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HomeMy WebLinkAbout4445DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.14 -1 -18 BOX 34 04445 -, ,, .ti y . , k , i 04445 c+ q m q a 7;; k' Y641K IkFt a f �y. Building UWoxi'or P14rchAiset, or WURICIPAlity 119 2 81- Geyersberg bo t GUARANTY OF SEPARATE SEWAGE SYSTEM I r-opre-sent that I am wholly and completely resppno for the 7,oc►t14no wqrkmanship, material drainage of the sewage conatructipp and dra, dispoaal system serving the above described property,' and that I.t hap been .constructed as shown on tho Approved plan or approved oved amen dment thereto, .;ancl in accordance with the st4ndar4s, rules and regulationo-of.tho Putnam County Department of Health .and hereby guaranty to the owner, - his sorp, heirs or'* assigns to place, in good operating condition any part of said 4y.5tpm.cqnjtructed by me which rails to operate for a period of two ..,year4 immediately following the date of initial use of the sewage,dispoagj system* or any repairs—inade by me to such system, except where the failure toopprate properly Is caused by the willful or negligent. act of the ocau" pght of the building utilizing the*.gyatem. A The undersigned further agrees to accept as concliasive.the do, ..tormlqatlon of the Director of the Division of &jVj .1rQnmenral Health $erm. -h'- -O'th J, 0 -'nab- -the '", failure Of the system to operate was oa4ead by the willful or negligent act of the qqqu ant of the building utiltzlng the 4yete 25th day of AUVet 3.97? Dqtq4 this Signature 8 Title President - B qlmtr (If corporation, givo name Date and address) ftinz Geyer, Lovers Lane THRE9 -(3) COMS ARE RE(4UI RED WITH THREE COPIES OF FINA PLANSFFRE CERTIFICATE QF QQMPLE.TION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE QTICF, OF DATE OF' FIRST USE OF SYSTEMq? 4VI4104 of Environmental Health $qVvIqea' Put;1414 County. Department or P04101 J914) 562-0890, EnvrorT�est' ® 234.BROADWAY. NEWBURGH, NEW YORK 12550 Lab`:oral=airie.s ,SACTERIOLOGrcAL EXAMINATION OF WATER r,'EG,::�oo'�iS°C r'�tJ^. ``•?,,y�!$t �bi'�Li!"rf - �'±= `'%a�+;;>.�' 7s:.�i.i.�r �Lt.Y nC,, """ET: +: Lab No.- N- Lab-No. Ent % Time Set - - Tests.- Requested - J- .• _ ��`� � Refrigerated.` Coll d. ,bY, 7- v t'~ l /c: ggency Goli d °for - a Coll d from; 'Name P'v lea F (St., Rd) (City Town, V illage) (Zip Code) (County) Identrfcation`of Source ", G= (�• - Sap�rng Point m Supply Chlorinated wlen sampled Yes ; No (?�°e Free Comb pH RESULTS'OF EXAMMATION OF.WATER Standard Plate Count s 10 1r MPN�1:00 ml Bacteria per ml '- `� ` " �• � �. � e Method /100 rnl � ° Coliform Group_ - mbran Total-Coliform Fecal Coliform Fe aal Coliform ` s These results indicate = s' ample (was, was not),of satisfactory sanitary quality when the sample „" .: _ . F" was collected. CH ' AICAL .A�VD 'RHYSI_CAL EX'AMIINATlFON OF- WATER GHEM4C -AI: EXAMINAT(064 (Results`in Milfigrams Per Liter)' gii monia Free,(.. Nw1 [} Arsenic. ( WAS (Detef9ent0.. . Barium � Nitrates (as NI Cadmwm [] Chromium Q .- -- -- -- u Ial [] Sodium . ; ;" �] Iron El : Q Stilates i� Lead Q -, -• . Fluorides - ` ❑ Manganese , PHYSICAL EXAMINATION Cfitorides,. TO Q Mercury . n E] -Hardness, Total (asCaSelenium 31 Selenium [] Color U its [].T.urbidity Units _ Alkalinity (asCaCo,Jy�,, []. Silver �' Odor Units Zinc, The chemical parametees tested (were, werer ot) within •` - the$ - limitations of the Neiw .York State drinking water R ep ortedby DATE REPORTED standards when the sample was collected The results RONALD A „BAYER LABORATORY DIRECTOR circledstepresent,those m =excess of the liggations _ �_ WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK :,.'°7r:; ^�, - 0��11�- �^• 9yat? �' 6S" ' L' 7. �w7- Z: fSr"' IF' S'.'.. �° e". C' l��G"' if' 7�i' a�` �' e- iFr' �; i8: tir3: Z�uli` D�riii�C1 '�fD +r+�ili���'r'IB�ii�l�-tl' ief!"v'iO�. a�1e'� �ilfl�'li 1'13G`r6�Ol�f 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 NAM ADDRESS K /ice LOCATION OF WELL (Nora Street) (Town) (Lot Number) PROPOSED USE OF WELL DOMESTIC 11 SUPPLY BUSINESS ❑ ESTABLISHMENT El INDUSTRIAL l ❑ FARM ❑ CONDITIONING ❑ TEST WELL ❑ O(Specify) DRILLING EQUIPMENT 1:1 ROTARY COMPRESSED )LJ AIR PERCUSSION ❑ CABLE PERCUSSION ❑ OTHER (Specify) CASING DETAILS LENGTH ( feet) �� DIAMETER ( /nchesJ 4 r r WEIGHT PER FOOT / % THREADED ❑ WELDED E 5 O YES ❑ NO W CASING LJ YES NO _ YIELD TEST ❑ BAILED HOURS ❑ PUMPED COMPRESSED AIR G.P.M. YIELD (G.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE— STATIC (Speclfy feet) feet) DURING YIELD TEST fleet) 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 r i , If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WEL C MPPLLET D DATE OF REPORT W RILLER 5 nat e) " •p _san't''S `- .',°,r >•.�:, :li: T' 1 .i -» _ 't ,1: .TS:o :y -_ 4 " - _ r r _ L' I 9O CQTlFY:,TtJ 4T T � �„ �� b'*, "t'"•3:�• rr; � c •r•� �° � NE 'S'E'WAGE �AISl,��SA:L i :x.. L s. 3 ttiM' }. _.3n'•.8'-r•FE L1. �z i,. SYSTE/vl: YVAS " RUCTED AS IND7G 4TE'D ON Tw. 'PLAN. ' k x� vi a THAT -TRE SYSTEM WAS 7NSr?ECTED: 8Y. ME :pEF(�qE %7 ?' WAS COVERED.OVER_ THE SYSTEM WAS CONSTRUCTED IN`. ACCORDANCE WITH ALL THE -2ULE5.A1VD'REGULA• i` 1ONS OF THE PUTNAM COUNTY DEPARTMENT OF f-IEALTI-l_k' >sE } �• t f . '{ LJT�, [: x7S 7 r IV G 9 EXCEPTION $ , TO T14L ABOVE IFANY NOTED 13ELOW. SIR SYS T EM HA 3 WELL ConlSrRt -t.CT � D. /W TEGRATEG Cu ,erAYN JR/+:n/� 1 f?OM t ?IGNT ,l tQon r' CORM �,r : s E /'i A) TO z s ;noT -id+ DRA iN ;r EASE.M €r �Stul._ G'. �•� , ;�N t - ( F rp.r p t. '� i !CartTJ N;dNps -UEp NOUS r REyERSe OtK'ECjOy:�F i/4LLQ7V .SxYALEY_ A/(D ;Okt /'EYED CURTAaN Q»TA /%/..-rim 'j. s� � 3. k,7?4E DR/ v5WAY,. IVONLdCA.iEOIJNTNERIGNT•-N.�n/D -SIDE �FfKTiyE-xy LrN ` �.I Cl/7 oAF k� ,ArER THAT MiG�yTO�PDiN,4_RiG y cF�ECT.. THE F/E t,aRE�t,.T�E Q FULL EASEMENT f 7?N.G OR/� /N LbCS.77/E SAME' .0 S /j RC7E ,� R:� �� -,thy' _� -. 6O •, J.. � I! - �... - .�. .•. -. ,..: .. s..� fi E oTNF A UR/4INs /rs.o -�a.P. 1/v/CA _ If THAT BASEDDiVTNE A lORE% VIE /VT /0/VED `AGjS� 7�/EGJR�A /N DA'A /nl MF/vTiONU /N /va! -F 2 /S NOT AS BlJ1LT LAN IS8 2Q MAI,iG NANGC ' �° OF SAC WAGE.. D 5005AL SY.3TEM IN r fig- fifl' RIME TS' B N i r Ark.. T PL/TNA •� a • box TO OFLJ NAM VAL[ E �' . NTY, N:1! .b L,- OF 2(R`7Y . S(O O4 F� r. .✓u4y5;+ /9.77. ^'�.Cqu r/ act fLEY4T'•!ONS �i°TcSFAC D?m t cw /� r itr •n T i . <� 6� fa �4 SY., 4 �'x 0tr v✓OTE 3 ADDED S /i/ VVD �. ) �- � F 4':� l ',F' `t. j;.._ f�, .•Q/ C. �cs,•`.'a'., �4•: ..r.'•" t ..J.`. _ ,1- 1. ir., T .;.b154 q kSt4 -K� _ hp :9i t ... �p /�4 '. -3rT�< :�fiOK- •-h 5 � ta:9. H. �1-. �rty.}�P b t � R - - 11f1A41 y _ x 7 f r"•:a -,., �F•:,. 4' -. ;�r 4.- r...: e.•.,,> .1'.:4_ Y �r� �yonP. f9S1 ��Q / � Q / � /� /•� /- a QIT ��rr !• HEMiG �.. ;2.: b ,t.�'`�'K,� r M(:'t.. "i �e S � Rv k - G7 V S.S �` GJ�!'7 K `. �/•� y ye. � r: - < -.rc ��. ,Y�':�'eJJi +. �xi .iq's"T'. ✓�' 7s.�`S') -., :�?• . -� ,ar .: �:., -,. _ 7�.. ♦ i.. ! }., :• .,,i . •�::�.._ , �a _. .! ' Fc r., hr 'i•_ : ,r - r ,., ` r. t Ea �, ��` `$• �•• :a, -� •��yy� �, :�._ ,.� -�• r • -^ � Pro'` assrona /_ Eri' .ne��in ci 'Gored �Scr .re /n DIRE Far•.�"�4z• „.'3,M, rya.,�� T ;,,S 'w,� .j �s .`i a` si "* z _1 �.- 9 - y... :9. _ �s 3.. ,e y.;- t �� �•'; �j_s� nr:,�a � > '-a :' ^• .�+' .v.� !�'s '� "� >u . ✓2��7'IFiT.0 /Ci0 A✓Nri u,.L°'. .. ��d/'/n N'Y 4 ?'r:: Y? y .rh "4n�at a .:vt ' : ',�`•:. , rs��:� .�'�..;4.t '' -e .N'3 '•�'.•� .t -.�:,: a ,�1 ", s e f�i ; :.t . _ ? � _ ,s ^ , ,rh q ) 2y "c +S Fr r ♦ j - -. - { � at. ��'�i�l��'"i�^!. `r4 x.36'. �.. ,7• .,. ��. : .o-. .. � .. •_ .. DF, yv: A •i 'a . W) s a ;. r --- e',•-w� =i.""a 'M a`e i1''*"s's"v'�4 s a`e ,r-1s 1 f ,j.,ja^r"i<- k a c. ik` _.E 5"i'"` ' ✓ -��i 7� } M PUTNAM COUNTY - DEPARTMENT OF HEALTH t 4�3* Ofwsion of .Enwronmenta /4Health' Services Carmel N •Y 10512 CQNSTRUCTION; PERNIIT-�FOR S�WAGE.DISPOSAL $XSTEM ;,' w, . T.o:�an - of..Putnam'wU,alley - ° Sou the y se in ;� s ane ppro a t: t �T n or Udge r 3 ow 1LS • e7� „i.- $LSd.&Te�'i— ;'�— x��•c.�� .. *,.ifl= 1�'LSTnT+'"�Rd1°(t x <o.,..r4 .r'cn.rp`ol'a X�`�1�aP �+ °4 BIOCk e v} 072 575 Subdivision,. He i nz Geyer. Lovers Lane Owner Addres - euiltling Type SpZlt level' Lot Area 1 acre plus Putnam Valley, 10579 Number of °Betlrooms Design Flow T al Habltatye pace �K n Squ r t x -N - r J _ t of �ncE tr h N '.Separate_ Sew re a e,5 stem,�;tot,, consist of +q�� ' c tic To;.'be constructed by h 1 Std Martin y A r `sr yY Water Supply Public Supply From _ . x Ma; a c w Private Supply to be dulled by Address Cr:o t on.< F6118' , N . Y ' Other Req'u`irements e 1 n all details Shown on IntEgrated Plan d t 10 2 to; r 1d . I,represent''that I am' wholly and completely responsible for thedes�gn and location of the proposetl sy'stem(s 1j th f separate sewage . isp 's .system above described .'will, be constructed ,as shown on the approved. amendment there to and in "accordance with.the stantlard les an�egu a ions o r u nam County Department, of Health, andathat on,completron thereof a Certificate :of Constructwn,:Compliance saRtisfactoby;to the Comma ;stoner f Healthwill be, - submitte i to the Department and a written guarantee' will be furnished ,the owner his successors; heirs o►'assigns ti'y the builder that id ­builder-will :- place m good 7operating condition any pact ;of said sewage „ disposal,. system'tlunng the period of two ;(2) years ;immediately followingz;t `edate.of .643 153'67: ante of 'the- approval of tRe Certificate of Construction CompUanee: of the original. system or any repairs thereto,e2) that the d ►,riled: ell described above 4wiil -'De located as shown on ahe approved plan`and that `said well will bAe; installed =in accordance with the standards rules. 'and re Tula i— o� ns of the Putnam i County )Department' of Health w T September 28, 1976 .� ` Date P E R A ned urges 8c Be.Y4, 9845 V Address License No ? 4 APPROVED °FOR GONSTRLCTION: This approval expires one year from the date issued unl constructwn of the.building hiss been undertaken and is 'revocable,;for rouse or may_beamended or;motlified wlien'con'si a net nary by,the;,Com ssio r, ,of'HeaIt > Any change'or, alteration of construction requires a new rmit pro f disposal of ;domestic. nda y," age / pit er y only. A I Date Title iw_._.�....'"v.�.�,_.c,:._ -.., _. -_ .— .w__—'--`_ .___ ....�___•__._. ..............�_. ..,� - �,..�.r,,...._.r_.s_. �i�.vc...__.. .. .__.., .. �. a�.._. �.. 1.,._. ..e...�„e_a,_......>W.;�.._,.� __._` t.. -� m PUTNAN COUNTY DEPARTMENT. OF-J,1TIALTH. - DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.1072 °575 Nher Heinz Geyer9 Inc o' Address .R. "D. 1 Putnam Valley,, N. Yo G Cind s Lane 119 Located at (Street y Sec. Block Lot Ind- ate c nearer cross street) Lot V Geyersberg Municipality Town of Putnam Valley Watershed New York City SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS I p 0I0 e Number CLOCK TIME PERCOLATION T +� PERCOLA_�C Runn Elapse No. Time Start -Stop Min. Depth to Water From Ground Start Inches Surface Stop Inches Water Level in Inches Drop in Inches Soil Rai; Min. /in 3ro 1 10°45 11:03 18 24 25 1 18 Min. 2 11:04 11:22 18 24 25 1 18 " 3 11:22 11°40 18 24 25 1 18 „ .... mac- '. . C ...- ..._ :.'....... ..-.. -^ .. _/ ° 1 11-:48 12:06 18 24 25 1 18 „ 2 12:06 12:42 36 24 26 2 18 " 3 12:42 1:00 18 24 25 1 18 " 4 5 2 3 5 •'ote3: 1) Tests to be repeated at same deg ..xir" te cup_ rates & e obtained at each percola*:*- test- ata to 5e .:.-- reptr. measure,. ents t� �e' ^:::r;, top 01. 40 DEPTH G.L. 6 1211 1811 2411 3011 3611 1211 4811 5411 6011 6611 HOLE NO. ( 1 ) Topsoil 44 � 1 44 HOLE No.. (2) Topsoil Dry sandy Loam sqLnay Hardpan /0 1-- 1) np- _C1 VV 0 V WL L 7211 7 811 :84 .-INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Burgess 8- Behr, Po C Date 7'-7/74 DESIGN Soil Rate Used 18 Min/l IlDrop: S.D. Usable Area Provided4000 SF+ No. of Bedrooms 3 Sep is Tank Capacit 900 Gals. Typj'ra -cast cone Absorption Area Provided' By 30 L.F.x2411 width trench. Other , QN_ HOLE NO. ivame bignature Burgess & Behr, P. C. S - Address SEAL horsupr5und Road arme L Ye LU5L? THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate.Approved Sq. Ft/Gal. b e----- V r PUTNAM COUNTY DEPARTMENT OF HEALTH - ,,,,,�,- ,�;.�.�.. =-a.: 7Z�;:. Date September 28,. 19% Re : Property of He inz. Geyer, Inc. ,Located at Lot '2 Geyersberg9 Cindys Lane., T.'of Putnam Valley Section- 119 Block 2 Lot 8 Gentlemen: This letter is to authorize Roy A. Burgess: a duly licensed professional engineer X 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 connection with this matter and to supervise the construction of-said system or systems in conformity with the provisions of Article 14S or 147,. 'Education Law, the.. Public. Health Law, - and:-. -the . Putnam.- ,Cou -nty - Sani- tart' Code. Very truly yoUA , r Signed Val�' Owner of Prop r y Countersigned:`i R D 1 e Lovers Lane 984 P t Add e s1 N Y 10579 P.E., R.A., ## Burgess & Betirp Fo Uo R D 8 - Horsepqund Road' A ress Carmel, No Y. 10512 2253312 " Telephone U ham a ey, 528 -2.144 Telephone