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HomeMy WebLinkAbout3695DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74:17 -1 -27 BOX 29 03695 ��- �r_- -•--•– --r—G— . a, - �rro–.; der*^' rr y. ar.. �4'a, ,, :PUTNAM COUN Division of Environme . CER,TryFIGAT-E= Q_F1.CQ-INSTRVC -TI- SE PI;IAl CE.- UMENT'OF HEALTH { _ s { vvices cirmei; � N. Y 10512 •DlSPQSE! �- SYSTEIIn , ;� �� .. % ®t?. ti_' _T��.�'°r✓Ti#�!,A s�:y_ d!�L� �j: Address:. �'� 0Y. 4416,Y, y. /V,, Y -T-5 96iltliri9 Type ���� Date 'Permit Issued i .. ;.A MC,�/ No: of: Bedrooms - Has Erosion Control Been Completed? I certify that the system(s);as hstedserving the above premrses were constructetl essentially as shown on -the plans of the completed 1. work;(copres.of which'are' j 11 attached), and in accordance with .'the ifandards,.,rules and regulations plans filed,: and the',permit'issued-by "the ,Putnam .`county Department of ;:Health..',, i Date wC Certified,' ertified by ._ Address Za7 �AlcJ /%% /dL +��%�iC J� r� License No Any, person occupying. premises servetl by -the above systems) shall ;promptly take such actioF as maybe necessary to secure t he ,correctio9 of any unsanitary conditions resulting from such usage Approva6 of the separate 'sewerage.`system'shall become null and void`as soon as a` public 'sanita`ry• sewer . becomes available and the approvpl of' the :private :water supply shall become`:null and: void. when- a. public .wateT, - s u- pp) Y becomes available.., Such• approvals - are subject. to modification" or change when = in the:Judgmenf: of the .COmmliiioner, of .Health; ,such revocation, , modification or`.ehange,.is necessary .x Date % / BY/Z/ .. Tale —! �/T Co•f� � v L�r;/�,.'... V =psi, .Owner or PurcFiaser 6-f Building :5471" e Building Constructed by Location - Street Building Type Municipality %M ©X5 , Section a/ Block 17 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.follo : air_g 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- termination of the Director of the Division of Environmental Health Ser- -vi-c e s of the :- Putnam County-Departmen•t of Health as. to_whether..or. no-t the , failure of the system to operate was 'caused 'by"t'he "t4ilrfTr'"or -`neg2 g'ent`' " act of the occupant of the building utilizing the system. Dated this day of '41,141E 19%1 Signatura�,� Title If co oration, give name and 00,7 4C7 -- - - - - - - - - - - - - - - - - - - - -!' G - - - - - - - - - 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 WELL COMPLETION REPORT 3/71 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY'OFFICE BUILDING - CARMEL, NEW YORK -ory. ampleted..by..well, dri Her-and. submitted -to_CouM...H !th,,_P�p_a4tp.r�t..tQqethLer.,w,ith.1aborat -repart.o.f.._..... if icate c4- analysis of water sample indicating water is of satisfactory bacterial ality before cert construction, compliance is issued. REPORT REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER tr ADDRESS I (No .,,& Street) (Town) (Lot Number) LOCATION OF WELL A 61' BUSINESS ❑ ❑ PROPOSED DOMES STABLISHMENT FARM TEST WELL USE OF WELL PUBLIC AIR F-1 E] CONDITIONING ❑ OT I (SpleER SUPPLY INDUSTRIAL cify) DRILLING COMPRESSED CABLE OTHER EQUIPMENT ROTARY AIR PERCUSSION PERCUSSION (Specify) CASING LENGTH (feet) DIAMIETER(/nches)IWEIGHT PER FOOT 9. ❑ DRIVE SHOE r7cli FIND WAS CASING GRO TED? ❑ [:1 DETAILS //7 THREADED WELDED L/*�:[YES YES NO HOURS M. P. ❑ ❑ Z YIELD (G.P.M.) TYIELD EST BAILED PUMPED COMPRESSED AIR WATER MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD T EST (feet) Dept of 'Completed Well LEVEL in feet below Land surface: . MAKE LENGTH OPEN TO AQUIFER (feet) SCREEN DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL Diameter of . well including GRAVEL SIZE (inches), FROM flee, 10 last 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 7 40 el A� 7 If yield was tested at different depths during'drilling, list below FEET GALLONS PER MINUTE DATE WELL COP,,LETD DATE OF REPORT WELL DRILLER (Signature) I I V 7 PUT K. •g Dwisfon ,;:ON ST, RUCTI,ON `PERMIT °FQR A`G l._acate'd At _Subdivision�� `� Owner 1 -��-- t� TN•'d !'�9f� �7y ♦�iC�,r�� � Builtling •Type �` ,� . - Number of�Bedroo MS' ? Ir "Water SuPPIY -` =Public Supply From �' - r '• --f `L`-/G`'c��0_ ^�Lr'C r� /Y�'')',°t y-:= Private Supply ••to be drilled ,L /tom 1 4 s :Address ' ,� ci '�.° i�J° Ffi��C+�� �� 4 _ t ry r{ 5 `` -Other Requirements eg • 1.'iepiesent that ham wholly antl completely responsible for-the design, and Idcationh of ,.the ,proposed system(s);- 1) that the sepa'rate_;sewage, disposal system w I above described will be;constructedlas shown on the approved amendment there to and m accordance with the'standard5 -rules an iregul u nam County. .Department of - Health and`that -6n completion thereof-:a' Certificate of Construction Compliance `sat�sfiactory to the " limper fw hwill 6e submitted to t -he Department and a °wrlttenWguaranteewlll be` furnished the,owher, his, successors helrs.or<ass�gns,by the 3s will j place sm good operating condltlontiany par'.t of said sewage disposal system during, the periodFof two (2) years Immedlate'ly" w' d ante of ahe approval of ahe Ceriif�cate o'f: Construction Compliance of th'e original,systern'bl any repalrs`fhereto 2)rtthat a `3ff�p b- will be locateq as shown -'ori the approvetl plan and that sa�tl well will beAnstalled in accordance..' with the standartls eules, an r,@g County Department of Health s� �`�-- d r Y =� Signe 1 r s AddressO O a APPROVED FOR CONSTRUCTION This approval expires brie yeak, from the date issued unless constructwn" of the bwld� N �n underfi V@Fi s• evocable''for cause; or may, be amended ormodrfied °when,consc ere d nets sar'y by the =Co s�onerl o`f Health Any- change;_ - ' ? > " "stru on- ZPY regwres_ra' new : ermd "Approved for disposal ofdomestic is wage; ad or,-,pr. ter supply orily 0 n 1 Date ~ uey Title .__.. w'_`....,... _...�.__ .. _.t ..._x.'.7.._ _•__�� __.e. �' ;_.__.�,. _ L.. °__.b -. °s. ...-...._. s:. ,.- ...._..x.«___s_.._- �._.__._. _._.w____.i•.. ___._�. _�__._. ,�_......_ _,._.- _ „- �..�_,_ ,.•. __ .... k......w.._...�.. -. _._. y -.«.__ 0 COUNTY DEPARTMENT OF HEALTH )viroriin to l Health Seniides Carmel N Y 1Q512 °�` L f'sC gyp. r:. - z tiLL> a _Town or Village :r t Sect ion Ble_ck i/��►'� ' dY` LOt t7 Job �- -- i Address��.�� ire ►rea�r Ay Jy ;+ g, /�' P ��� ✓mod '/ ;0" -+i " Tota( Habitable Space —�O� -f Square Feet Ir "Water SuPPIY -` =Public Supply From �' - r '• --f `L`-/G`'c��0_ ^�Lr'C r� /Y�'')',°t y-:= Private Supply ••to be drilled ,L /tom 1 4 s :Address ' ,� ci '�.° i�J° Ffi��C+�� �� 4 _ t ry r{ 5 `` -Other Requirements eg • 1.'iepiesent that ham wholly antl completely responsible for-the design, and Idcationh of ,.the ,proposed system(s);- 1) that the sepa'rate_;sewage, disposal system w I above described will be;constructedlas shown on the approved amendment there to and m accordance with the'standard5 -rules an iregul u nam County. .Department of - Health and`that -6n completion thereof-:a' Certificate of Construction Compliance `sat�sfiactory to the " limper fw hwill 6e submitted to t -he Department and a °wrlttenWguaranteewlll be` furnished the,owher, his, successors helrs.or<ass�gns,by the 3s will j place sm good operating condltlontiany par'.t of said sewage disposal system during, the periodFof two (2) years Immedlate'ly" w' d ante of ahe approval of ahe Ceriif�cate o'f: Construction Compliance of th'e original,systern'bl any repalrs`fhereto 2)rtthat a `3ff�p b- will be locateq as shown -'ori the approvetl plan and that sa�tl well will beAnstalled in accordance..' with the standartls eules, an r,@g County Department of Health s� �`�-- d r Y =� Signe 1 r s AddressO O a APPROVED FOR CONSTRUCTION This approval expires brie yeak, from the date issued unless constructwn" of the bwld� N �n underfi V@Fi s• evocable''for cause; or may, be amended ormodrfied °when,consc ere d nets sar'y by the =Co s�onerl o`f Health Any- change;_ - ' ? > " "stru on- ZPY regwres_ra' new : ermd "Approved for disposal ofdomestic is wage; ad or,-,pr. ter supply orily 0 n 1 Date ~ uey Title .__.. w'_`....,... _...�.__ .. _.t ..._x.'.7.._ _•__�� __.e. �' ;_.__.�,. _ L.. °__.b -. °s. ...-...._. s:. ,.- ...._..x.«___s_.._- �._.__._. _._.w____.i•.. ___._�. _�__._. ,�_......_ _,._.- _ „- �..�_,_ ,.•. __ .... k......w.._...�.. -. _._. y -.«.__ 0 kz PUTNAM COUNTY DEPARTMENT OF HEALTH -. .._ a ..; .. .. ..t'. DIVISION..OF ,ENVIRONMENTAL HEALTH; SERVICES .. -. �j..• •, . �.•n.' .'. ..tea.. . • - • - . DESIGN `DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner P07-st4A.99 g): I'n/C, Address. 377 ., �i�TRI�� 4Z_ Located at (Street). L ),_� i9,.C'7 -.�'l � 4/9 Sec . _t�G _� Block p6 Gf /.i of � ., (Indicate nearest�cr.oss .street} Municipality Watershed y'� /CS'��• SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATION . ". Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Water Level No. Time From Ground Surface in Inches Soil Rate Start Stop Min. Start Stop .. Drop in Min/in.drop Inches Inches Inches' 1 g J c-a pr's' ! !`9 :,:57 M /A/ 2 /,`" 3 4 .4 r 5 1 2 4 5 Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are ob- tained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. r, V PUT' Re: Pro' e-r'" of p //v(f Located at P14,4- 7-ie JO G, 4- Z-191V,6 S c t i 9 Bl o c 0 6!57 oll,2. Iot Gentle-.e- * Tin i S 1 0 a du, ce S--S 0 n e connec�;C-- J ^ a sI --S-n- ' S I )-7 'Fl d u c a -L. I - n La. 7- DI .- ' - - I i , c ­ - e a t h L +-h e Put Co--"n t---ry Code - o vm t- e r s i aP .-- 01 Very 1--ruly yours., d Address P E OF 0 P4 V r .Address < jK 44 0. d'- f ic n- a 1, ; il- - I - ll�-I- I z-,"', ­, - -- , " � �, " . ,�. - , � . 1, I �A." 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