Loading...
HomeMy WebLinkAbout3393DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.08 -1 -37 BOX 27 03393 1_6 I L 1 L_ , ELI L� I 03393 ' r ° a "k PUTIVAM COUNTI Of'Enwronri►ental t �r E CERTIFICATE OF aCONSTRUCTION COMPLIANCES FOR Located' at "Owner•" Separate Sewerage System +bwlt by j ��� ` Consisting of { BTU Gal. Septic YTank ` ,,; Other requirements '` .r ' ,,k *`••� r„ 9 m Water Supply PU-6 ic- Supply From 1 F 3 *Prrvate'Supply`. Drilled ,By �? Address t , Buildmg','TYpe ' Has Erosion nt rol Been C ompleted? Co I certrfy that the systems) as Iisted serving, the above premises we ' ! attached) and'iri accordance with the standards es ',an regul `' E � R `h. �1 i '� �,.� � � k�`�/�� iii.... )x'� y'•C { - f { „4i.. r,.�, avanaole aria; ine, approvai or ine. pgrva[e wacersupp�y - snap oecurr s subject 3o modrfication or change when. in the judgment of the r F + C 4 1 'Date DEPARTME!, 4. HEALTH } gal th Se ,vices z Carmel --N; Y­70512 WAGEr DISPOSAi SYSTEM Town or'tiillege T ` 9 ti$eCt On � �•� � � BIOCk� .i n .. ``� s, yr. �o, •/"/ � y �/'i ✓G' ~L�i . �G 1G ^Q'� -I Address 06 k � •�� h I heal Feet.'X a s width trench is [ ',..I t a ^i o � � � Date Permit Issued J ' f ` ^• • n on the plans of the complet ork'(copiesof which are ..` gaits filed a \i it i by.' the Pu m. y';' epartmenL of Health ; It 1 90FESSIUNP� �, y �% 'PE RA ►U EDE ,ti. License 2JERNCREST OR IV L i��$� u actlo as maybe necessary to secure the correction of any unsanitary, jygg �s ll�¢ null and void as soon as atipublic sanitary sewer becomes and void3when�a `public water supply ecomes aJailable.' Such "approvals are missioner Health; such cessary revocatio ` mo ifcation or cfiange.is ne , a `f .. rr - _ v _ .. .. _. .jl: • ter" s .. _ O- er or Pur-cfiasero Bing Murildipality Buildin Constructed by Building Type Section 7 Block Lot GUARANTY OF SEPARATE SEWAGE-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 on 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.succes- sor.s, 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 :Wade by me to such syaterq; except where the failure to`operate properly is caused by the willful or negligent act of the occu- pant of the building utilizing thA system. The undersigned further agrees to accept as conclusive the de- termination of the Director, of -t,he. Division of Environmental Health,_ Ser- �vi ces of -the �utrn rr -ifl my °D partme-n of- Health-as to whether or not tie failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this G day of 19�(� Signature Title If corporation,.give name and address)`- hOr-Uj_ Qf �Gr - - - - - - - - - - - - - - - - - - - - - - - - -? THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS - BEFORE CERTIFICATE OF COMP1,ETION 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 \k£tA . �,,} ir' 1" ,3 'J ,7f Y t FJ ' -' •5."iz- P ry.�.'�"5+�"""'S'a9r° .r„"[_' J �^`�ai i^ 'Y.' ,a,;, ^_' -Y �i... 3 � Y $ }S. _. l {' �;:,_ � i � Ly �ti .511' B V 1k...,�� 4F. C 1 �R � _ ��� .{ F 1 1� � .iP] �T C RY.. d- ,p t `F "f �:..;,} S �'.'3}? I' � ' R 'b. F '7'^Y r fr"y . , l= fi ?. r F „ .! 1�'^` 'M Wit. •• J . ' . A fJ . .F, , .5 !te ;- r. F, w. "}.,� -r ,' ,k� i`'.' { t, # 1 J.?� F` t..,�''°} i' i t - �. i ,i i b" A x �} 1. �` t1.. $'i'. y 11 4{ T `4y. f Y '7. C r ( " ! --,,9 Ya 11. .1 S L/ .:i 7 1 li`. q fi, 4 n C S I L1 'yt.. l�r ' r "] 3':. Iii t' t ' '7 r 1 '., i, �i. RN.L• .:A.+ vU ,. -5n \. .,: .d+FS y Ct.",1r, l : \1 ., T \ �',.r rJ ';Y e` x( 'a aA Y { i > {•t `{%\ ,� Ja +;.4i 7 ,Y 4 'i'< G Yx h�'q,'f ,i+ ,�(+Y,L 4 y '} i \ {,. f l D Y ( t `�`.jy J. 7i ly. lj�l f t �. �+ }'� Y 4-: 'Y C rr ti ; frP S"i:,. }t t �k yf 9 f .Y `l.. 4 • :1 1 2�1' Sn 1 Y 1 .0 \ ! 'i + f ',a, l i l+_ r i 1♦" k t ¢\ t 1't 1 S t y a,: i "r ' 4 i! r' -� X31.1 P t C r _4 t .�, . t t c t k ,° 7 2 r J ,\ Ct >J �l et Y + t i. 13 tr .�'i�}1 F b -. u tt a a n }y': �t , "S)�y n�� I " ,0.. �3 n, i F \ a i 'a `Y : i ¢ t :. i }S "'t ' Y,.Alni�tU t y rt F y'x 1 r� 1'tl Y i >1 b�%:t4.� 1 '.,J i t',k FH �-r 'l 0.4-.A j i!' 1 tb jS ." f fit . : [ V T pfG�,t f ., i i }IN''i ',} t Lt' a + f l i.i� "s? .' k ^4 11, ?si , '„ '' "'.�,',�.;• A, Eft Y\ a.{i :\1 i� i v:Cf -�.S A. I ,f r".. 1 WELL COMPL �iON i EPORT ' PiIT- C ®l1tZlTV ; ®EPAR.�MER9T;OF HEP,LTHt :` a gti� ''- :, s`}„ l -1pp », r +, ,J 41 e t 1 ycx �-, �+� ;:3 c 'l)+ ' .. 5 3�7Et Y'r + d� -R {'"� R7"� : i i } L� r 4 � i4 }x 9 �:t� t .fit ; �.lSV"` �b '«, l.. rt i�\ Dlvislon of y l: t O w4�7 ,Environmental Hea14h'Services r t L , ) r ai ,� \ t 2, c si r 11 .:b N 1 :, 3 a i, 5 3 S, ,y ,.. .\ 1 t t '. ti '� ! .: l r d .1 �.'.Y j y \ III e \ t F'� ti '�.; �.. a } $u `NEW- es K.' _ ,_v _ i _ COUNTY OFFICC BUILDING CARMEL YC ►RK -t _ a•y-?:� . +,. a, .+ -'P+: n;�A' -„-' :s-. -r st- •rr' =a. 'tr '?v'�. . e'.q j.^os f +4 i Tn �.,i^„ r 3l-- '.a < - +.l ..t %',1 T ' �` _, ,' ^., ; .)'"'.r'i�. .,4, - \, , . t ' t ` GThis re ort }es to be com feted b <vvell; duller and submitted to_ <Count Mealth' De artmenf1'to ether- wlth;•la6orator�' re ort of ' ?- , \�'n ,fir p<;r�, pM y P 9 r, P. , Y . z s . -. t r •. a r analyses of water, §ample Iniiicating;water , is of satisfactory bacterial quality before certificate of construction coinpleance es Issued �iw }:.I''1 Ya`+` .e y i. '' '�.9k�E r'� 3 1r .'S E:. K" ? #,: .A ,; :, d r ^5 ,!•. \. ,.2 ;,y J4i k 5 Vt � \,12 ktt }:1 �,ti -5 J ftt �,, �t tREP �� NiCiS7 BE:SUBMB�TED WI�Ii9N 30+�1�YS OF WELL,COI1t9PLETB.Oh! - 1 ,� r i t x ,�` yt it l� Mf y , y'^,r ?'.' „} r y a ,?' , , �' [ i !i+ ! t >•• ADDRESS sr t 4 t 1_ :. 11. NAME a ; A e: z ., p Y �„ ewwi ;xr °Er'; c ' t r. �� (7 MJe UL:D IVL L =1I ' b�' U {'u N' Y ,,10 � "'; s e <, AMR. mat �� f r rid `'; \ Q )fit $17 p,, , s >1 ;a . fi,..,,, +s .-n 1. r y.. b .r _.. t iS� F $t a„ ra. t ..0 .+r}! 7 @. v x - Y 1+ E G F . S,«. 5 c "5ka- x n ) \ A y i +.r t t* t'i -. FY r m : i6A+c F.. ' ,F it\ t r:•agx .S+N, �,t ^Y P ' �h5 + . j "ti (No 3 Stfeet)= ,t J )(Town) I 1 { v f 4' n (Lot Number) .4 LOCAT @ON 4 r z i r a } �( t Sa 1 "y, r'OP WELL it3�JVaELL r' ' l i L sj r ��r��rr rallr�LY, Ir,o Y l���l- s �rarl t x t ,y '' 1 !f` r i Sim ii \ 'n t hti. \ fx y L' :� t C if Nl. Yl $:� 7 E uc ;. � 1 y n f T': .i( Yi .,- L 4 1 �BU51NE$$ i ­10h; at t y� t ,{ :. \ ?i uj r 1 " .rF 4t } i .f d yi i` 'r 1; t \ tJ" ,�r{. m a ak t G D C� te'� PR ©POSED ) ?.-,', aer DOMESTIC ESTABLISHA4ENT FORM o' TEST WELL ' M` 1{: \ 1, s : 49 y r1,^; 4 ".� - JL` tW it �1 ..i t+ t r t ift,• �1)1 Y k5 5.a" �qCC �, .: USE V'P' \ ]t 1,_ ry^t !. ?2�,. {'1 � , Y`'l ;. ! ,� } ti{ YA', \ Yxf ,1(. -,� j1 \ F t J,td 1 1,, .. I i i, lh� �W �fi'�ii ltl ! !'J \. 3'( ', ' M . fl WELL'.': 11. ,.t off; t 11 \ { kz AIR " a iPUBUC a tiE 4 � . OTHER t y , s � t " 5UPPLY Y 4 IPIDUSTRiAI y i� ti r 'r E tl y } 1 + . A•' \ .;, 7 : K L CONDITIONING , , (SpoafY) � � yt ! :1 4 L : \ VF1 k i 5 1 k, '. 11 1 S ri } W 4 ,7 I . !* y 1V E�'' .Wf.�4 �` .. I :DRILLI@dG 4 4 9 r�. (t r GQMPRESSEDr�+ r n r Uzi k ,' c v 1. a <� c k ';, a ', .1 4 x K, CABLE f; xt M 07HER 't 1 ❑ sEQUIPiAEidT E a _ ,PERCUSSION ray + ,k ?(SponfY) o- , trti r w E:X'' F;. .;? r ; °, t':,I' :r.'....; 7 RCITARYx.�t,,, ,'c' AIR PERCUSSION4 s t k . t +.., x� s aK': x',:r i 5 " -cfi: -a•A rp . w z . ?,iN ,a .. ,.- ,:t'r, a : .' ,.: t :;• " , � .n,� a .; `r . , . a ,r. €.: >,. +¢e ; t c r J' .. r r CASiflG t LENGTH roef �'; DIAMETER ruches _, WE�wHT�PER FOOT .. _ i t ( ) } i ) t1 p ukIVE SHOE CASING: R UTED? i , V r, a� _: t" , r _ k /i y t 1 F' # f a C 9. °; DETAILS "i..- ". 1 ros i t i 7 THREADED ,WELDED . 'YES NO r YES NO;t , y. ", 'hn. Y V ktrit"., r hS �T.y '!,+ �� e (F v 3YIELD -t 1•} 1't V F S ?:� / tT� wY'.�N t`x+ L. . d NA "r5,1 -b `t) t 1 R�' , -Fv si15>k5,` Yk 'iv . i°' , ,1 FlIhb, +�'i A. .)„11'%,t. i U tF. .iLk.1 Srt1 a �' A' r „A ,F Lit "1xn l:. a, C. �L 1) et�' k j�1�{. J -`.i ){h f� ) "- \!{.��, h 1 `�;yw`ll{ {# $q,. .Y .. �. 3aM^ j�a. C..Jrt!C fi'1 1 �1� t t� W _ xk� x,TK E Y .:�:.^ ,"'Pb'y k :y t :e x t �a HOURS�fG P M rri f r x YIEL2 (0 P M) C�rf k: f TEST }l D BAILCD Erq S s et O ,PUMPED s� COMPRESSED AIR , #° { ti ` S sx,Ntf' ¢� . �n} �'1 7 '\ Litt xi .,E f GC A 1, /:1 w, <.,`�t 1 ..L .�:.:. ,._ ., k -.E x ,...4 �7' S� , .'S: } .:i� F�.n,n iclS ,.0 . ,1 A.Y•I:... -_ 7, x♦'t` �a", h x. Y }tiS f''t` ,C• 1 ' WATER`; MEASURE',FROM LAND SURFACE' )STATIC{Speclly lest) DURING YIELDtTEST leaf)? is i '. '`' + tti', " �rX , e r t '. ';. 1 " f s. �r} s .T r ti� Depth o'f Complefod WeII. `, }, a+ Ea I ° I i :� LEVEL : i v r:: iyLvv , Z {i L 3 + ti r a }�� t, w +i : . -` O" u v ,' ,r, e in feot below Lond surface` T 2, s' *'° •.r, v . :,,. A - =r.�,., ,r..tr� { -;r ty r }�� '':' <_ .;di ,. m ..�:�' .r ?k_.5., ,: r+f .'n.,.., �., taX v.' ., :. `5...a6 .,.,?s •.... ks, a v. 9hTS`, ,, ,z YI 1 A. J d '.- h S -Y.'R t r � ")�1?�: yt,*r sa } ' 11 I , MAKE i r "I IL `a ,tiyrx �.( 't "': _1 t r ''. A�" rm�. y io� ,it `) i ':r L r L .. a, ' y ' LENGTH OPEN T,O AQUIFER (le ©f) t I ^e, Q YY 4; -' A t n.' # ; C 1 r oR y' t ,. f..1 t \t..} V 41,-. I. '�•L it k 31: ,^e k MM1 'y .'fr .�i t .. �{, a.H 't'L .v' >t'r. 'S kt'T �.� �3, J. F 1•- 7 1 ; -, A �. }t J r, SCREEN: .5 1' k.: t" b. ik ,\iu:. r,>, y. k t x Y i, yr s J t Y 7 I , is s y , �, - c -{ �' i r "w asF +.. ;',? .,lH h,. t .h;'µ, '� r _ {r u 11 + . , } l. x., DETAILS % ,a..:.- ,. ..:. .. -. c_ ,1 ,it4' - _- a, !, , SLOT SIZE r;. DIAMETER (Inches) .` { - `' Yv ,t +. j'k- GRAVEL SIZE (! nches FROM',(Ieot o poet a #�� ) )fjva' ) t S t Se iF.GRAVEIr Dta'meter ofwell intludm -11 �a `3 s tit k ` r4 `-F 041,. Sy �•. "" 't i nt Xu+r igha [. t 'A 6? i s t t r PACKED Y ra,v I ack 'Inches . 1 r ( i ) r.: d s� s r r, Lt c {�9v�SC ,t; ,c r3 s ° _ t� m'fi :'. 1" ys K. _ ^, DEPTH FROMaAND SURFACE ° ' ` k '^ s a with dlsfancos gig gt tdast Y�Y ' ~v Deno FEET F +a FEET [1--- hFORMATION DESCRIPTION $ V. 'S'.,a. y,fi} ` (wofch f) $rtertr8wefl (�I T!_ fl a Y to aft a v ..� •_ 1ri Y:: .a, $.: e Ma I r - "' ? v r1> t, ,3 ' l , ' 5" s r {� � A ?,C r ',ham 1 r y r e 1 erbu ,deny I", - Jai k ,r. 1_ i'S3 it. r.,,a al\ %s , 1 t,r k w y. , y 4 "\*.. ' / 'E 5 i,Y, M 'r� J d ' :\ F. SC '.t } t" I i �. "i 4,i af+1 S S Y. E t .- y� '. ,i.\` h tHll;'1'%, � ix „a y) r"17", t F d t.. '- i ! 3`d i ?7'.'A �tt.Y '�[ �rl,A fy" :. t j t v iN {_. n�^kr a1 /), t I 'F .: 1 Sr''k i'.L.L.'" a+ rL uF 7;e} �r � ' ?+;'. F 'x ^J m r.:t'#1a „� x Ly"�? �«� ''Yes 4 ' � X : 1„y' ^�'4' a Yy A P J fti'i` �° ai4"'W i `;: Cf+ `.t. ,i 1- '\. .. 11 ! Ill , �nw,�.t ., .""'+^ re WrVR < ,� Y 1 t` `' ` ' J y 1 .It `) a 6,t +'t :-, ", S w' !0 1' S M ' y[ r+ : , ! ,�' t `k"t,' ! i1h. '4 h `'iY , h R 7y da I, r ,>Yp i d<' kc✓ C-1 xC - Y � .,y �. y 1y a C .. r y my, „ ' "Or: d 'K,..* < i +f4 Q' "q11._ 7Y" `M�.` i ! R�;r � apt �wyr a , tsfi a 49� i y 4Ps - y M � o Y 4 y k ur S , .t, : S'.,. y4 '{ j"Y -k r "'l R f& k '\ }! i �� v } j Jit SL i 5 L F s•r .4 �' i 3 1 . 4, ` C y t. i > 1 1 If.;. is 't J t "` �y IS ��'. 0.7'S' 1 446:. i y * u J 3 i �) )'teY }" h: ti i ' 'r t ' } -.,. }`� ?y ,, 9 Yy , , Y 4' r. -& •ri M�f4C�L ,c' -, ii _s'�G F s. t.: a ,' ''� 3t _ , i 11 t1S 1t \ t t vs # 4 5Y �1 sat, rF 1 �. i �{{�� .1 �. 4 i 5� ��� C't�'1r 'ik tl Ztl }�Ca' + fJ� tt -r S ,�.�? 1'EP 5 's. •>; y IE v'. s C-43X ~F%i r ``,a - p. �� �." � Anv. ��ik' a-, f, r +Y \.n+�t" ,S'g'zM`'t a4 ' {l yam. S- } H i S t t k - h. \' f r I '' S. \ Iv S� ,. tit , i _ �.y't 1 M 1 i n+ i ,'J t i f t :. R, � S i F - g - t ' '. f ' 7• {f �; r J ,� t" .ji F F X. l 9 1 f I f A a it •` lql� -; 7 - A i �*`' Y 5 4' J k e} i 1 l ', Y 6 1 4 t ,z I sy4, ,7A F 9 y 44..1" 'R i `+ 'R a E i H �y.,, } d 1 d _ Y T,,I':r .,"y Y - j� �' r t \ .. Y 1. 't4�1 ) # 1 n i k `< A _h tl Y" _• oc� 3,'K } Ut f 1 •r t tll }�4i 1: `; \ifh .J .+ 1. � £ J'dJ �i 1 41 t4 i .` y4 F..i 1. J', ! 4.r�t)dr #.A.�F ( ) t.!Y y 7 `$ ). h ,G 1'4k 2' 4 ) 4 �\` i..h fi :.f ;,tT4- ; "+: k 3, 7��?. ti `Y t ik .'t ' 1'., S ;. fo `- a, ,,^a Y v. Y ' tf. - - F .1 ' ::ag xk} #'� • L`;, �'�, N'rS{ s i YI lC,t _ rt 2yy �' , 'y,. ii'Fw N,,FF�. tr y.t 1114 f'�� k; n. ruuShc $ yJ �}! =,,�. }i tli.i. , y,t {t, ?J i G 1,;.`G t• 1`1 r.)} 2 A •.a 1(ty T�� YYT1 p,.:) }it k� ., �f t U"E #,� a. F�� 'ai f 1 r`'�a %. }I8 '^e y{. TL A4 P Y, ih i r V 1 P t. i3., ..{+' A Y;,�, k,... 5 y,< 1...Y +t �. fiF 4 '�4lti liy'.,1 -'1 't }�SN �G k l *i �� 33Y`� i ((P \•. J" k:,''J,ui ii ry Y' h+0 {.: i ",(' , J v{t l S r 4 1 .` �y~;� iN y° �. .P:F A �y �M .,.�. ha#, i "d`r1: k } , G'e �� t }S . S'`'' i } }' y six �i b, H, .`, ,1� 1 1f1ib: �'..�igae� 33 '., S r r q:r�' rwZ``x`dt. �,riY r. ,� t , iK{+riN�l �, r. I'll Wyi ,� z t. G.:, -,.,� 3:.FR x' ,.` >;`.., §.� �}' r 1°;.0 J �z a e``r J 9� tjk ,f \- ,N. t'^ et. .' .. w' `n t 9�,," 'i �n`d\ .. ° a- .µy '} ,+: 2- s 1 -: :z .i\.. k tk+..xi,;y 'yl 11 s '�}� '� l Y',.i4 r, t?2 x'" yFS ✓.. 'x.. M.! y " P �6 may{ +.- u A t F 'S l F T i : T i I �1 it�N 43 �� ..a1L` "uI (tom 3. � �' �,y1 { e . L� F . •'' = -`a '� ' . ` t `" �"r i`- "3 s C' 1 If yield was testa'4i' idifferedt'tdepths dunngl driller ;hat &'6o I % i "' PER MINUTE ' ; >`yd1 1%�.e :t% 7'All 1*14,`113-1 E,I i.il 1�3 iU1 +, d ' FEETia `'� x ya _ ` , t; w; s +S�'.'.7;�,.;, � ,ti<;., r `�,-- :;,'+ '��� rt,� .'fit .,ins.kt31 ;I', f . iGALIONS R W(� ( ��i r l r, , ,wx .11 :. �5�:rti- .,gip: rl.- x r 's . ," 4.: 'F _.y t ] 4 ;. L J "'. _.. t. ... 9 r „ ,v �'. e'r �^•,i '.fir SS+ ,Y 2 � i 'A+ F) r i i4 ,t `--. n 0 - t �.CI t 1 y ,1, v (t1'..� �J "`�• Ht*' PF 1 R d" !+ �• !i t( C 't'•T" k "] t + �r+., 7. }- i -aR d: 1't• }J i r ' 't r 1.re1�i , t� r , < y(, tp t k ) rt,� �. d lei y 9:I Tt,, itrv^ :.K P - 1 I<F bl�;"S' t Y J R r z '1'. Lr: t t 7a sw ..1 a v'�' r .'�xl Y ,� y 5 'h' n - 1- S. IT. ,� Y'i`' S�3""' t `�w r ,:M -*� v ,A ,:♦M' , � C } uk'.: Ra ! I ., f ¢v + x t Mb t,.4 . ' _ .M1 yy .. IJ' M�J' r \, ��.. fr n S` 4 f ,ff } 1 n t i i # 11 } -- '1 burn i11 i 4 r7^ V } 3t; 4 Ct r''sx Witr 4+1 x ! 1 ii tih tp t3 ,.:Y t:} S` �a:_h h 'i W :, y ,F _. �h , e F � ms,µ ..uri' k yf.' , e ;. r7h .��". i e+ ) r # _ I r . �i Il }�i�5t i w4 k C, u r . S,., , J� . s:,, `` day :-+' ,xk.;`c F =.,1 t ,j s �._% r # r e � o a € §. +{ 3 'wt 3 "#� A i S At i f ; r r I Y �.1ni•• 3 T 7 .j p vt, �n Y '4i t� i )1 �I A t Yf F ..r- 5 I .v � .r r r i � t i" r r u i i a5 +i f i ° J v€1 ak F t 1 t ( r 11 ._L .L a� A R.. , 4 ,� r 1. �£ 1 _ ` } ,*. , 4\ "A .I - F�' 4a" t s: tr: T _1, L 1 , ! ! i •y- J k �i l S .ti ' (, + I Y „� Y F Y _` 1 - 1. I y k t d T� i 4 � Px i Y. '1 1 d;' 3t 1 I .; 1 h t �-0 it A!. f .- ai a;r 1 1 i c.' "^3' , i -: T ..r y ¢ AM:" .F.]1 �t T� ",`,"Y' : 't 1 i d t": ".. A- H' ,,�{ 1- +1,^. 't`+T ? 3. C %_� °'' tl $ S 'Iv' k +- `GATE W L�GQIttP �A, fiDATE OfT REPORT WELL DRILLER (Sigmtu +r v.: �• a �. f JJ-@ 1 y.. •s f. #, J }, .� i47:1''t, ^ t 1� ; y.sy ��s }� x v S I '- a -:,, -.1..} 1. r n:�,� ,y 1 '�I , 11 =i. t , L i., 'i'6 tw-,A ., ..�. ,_- t ,.. J 1L �.. i•.: -. �, ?1{ de: StA )T' § e w 4,.i�,A y r, , ..d i r } PEEKSKILL MEDICAL LABORATORY ' 1879 Crompond Rd. Barclay Plaza Bldg. A, Apt. 1 > ! Peekskill, New York 1.056E -" PE 7 -8777 �r RESULTS OF EXAMINATION OF WATER DATE COLLECTED OWNER DATE RECEIVED P, Dcku 1 C19LLAGE, TOWN VOR NAMt OF SUPPLY DATE REPOR D OS itii -c ` d• V t 1-e / � 0 bj- $AMPLING'POINT i 1J -e-( I BACT8RIA PER ML. (Agar plate count at 350 Q. COLIFORM GROUP (Most probable 96. /100ml.) RD S, TOTAL - ppm DETERGENTS - ppm NITRATES (as N) - ppm IRON, TOTAL - ppm FLauRlue (r') - mg. /i. I These results indicate that the water was of a satisfactory sanitary quality when the sample was collected. a e S y� A. H. PADOVANI, M. T. (ASCP) SMAN•THIME 2972 FERNCREST DRIVE (ORKTOWN HEIGHTS, N. Y. 10598 '0/ TOWN OF E) SULLIVAN. - 7 CONSULTING -C - Js, 4`4 ppf r: ell m 1>4�-Yz!!:> �7 -GALLON SEPTIC TANK L F Xj':�LABS. TRENCH SMAN•THIME 2972 FERNCREST DRIVE (ORKTOWN HEIGHTS, N. Y. 10598 '0/ TOWN OF E) SULLIVAN. - 7 CONSULTING -C - f i Js, f i i ,,,.. r.� r-�ye � ,.' - „- .: -- F• .:: 4" { yr; - p - 't4 Y CONSTRUCTION PERMIT F.OR_.$EWAGE DISPOSAL 'SYS,TEM 1� 6 i Subdivisions G Owner 'Address- •Building Type % > f L, ot Area elf �L�i t8 L$nvr i of Bedrooms } ..NUmber Total Habitable Space' separate. Sewerage System to consist of Gal Septic Tank lineal feet .X o be :constructed by Address. hater Supply. Publid :'Supply,•Frorri Private' Supply 'to be dulled, by t )ther' Ft equireinents IV i CAP cis w w represent that 1 am wholly and completely response r esign avid of the proposed systems) 1) that the bove described will be constructed as shown on the p e• i m �n accordance withl thestandards rule ounty "' "Department of_; •Health, and that<on comp fio" tfSer a =? rf f61 nstructon Compliance, satisfactory t ;e submitted .to the Department- and a• written' ara tees. _�_` a ner his successors )heirs or assigns by, ilace�m good woperating;•condition ,many part {ofty wag � �i� 3the„per`,�od of two (2):years lmmediat nce�of_thetapproval of_; the_Cetificate =�of Const a�' n "C � e�� r�y� I system or any�repaies' thereto; 2j "tha Al? !f �+A sL`£•; 4k yta yb�k Of wiz. fiSS10Nr dr,r s}w rT WNW p ti`.y • Address „�: M ^ •, .' VED FOR CONSTRUCTION This approval expires one year from,the date; issued unless construction of the le for ceu`se or may be amended ormotlified when•consi necessary by,tle*`Co -missioner:�of Meeltti 'Any, is ew permit Approved for `disposal of domestic d y wage n r e water sup ly s ly r ? ' , _ 2 a.'.0 or' �Ilage l °) r. •r "Square <Feet width trench, `q• L 4 „ R p z F } i separate sewage. disposal system) san regu a eons o ' e.,, ,u nam o tFie,Eommisslonerof Health will. the builder; that said budder will ery followlig the•date of theaissu +a- t drilled,well; described' a bo ve_ Id,.regula�iTons of :the put am . a PE RA r P icense No (ding has been undertaken ;,anclAs•' nge. or alt ti, i tconstruction r, go PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION, OF ENVIRONMENTAL LTH- SERVICES f: ��. COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET-SEPARATE e /SEWAGE DISPOSAL SYSTEM FILE .NO Owner �t°i . /Clt� S ,'�; 16 Address !; /"% !p� �ri o-� �� Located at (Street Sec. Block 9 lot 4dicate neares cross s ree Municipality /mss; SOIL PERC r& ION TEST DATA Watershed��� !_�ia/ �✓'do'' ED TO BE SUBMITTED WITH APPI 5 , 4 V Notes: 1) Tuts 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. Hole Number ' CLOCK TIME PERCOLATION PERCOLATION Ran Elapse No. Time Start -Sto Min. Depth to Water From Ground Surface Start Stop Inches Inches water Level in Inches Drop in Inches Soil Rate. Min. /in'drop 3, 5 , 4 V Notes: 1) Tuts 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. or= .,:�- a�wso.n,,,.�.,.....�,.�:.. o.d...�.�:� -k,,., �x -'� axe— �u..- ri,�::_ �.,.. _z- acs- �:.:c"��`.,�,.r, ... •, � -��r ;w. . x,.....,. �.,-=_ �. �.► u- .t',- ..�..A'�.�:.::.M.h�+.�vF ��ra:�: .._tea,.:.: �..- ,- .�,Q::.. DEPTH G.L. 611 12" 1811 2411 3011 3611 4211 4811 5411 6011 6611 .7211 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. HOLE NO. e/ -7,8" - - - 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH ATER LEVEL SES FTER BE ING ENCOUNTERED �se TESTS MADE BY �u /`rah iPi e Date L�� 11i1V Soil Rate Used_e,, Min,/l "Drop: S.D. Usable Area Provided S"o ©O SF 'F No. of Bedrooms .,,3 Septic Tank Capacity Do69 Gals Type Absorption Area Pro ded By IS-0 L.F..x2411 kd,14 %trench. Name bignature Address RFST nflIVF SEAL Vn111/4n111N � IPOTPS pl���As;,__ _ THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq.-Ft/Gal. Checked by r Pk Q` A9��• 2382 \�� 81 J_ ��a6 to PUTNAM COUNTY DEPARTMENT OF HEALTH ION —& EIvVI ROiVt ENTAt A ;TIT =9ERVI E Date / -S' Re:* Property of Located at - Xa a a Sections .,Block 2 Lot Gentlemen: This letter is to authorize �'"�' ��e3 -7- i G� 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 o:VauieV41V1� w.iLfl L1115 MaLLet• ani-i to. supervJ.se the construcCIVIL of said system or systems in conformity with the provisions of Article 145 or 141- - Pdmatior,-- 4 Law, theF Public Health Law ar1cT the Putnam Ccsu;� iy 'Sani= tary Code. G., 0 � 1� �' Very truly yours, F " /vr� ' Signed Ow er of Property Address �s Address Pt OF bF� 2972 FERNCREST DRIVE VQRKTOWN HEIGHTS, N. V. 1059$ �o Telephone 2 3 g9 2 yOFtss�ubp� �;e a, T - rrnr�. rr1<•. .Prop ;rty lines or corner's found Can estj.,rr-,tc: hou:,e location.. .. . V il). driveway need cut . . . . . . . . . . . . MuSt trees be rcmoved -note these . is deep hole reps esentative of entire SDS area Au,c1:i_t;_iona.)_ deer 1�alcs n�,edcd. . :W. . . Sufi- i.cient SDS area available considering driveway cut, house location, separation . distances, etc. , .• . DE ►:i HOLE L y�A D,:pth . i•1ater elevation: rei-��- Rock elevation: 0' 'Lls descri nti on: Da to: . T:YrT•.TA Y c, -r nTTI 'rn7n -n-. /r fnT^�T n.,pTo;� u-. �, �. t�„ e- >Gciti� ►rc:�rt� ;�..e.:....xi� douse located llhere shown on approved plan SM loca.ted''t.here approved ... .••. _ Vaaflli.a yr VJ. Va_V'la •..v(..r4 C1 I �.c .... ... • .. '' ` _ 1.1h /Y'1'1•. I4• ty...r �h n..n .... .•..n .. .. .. .. ._ 1 1 Slope of ti l:e hi r--6 'and' trench a,ccep ±able Room allowed for expansion trenches . . • ' Over 50 ft . from swam), watercourse - Natural soil not stripped or SDS area . "- unn 10 FU-.. ma- intained from prop.line and 20 ft. from douse .. . . . . . . . Separation of trench from house, well - etc'. follows plan. . Nwnber of bedrooms checks . . . • . . Stcnes, brush, stumps, rubble, etc. greater -- khan 15 ft. from nearest trench . . '. 15 �� L• . of pJ ripherai soil horizontally from trench Junction boxes properly set Could surface run off from driveWay, roads, ground surface, etc. cl nnel near SDS . . . . .area .... ... _ 1�)o°s 16t dr. aina.re anrear 0. K. in area of SDS FIR ALL GRADING OF SITE ACCEPTABLE E® RED 151 CHECK SHEE`f.' i •6 Meets Std.( Remarks es No Rouse plans 'O. K. i Design data sheet Peres presoaked? ; `! Kin. � .30" perc test depth j __`_ Const. results for 3 runs: D. Hole loo; 0. K. Corporate Affidavit for other rthan: individual i 4� Authorization for engineer. Letter from Water Supply if applicable ! � If variance requested -such noted on plans & apps. j/ DETAILS if change is , proposed, ) (show Existing contours shown new contours) Slopes for driveTaay, cuts, etc.. shown . I ,ter service line .location. Doting._ drain; etc., location::, I `i'op . slope, bottom slope of fill ! Percolation tests -and deep test pit location Septic.tank size and conformance to std. _ 3 -D.R, house minimum House setback shown 1 JLUJ_ -Wa l;eY' �•!J. LIM 11 jv _L 1, , u t-U .. bi.Lvw�..L i -4!_, Plan.and profile SDS All other, dells and SDS closer 200' Property boundaries (metes and bounds- clearly shown SEPARATION DISTANCES SPECIFIED ON PLA'v 10' to P. L. 20' to Foundation walls _ 100' to Nearest well 50' to stream, march, lake, etc. inc'1 15' to Curtain drain 10' to .water line (pits -20' 15' to storm drain 10' to large trees 10' from foundation to septic tank 5' to pipe from leader drain & foofin 0 .expansion); i , i i ! ,r ` A;0 72f ESTABLISH ELEVATION OF�HOUSE'T.O. <PROVIDE DRAINAGE & LOWEST, FIXTURE TO SEPTIC TANK" AND FIELDS . .. :;AREA RESERVED FOgiSEWAGE DISPOSAL- " SYSTEM TO mREFAAIN UNDISTURBED - pit` CpNSTRUCfION TO CONFORM JO STATE -AND LOCAL. STANDARDS AND'REGUL'ATIONS l t Qf a . if,5L 1. .'! f �' rer. r.' Z30 r tr� w o w MUGS: 197}'. •urnn lee O l Ya ReA°.�1 �seYz.a a j vj.c 0'� 1:' ham. ~ o ci�lirnnsrt>flv 4 We4z a/yfY4MFNTer f. • f EN J' A117� l 41 o -.:� , c� �: 1 , 'i�� ,ice N � w .. t `�, - •� , {� 7^Gt9G / _ /4 • v 07 . 3 4 PI�OPO &ED .r �� ,f�? �� / = a ,7 /�'ORi x SERARATE SEWAGE DISRQSAL SYSTEM .. - i - .. �ciSW,.��{ �'SrFIT�✓� 3'6GT /ON -�:/.3 %•O% .S /�: O P.E�aatyiar/•`r�� fy` r T¢WN'.OF %3l�7 .%Mt Ye9l Yi r:' I tail.; d ' f rta n1 s.4 w '.? Iil COUCITY NEW'Yi9RK p -r6 1 71 ` t tDAT 501La#'ERtALATION'.R''ATE ...... :....:.....:tAIN�IK r, . O OD'GALCON;,SEPTIEbTANK CONSUl,T1WG�. -ENGINEE�tS :DEEP. ..f n t /Y© F I, • � • " -- - ..•:. :. �. �;'..z . - r� 4L�:: T'�W f/TS ..pEt7 YORK .•..° ;? a i t . r d7l , t. I• ie