Loading...
HomeMy WebLinkAbout3886DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.16 -1 -10 BOX 30 I IN INN a I IN r 61 Is Fixv A2A C0 �y46 i J PUTNAM COUNTY HEALTH DEPARmw ( % * * DIVISION of ENVIRONMENTAL HEALTH SERVICES P,w 0 PROPOSAL FOR SEWAGE DISPOSAL SYSTEM RERAM OWM' S NAME W &I $ 64Ac, I- `� ' PH � 06 - V CNE ;'* — 9d2 7ff SITE LOCATION � VD LOW Q& 20 T-5 f 1 ii. ' l —W Ci MAILING ADDRESS Q�►�U4w V+4U�•i -y t l . ( ©S`��1 PCHD Complaint # Name & Relationship (i.e, owner,tenant, etc.) TYPE FACILITY �S PHONE C`2- G •- o) SF S' REGISTRATION # 13? Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal from licensed professional engineer or registered architect. C N-CZk EwT,.x 6 F t rwv t 6�4 ox 0 W e, u- %roc s 191 $ UC*f -rtodl. sire Proposal approved Proposal Disapproved Inspector's Signature & Title Proposal aDDroved with the following conditions: 1. procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed camponents tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. system repair to be performed in accordance with the above proposal and conditions. I, as owner, reported agent of owner agree to the above conditions. SIGNATURE TITLE t'h Z1V-Z DATE C `r [PIE'S: Mite (MD); YeUm M3An ED[); Pink LITUmnt) S ,.9230; - YORKTOWN MEDICAL LABORATORY INC P.O., Box 99 321 Kear Street - Yorkto�in�H4ig ts; :Y::lf� 98� ._�� >:,, r _.__., .. -,. -- r.. ��2 5:341;.� ..a_ DATE COLLECTED RESULTS OF EXAMINATION OF WATER - DWNER DATE RECEIVED BROOK DALE GARDENS INC 12/26/72 CITY, VILLAGE, TOWN & /OR NAME: OF SUPPLY DATE REPORTED .UPLAND DR. PUTNAM VALLEY N.Y. 12/28/ ?2 bAMPLING POINT WELL -- BROOK. DALE HEIGHTS. PUTNAM VALLEY. N.Y. -- LOT.# BACTtrRI A PER ML. (Agar plate count at '350 C). 8 COLIFORM. GROUP (Most probable No, 100ml.) LESS THAN 2.2 DNESS, TOTAL - ppm DETERGENTS-ppm NITRATES (as N) - ppm IRON, TOTAL - ppm FLOURIDE (F) - mg. /i. These results'indicate that the water was YES of d satisfactory sanitary quality when the sample was c 1e • d. A. H. P.ADOVANI, T. (ASCP) WELL COMPLETION' REPOP14 Pl3TiVAM COUNTY DEPt,RTMFIJT OF tfE,4l_l'9 3171 3 Division of Environmental HealI:4 Services I COUNTY Or-I-ICE BUILDING - CANNEL, NEW YORF r This report is to he completed by well driller and submitted to County Health Department 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 DAMS OF WELL COWLETION�� OWNER NAIAE t �v�„ - Ev "'^ �. f/J.Cfjr' -)�F. L?i�+eLLb�l:'„S - '�N'C., - ADDRESS - �' ! �7 rit�'t -i/'•1 [/iQ[.t��.khyc�Cl7.'dLrt- fiO3,. LOCATION (No. 8 Street) (TosvnJ (Lot Number) OF WELL ,l.�jL 7 .r .fC.�_�'�_ ��PPG/1a10 '°�i' 1 ✓L= A -•-- -- f� BUSINESS jn�j (� D " ;PROPOSED DOMESTIC ESTABLISHMENT L� FARM l TEST VJEII J USE OF WELL r -j RUBLIC r- j ❑ AIR j-1. OTHER (1 SUPPLY' El INDUSTRIAL CONDITIONING I_J (Specify) " DRILLING n COMPRESSED CABLE OTHER ROTARY rx-1 EQUIPMENT 1.�J AIR PEP.CU55ION PERCUSSION (Specify, ^ LASING DETAILS LENGTH (feet) DtAh.1ETER(inches)._ WEIGt1T'PER FOOT (Cr�IVE SHOE( i' - '� l.�THREADED D WELDED RYES I_LT�iC7� �- (W�4; CASSN3 GknOUTED? 1� I YES � ( .I No - / �� . � MELD _L'1 - -� -- HOURS HOURS G.A.M. El YIELD (G.P M.) TEST L-1 :FUMPED ` ' COMPRESSED AIR WATER . MEASURE FROM LAND SURFACE- STATIC (Specify feet) F,I j DUNG YIELD TEST feet) Depth of Compleied Well LEVEL in feet beiew Land surface;• �2 j MAKE LENGTH OPEN TO AQUIFER (feet) SCREEN DETAILS SLOT SIZE CIAMETER (inches) - GRAVEL SIZE (inches) FROM (lee,) TO (feet) IF GRr�.YFL Diameter of well including 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 Le y +- If yield was tested at different depths during drilling, list below - FEET GALLONS PER MINUTE D, T.E WELL COMPLETED DATE OF REPORT wFt _L It-F:R (5' rlu/�rL) Owner or Purchaser o Bui ding Building Constructed by UfPPLdamD D,ikJe_= Location - Street . 7i2i5 5. ]>&Aj Building Type ..0 4 Municipality ',�A)4. A4 A9 . i 1`1 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 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 197^3 Signatur>ej���.�� Title 1�s. If corporation, give name and address) 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 9F DATE OF FIRST USE OF SYSTEM. - - - - - - - - - - - - - - - - - - -j� - - - - - - - - - - - - - - - - - - Division of Environmental Health Services, Putnam County Department of Health -s PUTNAM COUNTY DEPARTMENT OF HEALTH Re: Property P Y of ��. Located at an-11 d Block / Lot Gentlemen: STA�LEY '� ODE This letter is to authorize a duly l ice nsed.professional engineer or registered architect (Indicate— to apply for a Construction . Permit for a separate sewerage system; t.o serve the above noted property in accordance with the.standards, rules or regulations as promulgated by the Commissioner of the Putnam County T .+ ,....1 i� - TT. -..-.1 + yy,, .7 �.i. r l "1 v. is �.e� "eTn vrcr rn rr+ +n nv� mtr �o�nn 1 P i-n LCparl'1 el—Il� of 1-1GCL -L 1 11, cLilU UV Sigh all 112 �..�.�c, y yc�r._ S vii u.y v .ic,�i �• connection with this.matter and to supervise the.construction of said system or systems.in conformity with the..pr.ovisions of Article 145 -or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary.Code. Counte signed: P.E.,, # 7v STANLEY L LANDER ( seal) Address AMAWAK N. Y.--I 05 -2645 eiepnone i t 1 V� ,I f a i ! Very truly yours, Signed lVrj Owner o Property Address 71`6 —2 eiep one 5 Fu T C C" T Li T' DT i, ......... U Z V 1 1. t'_ DESILGN J.""T_A S'z=T FILE `30 0 r e� 0/'j ve 41 L oc a at Lo- 0/. ,41 Biockc> S 7 I/ X Mu, icioa' i:,. n �:)r T(-1TTC)\T S 0 1 P— TO r) E ST,- �.'T ED 2- LJ ­ Z-;- - __ Hole Nu r r T, C111 T 7 '.:' �" () P-7 -CT I P E'R C' 0 n Le N. 0 T i Fro.- �Sroul-._ _- QO j Spar -. .`LCc S -0:) r .3 n c e S T l-.C- z' cz /601 .3-3 44 4 2 le:.50 47-V T" it 3. sol" s 'i*ests tb ibe ree�eEt--C' at 21 tll e e au ta i nel-2L a t e c `1 P e 07 t_eSy. -o p s 01 TEST PIT DATA PEGUI,,v-7:) -0 S:u�,jTTTED .HOLD NO.R-, ")PrTr2 DESC---R'TDTTON 07 ?R-:,T) T': • T -f n r, DEPTH HOLE NO .HOLD NO.R-, HOLT,.: Vo. G.L. 121' 2 4' A 30" 36`' 42` ` -' 43" 54` 6 0- 66".- 2- i 78-) lvn -40 �L 00 -L d-34(7 IV till A RE .1h . Ltj,-, N 8 4". INDICATE' rLj':'k,--L AT r,,-HICH LMROTUND r,,TATE-, IS r T,, n- I,N- C TO C H WA �DE E -VE L R I S E F T E R 3 G ED N C OTUNTTEED R A T -,:' T. T TESTS '-'-E 3'� Date f- -12-71 t C !,'s Soil R::! e Drv1 S. D. 1: s I co r re- an TP-r 0.'l 1 f c^ No C) f -, B, o S Se' -,tic Tank C zs-el G: l s I LD-nz-ee 'Y Absorp ion rhea Elow.,ided Jai bf t!-2-d-ch t r en c Otiric-, L -a .7. e STMEY J. LAN DE Address BOX. 267 PU TA -f ,\ :TAO; \T OF F, I E' L ,7 CC"\,-Y DEPAL T L 3 4 WOW ,. di�tetl \` M ibis AD ad that the.srstem was iosparUd me heare it was coasted ow. The sgsEam 'Was coasmd in o ra RMOIlm a aR the rules ad Op y, t kA �1 OF i'� � � fW1 F '�.�. a;�",�,�':° .. $ ! . .yam �-.�• _ f iTY �.J.^ri!6tr '9+®' �^ W�%�cY' ri rr,w.. +.rny+. -.io n!<.e.•.+.� 4•r.:u -.a -. _ _ ._... -F..,f ++-: -- - w - «w+.tl.� "`�i° �•- e+TT„'•.^<" '�nP ..'^n`o,^' `Y"_ wW' _ e" „ a .. • i r� • r • 't ,n � , c ad