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HomeMy WebLinkAbout3697DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.17 -1 -29 BOX 29 03697 �'. 1,m4 + �, , . , '. I ll 03697 z TMs•- •--- �.- r,-..�.c. --•-- —e F - - -e - ^� s.n..'.^. YS'r'-'. 'r- ,."" s >' 'PUTNAM COUNPY DEPARTMENT OF HEALTH t� H{ Xo Division of Environmenra! Health Services, Caime% N' Y 10512 �( rERTIF: RG�4TrE: I( 1F.. C� )N3TR,l1CTltiil�&�Qh9Pl.irilyCE TOR •.SEU'v'AGE ®piSAL'S1f57EM, ' ~ .'�L/T�l+la4r49 . �/;tJ L c Et✓ 1 ' l: t Town or Village / 1 ;a Located .at Section Bloc I �. Owner ti Separate Sewerage System` built .tiy �ri/�OI�AG56✓ /TAT /fl.✓ Address Consisting ofr ,fZSa Gal Septic Tank lineal Feetw X `4 r; width trench - other requirements 111 later'Supply' 'Public Supply -From ` r f t/ ,Prl4ate Supply Drilled ev t �42M.4 �/ AND�.eso/✓ � a Address ',9R�E Q Gd!% Bwltl�ng .Type w /0i� r No, 'of Bearoomsk Date Permit Issuedt Has Erosion Control Been Completed z. T{ z I .certify that the system(,), as {istedservmg_ the above premise's were',constructeil essentially as shown on the plans of the'completed wd,rk,(cgpies of which a re, i attached)` and in accordance w�th;'the steridarde rules and regulatiohs plahs,f� led arid the permit issued by the Putriam County Department of Health. Date, i nn Certrfied by P E y,iR A �a Address <0� © /�� K�rf/z Yr /r 6/x.1 License No ' ` ' Lc` y ~^ \ x w'` _" 4" fr' a eces3ar do LL cure tlie.coiiection of a`n 'un`sanitar =�Any,!person, occupying - premises served by:the above system,(,) shall;promptlyF take_isuch action'as may b n .se y. Y ...Y conditions resulting from such `.sage Approval -of the separate sewerage.system r shal6 become null.antl void'as soon "as a•p,ublic• sanitary 'sewer becomes i available 1h1 the, approval of the,;prihdte; water supply shall;•become null anq: void when a public, water supply beebmes available Such ..app ovals. are ' Subject, 'to motlifiwtion or change. when m the Judgment of the Commissioner of'`Hea it such revocation modrFication or change is necessary It! ,n f�. +, t Y, �Y 5k . ,yt s •t 6 t i,. .9 Date. -�.� T,t�e'; l `i n lx 7770 YORKTOWN MEDICAL LABORATORY INC. P.O. Box 99 321 Kear Street Yorktown Heigh$�.::N.Y..Q598 ... .:,:.:: ;... 245 -3203 1. DATE COLLECTED RESULTS OF, EXAMINATION OF WATER OWNER DATE RECEIVED F 9/14/72 CITY, VILLAGE, TOWN VOR NAME OF SUPPLY DATE REPORTED 6 PARTRIDGE LANE— PUTNAM VALLEY N.Y. 9/16/72 SAMPLING POINT WELL BACTERIA PEI ML. (Agar plate count at 350 C). COLIFORM GROUP (Most probable No. 715omi.) LESS THAN 202 . HARDNESS; TOTAL - ppm DETERGENTS - ppm NITRATES (as N) =. ppm IRON, TOTAL - ppm ' These results "indicate t:hat the water was YES of a satisfactory sanitary quality when the sample was coliected. �� ' A. H. PADOVANI, M. T. (ASCP) r- WELL COMPLETION REPORT 3/71 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK -- - ..- ......T..his_re or. _jk.rtq be._com lexed fay wall drFllerr end. ubmitted. to_ QDupty_ H, galth _.Q @pilrtMenµt.tPgether:w,i .labolatohy,:re,por�of.:::. p, p, ,._...,, £ 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 _....} /,) J. �i ADDR „ n LOCATION OF WELL l . (No. Street) ✓�� -2_- -- (Town) (Lot Number) PROPOSED USE OF WELL BUSINESS r DOMESTIC ❑ ESTABLISHMENT ❑ SUPPLY ❑ INDUSTRIAL ❑ FARM ❑ CONDITIONING ❑ TEST WELL ❑ OTHER DRILLING EQUIPMENT ❑ ROTARY COMPRESSED. AIR PERCUSSION CABLE ❑ PERCUSSION OTHER ❑ CASING DETAILS LENGTH (feet) �Q ( DIAMETER �t WEIGHT PER FOOT / � THREADED ❑ WELDED DRIVE SHOE .YES ❑ NO WAS CASTG G�OjUT D7 ❑ YES ONO YIELD TEST ❑ BAILED HOURS El PUMPED © COMPRESSED'AIR G.P.M. YIELD (O: P /M.) WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify Ie et) DURING YIELD TEST (feet) Depth of Completed Well r in feet below Land surface: 176 SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (Inches): GRAVEL SIZE (Inches) FROM (feet) TO (feet) DEPTH FROM LAND SURFACE FOORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET / A) f 1'76 r L If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL OMP :7 TED , / Y DATE OF REPORT WEL RILLER (S' ature) K D' ' Jon_ � � ��CONSTRtUCTION PERMIT pF,QR SEWAG� Located ati�►.�Ti�'��ity� �� t Sub n divisio SGCC� '' owner ;Eu�.�ETT_ C.NIL*T/�i/�t {,x � Building Trype` � a5'%"} �CSL. �# Number of Bedrooms " F ' ° � Separate Sewerager System to consist of To be constructed by AIVI�/44o'�'it�C �= 'x Water Supply Public Supply Fromw- � � }z ,. P,rnrate Supply to ,be ` Fy Address 9Othbr Requirements, c I represer t that�t am wholly and completely resp( xabove tlescr�bed� will beiconstructed^`asshown:on , tl 4• :a .-. County De ar. t,n.e. n_ t 'of. =,MeaI t h,W.. a_nd. , ha . on t .c"o{ n n be submitted to the !Department; •;antl a ­writter place •in.'good operating condition any 'part of k ance -of -the approval of the Certificate of- Con ll be gc'atedas'shown on.the approved,planrand •County Department of Wealth oate�,.b3T %% z z _ Address' APPROVED FORzCONSTRUCTI ON. This'apprc .revocabie for.cause or may be amended or modifi qui res a new permit A'pprovedfor d� re sposaf; x ,.� IV '1 ` _ f ` COUNTY. DEPARTMENT OF HEALTH ��ronmenta( Hea /th Services Carmel N Y 10512 OSAL SYSTEM m nG+Td/.gr71;� E s +- -•`�'� .�s �' � }---�. T9wn4_or .V,Ilage c 1F•. Section `/• dL�'.��1�Block ' .. Lot 5� Job Atldress r " ;-� Total H Feet � e Gal �Se6t1C Tank lineal feet 'X - width' trench ng'7 r-- - x .7, j''�/d� C�rIG( )r: the tlesign`.and location of the proposed systems) '1) ,that 'the separate sewage disposal „system w o r. K n ved! +amendment there t a r o nd m acco dance with the standards rule an `r a n m -.':: thereof a Certificate of Construction Compliance 3 satisfactory to the <Commissloner of Healthwdl teeT'will be. "furn!shed the owner hissuccessors heirs'or, assigns'by the,builder;.that said- builder wilt j wage disposal system dunng ahe leper otl of two (2) years immediately followiiig,thedate_,of the i ;su Compliance of + +Eli's original system_or any?repa rs thereto 2 }'that the_drilleil wall describetl above I well will be msalled in , , oPutnam ulatins +Signed t ��4�'llJ x P. �tiR A i�� 1✓l's License No es one year_'from the date issued unless construction= of the- buildih §,Kas been undertaken and -is coris�dered`.necessary by 'the_Commissionei.'of Health Any change orealteration ofaconstruction stir ^sanitary sewage, antl %or - private ;water :supply only i ` 2 " ++.'� ,t�i c 17 T r� 07- Da. V--- TC Re.: 094 "r 4144.s -5 4: Located at /�qwne, o A'2-- Section BI o c LO Gen Z- a f zz ­0 r S connect-, -7 on e !-m I !---,)-d the nutnar- 11L.7, L tarty Gode. C o LLri -'U- 6 r s 1 ',':7 In e "' , 7 Seal' A,delress leg Very vcju.-,-ls, §zn 0 ell- A . r-e—s s 7- �A Tel en acne PUTNAM COUNTY DEPART!,ENT OF HEALTH DIVISION OF ..ENVT.RONIAiENT�_L. - HEALTH 'SERVICES-': COUNTY OFFICE BUILDING, CALRYEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner `�=i� ,c? r' C.4 frri� s:.�/7 Address Located at (Street Sec. c e-0, Block C// Lot 6dicate nearest cross street) Municipality Watershed�res,,� SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS --Hole Number. CLOCK TIME PERCOLATION PERCOLATION apse Dep n to Water Wate r ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min.. /in drop Inches Inches Inches ..2 19 " c i " ); 5 M, A/ 3 /4� f'- 6 114 1,11 4 1 2 3 5 Votes: 1) Tests to be repeated at same depth until approximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be ?ode from top of hole. 3 4-77 5 1 2 3 5 Votes: 1) Tests to be repeated at same depth until approximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be ?ode from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION _DES.C,RIPTION .OF_ SOILS ENCOUNTERED IN TEST HOLES _^ .DEPTH HOLE NO. (7) HOLE N0. � HOLE NO. 7 G.L. 611 1211 1811 2411 . 301f 3611 42" 48f1 5411 6011 6611 7211 7811 8411 o� sb / e re; /e:l 'ro I c.:. 1 1M?S`tn . .j i 1 Lvr1/" t/ J� i _INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISS AFTER BEING ENCOUNTERED TESTS MADE BY ti 7, ea�V � 6 Date t J,4/t/ 7?. DESIGN Soil Rate Used /O Min/111Drop: S.D. Usable Area Provided _5-oo o s.,c f No. of Bedrooms ¢ Septic Tank Capacity IZO- Q Gals. C��rYc, t Absorption Area Provided Bye .F.x2411 6 ` et 11F h. G" Name Name �//�Eiv, ;�' C;,��i�� G,' C�.. igna ur. e 5 Fk.� Address sa Sic✓ /Y�,Gcy �'.iJ�j� ,°A, SEAZ ' )ZD 2- ':�_6'G5 9 I Ewlt1 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved 1,7 Sq. Ft /Gal. Checked by i �� l , Date L07- 56 43572 S, f.