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HomeMy WebLinkAbout3378DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.08 -1 -22 BOX 27 03378 - r ir mil J6. - . r jr ,6 fr IV ML i 6A 03378 it Re t6 .�Spwprpgg erri- built Oither.. 634uirerAefifs p Addro *.4y v 3. W 1051.2 1 % -Town , Olkoe -or,. or.- 14" iock L C, Width' tiench 'Data '�Pefrnit I ssueO-L�: =1­2 t T he pl ns,of the completed work(Wpie , s , of ""Nw6ich'4're, - ids by'N t Putnam County y. epar men a t ff. z,," 'fit a Y, , - e essar y tos­ecu r, e`�'t 6 c rre ti Of, eny unsanitary ;" rid 1,voicli as soon; ,as a public. sanitary w,.',supply,Ib'dco'mes, iav'ailable Si'Such.ja I F" cation,imodrfication or;At ro PEEKSKILL, MEDICAL LABORATORY Cromporid Rd. Barclay, Plaza Bldg: A,"Apt.. 1 41982 RESULTS OF EXAMINATION OF. WATER OWNER CITY, VILLAGE, TOWN 6 /OR NAME OF SUPPLY WATL; Mreurfl ZLJ Lot #.3, Block 7, TM-62 8/1/74 SAMPLING POINT BACTERIA PER ML. (Agar plate daunt a_3_515 Cy. 7 _(j_0L1IFORM GROUP (Most probable N6./100ml.) less than 202 HARDNESS, TOTAL -ppm DETERGENTS - ppm NITRATES (as N) - ppm IRON, TOTAL - ppm PLOURIDE (F) - mg./l. These results Indicate that the water was Yes of a satisfactory sanitary quality when the -sample was colle A. H. PADOVANI, M. T. (ASCP) IUrcfiaser of huildli.nb R uk TO prm— - •-- .---__ . '.„'Y[na�i_r`co- .• - GV�•�2�. ]..�.,i- �i��.;"... y.i;;n•: `^.= ��--- ��¢.:'..'.., ... i::rn«= t� `.4••.a':c.- �,L--'wun �- n- •`.:;.:�x:_ivro v: :�." -k-nc 7'. -=-' 1�.i��+.'.�o °ve.�T:�c± chi "..ry...in.u..:..,.�:.�:i:.;�: 2::.v .'r:.i.^.i'c_ lsuildiiib Constructed y Section • n tj J1 vocation - Street Block •. . G, cLj - 3uilding Type Lot -GUARANTY OF SEPARATE MIAGE SYSTEM , I represent that I am wholly and completely responsible for the location, ,orkmanship, material, construction and .drainage of the sewage disposal syst-'em ;erving the above described property, and that it has been 'constructed as shown oil -he approved plan or approved amendment thereto, and in accordance with the standards, tiles and rep ilations of the Putnam County Department of Health, and hereby guaranty .o the owner, his successors, heirs or assigns, to place in good opo rating condition .ny part of said system constructed by me iahich fails to operate for a period of t-=•:o ears immediately following the date of initial use of the sec,aa e disposal system, or ny.repairs made by me to such system, 'except cohere the failure to operate properly 1 (_'aUbE'il .11V °Llle SJil11Ul UI' llc'k 1 L t11 L cll: L iJ1 i lid Ol:i i.ij�aiI i uJ. I ✓LL 1 A_ , /16 ..max.'. :::b he . The undersigned further agrees to accept as conclusive the determination f the' Director of the Division of Environmental Health Services of the Putnam County epax.tment o.f -Health,.-:as J- - -whether or.--: not _the .failure of the:-sys-tem -to - operate was--: aused by� the wiles ful or. negligent act of the occupant of the bu 'idino, utilizir. theA- J. ated this `�— day of '19� Signature Title 7--/ /.1 A (i, -f cbiEporati give "name and addres.; ---------------- ---------------------------------------------------------------- ___ HREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE F COMPLETION WILL BE ISSUED. JARANITOR IS RFOUTP.I:D TO. FILE NOTICE OF DATE OF •FIRST USE. OF SYSTEV1. - -------------------------------- ____..____------------------------------- -------- ivision of Environmental Realth Services, Putnam :County Department.of. Health i VVEft COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3)71 ° Division of Environmental Hoolth Sorvices COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report -is to,.be completed b-y -weld drillDT -and s�+i tatted to_gourity Health nepar- tment.t9gother with- labocato� r�or- t --of- :71;., x -r. 2°sr 2x; :. •-r �zz t-fi- _?;`...:. a;.- :,;`.. +��s %ni. -... �s�F,..- r�rr.KC anaiysi's of vra'ter sample iri'dicating water Is - Of sat lsfactory'bacterla� gIty lieo're ceruflcate of conttruetlon compliance Is Issued. REPORT MUST RE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OOWNER NA �� I I e—le 6/1/! 112 u c -/6 i/ DDR AESS LOCATION OF WELL (No. 6 Sheet) (Town) (Lot Number) ��/,/e `i ' U���/1�. �7' .. PROPOSED USE OF WELL BUSINESS L^J DOMESTIC ESTABLISHMENT FARM D TEST WELL �j lJ SUPPLY El INDUSTRIAL CONDITIONING (Specify) DRILLING EQUIPMENT ❑ �jj ROTARY �J COMPRESSED a CABLE a OTHER AIR PERCUSSION PERCUSSION (Specify) CASING DETAILS LENGTH (feet) 13 -2 DIAMETER (inches) �j WEIGHT PER FOOT ( - 7 IlJ THREADED D WELDED DRIVE SHOE OYES ❑ NO WAS CASING [:1 YES UT ED? (=J NO YIELD TEST ry HOURS G.P.M. BAILED PUMPED 4/j COMPRESSED AIR YIELD (G.P.M.) WATER LEVEL MEASURE LAND SURFACE- STATIC(Specl /yleetJ (o/ DURING YIELD e� Depth of Completed Well in feet below Land surface: SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: _ Diameter of well including gravel pack (Inches): GRAVEL S1ZE (Inches) FROM (loo() TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. 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I .. ;: . ., - . , - , - , I I .. } CONSTRUCTION '''L.oEatetl at' Subdivision Owner PUTNAM COUNTY DEPARTMENT ENT O]F HEALTH Division of. Environmental Health Services, Carmel, N. Y. 10512 PERMIT FOR SEWAGE DISPOSAL SYSTEM P6022aM aL Town or Village _ I "!�'C :. -4' .d"��i�I����c x: +. --� �_4�:`� —; :�.' .`- SBCtiOli`-t?e �, �.e�rs. ..< �t—i. =.'.�- �.� -... �i- `•,,; =�... .dock r Lot Job lyz4a Address GZr c /.Pct �?�lf�ff3i'. Building Type — L_ � Lot Area /17�-� 1 Number of Bedrooms 4 Total Habitable Space �s � � Square Feet Separate Sewerage System to consist of d� Gal. Septic Tank o lineal feet X j width trench To be constructed by �%V fi��/y'1 /e f' Address Water Supply: . / Public Supply From —R� Private Supply to be drilled by '?,f 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 and regulations of e Putnam 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 will be located as shorn on the approved plan and that said well will be installed in accordance with the standar rules and regula ions of the Putnam' County Department of Health. f//'` Date"– % Sign d P.E. ' R.A. Address g02Z le Lice a No, APPROVED FOR CONSTRUCTION: This appro I expires one year from the d to issued unless co ction of the building has been undertaken and is revocable for cause or may be amended or modified when consid necessar th Commissi er Health. Any change or alteration of construction requires a new rmit. A roomed fpr sposal of domestic itary w e, a t�� � Date By Title 13 __.-T __ - P�TTVu'�I_•GOT1�l�r'. -Y_ ��P ?�T:�l T��QF �N�'_aLT-+ -_ _. _ _._ •DIVISIO OF EN ? VIR0IND, `1TAL HEALTH SERVICES Gentlenen This letter is to authorize d a duly licensed professional en,ineer _ or registery .architect (Ind icat °) to apply for a Construction P ?r it for a separate se reray system; 'to serve the above noted ?)ror;rty 1i. aC ordance wit.C? ti?e standards, rUleS l ai_ a tf,» 7r L.v 'F, � n r�-;^;, l ,'�vr ' ', e tro.� tyt or _':, U_ t,y0 j S iQ..�tllva ,ed v� P_ do _ isS o._ of u n t't1t,..�TY1 COI.. ty D -_,,) ,r}.Y1_,— t- (' i-Tpal 1 i - l y'1 C ay,_� par r, Z behalf l f iY' :,. �.._� �f _ � and ��o si_� a1_ ece s _.+ pa��� s c__ r! r ben��:. _ ._�.�._ ..'eon�e�e��o.� RTC tit `t�l'?~e.. °27:%i; 3"�' _...�r . .;..__�.� ; �.. c•. �:..:.:+=: I': ��° �' f-'' 1?" S' �1" tJ�� ',t1::�'I^ "'.�lc?'.""J"�':i`� ... �Y'_R....,_ Systen or 3�FStef!S in COniO_' i ty Ji t =: .he -orCViSionS of article 1L 5 or 14.7, Education Law, the Public Hea. 1th Lai•., and the Putnam County' Sani- tary Code. 4A. K Very truly yours, E r , Countersign�q 3 998 TF . Op £va` /. P.E., R. ., (Seal) Addre s Telephone Owner o1' _ roper Uy Add s Telephone 9 ° PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES -r.o .�_.. .:..;".,-_:;.Cz rh.. ...: .. _ t »..� -.3 "' :r1. :.7i..: ' .. :.. ... .. _.:;' <..._:.^..;i v .:'.`_..i,: :.may::. �.r -... e+l..�+iro;':,_�':: �_:`v.:. _ wi'- �.- '^+=r•`�': =h`.._ "••:. -:.en .... COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. 96 �- Cwner I�) 64X-�Address S, le_. Located at ( Street rives Seca Block 7 Lot . 3 ndica e nearer- cross s ree Municipality. fia /l Q -e,u _Watershed C� � SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run apse Depth to Water Water ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 4 o 10.3 $ l l,3 3b 10 4 (90 / 3 4 5 • 1 2 3 5 • Notes: 1) Tests to be repeated at same depth until approximatelyy 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. 6" 12" 18" 24" 3011 36" 1 `t2" 48" 54" 60" 66" 7211 781f 8411 INDICATE L AT WHICH GROUND WATER IS ENCOUNTERED INDICATE L TO HICH WATER LEVEL RISES FTER BEING ENCOUNTERED TESTS MADE BY -- C_. Date ` Cj dam r) YSoil ^Rate rUsed _Min/1 "Drop`: S.D. Usable Area PProvided No. of Bedrooms 4 Septic Tank Capacity `2,0-0 Gals. Absorption ,Area Provided By�L.F.x24 "— ��E�trenc Address THIS SPACE FOR USE BY Soil Rate Approved NM 7EPARTPENT ONLY: Sq. Ft /Gal. Checked by 389 q re ofi NE`Ni 1m M X Date PLAN -�' ` q FN oc� 61111 LEVEL 441 -10N :1�ox - IJ �% \ -1 t�u 4�_ 46 �--. / it urn - �o r 7 4�- V 4,0 T—A cAs i6oN b .6: �Jlll 'N" TY N PICAL: Ico � Q. pRt T "Q icx. ailyyy % I& i. KQ fka LEVEL w BCKFILL 0:TE1,S' A; 5L 06, PAPPE '.A. J�6ri 2 OF 2 J, ERFORATED ti y -F T pif z CLCAN GRAVEL OR !q CRUSHED S�Ntit ABSORP MON TRENCH 7, ­ J 'p. ;.w A: T -D,114_Ar;fth N -,lNITk,TAft RUU5 AND cou U T—l"N A% hTY DEP ARTME-I* RE WL HEA0K. APPROVED...: -CTED E3 0 SIGN 0YZTEM ISHN-L �40T` E�. RAtKMLED' U4TILjN9Pt Y E ENGINEER ATOTHI LOCAL HEALTH DEPARTMEUT- IF R.EWIRZ-D. To _lLQ_o_ r -PT IC TANK C - ONSYST OF A RALLON SF + q 1- FT.* T13ENCH WITH. MAXIMUM NO 9. 0 -FT 3 19 PrTC H. -,,OF,.,, PER. FOOT. JUN 4 4[ y _NCED, TO"FINVSHED FIRST 64 M GRADES RETERE I'S luirl R.- I-E-VA.7 I ON U N R LESS OTHEW ISE NOTED. C) LT' .L.ANO .0 Of .-I T IR I VAL- PETE CON S W11RON -SYSTEM' FOR W4 6`,- 5 Sr 00. E 10 HOWARQ.A, KELLY,-JR. s s I , . I,-- , -]� I` ASSOCIATES 1$40-1. DATE I BY r..UPA vnpk, "OLE COY oc� 61111 LEVEL 441 -10N :1�ox - IJ �% \ -1 t�u 4�_ 46 �--. / it urn - �o r 7 4�- V 4,0 T—A cAs i6oN b .6: �Jlll 'N" TY N PICAL: Ico � Q. pRt T "Q icx. ailyyy % I& i. KQ fka LEVEL w BCKFILL 0:TE1,S' A; 5L 06, PAPPE '.A. J�6ri 2 OF 2 J, ERFORATED ti y -F T pif z CLCAN GRAVEL OR !q CRUSHED S�Ntit ABSORP MON TRENCH 7, ­ J 'p. ;.w A: T -D,114_Ar;fth N -,lNITk,TAft RUU5 AND cou U T—l"N A% hTY DEP ARTME-I* RE WL HEA0K. APPROVED...: -CTED E3 0 SIGN 0YZTEM ISHN-L �40T` E�. RAtKMLED' U4TILjN9Pt Y E ENGINEER ATOTHI LOCAL HEALTH DEPARTMEUT- IF R.EWIRZ-D. To _lLQ_o_ r -PT IC TANK C - ONSYST OF A RALLON SF + q 1- FT.* T13ENCH WITH. MAXIMUM NO 9. 0 -FT 3 19 PrTC H. -,,OF,.,, PER. FOOT. JUN 4 4[ y _NCED, TO"FINVSHED FIRST 64 M GRADES RETERE I'S luirl R.- I-E-VA.7 I ON U N R LESS OTHEW ISE NOTED. C) LT' .L.ANO .0 Of .-I T IR I VAL- PETE CON S W11RON -SYSTEM' FOR W4 6`,- 5 Sr 00. E 10 HOWARQ.A, KELLY,-JR. s s I , . I,-- , -]� I` ASSOCIATES 1$40-1. DATE I BY r..UPA vnpk, 5 TAX MAP -NO. 62 BLIK. NO. 7 c LOT NO. 3 TOWN OF Y AS N. U04 6-3-7 it et 7405- X62 4 5 TAX MAP -NO. 62 BLIK. NO. 7 c LOT NO. 3 TOWN OF Y AS N. U04 6-3-7 it et 7405- X62 h .WA This is to certify that I have surva ed Z° -e- A, of Sed'� q+ LAND,SURVEYORS .. 9 /Q; T18K@ PLAC$ Z42. MAtN.STREET:, . r �VERNON H if 603NEN N.Y ROOm aaa r. : / vWN Oy>= /a6 i'�/ii'i4J�7 W ,¢ �.�ry /OV / A/i9�9 C p[J fteT¢t.epHwrG MO 60®tTD T70.8PNOMi 2947929 Filed in'the Westchester County Clerk' Office Division of Land Records V Zilr eo '%9> i ' as AAap r3 I have located all existing buildings a d lines of possession and havo shown their poslioa, hereon I hereby certify this survey to !4'►c. cam % f/e �nf �. � �co�/er Ba.vt J A/cmrQoclve7f¢ } Survey complelod� _ s /2� /TSB; on scale of ono inch to ,f0 Map drafted r,. J-f 2gI7`l� tusua pro'' Ga 4so { '' ._ f°onorafros'` .Locafed 6�/a{/74 e 71zs17¢ ' /a6 0 G7G.36 t'1 ,. e� } I.r f•-' '�"� - ��\ -. _. . Cf': .... r , d_ a,$ �}{�� � �1p� =' } d C i7N 4 -> _ �, �•¢3S':y `^i..�..n. ..._.� -`, tt Yr�y` °s� r r. 'r-C.f uxG „= y�'�'''+ 1 ceu, � ny. mom' i � { •rVV�j` ca cF �. =g.74 ANN l -. 'lam'• /. /O, \ n. oo D° " Z6'L ';. R wX�D /�. I�OTTESCN_ - Cn ed _Qw •�o - 7 r:/'�.a� ez :O•Coes� a '.Cor' 9 an �000rdanc�e svidh the ewumhnn s4dndar 'a. for title survey's of the Now York State Laid iatian ' i r� v �QF►Np18, �BOtlB' iNG. .. '. - ' i .. 'G� ' - �_. r { f -s>aver+► x"73 -�75 � TWO Y COUNT. DEPARTMENT OF HEALTH Division of Env ironnien €a1.:,Health Services CENTER - :CARMEL,,N:Y. 10512 (914) 225 -3641 . .. . r,_ s __ .. .'. -c -r ;._.yr. v. ,. :.i�'`.1 --_ , ... �C. r -. .:} "a y.� a ^•k�'L �"` tri i. `:: v} -.:' APPLICATION TO CONSTRUCT A WATER WELL / PCHD PERMIT #_� /s� 8� WELL LOCATION Str et Address. To Vill ge Cit Tax..Grid NUMber. C�n� �Ty �R 1E tau "rAMA� , 3 a` o� , 7- WELL OWNER Name D7�%ES c w Mailing Address VR% VC ©'Private ❑ Public 'USE OF WELL - primary 2'- secondary 9- fESIDENTIAL 0 BUSINESS 13 INDUSTRIAL ❑ PUBLIC SUPPLY. Q AIR /COND /HEAT PUMP D FARM p TEST /OBSERVATION d INSTITUTIONAL ❑ STAND -BY DA BANDONED ❑ OTHER (specify p AMOUNT OF USE YIELD .SOUGHT_ ] gpm /# PEOPLE .SERVED_ `Z� /EST. OF DAILY USAGE gal .REASON FOR DRILLING 0 NEW SUPPLY OPROVIDE ADDITIONAL SUPPLY WEPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL ❑TEST /OBSERVATION DETAILED REASON.FOR DRILLING Si L 7 / WArt:5 WELL TYPE QDRILLED DDRIVEN QDUG aGRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 13,9.5 W LL 575 - 74 SEC T /ON1 / Lot No. 14 k i- ?�.3 . WATER WELL CONTRACTOR: ' NamegoiWIQ h16�V / Al G. Address: mc"ef- -5-r 4047Ai/f►y) 161U IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ✓ NO NAME OF PUBLIC'WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY PROM NEAREST WATER MAIN: LOCATION SKETCH.& SOURCES OF CONTAMINATION ON REAR OF THIS APPLICATION 5 -,,2 3 L (date) PROVIDED []ON S ARA`TE S EET< / '(signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit.a.Well Completion Report on a form provided by the Putnam County Health Department. Date of Issue: ZQ /j6: �. 19 Date of Expiration:w - e / 19 d Permit Issuing icia Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector 2/87 Pink Copy: Owner nranaim mnv • Wcl 1 n,-; 1 10,-