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HomeMy WebLinkAbout0342DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -44 BOX 4 -t •. ; . . ., . Si ir f �r . a . 00151 01 - - -- - - - - -- 11------,---.--. - ----- - ---- ........ . .. . . .. . ........ ..... .. ... A AlNno,�-, A13 I'll t nd .:Separate Sewerage System Consisting of Water Supply: Public Supply From X Private Supply Drilled By Address IBuilding Type Has Erosion Control Been Completed? �` C✓ I certify that the system(s) as listed attached), and in accordance with Date Address i lkrt p ,� S shown on the plansAf he comp 'W't ed work (copies of which are permit issued PUT NA P }ltj�aWtV�t e1 Department of Health. IC 7� } � ✓ iP.E. R.A. License No. Any person occupying .premises served by the above systems) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall becom4 null and.void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null an id when 'a .public water ptqply becomes available. Such approvals are subject to modification or change when, in the judgment of the Comm' sione of Health, such revo rtlpA, modification or change is necessary. Date �/ 72 BY / Title A VRLL 77 -2" r 4--Z, 7-1111S s 1 17AMA4 r.CV,";rj' 31 DEPT. of HEALTH 19/ irn Pud PQ NAN1 COU k STAN- 1--r ---- awn or PurctiaqOr of u= ng Municipality lui.lding Constructed by_ Section cation treet Block ,,qq i dlnj0 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 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- 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;79 Signature _ P Title A -.ZCV/ e�o t2y C-- If corporation, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP±.,ETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF' SYSTEM. .. - - - - - - - - - - - - -- - - - - - - - - -- Division of Environmental Health Services, Putnam County;; l7epra�t�rne�nt of Health WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH , 3/71 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 analysis of water sample 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 y, n Q�t�.3r3:al�..a.m,. stroot) LOCATION (No. a OF WELL _,MooneY Hill Rd.' atterson, N.Y. PROPOSED ® DOMESTIC LJ E TABL SHMENT , El FARM l_1 TEST WELL USE OF WELL ❑ SUPPLY ❑ INDUSTRIAL ❑CONDITIONING Q OpN ER ) DRILLING EOUIPMENT ROTARY ®A R ® PERCUSSION ❑ ❑ (Spe PERCUSSION if ) CASINO LENGTH (feet) 9 p V DIAMETER pnches) OQ9 WEIGHT P R FOOT SHOE �i631FJ' DETAILS 0 THREADED ❑WELDED YES LJ NO YES _ NO YIELD TEST HOURS 6 G.P.M. n 7 ❑ BAILED C7 PUMPED ® COMPRESSED YIELD (G.P.M.) n 7 AIR WATER MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST fleet) Depth of Completed Well 300 MEL 30 in feet below Land surface: 430 t �� LENGTH ORN To AAUliku It�elj SCREEN DETAILS _...._._,. SLOT'SFZE DIAMETER (Inches) GRAVEL SIZE (inches) FROM der) TO (root) m IF GRAVEL. Diametor of well including PACKED: gravel pack (Inches): DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch ;9xecf location of well with dialonco9. to of least '{ FEET to FEET two permanent landmarks. , t y 0 78 Hard pan,qlay,roak,boulde is 8 430 rock limesto a t JUN 10�� ppUT'-(NANi B✓t�RT, OF hL.,,LTi If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED DATE OF REPORT WELL DRILLER (Signature) �•_,^�-� i' "' � �;� r t BACTERIA PER.ML (Agar.plate count at- C) .COLIFORM GROUP (Most probable No: /100m1) D A TOTAL' ppm °, s !r5 ss .' ..: ;,3 •`K - r , h -` C .(.: _ �, ;.e3� "` rx„:.1 y ' � ; h ., ,y ,. t? FTFRGENTS tl1CJ NITRATES,-, (ae N) IDGJ L f IRON, TOTAL RiCJ L z x F ,Separate' Sewerage System t consist f Ga I Septi L,v r To be constructetl by e ' Water.,Supp1Y =Public SupPIY From Private Supply Ito be Arilidd by / Address ` p Other - Requirements J represent that I_am wholly M16, completely response le for,the design antl locatio above--described..will be 6onsfructed as'shown on the approved amentlmentthereat .County, Depart -ment' of .Health,,and that on completion thereof;a "Certificate c be submitted to the Department, and a' written guarantee will zbe furR!shed tt place in good, operating condition any part of said sewage disposal system d r ' ante: of the : approval of the_ Certificate -of Construction` Compliance of: the 6' f will be located as shown on the approved plan and that said well will be installed County• +Dep ment H th x Date Signed r - _ Jz- = Address APPROVED -FOR CONSTRUCTION` ,The approval ezpues •Y r from the is revocatile for.cause ormay'be amended =o "r modified when__ " nsi ed nice'ssary•''q require new permit Approved for disposal of dom nitary sewage , 5: } Tank ° lineal feet 'X width trench'. Address { t r - r� 4- nstruction Compliance' satisfactory to the Coin mssionei.of Heaithwill ner sth e;;o asi` gnb t.ha ebuilder' c hat said builder Will l o y the' er od oftwo 2- s4earsimmediately's f6ll9wi6g thedate.. 6f the ,ssu em epairstheretop2)that- the :drilled,well described above 5r_tdance wit the Bards rules and regula —f ons of the Putnam P.E. R A ! License -NO. sued unless constructs' ' f the building has bee undertaken and is j Commi rier- H h. Any change_ -or alteration of;construction. pre at at isu ly_t.only. - s ° r / �TAMr COUNTY DEPARTIIIET ©F`'' HEALTH �. ,3 ' .� j!4 - DlVfsion of Envi�onmeniFa/ Healih Serliices, Ca�mel,'..N 10512 CONSTRUCTION PERMiT -FOR SEWAGE DISPOSALSYSTEM. --„ - Town. or 1/�Ila9e ' Located at t Sec n 810 k � �I'Subdivision '�� x. � � Lof`'o - 1 A dress d OE ro .Owner r F building Ty_ x Lot Area' 't ,! , Number of `$edroom`s - Total Habitable Space 5quare-Feet .rte ,Separate' Sewerage System t consist f Ga I Septi L,v r To be constructetl by e ' Water.,Supp1Y =Public SupPIY From Private Supply Ito be Arilidd by / Address ` p Other - Requirements J represent that I_am wholly M16, completely response le for,the design antl locatio above--described..will be 6onsfructed as'shown on the approved amentlmentthereat .County, Depart -ment' of .Health,,and that on completion thereof;a "Certificate c be submitted to the Department, and a' written guarantee will zbe furR!shed tt place in good, operating condition any part of said sewage disposal system d r ' ante: of the : approval of the_ Certificate -of Construction` Compliance of: the 6' f will be located as shown on the approved plan and that said well will be installed County• +Dep ment H th x Date Signed r - _ Jz- = Address APPROVED -FOR CONSTRUCTION` ,The approval ezpues •Y r from the is revocatile for.cause ormay'be amended =o "r modified when__ " nsi ed nice'ssary•''q require new permit Approved for disposal of dom nitary sewage , 5: } Tank ° lineal feet 'X width trench'. Address { t r - r� 4- nstruction Compliance' satisfactory to the Coin mssionei.of Heaithwill ner sth e;;o asi` gnb t.ha ebuilder' c hat said builder Will l o y the' er od oftwo 2- s4earsimmediately's f6ll9wi6g thedate.. 6f the ,ssu em epairstheretop2)that- the :drilled,well described above 5r_tdance wit the Bards rules and regula —f ons of the Putnam P.E. R A ! License -NO. sued unless constructs' ' f the building has bee undertaken and is j Commi rier- H h. Any change_ -or alteration of;construction. pre at at isu ly_t.only. - s ° ... YI'II'. TATI STT7? :L1• ?:11'1 CIPT.Or1 �. , _ - — 1.e:3 r'o Prop :r. ty 'Lines or cor.•ner:1 found Can astJ.imato ho' -,t;C location _ -- Hill drivp-way need cut Mm.. ",t trees do rcinove;d -note these — -- - - -_,. Is deep hole. rop., :- .se.nta,tive of entire SDS area - -4�'�- —". ft, C,d _I iona,l dccp iiol.cs necdcd. . ... . . . . ... ;��ff.i.cie;nt SDS ar. ca ava:i�aa.ble cons i.dc.�riz� ; - dr:i.veiray cut, house location, separ. a, cion distances, etc. . )r ►�;� ROLE L �TA Dopth : 41 ®o �'0 Water elevation: ;P'v . I►ock elevation: Soils dGScrirti on: 'IhT' L SITE Il ?SPECTI01•1 InsD. bq: ' ouse. located t, :here shown on approved plan Tr, loc:a.tc- dC 'wh..ere a.ppro .-d lops of tile, lire and' tre-n i a.cceptab7 e - oom allo,aed for expansion trenches .. , • -_ ver 50 t . f rom swai�m, era %ercourse .. ` -- - -- atural soil not stripped or SDS area -- w,mecessa.r:ily graded . _ .... . I� t... i.^.ainta.-L:ed from prop.line and 20 ft . from 1�o.zse ....:::- ... , .. ;paration of trench from house, well etc. follows plan . inber Of bedroc -ms. checks, ... .. ;cnes, brush, sttunps, rbble, etc. greater — than 15 ft. from.near--st trench . . . . . . i Pt. of reripheral soil horizontally from '- trench . . . . . •• . traction boxes properly set - )uld surface run off from drive�iay, roads, ground surface, etc. ctman rel noar SDS , ' area yes 16t drainage a.tirca.r O.IC. in area of SDS IML GRADING OF. SITE ACCEPTABLE ,, a REVIEU CEECK MEET ET DOCUMENTS House plans O.K. Design data sheet Peres presoaked? min., 30" perc test depth Cont . - results for 3 mans D. Hole log 0. K. Corporate Affidavit for.other than indivi Authorization for engineer 'Letter from Water Supply.if applicable If variance requested -such noted on plans t I I i �l I i apps.,: ets Std. DETAILS if charge is proposed.,) Existing contours shown show new contours) Slopes for driveway cuts, etc. shown Water service line location Footing.drain, etc..location i Top slope, bottom slope of fill ! ►. Percolation tests and deep.test pit, location Septic tank size and conformance to std. _ ! 3 B.R. house- minim-Lun i House setback shown l �i.l'_1_lil•.t.V!.1. l.1ll:�. .t �,�,: .Oe -1Qw All Wa L.c,-L• w L uhtin 50 11. ul FL dauw11...... _... :....._ _t'. .. goo Pa .an and profile SDS All other wells and M-9 closer 200' shown or.reference made Property boundaries (metes and bounds- clearly shi SEPARATION DISTANCE'S SPECIFIED ON PIA 10' to P. L. 20' to Foundation walls 100" to Nearest well 50' to stream, march, lake, etc. incl.expansion 15' to Curtain drain 10' to water line (pits -20' 15! to storm drain 10' to large trees 0' from foundation to septic tank 5' t:o i.pe fr ,n leader drain & fcoLIng drain No o Ole _ 1091J.err cfo . C �A. d ® 9 Remarks . ✓i al i a ko :$ t i I I I - -- i i I I 1 � Y PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING CARMEL N Y 10512 z DESIGN WT.4 HEET - SEPARATE SEWAGE DISPOSAL YSTEM FILE NO. Owner ddress � _ ;N A Located at ( Street See. Block tihot: -'1, is e near cross s re •- / /.�!% is /i/: Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMIT !Z WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION v PERCOLATION Run Elapse Depth E`o_Wa"Fe_r Water ve . ; No. Time From Ground Surface in Inches i ',Soil Rate Start -Stop Min. Start Stop Dropi�n; �n /in drop Inches Inches Inches r /II r :a2 _1117.1 3 5 Notes: 1) Te':�ts to be repeated at same depth until apppproximatelyy 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. .J' DEPTH G. L. 611 1211 18" 2411 3011 3611, 42" 4811 5411- 6011 TEST PIT DATA REQUIRED T'0 BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED •IN TEST HOLES HOLE NO.-/ HOLE NO. HOLE NO. 211 `' � � °�a: `y'.:7 '�',� � ,M.•.'y.� r (y„� �•c a� 7811 8+11 k INDICATE.`hEVEL AT WHICH IS ENCOUNTERED GROUND" WATER INDICATE,'�.LEVEL WHICH WATER LEVEL RISES AFTER BEING `_;,ENCOUNTERED -.• ; - . TESTS, MADE BY t _. _ Date 6611 U 211 `' � � °�a: `y'.:7 '�',� � ,M.•.'y.� r (y„� �•c a� 7811 8+11 k INDICATE.`hEVEL AT WHICH IS ENCOUNTERED GROUND" WATER INDICATE,'�.LEVEL WHICH WATER LEVEL RISES AFTER BEING `_;,ENCOUNTERED -.• ; - . TESTS, MADE BY t _. _ Date Soil Rate yUse -mmr /1 "-Drop: No., of Bedrooms Septi Absorption Area PrJov ded � 19 f /' Z_ - G/ , AA Address Lr,,711x1V S.D. Usable Area Provided.D Tank Capacity L. F. x24 It THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by i s WQ�9 ;: Z . `fJ' srrral�sssss� Date �g s ',o y - a ! on, on X fa, W/ " _ r t r F.sc 1 .p E t� 1 Y ry+s., pp J 7 tz as tF'� w'' 'w P ld'`"i !A :9 ,• L! w M d <� t: µ tas a t a ! 4> n ;{ + I ,P.' , 4a c r ?vr'r�y. +r w„ t 'j 3 x ti 9 x ..'= i�- } = {is'-f a ��k$x 'x 'rc�... . c , �'tg'y `x°.', 43 j r _ ` r'`t ` v.'.;'x 'r'• �},�✓r',`.^',,(t'�n'^' 'iv'' ,zy 'N,. ' e ,si^`��Y�a L 4 �2� F `fi �x � �'x,� ' ' � ' Is s .�" t : r•rF 7 `ro F � An � ps a', -fx •ci} '.t ' � M .�uY. .•Fa �"' 4 cte " YE fi3- ' Ix1 1�� . } •� ^J r 2 C a -r 'r >- `r5 ' h .•r �..Ps�• ,t - r¢�v #.' ;.r �Tt r r +...a }x3•r.- °€N�•rsY �, xf n t � _ . .�• Y ��] SSA 4Y� y• Jr /2 ' ;i, M# I`iJl7. �l SIR S � 1 wa }z s L * itC i {"'�;. 4' wr -'" tyf:.: t �'�: S�PC Tdli✓.. Cd. a 7:, QsJ . s r Fw4wi zL Ski l t �'• `V i� b qt c.t ° ffvi•r. y > ,`+. ,t:. rf4Q .. r V F = P 7 V i t t "k ism 141 r .a `� '� s l r # f 1 •: t �,�°'�' �' i f _ 4 r + {; - rFl.' k1 Y Y l n law tfi u e K jt., t g {1;5�� w a� tit � � y�1 t�1..y�P�+� ��' / } �.> h ''• � 't -t� � k�,, r7 ! � k s �,.• � � yt�� /y'f c.s &wT; -� /,F,.. E !'ri�Ij a+ L % � - r^`� � ,� t . fA 3 - fsi �t r TO Ito' r aovvn atlscrionq Will vv wn baruucy.ab mw—l'u r mu ayy­!vF? n�anu� County Department of Health, and that on completion thereof a <' : 6e 'submitted,:to tFie Department, and'.a_^ "written guarantee',will ae wm oe..iocateaa as snnown on�L/nn Date e approvea plan ana tnac sa!a weii t �C� • eG'�e H�7 Address M' IVA-C J APPROVED FOR,CONST,RUCTION: This approval expires,o revocable for cause' -or mai ibe amended ormod!fied when =con! Y requires, a new permit. Approved, , for disposal of .domesti$]��/ Date �p -J By ++ successors, ^heirs or assigns`by_ the builder, that said builder will iod of;.two (2) ;years immediately, following the date of the, is4u- I or an thereto; 2) that -the drilled well described above with the'_'standards rules and regula ions. — of the Putnam, P///E---. . �l��►r�� " License No .'�'r— j Mess construction of–the building has-,been undertaken. and is , sioner of Health:.' 'Any change :or alteration .of construction i water. supply'. only. . 11 } Title