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HomeMy WebLinkAbout3400DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.08 -1-44 BOX 27 1 rm Tyir .14 �1 1'L i 1 1 ,1� UIN NN r L13M �,e' ' ..`c' t i:' . '.Tr q F..._.p� 4 "^i �'�" ze. _> is 1. s } ' E �,^rr' +'�' +i "u `y j'• 7" . -zn.�^ °* fit.^ . ,.r .rvv �t ?,, J 'd ^7.,, °'+a.".Tr"' --^*°r £ rr ` ,'� ` ;: PUTNAM COUNTY DEPART1GhENT OF HEALTH Division of:Environinental Health'_Ser." "vices; EarmeJ,.:N Y.:10512 C RTIFIC, EcQ�� CQNST•.Ft1�CT1.QAI CQ�I�IRUANC FQR.. SEUU�R►GE;- DtSP,O*SAL.SVSTM ;_.; 1� �t�c � = :-',: •, Town or:'Village' . D /j Located at��. Q.i 92 V i (� Sectio n Block �• Owner •v AA 6c)Y-NS \.. Lot 1011 6S 1 A Y �Ai��E 1 C�?Y Separate Sewerage System ebuilltt 'by A '� Address G Consisting of LLB -Gal; Septic Tank ?At lineal Feet X width trench Other requirements Water Supply: Public Supply From Private.Supply Drilled By Address �L�d Building Type '�1 = C..+1' Has - Erosion, ControI Been Completed? ar' \is No, of Bedrooms Date Permit Issued_ 1 certify that the systems) as listed serving the above premises were constructed-essentially as shown on the plan of the; completed ,Work (copies of which are attached) and in accordance with the standards rules and regulations plans filledu, d the permit issue b' the Putnam County Department of Health. Date G� `r �� t.� ertlfietl hv ,. 47 E R.A. _ Address��� ' �-4\ License No Any person occupyipg. premises served by, the apoye system(s) hall promptly take such action as may be necessary to secure the correcti9n: of any unsanitary conditions resulting from such lusage.. Approval' of the separate sewerage` system shall become null and void as soon as a'public sanitary.sewer becomes available and the: approval of the private water supply ;hall become null end void when 'a public water supply becomes available. Such approvals are subjecti to.,modification or ;change when, in the judgment of the mi oner of Health, s ch- revocation, modification or change is .necessary. Date g Title . a lu 1:tner or 110rcha::cr of twilculig R 11124 C-4XP /3". l'unicipal.iCy Suildi>>g Con-structed by Section •�� JrsN -� N ,ocation - Street O .. milding Type Block .= .. Lot GUARANTY OF SEPARATE KMAGE SYSTEM , ° I represent that I am wholly and completely responsible for the location, iorkmanship, material, construction and .drainage of the sewage disposal sysfiem -erving the above described property, and that it has been 'constructed as sho-:;n on `h'e 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 o the owner, his successors, heirs or assigns, to place in good operating condition my part of said system constructed by me which fails, to operate for a period of tv:o rears immediately following the date of initial use of the sea:age disposal system, or lny.repairs made by me_ to, such system, except where the failure to operate properly LS C cLt:�eU _LV -che willful ui' 11C' l 1�t11 L c1i: L O 111e ola:Upaii f- u1 �„i: :he The undersigned further agrees to 'accept as conclusive the determination )f the Director of the Division of Environmental Health Services of the Patnam County )epartfierit. oT -Health --as to whether or not the failure of the system to operate was caused by the willful or negligent act of the becupant of the building utilizii:o the` ,ystem. )ate'd this 5� day of �,�y'i 19,E 5 Signature I1 Title ' Y,4 Lo ' •- f ��� f con poration, give name and addres r� PHREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS' BE17ORE CERTIFI.CA'1'i R C0MPLETION WILL BE ISSUED. 'UAMN'TOR TS REQUIItTD TO. FILE NOTICE OF DATE OF TIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam. County Department of Health PEEKSKILL MEDICAL LABORATORY 1879 Crompond Rd. Barclay Plaza Bldg. A, Apt. 1 Peehk111, New, York 10566 K".L.` _, "r.` �' *- `•5;..a�'�t,•iri' �d , b' �'. 3'" ��`. �. c, �anti• �•: + �. +v,:..;:t^.'- �e�"�- .+C..r-:.! -. w- .:.'-r.�: v .....h'a' -..•^� ♦.nom•: �rs. .w.ra:i xk°."..e.wv:mr��.i. .,rro DATE COLLECTED RESULTS OF EXAMINATION OF WATER OWN QI /� / /1 DATE RECEIVED _le, C S r(AJ10 1. o 6randuilc HI`s c� -off 0' %5 CITY, VILLAGE, TOWN & /OR NAME OF SUPPLY DATE REPORTED b - Lo C Su 3 -fir SAMPLING POINT BACTERIA : PER ML. (Agar plate count at 350C). COLIFORM GROUP (Most probable N6. /100ml.) HARDNESS, TOTAL -ppm DETERGENTS - ppm NITRATES (as N) - ppm IRON, TOTAL - ppm FLOURIDE (F) - mg./i. These results indicate that the water was yGS of a satisfactory sanitary quality when the sample was collsO. - a qL A. H. PADOVANI, M. T. (ASCP) .y c, ! q WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING CARMEL, NEW YORK _ - •7his. rE.poct.:iz, to: bEaxmolete¢, by .v4!ell.deillec.and,sut r,:i.tted to County, {health De��artment together H ith .laboratory repor* of 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 ---" ADDRESS LOCATION OF WELL (No. & Street) p (Town) (Lot Number)" 4 .' %s�I• • Z)l i' i �er�k� PROPOSED USE OF WELL + BUSINESS U DOMESTIC ESTABLISHMENT L FARM TEST Will SUPPLY INDUSTRIAL D CONDITIONING � Ope (Specify) DRILLING EQUIPMENT ROTARY ®A R PERCUSSION a PERCUSSION (specify) OTHER CASING DETAILS LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT THREADED ❑WELDED (( (� DRRI�IV''E SHOE .,I�..JYES LINO WAS CASING ❑YESNO ROUTE . YIELD TEST HOURS G.P.M. E BAILED IpJ PUMPED 1:1 COMPRESSED AIR 151 YIELD (G.P.M.) WATER LEVEL . MEASURE FROM LAND SURFACE— STATIC(Specify feet) -1? DURING YIELD TEST (feet) Depth of Completed Well in feet below Land surface: SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (feet) SLOT SIZE =METER (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. y fCLI 1J IlC\ ..,)...._ o _ 7 '! I 1-,70 it /pr Cc .� /) If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPL TIED (�Z -I31 —f DATEpF� R POORTj �/ -J 7/ i� WELL DRILLER (Signature) //► J G .,above des6ibed will be const , ruc , ted. , �as show6 on tWapproviid amen - County - -, - - � , - -, - y, ' .and — - ­ ­`�­­ 'Department,, of,, Health, -.an that-,on. completion.', hereof zf be submitted io Ahe Depart'mQni­,-and,,'a,,wrj en',guaran ee will jl place in ';good operating ;coinclition any part- of 'said - sewage. clis�. of s i -.anee of•-the app.r-o-v-al,,o'f the Construction -CQmp i that saNdWe Wi vykl!, b,q,lqcatqgd,a s-.sh own. on the ai:;,pibved-ia` a nty.�Depa mewt, Health Cdii t :n ,o . Date Address -,,-,-,APPROVED FOR - CONSTRUCTION " T h.Zisapproval -pires.!o_p%e.,— y `.revoca ca USe'or may be ame& ed.or.modmied w h en onst der ,requires a new 0 permit. '-,A Id for disposal - '-of -d : ome - sa Ff 'A 0 MI _dU the . - g,, fieriod of_two (2) year sfactory to. the, ,com rnissi6ner alkealthwill 3ssigns,by th ' ' ui Id r that said build - ' will ,immediate ly following the - date of the issu- ' e diWell.clescribed above to ha h drilld `the' rU 1, nd - ulations of 1. ine ri_sp I from iuedU6iess.-.cc?,nstr6ciion oft building hae.beeh'�undertaken. and Js om - misss q o W. 'f Heal ."'n cfiahge or :alterat i6ii of'co-ristruct ion rivate supply- only to Sir O_ ' .. .. .4'Z, C.0.U_,TY D7?aRTi 'T 0N- •H�'A.L•.TH,.. ..r.e�� - • ..!e^- �.��'�,- .:�^?F�- .,'�:�p:, .yam f�...:.�y".�.•n....tl"5.te wa°i'a..M1amCJl.r,.�t Ya �w:vtw.t ri*u.vos0.4ri •DIVISIO`? On atVIRO_,r',=',. -,TAL HOALTH SERVICES Date Re: Property of Located at Section Block r Lot Gentlemen: nor ut - This. letter is �o a�� �orl ., a duly licensed enVineer or registered architect (Indicate) �' In a ,,, t� n T> ..-- = ., r e?,7 _r y 1.e • '.. t., app_y 10�. Cons ;,r �c �_o:: : e_ _,.� :, for a se-pa-rate s , e: �v s fs � .:, .,o serve the above no led p ert7T _ _ accordance w! th '[le s �andards, rules 1, 4- , ' y Or re �1l c'1tiOnS .a..S 7`'O.':t;1 ra �ed v�J' „�'?: i3Or">1SS� C_"?Or Ol � i0 Plltnp1r. v0�::'„' De,jartrilnt of Heal'n, and to s i ?'Ii all necessary papers on my Je lalr' in C- Kj - (, connec., �_ ._ n "t r �., : -to� •s -� p•�� ._5• - v��-- �__• ����i�.,- �:' o:~ ;�o:f-::s,- ��.d�...._.._.`..__.� systerm or systems in conforn-n-i ty ,Ti th the provisions of Article .lL5 or L!7, Education Lavr, the Public Health La:•r, and the Putnam County Sani -• tary Code.. �f ro� X Counters P.E., Rte!; (Seal) Addres Te epnone Very truly yours, Signea- - 0t,mer of Property Address DL r Telephone a qq (Seal) Addres Te epnone Very truly yours, Signea- - 0t,mer of Property Address DL r Telephone a t:. t �`e�_ ��� i t -s. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ...�,..t..'„ ....._ r r;. ,�,s, .r.. _ ..-.._ .�:..- +..y�.Y.,. :,i- �..+-- '-x'r.-"�. fit,,. -�. ::.e•.a..�C�. ..,. >..�e*.n....:ati�...;.R,t y.. COUNTY OFFICE BUILDING,* CARMEL, N. Y. Y10512" DESIGN , D/ATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. S-14 1 1 10-LS Owner VAL -PATE CouSj, Address A9_p5LF-j� �.�. Located at (Street JEAN11,L 7i 6�• Sec. (0-A- -Block — - Lot ')� Indicate cross street) Municipality `•QuT K)gM Y iLLr_V Watershed PE�4E74S V-1LL u.OV.) SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run apse 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 i t0'�f 2 100 11 i g a- I �( 3 i 1' 5114 12 °� 1( 42 a43Iq- 3r4 �Z> l 3 4 l 2 3 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. DEPTH 6" TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION 7 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. HOLE NO. 12" 181► 24" .&AIX 3011 .. 36 If \ 42" 48" 54ff SCL 60" 66 7211 7811 84" INDICATE L AT WHICH GROUND WATER IS ENCOUNTERED INDICATE' L TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY `� , �. Date 10-3O--?d _ - DESIGN � - -- -: . Soil Rate Used t$ Min/1 "Drop: S.D. Usable Area Provided S dam Septic Tank Ca - � T --, p Pacity- !Gals, 4j =Type' No. of Bedrooms Se , Absorption Area Provided By�2go L. F. x24 dtfi�rench. c ivame - F -4oWar t-4 vs, . 0 4.1.1 J g-, bignature Address Gene `��, /` SEAL \ \� 38998 F THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by Date ' ,Y F{ F } .r st J-�" 1•. - t - t I t. - is MANNpLE C Y� ' i; •" is LAN. �: =i. 4� f i JUNCTION BOX MIN 12 ,-til V ir- `. $MIN r' - CA 9T IfiDN ; �'; - •` -'`,y •,�.�q' �f• \ �•S. /` SECTION- SANITARYTE i t TYPICAL CONC. ' - % � 1 �•'.' '' -s'r :�G.<'` i � '\ . �•! .t vRE CASTI SEPTIC TANK ,, REtNF a rC C B/w _ I > ° i91 =:p1 '.��•• �7 �:�. � + 'GRU 'LEVEL -i EARTH %�. i.' .''\4. •;. y f : O u% BACKFILL. " JOINT 8'.19•• ,;- : .� .�.. • � >.;�• ilia ` � -.. .; ,'� t _ % .., �`.(�a _`�� / �,t. _ Mfr' .:,fii; ,�t?. _ ..8f;:06.!?APF.R COVEP 'Y -r .• ', _.� -: ��Z-Si � ., ,. -,. .i �` J A ?•o OR MAY. / % ` PERFORATED gt�, 1 �, .., rv� r .t � �.�, i. r'. -c!• '�. �� , r� [�� f �f a. oh�`•; ♦- '.Pt P,E .. � `.t. .s. .• . :p.. o '•.! ,�. ;dam ?�' / .r.-' V / .n i., � •i.. "ia -. CTt�_ 'a � s.��t: � .24.MIJy,. �� �g �� CLE4N;6.,RAV£L � .i;�a• ��. _ _ .h."__"'1 CRUSHED STONE . ;N 1•.r_ t»: r'r ,t. -t ,t. a ,r%r' �; it'. :s: AB ORF'T1 N TRENGII' Af4u.1. - - :,.m y u E y.:.., I r• ,. �aYSTEfti� T;.Q gE CONSTRllGT p fN'AC' ROQNCE VYITIj TH£.;R1�LliSAiiR> �_! t �4A COUNT.f D FIAq;TM NT" •c ,� ,.-. z�_ _, _ - , � RJ~GUI:ATV'ON$ -.OF' -THE � _ .E a � V. ry :,. 4 fy:r � c. � -T.r �-•.'� i '.r. -t' } � QF'Y:N p- I,", tia• rw ... .'� , .f _ 1 14.�»A :I BACKFI HR .UNT14 .INSREC F� 9Y F E51GN .^ YSYSTEM `SNALi NOT: BE.. sf�.. (� ?.i..,.•A :A H CA _ T DE T' T riP:..;R IREO Rf L'Q - L': HEA MEN Qtl EltidiNE� ..7E H PAR F ; t OF,,.A.�_ _ GALLON S, PTIC TANK W'ITH'•A MAXf UM , n _ r Y' S $T M TO CONSt3T� ' t AND`— F � FT TRENCH• .. F �� yy ;('4'; .1 Pt'TCH OF I /tI P,99 FOQT. OS'Al SYTE'M LG,RIaUES REFE.RENCEO''TO. N►S.ND FIii ST OISP yu unr FLbORi ELE'VAF'IQIV ,'UNIE'SS'. tjTH Rjro.iSE' P1) 7FD.. 1VIS LP- OF en . 31 s aouMEt+tN.r�9AIP.�/L�.D: .s�isT:�erra:; FOR iaL..:Q��k� �O?S `. ' : 3 :. _ 'R�'i' �IrLAV.(' F'I?6S. 1e'1K✓~, . ` y F;r R V1579MS HOWAFCD Q' KELLY, 'y /� ASSOCIATES f11 \' 4'A AIr jigEI6s .`NS (F 1!?� �/, .,% DATE BY CARMEI 'N£W YORK d e' _ . TAX M' AP NO. 6� ''6Lit. NO .LOT NO. 32: x cS;UsER-CE_ �? .:2£MgVtr53'' � / . . —� -SE�c.`�'AN � TOWN OF PU-j tJ A M '_ra Ju a ION -•Vr SJ ? a i 'L�jOi.l:S \ -� 4 CAkO Dote 1j- \ -"�4, { rawiny No. 10 i.� LA - — -- - Q t ry .. _ N�,' Traced AOOS -��f 1'.�6.� . tl.. tst' L i• •� ' SL k� t'1