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HomeMy WebLinkAbout0620DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -2 -30 BOX 7 ir 661 04111 I ., ME, Ir 1 16 11'. r - ;i .. I :i rr' A f i 1 f M 47.1 r rr,:� N i 00620 n S J C) rtr S Owner or Purchaser of Building Building Constructed by Location - Street %9 %�tz 2S " /)/—/ Municipality t a 57 _ Building Type Section Block t Lot Subdivision Name Subdv. Lot ## GUARANTEE 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 guarantee to the owner, his success- ors, 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 determin- ation of the Director of the Division of Environmental Health Services of the Putnam County Department of Health as to whether or not the fail- ure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. I -A/ PV2 / v Dated this i day of 1940./ Signature LRd_&,Aed I Title /Y,1� -J� JUL, 21 1983 ------------- PUNAM.0 gay - DEPi, ®F h'E THREE (3) COPIES ARE REQUIRED WITH CERTIFICATE OF COMPLETION WILL BE ISSUED. CCoo�c ryporation Name if corp. lit-. • ��` �• 9 Address (3) COPIES OF FINAL PLANS BEFORE GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health rw 11v Nlvr \.Vljaer to ua.r it it r lwa Cav a Vr f{CIi,LIf 31`71 Division of Environmental lluolth Services r COUNTY OFFICC BUILDING - CARMEL, NEW YORlt ",iris report is to be completed by well driller and submitted to County Health Department together with laboratory report of snalysh 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 OWNER NAME Raymond Jones ❑ CABLE ADDRESS RFD #2, Box 179, Patterson, NY LOCATION oFwELL Bullet , (No. i Sdeery Hole Road (Torn) (Lot Number) Patterson, New York - rRQPOSED D DOMESTIC USINESS ❑ E TABI SHMENT ❑ FARM ❑ TEST WELL USE OF WELL 11 SUPPLY ❑ INDUSTP,IAL El CONDITIONING El OTHER ) DRILLING (-j ❑ COMPRESSED ❑ CABLE OTHER EQUIPMENT L11 ROTARY X AIR PERCUSSION PERCUSSION (Specify). CASING LENGTH /leetj DIAMETER /+ncnes) WE+t,HT PER FOOT Q [1 OVIVE SHOE ER ❑ WAS A iNG UT 07 ox DETAILS 41 6 19 THREADED WELDED YES NO YES �l NO YIELD ❑ HOURS ❑ © G.P.M. YIELD (G.P.M.) TEST BAILED PUMPED COMPRESSED AIR 4 15 15 WATER MEASURE FROM LAND SURFACE— STATIC (Specify tsetl DURING YIELD TEST f leet) Depth of Completed Well LEVEL Overflow 345 In feet below Land surface: 345 MAKE LENGTH OPEN TO AQUIFER (leetj SCREEN DETAILS SLOT S42 DIAMETER (Inches) GRAVEL SIZE (Inches) FROM (leell TO (1001) f 100 N- 1 y\ JUL i 1983 . PUTNA COU D'E1� h�ALtH If yield was forted of diRsient depths during drilling, list below FEET GALLONS PER MINUTE 345 15 It WILL COMI'LtltD DATE Of' REPORT WELL D L (5 5/6/83 5/10/83 iden t - MILL DRILLING, INC, `� IF GRAVEL Diameter of well including PACKED: gravel pack (inches): tJE►TM 110M LARD SUIFACEI FEET to FEET FORMATION DESCRIPTION Sketch exact location of vie/l with distances, to at least two permanent landmarks. 0 10 Sandy-Clay 30 Hardpan & Boulders 10 33 Soft weathered Ledge 30 33 1 alil - 345 Hard Grey Granite f 100 N- 1 y\ JUL i 1983 . PUTNA COU D'E1� h�ALtH If yield was forted of diRsient depths during drilling, list below FEET GALLONS PER MINUTE 345 15 It WILL COMI'LtltD DATE Of' REPORT WELL D L (5 5/6/83 5/10/83 iden t - MILL DRILLING, INC, `� 3 J +� rourct of q of ratirfactery roxitary quality whte BREWSTER LABORATORIES Box 224 - BREWSTER, N. Y. WATER ANALYSIS REPORT SAMPLE NO. , 5085 SOURCE: Raymond Jones Bullet Hole Road Mahopace NY COLLECTED: Ma y 6, 198 BY :. Mill Drilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method , Well Discharge This rtrult iwdicattr the rourct of tht rampit wat of ratirfactery roxitary quality whte thi iamplt war colltcttd. 0 per 100 ml. PU J / 2 7983 0,p4 A41 COUJVr OF l ( � May 11, 1983 CJ� Bickwit P. E. Director once of the approyai►of the Certificate of Construction Compliance- of. the, will be located as`ihown on'the approved plan_and that, said weli will be instal"- County Department. of ,Health Date r �* ySigned Ad, ress ' A RRCP1 APPROVED FOR CONSTRUCTION:.-This approval expires one yeaiYfrom the revocable :for cause or may -be- amend_ ed or modified when considered necessary; r`equires.a:`new Perm Approved Approved for',dispossl of domestic'sahitary °sewage, Date yBY Y 3 1 PUTNAM COUi'd`I'Y D.I��PARTMENT OF J11,ALTII DIVISION OF ENVTRONKENTAL I-JF_U,TH S }ERVICES COUNTY OFFICE L-'U:CLDING. CARMEL. N. Y. 10512 DESIGN DATA SHEET - SEPARATE SE'dAGE DISPOSAL SYSTEM ((�� FILE NO. Oianer Address- 3t j Q&nE Q,� d� Located at (Street &lQ. a 1-�W )&p Sec. , %j Block_!!?�-_Lot PAL, indicate nearest cross street) Municipality Watershed k. • G , SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIOi S hole Dumber CLOCK TITHE PERCOT 4TION PERCOLATION Run Elapse Depth to Water Vat,er eve_ _ No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Tnnhae Tnnh,�e Inches i 9o0 q11 / $` �`� , i0 7 3" S 17 ,3-1 1 7 4 5V IDc7 �- 1 /7 -- 5 1 3 r 010 .� 4 dS /03 — 5 1 Y 2' prrr -IVFD 9 w ® 4 5 OCT PUTNAM. COUNTY DEPT. OF HEALTH Notes: 1) Tests to be repeated at same depth until a roximatel.y 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 REUTRIE'D TO BE V11-.91i APPLTCA'f10f,1 DESCRI1�1'10N OF SOIL'", 114 'i-IRST BOLES DEPTH HOLE_ NO.— HOLE NO. HOLE NO. G.L. 6 1211 1811 2411 3011 3611 4.211 48" 5411 6011- 661f 7211 78" 84 o rz ,0 Mob- E100 Qown - C alms 01 W1 'SAA.Li, SjV1)9,_ rYWID 6UW J-P T'G47 SAA) S4-o ri e:-::> A?b.�b PAO INDICATE LEVEL AT =CH GROUND WATER IS ENCOUNTERED INDICATE =fEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date- DESIGN .4- Soil Rate„ _U s.e�d min,/1 , "Drop: S.D. Usable Area Provided 4'. No'. "`of ie r'o6' 'I] 4s Septic Tank Capacity 1000 Gals. Type AbsorptionArea.Provided By_4.).4 LL. F. x24 3611- width trench. Other - L _�VpoCLU4Aj bignature. FOR, Address SEAL WILLIAM A'-. I KEANE AssociATES P.Q A PROF TCRqAC CORP01RATION THIS SPACE FOR USE BY HEA12H I)EPARTMEIIT ONLY: Soil Rate Approved :;Sq. Ft/Gal. Chocked by Date ? 2. �r SJ , i -'14 1 �s 7 %r k +n t ti �' { . r a b I � � . f >G r P � , 6 a+ x e4 i j,` S v+ S r -;�" , } 4 1 '� I � 1 �� ° s � k.•,- �+y,� � `,''�"'yj� J� °`Fi��w�p�.,lTU.;- ..- k+c+Y�`�# �'°^i.`:�,'xk -.« � r� 1 "'+ +" ,n Ir � '�' 'r � . -f• - , r>,'�''•+ r x tit Fnb ia{ s yy- IT r •rt .v ,��s 4,� wc - --r—z• M " ^x•+.,:. Iii:,'~' ;'. Ir rvQJ Wi 1�1cF� i 5 ti� a�2 A Ft ,Y a3 �+ 5,� ' +�+ t ion �� � -•!a Cj� f �� � � - T.� $ d qtr _s '""�•i,. ��N'�',ti7� i' r�" � ' J Ah .. 3 s , - RECEIVEDr tment >o� +,; , .�.=, •.. } ��tY i�2p?r 1 $ealt� S " . s .�„�" w� ' ° �.i o Cnta n�1t� a O.CT 2 5,1982 4 DiQision con£o of the {. TY gi w n .: ",nosed oTP�3�ation8 j( PUNAM COUN ti. APPliaab e ^� D�Pept L _ AEPT OF HEALTH 2 k ,.. I Out Co date I FOR, sI itle WjtjL.jAjA WA.A ASSOCIATES P C TION �+ /q v j PROFESSIOMAI- _-ORPORA •. i. a a,;� /. 4 .. .�.'•Jw .r,�a I... .t . s7R'ittL.L�T :'� ©s.'. 2n• CONSULTING ClV }L �, EtdVtRi?NA�EtdfAL Ql3aS3Y �.l'fAC,tI Y `, ENG I FLEE RS TUv�NF?s"i� . . l7 '�yj�F'i.i• ,r r . r , , . LoTS'NO Bls3CAt: AT�3P��". I 'DEER PARK PLAZA �QQSU$F'v(s Dnie , y 14, �o (� ?I C)\C� V of Oc \0Z ey ,44,'1-' Pwtv&m couht L 45 <=> A. All' e!54- WATED EARTH SHALL BE tUGTION OF THE SYSTEVTO BE IN iERE T10 AND THE RULES AND N TAL.. AGENCY. Pm Comity En­,tj Apprp;ved applies; .ft, t,nat `1 'ali-i'tty WILLIAMA. KEANE ASSOCIATES, M M MM WATED EARTH SHALL BE tUGTION OF THE SYSTEVTO BE IN iERE T10 AND THE RULES AND N TAL.. AGENCY. Pm Comity En­,tj Apprp;ved applies; .ft, t,nat `1 'ali-i'tty WILLIAMA. KEANE ASSOCIATES,