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HomeMy WebLinkAbout3381DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.08 -1 -25 BOX 27 I I IMF 1. �� WO ,f , oil IF - h 03381 k ,'(copie`s.'gf which.lare. y C)c ner Q Y PuxlQ aspr of, bu'3�.�1 ► n p� > F ' q j 'BIT ci?nghruQfi ,. SeexA! F T�oest�.on �fi�reet • t , Qe GUARAN'T'Y OF SEPARATE 'SEWAGE 5YM represent t at.'am whp�,�,Y. aod.Qmet� re Po pb or t. he i f "' f eYta�l' worl<mal7ahR materlal strvic f end na q,, tie aew $ d spgaal drab aervin tl above" do c'r p 'opertY� and that it harp been P911. trueted 'as ahown on the apoya plan or apt�ved. aR�Qndman taret4, andn accordance ca�t�1 fi1ie, skandard rules andtions o fiha PL{tn4iTl .Cour}t'Y Da�artms p Heal a aa�d 1erabu guar. apty - to tl�e awneI� h 9ueeeQaa hex'.c►r aspgna� .dace �n.Qo�`n'Cat.�ng`RP�?d?tfan ..' anY parfi oF. ?sac aystem'po stx'uet .bY me W��ch a 1, p .oporq -t. e - o a per .qc gf p years rimed afi Y fo1gF??i$ tie clt� °. q it} tial use of t1s seiage disposal sy& to t?, p a i e aiz+s act e fi s c e-(Rep,, here thea ure to gpexate` px�ope?�l.y is causal Y tip �aillEu }. or e$� aU qet p t}�e oq llo ?lt of ►� b airs i� � Z n VIP 19 Q. und►si reedtl�ex+ a �, g, , - ,, R 9� .es i'o soeept as ponellzs:i.ve. he cieter+m rat Qd .. of te.:Dxdto!;ci: nevi PU n Efivro?1men�a Hea�tt► Sprviees of t}e lai }am Count Rep art enfi .off aa� �1: asdJPq AeVhe;r or )19 fie f449VP Of rthe eYatpm " .o °e f�usea:._by�tl�e_w � Eu ! " €o � q�' u�a} fi �U? u; axr, �, pl . ,- Aso o ' t�# n� systeM,. Uaateq tb q- of 9? nature ra Cad roc for sp��-actoro .rt'Qn�vaam "ll adclxs ` f TiIRE (� Co ? E3 AId>a RT;QLI A W T C 3) oPZ Pp FTC Ab PANS PUQ91 CUT TCAT, f o COMPLI TFQN QUARANTOR U RE D TO F_ NO Q ' D U6E QE SYSTEM U --�—.— .. ...�., .. .,.n.q. ^"} ^inn— "'T9l �I !:7 R++., !',7 G,t w.�n*7 ;r nn. nr!- �s*,"!r*ER !7 n!a ;�.n., {Z •n _... n.�-t, _ ,.r, ^I� �.,.. .. ,r .,.. .. r... , »i pion o EnVjranmentaj,, l PutUam. E911TIty ep t Pf Hea1th PEEKSKILL MEDICAL LABORATORY 1879 Crompond Rd. Barclay Plaza Bldg A =Apt 1 4Q435 °"`° �T2 Ri��,: '�. "Y' 9�I C .:ziq a "�:: ..: =- .:» oz RC .`•+de's m . .. r.,;a c _ . c ... =�.. aiV4 .EXAMINATION OF WATER DATE coLLECTED RESULTS OF '5 11 =74 OWNER DATE RECEIVED BOSWELL SUBDIVISION 5 11 -74 CITY, VIL .LAGS; TOWN VOR NAME OF SUPPLY DATE REPORTED' SAMPLING POIN LOT #6 BLOCK #j .:.. •BACTERIA'PER ML. (Agar plate count at 35 C). COLIFORM GROUP (Moat: probable; ,IN6%100nl1.) ":. E$S, AL 'ppm' .DETERGENTS!,'.;. ppri NITRATES (as N) - ppm IRON, T9T -AL'-,0 b WELL" dOMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE ,BUILDING - CARMEL, NEW YORK _..._..,._.__T #;ss;:resart::is t: samp:�. d•: ;.� k! ri#! r-a:d s: s nittEd .10-Co!inty:-Health-Department tojether :%with. laboratory irIaart of 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 G OWNER ,NAjffi E � / V 41 44 1 6N�2uC' / /6y✓ ADDRESS , / 1111 N. , ft 1A116 LOCATION OF WELL (No. 8 Street) (Town) (Lot Number) PROPOSED USE OF WELL BUSINESS DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL 11 SUPP Y El INDUSTRIAL El CONDITIONING ❑ (S(Specify) DRILLING EQUIPMENT ER El ROTARY ®A COMPRESSED CABLE R PERCUSSION ❑ PERCUSSION (S(Specify) ds J. DIAMETER (inches) 177 HT PER FOOT D THREADED ❑ WELDED jDR�IV{E SHOE LJ YES ❑ NO W EYES C SING U D � NO WELL" dOMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE ,BUILDING - CARMEL, NEW YORK _..._..,._.__T #;ss;:resart::is t: samp:�. d•: ;.� k! ri#! r-a:d s: s nittEd .10-Co!inty:-Health-Department tojether :%with. laboratory irIaart of 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 G OWNER ,NAjffi E � / V 41 44 1 6N�2uC' / /6y✓ ADDRESS , / 1111 N. , ft 1A116 LOCATION OF WELL (No. 8 Street) (Town) (Lot Number) PROPOSED USE OF WELL BUSINESS DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL 11 SUPP Y El INDUSTRIAL El CONDITIONING ❑ (S(Specify) DRILLING EQUIPMENT ER El ROTARY ®A COMPRESSED CABLE R PERCUSSION ❑ PERCUSSION (S(Specify) CASING DETAILS LENGTH (feet) 4 DIAMETER (inches) 177 HT PER FOOT D THREADED ❑ WELDED jDR�IV{E SHOE LJ YES ❑ NO W EYES C SING U D � NO YIELD TEST _ HOURS G.P.M. ❑ BAILED ❑ PUMPED COMPRESSED AIR 7 YIELD (G.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST (feet) Depth of Completed Well // in feet below Land surface: V 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 1 �O ry�.. =11Cj If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE W LL C MPLETED 6 Mn)�o REP RT WELL DRILLER (Signature) A17A NUN. MAY 11 To /UT 4 ' rvcroA-R 4 .1 0WINOWM91TALI SS A 4u W OF PLA40U VA CON DO ....... ..... I,X LC 49 .3" APP A17A NUN. MAY 11 To /UT 4 ' rvcroA-R 4 .1 0WINOWM91TALI SS A 4u W OF PLA40U 2 As 43., -6-74 oie PUTN'AM. COUNTY DEPARTMENT =0F HEALTI Division pf Envic4nmental Health Services, Carme% IV.-.'.'Y,., 1'051 =2 CONSTfiUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM' ),L r FI.G (, Town or VJlage' Located at v— own 1 N � _..�•� �-,� -,• :n '-4 _ � �•sr ':"'�"'� - Block 7 Subdlv.ision o�sW�i- T��/+ F tf_ Lot _ / (',Job Owner• ,� ®✓ Q• �AiS�� ( +B�G o Address ��ff. C`]UaNiQCV'l 8uilding Type . QC lT L'ot Areak'Ll fo� Q,R:ose-y n Number of Bedr � Feet Separate;.Sewera a� gx r z tc s s s a w width trench ge5yemto al5ep . <h ",� 5" a: ^� ��s ®E'12l11ae� To be constructed bey, Address - Water Supply'' ublic Supply iFirom ti u i Prrvate.:su to be drilled by `�Z? —T r - sAdtlress', e� Other :Requirements °County, iQepartment of :Health, antl Ithat.4n completion (hereof a .Cert�fi�cate of Gonstrucfon Compliance •sa[isfa 6e submitted to fhekiDepartment `rand a: ,wrdten iguarantee:;will be 'furnished +the owner 'hi; "successors ahe�rs or a s place m ?!good operating _conditwn any Bart fof said sews d�spose�l system durmgr the °per`iod of ,tyi o (2) years'1'iri ZM of approval of .therCertif sate of fCoristruction :Compliance ofhe original system,7or any repairs thereto will'6el16cated as'shown on the ap` rovedt 7en.�andithat sa�d'.Gve6 illibef�nstalled i 'accordance• with t•fie sta "n` "' ds County Department+ of MA 41" N ➢ hva ,r t SL „A'PPROV,E❑ FOR CONSTRUCTION Thisrapprov,l expires one year from the date issued unless construction of� `,revocable'-for cause or may Abe amended ofm&d ffJOd�,wN!nI,,qo nsiderednec slay by xtFie Com sinner of Health .F r,,equire's +a new ,permit ApprFoved for disposal of:dorriest +': ry wage' sand' or` r= .aupply only.'•. Date ;� i t o- o tt:e Commissioner of Health will i the builder, fhat said `,builder, will' tely following the.date of the ' issu - at the; dri(leo. well, described _aboye nd regulatio_ns of the , UtDam y . PcE - R A erase INo��� ildmgshas been un_'dertaken and is 9n11e. or- alteration of C ruction y. a°" PUTNAM COUNTY DEPARTMENT OF HEALTH efi %te �iJ:i .t .r .-° _.= ualia�%iw:' -...w «,.. . .._ter •_.-rR r ^l-X� �. __ _ .. -a . � _ _. ? ��«: "fir. _ _.......�a:P -yw�•. w'L':c�.�:.ty,�wr�:sR�•r'e'ea c� �DI'1�ISTON OF "'ENV]:ROI�l�1�TAD 1�E11LTH SERDICE5 "' °�"- Re: Property o Located at Date Section boa— Block '1 Lot Gentlemen: This letter is to authorize f t'1 -Q �1. r • 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 Lv,ulCV L.LVII w1 L11 U116 ma L Lit• ailU to. Supervise ine construe ciuri of said system or systems in conformity with the provisions of Article 145 or -Public Health-i;aw; -and~=the—Pa-tn,am -County_ San - -- -^ tary Code. Very t s` F Signed Countersigneld:ti. ss Telephone a,LL - k,\ - •Telephon, . _ ,FIF�'Ln . CID7X1,K LIST Late.: ,....r.- ..:=+. a:. : r ua ...".' _•. -. .. re J �,. <:..,..N.riaa �....,..yrn.cv -,.. -• - -•.�.: ,ran _ °. Ins, bv INITIAL SITE INSPECTION Yes No Comments Property lines or corners found Can .estimate house .l_ocati on 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: 5.9 7 1: T- FIXAL� SITE INSPECTION ins b House .located where shown on approved plan- SnS l )ca:ted where aTprove 1t4 �. .. •.. - �- Width of trench average .Slope of tile line and trench acceptable Room allowed for - expansi on trenches _ Over 50 ft from . swamp, watercourse - �- --• .. !� �z7'cz °3t31 ^-ii ..d'-o3''•'St�S' cl,��l,° unnecessarily graded . . ..10 Ft. maintained from prop line and j 20 ft. from house . , Separation of trench from house, well etc. follows -plan. . .. . . Number of bedrooms checks . . .. , . . ,.•,4 A. `l Stones, brush, stumps, rubble, etc. greater than 15 ft.., from nearest . trench o 15 _ t . of peripheral . soil horizontally from trench Junction boxes prope_­ly ..set Gould surface run of from driveway, : roads, ground surface, etc.-channel. near SDS area Does lot drainage appear O.K. in area of SD,' . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES K;....�.,,..: f<tOUNTY"OFFICE -BU2LD'ING yrt� , DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. S-1 6'L 90_1 Owner 1- V,2_4 q ,1tj , CQaAddress )b 6 01 ' 0 Located at (Street Seca ( Block ''� Lot (J indicate near s cross street) Municipality. SRmockm ocj[e� Watershed Pays W SOIL PERCOLATION TEST DATA RE's ED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Elapse Depth to Water Water Level No. Time From Ground Surface in Inches' Soil Rate Start -Stop Mina Start Stop Drop in Min. /in drop Inches Inches Inches 1 211' a- a3 3 I1: 1S )0 a3 a4- 1 V :?S 10 1 to 3. 5 1 2 3 4 5 Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. DEPTH 6" 12" 18" 2411 30" 361f 42" 48" 54" 60" 66" 72" 78 ti 8411 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES unr.P Mr) 1 HOLE N0. HOLE N0. . • ^- 7,- ».'�- ^...��. :au .a .;'-5e - .:.•�a -r- •ar'.+crir . .. -..s. :�,�1: -� _ ..:s Cis -';., _.. --.x -r ,...,q::; INDICATE IX4L AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH ER LEVEL RISES A TER BEING ENCOUNTERED TESTS MADE BY { -� �(' C..� Date a3 ca c-T ..- ,.«..z. �a= .�— ..- ..� -..o.: - .,..: -..� ....•.. •.�:.!�i.S 1.kai`!' c.:... .., ::— .- .•— • »....... .. .. Y` ..:..-- `�:.:,:::y »�-r. � .. -...+ Soil Rate lf'Drop: ' S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity — Gals. Type Absorption Area Provided By e L.F.x24" . ench. I? Name igna ure Address �� �. SEAL P �J THIS SPACE FOR USE BY HEALTH DEPARTMENT T ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date 7, 48 L -T Ivb Ae CT 4 C-A 1/ �lj PN stP7r' �. 1p. 174 ;'r- 178 110 JUNCTION BOX . 1 04 L A 11,4. - PLAN rc MAN)AW COVER 4 MIN M1,4 F IL A P41 1 A S E Cl'i 0 N i. a0 t CONC. "W SEPTI�-' TANK 6"C "-- 1) 'w RT1% aL.1,C PAPER oll" HAY P PF,"-'R CL GPj.-VrL. i R ABS-" RPT tON TREW-H 2, TP 1. ah NOTFS L V9 A�A RFCULATIONS OF THE c,­r o4 4,,-_, (;0UNT�!•DFPART1,iFNT (D7 O HEALTH v tx% T -r v 5- V� SY:;TEM SHALL N()T 9I SACKFILLEC) UNTIL INSPECIErl BY DESIGN kp PROVED ENG!N FR ANC! iIIE LOCAL HEA1. TH DF-PARTNIENT OF REQUIRED. SYSTEM Si�j 0� A 90-9-- GAL U)N sjf�ril; TANK "Ti CON A -T. qF--3—,F,r WITH AO'k6:,XINIIJM ND SOC) F C" Pj:TcH OF i/IC' PER FOOT. DISPOSAL, SYSTEM GRADES RILFERENCED in. Vj.Ni'SHED F!FfST F 74 FLOOR ELEVATION ,UNLESS O'1HFRWI'*,F N. T FD. r--2­3 S.D. SYSTEM FOR VAL PET ECO'.�1R.Colz?. TA 0 N 1311 C75 S W. f�. E OR�- N ut X-2 Cl-ml SEV SG REVISIONS IL "T A u me-f k o 1-4 box f�oojtal.s 5 ET bE- Low �vsT. -I h IL . 1 04 L A 11,4. - PLAN rc MAN)AW COVER 4 MIN M1,4 F IL A P41 1 A S E Cl'i 0 N i. a0 t CONC. "W SEPTI�-' TANK 6"C "-- 1) 'w RT1% aL.1,C PAPER oll" HAY P PF,"-'R CL GPj.-VrL. i R ABS-" RPT tON TREW-H 2, TP 1. ah NOTFS s (57 EM TO BE CONSTRUCTED IN ACr.OROANCF WITIf:THE RUE'ES AND V9 A�A RFCULATIONS OF THE c,­r o4 4,,-_, (;0UNT�!•DFPART1,iFNT t-Lj tA V., c'j T-­ wlNir4 ic, z'r- O HEALTH v tx% T -r v 5- V� SY:;TEM SHALL N()T 9I SACKFILLEC) UNTIL INSPECIErl BY DESIGN kp PROVED ENG!N FR ANC! iIIE LOCAL HEA1. TH DF-PARTNIENT OF REQUIRED. SYSTEM Si�j 0� A 90-9-- GAL U)N sjf�ril; TANK "Ti CON A -T. qF--3—,F,r WITH AO'k6:,XINIIJM ND SOC) F C" Pj:TcH OF i/IC' PER FOOT. DISPOSAL, SYSTEM GRADES RILFERENCED in. Vj.Ni'SHED F!FfST F 74 FLOOR ELEVATION ,UNLESS O'1HFRWI'*,F N. T FD. r--2­3 S.D. SYSTEM FOR VAL PET ECO'.�1R.Colz?. BUT Of ".VHS 1311 C75 S W. f�. E OR�- N ut X-2 Cl-ml SEV SG REVISIONS HOWARD A. KELLY, Jfl.' ASSOCIATES f "T A No. DATE By CARMEL, NEW YORK TAX MAP NO. C72. BLK NO !L OT NO. TOWN OF AA 7 s �('?aV4--( -ChWL Wowing N.. 4 :m D Lv 1 14 Ao 5 -7 -507 And ap CI 7 - 5