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HomeMy WebLinkAbout0696DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23.12 -1 -6 BOX 8 1 ru I Ir N - ,, Lm k �..*.. .7 !' t Y• 4„ { RUTNAM CUUNTY,iDEBARTM OF HErALTH �. s Division of Enviro mentay� rayealfii Services, ICarm% N Y 10512 `IGERTIFICATE'In CONSTRUCTION: COMPLIANCE iFOR ,�'SEUTAOEr�DISPOSAL'�SY.STEM • , t�. own 0r V :4 T�iMwe _ L Located at Q r, �r 'n ytv ( & -3 T8 fiMap 4 B10Ck L; , ��' DWner *: � .. lIfJI�` •� ;� w Separate 5awerage System � built by cwt A+ dress 1 " - F u Consisting lof ' a GAI 'Septic Tank as +° r5 rt c- iar '`�. Other requirements Water Supply Public Supply From, 1 Private,' w S, v, r �fe 4. ,{ Y4 L. o � Address ' Y y R ` 1 Building Type ��`� hj, No of Bedrooms ` Date Permit 1isi d n zt�rkt`i'Y ,>t }. 7�^ t �i c itii. ti y Viii Erosion :Control Bien ; Completed? s �, r } . r r r -^tr 'My� Frv, + x 7 t. i� l }''A �7 ,,trv�'- i �e , % s,,:y1i,'•a.r l ' $ :ti t 4 a; .: v i., S�' t a' ��' "F�iG ti• r L . j F t S C 3 t t: c, I' certify, that tthe system (s) as 11isted'serving the above.prremiaes weret,,constru(it'ed essentially as shown on the` plans of- the completed work' (copies' of which,are attached),,`'and in accordance with .the standards aulea and re latio y a, +! x`:..;� `e J Y , P Pe - etluedby .the. '. . �� n accordance with the filed lan and the JI' rmit i Putnam Count be rtment Of Bealth r .x Certi ied Y //•� fJ��J PJ iR A 65s ,�G! / G .`» • (,.+' ..Cr i �.i• a Addr �_ �Liiense No� Any person occupying premises se_ryed by -the abovelsystem(s) tshall ,promptly. take such actlons5s may be necessary to secure thg',eorrad 6 .of; any- unsanitary conditions resulting from; -such u_sage Approval oijthe separate seweragesystem „shall become null {pnd yoldyas soon,as a•tRUblie unitary ewer becomes° available and ttie rapproval`bf the private 'water supply ihiillfbecomeiiiull�anq ;void when a`)puDlicw water supply becomes avid 0h., :"Such. approval >s-are.,. sub)ect ;o modif,icatiore :or ehangerawhen, in the fudgment`xof°therCommi '” ner o 'Health, weh rev tion, modif or ehangi' ication Ii ragaary DateE .— , s gY Titre t "" ,x;1...+"3^ +., y.= ,.raYt$ eta- ke -'t-, "� s 41. sr r n, S Tom �t DCA�T�I'`©NS �y f -I'}5, yll,rvry ncwnraI- -v,.xi ht77y35 14b'J[US >•. -F`'�� �d:�.. iFJ �i1 ,i4� »�' A �1�1.•p��� 't=om° yt+..- � ������v� ;Yoik�'o�rn�Ne'i +h�S� �" L�all�59 c,, �r ac a.�� ;,,.::��.+ E �'_:•> +r �: x � KIL� N'�`Y:'1'. -r�G. � ��';�ia �_ �. 201 B'U�T�TON,WO;OD A1VE?:;�PEEKS � ,, .� 0566 737- 8r77�7, ]�^'C.%,4. `�1� #..1�+�� fY+,�`3�Ny.:.,,�Yf wC+g's,../ Jfi.Y,i= 4[ J e•R•r,J Y'::.. bi u^f '�.+Y `� �.. + 35 ro3 4 `Yr.`�,L',+P' , :} •CL ?t '�.1. ,•.. {d VP ' � 'M'��tF`JjiCx� �,i.ti '�' s,'t • �' `tr`. �E L ? � " f,:�,,,� � `� M1Y �,�"> 1 t � � +4 iMA�tiN�ST _ MT KFSGOO �N Y j10549 '666 -3335 :, y .. 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YYry '�liT L?� Ge '�' '.t. 4 S wL','%>`ati �',1 .5'. o- 1T� b. "SJ a _-i't ._.._ i d �'�'%�. . .i �(' Gifu - �� S k'++�•'n ,s :i +ktC .3j.`?,'}Ft?� �' , ..a.; `%'�v }f .,3 •�»4"��'Z�y. �^ R; �i X`S G -r .. -Y t"f 9 � 4 t , i Y a�''Y •i- � lip +."+f•� r�,7� F F �,:�4R - iCLT• n nx � - 71( «�TYMUILLiAG''E LTOWIVb OR}NAMIr OF SUPPLY,ti c h r 5* ey.� 5'I"x. "z; tD "ATE %REPORTED T - tn• t '� "fi s2+r Y a x31t, x F j kr :i 'k� r� ., a ",�;nr P�1.' 8 mt� of ' a4" ¢.,fi aSAMPLING POINT i:r c at< = r..` _ _,.1� cola 4 " � • fF r A` Iate count's" crt?35 ±C 'COLIF OAtuI "GROUP (Most probable Nom /1t,U'Uml� 4� . • -- : ` . ;,i � ;T L,� •,pPm �;'" a � k � BACTERIk.P,ERkML. ,( 9 1P >. x, ?* n.,W "'qqX —, yw• t :e . �i„ P Y r 't'_«.c: C C - - �µiY �ri'�i'�t»'ri'a?i4i�. �? �t %:L�!'LO.SF.. •,:X �,ei•�a:S6 � " -a� T :. ,•fAt �•..4'.se».- ....r. -.x ...:..a..n.. ..t•� .J'. 1Y "bt .x✓"L�. i ._ x u p y�� i €r 3 t . ..uPr�S�'i> ✓ pi Ems 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 Andrew Rosaforte. ADDRESS 237 Main Sto. Mt. Kisco, NY LOCATION OF WELL (No. & Street) (Town) (Lot Number) Mt. View Rd. Patterson 67 -68 PROPOSED USE OF WELL © DOMESTIC ❑ ESTABLISHMENT ❑ FARM BUSINESS ❑TEST WELL ❑ SUPPLY El INDUSTRIAL ❑AIR ❑ OTHER CONDITIONING (Specify) DRILLING MENT EQUIPMENT COMPRESSED CABLE OTHER ROTARY AIR PERCUSSION ❑ PERCUSSION ❑ (Specify) CASING DETAILS LENGTH (feet) 33 DIAMETER (inches) 6 WEIGHT PER FOOT l.9 © THREADED ❑ WELDED PRIVE SHOE YES ❑ NO CASjIN EJ YES NO YIELD TEST HOURS G.P.M. ❑ BAILED ❑ PUMPED COMPRESSED AIR 2 1.00 YIELD (G.P.M.) 1:00 WATER LEVEL MEASURE FROM LAND SURFACE - STATIC (Specify feet) overflow DURING YIELD TEST [feet) total drau/down Depth of Completed Well in feet below Land surface: 225 SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (toot) SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack Onchea): GRAVEL SIZE (Inches) FROM (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET 0 119 overburden FFR 'i PUTNAM COUNTY, DEP_1, OF, HEALTH 11.9 225 ledge 4, If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED 1 li/1i.0/80 DATE OF REPORT 2/1:40/81 WELL DRILLER (Signature) '` L` Owner Ar Purctiasdr of ildi.ng Municipality P3 ,0 Building ConstructE. d by n �x nit �o Location - .Street Block r' Building Type Lot GUARANTY OF.SEPARATE SEWAGE -SYSTEM I represent that I..am wholly and completely responsible for the location, workmanship, material' 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.:di.sposal system, or any repairs made by me to ; sucYl 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 der 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 sy Dated this day of A/O%/,' 19949 Signatu e ,. Title If corporation, gave name and 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. - - - - - - - - - - - r - - - - - - -. - - - - --- - - - - - - - - - - Division of Environmental Health Services, Putnam Co Health log FEB 9'Vbl PUTT 0 H uEF LT 'CEP_ PUTNAM COUNT, DEPARTMENT OF HEALTH DIVISION,OFI'ENV'I-RQNMENTAL...,BEALTH SERVICES COUNTY; OFFICE BUIIQING,.,. CARMEL, - N. Y. -10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISP OS AL SYSTEM FILE N0. Owner Address, AAWA49 I</ Vilew Ab Located *at/( Street) /--:?6 -8�:.LLJW Block. Indicate n 4rest_cr0s,-E04U.ri�t) '-Municipalit, ,.Watershed SOIL PERCOLATION TEST DATA-'REQMRED..TO BA'SUBMITTED:WITH APPLICATIONS Number CLOCK TIME .PERCOLATION. PERCOLATIO• Run Eiapse No. Time Start Stop Min. Dep Water From Ground Surface Start Stop, Inches— Inches:' Water Level in Inches-. Drop in ' - Inches Soil Rate'` Min./in drop 0 3 5/1`0 2 A 7 4/07". 37- -2 ,.7 ao 3 *7Y '\ (A Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH .APPLICATION DESCRIPTION OF-SOILS ENCOUNTERED'IN TEST HOLES.., DEPTH 'HOLE NO. HOLE NO., oZ HOLE, NO.. G.L. 611 12" 24" 3011 3611 42" 48" 6411 60" 66" .72 n � 7.811 84" INDICATE LEVEL AT WHICH GROUND WATER IS.ENCOUNTERED INDICATE LEVEL TO-WHICH-WATER LEVEL RISES AFTER BEING ENCOUNTERED— TESTS MADE BY , Date.,, DESIGN,_ �.:. . Soil Rate Used,-,7 /-- 3o Min/111Drop: S. D. Usable Area Provided­-,' 000" No. of Bedrooms Septic Tank Capacity 6 Ga:Ts' Absorption Area Pr�ov d—eE By• Too.. 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