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HomeMy WebLinkAbout1299DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.71 -1 -66 BOX 12 Oil T I � Uri � ' ■ I� ~ �L ti ' 4L � r 1 01299 �, V 7q 1 V4.1 PUTNAM l`CUIVTY :DEPARTMENT OF .;HEALTH Division of Enlriro mental Health Services, Carmel, 'N K.10512 Putnam Lake SCERTdFICAT ,�. E OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM atterson* •; Town or Village -� •• Preston:,Place• _ , :� . bai A 4 i on T o g R -3405 thri� 3409 section T1Uf 43 . Block :Located at �1] o & Mrs Ronald E. Schlb 1.1` Owner — Lot 'Job �. King ' liiidress Lake Ave e Ex't Danbur Conn. Separate Sewerage System built, by • n y a, - 1 I Consisting of 90� Gal Septic Tank 136 .'8 / ..,59.6• lineal Feet• X 2 • 5.f . /� 3 • f width trench i as per: the; approved^ plan. & 'health department' regulations Other requirements. {l Water Supply:.- Public Supply From p X Private SuPPIY Drilled ,BY Fdvaard SaVOVi SriC. Aderees Allvi Avenue':; Brewster., New. York 10509 l family r@sidBTlce "No of :Bedrooms 3' Date Permit issued '6/04 Building Type; 1 Has'Eroston .0 ontrol Been completed: partially f ine� jtrading•;has :been completed - 'seeding & 60adi g::16 ,t:ake place in^ the :-Spring I q. 1-certify that the'systeni(s) asiisfed serving theabove premises were constructed essentially as shown on the plans.of: the c. om. pleted work (copies of which are attached) •and in?accordance'with the standards,,-rules and regulations .plans filed and th "permit' ued b the Putnam C up y Department of Health. January. 13 197.5 P E. R.A. I 'Date ! `Certified'by • X. 5� Address illt'ovha Road, RA Brew' er NY '1U50� 43952' icense�NO. Any person occupying premises served by the above systems) shall promptly takesuch action•as may be necessary to secure the correction of any unsanitary conditions resulting from such ,usage; °5 Approval of the.,seperate ,sewerage system shall become null andyoid,as soon. as a public -sariitary sewer becomes available and the approval of, the. private water.supply_'shall become null and void when's public water' supply becomes available. Such approvals are subject to modrf�cat�on or change when in the Judgment of "the Commissioner''of Health such revocation modification or .change' Is necessary. Date Z Title J 13 (NOTE: Pre-:5en.t Health Department regulations require that the guarantee form b &,signed by both the systern installer and by the general contractor) Mrs. Ronald EP, Schilb r Owner or Purchaser of Building w J Builders Building Constructed by Preston Place: west side of Location - Street utnarl Lake - (T) Patterson Municipality Tax i ap 4:3 Section 1 Block 1 famil,Zz frame dwelling, 121 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 success 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- vices of the Putnam County Department of Health as to whether or not the failure' 61' `the system to' operate was caused :by the willful or negligent` act of the occupant of the building utilizing the system. SEPTIC SYST14-IX INSTALLER: Dated this /3 day of January 19W- Signature Eofa Ring; Lake Ave. Exto Danbury, onno UbblO GRIPE FL�A,L CONTRACTOR: Title (If—corporation, glue iame and address) 'y - - - - - - - - - - - - - - - - - - War VIES Road; New Fairfield, Conn. 06810 THREE (3) 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. - - - - - - - - - - - - - - - - - - a"AE-LIARZ -19.7 3- - - - - - - - - - - - Division of Environmental Health Services, Putnam County Department of Health c> . b BREWSTER LABORATORIES Box 224 - BREWSTER, N. Y. WATER ANALYSIS REPORT SAMPLE NO. 3360 SOURCE: Shuts - faucet - new well Preston Road Putnam Lake, N. Y. COLLECTED: Dec. 24, 1974 BY: Ed Savoy BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 0 per 100 ml. This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. Deco 28, 1974 4 C/ "SWBickwit P. E. Director VVELB. COMPLETION'REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK. This, repo3•is, Yo be completed by_well driller and sut ,'.sitted.ip. 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 VVJITHIN 30 DAYS OF WELL COMPLETION OWNER NAME w. &Nirs e. Ronald. Schilb ADDRESS Prestbm Po B:3405- B3409 LOCATION OF WELL (No. d Street) 6 PY°estoib Pl. (Town) Pattersono N:eYo (Lot Number) B3405 Tru 8.3409 PROPOSED USE OF WELL BUSINESS DOMESTIC ESTABLISHMENT 1 SUPP Y .. CD INDUSTRIAL FARM (�1 LCJ CONDITIONING D TEST WELL if ) F] (Specify) DRILLING EQUIPMENT a COMPRESSED ROTARY AIR PERCUSSION CABLE PERCUSSION a OTHER (Specify) CASING DETAILS LENGTH (feet) 401 I DIAMETER (inches) 6 WEIGHT PER FOOT 171b ® THREADED WELDED DRIVE SHOE ® YES [I NO WAS CASING GROUTED? tj YES EI NO 'YIELD HOURS D BAILED El PUMPED ® COMPRESSED AIR J G.P.ti� YIELD (G.F�.) WATER LEVEL MEASURE FROM LAND SURFACE— STATIC(Specity feet) U , 32 DURING YIELD TE T (feet) .� 29;� Depth of Completed Well 2 95 in feet below land surface: _ SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (inches): GRAVEL SIZE (inches) FROM (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Top soil sand and! gravel Sketch exact location of well with distances, to at least two permanent landmarks. FEES io ILC6 250: r....:. HQL) u 259M 400 Elk, & White Granite .400 2950 "'-. Rlke & White, Granite © ^f 90 0 . Into rook ther-doubled and eemet: cased with 5" casing 1. If yield was tested of different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL OMPLETED 7V DATE OF REPp• RT 1-i WELL DRILLER (Signature) C11 I :1... i ..• <. r5 .'.lr r ':``S PTI HICi\ yam.^ ( SEPTIC SYSTEM! RESTO S. •PuTM N RONE��S BUILT SGH��p PL ACS." Am .L AK TM +3 el I LOT E 4. TO kJ AI OF^ PATTERSON ��� �'c�. +sy� °�•1 ' !j. C• tl/13/74 I ", IO f , I , i Y� its 1 t y jD157p16`T /ou !! ` i 4 \ bj AIN • 1 �B `\ s0 -e � • CF . 2 T r'4r eF (`wr. �Dr (SEPr1� �. ��` S•YSrFM F. E Sw . N yy THRtt �EDpcor� D ` wELa,�tJ,T • r ��ILDE RS As N�RAI Co"i7•kACTaQ� SE N `4 Cca r ra N KFI�CE Z. TRs,c I �o =4��F ysw I F'rE c To Po MP R M, H IN CONc P IT . rAS-BUILT" - for Mr. & Mrs. Schilb, . Putnam Lake [ABLE CF OFFSETS FROM HOUSE.CORVE (Tape 'distances in feet o level) TEM DESCRIPTION xW 17E SE SW optic Tank M.H.. 28919 15.2 :Manhole 24.7 19-.2 1� or - Galleyi- .17*2 .300 � Cor - Galleys 19,7 1905 istribution Box 6317 560 B am- A, bb, B 52 *-2 m 48,6 C 42,6 42,3 35.6 35.7 erflau Box Al 47.3 71e4 a 78*2 40.3 73.1 C, 32.0 55 *6 97.3 T)j 25,02 480 63,2 ell 118*7. 143.3 urtain Drain Out 59*7 ft I OW • N Sheet 2 of.2 Locations,by transit,, tape; & stadia Aethed. "This is to certify that the sewage disposal system was constructed as indicated on this plan and* that the system was inspected by me before it'was covered over. The system was constructed in s�eg 11 the rules and regulations-of the Putnam County Department of Health". -V f- lyli" LAUGALm C, I J AN I 19,7,4f tHN's, -I ' LTNAMLCOUNT V I Lel 4 G Of -d&&LW DW �dj9--:P--D1V!:S10)N OF "SEPTIC SYSTEM AS-BUILT" for Mro & WM N,MENTAL HEALTH SERVICE Mrs. Ronald E. Schilb @ Preston place TM 43 - BL 1 - Lot 1.1 - Putnam Lake I leneral Contractor: A & J Builders, Warwick Road Town of Patterson - Putnam County New Fairfield, Ctl APM .1/12/75 aeptio System Installer: E.E o, King, Lake Ave.-Ext, _:41"C:KEL) Danbury, Ct. Vell Driller: Edward Savoy, Inc,, Allview Averue, SHEET R 5 Brewster NY OF P-UTNAI Division; -of CONSTRUC- - - -- — - -- -- - - -- 1, :Located at.. Subdivision_ 4 COUNTY - DEPARTMENT OF _ HEALTH . �nvi�onmental Health Services, Carme%`N 10512 ISPOSAL 'SYSTEM FU` PJAM LACEP .T Own Of Pa. tb� soh Town or Village E�-340J`: txhru Section ax 1`.icab 43 Block 1, Job, 4 Place t r Owner .. Address i Building Type "1 1ar.2ilyr. �_ rel l� n .:Lot Area." 5 lots Pa ttexisoll,L PTew York •12563. Number, of Bedrooms T�1i'ee Total Hatittable Space OtTer_' 1500 Square Feet r A00 1� 9& }' 62 2 0 5 4 F �3' Separate Sewerage System to 'consist of Y e Gal Septie Tank lineal / feeet X . width trench t To be -constructed by ' �T S a bh "Ga r i' i a ti Address • F o-1J o • 7; ' 1.r�'1e *: Water Supply:* Public Supply From 1d, ;, CO �sewr Fair ruzecti cut : 06 610 Frans 'a.�roll in W° °ell E?r� ll Inc. Private Supply' to be ;drilled Isyi g:o: t,e ti: ;2 :'Br w- :� r iT;° Y 'r Q a •Address , , e s. j e + e o• k 1 5 9 r { ^ Other :Requirements a S 4'D nlan, `and per, "a"t s Zalat %,'ong of Foard :bg Ne lth r_`n r iI ' a _ arlanc6s mee r_5 of. Ain "a l 1'J, 1' 74 }above described' will ti wfiol(Y and construct d as slhown onthe e i Yoved ame idm'en the et to and,in accord 6ce'system(s) 1) tAat the .aeparat u sewage disposal system I p W the standar r e an r a pp ds, ul 5 egu a ons o e Putnam m L, 0-..; f "and that on orn let ionthsreof a' ertrfi to of: onstr "tro m to t sfa" r is .County;�fOepartment o _ Health, c � p C ca C uc• n Co pt nce'` sat cto y to the Commissioner of Health will be submitted 'to the• Department and a written guaeantje will ;be furrfli6go the owner, his successors heirs or. assigns by. the builder, that said builder will F ;place in good operating "condition any .part of said sewage disposal; system during the period,of.itwo (2)•years.immediately following thedate of the issu- �;ance. .be approval ;of the .Gertrficate of Construction Compliance 'of;,the original system or any repairs,thereto; 2)'that the drilled well described above, _ will 6e located as shown -on the approved plan and that said "II willbe installed lri ak6ordance with =the` standards rules and regu a Ions f the Putnam County °Department of lieelth r� al Date A �r l 1,, kt 1 J'7.9 Signed y ,' , P R. A. k — illto�ryrn ad:'° .'S. pr��. I�Tew fork nJ5 A Address •' •. ! License'No• a. ti t , APPROVED FOR CONSTRUCTION T_ his approval exptr,s one year from the date - rSSUed` unlese construction .oi'the .building has been undertaken and is revocable for cause or may be,- amended'or modified when e d necessary` y--,t he Commi sr er of ,.Health . "Any change or .alteratlon.of contr�u i .'requires a ne per it.;, Approved for disposal of do eat It r. sews , t r supply `only r ry- u* r 'Pate �/ Title ILL _Z - M DESIGN CALCULATIONS (Re- ised). Schilb 'Putnam-Lake April 12, 1974 FRO 04 PuTMQ C4 REGULg3100S FOR 94P k 0, to 04 Ow 11w . (� (�Y'E .....� �,P/' GAS -.I�. �. U SE AA An % alga a �A� �'t~ AppLIcAr,100 �y V' uSLZ IS 3 DEEDRa®I 1. ?' GSA Ir CHUCK W SATISFAcroRY: LF L Y. O Z. e4 A 1E GiVA,ILAam kR 18 1011 L tom' A P A W S 101\1 265 .9 sT: +�1i14 �, ®�0 SF AMU A, . MOE S PAQV 1) 9 FQ�. r s 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 Mr.. & Mrs:_. Ronald E. �ScIA:kj! •ess 10 Pre sto,n,,.Pla.ce; PattQr,y on., N.Y. 12563 Preston Place.... Tax. Map Located at ( Street l s s t ''s i cj e c�i') Sec.' Block 1 Lot^ Tncica e neares .cross s ree Municipality Town of Patterson-Putna4i Watershed Overland into rFutna fake La Re Map # 8 - Lots B-64Ub .thru 15--3 SOIL PERCOLATION TEST DATA REQUIRED TO•BE SUBMITTED,WITH APPLICATIONS Hole saturated before testing - hole 30« r , Hole. Number "CLOCK TIME PERCOLATION PERCOLATION apse p o. a er , r Ve , No` Time From Ground: Surface . in Inches:, . _. _ $oj Rate Start -Stop Min. Start ): Stop' Drop in Min 4ndrop ,.: ..Inches Inches .Inches: 0C� 1z 4. io AL tl�e3Q t►� .'� Ar�'�'r&m . o,� :�i� =i t� � : • � c�:t�•` . . •' �� 12. , . �c'.;�7, UT` • �� ?� :G''1Z.`�,C,., `�•..�t -v, �•��j' • t-3 i,�.C+'�U!L`p'i 1 ;�?c'.i N_G`.i .__ C.Cl..d�1. �.'i�A� �'rl� �+ `,��, Pi'_r 5.; .: :'i ill 14A --'> i o i?c: ;C:ot��,•'.�:NT�ONAL., i /'l.t `DTI 11! 1� ...• . .. � ..l .,_ .. •• , 1���� � � :- � 'iU � >t�9►N�r� �t� i:C•�t -,..i ^'�,b��;T'.'� ` .•�G•t�i..�?S��t� DEPTH G.L. 6 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. HOLE NO. 12" 18" 2411 -D--f LaWt 30" LOA" 36.. 42" 48" GA IQ cr LAO 5•" _M i tub t'- Paci< E`is 60" F CLA -f .4' $A�',V 66" 7 2" - 7$" INTO 8�" WT-MM aF MOLE Oet:. G Or— �$cs:. Cain WA 1 -� INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED - not observed INDICATE LEVEL TO-WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED - not encountered TESTS MADE BY PPrnelation test - Pat Cameron & ApM Date July 27; 1973 zt ry . . DESIGN Soil Rate Used 8 -10 Mi Vl "Drop: S. D. Usable Area Provided Less than 5, 000 sf No. of Bedrooms 3 Septic Tank Capacity ' 90-0 Gals. Type A proved. Concrete Absorption Area,'Provided By 216. L..F.xR�e" • 301t 214 width trench. E OF NFii, Other Name Add ress - 0 JA PRO EEISWNe��sn,� H��� P 9 J G MILLTOWitI BREWST rn :a w N THIS SPACE FOR USE BY HEALTH DEPARTMENT A N0. 43052 Soil Rate Approved Sq. Ft /Gal. Rod Date `:/. Rio` • � i = ♦Q �, 5_ ._WAS Alm P ✓ 9� a�`v ♦a r _a Lam. '.U,D mss....;:. ♦ ARC 1� ARC p F :AOw�tCg . bN PR0 _�. (let) Do •.lF ' low tAPW ,ice 3 � R • , S •.;,,,,,�„ . 15' ppFP1 z s tY .s' "ARC FRO t fixva'o. WeLL NOT �� .._ pp• At its .. T'..�..�... -__ ] -�? w`„' °�... /°' ;A1 LE "aT .PIT vn a N Y' 0 •RMI ITS '151 oCa- o�ERCr _ i'"',c,.•. atg Tale '3sRQvJ ' ?, PIPE `''�'.� i .11h � �, Io � ♦� � � + yam•' ,� to � _ f PT lko ' ARC FRor+ r �.. q Noss 3 aD h for `171,• .'t : 1 f b / IItt,� ' 1� A