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HomeMy WebLinkAbout3396DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.08 -1 -40 BOX 27 a ll F PO 4 T-A-U&T 1 " -T ,--, IP - JARC>" JF I —NI-I —Aj kfjl�TWRM -.A, m. fv 4 X� �Mat r�Isypp p z� .,ublic',SuOblw P- 0 r, i I I ed B Has Erosion -,,Cd-ntrol;'�B66&-'6dM ei ct Address —t . -- rconditionvr, �ullin, " om such' Appr p" Vp t,he'separSt 'avaablezand the-- .appro4al of the apg subject &—Jrh6difl6itidn' dr-,`cfiaris[e when. judgment Kq, HEALTH fT OF E ST V. 044 4� �- 1 'Town or Village .ction;— Block V ddress Width 'trench --Date Permit, Ilss rshown on the plans P I d, , H , 'a' 0 A ufi v fim�dpun Y-,epar ment-of,.; e tn.- -F 9:? P.E. A I License No ion ',al e��ary to:-sec6fe� the ,correction' of any *-unsanitary k :7null, -vqid- bli qme 404. ijso.q�,.as-,.a§ipu d'sanitary sewer j k t . cl lublic�'watef.',sul bec6ffi-esEI6viHiJbI6., . Such, ap _Orovals are ; such,revocat , daHication or cha4e is necessary. ;7 4`1 0 ;7 nt Owner or Purchaser Building C U13 rw_iV' Building Constructed by 7 rla Lo�ion - Street Building Type Mu icipality Section 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- sors, 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 occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the de- termi.natiLo.3 ;i ,c.f.. -the Director. of the-Division of ..Env.,ronmenual Health Ser- v'ic6's ""of�'tKe"-Pu riam' County" Department*'bf''HeaT h as'to whether or "not "the' 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 _ day of Zul - 19_ZSZ. Signatu� 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. <.. 4'130. rJ" r YORKTOWN,M.EDIC'AL LABORATORY -INC. P.O., Box 99 321 Kear Street DATE COLLECTED RESULTS OF, EXAM INATION OF WATER 4/8/75 DWNER DATE RECEIVED C . CHANG 4/8/?5 CITY, VILLAGE, TOWN. & /OR NAML OF SUPPLY DATE REPORTED JEANNE DR. PUTNAM VALLEY, N.Y. SAMPLING POINT WATER I TANK LOT 28 BACTI RIA' PER ML. (Agar plate count at '35o C). COLIFORM. GROUP (Most- probable No, /100ml.) LESS. THAN HARDNESS; TOTAL - ppm DETERGENTS - ppm NITRATES (as N) -, ppm IRON, TOTAL - ppm. 7LOURIDE (F) - mg./I. These resulis- indicate that the water was YES of a satisfactory sanitary quality when the a ple,was co lected. PER: J. TORLISH A. H. P.ADOVA I, M. T. (ASCP) WELL COMPLETI'0N 'RER,ORT, PUTNAM COUNTY DF.PARTMENT OP HEALTH 3171 Division of Environmental Health Sorvicos COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report is to be completed by well driller and subn-.itted to COUnty Health Department together w4h laboratory report of ;;,Ft %^ ar &Iysis• f "�Ai tfrrsar•Tiplsiii i�a in w�l;tet�is<erf :fisf � �;� y Is �ct�l Ul c#u$lit,�� before cer:tificatecof const ruction- cornplianve REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER ADDRESS (No. 6 Street) aj rJ" (Tartu) (Lot Number) IOCATiON OF WELL L E:41,siYe a 5 ule-11 BSI. 2,r ' PROPOSED DOMESTIC � ESTA6115ESTABLISHMENT ENT D FARM D TEST WELL USE OF WELL � SUPPLY O INDUSTRIAL LJ CONDITIONING El OPQCE y) DRILLING D � COMPRESSED � CABLE ❑OTHER EQUIPMENT ROTARY AIR PERCUSSION PERCUSSION (Specify) CASING LENGTH (fast) DIAMETER (Inrhes)iVrEIGHT PER FOOT, �(D�RIJV�E SHOE WAS CASING ROUTED? DETAILS I '�I 1'iiR[:.DEO ❑ Y <L'LOEf: I_ Lx; YES ❑ NO 0 YES WO — YIELD HOURS G.P.M. YIELD (G.P.M.) l• TEST � FAILED D PUMPED 1^1 COMPRESSED AIR WATER MEASURE MEASURE FROM LAND SURFACE — STATIC (Specify lecq DGRING YIELD TEST (loaf) Depth of Cempletod Well LEVEL in feet below fond surfrca: tzl?O A MAKE LENGTH OPEN TO AQUIFER (loaf) SCREEN ' DETAILS SLOT SIZE DIAMETER (Inches) GRAVEL SIZE (Inches) FROM (loaf) ITO (�eoi) IF GRAY[L Diometer of well including PACkEO: gravel pack (Incho3): DEPTH FROM LAND SURFACE Sketch exact location of well with distances, to at least FEET to FORMATION DESCRIPTION two permanent landmarks. iLC1 � -U If yield wos tested at different depths during drilling, list below FEET GALLONS PER MINUTE - b4 DATE WELL COMPLETED DATE F REP RT WELL DRILt_Ei2 (Sl9natur •� May 179 1977 Mr. Roger Mayes Roger Mayes Construction Coqq Inc. 36 Lakeview Road Carmelo N, Y. 10512 Re.: Separate Sewage Disposal System of Colbert,. Chan Dear Mr. Mayes: I have been advised by Mr. and Mrs. Chang that a separate sewage disposal system installed /by you in early 1975 is in a failing tonditioni, Mr. Chang advises me that You performed cer- f-1,976j.- but-th-is in-,.apprQximately -Sep-t -0 _did. ot rectify t-h e s f-i ua _ tion* . I"t would appear ­ that the warranty' for this system is still in effect. Would-you,please advise this office -of your plans to rectify this situation and the approximate dates that you in- tend-to. be on the site. Thank, you for your cOnsiderationci . Very truly yours o Robert Folchettiq P. E. Director Environmental health. Services JRF/ps cc: Mr. George Haughneyq. P.E.9 Route 529 Carmelo N. Y. 10512 Mr. Colbert Chang, R,D. 19 Geanne Dr.9 Putnam Valleyq NoYb 10579 ;_�^«'7°^-c-�•? 'M^.-'^--. .''.•.v t #. } '° „t '� 2 •-p.• r -.rT ,t L� � -z•* � .� x? a �., '� b?.'� r 4 a a t 'ti, y b "yx a PUTNA_M COUNTY `DEPARTMEN'f:`OF HEALTH s} w D/vis�on 'of Environmen H alth Services, rCarme/ N Y{ -10512 , L, CONSTRUCT E SYST EMS -0 x Y -r.� >r e� �x t 1 r✓ .r A Sbwn or -_ V�Ilage. LOC3tetl' . k e. ��,�_, -r—• -r _ �` Section ` /,j�,/p H oak - s �•.wr�f- . a � s, . .s -#r=�� ir's ; ni 3n- .a u- C-L �''"_. ,a>_�'T'� 11 a^•• ;-3 w, .a,e 'is Subdivision �� L�.s;T�� �$ Lot ob 4 k� 0 Wner ^'lac l"'p.�� •y t. { ,� e� �"kj h r3'k' �" •s •y7 S"� b inc�,��'S, # e ;... � .�[ �. `i 1' i j i � {y � ,� a 4`Y t R �.} T.� � � ',` b } '" t. as " •' F c x , ' y y .Number of ,Bedroom; ` V o� ' Total Habitable -Sppce 5 Square Feet Y s Separate Sewerage System to onsist o ` } Gal+ Sept Tank �' hheal feetX / width ;trench. Address 1 „ a`k�`'..`'a '.. � �c ,� t rr*, ' �. _, z 2m � ,vxF ,k. a -.nr.. �"q"ka5 r° `".e%.11 ?End ay''�,��4� �:c�r N' r _f �a y rah* �• �. -. � y i 3 x x,: s~���;WaterSSUpply �,�„w'° � �PUbIiC'SuPpIY.+FrOm '� "c s mrr y" k1:^ w+, y ,��7 Private- Supply t0 'be druie { 1 �> •�< r y.. b : t. { }.; •r- F x� y Address r �* -�c..• ra-' x 6 s¢ _�„r K- rim .a -.�a -k k 2 a a "'' � ,€ .-`3R '' `6 3� ���fi, �"�4 x � '� .. Frhrepresent that loam wholly and completely responsible for the design and location,of the pro i,islyfgtp s) ,1), that the separate .sewage .disposal. ystem. " a, w, apt ds rules =an ,regu a ons o e " ..0 nam R;3 :will befonstructeand' that on tom 8l�ton thereof atlCertif sate tofaConstac o i,a 'sfactory ; to- -the Commoner of?Healthwill �., Couhty Department o , Health, p �0 .Ii7Rl . J .4 be `submitted •to the =Department and, a. written guarantee will, be furnished the own�,;'t1y s}�Ee lf$, i.. �a signs by the builder; tha.:said builder will.' piace'.lin. good; operatirig condition any ;part of ?;said sewage disposal system during t�epenf of•;;two_(;ys lr►mediately, following thedafe'oi the issu -: ,• a i a ;ance of" the approval ,`of the Certificate of Constructwn "Compliance of the ina�s nor a 'air_ egeit 2) that the drilled well °described above.. =wUl beaoWied4i i"a on�the approved plan and that said well wil�lie instal `ac ld3li w a ,g r Iles and cegula —i ons of; the 'PUtriam COUnty= Department Of- Ffealth {', °` y' 'Al �i?<JK. , r J �s G Si9ne a t :ti a P ES R A. i_^ � � �`'� rt r �' �ikldtlre5s " , -� o- t �. s . � ".. Q r ..+ !•, �..iCense NO: '_APPROVED FO;R CONSTRUCTION This approval expires one year from theidate', issuedily `t+d�3tr�Q �b� -of bwldirig has .been undertaken 'and is revocable for cause or may beA ended or modified when consldered necessary byFS a Commi �dl klkl�tHealth A y than r. Iter Uon , f�con'struction. =regwres ewpermitS "�Appr ved for :dreposaFrof +dome' wageYan o private water supplyonly y' `.` a.s 3r F'`•r -z "S,a, r _fl 4 r"•e,. r'x✓ �' aer r .r'=a r 4y'�. E z 'r 5•- r v § . � c,. . �,,. �; .�„•� � �r Gw. ' x � w — "J _�.�r,� �.-. i5'F _ 1 . -• - - „jr � u5.,.:Y" Y "3+ ,._ .�...�n �.,_.ao..._ «�. .__.� _._u._. _... lu %r _ -,7 �t y�'� Ica �. !•. { j,;;.- ^e.:.o�..^ _s= �a i`- '�::'+ -. 7. > ••d::,. ;:r-s`;;.- .>::p*S a. r: e::Yix.:•i�F v : »4e _ x:-- .,�3, -'�^ 1 {•- fl, 4':.• '� .C. -ts: ar.. K�..i+s «•T� r- _v...�o:: •vii': ' - r.... -. __,3i- .,m.,,�...�,.,•.,•,� ..,LII.e..,m.,..m..,.,� <. >+a.._.la., , y(�1,.�m , 7 L 1`°._""_ � _» d:w�xxP _ 1 � 4'S� ...qty. ._. _.. � „r �� — a..— .....o.....,..• _._. T .... .. ..1— ,'� la 1 •L/ 3 to • . , c�,x,.,- .«,.....�.. r -,e . • N� z s• ' it � /I `"�° •' ..._._..__...� tl r" t €�i 111 fige f l � r. �'�.o.wo-Y ..e.:+x�weo. (. •�,yy.v.'an1x. L•.s^ a i -w =ar- � a.:uarnt+,tx+�%++.wa:�+'C"v, - .• ,, }, tiw . i Q , i Gentlemen: PUTNAM COUNTY DEPARTMENT OF HEALTH .DIV3SION� = -OF °- ENVIRONMENTAL ---fHEAI TH= rSE-RVICES�:= - °.,�-. w ;, Date��; T Re: Property of Mr. Colbert Chang Located at�.', :� !��S ' %;y. i TG� l/yf,�� %/�� y� Section Block Lot ,,2f This letter is to authorize George A. Haughney a duly licensed professional engineer X 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 vwnit!v L1.u11 w-L Sri iiti s ma c LL-r anti to. supervise the construc ciur! of said system or systems in conformity with the provisions of Article 145 or 143,.LEducatidn. :Unv, :the-Public -Health ''Law-, = arid''the 'Pufinam'.Couiity San.i tary Code. Very truly yours, Signed Owner of Property oCounters igr��� ` - ..... ii�lF1',.' Address 'T P.E., R.A.,` #C5 Route' Telephone Address �0,p �I.�. �resS 10\A Carmel, New Yo'r'k ") 0512 (914) 225 -9393 Telephone 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 0, q', r. .1 4i *:it1 v. :1-tio ;w ii"i•.n,. p��•, .MS, ,•v,.�rw iii`: aE,::: i.•+e- � .'din• Py :,y`iv�no ..r •j+n is .::�:..ii+%tily_ �.ia :i7.i. .rii iii..:.•, x.•.v+;, vn,4: >._ COUNTY OFFICE BUILDING, �CARMEL,�N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSALS TEM FILE N0. Owner Address 9 Located at (Street �Sec. Block of� lca e nearest cross s ree Municipality Watershed - _ SOIL PERCOLATION TEST DATA QUIRED TO BE SUBMITTED W H APPLICATIONS Hole Number CLOCK TIME PERCOLATION 1 PERCOLATION Run Elapse No. Time Depth to Water From Ground Surface Wa er Level in Inches Soil Rate Start -Stop Min. Start Stop Drop in Inches Min. /in.drop Inches Inches ` 1 for 2 ..:_,.•. , . ._ ,._......._ _. ,. - _.__ .. _ _ . _ jam/ / .d.r.. y�� W. 3 4 5 1 2 1 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. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES G DEPTH HOLE NO. HOLE NO. HOLE NO. .✓ ..�- ie'.,'•. }.lf�Sll:J •.'rv. -�tf ¢a� �. :A1 ir%tir' :1 �� •.r :. :: r. i.^.1•';.._......Ky .,N`� -,c +i•-a-m- +r.` -.-u a_. .- �� \visr.� .P-`c• wiri :�:..Y..:. h'. �'nr.: « \r.:.in 611 12" 10" 24'1 3011 36 4211 4811 54 �� All' I 60" 66" 72 7811 INDICATE LEVEL AT WHICH GROUND WATER S ENCOUNTERED INDICATE LEVEL TO WICI �R LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY / V Date ., DESI.GN:- Rate _...�.: _.:.:_Usabl...... o:. r• Soil ~ U e sd` Drop: S.`D. e Area Provided No. of Bedrooms C Septic Tank . Capacity Ga s. Absorption Area Prov ded B (r L.F.x24" � USE BY BI,ALTH DEPARTMEI T Soil Rate Approved Sq. Ft /Cal. Checked by_ Type L!%mo _ width trenc . wjia o@�, ,er i 00 pE 0438° :' igFFSS I �''I'i i ► ►1►►►►Date S :, ,p... ..; ,... Ct - _..... �, ..._. �, �� .... • , ._ _ .,. jy.,. ... •�.' '+ j'+ � S� t Mfr i :• -_r :r :�� -�- r�`�i: � ».JF�r.I..V.,�,:.' . 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