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HomeMy WebLinkAbout3266DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73. -1 -70 BOX 26 03266 MAO �'� L . 1�. me !` ± I f 4. , Ol- ` I Llit—La 03266 43 -A CERWF�JC r"ITE OF C Located.,at 7: `Consisting -C �-Other cequi 1%V ply.r �up "Building. iv e Has Erosion Control Bei System( I --Icptt q y tw A attached) ;.;.and -'jn - - accqr, Any person occupying pi conditions resulting T available° and the ap $ubject:fo modification:; D" -S Supply From:�,- Address Lott pc K Y. 44 M. A- 6. of,,Bedrooms W c as shown on; t of Whkfiwe, :1 plans cii, 9:; 3 `(copies na D e if artmento , eai .' P. ZtL li License 'No. Al� r such action as maybe necessary to secure the correction PfA ny unsanitary ary , ecqTP,991 I oid2!when a' u H c water supply becomes available Such approvals are jt, miss!? H" a It h;` such rev 6df i ?e. �ii` necessary ',,.- 7M, J -' - �` w -z" T W� ENT bf. fiALTH NAC !�j --t 'j 4, -1. -', INSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM R,4A'J 4' ......... ..... . -S Supply From:�,- Address Lott pc K Y. 44 M. A- 6. of,,Bedrooms W c as shown on; t of Whkfiwe, :1 plans cii, 9:; 3 `(copies na D e if artmento , eai .' P. ZtL li License 'No. Al� r such action as maybe necessary to secure the correction PfA ny unsanitary ary , ecqTP,991 I oid2!when a' u H c water supply becomes available Such approvals are jt, miss!? H" a It h;` such rev 6df i ?e. �ii` necessary ',,.- 7M, PEEKSKILL MEDICAL LABORATORY 1879 Crompond Rd. Barclay, Plaza Bldg A Apt, 1'; ,. York l 0565 PE �7�$?77 - - y_ DATE COLLECTED RESULTS OF EXAMINATION OF WATER OWNER DATE RECEIVED CITY, VILLAGE, TOWN &/OR NAME OF SUPPLY DATE REPORTED SAMPLING POINT BACTERIA PER ML. (Agar plate count at 35 C). b COLIFORM GROUP (Most probable N6. /100ml.) L• J-,a HARDNESS, TOTAL -ppm DETERGENTS - ppm NITRATES (as N) - ppm IRON, TOTAL -.ppm. FLOURIDE (F) - mg. /1. These results indicate that the water was �[! � of a satisfactory sanitary quality when the sample was collected. A. H. PADOVANI, M. T. (ASCP) MLL .COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEAMI 1/Tl Division of Enviranm•mtal 11c.Plth ,.:'rv:cus COUNTY OFFICE UUILDING . CAFIMEL, NEW YORK Tttt rc�O L is-,to be ccmplete(f.,hv well „driller and cPP! Y +. r! �(! r %! jo7H D •i • / t ` . _ .. !!r. �0.7n , .1 f, a iZ. rT” ^!1, 5-^ ^ ^:. R.' :1:it�: analysis of water sample indicating water is of satisfaet cry bacterial quality before certificate of construction Compliance Is Issued. REPORT MUST 13E SULDIM1TTED C ITHIN 30 DAYS OF t:ELL COMPLETION OWNER NA ADDRESS . LOCATION OF WELL (No. tol) (Town) for l:�r,:Gor ( 1 s �2-. PROPOSED USE OF WELL -- D DUSINESS O /ESTC ESTAIISH M- ENT FARJA TEST WEII D _ Alt SUPPLY OTHER INDUSTRIAL CONDITIONING � (Specify) DRILLING EQUIPMENT a (� COMPRESSED a CABLE - OTHER ROTARY L� AIR PERCUSSION PERCUSSION (Specify) CASING LENGTH (feet) DIAMETER(tnches) WEIGHT PER FOOT F.7 jL� THREADED El WELDED j11111E SHOE DYES ❑ NO �'�AS ASING G- OuTrb1 YES El NO YIELD TEST FAILED 11 El PUMPED 'COMPRESSED AIR HOURS G.P.M. YIELD (G.P.M.) CPO WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Spectlyfee DURING YIELD TEST.(lcer) Dep }(,.of Complelad Well � Fn feet below Land surface: SCREEN - IENGTH OPEN TO / QUIFER (feet) DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (inches): GRAVEL SIZE (inches) FROM (foot) 10 (tact) I I 'TN FROM LAND SURFACE 1 FORMATION DESCRIPTION I :koteh exact Iocat on Of we// wl'h distances, to at least two permanent landms /k3. FELT i.+ ;Lc, If yield was tested at different depths during drillin *j, list below FEET GALLONS PER MINUTE W�t JCOM E►ED / UA1'E OF itENPRT WELL UftILLErt (Signature) I .l J Owner.'or Purchaser of building �.�C.6 4/ Building. Constructed by Location - Street Building Type Municipality Block Lot GUARANTY OF SEPARATE SEMAGE 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 to the owner, his successors, heirs or assigns, to place.'in good operating c, Jtibi any part of said system constructed by me which fails to operate for a pA14,• ii—two years immediately following the date of initial use of the sewage disposh.' "-9` stem, or any repairs made by me to such system, except where the failure to operate properly i.c: nniiSprl by thn roil _1 fiil_ nr rn_acrl_irrnnl- ant of i+- nnr inpni- n_F +-}hra hi.ii.l_rli_nrr ii- Fil.i -jnrr -The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environmental Health Services of the Putnam County Department of Health as to whether.or not the failure of the system to operate was cau5od uy -'the w i fu - or* negligent act or the occupant of the buil ing util g the system_ Dated this day of ��� 19 �igna Title :."r,Fg_ b L11-Xorporation, give name ana aaaress. ----------------------=------------------------------------------------------ - - - - -- 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 rye" f am ee this gwar�at'e - `` uY (fisted BY mfft k was caaere 1 sywi,, was GBASGmw i s. 29 the r" doi ld rep " -w d tr L. f fi I c i j -- z T f APPROVED i �n 4Y , e CCT2 197 N7N U HEALT - we t. 1 D 0 ,DIVISION O I Pr EN f { . t�VTAI -NEUT SERYIfA �'.7 - 0 5:•_ }`�`tl .fA. '�„ b fK i �..�•t xx6` .. _ T�raYSn hEreaT r r'1.,•awn as J ,. _ .. _.,:...__ _, «� _. ,_ _ _ _ ..: ,.�.s"��f' :.I... 2p .. :. B1 oc.�E 3, ��c �/'xp:72 an Try Lis."•racm �,e.-� 11 i.%,'. A. _.G fP�eonT p �1� o a� F ro { �. e(-� 5(0'.•3 ,- t �J"�: Gf' /�.l . .rem. All Y �. PUTN��I n s t' ;DIvlSIO(J of EnvIto� men Y.'. CONSTRUCTION PERMIT FOR SEWAGE -DISPOSAL .' # Subdroision „ 3 s Owner At r ESlL7�.i% Building Type Are Number of Bedrooms ` s t .e a CitJ 4 o Separate Sewerage System Ito consists of i I n _y � •yam 1 Water Supply _`Public Supply From 1 - I _ ';Private Supply ;to be drNiled IS yZ � _ Address :VY �c _. L Other Requirements a EU C .Arepreserit that 1 am who lyantl eo nl i aboVe,desoribed' will beFconstructed' :County�`Department of�,Heatth, _ n'�fe _ }be _tubmitted_to the Departmeht� r ;place in',good gperatmg :jconditio a par d ( ance of the ap,prgvai of�the CeR. i of om lip } wUl be located is shown on the ap lan Ij said'wxell tll �� ;County Department of Health -� , , '40PR6VE6 FOR CONSTRUCTION This approval expir` s e-= 'amended o► mod�fred when d sides Eevocab'le for .cause or may b . i regwres :aj ne p(er�mit — A- 7p�pr?oved for disposal of dom w sa ` 't PARTMENT �OF� ,,HEALTH �. 'th Services, tame% N Y 10512 r6� F�ae� Town oTa a '� ... ,rc AddressDzX Total Habitable Spaces ���aC Square Feet ptic Tank lineal feet.X N width trench {y S3 ,,, 1• s W. .So s '7. r cation of••Fthe proposed system(s). lj that separate sewage di stem ire to and in accordance with the standards yule regu a, ions o '' u nam rte of Construction Compiiance % tisfactory.to th, mmissioger"` Heaith,will. ed the owner his successors heirs'or assigns by .the bull a said bwlderwtll in dur ..'g^ the period of two (2) years immetliately following the date of the issu Fie o nal system' of any'repai {thereto'2) that-.the drilled'twell described. above ed accordance h'tfie Bards, rules and • }egu a ions oi- the Putnam , - "Tfl ysc F •,, 1 a* t i E A'r ,,'License No -5Z�2A he date issued unl ss construction of the' bwlding hasibeenundertaken and is rj 'stoner ;of Health tAny, change or alteration of.coristruction,' 1r p ateT ater supply:,10 Title PUTNAM COUNTY DEPARTMENT OF HEALTH -- - -- - - - - - ..:...._..,,,, iit' ElvvikUltiftivT%'itr.AipEiiCLS Gentlemen: Date Re: Property of Jv yc 'e Located at %4GGal.J A104 a yOr JV Or- lv; ,a� L lox HAP ox n 72 Block Lot V ��r 2 T' M�9 E�9 � :M ;� R This letter is to authorize .�,� " .��u�`�� =�' � ��'��' ' a duly licensed professional engineer or registered architect (Indicate) to apply for a Construction Permit for a separate sewage system; to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and. to sign all necessary papers on my behalf in Lwilit_t.: L.Lui, wl Lr1 gilds ma a Lev ailii to. Supervise the cunstruc ciur! of said system or systems in conformity with the provisions of Article 145 or _. ,..-- ...... >�.....'i "tr-7 ..._ T�.7.: °.r_;_ -'r ':R.: ' : ?.1.1 r^: +ry .r_-7, i;uuuutyJ.. Tiaw �..a Lu&I i'i "-L = r- ;a �:n,a c• .I�,icirri E �u:'it=y"" �U: �" Lary Code. Very truly yours, Signed Owner of Property Address / P.E., Imo, # t f 2 l elep STA ��� BOX 267 Telephone 3 :J: r, i i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner 'JO YC 6 ,P- eA Address ox'. /6 /ycaTNaiy t�i}oT /j/ - Located at (St reet '4-w og0 2_ Block 3 Lot n ica e neares cross s Fee Municipality �,; �4tj 54 .G . Watershed aGd le- SOIL PERCOLATION TEST DATA REQUIRED TO'BE SUBMITTED WITH APPLICATIONS Hole Number. CLOCK TIME PERCOLATION PERCOLATION Elapse Depth.to Water . a er ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches. 2 z I/; 3 111�4 174 4/2/. 2 13 go --=, 5 1 7 r Tsrs - /d4- ke-A.� /V A 6 kI,— 1744.&T' .. 5 .. Notes: 1) Tegts to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All 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 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. /f/ G.L. 6 1211 1811 2411 3011 3611 4211 4811 5411 6011 6611 7211 HOLE NO. lei HOLE NO. C,4 Z= 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE'LEVEL TO WHICH WAT R LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY ----Date -Y -,5 7.r m Soil Rate Used J,9_Min/l. "Drop: DESIGN S.D. Usable Area Provided —5/ No. of Bedrooms Septic Tank Capacity,/00,a> Gals Type/reczv/ 2 1 - ;�;� Absorption Area Provided ByZg L.F.x 4' 3b width trench. STANLEY I WDER THIS SPACE FOR USE BY HEALTH Soil Rate Approved Sq. t We Tog and' water, analysis must .be submittet Health Dept befor- Certificate of'Construction` -•:�. mp a wi.1 ano. issued: _ �....., _ t o e 1T; ..After ?completion Of septio s+etem, top.drieas -� oCPAi15lbA/. T�2 an eed e area with 4" topsoil d s � un�<ll good stant� grass 44 apparent ot Of C .ul� ioE P/14f�eQr�a ( .'.�*lw�i b :iR xy ' r7p `T � CJ � �iZa� , cal; i \\ �N � � " ^r+ .•.o;:,�,.. t . -. ,..,F , : ,:.. r - >` fik GI •, .i 3t- {.v 's' ^.+an• aZ.�.:: - ..•: _ } 3.1:...x. -.u- -+...: -:, s.Y SSw>ti;.L:e.3• ✓ ��.t r 'Y$„ - - �: -: ...' ... .., .,Y.. ^'i' v; �... .. � ..... �. �'. ;�••, z.. -.'., I : "ws`i! 'ni._ C^.� _,�... r.. �,'..:1. t —,. 774. rip! _�, f.:; -,:T .., ». � +� ��- ..:;.1.»..,...,. :i' .�•� { i�' �; t x RA'iw:1p.:GG F. �- �VJA!eL'.._'. 2 -.Mli t?PS, �Ft. G_,. f*•�•�p� � R� .: v yFa s34 os =¢oW 2Jo c� t .Sk',� L G � �� �i4���. [. ''tom'..:: �,�.4 U Z��` 9 ",.4�rfrYCt V +nom A. 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