Loading...
HomeMy WebLinkAbout3207DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 72.19 -1 -22 BOX 26 03207 IN oil pt we } L `� m , 16 k. r on AJIL 03207 " f L-ocated,;at �'p6�osL?f condlti avalabl subject` Date a of Bedrooms- i ?'Date.Permd A ssued essenti ly as shown on the plan of the; complefed work j4oPies of which are Iled a the permit is ed th Putnam County Department ofSHealth ler "-0T 1"If'Ja1Lny Su GII`-I,CYV(Aa W11,� 111vYn14r0 n�,vr .7v Title AOPKT''. OWN ABORATORY INC. A RA P ra Q. 96k 3-21 - ;4 I sl WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY, OFFICE BUILDING - CARMEL, NEW YORK This report is to be completed by well driller and submitted to County Health Department together with laboratory report of alusis.of. water. ti 4 #T-�h t'a.r. p4iir. -is'J" ueo;,;-s..-. .aT..p dica -9 -�gjir n r. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION, OWNER NAME ADDRESS LOCATION (No. & Street) Town (Lot Number) OF WELL BUSINESS FMIDOMESTIC ❑ ESTABLISHMENT ❑TESTNOELL PROPOSED FARM USE OF WELL PUBLIC AIR ER SUPPLY (sTH INDUSTRIAL ❑ ❑ CONDITIONING (specify) DRILLING COMPRESSED CABLE OTHER DROTARY AIR ❑ ❑ EQUIPMENT PERCUSSION PERCUSSION (Specify) vez; CASIN G LENGTH (feet) 21 DIAMETER (inches) 61 WEIGHT PER FOOT ❑ DRIVE SHOE - OYES r_] NO WAS CASING QRQUTED? 1:1 DETAILS THREADED WELDED YES NO YIELD TEST HOURS G.P.M. []*at PUMPED ❑ COMPRESSED 6 YI ELD (G.P.M.) AIR 1 WATER MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST (feet) ;Depth of Completed Well LEVEL 15 j4e4 in feet below Land surface: P5 MAKE LENGTH OPEN TO AQUIFER (feet) SCREEN DETAILS SLOT SIZE DIAMETER (inches) IF GRAVEL Diameter of well including GRAVEL SIZE (Inches)l FROM (feet) TO (feet) PACKED- gravel pack (inches): DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two ps . manent landmarks. FEET to FEET 0 /0 /0 85 &Xy '00d fi&4 deea /40 05 5 V �, e" A dta Ay. 64d ck ��w wu 1% CA 165 225 V, haVfftach is White, L C�h &A 225 305 #&td N-ach & Mite, mix&4e ok U)Rie, 8 &wn If White N r r t, (,k If yield was tested at different depths during. drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED 12-11, DATE OF REPORT 112-1 IWELL DRILLER (Signature) L-71 ..jLM T .IL TI &L, AV; iMf" f", i Owner or Pura ase o Building MunicS alit ��- Building Constructed by 1 Location - Street Block Building Type Lot GUARANTY OF SEPARATE SEWAGE-SYSTEM I represent that I am wholly and completely responsible for the location, worlcnanship, 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 grade 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 Environrrienral Health Ser- vices of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent ac-t, of- the--. occubar - or t "e b ui l d- i - r a Ji, ng° - Dated this day of ��,�,� � 19 ~ Signature. -rf 'Title If corporation, give name nd address) - �- THREE (3') COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COY1P.7,ETI0N 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 � -s C � fit � �;Z rt'V�:-ir' .=#Y.l ���.C�{�i_ •r'Y ?•. �._v •� G %.t G.o G s► PROVEG : pi JUN 28•..1973 ` •f �yFtal 5`!e,'EP r t3cE(e- PUTNAM COUNIY I. HEALTI =. - - ..I�YJG'!v ".I Voicb•5 rr'' y.{, &i:L AP:$ l.%5 5330'i+:eh. � 0lItEdg , DIY 10�• Wl�4t NO• da:�t�ts•t�,Y poi'' Ik - ' OVIRONMENTAL HEALTH SEWRM IAIS'T9k.r. frti'r '�:A•(� if y��,?' (jY : � ". - . • i f� ' a r 77 �l�i.: �!f f I i i I i i I i I I , I it -s Y 2 i 44' � G %.t G.o G : pi •f �yFtal 5`!e,'EP r t3cE(e- - ..i..oCR T t�rv1 - - ..I�YJG'!v ".I Voicb•5 rr'' y.{, &i:L AP:$ l.%5 5330'i+:eh. � f� ' a r 77 �l�i.: �!f f I i i I i i I i I I , I it -s : pi •f �yFtal 5`!e,'EP r t3cE(e- - ..i..oCR T t�rv1 - - ..I�YJG'!v ".I Voicb•5 rr'' y.{, &i:L AP:$ l.%5 5330'i+:eh. � .._._ �' -`--.. . _ . r'lt?.' ���. tT,esr,TE _:� _k :.tact -i� . ;�30USE •,... • i 1{•4—V*47sj 7 S . G rT,, 0" 'Atl '• �� I?LGG� � IAX I -R. G-x� 1% 4rJ �:' FN•j P7°•:�4Q IL} ?44yp2px� t � I ' �I gyred Gt,9 f f� ' a r 77 �l�i.: �!f f I i i I i i I i I I , I it ( rr Y�f rrr`h.�.9 � o = ���2l�it��G. 5 f�.�iE► /T' � � � �, - :� } PUTNAM COUNTY DEPARTMENT OF HEALTH , F ?� Dwisron of Enwconmenta/ Health Services Carmel N Y 10512 N ;PERMITS FOR SEfNAGE, .DISPOSAL SYSTEM.. /U�✓.:�Cy/✓t CONSTRUCTIO r Town or Village Z� Nlrf dsvi�l �Aa • ae�a�u ° A ! " a wcK Lo�2 /"�/+ ®rJTlai#CRr i AL 'ViLtrr`4G. Lot Job A t F � Subdnrisian A a r 6w,- ni MIRAf.iJ�f1 At I�i1 PBtJ �1AC a�'i'/4'f� Buildype L'ot A in g T rea f r c e,. j `Square ,Feet . Number of Bedrooms Total Habitable Space Ci 3 b ! Separafei4'<Seweage Systei^i to cbns�st of - Q Gal Septic -Tank alm�eal feet X (O`, / width •trench !•. To be constructed UVater Supply Public Supply From S s I a x rivate ;SuPP1Y to be drilled by � � y �- y i Address�>~ l�rg� i L t. , /,v i Other Requirements ow 4 I:represept I•;am wholly and completely re, I , r��th� cation of the proposed syrtem(s) ° 1) that at the separe xL'sewage,disposal syst A: em` .above described will be constructed as shown o �kefiied amen a to and, m aeco�danee, with nj standards !Vles an regu ations o ;t e. , .0 n am Countyr'bepartrrent of Health,- and that,o f �gn"ti 9 P" of.Conrtruct on Compliance sat�sfectory to the Commisswner,of Heaithw�ll,, ' ° w tefi guar stee 10 it t- r the owner, his successors hevs'or al ssigri by the::bU1 r .that ;said builder will,' be submitted toFthe Department .land a . w ,, y J place,vm good.,oferatir con. tlijon .an pa _o #'sa`id ` " I s during the,,period of two 2_:years �Frirned�ately'.followigg the.dafe of the`issu. 5; p Yi+a ALf ( ) ante` of''the ,approval of the Certificate':; of Q truct QR An't r$ o tl or nal system or any;;repairsahereto 2j that the drilled well descr�bed,atiove „• will be' located as shown on the approved pia rift hat w8113U�I�;ie ins a "�tle accordance- won tFie ndards rules and :regulations of the Putnam ; County Department of Health r `Y 91i ^I'" Date { Address' `��•� /a License No 000ROVED FOR,CONSTRUCTION This approval exp ar from the tla a issued unless conrtrucUOn of the building has been undeitaken' and 4is `,! I :able for cause or may be amentletl or modif�e i;whenUconsidared- cessary by the Co "issionec "of Health Any; change'.or alteration of constructi0 gyres: a ne p rmit 'Approved for disposal of: domesti_c to sew a and " pn t ,water :supply' only ' BY Tole •F r d PUTNAM COUNTY DEPARTMENT 'OF HEALTH y' " D ► isfon of Environmental Health Services, -4 &6n l N. Y fb512 IS CONSTRUCTION PERMIT FOR SEWAGErDI$P,QSAL SYSTEM;} ~ter, _may,; y9�d �'y own or `Yxllage� at .lo y � r Subdivision Lot _ ,., r �/�.� °/V Addresses Owner �• "" 4� Buil�din9''TYPe} Number ;of Bedrooms - v Tota'1 Habitable Space ,!.1 Square .Feet I Separate_Sewerage System sto consist of -- gGal Septio Tankr lineal feet X� 9.� "� width tr "_encfib I{F.y To be constructed by Atldress _4 }t Wateh SapP1Y? P blic SuPPIY Fxom E Private Supply to be drilled by Oth r Requirements �A �� 4-0I'am wholly and completely. oh r, tlaocation of.the proposed ystem(s), 1) that theseparate,_sewage tlisposal system described will be constructed`asYsho rove: there to ajlq' m accordance w th thestandartls r les an ;regUla ions o the u na County `Departme`nt �ofs;Health, !and�tha of,. irate of Construction Compliance satisfactory to th'e Commissioner of Healtt'w1ll . ... -, _ e� submitted to; %the'.Department and i ra I be tied the owner hisysuccessors heirs or assigns by the budder •that said, +builderawill x�rpiace in'_`goDd operattng,�cd' ddion any of 3 t7 0` em during°'t a period of two (2) years cliately followingWthedate of the issu } ace of':the approval of the Certif�caf of ont_ Wv tb al. o the origin 1 system or any'- reparrs thereto; 2); that t_he dr�ll'ed' well described above" "w 11 be located -as`showii on the approved I nd t l ti�di - ) II b led i- a rdance.. with ttie stand ds rules antlF regulations xofi,.,the 'Putnam :. County fQepartmentof HHealth Date u t (./gam �y ig AlidressLxcense No APPROVED FOR CONST s;approva_ year from,the date issued unlessiconstructionrof4 the ^building nas been undertaken `revocable for cause or,may be amended or,modified:.when.co�nsidered, necessary by the Commissioner of Health Any;acha ge or alte[atwn of ,constructjon;. . requires a new per rtFlpproved- for disposal'of domestic nit y s age d /or' pppate "'{water supplyonly ti BY Titie j PUTNA1 COU\TY DE'A?T:T OF ri =zLTf[ _.::.» -'ems .. -•:� <_:,::�- '.�� =.:� 4 : �:.>ax.�: ��'�. -�� _ �: .: � =�.��' -T_: �i�� ;�..P�;.."..-. :�'L`:zr�iU� d :. ����-..- [�1�:_;,.�4'.�•:o.a:,...T,.'.. ". .;:.'�. 4._ -,r" DESIGN DATA SHEET - SEPARATE SEI% AGE. DIS_ OSAL .SYSTE FILE PTO'. avner E.�.hf� L�X4Md� Address / Idyz le Located. at (Street.l a6,,r Z410z 0.40 see. 77 Block �.,. Lot ..� ....; (I dicate nearest cross street) hluriic palityr,►l'%�i (•'.�i�/ �latershed SOIL 'PERCOLATIO` TEST DATA REQUIRED TO .BE SUP1I7'TED WTITH APPLICATION Hole ' h`umber CLOCK TI`IE PE RC0LATI0N PERCOLATION ''Run' t,laose Dept:: to Later S, ater Let %el No. 'since Fro::: Ground Surface in Inches Soil Rate . Start Stop Alin. Start. Stop Drop in Min/in.drop Inches Inches Inches %/ l 2 jam: 2� r 4o 141 i7. V© 7 1?1 4i- 4 r 2 X12 _4 - 5 • 1 .. S Notes: 1) Tests to be repeated at same depth until approx2.- ?te1,, equal soil rates are ob- tained a.t. each percolatio:: test hole . All data to be submitted for review. 2) Depth measv.rements to be made from top of hole. ' s ..�.:-_. �....: .. ..:.C� _.:., ---r - •- - _ -' • ,ate t _, �.. -., 1LJ1°i" Y�1 ,LiH1H f'.LUUlLtGU _iJ .._. J'tu�l� ?ll`t'.0 ': 1'••i�i "�"r''rLl�A1'1:t7:� ".'• HEALTH DESCRIPTION OF_ FOILS E`:�OUNTERED I,: :EST: HOLES . Sq . DEPTK HOLE N0. - . .HOL \,0 HOLE. 6. 8 4" .. • 12TT � . .INiDICATE LEVEL'' T S;N. ICH GROUND WA TER IS EZCOU�'TERr.D /v° e2 INDICATE LEL TO WHICH ;dATEF. LEA -LL RISES� AFTER 5EI'`G E`COUVTLRE D j TESTS... La DE .Y , .... Sy L �. ',.�Ln�O.!c_.. Date 24`s y y y -- L 301* k _Septic Absorption Area Prcvided By 56 L:F.x '' 't tn dr 6 0 =` OF HEALTH 66" Sq . Ft./Gal. Checked h-.• 8 4" .. • � . .INiDICATE LEVEL'' T S;N. ICH GROUND WA TER IS EZCOU�'TERr.D /v° e2 INDICATE LEL TO WHICH ;dATEF. LEA -LL RISES� AFTER 5EI'`G E`COUVTLRE D j TESTS... La DE .Y , .... Sy L �. ',.�Ln�O.!c_.. Date Soil Rate USed- Min /li Drop:. S.p. U,s=b1e Area ?r 0%,i eo �5 -�-= No. of Bedroo -.s_ -- L Tan'. Cap= ity zo« Gals. Type _Septic Absorption Area Prcvided By 56 L:F.x '' 't tn trench. Ot'-e Name. .. ��W����ll I �r� MER .Address uy Y7 E ll 1. PUTNAM COUNTY DEPARTMENT. OF HEALTH Soil Pate Approved Sq . Ft./Gal. Checked h-.• Date r,- . , , �z � I L' I i ri ,.. . ,.. ., _ . .`.� ,.fix.,, s r 1. t3 z f ,z t• .,"3' >5 - y �h �, E „`+., i- F'.r i n 3„ci '2' s 4 's' b y r .y 1.� c u f `,Y Y F ] - vi T 1 T il z YT, <, C` " —T Ti'�i ALT-+ - mrr * t" � p C F �l - T T� T LTI� SRV 1C.ES #� DIVI�IOT pF �iVI °� ,�µ� qL ,hE r r -f s: - '. ,c y 1. 7 e �; , a ICJ �/ / "-r ,�"� s r , � -c a l , o f �—� ► 4� rb-P Re pw,�J f� i. a µ �g T<v YA'e t1 Located at �t Y = r�- (�,i" y } a s _ Blocs ` , L o tt s f _, 11 ry } i r a z' 1r °fir v V" ", 0 -- (� UrOfe�S Ona e r a -- .,` x 4 1` v C, +-CD t - LO c S° �a '8te SQ:W.el S't .' - 11ll§trza.ct� or Pie wl � for a !, '- n w Ir ��, ti w - iT'l�a 1C c' �di t` � e S and � �5' TU e _ �r - T no �a�i n ac I o -._ ,fir 1 '.. - .� ,� rr' °Q vV tP° COii, -7i 5S� OI I -, Ol_ t.' t',titna�� C Out t 9S O t u� ^ ti - F4 T .. �,1. or r�Tr oena� " 'r -f �� ld tO �1� Z a '�eCr¢SG % V t I � , ' Of'S�sr a ' pi 1. 1 p, 1, c ,j °aL to L w, ,ai a the 1 L a r,� 4 c ' n t :Very _ truly yo;u s ; V f" 5,.'o d ,. eT 0- // I:- w� /L r� i--'- - ` Add: e s s` r lz ,.,� , p Y t . S z. L a5 11 ��h A v - d i f 267 *l �,. - {± s� } ��% r ZO I No 3�� 0 @' +--� . f y .. , . e ry v Ja ? . d �' ° d - -L- , - -t .. , I E . - -- , . 1. � . r J�� 1,4 V t �-� 11 - y .l W'i �, I . .,L-,r sSi 8 ^���,r. mil' t 5 y• e F w u a t e r 3 - S i { ;? , ,, , .� _� w " ...a . - _ . .. .k '� - _ - ivy'?.., a•-.�„�"�= .:�: =..i .c��..- :.�s�; - ..r ..-...... a..... rvow•. m. r�... ...,w.�s.�°"`•:v=�v'�= +1�+:"::. -. �. »��:;- +`++a► �= v::'•'=. :- ?ter•- :.a�av Putnam County Health Dept, Division of Envirohmental'Health Services County Office Building Carmel, New York, 10512 Rea Permit issued to Madeline Miranda. Sprout Brook Road, Town of Putnam Valley, Plan dated September 17, 19.71 Gentlemen: attached herewith is a new permit and dated Novo 16, 1971, plan revising the above referenced permit. It will be noted that the well has been relocated near the front of the property. The need for the new location has been brought about by hardship in creating a` temporary bridge over the stream in order to drill the well in its original location. Further, I understand that.the minimum distance between the well: a'nd existing up1jill septic system when in direct drainage line is 200' and betweea,the.newly proposed well and my downhill septic system is 1001. In the present situation.the location.of the well is about 110'.feet from the exist hg uphill septic system and 80' ._from. m se6ti.c- system.. Should any- y., of y - - lutcn ..o she "�weil occur-, i assume' full "respon`siybilty for this, completely absolving the Engineer, Contractor.and Health Department from any liability resulting from said location. In addition to this, I promi,se to periodically check the potability of the water and should pollution be evident, :move the well to the location originally planned. Very tru yours, J MM.-he 7Zeline randa ENC, CL/ Athl, 19 71 vr). r�:3•.3x::�:;i70 CJu,al:�is�a en front Ctun4'y COM-60- ba.uira� iJlarel+ 3D. 4�