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Home My WebLink About4534DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.05 -1 -14 BOX 34 04534 F. ,w r' PUTNAM COUNTY DEPARTMENT OF HEALTHF V> , Division of Environmental Health. Services, Carmel, N. Y. 10512 : :��:a�E�! �4' �L�_"- iOF:.= �O�!€ TRl 1��SA11�; �. �F1' �. ��1��.. �' ��; � 'V`1�G�.�i��'i�S£.L "•�Y- S'��E�R ; ��;61 � .,,-�/ � � },, . . ,4/} Town or Village Located at O e O Section Block — Owner Lot %Job j� Separate Sewerage System built by �L,�t —,LJ�l Address • P�' /+' Consisting of 112�Gal. Septic Tank lineal Feet X t� �? width trench Other requirements Water Supply: Public Supply From ,1 Private Supply Drilled By Address - k�� // Building Type / /c" j r */4f Has Erosion Control Been Completed? No. of Bedrooms — Date Permit Issued L• 1 certify that the system(s) as listed serving the above premises were constructed essentially as shown on the attached), and in accordance with the standards, rules and regulations, plans filed, and Q9 permit ' sued Date Certified ' Address NU Any person occupying premises served by the above systems) s"b"l conditions resulting from such usage. Approval of the separate sewerage available and the approval of the private water supply shall become null ;p subject to modification or change when, in the Judgment of the Com ii Date By is9046'th o plprleduvlc ftpies of which are 40 � Want of Health. jLajjiVjjj@iay be necess call become null and void ien a public water sup Health, stLch revocati , � \ 1 p (T \as�,a publi sa fl e =,aMIM. d�sOM1ccEba``1�9e �1 Title_ s 9L °or,y unsanitary r'�ewer becomes �,d approvals are SAMPLING POINT:: J BACTERIA PER ML. _(Agar plate'count at" 35 C). `COLIFORM GROUP (most probable No; /100ml.) :ss -a TAL -.ppm rhed «; f1 Z aM .,NAd Pe DETERGENTS - ppm NITRATES (as N) - ppm IRON, TOTAL ppm'.' Y, vw�sv�° vi- r �.ti-�.a�o►aat- vt D441J.U,i1J� u n Cons ru&te ��'?G� -dam oca on reo / Wu=dlng Type /_ ' municipality�� . a"e c on 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 owne., his_.sucees- sons, heirs or ass r. 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 init:Lal 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 utiliAing the system. The undersigned further agrees to accept as conclusive the de- termination of the-Director of the Division of Env' irgruilental Health Ser- vices of the Putnam County Department of Health as/to_wh ther�or o thA e `Pystem• t%a oparate was- loused by th wx11f #1 or n gli ent, act of the ocoupant of the building -utilizing theksystem. „ Dated this ' d f -t= -- ay o ' . ,- 19 Si Title a andnE��TCTi01� 8 Buckshollow Road - - - - - - - - - - - - - - -- - - - - - - - - - Q, THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS, BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTQH IS REED TO FILL? :,OF RATE Division of Environmental Health Se eat th WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT..OF'HEALTH 3)71 Division of Enviroffinental 'health Services COUNTY OFFICE BUILDING - CARMEL, NEW -YORK F This..report is .tO..t+�rnf* letec! :iii u?II ds!�l°a l�nri. S!!�^!ItCN`!'v a t� Health. art, n �., i 4: �" s �� th D p �r:,,nt•is��F' ..v.t:� :at;R�are�ry :�l;u� � c� 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 - v ADDRESS LOCATION OF WELL (No. f Stre, b1i / (Town) 7 (Lot Number) � PROPOSED USE OF WELL �j BUSINESS l'_t DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL ❑ SUPPLY El INDUSTRIAL ❑ CONDITIONING ❑ ((specify) DRILLING EQUIPMENT ❑ ROTARY E?.-COMPRESSED L�I AIR PERCUSSION L ❑,:P PERCUSSION ❑ (Specify) CASING DETAILS LENGTH (teat) DIAMETER (inches) « WE:uHT PER FOOT / ® THREADED ❑ WELDED O YES NO G KJ YES Dl NO 'YIELD .TEST _.. (.�j�_ HOURS G.P.M. ❑ BAILED ❑ PUMPED COMPRESSED AIR YIELD (G.P.M.) / b WATER LEVEL MEASURE FROM LAND-SURFACE — STATIC(Specllyteet) DURING YIELD TEST fleet) Depth of Completed Well in feet below land surface: �6�) SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS 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 If yield was tested at different depths during drilling, list below . FEET GALLONS PER MINUTE DATE ELL COMPLETED 5 7 3 D ATE OF REPORT WELL DRILLER (Signatur _. efz ) PUTNAM COUNTY DEPARTMENT OF HEALTH ..., ,'i�;. :�+:' ";� ..:�e1 ;rJ:. ot� �. � :�Pw °ids � ..��:�'Y '' Rte'' S- •_`•- "._•- '.�..'i•::.+: Ye.r'�.'S 3'r ".e:ieAc a -r ,..., �:�,• D-I-fis�I -�vl' OIL' �F= �E" �1f��( 3i�1yi�NT 'I�E;_��t�T1�»�EF.:C��•��- ...�" Date /,7 11 Re Property of Z/�10 0 9 .r' Located at/ Section S Block 7 Lot 3 Gentlemen: Si This letter is to authorize Z0:54,4 �ol�i ✓��% ,a duly licensed professional engineer P11", 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 uV,j„auLiu„ w_.:.n Lids macLez- and to. supervise ihO cunstx'ucciun of said system or systems in conformity with the provisions of Article`-'145 or - - 14�� Educati®n..Law,- - -the Public Healt Law,- "and .: thhe Putnam C.o�snty Sani - tary Code. Countersigned: yz-� Telephone Very truly yours, Signed ��l k U� f� O aj wner of Pr p ty 3 % Jam- 71 Addres ,,,4-1.h." Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _._ _�,- r:.,.. .a,•- S�c•r..- rr "'. °.xnT.'_ `..d.. _ r.c _'£Y:77,.".._ =_.:er — _"�.....e.4$`= 3.�= ^eaet�.. -w. "•+= •�.en =s:'i _i: -". Xt COUNTY OFFICE BUILDING, CARMEL,.N. Y: 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL, SYSTEM FILE FILE NO. Owner ,4" 4) o n,!h /I I , Address P�rp � 6 � !� t� � .. � �- re —C4 , Located at (Street), �oeewvce_ Ro¢ �. Sec Block 7 . Lot : -3 . n ica e nearest cross street) Municipality P,AV,arn I/ oL I)4 L% Watershed PoP+Ct _ SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS 5 TA 311.35 11: 4'7 Zv . 3 y 5. .. 1 2 �. 3 4 5 Notes: 1) T6E�ts to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. t`� Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop - Inches Inches Inches 10a. 3 9 j o D 0. 2do.� 1 18.0 1 9'', ?i 311' 10 11 "x4 3 5 TA 311.35 11: 4'7 Zv . 3 y 5. .. 1 2 �. 3 4 5 Notes: 1) T6E�ts to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. t`� TEST PIT DATA REQUIRED TO BE SUBMITTED WITH'APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES I DEPTH HOLE NO. HOLE N0. HOLE NO. r s n 'a.�.p.p- .r-,wo = :+' -"�.. s ':`r�"",�� 41n� yF4:'� ra !.•' 3'+ . ! , - �e.w >+: :.iG••y'•..= '�'[ti: e-.: -..-d �°.+.�.a e"-:�" k YZ •'"*n�'-,f'"i+..�,' . .'.S :C4;r.. r� ;sir.:. a:Y. .:� �:.':aa 611 1211 1811 WV 24 ". jc 30" 36116, 42 ", 481f ;e 5411 w% g Oa l6cv's 60" 66" 72" 78„ 84" . INDICATE LEVEL AT WHICH GROUND .WATER IS ENCOUNTERED INDICATE LEVEL TO WHI H WATER::LEVEL RIS S AFTER BEING ENCOUNTERED TESTS MADE BY Date Soil Rate Used ^ 6 '•Min/l "Drop: S'.D. Usable Area Provided S'p No. of Bedrooms. 7 Septic Tank Capacity /BOO Gals. Type_ ¢snor -- - Absorption Area Provided By ?Zao L. F. x24 "' y width trench. Other. ;1fyff EFf EP ». Name -_ - 'sari igr�a, urn- •' � r �, Address .Z .7 2- S L Or lc:s t IV f r ° ��; e a•FT , e �� 9 THIS SPACE FOR USE BY .HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by �`�i,apFSS�aP >�ate �4siaaaaa►s►