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HomeMy WebLinkAbout3329DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.05 -2 -4 BOX 27 ' I �i,, , it . ; 03329 loom II IL 6 .` I 03329 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health. Services, Carthel, N. Y. 10512 CONSTRUCj.FA(N..PERM -T FOR SEWAGE DISPOSAL SYSTEM r: WT nam Town or !ill$gc LocateAls�bn Section; Block Subdiv Lot ' Job Owner Address 5 BuildinLo Area Numb Total Habitable Space Square Feet �f dl Separate Sewerage System to consist f; Gal. Septic 'rank Q lineal feet X��¢ width , trench . + To be constructed by �-r �1 Address Water Supply. Public Supply From X _ Private Supply to be drilled by Address Other Requirements I represent that I am wholly.and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above. described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regulations o e u nam County Department of Health; and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following the date of the issu- ance of the approval •of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above a will be. located as shown on the approved plan and that said well will be installed ccordance with the standards, rules and regu ons of the 'Putnam Cou artment of. Health. Date Signed P.E. Address f r` License No. APPROVED FOR CONSTRUCTION: ..This .a proval expires one year from the date issued unless construction of the building has been un rtaken and is revocable for cause or.may be amended or modified when considered necessary by the C5ate/A4ferAWp.W—e-fy. is er of Health. Any change or alteration of construction requires a new permit, 'jApproved or disposal of - domestic Sa se ge, and o pri Date " — y ! BY 0 Title d 2,0 K, PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CERTIFICATE OF Located at Owner RUCTION COMPL Separate Sewerage System built by Consisting of Gal. Other requirements Water Supply: Public Supply From Private Supply Drilled By VCE FOR SEWAGE DISPOSAL SYSTEM Town or Village Section Block Lot J b f � Address 41 lineal Feet X width trench n Adtlr Building Type No, of Bedrooms %_ Date Permit Issued Has Erosion Control Been Completed? 1 certify that the system(s) as listed serving a above premises were constructed es58ntia s shown on the plans of the completed work (copies of which are attached), and in accordance with the standards, rules and regulations, plans filed, he permit iss b the Pu County Department of Health. Date p° ) Gam' ! i Certified by � P.E. R.A. Address iyJ License N Any person occupying premises served by the ab ve systems) shall promptly take such action as may be nece ry 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 public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Com er of Health, such rev ti n, modification or change is necessary. R�— % o �c"� 1 ___ _ 11 _• i. r or urc as er of Building Municipality Section 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 made 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 En.v;.,ronme nral Health .Ser- v t:c5 Uf tie ruLrialu Guurit;y Lcparcmeiit ui riealbu as to wiiether or nqt L c failure of the system to operate was caused by the willful or i act of the occupant of the building utilizing the system Dated this day of 193 Signature Title corporation, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP.TTETION 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 WELL .COMPLETION REPORT " PUTNAM COUNTY DEPARTMENT OF HEALTH 3/7_t b Division of Environmental Health Services _ ... • .. . .. v:_.r -. .... .v..... - -.. _ .�. %'J:1r - Irv''1':.rL _L��L ►•},y �u ' ~V1.L"�i elr'rI 'I St: IS''�I Vnh This report• is,to be completed by well driller and submitted to County Health Department together with laboratory report of analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued.' REPORT4AUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION NAME ' ADDRESS OWNER. Richard Scudero 101d Rte.' 6, Scrub Oak 10588 LOCATION (No. A Street) (Town) (Lot Number) OF WELL Ridge-Avenue Putnam VaZley 134 -`138 BUSINESS ❑ ❑ ❑ PROPOSED DOMESTIC ESTABLISHMENT FARM TEST WELL USE OF WELL SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (THE DRILLING COMPRESSED ROTARY AIR PERCUSSION CABLE 0 PERCUSSION. ❑ OTHER EQUIPMENT IJ tlJ CASINO DETAILS LENGTH (feerl� DIAMETER (Inches) WEIGHT PER FOOT 33 f 8 ft 17# Cl THREADED (` - j L� WELDED YES _J NO t 17 UYEDI YES � NO YIELD -..-_- - .•--• --- °-- __ _.. . CJ BAILED ❑ PUMPED HOURS G.P.M. YIELD (OP.f,/./ TEST COMPRESSED AIR 7 . 25+ 25+ WATER MEASURE FROM LAND.SURFACE— STAYIC(Specify feet) DURING YIELD TEST fleet) j Depth of Completed Well LEVEL 27 f 18-51 in feet below Land surface: 202 f MAKE LENGTH OPEN TO AQUIFER (loot] SCREEN NONE DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL Diameter of well including GRAVEL SIZE (Inches) FROM (tool) TO (fool) PACKED:- - gravel pack (Inchon): - DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, two permanent landmarks, to at toast FEET to FEEI Pitt 1 1.,1.�_....Vryrt2e'a -1- lure ±�. - �� -�•.6_ �i __.._._._. _ __._..... jr granite with a Zot of quartz. 192 202 Medium hard light gray 7 - - -- granite. - - J I�'i I Ve k?4 A — - -- -- -- `k, � � � •� ` 8 �� t If yield was tasted at diffarent•depths during drilling, list below FEET `' GALLONS, PER MINUTE 1851 1/2 g, p. M. \LL T catwotV 202' 25+ g.p.m. DATE WELL COMPLETED DATE OF REPORT WELL DRILLER (Signature) 5121175 5 22 75 !RGWS, ER_ l�..AAORAT0�21FS P.� .....• .- � � .. .-�.� .A 'Y' �.. n ill..:• r . � ..n .tI'•.., v 'N': .. .y�: _. . � - .. s. - - ` • ... :, n � • . • - w � Box 224 - �BRMSTER, N. Y. WATER ANALYSIS REPORT SAMPLE NO. 3500 SOURCE: S'cudero - water tank - well supply Putnam Valley, New York COLLECTED: August 29, 1975 BY: H.B.Noore BACTERIOLOGICAL EXAMINATION , Coliform Count, MF Method 0 per 100 ml. This result indicates the source 'of the sample was Of satisfactory sanitary quality when At sample was collected. August 30, 1975 iC)Ewit P. E. Director t � . PUTNAM COUNTY DEPARTMENT OF HEALT11 ••a- L'i V.L`J161�•`i- '^ L;t. "v i \&N,?. PJ'i'S[i9ji' JCL:t'3'U".LIPF'S'- XyIi l.L::i— clm•.` "a.',i+ �'c•:".ai • Date' RP- PrnnPrty of Richard Scudero • Locat SectionC ",p Aeof&& Block i6G% .... Lots 134,2 P, Gentlemen: - This ,letter is to authorize George. A.,' HaugFineY a duly licensed professional engineer X-. 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 connection with this matter and to.supervise the construction of said - system 'or- systems - in -conformity with the provisions of Article--1LES -or= ..._- -- —w!• `r.! ,.._.t.•�.i�1.0 r„l.- l,_�j3•!•...�rr13_ ..l. 11e"- -_ l:h:: v..:,r, -.'�:C ¢..Ll),Ti:3w; .�-i Q<.w_ JvLCZ4 tary Code.., ' Very trul r G Signe Owner of Property Countersigned: r r Address P .E ., R.A ., Ooo / % n- Route 52 one Teleph Address 1 9 iae�\ Carmel York !GJ 1b12 (9i4) 225 =9353 Telephone . . .1 R, '111-- -, ,--- I ­­:_ �'- . 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" -:( �. . .. �. -i - ,k ­�f..,�.. , - � - 11 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN TA SHEET- SEPARAT SEWAGE DISPOSAL SYSTEM FILE NO. Owner , jL1 . Address 7,x1b Imb oCak Located at (Street OA, Sec. Block Lot i.ca nearer cross street) Municipality Watershed.`�, SOIL PE COLATION TEST DATAU RE UIRED TO BE SUBMITTED WITH APPLICATIONS LICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse p o Water Vater Level, No. Time From- Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 3 " 2 ' D© 1,,yz ! 4 :10 1, ob /-Z 00 i �. 5 S - o XZ0 A ,--v / �0 YA ? 1 3 " 5 1 2 3 4 5 Notes: 1) Teets 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. HOLE NO. HOLE NO. 611 12" 'l1 18' 2411 � 3011 361f 421' 4811 5411 60" 66" 7211 7811 8.11 �r 1 INDICATE LEVEL AT wT43H GROUND WATER q S ENCOUNTERED INDICATE LEVEL I CH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS _MADE_ -BY - _ .. -- - _.- _ .. ... Date Soil Rate Usec_ Min/1 "Drop: S.D. Usable Area Providedz5_00C_> r THIS SPACE FOR USE BY .HEALTH DEPART14ENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date J i__ t4 j & O_L ',A >1 0 -i A 14 vv 44 -7=4 -0.9 0 T- T� a r 11"r '6 ' zlt tow, _ U X� = " TT' %- -rA EL it r. II II t i i i I i ;' -T a• -i" �: -11 ". 6•.�,• q•. g• 6'•8" q'-5" 7 =e' S•�q• ,9•a 1' -° �r }Y 0 3•. YP%1! t 3¢ i',;_ i S�,y.N. Al.un,y. A,. S�.. •,c D. P. 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