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HomeMy WebLinkAbout1595DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -5 -55 BOX 15 i. NO J � i . IN 6 No I ,` ` �o - � g . "O"o I 01595 PUTNAM COUNTY DEPARTMENT �OF:'HEALTH Division of Environmental Health Services, Carmel N Y,'f0512 h.., CERTIfICi4" fE" OF°COnISfiR�JCflEflh`C ®iIAPLt`ACE FOR SEWAGE.:DISPOSAL `S'YSTEM� -u' Patesm��=' or Village Located at Farm =to Market Road _. 4 , Sect ion Block w n ae .'Joan, & Ri chard Rei h'6 nrdt , Owner Lot B Job Me,1 m ck, Homes Wa�n n ers `Fa11 s . N . Y. 12590 Separate Sewerage System bwlt`;by Address Kt' r � L. Consisting °of l 000Ga1. Septic.Tank Z5Z lineal Feet 'x '36 l nch width trench r other.requirerrlentS =F1 11 Section - 90' W `X 30' L X 24" Deeo :& 160' 48" Average Beath Cur�1� . Drain To Grade. Water Supply Public Supply:,From X L John J':; Bi 1 ka &Sons ;€ Private Supply Drilled "By Address 30 Miry.Brook Road, Danbury; CT. 0681.0 `building Type = Frame No of Bedrooms' Three %Date .Permit Issued 6/24/71 • ....:Yes \ w;Has Erosion Control Been Completedi 1,certify' that theaystem(s). as listed serving the above premises were constructed essentially as Shown on the plans. of the completed work (copies of wh1lch ai.4 z 'attached) and 'in accordl,ance with, the �standards'_iules'anG r,e9ulations, -plans filed and the'.permit .issued .' - the - Putnam County Departmyent of Health. March 1972' Certified by r , P.E. X R.A.. R D rtnel New Yo 1051.2 29206 ` Address ;License No n person occupying - premises served,t y the above systems) shall promptly take such action as may, be necessary to secure the.correction of any unsanitary %iiditions resulting •from` such u`sag'e, Approval of the.`separata. sewerage system shall *become null and; void as soon as- a public sanitary. sewer, becomes 1-1 Iailable and "•the approval of, the -private water'supply shall become nun and void :when ..- ; public water supply •.becomes available. Such 'approvals ar subject Ao modification or change when, in the judgment of the Co is over of Hea such r vocatwn „mod}fication or a sage is necessary. - � �'',i"•'' . i 9 �' t r�. .`�'�,,. Kr � `���� Title .t � %� \ �'a' K BACTERIOLOGY = 'PARASITOLOGY:.., VIROLOGY - 4 ANTIBIOTIC USED ; ,SOUR .,CE .OF::MA-TERiAL. ©:.: • •. k'EQUEST p , ; ._ - _ . �Rtzb "ard - R4E4ih atxdt Farm° 't0 Market. Road' Patt6rsonr New York, Water analysis � . 3/27/72 ,. L PUTNAM DIAGNOSTIC LABORATORIES 10 STONELEIGH AVENUE - CARMEL, N. Y. ❑ Blood _p_SMEAR` -. ❑ CULTURE. ff Sputum. O Routine El, Nose . • ❑ T. B:" , El- Throat ❑ Diphtheria'.' _ ❑ pina -F ui , �O,Fun9us • > . - LL ❑ Llrine -• ❑ Feces _ ❑ us ,rom p ❑ Other _ ; ❑ ❑ Q Ova,and Parasites -p Viral Studies 5 NS.; p.SENSITIVITY RESIST. STAPHLOCOCCUS _- , - p Aeiobacter,_'. Chloramphenieol'" 4 . _ _ Q Non -Hemo: Coag.To: Follow p Corynebacterium Colistin Sulphate" ❑- Hemolytic- Coag.;To Follow Q Escherichia Deelomycin -. ❑ Coag. Positive 0 Klebsiella Dihydrostreptomycin" Q `:" =Negative , - Q Paracolo. Bact. Ery"thromycm STREPTOCOCCUS,,HEMOLYTIC Q Proteus- eomycin, _ °:.. 7. 0' Alpha' Q Bata" -. ❑ Gamma - Q Pseudomonas Nitrofurantoin _ >; .~ :'M Enterococcus `; Enteric Pathogens Oxacill;in Q Pneutnoc`occus ❑ Found -. Panalba Q Nei"eria. , ❑Not Found Penicillin ,Q -:Hemophilis -` Tetracycline _•. ' ,• TUBERCULOSIS SMEAR ;•'' TUBERCULOSIS CULTURE — Triaiet:y olean •,oinycin ` , Q Aci&_Fast -Not. Fours Q Neg.`For,Acid Fast Ampicil in ❑ Acid Fast- Found ❑ Pos. •, ;, _ Q `Smears; Routine Neg., Q O &P Not Found Q cultures, - Q 0& P Posi ive For ' PYESei1c OI - C011 =Pzw D42%;A.ca..La• Jucoca ..•••••• • •••�•• --r— of "water conforms to the ­ accepted; standards of purity wi era cOl1-ected , _ F� WELL COMPLETION REPORT 3/71 Y PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This.,repo.rt. is,to• fee �completed.by.well driller.and. submitted -.to- County Health Department together-with mlaboratoryjgp.Pr Qf _ " analysis of water 'sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued.M REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME ,7 ` L L �y1I �/f i A 1� /OI . f!( ADDRESS j f /r��Ii e— 76, �t:) 1 jt t' K�iJ`f :�� /% j`�'� t LOCATION OF WELL (No. Street) . umber) (Lot Number) 1 p ?z l �N' IG �J/ �(�ToJwf�n() � f BUSINESS ❑ ❑ ❑ PROPOSED DOMESTIC ESTABLISHMENT FARM TEST WELL USE OF WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ AIR OTHER ❑ CONDITIONING (Specify) DRILLING Fj]:a,,COMPRESSED CABLE R /ROTARY LJ-AR PERCUSSION El ❑ EQUIPMENT PERCUSSION ((Specify) CASING LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT /'7 ❑ jjDRRI�IVE�,S O RD ❑ W C�(NG iU L�YES DETAILS C 1 �t THREADED WELDED YES N( LJ NO YIELD f' HOURS G.P.M. ❑ © ❑ YIELD (G.P.M.) �7 TEST BAILED PUMPED COMPRESSED AIR ! ' %' - L4 WATER MEASURE FROM LAND SURFACE — STATIC(Specify feet) _ _ DURING YIELD TEST feet) ~ l Depth of Completed Well LEVEL `S �I j �� in feet below land surface: MAKE LENGTH OPEN TO AQUIFER (feet) SCREEN DETAILS TSLO�T SIZE \ �'r' /' 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'af, least FEET to FEET two permanent landmarks. j If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETEDi DATE OF�REPORT WELL DRILLER•(Signature)�`''_, j4 L _ .,,,._�.:��it�oa.�tta• +��: \tea =� •.. ' _: -.,._. .: ..�,._,: -' � ..a �=, Owner or Purchaser of Building M C 12A n� e � mfas Building Constructed by Location - Street Building Type cipality Block 9 g� 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- vices of the Putnam .Coun.ty Department of Health as to whether or not the failure o. f.-the. system -to operate wa-s cause.- by-,th6'-wi-1 'lful or negligent':. act of the occupant of the building utilizing the system. Dated this ��= day of 19_11 Signature Title °fa 44 - /4 If corporation, g ve 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 7 _ .,,,._�.:��it�oa.�tta• +��: \tea =� •.. ' _: -.,._. .: ..�,._,: -' � ..a �=, Owner or Purchaser of Building M C 12A n� e � mfas Building Constructed by Location - Street Building Type cipality Block 9 g� 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- vices of the Putnam .Coun.ty Department of Health as to whether or not the failure o. f.-the. system -to operate wa-s cause.- by-,th6'-wi-1 'lful or negligent':. act of the occupant of the building utilizing the system. Dated this ��= day of 19_11 Signature Title °fa 44 - /4 If corporation, g ve 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 PUTNAM - COUNTY. 'DEPARTMENT OF >HEALTH 9ivision of Environmental ,Health .Services, Carmel N. Y. 10512 :ONSTRUCTIOI� PERMIT FOR SEWAGE ©i$POSAL'SYSTEM_ Y7rsa� ' I „a Town or Village - c- =- [7/�'?/ �9�ock Located* at Section r .Subdivision y�Dj�+ �% `l ��'�? n Lot ,,[� Job/ - Owner Jldiflr�r ` �X !� L �%° KQ///fvt� /s Address '�lr ��ir1C�� i�ZTlP. —� Building. Type- i*e- Lot Area CJi�s07Z /irlC�s %C� ,V, Y. 10 7Zd _ Total Habitable of Bedrooms a w bitable Space �� Square Feet Separate Sewerage System to consist Of .0040 0 Gal Septic Tank Y�� lineal feet X 34C width trench To be constructed by Address � } - Water Supply Public. Supply, From T civate'Supply.to be.drilled.by r - Address fir "- Other Requirements / Jam. a,"+ I :represent` that I' am wholly and completely responsible for the design and location of the proposed :system(s) 1) that the separate sewage disposal system above described will be constructed as shown on the approvedaniendmentthere ' to and in accordance t.h.the standards, rules an regu a ions o e u nam County Department of Health, and that on completion thereof a "Certificate ;of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the. Department, and. a written guarantee will' be,furnished'.the owner, his successors, heirs'or assigns by .the builder, that said builder. will place in good` operating condition .any. part of said sewage . disposal system during the period" 'of two (2) years immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or <any, repairs- thereto; 2)'that the drilled well described above will be locatedas shd n on the approved plan,and that said.well will be installed -in: accordance, with th,e_jtandards, rules and regu ations of the Putnam County Department of Health:, Date � Signed P.E. R.A. G� Address r o License No, APPROVED FOR CONSTRUCTION: This. approval expires one. yearro , mtthe date' issued. unless construction of the building has.been undertaken and is revocable for cause. or may be amended or modif led 'when considered necessary,by- the,COmmissioner of- Health. Any change or alteration of construction �' w p quires a neermit. Approved for..disDOSaI of domestic sanitary se w a and /or rivite water 'supply, only.- n . ..- � By - � Title � 'T OF ­ILTH 1AM COU NTY :' PUTN zz V-j C r S DIVISI,QN, OF ENVIR%CN%Z,',,-T_;.AL MALTH L, "GE DIS�OSA-, SYSTE" FILE NO DESIGN DATA SHEET SEPARATE SEIff"A a,,,ne I. ..d Located at (Street). Sec,. ,Block Lot (Indicare nearest cross street) e L) ithinicipality _T,& 1,•!atershied SOIL PERCOLATION TEST DATA REQUIRED TO BE SU_;,";IT7,ED­WITH APPLICATION Hole OCr Y imiDer CL K TIME PER'COLMO- NL PERCOLATION' min t.-Laose ijeo-.-.- zo v:azer v.,azer ievei 'No. Time. From: Ground Sur f_=*ce in Inches Soil Rate Start Stop Min. Start Stop Drop i n Min/in .drop Inches I n,.,, e s Inches 0 2 %awl 3 _1112., A91, r.. I p, 5 2 3 4 Notes 1) Tests to be reb*eated a sarne depth u7--til aopro:-1-_`- ..Stele eaua- soil rates are ob- tained at each percola-t-ion test hole. All data t-o be su b1mit ted for revie,.,., . 2) Depth meas.reiments to be 'made from top o f hole L E:�T:. PI-TrDAmy -RE— QUi�yD~ " "O�� rt ':ITT�� :,;;ice. �az,;�L.} _ DESCRIPTION: OF SOILS E`:-'n-TL FD I`' "EST HOLES DEPTH HOLENO. .HOLED. HOLE G.L. 20 d2 141 Err l2" 24" f 30 3 6'T 42 5 4" _ 6 '0 66" -,2. cry t INDICATE :'LEVEL AT WHICH GROUND WATER I 'CCLT \TERM INDICATE LEjE L TO WHICH E+.A EP. LE:,L RIS S,AFTER REIN ENCOUNTERED TESTS L�DE BY rj Date9 Soil. Ra{ :' i�cn�i` � ®o, ®� n D. a'C1 n \ c` *a, � 4nr p �-� Ii. _ /1. ` Dr o S . L is r o 1 No . of Sedroams _Sep i c �'?- .. Cad == i t`'_ . ®� Gals. Type Absorpti on 'Irea Provided �y L. F.x2 -' 36:i d.t11 trci.Cl7. Otier ew Name John H. Rrentis� P.E;- C,E,C. Si--nature ,�pfESSI q Fy Addres's R.D..6p 6 353 L Carmel H.Yo 10512 PUTNIAM COUtiTY DEPARTHENT OF HEALTH Soil Pate Approved Sq. Ft. /Gal. 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