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HomeMy WebLinkAbout1156DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.57 -1 -6 BOX 11 01156 f - - � 196 , � - ., f ML ` rl , 1� r ' J , 01156 ` a• �'r � ' F ,• i y ` x 3 r-,` A) �� f, '�1 1. � DEPARTMENT: OF HEALTH COLTY - Division of Environmenfel Hea /ih Services, Ca&W N Y ,1,0v CERTIFICATE OF -CONSTR:VCTION COMPLIANCE- FO,R SEW.AGE.- DISPOSAL SYSTEM Patter son To wn or V�Il g e a Lakeshore) & Hud`sone Drives..:: Located at Section Block owner Mr. & Mrsa \46 n`. Royce �ot2674 =8 & ` 2722 -6 In�b: ..S01601 se crate sewers e S stem built by Thomas .Gfil l en Address l0: Mal onev Ln New Mi 1 ford, T ' 06771 . 1 Consisting,cf 1000 Gal: "Septic`Tank i 239, J!"' neel Feet:x 36 >4nch' ''Width' trench Other. requirements Effluent .P1'be �Verfl ow Tank & Al drm SaCSf Pm .. ri Water Supply: PubhcnSupply-•,From X Candlewood Ar <teslan We`ll Drillers Inc:' Private;Supply.Drilled'By 1.82,Clapboard, Ri 'dge.,..Danbury;_,CT.'0681.0,.. Address Pre =Fab re`e C e e Building TYpe v ;No, of Bedrooms Th Date Permit Issued 37j/2V�7J Has Erosion Control eeen Completed? Yes c' t certify that the systems) as listed serving the.aboye premises were constructed essentially as shown on the plans of the completed work (copies of which are attached), and irv, accordance with ;the,'stendards, rules and regulations, .plans filed, end:th'e permit issued "tiy` the °Putnam '. County Department of Health. 16 September 1976 P x X Date Certified by E R A Address' R. D.. 6 ' Box >35 armel NY� 1051.2 �icense.No 29'206 Any person occupying premises served by, the above systam(s)` shall;;p► ke such action as may "an necessary to'secure the correction of any unsanitary 'conditions resultin from such .usage. ,Approval,.`of the'sepa►ate Overage; sy em'shaI me hull d void as soon as a Putilid sariitacy •sewer ,becomes ` .9 available and the approval of the::.private. water supply -ihall be t me null and did"', en a', p lic' water supp ecbmes, available..:. Such, approvals are subject'r,to mo fiwtion r change when; ; in the judgment the'Com "stoner Heal m i#ication or change is necessary Date , 0 co( June 30, 1975 ems" To Whomjt May C oncern. Re: Sewage Sy-stem Lots 2674 -78 & 2722 -26 Lake "Shore Drive Putnam Lake, Patterson, N. Y. - in order to obtain -approval of .a.n - application for sewage system construction, variances from requirements for separation distances from the'Oroposed well to neighboring sewage disposal systems was. :. necessary, The well on this property is thus located closer .to sewage systems than specified in ou.nty e a gu ions0 e p p of this statement is to put this fact on record for future owners of the property: State of New York County of Putnam Sworn be orem is �A P t :0 1 +.'sq Wgsicficat 1Aeirch Signed; Day of June 1975 Re ,Orded in the Clerk's Ofon the tnam the GO: 1(2 of P �.� day Of ........................... . er: toe►t :; , o t �..h�ino at... .hours and... 6 . of........................ i.n .gook No ......................:... ared. �o.,K.and comp off. page ...... ........ r.� f 3 V;,;.. co( June 30, 1975 ems" To Whomjt May C oncern. Re: Sewage Sy-stem Lots 2674 -78 & 2722 -26 Lake "Shore Drive Putnam Lake, Patterson, N. Y. - in order to obtain -approval of .a.n - application for sewage system construction, variances from requirements for separation distances from the'Oroposed well to neighboring sewage disposal systems was. :. necessary, The well on this property is thus located closer .to sewage systems than specified in ou.nty e a gu ions0 e p p of this statement is to put this fact on record for future owners of the property: State of New York County of Putnam Sworn be orem is �A P t :0 1 +.'sq Wgsicficat 1Aeirch Signed; Day of June 1975 Re ,Orded in the Clerk's Ofon the tnam the GO: 1(2 of P �.� day Of ........................... . er: toe►t :; , o t �..h�ino at... .hours and... 6 . of........................ i.n .gook No ......................:... ared. �o.,K.and comp off. page ...... ........ r.� f 3 I' June 30, 1975 To Whom It-May Concern: a Re: Sewage System Lots 2674 -78 & 2722 -26 Lake Shore Drive Putnam Lake, Patterson, N. In order to obtain approval of pLki•application for sewage system construction, variances from requi- rl-ements for separation distances from the Proposed well to.,neighbo•ring sewage disposal systems was necessary. The well on this property is thus located closer to sewage systems than specified.in..County Regulations. The purpose of this statement is to put this fact9n record for future owners of the property. Signed; State.of New York County of Putnam Sworn be orem is Day of June 1975 10�1N FISHER _'•,��. N�! ►ubik, State a4 N+tD - No. 60-1231451D dtloliffltd ie w,rpstch3ster Covft 11bron expires March 19r r�a �P �s „- r�a �P WELL COMPLETION REPORT f-,tPUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This repo, -p t -is to be-completed by well -driller -an6-su1,;-.fltted #o Co,unty. .Q. of Health _ :department together with laboratory report 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 ROYCE,* Mr. & Mrs. John ADDRESS Patterson 2674-8 & 2722-6 In (No. a Street) (Town) (Lot Number) LOCATION OF WELL Lakeshore & Hudson Drives, Putnam Lake Su6d. PROPOSED BUSINESS DOMESTIC ❑ ESTABLISHMENT ❑ FA RIA ❑ TES EE ;9 USE OF WELL . PUBLIC AIR OT ❑ CONDITIONING (Sp SUPPLY INDUSTRIAL DRILLING or_r 16 6 r-/je(5JM`PRESSED CABLE OTHER ❑ lVI ❑ PERCUSSION (Specify) EQUIPMENT ROTARY AIR PERCUSSION CASING JDFTARS LENGT� ea�f R(inches) WEIGHT PER OOT 1, J!R�ITV E [�A S T11P i DIAMETER(inches) ED t�o -THREAD -YES A If WELDED _Y YIELD HOURS P.M. O'BAILED 9�_PUMPED FICOMPRESSED YIELD (G.P.M.) TEST AIR WATER MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST fleet) A Depth of Completed Well LEVEL r to in feet below Land surface: o/ MAKE LENGTH OPEN TO AQUIFER (feel) SCREEN DETAILS SLOT SIZE --DIAMETER (Inches) IF GRAVEL Diameter of well including SIZE (inches), FROM (feet) TO (feet) PACKED: A C LKE D.-! L] gravel pack (inches): DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. ... I FEET iv U 7- 7 • X-9 r If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE C;z DATE WELL COMPLETED WE OF REPORT WEL RILLE 9na J) 11ture), _A a C1 \4 •t BREWSTER LABORATORIES Box 224 - BREWSTER, N. Y. WATER ANALYSIS REPORT SAMPLE NO. 3 728 SOURCE: John Royce'- hose Bibb - well supply 244 Lakeshore Drive Brewster, New York COLLECTED: Sept. 10, 1976 BY: John Royce BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 0 per 100 ml. .N SEP 1 `'' OHN H, This result indicates the source 'of the sample was of satisfactory sanitary quality when th[ sample was collected. Sept. 11, 1976 r' Aoy Bkkwit P. E. Director Mr. & Mrs. John Royce Patterson Owner or Purchaser of Building Municipality Owner Building Constructed by Lakeshore & Hudson Drives Location - Street Pre -Fab Building Type Putnam Lake Subd. Section Block 2674 -8 & 2722 -6 Incl. 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 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 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 de- termination of the Director of the Division of Environmental Health Ser- v c.oa . of -.the. Putnam..Goun.ty. Department of - Health .,as_. -to • whether or, not the, failure of the system to operate was caused by the willfu 'or neglig7nt act of the occupant of the building utilizing the syste. Dated this day f Jul 76 y Y 19 Signatu e 10 Maloney Lane Title I corpora (5n, give 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. Division of Environmental Health Services, Putnam County Department of Health Mr. & Mrs. John Royce Patterson Owner or Purchaser of Building Municipa ity Owner Putnam Lake Subd. Building Constructed by Section Lakeshore & Hudson Drives Location - Street Block Pre -Fab 2674 -8 & 2722 -6 Incl. Building Type 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 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 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 de- termination of the Director of the Division of Environmental Health Ser- vi.ces. of .the -- Put -nam.- •Comity 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 system. Dated this J-6 day of July 19 76, Signature ^_ k Title O NER If :':corporation, give 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. Division of Environmental Health Services, Putnam County Department of Health WHEREAS9 John J. Royce is the owner in fee simple by deed dated lay 169 1975 and recorded in the Putnam County Clerk's Office in Liber 721 page 1153'of all that certain plot, piece or parcel of land with the buildings and improvements thereon erected situate,- lying And being in the Town of Patterson, Putnam County, New York.*knoi�m and designated' as Lots 2674 to 2678 inclusive on a certain map entitled "Fourth Nap of Putnam Lek-e9 Putnam County, New. York and Fairfield County C onnecticut" T filed in the Putnam County Clerk9s Office on March 20th, '.1931 as file number' 149-C ad Linda Royce, his wife 9 also knola*1 as . Linda 0 Donx .ell her maiden name is the owner in fee- simple by deed -. ated !'-lay 16v 1975 and re- corded in the Putnaki County Clerk's Office in Liber 727 page 1041 of all that certain .plot g piece or parcel of laird, �with the build- ings and improvements thereon erected e. situate, lying and being in the. Town-of--Pattarson, Putnam. County, New Yorkv. known and designat- ed as liots'2722 to 2726 inclusive on a-cexAain map entitled-17ourtj Map of Putn= Lake, Putnam County, New York and :Fairfield Country Connecticut" and filed in the Putnam County Clerk's Office in March 20, 1931 as. file Nwiiber 149--C6 M -aade t o the Putnam County Board REAS, an appeal was i of Health for a variance from 'the Count-,y" -.Regulations for approval �3 of a proposed well location on., the above noted -property.and the granting of same conditioned upon the filing in the Putnam County Cleetcls Office of this statement and for such, purpose we do hereby declare that: In order to obtain approval of an application for sewage.system construction, variances from requirements..for. separation distances from the proposed we,ll`to neighboring sewage disposal syst:ems are necessary. The well on thin property s thus looat,ed closer to sewage systems than specified in County Regulations© The purpose of this.6tatement is to put thiP fact on record for fu ;are.- owners of the p i erty, IN WITNESS W1 REOP, We have signed and sealed these presents on the �day of. August e .1976'0 J MN .J R. CE LIMA-' RO - L1N " O v DONNELL S� I 1 1 STATE' OF NEW YORK SS.- COUNTY OF On the 1-7L day of August, 1976 before me _personally came JOHN Jm ROYCE to me known to be the individual described in and wh executed the foregoing instrument and acknowledged that he execute the same o l rl ; SAUL SROUR Notary Public, State of, New York No. 31= 9141953 Qualified in New York'County Commission Expires March 30, 1978 STATE.OF NEW YORK COUNTY OF New On the/ day _of' Au us�.Q, X9'76_ before me personally e..me..., LINDA ROYCE aka LINDA 0 ° DONNELL to me lmoim to ..be the individual dese'ribed in and Oho executed the foregoing, instrument and ack® how'ledged that she execs tea the same, X) SAUL SROUR Notary Public, State cf New York No. 31. 9141953 Qualified in New York County Commission Expires March 30, 197 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Envir&me#iwl Health Services, Garm% r '"Y_ 16d17,' C6 STRUCTION. ~PERMIT, FOR SEWgGE'yD1SP)$AL_SYSTEIVI Patterso T n - - 4 - - - OW n r o Nrlld h . 8e . Located at _Lakesh6re. _$1 fil�d.sO lydyes Seetion Block Putnam fake 2674 8 & 2122 ^6 �.nc5 SA1.601_ Subdivision - ;. _ tfob Owner ' ' & Mrs �O�ln. _ROYGG Address ! 2 E. 4$tit. ,S 1, p s- 'Building 'Type.. Pre -Fab tot Area: 2000 a : _Ne ftLa MY, -10022_ - Number of Bedrooms -rte Total I fabitable Space - - $quare 'Feet• n c C.. Separate Sewerage System. to' wt)sist of Lineal `fees 'X _ 3v 1�nCY:1- width, trench To be constructed by - _ ? e Water. Su PP 1 Y• ., y XAv - Public Su PP IY From - - - - - P..rivate- Supply to be, drilleds +bYr fit_ R, 4Y 1;Q�rat� 'A1; Other Requirements ar - T rf q {' :represent that .l arri Wholly and completely responsible for, the design and locatiow(6o j the prgposed' system(s);;` 1) that_ -the separLate sewage disposal., system above described Will be constructed as'showil on,th approved al e; ment "there to, and imaccordance with the. ;t8ndards rulesan '7egu a eons o e u na County +Depar`tment of Health, And that on.compl-eetro6'thereof a "''Certificate of Construction Compliance e +satisfactory to the' Commissioner of Health,,will be'su"itted ,to -The Department,,,`fand a ,wYittem.guarantee will boy'furnished the owner his,successoi , hei_rs`.or assigns by the, .bur1der,3;hat,sa1d'bdider',w0f place in good . optlratirig+ conditio`rir any part of said sewage digposa� .system during ahe period sof two (2) y,;earsxim`mediately following ;the:date'of, the Jssu- ante •of` the approval of :the Ce[tifrcate:;4f Construction 'Gompl�an2e of A_he oY:iginal - system for 4any, repairs t "fiereto; 2.)"that ,then dr_illed'welP described above will be located asshown on the approved, plan and that said w-elliWitl 6e installed ln accordance -.with ,fhe andards, rules and regula irons , of . the '.'Putnam County Department of Health.� r Date 8 +� I7�J Signed4 U f AddJess 8 _ "•Laicense No 920 APPROVED FOR :C,ONSTRUCT.I.ON Th:)s aPPro I expires o ear rom.t`he date issued unlessAconstruction, of -the buiiding;has,'been• undertaken and is revocable for cause or may be amended or modified:wh onside ed:nece "ssa"r' +by the Commissroner of Health 'Any ehange;,:or alteration of construction requires a ri w per ,t�/4pproved for disposal of me c rtary se ge -pr a _water supply only � .;�,� r'yi�,��d 1'1G� -py, . �, t S- �`�.�C. .,w� u` �,,'. *t'�� � ±'�6•�,1C -� �..,< 3�.: �`� fief t'� W.���1�' .... v, .. .- _. K. M 1k 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 IIr, ee' M- . / ov _& Address r(e1 -� ��/SOh D.- :ve Located at ( Street 101. ,a'Q•n ��� Lot �Iftdicate'rfearest di cross street) Municipality /,W, O„ Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE.SUBMITTED WITH APPLICATIONS 3 Notes: 1) Tegt, %;,to be' repeated at same deptri until approximately equal soil rates are obtained at,Oach percolation test hole. Aff data to be submitted for review. '' =`' 2) Depth measurements to be made from top of hole. Hole _ Number CLOCK TIME PERCOLATION PERCOLATION Hun Elapse Depth to Water WaEer LFvel No. Time From Ground Surface in Inches Soil Rate' 'Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches / 1 d93i, 0A3 2 243 0 9 l3 ys l 3 4951 Iota A01- 2J: 4 /oio T of— 2 TT o9 3 Notes: 1) Tegt, %;,to be' repeated at same deptri until approximately equal soil rates are obtained at,Oach percolation test hole. Aff data to be submitted for review. '' =`' 2) Depth measurements to be made from top of hole. __......._._..._.._ _.. _.:_TEST- PIT — DATA - REQUIRED - -TO BE- SUBMITTED - WITH- -APPLICAT`I- ON°---,-- ---- DESCRIPTION OF SOILS.ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE N0. HOLE NO. G.L. 6�' 18" Loges. 24" 30.' 36" 42" S.. 0 48'! "� s" . 66" = .72 If 7811 ICAT ' LEVEL -AT' WHICH GROUND WATE UNTERED /ems .'io.n .S'wiri'$cr+ INDICATE LEVEL TO WHICH WATER LEVEL ISES AFTER BEING ENCOUNTERED /d'' To ::.`TESTS MADE BY DESIGN. Soil Rate Used //-/4- Dtn/l "Drop: S.D. Usable Area Provided Ddo No. of Bedroomsr�� Septic Tank Capacity, O 0 0 Gals. Type_/�'f�,r -a _ Absorption Area Provided By �� L.F.x2?+ "j '��- width .trench:` Other Address . . LEI THIS SPACE FOR USE BY HEALTH DEPARTMT ONLY: c Soil Rate Approved Sq. Ft /Cal. Che N PRe,y�/ yyf G �r `PtP� \ N ),"� TFD ate y �Sl .