HomeMy WebLinkAbout1840DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
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631- 589 -8100
35.06 -1 -22
BOX 17
l :- l
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. S 12 0— (0 eS
Owner A q f OVD l h-(_ Address�g (_ 0� Y`e '> 1 tr,ew 1V-
Located at ( Street OLD 9--le 2..L Sec . ® Block 4-- Lot l
�Indicate nearest cross streeET
Municipality 4)A:: ") ,e,r so Watershed C p
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
Run Elapse Depth to Water 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
1I2:o-o %Vo4 4-- W I I i Jli
2 lZ`.oj' I L% to S to I I I '/ 1
3 17 % id I'Z �_ I SM t o (2 i C S I
1
2
3
5
1
2
3
4
6i
Notes: 1) Te'�ts to be repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole. A11 data to be submitted
for review.
2) Depth measurements to be made from top of hole.
~•.. TEST PIT DATA REQUIRED.TO..BE . fiUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST.HOLES "
DEPTH HOLE NO.- HOLE NO. HOLE NO.
G.L. To
611
1211
1811
2411
3011
3611 0 CA-
4211
48"
5411
6011
.6611
7211
78'1
8411
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WBJLH WATER LEVEL RISES AFTER BEING ENCOUNTERED
;:TESTS MADE BY !� . Da (j te � % '%,."�..� -
\'\
DESIGN
Soil Rate Used (I' Min/l "Drop : S. AiMa, Provided
No. of Bedrooms Tank Capacit? f n's Typ
Absorption Area Provided Gals �; ,, e
p By 6,0 L. F..x24" 's -._ e z idth trenc .
`1 Other
Address�i
THIS SPACE FOR USE BY HEALTH DEPARTPZENT ONLY:
Soil Rate Approved' Sq. Ft /Gal. Checked by
Date
i
PUTNAM COUNTY DEPARTN2NT_:OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date �(:D� .*- i ') --I Z—
Re: Property of t'j.0 1 Q�
Located at CDk_V3 _P Gig ` 1 CE z Z
Section " 1(} Block Lot 9 �%
Gentlemen:
This letter is to authorizeUy'rl"kb)r`
_ T
a duly licensed professional engineer i,-�• or registered architect
(Indicate)^
to apply for a Construction Permit for a separate sewerage system; to
serve the above noted property in accordance with the standards, rules
or regulations as promulgated. by the Commissioner of the Putnam County
Tl.. r... ..1� -w.. +..� Ll TT..�lll_ 1
1/epa t,111G11'- V1 I1Cd1411, and to sign all riece66ary papers on my behalf in
connection with this matter and to supervise the construction of said
system or systems in conformity with the provisions of Article 145 or.
147, Education_Law.,...the Pliblic_.Health Law; • and - the- -Putnam County Sani-
tary Code.
Very truly yours,
Signed /q - (n 1/% N D /1V 4�
Owne of Pro ert
Countersigned:
Address
P.E., R,-A. ,
Address _
Teiep obi ne
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JUNCTION 'BOX
11 #6
14 '4_j T
C -L'-3
.
4 5 Ej Co
SECTION
TYPICAL CONIC.
SEPTIC TANK
..tJ W-F'AC i.
GRU LEVEL
EARTH
t bACKFILL JOINT 5"- 15"
BLDG. PAPER COVER
OR HAY
^0
PERFORATED 5
PIPE t 6
I
CLEAN GRAVEL OR
CR'JSHED STONE
ABSORPTION TRENCH
• NOTE3:_'"
APPROVED SYSTEM TO BE CONSTRUCTED IN ACCORCANCE WITH THE RU!_E:- ANO
REGULATIONS jF THE _-Pu:T N ANA COUNTY DEPARTMENT
OF HEALTH.
SYSTEM SMALL NQ'T SE BACKFILLED UNTIL INSPECTED BY DESIGN
ENGINEER ANC THE ',_0CAL HEALTH DEPARTMENT IF REQUIRED.
OCT2 01972 SYSTEM TEM TO CONSIST O� A "--)00 GALLUN SEPTIC T,4NK
PUTNAM COUNTY U OF HEALTH AND _240 FT. qF_I—_ FT TRENCH WITH A MAXIMUM
PITCH OF lllr,' PER FOOT.
ION OF DISPOSAL SYSTEM GRAOES REFERENCE) TO FINISHED FIRST
ENVIRONMENTAL HEALTH SIPWCp FLOOR ELENJAT!U -N , UNLESS OTHERVVISF NOTED.
S.S.D. SYSTEM
"o CIO
<
Lui
sT z
38998 '40
e OF .:C*71
R'ErVISIUNS
N0. DATE Sy
4
F Q FR a E AVI KI 01 KA C
HOWARD A. KELLY,-JR.
ASSOCIATES
CARMEL, NEW YORK
TAX MAP NO. 10 BLK.NO. 4 LOT NO.. 10
TOWN OF —+," Al T E W_ Ego 1,4
Ry T
,Materiel
�Dote Drowinq No.
Traced rsoz)
OLD leou7Z--.. 22
-P1...4 A Q
�,..:
A:
26
34
?�j
:.
33_
40
4$
54
64`
BREWSTER LABORATORIES
- - - - -
�4- � BREW T ,_ Pd: -Y:- - -
WATER ANALYSIS REPORT
SAMPLE NO. 29 78
SOURCE: Zema- Tavino, Inc. - hose Bibb - well supply
Old Route 22
Brewster, N.Y.
COLLECTED: June 22, 1973
BY: P, F.Bea l 8- Sons, Inc,
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
0 Per 100 ml.
This result
ixdicates the
source of
the sample was
of satisfactory sanitary
quality when
the sample
was collected.
June 23, 1973
l�
Bickwit P. E.
Director
WELL COMPLETION REPORT
3/71 '
PUTNAM COUNTY DEPARTMENT OF HEALTH
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°vvater sample indicating Water I?;'of satisfactory 6acterial'gi]ality before certificate of construction compliance is issued.
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWNER
NAME -
ZEMA TAYINo INC.
ADDRESS
ROUTE 124 BREWSTER NEW YORK
LOCATION
OF WELL
(No. & Street) (Town) (Lot Number)
BIG FJZ ROAD BREWSTER NEW YORK
PROPOSED
USE OF
WELL
BUSINESS
DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
F1 SUPP Y ❑ INDUSTRIAL ❑ CONDITIONING El (Speif ER
)
EQUIPLMENT
n ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION OTHER
CASING
DETAILS
LENGTH (teat)
4O
DIAMETER(lnches)
six
WEIGHT PER FOOT
1 lb
(�
Ei THREADED [I WELDED
DRIVE SHOE
®YES FIND
WAS C SING Cn D?
®YES LJNO
YIELD
TEST
HOURS G.P.M.
❑ BAILED ❑ PUMPED COMPRESSED AIR 2 _
YIELD (G.P.M.)
GPM
WATER
LEVEL
MEASURE FROM LAND SURFACE —STATIC (Specify feet)
DURING YIELD TEST (feet)
Depth of Completed Well
in feet below Land surface: 140 ft.
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
Sketch exact location of well with distances, to at least
two permanent landmarks.
FEET to FEET
0
8
Drilling in overburden-
ol&y and boulders
__....... _ .
it solid rock at 8 ft.
8
40
rilling in rock- setting
asin - . outed ° - -..
40
L40
rilling in rock -
anite
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL COMPLETED
1
DATE OF REPORT
6/7/73
� . ..... --
WELL DRILLER (Signature) >I -
Owner or Purchaser of b ilding Municipality
au1V10
Building "CoiisUucted by
Section
Location.- Street
Building Type
Block
Lot
GUARANTY OF SEPARATE SEtA]AGE 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 successors,, 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 occupant of the building. utilizing
thP. S Jrc i-nm .
The undersigned further.agrees to accept as conclusive the determination
of the Director of the Division.of Environmental Health Services 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 buil g utilizing the
system.- _..:. _ _ ..... _.
E
Dated this _ day of 19 Signature _
Title
corp& tion, give name a-rfd 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
Division of Environmental Heath Services, Carmel, N. Y. 10512
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM_...____ IPA,-1 T61-S0Xi
v•u
Located at 8 1�_N
Owner 7 EAAA - ?AV I ICI O I )►-
Separate Sewerage System built by )0 Oka cou(ito -lN
Consisting of 010 Gal. Septic Tank IL
Other requirements
Town or age
Section -10 Block 4-
Lot 10 �G%b 3� Job SE
Address
lineal Feet X
Water Supply: / Public Supply From
y Private Supply Drilled By S!0.3 S -a t &C- •
Address
Building Type .%
Has Erosion Control Been Completed?
width trench
I r�
No. of Bedrooms Date Permit Issued 0026 icriL
1 certify that the system(s), as listed serving the above premises were constructed essentially as shown on the plans of the completed work (copies of which are
attached), and in accordance with the standards, rules and regulations, plans filed, a50 the permit issued by the Putnam County Department of Health.
Date 2 Cer •fled by R.A.
Address *� -, License No. l "'
Any person occupying premises served by the above systems) shall promptly take such action as maybe necessary to secure the correct ion., of ariy unsanit
conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a public ;,sanitary sewer bec mes
available and the approval of the private water supply shall become null and void when a public water supply becomes available: Such appr9Vals are
subject to modification or change when, in the judgment of the Commissioner of Health, such revocation, modification or change is necessary.
B Title
v �
Water Supply:
Other Requirements
Public Supply From
Private Supply to be drilled by
Address
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 approved amendment there to and in accordance with the standards, rules an regu ations o t 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 a ove
will be located as shown on the approved plan and that said well will be installe in accordance with the standards, rules and regula iionsoof the team
County Department of Health.
Date %Z ',J`°ned E. q R.A.
Address �" License No,-? -< 4
APPROVED FOR CONSTRUCTION: This appr al expires one year from the date issued unless construction of, a building has been undertaken and is
revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction
requires a new permit. Approved for disposal of domestic sanitary sewage, and /or private water supply only ?_._—
r (t
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health .;Services, Carmel, N.
Y. 10512
`SYSTEM
CONSTRUCTION PERMIT
FOR SEWAGE DISPOSAL
""
-�--� iF� S
�®
J, `' TL
TOVAn Tr village
Located at
1-
^�' Section
p �-1 (� CS �L�%4 ,.ziew 9
i
Block
�, L i0 -• (�(`j
Subdivision �1iZ 4-�
Lot
[�,� Job
'C
—
Owner �y
1 Aq (Q 0 � 13 C.. .. Address''t')
or
j��At
Building Type "�'-t "��� Lot Area.
Number of Bedrooms Total Habitable
Space Square Feet
lineal feet,X width trench
Separate Sewerage System to consist
ofC°� Gal. Septic Tank
To be constructed by
Address
Water Supply:
Other Requirements
Public Supply From
Private Supply to be drilled by
Address
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 approved amendment there to and in accordance with the standards, rules an regu ations o t 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 a ove
will be located as shown on the approved plan and that said well will be installe in accordance with the standards, rules and regula iionsoof the team
County Department of Health.
Date %Z ',J`°ned E. q R.A.
Address �" License No,-? -< 4
APPROVED FOR CONSTRUCTION: This appr al expires one year from the date issued unless construction of, a building has been undertaken and is
revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction
requires a new permit. Approved for disposal of domestic sanitary sewage, and /or private water supply only ?_._—