HomeMy WebLinkAbout3142DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
63. -4 -34
BOX 25
7
.
No
. -
III
111
11
1jT6
�J
.�
61 ■
3
;
o
r
�r
''f
=
`,
1
,
1
Vim, ,
.
-1 ■
`,
mill
JL
03142
cated''at WD top
'R^' Y h 4 500 4 F N . C 4 4 ••.�
CYO DEPARTMENT= OF' HEALTH
�! Health "16 --a
Carm %.,.N Y h10512
I CEWAGE nISon SA! :SYSTEM i r 5i
k r r Town or, Village • '
` >..
,Owner /sI-Otd;4,C 17
Al
separate Sewerage System Duilt bydw'��'a '
T
Consisting, of DQ Gal, septic Tank
Other requirements'
Water Supply Pu'6IIC "Supply'From =
Private supply ,'Drilled 'BY y
a,a •.Address ''¢��%��� �✓�
Building-TYpe
LT
Has Erosion Control Been Completedi
l' certify that the system(s), as listed serving the above premises w e i
,attached), and m.',:accordance with the standards, ,iules and'regulati
Date �!'� c AW 1 Cerf
�a Address �O�d .Sfi4✓.
avanaole ana the approval or the.privatewater supply shall,becom
sub)ect Ito modification or change when; •in the juiJgment' of the
= =, x
e (7--
Dat.''. , ,,, r
_ _ ey.
m
f f
K� 1
�i
Division . °of Env;
CEFtTI'FICATF -� flF CONSTRUCTION COMPLIAP
cated''at WD top
'R^' Y h 4 500 4 F N . C 4 4 ••.�
CYO DEPARTMENT= OF' HEALTH
�! Health "16 --a
Carm %.,.N Y h10512
I CEWAGE nISon SA! :SYSTEM i r 5i
k r r Town or, Village • '
` >..
,Owner /sI-Otd;4,C 17
Al
separate Sewerage System Duilt bydw'��'a '
T
Consisting, of DQ Gal, septic Tank
Other requirements'
Water Supply Pu'6IIC "Supply'From =
Private supply ,'Drilled 'BY y
a,a •.Address ''¢��%��� �✓�
Building-TYpe
LT
Has Erosion Control Been Completedi
l' certify that the system(s), as listed serving the above premises w e i
,attached), and m.',:accordance with the standards, ,iules and'regulati
Date �!'� c AW 1 Cerf
�a Address �O�d .Sfi4✓.
avanaole ana the approval or the.privatewater supply shall,becom
sub)ect Ito modification or change when; •in the juiJgment' of the
= =, x
e (7--
Dat.''. , ,,, r
_ _ ey.
m
.1 352.
YORKTOWN MEDICAL LABORATORY INC
�:: ®rkow 1�ei�hs, NarYo 1®598 ^ � �Kw .:._. Syv ... 245 -3203
DATE COLLECTED
RESULTS OF EXAMINATION OF WATER � 4
OWNER DATE RECEIVED '
MR. NUIRA
11 4
CITY, VILLAGE, TOWN VOR NAME OF SUPPLY DATE REPORTED -
WOOD ST.. PUTNAM VALLEY. N.Y. '
SAMPLING POINT
WATER TANS -- SECTION 6 -- LOT 10 -1
BACT8RIA PER ML. (Agar plate count at 35' C). COLIFORM. GROUP (Most probable No, /100ml.) HARDNESS, TOTAL - ppm
LESS THAN 2.2
DETERGENTS - ppm NITRATES (as N) - ppm IRON, TOTAL - ppm
FLOURIDE (F) - mg. /1.
These resulis'indicate that the water was YES of o satisfactory sanitary quality. when the 4ple w as 1 ecied.
PER: J. TORLISH
A. H. P.ADOVANI, M. T.' (ASCP)
- - -- -- - -- -----------
v.
S-2 49�
A, G'A'.
R A,
0-HAWK
'
NJ 86 °I1 30•E ow,
1� 4 W "'j
T I
I . I x .
'
'7
2. 5,31-ACRES
t
J.
q-
w
Ali", i.
j7
3:
CD
7 h
v
Z -
Ix
-0
gi
L. V, St.•] pq
0 0 Mutt.
Z
t 01
to(; at w 61w �P
A
t"L . . ... ... tA,
tT 77,
,PROPOSED
3 Debao
!AN
CH
R,
V
W
ZIP
-
37- to
02'
-3.65
32 <1a <1a ^a cone MO r.
tt
4
200 or gooa:a w nsY rom , .. a 1 � y-�,� �. -TR,
;B01VIS:tON M AP 'qbR SUB'6`lvjSi N OF j;R
BERNARD .A KLEMM'
flQWp TAX `DESIGN AT fON 11 , I .
m4p
izi8
SECTION t 36
BLOCK G I
Mt
777"w
iq
WELL COMPLETION REPORT
3/71 _
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental floalth Sorvic03 .
COUN•rY OFFICE BUILDING CARMEL, NEW YORl<
This report is to. be .omoieted by. well- ArilleT and sut_ iittred to County_ Health DepartmentAogpther• .!vith laboratory report .q • _••-
.,_. • : a.�a r ; . ; . -T7tea.: - - - f-a6i : - ...:. - : "Vii ..�..,Y.,.
alr�jlats �tiTv�aFe'� saip'te'iiiUic3tiny water Is uT satlStactory bactenaTqualit�belore certificate of con'strudtion compliance is Issued.
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWNER
��
NAME
In
hu �DRE/SS
u _ _
( 000 S% / C1 i9/✓"✓ 6�/ /`� //
LOCATION
OF WELL
(No. a Street) ,,�rJ� (Town) % (Lot Number)
L"/O� 5,.� • !`G/�/y,�/ff �/� / /L'� z
BUSINESS
❑ ❑ ❑
PROPOSED
DOMESTIC ESTABLISHMENT FARM TEST WELL
USE OF
WELL
OTHER
❑ SUPPLY ❑ INDUSTRIAL ❑
CONDITIONING
DRILLING
COMPRESSED CABLE OTHER
❑ ROTARY Chi AIR PERCUSSION ❑ ❑
EQUIPMENT
PERCUSSION (Specify)
CASING
LENGTH (feet)
DIAMETER(inchcs)
WEIGHT PER FOOT
F7
❑
DRIVE SHOE
❑ 'E
%Y CA�G
QRQUTE ?
FIND
DETAILS
0�70
I 6
I �-Ak
` I-A 1. THREADED WELDED
YES NO
RJ YES
YIELD
HOURS G.P.M.
❑ ❑ ®
YIELD (G.P.M.)
TEST
BAILED PUMPED COMPRESSED AIR
WATER
MEASURE FROM LAND SURFACE— STATIC(SPecllyfeetf
DURING YIELD TEST fleet)
j
Dcplh of Completed Well
LEVEL
!�`°
in feet below Land surface:p Q
MAKE
LENGTH OPEN TO AQUIFER (tool)
SCREEN
DETAILS
SLOT SIZE
DIAMETER (Inches)
IF GRAVEL
Diameter of well including
GRAVEL SIZE ( Inches) FROM(/..,) TO (feet)
.
PACKED:
gravel pack (Inches):
I
DEPTH FLOM LAND SUP.FACE
FORMATION DESCRIPTION
Sketch exact location of wo!l with distances, to at least
two permanent landmarks.
P
FEET to iLci
If
yield was tested at different depths during drilling, list below
Y
FEET
GALLONS PER MINUTE
a s
DATE WEL��LiiC MPIGTED /
(J�`
0 .4 E 1)F R -� - PP+ORT
WELL. DRILLER (Signature)
' ��du✓ ®�'Li � n% /vim Q, %" Q� t .
oww
Uwncr' or.l'urcr.= .l.sc:r. �'I' bUIIuang Munic:lpaliLy
Au7:
Y ::. r � -w.�,a -ce.' � '�'�' ••-a. .v- •C-•� ...,�.rs..c a :r...,...- r.......,r.s....w .,.�a j� ✓ m - -
-- .-,.+_ : � % / e r•_ ...- �;�:t'�'% 1 rte_ >`
Building Cb �.: !.. uct,EC�b Suction -
i OOA •� 7Ros T Z
- cation 5:.� et Block
R; A/
�.
Bail di"n.g Type '— Lot
GUARANTY OF SEPARATE S3'WAGE SYSTEM
I represent that I am wholly, and coriple.tely responsible ,fox 'thG
location,. worlmanship, material, construction and .drair_age of. the.;.sew�ge _
disposal. system . serving tlie above described property, and that, it has: been:'
constructed a s s' oi.�n on the app ,off eci _ lap ors maro�red an�enc' ierit thereto,
: :,and -'n'accorda. :ce ,.:ith the standards' r.zles and re.-ulation.s of tYie.%Putnam;
Coun,t y Depar. ;; � of veal -th, and. hereby, 5zuaranty to the o n. er, his succe5
:-ors i rs or assigns, :to place in 'good Voper. tin. condition any .part of
said system constructed by me ti•rhich falls to operate. for a period of two
years ir�media te?_y fol].w4i the date o:'.' ini t i a:' use of tl.e sewage •;; isocsal
sys gem, or. any r. 4pa�.r a :rar'.e by to such s�rstem, eroept i,�here tlie'''. fa lure
to operate ��z,oac:r y caused by tl.e ;1i].l.fu1 or negligent act of the o.�c'u -:;:-
pant . of the - 'building utilizing the sys ;am.
The undersimed further ai:1 P_�:: to accept as conclusive the de
terniinatio'' cf the Di_rec'tor of tir *: Division cis Environ.nienral Healt!�.:Ser-
( -:
vices..of, the Putnam County..Depart..r.ent of Health as to whether or:-nof, the
failure of the system to operate. :vas. caus ^d by .the willful or negligent
ar_ t of the. -occ.unant of th,� . b tzil _ ui ? i�_in` :t'h. _.s T t -
r
Dated this day of - i_9 24 Si{/•na•ture =
� ^ 3!
(If corporation) gi v�. Harm
and. address)
-- - - - - - -- - - - - - .. - - - - - - - - - - -
THRE -E It 3) COEDS APE 13E, U;_ii^,II WITH T_iRL -'(3) COPIES OF FINAL PLANS BEFL�Z�.::.:'. •';;
`CERTIFICATE OF C0�1'_JETIO11I V.ILL -BE ISSUED.
GUARIu'dTOH 1S ,nEQtiJRE?) 1'0 FILE, NOTIME OH DATE OF FIRST. USE Or SYSTEM.
- - - - - - -I- - - -- - - _ - - ---
Division` of Environmental Health Services, Putnam County Departinent „:df Hoaftii ,
PUTNAM COUNTYDEPARTMENT'OF 4 ,HEALTH
0lVlSlOn o "f Enviion enta/ eal Sewices, Carmel, ,N 1'.• :10512 '
. f: -
t0NSTRUCT.ION •PERMIT FOR SEWAGE`;DISPOSAL=SYSTEM
Villdge
i wn r
,
Located.'af �.E0E7
S tstic.ri a r�s�by�ii�f�. w r't, ur 910Ck,
�._
,..
Subdivision ��A�J� ..cc8 ._Fob. _ l�E�°iysiQV i4 .�LE/yJNI` got Job
.. ,w
` OWner L7"'G(IA•� �' ..�. /,f��•e/�! v?.a Address ~� ®' !¢.. ./KOQ "
Buildrng;:TYPe O;evG N
r �o .3 }`.
�z♦ Number :of Bedrooms .3 4" " TotaP Habitable Space. X200 T_ Square Feet
�,ty 1 .• -) ., _ , +° S ,,. _...3 °9♦�O �..�� -
Separate:Sewerage System to ••.consist of _ Gal aseptic Tank �7% 9rneal feet:X e7�C
width trench
To be constructed by s
Addres
' s /� x
�.Weter .Supply d r" PPIY s• jvt ti; 4ci,_` C�`/Qie��L
Public 'Su From /��•
a `Private Supply: to be byy, r i4it/OEiE30nI �'Os✓ ,el
GL
ry er �•e r z , _ vT7tii9/�7 >. ii4GG � -4
i Address Y
Y Other R= j; x aNiyM $
<: a
equirerrients
r (*represent that 1 am wholly and completely responsible for,the design and location of} the proposed systein(s), 1) that t r swage disposal'Isystem,
bove�described.wiil b`e=.constructe•d , as-shown on the approvetl amendment tki`ere to ani! in accordance` with the standard ns o e u nam
x:
*Y lCounty';Depariment of ;Health;-.and that -on corripletronithereof a,',Cerbfida4e of'Construction Compliance ?- ,Mtisf or r�u - er of Healthwill
be
submitted. Department,, and awritten- guarantee will 'be furnisl etl the owner his':successors .heirs or i A fi o a id builder will
'place in ;good operating condition any -part of said sewage disposal -, system during the period of''two (2) Yea .im_ d he to of the'=issu-
ance of'the approval, Hof the Certificate•;'of Construction- ;6ompliance,of the original system or'a6y, "repairs h eto t t)i lied � ribed, above
hwrll be' located asshown,.on the approved plan and that said 'well will tiealnstalled in accordance, with `the stand'; ules h of he 'Putnam
County Department "o' f - Health
' Date y�• `_� Signed
isr� Address ense No.'
:ARPROVED FOR CONSTRUCTION This approval expires one year from the date .issued j6hiess construct do dertaken and -is
:.
G revocable for :cause or, may be amended ,or-motlifled_ when considered- necessary by ttie Commissioner -of Health C?iP npq. p�a(R n. of Construct on
regwres, a new, permit . A proved for disposal of_ domestic sam ary sewage, a r privet 'water <supply` only s• / //� �
Date BY ? Title
D a te
Re: Prope_^L.,, of L. �1aeq
Located at dgD 07-,6657-,
S e c t i o Blk oc U o
Th-Lis lett-eil Is to
a du'
n 7
7"-Ii--:- S
0— S ZZ
fL
c or r
Ir conf r
S
T Ed uc at-lon 0 7.7 Pu--na-:
t-s-,ry Code.
C o wri -'U- e r s i S n 5 d :
P .. R. , ` /z, 0 to 0
Very t-puly yours,
01,J
n6n o I
Address
Teleoh-cn-e
070 W1,0-4
OF NEyy k
Address FS OIP
z(
D T T cz T r, T
T
0 F
TC—Z
D a te
Re: Prope_^L.,, of L. �1aeq
Located at dgD 07-,6657-,
S e c t i o Blk oc U o
Th-Lis lett-eil Is to
a du'
n 7
7"-Ii--:- S
0— S ZZ
fL
c or r
Ir conf r
S
T Ed uc at-lon 0 7.7 Pu--na-:
t-s-,ry Code.
C o wri -'U- e r s i S n 5 d :
P .. R. , ` /z, 0 to 0
Very t-puly yours,
01,J
n6n o I
Address
Teleoh-cn-e
070 W1,0-4
OF NEyy k
Address FS OIP
z(
T
FIELD MERCK LIST
L
In:
INITIAL SITE INSPECTION
Yes
No
Comments
Property lines ' or corners found
Can estimate house location
Will, driveway need cut
Must trees be removed-note these . . . ... . ..
Is deep hole representative of entire SDS area rea
.Additional deep holes needed. . . . . . . . . .
0`100,
Sufficient SDS area available considering
driveway cut,house location.,separation
distahces., etc. . . ... . . . . . . . . . ..
/00
DEEP HOLE DYM
Depth:
Water elevation:
Rock elevation:
Soils description:
Date:
FINAL SITE INSPECTION Ins p. by:
House located where shown on approved plan—.
SDS located where approved
Width of trench average
Slope of.tile line and trench acceptable
Room allowed for expansion trenches
Over 50 f�-' from swa_mp,, watercourse
'N e C+ strippedL JL �a .Ura - !
unnecessarily graded . . . . . . . .... . . .
.
10 Ft. maintained from prop.line and
210 ft. from house . . . . . . . . . . . . . ..
Separation of trench from ,house, well.
etc. follows plan . . . . . . . . . . . . . .
Number of bedrooms checks . . . . . . . .
Stones,, brush., stumps, rubble., etc. greater
than -15 ft. from nearest trench
15 Ft. of peripheral soil horizontally from
trench. . . . ... . . . . . . . . . . . . .
Junction boxes properly set
Could surface run off from driveway., road6.,
ground surface., etc. channel near SDS,
area
Does lot drainage appear O.Y. in area of SDS
FINAL GRADING OF SITE ACCEPTABLE
� b
PUTNAM COUNTY DEPARTMENT OF HEALTH
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 `
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner Address 169—:0 s7..
Located at ( Street Ala000 FPZLV7- Sec. 3.- Block z Lot
6dicate nearest cross street)
Municipality Watershed PEE�s,�iLL
so -/
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
-
Hole
Number CLOCK TIME
PERCOLATION
_... ® 3
PERCOLATION
Elapse
p
o a ter
Water EFveT
��
No. Time
From Ground Surface
in Inches
Soil Rate
Start -Stop Min.
Start
Stop
Drop in
Min. /in drop
Inches
Inches
Inches
/9
T•'S "PV "✓
- _ 0 3 !s' /9 ,. Zak /�„ /�� d 6-
5
- 1 9.-02 9.'/7 /3 /9" 20 /°g�¢" 6,6
�G i9iV,o.LS!SlS a
2 , - T 20 %
T��T
3, C 4110Y /S % � Bvs�o o.v
4
5
Notes: 1) Tests to be repeated at same depth until apppproximatelyy equal soil
mutes are obtained at each percolation test hole. All data to be submitted
fcx review. 1
P) T)Pnth measurements to be made from top of hole.
_... ® 3
9.'32
9:47 /5'
/9 "
Z4 Ly �.
/
��
/yJ�.i%/ N
�G i9iV,o.LS!SlS a
2 , - T 20 %
T��T
3, C 4110Y /S % � Bvs�o o.v
4
5
Notes: 1) Tests to be repeated at same depth until apppproximatelyy equal soil
mutes are obtained at each percolation test hole. All data to be submitted
fcx review. 1
P) T)Pnth measurements to be made from top of hole.
� M
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
y7�r�rR rpTTn� n� �n,TT c �nTnnrrnTT nT,. TTT mr�r T F:
:.DEPTH HOLE NO. / HOLE NO. Q HOLE NO. 7 "TEsT
G.L. 7Ve� S'caG %O� �oL ?'b� J'®i�-
6
12" �',eo w.✓ CS.s�ivoyi L a Am
1811
24 fl .,
30
361 .,
4211 �
4811 a
5411
6011
6 6 it
7211 „
7811
8411
jl/U dct- y.,-- Gr1ATE.�'
'.INDICAU, LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
_ INDICAr LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS NODE BY /Yfir/.eY ,e�ENTE.e ` �. Date ,Vcla.. !6 l97�
DESIGN
Soil ]Rae Used /_,,7 Min/l "Drop: S. D. Usable Area Provided
No. o-• 3edrooms Septic Tank Capacity 900 Gals. Type Cove.
Absorption Area Provided By /77 L.F.x2411 �bi1— ,/ width trench.
Other
Dame_ f�on�n� t�d� �, ,off. signature V7 6. v _
Addre s ti o S.¢ �✓ IV-71e-e- ..2/ &6e-e "lea, SEAL �E of nFw
o.e %C %Obt//V /�l"Jt, • f� �g�� �ROnr• y��-
c,
THIS SECE FOR USE BY HEALTH DEPARTMENT ONLY:
CA
Soil Rte Approved AZ Sq. Ft /Gal. Checked by 9 - e �
NAt Eni;IyEE�' j