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HomeMy WebLinkAbout3376DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.08 -1 -20 BOX 27 03376 ' IN . ' . . IL NN% ■ 03376 Date Date � g . PEEKSKILL MEDICAL LABORATORY .1879 Crompond Rd. Barclay Plaza Bldg: A, Apt. 1 b ?n DATE COLLECTED. RESULTS OF EXAMINATION OF WATER , 0WNER . DATE RECEIVED ()rChrtrd, Pkcz rrqon - 76 CITY, VILLA E, TOWN &/OR NAME OF SUPPLY,. DATE REPORTED L -# 0 j v le a1- SAMPLING POINT BA7 RIA PER ML. (Agar plate count at 35 C). COLIFORM GROUP (Most probable N6. /100ml.) less HARDNESS, TOTAL - ppm DETERGENTS - ppm NITRATES (as N) - ppm IRON, TOTAL - ppm FLOURIDE (F) - mg. /1. These results indicate that the water was �CS of a satisfactory sanitary quality when-the sample was collected. e A. H. PYADOVANI, M. T. (ASCP) h TOWTT_.OF PUTNAM.-VALLEY Wj.;uIL,DRILLEIRS LOG AND REPORT WELL LOCATION J E:0,Vj t,3 A-- 09ovLt. street section block lot i.a.IL OWNER- a Cb)li n -` N address city or town' 4ELL DRILL'' ailed (Measure J.rom 1 d surface5 Lengh: feet or Pumped - Hrs.. Stati,., &­ft- Make: en Bailed lot Yield:/n Diameter: Inches GPM r Pumped 710 ft] Length Ft•, ize r 6 nd *5 2-4 El. f Diameter Inj 20TAL D L DEPTH OF WELL__ ^�epth from 'Give -description of:forma-u-ion -penetrated, such as: peat-' - Ground Surface silt, sand, gravel.,* clay,hardpan, shale, sandstone, ranit'e, etc. Include size of gravel(diameter and sand fine, medium, course), color of-material structure (Loose, packed, cemented,'.soft, hard),(Ex. Oft ..:,to.27 ft. yel -pranite),_ jow p_Acjtd la t' D s loff 6 E; r n tioj kotb exact loca ibji (3f ­V&li -to perenan a)a mar .s least two m . t L ­_d; k 4 'r, IV mate ','.4e!]- Completed 75 Date of 'Report 75 Well Driller signature- s ar rR . L-" .^ .+✓i ~J.JY �...L.�r.r.U[.�:.. �,f t.. ..arw6".� ..� n - s.+v�t /> o s -� � V � n-w � a.N� �:r.0'F.J... �ti.:4 .. "��i4✓'��i�'-� {S•'.�.]P f ..a n im.� +., r . -i Owfter or Purchaser of Building �cti. uL Municipality Builddiing Constructed by Section Location - Street Block Building Type Lot GUARANTY OF SEPARATE SEtiIAGE- 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 cf Environmental Iie ^�lth Ser -_ vices of the P:atnam 'County` f�epartment of` Health as to whether or not the failure of the system to. operate was caused by the willful or negligent act of the occupant of the building utilizing the system Dated this C� day of 5� 19� Si nature � �� T i t l e ' � / /i"(llGfii & (If corporat bn, give name/ :yC. and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR..'-LS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Division of Environmental Health Services, Putnam County Department of Health x, To. 2 3 G 7 A �o 54 5? 51 54 59 6 21 PUTNAM COUNTY DEPARTMENT OF HEALTH 1-kU -ALR W` Date Id /970 V Re:, Property of I- LA 7. Located at Z4--.4 'IV,1V4r_ 121 Ve- Section /,,13B -Block Lot Gentlemen: This .letter is to authorize E(:"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 connection with this matter and to supervise the construction of said _­- system or systems in conformity with the provisions of Article 145 or 147,_Ed.ie.ation- Law�,_ the..- Riblic... Health La•tt, and Count ri tary. Code . Countersigii 8998,4 P.E, R.A., cu .4 ye Address Telephone Very truly yours, Signed Owner of­Propet* /0 C124AWVAEA) Ara- Address dof Q Telephone �.- ;. -. . ..,. . ,; � n � 1 .�.. '. ,. .. e, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE N0.2498 -99'x- Owner Address /06r,,v",2/ Located at (Street Sec. Block Lot �Indicate nearest cross -street) Municipality SOIL PERCOLATION TEST DAT Watershed ?ZAMA TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Eiapse Depth to Water Water Levei No. Time From Ground Surface in Inches Soil Rate Start-Stop Min. Start Stop Drop in Mini/in drop Inches Inches Inches 1 1A 3� 2 ,0$a /0 7 o20314- J14 3 If 090 % Y14 4-4 5 /1 40 ,< in, 0 - 624 �� B2 �z l %- ��� �2 3- 5 2 3 4 5 Notes: 1) Tdsts to be repeated at same depth until agroximately equal soil rates are obtained at each percolation test hole. A data to be submitted for review. 2) Depth . measurements to be made from top of hole. DEPTH 611 1211 1811 2411 3011 36:' 42 1 4811 5411 6011 6611 7211 7811 84 if TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. AI HOLE NO._ HOLE NO. INDICATE' LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date 1 a CMG 2714, MT L Soil Rate Used__Cpo Min/l"Drop: S.D. Usable Area Provided s-em,, No. of Bedrooms Septic Tank capacity C?aq Gals. �--Tenchp44M Absorption. Area Provided By__4��L.F.x24 ure Address SEA . THIS SPACE FOR USE BY HEALTH DEPARTP/Ml T ONLY: Soil Rate Approved Sq. Ft/Gal. Checked by Date 'I -PLAN t. ,MANHOLE C(:V '• A. ' f I Q Q� r t .1• t g }p qq ��►►p GRO GEVE Y 10 \ ^JUNCTfON BOX ram fz' =ie_ A t, F _ 4 N..' I zo BAST If:7N. ., :iANiTARY fEE , . �. SECTION: 48' L JT P L AN CAL TYPI CCINC. Rv F .tI:NE F. cs a `st- ; .. p e. oBN/Cw I SEPTIC TANK . 1 � YSM ^� 1► nar4n6o ;3R!). ;'LEVEL EARTH f <,� SACKFILL J01A -�' CO,VER - - a aLL� ao � 1'R"•30' BLDG PAPER OR HA: 2. ...-� i -,`� -► Q6. f I'J , FRFORATPf PC 5. 56, Ci EAN.Cg9AVCL OR a �l \� "' �Zn ✓ �L .0 3. "� -"'I' 4RJSHrD STONE! iQ`���r S�i �i ✓I tom• AASORPTtf?N�TFiENCIi< C� O _--- I 1 i • �j /' NOTES *s C' I (J s T, q o St:S EA4 T� BE E)NSTRUCT1;�IN ACCORDANCE WITFiJHE RULES AND } .oJ RFCULATWNS.OF THE ufnc<m GUUNTYipEPARTMiE :N'f ,� 90o eT I• Fi `T t� . OF HEALTH. #. 59�pn Sept c � iti o j �' r' SY3TENI SHALL NOT BE BACKfi.ILLED UNTiL.IN °PECr1ED 8Y DESIGN k y9"1 "4� g�xeS _ ENCtP.IEF.R AND THE. LOCAL HEALTH •'CiEPARTMEh7TIF REQUIRED, T i SY, __M TLS GONSiST OF A _�GA.LLON 5t TK TANK eC +ion A1dDBOO FT. QF_3 —,FT. TRF-N[.H wiTH A.1sm,\X1M1jAt Pi7CI-i OF 1116 PER FOOT. ;< N.T.s. DISPOSAL SYSTEM GRADES RE.FFREhICED TO FINISHED FIRST S.i Junciion Box Foo +in3 Se+ 15.1c v Frost Lino FLOOR ELEVATION UNLESS o TkEPW ISF N`.7tL•.D. 21 S.e per. +ion .Dis +0.ncP_o SS(3 10 Leader fz)—in- IS Ft. ./v\inimum. VA L- PETE $ All .Lar e.Trees .Wt}hFn 10 of IJ sPos -1- S.S.D. SYS'TERA FAR_. -. A.rea�:'To. 6e'. Remove -d,'. .. _ .. ... ' R vtS1oNS HOWARD A., KELLY ASSOCIATES CAkNIEL NEW Y RK AQPRo s� ,I a r t 1 �b 15 ►3�iK� 'MAP NO.1238BLK,.NO f1LOT NO_ Sh woaa ,f o a o� a t 1. TOWN Of _ �b� growl L3.WV. •Seata0._s ro'rad atudof CW& Uafe:B 14�g DigN n4 H. X9087 _ 5 tl ADDd s -r. f •, j M1 A' I �T