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HomeMy WebLinkAbout3879DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.12 -3 -79 BOX 30 •r � 1 ' L '1 rr I ± r` 03879 Has Erosion Control Been Completed? QR� I certify that the systems) as listed serving the abovepre hsTru Attached), and in accordance w ith the standards, .rule a Date �� J Address Any person .occupying premises served by the above s I, [pro e s conditions resulting from such usage :Approval of'th?le available and the approval of the private Ovate _upply soli oagc hl� o wi subjeci� to modification ,or hange when ' . the.- judgme -ri KC i `of Date By i on the,plans the ccimpletied-work (copies of which are issue _bX am County,- pepartment of Health: P. E R A., . _ License No.. Zac'tion as maybe necessary to secure the correction of any unsanitary iall become null and'void asrsoon as a public'sanitary "'sewer 66c6mes ien a :public water becomes available., Such, ,approvals "Aire'.." ; Health, such re cation ` odificat'o - change-:is-necessary. Title': OWNER DATE RECEIVED EDGAR LITZROOT. 5/30/75 CITY, VILLAGE, .TOWN &/OR NAMIr OF SUPPLY DATE REPORTED RD3 ;BOg 107 :A, PO;TNAM; .VALLEY, :.NoYo 6/2/7 .5,AMPLING .POINT,.. . KITCHEN. 'TAP RD3, OSGAWANA EASE R-D o- PUTNAM VALLEY.; N.Ye = BACTIrRIA PER ML. (Agar plate count at'35: -.C). 4 COLIFORM: "GROUP- (Mostrprobable No: /100ml..) LESS THAN 2e2 ARDNESS; TOTAL -ppm DETERGENTS - ppm NITRATES'(as N) - pprii IRON, TOTAL -ppm. WELL`COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 0.3171 Division of Environmental Health Services COUNTY OFFICE BUILDING CARMEL, NEW YORK This report`is to'be_ completed'by well driller and su'bm'itted to County"Heaith bepartment together with laboratory report of 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 �/ hgjf ADDRESS �� r� � 6c'IJ 07 LOCATION OF WELL /� (No. 6 Street) (Town) (Lot Number) WO x.2.7 CA- LA rA �� PROPOSED USE OF WELL BUSINESS ® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL ❑ SUPPLY ❑ INDUSTRIAL AIR OTHER ❑ CONDITIONING (Specify) DRILLING EQUIPMENT OTHER ROTARY LEI A R PERCUSSION ❑ PERCUSSION ❑ (Specify) CASING DETAILS LENGTH (feet) -30 DIAMETER (inches) WEIGHT PER FOOT 7 /� THREADED ❑ WELDED DRIVE SHOE Fil Lpj YES ❑ NO AS G YES NO YIELD TEST HOURS G.P.M. ❑ BAILED ❑ PUMPED C9 COMPRESSED AIR YIELD (G.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST feet) ,i 1 '2 V Depth of Completed Well in feet below Land surface: 2-0 SCREEN MAKE / U N LENGTH OAP /EN O AQUIFER (feet) /` DETAILS SLOT SIZE rJC DIAMETE (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 P Y If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WE L 01LE D 3t 7 7S R DA REP T �f'�7S WELL D LLER (Signatur 61t. _441 �✓ �Gt� %i .r .;�' .�. -;.- -. ^c`r. - - • r ��i -:,:. :'5 o+.yf .. � t 'arcvc �'.r_rc h_ .. .�'�^" -•cn %'^ - v r ^� _ c _ .;:y`.�:��- .:. � � _.• ,v.4T �:vrcc © Owner or Purchaser o Building Municipality Building Constructed by ^ ct o_n V,4.,< 1A sc.�wBa�.4 GAll,5 Location - Street Building Type 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 :Wade by me to such-sIrstem, 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- -- vit'es of the- Putriam County Department of Health-as' to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. , Dated this day of , 19�� Signature Title If corporation, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP±,ETION 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 PUTiAM .,COUNTY DEGy PARTMENT OF HEAiLTH z 1 t. _ Divisron of Enw�onmental Health Ser4cpC. Carmel, N Y ;f0512 4 ld' .66NSTRU&ION PERMIT' FOR SEWAGE DISPQSAL SYSTEMS �Ww �� �rj- ` t j ALL y ! Town or 'dil age Located. at (/SC A W�4 n/si : 0,4 p ] % e � A r E FOR � Block Subdivision Lot =Job Addre4s5'C.aw•�,•J,.�Ja Z,4�CE "i 1�.3 •e/�G�.r fiUilding.TYpe LOt Area Number of Bedrooms Total Habitable Space Square .Fief 2� _. Sepaiate- Sewerage System to consist of,- Gal Septic Tank lineal feet -X width, trerich i , To be.'constructed by ",Q� Address 1 Water Supply Public Supply F►om rivate;Supply ;to be drilled byJ o . j Address ? • other, Requirements 1 represent that I';am wholly and completely responsible for the design and locption of the proposed systems) 1) that. the' separate, sewage - disposal system, - :` j K : an .regu a ions o e u nam s ount `,-De artment 'of. `Health and =that on;com letion thereof a- Certd�cate of :COnstcuction. Com (lance" satisfactory -to � .: C Y. rd ;; rules P..... Commissioner .of Healtli'w�ll beosubm tt det Wthe De artmenttl and aWwritten guarantee w II be urnished the owner hisrsuccessors, heirs or assigns by the builder;ahat said builder .will 1 _place„in good operating °,condition any,part of said sewage disposal system dur the period of tyro (2) years immediately following thedate of the -' County Department of Health Address X APPROVED FORiCONSTRUCTION This approval expires one y zrevocable for •.cause or may be. amended or modified when considei regwres 'a w .p mit 'Approved for isposal of. domestic sans oats � _ • ��' ,,�,{�, By mltoY U /aa,wrvanw ryN -. nv .awnu a uu loa a��ur. �vyu�nawna v .,uw - uumnr s s xc J: R A n the date-` ". .. i T- �ssued "unless construction of the ,building has been undertaken and is ssacy by the Commissions► HeaKh 'Any change,; or alteration ofonsf 'ction,, va and /o "r riv to water suPPly' only %�,` 3. Title or C' PUTNAM COUNTY DEPARTMENT OF HEALTH. :. DIVISION ' of ' tNVfROf l;tftAi; ""0TH SERVICES Date Re: Property of &D 6 A.< Located at 5 j4j Block Lot Gentlemen: This letter is to authorize_ STAKILEY I LAND.ER a duly licensed professional engineer or 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 necessary papers on my behalf in W111C1 L1V1J w_L Ln Ljilb ma is Lev and to. supervise the construe ciun of said system or systems in conformity with the provisions of Article 145 or _ �.:4 - Educa -fi on Law, -the Public Rea th Lair, - and- :the -Ritnam- Couunfy Sani tary Code. Very truly yours, Signed. l Owrj of -Property P eE ., -, # � Telephone _ -Z1fd-- Zj. Telephone l T-Insp. byl. �Wr —'1 ti iti''T ..n - .— IT'�pii. �+ l � '.2 r. `T'; °_11 ?. >P1sG'1'1.C)l:es' "`I��"o : Corriments - - Prop:^rty lines or corners found o 0 e e e Can esti111at;, house location ... . s e e 6 - W ill driveway need cut --`- �f�z�yt trees be removed -note these . . . -�� Is deep hole.repsesentative of entire SDS area - -Additional doep holes needed. Suf.f,'.i_cient SDS area available considering driveway cut, house, location, separation.. distances, etc.. . . . •. . e . . . . DEEP WL' D^-TA D -;pth VTater elevation: Rock elevation: So1S deSCriptiOn:iYSi�l ✓U!� Date.: 9 5. FINAL, SITE IDISPECTIOTd Insp. by: House located where shown on approved .plan SDS Inca Ued.li-There approved ... v Slop- of tile � � i ne and trench accPp +able .: ..e ROOM allowed for expansion trenches . e e •' Over 50 ft . from swamp, watercourse Natural soil r not st i ue SDS d or area unnecessa.rily - grad-ed °.- 10 j*1 t . ma:ihtained from prop. line and 20 ft. from house . e e Separation of trench from house, well etc. follows plan Number of bedrooma checks e , Stones, brush, . stumps, rubble, etc. greater: - than 15 ft. from nearest trench 10 5 I+ t . of peripheral soil . horizontally from trench . . . O e e e . e e e Junction boxes properly set Could surface run off. from driveway, roads,, ground surface, etc. channel near SDS , e�"'"� area W- -s lot drainage annear 0. K. in area of SDS Ll FIML GRADING OF SITE ACCEPTAIILE • 1 • I'UTD1AM COUNTY DEPARTMENT OF HEALTH DIVISION OF EAVIRONMENTAL HEALTH SERVICE° C50N'1'Y- OFFICE BUILDII`IG, CALL, N . Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. ,,rr, , ,� �� Owner �G/a� `: TL K �� C, Address 0.5e.4 wAA,,A Y41,14 �P14� . /?YWA)M 1'4,44fz.W X (Street. R0dIcate �AWA A IAKe 41 -'7 M�►P & Block 4-1 Lot. Located at nearest cross s reet Municipality �yvx� f v, °i„��t3 4/ 11aeK Watershed /Z i�Z j �� ��a�,� A`u,�- SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS F1019 Number CLOCK TIPS PERCOLATION PERCOLATION Run haapse Depth to a er Water LFve No. Time From Ground .Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches �j ` / /j Z177- 142- 0 4 4 2 3 5 Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. 36" 4211 v i ' a Y0,. 84t' INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED v 14 77e�e-- INDICATE LvTL .TO WHICH WATER'VEL RISES AFTER BEING ENCOUNTERED TESTS 14ADE BY _.1 ,q,�� � Date P } DESIGN Soil Rate Used�Min/l "Drop: S. D. Usable Area Provided' No. of Bedrooms Septic Tank Capacity. Gals. Typez'��,wt Absorption Area Provided ByaLoX L.F.x24" ---'-"/,,width trench. DER Other 4� tame Signature. Blom Address V w SEAL E'uNt�IvJ j7 � 7, n THIS SPACE FOR USE BY 1MLTH DEPARTP�NT .ONLY: _ Soil Rate.Approved Sq.. Ft /Cal. Checked by Dote TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION,!` DESCRTPTION OIL' SOILS ENCCI)DIT RED IN TEST HOLES a' DEPTH HOLE NO. PI HOLE NO. P 2 HOLD; NO `DC6 G.L.'sa�� 6" r y 12" �� /--1 C. C.� T n /�f�tx r•� c 18" 24" W 3011 ti 36" 4211 v i ' a Y0,. 84t' INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED v 14 77e�e-- INDICATE LvTL .TO WHICH WATER'VEL RISES AFTER BEING ENCOUNTERED TESTS 14ADE BY _.1 ,q,�� � Date P } DESIGN Soil Rate Used�Min/l "Drop: S. D. Usable Area Provided' No. of Bedrooms Septic Tank Capacity. Gals. Typez'��,wt Absorption Area Provided ByaLoX L.F.x24" ---'-"/,,width trench. DER Other 4� tame Signature. Blom Address V w SEAL E'uNt�IvJ j7 � 7, n THIS SPACE FOR USE BY 1MLTH DEPARTP�NT .ONLY: _ Soil Rate.Approved Sq.. Ft /Cal. 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