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HomeMy WebLinkAbout3389DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.08 -1 -33 BOX 27 No oil !7- mi -�'y�T I� �� ■ r IL 1 IL r� .1 me t. Em 6. r 03389 7 *1 �r 7 - 'Vo j"_A1,: �J, 4 Q t'V W" -'T"nh EN J1 V 4 "Vm".7 77. 77 - . UNT,,Y,,,,,..DEPARTMENT D iiasion.-Io of Environmental Health Services Carme% N "Y x'10512 S Qc z ' + ­Vl J M ma wi;� AL 777—qe ­Tow LL, on "Locate at 4 q"'J- 7 j2j:;�! A� V; J' 77, Owner,--:- Job NAddress P S ,System -built -,by' 'Separate Sewerage _ Width tlench )f , Consisting I _,'Septici Tank --b 7, U­ I AA lAtAl M., b I ,, .,VStev 'SUPP1,y1:,,.: Public .Supply Fr Private Supply; Drilled 'By.. r3 t Address Diie Peirmit I �4 0. of. AddVoorris 7�� S Building T_ H'ai'siAtr"Osic"in ,Gohtrol B" it6rii`pk6d�', L certify that he system(s).as.l�sted serving the above premises . , were dbi&V6te 'd,6sbntia`ll'y as sh'dwW,on' the plans of the 'complete-,d4.,qek, (copies o' f which are a ) � y Ahe •pu nam C ounty,,Depar 6 m int ea ittcfidd and j:q a�rp aA�:the pprp -!k�up `2` R.A. bati%,­ X 41— 77 7 77, 7, 7' LlCeO14' 0. Any person Address ' the above ­ .s. yq,e(.q j ­ r, ,b ­ 're the correction ,i 0 an y unsant conditions !�P 54Fh _ U�ge Xporqva 1 of the` isep t sewerage Y�iA as :soon a­,a.'public S�q'a �Y:�e wqr ec available angthe approval of ;the, private watqr$upp I y.sia I J,pecoTe"p�J!_jn(jVQjd W pp'# Public water •supply becomes i4alliblk ,Such t nodifi6itidi or the thb,CoMhiWonev of Health, sucWrqvqca t iop modification or change is necessary 3 Title' By V y. .......... % -E-E :MEDICAT,�p TEEKSKI LAB, T4. - - ----- PS�7-a77-Z A46d 2 4" �lw k -6:J7�b DATE RECEIVED T d, Stream Bul b 5/10/7 �W VILLAGE -TOWN - ` li-VT DATE REPORTED S. 1�4 s SAMPLING POINT Putnam Talley - BACTERIA :PER ,.4,b;fL . : (k plate count probable 3 less than 2024E SAMPLING POINT POINT OF TREATMENT JQ, MGM-ES-(C, w gp RI, -p 0 A -47 i N -77 le: w.-I as collect e, 5A, lu WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK '..:^.��._,:�'#�isT�'�p+ war, s�to•��a:i�'�f�3u= t;<i/°�Gea�l �lm)i-0�c»a?i�sLpi;�vlit,:e�e� f�ouF1t'r�'�{- tie; t�►* �` e���t�Tviesat�td�th�• e- witiNia��3�is `i�'��rr€�o�r�n:;����;= -; 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 NAME S' A. 81 kL-O(,4 ADDRESS V_ Ik L L Qi,J 13 LOCATION OF WELL (No. A Street) (Town) (Lot Number) PROPOSED USE OF WELL DOMESTIC ❑ SUPPLY BUSINESS ❑ ESTABLISHMENT ❑ INDUSTRIAL ❑ FARM ❑ CONDITIONING ❑ TEST WELL ❑ OTHER DRILLING EQUIPMENT ROTARY COMPRESSED ❑ AIR PERCUSSION CABLE ❑ PERCUSSION OTHER ❑ (Specify) CASING DETAILS LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT f • c THREADED ❑ WELDED D I E S O YES ❑ NO MyEs Lj NO YIELD TEST ❑ BAILED HOURS El PUMPED COMPRESSED AIR G.P.M. 2 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: J / SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (feet) 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 Q S v FCC If yield was tested at different depths during drilling, list below FEET PPEER' MINUTE GALLONS PM /0 ra; C.-PM DATE WELL COMPLETED Avg j `7.,3 / DATE OF REPORT ' n • l . WELL DRILLER (Signature) n Q `1 n _,_ _ Owner or Purchase-r - of bui_Lding Municipality o -e-�.. Building Constructed by Section Location - Street e Uovx C_ Building Type Block i3 .. Lot GUARANTY OF SEPARATE SngAGE 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 or, 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,successors, 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 occupant of the building utilizing tha c\.7ci -nm The undersigned further agrees,to accept as conclusive the determination of the Director of the Division of Environmental Health Services of the Putnam Countv Department of Health as to whether or not the failure of the system to operate was Cu'�sed .by_-' tote. _yy x p .r1 1.ig.eri.tt t -.,o f the occu pant o��the�li,� it d tii� :ut �.liz.i.n& :�he.:- system.. Dated this S day of -`' 10 5 Signature G / Title (if corporation,. give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF. FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health LA '. �� fµ �, t v .l � -.c "�L - ``��,tKN{,. '�?�'{�p" '" ®4;., � s,, •.4i, rye. ,#' .,. .,� 4 ; . y 33 y ' .. ... ._ __ . r•.m..., .. ....... a .w a .i t "�. #- .. ivx. -rN ��� 1'7"n"• *t. ^.:_ "+r r' l a u � xt �� fµ �, t v .l � -.c "�L - ``��,tKN{,. '�?�'{�p" '" ®4;., � s,, •.4i, rye. ,#' .,. .,� 4 ; . y 33 y ' .. ... ._ __ . r•.m..., .. ....... a .w a .i t "�. #- .. ivx. -rN ��� 1'7"n"• *t. ^.:_ "+r r' l a u � 7p7( �� 7�� 7� q (� y �7 g� �y �Q+p �w []r Il1�1�M i:®4NJ H ®�P�Y�Il 17IlLi11 A 3 1C �1L�llH� r a Division of Environmental Hea /th Services Carme/ N:: Y 1.0512 CONSiRUCTIOIV PERMIT FOR SEUIh4GE ,DISPOSAL .SYSTEIW - own 7 r r'• —,� I%rii+'.iv :u � Section ` Block g Subdivision �JOS:�c �5� `�' Lot Owner] CA�i C f.. S `E �e 7•lt.0 Address Y(;�) e `7' `�•�i O i. L W (�� . Building-TYPe Lot Area. 5�.�' ;_,9��i�i•E�Cti 1�i (�`�.�.� v Number of Bedrooms AA Total Habitable, Space Square Feet Separate,:Sewera§e�.System_to consist of II `- t,"fD g_ � •. ;;Gal. Septic .Tank. lineal feet .X � - 'w.idth trench. . � To be - constructed by Address' Water Supply: Public ,Supply From _v Private Sur ly to be drilled by Address a� Other .Requirements : MtB. • , .CRnr .r• .i3 , vv� o.: Us>� S ©s 1 I represent that 1 am wholly and completely responsible for,* or the design and location of 'the proposed system(s); 1) that the�separ`ate sewage disposal system ' above described will be constructed as shown'on the approved amendment there to and -in accordance with�the „standards,'rules an _,re)ula, ions o e' u nam County Department of Health, ,and that_on completion thereof a "Certif�cate:.of Construction Compliance” satisfactory to the;Comm'issioner. of Health will' 4be submitted to the Department, and a written guarantee ,will be;.,furnished the owner, his successors, heirs or assigns by ti a builder hat ,said builder will , place �n good operating condit�on`;any part of said sewage disposal system,dunng She period o. two (2) years irnmediatelytfotlowing the date of the is9u- mice of the approval of the Certificate;of ConStruct�on Compliance of the ongirial.system or any repairs thereto; 2)'that the drilled ell describe above I'll will be,loceted as shown on -the approved,pIari and that. said well will'be'nstalletl 'in ' ccordance with the standards rules regulations .' 5f'-`the 'Putnam County De'partmeot of Health . p Date Pl- Sin P.E. R A . �.- g �y Address. License N ` APPROVED FOR CONSTRUCTION, This:approv. expires one year,*.from the date. issued - unless constructio .of the building has been undertake and. is Y_ revocable`for'tause or may.,be amended or modrfied.,when:considered neces ry by the mi 'oner of Health. Any change or alteration of„ construction regwres a ;new er , Ap roved for disposal of `domestic: sane e,' An or r' at ter supply only: Date ° By Title M Gentleman: PUTNACOU PTY DE'-P"TPMTT OF EEALTH �, Z7 -DIVISIOIT OF 211T.VIRO,\TH;=--N'TAL HI'ALTH SERVICES Date MOq Re: Property, of SLO F-, L-L- E-s:j 61 Located at SW e7 L-.L- A Sect'-ion Block i Lot 13 This letter is to authorize a d uLicense-d' -orofessional enzine'-'- U -31. y r r re-ist-erad architect (Indicate) to' apply for a Construction 'Pernit - for a separate -S =T Teraz- system; to serve the above noted property in ac--o--dance with the standards, rules `ons- as 1- "n- ^o, 'he Putnam Count or o-ulca t 10� U U Of U U Y D P a rt m,- n � of Health, and 15-o sizn all necessary,- on' my behalf in -�he, n of sai -;conne c -�-fitlin:.*--'thi, S .--;--rrLa i o --CL system o.r S17- f A-rticle 1L,-- or .11 4--rS in conformi'C'y withi t-he �Drcvl-s ions o 147, Education taw, the Public Health Law, -and the Putnam County Sanil.- tary Code.- Countersic-ned: J4 Tr ZA rjjt*WqWAW- .Addreds qio phone -1), Very truly yours, Si gne of Prr-6pe.rty Addrass e_:� Tele-ohone :�.:��:.- �.M�..� • ��:, F:...-. �::• �''���CT���Il�'r"tI+��A�;�H�;,�: ; �,;_ �, �. ��::.-= 5:.: ��;.= �,;, �:: ,;z�5.:- .;,.;.�.��.,.;:s:a.i�:= Yeas *�'� DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM - FILE NO. S1941_6240 Owner D o s Uj CL L_ CAS a S Address J?�, �5 � t t f did i.' d�J Q • Located at (Street `6eS 9_,tj fZ4- • Sec. G ( Block Lot 13 indicate nearest cross street) 11 Municipality �U� �� V �•'F/1 Watershed A k% SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water a er ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 19144 it"5& 5314- g 4/e 3 ((' ';q i y sh jo 1 2 3 5 3 4 5 Notes: 1) Tents 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. zI =:�.�- ��7'•::�;;;, TEAT. A.,: FF�TJ?RED�T: 9_ ��' �: SUBM3 :T.�'F�%:.:�1TTH:�A,P,1'?, TIC' �I' I:r J• N�;.., �:; �.. .�:��.r_,t.�•:�.:.:���•�,.. DESCRIPTION�OF.SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 6" 12" 18" 2411 30 36.. ` 42" l: 48" 541 r 60" 66't 72•• 78" 8 r ,. "At' WTtCH GROUND WATER �IS�ENCOUNTERED . T . _.. INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED n ::TESTS MADE BY Q � A _ :j:CP1 C C- CA . Date C,, t \01) DESIGN Soil Rate Used -10 Min/1 "Drop: rea Provided a�O No. of Bedrooms 15 Septic Tank Ca �actT t.,::} S. Type- Absorption Area Provided By -:I" L.F.x '4; ;s width trench. ; �e.��,�Et s �.crsw..... . (iheLpu.a razz Address S.� THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by Date PLAN I. 1 ' MANHOLE COV •i•,.__. " I �''•w: +.� LEVY ;•3.. _ MI v" JUNCTLON' BOX N i2 -le" $0 1— U E CAST 1 ` -z .. 22!}.5 `•I SECTION SANITAR i 4 : p�� TYPICAL CONC: 4' PRE -ca: i L.C)'rm c5 OF 6ANk.RL1N •y REINFA" SEPTIC TANK s v, DISpoSAL:_AREA •4..:.:..•_.�•..,.:_ IZO u Is IoO..djA:u. JutilG'jlol�i- aRU`LEVEL S o . �,, ' . ; *•,,,;.. Cy- ANSIOwI� �/ `..E,A7IG �TA>s 1 EARTH /��'`,,�` ,,,ti,12E.SIDE.ISCF '' "4 4' •lam .1 . 1 1'JC%�.+°9 BACKFILL COVI i•- '`,., I•.,, 18 " -b0' BL DO. PAPER h� s �O` \ 1 'S'af 6414 d, PO4S 4 • S G i 0 a 1 A " a�A 7a�u'. PERFORATED PIPE ,.R.',•, _ X60 Q15POSAL AI? A' ' `1 ^•` X24 CLEAN{ CRUSH `. I o,,. ABSORPTION TRENCH • ,•\ ��� \ .` �,� � _ NOTES 9 _ P. I "Z! f?:. J . SYSTEMt TO BE CONSTRUCTED IN ACCORDANCE WIT] 1 A� r Y _ U "°°D R£GULA=bON.3 Off THt '�U'�NAM COUNT' Lo. °f 14 `.ti,TJ:• �``k �. \1 It�C OFrHEALTH. ':•. Nf BiALTHE @AC bE AE T ALTH RTMry ,ER AN � LOCAL HE NOV 151972' SYSTEM TOaCONSIST OF A.. %$oo GALLON SE AND 00 FT., QF �_ FT. TRENCH WITH R �i 4 33 �� " �A /�yR "OF H SPOSALF SYS.TEM.EGRADES REFERENCED TO 1 Z2•' p0 {Sd "'o OT _DIVIL HN FEALT PI • 01 d' VIRONMENTALHEA Eml�FCac FLOOR .ELEVAT'ION , UNLESS OTHERWISE N S, S, SYSTEM FOR /F s,a —rvq REVISIONS HOWARD A. KELLY, ; oF� ASSOCIATES _p L.Q NO _�T e� CA'R E NEW. O r" ii -fj- Cii• TAX MAP N0. 6i- BLK.NO. I 2. TOWN: OF .PrQ ,NAM OL.0 G 3 edMn r A. ea oA5 AiQ e.p 'j�3 yak p. Chkd. Dole BUOY: T7 pad Appd "MIN. ly EE r -coNe. . B/W Ll I VEL OR STONE iE RULES AND EPARTMENT I BY DESIGN REQUIRED. IC TANK' AXIMUM NISHED FIRST iED. LOT N0. 13 towlnp Nu. , 17W1 63.2 ' :: -U-33 �t f i�