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HomeMy WebLinkAbout3380DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.08 -1 -24 BOX 27 I I I'a"m -.1 j- -1 go-9 is I top 1 9, LO' -No J r 1 : 0. .1 091; l -, T ,'L �� `� ''� , 03380 i RT(F I GATE -'Of ,Cd ?ak% f:sewe,ragq,.,skir _St* "X Other bi ter., SupjAy'v, .'P Pillage i Town x wid• trench .4L - he-plansto ft her i(copi6s of .,which ,are ';PUt County Departure'' Health . . . . . . . . . . . r: be'comes� 'Owaner or P i,rcliaser of � bu d c ix� hlu� e i a ty Building Constructed Jay ' -, Secta0 , Location Streetioek. 'S B. J-1din Type GUARANTY OF SEPARATE SEWAGE SYSTEM represent th1t I am wholly and completely re! pons?ble for the logp., on, workmanship, material, construct 6n and drainage of the sewage dispoaal system serving the above desc�r3'b,�d prcpprty, 'and that it has been constructed. ps shown on the approved plan or app ved amendment thereto, and an accordance with the standard rules and regulations of the Putnam County pepartment or :fealth, and rierebi, g}iaran l y ' anytpartwofrsaadsssstems%ons hezrs .or as's signs, to.", o peace in good' operatl.ng eond t�.on y, ructed, by me which fa 1, to pperate- for a period o`f �vo }tears immediately following the date, of �.n tial use" of the secvage el spgs . - -system; o any repairs made by me to suiph system, except: when the failure to operate properly X-9 caused by the willfttl or TjeTli,geni ''act of the o of the budding utj .4.zing :: �'t�p G�r�fiartl •, �. a ti. .. The undersigned further , agrees .to. accept as 'con( Tus:i.ve the de termination of the .Director of, the DL :vJson ©'f Enyronmental'Health S�arvices. o :the Putnai Count leaxtrnent of Heath• asa whether ox nQt the faa lure of he sysl e.m to operate was „. , .. _ cause c) y .thew lfu1'or negligent' act °off" hie'`ts tp }fit q �ti bu der utj33Olg.- •the•- • ,system,. ; Dated th3:s day of 19'i .Signature T , Genera CQ .9tractor Septic C atQr (if corporation, give name and addre .. ., .. .,, .-r - -•...^ n •,w -, �.. r_-;.. ret �-.. nip -.... r*�- . +r^ .. r^, -..i -r n.. _ _.. .- ... THREE (3) COPIES ARE REgPIRED WITH T}fREE (3) COPIES '-,OP FI I PLANS BEFORE . CERTIFICA'1 Y OF COMPLETION WILT, BE ISSUED. ��', GUARANTOR IS RE UIRED M ,FILE NOTICE• OF DATE OF FIRST USE OF SYSTEM; — — - — - — - Division of Environmenta. Health Sere vices,: Putnam County 'department o f Health PEEKSKILL MEDICAL LABORATORY 40436 1879 Crompond Rd. Barclay Plaza Bldg. .A,.Apt..I ,1 Ij :w: `York.1: 0! .66 DATE COLLECTED RESULTS OF EXAMINATION OF WATER 5.=11 -74 OWNER DATE RECEIVED . BOSWELL,SUBDIVISION 5 -11 -74 CITY, VILLAGE; TOWN VOR NAME OF SUPPLY DATE REPORTED 5 -14 -74 SAMPLING POINT LOT. #5 BLOCK #7 - BACTERIA PER ML. (Agar plate count at .35 C). 5 COLIFORM GROUP (Most probable N6, /100m1.): LESS THAN 2.2 RD ES , TAL = ppm DETERGENTS - ppm . NITRATES (as N) - ppm IRON, TOTAL - ppm FLOURIDE (F) -mg./I. . These results indicate t hat the water was YES of a satisfactory sanitary quality when the sample was collected. A. H. PADOVANI, M. T. (ASCP) F__I_ rt WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK -.�� «az rt;i� ISQ ,csnp: #ecl. ;b?.,? s.l,.c i' wls >,L�b,rittrd c�3 iA�lrst��r 6i atr �artmant together with laboratory rapori- t5f., . analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER N E / f ADDRESS LOCATION OF WELL (No. & Street) (Town) (Lot Number) PROPOSED USE OF WELL BUSINESS L6j DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL ❑ SUPPLY El INDUSTRIAL ❑ CONDITIONING ❑ (Specify) DRILLING EQUIPMENT COMPRESSED CABLE OTHER ❑ ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION ❑ (Specify) CASING DETAILS LENGTH (feet) �y DIAMETER (inches) WEIGHT PER FOOT jam{ 7 - LJ THREADED El WELDED DRIVE SHOE ❑ YES ❑ NO WAS CASING ®YES R j TED? LJ NO YIELD TEST HOURS G.P.M. ❑ BAILED ❑ PUMPED Idl COMPRESSED AIR 12— YIELD (G.P.M.) /72— WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST [feet) � �� 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 SIZE (inches) FROM (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET / l �of P 11 ` G C� �oJI� ,;z U evL k- If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED DATE OF R PORT ±Lz WELL DRILLER (Signature) . A K) LIT o Lf or I E ; ,Z Ei , Z7 APPROVED 1974 FUYN uu 1W wam slovw"', a 41M. A40, ( 4 Nm� S: 0 0 o c A the' �ui 'blclei�'tfiat �aid;bullder will d:,t assign; OS�,, T). dpripg::,thlB.,;per,iod'of, two '(2'r)--,years-iiffimedia e y. following the date of -the ssu= 1 S4 e' above- i6f'i4ihal,,s��,.tteffiv6t.any,,repairs theret - 2)'thii tll�!�Adrill- wellf"ae crib_.� arcl--'441es si :Zr, d Jiii� "rd in 6e'�W it k­4 'h-e-,, taixA-d atioM;- -of,-' Putnam _4cco, 4� j ­­' E RA -Licen �e date As unless construct",, of the• *. building` has beep undprta ken and is S , 'Afi(.chAnge' or a iteratiow- I co and /or rwate��wa pply -only be located as shown on the approved plan and that said W� ell-"Wilfbetil N twill pyn, y_�� PVTN ANT ­tO. PA-RT-M:ENT',-OF IIEA,LTH-. _'Illi - 7 Wh7enta ea 051 -2 3, -A CONSTRULTIUN PERMIT FOR SEWAGE .aDISPOSAL SYSTEM ` 71A A A U-5 Y Address _ Town or Village ... ... a;x, P S % ;Subdivision L MI 40 AL PE,E CONS f a owner, -A lip Building y r 6t -Aeee-- 'A c Square Fee t T, Bedrooms e e ��,to., consist - Ainea I -feet 'width trench O.mera ..7 J", To be`construcfea, kiy�._ Address P ublic:jJ Su 0 1 From ,;,Water UPPI" Y y .77777 _ `PfNW�, Supply to 66 drilled 9 •kv -'an' V ,Address %t YL A Other Requirements ) the' �ui 'blclei�'tfiat �aid;bullder will d:,t assign; OS�,, T). dpripg::,thlB.,;per,iod'of, two '(2'r)--,years-iiffimedia e y. following the date of -the ssu= 1 S4 e' above- i6f'i4ihal,,s��,.tteffiv6t.any,,repairs theret - 2)'thii tll�!�Adrill- wellf"ae crib_.� arcl--'441es si :Zr, d Jiii� "rd in 6e'�W it k­4 'h-e-,, taixA-d atioM;- -of,-' Putnam _4cco, 4� j ­­' E RA -Licen �e date As unless construct",, of the• *. building` has beep undprta ken and is S , 'Afi(.chAnge' or a iteratiow- I co and /or rwate��wa pply -only be located as shown on the approved plan and that said W� ell-"Wilfbetil twill pyn, y_�� _'Illi - 7 3, -A Address the' �ui 'blclei�'tfiat �aid;bullder will d:,t assign; OS�,, T). dpripg::,thlB.,;per,iod'of, two '(2'r)--,years-iiffimedia e y. following the date of -the ssu= 1 S4 e' above- i6f'i4ihal,,s��,.tteffiv6t.any,,repairs theret - 2)'thii tll�!�Adrill- wellf"ae crib_.� arcl--'441es si :Zr, d Jiii� "rd in 6e'�W it k­4 'h-e-,, taixA-d atioM;- -of,-' Putnam _4cco, 4� j ­­' E RA -Licen �e date As unless construct",, of the• *. building` has beep undprta ken and is S , 'Afi(.chAnge' or a iteratiow- I co and /or rwate��wa pply -only PUTNAM COUNTY DEPARTMENT OF HEALTH DZVIS10 F�,EN -11-TRONMEN�ALt_ H- EALTH- SERVICES,�a � .. -= _.:...._.._.. Date 15 -+eg I2-14- Re: Property of _ VA L— 26-r- Come. Grp. Located at e6006114 1�(21 )C Section to'a- Block Lot 45 -TM Gentlemen: C This letter is to authorize a.duly licensed professional engineer or registered architect (Indicate) to apply for a Construction Permit for a separate sewage system; to 0 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 L: V1111t!C L11111 w_. i n Lids ma C i ev aiki to. supervise ine construe ciun of said system or systems in conformity with the provisions of Article 145 or 'r - 147,,7.-:fiduea•tion­.L -aw, - the Public .Heal th_ -Law, .hand- -the-_-.Putnam -Count y San g= tary Code. Countersigned: P.E., # ss a\ D-ZS— SOS$ Telephone Very truly a01s, Signed_ Owner of, Property Address f s Telephone 19•A K� . d m F PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA S T -SEA TE SEWAGE DISPOSAL SYSTEM FILE NO. �`1 40,Z-90(0 Owner — C. Address 0 4 Located at (Street V, Sec.'s Block Lot(, 1 ndlca e neares cross s ree Municipality, Z:rh)a.m - Watershed "4�_ 1 Lf SOIL PERCOLATION TEST DATA RE UIRED TO BE.SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Water Level No:. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop. n n_ Inches Inches Inches 1 to: 2 10:36 lo:Q ( S I 19 I 511 3 nor. 41 lo: 4`7 4(o:4'1 10:55 8 7­0 Z1 2 3. 4 5 l .. 2 3 4 5 Notes: 1) Te's�ts 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. DEPTH 611 1211 1811 2411 31011 36" 4211 4811 5411 60" 6611 7211 7811 84" TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. e -INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHIP WATER LEVEL RISE P AFTER BEIN TESTS MADE BY -:,:-DESIGN.. Soil Rate Used 8- I'D' Min/l "Di;6,f: S: D:' Usable No. of Bedrooms 4 Septic Tank Capacity Absorption Area Provided By t-4,0 L.F.x24" 3b" 6!gna 13 ENCOUNTERED Date 'Area _G��4.. T ype width trench. Address u, S EAL THIS SPACE FOR USE BY HEALITH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft/Gal. Checked by�_ m E 6 - G- n e r to, N ��t e 1 ' FTEID CI' s K L12T,. _ Date: y - ' :•• ...may I _ L~ -.z .tik i .411 -]�7� o b • j ' � � ti'��'�. .✓�1 ♦ w4+✓P Wei l.l. .. �' :Ii:k.J h. �,r .. .�.. - ti�_...y. �•�.F•4 .R- .J ?.'st�anl -� O'•���ya.mr�r��•�•r� .- �- '�t..' -��� - INI TTAt SITE INSPECTIOId Yes No Comments Property lines or corners:,: found Can . estimate - ,house location ... .Will driveway need cut . Must trees be removed -note these Is deep hole representative of entire SDS area Additional deep. holes needed. _ Sufficient SDS area available considering .driveway cut, house location, separation . distances, etc. DEEP HOLE DATA ... ` Depth:. ..:Water elevation.: Rock elevation: Soils description: Date : T_ FINAL SITE INSPECTION' Ins p. b House located where shown on approved plan. .SAS �. n�a.f Pri t•h�rP a?�nrn��Ara _ .Iqidth of trench average Slope of the line and trench acceptable Room allowed for expansion trenches Over 50 ft,. .' from- Swamp XTr. * giZov��p:�.._... lvatural soil noL stripped or SDS area unnecessarily'graded 10 Ft. rraintained from prop . lin° and .2Q ft. from house . Separation of trench fron house, well etc. follows plan . Number of bedrooms checks . Stones, brush, stumps, rubble, etc. greater. than 15 ft. from .nearest trench . . . . . 25 Ft. of . peripheral soil . horizontally from. trench . . . . . . . . . Junction boxes. proper: ,,ly set 0ottld surface run of from driveway, roads, .ground surface, etc., cik 1nnel near SDS area . . . . . . . G. . . . . 0. . . . . '_ . Does lot drainage appear O.K. in area of SDS FINAL- GRADING OF SITE ACCEPTABLE own SITE MAIL PERSON INTERVIEWED ��� � /� ate'"` PCHD Ca g3laint $ Name & Relationship (i.e,, owner ,,tenant,, etc.) DATE // TYPE FACILITY PROPOSED INSTALLER PHONE Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system,, Different location may require submittal of proposal from licensed professional engineer or registered architect. Proposal approved Inspector's Sig ur, `l ,( (y- N pate 'roposal approved with the following conditions: 1. Procurement of any Town pennit,, if applicable. 20 Submission of as built repair sketch in duplicate showing: a. Owner ° s name. bo Site Street Nam, Town and Tax Map number. ca Location of installed canponents tied to two fixed points (eogo,house corners). do System description (e.g., 1250 gal. concrete septic tank,, three precast 61 diam® x 60 deep drywells surrounded by one foot + gravel),, eo Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, or ported agent of owner agree to the above conditions, SIGNATURE TITLE DATE 3 : ftte MV; Yellnw (fin ffi)a Pink (kiiiamt) ,.PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONM.ENM HEALTH SERVICES' PROPOSAL FOR SEWAGE DISPOSAL SYSTEM, -7 atmls mm T PHONE W SITE I=TION Al"a 710 MAILING ADDRESS PERSON INTERVIEWED e- yo tv # PCHD'Cariplaint Name & Relationship (i.el owner, tenant, etc..) DATE TYPE FACILITY. PROPOSED INSTALLER PHONE Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location-and of same type as original, sewage diqposal :.syste Different location may require submittal of proposal frcm licensed professi I ona engineer or registered architect.' Proposal approved ;X- __ Inspector's Siqnafun Proposal Disapproved Proposal amroved with the following conditions: We l.-Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. C, Lomtion of installed components tied-to.two fixed points (e.g.8,hotise dorners), d:,System description (e. .,. 1250.gal.-c6ncrete septic ta'nk,,, three - 9 precast 61 diam. x 61 deep drywells surrounded by one..foot + gravel)..- e. Installer's name and number. 3. System repair to be perfonned in accordance with the above proposal and conditions. I. as owner,, or reported agent of owner--:agree.to the above - conditions. SIGNATURE TIME. DATE lr`c: V&be (PCED); Yellcw ('fin HO; Pink Qj:pliaint) Z ,v ,.I <z S_ All X, Proposal approved ;X- __ Inspector's Siqnafun Proposal Disapproved Proposal amroved with the following conditions: We l.-Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. C, Lomtion of installed components tied-to.two fixed points (e.g.8,hotise dorners), d:,System description (e. .,. 1250.gal.-c6ncrete septic ta'nk,,, three - 9 precast 61 diam. x 61 deep drywells surrounded by one..foot + gravel)..- e. Installer's name and number. 3. System repair to be perfonned in accordance with the above proposal and conditions. I. as owner,, or reported agent of owner--:agree.to the above - conditions. SIGNATURE TIME. DATE lr`c: V&be (PCED); Yellcw ('fin HO; Pink Qj:pliaint) i .. ; f d� 1. ♦.L`� I�1. 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QE o <'- �h ?,'�Y.`1 �i 1974 s" I ,o P�, �- \ .1 11 m ° a t3 ,� Z 0 (d` 1 1 ? , l,1 •` ®UT OU f Y ` J OFi HEAITF 1 *r t ,r� , a � t) } ti�3 j �,. . ;-DIR OR IYISIOH OF t. �t a l.r ..> / GVIf1f' y 4F t w . 1 r INVIROWNTAI NEALTH S1 gr r, xra ss Srt 3v�`Qj�p1�r i rr .11 }� iS s OF pltiY/ i' s abx {:yq F �VT�L! ,1�� t ♦� �i• i e ' �t v a < if ! �tb ���{ t 1 a. ; G- .. 't , , i = ?' r }'t K'� fx , ,{ o'• ! r; � t• .. f � i " O � / A �'�..:J : "y'i'. 1 + 3 �l AeJtvE.K�a i 1. 6 17 ,J F�� 4 } -.: r ,r s '' 'I;:»IJ �1.�4.14 e7' 1 fit! OW -,e r Wi� �5. ,qdr 15�t„Y �... k J 2 S� a �5. `ter' \i� Ir1''1'...1.+ Mr \�� '�V7�. t% 1. J I Tcy.1 II'l. cf ki ME vAjAl 5z) n 9 q 4 cl '44 APPROVED (oeP�� �. r �,.< '�,�` til. AY 16 19 74 BUT ALI*f; F t T %IR OUOR. Wl' 6ON OF T WWRONMENTAL HEALTH SERVIWc• A A T D /7- R pea 5 if A..: /24 Z.1 40, 7. G-1 f alV "IC P. L P L-A-!�. ScaLL-10W C -T t.1, 9 r), FMANHOLE COVLF .1 , T L A - - a_0 lay, 4 1 4 MIN. • wEVIDENCL SECTW --------- - -- -CN C: Jure 0-0-- rar--- I, w 1. T, S, 1>1 A.( Al, AA A.'r, I c Q, A Z. r- gzy, to t.1 i s 4?w to s a To L m, A, n kv. D, A- ri - AVE I c/ --Ir T)Ii PcISA L in c. SfF-cv To BF 11 :14 XTE9 J1 ACTORrANCE WHAP R." ANO R"QUATI N . 7 THE t AA OF mEALTH. E,"' T INSPECT D FT fit. l'id 'r QW111 SEPARTVLNT IF` RE I APPROVE -L T, son I* I -W AT&I W PEN F551 FE02 019T4 -01, 3-9 Ev T S F CORP. is "T IL 4— P-VlRnNUENTA� HFALTH SERVICD S- S- D- SYSITEM VAL PE-1 f ltc�5,ov.k-LL 0 - F55S 0/v A. KE F S kj A IT NX mar N062 wxw. 7 5,7 n" L U! Q 1 Wz IA NA Sit CA IUAA 402- 90