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HomeMy WebLinkAbout3493DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.20 -1 -18 BOX 28 03493 Vo J Ilirm, J Iv1 � jA r6 � 1 r r I 03493 *— i'�✓•�kFr�'. yt , t ti t i n %i i� s�{Y�,9 �, $'3•l7Y lrr is 9 t tl a'F i' �i the r i... i < n ,i 7,7 ll " :l r p t t G AR EN .r OF H r P1 T COUNTY DEP TM T, HEALT a " i Division of t Or,'on entaSl Heal th r Seivices; 4 rme %t' N Y :1,0512 ' r ," ' rt1C .�'Aa1cz4l;r`Tt� {_i1 SEW�Lr,,F Q.ICPna�lYlctta �e. se Town or `V�Ilag ._ e Located at �.9tE'TA� i d G E L N E' Section Block v, 4 1? t o-,, `owne► �77e.✓.o it/tiL /V% Q Z &Z..ZO Lot .` 5� c / r{ Job tv a s Separate sewerage'System built by �l?�/ Cesar/nf Rddress Consisting of ZOm -Gal. Septic.. tank 22 7, lineal Feet,:X . —�° �� Wv width trench'•.'" Other requirements , Water •Supply:. Public Supply From , Private. Supply Grilled By ' r Address Building Type. �� -fP�/ e "� No, of .,Bedrooms Date Permit Issued - - rm , Has Erosion Control Been Completed?, t certify that the system•(s) as listed serving the above premises were constructed essentially as 'shown on the -plans of the completed Workt(copies;of which are attached), and' In' accordance 'with the standards;A'rules';and regulations plans filed; and the permit Issued° 'by the Putnam County Department of. Health, 0 t' f9 J Date Certified b P E R A —�—J— 1t Address �C Lic N D D ;,Any;.person occupying premises'seived by the above systems) shall promptly take such action as maybe necessary to secure the correction If any uneanitaiy conditions resulting �i'jom such':usage „Qpprova( of the separate"'sewerage system'shall become null and void a4 soon as a.public sanitarysewer becomes.' available and the approval of they private .Water su'pplyshall become null and void.When 'a;'putilic,',water supply 'be comes'.available Such,kepprovals"•ar, , ri. , r r.. subject' to modification or change when, in the: judgment of:'. the. Commissioner'of Health, such..revocation, modification or changexis necessary 13v' Tltle; • ' < �Y.✓µ (jFY, VLLL.AUt;, TUWN N/um i-4m4r- ur ouk-t-"x. LJ111 L t a ar_' I 1 -51-40 18th AVE. WHITESTORE, N.Y. 11352 9Z4/-73 15AMPLING POINT ;rpAp BAI'RIA'PER ML.- (Agar plate count at 350 C). COLIFORMIGRON (t46st, probable ./100ml.) HARDNESS, TOTAL - ppm 15. LESS DETERGENTS--r ppin NITRATES (as N) Ppm IRON, TOTAL- ppak FLOURIDE (F) - m4: /1- 'These re'sults'indipqte that the water was YES of a scftis'fa6tory sanitary quality when the e was coil PER: HENRY CARPENTER. SAW MILL RIVER RD. Y.H. NI, M. T.I(A:SCP) Ilev d1lo z .4 0 (JI•In.or or Purch.ascr' of Building Municipality M- T�_UTRTT_n.g, GonstrucT'7T 1-17Y ion LOC 7tion Street Block /e 6/ 4,41eh ding Type. Lot GUARANTY OF SEPARATE SDIAGE SYST�, t f ' o_� ho I represent that am wholly and completely res-Donsl ble. location, worlLrianship, material, construction and drainage of the sewago e in servinu the . above described property, and that it has been disposal syst 0 - -constructed as shown on the approved plan or approved amendment thereto and in accor-da; -icb V ;ith the standards rules and regulations ' of the Putnaia County Department of Health, and hereby guaranty to the of -mner, his succes- sors, r.Airs or assigns, o place in good operating condition any part of . t said system constructed by -me which fails to operate for a period of two follo,.-iin� the date 'OLf initial use of 'L-,h-- sewage disposal pystem, or any repairs i-.1ade by irie to 'such system, except the failure to operate propcerly is caused by the ..i-illful -or negligen't act of the 'occu- pant of the buildinr.,,, atilizing the syst'-m- Vh e undersItc-ned �°urther-agrees to accept as conclusive the de- termination of t. I he Director of the Division of _',_'nvJrom-nen-rLa1 Health Se6_-- aty Dn'o w� a r t,,r-e n t of Health as to whet)—r or not tie vi c a s of the ',Dutnai!1 C, Failure of the s'ysteri to oporate !,as caused by the. willful or negligent -he building. ut i 1A z J:n g . t h c. sy s t em the--o-c--cup!f--,.nt of t D -i 'Dated this day of 19yjr Signature corporation, give nalric an.d address) 13 THREE (3) COPIES ARE REQUIRED WT9' THr-,E'-,' (3) COPIES OF FDTAL PLANS BEFORE CERTIFICATE Or, COILPTJETION WILL BE ISSUED. GUARP211TH TS REQUIMED TO NOTIC-13 OF DATE OF FIRST U'f_-"_E OF SYSTEM. Division of Envi:�oni-ric;ntal Health Services, Putnam County Department of Heal th V %'ELL CO[ PLETION REPORT PUTNAM COUNTY DEPARTMENT OF HCAi_i'1 3)71 Division of Environmental Health Services I , i COUNTY OFFICE BUIL.DING - CAHNIEL, NEW YC)7x This report is to be completed by well driller zind submit ad to County Health Department togethdr with laboratory report of F4�`nanalysis of wavar sample indicating water Is of sat sfactory_bacferigl qua!ity befQrex errW .ic3Tg,of- conUruction-scam.p4ian cee- ss,-jed. a T�R EPORT .MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER AME AUURE55 LOCATION OF VVELL (No. & Street) (Town) (Lot Number) r ' ` USE OF WELL �BUI ESS DO9�STIC STAB5HMENT FARM � O TEST WELL (('l� PUBLIC ❑ AIR ❑OTHER �l SUPPLY INDUSTRIAL CONDITIONING (Specify) r DRKLING EQUIPIriENT n COMPRESSED ❑ CABLE Q OTHER t�� ROTARY -AIR PERCUSSION PERCUSSION (Specify) CASING DETAILS LENGTH (leaf) DIAAIETER(inches) WEIGHT PER FOOT ((�� < / (� I Ln1. THREADED WELDED y ((Dg�RI SHOE L�1YES a NO WAS CASING ''O'�L ED? ® YES LJ NO Yi "clu TEST HOURS G.P.M. YIE:D (3.P.,V.) II II (( j� u j BAILED L l PUMPED Is COMPRESSED AIR 'fly YIELD TEST MEASURE FROM LANG SURFACE— STATIC(S;.e Depth of Completed Well _— I in feet below land surface: Z--w O LEV'cL SCREEN fnAY.E _ LENGTH OPEN TO AQUIFER (leer) DETAILS T. SLOT SIZE DIAMETER (inches) IF GRAVEL PACKED: Diameter of well including gruvel pack (inches): GRAVEL SIZE (inches) FROM (feet) TO (feet) DEPirt FROM LAND SURFACE - FEET to FEET _ FORK.IJION DESCRIPTION Sketch exact locaflon of n•ell with di; lances, to at least two permanent landmarks. 0 If yield was tested at diffe•ent depths during drilling, list below FEET GALLONS PER MINUTE �...._:_ _...,.m .�...... ......_. DATE WELL OMPLET:D DATE OF REPORT W -L 0RILL 'Sign Lure) F i PTJTINAM COUN 1sY= DEPARTMENT' OF HEALTH S y < F D.ivision_,of Enl!�ronmentl Health Serrvices, Carmel, ,.N Y.'14' 512 :CONSTRUCTI'ON_, PERMITr'FOR SEWAGE. DISPOSAL `SY,STEN1 ,��.ws�s� -j ' "L� riUz. --C $ Town or illage r 5ubdivision'f= �G7 'i/`r y�%� CJT/i/�if�'I er.S' -� a " .lotC7 Job a Address Q `_ �iois 0. / / 1A/�'/�% ;Lot Ar`.ea �i(.�C _B /i��"� x� J,+ X .S`727AIA4 -• l' �. :. Building TYPe, :, l,yi ,Number: of Bedrooms ? `- A `-�1 Total Habitable Space© =T Square Feet h Separate Sewerage SystemY to consist of e a r , ,Gal Septic Tank lineal feet. X -! �� width' trench. c�++ To be constructed by L -;�V�S .CrG�Cl J2 Address Qfi '�' _ -r 4141 2 "Water SuPPIy .,� Public.SuPpIY :FromU! �✓����. / }' ` Prrvaie SuPP,I�y`,'to be ;drilledjby / I�a�JQ'�/' .SQ�V - �LL-` iL d' a�"5' ,'O7`her Requirements ; r-T� x "I represent that i am wfiolly an j' completely responsib -'for the d sign and Iocatan Jof the proposed ysystem(s) 1) that the separate sewage disposal system - :above described will be constructed as shown on-the approved amendment there to,and in;iccbidbhc6,with the' :standards :r4los-an ;regu a to e Putnam County'., Department of Health; °and that on rgom,pletion; thereof a Certrficate of`Construction Compliance' sati`sfacfory to the CO' a althwill be .submitted -to` thec Department, and ;a written jguarantee will, 6e furnished the- :owner this successors; heirs, or, assigris`by the ' K�31 Mvbp will.: place in good.;o,perating condltion any' part of, `.said sewage disposalf� system dur,)ngsthe5!period'of`two(2)` -ears immediately loySin9ltlte �� Su- rice of, the approval ;of' the Certificate of Construction,VCompliance of fhb original system or. anY repairs "thereto; 2)'that Ifad well, clescc ab e 11 5 ocated a;,shown`on the approvedgplan andythat said well will°be �inStalled in' .a cordance with`the standards,: rules an regu. wn die " OU*a will jbe :County Department of Health h {, ;n - c` AddressCiCi' .kJ. �J /6`L�pf 'iCd%�ie!/1�. A ' {APPRQVED FOR CONSTRUCTION This approval exp res one year from'the dateissued - unless construction of: the build en" undert ke 4 s ;revocab1e,for ,cause,or may be amended or modified whikn,,,cp qsic[44 necessary by the Commissioner, of Feelth. Any •change tioi� @ HStxFi n 1. ';requires' new ,permite pproyed for disposal. df domestic Sa it'ary'sewa and %or rd_ e" water supply. only.�H rDatef _ } T, it /r 0 .D--- �TJSTO"' 07 L, L r'7• T,'7-7 Da -l" e Re: property Of "wv A*./ Located at r U--n, r, G e n Tin i s 1 e t e r, I s t -o a i t o I, i z G. duly 1 e___ 0 r : a-- 0 e f uiv''_ s ec a a "n oll 0 D 41 —u t COQ n e c t a n d o s ul 1p e f s I- or stIr's 3 17 -:1 _J ons 0 0-- the Putnar Co-anty Zasni.- ' -!!7, d,,-,. c a t_-- o n La: .r thze Pulblic tary Code Coveters reed p E Sn A dry'' E 5 S V 11 ery -I ulv yours, 0_ fe L9 Adld�*�, a s s 15� ,0' 0 op— Al *` �t a PUTNAM COUNTY DEPARTMENT. OF HEALTH r .orn:vi.^tt- .� ^'...� rc�Y.='` �T' eT ':��'i•Y.�"�1�y'``1i'��v�p'��Tn li; eLr�. rr.: aJ_ �f '" >:r2�'+t�5:�-3•�'= :,s-�Pt%`I iti :. _.:..` .. R. '.. '�. ,. _a:- :�.:.:�� -- COUNTY OFFICE BUILDING, CARMEL, N. Y: 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Gfoe %a.vAvr /,11,0 .eLtrzzo Address '1-,51 ao I&1,or,. , G(m/a'Et-5i -o/v& 'Located at (Street �o�,��/�io E ,�/g, Sec. PC, 9 Block Lot 5V �Jndicate nearest cross street) Municipality . 4-EY Watershed p�s «��� SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Number CLOCKTIME PERCOLATION ,PERCOLATION Elapse Depth o a Water Level No. Time From Ground. Surface in Inches Soil Rate Start -Stop; Min. Start Stop . Drop in Min. /in'drop Inches Inches Inches ml1 .1•'.�© ,� ``r` s �,� �_9 it �I 5 T' .0 1 Ailk 9 1u12 - 2 PU*i NAM COUIV l'Y 5 Notes: 1) -Tests,to be repeated at same depth until apppproximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted' for review. `. 2) Depth) measurements to be irade from top of hole. _. 2 9•'47 1,0.'6z <<S /'-.5 „ Z /���,, 3/.�” 6" S, T' .0 1 Ailk 9 1u12 - 2 PU*i NAM COUIV l'Y 5 Notes: 1) -Tests,to be repeated at same depth until apppproximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted' for review. `. 2) Depth) measurements to be irade from top of hole. 'DEPTH, G., L. 6" 1211 1811 2411 3011 3611 4211 4811 5411 6011 66" 7211 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICAT -..- -... -.nRSrP-TP-rPTn1\T - nTP--.0,nTT.R -T.AT,--.-rFW.-,9rP.--T-T0, T-,Rg - HOLE NO.--- HOLE NO. loe ^11T HOLE NO. 7 7-,- ,,e a 7811 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED .INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date lquo 7 Z- DESIGN Soil Rate Used 6 Min/1"Drop: S.De -Usable Area Provided 5 No. of Bedrooms 4 Septic Tank Capacity /zoo Gals. Type Absorption Area7 By L. F. x24 3b" width T—r—en—cTT.-- zj'o .Other iName / eo "",73 /-/a e- z bignature Address SEAL* ial map 4 THIS SPACE FOR.USE - BY HF-ALTY. DEPAY?TnE]1111T ONIY: Soil Rate Approved 2,o,57. Sq. Ft/Gal. Checked by tOT i 6 y... -ir.' w _ ( 'a.� •:w.... �4, F.,rg4 ♦... �s .n�:- •:ws+ax.�' 9 mod' + 43•y� a 4 s..�i> wv..r ,RC. +�aa. •aw. i '�i .+C�6•' .. t+; �. e`nII•3•'��K.�i:wsee �: ia�•� �....a a LOT 15 W �,LG N Z2 33 40-yy - o c Oa I LOT 58 1.000 'ACRES / ( EXP4NS/ON AREA ' 10 _� 1200 GAL. l LOT 57 A ( / 1-50.47 i 4 BEORDOM r i R41SED R4NCH' oy Cosy \ j 5152' - -- J �0 °9. �6 i, •r r F 10 a WEL\L S- 76' 28-. 1 0-E' 77.50 R 194.12 _- •- .-'''� _. //, i� PARTRBD..GE; I '`200' MIN. ALLOWED FOR PROPOSED SEPTIC SYSTEM ON LOT !40 AT HIGHER . ELEVATION'- ' e ,w