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HomeMy WebLinkAbout1856DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35.06 -1 -44 BOX 17 INN% - ; ; . r mom r ire, jr I is IN in m 01856 Z ill, x P T -NA M,C0tN TY DEPARTMENT-`OF HEALTH ? ' { Di.visfon .of EnvironmentaY Health, ' Serlces; Ca�rr�% .N: Y .10512 ' - -,. - � = = .Patterson CERTIF,ICATE'OF CONSTRUCTION COMPLIANCE FOR_SEWA.GE DISPOSAL SYSTEM _ — r _ � .Tow or• Village 'Lakes.'*1rig privet Section Tax Map `70_ Block 2 .Located at • Forrester B1drs Inc :. 6 1002 Owner '. Job • .Lot • SO Separate_ Sewerage System built -by Owner ry r AddressMoo_ney Rd Patterson, AY C 36. 1 In - width trench `t Consisting of• 1250 Gal. Septic Tank 202 lineal Feet X 2 iE ti r Other requYrements NOne'" 2 a ,.r c $gym < • '` .. r j yam+ ti v F 1� { Water - Supply `Public' Supply From n, X Private Supply DrUletl By Boyd Artesian :;Well's' Ro 52 Carmel, NY Address _ ute 105`12 ' Frame :; Building Type, No, of B'e'drooms r ur Date Permit Issued d Has .Erosion �d�t ►o1. been �omp�ked� Yes Fi l:ed Map #87:2 (Lakespr�ng ;Meadows Subd ) _._ I certify. that the system(sj;es listed serving the above'premises were constructetl essentially as shown on_.4he plan f the completed work (copies'of which are attached), and in.accordance with the standards, rules and regulations plans`fil_ ` and' the permit Is ue" x- unty Department of•Health. e MPUtnam',Co Date 1 °0 September 1973 s �ert� red b� P.E. X. _RA Address R`D 6 Box 3 a~ rmel NY. License No.292'06 Any person occupying premises sec „veil by the above'system(s) shall p qtly take "such action:as may be necessary to secure the correction of any unsanitary - conditions resulting from !such usage Approval of the separate sewerage aystem shall become null and vo�tl ya5 nh'as a public sanitary. sewer• becomes available and the. approval" of the ,p, .,, .water supply shall;-bec, a null and, voitl when :a -'public :waster supp beca esrava !able, Such approvals, are i•sutiject to. modification or change` when; =in the, judgrnent'of thxe Commissioner of {;Health `;s reVOCatio 'mod' twn or 'change ie necessary i ra Date - ey - "Title Z } #� .... PUTNAM COUNTY DEPARTMENT OF HEALTH N, Division o-f. Env�ronmente% Health Services, Carmel /V. Y 10512 CONSTRUCTION' PE :RMIT'FOR SEWAGE.`.DISPOSAL SYSTEM ;' _” :;;: - Pat.•rSOn ". y' Town or Village L�ikesri n 76r— ive Tax` Mai 7o Bloc Located of Subdivision Lakesp`rinq Meadows _ _ �ot.:;18 ' v Ylob S- `602; A Owner Forrester Builder, x ^ Address BOx- 41 :Frame: On Acre 2 Building ;Type Lot Area 6 e f Patterson ,� N Y 1 5 3 } 4 I , h Four 1.512 on 1 F1 Number of Bedrooms Total''Habitable Space f 1, Square Feet , Separate Sewerage System'_to consist- of 1 250 Gal Septic Tank 236 lineal feet X 36 'I nth width trench 4 X To be constructed- by ' ? Address Water,.Supply: Public Supply From x - , X Private.SuPPIy to be !.drilled by ? ' °Address Other 'Requirements None .: _ c a� YI, represent that d :am wholly and completely. iespo"nslble for the design' and location of the ,proposed aystem(s) ..1) that -the separate: sewage disposal •system • ' : ,above described will,be constructed'as_ shown on the,approveq`amendment there. to and,ln accordance with the standards- rules an - regu a ions o e u am r. ,County Department of ;Health, and that,on completion thereof a ;Certif icate of Construction Compliance satisfactory to the ;Comniissionerof.:Health.wilf be aubm.itted to 'the Department sand a written 'guarantee'.Wj!l be_<turnishe'd' the owner his succesidrs heirs o ass�gns``by the builder, that said builder wilt place In' good operating cond¢fon.- any'part of .said sewage disposal system during >t period of. two (2) years immediately following thedate; of the issue ance'of -the 'approval of ,;the Certificate of• Construction Compliance of the original system or any.:repairrfhereto 2j „that the; drilled well described above.'_ wilt tie, located as shown on:the approved Plan and. that said well 1ll'bemstalled m :accordance with.ahe, arils rules` -and :regulations of the-, - ,Putnam County .Department of Health..' - 12/20/72` ` z Date SKJned,' r P:E. n R.A. R. p 6_,• Box_.353;; a "el New York” 1 512 29206 Address ' - License No. APPROVED FOR CONSTRUCTION. This approval expires one yearfebrill date: issued unless construction of the building has been undertaken and is revocable for.cause or may ber amended or modified Whenconsidnecessary ,-by' a - eretl r: the Cornmissioner,,of Health. Any change 'or altera {ion of construction requires a. new permit: Pi'pproVetl' for disposal of domestic sanitary. sewage, '.a-'d' or. =:private water, supply --only .t /•��--- Date �r �� By 49 '.�,'� pk?. `�v +sa-. a'„ -; F£ ti .s'#n -•-G �.Y '=�' # r 3 "d { -: ,'tk "'+.5..£x.1 fz d�+ A i 5`!+° 3 �'..Sa.. !3. Q, fl v' .C3,"r -i' d' s'�}y�^v•'k.%.,eya?mitd•' -h.r^' " @ ��A�EI�1J $gLCGYPARAITOLOCY =ViRQOGf A�rp � A N A. +� "�� $'�'�`�`�'�' 'i. "� � en.'ts.. f a3° � 'n ..4 �, �'t�'Y�i E+7 v.�': "�' �` �"� �- •.�€ 'a' r E , )ps ,� . y e yF� /iNF BIOTIC USEb may,: :'y, =W144 v 56ilR4f°QF`I41aElA7 Forr sty rs_ p*116,d V - °s EaR C, ITURE � py�Build Putum� �E7 Rauf� . Water- Test; x n n�r If KIM , a� Qui►gitS �^F� ` 4�' v � �A � V `,��.d' € �i�§ � '�i"����` ��„i � �;�.5- L.M�..a✓ � �f:1.1Ca t Y ".�` � �* haN�+"�^-� �d� '� _ � �4' �� �i t* � � _ F :us�'Frota 1 kE7 �.. k. � yak +SxH. -�"p 'mot �pO.F.,� # q C"�^ � �Y g4,'i � �+F�i '� » �, S 9 a F �`'fi �5�.� E' •� Fa F R � � m ' ©'; WELD - 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' coiripldlid "by�well- deiller'and- sdbmitted to County' Health "Department togethef'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 WITHIN 30 DAYS OF WELL COMPLETION OWNER�j�2�� NAME > ADDRESS , LOCATION OF WELL ,(No. 6 Street) jK (Town) (Lot Numb r) PROPOSED USE OF WELL r BUSINESS ® DOMESTIC ;/ESTABLISHMENT ❑ FARM t El TEST WELL 11 SUPP Y El INDUSTRIAL ❑ AIR El CONDITIONING (Specify) DRILLING EQUIPMENT COMPRESSED CABLE ® ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION ❑ OTHER CASING DETAILS LENGTH (feet) DIAMETER (inches) �7 WEIGHT PER FOOT THREADED ❑ WELDED D I S 0 YES ❑ NO CASING YES NO YIEL TEST HOURS G.P.M. ❑ BAILED ❑ PUMPED IdJ COMPRESSED AIR S YIELD (G.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) �C5 DURING YIELD TEST (feet) Depth of Completed Well in feet below land surface: SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (feet) SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (Inches): GRAVEL SIZE (Inches) FROM (teat) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET ^ d l Ste" If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED DATE OF REPORT I WELL DRILLER ignature) r i Owner or Purchaser of building Building Constructed by Location - Stre t 5�,IC1& dwelI I'PQ Building Type 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 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 +he syst --M. 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_.negi.igent: --act_of_ the -_ occupaht:I 'Q:f_.. the _..}�i�i1�din&- ,u.tilizing_.th6 system: Dated this day of 19_ Signature Title Off.,, (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 DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner& ..&, ,��,; �a/e,, 5 � � , 'Address. L ToxH.► Located at ( Streets y�ie . 2 2.- 70 - Bl ck 2 Lot /g n dica e nearest cross street )Lytes�. :, He4e+/o�s 872. Municipality ��, e1,r Watershed C'ra 35 SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK-TIME PERCOLATION PERCOLATION Run apse p o a er 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 2 DPSB O %o4¢ 6 3 G jo¢ d 9/1 7 2 4 5 1 2 3 4 Notes: 1) Tuts to be repeated at same depth until approximatelyy 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. a . _ _ TEST PTT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION ...... ...: .. 'DESCRIPTION 'OF SOILS ENCOUNTEREI) _IN, TEST HOLES DEPTH HOLE NO. / HOLE NO."�-\, HOLE NO. G.L. 6" 12" 18" 24" 3011 36" 42" 48" 5411 60" .. 7211 78" 84" -- INDICATE '=L AT WHICH, GROUND WATER IS- ENCOUNTERED- __ INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING E COUNTERED Alame #tee- A TESTS MADE BY i, Datei ®g /� Liu -Lulu Soil Rate Used—R- ye Min/l "Drop: S.D. Usable Area Provided . ,s"Doo s9+ No. of Bedrooms emu,. Septic Tank Capacity1 Gals. Type Absorption Area Provided By L.F.x24" " _width trench. Other do ,,gr Address pp . :, �yCN THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal. Ch y R Date \�TPIQ 21 ��oE