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HomeMy WebLinkAbout4658DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 85.13 -1-49 BOX 35 NOON - T • ' ON }� r - , ,t, NO NO IN '', L - • ' 8 ' '- PUTNAM ^COUNTY ?DEPARTMENT OF' "HEALTH ;.. r = Division .of Environmental Health Services; Carmel N Y, 1.05'12 j m-ft i -�F -Go del ¢t1j�°��tDE'�i r i,ovif��l�►i E FOR •-SE61iAGE.- DIoPd�4� S��ir� °,� j G�ws�� '�'r'.�:°'��i/�l �Gd"0 y r • z -� a � 'Town or Village . iaxl"%R, Located at �"L�'s�iiJ v //!'I /'T!/ �i�.d'✓ f 2 //yy r IOCk G, Lot JoG Separate sewerage system - built. by "l`SSL Address'�T'4� i >r -T7 Consisting of .Gal: septic`° Tank ''�ry lineal Feet :X width trench Other, requirements Water Supply: /Public Supply From Private •Supply, Drilletl By Address g Building Type,..������ /fG , No of Bedrooms Has Erosion Control Been Completed? ESSIO 1-certify that the system(') as listed serving the above pram' struct attached) and,;in accordance,with the stand`a'r`ds;'.rules'a' V Date r 7".'/ Cer J '.'Address A. L i4ny' person occupying preniises-served'by the above syste <� p rrip I � i conditions resulting from such usage. Approval of 'the. shown on permit isa available and the approval of the private; water .supply shall b, a tTilA vi hen a F subject tolmodification ,or change when,` Jn �the';`judgment oft Rai Health I Date Permit 'Issued - plans or he completed work (copies of ,which are by, -. t Putnam County Department of Health:. License No s1may be-necessary to secure'the correction of any unsanitary e. null and void. is soon as a public. sanitary sewer'becomes lic ,water sup becomes available. Sucn approvals are ch "revoca ' n, tlifica'Jon or •change is necessary. Title # 1719 VORKrOWM MEDICAL LABORATORY INC. P e Box -99 321, Kear Street Y Oa ktow n He I�hLs, N;Y. e059& - - . 245-32 03 DATE COLLECTED RESULTS OF EXAMINATION OF WATER OWNER DATE RECEIVED ROBERT J. TRISSLER 12/20/74 CITY, VILLAGE,.TOWN & /OR NAME OF SUPPLY DATE REPORTED STEPHEN SMITH DRIVE, PUTNAM VALLEY., N.Y. 1V;/ /74' $'AMPLING POINT _ ..W BACTERIA PER ML. (Agar plate count at '350 C). 4 COLIFORM. GROUP .(Most probable N6. /100ml.) LESS THAN 2.2 A9159ES -' ppm 6.0 GRAINS PER GAL. MED.HAR: DETERGENTS - ppm NITRATES (as N) -:ppm IRON, TOTAL - ppm. FLOURIDE (F) - mg. /1. 'These results - indicate that the water was c` of a satisfactory sanitary quality when the sample was c ed. A. H. P.ADOVANI, M. T. ( SC ) D.G. WF,LL COMPLETION REPORT 3/71 PUTNAM COUNTY, DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report is to be completed by well driller and submitted to County Health Department together with laboratory report of _ ,• :-:• �:.=::: �:' iildl5ly�ls' Gf:' 1qf. 9tQ" iSa ;A?C3ip`OY2CiEus'6F'�§•W�'ec^r is 'rf= satisfactory'iiJC"�eerial �juaiet��efbre•ceriifi� ate of-bor tit•ucYion'c�►i�pj`r�rl�e`�s "issued: RfPQRT MUST BE SUBMITTED' WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME Builder - Robert Trissler ADDRESS LOCATION OF WELL (No. 3 Sheet) (Town) (lot Number) Putnam Valley, N.Y. 10 PROPOSED USE OF WELL BUSINESS ® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL ❑ SUPPLY El INDUSTRIAL ❑ CONDITIONING ❑ ((Specify) DRILLING EQUIPMENT COMPRESSED CABLE 11 ROTARY ®A R PERCUSSION ❑ PERCUSSION OTHER F-1 (Specify) CASING DETAILS LENGTH (feet) DIAMETER (inches) 6 tt WEIGHT PER FOOT 15 ®THREADED ❑WELDED 5 YES NO CA51N YES D? U NO YIELD TEST HOURS G.P.M. ❑ BAILED ❑ PUMPED ® COMPRESSED AIR YIELD (G.P.M.) G WATER LEVEL MEASURE FROM LAND SURFACE— STATIC(Spec /fy feetJ DURING YIELD TEST (feet) Depth of Completed Well in feet below Land surface: 0 SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (loot)' SLOY SIZE DIAMETER (Inches) EIFGRAVFEL : Diameter of well including gravel pack (inches): EL 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 --vt� 461— 1 If yield was tested of different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL C MPLET D PATE OF REPORT W XLL DRILL Sign ure) U�l»tr oi� �Ibrc �)ase�).�oJ%build.ijlg t'kin.icipality 'r�°.•'•''"4"4 -�!°'�.rY,�..�.�°3' .•a� /tjJ �4'C.ti -� �• „Y3�'2�'�w:� �v:v�y;.:.:m,�. b•: �'vr•Nea %r .i!..__ar .'��: s�: '.�cK'Q .,• �a '+.,•.�,,;,'.I�.':'Q,w`, %..._.. .• � ��:: ,;,,1f�i. ;�,�. _• '., i�0 �_ • . w.rs �' .Pi'•o ' /� •' / building Constructed by a f� Location - Street o .. r as Building Type Block Lot GUARANTY OF SEPARATE SIMAGE SYSTEM I represent that I am wholly and completely responsible for the location, .00rkmanship, material, construction and .drainage of the secrage disposal sysfem serving the above described property, and that it has been 'c ons true ted as sho,,.n oil 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 op-crating. condition my part or said system constructed by me iehich fails to operate for a period of twb ,ears immediately following the date of initial use of the sewage disposal system, or iny.repairs made by me to such system, except where the failure to operate properly lti CaUbE'_U JJV LllE' willful Ur J1eg11�4t111. ac L of Che Ok iL:Upaii L ui uii: uLL11 - -J'6 -he inisi-cen The undersigned further agrees to accept as conclusive the determination �f the Director of the Division of Environmental Health Services of the Putnam County_ .) epartment- of .ricalth - as to : whether.-:'..ar- not the failure of -;the-:-.'system.-to .operate . was . !aused by the willful or negligent act of the occupant of the building utilizing the system. - )ated this day of k ° 19 Signature Title (if corporation, give name and address WREE (3) COPIES ARE REOUIRED WITH TIMEE (3) COPIES OF FINAL PLANS' BEFORE CERTIFICATE IF COMPLETION WILL BE ISSUED. UAWNTOR IS RFOUIR D TO. FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. • ° ----------------------------------- s ------------------------------------------- ivision of Environmental Health Services, Putnam. County Department of liealth • I . 4 - = PUTNAM COUNTY DEPARTMENT OF HEALTH Division of . Environmental Health Services, Carmel,,. N. ` Y. 10512 CONSTRUCTION PERMIT: FOR. 'SEWAGE DISPOSAL SYSTEM Subdivision TAr b� , Owner r� Building Type Number of Bedrooms Town or Village le-51 I �L.J_,VQ .e'.��i�' ,p••tyi}r- .t, c+f•�PTt�:S�l�':;.: �- �_+i.. g- I�iCI(..^ �`C� :...�: .:�.'G e. j8;f!�c`_'.��'..<Ol�- �` Lot / Job AdtlressPw.,'_- -2 2 j&9 Lj-» 0,6we, AL V, , � Lot Area � "71 '`,a Total Habitable Space 1106-d— 1 6S Square Feet I j �j af Separate Sewerage System � consist of 8 -Z a Gal. Septic Tank N lineal feet X S -1 width trench To be constructed by �iC f p� Address Water Supply: Public St Private S Address Other Requirements I represent that 1 am wholly and completely responsible for the above described will be constructed as shown on the approved County Department of Health, and that on completion be submitted to the Department, and a written guara place in good operating condition any part of said I ante of the approval of the Certificate of of R will be located as shown on the approved plan and that II County Department of Health. �! Date f �• "►, Address "`ter• c- APPROVED FOR CONSTRUCTION: This.approval expire revocable for cause or may be amended or modified when cor requires a ne� it. Approved ford osal of domestic Date A/��F -- By — of the proposed system(s); 1) that the separate sewage disposal_ system in accordance with the standards, rules and regulations of the Putnam struct,on Compliance" satisfactory to the Commissioner of Healthwill ,Vir, his successors, heirs or assigns by the builder, that said builder will period of two (2) years immediately following thedate of the issu- tem or any repairs thergto; 2) that the drilled well described above nce with t& standarldf, rules and regu a� oil ns of the -Putrlani the P.E. R.A. License No, unless construction of the building has been undertaken add' -Is missioner Health. Any change or alteration of con truction Title Gan , 1 e".-,, n : Re: Frope--t-- c' Asel �rzg Looated Cat Z)"ok"A MI XL E le, LANDER SIA Timis 1e e r _s o a o_ d5t, a dul, e o e s en; 0 co e c 2 s vs. 3 s S 11 T T- Z) - ", I i C jeD !.'1 1 , c ��7 E,*d,�,,.c EL t IT o r- J7. ., , J i-Z: L -1 � - - -- I , 45-he. Put,-n-ca--,r- Co---In tl-Y San i - tart' Code. .. Very You-r, 17 L 32-- ISTn 'T O-,l TC—,S Date 74� Gan , 1 e".-,, n : Re: Frope--t-- c' Asel �rzg Looated Cat Z)"ok"A MI XL E le, LANDER SIA Timis 1e e r _s o a o_ d5t, a dul, e o e s en; 0 co e c 2 s vs. 3 s S 11 T T- Z) - ", I i C jeD !.'1 1 , c ��7 E,*d,�,,.c EL t IT o r- J7. ., , J i-Z: L -1 � - - -- I , 45-he. Put,-n-ca--,r- Co---In tl-Y San i - tart' Code. .. Very You-r, 17 L 32-- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF EPMRONMENTAL HEALTH SERVICES --• � T ) ot« .i. : � t_ t.:.�o:.,;�; �•� �f..`x.•` � -alt.. ar , tav •• .r ... ��T` COUNTY OFFICE BUILDIPIG, CARPEL, N.-Y. 10512 DESIGN DATA-SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. ,/ Owner 0a g f �� >ss%. �° Address , a c ��' �/ �r�, 0x e, - / /'� _r4 Y. &fAP Located at (Street � 1wit J�vrti E�ry _ 2 2- Block .6 Z Lot �. Indicate neares cross s ree Municipalit ; • Watershed /f5�,YsWwzz h'��'•� ��Y` %l 'oo, . SOIL-PERCOLATION TEST DATA - REQUIRED TO BE SUBMITTED WITH APPLICATIONS 5 .5 2 3 4 01 do -fI- Notes: 1) Tests to be repeated at same depth until a pproximately equal soil rates: are obtained at each percolation. test hole. Ay1 data to e submitted for review. 2), Depth measurements to be made from top of hole. Ll oe Number CLOCK TIFF PERCOLATION PERCOLATION Run Elapse Depth to WdEer Water Leve No. Time 'From Ground Surface in Inches Soil Rate Start -Stop Mina Start Stop Drop in Min. /in drop Inches Inches Inches 5 .5 2 3 4 01 do -fI- Notes: 1) Tests to be repeated at same depth until a pproximately equal soil rates: are obtained at each percolation. test hole. Ay1 data to e submitted for review. 2), Depth measurements to be made from top of hole. Ll 84" yam/ MICATE LEVEL AT VMCH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER EL RISES AFTER BEING ENCOUNTERED, TESTS MADE BY ,lf��tt�� Date. DESIGN / Soil Rate Used Nin/l "Drop: S.D. Usable Area Provided ` 1, 4), No. of Bedrooms Septic Tank Capacity % Gals. Type &e 6a-.F7'- Absorption Area Provided By. L.F.x24f1 idth trench: -- Other J [ ST Address THIS SPACE FOR USE BY FMALTH DEPAR j'T 7 Soil Rate. Approved Sq . Ft/ C 1; Date ^~ a ' >,¢i — Ya. w eo- -o�.A• :.cy�. .�a,7. .. , . _'�T... 1.' .C: � w'F wit as y�+•..m. .a.. 1�`.a.:A • - cr_v cab _...1 i TEST PIT DATA REQUIRED TO BE SUBMITTM WITH APPLICATION DESCRIPTION OF' SOILS ENCOUNTERED IN `i'.E.ST HOLES DEPTIi HOLE NO. 61, HOLE N0. f' HOLE NO. G.L.'�� . ,. %C � , 1211�°1� ✓l� 1811 2411 ,-, �I, 3011 �:, X12 / ✓�,� /�'- ��`'�c% � �/)y v, �_fw,e 3611 1, 211, '4811 5411 0 .60" g 66t1 7211 84" yam/ MICATE LEVEL AT VMCH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER EL RISES AFTER BEING ENCOUNTERED, TESTS MADE BY ,lf��tt�� Date. DESIGN / Soil Rate Used Nin/l "Drop: S.D. Usable Area Provided ` 1, 4), No. of Bedrooms Septic Tank Capacity % Gals. Type &e 6a-.F7'- Absorption Area Provided By. L.F.x24f1 idth trench: -- Other J [ ST Address THIS SPACE FOR USE BY FMALTH DEPAR j'T 7 Soil Rate. Approved Sq . Ft/ C 1; Date ^~ a ' >,¢i — Ya. w eo- -o�.A• :.cy�. .�a,7. .. , . _'�T... 1.' .C: � w'F wit as y�+•..m. .a.. 1�`.a.:A • - cr_v cab _...1 i PUTNAM COUNTY HEALTH DEPARTMENT If 2 11 .a 1 DIkTISI0IY- OF EN�?IRONN1ENi'I�L ;I�A�T,...,SERV10ES ~ 225- 3838/225- 3833/225 -3641 :;_,. :..:,::.;:: - :: , ;::. �-::`` ~• : ,,.. - PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR OWNER'S NAME SITE LOCATIM MAILING ADDRF PERSON INTERN_ Name & DATE PROPOSED (i.e, owner,tenant, etc.) TYPE FACILITY PHONE Proposal (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 Proposal approved Proposal Disapproved pec 's Sig natur T tle Dat 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' diam. 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 jis owner o reported agent of own agree to the above conditions. SIGNATURE - TITLE DATE XIES: V&te (P H)); YeUoww (Tam BI); Pink (AVplicant) -14 A a: 35- C ` ' .: .' ,, -• o � ,$ 3T3'. 3310" j 4 dS •,g � �o °Jo •�'+�FaNStd>>t: Aim � _ �. . r. .- w. .. .�.-.r �.., ._..� � . ♦ - •�. Iv•C". � _ _ S•t:. .•K .. .'^ '�i1ts. G W �G.W IiY - ., ».— m.a.,. w... �.. .w� .� t$rrp spatem gas Cam as ,v j Q d nn this plan and tw tho syd Wected by me before it was carp — --'m A P P R V E T G The system was constructed UMCIM -. With all the rules and rq bob .9 b Pam C mdv Dept. JAN 1 19 A .. OF XEALTX _ .Tire /lca11.aIww,7 hel-e --p , DIVISION OF• L HEALTH SERVICfi o/r �a h•'7 /?�.SC^T/J�tlrr' /Ye o",''JS 5 h, r i I-VWV 0r= lr-VI- ,411,' Y4 :: ��rrelarl �v.✓ry� Y�