. ; /60.0 v CD �N �s � C 9GtJ G.L. S� %? %.C'T,9N•L 1 n jam" ., 6/ � � Juucrrav Box /cs ' JJ JJ �jJ ✓ Y, _ if��/Y1,+Ji �.h /�4.�!:: �1p5 /G'17-.( /3 /.S - yS.,G /G. xZR Z-?80Z Y — ^ AS CONSTRUCTED SEPARATE: SEWAGE DISPOSAL SYSTEM ��% ar ��,v .i ! /` y, y �� �f ✓E.s: s, =,cam# � G�rv�- +.. TOWN OF JAN 191973.. y "r ' o �IJ %iC /f�/✓: COUNTY. NEW.YORK . PUTNAM CUUNTY 0Etl H ALIT �\; "',`; y' "• =� ` �� /j DATE /- J'7 -T3 SCALE �s �r�asv�/ JOB NO. 7,2• t3 900 GALLON SEPTIC TANK ;,.. �' .re��IS18H' �F �� J.� ? ? 1 i j;� SULLIVAN - THIEDE y £ 52 LF % .l& "A BS. TRENCH Y4MNMENTAL HEALTH SERYICET- _ �. ytlunl CONSULTING ENGINEERS - CLARK PLACE MANCIPAC. NEV YORK . �L v z y e f ` 4- / ?� lb � e 4! - - - -- - --, C Dtp i Z ��� 4 L s o D 5k �I O r D Lln n y� g � 2.� ' ;- . =_t.__ p o J� T eV �e G.GB '' 'i' i X ! � ' :i '`C; "T. i '�i•ti ' i0 �`'�, — .: /if GIROS D'e,.e Db'�IO A� _ � O `J •' rp 01 1p n Zr - m 14 ow- • r i I O rp, i d t0 Z 7 tl r N • �. Z �T T) p Jo r rnl A `4r A N is I, .Q • �x I ^ TuI� " 11. O Z �� _ C r iw 60 z Q c, ->4 r !q a c _ _- . _ ' :.-- 'tip+:.°.'•- t � L i N Fay r' d _ O v1Tcy A nd L p r 0 4 tT 4- b r r - \`�Ifi - a -- -�` .{�.._. __. / � •I �.Q° .� � r. �' fit. i e � - ' !�-�= �•e'1. � 0 ! I t rj� .. D(A��p 111 •,jij j rApDr 24.16E O Hr AOZTH �N J t-7 — —°{ 0 e -- -r- -r - -t� 0° y It' ` •� Oaf, 1 C. j Z w �� NPDm . gig° 6 � 'I t s � _ ApOp lA,� L; N Pgj n p P a 3f, ' F?mr tp I o� o r r I R - r nLp p S O" Ill Ar ND NC _ — _. rt <2 —may t° �1`�_— �����J�� _°fie?+_ o: n�sbP� e► o"�3yc II' , r' 1° 4 O' t_ouve¢e \_� j il-n HAROW000 r-L004 {.a`� -�•\ IQ PLCSireR P�04R0 oQ = •t 0] �, i,. {.- �E,�. W ��9'oLiN�r1lpol�'��- /r I lV I�r I J, w SQGH i t i � A A � •` ��� o. App Z v 1r � � r : y rlor! ® p A I% 10 r , A ➢ O. rF 1p IL J -- - - --i -r=r I- a � t t' 2' 1 0 •. •r at L gym �'�; r �j j � �'z ',� - - — _ I y, �, ; i I s, � I � �; �' � i � � -Nf jC ,, G - - -- _.. _� ._ _ _ ..�2. ��, i �� !' �~� 'e i ;- i � t. '► �� ;.� J' 1 , i. +. :� � ; J �I _ �' ' . 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