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HomeMy WebLinkAbout4531DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.05 -1 -9 BOX 34 1 rm i�-Jjj- � .1 I.%%. Imok ?r " :;" i A;�': �Y'611 11 oh Or. r 10 l , l- - , rm Iss if. - is 04531 ID - •EREW-STER` - ,.L.ABORATORIES. - ..._.. .."'+:•r:� %�.�,i "' - '�•- �sv`�}"+-el. .._:; "=s -.::, i �•.x,.. ,i,�.�:es;.:• `•i,:.jl.�°f3•- .�_.��,ro•�_ �f��.�; ._+�., %.v". "'p:'�C,..e.�. �_..ew1'fe -: ^, Box 224 - BREWSTER, N. Y. WATER. ANALYSIS REPORT SAMPLE NO. 3657 SOURCE: Roger B isch, B.l dr. John.Tomaselli, owner Bellesite Homes, Lot 16 Florence Road, Putnam Valley, N.Y. COLLECTED: June 29 1976 BY: P.F,Beal & Sons`, 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 thi sample was collected. June 5, 1976 Roy $ickwit P. E. Director _ . 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IA. /�~ Owner or; ' Purchaser of Building bUilai.n, uons true tEa by Location Street Building Type Municipality Section Block Lot GUARANTY OF SEPARATE SEWAGE-SYSTEM U?.r represent thattc,C 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. 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- r- ,.:pa -nt of'- the...�iu?1rl�r� - u•ti�l.i :z.ing..,th.e, s- y�tWm, >, _ _y...._.._._._ :�..�. ._v -� ., :.... w . :.- ,�... :_ 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 negl''gen act of the occupant of the building utilizing the sys Am. Dated this day ' of t,(,�'_iit 19 Signature rf Title �Z > _6z� ? Lg Lt' 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. WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTfi 317,11 Division of Environmental Health 1:nrvecos �COUN7Y OFFICE ElUILDING CARMEL.- NEW YORK Thic report is to be completed by w0l driller and su'••--;.(If•d lo County licalth Depirtment together with laboratory report of analysis of water sample indicating water is of satisfactory bacteria[ quality before certificate of construction compliance is issued..— -i;.TbS�f ;67E,t j7- - Xi I itD'7V;ITHIr-J 30 DAYS OF V,'ELL COMPLETIO NAME ADDRESS OWNER Bellsite Homes Inc i Old Bullet Hole Road, R11#1 LOCAT'101"I urn (No. a Street) (Town) (Lot Ntef) OF iMl. Florence Drive, Putnam Valley #16 BUSINESS PROPOSED DOMESTIC ESTAELISHMENT FARIA' TEST WELL USE OF WELL PUeLIC AIR OTHER SUPPLY INDUSTRIAL CONDITIONING (Specify) DRILLING COMPRESSED CABLE OTHER EQUIPMENT ROTARY D, AIR PERCUSSION D PERCUSSION (Specify) LENGTH (feet) I DIAMETELImcpe�) 'EIG T PER FOOT, -S'- jj�`j ko CASING YEt -JHREADED�.. DETAILS 0. . , H- - , - - 361 4 'Ez �o k7_ "P FAILED COMPRESSED AIR Zlgi YIELD ^xL x2 TEST VLF EDIf D WATER MEASURE FROM LAND'SUKFW LEVEL MAKE fi 3 r£ 19. Mao SCREEN SLOT SIZE ,7 & ,DETAILS d DETAILS R ITH FPOM LAND SUOACE1 'M -4 M K N 47- gaw Nm 26 Dr;L 72 1 ��+r83�3F�NY�k� w� } wY� .pqr- z 2,6.. - 16., Dr 1 -1 - . If yield wos tested of different FEET WlILL COMPLEILD 1191 106 n Z% TM A T S;. Qr'*TJ'w. Tmrl. I 4 4a " 11P v . I .PUTNAM COUNTY DEPARTMENT OF HEALTH _. DTVii'ib -dr�tN IkONMENTNf," TH`- SERVICES" Ft Date Re: Property of n A-"v�.i e ;7j;'.r>i Located at C�pr_elkl C-C _Z1 Section 60. Block Lot ZZ Gentlemen:. This letter is to authorize a duly licensed professional engineer 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 Departr*nt of Health, and. to sign all necessary papers on my behalf in, L:U1111CL LiUll w1 LI1 Ljii,.` ma.l Ler anLi to. supervise Lhe construc clan o]: Said system or systems in conformity with the provisions of Article 145 or j 4 � -°_ . _„...:147; --- Educatiar Law, t;�e;..�PFdolic - iirCaJi L ;.La t, - aIld�tkle ,Puinaifi County ,and - _ Lary Code. ''',11111 /1, +4 t OF iYE-P��r "rr s zo `: a 000u�'FOae•/�i0 g5 �� � P .E ., R.A ., # 12, 1l %--5 Very truly yours, Signed_ &4--_. d Owner (of Property Address y. S-Ze-93N Telephone Address SULLIVAN- THIEDE 2912 FENCREST DRIVE 1ORKTON HEIGHTS, N. Y. 10598 Telephone PUTMIM COU171Y DETART1VENT OF DIVISION OF ENVIRONMET11I.Ppi, HEALTH SEeRVICES wA DESIGN DATA SHEET- SEPARATE SEWAGE-DISPOSAL SYSTEM FILE NO. Owne r e-11 Address_/Zep Located at (Street r-e r?,r e Sec Block Lot Indicate- nearest cross street) Municipality A51, I_1,v7 0 r" Watershed ..SOIL PERCOLATION TEST DATA REQ tJIR ED TO BE SUB141ITTED WITH APPLICAT- ONIS Role Numb e r CLOCK TID4E PERCOLATION PERCOLATION_ Run Eiapse Depth to Water Water Level No. Time From Ground Surface in Inches Soil Rate -Start-Stop Min. Start Stop Drop in Ydn./in drop Inches Inches Inches 3 20 ZA, 2 Notes: . 1) Tests to be repeated at same.depth until approximately equal soil .rates are obtained at each percolation test,�,,hole. A. data to e submitted 4 4' U.0 . I '� V U W 6 2) Dcpt-IL mcasureffients to be tiride from top of hole. TEST PIT DATA RE1011IRED TO BE SURP4,19.71M WITH APPLTCA'J.'1ON DESCRIPTION 'OF SOIJ vc -,_ IN 9.'E­�T HOL1,11's DE PTH HOLE NO. j HOLE NO. HOLE NO.; ._3 6" .12" ak 2411 30' 3611 42" 4811 5411 60 66 7211 7811 lk 8411 INDICATE LEVEL AT GROMITD WATER -IS ENCOUNTERED INDICATE LEVEL TO WHICH JJ_ T R IZVEL RISE EING ENCOI)TITEqm,� TESTS FADE BY 01',ozele Date- Soil Rate Used OP —_:5r_Min//1;!'Dr,',op.: S.D. Usable Area Provided cp of No. of Bedrooms:_ /4-1 Septic Tank Capaclt a s Type Absorption.Ar L.F. y �_�Y ��..AG width trench. ea Provided x24 Other Name 1A ► ✓a 6ignature Address 29,72 FERMCREsy nRIVE THIS SPACE , FOR USE BY HEALTH DEPARTKENT ONUI., Soil Rate Approved 1 Checked by 4. - I - 0 o 2469b I `I� n� ESTABLISH ELEVATION OF HOUSE TO PROVIDE DRAINAGE F LOWEST FIXTURE - -41 t _ _p TO SEPTIC TANK AND FIELDS .....� . AREA RESERVED FOp, SEWAGE DISPQ$AL,, SYSTEM TO REMAIN UNDISTURBED.ALL CONSTRUCTION TOiCONFORM TO 5T'ATE S a AND LOCAL STANDARDS AND REGULATIONS 1:.. IN \ ,c j.. \ A& \. f i o IoV ippp� . 9e, ��a.,1,f lea 74; St.✓4 G" :��osA� i�co q�. /i>> • \_� tje c7 Yin �c T -'1X I�;l" •s * =' P�aPesCO, .,,} ` i, 1 \_,. \ \�. 1 � / ,St/:�•Y�I qld �jei'<c+' �%D , i h O /�c/- ,e. , ' � , 6 \ ��� \ \ � \ I i� i � \�1 � /7a � ><u. yo �e. o,•, a/ ?oo ' Xti -,;1�s - <<- 7�;,�, �z� ' I�, , , • / - t � �1..- <��, -_ _ APP F OVE- SEP }519Z� mot. RR OR;- �IYISION, {RVIRO mENTALI NEALTN SEIfY1C�;L — -- /°L N ly "? PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICE! :— ROPOSALf-OR SEWAGE TREATMENT SYSTEM REF Internal Use U FRepair epair Permit issued in last 5 years ❑ epair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ within 200 ft. of a watercourse or DEC - mapped wetland SITE LOCATION 009444 TOWN n/Arh OWNER'S NAME -foAI &R,4 / MAILING ADDRESS 1_<', PERMIT-# `"02 l � ° ,/(!5 of in Watershed ff Delegated ❑ Joint Review TM # i ._C' PHONE # FAV rl 'y3 APPLICANT C6-1`'1 IP540W I'K, ame & Relationship (i.e., owner, tenant, contractor) ` DATE a / ® FACILITY TYPE •�'i.✓�, `t r?t l" PCHD COMPLAINT # PROPOSED INSTALLER Zoo A,I ol wt exi 013A4 PHONE # FW49 ;/ C9 135 ADDRESS . �ie� -�� GN Gjfy-CZ Xal REGISTRATION /LICENSE # Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of'proposal from licensed professional depending on the nature and extent of the re air. I, as owner,agree to the conditions stated on SIGNATURE TITLE DATE (owner) • - = - - 1,-thd-septic in�taiier, to-com ly with a conditions °of this permit for for the septic system repair SIGNATURE TITLE / (y DATE a f (installer) Proposal approved with the following conditions: s 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions . 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. No completed work is to be backfilled until authorization to do so has been obtained from the Department. INTERNAL USE ONLY Proposal Approved Proposal Denied ❑ In pector's S na ure &Tit Date Expiration ate ,Repair proposal is in com liance with applicable codes Yes No O COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 0 Tac^f _"F v iVf �- nJC,+.� d�J�SimU2��.J 3py� Z OA I � � �Nff Vj-�7t� Ar N. �s '3. Oct 47 a ! I 69G .GZ 1 Tj %i '47 6a � SOIL PERCOLATION RATE ....... ?:- .S...:.. MIN/IN / ZGC� GALL�N SEPTIC TANK DEEP TEST . /1ln L. � �'� � ���+ �,�,. A .1 _ ..- LF ABS. TRENCH PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES ' PROPQSAL FOR E� , EXPLORATION OF SEPTIC SYSTEM FAILURE All Information below must be fully completed prior to any scheduling SITE LOCATION OWNER'S NAME MAILING ADDRESS TOWN ANWAM, I*� TM # PROPOSED CONTRACTOR/INSTALLER 1-ocA 6vy PHONE #XW -6 ) V7 ADDRESS 3 REGISTRATION /LICENSE# aggson for-'exRloration: Yfailure to surface* 0 back-up In house,1 ( find limits of system for repair 0 other (explain below) FOR COUNTY USE ONLY & Title Date Date: Time: kly:excel:septic Sheet of PUTNAM COUNTY DEPARTMENT OF HEALTH-) 1�7�'-`'DIVIS-ION-GF,-E-NVIRONMENTAL-H-EA,T'�L-11' °-SEtR-VICE,S}7'---'.-.:'a-,- , " FIELD ACTIVITY REPORT AT)T),RF.o,.q: I.L -4Lc7zg7c,4A&e-,,g- Street Town State Zip PERSON IN CHARGE 'TI-3 / r)P TNJTPPVTPVJPT)-. T),q fp- . Name and Title - I TYPE OF FACILITY : SST FINDINGS: K ft- — /.5 / 4t"4-1 /0 TN0,PF.rT()'R- TF.T Signature and Title REPORT RF.CF.TVF-T) RV: I acknowledge receipt of this report: SIGNATURE: 02/96 Title: L r TO SEPTIC W Z' TANK AND FIELDS ......AREA RESERV D F:OR SEWAGE :DISPOSAL EMAIN `UPIDI$TURBED•ALL CONStRUCT N TO C,oN�itaRM TO STATE a" SYSTEM TOR , LOCAL STAN DARDS AND REGULATIONS .. . ,AND, ��z :;? a ,�zn . _.p _ ; . - ►, a.: ._ a .. r a • .� . �It/T � •¢-ms`s LJ l� / . �7Fe-1/ �c /a.s sue / AJ ACC. RA 07V E SEP25.197. Tl►l Hvo.Ti1 SERVICw"' x -r . PRO OSED 1 D POSAL SYSTEM " ` > SEPARATE SEWAGE �� fah: �1,/ i • /i/J'. / %,". ,r Y. � a �'� � / "e • � i ,-.' .'✓,� �' .: :.;r µ•Vi d i':. ✓ t ! / . -_., " J, J' a k. N. OF �, r NTY NEW Ae TOW '` / J YORK y 1. ;,�.� .?� DATE t� 3 rr SC.ALE�. JOB 3; bULLIVA N - TWIEDE. CONSULTING MAl0t3f°AC qE YORK fr! 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