Loading...
HomeMy WebLinkAbout4542DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.05 -1 -23 BOX 34 y 16 r .. 04542 BACT8RIA-PERML. (Agar plate 6oufit'Cit --.3510 C)* COLIFORM. GROUP (MJst probable 6.,/I00MI.) 2 -.' THAN, 1 SS :.HARDNESS TOTAL DETERGENTS= NITRATES , ARM; TOTkL. 21 P'ihGOR �1S OCIA'I��S, IATC•,`. L Va hn e. e Putnam Val] ey (T) AV Rochelle N, ter ui•. llirclla::e�� " "o L' °t:uildi.il�• Mun.ic•a.j, ;i li ty� �s.,ip -. -_�[ li`.A✓36B.dt+Ui:�x rtM ,Yvr �,r+ t • C I .w+ a • • •n r M _ �' i -. i!2T•i`�GOF�" t�aSS'OL"I�i''LLS", .f n1G" v�=�. •� ,.. �., .�._..:.�;.. , -.�., rt.•x -.. :,�.�y�.,, .:::: ,.�..:..; .1dilig. ConSti'uctud by .Section , Gardineer Read a .atiun - Street Block - Split Level • . • 8 (lot :,IOC of Drip Farlp) ldir.� .1;ipe Lot.. GU11R�'�NTY OF SEnrIRaTE' SLi'.'��GE SYSTL';1 Y represent that I am wholly and,:eompletely responsible for the lccatio;l, knianship, material, construction and drainage of .the se -wade .disposal sysir_, V' the above described property, : and that it has been constructed as sho::n on :approved plan 'or approved . ampndmrent thereto, . and. in accorca;ice with the starleares 2s and regulations of : the Putnam County Depalrtment of ..Health, and hereby gua_^anty the oc•:rer, 'his successors, heirs or assigns, to place in ocod operating conditio_1 part of ''said system constructed by .me c,Thieh fails to operate for. a period. 01 t �:o . -s in; iediately following the date of °initial use of the sewa-e disposal sys em. or' :repairs made by me_ to such system, except there the failure to operate' properly r !auJ('ie .'UV Tale will ul . Ul' llek�.s.461 L ac: is iii ilia OuL:'UPCAi+o- U.L. Li,iT "LA—A. - - /1�, .. The undersigned further aCr.ees to accept as conclusive i-iie deterrriii tiCr. .}1e D.ix'CCtOr Of, t7�1e D.1ViS.lOi1 of En:'iror „Te,ctal 1[ealt}r Services .of.t.le. YittIi�d:.P• C O::i:i'.' lrtcmnt of. Health as 'to whether or not the failure of t:7e . syste�<< to oper�t to =mss ;ed by the will`ill or negligent act. of the occupant of the Luilding u �ilizi :em. h A$ C A this. 7 day of eA 1:9.75 Signature . . a Title (if corporation,. gi`te . name and ad%ires & D E CAVAT0RS� .E (3) COPIES ARE PECUIRED.1 ITH THREE (3) COPIES OF FINiNL PLANS BEFORE C1ERTIFIC��TE O��IPLETION I-JILL. BE ISSUED. i ANT0?i TS' FF.C�UTrrD T0. FTLE NOTICE OF DATE OP FIhS1' USF..OF S�'STF`1. - - - - -- - - - - -- - ----------------------------------------------- sion of Environmental health Services, Putnam. County Department of 11palth WELL COMPLETION IIEPOR j PUTNAM COUNTY DEPARTMENT OF 1IEALT11 Division of Environtnrntal Ncetth !- ervicus G COUNTY WIFICE UUILDING CAHMEL, N,EW YORK k repo,-t is to be completed by wrll driller and, su+• :.'il:-d. to Co,.mty,aiC,��-,De4i.�tmcnt:Acr char =with �3€a: s asfzr iaF�i '{t+9ihcafingat�ts'f'i�S4e'fc�i +hactcriaf quality b {ore certificate of con tr.uction compliance is issued. REPORT MUST f3E SUi;' .111'TED l'rITHIf•1 30 DAYS OF Vr`- .COP �f'L[TIOU ;H FROM tAND $1,10ACE1 FORMATION DESCRIPTION FFit7 1 12 hardpan 12' 2901 bedrock shut i tv If yield was fasted of different depths during drilling, list below FEET GALLONS PER MINUTE Lit COMPLL LD • ; , r �/� �UAI'E OF RLVOfLT I WELL ClIIL}+EfT All ature) �� Sketch exact focat;cn of well wf:h distances, t0 at least two permanent landmarks. , a re NAME ADDRESS ' OYlNER r LOCATION (No. 6 $vent) (Town) (loi l: naer) OF WELL Re Do #3 Putnam Valley, N. Ye 10579 - -- euslvlas L O PROPOSED DOMESTIC ESTAELISHMENT . FAR)A TEST WELL USE:OF YlELL SUPPLY INDUSTRIAL, CONDITIONING ((Spec ffy) DRILLING ® COMPRESSED a CABLE a OTHER EOUIPMENT ROTARY' AIR PERCUSSION PERCUSSION (Specify) CASING LENGTH (feet) I DIAMETZR(inches) WEIGHT PER FOOT _. � RIVE SHOE((��'�� �'ra5 ASING G O�T['�T -- Dc'iAILS --- -- -- • - --22 � -- ' � -- -- 6 -- _ -. 17 L THREADED- WELDED TES L.1)`O OYES NO YIELD � HOURS G.P.M. O 1.] 'PUMPED ] YIELD (G.P.M.), TEST FAILED COMPRESSED AIR . #7� 6 ` 6, WATER MEASURE FROM LAND SURFACE— STATIC(Specify7e0t) DURING YIELD TEST (1001) Oeptb of Complel:d Well LEVEL in feet below Land surface: 2901 — - - -_ MAKE_ — —_— _ _ _ LENGTH OPEN TO' /.CtUIfER (!sel). SCREEN DETAILS SLOT SIZE DIAMETER (Inches) GRAVEL SIZE ( lnches) FROM float) TO (1091) IF GRAVEL Diameter of well including PACKED: gravel pock (inches): I I" ;H FROM tAND $1,10ACE1 FORMATION DESCRIPTION FFit7 1 12 hardpan 12' 2901 bedrock shut i tv If yield was fasted of different depths during drilling, list below FEET GALLONS PER MINUTE Lit COMPLL LD • ; , r �/� �UAI'E OF RLVOfLT I WELL ClIIL}+EfT All ature) �� Sketch exact focat;cn of well wf:h distances, t0 at least two permanent landmarks. , a re ` PUT�NAM COUNTY DEP) Dcvision of Envw onm MMI Health CONSTRUCTION •PERMIT7. _0A: ttW_ Ot,� JI AL SYSTEM Y s F iLiit3'+eTi at _ Subdivision Dri> ��ffi (lOt 1b) Owner �. Pttl'.Aam gCr @8 'It�t4 • � , � t � z � _ t fro• :'` h To be cructed by onst `Ai�xlslm �t`�` @8 �1lCe 3 5 �i • :- :,Water Supply - Public - 'Supply From £` Prwate 54pply.5to be drilled Address A .argOr ►�'1.tereeti Pt .Other Requirements 6"_ IIse Ehl Q represent that I am wholly and completelyuespo sib le for the design irrd II c above described will be constructed as shown on the approveC amendment thel <Gounty _Depart`Inent of (Health, and thaton completiqqtK.6FeoV,ii ''Certifical tie submitted to ;the .Department'. and `a wrdten4guarantee wUl tie'furtinehe ;place m {good'.operat�rig_ condition any'part ofwsa�d sewage d�spo'sal systei ;ante of;the approval of the Certlficatbi�df�Cbh'tructio Compl {ance of tf will be, located a3shown oh the approved plan and fFiat said well witl'be msti le (county Department of Wealth K ° March 15', 1975 `} Date Signed .Address ` 1 l�ertbriaga R�Ad. -pY4 ­":,4:13! ,ED FOR CONSTRUCTION T_fi_R7aO_6toviu expires; one year from tt revocable -for cause or,may be amended or mo' Wied when c?"Wed n essay requires 4-,pew 'p9 d pproved disposal of domestic sane • ry se Date{ V �L.Y 1gy KENT .OF HEALTH _ kf > %ices Carmel „� N ,Y.. 1`0512 _• - f : �patnam�valley�(�)r: - Town orWillage - x LOY V Job i B©a 262, RFD r3 Bar er .Sz`t _ ., Address N t =5 Putnam oall ®g, N.Y. 10579 Total Habitable AWA'c6 ” 3 -Q + Square Feet ik Lineal feet ,x « width trench: Y ti K V Ab©ved Address - - , , _y L driller�� - �alley, AY. fFthe2pl` sy1Sg tl eV that` the •separate 'sewage. disposal system d; m pc ndertls- :rules an re. a Ions o :',t, e, u nam -' f�he Commissioner ,of Healthwill ;�: w ®e i .• hAi ign §Y bytthe bwlder';that �sa;id' bullder�,Will get rib f` ) y., ran ediately;fo�llowing the date of the' ;issu - .�t m". ri e2) that�the Crilled,_wel'tAescribed° abovi . cgl n eta dO ) n4les land reguta ions of ,. the Putnam,, • P.E RA :issued unI& ilon of the bwldmg has been. uncle js - ie Comm o r%ISf >H,ealth ,Any change or alteration f construction' :r �STn y== E� Tale PUTNAM COUNTY DEPARTMFN'T OF HEALTU " . } DIVISION OF F; NVIRON�1FiVT11L- IiF /�I,Tli_.SI'RVICE'S Q. �• +1n.? .T •E'7^ -f� � ..- iY ..e6.: s•- rl�.Y-., ✓.r ^e � .w_ra+.: d :...•, 7 - etw,::lr Q>1. r+ .h'i' .v: 4XS7". .°r. —. , b eA t!yP�t a`. -.s - r.- �t� ^ -• s� - d��a., d: -�'4:% Date AP'ril .5s 1975 Re : Property of Putnam Acres Inc. Located at Gardineer Road, 'PutWM Valle Section 68 Block 8 Lot 8 (Drin Ram lot 10) Gentlemen: This letter is. to authorize johla S ° m®® :d' .. 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.pro.perty in accordance with 'the . standards, rules - or .regulations as promulagated by the Commissioner of the Patnam" Count} Department of Health, and to sign all necessary paper.s;on my behalf in lYlr.'rrani-4w# vvi'vo 'i1h;� i i- 11no ho nnncrratn�; i-i�n of cain'. system or systems in conformity with the provisions of Article 145 or . .Edu�c:ation...hat�, :. the:. Publ -ic- Health; - Law,:.:_. and:, the ,P4tnam C.ounty. Sani -. tary.. Code Very truly:.yours, Signed - Ownler of Property Countersigned: �' 78 Vaughn .Avenue Now Rochelle, N.Y. 10801 027846 Address P . E ., LA 8 ®8267 1. Nertbridge Rem 'Telephone Address ° LNG Peekskill , N.Y. X0566 ® o� <fi.?lt .gip S� ° lip 737 1656 ''Telephone ® X/ • ® � ilf NEW �� 4° .. . Putnam County Department of Health. Division.of Environmental Sanitation AFFIDAVIT. - CORP. ORATE OWNER APPLICATION Tvw nqn k;;II &L--IE PUTNAM COUNTY HEALTH DEPARTMENT T0: Commissioner of Health - In the matter of application for I° --- IQCIRLi,<L .L• _tit LLrfl�_ ---- — — — — — — — — — 'represent that I am.an officer or .employee of the corporation and am authorized to act for �U.; l0. _ S �^ .. — — _ — .. . • — — — — — — - - _. . ' (name of corporation) having offices at _�� V�G{- `.lsl_ �V�_ _ �P� _ /lOL�p�i Whose officers are President M�H-(S .. L. M Ater _ �� (lau��°n �►' _ l�PY / o��� %i°.1 � _ — — -(Narrie and Address) . Vice - President _Nt9 H,4d _ _l Df3f31 NS _ SS_.�L '1= � St' _ _ (Name and: Addressl Secretary _Gb(TM f�K_ _ (3)PRGE -R _ S-t . _ .Sh►-gb (Name and Address) ___ - -- Treasurer _ _ - - • ..: Name. and' Address _ .. and that I am and will be individually responsible for any or all acts of the corporation with respect to the approval e ted and all sequent acts relating thereto. Sworn to before ype this day Signed _ �- — _ — — of � 19, Title '! — — — — wNora-ry Ul.Lc: tAa x ` Corporate Seal J % PUTNAM M TH I)TMTY'- DEPAIRP,"FNT 0 F Y L CAS COUNTY'-OFFTCE BUILDING, R, MI E L, IL Y. 10512 DESIGN aATA S T-SEPARATE SEWAGE DISPOSAL SfSTEM FILE NO. Owner ML= Awefa Zma. Addl .ss M= M 20 03,, Baww K. fttmw Located at (Street 6127fi4 mear lbsfi Sec'. 68 Block 8 Lot Q BrIva FMPM lot are indicate nea�ef cross 'street) Municipality DC BE '6 -APPLICATIONS SOIL PERCOLATION TEST DATA REQUIRED TO E SUBMITTED IIIIH Hole Number CLOCK I-P F-E�'FCOLATIOT, -TON PERC OL.�M Run apse 5ep n to 7a ter Water Level NI o Time From Ground S-drface in Inch-s Soil Rate St o-D -art Stop Drop in Min../in' drop Start Min. St Inches 'Inch s In ches,- - - - . ; - 19o25 2%o25 2 19 19,60 '6j3 3 .2200 21 29029 22625. y. M0 IPAD .4 5: 22.60 a Ue50' 22910 20 89.50 '22050. 3.00. 4 2 Not N1. �.eq a,. -'.. soil, 'Tests be repeated at same, -depth until rox ma,e rates are obtained at each percolation test bole'. Ay� data*to submi.tted or review. Depth measurements to b e mad- from top of hole. 4, Z* 4 2 4811 5411 6011 06" 72' .8411 INDICATE LEVEL =:T WJ t7- C 11 TROT= WATER IS _h C-C)ITNTHERED Lb= 'L R i EES' AFTER BEING ENCOUNTERED-- I-14DICATE LEVEL Ti 1I CH WATER IZVI] S� -TESTS - MOE BY Date DES T G` Soil Rate'Used QM Min,/1 "Drop: '.S. D. Usable.Area Provided 7o No. of Bedrooms Septi6 Tank Capadity ILM Gals Type 01mv- Absorption Area -Provided _?,Y�280LL L. F. x 2 4 �,b" width tr n ()tile 0, Address. Qw%vadge Row LIM—_ FOR T7 T 0';L`_': TZHILS SPACE 3 E BY YLEILTH q. Chc-c'ke(I by Soil Rate.App. J 0. 4, TEST ?IT DATA REQU I _Rj, 0 TO 5E- SUBM TFPTM 7 WYTTH APPLTCAT7� ._'., -PT- DESCRI ION T31RF OF 501 Q Ta 1D.1 U1, KC V "I TH TEST- DEPTH HO NO lloij�! i\TO. 2 HO G. L. 1211 120 12gypen lam 2411 3011 V, 3611 4 2 4811 5411 6011 06" 72' .8411 INDICATE LEVEL =:T WJ t7- C 11 TROT= WATER IS _h C-C)ITNTHERED Lb= 'L R i EES' AFTER BEING ENCOUNTERED-- I-14DICATE LEVEL Ti 1I CH WATER IZVI] S� -TESTS - MOE BY Date DES T G` Soil Rate'Used QM Min,/1 "Drop: '.S. D. Usable.Area Provided 7o No. of Bedrooms Septi6 Tank Capadity ILM Gals Type 01mv- Absorption Area -Provided _?,Y�280LL L. F. x 2 4 �,b" width tr n ()tile 0, Address. Qw%vadge Row LIM—_ FOR T7 T 0';L`_': TZHILS SPACE 3 E BY YLEILTH q. Chc-c'ke(I by Soil Rate.App. J 0. O Z7 >x �: , -,,� :t1 i '% ;{ -g %. .�� 'S a� :' ' '