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HomeMy WebLinkAbout1857DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35.06 -1 -45 BOX 17 ru . sm, ' r ! 'lLt Mr. I ': , r L r I� � � r ` I� 01857 ,... PUTNAM COUNTY DEPARTMENT OF HEALTH DNision 'of Environmental Health Servi! rs; Car'mel, N. Y. 10512 =''GERTiFICATE'OF' CONSTRUCTION -Ci)cv1rPLIANCE:E•i R- SEWAGEr`DISPOSAL SYSTEIM - llt- Locate Owner Separai Consisting of C, 0 Gal. Septic Other requirements ?-Ji Water Supply: blic Supply From % Ivate Supply Drilled ey'd Address G P Building Type Has Erosion Control Been Completed? AIL TdWn or Village Section Block T Lot Job Address 2X�t' L t1M-9 lineal Feet X width trench A ? ­to No, of Bedrooms Date Permit Issued �. I 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, and the permit issued by_, the �Putnam County Department of Date, 1— Certified by �t� C 1 �i� I" �E R.A. Address ` License No� ' Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the Judgment of the Commissioner of Health, such revocation, modification or change is necessary. c!/ G Date _42�• :? BY�/ -r"� ta— _ �� �/ ' itle PUTNAM COUNTY DEPARTMENT OF HEALTH 'Division of-Environmental- Health Services,. Carmel,-N.. )'., 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM ®K) 1 fown or Village Located at �wf Ic sneg'ir`e �'� V �' Section Block Subdivision ^ '� �, tr�� � G Lot A, ` ` Job W .4t rkl i. O Address r( t�ikk_ Owner Building Type `" iD� Lot Area 4Q + o�' �CK,--�� Number of Bedrooms Total Habitable Space , °� Square Feet Separate Sewerage System to consist of > p G.I. Septic Tank lineal feet X' width trench To be constructed by Address Water Supply: P blic Supply From Private Supply to be drilled by Address --7 1 Other Requirements 1 represent that 1 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 regulations o he 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 located as shown on the approved plan and that said well will be installed in accordance with the standards, rules and regulations of the P nam County Depart .entrof ealth. Date C / % , Signed 11 P. R.A. Address License N� , J 1 APPROVED FOR CO STRUCTION: This approval expires one year from the date issued unless construction of the b ilding has been undertaken and is revocable for cause or may be amended or modified when considered necessar by the Commissioner Health. Any change or/a�lteraio of construction --i-4 a new permit. AppQved fo_disp -of domestic sew nd /or priva�w= y. only. It Uwrlor or y .1jocation -.5trect )31 o ck'- Builddng' Type t, GUAR ILNITY OF SEPARATIBI S;,"JAGE T an. wholly �md ncl',11131etely re.s�)onsibl(z foi- the I represent th-,L, o c a t j. on, worknanSh4p, naterial, cons tr*,).r, t ion and draimaLge oil the sewage J_ :,_.-..disposal system serving tl�e above desc.rilbed property, and that it has been constructed as shoi-M on the approved plan or approved amendment thcrc*;r, and in ace-ordance ,'it1h the standards* rules and r­cgulati-ons of the Yutnem County Departrwant of 'Health, anid hcreb-, 7uaranty . to the o,.,:,ne.r, 1-.Lis succe� „- sors, or assigns, to place in good oper?'Uinr:- condition any part. -of said systeri constructed by ri-e i•i.hich fails to operate. for a -,:)-riod of two U Nears iririediately the date of initial us.e of 'h- se•ave disnosal U system, or any repairs made by me to such systeni, -.:.,xcei)t iqhi;re thl-, f!jilure ro - riv is caused by the ,,illful or ne-glirr'ent act of the occu” to operatc p_ �,c C 0 pant of the buildinc, utiliz-1-n- t1.-;e syst-e-ri. "Pth-0i:, v,�'_•ces w acc.epi. ,.,s concliasive :t"I'le do, t o r,,i i i n a t on of the D-irectoi, of the; Division. of Health SO. - vices of th-- ljuit'-.nam ("ounty- DepartmQnt; of as to whctl�er or not the faillure of tl-ic systei-!: to operate !.,.ras cwausod by tho. willful or -wrligon` V . - 'let of the oc.o.upant of the building utilizing the system. ...Dated this day of �al 19 Signature Vj 'Title c 0 rp 0.r a -L; 10 n, — ve nare 0 and address) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - THREE (3) COPIL'S ARE MEQUIRED WIT-H T`-HR 17, (3) COPIES OF' - F 111. A L PLANS 3'U'i F 0 1 CERTIFICATE OF CO1•LP1 _1ETION WILL BE ISSUED. GUARANTOR IS P311"QUIRED 70 FILE NYDTICi� Or DATE, OF FIRS"-' USE Or SYSTEM. Division of Ehvironmantal Health Services, Putnam Count-y D--part-Ament, of 11caltn. BRGWSTER LABORATORIES Box 224 - BREWSTER, N. Y. WATER ANALYSIS REPORT SAMPLE NO. 2� SOURCE: Ed P ine Z .Z o �* riew w $ t off Route 22 t° yy pp�� 4h of BrOws4oro •v. r. COLLECTED: Nt:}i1 • It .2972 BY: Lo $aZtxilahak cue Son,, XR4o BACTERIOLOGICAL EXAK[NAnON Coliform Count, MF Method 0 Per 100 ml. This result indicates the source of the sample was of satisfactory sanitary quality when thi sample was collected. Not)a if 1972 R y ickwit P. E. Director 6 WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Serviqes COUNTY OFFICE BUILDING - CARMEL, NEW YORK _1:This xeport ag- tEt•bercor:plete �.y wBF� ri1 {er= end =submitted to Cbunty Health Department - together with labaratory� 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 NAME , ADDRESS LOCATION OF WELL -(Na. & Street) (Town) (Lot Number) LL PROPOSED USE OF WELL USINES VN DOMESTIC ❑ ESTABLIS ENT ❑ FARM ❑ TEST WELL P Y ❑ INDUSTRIAL ❑ AIR ❑ ❑ PUBLIC OTHER CONDITIONING (Specify) DRILLING EQUIPMENT COMPRESSED CABLE ❑ ROTARY ®A R PERCUSSION El P PERCUSSION El (s(specify) CASING DETAILS LENGTH (feet) f N DIAMETER(inches) WEIGHT PER FOOT , 1 t ® THREADED ❑ WELDED DRIVE SHOE H YES SNO CASING D? IN YES NO YIELD TEST HOURS G.P.M. ❑BAILED ❑PUMPED ©COMPRESSED AIR .3 YIELD (O.P.M.) D WATER LEVEL MEASURE FROM LAND SURFACE — STATIC(Specifyfeet) 8 DURING YIELD TEST fleet) �� Depth of Completed Well � in feet below Land surface: �S~ SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE /N DIAMETER (inches) IF GRAVEL PACKED: I star of well including gray I pack (Inches): GRAVEL SIZE (Inches) FROM (fe TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET 6 ` 3 �s If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE cDATE WELL COMPLETED DEiTE OF REPORT WELL DRILLER (Signature) A 10 'rte t 2 3 4-.15 6 "j 8 q t o t► IL : k-5 A. Z1' 32 46 S4 GS 55 55 P9 35 44 :51, o ol 41. 53. 45 30 .25 X06. 4A 11 j q CY �4 Ian La � .{ -�'�n t,� }t l,.i i } �., •�s . Q��'�oR' eA i° rc �+�sy 9. .+�1 �11 �:40�'1 a m 2 Y �� !!� '� �f b•' �' s4 f ' i�.� , s 9i `� r ifs /.iY h� .`,ti k�� j.. ....rw. -+.- - .-..+. '.:_ •'...� —, ....+.w .. .. w�. ..P.L..A M. i •� } �� '� �' �� `d:s � .r p!j4.41?Cf4�bS 9 'd•• 5. s. 7 r r 1 {•. ��., r "' It i .: a; w t i R 1 caF� Fr�� `4a��rvr�� �,ar���► i n y E/ ti61 R �..... �� \�� — =✓ }! ., 7¢~_ ( .- ... �`. ...) -�F 1f°I %M: Rrw�ii' .. +u�Ww.. �. ., / ,qr -OF- ITEALTH�.. DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FGI�L�E NO. Owner ff-hufheb Pi Rte l-. Addre s s Located at ( Street "t<CsPP -wG t)gj OE Sec . o Block Lot 1 �Indica e nearest cross s ree Municipality 'PR-1 E7 cSQrJ Watershed cr-01 d r` 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 3V.7-3 2:x.8 l 2- 13 L S� 1 3 5 2 3 5 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. TEST, PIT DATA. REQUIRED. TO BE SUBMITTED- WITH _APPLICATION DEPTH HOLE NO. G. L. 6" 12" 18„ 24" 30" 36" 42" 48" 5411 60" 66" 7211 HOLE NO. HOLE NO. ATE L:VEL-AT WHICH GROUNDWATER IS ENCOUNTERED ".R .:.._ . >......> _........ . INDICATE LEVEL TO W ATER LEVEL RISES AFTER BEING ENCOUNTERED .INDICATE MADE BY X-e-1 S G_ ri Date r o — l (— 1 i'- DESIGN Soil Rate Used Ltt ' Min/1 "Drop: S.D. Usable Area Provided No. of or Septic LkCXp� city Cv k \ �e Absorption Area Pry d By Type < her Name �, Q ign Address rM, Op N THIS SPACE FOR USE BY HEALTH DEPARTPAENT ONLY: \�-- Soil.Rate Approved Sq. Ft /Cal. Checked by Date -- PLAN I. MANHOLE COV I t I 1 .1 .I LO RD. LEVEL' i ie), f _JUNCTION BOX MIN.IZ' =19" 3 MtN. 1: CAST IRON 'J SANITARY TEE "I ' i �k�posev i I+.1 3 of un+� �zor� ' L� SECTION .t ESJOENCE I A t c 1 48'1. - __Loc17'iu+/ . i � I .) /ice PTO L[n\t,.,P ' •1 .+ I• J-•--1 ' " "' � ; a ( (�' 1 l�-l-T � j ^ TYPICAL CONC. PQ rtW,.r o5P0 '-AL ne�\ PRE-CAST CONC. SEPTIC TANK EINF. B "C.C. B W �• ? SePT'd i I I$ `l pi'w 0660 ! GRO. LEVEL - �" EARTH fiACKFILL JOINT 5.15' . �/. 310.26i' 18 "-30' BLDG.PAPER COVER 1 d A OR HAY 2 PrRFORATED 5" PIPE 6, •p i 4. + , zq "MIN ',y „ -. ;6” r CLEAN GRAVEL OR �!"�1 CRUSHED STONE kl _ ED ABSORPTION TRENCH 1 APP �O�' n NOTES: 0 -�- - S5 oS SYSTEM TO BE CONSTRUCT DIN ACCORDANCE WITH THE RULES AND REGULATIONS OF THE L-+ AAA COUNTY DEPARTMENT OF HEALTH. . OC I $ 192 SYSTEM SHALL NOT BE BACKFILLED UNTIL INSPECTED BY DESIGN ENGINEER AND THE LOCAL HEALTH DEPARTMENT IF REQUIRED. f PUT Pl. OF HEALTH eY,.....: ......•••.., Pf. SYSTEM TO CONSIST Of A �O.C? GALLON SEPTIC TANK 4 mR Drv1s1oN of AND _4o,.._ FT. CtF _..3...._ FT. TH E N C H WITH A MAXIMUM ENVIRONMENTAL HEALTH SIRVICE? PITCH OF 1/16 PER FOOT, (�FSInEr1�F ! DISPOSAL. SYSTEM GRADES REFERENCED TO FINISHED FIRST pppF __ice G o n FLOOR ELEVATION , UNLESS OTHERWISE NOTED. $a Tt --- _ p- -"� S.S.D. SYSTEM . FOR 3 J J r. vw "T10u �xE.s T NK !/ -- _ REVISIONS HOWARD A. KELLY, JR. .K / /•."'`.. %.._,,._.`,_- CaI S-i C F +OF ESSiON ND� DATE BY ASSOCIATES Dts�ILIFSr�� gal+ »QvUn e A K < CARM NEW YORK r- i L{7 J�'ti r.^ ` Sc _.._ __ _ TAX MAP N0. 70 BLK.NO. JL LOT' NO. 17 i TOWN OF AT. L.CL S0'4 _ _ •�•, !1 � �roJw�' c lq Mntei+nl ' . _:.�l.b,.'C�.R�..1i4Nl.lh -"4't �. J � — •....•.» �.— ChkA -DOf. � � DrnWfnq No. �rE.OF rre•ry °" ,'. 5 Traeen AGOA "r...�. � i I 't J MANHOLE PLAN. 1 I RD. LE VELT 18 JUNCTION BOX MIN. 12':19' In r J�L.T 4.'Mir •I 4.MINI ID FV � 3 MIN CAST IRP. N l SANITA RYI TEE SECTION GounT 4g • .1 A• 1O ' OV aF�'. -4 j . L? TYPICAL CONC. �' NRE -GASJ CONc Ij /DSEPTIC TANK , REINF. a "Cre. eEw 7/ °� 0 j CD Sk ORD. LEVEL EARTH � BACKFIl1 a JOINT g_Ig" \� ! 3 /D• 26i.' 18 -80 SLDG.PAPER COVER OR HAY 2�• 1 ! ! fi WT A u /t FF. R FORAYED 5'• v,i• '.I16 o� . PIPE _ : f Q�.6•. } v r,. fl L a, ^ ^ I _._- _ _ TAX MAP NO 0 BLK.NO. 2 4.0T NO. 17 i q�,I z m 6 TOWN OF AT, -EP, J01 T.SE- T.1c r� hU - �✓, s rfq T- nI.fa.�9txa.Ae v�A. -.I � _ �fa�.+ cps fii2. M41e' 1 ..� Ckk d '00,0 DI talnq Nu. . ' 4 2 _ %2_ j��{ Irk �9 FruCa4 _..... - AOGiI� � !� � . �N � ✓�1J �i . F. r y E; - 24 "MtN CLEAN- GRAVEL OR �'•`" —"-"� Cgt1BHCv'D STONE i ABSORPTION TRENCH p; _ p- I� � { ' � J�s NSYSI ACCORDANCE WITH:iTHE RULES AND -.L- .F � ..LAN I - ! EM TO BE CONSTRUCTED IN REGULATIONS OF THE u f�/-AA COUNTY DEPARTMENT 0C I' 18 1972 OF. HEALTH,. SYSTEM SHALL NOT BE BACKFILLED UNTIL INSPECTED- BY DESIGN ENGINEER AND THE LOCAL HEALTH DEPARTMENT )F REQUIRED. ' rI PUT I qY, -A It DIR DIVISION OF SYST M TO CONSIST OF A 00 GALLON SEPTIC TANK AND 0 FT. RE N CH WITH A'`'M AX I MUM • �' / ENVIRONMENTAL HEALTH SERVICES _.-, QF _._.�:.._FT. PITCH OF i 1165' PER FOOT, (ta51gEK�f i ��`OI'• DISPOSAL SYSTEM GRADES REFERENCED TO FINISHED FIRST P. V FLOOR ELEVATION UNLESS OTHERWISE NOTED. Li �"`"`+ `— S.S..D. SYSTEM FOR � -DWAZD . PI OLL® -- ;. sipp;I�--.._: J f / T4„u �.,ax�.s ______._•____.._.� ._ -• - Tf i _...--... REVISION$ HOWARD A. KELLY, JR.` / C20UA� - orESSf;ti �� a. xr �\ NC. DATE BY ASSOCIATES S• CARMEL NEW YORK fl L a, ^ ^ I _._- _ _ TAX MAP NO 0 BLK.NO. 2 4.0T NO. 17 i q�,I z m 6 TOWN OF AT, -EP, J01 T.SE- T.1c r� hU - �✓, s rfq T- nI.fa.�9txa.Ae v�A. -.I � _ �fa�.+ cps fii2. M41e' 1 ..� Ckk d '00,0 DI talnq Nu. . ' 4 2 _ %2_ j��{ Irk �9 FruCa4 _..... - AOGiI� � !� � . �N � ✓�1J �i . F. r y E;