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Home My WebLink About3568DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74. -1 -53 BOX 28 03568 I ell 1 IL I I 0 J Jno I r .� b 4 � I 91k ! 03568 ,-3 9`1 CONSTRUCTION PERMIT FOR Located at SubdivisionCd Owner PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 SEWAGE DISPOSAL SYSTEM AyIadr" � W Town or village I Tea: • t.1a �_ p p_ _ Jr! �`,• Lot p:._ / l �� Job` Address n Building Type r°. Lot Area sx "�CrG�i /� Number of Bedrooms Design Flow Total Habitable Space Square Feet Separate Sewerage System to consist of Gal. Septic Tank and C) Gj L e� W Add re ress To be constructed by Water Supply: Public Supply From Private Supply to be drilled by Address _ Other Requirements �U I NAM C OUN 1 Y. OF HEALTH I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) ,An above described will be constructed as shown on the approved amendment there to and in accordance with the stlo d County Department of Health, and that on completion thereof a "Certificate of Construction Compliance �;ctgs ac be submitted to the Department, and a written guarantee will be furnished the owner, his successors, he ' lR aq ii place in good operating condition any part of said sewage disposal system during the period of two (9. ) ye;! ante of the approval of the Certificate of Construction Compliance of the, original system or anIthedWi. 7 to; will be located as shown on the approved plan and that said well will be installed in accordance with County Department of Health. ' Date ze is 7y ✓/f (Y ISiigned I + y ^, re, arate .sewage disposal system; �£ u ons o e Putnam tq The&missioner of Healthwill '! V.§tb,b W�, that said builder Will „I itelj 1owif g the date of the issu- fat th"rilleedd°°nwell described ab0�ye ind r40 of the Putnam..' 1 >0 c 1 P E. R.A. L Z Address t`�4C�setlo. APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued u ess tonstructi dn. �dgt' bUili�r),9 had' been undertaken and revocable for cause or may be amended or modified when con5ided Enecessary by the Co ssioner of HeaIth"As � tfeh s.6� alteration of constructir requires a new permit. A proved for disposal of domestic /or pr' to y only. "0 arcrs +� Date ^ By Title ` la,910 -� l S-3 i •I,r]TNAML C 01iJNTY :DEPARTMENT: OF._HEAU11 .:T' Division of Environmental Health Services, Carmel, N. Y. 10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM.y j /�./ Town or Vilagge� Located at / Section �' ° L Block �� ! /^ Owner - 'C.� �'/l /.S �' .1�,. (O "'7_J w J" L t � ;f3 Separate Sewerage System built by � JA/ Consisting of 0y� Gal. Septic Tank Other requirements Water Supply: Public Supply From Private Supply Drilled By o Job Address h �,ee v�I — �r✓�/7G' '° i• y° lineal Feet X width trench Building Type No, of Bedrooms Oate PerrR)t;,ls . 4 ed Has Erosion Control Been Completed? ytl I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the. plans of{tfia conlpleted,wnrk ' ples of which are attached), and in accordance with the standards, rules and regulations, plans filed, and the permit issued 4 66 Pu narpf `Court{yj`De a'tment of Health Date Certified by 24 7 •Z ic;�0 7 �- r + R • F U 4 x.' nP� rn ; L t% rpm Any person occupying premises served b the above system(s) shall y �'�} ' Y y O promptly take such action as ma be necess'V }0,ysBc re`fhe c�{rreetIon of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as "•suo 05 ea <P I' :'sanitary sewer becomes. , available and the approval of the private water supply shall become null and when a public water su ply becoirf$ "e�8�able. Such approvals are .- subject to modification or change when, in the judgment of the Commis oner f ealth, uch revocat' , modification or change Is necessary. Date Rv r :.. r TOWN OF PUTNAM VALLEY WELL DRILLERS LAG AND REPORT WELL COMPLETION-REPOI;1"- -..; , ..... _ ..... . This repr%rt is to be completed,by well driller and submitted to ,J�dg. department, together -with laboratory report of analysis of water sample i.ndicatingu water is cif satisfactory bacterial quality. Well Locatio Well Own Tax Map Name Well DrillerT e .Name CASING DETAILS Length 2.0 Ft. Street ST. Mail Address Mailing Ac -` � Sec. " B1. Lot ��wvc't~L Tcx y City or Town t'c� Tel. # aQG 46Q 1 ss ty or Town YIELD TEST WATER LEVEL I SCREEN DE Bailed Measure from land surface or 1 Pumped Hrs.IStatic: Ft. Make: unpressed Air 1 @(ra.._,4 -1 When Bailed I Slot Diameter: 6 Inches Yield: 7 GPM lor Pumned FtJ Length Ft.Size Kind: Gtppi til 1 Diameter In. TOTAL DEPTH OF WELL 202 Feet WELL LOG Depth from Give description mf formations penetrated, such Ground Surface. as: peat, silt, sand, gravel, clay, hardpan, _. _..shale., . sands.tone, granite.,.: etc. . Include: size,.-of. gra�rei° ('diameter) _and" sans "'(tine; me�uFn, "° coarse) - color of material, structure, (LAose, packed, cemented, sort, hard). For example: O ft. to. 27 ft. fine, packed, yellow sand; 27 ft. to 134 ft. _pray granite meet to Feet Formation Description 01 tn 31 _'_ 2 02 ' Granite Date Well Completed 1/9/80 Date of Report, 1/28/80 Well Drillers 4-2.�� Signature BZS 1 -77 0 ,Laboratory NANCO. ENVIRONMENTAL SERVICES, INC, P.O. Box :10. Hopewell junction,i New York 12533 Unit .Y'St, &:37.6 Hopewell Junction, New.- York 12533 Phone 914 - 226 -5155 ....:. P .w. -..v .� y� s. • - �T P a <. . a ...ry ... _ - Y.Y1 .y� o•b_ a.: a. E'• orw( i�:. J. h4' giv��T, o=• �iaa�l. ..a...•�,aY',�v43'1�'6'C'R.+•Y" .�g74YM+c'. ...�.vw.n� <a'�Y!� .`�,' "r tTG' ... .a....,.,e Address: 'Received 7Iti /An i ;an .;Sampling Point & Address :. #3 Wood Street, .putmm Co _ Time Set ?!x/80 ;aT� Owner /Buyer Name; Address: Tel , -Noo Treatment: Chlorinated Softened Other Source: Drinking Water System _ Other Collected By: Staff Date: 2 / & /g0 Time: morn BACTERIOLOGIC 'EXAMINATION OF WATER Examined°�";.,! -- Total Coliform Count . , _Fe cal C oliform Count Fecal Strep Count Total C olif orm Count Fecal Coliform Count Sterile Blank Mb F, T. -at t Per 100 ML Per 100 ML Bacieri`o ogist l Date Reported /Mailed THESE RESULTS INDICATE THAT THE WATER SAMPLE DID (� DID NOT MEET SATISFACTORY SANITARY QUALITY WHEN COLLECTED, The results of these tests represent a physical and chemical analysis of the sample as delivered to this laboratory. This laboratory assumes no responsibility for the identity of the sample or for the'-sampling technique or storage procedures employed prior to the receipt of these samples at this facility. C#iEMICAL AND PHYSICAL EXAMINATION OF WATER Chemical Examination (Results in Milligrams Per. Liter) Ammonia Free (asN) Per 100.,ML M,F6T. Per 100 ML M.P.N. Per 100 ML M. P. N. Per 100 ML Per 100 ML Bacieri`o ogist l Date Reported /Mailed THESE RESULTS INDICATE THAT THE WATER SAMPLE DID (� DID NOT MEET SATISFACTORY SANITARY QUALITY WHEN COLLECTED, The results of these tests represent a physical and chemical analysis of the sample as delivered to this laboratory. This laboratory assumes no responsibility for the identity of the sample or for the'-sampling technique or storage procedures employed prior to the receipt of these samples at this facility. C#iEMICAL AND PHYSICAL EXAMINATION OF WATER Chemical Examination (Results in Milligrams Per. Liter) Ammonia Free (asN) Arsenic RECOMMENDATIONS Nitrites asN Barium Nitrates asN " Cadmium MBAS (Detergents) Chromium Sodium Copper Sulfate s Iron Fluorides Lead Chlorides Manganese Physical Examination - Hardnass, Total (asCaC 2-31 Mercur Color) Units Alkalinit asCaCo Selenium Turbidity Units H Silver Odor . Units Zinc Conductivity Units The chemical parameters tested (were, were not) within the limitations of the New York State drinking water standards when the sample was collected. The results circled represent those in excess of the limitations. Reported by Date Reported d" PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ Date % ��s /7 ! Re: Property of f'U f S �:i .�.4 C.�•;e�. Cy Located at 2a)' �, �-� �•' Section Block Lot. Gentlemen.: This letter is to authorize a duly licensed professional engineer r 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 nee..e$sary'papers on my behalf in l]VJ11jt:QL.1V11 wlLIl LIU-S IlIaLLev ailLi to. supervise the coristvucriuri o:F said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- - Lary - Cade : Countersig 3. 017 2— 0 Address AE. VO4, V , 7d1 ?J; ri w L %�.>- � Z Telephone Very truly yours, Signed ner of Property ./� ,130 M "a I& Address �. f Telephone �t All 4t PU3UANI. COUNTY � It, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY.: OFFICF. BUILDING, : �]_05� DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. r �. �( Owner Cn, hs; e v- � r , , , Address "70 130 it e -:��% �� i•%/ r Located at (Street Al,,-J41- Sec. e2, Block 3 Lot J indicate neares cross street) Municipality / dy Ala -rl llaj.A Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED.WITH APPLICATIONS Hole Number . CLOCK TIME PERCOLATION PERCOLATION Elapse Depth to Water Water Levei No., Time From Ground Surface in Inches .Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches. 22 3f 3 7 2-2- / 5 Notes: 1) rates are for review 2 Tots to be repeated at same depth until approximately equal soil obtained at each percolation test hole. All data to be submitted Depth measurements to be made from top of hole. 41 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES GiL. 611 1211 18" 2411 �011 3611 42 48 54 .6011 6611 7211 78i, 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED PESTS MADE Date--', Soil Rate Used Min/1"Drop: S. D. Usable Area Provided cJ No . . of Bedrooms __Septic Tank capacity. Gals. Type Absorption Area Provided By ,3 L.F.x2411 3b" width trench. her. Name Z--Te; -,viv) h 11— 3% 1 F-i vCt-"- Sigm�ure Address v Tr z THIS SPACE FOR USE BY HEALTH DEPART NT ONLY: + 40.1, 0, sq Date Soil Rate Approved Ft/Gal. Checked by .0 I 'IN t" Zc Apo, O ECI s F E,,:rd 2 019$0 .,z olm OR. DIVISION OF ujfaw�w 13,10 elr 0Q D. -TR T� AS CONSTRUCTED Pz q SEPARATE SEWAGE DISPOSAL SYSTEM 74 _1 7' /00 0 va, GALLON SEPTIC TANK t _LF X.Llf4S. TRENCH TOWN Of --- /•—C,, 6 or //c t t COU TY. NEW. YORK DATE ISCALEA!j 5A--,lJ0llNO. 79-,1-1 -0' F' -SULLIVAN TZ=E41-1; CONSULTING ENGINEERS' ==*-C*MC)/oAX 'TOW F4 PIEW YORK d. i. 4:, V z 7/ 74. 26 6 _44 ..7 o. 93 t" Zc Apo, O ECI s F E,,:rd 2 019$0 .,z olm OR. DIVISION OF ujfaw�w 13,10 elr 0Q D. -TR T� AS CONSTRUCTED Pz q SEPARATE SEWAGE DISPOSAL SYSTEM 74 _1 7' /00 0 va, GALLON SEPTIC TANK t _LF X.Llf4S. TRENCH TOWN Of --- /•—C,, 6 or //c t t COU TY. NEW. YORK DATE ISCALEA!j 5A--,lJ0llNO. 79-,1-1 -0' F' -SULLIVAN TZ=E41-1; CONSULTING ENGINEERS' ==*-C*MC)/oAX 'TOW F4 PIEW YORK d. i. 4:, V