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HomeMy WebLinkAbout0062DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 3.15 -1 -15 BOX 1 J y. i IL , h , 00062 5. U4n(1r or 11),reaaser o! buildilig 11U i.lding Constructed. by Loca on - S- et Building Type I-IUI1a:CipaJ.ity Se:tion Block Lot GUARANTY OF SEPARATE SEPIAGE SYSTEM I represent that I am whol'ly and completely responsible fcr the location, siorkmanship, 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 folloc,.ing 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 .lti l'%ib11E ?U- Uv- LITE? W11J..1U1 Ul' 11eL'l1Y,t11L 4LL Vl -- L11C V1::VLL{ -1u11 4...Vi ­-A.&, . The undersigned further agrees to accept as conclusive the determination of the Direetor 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 ie occu ant of t e building ut'1izir.? the system. - 4- , Dated this day of ✓ `19 Signature Q �� Title R s....46 (if corporat on, giv6 name and addres THREE {3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR TS REQUIRED TO. FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam. County Department of Health ° ' " �. BACTERIOLOGY PARASITOLOGY :VIROLOGY A,. ANTIBIOTIC USED. .; M0rr131 -` nduetrxes SOURCE OF MATERIAL "p REQUEST .p _6.,Ut`2: t- -- ❑ 06 ❑ =SMEAR "" CULTURE F1S�11 V @VJ YOZ'i� — ❑-SPmNm- C, O-K OUtlnes" ' ❑ Nose ❑ T B .? ❑ T rdat ❑ D,�pbtheria " El pine j F ui8 ' , ❑. Furigus ..., ❑ ❑ Feces ❑ ❑ us" rom El k ❑ PUTNAM LABORATORIES ❑ Ova and ;Parasites ,DIAGNOSTIC. p: ❑ Yiial Studies io STONUEIGH AVENUE - GARM EL Ni Y. ❑ ,SE SITIVITY, 5 NS `RESIST. 'f 6TAPHLOCOCCUS ❑ .Aerobacter ° ^ Cloranip enco! `H o oeg ,T Follow: ❑ Coryngbacterium .Cohstm Sulphate , _ (]. He nol�ticr;Coag q? Follow '." ❑a;Eschecich�6 , Declomycim ' ❑ C64 Positive ❑.KIe6siella , Di hydrostreptomyciri O . "- .Negative .- ❑ Paracolo Bact. Eryt,iomycin STREPT CGUS, HEMQLYTIG ❑Proteus;.t eomycin, i .C_ ❑ -Alpha. -,(] ,Beta . <- Gamma `. G]. "Pseuilomona3 ; Nitrofiiiartom . _ [.:E coccus'r Enteric Patho errs Oxacillin ococcus ❑found , Panallia , .' rp ❑Not found Penicillin ph�hs, .< Tetracycline LOSIS SMEAR,; TUBERCULOSIS CULTURE: aeetyloleandomycin - „< , ast ;Not Foutrd, 3❑ Neg. For Acid Fast Ainpicillin` " ":' " r: d Fast ;:Found ❑ Fob s, Neg. ❑;O &P otFound es ;O O & P Positive for "GILLI 1G COLIFOM t B ITTL D. ` ,AT . .. IOZ 'D FROM St�CIl�AT" TIM WATT H ATF ,3.CF :. ^" 'vdAS 0' :"GGOD: _QUALITY. u i WELL - C0MPL Ei'ION REPORT ► _ ; NAM COUNTY .DEPARTMENT OF HEALTH 3/71 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 Lirng , is of satisfactory bacterial quality before certificate of construction compliance is issued. rUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION rm P ■ an— . OWNER • • ADDRESS C LOCATION OF WELL (No. 6 Street) (Town) (Lot umber) �' PROPOSED USE OF WELL �/ BUSINESS �I DOMESTIC ESTABLISHMENT ❑ FARM L-1-TiST WELL ❑ SUPP Y ❑ INDUSTRIAL ❑ CONDITIONING ❑ (s(specify) DRILLING EQUIPMENT rn ((�'� CCIMPRESSED CABLE OTHER � ROTARY L—�J--tt1Ik PERCUSSION ❑ PERCUSSION ❑ (Specify) CASING DETAILS LENGTH (feet) J yUt /' DIAMETER (inches) t�• "L- �/. -,; WEIGHT PER.FOOT ��.� © THREADED ❑WELDED ((DRI�R''V�E SHOE LJYES ❑NO C�S(NG U�57 YES 140 YIELD TEST HOURS G.P.M. ❑ BAILED ❑ PUMPED 'COMPRESSED AIR YIELD( WATER LEVEL MEASURE FROM LAND URFACE-STATIC(Specify feet) �J Cry DURING YIELD TEST fleet) �,? ��� � �~ Depth of Completed W in feet below Land su ace: 3[REEN MAKE L OPEN TO.AQU (leaf) DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED; Diameter of well including gravel pack (Inches): GRAVEL SIZE (inches) FROM (feet) TO (teat) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two ermanent landmarks. P FEET to FEET C `J If yield was tested at different depths during - drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED ..-- DATE OF REPORT WELL DRILLER (Signature) 1. _ PUTNAM CQiTTY DEPARTMENT OF HEALTH = i Divsron of Environmental Health ,Services CaKmel N Y 1Q512 CONSTRUCTION PERMIT FOR SEWAGE - DISPOSAL SYSTEM' Located ate ��% Section T orb olck9e own Subdrvis�on Ownera - v» - r r e t� Address Buildm9 =TYPe•. �N. L- pt.Area _ Number of Bedrooms Total Hab�ta6le Space - Square,: Feet separate -Sewerage System to consist ofd ��� Gal Septic, Tank �U linea'I feet X� width .trench' To be constructed by ,- v�r%��ey Address - - 4 Water Supply = Public supply From - %� r� .Brrvate Supply to be drilled -•- ` r I•representthat I, am +wholly antl completely? responsible for the design'',and location Of the proposed system(s);' 1) that.ithe` separate sewage disposal system above described -will be constructed °as shown onthe approved arriendriment tAere-16 and in accordance with, the. standards, rules,andregulations o. -t o, u, nam - Count 'e - - {i . _ Y'`O partment -of_ Health, -,and that:on completion thereof a -- 'Certificate_,of.Construction Compliance': satisfactory to tFSe•Commissione "r °'of Health -will. be submitted to thb-D'epart` "t ,and a,wfitfen. guarantee will be:.:furnWie ,fhe owner, fiissuccessoes lieirs':or assigns'by the.builderthat said builder will . . glace on..good,,'oper'atin9 condd�on. °any pat of said sewage disposal system tluring the period of two (2)- years immediately+ following -the date 6f the.i55u `ance of the .approval of. the Certificate of,•Construcfi6n Compliance of the or* al'•system or any repairs thereto; 2) °'that the,drilled -well described• above... . will be.,loc_a`ted as shown onI-the approved plan and that sa dwell will be- instMie � . accordanceq-with :the standards ? ules and ri:gulations of the Putnam. County be rtment�oo Healt�h _ late ' `� �/ s Signed P E R A Address SOZ Lwense No %APPROVED FOR= :CONST'_RUCT16,N This approval expires one yearfrom the date, issued unless construction: of the'build�ng has been unde'rtakert and revocable for cause`.: or may,-be.ariienifa or °modrf�ed when, ' ` ered,.necessary .y, the;= issioner of Health_ Arty,`chan`ge or alteration of ,constructiooc. - q _ permi . Approved for disposal of do an�tary sews` a ;water supply ;only .re wren a ' w -Date ti, ` Title ti _ C 0 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. 1 Owner/ 61 z i Address ©' - Iv• ! Located at (Street Sec. Block Lot w Indtcate qjarest cross streefT Municipality Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Elapse Depth to 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 5 Notes: 1) Tests 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. & 17 / 3 2�- 8 /7 /1. I S: 2 5 Notes: 1) Tests 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. TEST PI`1' DATA REQUIRED TO BE. SUBMITTED WITH APPLICATION' + DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. I HOLE NO. HOLE NO. G.L. a° 6" 12" 18" 24" 3011 3611 42" 48fl 5411 60" 66" 72 7811 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED A C-� INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED Nb�E TESTS MADE BY Date DESIGN Soil Rate Used /O Min/l "Drop: S. D. Usable Area Provided,.�-C900 No. of Bedrooms 1_Septic Tank Capacity, 0-)e-CS:) Gals . Type ' f�Soiclfl iJ Absorption Are Provided By 1,f0I L.F.x24" jb width trench. 40, %1111M Sf ! W—/ / , .r%� Q�va Z= Name Signature Address oZ - THIS-SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by all, Date SEAL _ c� s� �.,F+: AN PC � °Fes " i o`���`' •���• i Putnam County Department of Health Division of Environmental Sanitation AFFIDAVIT - CORPORATE a4NER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health - In the matter of application for Lot 10 Maplewood Estates _ - Ialco.lm I, ------ ---------------- - - - - -- represent that I am an officer or employee of the corporation and am authorized to act for Merrol Industries,—Inc — — — — — — — — — — — — — — — — — — — -- — — — — — — -- — — (name of corporation) having offices at Route 9 Fishkill, N.Y. 12524 — — _ — — — — _ _ -_ — Whose officers are -- — — — — — — — — — — — — — — — — — — — — — — — — — Presiden t Errol Rappaport, Oak Pt. Club, Lake Candlewood, New Milford, Conn. — (Name' and— Address) — — — Vice- President Mark Ritter— _ _ 6 Flower Hill Rd_. _ PoMghkeepsie,_N.Y. — — (iVa;1te dilu 'M Uu *ems Secretary Morris J. F_ellner_ _c /o Fellner & Rovins_ 230 Park Ave. New Yorks N.Y. (Name and Address) _ — — _ Treasurer — _ Errol D._Rappajor_t — — — — — — — — — — — — — — — — (Name and Address) and that I am and will be individually responsible for any or all acts of the corporation with respect to the approval requested and all sub - sequent acts relating thereto. ` Sworn to efo e me this Z-7" day Signed of 1ST 7" Title otary 'o -1 York �Otfl?i' t. lliL 1C, �� '%u ,iiiea in Fu;:;ss;l %aunty a " ir'es March so, 1 T� (;olnm'sssiorl rh;• Corpcii'ate Seal Insp. by: y -s �10 it s e Commol Prop-rty lines or corners found Can estimate hou:,e location . . . . . . ... . 1111). driveway need cut . . . . . . . Mu,­,t trees be removed-note th.-se . . . . . . . . ls- .deep .hole representative of-cntirb*ST)'3 area,. A&U-1-donal does holes needed. . . . * - . .1 . . . Sufficient SDS area available considering driveway cat, house location, separation . . distances., etc.. 0 0 DEEP HOLE LA' TA Depth: •"')AGer elevation-. 0 Rock elevation: Soils d e s c r DL i i L SIM, ITISPEECTION, Ins T). bv House located i•ffiere shown on approved plan SPS C- t ed I -lb-re aDpr 0 ved U U ope,; 5- lire a C1 t Y56 �n'.�. b b_ e- 0 Room allowed for expansion trenches Over. 50 ft. from si•laimD., watercourse Natural soil. not stripped -Pr. SD3 area unnecessarily graded 10 Pt. maintained from prop. line and 20 ft.- from house Separation of trench from house i-;ell etc. follows plan . . . . . . . . . . . . .. Nwiiber of bedrooms. checks . . ... . . . . . Stones, brush., stumps, rubble, etc., greater than 15 ft. from nearest trench 15 1i't - of pew -1-pheral. soil horizontal--'L,.Y, from trench Junction boxes properly. set Could surface run .off from driveway, roads,, ground sur.-Cace., etc. channel near SM area' Does -lot drainar%-e aT)-oear O.K.. in area of ' SDS 'I FIN-LT. GRADING OF SITE ACCEPTARLT - r R_EVI_EW ' CjECK SHEET IMeets Std. DOCUI` ENTS House plans O.K. Design date. sheet _ Peres presoaked? Min. 30" perc. test depth Const.. results for 3 runs D. Hole log 0. K. , Corporate Affidavit for other than indiviH Authorization for eiigineer Letter from Water Supply if applicable If variance requested -such noted on plans.(' DETAILS if charge is proposed,,) Existing contours shown show new contours) T cuts, Slops for driveway it c , etc. shown Water service line location Footing drain., etc. location ! Top slope, bottom slope of fill ! Percolation tests and deep test pit location i Septic tank size and conformance to std. - 3 B.R. house.minimum I. House setback shown ! Dis I.r`1 (li.i'f,-1 t ,r + t:h_''1C �i � ' -'e- i 1717 S 1,-,3 � I A-LI va ter vi hull �0 t . vi `r �iiuwli Plan and profile SDS All other wells and SDS closer 200' shown or °reference made Property-boundaries (metes and bounds - clearly show SEPARATION DIS`IANCE& SPECIFIED ON PLAN 10' to P.L. 20' to Foundation walls 100' to Nearest well 50' to stream, march, lake, etc . incl.e 15' to Curtain drain 10' to water line (pits -20' 15' to storm drain 10' to large trees 10' from foundation to, septic tank 5' to pipe from leader drain & footing Jwa"O.' z I -i 3,nsion i I I Remarks . . . . . . . . . . . 'man 1 qmmg O"no M—M 11-11-3- 4 A wh0m, IV ova" WK a p wa 111", "', 7" PJN ;li' ""k," -k� lw� W-- An, WMA Akwu& jv ljj '+ly v. Ow as Sam . . . . . . . . . . . W4 I aE;o Tway: n b-f"A"JANY", °r t 1 ................. .... ... ... M YAA� OnT