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HomeMy WebLinkAbout4527DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.05 -1 -5 BOX 34 Is%%. - 1 a 1 I ,. tall 6 0 'y. .� _ o�l l � 04527 i' f 0 w'ii e r o f �� lun Ei.ci1)aliLy lJ j�'° j } „•r" -' _. ",.Y` 4:�':�'- r_'���-�.-.e, x -'c° f +a n��. i?S a _ � '�''�, ''c 'T. Bu.,.J ding Cora ',� uE.c1 1)y Seict7.on y ' cation Via.:.'...: Block _ Ilun / `i , __.f :.... Lot J p f , GUARAr;'.�Y QI�' SEI':_RATE �EIIAGE SYSTEM • I r : nt that 1 .arr, wholly and comp etely responsible for 'tho ;_,loea :lion, wog i ,}`c ��, material, .construction and drair_apze of, the sewage disposal, sys' t. v i 4 the above described property, and that: it has been constructed �.n o:� the appr^u€ci . -plan or irprot ►ec? a.�llcndnent thei�eto, and' ixx accord;_ ::...;,i';�: the st:: ziidaz °ds, ::'ales rind re0 ulaticns o the .Putnam .'. Coynty, D.epar ; _; o'' Health, and. hereby guara ty to she c;mer, his .st;cc,es sors, ,'h.nir's or c1 -,�: to place in good ot��r8 n condition .any part of sala. system co :__:_' ,^ tee: by ine irti�ich fa _ to oi�arate for a period of tl�b .. years .i.ieciia_te.;.; the date. o f i.nit- iai use of tl.e setiaaz di spcsal' Sys vein, or, any :­ :' --- iy''s made by one, to s_lch sirste.m, except where the failure to- .operate.- pro , !.y i-g caused b;� the , ;r ]_lful or negligent act of the occu parzt of the bl.._ = =_I1 nc uti_..ziriS the syst:erl. Uac c.r r�::es ;o acc'e it as. conclusive the de- ternlination ei 'he. 71 rectos of �:i:-: Division of '�41V. r0:�?1I('i1�a1 Health Ser- vac -es of the Y.1:,,... _ ;un'.y ne :�ar�. r:t o... t�ealt:� as to whetl.er or not -the _failure of tho c a to ot) -_rate •, a. c:rc_scd by the willful or neglig.erit aci, of .t�e..o�ce;u'.> 17 -C ut e: 1;�.. Dated this 0 19 ' Signature 'Title�e� (Ij'... corpora-c:,-gin, ba. vo Aft' ame an, �p address ) THRRIE �(:3) C0.1;'IL'S ARE 'REQUIRM WITH TIiRr:.T -(3) COPIES OF FINAL PTJANS' IlEF1�R- CERT'Ib'ICATE OF CO `?'-�1~;`.C'IOi1 JJ1ILL BE ISSUi.:D . - GUAR4NITOR I'S :i3F,QTJ RED TO FILL', NOTICE OF DATE Or, 111ST. USE 01' SYST.'Eh1. Dzvasi.on` of hvironlnenta1. Health Services, Putn.m Go=i y Departilien- t.idf: ixoalth 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 watet..is of satisfactory bacterial quality before- certifi ape of C0.ns Pry cti�pn C�orT1 lian�e is issued ti.. .om= ';rse.. ` -a:.." .i..;r., ebir c. f,'r - _ .:.r' n ..:tt <:i+ -' ...fi•:i -..v : -oa�a' L. vl .�i �✓°"c -oc �...n x.sp.`- . -.. G .w. . ate: I REPORT MUST BE SUBMITTED WITHIN' 30 DAYS OF WELL COMPLETION I OWNER NAMGSf E/) (Z l�L I /�i ADDRESS LOCATION OF WELL (No. 8 Street) (Town) I (Lot Number) C7 PROPOSED USE OF WELL NESS © DOMESTIC ❑ ESTAB I HMENT ❑ FARM TEST WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (spe�fy) EQUIPMENT ❑ OTHER U ROTARY ❑ A R PERCUSSION PERCUSSION (specify) CASING DETAILS LENGTH ( leaf) I f "_7 ETER(inches) WEIGHT PER FOOT 2 THREADED ❑ WELDED SHOE YES El NO MES CASING NO YIELD TEST HOURS G.P.M. ❑ BAILED F-1 PUMPED ® COMPRESSED AIR oLd YIELD (O,P.M :) � & WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) d DURING YIELD TEST (feet) (� Depth of Completed Well in feet below Land surface: / SCREEN MAKE l TH OPEN TO AQUIFER (test) DETAILS SLOT SIZE tAMETER (inches) IF GRAVEL PACKED: is star of well including grave pack (inches): GRAVEL SIZE (!n ea) (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 If yield was leafed at di$erent depths during drilling, list below FEET . GALLONS PER MINUTE DATE WELL COMPLETED zJ; 00 DATE OF REPORT 3 . P 7J I WELL DRILLER (Signature) v ,� �— �•w� -L.e, ��;ti �1�- +- �C/l�l/�/i/ /t ).� �y +(.t I C! 4 BREWSTER LABORATORIES /p�{�y vi'*j _ .. .. d. w .. N...an.. ...T u.+ 6`7. ... ae...At V+.t., ..•. - '�%c+a c. -�. •:v'�-,"a.�'.�r�. ty.r.� q.__j6„Y";.. ra._s7gw v - -. •_::. :y 2aP+ ..:::,'vS ::ti ,- cia.�Gtrr+�. . - - s.,q. «"�.. $.',:il.'.•�;.j�iC. Qyia< o - "'�•.r �.•- i%Yc:i= l- ""��e�. �. %:a`I� WATER ANALYSIS REPORT - sAMPLE No. 3333 SOURCE: Shear Hill Developers new well Florence Road Seca 068 Putnam Valley, N.Y. Block 03 Lot 20 COLLECTED: Novo 11, 1974 BY: Louis Nalanchuk & Son, Inc. BACTERIOLOGICAL EXANIINATION Coliform Count, MF Method' 0 Per 100 ml. This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. t Novo 13, 1974 Bickwit P. E. Director • �' _. S S a .F� H...�,.4 `rr � ' �. �� a � a: a d ' � � n- �. <r s r` as S. ,. `„z � � r j COUNTXWDEPARTM ENT ,OFY HEALTH r `t st n r Division of Enwronmenta/ Health Services Carmel N Y 10512 h;: " -° 4: x ¢'�, ,,, Z ti it ,CONSTRUCTION PERMIT FOR SEWAGE :DISPOSAL SYSTEM �° 5 PU T N AM OVA L t E Y L�rsfd,?tt <FL9REMC_E ROAD set n _f� :,� own* _ olci<9 - r � T or e Subtlwisionc DR f* 6 ': ARN< , F x Lof 20 3' ob I SNE11R HILLEV..,. LTD.. SNE,AR'.kIIL_L R0'I1D Owner Address L i'T_ LEVEL �+5 °x+49 so. FT • MA, NOPAC ce Building Type JP Lot Area4 . • • Number of Bedrooms o-` S Total] abitable Space Square Feet, Separate _Sewerage System to consist of " ` R� G © ©M1 �T� Gal Septic Tank =.]� neal feet .X� trench i j 3 To be constructed by MEKLA CONSTRUCT 1 ®:N YCO.• Address E3UCKSFiOLC6w RD.i water Supply Public Supply.From X Private SuPPIY -fo be drilled tiv AL A N C N OiC K r Address.', BRE= .WST�R ST/1TE ROAD, CROT_:ON rFAL,L'S'`� N. ;Y• _ her,, Reggjrements 6 K l, represent that l am wholly 9, 'c6mpieiefy responsible for the design and,locat�on of, the proposedtsystem(s)" 1) that" the ^separate- 'sewage disposaLSystem I ,above described will be constructed as'shown on the approved amendment the etito and m accordance with the standards, rules a ations o he u nam , (, Gounty 2Department of_HealtFi, and thatson cdmpletion_ thereof a 4Certrficatewof Construction Compliance satisfactor ' on`er'of Health'wilL 'be submitted to the Department,: and a wrd'ten guarantee will be- ;furmsheG the owner his `successors heirs °or asst ; u ADp� id budder .will. place in :good .operating' conddign any part of said sewage O!sposal system dunng. the period of two (2) yearsri a �,Q a of the. issu r ante the approval of .the Certificate: of Construction ,,Compliance• of�the original system`or any?cepairs iAere 1i :$Fie ' _# idrille f,� d ribed' above will be'locatetl as shown on the approved plan and that Said well will be installed in accordance .with the standard rul 'P.utnain_., County Department Date � " r�� A a ice, S igned r a t Address Z ©70 SAW MILL :R F r Yak APPROVED FOR CONSTRUCTION This approval expires one year from the date issued unless construction o 1 din has -been ken antl is. 9. :'revocable''for cause or may be amended or motlif�i3d..when consideredrnecessei by the ommissioner "of Health �p�, e'•�r �(ffi i` COrist ion I f requues `a, new permit Approved for isposal of� domestic nitary sew a and/ r rw e,water - upply only o�pNq� ' iNEE� I Date BY ' Title' utl�Il M 773r IF I D I T n 0 :,1 P �: S Date tllL/Zli_l 17 /P.;V Re: _T-Irope_---"-y of SHEAR HILL REV., LTD. Loca' . U­eed FLORENCE . ROAD Se c t i . n 068 B I o cl�-_ 0 T 0 20 Gen t I e 311 Z c� H. E. FROMMMOLZ Tin s 1 e- t en S 0 a f f S f X 4-- fc— a s e,-- a 0 -_ � . I s n D of sa-la and t_ery Code. Very �rulv yours, d__ f-,D 4 TO ' Gowit A d ers-I.--a. d -ess 00^ p 9.5 '*2g 12 400 OF NE A. e-Qocn.� to, 0+ 2070 SAW MILL RIVER R6. (Seal) A,, Address HTS N. Y. ­962 2689 0. 1, l C'j' El G VA 147, Educ-at--fol-I La. , t--lh_­_---, IP-ablie- '' ealth a'.'_,_-1 the iJ Cc-.-Int.r t_ery Code. Very �rulv yours, d__ f-,D 4 TO ' Gowit A d ers-I.--a. d -ess 00^ p 9.5 '*2g 12 400 OF NE A. e-Qocn.� to, 0+ 2070 SAW MILL RIVER R6. (Seal) A,, Address HTS N. Y. ­962 2689 0. 1, l C'j' El G VA 'PUT N a M County Depantt ox Health it�1 >Ale atb'h __r-Wi M A AFFIDAVIT o CORPORATE OWNER APPLICATION FOR PERMIT REQUIRED BY PUTNAM COUNTY SANITARY CCDE (Please type or print in ink) TO: Cow d mdoner of Health -,In the matter of application for _ C�..y't.�iY3T.E'vcTi��✓�C���- .i)i:;T�'� �C�ii/A�C�,sy�l:Sf''oS.sc. J�-'Si��J /�iv0 Gv'.®LT�.� J"` ✓BBB!' I,r /.s •s'b '_ _ " is ® r. represent — _ — _ — _ — _ - _ - — m w that I am authorized to act for the — — — _ — _ _ s a ti TNaute of Corpor8on7 — — — — _ _ m m r — having offices at j° �, �i? R Iti /L L �P_D . /V,A whose officers are President _ Q Lr� I/ i¢ T/L - �iE ' N/L 6 _ a _ .r _ m r R . Vice -Pres. --- ---- -Trfa-29 Klfo;i adz— iss7— _— _ - - - -- r r 1 K Roan A c&BST by Resolution adopted ZzJ& ---- with respect to the approval requested and al.l. subsequent acts relating thereto. Sworn to before ffie this / day Signed LGL�' of 19. Title �0 a�t�l 11C EILE£N A. SCAWLbT' NOTARY PUS i ^, Stott t of New Yb� 6�?i�94�25 QtutNtled irrlly02hester Commies toe. Ex,�ires MSrch 30� a F COUNry OF 'PUT I;QM - ,:', DEPARTigENTOF HEALTH - Division of Environmental Health Services.: DFSGl� DATA -SHEET - SEPARATE SEWRACE._ SYSTEA�, ; =�,•c �:'II d =` _ - �= J P':Y�r = b - OwncrLl�r�e!1/ .LD Address_ Located At (Street) ,�[.ae,it/P ' �dA Sec.. `0669 Block_ Lot e ... (IndicaCe nearest cross street) Muaicip ;lityr ✓i"/v�/�i�e?."' Watershed_ r. SOIL PERCOLATION TEST-DATA-REQUIRED TO BE SUBMITTED WITH. APPLICATION Hole CLOCK: TIME PERCOLATION 'PERCOLATION Elapse.. 'Depth to Water Water Level ' °No. '.- ° Time 'From Ground Surface in Inches .:'So Rate.' .' '.Start Stop.- ° 'Min. 'Start Stop.: Drop in °Min /ia.drop •; °Inches Inches. Inches ° 1 1, , 1 1 1 . 2 �'— ®`'cep j ial `/ .• 2..:� �' �2 � . o � ,�T a : ^` /5 �, 1� 1 � a .. -:.. �� J ° _ , .� v : ` - e " ° 3 L ° /�5` r ° ,70 '. a `�f ,�� y Q AI " -'. 4 ° ` /ee.� Q� 1 . �O�' /� 1 . , /fir," .'.•. _ 1 :.� >•' 1�� / - °" IJ 2 'potes•' _ 1,} Tests .to be' repeated at: same depth until approximate1ly equal soii.rates'sre obt &incd at each percolation, test hole. All data to be submitted for:r.eviewo 2) Depth.measurements.fio be. made- top of hole; 1 f i 6, / 9 c 17211 4I aSA \ •..m Ft- jas ;m- .)./.e. 4_ -8 � Q, ... T� N ?/�i� Y I •Q Y�Q\fi�A YvaaA �i �.ue k` I� dS. r i wt3• i i� j � fr �'� ��� gg _� t � r y � � 1J e •i{ r *�3`�?, ry + },.r � J .,� j, t " r? � I 1 � }. �T � v�f��,�,�y3. i'> � f 's ° � :.•;� k: e, r} k r3 d J. ? y� � 1 r� AI V TAf i- i f. F ,. .t S t. I -_ fir l4 � �� �l�• � � ;�9 Of v3 DIRECTOR OIYISIOM OF s stllixF1EeL'$e_ a SITE AREA 445;;449 SF: - cD cD gL.tI+C' P_CO�737 j�.�'�GSiE•lJ'. .. I' . �0 �� sE^?^ �C a .�• �,.ueCgtaNO 3'2�,� I{7 / Q � R V'NOJniY✓a!Id t.�Tif�LC"N7'�S� %pt ' /y '�i b� �^ .. /eeaT f" <5Y✓ ";:caR dsRCi'!YRS +dPCM�' .... _ ... 2� \ O i "/ �\` s fl r r� ,t� ?�"a�%•9�r f9 %F•e- . '1 \- I SUBDIVISION OF PROPERTY KNOWN AS ii .�- / - ,*.t— ".•. =--- -` .— .••-- T,j f*I.y .S'r5 �„F THE ORING FARM ^s MAP No 1319 {- I�1 &.g �» (Ji"Q'x'M t\l.:. icJtr_PS x068 �, .• �� , � � ta� l�s VF "SFtfiE,r �a�� I{( X03 S i x'.20