Loading...
HomeMy WebLinkAbout0623DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -2 -39 BOX 7 hr . `�. Wpi-' `� ET ` - JT ` i ■,' ., .1 ,�, I. jr III 4L , . i. NINE . , r 00623 r � A PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N.. Y. UK12 CERTIFICATE OF CQNSTRU,CTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM �/�TTF�C?SDi \l Town or Village Located at LJ 01- L r t- HO fit R76 A 1 Section _ Block Owner + a i(�1i�C f 6 Ai%3/7 - %/iI Lot r� Job rL Separate Sewerage System built bye'? /7L� �tY�� l Address�u,f% /fir ? ) 1 r/a /l width trench Consisting of 9� c Gal. Septic Tank � - -- lineal Feet X � �1`• Other requirements �`- /JC 1 S/�e7 /C)ii/ ' f��i°2 ©t�1C® �• C7 S%4�yD�t�i/?//E L Water Supply: Public Supply From JL_ Private Supply Drilled ,By Address r -r LL v r `- r .7 yG J ice— c- r,1.z_7 • c .c _ —11 i _ � _ Building Type R F & d VI Zr 0 if % ,dr- � No. of Bedrooms Date Permit Issued Has Erosion Control Been Completed? I certify that the system(s), as listed serving the above premises were constructed attached), an in accordance with the standards, rules and regulations, plans f Date �w Certified by_�_ -as shown on the plans of the completed work (copies of which are he permit issu @d by the Putnam County 'Department of Health. P. E: L R.A. Address ` r rs c- 6=rriv is CIry c_ r7 rc 01-f A-- c , License No. Any person occupying premises served by the above system(s) 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 become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water suppl mes available. Such approvals are subject to modification or change .when, in the judgment of the Commissigaer-�gf "Ith, such revocatio , m ication or change is necessary. Date t By ��� Title Owner or Purchaser of building Building Constructed by Location - Street Building Type �,x ;r74 /'sv n/ Municipality -- Section 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 successors, 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 t,,,,-,o 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 occupant of the building utilizing tho cvai-Am The undersigned further agrees to accept as conclusive the determ-,.n:ition of the Director of the Division of Environmental Health Services 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 :- uildino utilizi.na the system.. Dated this _� day of S4F � T 14_Z3 Signature " , Title ,�-� (if eo orati , gi-Ve name and dress') THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION 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 } ialth eaffdaeidated 5rechoolofy., VW. P. O. BOX 261 - MT. KISCO, N. Y. 10549 - (914) 241-0493 August 31, 1973 Mr. Larry.Kreighbaum P.O. Box 232 Millwood, N. Y. 10546 Dear Mr. Kreighbaum: Following is the result of the laboratory . analysis performed.on a sample of water received on August 30, 1973: Analysis Result Remarks Total Coliform 1/ 100 ml Meets. Drinking :Water Bacteria Count Standards; Max. Count = 4/ 100 ml, one sample. Very truly. yours,. C olidated Technology, Inc. ohn P. McGuire, P.E. JPM:d 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 OWNER NAME L, �� f %y� — Wt/�� / ADDRESS y g� �l� — MI 'vow rte► ++i/ow '. LOCATION OF WELL y . (No. & Street) U L LE L (Town) 73 (&/ (Lot Number) PROPOSED USE OF WELL DOMESTIC SUPPLY BUSINESS ❑ ESTABLISHMENT ❑ INDUSTRIAL ❑ FARM ❑ TEST WELL ❑ CONDITIONING ❑ OPeHER) f DRILLING ' EQUIPMENT ROTARY COMPRESSED ❑ AIR PERCUSSION CABLE OTHER ❑ PERCUSSION ❑ (Specify) CASING DETAILS LENGTH (feet) DIAMETER (Inches) WEIGHT PER FOOT 10THREADED ❑ WELDED DRIVE SHOE ❑YES NO WAS C ING GRR UTED? YES Li NO YIELD TEST ❑ BAILED HOURS G.P.M. ❑ PUMPED COMPRESSED AIR YIELD (G.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE — STATIC(Specifyfeet) DURING YIELD TEST leet) p l Depth. of Completed Well in feet below Land surface: SCREEN MAKE' ]LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE DIAMETER (Inchea), F GRAVEL PACKED: Diameter of well including gravel pack (inches): GRAVEL SIZE'(inches) FROM (leaf) TO ( /eat) 4.., DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well two permanent landmarks. with distances, to at least FEET to FEET .. 0 C..P" TO 45- -' 1 If yield was tested at different dept!is during drilling, list below FEET GALLONS PER MINUTE y'DAT 1. COIPPLETED a AT O REPORT WELL DRILLER (Signature) k � ,- 7^ 4 h rr el �x t I ry 4 �7 �l - � t �A A 1 .y M1.1 t j n ,a w c u' i; ;, f) 1, �rS C :� - _ �G.. ✓.ct, ' ' LI% F ; '�-1 r ,�� � �r r r ' . .... . r f,.. spr.. ,� d ... , ,�,, ti .,... �r r�� a .. r1 s tRR�� 9 � /(� W f✓ J F t,ry, G''� _ y , w S 1'� HUR .. SEP . ......... s I � QG� FGA` �'/' r _. -. _.. ..`.- 'r' �:.. ..^, e.:. :._ r,,. � .sf. :��' �•r it I Ito, Other; Requirements I represent that d -am wholly and completely respons above described will be constructed as shown on the a :County Department of Health, 'and that on comple "be 'submitted -to :the Department'.sand aawrItten g place in" goo_ d operating' ;conditi'ori any part of _`sail ance of` She :approval of.rahe .Certificate :of Constru Will be located ' as. show n -on the approved plan and tha County Depart-meant of ealth Date Address v - APPROVED FOR CONSTRUCTION This` provaf revocable r cause or maybe amended or modified! >le for the design and locat;on of the prgposed- s) �pr'ovegamendment there to and`in accordance wi :.- By !well N S� s); 1) that the 'separate sewage disposal, ystem' i standards rules an regu a ions o e _ ; satisfactory to the: Commis "stoner of Healtkwill ,'; posal system during ;the period of two'( ) yearsfmmediatelyfollow�ng '_•thedatesot the, '_issu lance of 4he _6H '- al, system :'or any ;repays thereto ,2)ahat the ,drilled =_well tlescribed. above 11 be installed raccordance with "the standards rules and egu a iTf ons of the-.- Putnam ' ne p 'E >r, c38/'0 - - ♦ , _License - year from •the date ,issued less constr n of the ;building. has been undertaken and is red neces ry by tjhe Commissions change or alteration_ of cons ruction , r Title 77 T W. t /QErt/Ov!9Tior✓ a. rt PUTNAM COUNTY DEPARTMENT OF AE- it DiGisron of„ Environmental Health Services, Carmel , N Y ' 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM . �i ��fTTEi�So•t/ ?i Town or V;Ildge �� Located at !✓L L' �T /�GL / ' T Section �BIOCk (-divisionUN� Sub Lot ,L-�• �RF/i���� V � Add ►e6s PC's GTVX ':°�s� °2 Owner RTEl� G/yi RCi� °� % % AGRE $ ,� /LG L✓ O oTj: �OSf G t Building' TYPe�A —Vb Lot Area! Number ot.Bedooms, ��'SQ -, O Tota6 Habitable Spaca Square Feet ' - Separate Sewerage System to consist of 900 .'Gal. sell Tank lineal feet X width: trench t R `"� �.t�T��- Y� Addiess To be constructed by Water Supply Publir:SupplY From � ,Private; Supply• to be drilled by , Address � " { t Other; Requirements I represent that d -am wholly and completely respons above described will be constructed as shown on the a :County Department of Health, 'and that on comple "be 'submitted -to :the Department'.sand aawrItten g place in" goo_ d operating' ;conditi'ori any part of _`sail ance of` She :approval of.rahe .Certificate :of Constru Will be located ' as. show n -on the approved plan and tha County Depart-meant of ealth Date Address v - APPROVED FOR CONSTRUCTION This` provaf revocable r cause or maybe amended or modified! >le for the design and locat;on of the prgposed- s) �pr'ovegamendment there to and`in accordance wi :.- By !well N S� s); 1) that the 'separate sewage disposal, ystem' i standards rules an regu a ions o e _ ; satisfactory to the: Commis "stoner of Healtkwill ,'; posal system during ;the period of two'( ) yearsfmmediatelyfollow�ng '_•thedatesot the, '_issu lance of 4he _6H '- al, system :'or any ;repays thereto ,2)ahat the ,drilled =_well tlescribed. above 11 be installed raccordance with "the standards rules and egu a iTf ons of the-.- Putnam ' ne p 'E >r, c38/'0 - - ♦ , _License - year from •the date ,issued less constr n of the ;building. has been undertaken and is red neces ry by tjhe Commissions change or alteration_ of cons ruction , r Title PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE FJILDING, CARKEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner 4 Address Located at (Street Sec. Block 6dicate nearest cross street Municipality /�i9T�.11Sr�t/ Watershed ,t;/ yG Lot SOIL .PERCOLATION TEST .DATA REQUIRED . TO BE SUBMITTED WITH APPLICATIONS tioi.e Number CLOCK TIME PERCOLATION 2/G.. ,Q/ PERCOLATION Run Elapse llep o a er Water Level No. Time From Ground Surface in Inches Soil. Rate Start -Stop Min. Start Stop Drop in Min. /in drop /J Inches Inches Inches i IJ 2 1 - 2 3 G Notes: 1) Tests to be repeated at same depth until approximately 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. 17 / 7 2/G.. ,Q/ 17 /P If 4/0- 50 10 :.sC /J j7 ?o i IJ � r 1 2 1 - 2 3 G Notes: 1) Tests to be repeated at same depth until approximately 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. ��EQUIRED TO BE SUBMITTED 14ITH APPLICATION. DESCRIPTION OF SOILS ENCOTJNI TERED IN TEST HOLES DEPTH BOLE NO. __ HOLE NO.T HOLE NO. G.L. I 6t1= i�-5a /G- 1211 1811 24" 3011��% 3611 4811 5411 60" 66" 7 2 " 7815 84" INDICATE- LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date c�73 DESIGN Soil Rate Used/ /.,/" Min/1 "Drop: 'S.D. Usable.Area, Provided No. of Bedrooms Tank Capacity Gals. Type Absorption Area Provided By� L.F.x24" 5b"— width trench. Name Signature - Address L`'�i�,� -� /'� SEAL THIS SPACE FOR USE BY ITALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by — n • .,d °- •' -: -3 - ter• ` !1... � ._ "S S 14����\`�.�� e a rl4 ScncE h/oR - < r\ H L i 1y r -• Utr Pt n Ct c:- �C'i D. .y t N 0 tZ s� - ._- ._:::-- .._..` a - . � nit • `��n a rl4 ScncE h/oR - < r\ H L i 1y r -• Utr Pt