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HomeMy WebLinkAbout2039DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.41 -1 -3 BOX 18 lirs -1 TI .� ' 'IdL I I � �z 02039 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEW!AGE DISPOSAL SYSTEM REPAIR OWNER'S NAME Gf S.0 � 6 � S,4Wo4-,4 X /O 64-W PHONE a �9 - 911,6.3 SITE LOCATION 01-7WeXo,J A TM# V% / -. MAILING ADDRESS PERSON INTERVIEWED PCHD Canplaint # Name & Relationship (i.e, owner,tenant, etc.) DATE TYPE FACILITY 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. i ii47. Q Proposal approved Inspector's Signatu're & Proposal Disapproved Proposal approved with the following conditions: Datt 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 corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, or reported agent of owner agree to the above conditions. SIGNATURE C TITLE DATE IPUS: White (PAD); YeUc w (inn HO; Pink (Appli®nt) L�O-- s� -,,2 - 2 -, � � Art- 4dro r"A-7- 6ey�&LL- ,&l vas I - 3 PUTNAII� COUiTY DEPARTIVIENTrOF HEALTH Division o ental Health SerGices,_ Caime/ N Y..f0512 . Patterson ^--:,.C�.IF,L .CAT.E -QF CONSTRUCTION COMPLI. FOR ,SEWAGE DIS SAL_YSTEM - Y Located at G.ameron Rd &Shoreham Dr kMap 9' or3 VII BI ckw a n Iage 14 Owner JericFo. BiiY" ders; Tnc. of .785 =789 Inc1 Job S016'17 Separate 'Sewerage; System. built by r� sPerag1�ne Address BreWSte'r NY° Con'sist�n 10�QD " -- g -.of T Gal =;Septic'Tank lineal Feet,X width _.trench `- Other requirements f - age wo 8`�=x 9` Deep Seep Pits 1Kater Supply Public Supply From ms Private .Supply Drilled BY P' `Beal Address- Brew$terD Nl� Building Type Frame ` No of Bedrooms Three pate Pedmit Issued 1 Sep "t.• `75. t one'Re } Has Erosion Control Been Completed., I ce_'Ify'that the,system(s)`as listed `serving the above.epremises were constructed essentially as shown on'the plans of thd,corripleted work� (cop ies of which are- - attached); and in, accordance wiih'the standards •rules and regulations plans filed acid the permit >issued by ;the', Putnam County Department of Health. 27 `September 1977 x Date . ; ,.Certified -by,_ P;E. R.A. R A...'4 air Ste . Carme.l N 0 N . 29206 . i .. . Address License No. Any pers`gn'oceupylng prernisesserved by the above systems) shall,prompfly'take such action as may; be necessary to secure the correction of any unsanitary=; conditions resulting from such ,_usage Approval. of the - separate - sewers m shall ` become'. null' and void- as"soort as -a .public sanitary sewer becomes available and'tne a pproval ;of the_ _private water, supply shall,become'n and' v id .w puOil ater supply becomes.available = Such approvals are '- : subfect`.'to modification oc_ change- when.;in- the'.judgment,of the ommi ner. 'H r cation,- motl)fication or chan'ge_is' necessary.. ti .. Date % TitIA ;l !lf •.Y�rJlt%1'rl^ � '.Yll�- �: Q '_/'9. �' � v '� _ .� r y t BREWSTER LABORATORIES Box 224 - BRF- WSTER, N. Y. WATER ANALYSIS REPORT SAMPLE PTO. 3870 SOURCE: Jericho -Developers, Inc, - faucet well supply Cameron & Shoreham Putnam Lake, New York COLLECTED: ll a y 19j, 1977 BY: Joseph A. Bijou BACTE_RIoLoGICAL EXABUNAT ON Coliform Count, MF Method 0 per 100 ml. This mult isdicoter the source 'of the ramplt was of satisfactory ranitary quality whim the rample was collected. lvlay 219 1977 R C Roy kwit P. E. Director ` s � i' klols 6P d B 0 Owner or urc aser o Building VG4rcv PjAf' pER S Building.Constructed by e'l At C- A 0.'V Location - Street RANCH Building Type b porfv.jm kikc PvreAszw Municipality Section Block 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 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 d day of Pee, 19 76°' Signature VG�.�-,.- Title 6c),v .7 c r 0 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 b' O e -Patterson Owner or PurcHaser of Building Municipality Jose h Bijou Building Constructe .by Cameron'Rd. & Shoreham Dr. Location - Street Frame Building Type Map 149 Section Block 785 -789 Incl. 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 systerm,.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= ..vi.ce.&..of ..t.he.,.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 May 1977 Signature g� Title ,4 -E V ►' ' i� /� e /y a :, If corporat.i.on , 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 b WELL COMPLETION REPORT 3/71 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK - _...:. T4iis., report. -is- totbe- completed by,- well.drVer• aiW submitted to County Health - Depart nent together 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 NAME Joseph Bijou ADDRESS RFD #1, East Branch Roadt Patterson, N1 LOCATION OF WELL (No. 6 Street) . (Town) (Lot Number) Cameron Road Lake Putnam PROPOSED USE OF WELL ((yy�� BUSINESS t` )`DOMESTIC [] ESTABLISHMENT ❑ FARM ❑ TEST WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING El (S(Specify) DRILLING EQUIPMENT ba COMPRESSED CABLE =ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION ❑ ((SSpe ify) CASING DETAILS LENGTH (feet) ,r- DIAMETER (inches) ( WEIGHT PER FOOT 1916 S © THREADED ❑ WELDED jDyj SHOE L-1 YES ❑ NO ING ED4 1=J YES NO YIELD TEST HOURS G. P.M. ❑ BAILED ❑ PUMPED 91 COMPRESSED AIR 6 50 YIELD (G.P.M.) 50gpm WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specif) feet) 20 DURING YIELD TEST (feet) Depth of Completed Well in feet below Land surface: 145 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 41 I- Drilling in overburden- lay and bou ders g= hit solid rock at 41 feet 41 53' Drilling in rock -set casi grouted 53 145 Drilling in rock- granite If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED 12/22/75 DATE OF REPORT 10 5/ 77 WELL DRILLE i ature) L- i- -"�,:se or -u^•— ern' -r t. '.,"^'nP''t g *w�ST^ ,-ga"" a. "^cmtt ,�-+ -''�'' xkq "x rtT_'yt S"'- ,."'"'." r z' `PUTNAM COUNTY DEPARTMENT" OF HEALTH Dives of n ..of Environmental Health Serpices, TCarmel N Y. ;10512 CONSTRUCT.ION,.PERMIT, FOR ` `SEWAGE -0ISPOSALc$YSTEM. i?.dtte)",SO n+ •Cameron Rd�. & S Town or Village hpreham Dr'a� 1.4 Located at i ' _ fit e - ��.® _ - :9 lock• -� E Subdivision Putnd iJ LaIE� got 785 789 NO .' iob 501617 IF Owner , - , Address °EaS t gX'�nGFt 'ROdd a Bwiding''Type LOt Area 1 C' OC Pat:terSOn Number' ;of Bedrooms TilC Total Habitable Space Square Feet Separate_ Sewerage System to co_ns�st of Gal, Septic. Tank lineal feet X width trench `To be constructed by Address Water SuPPlyi` `.. Y Public SuPPIY.'From. M1 s n Priv ate, .Supply to be drilled by j: Address z Other' Requirements T. O ^'= X' 1 , S .`� Pit I represent that ( am whoily and com to 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 e Putnam q ! ;place m, good operatIng:°conditio6 any,part of.. said anee of `the approval ,of'Ah'e Certificate`of,Constru viii be iocatedas'shown on the .... 'ed'pI n and that ;County,'Oepartment of Health nate .11 f$e,�t r 1975 sy. .. Address • • 6 APPROVED FOR CONSTRUCTION This approval e evocable fo77'i a ;e or ay be' amended or modified w °squires ;a Approved for disposal of.d ion'tp reof -a "Certificate of Construction Compliance" satisfactory to the Commissioner. of Healthwill rantee wilt ?be furnished the owner, his successors, heirs or assigns by the builder, that said builder will sewage disposal system during the period of two (2) years immediately following the date of the issu- ction Compliance of the original system or. any repairs thereto; 2)'that the drilled well described above said well Will be Install in accordance with. .the ndards, rules and regu a�ons f the Putnam Signed, P.E. X R.A. OX 3 License No. 29266 xp�r ` one y `r rom the 'ssued; urep At t" of the building has been undertaken and is he ,consider, neceesar y,. Health. Any change or of construction ➢st itary sewa , /or privat pply only. .I f :..,...�. . _._..,,.... �. �, .,..,- .�..........,�......®. «.s w:.:�.... ,.„ ... . .. ..... .......a.ro .<n_� «....- ....,; w..: e ^.. �..9 .,..: .. �..:.�.- is - ✓r.»� ,^.r ,r.:. sin. .»:Qy. t a,.. •'�wa r,,ry.;f +, r'tt'' ,e, ¢��. '+`u"Y`y"`'m4C...`'�'�'S September 12, 1975 Putnam County Dept. of Health County Building" Carmel, New York 10512 Att.: Robert Caddell, P.E., Director Environmental Health Services Re: Well Separation Variance Dear Sir: I hereby request that you grant exception.to the 100' well sepa•rati:on regulati.on on my property located at Cameron Rd: I &,Shoreham Dr., Map 149, Lots No. 785 -789 Incl., Putnam Lake Subdivision. This well separation and proposed sanitary system are shown on Owg. 1, S.O. 1617 by Joh'nlfi. Prentiss, P.E:. ` All' "paper`s- 'neddssary -for'*sa)ni tary - de`s'ign- ''appirova i are ` attached.' Very truly yours, JE. ICHO BUILDERS, I -NI-_7 <. •` Joseph Bijou, President-.... JB /pr C` 4� RAAROUE ,1TE DAHNCK9 Notary p,,L'ii Stte of NX Qualified in i'utram County Commission Expires March fO 1 9 �� .....- = PUTNAM- COUNTY DEPARTMEN -T -:�,OF — HEAL,'THT. DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner ✓Gri c 0 Xadaagfs, THC . Address Located at ( Street �,,,, f�,�'�� U a� a BBJ c0k Lot 7 f ,91"„� 6dicate Tnearest cross ree Municipality pay.`, -sa„ Watershed�d SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run apse Depth to Water Water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 2 4#0 /fnt -- 3 /.9ff �Zf f'? 4 01? /SAD 3 T' 2 3 leg 6� 3 to 9 3 ea e, L) 1 2 Notes: 1) Tents to be repeated at same`deptri until approximatelyy equal soil rates are obtained at each pe- rcolation test hole. All data to be submitted for review. 2) Depth measurements to be -made from top of hole. -.....-.,.TEST .PIT... DATA TO BE SUBMITTED. -141TH.APPLICATION. DESCRIPTION OP -SOILS. t NCOUNTERED IN' TEST HOLES DEPTH HOLE NO. G.L. 6 TT^'r T1 AT^ 1211 4L*. Ore% 4d� 1811 A pod" 2411 3011 3611 4211 Ogg 4811 5411 6011 6611 7211 78„ 8411 ICA T, -L=EVEL AT WHICH GROOO T' ET 1 ENCOUNTERED INDICATE LEVEL TO WHICH WATER WEL RISES AFTER BEING ENCOUNTERED V"e 40*w '.TESTS MADE BY?e t .4a�gi j2eeta e DESIGN Soil Rate Used_( Pnn/l "Drop: S.D. Usable Area Provided OiP No. of Bedrooms 79�e Septic Tank Capacity. 4000 Gals. Type Hcvc — Absorption Area Pg9vided By L.F.x24" �b" width trench. OT F, Other %AT,119011- 91 5-.®m e Jae AVZ4. A - � 93-MESPENU Address A. PRE THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY.; 0 Soil Rate Approved Sq. Ft/Cal. Che -e Date, 4V or THE sjP0, lIP-7 f 1i ii • "I i;. k