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HomeMy WebLinkAbout3384DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.08 -1 -28 BOX 27 La� , �� ` 03384 Ott MISPOV 5- Which -show hasho _1215L r 3my many 00 " Some my Cot ir W-F Wes AA / • .ti � ,� � ri E fL' ,r � . N K ' 1 tti y� a t n�. _7' I ~` LF ,. ,y MAY 74 (NC. U �i PUT UI' lii:iljl F C ;? : J. ._ !'.'^ sT 3899 y0 %i I CTOR, DIVISION Of ' k: E li .v i i� [ . ; `,i f.. qTe of NE #R NMMIAL HEALYN 0190W . .. ;''. - ' -- � � � � '.., "] i -ter•; , ­7 Z ,2Z _C6 n e r or'' Ila's 6p. -of 'bulldfn,'r VU i Ti c1pal't ;,y Buildi' n g Constructed t6'd by Section Location treet aP4 i 1 d in9 pe �_ i ' ' _­ -:11 Q) ANTY O� SEPARATE' SEWAGE WqfUN pqent wholly and qonlpletply re9ponsible for the location, I repr 11, . � -1, ; .1. " I . � 1�!. wprkm4pship, material, cop. i drainage ­of ibe sewage dispq �,a' �;ys em ,_q�ruct on and serving the above' des.c'_irl I: pe0. p lopep_y ppO �.baf it- has been constructed: as. slicmii on the approyqO- plan'or apprQ d!�,L pcjanee witli. the ptandiird aqie' nt- thereto; and in aQop rules and regulart.ions of thq Putnam. County Qqpa."btipelpt of 'Fie E.4,p b, and 1-�erebv gqfIrpp-Ly to -the owner,.-hip 5ueco��6r�, heirs or 4sqjgpp, -�-o place operating c()ndition ­ - I I I I .. successors, I operating airy part of said systerp' f Oj c) qpp�trqcteO by me which fails to operate f or, a period o p- , initial use q f th years #m.poiately folldwi the date I F - dispps�al, syptem, o .9 19PWa9,e any repairs made by me to such qyqt0M, except where the failure to operate properly is caused by' the willful` or n q; gqjjt t �qt' b� bq occupant of the building utilizing top The pj-)dq•signed furtheP, agrees to accept as qonplu5ive,the determinatJon of' the Director of the L)�.L,vipion of ETlyi.ponniental . ffea'16 'Sr_�rviqes of the Pa -tnam Count -Departmert of Health as +o whether or not the f a il ur e o f ithp qyptem to operate tyqs, pse . "b w qilding,,utiliziT)g -the q.E d' y b t 0001i P'it of' t Dated t d f 1Xo!.wX- 19 Signature X5 this 46r .4y 0. _Z( Genero Contractcel. S1 haturefi Septic Co Actor ib, d' d' g,�_,4yp name an. a. dre A 7777-77n,7 THREE '(3) ;:COPIES ARE RE q1J 1 RE D WITH THREE,' �3) COPIES OF FLAT, PLANS BE FORE CERTIFICAT OF COMPLETION WILL, BE TS SUED .. GUARANTOR IS RE, QU I RE 1) TOIFILE NOTICE OF DATE OF FIRST USE OF SYSTEM. ------------ Pfv#iQp of Environmental, Healt1i Services, Putnam qqijrlty j epartment of Health r . 11 PEEKSKILL MEDICAL LABORATORY 40434 1879 Crompond Rd. Barclay Plaza Bldg. A, Apt. 1 - Peekskill," New "Y6A 1055 : • - PE 7 -8777 . DATE COLLECTED RESULTS OF EXAMINATION of WATER 5 -11 -74 OWNER DATE RECEIVED j nTirrsTna 5 -11 -74 CITY, VILLAGE, TOWN VOR NAMt OF SUPPLY DATE REPORTED 5 -14 -74 :A,HMYL11V la YV11Y 1- - LOT ## 18 BLOCK 9 8 BACTERIA PER ML. (Agar plate count at 350C). COLIFORM GROUP (Most probable N6. /100ml.) LESS THAN.2e2 ES , TAL -ppm DETERGENTS - ppm NITRATES (as N) - ppm IRON, TOTAL- ppm. r Luunlur. tr 1 - mg. / 1. These results indicate that the water was yes. of a satisfactory sanitary quality when the sample was collected. i WELL CO''APLETION REPORT PUTNAM COUNTY. DEPARTMENT OF HEALTH 3(71 ' Division of Environmental Health Services COUNTY OFFICE BUILDING CARMEL, NEW YORK - �""""" ' T` tit r' r�I5Y5Ptt+` fi��^ CO' be•' �iStYilitiyt" �' ti" i39° vv�1i^ �drifi' er' 2nci' sli6�rtltitea° �to° CaLrnty�Fieaitii�DepariY" rr` en' �togeffyer�WtYh��iakioratary�r "eport "i�r' =�° ^� -�� 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,AM,E +' ADDRESS ',,/ /9U; /4 �r /97 A/1 LOCATION OF WELL (No. 8 Street) (Town) (Lot Number) PROPOSED USE OF WELL ry L J DOMESTIC PUBLIC ❑ SUPPLY BUSINESS ❑ ESTABLISHMENT El INDUSTRIAL ❑ FARM ❑ TEST WELL AIR ❑ CONDITIONING ❑ O(Specify) DRILLING EQUIPMENT ❑ ROTARY � COMPRESSED AIR PERCUSSION CABLE ❑ PERCUSSION OTHER ❑ (Specify) CASING DETAILS LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT / j�j M THREADED ❑ WELDED DRI E SHOE-- YES ❑ NO j� L�J CASING I U 7 YES NO TEST ❑ BAILED ❑ PUMPED IG]J COMPRESSED AIR HOURS G.P.M. YIELD (G.P.M.) _ O(/ WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) /`Cj DURING YIELD TEST (feet) Depth of Completed Well in feet below Land surface: `t1� SCREEN MAKE LENGTH OPEN TO AQUIFER (lest) DETAILS SLOT SIZE DIAMETER (inches) IF GRAVEL PACKED: Diameter of well including gravel pack pnches): 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 7i i f7' �w poU-S� If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COM LETED DATE OF RrEPORT WELL DRILLER (Signature) .'I . t x` PUTNAM CUUNTY DEPARTMENT-OF #,EALT- H Divisions,.of Environmental Health Services, Carmel, "'N Y 10512 k T z �COfVSTRUCTI,OIV- PERMIT .F_OR SEWAGE DISPOSAL, SYSTEM .? , _ re %s > own or- - s Fyr /i r a 1 L •RCat at _�SSCns:6's'P+:fk w'^ Z.....c. '" �•a� �_sYl saC'A - - \-f� ��., v , :.tL . _. H%- r Subdivision '_ iJ��. `. -`: - 1 - V Lot. '� ! ` Job Owner� �` Address l� i Builtling fype� c L gRrea i �t-C► v 2 J 2JC - .. .._ k Number: of Bedrooms # Total Habitable Space 1 Square Feet i Separate Sewerage System to co !s.t of d% : -Gal Septic Tank lineal feet X s- width' trench To be constructed by �, Address f �iLtn! Water Supply Public °Supply From -,Ph ate Supply to be dulled by Other Requirements 1 r' r - + Igrepresent that I am wholly and completely responsblfor the des�gn�tand location of 'thepro.posed systems) sl) that the separate ,sewage disposal. system 4160ve described will be cor structedtas shown on the approved amendment there to antJ`nn accordance with the standards,'rulesvand regula ions o t e; u nam + County .,Department of .;Health, Yand that 'on complete n. thereof a rCertif�cate of Construction C_ompl�ance satisfactory to the Commissl ofrHeaittiwiii `Lie submitted to Kthe Department; .and 5': wrAten •.guarantee;. will tie ,furnlehed the owner his `successors heirs or' assigns by the builder;. That said >.builiJer will place ain, „good operating: conditiori= any `part of said sewage di spolsystein during' the period .of.two (2) years immediately - following the date of the issu- ante oE':fhe approval: of. the Certific'ate_'of Construction' ,Compliance of tFie original system or any repairs thereto 2) that the drilled well describeG °above will be located as shoain on the approved'plen and that said well will,te installed m accordance;`_wifh .ahe standards, .rules and regulations of ;tFtie 'P,utoam . I County Department of Health ., r s Date a a 5�9 -R E R A fi ,r! S Y R Address `u 7 �” License No, 4 ? ?� A_PPROV.ED FOR "CONSTRUCTION This approval xpires "one year from the date ,issued unless construction'.df the .burltlingw has been underaaken and is revocab)eIor cause or.' may be amended of modified when considered`necessary by 'the Commission 'of Health.. Any ;change or alteration of -construc tion `- 3regwres a new permit Approved for disposal or omestic a e Y an " r psry i :wee ater: ;u�gJy only., K -tDate 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 deer holes needed: . Sufficient SDS area available considering driveway cut, house location, separation . distances, etc. . DEEP ROLE DATA ` Depth: • . Water.elevation: Rock elevation: Soils description: i)ar e FINAL SITE INSPECTION Insa. bv: House-located where shown on approved plan. .. . SAS �.nC'A.fip�. t.h�rP a�1T?rOve . Width' of trench average Slope of the line and trench acceptable . . Room ali.owed for expansion trenches . Over 5.0 ft ; from swamp .,. •tercou=e- :. �Va't-ura17 soil` not stripped or SDS area unnecessarily graded . . . 10 Ft. Yaintained from prop-line and 20, ft. from house . . . . . . . Separation of trench from house, well. etc. follows plan . Number of bedroci-as checks . Stones, brush, stumps, rubble, etc. greater. than 15 ft , from nearest trench . . . . . .15 Ft. of.peripheral soil horizontally from trench . . . . . . . . . . . . . • . . . Junction boxes propel-ly set Could surface run of from driveway, roads, ground surface, etc. channel near SDS, , area . .. Does lot drainage appear O.K. in area of SDS FINAL GRADING OF SITE ACCEPTABLE 3 b .. F D CJ If C:K LT EST �.. = Date.: %�.o �..e �.+e+ . - � z+y,r ..: vy �.-e7^t.r:•,�.,•:; �,.w+c�,ei«.e . +, ,:. =r,'. :..i.e.. s.•... .,.,,�:• INITIAL SITL INS PE (Yes I 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 deer holes needed: . Sufficient SDS area available considering driveway cut, house location, separation . distances, etc. . DEEP ROLE DATA ` Depth: • . Water.elevation: Rock elevation: Soils description: i)ar e FINAL SITE INSPECTION Insa. bv: House-located where shown on approved plan. .. . SAS �.nC'A.fip�. t.h�rP a�1T?rOve . Width' of trench average Slope of the line and trench acceptable . . Room ali.owed for expansion trenches . Over 5.0 ft ; from swamp .,. •tercou=e- :. �Va't-ura17 soil` not stripped or SDS area unnecessarily graded . . . 10 Ft. Yaintained from prop-line and 20, ft. from house . . . . . . . Separation of trench from house, well. etc. follows plan . Number of bedroci-as checks . Stones, brush, stumps, rubble, etc. greater. than 15 ft , from nearest trench . . . . . .15 Ft. of.peripheral soil horizontally from trench . . . . . . . . . . . . . • . . . Junction boxes propel-ly set Could surface run of from driveway, roads, ground surface, etc. channel near SDS, , area . .. Does lot drainage appear O.K. in area of SDS FINAL GRADING OF SITE ACCEPTABLE 3 .0- PUTNAM COUNTY DEPARTMENT OF HEALTH 'DYVI §ION OF ENVIROI�MTAL ,HE LTH"fSERVICES ::....,. Date Rea Property of `c jG. - COIAS: eo c: i t 0� Cep Located at" Section L,`�- Block Lot��� I Gentlemen: This letter is to authorize ; .s�� _ ' VC 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 nece-ssary papers on my behalf in vvimt-c L1VlJ w jL Ln Liiis ma L L' ev anL*i to. supervise i.ne construe ciun of said system or systems in conformity with the provisions of Article 145 or "1�b7, 'Education Laid;' -th`e. Public--Heslth Law, and the 'Putnam County Sani tart' Code. Countersigned: # G `Address Telephone 14 VIA IIYrF�A 0 Very trul yo 'pir s, Signed Owner of 'Property Address •t Y!I Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES : -� COUNTY 'OFFICE BUILDIIVG,� DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner l) (�1_. - � -�L c��d�S' ^�� Address Palo a �`� . Located at ( Street �� � . Sec. b��- Block - Lot Indicate' nearest cross street) Municipality Pal oA 1 .0 Watershed �I� l2y�t 1,6 SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse 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 2 1.`. i i '.11Q,- 5 4 f`. 41- i' 12 5 i °. S 4 a: O'-L -- 1 cL 2` iv 3 5 1 2 3 4 5 1, '2.4 1 Notes:. 1) Tests 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 N0. HOLE NO. HOLE NO. CP 121.1 In 24 r► 3011 3611 4211 ME 601.1 6611 7211 7811 I 8411 r'. INDICATE L AT WHICH GROUND WATER IS ENCOUNTERED INDICATE AL TO WHICH WATER LEVEL RISES�AFTER BEING ENCOUNTRD TESTS MADE BY C� (1 .',.. 1 S C- Date i DES Soil Rate Used t0 Min/1 "Drop: S.D. Usable Area Providedr a110 No. of Bedrooms Septic Tank Capacity uU Gals,_ Type �I Absorption Area Provided By s-n L. F. x2411 VES�kt' trench. Z-1 a. KE er Name �e•1r1 rr .- 1 na ure Address �a THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by Date qT �/Op N F`1'1 Date r ALAN_ { MAtJHO�E� T.,p O � { s - t h , i :Pe � t { GRU LEVEL .''� r / S 4q.° 30N 2F7:. s �-" JUNCTION BOX muN.li =IF3' MA N Lot 14 �— 4" MIN /`r ,� , popg WELL '3nMIN...i.' uA'ST pow-, q�� `— f � . S ,1. \1\ i �:.L t ~ \; _ SECTION ' 4H I At+tT? 1 ° a. e m cas TYPICAL: CONC• �•' R ,' _ , - 9 N4 l -•! / j Y / I j._ w l�_ f�,r �jW /1Rklra� tai J } }r�4s1 1 ✓/t SEPTIC TANK J.. I 'I I ' ,�xi• 4 5 x rI To TJN(; .q.yp , ( r; OR 4,- +•+•'F,y , /J 0 r r�7 i Nv J. 'i' r� J %w f J,� -1 ifl '• 'gip .r- ,..:'4 r•'e -_ ^ GRt=. t.r VR.L !P I t � y �� �'% �I-^"" /, -- , 0. ,� . -1 r =� EtACKPILL °� G'GAP4R� ci'` K � a�- �' !• '`•'..,, / ! 1 !.. _ �. t j' " f _, : --•�' SF1)r I :8'•.gd' ©6 bG. FAPrit t tr£ a ^--2 ! 7 , ryJ 04 ?. �..•-.". ,,�L� TR!4 L! e"° Vii HAY \ � r_ , -._ _ sfl Rl JurJcrtot� BvYC rte" OiSr'IIRtCV(16ru ('� (' '}'' I.G MI ia..•�.t".__ CL RUI�U �Tr:-a,.. 74 I i ;y pCnG.uAM MAT! G " ABSORPTION TRENN_ u �x� SYSTEM TO BE CCWSTRt1CiED IN ACCORDANCE WI ti ThE tSlf� RFrVLAI'Ii}NS tjf THE UTN'A COUN } <f? � zs � J _• � APPROVEI) OF HEALTH" it. t SYSTEM `HALL Neil BE BACKFILtED UNTit IN$,±Ii TEI) �. l/ ENGINEER SNQ THE LOCAL HEALTH OEfARTMENI. Ih � 1 - I °T ,� , SYSTEM TO Ct7Pi51, T OF g�29 t',ALLQN3%tC l ➢i f — p r� -� \ JAN'3 1974. QND 20.0' F7, QF —_,3--. FT. TRI- N L H W ITr+:., �t ,�A� -�� '` -0. �. I?I Tr, H 0 F .i /IG PrR FOOT- M;I.i� `� POFQL SYSfEta GfiAi CS. ,ii EN EO.-T: MN , y CH :nrvisloN.ol•. FLOQR.EI.1,—, lCJlti Nl.ES; 0THERWts� :¢! �3 � M1 OiVIRONM[N l HEALTH CCpv,rpl E ���vC.T SYS1`EPb9 IaH VAS NE1 E C4N�T& u TCS : $cr.LE 1 "- 5.0' 1 oFESSio� Rivlssurts HOWaI(O A PLC tiWla J �v Pa A. K �S Auri�ii �+ r �• - I �O PO EC�� F -Nt} l7AYE i fiY CARMt£:L NEW YOR I. UNC -1ION 60x roo?IN(i SET Fk)ST LINE. i N �......._" w T A c ( �_ ._ TAX MAr NO. 62 SLI NO .8 q1 �� $ 2. fill L ARG: TQEES 1J173i lAl 16` GY' OIS/>oSfs _. p't i7 $t 4 AREA - To BE $£MOVF_p. 2- t' ^� 2 j IYaWN OF PUT AtAP7 if iLt�e1� .0 g. /� Q \ ✓V ASroo z n .'y , hk'c! (fate ��r' ;. a. w V - � � E oF., � -e;�✓ ,J - } lucaj_.- «�...... -._ � e +It I