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HomeMy WebLinkAbout0690DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23.11 -1 -68 11.•1 4 IL Va. ' % 9r L 16? Xr mr -� -11 6 I : 'I Jr r t L� r 11.•1 PUTNAM COUNTY DEPARTMENT Ol D vwon of Enwronmeni;al Health Services, Cahfn C-.ONST,RUCTION;:PE'RMIT.'fOR_ SEWAGE; DISPOSAL .S;YSTEIVI Located'.at 1: Sectron Subdivision Moodr�. Owner �$' �4i �� F Addresi n £. Building Typeh " Lot Area / *��S Number of Bedrooms -'-Total :4 Separate` Sewerage System to coits�st of �l�GO Gal FSeptic Tank.[ i 4• ". 4 T6 rbe;construcied by Addres v b v Water'Suppiy Pub lic.'Supply ;From J Prnate�,Supply;'to be dril lei by > C" Address ?Other Requirements / ' 6 k k �6 DrR°a xa:� fi s I represent tha£ I am wholly and completely.responsible for the design and_ `location `of the `propo above described will be. constructed a's shown on the approved amend'menftFtere to-and;n accordai County ,Department ,of ` Health,•y, and that_•on completion thereof a `?Certificate of `Construction be ",submitted' },to the Department and a written;.guarantee will'be�furnished the owner his'su( :place in good ,operating: condition any part of `said sewage disposal system during the'perioil ance of the approval'-of the Certificate of, Construction:= Compliance of the original_system or .will -be located as shc*Jn on the approved plan and that`said'well: will be installed in= 'accordance wi �County'Department of Health �: �k``� � '.� Date S i9n et�o ; ;? Address ` x k APPROVED, FOR CON_ STRUCTl This approval expires one year from the date "issued unle .,'revocable for cause of mey,'.be amIended , or- modified Gvhbn;consider_ed nece`ssary_._ by, e4Coinmiss requires' ' a new .permit .Approved for disposal of doroeeti san ar wage, /o Date _ — ? BYCC C7 0 ti. abatable Space Square Feet . hneai feet --X width trench 7. ed: system(s) i).'that the separ ate 'Sewage disposal system ce „with thii,Siandards,'rules an regulations of e u nam ornphance ". saGsfacforyto the Commissioner of Healthwill essors heirs or assigns by,dhe builder', that said builder will. of two (2) =years immediately following the'date of theAssu- anyrepairs theretoy2) that the drilled weli'described'above , h :the rds, "rules` and regulaons of the •Putnam P E - R.A. * License No./ 'construction of the L. bwlding,has* been undertaken and is mer oft Health Arny" change :or- alteration of 'construction WX -�nIY ' : • F * r Title ' -n•'M1f BRGWSTER LABORATORIES Box 224 - BREWSTER, N.Y. WATER ANALYSIS REPORT SAMPLE No. 2651 SOURCE: Forrester Builders, Inc. — faucet Mountain View Road Lots 8 & 9 Patterson, N.Y. COLLECTED: Jan. 31, 1972 BY: Wi l I tam Bush BACTERIOLOGICAL EXANIINAnON Coliform Count, MY Method 0 per 100 ml. This result indicates the source of the sample was of satisfactory sanitary quality when the sample was 'collected. Feb. 2, 1972 Roy ickwit P. E. Director OWNER OR : URCHASER OF BUILDING BUILDING CONSTRUCTED BY RL LOCATION - STREET BUILDING TYPE �g! Vic+ n MUNICIPALITY SECTION - WARD OCK OT 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 guarantee to the owner, his successors, heirs or assigns, to place in good operating condition of two years immediately following the date of completion 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 wilful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the deter- mination 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 wilful or negligent act of the occupant of the building utilizing the system. Dated this _JILday of��,�,� 19 Signature at,,e,` ul Tott Title PLACE & STATE CORPO ADDRESS) GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health WELL 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 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 1 ADDRESS 1 %j� q �J �— ! ✓L'�Pol /N LOCATION (No. & Street) (Town) (Lot Number) OF WELL / r j� BUSINESS ❑ ❑ ❑ PROPOSED LL DOMESTIC ESTABLISHMENT FARM TEST WELL USE OF WELL ❑ 1:1 ❑AIR CONDITIONING ❑ OTHER SUPPLY INDUSTRIAL (Specify) DRILLING COMPRESSED ❑ ROTARY 1:1 PERCUSSION �ABLE ,� OTHER ❑ EQUIPMENT AIR L� PERCUSSION (Specify) CASING LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT RTHREADED [] I DRIVE SHOE RI ❑ WAS CASING G� UTED7 D TAILS WELDED YES NO YES NO YIELD �� HOURS ❑ ❑ Eg- G.P.M. YIELD (G.P.M.) TEST BAILED PUMPED c-OMPRESSED AIR WATER MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST f feet) Depth of Completed Well / LEVEL 01211evlallpl P 4(/ 0,!6 in feet below Land surface: MAKE LENGTH OPEN TO AQUIFER (feet) SCREEN DETAILS' SLOT SIZE DIAMETER (Inches) IF GRAVEL Diameter of well including GRAVEL SIZE ( lnches) FROM (feet) TO (feet) PACKED: gravel pack (Inches): DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, two permanent landmarks. to at least FEET to FEET r I BOYD ARTESIAN WEL If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE RFD 9 DATE WELL COMPLETED DATE OF REPORT WELL DRILLER (Signature) ROUTE 52 Jhl 30 / L C� 7 CARREL, :4.Y. - FA a Co 2 4 5 Notes 1)'Tests to be repeated at same depth until approximately equal s o il rates are ob- tained at each percolation test hole. All data to be submitted -for review. 2) Depth measurements to be-made from top of hole.. FUTNAM COUNTY DEPARTMENT . OF H—ALTH DIVISION OF E NV IR. ON L E N TAL HEALTH SERVICES DESIGN 'DATA SHEET SEPARATE SEI,�;AGE DISPOSAL SYSTEM FILE. NO. Owner ;i, Address He& T o Lokh_ c ate d at ­(Street).—_ - Sec. y O�It* L Lt o (Tndicate nearest cross street) f '&:i4- Mun ic i, p Watershed. SOIL PERCOLATION TEST DATA REQUIRED 'TO BE SUBMITTED WITH.-APPLICATION Hole MI, mb e r CLOCK TIME PERCMATION,,, _:Or; 'C . ATION PEROL n, Elapse Run . Depth to Water Mator. Level. No. Time 'From Ground Surfac,e Os tx.-Jit`&hes Soil Rate Start Stop Min. Start Drop in Min/in.drop' Inches Inches. Inches OR, 2 3 fd)4L 11101.- _1'604t 4 2 4 5 Notes 1)'Tests to be repeated at same depth until approximately equal s o il rates are ob- tained at each percolation test hole. All data to be submitted -for review. 2) Depth measurements to be-made from top of hole.. 2 3 LL f 2 4 5 Notes 1)'Tests to be repeated at same depth until approximately equal s o il rates are ob- tained at each percolation test hole. All data to be submitted -for review. 2) Depth measurements to be-made from top of hole.. 12't .. :. 1811. 30 3:6" .42 14S ~t. S4 6611 78t1 { 8 41: TNDTCaTE LEVEL AT WHICH GROUND` WATER. I'S ENCOUNTERED: � ::;.� INDICATE LEVEL TO WHICH WATER EVE RISES AFTER BEI \'G NCOU'NTE D TESTS °LADE BYE Date �® Soil Rate Used_® Min/1" IG Drop ": S:D. Usable Area Provided No. of Bedroom s Septic Tank Capacity @.g °Gals. Type_ _ Absorption Area Provided.By. L.F.x24" 36" width trench. Other o a ® 00 Name John H. Prentiss,P.E.- C.E.C. Sio ature °NA Address R. D...6, B 353 Carmel; N.Y. 10512 PUTNAM COUNTY DEPARTMENT OF HEALTH Soil Rate Approved Sq. Ft. /Gal. rs s r Az No. Checked b'' AFT �SEO Date e y N. ST _ r� ' .dam !. • r � ^ >a y P^ Q ; f'f \i; S rra 44 r. !, t 0 -v 7 a j I tt t 2tFy r tut o { Qr I �- o j�F•i'. � �f� � t ° '..pit 1�mw5�1 z •�+a" C h , PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR 'ES N Internal Use Only' ©� ❑ Repair Permit issued in last 5 years ❑ Not in Watershed ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. Delegated ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland lJ Joint Review SITE LOCATION SS MT. VIEW jt At> pATTEP,Sor( TM # 23 •(�- (''6�% OWNER'S NAME PHONE # 9`78-7-696 MAILING ADDRESS S5 M T V104 F-oA O PAj T6F S0/N NY 1 25-43 APPLICANT JOAO A• �P�IN, �.E Name & Relationship (i.e., owner, tenant, contractor) DATE 3 7I o7 FACILITY TYPE P-64 ID6NI.�. PCHD COMPLAINT # PROPOSED INSTALLER, PHONE # ADDRESS l 3 7 D 14-TUi REGISTRATION /LICENSE # S4vtvow fit e, Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed trenches) KOTE: Repair must be in same location and of same type as original sewage disposal system. Offerent location and proposed pump systems will require submittal of proposal from licensed professional eigineer or registered architect. o­/Ps or a �- .Q�ep•f /o,�is+ •for- .�or;rkt;c aS�iS�a.u�G�, I:as owne c6rP�rpb�ted ae caner agree to the conditions stated on this form 9GNAT TITLE 0,l IA.�, DATE 'a7 1 •O 7 Procure �tp}`a��irsketch it, if applicable. Submission v, -- i 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 d. System description (e.g., 1250 gal. Concrete septic tank, etc.) e. Installers' name and phone number ! System repair to be performed in accordance with the above proposal and conditions. ?roposal Approved 'y . Proposal Denied Gc4-'15, PLX;As6 eo"TAc T M%� FOf S iTV VtoIT (11Y 117 -57YJ 'RAN ogcl�). pz_ej:;�L, i� 110-L Y_ /0 0 7 5s P ector's Signatu e & Titl& Ddter OPIES: White (PCHD); Yellow (Town BI); Pink (installer), Orange (Applicant) IC -RP 99ML tev. 8/05 Great 64 311 a Swamp 12563 1312 )� S.W. Nwh St. T ;.'"('Mendel Pond ag ibeci-, Pond Lake Charles DuN 22 o NILL AD a' ,N. Mount Ebo Corporate HS wN GES DOUFI, u011g k Vice 0 Id Old Southeast Church 312 - I 1 0. I Q arv; em 0 LOOK MOU DR ern rewBter p It Woods BO'.: Biook. A. eservoir. ,, Vice 0 Id Old Southeast Church 91 65 W:�lwrlrm 312 - I 1 0. I Q arv; em 0 LOOK MOU DR ern rewBter p It Woods BO'.: Biook. A. eservoir. 91 65 W:�lwrlrm S h ect_/ of_� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLH SERVICES FIELD ACTIVITY REPORT ._...hZ- • TP,: 4578 Street Town State Zip PERSON IN CHARGE Name and Title TYPE OF FACILITY : Z &rz2 /%z n FINDINGS: 4r-X15jZAZd 40l- Z7 X72 2>07e- R�AA) SUrkM (TD ice. 0i I U 4 -- rwAmln-,� gTS DNS t(Qee b4 �x2S Yitq M p 13, Ok, Tal Signature and Title RF, PC1 r�r.nFTVFTI RV• I acknotdge receipt of this report: SIGNATURE: 02/96 Title: ��- WELL wi 1>'okY.c••P�e ' 1 511.TFENct j 'S t lop • �►, .�,� . �.j'c�. I SP�ri.�rF 8 N�TF.F.rt�s WELD CN =I e EA (3.t osl.F Toth) t; } s < •-.i. s i j3 j u L 3 �_ ; n -:. !EiJ1. Fo BE t6t+TGFF.b11N t3ETw66rJ �5 XZ ff � '� .. Y ^.I)� `F "(,k,,��,yy1��"'�� •i 2-Y� jd' .J_ j 1 - .e,,, .L /' _.•_I, $d : .t�4 s # f :i .` $ EX J Bwc C.TYPJ _ x ' Nfp w(7+�ilVG. �• MIN _ 1 ; x' iN -- } I .LUO pOG Pi/E IN . I� - ;31'I. NIN Plftfl i OWNE� c E{AE� ES I� AF4114 S i s r a y h ay �4 ^.. 1 .. CE ARiCNaaNttb _ r r lNSbQL;Ib� N��za '� QE'i�Y t 3 ��r� � . ) � tN pt•A�E. �-- EJ(' NATE�.GOrt�, PE A> Cv PP °Tr TY w,4& NFi $}6 jNFD(�+A7�Dlp�DF.Oct p' ' s wo REVSE�. �...........SI'Y ` p . / � . Povl t �Y 1, -., !0t- t °cast a�vb I� y��z \ ' S ,t+i GV4Vi5 n p s r 4ter NO. r,z T 1 _r PRat£�r: I���tla5�i �EsIDENLE SSTS 200 jP H0 4; PMPA(W Gy �joNr� . • i-N -t tl P.r,. SlAf AVC, AWWIVN NY O Fax:914- 773 -0343 Apr 12 2007 11:14 P.01 o c`TY dEPARr4f, New York City ter. Department of �' �;' Environmental Protection SUBSURFACE SEWAGE TREATMENT SYSTEM REPAIR DETERMINATION Pursuant to the authority granted under: Article 11 of the New York State public Health Law; Rules and Regulations For The Protection From Contamination, Degradation and Pollution Of The New York City Water Supply and Its Sources, 15 RCNY Section 18 -38 (or Chapter 18); and 10 NYCRR Appendix 75 -A Wastewater Treatment Standards - Individual Household Systems; Putnam County Septic Repair Program Plan -- March, 2005. DEP Project# A PCHD Repair# Site Location: �'►� ' �i e w �. �t�Vs6 •-� T.M.# "� 1 Reason for Joint Review: Drainage Basin 200' of WC/Wetland Repeat Repair in 5 Yrs. Name of Owner: dkirfm krr,ri r k i Owner's Address: 55' AJ- life L) r4, ' a,1 pv-t, h Drainage Basin of Project Site: 6'r"14 E'ci L.,c Installer: -M t General Description of Sewage System Repair: Dates of Site Inspections and Sons Tests: Approved *Incomplete !/ Delegated "Denied *Required: Soils Tests * *Reason R a�WC/Wetlands -I,- . 4-'J"L - lkt's -rl Wells Other A7vte-r eulvP ih r5x Determinatio de by: Z/ // 2- Engineering - ton Date