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HomeMy WebLinkAbout3988DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.58 -1 -79 BOX 31 slim IN III % ` i 4 �F Ir . :1 �. �` r ` ,,T IN 91 111 �� 'I 4 l'✓ F x '� � ,1. , 1 PUTN �F ��� ,•� 'Dfvisfon of� 2 � K COUNTYD,EPARTMENT OF HEALTH ayironmental, Healfh' Services i^,arme N:° Y 105- 2 , ANCE FOR 'SEWAGE QISPOSAt SYSTEM o Tu,#n or Niilag ' , `. ,� � � � .St°'Gi /fir✓ �, Located at Pa7rTrtap Block S{ Owner' ` Lot '`� acl�C� ��a X9 Job Separate Sewerage System bwlt 6y 3Addre'ss • CO • � "' Condlsting :of;Qal'c Septic, Tank and. � - Q` •. Other requirement; -:• - k• ,'; ; it _ G s Water Supply Public Supply. "From Private Supply. Drilled: By j Addr s: ti z x ti Building° Type No °of Bedrooms Date Permit Issued Has Erosion,Control Been:Completed? •` r •1 Icertify; that ' the .system(sj'`as listed serving the above premises were constructed essential hown on 'the plans -of the completed work'.(copies'of which are . ,attached), and'in accordance with` the_standards rules and'regulatwns plans,.filed,' he per I ss y Putnam County; Department'of. :Health. 4• 1 f.' A.. Certified by P.E. R.A. do y' Address license No: t wv Any person occupying premises served by the aboveayst rn'k, shalljpromptlj take such action as may b necessary toaecure th'e correction of any unsanitary conditions. resulting,. from, such' usage: Approval.,of,the , soparate seweragesystem'shall° become null and `v on as .a public sanitery."or becomes available'and the;appr`oval of 'the private water supply shall become nul an ..when a,.',public. wat" supply becomes' available. . , Such approvals are subject to modification or change -w n • in tha Judgment•:of the Co issiona f Health su revocation, rpqd4ficatIon or: change' is necessary. Date r-► ` ey } Title ?'. , x• i , BACT. PER I PER ML. (Agar plate count at 35 C). COLIFORM GROUP (Most- probable No. /100ml.) D , AL --ppm. DETERGENTS - ppm NITRATES (as N) - ppm IRON, TOTAL - ppm FLOURIDE (F) mg. /1. These results indicate that the water was ��� of a satisfactory sanitary quality when the sample was collected. A. H. P ANI, (ASCP) lu r` WELL COMPLETION REPORT. 3)71 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This .Deport. is to be_completed..by, well .driller and.submitted o County '_Health Dep@q- eqt #ogQther yyit11 )a1)0 �atory report,of.. "anclysis 6f, f water sampfe'iliaicating ullater`is'of satisfactory bacterial quality before`c`ertifit:ate,of construction compliance is issued'. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER ME ADDRESS LOCATION OF WELL ^ (No. 8 ree (Town) (Lot Number) PROPOSED USE OF WELL BUSINESS DOMESTIC ESTABLISHMENT ❑ FARM ❑ TEST WELL ❑ Al R OTHER SUPPLY ❑ INDUSTRIAL ❑ ❑ CONDITIONING (Specify) DRILLING EQUIPMENT ❑ OMPRESSED CABLE OTHER ROTARY AIR PERCUSSION ❑ PERCUSSION ❑ (Specify) CASING DETAILS LENGTH (teat)/ DIAMETER(inches) WEIGHT PER FOOT / (� /1_y THREADED Cl WELDED O I EgYES NO L<J C'ASIN YES NO YIELD TEST ❑ BAILED ❑ PUMPED HOURS G.P.A. COMPRESSED AIR y / �/ YIELD (G.P.M.) ;::III ' WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST [feet) Depth of Completed Well �! in feet below Land surface: SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (feet) 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 /� ✓1 If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE 71. L COMP ET� DATE OF REPORT IWELLDRILLER (Sign re RONALD GARRISON Owner or Purchaser of Building RIEGER HOMES: ING a Buil ing Constructed by LAKE DRIVE Location - Street RES © -- Building Type Block INDI'V'IDUAL 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 stA. . s day of 19 Signature] l� , Dated this �,? y JUNE � W'& VCOOPER INO Title P(�[TG' AG_ N_Y. x:570 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 OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health - PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health: Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM `' -Se'd o�ny ":c�tT� Subdivision Lot c ✓1��'�-���c�' '° Lot1��6 G��rg'C'�C� Job Owner /i�C�f�! ! �itr%�Of�•% Address Building Type Lot Area Number of Bedrooms 7Vy Separate Sewerage System to consist of Galy%Septic Tank To be constructed by � i%L�(' -a Water Supply: _ Other Requirements Public Supply From Private Supply to be drilled by Address Total Habitable Space Square Feet drr lineal feet X 1� width trench Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations o e u nam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following thedate of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed in accordance with the standards, rules and regu aeons of the Putnam County DDypartment of Health. Date �✓� Signed P.E. ✓ /R.A. Address GG %!� License No.v APPROVED FOR CONSTRUCTION: Thi approval expires one year from the date issued unless ruction of the building has bee undertaken and Is revocable for cause or may be amended or modified when considers essary by the Commis er of Health. Any change or alteration of construction requires a ne ermite �pro�r. sposal of domestic ary age, and r' ate su ply only. Date By Title` PUTNAM COUNTY DEI'ARTMEN'IT OIL HEALTH DIVISION OF ENV7ROV`MJ_sNTAL T ALTH SERVICES OFFICE =-K —1- Z.-N. DESIGN DATA SI-IEET- SEPARATE SE�JAGE DISPOSAL SYSTEM FILE, NO. Owner �64Z /J lfi�IC�R�1 SCAJ Address /��E,�SR�� << ,'1/ Y ._ Located at (Street Sec. Block Lot ` �Indicate nearest cross street) Municipality Waters. hVed IV- :1 SOIL PERCOLATION TEST. DATA P,EaUIRED TO BE SUBMITTED WITH APPLICATIONS d Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse No. Time Start -Stop Min. DaTE7 to Vater Wa P,r eve From Ground Surface in Imch6s ' ", btSoirl Rate Start Stop Drop in Min: /in drop Inches Inches Inches 2 IF 5 Notes: 1) Tests to be repeated at same depth until a roXilnately equal. soil rates are obtained at each percolation -test hole. A1ll pr� data to be submitted f or review. 2), L;pth measurement i to be a6de from top of, hole. 3 3 w 2 IF 5 Notes: 1) Tests to be repeated at same depth until a roXilnately equal. soil rates are obtained at each percolation -test hole. A1ll pr� data to be submitted f or review. 2), L;pth measurement i to be a6de from top of, hole. TEST PIT DATA REQ1JIR2D TO nE SUM41TTED 141-TIT APPL.-I-CATION DESCRIPTION OF SO-IL'") 1PT,'COU'JT1'j,'RFD I1\1 'VEST HOLES DEPTH HOLE NO. HOLE, NO. HOLE NO. 1211 18" SA01, 2411 3011 .3611 4211 4811 5411 60" 6611 7211 7811 8411 INDICATE IENTIL AT WBTCH GROUND WATER IS ENCOUNTERED � INDICATE LEVEL T97 WHICH jW TER LEVEL RISES AFTER BEING ENCOUNTERED 2F TESTS MADE BY Date DESIGN Soil Rate Used"/-%? DZ1'n/l-"'blr­b"-'p: S.D. Usable Area Provided No. of Bedrooms o2 Septi Tank Capacity cDOO Gal s\,,F,\1 Absorption Area Provided By /' !,.F- x24" 37 gna V v . I Address Ywi 6-1:7-- SEAL THIS SPACE FOR USE BY BE-AU.VH DEPARTM1EHT ONLY: Soil Rate Approved___ Sq. Yt/Gal. Chcckod by�_ Date March 19, 2975 94ro. ftnald Harrison, 4,25 1616h"kV hu'io, Oddkl-i '010 New York -10,56,611 bear Kro- karrUom, xreviow—of your 4pplipatioh to construct a sanita ,wy' sags, •disposal system to dorve the propotod r ebt46de on Lak6 Dki Via. PepokAkill has b6 n .c n o eld by - hIs Depar, menttw 1, hav,e I no 014-erhotivo applieation;. thii. titer. due to ppopaL W., for Processing Of-thU, WPI d Ac t thid 61fidd, if you oekt " me A RT gdlih wt to reject this an inaqaquato area the delay in.. the Ple,o$e k6l fp",,-to; .h4v-e-an'yQuoati6hs ver y truly-yours, Robert-Tutooit Envir'Ohm6ntal Health Tech* H t- • A Luca j.'•o,�:� �. • �! . } oa _. ! • 477"A Z L Ow AIW olli x t : t2 „ 'Y• r A iz 3 ye.2p"F ASR P T h .N ) S- 41" AT. • L.'C� � 5. 'i f � 5. f L � hY � r,,� � �w ,¢ ,•y 'S ,.J' '^ twwnw, ✓t "T' � �, 4 S� Y� „ tY y, f 4 .yra� to �" t e � ''°° 3. � ,✓ -i a ' yN 3 "Tu t 1 h l' § 5 a .,?'!4 �`^+ , �. ... � _ �.m: is •J arc' �. .. '' # .aQ'' � > °e..� °! z z l.. C � ` a �r i P � . nvxq f �SC'K a h� z5 t; "mss x.: >° - � • t'y'Rn v! . f1�Js+ x Ix VV i w EP R i