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HomeMy WebLinkAbout4371DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -2 -25 BOX 33 04371 Y PUTNAM COUI T,V D'- E.:PARTMENT OF HEALTH .'Division of Environmen6l`•'Healih_ Services, Carmel, N. Y. 10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM rnw,� ... - ...�..n..9iai ^'�J: r•�G SIT �L/ s "�7!i -%�p Owner Town or,Village section NYI'J u Block Lot Job 4 Separate Sewerage System built by—EM d4. 4 rTL ^,, Address o dG­©l`fj 'zdC Consisting of 010 Gal. Septic Tank '� lineal Feet X 3 H width trench Other requirements CO �CFQ ��'6 A0%) QAA;A; d� -owa �p r"4� L'� �[+ri•il �% �`7SA�75�rs.J /•14i.t� -�4: Water Supply: Pu • Supply From d• Private Supply Drilled By Address Building Type �-) /'% /AIL' Has Erosion Control Been Completed? certify that the system(s), as listed serving t attached), and in accordance with the Stan Date /VOV Any person occupying premises served by th conditions resulting from such usage. Appro available and the approval of the private water s .7hlect to modification or -change when, in the ) I d-1- E Y Al No, of Bedrooms Date Permit Issued d essential as shown on the -plans o the completed work (copies of which are filed, an�he permit iss4d py�ie/ Putnam County Department of Health. WVA P.E. A 7�R.A. License No. ly take such action as may be necessary to secure the correction of any unsanitary e't ge system shall become null and void as soon as a public sanitary sewer becomes II and void when a public water supply becomes available. Such approvals are Commissioner of Health, such revocation, modification or change Is necessary. BY � Title's I PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 STRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM odivision SWOWN OVY /f t AIAP 9 F , 'caner ;L- �16V1A 1V11V Building Type �SA0,0Y ;/ ✓'4L Lot Area Number of Bedrooms r. Separate Sewerage System to consist of r% Gal. Septic Tank To be constructed by i .. Water Supply: /P'ublic Supply From Private Supply to be drilled by NJ0�.S - Address Other Requirements I represent that I am wholly any above described will be constru e County Department of Health, be submitted to the Departmehl ;place in good operating conditi( ance of the approval of the Cei will be located as shown on the ap County Department of Health. �4 '- - - - -'- - -- —._ ce N of Arm am m r;!. 44 •sr. 7-)e „�plar t ^� Town or Village if , Section. !'.._.. ­"Brock Lot 1'' `% Job `� Address "T�� •” ' ,,,S of = -J r AIZPY° yu� /` Al 1©019 316 % Total Habitable Space Q ya/. Square Feet b'' %�.Z lineal feet X/j% width trench Address I %b Ionsib 'on and location of the proposed system(s); 1) that the separate sewage disposal system v9� ent there to and in accordance with the standards, rules and regulations of e Putnam 0 0 ,here eft ificate of Construction Compliance" satisfactory to the Commissioner of Healthwill a w furnished the owner, his successors, heirs or assigns by the builder, that said builder will I : ;.... par . -3a�id,;;�;l;• a isp I system during the period of two (2) years immediately following the date of the issu- of+ �raflb�) ti, Co a of the original sy or any repairs thereto; 2)'that the drilled well described above 4t'... ,yy plan�.d�d;tgat"+�•ed�vel ill installed in accopoance with the standards, les and regula ons of the Putnam 3 -� SJ� NO. 3`d lei ' ned c/ F� P.E. LjO�R.A. Date - Address License No.5Z72-e' >PPROVED FOR CONSTRUCTION: This approval expires one year from -(he dot issued unless construction of the building has been undertaken and Is evocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of c nstruction equires a n permit. Approved for disposal of domestic anitary sew and /or riva a water supply only. late � � BY Title f. t. WELL COMPLETION REPORT 3/71 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report is to be 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 DAYS OF WELL COMPLETION j OWNER NA ME� � ADD�R�FS�J�� LOCATION OF WELL (No. 11 Street) (Town) (Lot Number) . PROPOSED USE OF WELL BUSINESS 1! rDOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL ❑ SUPPLY El INDUSTRIAL El CONDITIONING (S(Specify) DRILLING EQUIPMENT COMPRESSED CABLE ❑ ROTARY 1�1 AIR PERCUSSION El P PERCUSSION ❑ (S(Specify) CASING DETAILS LENGTH (feet) 7�� I DIAMETER(inches) '� WEIGHT PER FOOT 17 �` THREADED El WELDED jDj E SHOE I'� J YES ❑ NO CAS E YES n NO YIELD TEST HOURS G.P.M. ❑ BAILED ❑ PUMPED COMPRESSED AIR 7t %Q YIELD (G.P.M.) lb 7'' WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST fleet) Depth of Completed Well in feet below Land surface: J�� r .SCREEN.:.. MAKE — _ .. .. ... .... .... _ — ^Diameter LENGTH OPEN TO AQUIFER (feet) ... . . DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: 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 ew.s: �..'.Y^." YC... �o�ac^�..iZ�ya.�w,ak.o&ro. o °P �' '_ - .':ra;'.d.r.... ... «u '�l'.wN c�1 Z /. If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE .v.. �4 ".o .�nl:�:•djr'.o: a�,n`aw. •.J we _.. _...�.'.`��. .__.. :T' .1 su tl. r4r DATE WELL CO(M/P, TED DATE OF REPORT WELL D ILLER (Sig�ture r Owner or Purchaser of Building Building Constructed by Location - Str eet X. Building Type Municipality 1 149- 'P.4� %19 Ole Block la. 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 " or S., - heirs'- or assigns', to place in good oporatirig 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 19"71 Signature Title_ (If-.Corp--oration, ive name an address) � w 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 �' o:jr... .' . =�. � _ r : �'' ✓ :' :� G4T- �,!Y. . o s_ _ .r _ ...ays a.1i - .,t:e },a . L:'�. �. � .. � _ r' - � . ,t - � . � r�.. � A,U -� �n',rx �' r. .. i1 _ . ,. �,; g °W %x% pt E r a ;l' of 1 - y 0 My !' _ 0 i r a a v k r 'too e ,1b ,'fg�'S .A+„ t a• 3 ° a "9s, ° t.""+'rf¢ ma own 1 r -t isSsfi ?j r f �=4'3ar tt Nt7 3� 4 d k-� t�sr ;•7'1�� -rt'' t 'y 1 itr � +:. � in�xkt nn s ��� r,r o>• � r Lw.� }u .r.. t. s r- a fat k� n 1 .F 'yr�, r3 �'�rt r �kA fi rFQ� v � �r 4 iNi it `�WOIA 11 5Iqq �5tt 4. in Qs 1 Q t Not %4"�. 0 t`/ yCK l7dGlENgd 4-.sLr � b�t� =; �'^� +? � `.y, � � � jc�:d �t"� r' drt'S�''x���`•i �" . f Wr . � �2� J .. l: } /�` Uw Ci /yam /P }5 t , sYrcrr }t,�x 4 �r.l itt +4 Jt;x.,,d]je " }ku,�r a.'. is �YV��,�� A d,a a�`f1f > ds�N13F i i jxya „ •a� c t� "5 � + ,, - M�c, L + �'�� %: s{ r) fi u �,q35 , •� ar s i Q y '�t y k S''4 3K x i � a s fYf$1t- �¢¢�'c t i' -�r`7Y t ryk i ! . �aL•.y��`+ ' v F�r G.tly} .��: �t,,ySiA�. ���c... �._ i:C,t(� -' •',nt'J�t�ti � �:x:i ft,?� �.i �,.. j .'fi',� -��.` USA PUT \'.A�i .COUNTY DE?ART`rNT OF =' -LTH DIVISION OF ENVIRO��rtiT_aL 'EALTH —> ACES DESIGN DATA SKEET - SEFAR,TE SE:,: aGE DIS =tOSAL. SYSTL: FILE. NO. Ocaner . � �ii,1 [6i�'� -• Address G�G(�= .f�T -'� ,� �'v� d K-�c. � A ;k ��' Lot 1'.1/4 .. Located at (Street). °OT/�icG •Sew -._,. Block,O. O ndicate nearest tree,t) ( MunicipaliLy. cresS s ater.shed 'Pole-- SOIL PERCOLATION TEST DATA REOUIRLD TO BE SUF. TTTED HITH APPLICATION Hole 1tmber CLOCK TIME PERCOLATION PEP,COLITION RA Elaose Dept: to t.;ater ;eater Level No. Time From Ground Sur = -, e i7 Inches Soil Rate Start Stop Llin . Start Stop Drop in Min/in .drop Inches Inc=:es Inches 4 S 3 3`/ 1 4 Notes: 1) Tests to.be repeated at same depth until approxi -_tely equal soil rates are ob- i tained at each percolation test hole. all data to be submitted for review 7 S 4'k: r JEST PIT DATA RE OU I RE D --0 3E SUBINITTED ',`:I TH APPLIC- TIO.\-' DESCRIPTION OF SOILS E`."-`-)'U-N1TER--rD. I TEST HOLES DEPTH HOLE NO. OL-- \TO,. HOLE t 70 G.L.. _7 6" 12 pjx J1,11 Cx Av6 Ai. 2 W' AA 30" JA 3.6 rr 42'r 481, 6 0" 66" 77 2:' 78 tr 8 47 INDICATE. LE �T L AT MHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEEL TO WTHICH S,,AT-R LEVEL RISES AFTER B E. I G ENCOUNTERED TESTS '1LADE BY.,;.. Date `37 f Soil. Rate Lsed Min/1" Drop . S. D. U s a- e Area Pr*o-,.7-ided No. of Bedroo.1-3, Septic Tank Cap-=-- t Gals. „,.,Type .Absorption Area Provided By. L. F.x2 her e.- '/t S -.5 'T -7 -7— k1gr mr, t AVW 74 - 2 X I I Name Sicnatu Address AMAWALK 9 0 0 UOU 9. PUT TALI COUNTY DEPARTMENT OF. HEALTH Soil Rate Approved Sq. Ft./Gal Checked bi' ; - „2'z",- // 01, Date