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HomeMy WebLinkAbout3116DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 63. -4-4 BOX 25 03116 �N3# v . PUTNA'M. COUr r Division .,of EnJironmer 4., ' CERTIFIC�^TE ©FrC�L'�11STR�ICTI�N COMPLIAN0". FC 4 rte.... 1 ti h' � —itid "'At 7 Y Owner, ?Separate ,'Sewerage S yste m bwlt by�� ^�' V� ��\ b Cohsiystmg of Gal; SepUc'Tank Other, regwr"ements f� Y} : s '-Water supply Public Supply_ From y I _ - Private- Supply "Drilled By r ' Address `e: BuiIding ;Type h ,, ��Hass�Ero3ion Control Been Corri:pleted� < i` Y 1 5- ♦ 4f � -.�' 1. t I certify that the "systerri(s) as41isted serving the above premises were attached) and �n', accordance twith the standards' rules and, "7re,.guiai v' � Cer iilK�r ,,2 r .t tit. ..xf Add1'�855� a n iAny person occupying premises- served by`theabove system(sj ha �. "conditions resulting.',fro Fn, such: sage , Approval.�,of th ?separate iavailalile =and the approval of the prnra ;e water supplyh3;ll becon fjsubject�to modif,,catioh :or change, when, in the ijudgmerjf aof�t -h `z :k= rr� Date s By. PI Y. LPAR� MENT OF eal th � Services Qeihe%, A Y 105ji fi r r WAVE 'dISPOSA!L ,SYSTER7 `M nAq� `� n A Town on N�llage, ' Section ' , r Block' 6 Lot " Joti Address N lineal ,Feet 'X c } width. trench d. �'_=: tirs ti as �tiE r� • r t � r 9 � � e No iof Bedrtooms- �Date4Permit Issued v, uM'ed else pally a ishown on t e plans of `the completed worl2'(copie; of'whch' are•, lan ed rid erm'i i y', the Putnam, ;County, Department of Health'.,' r' .t iry ' ♦� v Ss t + Y t _ Q �% �t Akk � •� Lit L Ise; No iptlk ake_such action asumay,be necessary to.`secure the correction, of. "'any unsanitary age`: system shall becomefnulf and ,void as soon as a public sanitary. sewer b ecomes. and void ,when a ,public Water _sup becomes available -' •Such ;approvals are m3 o ealth ocaY odrfication, or change `is. necessad" v T i tl r U 1 - � 7. '.-ec: .�::�• .. •C . �.'�. - -=7 -rte •• �.: ���5 � .x., _-.. ... -i - .. �. «'+. .. � Owner oT Building Municipality Building Constructed by _ W sk_�M Location - Street Building Type Section (07 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 :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- ._:__.___.terminAt.i on_:o.f •the ..D.irecto-r of the .Dix..j s.i an_ of.....Davironmenral Health .._.Ser_ ` "- -ides of 'the rutriam _County'Departmerit of Health as 'to whether or .not the failure of the system to operate was caused by the willful or gli act of the occupant of the building utilizing the syste Dated this Wi4k%. day of 19 Signature Title "111000, (If corporation, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPj-jETION 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 -YORKTOWN RED ox, - -VArIAimn,Uall ff�k M V 1--ARCjR- BACTERIA PER ML (Agai� plate, count 'at '35 C) ORM.:G 10 0 rhd o's -COLIF i7osf br6babb -N6 GROUP 'Ess "E ARDNESS, pIjT 4 NITRATES �afb N) X8852, - :DV JN BACTERIA PER ML (Agai� plate, count 'at '35 C) ORM.:G 10 0 rhd o's -COLIF i7osf br6babb -N6 GROUP 'Ess "E ARDNESS, pIjT DETERGENTS.L--*PPM. NITRATES �afb N) TOTAL pprr� IE WELL COMPLETION REPORT + PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services ,. COUNTY OFFICE BUILDING CARMEL, NEW YORK .: r.::-E•i�,i5°i%�r)ii c- '�iT'•'z � as n.:'.'�.°r._LBvi ti7:� Fa�,. _. �� ?.tr:'�FLi;•S._......---�. - " -._ r....:.�y'- fit:'= ; °_r:�.�+:',��e`„ .l,.r_.r,.+{_ !3a,.. _,.�. .:lL:;• "SG .. �'.�L';.r..S::ia�. °:�: 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 OWNER NAME ADDRESS LOCATION OF WELL (No. & Street) (Town) (Lot Number) PROPOSED USE OF WELL BUSINESS IDOMESTIC ❑ ❑ TEST WELL SUPPLY ❑ INDUSTRIAL ❑AIR F1 OTHER ❑ CONDITIONING (Specify) DRILLING EQUIPMENT COMPRESSED CABLE ❑ ROTARY AIR PERCUSSION ❑ PERCUSSION ❑ OTHER CASING DETAILS LENGTH (feet) % 1 DIAMETER(Inches) WEIGHT PER FOOT _ LJ THREADED ❑ WELDED DRIVE SHOE ,�J -YES I❑ NO jW�S CMG GROUTED? (_J YES E NO TEST ❑ BAILED ❑ PUMPED �,, HOURS G.P.M. COMPRESSED AIR YIELD (G.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet)l DURING YIELD TEST [feet) Depth of Completed Well / in feet below Land surface; SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE DIAMETER (inches) IF GRAVEL PACKED: Diameter of well including gravel pack (Inches): GRAVEL SIZE (Inches) FROM (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET r Z. ,x S, AA� If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WEl C�OjM LET�ED/ DATE OF REPORT WELL DRI ER (Si ure) SY. " ° m k.vo } iT t.n -rte ns•w ,- .,•,. �.,+drv.71 .-t� i-+• .wa' <c•' v. -tr. 4^" :ir -c ...TVer� ei�:o� - - �:+ '; .. _� _ eRw•a. - . _ - wriierrr+:n+ic �F tib �:"�' T M;T,'T ,. .- �!�NCAr.'+4'+tdt'N..'Y.�w~rt.+� a.�M• QIC- �M• +YR]�M� w w , 4` Jb C �1t� t ti � • f- .1 � t '� J 1 T 5• 1T�'�ri��Y�.1/' IM��.,N��j���� ���^7.}t�� .l r , . ; i '" �P�� � y � '�� yo ' ' •�e\3 �q y,, `� /G..G�Na�i+E��.°�' `ti • �' '-�;� v�PM : `tF, y ``fi'''r �'� ,, r �� � T� �. Ex� . +'. / < Q !�'�'"%� 1 • 'r�� ��`✓' a i�'���j'°.Y�%i tfi' i��.'� �i 1 ,'. . 3 tt r. t \ 4, tl / + L.,�r n� • 4 , 6({r !� , i \4d" \S 1 2 f 3�1� ) • k n v A R+ kti �1.. _. yx iF /'i:.; 'rte Jp "3� �Qj•, �� ' .. � 3, i t< ^S M.,., h r ... '� -. r. � Y C � "� , � � A J�J�+ w.. j/r r_.1..• + y/ �,+�,� f 5 .=' .R .3M S•'. i t fi t F<k� .'. i t f �a.�• �� ,� ti.w/ffN� 1 � } ti,. r '+�`k� s• it a� . i a ker r ��s:��t '" } a r r 4 �' N,� l 1 �9A yr `: • +.. � ',ay v: 4 r< � V i+ � s , i ,�..' p N 41?�5�r �', '�' rl ts. 1. C"1 �+ } ✓ Jt �_., 1.,".' i -4 T_ N PUTNAM :,COUNT, Divisioi; of M Environment -1 T3 r -�AL '7 777 IA 'jb'Wner 00!!d n , 4:TyP. Lot Area Bedrooms - t� Separate;. Sewerage yst%Wn,qto" cot slSi of 9_1: be,,constructed by' Viter,. Supply: Public,Supp ly rom c a_ Private Supply+ to be d 6 ddress 'am d:,ci)rnpletely,respons ble.4o'r ihe'deiiii -d' iibed�will be 6�'&U'icted as shown 6fi'. above escr� , f I I toe appro4ed amendi :County bepartm6rit, bi .44 1 6" '06 complitloinit'he�6bti:'! pa,t _, a ' nd that p, 'td, the 'DO trn�eht, and a -WM66'givaraniee will b'- place . in, good opera in.g., condition any -part o sewage -disOo , --p-- the . apPjroya q .,,the,,,CertifidAte,,o!,,C,o.nstrUction -Com li a- 'r -u" 0 y' D's 1'�a r t Address :WJ PROVED FOR CONSTRUCTION This �Rcoble , for ,cause qr; may .'6e -a minded orp wires :ii new .�Appr6yed for disi: ey 41 §eivke OQC? T. V 'N Y 105,12 A 94 ,EM A " , T.oWr!,'-,or Vill age 6 Lot` I J b Total .: albli ttp I q q Ua r 6 Feet L,�'Septi6 Tank lineal feetX 3 width tr(inch' .,jr. YM 4`, 0� 2,, �Q _ I X 'e, ;-A % 1 t 1. 0 i"St 6 . id the" PrOpbsed-' systein( s) ))�,,t ha age,,disp6sal 'S m j:LLL there L.to �a ith 166 ita ndAi. rules ' an - r eg u lat ions of ' t he, ,Put nj m t,Oiciti-, ftr,. iancq- s-y_iiiira`ct'6'­-'6 the CoMmiWoner of Health'will h a I r5. o F,4 ss ig n s b y the, e said builder will ry, I �_ . -Ms h d -buil qr,xnat., iyst d F* U er.'Pei yeirs',irnmediately fo!!Ov,Vihlg thedati of'theAssu- Ira 6f e al rs ereto; t deScrlbed the drilled well ' th6L P6tnam r n and -veguraTGRTZ: gf'L' p E.t —I A. License 'N o. -5 isd cgft ctign of the -undertaken and i ces— V, ft&7 Health .Any-.ch a n ge or Slt6raiior of-constructio-' only., ,,qwa a Title PUTNAM COUNTY DEPARTMENT OF HEALTH IITZTTCT/l1`T (1 yU''Tr�r �prnrTyT `T1 1 T -M A T ,„�, 1= s Date Re: Property of Located at�c Section Block 3Co - 2 °l Lot Gentlemen: This letter is to authorize a duly licensed professional engineer VI 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 Lepai tu,cnt 'vf -Hca. til, alld to 81'gn d13. 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 Arti.ci e. 145 ,or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersi P. E. moo, (Seal) Address Telephone " Very truly y pdrs, .- Signed Owner 0 operty Address e ep one PUTN At, 1 COUNTY DE?_ -' - 7, NT OF "LTH -u1V'1SIU�N__0 1;\'VIRO\ C'KTAL�HEALTH'�~'zv.'.VICES - DESIGN DATA SHEET - SEPARATE. SE:':_1GE. DISPOSAL SYSTEM' FILE NO Ocaner .olbo . Address y Located at (S tr�et). . S� Sec . 9. Block3G 2-13. Lot .. z (Indicate nearest. cross street) Municipality, �UiV\_QKM Q SKLA Natershed SOIL PERCOLATION TEST DATA REQUIRE? TO BE SUB-TT-TED WITH APPLICATION. Hole hiumber CLOCK TIME PERC0UT10 \' PERC0U1TI0NT Run. El;aose Dept',- Co [ a.te'r Mater Level No. Tinte From Ground Sur r�.ce in Inches Soil Rate Start Stop Min. Start Stop Drop in hlin/in.droa Inches. Inches Inches. Z2. CO 2 1c�;t�t� ��.�� �0 V7 7_0 2 17 3 i� =(� 11; 34 3 8 13 2 19 1 2 3 VL t0'.�34- I O' �3 �� L? 20 3 04 _ t z 17 + 3 JZV 0., AG 4 .. i .Notes-'. ' 1) Tests to be repeated at same depth until approxi -ately 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 t» of hol P: ,.,.:.'`:%�"....::.c ra::.rs. "axra"".mz.... :'- v` ar:: c>`-%; e%. �:.,:. o- d^sr�;.;••.o.,,= iu�."- ..�.ii, _.�'::•�F- =ate a%.,.o:�.:+�i..e ,;:- i+`�.= .:e..::n.'i �asz c+ ve:: imw ..:•o,oaE.:- .,,.•�m:,�... -..., z; .i-': TEST PIT DATA REO_UIRLE D _0 EE S'U3L`jITTED `.':I TH APPLICATION DESCRIPTION OF SOILS E` ^UNTERED I': `:'=ST HOLES DE* PtH HOLE' NO 1�-�� z- HOL o 1\10. `^ 1 HOLE -NO'. G.L. 6' �U 18" 24TH 30" 3 6'� 421: 48'T 5 4" 60,r 66" 72.. 78 ". . 8.4" INDICATE LEVEL AT W41 ICH GROU \D WA TER IS. EN:COUN'TERE -n-- INDICATE IEL TO SvHICH jti'ATER LEA %tL RI-; AFTER ELI':G c:'COUNT�RED TESTS :i LADE :BY.,.::CS�1,'y� Date Y', Z 1 Z jj11 J_v\ Soil Rate Used �b -ZOO Min/1" Drop S.D. L's_'�� e L� Dr'o;.-i ded �- r o ,, Se ti c Tank Ca- ae i t � O�^. ����� No . of sec_ oo P 2 5 t !,Al. R. << _ F 'r Absorption Area Provided By ` Q0L.F.:Y2 -. 35 dMal r n. :Other l Named �1�' C� y Sim re 1. Address VA Q\.-Jt SEAL PUTNAM COUNTY DEPARTMENT' OF HEALTH Soil Rate Approved, Sq. Ft./Gal. Checked by �_ Date V V.!F ­Tj o V) �� i C _— ___._— _— ._ —___— Y� .. r 4•t �lc 7 �eo .5C2.:) '1rX .5ej,. -.�j5,5 7— jjSYST :. EM. X SEPARATE S EWERAGk of V., OWNER .:'141 wCAT'ION!" SEC. K.—LOT-�: MAY 9 1972 NO TRUCKS,MACHINERY.:BUILDING MATERIALS NOR EXCAVATED EARTH SHALL BE CONTRACTOR: .'ALLOWED IN THE SEWAGE DISPOSAL AREA., CONSTRUCTION. OF THE .SYSTEM IS illy sl TO BE IN ACCORDANCE WITH THESE PLANS ANY REVISIONS THERETO AND THE PL"AM CoUl RULES AND,REGULATIONS OF THE PERMIT ISSUING GOVERNMENTAL AGENCY. lmlo-N (O7F� PRQP�OSED POLPH ROTFIELD As.*t[ATES . a t EWROKMENTAL.KEALIH My.law IAS BUILT ]512 MAMARONECK AVENUE,WHIT _ PLAI.NS,NY