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HomeMy WebLinkAbout3538DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74. -1 -13 BOX 28 03538 T ML NIL Z 03538 �CF PUTNAM COUNTY DEPARTMENT OF HEALTH 'Division of Environmental Health Services, Carmel, N. Y. 10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Located at �? Owner Separate Sewerage System built by Consisting of 2'3 C/Gal. Septic Tank Other requirements Water Supply: _ Public Supply From Y Private Supply Drilled BY Address Building Type •V ✓/� �CS rG>✓es�i GY / Has Erosion Control Been Completed? Section Town or Village Block / U Lot lam' Job Address�iri�iGiOk� , /iar/!O%pOc� /• lineal Feet X 3 a „ width trench No, of Bedrooms Date Permit Issued_ 1 certify that the system(s). as listed serving the above premises were constructed essentially as srgo attached), and in accordance with the standards, rules and regulations, plans filed, the p#mil g 7 9' SULLIVAN -JALUby2�V Date CLARK PLACE ° Address . Any person occupying premises served by the above s yi0eAgSXs& promptly take such actioli A�-A conditions resulting from such usage. ApprovalfYtl .10K e► i t j Braga system shall becorpe�p available and the approval of the private water supply shalt become null and void when a pub�ltc subject to modification or change when, in the judgment of the Commissi ealth, such By �� Date OF NEW °completed work (copies of which are m County Department of Health. 4,5ut � r P.E. R.A. °.2 h License No? �p� 4 to ,,*-Ore the correction of any unsanitary spF1>as a public sanitary sewer becomes wtres available. Such approvals are nation or change is necessary. Title l' PUTNAM COUNTY DEFARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Located at Subdivision .80S1,VC —" C—ST19739-5 `071I19 Owner A/A/T/MX2A/)e Al. Building' Type 2r,2��(�'i� -�� Lot Area•.S/ Number of Bedrooms Separate Sewerage System to consist of A?goep Gal. Septic Tank To be constructed by Water Supply: Public. Supply From Private Supply to be drilled by .� Address Other Requirements Town or Vilipge Section &Z Block /0 Lot / Job Address -4,24-45 _20,940 ARM .57'" .8i,9� ,y AzaLC A/. )� Z/3S6 Total Habitable Space /SO0 f' Square Feet Z- O b lineal feet X A& width trench 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 and regulationsof the Putnam 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 accordanc I with-Abe standards, rules and regu a ions of the Putnam County Department of Health. Date ZC73 �SSigned , / P•E.� R.A. Address �'L/�.L°�G Alb~ d2AM6Q� /� A/ y �QS � License No. X 95 APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of. the 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 san' ary sewage, aF47JOr pr iv a ater supply only. By Title Date Ct`�� �i1 4 �47 Y. BACTERIQLOGY - PA_ RASITOLOGY VIRO LOGY '4, ANTIBIOTIC USED ' t -:W219 : °�SOURCE OF, MATERIAL x❑ REQUEST Q . ❑:Blood ❑ SMEAR.,.:'.: CULTURE 'Sputum -_ ❑. Routi E &'''M construction ❑ Nose 7, ❑ TA `❑;T _roat �;.' ".'_ • :CJ Diphtheria - Archer -Road-, M3Y op:ac NY �� ❑� Pina F u�d- ? � "` r ❑Fungus � _ - ,❑ �ZF Feces :' Water ; test` 3/8/74 ,Pus From ❑. Other ❑ = " `7 >{ `' R00,TNAM DIAGNOSTIC . ❑- Ova, and> , aras�tes _LABORATORIES a.; ' , ❑ •Viral Sfudi_es ° 10. STONELEIGH.'AVENUE `- CARMEL, N:` Y. :'_❑ SENSITIVITY. SENS.:: RESIST.- STAPHLOCOCCUS` ,❑ Aerobacter Chlorampfienicoh:, , :" �' _ ❑Non- Hemo.?Coag'.:TO Follow = ,. ❑ Corynebacterium ,Colistin�$ulphate.: $_.;_ :. , .., .` _. _. t'. <CZ:= Hemolytic =Coag, To. Follow.' ' ` - ❑ Escherichia :., eclomyein 1 > , - , . ' <, 2;`¢ ❑ ,Coag..Posit' ve " ... ❑, Klebsiella a r- ph dro`stre tomycin Y P _r ,' 'a . ❑° _ `' Negative . :, ' ❑ Paracolo. Bact. Erythrorriycin : - . STREPTOCOCCUS,-HEMOLYTIC ❑ Proteus- - Neomycin „, ❑,Alp a C3-Beta ❑ Gamma ❑ Pseudomonas ' :Nitrofurantoin El, Interococcus'`- Enteric Pathogens” ,Ozacdliri _ (3,%, P.,neumococcus_ []Found Pana ba Nei "ssena. ;" Not Fourid Pemalhn. " `_U._�Hemop ili9"" Tetracycline. - TUB ERCULOSIS -SMEAR TUBERCULOSIS CULTURE " eTriacetyloleaodomycin =❑ :'Acid Fast = Notfound [:1 Neg. For Acid Fast mpicillin __E] Acid Fast zFound .❑ Pos ;, Routarie :Neg. , El O & P Not Found .- . • .. ,,- , ut :. .._ �7 Cult; 'res O & "P '.Positive for NO, ""coliform baci l.i. isr latex rom. specimeiK. submi tecf. At time of examinatlonr this water was of go 94 aal i ty t L 'WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/7t Division of Environmontal Health. Sorvicos 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 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 NAME ADDRESS OWNER E and N Const . Co Archer Rd. 7 +lahopa.c LOCATION (No. b Street) (Town) (Cot Number) OF WELL Futnan Valley'. BUSINESS PROPOSED DOMESTIC D ESTABLISHMENT L_ 1 FARM �j D TEST WEII• USE OF.. W PUBLIC AIR ELL SUPPLY D INDUSTRIAL ❑ CONDITIONING (OSpe OTHER ). "'' DRILLING ® COMPRESSED CABLE OTHER EQUIrV%ENT' ROTARY AIR PERCUSSION PERCUSSION (Specify) CASING LENGTH (feet) DiAMETER(Inches) WEIGHT PER FOOT DIVE SHOE�' jj S .,ING —G OU1�D?. DETAILS '72 7 26 ® THREADED El WELDED EYES (J NO I, YES L J NO YIELD j HOURS G.P.M. YIELD (O.P.M.) 5' TEST D BAILED El PUMPED, [XI COMPRESSED AIR 2 5 WATER MEASURE FROM LAND SURFACE —STATIC (Spo*eW7 f, - Dt1J.I(ING'�YFECD`71kEST7tt88 k s h +*�� ii i a U2� Y' E . td ti ° Depth o arpp ef8'd°4�81(,` LEVEL 25 x in feg#s eloW'Lan 1 Hsu achr 1 MAKE F( , Sa 7 c.. zYo ; L G O T0, Rob II,e eels ' SCREEN." a�.a,•v DETAILS SLOT SIZE DIAMETER GRAVEL Diameter of (Inches) -p, � well incl GRAVEL SIZE (Inches) FROM (foot) TO (feet) 14 uding PACKED: gravel pack (Inches): DEPTH FROM LAND SURFACE Sketch exact locellon of wall with distances, to at least srFT 4„ r.. ^�T FORMATION DESCRIPTION two permanent landmarks. 0 -0 clay 10 20 gravel bank run 20 35 clay 35 55 brown rock. sand stone 551 220 ledge granite 'light gr, If yield wos ieiiBd at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL OA221PlfifD DAT OF'JEPORT I WELL DRILLER (Signature) R. D. 5 Roijte 52 4z -d C caner or Pdfcha. ser of Building E & M Construction "Af4 Roswell Estates Building Constructed by Section Boswell Location - Street Block One Family High Rarich. 19 Building Type Lot GUARANTY OF SEPARATE SEWAGE SYSTEM I repres'en.t.that I am wholly and completely responsible for the location, workmanship, material, construction-and-drainage of;•t:he sewage disposal system.,serving the above described property, and that;_it has been constructed as ::shown on the approved plan or approved amendment th6reto, and in accordance with the standards, rules and regulations oi'.;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. y Municipality 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 ar negligent act of the occupant of the building utilizing the system. Dated this 12 day of March 19 74 Signature Title CustoM Bui�dl r a��r1; Caf'p, ..10 If rpo'r"At ffh `g "ive titAe and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP,ETION 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 9 i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date 4A) f J� Re : Property of '. O ,P7 Located at T? dsr.�e Section v�Z Block J Lot Q 2- Gentlemen: l // This letter is to authorize a duly licensed professional engineer `� or registered architect (Indical`37- 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 �partu,ciit Of ntV -L Uii, and to sign £iI1 tlecessary 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 Public Health Law, and the Putnam County Sani- tary Code. Very trul yours, Signed S `�"44W1 OwnejKbf Pro er Countersigned: � e� °° �mAddress ,v0 • f P.E., R.A., e one Address g.n %�jj� pR�FES510NP� �.. rele-ohone " " "�� ►` y'Y11rj 1^ r. -C (�f� cy ,��� �';C(• !' Gam! � � • • ••6 ., INITZELL SIZE TTISPECTTOId _ �p� s I No Property lines or corners found. . o 0 0 a 0 0 0 Can estimate house location o . o , 0 0 , Will driveway need cute . Mpst trees be removed-note these o o Is deep hole representative of entire SDS area Additional deep holes needed. . . 0 a Sufficient SDS area available considering driveway cut, house locatior_,seraration . , . --distances., etc.. G 0 c... 0 a a c 0 DEEP HOLE DATA • Depth: Water elevation: Rock elevation: Soils description: Hate: FINAL SITE INSPECTION insp, by: House located where shown on approved,plan. . ST)S l oGa.ted tahere japproved , 0 0 i id, thf of trench average � Slope of tyle line and trench acceptable . Room ail.owed for expansion trenches , Over 50 ft. from swamp, :•:atercourse . o Natural soil not stripped or SDS area unnecessarily graded 0 0 0 c c 0 1.0 Ft .o tr.�aintain °d from prop . line and 20 A. ' from house o , . o. . 0 o . , Septon of trench from house9 well efc o follows plan o, 0 0 0 ..dumper of bedrooms checks , a 0 a a 0 0 a 0 0 : . Stones, brush, stumps, rubble, etc greater i� than 15 ft . from nearest trench . , 0 G 0 .15 It o of peripheral soil horizontally from •'' trench O O O O O O 0 0 O 0 � 0 0 0 • 0 0 0 0 Junction boxes properly set Oouid . surface run of f from driveway, roads, ti ground surface, etc, channel near SDS , area o. 00 00,000 0 o a Does lot draina,.e aanear O.K. in area of SDS F121L GRADING OF SITE ACCEPTART,F'. U -J 100. O�� c� . •S Q y, rC �a ;t �u . �1 r rS f . l o.f.�_A�V`j'j� �vV "7`L� �rVl Ui \1 "'• (fir W���. _�� cJ �,'VL�.{� ;�'�� /' 7�sJcd / f 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 iyThf5,wy1. , e1 y 1c000i° Address 3� 5.%,ro.9WST, Located at (Street Sec. !02 Block /O Lot �Indicate neares cross street) Municipality 40yfw,,,9," 1/.7o4,gy Watershed 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 1 20 .2 3 3 3 2 so 7-5 9 9 3 .3 3 4 `V 1 /O.'�S lo;3sC 9 20 2� 3 •3 2 10" &( X0.'43 9 20 2 3 3 3 3 4. 5 ..., 5 Notes: 1) Te'gts to be repeated at same depth until approximately 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. e TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN 'PEST HOLES DEPTH HOLE NO. O HOLE NO. O HOLE NO. G.L. 6 ►. 12" 18" / -AI,0Y /-0,09P" 2`t" 3011 36" 42" x+811 5411 60" 66" 7211 78" 84 l TOE 5c�lc., .r✓r y INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date X30 -- --73 DESIGN Soil Rate Used Co Min/l "Drop: S.D. Usable Area Provided 600 No: of Bedrooms- 4 =— Septic Tank Capacity /000 Gals. Type /r7,460wk' Absorption Area Provided By goo L.F.x2411 3 width trencS. AddressGLr�.c.� .OG�- SEAL .oigc w)/, io sue/ THIS SPACE FOR USE BY HEALTH DEPARTPZENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date . .! ill: t)). 1ilr'_......_._..__.._...._.:. ..._...___....._......._. ' )J Y P 1 Pr ,j ,,rty l i.ncs or CUI'nt.'L' founT _ iir.,ed cut. trC;C;f_:1 Dc: . T': nlE)VE;d -J7Utn th•'_: (7.CeP llU...�' T'"i��'=; C 11i :F, l:�_�TC3 Of C711'l , _.._.__._.._.......__..._.... hJ.LC: j `��.�•. t.7 i.7_(::l)tJ I.i C7 � ''r+ •.i Trj '1, vl .��?(., 1,'1 �r �_._ -_�_ __..�.- ___...._.____- . -.__.. __._•__�. -_... cJi' :F_��e�,T��y cpit, hous0, :!_c)c�,t .on, ac;P;.r. rLt:i on d:i_staJlccs, eL,C. J)EYIII -- 1101-JE n r fleck elevation: -"� -Date .�i.�. s' ,TCC;TIOT'' r 1 In D. b 3'GUS;e; oc I.te :rl�ere sho��n on approved p „ ., la,n . 1)1 }_, :toca,ted`'t.,he� - a:ppro:�ed Of t_-L'' 0 ` 1 .' -n C t_ir ,�=�� � C t {n,;,rn allow, f ,xI nsion t }_ - r Is Oi %C:):' jU - U j_ om - _....__— .--- ._...._.. I''atu_r. al soil not stripped or STG area• a4.1J..m ,s , f �• — ..C. .,s�:,1 10 1 Min __ _ed Lroln prop.. el and ; 20 i:'t . fr'olll i-GUse . . . . 4xarzation of "C,r•,neh from house, well . c -C . follo�•, s' plan . . . . . • . . . JQti!i;i;�`r of be:iroc; s chec) s brush, stuurps, nibble, etc. greater X a. j 't. from • nes.rest trench 5 71 ,t...� 1:, ral soil 1.LvI'i. Z vrl l.cLl l;y f r Ulf] tyc�n�h . . . . . ..: . . . . . . Junction boxes pro;;er ly set Crn_.i_ld suff,':cc run off from driveway, roads, �� r7 �• i r'Cit1I1Ci surf: ce, etc. channel near ��D.� , area . } !�.� 1..6t E� _r. C1 :'? ^r' I l roar O.K. r , r - SDS `1'11�;4:f., Gn �DEM' 0' SITE ACCI'3PTAME, ] 1 1. - •. I 01- kk111JzWM 1. *10 I mm, s mm P4-t6/L, `^ i L(qD, ,v i PHME 15 G- O - SITE IMTION :e Z_ A J'_i -1 -AV - -- = -- - - - 240 Mh1IMLZ ADDRESS it PEA Name PM complaint � e & Relationship (i.e, ownerptenant, etc.) DATE q1" TYPE FACILITY Pki'v 4t4 140 M,C PROPOSED niSTALLM Pd z ?-&-I W &Zg s l/i.G PHONE 231- ? / 1;' (include sketch locating all adjacent wells): 1Lm: 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. PRoP ©sL To mNSyr� {! Z©� `1�= e a " L- �4cG�:� i✓L�•ycd�'ics i N 'ex, s r-r../a SAP t ; c. 41LC54 SYS7� i1�s °�•�,'CEt1 �o %o yvi ,ar Proposal Disapproved 1A 141 Date with the following conditions: 1. Procurement of any Town pernut, it applicaoLe. 2. Submisgion of as built repair sketch in duplicate shoving: a. Omer ° s name. b. Site Street late, Town and Tax Map number. c. location of installed components tied to two fixed points (e.g.,hcuse corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 61 diem. x 61 deep drywells surrounded by one`foot + gravel). e. Installer's name and number. 3. System repair to be perfomed in accordance with the above proposal and conditions. i t'� 0: b%very or.. = fit-srted agent - agree , , to above conditions. DATIS lob` 00 s O E` � a ,7X;.16 w41 ��� X04 57i P/y Pars a L'; v,4 D' :L4 i3osw -11 RD o•• �o 01f It (� � I, go • o •i n ct �r Al Al f' -:: GALLON SEPTIC TANK 2!O LF X�ABS. TRENCH t 1 .F •s; .Y; I kit C, � a �` '•r � � a APPROVED AS CONSTRUCTED MAR 1974 - fi? p SEPARATE SEWAGE DISPOSAL SYSTEM •VUT(IAM_C f k OF I&ALi{ eY a. .P. E% �� 6F 2 R rr f,- ,�, "v' "� /r1 �� /f7•;icc Ut_G /' �� DIRECTOR, DIVISION Of - Z .„ - ° FNVIR�NMENTAL HEALTH $CRVICPT •1n,5 / r POW OF d ti / ? ✓7i✓ tix . :'COUNTY NEW,_VORKa j' — /,a —7j/ SCALE ,.;15 f,(�svv JOB NO SULLIVAN THIEDE CONSULTING ENGINEERS ARK PLACE O wF`� _ "L 1 y kit C, � a �` '•r � � a APPROVED AS CONSTRUCTED MAR 1974 - fi? p SEPARATE SEWAGE DISPOSAL SYSTEM •VUT(IAM_C f k OF I&ALi{ eY a. .P. E% �� 6F 2 R rr f,- ,�, "v' "� /r1 �� /f7•;icc Ut_G /' �� DIRECTOR, DIVISION Of - Z .„ - ° FNVIR�NMENTAL HEALTH $CRVICPT •1n,5 / r POW OF d ti / ? ✓7i✓ tix . :'COUNTY NEW,_VORKa j' — /,a —7j/ SCALE ,.;15 f,(�svv JOB NO SULLIVAN THIEDE CONSULTING ENGINEERS ARK PLACE