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HomeMy WebLinkAbout4536DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.05 -1 -16 BOX 34 Is logo %A 11 oil Ki. I I ll or Or Or L' .' , � r y. �� . r ., r I ti ; .. goA ; go ` Mir 04536 5� 5 PUTNAM COUNTY DEPARTMENT OF HEALTH t "' ' �� Diws�on 'of SHealth `Services Cerm% N "Y A{ Enwrorimental s X10512 AN P a down or Villa ge ElJG.�c iZl1/Ei 1�� .Block Located at: r--o L�= -' Tax Map Separate Sewerage ''System built by.; Address BACTt RIA'PER ML. (Agar plate; count at 35 C). COLIFORM. GRQUR (Most probable N6. /100ml.) 0 MFT' HARD NESS, TOTAL - ppm DETERGENTS-' Mg NITRATES (as N) -, 149 /L . IRON, TOTAL.,- IIiCJ j, omew C.. Owneir or "Purchaser of. building `,�Lc;vz.E Nc-cs; LSAJ Vr Location - Street - :ale -A inn E5 Building Type Municipality ,> tir..uS'.i _'+ao:®i �'-,�''T"'+'t.:.�':.o �sY: ik:. ^ts .s/'i-%�(`S�Pf��'¢.. '; .1.i?'•_'mi�� i9� ".:,:eL�+ -. _��::,.oa ��`.: Section 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 successors, 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 selvage 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 occupant of the building utilizing The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environmental Health Services of the Putnam Coun tv_ Department of Health as to whether or not the failure of the system to operate was cause.d:.by; the - willful• or .negligent act of the occupant of the building utilizing the system.. Dated this day of /'(��1`` 19,��/511'Signature Title X�4 THREE (3) COPIES ARE REQUIRED WITH THREE (3) COI OF COMPLETION WILL BE ISSUED. ve namee ana aaa.r.es BEFORE CERTIFICATE 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 3/71 u analysis of water sample indicatin& REPORT M llj of satisfactory bl SUBMITTED W PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK . --lal quality before certificate of construction compliance is issued. °WIN-30 DAYS OF WELL COMPLETION OWNER NAM ADDRESS LOCATION OF WELL (No. 8 Street) ,O� 3 (Town) "' (Lot Number) 27. PROPOSED USE OF WELL BUSINESS ® DOMESTIC ❑ ESTABLISHMENT 11 SUPP Y El INDUSTRIAL '0' ❑ FARM ❑ CONDITIONING ❑ TEST WELL (Specify) DRILLING EQU PMENT 11 ROTARY COMPRESSED DAR PERCUSSION CABLE ❑ PERCUSSION O(specify) CASING DETAILS LENGTH (lest) 3„L DIAMETER (inches) �o A WEIGHT PER FOOT 2 THREADED El WELDED E S O 'j [I x YES CJ NO CASING E YES D NO YIELD TEST ❑ BAILED HOURS El PUMPED ® COMPRESSED AIR G.P.M. YIELD (O.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST (feet) Depth of Completed Well in feet below Land surface: sZ %J 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 I 0402 If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL CO LETS DATE OF REPORT WEL ILLER (Si ture) r � e 1'" -3X h,w do - y.,... y '.:rs �'..eF :gs., i+ ,, q - +.s_ � � :x.,. 11 S K i L. 4 -3 _ P F R -- •- - -.. £ - `� _S`i 2 a _ K 4 g .. t 1-,. �... a " :. „ „ ":iE- w... 'x e e xv,..o+�e� . >t�.-�cx= _ .:_,� s _ ,:w� yi -t'� . g .,, . s , r n :. ".3;- -, -.. ; ' ar,; ,�. . -, - ;�; ,..... - .._I, �'- a �� - "'-ate -. - � r . , "f- - �,� — - -'fin a 11 a -'_K z s r �r� 3 �,� - - - i._ ,� , r i S^ gym. -. _-Z'n 5" _ - - ' t" i .. .c ,.. .. y e. t> d.3. • 'ti -a e..,. T I I '�:`c E'7 ia°- *,-.i. t f �` _ '�f s_ ... a ,. -Y.k .. - .! -s: -� "., "� r z _ w`?. ts'° max" '" :.. - - rm r. d y�a 3 - -i c'S,t r f�.. ',N. d.. t -3. ' _ .,:5. 'xy �'� -..�+ :j " t I. F� �T 8 r p r , �' ,� � �- ,.- � , � � . ",,�, I., ��I\ ��\ ��, - - , - . 1� , , ,�I- , ,.- �,, — , � , � -N � , �Z. : " I �, ,. I - I I ...< t; , is _ S_. .' s �.. ' `}'.e. a. ��..' :. e ...,� - 5 jv € i y i- -1 m ;2... ,e„ ,}- ;.. �,. L ° :. . -: >'' .. x € - z air atc= - 3` -1 Y V'; », , a _r v. ; _', _ ' . a d ,.ar' "fit ' •' ��=z - �' s'.x. .m.. .k..,i .', y -34.. �'S1' pyix'Ec - "+tE c'r. t! ^ "° a Y,; .. I , ` - �,, �+ -r -r e k liz -- _ I If . 'E ? t - 0 1v - 4 r..: - - _ 3I- 1 ^t".-il -11 -,— . f.,r� _ +_` ' A ,�% . *= : i s a¢ t _ .. J _ ( Sti y - - Y _ - :- : ., - _ ,_ - , : G ^ ^ " :x pa i l ! - s - - . t. yp f - " - q . 111 �..- f7 -mss' h `s2_� 7 - - .i�'x < 33. �?�_.S. aF' F ?j �:4 w fi . - L 3zK"i# t' -., -. _,__.,yet._... s. �.._,., t .x .. .17 :.. 2..... -. v,_ a.. '- -" _ 44,,. _ w., i.. . x k. _ �. —., + may¢ ?�r.�. . - ., - - - _ _. f -z z �' ..: -' -1 -fir , Gf" {{,may Y�L tits .2 -.- s ., -- _ s_ °C n r'n k.i $`i .-. - _ '", ., ,'� -j ^,..: -+ ,is rg _ 4v=(• v- p a - "., -,,.,r X ac a. .ice' a s-.,. ,, ;. - -- ' -.. .i ),-` wz -` :' r, 4 . t -_ " Ds t - r,•.5.., -p. ,,..•, - "M }R n£ : !iE' °- ';v 6 "?(�y.,,, & :w .:,fa,'.' � 3 ^¢ ., .. o. .�4v - " - -T ..i,. i c. v -, "� c_". `£"�;�.. F d. N ,-11 _ <,$ q,, - - e -g <` -. r : :<-:n °r i.. ,..� +;-F ri. 2gfi-,.7• ..F: o .� ?'^x _ -'-#h '-�2', .. `.LS , .. y� �>'.,.. -,. xt ' ':sc, 6 _ -,.,`' - $i - Y . _:�., S w : :-.."' G4 V --L . u . _, "`'a- �.o ¢ .,5 S k, e Tai �.'�"" , a�...,.� <. z! s -. ax <. ., e •'s ' %`.a.... G... a F - -s - ,,. ry'� 5, e e- 4._.d` - ,sg.4 _ .2N�"ii' "..E".i •Y4 .:-i' .F Y 3,. -.t- -- f ,.' 11 I t,. -t ^' - d;i 1 { , r{ � ; 21, V)1. ,I - . 't6 . ;+ +J N., q. PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y.;10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM'- 8aa�i- _� g _ Town Qr Village __ r. a. E6iSt0 --d i �w,"'•- °l:r %�cv�"" '^ 1T,s -ca`°u w' n 'i Jia ma+ �..• = �'.:: >a -"'w '._'` .7-p,=�3C'v�:•; .. :'1 ::.: mT+e- 810Ck ` m v _,w`e so-e •Te a --fit MFerr° Fa -0- Ma • -,•. T_ Subdivision 8 �"� R`" r ��' '�f�-M Lot E ' YJ orb. Owner � °� T `JV` i 44 C> Clkv-ti Address G9fs4 � ..�� w Cr. { Nd�V1 �%Ai_1_.�✓✓�' Building Type, Ct °4-j12 G Lot Area ' �J Number of Bedrooms Design Flow 6 ® Total Habitable Space `�•' d�� 0 � s�Square Feet Separate Sewerage System to consist of 6 2 50 Gal. Septic Tank and S -� I- -P• H R d l�. ^ -+1C To be constructed by � A F t j C: n= TEM Address �i: `v`f ®c %��'�- Water Supply: Public Supply From /q� Private Supply to be drilled by IV 1� C} PV, �A11 V Ai�F� f 1A� Address Other Requirements I represent that I am wholly and completely responsible for the design and location of the above described will be constructed as shown on the approved amendment there to and in -A County Department of Health, and that on completion thereof a "Certificate of gpyltC be submitted to the Department, and a written guarantee will be furnished the Or. place in good operating condition any part of said sewage disposal system d g ance of the approval of the Certificate of Construction Compliance of Mi will be located as shown on.the approved plan and that said well will be Inst County Department of Health. Date P ®+} 76 �7 Signed Address APPROVED FOR CONSTRUCTION: This approval expires one year from the revocable for cause or may be amended or modified when consioWV necessary requires a new permit. Approved for disposal of domestic i nit ry, sewage Date // 7!L�, By a....... proposed system(s); 1) that the separate sewage disposal system c¢CdAtrj yyith the standards, rules and regulations o e u nam :tioh dlrrmbb cell satisfactory to the Commissioner of Healthwill i%VS rs or assigns by the builder, that said builder will :(e d�of ears immediately following the date of the issu- Is a h ereto; 2) that the drilled well described above �e s nd s, rules and regulations of the Putnam P.E. y R.A. License No. 4,zi S 3 of the building has been undertaken and is Any change or alteration of construction only. r�- Title