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HomeMy WebLinkAbout4547DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.05 -1 -28 BOX 34 '1 or v f .. Is Ir Is br t.-4 I 's 1�6 #'11 I 1 to fi ME -is Ilk _� 04547 WELL 66MPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report is to be om eted by. well driller,ano submitted. to.,County,Fleali i:D!apattple t b weth lalioratocy report of:: r ... -, r .. ... - °ter 7 a...c.. - "� analy"sis`o water simple indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION NAME` ADDRESS OWNER LOCATION (No. 6 Street) (Town) (Lot Number) OF WELL z... 9 ❑ BUSINESS ❑ ❑ PROPOSED DOMESTIC ESTABLISHMENT FA TEST WELL USE OF WELL ❑ ❑ SUPPLY INDUSTRIAL ❑ CONDITIONING ❑ (specify) DRILLING ❑ ❑ COMPRESSED CABLE EQUIPMENT ROTARY AIR PERCUSSION ❑ PERCUSSION ❑ ((SSpe ify) CASING LENGTH (teat) f DIAMETER(Inches) WEIGHT PER FOOT ®THREADED ❑WELDED DRIVE SHOE ❑NO [� CASING U DETAILS �', 16 YES X�)YES NO YIELD 11 E] ET HOURS G.P.M. '7 YIELD (G.P.M.) TEST BAILED PUMPED COMPRESSED AIR WATER MEASURE FROM LAND SURFACE— STATIC(Spec //y feet) DURING YIELD TEST fleet) Depth of Completed Well LEVEL in feet below land surface: /70 MAKE ILENGTH OPEN TO AQUIFER (test) SCREEN DETAILS DEPTH FROM LAND SURFACE FEET to FEETT� j . / /'0 IF GRAVEL Diameter of well including PACKED: gravgI pack (inches): FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. If yield was tested at different depths during drilling, list below p FEET I GALLONS PER MINUTE —tN DATE WELL COMPL ED DATE OF REPORT JWEL5DRILLER ignat re) .a e:: 7 -• •s.. -• �, - � v'.. Aru_s _ pya. s t i ^4.a..... : M+u. �•��.r.�..r r s`.� <r •'.�., ` "; ,G.. u• •a,vT N'. t'f Owner or PurcRa.ser oT Building Municipality.. August Damelio Map 1319 Building :Constructed by Section Gardiner Road Location - Street Brock Raised Ranch 5 Building Type 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 r.. 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 me 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 aat of the occu- pant of the building utilizing the system; The undersigned further agrees to accept a•s3 conclusive the de- termination of the Director of the Division of Environmental` Health Ser- G.oun.ty:.D.eps.r. tmsent . of Health .as to whet:ner;:er 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 12- day of Fasp,4147-7 19'7) Signature Title U 1— 13iill;7iCs U ;V rl tw If corporation, 'gi.v e n Lme �and address) / - - - - - - - - - - - - - - - - - - - - - - -1 - - - 4) 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 .0 Y >T� Mil - 1 _PUTNAM COUN7'y DEPARTME NT OF' HEALTH DIVISION OF iNVTRONMENTAL HEALTH SERVICES , - Date an 1976.• January Re : Property of August Damelio Located at Gardineer Road Putnam Valley Map Sec tion Bloc k o —�Lot �Sr Gentlemen:' This Iloha. S.: letter is. to authorize Romeo a duly licensed professional engineer x 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 ,. 1-7 0rstl N( F l(IT o ,'r) 1-hj c MA7 ,*e�r` wm i-n q1lnprVi eP -rhp nnnsrritf . - , IlT CSll system.or systems in conformity with the provisions of Article.145 or 147, Education Law, the Public Health Law, and the Putnam. County Sani- .Y. Lary Code. � = .. _ _ _ •. _ _ _ ._ `� Very truly. yours, Signed ner of Property. . Countersigned: .- r - G P . E . , XXXAX� # 027546 1 'Northridge Road Telephone Address PekSkill­ ...,.Na;..10566..., o-a. ; s ©�U_ENunrf� g 737 — 1056. =0; e Telephone 9 x 278,';b 1' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA STET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE. NO. Owner August.Damelio Address Finnerty Road, Putnam Valley, N.Y. 10579 Located at ( Street 4Gdicate ardineer Road Sec . P4ap 1319Block �' Lot 5 nearest cross street) Municipality Putnam Valley (T) Watershed Peekskill SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole 1 Number CLOCK TIME PERCOLATION 2 PERCOLATION Run apse Dep o Water Water ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches (1) 1 .4 :17 4:45 28 24.5 . 27.5 3.00 - 9.33 2 4:50 5:20. 30 22.75 25.50 2,75 10.91 3 5 1 2 3 5 Notes: 1) Tuts to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. 2 HOLE NO. 3 0j O �a3S ©i ,.- f' 611 Topsoil Topsoil. Topsoil 12" 18" 24" 30" 3611 4211 48 5411 60" 66" 7211 brownish, loam with some stores brownish loam with some stones brownish loam with ,some. stones.. 7S" 84 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED Non® INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED ` TESTS MADE BY John S. Romeo Date January 13y 1976: _ . -DE 3GN Soil Rate Used.I7-I5 Min/1' Drop: - S D. Usable Area. 000 S, + No. of Bedrooms _T Septic Tank Capacity lOQO Gals 6 R ° 'y Absorption Area Provided By -__'AO L.F.x24 j Address 1 Northridge Road Q SEAL % t���� � 0. THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date f . Z , N{ - '+. I + L � 1 " i " , r, } � i � ?�' ' e s(¢Jt � a °J+/.`. %p, ` y'��/,1!•iA/ i�'.Ti� 4 r �[ r: �r aE ,t s r: Ut �tiAtr lac ^rr•, s • 1 15 �(( t. ,L4'Zi•C�.pI 2 t 5Y 21W. Y5 i. 5. SEPTiC SYSTEPq ar' 3: & SURERYIS @D BX.. da, 'Q{} iW,'' FOR mvisnN IE T ASIOtr Of `;4.`• EN AIJH EfHXllfit - -. 41 l HE t - R. OMEC7 ROMA 'L • _:AM ' t�IE L1 ICO- OILS RA` it Lei:[/Si' � ,'.. s_: ": • -_. w GAL TAN Hr F NORTHRIDGE ROAD e. i� w s.x - T WN OF S?UTlJA1JI ,NLL�! 9 h s O V &� W``dF11Ri'«.4 1 F 36 Tt2EfVCHE'a CIiZ A�lCY1= COUN7S='i PEEK'SKILL: N Y eR.oQa ; ORICa1NAL J A'N J!� i s 7. 33 ,'T6 NEW YORK i `rit7 y,•