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Home My WebLink About4286DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.83 -1 -23 BOX 32 ' r- �I r �� = , ARIV7. /R6 •I ER C . Located PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Mast Provide P.C.H.D. Permit N —� E FOR SEWAGE DISPOSAL Owner /applicant NameP, Dee a n � . 4 i= Forme / rly Mailing Address R 0 2is y Z JCffyi"O" 4/1*Z1p „ !41 11 f Hn 14 /A? y- _ "•-Town or Vifte Tax Map l D // Block� �� lo Subdivision Names I�0L�S�; Date Permit Issued Separate Sewerage System built by 1911 Aoeir✓ Address i` e'Gd v �i a- /&I . `G Al 6 : i Consisting of Gallon Septic Tank and s�5 L d ill. >`YGX c: Water Supply: Public Supply From Address or: — Private Supply Drilled by41a A l d tai n Address PCd hG1h l< //P:z Building Type Lon L%) __Has Erosion Control Been Completed? ALP Number of Bedrooms _,� Has Garbage Grinder Been Installed? /J0- Other Requirements i aaaaiEY Ohaa Yi�e- eyre:.u.Fli -- - - -- -- y- e ebeve ( copies bosls' wales and r he /i �N X e L AJo es a 4? O J14 d e Cd 01 Date C En d Arat6 i Certified by r ,' n P .Ef . __,t�_ s � �R.A�i. IF Address �PJ1 44-106 V -7 6,6 �rec�e l/ �JJ License NO. Any person occupying premises served by the above system($) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a pub(': sanitary sawer becomes available and the approval of the private water supply shalt become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the Judgment of theeCCo�mm�lsstiioner of Health, such revocation, modification or change Is necessary. Date % K �y TItdF _CtyiJhTY -or, WESTOIESTER _ AMMU WATER FILTRATION PLANT Results of Examination of Water Laboratory No.. Collected by Set b / Y Date Collected Set Reported DISTRICT: T - in ow SAMPLING POINT: SINK U E1; Owner �_�•� -�� Address - -, �.��r ��.r� _.'o:% Chlorins: Free PPM or Total 1- �PPt4 -`' Color_ Units Turbidity •p Units Fluoride MG/1 BACTERIAL EXAMINATION: Membrane per 100 ml < P H Yolue wa s ) . These results indicate the source of the sample of a satisfactory bacterial quality for the indicated use was not the sample was collected. i J 1 01-X4+ T.TV T T nAMDT V rTnNT DVDnVrr vypj�j� DEPARTMENT OF HEALTHY Qty Dh -at v! .a H PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION SIR ADORES S. CIIY TAX GRID NUMBER:— WELL OWNER DRESS: 44 - -&PBIVATE ❑ PUBLIC USE OF WELL I - primary 2 - secondary 9CRESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR/ HAT PUMP ❑ eBAND-ONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY ❑ AMOUNT OF USE YIELD SOUGHT gpm./ NO. PEOPLE SERVED EST. OF DAILY USAGE gal. REASON FOR DRILLING WNEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST/OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH —13 0 0 f TtS STATIC WATER LEVEL -j1:EftTDATE MEASURED DRILLING EQUIPMENT ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. )Z/OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH ft- MATERIALS: XSTEEL ❑ PLASTIC 0 OTHER LENGTH.BELOW GRADE ft. JOINTS: ❑ WELDED JkNBEADED ❑ OTHER —'DIAMETER in. SEAL: O CEMENT GROUT 0 BENTONITE MOTHER WEIGHT PER FOOT /T lb./ft- I DRIVE SHOE.AYES-0 NO LINEFLOYESXMO SCREEN I DIAMETER (in) SL07 SIZE LENGTH (ft) DEPTH TO SCREEN (IQ DEVELOPED? -S. ETAI-L FIRS T-- 0—YES , Ne _ff SECOiTD*-'--- HOURS GRAVEL PACK ❑ YES 0 NO GRAVEL SIZE: DIAMETER OF PACK. in. I TOP DEPTH —ft.. BOTTOM OEM — it. WELL YIELD TEST If detailed pumping �I§IHOD: 0 PUMPED tests were done is in- COMPRESSED AIR formation attached? 0 BAILED ❑ OTHER '0 YES ❑ NO WELL LOG -It more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE W"e' 81, hg Well Oia - Meter FORMATION DESCRIPTION COOS. ft . WELL DEPTH it. DURATION hr, min. DRAWOOWN it. YIELD 1.2nd surlace Ar WATE9 CLEAR TEMP. QUAO CLOUDY HARDNESS LI � 0 COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? 0 YES 0 NO STORAGE TANK: TYPE CAPACITY GAL. 10- WELL ORIL NAME ADORES > -77. ► PUMP INFORMATION TYPE CAPACITY MAKER DEPTH MO-DEL'-'§ VOLTAGE�1— HP P,UTNAM.COUNTY DEPARTMENT OF HEALTH - a; VI5MR— OF-EZ�'J�1Fcl�VMMM `HEALTH TMVrc�TS Owner or Purchaser of Building o�.tiz.P Building Constructed by Location - treet Municipality Building Type Section Block Lot Subdivision Name Subdivision Lot # 'GUARANTM OF SUBSURFACE SEWAGE.DISPOSAL SYSTIM 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 guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to t,e for a icd- •of - two eam, mmediate1 fo -11aw� the .date of . a royal -of the. :.. - 9a�_..�.... Per. Y . ,._ . _....._.,_. ?'. .:. ..q. PP -r "Certificate of Construction Compliance" for the` sewage- disposal'systee, "-bt ariy repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environinental Health Services 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 _2&�— 19-Zn; iq./ ✓W S General Con actor (Owner) - Signature -Az- W^ �"-f f CAZJ 0'-> Corporation Name (if Corp.) C? ell Address rev. 9/85 mk Signature Title i )MOT 1 IE-L 'fib J�'"?tad'U/0oi��'dc Corporation Name (if Corp.) SL5epo? 0 /�I9W6000c Address ii. 4� • `1 1f 1:1iE EAST 30' 30 JBS i 35' 183 35, 18 Z TS gor.. f r�r L = 9.o4 , •�t :W `di bM4 s N �y ai• R i 6 P 30' 30 JBS i 35' 183 35, 18 Z TS gor.. Io- I !i / 37, ?6' i Ak -4 +: � i 1 30' 4-O 35' /k- loo' K T4 ; / We L.Lw l0004��, PRE - CA5-r cowic, PLAW 16Y 545M 4c- TAW K OT1�Z5 ; ,i ro Dis Ns�A• � 3 F� /ice PA PROM r�s R9cn ve PA I 5V-,D f3Ll�� • cowl ElZS Putnam Co ty Depaxtmert o-t Hea.l. I J.ivision of. E ironmontal Health Servi'll. !.pprovod�as+n' a,ed` for Conformance with.) -. ..:.,,..,.).3'3;iOn8 of the ',.,team C01;;rty Hoalth �5c e 2 0, AS BUILT MEASUREMENTS: LOCATION A B Septic Tank @ 3112" 1410" JB 1 37111" 2414" JB 2 4119" 2864" JB 3 4519" 3414" JB 4 49'9" 4010" JB 5 53'9" 4516" JB 6 5719" 5114" NOTES: I. House location and boundary survey obtained from foundation plan and survey prepared by Badey and Watson dated Sept. 14, 1976; premises designated as Lots 15 thru 22, Block 8 on "Map of Lake Peekskill - Section B ". 2. Sewage disposal system shown is based upon measurements supplied by owner which were spot checked by engineer during field inspection of approximate exposed ends of trenches on Feb. 14, 1987. 0� 3. Engineer did not supervise construction ryj of this sewage disposal system and has b prepared this plan to show the as built well location, septic tank location and approximate sewage absorption trench configuration and location. Q 1 — A's - F3 u I J)AVIV VCi�.1N f�DT :W `di ai• R a 1�i ,i- DeILI� ; WELL- r. �f ay :1 Io- I !i / 37, ?6' i Ak -4 +: � i 1 30' 4-O 35' /k- loo' K T4 ; / We L.Lw l0004��, PRE - CA5-r cowic, PLAW 16Y 545M 4c- TAW K OT1�Z5 ; ,i ro Dis Ns�A• � 3 F� /ice PA PROM r�s R9cn ve PA I 5V-,D f3Ll�� • cowl ElZS Putnam Co ty Depaxtmert o-t Hea.l. I J.ivision of. E ironmontal Health Servi'll. !.pprovod�as+n' a,ed` for Conformance with.) -. ..:.,,..,.).3'3;iOn8 of the ',.,team C01;;rty Hoalth �5c e 2 0, AS BUILT MEASUREMENTS: LOCATION A B Septic Tank @ 3112" 1410" JB 1 37111" 2414" JB 2 4119" 2864" JB 3 4519" 3414" JB 4 49'9" 4010" JB 5 53'9" 4516" JB 6 5719" 5114" NOTES: I. House location and boundary survey obtained from foundation plan and survey prepared by Badey and Watson dated Sept. 14, 1976; premises designated as Lots 15 thru 22, Block 8 on "Map of Lake Peekskill - Section B ". 2. Sewage disposal system shown is based upon measurements supplied by owner which were spot checked by engineer during field inspection of approximate exposed ends of trenches on Feb. 14, 1987. 0� 3. Engineer did not supervise construction ryj of this sewage disposal system and has b prepared this plan to show the as built well location, septic tank location and approximate sewage absorption trench configuration and location. Q 1 — A's - F3 u I J)AVIV VCi�.1N f�DT