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HomeMy WebLinkAbout4545DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.05 -1 -26 BOX 34 04545 so ., . I me '. 4, T - - r' � ; '?'� ' son ' i 'o i 04545 PUPNAM COUNTY HEALTH DE:PARDIlGW DIVISION OF ENVIRONMENTAL HEALTH SERVICES ;. <: ' i%,- - ' :� ;:`a "tom'., -: r: � '�. _. • <•.. 4. PROPOSAL FM DISPOSAL SYSTEM REPAIR ll OWNER'S NAME M ". 4nge.(a Gaapaano PHONE 526 -3322 SITE LOCATION / / GaAAneea road, Putnam Va UeV, NY /0579 �! Q � -- �— a6 M;LILM ADDS Same PERSON INTMMEWED 4. gia4 eaRrcv (Owners% PCHD Canplaint # Name & Relationship (i.e, owner,tenant, etc.) DATE Yanuaay 16, /998 TYPE FACILITY % n i.vat e ,owe U i.ng PROPOSED INSTALLER Mahopac SanLflat i.on Sept f c, Inc. PHONE 628 -4526 REGISTRATION # 41 Pr 1 (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal from licensed professional engineer or registered architect. Odd 100'x2' o� dnaLn �Le. d to exZAfLag �LeAli. Inu.taU two (2% junction boxer. No CLo .4ea to WeU. Proposal approved Proposal Disapproved s Sianature & Date Proposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed components tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diem. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I,.as owner, re agent of owner agree to the above conditions. SIGNATURE '+� TITLE FM: White MV; YeLLow (`am ED; Plink (k#i®nt) Pr -PP a7 MAHOPAC SANITATION SEPTIC, INC. Septic Tank Service_ 77 0' Ro6d- MAHOPAC, NEW YORK 10541 628-4526 Joseph A. Mantovi A //0 9 - 9�" / Tl�w k /811401 i F� A) a-,- ) I A 180)(. --- ZH—d"". 80)( 80 x 31 T-F &X a ox S;F lll :Oxll 0 7) 00 `PUTNAM COUNTY DEPARTMENT : O ALTH F HE D/vWd1 :.of EhWrdnmentel Health Seel ices Ca m% N Y 10512 i 17; .,; ats CAT E. F ,! {VAT R U CT IOF: L6A�IdE• FOR- ,SEWA4t. _- OUPUSA� Town : or'',V �Ilage iL1fli2D /N� iE sqo Ldcated_at < Section. Block ,. L'ot. Job CUfi✓% Separate Sewerage System built .by`CWA4�� Address/✓ /© �C►il�I ��,. Ciy.e<?fn,E4 , N, Consisting Of _' Gal. Septic Tank' lineal Feet .X —width, trench Other requirements Water .Supply Public Supply From j1 v Private Supply' Drilled By Aban'—CA so Address Building Type 'Ais� ?4 QA f'eAl No. of Bedrooms Date Permit Issued. Has Erosion Control Been Completed? 3 'certrfy'that the :sy`stem(s), as listed serving the above premises were constructed essentially as shown on the .plans of.the completed w e attached); and in accordance with the standards, rules and regulations, plans fil , and the permit issued by 'the Putnam Cou �Dl1it Date:.,; Certified by l Address �ra7C�.. �a..s� f=O, /a��..tyHTtN. a -No, Any person occupying premises served •tiy the above systerri(s) shall promptly cake such action as may be necessary to secure th o�i do conditions'resulting "from such usage Approval of the separate. saws rag it. . hall become null and void as so s a p kp no y available' and the approval of the private water supply shall 11 d Jvoid .wh a public a er s ly bec m s avail e���, 'ch subject;to modification. or change when in the )udgment'of th Co �tiioner of Ith,. WC ocat , mo rf ton 'or .c t� e L)I..Ec Date v' By T It le BCTEMA PERML. (Agor'plate count, at 35 C). COLIFP RM GROUP (Most probable No, /l 00ifi1.)l Ae - HARDNESS TOTAL ppm DETERGENTS - 01*1 ,NITRATES ,(as N) ppin IRON, TOTAL - pprn.., WELL COMPLETIO',y REPORT 3/71 PUTNAM COUNTY DEPARTEiENT OF HEALTH Division of Environmental Hoalth Sorvicos COUNTY OFFICE 13UILDING - CARMEL, NEW YORK report is to -;-olited to County Health Department together with laboratory report of This repo, .,be completed by vv.dl.drilfi�.r.a.nd $W. y ts a M e at nglo6t& i� bf,S5r10bCtd(�'ITb rivi er I F��l �, ieFsa 6,1 -rl' �,Vl aii 1-6 ii f& if atedf c6n llahc:6 is ISSU'dd. I REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION I OWNER E ADDRESS LOCATION OF WELL 11�V(No. d :'Hoof) (Town) (Lot Number) A J17 PROPOSED USE OF WELL BUS:NESS ell/ DOMESTIC ESTABLISHMENT ❑ FARM TEST WELL PUBLIC AIR THER SUPPLY INDUSTRIAL ❑ CONDITIONING (S (Specify) DRILLING !EQUIPMENT COMPRESSED F—] CABLE OTHER [:1 ROTARY AIR PERCUSSION ❑ PERCUSSION ❑ (Specify) CASING DETAILS LENGTH I DIAMETER(Inches) WEIGHT PER FOOT DRIVE SHOE T, FZ71 ❑f711 11 / j' L2J THREADED El WELDED 111YES ONO HOURS G.P.M. FIBAILED ❑ PUMPED COMPRESSED AIR' WAS CASING GROUTED? K] YES NO YIELD TEST I YIELD (G.P.M.) WATER -LEVEL I MEASURE FROM LAND SURFACE —STATIC (Specify-feelf) DURING YIELD TEST (feel) I !:fi Depth of Completed Well In feet below Land surface: SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (feel) SLOT SIZE =ETER (Inches) )F GRAVEL . 9 Diameter of well including including gravel pack (inches). GRAVEL SIZE (inches), FROM (feet) TO (feet) 1 DEPTH FROM LAND SURFACE 'T FORMATION DESCRIPTION Sketch location of well with distances, to at least two exact location landmarks. FEET to rIET If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL CO PLETE �D _J_ I ) DATE OF REPORT WELL DRILLER (Sig nature)—, I' � _W_- �OUT/V44i ( mer.nr Purchaser of Building Municipality , -i%*st Td:.;v ' -: ,,.- ...:f -..:. ^F. "io:Rt- $%..�:.q ti.'i„�' .+e. ...:'p.: '.F .s:et —_ ...4e`�' w.IL./g;� � �° �,,r ','- :r..:i','A. '..bs 'L-ae�.. ;C. t �3.:• . i Building Constructed By' Section –Ward Location – Street Block ,'0lsEd ' >.... Building ��pe Lot GUARANTY OF SEPARATE SEWAGE SYSTEM. I represent that I am wholly and completely responsible for the locations wor}ananship, materials construction and drainage of the sewage disposal system servi.ng,,:thP above described propertys,and that it has been constructed as shown on thoO pproved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the ' - PITNAM;.,: County Department of Health, - and hereby guaranty to the owners his successors,. heirs or assigns, to place in good. operating condition any part of said system constructed by me which fails to oDerate:wfor a period of two.years immediately following the date of completion of the sewage disposal system or any repairs made by me to.such system, except where the f -47ure to operate properly is caused by the willful or negligent act of the occu�art of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the :Director of the Division of Environmental Health Services of the:,PF. '. 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. Dated this ay of owle- 19 7. Signatur tJ at TO n� ��`PJ'. Al � Z`itl S � �S��o � u�°� >' ,e•.�'Taw Place & State f corporation, give name and address) -- – – – – – – – – – – – – – – – – – – – – - – – – — – – – – – – – – – – – - – FIVE. (5) COPIES ARE REQUIRED WITH FIVE (5) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WII,L BE ISSUED. GUARANTOR IS REWIRED TO FILE NOTICE OF DA TE OF FIRST USE OF SYS MI - - – – Division of Environmental Health Services, 'PU`fNkM ,..3: County Department of Health Form S.D. 50 '' January 1, 1960 (1971) T PUTNAM NCO J' TYu DEPARTMENT AFB HEAL'TH< a s f 3 s 3y r of Enwi6nmen611 Health Services Ca"rme/ N Y '10512 CONSTRUCTION PERMIT F. R SEWAGE'`'DISPOSA'L SYSTEM' = ►yq�j�LL.E}� - { y Town or :Village Y 1 5 Subdrvlsion Y /i Lot Job 6- ;V .Y.O/S7/C Q x Address �� /�`liQ/L/T!C''- O�f'/� �Ti9?7an/r �Q - Bulldin �T e 9 Yp i Number ;of Bedrooms4 # �` ITOtal Habitable Space Square Feet crate ;Sewerage System to�c%ons�st of jZoa ;•Gal Septic Tank 3 6 `lineal feet X 3� width trench T.o Address � 4 s r water Supply " <Public-:Supply From = '_` "'zPrrvate �SUppIyYO berydrllletl by'''' aE /�/✓i�%��/�� '.:7`7�✓ Y�'.�+L D/��/�:p r Addres'S', 1��/� �4.!`/Q S'a'i �QCSTI✓�4� -, �i2G[�i?� 'Requirements F r �.l represent that I am wholly and;complet ly responsible for . t`he design and IocaUon of, the ,proposed systems) - 1){ that t - -a - of isposbl.�system,`.� ;above - describ9 will be constructetl'as shown on the:;approve l amendment there to and An-.a ccordance with then andards,- eta y e;�gg he," u nam'; 9 - y - -.De artment ofMHealth °and that'on completion thereof a ,.Certificate of Construction Compliance 'satisfac to3'h91 -m iS6r ealthwil6 Count p , be submitted to the Department f and ta. ;written:fguaranfee will tie furnished the owner his successors heirs or ass' `s y n tin at iltlerswllf ' place in :good operating .condition an y ,part of said sewage disposal system durm the e`r,iod of two 2 { r 9, p ( )years! @da�e ,oil Inge a e the.iissu'-;" _once of the approval of ^the Certificateof Construct ion`"Gompliance of<tKe original system orany'ceparrs theret ;'2� 1hat" I. de " i d above wile be located as`shown >on the a'"` pproved plan and That said well will be installed �n accordance:.with the standards u and iit 4tl f Putnam a s County Deepper /a}rtment,Qof - 111 ..• .I n Y S i9ned� ,° Address sei0 [� APPROVED FOR: CONSTRUCTION This approval expire "s' -one year from he date.: sni6d' unless constru_Ctiori of then �{igCFipp(j�gb+��' taken aril " : i- s ' 4 !evocable- -for ,cause or may be amended or modified`when cons�dered.necessa by';tne di elth Any,cha „ of 'construction. i requires a new permd Approve' for s osal fe domestic sa e' a and - a r °s nly• v ` Date t BY - - ' - - 1 - - � _ Y Title _ _ vrz� 7Y7 m . ..`0 ��. • .pe<. Yi... . • "s -�.., .i:. m.s. . ;.r ,.- �pt9TMAM `COUNTY .DI=PAPTM NT _'_O� AE "LTA#-, �:,.. d...f' .1. "t•G�:�i �h -.G -. I•-e . -i c.. DIVISION OF ENVIRONMENTAL HEALTH SERVICES DATES RE: PROPERTY OF U' SAO'L" o LOCATED AT SECT.ION 0619 BLOCK p1:7 LOT GENTLEMEN: THIS LETTER IS TO AUTHORIZE A DULY LICENSED PROFESSIONAL ENGINEER Z OR REGISTERED ARCHITECT (INOIC ATE ) TO APPLY FOR A CONSTRUCTION PERMIT FOR A SEPARATE SEWERAGE SYSTEM; TO SERVE THE ABOVE NOTED PROPERTY IN ACCORDANCE WITH THE STANCARDS, RULES OR REGULATIONS AS PROMULGATED BY THE COMMISSIONER OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH, AND TO SIGN ALL NECESSARY- PAPERS ON MY BEHALF IN CONNECTION WITH THIS MATTER AND TO SUPERVISE THE CONSTRUCTION OF SAID SYSTEM OR SYSTEMS IN CONFORMITY WITH THE PROVISIONS OF ARTICLE 145 OR I fD.UC'A.T'_LON..L.AiF;', -THE - PU'SL IC - HE'ALTk .1AW, AND THE PUTHAM COU,NVY: SA.N i TARY CODE. COUNTERSIGNED: VERY TRULY YOURS, SIGNED OWNER OF IrROOCIRTY A D D sRR El�S �� 6L�y P. E., 194WO &Gt � TELEPHONE ADDRESS 2070 -IA"c4/ /1%� /��� .�4 SEAL �.. TELEPHONE ;''` • '`r�'''`�` "�.� k',��'�" T !COUNTY OF '; ;.U- ,Tk-AM :..: DEPARTMENT OF HEALTH - Division .of .Environmental Health Services ` r '. DESIGN DATA SHEET' - SEP_ARATE; SEWgERAGE SYSTEM 1+ILE. NO s ;�dY rA � la.' •'.'Q�.- '4. rSJ � .. ♦ :r+.. �+.. /'^ Y+ u Q'n! v T F iiF: C ���. � .",.xii i' ^..`wi � �+�.o.r�i;ts ..2+' 'a•�'.+n T1"7' a 7_ ,.. ;,., :, Owner iG/L "C1 A /0/�TP. yddre s a .SCf .94. r cif' !! „Located .At ' (Street) a9Ad�l"6d 16 Sec. 4 &6 Block 43 Lot (Indicate nearest cross street)., 'j Muaicipality .wT�1//�/n l/AGGi Watershed SOII. PERCOLATION.TEST'DATA;REQUYRED TO BE SUBMITTED WITH APPLICATION,. jr r Hole - Number' : CLOCK TIte PERCOLATION ' PERCOLATION .` =.:': 'Run'. '::Elapse:;: 'Depth to Water Water Level ' �::;;;:::•: 'No.''• '•: :'Time " From Ground Surface in Inches 'Soil Rate', ' 'Start Stop ' :' ..Mia.' 'Start . ... Stop.. Drop in 'Min /in.drop 1Inchea. Inches Inches 1 .. ' /O >'�� ' LO..:'"'•.SS 1 ?p' `' ' '' Z/ 3��c Y / �'� ' f''�.Pj' %yJ.�t! .3 1 5 ' �.. ..- r:.• °_.,Z .1 -- f�• -!' 1��:��� -°1 _ .�� ° __��T'' - � _ .G-�. !_`�� 1 - /,/ -'�- 1 •- ��J.'f- /.��J1i.. ! !I 1 .S 1 i 1 i i , 1• 'all; a' Z a ''�a� I r . 1 '4' 1 1 1 Ir•+ tl �r�l ,� 1 1 f 1 5 1, 1 ... 6: 1f � Notes Tests:to be repeated at same depth1until'.approximately equal soil rates are: obtained at each percolation test h'ole..i "'All data to bt submitted:for review. 2) .:'Depth measurements, to be made . from top of hole. TEST PIT TO B �U"3`'fITTED WITH APPLICATION lD. +ITAri tRtEQfUlIRE.D^ tii+'•.. '" .y: .+i - r ".As- ,,,r •..�. f- ..:.0„!Z .l•.p 6,.7 V�i :'•,el .b ' eYi.Es i/� ,7:.L".:'64i:D' ;ea;..�ri Z:aSrs l�= 11T..:':g�7'.. .-._ .. _.., • ;•� a� .'e DrPTId !: BOLE NO. ® �iCbLE NO .OLE NO. HOLB .2:0. G.L. + 18AA . " ✓� W . ;42is r+ 4811 c� 60#' . ':. _ T Ct C��►Y add. ;(` 6611, w ' 72" 78" h 84'x` — — --r-°. INDICATE LEVEL AT WHICH GROUND WA1ER. 'IS ENCOUNTERED". ;.I23DICATL LEVEL FOR WHICH j TER I:EVEL ISES AFTER IIEZtr'C ENCOUh 3.ti:?D TESTS MADE BY' DATE ©C77 6 „ 1427 • - DESIGN ...... ..... �.... Soil Rate Used Min /1" Drop:. S.T1. -Usable Area "Provided��o .S <� No of Bedrooma_Septic Tank Capacity /��� Gals. Aiaaonry�al '"Absorption Area Provided By ,e96_^ L.F.x24" 36" width -rencn. 0t?, w _-. Signature Addr sAs Za7o 3A6✓ yi.� %E.e SEAS e+ eE OF Nc� �;t F �,— i ± c? .�L......��a> .. .. " f � ; ,_QUTNAM;. County Health Department.. • ;. y X01, .; .:: ., � ,.,,.Soil hate Approved -7Sy,.Ft. /Gal'. -Checked by 40 ��s / °N M cli WELL � I 46:90' 49.10' ®. 46.82' l 49.19' k P Mi.'.. is ti / V w ro / \ �� � / �qr✓ FG -� iN� � , i� / r .564.58' TO THE NORTHERLY SIDE M Of FINNERTY ROAD. -70 Z x:65 • Sy - -A 4 1T °3o',15 -- ARDINEER SUBDIVISION MAP KNOWN AS °TNE BRING FARM MAP No51319 TOWN TAX DESIGNATION:::, SECTION : 068