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HomeMy WebLinkAbout1334DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.78 -1 -8 BOX 13 01334 go M. I % I* li I � go Fog lIj. I 6 go. F , %i ! I or I lo-irmi 'I � - gir 1.6 f . rOr.�or ��� �. IN R 01334 lu Owner or P c aseAr�o Building Building Constructed by Location - Street Building TaWe Municipality AaAgi, Section Block GUARANTY OF SEPARATE SEWAGE-SYSTEM M M 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 hE;reby 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 ELgrees 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 of'"the system to 'operate wEs­caused -by the willful or negligent act of the occupant of the building utilizing the sy tem. Dated this � day of asf- 19YA Signature Title If corporation, give name' and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP,ETION WILL BE ]ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 7 - - - - - - - Division of Environmental Health SE:rvices, Putnam County Department of Health L ARL hl e--A; T2ATo Owner or urc aim senor Building (,aaL, � TOS. NAGA I&ATo Bui ding Constructed by i�ATTC25d r!. Municipality PLJ TNAM LAKE SUBDIVISION Section 14 A:L 6: L 1) R. I WPikm�R PL Location - Street Block Building Type Lot GUARANTY OF SEPARATE SEWAGE-SYSTEM s 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- 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 system. •� Dated this day of 0616• . 19 7y Signature Title If corporation, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP1,ETION 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 BREWSTER LABORATORIES Box 224 - BREWSTER, N. Y. WATER ANKLYSIS REPORT sAmP'x NO. 31-?30 SOURCE: :Car I- Raparatb f=Oet now we 1. 1 LO$4 B15.50 to I Pattersoni, Stir4i coLLEcnm 4uguat 4. 4974 B 'CaPI Sao, rato Y: rl BACTERIOLOGICAL EXAMINATION coliform Count, MF Method This result indicates the source of the sample was of satisfactory sanitary quality wht,v the sample was collected. August G. 1974 0 per 100 ml. -Aickwii P. E. Director 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 anatysis•of water sample:indicatiry rvvater -is'af-satisfactory-bacterial qua Iity"before certificate- of- constructi omcompl•sance-is-issuedr= = ~ - ~- REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME ! / ' j c 1r ADDRESS J,1 •' /: LOCATION (No. A Street) ' � (Town) / (Lot Number) / I OF WELL y _ +I ; �''y' .1;. /j r, C. `. / .� �. L -C i. '. j`/ BUSINESS ❑ El ❑ PROPOSED DOMESTIC E STAB L SHMENT FARM TEST WELL USE OF WELL ❑ ❑ 1:1 CONDITIONING ❑ OPeHER SUPPLY INDUSTRIAL cify) DRILLING COMPRESSED CABLE OTHER ❑"ROTARY ❑ ❑ EQUIPMENT _,_,,AIR TERCLISSION PERCUSSION (Specify) CASING CASING LENGTH (feet)-' 1 J DIAMETER( Inches) WEIGHT PER FOOT r ©'� ❑ DRIVE SHOE ❑ C 5 N GROUTED? � i 'NO ') Jf . -: �.,+ . L' THREADED WELDED LJ YES-- NO YES NO- YIELD HOURS ., G.P.M. /' ❑ ❑ COMPRESSED AIR YIELD (G.P.M.) TEST BAILED PUMPED Lt_J— WATER MEASURE FROM LAND SURFACE —STATIC (Specffyfeet) / z ' DURING YIELD TEST [feet) j Depth of Completed Well LEVEL / :— J 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 (Inches) FROM (feet) TO (feet) PACKED: gravel pack (Inches): DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,'to at least two permanent landmarks. FEET to FEET TI J. 1 ; If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED DATE O'" REPORT WELL DRILLER (Signature) _i I - -_ .. _ . _ .... .... , ..._ .._ .- ... PUTNAM- COUNTY DEPARTMENT' -OF' BE,ALTH - -- :. _. _..._ _ DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner_ IVg e_ ryrd►,o Address q, 6a te„/%is.�: ✓e Located at ( Street Sdc . 'NaI 41ck yXV1 Lot,C�,rM-4 —I � Indicate ' nearbs —cross street) Municipality �. @o n Watershed C--&L_Cbh SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION apse Depth to Vater a er ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches will ,IIIII IF111 III I 4 2 Notes: 1) Tents 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 DATA_ R.EQUIRFD_ TQ..BE.- SUBMITTED. -14 TH. APPLIDATLON._.... DESCRIPTION OF -SOILS_ E NCOUNTERED IN' TEST. HOLES DEPTH HOLE NO. i unTR NO-' n '\ G.L. 6t1 1211 1811 2411 30f1 3611 42t1 4811 54" 6011 661f 7211 78f1 8411 All cA "' INDICATE LEVE h_ flUND WATER 10 ENCOUNTERED 00fea ' %= rc7 INDICATE LEVEL TO WHI H WATER E RISES AFTER BE NG ENCOUNTERS ..TESTS MADE BY eo b to 9 --DESIGN Soil Rate Usedle ;& "Drop: S.D. Usable Area Provided No. of Bedrooms ��� p c an /, acity ® Gals. Type �e _ Absorption Area Provided BY L.F.X24" 5b" width trench. Other 19 Nam ~ ® °!* �/ _ nh, kL 2renfisc D r7 Signature - - - - -- -- - Address y {_ Fig ' (i'C _ ^ ti. PR f/V. y� THIS SPACE FOR USE BY HEALTH DEPARTI`/1ENT ONLY: ' ao Soil Rate Approved Sq. Ft /Cal. Chec y a Date — Dear Re : Oki OWCAALAA 0 . d......._ A review of the submitted application to construct a Sanitary Sewage Disposal System for the proposed premises has been 'Concluded by this department. The plans are being returned to.you for the following reasons, REQUIRED INFORMATION MISSING (1) Completed application (2) Design data sheet "(3) House plans (2 sets) (4) . Authorization for engineer. (5) Layout plans (SDS) (a) House location (b) Plan and profile of SDS (e ) r,a (e) .. (f) Location Contours Location property of driveway of property of any water courses, ponds or lakes.on ..or. within .5.0 feet -of property (g)- Location of deep test holes and percolation test holes (h) Location of all wells and sewage disposal systems within 200 feet of property lines (i) douse setback , (j) Footing and leader drain location 1 (k) 101 to property line �l (1) 20t to foundation walls (m) 1001 to nearest well (n) 151 to curtain drain (o) 101 to water line ( pits 201) (p) 151 to storm drain (q) 101 to large trees (r) 101 from foundation to septic tank , (s) 151 to pipe from leader drain and footing drain(C,co t Othe : If you have any questions concerning this matter, please feel free to contact me at this office. V trulV.y�-��� REV +. }�,j (,,.HE. ST a ;T . r DOCIT14ENTS , House plans O . K. Design data sheet _ Peres presoaked? Min. 30" perc test depth _ Const. results for 3 runs D. Hole log O.K. Corporate Affidavit for other than individua Authorization. for eri.gineer ets Std.. rks .Letter from Water Supply if applicab =_e I.f variance requested such noted on plans & apps.; DETAILS if change is proposed, ) Existing contours shown show new contours) Slopes for driveway cuts, etc. shown Water service line location Footing..drain, etc. location. I� Tap slope, bottom slope of fill i Percolation tests . and deep test pit __ocation ; I .Septic tank size and conformance to std. 3 B.R. house miniffLun (, + House setback shown ! iii ls', � ;'l 1 i , l r 1 --4- � � r 7j s 1 All vzattez' W1 Ll1:L11 DU l L . U1. IJ_1 6LIUW11 I e�' Plan and profile . 'SDS I h11 other wells and SDS closer 2001 show M or .reference - .made_...._ _ .. �. _ Property boundaries (mete-- and bounds - cleanly show)�--- ; t ao' SEPARATION DISTANCES SPECIFIED ON PIA 10' to P.T. 20' to Foundation walls I i 100' to Nearest well 50' to stream, march, lake, etc. ..incl.expansion; 15' to Gu.r. twin drain 43 10' to water line (pits -20' + 1 15' to storm drain i All 4-1 10' to large trees ! V", 101 _ _ from foundation to septic tank ! ✓ 5' to pipe from leader drain & foo clng drain t - ...INITIAL- .SITE II' ?SPECUIIOPIT Insp.by: Yes No Comments Prop.! r. ty lines or corners found.. Ca.a:i c °stiMat- hou e location: Will driveway need cut . , . . . Must trees be removed -note these -- -- - -_ -- 1s d:c,ep hole r. eprc:se_ntatiue of entire SDS area Additional deep holes r!eeded. , ,Sul .f c i e;nt SUS area a %,a_l.lable conside,:rin g - driveway cut, house location, separation , d:i_stances5 etc. , .. DEEP BOLL L-^�Tll Depth .1-later elevation: Roc }: elevation: Soils description: _.._. - Date F.l-MT L SITE DISPECTION Insp. by House. located where shown on approved plan Sn5 located vTh..ere approved .. . - Slops of, ti_l e Lire .�d.. trench cceh ±a;le Room allowed for expansion trenches Over 50 ft . from sz•,ainti, watercourse . . - - -- Natura.l soil. not stripped or SDS area � -- - - ---- unnecessarily. graded in-t-a i red from prop .line and 20 ft. from house .. . Separation of trench from house, well - etc. follojjs plan Number of bedrooms checks , Stones, brush, stumps; rubble, etc. greater than 15 ft. from nearest trench . . . . . . _ 15 Pt. of per.4pheral soil horizontally from trench Junction boxes properly set Could surface run off from driveway, . roads, ground surfa.ce., etc . channel near SDS area Does 7_ot dr. aina.�;e aunear 0. ��. in area of: SDS PII U GRADING OF SITE ACCEPTARLF -_ Putnam County Health Dept. County Bldg. Carmel, New York 10512. Re: Parcel on Hazel Dr.,,Putham Lake Subd. T..Patterson, Sec. "B ", Lots 1550- 6'Incl. . Gentlemen: �7 ,Request is hereby made to permit well t'93 fg6t separat -ion from sanitary disposal system instead of the '1'00 feet required. See Dwg: I (Job #S =.O. 1410), Rev. "A" (I-�22/74) of John H. Prent•i ss, P.E. . Very truly yours,, Earl Nacarato.. 24 Allen Road Brewster, NY 10509 i August 19, 1974 Putnam County Health Dept. County Office Building Carmel, N.Y. 10512 Re: Parcel on .Hazel Dr., Putnam Lake .Subd.... (T) Patterson, Sec. "B ", Lots 1550 -6 Incl. Gentlemen: Request is hereby made to permit well at 77 feet separation from sanitary disposal system instead of the 1.00 feet required. See Dwg. 1 (Job #S.O. 1410), Rev. "A" (1/22/74) of John H. Prentiss, P.E.. Ve y truly yours, ose Nato 7 Kenwood Rd._ Patterson, N.Y. 1.2563 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR SITE LOCATION 69 OWNER'S NAME MAILING ADDRESS -!3.:) V- TM# PHONE OFFICIAL USE ONLY PERSON INTERVIEWED "�— t u Sct`ks� p PCHD Complaint # —Raine & Relations Ip I.e., er, tenant, etc.. DATE 4 - I � - o � TYPE FACILITY 9-2_ - PROPOSED INSTALLER IJ1 - ST-� PHONE d- O -°' °156S ADDRESS /JIGISTRATION# Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same,type as original sewage disposal system .Different location may require submittal of proposal from licensed professional engineer or registered architect. R c. -I, as owner; or r e 9 t of owner agree to the conditions stated on this form-. SIGNATURE TITLE =r%�i f/?l-- DATE Proposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch 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 (e.g.,house comers). d. System description (e.g., 1250 gal, Concrete septic tank, three precast 6 diam. X 6' deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Proposal approved_ Inspector's Signature & Title COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML DATE i V