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HomeMy WebLinkAbout4655DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.13 -1 -46 BOX 35 04655 �C �. , • z t ) PUTNAM COU D ivision of Enwrornri t1G 7;, I Q, " , ^1;t °A , AAIC —.7 .�� 4 c LOCated':at 'Owner 1 ` Separate Sewerage System built Consisting of �tda Gal: ' ep W-Tank' s e__ er requirements; Water SuPPIy }'' y. Public ;Supply From j Private Supply-. ey '' Address ^ Building Type Has Erosion Control Bee "n�Completed7 x t ®g: Y � I certify that the systems) as listed serving`ttk above premi attachedj, and In accoriiance with the standards;.rrules an eyu ,,. Date c ' Address O p� �^!1T•M1 y4 { t +t { R y DEPARTMENT OF :HEALTH ' lealth ,Sere Garmel, {N Y `,10512 VV ir"�� ,[. ^�? Al. � fs� .Town or• Villaga. available and .the' approval of the private water supply shall become null and r,subject to modification, or change when in the .judgment of the Commissil Date �_ B 19eeg6n Block { l-ot. AddresstJiN width trench -Date Permit Issued ntial a hown on plans of the complet work (copies; of Which, are an th ` "ermit is d by' th'e'.1 `Putnam" nty,.Depar'tment of :Health.' w, iPit RA such action as maybe necessary tosecure the correction of any unsanitary shall become null an „ of as soon as a, public sanitary,'sewer becomes. ,when a:pubUc wat sup Y becomes available s. Such 'approvals •are HealtW,Vsuch re ratio modification .or change As necessary Title J- z -A V :j 'o W-MEDICIDAL 0 RATURY I N`C.-, 210;3 y P 10 .In E -203 r; ',�— I DATE COLLECTED LECTED' RM AM-INAT-JON.: 5ULTS* OF WATER OWNER DATE RECEIVED 'r, g —R JOT 'nk • CITY, - �VILLAGE` ITOWN -'&/O5�-.,V-AM8- 77 DATE M "A A AIS46- ',PE,. SA RI E., (A4 3 59,C). T- 'A ZOLIF GROUP 0 0 hiii' ��,ORM., TiAHONES&�TOTAL l'zlpp- -OW6' DETERGENTS ppm NITRATES ,,(ds� 4 ;FI:OUR'IDE;(-F) A P v* These results -Indk:ate-t `the, U�ULis satisfactory s Y;W when the sample , E�. S� ,v . ..... A' -H`P 1,.M,.ST.,:(ASQP)!, ' 4 APPROVED aZ�S ��IQV 1971 BYn vo Df Hfmlr, DIVISION Of [NVIRON AL HE�11TH SEHVICCS Owner or Purchaser of Building Municipa ity Building Constructed by Location - Street /� ?e ° -S1�ec ;V," r®'-1 e, Building Type 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 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 act of the occu- pant of -the building utilizing the system. The undersigned further agrees to accept as conclusive the de- termination of the Director of the Division of Environmental Health Ser- v ..the.- Putnam - County - Department of Healah::as. -to awh th rQa.r n;t the, ,�: "`� r "'ilure "o'" the sysaein t'o ' operate was caused by the willful or negligent act of the occupant of the building utilizing the system. , Dated this Vo day of 19 Signature Title If corporation; give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP1,ETION 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 1Y G J. L iQVG Vi V� , tl 111G1�V Vi .IV9 YY gJ e .. yy.. Y ®O reSa� ,►;'� IJWWjij��Pi•jL,�• Depth of tvell� Sa,�Diameter �� fielder as we. is ected gpm® yes or no Ante of casing above ground- /t •. Below ground. c-26' . Well seal i ice packer, cement grout Draw a well diagram in the space provided belo� and show the depth of (casing, the well seal,,'kind and thickness of ;formations penetrated.,•water bearing formations, diameter o fz, driil holes with dotted lines and casing s) with solid lineso , WELL DIAGRAM FORMATIONS PENETRATED.:`~' REMARKS i Diameter ' .n, Depth Kind; thickness and Type of well in ft. if water bearing Drilling method . -..... _G has 'well dynamited. 25D L% PUMPING TESTS Details #1 #2 T #3 i Static water I }- _ .... level 9 in ft. , S I 50 below grade Pumping rate _ I in ona - g p i 75 Pumping level in I 1 ft o_!_below _grade Duration of : j 100 test9 in hrs. , ,�_ .. e�..'_.w�,.. .�y. ,pt>cn�•."'FF' -. •.:a.o- ... ...o.�•ay,,,,v• -v- ;_; _—� _.._ `_- ..fEE�+-oa- .�_..,..vro -�. � ._ 11 E1V�O1 . a.. Cleo Cloudy Turbid j 150 Recommended depth of pump in t well, feet below grade WELLS IN SAND & GRAVEL:. i I 200 Sand -Eff. o : size nm ' Unif © Coef. o Length of screen ft. i Diama.of screen ino 250 Type of screen Screen openings x tt + COMMENTS i i Drps a sketch of the property on the ba k of this sheet Drilling started Completed .5 'lo in he well and sewage di,josal systems. Well Drlle -,� "Signature f 1 1 ♦�' a ! 4 .`. {, , ' _'; � . 3 as PUTNAM COUNT, . Drvrsroir of Envr.'onmenta CONS'TRUC,TION, PERMIT- F:OR SEW4dE-DISPOSAL SY r t d .8uildmg `Type Lot Area ,Number. of Bedrooms �►wv r f5'eparate Sewerage Systeni-to consist ofh r• r {° To rbe constructed by iy.l.P�GAEi�.f + 5 Water Supply Public Supply From F ^a tPnvate a'5upply to ybe drilled by , e 1 Address Pv �NQ M 4 Y Other.:Requ; rhents } IO (:represent that l am,wholly and completely r�Fi n '`' above described will be constructed -ae show' a Gounty,Department of.- Health,. and tha I 'o a -. e be submitted'to Y ,C Department and a en' I b :•,place in good .:gperating condition ,any` rt f 'sa osal ;ance: "of the approval of the Certificate; nst n& will be located as shown on;the approved n a d-t II be a County Department of Health ji Date ` SEPT, 49 ;p0 Np. 32 O Address d " NE � t x'. "APPROVED FOR..CONSTRUCTION This;approval.ex a year' _. revoca ,l -forrcause.or may be amended-.6i-modified when conside ;'requires new 'per it ,- Approved Jai disposal of domestics r„y D ate .9'p ey ' DEPART M'ENTOF HEALTH Health Services :Caeme% N. Y 6512: Py.rv,4, -i YA-.c GEy Town or village - .14,QT of 74XN,4v+' /2 a -ate! Section dock p-.;. *,� ,:,,.ro m'*r[a •�• r �� nom" v� �-�,." u i ,•. •.c + .. ..L. " ' ' , ,,,yam' Job Address Total Habitable S' e Square Feet alp' Septic Tank �' ` 3 � -•- lineal feet.�XL/ - ' �� y wid�t /h trench r ` Address _,Bo�C 22` os/!r ✓� �E7�'. /1% �Y a' -A OE�Q Sod% 4LLE✓,r.W , �� y location of ,the proposed- system(s); .1)'.that the .separate ,sewage disposal ,system " a here to and in accordance with the standards, rules an regulations o e u nam to atisfa of Construction Compliance' satisfactory to the Commissioner of Healthwill �i ed the owner his "successor's heirs or"assigns: by,the''builder, that'said builder will m during,''the- period of_two"(2), 'gears immediate ly following the date. of the. issu- he•or ah`system or any-rep-_ i ars thereto;2)`that the drilled well described above nst ed i ccordance. with the` st ndards rules and regulations of , the 'Putnam. P., E. - R.A. A'CK 'License. No. yqm the date _issued unless constructions of the building "" has been 'untlertaken and is cessary by the Commissioner ' -of H ealth Any 'change or - ,alteration of construction sewage pr water supply only ff Title PUTNAM COUNTY .DEPARTMENT OF :HEALTH !z ao DIVISION OF ENVIRONMENTAL HEALTH; SERVICES s-% '•�DRSTGN -DATA *SHEET .SEPARATE, SEWAGE.DISPOSAL SYSTEM FILE NO._ -- Owner .. o�3E,�T ✓R /SL:E,�.. Address �x 22G aS.�ir�6 Da ` f'aRr Tq .122-1) Located at (Street Sec. Block 7` �ieh rn. rev -'07 -/ Lot (Indicate nearest street) Municipality vEWA) D,-- Watershed E4, SOIL PERCOLATION TEST DATA REQUIRED.TO BE SUBMITTED WITH APPLICATION . 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 4 5 2 1z !z ao 3 s-% 3 a;¢4 1,•dy /d'' /7¢ mod¢ 3 �.p , 4' 5 2 3 Notes 1) Tests to be repeated at same, depth until ;approximately equal soil rates are ob- . tained at each percolation test_ h6le .''.:A' � data to ,be submitted for review. 2). Depth measurements to be made from top of hole. .> 42 TT 48 TT 5 4TT 6 OTT 66" y.. . 72TT 8411 w . INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED WO -rc9 -, INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Anl06le- Date 9 17 7" _ DESIGN o ��- Soil Rate Used ©- Min/1" Drop: S.D. Usable Area Provided croi No. of Bedrooms 4- Septic Tank Capacity Gals. Type Sd,26e Absorption Area 'Provided By �2 36 L. F.x2,4T1 - 3 TT width trench. Other Name STANLEY J. LANDER fE�10 Address BOX -267 ARdAWALK?' o If A tea: ir. PUTNAM COUNTY DEPARTMENT OF HEALTH "' ' ®® Soil Rate Approved Sq. Ft . /Gal. �' y Date_ __ TEST PIT DATA REQUIRED 10 BE SUBMITTED WITH APPLICATION a .; ,y ,1rw:C� ':2°S 1w12r DESCRIPTION OF SOILS ENCOUNTERED- IN.T&ST_HOLE ------ ....lY `�.3'?'.V•r.ay._....a. -._.. v..u.0 l.. .. � 6 ;,asI.'�.__N s ":J . .�a -' Tom. __r, � �y°j 't@L1 '-` V-u Yk'1' ro. V�� +PAT'i F.. DEPTH HOLE NO. ° :.:.HOLE NO. HOLE . NO . G.L. BPS ° /crams ° /c'spr� 6TT 12T' � �� �� a7 n 744 c �Ja,�� , Ra c� 24" N A 3 OTT y b y 36TT _ q 42 TT 48 TT 5 4TT 6 OTT 66" y.. . 72TT 8411 w . INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED WO -rc9 -, INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Anl06le- Date 9 17 7" _ DESIGN o ��- Soil Rate Used ©- Min/1" Drop: S.D. Usable Area Provided croi No. of Bedrooms 4- Septic Tank Capacity Gals. Type Sd,26e Absorption Area 'Provided By �2 36 L. F.x2,4T1 - 3 TT width trench. Other Name STANLEY J. LANDER fE�10 Address BOX -267 ARdAWALK?' o If A tea: ir. PUTNAM COUNTY DEPARTMENT OF HEALTH "' ' ®® Soil Rate Approved Sq. Ft . /Gal. �' y Date_ __ .v /� (sU.NNER H SARK '• . t e: (589 °0OW C— /x.00' • 'y' 4.3 944 ' °R��1/ /sue✓ Sh�OrViV HEREON "B� /NG GOre AS SHOWN ON /�Y/P401/EiY/EN% CLAN FOR "RUSj" /G YALE 1910A,51 PVTNA/Y/ LOUrVJ'y OG�RKS OFF /O� oN �/U�y /7 p Q O o sU�41/�J' O/4 P�40Pzti'T-1l' ,siTVArE 11V Y it PZ,)7 q1)- -1 CoUrVT11' 0- O2j �: /50 00' NEW YORK c5�-L / i '% 28, /970 X75 58 50 rT ••Ni.r:er::`Y�r. -.Tt.+ -'t u aY ?rtt: - -ti* 1 t •s '.- t, i rI, e: - ?I :i Ott t, !� .. ,.. e t _u : .,,n:al.r.r ..•t.! Sha Si erl. 7 .f .r.:d SURVEYED & PREPARED BY . -, ;]3dn at Frac'.ICC 1c, istid !sycl 0: to -. r,.. ; n e4;o;!• t, : +;ir t -- •a:: 'n c ;n.`. Suss P.,`::rtoP' e!i by Ne Ne =.w York State 1 ?} BUNNEY ASSOCIATES Esc - +xtt� a t u•,;�s ........� ENGINEERS &'SURVEYORS :l .20 WOODSBRIDGE ROAD KATONAH. NEW YORK 10536 bf �t���� SUR!/EY.EO� FOR ROBERT Tf7 /SSLER ?�' '— SURVEYED AS IN POSSESSION FILE No. d: 'f qt y. r S!• (a ' . -gU s t1T+d cars iyt,.Q�l",:' ,01 C: Dili sing at, ra ,r P k ��, k `3i" .g ..+ 4 J a�•,,; A x+{ Nn �+ ,�s�' Posy f` th�y 'Y`4il#yyL,,'�i '�fry.fJ&}�� i.P {. a ytd� ,,,vn�""g4 �A7• '"� .','�h�dat ti�'T3rar�.' *. ")%t'c..t.,.'�%gF 'uy� s ``` 44�}. a 'io�21S�'nk51{45d$.�'b�' @� »l +� E� i x..4r Z + }.c � t .+��5$� wa�ar -tight and rc>Qt ,p f: 9 Provide 4" approved non me i pipe or egrya'i to junction, box 1 slopes as .required`t'o meet `fiy S conditions. 4. Absorption fields shall col of 1+0 open joint or perforate( bituminous impregnated fiber ! laid on a' grade of 1/16" per ; r wasEied grabel.or crushed stop, \� ur_Lfbrm. size. (3/4 "' to 2 11211) • �c ! shall be laid in 13!' of stone that its invert shall be 6" f: o0 4.�gu. bottom of the trench. cover 1?' - as ry gravel shall be 5" minimum to maximum.: The minimum cover s! used` wherever possible. j h 5 Dd:�sposal.'fields ;shall be 3! ! and of the length. shown on'th• i 6. For details of septic tank �+ distribution box and junction see County Standards. .� f( A 7• Al .1 trees in field area an within 10' thereof shall be r 8. -During any construction, k j� �tl ro heavy Toads off field area. g. Leader and footing drains 1 + foil discharge-away from septic fi l b 261 1, F .. t9r1 N 0O � f t OCT 7 1970 r✓ C ' OF DI ? R. TH: SEF�� ffJjy1R0NMEMAL H ' %s'S Y?,::+r; P.:+.1G.c. «.?/�' . / /I•' liC 'T� Y1 / 'y > J '�.'' r C'.'J r.�tJ 1 54v7ME�lT �J� - ! 1 C re' ",,.'� �E �Y: .9 � 1r� +�LY�'. u�3'YJ±/ :,''1✓ 'max 7 '5�7. X ' - , OF HEM �� • -.. .'F� ` ✓5 k '6'.. CV,^•`}'T.'.. --' �fi°id. ^� ���:'r'+`�r�':� f� tw•.. .a >