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HomeMy WebLinkAbout3398DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.08 -1 -42 BOX 27 i,yti L me k.-illri F . ' 96 ' . �, ., r LAol -V, 7- 8, HEALTH; CPUTNAW COUNTY DEPARTMENT RVA 18caied at _a, � Owner Town. or Village . . . . . . ..... ..... ect R -,so-n` 1, -PAD i Ji , S I epirate iew�ara`­` 9e System bwit Y -Septic h k: 'hea 1. Feet width ,trench ch her -requirement, - Water u, P,ibilr`S6'poiy Fr6rii Private S Ili i B y I CHE�TEft , _ . • ss -Building TyRa, No, of jBedrooms - 3 date per'hili I ssUed ..as, Erosion donirbi, 641iiW Completed? 7-4 L certi fy 'tha t t" n co nstructed , "on the plans of the completed work (copies o wn icn, are attached), a rid in,ictordarke With- 6 standards I" U I f I I e, permitiSiued -by ­ the 16in Department Health. ' A. v RE. Date e A r)i A ..... . �IAddre - - - - - - 04 T �Llcense N 4j Any pirson occupying prernises,,jeryed Py action as e necessary to secure `ihe;tcorrecii6n­ of ag�: urisariltir t ­ y -6dinditi6wiesWtlnj,' n.c:,�,ap!.."� qkF ara ra e system ihall bac l.a Public sanitary sewer, 5UCI p�oyal,.qf-_jnp .�ep .�iMjAa� I n. as - a P1 VojG_ when -a, u I es available. ' ;Such approvals are becomes available and and .void u e. Ith a 5 r t I.- - _h, Subjectl,,to modification oe,� chan t nit;ni Ion or change: Date le j 0 "M Now, -0XV00-y"IN 1. VR>11 Zt , ��z A-7. A AT A t -NOV 'WA NW a 0 n"n QW-M 7N 2 of ;z Ion, IN IM— A son - fturd "M trot A SuM ' 'LTE-41tar >ZA 'Too OW. - Mnl Ilk I PIC , P- IV- o O"M Vok Ilk WELL COMPLETION REPORT 3/7`1 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING CARMEL, NEW YORK !f3 §. ` R w- A. t � �! �. r>ille .ad zuhmitted :to- Couo,lW - ealtti.,Dep, ent tegethe .witch la st ep°: t'rof. :: •_; 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 AME \ ADDRESS LOCATION T' (No. & Street) (Town)' (Lot NumbeiV OF WELL P�nn�'Q 11P�' BUSINESS % ❑ ❑ ❑ PROPOSED DOMESTIC ' ESTABLISHMENT FARM TEST WELL USE OF WELL PUBLIC AIR OTHER. 11 ❑ ❑ CONDITIONING S7 LY INDUSTRIAL (Specify) DRILLING COMPRESSED CABLE OTHER ❑AIR ❑ ❑ EQUIPMENT ROTARY PERCUSSION PERCUSSION (Specify) CASING LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT © ❑WELDED DRIVE SHOE ©YES ❑ AS C S G T DT DETAILS � THREADED NO YES NO YIELD ❑ ❑ HOURS G.P.M. % YIELD (G.P.M.) y~ TEST BAILED PUMPED COMPRESSED AIR WATER MEASURE FROM LAND SURFACE —STATIC feet) DURING YIELD TEST jfeet) Depth of Completed Well LEVEL in feet below Land surface: I MAKE LENGTH OPEN TO AQUIFER (feet) SCREEN DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL Diameter of well including GRAVEL SIZE (inches) FROM (feet) TO (feet) PACKED: gravel pack (Inches): DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET VAA, 17 3C ��13 hod I oCJ I �c �` . '30 131��� sizxvwk If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED DATE OF REPORT WELL DRILLER (Signature) 7. W i . =a. :.. '�<S - !�? ••v (.L,±- - 1-- .._`.... s �T ,...erg.. _ ...._ .. .,.. ,'.. .._ .. _..-.. .. _' :.... -. ' - :: o. •. .. •:..r'. ..;. -..,,: 7.s -- ..r.. .a+•z �. -r ..... v a+..... .-rc -' .. .lr +t- m4.�n '.Yr':- �±�;'z - .•1,,> ?>'h� "t,•' '=- .•.e,:�:. " ' ,'r �.ra,',i� "..°.:.a .,..•...0 :��, fin ;�.2:...�y VA P.Y er or Purchaser of Buildin .Municipality ST►2E�.�� 3 Lt> �2 Building Constructed by Section. TD Location - Street Block Building Type Lot GUARANTY OF SEPARATE SEWAGE- SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material;,construction and drair_age of the sewage disposal system serving the above described property, and that it has been constructed as shown on 'the approvedplan 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 trade by me to such system, except where the failure to operate properly is caused by the willful o•r negligent act of the occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the de- termination of the Director of the Division of Environmental Health Ser- ^vicz`s"�of t`h 'PAnam-••�County Departr:erit of Health• -a -s • to �hetr�cr 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 19 Signature C) z . k A I n Title lli' torpor t , ve name and addr s 1 THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF. FINAL PLANS BEFORE CERTIFICATE OF COMK 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 . PurrAW covrTY n E ���T�E�� �� ��� I . �r Drl%rsion= oOf" nvrronmental'Healtl. Servrces Carmel, N Y 10512 Y �. __ -CONSTRUCT FOR _SEWAGE DISPOSAL SYSTEM.`'' a TO or illage t Located at J F �.)%1a� fa/ K %UG k ° t � ceecl s�dy �dSL �.✓""� r`C IoCk } t . , v t .• -.o . :i ,�. ;^ �r1 ---r 1 it : -r+ r +✓ t e^1/ -//O ,j Job' e,¢�r lf�c.r/JS L/LG Address���A�i�� x, Bu�{tl�ng:Type 1PA-s Lot Area ��°; S�7 ��..'Y yRLL�� � /i Number of Bedrooms < Tota6'Habitable Space ��0� f SQUere Feet _ Separate sewerage -System to consist of Jr!6'Q Gal Septic Tank �� I n feet X- „ __ width trench To bey constructed by t Address s _ a s N �tNater a SuPplYj Rubltc SuPP1Y `F( om l private Supply to, be drilled by Other Requirements F ~ y _ krepresent_ that I 'am wholly and completely responsible for_the design and location of the proposed system(s), J) that the' separate „sewage disposal iysteirr t .above descr,ibed .will be constructed a`s shown.pn the;approved- amendment thereto and ;in accordance with the standards rule , s,:arjd, regu a ions o e -, u.na►n a, County Department of H881th, dnd that on comple €ion thereof a Certrftcate of �Construct�on „Compliance satisfactpry to the,'Commss)oner of HealttiVVilf j be submitted to the Department,.,.and a written guarantee will bekfurnished, the owner his successors; he(rsor assigns °by thebuilder; that said<builder; will t3 ;place �n good operatmg,eondttwn`, ny part of said: sewageFd�sposdl. system- -dur�ngthe period'of.fwo'(2) years tmmetliately follow.ing..thedate.'of the -issu- l r ” ance of the appro I of afie Cerfificate,of Construction Compliance of th, a onginal system or ariy. repa�rsahereto ,'2)thaf;the:driiied well described above' , '{ will the located as shown on.`fhe approved plan °.and that said weH wil{ be; installed' corrdance with the .'standards rules'and regulate; of the P,ufnam_ 4 County Department - of Health , y s x { x � Date Signed P E. R.A. f x ` Address License No APPROVED FOR CONSTRUCTICrN. This approval'exp res one year from the „date issued unless construction of the bwlding. has been undertaken and'is f: revocable,tmor causefor may tie amended or:mod�fiad when considered essary:by t6 tommiss�oner of, Health:; Any change or alteration of construction regwres a one permit Approved . for disposal of domestic sanita ew a 'an /or pr,v w t supply omy Date t t ”" 9Y kt Title (Jn .r r -e "�T A � TPUT-".r.1 --Y _'�' DE T' t-,TT OF HIEALTH CO FA RT -,'E, -DIVISIO-T., �OF V TD T A L HEALTH SEER ICES Date a e Re: Property of Located at Section Block Lot 7 Gentiei-,ian: This letter is to au-W z eA a duly 'Licensed -orofess-:onal anz`lneer or 'r'e,7iste_ a ,"a'rc'_-_i- -,--ct, (Indica-e) _=7 , S4 1-0 to apply for a Cons t-Iuction Pe_,-mit for a separate se,. e , serve t1he above noted p-roperty it T-.c coidalily with �Uhe s_5anda,_--ds, -rules or -_r,-_­,fula` ons as ted '-ir the Corrr-ii ss ion er. of the PL7,tn_a_m County U De,oart-.-Ilze n t, o1 Ii,eal -L.n, , and -uo s IL:7n all -.---c e, s s ary papers on m-,., be hal- f in 4- 'r-) _-� S -u^--ion of said COnlIeCt.ibn- ma-ter and to super, e cons t System or s7.7 ;tarp:. in conf ormi th thm ncrovisions o LL5 or 147, Education LaT,.T, -he Public Health Laj..7 , and the Putnam County Sani tary Code. Co,mtersicma d P.E., R.A., Seal) AdE_F_6_ss__ ,,'.Telephone_ Very truly yours, S i gn e Olwner of -'Pro-,)er-U -,7 Addr6st Telephone r. PUTNAM COUNTY DEPARTPENT OF F ALTH DIVISION OF ENVIRONMENTAL HEALTH .SERVICES..:... .. COUNTY OFFICE BUILDING CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.S,7 1_ g..3Sr Owner Address�p,_1,,1« Located at (Street JsAhmE7 DiR, f ec. Block _Lotj2 �Indicate nearest crbss street) �, Municipality J Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse. Dep o Water Wa t er Leve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop , Drop in Min. /in drop Inches Inches Inches 7 G 7 T 1 /c,. 7 G H %y 2 310: is , ;c� a; G 7 C �I- 5 01 2 Notes: 1) Tests to be repeated at same depth until a.p roximatelyy equal soil rates are obtained at each percolation test hole. Alf 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 DFSCR1FT1DN..,0Y.3,OT-LS ENC0 UN TERED__TN-..,T1EE _�T_,HOLE DEPTH HOLE NO. HOLE NO. HOLE NO. G. L. Of 12" 1811 24 ft 3011 36" 4211 4811 5411 60" 6611 7211 8411 11 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date DESIGN Soil Rate Used_6_/0 Min/1"Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity Gals. Typed ?_ -3 -_ 501Y Absorption Area .Provided By_ZL6io L. F. x24 36 width trencif.4 Other_ Address u.re co SEAL THIS SPACE FOR USE BY DEPARTMENT ONLY, Soil Rate Approved__­... Sq. Ft/Gal. Checked by Date 1.1, A vlo, 10 VV M� A 140 X Ar V� N oorf, c"91 WIT A/z AN Z- .5 s -PLOT PLAN S r-.%Lp-, I" -So' Tax hAA-?, Gz pD Locv_ I F"T of LOT 11-1 ft-f. 4 S. ? uwtnEy 7*7_ _ - -4, p J_ -J k I J [7- J, - y JOWA of PUTNAM IXLLE- .. L) T a AAA It ck ale As. A.- fe Chkd 'cl Z 71 fq r ­J L N,. '1.* , pj(,L AI �,E ifut.-E5 AW GHt..ATH - ',,N 01i THE tj k; L) ( �'Ar, N 1 APPROVED �,l HF-Al-TH. ii, J! lt EL"T T A - I j Pic, j 11101 AUG 191971 r T(, I i OF PEH trot. 2to u- T. I, F09— ENVIRONMENTAL SERVICES STREAM bUILDEKS kt, A 6 F_ 0 V_.G F_ & 4AAOG ►A4--K,,P.E Dole sy A2.s oct A I'll o t4 E f- SUBMVISIW4 /AAP SECT, LL LSTA-T ; A- T( a— A - y JOWA of PUTNAM IXLLE- .. L) T a AAA It ck ale As. A.- fe Chkd 'cl Z 71 fq r ­J L N,. '1.* , pj(,L AI �,E ifut.-E5 AW GHt..ATH - ',,N 01i THE tj k; L) ( �'Ar, N 1 APPROVED �,l HF-Al-TH. A I d> c) F n i 3 F T t E_ N H ',N AUG 191971 r T(, I i OF PEH trot. PUTNA C UN D E LT BY . ...... -LAYOUT OF S S D S,YSTF_/A' D V SIO OF I, F09— ENVIRONMENTAL SERVICES STREAM bUILDEKS _rPkc. RIE VISIC)NE 6 F_ 0 V_.G F_ & 4AAOG ►A4--K,,P.E Dole sy A2.s oct A E f- SUBMVISIW4 /AAP SECT, LL LSTA-T ; - y JOWA of PUTNAM IXLLE- .. L) T a AAA It ck ale As. A.- fe Chkd 'cl Z 71 fq