HomeMy WebLinkAbout0321DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www. s ca n y o u rd o cs . c o m
631- 589 -8100
11 -2 -20
BOX 4
IN6 ' 2 o
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00130
In
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0
Boyd Artesian Well, Co., Inc.
R. D. No. 5 Rte. 52
Carmel, N.Y. 10512
. (914) 225 -3196
November 1, 1983
Pete O'Hara
Box 282
16, /
Patterson, N.Y. 12563
(13,il)
WELL
Route 311
Patterson
Depth: 1059
Casing: 21'
Drive shoe
Tests 25 gpm
RECEIVED
NOV S C 1983
PUTNAM COUNTY
DEP r. OF HEALTH
a
PA-
Owner or Purchaser of Building Municipality
Building Constructed by Section -
Location - Street Block
0I b Gam) C- S �;� �i Di .i/� T : 4
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 servir_g 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 success
sors, heirs.or assigns, to place in.good operating condition any part of.
.said system constructed by me which fails to operate fora 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-
vices of the. Putnam 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 day of 19 Signature \,..-'S--:��
Title
If corporation, give name
and address)
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE,
CERTIFICATE OF COPPLETION WILL BE ISSUED.
IM
GUARANTOR IS,RE UIRED TO FILE NOTICE OF DATE.OF FIRST US UX-,44�r
�
VFD
_ _ _
G i09,83-
Division of Environmental Health Services, Putnam County PWphWAn 0UNJJY Health
DLe L OF heALTH
,f
0
:, Acts ®t i, l_NG PAATERIA L S lOR Eft VA 'ED . Ai T H . 51 A►�L E .
AL,t� i � ,'��-�V ` T••H£ �1�A�� €?i ��'��SA� .�►��A: �C�#N�TR�l�T1.4N. 7�:�.:..�YSTEt� � }:
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Putnam County Department of Realtia
Oir4si'on of Environmental Health ServiOGs FOR
WILLIAM A: 10EANE
ance with
as rotsd fex eon osAoprovc c . d ;ulations of the ASSOCIATES, P.C:
A PROFESSIONAL CORPO
RATION-
h Lulty " �Department., o
3Wature -&)Title
,
DEPT OP ` wev' it
.<� HEALT11
STREET
SWBD VlS T4 y
.. .. .: i
C� .. PUTNAM CJUNT ' -' DEPARTMENT OF HEALTH ; ({...- P. r
Divis /on o.f EOv ronmental'Health Services Carmel N ': Y.. 10512 P) t,.O-i7 .1
CONSTRUCTION - :PERMIT FOR, SEWAGE DISPOSAL SYSTEM
7. Town .or , Villa
Located ',at
6
Tax'Map Block
�J f 1
/�' �'��� �'
j'5ubdrviswri
tr T�`i� �A.
Lot Job
'!Owner f` C/� !'B►�
Building. Type 11D C1 Lot Area; 'c.N
• Number of'Bedrooms Desidn Flow ��}'�
Total - Habitable Space' I Square 'Feet '
Separate' - Sewerage System to consist of I �C�e� '- Gal - :Septic -Tank
and -_4 �j �„F -�
v
;. - : _.
•
,To' be constructed by - ii?li- g_;y s
, ..
AddressS
{Water Supply Public Supply From "-
-.
r
Private SuPPIY to:be drilled by,. t"�L
-
`Z✓�
i
n Address�J
Rr
Other' Regwrements �A Y_ �:. c
- -
I, represent that 1 am wholly and completely responsible for the design an r ocati
t p stem(s); that the separate sewage disposal system
above described will be constructed as shown �on the,approved amendment they
,1)-
the standards, rules an .regu a ions of e .Putnam
County , Department. of Health, ' and that on completion thereof a •'Cert-hica
ce•' satisfactory to the Commissioner of Healthwill '
be submitted to the Department, and a written. guarantee will be furnis no fs, irs or assigns'by' the builder,=that_ said builder will
place. in good operating condition any part of said sewage disposa0y n
e iod o�� CO) ( ; years immediately fo,llowiny thedate'of the issu=
,ante of-the approval of the Certificate of; Construction :Compliance: of rigi
ny;, `pai ,thereto, 2). that the drilled well- described above
;will be located as shown on the approved plan,,and that said well will be;in:. m', c
2,. th _fit dards, rules' and regula�ons:,. of the Putnam
County Department of(a Health.
'Date 9
Signed
P RA
Address t 6:
License No.'s
dAPPROVED FOR. CONSTRUCTION: This a r ,
ppro4al expires -one year f the R(isst8s StrucGOn :of the builtlmg has been undertaken and is
,revocable for 'cause or maybe amended or;modified; when consitlereC n�tkipy
er `of Health. A�nY_ change or. alteration of; construction
requires a new permit. App� moved for disposal of .domestic'. sa wage ndZ r
rive a te�su_pply^artly—
Date BY
Title
i
-K.
_6
PUTNAM COUNTY DEPARTM1'NT OF IIJ FILTH
DIVISION OF FNVIRONP1II;NTAL IMLTH SERVICES
COUNTY OFFICE, EUILDIPIG, CARMRL,, N. Y. 10512
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner t'c>`f' � ®'.14AQA Address .31 ��
Located at ( Street �Sec. G Block 16. 'Lot, 4 (S) L-T
4dlcate earest street)
1
cross
Municipality Watershed �' Y, C.
SOIL PERCOLATION TEST DATA REQUIRED TO ICE SUBMITTED WITH APPLICATIONS
Hole
1 / o l � °
Number
CLOCK TIME
'12
PERCOIATION
-
PERCOLATION
Run
apse
D-epth to %-a -er
water r6vel
3 l r a� I1 z.i
No.
r�.
Time
From Ground Surface
in Inches
Soil Rate
i -7
Start -Stop
Min.
Start
Stop
Drop in
Min. /in drop
Inches
Inches
Inches
1
9 oc q ;;V7
1 %
1���
/ �% ��
3
�� 7
_ lc�v'
`�13/�
3i
3
6, .3
17
Y�
6,8
5
1
. 2
4
E P 14 1981
!'iTNAAA COUNTY
HtALTH
Notes: 1) Tests to be repeated at same depth'until a roximately equal soil
rates- are "obtalned' at' each percolation test hole. All data to e submitted
for review.
2) D-:pth measurements to be made from top of hole.
r_-
1 / o l � °
14
'12
Z Y2
-
2 I f
3 l r a� I1 z.i
l ��
r�.
25'�2
3
.7
4 // > .-
i -7
'/2.
5
1
. 2
4
E P 14 1981
!'iTNAAA COUNTY
HtALTH
Notes: 1) Tests to be repeated at same depth'until a roximately equal soil
rates- are "obtalned' at' each percolation test hole. All data to e submitted
for review.
2) D-:pth measurements to be made from top of hole.
r_-
Address L `AFC fig• 42 ;t"
V 14
A1 SS! Not
..THIS SPACE....FOR.USE BY.HEALTH_DEPARTMENT ONLY:
Soil - _.Rate - :Appro)ed . _ ..Sq, , ..Ft /Gal,... - Checked, by Date
A
CEF
SEP 14 1981
DEPT. Of I-itAL'rij
TEST PIT DATA REQUIRED
TO BE SUBMITTED WITH APPLICATION
DESCRIPTION•OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH
HOLE NO. %`
HOLE NO. �� � �
HOLE NO.
G.L.
..,..
6"
12"
, .. _....
24"
`,� �v ' SQL. -T
3011
OF-
3611
42"
48"
1
.
qy -
6o„4
6611
e. buesrws
-
72 11
a.Un�r� "C:S��C-
7811.
I
84"
1
INDICATE
LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
_-
INDICATE
LEVEL TO WHICH WATER LEVEL RISES AFTER.BEING ENCOUNTERED —
TESTS MADE BY
Date .5
Soil Rate Usedk ( M n/l "Drop:.
DESIGN ...:.
S.D. Usable `A
vo
No. of Bedrooms 3. Septic Tank Capacity =C3
-I
Absorption
Area Prov ded By2 5
L.F. x24"
tt,, rdhch.
Address L `AFC fig• 42 ;t"
V 14
A1 SS! Not
..THIS SPACE....FOR.USE BY.HEALTH_DEPARTMENT ONLY:
Soil - _.Rate - :Appro)ed . _ ..Sq, , ..Ft /Gal,... - Checked, by Date
A
CEF
SEP 14 1981
DEPT. Of I-itAL'rij
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