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HomeMy WebLinkAbout0692DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23.12 -1 -1 BOX 8 ga IL III Kal 1. ,�. , ` f ii . , ` 4 ' I - AIL. 1 L 00692 PUTNAM COUNTY DEPARTMENT 'OF HEALTH ENGINEER ' MUST Division of ;Environmental � Haa /th :Services, Caimel, N °,Y 10b 2 PROVIDE' PER - - P MIT # •':. CERTIFI'dATE -`OF,CONSTRUCTION .COMPLIANCE F' OR``SEWAGE DISPOSAL SYSTEM Town or Village Located at rf r Tax Map v :Block J n Owner— r/t Formerly Tax -Map Iat: A Subd Lot Separate Sewerage. System built ,.by Address Consisting _ of. �� Oal.•'Septic Tank and tp'� Other requirements: " Waiter, Supply:,' 1 Public- Supply.;Frdm i Private .Supply' Oiilled;,BY Address' _ ' t Building Type���� No.' of Bedrooms Date Permit Issued .Has EfOflOn COntrOi Beer) COmpletedl • ;Has garbage grinder beeir installed? r I certify that' the system(s) as listed serving the above`premises' were constructed essentially as shown on the plans of 'the completed work ( copies Y , of which are aitpched},•• and in:accordance with. the, - standards „rules'and; regulations, in accordance; with the filed plan, and the permit aseued by the Putnam County.Department Of Health. Date. %C,l -� �� J��R t Ce►tified by P.E. R.A Addreu License NO.- Any person .occupying` premises served' by.the above, systems) shall promptly. take such action as may'ba necessa►y to securelh correction., of any'unsanitary' conditions retulting -from such usage. :Approval- of,,thetsel; rate fewerage;system,fhall' become null'and'vold "as aoon'as a' public, sanitary sawer bscomei available and the approval. of the private water suppiy - shall become null and -,void,. wheA a public w ly„ becomes 'availabla ti' :Such appiovaIs, are ,. subject to modification or change when, in'the, }udgment` of,the- m r •of Health, •such evocation; odlflerttl0, orchanIle Is necessary, ,. Oats Title i • .•.. ... v. e•••n rrnnarll•I 11Y/1111 Y /100111-1 • — COUIJTI' OJ'FICC DUILDING • CAnMEL. NEW Y This report is to be 'eompleted by well driller and submitted to County+lcalth Department logcther with laboratory report o1 snaly;i; Of'waier Semple Indicating water t; pf sati;taetory bacterial quality before eertlfiertc of con;truetion compliance is fssuc!!. REPORT If UST (IE SUMAITTED WITHIN 30 DAYS OF WELL CO- MPLETIO:J — '-' tw.a.t ADDaLSs ownit Classic 'gores, Inc. I !Ite. 22, Brews :er, Ic y �OCR.TIDN l ., — IMO. a 3weU ; -? • n :�� 11 orp) P :. 1- r c r (LOP A ✓moerl OF WLU t'tDPQSEG DOMESTIC BUSINESS D LSIAtI SHMENT 0 VAW TEST WELL USL OF o `i1LLL S rustic PPLT D tNDUSTf.IAI All CONDITIONING D OspME'1 L..J SWILLING R07ART COMPRESSED 't AIR PERCUSSION CABLE D OTHER QUIPY.Efn1 10 PERCUSSION ISe.�:lr1• CAtS ING L11•G)n flealj L'lAML1t111ALAe3) 6 wtlyril Its tool ( 19 . ❑ W:1 VI SMO!� �Aj LA. j�P4, � �r- ((-�� ox DETAILS 50 I THREADED WELDED TES Lj NO 1 L`' j 1'ES U NO nrLD 11 "Outs TILLD (G.P.M,) . -- TEST LA1LED PUMPED " COMPRESSED AIR 4 60 60 �JATFR ALASURS 110M LAND SURFACL— S1AIlC(Speugfeet) DUa1NG ft TILLD TLS1 et) � Depth of Completed Well UYLL Overf low 305 � In rest below. Lend surioze: 305 MALL I.SGIM OFLN 70 AG:i1FEi =LtEEN� DETAILS SLGi 5:.: + OIAMLILt (mends/ IF GRAYEL I Diameter of well inclvding GRAVEL I= (rncncs) ftOM (feel/ 70 usat)— I PACKED: etorel pock (1ns!1ef): I I IN PE:rrr %A• ::) FLIT n FIST i ! FORMATION DESCRI7710H 0 20 lclay,, -silt & boulders. 20 3c I Soft weathered b- edroch. 30 305 Hard granite. Sketch •tact loevoon of well with distances. to at feast rwo perR:enenl tanomems. if yield was trued of oine•ent dertht dvrino dr:IGnC, Lot boio.r ` ItET GALLONS rLt MINUTE 305 60 \ J� =t /t�•,. —ttitJ i Unj�[ � R IiT I%vt :.1_L 01411 -1-01 (iron, tut C Z4 141"r A LL— ®d. ga.A -'v&J lilt �iDl�Y9 �1 , 4 BREWSTER LABORATORIES Box 224 - BREWSTER, - N.Y. (914) 225 -2072 . WATER ANALYSIS REPORT - SAMPLE NO. 6037 SOURCE: Classic Homes Inc. Bullet Hole Rd. Patterson, NY COLLECTED: January 3, 1986 BY: Mill Drilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method Well p per 100 ml. This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. January 9, 1986 Roy Bickwit P.E. Director CLASSIC HOMES ' Owner or Purchaser of Building Classic homes Building Constructed by Bullet Hole Rd. Location - Street Patterson Municipality Raised Ranch Building Type 73 Section 4 Block 4.2 Lot 'r 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. Dated this 14 day of Feb ` 19 86 Signature 2 a, 4W Title v Corporation Name if core. Address 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 Health] I PUTN AM COUNTY, DE Division of Enviroh iiii a1: Heal r CON8T UCTION PERMIT FOR SEWAGE' DISPOSAL SYSTEM Located at 1 lLCPfG2 �(p 9, Subdivision subd. 161- 4 Owner %Addzese Z // , _ ,Building TYP ..Lot Area'_(? :'Number of Bedrooms ;�' ` Deaign:Yloui c /P /q O© .: d Separate 'Sewerage System to consist f Q• 9!(, S F' :,.,,to b'e' constructed by ,water' Supply., Pubtic up Yom Private Supply "to, be drilled iby'` Adtlress Other. Requirements. 9. represent that, ,am wholly antl completely- responsible for the design and to ..- t r: .aboye_describetl will be "constructed•'assh own on'4he approved amen Cment the %County Department- of Health; and that.on compiet�oWthereof a "Certifica !ie sutirnitted to ,the - Department; "and a'iwritten guaran "-%: ili 6`i-, ;fur"nish place :`in good 'operating condition any -part of said sewage. di ;posal syste ;ante o1,,,the approval ;of the Certificate' _ f Construction ;Compliance of t wili be' located as "!'ion the approved plan and 'tt at.said well wJl.be Instill County Department of Health c .•Date Address 1 APPROVED'FOR` CONSTRUCTION This, approval' expires one year from t revocable for cause. or may be amended' or. modified" wh2 s,d d necessa �(equires'a:new: permit_ ';Approved (for Aispo -,,Of' dome is ii ryN sewag PP , Date�11 —�—� 7.f � BY L7 Rev. 9 -83 f 11 i IM 4RTMENT�OF HEALTH Permit e th. Serwces, 1^arme% N -Y: 105.12 t N 77 r. Own or Village, t Tax Map eiook Lot. Renewal ❑ Revision ❑ "- ���I', Date Of evioua Approval � _ ' 9 section Only ❑ n P C H �D Noti1'.ication�•Required �' - ` i optic Tank : and L F' t i Address 5,e0M cEkA 6 C caUOn ,of .the proposetl system(sp l) that` the separate sewage, `disposal system r'e 10 and'4n accordance with the Standards;. rules and regulations of - 'the Putnam.. to'. of�Construction:Comphance:- satisfactory to the'Cominissioner of, Healthwill ed the owner - his`wccessors, 'helrs;o assigns,- by the builder, that sold builder will'',- m;dunngthe per,igd of two :(2) years immediately following the data of the issu- ne original;syste`m'•or any'repsirsitfieieto;'if that the drilled well described above ad Jn accordance' with the'standards .rules_, d:regua ons of the Putnam, uc "- EI R -A License No he' date 'Issued unless c struetion of the'�bwlding has been undertaken and is ry Dy the`- iisioner ;of Health. Any -change or alteration of ,construction. . rwa water su Y r Title PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL-, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Address Located at ( Street 9'j t)Jv6 Q-4.4 1 G4 Sec Block 04 Lot.- 0 o �.. Indicate nearer cross s ree Municipality. " r n . (i RA(Qmi) Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Role 5 Number CLOCK TIME r.. PERCOLATION PERCOLATION apse DepEh to Water; Water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. - Start Stop Drop in Min. /in drop Inches Inches Inches 1 1'-52 2:22 30 2,4 2651, 25/3 22:2- 2 -2.52 3Q 29 2.-CrA/8 2; 518 tI,S 31 s2 - 5:22 80 216 2 4 v 1 1: 55 ' 2 2 2 27 24 27 9 2 2:22 - 2.51 2 9 '.24 - - - - -- 2? 3 2.51 T . 3'- 2. .0. ' a9 2'4- 27 C 4 5 1 :4 Notes: `n'1) ,,Tests +t, be repeated at same depth until a roximately equal soil rates are`obtainel at each percolation test hole. All data to be submitted for review. 2) �D6­th'measurements to be made from top of bole. y� . DEPTH G.L. 6" 12" 18" 24" 30 u 36" 42" 5411 60" 66" 7211 84" TEST PIT'DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN `.PEST HOLES HOLE N0. k HOLE NO. HOLE NO. INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED AoVW- INDICATE LEVEL T HIC11-WATER LEVEL RIS C1,AFTER BEING ENCOUNTERED TESTS MADE BY �IkC tAA ck �`W,, Dater (S — %4- , 2-19 DESIGN Soil Rate Used f l- t7 MirVl "Drop: S.D. Usable Area Provided JrOOC7 No. of Bedrooms __Septic Tank Capacity 1 O C CU- Gals . Type µd4onok 1,bsorption Area Provided By_'Z�L. F. x24" j6"- width trench. Other me Address 1�+9 `r SEAL Lrr�on____i_T ' THIS SPACE FOR USE 4Y HEALTH DEPARTMENT ONLY Soil Rate Approved Sq. Ft /Cal. Checked by Date �� G K