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HomeMy WebLinkAbout3699DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.17 -1 -32 BOX 29 F,ti,. I so NNNNI r L 4 NNN I IN � . i+ . � . 0 NOR f - Or - AN IN Located •V Owner Separate ,Sewerage System built, by Cl� s v� Coneist�ng of sf�4l� Gal S.a„eptic Tank her repuirements z - Water Supply Publlir. Supply From rPnvate Supply bnlled,BY Building Type � ,Has Erosion Control Been Completed I I;`cert,fy .'that thesystem(s), as listed ;serving the above premises attached'); and iri'.accordarice with the�stantlards .rules anCi , ,a x ' 1 / n SP Zb /7 :� x Date r r l k` ,• t 1 l w Address ' %9 Any, person �occupy,ng premises served by the above system(s conditions resulf(ng from,such' :usage Approval ,of the -s6p availabld an�dr,06 approval of the,prrvate water;'supply shall`° subject to modification or change when in the judgment_ � O Section _ Block Job •Address DrP sn- e�e�.E'iS:Fi /� ��`:,. q ' ZOa line 1 Feet X, �6 width trench 1 � z t y k b � '� _ �.^ '.Nn'• of YD'M' rnnme � ':. a -rla}o Dnrm.}.e lee�wrl . - ✓' x , ;�,', $ r'" �, �, f 7 t qT ��. ;y f •rJ.:V �,. r i were constructed essentially as'shown,on ,the plans of the'completed work"(copies of which are. egulat,ons, 1"' plans filed and the permit issued $by the Putnam County Department of Health. lY Certified by �r —r'"' �P ER A 2eeK p%�r/7 License No. shall promptly takesuch act�on.as maybe necessary to secure the correction of any unsanitary, crate sewerage system shall become riull'antl vo)d•as soon ;as a public sanitary sewer becomes,: ' become•nulijanq' void when a ;public waterrsupply becomes available :'Such ,approvals are of the. Commissioner of <Health''such revocation ''modrfication or. change is necessary Title ^� .�I a'. `, �'• .a �.,r yam`,.; _ 3 7 x PUTNAM ;COUNTY DEPARTMENT' OF HEALTH---, Division of Env�onmenial Health Se�wces, fCarmel N' Y 10512 f CERTIFII'�4TFr C1FaiCQN TRlJCTIQl1! COM �E�I G L�I�F� ^Ad. S�'ST Mfl �f - i `��✓�� . .PjLjAt1C�`FQU n .� 1 'Town Vil lage jk ' Located •V Owner Separate ,Sewerage System built, by Cl� s v� Coneist�ng of sf�4l� Gal S.a„eptic Tank her repuirements z - Water Supply Publlir. Supply From rPnvate Supply bnlled,BY Building Type � ,Has Erosion Control Been Completed I I;`cert,fy .'that thesystem(s), as listed ;serving the above premises attached'); and iri'.accordarice with the�stantlards .rules anCi , ,a x ' 1 / n SP Zb /7 :� x Date r r l k` ,• t 1 l w Address ' %9 Any, person �occupy,ng premises served by the above system(s conditions resulf(ng from,such' :usage Approval ,of the -s6p availabld an�dr,06 approval of the,prrvate water;'supply shall`° subject to modification or change when in the judgment_ � O Section _ Block Job •Address DrP sn- e�e�.E'iS:Fi /� ��`:,. q ' ZOa line 1 Feet X, �6 width trench 1 � z t y k b � '� _ �.^ '.Nn'• of YD'M' rnnme � ':. a -rla}o Dnrm.}.e lee�wrl . - ✓' x , ;�,', $ r'" �, �, f 7 t qT ��. ;y f •rJ.:V �,. r i were constructed essentially as'shown,on ,the plans of the'completed work"(copies of which are. egulat,ons, 1"' plans filed and the permit issued $by the Putnam County Department of Health. lY Certified by �r —r'"' �P ER A 2eeK p%�r/7 License No. shall promptly takesuch act�on.as maybe necessary to secure the correction of any unsanitary, crate sewerage system shall become riull'antl vo)d•as soon ;as a public sanitary sewer becomes,: ' become•nulijanq' void when a ;public waterrsupply becomes available :'Such ,approvals are of the. Commissioner of <Health''such revocation ''modrfication or. change is necessary Title ^� .�I WEI.1 COMPLETION REPORT 3/71 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK . `This' prep oiA,-= i3- to-.bs : com pleted••by:.�F�eld'.drillev;and submitted : to- County,Health. Department together •with--lab'oratory: report :o#.- 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 / V ADDRESS LOCATION OF WELL (No. & Street) (Town) (Lot Number) > PROPOSED USE OF WELL BUSINESS DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL if ) 11 SUPP Y El INDUSTRIAL ❑ CONDITIONING El (Specify) DRILLING MENT EQUIPMENT ❑ ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION (Specify) CASING DETAILS LENGTH (feet) `i DIAMETER (inches) f' WEIGHT PER FOOT j O. THREADED ❑ WELDED DRIVE SHOE OYES ❑ NO — OU D4 El YES NO YIELD TEST HOURS G.P.M. ❑ BAILED ❑ PUMPED © COMPRESSED AIR �� ��j YIELD (G.P.M.) A) WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Spectry feet) DURING YIELD, TEST (feet) Depth of Completed Well in feet below Land surface: /i U 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 FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET r ; If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMP ETED DATE OF REPORT WELL DRILLER (Signature) _t r r. ; Owner or Purchaser of Building Municipality Building Constructed by Location - S reet Building Type Section Block 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 following 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- vices of the Putnam County Department of Health as to whether or not the failure ef,. -the .-system• to ,- operate was caused by the willful or negligent act of the occ�up/ant of the ilding utilizing the syst( . Dated this o44 day of 19�c?-Signature Title 10�1T' l.Li,,icorpor ion, give name an . -addre s — — — — — — — — — — — — — — — — — — — — — — —�c_r — — — — — — — L 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 f Aro ' J PUTNAM COUNTY DEPARTMENT OF HEALTH ...,.�. � -.�::� ,..,....,,- �: =._: =:gin = „�,- D.•IVISION�OF�_.�TVIRO.l�I ,:T�4L�,HEALTH ^- .SERU;�,CME$ -. -.” n.- .� ., _, �. F Date C-7- /.3 ..,1 970 Re: _ Property of Located at ,1-4. Section r�C -9 BlockaWPaOa'2-- Lot 4v' Gentlemen: This letter is to authorize. a duly licensed professional engineer _� or registered architect (Indicate) to apply for a'Construction Permit for a separate sewerage system; to serve the above noted property in accordance with the standards, rules or regulations as promulgated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said. ..system- -or-'is:ystem -s - in-- eooformi•ty<.with -thie provi..sions -of_. A-rticl.o... 45,.Qr...._.:. .... 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned: P.E., R.A., h Address Very truly yours, Signed puT q&nl r le.�. & • . Owner of Propertly 'address tl-( LL, 161-1 vL' �°tZ�v�t cJ+Ml i-- q N4 Y. Telephone 4 Of 1VFro,� ! LJ ;Z 6S m r tz Telephone CUP 0 "y� 0 �4V f 24 ��� fN6 {NEEtw . PUTNAM COUNTY.DEPARTMENT OF HEALTH DIVISION OF' .ENVIRONMENTAL. HEALTH ISERVI.CES . : .:aq.. -.: vw- . +.- ..Tt- __.... .... .►.... .<5...r w.. ___. r['.. >t ..'::- 'a�.�aCl 'bi- m_v.VV'^ _`.{w:4' .. .r.V P.. .. .M_..c't: a .. - a . ^:..1 -Y dos- ws.4.: DESIGN .DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Address /� .5rv�r STiiy'T r�vo4 itJi= av��y.�.�, /✓ 5! Located at (Street) /:�PloT�e/�4504 /0C-9 Bloc iLot (Indicate nearest cross street) Municipality Watershed .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 Z y -lt " ?ice /� S's 7 -N 4: 5' 2 5 2 , 3 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. TEST PIT DATA..REQUIRED 1-0 BE- SUBMITTED WITH APPLICATION -- -- -• - - -• . - ..;..�:. _. -�. = =DESC�2IPTION- Or-- SOFLS.: ENCOi�iVTBRF ;I3:..IitT�l�,S "�'•Tri'OiE.J .:,.:; -_ :.h .,• .... _.._...,,,_ ....,, .,... DEPTH HOLE N0. ,HOLE NO.--O HOLE NO.. 7 T�� G. L. 7p/' S'o „4- 7Of So."d- %oF� 61T 1211. 18T1 y 2411 r , 3 011 361t �.eozin�l> G✓.d T•E,t° 48 if ti 5 4” " 6011 6611 n 721? ....,,.........7811 �.......,........ _ .,..... ......._...._ � ...._.__ .._ , ._._._...,..:.__.,......... . , ..,.....,- ..._............ .... _.. 8 411 /.. INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVE L TO WHICH:WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY �. /� =�v-� r� r�,_o,o��v >,�,e , Date CC 7- DESIGF- Soil . Rate Used-- Min/l?! Drop :... S.D. Usable,. Area.. Provided 50.'oo No. of Bedrooms 4 Septic Tank Capacity, /2yci Gals. Type Absorption. Area Provided By�/ 5 L. F,x24" 36T'_j:,�'width trench_. Other -�" Gc/E�� p,E'.o %tJE� c5�i� -O _$,� .. /Nsifo[ c.E® /3..S' . S is�oz..rnJ aN .�A/✓. Name or-?,e . Signature Address 7-z o SEAL PUTNAM COUNTY DEPARTMENT OF HEALTH o � Soil Rate Approved - ,® -Sq.: Ft. /Gal. Checked by• ���® 12A4 ate. .... -�... i R..�- •'e"ss.r - na..�:er.+c r�.r-ae'�= a�.-= ..e.:a: rrzr�t'.we�•:� -.�x.- � r..'.,..r.F,.�m.�:*4 - -.'� -_ "'-_'` �c- ..a.� —..— — '-.- s�•`c.cacr;- �- ,.' <�:... Y.:' ; _ _ _. GO.OPr8AV VE ftEE W 0 n A YRO L^,J..i'3"_'. +� ���• ��� OT 45 " • TO TX5 OE �E�E WA MR I fY EXISTlNB SURFACE tt . L 0,F � 4, OF WELL fi NEf1 sea iS EOUJREtf ' i. . O %/OE TXEN'ECESS�RY X 0,& 5-'0'OYERGROUND + R. 1 ,k coT.44 k +"� P'; � "..:Sty .\ f, rv.,.s �- « • I � ,. ��� . , f3By'`f3 TO NOJ?TilSlOE OF SDM£RSt7 LA. �" l N p W 00-'rY v LANe r v16F /nlfSxElS} .:lY 4 °/ClG'}FOfvP tom' PARCEL SXQlyN XEREON•KNOWN QS LOT 45' u� a SUBD /Y!S /ON MAP-SEC. B OF PUMA ACRM _ t ToWN,OFPUTNA -4i VALLEY T.pX MAP - fi _ : s��,,��«,, ' �� �'�. � °++��, '� :": '. � . � vrs>rcNArraN • �.O r �`;�� � • as��?�OP �{ < �� '� �