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HomeMy WebLinkAbout4528DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.05 -1 -6 BOX 34 .; IN N! t {� or oil .91 IS IN �` Sol No 0 IN No Jr No oll r 0 1ti IN 0 ` No' o■ o 04528 -p -- -- �n �:" ,- -.. a r '�a ��, ,„�Y �+•. "v � C = �� � _' t �-$. �5 °f.... y k' �' � �� � � � ��'h �� � z. � Lt v� r � 3`� � -. t r � � Division of Environmental4Health Services, Camel 'N Yr �f0512 1 { .�- TIFICATFCOI�S�R.l3C��Q�V C ©l��13111E SEIN`AGE RISPOSA L Sli'STEAa! /jl,��j��d� To F. * wn or Village ' dated at ��� Block L Sect ion 1 �i ner •�I!/,lti9�Q %i� /LL!/�_EI:OP�QS' LT'� I_ot 1 ',t, s v b.• .: i Separate{ Sewerage System built by Addressrt ro Consisting of �Gal�Septic Tank '2�d� *'4 Imeal Feet X� ,Wic th trench Other requirements Water Supply t `Public Supply From } ; a ,, ` a i jL Pri-- SuppIY Drilletl BY �oG/ /J /IJ.Q`L�iNC�/yiC, - s$o•�/', si�rE' Address Building Type v�L�a,, M ✓titY r97 No, of Bedrooms ,Date Permit Issued k Has Erosion Control Been Completed f r a I certify that the system(s). as listed serving the above premises were eonstructed esseiitiali as -shown on'- -the an of f z Yr pl, s he completedwork;(copies of which are attached); antl in ';accordance wdh the standards rules and'';;regula ions, plans filed, and the {permit Issued, by _'the Putnam'.County'pepar "tment of Neatth R A Add ►855' ^4 �i tri�►i� �L4 /�`s' ^. :Jcr., g . iGense No l4ny person occupying premises served by the above systerr%(s) shall promptly take{such action' as maybe necessary to secure the;correction of any, unsanitary :conditions resulting from:such�ysage Approval' of the 'separate sewerage, system shall become null and void as soon 4s ",p pub Ile asanitary:sewer' becomes:• available :and the °approvaf•of thep`rivate; water supply shall become -null apd void :when a ;public water Supply becomes available ". 'Such_ approvals, are s_ubJect to modification or change when, m the Judgment oTf the,Comm ssio er of {Health, such vo ti on ,modrfication or_':'chan" 'is necessary r 4 Y s _ Tdle °� BREWSTER LABORATORIES +`. ;: <c.Xti..yT �=dl� '�..%�T� fro;.= 't . .' "'•S'n... ,... •.:a -..Y� .c. . . pp��' -n .: q..ry. �y�. yy-- IY: DvX '17�6V - DPZEIWSI�Kj� •4 la WATEIR ANALYSIS Y RETORT SAMPLE NO. 3419 4 SOURCE: Shear Hill. Uev e l opens - new well Florence Road Lot 19 Putnam Valley, N.Y., COLLECTED: May .199 1975 By: Louis Malanchuk & Son, Inc, BACTERIOLOGICAL EXAMINATION 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. May 22, 1975 Eckwit P. E. Director I— WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This ieRQ(x:is t be.cO pJgt(O: y-weli;.drill?r; and ,.submitted::!® CGUptyjEleallth f�epartment- together..�roi* laborato re on ofa. 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 NAME / ' / /� p P_ l�t L FUU1 D/ � ADDRESS P 4 e— dU LOCATION OF WELL (No. Street) ' 1 (Towns) (Lot Number) —APP C, lE PROPOSED USE OF WELL BUSINESS L.4kDOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEWELL � ❑ SUPPLY F] INDUSTRIAL ❑ CONDITIONING F] ((Specify) DRILLING EQUIPMENT COMPRESSED CABLE IR PERCUSSION E] P PERCUSSION E] OP�ER ) [ V1 ROTARY ❑ A CASING DETAILS LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT e ❑ THREADED El WELDED O YES ❑ NO . YES NO YIELD TEST HOURS G.P.M. ❑ BAILED ❑ PUMPED 14 COMPRESSED AIR YIELD (G.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST [feet) D ! C Depth of Completed Well in feet below land surface: SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE DIAMETER (Inches) I GRAVEL P KED: Diameter o II including gravel p (In hoe): . G L SIZE (Inches) FROM a TO (le ) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION. Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET a C.5~ era "1645 s�r� �c 9A/ -- Q ..-� { If yield was tested of different depths during drilling, list below FEET GALLONS PER MINUTE ATE WELL COMPLETED_ d" a/ 7� ATE OF REPORT t" /& lc7S ELL DRILLER (Signature) i�1�x,�ecN�c�G� ��K 1 r 1Crt1� 11VVV��� �1�Y1 �� (-/ U I? I /'1 • Q M /7 U /I U ti k :i'�':- '.+..�� � " >`t-a:.c: .s; � � ...,._°��._. 'A.- ��r:., :tea.:.= .:��_- _:'ice: -af v`:-im r$'.'�= 'w�`dr'Y� ;+:= �.:%«a «:":'�;' <.z:::�6r r: o��. .�.•,: ... ._.. ��- Qwner or Purchaser oT Building Building Constructed by Location - .Street Municipality Section Block Building Type 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- _Y,.. terminat:ion.,.of ,the. Director. of. th.e Divi,sigon..of ...�iv�ronmential.. -He lth.. Se r- vices of "the Putnam County Department of Hear -th as" to`wYieth:er or hot 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 Signature Title (If corporation, giv ame and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE, CERTIFICATE OF COMK ETION 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. e. a. Owner or Purchaser of Building Municipality _ t9 Building.Constructe,d b Location - Street 9 Building Type 06 k Section p3 Block / 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- terminati.on.:.o_f,;the. Director• of the . Division of Env - ronmen al- :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.� ,� r Dated this day of 19 Signature/ aw�. / /���b c� ✓�Pa4. l �v� � T i t l e � 10 -g,,, / TD.. 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 i L O ni VAi -co � � • � tg � o G � ti t P / y / A/c, 4, / 68.21' 34.58' - -T fR. DWG. 62.14' P 1 •r 39.47 i Ci t0 WELL a o t .150.0 ° c AM Erb` 00� J _ ROAD ISO • Rothe SG�i� � oept90� gt i �� 7 z c G 72Z . .. � INT£Gf_'.i,•rFc �- aT- re.4N SUBDIVISION OF PROPERTY KNOWN AS TH£D Y. ,fib, d _ a -� r �,u'? x u w ;ny�- ` i.:r< i a' 4j, PUTNAM` COUNTW� DEPARTIIIENT OF H f Division of Environmental Health Serweos,,Carmel 1 � . CONSTRUC110N PERMIT FOR SEWAGE DISPOSAL SYSTEM '�.. �.-LOt a {e0 s8� k. �rri�C�3. R �:l`.+=1� ,.. .,. -;e a •c':c to h s Section < Subdivisi`on ©R owner E A R M 1 L'L ©E V • `i.TE1 .{'' Address �S 2 ST9RY GVLO'NJ'AL Bull ding Type Lot Area' Number—o. Bedrooms To, w Habit •tws.e- >r..'4�r y t.•.»�.-°�^{^�'r°yr x^'^^v'^" rr'^�'Z� ,,,- .•i,.g Separate Sewerage System to con §ist of 2a0 Gal SepUC T7' - HEKLA CON$TRUCTtON CO. E T,o be constructed by Address .pI 4 P k Water-,, Supply a Public Supply From ¢ ? ,t• � a ,� :Private Supply ao be Grilled by '� 4ACdress BR E W S T E R $T A'T E R'0. C 7 0 L Other Requirements r. Y 'F_ represent that I am wholly and completely responsible for the tles gn antl locat,on of °the proposed s above aescribed wail be constructed astshown on the approved amendment there to and m accordance;w County Department of Health, and thafon completion thereof a :Garth cafe of Construction Comj submitted to -.the D`epartment;d and a�"wr�tten guarantee will be furnished the owner his'successc y r LINAIA �tiiALLEY _ • T -*' Town aor Village 4 ' tiirltk � - R r r Jobs ►R HtLt R® i; )PA6� ,pace 250© SQ •Y �T •� Square Feet lineal feet -X width trench �SHOLLOM Rt). - � ►t; N.�`Y.. 4 i( ) that; the separate sewage disposal system ;Is ndards,,irules'an 'r t e >..u, nam B iiitisfactory tot 10 It ealth"ll 1irs�or, assigns bye p '- er will "' years] y�irl9' o issu `• s thereto 2j t t4 d ove ; will be; =Igcatetl as shown on the.approvetl plan and that said wall will be installed m accordance'wdh the standards rules nd • �o f ` °tt�V,Pu am ! y r d County Department of Health } � �,, f r f3' H- 4r . k s } l.. 411 •Address. t� � iJ.'ul •� `1 APPROVED FOR CONSTRUCTION T,hi; approvalEexpir.Wone year from the date issued unless construction of the b i , been tur prt�l�� Y nd is revocable -for cause or may be amended orinodified "when considered necessary by'ttie Commissioner of Health Any, cha =Wok s o 'Uon requirpermit Approved for d�spo5al of domestic= nitar`y se a e a / private,; water ''supply only '� A( N(-�= "' ' S Date a r S BY Tale t a , _ - 4 0 .. . �_ .r. _. .. _ r ' ...- ._ -�i: •. .{ .y`, r :Y.R = "J� U • 'Li Date .%vim i' /7 1-974 Re: ?_'ope- 07 SHEAR HELL REV., LTD. Located', at FLORENCE R ®. Sect. 068 Bloc'_: 03 o 19 Gen et`:�__ . T S I _ s to Gi.-l' ^ H. E. FROMMkOLZ a!n l __ fo_ _ n _ _ . ��_ _� vim' w _-�1•'.'..,_;.. ., .�. Jam.._ -- C__J �:,_ r:/ I in ar -1' 1 - - --- - - -- - - -- - _ _ r -.� Le - vQN l ^ --'- •.. -v.. .J._G _w `._J1Q:.J Q = _'v_v --�. 11�� Q_ �,. _'.�. L� • .J�� rr �.i� v ea '.i Lal.-7 aI'. . lei �_a Pu'✓­..._- C- -, .ice �- ^�•~ -.- tart' - Code '. J Very ;,yUltiyours,si�/R'%� / «' � .-, J � dr s CoL?n�ex s._�,_�u: Aa' reams • s �— -- E of Fv Lr ele-oh-cne - 2070 SAW MILL REVEk RD: . Address m 1� wr YORKTOWN. HTS.., N. Y. _962 26_89 90 _ � o Fps /�( FNt31NO4�r`f PO T N AA County Depart�td�of�rHealth -e: ?� _..� t.; "" >. xel! -'<o✓i >, ,.c -Di io -''J ..�' 4 u-`,' � +Y. l�L3 ►3PJ , .�i _ : `ice n 7"7_'-;77 � .. — . .. APFIDAVIT - CORPORATE OWNER APPLICVION FOR PERET R.9QUIWD BY PUTNAM COUNTY'SANITARY CODE (Pl,eafe type or print in ink) TO: Co=iasioner of Health -.In the matter of application for — — — _ — VISE %4.,- ------- - - - - -- represent that I am authorized to act for the — — m w w + o _ — — — w + TNi , ofP Corp6oraEion7 i having offices at S� Q �lgR k1Z L � —+ + 0 o w — — _ 1 whose officers are o o — o 0 0 ® ® — President ..�T_� � � m,��/.E'/4�' l�/ /LL qp o w w o— o o r l A�t3Xilti oc .nu.*tits asilclYYi azs 7 Vice -Pros. - - - - - - w - - - - — ���dCtB � ri01� lddresaT sit►. yy sa e�D�',LrC' Trews. _ _ _ — — — — — — — — — o — — — — — — — — &�81® & Wosi azasT by Resolution adopted wipe l 19741.' with respect to the approval requested and all submquent acts relating thereto. OL Sworn to before, me this Tyd-, Signed —�i — — — — - — — of 192L. Title r .o sr9 Public EILEEN A. SST. l±t4TltRl! .PU k'C,. Sfatt(" ©f Now t%Ofltmir (pr Exa.'rag March 30, 4 GOUPTT,Y OF 'PUTNA OF .HEALTH - Division of Environmental' Health Services f, i 1 a DESGPt DATA SHEE�� SEPARATE SERACyR.-Sy, STM : �„ r iFI.$,� ,.a ;.:�e. .:- >:: -, : •{ ter- Address 04,e -XP.: Located At (Street.) C[ir.E'N�,� . ���a✓ Sec. c�66'. Block 0; Lot u (Indicate nearest 'cross, street) r Aquaicipalit'y u.•� G'i;LO Watershed��cCY� SOIi.'PERCOLATION TEST D,T A REQUIRED TO'`BE SUBMITTED .WITH APPLICATION Hole Number °'... CLACK TI: PERCOLATION 'PERCOLATION 'Run'.. ' Elapse 'Depth.to Water Water Level °No.'. Time From Ground Surface. in Inches 'Soil Rate o 'Start Stop ' .`.Min. 'Start.". Stop Drop -in °Min /in.drop .: —Inches Inches Inches; t 1 1 a - .1 ell, r ..4', i" �. -� �. a •• o `° a . .` it •_.. 1 t 1 t 1 t t 3 t t e 1 � 1 . ° 1 N0.es Tests to b., repeated. `at same depth until approximately equal soil rates are obtained at.:: each . percolation. trest' hole.' :All data to be; submitted `for : r.eview. 2.). Depth `measurements to be made from, top of hole..!